Lower Partial Denture Research Articles

Management of obstructive sleep apnea and insomnia in a patient with complete and partial removable dentures

In this case, we assessed the feasibility of managing obstructive sleep apnea (OSA) with an oral appliance (OA) for an edentulous patient. Given that promoting patient compliance with continuous positive airway pressure (CPAP) is challenging, OA therapy could improve patient adherence and quality of life. A 56-year-old male with a medical history of moderate OSA and insomnia was referred to our center by a sleep physician for OA therapy. He reported intolerance to CPAP with different types of masks and nasal pads. Upon clinical examination, the patient had a fully edentulous maxilla and three healthy abutment teeth in the mandible. He wore a complete upper denture and a lower partial denture both day and night. We used a custom-made adjustable OA (semiedentulous design) for both dentures. During the last follow-up visit, a significant improvement in OSA indexes was observed. The patient's apnea[FIGURE DASH]hypopnea index (AHI) decreased from 11.8/h to 6.8/h, whereas his nadir oxygen saturation increased from 83% to 92%. The rapid eye movement (REM) stage of sleep drastically improved from 15.7% to 26.6%, and the respiratory disturbance index decreased from 40/h to 15.8/h at the REM stage. OA was an effective alternative to a tongue retainer device for a completely and partially edentulous patient refusing to comply with CPAP and unable to tolerate the tongue retainer device. Further studies with larger sample sizes using different OAs are recommended.

The Physiological Basis Of The Oral Surgical Management Of A Patient With Polycythemia Rubra Vera: A Pathway For The Development Of A Protocol

Various oral surgical procedures are currently performed under local anaesthesia and conscious sedation as a day surgery procedure. Both oral and intravenous conscious sedation are available as a choice. Oral sedation with Alprazolam and Codeine is very effective for most oral surgical procedures especially the removal of impacted third molars and surgical placement of implants. It is this sedation regimen that comprises the synergistic use of both aprazolam and codeine to effect sedation with amnesia that is the standard procedure at the Faculty of Dentistry of the International Postgraduate Medical College. The purpose of this case report is to appraise the possible negative effect of Alprazolam and Codeine sedation mentioned above on a patient who presented with polycythaemia rubra vera (a very rare haematological condition). This is because the codeine component of this combination will depress the respiratory centre in the medulla oblongata putting the patient at risk. The case study is that of a 70-Year-old male patient who had been a regular patient for approximately 10 years ago at the Faculty of Dentistry, International Postgraduate Medical College (IPMC), where a total upper denture and a partial lower denture were placed. The patient returned in 2019 with the chief complaint of halitosis and pain in the mandibular posterior right region. The patient gave past medical history of PRV, epilepsy and hypertension and history of being on multiple medications for these conditions. The treatment plan advised was total extraction of the remaining mandibular dentition and excisional biopsy of the suspicious lesion mesial to the mandibular right first molar, together with a complete lower denture replacement. The procedure was done without sedation and at no time was the patient considered to be in danger as it relates to oxygen saturation, carbon dioxide drive to the brain and bleeding. Every hematologist managing patients with PRV will be very concerned as to how these patients are managed by dentists, particularly as it relates to oxygen saturation, carbon dioxide drive to the brain and hemostasis. Similarly, most dental practitioners that are managing such patients may not be familiar with the technicalities surrounding the clinical and operative management of these patients. It is for this reason that this case report focusing on oral surgical management of a patient with PRV is of significance to the dental literature, particularly as it aims to develop a working group for the development of the protocol for the management of PRV.

ORAL CHRONIC ULCER: A DIAGNOSIS CHALLENGE

An 85-year-old retired white man sought the dentistry service with an ulcerated lesion without symptomatology in the attached gingiva between upper molars. The ulcer presented approximately 1 × 1 cm surrounded by a white plaque. He has hypertension, hypercholesterolemia, hypothyroidism, and prostate alteration and regularly uses metoprolol, amlodipine, simvastatin, levothyroxine sodium, and finasteride. Hematologic, laboratory, and radiographic examinations are within the normal range. The patient uses upper and lower partial dentures and denied smoking or drinking habits. However, he reported the habit of brushing the area with force. Histopathologic diagnosis suggested eosinophilic ulcer. Even after instruction of atraumatic hygiene, antifungal treatment, application of topical corticosteroids, and sublesional infiltration and photodynamic therapy, there was no regression of the lesion. Over time, the ulcer increased in size and migrated to the buccal mucosa and labial commissure. This case remains without a conclusive diagnosis, and new analyses are being made. An 85-year-old retired white man sought the dentistry service with an ulcerated lesion without symptomatology in the attached gingiva between upper molars. The ulcer presented approximately 1 × 1 cm surrounded by a white plaque. He has hypertension, hypercholesterolemia, hypothyroidism, and prostate alteration and regularly uses metoprolol, amlodipine, simvastatin, levothyroxine sodium, and finasteride. Hematologic, laboratory, and radiographic examinations are within the normal range. The patient uses upper and lower partial dentures and denied smoking or drinking habits. However, he reported the habit of brushing the area with force. Histopathologic diagnosis suggested eosinophilic ulcer. Even after instruction of atraumatic hygiene, antifungal treatment, application of topical corticosteroids, and sublesional infiltration and photodynamic therapy, there was no regression of the lesion. Over time, the ulcer increased in size and migrated to the buccal mucosa and labial commissure. This case remains without a conclusive diagnosis, and new analyses are being made.

Factors that influence the oral impact on daily performance of older people in Brazil: A cross-sectional population-based study.

To investigate factors that influence the oral health-related quality of life of older people (65years and over) in Brazil. Population-based studies should be conducted to support health-planning interventions. Data from the São Paulo State Survey on Oral Health (SBSP-2015), which consisted of 5951 individuals, were used. A theoretical-conceptual model was built based on the impact of family socio-economic characteristics, individual social-demographic features and self-perceived and clinical oral health status on the oral impact on daily performance (OIDP). Multivariate binary logistic regression analysis was conducted at 5% significance level. Statistically significant variables included within the adjusted logistic regression model entered the multiple correspondence analysis (MCA). Oral health impact on daily activities was observed in 34.6% of older people. Characteristics significantly related to impact on OIDP score were as follows: family income up to R$ 500 (OR=2.73), self-perceived treatment need (OR=1.33), self-perceived toothache (OR=1.52), self-perception of denture replacement need (OR=1.27), dissatisfaction (OR=1.50) or very dissatisfied (OR=2.57) with own oral health, partial lower denture use (OR=1.34) and needing partial lower dentures (OR=1.28). Increased number of people living in the same house (B=0.05, OR=1.06), number of bedrooms in the house (B=-0.10, OR=0.90), age (B=-0.03, OR=0.97) and number of teeth needing treatment (B=0.08, OR=1.08) contributed significantly to OIDP. Prevalence of OIDP of older people in the state of São Paulo was related to factors other than their clinical and self-perceived oral health status.

Orofacial Lesions among Denture Wearers

Introduction: Removable dentures are being used as a replacement for missing teeth to restore function and aesthetics that has resulted in improved quality of life. However, different orofacial lesions may be presented as an associated complication to these appliances.Aim: The present study aims at investigating the prevalence of denture-related lesions (DRLs) among the denture wearers.Method: This was a descriptive, cross-sectional study. Clinical examination of 167 individuals with dentures was conducted from December 2013 to April 2014. Data form was designed to collect general information including personal data (e.g., age, gender), smoking practice, and frequency, duration and number of DRLs. The data were analyzed using the IBM SPSS software, version 22 (SPSS, Inc. IBM, Chicago, IL, USA). The responses were expressed as percentages.Results: A total of 167 patients (82 men and 85 women) with a mean age of 58 years were enrolled in the present study. Of them, 84 had partial dentures while 75 had complete dentures. Eight patients had upper complete dentures and lower partial dentures. Different DRLs were reported. Sixty-six participants (39.5%) had one or more denture-related abnormalities. Traumatic ulceration was the most common denture-associated lesions and was observed in 25 (15%) participants.Conclusion: DRLs were found to be more common among complete denture wearers than in partial denture wearers. However, regular follow-ups would help in early detection of the unnoticed abnormalities or complications of the dentures.

An Osteoplastic Advancement Flap, “Sandwich” Osteotomy and Application of a Skin Regeneration Template Prior to Implant Placement

Introduction: Following oral cancer resection patients will have differing degrees of morbidity with regards to mastication, speech and aesthetics and this can be a difficult problem to manage. We present a case that describes an innovative technique involving implant placement and deepening of the labial sulcus in the atrophic mandible of a post-operative oral cancer patient to facilitate partial denture retention. Methods: a 70-year-old female patient presented with significant vertical and horizontal bone atrophy and a shallow, tethered labial sulcus in the anterior mandible, following cancer resection of the floor of mouth and alveolar ridge. She was unable to retain a partial denture. An initial procedure included an osteoplastic advancement flap and a horizontal "sandwich" osteotomy as a combined approach that improved the bone volume from a Cawood & Howell classification grade V to grade II. A sulcoplasty and insertion of Integra@ skin regeneration system improved sulcus depth in a second procedure. Dental implants were successfully placed 4 months after bone augmentation to allow retention of a lower partial denture. Results: These staged procedures were carried out with excellent healing and no complications in the post-operative 6 months. Conclusion: This technique for gaining bony height and width, with improved sulcus depth in an atrophic mandible is a useful adjunct in the rehabilitation of post-operative oral cancer cases. Maintaining the periosteal attachment in the osteoplastic flap promotes excellent healing in patients who have received adjunctive radiotherapy treatment in this safe and effective osteotomy procedure.

COSTEN'S SYNDROME

Costen’s syndrome is defined as a set of auditory and vestibular signals and symptoms in patients with temporomandibular joint disorders (TMD). It has a predilection for females in the fourth decade of life. Herein we present a case involving a black female patient, 74 years old, reporting intense headaches, ear pain, ear fullness, tinnitus, and vertigo with nystagmus. She uses badly adapted upper and lower partial dentures. After diagnosis of her condition, occlusal splint was prescribed, systemic and, specially, masticatory and cervical physiotherapy, and global postural reorientation beyond the prosthetic rehabilitation. The multidisciplinary monitoring of these patients is imperative in the establishment of effective therapies. The patient improved with the prescribed therapies.

An unsuspected foreign body: How we managed it

Ingestion or inhalation of foreign bodies can prove to be a diagnostic challenge. Unexplained throat pain and acute onset of dysphagia in an elderly patient should alert the clinician to the possibility of accidental foreign body ingestion. A patient presented with complaints of sudden onset of difficulty and pain in swallowing associated with ear pain, neck pain, and hypersalivation. The examination was within normal limits. It was on radiology that the suspicion of a foreign body was aroused. During esophagoscopy, an unsuspecting foreign body was discovered; a lower partial denture, swallowed unknowingly by the patient four days previously. Postoperatively the patient was stable. The case demonstrates how the clinician must have a high index of suspicion of foreign body ingestion, should a patient present with such symptoms. It also demonstrates the need for immediate and prompt intervention in order to prevent progression to fatal complications.

Oral Health Status and Treatment Needs of Visual Impairment in Phitsanuloke, Thailand

There is little information on the oral health status on the visual impairment in Thailand. Objective: To investigate the oral health status and dental treatment needs of visual impaired Thai. M ethod: The subjects were 146 visual impairment (70 males and 76 females, mean age 48.8+5.9), who live in Phitsanuloke, Thailand. Information on self-perceived oral health problems, oral function and oral health behavior was obtained via questionnaires. Oral examinations investigated the DMFT, The Simplified Oral Hygiene Index:(OHI-S) and prosthetic needs index. Results: The mean DMFT score was 16.0 (DT=4.4, MT=10.2, FT=1.4), the mean number of teeth present was15.5. Thirty-five percent of subjects needed dental fillings and 12.3% required tooth extractions. The percentage of visual impairment had periodontal disease were 34.8 and mean OHIS score were 2.52. Thirty-eight percent of subjects need both upper and lower partial dentures. Visual impaired suffer from oral function problems (speaking problem 26.5%, swallow problem 32.6%, taste problem 29.2 and chewing problem 45.2%). Conclusion: The oral health status of visual impairment was poor due to high levels of tooth loss, caries experience and periodontal disease. Oral health and oral function amongst the visual impairment is a public health concern. Therefore, the important of a preventive approach and service delivery programs to improve the oral health condition of this population.

Gingival necrosis due to the ill-fitting denture.

We present a case of an 80-year-old male who was referred to the Department of Oral Medicine, School of Dental Medicine University of Zagreb, Croatia due to gingival ulcer which was present for eight days. Clinical examination has revealed exposed bone on the toothless alveolar ridge in the lower molar region on the right side of 0.8 cm in diameter. Otherwise, the patient was taking doxazosin due to urinary problems and ipatropium bromide due to respiratory problems. The patient wore a 6-year-old partial lower denture. He was initially treated with periodontal bandage (Resopack, HagenWerken, Germany) for the first three days and was instructed not to wear the denture; however, no benefit could be seen. Therefore, we added a local corticosteroid (betamethasone) and am oral antiseptic (chlorhexidine digluconate) applied three times a day. After 3 weeks the lesion healed. A list of possible causative factors regarding gingival ulcers is included.

Eagle’s Syndrome: A case report

Eagle’s syndrome result from elongation of styloid process or mineralization of styloid ligament. Eagle’s syndrome include symptoms such as foreign body sensation, pain in the area of tonsillar fossa, pain which spreading toward ear. Diagnosis of Eagle’s syndrome can usually be made on physical examination by digital palpation of the styloid process in the tonsiller fossa. The treatment of Eagle’s syndrome is primarily surgical. In this article, we presented a 57-year-old male patient who was have a trauma of lower partial denture with of Eagle’s syndrome.

Cuidados odontológicos na paralisia supranuclear progressiva: relato de caso

Este trabalho teve como objetivo relatar o tratamento de complicações bucais numa paciente hospitalizada com diagnóstico de paralisia supranuclear progressiva (PSP), causa mais comum de parkinsonismo degenerativo. A paciente fazia uso de vários medicamentos, tinha 70 anos de idade, sem acompanhamento odontológico durante a hospitalização, com edentulismo total na arcada superior e usuária de prótese parcial na região inferior, mas em função do quadro clínico sistêmico não fazia uso da mesma. No exame bucal, constatou-se uma lesão na mucosa e lábio superior em decorrência de trauma dos dentes inferiores. Planejou-se inicialmente o tratamento da lesão com laserterapia e exodontias dos dentes que provocaram a lesão traumática. Após a cicatrização da lesão, os dentes inferiores remanescentes foram extraídos. Os resultados obtidos da terapêutica aplicada foram eficazes na melhora clínica da paciente. Conclui-se, assim, que é marcante a necessidade de um cirurgião-dentista como membro permanente da equipe multidisciplinar para o tratamento dessa e de outras patologias, a fim de permitir melhor qualidade de vida aos pacientes.

咬合崩壊を起こした顎口腔系を再構築した１症例

A 70-year-old male patient visited our clinic with the chief complaint of masticatory dysfunction due to ill-fitting upper and lower partial dentures. Serious periodontal disease was observed around the remaining teeth. The occlusal condition was crossbite due to mandibular protrusion, and the occlusal supporting area was classified as Eichner's B-3. A Konus telescopic denture was selected as a prosthesis. Dealing with the increase in occlusal force, the sagittal and lateral imbalances found using the Dental Prescale Occluzer system allowed us to minimize the damage to the prosthesis and effects on abutment teeth and periodontal tissue. It is vital to identify and remove early pathological factors of force in postoperative management to prevent the occurrence of new occlusal collapse in the reconstructed stomatognathic system.

Conservative treatment of prolonged bilateral mandibular dislocation with the help of an intermaxillary fixation screw

0 n 81-year-old woman was referred to our department by er dentist after several unsuccessful attempts had been made o reduce her bilateral mandibular dislocation. Examination rior displacement of both condyles, particularly the articular eminence. Because she had a history of cerebral infarction, she did not want a general anaesthetic. We, therefore, decided to reduce the dislocations by anterior elastic traction, using acrylic bite blocks in the molar region as a fulcrum. The patient was edentulous except for the lower right canine and first premolar. We prepared a lower partial denture, and fixed this to the remaining teeth by an arch bar and circumferen-

Ameloblastoma of the Mandible

A 28-year-old woman presented with a 9-month history of progressive right-sided facial swelling. A transoral incisional biopsy was performed at a community hospital and was suggestive of ameloblastoma. The patient subsequently presented to our center for further management. X-ray (A) and CT scan (B) demonstrated a multiloculated mass extending from the ascending ramus to the body of the mandible but not involving the temperomandibular joint. The extent of this mass was readily appreciated on 3-dimensional CT reconstruction (C). She underwent a right hemimandibulectomy with an immediate right fibular myosseous free flap microvascular reconstruction from a right leg donor site. Grossly the specimen showed a 6.0 2.0 3.5-cm mass involving the ramus of the right mandible. On sectioning, the mass had a multicystic appearance and histology was suggestive of an acanthomatous variant of ameloblastoma. The postoperative course was uneventful and the patient was discharged home on postoperative day 13. She was subsequently fitted with a partial lower denture and 20 months postoperatively she remains disease free and reports a good functional outcome. Ameloblastoma of the jaw is a rare odontogenic tumor. A review of 3,677 cases reported over 33 years in the world literature has been previously published. Ameloblastomas tend to present in young patients (average age 36 years) as a painless slow-growing mass in the molar region of the mandible. Radiographically they can be classified as unicystic or multicystic. Unicystic lesions have a higher recurrence rate than multicystic lesions. On histopathologic assessment one-third are plexiform variants, one-third are follicular variants, and one-third are other types. Follicular variants recur more commonly than plexiform variants. Surgery is the therapy of choice for these tumors and the role of chemotherapy or radiotherapy in disease management is limited. Vascularized fibular free flap microvascular reconstruction can offer these patients an excellent aesthetic and functional outcome.

Ramsay Hunt Syndrome: An Unusual Variant After Dental Infection

Ramsay Hunt Syndrome: An Unusual Variant After Dental Infection

Nutrient intake in partially dentate patients: the effect of prosthetic rehabilitation

Objectives. The objectives of this study were to investigate the impact of prosthetic rehabilitation of the shortened dental arch on the intake of nutrients, non-starch polysaccharide (NSP) fruits and vegetables (dietary fibre), and to compare dietary intakes between patients receiving bilateral resin-bonded bridges with patients receiving conventional partial dentures. Methods. As part of an ongoing randomised clinical trial to compare the effectiveness of bilateral resin bonded bridges with conventional partial dentures, the diets of 40 partially dentate patients were assessed prior to and at 3 and 12 months following treatment with bilateral resin-bonded bridge-work or a lower partial denture. Results. At baseline, three months post treatment and one year post treatment there were no significant differences in the intake of nutrients between groups. A significant increase in the percentage of energy from fat was observed in the patients fitted with a lower partial denture. Apart from this, prosthetic rehabilitation did not result in any other change in the intake of nutrients or in the amount of fruits and vegetables consumed. Levels of intake of NSP, fruits and vegetables were low in both groups of patients on all occasions measured. Conclusions. Prosthetic rehabilitation of the severely shortened dental arch does not result in dietary improvements. Dietary advice that takes into account all the factors that influence food choice (such as taste, cost and cooking skills) needs to be considered in this at risk group.

Relationships between facial morphology and activity of orofacial muscles in patients with a complete upper and a partial lower denture

In a sample of 30 partially edentulous subjects, provided with an immediate complete upper denture and a partial lower denture and followed for 2 years, a correlation analysis was performed between facial morphology, as measured by lateral head films, and EMG peak mean voltages of the anterior temporal and masseter muscles when clenched and during swallowing and chewing, and of the lip muscles during swallowing. At the pre-treatment stage, when the patients occluded on a residual anterior dentition, correlations between facial morphologic characteristics and peak mean voltages of the jaw closing muscles indicated stronger muscle activity in individuals with a square facial type. No significant associations were observed between muscle activity and the age of the subjects, which ranged from 36 to 71 years. After placement and use of the dentures a significant forward-upward rotation of the mandible with a decrease in overbite occurred, as a result of resorption of the edentulous maxillary ridge. At the 1 year stage of denture use, the elevator activity showed no significant correlations with facial morphology. On the other hand, negative correlations were observed especially between the anterior temporal activity and anterior overbite. Similar negative correlations were observed for the lip activity during swallowing, especially of the upper lip. These findings suggest occlusal contact between the incisors during the various functions in subjects with a small overbite. The findings further suggest that the anterior temporal and the upper lip muscles are sensitive to changes in anterior occlusal relations of the dentures.

Changes in Head and Cervical-Spine Postures and EMG Activities of Masticatory Muscles Following Treatment with Complete Upper and Partial Lower Denture

A clinical stomatognathic, cephalometric and electromyographic (EMG) study was performed in relation to 14 subjects (10 women, 4 men), each with an edentulous maxilla and residual mandibular dentition before and six months after treatment with complete upper and partial lower dentures. The mean age of the subjects was 54.4 years (range 43-64 years). The mean period of edentulousness and age of dentures were 22.5 years (range 15-33 years) and 14.1 (range 1.5-30 years), respectively. Natural head position was recorded (using a fluid-level method) and measured from cephalograms. EMG activity was measured in relation to masseter and temporal muscles. A decrease in clinical dysfunction index was noted in 12 of 14 subjects (86%). There was no change in cervical inclination, but a slight extension of the head was noted after treatment. Rapid recovery of the masticatory muscles was reflected in increased EMG activity, especially when biting in the maximal intercuspal position. In cases of edentulous maxilla and residual mandibular anterior dentition, treatment with a complete upper and lower partial denture had a favorable effect on craniomandibular disorders and masticatory-muscle function.

小口症患者の補綴処置例

This paper describes the treatment of a partially edentulous patient with microstomia. A 65-year-old patient's face was severely burned when he was 2 years old. His mouth circumference was about 120 mm and perioral burn scar contraction strictly limited access to the oral cavity. Upper and lower preliminary impressions were obtained by using a sectioned stock tray for an edentulous patient. A sectional custom tray was made for a maxillary final impression. A larger section encompassed an area of the denture base and retainers. A small section encompassed a remaining dental arch. This technique minimized the influence of errors resulting from sectional impression. Two halves could be assembled and disassembled in the mouth and reassembled outside the mouth by LEGO plastic building blocks.An outline of the deture base was simplified by partial overdeture, which an isolated and mobile tooth was served as an abutment. An arm tip of the farthest clasp from the denture base travelled mesially so as not to injure the angle of the mouth. Upper and lower partial dentures could be carefully inserted and twisted into place. Upon reexamination 1 year later, the dentures were in good condition.