Direct chairside fabrication of a two-piece brachytherapy appliance.

This article reviews the prosthodontic steps in the direct chairside fabrication of a two-piece custom brachytherapy appliance consisting of an intraoral and extraoral component. This technique is described through the treatment of a 77-year-old patient with a T1N0M0 squamous cell carcinoma of the lower lip vermillion, referred for the most expeditious fabrication of a brachytherapy appliance because of the urgency of beginning brachytherapy. Fabrication of the appliance consisted of an expedited clinic visit in which both intraoral and extraoral components were fabricated chairside. A traditional indirect laboratory-based fabrication of such an appliance would have been more time-consuming, thereby delaying delivery of radiation treatment of the rapidly progressing malignancy.