Validation of the "obturator functioning scale" for Chinese-speaking patients with obturator prostheses after cancer-related maxillectomy.

Objective: The Obturator Functioning Scale (OFS) is a scale without formal measures of validity in any language. This study aimed to translate and adapt the OFS from English to Chinese and check its reliability and validity in Chinese-speaking patients with obturator prostheses after cancer-related maxillectomy. Methods: The 15-item Chinese preversion of the OFS was completed by 133 patients in three tertiary stomatological hospitals. Of these, 41 completed it again one week after the first measurement. The patients also completed the Chinese version of the University of Washington quality of life scale (UW-QOL, Version 4). Results: Item 12 ("upper lip feels numb") was deleted to achieve a better statistical fit. The 14-item Chinese version of the OFS (OFS-Ch) demonstrated high internal consistency (Cronbach's alpha = 0.908). The test-retest reliability coefficients for most items exceeded 0.90, indicating substantial reproducibility. Confirmatory factor analysis found that the scale consisted of three correlated factors: 1) eating (four items), 2) speech (five items), and 3) other problems (five items). This explained 70.2 % of the total variance using exploratory factor analysis. The scale was significantly convergent and discriminant and could validly discriminate between patients with Brown I and IId maxillary defects. Conclusions: Our results showed that the OFS-Ch scale is a valid tool for evaluating oral dysfunction and satisfaction with appearance for patients with the obturator prosthesis and identifying those at risk of poor obturator function in clinical settings.

Quality of life in patients with cancer-related Brown IIb maxillary defect: A comparison between conventional obturation rehabilitation and submental flap reconstruction.

OBJECTIVES: The purpose of this retrospective study was to compare the differences in quality of life (QOL) outcomes between the conventional obturator prostheses (COP) and the pedicled submental artery island flap (SAIF) in the reconstruction of Brown IIb maxillary defects. MATERIALS AND METHODS: The QOL of 116 eligible patients who had a lapse ≥ 12 months after the cancer-related maxilla ablation was evaluated by the University of Washington quality of life scale (UW-QOL), Performance Status Scale for Head and Neck (PSS-HN), and Obturator Functioning Scale (OFS). RESULTS: Patients in the SAIF group reported statistically and clinically significant higher overall QOL scores but lower chewing scores in the UW-QOL scale when compared with those in the COP group (P < 0.05). Clinically significantly higher scores were also observed in the recreation and anxiety domains in the UW-QOL scale for the SAIF group, but there was no statistical significances. The COP group reported more complaints about the nasal leakage when swallowing and the shape of the upper lip, and had a stronger willingness to avoid family or social events in the OFS (P < 0.05). CONCLUSIONS: For patients with Brown IIb defects, SAIF reconstruction can achieve reduced nasal leakage when swallowing, improved upper-lip contour, increased social activity, and superior overall QOL than COP. The inferior chewing function in the SAIF group indicated the need for dental rehabilitation with a conventional denture or osseointegrated implants.

3D Evaluation of Accuracy of Tooth Preparation for Laminate Veneers Assisted by Rigid Constraint Guides Printed by Selective Laser Melting.

OBJECTIVE: To design and fabricate 3D-printed rigid constraint guides for the tooth preparation for laminate veneers and to evaluate the accuracy of guide-assisted preparation. METHODS: Twenty maxillary right central incisor resin artificial teeth were randomly divided into two equal groups and prepared for laminate veneers. Tooth preparations were performed, assisted by guides in the test group and by depth gauge burs in the control group, and both were finished by freehand operation. The typodonts were 3D scanned before preparation, after initial preparation and after final preparation. The tooth preparation depths at each step, including initial preparation depth, final preparation depth and loss of tooth tissue during polishing, were measured by 3D deviation analysis. Statistical analyses were conducted to investigate differences. RESULTS: The initial preparation depth was 0.488 mm (median, quartile 0.013 mm) in the test group and 0.521 mm (median, quartile 0.013 mm) in the control group. A statistically significant difference was found between them (P < 0.05). The final preparation depth in the test group (0.547 ± 0.029 mm) was significantly less than that in the control group (0.599 ± 0.051 mm) (P < 0.05), and closer to the predesigned value (0.5 mm). There was no statistically significant difference in the loss of tooth tissue during polishing between the test group (0.072 ± 0.023 mm) and the control group (0.089 ± 0.038 mm) (P > 0.05). CONCLUSION: In maxillary central incisors, the tooth preparation for laminate veneers could be conducted using 3D-printed rigid constraint guides, the accuracy of which is better than that of depth gauge burs.

[Constructing 3-dimensional colorized digital dental model assisted by digital photography].

OBJECTIVE: To explore a method of constructing universal 3-dimensional (3D) colorized digital dental model which can be displayed and edited in common 3D software (such as Geomagic series), in order to improve the visual effect of digital dental model in 3D software. METHODS: The morphological data of teeth and gingivae were obtained by intra-oral scanning system (3Shape TRIOS), constructing 3D digital dental models. The 3D digital dental models were exported as STL files. Meanwhile, referring to the accredited photography guide of American Academy of Cosmetic Dentistry (AACD), five selected digital photographs of patients'teeth and gingivae were taken by digital single lens reflex camera (DSLR) with the same exposure parameters (except occlusal views) to capture the color data. In Geomagic Studio 2013, after STL file of 3D digital dental model being imported, digital photographs were projected on 3D digital dental model with corresponding position and angle. The junctions of different photos were carefully trimmed to get continuous and natural color transitions. Then the 3D colorized digital dental model was constructed, which was exported as OBJ file or WRP file which was a special file for software of Geomagic series. For the purpose of evaluating the visual effect of the 3D colorized digital model, a rating scale on color simulation effect in views of patients'evaluation was used. Sixteen patients were recruited and their scores on colored and non-colored digital dental models were recorded. The data were analyzed using McNemar-Bowker test in SPSS 20. RESULTS: Universal 3D colorized digital dental model with better color simulation was constructed based on intra-oral scanning and digital photography. For clinical application, the 3D colorized digital dental models, combined with 3D face images, were introduced into 3D smile design of aesthetic rehabilitation, which could improve the patients' cognition for the esthetic digital design and virtual prosthetic effect. CONCLUSION: Universal 3D colorized digital dental model with better color simulation can be constructed assisted by 3D dental scanning system and digital photography. In clinical practice, the communication between dentist and patients could be improved assisted by the better visual perception since the colorized 3D digital dental models with better color simulation effect.

[Application of patient-participated digital design in esthetic rehabilitation of anterior teeth].

OBJECTIVE: To explore a new method of patient-involved digital design, esthetic outcome prediction and fabrication for the esthetic rehabilitation of anterior teeth, and to provide an alternative choice for the restoration of anterior teeth. METHODS: In this study, 32 patients with esthetic problems in their anterior teeth were included and divided into two groups randomly: the experimental group (16 patients) and control group (16 patients). In the experimental group, the dentition and facial images were obtained by intra-oral scanning and Three-dimensional (3D) facial scanning and then calibrated. The design of the rehabilitation and the esthetic outcome prediction were created by computer-aided design (CAD) software. After morphologic modification according to the patients' opinions, prostheses were fabricated according to the final design by computer-aided manufacturing (CAM) equipment. As for the control group, the regular design method was applied to restore their anterior teeth. The time consuming in the first insertion of each restoration in both groups was recorded. The quality of the prostheses was assessed by another prosthedontist. The satisfaction to prostheses and the facial appearance were evaluated by the patients. RESULTS: The process of the patient-involved digital design and outcome anticipation was successfully established. The patients were satisfied with the esthetic effects of the anterior restoration made by the digital technique. The acceptance rate of the patients on the digital rehabilitation in the experimental group was 100%. There was no significant difference of the quality of the prostheses between the two groups. The satisfaction rate of the patients on prostheses and facial appearance was significantly higher in the experimental group than in the control group (P < 0.05). In addition, the time consuming in the first insertion of the experimental group was much shorter than that in the control group (P < 0.01). CONCLUSION: The new method of the patient-involved digital design, esthetic outcome prediction and fabrication for the esthetic rehabilitation of anterior teeth is a practical technique. This method is useful in shortening the time consuming of the restoration of anterior teeth and improving the patient satisfaction with the esthetic outcome.

Inflatable hollow obturator prostheses for patients undergoing an extensive maxillectomy: a case report.

The presence of a large palatal or maxillary defect after partial or total maxillectomy for tumor, trauma or congenital deformation poses a challenge to prosthodontists, particularly when the use of an implant cannot be considered. This case report described the use of an air valve in a hollow silicone obturator to manufacture an inflatable obturator that could be extended further into undercut area to retain itself. The inflatable obturator exhibited adequate retention, stability and border sealing, thereby improving the masticatory,pronunciation and swallowing functions of patients. It may be a suitable alternative treatment option to an implant-retained obturator.