Crestal Bone Loss under Delayed Loading of Full Thickness Versus Flapless Surgically Placed Dental Implants in Controlled Type 2 Diabetic Patients: A Parallel Group Randomized Clinical Trial.

PURPOSE: To compare crestal bone loss around dental implants using a delayed loading protocol. Bone loss was compared in patients following conventional full thickness flap and flapless surgery in controlled type 2 diabetic patients. MATERIALS AND METHODS: Eighty-eight type 2 diabetic patients satisfying predetermined inclusion and exclusion criteria were selected for this single center, parallel group study after obtaining institutional review board approval and informed consent. These patients were randomly divided into two groups. Group I consisted of patients undergoing full thickness flap surgery for implant placement, and group II consisted of patients undergoing flapless surgery for implant placement. The mean age, duration of diabetes, glycosylated hemoglobin levels, and male-to-female ratio in both groups were matched and compared statistically. Dental implants were placed followed by delayed loading (4 months) in both groups. Crestal bone loss was assessed with intraoral periapical radiographs with the help of computer software (DBSWIN viewer). Actual implant length acted as the radiographic index, and implant-abutment junctions were used as a reference point for all measurements. Mesial and distal bone levels at baseline, 6, and 12 months post implant placement of the two groups were determined. Mesial and distal crestal bone loss from baseline to 6 and 12 months were calculated and compared with Tukey test using SPSS v15.0 statistical analysis software. RESULTS: Tukey test revealed similar (not statistically different) mean mesial crestal bone loss between the two groups after 6 months (0.47 ± 0.08 mm vs. 0.36 ± 0.13 mm, p = 0.576) and after 12 months (1.56 ± 0.25 mm vs. 1.50 ± 0.22 mm, p = 0.891). The mean distal bone loss resulting between the two groups was not statistically different at 6 months (0.44 ± 0.08 mm vs. 0.35 ± 0.12 mm, p = 0.687) and at 12 months (1.57 ± 0.23 mm vs. 1.61 ± 0.22 mm, p = 0.947). CONCLUSIONS: The results of this clinical randomized control trial indicated that in controlled type 2 diabetic patients, levels of crestal bone loss around dental implants placed following conventional full thickness flap surgery was comparable to crestal bone loss around dental implants placed with the flapless surgical technique. More clinical studies are required regarding controlled type 2 diabetics with larger sample sizes, for long time periods to obtain more predictable results.

Management of mandibular deviation after mandibulectomy by simplified approach.

Unfavourable sequelae from mandibular surgeries include malocclusion and temporomandibular joint dysfunction. The management of the situation before these complications arise is largely based on experience. This report presents a case where mandibular deviation is decreased through an additional row of teeth in the maxillary removable partial denture, and by decreasing scar contracture in the surgical site by means of a simple exercise.

Effect of complete dentures on craniofacial growth of an ectodermal dysplasia patient: a clinical report.

The aim of this clinical report was to observe the effect of complete dentures on craniofacial growth and development of an ectodermal dysplasia (ED) patient. A complete anodontia patient diagnosed with ED was successfully rehabilitated with conventional complete dentures at the ages of 5, 8, and 10 years. Three sets of complete dentures were made with age-appropriate denture teeth and a bilaterally balanced lingualized occlusal scheme. Periodic follow-up and adjustment when needed was done to maintain proper oral function and esthetics. Serial cephalometric analysis exhibited a marked restriction of forward growth at the anterior nasal spine (ANS) point between 5 and 10 years of age, although there was little change from average in the anteroposterior length of the mandibular body and the height of the mandibular ramus. So, while maxillary growth was reduced, mandibular growth did not significantly change. Cast analysis showed that the increase in arch length was greater than in arch width for both the maxilla and mandible. There was little increase in alveolar ridge height in the anterior region but a considerable increase in the height of the alveolar ridge in the middle and the posterior region. Our findings concluded that the absence of teeth did not affect the growth of the jaws, and it is probable that the denture flange did not arrest the jaw growth, but rather improved the masticatory function by providing good denture stability and retention.

Removable partial denture with molar uprighting spring: an innovative hybrid appliance.

PATIENT: A 45-year-old female patient with need of fixed replacement of her missing teeth which were lost long time before. Posterior teeth were severally tipped bilaterally in the edentulous space. Hybrid removable partial denture with molar uprighting spring was fabricated for molar uprighting on both side tilted molars. After 3 month and 15 days of treatment with hybrid appliance the molar abutment were uprighted for fabrication of fixed partial dentures. DISCUSSION: The objective in molar uprighting is ideal positioning of the molar which will eventually become an abutment tooth for a fixed prosthesis. The ideal position will provide an optimal periodontal environment for the molar. The prosthodontic advantages of molar uprighting via distal tipping include an improved line-of-draw if a FPD is being constructed. Concept of designing of appliances was based on our basic knowledge of forces for uprighting the tooth along with maintaining the function during the treatment period. Another advantage of this appliance was that it prevented supra eruption of opposing teeth during the period when the molar was being uprighted. CONCLUSION: Uprighting of tilted molar is extremely beneficial for long term success of fixed denture prosthesis by using hybrid appliances in very short period of treatment without hampering the function of the patient during the treatment period which is very economical as well.

Management of trismus following radiation therapy by cost-effective approach.

Radiotherapy when used in head and neck cancer treatment can produce side effects in patients such as the trismus. If allowed to progress trismus can become so severe that the patient becomes debilitated due to lack of nutrition. Furthermore, trismus and limited oral access present a challenge to the clinician for dental treatment. This article describes a simple and cost-effective appliance for management of trismus.

Novel registration technique to register neutral zone.

INTRODUCTION: The three dimensional volume of complete dentures optimally occupies an edentulous space that is substantial, in the light of the progressive changes that accompany edentulism and functional dynamics. The paper discusses current knowledge of neutral zone registration and presents a novel technique for this registration. MATERIAL AND METHODS: Fabricate maxillary and mandibular occlusal rims over conventional record bases using high fusing impression compound. Register the maxillary and mandibular neutral zone separately by swallowing method and after try in of complete denture; remove the wax apical to the tooth surfaces and recording will be completed with putty and light body impression material. RESULTS: Complete dentures are a biomechanical device that must be designed in harmony with normal neuromuscular function to get stability and proper function. Improper teeth positioning and polished surface contour will result in compromised stability of denture. CONCLUSIONS: This article describes a preview of facio-lingual positioning of denture teeth along with a novel approach of recording the neutral zone with an elastomeric impression material.