Effect of rehabilitation by using the shortened dental arch concept on the thickness of the masseter muscle and occlusal force: A pilot study.

STATEMENT OF PROBLEM: Knowledge of the effect of a shortened dental arch on masseter muscle thickness and occlusal force is sparse but could help clinicians understand how a shortened dental arch might affect the stomatognathic system. PURPOSE: The purpose of this pilot clinical study was to evaluate and compare the masseter muscle thickness and occlusal force of participants rehabilitated by using a shortened dental arch with matched completely dentate individuals. MATERIAL AND METHODS: Twelve partially edentulous participants with a minimum of 1 posterior occluding pair on each side of the arch were enrolled in the study. The mandibular arch of these participants was rehabilitated by using a single posterior mandibular implant crown (group S). The maxillary arch of all participants in group S was intact. Masseter muscle thickness (cm) and occlusal force (N) were recorded before (T1) and 6 months after implant rehabilitation (T2) for each participant. Twelve participants were selected as controls (group C). They were matched for age, sex, height, and weight with group S and evaluated for masseter muscle thickness and occlusal force. Masseter muscle thickness was evaluated by using ultrasonography during the rest position and maximum volumetric clenching. Occlusal force was measured with an occlusal force measuring appliance. All recordings were done for the left and right sides of the arch. Descriptive analysis was followed by comparison between groups and within group S by using the paired t test (α=.05). RESULTS: Higher masseter muscle thickness and higher occlusal force were observed in group C than in group S before and after rehabilitation. An increase in masseter muscle thickness in the rest position and in maximum volumetric clenching was observed within group S after rehabilitation. Before rehabilitation, a difference in the masseter muscle thickness between group S and group C was statistically significant for the left side at the rest position (P=.017) and during maximum volumetric clenching (P=.016). After rehabilitation, the difference between group S and group C was not statistically significant for masseter muscle thickness at the rest position (P=.890 for right side and P=.555 for left side) and during maximum volumetric clenching (P=.109 for right side and P=.755 for left side). The difference in occlusal force between group S and group C was statistically significant for the right side and left side (P<.001) before rehabilitation and statistically not significant after rehabilitation (P=.161 for the right side and P=.134 for the left side). CONCLUSIONS: Rehabilitation following the concept of a shortened dental arch increased masseter muscle thickness and occlusal force in partially edentulous individuals, making the masseter muscle thickness and occlusal force comparable with those of a completely dentate arch.

Evaluation of the wear of glazed and polished zirconia crowns and the opposing natural teeth: A clinical pilot study.

STATEMENT OF PROBLEM: Clinical studies on the wear properties of different zirconia surfaces are lacking. Selecting a surface that causes and undergoes minimal wear will help improve clinical outcomes. PURPOSE: The purpose of this clinical study was to evaluate and compare the wear over 1 year use of glazed zirconia (GZ) and polished zirconia (PZ) crowns opposing natural enamel and the wear of natural enamel opposing PZ and GZ crowns. MATERIAL AND METHODS: This prospective, split mouth, randomized clinical trial included 14 participants requiring complete coverage crowns on first molars, bilaterally, in a completely dentate mandibular arch. GZ and PZ crowns were cemented according to a randomization chart. Polyvinyl siloxane impressions were made immediately and 1 year after the cementation of the crowns. The respective casts were scanned by using a 3D scanner and a software program to measure the amount of linear wear of zirconia crowns and opposing natural teeth. Wear was observed in 8 groups: PZ crowns, GZ crowns, natural enamel opposing natural enamel in the molar and premolar regions (NE-M and NE-PM), natural enamel opposing PZ crowns in the molar region (NE-PZ-M), natural enamel opposing GZ crowns in the molar region (NE-GZ-M), natural enamel opposing PZ crowns in the premolar region (NE-PZ-PM), and natural enamel opposing GZ crowns in the premolar region (NE-GZ-PM). A descriptive analysis was followed by comparison between groups by using a repeated-measure ANOVA with post hoc adjustments (α=.05). RESULTS: The mean wear (µm) observed was as follows (in ascending order): PZ crowns (13 ±3), NE-PM (13 ±1), GZ crowns (27 ±9), NE-M (34 ±3), NE-PZ-PM (44 ±18), NE-PZ-M (63 ±22), NE-GZ-PM (69 ±21), NE-GZ-M (113 ±33). Wear of GZ and PZ crowns was less than wear of NE-M. The difference was statistically significant when comparing PZ with NE-M (P<.001, CI=-17 to -24). Wear of NE-GZ-M and NE-PZ-M was higher than wear of NE-M, with a statistically significant difference (P<.001, CI=-49 to -107 and P =.004, CI=-8 to -49, respectively). Wear of NE-GZ-M was more than that of NE-PZ-M, and the difference was statistically significant (P<.001, CI=-68 to -32). Wear of NE-PZ-PM and NE-GZ-PM was also more than the wear of NE-PM, and the difference was statistically significant (P<.001, CI=-17 to -43 and P<.001, CI=-39 to -70). CONCLUSIONS: PZ and GZ crowns wear substantially with time, with lesser wear observed in PZ crowns. PZ and GZ crowns also cause more wear in opposing natural enamel than natural enamel antagonists, with the highest wear caused by GZ crowns.

Prosthetic rehabilitation of resected orbit in a case of mucormycosis.

The design of orbital prosthesis to rehabilitate patients with orbital exenteration depends on the underlying clinical condition, material chosen for prosthesis, method of retention of the prosthesis, and and preference of the patient. Rehabilitation of a patient with orbital exenteration due to mucormycosis has been described by fabricating a prosthesis that used polymethyl methacrylate (to fabricate a conformer) and silicone material (to fabricate prosthetic superstructure). The two-component prosthesis was designed to attain dual mechanical retention using an anatomic undercut (conformer) and manually created mechanical undercut (prosthetic superstructure). The objective was to maintain the biological health of the underlying postsurgical tissue, longevity of the prosthesis, optimal esthetics, and adequate retention.

Cameo surface recording in complete denture fabrication using transcutaneous electrical nerve stimulation: A clinical report.

Severe bone loss in patients with complete edentulism poses a treatment challenge. In fabricating a denture, the stability of the prosthesis must be enhanced by recording the cameo surface within the confines of the physiological position of the cheek and tongue muscles (the neutral zone) and by shaping it accordingly. The treatment of a patient with a completely edentulous maxillary arch and severe maxillary anterior bone loss is described. The cameo surface was recorded within the physiological limits during the fabrication of a complete denture by using transcutaneous electrical nerve stimulation (TENS).

Influence of different forms and materials (zirconia or titanium) of abutments in peri-implant soft-tissue healing using matrix metalloproteinase-8: A randomized pilot study.

STATEMENT OF PROBLEM: It is unclear how pathogenic bacteria adhere to different implant materials and whether biomarker matrix metalloproteinase-8 (MMP-8) level provides a reliable method of evaluating the connective tissue status of peri-implant tissues. PURPOSE: The purpose of this pilot clinical study was to evaluate peri-implant connective tissue response by assessing the MMP-8 levels in peri-implant crevicular fluid around titanium and zirconia abutments. MATERIAL AND METHODS: The study was designed as a prospective, within-subject comparison with left-right randomization low. Twelve participants with partial edentulism were selected according to inclusion and exclusion criteria. Peri-implant sulcal fluid sampling and pocket probing depths were assessed at 1, 3, and 12 months after placing the abutments. The MMP-8 protein level of the peri-implant sulcal fluid was determined by MMP-8-specific sandwich enzyme-linked immunosorbent assay system. The independent t test or Wilcoxon test was used to compare MMP-8 levels and probing depth assessment between the zirconia and titanium groups at different time points (1, 3, and 12 months). Repeated measures ANOVA was used for within-group comparison of the MMP-8 levels at 3 time points (α=.05). RESULTS: At 1 and 3 months, the titanium abutments showed significantly higher MMP-8 levels and probing depths than the zirconia abutments (P<.05), but no significant differences were found at 12 months for either variable (P>.05). CONCLUSIONS: This study suggests the presence of more remodeling and/or inflammatory phenomena around titanium implant abutments than around zirconia abutments of a different design during the early stages but not at 1 year.

Technique for adapting a spacer for a custom impression tray.

A method of adapting a spacer for the custom trays used to make a definite impression for complete dentures is presented. The technique can be used under a variety of conditions and offers several advantages.

Correction of microstomia in an edentulous patient.

The problem of small oral aperture is big. Irrespective of the etiology, this problem may be overcome by adjunctive therapies in the form of prosthesis, surgery, or exercise. A patient is described with this problem, which was overcome by revisiting the 3 adjunctive therapies including a commissural stent designed with the patient's edentulous state in mind.

Correction of cheek biting in a dentate patient.

Postsurgical injury by teeth to oral mucosa (reconstructed by a flap) can lead to ulceration and subsequent infection at the reconstructed site. A prompt intervention by fabricating a specially designed prosthesis to deflect the reconstruction flap away from the occluding teeth has been described for the treatment of cheek biting in the present clinical report.

An Alternate Vista in Rehabilitation of Cranial Defects: Combining Digital and Manual Techniques to Fabricate a Hybrid Cranioplast.

The desired features of a cranioplast include providing an acceptable contour, continuity with the remaining skull (marginal adaptation), improvising the aesthetic outcome, providing a strengthened prosthesis to avoid fracture in case of repeat trauma, and protecting the remaining neurological structures. Combining digital and manual techniques to fabricate a hybrid polymethylmethacrylate cranioplast during the rehabilitation of a pediatric patient with cranial defect has been described. Utilization of digital techniques (rapid prototyping to obtain skull analog) and manual (hand) sculpting of the prosthesis strengthened with glass fiber enabled the authors to fabricate a hybrid cranioplast. Satisfactory outcome was achieved.

Alleviating speech and deglutition: Role of a prosthodontist in multidisciplinary management of velopharyngeal insufficiency.

Surgical resection of soft palate due to cancer affects the effective functioning of the velopharyngeal mechanism (speech and deglutition). With the loss of speech intelligibility, hyper resonance in voice and impaired function of swallowing (due to nasal regurgitation), there is a depreciation in the quality of life of such an individual. In a multidisciplinary setup, the role of a prosthodontist has been described to rehabilitate such patients by fabrication of speech aid prosthesis. The design and method of fabrication of the prosthesis are simple and easy to perform. The use of prosthesis, together with training (of speech) by a speech pathologist resulted in improvement in speech. Furthermore, an improvement in swallowing had been noted, resulting in an improved nutritional intake and general well-being of an individual. The take-home message is that in the treatment of oral cancer, feasible, and rapid rehabilitation should be endeavored in order to make the patient socially more acceptable. The onus lies on the prosthodontist to practise the same in a rapid manner before the moral of the patient becomes low due to the associated stigma of cancer.

Role of a dentist in comprehensive management of a comatose patient with post traumatic head injury and neuropathological chewing.

Injury of the head and neck region can result in substantial morbidity. Comprehensive management of such patients requires team work of several specialties, including dentists. A young female patient with extensive loss of cranium and associated pathological chewing was referred to the dental department. The lost cranium was replaced by a custom-made, hand-fabricated cranioplast. Trauma due to pathological mastication was reduced by usage of a custom-made mouthguard. Favorable results were seen in the appearance of the patient and after insertion of the mouthguard as evidenced in good healing response. The intricate role of a dental specialist in the team to manage a patient with post traumatic head injury has been highlighted. The take away message is to make the surgical fraternity aware of the scope of dentistry in the comprehensive management of patients requiring special care.

Comparison of Soft Tissue Volumetric Changes and Pink Esthetics After Immediate Implant Placement with Socket Shield and Conventional Techniques: A Randomized Controlled Trial.

PURPOSE: To compare volumetric changes in buccal soft tissue and pink esthetic scores after immediate implant placement performed with a socket shield technique (SST) or the conventional technique (CT). MATERIALS AND METHODS: This parallel-arm, randomized controlled trial included 22 participants requiring replacement of a single maxillary incisor with an immediate implant. Immediate implants were placed via either the SST or the CT, with patients randomly allocated to one of the two groups. All implants underwent an immediate loading protocol. Definitive crowns were placed 6 months after implant placement. Scans of casts were recorded with a digital white light scanner before implant placement and at the end of 12 months. Volumetric changes to soft tissues on the buccal aspect were assessed by superimposition of the scanned cast. Esthetic evaluation of the soft tissue was done by evaluating the pink esthetic score (PES) before implant placement and 6 and 12 months after implant placement. Statistical analysis of the data was performed using statistical software (Stata 16.0, StataCorp). RESULTS: The mean volumetric change in buccal soft tissues at the end of 12 months in the SST group was -0.1520 ± 0.86 mm, and in the CT group, it was -0.643 ± 0.35 mm. The difference was statistically significant (P = .001). Higher PES was observed in the SST group at all time intervals. The difference was statistically significant at 6 months (P = .001) and 12 months (P = .007). CONCLUSIONS: The results of this study showed less volumetric changes in buccal soft tissues and higher PES when the SST is used rather than the CT.

Comparison of soft tissue volumetric changes and pink aesthetics in immediate implant placement by socket shield and conventional technique: A randomized controlled trial.

PURPOSE: The purpose of this study was to compare soft tissue volumetric changes on buccal aspect and pink aesthetics score in immediate implant placement by socket shield and conventional technique. MATERIAL AND METHODS: This parallel-arm, randomized controlled trial included 22 participants requiring replacement of single maxillary incisor by immediate implant placement. Immediate implants were placed with socket shield technique (SST) and conventional technique (CT) in respective two groups after randomization. All implants were immediately loaded by immediate loading protocol. Definitive crowns were placed 6 months after implant placement. Scans of casts were recorded by using a digital white light scanner before implant placement and at the end of 12 months. Volumetric soft tissue changes on the buccal aspect was assessed by the superimposition of scanned cast. Esthetic evaluation of soft tissue was done by using pink esthetic score (PES) before implant placement, 6 months, and 12 months after implant placement. Statistical analysis of the data was performed using statistical software (Stata 16.0; Stata Corp LLC). RESULTS: The mean soft tissue volumetric change on the buccal aspect at the end of 12 months in the SST group was -0.1520 ±0.86 mm, and in the CT group was -0.643 ±0.35 mm and the difference was statistically significant (P=.001). Higher PES was observed in the SST group when compared to the CT group at all time intervals. The difference was statistically significant at 6 months (P=.001) and 12 months (P=.007). CONCLUSIONS: The results of the study show less volumetric change on the buccal aspect and higher PES in SST when compared to CT. Int J Prosthodont 2023. doi: 10.11607/ijp.8063.

Osteogenic markers in peri-implant crevicular fluid in immediate and delayed-loaded dental implants: A randomized controlled trial.

INTRODUCTION: The study evaluates the levels of matrix metalloprotease-8 (MMP-8), and Cathepsin-K (CatK) in peri-implant crevicular fluid (PICF) among patients with immediate loaded (IL) and delayed-loaded (DL) implants at different time points to know the inflammation and osteogenic status. METHODS: The study population consisted of two groups (n = 25, each group) with a mean age of 28.7 ± 3.5 years, and PICF was collected. MMP-8 and CatK levels were quantified through ELISA. RESULTS: We observed the concentrations of inflammatory markers (MMP-8 and CatK) at three time points in the IL and DL groups. The mean concentration of MMP-8 in the IL group was 9468 ± 1230 pg/mL, 5547 ± 1088 pg/mL, and 7248 ± 1396 pg/mL at 2 weeks, 3 months, and 12 months, respectively; while in the DL group was 10 816 ± 779.7 pg/mL, 9531 ± 1245 pg/mL, and 9132 ± 1265 pg/mL at 2 weeks, 3 and 12 months, respectively. The mean concentration of Cat-K in the IL group was observed at 422.1 ± 36.46 pg/mL, 242.9 ± 25.87 pg/mL, and 469 ± 75.38 pg/mL at 2 weeks, 3, and 12 months, whereas in the DL group was 654.6 ± 152.9 pg/mL, 314.7 ± 28.29 pg/mL, and 539.8 ± 115.1 pg/mL at 2 weeks, 3 months and 12 months, respectively. CONCLUSION: In this study, the levels of CatK and MMP-8 levels decline at 12 months in both groups, and the IL group shows lower values compared to the DL group; however, no significant changes were observed after analyses were adjusted for multiple comparisons (p > 0.025). Therefore, there is not much difference observed in the inflammation process between immediate and delayed loading. (Clinical trial identifier: CTRI/2017/09/009668).

Acrylic cranial implant: an alternative vector in management of cranial defect.

In a pediatric patient with cranial defect, in order to replace the missing portion of the cranium, an acrylic cranial implant was fabricated prior to the surgical procedure. The primary aim was to fabricate this cranial implant prior to the surgical procedure and with optimum fit. A customized hand-sculpted acrylic cranial implant fabricated by lost wax technique was made prior to the surgery and with adequate precision.The prefabricated cranial implant was used by neurosurgeons on the patient in order to restore the continuity of bone (by the acrylic cranioplast) over the cranial defect, improving the aesthetics and more importantly providing protection to the vital neural tissue.Though with recent advancements (like computer-aided design and manufacturing, and rapid prototyping), rapidity and precision can be achieved in the fabrication of cranial prosthesis, yet most of the apparatus may not be amenable in every setup and may not be affordable by all patients. A simple, operator-friendly technique which acquires satisfactory precision has been described for a patient much in need. Optimal postoperatory results were attained.

Comparative Evaluation of Osteocalcin in Peri-implant Crevicular Fluid and Radiographic Bone Loss in Immediate Loading and Delayed Loading Protocols: A Preliminary Split-Mouth Randomized Controlled Trial.

PURPOSE: To compare osteocalcin and crestal bone loss in implants placed under an immediate loading (IL) compared to a delayed loading (DL) protocol. MATERIALS AND METHODS: This preliminary, split-mouth, randomized controlled trial included 14 participants who required replacement of both mandibular first molars opposing a completely dentate maxillary arch. Two implants were placed in each participant. According to the split-mouth randomization method, a temporary crown was used for the IL protocol and a healing abutment was used for the DL protocol in each participant. Definitive crowns were cemented 3 months after implant placement. Osteocalcin levels were determined using ELISA, and crestal bone loss was evaluated using radiographs at 2 weeks, 3 months, and 12 months after implant placement. RESULTS: The mean osteocalcin level was significantly higher with IL than DL at each point (P < .001), with 95% CI of -262.89 to -439.10 (2 weeks); -238.02 to -375.98 (3 months); and -83.24 to -211.61 (12 months). Higher crestal bone loss was observed in IL when compared to DL implants at 2 weeks (P = .458, 95% CI: -0.10 to 0.21). Less crestal bone loss was observed with IL than DL at 3 months (P = .935) and 12 months (P = .42). CONCLUSION: Osteocalcin levels increased in both IL and DL implants, but higher levels were observed with IL. Higher crestal bone loss was observed with IL during the initial stages of treatment only.

A long-term nutritional assessment of maxillary cancer patients undergoing prosthodontic rehabilitation after surgery: A longitudinal study.

Purpose: To evaluate the nutritional status (NS) of patients planned for maxillectomy and prosthodontic rehabilitation using three nutritional assessment methods. Methods: This longitudinal study enrolled 18 planned maxillectomy patients following the inclusion and exclusion criteria. NS was evaluated at five stages: before surgery (S0), 2 weeks after surgery (S1), 3 months after insertion of intermediate obturator (S2), just before fabrication of definitive obturator (S3), and 3 months after insertion of definitive obturator (S4) using two nutritional assessment tools i.e. Patient Generated -Subjective Global Assessment (PG-SGA) &Nutritional risk index (NRI); and body composition indicators i.e. body mass index (BMI), fat free mass (FFM), total body water (TBW), skeletal muscle mass (SMM) and skeletal muscle mass index (SMMI).To determine the changes in patient's nutritional status among different time points Repeated Measure ANOVA with Bonferroni post hoc adjustments was used. Results: Out of 18 patients, 12 were completed the study. NS of maxillectomy patients deteriorates significantly (p < .05) till stage S2. At S3, significant improvement occurred as compared to stage S2, but it remained significantly less than pre-surgical level. However, at stage S4, all parameters were statistically comparable to S0 (p > .05) except for PG-SGA (p < .001) and SMM (p = .044). Conclusion: NS of maxillectomy patients worsen post surgically due to surgical morbidity and adverse effects of radiotherapy (RT) but improves with post-surgical healing, resolution of sequel of RT and improved oral function due to well-adapted obturator prosthesis.