Analysis of the Effectiveness of 3D Printed Patient-Specific Implants for Reconstruction of Maxillary Defect Secondary to Mucormycosis.

Introduction: Patients affected with mucormycosis of maxilla have been increasing following Covid-19 infections. We followed the reconstruction of the maxilla using 3D manufactured patient-specific implants. The additive manufacturing technology is capable of fabricating custom-made titanium implants precisely for oral and maxillofacial reconstructions. Aim: To analyse the effectiveness of 3D manufactured patient-specific implants in the reconstruction of maxilla affected by mucormycosis secondary to Covid-19. Methodology: This study was conducted among 20 patients receiving patient-specific implants for surgical and prosthetic reconstruction of the maxilla. The parameters analysed at baseline, 3 months, 6 months, and 12 months were pain, implant exposure, infection, wound dehiscence, fit of implant, postoperative surgical rating scale, and patient experience evaluation rating scale. Results: Inferential Statistics revealed a positive correlation. Conclusion: From the present data, it can be concluded that within the limitations of the study, patient-specific implant systems are an effective treatment strategy for the reconstruction of the maxilla affected by mucormycosis secondary to Covid-19. More studies with larger sample size and longer follow-up periods are required to substantiate the results from the present study. Supplementary Information: The online version contains supplementary material available at 10.1007/s12663-023-01922-7.

3D-Printed Ergonomically Designed Feeding Aid for Patients With Limited Manual Dexterity.

Self-eating is a difficult task when hand and finger movements are restricted. Many patients find difficulty in holding utensils because of slender handles. It is essential to have a customized handle that will allow a better grip on traditional feeding aid. When the handle is customized to the patient's hands and fingers, patients will have better control while eating. This reduces their dependency on others, thus helping to regain their lost self-esteem. This technical report describes a simple method of fabricating a three-dimensional (3D)-printed ergonomically designed handle for a feeding aid from materials readily available in the dental office.

Management of Sunken Cheeks With Magnet-Retained Cheek Plumpers.

The loss of teeth, associated with sunken lips and cheeks, has a debilitating psychological effect on a person. It is essential for clinicians to incorporate facial esthetics into their treatment plan for complete denture patients in order to improve the patients' confidence and quality of life. Cheek plumpers ensure adequate support to facial muscles, which, in turn, minimizes the appearance of wrinkles, lines, and sagging over time. This case report describes the fabrication of detachable cheek plumpers using magnets to enhance the facial esthetics of a completely edentulous patient. Magnet-retained cheek plumpers, being small and lightweight, allow ease of placement and cleaning without the addition of weight to the prosthesis.

Management of Comminuted Fracture of Mandible Using Titanium Mesh.

Comminuted mandibular fractures are common following a high-velocity injury to the face and jaws. The inherent nature of injury and damage to the underlying hard and soft tissues often complicate the management of comminuted fractures. Traditionally, comminuted fractures were managed by closed reduction and external skeletal fixation. Titanium mesh serves as an excellent alternative in the management of comminuted mandibular fractures. The present case report presents the successful management of comminuted mandibular fractures using titanium mesh.

Cylindrical Implant Versus Tapered Implant: A Comparative Study.

AIMS AND OBJECTIVES: The aim of this study is to compare the efficacy of tapered implants with cylindrical implants by evaluating the implant stability using the Osstell implant stability quotient (ISQ) instrument (W&H Dental India PVT Ltd., Bangalore, India) postoperative pain using the visual analog scale (VAS) score, and the peri-implant health using implant mobility scale. MATERIALS AND METHODS: This study included 30 patients who were partially edentulous with single or bilateral missing teeth and received 30 tapered implants on the one side and 30 cylindrical implants on the other side. Implant stability, postoperative pain, and peri-implant health were evaluated. RESULTS: In the evaluation of 30 tapered implants and 30 cylindrical implants, the implant stability quotient (ISQ) value for the tapered implants was higher when compared to that of cylindrical implants, and the group that received tapered implants had the least pain and good peri-implant health than the group that received cylindrical implants. CONCLUSION: On the basis of our clinical findings, it can be concluded that tapered implants provide greater primary stability than cylindrical implants. With the popularity of loading protocols in implant dentistry, the implant surgeon can increase predictability and success by selecting a tapered implant.

Massage Therapy to Control Anxiety Before Extraction of an Impacted Tooth.

Anxiety creates a stressful situation for the dentist as well as the patient. This article describes a simple technique to manage anxiety using an eye massager. The audio and visual distraction technique helps the patient relax and complete the procedure. This article also stresses some basic skills like good communication skills and establishing mutually trustworthy dentist-patient relationships to enhance patient satisfaction during treatment. Managing anxiety during dental visits will help improve oral health in the long term.

A Simple Denture-Marking Technique for Patients Residing at Old Age Homes.

Denture marking helps to identify unknown individuals in social and forensic scenarios. This article describes a simple technique of incorporating a patient's photograph with details in the patient's denture. The photographic marker will help in quick identification in old age homes as it is easily readable by a layperson, playing an important role in day-to-day identification. This technique can be used to label both new and existing dentures that are not marked. The simple technique will ensure positive identification of denture wearers.

Aadhar Number Marking on Surgical Plate for Forensic Identification.

Dental identification is the most reliable and frequently applied method of human identification, predominantly by comparing the antemortem and post-mortem records. Hence, all types of dental treatment should be recorded and kept properly. Aadhaar is a 12-digit individual identification number issued by the Unique Identification Authority of India on behalf of the Government of India to all residents of India.Marking an Aadhar number on a surgical plate can play an important role in forensic identification when other methods fail. In the case presented here, considering the importance of forensic records, the patient's surgical plates were labeled with the Aadhar number using a laser. A little effort from all dental practitioners to get surgical plates marked with patient details can help in quick identification if the need arises in the future.

Facial soft-tissue changes after anterior maxillary osteotomy: A prospective study.

Aims: The aim of this study was to analyze and assess the soft-tissue response in patients treated by anterior maxillary osteotomy (AMO) in the postoperative period at 3, 6, and 9 months and to qualitatively assess the outcome of the surgery by the patients. Patients and Methods: The study included twenty adult healthy patients between 18 and 25 years with skeletal Class II malocclusion and requiring AMO setback for the correction of facial deformity. Preoperative and postoperative lateral cephalograms were taken and soft-tissue changes that occurred following AMO were compared at 3, 6, and 9 months postoperatively. The stability and acceptance of the soft-tissue changes were analyzed, and the patient's acceptance for the soft-tissue changes was measured on the surgical rating scale (SRS). Results: All the soft-tissue parameters showed noticeable changes following AMO. Statistically significant difference was observed with nasolabial angle, upper lip, and lower lip inclination. All the patients were moderately satisfied with the outcome of the surgery. Conclusion: This study aims in quantifying the soft-tissue changes following the AMO and the quality of the changes were recorded based on the SRS by the patients. Although there are changes associated with all the parameters assessed, significant differences was observed in nasolabial angle, upper lip, and lower lip inclination. The surgeon must be aware of the soft-tissue adaptation following the surgery for better outcomes.

Custom Sectional Impression Tray With Sectional Handle for Microstomia Patients.

Microstomia presents a unique challenge to the dentist as well as the patient. Microstomia patients often face difficulty in inserting or removing removable dental prostheses due to constricted opening of the oral cavity. Dentists often face difficulty in inserting impression trays in these patients because of the limited mouth opening. Standard impression procedures need to be modified in such patients. This article describes a simple design for the fabrication of a sectional handle for a definitive impression in microstomia patients. The sectional handle could be sterilized and reused.

A Simple Technique to Manage Anxiety During Tooth Extraction.

Pain-free dental treatment is important for reducing anxiety, treatment completion, and enhancing acceptance of future dental treatment. Injectable local anesthesia assists this pain-free approach but can cause anxiety in few patients. Achieving proper anesthesia is important to complete the procedure successfully, thereby adding to patient's care and comfort. This article describes a simple technique to manage dental anxiety using virtual reality headset. Audio visual aid helped the patient to relax and eliminate the phobia of local anesthesia injection during surgical tooth extraction. The simple technique enhanced the patient's ability to continue the dental procedure.

Customized Pen for Patients With Arthritis.

Patients with arthritis present with pain, stiffness and limited movement of fingers and hands. Performing tasks independently lead to a lot of anxiety and emotional trauma. Holding simple things like a toothbrush or pen is a cumbersome task. This article describes a simple technique to customize a pen for arthritis patients. The pen holder is customized to the patient's fingers making it easier to write.

Efficacy of diode lasers in oral verrucous hyperplasia: A case series.

Oral verrucous hyperplasia (OVH) is a potentially malignant lesion that may transform into an oral cancer. Cases without local metastases can be conservatively managed with local excision, laser therapy, photodynamic therapy, chemotherapy, etc. The aim of this article is to present a case series showing treatment outcomes of OVH excised with laser. A total of 5 cases of OVH diagnosed histologically were included. All the 5 cases were excised using a diode laser and the specimen was sent for histopathological examination. Histopathological examination of excisional biopsy specimen with adjacent normal epithelium result has shown to be verrucous hyperplasia excluding the chance of verrucous carcinoma in any of the case. All the 5 cases were followed up for 18 months. All the 5 patients have shown excellent healing and epithelialization by 1 month and have shown full range of healing by the end of 3rd month. There were no complications reported over a follow up period of 18 months. Verrucous hyperplasia is a challenging pathological state for success after excision. A high degree of chance for recurrence and scarring of the tissue compromises treatment outcomes. In our experience use of diode laser for excision has shown satisfactory healing with minimal scarring and there were no cases of recurrence after 18 months follow up.

Three-Dimensional Printing of Customized Scaffolds with Polycaprolactone-Silk Fibroin Composites and Integration of Gingival Tissue-Derived Stem Cells for Personalized Bone Therapy.

Regenerative biomaterials play a crucial role in the success of maxillofacial reconstructive procedures. Yet today, limited options are available when choosing polymeric biomaterials to treat critical size bony defects. Further, there is a requirement for 3D printable regenerative biomaterials to fabricate customized structures confined to the defect site. We present here a 3D printable composite formulation consisting of polycaprolactone (PCL) and silk fibroin microfibers and have established a robust protocol for fabricating customized 3D structures of complex geometry with the composite. The 3D printed composite scaffolds demonstrated higher compressive modulus than 3D printed scaffolds of PCL alone. Furthermore, the compressive modulus of PCL-Antheraea mylitta (AM) silk scaffolds is higher than that of the PCL-Bombyx mori (BM) silk scaffolds at their respective ratios. Compressive modulus of PCL-25AM silk scaffolds (73.4 MPa) is higher than that of PCL-25BM silk scaffolds (65.1 MPa). Compressive modulus of PCL-40AM silk scaffolds (106.1 MPa) is higher than that of PCL-40BM silk scaffolds (77.7 MPa). Moreover, we have isolated, characterized, and integrated human gingival mesenchymal stem cells (hGMSCs), an effective autologous cell source, onto the 3D printed scaffolds to evaluate their bone regeneration potential. The results demonstrated that PCL-silk microfiber composite scaffolds of Antheraea mylitta origin showed much higher bioactivity than the Bombyx mori ones because of arginine-glycine-aspartic acid (RGD) sequences present in the Antheraea mylitta silk fibroin protein favoring cell attachment and proliferation. By day 14, the metabolic activity of hGMSCs was highest in PCL-40AM (4.5 times higher than that at day 1). In addition, to show the translational potential of this work, we have fabricated a patient defect-specific model (mandible) using the CT scan obtained by the micro-CT imaging to understand the printability of the composite for fabricating complex structures to restore maxillofacial bony defects with precision when applied in a clinical scenario.

Individually Modeled 3D Printed Toothbrush and Interproximal Brush Handle With Name for Patients With Limited Manual Dexterity.

Maintenance of proper oral hygiene is a cumbersome task when hand and finger movement is restricted. The customized handle allows better grip on the toothbrush, making it easier to brush teeth or dentures. This increases self-esteem by reducing their dependency on others. This article describes a method of fabricating a 3D printed two-in-one customized handle for a patient with limited manual dexterity. The 3D printed handle is simple and requires less fabrication time than other methods. The customized handle is strong, durable, and resistant to water absorption. It also allows reuse with a new brush design, thus saving additional time and cost. In addition, using a customized toothbrush handle is more effective in oral plaque control than a standard toothbrush.

Diplopia following posterior superior alveolar nerve block: a case report and review of literature.

Posterior superior alveolar nerve block (PSANB) is one of the most common and safe injection techniques in the field of dentistry. As with any other procedure, it also has inherent complications, of which ophthalmic complications are relatively rare. Transient diplopia following the administration of PSANB is rare and daunting for both the patient and the clinician. We present a case of transient diplopia in a 26-year-old female patient following administration of PSANB and review its probable pathophysiology and management and prevention.

Arthroplasty Followed by Distraction Osteogenesis Versus Distraction Osteogenesis Followed by Arthroplasty in the Management of TMJ Ankylosis: A Comparative Study.

AIM: To compare treatment outcome of arthroplasty followed by distraction osteogenesis (AFD) and distraction osteogenesis followed by arthroplasty (DFA) in the management of mandibular deficiencies in temporomandibular joint (TMJ) ankylosis. MATERIALS AND METHODS: A total of 20 patients with TMJ Ankylosis were included in the study. Patients were randomly divided into two groups. Group 1 consisted of patients for whom arthroplasty was done prior to distraction osteogenesis (AFD) for the correction of deficient mandible. Group 2 included patients where distraction osteogenesis was performed prior to arthroplasty (DFA). The treatment outcome was assessed based on maximum interincisal distance, overjet, corpus length, ramus height, upper airway, lower airway, duration of the procedure and the complications for the treatment at the end of 3, 6 and 12 months. RESULTS: After the treatment was ended, the patients of both groups had increase in mouth opening and appearance was improved remarkably. There was general increase in all the parameters in both the groups. But at the end of 12 months, airway and the ramus height were more stable and the control of the proximal segment was superior in DFA group. Open bite was noticed in 2 cases of AFD group which was treated by elastics. There required additional surgery for the removal of distractors in the AFD Group. Establishing the airway during the surgery was easier in AFD group. CONCLUSION: The study concludes that distraction followed by arthroplasty was a better procedure for the management of TMJ ankylosis owing to its stable results and less number of surgeries.

A cut-off value of third molar maturity index for indicating a minimum age of criminal responsibility: Older or younger than 16 years?

Providing appropriate legal mechanisms, that evaluate the progression of development from the age of childhood innocence to maturity and full responsibility, considered one of the difficult areas of criminal justice policy. The minimum age of criminal responsibility (MACR) in children varies among countries and differs widely owing to history and culture. Due to rising and brutality of criminal offenses, particularly by juveniles, few countries have lowered the minimum age of criminal responsibility, and many have considered/considering to do the same. India is one such country in which is under the proposal of lowering the age of criminal responsibility to 16 years. As there is lack of useful age assessment methods, that can indicate whether if the individual in question is younger (<16 years) or older than MACR (≥16 years), the present study was undertaken to derive a specific cut-off value of the third molar maturity index (I3M) for this purpose. The sample consisted of 1078 orthopantomograms (OPTs) from Andhra Pradesh, India, aged between 11 and 20 years (45.4% males and 54.6% females). The reproducibility of I3M was calculated by intra-class correlation coefficients, which showed an intra-rater and inter-rater agreement of 0.912 and 0.891, respectively. The sample was divided into training dataset (819 OPTs), to test I3M and gender as independent variables and MACR as a dependent variable by logistic regression analysis, and test dataset (259 OPTs). A receiver operating curve (ROC) analysis was performed to evaluate the specific cut-off value of I3M for predicting MACR status. A logistic regression analysis showed that gender was not statistically significant for predicting MACR status while ROC analysis indicated a cut-off value of I3M = 0.293 as best for predicting MACR status. The performance of derived cut-off value was tested in a test data set. The sensitivity of the test was 90.6% and 90%, while specificity was 86% and 87.1% in males and females, respectively. The proportion of correctly classified individuals was 88.0% and 88.7% in males and females, respectively. The estimated Bayes post-test probability in males was 87.2% and while in females it was 88.3%. The results highlight the contribution of the derived cut-off value of I3M for discriminating individuals around MACR and should be evaluated in other populations.

Comparative Analysis of Intravenous Midazolam with Nasal Spray for Conscious Sedation in Minor Oral and Maxillofacial Surgeries.

AIM: The aim of the current study was to evaluate the efficacy of nasal spray midazolam by collating it with conventional intravenous midazolam for conscious sedation in minor oral surgeries. MATERIALS AND METHODS: Sixty patients were selected randomly and divided into two groups: group A for intranasal midazolam atomized spray (n = 30) and group B for intravenous midazolam (n = 30). Physiological parameters, anxiety score, sedation rating, patient's cooperation score, and retrograde and anterograde amnesia were recorded for each patient during preoperative, intraoperative, and postoperative period. Final evaluation of safety and efficacy in the nasal and intravenous routes of midazolam drug during minor oral surgery was compared. RESULTS: In this study, both intranasal and intravenous groups showed decrease in systolic blood pressure and diastolic blood pressure intraoperatively but within physiological limits and increase in the average pulse rates in both the groups. The average oxygen saturation levels were maintained to normal range in both the groups. The average respiratory rate decreased in both intranasal and intravenous groups during surgical procedure. The preoperative to postoperative anxiety scores were decreased significantly in the both groups and there was no significant difference in pre- to postoperative anxiety scores between the groups. CONCLUSION: Both intravenous and intranasal administration of midazolam showed better patient cooperation, satisfaction, and clinical effectiveness. Intranasal midazolam spray is effective in the reduction of subjective stress, reliable anxiolysis while preserving protective reflexes.

Transport Distraction Osteogenesis in Reconstruction of Condyle: Use of a 3D Model for Vector Planning.

INTRODUCTION: The temporomandibular joint (TMJ) is a complex joint, and it allows bilateral synchronous rotatory and translatory movements. TMJ reconstruction has evolved as an important step in the management of conditions affecting the TMJ like ankylosis, traumatic injuries and congenital deformities. Distraction osteogenesis (DO) is a biological process of forming new bone and adjacent soft tissues by gradual and controlled traction applied on osteotomized bone segments. CASE REPORT: Here is a case report of bilateral TMJ ankylosis which was managed effectively by resection of ankylotic mass and reconstruction of TMJ by transport distraction osteogenesis with preoperative vector planning using a 3D printed model. CONCLUSION: Distraction osteogenesis can be considered as an effective means of condylar reconstruction for an anatomical and functional TMJ with minimal complications. Use of 3D models can help making such complex TMJ reconstruction procedures simpler.