Less Is More: A Case Report on All-on-4 Prosthesis.

Severe alveolar ridge atrophy following tooth removal poses a common and worsening issue in edentulous jaws, affecting patient comfort and quality of life. The All-on-4 approach involves axially positioning two anterior implants and distally orienting two posterior implants, reducing cantilever length and enabling prostheses with 12 teeth. This less invasive option, utilizing distal tilting of implants at 30°, offers biomechanical advantages and has shown short-term success, though long-term research is limited. Immediate-loading treatments are gaining popularity for their high survival rates. Understanding the biomechanics of implant-supported prostheses is crucial for long-term success, emphasizing the importance of optimal occlusal schemes. Challenges such as bone defects and surgical complexity have led to the exploration of achieving full-arch fixed restorations with fewer implants, building upon Brånemark's early work with four implants. The All-on-4 concept, originating in 1999, proves to be a viable treatment option, providing excellent long-term results and improved load distribution in challenging clinical circumstances. This case report explores the successful rehabilitation of a jaw using the All-on-4 implant prosthesis concept, a technique strategically placing four implants in completely edentulous jaws to support a fixed, immediately loaded prosthesis.

Digitization in Skin Shade Matching for Maxillofacial Prostheses: A Systematic Review.

Color matching of maxillofacial prostheses for the restoration of maxillofacial defects is an important factor for esthetic results. Various methods have been introduced for the accurate and reliable color matching of prostheses with the skin color of patients. A systematic review was conducted to search the existing literature on color-matching digital techniques for maxillofacial prostheses. An electronic literature search was conducted in PubMed/Medline, Scopus, and Web of Science from January 2000 to December 2022 using Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Two independent reviewers conducted the search. Eight articles that fulfilled the inclusion criteria after a full-text evaluation were included in this review. Most of these studies were published in prosthodontics journals and conducted in various countries around the world. A computerized color formulation system was used in three studies; a non-contact spectroradiometer (PR 705; Photo Research Inc., Chatsworth, CA) with a Xenon arc lamp was used in two studies; a mobile phone colorimeter was used in one study; additive manufacturing of 3D facial skin with a spectrophotometer was used in one study; and a recently introduced computerized method known as e-skin (Spectromatch, Bath, UK) was used in two studies. Most of these methods were accurate in color matching, except for the additive manufacturing system, which showed less accuracy, but good repeatability. Owing to a lack of sufficient studies, no method can be labeled as the best method for color-matching maxillofacial prostheses. The latest computerized method, the e-skin, can be used to achieve better accuracy and good color matching. However, further studies are required to validate the use of e-skin for precise color matching.

Quad Zygoma: A Graftless Solution in Post-mucormycosis Maxillectomy.

Mucormycosis, a fungal infection that commonly affects individuals with diabetes and compromised immune systems, often requires surgical excision and debridement. However, this can result in significant defects, posing a challenge for clinicians in terms of reconstruction and rehabilitation. Prostheses, local and regional pedicled flaps with or without bone grafts, and titanium mesh application are available options for maxillary reconstruction. Soft-tissue flaps are not sufficient to provide osseointegrated implants with both bone repair and structural support, which emphasises the quad zygoma's beneficial role in treating maxillary abnormalities. Patients benefit from quad zygoma, which uses zygomatic implants and eliminates the need for subsequent procedures, which shortens the course of treatment and lowers costs. Because zygomatic implants are securely fixed into the zygoma, temporary prostheses can be loaded right away. Then, four to six months later, a fixed prosthesis may be introduced. Clinical results with zygomatic implants often surpass those of bone grafting, representing a potential novel gold-standard approach for the compromised maxilla. This case report details the rehabilitation of post-mucormycosis patients with maxillary defects using quad zygomatic implants. The absence of complications during follow-up, conducted at 15, 30, 45, and 90 days, and subsequently monthly for two years, highlights the success of this approach. Evaluation parameters included soft tissue recovery, infection, wound separation, stability of prosthesis, eating effectiveness, and aesthetic outcomes. The positive outcomes observed at follow-up appointment emphasize the viability and effectiveness of quad zygomatic implants in addressing maxillary defects post-mucormycosis.

Enhancing Esthetics Using Prosthetic Cheek Plumper With Magnet Retention for Rehabilitation of an Edentulous Patient: A Case Report.

The patient's state of health is significantly impacted by aesthetics. The face undergoes various changes as we age, including the loss of fat and muscle tonicity. The loss of teeth and these modifications accentuate the look of sunken cheeks. As a result, facial deformity may have an effect on a person's mental health, especially young people who are edentulous patients. Cheek plumpers and complete dentures (CDs) can be utilized to help these people recover or enhance aesthetics. The manufacturing of a CD with magnets is described in this case report.

Comparative evaluation of effect of microcurrent electrical stimulation on acupoints to control gag reflex in patients receiving prosthodontic treatment: An in vivo study.

Aims: The aim of this study is to see if microcurrent electrical stimulation on two acupoints, auricular and Hegus, can help patients prevent their gag reflex. Settings and Design: This was an in vivo cross-sectional study. Materials and Methods: Thirty patients were randomly assigned to three groups: A, B, or C, of ten patients present in each group. Group A and Group B undergone electroacupuncture (microcurrent electrical stimulation) using electroacupuncture device on auricular point and Hegus point (Li 4), respectively, for 1 min and Group C formed the placebo group, point Shou San Li (Li 10). The gag severity index and the gag prevention index were used to measure the gag reflex, which was done in two steps. Statistical Analysis Used: SPSS (SPSS Inc., Chicago IL, USA) version 24 software was used for statistical analysis. Paired t-test, one-way analysis of variance test, post hoc Bonferroni test was used to analyse and compare the data. Results: It was found that Point A and Point B were significantly effective in reducing the severity of gag reflex. Point C demonstrated insignificant results. In addition, Point B (Hegus [Li4]) is more effective than Point A (auricular) in controlling the gag reflex in patients within the set age group of 20-70 years of age. Conclusions: Microcurrent electrical stimulation is a useful adjuvant in the treatment of unfavorable gag reflexes during routine dental procedures. Point Hegus and point auricular acupuncture are both useful in decreasing the severity of gag reflex, with point Hegus being more effective than point auricular.

An appraisal of bone resorption in completely edentulous diabetic and nondiabetic patients at prospective implant site in anterior mandible using digital volumetric tomography and its correlation with glycemic control: A case-control study.

PURPOSE: The prospective case-control study aimed at comparing bone resorption at prospective implant sites in anterior mandible between diabetic and nondiabetic patients using digital volumetric tomography (DVT) and establishes a correlation between glycemic control and residual ridge resorption. MATERIALS AND METHODS: Twenty apparently healthy and 20 type 2 diabetic edentulous male patients between the age group of 55-65 years providing with written consent were recruited in the present study. First-time denture wearers were considered who were edentulous for at least 1 year. Glycated hemoglobin (HbA1c) analysis of all individuals were done to affirm the diagnosis and quantify glycemic control. DVT of all the individuals were performed and bone height was determined at 5 prospective implant sites were determined, on the same scans Wical and Swoope method was used to determine the residual ridge resorption on the right and left side of mandible for all the individuals. The data wer tabulated and descriptive and analytical statistics were performed to compare bone resorption between diabetic and nondiabetic groups. Pearson's correlation was carried out to establish correlation between glycemic control and residual ridge resorption. RESULTS: There was no statistical difference between the bone height measurements at prospective implant sites between diabetic and nondiabetic groups. The residual ridge resorption was more in diabetics when compared to nondiabetics, and a significant moderate negative correlation existed between the glycemic control and residual ridge resorption on left (r = -0.541; P ≤ 0.001) and right (r = -0.408; P = 0.009) side of the mandible. CONCLUSION: It can be concluded from the present study that bone resorption at prospective implant sites is statistically similar in diabetics when compared to nondiabetics. Patients with poor glycemic control show increased residual ridge resorption.

Evaluating the Color Stability of Ocular Prosthesis after Immersion in Three Different Immersion Media: An In Vitro Study.

BACKGROUND: Immersion media such as ophthalmic irrigation solution, eye lubricant solution, and neutral soap solution will be the best, which will help in the longevity as well as the color stability of ocular prostheses. AIM: The aim of this study was to evaluate and compare color stability of ocular prosthesis after immersion in three different immersion media. MATERIALS AND METHODS: A total of 90 samples of scleral acrylic resin were prepared, which were painted with natural dry earth pigment NEAS and then were divided into three groups. These samples were checked before and after immersion in respective media after 8 weeks. To assess the color change, a spectrophotometry test was performed and the results were statistically analyzed by one-way analysis of variance and post hoc Tukey's test. RESULTS: Among all the three groups, the samples immersed in neutral soap solution proved to be most color stable, followed by eye lubricant solution, and the least color stable among the three was ophthalmic irrigating solution. CONCLUSION: The neutral soap solution proved to be the most color stable.

Positioning of iris in an ocular prosthesis: A systematic review.

AIM: To evaluate different methods, techniques, and concepts documented in the literature to assess iris positioning accurately to the related dimensions needed to effectuate maxillofacial rehabilitation of ocular prosthesis. SETTINGS AND DESIGN: This systematic review was conducted as per the PRISMA guidelines which is the most opted reporting protocol. MATERIALS AND METHODS: Two electronic databases PubMed and Cochrane Library) were searched for manuscripts published from 1969 till September 30, 2019. An electronic search (of peer review restricted to English language dental literature was conducted to identify the relevant scientific article on iris positioning in maxillofacial prostheses. Two observers independently read the abstracts and selected 17 full text articles fulfilling the inclusion criteria. STATISTICAL ANALYSIS USED: No meta-analysis was conducted due to heterogeneity of data obtained. RESULTS: All the 17 documented articles related to determination of the iris positioning to perform maxillofacial prosthetic rehabilitation depicting the use of a strip of plastic template, a Boley's gauge, a millimeter ruler, a pupillometer, window light, an ocular locator with fixed caliper, inverted anatomic tracings, a transparent graph grid were reviewed systematically. CONCLUSION: Currently, there is no evidence in the form of a systematic review of the available literature discussing the best technique available for perfectly matching the iris positioning. However, the latest techniques making use of digital technology such as digital photography, is believed to be more precise for iris positioning in the ocular prosthesis.

Evaluation of the effect of different surface treatments on the bond strength of non-precious alloy‒ceramic interface: An SEM study.

Background. Dental porcelain has excellent esthetics in combination with biocompatibility and is one of the most commonly used restorative materials. Its low tensile strength remains a major drawback. The porcelain-fused-to-metal restorations have been introduced to increase the fracture resistance of dental porcelain. The aim of this study was to evaluate the effect of different surface treatments on the bond strength of a non-precious alloy to ceramic. Methods. The present cross-sectional observational study was conducted with forty samples of cobalt‒chromium that were fabricated with porcelain interposed between the two metal test pieces. The metal was subjected to combinations of different surface treatments. The samples group A (n=10) were not subjected to any surface treatments. Group B samples underwent sandblasting and surface grinding. Group C samples were subjected to sandblasting, surface grinding and degassing; and group D samples underwent sandblasting, surface grinding, ultrasonic cleaning and degassing. The tensile bond strength was measured in a universal testing machine, and a scanning electron microscope (SEM) was used to obtain images of the samples after surface treatment to determine the surface irregularities and after the debonding of the samples for the type of the bond failure. ANOVA was used for the statistical analysis. Results. The results showed significant variations in the tensile bond strength between the four groups (F=251.05, P=0.000). The SEM images of group A showed no surface irregularities; group C samples exhibited surface irregularities more than those in group B. Group D had the highest surface irregularities. SEM evaluations showed a statistically significant difference in the type of bond failure (P<0.001). Conclusion. Based on the results of this study, it can be concluded that the surface treatments on the metal increased the bond strength of the metal‒ceramic interface significantly. A combination of sandblasting, surface grinding and ultrasonic cleaning, followed by degassing, resulted in the highest tensile bond strength.

Perception of Buccal Corridor Space on Smile Aesthetics among Specialty Dentist and Layperson.

OBJECTIVES: The aim of this study was to assess and compare the perception of smiles with and without buccal corridor spaces (BCSs) among prosthodontists, orthodontists and laypersons on smile aesthetics. MATERIALS AND METHODS: Smiling photographs of subjects with wide BCSs were collected and digitally manipulated to eliminate the BCSs. Digitally altered and unaltered photographs were placed together and assessed for aesthetic appeal using visual analog scale of one to ten by prosthodontists, orthodontists, and laypersons. One-way analysis of variance (ANOVA) and two-way ANOVA were applied to evaluate the collected data using the Statistical Package for the Social Sciences (SPSS 22), Epi Info 6.0, and GraphPad Prism, version 6.0. RESULTS: The total mean value scores of smiles with BCSs were significantly higher than those of smiles without BCSs (P < 0.001). Orthodontists and prosthodontists significantly appreciated BCSs and graded the smiles with BCSs to be much more attractive (P > 0.005). Laypersons rated the smiles with BCSs with greater mean values, but the difference in mean values of smiles with and without BCSs was not significant (P < 0.005). No significant difference was found between the perceptions of prosthodontists and orthodontists. CONCLUSION: The results of this study reveal that the smiles with BCSs were notably more desirable than the smiles without BCSs. Laypersons, orthodontists, and prosthodontists evaluated smiles differently. The smiles with BCSs were appraised much more pleasing by prosthodontists and orthodontists. Laypersons could not significantly appreciate BCSs, but rated smiles with BCSs as more acceptable.

"Comparative Evaluation of the Effect of Three Polishing Agents on Staining Characteristics of Provisional Restorative Material:" An in vitro Study.

AIM: The present study aimed to evaluate the effect of three various polishing agents on provisional restorative material on immersion in a staining solutions. OBJECTIVES: The objective of the study is (1) To evaluate the effect of pumice on staining characteristics of provisional restorative material before and after immersion in chlorhexidine. (2) To evaluate the effect of aluminum oxide paste on staining characteristics of provisional restorative material before and after immersion in chlorhexidine. (3) To evaluate the effect of diamond paste on staining characteristics of provisional restorative material before and after immersion in chlorhexidine. (4) To compare and assess the outcome of three polishing agents on staining characteristics of provisional restorative material. MATERIALS AND METHODS: Sixty samples (10 mm × 2 mm) were fabricated of bis-acryl composites (Protemp™ 4) by utilizing a metal mold. The samples were grouped into three groups (n = 20), and various polishing agents were used, including pumice, aluminum oxide paste, and diamond polishing paste. The samples that were not exposed to any polishing agent served as the control group. The samples were kept in a water bath for a day at 37°C and were stained with chlorhexidine mouthwash. The color of all specimens was measured with a spectrophotometer before and after polishing, and color changes (ΔE) were calculated. RESULTS: By using one-way ANOVA, significant difference was found in mean color change in three polishing materials (F = 4.44, P = 0.016). By using Tukey test, statistically significant difference was found among pumice and aluminum oxide paste (P = 0.027), among pumice and diamond paste (P = 0.041) and no significant difference was found among aluminum oxide paste and diamond paste (P = 0.985). CONCLUSION: Pumice exhibited less staining which was statistically significant when compared with aluminum oxide paste and diamond paste. Hence, it can be considered the most efficient polishing agent.