Kamleshwar Singh

A Multidisciplinary Approach for Management of Postenucleation Socket Syndrome with Dermis‐Fat Graft and Ocular Prosthesis: A Clinical Report

A contracted eye socket is a cosmetic blemish to the patient. It not only renders patients unable to wear an eye prosthesis, but also becomes a source of chronic discharge and irritation. Orbital implants allow for cosmesis and volume replacement of an enucleated or eviscerated eye. Alloplastic orbital implants are associated with potential complications, including exposure and extrusion. A dermis-fat graft offers the advantages of relative availability and an autologous nature. This article reports on a patient suffering from severe postenucleation socket syndrome after enucleation of the bulbus with postoperative irradiation of the orbit due to retinoblastoma and its subsequent management by a dermal-fat graft and ocular prosthesis. The purpose of this article is to emphasize the usefulness of dermal-fat grafting as a safe and stable orbital volume replacement following enucleation.A contracted eye socket is a cosmetic blemish to the patient. It not only renders patients unable to wear an eye prosthesis, but also becomes a source of chronic discharge and irritation. Orbital implants allow for cosmesis and volume replacement of an enucleated or eviscerated eye. Alloplastic orbital implants are associated with potential complications, including exposure and extrusion. A dermis-fat graft offers the advantages of relative availability and an autologous nature. This article reports on a patient suffering from severe postenucleation socket syndrome after enucleation of the bulbus with postoperative irradiation of the orbit due to retinoblastoma and its subsequent management by a dermal-fat graft and ocular prosthesis. The purpose of this article is to emphasize the usefulness of dermal-fat grafting as a safe and stable orbital volume replacement following enucleation.

Dental lamina cysts in a newborn infant.

Cystic lesions of transient nature viz. Epstein pearls, Bohns nodules and dental lamina cysts are frequently found in the oral cavities of newborn infants. These cysts arise from the developing dental tissues or from their remnants. These cystic lesions are not commonly seen by the dental surgeons due to their self-limiting nature and ignorance of the parents to seek the professional opinion. However, when contacted by anxious parents seeking treatment, dental surgeons should be able to explain and reassure the parents about the transient nature of these lesions and need for no treatment but regular follow-up. The present case report was written with the purpose to increase the awareness in dental surgeons about the peculiar clinical presentation and self-limiting nature of these cystic lesions, so that unnecessary surgical intervention can be avoided in such young infants.

Evaluation of various treatment modalities in sleep bruxism

STATEMENT OF PROBLEM Sleep bruxism (SB) is an oral condition that is associated with tooth wear, orofacial pain, and interference with sleep. The most recommended management technique is the use of an occlusal splint. Although the mandibular advancement device (MAD) has shown good results, few well-designed randomized controlled trials are available with which to compare these treatment options. Therefore, an evaluation of the effect of these 2 appliances on SB is needed. PURPOSE The purpose of this study was to evaluate the effect of a MAD and a maxillary occlusal splint (MOS) on the sleep quality and SB activity of participants with SB. MATERIAL AND METHODS In this randomized controlled trial, 28 participants were randomly supplied with either a MAD or MOS. The sleep quality of the participants was evaluated with the Pittsburgh Sleep Quality Index (PSQI) and their SB activity with electromyographic activity of the masseter with polysomnography. These variables were measured at baseline, 1 month, and 3 months. RESULTS Of 32 participants, 28 had data available for statistical analysis, as 4 participants did not return for follow-up examination. Both the MOS and MAD significantly reduced the PSQI and SB episodes and bursts in participants after 3 months (P<.05). The MAD provided greater reduction in SB episodes per hour after 3 months compared to the MOS. Participants supplied with a MAD reported more discomfort in their feedback form than participants using a MOS. CONCLUSIONS Both the MAD and MOS provided significantly improved sleep quality and a decrease in SB episodes at 3 months.

Effect of complete dentures on craniofacial growth of an ectodermal dysplasia patient: a clinical report.

The aim of this clinical report was to observe the effect of complete dentures on craniofacial growth and development of an ectodermal dysplasia (ED) patient. A complete anodontia patient diagnosed with ED was successfully rehabilitated with conventional complete dentures at the ages of 5, 8, and 10 years. Three sets of complete dentures were made with age-appropriate denture teeth and a bilaterally balanced lingualized occlusal scheme. Periodic follow-up and adjustment when needed was done to maintain proper oral function and esthetics. Serial cephalometric analysis exhibited a marked restriction of forward growth at the anterior nasal spine (ANS) point between 5 and 10 years of age, although there was little change from average in the anteroposterior length of the mandibular body and the height of the mandibular ramus. So, while maxillary growth was reduced, mandibular growth did not significantly change. Cast analysis showed that the increase in arch length was greater than in arch width for both the maxilla and mandible. There was little increase in alveolar ridge height in the anterior region but a considerable increase in the height of the alveolar ridge in the middle and the posterior region. Our findings concluded that the absence of teeth did not affect the growth of the jaws, and it is probable that the denture flange did not arrest the jaw growth, but rather improved the masticatory function by providing good denture stability and retention.

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.

Management of maxillectomy defect with a hybrid hollow bulb obturator

A woman having already undergone maxillectomy came to the department complaining of difficulty in eating and speech. During the construction of an obturator, the bulb area should be hollowed to reduce weight so that the teeth and supporting tissues are not stressed unnecessarily. The conventional open design drains fluid from the adjacent mucosa, possibly increasing the weight of the prosthesis, and is difficult to clean. The closed bulb design does not drain secretions and may cause obstruction and susceptibility to infection in the paranasal and pharyngeal regions, though it is easier to maintain. An alternative to the two designs, combining their advantages, is presented in this report. As the open hollow part of the obturator was shallow, it was easy to clean. Making the inferior part of the bulb hollow and closed led to a reduction in the overall weight of the prosthesis while increasing its resonance.

Management of trismus following radiation therapy by cost-effective approach.

Radiotherapy when used in head and neck cancer treatment can produce side effects in patients such as the trismus. If allowed to progress trismus can become so severe that the patient becomes debilitated due to lack of nutrition. Furthermore, trismus and limited oral access present a challenge to the clinician for dental treatment. This article describes a simple and cost-effective appliance for management of trismus.

An Impression Technique for Preserving Interdental Papillae

An esthetic revolution is occurring in dental profession. The esthetic treatment enhances appearance, improve smiles, restore function and raise self esteem. This is now well known that both teeth and gums make good smile and good facial esthetic. Sometimes while doing treatment in esthetic zone, impression procedure can cause strangulation of interdental papilla, causing loss of papillae. This article therefore describes a new impression technique that involves the matrix impression system and “every other tooth” technique.

Color matching in facial prosthetics: A systematic review

Color matching to the surrounding skin is extremely important in patients wearing maxillofacial prostheses. It is of utmost importance to know the different techniques of color matching and coloring in maxillofacial prostheses. The purpose of this study is to review the literature data with regard to color matching in maxillofacial prosthetics. An electronic search of peer review restricted to English language dental literature was conducted to identify the relevant scientific article on color matching and coloring in maxillofacial prostheses. The publication year was up to December 2015 so that the search could include all the articles provided in that particular database. Two independent observers independently read the abstracts and later preselected full-text articles. A full-text review was carried out only for 15 articles. Out of the 15 articles, 7 were related to coloring using tinting, spraying, milling, and use of commercial cosmetics. Three studies were related to shade matching in maxillofacial prostheses. Two studies conducted the measurement of color in maxillofacial prostheses. Only one study had explained color and its relevance in maxillofacial prosthetics. Only one study was done for reproducing silicone shade guide matching Indian skin color. In addition, a single pilot study was done to measure facial skin and lip color in a human population sample stratified by race, gender, and age. Currently, there is no evidence discussing the best technique available for perfectly matching the color for the fabrication of maxillofacial prostheses. However, the latest instruments such as spectrophotometer and colorimeters are believed to have improved efficiency in matching the color.

An In Vivo 24-Month Study to Compare Crestal Bone Loss and Pocket Depth of Platform-Switched Implants Placed in Maxillary Anterior and Mandibular Posterior Regions.

PURPOSE To analyze and compare crestal bone loss and pocket depth around platform-switched implants placed at two intraoral locations. MATERIALS AND METHODS Eighty platform-switched implants, 40 in the maxillary anterior region (group - ANT) and 40 in the mandibular posterior region (group - POST), were placed in healthy men aged between 25 and 45 years, and restored following two-stage surgical and progressive loading protocols. Digital radiographs for crestal bone level assessment and pocket depths on facial, mesial, distal, and palatal/lingual sites around the implant were recorded at definitive restoration cementation (baseline) and 6-month follow-up. Difference in pre- and post-periodontal pocket depths and crestal bone loss levels were measured and analyzed statistically using SPSS v.16.0, applying the Mann-Whitney test (p < 0.05 considered significant). RESULTS Mean bone loss was significantly higher in group ANT (1.2 ± 0.3 mm) than in group POST (0.7 ± 0.02 mm). Palatal pocket depth increase was significantly greater in the ANT group (p = 0.01), and distal pocket depth increase was significantly greater for the POST group (p = 0.002). CONCLUSION The amount of bone loss noted in the maxillary anterior region compared to the mandibular posterior region was significantly more. This could possibly be because of greater vertical cantilever and offset loads in the anterior compared to the posterior region. Significantly greater pocket depth in mandibular posterior distal and maxillary anterior palatal regions could be related to oral hygiene maintenance issues.