CAD-CAM for removable partial denture fabrication after marginal mandibulectomy based on a well-adjusted pre-existing denture.

This clinical report summarizes a workflow that introduces two approaches for fabricating a metal framework removable partial denture for a marginal mandibulectomy patient. First, the pre-existing denture was adjusted according to the piezographic technique to determine the optimal configuration for adhering to the available denture space. Second, computer-aided design-computer-aided manufacturing (CAD-CAM) technology was used to fabricate a new removable partial denture by digitally scanning the oral condition and the well-adjusted denture and then using the obtained data to design and fabricate the new denture. These two approaches can help to reduce chair time not only for maxillofacial prosthetic treatment but also for other denture cases.

Maxillectomy patients' speech and performance of contemporary speaker-independent automatic speech recognition platforms in Japanese.

BACKGROUND: Automatic speech recognition (ASR) can potentially help older adults and people with disabilities reduce their dependence on others and increase their participation in society. However, maxillectomy patients with reduced speech intelligibility may encounter some problems using such technologies. OBJECTIVES: To investigate the accuracy of three commonly used ASR platforms when used by Japanese maxillectomy patients with and without their obturator placed. METHODS: Speech samples were obtained from 29 maxillectomy patients with and without their obturator and 17 healthy volunteers. The samples were input into three speaker-independent speech recognition platforms and the transcribed text was compared with the original text to calculate the syllable error rate (SER). All participants also completed a conventional speech intelligibility test to grade their speech using Taguchi's method. A comprehensive articulation assessment of patients without their obturator was also performed. RESULTS: Significant differences in SER were observed between healthy and maxillectomy groups. Maxillectomy patients with an obturator showed a significant negative correlation between speech intelligibility scores and SER. However, for those without an obturator, no significant correlations were observed. Furthermore, for maxillectomy patients without an obturator, significant differences were found between syllables grouped by vowels. Syllables containing /i/, /u/ and /e/ exhibited higher error rates compared to those containing /a/ and /o/. Additionally, significant differences were observed when syllables were grouped by consonant place of articulation and manner of articulation. CONCLUSION: The three platforms performed well for healthy volunteers and maxillectomy patients with their obturator, but the SER for maxillectomy patients without their obturator was high, rendering the platforms unusable. System improvement is needed to increase accuracy for maxillectomy patients.

Dental and bony changes following subtotal glossectomy for cancer: A clinical report.

The impact of tongue size and forces on surrounding tissues have been described, but clinical reports on the influence on dentoalveolar structures after glossectomy for cancer are lacking. This report describes the dental and bony changes after subtotal glossectomy for squamous cell carcinoma by comparing 3-dimensional models generated from computed tomography scans at various time points during the clinical course. Surface comparison showed lingual tipping of the teeth and areas of bone surface remodeling on the alveolar bone, basilar bone, coronoid process, and condyles. Early denture planning or splinting teeth before glossectomy could be encouraged in some patients, and clinical studies are recommended.

Factors Related to Masticatory Rhythm in Patients with Oral Tumors.

Background: Older adults who have undergone surgery for oral tumors are at increased risk of impaired masticatory rhythm. This study investigated the correlations between masticatory rhythm, objective masticatory performance, and subjective masticatory performance as well as factors related to masticatory rhythm. Methods: The participants were 44 adults (24 men, 20 women; age range 42~90 years old) who had undergone maxillectomy, mandibulectomy, or glossectomy and were rehabilitated with a maxillofacial prosthesis. The number of functional contact teeth pairs was confirmed by intraoral examination. Chewing rate, cycle duration, coefficient of variation (CV) for cycle duration (reflecting the stability of masticatory rhythm), and mixing ability were measured simultaneously using a mastication movement rhythm tracking device during gum chewing. Maximum occlusal force was measured using the dental prescale system. Patients' perception of chewing ability was rated using a questionnaire. Results: The Spearman's rank correlation test revealed that mixing ability, patient-rated masticatory scores, cycle duration, CV for cycle duration, and maximum occlusal force showed significant correlations with chewing rate. Multiple linear regression analysis identified mixing ability and the CV for cycle duration as significant predictors of masticatory rhythm. Conclusions: Factors associated with a faster chewing rate were higher mixing ability and masticatory scores, greater maximum occlusal force, shorter cycle duration, and smaller CV for cycle duration. Stable masticatory rhythm and mixing ability are significant predictors of chewing rate. Poor masticatory performance and unstable masticatory rhythm can result in slower chewing and thus a higher risk of inadequate dietary intake.

Frequently used extraoral maxillofacial prosthetic materials and their longevity - A comprehensive review.

The longevity of an extraoral prosthesis depends on its physical and mechanical properties and user maintenance. Faced with multiple outcome measures, researchers find it difficult to determine the most appropriate extraoral prosthetic material. This comprehensive review evaluates the most used extraoral prosthesis materials and qualitatively assesses their longevity and function. The study aims to identify and interpret the results of current updates on the factors that affect longevity and functionality. This comprehensive review summarizes and evaluates differences in the properties of commonly used extraoral maxillofacial prosthetic materials. The review was planned to focus on all factors related to the longevity and function of the extraoral maxillofacial prosthetics. An electronic search covered English articles in PubMed, Scopus, Google Scholar, Web of Science, and grey literature. Manual searching was also performed. Six authors participated in the screening. Search engines extracted 1107 records, and 88 studies were included for qualitative and bias assessments. Silicones are the most frequently used extraoral maxillofacial prosthetic materials. Heat-cured silicones are more color-stable than those cured at room temperature. Additional ingredients and processing techniques affect prosthesis longevity.

Machine Learning Prediction of Tongue Pressure in Elderly Patients with Head and Neck Tumor: A Cross-Sectional Study.

Background: This investigation sought to cross validate the predictors of tongue pressure recovery in elderly patients' post-treatment for head and neck tumors, leveraging advanced machine learning techniques. Methods: By employing logistic regression, support vector regression, random forest, and extreme gradient boosting, the study analyzed an array of variables including patient demographics, surgery types, dental health status, and age, drawn from comprehensive medical records and direct tongue pressure assessments. Results: Among the models, logistic regression emerged as the most effective, demonstrating an accuracy of 0.630 [95% confidence interval (CI): 0.370-0.778], F1 score of 0.688 [95% confidence interval (CI): 0.435-0.853], precision of 0.611 [95% confidence interval (CI): 0.313-0.801], recall of 0.786 [95% confidence interval (CI): 0.413-0.938] and an area under the receiver operating characteristic curve of 0.626 [95% confidence interval (CI): 0.409-0.806]. This model distinctly highlighted the significance of glossectomy (p = 0.039), the presence of functional teeth (p = 0.043), and the patient's age (p = 0.044) as pivotal factors influencing tongue pressure, setting the threshold for statistical significance at p < 0.05. Conclusions: The analysis underscored the critical role of glossectomy, the presence of functional natural teeth, and age as determinants of tongue pressure in logistics regression, with the presence of natural teeth and the tumor site located in the tongue consistently emerging as the key predictors across all computational models employed in this study.

Assessment of the color stability of two silicone elastomers for maxillofacial prostheses upon exposure to cold beverages.

PURPOSE: This study investigated the color stability of different commercially available silicone materials for facial prostheses upon exposure to everyday beverages. It was hypothesized that the beverages would not alter the color of the silicone under conditions simulating daily exposure. METHODS: Sixty specimens were fabricated using two materials - VST-50 and Silfy - and exposed to commercially available cold mineral water, tea, or coffee. Specimen color was evaluated on days 1 and 15. The color was measured with a spectrophotometer based on CIELab system and color differences were calculated as ΔE. Statistical analysis was performed using the Kruskal-Wallis test and Mann-Whitney U test. RESULTS: The mean ΔE values after 15 days of exposure to mineral water, cold green tea, and coffee were 1.016, 3.480, and 3.636 for VST-50 and 0.440, 0.798, and 1.425 for Silfy, respectively. Both materials showed significant differences in color, and VST-50 showed a greater color change than Silfy, especially for coffee. CONCLUSION: Pigmented silicone elastomers have low color stability, leading to an overall color change in silicone prostheses when exposed to pigmented beverages. Color changes in such prostheses can be mitigated by selecting materials with better color stability to extend their longevity.

Evaluation of the color stability of three maxillofacial silicone materials after exposure to beverages: An in vitro study.

Purpose: Oral cancer often requires treatments like surgical intervention, involving surgical resection of lips and other facial parts. For those patients, prosthetic rehabilitation following surgery promotes social reintegration. This study explores the color stability of various commercially available silicone materials for facial prostheses when exposed to everyday beverages like coffee and tea. The hypothesis is that these beverages can induce color changes in silicones, simulating conditions of daily use. Material and methods: A total of 90 specimens were fabricated. There were 30 specimens deefor each of 3 nonpigmented silicone elastomers: Silfy, A-2186-F and VST-50 and were immersed in tea or coffee at drinking temperature and evaluated for color changes at time points of 0 h, 1 h, and 6 h. The color was measured with a colorimeter that used the CIE L*a*b* system and the color change ΔΕ was calculated to quantify the color change. Statistical analysis was performed by using the Kruskal-Wallis test, the Mann-Whitney U test, and the Wilcoxon signed-rank Test. The threshold for statistical significance was P < .05. Results: Color change was observed for each of the silicones exposed to the beverages (P < .05). The value of ΔE was significantly higher for A-2186-F compared with VST-50 and Silfy (P < .05 in all beverages at 6 h). The color of the elastomers progressively changed while immersed in the beverages over 6 h. The change in color was significantly greater for coffee compared with tea (P < .05). Conclusions: The color stability of nonpigmented silicone elastomers is inherently low, which contributes to the overall color change of silicone prostheses when they are exposed to beverages that contain pigments. The elastomer A-2186-F had greatest values of ΔE among the materials tested. Color changes of silicone prostheses can be lessened by selecting materials with consideration of color stability to improve their longevity and extend their period of use.

Digital design of open hollow obturator framework using existing dentures: A dental technique.

Computer-aided design and computer-aided manufacturing technology has been applied to the fabrication of maxillary obturator frameworks, both directly and indirectly. However, with earlier techniques, it was not possible to accurately determine the position of the framework conforming to the palate, an issue that has been resolved in current fabrication methods. Using the patient's existing denture, prosthodontists can determine where the framework should be positioned in the defect area. This allows the obturator bulb to be hollowed, thereby reducing weight and making adjustment easier. The most appropriate position for the finish line can be determined by accurately establishing the arrangement of the artificial teeth as well as the most appropriate polishing surface morphology. In maxillofacial prosthetics, restoring proper articulation and the swallowing function through rehabilitation is important, and determining the proper palatal morphology enables good tongue movement and facilitates the restoration of adequate function. The lighter weight contributes to protecting the remaining teeth and improves patient comfort.

Case report of a patient with mandibulectomy followed up for 11 years.

Mandibular deviation and rotation following mandibulectomy can significantly impact oral function and quality of life. The postoperative course of a 57-year-old patient who underwent mandibulectomy for oral cancer and findings over 11 years of follow-up observation to monitor changes in the mandibular position are described here. Based on the observations, it is important to raise awareness regarding the necessity of continued monitoring of mandible position and regular adjustments of prostheses for patients who have undergone mandibulectomy.

Creating and analyzing digital scans of a mandibulectomy cast with simulated trismus.

STATEMENT OF PROBLEM: Trismus associated with maxillofacial defects resulting from tumor resection or radiotherapy can make dental treatment uncomfortable for patients. Using an intraoral scanner instead of making a conventional impression could help to make prosthetic rehabilitation more comfortable. However, limited information is available regarding the feasibility and accuracy of intraoral scanners for scanning mandibular defects. PURPOSE: The purpose of this in vitro study was to evaluate the feasibility and accuracy of using an intraoral scanner to digitize a cast of a mandibular defect under various simulated trismus conditions. MATERIAL AND METHODS: An intraoral scanner was used to scan the mandibular cast under different simulated degrees of trismus (mouth opening 10, 20, and 30 mm) and nontrismus (mouth opening 40 mm). The surface areas captured were compared. The datasets were loaded into a 3-dimensional (3D) evaluation software program and then superimposed for precision analysis and on reference data for trueness analysis. One-way analysis of variance was used to compare surface area captured, precision, and trueness of the measurement under the different mouth opening conditions (α=.05). RESULTS: The surface area for which 3D data were obtained by the intraoral scanner ranged from 3199.1 to 6161.6 mm2. The area differed significantly under all mouth opening conditions (P=.001), with a smaller scanned surface area captured in severe trismus (10 mm). Precision ranged from 0.032 to 0.056 mm, and trueness from 0.037 to 0.076 mm. No significant differences were seen in precision (P=.312), but significant differences were seen in trueness (P=.016) under all trismus conditions. CONCLUSIONS: Using an intraoral scanner appears feasible for digitizing mandibular defect casts with simulated mild and moderate trismus. The accuracy of the obtained data was clinically acceptable.

Use of digital technology in prosthesis fabrication for an elderly patient with a maxillectomy and severe trismus: A clinical report.

This clinical report describes a novel approach based on digital technology to fabricate a maxillofacial prosthesis for a 90-year-old woman with severe trismus who had undergone maxillectomy on the right side. The approach was safe, rapid, and less burdensome on this elderly patient, and the storage and communication of intraoral and maxillofacial prosthesis data without temporal and spatial constraints was helpful. A combination of digital and analog technology provided a maxillofacial prosthesis that improved the quality of life of this elderly patient with head and neck cancer and severe trismus.

Detailed speech evaluation including formant 3 analysis and voice visualization in maxillofacial rehabilitation: A clinical report.

Objective speech evaluation such as analysis of formants 1 and 2 and nasality measurement have been used in maxillofacial rehabilitation for outcome assessment. However, in some patients, those evaluations are insufficient to assess a specific or unique problem. This report describes the use of a new speech evaluation including formant 3 analysis and voice visualization in a patient with a maxillofacial defect. The patient was a 67-year-old man who had a maxillary defect that opened to the maxillary sinus and who had an unnatural voice even when wearing an obturator. Nasality was low and the frequency of formants 1 and 2 were normal even without the obturator. However, a low frequency of formant 3 and a shifted center of voice were observed. These results indicated that the unnatural voice was related to increased resonant volume in the pharynx rather than hypernasality. This patient demonstrates that advanced speech analysis can be useful for detecting the cause of speech disorder and planning maxillofacial rehabilitation.

Prevalence of Possible Dementia in Patients with Maxillofacial Defects and Difficulty of Inserting Obturator in Maxillectomy Patients: Toward Better Provision of Supportive Care.

As society ages, it is important to understand the prevalence of dementia and the difficulties of inserting prostheses in patients with maxillofacial defects in order to clarify issues in supportive care. We screened 183 patients for dementia using the revised Hasegawa's dementia scale (HDS-R) at the Clinic for Maxillofacial prosthetics, Tokyo Medical and Dental University, and investigated age and sex differences in HDS-R score. We asked 47 of the 183 participants about the difficulty of inserting a maxillofacial obturator prosthesis and collected subjective comments, information about the prosthesis, and data from five assessments. Multiple regression analysis was used to reveal factors associated with insertion difficulty. Overall, 8.7% of the participants were judged to have possible dementia. Men were more likely than women to have possible dementia, and the risk increased with age. Of the 47 participants, 26 reported difficulty inserting their prosthesis, 12 of whom attributed it to their oral defect. Fourteen patients advised following doctor's instructions to practice insertion in order to become accustomed to it. A lower HDS-R score had a significant impact on insertion difficulty. Cognitive function and difficulty inserting maxillary obturator prostheses should be considered in the provision of continuous supportive care to patients with maxillary defects.

A 20-year clinical survey of radiotherapy prostheses at the Clinic for Maxillofacial Prosthetics of Tokyo Medical and Dental University Hospital.

PURPOSE: To identify secular trends in the use of radiotherapy prostheses in the Clinic for Maxillofacial Prosthetics at Tokyo Medical and Dental University Hospital and to ascertain patient characteristics and future needs. METHODS: The study included all patients who visited the clinic between January 1, 2000, and December 31, 2019. Data on numbers of cases, gender and age, numbers and types of radiotherapy prostheses, primary cancer site, and time required for prosthesis fabrication during the study period were collected from medical records and retrospectively analyzed. RESULTS: During the 20-year study period, 1,066 prostheses were fabricated for 1,135 cases. In most years, at least 60% of cases were male. The mean age increased from 60.6 to 67.1 years during the study period, and the number of cases older than 70 years increased over time. The most common cancer site was the tongue, and the most common type of radiotherapy prosthesis was a spacer. The mean time for spacer fabrication was 11 days. CONCLUSION: During a recent 20-year period, mean age and the proportion of elderly patients requiring savers increased. When treating elderly patients, prosthodontists responsible for fabricating radiotherapy prostheses must collaborate effectively with radiation oncologists.

Use of an occlusal ramp for rehabilitation after a mandibulectomy and its effects on mastication.

STATEMENT OF PROBLEM: Patients with a mandibular defect can develop mandibular deviation, resulting in a loss of or reduction in occlusal contact and ultimately loss of function. The occlusal ramp is a prosthesis used to help restore the masticatory function of such patients and is used particularly in the maxillofacial rehabilitation of patients with masticatory dysfunction resulting from mandibular deviation. The occlusal ramp is usually attached to a mandibular denture or worn as an independent device placed on the palate corresponding to the mandible that produces the offset. However, evidence of the effects of its use is sparse. PURPOSE: The purpose of this clinical study was to investigate the effects of occlusal ramp use in functional rehabilitation. MATERIALS AND METHODS: This study included 10 patients who had received mandibulectomies (5 men and 5 women; mean age 76.7 years, range 67 to 90 years) with deviation of the mandible. An occlusal ramp was fabricated for each participant as part of their maxillofacial prosthetic treatment. Masticatory performance was evaluated before and after the treatment by measuring glucose extraction while masticating a piece of gummy jelly. The Wilcoxon signed-rank test was used for statistical analysis (α=.05). RESULTS: The median masticatory performance score, represented as glucose concentration (mg/dL), was 82.45 before treatment and 115.45 after treatment, with an overall improvement of 33.00. Scores differed significantly before and after treatment (P=.005). Masticatory performance for each participant improved in the range of 17.7 to 103.3, highlighting the role that the occlusal ramp played in mastication, although with differing effects in each participant. CONCLUSIONS: Masticatory performance in participants with mandibular deviation after a mandibulectomy was significantly improved with an occlusal ramp. This suggests the effectiveness of using occlusal ramps in maxillofacial prosthetic treatment for the recovery of masticatory function in patients with mandibular deviation.

Three-dimensional evaluation of the dental arch in cleft lip and palate after prosthetic treatment.

PURPOSE: This study aimed to evaluate the stability of the surface of the maxillary teeth and mucosa in cleft lip and palate (CLP) patients with a maxilla defect or tissue deficiency according to the duration of observation and cleft type. METHODS: Pairs of maxillary casts taken from 18 patients at different time points after prosthodontic treatment were investigated in this study. All 36 casts were scanned with an intraoral scanner, and the acquired images were saved in standard tesselation language (STL) files. The two STL files for each patient were then superimposed using three-dimensional (3D) evaluation software, with 3D deviations shown as a color map. Areas with a 3D deviation within ±0.100 mm were defined as stable. The influence of cleft type and duration of observation on the ratio of stable areas to the entire maxillary surface comprising the teeth and mucosa was investigated using multiple regression analysis. Statistical significance was set at p <0.05. RESULTS: Multiple regression analysis showed that the duration of observation was significantly associated with the stable area ratio (B = -23.463, P<.001), whereas cleft type was not (ß = 0.13, P = 0.301). CONCLUSIONS: The maxillary teeth and mucosa of CLP patients changed over time, with stable areas showing a negative correlation with the observation period. However, the stability of the dental arch was not significantly affected by the cleft type. 3D analysis of the casts of CLP patients allowed for measurements and to accurately assess relapse of the maxillary arch after prosthetic treatment.

Evaluating the Feasibility and Accuracy of Digitizing a Maxillary Defect Model Simulating Various Trismus Conditions.

PURPOSE: To compare the feasibility and accuracy of using intraoral scanners to digitize a maxillary defect model simulating various trismus conditions. MATERIALS AND METHODS: Four intraoral scanners were used to digitize a maxillary defect model simulating four different degrees of trismus (mouth opening = 10, 20, 30, and 40 mm), and the scanned areas were compared. The scans were also superimposed on each other for precision analysis and on reference data for trueness analysis using 3D evaluation software. Two-way ANOVA was used to compare area, precision, and trueness among scanners and among conditions. RESULTS: The surface area for which 3D data were obtained by the intraoral scanners ranged from 2,672 to 6,613 mm2. Significant differences were observed between the scanners (P < .001) and between the trismus conditions (P < .001), with a smaller scanned surface area in severe trismus (10 mm). Trueness ranged from 0.033 to 0.301 mm, and precision from 0.022 to 0.397 mm. Significant differences in trueness and precision values were found among the scanners (P = .001 and P = .001, respectively), but not the trismus conditions (P = .260 and P = .075, respectively). CONCLUSION: Although trueness and precision differed between intraoral scanners, digitization of the maxillectomy model simulating various trismus conditions appears to be feasible from the perspective of accuracy with all of the scanners used. The smaller scanned surface area in the severe trismus condition was due to lack of data on the defect site in that condition.

Custom-made radiotherapy prosthesis for external and internal radiotherapy in a patient with lip cancer.

Definitive radiotherapy is an effective treatment for early-stage lip cancer. The goal of radiotherapy is to irradiate the cancer site effectively while protecting healthy surrounding tissue from the adverse effects of radiation. To this end, radiotherapy prostheses have been widely and effectively used. A maxillofacial prosthodontist working in collaboration with a radiation oncologist can create a custom-made radiotherapy prosthesis that minimizes adverse effects. This report demonstrates the successful use of spacers in external beam radiotherapy and brachytherapy in consideration of the patient's radiation therapy treatment plan and wearing conditions, ensuring adequate availability and preventing radiation-related complications.

Effect of cut-out rescan procedures on the accuracy of an intraoral scanner used for digitizing an ear model: An in vitro study.

PURPOSE: The purpose of this study was to evaluate the impact of the rescanning of mesh holes of different diameters on the accuracy of an intraoral scanner (IOS) used to digitize an ear model. MATERIALS AND METHODS: An ear model was digitized using an intraoral scanner (Medit i500) to obtain a reference mesh. A baseline experimental scan was created by editing a duplicate of the reference mesh using the cut-out tool of the IOS software. Three equal groups were created based on the diameter of the cut-out areas: 2 mm (G1), 5 mm (G2), and 8 mm (G3) (n = 15). The cut-out areas were rescanned and a total of 45 digital files were exported. The discrepancy between the reference and the experimental digital scans was measured using the root mean square calculation (RMS). The data were analyzed by a Kruskal-Wallis test followed by a post hoc Dunn's test with Bonferroni correction. RESULTS: The trueness values ranged from 19.53 to 27.13 µm. There were significant differences in the RMS error values among the groups tested (p < 0.001) and post hoc multiple comparisons showed significant differences between the G1 and G2 groups (p = 0.04), G1 and G3 groups (p < 0.001), and G2 and G3 groups (p = 0.004). Overall, the precision values ranged from 4.93 to 7.73 µm and significant differences in the RMS values were only found between the G1 and G2 groups (p = 0.014). CONCLUSIONS: Mesh hole rescanning affected the scanning accuracy (trueness and precision) of the IOS tested. The larger the diameter of the mesh holes, the less the trueness of the IOS tested. The precision values seemed to be less affected compared with the trueness by the cut-out and rescanning procedures.