Manawar Ahmad

An Evidence Based Restoration of Esthetically Challenged Maxillary Anterior Arch with Andrews Bridge System - A Case Report with 5 Years of Follow Up

The replacement of missing teeth and restoration of alveolar contour has always presented a problem in those patients who have suffered traumatic injuries to the anterior dentition and alveolar processes. Many of these injuries lead to excessive loss of the residual ridge and make it extremely difficult to restore with a conventional fixed prosthesis. Due to constrain of fixed pontic in relation to these residual ridges, the use of this modality is virtually eliminated as a successful means of restoring such defects. An approach to the treatment in such patients has been conceived whereby a removable pontic section is supported directly by adjacent abutment teeth in a manner similar to that of fixed prosthesis. This case report represents restoration of esthetically compromised partially edentulous maxillary anterior arch with a fixed-removable prosthesis. This article also illustrates the indications, advantages, disadvantages and limitations of the Andrews bridge system.

A comparative evaluation of linear dimensional accuracy of the dies obtained using three conceptually different die systems in the fabrication of implant prosthesis: an in vitro study.

STATEMENT OF PROBLEM Given that meticulous implant prosthodontic procedures are recommended to obtain the best possible intraoral fit, the die systems used for multi implant casts warrant further investigation. Die stone expansion and errors introduced by removable die casts may exceed the accuracy required for the passive fit of implant prosthesis. PURPOSE The purpose of the study was to evaluate the linear dimensional accuracy between the implant master die and three conceptually different die systems such as Pindex system, Accu-trac precision die system, and Conventional brass dowel pin system. MATERIALS AND METHODS Thirty impressions of implant master die were made with polyether impression material. Ten experimental implant casts were fabricated for each of the three different die systems tested: Accu-trac precision die tray system, Pindex system, and conventional brass dowel pin system. The solid experimental casts were sectioned and then removed from the die system 30 times. Linear distances between all six possible distances were measured from one centre of the transfer coping to the other, using a co-ordinate measuring machine in millimeters up to accuracy of 0.5 microns. Data were tabulated and statistically analyzed by Binomial non parametric test using SPSS version 15. RESULTS Significant differences were found for distance A-B (P = 0.002), A-C ( P = 0.002), A-D (P value = 0.002), and B-D ( P = 0.021) in Conventional Dowel pin system however for Accu-trac precision die tray system, it was significant only for distance A-D (P = 0.002) but for Pindex system it was non-significant for all the distances measured. CONCLUSION Within the limitations of this study, use of Pindex system is recommended when sectioned dies are needed for a multi implant retained prosthesis.

An innovative technique to restore velopharyngeal incompetency for a patient with cleft lip and palate.

Treatment of cleft lip and palate patients often demand well-coordinated work of medical and dental specialists. In spite of surgical and orthodontic therapy, prosthetic rehabilitation is always necessary because of partial anadontia, maxillary hypoplasia and velopharyngeal dysfuction. The aim of the prosthetic treatment is to improve aesthetics, function and speech of the patients; however, factors like underdeveloped and collapsed maxillary arch, retrognathic maxilla and reduced alveolar ridge height make the treatment challenging. This clinical report describes an interdisciplinary approach for the management of cleft lip and palate patient associated with mutilated dentition. The prosthetic phase began along with orthodontic treatment to achieve sufficient space distribution, which was restored with fixed dental prosthesis to stabilise the achieved status of occlusion. Palatal lift prosthesis was fabricated to restore the velopharyngeal incompetency with an innovative technique using ‘standard orthodontic expansion screw’ to eliminate hypernasality, decrease intelligibility of speech and to aid in deglutition.

Esthetic and Functional Rehabilitation of moderately mutilated Dentition with Multidisciplinary Approach

Treatment of patients with severely mutilated dentition is a challenging task for a dentist and needs specialized skills with multidisciplinary approach for treating a complex clinical situation. Multiple carious lesions, tilting and rotation of several teeth, grossly decayed teeth and loss of multiple teeth in the maxillary, and mandibular arch may lead to the severely mutilated dentition. Dentist doing oral rehabilitation of a severely mutilated dentition must be through and efficient with the principles of reconstruction as an architect who prepares detailed plans and specification for any building prior to construction. Careful treatment planning using fixed or removable prosthesis is required to manage such cases to get a favorable prognosis. A multidisciplinary approach is required to restore the severely mutilated dentition to achieve the freedom from all the dental diseases, to maintain the healthy periodontium, to stabilize the temporomandibular joints, to achieve a stable occlusion with optimum esthetics, and comfortable oral function.

Implant placement with guided bone regeneration in the maxillary aesthetic zone - A case report with 3 years of follow up

The placement of implants in a prosthetically driven position depends on the quantity and quality of available bone especially in the anterior region of maxilla. Implant placement and its restoration becomes clinically challenging when the alveolar ridge lacks sufficient bone volume. Additional surgical procedures are required to augment the bone deficiency in such clinical situations. Advanced procedures such as guided bone regeneration provides a conducive environment for successful placement of implants, where non-osseous cells are inhibited and osteoblast derived from the periosteum and the bones are induced to form new bone. This article presents a case report of simultaneous approach of guided bone regeneration and implant placement in the maxillary anterior with narrow ridge defect. After six months of healing period implant was aesthetically restored. Correspondence to: Manawar Ahmad, Assistant Professor, Department of Prosthetic Dental Sciences, College of Dentistry, Jazan University, Saudi Arabia, E-mail: ahmad955mls@gmail.com

Reconstruction of esthetically compromised maxillary anterior teeth with CAD CAM zirconia crowns – A case report

The advancement of new technologies for the creation of biomaterials has been inspired by the demand for materials, capable of bearing new specifications and applications. Ceramic materials based on alumina (Al2O3) and zirconia (ZrO2) is used as material of choice for fixed dental prosthesis due to their excellent properties, such as strength, corrosion resistance and biocompatibility. Full coverage zirconiabased ceramic crowns with knife edge preparations can offer a good esthetic result with minimum tooth preparation combining strength and could be considered as a treatment option in selected clinical cases. All-ceramic frameworks are fabricated from zirconium oxide and veneered in the layering technique. Additional advantages of the zirconia based all ceramic restorations are the esthetic characteristics, the biocompatibility and durability. They also show increased abrasion resistance, color and contour stability, appropriate translucency and excellent tissue response due to minimal plaque accumulation. Correspondence to: Manawar Ahmad, Assistant Professor, Department of Prosthetic Dental Sciences, College of Dentistry, Jazan University, Saudi Arabia, E-mail: ahmad955mls@gmail.com

A conservative approach to replace missing teeth in the aesthetic zone with Maryland bridge – A case report

Restoring the missing central incisors in the mandibular jaw is one of the most difficult esthetic challenges in dentistry. A space in the mandibular anterior region of the dental arch can produce a psychological impact on the young patient. Resin bonded bridges are highly effective treatment option in these situations to restore the oral function and aesthetics and result in high levels of patient satisfaction. Maryland bridges are the type of resin bonded bridge with certain advantages over conventional fixed dental prosthesis such as minimal removal of the tooth structure, minimal potential for pulpal trauma, supra gingival margin preparation and reduced time and cost. Provisional restorations are usually not required. Maryland bridges are cemented to the abutment tooth using electrolytic etching of the metal surface to retain the metal framework. After etching of the metal, the bond is stronger between the tooth surface and the prosthesis. The bridge retention has been enhanced by the development of resin cements which bond chemically to both the tooth surface and the metal alloy. However, there are certain limitations of resin bonded prosthesis such as short clinical crowns, long edentulous spans, restored or damaged abutments, para-functional habits, deep bite and compromised enamel hyperplasia. This case report mentions the advantages, disadvantages, indications, contraindications and a simplified technique to restore the missing mandibular central incisors in a young adult patient with fabrication of Maryland bridge. Correspondence to: Manawar Ahmad, Assistant Professor, Department of Prosthetic Dental Sciences, College of Dentistry, Jazan University, Saudi Arabia, E-mail: ahmad955mls@gmail.com

Comprehensive Rehabilitation of Partially Amputated Index Finger with Silicone Prosthesis: A Case Report with 3 years of Follow Up

The loss of all or part of a finger following traumatic amputation may have a negative impact on physical and psychological well-being. An esthetic prosthesis can offer psychological, functional, and rehabilitative advantages. One of the major problems associated with somato-prosthetic replacement of partially amputated finger is inadequate retention of the prosthesis. This may stem from the weight of the prosthesis, inadequate tissue support, and/or the particular area of the finger to be replaced. A number of means have been employed to enhance retention. Among the more common are adhesives, adhesive tape, magnets and implants. The purpose of this article is to describe a technique which eliminates the need for adhesive materials and utilizes copper wire to fabricate a finger ring as a primary means of retention. This technique can be utilized whenever the prosthesis encompasses more than 180° of the affected area. This clinical report presents a case of rehabilitation of a partially amputated index finger defect and describes a method of retention for the same with a copper ring.

Replacement of missing anterior tooth using screw retained implant prosthesis in the esthetic zone: a case report with 3 years of follow up.

As more and more dental practitioners are focusing on implant-supported fixed restorations, some clinicians favor the use of cement retained restorations while others consider screw-retained prosthesis to be the best choice. As both types of prostheses have certain advantages and disadvantages, clinicians should be aware of the limitations of each type. Screw-retained implant restorations have an advantage of predictable retention, retrievability and lack of potentially retained sub-gingival cement. However, a few disadvantages exist such as precise placement of the implant for optimal and esthetic location of the screw access hole and obtaining passive fit. On the other hand, cement retained restorations eliminates unaesthetic screw access holes; have passive fit of castings; reduce stress to splinted implants because of minor misfit of the framework; reduced complexity of lab procedures; enhanced esthetics; reduced cost factors and non disrupted morphology of the occlusal table. This case report presents the replacement of missing left central incisor using screw-retained implant prosthesis due to palatal trajectory of the implant placement and inadequate abutment height for retention of cement retained prosthesis.