Pathways for the rehabilitation of resection defects in the maxilla.

Oral rehabilitation of head and neck cancer patients is an integral component of the care pathway. Maxillectomy procedures can cause significant defects, such as oronasal fistulas, loss of support for the cheek and lip, aesthetic defects in the middle third of the face and functional impairments. Orofacial rehabilitation plays a fundamental role in restoring aesthetics and functional capabilities, such as speech, mastication and deglutition.Rehabilitation of maxillectomy patients poses a challenge for both clinicians and patients. This paper utilises case examples to demonstrate the treatment options for the oral rehabilitation of these patients. We will summarise the treatment pathways for conventional obturators, delayed (secondary) implant retained fixed rehabilitation following composite free flap and early rehabilitation using a zygomatic implant perforated flap technique. This paper aims to highlight the challenges in treatment planning and the importance of a multidisciplinary approach in improving patient outcomes.

Quantifying composite restoration removal and cavity re-preparation using novel region-specific volumetric analysis.

OBJECTIVES: This in-vitro study investigated the effect of 400-405 nm light used during removal of a composite restorations on volume of tooth tissue removed iatrogenically (IATR) and the volume of residual composite. METHODS: Thirty unrestored premolar teeth obtained via a university tissue bank were evenly allocated to test and control groups; material removal with and without violet light. Three clinicians (blinded to the protocol) prepared class V buccal cavities in the teeth. The teeth were scanned using CEREC Omnicam and reallocated to another clinician prior to restoration and rescanning. The teeth were reallocated, and the restorations were removed prior to rescanning. Volumetric scan data was obtained on: changes in cavity volume; the volume of IATR; the volume of residual composite. Data were analysed using Shapiro-Wilk and Kruskal-Wallis tests to a significance of p<0.05. RESULTS: Data showed that there is more IATR when the light was used with mean volume CAV2-over cut of (3.4 mm3, SD 4.22) whereas less IATR was seen when the light was not used (1.2 mm3, SD 1.00), (p<0.05). Data also showed that there is no significant difference in the overall volume of resin composite left when the light was used or not (p> 0.05). However when the light was used, less resin composite material was left around the margins of the cavities when compared to the no light group. SIGNIFICANCE: This novel region-specific cavity analysis method reveals patterns of iatrogenic damage and retained composite which may hold clinical relevance. The use of violet light may result in more complete removal of composite at margins, but also increase IATR. Further research using the novel method is required to ascertain the repeatability and clinical significance of findings.

Implant-supported overdentures: part 2.

The ability to provide high-quality complete dentures is a key skill for the general dental practitioner. The introduction of new implant attachments and dental technologies has opened the possibility of a wide variety of treatment options when considering implant-supported overdentures (ISODs).A thorough understanding of the advantages and disadvantages of ISODs is essential to ensuring appropriate treatment planning, consent and maintenance. Part one of this paper discussed the role of ISODs and the different attachment systems available. This second part will explore the relevant treatment planning considerations and maintenance requirements.

Implant-supported overdentures: part 1.

The ability to provide high-quality complete dentures is a key skill for the GDP. The increasing prevalence and utilisation of implant-supported overdentures has opened the possibility of a wide variety of treatment options to support patient care, while also creating the need for primary care practitioners to have a greater awareness of commonly used prosthetic attachments.A thorough understanding of the advantages and disadvantages of implant-supported overdentures is essential to ensuring appropriate treatment planning, consent and maintenance. This two-part series explores various aspects of implant-supported overdentures including assessment of the patient, treatment planning, different attachment systems and maintenance requirements.Part one will explore availability of implants in the NHS, the commonly available implant attachment systems, including their relative advantages and disadvantages.

How to assess and manage external cervical resorption.

External cervical resorption (ECR) is a type of pathological resorption which starts below the epithelial attachment to the root of a tooth. Various aetiologies relating to exposure of root dentine have been proposed. However, this is poorly investigated in the literature. Due to the nature of this lesion, early detection via thorough examination is essential to maintaining restorability of affected teeth. This article aims to summarise the available literature and describe management strategies for ECR, highlighting the role of clinical findings and patient-related factors in treatment planning.