Prosthetic Reconstruction, Rehabilitation & Surgical Planning —
Training activity: 7

Details

Plan, design and manufacture a sectional prosthesis for a patient requiring intra and extra-oral components.

Type

Developmental training activity (DTA)

Evidence requirements

Evidence the activity has been undertaken by the trainee​.

Reflection on the activity at one or more time points after the event including learning from the activity and/or areas of the trainees practice for development.

An action plan to implement learning and/or to address skills or knowledge gaps identified.

Reflective practice guidance

The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.

Before action

What are the intended outcomes of the training activity?

• How will you define a successful outcome for the sectional prosthesis? Does success include delivering quality patient-centred care that prioritises the patient’s best interests in both the intra and extra-oral elements?
• In what ways will your planning ensure you practice in accordance with local and national health and safety policies, regulatory requirements (such as the Medical Devices Directive), and overall service governance?
• How will you apply the principles of a quality management system (QMS) to your professional practice to ensure the device is manufactured to a safe clinical standard?
• How do you intend to use the findings from multimodal imaging and clinical investigations to formulate a definitive treatment plan for this combined deformity?
• What are the intended outcomes for your communication with the patient and stakeholders, particularly regarding their expectations for a complex reconstruction?

What do you anticipate you will learn from the experience?

• What specific insights do you hope to gain from performing a systematic examination on a patient with a combined oral and extra-oral deformity?
• What do you already know about selecting appropriate biomedical materials (e.g., silicone elastomers or resins) and components that can withstand both the intra-oral and extra-oral environments?
• What do you anticipate learning about identifying patients who need further specialist support (such as psychological or emotional help) and the pathways for referring them to appropriate healthcare specialists?
• How do you expect this activity to improve your understanding of the roles within the multidisciplinary team (MDT) and how your prosthetic design impacts the broader patient care pathway?
• What do you hope to learn about preparing surgical treatment plans for complex head and neck surgery where a sectional prosthesis is required for rehabilitation?

What actions will you take in preparation for the experience?

• Have you discussed the training activity with your Training Officer to clarify the technical design features required for sectional retention and stability?
• What actions will you take to assess and interpret the patient’s medical, physical, social, and psychological requirements to ensure the treatment is fully customised?
• How have you prepared to handle potential challenges, such as discrepancies between radiographic imaging and clinical presentation, or technical difficulties in manufacturing two-part devices?
• Have you reviewed the classification of post-surgical defects and the principles of obturator design to ensure your plan accounts for the patient’s specific anatomy?
• How do you feel about embarking on this activity, which requires balancing complex clinical assessment with the manufacturing of a high-precision medical device?
• What resources, such as clinical governance frameworks or existing protocols for combined deformity prostheses, will you review to support your preparation?

In action

What are you doing?

• How are you approaching the systematic physical examination, and the analysis of multimodal imaging to ensure the sectional design accurately addresses the interrelation between intra and extra-oral components?
• What real-time decisions are you making regarding the selection of biomedical materials (e.g., silicone vs. acrylic) to ensure the device meets a safe clinical standard and is appropriate for the surgical site?
• Which aspects of manufacturing this complex, multi-part medical device feel intuitive based on your prior experience, and where are you applying more conscious effort to ensure you follow the department’s Quality Management System (QMS)?
• Why have you chosen a specific sequence for the examination and manufacture, and how does this approach prioritise the best interests of the patient?

How are you progressing with the activity?

• How effective are your current actions in achieving a functional and aesthetic sectional prosthesis that integrates seamlessly with the patient’s anatomy?
• What challenges are you facing as the activity unfolds, particularly in translating the surgical treatment plan into a functional laboratory-made device for a complex head and neck case?
• What immediate insights are you gaining regarding the patient’s physical and psychological requirements—such as their comfort and response to the prosthetic—as you refine the design?
• How does this advanced activity connect to your existing knowledge and skills in prosthetic reconstruction and your understanding of local and national health and safety policies?
• In what ways is your partnership with the multidisciplinary team (MDT) influencing the progress and refinement of the device in the moment?

How are you adapting to the situation?

• If the patient’s deformity presents unexpected complexities during the fitting or manufacture, what alternative design features or attachment methods are you considering in real-time?
• Are you identifying signs that the patient may need further specialist support (e.g., psychological or emotional) and how are you adapting your communication to prepare for a referral?
• What immediate support or guidance do you need from your Training Officer or Consultant Surgeon/Restorative dentist to ensure you stay within your scope of practice while managing this complex case?
• How are you ensuring that your actions remain in accordance with regulatory requirements and overall service governance even when you must adjust your technical approach?
• How are you adapting your communication style to effectively interact with patients and relatives when explaining the complexities of a sectional, multi-component device?

On action

What did you notice?

• How would you summarise the key stages of the systematic examination and the subsequent planning, design, and manufacture of the sectional prosthesis?
• What were the most significant findings from your analysis of patient investigations and multimodal imaging regarding the relationship between the intra and extra-oral components of the deformity?
• Did you observe specific technical challenges in achieving adequate retention and sealing for a multi-part device, and how did the patient’s physical requirements influence your manufacturing sequence?
• What did you notice about the interprofessional communication during the development of the surgical treatment plan, and how did the multidisciplinary team (MDT) contribute to defining the prosthetic goals?
• How did you ensure that your actions in the laboratory and clinic remained in accordance with local health and safety policies, regulatory requirements, and your department’s Quality Management System (QMS)?

What did you learn from the activity?

• What specific skills or knowledge did you develop regarding the selection of biomedical materials and components that are biocompatible for both oral mucosa and facial tissues?
• How did you learn to assess and interpret the patient’s psychological and social requirements, and what indicators did you use to determine if they needed further specialist support or a referral?
• Were there any unexpected challenges or successes during the manufacturing of the sectional components? For instance, did the biomechanical stability of the final device meet the intended safe clinical standard?
• In what ways did your reflection-in-action—such as adjusting a design feature in the moment based on a clinical finding—influence how the final prosthesis unfolded?
• What insights did you gain into the impact of your role on the broader patient care pathway, particularly in how a sectional prosthesis facilitates rehabilitation following complex head and neck surgery?

What will you take from the experience moving forward?

• What areas for continued development have been identified, such as a need for more advanced training in CAD/CAM planning for combined deformities or deeper knowledge of obturator retention mechanisms?
• What immediate ‘next steps’ will you take to support the assimilation of your learning, such as following up on the patient’s adaptation to the device or reviewing clinical governance documentation?
• How will you apply the learning from this activity to your routine practice, specifically in how you manage the medical, physical, and social needs of patients with multi-site defects?
• What support or resources might you need to further develop, such as guidance from a Consultant in Restorative Dentistry or additional research into novel prosthetic materials?
• How has this experience shaped your commitment to delivering quality patient-centred care in the best interests of high-complexity reconstructive patients?

Beyond action

Have you revisited the experiences?

• How has your understanding of the interrelation between oral and facial deformities evolved since you first reflected on the systematic examination and manufacturing process for this sectional prosthesis?
• When evaluating and re-evaluating this experience, how does it now compare with your Observed Training Activities (OTAs) or clinical observations? What specific behaviours regarding quality patient-centred care have you since assimilated into your daily practice?
• How has professional storytelling or a mutual exchange of experiences with colleagues and senior prosthetists transformed your view of the technical challenges associated with obturator retention and sealing in combined defects?
• Looking back at this training activity how has it enhanced your ability to formulate surgical treatment plans for other complex head and neck cases?
• In revisiting your initial reflections, do you now see more clearly how the best interests of the patient were served by the specific sequence of clinical investigations and material choices you made?

How have these experiences impacted upon your current practice?

• How are you currently applying the principles of a quality management system to ensure that all custom-made medical devices you produce meet safe clinical standards and regulatory requirements?
• In what ways has the learning from this activity supported your preparation for observed ‘in-person’ assessments, such as the Observed Communication Event (OCE) where you must present a facial prosthetic treatment plan?
• How effectively are you now examining, analysing and interpreting multimodal imaging for current patients, and has your ability to translate these findings into customised treatment improved since this experience?
• How has your approach to multidisciplinary partnership changed? Are you more proactive in discussing the impact of prosthetic design on the patient care pathway with the wider surgical and restorative team?
• Since this original experience, how have you refined your skills in identifying patients who need further specialist support, such as psychological or emotional referral?
• Can you identify specific instances where your selection of biomedical materials for current cases has been influenced by your experience with the unique requirements of sectional, multi-component prostheses?

How might these experiences contribute towards your future practice?

• What transferable skills—such as effective communication with stakeholders or the interpretation of medical, social, and psychological requirements—will be most valuable in your future role as a Clinical Scientist?
• How will this experience contribute to your future ability to manage rare or complex craniofacial conditions that require a holistic, systematic approach to examination and rehabilitation?
• What clear actions for continued development have you identified, such as pursuing advanced training in CAD/CAM digital planning for combined deformities or deepening your knowledge of regulatory governance?
• How has this activity shaped your long-term commitment to service governance and your understanding of the legal and ethical frameworks required to manufacture complex medical devices?
• In what ways will your improved understanding of the roles within a multidisciplinary team enhance your future leadership in coordinating complex surgical and prosthetic pathways?

Relevant learning outcomes

#	Outcome
# 1	Outcome Deliver quality patient centred care with the best interests of patients in all elements of practice.
# 2	Outcome Practice in accordance with local and national health and safety policies, regulatory requirements and overall service governance.
# 3	Outcome Communicate effectively with patients, relatives, healthcare professionals and other stakeholders.
# 4	Outcome Identify patients who need further specialist support and refer to the appropriate healthcare specialist.
# 5	Outcome Analyse and interpret patient investigations, multimodal imaging and information.
# 6	Outcome Perform clinical investigations, formulate treatment plans and manufacture medical devices to a safe clinical standard.
# 8	Outcome Select appropriate biomedical materials and components/instrumentation used in the treatment of patients and the manufacture of custom-made medical devices.
# 9	Outcome Practice in partnership with other clinical specialisms as part of a multidisciplinary team and understand their roles and their impact on patient care and pathway.
# 10	Outcome Apply the principals of a quality management system to their professional practice.
# 12	Outcome Assess and interpret patients’ needs to provide customised treatment dependent on medical, physical, social and psychological requirements.