Amit Porwal

Modified mandibular advancement appliance for an edentulous obstructive sleep apnea patient: A clinical report

Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder with periodic reduction or cessation of airflow during sleep. It is associated with loud snoring, disrupted sleep and observed apneas with prevalence up to 54% in elderly people. Treatment of OSA varies from simple measures such as dental appliances and nasal continuous positive airway pressure (CPAP) to surgical procedures like uvulopalatopharyngoplasty and tracheostomy. Dental appliances are a viable nonsurgical treatment alternative in patients with OSA, of which mandibular advancement appliances are most common. Edentulism which contributes to the worsening of OSA reduces the number of available therapeutic strategies and is considered a contraindication to oral appliance therapy. This clinical report describes the treatment of a 61-year old edentulous OSA patient for whom a modified mandibular advancement appliance was designed. The patient reported an improvement in AHI index and he was satisfied with the modified appliance. This clinical report describes the newer technique of fabricating oral appliance for edentulous OSA patient.

Comparison of immediate complete denture, tooth and implant-supported overdenture on vertical dimension and muscle activity

PURPOSE To compare the changes in the occlusal vertical dimension, activity of masseter muscles and biting force after insertion of immediate denture constructed with conventional, tooth-supported and Implant-supported immediate mandibular complete denture. MATERIALS AND METHODS Patients were selected and treatment was carried out with all the three different concepts i.e, immediate denture constructed with conventional (Group A), tooth-supported (Group B) and Implant-supported (Group C) immediate mandibular complete dentures. Parameters of evaluation and comparison were occlusal vertical dimension measured by radiograph (at three different time intervals), Masseter muscle electromyographic (EMG) measurement by EMG analysis (at three different positions of jaws) and bite force measured by force transducer (at two different time intervals). The obtained data were statistically analyzed by using ANOVA-F test at 5% level of significance. If the F test was significant, Least Significant Difference test was performed to test further significant differences between variables. RESULTS Comparison between mean differences in occlusal vertical dimension for tested groups showed that it was only statistically significant at 1 year after immediate dentures insertion. Comparison between mean differences in wavelet packet coefficients of the electromyographic signals of masseter muscles for tested groups was not significant at rest position, but significant at initial contact position and maximum voluntary clench position. Comparison between mean differences in maximum biting force for tested groups was not statistically significant at 5% level of significance. CONCLUSION Immediate complete overdentures whether tooth or implant supported prosthesis is recommended than totally mucosal supported prosthesis.

Serum interleukin-1β in subjects with abdominal obesity and periodontitis

BACKGROUND & OBJECTIVE Abdominal obesity and periodontal diseases are believed to share close relation through commonality of chronic inflammation. Both inflammatory periodontal disease and excess abdominal fat modulate their systemic influences through several inflammatory mediators. The present study was carried out to evaluate and compare serum interleukin-1β levels in subjects with abdominal obesity and periodontal disease. METHODS Sixty non-diabetic and non-smoking subjects (aged 25-49 years; 28 females and 32 males) were assessed for abdominal obesity by waist to hip ratio. Full-mouth clinical periodontal measurements were recorded for determination of periodontal status. Serum samples were obtained and interleukin-1β was assessed using commercially available ELISA kit. Obtained data were analyzed statistically. RESULTS Measures of abdominal obesity and periodontal disease were found to significantly influence the serum interleukin-1β. Abdominally obese subjects had significantly higher serum interleukin-1β in healthy (p=0.006), gingivitis (p<0.001) and periodontitis (p<0.001) groups. There was a significant difference in serum interleukin-1β levels among subjects with different periodontal status in both non obese (F(2,27)=18.17, p<0.0001) and obese groups (F(2,27)=15.70, p<0.0001). Serum interleukin-1β was significantly correlated with PI, GI, BOP%, PD and CAL non obese and obese groups. A significant correlation was also seen with WC, HC and WHR only in obese group. CONCLUSION Significant changes in serum interleukin-1β are influenced by abdominal obesity and periodontal status independently even in the absence of diabetes mellitus and smoking. Serum interleukin-1β was significantly higher in patients with abdominal obesity and periodontitis.

Prosthetic rehabilitation of phthisis bulbi by digital imaging technique—A case report

Phthisis bulbi is a condition of an eye wherein there is atrophy and disorganization of the intraocular structures, leading to anatomically disfigured and shrunken eyeball. Prosthetic rehabilitation over the residual eyeball is the preferred treatment of choice over surgical intervention such as enucleation or evisceration. A fundamental objective of any maxillofacial rehabilitation is to enable the patient to cope up with his loss and endure the process of rehabilitation. The present article reports a simplified technique of fabricating the customized prosthesis using digital imaging technique for phthisis bulbi patients. The customized Scleral shell provides better mobility, improved appearance and less discomfort to the patient.

Effect of porcelain-firing cycles and surface finishing on the marginal discrepancy of titanium copings.

PURPOSE The aim of the study was to evaluate the effect of simulated porcelain firing cycles and surface finishing on the marginal fit of commercially pure titanium (Cp Ti) copings. MATERIALS AND METHODS A machined stainless steel die system with standard 0.5-mm copings was fabricated. Wax patterns were prepared by pouring the molten wax on a two-part stainless steel die. Thirty specimens were cast in Cp Ti. These were divided into three groups with ten specimens in each group. Group 1 was treated with conventional cold working and later oxidized. Group 2 specimens were oxidized initially and then cold worked. Group 3 was heat treated in its original investment and later treated as in group 1. All specimens were later subjected to sequential simulated porcelain firing cycles, that is, oxidation, bonder, opaque, body, and glaze firing. Following the completion of each firing cycle, marginal discrepancy was measured in μm using a traveling microscope. The obtained data were subjected to one-way analysis of variance (ANOVA) and Students t-test. The statistical level of significance was set at 1%. RESULTS The results showed that the mean and SD values (in μm) were 55 ± 2.6, 43 ± 3.0, and 68 ± 4.0 after oxidation for groups 1, 2, and 3, respectively. Mean and SD values (in μm) after glaze firing were 76 ± 3.9, 64 ± 4.1, and 89 ± 4.3 for groups 1, 2, and 3, respectively. The mean marginal opening was largest for group 3 specimens. One-way ANOVA showed the difference within the three groups was highly significant after oxidation (F-value 149.37 at p-value 0.0000) and glaze firing (F-value 82.43 at p-value 0.0000). CONCLUSIONS (1) The Students t-test values demonstrated that increased marginal openings of the specimens resulted after the sequential simulated porcelain firing cycles. (2) Marginal discrepancy values improved when the specimens were thermocycled prior to cold working.

Effect of Cast Modification on Linear Dimensional Change of Acrylic Tooth Position Following Maxillary Complete Denture Processing.

PURPOSE To investigate the effect of different cast modifications on the vertical and horizontal tooth position following maxillary complete denture processing. MATERIALS AND METHODS A total of 60 maxillary master casts were prepared and arranged in six groups (n = 10). Variation in modifications between study groups 1 through 6 were as follows: no modification, butterfly post palatal seal preparation only, butterfly post palatal seal preparation with 10 mm wide/4 mm deep box, butterfly post palatal seal preparation with 10 mm wide/4 mm deep box and four round holes, butterfly post palatal seal preparation with 20 mm wide/4 mm deep box, butterfly post dam preparation with 20 mm wide/4 mm deep box and four round holes, respectively. The boxes in the respective groups were prepared on the mid-heel area of the cast. The first group was included in the study as control. The initial master cast was indexed to standardize the measurement technique on all specimens before duplication. Maxillary denture tooth set-up was completed and indexed using laboratory putty to ensure a similar set-up on all specimens. Vertical and horizontal tooth positions were measured for the maxillary left central incisor, right and left first molars in waxed complete dentures, and following processing. The measurements were done using a digital vernier caliper with manufacturing accuracy of up to 0.01 mm. The study data were entered in a Microsoft Excel Spreadsheet. Statistical analysis was done using a paired Student t-test, ANOVA, and Tukey post hoc test set at 5% level of significance. RESULTS The paired t-test (within groups) showed significant change in all linear tooth positions for groups 1 and 2. Groups 3 through 6 had significant change in vertical dimension only. One-way ANOVA indicated that no significant difference was seen in the vertical tooth movements between the groups; however, statistically significant reduction was seen in the horizontal tooth movements at the maxillary left central incisor, right and left first molars for groups 3 through 6 when compared to others without significant difference between them. CONCLUSIONS Within the limitations of the study, it was concluded that the movement of the teeth horizontally could be reduced with master cast modification (box alone or box and round holes) whereas the vertical movement of the teeth was not affected by the cast modifications made across all groups.

Effect of Cast Modification on Denture Base Adaptation Following Maxillary Complete Denture Processing

PURPOSE To investigate the effect of cast modifications on denture base adaptation in coronal and sagittal projections following maxillary complete denture processing. MATERIALS AND METHODS A total of 60 edentulous maxillary casts (n = 10) were distributed among six groups. Group 1 was the control group with no modification, groups 2 through 6 included a butterfly postdam preparation, groups 3 and 4 also included a 10-mm wide/4-mm deep box with addition of four round holes in group 4, and groups 5 and 6 also included a 20-mm wide/4-mm deep box with addition of four round holes in group 6. The boxes were prepared at the mid-heel area of the casts. Two layers of baseplate wax (1 mm each) were used to standardize denture base thickness across the groups. A standard technique was used to replicate the denture tooth set-up, and standardized processing was done for all the groups. Following deflasking, casts with the dentures were sectioned in the coronal and sagittal directions. Microscopic pictures were taken at preselected points. Data were organized in tables, and statistical analyses were performed using repeated measure ANOVA, Tukey post hoc tests, and post hoc comparison tests set at 5% level of significance. RESULTS Maximum gaps were measured at the mid-palatal area followed by nearby areas and the areas near ridge crests in both coronal and sagittal projections. The analyses revealed significant differences between the groups in coronal projection (1/2, 3/4, 5/6) and sagittal projection (1, 2, 3/4, 5/6) without significant differences within the pairs. The groups were ranked from the highest group 1 to the lowest group 6 relative to the gap means. Post hoc comparisons showed that points 1C and 2A had the highest gap means across the study groups. CONCLUSIONS Within the limitations of this study, it can be extrapolated that the denture base adaptation can be effectively increased with the box preparation at the mid-heel aspect of the casts. Significant reduction of gaps was seen when the box size increased from 10 to 20 mm in coronal and sagittal projections; however, the addition of four holes had no significant effect on gap size alterations.

Association of Neutral Zone Position with Age, Gender, and Period of Edentulism.

PURPOSE The changing dynamics of an aging mouth influence the position of the neutral zone (NZ). While the advantage of the NZ concept in complete denture treatment is quite established, what is not clearly understood is its position in relation to the crest of the residual ridge due to conflicting reports from previous studies. The purpose of this study was to investigate the distance and direction of NZ position in relation to crest of the residual ridge in edentulous patients and its association with age, gender, and period of edentulism. MATERIALS AND METHODS A cross-sectional study was conducted in 133 patients (70 males, 63 females) with a mean age of 58.81 ± 11.78 years. NZ recording was done using admix material by following standard procedures. Two metallic wires were adapted, one on the ridge and another on the center of the occlusal rims, and standardized digital radiographs were made. The position of NZ in relation to the crest of the residual ridge was recorded by noting the direction and measuring the distance between the adapted wires digitally at five locations (right molar, right premolar, incisor, left molar, left premolar regions). RESULTS Age, gender, and period of edentulism had no significant association with the position of NZ. No specific trend was observed in the in NZ position with a non-significant correlation. CONCLUSIONS Distance and the direction of neutral zone position in relation to crest of the residual ridge in edentulous patients bear no significant relationship with factors such as age, gender, and period of edentulism.

Association of Neutral Zone Position with Age, Gender, and Period of Edentulism: Neutral Zone Position in Edentulous Patients

PURPOSE The changing dynamics of an aging mouth influence the position of the neutral zone (NZ). While the advantage of the NZ concept in complete denture treatment is quite established, what is not clearly understood is its position in relation to the crest of the residual ridge due to conflicting reports from previous studies. The purpose of this study was to investigate the distance and direction of NZ position in relation to crest of the residual ridge in edentulous patients and its association with age, gender, and period of edentulism. MATERIALS AND METHODS A cross-sectional study was conducted in 133 patients (70 males, 63 females) with a mean age of 58.81 ± 11.78 years. NZ recording was done using admix material by following standard procedures. Two metallic wires were adapted, one on the ridge and another on the center of the occlusal rims, and standardized digital radiographs were made. The position of NZ in relation to the crest of the residual ridge was recorded by noting the direction and measuring the distance between the adapted wires digitally at five locations (right molar, right premolar, incisor, left molar, left premolar regions). RESULTS Age, gender, and period of edentulism had no significant association with the position of NZ. No specific trend was observed in the in NZ position with a non-significant correlation. CONCLUSIONS Distance and the direction of neutral zone position in relation to crest of the residual ridge in edentulous patients bear no significant relationship with factors such as age, gender, and period of edentulism.

Effect of Cast Modification on Linear Dimensional Change of Acrylic Tooth Position Following Maxillary Complete Denture Processing: Linear Dimensional Change after Maxillary Cast Modifications

PURPOSE To investigate the effect of different cast modifications on the vertical and horizontal tooth position following maxillary complete denture processing. MATERIALS AND METHODS A total of 60 maxillary master casts were prepared and arranged in six groups (n = 10). Variation in modifications between study groups 1 through 6 were as follows: no modification, butterfly post palatal seal preparation only, butterfly post palatal seal preparation with 10 mm wide/4 mm deep box, butterfly post palatal seal preparation with 10 mm wide/4 mm deep box and four round holes, butterfly post palatal seal preparation with 20 mm wide/4 mm deep box, butterfly post dam preparation with 20 mm wide/4 mm deep box and four round holes, respectively. The boxes in the respective groups were prepared on the mid-heel area of the cast. The first group was included in the study as control. The initial master cast was indexed to standardize the measurement technique on all specimens before duplication. Maxillary denture tooth set-up was completed and indexed using laboratory putty to ensure a similar set-up on all specimens. Vertical and horizontal tooth positions were measured for the maxillary left central incisor, right and left first molars in waxed complete dentures, and following processing. The measurements were done using a digital vernier caliper with manufacturing accuracy of up to 0.01 mm. The study data were entered in a Microsoft Excel Spreadsheet. Statistical analysis was done using a paired Student t-test, ANOVA, and Tukey post hoc test set at 5% level of significance. RESULTS The paired t-test (within groups) showed significant change in all linear tooth positions for groups 1 and 2. Groups 3 through 6 had significant change in vertical dimension only. One-way ANOVA indicated that no significant difference was seen in the vertical tooth movements between the groups; however, statistically significant reduction was seen in the horizontal tooth movements at the maxillary left central incisor, right and left first molars for groups 3 through 6 when compared to others without significant difference between them. CONCLUSIONS Within the limitations of the study, it was concluded that the movement of the teeth horizontally could be reduced with master cast modification (box alone or box and round holes) whereas the vertical movement of the teeth was not affected by the cast modifications made across all groups.