Modification of existed prosthesis into a flexible wall hollow bulb obturator by permanent silicone soft liner for a hemimaxillectomy patient with restricted mouth opening.

PATIENT: A patient of hemimaxillectomy with restricted mouth opening, wearing a hard acrylic bulb obturator encountered difficulty in insertion and removal of the prosthesis. The prosthesis was converted into a open hollow bulb obturator with flexible walls with permanent silicone soft liner for easy insertion and removal. DISCUSSION: Patients having acquired maxillary defects due to surgical resection of the maxilla often suffer with difficulty in mastication, swallowing, nasal regurgitation, speech disturbances and poor esthetics. Different types of obturator with various bulb designs most commonly fabricated from acrylic resins together with "acrylic resin plate and/or" metal framework are used to improve the quality of life of these patients by restoring the function. But restricted mouth opening in some of these patients makes it difficult to place and remove the prosthesis with hard acrylic bulb. Fabrication of flexible open hollow bulb and relining of remaining obturator with resilient permanent silicone soft liner makes easy insertion and removal of the prosthesis and also improve the retention by intimate contact of soft liner with the tissues. CONCLUSION: Permanent silicone soft liner open hollow bulb obturator is a novel way for the functional rehabilitation of a hemimaxillectomy patient suffering with restricted mouth opening.

Prevention of trauma to soft tissues from opposing dental implants in completely edentulous patients.

OBJECTIVE: To suggest a technique to prevent trauma of the edentulous ridge from opposing dental implants when prosthesis kept out during night. BACKGROUND: In modern dentistry, implant-supported overdentures are commonly fabricated to minimise the problems associated particularly with mandibular conventional removable denture such as the lack of retention or stability, decreased chewing efficiency, difficulties in speech and soft tissue abrasion. The patients wearing two implant-retained overdentures that are mainly soft tissues supported-implant-retained overdentures are advised to keep prosthesis out of the oral cavity during night to allow the tissues to rest and remain healthy. Few of such patients might complaint about trauma of the opposing soft tissues by the dental implants when prosthesis is kept out. MATERIALS AND METHODS: A thermoplastic resin mouthguard was fabricated by adapting the modelling wax over the abutments on the master cast from thermoplastic resin sheets. The wax was removed and guard was filled with chemically cure permanent silicone soft liner and immediately placed in the patient mouth. CONCLUSION: The trauma caused by dental implants to the opposing edentulous ridge was effectively managed by soft thermoplastic resin mouthguard filled with permanent silicone soft liner.

A direct approach for fabrication of a provisional restoration immediately after tooth preparation for custom cast dowel and core.

When a tooth is fractured at the gingival level due to accidental trauma and there is insufficient coronal tooth structure to retain a crown, a custom cast dowel and core often is necessary, followed by the fabrication of a definitive crown. It is very difficult to fabricate the provisional restoration for a tooth until the custom cast dowel and core are cemented permanently. This article describes a direct procedure for fabricating a provisional restoration (with a prefabricated temporary titanium post and an acrylic resin denture tooth) immediately after the tooth has been prepared for a custom cast dowel and core. This technique produces excellent clinical results while being less time-consuming than an indirect approach.

Esthetic and functional rehabilitation of missing anterior teeth with a conservative treatment approach: a clinical case series.

The current scenario in dentistry proposes several treatment modalities for the esthetic and functional replacement of a congenitally or traumatically missing anterior tooth in young and adult patients which includes implant supported single crown, conventional FPD, Resin Bonded FPD (RBFPD) or RPD. However when certain clinical conditions or unwillingness of the patient preclude the replacement of missing tooth with any of these prostheses, in such cases, a more conservative treatment modality, fiber reinforce composite resin fixed partial denture with composite resin, porcelain fused to metal, all ceramic or natural tooth pontic can be consider as a definitive treatment alternative in certain clinical conditions. This article describes successful rehabilitation of three different patients with three types of pontics by this technique.

Knowledge of mothers with different education levels about the emergency management of avulsed teeth.

PURPOSE: The present study was undertaken to evaluate and assess, through questionnaire, the knowledge of mothers with different education levels regarding the emergency management of avulsed permanent teeth. BACKGROUND: The replantation is the preferred treatment for avulsed tooth. The prognosis depends upon the handling of the periodontal ligament and speed of replantation. Mothers are commonly taking care of children and are around them when such injuries can occur. Their knowledge about emergency management of avulsed tooth is important; that can vary upon the level of education of mothers. METHODS: The 800 mothers were divided into two groups of 400 each depending upon two different educational levels- primary and higher/technical education. After obtaining the consent, they filled 10 item questionnaire containing both correct and wrong answers related to emergency management of avulsed teeth. Collected data was statistically analyzed. RESULTS: The results indicated highly significant difference in the knowledge of mothers of two groups regarding emergency management of avulsed teeth with better knowledge and awareness in mothers with higher/technical education. CONCLUSION: Mothers with technical school education had better knowledge than mothers with primary school education. However, mothers of both the groups were severely lacking in the complete and accurate knowledge.

A conservative treatment approach to replacing a missing anterior tooth.

An implant-supported crown or conventionally fixed partial denture is the most common treatment modality to replace a missing anterior tooth but a more conservative approach, with a fiber reinforced composite resin FPD, can be used to replace a missing anterior tooth in young patients or when the patient does not agree for an implant, or conventional FPD or RPD therapy. It is an esthetic, conservative single sitting chairside procedure which can be used as a definitive treatment alternative in certain clinical situations for esthetic and functional replacement of a missing anterior tooth. To achieve desirable results, putty matrix was used for proper positioning of the pontic during direct fabrication of FRCFPD.

Prosthodontic management of a patient with Gardner's syndrome: A clinical case report.

Gardner's syndrome is a genetic condition demonstrating an autosomal dominant trait and characterized by the multiple colonic polyps (familial adenomatous polyposis coli) with sebaceous cysts and jaw osteomas. Various dental abnormalities present in patient's suffering with this syndrome includes multiple impacted or unerupted teeth, supernumerary teeth, hypodontia, compound odontomes and dentigerous cyst. In this case report, a patient with Gardner's syndrome who suffered from functional and psychological problems owing to multiple impacted, unerupted teeth and hypodontia was presented. Patient was treated with a maxillary conventional overdenture opposing mandibular custom bar supported overdentures.

Prosthetic rehabilitation with collapsible hybrid acrylic resin and permanent silicone soft liner complete denture of a patient with scleroderma-induced microstomia.

Scleroderma is an autoimmune multisystem rheumatic condition characterized by fibrosis of connective tissues of the body, resulting in hardening and impairment of the function of different organs. Deposition of collagen fibers in peri-oral tissues causes loss of elasticity and increased tissue stiffness, resulting in restricted mouth opening. A maximal oral opening smaller than the size of a complete denture can make prosthetic treatment challenging. Patients with microstomia who must wear removable dental prostheses (RDPs) often face the difficulty of being unable to insert or remove a conventional RDP. A sectional-collapsible denture is indicated for the prosthetic management of these patients, but reduced manual dexterity often makes intraoral manipulation of the prosthesis difficult. A single collapsible complete denture is a better choice for functional rehabilitation of these patients. This clinical report describes in detail the prosthodontic management of a maxillary edentulous patient with restricted mouth opening induced by scleroderma with a single collapsible removable complete denture fabricated with heat-polymerized silicone soft liner and heat-cured acrylic resin. The preliminary and secondary impressions were made with moldable aluminum trays by using putty and light-body poly(vinyl siloxane) elastomeric impression material. The collapsed denture can be easily inserted and removed by the patient and also provides adequate function in the mouth.

Putty Index: An Important Aid for the Direct Fabrication of Fiber Reinforced Composite Resin FPD.

Fiber reinforced composite resin fixed partial dentures (FRCFPD) with composite resin, PFM or all ceramic pontic can be used as a short term or long term alternative to conventional fixed partial dentures or implant supported crown in young patients where conventional FPD is contraindicated (large pulp chambers) or in patient's unwilling to invasive implant placement surgical procedure and those who do not want to allow preparation of natural sound abutments for placement of retainers for FPD. FRCFPD can be successfully used for replacing missing anterior tooth (Turker and Sener, J Prosthet Dent 100:254-258, 2008), in conditions which allows minimum occlusal loading of pontic, over jet and overbite not greater than 3 mm (Ricketts, Provocations and perceptions in craniofacial orthopedics: dental science and facial art/parts 1 and 2. Rocky Mountain Orthodontics, Denver, p 7023, 1990) and structurally sound and intact abutments for the fiber reinforced matrix (Rose et al., Quintessence Int 33:579-583, 2002). The successful esthetic and functional rehabilitation of missing tooth with fiber reinforced composite resin FPD depends on accurate positioning of pontic in patient's mouth. It is difficult to hold the pontic in proper position with instrument or fingers while direct fabrication in mouth. For accurate positioning, stabilization of pontic is very important which can be achieved with putty index. Putty index maintain pontic in accurate mesiodistal, labiolingual and cervicoincisal position while fabricating FRCFPD directly.

Flexible thermoplastic denture base materials for aesthetical removable partial denture framework.

Conventional fixed partial dentures, implant supported Fixed Partial Dentures (FDPs) and removable partial dentures are the most common treatment modalities for the aesthetic and functional rehabilitation of partially edentulous patients. Although implants and FDP have certain advantages over removable partial dentures, in some cases, removable partial dentures may be the only choice which is available. Removable cast partial dentures are used as definitive removable prostheses when indicated, but location of clasps may affect aesthetics. So, when patient is concerned about aesthetics, flexible partial dentures which is aesthetically superior to flipper and cast partial dentures, may be considered. But for the success of flexible removable partial denture, proper diagnosis, treatment planning and insertion technique of this prosthesis is very important, which have been thoroughly described in this article.

Hader bar and clip attachment retained mandibular complete denture.

Bar and clip attachments significantly improve the level of satisfaction of denture-wearing patients by enhancing the retention and stability of the prosthesis. These attachments have been most commonly used for connecting the prosthesis to implants, but they can be effectively used to retain tooth-supported prosthesis as well. The primary functions of bar attachments are splinting the abutments together, even distribution of forces to the abutments and supporting areas, guiding the prosthesis into place, improving the retention, stability, support and comfort of the patient. The primary requirement for the use of bar attachments is the availability of sufficient vertical and buccolingual space for the proper placement of the bar, sleeves, teeth arrangement and sufficient thickness of acrylic denture base to minimise incidence of denture fracture in the area of bar assembly.

Unconventional prosthodontics for the aesthetic rehabilitation of discoloured rotated maxillary central incisor.

Orthodontics is always the first choice treatment for aesthetic and functional rehabilitation of malaligned teeth but in some exceptionally rare cases, the unwillingness of the patient for orthodontic correction poses a tough challenge to the dentist. In such cases, the only other option for aesthetic restoration is the change in angulation with custom cast post and core followed by the placement of an aesthetic crown.

Bilateral radix entomolaris with primary and permanent mandibular first molars.

Dental practitioners should be aware of the morphological dental anomalies like additional roots; their location, incidence and associated unusual root canal morphology. They should also carefully interpret the intraoral radiographs so that such anomalies do not go unnoticed.

Palateless custom bar supported overdenture: a treatment modality to treat patient with severe gag reflex.

OBJECTIVE: To suggest a custom bar supported overdenture treatment modality for prosthodontic management of patients with severe gag reflex. BACKGROUND: Some patients have a severe gag reflex and cannot tolerate conventional maxillary complete dentures with maximum palatal coverage and extensions of all borders. The condition further gets complicated in patients suffering from respiratory problems along with severe gag reflex. Severe gagging acts as a barrier to treat such patients with accepted clinical procedures and prevent patients from wearing the prosthesis. By saving some of the remaining natural teeth and fabricating, a horse shoe shape palateless simple tooth or bar supported overdenture can be successfully used for treating such patients. MATERIALS AND METHODS: The remaining maxillary right and left canines were prepared with the tapered round end diamond bur to receive copings of custom bar after intentional root canal treatment of same teeth. Impression was made with light body and putty of the polyvinyl siloxane elastomer with double step putty wash technique. Impression was poured with die stone. Wax pattern of copings with bar was fabricated with inlay wax which was invested and casted. After retrieving the bar, it was finished and its fit was evaluated. The coping-bar assembly was finally cemented with the glass ionomer cement. Palateless overdenture was fabricated by conventional technique used for the fabrication of complete denture. CONCLUSION: Palateless custom bar supported overdenture procedure can be successfully used for the management of patients with severe gag reflex with improved denture retention, stability, chewing efficiency and comfort of the patient.

Prevention of trauma to edentulous ridge from opposing natural teeth.

OBJECTIVE: To suggest a technique to prevent trauma of the edentulous ridge from opposing natural or restored teeth. BACKGROUND: The prevalence of the condition where one edentulous arch opposes a natural or restored dentition is quite common. In most of cases, the maxillary arch is completely edentulous and either all teeth or only anterior teeth are present in the mandibular arch. These remaining teeth may continuously cause trauma to the opposing edentulous ridge during the night when a removable prosthesis is kept out of the mouth. MATERIALS AND METHODS: A thermoplastic acrylic resin mouthguard was fabricated on a cast of the remaining teeth dentition. CONCLUSION: This article presents a simple and inexpensive procedure to prevent self-induced trauma of the edentulous ridge from opposing natural teeth by using a thermoplastic acrylic resin mouthguard.