Arvind Tripathi

A pilot study to evaluate posttreatment cephalometric changes in subjects with OSA.

STATEMENT OF PROBLEM Obstructive sleep apnea (OSA) is a life-threatening condition that is diagnosed and evaluated primarily by polysomnography (PSG). The procedure is time consuming, expensive, and inconvenient for the patient, and may not be universally available. PURPOSE The purpose of this pilot study was to evaluate posttreatment results on lateral cephalograms in patients with OSA. MATERIAL AND METHODS Lateral cephalograms of 16 patients diagnosed with OSA were made at the beginning of treatment and 4-6 weeks following treatment. Treatment modalities used in the study were the mandibular advancement device (MAD) and continuous positive airway pressure (CPAP) therapy (n=8). Pharyngeal dimensions, soft palate area and angle, and hyoid bone position were recorded for the comparisons. The data were analyzed using Students t test for the parametric analysis (alpha=.05). RESULTS A significant increase in the pharyngeal area (P<.001), a significant decrease in the soft palate area (P<.001), and vertical changes in the hyoid position were observed, with no significant change in the anteroposterior position of the hyoid bone. CONCLUSIONS Within the limitations of this pilot study, lateral cephalograms were shown to be useful in evaluating treatment efficacy in subjects with OSA.

Bisphosphonate Therapy for Skeletal Malignancies and Metastases: Impact on Jaw Bones and Prosthodontic Concerns

Healthy jawbones ensure better tooth anchorage and the ability to masticate and maintain metabolism. This is achieved by a delicate balance between bone formation and resorption in response to functional demands. An imbalance in the expression of receptor activator of nuclear factor kappa-B (RANK) ligand (RANKL) and osteoprotegerin (OPG) or osteoclastogenesis inhibitory factor (OCIF) is believed to be the underlying mechanism of osteolysis in metastases, multiple myelomas, and cancer therapy-induced bone loss in patients. Considered mainly as bone-specific agents to treat postmenopausal osteoporosis, bisphosphonates, in combination with certain chemotherapeutic agents have proved to be effective in prevention of tumor formation and metastatic osteolysis in bone tissue. Osteonecrosis of the jaws associated with them has, however, been of grave concern to the prosthodontist, as it predisposes patients to a bone-deficient basal seat for dental prostheses. This manuscript reviews available information over the past 13 years on possible mechanisms of bone loss, bisphosphonate-induced osteonecrosis of jaw bones, and prosthodontic concerns.

Full mouth rehabilitation of hypomaturation type amelogenesis imperfecta: A clinical report

PROBLEM CONSIDERED This clinical report describes the prosthodontic treatment of an 18-year-old female diagnosed with amelogenesis imperfecta. MATERIALS AND METHOD The specific objectives of the treatment were to restore esthetics and masticatory function. Metal-ceramic fixed partial dentures were fabricated at the existing vertical dimension of occlusion utilizing the PMS occlusal scheme. RESULTS Clinical examination of the patient 12 months after treatment revealed no evidence of disease or degeneration of the restored teeth. CONCLUSION The patients esthetic and functional expectations were satisfied.

Prevalence of dental myths, oral hygiene methods and tobacco habits in an ageing North Indian rural population.

BACKGROUND AND OBJECTIVES Though increased emphasis is being given to expanding dental care facilities and awareness in Indian villages, the target population is unfortunately less literate and financially-equipped compared to their urban counterparts. This study attempted to evaluate dental myths, oral hygiene methods and beliefs, and tobacco habits present in a rural ageing population. MATERIAL AND METHODS The study area consisted of a group of 10 villages, situated in the district of Lucknow, Uttar Pradesh, India. The sample comprised 681 people aged 50 years or above. The subjects were questioned about dental myths, tobacco habits and oral hygiene methods and then divided into groups on the basis of age, gender, and educational status. Mean values, standard deviation, chi-square test, t-test and p values were used to obtain inter-group comparisons. RESULTS Forty percent of the subjects considered oral hygiene unnecessary, with 61% relying on simple mouth rinsing for maintaining oral hygiene, 48% either smoked and chewed tobacco or both and 81% had one or more dental myth. CONCLUSION The results showed that the rural ageing population is deprived and a targeted programme to spread scientific dental practices to them is necessary.

An overview of osteoporosis for the practising prosthodontist.

Osteoporosis is an insidious and common bone disorder of the modern age, as a result of the rapidly increasing number of older people in the total population. It has long been concluded that this disease has definite deleterious effects on the stomatognathic system and is therefore of major concern to a Prosthodontist. If features on a dental radiograph, which are the most commonly required radiographs, can be detected regularly and consistently, it would place a prosthodontist in a position to refer the patient for timely management and also modify his treatment plan, greatly improving the prognosis. Available literature was therefore reviewed for pathophysiology, dental radiographic screening measures, implications and management of osteoporosis from the perspective of a prosthodontist.

The efficacy of guiding flange appliance in correcting mandibular deviation in the hemi-mandibulectomy patient. A correlative study.

PURPOSE This report describes the efficacy of a guiding flange appliance in correcting mandibular deviation in the hemi-mandibulectomy patient and correlates the time elapsed between surgery and placement of the appliance and the extent of initial mandibular deviation to the success rate of a guiding flange appliance in correcting the deviation. MATERIALS AND METHODS A total of 15 hemi-mandibulectomy patients participated in the study. All had various degree of mandibular shift consequent to surgery. The patients were given a guiding flange prosthesis for about 4 months, and the efficacy of the guiding flange prosthesis was calculated in terms of percentage deviation corrected after 4 months. RESULTS Time elapsed between surgery and prosthetic rehabilitation was in inverse relation to the percentage correction in mandibular deviation at 4 months (B = -7.668; p = 0.002). The less the initial deviation postsurgery, the better the correction (B = 9.798; p = 0.008). CONCLUSION Percentage correction of mandibular deviation is dependent on the timing of prosthetic rehabilitation. The less the initial deviation, the better the correction.

Dermatoglyphic Assessment in Subjects with Different Dental Arch Forms: An Appraisal

Successful rehabilitation of edentulous individuals involves selection and arrangement of artificial teeth in accordance with the patient’s original arch form. Various criteria exist for harmonious tooth arrangement but none is accepted universally. Finger and palm prints are unique to an individual and once formed in the sixth week of intra-uterine life, remain constant thereafter. Since dental arches are also formed during the same prenatal period, it is believed that the similar genetic factors may be involved in formation of dental arches and dermal patterns. This study was conducted to identify the association if any between type of dental arch forms and type of dermatoglyphic patterns. If specific dermal characteristics exist in individuals with specific dental arch forms, dermatoglyphic assessment of long standing edentulous subjects may help identify the patients preexisting dental arch form and thus aid in proper tooth arrangement. Ninety dentulous subjects were categorized into three groups on the basis of dental arch form (square, tapering or ovoid) and their finger and palm prints were recorded. The type of fingertip patterns, distribution of palmar patterns, Total Finger Ridge Count and angle atd were assessed. Subjects with square arches demonstrated a significantly high frequency of loops and a large atd angle with palmar patterns being most frequent in I3 region. Subjects with tapering arches showed a high frequency of whorls, a small atd angle and greatest distribution of palmar patterns in I4 region. In ovoid arched subjects, loops were the most common and palmar patterns were mostly observed in I4. Since distinctive dermal patterns were observed in subjects with different dental arch forms, it is believed that dermatoglyphics may be used as a reliable tool for identifying original arch form in edentulous patients.

Adhesion of different brands of glass ionomer cements to a ceramometal alloy

AimsThe aim of the study was to assess, compare and evaluate the adhesive strength and compressive strength of different brands of glass ionomer cements to a ceramometal alloy.Materials(A) Glass ionomer cements: GC Fuji II - GC Corporation, Tokyo; Chem Flex — Dentsply DeTrey, Germany; Glass ionomer FX — Shofu-11, Japan; MR dental — MR Dental Suppliers Pvt. Ltd., England; (B) ceramometal alloy — Ugirex III; (C) cold cure acrylic resin; (E) temperature cum humidity control chamber; and (F) Instron universal testing machine.MethodsFour different types of glass ionomer cements were used in the study. From each type of the glass ionomer cements, 15 specimens were made to evaluate the compressive strength and adhesive strength, respectively. Fifteen specimens were further divided into 3 subgroups each having 5 specimens. For compressive strength, specimens were tested at 2, 4 and 12 hours by using Instron universal testing machine. To evaluate the adhesive strength, specimens were surface treated with diamond bur, silicone carbide bur and sandblasting, and tested under Instron universal testing machine.Results and conclusionsIt was concluded from the study that the compressive strength as well as the adhesive bond strength of MR dental glass ionomer cement with a ceramometal alloy was found to be maximum compare to other glass ionomer cements. Sandblasting surface treatment of ceramometal alloy was found to be comparatively more effective for adhesive bond strength between alloy and glass ionomer cement.

Cranioplasty with alloplastic cranial implant.

Cranial defects result either from trauma or after intentional osteocraniotomies or external decompression craniectomies. These lead to mechanical vulnerability of the brain, esthetic disfigurement, and transmission of vibrations and pulsation of the brain that cause disconcerting sensations to the patient. Subsequent cranioplasty may be required to compensate for the defect and alleviate various signs and symptoms. A referred posttraumatic patient of a cranial defect that was restored with an alloplastic heat polymerizing methyl methacrylate cranial implant is presented in this case report.

Nutrition in maxillofacial prosthetic patients: The unexplored frontier

A patient who undergoes/has undergone maxillofacial surgery is already under enormous apprehension and fear. Postoperative physical and mental stress because of depression, shock, anger and ostracisation add to functional and esthetic impairments and all these make the sufferer prone to malnourishment. An approach that involves simple nutritional principles preceding the surgery, continuing postoperatively and proceeding life long will translate into improved prosthodontic prognosis. We have attempted to apply these principles to solve the common nutritional problems affecting maxillofacial prosthetic patients, keeping in focus the diet and economics of a normal Indian patient.