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.

Clinical outcomes of rigid and non-rigid telescopic double-crown-retained removable dental prostheses: An analytical review

PURPOSE: The objective of this literature review was to analyze the cumulative survival rates (CSRs) of rigid and non-rigid double-crown-retained removable dental prostheses.MATERIALS AND METHODS: Screening of the literature published from January 1995 to December 2019 was performed by using electronic data base (Pubmed) and manual search. The CSRs of rigid and non-rigid double crown removable dental prostheses were investigated.RESULTS: A total of 403 articles were reviewed and 56 relevant articles of them were selected. Subsequently, 25 articles were included for data extraction. These articles were classified according to rigid and non-rigid type double crowns and further subdivided into teeth, implants, and teeth-implant combination types. The CSRs of rigid type double crown ranged from 68.9% to 95.1% of 5 to 10 years in tooth abutments, 94.02% to 100% over a 3-year mean observation periods in implant abutments, and 81.8% to 97.6% in tooth-implant combination. Non-rigid type double crowns had various CSR ranges from 34% to 94% maximum during 10 years observation in teeth abutment. The CSRs of non-rigid type had over 98% in implant abutments, and ranged from 85% to 100% in tooth-implant combination.CONCLUSION: The CSRs of double crowns varies according to types. With accurate evaluation of the remaining teeth and plan of the strategic implant placement, it could be successful treatment alternatives for partially or completely edentulous patients.

Simulación Mediante Elemento Finito de Sistemas Intramedulares Telescópicos para Rehabilitación de Pacientes con Osteogénesis Imperfecta / Simulation by Finite Element Method of Intramedullary Telescopic Systems for Rehabilitation of Patients with Osteogenesis Imperfecta

Resumen En el trabajo se plantea el análisis de diferentes geometrías para un dispositivo intramedular, las cuales ayudan a reducir y evitar la migración, deformación y rotura del implante en tejido óseo afectado con Osteogénesis Imperfecta (OI). Se realizaron diseños en CAD de diferentes prototipos, donde se analizan las propiedades mecánicas en el alma del dispositivo, así como en las roscas distal y proximal de los implantes macho y hembra. Asimismo, se obtuvieron modelos 3D de huesos de un infante afectado con OI para realizar simulaciones mediante elemento finito de la interacción entre el hueso y el dispositivo intramedular. Los resultados muestran que los prototipos propuestos disminuyen la deformación del dispositivo, así como el aumento en la rigidez de la relación hueso-prótesis. Asimismo, las roscas generaron un menor esfuerzo en la unión con el hueso, lo que prevé un menor daño al tejido óseo. El trabajo se limitó al análisis numérico del rediseño de implantes telescópicos intramedulares para afectados con OI. Concluyendo que la geometría semicircular 3/4 de caña, otorga un óptimo resultado en las pruebas realizadas, al tiempo que las roscas ACME proveen una mejor sujeción en las epífisis distal y proximal de los huesos largos.

Abstract In this work we propose the analysis of different geometries for an intramedullary device, which help to reduce and avoid the migration, deformation and rupture of the implant in bone tissue affected with Osteogenesis Imperfecta (OI). Designs of different prototypes were made in CAD, where the mechanical properties in the device's soul are analyzed, as well as in the distal and proximal threads of the male and female implants. Likewise, 3D bone models of an affected infant with OI were obtained to perform finite element simulations of the interaction between the bone and the intramedullary device. The results show that the prototypes proposed decrease the strain of the device, as well as the increase in the stiffnes of the bone-prosthesis relationship. Also, the threads generated less stress in the union with the bone, which provides less damage to the bone tissue. The work was limited to the numerical analysis of the redesign of intramedullary telescopic implants for patients with OI. Concluding that the semicircular geometry 3/4 of cane, gives an optimal result in the tests carried out, while the ACME threads provide a better subjection in the distal and proximal epiphyses of the long bones.

Telescopic overdenture for oral rehabilitation of partially edentulous patient

A case report describing the rehabilitation of a patient presenting with partially edentulous arches and compromised abutment teeth has been described. The aim of this study was to restore function and esthetics and uplift the psychological status of the patient by fabrication of a fixed removable prosthesis using the existing abutment teeth as telescopic overdenture.

Clinical Report by using hybrid telescopic double crown Removable Partial Denture on a few remaining teeth with severe periodontal disease / 대한치과보철학회지

The successful results of the treatment using a double crown denture have been reported in several papers for some of the few remaining teeth in patient. In particular, double crown dentures may be an alternative to treatment in cases where the periodontal status is poor and clasp type removable partial dentures are inappropriate (crown/root ratio > 1). In this case, the patient visited clinic with a chief complaint of difficulty in mastication due to loss of posterior teeth and overall teeth mobility. After teeth with severe periodontitis were extracted, treatment plan of mandible is Kennedy class I removable partial denture (RPD) and treatment plan of maxilla is hybrid telescopic double crown RPD with a friction pin. Patient is well adapted after the prosthetic treatment and we report due to achieving satisfactory results in pronunciation, mastication, retention and aesthetics.

A case of maxilla implant overdenture using Pekkton telescopic attachment with severe alveolar bone resorption / 대한치과보철학회지

It is necessary to set the correct occlusal plane and to distribute the occlusal force uniformly considering the state of the opposing dentition during the prosthetic of the single edentulous patient with severe alveolar bone resorption. Implant supported overdenture is superior to complete denture in terms of maintenance and stability, and limited implants are used in fully edentulous patients with high alveolar bone resorption. Telescopic attachments using a newly introduced material based on poly-aryl-ether-ketone (PAEK) have the advantages of typical telescopic copping, excellent abrasion resistance, and are lighter and more economical than conventional implant overdentures. In this case, we restored maxillary arch with a implant retained overdenture using the telescopic attachment made of Pekkton and the mandible was restored with fixed implant prosthesis. Through these procedures esthetic aspects and functional outcomes were satisfactorily achieved.

Literature review and case report of prosthetic rehabilitation with telescopic denture / 대한치과보철학회지

Telescopic denture has advantages such as transfer the occlusal force to the long axis of the abutment, easiness of oral hygiene management, increase of retention and stability, splint effect due to secondary fixation between abutments and have been reported a higher success rates than conventional removable partial denture (RPD). However, there are disadvantages such as complex laboratory procedures, long treatment periods and high costs, and high incidence of complications. This clinical report describes two cases, a 4-point supported telescopic denture using telescopic crown and a 2-point supported telescopic denture using conical crown with functionally satisfactory results. Frequent complications of telescopic denture, which are reported in various literature were reviewed. Clinical and laboratory procedures were performed in consideration of complications that reported.

Causes of failed implant attachments and application of double crown implant overdenture in one patient / 대한치과보철학회지

In this case, the patient was restored with gold Hader bar mandibular implant overdenture using two implants about 10 years ago, and the retentive force was lost due to severe wear of the bar due to 3.5 years use. The overdenture was repaired using a Locator attachment, but the male part was completely worn after 6.5 years use. Finally, we used a hybrid telescopic double crown with a friction pin to fabricate a new implant overdenture, which was observed for 2 years and showed excellent prognosis. So, we describe the cause of failure of each attachment (Gold Hader bar, Locator) in two implant overdentures and report on the advantages and disadvantages of double crown implant overdenture and the conditions for success.

Causes of failures of long-term used double crown denture and new rehabilitation with dental implant and tooth combined denture using remaining teeth and implants / 대한치과보철학회지

Hybrid telescopic double crown have ever been good treatment option for patient with periodontally unfavorable few remaining teeth for successful prognosis. Tooth and implant combined telescopic double crown can be used for improving retention and support for denture with strategically placed implants on edentulous ridge. In this case, an 55-year-old female patient had chronic periodontitis with few remaining teeth on maxilla and fixed partial prosthodontics on mandible. Treatment of hybrid telescopic double crown with friction pin lasted 9.5 years only with natural teeth. After 9.5 years, additional implants was installed due to fracture of cast-posted abutment teeth. After implantation, tooth and implant combined double crown had fabricated. Through re-treatment, no complications of new denture has been found during 2 years follow up. This case presents fair prognosis of tooth and implant combined double crown denture in periodontally unfavorable condition.

Prosthetic rehabilitation for patient with hemi-maxillectomy: Obturator combined with a hybrid telescopic double crown using friction pin

When oral cancer develops in the maxilla, oro-nasal communication occurs after surgical treatment including removal of the primary site. Restoration through an obturator is necessary to prevent food from storing due to non-oral opening, and to ensure proper pronunciation and aesthetic restoration. In this case, the patient was treated with right hemi-maxillectomy due to oral cancer and has residual abutment and poor periodontal support due to the effect of head and neck radiotherapy. The obturator was treated with a hybrid telescopic double crown denture. Reporting a successful prognosis in 18 months of follow-up.

Use of polyaryletherketone (PAEK) based polymer for implant-supported telescopic overdenture: A case report

Although many prosthetic materials exist for fabrication of implant-supported telescopic overdentures, available materials have not been thoroughly evaluated from a functional standpoint. This case report describes the use of polyaryletherketone (PAEK) based polymer for an implant-supported telescopic overdenture, a seldom used material in dentistry. This material is lighter than traditional materials, can accommodate changes in retentive forces, and is an easily retrievable by CAD/CAM fabrication. This case highlights the possibility of using new polymer materials for implant-supported telescopic overdentures.

Treatment of the cleft lip and palate patient with few remaining posterior teeth using hybrid telescopic crown denture

For individuals with cleft lip and palate, the removable partial dentures (RPDs) have been an important treatment option. Some modifications from conventional prosthetic treatment may be necessary to achieve satisfactory functional and esthetic results in cleft patients. In case of cleft palate patient with periodontally compromised and only posterior few remaining teeth, removable partial prosthesis connected to telescopic crown can be the alternative treatment option. When connected to the RPD, telescopic crowns increase the prosthetic stability and retention, optimize favorable force transmission to the long dental axis, and improve esthetics. And the cross arch stabilization of double crown denture helps to stabilize both divided maxillary ridges in CLP patient. This case present one adult CLP patient using an RPD connected with hybrid telescopic crowns with friction pins to improve not only retention and stability but also aesthetics.

Transverse Discrepancy in Orthodontics: A Review.

In today’s orthodontic practice esthetics is a primary concern both for patient and the orthodontist. The perception of esthetics for a lay person largely depends on the symmetry of the face. Hence, diagnosis and correction of the transverse discrepancy are imperative for optimum result. Some occlusal relations can result from skeletal jaw relation or from tooth positions. Malocclusion can occur in three planes of space, i.e., sagittal, transverse, and vertical plane. Transverse discrepancy is “An abnormality of development in transverse plane.” In orthodontic diagnosis and treatment planning, the emphasis is placed on recognizing asymmetry and achieving symmetric results with dental midlines coincident with each other and with the facial midline. Humans, like most other animals, are considered to display bilateral symmetry. By strict definition, this implies that mirror-image mathematical identity exists between right and left halves. In orthodontic diagnosis and treatment planning, emphasis is placed on recognizing asymmetry and achieving symmetric results. Treatment of an asymmetry can be challenging. The 1st treatment step is to diagnose if the asymmetry is of functional, dental or skeletal cause. The treatment options for transverse problem may include arch coordination, asymmetric extraction, asymmetric mechanics, and skeletal correction by orthopedic or surgical procedure. However, it is crucial to determine that the observed asymmetry is genuine and not the product of a functional or habitual shift of the mandible as is often the case with unilateral cross-bites due to reduced width of the maxillary arch.

Mandibular implant-supported overdenture using CAD-CAM Konus type attachment: A case report / 대한치과보철학회지

In edentulous mandible, implant supported overdenture was considered as a first treatment option. Konus type attachment supplies rigid support and cross arch stabilization so that more favorable force transmission and distribution can be attained. In the dentistry, computer aided design-computer aided manufacturing (CAD-CAM) system makes it possible to fabricate restorations with high precision and effectiveness. Recently, Palladium-silver (Pd-Ag) alloy which is millable has been developed. This article presents that application of CAD-CAM Konus type attachment can be provide satisfactory stability and function on four-implant supported mandibular overdenture.

Clinical outcome of double crown-retained implant overdentures with zirconia primary crowns

PURPOSE: This retrospective study aims at the evaluation of implant-supported overdentures (IODs) supported by ceramo-galvanic double crowns (CGDCs: zirconia primary crowns + galvano-formed secondary crown). MATERIALS AND METHODS: In a private practice, 14 patients were restored with 18 IODs (mandible: 11, maxilla: 7) retained by CGDCs on 4 - 8 implants and annually evaluated for technical and/or biological failures/complications. RESULTS: One of the 86 inserted implants failed during the healing period (cumulative survival rate (CSR) implants: 98.8%). During the prosthetic functional period (mean: 5.9 +/- 2.2 years), 1 implant demonstrated an abutment fracture (CSR-abutments: 98.2%), and one case of peri-implantitis was detected. All IODs remained in function (CSR-denture: 100%). A total of 15 technical complications required interventions to maintain function (technical complication rate: 0.178 treatments/patients/year). CONCLUSION: Considering the small sample size, the use of CGDCs for the attachment of IODs is possible without an increased risk of technical complications. However, for a final evaluation, results from a larger cohort are required.

A case report on telescopic denture with a small number of residual teeth in mandible / 대한치과보철학회지

Restoration of a patient with thin and low residual ridges using a removable partial denture cannot provide proper anterioposterior stability and support, so it results in patient discomfort and severe occlusal force. Also, when a small number of residual teeth are far apart from one another, it is difficult to splint. When these teeth are not splinted, they become solitary abutments, which is not a wise treatment decision. In this case, telescopic system reduces severe lateral load on abutments resulting from a clasp denture and it provides stable and definite retention and solidity. In this case report, a patient exhibited full edentulism in maxilla, and a small number of residual teeth in mandible, which were restored with a complete denture and a telescopic denture respectively. In treatment planning, it was concluded that a patient was restored with a telescopic denture since it was highly probable that a clasp denture would create discomfort and difficulty due to a small number of residual teeth located far apart and residual ridges without proper support.

Complicações clínicas durante o uso do aparelho de Herbst com cantilever e com splint de acrílico removível inferior / Clinical complications during Herbst treatment with cantilever and removable mandibular splint

As quebras do aparelho de Herbst que podem surgir durante o tratamento da má oclusão de Classe II são preocupantes. Da mesma forma que as quebras com os aparelhos fixos geram compromissos adicionais para os pacientes, além do desconforto associado, incluindo também perda de horas de trabalho e tempo. Isso tudo gera custos financeiros adicionais para o consultório e/ou para o paciente e seus responsáveis. A literatura tem mostrado que, independente do desenho do aparelho utlizado, as chances de surgirem complicações durante a utilização do aparelho de Herbst são grandes. Entretanto, isso não deveria desestimular o clínico a utilizar esse tipo de aparelho, pois ele é o aparelho mais eficiente para a correção da Classe com retrognatismo mandibular. O objetivo deste artigo é descrever as principais complicações clínicas observadas com dois tipos de aparelho de Herbst, com cantilever e com splint removível inferior, e sugerir as possíveis soluções para cada situação. As complicações foram classificadas de acordo com o grau de complexidade, em simples e complexas. Após a descrição das complicações e das suas soluções, concluiu-se que é comum a ocorrência de alguma complicação durante o tratamento com o aparelho de Herbst. Sendo assim, o clínico deve estar apto a resolvê-la. Para diminuir as complicações, o aparelho deve ser construído com coroas de aço usando um sistema telescópico sem parafusos. Do ponto de vista clínico, o aparelho de Herbst com cantilever apresenta mais vantagens do que com o splint removível inferior durante a correção da Classe II

The breakages of the Herbst appliance that may arise during the treatment of Class II malocclusion are worrying. Like it happens with breakages of fixed appliances it generates additional appointments; on the loss of work hours and time. Such consequences generate higher costs for the office and/or for the family of the patient. The literature has shown that there are great chances of complications during the use of the Herbst appliance. However, this should not discourage the clinician to use this type of appliance since it is the most efficient on the correction of Class II with mandibular retrognathia. The purpose of this article was to describe the main clinical complications observed on two types of Herbst appliance, with cantilever and with lower removable splint, and suggest possible solutions for each situation. Complications were classified according to the degree of complexity in simple and complex. After a description of the complications and their solutions, it was concluded that it is common the occurrence of complications during the treatment with Herbst appliance. Thus, the clinician should be able to solve them. To minimize these complications, the appliance should be constructed with steel crowns and with a telescopic system without screws. From a clinical standpoint, the Herbst appliance with cantilever presents more advantages than the lower removable splint for the correction of Class II.

A FEM study on stress distribution of tooth-supported and implant-supported overdentures retained by telescopic crowns / 대한치과보철학회지

PURPOSE: The purpose of this study was to investigate the stress distribution in mandibular implant-supported overdentures and tooth-supported overdentures with telescopic crowns. MATERIALS AND METHODS: The assumption of this study was that there were 2, 3, 4 natural teeth and implants which are located in the second premolar and canine regions in various distributed conditions. The mandible, teeth (or implants and abutments), and connectors are modeled, and analyzed with the commercial software, ANSYS Version 10.1. Stress distribution was evaluated under 150 N vertical load bilaterally on 3 experimental conditions - between canine areas, canine and 2nd premolars, 10 mm posterior to 2nd premolars. RESULTS: Overall, the case of the implant group showed more stress than the case of the teeth group in stress distribution to bone. In stress distribution to superstructures of tooth and implants, there was no significant difference between TH group and IM group and the highest stress appeared in TH-IV and IM-IV. The stress caused from bar was much higher than those of implant and tooth. TH group showed less stress than IM group in stress distribution to abutment teeth and implant. CONCLUSION: The results shows that it is crucial to make sure that distance between impact loading point and abutment tooth does not get too far apart, and if it does, it is at best to set abutment tooth on premolar tooth region. It will be necessary to conduct more experiments on effects on implants, natural teeth and bone, in order to apply these results to a clinical treatment.

An innovative prostheses design for rehabilitation of severely mutilated dentition: a case report

Partial edentulism has multiple implications in relation to function, esthetics and future rehabilitative treatment. This case report illustrates the management of a patient with extreme consequences of partial edentulism. The main clinical findings were unopposed remaining teeth, overeruption of the remaining teeth, loss of vertical dimension of occlusion, and significant disfigurement of the occlusal plane. Following the diagnostic procedure, a well-coordinated prosthodontic treatment involving liaison with other dental disciplines was indicated. The management involved an innovative combination of fixed and removable prostheses in conjunction with crown lengthening surgery and strategic implant placement. Series of provisional prostheses were applied to facilitate the transition to the final treatment.

The effect of TiN coating on retention of conus telescopic crowns after repeated insertion/separation tests / 实用口腔医学杂志

Objective:To evaluate the effect of TiN coating on retentive force of conus telescopic crowns after repeated insertion/separation tests. Methods: Fourteen pairs of standard metal specimens fabricated by precision Computer Numerical Control (CNC) Lathe were randomly divided into experimental group and control group, seven pairs in each group. The external surfaces of inner crowns and internal surfaces of outer crowns of experimental group were coated with a 2.0 μm titanium nitride (TiN) by multi-arc ion plating method. The group without titanium nitride coating was served as control. The retentive forces of two group telescopic crowns was investigated by repeated insertion/separation tests. Statistical analysis of group t-test was performed by SPSS 13.0 software package. Results: The results demonstrated that the initial retentive force of titanium nitride group in our study were lower than that of uncoated titanium nitride group. The retentive forces of two groups gradually decreased depending on the number of insertion/separation cycles and the rate of retention attenuation was found to be statistically significant. It was also shown that the retentive force of titanium nitride coating group began to decrease after 3 000 cycles and declined slowly not only before 3 000 cycles but also after 7 000 cycles. Conclusion: Titanium nitride coating deposited on external surface of inner crowns and internal surface of outer crowns can significantly decrease retention attenuation rate of conus telescopic crowns and maintain persistent retentive force.