Ocular prosthesis for a geriatric patient with customised iris: a report of two cases

doi:10.1111/j.1741‐2358.2009.00327.x
Ocular prosthesis for a geriatric patient with customised iris: a report of two cases Objective: An ocular prosthesis is given when trauma or disease may lead to enucleation or evisceration of the eye and the combined efforts of the ophthalmologists and the maxillofacial prosthetist can provide a cosmetically acceptable ocular prosthesis. Methods: An ocular prosthesis is either pre‐fabricated or custom‐made. One of the important factors for achieving a cosmetic result is accurate colour matching of the iris with the contralateral iris. Results: A knowledge of the anatomy of the eye facilitates hand painting of iris and sclera to produce a satisfactory result. Conclusion: The custom‐made ocular prosthesis allows infinite variations during the fabrication.     

Cast titanium overlay denture for a geriatric patient with a reduced vertical dimension

An older patient reporting to the dental surgery for his/her dental treatment is becoming a common occurrence. Improved oral hygiene has meant that teeth are retained for a longer time, along with the potential problems of attrition, decreased vertical dimension, temporomandibular joint discomfort/strain, and poor aesthetics. The case in question is that of a 65-year-old male patient who had severe attrition in the lower arch, temporomandibular joint pain and reduced vertical dimension. The maxillary arch had previously been restored with a fixed partial prosthesis. For restoration of the lower teeth, a removable cast titanium overlay denture was fabricated incorporating an increased vertical dimension. Porcelain facings were placed to restore the aesthetics of the anterior teeth. The titanium was cast in a semi-automatic electric arc, pressure type casting machine. A titanium overlay denture with porcelain facing on the anterior teeth may provide a means of restoring a patient's concerns regarding aesthetics and function.     

Implant‐retained thumb prosthesis with anti‐rotational attachment for a geriatric patient

doi:10.1111/j.1741‐2358.2009.00283.x
Implant‐retained thumb prosthesis with anti‐rotational attachment for a geriatric patient This report presents the use of a dental implant with an anti‐rotational attachment for the retention of a thumb prosthesis. A retention system was manufactured with an attachment (UCLA) screwed into the implant with a two‐bar system that was cast in metallic silver palladium. A substructure made from heat‐cured acrylic resin was joined to the retention system by clips to join the thumb to the finger (bar clip) in the cast with implant rejoinder. The silicone material, Silastic‐MDX 44210, was used to achieve function and aesthetics. Following osseointegration, no skin problems were observed. Whilst the implant‐retained digital prosthesis presented some motor limitations, it allowed the patient to return to entertainment and achieve social conviviality.     

Zygomatic implant-retained fixed complete denture for an elderly patient

Dental rehabilitation of a completely edentulous geriatric patient has always been a challenge to the clinician, especially in treating those with higher expectations and demands. Treatment duration and the amount of residual alveolar bone available are often important considerations when planning for dental implant-based fixed treatment for these patients. With the introduction of zygomatic implants, a graftless alternative solution has emerged for deficient maxillary bone with provision for immediate loading. This article describes the treatment of a completely edentulous elderly patient using zygomatic implants in conjunction with conventional implants. The implants were immediately loaded using a definitive acrylic resin fixed denture reinforced with a cast metal framework, to provide function and aesthetics.     

Management of a dentigerous cyst in a medically compromised geriatric patient: a case report

doi: 10.1111/j.1741‐2358.2011.00576.x Management of a dentigerous cyst in a medically compromised geriatric patient: a case report Background: Because of the increasing number of older persons seeking dental care, the growing trend towards a longer dental appointment and increased administration of drugs in dentistry, the possibility of occurrence of medical emergencies in dental offices has shown an upward trend. Objective: This case report discusses enucleation of a central dentigerous cyst in a 72‐year old male on long‐term low dose aspirin therapy. Material and methods: Surgical removal of impacted tooth with total enucleation of cystic lesion was performed in the dental chair under 2% lidocaine with 1:200,000 adrenaline, 3 days after aspirin cessation. After complete debridement of the surgical site, the wound was sutured and a gauge saturated with 10% tranexamic acid was placed on surgical site for 30 minutes. Result: No post‐operative complications or bleeding was seen on subsequent appointment and healing was normal. Conclusion: A geriatric and medically compromised patient demands special care and attention; and the decision to cease aspirin before surgery or not is of critical importance.     

Unnoticed ingestion of dislodged fixed prosthesis in an elderly patient

doi: 10.1111/j.1741‐2358.2010.00408.x
Unnoticed ingestion of dislodged fixed prosthesis in an elderly patient     

Implant-supported palatal lift prosthesis in a patient with velopharyngeal incompetence: a case report

doi: 10.1111/j.1741‐2358.2011.00561.x Implant‐supported palatal lift prosthesis in a patient with velopharyngeal incompetence: a case report Objective: To describe the use of dental implants in the treatment of velopharyngeal incompetence. Background: Velopharyngeal incompetence is characterized by the inability to contract the tissues of the soft palate. The most common causes are neuromuscular problems resulting from concussion and degenerative conditions of the central nervous system. Materials and methods: The treatment using palatal lift prosthesis is well established in the literature; however, reports on the use of osseointegrated implants are scarce. Rehabilitation using only this type of fibromucosal support is difficult in edentulous patients, since the prosthesis has a palatal lift extension. Results: The implants provided retention and stability to the prosthesis, improving swallowing and speech and contributing to improve the patient’s quality of life. Conclusion: This article reports the rehabilitation of a patient with a totally edentulous maxilla with velopharyngeal incompetence using an implant‐retained palatal lift prosthesis.     

A 30-year review of a geriatric dentistry teaching programme

doi: 10.1111/j.1741‐2358.2011.00471.x A 30‐year review of a geriatric dentistry teaching programme Objective: To review the development of the Geriatric Dental and Special Needs Education programme at the University of Iowa over the last 30 years. Background: The programme at Iowa evolved from a didactic elective programme taught by a single faculty person to a required didactic and clinical programme, which includes a Special Care Clinic in the dental school and a mobile unit with portable dental equipment which serves ten area nursing homes with comprehensive care. Materials and methods: Changes have been made in the programme over time based on formal and informal feedback from students and graduates, and we have also looked at the impact of the programme on dental services to our target population. Results: The factors influencing the curriculum development are identified and discussed. Conclusion: As no dental schools are the same, some general applications are suggested from the Iowa experience.     

Laboratory passage and characterization of an isolate of Toxoplasma gondii from an ocular patient in Korea

Toxoplasma gondii tachyzoites were isolated from the blood of an ocular patient, and have been successfully passaged in the laboratory, for over a year, by peritoneal inoculation in mice. The isolated parasite was designated the Korean Isolate-1 (KI-1) and its characteristics were compared with those of the RH strain, a wellknown virulent strain originating from a child who suffered from encephalitis. The morphology, pathogenicity, infectivity and cell culture characteristics of the KI-1 were similar to those of the RH strain. Both RH and KI-1 antigens were detected by an anti-T. gondii monoclonal antibody (mAb), Tg563, against the major surface protein SAG1 (30 kDa), whereas no reaction was observed against an anti-Neospora caninum mAb, 12B4. The KI-1 was confirmed as an isolate of T. gondii. A long-term laboratory maintenance and characterization of a local T. gondii isolate is reported for the first time in the Republic of Korea.     

Effect of different disinfectants on the microhardness and roughness of acrylic resins for ocular prosthesis

Background: Ocular prosthesis materials should have specific properties for their indication and durability; therefore, it is important to investigate their physical behaviour when affected by several disinfectants. Objectives: This study evaluated the influence of different disinfecting solutions on the microhardness and surface roughness of acrylic resins for ocular prosthesis. Materials and Methods: Fifty samples simulating ocular prostheses were fabricated with N1 resin and colourless resin and divided (n = 10) according to the disinfectant used: neutral soap, Opti‐free, Efferdent, 1% hypochlorite (HYC) and 4% chlorhexidine (CHX). Samples were stored in saline solution at 37°C and disinfected during 120 days. Both microhardness and roughness were investigated before, after 60 days and 120 days of disinfection and storage. Microhardness was measured using a microhardner and the roughness with a roughness device. Results: N1 resin showed lower microhardness when compared with colourless resin (p < 0.05). HYC and CHX groups exhibited the highest change of microhardness and roughness values (p < 0.05). An increase in roughness and reduction in microhardness of ocular acrylic resins were observed after both periods of disinfection and storage (p < 0.05). Conclusion: Both disinfection/storage periods affected the microhardness and roughness values of the samples.     

Ocular toxocariasis in mice: distribution of larvae and lesions.

The distribution of Toxocara canis larvae in the eye was determined for mice given a single challenge dose (C-mice) as compared to mice similarily challenged after 2 or 3 previous infections (SC-mice). Controls were mice given only the 2 or 3 previous infections and uninfected mice. Eyes were observed in situ during a 34 day post-challenge period to compare inflammatory responses in the anterior eye; histologic examination of serial sections of the eyes of these mice was done at the end of this period. In situ observations showed that lesions in the anterior eye converted from hemorrhagic to white cell more rapidly in the SC-mice; white cell lesions were predominant in SC-mice as early as day 5, whereas similar predominance in C-mice was not noted until days 16–21. Histology revealed that approximately 90% of these eyes were infected. Worm burdens per eye correlated more closely with total dose per mouse than with the effects of immunization. Histologic study showed that 90% of larvae observed were in the retina, but that most lesions were in the uveal tissues which harbored only 0·8% of the total number of larvae.     

Microbiological analysis of conjunctival secretion in anophthalmic cavity,contralateral eye and ocular prosthesis of patients with maxillofacial abnormalities

The purpose of this study was to identify and analyse the micro‐organisms present in the conjunctival secretion in anophthalmic cavities of wearers of ocular prostheses, as well as on the prostheses used by them, correlating them with the microbiota of the contralateral eye. Nine patients with maxillofacial abnormalities, wearers of an acrylic resin ocular prosthesis participated in the study. Collections of conjunctival secretions and biofilm were performed on the prosthesis, anophthalmic cavity and contralateral eye for the mycological and bacterial analyses. The data were submitted to statistical analysis, performing a Kendall correlation test to identify the correlation between the collection site and the identified micro‐organism (P < 0·05). It was verified that the most prevalent micro‐organisms were the Staphylococcus aureus and Staphylococcus epidermidis, independent of the collection site, and that negative cultures for fungi were encountered in 85·2% of collections, independent of the region. It was not possible to establish a correlation among the types of micro‐organisms and the collection sites.

Significance and Impact of the Study

Some evidence suggests that the surface roughness of ocular prostheses can influence interactions with micro‐organisms, with greater prejudicial consequences, such as the establishment of biofilms, which could lead to infections. Thus, it becomes extremely important to identify the micro‐organisms present on the acrylic surfaces of ocular prostheses, as well as the microbiota of the anophthalmic cavity and contralateral eye of wearers of the same, so that subsequent control measures promote the homeostatic maintenance of the ocular region.     

Collaboration of a dentist and speech-language pathologist in the rehabilitation of a stroke patient with dysarthria: a case study

Objective: To elucidate the effectiveness of the collaboration of a dentist and speech‐language pathologist (SLP) in the rehabilitation of a stroke patient with dysarthria. Design: A clinical case report treated in the rehabilitation hospital and dental surgery. Subject: A 71‐year‐old Japanese man who was admitted to the rehabilitation hospital for speech rehabilitation 2 years and 5 months after a stroke. Methods: Provision of prosthesis (palatal lift prosthesis + palatal augmentation prosthesis) for improving velopharyngeal incompetence (VPI) and articulation by dentist, and speech behavioural management by SLP including self‐monitoring and bio‐feedback training using the See‐Scape. Results: Speech behavioural management proved useful for promoting improvement in speech intelligibility to a functionally sufficient level after improving VPI by prosthesis. Conclusion: The collaborative efforts of the dentist and SLP in the rehabilitation of post‐stroke patients with velopharyngeal incompetence should be encouraged.     

Bats and Viruses： a Brief Review

Bats, probably the most abundant, diverse and geographically dispersed vertebrates on earth, have recently been shown to be the reservoir hosts of a number of emerging viruses responsible for severe human and livestock disease outbreaks. Flying foxes have been demonstrated to be the natural reservoir for Hendra and Nipah viruses. Evidence supporting the possibility of bats as potential reservoirs for SARS coronavirus (SARS-CoV) and Ebola virus has also been reported. The recent discovery of these viruses and other viruses occurring naturally in the bat population provides a unique insight into a diverse pool of potentially emergent and pathogenic viruses. The factors which influence the ability of zoonotic viruses to effectively cross the species barrier from bats to other animal populations are poorly understood. A brief review is provided here on the recently emerged bat viruses and on current and future strategies for research in this area.     

Accelerated rehabilitation of an edentulous patient with an implant retained dental prosthesis: a case report

This case report details the successful rehabilitation of an edentulous patient using a complete upper prosthesis and a lower implant retained overdenture. The provision of care was split between a specialist centre and a primary care setting. This approach reduced inconvenience to the patient. Modern surgical and prosthodontic techniques also reduced the total delivery time. After initial consultation a new set of complete dentures was prescribed with changes in design to the originals. The patient was also planned for placement of two mandibular implants to stabilise and retain the mandibular denture. The first line of treatment involved provision of a new set of dentures constructed by the patient's general dental practitioner. Dental implants were then placed in a specialist centre and the patient returned to the dental practice for attachment of the lower denture to the dental implants. The benefits and success of mandibular implant retained dentures are well documented. With delivery of the overdenture, the patient reported increased satisfaction with his prostheses which allowed him to eat a greater range of foods and enabled him to feel confident when speaking and socialising.