1 Volume 24 2025 e255409 Original Research Braz J Oral Sci. 2025;24:e255409http://dx.doi.org/10.20396/bjos.v24i00.8675409 1 Faculdade de Odontologia, Atitus Educação, Porto Alegre, Rio Grande do Sul, Brazil. 2 Faculdade de Odontologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil. Corresponding author: Natália Batista Daroit R. Ramiro Barcelos 2492/503. Porto Alegre, RS, Brazil. CEP 90035-004 natalia.daroit@ufrgs.br phone number: 51 3308-5011 Editor: Dr. Altair A. Del Bel Cury Received: January 01, 2024 Accepted: May 29, 2024 Brazilian oral and maxillofacial prosthesis: a dentistry potent expanding specialty Daiane Amador Fraga Martins1 , Adriana Corsetti2 , Natália Batista Daroit1,2* Oral and maxillofacial prosthesis (OMP) is a specialty of Dentistry for prevention, protection, functional, and orofacial rehabilitation. Aim: The present study aimed to describe the OMP Brazilian panorama, verifying specialists, patient access forms, and service characteristics. Methods: OMP specialists were identified on the Federal Council of Dentistry (CFO) website. Additionally, professionals linked to the specialty were invited to answer a questionnaire (Google Forms®) through email or social networks. The questionnaire was available between October and November 2022. Data referring to the professional, service, and assistance were collected. Results: CFO records showed 89 active registered OMP specialists. There were 35 responses to the online questionnaire. The majority of participants were women (74.1%), who were non- specialists (51.9%), with an average age of 54.26 years, while some were specialists in other areas of training such as dental prostheses and oral and maxillofacial surgery. Concerning services comprised universities, institutes, hospitals, and private networks, and most OMP services were located in the southeast region, especially in São Paulo, followed by the northeast and south regions. As for the developed prostheses, the most frequent etiology was malignant pathology, and the produced type is the ocular, followed by the obturator. Conclusions: We concluded that OMP is still under development in Brazil and the number of professionals is small and regionalized. There is an imperative to establish new, specialized training centers and decentralize the presence of professionals, thus expanding access and enhancing services for oral and maxillofacial prostheses throughout Brazil. Keywords: Maxillofacial prosthesis. Dental prosthetisis. Prosthodontics. https://orcid.org/0009-0008-1908-9363 https://orcid.org/0000-0002-0136-1321 https://orcid.org/0000-0002-0764-8999 2 Martins et al. Braz J Oral Sci. 2025;24:e255409 Introduction Oral and Maxillofacial Prosthesis (OMP) is a dental specialty for prevention, protec- tion, functional and aesthetic rehabilitation of missing oral and facial regions, using prostheses and devices. It aims to restore masticatory, phonetic, and aesthetic func- tions, as well as enhance confidence, safety, and quality of life1. This specialty exper- tise comprises patients who have oral and maxillofacial deformities owing to different etiologies: Patients who have deformities of traumatic origin, congenital malforma- tions, and neoplastic, which can be benign or malignant2. The rehabilitation of these patients with plastic surgery is often not possible, and OMP becomes a great resource for those left with irreparable sequelae3. OMP can be classified into intraoral and extraoral and further subclassified into temporary and definitive1,4. They are used to rehabilitate several anatomical areas, including nasal, auricular, ocular, facial, oculopalpebral, or association of more than one anatomical area in the same prosthesis5. Intraoral prostheses may also be associated with extraoral use6. The type of prosthesis used depends on the region and size of the defect to be repaired, adjacent tissues, and the con- dition of the patient or family member for maintenance of the prosthesis and oral hygiene7. Most patients treated by OMP specialists have deformities owing to neoplastic eti- ology. According to the Brazilian National Cancer Institute, head and neck cancer rates are alarming. Approximately 76% of cases are discovered in an advanced stage, making treatment difficult and leading to significant postoperative surgical defects8. Trauma is another cause for patients receiving OMP rehabilitation. Maxillofacial frac- tures are strongly associated with severe morbidity, loss of function, and deformity9. The most common congenital etiologies are cleft lip and palate, auricular malforma- tions, agenesis, and, rarely, nasal agenesis and malformations1. In Brazil, few professionals are registered in the OMP specialty10. Information regard- ing OMP professionals, available services, locations, access forms, and treatments carried out enhances public knowledge, assists in planning healthy public services, and provides an appreciation of the specialty in Brazil. This study aimed to survey the Brazilian overview of OMP to describe both the services and professionals working in OMP in Brazil. Materials and Methods This descriptive cross-sectional study was approved by the Atitus Educação Research Ethics Committee (CAAE 59600322.1.0000.5319). Initially, a search was carried out in the Federal Council of Dentistry (CFO) public database identifying all dentists and those registered as specialists in OMP by state. Furthermore, a comparison of the density of specialists was made regarding the total population of the local site accord- ing to the Brazilian Institute of Geography and Statistics11. Additionally, an internet search (Google) was carried out with the keywords “Pró- tese Bucomaxilofacial” to identify the services linked to this specialty. After placing 3 Martins et al. Braz J Oral Sci. 2025;24:e255409 the contact of those responsible, an invitation to participate in the survey was sent through e-mail and social media (WhatsApp® and Instagram®). The invitation was also made in person to professionals working in Brazil who attended the Latin Amer- ican Congress of Oral and Maxillofacial Rehabilitation, 2022 edition. After accepting and signing the online informed consent form, the participant answered a question- naire (Google Forms®). Institutions and professionals involved with OMP and its services in Brazil either for free or as non-profit organizations were included in this study. Dentists and institu- tions not involved in OMP or exclusively providing privately funded prosthetic ser- vices were excluded from the study. The interviewees’ self-analysis identified if their profile suited the research. The participants answered the questionnaire containing questions related to their personal and institutional profile, including details regard- ing services, such as the prostheses, their types, quantities produced, and average production time. Each question was analyzed to determine the number and percentage of responses. Data were analyzed and recorded in database software (Microsoft Excel®). A descrip- tive analysis of the data with mean and standard deviation was performed. Results A total of 89 OMP specialists were found in the CFO website database. The distribu- tion of specialists in OMP is irregular across Brazil, with most professionals located in the Southeast region. The highest concentration is in the state of São Paulo, with 52 registered OMP specialists, while other states such as Acre, Amapá, Bahia, Paraíba, and Espírito Santo did not present any record (Table 1). Table 1. Distribution of dentists and OMP specialists and ratios in Brazil across Federal administrative regions and states. Region/State OMP Specialists (n) Dentists (n) OMP specialists/ dentists ratio (10-4) OMP specialists/ population ratio (10-6) NORTH Acre 1 1.322 7,56 1,20 Amapá 0 1.487 0 0 Amazonas 2 6.221 3,21 0,50 Pará 2 8.174 2,44 0,24 Rondônia 1 3.043 3,28 0,63 Roraima 0 1.155 0 0 Tocantins 0 2.988 0 0 Subtotal 6 24.390 2,46 0,34 NORTHEAST Alagoas 2 4.166 4,8 0,63 Bahia 0 19.123 0 0 Continue 4 Martins et al. Braz J Oral Sci. 2025;24:e255409 Continuation Ceará 1 10.768 0,92 0,11 Maranhão 1 6.771 1,47 0,14 Piauí 0 4.396 0 0 Pernambuco 2 12.782 1,56 0,22 Sergipe 1 2.895 3,45 0,45 Paraíba 0 7.005 0 0 Rio Grande do Norte 3 5.162 5,81 0,90 Subtotal 10 73.068 1,36 0,18 MIDWEST Distrito Federal 0 9.343 0 0 Goiás 2 14.839 1,34 0,28 Mato Grosso 1 7.045 1,41 0,27 Mato Grosso do Sul 1 5.286 1,89 0,36 Subtotal 4 36.513 1,09 0,24 SOUTHEAST Espírito Santo 0 7.837 0 0 Minas Gerais 5 49.052 1,01 0,24 Rio de Janeiro 5 36.984 1,35 0,31 São Paulo 52 111.572 4,66 1,17 Subtotal 62 205.445 3,01 0,73 SOUTH Paraná 3 24.512 1,22 0,26 Rio Grande do Sul 3 21.820 1,37 0,27 Santa Catarina 1 16.836 0,59 0,13 Subtotal 7 63.168 1,10 0,23 Total 89 402.584 2,21 0,43 Source: Federal Council of Dentistry. (https://website.cfo.org.br/) and Brazilian Institute of Geography and Statistics (IBGE) (https://www.ibge.gov.br/cidades-e-estados.html) December 2023. A comparison between the total number of OMP specialists, dentists, and popula- tion was performed to obtain the density of these professionals by state (Figure 1). Despite the state of São Paulo showing the highest number of specialists, states such as Acre, Alagoa, and Rio Grande do Norte had a higher density of OMP specialists. On comparing the OMP specialists/habitants ratio, states such as Acre (1.20), São Paulo (1.17), and Rio Grande do Norte (0.9) presented the highest taxa, while Ceará (0.11), Santa Catarina (0.13), and Maranhão (0.14) demonstrated minor results. 5 Martins et al. Braz J Oral Sci. 2025;24:e255409 OMP specialists 0 1–2 3–5 >5 OMP specialists/ dentists (10-4) 0 0.1–2 2.1–5 >5 OMP specialists/ population (10-6) 0 0.1–0.5 0.51–1 >1 A B C A) Number of OMP specialists per state (n). B) OMP specialists/dentists ratio per state (10-4). C) Number of OMP specialists/population ratio per state (10-6). Figure 1. Distribution of Brazilian OMP specialists Of the 35 professionals who began answering the questionnaire, five did not fit the research profile, and one was not interested in participating in the research. A total of 29 responses were collected, two of which were excluded owing to incomplete data and a total of 27 answers comprised the sample. Of the professionals involved in OMP services in Brazil who answered the question- naire, the majority were women (74.1%), with an average age of 54 years. There were 51.9% of professionals who were non-specialists (dentists who, while not specializing in OMP, were actively involved with OMP procedures), while 92.5% of them were spe- cialists in other areas, such as dental prosthesis (33.3%) and oral and maxillofacial surgery (22.2%), among other specialties described in Table 2. Table 2. Demographic data of survey respondents. Characteristics Gender n (%) Female 20 (74,1%) Male 7 (25,9%) Age Mean (DP) 54,26 (±8,09) OMP Specialists n (%) Yes 13 (48,1%) No 14 (51,9%) Another dental specialty n (%) Dental prosthesis 9 (33,3%) Oral and maxillofacial surgery 6 (22,2%) Stomatology/ Implantology 2 (7,4%) Continue 6 Martins et al. Braz J Oral Sci. 2025;24:e255409 Continuation Not informed 2 (7,4%) TMD and Orofacial Pain 1 (3,7%) Dentistry 1 (3,7%) Stomatology 1 (3,7%) Implantology 1 (3,7%) Dental prosthesis/ Implantology 1 (3,7%) Sports Dentistry/Orthodontics 1 (3,7%) Facial Harmonization 1 (3,7%) Oncology 1 (3,7%) Type of service n (%) University 10 (37%) Private 8 (29,6%) NGO/ Foundation/ Institute 4 (14,8%) Hospital 3 (11,1%) Private / Agreement with the State 1 (3,7%) Not informed 1 (3,7%) The majority of the specialists were related to universities (37.03%), followed by 29.6% with- out a connection, 14.8% with non-governmental organizations (NGOs)/Foundations, 11.1% with hospitals, and 3.7% were associated with private institutions with state agreements. The location of the services mapped demonstrated that 14 were in the Southeast region, 9 in the state of São Paulo, 6 in the Northeast, 5 in the South region, 2 in the Midwest, and the North region had no local service (Table 3). Table 3. Characterization of OMP services in Brazil Type of institution Institution University University of São Paulo University of Fortaleza Federal University of Rio Grande do Sul Federal University of João Pessoa University of Vale of Paraíba University of Brasília Federal University of Ceará Faculty of Dentistry of Ribeirão Preto – USP Federal University of Minas Gerais State University of Rio de Janeiro Continue 7 Martins et al. Braz J Oral Sci. 2025;24:e255409 Continuation NGO Foundation/ Institute Adapta – Camaleão Institute National Cancer Institute/ HC1 Hospital (INCA) NGO – Instituto Mais Identidade Hospital Hospital for Rehabilitation of Craniofacial Anomalies – Bauru/São Paulo Rehabilitation Hospital – Worker’s Hospital Complex Hospital AC Camargo Private Private – Rio Verde/GO Private – São Paulo Oncobio/Oncoclínicas Private – Londrina/ PR Private – São Luís do Maranhão Private – Campinas/SP Private – Taubaté/SP Private – Recife/ PE Private / Agreement with the State Secretary of Health of the State of Santa Catarina Location of Services by Region North 0 North East 6 (22,2%) Midwest 2 (7,4%) Southeast 14 (51,8%) South 5 (18,5%) Year of implementation Mean (SD) 2000 (± 22,48) Number of OMP Specialists 0 10 (37%) 1 12 (44,4%) 2 0 (0%) 3 1 (3,7%) 4 1 (3,7%) 5 1 (3,7%) Not answered 2 (7,4%) The Service is totally Brazilian Unified Health System subsidized No 14 (51,9%) Yes 11 (40,7%) Not answered 1 (7,4%) Continue 8 Martins et al. Braz J Oral Sci. 2025;24:e255409 Continuation Does the service receive any government subsidy or another sponsor? No 18 (66,7%) Yes 6 (25,9%) Yes, when it involves notices and projects 1 (3,7%) Not answered 1 (3,7%) Is there a cost or fee per patient served? No 12 (44,4%) Cost of prosthesis 7 (25,9%) Attendance rate 5 (18,5%) Not answered 1 (3,7%) Sporadic cases 1 (3,7%) Fixing sticker cost 1 (3,7%) Average number of prostheses/month Mean (Standard deviation) Mean (SD) 9,63 (±19,13) Prevalence of etiology Malignant Pathology 22 (81,5%) Traumatic 3 (11,1%) Congenital 1 (3,7%) Not answered 1 (3,7%) Benign pathology 0 (0%) Prevalence of prosthesis confection Eyepiece 13 (48,1%) Obturator 8 (29,6%) Not answered 2 (7,4%) Surgical 1 (3,7%) Headset 1 (3,7%) Oculo-palpebral 1 (3,7%) Radiiferous/Protective Prosthesis 1 (3,7%) Facial 0 (0%) Nasal 0 (0%) Average delivery time of prostheses Mean/Standard Deviation In weeks 4,3 (±3,15) The implementation of these services varied from 1934 to 2022. The services com- prised dentists, of which 10 had no OMP specialist, 12 had one specialist, 1 had three specialists, another had four specialists, and 1 had five specialists. Two institutions did not inform regarding professional qualifications. 9 Martins et al. Braz J Oral Sci. 2025;24:e255409 Among the financial support of OPM services, 51.9% were not completely subsidized by the Brazilian Unified Health System, while 40.7% received a full subsidy. The remain- ing institutions did not provide information on their subsidy status. Considering any possible government assistance or other sponsorship, only 25.9% of these institu- tions received any form of subsidy, either from the government or another project. A minor percentage, 3.7%, reported occasional subsidies, while 51.9%, did not receive any form of assistance (Table 3). Approximately 44.4% of the institutions supplied prostheses free of cost, 25.9% charged only the fabrication cost (without profit), 18.5% had a minimal service fee, 3.7% had some cost in sporadic cases, 3.7% charged only the adhesive cost, and 3.7% did not inform. An average of 9.63 prostheses were fabricated, where the most common etiology was linked to malignant pathologies (81.5%), followed by trauma (11.1%), 3.7% of congen- ital origin, and 3.7% did not report. The most fabricated prosthesis by the institutions was the ocular (48.1%), followed by the obturator (29.6%), among others. The average delivery time for prostheses was 4.3 weeks, varying according to the institution and prosthesis type (Table 3). Discussion The concept of OMP is found in the resolution that regulated the specialty exercise in Brazil in 199312. This study conducted a survey involving professionals and ser- vices associated with Brazilian OMP. Our results showed a small and regionalized number of specialty dentists in this area; most of these services are established within universities, providing free service to the patient and receiving minimal or no financial incentives. According to the CFO database, 404.113 active dentists were registered in Brazil at the time of data collection for the present study. The largest concentration of these professionals was in the Southeast region, which also comprised the most OMP spe- cialists13. The region with the highest concentration of specialists is also where the two OMP specialization courses are located14,15 and, according to our results over half (51.8%) of the Brazilian services are situated within this region. A specialist degree is not a prerequisite for working with OMP. All dentists can provide care in this specialty, provided they have theoretical and practical knowl- edge16. States such as Amapá, Roraima, Tocantins, Bahia, Piauí, Paraíba, Distrito Federal, and Espírito Santo do not have any OMP specialists. Our results showed that in 37% of the services, professionals are not OMP specialists. One possible explanation is that, in the past, only two specialties per dentist could be registered in the CFO. It meant that if the professional had multiple pieces of training, the OMP might not be officiality registered. An alternative reason could be that until 1971, dental prosthesis and OMP were part of a single specialty called Dental Prosthe- sis, which is valid even today in some countries17, indicating that many profession- als may have received training within this combined context. Our results showed that of the professionals involved in OMP services, 92.6% were trained specialists in some other field; most of them in the specialty of dental prostheses (33.3%). 10 Martins et al. Braz J Oral Sci. 2025;24:e255409 Dentistry specialties with the lowest number of specialists are OMP followed by Sports Dentistry10. The small adherence of professionals to the specialty can significantly correlate with low service offerings. An additional potential factor is a minimal exposure to it during graduation. Medeiros et al. conducted a study assessing the inclusion of participants related to OMP in the curricula of Brazilian southeast dental institutions. Their findings revealed that only 5.55% of institu- tions regularly incorporate OMP as a discipline. Given our results, indicating that this region presented the highest number of specialists and services, the gap in other regions across the country is likely to be even more pronounced since most services within universities serve as a field of activity for students. Public univer- sities stand out in this regard, constituting 62.5% of institutions offering such par- ticipants3. This is in accordance with our results, indicating that the public is the primary contributor to the provision of OMP services between universities. Some institutions, such as Minas Gerais, Brasília, and Rio Grande do Sul Federal Univer- sities, São Paulo University, and Rio de Janeiro Pontifical Catholic University, offer extension activities, which allow students to come in contact with the area and offer services to patients18-22. One of the objectives of the graduation course in dentistry is to comprehend and control the techniques and skills for the diagnosis of oral conditions and compli- cations. This includes intercepting and treating oral diseases, as well as achieving aesthetic-functional restoration and maintaining the balance of the stomatognathic system, according to the Dentistry National Curriculum Guidelines23. Following these recommendations, OMP content should be covered in dentistry courses. A detailed systematic review of courses’ pedagogical projects is desirable for future investiga- tion, to provide an overview of students’ contact with the specialty, highlighting that even if there is no discipline with the OMP theme, the participant can be addressed within integrated clinical disciplines. Representing OMP professionals in Brazil, the respondents majority in this survey were women (74.1%), aligning with the current trend24. However, analyzing the data of professionals specialized in OMP registered in the CFO, 56% were men; such a discrepancy could be because of registrations from active and inactive professionals. The average age of Brazilian OMP professionals was 54.26 years. In an American study, Sheets et al. demonstrated that the average age of OMP professionals was 55.08 years25. Ariani et al. conducted a survey in 32 countries and demonstrated that the average age of professionals was 46 years17, showing a trend of more experienced specialists nationally and worldwide. This study demonstrated that educational institutions were the primary providers of the OMP service. Following universities, professionals with private affiliations, insti- tutes, NGOs, foundations, and hospitals were noted. Most services had students linked to the service, allowing some contact with the specialty. A small number of services were observed throughout Brazil, with the highest concentration in the Southeast region. The main concern was the lack of access to the service in approx- imately 15 states. This lead to large patient displacements and even the impossibil- ity of rehabilitating others. 11 Martins et al. Braz J Oral Sci. 2025;24:e255409 According to this study, the average production time of OMP was 4.3 weeks, varying according to the type of prosthesis needed and demand for the service. Multiple visits are required during the development of the OMP. However, it is not feasible for many patients to travel multiple times owing to financial, physical, or emotional conditions. They can be embarrassed to expose their deformities to the public, as they are psychologically traumatized and in great distress and have difficulty reinte- grating into society, improving significantly after the use of OMP26. As for the OMP costs of services were studied, most of them were free of charge; however, only 25.9% are entirely free, and the same percentage reported receiv- ing some government subsidy or another sponsor. Other institutions charge the material cost without any profit because they do not obtain any aid. Con- sidering the patients who seek these services, have acquired defects, mainly of malignant etiology, and have a low socioeconomic level, this factor is decisive for treatment execution27. In this study, the most common etiology that required OMP was malignant pathology. According to the National Cancer Institute, the rate of head and neck cancer is alarm- ing. Approximately 76% of cases are diagnosed in advanced stages, making treat- ment difficult, increasing morbidity rates, and causing mutilating defects8. Another cause for using OMP was trauma, in which the maxillofacial traumas were the most common at polytrauma centers. These injuries have a high morbidity rate and capac- ity for severe facial deformations9. Most of the services studied produce the most diverse types of OMP. Obturators and eyepieces are the most frequent owing to the number of institutions fabri- cating them and quantity produced. Intraoral prostheses are used to rehabilitate post-surgical patients after partial or total maxillectomies4. They provide signif- icant benefits to the patient. It occludes the oroantral communication after the surgical resection, allowing adequate swallowing, consequently maintaining the nutritional status, in addition to restoring speech, chewing, vertical dimension, and maintaining acceptable aesthetics1. In addition to having an aesthetic benefit, the prostheses that replace the ocular unit maintain the support and tone of the eyelid muscles and protect the ocular cavity2. The necessity and significant contribution of OMP to patients’ lives are undeniable28. Essential measures include the formulation of public policies and increased govern- ment financial incentives. Potentially incorporating these rehabilitations within the Dental Specialties Center or implementing the procedures to care for individuals with special needs allows the growth of this specialty within Brazilian Dentistry. The research may have been limited due to restricted access to OMP professionals in Brazil. The study did not include institutions and professionals that provide the ser- vice for profit. A larger sample is suggested for future studies on this topic. Further- more, no specific class entity represents and promotes this oral specialty in Brazil. The Sociedad Latinoamericana de Rehabilitación Bucomaxillofacial is an organiza- tion that connects and organizes congresses of the specialty in South America. This continental institution has great importance in the area. 12 Martins et al. Braz J Oral Sci. 2025;24:e255409 In conclusion, OMP is still under development in Brazil and the number of profes- sionals is small and regionalized. There is an imperative to establish new, spe- cialized training centers and decentralize the presence of professionals, thus expanding access and enhancing services for oral and maxillofacial prostheses throughout Brazil. Competing interests The authors have no conflicts of interests to disclose. Data availability Datasets related to this article will be available upon request to the corresponding author. Author contribution Daiane Amador Fraga Martins: data collection, draft manuscript preparation. Adriana Corsetti: study conception and design. Natália Batista Daroit: study concep- tion and design; data collection, draft manuscript preparation. All authors analyzed, interpreted, and reviewed the findings and revised and approved the final version of the manuscript. References 1. Phasuk K, Haug SP. Maxillofacial Prosthetics. 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