Anterior Prosthesis Research Articles

Binary Logistic Regression Analysis on the Association of Occlusion with the Temporomandibular Joint Arthralgia in the Partial Denture Wearers-A Retrospective Study.

To analyze the potential association between the occlusion features and the incidence of temporomandibular joint (TMJ) arthralgia in patients with partial dentures. A total of 101 partial denture wearers were collected, 45 with unilateral TMJ arthralgia diagnosed according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). Binary logistic regression analysis was adopted. The TMJ asymptomatic group (n = 45) was quantified as 0, while the TMJ arthralgia group (n = 56) was quantified as 1. In total, 13 occlusion variables were analyzed: gender, age, number of prosthetic teeth, number of dentition quadrants with a prosthetic tooth, anterior or posterior prosthesis location in maxillary or mandibular dentition, occluded prosthesis pair, anterior overjet, and overbite relation. Simple and multiple binary logistic models were adopted, accordingly, for the risk impact of them on TMJ arthralgia. Overbite (OR = 2.238) and maxillary anterior prosthesis (OR = 0.305) were entered into the simple binary logistic model; while overbite (OR = 2.774) plus maxillary anterior prosthesis (OR = 0.347), overbite (OR = 3.425) plus unilateral maxillary posterior prosthesis (OR = 4.672), and overbite (OR = 3.476) plus overjet (OR = 0.436) and mandibular anterior prosthesis (OR = 0.177) were entered into the multivariate logistic regression model (all, P < .05). Partial denture wearers with a deep overbite, especially those with a unilateral maxillary posterior prosthesis, had a higher prevalence of unilateral TMJ arthralgia.

Biomechanical comparison of different prosthetic reconstructions in total en bloc spondylectomy: a finite element study

ObjectiveTo analyse and compare the biomechanical differences between 3D-printed prostheses, titanium mesh cages and poorly matched titanium mesh cages in total en bloc spondylectomy (TES).MethodsThe finite element model of T10-L2 for healthy adults was modified to make three models after T12 total spondylectomy. These models were a 3D-printed prosthesis, titanium mesh cage and prosthesis-endplate mismatched titanium mesh cage for reconstruction. The range of motion (ROM), stress distribution of the endplate and internal fixation system of three models in flexion and extension, lateral bending and axial rotation were simulated and analysed by ABAQUS.ResultIn flexion, due to the support of the anterior prosthesis, the fixation system showed the maximum fixation strength. The fixation strength of the 3D-printed prosthesis model was 26.73 N·m /°, that of the TMC support model was 27.20 N·m /°, and that of the poorly matched TMC model was 24.16 N·m /°. In flexion, the L1 upper endplate stress of the poorly matched TMC model was 35.5% and 49.6% higher than that of the TMC and 3D-printed prosthesis, respectively. It was 17% and 28.1% higher in extension, 39.3% and 42.5% higher in lateral bending, and 82.9% and 91.2% higher in axial rotation, respectively. The lower endplate of T11 showed a similar trend, but the magnitude of the stress change was reduced. In the stress analysis of the 3D-printed prosthesis and TMC, it was found that the maximum stress was in flexion and axial rotation, followed by left and right bending, and the least stress was in extension. However, the mismatched TMC withstood the maximum von Mises stress of 418.7 MPa (almost twice as much as the buckling state) in rotation, 3 times and 5.83 times in extension, and 1.29 and 2.85 times in lateral bending, respectively.ConclusionDifferent prostheses with good endplate matching after total spondylectomy can obtain effective postoperative stable support, and the reduction in contact area caused by mismatch will affect the biomechanical properties and increase the probability of internal fixation failure.

Meshed Acellular Dermal Matrix for Two-Staged Prepectoral Breast Reconstruction: An Institutional Experience.

The introduction of acellular dermal matrix (ADM) to breast reconstruction has allowed surgeons to reexplore the prepectoral implant placement technique in postmastectomy breast reconstruction. Our institution adopted a novel approach using meshed ADM to lessen the financial burden of increased ADM utilization with the prepectoral breast reconstruction. This is a retrospective, single-center review of two-stage prepectoral breast reconstruction using meshed human-derived ADM for anterior prosthesis coverage. Patient demographics, oncologic data, perioperative characteristics, and complications were examined and reported as means with standard deviations. Cost-saving with the meshed technique was evaluated. Forty-eight patients (72 breasts) with a mean age of 48.5 ± 15.0 years (range 26–70 years) were included in the study. The mean follow-up time was 13.2 ± 4.4 months (range 4.1–25.8 months). Nineteen breasts (24.6%) experienced complications, with seromas being the most common complication (12.5%, n = 9). Expander removal and reoperation occurred at a rate of 8.3 and 9.7%, respectively. The average time to drain removal was 18.8 ± 6.6 days (range 8–32 days). Meshed ADM provided an average cost savings of $6,601 for unilateral and $13,202 for bilateral reconstructions. Our study found that human-derived meshed ADM can be safely used in two-staged prepectoral tissue expander-based breast reconstruction and can result in significant cost savings.

Automated Noncontact Facial Topography Mapping, 3-Dimensional Printing, and Silicone Casting of Orbital Prosthesis

A proof-of-concept workflow study for the fabrication of custom orbital exenteration prostheses via automated noncontact scanning, 3D printing, and silicone casting. Noncomparative, interventional case series. Setting: Single-center institutional study. StudyPopulation: Three patients who have discontinued wearing of the ocularist-made exenteration prosthesis due to altered fit, discoloration, or material degradation. InterventionProcedure: A digital representation of the exenteration socket and contralateral periocular region was captured through noncontact facial topography mapping. Digital construction of the anterior prosthesis surface was based on the mirrored image of the contralateral side, and the posterior surface contour was based on orbital cavity geometry. The anterior and posterior surface details were digitally merged. A 2-piece mold was designed and produced in a 3D printer. Colorimetry was used to create a custom blend of pigments for incorporation into the Shore 40 silicone elastomer to generate a prosthesis that approximates the patient's skin tone. MainOutcomeMeasures: Prosthesis symmetry, skin tone match, comfort of wear, and appearance. The first copy of every 3D-printed orbital prosthesis using this fabrication workflow produced good symmetry, color match, and prosthesis fit. In one case, the recontoured second copy with improved prosthesis edge-to-skin interface was made without the patient present. A noncontact 3D scanning, computer-aided design, 3D printing, and silicone casting for fabrication of orbital prosthesis was developed and validated. This production workflow has the potential to provide an efficient, standardized, reproducible exenteration prosthesis and to overcome the principal barriers to an affordable custom prosthesis worldwide: access and cost.

Laparoscopic Sacrocolpopexy with Vaginal Prosthetic Adhesive: Multicenter Prospective Study of 45 Patients

Study Objective To evaluate the effectiveness and safety of using a liquid adhesive solution for prosthetic bonding during laparoscopic sacrocolpopexy. Design Multicenter observational prospective study conducted in three French gynecological surgery centers between June 2015 and February 2017. The effectiveness of the intervention was assessed by means of validated symptom and quality of life questionnaires (PFDI-20 including POPDI-6, CRADI-8 & UDI-6, and PISQ-12) and a clinical examination one year after surgery. Setting The medical device used was a compound of pure, fluid, translucent and sterile n-hexyl cyanoacrylate monomers (IFABOND, Peters Chirurgical, France). The glue is applied by means of a cannula. Patients or Participants 45 patients were included from June 2015 to February 2017, with stage 2-4 genital prolapse according to the Pelvic Organ Prolapse Quantification (POP-Q) classification. Interventions A modified laparoscopic sacrocolpopexy using a liquid adhesive solution to fix the prosthesis to the vagina and to the levator ani was performed. Two non-absorbable sutures were performed to attach the anterior prosthesis to the isthmus and promontory. Measurements and Main Results The average operating time was 102.5 minutes (40-210 min) and the average hospitalization time was 2.6 days (0-5 days). At one year, clinical examination and questionnaires were available for 33 and 37/45 patients, respectively (73.3 and 82.2%). The analysis of the PFDI 20 questionnaire revealed an improvement in quality of life with an overall score of 41.5/300 one year after surgery vs 106.3/300 preoperatively (p Conclusion The use of a liquid adhesive solution for prosthetic bonding during sacrocolpopexy appears safe and effective at one year with an improvement in the patient's satisfaction and overall quality of life.

Maintainer of Aesthetic Space - Functional in Pediatric Dentistry. Case Report

Early loss of deciduous teeth is a common problem in pediatric dentisty, can be associated with traumas of the anterior region of early childhood caries (ECC), ectopic eruption among others, and can cause occlusal damage and other undesirable aesthetic-functional squeal. The preparation of a functional - aesthetic space maintainer device is one of the most used treatment options in this type of condition; Among the indications of this, is the functional, phonetic and aesthetic recovery in order to prevent emotional disorders in children, improve the social aspect and preserve the correct dimensions of the arch, avoiding occlusal disharmonies. Within the main space mantainer devices we the partial anterior prosthesis of the Denari tube-bar system. This clinical case report shows the importance of the esthetic - functional maintainer, the correct preparation and clinical application in early childhood, orienting the professionals who treat pediatric patients.

Influence of resin cement rigidity on the stress distribution of resin-bonded fixed partial dentures

The mechanical properties of the adhesive cement used in resin-bonded fixed partial dentures (RBFPD) can modify the clinical performance of the rehabilitation. The goal of this study was to evaluate the influence of the elastic modulus of different cements on the stress distribution in RBFPD using finite element analysis. For that an anterior 3-unit prosthesis was modeled based in a stereolithography file. The model was meshed with tetrahedral elements and materials considered isotropic, linearly elastic and homogeneous. The force applied to the palatal area of the lateral incisor (pontic) at 45° was 100 N. The cements used presented 7 different elastic modulus (E): 2, 6, 10, 14, 18, 22 or 26 GPa. The total deformation, von-Mises stress and maximum principal stress criteria were used to calculate the results. The lower tensile stress occurred in the cement layer with E = 2 GPa [25.6 (canine) and 16.32 MPa (incisor)]. For the prosthesis, the model with the lower tensile stress [287 (canine) and 248 MPa (incisor)] occurred when the cement presented E = 26 GPa.In this way, the stress concentration may have its magnitude modified depending on the stiffness of the cement. Since more flexible cements concentrate less tensile stress in its structure, but allow an increased displacement of the prosthesis, which is friable and rigid and ends up concentrating more tensile stress at its connector. In that way the clinician should avoid the use of adhesive cement with lower elastic modulus due to it increases the stress concentration in the ceramic.

Long-term anatomic and functional results of laparoscopic sacrocolpopexy: a prospective study

The aim of our study was to assess the impact of laparoscopic sacrocolpopexy on pelvic symptoms, quality of life and sexual function in patients with symptomatic pelvic organ prolapse. Secondary goals included the assessment of anatomical correction, recurrence and complication rates. This is a prospective, single-center study that included 82 patients between 2009 and 2016. A clinical evaluation took place before surgery, and was repeated at 3, 12, 36 and 60months postoperatively. Patients routinely received an anterior prosthesis, associated with a posterior prosthesis in case of symptomatic rectocele. Patients included self-administered questionnaires for functional pelvic problems (PFDI-20), quality of life (PFIQ-7), and sexual function (PISQ-12), and a clinical examination with POP-Q staging, at each medical visit. Functional pelvic problems derived from prolapse (PFDI-20 scores) and their impact on patients' quality of life (PFIQ-7 score) significantly improved at 3, 12, 36 and 60months postoperatively. Improvement on sexual activity was significant at 3 and 60months postoperatively. Effective prolapse anatomical correction (POP-Q score < 2) was found in 94.4% and 97.2% of patients at the anterior and middle stages, respectively, at the end of follow-up, but only in 80.3% at the posterior stage. Symptomatic recurrence required surgical intervention in 4 patients (5.3%). This long-term follow-up prospective analysis confirms the good functional and anatomical results of laparoscopic sacrocolpopexy for pelvic organ prolapse.

Cirugía reconstructiva de la pelvis en el prolapso genital severo con uso de prótesis anterior y fijación al ligamento sacroespinoso

Una alternativa con algunas ventajas e iguales resultados en el manejo quirúrgico del prolapso genital total para la fijación de la cúpula al sacro por vía abdominal es la fijación de la cúpula al ligamento sacroespinoso. Objetivo: Evaluar los resultados del empleo de malla anterior y fijación al ligamento sacroespinoso en el prolapso genital total. Diseño: Estudio retrospectivo y descriptivo. Institución: Servicio de Ginecología Especializada, Hospital Nacional Edgardo Rebagliati Martins, EsSalud, Lima, Perú. Participantes: Mujeres con diagnóstico de prolapso genital total. Método: Revisión retrospectiva de 12 pacientes con diagnóstico de prolapso genital total y que tuvieron cirugía reconstructiva pélvica con empleo de malla anterior y fijación al ligamento sacroespinoso. Principales medidas de resultados: Resultados de las técnicas. Resultados: La edad promedio fue 64 años. La comorbilidad principal fue la obesidad. La histerectomía abdominal fue el antecedente quirúrgico más frecuente. Se realizó histerectomía vaginal más colocación de malla anterior con fijación al ligamento sacroespinoso a tres pacientes, solo malla anterior con fijación sacroespinosa a cuatro pacientes, malla anterior con fijación sacroespinosa y malla transobturatiz (TOT) a tres pacientes, histerectomía vaginal con malla anterior, fijación sacroespinosa y TOT a dos pacientes. Como complicaciones hubo extrusión de malla en un paciente; dos pacientes a las que no se colocó TOT presentaron incontinencia de orina al esfuerzo, una urgencia miccional nueva, una dispareunia; dos pacientes presentaron granuloma de sutura y una refirió dolor pélvico inespecífico, síntomas que evolucionaron favorablemente. La evaluación del prolapso genital después de la cirugía no fue mayor de grado I. Conclusiones: Al fijar el compartimento apical al sacroespinoso mediante el uso de TOT y de la malla anterior garantizó que no se presentara incontinencia urinaria de esfuerzo, recidiva o aparición de defectos del compartimiento anterior.

Accurate transposition of peri-implant soft tissue morphology in anterior prosthesis: case report

Accurate transposition of peri-implant soft tissue morphology in anterior prosthesis: case report

Posterior Transpedicular Dynamic Stabilization versus Total Disc Replacement in the Treatment of Lumbar Painful Degenerative Disc Disease: A Comparison of Clinical Results

Study Design. Prospective clinical study. Objective. This study compares the clinical results of anterior lumbar total disc replacement and posterior transpedicular dynamic stabilization in the treatment of degenerative disc disease. Summary and Background Data. Over the last two decades, both techniques have emerged as alternative treatment options to fusion surgery. Methods. This study was conducted between 2004 and 2010 with a total of 50 patients (25 in each group). The mean age of the patients in total disc prosthesis group was 37,32 years. The mean age of the patients in posterior dynamic transpedicular stabilization was 43,08. Clinical (VAS and Oswestry) and radiological evaluations (lumbar lordosis and segmental lordosis angles) of the patients were carried out prior to the operation and 3, 12, and 24 months after the operation. We compared the average duration of surgery, blood loss during the surgery and the length of hospital stay of both groups. Results. Both techniques offered significant improvements in clinical parameters. There was no significant change in radiologic evaluations after the surgery for both techniques. Conclusion. Both dynamic systems provided spine stability. However, the posterior dynamic system had a slight advantage over anterior disc prosthesis because of its convenient application and fewer possible complications.

Promontofijación laparoscópica. Nuestra técnica

Objectives The pathology of the pelvic flool, including the urinary incontinence, the anal incontinence and the genital prolapse, is very dominant, concerning approximately a third of the adult women. It is fundamental that this musculature supports a good function, because of the weakness of the pelvic floor produces urinary incontinence, cysto and rectocele, genital prolapses and sexual dysfunctions. The above mentioned pathology can be corrected by laparoscopic promontofixation, whatever the previous history of pelvic surgery, including the placing of prosthetic material. In this article we describe the above mentioned intervention. Material and methods Preoperative care is standardized and is accompanied by antibiotic prophylaxis, preventive antithrombotic treatment and in the event of a history of pelvic surgery, a digestive preparation. Positioning of the patient must plan a 30° Trendelenbourg position. After the introduction the trocars, initial surgery comprises anterior dissection of promontory after incision of the posterior peritoneum with the patient placed beforehand in a Trendelembourg position. After that, we make interrectovaginal dissection to free the whole posterior surface of the vagina. This is followed by the installation of a posterior mesh pre-cut in an arc. After intervesical vaginal dissection, the anterior prosthesis comprising a precut polyester mesh is fixed avoiding excess traction. The end of the surgery involves careful reperitonization of all the prosthetic parts. Possible specific surgical complications are vascular and visceral wounds. Results y conclusions The technique allows the correction of the dysfunction of the pelvic floor and incontinence with good anatomical and functional results. Postoperative secondary haemorrhage and gastrointestinal occlusion may ocurr. Occurrence of an inflammatory syndrome and low back pain suggests spondylodicitis and MRI should be performed. Vaginal erosion on the prosthesis may occur after several months and seems relatively independent of the prosthetic material used.

Laparoscopic promontofixation. Our technique

ObjectivesThe pathology of the pelvic floor, including urinary incontinence, anal incontinence and genital prolapse, is very dominant, concerning approximately a third of adult women. It is fundamental that this musculature supports a good function, because weakness of the pelvic floor produces urinary incontinence, cysto and rectocele, genital prolapses and sexual dysfunctions. The abovementioned pathology can be corrected by laparoscopic promontofixation, whatever the previous history of pelvic surgery, including the placing of prosthetic material. In this article we describe the abovementioned intervention. Material and methodsPreoperative care is standardized and is accompanied by antibiotic prophylaxis, preventive antithrombotic treatment and in the event of a history of pelvic surgery, a digestive preparation. Positioning of the patient must plan a 30° Trendelenbourg position. After the introduction of the trocars, initial surgery comprises anterior dissection of promontory after incision of the posterior peritoneum with the patient placed beforehand in a Trendelembourg position. After that, we make interrectovaginal dissection to free the whole posterior surface of the vagina. This is followed by the installation of a posterior mesh pre-cut in an arc. After intervesical vaginal dissection, the anterior prosthesis comprising a precut polyester mesh is fixed avoiding excess traction. The end of the surgery involves careful reperitonization of all the prosthetic parts. Possible specific surgical complications are vascular and visceral wounds. Results and conclusionsThe technique allows the correction of the dysfunction of the pelvic floor and incontinence with good anatomical and functional results. Postoperative secondary haemorrhage and gastrointestinal occlusion may occur. Occurrence of an inflammatory syndrome and low back pain suggests spondylodicitis and MRI should be performed. Vaginal erosion on the prosthesis may occur after several months and seems relatively independent of the prosthetic material used.

Safety of Trans Vaginal Mesh procedure: Retrospective study of 684 patients

To study peri-surgical complications after cure of genital prolapse by vaginal route using interposition of synthetic prostheses Gynemesh Prolene Soft (Gynecare) following the Trans Vaginal Mesh (TVM) technique. The present retrospective multicentered study comprised 684 patients who underwent surgery at seven French centers between October 2002 and December 2004. All patients had a genital prolapse >or=3 (C3/H3/E3/R3) according to International continence society (ICS) classification. According to each case, prosthetic interposition was total, or anterior only or posterior only. Patients were systematically seen 6 weeks, 3 months and 6 months after surgery. Multivaried statistical analysis followed a model of logistic regression applied to each post-surgical complication. The mean age of patients was 63.5 years (30-94). The mean follow-up period was 3.6 months. 84.3% of patients were post-menopause, 24.3% had hysterectomy, 16.7% previous cure of prolapse, and 11.1% cure of stress urinary incontinence (SUI). During the procedure, hysterectomy was combined in 50.3% of cases, cervix amputation in 1.5%, and cure of SUI in 40.9%. 15.8% were treated for a cystocele only. 14.8% had only a rectocele +/- elytrocele and 69.4% had a prolapse touching both compartments, anterior and posterior. In peri-surgical complications, (2%) were five bladder wounds (0.7%), one rectal wound (0.15%) and seven hemorrhages greater that 200 mL (1%). Among early post-surgical complications (during the first month after surgery) (2.8%) were two pelvic abscesses (0.29%), 13 pelvic hematomas (1.9%), one pelvic cellulitis (0.15%), two vesicovaginal fistulas and one rectovaginal fistula (0.15%). Among late post-surgical complications (33.6%) there were 77 granulomas or prosthetic expositions (11.3% [6.7% in the vaginal anterior wall, 2.1% in the vaginal posterior wall and 4.8% in the fornix]), 80 prosthetic retractions (11.7%), 36 relapse of prolapse (6.9%) and 37 SUI de novo (5.4%). Multivaried analysis shows that previous history of hysterectomy or placing of an isolated anterior prosthesis increase the risk of peri-surgical complication; preserved uterus and isolated posterior prosthesis lessen the risk of granulomas and prosthetic retractions; and association of a Richter's intervention increases the rate of prosthetic retractions. Cure of genital prolapse with synthetic prostheses interposed by vaginal route is now reliable and can be reproduced with a low rate of peri- and early post-surgical complications. However, our study shows a certain number of late post-surgical complications after insertion of strengthening synthetic vaginal implants (prosthetic expositions and prosthetic retractions). These retrospective results will soon be compared to a prospective study.

補綴処置により前歯部開こうの改善を認めた慢性関節リウマチの１症例

A prosthodontic treatment of a 39-year-old female who had severe anterior open bite with rheumatoid arthritis was reported. Rheumatoid arthritis had been diagnosed 5 years previously, and she had been hospitalized for infection of the spine, shoulder and knee joints. In her medical history, the patient stated that her mandible had continued to gradually retrude for the past 3 years, resulting in severe anterior open bite.Because of the progressive nature of rheumatoid arthritis, the decision was made to perform a reversible procedure to apply a prosthesis made of acrylic resin for stable occlusal contact with a posterior tooth. Afterthe eighth month, even distribution of posterior tooth contact was acquired with decreased vertical overbiteof 1 mm. After maxillary anterior prosthesis made of acrylic resin were provided with suitable verticaloverbite and anterior guidance, the metal prosthesis were provided at fourteen months after the first examination.In this report, it was suggested that occlusal management could improve anterior open bite caused byrheumatoid arthritis of TMJ, however, lateral transcranial radiography of TMJ findings still showed deformityand flattening of the condyle and the articular eminence of bilateral TMJ after treatment.

Essix Appliances: Provisional Anterior Prosthesis for Pre- and Postimplant Patients

Essix Appliances: Provisional Anterior Prosthesis for Pre- and Postimplant Patients

Diagnosis of the aesthetic components of the mandibular anterior prosthesis.

This paper explores seven different factors which should be considered when prescribing the lower anterior prosthesis: alignment as seen from the incisal; height of the incisal edges; degree of irregularity of the teeth; character of the incisal edge; height of the cuspid; mesio-incisal angle of the cuspid; and ridge coverage. The weights and variations of these different factors are discussed and suggestions made for a complete work authorization.

Laminagraphic study of mandibular condyle position when recording centric relation

Laminagraphs were made of each temporomandibular joint of 20 subjects (1) with the mandible forcefully retruded to centric relation and (2) with the mandible positioned by a closing force while an anterior guidance prosthesis was being used. The radiographs were compared by measurements of condylar position; results indicated the condyles to be significantly more superior in the glenoid fossa when anterior guidance was used. The difference in anterior-posterior positioning of the condyles appeared to occur randomly. Measurements of the joint spaces with the mandible in centric relation using anterior guidance indicated that mandibular condyles were not centered in the fossae. There seemed to be a range in the size of the space that could be considered normal.