Advances in dental implant design and surface treatment beside the growing interest in dental esthetics have made a paradigm shift in implant dentistry. Instead of focusing on achieving successful implant osseointegration, constructing highly esthetic implant restoration and shortening the total treatment time have become the area of interest. The new philosophy has supported the protocol of immediate implant placement that showed high success rates and esthetic results. However, careful case selection and meticulous prosthetic and surgical implant planning are essential. This review discussed and summarized the important factors affecting case selection and implant planning to achieve an osseointegrated immediately placed implant with satisfying esthetic outcomes. The affecting factors were categorized into patient-related and clinician-related factors. Patient-related factors were periodontal phenotype, post-extraction socket type, presence of infection, smoking and esthetic risk assessment analysis. Clinician-related factors included position and design of the implant, jumping gap dimensions, surgical technique for implant placement, and socket-sealing technique.
INTRODUCTION:Recent researches had shown that, in principle, computer-assisted design, computer-assisted manufacture and rapid prototype technologies (CAD/CAM) can be successfully applied to the fabrication of removable partial denture (RPD) alloy frameworks and replace laboratory crafting techniques. The (CAD/CAM) techniques have been widely used for a long time to manufacture dental prostheses. Polyoxymethylene (POM) also known as acetal resin has been used as an alternative tooth-colored denture base and denture clasps material since 1986 and was promoted primarily for superior esthetic. OBJECTIVES: To evaluate clinically the use of Polyoxymethylene partial dentures designed and fabricated by using CAD/CAM technology compared to conventional cobalt chromium partial denture through both the masticatory efficiency and patient satisfaction. MATERIALS AND METHODS: This clinical trial was conducted on twenty mandibular partially edentulous patients (Kennedy class I) who received two types of RPD. Type I was Polyoxymethylene partial denture designed and fabricated by using CAD/CAM Technology and Type II was cobalt chromium partial denture fabricated using the conventional technique .At time of denture insertion, the masticatory efficiency of both types of dentures was evaluated for each patient .After 3 months of denture use, each patient was clinically evaluated through both the masticatory efficiency and patient satisfaction. RESULTS: Type I RPD showed better masticatory efficiency than Type II RPD but without statistical significant values at different follow up periods. Patients showed more satisfaction with type I RPD than with type II RPD with a significant value. CONCLUSIONS: Polyoxymethylene partial denture designed and fabricated by using CAD/CAM Technology is a favorable treatment for partially edentulous patients showing improvement of masticatory efficiency and favorable patient satisfaction.
Background and Aims Sleep disorders are common among end stage renal disease (ESRD)patients undergoing hemodialysis (HD). The etiology of sleep disorders in these patients is known to be multifactorial. However, the role of hydration status in sleep disorders in HD patients is not well studied. Therefore, our aim was to study the effect of predialysis fluid overload on sleep quality in HD patients. Methods This cross-sectional study included 100 prevalent HD patients from HD unit of El Sahel teaching hospital. fluid status and fluid compartments [total body water (TBW)], extracellular water (ECW)] and overhydration index (OH) were analyzed by a portable whole-body bio-impedance spectroscopy (Body Composition Monitor ‘BCM’) before mid-week dialysis session. Overhydration was defined as OH/ECW ≥15%. HD patients were then classified into 2 groups: Group 1 (non- overhydrated) and Group 2 (Overhydrated) according to OH/ECW. Sleep quality were assessed in all patients by Pittsburgh Sleep Quality Index (PSQI) questionnaire. Patients with Concurrent diagnosis of either obstructive sleep Apnea or psychiatric disorder and patients on any medications which affect the sleep pattern were excluded. Results our study included 100 HD patients (49 male, 51 female - mean age 49.3 ±11). 42 patients (42%) had overhydration (i.e. Group 2). Poor sleep quality (defined as PSQI score ≥5) was reported in 57% (n=57) of HD patients included in our study. Poor sleep quality was significantly higher in the HD patients with overhydrated (Group 2). Total PSQI scores were significantly higher in overhydrated patients (Group2) compared to non-overhydrated patients (Group1) (7.92±3.32 vs 4.83±2.27, P= <0.001). The component scores 1, 2, 3, 4, 6 and 7 of the PSQI showed significant differences between the overhydration and non-overhydration groups with higher values (i.e poor sleep quality) in overhydrated patients (Group2). Moreover, there was significant positive correlation between total PSQI score and overhydration index (OH/ECW %) in all HD patients included in the study (r=0.283, P= 0.004). Conclusion We may conclude from our study that sleep disorders are prevalent in HD patients. Predialysis fluid overload in HD patients may be associated significantly with poor sleep quality.
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