Arzu Atay

Assessment of health-related quality of life in Turkish patients with facial prostheses

BackgroundFacial prostheses are intended to provide a non-operative rehabilitation for patients with acquired facial defects. By improving aesthetics and quality of life (QOL), this treatment involves reintegration of the patient into family and social life. The aim of this study was to evaluate the perception of QOL in adult patients with facial prostheses and to compare this perception with that of a control group.MethodsThe study participants consisted of 72 patients, who were divided into three equal-sized groups according to the type of prosthesis (OP- orbital prosthesis, AP- auricular prosthesis, NP - nasal prosthesis) and 24 healthy control participants without any congenital or acquired deformity of face or body. Clinical and socio-demographic data were gathered from each person’s medical chart. Participants completed the Turkish version of the World Health Organization Quality of Life Instrument, Short Form (WHOQOL-BREF). Descriptive statistics, independent sample t-tests, Pearsons chi-square test, ANOVA, ANCOVA, and Pearson correlation were used to analyse the data.ResultsCompared with the control participants, patients with NP scored lower on the all domains of QOL and all three patient groups had lower scores on overall QOL and its domains of physical and environmental health. Patients with OP reported significantly lower physical health scores than those with AP, while patients with NP reported significantly lower overall QOL and psychological health scores than those with AP. Female patients had lower environmental domain scores than did male patients. The patient’s age and income correlated with social relationships QOL, while the patient’s income and the age of facial prosthesis were correlated with environmental QOL.ConclusionPatients with facial prostheses had lower scores in overall QOL, physical and environmental health domains than the control participants. Socio-demographic and clinical characteristics such as age, gender, income, localization of the defect, and age of facial prosthesis were associated with patients’ QOL. These findings may provide valuable information about the specific health needs of these patients that may affect their well-being. Further studies are needed to confirm these results. Use of the WHOQOL-BREF may provide valuable information for determining patients’ needs and priorities as well as for planning and developing comprehensive prosthetic rehabilitation programs.

Stress analysis of effects of nonrigid connectors on fixed partial dentures with pier abutments

STATEMENT OF PROBLEM In some patients, the pattern of missing teeth may require the use of a fixed partial denture (FPD) with an intermediate pier abutment. Information is needed regarding the biomechanical behavior and the position of a nonrigid connector for this treatment option. PURPOSE The purpose of this study was to evaluate, by means of finite element method (FEM), the effects of rigid and nonrigid design types on stress distribution for 5-unit FPDs with pier abutments. MATERIAL AND METHODS A 3-dimensional cross-section FEM model (SAP 2000) simulating a 5-unit metal ceramic FPD with a pier abutment with rigid or nonrigid designs (connector location at the mesial region of the second molar, at the distal region of the second premolar, at the mesial region of the second premolar, and at the distal region of the canine) was developed. In the model, the canine, second premolar, and second molar served as abutments. A supporting periodontal ligament and alveolar bone (cortical and trabecular) were modeled. A 50-N static vertical occlusal load was applied on the cusp of each abutment to calculate the stress distributions. Three different types of load were evaluated: loading of all cusps to simulate maximum centric occlusion contacts, loading of the canine to simulate a single anterior contact, and loading of the second molar to simulate a posterior contact. RESULTS The analysis of the von Mises stress values revealed that maximum stress concentrations were located at the load areas for all models. Also, for all models, the highest stress values were located at connectors and cervical regions of abutment teeth, especially at the pier abutment. CONCLUSIONS The area of maximum stress concentration at the pier abutment was decreased by the use of a nonrigid connector at the distal region of the second premolar.

Treatment outcome of extraoral implants in the craniofacial region.

Extraoral implants for the retention of facial prosthesis have been used for better support, stability, and retention. Other than the clinical experiences, treatment outcomes of these prostheses should be evaluated for predicting the long-term success. The aim of this study was to evaluate the survival rates and soft tissue responses of extraoral implants. In total, 52 patients were examined, including 16 with auricular defects, 16 with orbital defects, 13 with nasal defects, and 7 with midfacial defects. Data on implant length and location, radiation-treatment history, systemic diseases, and alcohol and cigarette use were collected and assessed, and data on the health of periimplant soft tissue were recorded for all of the defects. Statistical analyses were performed with t and &khgr;2 tests and correlation and regression analyses for the determination of the survival rate. According to results, the defect area has a significant effect on success rate. The overall success rate was found highest in the auricular area and least in the midfacial area. The presence of diabetes, alcohol use, and age were found as significant factors for implant loss, whereas smoking and radiotherapy were found as insignificant.

Facial defects restored with extraoral implant-supported prostheses.

A facial defect results in cosmetic, functional, and psychologic problems and acts as a difficult and challenging procedure for the maxillofacial surgeon and the prosthodontist. Retention of a facial prosthesis is an important key in the patients satisfaction and acceptance. The introduction of extraoral implant applications have been accepted as an advanced retention method. The purpose of this article is to report the results from our clinical experience with patients wearing facial prostheses anchored to extraoral ITI implants (Straumann, AG, Basel, Switzerland).

Fabrication of an auricular prosthesis using computed tomography and rapid prototyping technique.

This article describes the use of computed tomography and rapid prototyping method to produce a wax pattern of a missing ear. Computed tomographic scans were obtained from the patient, and a three-dimensional digital image was produced using a computer-aided design software. Then, the image of the present ear was extracted, and its mirror image was obtained with the software. The pattern of the inverted three-dimensional cast was produced using a rapid prototyping machine. The cast was duplicated in wax of identical dimensions and shape of the opposing ear, and the auricular prosthesis was fabricated with traditional methods.

A preoperative appliance for a newborn with cleft palate.

Cleft palate is a commonly observed congenital maxillofacial defect. One of the most important problems with clefts is the interference with feeding. An affected infant cannot produce negative pressure in the oral cavity and therefore cannot move the bolus backward to the pharynx. To obtain better nutritional intake prior to surgical correction, a palatal lift obturator is recommended. In this clinical report, a modified technique of obturator fabrication is presented. The new method uses a piece of tulle, a flexible and durable material that is frequently used in theater attire. With the help of this material, the bulb part is connected to the plate as a labile piece, and this connection acts like a natural velopharyngeal extension. Additionally, because of the softer property of the silicone elastomer, the posterior pharyngeal wall is less irritated.

A Modified Feeding Plate for a Newborn With Cleft Palate

Objectives Cleft palate is a common congenital maxillofacial defect. We wish to present the fabrication of a modified feeding plate that will adapt to the changing palatal and velopharyngeal morphology during function. Case Report A neonate with unilateral cleft lip and palate was referred to our clinic for the fabrication of a feeding plate. Intraoral examination revealed a cleft involving the uvula and the soft palate, with an alveolar defect on the left side. An impression was taken and a dental cast was obtained. A 1-mm Bioplast clear soft plate was pressed on the model. After trimming the edges of the plate, several retentive holes were made for its attachment to the hard plate. With the Bioplast soft plate replaced on the cast, plaster was used to cover parts of the soft plate that were not to come in contact with the hard plate. Biocryl resin was put on the retentive holes and 2-mm Biocryl C Rosa-transparent plate was pressed. The edges of the plate were cut, trimmed, and polished. Conclusion This modified feeding plate effectively obstructed the soft palate defect. The adaptation of the flexible bulb of the appliance with the soft palate was excellent. Evaluation with nasoendoscopy revealed the synchronized movement of the bulb of the appliance with the soft palate during swallowing. Soft extension of the feeding plate eliminated the risk of irritation, and the baby accepted the appliance easily.

Assessment of Implant Stability of Patients With and Without Radiotherapy Using Resonance Frequency Analysis

The purpose of this study was to clinically monitor the stability of dental implants in patients with and without a history of radiotherapy, using resonance frequency analysis over 1 year. The stability of patients with 80 implants was monitored with resonance frequency analysis (Osstell Mentor) over 1 year. Data were assessed with Mann-Whitney U test and correlation analysis. Irradiated maxillary implants showed statistically lower values than the mandibular implants at a significant level (P < .05).

The combined use of the nasal prosthesis with nasal stents

Severe and composite defects of the nose due to trauma or excision of neoplasms can cause significant functional and aesthetic problems. It has been known that nasal stents have been used to maintain the nasal patency and nostril shape for a long time. Recently, nasal prosthesis was introduced as a method to solve aesthetic problems of the patients who had an amputated nose. In the present study, nasal prosthesis combined with nazal stents was used to camouflage the nasal disfigurement and to maintain the nasal patency in two adult female patients. Functional and aesthetic results was accepted as satisfactory by both the patients and the physicians.

Quality of life assessment of implant-retained overdentures and fixed metal-acrylic resin prostheses in patients with marginal mandibulectomy

Statement of problem. Several factors affect the prosthetic outcome of patients with mandibular defects. However, it is questionable whether fixed or removable implant‐supported prostheses meet the expectations and satisfaction of the patients. The perspectives of these patients are important in managing the prosthetic treatment strategies. Purpose. The purpose of this prospective clinical study was to evaluate the satisfaction and oral health‐related quality of life of patients with marginal mandibulectomies with implant‐retained overdentures and fixed metal‐acrylic resin prostheses. Material and methods. Twenty‐two participants with marginal mandibulectomies were included in the study. They completed an oral health impact profile questionnaire designed for patients with edentulism (OHIP‐Edent) for the assessment of quality of life and visual analog scales (VASs) to validate their general satisfaction before treatment. Ten participants received 4 implant‐retained fixed metal‐acrylic resin prostheses, whereas 12 participants were treated with 2 implant‐supported overdentures. Six months after delivery of their prostheses, the participants completed the OHIP‐Edent questionnaire and VAS again. For the statistical analyses, Student t tests together with descriptive statistics (mean, standard deviation, frequency) were used in the 2 intergroup parameter comparisons that showed normal distribution. The Mann‐Whitney U test and Kruskal‐Wallis test were used for intergroup comparisons, and the Wilcoxon signed rank test was used for intragroup comparisons. Results. Compared with pretreatment mean values, a statistically significant (P<.05) decrease in mean scores of all OHIP‐Edent values and an increase in VAS scores were found in both groups. After patients were treated, their OHIP‐Edent values in the group with an overdenture prosthesis were higher than those in the group with a fixed metal‐acrylic resin prosthesis (P<.05). Conclusions. These results demonstrate that implant‐retained overdentures and fixed metal‐acrylic resin prostheses provide better function and, thus, oral health‐related quality of life for patients with marginal mandibulectomies.