Group 2 ITI Consensus Report: Prosthodontics and implant dentistry.

OBJECTIVES: Working Group 2 was convened to address topics relevant to prosthodontics and dental implants. Systematic reviews were developed according to focused questions addressing (a) the number of implants required to support fixed full-arch restorations, (b) the influence of intentionally tilted implants compared to axial positioned implants when supporting fixed dental prostheses (FDPs), (c) implant placement and loading protocols, (d) zirconia dental implants, (e) zirconia and metal ceramic implant supported single crowns and (f) zirconia and metal ceramic implant supported FDPs. MATERIALS AND METHODS: Group 2 considered and discussed information gathered in six systematic reviews. Group participants discussed statements developed by the authors and developed consensus. The group developed and found consensus for clinical recommendations based on both the statements and the experience of the group. The consensus statements and clinical recommendations were presented to the plenary (gathering of all conference attendees) and discussed. Final versions were developed after consensus was reached. RESULTS: A total of 27 consensus statements were developed from the systematic reviews. Additionally, the group developed 24 clinical recommendations based on the combined expertise of the participants and the developed consensus statements. CONCLUSIONS: The literature supports the use of various implant numbers to support full-arch fixed prostheses. The use of intentionally tilted dental implants is indicated when appropriate conditions exist. Implant placement and loading protocols should be considered together when planning and treating patients. One-piece zirconia dental implants can be recommended when appropriate clinical conditions exist although two-piece zirconia implants should be used with caution as a result of insufficient data. Clinical performance of zirconia and metal ceramic single implant supported crowns is similar and each demonstrates significant, though different, complications. Zirconia ceramic FDPs are less reliable than metal ceramic. Implant supported monolithic zirconia prostheses may be a future option with more supporting evidence.

Assessment of health-related quality of life in Turkish patients with facial prostheses.

BACKGROUND: Facial prostheses are intended to provide a non-operative rehabilitation for patients with acquired facial defects. By improving aesthetics and quality of life (QOL), this treatment involves reintegration of the patient into family and social life. The aim of this study was to evaluate the perception of QOL in adult patients with facial prostheses and to compare this perception with that of a control group. METHODS: The study participants consisted of 72 patients, who were divided into three equal-sized groups according to the type of prosthesis (OP- orbital prosthesis, AP- auricular prosthesis, NP - nasal prosthesis) and 24 healthy control participants without any congenital or acquired deformity of face or body. Clinical and socio-demographic data were gathered from each person's medical chart. Participants completed the Turkish version of the World Health Organization Quality of Life Instrument, Short Form (WHOQOL-BREF). Descriptive statistics, independent sample t-tests, Pearson's chi-square test, ANOVA, ANCOVA, and Pearson correlation were used to analyse the data. RESULTS: Compared with the control participants, patients with NP scored lower on the all domains of QOL and all three patient groups had lower scores on overall QOL and its domains of physical and environmental health. Patients with OP reported significantly lower physical health scores than those with AP, while patients with NP reported significantly lower overall QOL and psychological health scores than those with AP. Female patients had lower environmental domain scores than did male patients. The patient's age and income correlated with social relationships QOL, while the patient's income and the age of facial prosthesis were correlated with environmental QOL. CONCLUSION: Patients with facial prostheses had lower scores in overall QOL, physical and environmental health domains than the control participants. Socio-demographic and clinical characteristics such as age, gender, income, localization of the defect, and age of facial prosthesis were associated with patients' QOL. These findings may provide valuable information about the specific health needs of these patients that may affect their well-being. Further studies are needed to confirm these results. Use of the WHOQOL-BREF may provide valuable information for determining patients' needs and priorities as well as for planning and developing comprehensive prosthetic rehabilitation programs.

The effects of two methods of Class III malocclusion treatment on temporomandibular disorders.

The aim of this research was to evaluate, within a controlled clinical study, the effects of a Delaire-type facemask or a modified Jasper Jumper (JJ) used in the treatment of children with Class III malocclusions due to maxillary retrognathia on temporomandibular disorders (TMDs). Forty-six patients with Class III malocclusions referred for orthodontic treatment were divided into two groups, a test and a control. The test group comprised 33 randomly chosen patients (15 females, 18 males) aged 8-11 years. The control group included 13 patients (eight females, five males) with similar features. TMD assessment was performed before and after treatment using a two-axis questionnaire, the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMDs). Qualitative data were evaluated using chi-square and McNemar tests. No statistically significant differences related to the presence of TMD were observed pre- or post-treatment (P > 0.05). The most commonly encountered diagnosis was arthralgia in the JJ group both before and after treatment. Evaluation of joint and muscle regions showed decreased symptoms, apart from the diagnosed discomforts, in the JJ group (P < 0.05). Reduced symptoms were observed in the Delaire group; however, this reduction was not statistically significant. An increase, not considered to be statistically significant, was observed in the control group. The Delaire-type facemask and modified JJ used in the early phase of Class III malocclusion treatment did not result in TMD.

Evaluation of Candida albicans formation on feldspathic porcelain subjected to four surface treatment methods.

Candida albicans, known for its adhesion on prosthetic materials and oral tissues, is the most frequently encountered fungal infection in dentistry. The aim of this study was to evaluate the effects of four different surface treatment methods and immersion in artificial saliva on the surface roughness of and candida adhesion on dental porcelains. The four surface treatment methods were namely: natural glaze, overglaze, dual ion exchange, and polishing. Surface roughness of porcelain was evaluated using a surface profilometer and by SEM. Candida adhesion was examined by culturing two Candida strains on porcelain specimens followed by a colorimetric method using XTT/Coenzyme Q0. It became evident that Candida adhesion was found more in the specimens treated with natural glaze and polishing. Further, by the visual inspection of SEM images and comparison of surface roughness, polished and natural-glazed specimens showed rougher surface characteristics than overglazed and dual-ion-exchanged specimens.

Effect of colored beverages on the color stability of feldspathic porcelain subjected to various surface treatments.

OBJECTIVE: To investigate the effects of porcelain treatment techniques on the color change of feldspathic porcelain before and after exposure to distilled water, coffee, red wine, and cola and examine the surface texture of the porcelain with field-emission SEM. MATERIALS AND METHODS: Test specimens were prepared in the form of discs 15 mm in diameter by 2-mm thick and divided into four groups: Naturalglaze, dual-ion exchange, overglaze and polishing. The specimens were prepared according to their group and stored in red wine, coffee, and cola. After removal, the specimens were dipped in distilled water. Color measurements were made with a spectrophotometer, and color differences were determined using the CIE-LAB system. Statistical analysis was made with SPSS 13.5. RESULTS: Immersion time and types of surface treatment were significant factors for color stability (P < .01).

A preoperative appliance for a newborn with cleft palate.

Cleft palate is a commonly observed congenital maxillofacial defect. One of the most important problems with clefts is the interference with feeding. An affected infant cannot produce negative pressure in the oral cavity and therefore cannot move the bolus backward to the pharynx. To obtain better nutritional intake prior to surgical correction, a palatal lift obturator is recommended. In this clinical report, a modified technique of obturator fabrication is presented. The new method uses a piece of tulle, a flexible and durable material that is frequently used in theater attire. With the help of this material, the bulb part is connected to the plate as a labile piece, and this connection acts like a natural velopharyngeal extension. Additionally, because of the softer property of the silicone elastomer, the posterior pharyngeal wall is less irritated.

Effect of tulle on the mechanical properties of a maxillofacial silicone elastomer.

The purpose of this research was to investigate if physical properties could be improved by incorporating a tulle reinforcement material into a maxillofacial silicone elastomer. A-2186 silicone elastomer was used in this study. The study group consisted of 20 elastomer specimens incorporated with tulle and fabricated in dumbbell-shaped silicone patterns using ASTM D412 and D624 standards. The control group consisted of 20 elastomer specimens fabricated without tulle. Tensile strength, ultimate elongation, and tear strength of all specimens were measured and analyzed. Statistical analyses were performed using Mann-Whitney U test with a statistical significance at 95% confidence level. It was found that the tensile and tear strengths of tulle-incorporated maxillofacial silicone elastomer were higher than those without tulle incorporation (p < 0.05). Therefore, findings of this study suggested that tulle successfully reinforced a maxillofacial silicone elastomer by providing it with better mechanical properties and augmented strength--especially for the delicate edges of maxillofacial prostheses.

Facial defects restored with extraoral implant-supported prostheses.

A facial defect results in cosmetic, functional, and psychologic problems and acts as a difficult and challenging procedure for the maxillofacial surgeon and the prosthodontist. Retention of a facial prosthesis is an important key in the patient's satisfaction and acceptance. The introduction of extraoral implant applications have been accepted as an advanced retention method. The purpose of this article is to report the results from our clinical experience with patients wearing facial prostheses anchored to extraoral ITI implants (Straumann, AG, Basel, Switzerland).