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.

Evaluating the osteogenic potential of insulin-like growth factor-1 microspheres on osteoblastic activity around dental implants in patients with type 2 diabetes mellitus using bone scintigraphy: A split-mouth randomized controlled trial.

STATEMENT OF PROBLEM: Dental implants are susceptible to early failure when placed in patients diagnosed with type 2 diabetes mellitus. The osteoinductive potential of insulin-like growth factor-1 (IGF-1) has been widely investigated in animals with type 2 diabetes mellitus, but studies investigating the osteoinductive potential of IGF-1 around dental implants in patients diagnosed with type 2 diabetes mellitus are lacking. PURPOSE: This randomized controlled trial was conducted to assess the osteogenic efficacy of poly(lactide-co-glycolide)- (PLGA) encapsulated IGF-1 microspheres around dental implants placed in patients diagnosed with type 2 diabetes mellitus. MATERIAL AND METHODS: A split-mouth, randomized controlled trial was conducted in 10 participants diagnosed with type 2 diabetes mellitus and with bilaterally missing mandibular posterior teeth. The 20 sites were randomly allotted to receive the PLGA encapsulated IGF-1 or placebo microspheres followed by the placement of Ø3.8×11-mm implants. Osteoblastic activity was quantitatively assessed with bone scintigraphy scanning on the thirtieth, sixtieth, and 90th day after implant placement. The Shapiro-Wilks test was used to analyze the normality of data, followed by the independent t test to compare the experimental and placebo groups. Intragroup comparison was performed by using repeated-measures ANOVA and the post hoc Bonferroni test (α=.05). RESULTS: Statistical analysis revealed that the mean osteoblastic activity was higher in the experimental group which received the PLGA-encapsulated IGF-1 than in the placebo group at the 30th, 60th, and 90th day after implant placement (P≤.001). CONCLUSIONS: This randomized controlled trial indicated that the PLGA-encapsulated sustained release of IGF-1 microspheres enhanced the process of osseointegration in patients diagnosed with type 2 diabetes mellitus until the 90th day after implant placement.

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.

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.

Platelet-Rich Plasma and Platelet-Rich Fibrin as a Regenerative Tool.

Platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) are used as a valuable adjunct in the treatment of maxillofacial rehabilitation. PRP used along with growth hormone helps in bone healing and tissue regeneration in the areas affected by bone and soft tissue-related defects. It aids not only in faster and better healing of the surgically debrided area but also in regeneration of the bone at a faster rate. This review comprises the applications of PRP and PRF and their uses in various procedures.

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.

OHRQoL, masticatory performance and crestal bone loss with single-implant, magnet-retained mandibular overdentures with conventional and shortened dental arch.

PURPOSE: The aim of this study was to assess the use of single implant-supported, magnet-retained mandibular overdentures to improve the oral health-related quality of life (OHRQoL) and masticatory performance of patients wearing conventional complete dentures. The study also aimed at comparing the OHRQoL, masticatory performance, and crestal bone loss with two different types of overdenture prosthesis. MATERIALS AND METHODS: Ten completely edentulous patients with atrophic mandibular residual alveolar ridges and having difficulty coping with technically adequate mandibular dentures were selected for implant-supported overdentures (ISOD). To assess the success of the implant fixture clinically, a crossover study design was followed, and the patients were divided into two groups. Group A received ISOD with conventional complete dental arch, and group B received ISOD with a shortened dental arch for the first 3 months and vice versa for the next 3 months. The OHRQoL was measured with the OHIP-49 questionnaire, and masticatory performance was assessed with the sieve method using peanuts as test food. Peri-apical radiographs were taken to evaluate the crestal bone loss. RESULTS: A significant improvement was seen both subjectively and objectively when conventional complete dentures were modified to implant-supported prosthesis. When comparing the implant overdenture prosthesis, patients were more satisfied with conventional arch than with the shortened dental arch. In the first 3 months following implant placement, less bone loss was seen with the shortened dental arch overdenture (P < 0.05). CONCLUSION: Single implant-supported, magnet-retained mandibular overdentures significantly improve the OHRQoL of completely edentulous patients.

Short-term evaluation of dental implants in a diabetic population: an in vivo study.

PURPOSE: The study was conducted to evaluate the efficacy of implant supported tooth replacement in diabetic patients. MATERIALS AND METHODS: The study involved placement of implants (UNITI implants, Equinox Medical Technologies, Zeist, Holland, diameter of 3.7 mm and length 13 mm) in five diabetic patients (three females and two males) of age ranging from 35-65 years with acceptable metabolic control of plasma glucose. All patients included in the study were indicated for single tooth maxillary central incisor replacement, with the adjacent teeth intact. The survival of the restored implants was assessed for a period of three months by measurement of crestal bone heights, bleeding on probing and micro flora predominance. Paired t-test was done to find out the difference in the microbial colonization, bleeding on probing and crestal bone loss. P values of less than 0.05 were taken to indicate statistical significance. RESULTS: Results indicated that there was a significant reduction in bleeding on probing and colonization at the end of three months and the bone loss was not statistically significant. CONCLUSION: The study explores the hypothesis that patients with diabetes are appropriate candidates for implants and justifies the continued evaluation of the impact of diabetes on implant success and complications.

Evaluation of nutritional status and eating pattern in first and second-time denture wearers: a prospective 60 days (2 months) pilot study.

Elderly individuals with extensive tooth loss preferentially consume soft, easier to chew foods which have a low nutrient density. The purpose of this study was to suggest that every complete denture wearer has to be periodically counseled by a registered Dietician and Dentist for check up to avoid malnutrition and disease. Fourteen patients were selected for this study. Seven of them with four or five teeth remaining without any functional units and seven patients who were known cases of complete denture wearers with ill-fitting or worn out dentures. The results of the study analyzed the change in eating pattern and hence the nutritional status of two groups of edentulous subjects; Group I (patients who underwent a recent transition from partially edentulous state to a completely edentulous state), and Group II (known complete denture wearers for five to ten years). Clinical examination of Group I showed an improvement, by, the decrease in percentages in both the paleness of the conjunctiva and nails of the selected patients. In Group II, there was a significant change in anthropometry and iron intake and the clinical examination showed positive changes in the patient's normal appearance, eyes and nails. Paired sample statistics between both the groups evaluated significant changes in energy, iron and vitamin C intakes in the dietary assessment chart. The general questionnaire assessment showed an improvement in the eating pattern of both the groups, which, may definitely account for a positive change in the nutritional status of the participants later. This study emphasizes that every complete denture wearer needs to be periodically counseled by a registered dietician and dentist for checkup to avoid malnutrition and disease.