Evaluation of active tactile sensibility in a single-tooth implant opposing a natural tooth with either an immediate or delayed functional loading protocol: A parallel design clinical study.

STATEMENT OF PROBLEM: High primary stability makes immediate loading more predictable, but immediately loaded implants are subjected to higher stresses and strains during the healing phase than implants that are left to heal for 3 months. Whether an earlier sensory-motor phenomenon with an immediate loading protocol helps to reduce the risk of overloading at the implant-bone interface is unclear. PURPOSE: The purpose of this concurrent parallel design clinical study was to evaluate and compare active tactile sensibility for a single-tooth implant opposing a natural tooth in the mandibular posterior region with either a delayed or immediate functional loading -protocol. MATERIAL AND METHODS: In this parallel group randomized trial, 2 test groups were formed: the DL group comprised 20 participants with the delayed loading protocol (loading after 3 months), and the IL group comprised 20 participants with the immediate loading protocol (loading within 2 days). Natural tooth-to-tooth contact on the side contralateral to the implant site (split mouth) in both test groups was used as a control to evaluate active tactile sensibility, which was evaluated in the test and control sites of both groups by using interocclusal articulating foils of varying thickness in maximum intercuspation. Active tactile sensibility was compared between the DL and IL groups at 3 and 6 months of follow-up. The nonparametric Mann-Whitney test was used for intergroup comparisons (P=.05). RESULTS: A significant difference was found for 8-µm- and 12-µm-thick articulating foil at 3 months and for 8-µm-thick foil at 6 months (P<.05), indicating a difference in active tactile sensibility between the DL and IL groups. No implant failure was recorded in this short clinical study. CONCLUSIONS: An immediate loading protocol can be performed in implants with sufficient primary stability. Upon loading, the IL group has shown more active tactile perception than the DL group.

Efficacy of Arthrocentesis and Stabilization Splints in Treatment of Temporomandibular Joint Disc Displacement Disorder Without Reduction: A Systematic Review and Meta-analysis.

Background: Temporomandibular joint disc displacement disorders are a group of temporomandibular disorders beside from other inflammatory disorders and growth related disorders of joint. The purpose of this analysis was to evaluate the efficacy of arthrocentesis procedure in comparison with stabilization splints used for disc displacement disorders without reduction. Materials and Methods: A systematic search was done in electronic databases (PubMed, Cochrane Central, Web of Science). In addition to this hand search of references and grey literatures was done. Qualities of randomized controlled clinical trials were assessed by Cochrane's tool for Systematic Reviews of Interventions and the Newcastle-Ottawa Scale was followed to assess the prospective and retrospective studies. Outcome variables pain (VAS) and maximum mouth opening were assessed by the software review manager 5.03. Results: A total of five studies were included in the review. Three studies showed greater improvement of symptoms in patients of arthrocentesis group in terms of maximum mouth opening, pain (VAS) value. Two other studies found no significant advantage of arthrocentesis over the other treatment protocol. The meta-analysis resulted in statistically significant difference between outcome variables favouring arthrocentesis group (VAS 1-10) (Mean Difference: 3.10; 95% CI 1.74, 4.45; P ≤ .00001, Mean difference: 2.00; 95% CI 0.29, 3.71; P = 0.02). Conclusion: Arthrocentesis showed effective result in terms of increase in mouth opening and reduction of pain level compared to stabilization splint and other non-invasive approaches in patients with disc displacement disorders without reduction. Overall, results supported the rationale of using arthrocentesis in patients with disc displacement disorders without reduction.

A comparative evaluation of neurophysiological activity, active tactile sensibility and stereognostic ability of complete denture prosthesis, and implant-supported prosthesis wearer-A pilot study.

AIM: The study aimed to evaluate the effect of implant-supported prosthesis in completely edentulous participants in terms of osseoperception ability, neural activity, and stereognostic ability in comparison to removable prosthetic options. MATERIALS AND METHODS: A total sample of 18 patients, irrespective of gender and age were allocated into three groups according to the three-treatment protocol (upper and lower complete denture, upper complete denture opposing lower implant-retained overdenture, implant-supported fixed prosthesis in both arches). Four weeks after completion of the treatment procedure active tactile sensibility (ATS) was checked by using varying thicknesses (12, 40, 80, 100, 200 µ) of articulating foils and papers. Functional magnetic resonance imaging (fMRI) was performed to record neurophysiological activity in cerebral cortex in all the participants. Various forms of test pieces (heat cure acrylic resin) were used to evaluate stereognostic ability. Data regarding the neurophysiological activity were analyzed by using Krushkal-Wallis test and p ≤ 0.05 was considered to be statistically significant. Data from stereognostic ability test procedure and ATS were compared by using chi-squared test and p ≤ 0.05 was considered to be statistically significant. RESULTS: Statistically significant difference was found in between the articulating foils in terms of true negative responses as the foil thickness increased in participants wearing complete denture in both the arches (p = 0.004) and implant-supported fixed prosthesis in both the arches (p = 0.010). Participants in implant-supported fixed prosthesis group showed significantly more activation in primary motor cortex (right side), somatosensory cortex (left side), angular gyrus (both sides), temporal lobe (left) compared to other groups. No significant difference found in thalamus and premotor cortex region in between the participants of different groups. No statistically significant difference found in between the groups in terms of true responses identifying correct shapes. Mean number of correct responses in stereognostic ability test were 4.16 (83.33%), 3.5 (70%), 3.83 (76.66%) for participants of complete denture group, upper complete denture opposing lower implant retained overdenture group, and implant-supported fixed prosthesis group, respectively. CONCLUSION: Primary motor cortex, somatosensory cortex, and other regions of brain were diffusely activated in participants wearing implant-supported fixed prosthesis in both the arches. Less number of false responses were recorded in participants of implant-supported fixed prosthesis group and upper complete denture opposing lower implant-retained overdenture group in ATS test compared to participants wearing complete denture in both the arches.

Comparative evaluation of biting force and chewing efficiency of all-on-four treatment concept with other treatment modalities in completely edentulous individuals.

AIM: To compare and evaluate biting force and chewing efficiency of all-on-four treatment concept, implant-supported overdenture, and conventional complete denture. SETTINGS AND DESIGN: Invivo - comparative study. MATERIALS AND METHODS: A total of 12 edentulous patients were included in the study and conventional complete dentures were fabricated. Patients were divided into two groups. In Group 1, complete dentures were replaced with implant-supported overdenture, and in Group 2, complete dentures were replaced with hybrid denture supported by all-on-four treatment concept. The biting force was assessed using a bite force sensor and electromyographic recordings were made by electromyogram for masticatory muscles when chewing three different consistencies of foods. STATISTICAL ANALYSIS USED: The data was statistically analyzed using software SPSS version 22.0. Paired t-test was used for intra-group comparison and unpaired t-test was used for intergroup comparison. RESULTS: The difference in biting force and chewing efficiency for all-on-four treatment concept was statistically significant for overdenture and complete denture. The highest biting force and chewing efficiency were observed for all-on-four treatment concept, followed by implant-supported overdenture and complete denture. CONCLUSION: The study concluded that the completely edentulous individuals with atrophic posterior alveolar ridges can be rehabilitated successfully with improved biting force and chewing efficiency by All-on-four treatment concept.

Evaluation of efficacy of platelet-rich fibrin membrane and bone graft in coverage of immediate dental implant in esthetic zone: An in vivo study.

OBJECTIVE: This study compared and evaluated the clinical and radiographic results of guided bone regeneration using platelet-rich fibrin (PRF) and collagen membrane as barrier membrane in immediately placed implants with severe buccal bone defect (with respect to marginal bone level, implant stability quotient [ISQ]), and histological analysis of new bone formation. MATERIALS AND METHODS: Sixteen implants were placed in patients requiring immediate implant placement and having a buccal wall defect and randomly divided into two groups one receiving PRF membranes and other collagen membrane. The sites were grafted with bone-substitute material in both the groups. After 4 months, at the time of second-stage surgery, implant stability is measured by Osstell Mentor, crestal bone level on mesial and distal sides of implant by digital intraoral periapical, buccal defect clinically by probe and histological analysis of biopsied bone. RESULTS: The results were insignificant and comparable in both the groups when comparison was made between the groups. The mean buccal defect, mean values of average ISQ, crestal bone level in both the groups at baseline and after 4 months were compared. No significant difference between both the groups was found after 4 months. Bone quality seemed to be equal in both groups after histological analysis. Within the limits of the study, both the groups had shown similar results in all criteria. CONCLUSION: Within the limitation of the study, it can be concluded that both the treatment modalities are successful in terms of buccal defect reduction, stability, and increase in crestal bone level.

Andrew's bridge system: A boon for huge ridge defect in aesthetic zone.

Tooth loss may pose a challenge for prosthetics when several missing teeth are associated with huge vertical and horizontal bone defects due to cleft palate, road traffic accidents, congenital defects etc. This case report presents prosthetic rehabilitation of a 22 year old male patient of cleft lip and palate with missing upper front teeth along with severe ridge defect since 1 year due to surgical intervention in premaxillary region. The extensive soft and hard tissue defect in aesthetic region was evident and it made the prosthetic rehabilitation more challenging. Among treatment options, fixed partial denture (FPD) was not feasible due to long edentulous span and extensive soft and hard tissue loss. Psychologically, patient was not ready for removable prosthesis. Patient was also not ready for next implant or bone augmentation surgery procedure. The patient presented with Kennedy class IV edentulous area with Seibert's class III ridge defect, so fixed-removable prosthesis was planned to compensate soft and hard tissue defect. The patient with several missing teeth and extensive visible bony defect in the anterior region was successfully rehabilitated using fixed-removable Andrew's bridge system. Although it is not commonly used by dentist so this present case report shows effective management of huge defect case by very simple and conservative technique.

Bone augmentation with sticky bone and platelet-rich fibrin by ridge-split technique and nasal floor engagement for immediate loading of dental implant after extracting impacted canine.

Nowadays, dental implants are the best treatment option for tooth loss, but implant placement requires sufficient bone volume. In defect area of alveolar ridge, augmentation is done by various available methods. Utilizing the growth factors such as platelet-rich fibrin (PRF) derived from patient's blood platelets improve treatment outcome. PRF accelerates the wound healing, enhances osteogenic activity as well as regulates the inflammation. Bone grafting, guided bone regeneration, and ridge-split technique promote new bone formation. The aim of this case report is to demonstrate an efficient method of bone augmentation using sticky bone along with PRF membrane, followed by ridge-split technique and engagement of nasal floor to place implant.

Prosthetic management of post surgical nasal skin graft contracture.

The sequelae of trauma to the nose include nasal deformity and nasal obstruction that can have a long term negative impact on patient's quality of life. Successful management of posttraumatic nasal obstruction relies on a detailed history, careful analysis, and accurate diagnosis. Treatment must balance the seemingly disparate goals of re-establishing structure, improving contour and esthetics, as well as restoring the nasal airway. Indications and technical steps for fabricating bilateral nasal stents are presented, for a case of surgical opening of bilateral nasal synechia necessitated due to failed initial corrective surgery, post contracture and collapse of skin grafts. The objective of nasal stent was to maintain patency of nasal passage post surgical intervention. This is achieved by support to graft and residual tissues and prevention of mouth breathing. The nasal stents were modified post insertion at regular intervals to ensure adaptation to changes in mucosal lining of nasal.

Familial florid cemento-osseous dysplasia: a rare manifestation in an Indian family.

Florid cemento-osseous dysplasia (FCOD) is one of the uncommon dysplasias affecting the maxillofacial region. The age group may vary from 19 to 76 years and typically presents in the 4th and 5th decades. In most cases patients do not have hereditary basis of disease, and only a few familial cases have been documented. As far as we know this is the 1st reported case of familial FCOD in an Indian family. The mother and son exhibited multiple sclerotic masses in both jaws. The mode of transmission appeared to be autosomal dominant with variable phenotypic expression.

Van der woude syndrome associated with hypodontia: a rare clinical entity.

Van der Woude syndrome (VWS) is usually underreported and frequently not diagnosed. The phenomenon that cleft lip and palate are regularly combined in the same pedigree makes it unique. A meticulous examination of a patient with lip pits may reveal a hidden form of a cleft, for example, submucous. This paper presents a case of VWS in a ten-year-old boy with characteristic orofacial features. Special emphasis has also been given on the need for appropriate genetic counseling.

Surgical Management of a Rare Case of Congenital DoubleUpper Lip.

Congenital double lip is a rare developmental anomaly which usually involves the upper lip. It may occur in isolation or as a part of Ascher's syndrome. The occurrence of double lip may result in facial deformity especially when patient attempts to talk, smile, or even try to show the teeth. It affects esthetics and also interferes with speech and mastication. Although surgery may be undertaken to facilitate speech and mastication, majority of cases are operated for cosmetic reasons. A case of congenital double upper lip which was surgically treated for cosmetic reason is reported.

Oral rehabilitation of a patient with sub - total maxillectomy.

This clinical report describes oral rehabilitation of a patient with sub-total maxillectomy with palatine process of maxilla and horizontal plate of palatine bone intact to retain the maxillary obturator. Clinical examination has been performed to know the amount of favorable undercuts to be used for retention of the obturator for better functional efficiency. Successful prosthetic reconstruction of hemimaxillectomy defect is a challenging procedure that requires multidisciplinary expertise to achieve acceptable functional speech and swallowing outcomes. This article describes the oral rehabilitation of a patient with sub-total maxillectomy with a maxillary obturator. Oral rehabilitation of sub-total maxillectomy patient is a challenging task. Obturation of the defect depends on volume of the defect, and positioning of remaining hard and soft tissues to be used to retain, stabilize, and support the prosthesis. A maxillary obturator for edentulous patient must provide for retention, stability, support, patient comfort, and cleanliness.

Evaluation of the effect of different surface treatments on the retention of posts: a laboratory study.

BACKGROUND AND OBJECTIVES: There are numerous post and core systems variety of materials. Several methods are used to increase the retentive strength.The present study was conducted with the purpose of analysis of the effect of surface treatment with ethyl alcohol, resin primer and air-borne alumina particle abrasion on retention of glass fiber posts, carbon fiber posts and cast metal posts MATERIALS AND METHODS: Surface treatment of glass fiber posts, carbon fiber posts and cast metal posts was done with ethyl alcohol, resin primer and air-borne alumina particle abrasion and cemented with dual cure resin cement into the post spaces prepared in the teeth. For the Retentive force test, a screw driven universal testing machine was used to apply tensile load to the post. The force required to dislodge each post from prepared post space was recorded. STATISTICAL ANALYSIS: Comparison of the mean retentive strength was done using two-way Analysis of Variance (ANOVA) followed by Bonferroni method for multiple comparisons. RESULTS: Significant difference in the retentive strength between air borne alumina particle abrasion and resin primer treated posts was (P < 0.001) noticed. Further, there was no significant difference between ethyl alcohol and resin primer treated posts. CONCLUSION: Air-borne alumina particle abrasion increased the retentive strength of all the type of posts used in this study. Treating the surface of the posts with resin-primer and ethyl alcohol produced no statistically significant difference in the retentive strength.