Prosthetic Management Research Articles

Prosthetic management in mayer-rokitansky-küster-hauser (MRKH) Syndrome: A case report highlighting vaginal reconstruction and its impact on quality of life

Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome, a congenital condition affecting 1 in 4,500 female births, is marked by the absence or underdevelopment of the uterus and upper vagina. Vaginal reconstruction is vital for sexual function, with prosthetic stents playing a key role in maintaining neovaginal patency.Femal patient with MRKH syndrome were treated using custom-made hollow vaginal stents following the Abbe-McIndoe technique. Stents were fabricated from heat-cure acrylic resin based on MRI measurements, ensuring optimal fit and function. Follow-up confirmed maintained vaginal patency. This case report highlights the critical role of prosthodontists in managing MRKH syndrome. Custom prosthetic stent provided excellent outcomes, though challenges with retention and patient compliance was noted, underscoring the need for continued innovation. Personalized prosthetic vaginal stents are effective in managing MRKH syndrome, improving patient quality of life. These findings support their use as a standard treatment option.

Retrospective analysis of medication-related osteonecrosis of the jaw at a maxillofacial prosthetics clinic

Purpose: Medication-related osteonecrosis of the jaw (MRONJ) poses significant challenges in patient care because of its complex etiology, clinical manifestations, and management. This study aims to provide an overview of patients with MRONJ treated at our clinic over the past 12 years, highlighting incidence, clinical characteristics, and prosthetic treatment outcomes. Materials and Methods: The study included patients with MRONJ who visited our clinic between January 2012 and April 2024. Data on demographic characteristics, lesion location, clinical presentation, primary diseases, prosthetic management and medications were collected from health records. Results: This retrospective analysis of cases of MRONJ over 12 years at a maxillofacial prosthetics clinic reveals a rising prevalence of the condition, particularly in the elderly, with treatments for breast and prostate cancer emerging as prominent risk factors. Distinct medication-specific effects on distribution of lesions suggest variation in pathogenic mechanisms, which require tailored treatment strategies. Management strategies encompass a spectrum of interventions from conservative measures to prosthetic rehabilitation, highlighting the importance of interdisciplinary collaboration and personalized care. Conclusion: The rising incidence of MRONJ, especially among elderly patients, indicates the need for enhanced preventive measures and interdisciplinary care. Breast and prostate cancer treatments are significant risk factors, necessitating tailored monitoring. Effective prosthetic management is crucial for improving oral function and quality of life in MRONJ patients.

Prosthetic management of mandibular defect: 2 case reports

Prosthetic management of mandibular defect: 2 case reports

Prosthetic management of maxillary defects: 2 case reports

Prosthetic management of maxillary defects: 2 case reports

Prosthetic management of angulated implants with custom abutments

Prosthetic management of angulated implants with custom abutments

An Overview of Prosthetic Implant Attachments in EdentulousPatients

Edentulism is an unresolved health care issue of sustained significance and prevalence in the aged population. Adaptation to wearing complete dentures is a complex process and must be considered from both somatic and psychological standpoints. The difficulties of wearing dentures have been attributed to deficiencies of the denture-bearing tissues, reduced salivary flow,vulnerable tissue and severe ridge resorption. The prosthetic management of the edentulous patient has always been a major challenge. Complete maxillary and mandibular dentures have been the traditional treatment option. However, most of the patients report problems adapting to the mandibular denture due to lack of comfort, retention and stability. It is well known that implantretained/supported overdentures provide improved retention, support, stability, function, and comfort for patients

Challenges in Managing an Edentulous Down Syndrome Patient: A Case Report

Patients with Down Syndrome (DS) are caring, affectionate, and quite social. However, the prosthetic management of edentulous patients with DS depends on the level of their disability, developmental delay and neurobehavioral problems. Muscle hypotonia can affect patient gestures and handling of their prostheses. In addition, intraoral manifestations need to be taken into consideration when designing removable complete dentures, such as macroglossia and maxillo-mandibular sagittal and transverse skeletal misalignment. Dentist is asked to be consistent and to establish a gradual and an atraumatic approach based on the cooperation of the patient and his or her parents, and on the importance of follow ups in the integration of removable prostheses to improve the quality of life and the oral health of these individuals. This article presents the prosthetic treatment of an edentulous 29-year-old female patient with DS and a moderate intellectual disability.

Fabrication of a definitive obturator for a patient with partial maxillectomy defect following post-covid mucormycosis: A case report

Mucormycosis was a rapidly progressing and life-threatening fungal infection. After surgery, we should anticipate seeing more individuals with orofacial abnormalities given the total number of cases and the orofacial region's primary involvement in the previous COVID-19 pandemic. Thus, in order to improve the quality of life for individuals suffering from mucormycosis, maxillofacial prosthetic rehabilitation is of paramount importance. Postoperative maxillary defects can be rehabilitated through surgical and prosthetic procedures. An obturator was utilized as a part of prosthetic management to facilitate efficient deglutition and articulation. It also provides support for the facial soft tissue to restore the midfacial contour in cases of palatal defects. This case report describes about the fabrication of a definitive palatal obturator for a patient with postsurgical maxillary defect wearing interim obturator made of polymethyl methacrylate (PMMA). Food impaction and irritation of the fitting surface over the tissue defect, resulting in erythema to the tissue surface and discomfort of using interim obturator. With the remaining teeth and tissues serving as support, the definitive obturator made of cobalt and chromium was made. With no degradation in the prosthesis, the follow-up showed satisfactory outcomes.

Prosthodontic Management Of Post Covid Mucormycosis

Background: Post covid mucormycosis although very uncommon, came to the limelight after the covid pandemic owing to the decrease in immunity of affected individuals. Post treatment, most of the patients were subjected to physical and mental trauma owing to the aggressive resection of the affected tissues. Patients faced difficulty in swallowing, speech and it affected the esthetics which had a negative impact on the quality of life of patients. Prosthetic management of such patients involves fabrication of maxillofacial prosthesis which replaces the resected tissue thereby restoring normal oral functions. Aim: To manage patients affected by post covid mucormycosis prosthetically thereby improving the oral health of the individual. Case description: In this article three cases are described which were prosthetically managed with help of obturator, cast partial denture, and hollow denture. Conclusion: Prosthetic rehabilitation of patients affected by mucormycosis is quiet complex considering the fact that surgery cannot be planned as per prosthetic requirements. Most of the time prosthodontists are left with minimal structure which would aid in retention, stability and support of denture. Rehabilitation of such patients with implants is a question of debate as more research is required to have clarity regarding the success of implants in mucormycosis affected patients. Conventional treatment with obturator, partial and complete denture is proven to be successful.

Digital workflow for prosthetic management of malpositioned implant in an adolescent patient: A 20-year follow-up.

Dental implants placed in adolescent patients pose a challenge to restore and maintain an esthetic outcome over longer period of follow-up. Maxillomandibular changes throughout adulthood may lead to complications such as implant infraocclusion and interproximal contact loss. This case report describes an alternate prosthetic treatment strategy for maxillary single implant placed in an adolescent patient in the esthetic zone with inappropriate implant axis and screw hole placement. With temporary restorations, the gingiva and soft tissues were shaped to imitate the emerging profile of the contralateral side. A zirconia screw-retained abutment was customized as a copy-mirror from the contralateral prepared tooth to mimic the exact shape and to avoid labiolingual over contour by computer-aided design/computer-assisted manufacture (CAD/CAM). The porcelain laminate veneer was bonded to the zirconia abutment. Porcelain adhesive approach was used instead of traditional principles of retention and resistance form of the abutment. A functional and esthetic outcome was achieved and maintained, while a minimally invasive procedure was implemented to use the malplaced implant instead of explanting it. The present report illustrates the prosthetic management of a malpositioned dental implant placed 20 years ago, utilizing a minimally invasive digital protocol.

Patient Outcomes in a Novel Osseointegrated Device for Transfemoral Amputation: a case series

Background Socket suspension (SS) prosthetics are the current standard for transfemoral amputee prosthetic management. The SS systems have been shown to be inefficient in energy transfer, leading to gait alteration, wear discomfort, and skin complications. Many studies have shown osseointegrated (OI) devices are not associated with these problems and offer many benefits. Purpose Through this report the authors will describe surgical outcomes following transfemoral amputation (TFA) surgery using a novel OI device. Methods Patients with problematic TFA were identified from 2013 to 2018 were treated with a novel OI system. Candidate TFA patients identified through record review as part of an IRB authorized retrospective study. The study group all had the following characteristics: (1)No diabetes, (2)no peripheral vascular disease, and (3)mature healed TFA. All study subjects had attempted use of SS and had failed for many reasons related to the skin to socket interface. The outcomes measured recorded included: (1)Q-TFA Scores, (2)SF-36 Score, (3)time coupled per day, (4)resolution of back pain, (5)residual limb pain, and (6)overall satisfaction. Radiographs of implanted stems were reviewed for evidence of loosening or bone on growth. Results A group of TFA patients (11) had been treated with the OI system and agreed for follow up evaluation. Mean age 52 (37-73) years at the time of OI stage I surgery, with a mean time of 9 (3-20) years post amputation to implantation of the OI system. Original indications for the amputation included: 1 chronic osteomyelitis, 1 neoplasm, and 9 traumatic. Mean time to from TFA to OI was 73 months (2- 216). All patients reported a reduction or complete resolution of back pain after OI. Ambulatory/device coupling status reported was mean 12 hours/day. Average Q-TFA Prosthetic use score 66.1, Prosthetic mobility score, 60.2, Problem score 18.2, and Global score 72. Average SF-36 PCS 56.2 and average MCS 70.0. Radiographs reviewed all showed 4 to 6mm of distal circumferential bone reabsorption with robust bone on growth in the diaphysis of the implanted femurs. Conclusion Early data on the effectiveness and safety of the custom Patriot™ OI device is favorable. Future study evaluating long-term device survivorship and patient reported outcomes is warranted. Bone remodeling post implantation and coupling showed positive effects of the system. This study found the custom OI device to be safe and effective in the management of TFA in patients with controlled indications.

Effect of prosthetic management and its timing on otological and audiological outcomes in infants with cleft lip and palate: A clinical trial.

To evaluate how prosthetic management affects the otological and audiological state of infants with cleft lip and palate by preventing or treating otitis media (OM). Thirty infants with cleft lip and palate (L/P) were assigned to three equal groups according to the age of prosthetic intervention; Group I: immediately after birth, Group II: 2 months old, Group III: 5 months old. Assessment of middle ear function by tympanometry and hearing quality by auditory brainstem response (ABR) under natural sleep was conducted before and after prosthetic treatment every month till 10 months of age. Data from the study groups were compared. No statistically significant differences were found between Gp I and Gp II in the 2nd, 3rd, and 4th months for right and left ears (p > 0.05). In the 5th month, statistically significant differences between the three groups were found in tympanometry for right (p = 0.011) and left (p = 0.024) ears also, in ABR for right (p = 0.007) and left (p = 0.011) ears. Tympanometric readings starting from the 6th till the 10th month showed no statistically significant differences between the three groups (p >0.05). The final ABR outcomes of the 10th month indicated statistically significant differences between the three groups for both ears (p = 0.027). Early prosthetic care could delay the development of OM, so it could potentially improve the otological and audiological state in infants with cleft L/P. However, prosthetic treatment may not be able to completely prevent or eliminate middle ear disorders.

Evaluation of open-face maxillary complete denture for patients with prominent premaxilla: a crossover study.

The establishment of good facial esthetics is one of the main objectives of complete denture construction. Unfortunately, it may be the caused issue for patients having a prominent premaxilla due to excessive lip support by the labial flange of the maxillary denture. Open-face dentures (OFD) may suggest suitable prosthetic management for these patients. However, clinical evidence regarding the efficiency of OFD is scarce. A total of 38 completely edentulous participants having prominent premaxilla and skeletal class I Angle's classification were enrolled in this study. Each participant received a mandibular complete denture and 2 opposing maxillary dentures; conventional (CD) and open-face (OFD). On the day of denture insertion, the participants were divided into 2 groups; CD-OFD and OFD-CD where CD-OFD group was instructed to use the mandibular denture and the maxillary CD for 3 months and then to use the maxillary OFD for another 3 months after a wash-out period of 2 weeks. While group OFD-CD was instructed to use the mandibular denture and the maxillary OFD for 3 months then to use the maxillary CD for another 3 months after a wash-out period of 2 weeks. The dislodging force of the maxillary dentures was evaluated using the universal testing machine and the patient perception of retention, esthetics, and comfort was evaluated using the Visual Analogue Scale (VAS). Evaluation was carried out 1 day, 1 month, and 3 months after denture insertion. The Student t-test was used to compare the 2 maxillary dentures and the intervals for each denture were compared by using the ANOVA test with repeated measures followed by a Post Hoc test (adjusted Bonferroni) for pairwise comparison. The significance of the obtained results was judged at the 5% level (P value). The dislodging force and patient perception of retention did not show significant differences between the 2 dentures, while the perception of esthetics showed significant differences throughout the follow-up period. Perception of comfort showed an insignificant difference only at the 3-month interval. Open-face maxillary dentures can be a suitable alternative for patients with prominent premaxilla to achieve satisfactory retention, aesthetics, and comfort.

Lip prosthesis as a palliative care modality for a head and neck cancer patient—A case report

The present case report describes the prosthetic management following partial loss of free-fibular osteocutaneous flap in an irradiated patient diagnosed with recurrent head and neck cancer. The patient presented with constant drooling of oral fluids due to an anatomically deficient lower lip. Salvage reconstructive surgery was not considered feasible due to past history of recurrence, multiple surgeries and radiotherapy, and financial constraints. An adhesive-retained interim silicone prosthesis was fabricated to alleviate the functional and psychosocial morbidity. The prosthesis served to restore the oro-facial seal to prevent constant drooling of oral fluids. It also aided in providing an excellent aesthetic solution to palliate the psychological suffering experienced by the patient due to lost facial contours.

Prosthetic Management of Inguinal Hernias Using the Lichtenstein Technique in 100 Cases

Introduction: There has always been a plethora of hernia repairs in the absence of consensus. Techniques described as ancient, such as the Bassini, Mac Vay or Shouldice procedures, are still widely practised. Aponeurotic plasty has proved its worth in our practice. Prosthetic plasty, which has reduced recurrence by half, has become the gold standard. The aim of this study was to report on the feasibility of prosthetic management of inguinal hernias using the Lichtenstein technique. Material and method: This was a prospective fifteen (15)-month study: from July 1, 2022 to September 30, 2023. Study variables were sociodemographic, clinical and therapeutic. Results: During the study period, 173 patients underwent surgery for inguinal hernia. We noted one hundred (100) patients operated on according to the Lichtenstein procedure, i.e. 58% of all patients operated on for inguinal hernias in the department. We noted 98 men and 02 women. The mean age was 48.8 years (extremes: 20-91). The category of heavy laborer (laborer, farmer, etc....) accounted for % of cases. The hernia was exclusively right in 9 cases, left in 21 and bilateral in 10. A strangulated hernia was present in 9 patients. NYHUS classification was dominated by type IIIA (38.9%). Therapeutically, spinal anesthesia was the most common treatment: 8 cases. 40% of patients were pain-free in the immediate post-operative period, according to the analogue pain scale. The main complications were chronic pain in 10 patients and seroma in 02. After a minimum follow-up of three months for each patient, we noted no recurrence. Conclusion. The Lichtenstein technique is a relatively new procedure in our practice. Today, it is the technique of choice, with little postoperative morbidity.

Pre-prosthetic atraumatic laser-assisted mandibular rehabilitation: Er,Cr:YSGG 2780 nm for alveoloplasty and mucocele removal. A case report

Lasers are a popular technology in many areas of dentistry due to their low invasiveness, quick tissue response, and rapid healing time. Mucoceles develop from minor salivary glands, whereas bony exostosis is a prosthodontic challenge that prevents optimal prosthetic management. Scarring, pain, and discomfort are common drawbacks of traditional surgical approaches, which are followed by prolonged postoperative healing. Laser-assisted mandibular rehabilitation is a promising approach with predictable results. The patient complained of severe pain during denture fabrication, as well as a small, painless swelling on the inner aspect of the lower lip. The patient was able to receive the planned complete dentures after undergoing atraumatic laser-assisted removal of mucocele and bone exostosis with an Er,Cr:YSGG (Erbium, chromium-doped, yttrium, scandium, gallium, and garnet) laser treatment at 2780 nm. Both procedures were completed quickly, and there were no postoperative complications to report. Blanching overlying both lesions quickly faded after healing and was replaced by a healthy pink mucosal color; both lesions were monitored until complete healing. The Er,Cr:YSGG effectively ablated and removed both soft and hard tissue lesions with minimal bleeding and pain.

Pre-prosthetic atraumatic laser-assisted mandibular rehabilitation: Er,Cr:YSGG 2780 nm for alveoloplasty and mucocele removal. A case report

Lasers are a popular technology in many areas of dentistry due to their low invasiveness, quick tissue response, and rapid healing time. Mucoceles develop from minor salivary glands, whereas bony exostosis is a prosthodontic challenge that prevents optimal prosthetic management. Scarring, pain, and discomfort are common drawbacks of traditional surgical approaches, which are followed by prolonged postoperative healing. Laser-assisted mandibular rehabilitation is a promising approach with predictable results. The patient complained of severe pain during denture fabrication, as well as a small, painless swelling on the inner aspect of the lower lip. The patient was able to receive the planned complete dentures after undergoing atraumatic laser-assisted removal of mucocele and bone exostosis with an Er,Cr:YSGG (Erbium, chromium-doped, yttrium, scandium, gallium, and garnet) laser treatment at 2780 nm. Both procedures were completed quickly, and there were no postoperative complications to report. Blanching overlying both lesions quickly faded after healing and was replaced by a healthy pink mucosal color; both lesions were monitored until complete healing. The Er,Cr:YSGG effectively ablated and removed both soft and hard tissue lesions with minimal bleeding and pain.

Impact of Patient Education Formats on Treatment Adherence and Denture Hygiene in Edentulous Patients: A Comparative Study.

BACKGROUND Effective communication and patient education are important in geriatric dental care. Memory decline complicates patient adherence. This study aimed to compare verbal, audio, and video patient education material (PEM) and adherence to dental prosthetic management in edentulous patients. MATERIAL AND METHODS 90 completely/partially edentulous patients (aged 40 to 70 years), were divided (simple random) into three groups (Gp) of 30 each . A total of 68 instructions were organized into 9 learning categories. For GpVi, a 20 minute video was shot using a Sony camera (PD170), with two actors depicting related PEM information. Patients were recalled after 1 day and 7days, to recall the PEM instructions. A Denture plaque Index (DPI) determined the efficiency of the instructions at both time intervals. Frequencies, means and standard deviations were derived for each group and then compared using Chi square, paired and unpaired t test and a Neuman-Keul post hoc pairwise test. All significant differences were kept at probability t value of ≤0.05. RESULTS PEM instructions related to patient individuality, proper tongue position and miscellaneous showed poor patient recall. At 1 day interval, audio was found to have better recall than video and verbal in 5 PEM instruction categories. At 7 day interval, video showed better recall than other two groups (P≤0.05). Despite improvements in patients recall, DPI revealed better denture hygiene maintenance in patients receiving instructions through video format (P≤0.05). CONCLUSIONS For all categories, no single media was considered to be sufficient, audio produced early better recall while video influenced long term recall and better denture hygiene maintenance.

Surgical and Prosthetic Management of a Juvenile Ossifying Fibroma In a 5-Year-Old Child: A Clinical Report

Juvenile ossifying fibroma (JOF) is a rare and benign fibro-osseous lesion of the craniofacial skeleton commonly seen in children under 15 years of age. Despite being classified as benign, JOF lesions are aggressive in nature and reach large dimensions in a short period of time. Thus, their resections may cause large orofacial defects which have serious detrimental effects on the functional and nutritional requirements of pediatric patients being in the pe-riod of growth. Therefore, its early diagnosis and proper surgical and prost-hetic management are of vital importance for the survival of patients. However, no detailed reports in the literature describe the prosthetic mana-gement of large intraoral defects in pediatric patients under 10 years old.

Oral Prosthetic Rehabilitation in Patients with Epidermolysis Bullosa Hereditaria: A Systematic Review.

To review the oral prosthetic rehabilitation of patients with epidermolysis bullosa hereditaria (EBH) and study the level of evidence and quality of the presented available articles and establish clinical recommendations for the prosthetic management of these patients. An electronic search was done in July 2022 in five databases following PICOTS elements. The quality of the reports was established using the modified Pierson, Bradford Hills, and Ottawa Newcastle scale. Data extracted from 19 case reports for protocolized analysis corresponded to 64 patients and 80 dental prostheses, with almost 9 out of 10 patients being completely edentulous. The distribution of EBH types was 84% dystrophic, 10.5% junctional, and 5.5% simplex. The difficulties encountered by the authors synthesized in this review characteristically reflected those most likely encountered in dental practice. Most rehabilitations were implant-supported prostheses (85%), followed by removable dentures (10%) and dental-supported rehabilitations (5%). Fixed full-arch implant-supported prostheses represented 76.4% of implant-supported prostheses, and this prosthetic solution reflected the highest scientific quality. For an individualized approach to treatment, we recommend that in cases of total edentulism, fixed full-arch implant-supported prostheses are the most appropriate because they allow the best computer-aided planning, design, manufacture, and fitting of the prosthesis in such a complex clinical context.