Precision Attachments for Aesthetics and Function: A Case Report Dentistry Section

ABSTRACT Successful restoration of the dentition requires plenty of contem porary and conventional treatment techniques and planning and attachment retained partial dentures are one such kind of treatment modality in prosthodontics. Limited space for extracoronal attachments is a serious gap in the design and the fabrication of a precision attachment Removable Partial Denture (RPD). A custom semi-precision attachment with a partial denture offers strength and improved aesthetics in cases with minimal space. This article presents a method of fabrication of semi-precision attachment to eliminate metal display and enhance aestheticity. CASe RepoRT A 38-year-old female was presented to the Department of Prosthodontics, with a failing dentition. Examination revealed that some of the teeth required conservative and endodontic treatment. There was reduced vertical facial height due to loss of mandibular posterior teeth. She was diagnosed for full-mouth rehabilitation. According to the Kennedy's Classification System and Applegate's rules, the maxillary partially edentulous arch was classified as Class III and the mandibular arch as Class I [Table/ Patient was advised to wear the interim removable prosthesis with an increased vertical dimension for 1 month, to determine the appropriate vertical dimension. Restorative and endodontic treatment procedures were initiated. Post and core was customised for the grossly mutilated maxillary anterior teeth. Single metal ceramic crowns and a cast partial denture were planned for the maxillary and mandibular arches. The RPD for the mandibular was desi gned and fabricated in the conventional manner. While designing the maxillary partial denture, it was seen that a clasp would have to be placed on the right central incisor. Since the clasp would appear unaesthetic, a custom precision attachment (CPA) was fabricated on the right central incisor to make it more aesthetic and pleasing without compromising on the principles. Technique • Preliminary impressions were made and the casts mounted on a semi-adjustable articulator with the pre-established vertical dimension. • The diagnostic wax-up was completed and the RPD designed. A-P palatal strap major connector was designed for maxillary and lingual bar for the mandibular arch, respectively. • A putty matrix of the completed diagnostic wax-up was made to evaluate of the existing space for the extracoronal attachment. • Maxillary teeth were prepared and full contour wax-up made. The wax-up was separated carefully, where the use of an attachment was required. • The patrix was added to the distal surface of the anterior abutment wax-up on the master cast (central incisor). • The dental surveyor was used to maintain parallelism with the collateral side and the additional guide plane surfaces. [ • The crowns were fabricated and veneered. • A pick-up impression of fixed components was made and poured to obtain the cast. • The patrix was positioned on the cast and parallelism was obtained with the milling tool attached to the surveyor

Single center, observational study to analyze correlation between vitamin D-3 deficiency and age in patients with orthopedic disorders

Background: Vitamin D deficiency has been strongly associated with various health outcomes, including all-cause mortality. Chronic vitamin D deficiency in adults and in old age results in osteomalacia, osteoporosis, muscle weakness, and increased risk of fall and long bone fractures. Methods: We examined records of 1029 such patients and to analyze association of vitamin d-3 levels and categories of age groups (1-20, 21-30, 31-40, 41-50, 51-60, 61-70, 71-80, 81-90 years). We categorized mild, moderate and severe cases age wise.Results: During the study period records for 1029 patients were evaluated, of which 347 (33.72%) male and 682 (66.27) were female the mean age with standard deviation for male was 38.25±15.64 years and for female was 41.43±15.23 years. Vitamin D deficiency (<20 ng/ml) was present in 623 patients (61%), 189 patients (18%) had vitamin D level 20-30 ng/ml and 217 patients (21%) had sufficient levels of vitamin D.Conclusions: Our study concludes that although there is high prevalence of vitamin D-3 deficiency across all age groups among orthopedic patients, age group 31-40 years, was found to be more affected.

A cross-sectional study of diseases prevailing in an orthopaedic OPD at a tertiary care hospital in the Mumbai metropolitan region

Background: The orthopaedic out-patient department of a tertiary care hospital plays a crucial role in the health care system as it attends to a large number of patients. The goal of the study is to observe the etiological patterns of common issues that prevail in an Orthopaedics OPD of a hectic tertiary care hospital, which could in turn help to understand the distribution of illnesses in a particular geographical area.Methods: Analysis of 1605 patient records was carried out from the period July 2020 to December 2020, to assess the orthopaedic out-patient load and prevailing diseases. Initial medical records of the patients were analyzed and the data collected were subjected to statistical analysis using IBM SPSS software version 1.0.Results: The primary diagnosis of patients visiting the orthopaedic OPD during the Covid-19 period are observed to be as follows: acute and chronic back ache (27.29%), arthritis (26.23%), joint stiffness (10.03%), ligamentous sprains (9.84%), neck-related problem (6.92), tendinopathies and enthesopathies (6.60%), non-specific body aches (5.11%), post-operative follow-up (4.05%),bone fractures (2.37%), soft tissue injuries (0.93%), and neuropathies (0.62%).Conclusions: The study presenting the overview of diseases prevailing in an orthopaedic OPD in a tertiary care center could help in formulating better prevention and treatment strategies to overcome such medical conditions irrespective of the presence of a pandemic

Understanding the pattern and volume of various orthopaedic disorders observed at a tertiary care hospital, before and during the COVID-19 pandemic

Background: The COVID-19 pandemic has lead to a huge loss of life and disruption of lifestyle. The pandemic has also led to disruption in the health sector, as significant changes in the pattern of hospital admissions, medical care and variations in disorders have been observed especially in the orthopaedics department. To assess the change in pattern and volume of trauma in our region, we evaluated data from our center for the pandemic period and compared it with the previous years’ data (pre-pandemic period).Methods: Comparison of orthopaedic in-patient records was carried out of the pre-pandemic and during the COVID-19 period, to assess the effect of COVID-19 on the orthopaedic in-patient load and prevailing diseases. Medical records of the patients were analyzed and the data collected were subjected to statistical analysis using IBM SPSS software version 1.0.Results: Significant reduction in patient load was observed during the pandemic period. Cases of various types of fractures were observed to be high in number, followed by arthritis. The only disorder that was observed to be highly prevalent in both the periods is proximal femur fractures.Conclusions: A high variation was observed in both the volume and nature of trauma presentations during the COVID-19 lockdown. A significant decrease in overall admissions was observed, this could be related to the period of societal restrictions and nationwide lockdown.

Association of metabolic syndrome and lower urinary tract symptoms amongst South Indian postmenopausal women

Background: Women spend one third of their life in menopause. The age related anatomical and physiological changes predispose them to MetS and lower urinary tract symptoms (LUTS). The aim was to study the prevalence of metabolic syndrome (MetS) and lower urinary tract symptoms in postmenopausal women attending menopause clinic, to study the correlation of LUTS and body composition among women with MetS.Methods: 154 post-menopausal women who attended menopause clinic at the Christian Medical College Hospital Vellore, were recruited. MetS was diagnosed using IDF criteria. LUTS were assessed BFLUTS questionnaires. Blood was taken to assess serum fasting glucose and lipid profile. DEXA was performed to assess the whole-body composition.Results: Of 154 postmenopausal women, 64% had MetS and 43% of women had a total LUTS score > 5. 90% of women had filling symptoms,57% had incontinence,17% had voiding symptoms,14 % had quality of life issues and 6 % had sexual symptoms. However, there was no statistical significant difference between two groups in correlating the variables of MetS with LUTS (P >0.05). The percentage of total body fat by DEXA scan was significantly greater (P=0.006) in women with MetS (37.32±5.04) when compared to the women without MetS (34.629±3.65).Conclusions: Prevalence of MetS among the study population was 64 %. LUTS were observed in 43% of the patients. There was no significant difference in LUTS in women with MetS and without Mets. However, there was a significant difference in body composition among women with and without MetS

Correlation of Serum Insulin-Like Growth Factor-1 and Hand Wrist Radiographs as Skeletal Maturity Indicators: An ex-vivo Study

Introduction: Conventional Hand and Wrist radiographs, have certain drawbacks of exposing orthodontic patients to unnecessary radiation hazards and subjectivity to errors. Serum insulin-like growth factor 1 (IGF-1) levels have been reported to increase until the pubertal peak in literature. The present study aims to assess the relationship between serum IGF-1 and skeletal maturity indicators Materials and Methods: Lateral cephalograms of 60 patients were assigned SMI stage according to Fishman’s classification system. The serum IGF-1 levels of the patients were also evaluated. Correlation between the serum IGF-1 levels, age of the patient, and their SMI stage was analyzed. Results: Pearson's coefficient of correlation revealed a non-significant weak positive correlation (p=0.69; >0.05) between age and IGF-1 levels, and a non-significant weak negative correlation (p =0.52; >0.05) between SMI stages and IGF-1 levels. Results of the ANOVA test indicated that there was no significant difference between mean IGF-1 levels across the different age groups and eleven SMI groups. However, there was a significant difference noted in the mean IGF-1 levels and the restructured SMI categories and groups. Conclusion: The moderate correlation between age and serum IGF-1 fluctuations during puberty underscores the hormone's pivotal role in adolescent growth. This positions serum IGF-1 as a potentially specific and reliable marker for assessing mandibular growth modifications, offering a radiation-free alternative to conventional radiographic methods

A novel variant of the AGPAT2 mutation in generalized congenital lipodystrophy

Inherited lipodystrophies are rare causes of young onset diabetes characterised by abnormal fat distribution with unique set of clinical features. We present a case of 24 year old lady with young onset diabetes mellitus, acromegaloid features, virilisation, hepatomegaly, hypertriglyceridemia with almost complete absence of subcutaneous and visceral adipose tissue as assessed by DXA scan body composition and MRI abdomen. Based on the clinical presentation, a diagnosis of Berardinelli–Seip generalized lipodystrophy was considered. Genetic analysis using next generation sequencing identified a novel homozygous insertion mutation in 1-acylglycerol-3-phosphate O-acyltransferase 2(AGPAT2) gene which was further confirmed with Sanger sequencing

Osteoporosis in Healthy South Indian Males and the Influence of Life Style Factors and Vitamin D Status on Bone Mineral Density

Objective. To study the prevalence of osteoporosis and vitamin D deficiency in healthy men and to explore the influence of various life style factors on bone mineral density (BMD) and also to look at number of subjects warranting treatment. Methods. Ambulatory south Indian men aged above 50 were recruited by cluster random sampling. The physical activity, risk factors in the FRAX tool, BMD, vitamin D, and PTH were assessed. The number of people needing treatment was calculated, which included subjects with osteoporosis and osteopenia with 10-year probability of major osteoporotic fracture >20 percent and hip fracture >3 percent in FRAX India. Results. A total of 252 men with a mean age of 58 years were studied. The prevalence of osteoporosis and osteopenia at any one site was 20% (50/252) and 58%, respectively. Vitamin D deficiency (<20 ng/dL) was seen in 53%. On multiple logistic regression, BMI (OR 0.3; P value = 0.04) and physical activity (OR 0.4; P value < 0.001) had protective effect on BMD. Twenty-five percent warranted treatment. Conclusions. A significantly large proportion of south Indian men had osteoporosis and vitamin D deficiency. Further interventional studies are needed to look at reduction in end points like fractures in these subjects

Needle(s) in the Haystack – Synchronous Multifocal Tumor Induced Osteomalacia

This is the author accepted manuscript. The final version is available from Endocrine Society via http://dx.doi.org/10.1210/jc.2015-3854MG is supported by the NIHR Cambridge Biomedical Research Centre

Gallbladder reporting and data system (GB-RADS) for risk stratification of gallbladder wall thickening on ultrasonography:an international expert consensus

The Gallbladder Reporting and Data System (GB-RADS) ultrasound (US) risk stratification is proposed to improve consistency in US interpretations, reporting, and assessment of risk of malignancy in gallbladder wall thickening in non-acute setting. It was developed based on a systematic review of the literature and the consensus of an international multidisciplinary committee comprising expert radiologists, gastroenterologists, gastrointestinal surgeons, surgical oncologists, medical oncologists, and pathologists using modified Delphi method. For risk stratification, the GB-RADS system recommends six categories (GB-RADS 0–5) of gallbladder wall thickening with gradually increasing risk of malignancy. GB-RADS is based on gallbladder wall features on US including symmetry and extent (focal vs. circumferential) of involvement, layered appearance, intramural features (including intramural cysts and echogenic foci), and interface with the liver. GB-RADS represents the first collaborative effort at risk stratifying the gallbladder wall thickening. This concept is in line with the other US-based risk stratification systems which have been shown to increase the accuracy of detection of malignant lesions and improve management. Graphical abstract: [Figure not available: see fulltext.]