Kaushal Kishor Agrawal

Prosthodontic Rehabilitation in Sjogren's Syndrome with a Simplified Palatal Reservoir: Two Year Follow Up

PATIENTS A 45-year-old female patient came to the institute complaining of reduced salivation, pain and food lodgment in multiple teeth, and difficulty in eating. The systemic examination revealed dry eyes, dry mouth, cracking of corners of mouth and lack of appetite. The diagnostic tests were conclusive of Sjogrens syndrome, which is associated with xerostomia, ocular dryness and connective tissue disorders. Major oral problems in such patients include high caries rate, burning of oral mucosa, early tooth loss, increased tooth wear, poor tolerance for dentures and repeated failure of dental restorations. DISCUSSION Prosthodontic therapy for this unique patient group is challenging and neglected, due to limited choice of abutments, loss of vertical dimension and poor occlusion. Two-year follow up of a patient of Sjogrens syndrome who was rehabilitated by a combination of fixed and removable prostheses, with a simplified palatal salivary reservoir is presented. CONCLUSION Though the patient felt an improvement in quality of life due to the prosthesis, slurred speech and frequent reservoir refilling remained problems.

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.

Impact of delayed prosthetic treatment of velopharyngeal insufficiency on quality of life.

Palatopharyngeal dysfunction may take place when palatopharyngeal valve is unable to perform its own closing due to a lack of tissue (palatopharyngeal insufficiency) or lack of proper movement (palatopharyngeal incompetence). Palatopharyngeal insufficiency induces nasal regurgitation of liquids, hypernasal speech, nasal escape, disarticulations and impaired speech intelligibility. Prosthetic management of palatopharyngeal insufficiency requires a close co-operation between an otolaryngologist and a speech pathologist. As a result, the patient can be socially and physically rehabilitated with the improved speech quality as well as prevention of leakage of liquids.

Prosthodontic Rehabilitation in Sjogren’s Syndrome with a Simplified Palatal Reservoir: Two Year Follow Up

Sjogren’s syndrome is a distinct clinical condition which includes xerostomia, ocular dryness, rheumatoid arthritis and other connective tissue disorders. Major oral problems reported by such patients include high caries rate, burning of oral mucosa, early tooth loss, increased tooth wear, poor tolerance for dentures and repeated failure of dental restorations. Prosthodontic therapy for this unique patient group is challenging and neglected due to the limited number of abutments, loss of vertical dimension and poor occlusion. Two year follow up of a patient of Sjogren’s syndrome, rehabilitated by a combination of fixed and removable prostheses with a simplified palatal salivary reservoir is presented. Though the patient felt an improvement in quality of life due to the prosthesis, slurred speech and frequent reservoir refilling remained problems.

Mercury and other biomedical waste management practices among dental practitioners in India.

Objectives. The objective of the study was to assess the awareness and performance towards dental waste including mercury management policy and practices among the dental practitioners in North India. Materials and Methods. An epidemiologic survey was conducted among 200 private dental practitioners. The survey form was composed of 29 self-administered questions frame based on knowledge, attitude, and those regarding the practices of dentists in relation to dental health-care waste management. The resulting data were coded and a statistical analysis was done. Results and Discussion. About 63.7% of the dentists were not aware of the different categories of biomedical waste generated in their clinics. Only 31.9% of the dentists correctly said that outdated and contaminated drugs come under cytotoxic waste. 46.2% said they break the needle and dispose of it and only 21.9% use needle burner to destroy it. 45.0% of the dentists dispose of the developer and fixer solutions by letting them into the sewer, 49.4% of them dilute the solutions and let them into sewer and only 5.6% return them to the supplier. About 40.6% of the dentists dispose of excess silver amalgam by throwing it into common bin. Conclusion. It was concluded that not all dentists were aware of the risks they were exposed to and only half of them observe infection control practices.

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.

A study to evaluate the effect of oral stereognosis in acceptance of fixed prosthesis

AIMS The aim of the study was to evaluate and compare the oral stereognostic ability and satisfaction for fixed prosthesis in human being. MATERIALS AND METHODS The present study was carried out on 40 subjects, the purpose being to investigate the relation of oral perception to diagnostic and therapeutic procedures. Two types of cast metal crowns--one had morphology closely resembling original tooth and other one confirmed to ideal contours were constructed on endodontically treated posterior tooth. One cast metal crown was randomly selected from two cast metal crown and fitted on prepared tooth. Oral stereognostic score of subject was determined by correct response to questionnaire based on the recognition ability of subjects. Patient satisfaction level was checked by psychometric parameter Likert scale. Same procedure was repeated with other type of cast metal crown. RESULTS Data obtained were compared by paired and unpaired two sample t-test. Oral stereognostic score and satisfaction score were found to be higher for cast metal crown with morphology resembling to original tooth due to recognition and discriminatory ability of subjects and recall-memory. Oral stereognostic level was found to be higher in younger than older subjects. The level of satisfaction was found to be higher in older subjects than younger subjects. CONCLUSION It was concluded that acceptance of fixed prosthesis is not only based on dentists routine procedure of treatment and patients judgment about oral health, function, and esthetics, but also depends upon patients oral perception and discriminatory skill for external morphology of fixed prosthesis.

Stud Attachment Retained Mandibular Overdenture-A Case Report

Utilizing natural teeth to enhance support for prosthesis is not new in prosthodontics. Few teeth can be conserved in compromised edentulous ridge patients and be used to provide support to the prosthesis. The use of stud attachments allows the ability to the clinician to improve the retention of the prosthesis, thus allowing the patient to experience better comfort.

Evaluation of Intra-osseous Stability of Immediately Placed Implantsinto Infected Alveolar Socket

Purpose: To describe a protocol for the immediate placement of implant into infected alveolar socket. Materials & Method: A total number of 40 implants were placed immediately into extraction socket. The periapical conditions were different in all the cases (acute, endodontic and periodontal infection). Great care has been taken in debridement of the socket and extraction of tooth /teeth, guided bone regeneration along with the use of preoperative & postoperative anti-microbial agent. Results: All implants but three were osteo-integrated in six months to one year. Complications were related to the extraction process and bone regeneration process. Conclusion: Predisposing factors for failures are incomplete debridement of the socket, poor oral hygiene, incomplete closure of the wound, systemic factors like hormones. With this study we may conclude that an experienced maxillofacial surgeon may consider immediate implants as a viable treatment option for the patient having periapical infections.

CAD-CAM System: A Road for Pragmatic Maxillofacial Prosthesis

Neoplasms and trauma of the maxillofacial region are quite common. On their own (which one trauma or neoplasm?), or as a result of their surgical management, they can result in large acquired defects of the maxillofacial region. There are also certain syndromes and congenital conditions which lead to disturbed formation of facial structures. Patients suffering from such deformities face serious loss of esthetics, function and psychological compromise.