This document discusses the oral and dental manifestations of radiation therapy and their implications for prosthodontic planning and treatment. It covers topics like:
1. The different types and modalities of radiation therapy and their primary biological effects.
2. The dentist's role in managing patients before, during, and after radiation therapy, which includes fabricating stents, managing oral mucositis, and addressing issues like trismus, xerostomia, and osteoradionecrosis.
3. Prosthodontic considerations for patients who receive radiation therapy, such as special impression techniques, altered vertical dimension and occlusal schemes, and increased focus on post-insertion care due to complications from
The document discusses soft tissue management and fluid control during fixed prosthodontic procedures. It covers saliva control methods like rubber dams, high-volume evacuation, cotton rolls, and anti-sialagogues. It also discusses gingival tissue displacement techniques like copper bands filled with impression material, displacement pastes, temporary restorations, and retraction cords. Retraction cords are classified based on configuration, surface finish, chemical treatment, number of strands, and thickness. Proper soft tissue management and fluid control are critical for making accurate impressions of prepared teeth during fixed prosthodontic treatments.
Mouth preparation for removable partial dentures involves both prosthodontic and non-prosthodontic procedures to prepare the mouth for the prosthesis. Non-prosthodontic procedures include oral surgery to extract teeth and remove cysts or tumors, periodontal treatment like scaling and root planing to improve tissue health, and endodontic or restorative treatment of teeth. The goals are to establish oral health, eliminate interferences, and establish an acceptable occlusal scheme to enhance the function and long-term success of the partial denture.
This document provides an overview of prosthodontic management of mandibular defects. It begins by classifying mandibular defects and outlining various complications that can arise. Several key factors that affect treatment are then discussed, including the location and extent of the defect, remaining teeth/implants, degree of deviation/rotation, mouth opening, tongue function, vestibular depth, skin grafting, radiation therapy, and previous denture experience. The relationship between surgical reconstruction techniques and prosthodontic rehabilitation is explored. Finally, general principles of complete denture construction for these patients are covered, along with various treatment options and techniques for impressions and provisional bases.
The document provides sample questions from past exams for the MDS Degree Examination in Prosthodontics and Crown & Bridge. The exams assess knowledge of fixed prosthodontics, temporomandibular joint disorders, occlusion, and implant-supported prostheses. The exams consist of essay questions and short note questions. Sample topics covered include occlusal considerations for fixed partial dentures, classifications of fixed partial dentures, abutment selection, pontic designs, and implant osseointegration and loading protocols.
The document provides guidance on delivering complete dentures to patients. It discusses conducting a final psychological evaluation and fitting of the prosthesis. It emphasizes managing patient expectations and preparing for post-insertion issues. Most of the document then focuses on the technical procedures for initial placement of the dentures, making adjustments based on pressure indicators to ensure proper fit, and conducting follow-up appointments.
This document discusses immediate complete dentures. It begins by defining immediate dentures and classifying them as either conventional (placed after all teeth are extracted) or interim (placed immediately but replaced later). It describes the ideal requirements, indications, contraindications, advantages, and disadvantages of immediate dentures. The document provides details on the diagnosis and treatment planning process, including patient examination and molding. It explains the clinical technique of making impressions and setting up the jaw relations records. The document concludes with sections on explaining the treatment to patients and providing post-operative instructions.
Prosthodontic treatment planning flow chart and communication with patientjojo smn
This document outlines the process for developing a prosthodontic treatment plan and communicating it to the patient. It discusses defining treatment planning, assessing the patient's current conditions and needs, determining appropriate treatment objectives. A treatment plan may involve multiple phases including preliminary treatment of symptoms, disease control, definitive therapy like restorations, and follow-up/maintenance. Effective communication with the patient is important, using techniques like building rapport, explaining the dental condition clearly, and overcoming objections to reach consensus on treatment.
The document discusses soft tissue management and fluid control during fixed prosthodontic procedures. It covers saliva control methods like rubber dams, high-volume evacuation, cotton rolls, and anti-sialagogues. It also discusses gingival tissue displacement techniques like copper bands filled with impression material, displacement pastes, temporary restorations, and retraction cords. Retraction cords are classified based on configuration, surface finish, chemical treatment, number of strands, and thickness. Proper soft tissue management and fluid control are critical for making accurate impressions of prepared teeth during fixed prosthodontic treatments.
Mouth preparation for removable partial dentures involves both prosthodontic and non-prosthodontic procedures to prepare the mouth for the prosthesis. Non-prosthodontic procedures include oral surgery to extract teeth and remove cysts or tumors, periodontal treatment like scaling and root planing to improve tissue health, and endodontic or restorative treatment of teeth. The goals are to establish oral health, eliminate interferences, and establish an acceptable occlusal scheme to enhance the function and long-term success of the partial denture.
This document provides an overview of prosthodontic management of mandibular defects. It begins by classifying mandibular defects and outlining various complications that can arise. Several key factors that affect treatment are then discussed, including the location and extent of the defect, remaining teeth/implants, degree of deviation/rotation, mouth opening, tongue function, vestibular depth, skin grafting, radiation therapy, and previous denture experience. The relationship between surgical reconstruction techniques and prosthodontic rehabilitation is explored. Finally, general principles of complete denture construction for these patients are covered, along with various treatment options and techniques for impressions and provisional bases.
The document provides sample questions from past exams for the MDS Degree Examination in Prosthodontics and Crown & Bridge. The exams assess knowledge of fixed prosthodontics, temporomandibular joint disorders, occlusion, and implant-supported prostheses. The exams consist of essay questions and short note questions. Sample topics covered include occlusal considerations for fixed partial dentures, classifications of fixed partial dentures, abutment selection, pontic designs, and implant osseointegration and loading protocols.
The document provides guidance on delivering complete dentures to patients. It discusses conducting a final psychological evaluation and fitting of the prosthesis. It emphasizes managing patient expectations and preparing for post-insertion issues. Most of the document then focuses on the technical procedures for initial placement of the dentures, making adjustments based on pressure indicators to ensure proper fit, and conducting follow-up appointments.
This document discusses immediate complete dentures. It begins by defining immediate dentures and classifying them as either conventional (placed after all teeth are extracted) or interim (placed immediately but replaced later). It describes the ideal requirements, indications, contraindications, advantages, and disadvantages of immediate dentures. The document provides details on the diagnosis and treatment planning process, including patient examination and molding. It explains the clinical technique of making impressions and setting up the jaw relations records. The document concludes with sections on explaining the treatment to patients and providing post-operative instructions.
Prosthodontic treatment planning flow chart and communication with patientjojo smn
This document outlines the process for developing a prosthodontic treatment plan and communicating it to the patient. It discusses defining treatment planning, assessing the patient's current conditions and needs, determining appropriate treatment objectives. A treatment plan may involve multiple phases including preliminary treatment of symptoms, disease control, definitive therapy like restorations, and follow-up/maintenance. Effective communication with the patient is important, using techniques like building rapport, explaining the dental condition clearly, and overcoming objections to reach consensus on treatment.
The document discusses various techniques for making fixed prosthodontic (FPD) impressions, including conventional and recent methods. Conventional techniques include the putty-wash technique, copper tube/resin coping system, monophase technique, and dual viscosity technique. The putty-wash technique uses putty and wash materials simultaneously or in two steps. The dual viscosity technique uses a light body material injected around preps and a heavy body material in a tray. Recent techniques include digital impressions made either chairside, in a lab, or production center. The document provides details on procedures, advantages, and disadvantages of different impression techniques for FPDs.
The document discusses the effects of radiation therapy on osseointegration and implant success. It describes how radiation can damage bone tissue by reducing vasculature, killing osteoblasts and osteocytes. This compromises implant anchorage, remodeling, and the body's response to infection or forces. Animal studies show reduced success rates with higher radiation doses. The risks and benefits of implant placement in irradiated sites are evaluated based on the location, radiation dose/method, and functional goals for the patient.
This document provides information on bilateral sagittal split osteotomy (BSSO), a common surgical procedure for the mandible. Some key points:
- BSSO involves making sagittal cuts along the ramus and body of the mandible to allow advancement or setback of the mandible. It was first described in the 1950s and has undergone several modifications.
- Indications for BSSO include mandibular deficiencies, prognathism, asymmetries, open bites, and cross bites. Contraindications include decreased posterior body height and ramus hypoplasia.
- The surgical procedure involves incisions, osteotomy cuts, splitting the segments, mobilization, positioning, and
Abutment & Its Selection In Fixed Partial DentureSelf employed
This document discusses factors to consider when selecting abutment teeth for fixed partial dentures (FPDs). It defines an abutment tooth and outlines how to assess potential abutments, including taking radiographs and evaluating crown morphology, root configuration, crown-to-root ratio, and other anatomical features. Good abutment teeth are vital with adequate bone and root support and crown structure to withstand forces from the FPD. Location, occlusion, tooth structure and root health must be optimized for successful force distribution from the prosthesis.
The document discusses pontic design for fixed dental prostheses. It covers pretreatment assessment of residual ridge contours, classifications of ridge deformities, surgical modification techniques, and ideal requirements for pontics. Pontic designs are classified based on their shape and materials. Factors in pontic selection include esthetics and oral hygiene. Common designs for anterior and posterior regions are described, including sanitary, ovate, and saddle pontics. Biological considerations for pontic design involve maintaining the residual ridge, abutment teeth, and supporting tissues.
Radiation therapy can cause damage to oral mucosa and tissues. It commonly results in mucositis, which initially presents as erythema and develops into oral ulcers. Mucositis severity depends on factors like treatment dose and site of irradiation. While supportive care remains the standard, research focuses on radioprotective agents, anti-inflammatories, growth factors, and mucosal decontamination to reduce mucositis. However, effective preventative or treatment measures have yet to be established.
This document discusses diagnosis and treatment planning for removable partial dentures. It begins by defining key terms like diagnosis, treatment planning, and removable partial denture. It emphasizes the importance of a thorough patient interview and medical/dental history to accurately diagnose issues and develop a treatment plan. The document outlines factors to consider in the patient interview and examining the patient's mouth, teeth and bone. It discusses how various medical conditions and medications can impact treatment and the need to consult physicians in some cases.
1. The document provides guidelines for the management of avulsed permanent teeth. It discusses the importance of immediate replantation or storage in appropriate media.
2. It outlines treatment protocols for avulsed teeth with closed and open apices, including cleaning, splinting, antibiotics, and follow up care. Teeth with closed apices usually undergo root canal treatment 7-10 days after replantation.
3. Additional considerations include use of local anesthesia, topical or systemic antibiotics, tetanus prophylaxis, and splinting. Patient instructions focus on a soft diet and good oral hygiene. Follow up involves monitoring for signs of successful healing or complications.
Treatment planning for partially edentulous patients /fixed orthodontics coursesIndian dental academy
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
This document discusses temporization, or the placement of interim restorations. It describes the importance of temporization for maintaining tooth vitality and position. Common problems with temporization include underestimating fabrication time and delays replacing temporaries with permanent restorations. The document outlines several techniques for fabricating temporary crowns from various materials to address these issues, including metal, acrylic, and polycarbonate crowns. It also lists cardinal requirements and limitations of temporary crowns.
This document discusses the preparation of abutment teeth for removable partial dentures. It covers non-prosthetic and prosthetic mouth preparations, objectives of abutment tooth preparation, classification of abutment teeth, sequence of preparation for minor modifications, burs used, preparation of guiding planes, modification of height of contour, preparation of retentive undercuts, and preparation of rest seats for both posterior and anterior teeth. The goals of preparation include directing stress along the tooth axis, eliminating interferences, creating retention, and allowing prosthesis placement and removal without damage to teeth.
The document discusses various concepts related to complete denture impressions including definitions, techniques, materials and anatomical considerations. It defines key terms like preliminary impression, final impression, relief and supporting areas. It describes different impression techniques like mucocompressive, mucostatic and selective pressure. Factors affecting retention, stability and support of dentures are also summarized. The steps involved in making impressions are outlined which include examination, tray selection, border molding and the final impression.
Role of radiotherapy in oral ca ppt for csmsailesh kumar
Radiotherapy plays an important role in the management of oral cancer. It uses ionizing radiation to deliver tumoricidal doses to cancer while limiting dose to surrounding normal tissues. There are several techniques of radiotherapy including external beam therapy and brachytherapy. Factors like total radiation dose, chemotherapy combination, treatment delays and interruptions can influence effectiveness. Complications include both early side effects like mucositis and late effects like osteoradionecrosis. Advances in radiotherapy techniques aim to improve targeting accuracy and reduce side effects.
Biomechanical problems associated with free end saddle denturesDr sirisha sambhangi
This document provides terminology and concepts related to biomechanics and distal extension partial dentures. It discusses lever systems and the three classes of levers. Removable partial dentures can experience rotational movement around three axes. Distal extension partial dentures function as class I levers when occlusal forces are applied. The fulcrum is located at the terminal abutment clasp. Soft tissue support provides less resistance to movement than tooth support. Biomechanical problems with distal extension partial dentures include increased potential for movement due to less efficient soft tissue support compared to tooth support.
QUICK REVIEW OF PROSTHODONTICS – TNMGRMU SOLVED B.D.S FINAL YEAR QUESTION PA...Arun Kumar
This document contains solved question papers from 2012-2015 for the BDS final year prosthodontics exam at TNMGRMU. It includes long notes and short notes questions from each exam, covering topics like principles of tooth preparation, mouth preparation for complete dentures, types of finish lines, bar clasps, posterior palatal seals, obturators, balanced occlusion, and denture stomatitis. The long notes provide detailed explanations of the topics, while the short notes give concise overviews in bullet point form.
This document discusses factors to consider when selecting abutment teeth for fixed partial dentures. It outlines Ante's law which states the root surface area of abutment teeth should be greater than or equal to the teeth being replaced. Ideal abutments have adequate root length and bone support, proper crown-root ratio, and good periodontal health. Other considerations include a patient's occlusion, arch form, oral health, and long-term prognosis of the abutment teeth. Careful evaluation of anatomical, functional and biological factors is necessary for successful abutment selection and long-term outcomes.
This document discusses osteoradionecrosis of the jaws, which is bone necrosis caused by radiation therapy for head and neck cancer. It defines osteoradionecrosis and describes its classification, types, risk factors, and theories of pathophysiology. The document outlines protocols for preventing and treating osteoradionecrosis, including conservative management, hyperbaric oxygen therapy, pentoxifyllin and tocopherol supplements, and surgical interventions. Hyperbaric oxygen therapy is described as an adjuvant treatment involving intermittent high-pressure oxygen sessions to promote revascularization and healing.
The patient who requires a single denture opposing a natural or restored dentition challenges the clinician even more than the completely edentulous patient does. This is due to the biomechanical differences in the supporting tissues of the opposing arches. So a proper evaluation, correction of the existing factors and proper sequence of denture construction is necessary to give a more stable prosthesis.
This document discusses root canal sealers and their use in endodontic treatment. It provides information on the rationale and timing of obturation after root canal treatment. The key purposes of root canal sealers are to seal the root canal system, fill any irregularities or voids, and entomb any remaining bacteria. Common types of sealers discussed include zinc oxide-eugenol based, calcium hydroxide, and resin-based sealers. Properties of an ideal sealer and factors influencing the selection and performance of different sealer materials are also outlined.
This document discusses osteoradionecrosis (ORN), a serious complication of radiation therapy where exposed irradiated bone fails to heal. It can occur spontaneously or after trauma. The mandible is most commonly affected due to its tenuous blood supply. Pathophysiology involves hypoxic, hypocellular tissue with impaired healing ability. Management includes controlling infection, supportive care, and hyperbaric oxygen therapy (HBO) as an adjuvant to surgery to improve tissue oxygenation and revasculation. The Marx protocol uses HBO followed by surgical resection of necrotic bone in stages depending on severity.
Oral care of patients undergoing chemotherapy andAlaa AlQutub
Cancer is characterized by uncontrolled cell growth caused by an imbalance between cell division and cell death. Chemotherapy and radiation treatments can damage rapidly dividing normal cells, causing side effects. Dental surgeons should implement preventive strategies before, during, and after oncology treatments to manage oral complications and rule out infections. A thorough oral exam and hygiene instructions are important to minimize oral issues during cancer therapy.
Protocol of Dental Treatment in Radiotherapy Indicated Patients.pptxHoor-E-Jannath Prity
The dental management of patients who are to or have received radiotherapy pose a great challenge for general dentists. It is very important that we adhere to the established treatment regime to avoid any complications that may occur because of unplanned dental treatments.
The document discusses various techniques for making fixed prosthodontic (FPD) impressions, including conventional and recent methods. Conventional techniques include the putty-wash technique, copper tube/resin coping system, monophase technique, and dual viscosity technique. The putty-wash technique uses putty and wash materials simultaneously or in two steps. The dual viscosity technique uses a light body material injected around preps and a heavy body material in a tray. Recent techniques include digital impressions made either chairside, in a lab, or production center. The document provides details on procedures, advantages, and disadvantages of different impression techniques for FPDs.
The document discusses the effects of radiation therapy on osseointegration and implant success. It describes how radiation can damage bone tissue by reducing vasculature, killing osteoblasts and osteocytes. This compromises implant anchorage, remodeling, and the body's response to infection or forces. Animal studies show reduced success rates with higher radiation doses. The risks and benefits of implant placement in irradiated sites are evaluated based on the location, radiation dose/method, and functional goals for the patient.
This document provides information on bilateral sagittal split osteotomy (BSSO), a common surgical procedure for the mandible. Some key points:
- BSSO involves making sagittal cuts along the ramus and body of the mandible to allow advancement or setback of the mandible. It was first described in the 1950s and has undergone several modifications.
- Indications for BSSO include mandibular deficiencies, prognathism, asymmetries, open bites, and cross bites. Contraindications include decreased posterior body height and ramus hypoplasia.
- The surgical procedure involves incisions, osteotomy cuts, splitting the segments, mobilization, positioning, and
Abutment & Its Selection In Fixed Partial DentureSelf employed
This document discusses factors to consider when selecting abutment teeth for fixed partial dentures (FPDs). It defines an abutment tooth and outlines how to assess potential abutments, including taking radiographs and evaluating crown morphology, root configuration, crown-to-root ratio, and other anatomical features. Good abutment teeth are vital with adequate bone and root support and crown structure to withstand forces from the FPD. Location, occlusion, tooth structure and root health must be optimized for successful force distribution from the prosthesis.
The document discusses pontic design for fixed dental prostheses. It covers pretreatment assessment of residual ridge contours, classifications of ridge deformities, surgical modification techniques, and ideal requirements for pontics. Pontic designs are classified based on their shape and materials. Factors in pontic selection include esthetics and oral hygiene. Common designs for anterior and posterior regions are described, including sanitary, ovate, and saddle pontics. Biological considerations for pontic design involve maintaining the residual ridge, abutment teeth, and supporting tissues.
Radiation therapy can cause damage to oral mucosa and tissues. It commonly results in mucositis, which initially presents as erythema and develops into oral ulcers. Mucositis severity depends on factors like treatment dose and site of irradiation. While supportive care remains the standard, research focuses on radioprotective agents, anti-inflammatories, growth factors, and mucosal decontamination to reduce mucositis. However, effective preventative or treatment measures have yet to be established.
This document discusses diagnosis and treatment planning for removable partial dentures. It begins by defining key terms like diagnosis, treatment planning, and removable partial denture. It emphasizes the importance of a thorough patient interview and medical/dental history to accurately diagnose issues and develop a treatment plan. The document outlines factors to consider in the patient interview and examining the patient's mouth, teeth and bone. It discusses how various medical conditions and medications can impact treatment and the need to consult physicians in some cases.
1. The document provides guidelines for the management of avulsed permanent teeth. It discusses the importance of immediate replantation or storage in appropriate media.
2. It outlines treatment protocols for avulsed teeth with closed and open apices, including cleaning, splinting, antibiotics, and follow up care. Teeth with closed apices usually undergo root canal treatment 7-10 days after replantation.
3. Additional considerations include use of local anesthesia, topical or systemic antibiotics, tetanus prophylaxis, and splinting. Patient instructions focus on a soft diet and good oral hygiene. Follow up involves monitoring for signs of successful healing or complications.
Treatment planning for partially edentulous patients /fixed orthodontics coursesIndian dental academy
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
This document discusses temporization, or the placement of interim restorations. It describes the importance of temporization for maintaining tooth vitality and position. Common problems with temporization include underestimating fabrication time and delays replacing temporaries with permanent restorations. The document outlines several techniques for fabricating temporary crowns from various materials to address these issues, including metal, acrylic, and polycarbonate crowns. It also lists cardinal requirements and limitations of temporary crowns.
This document discusses the preparation of abutment teeth for removable partial dentures. It covers non-prosthetic and prosthetic mouth preparations, objectives of abutment tooth preparation, classification of abutment teeth, sequence of preparation for minor modifications, burs used, preparation of guiding planes, modification of height of contour, preparation of retentive undercuts, and preparation of rest seats for both posterior and anterior teeth. The goals of preparation include directing stress along the tooth axis, eliminating interferences, creating retention, and allowing prosthesis placement and removal without damage to teeth.
The document discusses various concepts related to complete denture impressions including definitions, techniques, materials and anatomical considerations. It defines key terms like preliminary impression, final impression, relief and supporting areas. It describes different impression techniques like mucocompressive, mucostatic and selective pressure. Factors affecting retention, stability and support of dentures are also summarized. The steps involved in making impressions are outlined which include examination, tray selection, border molding and the final impression.
Role of radiotherapy in oral ca ppt for csmsailesh kumar
Radiotherapy plays an important role in the management of oral cancer. It uses ionizing radiation to deliver tumoricidal doses to cancer while limiting dose to surrounding normal tissues. There are several techniques of radiotherapy including external beam therapy and brachytherapy. Factors like total radiation dose, chemotherapy combination, treatment delays and interruptions can influence effectiveness. Complications include both early side effects like mucositis and late effects like osteoradionecrosis. Advances in radiotherapy techniques aim to improve targeting accuracy and reduce side effects.
Biomechanical problems associated with free end saddle denturesDr sirisha sambhangi
This document provides terminology and concepts related to biomechanics and distal extension partial dentures. It discusses lever systems and the three classes of levers. Removable partial dentures can experience rotational movement around three axes. Distal extension partial dentures function as class I levers when occlusal forces are applied. The fulcrum is located at the terminal abutment clasp. Soft tissue support provides less resistance to movement than tooth support. Biomechanical problems with distal extension partial dentures include increased potential for movement due to less efficient soft tissue support compared to tooth support.
QUICK REVIEW OF PROSTHODONTICS – TNMGRMU SOLVED B.D.S FINAL YEAR QUESTION PA...Arun Kumar
This document contains solved question papers from 2012-2015 for the BDS final year prosthodontics exam at TNMGRMU. It includes long notes and short notes questions from each exam, covering topics like principles of tooth preparation, mouth preparation for complete dentures, types of finish lines, bar clasps, posterior palatal seals, obturators, balanced occlusion, and denture stomatitis. The long notes provide detailed explanations of the topics, while the short notes give concise overviews in bullet point form.
This document discusses factors to consider when selecting abutment teeth for fixed partial dentures. It outlines Ante's law which states the root surface area of abutment teeth should be greater than or equal to the teeth being replaced. Ideal abutments have adequate root length and bone support, proper crown-root ratio, and good periodontal health. Other considerations include a patient's occlusion, arch form, oral health, and long-term prognosis of the abutment teeth. Careful evaluation of anatomical, functional and biological factors is necessary for successful abutment selection and long-term outcomes.
This document discusses osteoradionecrosis of the jaws, which is bone necrosis caused by radiation therapy for head and neck cancer. It defines osteoradionecrosis and describes its classification, types, risk factors, and theories of pathophysiology. The document outlines protocols for preventing and treating osteoradionecrosis, including conservative management, hyperbaric oxygen therapy, pentoxifyllin and tocopherol supplements, and surgical interventions. Hyperbaric oxygen therapy is described as an adjuvant treatment involving intermittent high-pressure oxygen sessions to promote revascularization and healing.
The patient who requires a single denture opposing a natural or restored dentition challenges the clinician even more than the completely edentulous patient does. This is due to the biomechanical differences in the supporting tissues of the opposing arches. So a proper evaluation, correction of the existing factors and proper sequence of denture construction is necessary to give a more stable prosthesis.
This document discusses root canal sealers and their use in endodontic treatment. It provides information on the rationale and timing of obturation after root canal treatment. The key purposes of root canal sealers are to seal the root canal system, fill any irregularities or voids, and entomb any remaining bacteria. Common types of sealers discussed include zinc oxide-eugenol based, calcium hydroxide, and resin-based sealers. Properties of an ideal sealer and factors influencing the selection and performance of different sealer materials are also outlined.
This document discusses osteoradionecrosis (ORN), a serious complication of radiation therapy where exposed irradiated bone fails to heal. It can occur spontaneously or after trauma. The mandible is most commonly affected due to its tenuous blood supply. Pathophysiology involves hypoxic, hypocellular tissue with impaired healing ability. Management includes controlling infection, supportive care, and hyperbaric oxygen therapy (HBO) as an adjuvant to surgery to improve tissue oxygenation and revasculation. The Marx protocol uses HBO followed by surgical resection of necrotic bone in stages depending on severity.
Oral care of patients undergoing chemotherapy andAlaa AlQutub
Cancer is characterized by uncontrolled cell growth caused by an imbalance between cell division and cell death. Chemotherapy and radiation treatments can damage rapidly dividing normal cells, causing side effects. Dental surgeons should implement preventive strategies before, during, and after oncology treatments to manage oral complications and rule out infections. A thorough oral exam and hygiene instructions are important to minimize oral issues during cancer therapy.
Protocol of Dental Treatment in Radiotherapy Indicated Patients.pptxHoor-E-Jannath Prity
The dental management of patients who are to or have received radiotherapy pose a great challenge for general dentists. It is very important that we adhere to the established treatment regime to avoid any complications that may occur because of unplanned dental treatments.
The document discusses oral mucositis, a common side effect of chemotherapy and radiation therapy for head and neck cancers. It describes the epidemiology, pathophysiology, and treatment options for oral mucositis. The pathophysiology is explained in four phases: initial inflammatory phase, epithelial phase, ulcerative/bacteriological phase, and healing phase. Treatment focuses on prophylaxis through oral hygiene and includes topical agents for fungal infections, ulcers, and pain. While treatment can be challenging, prophylaxis is emphasized to reduce the severity and complications of oral mucositis.
This document discusses dental considerations for patients undergoing radiation therapy. It covers the immediate and delayed effects of radiation on oral tissues, including mucositis, xerostomia, candidiasis, trismus, and osteoradionecrosis. Management strategies are provided for each complication. Radiotherapy prostheses are described that protect healthy tissues, improve treatment accuracy, and enhance patient comfort during radiation. Factors affecting radiation damage and the role of hyperbaric oxygen therapy in managing osteoradionecrosis are also summarized.
Dr. Rahul VC Tiwari - Fellowship In Orthognathic Surgery - Jubilee Mission Medical College Hospital and Research Center, Thrissur, Kerala - 31st publication IJAR 1st name
This document discusses laser induced biostimulation as a potential treatment for endo-perio lesions. It presents a case study of a patient with an endo-perio lesion on tooth #32 who was treated with both endodontic and periodontal procedures in the same appointment using a 980nm diode laser. The laser was used for canal disinfection, new attachment procedure and hemostasis. At the 1 month recall the patient was asymptomatic with healed sinus tract and reduced pocket depths. Follow-ups showed continued healing over 4 years. The conclusion is that laser treatment may be an effective way to simultaneously treat endo-perio lesions in a shorter time.
- Chronic rhinosinusitis with nasal polyps (CRSwNP) affects 1.7-2.7% of the US population and is characterized by nasal polyp formation and inflammation.
- Treatment involves medical therapies like antibiotics, steroids, and surgery, but many patients experience uncontrolled symptoms or polyp recurrence.
- New biologic therapies targeting type 2 inflammation show promise but require defining optimal use, such as timing with surgery or indication for treatment failure.
Radiotherapy can cause both short and long term effects in the oral cavity by damaging rapidly dividing cells. Short term effects include mucositis and pain, while long term effects include fibrosis, trismus, and xerostomia. Management involves preventative dental treatment before radiotherapy when possible, frequent follow up care and cleanings after treatment, and supportive measures to manage complications like dry mouth, infections, and tooth decay. Extraction of teeth in the radiation field requires careful planning to avoid osteoradionecrosis, and reconstructive procedures may be needed for severe late effects.
Non Surgical Periodontal Therapy by Dr Santosh Martandesantoshmds
Review and Essay Material on Non Surgical Periodontal Therapy. Illustrative Contents for proper presentation on all aspects of NSPT. The Presentation helps in drafting A to Z of NSPT. Readers are encouraged to add newer studies and ideas under each aspect of NSPT.
The document summarizes the key phases and techniques involved in nonsurgical periodontal therapy (NSPT). It discusses the goals of NSPT to eliminate pathogens and halt disease progression. Techniques include scaling and root planing to remove calculus, contaminated cementum, and bacterial toxins. Studies found that aggressive root planing is not needed and that clinical improvements result from scaling alone or with root planing. The effects of NSPT on subgingival microflora and selection of instrumentation techniques are also summarized.
This document discusses the use of nanotechnology for cancer treatment. It begins with background on cancer and challenges with chemotherapy. It then introduces various nanoparticles being explored for cancer applications, such as quantum dots, iron oxide, and gold nanoparticles. The document discusses the enhanced permeability and retention effect that allows nanoparticles to passively target tumors. It provides the example of Doxil, an FDA-approved liposomal drug delivery system. Other nanomedicine examples discussed include Abraxane protein-bound paclitaxel nanoparticles. The document covers topics like tumor tissue targeting, overcoming drug resistance, vascular and cellular targets, and using heat-generating nanoparticles for thermal ablation of cancer cells.
This document provides an overview of recent advances in various dental specialties from oral medicine and radiology to prosthodontics, periodontics, orthodontics and more. It discusses new technologies like 3D soft tissue CT scans in oral medicine, lasers for curing pit and fissure sealants, clear aligner therapy in orthodontics, and nano composites and glass ionomers as new materials for pit and fissure sealants. The document aims to give public health dentists an update on advances to help bridge information between specialists and communities.
This document provides an overview of host modulation therapy for the treatment of periodontal disease. It discusses the concept of modulating the host immune response to reduce tissue destruction and promote healing. Various host modulation agents are described that target immune mechanisms, matrix metalloproteinases, bone remodeling, and locally vs. systemically administered therapies. Key agents discussed include non-steroidal anti-inflammatories, bisphosphonates, sub-antimicrobial doses of doxycycline, lipoxins, triclosan, enamel matrix derivatives, and growth factors.
The document discusses local drug delivery systems for treating periodontal disease. It covers the historical perspective of using antimicrobials as adjuncts to mechanical therapy. Various drug delivery methods are described including fibers, films, gels, strips, and microparticles. Specific drugs discussed include tetracycline, doxycycline, minocycline, and chlorhexidine. Studies show that local drug delivery of these antimicrobials can provide higher concentrations in periodontal pockets and help reduce probing depths and disease progression when used as an adjunct to scaling and root planing.
This study compared outcomes of patients undergoing either laser ablation (PiLaT technique) or Limberg flap (LF) surgery for primary pilonidal sinus. 200 patients were randomized to each group. Results showed PiLaT had significantly shorter surgery time, less post-op pain, earlier return to daily activities, higher patient satisfaction, and no recurrences at 2-month follow-up compared to LF surgery. The authors conclude PiLaT is an effective treatment that may be preferred over LF due to benefits of less pain/tissue loss.
Curcumin—A NaturalMedicament for Root CanalDisinfection: Effects ofIrrigat...Dr ATHUL CHANDRA.M
Curcumin—A NaturalMedicament for Root CanalDisinfection: Effects ofIrrigation, Drug Release, andPhotoactivation
Julian M. Sotomil, DMD, MSD,*Eliseu A. M€nchow, DDS, MSc,PhD,†DivyaPankajakshan,PhD,‡Kenneth J. Spolnik, DDS,MSD,§Jessica A.Ferreira, DDS,MSc, PhD,kRichard L. Gregory,PhD,‡and Marco C. Bottino,DDS, MSc, PhDk
JOE � Volume -2, Number -, - 2019
DR.Athul Chandra.M
Iid year postgraduate
Vertical jaw relation in Complete Dentures- KellyKelly Norton
1) The vertical jaw relation refers to the distance between selected points on the face, usually the tip of the nose and chin, and aims to determine the optimal vertical dimension of occlusion for complete dentures.
2) There are several proposed theories for the physiologic rest position, including positions where the opening and closing muscles are in equilibrium or where elastic elements balance gravity, but no single method is universally valid.
3) Determining the vertical dimension at rest provides a reference point, being approximately 2-4mm less than the vertical dimension of occlusion, which is the distance between contact points with the teeth occluding.
Biocompatibility of dental materials- kellyKelly Norton
The document discusses the biocompatibility of dental materials. It defines biocompatibility as the ability of a material to elicit an appropriate biological response. A number of factors determine the biocompatibility of a dental material, including its ability to avoid toxicity, immunotoxicity, allergic reactions, and other adverse effects. A variety of in vitro, animal, and human tests are used to measure the biocompatibility of dental materials before clinical use.
The document discusses immediate loading of dental implants. It begins with introducing immediate loading and defining related terms like immediate restoration, non-functional early restoration, and early occlusal loading. It then covers indications and contraindications for immediate loading, as well as advantages and disadvantages. The rationale for immediate loading is discussed, focusing on reducing surgical trauma and promoting bone remodeling. Factors that can decrease risks of immediate loading like implant number, size, design, and surface area are also outlined.
This document discusses occlusal equilibration and selective grinding. It begins by defining the key characteristics of a stable occlusion and the signs of an unstable occlusion. It then outlines the principles, indications, goals and procedures for occlusal equilibration and selective grinding. Specific techniques are covered such as how to eliminate interferences in centric relation, achieve the centric contact position, and adjust for lateral and protrusive interferences. The document emphasizes developing simultaneous contacts between cusp tips and flat surfaces to achieve occlusal stability.
Diagnosis of temporomandibular disorders- Kelly Kelly Norton
The document provides an overview of temporomandibular disorders (TMD) including:
1) TMD are misdiagnosed conditions involving the jaw joint and muscles causing facial pain and limited jaw movement.
2) Signs and symptoms include pain in the jaw muscles or joint, joint sounds, headaches and referred pain.
3) Diagnosis involves examining the muscles, jaw joint, dental occlusion and using imaging techniques to classify TMD conditions.
The document summarizes laboratory procedures for fabricating a metal partial denture framework. It discusses preparing the master cast, duplicating the cast, wax pattern and spruing, investing and burnout, casting the framework, and finishing. Key steps include:
1) Preparing the master cast by beading the major connector, spraying with sealant, blocking out undercuts, and providing relief.
2) Duplicating the master cast using reversible hydrocolloid in a flask.
3) Creating the wax pattern by adapting pre-made plastic patterns to the refractory cast and joining them with wax, then spruing the pattern.
4) Investing involves using gypsum, phosphate, or sil
Diagnosis and treatment planning for removable partial dentures- KellyKelly Norton
The document discusses the process of diagnosis and treatment planning for removable partial dentures. It involves:
1. Taking a thorough patient history and medical/dental examination to understand the patient's needs and concerns.
2. Performing a clinical examination including diagnostic casts, radiographs, and assessment of teeth and ridges.
3. Developing a treatment plan that addresses the patient's desires and oral health needs in the most appropriate manner.
The document discusses different types of partial veneer crowns, including maxillary and mandibular posterior three-quarter crowns. It describes the tooth preparation steps for each type in detail, including occlusal and axial reduction, placement of grooves and bevels, and finishing. The advantages of partial crowns include preserving more tooth structure while still providing adequate restoration of function. Key factors in the preparation like extent of reduction, groove placement and size, and bevel design help ensure strength and longevity of the restoration.
This document discusses pontic design in fixed partial dentures. It begins with definitions of a pontic and outlines key considerations for pontic design including pretreatment assessment of the pontic space and residual ridge contour, classification of pontics, and biologic, mechanical and esthetic factors. Optimal pontic design aims to provide an esthetic appearance while enabling adequate oral hygiene and preventing tissue irritation. Pontic selection depends on factors like location and materials used. The document discusses various pontic designs like sanitary, modified sanitary, saddle/ridge lap and ovate pontics and their appropriate uses. Biologic considerations for pontic design include maintaining pressure-free contact to prevent inflammation.
This document discusses different types of immediate dentures. It defines an immediate denture as any removable dental prosthesis fabricated for placement immediately following tooth extraction. There are two main types: conventional (classic) immediate dentures and interim/transitional immediate dentures. The conventional type is intended to serve as the long-term prosthesis after refitting, while the interim type is replaced by a second denture after healing. The document outlines the advantages, disadvantages, indications, and contraindications of each type. It also describes the diagnostic and treatment planning process, including clinical and laboratory procedures, for fabricating immediate dentures.
Diagnosis and treatment planning for removable partial denturesKelly Norton
The document discusses the process of diagnosis and treatment planning for removable partial dentures. It involves a thorough patient interview and medical/dental history to understand the patient's needs and concerns. A comprehensive clinical examination including intraoral photos, diagnostic casts, and x-rays is then used to evaluate the oral health, identify treatment needs, and assess teeth for suitability as abutments. The findings are interpreted to formulate a treatment plan addressing disease management and prosthetic reconstruction.
The document provides information on alloys used in prosthodontics. It begins with an introduction that defines an alloy as a mixture of two or more metals. It then provides a timeline of important events in the history of alloys used in dentistry. The document proceeds to discuss different types of metals used in alloys, including noble metals and base metals. It also covers topics such as solidification and crystallization of metals, phase diagrams, and heat treatments. Finally, it concludes by classifying different types of alloys and discussing their applications in dentistry.
This document provides an overview of sterilization and infection control. It begins with definitions of key terms like sterilization, disinfection, and antisepsis. It then covers various physical and chemical sterilization methods like dry heat, moist heat/autoclaving, filtration, radiation, and chemical agents. Biological controls for different sterilization methods are discussed. The relevance for prosthodontics is explained, including sterilizing instruments, impressions, and elastomeric materials. Studies on the effects of chemical disinfection on dimensional changes in impression materials are summarized. Occupational infections and conclusions are also mentioned.
Synthetic Resins used in ProsthodonticsKelly Norton
The document discusses synthetic resins used in prosthodontics. It provides a brief history of dentures from ancient bone and wood dentures to modern resins like polymethyl methacrylate. Ideal requirements for dental resins include biocompatibility, adequate physical properties, and ease of manipulation. The basic nature of polymers is explained including types of spatial arrangements and polymerization techniques like addition and condensation polymerization. Common denture base resins are classified and compression molding technique is summarized in 3 main steps: stone mold preparation, dewaxing, and resin manipulation.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
10 Benefits an EPCR Software should Bring to EMS Organizations Traumasoft LLC
The benefits of an ePCR solution should extend to the whole EMS organization, not just certain groups of people or certain departments. It should provide more than just a form for entering and a database for storing information. It should also include a workflow of how information is communicated, used and stored across the entire organization.
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
DECLARATION OF HELSINKI - History and principlesanaghabharat01
This SlideShare presentation provides a comprehensive overview of the Declaration of Helsinki, a foundational document outlining ethical guidelines for conducting medical research involving human subjects.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
7. Role of the dentist
• Initial appointment – information source
• To make the patient aware of the short term and long term effects
of radiation
• Manage oral complication after radiation therapy
52 7
8. 52 8
DENTAL MANAGEMENT OF RADIATION THERAPY PATIENTS
1. PRE-RADIATION
2. DURING RADIATION
3. POST RADIATION
9. 52 9
CRITERIA FOR PRERADIATION EXTRACTION
PATIENT RELATED:
1. Residual Dentition
2. Mandible vs maxilla 3. Oral compliance
10. Urgency of treatment
52 10
Prognosis for tumor control
Mode of radiation therapy
RADIATION DELIVERY FACTORS
12. 52 12
PROSTHODONTIC ROLE PRIOR TO RADIATION
1. POSITIONING STENT
Goel A, Tripathi A, Chand P, Singh SV, Pant MC, Nagar A. Use of positioning stents in lingual carcinoma patients subjected
to radiotherapy. International Journal of Prosthodontics. 2010 Sep 1;23(5).
Edentulous patientDentulous patient
13. 52
13
2. SHIELDING STENT
CERROBEND ALLOY
Mantri SS, Bhasin AS, Shankaran G, Gupta P. Scope of prosthodontic services for patients with head and neck cancer. Indian
journal of cancer. 2012 Jan 1;49(1):39.
15. 52 15
5. TISSUE BOLUS DEVICE
Singh BP, Vero N, Singh PK, Verma TR. A simplified technique to fabricate tissue bolus device to manage dose distribution in
maxillectomy patient with orbital exenteration. Journal of oral biology and craniofacial research. 2013 Aug 31;3(2):102-4.
16. 52 16
DENTAL MANAGEMENT DURING RADIATION THERAPY
1. ORAL MUCOUS MEMBRANE
WHO GRADING OF
MUCOSITIS
Dent Clin North Am. 2008 Jan; 52(1): 61–viii.
17. 52 17
PATHOPHYSIOLOGY OF RADIATION MUCOSITIS
Current five-phase pathobiologic model of oral mucositis.
(Reprinted from Sonis ST. A Biological Approach to Mucositis. J Support Oncol 2004; 2:21–36
Lalla RV, Sonis ST, Peterson DE. Management of oral mucositis in patients who have cancer. Dental Clinics of North
America. 2008 Jan 31;52(1):61-77.
19. Palifermin for oral mucositis after intensive therapy for
hematologic cancers
• The aim of this study was to test the ability of palifermin (recombinant human
keratinocyte growth factor) to decrease oral mucosal injury induced by cytotoxic therapy.
• This double-blind study compared the effect of palifermin with that of a placebo on the
development of oral mucositis in 212 patients with hematologic cancers.
• The incidence of oral mucositis of World Health Organization (WHO) grade 3 or 4 was
63 percent in the palifermin group and 98 percent in the placebo group (P<0.001).
• Palifermin reduced the duration and severity of oral mucositis after intensive
chemotherapy and radiotherapy for hematologic cancers
52 19
Spielberger R, Stiff P, Bensinger W, Gentile T, Weisdorf D, Kewalramani T, Shea T, Yanovich S, Hansen K, Noga S,
McCarty J. Palifermin for oral mucositis after intensive therapy for hematologic cancers. New England Journal of
Medicine. 2004 Dec 16;351(25):2590-8.
20. EDEMA
52 20
Tongue-depressing stent in place
Tongue-deviating stent in place
Treatment planning computed tomographic (CT) image with the CTD
stent in place. The planned target volume (PTV) to receive 70 gray of
radiation is shown in red
Johnson B, Sales L, Winston A, Liao J, Laramore G, Parvathaneni U. Fabrication of customized tongue-displacing stents: considerations for use
in patients receiving head and neck radiotherapy. The Journal of the American Dental Association. 2013 Jun 30;144(6):594-600.
21. 52 21
TRISMUS
• 3-6 months after radiation
therapy
• Secondary to fibrosis of the
muscles of mastication
TREATMENT FOR TRISMUS
22. PROSTHETIC REHABILITATION FOR A PATIENT WITH MICROSTOMIA:
A CLINICAL REPORT.
52 22
Gauri M, Ramandeep D. Prosthodontic management of a completely edentulous patient with microstomia: a case report.
The Journal of Indian Prosthodontic Society. 2013 Sep 1;13(3):338-42.
24. POST-RADIATION SEVERE XEROSTOMIA RELIEVED BY PILOCARPINE:
a prospective study
• The aim of the study was: (1) to confirm the action of pilocarpine hydrochloride (Salagen)
against xerostomia: (2) to correlate the response to dose/volume radiotherapy
parameters.
• From June 1995 to February 1996, 156 patients with severe radiation induced xerostomia
received pilocarpine hydrochloride orally. IS mg per day with a 5 mg optional increase at
S weeks up to a daily dose of 25 mg beyond 9 weeks
• No difference was found according to dose/volume radiotherapy parameters suggesting
that oral pilocarpine hydrochloride: (1) acts primarily by stimulating minor salivary
glands: (2) can be of benefit to patients suffering of severe xerostomia regardless of
radiotherapy dose/volume parameters.
52 24
Horiot JC, Lipinski F, Schraub S, Maulard-Durdux C, Bensadoun RJ, Ardiet JM, Bolla M, Coscas Y, Baillet F, Coche-Dequéant B, Urbajtel M. Post-
radiation severe xerostomia relieved by pilocarpine: a prospective French cooperative study. Radiotherapy and Oncology. 2000 Jun 1;55(3):233-9.
25. Functional salivary reservoir in
maxillary complete denture–
technique redefined
52 25
Joseph AM, Joseph S, Mathew N, Koshy AT..
Functional salivary reservoir in maxillary complete
denture–technique redefined Clinical case reports.
2016 Dec 1;4(12):1082-7.
A 60‐year‐old patient reported to the
Department of Prosthodontics at
Pushpagiri College of Dental Sciences for
the replacement of missing teeth. The
patient also complained of difficulty in
swallowing and mastication and
experienced difficulty in opening his
mouth. The patient gave a history of
radiation therapy 2 months back for focal
keratinizing squamous cell carcinoma.
26. 52 26
Such bone is essentially non vital and is
lacking the capacity for remodeling
BONE CHANGES
IRREGULAR BONY CONTOURS
27. PERIODONTAL CHANGES
52 27
The periodontium is a prime pathway for
infection.
This patient developed an
osteoradionecrosis 4 years
post radiation secondary to
a periodontal abscess
29. 52 29
OSTEORADIONECROSIS
• Definition – Exposure of bone within the field of radiation of 3 months duration or longer
CLINICAL SYMPTOMS:
Pain
Swelling
Trismus
Exposed Bone
Pathologic Fracture
Orocutaneous fistula formation
31. • 1. Conservative treatment:
• Irrigation with saline and chlorhexidine
• Iodoform gauze packing
• Gentle debridement with removal of sharp bony spicules.
• Antibiotic coverage if necessary
• PEN-TO-CLO- Pentoxyfylline+ tocopherol+ clodronate
• Strict oral hygiene measures.
52 31
TREATMENT OF OSTEORADIONECROSIS
Robard L, Louis MY, Blanchard D, Babin E, Delanian S. Medical treatment of
osteoradionecrosis of the mandible by PENTOCLO: preliminary results. European
annals of otorhinolaryngology, head and neck diseases. 2014 Dec 31;131(6):333-8.
32. 52 32
• Dr. Marx and his colleagues believe almost all osteoradionecrosis of the mandible
require treatment with hyperbaric oxygen
Hyperbaric Oxygen Therapy
How does HBOT work and why is
it effective ?
In air, normal 21% oxygen
100% O2 combined with pressure
delivers 15 times O2 to all body
fluids
Enhanced growth of new blood
vessels
Increased ability of white blood
cells to destroy bacteria and
remove toxins
Increased growth of fibroblasts
(cells involved in wound healing)
34. Topical Fluoride
• Mouth rinse
• Toothpaste
• Gel applied with custom carriers
52 34
The use of stannous fluoride gel applied with custom carriers and five minute daily
applications.
DENTAL MAINTAINANCE
POST RADIATION CARE
36. Examination findings of unique importance
• Condition of oral mucous membranes
• Contours of the bony bearing surfaces, presence of bony
undercuts
• Amount and Viscosity of saliva
• Posterior palatal seal area
• Trismus
• Scarring at the tumor site
52 36
PROSTHODONTIC PROCEDURES
• History findings of importance
• Fields of radiation
• Dose to mandibular bearing surfaces
37. Impressions
• Border molding
• Border mold with a low fusing compound
• Apply petrolatum to prevent sticking to the dry mucosa
• Develop maximum extensions but avoid overextension at
the tumor site
• Do not attempt to displace the floor of the mouth to
obtain peripheral seal.
52 37Thermoplastic wax
Polysulfide
• Wash impression materials
38. Assessment of Vertical dimension
• Determined by phonetics, closest speaking
space, swallowing , VDR
• The VDO is reduced only in patients with
severe trismus so as to facilitate easy entrance
of the bolus by increase in interocclusal space.
• In case of severe scarring of tongue, lower the
occlusal plane
52 38
39. Centric relation records are
made in the usual manner
using wax, ZOE or silicone
materials
• A facebow transfer record is used to mount the maxillary cast on the articulator.
52 39
40. Lingualized / bilateral balance
52 40
Nonanatomic with balancing ramps
• Less horizontal forces are generated
• Proper horizontal overlap to maintained
Occlusal forms
41. Delivery and Post-Insertion Care
• Pressure indicating paste
• Disclosing wax- delineate overextension
• Clinical remount
• 24 and 48 hour follow up
• Leave dentures out at night
• Educate the patient
52 41
42. Period between Completion of Radiation Therapy and Prosthetic Rehabilitation in Edentulous
Patients: A Retrospective Study
Purpose:
1. to describe the number and types of complications patients had before and after insertion of a
removable prosthesis (i.e., denture) following radiation therapy to the head and neck and
2. to investigate whether the time between radiation therapy and denture insertion might contribute to
those complications
Materials and Methods: A total of 190 patients met the inclusion criteria with data available for review.
Conclusions:
• The majority of patients had no complications.
• The patients who received their dentures in 180 days or less had the same number of complications when
compared with those patients who received their dentures in 181 to 365 days and those who had to wait
longer than a year for prosthetic rehabilitation.
• Patients with more pre-insertion complications tended to have delayed prosthetic rehabilitation.
• The majority of patients who experienced complications before and after denture insertion had greater
than 5000 cGy.
52 42
Period between Completion of Radiation Therapy and Prosthetic Rehabilitation in Edentulous Patients: A Retrospective Study Peter J. Gerngross, et al . J
Prosthodont 2005;14:110-121
43. Implants in irradiated tissues
• Radiation effects :
• Reduced vasculature
• Loss of osteo progenitor cells
• Fatty degeneration
• Compromised remodeling
• Susceptibility to
osteoradionecrosis
52 43
Root
surfac
e
Marrow
Trabecular bone
• Loss of central artery in
Haversian systems
• Death of osteocytes
44. Implants in the irradiated maxilla
• Predictability-Maxilla %Success
• Roumanas et al, 1998 55
• Nimi et al, 1998 63
52 44
Without HBO
Implants in irradiated edentulous maxillectomy patient (UCLA Data)
Patients Number of implants Success
Treated placed uncovered buried failed %
Irradiated 13 50 29 11 10 55.2
45. 52 45
In the mandible, one would expect risk to become significant at
doses to bone above 6500 cGy. This patient received 6600 cGy for a
squamous carcinoma of the lateral tongue. Three years later implants
were placed.
Eventually, the patient developed an osteoradionecrosis, a pathologic fracture
of the mandible and subsequently the mandible was resected.
Three years after implant
placement the patient
developed an infection
associated with left posterior
implant.
Implants in the irradiated mandible
46. IMPLANTS IN THE CRANIOFACIAL SITES
Success is poor and failures are late because:
• Anchorage is mechanical: short implants have
higher failure rate
• Exposure of flange leads to persistent irritation of
perimplant skin or mucosa
52 46
Flange exposure Eventually led to loss of implants
47. IRRADIATION OF EXISTING IMPLANTS
52 47
These implants were
irradiated 2 years
following placement.
Note the exposure of the
implant flanges.
Recommendation:
Abutments and superstructures should be removed
and skin and/or mucosa closed over the implant
fixtures prior to radiation.
48. SUMMARY
• Implant material : Advanced dental implant surfaces like TPS [titanium plasma spreaded],
SLA [sandblasted and acid etched], Ti-Unite and different implant materials like zirconia
[zirconium oxide]
• Implant position : Implants can be best placed in the mandibular anterior / symphyseal region
as it is the area which receives the least amount of radiation. The maximum implant failures are
reported in the maxillary jaw [69% to 95%] .
• Type of prosthesis : Fixed implant supported prosthesis is advocated in irradiated mandibles.
• Effect of radiation dose :. Favorable osseointegration is found in radiation doses lesser than
45-50 Gy.
• Effect of smoking: Irradiated patients who continued to smoke must be considered as an
absolute contraindication to treatment.
52 48Dholam KP, Gurav SV. Dental implants in irradiated jaws: a literature review. Journal of cancer research and therapeutics. 2012
Jan 1;8(6):85.
49. • Soft tissue complications : Gingivitis was more common in these patients than normally
observed. Cover-screw mucosal perforations were observed over the areas of 17% of
implants during the healing period between stage one and stage two surgery.
• Hyperbaric oxygen : Some studies found it useful while others considered it as an
additional burden of treatment.
Timing of implant placement: One year time interval between tumor therapy and the time
of dental implantation seems logical
• Timing of abutment placement and loading the implants: Abutment connection,
fabrication and loading of the prosthesis should be delayed for six months instead of the
traditional three to four months to permit osseointegration.
52 49
Dholam KP, Gurav SV. Dental implants in irradiated jaws: a literature review. Journal of cancer research and therapeutics. 2012
Jan 1;8(6):85.
50. Osseointegrated implants in irradiated bone: A case-controlled study using adjunctive
hyperbaric oxygen therapy
• The current investigation was undertaken to study whether osseointegration of implants in
irradiated tissues is subject to a higher failure rate than in non irradiated tissues. It further aimed
to study whether hyperbaric oxygen treatment (HBO) can be used to reduce implant failure.
• Patients and Methods:
• 78 cancer patients who were rehabilitated using osseointegrated implants between 1981 and 1997
were investigated. Three groups of patients were compared: irradiated (A), nonirradiated (B), and
irradiated and HBO-treated (C). In addition, 10 irradiated patients who had lost most of their
implants received new ones after HBO treatment. These were compared as a case-control group.
• Conclusions: Implant insertion in irradiated bone is associated with a higher failure rate. Adjuvant
HBO treatment can reduce the failures.
52 50
Granström G, Tjellström A, Brånemark PI. Osseointegrated implants in irradiated bone: a case-controlled study using adjunctive
hyperbaric oxygen therapy. Journal of oral and maxillofacial surgery. 1999 May 1;57(5):493-9.
51. 52 51
The aim of this systematic review was to evaluate the effect of radiation therapy on osseointegrated
dental implant survival in oral cancer patients.
MATERIALS AND METHODS:
A review of the literature published between 1990 and June 2012 was conducted. Overall implant
survival rates were compared with respect to timing of radiation ,site of implant placement, radiation
dose, time interval between radiation therapy and implant placement, and the effect of hyperbaric
oxygen therapy.
CONCLUSION:
There, was no significant difference in dental implant survival rates between pre implantation and
post implantation radiation therapy. The anatomical site of implant placement in preimplantation
radiation therapy was the most pertinent variable affecting implant survival, with a better survival
rate in the mandible compared to the maxilla and grafted bone.
Dental implant survival in irradiated oral cancer patients: a
systematic review of the literature.
Nooh N. Dental implant survival in irradiated oral cancer patients: a systematic review of the literature. International Journal of Oral &
Maxillofacial Implants. 2013 Sep 1;28(5).
52. Implant-prosthetic rehabilitation after radiation treatment in head and neck cancer
patients: a case-series report of outcome.
• The aim of the study was to review the
outcome of implant-prosthetic treatment
after radiation therapy.
• Patients and methods. Twenty irradiated
head and neck cancer patients received a
removable implant supported denture
• Results. Twenty patients had 100 implants
inserted. The estimated implant survival
rate was 96% after 1 year and 87% after 5
years. Failures were mostly observed
before loading (91.2%). The attachment
system and the number of implants did
not have a statistically significant
influence on the success rate.
52 52
Conclusions. Implant-supported dentures have been
shown to be a reliable treatment modality after head and
neck cancer surgery and radiation therapy. Possible early
failures should be communicated with the patients
Cotic J, Jamsek J, Kuhar M, Ihan Hren N, Kansky A, Özcan M, Jevnikar P. Implant-prosthetic rehabilitation after radiation treatment in
head and neck cancer patients: a case-series report of outcome. Radiology and oncology. 2017 Mar 1;51(1):94-100.
53. Conclusion
52 53
In summary, it is our intention and goal as dentists to minimize and/or prevent
potentially devastating side effects of Radiation therapy from occurring and to
help the patient maintain the highest possible level of oral health and function
both during and after Radiotherapy.
54. REFERENCES
52 54
1. Beumer J, Curtis T, and Nishimura R. Prosthetic management - Edentulous patients. In
Beumer J, Curtis T, and Marunick M, editors. Maxillofacial Rehabilitation. St. Louis –
Tokyo: Ishiyaku EuroAmerica 1996.
2. Thomas T Taylor , Clinical Maxillofacial Prosthetics, First edition,2000, Quintessence
publications, Illionis, pp 37 – 52
3. Goel A, Tripathi A, Chand P, Singh SV, Pant MC, Nagar A. Use of positioning stents in
lingual carcinoma patients subjected to radiotherapy. International Journal of Prosthodontics.
2010 Sep 1;23(5).
4. Mantri SS, Bhasin AS, Shankaran G, Gupta P. Scope of prosthodontic services for patients
with head and neck cancer. Indian journal of cancer. 2012 Jan 1;49(1):39.
5. Singh BP, Vero N, Singh PK, Verma TR. A simplified technique to fabricate tissue bolus
device to manage dose distribution in maxillectomy patient with orbital exenteration. Journal
of oral biology and craniofacial research. 2013 Aug 31;3(2):102-4.
6. Lalla RV, Sonis ST, Peterson DE. Management of oral mucositis in patients who have cancer.
Dental Clinics of North America. 2008 Jan 31;52(1):61-77
7. Spielberger R, Stiff P, Bensinger W, Gentile T, Weisdorf D, Kewalramani T, Shea T, Yanovich
S, Hansen K, Noga S, McCarty J. Palifermin for oral mucositis after intensive therapy for
hematologic cancers. New England Journal of Medicine. 2004 Dec 16;351(25):2590-8
55. 8. Johnson B, Sales L, Winston A, Liao J, Laramore G, Parvathaneni U. Fabrication of
customized tongue-displacing stents: considerations for use in patients receiving head
and neck radiotherapy. The Journal of the American Dental Association. 2013 Jun
30;144(6):594-600.
9. Gauri M, Ramandeep D. Prosthodontic management of a completely edentulous patient
with microstomia: a case report. The Journal of Indian Prosthodontic Society. 2013 Sep
1;13(3):338-42.
10. Horiot JC, Lipinski F, Schraub S, Maulard-Durdux C, Bensadoun RJ, Ardiet JM, Bolla
M, Coscas Y, Baillet F, Coche-Dequéant B, Urbajtel M. Post-radiation severe
xerostomia relieved by pilocarpine: a prospective French cooperative study.
Radiotherapy and Oncology. 2000 Jun 1;55(3):233-9.
11. Joseph AM, Joseph S, Mathew N, Koshy AT.. Functional salivary reservoir in maxillary
complete denture–technique redefined Clinical case reports. 2016 Dec 1;4(12):1082-7.
12. Robard L, Louis MY, Blanchard D, Babin E, Delanian S. Medical treatment of
osteoradionecrosis of the mandible by PENTOCLO: preliminary results. European
annals of otorhinolaryngology, head and neck diseases. 2014 Dec 31;131(6):333-8.
13. Period between Completion of Radiation Therapy and Prosthetic Rehabilitation in
Edentulous Patients: A Retrospective Study Peter J. Gerngross, et al . J Prosthodont
2005;14:110-121
14. Dholam KP, Gurav SV. Dental implants in irradiated jaws: a literature review. Journal
of cancer research and therapeutics. 2012 Jan 1;8(6):85.
52 55
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Editor's Notes
Cancer is the 2nd leading cause of death after heart disease with 30 % being oral cancer.
Principal methods of treating malignancies of the head neck
are: surgical resection and radio therapy. The Prosthodontist is commonly consulted when custom prosthetic devices are used to facilitate the delivery of radiation therapy.
Direct action results when secondary particles (i.e., recoil electrons and protons) interact with the target molecule, while indirect action results from interaction with water to produce free radicals (hydroxyl and hydrogen), which in turn interact with the target molecule by oxidation reduction
reactions.
Radiation is delivered via an external source
IMRT allows delivery of different doses to each volume at the same time
Radioactive sources are implanted locally within the tissues (encompassed Iridium 192 seeds ) To deliver the dose at a shorter distance
They are used primarily in T1 and T2 carcinomas of the oral tongue and floor of the mouth
Advantages:
Dose to the buccal side of the mandible and the salivary glands is generally limited to the dose delivered by the external therapy.
This level (5000-5500cGy) of radiation is not sufficient to totally eliminate the fine vasculature of these tissues.
Teeth with questionable prognosis . Especially mandible ..higher risk of orn
TRISMUS , IMPAIRED OTOR FUNCTIONS AND SURGICAL MORBIDITIES
This situation occurs very rarely.
When it does both the radiation therapist and the dentist must accept the risk of future dental complications
OCCURS DUE TO CELL DEATH OF THE BASAL LAYER OF THE EPITHELIUM. Oral mucositis initially presents as erythema of the oral mucosa which then often progresses to erosion and ulceration
Initiation of tissue injury: Radiation and/or chemotherapy induce cellular damage resulting in death of the basal epithelial cells.
free radicals activate second messengers that transmit signals from receptors on the cellular surface to the inside of the cell.This leads to upregulation of pro-inflammatory cytokines, tissue injury and cell death.
amplify mucosal injury
There is a significant inflammatory cell infiltrate associated with the mucosal ulcerations,
This phase is characterized by epithelial proliferation as well as cellular and tissue differentiation 15, restoring the integrity of the epithelium.
loss of central artery in the Haversion systems (arrow)
b) loss of osteocytes from their lacunae (arrow)
Periosteum and overlying soft tissue undergo hyperemia, inflammation and endarteritis. Leading to thrombosis, cellular death progressive hypovascularity, and fibrosis.
Pentocifylline + tocofeol reduce post radiation fibrosis
Clodronate- bisphosphonate – reduces bone resorption allows for bone formation
20 dives before treatment 10 dives after treatment at 2.28 atmospheric pressure for 90-120 minutes