Challenges and Solutions in Clinical Workflow for the Rehabilitation of Completely Edentulous Patients Through CAD/CAM Dentures: A Case Study.

In the field of removable prosthodontics, computer-aided design and computer-aided manufacturing (CAD/CAM) have become widely recognized. The traditional method, which uses heat-polymerized resins for injection or compression molding, necessitates up to five patient visits and laborious laboratory processes. A digital workflow combined with a CAD/CAM methodology can provide prompt prosthesis delivery for patients with time constraints. This article's goal is to outline the steps and the limitations in the fabrication of digital dentures as well as the challenges, limitations, and solutions developed while developing a clinical workflow for the rehabilitation of completely edentulous patients with the CAD/CAM System.

Developing an instructional module of 'digital dentistry' for undergraduate prosthodontics curriculum.

Purpose: To prepare a module on 'Digital Dentistry", which can be used to sensitize dental undergraduate students during their final year Prosthodontics curriculum. Methods: Ethical approval (167/Ethics/2022) was taken from the Institution before starting the study. Need assessment was achieved using focused group discussion (Online Zoom meeting) of various stakeholders of the Department of Prosthodontics of the institution. A preliminary module content was prepared in google questionnaire form after thorough literature review by the research team and final content was developed using modified Delphi technique in 3 questionnaire rounds with the help of 27 experts. Result: Thematic analysis of Need Assessment focussed group discussion led to the emergence of both theoretical and practical aspect of learning in digital dentistry. The final module was developed with the process followed in modified Delphi technique. Conclusion: Within the limitations of the study the module of Digital dentistry was developed which can be implemented in most of the dental institutes depending on the resources and available infrastructure.

Evaluation of dimensional stability, compressive resistance, and detail reproduction of thermoplastic resin (BDIMPRESS), elastomeric and composite bite registration material: An in vitro study.

Aim: The fabrication of an accurate prosthesis depends mainly on precise recording of the maxillo-mandibular relationship of the patient and transferring it to the articulator. BDIMPRESS is a new thermoplastic material that has been proposed as a potential material to be used as an inter-occlusal registration, but there has been no literature evidence regarding its application as a bite registration. The main purpose of this study is to evaluate and compare the dimensional stability, detail reproduction, and compressive resistance of new interocclusal recording material with other two commonly used materials. Settings and Design: In Vitro Comparative study. Materials and Methods: The study was conducted according to ADA Specification standards of testing for dimensional stability, detail reproduction and compressive resistance. Specimens were prepared for three different materials (Thermoplastic resin, Polyvinyl siloxane, and Bis- acrylic) with 12 samples each. Statistical Analysis Used: One way ANOVA was done for statistical analysis. Results: Polyvinyl siloxane material was dimensionally stable (mean at 1 hr: 24.928 mm; 24 hrs: 24.919 mm & 48 hrs: 24.912 mm) followed by Bis- acrylic material (mean at 1 hr: 24.851 mm; 24 hrs: 24.825 mm & 48 hrs: 24.815 mm). On one way ANOVA, strong significance was observed between groups (P = 0.00). Thermoplastic resin showed higher amount of detail reproduction with 10 (out of 12 samples) samples showing satisfactory results. While bis- acrylic material showed the least compressive resistance (Strain %: 0.484%; Displacement- 0.0990mm). One-way ANOVA showed presence of significance between the groups (P = 0.024). Conclusion: Polyvinyl siloxane showed superior dimensional stability, thermoplastic resin showed better detail reproduction and bis- acrylic showed high resistance to compression over other materials.

Effect of silver diamine fluoride, potassium nitrate, and glutaraldehyde in reducing the post vital tooth preparation hypersensitivity: A randomized controlled trial.

Aim: Hypersensitivity is the most common clinical problem which is encountered by most of dental patients undergoing a vital tooth preparation for a fixed crown prosthesis. The aim of this study is to evaluate the effect of silver diamine fluoride, potassium nitrate, and glutaraldehyde in reducing dentinal hypersensitivity following vital tooth preparation. Settings and Design: This study is a randomized control trial performed on 119 teeth of 68 patients who are in need of fixed prosthesis treatment. Materials and Methods: After a thorough clinical examination, patients were allocated into any of the randomly assigned four groups (Control, silver diamine fluoride, potassium nitrate, and glutaraldehyde) and the level of hypersensitivity was measured by blasting air on the surface of tooth at five different intervals (before preparation, after preparation, after application of desensitizers, before cementation and after a follow up period of about 30 days) and is graded using Schiff 's cumulative hypersensitivity index. Statistical Analysis Used: Kruskal wallis test is used to compare the rate of sensitivity between the 4 groups. Friedman and Wilcoxon test is used to compare the rate of sensitivity at 5 different intervals. Results: All the desensitizers used in this study reduced the level of hypersensitivity. Among which, silver diamine fluoride was found to be more effective after application, before cementation, and after a follow up period of about 30 days followed by GLUMA and potassium nitrate. Conclusion: The results of this study suggest that silver diamine fluoride was found to be more effective after application, before cementation of the definitive prosthesis and after a follow up period of 30 days.

A Journey toward Immediate Denture: Overcoming Bitter Reality with Psychotherapy.

The loss of teeth affects the aesthetics, function (mastication and speech), confidence, mental state, and the overall quality of life of an individual. Aggressive periodontitis is a destructive condition leading to loss of teeth at early stages of the disease. Individuals facing this inevitable condition of losing the teeth and replacement at a younger age experience formidable psychological distress. The prosthodontic procedure when supported with psychotherapeutic interventions can support the patient in accepting the prognosis and treatment. We report the scenario where psychological intervention was provided in a systematic manner adopting the SPIKES protocol for a 42-year-old man presenting with aggressive periodontitis.

COVID-19 Pandemic-Frontline Experiences and Lessons Learned From a Tertiary Care Teaching Hospital at a Suburban Location of Southeastern India.

The key challenges to any health care setup during emergency situations, such as that of the COVID-19 pandemic would be to rapidly address hospital preparedness and response tailored to the local population, societal influences, political factors within the existing infrastructure, and workforce. Second, to adopt and moderate policies, standard operating procedures (SOPs) and guidelines issued by national and international agencies, such as WHO, CDC, and the Indian Council for Medical Research (ICMR) were tailor-made to the local conditions of the hospital and community. In this publication, we have discussed the challenges and experiences in preparation and responses to the ongoing COVID-19 pandemic at a tertiary teaching hospital situated at a suburban locale in a small union territory. Puducherry is located in the South Eastern Coromandel Coast of India. The core processes, such as hospital preparedness, adoption, and amendments to SOPs based on dynamic changes in guidelines released by the central and local government, training given to health care workers, setting up the in-house diagnostic facility, surge capacity, management of supplies during the lockdown, infection prevention, and control and patient care are discussed. We have also reinforced our experiences in translating COVID-related opportunities for research and innovation in the form of awards and research proposals for the faculty and students of our institute. The lessons learned in terms of strength and limitations on the ground level of public health during this process is worth sharing as it would provide guidance in preparing the health care setups for pre- and post-pandemic.

Potential biomarkers for the early prediction of SARS-COV-2 disease outcome.

The current pandemic due to the fast spreading of SARS-CoV-2 infection has caused severe impairment in health, social, economic, scientific, and medical sectors across the globe. Owing to the not so well understood mechanism of disease pathogenesis in terms of variations in immune responses, there remains obscure why some of the patients who are infected by the novel SARS-CoV-2 develop an unpredictable clinical course that rapidly causes severe and deadly complications/manifestations. Currently, several assays are available for the confirmation of SARS-CoV-2 infection at the point of care. However, none of these assays can predict the severity of the COVID-19 disease. Thus, the identification of a prognostic biomarker that forecasts the condition of SARS-CoV-2 patients to develop a severe form of the disease could enable the clinicians for more efficient patient triage and treatment. In this regard, the present review describes the role of selected biomolecules that are crucially involved in the immune-pathogenesis of SARS-CoV-2 infection such as hyper-immune responsiveness, bradykinin storm and vascular leakage assuming these may serve as an effective prognostic biomarker in COVID-19 to understand the outcome of the disease. Based on the review, we also propose the development of a cost-effective SERS-based prognostic biosensor for the detection and quantification of biomolecules for use as a point-of-care system during a disease outbreak.

Correlation of Vertical Dimension of Occlusion in Parents and Their Offspring: A Cephalometric Study.

BACKGROUND: Establishment of optimal vertical dimension of occlusion (VDO) for prosthetic patients, either complete denture or fixed full mouth rehabilitation, is a vital step to discern at a pleasing esthetics and harmonious function. None of the experiments in the literature studied the hopeful inheritance of the VDO from a parent to offspring. PURPOSE: The aim of this study was to establish the dominant mode of inheritance of VDO from parents to offspring using cephalometric landmarks. MATERIALS AND METHODS: Following the inclusion criteria, 20 families were selected and explained about the study design. Individual cephalograph of father, mother, and offspring were traced out of bony landmarks. The reference planes were delineated for the measurements from maxillary incisal (I) tip and mesio-palatal cusp tip of maxillary first molar (M) to palatal (PP) and inter-foramina (IFP) planes. RESULTS: In all the distances measured, there exists a statistically significant difference between both father and son and mother and son. For the measured IPP, MPP, and IIFP distances, there is no statistically significant difference existed between father and daughter. However, in MIFP distance, there is a significant difference between father and daughter. Except for the IIFP distance between mother and daughter (P = 0.08), in all other measured distances, there existed a statistically significant difference. CONCLUSION: There is no dominant mode of inheritance from the parent to the son with respect to the measured parameters. Inheritance was observed to be stronger between father and daughter than between mother and daughter.

MATLAB Simulation of UPQC for Power Quality Mitigation Using an Ant Colony Based Fuzzy Control Technique.

This paper proposes a fuzzy logic based new control scheme for the Unified Power Quality Conditioner (UPQC) for minimizing the voltage sag and total harmonic distortion in the distribution system consequently to improve the power quality. UPQC is a recent power electronic module which guarantees better power quality mitigation as it has both series-active and shunt-active power filters (APFs). The fuzzy logic controller has recently attracted a great deal of attention and possesses conceptually the quality of the simplicity by tackling complex systems with vagueness and ambiguity. In this research, the fuzzy logic controller is utilized for the generation of reference signal controlling the UPQC. To enable this, a systematic approach for creating the fuzzy membership functions is carried out by using an ant colony optimization technique for optimal fuzzy logic control. An exhaustive simulation study using the MATLAB/Simulink is carried out to investigate and demonstrate the performance of the proposed fuzzy logic controller and the simulation results are compared with the PI controller in terms of its performance in improving the power quality by minimizing the voltage sag and total harmonic distortion.

Influence of Full Veneer Restoration on Fracture Resistance of Three Different Core Materials: An Invitro Study.

AIMS AND OBJECTIVES: One of the factor which affects the strength of the tooth restored with core material is the property of the material. In clinical situation all such restored teeth are protected by crowns. This study evaluated the strength of different core materials on a compromised tooth structure after restoration with a crown. MATERIALS AND METHODS: Seventy extracted intact human premolars were collected and mounted within a mould using auto-polymerizing resin. The teeth were divided in-to four groups - A, B, C and D. Each group contained 20 teeth except group A with 10 teeth. All the teeth were prepared for full veneer cast crown. Except for the teeth in group: A) extensive class-I cavities were prepared in the teeth of all the groups and restored with; B) composite resin, 3M EPSE Filtek P60; C) Silver reinforced glass ionomer, SHOFU Hi Dense XP and; (D) Resin reinforced glass ionomer, GC Gold Label light cure GIC. All the teeth were restored with cast-metal alloy and exposed to 1.2 million cycles of cyclic loading in a chewing simulator. Subsequently, the teeth that survived were loaded till fracture in the universal testing machine. Fracture loads and type of fractures were recorded. RESULTS: All the specimens survived cyclic loading. The mean fracture strength of the silver reinforced glass ionomer was greater with and without crown (p<0.001). Statistical analysis for the mean fracture load of each specimen showed significant difference between the groups. CONCLUSION: Under the condition of this study, core materials when restored with artificial crown had a significant increase in fracture resistance.

A newer technique to program a semi adjustable articulator.

INTRODUCTION: The difficulty in reproducing accurate angle of condylar guidance in semi-adjustable articulators. PURPOSE: The purpose of this study was to determine the correlation between the angle of horizontal condylar inclination obtained on a semi-adjustable articulator and the corresponding angle traced on a temporomandibular joint (TMJ) radiograph in completely edentulous subject. MATERIALS AND METHODS: The horizontal condylar inclination angle was obtained in a semi-adjustable articulator by means of height tracer (extra oral tracing device) and interocclusal records to program the articulator in 21 subjects. TMJ radiograph were recorded by the same operator with same orthopantomogram (OPG) machine (planmeca). Tracings of inclines of articular eminence on the radiograph were compared with the angle obtained on a semi-adjustable articulator. Each measurement was made using manual methods of measuring angle. The results were subjected to the Pearson correlation statistical analysis (α =0.01). RESULTS: The outline of the articular eminence in a TMJ tomogram radiographic image was identified and traced. A significant correlation was found between the horizontal condylar inclination on a semi-adjustable and the corresponding TMJ tomogram radiographic image for both right (R = 0.789; P = 0.001) and left (i = 0.747; P = 0.004) sides. CONCLUSION: The articular eminence traced on a TMJ tomogram image represents the horizontal condylar inclination with a mean difference of 5° in 21 subjects evaluated.