The Impressed Study

Description

The Impressed Study: Improving facial prosthesis construction with contactless scanning and digital workflow

Facial prostheses are bespoke removable silicone devices that emulate a facial part such as an eye, nose, or ear. Patients may wear facial prostheses for various reasons, for example following cancer treatment, facial trauma, or developmental conditions. Facial prostheses are made by a small number of highly trained Maxillofacial Prosthetists. It takes multiple appointments and laboratory stages to make a prosthesis. The key steps involve taking an impression (mould), sculpting a wax pattern, turning this into silicone, and adding fine detail. This process requires a lot of time, skill and resources. Prostheses need to be replaced regularly, usually on a 6 to 24 month basis for example due to deterioration in colour, change in fit, or wear and tear.

The conventional method of making facial prostheses has limitations from a patient and healthcare perspective. Patient and Public Involvement Contributors helped identify research priorities from a patient perspective. These were to 1) replace the uncomfortable and claustrophobic facial impressions (moulds), 2) improve the aesthetic outcomes to restore their face closer to their pre-treatment appearance, and 3) shorten the overall time of the rehabilitation process.

Digital workflows could address this significant health problem and help support or replace steps in the conventional manufacturing processes. Firstly, 3D facial scanning could offer a contactless and comfortable way of capturing the shape and texture of a patient’s face. Secondly, 3D Morphable Models (a leading-edge 3D face tracking and reconstruction technology) could help semi-automate the facial prosthesis design process. Lastly, 3D printing technology may help reduce the time and stages needed to make a facial prosthesis.

A translational research study was conducted that explored the use of digital manufacturing workflows during the manufacture of facial prostheses from patient, healthcare, and NHS perspectives. ‘The IMPRESSeD Study’ comprised a range of research methodologies including a systematic review, laboratory-based research, a multicentre feasibility trial, qualitative research, and early health economic modelling. The final stage of the project involved the co-production of an arts-science public engagement project to share the lived experience of people who wear facial prosthesis, bring research findings out into the wider community, and highlight the valuable contributions patients make to research and public engagement. 

Funders:

Proof of Concept Work

• Royal College of Surgeons of Edinburgh (RCSEd) Small Pump Priming Grant, SRG/16/094, £9,998. 01/11/16 - 31/10/17

• National Institute for Health and Care Research (NIHR) Research Design Service Public Involvement in Grant Applications Funding Award, Call 30, £500. 24/07/17 - 23/07/18

Research Funding

• NIHR Doctoral Fellowship, NIHR300235, £400,649. 01/10/19 - 30/11/23

• Leeds Hospitals Charity Research and Innovation Funding, ULXXO.A200515, £24,699. 06/03/20 - 05/03/21

Training and Development

• University of Leeds Engagement Fellowship, Engagement Excellence Scheme, £400. 01/11/19 - 01/09/21

• Restorative Dentistry UK (RD-UK) Travel Fellowship, £1000. 25/10/20 – 24/10/22

Public Engagement Activities

• Research England’s Enhancing Research Culture Open Call 2022-23, £23,432. 25/01/23 – 31/07/23

• Research England’s Enhancing Research Culture Open Call 2023-24, £25,680. 01/08/23 – 31/07/24

Please note that the views expressed are those of the authors and not necessarily those of the NIHR, other funders, NHS or the UK Department of Health and Social Care.  

PhD thesis available from:
[PhD thesis] Jablonski RY. Improving facial prosthesis construction with contactless scanning and digital workflow. PhD thesis, University of Leeds; 2023. https://etheses.whiterose.ac.uk/34038/  

Information from funders’ websites:

• NIHR funding award: https://fundingawards.nihr.ac.uk/award/NIHR300235

• Leeds Hospitals Charity funding award https://www.leedshospitalscharity.org.uk/news/leeds-hospitals-charity-funds-technology-to-support-research-project

 

Impact

Systematic review

• A systematic review of previous research studies demonstrated a need for further clinical research in this area. https://doi.org/10.1016/j.prosdent.2020.09.010

Laboratory study

• An open-access digital database of nose models was created for the computer aided design of facial prostheses based on a 3D morphable model approach. https://doi.org/10.5518/1228
• A laboratory study compared different methods of designing orbital and nasal prostheses. This suggested that a semi-automated 3D morphable model approach may help provide a starting point for facial prosthesis design which could be adapted to an individual’s needs. https://doi.org/10.1016/j.prosdent.2024.03.006  https://doi.org/10.1016/j.prosdent.2023.02.019 

Feasibility trial

• A feasibility trial recruited 15 patients and provided participants with 2 different facial prostheses in a crossover manner – one prosthesis was made by a digital manufacturing workflow and the other was made through conventional techniques. This work suggested a definitive trial could be feasible to deliver. https://doi.org/10.1186/s40814-023-01351-w 
• A qualitative substudy was conducted involving semi-structured interviews with 10 patients. This explored patients lived experience and preference for the 2 different methods of facial prosthesis manufacture. This found that most participants preferred digital over conventional manufacturing processes.

Early health technology assessment 

• An early stage health economic model was created to explore whether digital manufacturing of facial prostheses could be cost effective to the NHS.

Public engagement

• A collaborative art-science public engagement project was developed called I’m Still Me. This was co-created with Patient and Public Involvement and Engagement contributors, healthcare professionals, researchers, artists, and public engagement practitioners.

Publications and outputs

• Jablonski RY, Osnes CA, Khambay BS, Nattress BR, Keeling AJ. An in-vitro study to assess the feasibility, validity and precision of capturing oncology facial defects with multimodal image fusion. The Surgeon. 2018; 16(5): 265-270. https://doi.org/10.1016/j.surge.2017.11.002
• Jablonski RY, Osnes CA, Khambay BS, Nattress BR, Keeling AJ. Accuracy of capturing oncology facial defects with multimodal image fusion versus laser scanning. J Prosthet Dent. 2019; 122: 333-8. https://doi.org/10.1016/j.prosdent.2018.10.017
• Jablonski RY, Veale BJ, Coward TJ, Keeling AJ, Bojke C, Pavitt S, Nattress BR. Outcome measures in facial prosthesis research: a systematic review. J Prosth Dent. 2021; 126(6):805-815. https://doi.org/10.1016/j.prosdent.2020.09.010
• Jablonski RY, Malhotra T, Coward TJ, Shaw D, Bojke C, Pavitt SH, Nattress BR, Keeling AJ. Digital database for nasal prosthesis design with a 3D morphable face model approach. J Prosth Dent. 2023  (in press) https://doi.org/10.1016/j.prosdent.2023.02.019 
• Jablonski RY, Coward TJ, Bartlett P, Keeling AJ, Bojke C, Pavitt S, Nattress BR. IMproving facial PRosthesis construction with contactlESs Scanning and Digital workflow (IMPRESSeD). Study protocol for a feasibility crossover randomised controlled trial of digital versus conventional manufacture of facial prostheses in patients with orbital or nasal facial defects. Pilot Feasibility Stud. 2023; 9: 110. https://doi.org/10.1186/s40814-023-01351-w
• Jablonski RY, Malhotra T, Shaw D, Coward TJ, Shuweihdi f, Bojke C, Pavitt SH, Nattress BR, Keeling AJ. Comparison of trueness and repeatability of facial prosthesis design using a 3D morphable model approach, traditional computer-aided design methods, and conventional manual sculpting techniques. J Prosth Dent. 2024 (in press) https://doi.org/10.1016/j.prosdent.2024.03.006