Digital fabrication of customized intraoral appliances for head and neck radiotherapy.

Introduction: The radiotherapy received by head and neck cancer patients commonly has adverse effects on oral tissue and the muscles of mastication. This short communication describes the digital fabrication of intraoral appliances for radiotherapy and muscle exercises. Methods: Three patients diagnosed with tongue squamous carcinoma were treatment-planned for radiotherapy using different radiation techniques. The patients were referred for oral scanning and digital bite records, and the appliance was collaboratively designed by a radiation oncologist, dentist, and laboratory technician. The appliance covered the occlusal surface of the remaining teeth with a 1-mm engagement. The lingual plate was 2-mm below the occlusal plane, and extended 4-mm distally, and the jaws were opened by 20-mm. The appliances were printed overnight using a rigid and biocompatible 3D printing material. Results: Requiring minimal chair-time, the appliance was easily inserted and adjusted to comfortably fit in the mouth. The patients were trained to insert it themselves. The tongue was at a pre-determined position during daily radiotherapy, and the healthy tissues were separated from the radiation field. The patients had mild adverse effects on their oral mucosa. Additionally, the appliances were used for muscle exercises after the radiation courses to prevent trismus. Conclusions: The interprofessional collaboration to fabricate customized intraoral appliances using digital workflow to maximize patients' benefits is feasible. Clinical significance: The use of intraoral appliances is potentially increased when the fabrication process is facilitated. Using an intraoral appliance precisely targets the tumor are for better treatment outcomes, and the healthy adjacent tissues will be preserved to maintain the patient's quality of life.

The effect of fiber dowel heights in resin composite cores on restoration failures of endodontically treated teeth.

In vitro and in vivo testing suggest that fiber posts may reduce the incidence of root fractures of endodontically treated teeth. The purpose of this in vitro study was to compare the effect of fiber post height in resin composite cores on the fracture resistance of endodontically treated teeth. Forty maxillary central incisors were randomly divided into 2 control groups (Groups 1 and 2) of 5 teeth each, and 3 experimental groups (Groups 3, 4, and 5) of 10 teeth each. The teeth in Group 1 had their opening restored with composite resin, the teeth in Group 2 were restored with quartz fiber posts without resin composite cores, and the teeth in Groups 3, 4, and 5 were restored with quartz fiber posts of 2, 4, and 6 mm high, respectively, in 6-mm resin composite cores. Ceramic crowns were fabricated for the specimens. Specimens were positioned in a mounting device and aligned at a 130-degree angle to the long axis of each tooth. A universal testing machine was used to apply constant load at a crosshead speed of 0.5 mm/min until failure occurred. The highest fracture load and mode of failure of each specimen was recorded. The highest fracture resistance force was observed in Group 2 (290.38 +/- 48.45 N) and decreased, respectively, in Group 1 (238.98 +/-26.26 N), Group 5 (228.35 +/-58.79 N), Group 4 (221.43 +/-38.74 N), and Group 3 (199.05 +/-58.00 N). According to one-way analysis of variance (ANOVA) and Duncan's test (P < or = .05), there was no statistically significant increase in the force from Group 3 to Group 5, and the force in Group 2 was significantly higher than that of the experimental groups. There was no statistical significance difference in force among the experimental groups, and the amount of residual tooth structure was found to be the critical factor in fracture resistance. The results suggest that endodontically treated teeth should be restored with the longest possible post height while preserving maximum tooth structure.

The effect of compressive cyclic loading on retention of a temporary cement used with implants.

Masticatory forces cause fatigue to cement-retained crowns and abutments and may adversely effect retention. The relation between the number of load cycles and the retentive forces is important. This study evaluated the effect of compressive cyclic loading on the retentive forces of a temporary cement used to retain implant crowns and the relationship between load cycles and retentive forces. Ten castings and implant abutments were cemented with zinc oxide-eugenol temporary cement. The retentive force necessary to dislodge the casting from the abutment was determined before and after the application of 2 Hz of vertical off-axis 3-mm sinusoidal-type compressive cyclic loading between 20 and 130 N for 500000, 1000000, and 5000000 cycles. These forces were equivalent to approximately 6 months, 1 year, and 5 years of human mastication. Data before and after the applied loading were analyzed with a paired sample t test (alpha = 0.05). The retentive forces of the 3 groups were analyzed by 1-way analysis of variance and post hoc by Scheffé multiple comparison (alpha = 0.05). The relation of the loading and the altered retentive forces were analyzed with the Pearson correlation coefficient. Compressive cyclic loading reduced the retentive forces significantly in all groups (P = .000). The retentive forces were reduced 16.75%, 18.73%, and 19.68% during the applied loading cycles of 500000, 1000000, and 5000000. All reduced retentive forces were not significantly different (P = .792). Although cyclic loading reduced the retentive forces, the increased cycles had little relationship (R = 0.119) to the decreased retentive forces of the temporary cement. The relationship between occlusal loading and retentive force can influence the choice of a temporary cement for a particular clinical situation.

The functional and esthetic deficit replaced with an acrylic resin gingival veneer.

Periodontal attachment loss in the maxillary anterior region can often lead to esthetic and functional clinical problems including disproportional and elongated clinical crowns, visible interdental embrasures, and altered linguoalveolar-labiodental consonant production. Assuming fixed prosthetic reconstructions will be chosen to treat these areas, it becomes a hygienic compromise to fill these areas in with porcelain. In the presence of these problems, an acrylic resin gingival veneer is an easily constructed, inexpensive, and practical device to optimize the esthetic and functional outcome in these special situations while permitting cleansibility of the prosthesis and supporting tissues. This article presents a step-by-step technique for the fabrication of a gingival veneer.

Alternative retention for an implant-retained auricular prosthesis.

The introduction of intraoral endosseous implants was inevitably followed by their external use in maxillofacial prosthodontics. Bar and clip attachments provide satisfactory retention for auricular prostheses, although the bar may inhibit patient hygiene by limiting access to the defect area. A simple clinical and laboratory technique to enhance the retention of an implant-retained auricular prosthesis is described, with custom-made stud attachments used for retention. Improved access for hygiene is provided. A clinical case is presented.

Interactions of pigments and opacifiers on color stability of MDX4-4210/type A maxillofacial elastomers subjected to artificial aging.

STATEMENT OF PROBLEM: The color instability and degradation of maxillofacial elastomers limit the function and cosmetic quality of facial prostheses. PURPOSE: The purpose of this study was to measure the interactions of oil pigments plus dry earth opacifiers at 5%, 10%, and 15% by volume in stabilizing the color of MDX4-4210/type A silicone elastomers before and after artificial aging. MATERIAL AND METHODS: In the first part of the study, each of 5 opacifiers (Georgia kaolin powder neutral, kaolin powder calcined, Artskin white, dry pigment titanium (Ti) white, or Ti white artists' oil color) at 10% concentrations were combined with each of 5 oil pigment types (no pigment, cadmium-barium red deep, yellow ochre, burnt sienna, or a mixture of the 3 pigments), for a total of 25 experimental groups of elastomers. In the second part of the study, 50 experimental groups of elastomers were made by combining 1 of 5 opacifiers at 5% and 15% concentrations with 1 of 5 oil pigments as in Part 1. Five specimens of each elastomer were tested, for a total of 375 specimens. In each part of the study, all specimens were aged in an artificial aging chamber. CIE L*a*b* values were measured by a spectrophotometer. The color differences (DeltaE*) were subjected to repeated-measures analysis of variance. Mean values were compared by Tukey-Kramer intervals (alpha = .05). RESULTS: In Part 1, when the opacifiers were tested at 10% concentration, Ti white oil color had the most color change, and dry pigment Ti white had the least; all other opacifiers were not significantly different from each other. In Part 2, at 5%, Ti white oil color had the most color change; all other opacifiers were not significantly different from the others. At 15%, Ti white oil color again had the most color change, followed by Artskin white, kaolin powder calcined, and Georgia kaolin; Ti white dry earth pigment had the least color change. Overall, 5% Artskin white had less color change than the 15%, whereas 15% dry pigment Ti white had less color change than the 5% (P < .001). The 5% and 15% of other opacifiers were not significantly different. CONCLUSIONS: At all 3 concentrations, oil pigments mixed with opacifiers helped protect the MDX4-4210/type A silicone elastomer from color degradation over time. Dry pigment Ti white remained the most color stable over time, followed by the pigments mixed with kaolin powder calcined, Georgia kaolin, Artskin white, and Ti white artists' oil color.

The influence of water storage on durometer hardness of 5 soft denture liners over time.

PURPOSE: This laboratory study investigated the influence of water storage on the durometer hardness of 2 RTV and 3 HTV soft denture liners over a 1-year period. MATERIALS AND METHODS: Five soft denture liners were used: 2 HTV silicone rubber (Luci-Sof and Molloplast-B), 1 RTV silicone rubber (Tokuyama), 1 HTV polyphosphazene (Novus), and an RTV plasticized acrylic (PermaSoft) that uses a surface sealer. They were processed following manufacturers' instructions, cured, and stored in tap water at 37 degrees C. The water was changed every 2 weeks. Five durometer A hardness measurements were made at logarithmically spaced intervals of 16.7 minutes, 27.8 hours, 11.6 days, 34.7 days, 115 days, and 347 days. Repeated measures analysis of variance (MANOVA), one-way analysis of variance (ANOVA), Pillai trace statistic, the difference scores (last-first) among the groups, and the Tamhane T2 multiple comparison test were used to compare the groups over time, all on SPSS V. 7.5 and 9.0. RESULTS: The order of highest initial indentation hardness was Luci-Sof, Molloplast-B, Novus (H(D)= 38 to 33). Tokuyama and PermaSoft as a group were softer (H(D)= 18 to 22). Tokuyama Soft Relining changed the least over 347 days, followed by Luci-Sof, Novus, Molloplast-B, and PermaSoft in that order (p < or = 0.05). Within the PermaSoft group, sealer applied only once changed the least over 347 days, followed by no sealer, and then sealer applied every month (p < 0.0005). CONCLUSIONS: After 347 days of water storage, Tokuyama had the lowest indentation hardness changes, followed by Luci-Sof, Novus, PermaSoft with sealer applied once; Molloplast-B, PermaSoft without sealer; and PermaSoft with sealer applied every month. All HTV soft denture liners had higher indentation hardness than RTV liners initially. After 347 days, PermaSoft without sealer and with sealer every month became the hardest.

A mold-making procedure for multiple orbital prostheses fabrication.

Traditional methods of fabricating orbital prostheses rely on the "lost wax" technique to produce a realistic representation of the sculpted pattern produced in the defect. The usual constituents of the mold that reproduces the subtleties of the palpebral fissure are often minute, making them prone to fracture and subsequent dissolution by repeated attempts at pressing each prosthesis. The following method provides a mold resistant to these problems with light-polymerized resin surrounding the palpebral part of the orbital mold.