Effectiveness of anterior repositioning splint versus other occlusal splints in the management of temporomandibular joint disc displacement with reduction: A meta-analysis.

BACKGROUND: Disc displacement with reduction (DDwR) is among the common disc disorders of temporomandibular joint (TMJ), which can be managed conservatively by splint therapy. Anterior repositioning splint (ARS) is the most commonly prescribed splint by dental practitioners, but not getting a normal disc-condyle relationship always and other side effects lead to need of comparing with other occlusal splints. This review will help in informed decision-making by clinicians in choosing an appropriate splint type for patients. AIM: The aim is to compare the effectiveness of ARS in the management of DDwR with other occlusal splints for TMJ and muscle pain, TMJ noise, any adverse effects, regaining normal disc-condyle relationship. MATERIALS AND METHODS: We followed published protocol in the International prospective register of systematic reviews. Databases were searched till May 2023 using different search strategies as per the database. Title and abstract screening, followed by full-text screening and data extraction with risk of bias, was done by two independent reviewers in Covidence. Outcomes were reported as risk ratio (RR) or mean difference (MD) for dichotomous or continuous outcomes, respectively, using RevMan 5.4 (Review Manager 5.4) software. We used a random effect model for statistical analysis. Certainty of evidence was assessed using the Grading of Recommendation, Assessment, Development, and Evaluation Guideline Development Tool (GRADEpro GDT) software. RESULTS: A total of 1145 reports were found from a database search. After screening, four studies were included for systematic reviews. Other occlusal splints reported were sagittal vertical extrusion device and mandibular ARS, full hard stabilization splint of canine or centric stabilization type. Data of only two studies could be used for meta-analysis having 30 participants received ARS and 40 received other occlusal splints. We did not find evidence of any difference between ARS and other occlusal splints for TMJ clicking in short term (RR 1.25, 95% confidence interval [CI] 0.91-1.72) but a small difference in favor of other occlusal splint in long term (RR 2.40, 95% CI 1.04-5.55). No evidence of any difference was found between both treatments for TMJ pain in short term (MD-5.68, 95% CI-17.31-5.95) and long term (MD 0.00, 95% CI-2.86-2.86) and muscle pain in short term. The certainty of evidence for comparison of two treatments for different outcomes was of low or very low level. CONCLUSION: Evidence is uncertain that other occlusal splints reduced TMJ clicking slightly in comparison to ARS. For the remaining outcomes, no evidence of any difference was found between the two splints and it may be biased due to selection bias, inadequate blinding of participants, and outcome assessor.

Assessment of craniofacial growth in individuals with ectodermal dysplasia after complete denture rehabilitation: A preliminary study.

Aim: The main purpose was to evaluate the effect of complete denture rehabilitation on the jaw growth pattern in individuals with ectodermal dysplasia from an early age to maturity. Settings and Design: This was a prospective in vivo study performed in the Department of Prosthodontics, King George Medical University, Lucknow, India. Materials and Methods: Rehabilitation with three sets of conventional complete dentures was completed in an ectodermal dysplasia case at the age of 5, 10, and 17 years. Cephalometric and diagnostic cast analyses were the methods performed to evaluate jaw growth patterns. Linear and angular measurements obtained after denture rehabilitation were averaged and compared with mean standard values of nearly corresponding ages, as given by Sakamoto and Bolton. Conversely, alveolar ridge arch width and length were evaluated for their dimensional changes during the same age intervals. Statistical Analysis Used: Mann-Whitney U-test was used to check the difference between the groups. The significance of the level adopted was 5%. Results: Nasion-anterior nasal spine, anterior nasal spine-menton, anterior nasal spine-pterygomaxillary fissure, gonion-sella, and gonion-menton lengths were found to be not statistically significant than the mean standard values of nearly corresponding ages (P > 0.05). The decrease in facial plane angle, increase in Y-axis angle, and mandibular plane angle after complete denture rehabilitation were statistically significant when compared to their mean standard values (P < 0.05). Cast analysis showed more increase in the length compared to the width in both arches. Conclusion: Complete denture rehabilitation did not significantly affect the jaw growth pattern, although it improved facial esthetics and masticatory activity by establishing adequate vertical dimensions.

Evaluation of mandibular advancement device placement based on levels of TNF-alpha in participants with obstructive sleep apnea: A clinical study.

STATEMENT OF PROBLEM: Objective assessments of the effect of mandibular advancement device on patients with obstructive sleep apnea are lacking. PURPOSE: The purpose of this clinical study was to compare levels of serum tumor necrosis factor alpha (TNF-alpha), Epworth Sleepiness Scale score, and Berlin Questionnaire score in patients with mild to moderate obstructive sleep apnea before and after treatment with a mandibular advancement device. MATERIAL AND METHODS: Twenty participants diagnosed with mild to moderate obstructive sleep apnea based on polysomnography testing were enrolled. A custom nonadjustable mandibular advancement device with 70% mandibular protrusion was provided for each participant for management of the obstructive sleep apnea. Evaluation of TNF-alpha levels was performed before treatment (baseline) and 3 and 6 months after starting mandibular advancement device therapy by using a Human TNF-alpha enzyme-linked immunoassay (ELISA) sandwich kit. The Epworth Sleepiness Scale and Berlin Questionnaire were also filled out by the participants at the same time intervals (α=.05). RESULTS: A statistically significant decline in the levels of TNF-alpha was observed at 3 and 6 months compared with baseline (P<.001). The Epworth Sleepiness Scale scores showed a statistically significant reduction at 3 and 6 months compared with baseline (P<.001). The risk of obstructive sleep apnea assessed by using the Berlin Questionnaire was found to be significantly reduced at 6 months compared with baseline (P=.001). CONCLUSIONS: Patients with mild to moderate obstructive sleep apnea showed reduced levels of TNF-alpha and Epworth Sleepiness Scale and Berlin Questionnaire scores when treated with a mandibular advancement device.

Speech intelligibility, nasal resonance, and swallowing ability of maxillectomy patients with customized obturator: A non randomized controlled study.

Aim: To compare speech intelligibility (SI), nasal resonance, and swallowing ability in maxillectomy patients with a customized obturator to the conventional obturator. Settings and Design: Non-randomized controlled study. Materials and Methods: Forty-eight maxillectomy patients were recruited and assessment of SI, nasal resonance, and swallowing ability was done at three situations: without obturator, with conventional obturator, and with customized obturator. Recordings of unrehearsed conversation, counting from number 1-20 and four sets of Chapel Hill Multilingual Intelligibility Test in the Hindi language were used to assess SI and nasal resonance. SI was evaluated by untrained listeners and graded according to a 6-point scale. Nasal resonance was evaluated by speech pathologists on a 7-point scale of severity. Swallowing ability was evaluated by water drinking test. Statistical Analysis Used: One-way ANOVA, Post hoc Bonferroni and Chi square test. Results: SI and nasal resonance showed a statistically significant difference between any two groups (P < 0.001). Water drinking time was significantly different between without obturator and with customized obturator (P < 0.001), but the difference was not statistically significant between without obturator and with obturator (P < 0.004). Conclusion: SI, nasal resonance, and swallowing ability improved with customized obturator in comparison to the conventional obturator.

Obstructive sleep apnea risk for driving license applicants in India - A community based study.

OBJECTIVES: To determine the risk of obstructive sleep apnea (OSA) for male permanent driving license (DL) applicants of Lucknow, India. MATERIAL AND METHODS: In this cross-sectional community based, study body mass index, waist-hip ratio, blood pressure of each subject were determined as an anthropometric parameter along with the history of habit of smoking, tobacco chewing, alcohol consumption. STOP-Bang (Snoring, Tired or sleepy, Observed apnea, high blood Pressure, Body mass index, Age, Neck, Gender) Questionnaire - a scoring risk assessment tool - was applied for assessment of OSA risk (high OSA risk defined by score ≥ 3) for 542 male DL recipients at 2 Regional Transport Office (RTO) centers in Lucknow, India. The statistical software SPSS 17.0 was applied to the testing. RESULTS: In total 23% (N = 125) of participants were found with the risk of OSA. High blood pressure (≥ 140/90 mm Hg) was found for the maximum number of participants (40.5%) followed by neck circumference > 40 cm (17.1%), age (> 50 years old) (15.3%), snoring (12.3%) and tired/sleepy (10.5%). Mean values of age, anthropometric measurements and blood pressure were observed significantly higher (p < 0.001) for participants with the OSA risk. In this population the risk of OSA risk (STOP-Bang score ≥ 3) was observed for 6.7% of young (< 35 years old), 34% of middle (35-45 years old) and 73% of elder age adults (> 45 years old). CONCLUSIONS: In view of findings of this study a high number of male driving license applicants were observed with the risk of OSA. Therefore efforts should be made to develop a national screening guideline/protocol for the OSA risk assessment for driving license applicants in India. This may reduce the possibility of road traffic accidents due to the OSA-associated fatigue and drowsiness behind the wheels. Int J Occup Med Environ Health 2018;31(1):25-36.

Comparison of the effectiveness of Tokuyama and GC II metal primer on the bond strength of acrylic resins to Ti-6Al-7Nb.

STATEMENT OF PROBLEM: Because of the toxicity of vanadium in Ti-6Al-4V alloy, next generation of titanium alloys is proposed to focus on niobium-containing alloy, but for clinical applications, it is crucial for this alloy to bond with acrylic resins with or without the use of primers. However, literature was lacking about the effect of primers on bonding of autopolymerizing resins to Ti-6Al-7Nb. OBJECTIVES: To evaluate the effect of different metal primers on the shear bond strength of acrylic resin to Ti-6Al-7Nb. MATERIALS AND METHODS: A total of 30 dis-shaped wax patterns (10 mm in diameter and 2 mm thickness) were prepared and casted using Ti-6Al-7Nb. After casting, the disk surfaces were finished with abrasive paper under water. Specimens were equally divided into three groups on the basis of the use of primer: metal primer (GC II metal primer) (Group 1), Universal Tokuyama primer (Group 2), no primer (Group 3). Tape of 50 µm thickness was applied on each of the specimens. Then, self-cure acrylic resin was mixed and applied on the center part of the tape, on which Bernouilles tube was placed. The tensile bond strength was measured with a universal testing machine. The data were obtained for all the specimens and analyzed using Statistical Package for Social Sciences version 17.0 at a statistically significance level of <0.05. RESULTS: Mean tensile force was maximum for Group 2 (28.58 ± 39.40 N) and minimum for control Group 3 (6.24 ± 10.97 N), thereby showing a significant inter-group difference (P < 0.001). On applying post hoc test (Tukey HSD), both the Group 1 and Group 2 showed a statistically significant difference as compared to control Group 3; however, the difference between two experimental groups was not statistically significant (P > 0.05). CONCLUSIONS: Tokuyama primer and GC II metal primer had a significant effect on improving the bond strength between autopolymerizing denture base resin and Ti-6Al-7Nb.

Effectiveness of Positioning Stents in Radiation-Induced Xerostomia in Patients with Tongue Carcinoma: A Randomized Controlled Trial.

PURPOSE: The aim of this study was to perform an objective and subjective evaluation of the efficacy of positioning stents in radiation-induced xerostomia in patients with tongue carcinoma. MATERIALS AND METHODS: A total of 30 patients with tongue carcinoma and undergoing conventional radiotherapy were randomly assigned to control (n = 15) and study (n = 15) groups, without and with a positioning stent, respectively. Assessment of salivary output reduction was done before and after radiotherapy, at 3- and 6-month intervals, by measurement of unstimulated and stimulated salivary flow rates (objective evaluation). Xerostomia (subjective evaluation) was noted using six items from the Quality of Life Head and Neck Module (QLQ-H&N35) as proposed by the European Organization for Research and Treatment of Cancer. The significance level was set at .05. RESULTS: Mean unstimulated and stimulated salivary flow rates at 3- and 6-month intervals revealed significantly (P < .05) higher scores for the study group as compared with the control group. The mean quality of life scores in the study group were significantly (P < .05) lower compared with the control group. CONCLUSION: The use of a positioning stent minimized radiation-induced xerostomia and its symptoms.

Assessment of the quality of life in maxillectomy patients: A longitudinal study.

PURPOSE: To longitudinally assess the quality of life in maxillectomy patients rehabilitated with obturator prosthesis. MATERIALS AND METHODS: Thirty-six subjects were enrolled in the span of 16 months, out of which six were dropouts. Subjects (age group 20-60 years) with maxillary defects, irrespective of the cause, planned for definite obturator prosthesis, were recruited. The Hindi version of European Organization for Research and Treatment of Cancer, Head and Neck version 1 of Quality of Life Questionnaire was used before surgical intervention and one month after definitive obturator. Questionnaire includes 35 questions related to the patient's physical health, well being, psychological status, social relation and environmental conditions. The data were processed with statistical package for social science (SPSS). Probability level of P<.05 was considered statistically significant. RESULTS: The quality of life after rehabilitation with obturator prosthesis was 81.48% (±13.64) on average. On item-level, maximum mean scores were obtained for items problem with teeth (1.87 ± 0.94), pain in mouth (1.80 ± 0.92), trouble in eating (1.70 ± 0.88), trouble in talking to other people (1.60 ± 1.22), problems in swallowing solid food (1.57 ± 1.22) and bothering appearance (1.53 ± 1.04); while minimum scores were obtained for the items coughing (1.17 ± 0.38), hoarseness of voice (1.17 ± 0.53), painful throat (1.13 ± 0.43), trouble in having social contacts with friends (1.10 ± 0.40) and trouble having physical contacts with family or friends (1.10 ± 0.31). CONCLUSION: Obturator prosthesis is a highly positive and non-invasive approach to improve the quality of life of patients with maxillectomy defects.

A simplified technique to fabricate tissue bolus device to manage dose distribution in maxillectomy patient with orbital exenteration.

The primary goal of radiotherapy is to deliver maximum dose to tumor but minimal dose to normal tissues. Irregular surfaces along with cavities sometimes make it difficult to deliver a homogenous radiation dose. Data incorporated in the delivery of prescribed dose are measured from the dosimetric system which are homogenous in nature, hence the exposed medium (i.e. tumor) should posses the same property in constituents and nature. At the inference of two different mediums, such as in case of cavity in the treatment field; there occurs build up and build down effects in dose delivery that may result into hot spot and cold spot. These cold spot may result in recurrences. The aim of this paper is to fabricate a simple, cost effective tissue bolus device, which may be filled with normal saline to reproduce homogenous and regular medium at the time of radiotherapy.

Use of diagnostic and surgical stent: a simplified approach for implant placement.

Dental implantology has emerged as a practical alternative to traditional prosthodontics. Since the beginning, placement of implant in the bone to achieve a prosthetic solution that fulfils biologic, aesthetic and biomechanical requirements has been a challenge. In the past, implant site and inclination were dictated by residual bone quality. The desire for predictable prosthesis led to the development of prosthetically guided implantology. This concept establishes the correct implant position during the diagnostic stage according to planned definitive restoration. In prosthetically guided implantology where ideal placement of implant is determined by the definitive restoration, use of radiographic and surgical stent in conjunction with dental CT scan can play an important role. A stent is an appliance used for radiographic evaluation during treatment planning for implant placement and during surgical procedures to locate optimal implant placement site. The stent with dental CT scan enables the dental team to identify specific sites of prospective implant surgery and hence determines the optimal position and angulation of implant relative to occlusal load. Aided by stent the surgeon can avoid undesirable implant site preparation and minimize unnecessary osteotomy, resulting in favorable design of prosthesis, reduced surgical trauma, reduced surgical time and increased patient comfort. This case report is an insight into the method of fabrication of simple and cost effective stent for implant placement and its advantages over the other techniques of stent fabrication.