Intraoral Digital Impression for Speech Aid/Obturator in Children: Report of 2 Cases.

Cleft patients may develop an abnormal opening (fistula) between the oral and the nasal cavities. Surgical repair minimizes the adverse effect on speech and feeding. However, an obturator prosthesis is a nonsurgical approach to help close the communication. The purpose of the case report presented is to show the clinical use of an intraoral digital impression in the fabrication of obturator/speech aid appliances in children with cleft lip and palate deformity. Minimal adjustments were needed, and patients and caregivers responded positively. Prostheses demonstrated good stability and retention at delivery. The use of digital technology seems to have several benefits as an alternative method for capturing impressions, especially in young children with cleft lip and palate deformity.

Complications Associated with Rehabilitation of a Unilateral Partially Edentulous Mandible with Inferior Alveolar Nerve Transposition and Implant Placement: A Clinical Report.

Rehabilitation of an edentulous posterior mandible to restore function and arch stability can be accomplished with a removable partial denture or an implant supported fixed partial denture. If the alveolus is severely resorbed, implant placement becomes challenging due to inadequate bone and the position of the inferior alveolar nerve. This report details a situation where a mandibular fracture occurred soon after inferior alveolar nerve (IAN) transposition and simultaneous implant placement. The prosthodontic reconstruction was completed using a fixed-dental prosthesis.

Aesthetic Concepts and Interdisciplinary Approach in a Patient With Bilateral Cleft Lip and Palate and Missing Premaxilla: A Case Report.

The smile is an important part of the individual's facial expression, it allows the communication of emotions and ideas. However, its aesthetics can be severely compromised in patients with cleft lip and palate due to multiple missing, malformed and malposed teeth, abnormal soft tissue morphology, upper lip scar tissue, and altered anatomy in the lower third of the face. This clinical case reports the interdisciplinary treatment approach of a young male patient with complete bilateral cleft lip and palate and missing premaxilla. Prosthodontic rehabilitation included a zirconia-based fixed dental prosthesis, with pink porcelain to camouflage the bony defect and restore the facial and dental aesthetics. Maxillary second premolars received lithium disilicate crowns to obtain a more harmonious smile line and adequate occlusion. A resin-bonded fixed partial denture restored a missing mandibular central incisor. Tooth proportions, gingival contours and facial ratios routinely used in noncleft patients, were used to achieve a consonant smile. The final restorations satisfied the patient's expectations, restored an aesthetically pleasant smile, and provided an adequate occlusion.

Use of an esthetic overdenture as an alternative treatment in a patient with bilateral cleft lip and palate.

Stable occlusion and a pleasing esthetic appearance are often difficult to achieve in patients with congenital defects and severe midfacial deficiencies. Conventional therapy, such as orthodontic treatment followed by orthognathic surgery, is often not sufficient to fully correct the dental and esthetic problems. An interdisciplinary approach for these patients should include prosthodontic treatment that will assist in establishing a harmonious occlusion and improve facial appearance. This clinical report describes the interdisciplinary approach for a young patient with a history of bilateral cleft lip and palate, spina bifida, hydrocephalus, and ventriculoperitoneal shunt. The patient was treated with conventional orthodontic treatment and orthognathic surgery that failed to fully correct the malocclusion. A removable overlay prosthesis made of crystallized acetyl resin was used to reestablish esthetics and create a stable occlusion.

Immediate Vacuum Formed Overdenture for a Pediatric Patient with Ectodermal Dysplasia.

Restoring the dental and facial esthetics in a growing patient with ectodermal dysplasia (ED) is fundamental to improve psychosocial issues, esthetics, and function. The purpose of this clinical report was to present a simple, fast, and cost-effective technique to re-establish a pleasant smile of an eight-year-old male patient with hypohydrotic ED. A vacuum-formed overdenture prosthesis is described, which is recommended as an immediate interim restorative treatment in the maxillary arch with excellent stability and retention.

A Technique to Facilitate Tooth Modification for Removable Partial Denture Prosthesis Guide Planes.

The technique in this article was developed to provide a means to create prepared guide planes of proper dimension to ensure a more stable and retentive removable partial denture prosthesis (RPDP) framework when providing this service for a patient. Using commonly found clinical materials, a paralleling device can be fabricated from the modified diagnostic cast of the patient's dental arch requiring an RPDP. Polymethyl methacrylate or composite added to an altered thermoplastic form can be positioned intraorally and used as a guide to predictably adjust tooth structure for guide planes. Since it can potentially minimize the number of impressions and diagnostic casts made during the procedure, this can help achieve the desired result more efficiently and quickly for the patient.

Restoration of Anterior Dental Erosion with a Combination of Veneers and Crowns: A 3-Year Case Report.

This report describes the conservative management of a 40-year-old female patient with smooth, eroded facial enamel affecting her maxillary anterior and some posterior teeth. Using conventional enamel bonding, pressed leucite-reinforced laminate veneers were used to restore the length, contour, and esthetics of the maxillary right canine, as well as of the right lateral and both central incisors; at the same time, it was necessary to restore the maxillary left lateral incisor, canine, and first premolar of the same quadrant with all-ceramic crowns of the same material. The patient has been followed for 3 years and demonstrates a good esthetic outcome with no shade discrepancy between the two types of restoration. Apparently, the tooth structure, though eroded, was able to provide an adequate bonding substrate for these adhesive restorations.

Fabrication of a definitive obturator from a 3D cast with a chairside digital scanner for a patient with severe gag reflex: a clinical report.

Patient gagging is a common problem during dental procedures such as maxillary impression making. This clinical report describes the use of a chairside intraoral scanner for a patient with a hypersensitive gag reflex. The technique proved to be a more comfortable alternative for the patient and an accurate method for the clinician to capture both hard and soft tissue detail for the fabrication of a definitive obturator.

Interdisciplinary treatment of an adult with bilateral cleft lip and palate with missing premaxilla: The prosthodontic perspective.

Conventional orthognathic surgery and orthodontic techniques occasionally fail to completely correct the occlusal relationship and esthetic deficits of patients with cleft lip and palate and severe midface deficiency. Prosthodontic rehabilitation is often required to establish adequate occlusion and provide a more proportional facial appearance. This clinical report describes the interdisciplinary management of an adult with complete bilateral cleft lip and palate who was treated with distraction osteogenesis using a rigid external distraction device for maxillary advancement and his prosthodontic rehabilitation with a dual path removable partial overdenture to develop definitive facial and dental esthetic form.

Use of a bite registration vinyl polysiloxane material to identify denture flange overextension and/or excessive border thickness in removable prosthodontics.

Vinyl polysiloxane (VPS) has multiple applications in prosthodontics. This article describes how a bite registration fast-set VPS material was used to identify length overextension and/or excessive border thickness of denture flanges. In addition, the advantages of VPS over conventional materials are presented.

Complications and solutions in presurgical nasoalveolar molding therapy.

OBJECTIVE: To outline three main categories of nasoalveolar molding complications, describe their etiologies and manifestations, and prescribe preventive and palliative therapy for their proper management. Estimates of the incidence of each complication also are provided. MATERIALS AND METHODS: Data were collected retrospectively from the charts of 27 patients with complete unilateral cleft lip and palate treated by the first author (D.L.-B.) at the University of Puerto Rico (n = 12) and the Medical College of Georgia (n = 15). Confidence intervals for the true incidence of each complication were calculated using exact methods based on the binomial distribution. A significance level of .05 was used for all statistical tests. RESULTS: Of the soft and hard tissue complications considered, only one (tissue irritation) had an estimated incidence greater than 10%. Compliance issues were of greater concern, with an estimated incidence of 30% for broken appointments and an estimated incidence of 26% for removal of the nasoalveolar molding appliance by the tongue. CONCLUSIONS: Although benefits outnumber the complications, it is important to address all complications in order to prevent any deleterious outcomes.

Effect of vital tooth bleaching on solubility and roughness of dental cements.

STATEMENT OF PROBLEM: Vital tooth bleaching may affect properties of dental cements used for fixed prostheses. PURPOSE: The purpose of this study was to examine the effect of a combined in-office and at-home bleaching regimen on changes in surface roughness and depth loss of a variety of commercially available dental cements. MATERIAL AND METHODS: Five cement classifications were tested: glass ionomer, resin-modified glass ionomer, resin,self-adhesive resin cement, and zinc phosphate. Cements were placed in multiple wells in plastic blocks. After setting,the surface profile of each block was determined, and average roughness and vertical height of cement surface from the specimen holder were recorded. Blocks were water stored (control) or subjected to in-office and at-home bleaching(n=12). Surfaces were rescanned and pre- and posttest parameter changes were calculated. Statistical analysis consisted of Mann-Whitney-Wilcoxon Rank Sum and Student t tests applied to control and bleaching parameterc hanges within the same cements. A family-wise alpha of .05 was maintained by using a Bonferroni-adjusted level of significance preset to .01 per test. RESULTS: Zinc phosphate showed the only significant depth increase (P=.004) from bleaching: 0.9 +/- 0.7 microm deeper than the water-control group. Only resin-modified glass ionomer showed a significant (P=.004) increase in roughness from bleaching; values increased by 0.05 +/- 0.03 microm over the water-control group. CONCLUSIONS: In-office and at-home bleaching significantly increased depth loss of zinc phosphate and increased resinmodified glass ionomer roughness. However, the absolute values of differences observed, as compared to the wateronly control, were considered to be clinically insignificant. (J Prosthet Dent 2009;102:148-154)

Tensile bond strength of an adhesive resin cement to different alloys having various surface treatments.

STATEMENT OF PROBLEM: The ability of a resin cement to bond to a restorative alloy is critical for maximal crown retention to nonideal preparations. Surface treatment and metal type may have an important role in optimizing resin-to-metal strength. PURPOSE: The purpose of this study was to examine the effect of surface pretreatment on the tensile strength of base and noble metals bonded using a conventional resin cement. MATERIAL AND METHODS: Cylindrical plastic rods (9.5 mm in diameter), cast in base (Rexillium NBF) or noble metal (IPS d.SIGN 53), were divided into rods 10 mm in length (n=10-12). Specimens were heated in a porcelain furnace to create an oxide layer. Test specimens were further subjected to airborne-particle abrasion (50-microm Al(2)O(3) particles) alone or with the application of a metal primer (Alloy Primer). Similarly treated rod ends were joined using resin cement (RelyX ARC), thermocycled (x500, 5 degrees -55 degrees C) and stored (24 hours, 37 degrees C) before debonding using a universal testing machine. Debond strength and failure site were recorded. Rank-based ANOVA for unbalanced designs was used to test for significant interaction (alpha=.050). Each pair of treatments was compared separately for each metal (Bonferroni-adjusted significance level of .0083, overall error rate for comparisons, .05). The 2 metals were compared separately for each of the 3 treatments using an adjusted significance level of .017, maintaining an overall error rate of .05. A multinomial logit model was used to describe the effect of metal type and surface pretreatment on failure site location (alpha=.05). RESULTS: Interaction between metal type and surface pretreatment was significant for stress values (P=.019). Metal type did not significantly affect tensile bond strength for any of the compared surface pretreatments. Metal primer significantly improved tensile bond strength for each metal type. Most failures tended to occur as either adhesive or mixed in nature. CONCLUSIONS: Metal primer application significantly enhanced tensile bond strength to base and noble metal. No significant differences in tensile strength were found between alloys. Differences in failure site incidence were found to be related to metal type and surface pretreatment.

Effect of metal type and surface treatment on in vitro tensile strength of copings cemented to minimally retentive preparations.

STATEMENT OF PROBLEM: Due to the potential lack of ideal preparation form, the type of alloy and its surface pretreatment may have clinically relevant correlations with the retentive strength of castings to minimally retentive preparations. PURPOSE: The purpose of this study was to evaluate the effect of alloy type and surface pretreatments of base and noble metal copings on their tensile strength to minimally retentive preparations. MATERIAL AND METHODS: Minimally retentive, standardized crown preparations were made on recently extracted human third molars (n=68). Noble (IPS d.SIGN 53) and base metal (Rexillium NBF) copings were fabricated. All copings received heat treatment for oxide formation. Three experimental groups were then developed for each metal type (groups ranging from 10 to 12 specimens each): oxide only, airborne-particle abraded, or metal-primed. Copings were cemented using a self-adhesive universal resin cement (RelyX Unicem) and were thermal cycled (500 cycles between 5 and 55 degrees C) and stored (24 hours, 37 degrees C) before debonding using a universal testing machine. Frequency of debond location was compared among specimen groups. A 2-way ANOVA was used to test for interaction between the metal type and surface treatment, and, if no significant interaction was found, to test the main effects for metal type and surface treatment (alpha=.05). A multinomial logit model using the likelihood ratio test was used to describe the effect of metal type and surface treatment on failure site location (alpha=.05). RESULTS: The 2-way ANOVA indicated no significant influence of any factor on debond load: metal type (P=.885), surface treatment (P=.555), or their interaction (P=.644). The multinomial logit statistical model showed that noble metals and metal primers significantly (P<.05) shifted debond failures to occur more frequently at the resin/tooth interface or within the tooth itself. CONCLUSIONS: Neither metal type nor surface pretreatment affected bond strength. However, alloy type and surface treatment affected site of debond location. (J Prosthet Dent 2007;98:199-207).

Oral rehabilitation of a patient with complete unilateral cleft lip and palate using an implant-retained speech-aid prosthesis: clinical report.

OBJECTIVE: To report the oral rehabilitation of velopharyngeal insufficiency due to a congenital anatomic defect using an implant-retained speech-aid prosthesis. CASE REPORT: A 65-year-old man with a diagnosis of complete unilateral cleft lip and palate on the left side with an unrepaired palate was examined. A removable partial denture with a speech bulb had been used for approximately 40 years. After primary care for gross caries and tooth mobility, an implant-retained obturator with a speech bulb was fabricated. RESULTS AND CONCLUSION: Improvement in mastication, speech, and velopharyngeal function was achieved with a satisfactory esthetic result.