-
Journal of Cancer Research and... Jan 2012Surgical treatment of head and neck cancer frequently results in defects that challenge conventional prosthetic rehabilitation. Successful rehabilitation using tissue... (Review)
Review
Surgical treatment of head and neck cancer frequently results in defects that challenge conventional prosthetic rehabilitation. Successful rehabilitation using tissue supported dentures in such cases has been reported to be less than 20%. With the loss of jaw bones and thus the support, there is loss of retention to a great deal. Also, teeth loss on the side of the defect adds to failure in retention. Scar tissue formation, deviation of jaw due to muscle pull, decreased mouth opening, loss of sulcus and non vertical force are some of the common adversaries of jaw resection especially mandibular resection which pose great limitation on the stability and success of prospective prosthetic rehabilitation. The advent and application of biologically acceptable implants in clinical dentistry has contributed to restoring the defects of the deficient maxillofacial systems. Surgical intervention in patients who had received head and neck irradiation is preferably avoided as it has been associated with decreased healing and increased potential for development of osteoradionecrosis. Hence an implant as an option when surgical field has received tumerocidal radiation is empirically excluded. The purpose of this article is to review the studies and reports published in various journals related to osseointegrated implant rehabilitation in irradiated bones.
Topics: Dental Implantation, Endosseous; Dental Prosthesis, Implant-Supported; Head and Neck Neoplasms; Humans; Jaw; Orthognathic Surgical Procedures
PubMed: 22322737
DOI: 10.4103/0973-1482.92220 -
BMC Oral Health Mar 2021Immediate loading has recently been introduced into unsplinted mandibular implant-retained overdentures for the management of edentulous patients due to their increasing... (Meta-Analysis)
Meta-Analysis
Effects of immediate and delayed loading protocols on marginal bone loss around implants in unsplinted mandibular implant-retained overdentures: a systematic review and meta-analysis.
BACKGROUND
Immediate loading has recently been introduced into unsplinted mandibular implant-retained overdentures for the management of edentulous patients due to their increasing demand on immediate aesthetics and function. However, there is still a scarcity of meta-analytical evidence on the efficacy of immediate loading compared to delayed loading in unsplinted mandibular implant-retained overdentures. The purpose of this study was to compare the marginal bone loss (MBL) around implants between immediate and delayed loading of unsplinted mandibular implant-retained overdentures.
METHODS
Randomized controlled trials (RCTs), controlled clinical trials (CCTs), and cohort studies quantitatively comparing the MBL around implants between immediate loading protocol (ILP) and delayed loading protocol (DLP) of unsplinted mandibular overdentures were included. A systematic search was carried out in PubMed, EMBASE, and CENTRAL databases on December 02, 2020. "Grey" literature was also searched. A meta-analysis was conducted to compare the pooled MBL of two different loading protocols of unsplinted mandibular overdentures through weighted mean differences (WMDs) with 95% confidence intervals (95% CIs). The subgroup analysis was performed between different attachment types (i.e. Locator attachment vs. ball anchor). The risk of bias within and across studies were assessed using the Cochrane Collaboration's tool, the Newcastle-Ottawa scale, and Egger's test.
RESULTS
Of 328 records, five RCTs and two cohort studies were included and evaluated, which totally contained 191 participants with 400 implants. The MBL of ILP group showed no significant difference with that of DLP group (WMD 0.04, CI - 0.13 to 0.21, P > .05). The subgroup analysis revealed similar results with Locator attachments or ball anchors (P > .05). Apart from one RCT (20%) with a high risk of bias, four RCTs (80%) showed a moderate risk of bias. Two prospective cohort studies were proved with acceptable quality. Seven included studies have reported 5.03% implant failure rate (10 of 199 implants) in ILP group and 1.00% failure rate (2 of 201 implants) in DLP group in total.
CONCLUSIONS
For unsplinted mandibular implant-retained overdentures, the MBL around implants after ILP seems comparable to that of implants after DLP. Immediate loading may be a promising alternative to delayed loading for the management of unsplinted mandibular implant-retained overdentures. PROSPERO registration number: CRD42020159124.
Topics: Alveolar Bone Loss; Dental Implants; Dental Prosthesis, Implant-Supported; Denture, Overlay; Esthetics, Dental; Humans; Immediate Dental Implant Loading; Jaw, Edentulous; Mandible
PubMed: 33731092
DOI: 10.1186/s12903-021-01486-3 -
Journal of Biomedical Materials... Jun 2022The wear of a novel temporomandibular joint (TMJ) prosthesis was evaluated in an animal model. The prosthesis consisted of an additively manufactured titanium alloy (Ti...
The wear of a novel temporomandibular joint (TMJ) prosthesis was evaluated in an animal model. The prosthesis consisted of an additively manufactured titanium alloy (Ti Al V) mandibular condyle and glenoid fossa created through selective laser melting, with a machined vitamin E-enriched ultra-high molecular weight polyethylene (UHMWPE) surface attached to the fossa. Thirteen TMJ prosthesis were implanted in sheep, six of which had condylar heads coated with HadSat® diamond-like carbon (H-DLC). Euthanasia took place after 288 days, equaling 22 years of human mastication. Linear and volumetric wear analysis of the fossa was performed by optical scanning. The condylar head surfaces were assessed by scanning electron and confocal laser microscopy. The average linear UHMWPE wear, when combined with the coated condyle, was 0.67 ± 0.28 mm (range: 0.34-1.15 mm), not significantly differing (p = .3765, t-test) from the non-coated combination average (0.88 ± 0.41 mm; range: 0.28-1.48 mm). The respective mean volumetric wear volumes were 25.29 ± 11.43 mm and 45.85 ± 22.01 mm , not significantly differing (p = .1448, t-test). Analysis of the coated condylar surface produced a mean Ra of 0.12 ± 0.04 μm and Sa of 0.69 ± 0.07 μm. The non-coated condylar surface measured a mean Ra of 0.28 ± 0.17 μm and Sa of 2.40 ± 2.08 μm. Both Sa (p = .0083, Mann-Whitney U test) and Ra (p = .0182, Mann-Whitney U test), differed significantly. The prosthesis exhibits acceptable wear resistance and addition of the H-DLC-coating significantly improved long-term condylar surface smoothness.
Topics: Alloys; Animals; Hip Prosthesis; Joint Prosthesis; Mandibular Condyle; Prosthesis Design; Prosthesis Failure; Sheep; Temporomandibular Joint; Titanium
PubMed: 35088936
DOI: 10.1002/jbm.b.35010 -
Animals : An Open Access Journal From... Mar 2021The cat mandible is relatively small, and its manipulation implies the use of fixing methods and different repair techniques according to its small size to keep its... (Review)
Review
The cat mandible is relatively small, and its manipulation implies the use of fixing methods and different repair techniques according to its small size to keep its biomechanical functionality intact. Attempts to fix dislocations of the temporomandibular joint should be primarily performed by non-invasive techniques (repositioning the bones and immobilisation), although when this is not possible, a surgical method should be used. Regarding mandibular fractures, these are usually concurrent with other traumatic injuries that, if serious, should be treated first. A non-invasive approach should also first be considered to fix mandibular fractures. When this is impractical, internal rigid fixation methods, such as osteosynthesis plates, should be used. However, it should be taken into account that in the cat mandible, dental roots and the mandibular canal structures occupy most of the volume of the mandibular body, a fact that makes it challenging to apply a plate with fixed screw positions without invading dental roots or neurovascular structures. Therefore, we propose a new prosthesis design that will provide acceptable rigid biomechanical stabilisation, but avoid dental root and neurovascular damage, when fixing simple mandibular body fractures. Future trends will include the use of better diagnostic imaging techniques, a patient-specific prosthesis design and the use of more biocompatible materials to minimise the patient's recovery period and suffering.
PubMed: 33806397
DOI: 10.3390/ani11030683 -
Dental Research Journal 2023The purpose of this study was to conduct a randomized controlled clinical trial to compare and evaluate the effect of provisional restorations fabricated by two...
Effect of conventionally fabricated and three-dimensional printed provisional restorations on hard and soft peri-implant tissues in the mandibular posterior region: A randomized controlled clinical trial.
BACKGROUND
The purpose of this study was to conduct a randomized controlled clinical trial to compare and evaluate the effect of provisional restorations fabricated by two techniques, namely, conventional and three-dimensional (3D) printing processes on the peri-implant hard and soft tissues over early nonfunctional loaded implants in the mandibular posterior region.
MATERIALS AND METHODS
A randomized controlled clinical trial was conducted across 24 subjects broadly divided into two groups with 12 dental implants each, i.e., GpIC with conventionally fabricated provisional restoration and GpIID with 3D printed fabricated provisional restoration. The prosthetic phase was carried out at 2 weeks, and subjects were evaluated at baseline (at the time of prosthesis placement), 2 months, and 4 months for peri-implant marginal bone level, mucosal suppuration, sulcular probing depth, and modified sulcular bleeding index. Patient satisfaction was assessed using 5-item questionnaires at 4 months. The intragroup comparison for all the data was done using Wilcoxon signed-rank test. The intergroup comparison for all the data was done using Mann-Whitney -test. The comparison of frequency of responses between GpIC and GpIID was done using Chi-square test. < 0.05 was considered to be statistically significant.
RESULTS
Nonsignificant difference was observed in all the hard and soft tissue parameters between the groups at baseline, 2 months, and 4 months ( > 0.05). Improvement in bleeding on probing was found to be greater around dental implants restored with 3D printed provisional restoration than dental implants restored with conventionally fabricated provisional restoration from baseline to 4 months of follow-up, and the difference in finding was statistically significant ( < 0.05). There was a statistically nonsignificant difference seen for the frequencies between the groups ( > 0.05) for all questions related to patient satisfaction.
CONCLUSION
The effect of conventionally fabricated and 3D printed provisional restorations on peri-implant hard and soft tissues was comparable to each other on an early nonfunctionally loaded implant in the mandibular posterior region.
PubMed: 38020257
DOI: No ID Found -
Journal of Cancer Research and... Jan 2024Squamous cell carcinoma is one of the most prevalent cancers affecting the oral cavity. Rehabilitation following surgical treatment requires a multidisciplinary approach...
Squamous cell carcinoma is one of the most prevalent cancers affecting the oral cavity. Rehabilitation following surgical treatment requires a multidisciplinary approach and care. Multiple disabilities such as dysarthria, dysphagia, unesthetic appearance, and psychosocial disorders following the surgery for carcinoma can greatly impact the quality of life of such patients, thereby necessitating multidisciplinary intervention. The clinician has to wait for the healing of the lesion and the effects of radiotherapy to be dwindled in case a secondary osseous grafting is planned. During this time lag until a more definitive prosthesis is planned, an interim prosthesis is must to correct the mandibular deviation due to the unilateral muscular pull. This case presentation describes the utilization of guiding flange prosthesis (GFP) as an interim modality for the establishment of a stable and functional maxillomandibular relationship following combined ipsilateral partial mandibulectomy and maxillectomy.
PubMed: 38261439
DOI: 10.4103/jcrt.jcrt_170_23 -
Clinical and Experimental Dental... Apr 2021The World Health Organization (WHO) recognizes edentulism as a physical impairment that results in a negative impact in the daily activities. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The World Health Organization (WHO) recognizes edentulism as a physical impairment that results in a negative impact in the daily activities.
OBJECTIVE
The study aimed to compare the satisfaction and the quality of life, in patients treated with implant retained overdentures with two mandibular implants (IOD) against those with mandibular conventional complete dentures (CCD).
METHODS
Different search strategies were used to screen for articles in Pubmed/Medline, Cochrane Library and Scielo of the last 17 years (2003-2020). The keywords used were: "quality of life OR satisfaction" AND "complete denture OR conventional denture" AND "overdenture OR implant retained."
RESULTS
Six articles and two more were added by manual search. The population was 400 in the CCD and 412 for IOD. The mean age was 64.3 ± 6.41 years. The group was comprised of 283 men and 427 women. The scores obtained in the visual analog scale (VAS) before and after the treatment were statistically significant in favor of the IOD for overall satisfaction, (WMD: 12.329; 95% CI: 4.873 to 19.784, p-value = 0.001), comfort, speech and stability. For esthetics and chewing there was non-significant improvement while hygiene worsened for the IOD. For the comparison after the treatment between both treatment modalities a statistically significant improvement was found in overall satisfaction (WMD: 14.408; 95% CI: 8.589 to 20.226, p-value < 0.001), comfort, speech, chewing and stability in favor of the IOD but not in esthetics or hygiene.
CONCLUSIONS
This systematic review and meta-analysis show the superiority of the IOD, despite is not achieved in all aspects.
Topics: Aged; Dental Implants; Dental Prosthesis, Implant-Supported; Denture, Complete; Denture, Complete, Lower; Denture, Overlay; Female; Humans; Male; Middle Aged; Patient Satisfaction; Personal Satisfaction; Quality of Life
PubMed: 33205918
DOI: 10.1002/cre2.347 -
Journal of Prosthodontic Research Apr 2023This study aimed to assess patients' expected burdens before treatment and their perceived burdens after the surgical and prosthodontic procedures of mandibular... (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
This study aimed to assess patients' expected burdens before treatment and their perceived burdens after the surgical and prosthodontic procedures of mandibular overdenture treatment and to evaluate factors influencing patients' perceptions.
METHODS
Data were collected from 47 participants enrolled in a randomized clinical trial comparing mandibular overdentures retained by one or two implants. A 20-item questionnaire measured on a four-point Likert scale covering the surgical and prosthetic treatment procedures was used to assess the patients' perception of the procedural burdens before (expected burdens) and immediately after (experienced burdens) each procedure. Operators' perceptions of intercurrences associated with the procedures were also assessed as an independent variable.
RESULTS
Low levels of perceived burdens were observed both before and after treatment. The mean overall scores of 1.65 ± 0.46 and 1.53 ± 0.33 for expected and experienced burdens, respectively, indicated that most items ranged between "not burdensome at all" and "somewhat burdensome." Significant differences between expected and experienced burdens were found for eight items (P < 0.001). Considering the treatment stages, expected burdens scored higher in the pre-surgical, surgical, and prosthetic stages and lower in the post-surgical phase than experienced burdens. Overall, the experienced burdens were significantly affected by the expected burdens (P < 0.001) and operator's perceived burdens(P = 0.045).
CONCLUSIONS
Treatments were associated with low levels of perceived burdens related to surgical and prosthodontic procedures and were highly correlated with the expected burdens before treatment. However, patients tend to overestimate the expected burdens before treatment, especially for surgical procedures.
Topics: Humans; Denture, Overlay; Dental Implants; Patient Satisfaction; Denture, Complete, Lower; Jaw, Edentulous; Mandible; Dental Prosthesis, Implant-Supported; Denture Retention; Treatment Outcome
PubMed: 35786572
DOI: 10.2186/jpr.JPR_D_21_00343 -
BMC Oral Health Jun 2022The aim of the present study was to evaluate the retention and loss of retention after fatigue testing at different time intervals between two types of bar clip...
OBJECTIVES
The aim of the present study was to evaluate the retention and loss of retention after fatigue testing at different time intervals between two types of bar clip materials (digitally designed PEEK bar clip and regular Nylon bar clip).
MATERIALS AND METHODS
An epoxy model was constructed for a completely edentulous mandible. Two implants were placed according to prosthetically driven implant placement by a computer-guided surgical stent. Bar clips were digitally designed, 3D printed, and pressed into Poly Ether Ether Ketone (PEEK). Pick up of PEEK and nylon clips was performed on the dentures fitting surface using self-cured acrylic resin. Each study group was subjected to an insertion and removal fatigue test simulating 3 years of patient usage. Retention values were recorded using the universal testing machine at initial retention and after 1, 2, and 3 years of simulated usage. For proper sample sizing, 24 models and dentures (12 for each group) were used. An independent sample t-test and repeated measures analysis of variance were used to compare the data.
RESULTS
There were statistically significant differences in retention between the PEEK and nylon bar clips at the beginning of the experiment (p = 0.000*). But after 3 years of simulated use, there was no significant difference in retention between the test groups (p = 0.055, NS). After 3 years of simulated use, the retention of PEEK clips decreased by - 58.66% recording 17.37 ± 1.07 N, while the retention of nylon clip increased by + 2.99% recording 16.56 ± 0.88 N.
CONCLUSION
The digitally designed PEEK clip showed comparable retention results to the nylon clip after 3 years of simulated use.
CLINICAL RELEVANCE
Maintenance of bar attachment with PEEK clip offers a clinical solution after the wear of normal plastic clips, which is a cheap solution that is easily fabricated and picked up into the denture. Digital fabricated PEEK bar retentive inserts can be used in cases of bar attachment wear.
Topics: Dental Implants; Dental Prosthesis, Implant-Supported; Dental Stress Analysis; Denture Retention; Denture, Overlay; Ethers; Humans; Mandible; Nylons; Surgical Instruments
PubMed: 35681163
DOI: 10.1186/s12903-022-02262-7 -
Deutsches Arzteblatt International Apr 2011Obstructive sleep apnea (OSA) is a very common disorder among adults: the prevalence of mild OSA is 20%, and that of moderate or severe OSA is 6% to 7%. Simple snoring... (Review)
Review
BACKGROUND
Obstructive sleep apnea (OSA) is a very common disorder among adults: the prevalence of mild OSA is 20%, and that of moderate or severe OSA is 6% to 7%. Simple snoring is even more common. Conservative treatments such as nocturnal ventilation therapy and oral appliances are successful as long as the patient actually uses them, but they do not eliminate the underlying obstruction of the upper airway.
METHOD
The relevant literature up to 2008 on the surgical treatment of OSA was selectively reviewed.
RESULTS
Five types of surgical treatment for OSA are available, each for its own indications: optimization of the nasal airway to support nasal ventilation therapy, (adeno-)tonsillectomy as first-line treatment for OSA in children, minimally invasive surgery for simple snoring and mild OSA, invasive surgery as first- and second-line treatment for mild OSA, and invasive multilevel surgery as second-line treatment of moderate to severe OSA that remains refractory to ventilation therapy.
CONCLUSION
Surgical treatment for OSA is appropriate for specific indications as a complement to the established conservative treatment methods.
Topics: Adenoidectomy; Adult; Child; Combined Modality Therapy; Continuous Positive Airway Pressure; Humans; Hypopharynx; Mandibular Advancement; Minimally Invasive Surgical Procedures; Palate, Soft; Pharynx; Prosthesis Implantation; Sleep Apnea, Obstructive; Tongue; Tonsillectomy; Treatment Outcome; Uvula
PubMed: 21505609
DOI: 10.3238/arztebl.2010.0216