Search

This clinical report describes how a hollow obturator prosthesis was designed and fabricated for an 82-year-old partially edentulous patient with a large palatal defect. Computer-aided design (CAD) was used to design, articulate, and align the mandibular denture with the obturator prosthesis. The prosthesis was printed, adjusted chairside, rescanned, and made hollow by using a CAD software program. The prosthesis was printed in resin with a dental 3D printer. Quantitative evaluations of clinical (prosthesis dimensions, rest, and occlusal vertical dimensions) and virtual (surface area, volume, weight, interpoint mismatches, spatial overlap) parameters found that the 3D-printed prosthesis required an additional 5% chairside modification. The greatest differences in volume (24.7% less) and weight (22.2% less) were observed when the modified obturator bulb was made hollow via CAD. Hollowing the bulb, therefore, reduced the spatial overlap in volume by 16.8%.

Ingestion or aspiration of foreign objects may present as a significant complication with various common dental procedures. The most reported ingested or aspirated dental materials have included endodontic instruments and metal restorative and prosthetic materials, which can often be identified clinically and radiographically from their relative radiodensities. The authors present an unusual report of lodged impression material in the hypopharynx, which was not detectable radiographically.

Osteopetrosis (marble bone disease) is a family of rare genetic disorders characterized by impaired osteoclast function leading to hyperdense, hypovascular, brittle bone. Typical imaging shows increased bone mass and thickened cortical and trabecular bone. Bones are more prone to fracture and osteomyelitis may develop. When considering dental implant placement in a patient with osteopetrosis, the potential for bony fracture and/or osteomyelitis should be considered along with the decreased likelihood of successful osseointegration because of hypovascularity. This clinical report describes an unusual imaging presentation and successful osseointegration of multiple dental implants supporting an implant-supported fixed mandibular prosthesis with long-term survival.

A direct composite resin placed by using digitally planned prototyped 3D guides and retained with a digitally guided fiberglass micropin was used to restore an extensively damaged maxillary left central incisor.

Total flap failure is a devastating complication in head and neck reconstruction. This clinical report describes the rehabilitation of an extensive maxillectomy defect communicating with the midface by using a 2-piece magnet-retained orofacial prosthesis fabricated in heat-processed acrylic resin. The innovative design and choice of material allowed early rehabilitation of a patient receiving palliative care at a resource-constrained tertiary care oncology center. Prosthetic treatment served to reduce the period of hospitalization and helped the patient to resocialize.

This clinical report describes the prosthetic restoration of a failing dentition subsequent to methamphetamine abuse. The treatment involved the use of endosteal dental implants and milled cobalt-chromium, screw-retained, implant-supported fixed dental prostheses. At the 1-year follow-up, the prosthetic rehabilitation had markedly improved the patients’ health, esthetics, and function.

This clinical report describes a conservative approach to improve an unesthetic implant-supported crown and peri-implant mucosal recession around a malpositioned, 1-piece implant in the maxillary right central incisor region by using digital technology. In such clinical situations, the implants are usually removed because of an unpredictable definitive esthetic outcome. However, this clinical report describes the preservation of such a compromised implant by improving the esthetic outcome with a connective-tissue graft, and a digital approach used a 1-step preformed zirconia coping technique with an appropriate emergence profile.

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.

Custom intraoral radiation devices protect normal tissues, minimizing the adverse effects of radiation therapy. These devices also help immobilize the target by placing the patient's head in a precise, repeatable position. This clinical report describes the fabrication and benefits of a modified mouth opening, tongue depressing radiation stent with bilabial protrusion of the lips that was used in proton radiation therapy for a malignancy of the upper lip.

Purpose To evaluate whether pharmacist engagement on the interdisciplinary team leads to improved performance on diabetes-related quality measures. Methods This was a retrospective observational study of patients seen in primary care and specialty clinics from October 2014 to October 2020. Patients were included if they had a visit with a physician, nurse practitioner, physician’s assistant, or clinical pharmacist practitioner (CPP) within the study period and had a diagnosis of diabetes. The intervention group included patients with at least one visit with a CPP, while the control group consisted of patients who were exclusively managed by non-CPP providers. The primary outcome of this study was the median change in glycosylated hemoglobin (HbA1c) from baseline to follow-up at 3, 6, and 12 months. The secondary outcome was the probability of achieving the HbA1c targets of Results Patients referred to a CPP had higher HbA1c levels at baseline and were more likely to have concomitant hypertension (P < 0.01). Patients seen by a CPP had 0.31%, 0.41%, and 0.44% greater reductions in HbA1c compared to patients in the control group at 3, 6, and 12 months, respectively (P < 0.01). Patients managed by a CPP were also more likely to achieve the identified HbA1c targets of Conclusion Patients referred to a CPP were more complex, but had greater reductions in HbA1c and were more likely to achieve HbA1c goals included in the organization’s quality measures. This study demonstrates the value of pharmacists in improving patient care and their role in supporting an organization’s achievement of value-based quality measures.

RESUMO: A proposta do artigo é discutir a produção de registros em uma pesquisa psicanalítica. Tal pesquisa realizou o acompanhamento de bebês e educadoras em escolas de educação infantil, e o método de registro construído foi desenvolvido em três tempos. O tempo da experiência refere-se ao encontro com o campo, englobando exterioridade, alteridade, mas também reflexividade, transformação. O segundo tempo, que foi a escrita do diário clínico, comporta tanto o aspecto subjetivo como a tentativa de descrever cenas, acontecimentos. O terceiro tempo, da composição do relato clínico, envolve teorização metapsicológica, na qual se busca produzir fechamentos e abrir novas perguntas. Abstract: This paper aims to discuss the production of records in psychoanalytic research. The research carried out an accompanying process of babies and educators in kindergarten schools, and the recording method in question was developed in three stages. The time of experience refers to the encounter with the field, encompassing exteriority, alterity, but also reflexivity, transformation. The second time was the writing of the clinical diary, which includes both the subjective aspect and the attempt to describe scenes and events. The third time, the composition of the clinical narrative report, involves theorizing. It’s when we seek to produce some closings and to uncover new questions.

This clinical report presents the rehabilitation of extensive hard and soft tissue defects caused by rhino-orbital-cerebral mucormycosis as a result of untreated diabetes mellitus. The patient underwent subtotal maxillectomy and was rehabilitated with an implant-supported maxillofacial prosthesis with zygomatic and pterygoid implants by following an immediate loading protocol.

Persistent genital arousal disorder (PGAD) is a condition of persistent genital arousal, in the absence of a psychological component and organic pathology from the vascular, endocrine and nervous system. The aim of the study is to examine the symptoms, clinical picture, developmental dynamics, risk factors, and treatment for PGAD. Materials and methods. The clinical case of observation of PGAD in a 20-year-old female patient suffering from recurrent depressive disorder is presented. Methods included in clinical, psychopathological and psychodiagnostic examination have been with using the following techniques: Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Visual Analogue Scales of pain intensity (VAS). Results. As a result of collection of life and disease history, analysis of examination findings by related specialists and additional research methods of patient with PGAD the next diagnosis has been made according to the International Classification of Diseases 10th Revision: Recurrent depressive disorder, current episode of moderate severity with somatic symptoms (F33.11). She has been treated with a number of drugs from the Selective serotonin reuptake inhibitors group and mood stabilizers, the combination of sertraline and lamotrigine appeared the optimal treatment option. The results of the treatment have been satisfactory, the symptoms of PGAD have stopped bothering the patient, the emotional state has improved significantly. Conclusions. The case of the PGAD is presented. Clinical picture of the case turned out to be typical in comparison with the results of other researchers. The peculiarity is the possible association of symptoms with withdrawal of escitalopram. The case confirms the data upon the high suicidal risk in this disorder. The patient’s treatment requires intervention of different medical specialists to rule out organic pathology and using of multidisciplinary approach. Sertraline and lamotrigine appeared effective in the treatment of PGAD., Розлад постійного генітального збудження (англ. Persistent genital arousal disorder, PGAD) – стан безперервного генітального збудження без психологічного компонента збудження й органічної патології з боку судинної, ендокринної та нервової систем. Мета роботи – вивчення симптомів, клінічної картини, динаміки розвитку, факторів ризику та методів лікування розладу постійного генітального збудження. Матеріали та методи. Наведено клінічний випадок власного спостереження розладу постійного генітального збудження в пацієнтки віком 20 років, у котрої діагностовано на рекурентний депресивний розлад. Дослідження передбачало застосування клінічних і психопатологічних методів, здійснення психодіагностичного обстеження з використанням Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), візуальної аналогової шкали інтенсивності болю (ВАШ). Результати. У результаті збору анамнезу життя та захворювання, аналізу висновків обстеження суміжними спеціалістами та даних додаткових методів дослідження встановили діагноз за Міжнародною класифікацією хвороб 10 перегляду: рекурентний депресивний розлад, поточний епізод помірної тяжкості з соматичними симптомами (F33.11). Пацієнтка отримувала лікування низкою препаратів із групи селективних інгібіторів зворотного захоплення серотоніну та стабілізаторами настрою; оптимальною схемою лікування виявилась комбінація сертраліну та ламотриджину. Результати лікування задовільні, симптоми розладу постійного генітального збудження перестали турбувати пацієнтку, її емоційний стан значно покращився. Висновки. Наведено випадок доволі рідкісного в медицині розладу постійного генітального збудження, клінічна картина якого виявилася типовою порівняно з результатами досліджень інших авторів. Особливість наведеного клінічного випадку розладу постійного генітального збудження полягає в можливій асоціації симптомів зі скасуванням есциталопраму. Цей випадок підтверджує відомості про високий суїцідальний ризик при розладі постійного генітального збудження. Курація пацієнтки потребувала втручання фахівців із різних галузей медицини (неврологія, гінекологія та психіатрія) для виключення органічної патології та забезпечення мультидисциплінарного підходу. Під час лікування цього випадку розладу постійного генітального збудження ефективними виявилися такі препарати, як сертралін і ламотриджин.

In patients with implant-supported restorations, intrusion rarely occurs in nonconnected natural teeth. This clinical report describes the intrusion of a natural tooth located between 2 implant-supported crowns after 4 months of normal function. The second premolar was intruded by 3 mm. The intrusion was completely reversed after interproximal contact adjustments, and the tooth position was stable at the 7-year follow-up.

An oral prosthesis can help maintain a sense of normalcy by preserving psychosocial and physiologic function in the aftermath of a maxillary resection. Rehabilitating the resulting defect in a timely manner requires strategic choices in treatment sequencing and prosthetic design. This clinical report describes the process of fabricating a series of removable and implant-retained prostheses to minimize a patient’s time without the restoration of critical craniofacial structures.

The present clinical report describes the rehabilitation of a patient diagnosed with ectodermal dysplasia performed by an interdisciplinary team in a comprehensive approach aided by digital technology. The complexity of the treatment was related to predictability regarding timing and the type of approach. The patient was referred for treatment because of congenitally missing and abnormally shaped permanent teeth. The need for an interdisciplinary team involving orthodontic, periodontic, and prosthodontic specialists was identified. A virtual treatment plan was developed to guide tooth movement, placement of dental implants, and tooth preparation for indirect restorations. Therefore, each treatment phase could be communicated to the patient and treatment team in a predictable way.

The excessive occlusal wear of complete-arch implant-supported prostheses made with metal and acrylic resin is a clinical complication that can require repeated maintenance in certain patients. A patient who presented with moderate occlusal wear of the prosthetic teeth and substantial fracture of the maxillary anterior acrylic resin base only 2 years after a previous replacement of the acrylic resin base and denture teeth is described. Because of the patient's history and existing wear, both the maxillary and mandibular prostheses were repaired by replacing the acrylic resin bases and resin denture teeth but with the addition of cast gold occlusal surfaces on the posterior prosthetic teeth. The provided treatment helped this patient, who was likely to need more frequent maintenance visits in the future because of his history of accelerated occlusal wear and increased occlusal force.

This clinical report with an 8-year follow-up describes the multidisciplinary management of a patient diagnosed with amelogenesis imperfecta. The rehabilitation included horizontal-guided bone regeneration, implant placement, use of a fixed interim prosthesis to preview the correction of occlusal disharmonies, and placement of a custom screw-retained definitive implant-supported restoration with a design that was retrievable and minimized maintenance problems.

This clinical report describes a completely digital workflow for the rehabilitation of the maxillary and mandibular arches with implant-supported fixed interim prostheses. Computer-assisted implant planning was used to fabricate a multifunctional surgical template for the guided placement of transitional and endosteal dental implants. Advantages of this technique include the integration of a completely digital workflow into the production of a virtual diagnostic tooth arrangement for edentulous patients, the planning of implant placement as per a restorative-driven approach, and the delivery of implant-supported fixed interim prostheses.

The rehabilitation of facial esthetics when transitioning from a failing dentition in a patient with maxillary protrusion is challenging. This clinical report described such a patient treated with an immediate cross-arch implant-supported fixed prosthesis. The ideal virtual upper lip position was used to predict the sagittal and vertical position of the restoration. A stackable device was fabricated to guide the osteotomy and implant placement.

The virtual articulator is a tool that reproduces the relationship between the jaws in a virtual environment. The purpose of this clinical report was to describe a completely digital protocol starting from the virtual articulator mounting to developing static and dynamic occlusion in a complex prosthetic rehabilitation.

Mucormycosis is an opportunistic invasive fungal infection, recently been detected in Covid-19 due to several underlying conditions. Otologic involvement in such patients though exceptional, should not be simply ignored even when presented without any clinical signs or symptoms. This report manifests the need of evaluating otologic involvement in post-covid mucormycosis.

Objective Modified surgical lip repositioning (MLR) is a conservative method for correcting gummy smile (GS). However, its long-term evaluation in the prevention of relapse following lip repositioning surgeries remains questionable. This long-term study was therefore conducted to assess MLR with and without an adjunctive internal dual muscle traction approach (iMTA) in the treatment of GS. Methods This study was performed on 20 cases with GS. They were randomly and equally distributed to be treated either by MLR alone (Control) or augmented with iMTA (Test). Participants were assessed for GS reduction at 3, 6 and 12 months postoperatively. The patient's satisfaction scores were assessed at 12 months in both groups. Results The control participants revealed in a remarkable decrease in gingival exposure (2.7 mm ± 0.48) (P-value ≤ 0.05), while the test ones demonstrated a more significant reduction in GS (1.6 mm ± 0.52) (P-value ≤ 0.05). Satisfaction scores were significantly reported in the test group (9.3 ± 0.78 when compared to the control group (7.8 ± 1.3), (P-value ≤ 0.05). Conclusions Within the limits of this study, our long-term results revealed that MLR is an effective method for treating GS, while iMTA offered more stable results at 12 months when used as an adjunct to MLR.

Screw-retained implant-supported ceramic restorations have shown increased rates of technical complications compared with their cemented counterparts, including fracture and chipping of the ceramic structures. The present clinical report identified the causes leading to the catastrophic failure of a screw-retained lithium disilicate veneered crown cemented to a zirconia abutment with a titanium base by using a systematic fractographic approach. A combination of occlusal overloading, a deficient design and inadequate material selection was identified as being responsible for the fracture. These findings highlight the importance of a thorough analysis of the anatomic conditions and loading scenario of screw-retained implant-supported restorations.

A new implant design to increase labial plate dimension and tooth-implant distance in maxillary anterior extraction sockets over traditional tapered implant designs is presented. Generally, tapered implants are divergent and wider at the coronal aspect of the implant adjacent to the lowest bone volume. Decreasing bone around implants over time can lead to ridge collapse, recession, and a graying effect of the gingival tissues that eventually impacts esthetic outcomes adversely. This implant design incorporates a body-shift in both diameter, shape, and thread pattern and reduces the coronal portion to allow greater circumferential bone thickness to be created where it is needed most for long-term stability.

Hepatocellular carcinoma (HCC) is the most common primary malignancy of the liver. It most commonly metastasizes haematogenously to the lungs and bones, less commonly via lymphatics to lymph nodes. However, metastasis to the parapharyngeal space has yet to be reported. This is the first clinical report of the treatment of parapharyngeal metastasis from HCC. The case of a 46-year-old man who was found to have a parapharyngeal soft tissue mass during routine follow-up 12 years post deceased-donor liver transplantation for hepatitis B-related HCC is reported here. This was investigated and diagnosed to be metastatic HCC. He underwent excision of the parapharyngeal metastasis, followed by adjuvant radiotherapy. Parapharyngeal metastasis is a rare occurrence in HCC. It is important to be cognizant of the possibility of disease spread to this location in order to ensure early detection and treatment. Surgical excision with adjuvant radiotherapy should be considered to achieve disease control.

The landscape of breastfeeding has changed over the past several decades as more women initiate breastfeeding in the postpartum period and more hospitals are designated as Baby-Friendly Hospitals by following the evidence-based Ten Steps to Successful Breastfeeding. The number of births in such facilities has increased more than sixfold over the past decade. With more women breastfeeding and stays in the maternity facilities lasting only a few days, the vast majority of continued breastfeeding support occurs in the community. Pediatric care providers evaluate breastfeeding infants and their mothers in the office setting frequently during the first year of life. The office setting should be conducive to providing ongoing breastfeeding support. Likewise, the office practice should avoid creating barriers for breastfeeding mothers and families or unduly promoting infant formula. This clinical report aims to review practices shown to support breastfeeding that can be implemented in the outpatient setting, with the ultimate goal of increasing the duration of exclusive breastfeeding and the continuation of any breastfeeding.

Mucormycosis is a fungal infection commonly seen in Indian population, in which aggressive surgical intervention to cut away the infected tissue becomes necessary. This may cause disfigurement and leave open wounds which requires prosthetic replacement for psychological benefit and also protect the inner soft tissues of the patient which are exposed to the foreign bodies. Mucormycosis has shown a sudden surge in recent times associated with patients affected by Covid-19. It is a rare but serious complication which can cause loss of eye, nose and associated structures leaving the patient disfigured. The aim of this case report is to describe an economic but effective nonsurgical treatment option to restore the facial defect using acrylic resin baseplate to enhance retention by using the available undercuts and was packed using silicone material. The prosthesis was retained mechanically and omitted the use of any retentive aids such as the use of spectacles or implants.

Purpose Inpatient diabetes management involves frequent assessment of glucose levels for treatment decisions. Here we describe a program for inpatient real-time continuous glucose monitoring (rtCGM) at a community hospital and the accuracy of rtCGM-based glucose estimates. Methods Adult inpatients with preexisting diabetes managed with intensive insulin therapy and a diagnosis of coronavirus disease 2019 (COVID-19) were monitored via rtCGM for safety. An rtCGM system transmitted glucose concentration and trending information at 5-minute intervals to nearby smartphones, which relayed the data to a centralized monitoring station. Hypoglycemia alerts were triggered by rtCGM values of ≤85 mg/dL, but rtCGM data were otherwise not used in management decisions; insulin dosing adjustments were based on blood glucose values measured via fingerstick blood sampling. Accuracy was evaluated retrospectively by comparing rtCGM values to contemporaneous point-of-care (POC) blood glucose values. Results A total of 238 pairs of rtCGM and POC data points from 10 patients showed an overall mean absolute relative difference (MARD) of 10.3%. Clarke error grid analysis showed 99.2% of points in the clinically acceptable range, and surveillance error grid analysis showed 89.1% of points in the lowest risk category. It was determined that for 25% of the rtCGM values, discordances in rtCGM and POC values would likely have resulted in different insulin doses. Insulin dose recommendations based on rtCGM values differed by 1 to 3 units from POC-based recommendations. Conclusion rtCGM for inpatient diabetes monitoring is feasible. Evaluation of individual rtCGM-POC paired values suggested that using rtCGM data for management decisions poses minimal risks to patients. Further studies to establish the safety and cost implications of using rtCGM data for inpatient diabetes management decisions are warranted.

Patients with unrepaired cleft palate defects still exist within remote rural areas. The prosthodontic rehabilitation of an adult edentulous cleft patient could be very demanding for treating maxillofacial prosthodontist, since most of them are edentulous, challenging the retention and the stability of the maxillary prosthesis. It is therefore highly important that cleft palate patients seek dental and prosthodontic care as early in their life as possible. In this report, an unusual case of a patient self-obturated cleft palate defect is presented. The patient’s self-made prosthesis was replaced by an appropriately fabricated pharyngeal obturator prosthesis in order to improve speech and swallowing.