Customised Vaginal Stent-The Phases in Management of Vaginal Agenesis in Mayer-Rokitansky-Küster-Hauser (MRKH) Syndrome.

Objective: Vaginal agenesis or atresia in females suffering from MRKH syndrome is more common and management involves both surgical and non-surgical approaches. Use of prefabricated stents to maintain the patency of the canal may not fit appropriately during the initial surgical phase and are not economical. This case report discusses a series of modifications in a custom-made vaginal dilator to improve the retention for expansion after surgical management of MRKH syndrome. Case report: A 28-year-old female diagnosed with MRKH syndrome with characteristic Mullerian agenesis was referred for customised vaginal stent. Customised surgical stent was fabricated with loops for orientation and retention, which was later modified into interim expansion and passive stent. Conclusion: The customisation of the vaginal stent, provision of a retentive loop that positioned the stent in the proper orientation, and gradual increase in the size of the stent, ensured dilatation in a patient with vaginal agenesis.

Quality of Life with the Rehabilitation After Partial Mandibulectomy: a Systematic Review.

To evaluate the QoL before and after prosthetic rehabilitation of partial mandibulectomy patients based on the type of surgery, effects of radiation, the type of prosthesis, and to enlist their outcome on the rehabilitation. Literature search as per PICO format was carried out within a time range from January 2000 to June 2021. The review followed PRISMA guidelines and registered with the PROSPERO(CRD42021258472). The focus question was established as per the PICO format (Population, Intervention, Comparison, Outcome). The population involved partial mandibulectomy individuals with prosthetic rehabilitation as an intervention. The outcome, quality of life (QoL), was compared with the pre and post partial mandibulectomy patients rehabilitated with a prosthesis. The search yielded 367 articles and based on the search criteria only 7 articles were suitable for qualitative analysis. Marginal resection of the mandible is less aggressive than segmental resection which provided function, phonation, and esthetics at acceptable levels but the food mixing ability was reduced when resection is accompanied by glossectomy. However, the perceived chewing ability and OHRQoL were not accountable to the extent of surgical excision. An overall increase in the QoL on rehabilitation with acrylic prosthesis depicting satisfactory functionality with a considerable improvement in mastication, speech, and social life. QoL and Denture Satisfaction Index did not differ based on the number of implants in an implant overdenture prosthesis, but the chewing ability was improved. An increase in the number of remaining occlusal units improved the overall QoL. Restoration of the function, psychological comfort, and improvement in esthetics was significant in patients who underwent prosthetic rehabilitation. The QoL between conventional and implant prostheses was observed to be more similar, and the effect of remaining hard and soft tissue structures has a major influence on patient comfort signifying the influence of the extent of surgical excision. Supplementary Information: The online version contains supplementary material available at 10.1007/s13193-022-01664-x.

Bone Morphogenetic Protein as Bone Additive around Dental Implant and its Impact on Osseointegration: a Systematic Review.

Statement of the Problem: Bone morphogenetic protein (BMP), a potential osteoinductive agent, was systematically reviewed for merits and demerits when used as a bone additive that was intervened during the surgical phase of dental implant placement; and suitable drug carriers that could withstand the functional load and deliver BMP at its lowest concentration. Purpose: To identify the carriers and concentration of BMP acceptable during surgical phase of implant placement and evaluate its efficacy in bone gain and osseointegration. Materials and Method: The study design was systematic review. Literature search as per PICO format was carried out within a time range from 2000 to July 2021. The review fol-lowed PRISMA guidelines and registered with the PROSPERO (CRD42020171667). The focus question included the population with an intra-oral implant placed in both animal and human models that were intervened with BMP-2 as an external additive biomaterial during the surgical phase. 2631 articles selected from the initial search were systematically filtered and yielded 16 articles that were qualitatively analysed. Results: The inter-rater reliability and level of agreement were 93.71%, κ(Kappa)>0.81 re-spectively. Results revealed the collagen carrier was commonly used for BMP delivery but lacked the property to withstand functional load and sustained release. BMP concentration varied in the range of 0.215µg to 0.8mg and the study revealed significantly indifferent out-come with low dose compared to the highest dose. BMP supplement showed better osseointe-gration in comparison with non-supplemented sites during the early period (within 6 months). Conclusion: BMP at lower concentrations and with appropriate carriers, collagen sponge, hydroxyapatite/tricalcium phosphate (HA/TCP) with a bio ceramic bulking agent, and poly (D, L-lactide-co-glycolic acid) (PLGA) reinforced with gelatin/HA/TCP accelerated bone growth during the initial stages of healing. Further long-term clinical trials for dental implant, analysing the sustained release of BMP with biodegradable and load-bearing carriers should be considered.

Influence of dental magnets on human brain activity: A quantitative EEG analysis.

PURPOSE: The magnetic field is known to attenuate mental depression, but it is not clear on the effect of dental magnets on human brain activity. Therefore, this study was to determine the influence of magnetic field from intraoral magnets on the human brain activity by analyzing the changes in alpha waves. MATERIALS AND METHODS: Twenty complete denture male patients aged between 50 and 60 years were included after their consent. The neodymium-iron-boron sintered magnet was incorporated into the existing mandibular denture bilaterally in canine region. The participants were subjected to electroencephalogram (EEG) and the output measured alpha waves at three phases: (i) without placement of magnets (WM0), (ii) 30 days post-magnet placement in the mandibular denture (WM), and (iii) after 6 months post-removal of magnets (WM6). The data obtained was skewed (non-parametric), and hence multivariate analysis using Friedman test, and bivariate analysis using Wilcoxon signed rank test and Mann-Whitney test were done to assess the significant difference among the groups. RESULTS: The comparison of alpha waves between different phases showed a significant difference in all the pairs (p < .05) except WM-WM6. Comparison of alpha waves between right and left hemisphere showed no statistically significant difference (p > .05). CONCLUSION: We concluded that dental magnets had an influential effect on the alpha waves in the brain on both the left and right hemispheres. The removal of dental magnets retained the changes in brain activity even after 6 months of removal, denoting the alternative therapy to management of mental depression.

Management of Shrunken Cheeks by Hollow Buccal Cheek Plumper Prosthesis.

Aging and a long period of edentulousness causes resorption of the maxillary residual ridge, resulting in narrowing of the arch and loss of facial muscle support that leads to the sunken appearance of cheeks. In completely edentulous patients, though the conventional complete denture does offer provision to the muscles encircling the mouth, yet the cheek plumber prosthesis is required to improve the muscle tone. This case report highlights the advantages and the sequential steps required in the indigenous method of fabricating a hollow cheek plumper appliance for a completely edentulous patient with a sunken appearance.

Assessment of a smartphone-based software application as a potential digital tool in tooth shade selection: a prospective clinical study.

OBJECTIVE: To determine the reliability of a newly developed software application (Shadent) in natural tooth shade selection. METHOD AND MATERIALS: A smartphone device with the self-developed Shadent software (patent no. 201841046815, Intellectual Property of India) recorded tooth shades of the maxillary right central incisor and canine for 250 volunteers. A prospective, clinical, double-blind trial was conducted. The shade match obtained under the standardized condition from Shadent software was compared with the visual method and spectrophotometer. The digital recordings were captured by two master's candidates, while the visual shade match was evaluated by four master's candidates and one faculty member from the Department of Prosthodontics. Crosstab analysis assessed the relationship between the visual method of shade selection, a spectrophotometer, and the Shadent software. Cohen kappa was used to measure the agreement between the methods. RESULTS: A kappa coefficient of 0.59 was observed between the visual assessment and the Shadent software, with an agreement percentage of 64.6%. A kappa coefficient of 0.65 was observed between the spectrophotometer and the Shadent software with an agreement of 69.3%. The software also had a better Cohen kappa agreement with the maxillary central incisor than the maxillary canine. CONCLUSIONS: Shadent's reliability was comparable with the visual and spectrophotometric methods and offered repeatability with standardized light intensity.

Effect of an implant-retained complete overdenture on the hearing ability of edentulous patients: A clinical pilot study.

STATEMENT OF PROBLEM: Edentulism has been associated with sensoneurinal hearing reduction, but whether hearing is improved by the provision of an implant-retained overdenture is unclear. PURPOSE: The purpose of this pilot clinical study was to provide completely edentulous participants with implant-retained complete overdentures and to evaluate the effect on their hearing ability by pure tone audiometry (PTA). MATERIAL AND METHODS: Fifteen completely edentulous first-time denture wearers were enrolled, and their hearing was evaluated with PTA for air conduction and bone conduction at 6 time intervals: before denture insertion (R1), after denture insertion (R2), 1 month after denture insertion (R3), on the day of suture removal after implant surgery (R4), 3 months later, at the time of loading (R5), and 1 month after implant loading (R6). The Friedman test was performed to find significant differences in the measurements from the completely edentulous state to rehabilitation with a complete denture and an implant-retained complete overdenture. The post hoc Tukey test was used for multiple comparisons (α=.05). RESULTS: Significant differences were found between R1 and R6, between R2 and R6, between R3 and R6, and between R4 and R6 in PTA in multiple comparisons (P<.05). The post hoc test revealed significant difference in the R1and R6 and R3 and R6 pairs (P<.05) at 500 Hz, 1 kHz, and 8 kHz, whereas only between R1 and R6 (P<.05) at 2 kHz for the air conduction test. In the bone conduction test, a significant difference was observed between the R1 and R6 and the R3 and R6 pairs (P<.05) at 500 Hz and 4 kHz, but only between R3 and R6 (P<.05) at 1 kHz and 2 kHz. CONCLUSIONS: The study showed that the placement of dental implants improved hearing acuity via the acoustic pathway through air and bone conduction.

Stress analysis of maxillary central incisors endodontically -treated with varying ferrule heights and three different post dowel materials - a finite element analysis / Análisis de tensión de los incisivos centrales superiores tratados endodónticamente con diferentes alturas de férula y tres materiales diferentes de clavija posterior: un análisis de elementos finitos

Statement of problem : fracture of endodontically treated teeth is reduced by the use of a post with ferrule, but the effect of different ferrule configurations and dowel materials is not clear. Purpose: to evaluate the effect of ferrules with different configurations and heights on the stress of endodontically treated teeth restored with three different post and dowel materials. Materials and Methods: fifteen models of maxillary central incisors restored with porcelain fused to metal crowns were obtained using pro engineer software. the models were divided into three groups, each consisting of five models with ferrule heights of 0mm, 2mm, 4mm, 2mm with oblique fracture, 4mm with oblique fracture, the models under group GFR were restored with fiberglass reinforced post (GFR) and composite core build-up, group NiCr with a custom cast post metal alloy (NiCr), and group Zr with zirconia post (Zr) and composite core build-up. an oblique load of 100N and 150N at an angle of 135 degrees was applied to the palatal surface of the tooth, a vertical load of 100N and 150N at an angle of 90 degrees was applied to the incisal tip of the tooth. The maximum principal stress and the von mises stress was calculated for the remaining tooth structure and post apex using the finite element analysis (FEA) software. Results: the maximum von misses stress was observed in the apex of the post (p<0.05). Group Zr showed the highest mean stress (6.39Mpa) followed by group NiCr (5.65Mpa). There was a significant difference between post and between NiCr and Zr post for 2mm and 4mm ferrule height, while for 0mm ferrule there was a significant difference between the GFR and NiCr groups (p<0.05). Under oblique load, the maximum mean stress was observed in remaining tooth structures while for vertical load, it was observed at the apex of the post. Regarding ferrule heights, there were significant differences between 0mm-2mm, and 0mm-4mm uniform ferrule in post apex in the case of NiCr posts (p<0.05). Absence of ferrule resulted in higher stress for the NiCr group. Conclusion: higher loads that led to fracture were observed only at the apex of the post. Zirconia posts (group Zr) had higher fracture loads, whereas absence of ferrule resulted in higher fracture load with custom cast posts (group NiCr). Fracture thresholds were high on the remaining tooth structure for all the dowel systems especially for composite core build up irrespective of ferrule height and configuration. Clinical implications: appropriate selection of post and dowel materials in different configurations of ferrule heights ensures clinical success.

Indicación del problema: la fractura de los dientes tratados endodónticamente se reduce mediante el uso de un poste con férula, pero el efecto de diferentes configuraciones de férula y materiales de clavija no está claro. Propósito: evaluar el efecto de los casquillos con diferentes configuraciones y alturas sobre el estrés de los dientes tratados endodónticamente restaurados con tres materiales diferentes de postes y tacos. materiales y métodos: quince modelos de incisivos centrales superiores restaurados con porcelana fundida a coronas de metal se obtuvieron con el software Pro Engineer. Los modelos se dividieron en tres grupos, cada uno de los cuales consta de cinco modelos con alturas de casquillo de 0mm, 2mm, 4mm, 2mm con fractura oblicua, 4mm con fractura oblicua. los modelos del grupo GFR fueron restaurados con poste reforzado con fibra de vidrio (GFR) y acumulación de núcleo compuesto, grupo nicr con una aleación de metal de poste fundido personalizado (NiCr) y grupo Zr con poste de zirconia (Zr) y acumulación de núcleo compuesto. se aplicó una carga oblicua de 100N y 150N en un ángulo de 135º a la superficie palatina del diente. se aplicó una carga vertical de 100N y 150N en un ángulo de 90º a la punta incisal del diente. la tensión principal máxima y la tensión de von mises se calcularon para la estructura dental restante y después del vértice utilizando el software de análisis de elementos finitos (FEA). Resultados: el estrés máximo de von falta se observó en el vértice de la publicación (p<0.05). El grupo Zr mostró el mayor estrés medio (6.39Mpa) seguido del grupo NiCr (5.65Mpa). Hubo una diferencia significativa entre la publicación NiCr y Zr para la altura de la férula de 2mm y 4mm, mientras que para la férula de 0mm hubo una diferencia significativa entre los grupos GFR y NiCr (p<0,05), bajo la carga oblicua, la tensión media máxima en las estructuras dentales restantes, mientras que para la carga vertical, se observó en el vértice del poste. En cuanto a las alturas de la férula, hubo diferencias significativas entre la férula uniforme de 0mm-2mm y de 0mm-4mm en el post-apex en el caso de los postes de NiCr (p<0.05), la ausencia de férula dio como resultado un mayor estrés para el grupo NiCr. Conclusión: las cargas más altas que llevaron a la fractura se observaron solo en el vértice del poste; Los postes de zirconia (grupo Zr) tuvieron mayores cargas de fractura, mientras que la ausencia de férula dio como resultado una mayor carga de fractura con postes moldeados personalizados (NiCr de grupo). Los umbrales de fractura fueron altos en la estructura dental restante para todos los sistemas de clavijas, especialmente para la acumulación de núcleos compuestos independientemente de la altura y configuración de la férula. Implicaciones clínicas: la selección adecuada de materiales de postes y tacos en diferentes configuraciones de alturas de férulas asegura el éxito clínico.

Analysis of crestal bone loss around single piece ball attachment implant placed bilaterally in canine region and wear of O-ring in implant supported overdenture: Three year follow-up.

BACKGROUND: Single piece implant in fixed prosthesis is widely been evaluated, however, long term evaluation of crestal bone loss and the wear of O-ring in single piece ball attachment implant supported overdenture is yet to be evaluated PURPOSE: The present article evaluates the crestal bone loss around single piece ball attachment implants placed bilaterally in the canine region and the wear of O-ring in implant supported overdenture over a period of three years. MATERIALS AND METHODS: Twelve completely edentulous patients between the age group of 55-65 years were selected. Two 3.3 mm × 13 mm myriad snap fit implants were placed in the mandibular interforaminal region. All the implants were conventionally loaded at three months after surgical placement. Intra-oral periapical radiographs were made and crestal bone loss was measured at the end of one year and three years. The elasticity and wear of O-Ring was assessed after three years of usage. RESULTS: The crestal bone loss showed no significant difference between the first and third year after implant placement. The mean bone loss at the end of third year was 1.5 mm. Analysis of O-ring for change in the elasticity showed reduction in displacement and a significant increase in maximum displacement and elongation. The area of O-ring and yield stress did not show any changes from the standard value. Compression set damage was observed in the O-ring at the end of three years. CONCLUSIONS: The present study shows that the bilateral single piece implant supported overdenture has a success rate equivalent to the two piece implant supported overdenture and is a viable treatment option.