Prosthetic Therapy Research Articles

Clinical Applications of Intraspinal Microstimulation

Intraspinal microstimulation is a neuroprosthetic approach for activating specific spinal reflexes using penetrating electrodes chronically implanted into spinal cord. Artificial control of spinally mediated functions, such as arm and leg movement or bladder voiding, may be necessary in spinal cord injury, multiple sclerosis, cerebral palsy, amyotrophic lateral sclerosis, and spina bifida, when the brain becomes disconnected from spinal cord and a person loses control over these functions. Animal studies indicate the feasibility of efficient control of bladder voiding and limb movement. Development of novel microstimulation electrodes focuses on reduction of electrode dimensions for improved targeting efficiency, decreased tissue trauma, improved biocompatibility, and long-term safety and reliability of applied stimulation. Clinical usefulness of existing devices is limited by a lack of highly integrated and biocompatible neuroprosthetic systems, comprising high-density electrode arrays and integrated electronics for pulse generation and stimulation site addressing. Future developments will require a coordinated effort in the areas of neural prosthetic engineering, applied neurophysiology, neurosurgery, physical therapy, and rehabilitation. In the long term, clinical applications of intraspinal microstimulation may include treatments of such spinal cord-related disabilities, such as bladder and bowel emptying, sexual function, hand and arm control, and even walking. These treatments can address the long-standing needs of paralyzed patients aimed at improving their medical, psychological, social, and work-related conditions.

補綴歯科治療に簡易精神療法を導入した症例

A 50-year-old male with a history of schizophrenia is reported. He had severe periodontal disease and visited the clinic complaining of occlusal abnormality due to buccally inclined maxillary right first and second molars. Occlusion was steadied to the utmost using a removable splint, and approach based on brief psychotherapy was applied for his gaining an understanding of prosthetic therapy. The patient was successfully desensitized to occlusal abnormality by the splint. Furthermore, the patient was consistently treated with acceptance, support and reassurance for his complaints; for example, prosthetic appliances were selected with forethought, and thereby favorable results were obtained. Introduction of brief psychotherapy in prosthetic therapy provided understanding and satisfaction of the therapy to the patient.

Frequent point of care monitoring demonstrates the safety of low intensity warfarin therapy in Asian patients with mechanical heart valve

Genetic variants of the main cytochrome P-450 (CYP) and ethnicity may influence warfarin dosing. Chinese patients are reportedly more sensitive than Caucasians to the anticoagulant effect of warfarin. The use of the Point of Care Testing (POCT) and frequent monitoring of the international normalization ratio (INR) had facilitated measurements of essential coagulation parameters of warfarin therapy. To our knowledge, POCT has not been evaluated in clinical trials that underlay ethnic differences between different geographic regions. We have conducted a multi-center prospective trial to evaluate the safety of low warfarin dose, and the role of frequent INR measurements by POCT in Chinese patients. A total of 488 patients from 11 geographically diverse hospitals in China underwent implantation with CarboMedics aortic or mitral valve prosthesis (Sulzer Medica, Austin, TX). Patients received two consecutive doses of 2.5 mg warfarin at 24 and 72 h post-surgery, followed by a daily dose to maintain INR range of 1.5–2.5. The follow-up was performed weekly or biweekly and the INR was measured on fingerstick fresh whole blood, using the HEMOCHRON Signature Microcoagulation system (ITC, NJ). The majority (99.3%) of Chinese patients who required prosthetic heart valve and warfarin therapy were \70 years old with a mean age of 45.28 ± 12. The mean follow-up duration was 86.8 ± 11.2 weeks (range 72–104 weeks). A total of 4,886 INR values were obtained with a mean INR in all 11 sites at 1.76 ± 0.50. The majority of INR values (67.8%, n = 3,312), was in therapeutic range (1.5–2.5), a moderate number was below range (26.2%, n = 1,281), whereas only 6.0% (n = 293) of INR value was above range. Mean daily maintenance dose was 2.5 ± 0.60 mg in all sites; a significant reduction from age-matched ACCP guideline for rest of the world (ROW) patients. Minor bleeding occurred in 42 cases, no patient required hospitalization. Major adverse events (4 cases) were lower than reported ROW data. The maintenance of antithrombotic efficacy with low warfarin requirement and narrow INR range in Chinese patients was independent of demographic factors and geographic locations. Frequent INR-POCT confirmed the safety of low dose warfarin requirements in Chinese patients. Monitoring by POCT may provide a mean to standardize warfarin monitoring across diverse geographic regions and therefore allow the analysis of ethnic variation in various subpopulations.

Immediate post‐traumatic upper incisor reconstruction using composite resin materials

Single visit reconstruction of the fractured crown can be completed with composite resins if there is no bleeding due to the soft tissue injury. Clinical inspection revealed a complex crown fracture of the central incisor as well as a simple horizontal fracture of the lateral incisor crown of the enamel-dentin type. Vertical fracture separated the palatal enamel wall from the rest of the lateral incisor crown. After the completion of the endodontic sanitation, root canals were prepared for prefabricated composite posts and crown reconstructions were performed with the Finger Tip Technique by using composite resin materials. The advantage of this kind of reconstruction is preservation of the hard dental crown tissue removed in case of prosthetic therapy, especially in younger patients. Reconstruction can be finished in one visit, without the need for a dental technician and laboratory.

Effects of mandibular odontogenic keratocyst surgery and removable partial prostheses on masticatory performance

Surgical treatment of odontogenic keratocysts often results in tooth loss. However, information about the effects of different surgical methods and postoperative prosthetic therapy on masticatory performance is lacking. The purpose of this study was to compare tooth loss following odontogenic keratocyst treatment by enucleation, segmental mandibulectomy with reconstruction, or marsupialization, and the resultant effect on masticatory performance with and without removable partial dentures (RPDs). Patients with odontogenic keratocysts of the mandible were treated with either enucleation (n=33), segmental mandibulectomy and immediate autogenous bone reconstruction (n=18), or marsupialization in combination with secondary enucleation (n=9). Clinical and radiographic examinations were used to assess the number of teeth with cyst involvement preoperatively and the number of teeth lost following cyst treatment. Masticatory performance with peanuts was measured after cyst treatment both with and without an RPD. The differences in the number of the teeth involved preoperatively and lost postoperatively were compared among the 3 groups with a chi square test for trend. The absorbance value (reflecting masticatory performance) difference among the 3 groups preprosthesis and postprosthesis was analyzed using a 1-way analysis of variance (ANOVA), respectively. The pre- and postprosthetic comparison was made within each group, and a paired t test was used. Age was compared using 1-way ANOVA among 3 groups. Gender was compared using the chi square test (alpha=.05). Although the average number of teeth involved preoperatively with the cyst was similar among the 3 treatment groups, the number of teeth lost following marsupialization was significantly less than the number lost following enucleation or segmental mandibulectomy. Prior to provision of an RPD, mean masticatory performance (mean absorbance value of 0.36+/-0.08) in subjects receiving segmental mandibulectomy was significantly lower than for subjects receiving enucleation (0.52+/-0.15) or marsupialization (0.89+/-0.12) (P<.01). Provision of an RPD significantly increased masticatory performance in subjects who were treated by enucleation or segmental mandibulectomy (P<.01). Masticatory performance following odontogenic keratocyst surgery is related to the number of lost teeth, which is a function of the operative method used. Restoration with an RPD postoperatively may improve masticatory function when multiple teeth are lost following enucleation or segmental mandibulectomy.

Terapia de reentrenamiento (TRT) en el acúfeno de la enfermedad de Ménière

To evaluate the response of tinnitus in Meniere's disease patients (MD) using the Tinnitus Retraining Therapy (TRT). This management includes a wide cognitive medical counselling and natural or prosthetic sound therapies (hearing aid or noise generator). Descriptive prospective study (EBM level 3). Twenty-five patients diagnosed as definitive MD (AAO-HNS 95 criteria) were enrolled in our tinnitus protocol. Tinnitus changes were reported according to patient's self-evaluation, a visual analogue scale on tinnitus intensity (EVA) and the Tinnitus Handicap Inventory (THI). Seventy-three percent of the patients improved their tinnitus after 6 months of treatment (p < 0.05). THI scores were reduced from the initial 47% to 24% (p < 0.05) and EVA from 6.6 to 5.2 (p < 0.05). After 12 months, the response was slightly worse: 68% improved according to their self-evaluation (p < 0.05), THI score reached 20% (p < 0.05) but EVA did not improve significantly (6.4). Patients that refused prosthesis adaptation (hearing aid or noise generator) did not improved and the THI score (48%) and EVA score (6.6) did not change. TRT has proved to be an effective method for tinnitus treatment in MD that improves patient's self-evaluation, tinnitus loudness and handicap scores. Individualized medical counselling and an exhaustive prosthesis adaptation are crucial to guarantee satisfactory results.

Post-operative re-construction of dentoalveolar tissue and the mandible and maxillae using prosthetic therapy

To determine the range of ablative surgery and rehabilitative procedures performed on maxillofacial structures. A retrospective descriptive study. University of Nairobi Dental Teaching Hospital. Patients operated on at the institutions theatre, and followed up at the University of Nairobi Dental Teaching Hospital Oral Surgery Outpatient Clinic during the period February 1996, August 1998. Forty four patients underwent ablative surgery during the study period. Complete records were available for 38 patients, 27 females and 11 males aged 10 to 79 years (mean 32.6 years). Surgical procedures performed included: partial mandibulectomy, marginal mandibular resection, subtotal maxillectomy, sequestrectomy and enucleation. Six (15.8%) patients who underwent mandibular resection had rigid bone plating. Five (13.2%) patients who had maxillary involvement were given surgical obturators post-operatively with one receiving a complete denture after full recovery. A total of 22 (57.9%) patients who would have reaped benefits from prostheses therapy received none. Individual patient follow-up periods ranged from seven days for two patients who had cyst enucleation to two years for three cases with ameloblastoma, and two cases with squamous cell carcinoma. It is concluded that prosthetic rehabilitation of patients undergoing extensive surgery at the University of Nairobi Dental Teaching Hospital is largely inadequate.

Prosthodontic Treatment Planning: Current Practice, Principles, and Techniques

In this series of articles, the faculty of the University of Southern California New Odontic Seminar have taken the 25 years of documented treatment of sample patient "A.K." and used it as a foundation on which to base discussion of the concepts and technology that have developed in prosthodontic treatment planning. Each of the contributing authors was asked, "What are your thoughts retrospectively if you were to treat the patient A.K. in your practice today?" And, since all dentists are challenged with evidence-based treatment planning, each author was also asked "On what evidence in the literature do you base your treatment planning for patients who need prosthetic therapy?" Dentistry's experience with long-term success of endodontics, periodontics, and implant dentistry is expressed in the presentations discussing when an implant may be better suited for a prosthetic abutment than a restored tooth.

Representative survey of dental students about the present state of education, PC equipment and configuration requirements for a net-based dental education system

A representative survey of 130 dental students revealed that the necessary conditions for using net-based education systems seem to exist, as 99% of all students have access to a PC, of which most (78%) own one. As most of them use the PC at least several times a week, they seem to be adequately skilled to deal with hard- and software. Internet and emailing are the most commonly used features of the PC after text documentation, therefore it can be inferred that almost all computers have Internet access. The students' requirements for the planned net-based dental education system are case documentation, multimedia documented workflows, checklists related to workflows, a training tool for prosthetic therapy planning, practical advice and films about dental treatment methods, timetables and discussion fora. The net-based dental education system can support private study but may also be used for seminars in small groups.

Prosthetic therapy in the management of nasopharyngeal stenosis following uvulopalatopharyngoplasty for obstructive sleep apnea

Uvulopalatopharyngoplasty (UPPP) was first proposed by Fujita et al. [1] as a treatment for obstructive sleep apnea due to redundant oropharyngeal tissue. The surgical procedure consists of removal of redundant tissue from the lateral pharyngeal walls upward to the lateral aspects of uvula along with the removal of tonsils. Most of the patients find some relief of symptoms and demonstrate improvement in nocturnal respiration and sleep pattern. Nasopharyngeal stenosis is an infrequent complication of UPPP. Nasopharyngeal stenosis has been defined as partial or complete nasopharyngeal obstruction due to scar tissue [2]. It is further defined as an obliteration of the normal communication between the nasopharynx and the oropharynx resulting from the fusion of tonsillar pillars and soft palate to the posterior pharyngeal wall [3]. Nasopharyngeal stenosis can compromise the nasal breathing, cause hyponasality, rhinorrhea, dysphagia and at times can cause obstructive sleep apnea [4]. We present a case of a 66-year-old male who developed nasopharyngeal stenosis after UPPP. Despite repetitive trials with surgical correction, the patient had persistent nasopharyngeal stenosis. We treated the patient with maxillofacial prosthesis for symptomatic relief.

Nutrition and oral health

Reduced chewing function in community-dwelling older people with adequate general health is linked to having fewer than 20 teeth present or to wearing removable dentures. By chewing for longer periods of time or swallowing larger food particles they are normally able to compensate for the impaired function. The masticatory function can be restored by adequate prosthetic therapy, which results in increased activity of the masticatory muscles during chewing and reduces the chewing time and the number of chewing strokes until swallowing. In frail or dependent elderly people undernutrition is prevalent because of health problems, reduced appetite and poor quality of life. Poor oral health and xerostomia are often associated with a reduced body mass index and serum albumin level and the avoidance of difficult-to-chew foods. Maintenance or re-establishment of masticatory function is an integral part of the medical health care of these patients, with the aim of improving their nutritional status and quality of life.

Prosthetic dentistry in the treatment of movement disorders: dyskinesias and other neurological abnormalities

As long as the scope of dentistry is limited to teeth and supporting structures, their care and repair, probably no body of medical knowledge can be considered more traditional. However, a number of muscular and neurologic phenomena have been related to the dentition: unconventional dental prosthetic therapy has been shown to be effective in the treatment of temporomandibular joint disorders and movement disorders such as spontaneous orofacial dyskinesia and tardive dyskinesia. Although only anecdotal, the above results and an unanticipated event that occurred in one case of dystonia muscolorum deformans question everything that had been previously assumed about the limits of dentistry.

Successful aging--the case for prosthetic therapy.

Reduced chewing ability in community-dwelling older people is linked to the presence of removable dentures and having fewer than 20 natural teeth present. Compensation is provided by chewing longer and swallowing larger food particles. Replacement of posterior tooth loss by fixed or removable prostheses increases the activity of the masticatory muscles, and reduces chewing time and the number of chewing strokes until swallowing. In residents of nursing homes and long-term care facilities undernutrition is prevalent because of general medical problems, reduced appetite, and poor quality of life. Poor oral health and xerostomia are often present and may have a negative effect on masticatory function and nutrition, precipitating avoidance of difficult-to-chew foods. There is no evidence that the provision of prosthetic therapies can markedly improve dietary intakes; however, it might improve oral comfort and quality of life and avoid enteral alimentation.

Need for occlusal therapy and prosthodontic treatment in the management of temporomandibular disorders. Part II: Tooth loss and prosthodontic treatment.

The second part of this review, evaluating the literature on the relationship between dental occlusion and temporomandibular disorders (TMDs), focuses on the aetiological importance of tooth loss and the place of prosthodontic replacement in the treatment of TMD. Loss of teeth and lack of posterior occlusal support seem to have little influence on the development of TMD, which calls into question the use of prosthodontic restoration as prevention or treatment for TMD. In addition, there are practically no studies assessing the benefit of instrumental analysis in diagnosis or comparing the outcome of prosthodontic treatment with simple reversible methods in the management of TMD. There is a trend in the current literature to abandon any treatment, including positioning appliances and prosthodontic measures, to 'recapture the disk' in patients with disk displacements because of the favourable, long-term results achieved after using more simple methods. It is concluded that prosthetic therapy in TMD patients is not appropriate for initial TMD treatment and should only be carried out on prosthodontic indications after reversible treatment has alleviated pain and dysfunction.

KONUS KURON TUTUCULU HİBRİD PROTEZ UYGULAMASI-HYBRID PROSTHESIS APPLICATION WITH CONICAL CROWN

Ozet Sunulan makalede; dikey boyut kaybi, ortulu kapanis, oligodonti, kucuk boyutlu disler, tam olarak sekillenmemis dissiz alveol kretleri ile karekterize olan ekto-dermal displazil hastaya uygulanan protetik tedavi ve iki yillik takibi aktarilmistir. Tedavi uygulamasinda oncelikle gecici bir protez araciligi ile dikey boyut saglanmistir. Vak'ada nihai protez, konus kuronlu hibrid protez olarak planlanmis ve protetik restorasyonun yapimi esnasinda uygulanan yontemler ayrintili olarak anlatilmistir. Iki yillik takip sonucu, konus kuronlu kombine protezin; uygulanan vak'ada basarili oldugu, hastaya eksik olan fonasyon fonksiyon ve estetigi sagladigi, kalan dis ve cevre dokularin devamliligini korudugu gorulmustur. Anahtar sozcukler: hibrid protez, konus kuron, ekto-dermal displazi. Abstract A patient with ectodermal dysplasia who were characterized with vertical dimension loss, over bite, oligodontia small teeth in volume and unformed alveol crests without teeth were reported in this article. The patient have undergone prosthetic therapy and the follow up period was for two years. The first step of the treatment was to regain the lost vertical dimension using a temporary prosthesis. The final prosthesis for this case has been planned as a hybrid prosthesis with conical crowns and all the methods of prosthesis fabrication were explained in detail in this case report. At the end of Uie two years follow up period we have concluded that the hybrid prosthesis with conical crowns had been successfulfor the above mentioned case and the missing phonetic, function and esthetic were regained and the protection of the left teeth and (he surrounding tissues were provided. Key words: hybrid prosthesis, conical crown, ectodermal dysplasia.

A retrospective evaluation of traumatized permanent teeth

The purpose of this retrospective study (15 years follow-up) was to evaluate the long-term results of treatment to injured teeth following acute trauma. A total of 198 patients with 488 injured teeth were available for analysis. Uncomplicated crown fractures were restored with composite restorations in 106 teeth. 19% of the restorations had been replaced more than 10 times and at the final examination approximately 25% were rated as unacceptable, i.e. needing clinical treatment. Fixed prosthetic therapy had been provided for 106 teeth and endodontic treatment had been provided in 114. Colour changes appearing at late stage suggested obliteration, necrosis or endodontically treated teeth. Anterior composite restorations have been considered acceptable as semi-permanent restorations in patients of early school age (7-15 years), and may have been an advance on what was possible previously, but results of this clinical study suggest that they still do have major shortcomings. There remains a need for a simple, conservative method of restoring aesthetics to fractured and discoloured anterior teeth for clinical use in young patients of late school age.

Prosthetic therapy for sleep apnea syndrome

Twenty patients with sleep apnea syndrome were examined polysomnographically with and without an Esmarch sleep apnea appliance. The relationship between the therapeutic effect of the device and dentofacial morphologic characteristics of the patients were analyzed with the use of diagnostic casts and cephalometric radiographs. The apnea index or number of apneic episodes per hour decreased significantly ( p < 0.0001) after insertion of the appliance. The diagnostic casts and cephalometric analyses revealed that the device was most effective for patients who exhibit a tendency toward micrognathia ( p < 0.03) and a short soft palate ( p < 0.01). The Esmarch appliance is indicated for the treatment or diagnosis of sleep apnea syndrome.

Condylar resorption after orthognathic surgery: Evaluation of treatment in 8 patients

Several articles have been published on the subject of condylar resorption as a complication of orthognathic surgery. However, since there is little reference to treatment, the frequency of this phenomenon and the results of therapy are evaluated in a retrospective study. 8 patients out of a group of 329 who underwent sagittal split osteotomy in a 10-year period (251 bilateral, 73 Le Fort I + bilateral and 5 unilateral), were treated actively following the development of condylar resorption. 4 patients were operated upon a second time while others underwent occlusal rehabilitation. The results for the patients who underwent revisional surgery were unsatisfactory, with poor aesthetics and occlusal stability. The patients treated with an occlusal splint (+/- orthodontics and/or prosthetic therapy) had a functional occlusion and tolerable temporo-mandibular-joint complaints.

有床義歯補綴臨床におけるオルソパントモグラムによる診断法

n removable prosthetic dentistry, the interrelations among anatomical landmarks, which can give significant information for diagnosis, can be observed on an orthopantomogram.This study was to investigate how to use an orthopantomogram in prosthetic therapy.Veraview (J.Morita Corp., Tokyo) was used as panoramic equipment.The removable hand-made ear-rods that attach to the plates supporting the temples, were used to ensure correct posture of the head, with the forehead rest.First, the effects of posture of the head in the equipment on the image were examined experimen-tally by using dry skulls, one with dentulous ridges and the other with edentulous ridges.Theposture depends on the positions and angle of the antero-posterior direction.Secondly, 63 orthopantomograms of students in our dental school were traced.The interrelations among certain anatomical landmarks on those traces were analyzed linearly and angularly.Finally, the measurements from the orthopantomograms of the students were used to make a diagnosis of the occlusal plane and vertical dimension for old and new dentures of an edentulous patient.This study indicates that the analyzing method, on the traces of orthopantomograms, was useful for the diagnosis of the occlusal plane and vertical dimension in edentulous patients.

Contribution of prosthetic therapy in the management of nasopharyngeal stenosis following uvulopalatopharyngoplasty

Contribution of prosthetic therapy in the management of nasopharyngeal stenosis following uvulopalatopharyngoplasty