Occlusal Splint: A Vital Adjunct in Full Mouth Rehabilitation for Cases of Severely Worn Dentition

Introduction: Excessive wear of dentition results infunctional disharmony, loss of esthetics, pulpal injuries andcompromises longevity of dentition adversely. The etiologicalfactors of tooth wear may be abrasion, attrition, or erosionacting individually or in combination.Case Report: The present case report emphasizes the use ofa ‘sectional occlusal verticalization splint’, as a guide for fullmouth rehabilitation. As the treatment plan envisaged wasocclusal rehabilitation using reorganized approach, sectionalsplint offered the advantage of restoring the exact amount ofvertical dimension to which patient had got programmed. Thevertical dimension was maintained during various phases ofsegmental technique using sectional splint.Conclusion: Although there are plethora of philosophiesand techniques available for full mouth rehabilitation thereis a limited evidence-based literature on a particular methodfor exact restoration of vertical dimension. Also, due topresence of many hard and soft tissues variables in humanstomatognathic system, making various occlusal records andrepeated transfer to mechanical articulator may introduceerrors. Therefore, an occlusal ‘verticalization splint’, wellaccepted by patients stomathognathic dynamics, may act asthe best guide to restore vertical dimension with an addedadvantage of reduction in errors due to omission of varioussteps of occlusal recordings, transfers and use of mechanicaldevices.

Rehabilitation of an Orbital Defect with Silicone Orbital Prosthesis: A Case Report

Introduction: Loss of eye, apart from impaired vision has adetrimental effect on psychosocial wellbeing of an individual.The replacement of the lost eye as soon as possible after thesurgery is necessary to improve social acceptance and qualityof life. Multidisciplinary management and team approachbetween surgeon and prosthodontist are essential in providingaccurate and effective rehabilitation and follow-up care for thepatient.Case report: This case report describes a simplified methodfor the fabrication of a custom silicone orbital prosthesisretained with spectacles for rehabilitation of a residual defectpost exenteration of left eye. It highlights the importance ofindepth analysis & comparison of the defect with the normalcontralateral eye which was used as an anatomical guide forfabrication of an aesthetic prosthesis.Conclusion: Advanced digital technology like rapidprototyping and CAD/CAM have made fabrication ofcomplex prosthesis like orbital prosthesis simpler andquicker. However, these contemporary methods are techniquesensitive, equipment dependent and may not be availableeasily. Thus, a maxillofacial prosthodontist should be able toread the available anatomical guides and use them to fabricatean aesthetically acceptable prosthesis using conventionaltechnique to rehabilitate patients and improving quality of lifeas soon as possible.

Comparative Evaluation of Various Cooling Techniques on Intrapulpal Temperature Rise during Direct Provisionalization - An Ex-vivo Study.

Introduction: Use of autopolymerising resin for directprovisionalization is one of the commonest methodsemployed by clinicians. However, these materials exhibit anexothermic reaction and are prone to cause pulpal damage.Thus, a combination of cooling technique and matrix materialto reduce the quantum of heat transferred to a healthy vitalpulpal tissue may be employed for minimal tissue damage.An ex-vivo study was thus envisaged to compare the efficacyof various matrix materials and cooling techniques on timerelated temperature changes in the pulp chamber duringthe fabrication of provisional FPD restorations using directtechnique.Material and Methods: A total of 100 provisionalrestorations were fabricated and were grouped on the basisof three different matrices: Vacuum template, Putty index andAlginate index and further subgrouped on the basis of variouscooling techniques employed. Thermal changes in the pulpchamber was evaluated using Cr/ Al thermocouple placedin the pulp chamber of a prepared tooth and connected to adigital thermometer. Intrapulpal temperature variations wererecorded, tabulated and statistically analysed.Results: The inter-group and intra-group statisticalcomparisons of continuous variables were done using analysisof variance with Bonferroni’s correction for multiple groupcomparisons considering the independent study groups. Theunderlying normality assumption was tested before subjectingeach variable to t test and ANOVA. In the entire study, thep-values less than 0.05 were considered to be statisticallysignificant. All the hypotheses were formulated using twotailed alternatives against each null hypothesis (hypothesis ofno difference). The entire data was statistically analysed usingStatistical Package for Social Sciences (SPSS ver 21.0, IBMCorporation, USA) for MS Windows.Conclusion: The order of heat dissipation for the differentmatrices used is as follows: Irreversible hydrocolloid matrix >PVS putty matrix > vacuum form template. It was concludedthat intrapulpal temperature rise during the direct fabricationof provisional restorations can be limited by employingdifferent cooling techniques. “Cooling” of PVS putty andalginate impression index for 2 minutes in refrigerator(Ambient temperature 10-120C) was found to be most effective“cooling” method for preventing temperature rise in pulp.

Impressing for Excellence: Special Impression Techniques for Compromised Ridges: Case Report

Introduction: Prosthodontic rehabilitation of a patient withcompromised edentulous ridges in a conventional manneris a difficult task. Modifications in the treatment proceduresshould be considered to fulfil the patient's functional andesthetic desires.Case report: This case report describes various compromisedsituations like atrophic ridges, flabby ridges and knifeedge ridges encountered in a routine clinical practice andmodification of treatment plan for each of them.Conclusion: The treatment modifications for compromisedridges starts from accurate impression making which recordmaximum denture bearing area without interference withmovements. Recording the entire functional denture-bearingarea ensures maximum retention, stability and support for thedenture during use.

Microstomia: Difficult Proposition to Rehabilitate

Introduction: The rehabilitation of microstomia patientspresents difficulties during fabrication of denture as themaximal mouth opening is inadequate. This condition mayresult from the surgical treatment of orofacial cancer, cleft lip,trauma, burns, Plummer–Vinson syndrome or scleroderma.The reduced mouth opening also leads to difficulty in speech,mastication and psychological problems secondary to facialdisfigurement.Case report: It is often difficult to apply conventional clinicalprocedures to fabricate prosthesis for patients who demonstratelimited mouth opening, since it is difficult to follow theprotocol of fabrication of prosthesis and also insertion andremoval of one-piece prosthesis into the oral cavity. Thepresent case report focuses on rehabilitation of microstomiausing sectional prosthesis and intraoral magnets with whichenabled easier and competent removal and insertion by thepatient.Conclusion: The sectional denture attached by the magnetcan be more comfortably removed and inserted by the patientwith reduced mouth opening. It is simple and cost-effectivemethod for rehabilitation of microstomia patient.

Prosthetic Rehabilitation of Composite Hemi-Facial Defects – A Case Report

Introduction: Rehabilitation of severe hemi-facial defectsposes a challenge to the Prosthodontist. Defects involvingmore than one facial part with asymmetry of contra lateralside require careful planning and technical skills to providethe prostheses.Case Report: This article presents a case of of hemi-facialdefect due to chemical burn injury rehabilitated with custommade silicone prosthesis. It also highlights a technique offlasking used for the fabrication of the prosthesis combiningorbital and nasal defects.Conclusion: The technique used for the rehabilitation ofconventional silicone prostheses can be well utilized whenimplants are not feasible.