Current Trends in Removable Partial Prosthodontics Teaching in Undergraduate Dental Colleges of Sindh, Pakistan

Objective: To explore current trends in removable partial prosthodontics teaching in undergraduate dental colleges of Sindh, Pakistan. Study Design: Descriptive Cross-sectional. Place and Duration of the Study: Department of prosthodontics in dental colleges of Sindh in September 2019. Methodology: A descriptive cross-sectional study was done in which a questionnaire was sent by email to head of Prosthodontics department of 16 dental institutes of Sindh, Pakistan. The survey included different questions regarding current trends in removable partial prosthodontics education in undergraduate dental colleges. Results: Out of sixteen questionnaires, fourteen were completely filled and returned. Majority (69.2%) of the institutes teach fabrication of removable partial dentures (RPDs) in third year of dental college. Students of only one dental college fabricate 10-12 RPDs in their clinical rotation. All dental colleges teach acrylic RPD construction in their preclinical years. Faculty in 12 (85.7%) dental colleges always give clinical demonstrations to students before their clinical rotations. Eleven out of the fourteen colleges teach cast partial dentures (CPDs) theoretically, but no CPDs are fabricated by the students during their clinical rotation. About 70% dental schools do not have in-house facility to fabricate cast partial dentures. Conclusion: This study describes current trends of removable prosthodontics teaching in undergraduate colleges of Sindh. A large majority of undergraduate dental students are not fabricating the minimum number of partial dentures as per PMC requirement. Although theoretically cast partial dentures are taught in lectures but students do not construct them in their undergraduate years. Efforts should therefore be made to improve teaching practices and clinical skills of undergraduates, for them to be able to treat partially dentate patients after graduation.

Implant rehabilitation of edentulous maxilla in digital dentistry: A case report utilizing CAD/CAM technologies

The replacement of missing teeth utilizing dental implants and digital dental technologies has gained significant popularity in daily clinical practice over the last decade. Partially dentate patients present more anatomical references to guide the implant position and prosthetic reconstruction as compared to completely edentulous arches. Therefore, the management of edentulous maxilla using implant digital dentistry represents a challenging clinical situation where a thorough treatment plan is paramount to achieve a final prosthetic result that meets both functional and esthetic requirements. This case report discusses the oral rehabilitation of an edentulous maxilla and partially dentate mandible using a digital workflow for both the surgical and prosthetic phases of the implant therapy. Protocols for clinical assessment, treatment planning, and restorative management are described to provide a predictable and prosthetic-driven treatment for implant-supported prostheses.

Calvarial bone grafts to augment the alveolar process in partially dentate patients: a prospective case series

Background Calvarial bone grafts as a pre-implant augmentation procedure are mostly used to reconstruct the edentulous maxilla, although calvarial grafts could also be used in the partially dentate patients needing extensive bone grafting. Methods In 7 consecutive partially dentate patients needing bone grafting because of a large bony defect as a result of trauma (n = 1), oligodontia (n = 1), failed previous bone augmentation (n = 1), or atrophy (n = 4), the alveolar process was reconstructed with calvarial bone as a pre-implant procedure. Results A total of 30 implants was placed either immediate at the time of bone grafting (13 implants) or after a healing time of 4 months when immediate placement was not possible (17 implants). One wound dehiscence occurred that needed secondary intervention. During follow-up (40 ± 14 months), one implant was lost due to peri-implantitis with an infected osteosynthesis screw. Marginal peri-implant bone loss was 0.65 ± 0.47 mm during this period. Conclusion Calvarial bone is a sound extra-oral donor site when aiming for reconstruction of a large bony defect of the alveolar process of partially dentate patients.

Removable Partial Dentures for Older Adults

Improvements in oral health including increased retention of natural teeth have given rise to a partially dentate older population. Replacement of missing natural teeth is important to improve function, aesthetics and quality of life for this patient group. A variety of options are available to replace missing teeth in partially dentate older adults, including fixed, removable and implant retained prostheses. This article will discuss the provision of removable partial dentures including treatment planning and denture design. When planning removable partial dentures, careful attention must be paid to stabilising the patient prior to delivering any prosthesis. Partial dentures should be designed to minimise the potential for plaque accumulation with carefully designed metal based frameworks. Acrylic resin can also be utilised with attention to detail to minimise the risk of damage to delicate supporting tissues. Removable dentures have the advantage that they can be readily added to in the event of further tooth loss which may be particularly relevant for older adults. Partial dentures which optimise support, retention and stability can function very successfully and significantly improve patients’ oral health related quality of life.

Assessment of Nepalese prosthodontist’s attitude towards morphological completeness of dental arches in partially dentate older patients

Background: Complete dentition is not always appropriate for old aged medically compromised and financially weak individuals. It is the dentist to decide what minimum number of teeth should be restored to have the proper oral function. The aim was to find out the opinion of prosthodon­tists of Nepal regarding the suitability of shortened dental arch as treatment modality and how frequently is this treatment choice for an old aged Nepalese patient. Methods: A pretested close ended questionnaire was usedin this study.After taking ethical clear­ance from Nepal Health Research Council, online questionnaire was sent to the participants along with the consent. Analysis was done using SPSS (version 21) statistical software package. Descrip­tive statistics was used. Percentage and frequencies were calculated. Results: Among respondents, 96.2% (n=51) had heard about shortened dental arch therapy but 3.8 % (n=2) had never heard about it. Forty-two (79.2%) do support shortened dental arch. Eleven (20.8%) do not favorshortened dental arch. Their main reason for replacing molars was to improve masticatory function.Instead of shortened dental arch,n=5(45.5%) prefer cast partial denture and 6(54.5%) advice implant supported fixed prosthesis. Among Prosthodontists who recommended shortened dental arch therapy, eight (19.1%) always advised patients not to replace molars. Twen­ty-four (57.1%) prosthodontists who support shortened dental arch therapy mentioned chewing function in shortened dental arch patients as satisfactory. Conclusions: Majority of Prosthodontists agree that shortened dental arch is a suitable treatment option for older people in developing countries like Nepal. But the treatment is not employed in clinical practice as required.

A Tailored Habits-based Dietary Intervention Combined With Oral Rehabilitation on Partially Dentate Older Adults: Nutritional Impact

IntroductionReplacing missing teeth alone is not enough to engender dietary behaviour change amongst older adults. Whilst there is a body of evidence to support oral rehabilitation in conjunction with dietary advice, this is currently limited to edentate patients even though the majority of older adults are now partially dentate. One approach proven to change long-term food behaviours but is novel in this population is habit-formation. Consequently, this study developed and tested a habit-based tailored dietary intervention, in conjunction with oral rehabilitation amongst partially dentate older adults.Materials and methodsA pilot randomised control trial was conducted on 57 partially dentate older patients. Participants were randomised to an intervention group (habits-based dietary intervention) or a control group and followed up for 8 months. The intervention group attended four meetings with a trained researcher to target habit-formation around 3 dietary domains (fruit/vegetables, wholegrains, healthy proteins). The primary outcome measure was self-reported automaticity for developing healthy habits and habit formation was assessed using the Self-Report Behavioural Automaticity Index (SRBAI). Preliminary analysis was conducted on n = 36 participants between baseline and 8 month follow up.ResultsPreliminary results showed that SRBAI scores and self-reported frequency of days doing habits in the intervention group for all tailored dietary habits was significant between baseline and follow up visits (p < 0.001). There were moderate positive correlations between automaticity and habit adherence (Fruit/vegetables rho = 0.43, p = 0.09: Wholegrains rho = 0.44, p = 0.08: Healthy Proteins rho = 0.52, p = 0.03) for the intervention group. Automaticity trends were increased in the intervention group for all 3 dietary habits compared to the control group but, other than wholegrain (p = 0.005), between group differences were non-significant (p > 0.05). BMI decreased in the intervention group (29.6 to 28.7 kg/m2) compared to a non-significant increase in the control group (27.7 to 27.8 kg/m2) (p = 0.08). There were slight increases in Mini Nutritional Assessment mean change scores (0.19 intervention: 0.32 control) for both groups, however between-group differences were not statistically significant (p = 0.9). Greater improvements in food intake around dietary habits were observed in the intervention group (Fruit/vegetables:108 g Fibre 4g: Protein 11g) compared to the control group (Fruit/vegetables -17g: Fibre 2g: Protein -4g).DiscussionPreliminary results demonstrate the success of a habit-based dietary intervention coupled with oral rehabilitation in positively influencing dietary behaviours and other nutritional outcomes in partially dentate older adults.

Marburg Denture System: Aiming to Preserve the Proprioception-A Case Report

All efforts to save the natural teeth should be made during restoration to achieve optimum functionality and aesthetics. Tooth loss is associated with appetite loss and loss of nutritional values. Thus, rehabilitating complete or partial edentulous conditions contributes to improvement in the functioning of the masticatory system. In the latter case of partially dentate condition, the natural teeth present preserve the residual ridges. Extraction of teeth causes alveolar ridge resorption. Poor foundation or ridge form donot provide support for the denture bases which is the factor of utmost consideration for stabilisation of the denture bases. In these instances, use of the telescopic dentures may be indicated. A telescopic denture retains and preserves the natural teeth beneath it. Every dentist aims at preserving the natural and restoring the lost. Preservation of the remaining teeth in turn preserves the natural proprioception mechanism, was thus followed and applied in this case report in which a 25-year-old female patient with diabetic history and on medication since past four years, presented with multiple missing teeth in December 2019. After thorough evaluation, the patient was treated by Marburg double crown system or synonymously termed as telescopic denture opposing the tooth supported overdenture. Follow-up and recall schedule was then explained and operator noted a satisfactory response from the patient. Consecutive follow-ups were maintained.