Absence or loss of facial structures causes functional deficits and enormous psychological distress, so rehabilitation is necessary.¹ Prosthetic rehabilitation can improve function and self-confidence. However, facial prostheses have some difficulties due to mobile underlying tissues and retention.

Different methods have been improved to solve the retention problem. External devices for example glasses are one possibility.² Skin adhesive is an old method and causes skin reaction in some cases.³ It is difficult to wear and take off adhesive retentive prosthesis during daily actions such as bathing and swimming due to add and remove adhesive materials, repetitively. Osseointegrated implant is another possibility for retention and because of natural sense of prosthesis, ease of use,⁴ long life time,⁵ and retention during daily activities is accepted by patient.⁵,⁶ Different variations can affect maxillofacial prosthesis successfulness. For example, durability of material used in prosthesis as exposed to water and other chemical component such as soap would be reduced.⁷ Hence, implant-retained prosthesis with attachment such as bar or magnet which are removable when it is necessary is favorable⁸,⁹ and increases patient satisfaction.¹⁰

A 22-year-old male with left congenital ear loss Figure 1 was referred to the Dental and Maxillofacial Prosthetic Department of Dental School of Isfahan University of Medical Sciences. First of all, a surgical stent should be made. The impression was made with irreversible hydrocolloid from both ears. Hence, a wax-up for left ear was made to predict proper position of implants to achieve natural future prosthesis and according to the right ear position and form. The wax-up was flasked to make surgical stent. Computed tomography evaluation of mastoid bone was done in coronal, sagittal, and axial planes. The implants were placed by one-stage surgery.Figure 1

Primary view.

Extraoral implants in mastoid region have very high success rate near to 100%.¹¹,¹² The implant-retained facial prosthesis provides more satisfaction rather than adhesive retained due to ease of use and proper retention in daily activities.⁹ Implants commonly used in facial prosthesis are extraoral implants which are much more expensive than conventional dental implants. Patients with maxillofacial defects often have financial burdens because these patients often are unemployed as a result of their diseases.¹ In this case report, we used dental implant because of financial considerations and better accessibility of dental implant components in surgery and prosthesis procedures. Our patient had properly large deficiency so longer 6 mm dental implants had some advantages versus short 3 mm extra oral implants to provide proper anchorage for this heavy auricular prosthesis.¹³ We used bar and bridge abutment in the role of transcutaneous component, and because of fixation with an independent screw, other steps could be run without need to take out of this transcutaneous component. Placement of implants in antihelix part of future auricular prosthesis caused hiding of retentive components easy and provided esthetic and natural view which was accessed through a surgical stent which mimics final auricular prosthesis.

In this case report, we used dental implant and safe on four prosthetic systems for an auricular prosthesis.

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The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.