Troubleshooting in Designing and Fabricating a Hollow Bulb Cast Partial Denture in a Partial Maxillectomy Patient: A Case Report.

The most common complication post COVID-19is mucormycosis. It is an opportunistic infection caused by the fungus mucormycetes which belongs to the order Mucorales. This infection can spread from the oral cavity to the nasal cavity and sometimes also involve the orbit. Surgical resection of the affected region followed by its prosthetic rehabilitation is one of the viable treatment options. In this case report, we will discuss the problems in designing and fabricating a hollow bulb obturator and its solutions.

Assessment of emotional stress among patients suffering from obstructive sleep apnea: A cross-sectional study.

Background: Obstructive sleep apnea (OSA) is a sleep disorder in which the upper airway is partially or completely blocked during sleep. As a result, sleep arousal and arterial oxygen saturation are reduced. According to the epidemiological survey, OAS is relatively common among people that may be associated with psychiatric illnesses. Objectives: The primary objective was to evaluate the stress level among patients suffering from OSA. The secondary objective was to compare the gender preference for stress among patients suffering from OSA. Materials and Methods: A cross-sectional study, approved by the Institutional Ethics Committee, was performed to assess emotional stress among patients suffering from OSA. The study involved 20 participants diagnosed with OSA and reported to the Respiratory Department. The stress levels of the study participants were evaluated with a validated, Perceived Stress Scale (PSS) questionnaire given by the American Sociological Association (ASA). Result: The stress levels presented by the study participants showed that 40% (n = 8) subjects had moderate stress and 60% (n = 12) had severe stress and 30.3% of females depicted emotional stress and 26.2% of males for the same. Conclusion: There is a high psychological stress level among patients suffering from OSA. The females had higher predictions when compared to males. Such patients should be offered an intervention program aimed at stress management to enhance their quality of life.

Comparative evaluation of the efficacy of customized maxillary oral appliance with mandibular advancement appliance as a treatment modality for moderate obstructive sleep apnea patients-a randomized controlled trial.

BACKGROUND: Obstructive sleep apnea (OSA) is quite common among the adult population, according to recent epidemiological studies. The most frequently suggested alternate treatment for mild to moderate OSA is oral appliances (OA). The purpose of the present study was to assess as well as compare the effectiveness of custom-made maxillary oral appliances against mandibular advancement appliances in the care of individuals suffering from moderate obstructive sleep apnea. METHODS: A prospective interventional research was carried out with 40 participants. Polysomnography (PSG) was done and the participants with an apnea-hypopnea index (AHI) >15-30 were involved in the research. Study participants were randomly split up into two test groups: group I was the "Control Group" (group treated with a mandibular advancement device (MAD), n=20), while group II was exposed to a "customized maxillary oral appliance" (CMOA, n=20). Both groups had reference measures for AHI, blood oxygen saturation (SpO2), oro-nasal airflow via respiratory disturbance index (RDI), and the Epworth Sleepiness Scale (ESS). Appliances were fabricated and delivered to the respective study group participants. PSG was again conducted after a period of 1 and 3 months of appliance delivery and re-evaluation was done for all the parameters and was compared with reference measurements. The facts were analyzed using descriptive and analytical statistical methods. The statistical program utilized in the study was "SPSS (Statistical Package for Social Sciences) Version 20.1." After 1 and 3 months, the statistical significance between the two study groups was assessed at P<0.05. RESULTS: The analysis of mean AHI, SPO2, RDI, and ESS for both test groups manifested statistically significant measures (P<0.001). The study results revealed a statistically significant depletion in mean AHI scores, improvement in mean SPO2 scores, and reduction in mean RDI scores and ESS scores when compared with reference measurements to 1 month, 1 to 3 months, and between reference measurements and 3 months. CONCLUSION: The CMOA was effective in managing moderate OSA and has great therapeutic potential. It can be an option for the MAD for treating patients suffering from moderate obstructive sleep apnea. TRIAL REGISTRATION: The study was registered under Clinical Trials Registry-India and the registration number is CTRI/2020/07/026936 . Registered on 31 July 2020.

Quantifying the Selection of Maxillary Anterior Teeth Using Extraoral Anatomical Landmarks.

BACKGROUND:  Regardless of skin color, age, sex, or other factors, all beautiful faces follow the divine proportion. Proportions of face components appear to play a role in facial attractiveness. AIM:  The study determines the correlation between the mesiodistal width of anterior maxillary teeth, inter-canthal distance, inter-alar distance, and inter-commissural distance as a criterion for selecting anterior maxillary teeth. MATERIAL AND METHODS: A cross-sectional study was carried out at the institutional level with a sample size of 200 participants with 100 male and 100 female participants. Inter-canthal distance, inter-alar distance, and inter-commissural distance were measured using the digital caliper and a customized silver scale to measure the mesiodistal width of anterior maxillary teeth. The data obtained were analyzed using Statistical Package for Social Sciences (SPSS) version 24.0 (IBM Corporation, Chicago, USA). Pearson's correlation test calculated the correlation coefficient, and the level of significance was kept at p<0.05. RESULT: The width of the maxillary anterior and the inter-canthal gap showed a strong positive correlation, the inter-alar difference and the mesiodistal width of anterior teeth showed a moderately positive correlation, and the estimated inter-commissural width and the mesiodistal width of anterior teeth showed a strong positive correlation (p<0.05). CONCLUSION:  These parameters are correlated to the dimensions of the tooth size and can act as a guide while selecting the teeth for future rehabilitation treatment when the natural teeth are lost.

Individual and Synergistic Effects of Tea Tree Oil and Neem Extract on Candida albicans Adhesion to Denture Soft Liner.

Background Inflammation is present in denture stomatitis. Denture stomatitis's etiology is complex, but there is evidence that it is brought on by Candida albicans growing in biofilms on its surface. Objective This study aimed to examine and assess the effectiveness of several herbal products, such as tea tree oil and neem extracts, on Candida albicans adhesion to denture soft liners. Method Each wall of the tissue culture plate was filled with 30 acrylic blocks lined with soft liners, followed by the addition of 0.1 ml of the standardized Candida albicans suspension, which was then left to incubate for 48 hours. Each specimen was placed in a disinfectant solution for 10 minutes. A colony was counted after 0.1ml of the solution was plated on a sabouraud dextrose agar (SDA) plate and cultured for 72 hours. Data were compared using a one-way analysis of variance (ANOVA) test. Results The mean colony forming units (CFU) per ml for combined tea tree oil and neem extract was least (0.40), followed by tea tree oil (2.30), followed by neem extract (30.33). The treated blocks were effective in reducing the growth of Candida albicans. Conclusion Combining tea tree oil and neem extract significantly reduced the growth of Candida albicans, suggesting a new form of intraoral effective antifungal treatment.

Assessment of Bone Mineral Density in Type 2 Diabetes: A Cone Beam Computed Tomography (CBCT) Study.

Introduction The main purpose of the study was to assess and compare bone mineral density (BMD) at prospective implant sites in the mandible in type 2 diabetes mellitus (T2DM) and non-diabetic patients using cone beam computed tomography (CBCT). Material and methodology A total of 40 patients were included in this type of cross-sectional study. They were divided into two groups, A and B, according to their haemoglobin A1c values. Group A consisted of patients with HbA1c between the range of 6.1%-8% and group B had patients with no history of T2DM. CBCT scans were made of the mandibular arches of both the patients to evaluate the BMD at lingual and buccal cortical plates and the trabecular regions in two successive slices with the assistance of PlanMeca Romexis software (PlanMeca Romexis®, Helsinki, Finland). The Shapiro-Wilk test was used to determine the normality of continuous data. The Mann-Whitney U test was used to compare the groups. Results There were no differences that were statistically significant between the two cohorts according to the Mann-Whitney U test at buccal cortical plate points 1 and 2. However, the diabetes group's mean bone density at implant sites-A, B, C, D, and E at trabeculae points 1 and 2 was considerably (7p>0.001) lower than the non-diabetic groups. The mean bone density of the diabetes group was marginally but significantly (p=0.009) lower than the non-diabetic group at lingual cortical plates. Conclusion Individuals with type 2 diabetes mellitus show significantly lower bone mineral density in the lingual cortical plate and trabecular region, however, implant therapy can be performed with certain mentioned guidelines in such regions. In the buccal cortical region, the bone mineral density is seen to be unaffected.

Effect of Rehabilitation of Completely Edentulous Patients With Complete Dentures on Temporomandibular Disorders: A Systematic Review.

The present study evaluates the effect of rehabilitating completely edentulous patients with complete denture prosthesis on temporomandibular disorders (TMD). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards were used to perform this systematic review, primarily to describe the technique. Manuscripts published between 1965 and December 31, 2021, were searched in the two most common electronic databases, PubMed and Cochrane Library. To find relevant scientific papers on the influence of complete dentures on temporomandibular disorders, an electronic pursuit of peer-reviewed articles confined to the English language and a dental survey were undertaken. Two observers reviewed the abstracts separately and chose five full-text papers that met the inclusion requirements. Due to the heterogeneity of the data provided, a meta-analysis could not be performed. The result of complete dentures on temporomandibular problems was studied in detail in five peer-reviewed papers. The result of the present study concluded that the complete denture could act as a conducive treatment option to the revocation of TMD for elderly edentulous patients.

Comparative evaluation of the efficacy of customized maxillary oral appliance with mandibular advancement appliance as a treatment modality for moderate obstructive sleep apnea patients-protocol for a randomized controlled trial.

BACKGROUND: Obstructive sleep apnea (OSA) is due to the obstruction of the upper airway during sleep. This condition is often associated with multiple symptoms and co-morbidities. There are many treatment options mentioned in the literature to manage OSA, among which interventional option of continuous positive airflow (CPAP) and non-interventional option, i.e., mandibular advancement device (MAD), which is an oral appliance (OA), are the most preferred ones. This study aims to evaluate the efficacy of customized maxillary oral appliances with mandibular advancement devices in moderate OSA patients. METHODS: A prospective interventional study with a randomized controlled trial will be carried out involving 40 participants (sample size), with an apnea-hypopnea index (AHI) > 15-30, recorded on polysomnography (PSG). Study participants will be randomly divided into the following treatment groups: control group or group subjected to mandibular advancement device (MAD, n=20) and second group subjected to customized maxillary oral appliance (CMOA, n=20). Baseline assessment of apnea/hypopnea index (AHI), oxygen saturation in blood, percentage of rapid eye movement, electroencephalogram, electrocardiogram, oro-nasal airflow via a pressure transducer, and Epworth Sleepiness Scale will be done. Then both study group participants will receive their respective appliances. And after one month and three months of delivery of the appliance, all the parameters, i.e., AHI, oxygen saturation in blood, percentage of rapid eye movement, electroencephalogram, electrocardiogram, oro-nasal airflow via a pressure transducer, and Epworth Sleepiness Scale will be re-evaluated and compared with the baseline measurements. Descriptive and analytical statistics will be done. SPSS (Statistical Package for Social Sciences) Version 20.1 will be used as statistical software. The statistical significance between the two groups after one month and three months will be evaluated at p< 0.05. DISCUSSION: We expect, customized maxillary oral appliance to be more efficient in managing moderate OSA, in comparison with MAD. If the hypothesis of the present study is confirmed, then this customized maxillary appliance will be quoted as a "gold standard" for managing moderate OSA. TRIAL REGISTRATION: CTRI/2020/07/026936 Registered 31 July 2020.

Oral appliances for obstructive sleep apnea: Emerging issues, upcoming challenges, and possible solutions.

BACKGROUND: As per the current epidemiological studies, the prevalence of obstructive sleep apnea (OSA) among the adult population is very high. Oral appliances (OAs) have emerged as the most recommended alternative treatment option for mild to moderate OSA. OBJECTIVE: The objective of this article is to propose or develop a new design of OA named "customized maxillary oral appliance (CMOA)," for managing moderate OSA syndrome. METHODS: The design proposed in this article is first of its kind that is fabricated on the maxillary arch. CMOA is developed by combining the principles of the three most popular OAs used in OSA, namely, soft palate lifters, tongue retaining devices, and mandibular advancement devices. CONCLUSIONS: Given the potential impact of OSA on general and mental health and the side effects of existing appliances, there is a need for a new remedy to be introduced in the field of sleep medicine. This novel design can provide a new therapeutic option for patients with moderate OSA.

An appraisal of bone resorption in completely edentulous diabetic and nondiabetic patients at prospective implant site in anterior mandible using digital volumetric tomography and its correlation with glycemic control: A case-control study.

PURPOSE: The prospective case-control study aimed at comparing bone resorption at prospective implant sites in anterior mandible between diabetic and nondiabetic patients using digital volumetric tomography (DVT) and establishes a correlation between glycemic control and residual ridge resorption. MATERIALS AND METHODS: Twenty apparently healthy and 20 type 2 diabetic edentulous male patients between the age group of 55-65 years providing with written consent were recruited in the present study. First-time denture wearers were considered who were edentulous for at least 1 year. Glycated hemoglobin (HbA1c) analysis of all individuals were done to affirm the diagnosis and quantify glycemic control. DVT of all the individuals were performed and bone height was determined at 5 prospective implant sites were determined, on the same scans Wical and Swoope method was used to determine the residual ridge resorption on the right and left side of mandible for all the individuals. The data wer tabulated and descriptive and analytical statistics were performed to compare bone resorption between diabetic and nondiabetic groups. Pearson's correlation was carried out to establish correlation between glycemic control and residual ridge resorption. RESULTS: There was no statistical difference between the bone height measurements at prospective implant sites between diabetic and nondiabetic groups. The residual ridge resorption was more in diabetics when compared to nondiabetics, and a significant moderate negative correlation existed between the glycemic control and residual ridge resorption on left (r = -0.541; P ≤ 0.001) and right (r = -0.408; P = 0.009) side of the mandible. CONCLUSION: It can be concluded from the present study that bone resorption at prospective implant sites is statistically similar in diabetics when compared to nondiabetics. Patients with poor glycemic control show increased residual ridge resorption.

Assessment of the Change in Color of Maxillofacial Silicone after Curing Using a Mobile Phone Colorimeter Application.

AIM: To evaluate the change in color of the maxillofacial silicone after curing using a mobile phone colorimeter application. MATERIALS AND METHODS: A two-piece metal mold was fabricated. Twenty five samples were made using M511, maxillofacial silicone. A jig was prepared to hold the mobile phone at a fix distance from the samples. The color was measured for each sample in terms of HSV (hue, saturation, value) with the mobile phone colorimeter application after manipulation and after polymerization of the samples. Data were statistically analyzed using the Student's paired t test and the software used in the analysis was SPSS 22.0 version. RESULTS: The mean difference of hue was 1.32 ± 2.71, with p value 0.053. Mean differences in saturation was 0.72 ± 2.01, with p value 0.066. Mean differences in value were 2.16 ± 3.11, with a p value 0.002. The measure of value showed statistically significant differences (p < 0.05). CONCLUSION: There was a significant change in the value of the color of the maxillofacial silicone after polymerization. CLINICAL SIGNIFICANCE: Increasing the value of the color by 2-3% at the time of manipulation of the maxillofacial silicone with the use of a mobile phone colorimeter application can help the clinician to reproduce the same color in the final prosthesis after curing to achieve a predictable esthetic outcome for a facial prosthesis.

Perception of Buccal Corridor Space on Smile Aesthetics among Specialty Dentist and Layperson.

OBJECTIVES: The aim of this study was to assess and compare the perception of smiles with and without buccal corridor spaces (BCSs) among prosthodontists, orthodontists and laypersons on smile aesthetics. MATERIALS AND METHODS: Smiling photographs of subjects with wide BCSs were collected and digitally manipulated to eliminate the BCSs. Digitally altered and unaltered photographs were placed together and assessed for aesthetic appeal using visual analog scale of one to ten by prosthodontists, orthodontists, and laypersons. One-way analysis of variance (ANOVA) and two-way ANOVA were applied to evaluate the collected data using the Statistical Package for the Social Sciences (SPSS 22), Epi Info 6.0, and GraphPad Prism, version 6.0. RESULTS: The total mean value scores of smiles with BCSs were significantly higher than those of smiles without BCSs (P < 0.001). Orthodontists and prosthodontists significantly appreciated BCSs and graded the smiles with BCSs to be much more attractive (P > 0.005). Laypersons rated the smiles with BCSs with greater mean values, but the difference in mean values of smiles with and without BCSs was not significant (P < 0.005). No significant difference was found between the perceptions of prosthodontists and orthodontists. CONCLUSION: The results of this study reveal that the smiles with BCSs were notably more desirable than the smiles without BCSs. Laypersons, orthodontists, and prosthodontists evaluated smiles differently. The smiles with BCSs were appraised much more pleasing by prosthodontists and orthodontists. Laypersons could not significantly appreciate BCSs, but rated smiles with BCSs as more acceptable.

"Evaluation of the Effect of Ultraviolet Disinfection on Dimensional Stability of the Polyvinyl Silioxane Impressions." an in-Vitro Study.

INTRODUCTION: Infection control is an important concept in the present day practice of dentistry. The prosthodontists are at an added risk of transmission because of the infection spreading through the contaminated lab equipments while working in the lab. The purpose of this study is to evaluate the effect of UV light disinfection on dimensional stability of polyvinyl siloxane impressions. Materials and Methods : Impressions were made in perforated custom tray. After polymerization of impression, half the samples were disinfected in UV light and remaining samples were not subjected to disinfection and poured in die stone which served as control group. Linear dimensions were measured on the cast with travelling microscope of 0.001accuracy. Result : The result showed that UV light disinfectant showed no significant dimensional changes on impressions. CONCLUSION: Hence, it can be safely used to disinfect impressions in clinical prosthodontic procedures.

Effect of complete edentulism on masseter muscle thickness and changes after complete denture rehabilitation: an ultrasonographic study.

AIM: The aim of the present study was to determine the changes in masseter muscle thickness due to the state of complete edentulism and the effect of complete denture rehabilitation on the masseter muscle. METHODS: Real-time ultrasonography of the masseter muscle at relaxed and contracted states was carried out for twelve patients (six dentulous and six completely edentulous). Edentulous patients were scanned at the time of denture insertion and at the end of 3 months' follow up. RESULTS: The mean masseter muscle thickness of the edentulous patients was significantly increased after the 3-month follow-up than the thickness at the time of denture insertion, but was significantly lower than that of the dentulous patients of the same age group. CONCLUSION: Within the limitations of this study, it can be concluded that change occurs in the masseter muscle thickness after rehabilitation with complete dentures in the form of increased muscle thickness. However, the thickness of the muscle remains smaller than that of dentate individuals.