Treatment of a Patient with Severely Worn Dentition: A Clinical Report

This clinical report documents the prosthodontic treatment of a Prosthodontic Diagnostic Index Class IV 63-year-old white male, referred to the prosthodontic clinic by his general dentist for evaluation and treatment. The patient was concerned about the severe wear on his teeth and understood the need for comprehensive (full-mouth) rehabilitation to restore his dental condition. The clinical findings, diagnosis, treatment plan, and sequence of treatment are presented.     

Sound Analysis of a Musical Performance to Evaluate Prosthodontic Treatment for a Clarinet Player

Some dental patients use the orofacial region to play wind instruments; however, musical performance has not been objectively evaluated following prosthodontic treatment in such patients. The purpose of this report was to describe prosthodontic treatment for a clarinet player using sound analysis. The patient required a removable partial denture for his maxillary anterior teeth. Sound analysis was performed before and after denture adjustment, and the patient completed a questionnaire regarding his perceptions while playing his clarinet. After adjustment, the denture showed better performance, and patient satisfaction increased compared with that before adjustment.     

Fixed prosthodontic rehabilitation in a wear patient with Fabry's disease

Fabry's disease is an uncommon X-linked metabolic disorder that leads to abnormal accumulation of glycosphingolipids in the body resulting in a variety of systemic disorders. Few reports have addressed dental findings and management of these patients. This clinical report describes the fixed prosthodontic rehabilitation of an adult male patient with Fabry's disease, who presented with generalized severe wear of the dentition. In addition to numerous systemic morbidities, the patient also presented with intraoral angiokeratomas, telangiactasias, anterior diastemata, bimaxillary prognathism, and other oral findings known to be prominent in these patients. The patient was managed by an interdisciplinary team of dental specialists in close coordination with his nephrologist. The prosthodontic treatment included restorations on all teeth, except mandibular anterior teeth, and the patient was restored with a partial group function scheme of occlusion. At the 3.5-year follow-up appointment, the patient's oral health and integrity of the restorations remained stable. This is the first clinical report describing the prosthodontic management of a patient with Fabry's disease. Unique features related to this patient's fixed prosthodontic treatment include accommodation to complex medical problems, management of maxillary diastemata, and choice of occlusal scheme.     

Allergic palmoplantar pustulosis caused by cobalt in cast dental crowns: a case report

Cobalt chrome alloy is a common material in prosthodontic restorations; however, instances of palmoplantar pustulosis owing to cobalt allergy are rare. Here, we report an unusual case of palmoplantar pustulosis in the hands and feet of a 58-year-old male patient caused by a cobalt allergy. The patient developed palmoplantar pustulosis characterized by redness, pustules, vesicles, and scaly erythema on his hands and feet 1 month after obtaining cobalt chromium alloy cast crowns on his molar teeth. The symptoms persisted for 1 year. He underwent standard patch testing, which showed a strong positive reaction to cobalt chloride. After the crowns were removed, the symptoms disappeared in 3 weeks. This study may serve to remind dental practitioners to be aware of potential allergic reactions to dental materials used in prosthodontic treatment and to enable them to recognize a metal allergy if it appears.     

A combined prosthodontic and orthodontic treatment approach in a case of growth inhibition induced by dental implants: a case report

Functional and esthetic results can improve significantly when a combined prosthodontic-orthodontic treatment approach is employed in cases requiring extensive oral rehabilitation. The patient presented in this case report was treated in his late teens with dental implants as a replacement for his maxillary incisors. Ten years later, the entire maxillary anterior segment was in infraocclusion compared to the rest of the dentition and lip line. Since prosthodontic follow-up treatment alone could not achieve an optimal functional and esthetic outcome, the patient was treated orthodontically prior to renewing the restoration. A fixed appliance was used to intrude the mandibular anterior teeth as well as vertically align the infrapositioned maxillary lateral incisors.     

牙列缺损老年人的口腔修复医疗费用分布与影响因素分析

目的:讨牙列缺损老年人的口腔修复医疗费用分布情况及其影响因素。方法:对在第四军医大学口腔医学院修复科就诊的168名牙列缺损的老年人(年龄≥60岁)进行问卷调查并对数据进统计学分析,明确老年患者的口腔修复费用分布情况及影响口腔修复医疗费用的因素。结果:牙列缺损老年患者口腔修复医疗费用的影响因素是:修复方式、一年内曾行口腔治疗的费用和每月经济收入(P<0.05)。结论:牙列缺损老年患者的口腔修复费用在不同特征组间分布不同,其主要影响因素为口腔修复方式、一年内口腔治疗费用及每月经济收入。     

Aesthetic smile evaluation--a non-invasive solution

Enhancement of the aesthetic zone is a common reason for patients to seek dental care. This article describes a protocol for the examination, assessment and treatment planning for a patient seeking a solution to an aesthetic concern. The technique of undertaking an intra-oral'mock-up' using resin composite as a diagnostic approach can be particularly helpful when planning for future prosthodontic rehabilitation. The latter can allow the operator and patient to visualize crudely what is aesthetically and functionally possible, given the constraints imposed by that patient. The patient has ultimately managed in a minimally invasive manner. CLINICAL RELEVANCE: It can be very tempting for a dental operator to impose his/her concepts of the'artistic ideal' when planning for care in the smile zone. Such ideals are largely based on established universal aesthetic principles of tooth colour, size, shape, form, position, symmetry and proportion. However, beauty is a very subjective matter. It is essential for the operator to listen attentively to his/her patient's concerns. Meticulous patient examination and assessment are absolutely critical factors in attempting to attain a successful outcome. The use of reversible, chairside intra-oral mock-up techniques can not only help with the transference of essential information to the dental technician when planning for restorative intervention in the smile zone, but can also allow the patient to gain an insight and indeed contribute his/her views to the possible restorative endpoint, respectively.     

Oral rehabilitation of an orthodontic patient with cleft lip and palate and hypodontia using secondary bone grafting, osseo-integrated implants, and prosthetic treatment.

OBJECTIVE: Complete skeletal and dental reconstruction of the anterior maxilla is of great importance to patients with cleft lip and palate. Accordingly, osseo-integrated implants have been utilized for dental reconstruction after secondary bone grafting. In this report, the orthodontic management of a patient with unilateral cleft lip and plate with associated hypodontia is described. The patient was treated with comprehensive orthodontic treatment in addition to secondary bone grafting, and dental reconstruction was achieved with a combination of osseo-integrated implants and fixed prosthodontic treatment.     

General dental practitioners' perceptions of removable prosthodontics in the undergraduate curriculum

The undergraduate dental curriculum is undergoing rapid change and revision in dental schools worldwide. Decreasing edentulism, the advent of the clinical dental technician, and advances in technology (such as dental implantology) have led to changes in patient management and treatment options for general dental practitioners in New Zealand. The current undergraduate removable prosthodontic curriculum has seen very little change in past years at the School of Dentistry, University of Otago, and is under review to facilitate the teaching of general dental practice in the Final Year. A questionnaire-based survey of 150 general dental practitioners (response rate 74.6 percent) supported modification of the existing removable prosthodontics curriculum to improve its relevance to modern general dental practice. Integration of fixed and removable prosthodontic teaching was recommended.     

Patient Satisfaction in Prosthodontic Treatment: Multidimensional Paradigm

A number of different factors contribute to an efficient clinical outcome in prosthetic dentistry. Differences between patient’s and prosthodontist’s perception of treatment display great variability. Patient satisfaction in prosthetic dentistry is a multidimensional concept as is patient’s perception of dental care. Patient satisfaction can be assessed if it is carefully defined. In the prosthodontic treatment context patient satisfaction can be expected to interact with the patient’s entire life situation. This article highlights the issues that reflect the different dimensions of patient satisfaction in prosthodontic care.     

The psychological impact of prosthodontic treatment—a discrete response modelling approach

Investigating the psychological impact of dental treatment is of high relevance to clinical decision makers and a promising approach for furthering patient satisfaction. This paper aims at detecting factors which influence the psychological impact of prosthodontic treatment and its relevance for the dentist. We apply microeconometric techniques and, specifically, control for sample selection bias in order to derive evidence from a panel database which measures oral health-related quality of life (OHIP-G) before and after treatment. The survey rests upon an initial evaluation of 381 patients between 2004 and 2005 and a follow-up in January 2006 (response rate 47%, corresponding to 180 patients) at the University Medical Centre Regensburg, Germany. Our findings indicate that persons of different age have unlike mindsets towards prosthodontic interventions and that there are gender differences with respect to the psychological sensitivity towards prosthodontic interventions. Moreover, the psychological impact attributable to treatment is influenced by the type of limitation in oral well-being before treatment. We could identify distinct factors including age, gender and the type of limitation in oral well-being as causing differentiation in the psychological impact of prosthodontic treatment. Specific patient characteristics may modulate the psychological impact of prosthodontic treatment.     

Prosthodontic treatment of a patient with Ewing sarcoma of the left maxillary sinus: A clinical report

This clinical report describes the prosthodontic rehabilitation of a 22-year-old woman with a substantial treatment history of Ewing sarcoma of the left maxillary sinus. The patient was diagnosed with Ewing sarcoma at the age of 7 years and went through chemotherapy, radiation, surgical resection, and free-flap reconstruction, initially without prosthodontic rehabilitation. The patient aged 22 years was referred to the oral oncology clinic at The University of Texas MD Anderson Cancer Center for prosthodontic treatment. The patient's prosthetic rehabilitation with dental implants and a definitive maxillary obturator prosthesis is presented in detail.     

Prosthodontics. Diagnostic, treatment planning, and prognostic considerations

The prosthodontic rehabilitation of a patient is usually the culmination of a patient's dental treatment. In order to maximize the prognosis, it is necessary to understand the patient, to make a thorough diagnosis, to coordinate the restoration with the other disciplines of dentistry, and to be knowledgeable of the spectrum of treatment modalities available.     

Expanding prosthodontic services to the older patient in dental practices

Numerous articles report on the unmet dental needs of the older patient, yet few have suggested strategies to overcome barriers to care for this unique demographic. At a time when prosthodontic services, including dental implants, offer improved outcomes, the elderly remain the least served of all patient groups. Obstacles to treatment include ageism, medical and dental complexity, financial limitations, and patients' resistance to treatment. Expanding prosthodontic care of the elderly requires a departure from traditional patient management techniques. The attempt to reverse ageism in your practice must go beyond simple awareness. Those off?ces that can relate to, treat with respect, and fulfill the health aspirations of the older patient create the atmosphere where care is more readily accepted. A successful team approach to patient management depends upon the ability to listen and respond to the elderly denture patient with information on denture maintenance and implant enhancements. An essential piece is encouraging regular recall for all denture wearers by every staff member. A well documented problem area in dental practice is the timely replacement of worn out or inadequate dentures. By using a simple assessment tool called the Satisfaction/Condition Score along with motivational interviewing, we have found increased treatment acceptance among our existing patients. Use of these suggestions in a general dentistry practice is more likely to encourage the older patient to better accept enhanced prosthodontic services.     

Caries Risk Assessment and Management for the Prosthodontic Patient

Prosthodontic patients are often at a high risk for caries, and assessing that risk prior to treatment is important. Historically, the nature of dental education and clinical practice has oriented clinicians toward recognizing and correcting the damaging effects of caries, rather than actively assessing and managing caries risk potential. New developments have led to better diagnostics and protocols for caries management, although one adapted to the specific needs of the prosthodontic patient has not been proposed. Our purpose is to outline caries risk assessment and management for the prosthodontic patient.     

Prosthodontic considerations

The prosthodontic section of the 1997 ITI Consensus Conference in Vitznau, Switzerland, examined a broad spectrum of issues related to the prosthodontic phase of dental implant therapy. Topics included diagnosis and treatment planning, considerations for the use of ITI prosthodontic components, management of the partially edentulous patient, management of the edentulous patient, implant occlusion, and the use of narrow- and wide-body implants. The management of partially and totally edentulous patients will be discussed in separate papers. This paper is written so that each major consensus point discussed by the prosthodontic section is the first sentence of a paragraph. The remainder of each paragraph serves as background information or justification for the consensus statement. It should be noted that agreement on all points was reached by voting within the prosthodontic section. Many of the consensus statements were reached unanimously, while some were reached through compromise and split vote. Not all of the points presented here were presented to the plenum session on the final day of the conference.     

Combined orthodontic and prosthodontic treatment in an adolescent patient with traumatically ankylosed incisors: A case report

Symmetric extraction of premolars is a frequently used orthodontic treatment for dental crowding and protrusion. However, when a patient has incisors with ankylosis, the establishment of a treatment protocol often plagues orthodontists. An adolescent patient with a history of incisor trauma sought treatment for dental protrusion and crowding. Upon percussion of his infrapositioned maxillary central incisors, characteristic dull metallic sounds were noted, and a lack of normal mobility of these teeth under the application of external forces was detected. Follow-up radiographs after the trauma showed replacement root resorption of the maxillary central incisors. Based on clinical and radiological findings, ankylosis of the maxillary central incisors was tentatively diagnosed. A combination of orthodontic and prosthodontic treatment options involving extraction of the maxillary central incisors and mandibular first premolars was chosen to resolve the functional and esthetic problems. After treatment, well-aligned dentition, improved smile esthetics, and a more harmonious facial profile were achieved, and these outcomes remained stable during the follow-up period. This case report illustrates a viable treatment strategy for tackling predicaments caused by ankylosed incisors, which is unusual in the literature.     

Oral Rehabilitation of a Patient With Amelogenesis Imperfecta

A patient with Type I hypoplastic patterned amelogenesis imperfecta, subtype D, presented for prosthodontic evaluation. This article describes the developmental and pathophysiological background of this disease. A clinical report describing the diagnosis, treatment planning, and dental rehabilitation of the patient is reviewed.     

Construction of the new dental arch in the prosthetic rehabilitation of cleft lip and palate. Case report

The authors describe the prosthodontic rehabilitation of an adult patient with unilateral cleft lip and palate. After the surgical and orthodontic treatment of cleft lip and palate patients the prosthodontic treatment was started to correct the palatal defect, the malocclusion and the missing teeth. The authors emphasize on preliminary steps by using diagnostic casts and try-in dentures and they also suggest other directives in the dental management of cleft lip and palate patients.     

A Case of Cleidocranial Dysostosis: Dilemma for a Prosthodontist

Cleidocranial dysostosis (CCD) is an uncommon, generalized skeletal disorder characterized by delayed ossification of the skull, aplastic or hypoplastic clavicles, and complex dental abnormalities such as retention of multiple deciduous teeth, impaction or delayed eruption of permanent teeth and presence of supernumerary teeth. This case report describes a 30-year old male patient of CCD with classical findings and the challenges faced in his prosthodontic rehabilitation. Conventional complete dentures following interim complete dentures therapy had to be given as all other treatment modalities were ruled out because of anatomic limitations. Despite the disadvantages of removable dentures the patient adapted admirably to them with significant improvement in self-esteem. Though orthodontic and surgical correction may be the treatment of choice, the need to preserve the alveolar ridge could make fabrication of removable dentures in such patients, a viable option.