Conventional Prostheses Research Articles

Safety evaluations for transtympanic laser stimulation of the cochlea in Mongolian gerbils (Meriones unguiculatus)

Infrared laser stimulation of the cochlea has been proposed as a possible alternative to conventional auditory prostheses. Whereas previous studies have focused primarily on the short-term effects of laser stimulation, the practical application of this technics requires an investigation into whether prolonged laser exposure can induce neural responses and safely. This study assessed the effect of laser-induced damage to the cochlea on auditory perception using Mongolian gerbils (Meriones unguiculatus) trained with a classical conditioning task. The broadband noise was presented as a conditioned stimulus, and reward licking was recorded as a conditioned response. After training, the subject's cochlea was exposed to a continuous pulsed laser for 15h. Broadband noise of various intensities was presented without pairing it with water before and after laser exposure to assess the decrease in auditory perception due to laser-induced injury. The licking rate did not change after laser exposure of 6.6W/cm2 or weaker but drastically decreased after 26.4W/cm2 or higher. These findings showed, for the first time, that the safety margin of long-term, at least several hours, cochlear laser stimulation exists and will contribute to the appropriate delimitation of the safe and effective laser stimulation parameters in future research.

The Ross Procedure in Active Infective Endocarditis: A Comparison With Conventional Prostheses

BackgroundThe Ross procedure can be an ideal option in infective endocarditis (IE) due to greater resistance to infection. However, limited literature has highlighted the comparison with conventional prostheses in this setting. MethodsBetween February 2013 and September 2022, 25 patients (median age, 50 years) underwent a Ross procedure for IE (Ross group). The results were compared with those after other aortic valve procedures (aortic valve replacement and aortic root replacement) for IE (n = 37, other group. ResultsThe patients in the Ross group included more intravenous drug users and had more prosthetic valve endocarditis and annular abscess formation compared with the other group. Although cardiopulmonary bypass time and aortic cross-clamp time were significantly longer (P < .001 and P = .003, respectively) and the blood requirements were significantly higher (P = .001) in the Ross group, most postoperative short-term outcomes were equivalent between the 2 groups. During follow-up, 1 patient (4%) required reoperation in the Ross group, whereas 6 patients (16%) required reoperation in the other group. Freedom from composite events was significantly better in the Ross group (P = .04). Multivariable analysis found the Ross procedure, compared with other procedures, was a significant independent protective factor for composite end points (P = .03). ConclusionsFor IE, despite surgical complexity, the Ross procedure yielded short-term outcomes similar to other procedures. In the midterm, the Ross procedure provides a lower reoperation rate, resulting in significantly fewer composite events. The Ross procedure appears to be a better option for patients with IE, but long-term follow-up is necessary.

Chondroitin Sulfate Derivative Cross-Linking of Decellularized Heart Valve for the Improvement of Mechanical Properties, Hemocompatibility, and Endothelialization.

Tissue-engineered heart valve (TEHV) has emerged as a prospective alternative to conventional valve prostheses. The decellularized heart valve (DHV) represents a promising TEHV scaffold that preserves the natural three-dimensional structure and retains essential biological activity. However, the limited mechanical strength, fast degradation, poor hemocompatibility, and lack of endothelialization of DHV restrict its clinical use, which is necessary for ensuring its long-term durability. Herein, we used oxidized chondroitin sulfate (ChS), one of the main components of the extracellular matrix with various biological activities, to cross-link DHV to overcome the above problems. In addition, the ChS-adipic dihydrazide was used to react with residual aldehyde groups, thus preventing potential calcification. The results indicated notable enhancements in mechanical properties and resilience against elastase and collagenase degradation in vitro as well as the ability to withstand extended periods of storage without compromising the structural integrity of valve scaffolds. Additionally, the newly cross-linked valves exhibited favorable hemocompatibility in vitro and in vivo, thereby demonstrating exceptional biocompatibility. Furthermore, the scaffolds exhibited traits of gradual degradation and resistance to calcification through a rat subcutaneous implantation model. In the rat abdominal aorta implantation model, the scaffolds demonstrated favorable endothelialization, commendable patency, and a diminished pro-inflammatory response. As a result, the newly constructed DHV scaffold offers a compelling alternative to traditional valve prostheses, which potentially advances the field of TEHV.

A World Update of Progress in Lower Extremity Transplantation: What's Hot and What's Not.

The field of vascularized composite allotransplantation (VCA) is the new frontier of solid organ transplantation (SOT). VCA spans life-enhancing/life-changing procedures such as upper extremity, craniofacial (including eye), laryngeal, tracheal, abdominal wall, penis, and lower extremity transplants. VCAs such as uterus transplants are life giving unlike any other SOT. Of all VCAs that have shown successful intermediate- to long-term graft survival with functional and immunologic outcomes, lower extremity VCAs have remained largely underexplored. Lower extremity transplantation (LET) can offer patients with improved function compared to the use of conventional prostheses, reducing concerns of phantom limb pain and stump complications, and offer an option for eligible amputees that either fail prosthetic rehabilitation or do not adapt to prosthetics. Nevertheless, these benefits must be carefully weighed against the risks of VCA, which are not trivial, including the adverse effects of lifelong immunosuppression, extremely challenging perioperative care, and delayed nerve regeneration. There have been 5 lower extremity transplants to date, ranging from unilateral or bilateral to quadrimembral, progressively increasing in risk that resulted in fatalities in 3 of the 5 cases, emphasizing the inherent risks. The advantages of LET over prosthetics must be carefully weighed, demanding rigorous candidate selection for optimal outcomes.

Analysis of Postoperative Complication and Revision Rates and Mid- to Long-Term Implant Survival in Primary Short-Stem Total Hip Arthroplasty.

Background/Objectives: Short-stem prostheses were introduced as an alternative to conventional straight-stem prostheses. Despite their benefits, including minimally invasive approaches, soft-tissue- and bone-sparing implantation, and physiological load transfer to the metaphysis, data on postoperative complication and revision rates as well as on implant survival are scarce. Methods: A retrospective analysis of 1327 patients who underwent primary total hip arthroplasty (THA) using the Metha® short stem between 2006 and 2023 was conducted. Complication and revision rates were analysed for the intraoperative, direct postoperative, and follow-up episodes. Implant survival was analysed with the endpoint of all-cause stem revision. Results: Intraoperative complications were observed in 3.77% of the cases and included 44 hairline cracks and 6 fractures. In 15 cases (30.0%), conversion to a straight-stem or revision implant was necessary. The direct postoperative complication rate was 2.44%, and 11 revision procedures were performed during inpatient stay (0.84%). Mean follow-up was 7 years (range 1-17). During follow-up, femoral component revision was performed in 60 cases. Aseptic loosening and stem subsidence accounted for a combined percentage of 80% of all indications. Implant survival rate was 95.66% after 5 years, 95.58% after 10 years, and 95.50% after 15 years. Conclusions: Our study provides a comprehensive analysis of postoperative complication and revision rates in a large sample undergoing primary short-stem THA. Postoperative complication rates were favourable, and the long-term implant survival rates were comparable to conventional straight-stem prostheses. Therefore, short-stem THA may be considered an alternative for younger patients.

Three-dimensional printing technology applied to the production of prosthesis: A systemic narrative review.

The purpose of this scoping review was to investigate the effects of 3-dimensional (3D)-printed prostheses. Articles published up to August 19, 2023, were searched in the PubMed, Cochrane Library, Embase, and Scopus databases. The search terms used were "3D printed prosthesis," "3D printed prostheses," "3D printed prosthe*," "3D printed artificial arm," "3D printed artificial leg," "3D printing prosthesis," "3D printing prostheses," "3D printing prosthe*," "3D printing artificial arm," and "3D printing artificial leg." This review included studies that applied 3D-printed prostheses to upper- or lower-limb amputees. Case reports, conference abstracts, presentations, reviews, and unidentified articles were excluded from the analysis. A total of 937 articles were identified, 11 of which were included after confirming eligibility through the title, abstract, and full text. The results indicated that the 3D-printed prostheses demonstrated the ability to substitute for the functions of impaired limbs, similar to conventional prostheses. Notably, the production cost and weight were reduced compared with those of conventional prostheses, increasing patient satisfaction. The use of 3D-printed prostheses is expected to gain prominence in future clinical practice. However, concerns regarding the durability of 3D-printed prostheses have increased among users. Therefore, there is an ongoing need to explore highly durable materials that can withstand the weight of the user without breaking easily. In addition, advancements are required in technologies that enable the depiction of various skin tones and the production of smaller-sized prostheses suitable for clothing.

Rapid-Deployment Valves versus Conventional Valves in Aortic Valve Replacement in Intermediate-Risk Patients

Background: Aortic valve replacement (AVR) in intermediate-risk (IR) patients is particularly challenging when determining the type of prosthesis to use. Rapid-deployment valves (RD-V) are emerging as a potential alternative in this patient population. Objectives: To compare early mortality, postoperative complications, and transvalvular hemodynamic parameters between AVR with conventional valves and RD-V in IR patients. Methods: We conducted a retrospective observational study of consecutive IR patients (STS-Prom score 4-8) undergoing AVR with conventional prostheses and RD-V between 2007 and 2023. Results: A total of 205 patients were included (140 AVR vs. 65 RD-V). Surgical risk was similar between both groups (STS-Prom 5.07 % vs. 5.7 % respectively, p = 0.211). The minimally invasive approach was more common in the RD-V group (32.3% vs. 0.7%, p &lt; 0.001). The cardiopulmonary bypass time and aortic cross-clamp time was significantly shorter in the RD-V group (134.5 vs. 100 min and 104 vs. 73 min, respectively, p &lt; 0.001). There was a trend to lower incidence of pacemaker implantation in the conventional valve group (4.3% vs. 10.8%, p = 0.075). There were no significant differences in postoperative complications, and a strong trend to lower 30-dat mortality with RD-V (0% vs. 5.7% for conventional valves, p = 0.057). The mean postoperative gradient across the prosthesis was significantly lower in the RD-V group (7.90 ± 3.3 mm Hg vs. 12.74 ± 6.07 mm Hg, p &lt; 0.001). There were no differences in the incidence of valve thrombosis or prosthetic endocarditis. Conclusions: Rapid deployment valves demonstrated trend to lower mortality, shorter cardiopulmonary bypass time and aortic cross-clamp time, improved hemodynamic profile, and were easier to implant via a minimally invasive approach.

Long-Term Outcomes of Dental Rehabilitation and Quality of Life after Microvascular Alveolar Ridge Reconstruction in Patients with Head and Neck Cancer.

Background/Objectives: Dental rehabilitation after extended tumour resection and jaw reconstruction is challenging. The present study aimed to report the prosthetic outcome and quality of life (QoL) in patients with head and neck cancer (HNC) after microvascular alveolar ridge reconstruction. Methods: The prosthetic outcomes of all consecutive patients with HNC who underwent microvascular alveolar ridge reconstruction at the University Hospital Salzburg between 2011 and 2018 were investigated. Oral health-related QoL (OHrQoL) and overall QoL were assessed using the validated Oral Health Impact Profile-49 (OHIP-49) and Short Form-36 questionnaires. Results: During the study period, 115 consecutive patients with head and neck cancer underwent microvascular jaw reconstruction. Among them, 23.3% and 27.4% received conventional tissue-borne prostheses and implant-supported prostheses, respectively, while 48.7% did not undergo dental rehabilitation. The prosthetic outcome was not associated with tumour stage (p = 0.32). Oral health-related quality of life (OHrQoL) was best in patients with implant-supported dental rehabilitation (OHIP-49 median score = 7) and worst in those with conventional removable dentures (OHIP-49 median score = 54). The corresponding OHIP-49 median score for patients who could not undergo dental rehabilitation was 30.5. All Short Form-36 subscale scores were equal to or higher than the malignancy norm scores. Conclusions: After microvascular jaw reconstruction, approximately one-third of the HNC patients received adequate implant-supported dental rehabilitation. However, the risk of dental rehabilitation failure was 50%. The different prosthetic outcomes affected OHrQoL, but not overall QoL.

Emerging Value of Osseointegration for Intuitive Prosthetic Control after Transhumeral Amputations: A Systematic Review.

Upper extremity limb loss profoundly impacts a patient's quality of life and well-being and carries a significant societal cost. Although osseointegration allows the attachment of the prosthesis directly to the bone, it is a relatively recent development as an alternative to conventional socket prostheses. The objective of this review was to identify reports on osseointegrated prosthetic embodiment for transhumeral amputations and assess the implant systems used, postoperative outcomes, and complications. A systematic review following PRISMA and AMSTAR guidelines assessed functional outcomes, implant longevity and retention, activities of daily living, and complications associated with osseointegrated prostheses in transhumeral amputees. The literature search yielded 794 articles, with eight of these articles (retrospective analyses and case series) meeting the inclusion criteria. Myoelectric systems equipped with Osseointegrated Prostheses for the Rehabilitation of Amputees implants have been commonly used as transhumeral osseointegration systems. The transhumeral osseointegrated prostheses offered considerable improvements in functional outcomes, with participants demonstrating enhanced range of motion and improved performance of activities compared with traditional socket-based prostheses. One study demonstrated the advantage of an osseointegrated implant as a bidirectional gateway for signal transmission, enabling intuitive control of a bionic hand. Osseointegrated prostheses hold the potential to significantly improve the quality of life for individuals with transhumeral amputations. Continued research and clinical expansion are expected to lead to the realization of enhanced efficacy and safety in this technique, accompanied by cost reductions over time as a result of improved efficiencies and advancements in device design.

Changes in masticatory performance and bite force after treatment with mandibular overdentures retained by four titanium-zirconium mini implants: One-year randomised clinical trial.

This prospective study is part of a randomised clinical trial and reports the changes in masticatory performance (MP) and bite force, and explores their influential factors, 1 year after the provision of mandibular overdentures retained by four titanium-zirconium mini implants. Edentulous patients received conventional complete dentures, followed by placement of four mini implants (Straumann® Mini Implant System) in the anterior mandible and converting the conventional prosthesis into a mandibular overdenture. Treatment protocols were randomised using a 2×2 factorial design combining different surgical (flapped vs. flapless) and loading (immediate vs. delayed) protocols. MP was assessed using a two-colour mixing ability test and a colorimetric analysis to measure the level of colour mixing (Variance of Hue-VoH). Maximum voluntary bite force (MBF) was measured by a digital gnathodynamometer in the posterior and anterior regions. Sex, age, surgical and loading protocols and ridge morphology were tested as independent variables. MP and MBF tests were performed at baseline (pre-treatment) and the 3-, 6- and 12-month after implant loading. Descriptive statistics, independent t-test, and linear mixed-effect model (LMM) regression were used for data analysis. Seventy-four participants were assessed and 73 completed the 1-year follow-up. Statistically significant improvements in functional parameters were observed in all follow-up periods compared to baseline (p < .001). The flapless protocol was associated with higher improvement in MP at the 3-month follow-up (p = .004), while less resorbed ridges were associated with better MP (p = .038) and higher MBF (p < .001). The mandibular overdenture protocol using four titanium-zirconium mini implants was effective in improving MP and MBF of edentulous patients, compared to pre-treatment values. The findings also suggest that improvements in chewing function and bite force are impacted by clinical factors since better outcomes were observed for flapless surgeries and less resorbed edentulous ridges. ClinicalTrials.Gov ID NCT04760457.

Analysis of Satisfaction Levels in Completely Edentulous Patients Treated with Different Configurations of Implant- Supported Prostheses.

To evaluate and compare patient satisfaction levels in edentulous patients treated with different configurations of implant-supported prostheses as well as previous prosthesis experiences before implant treatment. A study population of 142 patients was identified and separated into four treatment groups: group 1 comprised 43 patients treated with an implant-supported overdenture in the mandible and conventional complete denture in the maxilla; group 2 comprised 32 patients treated with implant-supported overdentures in the maxilla and mandible; group 3 comprised 26 patients treated with an implant-supported overdenture in the mandible and a fixed prosthesis in the maxilla; and group 4 comprised 41 patients treated with implant-supported maxillomandibular fixed restorations. Questionnaires asking about masticatory performance, pronunciation, comfort, and social ability were used to evaluate treatment outcomes. The patients in group 4 were significantly more satisfied regarding masticatory performance than other treatment modalities. Visual analog scale (VAS) scores for comfort and social ability were similar in groups 3 and 4 and significantly higher than those in groups 1 and 2. The patients who used a conventional removable prosthesis before implant treatment were more satisfied with their implant-supported prosthesis regarding social ability (P &#61; .03). The treatment design of an implant-supported fixed prosthesis in the maxilla and implant overdenture in the mandible provided a comparable level of satisfaction with maxillomandibular fixed prosthesis for edentulous patients. This combination served as a practical solution especially for patients with mandibular atrophy who would require extensive surgeries to support maxillomandibular fixed prostheses. In the maxilla, patient satisfaction with an implantsupported overdenture was not superior to that with a conventional prosthesis. Note that previous removable prosthesis experience may influence social comfort for patients.

Diverse Labial Flange Designs to Accomplish Lip Aesthetics in Conventional Complete Denture Prosthesis

Diverse Labial Flange Designs to Accomplish Lip Aesthetics in Conventional Complete Denture Prosthesis

Two-Parts Bilateral Dse-Hinge Design Maxillary Denture Stabilizer

Nowadays, the adult patient male or female demand for esthetic as a first choice in relation to other factors. The current case report introduces a technique of treating a young patient with complicated problems of bad condition of remaining teeth with partially edentulous arch. In this study a new precession attachment (Dse-HINGE) design was used to make prosthodontic appliance more comfortable, and esthetically acceptable than traditional design removable partial denture. The results of this procedure showed a successful clinical treatments with fixed bridge and new Dse-Hinge attachment removable prosthesis. Finally, patient remarks a preferable esthetic, stabilization, retention, and more comfortable function results of fixed prosthesis with Dse-Hinge attachment in relation to previous conventional removable prosthesis.

Megaprosthetic replacement in complex distal humerus fractures in elderly patients: a case series

BackgroundManaging distal humeral fractures can be challenging for orthopedic surgeons. There are several treatment options for managing this type of fracture, and the treatment method for these fractures should be based on patient-related factors. In elderly patients with osteoporotic bone and severe comminution of the fracture, adequate fixation can be a major challenge for surgeons. The use of megaprosthesis has been recently proposed in traumatology as an alternative to osteosynthesis or conventional prosthesis for the management of comminuted articular fractures in elderly patients with poor bone stock.MethodsA consecutive case series of 5 patients who underwent reconstruction of the elbow joint with a trabecular hinged modular elbow megaprosthesis was reviewed retrospectively. All patients included had AO/OTA 13C2 and 13C3 fractures with metaphyseal extension and considerable bone loss of the distal humerus. The primary outcome was the evaluation of functional and clinical outcomes with the MEPS score in comminuted distal humerus fractures with metaphyseal extension and poor bone stock in elderly patients treated with elbow megaprosthesis. The secondary outcome was assessing the treatment-related complication rate of this technique in non-oncological fields.ResultsFive patients were included in the study with a mean age of 82.66 ± 7.72 years at surgery. The mean MEPS value was 63 ± 24.2 at 1 month, 81 ± 23.53 at 3 months, 83 ± 24.2 at 6 months, and 84 ± 24.57 at 12 months. No intraoperative complications were recorded in our series. Of 5 patients, four patients had excellent clinical and functional outcomes. We did not encounter wound dehiscence, prosthetic joint infection, aseptic loosening, or periprosthetic fractures.ConclusionsThe indication for this type of treatment must be selected and narrowed down, as it is a salvage procedure, and any failure would cause even more complex situations. Short operating times and early mobilization of the elbow are the advantages of this technique.

Single-center real-world data and technical considerations from 100 consecutive patients treated with the Perceval aortic bioprosthesis.

Although the Perceval sutureless aortic valve bioprosthesis presents a feasible alternative to conventional aortic valve prostheses, the extent of its applicability with respect to technical considerations for a real-world patient collective is still under debate. One hundred patients received the Perceval prosthesis [males: 59; age: 72.5 (7.3-79) years] between December 2015 and February 2023 [EuroSCORE II: 2.8 (1.7-5.4)] for an aortic valve replacement (AVR), with additional concomitant procedures, for underlying severe aortic valve stenosis [n = 93 (93)], endocarditis [n = 5 (5)], and redo AVR [n = 7 (7)] including a prior surgical AVR [n = 4 (4)] and a failed transcatheter aortic valve implantation [n = 3 (3)]. Surgery was conducted primarily by median sternotomy [n = 71 (71)] and, alternatively, by the upper hemisternotomy approach [n = 29 (29)]. Over a median follow-up time of 36.5 (16.5-53) months, eight patients (8%) underwent postoperative pacemaker implantation, with five (5%) due to high-grade atrioventricular block, while nine patients experienced a stroke (9%). The median values of maximum and mean gradients across all valve sizes were 22 (18-27.5) mmHg and 10 (13-18) mmHg, respectively. Two patients (2%) had moderate and one (1%) had severe paravalvular leakage, with the latter presenting the only case of underlying valve migration and induced redo AVR with valve explantation 2 days following initial surgery. Thirty-day mortality (and overall mortality) was 5% and 26%, respectively. The implantation of the Perceval bioprosthesis is feasible for a variety of indications, with excellent hemodynamic results and low complication rates in a real-world high-risk patient collective.

Transcutaneous Osseointegrated Prosthesis Systems (TOPS) for Rehabilitation After Lower Limb Loss: Surgical Pearls.

Transcutaneous Osseointegrated Prosthesis Systems (TOPS) for Rehabilitation After Lower Limb Loss: Surgical Pearls.

Thighplasty at the Time of Stage-1 Bone-Anchored Osseointegration Surgery.

For patients with transfemoral amputations and difficulty tolerating conventional socket-based prostheses, osseointegrated (OI) implants have enabled increased prosthetic use, improved patient satisfaction, and shown promising functional outcomes1,2. Although the use of OI implants effectively eliminates the soft-tissue-related challenges that have plagued socket-based prostheses, the presence of a permanent, percutaneous implant imparts a host of new soft-tissue challenges that have yet to be fully defined. In patients undergoing OI surgery who have redundant soft tissue, we perform a thighplasty to globally reduce excess skin and fat, tighten the soft-tissue envelope, and improve the contour of the residual limb. First, the orthopaedic surgical team prepares the residual femur for implantation of the OI device. After the implant is inserted, the residual hamstrings and quadriceps musculature are closed over the end of the femur, and the subcutaneous tissue and skin are closed in a layered fashion. Although the anatomic location and amount of excess soft tissue are patient-dependent, we perform a standard pinch test to determine the amount of soft tissue that can be safely removed for the thighplasty. Once the proposed area of resection is marked, we proceed with longitudinal, sharp dissection down to the level of the muscular fascia. At this point, we use another pinch test to confirm the amount of soft-tissue resection that will allow for adequate resection without undue tension3. Excess subcutaneous fat and skin are carefully removed along the previously marked incisions, typically overlying the medial compartment of the thigh in the setting of patients with transfemoral amputations. The thighplasty incision is closed in a layered fashion over 1 or 2 Jackson-Pratt drains, depending on the amount of resection. Depending on the amount of redundant soft tissue, thighplasty may not be necessary at the time of OI surgery; however, in our experience, excess soft tissue surrounding the transcutaneous aperture can predispose the patient to increased shear forces at the aperture, increased drainage, and increased risk of infection4. Although superficial infectious complications are most common following OI surgery, the need for soft-tissue refashioning and excision is one of the most common reasons for reoperation1,5. Our group has been more aggressive than most in our use of a vertical thighplasty procedure to globally reduce soft-tissue motion in the residual limb to avoid reoperation. Although much of the OI literature has focused on infectious complications, recent studies have demonstrated reoperation rates of 18% to 36% for redundant soft tissue following OI surgery1,5. We believe that thighplasty at the time of OI not only reduces the likelihood of reoperation but may also decrease infectious complications by reducing relative motion and inflammation at the skin-implant interface4,6. The thighplasty procedure is ideally performed as part of the first stage of the OPRA (Osseointegrated Prosthesis for the Rehabilitation of Amputees) procedure to limit the likelihood of problematic ischemia-related complications.We utilize a confirmatory pinch test both before and throughout the thighplasty procedure to ensure adequate resection without undue tension.The thighplasty excision pattern utilizes a long vertical limb designed to decrease the circumferential laxity of the residual limb. Maximal tension is borne on the vertical limb and not on the transverse extensions, as these are prone to scar widening and distortion of surrounding tissues.Closed-suction drainage is utilized liberally to decrease the likelihood of a symptomatic seroma. OI = osseointegratedOPRA = Osseointegrated Prosthesis for the Rehabilitation of AmputeesPVNS = pigmented villonodular synovitisT-GCT = tenosynovial giant-cell tumor.BMI = body mass indexPMH = past medical history.

Management of Edentulous Patients with Maxillary Substance Loss: A Case Report

Depending on the location and extent of the loss of substance following maxillary resection surgery, all functions of the masticatory apparatus may be adversely affected. Eating and communication are impaired, which has a negative impact on the patient's psychological state [1]. When reconstructive maxillofacial surgery is not possible, rehabilitation with a maxillofacial prosthesis is essential. It must restore functions (phonation, eating, breathing, etc.) and reintegrate the patient into his psychosocial environment by masking his disability [2]. To achieve these objectives, this prosthesis, like a conventional removable prosthesis, must meet the Housset triad (support - retention - stabilisation), but also the objective of tightness. We therefore speak of a "prosthetic tetrad in PMF" (Housset's triad completed by the objective of tightness) [3]. In the case of a completely edentulous arch with substance loss, the treatment becomes more complex due to the reduced support surface. The maxillofacial prosthodontist must therefore be extremely vigilant to ensure the success of this appliance. A wise choice of technique and impression material, as well as respect for the occlusal parameters (occlusal plane, vertical dimension, centric relation, etc.) will ensure prosthetic stability and integration [4]. In this article, we will focus on the peculiarities of the management and the different stages in the fabrication of a maxillofacial prosthesis for a patient with total edentulism and loss of maxillary substance.

Musical instruments, oral problems and prosthodontics: A review and a clinical report of a musician menopausal woman

The condition of teeth and the function of the oral organs are important when playing musical, especially brass or wind, instruments. This article describes the prosthodontic treatment provided for a musician who had lost a tooth and her subsequent musical performance. The relevant literature is also discussed. A 49-year-old professional clarinet player who fractured and avulsed the upper left central incisor during a fall sought maxillofacial rehabilitation for the missing tooth to maintain her ability to play the clarinet. Her treatment consisted of a provisional removable prosthesis with an acrylic base and clasps followed by a final fixed implant and conventional prostheses, designed accordingly. Her satisfaction with the prostheses was assessed by a self-reported questionnaire. The dental treatment helps to ensure that the musicians with oral, mainly prosthodontic, problems can continue playing the wind or brass instrument, especially the clarinet at their previous performance level professionally.

Comparison of the adhesion of adhesive pastes on removable dental prostheses from different commercial companies

The use of conventional removable dental prostheses shows the lack of retention and stability, so the use of adhesives for prostheses has been generalized to improve their resistance to detachment. The adhesion of adhesive pastes in removable dental prostheses of different commercial companies was compared. The empirical component involved an in vitro experiment using two adhesive pastes: Corega and Denta Firme, applied on acrylic discs that were previously hydrated and then placed on glass slabs to measure the adhesion strength. This process involved the uniform application of 5 ml of each paste on the discs, followed by a hydration period of 8 minutes. Adhesion strength was measured using a digital scale, recording the highest value obtained during vertical debonding of the disc from the tile. This study revealed that the differences in the bond strength of the adhesive pastes evaluated for dentures are minimal. Denta Firme demonstrated the highest bond strength in the short term. It is concluded that the study failed to determine the durability of the bond strength of the pastes over time. However, the findings indicate that the use of adhesives significantly improves the retention of conventional removable or total dentures. Consequently, it is recommended that dental professionals carefully choose the most appropriate adhesive for each patient, considering individual characteristics and specific needs, in order to take full advantage of the benefits offered by these products