Glenn E. Minsley

Surgical and prosthodontic rehabilitation for a patient with aggressive florid cemento-osseous dysplasia: A clinical report

Florid cemento-osseous dysplasia is an extensive form of periapical cemental dysplasia, which usually involves 1 to 4 posterior areas of the maxilla and mandible. The affected area undergoes changes from normal vascular bone into an avascular cementum-like lesion. The lesion is usually benign; however, treatment of a secondary infection of this lesion can be difficult and complicated. This clinical report describes a rare but aggressive secondary infection of this type, which was successfully treated by a combination of complex surgical and prosthodontic procedures, including dental implant therapy.

Physiologic responses to maxillary resection and subsequent obturation

Aerodynamic assessment of prosthetic obturation provides the clinician with important information on adequacy of the seal between the oral and nasal cavities. The technique is easy to apply and provides quantitative data on effectiveness of obturation. In addition, the pressure-flow technique provides important information on how individuals respond to changes in the integrity of oral and pharyngeal structures. This study demonstrates that individuals with large surgical defects increase respiratory effort during nonnasal consonant productions in order to maintain adequate intraoral speech pressures. Successful obturation of the defect maintains the speech pressures while dramatically reducing respiratory effort.

A method of fabrication of a facial prosthesis that improves retention and durability: A clinical report

This clinical report describes a technique for the fabrication of a facial prosthesis with a visible light-curing resin overlaid with a silicone elastomer. Clinical observations have revealed considerable improvement in the duration of retention of the prosthesis with an adhesive and enhanced longevity of the prosthesis as compared with conventional silicone elastomer facial prostheses retained with the same adhesive.

Use of the afterloading technique for intraoral radiation carriers

A method for fabrication of a radiation carrier with an adaptation of the afterloading technique has been described. The use of the afterloading technique allows for quick and easy placement of multiple radioactive sources; thus time and exposure to the radiotherapist and the patient are minimized during the period of placement and activation of the prosthesis at the time of therapy.

Prosthetic Reconstruction of a Patient with an Acquired Nasal Defect Using Extraoral Implants and a CAD/CAM Copy-Milled Bar

Traditionally, patients with maxillofacial defects have been challenging to treat. A multitude of challenges associated with maxillofacial prosthetic treatment are not typically seen with patients who need conventional prosthodontic treatment. These types of patients generally require replacement of significant amounts of hard and soft tissues than do conventional prosthodontic patients. Most maxillofacial patients also warrant more emotional support than do conventional prosthodontic patients. Successful maxillofacial prosthetics still need to embrace the traditional goals of prosthodontic treatment: stability, support, retention, and esthetics. It is unlikely that a maxillofacial prosthesis will exactly duplicate the anatomy and function of missing or damaged structures. Although craniofacial implants (CFIs) have lower cumulative survival rates (CSRs) than intraoral endosseous implants, osseointegrated CFIs have proven to be significant adjuncts to improving retention of maxillofacial prostheses. However, CSRs of CFIs have been reported to be lower than CSRs for intraoral endosseous implants. Lately, computer-assisted design and computer-assisted machining (CAD/CAM) has been used in dentistry to facilitate fabrication of implant-supported frameworks. CAD/CAM protocols have numerous advantages over conventional casting techniques, including improved accuracy and biocompatibility, and decreased costs. The purpose of this paper is to review the literature on cumulative survival rates (CSRs) reported for CFIs and to illustrate the treatment of a maxillofacial patient using CFIs and a CAD/CAM copy-milled framework for retention and support of a nasal prosthesis.

Maintenance of intraoral pressure during speech after maxillary resection

Although structural defects such as cleft palate and severe anterior open bite alter vocal tract resistance, compensatory responses usually result in maintaining consonant pressures at an adequate level. The purpose of the present study was to determine if individuals with an acquired palatal defect spontaneously develop similar compensatory behaviors. The pressure-flow technique was used to measure aerodynamic variables associated with consonant production after surgery and obturation. Although intraoral pressures decreased considerably immediately after surgery, pressures were maintained at a mean level of 3.5-cm H2O. Respiratory volumes increased as much as fourfold without obturation and were normal with obturation. Voice-voiceless differences in air volumes among consonants were maintained even in the presence of the defect. These findings suggest that compensatory responses are directed toward maintaining an appropriate level of intraoral pressure for consonant production.

The effect of cleft palate speech aid prostheses on the nasopharyngeal airway and breathing

This study determined the effect of a speech aid prosthesis on resting breathing. Nasal cross-sectional area was measured during inspiration and expiration in eight cleft palate patients. The measurements were made for the unobturated defect during both phases of respiration and then repeated while the defect was obturated by a speech aid prosthesis. The results of the study revealed that the presence of a speech aid prosthesis significantly decreased the cross-sectional region of the nasal airway. In 50% of the subjects, the cross-sectional region was less than 0.40 cm2 with concomitant impairment in nasal respiration when the speech aid prosthesis was present in the oral cavity. The data suggest that the design of these prostheses should account for breathing requirements as well as for speech.