Development of a psychosocial perception scale and comparison of psychosocial perception of patients with extra oral defects before and after facial prosthesis.

STATEMENT OF PROBLEM: Loss of facial organs and subsequent rehabilitation affects a patient's psychological status. Understanding the perceived psychosocial aspects of quality of life among patients with missing organs and after prosthetic rehabilitation is essential, but studies that quantify this aspect are lacking. PURPOSE: The purpose of this clinical study was to develop and validate a psychosocial perception scale and compare psychosocial perception before and after the prosthetic rehabilitation of a missing facial part. MATERIAL AND METHODS: A psychosocial perception scale was developed to quantitatively measure the perceived psychosocial aspects of quality of life among patients with extraoral defects. The instrument was translated in the Hindi and Marathi Indian languages by using a forward and backward translation method. Depending on the responses obtained from the patients in the interview about the interpretation and ease of understanding, the questionnaire was modified and further pilot testing conducted. In the first phase, validation of the questionnaire was carried out with internal consistency, interdomain correlation, and intraclass correlation assessed by using the Cronbach α, Pearson correlation, and test retest reliability. Construct validity was established by the exploratory factor analysis. In the second phase, 32 participants were evaluated for their psychosocial response before and 3 months after prosthetic rehabilitation. Responsiveness and change in the domains scores of the psychosocial perception scale were studied by using the Wilcoxon signed-rank sum test (α=.05). RESULTS: The Cronbach α for internal consistency of overall psychosocial perception was .855 and .809 in the pretreatment and post-treatment visits consecutively. Most of the domains in the psychosocial perception scale had a Pearson correlation (r)>0.40. The domain of esthetics had r=0.84(confidence interval: .43-0.95), indicating good intraclass correlation. The domains of esthetics (P<.005), function (P<.005), positive emotions (P<.005), negative emotions (P=.011), and social and personal relationship P=.003) of the psychosocial perception scale showed statistically significant improvement in the scores after prosthetic intervention and had excellent (r>0.90) intraclass correlation. CONCLUSIONS: The psychosocial perception scale was a reliable tool to assess the patient response toward the prosthetic rehabilitation of extraoral defects. Positive improvements in the domains score (esthetics, function, positive emotions, and social and personal relationship) contributed to better perception after prosthetic rehabilitation.

Postradiotherapy Prosthetic Management of Mandible Reconstructed With Fibular Graft.

Intraoral defects secondary to resection of mandible leading to mandibular discontinuity are very complicated to treat as the muscles exert forces on the residual portion of the mandible. Primarily this leads to disfigurement of the face. These forces also make mastication difficult due to imbalance. Ultimately it leads to poor quality of life for the patient. Apart from that the clinical outcome and prognosis of prosthetic rehabilitation of such patients is very poor. The composite fibular flap is the preferred donor site for reconstruction of most complex orofacial-mandibular defects. The addition of a skin island allows for absolute tension-free intraoral closure that enhances tongue mobility. After reconstruction with free fibula graft, planning for prosthodontic rehabilitation by various methods can be carried out. Treatment strategy is dependent on the intraoral situation and patient's acceptance. This article reports various treatment considerations for implant retained prosthetic rehabilitation in a patient who had undergone mandibular reconstruction with free fibula flap.

Appraisal of Function After Rehabilitation With Tongue Prosthesis.

STATEMENT OF THE PROBLEM: Prosthetic rehabilitation following total glossectomy is very complex procedure from clinical as well as laboratory point of view. The basic objective of prosthodontic rehabilitation is to deliver a comfortable as well as esthetically suitable prosthesis, which restores the impaired speech and deglutition function. PURPOSE: Prosthetic rehabilitation of patients after total glossectomy with tongue prosthesis to evaluate improvement in speech as well as swallowing function. MATERIALS AND METHODS: Tongue prostheses were fabricated with high-temperature vulcanizing silicone and heat-polymerizing acrylic to restore the functions affected after surgical resection of tongue. Patient's speech was evaluated with Dr Speech software version 4. The speech software was used to assess different speech parameters such as maximum phonation time, fundamental frequency, intensity, jitter, and shimmer. Deglutition assessment was done subjectively by using a standardized questionnaire designed by the speech pathologist. Speech was recorded for assessment before prosthetic rehabilitation and 2 weeks after delivery of the tongue prosthesis. RESULTS: After analysis of various speech parameters frequency range was improved with prosthesis (ie, 172.19 Hz) as compared to without prosthesis (ie, 111.47 Hz). Speech intelligibility was improved with tongue prosthesis. Deglutition assessment revealed that patient's deglutition abilities were improved. CONCLUSION: Tongue prosthesis helps to improve speech and articulation in patients with total glossectomy. Apart from that deglutition capability is also significantly improved. CLINICAL IMPLICATIONS: Total glossectomy affects speech, mastication, and swallowing to a greater proportion. It may also lead to psychological impairment of the patient. Tongue prosthesis efficiently improves speech and deglutition abilities of the patient leading to a better quality of life.

Fibular Graft-Effective Panorama for Prosthetic Rehabilitation of Resected Mandible.

Surgical management of extensive tumors in the mandibular region leads to massive disfigurement of the face. Also the prosthetic outcome of such patients rehabilitated with free soft tissue flaps is very poor. Reconstruction of extensive defects to overcome the disfigurement is a challenging procedure and can be achieved with free fibula flap. Free fibula graft provides sufficient length of bone for the reconstruction of the postsurgical defects. Excellent vascularity of fibula flap allows for easy uptake of the graft and osseointegration of the dental implants. The addition of a skin island allows for absolute tension-free intraoral closure that enhances tongue mobility. Fibula graft allows proper tissue support after mandibular reconstruction. After rehabilitation with free fibula graft we can plan for prosthodontic rehabilitation with implant retained prosthesis leading to improved masticatory function. It also helps to improve speech outcome as a stable prosthesis can be delivered with the help of implants retained in the fibula graft. It is essential to assess the outcome of surgical reconstruction with fibula graft followed by prosthetic rehabilitation with implant retained prosthesis for their recognition as a treatment of preference. This article details the clinical report along with various clinical parameters for implant retained prosthetic rehabilitation of the patient who had undergone mandibular resection and reconstruction with free fibula graft.

Anterior indexing technique for orbital prostheses.

This article describes a straightforward technique for indexing the ocular part of an orbital prosthesis from the anterior aspect. The iris of the ocular portion remains unaffected while using this technique. There is no damage to the moulage as indexing is done from the anterior aspect. This technique provides stability, prevents rotation of the ocular portion, and allows the moulage to be used multiple times. It is cost effective and requires minimal manipulation during processing.

A technique for fabrication of cranial prostheses using high-temperature vulcanizing silicone material.

Cranioplasty is performed with various alloplastic implant materials, each having advantages and drawbacks. High-temperature vulcanizing silicone is used to fabricate cranioplasty implants because of certain beneficial properties. Silicone cranial implants lead to better adaptation with the bone adjacent to the cranial defect than acrylic resin and metal cranial prostheses. This article describes a technique for fabricating cranial implant prostheses using high-temperature vulcanizing silicone material.

Conservative management of grossly carious mandibular first molar with a hemisection approach: a case report.

The term hemisection refers to the removal or separation of a root-with its accompanying crown portion-from a 2-rooted tooth, such as a mandibular molar. A hemisection is considered a conservative treatment option for mandibular molars that would otherwise require extraction. A hemisection of an affected tooth helps to preserve the tooth structure and alveolar bone and is more economical than other treatment options. Therefore, hemisection may be a suitable alternative to extraction and implant therapy and should be discussed with patients during their consideration of treatment options. This case report describes a hemisection procedure in which the grossly carious distal half of an endodontically treated mandibular left first molar was removed.

Simple prosthesis for a cancer patient with a segmental mandibulectomy and free fibula flap reconstruction: a clinical report.

Tumors of the mandible often necessitate the resection of a major portion of the body of the mandible as well as tissue from the tongue. Resection of the body of the mandible often leads to discontinuity of the mandible, affecting function to a large extent. While the rehabilitation of such defects with free fibula flaps may provide a certain level of stability to the mandible and aid in the prosthetic rehabilitation of these patients, the bulk of these flaps may create difficulties during prosthetic rehabilitation. The economic constraints of patients and/or their fear of implant surgery may also rule out prosthetic rehabilitation with implant-retained prostheses. This case report describes a simple and cost-effective method of prosthetic rehabilitation for a cancer patient who had undergone a segmental mandibulectomy followed by reconstruction with a free fibula flap.

Comparative Evaluation of the Effect of Manufacturing Process on Distortion of Rotary ProFile and Twisted File: An in Vitro SEM Study.

Background and aims. The manufacturing process of rotary Ni-Ti file can influence its resistance to fracture. The rotary ProFile (Dentsply-Maillefer, Baillagues, Switzerland) is manufactured by grinding mechanism whereas Twisted File (Sy-bron Endo, USA) is manufactured with a twisting method. The purpose of this study was to comparatively evaluate the effect of manufacturing process on distortion of rotary ProFile and Twisted files using scanning electron microscopy after in vitro use. Materials and methods. Five sets of each type of file were used for this study -rotary ProFile (group A) and Twisted file (group B). Each set was used according to manufacturer's instructions to prepare 5 mesial canals of extracted mandibular molars. The changes in files were observed under a scanning electron microscope at ×18, ×100, ×250 and ×500 magnifications. Observations were classified as intact with no discernible distortion, intact but with unwinding, and fractured. Group A and B were then compared for deformation and fracture using two-proportion z-test. Results. On SEM observation, used rotary ProFile showed microfractures along the machining grooves whereas Twisted file showed crack propagation that was perpendicular to the machining marks. On statistical analysis, no significant difference was found between ProFile and Twisted file for deformation (P=0.642) and fracture (P=0.475). Conclusion. Within the experimental protocol of this study, it was concluded that both ProFile and Twisted files exhibited visible sign of distortion before fracture. But Twisted file gained edge over ProFile because of its manufacture design and unparalleled resistance to breakage.

Management of velopharyngeal disorder with a pharyngeal obturator: a case report.

Patients with acquired defects or congenital malformations of the palate reveal disturbances in speech, including hypernasality, nasal emission, and decreased intelligibility of speech. Deglutition is also affected. All of these side effects have a negative impact on the psychological and social status of the patient. Maxillofacial prosthetic treatment can restore the palatopharyngeal integrity and offer the potential for acceptable speech using a pharyngeal obturator, also known as a speech aid prosthesis. This article describes the prosthodontic management of a patient with a palatopharyngeal defect using a pharyngeal obturator.

Simple method for fabricating a cast partial framework obturator for lifelike appearance: a case report.

Defects can form after tumors in the maxillary region are resected surgically. Maxillofacial defects can affect a patient's physical, psychological, and social status. Surgery reduces the residual teeth and tissue's ability to provide optimal cross-arch support, stability, and retention. The design of the obturator can improve the esthetics of the prosthesis and give it a more lifelike appearance. This case report describes the fabrication of a cast metal framework design for a partial obturator prosthesis in a maxillectomy patient.

Indirect resin-bonded fiber-reinforced composite anterior bridge: A case report.

The loss of anterior teeth can be painful for patients, both psychologically and socially. In recent years, fiber-reinforced composite resins (FRCs) have gained increasing acceptance in mainstream prosthodontics as viable alternatives to alloy-based restorations. A combination of good esthetics and fracture toughness validates their use in a diverse range of clinical applications. In this study, a bridge was constructed with hybrid composite resin placed around a resin-impregnated, plasma-etched, polyalkene fiber bonded to the abutment tooth enamel using the acid-etch technique. This method of tooth replacement is viewed as a fast, simple, cost-effective means of replacing anterior teeth. The restoration remained intact, with no discoloration or deterioration at the recall visits. While definitive long-term data about their clinical performance is scarce, FRC prostheses appear to have a worthwhile role in the conservative treatment of short, edentulous spaces.

A simple, time-saving chairside device for radiographic diagnosis of vertical bone height and soft tissue thickness for implant placement--clinical report.

A diagnostic radiograph of the posterior regions of the jaws is mandatory if implant placement is considered at these sites. The goal is to avoid damage to important anatomical structures such as the inferior alveolar canal and maxillary sinus. Using radiographs to evaluate the remaining bone height available for implant insertion is a common procedure. Many articles have evaluated the success rates of fixed prostheses supported by osseointegrated implants, indicating high rates of success for prostheses 5-10 years in function. However, if an orthopantomogram machine is not readily available, periapical radiographs can be used for vertical bone height assessment. The familiar procedure of incorporating a metal ball of known diameter into an acrylic template is the method of choice. This is a relatively tedious and expensive procedure involving multiple steps, including impression taking, creation of a study model, and manufacture of a metal ball-bearing acrylic template. A further disadvantage for the patient is that a diagnostic radiograph can be taken only at the next appointment. This paper describes a quick and simple method to obtain a radiographic evaluation of remaining alveolar bone height and soft tissue thickness prior to implant placement with help of a metal ball device to avoid template fabrication and time consumption. Soft tissue thickness is measured nonsurgically.