Post-residency fellowship training in maxillofacial prosthetics is needed in Pakistan

Objective: To determine the spectrum of maxillofacial prosthetics services in Pakistan, to explore the need of a relevant fellowship training programme in the country, and to determine whether they contribute to tumour board of head and neck oncology.Methods: The cross-sectional online survey was conducted from March to June 2020 and comprised all prosthodontists registered on the portal of the Pakistan Prosthodontics Association. Using Google Forms, the survey questionnaire was sent via email. The survey form was self-generated. Data was analysed using SPSS 23.Results: Of the 84 prosthodontists approached, 44(52.4%) responded. The overall median age was 39 years (range: 30-60 years), and 34(77.3%) subjects were males. Overall, 19(43.2%) subjects were from Punjab, 14(31.8%) Sindh, 6(13.6%) Khyber Pakhtunkhwa, and 5(11.4%) Islamabad. None of the participants had received any formal accredited training in maxillofacial prosthetics. Although 37(84.1%) respondents reported providing maxillofacial prosthetics services to their patients as they had learnt it during their prosthodontics residency. Only 3(6.8%) respondents were contributing to head and neck tumour board. An overwhelming majority 42(95.5%) stressed the need of structured training programmes in maxillofacial prosthetics.Conclusions: There is no accredited maxillofacial prosthetics training centre and an obvious lack of prosthodontists with formal training in the professional area. The participation of prosthodontists in the head and neck tumour board was negligible

Maxillofacial prosthodontists are needed for the rehabilitation of patients with congenital and acquired craniofacial defects

Maxillofacial Prosthodontics (MFP) is a super-specialty of prosthodontics that involves around rehabilitation of patients presenting with congenital maxillofacial defects or craniofacial disabilities acquired due to disease such as cancer or trauma. (1) There are several types of prostheses that can be designed and fabricated by a maxillofacial prosthesis to improve the quality of life of patients. A simple classification is shown in figure 1. Continuous..

Comparison of Micro-Leakage around Temporary Restorative Materials Placed in Complex Endodontic Access Cavities: An In-Vitro Study

Objective: To compare mean micro-leakage around 3 types of temporary restorative materials in-vitro, when placed adjacent to permanent restorations (amalgam) in complex endodontic access cavities.STUDY Design: Randomized controlled trial.PLACE AND DURATION OF STUDY: Dental Clinics, Dental Laboratory and Research Laboratory at The Aga Khan University Hospital, Karachi, from January to June 2014.METHODOLOGY: After random allocation of 60 teeth into 3 experimental groups, each group had conventional class II cavities prepared and amalgam placed. After 14 days, endodontic access cavities were made in these teeth, followed by placement of Cavit, IRM and CLIP(depth of 4 mm each). After thermo-cycling and immersion in 0.5% methylene blue dye, the teeth were sectioned mesio-distally and observed under stereoscopic microscope (magnification x4) along 2 interfaces \u27a\u27 and \u27b\u27 (tooth-temporary restoration and temporary restoration-primary restoration), respectively. Depth of dye penetration was measured in millimeters.Results: IRM was leakiest at interface \u27a\u27, cavit had highest dye penetration at interface \u27b\u27, while CLIP exhibited least micro-leakage at \u27a\u27 and \u27b\u27. The mean dye penetration for Cavit was 0.80 ± 0.23 mm at \u27a\u27, and 2.24 ± 0.48 mm at \u27b\u27. For IRM, it was 1.82 ± 0.09 mm at \u27a\u27, and 0.44 ± 0.13 mm at \u27b\u27. For CLIP, the mean dye penetration was 0.43 ± 0.05 mm at \u27a\u27, and 0.32 ± 0.12 mm at \u27b\u27. The difference in dye penetration observed between the 3 groups at both interfaces was statistically significant.CONCLUSION: In a complex access cavity made adjacent to a pre-existing amalgam restoration, CLIP exhibits the least micro-leakage, followed by IRM and Cavit

Staged dental extraction and three interim prostheses for implants based rehabilitation in a periodontally compromised subject

Studies have shown that the presence of advanced periodontal disease lowers the success of dental implants. The recommended approach for such cases is the delayed placement and delayed loading of implants. The present paper reports a case of a subject who presented with severe periodontally compromised dentition. Placement and early loading of 12 implants was done using a staged approach. Three different sets of fixed-type dental prostheses were employed in the interim period. The final prostheses were cement retained metallo-ceramic fixed bridge. Use of staged extraction and using three sets of interim prostheses helped the patient to maintain his aesthetics and function during the entire treatment period. This approach can be a predictable management option in cases of advanced periodontitis. The key is proper planning and execution of the implant surgery and prosthetics

Relationship of natural occlusal plane with different anatomical landmarks

Objective: To evaluate the parallelism of natural maxillary occlusal plane with inter-pupillary line and ala-tragus line, and to evaluate the anatomic relationship of natural mandibular occlusal plane with retromolar pad among dentate subjects.Methods: The cross-sectional study was conducted from September 2017 to February 2018 at Fatima Jinnah Dental College, Karachi, and comprised front and profile photographs of subjects aged 20-28 years while holding the camper\u27s plane against the maxillary occlusal plane. The photographs were imported in a software and an interpupillary line was drawn and the angle with Camper\u27s plane was measured. On both profile pictures, lines were drawn from base of the ala to the superior, middle and inferior points on the tragus. The angle between ala-tragus line and Camper\u27s plane were measured. Intra-orally, height of the mandibular occlusal plane in relation to the retromolar pad was evaluated using a stainless steel scale. Data was analysed using SPSS 23.Results: Of the 109 subjects with a mean age of 23.03±1.36 years, 76(69.72%) were females. Horizontal parallelism of occlusal plane with inter-pupillary line was observed with a mean angle of 1.17±1.27 degrees. The angle between the occlusal plane and the inferior ala-tragus line was 4.25 degrees on the right side, and 4.50 degrees on the left. Intraorally, mandibular occlusal plane coincided with the inferior 48(44%) and the middle third 48(44%) of the retromolar pad.Conclusions: Inter-pupillary line and retromolar pad area should be used as a guide in the determination of plane of occlusion. The ala-tragus line was not found to be a reliable guide

Comparison of pre operative curvature with postoperative curvature In root canals treated with K 3 rotary systems

BACKGROUND: With root canal treatment, the organic debris and micro-organisms from pulp space is removed and an ideal canal preparation is achieved that is conducive of hermetic obturation. The purpose of this study was to correlate the pre-operative canal curvature with the postoperative curvature in human extracted teeth prepared with K-3 rotary systems. METHODS: The root canal preparation was carried out on extracted human molars and premolars using K-3 endodontic rotary files. A pre and post-operative image of the teeth using digital radiograph were taken in order to compare pre and post-operative canal curvature. The images were saved in an images retrieval system (Gendex software, USA). Change in the canal curvature was measured using the software measuring tool (Vixwin software, USA). Student paired t-test and Pearson correlation test was applied at 0.05 level of significance. RESULTS: There is a statistically significant difference between pre-operative and post-operative canal curvature (p-value \u3c0.001) and a strong positive correlation (91% correlation) between pre-operative and post-operative canal curvature in teeth prepared with the K-3 rotary files. CONCLUSIONS: A significant difference between pre and post instrumentation curvature was found. Degree of canal curvature was not correlated with time taken for canal preparation

Evaluation of micro leakage of root canals filled with different obturation techniques: an in vitro study

Background: Despite a plethora of studies done comparing different obturation techniques using gutta-percha, there is no consensus as to which obturation technique results in a \u27better\u27 sealing of root canal space. Aims of the study are to compare mean apical micro leakage in root canals of extracted teeth obturated with cold laterally compacted gutta-percha and thermoplasticised injectable gutta-percha using calcium hydroxide based sealer. Methods: It was an in-vitro experimental study carried out using extracted teeth. After access cavity preparation and canal preparation in 70 teeth, they were randomly divided into 2 groups and filled with two different obturation techniques using Sealapex sealer. Teeth were placed in 2.0% methylene blue solution, sectioned longitudinally, observed under microscope and images were captured using microscope attached camera. Amount of dye penetration was measured in millimetre from apex to most coronal part of dye penetration. Data was analysed using SPSS 20.0. Mean and standard deviation of continuous variables was computed. Independent Sample t- test was applied to compare micro leakage values in the two study groups. Level of significance was kept at 0.05. Results: According to the measurements, obturation with Obtura-II and Sealapex was leakier than the other group, with a mean dye penetration of 1.91±1.15 mm. There was a statistically significant difference in dye penetration among the two groups.. Conclusions: Cold lateral compaction plus Sealapex was the best combination for obturation as it exhibited least microleakage. Obtura IISealapex combination should be used with caution as it showed maximum microleakage. For obturation of single rooted teeth, we recommend cold lateral condensation with Sealapex sealer as it showed better sealability. Obtura-II and Sealapex should be used with caution in single rooted teeth as this group showed the maximum leakage.

In-vitro comparison of micro-leakage between nanocomposite and microhybrid composite In class v cavities treated with The self-etch technique

Abstract BACKGROUND: When a light cure composite resin is used to restore a class V lesion, certain stresses are generated at the tooth-restoration interface. If these stresses exceed the bond strength of the restorative material, microscopic gaps are formed which eventually cause micro-leakage at the tooth-restoration interface. The objective of the present study was to compare the micro-leakage values at the tooth-restoration interface using dye penetration method between a Nano filled and a Micro hybrid light cured composite resin in class V cavities using the self-etch technique. METHODS: Sixty class V cavities were made coronal to the cemento-enamel junction in the extracted premolars. These were then randomly divided into two study groups. Group A: Self-etch; filled with P-60 (microhybrid) n=30. Group B: Self-etch; filled with Z-350 (nano-filled) n=30. Specimens were subjected to thermo-cycling at 5-55 °C±2 °C with a 30 seconds dwell time. After which they were stained with 2% methylene blue. Later, sectioned bucco-lingually and examined using a stereo microscope (magnification X4) at the occlusal, axial and gingival surfaces. Micro-leakage around the toothrestoration interface was assessed by using the degree of dye penetration in millimetres. RESULTS: There was 100% micro leakage seen at both the occlusal and gingival surfaces when using the P-60 composite. With the Z-350 composite 84% occlusal and 88% of the gingival surfaces exhibited microleakage.. CONCLUSIONS: With respect to micro-leakage in class V cavities, Z-350 was found to be a superior restorative material compared to P-60 on the occlusal surface. Overall, there is no statistically significant difference in the micro-leakage exhibited by the two restorative materials in class V preparations subjected to self-etch protoco

Evaluation of the root and canal morphology of mandibular first permanent molars in a sample of Pakistani population by cone-beam computed tomography

Objective: To evaluate the root canal morphology of permanent mandibular first molars using Cone Beam Computed Tomography. Methods: The retrospective study was done at Aga Khan University Hospital, Karachi, and comprised medical records of patients who visited the dental clinics from December 2016 to March 2017. Mandibular first permanent molars were evaluated on Cone Beam Computed Tomography images. Frequency distribution of Vertucci\u27s classification was determined, and so was the association between Vertucci\u27s classifications and gender. SPSS 20 was used for data analysis. Results: A total of 142 mandibular first permanent molars were evaluated on 78 Cone Beam Computed Tomography images. The most common Vertucci\u27s classification was Type IV for mesial root 86(60.56%) and Type I for distal root 63(44%). There was no difference in the two genders for root canal morphology (p\u3e0.05). Conclusions: Type IV Vertucci\u27s were prevalent in the mesial root and Type I were common in the distal root of permanent mandibular first molars