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1.
Head Neck ; 46(7): 1737-1751, 2024 Jul.
Article in English | MEDLINE | ID: mdl-38561946

ABSTRACT

BACKGROUND: To address the rehabilitative barriers to frequency and precision of care, we conducted a pilot study of a biofeedback electropalatography (EPG) device paired with telemedicine for patients who underwent primary surgery +/- adjuvant radiation for oral cavity carcinoma. We hypothesized that lingual optimization followed by telemedicine-enabled biofeedback electropalatography rehabilitation (TEBER) would further improve speech and swallowing outcomes after "standard-of-care" SOC rehabilitation. METHOD: Pilot prospective 8-week (TEBER) program following 8 weeks of (SOC) rehabilitation. RESULTS: Twenty-seven patients were included and 11 completed the protocol. When examining the benefit of TEBER independent of standard of care, "range-of-liquids" improved by +0.36 [95% CI, 0.02-0.70, p = 0.05] and "range-of-solids" improved by +0.73 [95% CI, 0.12-1.34, p = 0.03]. There was a positive trend toward better oral cavity obliteration; residual volume decreased by -1.2 [95% CI, -2.45 to 0.053, p = 0.06], and "nutritional-mode" increased by +0.55 [95% CI, -0.15 to 1.24, p = 0.08]. CONCLUSION: This pilot suggests that TEBER bolsters oral rehabilitation after 8 weeks of SOC lingual range of motion.


Subject(s)
Biofeedback, Psychology , Mouth Neoplasms , Telemedicine , Humans , Pilot Projects , Male , Female , Middle Aged , Mouth Neoplasms/surgery , Mouth Neoplasms/rehabilitation , Biofeedback, Psychology/methods , Aged , Prospective Studies , Adult , Treatment Outcome , Deglutition Disorders/rehabilitation , Deglutition Disorders/etiology , Electrodiagnosis , Carcinoma, Squamous Cell/surgery , Carcinoma, Squamous Cell/rehabilitation
2.
Clin Oral Implants Res ; 29 Suppl 16: 270-275, 2018 Oct.
Article in English | MEDLINE | ID: mdl-30328187

ABSTRACT

OBJECTIVES: The aim of Working Group 3 was to focus on three topics that were assessed using patient-reported outcome measures (PROMs). These topics included the following: (a) the aesthetics of tooth and implant-supported fixed dental prostheses focusing on partially edentulous patients, (b) a comparison of fixed and removable implant-retained prostheses for edentulous populations, and (c) immediate versus early/conventional loading of immediately placed implants in partially edentate patients. PROMs include ratings of satisfaction and oral health-related quality of life (QHRQoL), as well as other indicators, that is, pain, general health-related quality of life (e.g., SF-36). MATERIALS AND METHODS: The Consensus Conference Group 3 participants discussed the findings of the three systematic review manuscripts. Following comprehensive discussions, participants developed consensus statements and recommendations that were then discussed in larger plenary sessions. Following this, any necessary modifications were made and approved. RESULTS: Patients were very satisfied with the aesthetics of implant-supported fixed dental prostheses and the surrounding mucosa. Implant neck design, restorative material, or use of a provisional restoration did not influence patients' ratings. Edentulous patients highly rate both removable and fixed implant-supported prostheses. However, they rate their ability to maintain their oral hygiene significantly higher with the removable prosthesis. Both immediate provisionalization and conventional loading receive positive patient-reported outcomes. CONCLUSIONS: Patient-reported outcome measures should be gathered in every clinical study in which the outcomes of oral rehabilitation with dental implants are investigated. PROMs, such as patients' satisfaction and QHRQoL, should supplement other clinical parameters in our clinical definition of success.


Subject(s)
Dental Implants , Dental Prosthesis, Implant-Supported , Denture, Partial, Fixed , Esthetics, Dental , Jaw, Edentulous, Partially/surgery , Patient Reported Outcome Measures , Dental Prosthesis Design , Dental Restoration Failure , Denture Design , Denture, Partial, Removable , Humans , Immediate Dental Implant Loading , Patient Satisfaction , Quality of Life , Treatment Outcome
3.
J Prosthet Dent ; 112(3): 663-71, 2014 Sep.
Article in English | MEDLINE | ID: mdl-24674804

ABSTRACT

STATEMENT OF PROBLEM: Speech bulbs and palatal lift prostheses are used to improve oral-nasal balance in speakers with hypernasality resulting from velopharyngeal dysfunction. Fabricating such speech prostheses is often a protracted process, and the nasopharyngeal impression can be uncomfortable for the client. PURPOSE: The purpose of this study was to develop and test a modular palatal lift prosthesis with a silicone velar lamina that can be fabricated without a nasopharyngeal impression. MATERIAL AND METHODS: Six adult participants with different etiologies were treated with both a conventional palatal lift prosthesis and the new prosthesis. The outcome measures were nasalance scores, speech acceptability ratings, and participant responses on a questionnaire. Inferential statistical analyses were conducted with nonparametric Friedman tests and 2-tailed paired Wilcoxon signed ranks tests. The probability was set at P<.1. RESULTS: Among the 3 speaking conditions (no prosthesis, acrylic resin prosthesis, modular silicone palatal lift prosthesis), no differences were found in nasalance scores for the oral stimuli. For the nasal sentences, a numerically greater reduction was observed for the silicone than for the acrylic resin prosthesis. Speech acceptability was better with the modular silicone palatal lift prosthesis (z=2.032, P<.05) and the acrylic resin prosthesis (z=1.753, P<.1) than with no prosthesis. The questionnaire showed better subjective speech acceptability with the acrylic resin prosthesis (z=1.706, P<.05) and the modular silicone palatal lift prosthesis (z=1.706, P<.05) than with no prosthesis. Swallowing comfort was also numerically better for the acrylic resin prosthesis than for the modular silicone palatal lift prosthesis. CONCLUSIONS: This study demonstrates the feasibility of a new design for a flexible and modular palatal lift prosthesis. The functional outcomes were comparable to those of the traditional design. Although the overall results in this study favored the traditional prosthesis, the new design may be viable for patients who require alternative treatment solutions.


Subject(s)
Biocompatible Materials/chemistry , Prosthesis Design , Silicones/chemistry , Speech Disorders/rehabilitation , Speech Therapy/instrumentation , Acrylic Resins/chemistry , Adult , Aged , Deglutition/physiology , Female , Humans , Male , Middle Aged , Patient Satisfaction , Speech/physiology , Speech Intelligibility/physiology , Surface Properties , Treatment Outcome , Velopharyngeal Insufficiency/rehabilitation , Voice/physiology
4.
Curr Opin Otolaryngol Head Neck Surg ; 17(4): 253-7, 2009 Aug.
Article in English | MEDLINE | ID: mdl-19448541

ABSTRACT

PURPOSE OF REVIEW: Cancer of the head and neck area is common worldwide. Rehabilitation of cancer patients can be done using a surgical and/or a prosthetic approach. This review presents the current trends in prosthetic rehabilitation of the head and neck area. RECENT FINDINGS: The literature is abundant with case reports describing prosthetic new techniques to rehabilitate patients with cancer of the head and neck area. However, limited evidence-based research exists on these techniques or on the science of materials used in prosthetic rehabilitation of patients with head and neck cancer. SUMMARY: The goals of the prosthetic rehabilitation of patients with head and neck cancer are management of speech and swallowing function, and the restoration of the original esthetics and functions of the bone and soft tissues. These goals remain a challenge. Dental implants are increasingly implemented to help in the prosthetic rehabilitation of patients with head and neck cancer.


Subject(s)
Head and Neck Neoplasms/rehabilitation , Head and Neck Neoplasms/surgery , Plastic Surgery Procedures/methods , Prostheses and Implants , Quality of Life , Dental Implants , Female , Humans , Male , Mandibular Prosthesis Implantation/methods , Maxillofacial Prosthesis Implantation/methods , Recovery of Function , Risk Assessment
5.
J Rheumatol ; 35(7): 1391-7, 2008 Jul.
Article in English | MEDLINE | ID: mdl-18528958

ABSTRACT

OBJECTIVE: Following publication of the first reports of osteonecrosis of the jaw (ONJ) in patients receiving bisphosphonates in 2003, a call for national multidisciplinary guidelines based upon a systematic review of the current evidence was made by the Canadian Association of Oral and Maxillofacial Surgeons (CAOMS) in association with national and international societies concerned with ONJ. The purpose of the guidelines is to provide recommendations regarding diagnosis, identification of at-risk patients, and prevention and management strategies, based on current evidence and consensus. These guidelines were developed for medical and dental practitioners as well as for oral pathologists and related specialists. METHODS: The multidisciplinary task force established by the CAOMS reviewed all relevant areas of research relating to ONJ associated with bisphosphonate use and completed a systematic review of current literature. These evidence-based guidelines were developed utilizing a structured development methodology. A modified Delphi consensus process enabled consensus among the multidisciplinary task force members. These guidelines have since been reviewed by external experts and endorsed by national and international medical, dental, oral surgery, and oral pathology societies. RESULTS: RECOMMENDATIONS regarding diagnosis, prevention, and management of ONJ were made following analysis of all current data pertaining to this condition. ONJ has many etiologic factors including head and neck irradiation, trauma, periodontal disease, local malignancy, chemotherapy, and glucocorticoid therapy. High-dose intravenous bisphosphonates have been identified as a risk factor for ONJ in the oncology patient population. Low-dose bisphosphonate use in patients with osteoporosis or other metabolic bone disease has not been causally linked to the development of ONJ. Prevention, staging, and treatment recommendations are based upon collective expert opinion and current data, which has been limited to case reports, case series, surveys, retrospective studies, and 2 prospective observational studies. RECOMMENDATIONS: In all oncology patients, a thorough dental examination including radiographs should be completed prior to the initiation of intravenous bisphosphonate therapy. In this population, any invasive dental procedure is ideally completed prior to the initiation of high-dose bisphosphonate therapy. Non-urgent procedures are preferably delayed for 3 to 6 months following interruption of bisphosphonate therapy. Osteoporosis patients receiving oral or intravenous bisphosphonates do not require a dental examination prior to initiating therapy in the presence of appropriate dental care and good oral hygiene. Stopping smoking, limiting alcohol intake, and maintaining good oral hygiene should be emphasized for all patients receiving bisphosphonate therapy. Individuals with established ONJ are most appropriately managed with supportive care including pain control, treatment of secondary infection, removal of necrotic debris, and mobile sequestrate. Aggressive debridement is contraindicated. CONCLUSION: Our multidisciplinary guidelines, which provide a rational evidence-based approach to the diagnosis, prevention, and management of bisphosphonate-associated ONJ in Canada, are based on the best available published data and the opinion of national and international experts involved in the prevention and management of ONJ.


Subject(s)
Bone Density Conservation Agents/adverse effects , Diphosphonates/adverse effects , Jaw Diseases/diagnosis , Osteonecrosis/diagnosis , Humans , Jaw Diseases/chemically induced , Jaw Diseases/therapy , Osteonecrosis/chemically induced , Osteonecrosis/therapy
6.
J Prosthet Dent ; 97(2): 65-9, 2007 Feb.
Article in English | MEDLINE | ID: mdl-17341372

ABSTRACT

This clinical report describes the rehabilitation of a completely edentulous 29-year-old man diagnosed with recessive dystrophic epidermolysis bullosa (EB). Four implants were placed in each arch, and metal-resin implant fixed complete dentures were fabricated for both arches. This treatment option appears to be favorable for EB patients, compared to other options involving removable prostheses, in that it causes less mechanical irritation to the oral mucosa.


Subject(s)
Dental Prosthesis, Implant-Supported/methods , Dental Restoration Failure , Denture Repair/methods , Denture, Complete , Epidermolysis Bullosa/complications , Mouth, Edentulous/rehabilitation , Adult , Dental Implants , Humans , Male , Mouth, Edentulous/complications , Tooth Extraction/methods
7.
J Prosthet Dent ; 96(3): 212-8, 2006 Sep.
Article in English | MEDLINE | ID: mdl-16990073

ABSTRACT

This article describes a comprehensive approach that enables the clinician to place dental implants, and fabricate a provisional prosthesis and a definitive metal-acrylic resin or metal-ceramic fixed complete denture in 3 appointments. This technique allows the practitioner to immediately load the implants with a provisional fixed complete denture at the time of implant placement, to record the relative positions of the implants and soft tissues, the occlusal vertical dimension, maxillomandibular relationship, and tooth position at the second appointment by using the information provided by the provisional fixed denture, and to insert the definitive prosthesis at the third appointment. This technique reduces chair time for both the patient and the clinician, and could ultimately reduce the cost of implant treatment and potentially increase treatment acceptance.


Subject(s)
Dental Implantation, Endosseous/methods , Dental Prosthesis Design/methods , Dental Prosthesis, Implant-Supported , Dental Restoration, Temporary , Denture, Complete, Lower , Acrylic Resins , Dental Alloys , Episode of Care , Humans , Jaw Relation Record , Metal Ceramic Alloys , Office Visits , Tooth Socket
8.
J Prosthet Dent ; 94(2): 195-8, 2005 Aug.
Article in English | MEDLINE | ID: mdl-16046973

ABSTRACT

This article describes the use of computer-aided techniques to produce a wax pattern of a missing ear. A 3-dimensional (3-D) computer model of a conventional cast from a patient was obtained using an optical surface capture device (scanner). The 3-D computer model was inverted, using computer-aided design software. A physical thermoplastic (wax) pattern of the inverted 3-D cast was produced using a rapid prototyping (RP) machine.


Subject(s)
Computer-Aided Design , Ear, External , Prosthesis Design , Computer Simulation , Humans , Models, Anatomic , Waxes
9.
J Prosthet Dent ; 91(6): 532-7, 2004 Jun.
Article in English | MEDLINE | ID: mdl-15211294

ABSTRACT

STATEMENT OF PROBLEM: The presence of a screw opening on the occlusal surface of implant-supported metal-ceramic crowns may decrease the porcelain fracture resistance and shorten the longevity of the crown. PURPOSE: The purpose of this study was to compare the porcelain fracture resistance between screw-retained and cement-retained implant-supported metal-ceramic crowns and to assess whether narrowing the occlusal table or offsetting the screw-access opening affects fracture resistance. MATERIAL AND METHODS: Forty standardized maxillary premolar metal copings were fabricated with a Pd-Ga alloy (Protocol) on an implant abutment. Copings were divided into 4 groups (n=10): Group 1 (Screw-retained; occlusal surface buccolingual width=5 mm), screw access opening placed in the center of the occlusal surface; Group 2 (Screw-retained; occlusal surface buccolingual width=5 mm), screw access opening positioned 1 mm offset from the center of the occlusal surface toward the buccal cusp; Group 3 (Cement-retained; occlusal surface buccolingual width=5 mm), copings were not altered; and Group 4 (Cement-retained; occlusal surface buccolingual width=4 mm), copings designed to have a reduced occlusal surface width. All castings were finished with aluminum oxide stones and airborne-particle abraded. Two layers of opaque and dentin porcelain were applied, respectively, on all specimens, which were then glazed. The crown specimens were positioned in a custom testing apparatus and vertically loaded on the middle of the occlusal surface with a universal testing machine at a crosshead speed of 0.5 mm/min until fracture. Mean values of load at fracture (Kgf) were calculated in each group and compared with a 1-way analysis of variance and Tukey's Studentized test (alpha=.05). RESULTS: Mean values of loads required to fracture the crowns were as follow: Group 1: 95.01+/-46.6 Kgf; Group 2: 108.61+/-57.9 Kgf; Group 3: 390.94+/-151.3 Kgf; Group 4: 380.04+/-211.8 Kgf. Groups 1 and 2 required a significantly lower force to fracture the crowns compared with Groups 3 and 4 (P=.0001). Comparing Group 1 with 2 (P=.9) and Groups 3 with 4 (P=.6), no significant differences were noted. CONCLUSIONS: Screw-retained implant-supported metal-ceramic crowns demonstrated a significantly lower porcelain fracture resistance than cement-retained crowns. Placing the screw access opening 1 mm offset from the center of the occlusal surface did not result in lower fracture resistance. Cement-retained crowns with 4- or 5-mm buccolingual width of the occlusal surface showed similar porcelain fracture resistance.


Subject(s)
Crowns , Dental Cements/chemistry , Dental Porcelain/chemistry , Dental Prosthesis Retention , Dental Prosthesis, Implant-Supported , Dental Restoration Failure , Metal Ceramic Alloys/chemistry , Analysis of Variance , Dental Abutments , Dental Implants , Gallium/chemistry , Humans , Materials Testing , Palladium/chemistry , Stress, Mechanical
10.
J Prosthet Dent ; 91(3): 210-4, 2004 Mar.
Article in English | MEDLINE | ID: mdl-15060487

ABSTRACT

This clinical report describes the fabrication of maxillary and mandibular cast overlay removable partial dentures for the restoration of severely worn teeth with accompanying loss of vertical dimension of occlusion. The frameworks supported porcelain veneers for esthetics and metal occlusal surfaces for strength and durability.


Subject(s)
Denture Design , Denture, Overlay , Denture, Partial, Removable , Dental Alloys , Dental Porcelain , Dental Veneers , Humans , Male , Mandible , Maxilla , Middle Aged , Tooth Abrasion/rehabilitation , Tooth Erosion/rehabilitation , Vertical Dimension
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