Minimal invasive prosthetic rehabilitation of a patient with Down syndrome: A case report.

INTRODUCTION: Down syndrome (DS), an easily recognized congenital disease, is associated with a high prevalence of dental anomalies. Therefore, special dental care is required. CASE PRESENTATION: This case report described the minimally invasive prosthetic rehabilitation of a 31-year-old female patient with DS. Prompt diagnosis, consultation with physicians and family, and accurate medical history were needed, and relevant dental, medical, mental, and behavioral factors were considered. A minimally invasive treatment plan was decided after clinical examination, orthopantomography (OPG), and study model analysis. For the upper jaw, an over denture was constructed. For the lower jaw, a simple metal-frame partial denture was made. This treatment plan was decided after considering the difficulty in dentist-patient collaboration and a small maxilla with poor positioning of teeth and negative overbite and over jet. CONCLUSION: Considering different patient factors including patient cooperation, as well as the medical and dental conditions associated with DS, a minimally invasive prosthodontic treatment option was recommended.

The relationship between tooth color, skin and eye color.

PURPOSE: Tooth color is one of the most important factors in dental and facial esthetics. The aim of this study was to determine the tooth color of the upper frontal teeth in subjects and to provide comparisons with different skin and eye colors. MATERIAL AND METHODS: Tooth color was determined in 255 patients in the intercanine sector of the maxilla using an intraoral spectrophotometer Vita Easyshade® (Vita Zahnfabrik. H Rauter GmbH & Co. KG. Bad Sackingen. Germany). Skin and eye color was determined by visual perception. The shades of the Vita Tooth Guide 3D Master (Vita Zahnfabrik, H Rauter GmbH & Co, KG, Bad Sackingen, Germany) were registered by the spectrophotometer. Pearson's chi-squared test was used to examine the differences between tooth color and skin and eye color. RESULTS: The most frequent shade registered in the central incisors was 2M1 (62 subjects, 8.10%); in the lateral incisors, 1.5M1.5 (65 subjects, 8.50%); and in the canines, 2M3 (142 subjects, 18.56%). Pearson's chi-squared test results showed a statistically significant difference in the relations between skin and eye color and central incisor color (p<0.01; p<0.001), lateral incisor color (p<0.001), and canine color (p<0.001; p=0.001). On the other hand, no significant difference was observed in the relation of the lateral incisors and canines with eye color. CONCLUSION: Skin and eye color significantly correlate with tooth color; however, the color of lateral incisors and canines does not correlate significantly with eye color.

Evaluation of the Masticatory Efficiency at the Patients with New Complete Dentures.

BACKGROUND: There are a lot of factors influencing the efficiency of mastication; therefore there are also a lot of methods for testing this efficiency. OBJECTIVE: The study aimed to test the efficiency of mastication and evaluate it in the function of time, based on previous experience with the complete dentures. METHODS: A total of 88 patients (42 female, 46 male, mean age 52.2, SD = 5.76), complete dentures wearers, participated in this study. Masticatory functions were investigated by using the method of electromyography (EMG), analyzing electromyomasticatiogram. For testing the masticator efficiency, the further parameters of the masticatiogram were used: duration of the Standard Masticatory Task (SMT) (t), number of the masticatory cycles within the masticator arch (F) and maximal amplitude within the masticatory arch (F). All data were statistically analysed by using standard software package BMDP (bio-medical Statistical package). Parametric data have been tested using One Way Repeated Measurement of ANOVA test. RESULTS: The changes of the relation A/t are evident in different time intervals in both measured sides: F-DS-time of the measurement = 34.86, P = 0.0000; F-NDS- time of the measurement = 26.1, P = 0.0000. There are also differences of the masticatory index A/t between sexes in both, dominant and non-dominant side: F-DS-gender = 237.05, P = 0.0000; F-NDS-gender = 12.90, P = 0.004. Masticatory index (A/F) varies in time, from first to the sixth measurement in both sides: F-DS-time of the measurement = 32.36, P = 0.0000; F-NDS-time of the measurement = 30.53, P = 0.0000. The interaction of the time and gender was also important: F-DS-interaction = 6.95, P = 0.0000; F-NDS-interaction = 14.9, P = 0.0000. CONCLUSION: Masticator indexes are A/F, and A/t are a very important indicator of the masticatory efficiency and the level of the functional adaptation on complete dentures. Both masticator indexes show the same dynamics (reaching the stationary condition after the 15th week after getting new dentures). After the observing period, all examinee express the same degree of masticator efficiency known as functional adaptation. Patients with previous experience with complete dentures reach faster the stationary condition, compared with those non-experienced.

ElectromyoFigureic Evaluation of Functional Adaptation of Patients with New Complete Dentures.

OBJECTIVE: The objective of this study was to evaluate the level of adaptation of patients to newly fitted complete dentures in their dominant and nondominant sides, by means of ElectromyoFigureic signals. MATERIALS AND METHODS: Eighty-eight patients with complete dentures were evaluated in the study. Masticatory muscle (masseter and temporal) bioelectric activity of the patients with complete dentures was recorded at maximum intercuspal relation. Parametric statistical data were analyzed with one-way repeated measures ANOVA test. RESULTS: Measurement time was significantly different for both dominant (DS) and nondominant (NDS) sides: FΣs-DS = 21.51, p=0.0001; FΣs-NDS = 13.25, p=0.0001. Gender was also significantly different: FΣs-DS-gender = 41.53, p=0.001; FΣs-NDS-gender = 85.76, p=0.0001. The average surface area values showed significant difference in females. Prior experience with dentures showed no significant difference for both sides of mastication: FΣs-DS-experiences = 1.83, p=0.1772; F Σs-NDS-experiences = 3.30, p=0.0697. CONCLUSION: The planimetric indicators of bioelectric activity of masseter and temporalis muscles at maximum physiological loading conditions are significant discriminators of the level of functional adaptation of patients with new complete dentures.

Adjunctive Platelet-Rich Plasma (PRP) in Infrabony Regenerative Treatment: A Systematic Review and RCT's Meta-Analysis.

BACKGROUND AND OBJECTIVE: The purpose of this study was to highlight the clinical performance of platelet-rich plasma (PRP) used as an adjunctive tool for regeneration in infrabony periodontal defects using different biomaterials or performing different surgical flap approaches. Comparative evaluation of main clinical outcomes as probing pocket depth reduction, clinical attachment gain, and recession reduction with and without the use of PRP has been analysed. MATERIALS AND METHODS: According to the focused question, an electronic and hand searching has been performed up to December 2016. From a batch of 73 articles, the selection strategy and Jadad quality assessment led us to include 15 studies for the meta-analysis. RESULTS: Despite the high heterogeneity found and the lack of complete data regarding the selected clinical outcomes, a comparative analysis has been possible by the categorization of used biomaterials and surgical flap approaches. This method led us to observe the best performance of grafts with the use of adjunctive PRP in CAL gain and PPD reduction. No difference has been outlined with a specific surgical flap. CONCLUSIONS: Although PRP is considered a cheap and patient's derived growth factor, the not conclusive data reported would suggest that its use in addition to bone substitutes could be of some clinical benefit in the regenerative treatment of infrabony defects. CLINICAL RELEVANCE: This systematic review was intended to sort out the huge controversial debate in the field about the possible use of PRP in regenerative surgery in infrabony defect. The clinical relevance of using blood-borne growth factors to conventional procedures is effective as these could determine a better performance and outcomes despite the surgical approach adopted and limit the use of additional biomaterials for the blood clot stabilization.

Evaluation of Maximum Bite Force in Patients with Complete Dentures.

OBJECTIVE: This study aimed to evaluate maximum bite forces (mBF) in dominant (DS) and non-dominant sides (NDS) at certain time periods after the insertion of new complete dentures based on prior experience and gender. MATERIALS AND METHODS: A total of 88 patients, complete denture wearers (CDWs), were examined. The maximum bite force at the intercuspal position between the first molars in 3 seconds was registered and recorded with piezoelectric gnathodynamometer. The procedure was repeated 3 times in identical conditions, with relaxation intervals of 1 minute between repeats and the limiting factor was the subjective feeling of pain. Testing of parametric data was performed with One Way Repeated Measurement of ANOVA test. RESULTS: The average mBF values increased during the observational period, both on the DS and NDS, with significant difference in DS, which was greater. The analysis of one-factor variance showed that there were differences of average mBF values in DS and NDS during six consecutive measurements (mBF-DS = 11.3, p = 0.0001, and mBF-NDS = 2.26, p = 0.047). Significant changes in the masticatory force (mBF) on the DS and NDS is explained by different measurement times and with the prior experience with complete dentures, BF-DS = 11.76, p = 0.0000; mBF-NDS = 2.42, p = 0.0351; mBFe-DS = 40.48; P = 0.0000 mBFe-NDS = 39.93, p = 0.0000. CONCLUSION: mBF represents a significant discriminating variable of the level of functional adaptation of new complete denture wearers (nCDWs) about the initial measurements.

The Effect of Gaseous Ozone in Infected Root Canal.

OBJECTIVES: During the treatment of chronic apical periodontitis and pulp necrosis the main role is to irrigate the root canal. AIM: The aim of this in vivo study was to irrigate with 0.9% NaCl (Natrium Chloride), 2.5 % NaOCl (Sodium Hypochlorite Solution, Sigma Aldrich - Germany) and 2% CHX (Chlorhexidine Digluconate Solution, Sigma Aldrich - Spain) combined with Gaseous Ozone (Prozone WH, Austria). MATERIAL AND METHODS: This study was realised in the University Dentistry Clinical Centre of Kosovo (UDCCK), respectively in the Department of Endodontic and Dental Pathology, Dental Branch, Faculty of Medicine, Prishtina, Kosovo. The 40 subjects involved in this study belonged to both genders, in age between 15 -65 years. The sample selection was randomised. The retroalveolar radiography for each patient was taken in the suspected tooth. As a therapeutic plan the authors decided to disinfect the root canal with the irrigants, as follows: 2.5 % NaOCl, 2 % CHX and gaseous ozone. RESULTS: The statistical analyses were based on Kruskal - Vallis test, X - test, DF = 3, r < 0.01. In the isolated average number of the aerobe and anaerobe bacteria colonies, when gaseous ozone was used, there was the significant statistical difference. CONCLUSIONS: When gaseous ozone was combined with irrigants 0.9%, 2.5 % NaOCl and 2% CHX, it was concluded that the number of colonies of aerobic and anaerobic bacteria was reduced.

Evaluation of Sensibility Threshold for Interocclusal Thickness of Patients Wearing Complete Dentures.

OBJECTIVE: The aim of this study was to evaluate sensibility threshold for interocclusal thickness in experienced and nonexperienced denture wearers after the insertion of new complete dentures. MATERIALS AND METHODS: A total of 88 patients with complete dentures have participated in this study. The research was divided into two experimental groups, compared with the previous experience prosthetic dental treatment. The sensibility threshold for interocclusal thickness was measured with metal foil with 8 µm thickness and width of 8 mm, placed between the upper and lower incisor region. Statistical analysis was performed using standard software package BMDP (biomedical statistical package). RESULTS: Results suggest that time of measurement affects the average values of the sensibility threshold for interocclusal thickness (F = 242.68, p = 0.0000). Gender appeared to be a significant factor when it interacted with time measurement resulting in differences in sensibility threshold for interocclusal thickness (gender: F = 9.84, p = 0.018; F = 4.83, p = 0.0003). CONCLUSION: The sensibility threshold for interocclusal thickness was the most important functional adaptation in patient with complete dentures. A unique trait of this indicator is the progressive reduction of initial values and a tendency to reestablish the stationary state in the fifteenth week after dentures is taken off.

Lightness, chroma, and hue distributions in natural teeth measured by a spectrophotometer.

OBJECTIVE: The aim of the study was to analyze the distribution of color parameters, lightness (L*), chroma (C), hue (H), a* and b*, in the intercanine sector in maxilla. MATERIAL AND METHODS: Patients' tooth color measurements were performed using an intraoral spectrophotometer VITA Easyshade® (VITA Zahnfabrik H. Rauter GmbH and Co. KG, Bad Sackingen, Germany). The measurements were made in 255 subjects in the intercanine sector in maxilla. RESULTS: The mean values for the group of 255 subjects were as follows: L*, a*, b*, C, and H as 81.6, 0.67, 21.6, 21.7, and 92.7, respectively. For F=206.27 and P < 0.001 between L*, a*, b*, C, H, and central incisor/lateral incisor/canines, there were statistically significant differences. CONCLUSION: With the statistical analysis, it was determined that there are significant color differences between the teeth of the intercanine sector, which differences are clinically significant also.

Patient's Satisfaction with Removable Partial Dentures: A Retrospective Case Series.

This retrospective clinical study aimed to assess patient's satisfaction with removable partial dentures (RPDs), as retention, chewing ability, aesthetics during the observation period. MATERIAL AND METHODS: A total of 63 patients with RPDs, participated in this study. The following data was collected: Kennedy classification, denture design, denture support, satisfaction and success of RPD. RESULT: The results showed that 73.6% of patients were wearing RPD for the first time and were finally satisfied. According to the denture support of RPDs, clasp-retained quadrangular RPDs were 100% effective, followed by triangular dental support 81% and linear dental support 47.7%. Comparison of RPDs with attachment with RPDs with claps assessed through Fisher exact test, confirmed statistically significant difference (P=0.008), despite retention; however, chewing ability and aesthetics showed no statistically significant difference with X 2 test on patient's satisfaction with RPD with or without attachment. CONCLUSION: Patients often would prefer not showing the anterior buccal clasps of RPD, therefore are generally satisfied more with RPD with attachment based on level of retention, chewing ability and aesthetics.

The influence of removable partial dentures on the periodontal health of abutment and non-abutment teeth.

OBJECTIVE: The aim of this study was to evaluate the influence of removable partial dentures (RPD) on the periodontal health of abutment and non-abutment teeth. MATERIALS AND METHODS: A total 107 patients with RPD participated in this study. It was examined 138 RPD, they were 87 with clasp-retained and 51 were RPD with attachments. The following periodontal parameters were evaluated for abutment and non-abutment teeth, plaque index (PLI), calculus index (CI), bleeding on probing (BOP), probing depth (PD) (mm) and tooth mobility (TM) index. These clinical measurements were taken immediately before insertion the RPD, then one and 3 months after insertion. The level of significance was set at (P < 0.05). RESULTS: The mean scores for PLI, CI, BOP, PD, and TM index, of the abutment teeth and non-abutment teeth were no statistically significant at the time of insertion of RPD. After 1-month, PLI was statistically significant (0.57 ± 0.55 for abutment and 0.30 ± 0.46 for non-abutment teeth). After 3 months, there were significant differences between abutment and non-abutment teeth with regard to the BOP (1.53 ± 0.50 and 1.76 ± 0.43 respectively), PD (0.28 ± 0.45 and 0.12 ± 0.33 respectively) and PLI (1.20 ± 0.46 and 0.75 ± 0.64 respectively). No significant mean difference in TM and CI was found between the abutment and non-abutment teeth (P > 0.05). CONCLUSIONS: With carefully planned prosthetic treatment and adequate maintenance of the oral and denture hygiene, we can prevent the periodontal diseases.

Differences between centric relation and maximum intercuspation as possible cause for development of temporomandibular disorder analyzed with T-scan III.

OBJECTIVE: To compare subjects from the group with fixed dentures, the group who present temporomandibular disorders (TMDs) and a control group considering centric relation (CR) and maximum intercuspation (MIC)/habitual occlusion (Hab. Occl.) and to analyze the related variables also compared and analyzed with electronic system T-scan III. MATERIALS AND METHODS: A total of 54 subjects were divided into three groups; 17 subjects with fixed dentures, 14 with TMD and 23 controls-selection based on anamnesis-responded to a Fonseca questionnaire and clinical measurements analyzed with electronic system T-scan III. Occlusal force, presented by percentage (automatically by the T-scan electronic system) was analyzed in CR and in MIC. RESULTS: Data were presented as mean ± standard deviation and differences in P < 0.05 were considered significant. After measurements of the differences between CR and MIC in the three groups were noticed varieties but the P > 0.05 it was not significant in all three groups. CONCLUSION: In our study, it was concluded that there are not statistically significant differences between CR and MIC in the group of individuals without any symptom or sign of TMD although there are noticed in the group with TMD and fixed dentures disharmonic relation between the arches with overload of the occlusal force on the one side.