Dual-Arch Prosthesis: Revolutionizing Partial Dentate Rehabilitation.

The utilization of natural teeth as denture abutments offers a significant advantage in retarding the residual ridge resorption (RRR). This approach distributes stress concentration between the denture-bearing areas and abutment teeth, thereby mitigating issues such as loss of sensory feedback, compromised mastication, and aesthetic concerns. Overdentures, by providing additional support and stability, play a pivotal role in reducing RRR while enhancing stability and retention. A cast partial denture (CPD) becomes the first choice in cases of long edentulous span where cross-arch stabilization is required. The simplicity of insertion, removal, and maintenance, coupled with effective oral hygiene practices, make CPDs a practical solution. This case presentation illustrates the successful prosthetic rehabilitation of a partially dentate patient through the implementation of a maxillary overdenture and mandibular CPD underscoring the efficacy of this treatment modality in achieving optimal outcomes. The combination of these prostheses restored the masticatory function, improved the aesthetics, and enhanced the quality of life of the patient. This case highlights the effectiveness of dual-arch prosthetic solutions in achieving comprehensive rehabilitation in partially dentate patients.

Prevalence of Osteoporosis and Its Effect on Residual Ridge Resorption in Postmenopausal Females of Rural Central Indian Region.

AIM:  To determine the correlation between body mass index (BMI), bone mineral density (BMD), and residual ridge resorption (RRR) in postmenopausal females and the effect of osteoporosis on RRR. MATERIALS AND METHODS:  A study was conducted with 60 postmenopausal female individuals. BMI was calculated using the weight and height of the patient using a formula. BMD was assessed and graded using a T-score. RRR was determined using the Tallgren method. RESULTS: Most individuals showed a higher BMI (63.33%), which is in the overweight or obese category. BMD was lower in approximately 68.33% of patients, and RRR was significantly higher in about 60% of total patients. CONCLUSION: The higher the BMI values, the lesser the BMD and the higher the RRR.

Prosthodontic Rehabilitation of the Flabby Edentulous Maxilla Using Hobkirk's Technique: A Case Report.

Edentulism is characterized by the loss of teeth, which can significantly impact oral health and the quality of life of older patients. Among the challenges faced by individuals with edentulism is the occurrence of flabby ridges, a common consequence of prolonged tooth loss. Flabby ridges, characterized by soft, compressible tissue in the edentulous ridge area, present unique management challenges for dental professionals. Fibrous or flabby alveolar ridges present challenges in the fabrication of predictable prostheses. Impression making, a critical step in prosthodontic treatment, becomes particularly problematic as forces exerted during the process can distort the mobile denture-bearing tissues, which will cause the denture to become unstable and loose. This case report aims at an impression technique that can enhance the treatment outcomes for edentulous patients with fibrous alveolar ridges as this decreases the pressure over flabby tissue.

Digitalization in Cranial Reconstruction: Revolutionizing Precision and Innovation.

Cranioplasty for cranial defects can be complex and challenging in composite defects. The intricate 3D structure of the craniofacial skeleton poses various difficulties encountered in surgical reconstruction. The continuous progress in computer-aided design and computer-aided manufacturing design, and fabrication technology has led to a growing array of applications for visual analog scale and 3D printing in craniofacial surgery, encompassing preoperative assessment, the creation of cutting guides, and the development of custom implants and stereolithographic models. Within this review, the authors detail the present and developing applications of virtual surgical planning, 3D bioprinting, augmented reality, and virtual reality in craniofacial reconstruction.

Osseodensification: An Innovative Technique With Manifold Gains.

Prosthodontics, which is removable and fixed, is the branch dealing with the replacement of missing teeth. Implant therapy is the popular treatment modality and commonly preferred treatment option by many patients and clinicians for missing teeth in recent years. Primary implant stability (PIS) is one of the crucial factors for osseointegration. It has been considered a crucial factor in the success of implants. Moreover, several factors influence PIS. On the other hand, both secondary implant stability and osseointegration are influenced by the PIS. Bone density, bone volume, bone-to-implant contact, and other factors that enhance or degrade the primary stability. Certain host sites such as the maxillary posterior region demand more dense bone to achieve desired results as they are the low-density areas of the jaw. So, a new promising and growing innovative concept of osseodensification (OD) offers a great solution with multiple benefits and desirable results. This review article aims to enlighten the multiple benefits of OD technique and their mechanism of action.

Optimizing Implant Placement in Cases of Limited Interocclusal Space: Strategies and Challenges.

Effective treatment planning is crucial for implant-supported dental prostheses' success, requiring a thorough assessment of various factors, including bone quality, quantity, and available space. Evaluating space availability, encompassing height, width, and angulation, is imperative to ensure optimal implant positioning devoid of anatomical limitations. Adequate vertical space is essential for accommodating the implant-supported restoration while preserving proper occlusal function and esthetics. However, not all cases adhere to ideal standards, especially those featuring limited interocclusal space, as seen in scenarios of long-standing edentulous areas lacking prior prosthetic rehabilitation. Ideally, the interocclusal space should measure between 8-12 mm vertically. This case report details the management of reduced interocclusal space through the strategic placement of deeply positioned implants and the incorporation of a screw-retained fixed partial denture, effectively addressing the challenges associated with limited space.

Fabrication of Hollow Acrylic Vaginal Stents Using Frozen Coconut Oil for Vaginal Agenesis Management.

In a rare condition known as vaginal agenesis, the uterus (womb) may develop only partially or not at all, while the vagina fails to develop altogether. It is common to diagnose vaginal agenesis, when a female does not start menstruation at puberty. This is a prenatal disorder that may also be linked to bone or kidney issues. Mullerian agenesis, Mullerian aplasia, and Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome are other names for the illness. Treatment modalities encompass surgical and nonsurgical interventions, including the utilization of prefabricated or customized vaginal stents for neovagina reconstruction and maintenance. This case report describes the development of a neovagina in a 27-year-old female diagnosed with vaginal agenesis, a characteristic of MRKH syndrome. A customized clear acrylic stent, designed to provide a resilient surface, serves as a straightforward and cost-efficient alternative for managing this condition. Significantly, it enhances patient's compliance and comfort during treatment, addressing both the physical and psychological ramifications of this congenital anomaly. This customized vaginal stent not only provides a practical solution but also contributes to enhancing the quality of life for individuals grappling with vaginal agenesis, thereby offering a promising avenue for addressing the multifaceted challenges associated with this condition.

Designing a Single Lithium Disilicate Crown: A Computer-Aided Design and Computer-Aided Manufacturing Approach With Exocad Software.

This case report presents an overview of the workflow and advantages of computer-aided design and manufacture (CAD/CAM) technology in designing single crowns for anterior restoration. The workflow of CAD/CAM systems involves extraoral scanning, virtual crown design, and automated milling processes. The advantages of CAD/CAM technology include enhanced accuracy, reduced chairside time, and improved patient satisfaction. Considerations for material selection, clinical indications, and associated factors in CAD/CAM single-crown design are also discussed. Additionally, CAD/CAM provided accurate and lifelike restoration contours, ensuring optimal fit, function, and aesthetics. This technology proved highly beneficial in this case for several reasons. This case illustrates the significant advantages of CAD/CAM technology in modern dental practice, offering precise, efficient, and aesthetically pleasing solutions for single dental crowns.

Rehabilitation of Congenitally Missing Bilateral Incisors With the Maryland Bridge: A Case Report.

Congenital partial hypodontia is a commonly encountered disorder, presenting a challenge for adolescents seeking treatment, as existing options often come with drawbacks. Among these options, the Maryland Bridge stands out for its accessibility and notable benefits in terms of both strength and aesthetics. This article explores the merits of this treatment modality, supported by a detailed case study demonstrating its successful application. An 18-year-old patient was referred to our hospital with a complaint of missing bilateral maxillary incisors. Upon clinical examination, it became apparent that the orthodontic treatment was done and exhibited the absence of bilateral incisors in the upper arch. Subsequent diagnosis confirmed congenital partial hypodontia. To address the missing teeth, a treatment plan centered around the use of a Maryland Bridge was devised. One of the persistent challenges faced by restorative dentists is devising solutions for congenitally missing lateral incisors. Despite the availability of numerous therapeutic alternatives, none are without their limitations. However, the outcome of the rehabilitation in this case proved to be notably aesthetically pleasing, effectively fulfilling the intended purpose. As a result, this article advocates for the Maryland Bridge as a viable option for patients facing similar dental challenges.

Transforming Smiles: A Case Study on Monolithic Zirconia Prosthetic Solutions.

In order to effectively address challenges related to anterior teeth restoration and achieve natural-looking results, considerations such as shape, size, gingival contour, and color are crucial. Due to an increasing desire for visually appealing alternatives that are free of metal, materials such as dental zirconia have become popular because of their superior aesthetics and mechanical characteristics. This case report presents clinical insights into anterior teeth rehabilitation with the use of layered zirconia fixed dental prostheses. It delves into the experiences associated with zirconia dental restorations on both endodontically treated and vital abutments, aiming to discern how various factors influence treatment outcomes. Beginning with the design of the restoration, its intricacies significantly impact its fit, strength, and overall durability. Moreover, the composition of zirconia used plays a pivotal role, as different formulations offer varying degrees of mechanical properties, influencing factors such as resilience and wear resistance. The shade selection is also scrutinized, as it directly affects the restoration's aesthetic integration with surrounding natural teeth, contributing to a more harmonious smile. Furthermore, the layering technique employed, particularly when additional porcelain or ceramic layers are applied, is essential for both cosmetic enhancement and structural integrity. Lastly, considerations of occlusion are paramount, ensuring proper alignment and contact between teeth to prevent premature wear and discomfort. By exploring these facets in zirconia restorations across different abutment types, this inquiry seeks to illuminate best practices for achieving favorable treatment outcomes in dental restoration procedures. The choice of zirconia composition, framework design, and shade must be carefully tailored to suit the characteristics of each individual abutment. This emphasizes the significance of adopting a tailored approach to tackle the distinct challenges posed by every clinical scenario. The manuscript provides detailed observations from a clinical case involving the restoration of anterior teeth utilizing monolithic zirconia-fixed dental prostheses. Through a combination of root canal treatment and composite buildup, successful restoration was achieved, with meticulous attention paid to aesthetic considerations. The utilization of computer-aided designing/computer-aided manufacturing (CAD/CAM) technology in crafting zirconia restorations ensured precise fit and superior biocompatibility, contributing to the overall success of the treatment. The study underscores the importance of personalized treatment strategies in achieving optimal outcomes in anterior teeth restoration, emphasizing the need for careful consideration of various factors such as design, composition, and shade selection. Overall, the findings shed light on the potential of zirconia-based restorations in addressing the unique challenges associated with anterior teeth rehabilitation, offering valuable insights for dental practitioners striving to deliver aesthetically pleasing and functionally sound outcomes for their patients.

Sustainable Dentistry: A Comprehensive Review of the Recycling Techniques for Gypsum Products in Prosthodontics.

This review explores the pivotal role of sustainable dentistry with a specific focus on the recycling of gypsum products in prosthodontics. As oral health practices increasingly impact the environment, the adoption of sustainable approaches becomes imperative. The review delves into the environmental challenges posed by gypsum waste in prosthodontics and examines current recycling techniques, presenting key findings and successful case studies. The call to action is directed towards the dental community, urging practitioners, educators, and policymakers to prioritize sustainable practices, encompassing responsible waste management and the incorporation of eco-friendly materials. Looking to the future, the review envisions a promising landscape for sustainable dentistry in prosthodontics, propelled by emerging technologies and a collective commitment to environmentally conscious oral healthcare. Ultimately, this review serves as a catalyst for positive change, advocating for a transformative shift toward sustainability within the dental community.

Readiness, acceptability, and feasibility of differentiated TB care for COVID-positive pulmonary tuberculosis patients diagnosed in a district in South India: Mixed methods study.

Background: Differentiated tuberculosis care (DTC) approach is the need of the hour to mitigate those risks and provide better treatment outcomes to reduce both mortality and morbidity. Before implementing such an approach, there should be adequate literature on healthcare facility assessment along with qualitative exploration on readiness and acceptability among various stakeholders that are currently needed to fill the gaps in National Tuberculosis Elimination Program. Objectives: Our study objectives were to assess the availability of equipment, treatment, and investigations for managing patients under the DTC approach, to explore the readiness, acceptability, and feasibility of the DTC approach among healthcare providers involved in TB care provision, and to determine the knowledge regarding DTC approach among healthcare providers delivering TB care for COVID-positive pulmonary TB patients. Materials and Methods: All Peripheral Health Institutes (PHIs) in two randomly chosen blocks within the Tiruchirappalli district's health units were selected for the healthcare facilities assessment. By the universal sampling method, all the stakeholders were included. The study population was assessed for their knowledge regarding DTC. Checklist-based assessment of the feasibility of healthcare services followed by a questionnaire-based knowledge assessment was done. An in-depth interview-based exploration of readiness and acceptability of the DTC approach was conducted. This study was conducted among various stakeholders involved in TB care in selected PHIs of Tiruchirappalli from July 2022 to October 2022. Results: The majority of healthcare workers (HCWs) are unaware of bidirectional screening (89.0%) and lack training in providing TB care to COVID-co-infected patients (87.8%), although the majority were aware of risk stratification for TB patients (90.2%) and are linking TB with other co-morbidities (82.9%). About 62.2% of HCWs claimed they are not using information communication technology-based services to receive lab findings from public scans and laboratory centers, and more than one-third were unaware of these facilities. Based on the qualitative assessment, most of them were willing to undergo periodic training to improvise their approach and treatment. Also, most of the HCWs felt manpower can be increased for the specific care of the patients. Conclusion: The research suggests that with sufficient training and upskilling of the HCWs, DTC is almost feasible and that HCWs will accept it if specific strategies are used. More studies like these in assessing the feasibility and acceptability of this DTC approach and exploring the challenges and solutions will help the policymakers in finding the lacunae before implementing this DTC model in various states across India.

Association of Salivary Cortisol With Anxiety in Type 2 Diabetes Mellitus Patients Before and After Complete Denture Rehabilitation: An In-Vivo Analysis.

Background Complete edentulism negatively impacts emotional, physical, social, and psychological well-being, leading to a decline in quality of life and heightened stress and anxiety. Stressful situations associated with edentulism can elevate cortisol levels, potentially increasing the risk of diabetes. Rehabilitation with complete dentures needs careful evaluation for its impact on general health, considering stress points and systemic effects. This study aimed to assess salivary cortisol levels in type 2 diabetes mellitus patients before and after complete denture rehabilitation, highlighting the intricate relationship between diabetes, cortisol, and the stress response. Methods This is a cross-sectional study centered on individuals with diabetes who were completely edentulous and undergoing evaluation by the outpatient prosthodontic department. Glycated hemoglobin, anxiety levels, and the fabrication of complete dentures were all accomplished with the participants' consent. Patients underwent evaluations before and one month after receiving complete denture rehabilitation. Results An absolute correlation between salivary cortisol levels and anxiety may be established because anxiety levels dramatically decreased during complete denture rehabilitation. Conclusion By learning how the patient's general health is related to their new set of complete dentures and how to correlate that information with dental rehabilitation, professionals can help patients better adapt to their new set of dentures.

A Comprehensive Review on Virtual Articulators.

The virtual articulator (VA) is a technology that simulates the jaw relation in a computer-generated setting. Augmented and virtual reality have been utilized as digital technology, which aids in many areas of dentistry and dental education. Today, a practicing dentist must keep up with the newer technologies, but with technology evolving so quickly it becomes challenging. In dentistry, the possibilities for digitization and technological advancements are limitless. Virtual articulators (VAs) allow a complete occlusion analysis using dental models that replicate all mandibular motions in static and dynamic scenarios. VA when executed in addition to other software enhances treatment planning and patient education, allowing quicker and more precise individualized diagnoses. The main objective of this study was to describe and evaluate the study outcomes in the available research on VAs, assess their needs, and evaluate their advantages and limitations in various aspects. A PubMed Central search was made of dental journals, with the identification of 135 articles out of which 30 were finally selected. The investigations conducted to evaluate the VA's dependability provide good visualization of the quantity and location of the dynamic interactions. A precise instrument for fully analyzing occlusion in a real patient is the virtual articulator.

Appliances Therapy in Obstructive Sleep Apnoea: A Systematic Review and Meta-Analysis.

Obstructive sleep apnea (OSA) is a recurrent partial or complete obstruction of the upper airway during sleep caused by narrowing or collapse of the pharyngeal wall. It leads to microstimulation and oxyhemoglobin desaturation, resulting in sleepiness and loud snoring. OSA negatively affects the cardiovascular system and may contribute to neurocognitive impairment. The aim of this systematic review is to evaluate the effectiveness and efficacy of appliance therapy in obstructive sleep apnea. The effectiveness was assessed by using the Apnea Hypopnea Index (AHI). An electronic search of the Cochrane Library, PubMed, and Google Scholar was conducted between 1998 and 2021. Articles were independently assessed by three reviewers. The quality of a randomised control trial (RCT) is assessed using the Cochrane risk of bias method. The tool GRADE was used to achieve the desired level of confidence for each outcome reported. Several studies used continuous positive airway pressure (CPAP), mandibular advancement devices (MAD), and tongue retention devices (TRD). The meta-analysis included a total of six papers that met the inclusion criteria. Results showed that CPAP significantly improved AHI compared with an oral appliance (random effects: difference in means = 8.40, 95% CI = 7.21 to 9.60). It was also found that oral appliance (OA) therapy significantly improved AHI compared with baseline before appliance therapy (random effects: mean difference = 13.40, 95% CI = 10.87 to 15.93; p.00001). For mild to moderate OSA, CPAP is considered the gold standard. Our meta-analysis of six RCTs found favorable evidence for OSA patients receiving oral devices; however, they were less effective than CPAP. A subgroup analysis found that MAD may be a beneficial treatment for mild to moderate OSA patients who do not respond to CPAP. The findings suggest that oral appliances may be an effective treatment for OSA, especially in patients with mild to moderate OSA.

Alternative Birthing Positions Compared to the Conventional Position in the Second Stage of Labor: A Review.

The position in which the woman delivers has a lot of impact on the ease of delivery. Women's satisfaction with their birthing experience and the care they receive is significantly impacted by the fact that giving birth is frequently a challenging experience. Birthing positions refer to various postures which can be assumed at the time of delivery by a pregnant woman. Currently, the majority of women give birth either while lying flat on their backs or in a semi-sitting position. Upright positions, which include standing, sitting, or squatting along with side-lying and hands-and-knees, are less common birth positions. Doctors, nurses, and midwives are among the most important healthcare professionals, having a significant influence in deciding which position the woman will give birth in and on the physiological and psychological effects of the experience of a woman in labor. There isn't much research to back up the best position for mothers during the second stage of labor. This review article aims to review and compare the advantages and risks of common birthing positions and know about the knowledge of alternative birthing positions among pregnant women.

Cranioplasty With a Customized Polymethylmethacrylate Implant Using a 3D Printer.

The occurrence of cranial injuries has increased dramatically, and due to greater awareness among the people concerned with aesthetics needing skull reconstruction, rehabilitation of these defects has also increased in our modern age. Rehabilitation of these deficiencies with prostheses not only works as a protective shell but also improves the patient's neurological state. These cranial deformities necessitate surgical correction or repair, known as cranioplasty. Its goal is not only to rehabilitate the imperfection aesthetically, but also to alleviate psychological issues and improve the patient's social acceptance and performance. New biomedical tools, technologies, and materials are available to surgeons and prosthodontists to improve aesthetics and functions. The purpose is to develop a novel method involving affordable 3D printing technology for creating individualized polymethylmethacrylate (PMMA) implants, aiming to democratize technology in prosthodontics.

Esthetic Solutions With Layered Zirconia Prostheses: A Case Report.

To meet the challenges of rehabilitating anterior teeth and achieving natural-looking restorations, it is essential to address issues such as improper shape, size, irregular gingival contour, and unaesthetic shades. The increasing demand for aesthetically pleasing and metal-free solutions has popularized materials like dental zirconia, offering optimal aesthetics and desirable mechanical properties. Within this context, a case report highlights clinical experiences with layered zirconia fixed dental prostheses designed specifically for anterior teeth. The report focuses on the prosthetic rehabilitation of both endodontically treated and vital abutments, exploring the influence of zirconia composition, design, layering technique, shade selection, occlusion, and the unique clinical challenges associated with each condition. The selection of zirconia composition, framework design, and shade in layered zirconia prostheses is intricately tied to the characteristics of the abutments. This interconnectedness underscores the importance of a thoughtful and customized approach to address the specific requirements of each clinical scenario.

A Systematic Review of Tripoding: A Step Towards Successful Rehabilitation.

This article aims to evaluate different methods and techniques published in the literature for tripodization in removable partial dentures. The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Electronic databases like PubMed, Cochrane Library, and Science Direct were searched for manuscripts published till August 15, 2021. An electronic search was restricted to the English language of the publications to identify the relevant articles on tripoding techniques in removable partial dentures. A hand search was also carried out. A total of 18 articles were included in this systematic review. The documented 18 articles associated with the tripoding techniques were reviewed systematically. Accurate repositioning of a cast on the surveyor is a critical step in the fabrication of a removable prosthesis. Based on the ease of use and no modifications to the existing cast, the "tripoder attachment" and "swiveling device" can be concluded to be superior to others. Once constructed, these devices are easy to use, can be operated for various patients, do not modify or damage the cast, and can be stored and disinfected for repeated use.

A Review of Episiotomy and Modalities for Relief of Episiotomy Pain.

Episiotomy is a surgically planned incision of the perineum and the posterior vaginal wall in the second stage of labour. It is one of the most commonly performed surgical procedures in the world. In episiotomy, the vaginal orifice is made larger to facilitate the birth of a baby. The postnatal period is very crucial in every mother's life, especially those who had a vaginal delivery and underwent episiotomy. Maternal benefits of episiotomy include reduced risk of perineal trauma, subsequent pelvic floor dysfunction and prolapse, urinary incontinence, faecal incontinence, and sexual dysfunction. Potential benefits for the foetus are thought to include a shortened second stage of labour. However, an episiotomy can also lead to potential adverse consequences, including the extension to a third- or fourth-degree tear, anal sphincter dysfunction, and dyspareunia. Different approaches can be adopted to reduce these complications in the postpartum period, including cleanliness, cold packs, sitz baths, kegel exercises, perineal care, and topical application of dry heat-infrared lamp therapy. Of all these approaches, infrared lamp therapy and sitz baths are the two most effective and commonly used for episiotomy pain relief and wound healing. In infrared lamp therapy, radiant heat or infrared rays are used to produce heat that is then applied to the episiotomy wound to facilitate pain relief and wound healing, while a sitz bath is a moist heat application process that is also effective for episiotomy pain relief and wound healing. This review aims to offer the most thorough understanding of episiotomy, its current concept, and episiotomy pain relief, with a particular focus on infrared lamp therapy and sitz baths.