Prosthetic Management Research Articles

A biologically oriented preparation technique (BOPT) for immediate posterior implant placement, immediate provisionalization, and definitive implant crown fabrication: A complete digital workflow.

Immediate implants and immediate alveolar sealing have been a widely utilized treatment with high predictability and biological advantages. The improvement in technology has made it possible to simplify clinical processes. The aim of the present report was to describe the complete digital workflow of the Biologically oriented preparation technique for immediate posterior implant, immediate provisionalization and fabrication of definitive implant crowns. The surgical process and prosthetic management to preserve the gingival contours of the extracted natural tooth during immediate implant placement and provisionalization are described. Additionally, during the same clinical intervention, the definitive intraoral digital implant scans for capturing the implant position, peri-implant tissue contours, adjacent and antagonist dentition, and profile emergence of the interim implant crown are captured for the fabrication of the definitive crown. Based on the technique described, the immediate implant placement and provisionalization in the posterior area provides biological and clinical advantages, reducing the number of abutment-implant disconnections and the number of clinical appointments, as well as increases patient comfort. The present article describes a technique for an immediate implant placement and provisionalization in the posterior region for maintaining the gingival architecture of the extracted tooth. During the same appointment, the implant position, peri-implant tissue contours, and adjacent and antagonist dentition, and profile emergence of the interim implant crown are captured by using an intraoral scanner and used for the fabrication of the definitive crown. This technique aims to reduce the number of abutment-implant disconnections and clinical appointments.

Prosthetic Management of Flap-Related Complications Following Glossectomy in Locally Advanced Tongue Cancer.

Total glossectomy defects resulting from postoncologic resection are commonly reconstructed with locoregional or free flaps. However, effectively managing complications that may arise after reconstruction can be a significant challenge. We present a unique case series describing prosthetic management of flap-related complications following glossectomy in patients treated for locally advanced tongue cancer. Three patients underwent total glossectomy, neck dissection, reconstruction using free flap, and tracheostomy. Two patients developed an intraoral fistula located in the anterior region of the floor of the mouth. The third patient developed a flap failure requiring a second procedure using a pectoralis major myocutaneous flap for correction of the orocutaneous fistula that ultimately did not heal. Mandibular obturator prostheses lined with a soft liner were fabricated for all the patients, which helped reduce salivary incontinence and improve swallowing and speech. This case series highlights that a collaborative interdisciplinary team approach is crucial for optimizing postoperative function and outcomes when managing complications from reconstructive procedures.

Early prosthetic management of mandible using interim guidance appliances in hemimandibulectomy patients

Mandible is the most common site for intraoral tumors which often requires resection of large portions of the mandible depending upon the location and extent of the tumor leading to various complications such as deviation of the mandible toward the resected side and facial disfigurement. Early prosthodontic intervention during the healing period helps in training the muscles and establish an acceptable occlusal relation using guide flange prosthesis (GFP). This article aims to describe the case reports of early prosthodontic management of two patients who underwent partial resection of the mandible due to squamous cell carcinoma using two different GFP: palatal ramp prosthesis and mandibular buccal GFP using an innovative approach. Prosthodontic intervention by guidance therapy serves the purpose of reducing mandibular deviation, preventing extrusion of maxillary teeth, and improving masticatory efficiency. Guidance appliances are the simplest and most commonly used treatment modality in restoring the form and function of the mandible.

Bite Force Evaluation in Implant-Assisted Prosthetic Rehabilitation of Reconstructed Jaws Utilizing Vascularized Free Fibula Flap: A Retro-Prospective Cohort Study.

Maxillary and mandibular defects due to tumor ablation pose considerable challenges to the reconstructive surgeon and in prosthetic management. Dental implants placed in vascularized fibula free flaps are considered to be a dependable technique for prosthetic rehabilitation in head and neck cancer patients. Although, there is evidence of survival of dental implants in the reconstructed jaw bones, there is lack of information regarding the masticatory performance and prosthetic success. The maximum bite force achieved through the prosthetic appliance is a measure of the therapeutic outcome. The purpose of this study was to determine the maximum bite force achieved through implant-assisted prosthetic rehabilitation in reconstructed jaw bones utilizing vascularized free fibula flap. The study included a total of 65 implants, from 16 patients who underwent surgical resection of jaw bones due to benign tumors followed by rehabilitation with implant-assisted fixed or removable prosthesis. The maximum bite force was determined with a transducer. Occlusal interferences were analyzed with mounted casts. The parameters were reviewed every 3months have T 0 marked the baseline assessment, and T 3, T 6, T 9, T 12, and T 15 were subsequent review periods. The mean occlusal force was increased in most of the patients through 15months (P < 0.01). The maximum bite force measured in the reconstructed mandible and maxilla were 225.63N and 176.51N, respectively. Occlusal interferences were absent in 68.8% of the study population. The bite force measured in reconstructed maxilla and mandible is comparable to the masticatory force measured with conventional implant supported prosthesis in native mandible and maxilla.

Surgical and prosthetic management of an invasive radicular cyst. Ten year follow-up clinical case

Surgical and prosthetic management of an invasive radicular cyst. Ten year follow-up clinical case

An Innovative Approach in the Fabrication of a Hollow Vaginal Stent Using Ice in a Gender Dysphoria Patient: A Case Report

Gender dysphoria is the term used for individuals who are unhappy with their assigned gender at birth. They experience a strong desire to have the body of the opposite gender or to be socially recognised as a person of the opposite gender. Gender dysphoria can occur in both genders, but it is more prevalent in males, ranging from 0.005% to 0.014%. In females, the prevalence rate is lower, ranging from 0.002% to 0.003%. This case report highlights the prosthetic management of a 31 years old male patient with gender dysphoria after undergoing surgical intervention to remove male genitalia and create a neovagina. The patient underwent multiple surgeries to fulfill their gender transition desires. The patient initially visited the Department of Prosthodontics before vaginoplasty, where a custom-made hollow vaginal stent was planned and fabricated using a novel technique. In addition to prosthetic treatment, the patient also required hormonal therapies and psychological counseling, both of which were provided.

Surgical and prosthetic management of an invasive maxillary odontogenic radicular cyst. Role of osseointegrated implants on bone healing outcomes. 10 year follow-up case report

Objectives: The aim of this report is to visualize the implications which may arise from an untreated maxillary odontogenic radicular cyst. This may initially appear like an ordinary lesion however it reaches an advanced stage of maturation and invasion, therefore surgical implications should help readers consider treatment strategy and timing when observing simple lesions in … Continued

Cost-effective External Keel SACH Foot for Syme’s Prosthesis

Abstract Background: The prosthetic management of Syme’s amputation is a challenge when it comes to the attachment of SACH foot. SACH foot is made up of small narrow wooden keel which is covered by soft flexible sponge rubber therefore it is difficult to attach SACH foot directly to the Syme’s socket. Moreover, there is no rigid structure of the SACH foot available for bonding with the laminated socket considering the Syme’s amputee. Aim: This new design of prosthetic foot provide easy attachment to the Syme’s socket, thus helping in the prosthetic management of Syme’s amputation. Methodology: We have developed this Syme’s prosthetic foot with polyurethane rigid foam block, balata cloth, high-density Ethaflex, wooden block, and microcellular rubber. The design and dimensions of the prosthetic foot were decided such that it helps in easy attachment to the Syme’s prosthesis. Results: The attachment of this new Syme’s foot to the laminated socket has made the fabrication procedure of the Syme’s prosthesis more easy. The amputee also should improvement in cadence and more natural gait with this design. Conclusion: The Syme’s foot design provides natural gait in addition to the reduction of energy expenditure. This foot can also be used for transtibial prosthesis in addition to Syme’s prosthesis.

Prosthetic management of mandibulectomy patient: A case report

Maxillofacial defects hampers function, form and esthetics. Cantor and Curtis classified the mandibulectomy defects. This is a case of prosthetic rehabilitation of Class 1 radical mandibulectomy where continuity of mandible was preserved. The patient has been rehabilitated with a definitive treatment of cast partial denture which provides better cross arch stabilization and does not subject already debilitated patient to more of surgeries.

Prosthetic Management Following Anterior Segmental Mandibular Resection: A Case Report

The rehabilitation of a patient in the Kennedy class IV situation demands biomechanical balance and aesthetic improvement. Larger defects usually lead to increased movement of the prosthesis, due to the compromised mucosal support and a longer edentulous span of the prosthesis. The article describes the prosthetic management of a patient following partial mandibular resection. The long span of missing teeth and the unavailability of a sufficient number of abutments are challenges for prostheses. This case report describes an inexpensive technique for the fabrication of attachment retained prosthesis over castable bar assembly for rehabilitating the long‑span Kennedy class IV situation.

Prosthetic Management of Post Brent Surgery in Microtia Repair: A Case Series

Prosthetic Management of Post Brent Surgery in Microtia Repair: A Case Series

Management of atypical occlusal discrepancy after condylar resection: A clinical report

This clinical report describes the prosthetic management of occlusion for a patient who had received condylar resection as part of cancer treatment. Previous reports have identified that patients with unrepaired segmental resection of the mandible experienced a frontal plane rotation of the mandible toward the nonsurgical side. In contrast, because of preservation of temporomandibular muscles and their attachments, the mandible rotated toward the surgical side, and occlusal contacts were limited to a pair of molars on that side. Manual manipulation and instructions for muscular stretching and massages were provided to reduce muscular tension. A mandibular guidance prosthesis was fabricated and gradually adjusted to guide the mandible progressively toward a normal position. These treatments helped improve general comfort, mastication, occlusion, and the gradual rotation of the mandible toward a normal position.

Polyetheretherketone subperiosteal implant retaining a maxillary fixed prosthesis: A case series

Statement of problemPatients needing dental rehabilitation of a complete atrophic maxilla would benefit from simplified treatment plans. PurposeThe purpose of this case series was to demonstrate the prosthetic management of 4 edentulous patients with severe maxillary ridge resorption who declined multiple stage surgery and sought a fixed prosthesis in single-stage surgery. Material and methodsThe patients were provided with completely digital computer-aided designed and computer-aided manufactured (CAD-CAM) polyetheretherketone (PEEK) maxillary subperiosteal frameworks, which were surgically placed in a 1-step procedure. The patients were followed up for 12 months and evaluated for signs of implant rejection, infection, prosthetic fracture or mobility, or implant exposure. ResultsAt the 12-month follow-up, all the implants were functionally stable with healthy soft tissue and showed no sign of prosthetic fracture, infection, or pus discharge. ConclusionsPEEK subperiosteal implants for maxillary atrophied ridges can be considered a promising treatment option within the limitations of this clinical study with low patient numbers and a short observational time.

Oral and Craniofacial Anomalies of Fraser Syndrome: Prosthetic Management

Fraser syndrome (FS, MIM 219000) is a rare autosomal disorder characterized by systemic and oro-facial malformation, usually comprising cryptophthalmos, laryngeal malformations, syndactyly, and urogenital defects. We presented a 21-year-old FS case with partial missing teeth seeking aesthetic dental treatment. Clinical examination revealed bilateral cryptophthalmos, extensive syndactyly of hands and feet broad nose with the depressed nasal bridge, and surgically corrected bilateral cleft lip. She presented class III jaw relation and reduced the vertical height of the face. Prosthetic rehabilitation of the patient was done with upper and lower overlay dentures made from acrylic resin (VIPI BLOCK TRILUX®, VIPI Industria, Pirassununga, SP, Brazil) using computer-aided design (CAD) and computer-aided manufacturing (CAM) process. At the follow-up visit, the patient presented improved aesthetics and function. Proper management and rehabilitation of FS patients are challenging, but standard guidelines for oral health management are currently lacking. This article presents a case of Fraser syndrome presenting oral and craniofacial anomalies, and prosthetic rehabilitation was done. We also provided recommendations for the optimal oral health care for the FS patients. Functional adaptation and rehabilitation have significant roles in the various functions, survival, and quality of the life of FS patients. Integrated medical-dental care is needed in such patients with support from family members, friends, and colleagues.

Prosthetic management of resorbed ridges through fabrication of hollow denture using three-dimensional glycerin spacer and neutral zone technique

Residual ridge resorption leads to diminished retention, support, and stability of the prosthesis due to decrease in the denture supporting areas, decreased denture space, and increased leverage due to increase inter-ridge distance. The prosthetic rehabilitation of the severely resorbed ridges needs modification for the fabrication of a stable prosthesis. This clinical report describes the prosthetic management of resorbed ridges using modified impression technique, neutral zone technique, external impressions, and fabrication of a hollow denture using three-dimensional glycerin spacer to enhance the retention and stability of the prosthesis.

PROSTHODONTIC MANAGEMENT OF KNIFE-EDGE RIDGE USING CUSTOMIZED PREFABRICATED METAL MESH CUSTOM TRAY IMPRESSION TECHNIQUE

Knife-edge ridge is a form of an alveolar ridge primarily caused by lateral resorption i.e. bone resorption on the buccal as well as lingual areas at a faster pace. It is usually a common clinical finding affecting the mandibular edentulous ridges; in particular, the mandibular anterior region. It can be attributed to a number of reasons i.e. the etiology is similar to the multifactorial etiology of the residual ridge resorption. The treatment options or management of knife- edge ridge generally includes a surgical and a non-surgical approach. The non-surgical approach involves the fabrication of conventional removable dentures using various modified impression materials &amp; techniques. Prosthetic management of the patients with knife-edge ridge is a testing situation for the prosthodontist. The basic principles of retention, support, and stability are important in defining the success of a complete denture; the same can be affected in unconventional situations like knife-edge ridge. The incorporation of the conventional impression techniques may lead to an unstable and an unsatisfactory denture. Therefore, various impression materials &amp; techniques have been proposed in literature to overcome such issues. This case report portrays an innovative and practical yet simple modified impression technique utilizing the incorporation of a customized prefabricated metal mesh into the custom tray i.e. single step impression technique using polyvinyl siloxane as the impression material of choice for managing the knife-edge ridge situation in the mandibular arch and ultimately ensuring a well-fitting prosthesis.

Management of Post COVID 19 Mucormycosis with Osteomyelitis Management of Post COVID 19 Mucormycosis with Osteomyelitis in The Maxilla, New Combined Consequences of The Pandemic. in The Maxilla, New Combined Consequences of The Pandemic. (Case Report).

Aim: This case report aims to demonstrate among health providers the importance of timely surgical and prosthetic management procedures of patients who suffered from the newly combined clinical entity of post COVID 19 mucormycosis and osteomyelitis of the palate. Materials and methods: Elaborate advanced diagnosis of the patients including CBCT, MRI, CT, Pathology examination, 3Ds printing reconstruction of the whole skull and digital design of reconstructive mesh that support the prosthesis were carried out. The patients undergone modified infrastructure maxillectomy and immediate prosthetic obturation of the palatal defect that was replaced later by a delayed obturator. Results: Surgical eradication of the necrotic bone and subsequent immediate obturation of the defect minimized morbidly and helped in improving the quality of life of these patients. Conclusion: Early diagnosis of this potentially fatal disease and reach-out a treatment plan immediately, is of prime importance in reducing the morbidly and mortality rate and enhance speech and eating in the two patients reported. It also decreases the psychological impact of this radical surgery.

Prosthetic management of acquired dentate maxillectomy defects: A clinical case series

Abstract Acquired maxillectomy defects produce hypernasal speech, food, and liquid regurgitation into the nasal cavity, impaired deglutition and mastication, and cosmetic deformity. Furthermore, patients with acquired maxillary defects face psychosocial stigma, which has a negative impact on their quality of life. Prosthetic rehabilitation of such defects is required for stomatognathic system restoration and oroantral communication obturation. This case series discusses the fabrication of surgical, interim, and definitive obturator prostheses to restore the acquired dentate maxillectomy defects of three cancer patients. All patients had their treatment in the prosthodontics department of the RUHS College of Dental Sciences. The surgical obturator prosthesis was made before surgery, whereas the interim and definitive obturators were made one month and six months after surgery, respectively. The surgical obturator formed a shield between the surgical pack and the oral cavity. After the surgical obturator and packing were removed, an interim obturator was inserted for three to six months to allow the surgical site to heal. After the surgical site had healed, the fabrication of the definitive obturator began. Prosthetic rehabilitation with obturator prostheses sealed the acquired tissue defects of the palate and restored swallowing, speaking, chewing capacity, and cosmetic value, as well as significantly improved the quality of life of these patients.

A review of the first wave of lower limb amputees from the Great March of Return in Gaza: Taking stock and preparing for the task ahead

AimBallistic injuries during the Great March of Return (GMR) protests in Gaza have resulted in young, civilian amputees. This article defines this unique population, their injuries and clinical variables that impacted on amputation. MethodA multidisciplinary team (MDT) assessed 103 lower limb amputees (104 stumps). Individualized prescriptions of care were formulated and applied for both stump and prosthesis management.The cohort's health state was assessed at screening by applying the EQ-5D-L5 questionnaire. The EQ-5D-L5 will be repeated on completion of the prescription of care. ResultsThe population is predominantly young, male, suffering unilateral amputation with an equal ratio of above knee (AKA) to below knee (BKA) amputations. 18% were amputated immediately and 82% with delay. Most amputations occur within 15 days of gunshot wound (GSW).All tissue elements were affected by the severe, ballistic injury. Division, gapping and tissue loss consolidated the decision for amputation rather than limb salvage. Knee zone injury was common, influencing the high numbers AKAs.Primary injury ramified beyond the amputated leg: 38% have contralateral leg injuries. 20% had physiological challenges requiring Intensive care unit (ICU) admissions. Infection was reported in 49% of amputees with 12% reporting acute sepsis. Psychologically, 49% reported severe, or extreme, anxiety and depression.AKAs were associated with greater morbidity: amputees are significantly younger, have more proximal vascular injuries, receive delayed amputations and experience longer time intervals to stump healing. ICU care and contralateral leg injuries were more frequent.One third of amputees used their prostheses’, one third did not and one third do not have a prosthesis yet. The limiting factor for repair was supply of materials. 11% of amputees needed no adjustment to stump or prosthesis. Surgical stump revision was recommended in 26% of stumps and prosthetic management in 41%. A further 22%, subject to the success or failure of prescribed prosthetic adjustment, could require stump revision. ConclusionYouth, proximal injury, high numbers of AKA, psychosocial issues and the need for stump and prosthetic support define this group of amputees. Unifying expertise within a National MDT will promote continuity of care necessary for decades to come.The ultimate aim is an evidence-based amputee care system in Gaza, with lower limb specialists promoting best outcomes, judicious allocation of funds and maximising amputee quality of life.

Prosthetic management of an enucleated eye: A case report

A person becomes disabled on loss of any sense organ of which eye is one of the most sensitive organ. Loss of an eye can occur due to various reasons and can be rehabilitated using various materials and methods. Among the various materials used, resin has proved to be the most accurate material. Rehabilitation of the missing eye can be done using stock eye shell, custom made prosthesis or by customizing the stock eye. Our clinical report aims to show the fabrication of a semi-customized ocular prosthesis using stock iris and customized sclera. The patient was both psychologically and esthetically satisfied.