Saumyendra V. Singh

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.

Platform Switching: A Narrative Review

Statement of the Problem:Bone loss around the implant is 1 of the important factors affecting its success. Fitting an abutment of smaller circumference in comparison with the implant is known as platform switching. The concept gained importance as investigations found reduced crestal bone loss around such implants. Several studies have been conducted to understand its efficacy, mechanism of action, and the extent of switching that would provide best results. Methods:Public databases were researched to assess if the concept of platform switching was helpful in reducing bone loss around dental implants using relevant keywords. Results:Most of the studies supported the use of switched platforms with only 1 reporting no effect of switching. No study reported any harmful effect of switched platform either on bone quality or on success of implants. Conclusions:Platform switching seems to be successful in reducing bone loss around dental implants. Further research regarding its exact mechanism of action would help explain and improve the success rate of implants.

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.

A pilot study to evaluate posttreatment cephalometric changes in subjects with OSA.

STATEMENT OF PROBLEM Obstructive sleep apnea (OSA) is a life-threatening condition that is diagnosed and evaluated primarily by polysomnography (PSG). The procedure is time consuming, expensive, and inconvenient for the patient, and may not be universally available. PURPOSE The purpose of this pilot study was to evaluate posttreatment results on lateral cephalograms in patients with OSA. MATERIAL AND METHODS Lateral cephalograms of 16 patients diagnosed with OSA were made at the beginning of treatment and 4-6 weeks following treatment. Treatment modalities used in the study were the mandibular advancement device (MAD) and continuous positive airway pressure (CPAP) therapy (n=8). Pharyngeal dimensions, soft palate area and angle, and hyoid bone position were recorded for the comparisons. The data were analyzed using Students t test for the parametric analysis (alpha=.05). RESULTS A significant increase in the pharyngeal area (P<.001), a significant decrease in the soft palate area (P<.001), and vertical changes in the hyoid position were observed, with no significant change in the anteroposterior position of the hyoid bone. CONCLUSIONS Within the limitations of this pilot study, lateral cephalograms were shown to be useful in evaluating treatment efficacy in subjects with OSA.

Prosthetic Rehabilitation Following Socket Reconstruction with Blair‐Brown Graft and Conformer Therapy for Management of Severe Post‐Enucleation Socket Syndrome – A Clinical Report

One of the most common tumors of the eye diagnosed in childhood is retinoblastoma, which mandates enucleation with adjunctive chemotherapy and radiotherapy to save the patients life. The most common late enucleation complication is post-enucleation socket syndrome (PESS), which poses a management dilemma for the prosthodontist and surgeon, along with being a major esthetic concern for the patient. The reconstruction of such sockets is complex. The purpose of this clinical report is to describe the rehabilitation of such a pediatric patient with severe PESS. The patient was successfully rehabilitated by presurgical conformer therapy, socket reconstruction surgery with non-meshed intermediate split thickness skin graft (STSG)/Blair-Brown graft, and postsurgical conformer stent. This was followed by fabrication of a custom ocular prosthesis, to achieve favorable functional, physical, and psychological effects.

Bisphosphonate Therapy for Skeletal Malignancies and Metastases: Impact on Jaw Bones and Prosthodontic Concerns

Healthy jawbones ensure better tooth anchorage and the ability to masticate and maintain metabolism. This is achieved by a delicate balance between bone formation and resorption in response to functional demands. An imbalance in the expression of receptor activator of nuclear factor kappa-B (RANK) ligand (RANKL) and osteoprotegerin (OPG) or osteoclastogenesis inhibitory factor (OCIF) is believed to be the underlying mechanism of osteolysis in metastases, multiple myelomas, and cancer therapy-induced bone loss in patients. Considered mainly as bone-specific agents to treat postmenopausal osteoporosis, bisphosphonates, in combination with certain chemotherapeutic agents have proved to be effective in prevention of tumor formation and metastatic osteolysis in bone tissue. Osteonecrosis of the jaws associated with them has, however, been of grave concern to the prosthodontist, as it predisposes patients to a bone-deficient basal seat for dental prostheses. This manuscript reviews available information over the past 13 years on possible mechanisms of bone loss, bisphosphonate-induced osteonecrosis of jaw bones, and prosthodontic concerns.

A modified approach of impression technique for fabrication of finger prostheses.

Background and Aim: The custom-made finger prosthesis is aesthetically acceptable and comfortable for use in patients with amputated fingers, resulting in psychological improvement and physiological well being. The success of the prosthesis depends on the precision of planning the prosthesis, making the impression, carving the model and choosing the material that best suits the concerned circumstances. In this article a simplified method was used regarding an accurate impression of partially amputated fingers. Technique: A plastic cylindrical small open container (impression cap) was used for making an impression of the fingers. A wax pattern of the missing part was made by replicating the same fingers of the other hand with melted modelling wax after slight modification. This pattern was finally cured with silicone material. Discussion: In the present technique, a modified approach of impression making was used for getting an accurate fit of the finger prosthesis with improved aesthetics, which is one of the most important criterion for the success of any prosthesis. Clinical relevance The present article provides a simplified approach for fabrication of partially lost finger prosthesis.

Full mouth rehabilitation of hypomaturation type amelogenesis imperfecta: A clinical report

PROBLEM CONSIDERED This clinical report describes the prosthodontic treatment of an 18-year-old female diagnosed with amelogenesis imperfecta. MATERIALS AND METHOD The specific objectives of the treatment were to restore esthetics and masticatory function. Metal-ceramic fixed partial dentures were fabricated at the existing vertical dimension of occlusion utilizing the PMS occlusal scheme. RESULTS Clinical examination of the patient 12 months after treatment revealed no evidence of disease or degeneration of the restored teeth. CONCLUSION The patients esthetic and functional expectations were satisfied.

Prevalence of dental myths, oral hygiene methods and tobacco habits in an ageing North Indian rural population.

BACKGROUND AND OBJECTIVES Though increased emphasis is being given to expanding dental care facilities and awareness in Indian villages, the target population is unfortunately less literate and financially-equipped compared to their urban counterparts. This study attempted to evaluate dental myths, oral hygiene methods and beliefs, and tobacco habits present in a rural ageing population. MATERIAL AND METHODS The study area consisted of a group of 10 villages, situated in the district of Lucknow, Uttar Pradesh, India. The sample comprised 681 people aged 50 years or above. The subjects were questioned about dental myths, tobacco habits and oral hygiene methods and then divided into groups on the basis of age, gender, and educational status. Mean values, standard deviation, chi-square test, t-test and p values were used to obtain inter-group comparisons. RESULTS Forty percent of the subjects considered oral hygiene unnecessary, with 61% relying on simple mouth rinsing for maintaining oral hygiene, 48% either smoked and chewed tobacco or both and 81% had one or more dental myth. CONCLUSION The results showed that the rural ageing population is deprived and a targeted programme to spread scientific dental practices to them is necessary.

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.