Comparing color match by conventional trial and error method with maxillofacial spectrophotometer method for the skin of Indian participants: A subjective and objective assessment.

STATEMENT OF PROBLEM: The comparative accuracy of different color-matching methods for maxillofacial prostheses is lacking. PURPOSE: This clinical study aimed to compare prosthesis color matching using the conventional trial and error method with that using the maxillofacial spectrophotometer method. MATERIAL AND METHODS: Fifty-four Indian participants were enrolled based on skin color and divided into Light, Medium, and Dark groups (n=18). Silicone specimens of different thicknesses were fabricated using both the conventional trial and error and maxillofacial spectrophotometer coloration methods for all participants. The color match of the specimens with natural skin was assessed subjectively and objectively using expert consensus and fiber optic spectroscopy with the CIELab color difference formula, respectively. Statistical analyzes included the Shapiro-Wilk and independent sample t tests (α=.05). RESULTS: The mean ΔL* (white-black axis) value for the Skin-Conventional color match difference was significantly lower and positive compared with the Skin-Spectrophotometer match (P=.090) for the sample. The mean Δb* (yellow-blue axis) value for the Skin-Conventional color difference was significantly positive compared with the Skin-Spectrophotometer match (P=.020). The mean ΔE* (color difference) for the Skin-Conventional color match was significantly lower than the Skin-Spectrophotometer value (P=.034). Expert opinion as assessed with a visual analog scale found color matching using the conventional method (7.12) to be significantly better than with the spectrophotometer (6.30). A qualitative analysis of expert opinion revealed that conventional color matching should have been less red (34.3%) and that spectrophotometer matching should have been less yellow (30.1%). CONCLUSIONS: Across different thicknesses of silicone and Indian skin shades, color matching was significantly better for the conventional versus the maxillofacial spectrophotometer method, both objectively and subjectively. The spectrophotometer match was significantly yellower and lighter than natural skin.

Associations among gene polymorphisms, crestal bone loss, and bone mineral density in patients receiving dental implants.

Objectives: Interleukin 1 (IL-1) and interleukin 6 (IL-6) gene polymorphisms have been suggested to be responsible for diminished bone mineral density (BMD) and high crestal bone loss (CBL) in some individuals. However, the effects of systemic BMD on variations in peri-implant CBL are unclear. Hence, this study was aimed at investigating the association of IL-1 and IL-6 gene polymorphisms with systemic BMD and CBL around dental implants. Methods: A total of 190 participants undergoing dental implantation in the mandibular posterior region were selected according to predetermined selection criteria and divided into a normal BMD group (NBD, 93 participants, T-score ≥ -1) and low BMD group (LBD, including both osteoporosis and osteopenia, 97 participants, T-score < -1 standard deviation) according to the BMD of the right femoral neck, measured with dual-energy X-ray absorptiometry. Dental implants were placed through the standard surgical protocol, and CBL was calculated after 6 months with cone beam computed tomography scans before second-stage surgery. Genotyping was performed on all participants for IL-1A-889 A/G, IL-1B-511G/A, IL-1B+3954, and IL-6-572 C/G gene polymorphisms. Results: The demographic and clinical characteristics of the participants in both groups were compared with t-test and chi-square test (χ2). The associations of NBD and LBD with the different genotypes and CBL was determined with odds ratios, and p < 0.05 was considered statistically significant. The frequency of IL-1B-511AA and IL-6-572 GG genotypes was significantly higher in LBD than in NBD (p < 0.05). In LBD, the IL-1B-511 AA (AA vs GA + GG; p ≤ 0.001) and IL-6-572 GG (GG vs CC + GC; p = 0.001) genotypes were significantly associated with higher peri-implant CBL. Conclusions: Individuals with the IL-1B-511 AA or IL-6-572 GG genotype had elevated risk of osteoporosis/osteopenia and were more susceptible to CBL around dental implants.

Effect of calcium and Vitamin D supplementation on residual ridge resorption in edentulous patients: An open-label randomized study.

AIM: Complete dentures (CDs) are fabricated to rehabilitate the edentulous. Severe residual ridge resorption (RRR) compromises CD functionality, adversely affecting function, appearance, systemic health, and quality of life. SETTINGS AND DESIGN: The purpose of this study was to assess the benefit, if any, of calcium and Vitamin D supplementation on the rate of RRR. Retarding RRR would improve treatment prognosis and make CD fabrication less demanding. MATERIALS AND METHODS: This longitudinal, parallel, open-label randomized study was conducted in the Department of Prosthodontics of the institute. One hundred and fifty edentulous subjects underwent bone mineral density (BMD) assessment followed by CD fabrication to measure RR height and width with computerized tomographic (CT) scans. Subjects were randomized to oral supplementation group - S, given combined Vitamin D and calcium daily, and nonsupplementation group - NS. Subjects from both the groups were followed up with repeat BMD test and CT scan after 12 months. Mean BMD, RR height and width, and RRR values were collected, analyzed, and compared for the two groups using STATA 17. STATISTICAL ANALYSIS USED AND RESULTS: Baseline mean T-score, RR height, and RR width were - 1.84, 22.30 mm, and 4.25 mm, respectively, for the sample. In both Groups S and NS, a statistically significant decrease in mandibular RR height (P = 0.000 for both) and width (P = 0.027 and 0.003, respectively) was observed at 1-year follow-up. There was a statistically insignificant difference between Groups S and NS for mean BMD, T-score, RR height and width, and RRR at both baseline and 12-month follow-up. One-year RRR rate for Group S (1.30 mm) was insignificantly lesser than for group NS (1.33 mm). CONCLUSION: Short-term oral calcium and Vitamin D supplementation was ineffective in reducing RRR and improving BMD.

Alarm Signals to Postpone Feeding Plate Fabrication and Nasoalveolar Molding.

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Mechanical failures of dental implants and supported prostheses: A systematic review.

Purpose: Though, mechanical dental implant and supported prosthesis failures are considered significant, a comprehensive evaluation is lacking. A systematic review analyzing different aspects related to such failures was therefore done. Methods: - Electronic search was carried out in PubMed/MEDLINE and Cochrane Library for articles published between 1981 and 2021. Articles were selected using predefined criteria. Data extraction was based on mechanical complications associated with dental implants, prosthetic implant failures, survival rate of implants, mechanical failure of implants placed in the maxilla and mandible, and mechanical complications associated with implant supported over dentures. Quality of included studies was assessed. Meta-analysis for heterogenicity testing, publication bias and implant failure assessment was conducted using MedCalc® Statistical Software version 19.7. Results: - Eighteen retrospective and prospective studies were included following PRISMA guidelines. Mechanical complications were more in the initial 9 years but reduced later. Abutment screw loosening was one of the more common mechanical complications (16.21%). Maxillary implant failure was greater compared to mandibular implant failure with an odds ratio of 4.66 (95% CI -3.21- 6.75). Failure of implant supported overdentures due to mechanical complications were 3% in the fixed effect, and 2.9% in the random effect model (P < 0.05). The overall prevalence of mechanical failure was between 5.6% and 7.7% (P < 0.05). Conclusion: Mechanical failures of implant and supported prosthesis have similar prevalence to biological and esthetic failures, and therefore need to be given due credence. Identifying specific factors contributing to such failures can help reduce incidence.

Half sphere and single clip-bar retained implant supported silicone auricular prosthesis.

Implant supported auricular prosthesis can be retained by several mechanical means, one of them being the Hader bar and clip system. Conventionally two or more rider clips are used. This technique describes a modified Hader bar design to maintain retention while eliminating the requirement of a second clip, significantly bringing down cost.

Association of interleukin-1, interleukin-6, collagen type I alpha 1, and osteocalcin gene polymorphisms with early crestal bone loss around submerged dental implants: A nested case control study.

STATEMENT OF PROBLEM: The reason for variations in peri-implant early crestal bone loss is unclear but may be due to genetic differences among individuals. PURPOSE: The purpose of this nested case control study was to investigate the association of single-nucleotide polymorphisms of interleukin-1, interleukin-6, collagen type I alpha1, and osteocalcin genes to early crestal bone loss around submerged dental implants. MATERIAL AND METHODS: Dental implants were placed in the mandibular posterior region (single edentulous space) of 135 participants selected according to predetermined selection criteria. Bone mineral density measurement by using dual energy X-ray absorptiometry, cone beam computed tomography scans at the baseline and after 6 months, and interleukin-1A-889 A/G (rs1800587), interleukin-1B-511 G/A (rs16944), interleukin-1B+3954 (rs1143634), interleukin-6-572 C/G (rs1800796), collagen type I alpha1 A/C (rs1800012), and osteocalcin C/T (rs1800247) genotyping were performed in all participants. Early crestal bone loss measured around dental implants was used to group participants into clinically significant bone loss (BL)>0.5 mm and clinically nonsignificant bone loss (NBL)≤0.5 mm. Early crestal bone loss was calculated as the mean of the difference of bone levels at the baseline and bone levels after 6 months as measured with cone beam computed tomography scans. The obtained data for basic characteristics, early crestal bone loss, and genotyping were tabulated and compared by using a statistical software program (α=.05). RESULTS: AA genotype and the A allele frequency of interleukin-1B-511 and GG genotype and the G allele frequency of interleukin-6-572 were significantly higher in BL than in NBL (P<.05). Multiple logistic analysis suggested that interleukin-1B-511 AA/GG+AG and interleukin-6-572 GG/CC+CG genotype expression were significantly associated with early crestal bone loss (AA/GG+AG; P=.014, GG/CC+CG; P=.047) around dental implants. Other risk factors were not significantly different (P>.05). CONCLUSIONS: Of the genes studied, individuals with interleukin-1B-511 AA (rs16944) or interleukin-6-572 GG (rs1800796) genotype had higher susceptibility to early crestal bone loss around dental implants.

Guide flange Prosthesis for management of hemimandibulectomy.

Guide flange is given to patients who have undergone surgical hemi/segmental/subtotal mandibulectomy due to various reasons (leading cause being squamous cell carcinoma), with resultant mandibular deviation. If procedures such as secondary osseous grafting are planned, the clinician has to wait for healing of the graft, lesion, or radiotherapeutic effects to abate. Only after the healing of the graft, a definitive prosthesis can be planned. During this time lag, prosthesis must be given to the patient to correct mandibular deviation on account of unilateral muscle pull. Furthermore, in certain cases, a definitive prosthesis has to be put on hold due to failure of bone grafting or when the patient is not willing for a second surgery. This report describes the fabrication of such a mandibular guide flange prosthesis.

Association of interleukin-1 gene polymorphism and early crestal bone loss around submerged dental implants: A systematic review and meta-analysis.

Aim: Early crestal bone loss (ECBL) has been observed regardless of the absence of possible etiologic factors for bone loss during the healing phase and before the second-stage implant surgery. The purpose of this systematic review and meta-analysis was to correlate the possible association of interleukin-1 (IL-1) gene polymorphisms and ECBL (bone loss before the second-stage surgery) around dental implants. Settings and Design: Systematic review and meta-analysis following PRISMA guidelines. Materials and Methods: Considering the inclusion criteria, an electronic search by using specific keywords of three databases PubMed [("Dental" OR "oral") AND ("Implants*") AND ("gene polymorphism" OR "genotype" AND ("IL-1" OR "interleukins")], Cochrane library [implant AND (biomarker or cytokine), interleukin-1 or IL-1 AND implants], and EMBASE [("gene polymorphisms"/de OR "interleukins"/cytokine exp OR "biomarker":ti,ab,kw) AND ("dental implantation"/de OR "oral implant")] and manual search from 1995 till March 2020 was made by 2 independently calibrated reviewers. ACROBAT-NRSI, Version 1.0.0 and Review Manager, Version 5.3, computer software were used for the risk of bias assessment and to conduct the meta-analysis respectively. Statistical Analysis Used: Cochran's Q test and I2 statistics. Results: Of 38 articles which were found eligible for full-text screening, two articles fulfilled the inclusion criteria and hence were included in the meta-analysis. The I2 statistic and Q-test values of the included studies revealed acceptable homogeneity for studied three IL-1 gene polymorphisms (IL-1A-889: I2 = 0%, IL-1B - 511: I2 = 0%, IL-1B+3954: I2 = 24%). Forest plot of association between IL-1B-511 gene and ECBL revealed a significant association between 2/2 genotype of IL-1B-511 gene and an increased risk of ECBL (OR = 0.23, 95% CI = 0.09-0.58, Pheterogeneity = 0.68, I2 = 0%, and P = 0.002). Results of the IL-1A-889 and IL-1B+3954 gene revealed no significant associations between any genotype of these genes with risk of ECBL. Conclusions: There is an evidence of the association of IL-1B-511 (2/2) genetic polymorphisms and increased ECBL in the individuals of Asian ethnicity (OR = 0.23, P = 0.002).

Acquired partial auricular defect rehabilitation aided by four-part mold technique and spectrophotometer.

Patients with auricular defects benefit greatly by an ear prosthesis. However, during the fabrication of auricular prosthesis, difficulties can be faced in obtaining a satisfactory outcome, such as tearing of the prosthesis, fracture of the mold and poor color matching. An 18 year old male lost part of his left auricle in an assault and battery because of which the patient was suffering from adverse psychosocial impact. Surgical reconstruction was ruled out because of patient's desire and financial constraints. Partial auricular prosthesis using four part mold technique and spectrophotometer was fabricated leading to a desirable outcome. Four part mold technique prevented fracture of mold and made retrieval of prosthesis easier. Spectrophotometer reduced the duration of patient visit and the artistic skill required for colour matching in tral and error method.

Mechanically retained functional prosthetic rehabilitation of partial lip necrosis: A rare clinical report.

Prosthetic rehabilitation plays a crucial role in restoring patients with facial defects to normalcy. Although comprising a small proportion, lip defect plays a pivotal role in drastically diminishing the quality of life of the patient, both functionally and socially, with dwindling confidence and self-esteem. Patients may experience speech impairment, uncontrolled drooling, and unesthetic appearance. In addition, constant exposure of tissues to air leads to drying and crusting of lips. This rare case report of a patient with partial lip necrosis describes her functional, mechanically retained prosthetic rehabilitation, which improved phonetics, esthetics, and function without the need of additional retentive features, increasing convenience and ease of use by the patient and at the same time cutting down cost.

Cerrobend shielding stents for buccal carcinoma patients.

Buccal carcinoma is one of the most common oral malignant neoplasms, especially in the South Asian region. Radiotherapy, which plays a significant role in the treatment of this carcinoma, has severe adverse effects. Different types of prosthesis may be constructed to protect healthy tissues from the adverse effects of treatment and concentrate radiation in the region of the tumor mass. However, the technique for fabrication of shielding stent with Lipowitz's alloy (cerrobend/Wood's alloy) has not been well documented. This article describes detailed technique for fabrication of such a stent for unilateral buccal carcinoma patients to spare the unaffected oral cavity from potential harmful effects associated with radiotherapy.

Interdisciplinary approach for somatoprosthetic rehabilitation of a patient with clino-syndactyly and unusual dermatoglyphics.

BACKGROUND: Traumatic injuries are the most common cause of finger amputations. Therapeutic amputations are less common but may be essential in some patients with congenital malformations of digits. CASE DESCRIPTION AND METHODS: A 21-year-old female patient reported for esthetic management of malformed middle and ring finger of right hand. Examination revealed clino-syndactyly with unusual dermatoglyphics. She was successfully rehabilitated by collaborative efforts of plastic surgeon and prosthodontist, by therapeutic amputation with surgical recontouring and fabrication of somatoprosthesis. FINDINGS AND OUTCOMES: The patient was satisfied with esthetics of the prosthesis and somatoprosthesis improved function. At 6-month recall, no alterations or repair of prosthesis was required. CONCLUSION: Individualized treatment planning with integration of modifications involving a multidisciplinary approach is required to meet needs of patients with congenital digital malformations. The duplication of unusual dermatoglyphics made the prosthesis more realistic. CLINICAL RELEVANCE: An individualized treatment plan with modifications to conventional techniques is required to cater to rehabilitative needs of patients with congenital digital malformations.

Incorporation of a vacuum-formed polyvinyl chloride sheet into an orbital prosthesis pattern.

Pattern formation is the most difficult and demanding step in the fabrication of a facial prosthesis. Traditionally, the pattern fabrication of an orbital prosthesis begins with the adaptation of softened base plate wax on the cast, over which the entire pattern is fabricated. However, owing to the inherent properties of wax, such as distortion and stress relaxation, incorporating discrepancies in the pattern adaptation is likely. This article describes a vacuum-formed polyvinyl chloride sheet to fabricate a durable, distortion-free base for pattern fabrication, thereby overcoming the drawbacks associated with a wax base.

A pilot study to compare patient perception of obstructive sleep apnea treatment with CPAP or appliance therapy.

STATEMENT OF PROBLEM: The continuous positive airway pressure (CPAP) device yields optimum results in treating mild to moderate obstructive sleep apnea (OSA). However it may be bulky, noisy, and difficult to sleep with for the patient. Mandibular advancement devices (MAD) have shown better compliance but at the expense of lesser efficiency. PURPOSE: The purpose of this study was to evaluate the patient's posttreatment subjective perception of the effectiveness of 2 common treatments of OSA. MATERIAL AND METHODS: Thirty-two patients diagnosed with OSA filled out the Epworth Sleepiness Scale and Berlin Sleep Quality Questionnaire before treatment and again at 4 to 6 weeks after treatment. Two groups were formed (n=16 each); one group was treated with MAD and the other with CPAP. The data obtained were recorded and compared with the Mann Whitney U test (between groups) and the Wilcoxon signed rank test (within groups) (α=.05). RESULTS: The analysis showed that the participants perceived significant posttreatment improvement (P<.05) for all variables of the Berlin Sleep Quality Questionnaire and the Epworth Sleepiness Scale for both the MAD and CPAP groups. CONCLUSIONS: According to the questionnaires, participants perceived significant improvement in OSA symptoms after treatment in both the MAD and CPAP groups. The study was inconclusive as to whether improvement of perceived symptoms was higher with MAD or CPAP.