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Mousa MA, Husein A, El-Anwar MI, Yusoff N, Abdullah JY. Evaluation of the biomechanics of Aramany class I obturators of different designs using numerical and experimental methods. Part I: Retention and associated stress. J Prosthet Dent 2024:S0022-3913(24)00469-4. [PMID: 39048390 DOI: 10.1016/j.prosdent.2024.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 07/02/2024] [Accepted: 07/09/2024] [Indexed: 07/27/2024]
Abstract
STATEMENT OF PROBLEM Studies on the biomechanics of obturators in the currently used designs of Aramany class I defect are lacking. Also, modifications of the designs presently used in unilateral palatal defects are needed to produce a prosthesis with more retention and less stress on the abutments. PURPOSE The purpose of part I of this study was to differentiate among Aramany class I obturators of 4 designs regarding retention and associated stress using numerical and experimental methods. MATERIAL AND METHODS Four finite element models and 36 different base obturators were fabricated and divided into 9 acrylic resin bases retained with Adams clasps and 9 linear, 9 tripodal, and 9 fully tripodal design obturators from casts obtained from a scanned skull. After modification, the prostheses were fabricated on the casts obtained from a 3-dimensionally printed cast. The retention was evaluated, and the data were collected and analyzed using a statistical software program (α=.05). The displacement and associated stress in the assorted casts were compared by using 5-N displacing force at 3 points using finite element analysis. The quantitative assessment was made by measuring the displacement and von Mises stress distribution on the prostheses and their supporting structures. The qualitative analysis was done by using a visual color mapping to depict stress location and intensity. RESULTS No significant differences were found between fully tripodal (4.478 ±2.303 MPa) and tripodal obturators (4.478 ±2.286 MPa; P=.153), although fully tripodal showed more resistance to anterior displacement (4.522 ±0.979 and 3.553 ±1.58 MPa for fully tripodal and tripodal designs, respectively; P=.007), and tripodal obturators produced more resistance to middle displacement (5.441 ±1.778 and 2.784 ±0.432 MPa for tripodal and fully tripodal design respectively; P=.001). The fully tripodal obturator showed more retention (3.736 ±1.182 MPa) than the linear one (2.493 ±1.052 MPa; P=.001). The maxillary central incisor was the most stressed abutment, followed by the lateral incisor, while the second molar was the least. CONCLUSIONS Regarding retention, the fully tripodal obturator produces retention comparable with the tripodal and significantly more than the linear. Acrylic resin prostheses retained with Adams clasps may be similar to metal-based prostheses regarding retention and stress distribution on the supporting structures.
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Affiliation(s)
- Mohammed A Mousa
- Lecturer, Prosthetic Dental Sciences, College of Dentistry, Jouf University, Sakaka, Saudi Arabia; and Researcher, Prosthodontic Unit, School of Dental Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Adam Husein
- Professor, Prosthodontics, Department of Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates; and Professor, Prosthodontic Unit, School of Dental Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | | | - Norwahida Yusoff
- Senior Lecturer, School of Mechanical Engineering, Universiti Sains Malaysia, Nibong Tebal, Malaysia
| | - Johari Yap Abdullah
- Senior Lecturer, Craniofacial Imaging Laboratory, School of Dental Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia; and Adjunct Professor, Dental Research Unit, Center for Transdisciplinary Research (CFTR), Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India.
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Abreu A, Londono J, Torosian A, Yu J, Levy-Bercowski D. Aesthetic Concepts and Interdisciplinary Approach in a Patient With Bilateral Cleft Lip and Palate and Missing Premaxilla: A Case Report. Cleft Palate Craniofac J 2020; 58:1056-1062. [PMID: 33251853 DOI: 10.1177/1055665620969290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The smile is an important part of the individual's facial expression, it allows the communication of emotions and ideas. However, its aesthetics can be severely compromised in patients with cleft lip and palate due to multiple missing, malformed and malposed teeth, abnormal soft tissue morphology, upper lip scar tissue, and altered anatomy in the lower third of the face. This clinical case reports the interdisciplinary treatment approach of a young male patient with complete bilateral cleft lip and palate and missing premaxilla. Prosthodontic rehabilitation included a zirconia-based fixed dental prosthesis, with pink porcelain to camouflage the bony defect and restore the facial and dental aesthetics. Maxillary second premolars received lithium disilicate crowns to obtain a more harmonious smile line and adequate occlusion. A resin-bonded fixed partial denture restored a missing mandibular central incisor. Tooth proportions, gingival contours and facial ratios routinely used in noncleft patients, were used to achieve a consonant smile. The final restorations satisfied the patient's expectations, restored an aesthetically pleasant smile, and provided an adequate occlusion.
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Affiliation(s)
- Amara Abreu
- Department of Restorative Sciences, Dental College of Georgia, 1421Augusta University, GA, USA
| | - Jimmy Londono
- Ronald Goldstein Center for Esthetic & Implant Dentistry, Department of Restorative Sciences, Dental College of Georgia, 1421Augusta University, GA, USA
| | - Aram Torosian
- Ronald Goldstein Center for Esthetic and Implant Dentistry, Dental College of Georgia, 1421Augusta University, GA, USA
| | - Jack Yu
- Department of Surgery, Plastic Surgery and Department of Pediatrics, Medical College of Georgia, 1421Augusta University and Craniofacial Center, Children's Hospital of Georgia, Augusta, GA, USA
| | - Daniel Levy-Bercowski
- Department of Orthodontics, Dental College of Georgia, 1421Augusta University, and Craniofacial Center, Children's Hospital of Georgia, Augusta, GA, USA
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Malgaj T, Plut A, Eberlinc A, Drevenšek M, Jevnikar P. Anterior Esthetic Rehabilitation of an Alveolar Cleft Using Novel Minimally Invasive Prosthodontic Techniques: A Case Report. Cleft Palate Craniofac J 2020; 58:912-918. [PMID: 33063533 DOI: 10.1177/1055665620964709] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Missing lateral incisors are the most frequent dental disorder associated with cleft alveolus. When orthodontic closure of the edentulous space is not possible, more aggressive prosthodontic treatments are required. Contemporary resin-bonded fixed dental prostheses (RBFDPs) represent a promising, time-efficient alternative treatment with fewer biological complications. This clinical report proposes a modified approach to the esthetic rehabilitation of a patient with a complete unilateral cleft lip and palate on the left side and an incomplete cleft lip and alveolar cleft on the right side. Digital diagnostics, treatment planning, and clinical procedures involved in the fabrication of facially bonded RBFDPs are presented. This modified technique enables the concurrent replacement of lateral incisors and correction of the malformed central incisors as well as increasing the retention of the restorations.
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Affiliation(s)
- Tine Malgaj
- Department of Prosthodontics, 37664Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Alja Plut
- Department of Orthodontics and Dentofacial Orthopaedics, 37667University Medical Centre Ljubljana, Slovenia
| | - Andreja Eberlinc
- Department of Maxillofacial and Oral Surgery, 37667University Medical Centre Ljubljana, Slovenia
| | - Martina Drevenšek
- Department of Orthodontics and Dentofacial Orthopaedics, 37667University Medical Centre Ljubljana, Slovenia.,Department of Orthodontics and Dentofacial Orthopaedics, 37664Faculty of Medicine, University of Ljubljana, Slovenia
| | - Peter Jevnikar
- Department of Prosthodontics, 37664Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.,Department of Prosthodontics, 37667University Medical Centre Ljubljana, Slovenia
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Prosthetic Rehabilitation of Cleft Lip Palate with Andrews Bridge Modified as Obturator Prosthesis: Case Report. BALKAN JOURNAL OF DENTAL MEDICINE 2020. [DOI: 10.2478/bjdm-2020-0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Summary
Background/Aim: Congenital defects such as cleft palate and lips require a long-lasting and multidisciplinary approach. In cases when surgical and orthodontic treatment is not feasible, prosthodontic management of these patients is advocated. Prosthetic rehabilitation of cleft palate in concerning of achieving aesthetic and function (such as swallowing and speech) outcomes is very demanding.
Case report: Material and method: After performing the necessary surgical procedures and orthodontic treatment, 24-years-old male patient was sent to the Department for Maxillofacial Prosthetics of Istanbul University. Followed the clinical examination, the necessary periodontal and conservative therapy was performed. After radiographic evaluation and dental cast analysis prosthetic rehabilitation was performed. The prosthetic rehabilitation of cleft palate was accomplish with conventional fixed partial denture whose number of included abutment were defined by biomechanical principles. Additionally removable partial denture were manufactured for closing oro-nasal defects and lip supporting.
Conclusions: The prosthetic rehabilitation resulted with functionally and aesthetically content prosthesis. With achieving proper swallowing Quality of Life of the patient was enormously enhanced.
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Levy-Bercowski D, Abreu A, Londono J, Haeberle CB. Use of an esthetic overdenture as an alternative treatment in a patient with bilateral cleft lip and palate. J Prosthet Dent 2018; 121:200-205. [PMID: 30017159 DOI: 10.1016/j.prosdent.2018.04.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 04/06/2018] [Accepted: 04/09/2018] [Indexed: 12/01/2022]
Abstract
Stable occlusion and a pleasing esthetic appearance are often difficult to achieve in patients with congenital defects and severe midfacial deficiencies. Conventional therapy, such as orthodontic treatment followed by orthognathic surgery, is often not sufficient to fully correct the dental and esthetic problems. An interdisciplinary approach for these patients should include prosthodontic treatment that will assist in establishing a harmonious occlusion and improve facial appearance. This clinical report describes the interdisciplinary approach for a young patient with a history of bilateral cleft lip and palate, spina bifida, hydrocephalus, and ventriculoperitoneal shunt. The patient was treated with conventional orthodontic treatment and orthognathic surgery that failed to fully correct the malocclusion. A removable overlay prosthesis made of crystallized acetyl resin was used to reestablish esthetics and create a stable occlusion.
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Affiliation(s)
- Daniel Levy-Bercowski
- Associate Professor, Department of Orthodontics, Dental College of Georgia, Augusta University, Augusta Ga; Associate Director, Craniofacial Center, Children's Hospital of Georgia, Augusta, Ga
| | - Amara Abreu
- Associate Professor and Section Director of Removable Prosthodontics, Department of Restorative Sciences, Dental College of Georgia, Augusta University, Augusta, Ga.
| | - Jimmy Londono
- Associate Professor, Department of Restorative Sciences, Dental College of Georgia, Augusta University, Augusta, Ga
| | - C Brent Haeberle
- Assistant Professor, Department of Restorative Sciences, Dental College of Georgia, Augusta University, Augusta, Ga
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Yu D, Xing G, Nie P, Zhang X, Steve Shen G. Multidimensional esthetic evaluation of patients with a cleft lip and palate wearing a maxillary partial removable dental prosthesis: A 5-year retrospective study. J Prosthet Dent 2015; 115:456-61. [PMID: 26581658 DOI: 10.1016/j.prosdent.2015.08.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Revised: 08/10/2015] [Accepted: 08/12/2015] [Indexed: 11/18/2022]
Abstract
STATEMENT OF PROBLEM No published quantitative or qualitative studies are available of the 2-dimensional (2D) and 3D esthetic evaluation of patients with a cleft lip and palate (CLP) wearing a maxillary partial removable dental prosthesis (MPRDP). PURPOSE The purpose of this retrospective clinical study was to qualitatively and quantitatively evaluate the facial esthetic improvements of patients with CLP wearing an MPRDP for 5 years by using 2D cephalometric and 3D photogrammetry methods. MATERIAL AND METHODS Six patients, 2 men and 4 women, with CLP deformity were recruited and treated with an MPRDP by the same dentist over 5 years. Results of the clinical examination were recorded before and after wearing the MPRDP. Sella-nasion-A (SNA) point, the U1-SN, 0-meridian to SN, nasolabial angle, and maxillary incisor exposure were measured by 2D cephalometric analysis before and after wearing the MPRDP. 3D photographs were captured by 3dMD software. Geomagic Spark Studio software was also used to measure the patients' improved upper lip projection after the MPRDP was worn. The paired sample t test was used to compare the participants (α=.05). RESULTS U1-SN (P<.05) and 0-meridian to SN (P<.01) had significant deviation statistically. After patients underwent clinical examination, SNA and nasiolabial angles were found to have improved, although no statistical significance was observed. CONCLUSIONS A maxillary partial removable dental prosthesis (MPRDP) can advance the upper lip forward, restoring the subnasal and upper lip projection. Patients' nasiolabial angles with MPRDPs were decreased, which led to a more harmonious facial contour.
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Affiliation(s)
- Dedong Yu
- Resident, Department of Oral and Craniomaxillofacial Science, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, PR China
| | - Guofang Xing
- Attending Physician, Department of Prosthodontics, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, PR China
| | - Ping Nie
- Associate Chief Physician, Department of Oral and Craniomaxillofacial Science, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, PR China
| | - Xiuyin Zhang
- Chief Physician. Department of Prosthodontics, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, PR China
| | - Guofang Steve Shen
- Chief Physician, Department of Oral and Craniomaxillofacial Science, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, PR China.
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Abreu A, Levy-Bercowski D, Yu J, Salgueiro M, Kalathingal S, Ferreira Susin L, Baker P. Interdisciplinary treatment of an adult with bilateral cleft lip and palate with missing premaxilla: The prosthodontic perspective. J Prosthet Dent 2015; 114:609-13. [DOI: 10.1016/j.prosdent.2014.09.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 09/05/2014] [Accepted: 09/08/2014] [Indexed: 11/24/2022]
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