Akshay Bhargava

Prosthetic Rehabilitation of Ocular Defect Using Digital Photography: A Case Report

The fundamental objective in restoring a congenital as well as acquired defect of eye with an ocular prosthesis is to enable the patient to cope better with the difficult process of rehabilitation after an enucleation or evisceration. A cosmetically acceptable prosthesis is that reproduces the color, form and orientation of iris and allows the patient to return to accustomed lifestyle. A sequence of steps for construction of custom-made ocular prostheses is outlined in this case report using the advantages of digital imaging technique.

Prosthodontic Management of a Child with Ectodermal Dysplasia: A Case Report

Ectodermal dysplasia is a rare congenital disease that affects several ectodermal structures. Children with ectodermal dysplasia may have various manifestation of the disease that differ in severity and may or may not involve teeth, skin, hair, nails, sweat glands and sebaceous glands. The most common form of the ectodermal dysplasia syndrome is hypohidrotic ectodermal dysplasia and is usually inherited as an X-linked recessive trait. Female carriers may have a variable degree of clinical manifestations. This case report discusses the management of a 5-year-old girl with ectodermal dysplasia. Clinical management consisted of fabricating upper and lower dentures to help in psychosocial development and to restore the vertical dimension, esthetics and functioning of the stomatognathic system.

A finite element study of teeth restored with post and core: Effect of design, material, and ferrule

Background: Different postdesigns and materials are available; however, no consensus exists regarding superiority for stress distribution. The aim of this study was to evaluate the effect of design and material of post with or without ferrule on stress distribution using finite element analysis. Materials and Methods: A total of 12 three-dimensional (3D) axisymmetric models of postretained central incisors were made: Six with ferrule design and six without it. Three of these six models had tapered posts, and three had parallel posts. The materials tested were titanium post with a composite resin core, nickel chromium cast post and core, and fiber reinforced composite (FRC) post with a composite resin core. The stress analysis was done using ANSYS software. The load of 100 N at an angle of 45΀ was applied 2 mm cervical to incisal edge on the palatal surface and results were analyzed using 3D von Mises criteria. Results: The highest amount of stress was in the cervical region. Overall, the stress in the tapered postsystem was more than the parallel one. FRC post and composite resin core recorded minimal stresses within the post but the stresses transmitted to cervical dentin were more as compared to other systems. Minimal stresses in cervical dentine were observed where the remaining coronal dentin was strengthen by ferrule. Conclusion: A rigid material with high modulus of elasticity for post and core system creates most uniform stress distribution pattern. Ferrule provides uniform distribution of stresses and decreases the cervical stresses.

Spectrophotometric evaluation of the color changes of different feldspathic porcelains after exposure to commonly consumed beverages

Objective: The aim of this study was to compare color stability and surface topography of three different feldspathic porcelains both qualitatively and quantitatively after exposure to routinely consumed beverages over different time periods using a Spectrophotometer, Stereomicroscope and Surface roughness tester, respectively. Materials and Methods: A total of 90 plastic discs were casted to obtain metal dies for three different newer ceramic applications each on thirty samples. The color and surface roughness of these samples were measured using stereomicroscope and surface roughness tester following which they were kept in different test solutions for different durations and revaluated for color changes and surface roughness in the similar manner. Results and Conclusion: Among all the five test solutions, Coffee showed the maximum staining of the ceramic whereas maximum surface roughness was shown by the Duceram Kiss (1.48 μm) by Orange Juice which could be due to its high titratable acidity.

A Two‐Piece Sectional Interim Obturator. A Clinical Report

Prosthetic rehabilitation of acquired maxillary defects can be achieved satisfactorily if all facets of treatment planning and design considerations are taken into account before the rehabilitation process. Complications associated with maxillary defects limit treatment protocols to a great extent. The prosthodontist has to identify these problem areas and suitably devise feasible options and incorporate them in the design. In this report, an acquired maxillary defect with unfavorable undercuts in the defect was successfully treated by making a two-piece sectional obturator. The two pieces were connected by the use of double-die pin system. The methodology greatly reduced chairside time and number of visits, and effective obturation was satisfactorily achieved.Prosthetic rehabilitation of acquired maxillary defects can be achieved satisfactorily if all facets of treatment planning and design considerations are taken into account before the rehabilitation process. Complications associated with maxillary defects limit treatment protocols to a great extent. The prosthodontist has to identify these problem areas and suitably devise feasible options and incorporate them in the design. In this report, an acquired maxillary defect with unfavorable undercuts in the defect was successfully treated by making a two-piece sectional obturator. The two pieces were connected by the use of double-die pin system. The methodology greatly reduced chairside time and number of visits, and effective obturation was satisfactorily achieved.

Marginal accuracy of metal copings produced with different ring casting techniques: An in vitro study

Objective: Evaluation and comparison of marginal accuracy of three porcelain fused with metal alloy using ringless and closed ring casting techniques. Materials and Methods: A total of 60 metal copings was fabricated on a metal die. Specimens were divided into two groups (Group I ringless and II ring casting techniques) of 30 patterns each. Groups are further divided into three subgroups of 10 each representing porcelain fused to metal alloys castings namely Mealloy, Wiron-99, and Bellabond plus. The measurement of fit of the metal copings was recorded by stereo photomicroscope at four different surfaces. Results: No significant difference (P < 0.001) was found when the mean vertical marginal integrity at all the buccal, palatal, mesial and distal surfaces among three porcelain fused to metal alloys for both the groups. However on comparing in between group I and group II, it showed that there is significant difference (P > 0.001). The mean of the vertical integrity for the group I (Ringless) was less than group II (Closed Ring). Conclusions: Within the limitations of the study design, it can be concluded that there is a significant difference between ringless and closed ring casting but both are clinically acceptable.

Surgical enucleation of Pindborg tumor and immediate prosthetic rehabilitation

Rehabilitating patients with maxillofacial defects is one of the most challenging therapies of the stomatognathic system. Maxillomandibular defects being the most common of these defects need to be rehabilitated to restore the lost form, function and speech. Prosthetic reconstruction of these defects may be achieved with the help of varied prosthesis, removable and fixed. The present case report describes a case of CEOT (Calcifying Epithelial Odontogenic Tumor) managed with a treatment obturator which allowed closure of the defect by secondary healing through granulation tissue maturation and associated bone fill. A 19 gauge wire was used for creating the substructure treatment obturator. Wire was adapted to stabilize the appliance, and provide retentive properties. The obturator allowed decrease in size of defect and enhanced comfort and overall well-being of the patient. Clinical Relevance to Interdisciplinary Dentistry Team work involving oral surgeon, oral radiologist and rehabilitation by a prosthodontist lead to the success of the procedure.

An innovative method to anchor mandibular overdenture by OT Cap semiprecision attachment: A clinical report

Since the establishment of implant in dentistry, the use of removable prostheses in replacing missing teeth apparently becomes less popular, still the preventive prosthodontics emphasizes the importance of any procedure that can delay or eliminate future prosthodontic problems. Most patients with removable partial or complete denture are dissatisfied with their retention and stability. Semiprecision attachments offer considerable advantages such as increased retention of a denture, preservation of teeth which are otherwise indicated for extraction, as a viable alternative to implant retained overdenture and the ability to obtain parallelism in divergent abutments. A prosthodontist who familiarizes himself with semiprecision attachments will be in a position to suggest a better treatment options in retaining teeth which might otherwise be considered for extraction or immediate implant placement. However, lack of proper knowledge, overwhelming number of attachments available in the market, multiple adjustments and repairs are making dentist reluctant to offer and provide attachment-retained prostheses to their patients. This case report describes an innovative technique for improving overall prognosis of mandibular overdenture using advanced and prefabricated housing attachment system.

A comparative evaluation of vertical marginal fit of provisional crowns fabricated by computer-aided design/computer-aided manufacturing technique and direct (intraoral technique) and flexural strength of the materials: An in vitro study

Background: With the advent of new provisional crown materials, it has become imperative to evaluate their marginal fit and strength to select the ideal provisional crown material. Aim: The purpose of this in vitro study was to evaluate and compare the vertical marginal fit and flexural strength of provisional crowns prepared using computer-aided design-computer-aided manufacturing (CAD-CAM) temporary material versus those fabricated using bis-acrylic composite-based autopolymerizing resin material. Materials and Methods: Eighty samples were divided into two equal Groups (I and II). Group I consisted of forty samples that were evaluated for flexural strength and Group II consisted of forty samples that were evaluated for their vertical marginal fit. Group I was subdivided as Group IA, i.e., bis-acrylic composite-based autopolymerizing resin material (Protemp™ 4) blocks and Group IB, i.e., CAD/CAM provisional material blocks. Similarly, Group II was subdivided as Group IIA, i.e., bis-acrylic composite-based autopolymerizing resin material (Protemp™ 4) crowns and Group IIB, i.e., CAD/CAM provisional material crowns. Marginal adaptation was evaluated using stereomicroscope and image analyzing software to measure the amount of marginal gap. For flexural strength, all specimens were subjected to a standard compression load in the universal testing machine until fracture occurred. Data were analyzed using Students t-test (P = 0.001). Results: CAD/CAM provisional crowns showed better marginal adaptation (34.34 μm) as compared to bis-acrylic composite-based autopolymerizing resin material (Protemp™ 4) crowns (63.42 μm) (P < 0.001). The flexural strength of CAD/CAM blocks (94.06 megapascals [MPa]) was not statistically different from bis-acrylic composite-based autopolymerizing resin material (Protemp™ 4) blocks (101.41 MPa) (P > 0.001). Conclusion: Protemp™ 4 and CAD/CAM provisional materials have comparable flexural strength. However, the marginal fit of temporary crowns fabricated by CAD/CAM was found to be superior to the ones fabricated using bis-acrylic composite-based autopolymerizing resin material (Protemp™ 4).

Evaluation of Influence of Thermocycling on Shear Bond Strength of Two Different Zirconia Systems Bonded to Dentin Using Resin Cements - An In Vitro Study

Objectives: Information about the retentive strength of luting agents for zirconium oxide–based crowns is limited. The purpose was to determine the ability of selected luting agents to retain a representative zirconium oxide ceramic crown under clinically simulated conditions. Methods: 56 sound freshly extracted first permanent molars were selected. Teeth were divided randomly into two groups based on the type of zirconia system used. Each group was further subdivided based on the type of resin cement used and each subgroup was further subdivided into two halves based on thermocycling. Shear bond strength was measured using Universal Testing Machine and then the samples were observed under magnification (80X) using a Stereomicroscope to identify the nature of bond failure. Student t test was applied on the data obtained. The log transformation, if required, was applied to normalize the data and p > 0.05 was considered significant. Results : Mean bond strength of Panavia F2.0 with Cercon before and after thermocycling was 9.45 Mpa, 13.45 Mpa and With Ziecon was 9.59 Mpa and 12.37 Mpa respectively. Mean bond strength of Rely X U200 with Cercon before and after thermocycling was 8.10Mpa and 11.81Mpa and with Ziecon was 8.12 Mpa and 10.63Mpa respectively. Significance: Panavia F2.0 was found to be better presented highly significant results than Rely X U200 with both Zirconia Systems. Thermocycling significantaly affects the bond strength of both the resin cements with dentin. There was no significant difference was observed between shear bond strength of two zirconia systems. Highlights: • This study revealed that the type and composition of Zirconia systems does not affect the shear bond strength of Zirconia todentin. • Composition, type of resin cement, and oral conditions affect the bond strength of Zirconia to dentin.