Restorative Management of A Patient With Pronounced Gag Reflex: A Case Report

@#Patients with hyperactive gag reflexes pose challenges when undergoing routine dental procedures, and this can create difficulties in their treatment. The subsequent issues that dentists face in executing the proposed treatment plan could hinder optimal patient care and reduce the overall success of the treatment. The clinician should be skilled in diagnosing as well as competent when managing the care of patients presenting with a hyperactive gag reflex. This paper discusses a technique utilizing telescopic copings and a long-span fixed partial denture as an alternative to fixed implant restoration on a patient with a pronounced gag reflex.

Customization of attachments in tooth supported overdentures: Three clinical reports

In elderly patients with few remaining teeth, overdenture is a good treatment option. Roots beneath the denture protect the alveolar ridge, offer proprioception and improve retention, stability and masticatory efficiency of dentures. Customization of attachments available is a viable alternative for some patients in which prefabricated attachments cannot be placed or in which cost is a factor; to improve the final outcome of the treatment. Due to competitive commercialization, implant treatment has become the norm in current dentistry and the concept of tooth supported overdentures has eclipsed, but with proper case selection, thorough treatment planning and modifications in the denture such as customization of attachments, amalgam stops, cross-linked teeth, and metallic mesh can be applied to prolong the longevity and success of the attachment overdenture prosthesis.

Evaluation of removal forces of implant-supported zirconia copings depending on abutment geometry, luting agent and cleaning method during re-cementation

PURPOSE: To evaluate the effects of different abutment geometries in combination with varying luting agents and the effectiveness of different cleaning methods (prior to re-cementation) regarding the retentiveness of zirconia copings on implants. MATERIALS AND METHODS: Implants were embedded in resin blocks. Three groups of titanium abutments (pre-fabricated, height: 7.5 mm, taper: 5.7degrees; customized-long, height: 6.79 mm, taper: 4.8degrees; customized-short, height: 4.31 mm, taper: 4.8degrees) were used for luting of CAD/CAM-fabricated zirconia copings with a semi-permanent (Telio CS) and a provisional cement (TempBond NE). Retention forces were evaluated using a universal testing machine. Furthermore, the influence of cleaning methods (manually, manually in combination with ultrasonic bath or sandblasting) prior to re-cementation with a provisional cement (TempBond NE) was investigated with the pre-fabricated titanium abutments (height: 7.5 mm, taper: 5.7degrees) and SEM-analysis of inner surfaces of the copings was performed. Significant differences were determined via two-way ANOVA. RESULTS: Significant interactions between abutment geometry and luting agent were observed. TempBond NE showed the highest level of retentiveness on customized-long abutments, but was negatively affected by other abutment geometries. In contrast, luting with Telio CS demonstrated consistent results irrespective of the varying abutment geometries. Manual cleaning in combination with an ultrasonic bath was the only cleaning method tested prior to re-cementation that revealed retentiveness levels not inferior to primary cementation. CONCLUSION: No superiority for one of the two cements could be demonstrated because their influences on retentive strength are also depending on abutment geometry. Only manual cleaning in combination with an ultrasonic bath offers retentiveness levels after re-cementation comparable to those of primary luting.

Effect of anatomic, semi-anatomic and non-anatomic occlusal surface tooth preparations on the adaptation of zirconia copings

PURPOSE: To compare the accuracy of marginal and internal adaptation of zirconia (Zr) copings fabricated on anatomic (A), semi-anatomic (SA) and non-anatomic (NA) occlusal surface preparations. MATERIALS AND METHODS: 45 extracted bicuspid teeth were prepared for receiving zirconia crowns, with different occlusal preparation designs A=15, SA=15 & NA=15. The Zr copings were fabricated by using CAD4DENT, CAD/CAM. The copings were adjusted, cemented and were cross sectioned centrally from buccal cusp tip to lingual cusp tip into mesial and distal halves. The copings were examined under electron microscope at x200 magnification and the measurements were recorded at 9 predetermined areas in micrometers. RESULTS: Overall mean gap values for the three groups was found to be 155.93+/-33.98 microm with Anatomical Occlusal preparation design having the least gap value of 139.23+/-30.85 microm showing the best adaptation among the groups. Post Hoc Tukey's test showed a statistically significant difference (P=.007) between the means of gap for A & NA preparation designs. Measurements recorded at 9 predetermined points showed variations for the three groups. CONCLUSION: Anatomical occlusal preparation designs resulted in better marginal and internal adaptation of Zr copings. There is a considerable variation between the measured marginal and internal gap values for the Zr copings fabricated by the (CAD4DENT-CAD/CAM). This variation may be associated with the lack of standardization of the preparation of teeth, computerized designing of the coping for each tooth, cement used, uniform pressure application during the cementation of the copings, sectioning of the copings and the microscopic measurements.

Palateless custom bar supported overdenture: A treatment modality to treat patient with severe gag reflex.

Objective: To suggest a custom bar supported overdenture treatment modality for prosthodontic management of patients with severe gag reflex. Background: Some patients have a severe gag reflex and cannot tolerate conventional maxillary complete dentures with maximum palatal coverage and extensions of all borders. The condition further gets complicated in patients suffering from respiratory problems along with severe gag reflex. Severe gagging acts as a barrier to treat such patients with accepted clinical procedures and prevent patients from wearing the prosthesis. By saving some of the remaining natural teeth and fabricating, a horse shoe shape palateless simple tooth or bar supported overdenture can be successfully used for treating such patients. Materials and Methods: The remaining maxillary right and left canines were prepared with the tapered round end diamond bur to receive copings of custom bar after intentional root canal treatment of same teeth. Impression was made with light body and putty of the polyvinyl siloxane elastomer with double step putty wash technique. Impression was poured with die stone. Wax pattern of copings with bar was fabricated with inlay wax which was invested and casted. After retrieving the bar, it was finished and its fit was evaluated. The coping-bar assembly was finally cemented with the glass ionomer cement. Palateless overdenture was fabricated by conventional technique used for the fabrication of complete denture. Conclusion: Palateless custom bar supported overdenture procedure can be successfully used for the management of patients with severe gag reflex with improved denture retention, stability, chewing efficiency and comfort of the patient.

Infraestructura de oro para prótesis metal-cerámicas obtenidas mediante técnica de electrodeposición / Infrastructure gold for metal-on-ceramic obtained by electrodeposition technique

La electrodeposición es un proceso químico por el cual se realiza una deposición galvánica de oro del 99% de pureza con el fin de obtener infraestructuras en prótesis metal-cerámicas. Las infraestructuras presentan, en promedio, un espesor de 0,2 mm y un desajuste marginal inferior la 20 µm, posibilitando la utilización de un mayor espesor de cerámica si la comparamos a técnicas convencionales. Esta técnica posibilita la disminución de la citotoxicidad, de las reacciones alérgicas y de la corrosión, determinando una mayor duración de las restauraciones. La coloración dorada del material permite al ceramista conseguir una estética más depurada, favoreciendo las tonalidades en la cerámica aplicada. Sin embargo, la necesidad de mano de obra calificada y de equipos modernos y de alto costo son factores que todavía hacen inviable la utilización de la electrodeposición de oro puro como práctica clínica habitual. El objetivo de este estudio es contribuir, a través de una revisión de la literatura, a la comparación en los siguientes factores: calidad del asentamiento marginal, durabilidad, biocompatibilidad, estética de las restauraciones cuyas estructuras hayan sido obtenidos por la técnica de electrodepoisición frente a restauraciones realizadas con técnicas metal-cerámicas convencionales y sistemas cerámicos

Electrodeposition is the galvanic deposition of 99% pure gold to obtain the framework for metal-ceramic prostheses. The framework is 0.2 mm thick, on average, with marginal maladjustment of less than 20 µm, enabling the use of greater ceramic thickness than that of conventional techniques. This new technique reduces cytotoxicity, allergic reactions and corrosion, resulting in longer restoration longevity. The golden coloration of the material allows the ceramist to develop a more evolved esthetic, favoring the tonality of the ceramic applied. However, the need for qualified labor and modern high-cost equipment are factors that hinder the use of electrodeposited pure gold in everyday clinical practice. The aim of this study is to perform a literature review to compare the quality of the marginal fit, longevity, biocompatibility, and esthetic of restorations whose copings were obtained by the electrodeposition technique using conventional metal-ceramics and ceramic systems

Fracture load and marginal fitness of zirconia ceramic coping by design and coloration / 대한치과보철학회지

PURPOSE: The purpose of this study was to compare the marginal fitness and fracture load of the zirconia copings according to the design with different thickness and coloration. MATERIAL AND METHODS: The evaluation was based on 80 zirconia copings. Zirconia copings were fabricated in design with different thicknesses using CAD/CAM system (Everset, KAVO dental GmbH, Biberach, Germany). The designs of copings were divided into four groups. The first group consisted of copings with uniform thickness of 0.3 mm. The thickness in the second group was 0.3 mm on the buccal surface and 0.6 mm on the lingual surface. The third group consisted of coping with uniform thickness of 0.6 mm. The thickness in the fourth group was 0.6 mm on the buccal surface and 1mm on the lingual surface. Each group consisted of 10 colored and 10 uncolored copings. Half of the copings (40) processed with a milling system according to the specific design were sent to be given a color (A3) through saturation in special dye by a manufacturing company. Just after sintering, the marginal discrepancies of copings were measured on the buccal, lingual, mesial and distal surfaces of metal die, under a Video Microscope System (sv-35, Sometech, Seoul, Korea) at a magnification of x100. It was remeasured after the adjusting of the inner surface. Next, all copings were luted to the metal dies using reinforced cement {GC FujiCEM (GC Corp. Tokyo, Japan)} and mounted on the testing jig in a Universal Testing Machine (Instron 4467, Norwood, MA, USA). The results were analyzed statistically using the one-way ANOVA test. RESULTS: The obtained results were as follow: 1. The measured value of marginal discrepancy right after sintering was the greatest in the contraction of the buccal area in all groups, except for group I2. 2. There was no significant difference of marginal fitness among the groups in the colored zirconia group (P.05), with no significance. CONCLUSION: There was difference in the marginal fitness according to the design and coloration of zirconia copings right after sintering, but it was decided that the copings may well be used clinically if the inner surface are adjusted. The copings should be thick enough for the reinforcement of fracture strength. But considering the esthetics of the visible surfaces (labial and buccal surface), the thickness of copings may be a little thin, without giving any significant effect on the fracture strength. This type of design may be considered when giving priority to preservation of tooth or esthetics.