Prosthetic Rehabilitation of a Nasomaxillary Defect Utilizing a two-Component Prosthesis: a Clinical Report.

Nasomaxillary defects may affect patients' speech, mastication, swallowing, breathing, quality of life, psychology, and social behavior. A combination of surgical reconstruction and prosthetic rehabilitation is frequently required to restore optimal function and esthetics. Of particular concern are the size, weight and contour of the prosthesis, as they can drastically affect comfort, retention, masticatory function and ease of insertion and removal. This clinical case report describes the prosthodontic rehabilitation of a partially edentulous patient with a nasomaxillary defect (Aramany class VI) with a two-component prosthesis joined by magnets.

Modified Technique for CAD/CAM Guided Implant Planning in the Presence of Existing Hopeless Teeth.

Immediate placement of dental implants presents many challenges, especially when partial or complete fixed restorations are the intended prosthetic outcome. With modern advancements in CAD/CAM technology, the ease and predictability of such complex cases is vastly improved. However, certain clinical situations remain that preclude the traditional implementation of this controlled approach to implant planning/placement and the current solutions to these problems each impose some level of compromise. This article describes a technique permitting both prosthetically-driven implant planning and increased surgical guide accuracy in situations where existing hopeless teeth would otherwise impede optimal treatment.

Transitioning a patient with failing anterior dentition and pre-existing posterior implant-supported fixed restorations using a staged approach.

This clinical report describes a staged approach using a removable partial denture (RPD) and a transitional implant-supported overdenture as interim prostheses in treating a failing anterior dentition with posterior implant-supported fixed dental prostheses (FPD), until the time a full-arch fixed implant-supported prosthesis may be inserted. The RPD replaced the anterior teeth following their extraction and during implant osseointegration. The implant-supported overdenture rehabilitated the arch during the fabrication phase of the definitive restoration.

Alpha lipoic acid and metformin alleviates experimentally induced insulin resistance and cognitive deficit by modulation of TLR2 signalling.

BACKGROUND: Obesity is commonly found to be co-morbid with type 2 Diabetes Mellitus. In obese diabetic patients, TLR-2 receptor induced inflammation leads to the development of insulin resistance (IR). Furthermore, the IR is considered to be the most important cause for promoting cognitive decline which is evident in brain of patients with Alzheimer's disease related dementia (ADRD). METHODS: In this study, the effect of α-lipoic acid (ALA) has been examined in rodent model of zymosan induced insulin resistance and cognitive deficits, targeting at TLR-2 signalling. TLR-2 agonist, Zymosan initiates inflammatory cascade, resulting in IR and cognitive dysfunction. Zymosan (50 mg/kg ip) was given to mice on 1st, 8th, 15th and 22nd day to induce IR which was confirmed by hyperglycaemia, hyperinsulinemia, hyperlipidimea, increased glycated haemoglobin and HOMA-IR. Further the cognitive performance was assessed in Morris water maze revealing cognitive deficit in zymosan treated mice. RESULTS: Daily treatment with ALA for 28 days (50, 100, 200 mg/kg, ip) significantly improved insulin sensitivity and cognitive performance in mice by decreasing insulin resistance, corticosterone, IL-6 levels, acetylcholinesterase enzyme activity and oxidative stress in liver, cortex and hippocampus. ALA also increased adiponectin level and reduced body weight. Combination of ALA (100 mg/kg, ip) with metformin (100 mg/kg, ip) exhibited a potentiating effect in improving cognitive performance and insulin signalling. CONCLUSION: The findings of the study supported the hypothesis that TLR-2 induced inflammation leads to insulin resistance and cognitive impairment and provides an evidence for the therapeutic effect of ALA in IR and ADRD patients.

Restoration of a partially edentulous patient with combination partial dentures.

Flexible partial removable dental prostheses (PRDP) provide superior aesthetics, durability, improved patient comfort due to softer surface and low elastic modulus, and require less time and expense for fabrication. However, when a flexible PRDP is used to replace several missing teeth, especially when no occlusal rests or vertical stops are present, rotation and sinking of the denture base and resorption of the residual ridge tend to occur. This may result in the concentration of excessive force in the resin clasp, along with clasp deformation or fracture, and compression of the marginal gingiva. In such situations, it is advisable to incorporate a metal framework and occlusal rests in the design of the flexible PRDP to achieve the optimal rigidity and support. This article describes a case restored with such a 'combination' prosthesis.

A Demonstrative Tactile Method to Guide Mandibular Movements.

Dental practitioners often require patients to perform specific mandibular movements (protrusive, retrusive, and lateral) in order to make centric relation and eccentric records. Occasionally, patients are unable to comprehend and perform the desired movements, even after repeated instructions. This article describes a quick, simple, and easy-to-follow technique to help guide patients with their mandibular movements.

Subcrestal Implant Placement and Recontouring Soft Tissue Using the Erbium YAG Laser to Manage Restorative Space in Implant Overdentures.

Subcrestal implant placement helps gain vertical restorative space at the location of the implants; however, this leads to the development of a tall mucosal cuff, necessitating the use of tall abutments. This article describes the technique of gaining restorative space by decreasing the height of the mucosal cuff with an Erbium YAG laser.

A Prosthesis Retention System for Full-Arch, Fixed, Implant-Supported Prosthesis.

Full-arch, fixed, implant-supported prostheses can be designed to be cement- or screw-retained. Both retention mechanisms have a few inherent disadvantages. A fixed attachment system has been introduced to circumvent the disadvantages of both screw and cement retention. This system eliminates the screw access holes and the use of cement. The number of intraoral procedures required is also reduced. The purpose of this article is to report a case using the Locator F-Tx Attachment System to facilitate fabrication of an esthetic, clinician-retrievable, full-arch implant-supported fixed dental prosthesis.

Synergistic action of ursolic acid and metformin in experimental model of insulin resistance and related behavioral alterations.

Chronic restraint stress (CRS) is known to cause metabolic and neurological complications in a number of ways. Prolonged exposure to stress evident by increased corticosterone level led to impaired altered insulin signaling and oxidative stress in mice, in the present study. Impaired insulin signaling or insulin resistance was characterized by hyperglycemia, hyperinsulinemia, hyperlipidemia, hypoadiponectinemia, increased glycosylated haemoglobin and HOMA-IR. It was also associated with increased proinflammatory cytokine TNF-α levels. CRS also caused significant increase in acetylcholinesterase activity and oxidative stress in brain along with cognitive impairment in behavioral test. Ursolic acid, metformin, gliclazide and their combinations when administered daily for 30 days significantly improved insulin sensitivity apart from behavioral and biochemical alterations in stressed mice. Treatment with drugs also decreased serum corticosterone and TNF-α levels. The findings of our study revealed that improvement in insulin sensitivity, learning and cognitive performance in stressed mice was attributed to attenuation of proinflammatory cytokines and oxidative stress. Moreover, combination of [Metformin (150 mg/kg) + Ursolic acid (10 mg/kg)] produced enhanced improvement in insulin sensitivity and cognitive impairment as compared to their individual effects, suggesting possibly the common mode of anti-inflammatory and antioxidant mechanisms.

Diagnosis and treatment of orofacial pain in a patient with unserviceable complete dentures: A clinical report.

An ill-fitting complete denture has the potential to create pain and discomfort as well as conceal or confound the diagnosis of other primary sources of orofacial pain such as trigeminal neuralgia. Guidelines of the American Academy of Orofacial Pain offer an evidence-based approach for the assessment, diagnosis, and management of orofacial pain. A complete and accurate differential diagnosis is paramount to the success of treatment as well as to the circumvention of unnecessary therapy. The purpose of this clinical report was to emphasize an evidence-based approach to the diagnosis and treatment of orofacial pain in a patient with edentulism and a history of prolonged denture wear.

Angulated Implants for Fabrication of Implant Supported Fixed Partial Denture in the Maxilla.

Until recently, angled abutments have been the only solution to correcting the trajectory of the emergence profile of labially inclined implants in the maxilla. However, the clinical implications of angled abutments reveal several shortcomings. Newly designed angulated implants with a 12-degree restorative platform angulation are an alternative to angled abutments. The purpose of this article was to report a case utilizing new angulated implants (Co-axis, Keystone dental, Burlington, MA, USA) in the premaxilla thereby facilitating fabrication of a multi-unit implant retained fixed dental prosthesis.

Managing maxillary proclination with novel designed angulated implants.

Implant-supported removable dental prostheses may be supported by a variety of splinted (bar and clip) attachment systems or nonsplinted abutment-based attachments (ball, magnets, and resilient stud attachments such as locators [Zest Anchors], ERA [Sterngold], and nonresilient-stud attachments such as ANKYLOS SynCone [Dentsply Implants]). Nonsplinted attachments are preferred as they are more economical, less technique sensitive, easier to clean, repair, and maintain than splinted (bar and clip) attachment systems, but they work favorably only when implants in the arch are placed parallel to each other. Often implants in the anterior maxilla have to be placed with a labial inclination (due to the proclination of the premaxilla), resulting in lack of parallelism between the anterior and posterior implants, making it challenging to fabricate a removable dental prostheses supported by nonsplinted attachments, and necessitating the use of angled abutments. Recently, a novel implant design with a 12° restorative platform angulation has been introduced by Southern Implants (Co-axis, Keystone Dental, Inc., Burlington, MA, USA). These new angulated implants aid in minimizing the divergence between the anterior and posterior maxillary implants without using angled abutments. The purpose of this article was to report a case utilizing the novel angulated implants (Co-axis, Keystone Dental, Inc., Burlington, MA, USA) in the premaxilla for fabrication of maxillary removable dental prostheses supported and retained by nonsplinted attachments.

Plausible anti-inflammatory mechanism of resveratrol and caffeic acid against chronic stress-induced insulin resistance in mice.

Stress is associated with many diseases and dysfunctions, such as depression, cardiovascular alterations, immunological function disorder, inflammation, obesity, and insulin resistance. Stress-induced inflammation is associated with the genesis of insulin resistance. Stress activates hypothalamic pituitary adrenal axis, Renin Angiotensin System pathway, and sympatho-adrenal system, all of which are involved in the production of cytokines, causing the negative downregulation of insulin signaling either by phosphorylating serine residues of IRS or by inhibiting the activity of Akt leading to insulin resistance. In this study, male LACA mice (20-30 g) were subjected to 2 h of chronic restraint stress daily for 30 days at variable time. Resveratrol, caffeic acid, glibenclamide, and their combinations were administered 45 min prior to restraint stress daily for 30 days and their anti-inflammatory effect was examined on CRS-induced behavioral, biochemical, and metabolic alterations. Induction of stress in mice was evident by increased corticosterone and decreased bodyweight. Chronic restraint stress for 30 days developed insulin resistance characterized by hyperglycemia, hyperinsulinemia, increased glycosylated haemoglobin (HbA1c), and homeostasis model assessment of insulin resistance index, hyperlipidemia, increased inflammatory cytokines, and TNF-α. Treatment with resveratrol, caffeic acid, and their combinations has attenuated stress-induced insulin resistance by reducing inflammation.

Fabrication of new restorations with a consideration of oral hygiene.

Maintenance of adequate and effective oral hygiene is crucial for the long-term success of any dental therapy. This article discusses a case that failed due to the poor oral hygiene of the patient. Fabrication of uncomplicated restorations, patient education, motivation, maintenance and recall are important factors to be considered when treatment planning patients with poor oral hygiene.

Predictable Technique to Register Retruded Contact Position (RCP) Using a Disposable Jaw Relation Recording Device.

The dental literature presents various definitions and techniques to describe and register centric relation (CR) or centric occlusion (CO). Briefly reviewing the literature in relation to CR, this article proposes the use of the term retruded contact position (RCP), clinically defined as retruded, unstrained, repeatable position and where the mandibular movements start when a Gothic arch tracing is used. With this clinical definition, a technique can be easily selected that meets all the requirements of such position. The article discusses the use of a jaw recorder that is an intraorally graphic recording device that results in a tracing of mandibular movements in one plane, with the apex of the tracing indicating the retruded, unstrained, and repeatable relationship. The intersection of the arcs produced by the right and left working movement form the apex of the Gothic arch tracing. Several clinical situations using the jaw recorder are described. Clinicians can now quickly and accurately record RCP, balance complete, partial, or implant dentures, and orthopedically reposition the mandible. The technique achieves highly reliable and reproducible results.

Accuracy and reliability of stitched cone-beam computed tomography images.

PURPOSE: This study was performed to evaluate the linear distance accuracy and reliability of stitched small field of view (FOV) cone-beam computed tomography (CBCT) reconstructed images for the fabrication of implant surgical guides. MATERIALS AND METHODS: Three gutta percha points were fixed on the inferior border of a cadaveric mandible to serve as control reference points. Ten additional gutta percha points, representing fiduciary markers, were scattered on the buccal and lingual cortices at the level of the proposed complete denture flange. A digital caliper was used to measure the distance between the reference points and fiduciary markers, which represented the anatomic linear dimension. The mandible was scanned using small FOV CBCT, and the images were then reconstructed and stitched using the manufacturer's imaging software. The same measurements were then taken with the CBCT software. RESULTS: The anatomic linear dimension measurements and stitched small FOV CBCT measurements were statistically evaluated for linear accuracy. The mean difference between the anatomic linear dimension measurements and the stitched small FOV CBCT measurements was found to be 0.34 mm with a 95% confidence interval of +0.24 - +0.44 mm and a mean standard deviation of 0.30 mm. The difference between the control and the stitched small FOV CBCT measurements was insignificant within the parameters defined by this study. CONCLUSION: The proven accuracy of stitched small FOV CBCT data sets may allow image-guided fabrication of implant surgical stents from such data sets.

Defining the posterior palatal seal on a definitive impression for a maxillary complete denture by using a nonfluid wax addition technique.

The posterior palatal seal area is defined as the soft tissue area at or beyond the junction of the hard and soft palates on which pressure within physiologic limits can be applied by a removable complete denture to aid in its retention. The retention of the maxillary denture is affected by the extent and the design of the posterior palatal seal. This article discusses a method of defining the posterior palatal seal on a definitive impression for a maxillary complete denture by using microabrasion and a nonfluid wax addition technique.