Prosthesis Rehabilitation Research Articles

Bite Force in Elderly with Full Natural Dentition and Different Rehabilitation Prosthesis.

(1) Background: This study aimed to investigate maximum bite force (MBF) in elderly patients with natural full dentition (FD), patients rehabilitated with Traditional Complete Dentures (CD), with overdentures (IRO) and edentulous patients (ED). We also tested whether MBF changes are associated with gender, age of the patients and body mass index (BMI) as result of altered food; (2) Methods: Three hundred and sixty-eight geriatric patients were included. We studied two types of prostheses: (a) IRO with telescopic attachments. (b) CD (heat polymerized polymethyl methacrylate resin). The MBF was measured using a digital dynamometer with a bite fork; (3) Results: We found that MBF is higher in males than females, regardless of teeth presence or absence (p < 0.01). In patients with CD or IRO, there are no differences between males and females; prostheses improve MBF compared to edentulous patients (p < 0.0001) and this effect is greater with IRO prostheses (p < 0.0001); the chewing force of FD subjects remains greater (p < 0.0001); there are no differences among chewing strength based on different BMI categories, although FD subjects have a reduced incidence of obesity; there is a significant negative correlation between MBF and age (p = 0.038; R = 0.145), and no correlation between MBF and BMI; (4) Conclusions: This study showed that MBF improves more in patients using IRO prostheses, although not reaching the MBF of FD subjects. MBF does not correlate with BMI, although we found increased percentages of obesity in edentulous subjects or those with prostheses. Thus, old people wearing prostheses require special attention by a nutritionist to avoid risk of malnutrition.

A combined digital technique to fabricate an implant-retained auricular prosthesis for rehabilitation of hemifacial microsomia

Implant-retained auricular prostheses provide an excellent treatment option with better retention and stability than a conventionally retained prosthesis. This article presents a technique for auricular reconstruction for a patient with misplaced implants. The scanning process combined the use of an intraoral scanner and a facial scanner to enhance accuracy in space management for different parts of the auricular prosthesis and to reduce sculpting time.

Periprosthetic Leakage in Tracheoesophageal Prosthesis: Proposal of a Standardized Therapeutic Algorithm.

Periprosthetic leakage represents the most demanding long-term complication in the voice prosthesis rehabilitation. The aim of this article is to discuss the various causes of periprosthetic leakage and to propose a systematic management algorithm. Retrospective cohort study. Otolaryngology clinic of the University Polyclinic A. Gemelli-IRCCS Foundation. The study included 115 patients with voice prosthesis who were treated from December 2014 to December 2019. All patients who experienced periprosthetic leakage were treated with the same step-by-step therapeutic approach until it was successful. Incidence, management, and success rate of every attempt are analyzed and discussed. Periprosthetic leakage was reported 330 times by 82 patients in 1374 clinic accesses. Radiotherapy, timing of tracheoesophageal puncture, and type of total laryngectomy (primary or salvage) did not influence the incidence of periprosthetic leakage. Salvage total laryngectomy increases the risk of more clinically relevant leakages. By using a systematic algorithm with a step-by-step standardized approach, periprosthetic leakage management could become a less treacherous issue.

Design, Development and Evaluation of Novel Force Myography Based 2-Degree of Freedom Transradial Prosthesis

Limb loss is a traumatic event as it has physical and psychological effects on an amputee. Recent advancements in mechatronics and biomedical engineering have resulted in development of dexterous myoelectric prostheses for rehabilitation of amputees. In addition, evolution in manufacturing and sensing technology presents ample room for improvement in mechanical design and control system of prostheses to enhance amputee experience while using prosthetic devices. The present study is focused on design of a novel and cost-effective externally powered two-degree-of freedom prosthesis for assisting amputees to switch from body-powered devices to externally powered prosthesis. The control system of the developed prosthesis is based on the muscles signals acquired through force myography (FMG) technique. For precise integration of force-sensitive resistor (FSR) inside the socket to measure muscle activity, a stand-alone housing for FSR was designed with the feature of mechanical adjustment to control sensitivity of FSR and auto-calibrate its threshold to meet the requirements of individual amputees. The housing was designed to handle the fabrication inconsistencies during socket shaping process and thus ensure that sensor is in-firm contact with the muscle to sense volumetric changes. The developed mechanical design and FMG based muscle acquisition technique was successfully tested on a transradial amputee and extensive experimentation was performed for characterization of the prosthesis. FMG signal for various gestures was successfully extracted from muscles of the amputee to control the prosthesis according to the developed control technique. The results suggested that integration of FSR in the socket has significantly reduced the effect of sweat and volumetric changes on the performance of the sensor. Due to its novel design, embedded features, and cost-effectiveness the developed prototype holds the promise to be successfully commercialized to assist transradial amputees in becoming active citizens for contributing towards socio-economic growth of their country.

Mandibular propulsion and dental implant rehabilitation for an edentulous patient with class II malocclusion and severe obstructive sleep apnea

Introduction: Orthognathic surgery can be a treatment for occlusal, oro-facial functional disorders and esthetics discrepancies as well as for obstructive sleep apnea. It is often practiced after an orthodontic preparation, but in edentulous patients, the preparation can be replaced with implant supported prosthesis to simulate the final occlusion. Observation: A patient presenting severe obstructive sleep apnea, vertical and sagittal insufficiency of the lower third of the face and poor dental health was treated with a guided mandibular advancement and an almost complete implant supported prosthesis rehabilitation. At first, the implants were placed and immediately loaded, giving the patient a class 2 occlusion. Then, an orthognathic surgery was performed, giving the patient a class 1 occlusion, and then the final prosthesis was made. Commentaries: The interest of this case is the combined treatment of the obstructive sleep apnea, the dental and facial deformities by mandibular retrognathia and the edentulous jaws. The gold standard for obstructive sleep apnea is a maxillary and mandibular advancement. In this case, for esthetic and anatomic reasons, a mandible propulsion alone has been performed, showing a positive and stable result for the treatment of obstructive sleep apnea. The use of surgical guide permitted to plan the treatment with more accuracy. Conclusion: This case combines a fixed prosthetic rehabilitation, which permitted to guide the orthognathic surgery and the treatment of obstructive sleep apnea.

English

English

Patients With Voice Prosthesis Rehabilitation During the COVID-19 Pandemic: Analyzing the Effectiveness of Remote Triage and Management.

ObjectiveTo describe a remote approach used with patients with voice prosthesis after laryngectomy during the COVID-19 pandemic and the resulting clinical outcomes in terms of voice prosthesis complications management, oncological monitoring, and psychophysical well-being.Study DesignProspective cohort study.SettingOtolaryngology Clinic of the University Polyclinic A. Gemelli, IRCCS Foundation.Subjects and MethodsAll patients with voice prosthesis who underwent laryngectomy followed by our institute were offered enrollment. Patients who agreed to participate were interviewed to inquire about the nature of the need and to plan a video call with the appropriate clinician. Before and 1 week after the clinician’s call, patients were tested with the Hospital Anxiety and Depression Scale. Degrees of satisfaction were investigated with a visual analog scale. A comparison between those who accepted and refused telematic support was carried out to identify factors that influence patient interest in teleservice.ResultsVideo call service allowed us to reach 37 (50.68%) of 73 patients. In 23 (62.16%) of 37 cases, the video call was sufficient to manage the problem. In the remaining 14 cases (37.83%), an outpatient visit was necessary. Participants who refused telematic support had a significantly shorter time interval from the last ear, nose, and throat visit than patients who accepted (57.95 vs 96.14 days, P = .03). Video-called patients showed significantly decreased levels of anxiety and depression (mean Hospital Anxiety and Depression Scale total score pre– vs post–video call: 13.97 vs. 10.23, P < .0001) and reported high levels of satisfaction about the service.ConclusionRemote approach may be a viable support in the management of patients with voice prosthesis rehabilitation.

Three-dimensional marginal bone loss around implants supporting metal ceramic and metal acrylic screw retained hybrid prosthesis for rehabilitation of atrophied mandible. A cone beam radiographic study

Purpose:evaluate three-dimensional marginal bone loss around implants supporting metal ceramic and metal acrylic screw retained hybrid prosthesis for rehabilitation of atrophied mandible using (CBCT) after one year. Materials and methods: Ten completely edentulous patients with mandibular ridge atrophy were randomly assigned into 2 groups; Group I; included 5 patients who received Metal ceramic screw retained hybrid prosthesis, Group II; included 5 patients who received Metal acrylic screw retained hybrid prosthesis. All patients then received 4 implants in the inter-foraminal area of the mandible using the flapless surgical approach. After osteointegration, implants were loaded by the prostheses with a distal cantilever not exceed 1.5 antro-posterior spread. Vertical and horizontal bone resorption was assessed at mesial, distal, buccal and lingual aspect of anterior and posterior implants using (CBCT) at time of prosthesis insertion (baseline), 6 months and one year later. Results: After 6 and 12 months, metal ceramic prosthesis showed significant higher vertical and horizontal bone resorption than metal acrylic prosthesis for anterior and posterior implants. Posterior implants showed significant higher vertical and horizontal bone resorption than anterior implants for metal ceramic group only and no difference in bone loss between anterior and posterior implants in metal acrylic group was noted. For both groups and implant positions, vertical and horizontal bone resorption at 12 months significantly increased compared to 6 months Conclusion: metal acrylic cantilevered prosthesis for screw retained hybrid restoration of edentulous atrophied mandible may be recommended than metal ceramic prosthesis

EMG-driven hand model based on the classification of individual finger movements

The recovery of hand motion is one of the most challenging aspects in stroke rehabilitation. This paper presents an initial approach to robot-assisted hand-motion therapies. Our goal was twofold: firstly, we have applied machine learning methods to identify and characterize finger motion patterns from healthy individuals. To this purpose, Electromyographic (EMG) signals have been acquired from flexor and extensor muscles in the forearm using surface electrodes. Time and frequency features were used as inputs to machine learning algorithms for recognition of six hand gestures. In particular, we compared the performance of Artificial Neural Networks (ANN), Support Vector Machines (SVM) and k-Nearest Neighbor (k-NN) algorithms for classification. Secondly, each identified gesture was turned into a joint reference trajectory by applying interpolation methods. This allowed us to reconstruct the hand/finger motion kinematics and to simulate the dynamics of each motion pattern. Experiments were carried out to create an EMG database from 20 control subjects, and a VICON camera tracking system was used to validate the accuracy of the proposed system. The average correlation between the EMG-based generated joint trajectories and the tracked hand-motion was 0.91. Furthermore, statistical analysis applied to 14 different SVM, ANN and k-NN configurations showed that Fine k-NN and Weighted k-NN have a better performance for the classification of gestures (98% of accuracy). In a future, the trajectories controlled by EMG signals could be applied to an exoskeleton or hand-robotic prosthesis for rehabilitation.

Determination of Relationship of Maxillary Occlusal Plane with Ala-Tragus Line: A Customised Approach in Aryan and Mongolian Ethnicity.

Background: Determining occlusal plane is challenging and difficult aspect during complete removable partial denture prosthesis rehabilitation. Numerous soft tissue landmarks like commissures of the mouth by Gillis in 1933, parotid papilla by P. F. Foley and G. H. Latta in 1985, height of the retromolar pad, the lateral borders of the tongue etc. had been proposed to assist clinician for determining the occlusal plane. No universally accepted reliable anatomical measurement has been proposed to assist in determining of occlusion plane for different ethnic groups in context to Nepal.&#x0D; Material &amp; Methods: This cross-sectional study was conducted in the 60 dentate subjects visiting Nobel Medical College, Nepal, from February 2019 to July 2019. A customized occlusal plane relator was used to evaluate relative parallelism between occlusal plane and alatragal line with respect to different borders of tragus. All the data were collected and statistically analyzed.&#x0D; Results: Maxillary occlusal plane was found to be parallel with the line drawn from ala of the nose to the middle of tragus in 66.66%, followed by inferior border of tragus in 18.33% with the least parallelism in superior border of tragus 15%. Relationship of maxillary occlusal plane with alatragal line was not statistically significant among Aryans and Mongolian ethnicity&#x0D; Conclusion: This study showed line joining ala of the nose and middle border of tragus is parallel to maxillary occlusal plane. And no difference was found for Aryan &amp; Mongolian ethnicity in relation to alatragal line and maxillary occlusal plane.

Functional capacity of elderly with lower-limb amputation after prosthesis rehabilitation: a longitudinal study

Objectives Elderly amputees are a specific clientele because of the interaction of this disease with the ageing process. The objective of this study was to determine the impact of prosthesis rehabilitation on the functional capacity of elderly with lower-limb amputation (LLA) in short and long time. Materials and methods A quasi-experimental study was developed. The sample consisted of 29 elderly with LLA who finished the prosthesis rehabilitation programme. Gait capacity was evaluated by Functional Ambulation Classification Scale (FAC), ability to perform basic activities of daily living (ADL) was evaluated by Barthel Index (BI) and Pfeffer Questionnaire was used to evaluate the capacity to execute instrumental ADL. Statistical inference was done by t-test, t-student test and chi-squared test. The significance level was fixed at 5% (p < 0.05). Results In the transtibial group (n = 15) no difference (p = 0.108) was found between BI score before amputation and after 3 months of follow up. The transfemoral group (n = 14) improved significantly (p = 0.045) the FAC before starting and after 3 months of discharge from ambulatory rehabilitation. Both groups increased the time of prosthesis use during the day after 3 months of follow up. However, no group has achieved FAC and Pfeffer Questionnaire pre-amputation performance. Conclusion Although elderly with LLA improved functional capacity after 3 months of a prosthesis rehabilitation programme, they did not achieve their pre-amputation functionality. Implications for rehabilitation Lower-limb amputation causes a significant socioeconomic impact and decreases functional capacity, autonomy and quality of life. Elderly people with a lower-limb amputation impose a heavy burden on health resources, requiring extensive rehabilitation and long term care. The specific presentation of elderly persons with lower-limb amputation, with multiple physical, psychological, cognitive, and social comorbidities, imposes unique challenges to ongoing care. The potential bias from the inclusion of younger patients into a study with an elderly population with lower-limb amputation supports the need for independent investigation. In our study we verified that although elderly with transfemoral or transtibial amputation have improved their functional independence after lower-limb prosthesis rehabilitation, they could not achieve their functional capacity before amputation. This improvement especially occurred for the basic activities of daily living, however elderly patients with transfemoral amputations presented greater difficulty in improving functional capacity. These results support that being able to better select elderly by their mobility potential and environmental barriers, is an important goal for future research to aim toward those who will achieve and maintain prosthetic walking or those who could better focus on regaining nonprosthetic mobility.

Screw and cement retained implant prosthesis rehabilitation of mandibular edentulous patients with severely absorbed ridge

Screw and cement retained implant prosthesis rehabilitation of mandibular edentulous patients with severely absorbed ridge

Voice prosthesis rehabilitation after total laryngectomy: are satisfaction and quality of life maintained over time?

SUMMARYTotal laryngectomy is the standard of care for advanced laryngeal/hypopharyngeal cancer. Effective voice rehabilitation is mandatory and tracheo-oesophageal speech (TES) has progressively gained approval. In 2011, we evaluated quality of life (QoL) and satisfaction after TES rehabilitation, demonstrating its efficacy in highly motivated subjects. The aim of the present study was to investigate whether those results are maintained over time within the same selected cohort. 15 of 24 patients were left with a minimum 12 year-follow up after voice prosthesis (VP) implantation. Short Form 36-Item Health Survey (SF-36) for QoL assessment and a study-specific structured questionnaire for evaluation of TES-related satisfaction were employed. The 9/24 patients who dropped out from the follow-up were excluded from the original count and the former results were recalculated. A control group of subjects with minor ENT diseases was used for SF-36 analysis. Many SF-36 items (RP, BP, SF, RE) significantly improved over time, approaching the results of the control group. VP duration also increased (6.3 ± 3.1 against 3.0 ± 1.8 months). TES-related satisfaction items did not change in a statistically significant way. Three patients (20.0%) would not have chosen the same kind of voice restoration: these subjects are those more distant from our institution (230 km and 462 km, respectively, against a mean distance of 15.4 ± 13.8 km for other patients). With the present work, we highlight how the striking results of TES can not only be maintained over time (i.e. TES-related satisfaction), but also substantially improve (i.e. QoL). An integrated, widespread network of centres for VP management is needed to optimise patient follow-up and allow studies on larger series.

Visual attention, EEG alpha power and T7-Fz connectivity are implicated in prosthetic hand control and can be optimized through gaze training

BackgroundProsthetic hands impose a high cognitive burden on the user that often results in fatigue, frustration and prosthesis rejection. However, efforts to directly measure this burden are sparse and little is known about the mechanisms behind it. There is also a lack of evidence-based training interventions designed to improve prosthesis hand control and reduce the mental effort required to use them. In two experiments, we provide the first direct evaluation of this cognitive burden using measurements of EEG and eye-tracking (Experiment 1), and then explore how a novel visuomotor intervention (gaze training; GT) might alleviate it (Experiment 2).MethodsIn Experiment 1, able-bodied participants (n = 20) lifted and moved a jar, first using their anatomical hand and then using a myoelectric prosthetic hand simulator. In experiment 2, a GT group (n = 12) and a movement training (MT) group (n = 12) trained with the prosthetic hand simulator over three one hour sessions in a picking up coins task, before returning for retention, delayed retention and transfer tests. The GT group received instruction regarding how to use their eyes effectively, while the MT group received movement-related instruction typical in rehabilitation.ResultsExperiment 1 revealed that when using the prosthetic hand, participants performed worse, exhibited spatial and temporal disruptions to visual attention, and exhibited a global decrease in EEG alpha power (8-12 Hz), suggesting increased cognitive effort. Experiment 2 showed that GT was the more effective method for expediting prosthesis learning, optimising visual attention, and lowering conscious control – as indexed by reduced T7-Fz connectivity. Whilst the MT group improved performance, they did not reduce hand-focused visual attention and showed increased conscious movement control. The superior benefits of GT transferred to a more complex tea-making task.ConclusionsThese experiments quantify the visual and cortical mechanisms relating to the cognitive burden experienced during prosthetic hand control. They also evidence the efficacy of a GT intervention that alleviated this burden and promoted better learning and transfer, compared to typical rehabilitation instructions. These findings have theoretical and practical implications for prosthesis rehabilitation, the development of emerging prosthesis technologies and for the general understanding of human-tool interactions.

Dental Implant Rehabilitation After Jaw Reconstruction Assisted by Virtual Surgical Planning.

To evaluate effects of preoperative virtual planning and jaw reconstruction guided by dental implant rehabilitation on dental prosthesis rehabilitation after jaw reconstruction. Patients indicated for segmental jaw resection and who agreed to receive jaw reconstruction procedures were enrolled in the study. Appropriate surgical procedures were determined by a maxillofacial surgeon and a prosthodontist before surgery. The virtual design was created according to preoperative computed tomography. Patients were divided into navigation and non-navigation groups. Implant surgery was performed 6 months after reconstruction surgery. After treatment completion, factors such as survival rate of implants, site of reconstruction, type of graft, and type of prosthesis were compared. In total, 29 patients were included in the study, with 16 patients in the non-navigation group and 13 in the navigation group. A total of 101 implants were inserted, and the implant success rate was 98.02% (2 implants extracted due to peri-implantitis). All patients received prosthetic treatment. Of the 13 navigation group patients, 9 received fixed implant-supported prostheses, whereas the other 4 received removable dentures. Of the 16 non-navigation group patients, 9 eventually received fixed implant-supported prostheses and 7 received removable dentures. There were no significant intergroup differences in terms of prosthesis type (P = .702). However, the proportion of fixed implant-supported prostheses in the navigation group was higher compared with the non-navigation group. Preoperative virtual planning and dental implant rehabilitation-guided jaw reconstruction through preoperative designing can provide a good opportunity to achieve high rates of implant success and dental rehabilitation. This method can also benefit fixed implant-supported prosthetic restorations. Moreover, the use of navigation after virtual planning has no effect on the type of prosthetic reconstruction.

Metachronous cancer of the nasal cavity after totally cured larynx squamous cell carcinoma

Head-and-neck region tumors are mostly seen on the larynx. The risk factors of this region may increase the secondary tumors. Nasal squamous cell carcinoma (SCC) can be detected after larynx SCCs, a second primary tumor. Second primary tumors are difficult to manage. Total rhinectomy is the choice of treatment modality, but rehabilitation is necessary. We present a secondary nasal SCC treated with total rhinectomy. A 67-year-old patient, who was treated for larynx SCC by total laryngectomy 3 years ago, was admitted to the outpatient clinic with a complaint of nasal swelling and pain. The patient was diagnosed as nasal SCC. Total rhinectomy was performed, and silicon nasal prosthesis was applied after 3 months of surgery. Total rhinectomy can be rehabilitated via silicon nasal prosthesis. This was cost-effective, safe, less time-consuming, and functional. Using prosthesis has given us better chance to detect recurrences. We encourage surgeons to use prosthesis for rehabilitation.

Ocular Prosthesis Rehabilitation after Treatment of Choroid Melanoma

Ocular Prosthesis Rehabilitation after Treatment of Choroid Melanoma

FEM Investigation of the Stress Distribution over Mandibular Bone Due to Screwed Overdenture Positioned on Dental Implants.

The objective of the present investigation was to evaluate how dental implant positioning can influence the masticatory stress distribution over screwed mandibular prosthodontics restoration and over the surrounding bone tissue. Moreover, the dental implant components and overdenture bar strengths under masticatory cycles have been investigated in order to evaluate possible screw and prosthesis breakage. A “virtual jaw” model and 3D dental implant were reproduced to realise finite element analysis in order to underline the parameters and the mechanical characteristics of the bone and of the dental implants connected to the overdenture bar. The distribution of a nonspecific chewing phase, analysing the overall load on the fixtures of the lower jaw, was performed. The study investigating frontal and horizontal planes and vertical directions of occlusal forces showed how position and perspective of fixtures strongly influenced the stress distribution and the consequent jawbone tissue remodelling. Prostheses elements such as cantilever, passing screws, and dental implants are strictly related to the correct selection of dental implant position. This study suggested a virtual method to guide the surgeon in the choice of implant number, position, diameter, and length, and cantilever length and shape, and to evaluate the prospective stress distribution of chewing strengths for a correct prosthesis rehabilitation.

Multidisciplinary treatment: association among orthodontics, implantodontia and prosthetics. Case report

Deficiencies in the alveolar ridge, dental migration and malocclusion are conditions that may hamper restorative treatment and thus must be resolved by taking a multidisciplinary approach. This clinical case report is associated with orthodontics, implantology and prostheses for rehabilitation. A 34-year-old male patient presented himself in a private practice complaining of aesthetics and discomfort when chewing. At the clinical examination, teeth numbers 11, 12, 21, 22 and 25 were absent, with a removable partial denture replacing them. Due to the prolonged use of this prosthesis, wear of the artificial teeth and the extrusion of the anterior inferior teeth were present. A depression was also present in the vestibular region of the upper incisors, which did not provide adequate lip support. The tomographic examination revealed that despite the deficiency of the vestibular-lingual bone volume, the remnant in this region allowed for the implantation of implants. Orthodontic treatment was performed for the intrusion of the inferior elements and the alignment of the arches, with the goal of providing more spaces for rehabilitation. Afterward, the patient underwent surgery to install implants in the 11, 21 and 25 regions, concomitantly with bone regeneration in the vestibular region of the upper incisors. During this time, the patient used a new removable partial denture. After eight months, the prosthetic phase was started. Ten years after the end of treatment, the patient is satisfied with the results and performs maintenance every six months.KeywordsTooth movement techniques; Dental implants; Bone transplantation; Dental prosthesis.

Tissue healing with polypropylene membrane used as conventional guided bone regeneration and exposed to the oral cavity for post-dental extraction: a case report.

Introduction: The maintenance of the alveolar ridge after tooth loss is very important for the installation of an osseointegrated dental implant and for the aesthetic result of the rehabilitation prosthesis. Regenerative surgery is often needed to recover the volume lost when a tooth is extracted. The blood clot that forms is very important in regenerative surgery because it allows the mesenchymal cells to differentiate into osteoprogenitor cells, which leads to bone regeneration. Objective: This case report compares the bone repair after dental extraction in the same patient via three different protocols and the healing in preparation for posterior implant placement. Case Report: A patient 50 year-old female required dental extraction of elements 15, 24 and 26 and prosthetic rehabilitation. The first technique used was tooth extraction and suture only, the second technique used exposedBoneHeal® polypropylene membrane after extraction, and the third technique usedBoneHeal membrane subperiosteally. After a few days, the subperiosteal membrane became exposed and it was not possible to keep it in position. However, the two regions in which the membrane was used obtained a greater increase in soft tissue. Conclusion: In our study case, the polypropylene membrane seemed to repair tissue.