Antimycotic prophylaxis with multispecies probiotics against oral candidiasis in new complete denture wearers: A randomized clinical trial.

STATEMENT OF PROBLEM: Changes in the oral microbiota of new complete denture wearers are the main cause of oral candidiasis. The drawbacks associated with traditional antimycotic therapies, especially drug resistance, have led to the search for potent therapeutic and prophylaxis agents with less harmful effects, including probiotics. However, investigation of the prophylaxis and preventive effects of probiotics on new complete denture wearers are lacking. PURPOSE: The purpose of this randomized clinical trial was to assess the prophylactic efficiency of multistrain probiotics (Lactobacillus and Bifidobacterium) in combating oral candidiasis in new complete denture wearers. The Candida relapse after 4 weeks of intervention cessation was also evaluated. MATERIAL AND METHODS: A total of 50 new maxillary and mandibular complete denture wearers with asymptomatic detectable levels of Candida were enrolled. The participants in the probiotics group received a daily dose of probiotic lozenges for 8 weeks versus placebo tablets taken by those in the placebo group. Collected mouth-rinse samples were microbiologically assessed to count Candida colonies and identify different species at different time intervals: baseline, 2 weeks after denture delivery, 4 and 8 weeks after the beginning of intervention, and 4 weeks postintervention follow-up. Data were assessed by performing the Shapiro-Wilk test to check the normality of the colony count, while the difference in the colony count between timelines was analyzed using the Freidman test followed by multiple comparison tests (α=.05). RESULTS: Two weeks after denture delivery, the Candida load had not risen significantly from the baseline count (P>.05). After the intervention, the probiotics had reduced the Candida count significantly in the fourth week and in subsequent follow-up periods, with the highest decrease observed in the eighth week, recording a median count of (0.00) compared with (2.74) at the baseline level (P<.001). Furthermore, in assessing the differential count of Candida species, a noteworthy decrease was found in the level of the most prevalent Candida albicans in the eighth week, with a relapse noticed in the twelfth week of posttreatment follow-up. CONCLUSIONS: Probiotic lozenges had antimycotic efficiency in asymptomatic new complete denture wearers, with short-term extended preventive effects after intervention cessation.

Biocompatibility profile of aged pigmented and non-pigmented silicone elastomer for combined maxillofacial defects.

PURPOSE: To assess the biocompatibility of platinum silicone elastomer A-2000 used in combined maxillofacial defects prosthesis, after being deteriorated by an accelerated aging process resembling both the extra and intraoral environment. This assessment was done indirectly on human-derived dermal and gingival tissues. MATERIALS AND METHODS: One hundred eight samples of room-temperature vulcanized A-2000 platinum silicone were equally divided into extrinsically pigmented and non-pigmented groups to replicate combined maxillofacial defects. Accelerated aging was applied to pigmented samples to mimic extra- and intra-oral conditions, while non-aged counterparts served as controls. After isolating human cell lineages, dermal and gingival fibroblasts were indirectly exposed to silicone sample media. Cytotoxicity to cultured fibroblasts was assessed via MTT assay. Statistical significance was determined by repeated measures of one-way ANOVA (p < 0.01), evaluating cytotoxicity on dermal and gingival fibroblasts. RESULTS: MTT assay showed increased cytotoxicity in pigmented silicon samples subjected to extraoral aging compared to non-aged counterparts (p < 0.01). Non-pigmented silicon, modeling intraoral conditions, exhibited cytotoxicity after 48 h (p < 0.05). Both aged and non-aged silicon extracts equally sensitized gingival fibroblasts at 72 h (p < 0.001). Negative correlations between pigmented and non-pigmented silicon were observed in dermal cell growth (p > 0.05, except at 24 h, r = 0.2), with accelerated aging showing minimal impact on the pigmentation effect (p > 0.05). CONCLUSION: The retrieved diminished cellular metabolic activity of platinum silicone elastomer was in an acceptable clinical range, pointing out the importance of periodic assessments of the maxillofacial prosthesis for replacement depending on aging and cytotoxic harmful cellular responses.

Evaluation of open-face maxillary complete denture for patients with prominent premaxilla: a crossover study.

BACKGROUND: The establishment of good facial esthetics is one of the main objectives of complete denture construction. Unfortunately, it may be the caused issue for patients having a prominent premaxilla due to excessive lip support by the labial flange of the maxillary denture. Open-face dentures (OFD) may suggest suitable prosthetic management for these patients. However, clinical evidence regarding the efficiency of OFD is scarce. METHODS: A total of 38 completely edentulous participants having prominent premaxilla and skeletal class I Angle's classification were enrolled in this study. Each participant received a mandibular complete denture and 2 opposing maxillary dentures; conventional (CD) and open-face (OFD). On the day of denture insertion, the participants were divided into 2 groups; CD-OFD and OFD-CD where CD-OFD group was instructed to use the mandibular denture and the maxillary CD for 3 months and then to use the maxillary OFD for another 3 months after a wash-out period of 2 weeks. While group OFD-CD was instructed to use the mandibular denture and the maxillary OFD for 3 months then to use the maxillary CD for another 3 months after a wash-out period of 2 weeks. The dislodging force of the maxillary dentures was evaluated using the universal testing machine and the patient perception of retention, esthetics, and comfort was evaluated using the Visual Analogue Scale (VAS). Evaluation was carried out 1 day, 1 month, and 3 months after denture insertion. The Student t-test was used to compare the 2 maxillary dentures and the intervals for each denture were compared by using the ANOVA test with repeated measures followed by a Post Hoc test (adjusted Bonferroni) for pairwise comparison. RESULTS: The significance of the obtained results was judged at the 5% level (P value). The dislodging force and patient perception of retention did not show significant differences between the 2 dentures, while the perception of esthetics showed significant differences throughout the follow-up period. Perception of comfort showed an insignificant difference only at the 3-month interval. CONCLUSIONS: Open-face maxillary dentures can be a suitable alternative for patients with prominent premaxilla to achieve satisfactory retention, aesthetics, and comfort.

A novel design for prosthetic ear guiding device: A technical note.

This article describes a newly designed Prosthetic Auricular Guide (PAG) that allows for accurate planning and positioning of both the auricular implants and the prosthetic auricle. The design aims to provide a cost-effective guiding device for more esthetic ear prostheses which is the patient's main concern. Along with determining the best clinically accepted position of the ear, the device can be used while taking CBCT which allows for the integration of the clinically approved position with the remaining bone for accurate planning of implant positions. Furthermore, the device can be fixed during surgery for accurate transmission of the planned position. The device is also adjustable making it suitable for all patterns of auricular defects, different ages, and even for patients with asymmetric faces.