Technique to prevent fracture of a partial auricular prosthesis mold.

One of the difficulties faced during the essential and demanding step of fabricating a mold for a partial auricular prosthesis is the fracture of its most elevated part, which engages the remnant concha and triangular fossa region, because of the presence of excessive convolutions and undercuts. This technique describes a 4-part mold for a partial auricular prosthesis in which the most elevated portion is poured separately, thereby preventing mold fracture.

Effect of mucostatic and selective pressure impression techniques on residual ridge resorption in individuals with different bone mineral densities: A prospective clinical pilot study.

STATEMENT OF PROBLEM: Although different impression techniques have been advocated for complete denture prosthodontics, objective studies that predict their effect on alveolar bone resorption are lacking. PURPOSE: The purpose of this prospective clinical pilot study was to objectively evaluate the effect of complete dentures fabricated by different impression techniques on mandibular residual ridge resorption in individuals with different bone mineral density. MATERIAL AND METHODS: Ninety-six participants with edentulism, selected according to inclusion criteria, underwent bone mineral density assessment and were divided into normal, osteopenic, and osteoporotic groups. Half of the participants in each group were provided with dentures fabricated by selective pressure impression technique (subgroup SIT), and the other half were provided with dentures fabricated by mucostatic impression technique (subgroup MIT). Computed tomographic scans of the mandible were made at denture delivery and 1 year after prosthesis use to assess alveolar bone height and width difference at marked locations at and after denture delivery. The data obtained were analyzed with the Student t test (α=.05). RESULTS: Significantly less reduction in mandibular ridge height and width was found in the MIT versus the SIT subgroups in both osteopenic and osteoporotic participants (P<.05). No significant subgroup difference was found for normal bone mineral density group, although resorption increased in height and width for the SIT subgroup. CONCLUSIONS: Mandibular residual ridge resorption was reduced for dentures fabricated using the mucostatic impression technique compared with the selective pressure impression technique in individuals with diminished bone density.

Nonimplant, Nonadhesive Overlay Approach to Retain a Partial Auricular Prosthesis.

Partial auricular prosthesis fabrication presents a more complex challenge than complete ear fabrication, with added aspects of merging/camouflaging a larger prosthetic marginal area, pattern try-in, and compromised retention. Better alternatives are excision of the remnant ear to make an implant-retained complete ear prosthesis or surgical reconstruction of the missing ear portion. Both need additional surgery/ies and expenses, neither of which may be acceptable to the patient. This report describes a prosthesis fabrication approach for such patients. This approach does not require implants or adhesives for retention. Issues of marginal camouflage and pattern trial were also addressed satisfactorily.

Comparison of Rehabilitating Missing Mandibular First Molars with Implant- or Tooth-Supported Prostheses Using Masticatory Efficiency and Patient Satisfaction Outcomes.

PURPOSE: To determine whether a fixed partial denture (FPD) or an implant replacement of a single missing tooth leads to better masticatory efficiency and patient satisfaction. MATERIALS AND METHODS: One-hundred and twenty participants with missing mandibular right first molars were selected on the basis of predefined inclusion and exclusion criteria. After obtaining informed consent, 60 participants were randomized to the teeth-supported (FPD) group and 60 to the implant placement group (IMP). The study was divided into the following parts: (i) Completion of a Likert scale satisfaction questionnaire (postrehabilitation) by the participants. (ii) Evaluation of masticatory efficiency and performance 3 months after rehabilitation. Data were evaluated by applying t-test and z-test using statistical analysis (α ˂ 0.05). RESULTS: Masticatory efficiency of participants in the IMP and FPD groups was 74.95 ± 0.90% and 74.41 ± 3.35%, respectively (p = 0.607). Total satisfaction questionnaire scores for the two groups were also not significantly different; however, the mean scores of overall satisfaction and function categories in this questionnaire were significantly higher for the IMP group, while the mean score for the duration of treatment question was higher for the FPD group (p < 0.05). CONCLUSION: The results of this study suggested that although masticatory performance and efficiency were not statistically different for single teeth replaced with implants or FPDs, patients perceived higher satisfaction with implant restorations; they also preferred the shorter treatment times for rehabilitation in the FPD group.

Measurements in Mandibular Pantomographic X-rays and Relation to Skeletal Mineral Densitometric Values.

The gold standard diagnostic modality for osteoporosis is dual-energy X-ray absorptiometry (DXA). But it is expensive and often unavailable. Studies have demonstrated that decreased bone mineral density (BMD) may affect mandibular bone morphometrically on radiographs. Such studies are rare in the Indian population. This study was conducted to evaluate correlation between radiomorphometric markers on digital orthopantomograms (OPGs) and BMD measurements done by DXA in an Indian population. A total of 344 subjects aged 45 years or above, who visited a dental outpatient department over a period of 6 years were included in the study after obtaining ethical committee approval and informed consent. Digital OPG and DXA BMD measurements were obtained. Subjects' T-scores were obtained, on the basis of which they were divided into osteoporotic, osteopenic, and normal. OPGs were evaluated to obtain the mandibular cortical index (MCI) and the panoramic mandibular index (PMI). Correlations of MCI and PMI with BMD were analyzed statistically with SPSS (version 16.0; SPSS, Chicago, IL). In the osteoporotic group, there was no subject with MCI finding of C1, and 77.42% prevalence of C3 finding was found. C2 finding was in highest proportion in the osteopenic group (p<0.05). Normal BMD group was associated with the C1 finding of 76.47%. Almost 48% of the osteoporotic group had a PMI score of <0.40, whereas 50% of osteopenic subjects had a PMI score of 0.4-0.44. Normal subjects having a PMI score of >0.44 constituted 49.1% of the population. Mean BMD scores decreased significantly with increasing MCI stage and increased significantly with increasing PMI (p<0.05). Significant correlations between PMI and MCI were obtained with DXA BMD. Digital OPGs may provide an economical and reliable diagnostic tool to rule out osteoporosis or osteopenia in undiagnosed patients, where DXA screening may not be available or is financially nonviable.

Early loading of delayed versus immediately placed implants in the anterior mandible: A pilot comparative clinical study.

STATEMENT OF PROBLEM: Numerous studies of the efficacy of immediately placed implants have been published but only a few of the comparative analyses of the early loading of delayed versus immediately placed dental implants. PURPOSE: The purpose of this pilot prospective clinical study was to evaluate and compare the outcomes of early loaded delayed versus immediately placed implants. MATERIAL AND METHODS: Eighty-eight participants satisfying predefined inclusion and exclusion criteria were selected for this pilot prospective study of 3 years' duration after obtaining institutional review board approval and informed consent. The immediate and the delayed implant placement group each consisted of 44 participants. The anterior mandible canine region was the implant placement site for all participants, and all implants were of the same size and manufacture. Participants were evaluated for hard (crestal bone loss and stability) and soft (periimplant probing depth) tissue implant success parameters at 6 and 12 months after implant placement. Data were analyzed, and results were computed. RESULTS: Intergroup comparisons for mean mesial, mean distal, and mean crestal bone loss at 6 and 12 months after immediate and delayed implant placement showed statistically insignificant differences (P≥.05). Intergroup comparisons of mean mesial, mean distal, mean labial, and mean lingual and mean pocket depth at 6 and 12 months also showed statistically insignificant differences (P≥.05). Comparative mean values using the Periotest also demonstrated statistically insignificant differences (P≥.05). CONCLUSIONS: The short-term outcomes of early loaded delayed and immediately placed implants were comparable. Therefore, early loaded immediately placed implants may be a promising option for the mandibular anterior region.

Modified technique to improve fabrication and outcome of definitive orbital prosthesis.

Facial prostheses are generally fabricated from silicones, which provide life-like appearance and flexibility. The longevity of silicone, however, is limited because of its tendency to support fungal growth, absorb oils and grease, and edge-tearing susceptibility. Polyurethane (PU) liners have been used on the tissue-bearing surface of such prosthesis to improve tear resistance and fungal resistance. Technique sensitivity, discoloration and metamerism are significant limitations of urethane lining. Further, this liner is incorporated during processing of definitive prosthesis, which precludes try-in of tissue surface of prosthesis. This article describes an alternative lining material for fitting surface of definitive orbital prostheses, which could overcome limitations associated with all silicone or PU lined silicone prostheses.

Impact of Different Prosthodontic Treatment Modalities on Nutritional Parameters of Elderly Patients.

PURPOSE: To assess dietary and nutritional changes among the elderly following pros-thodontic rehabilitation. Another objective was to study the relationship, if any, between diet and nutrition, with extent of edentulism and different types of prosthodontic treatment. MATERIALS AND METHODS: One hundred and thirty-five patients who satisfied the inclu-sion and exclusion criteria and agreed to be a part of the study after informed consent were recruited to this longitudinal study. Following selection, they were investigated on four aspects: dental examination, dietary assessment, anthropometric assessment, and serum biochemical assessment. All measurements were collected twice, first at baseline and then 6 months following prosthodontic rehabilitation. Treatment modalities included were complete denture (CD), removable partial denture (RPD), and fixed partial denture (FPD). The RPD group was of two types: distal extension prosthesis (RPDD) and tooth-supported prosthesis (RPDT). Change (post-pre) in outcome measures was compared by one-way ANOVA, and significance of mean difference between the groups was done by Tukey's honestly significance difference post hoc test. RESULTS: The improvement in diet was found to be: CD > RPDD > RPDT > FPD. Significant improvement in weight (p < 0.001), BMI (p < 0.001), protein (p < 0.001), carbohydrate (p = 0.021), calorie (p < 0.001), iron (p = 0.002), and vitamin B (p < 0.001) in group CD as compared to partially edentulous patients (group RPDD + RPDT + FPD) was noted. The protein and calorie intake increased significantly in group RPD as compared to group FPD in partially edentulous patients. CONCLUSION: Prosthetic rehabilitation becomes increasingly important as the level of edentulism increases to improve dietary, anthropometric, and biochemical parameters.

An In Vivo 24-Month Study to Compare Crestal Bone Loss and Pocket Depth of Platform-Switched Implants Placed in Maxillary Anterior and Mandibular Posterior Regions.

PURPOSE: To analyze and compare crestal bone loss and pocket depth around platform-switched implants placed at two intraoral locations. MATERIALS AND METHODS: Eighty platform-switched implants, 40 in the maxillary anterior region (group - ANT) and 40 in the mandibular posterior region (group - POST), were placed in healthy men aged between 25 and 45 years, and restored following two-stage surgical and progressive loading protocols. Digital radiographs for crestal bone level assessment and pocket depths on facial, mesial, distal, and palatal/lingual sites around the implant were recorded at definitive restoration cementation (baseline) and 6-month follow-up. Difference in pre- and post-periodontal pocket depths and crestal bone loss levels were measured and analyzed statistically using SPSS v.16.0, applying the Mann-Whitney test (p < 0.05 considered significant). RESULTS: Mean bone loss was significantly higher in group ANT (1.2 ± 0.3 mm) than in group POST (0.7 ± 0.02 mm). Palatal pocket depth increase was significantly greater in the ANT group (p = 0.01), and distal pocket depth increase was significantly greater for the POST group (p = 0.002). CONCLUSION: The amount of bone loss noted in the maxillary anterior region compared to the mandibular posterior region was significantly more. This could possibly be because of greater vertical cantilever and offset loads in the anterior compared to the posterior region. Significantly greater pocket depth in mandibular posterior distal and maxillary anterior palatal regions could be related to oral hygiene maintenance issues.

Prosthetic Rehabilitation Following Socket Reconstruction with Blair-Brown Graft and Conformer Therapy for Management of Severe Post-Enucleation Socket Syndrome--A Clinical Report.

One of the most common tumors of the eye diagnosed in childhood is retinoblastoma, which mandates enucleation with adjunctive chemotherapy and radiotherapy to save the patient's life. The most common late enucleation complication is post-enucleation socket syndrome (PESS), which poses a management dilemma for the prosthodontist and surgeon, along with being a major esthetic concern for the patient. The reconstruction of such sockets is complex. The purpose of this clinical report is to describe the rehabilitation of such a pediatric patient with severe PESS. The patient was successfully rehabilitated by presurgical conformer therapy, socket reconstruction surgery with non-meshed intermediate split thickness skin graft (STSG)/Blair-Brown graft, and postsurgical conformer stent. This was followed by fabrication of a custom ocular prosthesis, to achieve favorable functional, physical, and psychological effects.

Platform switching: a narrative review.

STATEMENT OF THE PROBLEM: Bone loss around the implant is 1 of the important factors affecting its success. Fitting an abutment of smaller circumference in comparison with the implant is known as platform switching. The concept gained importance as investigations found reduced crestal bone loss around such implants. Several studies have been conducted to understand its efficacy, mechanism of action, and the extent of switching that would provide best results. METHODS: Public databases were researched to assess if the concept of platform switching was helpful in reducing bone loss around dental implants using relevant keywords. RESULTS: Most of the studies supported the use of switched platforms with only 1 reporting no effect of switching. No study reported any harmful effect of switched platform either on bone quality or on success of implants. CONCLUSIONS: Platform switching seems to be successful in reducing bone loss around dental implants. Further research regarding its exact mechanism of action would help explain and improve the success rate of implants.

Prevalence of dental myths, oral hygiene methods and tobacco habits in an ageing North Indian rural population.

BACKGROUND AND OBJECTIVES: Though increased emphasis is being given to expanding dental care facilities and awareness in Indian villages, the target population is unfortunately less literate and financially-equipped compared to their urban counterparts. This study attempted to evaluate dental myths, oral hygiene methods and beliefs, and tobacco habits present in a rural ageing population. MATERIAL AND METHODS: The study area consisted of a group of 10 villages, situated in the district of Lucknow, Uttar Pradesh, India. The sample comprised 681 people aged 50 years or above. The subjects were questioned about dental myths, tobacco habits and oral hygiene methods and then divided into groups on the basis of age, gender, and educational status. Mean values, standard deviation, chi-square test, t-test and p values were used to obtain inter-group comparisons. RESULTS: Forty percent of the subjects considered oral hygiene unnecessary, with 61% relying on simple mouth rinsing for maintaining oral hygiene, 48% either smoked and chewed tobacco or both and 81% had one or more dental myth. CONCLUSION: The results showed that the rural ageing population is deprived and a targeted programme to spread scientific dental practices to them is necessary.

A case of cleidocranial dysostosis: dilemma for a prosthodontist.

Cleidocranial dysostosis (CCD) is an uncommon, generalized skeletal disorder characterized by delayed ossification of the skull, aplastic or hypoplastic clavicles, and complex dental abnormalities such as retention of multiple deciduous teeth, impaction or delayed eruption of permanent teeth and presence of supernumerary teeth. This case report describes a 30-year old male patient of CCD with classical findings and the challenges faced in his prosthodontic rehabilitation. Conventional complete dentures following interim complete dentures therapy had to be given as all other treatment modalities were ruled out because of anatomic limitations. Despite the disadvantages of removable dentures the patient adapted admirably to them with significant improvement in self-esteem. Though orthodontic and surgical correction may be the treatment of choice, the need to preserve the alveolar ridge could make fabrication of removable dentures in such patients, a viable option.

A study to evaluate psychological and occlusal parameters in bruxism.

PURPOSE: To evaluate the role of anxiety/depression and occlusal factors in bruxism using Hospital Anxiety and Depression Scale and T-Scan III respectively. METHODS: The present case control study was comprising of a group of thirty patients with bruxism (Group Br) and 30 healthy individuals as control group (Group NBr). Subjects were selected from outdoor patients visiting the dental unit with the chief complaint of wearing off/sensitivity of all the teeth due to habitual grinding. The cases were selected by using the diagnostic criteria as given by the American Academy of Sleep Medicine (AASM). Further based on similarities of age and gender, controls were selected. Tooth wear index was recorded using an index given by Ekfeldt et al. Hospital Anxiety and Depression Scale (HADS) questionnaire was administered to both the groups to evaluate anxiety and depression. Recording of occlusal parameters in both the groups was done digitally by using T-Scan III. Statistical analysis was done by using student's t-test, chi square test and Mann Whitney U test. RESULTS: Group Br had significantly greater mean tooth wear index (22.24 ± 11.5) than group NBr (5.17 ± 3.30). Group Br had significantly higher anxiety (9.03 + 1.87/7.17 + 1.82) and depression scores (8 + 1.93/6.17 + 1.23) as compared to NBr. The disclusion time of group Br was 0.652 ± 0.749 and that of group NBr was 0.247 ± 0.289 (p = 0.008). CONCLUSIONS: Subjects with higher level of anxiety, depression and increased disclusion time may have greater predilection towards suffering from bruxism (p < 0.05).

Bisphosphonate therapy for skeletal malignancies and metastases: impact on jaw bones and prosthodontic concerns.

Healthy jawbones ensure better tooth anchorage and the ability to masticate and maintain metabolism. This is achieved by a delicate balance between bone formation and resorption in response to functional demands. An imbalance in the expression of receptor activator of nuclear factor kappa-B (RANK) ligand (RANKL) and osteoprotegerin (OPG) or osteoclastogenesis inhibitory factor (OCIF) is believed to be the underlying mechanism of osteolysis in metastases, multiple myelomas, and cancer therapy-induced bone loss in patients. Considered mainly as bone-specific agents to treat postmenopausal osteoporosis, bisphosphonates, in combination with certain chemotherapeutic agents have proved to be effective in prevention of tumor formation and metastatic osteolysis in bone tissue. Osteonecrosis of the jaws associated with them has, however, been of grave concern to the prosthodontist, as it predisposes patients to a bone-deficient basal seat for dental prostheses. This manuscript reviews available information over the past 13 years on possible mechanisms of bone loss, bisphosphonate-induced osteonecrosis of jaw bones, and prosthodontic concerns.

Spectacle Cord-retained Oculo-Orbital Prosthesis.

Retention of an orbital prosthesis plays a key role in treatment success and patient acceptance as does aesthetics. Though numerous retentive aids are available such as implants, adhesives, etc, the cost, surgical aspect, difficulty of use and allergic potential may compromise efficiency. This report describes the case of an 11-year post-enucleation poor retinoblastoma patient, in whom an unfavourable defect leads to a major prosthetic challenge (from point of view of retention and camouflage). This report describes a simple, economical, and user-friendly approach to obtain satisfactory retention and camouflage for such patients with spectacle cords and customised spectacles. Key Words: Oculo-orbital prosthesis, Spectacle, Cord.

An overview of osteoporosis for the practising prosthodontist.

Osteoporosis is an insidious and common bone disorder of the modern age, as a result of the rapidly increasing number of older people in the total population. It has long been concluded that this disease has definite deleterious effects on the stomatognathic system and is therefore of major concern to a Prosthodontist. If features on a dental radiograph, which are the most commonly required radiographs, can be detected regularly and consistently, it would place a prosthodontist in a position to refer the patient for timely management and also modify his treatment plan, greatly improving the prognosis. Available literature was therefore reviewed for pathophysiology, dental radiographic screening measures, implications and management of osteoporosis from the perspective of a prosthodontist.

Rehabilitation of a Complex Oro-Facial Defect by Modified Prosthetic Approach.

Loss of part of the face is associated with physical disability, social isolation and immense psychological trauma. Proper rehabilitation of such a patient is a challenging yet satisfying task for a maxillofacial prosthodontist. Facial prostheses are commonly fabricated of silicone because of many favorable properties, though it predisposes to fungal growth.This report is of a patient with history of uncontrolled diabetes and associated invasive fungal infection, leading to a complex oro-facial defect, which was rehabilitated successfully with a silicone facial prosthesis lined by a material more resistant to fungal growth along with a cast partial obturator. Other design and procedural modifications were also made to suit the needs of the case. Wise selection of materials, keeping in mind the properties of materials, is important in successful rehabilitation.

Interim prosthesis preventing tongue protrusion following mandibular alveolar ridge and lower lip resection in a surgically compromised patient.

Carcinomas of the mandibular buccogingival region being aggressive rapidly destroy the supporting bone and adjacent soft tissues, making it mandatory for the oncosurgeon to resect substantial amounts of involved hard and soft tissues. Segmental mandibulectomy -followed by immediate bony and soft tissue reconstruction is the most acceptable approach. However, immediate reconstruction may not always be feasible or possible due to high recurrences potential of lesion, inaccessible residual pathology, or systemic -conditions that pose a risk for graft inosculation. In certain cases, where large portion of lower lip also needs to be sacrificed with alveolar resection, protrusion of tongue through the defect beyond the lip confines leads to drooling of saliva, difficulty in speech and worsening of esthetic appearance, social isolation, and compromised quality of life. So, pending reconstruction and definitive rehabilitation, patients would require provisional treatment to control some of the ill effects. This article presents a simple technique for fabrication of a provisional prosthesis for preventing tongue protrusion, salivary drooling following mandibular alveolar ridge and lip resection.

A pilot study to evaluate the efficacy of cerrobend shielding stents in preventing adverse radiotherapeutic effects in buccal carcinoma patients.

BACKGROUND: Radiation stents made of Lipowitz metal or cerrobend alloy are commonly used to shield uninvolved tissues from electron beams used in therapeutic radiation treatment of head and neck cancers. However, studies investigating the efficacy of cerrobend shielding stent in patients with unilateral buccal carcinoma remain rare. PURPOSE: To evaluate the efficacy of cerrobend shielding stents in minimizing the potential adverse effects of radiation on oral tissues in buccal carcinoma patients. MATERIALS AND METHODS: Twenty.eight participants were selected for the study based on predetermined inclusion criteria, out of which four participants were lost to follow-.up. Half of the remaining participants. (N = 12) were randomly given cerrobend shielding stent and the remaining 12 formed the control group. The effects of radiotherapy were evaluated by using Radiation Therapy Oncology Group. (RTOG) 0435 Head and Neck adverse effects grading tool. All participants were evaluated for xerostomia, mucositis, dysphagia, salivary changes, dysguesia, pain, trismus and radiation caries at baseline and 1 and 3. months post.radiotherapy. RESULTS: All adverse effects were higher in control compared to study group, with post therapy difference for pain in swallowing, salivary changes, mucositis, dysphagia, dry mouth and caries being statistically significant. CONCLUSIONS: Cerrobend alloy can be used effectively as shielding stent to reduce the adverse effects associated with external beam radiation therapy in unilateral buccal carcinoma patients.