Dental Prosthetic Rehabilitation Research Articles

Dental prosthetic rehabilitation of a patient with parafunctional habit: A case study

Introduction: Parafunctional habits such as clenching, grinding, gnashing of the teeth leave multiple consequences on the natural dentition if left untreated. Purpose: The purpose of this study is to represent a patient treated prosthetically with parafunctional habit of clenching his teeth. Material and methods: For the purpose of this study a 42 year old patient was analyzed, treated and rehabilitated with metal ceramic anterior dental bridge. He was treated with a dental splint before beginning of the treatment. His left central maxillary incisor, left maxillary lateral incisor, and left canine were treated endodontically, and then restaurated with posts and cores. After that a dental frontal aesthetic bridge was manufactured. Because the patient has a habit to clench his teeth, he needs to be monitored so that he does not damage the anterior bridge, which is the reason why a dental splint was designed for protecting the patient. Results and Discussion: Patients with parafunctional habits represent a highly challenging group for treatment. Authors worldwide have tried to find optimal solutions on how to help patients with different parafunctional habits and how to prevent them in the future. In this case study the patient was successfully treated and rehabilitated. Conclusion: The consequences that parafunctional habits can leave on the dentition can be observed, and dental prosthetic treatment can create functional – aesthetic solution that needs to be preserved.

Prosthetic rehabilitation in patients with jaw reconstruction by fibula free flap: A systematic review

This systematic review aimed to evaluate the dental prosthetic rehabilitation (DPR) in patients after jaw reconstruction with fibula free flap. Four databases were searched from January 2000 to January 2023. Of the 2507 studies identified, 36 observational studies were included. Cancer was the most common surgical indications for jawbone resection with 58.3 % of cases followed by benign tumours which representing 24 %. The DPR rate was estimated at 51.6 % across the studies (ranging from 38 % to 55 % depending on the benign or malignant nature of the tumors). Implant-supported prostheses represented 58.9 % of cases of which 66.9 % were fixed and 33.1 % were implant-stabilized overdentures. Virtual surgical planning (VSP) was used in 20 % of studies and aimed to improve the position of the grafted fibula, quality, and aesthetics of DPR and to decrease ischemia and the operating time. One in two authors performed DPR 12 months after jaw reconstruction. If implant survival rate reached 93 % in non-irradiated fibula, it fell to 38 %, 55 %, and 77 % if implantation occurred in the 12, 17, and 24 months after radiotherapy, respectively. Various parameters should be better investigated in further studies including the typology of the prostheses (implant-supported vs removable), the use of VSP, and the optimal time for DPR taking into account the characteristics of the tumor, the size of bone defect, and the need for external irradiation therapy

APPLICATION OF THE METHOD OF FREQUENCY-RESONANCE ANALYSIS OF IMPLANTS INSTALLED AFTER AUTOGENOUS BONE TRANSPLANTATION

Background: Purpose of study determine the timing of prosthtic rehabilitation of patients after autograft and dental implantation of the jaw bone using resonance-frequency method (RFA). Methods: The analysis of the treatment of 34 with vertical resorption of the lower jaws, and dental implant prosthetic rehabilitation performed for the period 2020-2023.All patients underwent a complex clinical, laboratory study, computed tomography (CT). At the first stage, the autogen bone grafting procedure, at the second stage, 4 months after autogen bone grafting implants were installed. 3 months later, after implants inserted to determine the timing of prosthetic rehabilitation, the method of RFA-Resonance Frequency Analysis method was used, if normal results were recorded, the prosthodontic phase began. Postoperative clinical and radiological monitoring was regularly conducted, and criteria for the success of implantation and success of prosthetics of implant- supported reconstructions were evaluated. Change in marginal bone levels was assessed by taking digital x-rays immediately after restoration fixation (base line for comparison), after 1 and 3, 5 years post operatively. Results: No intra-operative or immediate post-operative complications were noted after autografting procedure. The postoperative of the patients was favorable, with the integration of the autografts. 3 months after autogenous bone grafting, the resorption of the graft in some transplant recipients is up to 10%. All of the patients presented with healthy soft tissue. Marginal bone loss data were recorded, mean marginal bone loss (MBL) was 1.2 ± 0.25 mm after 3 years. The mean RFA recordings of all 136 implants were 65 ISQ at implant placement respectively 73 ISQ after 3 months. The functional load on dental implants was performed with ISQ values above 65 (dental prosthetic rehabilitation was performed after 3-4 months of submerged healing). A total of 8 implant failures were recorded. After 5 years show survival rates 97%. Conclusions: RFA could serve as a noninvasive diagnostic tool for detecting implant stability during healing stages and subsequent routine follow ups. The method of resonance-frequency analysis allows us to determine the timing of the beginning of the prosthetic stage in each specific case.

Dental Prosthetic Rehabilitation Interventions in Elderly Patients Hospitalized in the Nursing Homes of the Lombardy Region: A Retrospective Study.

Background: The difficulty of frail, non-self-sufficient or non-ambulatory collaborating elderly residents in nursing homes to eat due to a lack of teeth or the absence of a dental prosthesis leads to an increasingly evident increase in the patients' systemic pathological state, particularly in older patients who take a lot of medications. Total or partial edentulousness that is not filled with dental prostheses or that is filled with inadequate prostheses, associated with socioeconomic factors, depression, impaired motor functions, heart disease and a large number of chronic diseases including excessive use of drugs, often affects elderlies' feeding. Aim: In this study, prosthetic rehabilitation was performed on some frail elderly residents in 10 nursing homes in the Lombardy district, and, subsequently, meal behavior and social activity were examined in two information questionnaires through compilation. Methods: The research was conducted on only 67 patients, 26 men and 41 women, aged between 75 and 99, who were guests in 10 health facilities (nursing homes) in the Lombard district; only 8 residents did not undergo prosthetic rehabilitation, as they did not cooperate. All the patients who were visited underwent oral prosthetic rehabilitation, and, subsequently, some aspects such as nutrition and socialization were assessed with other residents through the aid of two information dossiers. Results: the results showed that all the residents, despite difficulties in chewing with the new prosthesis, were fed and did not refuse more consistent foods; in addition, there was an improvement in social activity among the residents. Only 19.3% of men and 22% of women continued to eat little; there was an improvement in the participation in social activities among the residents, with a percentage of 73% of men and 88% of women; in particular, during meals 35 residents conversed with the other residents. Discussion: The dental problems of elderly people residing in social welfare homes are increasingly evident when other systemic pathologies are present. It would be desirable to introduce telemedicine in residences for the elderly for the monitoring of dental problems. Conclusions: From the information obtained and from the evaluation of the change in the elderly, it can be concluded that it would be desirable to include specific dental protocols to create a network, including a telematic one, to monitor and perform more dental checks in nursing homes.

Prosthetic rehabilitation of a patient submitted to segmental mandibulectomy

Surgical rehabilitation with grafts and plates of an oncological patient submitted to segmental mandibulectomy may be limited due to the majority receiving late diagnosis, requiring rapid intervention with association of drug therapies and thus, the risk of osteonecrosis. We detail a dental prosthetic rehabilitation in a patient who underwent a segmental mandibulectomy without plates or grafts. Man, 47-years old, affected by a squamous cell carcinoma on the floor of the mouth, treated by segmental mandibulectomy, radiotherapy and chemotherapy, was attended to a dental prosthetic rehabilitation over the mandible segments with a removable partial denture. Initially, a temporary prosthesis was made, in order to adapt the patient with the restoration of the occlusion and recovering the muscle tone. The patient used the temporary removable partial denture for 6 months, accompanied by physical therapy to maintain occlusal stability and regain muscle tone. After this period, it was possible to make a removable partial denture for definitive rehabilitation. The patient proved to be adapted to the prosthetic device and satisfied with the treatment. Prosthetic rehabilitation is a viable option when surgical reconstruction is contraindicated or can be used until the surgical procedure can be realized.

Tubero pterygoid implants- a boom for atrophied maxillary ridges

Introduction: Dental prosthetic rehabilitation based on Osseo integrated implants is a well-established and highly predictable treatment modality. Hence we aimed to systematic literature review to analyze clinical outcomes of tubero-pterygoid / Pterygoid implant for the treatment of patients with atrophic posterior maxillae and to provide clinical recommendations for this dental implant technique. Material and methods: Online data was collected from the search engines of EBSCO, Pubmed, Google Scholar, Scopus to identify literature presenting clinical outcomes of tubero-pterygoid implants in the treatment of patients with atrophic posterior maxillae. The study articles were collected that from Jan 1999 to Feb 2021. Based on the PRISMA guidelines the meta analysis was performed. Results: From 331 only 6 were finalized. All studies were retrospective in nature and were classified with a poor level of evidence. A total of 634 patients received 1.893 tubero- Pterygoid implants, with a mean implant survival rate of 94.87%. The mean prevalence of implant failure was 0.056 with a 95% CI of 0.04 to 0.077. Conclusion: It can be concluded that tubero-pterygoid implants can be successfully used in patients with atrophic posterior maxilla.

Surface electromyography and mandibular motion recording input in prosthetic rehabilitation of segmental mandibulectomy: The MAC2 protocol

Lateral segmental mandibulectomy can be associated with sequelae, such as mouth opening limitation and mandibular deviation, that lead to altered oral functions (chewing, swallowing, speech) and complex prosthetic management. The authors present a new protocol for surface electromyography (sEMG) and mandibular motion recording to help clinicians with decision-making and dental prosthetic treatment planning for segmental mandibulectomy. The clinical case of a patient with a reconstructed titanium endoprosthesis is presented. The MAC2 protocol is used and consists of chronologically performing various recordings by using a device for sEMG and mandibular tracking. During the orofacial reeducation and dental prosthetic reconstruction, three therapeutic steps can benefit from the MAC2 protocol: to analyze the initial muscular imbalance, to provide guidance in the choice of maxillomandibular relationship and to quantify the functional improvement. sEMG of masticatory muscles is a useful diagnostic tool in a context of mandibular kinematic disorders and the MAC2 protocol adds some guidance for dental prosthetic rehabilitation in the context of segmental mandibulectomy. (Int J Maxillofac Prosthetics 2021;4:47-54)

Efficacy of Endoscopic sinus surgery for associated with filling material of the maxillary sinus, simultaneous sinus-lifting and dental implantation

Objectives: Optimization of the sinus-lifting in patients with filling material in maxillary sinus cavity by a one-stage endonasal endoscopic elimination of the sinuspathology and carrying out a sinus-lifting. Materials and methods: A total of 28 patients (12 males and 16 females, the age was 31 to 64 years, from 2016 to 2022) with ridge defects in age group were selected for the study. All patients had a partially or totally edentulous atrophied posterior maxilla. All patients underwent a thorough clinical examination according to a generally accepted scheme.For sinus surgery, used endoscope is 4.0 mm diameter rigid endoscope (Karl Storz). The fungal material, and hypertrophic mucosa within the maxillary sinus were removed and sent for pathological analysis.Sinus lifting procedures were performed using a lateral window approach. A total of 34 sinus lifting procedures were performed, using a mixture of bovine bone, autogenous bone and PRP. According to our surgical procedure we performed in our patients 1 a 2 stage sinus lifting, 98 implants were inserted. Dental prosthetic rehabilitation was undertaken 5 months after implants insertion and submerged healing. Implant success was assessed clinically and radiographically. The height of the graft and bone density was measured 6th and 9th month after surgery using serial CT. The following parameters were assessed: failure of the augmentation procedure, implant failure, and vertical bone height. Results: Any intraoperative and postoperative complications, such asbleeding, membrane perforation, swelling, ecchymosis, pain, nasal bleeding, and infection, were recorded clinically and radiographically. Of the 98 implants placed in these 28 patients, 3 failed to osseointegrate. The CT examination showed the presence of dense bone around and above the implants. The implants appeared to be well integrated with no peri-implant bone loss. At 6 years follow up, excellent integration of grafted tissue, steady levels of bone around the implants and healthy peri-implant tissues were reported. Implants placed in the reconstructed areas were demonstrated to integrate normally, postoperative occlusal function and esthetics have been favorable. Conclusion: The method of simultaneous endonasal sanitation of the maxillary sinus, sinus-lifting, dental implantation, allows to reduce the probability of perforation of the membrane, significantly shortening the rehabilitation period of patients with insufficient bone tissue in the maxillary sinus. These methods led to simpler, more comfortable, lower risks of morbidity, more predictable compared to more invasive maxillary sinus augmentation

Mandibular Reconstruction and Rehabilitation with Vascularized Free Fibula Flap with Further Endosteal Implants

Objectives:To evaluate of the effectiveness of rehabilitation in patients following mandibulectomy and free fibula flap reconstruction with further endosteal implants. Materials and Metods: The patient cohort consisted of 27 patients years (14 males and 13 females) with lower jaw defects due to resection for tumors, were reconstructed with fibula-free flaps in a 6-year period (2015-2020). All patients underwent a thorough clinical laboratory, radiological examination according to a generally accepted scheme. Patients were evaluated by preoperative and postoperative outcome using computed tomography scan evaluation. The surgical procedure included: Segmentar resection of the lower jaw, reconstruction with fibula free flap. The implants were evaluated with measures of Resonance Frequency Analysis (RFA) during the follow-up periods using Osstell Mentor at time of implant placement, after 3 months. The mean RFA recordings of all 134 implants were 65 ISQ at implant placement respectively 73 ISQ after 3 months. After 4-6 months of healing, 152 dental implants were placed in non-irradiated fibular bone. Dental prosthetic rehabilitation was performed after 3-4 months of submerged healing. Patients had received implant-bridge and hybrid denture that provided ideal facial balance and occlusion. Results:Postoperative clinical and radiographic controls were made regularly, the criteria for implant success were assessed.With dynamic observation, clinical and radiological indices were stable, of the 152 implants installed, 2 failed to osseointegrate and 5 after years of loading (peri-implantitis). Success rate of implants 5 years after was 96.1%. Conclusion:The reconstruction of the lower jaw defects after ablation of tumors with fibular flaps is a reliable method with good long-term results. In all 27 patients, fibula flaps provided adequate bone stock for implant placement. Implants placed in the reconstructed areas were demonstrated to integrate normally. The results showed that implant treatment is effective to improve patients‘ masticatory efficiency and an acceptable quality of life to the patient

CRANIOFACIAL OSTEOSARCOMA: A CASE REPORT

<h3>Background</h3> Osteosarcoma is the most common primary bone tumor, with 10% of cases affecting the head and neck. Demographics of head and neck osteosarcoma are different from those elsewhere in the musculoskeletal system. Prognosis is strongly dependent on negative resection margins with the use of neoadjuvant chemoradiotherapy in select cases. <h3>Description</h3> We present a case of a 58-year-old male nonsmoker patient who presented with a lump in his left upper jaw. Clinical examination revealed an exophytic mass in the upper left tuberosity of the maxilla suspicious for squamous cell carcinoma with no associated lymphadenopathy. <h3>Findings</h3> Radiological investigations revealed a metabolically active left maxillary lesion with destruction of the maxillary sinus. Histologic examination of a superficial biopsy initially suggested a proliferative fibro-osseous lesion; however, a second deeper biopsy was diagnostic of osteosarcoma, and the patient was referred to a sarcoma center. Immunohistochemistry showed AE1/AE3 and CK(MNF.116) positivity in occasional cells with a Ki67 proliferation index of 60%. This was diagnostic of grade 2-3 osteosarcoma. Multidisciplinary management of the patient included neoadjuvant chemotherapy and total maxillectomy and dental prosthetic rehabilitation. The patient is still under follow-up. <h3>Conclusions</h3> This case of primary osteosarcoma of the maxilla is rare and scarcely reported in the literature. Clinical differential diagnoses include squamous cell carcinoma, and histologic differential diagnosis includes fibro-osseous proliferative lesions in undersampled cases. It is important to consider osteosarcoma in destructive lesions, as it requires prompt and early specialist intervention to maximize the chances of negative surgical margins, which is the mainstay of treatment for this disease for prognosis.

Do implant-supported prostheses affect bioavailability of nutrients of complete and partially edentulous patients? A systematic review with meta-analysis

Summary Background & aims Debate still exists about the impact of dental implant-supported prostheses on nutritional status of partially and complete edentulous patients. This review aims to answer the focused question: “Do complete and partial edentulous patients, using implant-supported prostheses, present better nutritional and masticatory functions when compared to those using conventional rehabilitations?”. A possible cause–effect relationship between masticatory improvements and nutritional gain was also evaluated. Methods Literature search included 6 databases (PubMed/Medline, Embase, LILACS, Scopus, Web of Science, and The Cochrane Library - CENTRAL), grey literature (Google Scholar, Proquest Dissertations and Thesis and Open Grey databases) and manual search (last update June 2020), without language, publication time and follow-up restrictions. We included only studies evaluating both masticatory and nutritional outcomes. The PICO question comprised complete and partial edentulous patients (Population), submitted to implant-supported prostheses (Intervention), in comparison to conventional dental prosthetic rehabilitation, evaluating masticatory function and nutrition parameters (outcomes). Risk of bias was assessed by using Cochrane Collaboration's tool (randomized clinical trials), Joanna Briggs Institute critical appraisal checklist (paired clinical trials), and Meta-Analysis of Statistics Assessment and Review Instrument” (JBI - MAStARI) critical appraisal tools (cohort studies). All meta-analyses were conducted at 5% level of significance. This report followed the PRISMA guidelines. (Review registration PROSPERO - CRD42019135744). Results We identified 1199 articles while searching databases. Fourteen articles met eligibility criteria, including 817 prostheses installed in 660 patients (mean age = 66.8 years-old). Patients wearing implant overdentures (IOD) presented better masticatory function in comparison to conventional complete denture (CD) wearers (p Conclusion Current evidence indicates significant masticatory improvements for dental fixed implant-supported prostheses in comparison to conventional removable prostheses. However, bioavailability remained stable for most of the nutrients, especially for complete edentulous patients. These results indicate the importance of a multidisciplinary approach during oral rehabilitation (nutrient specialist), in order to enhance food choices and promote health benefits to the patients.

Marginal Accuracy of Milled Versus Cast Cobalt Chromium Alloys in Long Span Implant-Supported Frameworks: A Systematic Review and Meta-analysis

Aim: To assess if milled cobalt chromium (Co-Cr) alloy offers significantly better marginal accuracy than cast Co-Cr alloy for screw-retained long-span dental implant framework. Materials and Methods: A search PICO was formulated using suitable keywords and an electronic search was initiated. The databases of PubMed, Cochrane Library, Google Scholar and Embase were searched for related articles. Bibliographies of randomised control trials and reviews, identified in the electronic search, were analysed for studies published outside the electronically searched journals. Electronic search identified 26 studies. A total of 16 studies were eliminated after reading the abstracts. Out of the remaining 10 studies, 3 were eliminated based on the inclusion and exclusion criteria, and finally 7 studies were finalised for systematic review. Results Data were extracted from the included studies and analysed. The obtained data were suitable for meta-analysis, which showed an overall effect size z = 4.97 ( P &lt; .001) at 95% CI showing a significant statistical difference between milled and cast Co-Cr frameworks. Conclusion: Milled cobalt chromium frameworks are significantly more accurate than cast frameworks for long-span implant-supported frameworks used in dental prosthetic rehabilitation. More randomized controlled trials need to be conducted with a larger sample size to get a more authentic conclusion in a clinical scenario.

Functional evaluation of mandibular reconstruction with bone free flap. A GETTEC study

ObjectivesTo assess the functional results of oromandibular reconstruction by free bone flap, in terms of swallowing, speech and esthetics. Materials and methodsA transverse multicenter study included 134 patients reconstructed by free bone flap between 1998 and 2016, with more than 6 months’ follow-up, in 9 centers. A standardized questionnaire collected data on patients and treatment. Study endpoints comprised: weight loss, mouth opening, gastrostomy dependence, type of feeding, and DHI score. The impact of patient baseline characteristics on these functional criteria was explored by uni/multivariate analysis. ResultsNinety of the 134 patients had cancer. Fibula flap was mainly used (80%). 94% of reconstructions were primary successes. 71% of patients had pre- or post-operative radiation therapy. 88% had less than 50% lingual resection. 97% recovered oral feeding. 89% had intelligible speech. 86% judged their esthetic appearance as good/average. 9% had dental prosthetic rehabilitation. Radiation therapy and extensive lingual resection significantly impacted swallowing function (P=0.04 and P=0.03, respectively). Radiation therapy and oropharyngeal extension significantly increased gastrostomy dependence (P=0.04 and P=0.02, respectively). ConclusionOromandibular reconstruction by free bone flap enabled return to oral feeding in most cases. More than 80% of patients were satisfied with their result in terms of speech and esthetics. However, the rate of dental rehabilitation was low and the rate of complications was high.

Influence of the Variable Loading Factor on the Masticatory System and the Temporomaxilar Joint and Its Correlation with the Clinic

The integral analysis of the Temporomandibular Joint (TMJ) and the osteo-ligament-articular and muscular structures was carried out together with their associated neural network. This determined the high degree of correlation of the factors that affect the dynamic-functional balance of the Temporomandibular System (TMS) and the self-dynamics of the System. Finite element studies were used to represent the effects of load factors (G forces) in the laboratory and over military combat aircraft, to try to extrapolate the results to field work. The dynamic parameters of the TMJ were measured, using a variable load factor (force G) imposed on the pilots in a sequence of military flights. The application of sustained load factor allowed to visualize in a short period of time, what would take a researcher years to observe, about the typical anomalies of the temporomandibular system and the associated dynamic structures in a patient, besides being able to study the relaxation time that the masticatory system needs, in order to recover its physiological stability, understanding which are the adaptation mechanisms for it. It was determined that not only asymmetric efforts (responsible for the multiple positions of each tooth or dental prosthesis), are responsible for generating harmful loads on the Temporomandibular System, but also have a high degree of correlation, in general, with the damage caused at the TMJ, due to alterations in biomechanical lever systems. Therefore, the methodology of dental treatments must be reconsidered, starting from functional recovery, through appropriate biomechanical mechanisms, to then give way to the corresponding dental rehabilitation, which will result in the functional stability of the masticatory system, dental-prosthetic rehabilitation and the balance integral of the body understanding the masticatory system, as an integral part of a Whole (Holistic Vision).

Dental Prosthetic Rehabilitation of a Tumor Patient After Radiotherapy and Mandibular Resection

Many patients with a history of head-and-neck tumors present with hard- and soft-tissue defects resulting from their disease and treatment that will preclude any dental prosthetic rehabilitation without the use of implants.

Clinical Evaluation of Periodontal Tissue Status in Prosthodontic Treatment of Patients with Partial Tooth Loss and Generalized Periodontitis

The problem of selection and application of dental prostheses in periodontal disease is especially relevant in case of severe generalized periodontitis, which is accompanied by mobile tooth removal resulting in overloading the periodontium of the remaining teeth as well as the increase in tooth mobility. Therefore, in generalized periodontitis, it is important to apply the method of direct dental prosthetic rehabilitation since, in case of partial tooth loss, it will prevent the development of generalized periodontitis complications.The objective of the research was to improve the effectiveness of combination therapy for patients with generalized periodontitis and partial tooth loss applying the developed method of direct fixed dental prosthetic rehabilitation based on the study of the periodontal status.Materials and methods. The study included 129 patients with general periodontitis, II-III degree and partial tooth loss over the age of 45 years. According to prosthodontic treatment, all the patients were divided into three groups: Group I consisted of 42 (20 women and 22 men) patients who immediately after tooth extraction were rehabilitated with the application of direct plastic laminar immediate prosthesis and selective tooth grinding; permanent dental prosthetic rehabilitation was performed 6 weeks after tooth extraction; Group II included 43 (21 women and 22 men) patients who underwent traditional permanent dental prosthetic rehabilitation using fixed dental bridges 6 weeks after mobile tooth removal and wound healing; Group III comprised 44 (21 women and 23 men) patients who immediately after mobile tooth removal were rehabilitated with the application of direct fixed sectional dental bridge (Ukrainian patent UA 20995. 2007 Feb 15) and selective tooth grinding; permanent dental prosthetic rehabilitation was performed 6 months after tooth extraction. The control group consisted of 26 people with intact dentitions over the age of 45 years.Results and discussion. The application of direct dental prosthetic rehabilitation method after mobile tooth removal in combination treatment of generalized periodontitis allows stabilizing degenerative and inflammatory processes in the periodontium in the initial stages, as well as increasing the resistance of the capillaries and bone mineral density of the interdental septa. The obtained data indicated that the application of the proposed direct fixed sectional dental bridge was more effective as compared to conventional prosthetics methods.Conclusions. 1. Direct fixed prosthodontics using direct fixed sectional dental bridge is essential in combination treatment of generalized periodontitis, especially if mobile tooth extraction is needed. It allows increasing the effectiveness of treatment in comparison with direct removable prosthodontics using direct plastic laminar immediate prosthesis (Group I) and traditional treatment methods (Group II). 2. We have proved the advantages of direct fixed prosthodontics in treatment of patients with generalized periodontitis, II-III degree based on the improvement of oral hygiene indices, the gingival bleeding index, the papillary-marginal-alveolar index, the periodontal index and the depth of periodontal pockets 6-12 months after treatment.

Evaluation of use of acrylic resin-based surgical guide in the function and quality of life provided by mandibular prostheses with microvascular free fibula flap: A four-year, randomized, controlled trial

Statement of problemThe correct positioning of the microvascular-free fibula flap (MFFF) is essential for satisfactory mandibular reconstruction. However, the effect of acrylic resin-based surgical guides on prosthetic rehabilitations has not yet been properly investigated. PurposeThe purpose of this randomized clinical trial was to evaluate whether intraoral and extraoral acrylic resin-based surgical guides improve anatomic, functional, esthetic, and quality of life (QoL) results for dental prosthetic rehabilitation with MFFF. Material and methodsParticipants subjected to mandibular reconstruction with MFFF were selected and randomly distributed into 2 groups, control (Co; using conventional surgery) and acrylic resin-based surgical guides (Sg). Functional parameters related to prosthetic rehabilitation and QoL were evaluated by interviews and an oral health impact profile (OHIP)-14 questionnaire. Functional parameters and questionnaire scores were subjected to statistical analysis: the likelihood ratio and the Fisher exact and Mann-Whitney U tests (α=.05). ResultsOf 40 participants, 18 were rehabilitated, 10 with tooth-tissue-supported partial removable dentures and 8 with implant prostheses. In Sg, the study measured an enhancement in functional parameters and revealed a significant improvement in QoL (P=.020). ConclusionsThe guides proposed directly improved mandibular reconstruction. Functional aspects may be improved by allowing good intermaxillary relationships and posterior dental rehabilitation. Functional success is directly dependent on soft tissue status and the quality of its reconstruction. Soft tissue evaluation is important before dental rehabilitation.

Survival, Function, and Complications of Oral Implants Placed in Bone Flaps in Jaw Rehabilitation: A Systematic Review.

This systematic review attempted to determine the survival rate of implants placed in bone flaps in jaw rehabilitation and the functional gains and the most common complications related to these implants. An electronic search was undertaken of PubMed, EMBASE, and CNKI records from 1990 through July 2014. Two independent examiners read the titles and abstracts of the results to identify studies that met the inclusion criteria. Subsequently, the reference lists of the selected publications were hand searched. Descriptive statistics were used to report all data related to the survival rate of implants placed in bone flaps in jaw rehabilitation, the functional gains, and complications. A total of 20 studies were included for systematic review without repetition. The mean follow-up time after implant placement ranged from 1.75 to 9.5 years. Within the limitations of available studies, the survival rate of implants placed in bone flaps in jaw rehabilitation ranged from 82.4% to 100%. Of the 20 included studies, 15 reported a survival rate higher than 90%. The cumulative survival rate was 93.2%, with the longest follow-up time being 12.9 years. The most common complications related to these implants were peri-implant bone resorption or peri-implant inflammation, and peri-implant soft tissue proliferation. The main factors associated with the survival rate of implants in bone flaps were reported as time of implant placement and radiotherapy. Despite some persistent soft tissue problems and implant loss, most patients reached a satisfactory functional and esthetic outcome, as evaluated by clinical examination and subjectively by the patients at interview. Implant-supported dental prosthetic rehabilitation in reconstructed jaws improved the quality of life in terms of speech, nutrition, oral competence, and facial appearance. Placement of implants in bone flaps in jaw rehabilitation was demonstrated to be a reliable technique with a high survival rate. Multicentered randomized controlled clinical trials and longer clinical studies should be undertaken in this area.

Dental prosthetic rehabilitation of a child with ectodermal dysplasia: A case report

Ectodermal dysplasias (EDs) form a part of the complex group of rare congenital diseases, primarily observed as a result of the abnormal development of embryonic ectodermal derivatives. A 5-year-old male child reported to the Department of Pedodontics and Preventive Dentistry, with the typical features of hypohidrotic ectodermal dysplasia (HED), i.e., diff usely sparse hair, eyelashes and eyebrows, subsequent problems with thermoregulation and dry skin. The facial profi le showed a prominent forehead, sunken nasal bridge (“saddle nose”), and everted lips. Oral prosthetic rehabilitation was planned for the child to improve both the vertical and sagittal skeletal relationship, additionally providing better esthetics, improved speech, and masticatory function. The case report thus presents the early prosthetic oral rehabilitation of a young boy with HED associated with severe anodontia in the primary dentition.

Relationship between impact of maxillary anterior fixed prosthodontic rehabilitation on daily living, satisfaction, and personality profiles

Statement of problemPersonality profiles may affect the impact of dental treatment on daily living and patient satisfaction. PurposeThe purpose of this clinical trial was to evaluate the impact of maxillary anterior fixed prosthodontic rehabilitation on daily living and the satisfaction of patients and to investigate its relationship with personality profiles. Material and methodsFifty-nine participants (25 men and 34 women; mean age 32.4 ±6.9 years) received maxillary anterior partial fixed dental prostheses. The clinical success of the prostheses was evaluated following specific criteria. The Dental Impact on Daily Living (DIDL) questionnaire was used to measure satisfaction with the prostheses and their impact on daily living. The Neuroticism-Extraversion-Openness Five-Factor Inventory (NEO-FFI) was used to measure patients’ personality profiles. The paired sample t test was used to compare satisfaction and personality scores before and after treatment (α=.05). ResultsParticipants’ total satisfaction and their satisfaction with appearance, pain tolerance, oral comfort, general performance, and eating improved after treatment (P<.05). Before treatment, women were less satisfied with general performance (P=.047) and scored higher on the Neuroticism score (P=.039); however, after treatment, women were more satisfied with appearance (P=.004). Age and sex had no significant correlation with personality profiles after treatment. Before treatment, Neuroticism, Openness, and Conscientiousness scores were associated with dental satisfaction and impact on daily life (P<.05). After treatment, Neuroticism, Openness, and Extraversion scores were associated with dental satisfaction and impact on daily life (P<.05). ConclusionsPatient satisfaction with their oral condition improved after partial fixed dental prosthetic rehabilitation in the maxillary anterior esthetic zone. Psychological profiles (Neuroticism, Extraversion, Openness, and Conscientiousness) may be involved in and explain the impact on daily living and the degree of patient satisfaction with their prostheses.