Revised February 2010
1. JOB IDENTIFICATION
Job Title: Maxillofacial Prosthetist & Technologist
Reports to: Laboratory Manager
Department, Ward or Section: Dental Clinic
Directorate: Surgical and Anaesthetics.
Job Reference: SSSARAIGDENT11
No of Job Holders: 1
Last Update : Revised April 2014
2. JOB PURPOSE
Responsible for the management of a highly specialist Clinical Technical/Maxillofacial Prosthetic service for Oral & Maxillofacial Surgery and other surgical specialities as required (ENT,
Ophthalmic surgery, Plastic Surgery etc.)
The post holder is required manage scientific and advisory services to patients for their rehabilitation by restoration using implants, splints and prostheses within key areas of craniofacial reconstruction, congenital malformations of the face, jaw and head and neck malignancies. Also to construct the full range of Orthodontic appliances for the correction of malocclusions of teeth and dento-facial deformities, Oral Cancer, Splint Therapy, Sleep Apnoea and Post operative appliances with the highest degree of individual skill and responsibility. The post holder is also responsible for the delivery of Orthognathic surgery planning and diagnostic treatment planning, including innovative developmental work and design.
Regularly required to participate in research, development and internal / national audit activity programmes.

3. DIMENSIONS
The Dentofacial Unit operates from Raigmore Hospital Dentofacial Unit. The laboratory receives work from various Raigmore departments and Orthodontic and Oral and Maxillofacial peripheral clinics across the NHS Highland area.
The workload includes:

Orthodontic appliance work from the Orthodontics Department

Oral and Maxillofacial work, including clinical prosthetics, surgical splints and
Orthognathic surgery planning in conjunction with the Orthodontic Department.

Implant Borne Prosthetic work from the Ear, Nose and Throat Department.

Dental Prostheses from the Restorative Consultants
The post-holder is expected to supervise two members (1 Dental Technologist, 1 Assistant
Technical Officer) of staff as Deputy Laboratory Manager and act up as Laboratory Manager when required.
Although no formal budget is held, the post-holder is required to order all supplies for Prosthetic work, and to be accountable for these costs.

4. ORGANISATIONAL POSITION
Restorative
Consultant
Heads of
Service
ENT,
Plastics, etc.
Divisional Manager Surgical
Specialties
Head of Service
Oral &
Maxillofacial
Surgery
Assistant
Divisional
Manager
Surgical
Specialties
Head of Service
Orthodontics
This Post
Maxillofacial
Prosthetist &
Technologist
Dentofacial Laboratory
Manager
Dental
Technologist
Assistant Technical
Officer
Key

Solid Lines = Operational Management Relationships

Dotted Lines = Professional/Clinical Governance Relationships

5. ROLE OF DEPARTMENT OR SECTION
The department provides highly specialised, multi-disciplinary services for the Orthodontic clinics, Ear Nose and Throat surgery, Restorative Dentistry, Oral & Maxillofacial Surgery and
Dental Accident and Emergency Clinics for NHS Highland.
A clinical Oral & Maxillofacial Surgery service is based at Raigmore Hospital and from peripheral clinics at Wick and Stornoway.
A clinical Orthodontic service is on an outpatient basis at Raigmore Hospital and various peripheral clinics throughout the Highlands and Islands.
The Dentofacial laboratory fabricates a comprehensive range of custom made appliances for patients that have been referred to the department by their Doctor / Dentist.
The Maxillofacial Prosthetics service will be required to provide a full range of highly specialised technical and prosthetic services to NHS Highland and other referring authorities for the treatment of patients with deformities which will be congenital, acquired (trauma) or as a result of ablative surgery (cancer).
The Maxillofacial prosthetics services within the Dentofacial laboratory will be available to other surgical specialities as required (e.g. ENT, Ophthalmic surgery, Plastic Surgery)

6. MAIN TASKS, DUTIES AND RESPONSIBILITIES
1. The post holder will be required to manage the Maxillofacial Prosthetics and Technical
Services for NHS Highland.
2. Provides one-to-one patient treatment for the provision of facial and body prosthetics
3. Provide support and advice to medical and nursing staff as required in the practice of
Maxillofacial Prosthetics and Technology and Dental Technology, this will include carrying out invasive procedures in the clinic or operating theatre within specific time limits- i.e. Complex sectional impressions, fitting prosthetic abutments to osseointegrated implant fixtures.
4. Assess referrals from various medical and surgical disciplines and action as necessary in the best interest of patient care, with regard to clinical need/priority and currently accepted best practice. i.e. A patient with significant physiological and psychological complications requiring complex maxillofacial restoration may involve referral back/onto a consultant surgeon or specialist prior to pre-prosthetic surgery/treatment.
5. There will be frequent contact with facially disfigured or terminally ill patients. This will involve being with the patient for several hours at a time and counselling and empathetic skills will be necessary.
6. Ensure the highest levels of patient treatment and care.
7. Organise and participate in out-patients clinics at Raigmore Hospital.
8. Advise other health care professionals relevant to scope of own knowledge and practice within the context of maxillofacial prosthetics and technology and dental technology e.g.
Soft and Hard tissue remnant removal, type of intubation required, implant positioning etc.
9. Carry out procedures that involve skin/tissue preparations and identify tissue reaction. i.e. Application of conditioners and skin adhesives.
10. Follow departmental policy and guidelines regarding cross infection and carry out aseptic technique as required in the clinic or operating theatre.
11. Provide clinical and technical information regarding the long-term management of a medical device. i.e. Oro-facial prostheses, body prostheses, or care of osseointegrated implants.
12. Liaise with Secretaries/reception to arrange patient appointments.
13. Enter relevant details into patients’ medical records and enter relevant data via medical device processing system. This will include producing letter/reports to patients and other healthcare professionals.
14. Monitor quality control/auditing systems
15. Ensure Institute of Maxillofacial and Prosthetics and Technologists (IMPT) and General
Dental Council (GDC) fitness to practice and scope of practice regulations are observed and complied with.
16. Maintain Compulsory Personal Development hours for IMPT registration and GDC registration.
17. The post holder is required to make decisions and judgements involving highly complex clinical / technical information. This is evident in the development of innovative techniques that require analysis of situations that are complicated / unique and there is a multitude of treatment options available. The post holder is expected to assess the individual treatments case by case and come to a solution using his / her specialist knowledge and experience.

18. Responsible for the provision of rapidly changing highly specialist clinical technical service, constructing full range of highly complex appliances for removable, retention, fixed, functional, hybrid appliances, sleep Apnoea disorder, oral cancer, oro-facial abnormalities cleft lip and palate, post operative appliances, splint therapy, diagnostic treatment planning and technical aspects of planning and design for patients undergoing
Orthognathic surgery which includes innovative design and techniques. Plan and prioritise own duties to meet deadlines for completion of appliances, repairs and alterations for clinics at Raigmore and peripheral clinics throughout NHS Highland.
19. In the absence of the Laboratory manager, score pre and post treatment study models using the PAR index (Peer Assessment Rating) for local / national audits, to determine the degree of improvement due to the intervention of Orthodontic treatment.
20. Monitor output and flow systems to ensure quality standards according to Medicines and
Healthcare products Regulatory Agency (MHRA)
21. Demonstrates own duties to students and less experienced staff.
22. Discuss, advise and clarify appliance specifications with clinicians to assist them in providing appropriate treatment for patients.
23. Implements policies, service developments and regulatory changes.
24. Health & safety inspector for the Dentofacial laboratory.
25. Monitor and maintains the COSHH register for the Dentofacial laboratory.
26. Monitor storage and distribution of completed work to internal and peripheral clinics

7. EQUIPMENT AND MACHINERY USED
Responsible for safe use of equipment by others; use of expensive equipment.
Cleans and maintains specialised laboratory equipment, report faults to laboratory manager.
Computer; data storage, research/audit, Cephalometric tracing and digitising. Stereollithic model requests
Computer-aided Vacuum forming machine; EVA splints, retainers and PVC mouth guards.
Computer-aided Polymerising unit; to cure acrylic.
Micro torch; fine soldering.
Micro motor; grinding acrylic.
Spot welders; welding stainless steel.
Centrifuge; cast silver splints.
Fine tools; manipulation of stainless steel wire components and prosthesis construction.
Various hand held surgical instruments used for cleaning patients surgical defects (Probes, tweezers etc.) and attaching/removing implant retained abutments (Forceps, Screwdrivers,
Torque wrench)
Lathe; polishing and grinding
Surveying equipment; path of insertion.
Semi- adjustable articulators; diagnostic treatment planning, constructing functional appliances.
Fully- adjustable articulators; Orthognathic surgery planning
Facebow: jaw/skull position registration.
Fume cabinets. /Dust extraction unit.
Furnaces for heating and burning out casting moulds (Temperatures to 1200ºC)
Sand Blasting Equipment
Boiling and processing tank (Temperatures to 99ºC)
Bench mounted light curing machine (UV Light)

8. SYSTEMS
The updating of information consistent with national/local policies, protocols and standing regulations, consisting of:

COSHH risk assessments

The Medical Devices Directive

The Data Protection Act
Maintains patient’s appliance records.
Maintains patients’ medical records after every visit, ensuring lot/batch numbers are correctly recorded.
PAR score patient’s pre & post treatment study models generating reports for local and national audits to determine the degree of improvement due to the intervention of Orthodontic treatment.
The use of standard computer software packages (MS Word, Excel) for audit, letter writing etc.
Knowledge of Rapid Prototyping, spray moulding and CNC machining used in the production of precision moulds, and the ordering of such models for treatment planning/virtual surgery.
Issuing patient appointments and arranging special needs requirements (Transport, Hospital accommodation)
Ensures complaints are dealt with appropriately
The storage and recording of patient records observing and implementing national legal requirements (Post surgical casts, Orthognathic surgery planning records etc.)
The regulation and ordering Maxillofacial Prosthetic clinic and Implant materials, stock control and ordering system.
Tracing of Cephalometric images within the Dolphin Imaging Software system prior to
Orthognathic surgery planning.

9. ASSIGNMENT AND REVIEW OF WORK
Work is generated by Oral and Maxillofacial Surgery, Ear Nose and Throat Surgery,
Orthodontics and Restorative Consultants and other service users. Work is also generated in peripheral clinics attended by the consultants and clinicians weekly, fortnightly and monthly.
Clinical/Technical work will include highly complex intra-oral appliances/prostheses and highly complex pre-surgical osteotomy plans with associated splint work.
The post holder is wholly responsible for the out-patient facial and body prosthetic clinics for the treatment of referred patients and the provision of appropriate prosthetic restoration. This includes annual review appointments where patient implants and surrounding soft tissues are inspected for condition and prostheses checked for colour fit and function.
Technical work received at the laboratory is constructed as prescribed by the clinician, each appliance is custom made by the post holder working autonomously interpreting and analysing a range of options of complex facts in the prescription or treatment plan to achieve the best possible results for the patient.
All duties will be performed in compliance with Medical Devices Directive (MDD) 93/42/ECC.
(M.H.R.A. laboratory registration No CA 002311 )
Deals with unpredictable work patterns e.g. unscheduled alterations or repairs while the patient is in the clinic, urgent replacement of lost appliances/Prostheses.
The post holder meets on a daily basis with clinical staff to discuss, advise and clarify problem cases on appliance design.
The post holder is responsible for the storage and distribution of own work to internal and peripheral clinics.
The post holder will review the workload daily to ensure that appointment times are met especially for peripheral clinics.
Other issues are reviewed at regular department bi-monthly meetings or more frequently at informal meetings as required.
Regularly undertakes equipment & material testing or adaptation.

10. DECISIONS AND JUDGEMENTS
The post holder works autonomously following detailed occupational polices and laboratory procedures.
Displays autonomy within all prosthetic/technical aspects required.
Responsible for own day to day time management to meet pre-arranged appointments.
Deals with unpredictable work patterns i.e. emergency splints and appliances for the Dentofacial
Unit and urgent alterations or repairs of Prostheses/ Dental appliances while the patient is in the surgery/theatre.
Urgent replacement of lost Prosthetic/Dental appliances.
Analyses and develops highly complex treatment plans with Consultants advising them on the most appropriate technical course to achieve the best possible result for the patient.
Ensures implementation of policies as lead specialist in Maxillofacial Prosthetics and Technology and will be expected to be active in the development of the post by changing practice and procedures in the best interest of patient care, ie. updates from the National Institute of Clinical
Excellence (NICE), Medicines and Healthcare Products Regulatory Agency (MRHA)
11. MOST CHALLENGING/DIFFICULT PARTS OF THE JOB
Challenging
The frequent treatment of patients requiring facial or body prosthetic rehabilitation, particularly cases where the patient finds it difficult to accept their condition. This can be emotionally draining as a close working contact/relationship is established with the patient during long clinical visits.
Dealing with unpredictable work patterns with frequent interruptions to concentration i.e.
Telephone calls, instruction to junior technologists, advisory clinical visits etc.
Devising new appliance/prosthesis therapy. Mastering skills and techniques for new appliance/prosthesis designs.
Adapting standard procedures to incorporate the use of modern materials and equipment and overcome some of the barriers, demands and expectations that may exist in a constantly evolving profession.
Difficult
To complete each stage of patient treatment towards a desirable conclusion. This encompasses written and verbal communication between all members of the team. Judgement on the post holder’s part employing their knowledge and experience to overcome any problems and consider all technical/prosthetic options available.
To have a special awareness with an expert knowledge of anatomical shape, dimension and positioning when sculpting facial and body prostheses. There is also a requirement for expert knowledge of colour shade and hue which is essential when colour matching to the patient when producing custom made facial or body prostheses.

12. COMMUNICATIONS AND RELATIONSHIPS
Due to the highly specialist nature of the profession, contentious situations often arise while discussing patient care. In these situations negotiating skills, tact and diplomacy are required to ensure the best possible working relationship between clinical and technical staff, compromise and in depth technical discussion is often required to arrive at a suitable conclusion overcoming some of the barriers of understanding that exist between the clinical technical and clinical specialities.
NHS Highland internal
Participate in multi-disciplinary case meetings for patient treatment planning with consultants and nursing care staff.
Explain, advise and discuss various highly complex and sensitive clinical/technical procedures to different groups of patients/clinical/technical staff. i.e. Consultants, Specialist Registrars, Clinical
Assistants.
Parents and Patients expectations are extremely high and may exceed the parameters of technical capabilities. To help reduce the barriers of understanding and gain co-operation, which is vital in construction of facial and body prostheses for severe disfigurement, the post holder will be required to use tact, empathy, diplomacy and reassurance to explain why certain forms of treatment may not be possible due to the technical complexity/design restraints, or the prior medical treatment for their condition. i.e. Radiotherapy preventing the successful use of bone anchored implants for the retention of facial prosthetics.
Orthodontic Laboratory Manager- Service Requirements
Laboratory Staff- Service Requirements
Theatre Staff- Post-operative Appliances
Department Clerical Staff- Administration including appointment times, accommodation booking and requesting patient s’ notes
NHS Highland external
Clinicians and nurses from
Peripheral clinics - Dealing with problems and arranging appointment times.
Company representatives - Regular visits with information on new equipment and materials.

13. PHYSICAL, MENTAL, EMOTIONAL AND ENVIRONMENTAL DEMANDS OF THE JOB
Physical Skills
Daily requirement to use highly developed physical skills with a high degree of precision, speed and manual dexterity in order to produce work within specific deadlines.
There is a frequent requirement for sitting in a restricted position working to extremely small tolerance levels to produce appliances/prostheses requiring a high level of accuracy and precision. This involves the manipulation of wire components, positioning of individual precision attachments, extra-oral implant work, sculpting facial/body prostheses and denture/dental prostheses.
Physical Effort
Prolonged periods standing at plaster bench casting and trimming models.
Will be required to stand for long periods of time when sculpting prostheses during patients’ clinical consultations.
Will be required to assist patients in and out of the treatment chair during consultations if required.
Will be required to lift heavy bags of plaster to replenish plaster dispensers.
Mental Effort
There is a daily requirement for prolonged concentration on the production of appliances, manipulating fine tools, wire components and materials with a high degree of precision.
Emotional Effort
Consultations with terminally ill patients with severe facial disfigurement and speech difficulties can be difficult and highly emotional.
Consultations with patients and their families/carers can be highly emotive when discussing various treatment options for rehabilitation following facial or body disfigurement.
Patients may be angry, resentful, distresses or non-acceptant of their diagnosis or disfigurement and the Maxillofacial Prosthetist may have to give unwelcome news regarding prosthetic or splinting treatment plans.
Environmental Factors
Frequent exposure to unpleasant working conditions e.g. fumes from materials, abrasives, equipment vibration, body fluids (saliva, blood, mucus) from impressions and post fitted appliances.
Dealing with impressions from high risk patients.
Frequent exposure to body tissues which are present in post surgical theatre cover plates used to construct prostheses to repair the resultant defect.
Frequent exposure to hazardous chemicals such as Methyl Methacrylate, Silicone Solvents and polishing compounds which are used during appliance/prostheses construction.
There is a regular requirement for laboratory staff to remove oral debris from patient’s appliances before work can be undertaken.

14. KNOWLEDGE, TRAINING AND EXPERIENCE REQUIRED TO DO THE JOB
Essential
Qualifications
Degree in Dental Sciences.
Postgraduate Diploma in Maxillofacial Prosthetics.
Extensive experience to MSc level equivalent.
Or
Degree in Dental Sciences.
MSc in Maxillofacial and Craniofacial Technology with significant experience.
Full Membership of the Institute of Maxillofacial Prosthetists and Technologists.
General Dental Council Registration.
Evidence of continuing professional development.
Clinical / technical knowledge
Highly developed specialist knowledge of a range of Oral and Maxillofacial Surgery /
Orthodontic procedures.
Splint / Arch bar construction (for trauma cases / surgery).
Intra/Extra Oral Impression taking (techniques and materials).
Working knowledge of implant systems, their applications and safe practice on patients.
Anatomy of the Head and Neck.
Tooth eruption, morphology and clinical charting.
Band and bracket positioning (Orthodontic).
Diagnostic treatment planning.
Aetiology of malocclusion.
Understanding occlusal difficulties that can arise with temporo-mandibular joint dysfunction.
Understanding of static and dynamic occlusion.
Cross infection and disinfection procedures.
Understand the use of the anatomical Facebow and its relation to Orthognathic surgery planning and safe practice on patients.
Knowledge of Cephalometric Imaging systems (Dolphin)
Administrative knowledge
Laboratory booking in / out procedures.
Processing and storage of all relevant documentation.
Recording and maintenance of stock levels within the laboratory.
Audit and research lead.
Maintenance of patients medical notes
Desirable
Extensive practice as a qualified Maxillofacial Prosthetist and Technologist.

15. JOB DESCRIPTION AGREEMENT
I agree that the above Job Description is an accurate reflection of my duties and responsibilities at the date of signing.
Job Holder’s Signature:
Manager’s Signature:
Date:
Date: