Occlusion and its relationship to the function of the stomatognathic system have been widely studied in dentistry since many decades. This series of articles describe about occlusion in the complete denture, fixed partial denture, and implants. Part I and II of this articles series describe concepts and philosophies of occlusion in complete denture. So far, available research has not concluded a superior tooth form or occlusal scheme to satisfy the requirements of completely edentulous patients with respect to comfort, mastication, phonetics, and esthetics. Since then, several balanced and nonbalanced articulation concepts were proposed in the literature. A balanced articulation appears to be most appropriate because of tooth contacts observed during nonfunctional activities of patients. This article discusses about evolution of different concepts of occlusion and occlusal schemes in complete denture occlusion.

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Satisfactory restoration in a patient with a partially edentulous situation can be challenging especially when unilateral or bilateral posterior segment of teeth is missing. Successful restoration can be done with various conventional and contemporary treatment options. One such treatment modality is attachment-retained cast partial dentures. A key to success for an attachment retained cast partial denture is the strategic selection of teeth for retention. This clinical report discusses rehabilitation of a patient with the help of a combined prosthesis in the upper arch and stud retained overdenture in the lower arch.

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Aim of the Study: To evaluate and compare the linear dimensional changes of the three representative polyvinyl siloxane (PVS) impression materials and to compare the accuracy of single mix with double mix impression technique. Methodology: A study mold was prepared according to revised American Dental Association specification number 19 for nonaqueous elastic dental impression materials. Three PVS impression materials selected were Elite-HD, Imprint^™ II Garant, Aquasil Ultra Heavy. Two impression techniques used were single mix and double mix impression technique. A total of 60 specimens were made and after 24 h the specimens were measured using profile projector. Statistical Analysis: The data were analyzed using one-way analyses of variance analysis and significant differences were separated using Student's Newman-Keul's test. Results: When all the three study group impression materials were compared for double mix technique, the statistically significant difference was found only between Imprint^™ II Garantand Elite-HD (P < 0.05). Similarly, using single mix technique, statistically significant difference were found between Elite-HD and Imprint^™ II Garant (P < 0.05) and also between Aquasil Ultra Heavy and Elite-HD (P < 0.05). When the linear dimensional accuracy of all three impression material in double mix impression technique and single mix impression technique were compared with the control group, Imprint^™ II Garant showed the values more nearing to the values of master die, followed by Aquasil Ultra Heavy and Elite-HD respectively. Conclusion: Among the impression materials Imprint^™ II Garant showed least dimensional change. Among the impression techniques, double mix impression technique showed the better results.

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The stability of the implant at the time of placement and during the development of the osseointegration process are the two major issues governing the implant survival. Implant stability is a mechanical phenomenon related to local factors such as bone quality, quantity, type of placement technique and type of implant used. The application of a user-friendly, clinically reliable, non-invasive method to assess implant stability and the osseointegration process is considered highly desirable. Resonance frequency analysis (RFA) is one such method which shows almost perfect reproducibility and repeatability after statistical analysis. The aim of this paper is to review the various methods used to assess implant stability and on the currently used RFA method which is being highly accepted in the recent times.

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Context: To fully estimate the burden of illness due to edentulism and establish valid treatment outcomes measures in this regard, it is equally important to study its psychosocial repercussions. Aims: The aim was to conduct a study to explore the emotional reactions to tooth loss, screen for current depressive symptoms and test for association between the two; among an edentulous Gujarati population. Settings and Design: A total of 147 edentulous people visiting the Prosthodontics Department were surveyed. Subjects and Methods: A questionnaire (based on previous studies) to test the emotional reactions to tooth loss and Nine Item-Patient Health Questionnaire to test for depression were used. Statistical Analysis Used: The data were analyzed using the Chi-square (χ² ) test with the help of SPSS v. 18.0 (IBM Corp., Armonk, NY, USA). Results: Totally, 100 out of 147 edentulous people returned the questionnaire of which 58% experienced difficulties in accepting tooth loss and 37% felt unprepared for its effects. Those with difficulties accepting tooth loss had a greater effect on self esteem and social life, had more reservation about discussing tooth loss and was more likely to experience depression. Both groups were satisfied with dentures, had no problem meeting their friends or partners without dentures and leaving out dentures at night. Conclusion: About 58% of edentulous people had difficulties accepting tooth loss, which was unrelated to denture satisfaction. Respondents appeared to be restricted in social activities mainly due to functional limitations. Those with difficulties accepting tooth loss were more likely to experience depression.

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Aims: The aim of the study was to evaluate the stress distribution pattern in the implant and the surrounding bone for a passive and a friction fit implant abutment interface and to analyze the influence of occlusal table dimension on the stress generated. Materials and Methods : CAD models of two different types of implant abutment connections, the passive fit or the slip-fit represented by the Nobel Replace Tri-lobe connection and the friction fit or active fit represented by the Nobel active conical connection were made. The stress distribution pattern was studied at different occlusal dimension. Six models were constructed in PRO-ENGINEER 05 of the two implant abutment connection for three different occlusal dimensions each. The implant and abutment complex was placed in cortical and cancellous bone modeled using a computed tomography scan. This complex was subjected to a force of 100 N in the axial and oblique direction. The amount of stress and the pattern of stress generated were recorded on a color scale using ANSYS 13 software. Results : The results showed that overall maximum Von Misses stress on the bone is significantly less for friction fit than the passive fit in any loading conditions stresses on the implant were significantly higher for the friction fit than the passive fit. The narrow occlusal table models generated the least amount of stress on the implant abutment interface. Conclusion : It can thus be concluded that the conical connection distributes more stress to the implant body and dissipates less stress to the surrounding bone. A narrow occlusal table considerably reduces the occlusal overload.

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Aims and Objectives: The aim of this study was to asses & compare the load transfer characteristics of Ball/O-ring and Bar/Clip attachment systems in implant supported overdentures using analog and finite element analysis models. Methodology: For the analog part of the study, castable bar was used for the bar and clip attachment and a metallic housing with a rubber O-ring component was used for the ball/O-ring attachment. The stress on the implant surface was measured using the strain-gauge technique. For the finite element analysis, the model were fabricated and load applications were done in a similar manner as in analog study. Results: The difference between both the attachment systems was found to be statistically significant (P<0.001). Conclusion: Ball/O-ring attachment system transmitted lesser amount of stresses to the implants on the non-loading side, as compared to the Bar-Clip attachment system. When overall stress distribution is compared, the Bar-Clip attachment seems to perform better than the Ball/O-ring attachment, because the force was distributed better.

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Rehabilitation of maxillofacial defect patients is a challenging task. The most common prosthetic treatment problem with such patients is, getting adequate retention, stability, and support. In cases of large maxillofacial defect, movement of the prosthesis is inevitable. The primary objectives in rehabilitating the maxillofacial defect patients are to restore the function of mastication, deglutition, speech, and to achieve normal orofacial appearance. This clinical report describes maxillofacial prosthetic rehabilitation of large midfacial defect including orbit along with its contents, zygoma and soft tissues including half of the nose, cheeks, upper lip of left side, accompanying postsurgical microstomia and orofacial communication, which resulted from severe fungal infection mucormycosis. The defect in this case was restored with magnet retained two piece maxillofacial prosthesis having hollow acrylic resin framework and an overlying silicone facial prosthesis. The retention of prosthesis was further enhanced with the use of spectacles. This type of combination prosthesis enhanced the cosmesis and functional acceptability of prosthesis.

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Background: The issue of biomaterial-derived ionic release in various sites of the human body has attracted the interest of many investigators because of the possibility that debris or degradation products elicit a foreign body reaction or have a role in the induction of pathological processes. Purpose: The purpose was to evaluate the saliva of denture wearers after insertion of the prosthesis for leaching of metals from metallic denture. Materials and Methods: Total 20 subjects of age group of 40-60 years including both males (10) and females (10) were selected for the study. Total subjects were divided into 2 groups each containing 10 subjects, Group I (control group): Subjects having dentition intact up to second molar and free of any dental restoration; Group II (study group): Partially edentulous subjects rehabilitated with cast-metal removable partial denture. Saliva samples were taken at three stages that is, 1 h, 24 h and 72 h after the denture insertion from subjects of study group as well as from the control group. Atomic absorption spectroscopy (AAS) was used to estimate the concentration of elemental ions. Obtained data's were analyzed using SPSS (Statistical Package for Social Sciences) version 15.0 statistical analysis software. The values were represented in a number (%) and mean ± standard deviation. Results: At 1 h, 24 h and 72 h after the denture insertion in study group, chromium (Cr) had statistically significant higher mean concentration as compared to manganese (Mn) (P < 0.001). Cr had maximum concentration (0.1479 + 0.0052) immediately after denture insertion while maximum concentration of Mn (0.1479 + 0.0052) was found 24 h after denture insertion. Conclusion: Metal-based dentures show maximum leaching immediately after wearing of the prosthesis which decreased significantly over the period of 3 days. Cr and Mn were the metal ions mainly found in saliva of cast partial denture wearer. No concentration of cobalt, molybdenum (Mo) and iron (Fe) was found in saliva of metal base denture wearer. There was a significant change in concentration of elutes in saliva in first 72 h/3 days making time an effective variable was observed.

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Surgical resection of soft palate due to cancer affects the effective functioning of the velopharyngeal mechanism (speech and deglutition). With the loss of speech intelligibility, hyper resonance in voice and impaired function of swallowing (due to nasal regurgitation), there is a depreciation in the quality of life of such an individual. In a multidisciplinary setup, the role of a prosthodontist has been described to rehabilitate such patients by fabrication of speech aid prosthesis. The design and method of fabrication of the prosthesis are simple and easy to perform. The use of prosthesis, together with training (of speech) by a speech pathologist resulted in improvement in speech. Furthermore, an improvement in swallowing had been noted, resulting in an improved nutritional intake and general well-being of an individual. The take-home message is that in the treatment of oral cancer, feasible, and rapid rehabilitation should be endeavored in order to make the patient socially more acceptable. The onus lies on the prosthodontist to practise the same in a rapid manner before the moral of the patient becomes low due to the associated stigma of cancer.

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Background: Dentistry equipment are exposed to different types of pathogenic microorganisms. The aim of this study was to investigate the effect of spraying three different types of disinfectants on condensational silicones after 5 and 10 min. Materials and Methods: Totally, 66 circular samples of condensational silicone impression materials of 1 cm diameter and 2 mm thickness were contaminated by Staphylococcus aureus, Pseudomonas aeruginosa, and Candida albicans fungus. Except for control samples, all of them were disinfected with sodium hypochlorite (NaOCl) 0.525%, Deconex and Epimax by spraying method. Afterward, they kept in plastic bags with humid rolled cotton for 5 and 10 min. In order to isolate microbiotas, the samples were immersed in 2% trypsin for 1 h and diluted with normal saline in a portion of 1, 1/2, and 1/4. The trypsin suspensions were transferred to culture plates for incubation and colony-forming unit assay. The data were analyzed by Mann-Whitney test and SPSS software version 16 at a significant level of 0.05. Results: There was a meaningful difference between disinfection effects of Epimax-Deconex for all mentioned microorganisms after 5 min (P = 0.034), and between disinfection effects of NaOCl 0.525%-Epimax for S. aureus (P = 0.043) and P. aeruginosa (P = 0.046) after 5 min. Furthermore, there was a meaningful difference between disinfection effects of Epimax-Deconex (P = 0.034) and NaOCl 0.525%-Epimax (P = 0.034) for P. aeruginosa after 10 min. Conclusion: Condensational silicone can be effectively disinfected by spraying tested three disinfecting agents. More specifically, Deconex showed the best results compared to the other agents.

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Statement of Problem: The occurrence porosity in polymethyl methacrylate, the most commonly used denture base material is a problem. The occurrence of oral candidiasis and other infections has also been reported in denture users. Purpose: The aim of this study was to evaluate the effect of addition of an antimicrobial agent, silver zeolite on the porosity of denture base resin, which will be an effective tool in the prevention of oral candidiasis among denture wearers. This study also aims to analyze the effect of polymerization technique on porosity in zeolite incorporated dentures to develop a denture base resin which will be easy to process with optimal mechanical and antimicrobial properties. Materials and Methods: Eighty rectangular resin specimens (65 mm × 40 mm × 5 mm) were divided into one control group (A) and three experimental groups (B - Microwave cured denture base resin specimens, C - Conventionally cured denture base resin incorporated with antibacterial zeolites, D - Microwave cured denture base resin incorporated with antibacterial zeolites) porosity was calculated by measurement of the specimen volume before and after its immersion in water. Data were analyzed using one-way analysis of variance. Results: The mean values of the percent mean porosity were: A = 0.9555%, B = 0.9590%, C = 0.9630%, D = 0.9695%. No significant differences were found in mean porosity among the groups evaluated. Conclusion: Within the limitations of this study, it could be concluded that the addition of zeolites did not result in significant porosity and that the use of microwave processing is a viable option for denture processing.

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Objectives: The purpose of this study is to evaluate the effect of occlusal equilibration using immediate complete anterior guidance development (ICAGD) technique by Kerstein and Farrell on the subjective symptoms of myofascial pain. This technique is the most advanced verifiable and measurable way of digitally analyzing the occlusion using T-scan technology. The primary objective is to reduce the anterior disclusion time to <0.4 s and the secondary objective is to reduce the signs and symptoms of myofascial pain. Materials and Methods: This study is to assess the reducing effects of subjective symptoms of 100 patients diagnosed as myofascial pain patients treated by ICAGD technique as described by Kerstein and Farrell. The common complaints of the patients were a pain in the masseter and temporal muscles, jaw tiredness in the mornings, night bruxing and difficulty in chewing. In this technique occlusal equilibration involves removal of posterior interferences and establish anterior guidance. The patients were treated over three visits 1-week apart and followed for 3 years with an interval of 3 months for the subsequent visits. A visual analog ordinal scale is used to rate the symptoms. The symptoms reduction occurred for all the patients after the first correction in about 5-10 days. In about a period of 3 years review, no recurrence was seen of the chronic myofascial symptoms. Results: In spite of the chronic nature of the patient's symptoms, symptom reduction occurred in a week's time. This was assessed by the results of the ordinal scale values. This agrees with the studies of Kerstein and Farrell. Conclusion: Equilibration of occlusion using digital analysis by T-scan in which force is quantified against time, should be done to establish free functional movements without any interference; otherwise the disturbances in the excursive movements may lead to muscle dysfunction at later years.

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Purpose of the Study: It is difficult to achieve a reliable bond between the titanium and veneering porcelain. The aim of this study was to evaluate the bond strength between titanium ceramic crowns. Materials and Methods: The surfaces of titanium copings were divided in two groups. Group A sandblasted with 250 um (n = 10) and Group B without sandblasting (n = 10). Low-fusing porcelain was bonded over copings. A universal testing machine was used to determine the fracture load (N) of the crowns. All data were compared using Student's t-test. Results: There was a significant difference in fracture toughness between two groups (P = 0.05). The mean value of fracture strength for Group A was 721.66 N and for Group B was 396.39 N. Conclusions: Sandblasting improves the bond strength between titanium, and ceramic, mechanical bonding plays a crucial role in the bonding between titanium and ceramic.

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Background: Case-oriented small group discussions (COSGDs) can help students to correlate and integrate the basic science of dental materials into clinical application. We used COSGDs along with didactic lectures in dental material curriculum and hypothesized that case-oriented group discussions would be more effective than traditional lecture alone in terms of performance of students, student perception on the above two teaching methodologies and the feasibility in classes of 2010, 2011 and 2012. Methods: A total of 170 students were taught using both COSGD and didactic lecture in a randomized controlled crossover trial design. Their performance was assessed through multiple-choice questions (MCQs) as part of the formative assessment, and their perception was assessed through Likert scale questionnaire. Results: The mean difference in the scores between case-oriented group discussions with lecture and didactic lecture showed significant difference only in few topics. Around 94-96% of students perceived COSGD with didactic lecture help them understand theory better; 76-92% of students feel more comfortable asking questions in a group discussion; 89-98% of students feel such discussions motivate them and 91-100% of students agree that discussions make the subject interesting in the respective years of 2010, 2011 and 2012. Conclusion: Effectiveness of COSGD in terms of scores through MCQs is comparable to traditional lecture. However, most of the students perceive COSGD help them understand the theory better; co-relate clinically; more motivating and interesting than a traditional lecture. Feasibility in institution needs more time and resources to conduct COSGD within the dental material curriculum.

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Around 1300 different types of dental implants are available worldwide and the implant manufacturers are resorting to aggressive marketing strategies; claiming their implants to provide a superior outcome. The clinician is left with a constant dilemma on which implant to choose for better clinical outcome and welfare of the patient. Moreover, in India, economical consideration is a concern too. The dentist has to select an implant that provides a good result and is economical. Cochrane systematic reviews provide the gold standard evidence for intervention, diagnosis, etc., and follow a strict quality control. A Cochrane systematic review was done to shed light on whether the different implant surface modifications, shapes or materials significantly influence clinical outcomes. All randomized controlled trials (RCTs) till January 17, 2014 were searched and out of the 81 trials, only 27 met the inclusion criteria. This evidence summary from the review concludes that based on the available literature; there is no evidence of any one type of implant being superior to another. There is weak evidence showing roughened dental implants are more prone to bone loss due to periimplantitis. This review indicated that there is a need for well-designed RCTs, with long-term follow-up and low bias. Moreover, none of the included studies was from India, which also points out the need for improving the quality of RCTs conducted in India.

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