Dheeraj Koli

Influence of different forms and materials (zirconia or titanium) of abutments in peri-implant soft-tissue healing using matrix metalloproteinase-8: A randomized pilot study

Statement of problem. It is unclear how pathogenic bacteria adhere to different implant materials and whether biomarker matrix metalloproteinase‐8 (MMP‐8) level provides a reliable method of evaluating the connective tissue status of peri‐implant tissues. Purpose. The purpose of this pilot clinical study was to evaluate peri‐implant connective tissue response by assessing the MMP‐8 levels in peri‐implant crevicular fluid around titanium and zirconia abutments. Material and methods. The study was designed as a prospective, within‐subject comparison with left‐right randomization low. Twelve participants with partial edentulism were selected according to inclusion and exclusion criteria. Peri‐implant sulcal fluid sampling and pocket probing depths were assessed at 1, 3, and 12 months after placing the abutments. The MMP‐8 protein level of the peri‐implant sulcal fluid was determined by MMP‐8‐specific sandwich enzyme‐linked immunosorbent assay system. The independent t test or Wilcoxon test was used to compare MMP‐8 levels and probing depth assessment between the zirconia and titanium groups at different time points (1, 3, and 12 months). Repeated measures ANOVA was used for within‐group comparison of the MMP‐8 levels at 3 time points (&agr;=.05). Results. At 1 and 3 months, the titanium abutments showed significantly higher MMP‐8 levels and probing depths than the zirconia abutments (P<.05), but no significant differences were found at 12 months for either variable (P>.05). Conclusions. This study suggests the presence of more remodeling and/or inflammatory phenomena around titanium implant abutments than around zirconia abutments of a different design during the early stages but not at 1 year.

Correction of microstomia in an edentulous patient.

The problem of small oral aperture is big. Irrespective of the etiology, this problem may be overcome by adjunctive therapies in the form of prosthesis, surgery, or exercise. A patient is described with this problem, which was overcome by revisiting the 3 adjunctive therapies including a commissural stent designed with the patients edentulous state in mind.

Acrylic cranial implant: an alternative vector in management of cranial defect.

In a pediatric patient with cranial defect, in order to replace the missing portion of the cranium, an acrylic cranial implant was fabricated prior to the surgical procedure. The primary aim was to fabricate this cranial implant prior to the surgical procedure and with optimum fit. A customized hand-sculpted acrylic cranial implant fabricated by lost wax technique was made prior to the surgery and with adequate precision. The prefabricated cranial implant was used by neurosurgeons on the patient in order to restore the continuity of bone (by the acrylic cranioplast) over the cranial defect, improving the aesthetics and more importantly providing protection to the vital neural tissue. Though with recent advancements (like computer-aided design and manufacturing, and rapid prototyping), rapidity and precision can be achieved in the fabrication of cranial prosthesis, yet most of the apparatus may not be amenable in every setup and may not be affordable by all patients. A simple, operator-friendly technique which acquires satisfactory precision has been described for a patient much in need. Optimal postoperatory results were attained.

Checking the cheek bite injury: fabrication of an interim cheek guard appliance.

Among the various sequelae associated with the treatment of oral carcinoma (both surgical and radiotherapy), the two conditions that can be of serious concern are reduced mouth opening and mucositis. The limited mouth opening can lead to entrapment of buccal mucosa in between teeth during the chewing cycle, which in turn can lead to further injury of the mucosa. A simple method has been described by the authors to prevent the cheek bite by fabrication of a cheek guard appliance. Favorable results were seen within a few days after insertion of the appliance.Among the various sequelae associated with the treatment of oral carcinoma (both surgical and radiotherapy), the two conditions that can be of serious concern are reduced mouth opening and mucositis. The limited mouth opening can lead to entrapment of buccal mucosa in between teeth during the chewing cycle, which in turn can lead to further injury of the mucosa. A simple method has been described by the authors to prevent the cheek bite by fabrication of a cheek guard appliance. Favorable results were seen within a few days after insertion of the appliance.

Prosthetic rehabilitation of resected orbit in a case of mucormycosis

The design of orbital prosthesis to rehabilitate patients with orbital exenteration depends on the underlying clinical condition, material chosen for prosthesis, method of retention of the prosthesis, and and preference of the patient. Rehabilitation of a patient with orbital exenteration due to mucormycosis has been described by fabricating a prosthesis that used polymethyl methacrylate (to fabricate a conformer) and silicone material (to fabricate prosthetic superstructure). The two-component prosthesis was designed to attain dual mechanical retention using an anatomic undercut (conformer) and manually created mechanical undercut (prosthetic superstructure). The objective was to maintain the biological health of the underlying postsurgical tissue, longevity of the prosthesis, optimal esthetics, and adequate retention.

Cameo surface recording in complete denture fabrication using transcutaneous electrical nerve stimulation: A clinical report

Severe bone loss in patients with complete edentulism poses a treatment challenge. In fabricating a denture, the stability of the prosthesis must be enhanced by recording the cameo surface within the confines of the physiological position of the cheek and tongue muscles (the neutral zone) and by shaping it accordingly. The treatment of a patient with a completely edentulous maxillary arch and severe maxillary anterior bone loss is described. The cameo surface was recorded within the physiological limits during the fabrication of a complete denture by using transcutaneous electrical nerve stimulation (TENS).

Technique for adapting a spacer for a custom impression tray

A method of adapting a spacer for the custom trays used to make a definite impression for complete dentures is presented. The technique can be used under a variety of conditions and offers several advantages.

Alleviating speech and deglutition: Role of a prosthodontist in multidisciplinary management of velopharyngeal insufficiency

Surgical resection of soft palate due to cancer affects the effective functioning of the velopharyngeal mechanism (speech and deglutition). With the loss of speech intelligibility, hyper resonance in voice and impaired function of swallowing (due to nasal regurgitation), there is a depreciation in the quality of life of such an individual. In a multidisciplinary setup, the role of a prosthodontist has been described to rehabilitate such patients by fabrication of speech aid prosthesis. The design and method of fabrication of the prosthesis are simple and easy to perform. The use of prosthesis, together with training (of speech) by a speech pathologist resulted in improvement in speech. Furthermore, an improvement in swallowing had been noted, resulting in an improved nutritional intake and general well-being of an individual. The take-home message is that in the treatment of oral cancer, feasible, and rapid rehabilitation should be endeavored in order to make the patient socially more acceptable. The onus lies on the prosthodontist to practise the same in a rapid manner before the moral of the patient becomes low due to the associated stigma of cancer.

An Alternate Vista in Rehabilitation of Cranial Defects: Combining Digital and Manual Techniques to Fabricate a Hybrid Cranioplast.

The desired features of a cranioplast include providing an acceptable contour, continuity with the remaining skull (marginal adaptation), improvising the aesthetic outcome, providing a strengthened prosthesis to avoid fracture in case of repeat trauma, and protecting the remaining neurological structures. Combining digital and manual techniques to fabricate a hybrid polymethylmethacrylate cranioplast during the rehabilitation of a pediatric patient with cranial defect has been described. Utilization of digital techniques (rapid prototyping to obtain skull analog) and manual (hand) sculpting of the prosthesis strengthened with glass fiber enabled the authors to fabricate a hybrid cranioplast. Satisfactory outcome was achieved.

Fracture management of an edentulous mandible in a geriatric osteoporotic patient

Fracture of an edentulous mandible is a difficult task primarily due to the absence of teeth. The management becomes even more difficult if the patient is geriatric and osteoporotic. A simple technique of using bite block splint, maxillomandibular fixation screws, and intermaxillary fixation has been presented to enable healing of fracture of mandible in such cases. The technique, which crosses the boundaries of conventional fracture management provides, promising results with minimum morbidity thus imparting optimum quality of life ahead for the patient.