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   Table of Contents - Current issue
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January-March 2020
Volume 20 | Issue 1
Page Nos. 1-119

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EDITORIAL  

Ethics in prosthodontic research p. 1
N Gopi Chander
DOI:10.4103/jips.jips_455_19  
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REVIEWS Top

The use of concentrated growth factor in dental implantology: A systematic review p. 3
Bhavna Vasudev Lokwani, Deeksha Gupta, Reema Sarvesh Agrawal, Sonal Mehta, Narendra J Nirmal
DOI:10.4103/jips.jips_375_19  
In the era of evidence based dentistry, a well-documented consolidated data about improvements in dentistry is a necessity. Concentrated growth factor (CGF) is an emerging trend in periodontology and now in implant dentistry. Various studies have been published in the literature evaluating the effect of CGF on implant osseointegration, implant stability, survival rate, sinus augmentation, and peri-implant defects. However, no systematic review has yet been documented. The present systematic review, being first of its kind, aimed to evaluate the potential outcomes of employing CGF in implant treatment. A literature search was carried out in PubMed and Google scholar for articles published between 2001 and 2019, with various keywords such as “CGF,” “dental implant,” “bone regeneration,” “CGF,” and “osseointegration.” The screening of studies was done according to PRISMA guidelines. A total of eleven studies were included in this review. Majority of the included studies pointed toward the beneficial effects of CGF in implant treatment. CGF was seen to promote osseointegration and enhance bone regeneration. Although more clinical studies are required to validate the potential merits of CGF in the long run, the preliminary results seem promising.
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Influence of different implant placement techniques to improve primary implant stability in low-density bone: A systematic review p. 11
Jayant N Palaskar, Nikhil Joshi, Pooja M Shah, Poorva Gullapalli, Vineet Vinay
DOI:10.4103/jips.jips_244_18  
Aim: The aim of this study is to assess the influence of different implant placement techniques to improve primary implant stability (PIS) in the low-density bone. Materials and Methods: Citations published in English and those available in full text were searched from electronic databases (PubMed and Google Scholar) from the year 2000–2017 by which 75 manuscripts were revealed. After applying inclusion and exclusion criteria, seven were selected for the present review. The whole process was conducted by the following preferred reporting items for systematic reviews and meta-analyses guidelines. Results: The measurement of primary stability showed significant correlations with different bone densities and with implant outcome; however, these two parameters have not been investigated at the same time frequently. Of the seven manuscripts, three discussed standard drilling protocol, two used undersized drilling, one used guided drilling, and one compared standard drilling with undersized drilling. Several intraoperative methods of jaw bone-density assessment were reported, and resonance frequency analysis, periotest, and insertion torque values were used to quantify PIS. Conclusion: The use of undersized drilling has proven advantageous for increasing initial implant stability in the low-density bone. Although the PIS may be lower, the secondary implant stability is found to be correlated to acceptable values.
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Incidence of neurosensory disturbance in mandibular implant surgery – A meta-analysis p. 17
Harini Padmanabhan, Anand V Kumar, K Shivashankar
DOI:10.4103/jips.jips_373_19  
Aim: Implantology has been widely accepted as the mainstay treatment for rehabilitating complete and partial edentulism. However, it is associated with some failures and complications, the most concerning being neurosensory disturbance. Although neurosensory disturbance has been extensively studied, the incidence and cause remains largely variable. Thus, the aim of this systematic review and meta-analysis was to evaluate the incidence, distribution, and recovery rate of neurosensory disturbance. Settings and Design: This systematic review was conducted as per the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. A structured literature review was conducted using the following databases: PubMed, Science Direct, Cochrane, Ovid, and Google Scholar for reports related to neurosensory disturbance experienced after implant placement in the mandible. Statistical Analysis Used: Incidence and recovery rate for 100 person-years was calculated using the Poisson regression model. The risk difference of incidence between anterior and posterior implants was calculated with a random effects model. Results: Electronic database search yielded 1589 articles; a total of nine articles were selected for the meta-analysis. The risk of neurosensory disturbance was estimated at 13.50/100 person-years (95% confidence interval (CI): 10.98–16.03), with a greater risk with anteriorly placed implants: −0.02 (95% CI: −0.21–0.16) (P = 0.05). The overall recovery rate was estimated at 51.30/100 person-years (95% CI: 31.2–71.4). Conclusions: Within the limitations of the study, it can be concluded that mandibular implant placement is associated with a considerable risk of neurosensory disturbance. A large proportion of these patients present with spontaneous recovery; however, clinicians must take necessary precautions to avoid such complications. More randomized controlled trials are required to quantify the effect of factors leading to altered sensation during implant placement.
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Accuracy of an intraoral digital impression: A review p. 27
Kanchan Aswani, Sattyam Wankhade, Arun Khalikar, Suryakant Deogade
DOI:10.4103/jips.jips_327_19  
Intraoral scanners (IOSs) are used for capturing the direct optical impressions in dentistry. The development of three-dimensional technology and the trend of increasing the use of IOSs in dental office routine lead to the need to assess the accuracy of intraoral digital impressions. The aim of this review was to assess the accuracy of the different IOS and the effect of different variables on the accuracy outcome. An electronic search using PubMed with specific keywords to obtain potential references for review. A search of MEDLINE (PubMed) identified 507 articles. After title and abstract screening, 412 articles were excluded for not meeting the inclusion criteria and discarding duplicate references. Ninety-five articles were followed for full screening; only 24 articles were included in the final analysis. The studies indicated a variable outcome of the different IOS systems. While the accuracy of IOS systems appears to be promising and comparable to conventional methods, they are still vulnerable to inaccuracies.
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ORIGINAL ARTICLES Top

Clinical evaluation of performance of single unit polyetheretherketone crown restoration-a pilot study p. 38
Kavishma Sulaya, Satyabodh S Guttal
DOI:10.4103/jips.jips_228_19  
Aim: The aim of this study was to evaluate the clinical performance and patient satisfaction of PEEK Crowns. Setting and Design: In-vivo longitudinal pilot study. Materials and Method: 20 PEEK crowns were placed in 20 patients. 11 were placed in the maxilla and 9 were placed in the mandible. All procedural steps were performed by the same operator. The teeth were prepared with a chamfer finish line of 0.8 to 1 mm. The crowns fabricated were luted using resin cement. Using Modified Ryge's Criteria, the crowns were examined for anatomic form, marginal integrity, surface roughness, restoration staining, marginal discoloration and color match at a time interval of 1 week, 1 month, 3 months, 6 months, one year. Patient satisfaction was also evaluated at the same interval using a questionnaire. Statistical Analysis Used: The data collected was evaluated using fisher's exact test. Results: Based on modified Ryge's criteria, almost 90% of the crowns were rated satisfactory. Fracture was registered in only one crown. Slight chipping off was seen in two crowns. No significant difference was seen in any other factors assessed. Slight variation was seen in the periodontal status of 3 patients. Conclusion: Within the limitations of this study the following conclusions were drawn that the PEEK crowns demonstrated by the use of Modified Ryge's Criteria, its capability to produce quality prostheses that were rated satisfactory with a relatively low rate of fracture over the relative mean period of one year.
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To compare the stability and crestal bone loss of implants placed using osseodensification and traditional drilling protocol: A clinicoradiographical study p. 45
Anjum Sultana, Sumit Makkar, Deepesh Saxena, Amit Wadhawan, Chandan Kumar Kusum
DOI:10.4103/jips.jips_133_19  
Aim: The present study was done to evaluate and compare the stability of the implant and the loss of crestal bone in the implants placed using OD drilling and traditional drilling technique. Setting and Design: In vivo-comparative study. Materials and Methods: A total of 20 implants were placed in the anterior maxilla, and the patients were divided into two groups. In Group I, the implants were placed using traditional drilling technique, and in Group II, implant placement was done using OD drilling technique. Primary stability was measured in both the groups at baseline (immediate postoperative), and at an interval of 6 months, while crestal bone levels were measured at baseline, 6, and 8 months. Statistical Analysis Used: The data obtained were subjected to unpaired t-test to make intergroup comparisons, while one-way ANOVA F-test was used to make intragroup comparisons. Results: The primary stability of implant placed using OD drills was found to be slightly higher than implant placed with traditional drilling; however, there was no statistical significance (P > 0.05). When the data obtained for crestal bone levels were statistically analyzed, no significant difference between the two groups was obtained (P > 0.05). Conclusion: Within the limitations of this study following conclusions were drawn: there was no statistically significant difference in implant stability between the traditional drilling and OD drilling (P < 0.05). On comparison of crestal bone levels between OD and traditional drilling, no statistically significant difference was found between the two groups (P < 0.05).
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Comparative evaluation of crestal bone levels around endosseous implants as influenced by conventional and diode laser during second-stage surgery in mandibular implant-supported overdenture: An in vivo study p. 52
Sushant Bajaj, Sapna Rani, Gaurav Issar, Upasana Sethi, Shalabh Kumar, Sarvesh Mishra
DOI:10.4103/jips.jips_55_19  
Aim: This study aims to evaluate and compare the crestal bone levels around implants as influenced by conventional and diode laser during second-stage surgery in an edentulous mandible using cone beam computed tomography (CBCT) and digital radiography (DR). Settings and Design: A split-mouth in vivo prospective study on edentulous patients involving placement of two implants in mandible followed by the comparison of two different techniques for second-stage surgery. Materials and Methods: The study was undertaken to evaluate the crestal bone change around 16 implant sites distributed in two groups (eight implants each) following two methods during second-stage surgery, i.e., Group 1 - Conventional second stage and Group 2 - Diode laser. Measurements were made on two sides (mesial and distal) using intraoral periapical and four sides (labial, lingual, mesial, and distal) using CBCT scans for both groups. These measurements were conducted at two time intervals for both, i.e., immediately after implant loading and twenty 4 weeks after implant loading. The values obtained were subjected to statistical analysis. Statistical Analysis Used: The normality of data was checked by Shapiro–Wilk's test. Intragroup comparison was compared using independent t-test by post hoc comparison by Bonferroni method (P < 0.05). Results: Crestal bone loss at the time of loading for Group 1 evaluated by CBCT was 0.950 ± 0.988 while after 24 weeks of loading, it was 1.388 ± 0.576. For Group 2, mean crestal bone loss was 1.200 ± 0.925 at the time of loading, and after 24 weeks, it was 1.512 ± 0.674. Crestal bone loss at the time of loading for Group 1 evaluated by DR was 1.075 ± 0.849 while after 24 weeks of loading, it was 1.562 ± 0.480. For Group 2, mean crestal bone loss was 1.162 ± 0.833 at the time of loading and after 24 weeks, it was 1.700 ± 0.498. Conclusions: In the present study, no statistically significant difference was observed in crestal bone loss between conventional and diode laser technique.
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Determining the occlusal plane using hamular notch incisive papilla plane evaluator: An in vivo study p. 61
Sangamma K Tippashetty, Shalini Joshi, Chandrashekar Sajjan, Priyanka Konin, Soni Kumari, Riea P Sajan
DOI:10.4103/jips.jips_167_19  
Aims: Identification and establishment of the occlusal plane in patients with impaired occlusal plane, presents a major hurdle for the execution of natural esthetics, speech, and function. The aim of this study was to minimize such errors while occlusal rehabilitation, and employ hamular notchincisive papilla (H.I.P) plane as landmark and scribe it on the cast using H. I. P evaluator and utilise for occlusal corrections. Settings and Design: HIP plane being parallel to the occlusal plane could ease the operator when it could be scribed on cast to analyze and restore the compromised occlusal plane. Materials and Methods: Dentulous casts of two hundred participants were mounted on the Hanau Wide–Vue articulator. Reference points were marked on the maxillary right central incisor and maxillary molars on casts for attaining different occlusal planes, the incisive papilla and hamular notch region were also marked for HIP plane. A plane parallel HIP was scribed on cast using HIP Evaluator. The casts were then scanned using a three-dimensional coordinate measuring machine attached to perception V5 laser scanner and measurements were made using Geomagic X design software. The most parallel occlusal plane to HIP plane was evaluated, and the reliability of HIP evaluator was verified. Statistical Analysis Used: ANOVA test, Post hoc-Bonferroni test, and independent sample “t”-test were carried out for the comparison between occlusal planes, among the genders and for the analysis of the angle of deviation of scribed plane on the cast to HIP plane on the right and left sides. Results: Occlusal plane III (Mesio-labial incisal edge of upper right central incisor to Mesio-buccal cusp tips of upper second molars) showed least angle of deviation with 1.316° ± 1.158° to HIP plane among tested subjects. There is no significant difference between the genders. The plane scribed on the cast with H. I. P evaluator showed relative parallelism to H. I. P plane with minimum deviation of 0.010° ± 0.363°. Conclusion: Occlusal plane III is more parallel to H. I. P plane. Scribed plane on the cast using H. I. P evaluator is parallel to H. I. P plane. H. I. P evaluator can be used as an alternative tool to establish the occlusal plane to rehabilitate patient with deficient dentition or disordered occlusal plane.
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Influence of occlusal vertical dimension on lip positions at smile in completely dentulous adults p. 69
Dharti Rajubhai Parmar, Shruti Parthiv Mehta, Priyanka Vaibhav Sutariya, Yashpreetsingh Amarjitsingh Bhatia, Nidhi Kantharia Gupta
DOI:10.4103/jips.jips_239_19  
Aim: The study was conducted to evaluate the effect of increased vertical dimension on the lip positions at smile in dentulous subjects. Settings and Design: Invivo - comparative study. Materials and Methods: Thirty individuals aged between 22 and 30 years were selected for the study. Poly-vinyl siloxane (Jet Bite, Coltene, Switzerland) interocclusal bite records of varying thickness of +1, +2, +3, and +4 mm were made using articulated stone casts for all the participants, respectively. Posed smile photographs at different increased vertical dimensions of +1, +2, +3, and +4 mm were captured with D-SLR camera (Nikon D3200 of 18 megapixels with macro lens, Japan) mounted on tripod stand keeping a uniform distance of five feet from the face. Head positioning device (Genoray CBCT Machine Papaya 3D Plus, Unicorn DenMart, India) was used to stabilize the head position of the participants. Interlabial gap height, intercommissural width, smile index (width/height ratio), incisal edge-to-upper lip distance, incisal edge-to-lower lip distance, and display zone area measurements were made in AutoCAD software (Autodesk, Inc., California, USA). Statistical Analysis Used: One-way repeated measures ANOVA tests (α = 0.05) and Bonferroni's post hoc tests were performed for statistical analysis. Results: With increasing occlusal vertical dimension, the interlabial gap height, incisal edge-to-lower lip distance, and display zone area increased significantly (P < 0.001). The smile index decreased significantly as the occlusal vertical dimension increased (P < 0.001). No significant difference was found in intercommissural width and incisal edge-to-upper lip distance. Conclusion: It was found that an increase in occlusal vertical dimension led to an increase in interlabial gap height, incisal edge-to-lower lip distance, and display zone area measurements, whereas the width of smile and incisal edge-to-upper lip distance did not change with increasing occlusal vertical dimension.
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Assessment of the relationship between maximum occlusal force and median mandibular flexure in adults: A clinical trial study p. 76
Behnaz Ebadian, Majid Abolhasani, Anahita Heidarpour, Mohsen Ziaei, Mohammad Jowkar
DOI:10.4103/jips.jips_282_19  
Aim: T he narrowing of the mandible during opening and protrusion movements is defined as median mandibular flexure (MMF). MMF is caused by the attachment of mandibular muscles; therefore, it can be assumed that a greater amount of maximum occlusal force (MOF) may cause more flexion and could affect the survival of dental and implant restorations. The purpose of this study was to evaluate any relationship between MOF and MMF in a sample of adults. Settings and Design:In vivo– comparative study. Materials and Methods: In this descriptive, cross-sectional, nondirectional study, a sample of 90 volunteers were recruited (45 men and 45 women). MOF was measured by applying the strain gauge receptor to the first molar region, and MMF was measured by calculating the variation in the intermolar distance by a digital caliper with an accuracy of 0.01 mm using an impression and resulted in the stone cast during the maximum opening and closed-jaw positions. The body mass index (BMI) also was calculated. Statistical Analysis: Data were analyzed using the SPSS software (version 23) inferential and descriptive statistics, linear regression, and Pearson correlation coefficient. P < 0.05 was considered statistically significant. Results: There was no statistically significant relationship between MOF and MMF (P = 0.78), but there was a significant association between MOF and BMI (P < 0.001, r = 0.475) and gender. Conclusion: Although MOF and MMF are both important and effective factors in the success of prosthetic restorations, one cannot be expected by the other and both should be considered in the treatment plan separately.
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Comparative evaluation of natural enamel wear against polished yitrium tetragonal zirconia and polished lithium disilicate – An in vivo study p. 83
Girish S Nazirkar, Swati Vijay Patil, Priyanka P Shelke, Preetam Mahagaonkar
DOI:10.4103/jips.jips_218_19  
Aim: The aim of this study is to compare wear of the natural teeth against polished yttrium tetragonal zirconia and polished lithium disilicate crowns. Study Setting and Design: Experimental type of study. Materials and Methods: Polished yttrium tetragonal zirconia and polished lithium disilicate crowns were fabricated and given to 15 patients each (n=15). Crowns were fabricated opposing natural tooth. Patients were recalled after 1year and impression were recorded with opposing arch and baseline and final cast were scanned and superimposed using 3 D scanner. Statistical Analysis Used: Data collected by experiments were computerized and analyzed using the Statistical Package for Social Sciences (SPSS) version 16.0. The normality of the data was checked using the Kolmogorov-Smirnov test and Shapiro-Wilk tests. The data were normally distributed. Statistical analysis was done by using tools of descriptive statistics such as Mean, and Standard Deviation for representing quantitative data (enamel wear measured in μm) Parametric tests: Student t-test for intergroup comparison was done. Results: No statistical difference were found between wear of opposing enamel for polished yttrium tetragonal and polished lithium disiliacte crowns [p=0.446]. Conclusion: Within the limitations of the study, it can be concluded that polished lithium disilicate showed better clinical outcome than polished yttrium tetragonal zirconia, though the evaluated data was statistically non significant.
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In vitro evaluation of fracture resistance and cyclic fatigue resistance of computer-aided design-on and hand-layered zirconia crowns following cementation on epoxy dies p. 90
Kiran Kumar Pandurangan, Deepak Nallaswamy Veeraiyan, Thiyaneswaran Nesappan
DOI:10.4103/jips.jips_222_19  
Aim: This in vitro study was to compare the fracture resistance and cyclic fatigue resistance of hand-layered zirconia crowns and computer-aided design (CAD)-on crowns (lithium disilicate with zirconium oxide). Settings and Design: Comparative -Invitro study design. Materials and Methods: All ceramic crown preparation was done on a mandibular molar ivorine tooth, impression made, and duplicated. Twenty hand-layered zirconia crowns and twenty CAD-on crowns were fabricated using CAD/computer-aided manufacturing (CAD/CAM) technique. All crowns were cemented to their respective dies using resin cement for evaluating fracture resistance and cyclic fatigue resistance using universal testing machine. Statistical Analysis Used: Independent samples t-test, Mann–Whitney U-test, and Shapiro–Wilk test were used. Results: The mean fracture resistance of CAD-on crowns (2660.50 ± 501.303 N) was significantly more than that of hand-layered zirconia crowns (1963.60 ± 452.895 N) (independent samples t-test, P < 0.023). Cyclic fatigue resistance test results showed that the mean number of cycles before failure for hand-layered zirconia crowns was 175,297 and for CAD-on crowns was 212,097 (Mann–Whitney U-test, P < 0.012). Conclusion: CAD-on crowns were found to have significantly higher fracture resistance and cyclic fatigue resistance properties than hand-layered zirconia crowns.
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Analyse the effect of different investment techniques and pattern materials on surface roughness of raw Ni-Cr castings – An In Vitro study p. 97
Aditi Aneesh Kanitkar, Aneesh Shriram Kanitkar, Rutuparna S Sasane, Seema S Patil, Swapnil R Chopade, Seema Vaidya
DOI:10.4103/jips.jips_202_19  
Aims: This study aimed to analyze the effect of different investment techniques and pattern materials on the surface roughness of raw castings from nickel-chromium alloy. Settings and Design: This is an experimental in vitro study carried out in Bharati Vidyapeeth Dental College and Hospital, Sangli, Maharastra. Materials and Methods: Sixty square-shaped wax patterns, measuring 10 mm × 10 mm × 2 mm, were divided into four groups. A phosphate-bonded investment material (Bellasun, Bego, Germany) was used to invest 15 samples of inlay wax and kept under normal atmospheric pressure and the remaining 15 wax patterns were invested under a pressure of 3 bars for 30 min, and then allowed to bench set for another 30 min. The same investing techniques were carried out for the remaining thirty samples made from pattern resin. Statistical Analysis Used: The surface roughness (μm) of the castings was measured by a profilometer. Student's “unpaired t-test” was used for the statistical analysis. Results: Specimens that were invested at atmospheric pressure had significantly more surface roughness (μm) values than those invested under increased pressure (P < 0.01). Conclusions: Wax patterns exhibited the least surface roughness when invested under pressure and can be recommended as the material and technique of choice. In addition, resin patterns invested under increased pressure produced smoother casting surface than those invested at atmospheric pressure, and the difference is highly significant.
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Attitude of dental professionals toward cast partial denture: A questionnaire survey in India p. 104
Nithin Kumar Sonnahalli, Sunil Kumar Mishra, Ramesh Chowdhary
DOI:10.4103/jips.jips_304_19  
Aims: The use of cast partial dentures (CPDs) has been decreased and its importance has been declined in the teaching curriculum. The purpose of this survey was to evaluate the attitudes of dental professionals toward conditions using CPDs in private practice in India. Settings and Design: Descriptive survey Materials and Methods: This survey consists of eight close-ended questions concerning the use of CPD by dental professionals practicing in India. The URLs of the questionnaire were shared via E-mail to dentists practicing throughout India, to obtain a response of 384 which is a predetermined sample size. Statistical Analysis Used: Statistical analysis was done using counts and percentages and the results were further analyzed statistically by the Chi-square test. Results: Nearly 42.79% of general dental practitioners (GDPs), 47.26% of prosthodontists, and 9.95% of other specialist dentists responded to the questionnaire. GDPs mostly preferred removable partial dentures (RPDs) (71.87%) and fixed partial dentures (57.22%), whereas prosthodontists preferred mostly implant (60.91%). GDPs mostly preferred flexible dentures (62.42%), whereas prosthodontists preferred CPDs 62.84%. Almost 52.50% of the GDPs mostly raised a cost issue and 63.11% of the prosthodontists had difficulty in adjustment with CPDs. Nearly 63.46% of the dentists told that implant-supported restorations are better options compared to CPDs; still, majority of the dentists (53.23%) were in favor that more importance for teaching CPDs in graduation curriculum should be given. Conclusions: This survey shows that in India a significant proportion of GDPs (71.87%) preferred RPDs, mostly flexible dentures (62.42%) due to their low cost compared to CPDs. Prosthodontists mostly preferred implants (60.91%) because they are more confident and better trained in these. It is recommended that more importance be given in teaching implants along with CPDs in graduation curriculum so that practitioners can better educate their patients about implants and their advantages over flexible dentures and their utilization in cases where patients are not willing for CPDs.
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CASE REPORTS Top

Comprehensive prosthetic rehabilitation of a case of the orofacial digital syndrome p. 110
Rajat Lanzara, M Viswambaran, Anup Gopi
DOI:10.4103/jips.jips_326_19  
Maxillofacial defects can result from trauma, treatment of neoplasm, or congenital malformations. Many a time due to the size, location of the defect, or because of the patient's medical condition, surgical reconstruction may not be possible. In these cases, rehabilitation is indicated with the help of a maxillofacial prosthesis. Orofacial digital syndrome (OFDS) is a congenital anomaly that affects the development of the mouth, face, and digits. Such abnormalities or defects compromise form, function, esthetics, and social acceptance and deeply affect the psychological status of an individual. This report describes the comprehensive prosthetic rehabilitation of a case of OFDS with bilateral cleft lip and palate as well as syndactyly and brachydactyly of the foot. The individual was rehabilitated with a definitive obturator and a custom-made foot prosthesis using room-temperature-vulcanizing silicone. The prosthetic rehabilitation significantly improved esthetics, phonetics, and function as well as social and psychological status of the patient.
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An innovative sectional silicone obturator in a patient with partial maxillectomy: A Case report p. 115
Thirumurthy V Ramasamy, Jagadish Chandra
DOI:10.4103/jips.jips_171_19  
Prosthodontic management of palatal defect is fundamental to close patient's oronasal communication and improve masticatory function, phonetics, esthetics, and comfort. Maxillary defects are the direct consequence of the surgical treatment of malformations, neoplasms, or trauma. The primary goal of an obturator is to close palatal defects after maxillectomy and to improve speech and masticatory function. This clinical report describes the use of a flexible silicone obturator for the treatment of a 34-year-old patient with partial maxillectomy due to osteosarcoma of the maxilla. A conventional cast partial denture with a hollow bulb made in acrylic was given as a definitive obturator initially, which was not comfortable for the patient. Alternatively, a new technique of fabrication of obturator with silicone to close palatal defect was decided to establish an acceptable phonetics, comfort, speech, and function for the patient. This silicone obturator gets retention by “snug fit” from the defect site.
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