Interarch Space Research Articles

Prosthodontic rehabilitation with all-on-four implant treatment combined CAD/CAM prosthesis in an oral cancer patient: a case report

BackgroundThe microvascular free fibula (MFF) flap is a reliable treatment modality for mandibular reconstruction and is suitable for dental implant placement after oncologic surgery. The most common issue with the MFF flap is its limited bone height, which typically results in excessive interarch space and complicates prosthodontic therapy. Overcoming the physical limitations from tumor excision and reducing the treatment time for prosthodontic rehabilitation to improve quality of life are critical clinical challenges.Case PresentationA 64-year-old male with lower left gum and bilateral buccal cancer received a single-layer microvascular MFF flap to reconstruct a mandibular defect post-tumor excision. He underwent a bilateral modiolus Z-plasty combined with a skin flap debulking procedure to relieve oral contracture, achieving adequate mouth opening for prosthodontic rehabilitation. Scar tissue bands on the bilateral cheeks significantly affected retention and stability, hampering dental impression performance. The patient sought prosthodontic rehabilitation to enhance his chewing function and quality of life promptly. Prosthodontic rehabilitation with all-on-4 implant therapy, utilizing computer-aided design and computer-assisted manufacturing (CAD/CAM), was completed within one month.ConclusionThis case utilized the all-on-4 implant system to address the insufficient fibular height for conventional dental implant placements. Dental CAD/CAM was employed to mill custom prosthetic abutments and a large titanium framework for the implant bar overdenture, compensating for the excessive interarch space between the grafted fibula and maxilla. This treatment approach successfully shortened the prosthodontic rehabilitation time and overcame anatomical limitations.

#D Caramel Floating Denture: A salvage from high interarch space

#D Caramel Floating Denture: A salvage from high interarch space

Knowledge and Awareness of Dental Practitioners About the Utilization of Endocrown in Post-endodontic Management.

The objective of this study was to evaluate the knowledge, and awareness of dentists in Ha'il, Kingdom of Saudi Arabia, regarding the use of endocrown as post-endodontic restorations, utilizing an online questionnaire. A cross-sectional study was carried out among dental practitioners working in Ha'il, Kingdom of Saudi Arabia. Dentists who practice in the Ha'il were included in the current study. The survey study involved a sample size of 245 participants. The researchers employed the snowball sampling technique in this investigation. The validated, closed-ended questionnaires were disseminated to the entire sample of selected dental practitioners using electronic mail. The initial section of the survey encompassed inquiries pertaining to the demographic characteristics of the participants, encompassing variables such as gender, years of professional experience, and workplace. The subsequent section of the survey focused on assessing the participants' knowledge and opinions regarding the endocrown technique. The Chi-square test was employed to assess the associations between categorical variables. The most of participants 228 (93.1%) had knowledge about endocrown and 94 (38.4%) of them received information from their educational institutions. Among the responses of the participants, 232 (94.7%) expressed their preference for utilizing endocrown restorations specifically for molar teeth. Moreover, 183 (74.7%) of respondents indicated that the endocrown is preferred when there is a restricted amount of inter-arch space available. A majority of respondents 152 (62.0%) indicated that the ferrule does not exert any influence on the endocrown. A majority of participants 135 (55.1%) expressed a preference for utilizing lithium disilicate ceramic in the fabrication of endocrown. The most of participants 209 (85.3%) opted to use resin cement for the purpose of cementation. The characteristics of gender, experience, and working place were found to have a significant relationship with the knowledge of the participants about endocrown (p <0.05). The study participants need to enhance their knowledge and awareness pertaining to the utilization of endocrowns as a post-endodontic treatment.

Hybrid Prosthesis versus Overdenture: Effect of BioHPP Prosthetic Design Rehabilitating Edentulous Mandible.

To compare the BioHPP (biocompatible high-performance polymer) as a substructure for the hybrid prosthesis versus the BioHPP bar supporting and retaining implant overdenture by radiographic evaluation to identify bone height alteration around the implants and to evaluate satisfaction based on visual analoge scale questionnaire. Ill-fitting mandibular dentures were chosen for 14 fully edentulous male patients with adequate dental hygiene, enough interarch space, and free of systemic diseases and parafunctional habits. Patients who received new dentures (CDs) were randomly allocated into each group using computer software, and four interforaminal implants were inserted in parallel using a surgical guide. Three months after osseointegration, the patients received either CAD-CAM BioHPP framework hybrid prosthesis (Group I) or BioHPP bar supported and retained overdenture (Group II). Using digital preapical radiography, the bone loss is evaluated 6, 12, and 18 months after insertion. The subjective patient evaluation was done using a questionnaire based on the VAS includes five points for chewing, comfort, esthetics, speech, oral hygiene, and general satisfaction. The overall marginal bone loss (MBL) revealed that Group I (hybrid prosthesis) was more than Group II (bar overdenture) at all intervals in the anterior and posterior implants' mesial and distal surfaces. The patient satisfaction survey results showed that, after 18 months, the difference was statistically not significant between them all (P > 0.05) except for the comfort (for the overdenture group, 4.43 ± 0.53 while the fixed hybrid was 5.00 ± 0.00). BioHPP framework material is an alternative material for implant rehabilitation of edentulous mandible with minimal MBL in BioHPP bar overdenture compared to BioHPP hybrid prosthesis.

Hollow denture fabrication using putty index: A case report

Severely atrophic ridges are a challenge to prosthodontist for rehabilitation. Severe resorption leads to increased inter-arch space, long lip length, increased weight, and height of maxillary denture. These situations disrupt the retention, stability, and support of denture. Overloading of soft and hard tissues leads to further resorption. Hollowing of prosthesis reduces its weight. By reducing weight of the prosthesis, these severely atrophic ridges can be handled in a better way. This article describes a technique of fabricating a hollow maxillary complete denture.

A Novel Approach to Guided Implant Surgery: A Technical Note

Computer-guided software and kits have significantly improved the clinical applications of implant surgery. Nonetheless, some technical problems are still in evidence during clinical procedures because of cumbersome surgical tools that can limit access to implant sites, mainly in posterior areas of the mouth in the presence of bulky anatomical structures and in patients with reduced mouth-opening capacity. The present paper aimed to present a novel approach to guided implant surgery, describing the technical characteristics of an innovative guided surgical kit made up of modified sleeves and modular surgical drills. The proposed guided surgical kit is based on a novel patented system of sleeves and modular burs, with an increased length of the metal sleeves and a reduced height of the drills. The innovative design of the proposed system would allow the clinician to position guided fixtures in all clinical situations; the reduced encumbrance would be particularly helpful to gain access to the posterior areas of both maxilla and mandible, which have limited inter-arch space, with an easy and user-friendly approach. The modular system could overcome anatomical limitations, such as reduced mouth-opening capacity, and permit clinicians to maintain the stability and integrity of the surgical templates, even in cases where there is very limited intermaxillary space.

Implant retained overdenture using OT equator attachments

The aim of this clinical report is to demonstrate the technique used with OT‑Equator attachment with chair side incorporation of housings in pre-fabricated denture. Implant retained overdentures are evolving as an optimum and cost-effective treatment modality for patients with edentulism and the evolution of attachments have led to their increased use. The Article Describes a Series of Cases where implant retained overdentures dentures were given to the patient using OT EQUATOR attachments to improve the retentive properties of the dentures thus elevating their chewing efficiency and also the quality of speaking and boosting the overall confidence of the patient. The treatment described in the article should be 1advocated and used wherever possible as it preserves both hard and soft tissues. The OT EQUATOR attachment is specially indicated in cases of compromised inter-arch space and where retention is of utmost priority as described in this case report. The advantage of the attachment is that it is very easy and convenient to use and also offers a chair-side fabricating process.

Unsplinted Attachments and Patient-Reported Outcome Measures (PROMs) in 2-Implant-Retained Mandibular Overdentures: A Systematic Review.

Introduction The purpose of this review is to compare randomized clinical trials evaluating the patient-reported outcome measures (PROMs) using different unsplinted attachment systems in 2-implant-retained mandibular overdentures (2IRMODs). A focus question (as per PICOS) was set as follows: does one particular unsplinted attachment system (I) compared with another (C) result in better patient-reported outcomes (O) in two-implant-retained mandibular overdentures (P) using randomized controlled trials (S)? Materials and Methods A literature search was conducted in the PubMed MEDLINE and Cochrane Central Register of Controlled Trials (CENTRAL) databases between November 2010 and October 2020. Only randomized controlled trials (RCTs) on 2IRMOD using unsplinted attachment systems measuring patient-centered outcomes were selected. A total of 171 studies were identified in initial search, and 27 studies were shortlisted for full-text evaluation. A total of 5 studies were included for a systematic review. The risk of bias was evaluated using Cochrane Risk of Bias Tool 2.0 (RoB 2.0). Meta-analysis could not be performed as different studies evaluated different patient-reported outcomes, namely, satisfaction, quality of life, complications, preferences, or combinations of these. Results A total of 23 patients received low-profile (self-aligning) attachments (in 2 studies), 69 patients received standard ball attachments (in 5 studies), 25 patients received telescopic (or conus) attachments (in 2 studies), and 20 patients received mini-ball attachments (in 1 study). Two studies compared ball attachments and low-profile attachments and revealed similar satisfaction and quality of life (QoL). Two studies compared ball attachments with telescopic attachments and revealed less patient satisfaction in telescopic attachments. A single study compared mini-ball attachments with standard ball attachments and showed no difference in patient-reported outcomes. Three studies were found to have a low risk of bias, and the remaining two studies had a high risk of bias. Conclusions The standard ball, mini-ball, and low-profile attachments have no influence on PROMs in the normal interarch space. Inconclusive results were found in studies that evaluated PROMs using ball attachments versus telescopic attachments.

Hollow denture-a solution to post covid total maxillectomy patients: A case report

Retention, stability and support are the basic principles on which the success of a complete denture. The ability lies in applying these principles professionally in cases with total maxillectomy that are narrow and constricted with increased interarch space. This will provide decreased support, retention and stability and also increased weight of the processed denture will compromise them further and try to dislodge denture. This article highlights a technique for the fabrication of a hollow maxillary complete denture in situation where there is no ridge tissue due to total maxillectomy followed by post covid mucormycosis. Weight of a denture may be a contributing factor to the successful resolution of a patient’s problem; the hollow denture can be considered as one of the treatment modalities. The advantage of a hollow maxillary or mandibular denture is the reduction of excessive weight of acrylic resin, which normally replaces lost alveolar ridge in the interridge space of the denture wearer. This clinical report describes a case report of Total maxillectomy patient with resorbed ridges where a simplified technique of fabricating a light weight hollow maxillary complete denture was used for prosthodontics rehabilitation.

Effect of Surface Modifications on the Retention of Implant-supported Cement-retained Crowns with Short Abutments: An In Vitro Study

The study aimed to evaluate and compare the effect of incorporating one circumferential groove and bur modification on retention of cast copings on implant abutment cemented with glass ionomer cement. Fifteen straight shoulder implant abutments casted of height 6 mm used with corresponding 12 mm long stainless steel implant analog. The abutments were divided into three groups of five abutments in each group. Group I: Control group, without any surface modification, Group II: Milling of a circumferential groove, and Group III: Bur modification by creating punches of size whole round bur diameter 5 per axial surfaces. Glass ionomer definitive cement was used to adhere the cast copings to each group of abutments. After thermocycling, the specimens were evaluated for retention using the Instron Universal Testing Machine's pull-out test. The data were analyzed using One-way ANOVA, followed by the Tukey post-hoc test to compare the load among the three groups. According to the findings, the inclusion of a circumferential groove (Group II) increased the retention of glass ionomer cement maintained implant-supported crowns by 44.58%. The bur modification (Group III) boosted glass ionomer cement maintained implant-supported crown retention by 110.69% while retaining retrievability. Results were statistically significant. Bur modification revealed more retention when compared to the groove and control group. Short abutments are used in the clinical situation where interarch space is less. To achieve adequate retention of the implant crowns, surface modification of the abutments is necessary while selecting a cement-retained prosthesis.

Interarch space assessment in edentulous patients rehabilitated with complete removable dentures using open-access software.

BackgroundThe interarch space is defined as the vertical space between the edentulous ridge and the occlusal or incisal aspect of the opposing arch. Measuring the interarch space in a patient requiring an implant-supported fixed prosthesis is crucial for determining the prostheses to be used in each clinical situation. Depending on the measurements and other factors, such as the need for lip support or pink esthetics issues, decisions about the most convenient type of implant-supported prosthesis can be taken. Analogic workflow to measure the interarch space can represent a time-consuming and expensive procedure that may lead to inaccuracies. ObjectiveTo describe a step-by-step protocol to measure the upper and lower interarch space with open-access software, starting from the digital scan of the patient's complete dentures obtained with an intraoral scanner. MethodsAn extraoral scan (using an intraoral scanner) of the existing complete removable prosthesis is required to assess the interarch space for making an implant-supported prosthesis treatment planning. If the existing complete denture does not fulfill the required functional and esthetic parameters, a complete interim denture, a wax trial denture, or a printed denture prototype should be previously fabricated. The antagonist arch and the intermaxillary record scan also need to be obtained. Finally, all STL files are imported into an open-access software for measuring the interarch space. ResultsOpen-source software can be used to measure the upper and lower interarch space from existing complete dentures following the step-by-step protocol outlined in this paper. ConclusionInterarch space of edentulous patients rehabilitated with complete dentures can be measured with a 360 degrees scanning of the existing complete denture and open-access software by applying the protocol outlined in this paper. Clinical relevanceThe clinician can assess and digitally measure the interarch space of edentulous patients requiring an implant-supported fixed prosthesis using an open access software.

A Hollow Complete Denture Fabricated Using Neutral Zone Approach for a Severely Resorbed Ridge: A Case Report

Prosthetic rehabilitation using complete dentures is quite a challenging task when accompanied by severely atrophic ridges. Various modifications are required in the treatment strategy to optimize the prognosis of the finished prosthesis. Moreover, the increased inter-arch space demands the hollowing of the maxillary denture to mitigate the issues in retention due to increased weight. This case report aims to demonstrate a technique used to fabricate a hollow maxillary denture and a mandibular denture using the neutral zone approach in the case of a severely atrophied ridge.

Attachment Retained Tooth Supported Overdentures: A Case Series

Present case series describes the three different types of attachments use for tooth supported overdenture for prosthetic rehabilitation. Loss of teeth causes continuous resorption of the bone leading to a compromised treatment. Retaining two or more natural teeth can be used as an abutment for prosthetic rehabilitation of partial edentulism arches. Preventive prosthodontics includes tooth supported overdentures which preserves natural teeth, roots and maintains propioception. Depending upon the interarch distance available various types of attachments can be used to enhance the retentive factors. The first case (71-year-old female patient) describes the use of telescopic attachment overdenture on 33, 43 with available interarch space of 15 mm in mandibular arch. The second case (62-year-old female patient) describes the use of ball attachments overdenture on 34 and 35 with available interarch space of 13 mm in mandibular arch. The third case (60-year-old female patient) is about equator attachment overdenture on 33, 43 with available interarch space of 12 mm in mandibular arch. Use of telescopic, ball and equator attachments for tooth supported overdentures has enhanced the retention, stability, function and aesthetic outcome of the removable prosthesis in mandibular arch. The natural teeth provide additional support, stability and retention of the overdenture than the edentulous ridges alone which is particularly advantageous for mandibular arch.

Tooth Supported Overdenture as Prosthetic Solution for Elderly Patients: A Case Series

Overdenture treatment is a notion which precludes the inevitability of “floating plastic” in edentulous mouths. The concept of tooth retained overdenture is a simple and cost effective way to retain few firm teeth that are present in an otherwise compromised dentition to increase the retention and stability of complete denture leading to increased chewing efficiency of patient. The concept of overdentures is a positive means for delaying the process of complete edentulism and helps in reducing bone resorption. To top it all, it gives the patient the sensitivity and proprioception of having prosthesis with his natural teeth still present. In this article, case reports with three different types of Overdentures are discussed: Overdenture with submerged abutment, Overdenture without coping on abutment and overdenture with coping based on available inter-arch space.

Evaluation of quality of life and denture retention of mandibular overdentures using low profile versus self-aligning attachments in completely edentulous patients with limited interarch space. A randomized clinical trial

Aim Clinical evaluation of the effect of using low profile versus self-aligning attachment mandibular over-denture on oral health related quality of life and denture retention. Material and Methods Forty-two patients were carefully selected, complete dentures fabricated, then two implants were placed in the canine region for each patient. Low profile attachments were used in group I and self-aligning attachments in group 2. Results Regarding oral health-related quality of life, there was a statistically significant improvement. Regarding overdenture retention, the low profile attachment group showed statistically significant higher retention force compared to that of the self-aligning group at the time of insertion; however, there was no statistically significant difference between two groups at the 6 months follow-up. Conclusion Both types of attachments offer good oral health-related quality of life for completely edentulous patients with limited inter-arch space. Regarding overdenture retention, low profile attachments presented higher retention values than self-aligning attachments at the beginning of the study but faster retention loss than self-aligning attachment over time.

English

This article describes the fabrication of a hollow maxillary complete denture using silicone putty and a double flask technique. A successful complete denture directly depends on retention, stability and support accompanied by good aesthetics. However, in case of atrophic edentulous ridges the challenge lies in the fact that there is a significantly lesser denture bearing area that can lead to a number of problems. The most important of these is an increased interarch space resulting from excessive resorption of upper or lower arch. This can lead to a resulting heavy complete denture that further deteriorates the bone condition due to excessive and continuous load, accelerating bone resorption. Moreover, there is no effective support to deal with any kind of harmful lateral forces and this can lead to dislodgment of the denture. The operator’s efficiency lies in applying the basic principles of fabricating a denture and innovating various steps to counter critical situations. Various methods such as asbestos, silicone putty, modelling clay, thermocol, salt, wax have been used for creating a hollow space inside the denture. Out of the various methods that have been used for fabrication of a hollow space inside a complete denture, silicone putty method is one of the more convenient and accurate method for achieving the objective, thereby rendering a lighter prosthesis. A hollow maxillary denture is highly advantageous as it reduces the weight of acrylic resin, thereby preserving the residual alveolar ridge. It also helps in stability of the denture by indirectly reducing the lateral forces.

Restoration of a nonideally placed anterior implant: A clinical report

This article describes a restorative solution for implants placed at an insufficient depth and in a patient with limited interarch space, making the esthetics, emergence profile, and retention of a cemented restoration problematic. These challenges were overcome by adhesively bonding a pressed lithium disilicate veneer to a custom cast metal abutment veneered with a thin layer of feldspathic porcelain. The ceramic veneer with the attached core engaged a facially located screw-access channel, which increased retention and resistance form and facilitated seating of the veneer. Adhesive bonding via the application of a thin layer of feldspathic porcelain on the custom dental implant abutment was also used to overcome the lack of resistance form with a veneer preparation.

Impact of Image Context on Deep Learning for Classification of Teeth on Radiographs.

Objectives: We aimed to assess the impact of image context information on the accuracy of deep learning models for tooth classification on panoramic dental radiographs. Methods: Our dataset contained 5008 panoramic radiographs with a mean number of 25.2 teeth per image. Teeth were segmented bounding-box-wise and classified by one expert; this was validated by another expert. Tooth segments were cropped allowing for different context; the baseline size was 100% of each box and was scaled up to capture 150%, 200%, 250% and 300% to increase context. On each of the five generated datasets, ResNet-34 classification models were trained using the Adam optimizer with a learning rate of 0.001 over 25 epochs with a batch size of 16. A total of 20% of the data was used for testing; in subgroup analyses, models were tested only on specific tooth types. Feature visualization using gradient-weighted class activation mapping (Grad-CAM) was employed to visualize salient areas. Results: F1-scores increased monotonically from 0.77 in the base-case (100%) to 0.93 on the largest segments (300%; p = 0.0083; Mann–Kendall-test). Gains in accuracy were limited between 200% and 300%. This behavior was found for all tooth types except canines, where accuracy was much higher even for smaller segments and increasing context yielded only minimal gains. With increasing context salient areas were more widely distributed over each segment; at maximum segment size, the models assessed minimum 3–4 teeth as well as the interdental or inter-arch space to come to a classification. Conclusions: Context matters; classification accuracy increased significantly with increasing context.

The Concepts of Complete Denture Occlusion amongst Dental Fraternity

Objectives: To assess the concepts of complete denture occlusion among dental fraternity. Study Design And Setting: Cross-sectional study conducted at various dental hospitals and institutes of Karachi, for a period of six months, from 1st June’2019 to 30th November’2019 Methodology: Total 849 dental practitioners who are currently practising were included. A well-structured and validated questionnaire was used for data collection. SPSS version 25 was used. Results: Bilateral balanced occlusion was an ideal occlusion by majority subjects i.e, 530(62.4%) in patients with wellformed ridges, followed by 464(54.7%) candidates with skeletal class 1, total 376(44.3%) chose it with uncontrolled diabetes mellitus, 365(43%) in single complete denture cases, 339(39.9%) with increased inter-arch space, 298(35.1%) with parafunction habits, 296(34.9%) in patients with history of neuromuscular disorder and 271(31.9%) where a complete denture opposes a removable partial denture. Furthermore, Lingualized occlusion was preferred by 341(40.25%) participants for patients with skeletal class 3. Total 316(37.2%) candidates chose it for patients with displaceable supporting tissue followed by 264(31.1%) who chose it for skeletal 2 and 260(30.6%) for cases of highly resorbed ridges. Lastly, 311(36.6%) chose canine guided occlusion with highly resorbed ridges accompanied by high aesthetic demand A significant difference between education level and knowledge of occlusal schemes was also found. Chi-square (73.87), df 6, p-value =0.000. Conclusion: Dental practitioners lack adequate knowledge of occlusal schemes in terms of prescription in complete denture patients. A significant difference between the education level and knowledge of occlusal schemes was found. Therefore, awareness of various occlusal schemes should be increased at undergraduate level.

Classification of Dental Radiographs Using Deep Learning.

Objectives: To retrospectively assess radiographic data and to prospectively classify radiographs (namely, panoramic, bitewing, periapical, and cephalometric images), we compared three deep learning architectures for their classification performance. Methods: Our dataset consisted of 31,288 panoramic, 43,598 periapical, 14,326 bitewing, and 1176 cephalometric radiographs from two centers (Berlin/Germany; Lucknow/India). For a subset of images L (32,381 images), image classifications were available and manually validated by an expert. The remaining subset of images U was iteratively annotated using active learning, with ResNet-34 being trained on L, least confidence informative sampling being performed on U, and the most uncertain image classifications from U being reviewed by a human expert and iteratively used for re-training. We then employed a baseline convolutional neural networks (CNN), a residual network (another ResNet-34, pretrained on ImageNet), and a capsule network (CapsNet) for classification. Early stopping was used to prevent overfitting. Evaluation of the model performances followed stratified k-fold cross-validation. Gradient-weighted Class Activation Mapping (Grad-CAM) was used to provide visualizations of the weighted activations maps. Results: All three models showed high accuracy (>98%) with significantly higher accuracy, F1-score, precision, and sensitivity of ResNet than baseline CNN and CapsNet (p < 0.05). Specificity was not significantly different. ResNet achieved the best performance at small variance and fastest convergence. Misclassification was most common between bitewings and periapicals. For bitewings, model activation was most notable in the inter-arch space for periapicals interdentally, for panoramics on bony structures of maxilla and mandible, and for cephalometrics on the viscerocranium. Conclusions: Regardless of the models, high classification accuracies were achieved. Image features considered for classification were consistent with expert reasoning.