Robert F. Wright

Craniofacial osseointegration of a large midfacial bone-anchored combination maxillofacial prosthesis: A clinical report

The combination of retentive clips and magnets has been used with favorable results for smaller facial prostheses. This patients large midfacial defect created the need for an attachment design that would retain an intraoral obturator prosthesis and a large silicone facial prosthesis. The advantages of this design include having an obturator that is separately attached by clips to the framework. This allows the patient more ease in insertion and removal of the prosthesis. It also allows for better oral hygiene. The magnets aid the patient in the proper alignment of the facial prosthesis. The O-ring attachment was not a complicated technique in this patients treatment. The patient can, without the use of a mirror, snap the rubber matrix O-ring attachment over the patrix attachment on the framework. This resulted in a retentive facial prosthesis, which helped the patient feel more secure. The silicone margins were well adapted to the patients skin, which allows the use of thin translucent margins and the elimination of the inherent problems associated with the use of adhesives.

FABRICATION AND USE OF A SURGICAL TEMPLATE FOR PLACING IMPLANTS TO RETAIN AN AURICULAR PROSTHESIS

A procedure is described for the fabrication of a 3-dimensional surgical template to guide the placement of implants to retain an auricular prosthesis. This procedure requires a diagnostic wax pattern that is checked while on the patient to ensure it is positioned correctly and is also the correct size. The wax pattern is processed into a clear, methyl methacrylate resin, 3-dimensional surgical template. The most effective type of surgical template for planning implant placement is a 3-dimensional acrylic template that closely resembles the final prosthesis. This template will direct the implant placement where the retentive elements are most easily concealed, under the thickest areas of the prosthesis, which are the antihelix and antitragus. This location allows the best esthetic and functional results. An additional advantage of this technique is that it allows the retrieval of the diagnostic wax pattern of the auricle so that it can be used to fabricate the definitive prosthesis.

Ten-Year Survey of Program Directors: Trends, Challenges, and Mentoring in Prosthodontics. Part 1: Munoz et al

PURPOSE This study consisted of two parts. Part 1 was a survey of US program directors, and Part 2 reports on the survey findings distributed to the deans of US dental schools. Both surveys evaluated observations of trends in prosthodontic education. The first survey (2005) of program directors and deans was published in 2007. This second survey was conducted in 2009. The 2009 survey provided 10-year data on trends in prosthodontics as reported by program directors. MATERIALS AND METHODS A national e-mail survey of 46 program directors was used to collect enrollment data for years 1 to 3 of prosthodontics training for US and international dental school graduates, the total number of applicants and applications considered, and the trends over time of applicants to prosthodontics for US dental school graduates and for international graduates. In addition, the program directors were asked to rank 13 key factors that may have contributed to any changes in the prosthodontic applicant pool. Program directors were also asked for information on student financial incentives and whether their programs were state or federally funded, and whether their sponsoring institution was a dental school. RESULTS Of the 46 program directors, 40 responded, for an 87% response rate. Respondents reported that 66% of their enrollees were graduates of US dental schools. Between 2000 and 2009 the applicant pool in prosthodontics nearly doubled, with 50% of the program directors reporting an increase in US-trained applicants, 42.5% reporting no change, and only 7.5% reporting a decrease. Using the Spearman correlation for the 10-year survey, there was a positive, statistically significant correlation that societys demand for a higher level of training and credentialing and interest in prosthodontics among dental students contributed to an increase in the number of US dental graduates applying to prosthodontic programs. Only four programs offered no financial packages to offset tuition. The remaining 36 respondents reported some financial package. Among the respondents, there were 23 state-sponsored programs and 6 sponsored by private universities; the remaining 9 were sponsored by hospitals or federal agencies. CONCLUSIONS A nearly doubled applicant pool and more US-trained applicants to prosthodontics ensure a much more competitive applicant pool for our specialty. In the 2009 survey, program directors reported that factors such as societys demand for a higher level of training and credentialing, interest in prosthodontics among US dental students, advances in implant, esthetic, and reconstructive dentistry, literature pertaining to the need of prosthodontists for the future, marketing of prosthodontics as a career, and the dollar value of prosthodontic training have all had some impact on increasing the mentored applicant pool to prosthodontic training in the United States.

A simple, expeditious method for placement of thermoplastic impression material for speech aid prostheses☆☆☆★

The dental literature has discussed the attention to detail required when making impressions for speech aid prostheses, but many operators often do not capture all the patient’s soft and hard tissue details when making either preliminary or definitive impressions for frameworks, castings, and baseplates.1-3 In maxillofacial prosthetics, one responsibility of the clinician is the reestablishing of palatopharyngeal integrity and providing the potential for acceptable speech by generation of the speech aid prosthesis. Speech aid prostheses constructed for patients with soft palate defects must function in concert with soft palate tissues displaying considerable movement, yet the objective of obturation is to provide the ability to control nasal emission during speech and to prevent the leakage of material into the nasal passage during deglutition. The use of a 20-cc or 30-cc plastic disposable syringe (B-D 30 cc syringe, Becton-Dickson and Co., Franklin Lakes, N.J.), in conjunction with Iowa wax (Miner, Concorde, Calif.), modeling plastic and a custom tray with loops or mesh work is a simple procedure to ensure detailed final impressions when capturing soft palate defects on a consistent basis. Iowa wax can also be used to impress maxillary hard palate defects to generate the bulb portion of an obturator. The operator may also use a functional impression technique to allow the wax to flow to the pharyngeal walls. This article describes a simple procedures that can assist the dentist in routinely capturing soft palate anatomic defects when making final impressions for speech aid prostheses.

Maternal antenatal stress has little impact on child sleep: results from a prebirth cohort in Mexico City

Study objectives: Maternal antenatal stress may influence offspring development and behavior, but any association with child sleep is unknown. Methods: From 2007 to 2011, we recruited pregnant women in Mexico City to the Programming Research in Obesity, Growth, Environment, and Social Stressors prebirth cohort. Mothers completed the Perceived Stress Scale (PSS, a 4‐item questionnaire assessing past‐month stress) and the Crisis in Family Systems measure assessing negative life events (NLEs; how many domains among the 11 assessed in which the mother experienced a stressful event in the prior 6 months)—with higher scores reflecting higher stress—and provided 5 timed salivary samples per day on 2 consecutive days, from which we derived cortisol area under the curve, slope, and awakening response. At age 4‐6 years, childrens sleep was estimated using accelerometry over a 7‐day period. We performed secondary analysis of associations of antenatal maternal stress with child sleep duration and efficiency (time asleep/time in bed) using linear regression adjusted for maternal and child characteristics. Results: Among 594 mother‐child dyads, mean antenatal PSS score was 5.2 (SD = 3.2) out of 16, and mean NLE was 3.2 (SD = 2) out of 11; child sleep duration was 7.7 hours (SD = 0.7), and sleep efficiency was 79% (SD = 6). There was no association between any of the stress measures—PSS, NLE, or salivary cortisol—and sleep duration or sleep efficiency in adjusted or unadjusted models. Conclusions: Among mother‐child dyads in a Mexico City cohort, antenatal stress was not associated with important changes in child sleep at 4‐6 years.

Procedure for construction of a custom tracheostomal obturator: a clinical report.

SUMMARY This clinical report describes the treatment of apatient with Congenital Central Hypoventilation Syn-drome using a simple impression procedure and pros-thesis fabrication. Treatment required only the basicinformation provided by the otolaryngologist, mea-surements were taken at the initial appointment, andbasic skills were used in fabrication of intraoral andextraoral prosthetic devices. It is recommended that theclinical phase of this procedure be performed in thepresence of an otolaryngologist. Patients who live withthis syndrome have undergone many trials physically,emotionally, psychologically, and socially. The presenceof this type of prosthesis has many advantages such asallowance of speech without obvious air leakage, andbeing relatively inconspicuous. Compared with the WRIGHT ET AL THE JOURNAL OF PROSTHETIC DENTISTRY OCTOBER 1999 389 Fig. 5. Ten-year-old girl with CCHS with tracheostomal obtu-rator assembly in place. Prosthesis is esthetically pleasing topatient and held in place through bulb on terminal end ofobturator with beaded necklace.