Vidya Kamalaksh Shenoy

Dental implications of bisphophonate-related osteonecrosis

OBJECTIVES The aim is to explore the current theories about clinical , pathological and dental management of bisphosphonate related osteonecrosis of the jaws. Also discussed are the actions of bisphosphonates, pathogenesis related to the susceptibility of jaws, the predisposing risk factors for the development of bisphosphonate-related osteonecrosis of the jaws (BRONJ) and diagnostic criteria based on the literature review. DISCUSSION Osteoporosis is a disease that generally affects the mineral status of both cortical and trabecular bone in post menopausal women. Bisphosphonates are a group of drugs that preserve and increase bone mass. Bisphosphonate drugs are classified according to use and method of delivery. The bisphosphonates used for the treatment of osteoporosis are taken orally. Little is known about the side effects and dangers of the long-term use of therapeutic doses of Bisphosphonates. A recent complication reported is osteonecrosis of jaws. The use of IV bisphosphonates for multiple myeloma and metastatic bone diseases suggests that dosage, length of treatment, and route of administration, as well as cofactors such as use of glucocorticoids and immunosuppressive agents, and dental surgery, could all be related to the incidence of BRONJ. This review provides an update on current knowledge about clinical, pathological and management aspects of BRONJ. CONCLUSIONS Little evidence exists to direct the prosthodontic management of patients with a history of bisphosphonate use. Patients with active osteonecrosis related to bisphosphonate use have reduced tissue tolerance to function with removable prostheses and decreased potential for osseointegration of dental implants. Decisions should be based on clinical judgment tempered by the presenting conditions, medical profile, and patient needs. A better understanding would help in a dental setting to prevent any complication and help to improve the prognosis for those being treated for osteoradionecrosis.Until further evidence emerges regarding management of patients with active bisphosphonate- related osteonecrosis, conservative prosthodontic treatment is reasonable and prudent.

Evaluation of satisfaction with masticatory efficiency of new conventional complete dentures in edentulous patients ‐ a survey

BACKGROUND Knowing how patients really feel after treatment is, very often, as relevant as the success rate of the conventional dentures and it can even be the measurement of masticatory function. AIM AND OBJECTIVES This questionnaire survey aimed to analyse the satisfaction level and masticatory efficiency of patients treated with conventional complete dentures. DESIGN AND SETTING   Thirty edentulous patients were considered in the study. Satisfaction level and masticatory efficiency were analysed based on specific questionnaires for edentulous patients and by a likert rating scale from 0 to 5, at three moments: Prior to treatment (edentulous period), after the insertion of the new dentures and at 30-45 days follow-up. MATERIALS AND METHODS Thirty patients including 12 male and 18 female patients (mean age 65 years), who voluntarily came for the services. T-test was applied at three different levels. RESULTS The rehabilitation with conventional complete dentures produced an improvement (p < 0.05) in satisfaction level and masticatory efficiency. CONCLUSION Thus, those patients who were edentulous previously and dissatisfied with their masticatory ability showed improvement after receiving a new set of conventional complete dentures.

Resilient liners: a review.

Resilient liners when used intelligently are an excellent adjunct in removable prosthodontics. However, currently they have to be best considered as temporary expedients because none of the advocated permanent liners have life expectancy comparable to resin denture base. This article reviews the literature regarding their composition, functions, gelation characteristics, bond strength and influence on denture bases. It also presents their drawbacks and attempts made to extend their longevity. A Medline search was completed for the period from 1986 to 2007, along with a manual search, to identify pertinent English peer-reviewed articles and textbooks.

Pharmacological Agents in Dentistry: A Review.

All clinicians should be fully aware of the recent trends in their speciality to enable them to provide effective and successful treatment to their patients. One vital aspect of the treatment is that the clinician should constantly update his knowledge on the drugs being administered during the course of treatment and their interactions. The purpose of this article is to review the current pharmacological agents being used in Prosthodontics along with their interactions and indications. The paper mainly focuses on Therapeutic drugs and drugs that aid in prosthodontics treatment. Therapeutic drugs include local anesthetics, antiseptics, steroids, analgesics, antimicrobials, antifungals, antianxity drugs, centrally acting muscle relaxants. Drugs that aid in prosthodontics treatment include astringents, vasoconstrictors, hemostatic agents, sialogogues, anti-sialogogues, denture cleansers, gum paints, denture cleansers, denture adhesives, ORAL protective agents and demulcents. An odontologist should have sound knowledge of the benefits and drawbacks of all these agents. This will enable the clinician to provide a safe and predictable treatment to the patients.

Changing face of infection control: Dental unit water lines

The quality of dental unit water is of considerable importance since patients, staff are regularly exposed to water and aerosols generated from the unit. The contamination of dental unit waterlines (DUWL) is an issue that is of great concern to the dental profession, including Prosthodontics since the water in these lines has the capacity for rapid development of biofilms combined with the generation of potentially contaminated aerosols becoming an ideal environment for the growth of microorganisms. This article describes the conditions in waterline tubing that favour development of biofilms and discusses the level of risk that such microbial growth poses for both dental professionals and their patients. It is stressed that very few cases of infection have been linked directly to contamination in dental unit waterlines. Finally, potential solutions for minimizing risks are presented and discussed.

Single tooth implants: Pretreatment considerations and pretreatment evaluation

Today, implants are considered as a first treatment option to replace missing teeth due to the considerable advantages over the other available options. The ultimate goal of implant treatment is to restore natural esthetics, function, long term health, and patient comfort. Hence, case selection and treatment planning are very crucial to achieve longevity and predictability of the restoration. This article presents a step-by-step protocol for gathering and analyzing the various factors at the pretreatment evaluation stage to set the groundwork for a dentist to consider implant as a restorative option. Clinical Relevance to Interdisciplinary Dentistry To help the restorative dentist to identify the ideal implant receptor site. Sound periodontal and restorative status is prerequisite to consider implant treatment as an option. Restorative driven implant placement is paramount for overall integrity of the dentition.

Iatrogenic dentistry and the periodontium

The health of the surrounding hard and soft tissues is important for the optimal functioning of the natural dentition. The dentist plays a positive role in maintaining the health of the diseased oral tissues if a careful and meticulous diagnosis, treatment planning and treatment procedures are carried out. On the other hand, the dentist may be incriminated in perpetuating damage to the tissues as a result of injudicious / careless dental therapy. This article is a review on the implications of common dental procedures for the periodontium.

Iatrogenic complications of implant surgery

Implants have gained tremendous popularity in modern dental practice and their placement in the edentulous region for the prosthetic reconstruction has become routine. Four essential steps in the use of dental implants, are careful selection of the patient, correct choice of the implant, proper surgical technique and precise prosthetic replacement. The operator’s knowledge and skills have a significant role in each of these steps and each step is as important as others. Neglect in any one can result in iatrogenically induced damage. This article describes some of the commonly occurring iatrogenically induced complications during implant surgery and provides some guidelines to prevent the same.

Prosthodontic status and needs of elderly institutionalized residents in Mangalore: a prospective study.

AIM The aim of the present study is to assess the prevalence of Kennedys classification, status of existing prosthodontic appliances if any, awareness of the subjects regarding various treatment options, and treatment needs in a group of elderly institutionalized residents. MATERIALS AND METHODS The subjects were selected from various old age homes present in Mangalore city, with ages ranging from 60 to 80 years. The subjects were interviewed and examined by a single trained examiner and findings were recorded on a clinical case history report sheet. RESULTS Kennedys class I was most prevalent and class IV the least. Among the subjects examined, only 12.4% were wearing prosthesis. Based on the Nevalainens index and Karslons index, most of the prosthodontic appliances were found to be in poor condition. 86% of the subjects were in need of prosthodontic treatment. 75% of the subjects interviewed were unaware of the treatment options available. CONCLUSION The elderly patients living in institutions do not achieve a deserving and satisfactory oral health care. The oral care assistance in institutionalized elderly patients has been an unfulfilled service.

Effect of exposure time of eugenol containing temporary cement on tensile bond strength of permanent restorations luted with Self-Adhesive dual cure resin cement-An in vitro study

Purpose: This study was conducted to evaluate the tensile bond strength and fracture mode of permanent restorations luted with self-adhesive resin luting agent following provisional cementation with eugenol containing luting agents