Clinical outcomes of implant-supported prosthetic rehabilitation of severely atrophic maxilla: A systematic review.

Aim: The purpose of this systematic review is to evaluate the clinical outcomes for the various methods of rehabilitation of a severely atrophic maxilla with the help of implant-supported fixed prosthesis. Materials and Methods: The relevant publications published between 2013 and 2022 and written only in English were identified using an electronic search. The primary research question for this study was developed based on the PICO framework, which stands for population, intervention, control, and outcomes which was "What are the clinical outcomes of implant-supported prosthetic rehabilitation in patients with severely atrophic maxilla?" The relevancy of the articles was confirmed by examining their titles, abstracts, and complete texts to determine whether they satisfied the requirements for inclusion. Utilizing specialized study design-related bias assessment forms, the risk of bias was evaluated. Results: The database search resulted in 1568 results; however, 1529 of them were eliminated because of insufficient, duplicate, or missing data. Additionally, manual searching yielded 11 articles. After 50 full-text papers were assessed for eligibility, 17 articles were eliminated. Thus, 33 studies in total are included in the current systematic review. Risk of bias analysis and GRADE evidence analysis were performed. Data were found to be heterogeneous and thus meta-analysis could not be done and narrative synthesis is presented. Conclusion: The patient's condition and the clinician's expertise play a role in taking the decision on choice of technique for the fixed implant-supported rehabilitation of the severely atrophic maxilla. A high success and survival rate is produced by the majority of fixed implant-assisted prostheses despite the biologic and prosthetic problems. A single approach cannot be recommended as the gold standard. The choice is dependent on the patient's biological factors as well as the clinician's expertise. The included studies were assessed using GRADE criteria. The quality of evidence is low-medium. Therefore, to better comprehend the clinical effectiveness of the treatment alternatives, more well-designed randomized controlled trials with longer follow-up period are required.

Opacifiers on color stability of maxillofacial silicone under aging and Indian weathering conditions: An in vitro study.

STATEMENT OF PROBLEM: Resistance to long-term color change is a desirable property for facial prosthetic elastomers. Evidence for the color stability of maxillofacial silicones under aging and hot and humid Indian weathering conditions is lacking. PURPOSE: The purpose of this in vitro study was to evaluate the effect of adding opacifiers on the color stability of maxillofacial silicone under human aging and Indian weather conditions. MATERIAL AND METHODS: A total of 93 specimen disks were obtained from the A-2186, platinum-based, room-temperature vulcanized, maxillofacial silicone elastomer by using a Ø30×6-mm stainless-steel die. The specimens were divided into 3 main groups (n=30), C (control), T (titanium dioxide), and B (barium sulfate), and 1 additional specimen (n=1) from each group was stored in a closed box and further subgrouped as outdoor weathering (COut, TOut, BOut), acidic perspiration (CAcid, TAcid, BAcid), sebum (CSebum, TSebum, BSebum) (n=10), and visual comparison (CVis, TVis, BVis) (n=1). Baseline L∗, a∗, b∗ values were recorded by using a spectrophotometer and visual perception. The specimens were subjected to human and extraoral aging conditions, and the values were recorded again after 6 months. Data were analyzed statistically by using analysis of variance (ANOVA) and post hoc analysis with the Tukey post hoc test. RESULTS: In group C, the mean color change for COut was 3.69 ±0.49; CAcid, 3.58 ±0.68; and CSebum, 7.53 ±0.22 (P<.001). In group T, the mean color change for TOut was 2.60 ±0.24; TAcid, 2.35 ±0.13; and TSebum, 4.91 ±0.44 (P<.001). In group B, BOut was 1.59 ±0.28, BAcid was 1.46 ±0.28, and BSebum was 4.03 ±0.71 (P<.001). The specimens containing barium sulfate showed the maximum color stability. The least color stability was observed in all specimens exposed to sebum solution and was significantly different (P<.001) from the outdoor weather and acidic perspiration specimens. Visually perceivable color changes were observed in specimens exposed to the sebum solution. CONCLUSIONS: The addition of titanium dioxide and barium sulfate as opacifiers resulted in clinically acceptable color change when exposed to outdoor weathering and acidic perspiration but not in sebum solution.

Stomatognathic Risk Factors and Clinical Manifestations of Temporomandibular Disorders in Indian Population: A Case-control Study.

AIM: This study was aimed to compare the risk factors and associated clinical manifestations of patients with temporomandibular disorders (TMDs) in the Indian population. MATERIALS AND METHODS: A total of 52 patients were explored according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) and compared with 48 controls. The mean age of the study group was 30.96 ± 11.60 years, 41% were males and 59% were females. The mean age in the control group was 31.5 ± 9.9 years (37.5% males), measuring differences in TMD risk factors (self-perceived stress, parafunctions, occlusal interferences, history of orthodontic treatment, and/or extraction). RESULTS: The most common sign observed in the selected subjects was the joint sound (clicking) (42%), followed by mandibular deviation 39% as the second most common sign. Myofascial pain (MFP) (single or multiple diagnoses) was the most frequent diagnosis (n = 40, 76%), followed by disc displacement with reduction (DDWR) (32.1%), arthralgia (30%), and disc displacement without reduction (DDWoR) (7.6%). More than one DC/TMD diagnosis was established in 63.2% of the patients. The risk factors like presence of clenching, stress perception, parafunctions, tooth wear, and occlusal interferences were significantly more frequent in all the cases than in the respective controls. CONCLUSIONS: In the studied population, the presence of TMD was found to be positively related to factors namely female gender, parafunction, occlusal interferences, psychological stress, and tooth wear. Myofascial pain is the commonest diagnosis (either single or in combination). It is followed by DDWR (either single or in combination with others). Double diagnosis is also common. CLINICAL SIGNIFICANCE: Temporomandibular disorders showed a female predilection and were found to be positively related to factors, viz., parafunction, occlusal interferences, stress, and tooth wear. Clinicians should also be aware of common clinical manifestations of TMDs and their related stomatognathic risk factors to provide comprehensive oral care and to identify such factors for disease prevention.

Effect of Ball and Bar Attachment Type on Patient Satisfaction Using Two-Implant-Retained Mandibular Overdenture: A Crossover Randomized Clinical Trial.

Background: Considering the two-implant-retained overdenture as a first treatment of choice for edentulous mandible, patients using the overdentures need to be satisfied with the type of attachment used. The purpose of this study was to determine level of patient satisfaction with two-implant-retained mandibular overdentures opposing conventional maxillary complete denture using ball-socket and bar-clip attachments. Materials and Methods: In this within-subject crossover randomized clinical trial, total 20 edentulous patients were given conventional complete dentures for 3 months to use. All completed a satisfaction questionnaire before implant placement. They were randomly assigned to receive an overdenture retained by either ball or bar attachment. After 3 months satisfaction questionnaires were repeated, and crossover was done by changing the attachments. After use of 3 months of alternate attachments, patients were asked to complete the final questionnaires and asked to choose their preferred type. The patient satisfaction scores were recorded after using 3 months of conventional complete denture, 3 months of first attachment and 3 months of second attachment. Data were analyzed using Wilcoxon signed rank test. The P values were adjusted using Bonferroni multiple testing correction, and P < .05 were considered as statistically significant. Results: There was no significant difference in patient satisfaction between ball and bar attachments. However, patient satisfaction improved significantly between baseline and either-attachment-retained prosthesis. At the end of the comparative crossover experiment, 11 patients voted for the ball attachments and 9 for the bar attachments, thereby indicating them as their preferred attachments. Conclusions: Among ball and bar attachment, there was no statistically significant difference in satisfaction scores. Neither ball nor bar attachment was chosen as a preference over the other.

The color stability of maxillofacial silicones: A systematic review and meta analysis.

Aim: This systematic review aims to identify and interpret results of studies that evaluated the changes in the color stability of maxillofacial prosthetic materials due to chemical instability of silicones and pigments and the effect of exposure to environmental conditions and aging factors on the same. Settings and Design: This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines (PRISMA). Materials and Methods: Relevant articles written in English only, before November 15, 2019, were identified using an electronic search in the PubMed/Medline conducted to identify pertinent articles. The relevancy of the articles was verified by screening the title, abstract, and full text, if they met the inclusion criteria. A total of 42 articles satisfied the criteria, from which data were extracted for qualitative synthesis. This review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO registration number CRD42019124562). Statistical Analysis Used: Since considerable data heterogenicity was present in all studies except the ones on incorporation of TiO2 for which meta-analysis using random effects model was performed. Results: The database search resulted in 234 studies, of which 202 articles were excluded due to lack of relevance, duplication, and unavailability of data. The remaining 32 fulltext articles were assessed for eligibility, out of which 2 articles were excluded. Twelve articles were yielded by manual search. A total of 42 studies were included in the present systematic review. Due to heterogeneous data, meta-analysis could be only carried out with the effect of TiO2 nano particle on color stability. Conclusions: Although there has been extensive amount of research in this field, an ideal maxillofacial silicone exhibiting good color stability in various human and environmental aging conditions is yet to be identified. Human and environmental aging conditions have an adverse effect on the color stability and addition of TiO2 nano particle seems to improve the same.

COVID-19 pandemic and its impact on dental students: A multi-institutional survey.

PURPOSE/OBJECTIVES: To investigate dental students' perceptions and concerns regarding the COVID-19 pandemic, their coping strategies and support resources, and their perceived stress levels. METHODS: A customized 19-item survey and the perceived stress scale (PSS) were applied to undergraduate dental students from the US, Spain, Ireland, Chile, India, and Brazil between April 10 and July 5, 2020. Linear modeling and mediation analysis were used to explore the relationships among demographics, stressors, coping mechanisms, social support, and stress RESULTS: A total of 4475 students responded to the survey. The majority (72.4%) were women, and 52.3% had no COVID-19 training at the time of the survey. The students reported that they had to accommodate to changes in patient care (96.6%) and didactic learning (95.2%) activities, while 88.5% of the respondents indicated at least one of their courses moved online. Transition to online courses went "smoothly with some troubles" for 51.8% of the respondents, and 48.3% perceived the faculty as prepared for the online transition; however, 45.9% reported feeling extremely concerned about the impact of COVID-19 on their education. The average PSS score was 21.9 of 40 (moderate stress). Multivariate models were built for participants with full data (n = 3899). Being male, having completed more dental coursework, and perceiving a smoother transition were associated with lower PSS scores; more concern about academic progress was associated with higher PSS. Faculty support mediated the relationship between a smoothness of transition and concern about academic progress and PSS scores CONCLUSION: Stress caused by the pandemic may be alleviated by smoother transition and good faculty support.

Comparative evaluation of three types of denture base materials with saliva substitute before and after thermocycling: An in vitro study.

STATEMENT OF PROBLEM: Xerostomia refers to the decrease in the quality and quantity of saliva. In denture wearers, xerostomia affects the retention of the denture because of lack of wettability of the denture base. However, which denture base resin materials are best wetted by artificial salivary substitutes is unclear. PURPOSE: The purpose of this in vitro study was to determine the wetting properties of 3 different commercially available denture base resin materials with artificial salivary substitute by using contact angle measurements and to compare these properties before and after thermocycling. MATERIAL AND METHODS: A total 120 specimens were fabricated with 3 different denture base materials (n=40): heat-polymerized polymethylmethacrylate (DenTek), injection-molded nylon polyamide (Valplast), and microwave polymerized (VIPI WAVE). The advancing and receding contact angles were measured with a goniometer by using the WinDrop++ software program. The contact angle hysteresis was calculated from the advancing and receding contact angles values. The same specimens were subjected to thermocycling to measure the advancing and receding contact angles values. The comparative evaluation was carried out before and after thermocycling. RESULTS: The mean ±standard deviation contact angles of the microwave-polymerized material were (62.40 ±1.21 degrees) advancing contact angle, (32.12 ±0.66 degrees) receding contact angle, and (30.28 ±1.40 degrees) contact angle of hysteresis. It was followed by the injection-molded nylon polyamide material, whose mean ±standard deviation contact angle values were (68.57 ±1.72 degrees) advancing contact angle, (43.02 ±1.39 degrees) receding contact angle, (26.27 ±2.05 degrees) contact angle hysteresis and high impact strength heat-polymerized polymethylmethacrylate material, whose mean ±standard deviation contact angle values were (69.81 ±0.16 degrees) advancing contact angle, (41.90 ±1.02 degrees) receding contact angle, and (27.91 ±0.97 degrees) contact angle hysteresis. The statistical analysis showed significant differences among contact angle values of the microwave-polymerized material as compared with the heat-polymerized polymethylmethacrylate and injection-molded nylon polyamide materials (P<.001). CONCLUSIONS: The microwave-polymerized material showed better wettability with artificial saliva substitute than heat-polymerized polymethylmethacrylate and injection-molded nylon polyamide.

Evaluation of the educator's portfolio as a tool for self-reflection: Faculty perceptions.

Background: Preparing a teaching portfolio to document educational expertise has shown to be useful for both promotion and to stimulate faculty development. This article describes a study of the effectiveness of the Educator's Portfolio (EP) as a stimulus for faculty reflection about educational practice. Methods: A sensitizing session of thirty faculty from medical, dental, and physiotherapy colleges on the same campus was conducted; faculty members were asked to complete and submit their EPs. Out of 30 members, 25 responded (83%). Semi-structured interviews of 25 faculties who prepared EPs were conducted, and a qualitative content analysis of the resulting protocols was completed to determine how the EP development process had promoted their reflection on education. Results: All the 25 faculty members indicated that reflection about education had occurred. Four categories of reflection emerged, namely, (a) lack of understanding regarding how to categorize their work; (b) lack of evidence of the effectiveness of educational activities; (c) reformulating educational practice; and (d) source of motivation and self-regulation. Discussion: The findings indicate that EP preparation serves as a tool for reflection on educational practice, which promotes faculty development.

Comparative evaluation of diametral tensile strength of phosphate-bonded investment (ringless) material by using air-drying method, conventional hot air oven, microwave oven, and combination of microwave and conventional oven: An in vitro study.

AIM: This study evaluated and compared the diametral tensile strength (DTS) of phosphate-bonded investment (PBI) material (ringless) used in removable cast partial denture fabrication. SETTINGS AND DESIGN: Comparative - Invitro study. MATERIALS AND METHODS: The PBI material, Wirovest used in this study was subjected to four different drying methods. A total of 80 specimens were prepared in a cylindrical form; 20 specimens were air dried for 2 h, 20 specimens were dried in a conventional oven at 230°C for 1 h, 20 specimens were dried in microwave oven at 600 W for 10 min, and remaining 20 specimens were dried first in microwave oven and then in conventional oven. The dried specimens were tested at 2-h interval for diametral compression at a crosshead speed of 0.5 cm/min. STATISTICAL ANALYSIS USED: Pairwise analysis. RESULTS: The microwave drying technique and drying by combination method resulted in greater DTS, respectively. CONCLUSION: Within the limitation of this study, PBI specimens dried in microwave oven at 600W for 10 min increased the diametral strength and are also a time-saving procedure.

A Novel Mobile App for Oral Cancer Awareness amongst General Population: Development, Implementation, and Evaluation.

AIM: To develop a mobile app for education and screening regarding oral cancer in the general population. MATERIALS AND METHODS: A mobile app titled Prayaas-Oral Cancer Prevention, Treatment, and Rehabilitation was designed and developed to be installed on a basic mobile handset with or without internet. It was aimed for the common public, patients as well as healthcare providers. The contents included all information in the pictorial format as well as videos regarding oral cancer awareness, tobacco de-addiction, self-oral examination, various surgeries, and rehabilitation options. It was pilot tested in 50 factory workers of rural set-up. Participants' feedback was recorded using a self- report questionnaire. RESULTS: Overall feedback was very positive, they found the app easy to operate, enhancing knowledge regarding oral cancer and they recommended this to be used for the general population. CONCLUSIONS: Within limitations of this pilot study, it can be inferred that mobile technology can be successfully used to reach out to bottom of the pyramid population residing in inaccessible rural population for creating public health issues such as oral cancer. CLINICAL SIGNIFICANCE: Oral cancer is preventable through risk factor intervention especially tobacco de-addiction. The self- oral examination can be a very critical factor in early diagnosis of oral cancer. Access to care is a major issue in our country owing to low levels of education, lower income and exposure to risk factors such as tobacco. The fact that today there is widespread use of mobile technology by people belonging to all socioeconomic groups can be harnessed for this public health awareness initiative. This app can be used as a tool for patient education for prevention as well as early detection of oral cancer, both of which can be key to reduce oral cancer morbidity and mortality in India.

Mobile learning app: A novel method to teach clinical decision making in prosthodontics.

BACKGROUND: Prosthodontics involves replacing lost dentofacial structures using artificial substitutes. Due to availability of many materials and techniques, clinician's clinical decision-making regarding appropriate selection of prosthesis requires critical thinking abilities and is demanding. Especially during graduate training years, learners do not receive the exposure to a variety of cases, thus their clinical reasoning skills are not developed optimally. Therefore, using the trend of incorporating technology in education, we developed a mobile learning app for this purpose. The aim of this study was to evaluate learners' perceptions of this app's utility and impact on their clinical decision-making skills. METHODS: After taking informed consent, interns of the Department of Prosthodontics of VSPM Dental College, Nagpur, India, during the academic year May 2015-May 2016 were sent the link for the app to be installed in their Android smartphones. Their perceptions were recorded on a feedback questionnaire using 5-point Likert scale. The script concordance test (SCT) was used to check for changes in clinical reasoning abilities. RESULTS: Out of 120 students who were sent the link, 102 downloaded the link and 92 completed the feedback questionnaire and appeared for the SCT (response rate: 76%). The overall response to the app was positive for more than two-thirds of interns, who reported a greater confidence in their clinical decision-making around prostheses through this app and 94% of the students felt that this app should be regularly used along with conventional teaching techniques. Mean SCT scores were pretest 41.5 (±1.7) and posttest 63 (±2.4) (P < 0.005). DISCUSSION: Clinical decision-making in prosthodontics, a mobile learning app, is an effective way to improve clinical reasoning skills for planning prosthodontic rehabilitation. It is well received by students.

Impact of interprofessional education module on attitudes of health-care providers involved in maxillofacial rehabilitation: A cross-sectional study.

PURPOSE: Rehabilitation of maxillofacial deformities is a challenging task because it involves not only a lot of skills and expertise but also many disciplines working in unison for optimum outcome. However, more often than not a prosthodontist is not a member of tumor board and consulted after surgery which affects the prognosis of the rehabilitation adversely. There was a perceived need to create awareness among referring surgeons and physicians, and interprofessional education (IPE) initiatives were deemed necessary to improve this collaboration. METHODOLOGY: Four-hour IPE module was developed involving residents and faculty from three disciplines. The change in attitudes was evaluated quantitatively using Attitudes toward Health Care Teams questionnaire both before and after the module. Semi-structured interviews with selected participants provided the qualitative feedback. RESULTS: The questionnaire consisted of 14 questions answered on 5-point Likert scale (1-5). The mean score of pretest was 44.2 and of posttest was 49.1. Difference was statistically significant (P < 0.05). Higher score indicates better attitude. CONCLUSION: A brief IPE program can improve interprofessional attitudes and collaborative behavior of health-care professionals involved in maxillofacial rehabilitation. It enables the professionals to understand interact and share viewpoints regarding most critical issues faced by them and find solutions to achieve best possible patient care.

Development and evaluation of learning module on clinical decision-making in Prosthodontics.

PURPOSE: Best practice strategies for helping students learn the reasoning skills of problem solving and critical thinking (CT) remain a source of conjecture, particularly with regard to CT. The dental education literature is fundamentally devoid of research on the cognitive components of clinical decision-making. AIM: This study was aimed to develop and evaluate the impact of blended learning module on clinical decision-making skills of dental graduates for planning prosthodontics rehabilitation. METHODOLOGY: An interactive teaching module consisting of didactic lectures on clinical decision-making and a computer-assisted case-based treatment planning software was developed Its impact on cognitive knowledge gain in clinical decision-making was evaluated using an assessment involving problem-based multiple choice questions and paper-based case scenarios. RESULTS: Mean test scores were: Pretest (17 ± 1), posttest 1 (21 ± 2) and posttest 2 (43 ± 3). Comparison of mean scores was done with one-way ANOVA test. There was overall significant difference in between mean scores at all the three points (P < 0.001). A pair-wise comparison of mean scores was done with Bonferroni test. The mean difference is significant at the 0.05 level. The pair-wise comparison shows that posttest 2 score is significantly higher than posttest 1 and posttest 1 is significantly higher than pretest that is, pretest 2 > posttest 1 > pretest. CONCLUSION: Blended teaching methods employing didactic lectures on the clinical decision-making as well as computer assisted case-based learning can be used to improve quality of clinical decision-making in prosthodontic rehabilitation for dental graduates.

Impact of computer-based treatment planning software on clinical judgment of dental students for planning prosthodontic rehabilitation.

PURPOSE: Successful prosthodontic rehabilitation involves making many interrelated clinical decisions which have an impact on each other. Self-directed computer-based training has been shown to be a very useful tool to develop synthetic and analytical problem-solving skills among students. Thus, a computer-based case study and treatment planning (CSTP) software program was developed which would allow students to work through the process of comprehensive, multidisciplinary treatment planning for patients in a structured and logical manner. The present study was aimed at assessing the effect of this CSTP software on the clinical judgment of dental students while planning prosthodontic rehabilitation and to assess the students' perceptions about using the program for its intended use. METHODS: A CSTP software program was developed and validated. The impact of this program on the clinical decision making skills of dental graduates was evaluated by real life patient encounters, using a modified and validated mini-CEX. Students' perceptions about the program were obtained by a pre-validated feedback questionnaire. RESULTS: The faculty assessment scores of clinical judgment improved significantly after the use of this program. The majority of students felt it was an informative, useful, and innovative way of learning and they strongly felt that they had learnt the logical progression of planning, the insight into decision making, and the need for flexibility in treatment planning after using this program. CONCLUSION: CSTP software was well received by the students. There was significant improvement in students' clinical judgment after using this program. It should thus be envisaged fundamentally as an adjunct to conventional teaching techniques to improve students' decision making skills and confidence.

Evaluation of Effect of Astringent on Oral Mucosa as a Non-surgical Preprosthetic Treatment Modality in Edentulous Patients: An In Vivo Study.

Preprosthetic treatments are advocated in edentulous patients to enhance the denture bearing areas for good denture support. Most of the times the preprosthetic treatments are considered only in a surgical way. Ideally every edentulous patient undergoing complete denture treatment needs a non-surgical preprosthetic treatment. So that, the denture bearing area will be properly prepared before the denture construction. The present study was conducted on thirty completely edentulous male patients who had visited to our Institute for the treatment. Each patient was asked to massage with astringent gel on the denture bearing mucosa over a 4 weeks period. Exfoliative cytology was used to collect the surface cells from the palatal mucosa. First scrape was taken before the stimulation treatment was started. The second and third scrape was taken after the stimulation treatment with astringent gel for each patient. In this way total 90 scrapes were made and the each smear was stained with the Papanicolaou's technique to examine under light microscope. About 100 cells were counted from each stained smear. The number of parabasal cells, intermediate cells and superficial cells were recorded to calculate the degree of keratinization. Statistical analysis was performed. A significant difference (p < 0.001) in keratinization levels was found. The mean percentage of superficial cells before the stimulation treatment was 79.80 %; this percentage was gradually increased to 84.60 and 90.57 % after the 2  and 4 weeks period of stimulation treatment respectively with astringent gel.

Prosthodontic rehabilitation of dentinogenesis imperfecta.

Dentinogenesis imperfecta and its prosthodontic management is a challenging task. Treatment protocol varies according to clinical case. Although various reports in the literature suggest general guidelines for treatment planning, the present case report describes a full mouth rehabilitation of a young patient with dentinogenesis imperfecta treated by maxillary fixed partial dentures and mandibular fiber reinforced overdenture with metal occlusal surfaces.

Presurgical nasoalveolar moulding for a unilateral midfacial cleft: A case report.

Although surgical correction remains the mainstay of treating unilateral/bilateral cleft lip and/or palate deformities, some inadequacies still remain like scarring of the nasolabial complex, multiple interventions to achieve desired results, etc. Presurgical nasoalveolar moulding consists of selective repositioning by active moulding of the alveolar segments as well as the surrounding soft tissue. Clinical case of unilateral mid-facial cleft treated by the same, showed significant reduction in the defect size and improved contour of the columella-philtrum region for superior postsurgical esthetics.