Jitendra Rao

Assessment of the quality of life in maxillectomy patients: A longitudinal study

PURPOSE To longitudinally assess the quality of life in maxillectomy patients rehabilitated with obturator prosthesis. MATERIALS AND METHODS Thirty-six subjects were enrolled in the span of 16 months, out of which six were dropouts. Subjects (age group 20-60 years) with maxillary defects, irrespective of the cause, planned for definite obturator prosthesis, were recruited. The Hindi version of European Organization for Research and Treatment of Cancer, Head and Neck version 1 of Quality of Life Questionnaire was used before surgical intervention and one month after definitive obturator. Questionnaire includes 35 questions related to the patients physical health, well being, psychological status, social relation and environmental conditions. The data were processed with statistical package for social science (SPSS). Probability level of P<.05 was considered statistically significant. RESULTS The quality of life after rehabilitation with obturator prosthesis was 81.48% (±13.64) on average. On item-level, maximum mean scores were obtained for items problem with teeth (1.87 ± 0.94), pain in mouth (1.80 ± 0.92), trouble in eating (1.70 ± 0.88), trouble in talking to other people (1.60 ± 1.22), problems in swallowing solid food (1.57 ± 1.22) and bothering appearance (1.53 ± 1.04); while minimum scores were obtained for the items coughing (1.17 ± 0.38), hoarseness of voice (1.17 ± 0.53), painful throat (1.13 ± 0.43), trouble in having social contacts with friends (1.10 ± 0.40) and trouble having physical contacts with family or friends (1.10 ± 0.31). CONCLUSION Obturator prosthesis is a highly positive and non-invasive approach to improve the quality of life of patients with maxillectomy defects.

The effect of osteoporosis on residual ridge resorption and masticatory performance in denture wearers

AIM To compare masticatory performance, masticatory efficiency and residual ridge resorption (RRR) in osteoporotic and non-osteoporotic edentulous subjects after rehabilitation with complete dentures. METHOD Thirty subjects fulfilling the inclusion criteria were enrolled from the patients visiting the Department of Prosthodontics for complete denture fabrication. Two groups consisting of control subjects (group I; N = 15) and osteoporotic subjects (group II; N = 15) were formed. Complete dentures satisfying certain criteria were fabricated for both groups. Masticatory performance and efficiency were measured 6 months after denture insertion. Areal measurements were taken on lateral cephalograms before and 6 months after denture fabrication. The data were then computed to analyse differences between groups I and II using SPSS statistical software version 15.0. RESULTS Six months after denture fabrication, the masticatory performance and efficiency were significantly higher (p < 0.001) for group I, with a significant decrease in maxillary and mandibular sagittal area seen in both groups. The rate of bone loss was more in group II compared with group I. CONCLUSION Greater masticatory function was demonstrated by the non-osteoporotic group, and the rate of RRR was more in the osteoporotic group compared with the normal group. In this pilot study, osteoporosis leads to greater RRR, decreased masticatory performance and efficiency in edentulous subjects 6 months after denture insertion. Screening for osteoporosis is suggested as a routine procedure for all edentulous subjects undergoing rehabilitation. Recall check-ups for osteoporotic patients should be more frequent, and these patients may require more frequent denture remakes.

Fabrication of a functional palatal saliva reservoir by using a resilient liner during processing of a complete denture

One of the major problems associated with xerostomic patients is the poor tolerance and retention of removable dental prostheses because of thin dry atrophic mucosa and lack of a saliva film. The use of salivary substitutes can improve lubrication, provide irrigation for dry mucosa, provide significant relief from symptoms, and also improve the retention of removable prostheses. These substitutes can be delivered over prolonged periods by using saliva reservoirs in the prosthesis itself. This report describes a novel technique for the fabrication of a functional palatal saliva reservoir in edentulous xerostomic patients. The technique uses a resilient liner in the floor of the reservoir. The tongue presses against the liner during swallowing, resulting in flow of saliva substitute through a hole in the anterior part of the floor of the reservoir.

Evaluation of the efficacy of a prosthodontic stent in determining the position of dental implants.

PURPOSE To evaluate the efficacy of a dual purpose (diagnostic and surgical) acrylic resin stent with gutta percha marker used in conjunction with 3D imaging in determination of the position and inclination of dental implants. MATERIALS AND METHODS This study was performed as a case control study. A total of 41 implants, of which 20 had been placed without the use of stents and 3D imaging (control group) and 21 were placed using stents and 3D imaging (study group), were studied. A diagnostic and surgical stent with radio-opaque indicator (gutta percha) was fabricated to determine the planned prosthetic position and inclination of the implant. Computed tomography images were obtained and were analyzed using Denta Scan software. The position of the implant was analyzed in mesiodistal and buccolingual dimensions in terms of both position and angulation. SPSS v15.0 was used for statistical analysis (p < 0.05 was considered statistically significant). RESULTS The study group demonstrated an overall 98.9% efficacy of the test technique being used in the study. On qualitative assessment, the results obtained were within the defined ideal threshold level for four of five parameters (distance from buccal and lingual cortical plate, inter-implant distance, and buccolingual angulation of the implant relative to underlying alveolar bone). For mesiodistal distance from adjacent teeth, the observation was not above threshold value for only one case. For the control group, the overall efficacy was 66.9%. CONCLUSION The technique of combined use of a prosthodontic stent and 3D imaging is an efficacious and better technique in achieving an ideal position of dental implants as compared to conventional techniques using periapical and panoramic radiographs and a cast.

Changes in alveolar bone density around immediate functionally and nonfunctionally loaded implants

STATEMENT OF PROBLEM Few studies compare the radiographic changes in bone density associated with immediate implant loading protocols. PURPOSE The purpose of this longitudinal study was to quantitatively assess radiographic changes in alveolar bone density around immediate functionally and nonfunctionally loaded implants. MATERIAL AND METHODS A prospective longitudinal study was conducted in which 20 participants with partially edentulous mandibles received implants that were immediately loaded either functionally (IFL) or nonfunctionally (INFL). Standardized intraoral periapical radiographs were made at baseline, 3, and 6 months. These were digitized and analyzed using the histogram tool of the GNU Image Modulation Program for changes in alveolar bone density at crestal and lateral apical levels around the implant. RESULTS An increase in the mean lateral apical pixel grayscale values of 4.68 ±0.80 at 3 months and 4.15 ±0.29 at 6 months was observed with IFL, while INFL demonstrated an increase of 5.66 ±0.53 at 3 months and 6.07 ±0.59 at 6 months. A decrease in the mean crestal pixel grayscale values of -24.40 ±7.41 with IFL and -16.86 ±5.14 with INFL was found from baseline to 3 months. CONCLUSIONS On the basis of this longitudinal study, it was concluded that immediate loading stimulated alveolar bone formation at 6 months after implant placement. The immediate functional loading of implants resulted in a significantly greater degree of bone demineralization at the alveolar crest from implant placement up to 3 months compared with immediate nonfunctional loading.

Improving prosthetic prognosis by connective tissue ridge augmentation of alveolar ridge

The contour of edentulous ridge should be carefully evaluated before a fixed partial denture is undertaken. The ideal ridge height and width allows placement of a natural looking pontic which facilitates maintenance of plaque-free environment. The localized alveolar ridge defect refers to the volumetric deficit of the limited extent of bone and soft tissue within the alveolar process. Such type of ridge defects can be corrected by surgical ridge augmentation that can be accomplished by the addition of either soft or hard tissues. This article describes a procedure of surgical connective tissue augmentation of a localized deficient alveolar ridge in the maxilla, followed by fixed partial denture, enhancing the esthetics, function and health.

Impact of Different Prosthodontic Treatment Modalities on Nutritional Parameters of Elderly Patients

PURPOSE To assess dietary and nutritional changes among the elderly following pros-thodontic rehabilitation. Another objective was to study the relationship, if any, between diet and nutrition, with extent of edentulism and different types of prosthodontic treatment. MATERIALS AND METHODS One hundred and thirty-five patients who satisfied the inclu-sion and exclusion criteria and agreed to be a part of the study after informed consent were recruited to this longitudinal study. Following selection, they were investigated on four aspects: dental examination, dietary assessment, anthropometric assessment, and serum biochemical assessment. All measurements were collected twice, first at baseline and then 6 months following prosthodontic rehabilitation. Treatment modalities included were complete denture (CD), removable partial denture (RPD), and fixed partial denture (FPD). The RPD group was of two types: distal extension prosthesis (RPDD) and tooth-supported prosthesis (RPDT). Change (post-pre) in outcome measures was compared by one-way ANOVA, and significance of mean difference between the groups was done by Tukeys honestly significance difference post hoc test. RESULTS The improvement in diet was found to be: CD > RPDD > RPDT > FPD. Significant improvement in weight (p < 0.001), BMI (p < 0.001), protein (p < 0.001), carbohydrate (p = 0.021), calorie (p < 0.001), iron (p = 0.002), and vitamin B (p < 0.001) in group CD as compared to partially edentulous patients (group RPDD + RPDT + FPD) was noted. The protein and calorie intake increased significantly in group RPD as compared to group FPD in partially edentulous patients. CONCLUSION Prosthetic rehabilitation becomes increasingly important as the level of edentulism increases to improve dietary, anthropometric, and biochemical parameters.

Removable partial denture with molar uprighting spring: an innovative hybrid appliance.

PATIENT A 45-year-old female patient with need of fixed replacement of her missing teeth which were lost long time before. Posterior teeth were severally tipped bilaterally in the edentulous space. Hybrid removable partial denture with molar uprighting spring was fabricated for molar uprighting on both side tilted molars. After 3 month and 15 days of treatment with hybrid appliance the molar abutment were uprighted for fabrication of fixed partial dentures. DISCUSSION The objective in molar uprighting is ideal positioning of the molar which will eventually become an abutment tooth for a fixed prosthesis. The ideal position will provide an optimal periodontal environment for the molar. The prosthodontic advantages of molar uprighting via distal tipping include an improved line-of-draw if a FPD is being constructed. Concept of designing of appliances was based on our basic knowledge of forces for uprighting the tooth along with maintaining the function during the treatment period. Another advantage of this appliance was that it prevented supra eruption of opposing teeth during the period when the molar was being uprighted. CONCLUSION Uprighting of tilted molar is extremely beneficial for long term success of fixed denture prosthesis by using hybrid appliances in very short period of treatment without hampering the function of the patient during the treatment period which is very economical as well.

Non-syndromic multiple supernumerary teeth in permanent dentition: a rare phenomenon

Hyperdontia or supernumerary teeth in the absence of associated systemic condition or syndrome is an uncommon phenomenon. Non-syndromic supernumerary teeth need to have periodical radiographic observation. In the case of asymptomatic condition, as they impacted in the jaw, a careful examination is necessary because they may develop into pathological status such as dentigerous cysts. Surgical removal of such teeth is indicated if evidence of any pathologies, such as cystic lesion, resorption, delayed eruption, altered eruption and displacement of adjacent teeth, is evident or have occurred.

Teledentistry in India: Time to deliver

Teledentistry is rapidly gaining momentum in modern day dentistry although, it has its roots long back in the past. In the 1990s, concept of teledentistry was introduced and Cook in 1997 defined this as the practice of using video-conferencing technologies to diagnose and advice about treatment over a distance. Like other health professionals, dentists have seen a lot of change over the years from extractions and dentures to digital technology that is taking dentistry to other level - creating practice possibilities hardly imaginable even 10 years ago. In India, large number of population and school going children are lacking basic oral health education and services and subsequently affecting their health in various forms of disease and addiction toward the ill habits. Implementation of a telehealth system can improve primary health-care services hence widen the reach of specialty care as well as can expand the chances for utilization of medical education and training by health care professionals and community members. Utilization of these services and teledentistiry in India can set up a pivotal role in expanding and improving the oral health and other related ill habits such as smoking and tobacco chewing etc., in large extent.