Successful Prosthetic Rehabilitation Research Articles

Promising Prosthetic Rehabilitation Following Orbital Exenteration: A Case Report

This case report outlines the successful prosthetic rehabilitation after orbital exenteration. Postsurgical exenteration by an ophthalmologist and maxillofacial prosthetist led to a user-friendly customized ocular-orbital silicone prosthesis with spectacles providing an appropriate fit, restoring facial symmetry and aesthetics, and improving the patient's quality of life. This interdisciplinary approach highlights the significance of tailored prosthetic solutions in optimizing outcomes for such patients under the guidance of an ophthalmologist and maxillofacial prosthodontist.

Аналіз поширеності часткових дефектів зубних рядів та потреби в кістковій пластиці з метою встановлення ендоосальних імплантатів при дистально-необмежених дефектах зубних рядів

Relevance of research. In planning the treatment of partial edentulousness, the Kennedy classification of dentition defects plays an important role in the choice of the type and design of the prosthesis. The structure and morphology of dentition defects, in particular distally unlimited ones, is of great importance in the context of planning effective prosthetic rehabilitation of patients, including pre-prosthetic surgical preparation. The purpose of the study: to investigate the prevalence and structure of dentition defects and the need for bone grafting for the placement of endosseous implants in distally unlimited dentition defects for successful prosthetic rehabilitation. Materials and methods. Radiological, statistical and digital modelling methods were used for the study. Results and discussion. Partial absence of teeth is one of the most common types of pathology of the dental system. According to the results of the analysis of 198 computed tomography scans of the jaws, 76.76% of patients aged 25-60 years had partial defects in the dentition. Distally unlimited defects were found in 46.35% of jaws with partial edentulousness in the age group of 25-60 years. It should be noted that 15.7% of patients had combined distally unlimited defects of the dentition on both jaws. Based on the study data, a large percentage (42.37%) of jaws with Kennedy class I dentition defects that required bone grafting was noted, and a slightly lower percentage (26.53%) of those requiring bone grafting in Kennedy class II. Conclusions. The results of the study indicate the need for careful planning of the surgical and orthopedic stages of implantsupported prosthetics, risk assessment and, to some extent, delay of the final stage of prosthetic rehabilitation of patients with distally unlimited dentition defects. Key words: distally unlimited defects of the dentition, Kennedy classification, bone grafting, endosseous implants.

Extensive Partial Obturador Oropharyngeal in Class IV Aramany after Oral Adenocarcinoma

When a patient is interrupted by velopharyngeal closure or defects in the hard palate, air escapes inappropriately through the nose in nasal speech sounds. The obturator prosthesis with extension to the oropharynx is currently the best indication for maxillary defects, but it also represents a challenge for manufacturing and oral adaptation. The aim of this study was to report a clinical case of successful prosthetic rehabilitation of a 65-year-old woman who presented with a defect in the maxilla, soft palate, tonsil, and oropharynx after treatment for polymorphous low-grade adenocarcinoma. With her considerable loss of structure and tissue, she reported difficulties with impaired functions such as chewing, swallowing, and speaking and difficulty interacting with people. The oral rehabilitation was performed with an oropharyngeal obturator prosthesis with an extension to the oropharynx and a total mandibular denture. This case demonstrates that the rehabilitation with an oropharyngeal obturator prosthesis with an extension to the oropharynx and a total mandibular denture provides speech, chewing, and phonetics, directly interfering with her social life in the mutilated patient.

Marginal Mandibulectomy and Oral Rehabilitation of Xeroderma Pigmentosum Patient.

Xeroderma pigmentosum (XP) may cause tissue deformation in patients who have undergone oral cancer surgery requiring resection of any part of the mandible. Oral rehabilitation is a pivotal factor in the restoration of function and esthetics. The aim of this study was to report a clinical case of successful prosthetic rehabilitation of a 57-year-old woman who presented with marginal mandibulectomy and a significant reduction in maximal mouth opening after treatment for XP. With her reduced opening and considerable loss of structure and tissue, she had difficulty speaking, swallowing, and altered esthetics. The oral rehabilitation was performed with complete maxilla denture and mandible overdenture retained by 2 implants. This case demonstrates that the rehabilitation with mandible overdentures and complete maxilla dentures provide function and esthetic improvement in the mutilated area for XP patients with marginal mandibulectomies.

Challenges in irradiated bone implantation

Introduction. Implantation in irradiated bone is very challenging due to many factors: implant therapy parameters, irradiated tissue, and the patient?s general health. Implantologists have to consider all of these aspects when planning implant therapy and during the postsurgical recovery period. Case outline. A case presented in this paper is a 54-year-old male, who was admitted to the Clinic for Maxillofacial Surgery, School of Dental Medicine in Belgrade, Serbia, for implant-anchored orbital prosthesis. One year previously, the patient had orbital exenteration and postoperatively received radiotherapy with an overall dose of 60 Gy. After planning, three disk implants ? two double and one triple disk were placed (Ihde Dental, Switzerland). Implant stability was clinically satisfactory, with the immediate implant stability quotient score of 37, 46, and 51, respectively. After osseointegration implant retained prosthesis was manufactured. After six years due to osteoradionecrosis (ORN), implant stability was compromised. The patient received conservative and hyperbaric oxygen therapy. The implants regained stability, and the patient was in remission for four years. Afterwards, due to ORN, two implants were explanted, and the third implant was stable enough to anchor the prosthesis. The prosthetic plan had to be modified for one implant anchorage; afterwards, successful prosthetic rehabilitation was achieved. Conclusion. Implantation in irradiated bone is very delicate, and careful planning of implant insertion and prosthetic rehabilitation is essential. A possible occurrence of osteoradionecrosis should also be taken into account, as a result of which the implant may be lost, which compromises the retention of the prosthesis.

Splitting for good: A case report

: The bone split procedure is a unique technique used to increase the width of narrow ridge for possible simultaneous implant placement. : We would present a case of horizontal ridge augmentation in this article, using an alveolar ridge expansion approach and simultaneous implant placement. : In this report, we have described a ridge split technique and immediate implant placement for a 40-year-old male patient with missing teeth in maxillary anterior tooth region who reported to us for implant treatment: A successful prosthetic rehabilitation was obtained following the healing phase. This approach leads to restoration of aesthetics, function and speech with a predictable outcome.

Thoracic spine deformation may predict prosthetic rehabilitation outcome.

A considerable number of patients require prosthetic ambulation, which necessitates improvements in the success rate of prosthetics. This study aimed to determine the association between the presence of thoracic spinal osteophyte on imaging and the patient's ability to walk with lower leg prosthetics. Retrospective cohort study. This study included 15 patients with lower leg amputations who underwent prosthetic rehabilitation. Medical records and spine radiographs of patients with lower leg amputations between 2013 and 2019 at a private rehabilitation hospital were reviewed. The primary outcome was achieving prosthetic ambulation with a single T-cane or without a walking aid. Poor outcomes were associated with the presence of thoracic spinal deformation (P = 0.007) and the lower Berg Balance Scale score at admission (P = .067) and discharge (P = .033) groups. Monte Carlo simulation results showed a ≥33% difference in walking achieving rate between patients with and without thoracic spinal deformity. In addition, an 18% probability was found for randomly selected persons with an amputation to show a difference of ≥1 point in Berg Balance Scale scores. Thoracic spinal deformity on radiography and Berg Balance Scale score at admission are potentially associated with successful prosthetic rehabilitation. These findings potentially affect the indications for prosthetic limbs.

Issues Faced by Prosthetists and Physiotherapists During Lower-Limb Prosthetic Rehabilitation: A Thematic Analysis.

Successful prosthetic rehabilitation is essential to improve the physical and mental outcomes of people with lower-limb amputation. Evaluation of prosthetic services from a prosthesis user perspective have been published and commissioned by the national bodies, however, the perspectives of clinicians working with service users during rehabilitation have not to date been sought. We sought to determine factors impacting lower-limb prosthetic rehabilitation from a clinician's perspective to inform studies focusing on prosthetic and socket design and fitting. Six clinician (2 prosthetists, 4 physiotherapists) interviewees were self-selected from a survey exploring issues and frustrations during lower-limb prosthetic rehabilitation. Semi-structured interviews explored the impactors on and frustrations with rehabilitation and the prosthetic socket. A thematic analysis was subsequently conducted to identify themes in the responses. Five themes were identified: Service Disparity, Body Impactors, Consequences of Ill-Fit, Prosthesis Irritants, and Limitations of Practice. Each theme, though distinct, relates to the others either as a cause or consequence and should be viewed as such. Addressing the themes will have benefits beyond the issues addressed but also expand into the other themes. This study provides an insight into the clinician perspectives on lower-limb prosthetic rehabilitation, which has not been formally documented to date.

TOOTH SUPPORTED OVERDENTURES: COMPARISON OF DIRECT TECHNIQUE (RIGID) VERSES INDIRECT TECHNIQUE (RESILIENT) OF STUD ATTACHMENT

Several partially edentulous patients are advised extraction of sound teeth as these teeth are inadequate to provide support for a good prosthesis. An overdenture in such cases provides opportunity to preserve the sound teeth and still provide a successful prosthetic rehabilitation. Resilient precision attachments further provide additional advantage of improved retention and stability and their resiliency helps preserving the abutment teeth over a longer period of time. Various techniques are followed to fabricate and incorporate these attachments. This case report describes two partially edentulous patients rehabilitated with tooth supported overdenture by direct and indirect technique respectively.

Primary tooth autotransplantation: update and retrospective clinical study

Objective A new technique of primary tooth autotransplantation has recently been published demonstrating reliable replacement of missing permanent incisors in young children due to trauma or agenesis. This retrospective clinical study reports on the longterm success of this new technique in a larger patient group regarding its potential to support bone and soft tissue growth. Study design 40 children (age range: 2.7–17.6 years) received 53 primary tooth autotransplants (49 canines and 4 incisors) due to traumatic tooth loss (73%), agenesis (19%) or dysplasia/displacement (8%). Clinical and radiological follow-up examinations were performed to check up on root resorption, bone and soft tissue growth, survival and success. Results 22 transplants still present in the oral cavity of 18 patients yielded a success rate of 77%. The Kaplan-Meier estimator measured a median survival time of 86 months (7.2 years) for all 53 grafts. In all cases, increasing soft tissue and bone development enabled a successful prosthetic rehabilitation regarding aesthetics and function. Conclusions Primary tooth autotransplantation reliably restores edentulous anterior space in children experiencing traumatic tooth loss or agenesis and acts as an immediate therapy before other therapies such as premolar transplantation or orthodontic space closure can be carried out at a later time. It guarantees the co-development of soft tissue and bone in the teenage jaw which is associated with high patient satisfaction and acceptance of this method.

Prosthetic rehabilitation with framework obturator for hemimaxillectomy patient – A case report

Postoperative hemimaxillectomy defects cause the patient to develop conditions such as nasal discharge (hypernasal speech), leakage of fluid in the nasal cavity, and deterioration of masticatory function. Thus, comprehensive rehabilitation is required to improve mastication, speech function and normal orofacial appearance. Successful prosthetic rehabilitation of postoperative hemimaxillectomy defect is a challenging procedure that requires multidisciplina- ry expertise to achieve acceptable esthetics, functional speech and swallowing outcomes. This case report describes clinical steps and laboratory procedures involved in prosthetic rehabilitation of an Aramany Class IV hemimaxillectomy patient with framework obturator.

An Innovative Cost-Effective Approach for Characterization of Removable Prosthesis - Case Series

Esthetics plays a crucial role in rehabilitation of removable dentures to achieve a pleasant smile. Denture esthetics is the effect produced, which improves the beauty and attractiveness of a person. With the advances of implants and ceramics, the conventional removable denture needs to be updated. denture characterization is a must in avoiding denture look and giving natural look. Giving the prosthesis as close as possible to the natural apparatus before the tooth loss is the key to a successful prosthetic, esthetic and functional rehabilitation. As a prosthodontist dealing in fulfilling the aesthetic challenges an economical alternative to high-end costly procedures is a must considering the Indian scenario, keeping in mind the biocompatibility and longevity of the treatment. As per literature light cure, gum staining is one of the techniques for masking denture base color and imparting natural color to mucosa but considering the cost involved many patients requiring aesthetic enhancement of prosthesis avoid going for such treatment thereby compromising their aesthetic. the present case series describe an innovative cost-effective alternative to the previously describe technique for masking the denture base color by using composite mixed with stains to replicate the natural apparatus.

Combined rehabilitation of a lower lip defect after resection of floor of mouth cancer: A clinical report

This clinical report describes the successful prosthetic rehabilitation of a deficient lower lip in an edentulous patient who had undergone surgery for removal of a squamous cell carcinoma of the anterior floor of the mouth and vestibule. The rehabilitation used a combined approach of an extraoral lip prosthesis joined by 3 magnets to an intraoral implant-retained mandibular resection prosthesis. The outcome demonstrated rehabilitation of the lower third of the face by eliminating loss of fluids and by improving the facial profile, lip contour and competence, esthetics, the patient’s eating ability, speech intelligibility, and reported quality of life.

Rehabilitation with "Calibrated Alveolectomy” for Extruded Alveolus on Maxillary Quadrant

Loss of teeth leads to functional and esthetic problems within the oral cavity. The opposing teeth move into the edentulous space, if not treated in timely manner. Many a times loss of intermaxillary space due to long term edentulism results in compromised prosthetic outcome. Decreased interocclusal spaces can be a challenging task for prosthetic management of partial edentulism. In this kind of cases regaining the lost interocclusal space is the prime requirement for successful prosthetic rehabilitation. Several procedures are used to increase vertical dimension. In this case report, the author presents a special surgical technique, "calibrated alveolectomy”, and discussed about regaining adequate inter arch space for implant supported prosthesis.

PREDICTIVE FACTORS FOR SUCCESSFUL PROSTHETIC REHABILITATION AFTER VASCULAR TRANSTIBIAL AMPUTATION.

SUMMARYLower extremity amputation is a very common amputation and successful prosthetic rehabilitation is a desirable outcome. The aim of this study was to determine which factors affect the success of prosthetic rehabilitation after transtibial vascular amputation. The study included 61 patients who had undergone transtibial amputation (mean age, 64.2±10.4 years; 50 (82%) males). Patients who were able to walk at least 45 meters without aids or with only one walking stick after rehabilitation program were classified into the group of successful prosthetic users. Age, gender, comorbidities, patency of the popliteal artery, wound healing complications, and presence of the phantom limb pain were used as predictive variables. Multivariate logistic regression analysis was used to identify predictive factors of successful prosthetic rehabilitation. The model included all variables explaining up to 59.8% of variance, however, only age, absence of functional patency of the popliteal artery and compromised wound healing made significant contribution to the model. In conclusion, good general condition of the patient and sustained patency of the popliteal artery reliably led to clinical improvement and realization of full capacity of rehabilitation after below-knee amputation.

Prosthetic Rehabilitation of Partially Resected Edentulous Mandible Using Twin-Occlusion- A Case Report

Mandibular defects arising as a result of trauma, infections or ablative tumor surgery usually cause significant facial deformity, functional disabilities, and psychological problems. Successful prosthetic rehabilitation of a patient with partially resected edentulous mandible can be an especially challenging task for a prosthodontist. Apart from the deviation of the remaining mandibular segment, other dysfunctions are observed in mastication, speech, swallowing, respiration, salivary control and mandibular movements which can severely compromise the prosthetic prognosis. Hence, it becomes imperative to judiciously apply the basic principles of denture construction in such cases to obtain optimum retention, stability, support, esthetics & function. The present case report describes the successful prosthetic rehabilitation of an edentulous mandibulectomy patient using two rows of non-anatomic teeth on the unresected side of the maxillary prosthesis. The inner (palatal) row helped in restoring the function while the outer (buccal) row improved the cheek support and esthetics. Non-anatomic teeth were used to minimize the lateral displacing forces and enhance the stability of the dentures. The incorporation of twin-occlusion in this case helped in achieving a satisfactory aesthetic and functional outcome of treatment.

Effectiveness of Brushing Associated With Oral Irrigation in Maintenance of Peri-Implant Tissues and Overdentures: Clinical Parameters and Patient Satisfaction.

Hygiene of implant-supported prostheses and the health of peri-implant tissues are considered to be predictive factors of successful prosthetic rehabilitation. Therefore, the purpose of this study was to evaluate the effectiveness of brushing associated with oral irrigation measured as biofilm-removing capacity, maintenance of healthy oral tissues, and patient satisfaction. A randomized, crossover clinical trial was conducted with 38 patients who wore conventional maxillary complete dentures and mandibular overdentures retained by the O-ring system. The patients were instructed to use the following hygiene methods for 14 days: mechanical brushing (MB; brush and dentifrice, control) and MB with oral irrigation (Waterpik [WP], experimental). Biofilm-removing capacity and maintenance of healthy oral tissues were evaluated by the modified plaque index (PI), gingival index (GI), probing depth (PD), and bleeding on probing index (BP) recorded at baseline and after each method. In parallel, patients answered a specific questionnaire using a visual analog scale after each hygiene method. Data were analyzed by Friedman and Wilcoxon tests (α = .05). The results showed significantly lower PI, GI, PD, and BP after application of the hygiene methods (P < .001) than those observed at baseline. However, no significant difference was found between MB and WP. The responses to the satisfaction questionnaire for both methods showed high mean values for all questions, with no statistically significant difference found between the answers given after the use of MB and WP (P > .05). The findings suggest that WP was effective in reducing PI, GI, PD, and BP indices and provided a high level of patient satisfaction.

A pattern of care analysis: Prosthetic rehabilitation of head and neck cancer patients after radiotherapy.

While some medical associations provide guidelines for the implant-prosthetic rehabilitation of head and neck cancer patients, the circulation and implementation in the everyday routine of practicing dentists remain unknown. To analyze patterns of care for the prosthetic rehabilitation of head and neck cancer patients after radiotherapy in German speaking countries. An online survey consisting of 34 questions separated into three sections, (a) general inquiries, (b) treatment concepts, and (c) patient cases, was forwarded to university hospital departments for Prosthetic Dentistry and Oral and Maxillofacial Surgery, and members of different medical associations. Statistical differences between groups were analyzed using chi-squared test (P < .05). From May to October 2019, 118 participants completed the survey. The majority practiced in university hospitals, had more than 5 years of work experience, and reported to be involved in <10 post radiation prosthetic rehabilitation cases per year. Rehabilitation protocols involving dental implants were implemented by oral/oral- and maxillofacial surgeons and prosthetic dentists, while general dentists favored implant-free solutions. Xerostomia was recognized as a common problem for a successful prosthetic rehabilitation. The subsequent treatment choice with either fixed dental prostheses or removable dentures was divided among participants. As treatment planning differed with regard to the participants' field of expertise and work environment, and most practitioners only handle a low number of cases, patients might benefit from centralization in larger institutes with a multidisciplinary structure. A high agreement between the practitioners' treatment concepts and the current state of research was observed. While the choice between a mucosa- or tooth-supported, and an implant-supported restoration depends on numerous individual factors, guidelines derived from longitudinal studies would enhance evidence-based treatment in this field.

Successful prosthetic rehabilitation and gait analysis of individual with bilateral transtibial amputation: A case study with comparison to able-bodied gait

Background: Intensive rehabilitation of individuals with bilateral lower limb loss poses a great challenge to both rehabilitation team and amputees themselves due to unavailability of a sound leg to provide stability in standing and gait. Although gait characteristics of individuals with unilateral transtibial amputations are well documented in the literature, very less is known about those with bilateral limb loss. Aim: To examine the gait characteristics of an individual with bilateral transtibial amputation (BTA) and its comparison with an able-bodied (AB). This study also provides a real-life presentation of successful prosthetic rehabilitation. Case content and methodology: Temporal–spatial, kinematic and kinetic gait parameters were analysed for a 45-year-old male individual with traumatic BTA using prosthesis in a motion analysis laboratory setting with force platform (BTS P-6000) and cameras with reflective markers (BTS SMART-DX6000). Findings and conclusion: Variances in many temporal–spatial, kinematic and kinetic parameters were observed. The findings of temporal–spatial parameters revealed that the individual with BTA walked with slower speed, lower cadence, shorter step lengths and wider step width compared to that of AB. Ankle dorsiflexion, stance knee flexion and swing hip hiking were reduced in an individual with BTA compared to AB. In kinetics, he demonstrated low peak ankle muscle power, increased muscle power amplitudes and phase duration at the hip and knee joints compared to AB individual. The combination of an intensive prosthetic rehabilitation led to completely independent and remarkable degree of functional ambulation.

The Impact of Residual Limb Shape on Dermatosis and Prosthetic Rehabilitation

Achieving optimal residual limb shape has been shown to be critical to ensure successful prosthetic rehabilitation. Despite continued advancements in prosthetic technology, dermatological complications continue to remain a chronic issue for those living with lower limb amputation (LLA). The purpose of this study is to report on the relationship between limb shape and prosthetic rehabilitation outcomes.