Search

The rehabilitation of medically compromised elderly patients with long span partially edentulous arches has been a tremendous challenge for dentists. Proper dental management requires a commitment to provide the best treatment despite the compromised oral conditions. The aim of this paper is to describe the prosthetic rehabilitation of an elderly patient who presented with chief complaints of gagging sensation while using upper denture, loose upper and lower dentures and difficulty in eating food. Patient was rehabilitated using removable partial denture with semi-rigid attachments in the maxillary arch and telescopic prosthesis in the mandibular arch. Use of semi precision attachments helped in increasing the retentive ability of the maxillary prosthesis, even in the presence of only few abutments. Fabrication of a telescopic denture is a technique sensitive procedure but it offers advantages like bilateral splinting effect in long span partially edentulous arches, reduced effective crown–root ratio, maintenance of proprioception and transfer of forces along the long axis of the abutments. Although the management was complex but it improved patient’s esthetics, oral function and social confidence.

The art of maxillofacial prosthetics restores esthetics and function in patients with gross developmental or acquired defects of face and helps them to restore hope and ambition to lead a useful life. This valuable service provided by maxillofacial prosthodontist lifts the morale of the patient and thus aids in physical well being and quality of life. Diagnosis and treatment planning should include attention to each detail prior to rehabilitation process. This paper describes a clinical case of mid face defect due to basal cell carcinoma, rehabilitated with facial prosthesis and intraoral obturator.

Exenteration of the orbital contents as well as removal of a part of maxilla with an ablative surgery for the removal of a malignant tumor can severely affect a person in terms of function, esthetics and psychological trauma. A well-retained, user-friendly, removable maxillofacial prosthesis is the key to successful prosthetic rehabilitation in such cases. Various retentive techniques include using spectacle frame, conformers, adhesives, osseointegrated implants, magnets or buttons. This paper describes a novel technique for retention of silicone orbital prosthesis using acrylic resin base attached to maxillary obturator with the help of pin and socket of an electric plug wherein the latter is attached to the eye prosthesis with the help of a mechanical undercut. This helps in better retention of both the prostheses.

Dear Editor, We are thankful to the authors of letter to the editor entitled “improving the outcome of prosthetic rehabilitation following orbital exenteration” for having read our article and expressed their opinion.[1,2] Authors have recommended the use of heat temperature vulcanized (HTV) silicones due to its superior mechanical, esthetic and handling properties. Reference quoted by authors (Belgam et al.) nowhere states HTV silicones to be esthetic. On the contrary, literature mentions HTV silicones to have low edge strength, opaque with lifeless appearance and not adequately elastic in function.[3] Therefore, for facial prosthesis, where esthetics is a major concern, room temperature vulcanization (RTV) silicones are preferred. HTV silicones are preferred for limb prosthesis etc., because of better mechanical properties. Mahajan and Gupta have also mentioned that HTV silicones are designed for engineering applications because of higher tear resistance and they require more intense mechanical milling of solid HTV stock elastomers when compared with soft RTV silicones.[4] Fabrication of prosthesis in HTV silicones is difficult as the material requires special milling machines which are expensive and not commonly available.[5] Moreover, the references quoted for the above statement should be Bell et al.,[6] Lewis and Castleberry[7] and Lontz[8] instead of Begum et al. Second point raised by the authors is the allergic reactions because of adhesives or industrial grade silicones. Allergic reaction due to adhesives is an issue and has been already mentioned by us in our article. We have used best quality medical grade silicones (Factor II Inc., USA) for fabrication of our prostheses, not industrial grade silicones. Adhesives prescribed were also of the best quality (Dow Corning/Technovent medical adhesive) and none of our patients have reported with any allergic reaction so far. Corrosion of magnets has already been mentioned as a disadvantage in the manuscript. Attachments used in our patients may be harmful if they come into direct contact with the skin. However, the contact was only between two prostheses in our patients. Moreover, the pin and socket used were made of brass which is less prone to rust. “Photodynamic iris” uses a liquid crystal display in the prosthesis to vary the pupil size as a function of the ambient light. But, there are no clinical trials so far using this concept.[9] Use of tinted glasses, negative sphere lenses can be used but these methods mandate the use of spectacles for the patients even if the natural eye has normal power and also add to the cost. We had used these particular methods specifically because these patients had financial constraints. Prosthesis with built-in blinking mechanism are not currently available in our country. We are sorry to bring it to the notice of the editor that again the references mentioned are wrong. Osseointegrated implants undoubtedly provide better retention as compared to other mechanical methods. But, there are certain limitations already been discussed in our article. We accept evisceration and enucleation, usually followed by placement of ocular implants, are treatment of choice in painful or disfiguring blind eye instead of exenteration.

PURPOSE:This preliminary hospital based study was designed to measure the mean maximum bite force (MMBF) in healthy Indian individuals. An attempt was made to correlate MMBF with body mass index (BMI) and some of the anthropometric features.METHODOLOGY:A total of 358 healthy subjects in the age range of 18-47 years (mean age = 26.66 ± 6.83) were selected following the selection criteria. Demographic details along with general physical and facial parameters such as height, weight, facial form, facial profile, arch form, and palatal contour were recorded in a predesigned proforma. The maximum bite force was recorded on both (right and left) sides using a specially designed piezoelectric transducer based device.RESULTS:The MMBF in Indian individuals was found to be 372.39 ± 175.93 Newton (N). Males had significantly higher (P = 0.000) MMBF (448.47 ± 191.82 N) as compared to females (296.31 ± 116.79 N). Facial form (P = 0.001) and palatal contour (P = 0.000) showed a significant relationship with MMBF. Subjects having square facial form (421.34 ± 187.32 N) showed significantly higher MMBF as compared to other facial forms, that is, square tapered (358.86 ± 143.56 N; P = 0.038), ovoid (338.40 ± 163.02 N; P = 0.000) and tapered (349.22 ± 184.82 N; P = 0.028). Subjects with flat palatal contour showed significantly higher MMBF when compared to high (P = 0.002) and medium palatal (P = 0.002) contour. Though facial profile was not significantly related to MMBF, it was significantly higher in subjects having concave facial profile when compared to convex (P = 0.045) and straight (P = 0.039) facial profile. BMI and arch form showed no significant relationship with MMBF.CONCLUSION:The MMBF is found to be affected by gender and some of the anthropometric features like facial form and palatal contour.

Long-term clinical failures of cemented prosthesis depend, to a large extent, on the integrity of the luting agent. The causative factors that lead to microfracture and, hence, failure of the luting agents are the stresses acting inside the oral cavity. Therefore, the present study was designed to develop an understanding of the relationship between stresses in the tooth and the failure potential of the luting agent. Two-dimensional finite element stress analysis was performed on the mandibular second premolar. The behavior of zinc-phosphate and glass-ionomer were studied under different crowns (metal-ceramic and metal crown) and loading conditions (mechanical force of 450 N acting vertically over the occlusal surface, thermal loads of 60° and 0°C). It was observed from the study that failure threshold of the luting agent was influenced both by the elastic modulus of the luting agent and by the type of the crown.

The dilemma confronting many dentists today is that innovations and well-defined specializations have greatly enlarged the treatment realm for tooth preservation as well as tooth replacement. The objectives should be preservation of the remaining tooth structure, restoration of optimum function, esthetics with least invasive procedures, cost effective, and short treatment time. The number of remaining natural teeth is one of the most widely used method for evaluating oral health and the prosthetic treatment of patients with a mutilated dentition. Though the treatment of these patients can be complex, but there are some important principles applicable in most cases. This case report demonstrates a satisfying full mouth rehabilitation using the Hobo and Takayama twin-stage procedure for a patient with esthetically and functionally compromised dentition. The final prosthesis with this twin-stage technique ensured a restoration with a predictable posterior disclusion and anterior guidance in harmony with the condylar path.

Purpose of study : Proper color match of a dental restoration with the adjacent teeth is important not only at the initial stage of giving the restoration but also over a longer period of time. Out of different materials Porcelain has established itself as being color stable and durable but composites are known to be susceptible to discoloration because of internal mechanisms, external contamination and staining. The newer universal composite systems are optimized in terms of composition to minimize internal discoloration but still not much attention is given to resistance to external staining. Procedure : Visual shade matching and color determination being a psychophysical phenomenon suffer from subjective variations in interpretation, therefore the present study was undertaken to evaluate and compare the color stability of a porcelain (Vitadur alpha) and two universal composites (Filtek Z 250 and Tetric Ceram) after exposure to commonly consumed beverages i.e. tea, coffee, coca-cola and distilled water (as control) by using a reflectance spectrophotometer and CIELAB system. Conclusion : T0 he color match of esthetic restorations in the oral cavity is affected by dietary habits