Indonesian Journal of Prosthodontics

The benefit of chitosan adding as a reinforcement material for polymethyl methacrylate provisional fixed dentures

Dara Aidilla — 2025-01-02

Backgrounds: Provisional fixed partial denture (FPD) is an important procedure in prosthetic treatment such as crown or bridge. In particular cases, like crown lengthening as preliminary treatment, implant procedure until osseointegration process, and temporomandibular disorder as an occlusal therapy, the use of provisional FPD will take 3-6 months until the insertion of definitive restoration. Therefore, materials used in making a provisional FPD should be able to preserve the prepared tooth, maintain the periodontal conditions, and have superior esthetic for a long time. Self-cure polymethyl methacrylate (PMMA) is a most commonly used material due to its biocompatibility, high wear resistance, ease of application, and superior esthetic. Nonetheless, unmodified self-curing PMMA has weaknesses due to its degradation process in the oral cavity, which affects its mechanical and physical properties. To overcome this, addition of reinforcement material, namely chitosan, in provisional FPD is necessary. Chitosan is polymer compound obtain through partial deacetylation of acetyl glucosamine through deacetylation of chitin base and modified into magnetic nanoparticles with size 100-400 nm to increase absorption power. The addition of nanotechnology to polymeric materials has shown significant appeal and improved mechanical and physical properties.

Objectives: This review aims to explain the use of chitosan material in addition to self-cure PMMA provisional FPD to improve its mechanical and physical properties.

Conclusion: Chitosan material can be an alternative option to improve the mechanical and physical properties of self-cure PMMA.

Keywords: provisional fixed partial denture, self-cure PMMA, chitosan

The Accuracy of Cut-Out-Rescan Method in Digital Impression

Sabrina Ally — 2025-01-02

The process of fabricating fixed dentures starts with an impression of the anatomical structure of the teeth. Currently, the use of an intraoral scanner (IOS) for digital impression has improved due to its rapid workflow. One of the advantages of IOS is the availability of the cut-out-rescan method, which involves rescanning unscanned areas (mesh holes) without the need to repeat the entire impression procedure. This method is recommended to assist in the digital workflow of fixed denture fabrication, by performing a cut-out on the prepared tooth, rescan, and merge it with the initial scan (pre-preparation scan). The accuracy of the cut-out-rescan method is measured based on trueness and precision. The aim of this literature is to describe the accuracy of the cut-out-rescan method in digital impression. Rescanning procedure influenced the accuracy of the definitive scan. The number and diameter of mesh holes influenced the scanning accuracy of IOS. The higher the number and diameter of the rescanned area, the lower the accuracy of the IOS. The narrow anatomical structure of teeth such as the anterior teeth also made the rescanning process more difficult. Nonetheless, the use of the cut-out-rescan method is quite practical and makes it easier for clinicians to perform digital workflow as there is no need to repeat impression procedure to obtain a definitive virtual cast. Clinical workflow becomes quicker by the elimination of physical casts, thus reducing clinical expenses.

Keywords: IOS, workflow, cut-out-rescan, mesh holes, accuracy

The role of shoulder and chamfer margin design on the fracture resistance of zirconia crown

Andri Corentus Leo — 2025-01-02

In recent years, zirconia all-ceramic restorations are widely used in crown and bridge treatment due to their superior mechanical properties and aesthetics. Zirconia is the strongest ceramic material, thus it is the treatment of choice for posterior dental restorations. One factor that affects the fracture resistance of zirconia restoration is the margin design. The shoulder and chamfer are the recommended margin design to obtain maximum fracture resistance from zirconia restoration. Shoulder is recommended because it has greater fracture resistance while chamfer is more conservative and able to withstand maximum masticatory load. However, there is still a difference of opinion regarding the fracture resistance of zirconia crown with shoulder and chamfer margin designs. This literature review aims to discuss the role of chamfer and shoulder margins design on the fracture resistance of zirconia crown. The shoulder margin design results in a wide ledge, space for adequate restoration contours and maximum aesthetics that provide resistance to occlusal forces and minimizes stress that can cause fracture. The chamfer margin design on zirconia crown has a difference in the rounded internal angle of the preparation resulting in better force distribution, better marginal fit and more resistance to fracture compared to the shoulder margin design. Chamfer margin design is more conservative and resistant to fracture due to better marginal fit which distribute stress more evenly.

Keywords: zirconia, margin design, chamfer, shoulder, fracture resistance

The use of hydrofluoric acid as a surface treatment material on bond strength in repair system of lithium disilicate – Literature Review

Ludwika Patricia Razalie — 2025-01-02

Lithium disilicate is a glassy ceramic material that mimics the aesthetics and strength of natural tooth structure, making it very popular in recent years. Lithium disilicate has good flexural strength, translucency, and high mechanical strength of up to 360±60 MPa which is superior to feldspathic porcelain or leucite-reinforced glass ceramic. These excellent properties make it suitable for both anterior and posterior use. Naturally, ceramic materials are inherently brittle and tend to fracture easily in repetitive function. There are several methods of fracture treatment, one of which is repair. Composite resin is frequently used for ceramic repair as a simple and fast solution. The bond strength of ceramic repairs on lithium disilicate using hydrofluoric (HF) acid is higher compared to other methods. Hydrofluoric acid that has been used as a surface treatment for lithium disilicate is 4% and 5% HF acid. This article reviews the effect of HF as a surface treatment material on bonding strength between lithium disilicate and composite resin. The application of hydrofluoric acid in ceramic surface promotes the reaction with the glass matrix that contains silica and form hexafluorosilicates. This glass matrix is selectively removed and the crystalline structure is exposed. As a result, the surface of the ceramic becomes rough and this roughly etched surface helps to provide more surface energy prior to combining with the silane solution. Silane coupling agent forms a chemical covalent bond between silica on the lithium disilicate surface and composite resin. This bond will increase the micromechanical interlock.

Keywords: lithium disilicate, surface treatment, hydrofluoric acid, bond strength

Strain distribution on shortened dental arches complete denture using finite element analysis

Jasmine — 2025-01-02

Prosthetic management for edentulism could be challenging with the Inadequate interocclusal space due to enlargement of the maxillary tuberosity, causes difficulties in artificial tooth placement. Hence, reducing numbers of artificial teeth is indicated which is in line with the shortened dental arches (SDA) concept. The SDA concept could provide good occlusal and mandibular stability, comfort in mastication and appearance. An increase in strain distribution value in the anterior region of the mandible was found in the SDA due to partial changes of the occlusal load distribution pattern. Strain distribution can be analyzed using Finite Element Analysis (FEA). This literature review aims to analyse the strain distribution on SDA complete denture using finite element analysis. The SDA concept was aimed at preserving the anterior and premolar regions. Masticatory ability is correlated with the number of teeth and is impaired if there are less than 20 teeth. Based on FEA, the increase in strain distribution value in the SDA concept is due to changes in occlusal load distribution pattern, masticatory muscle activity and tissue morphology that is susceptible to stress. Nevertheless, the strain value in SDA models were of lower intensity than the yield reported to cause deterioration effects. In maxillary complete denture, the highest strain value was found at the incisal and labial frenal notches. Strain distribution on shortened dental arches using finite element analysis shows a satisfactory masticatory ability and an increase in the value of stress distribution in the anterior region of the mandible.

Analysis of Stress Distribution on Knife-Edge with Various Occlusion Schemes Using

Jhonson — 2025-01-02

Edentulism is an oral health problem that has an impact on quality of life because it causes a loss of balance in the stomatognathic system with disruption of mastication. The impaired masticatory function can be exacerbated from knife-edge conditions, thus the masticatory load received by the mucous in the form of stress distribution becomes greater. One of the efforts to reduce stress concentration is to modify the occlusion concept and anatomical shape of the artificial teeth. However, measuring the stress distribution on edentulous mucous with various occlusion schemes was difficult with in vivo and in vitro tests due to inability to represent the complex system of stomatognation. In silico test with A) can be a solution because the modeling simulation is obtained from CT-scan or digital design. This paper discusses the stress distribution analysis on knife-edge condition with various occlusion schemes using FEM. Stress distribution that exceeds the mucous pressure-pain threshold during denture function will cause poor mastication performance. This paper discusses the analysis of stress distribution under knife-edge ridge conditions with various occlusion schemes using FEM. Stress distribution that exceeds the mucous pressure-pain threshold during denture function will cause poor mastication performance. The use of Lingualized or Monoplane occlusion schemes can be a solution because they use semi-anatomical and non-anatomical artificial teeth to reduce the load passed on the cusp and also minimize resistance during lateral movement. The advantages of FEM in obtaining accurate modeling and flexibility in testing allow analyses that are difficult to perform in in vivo and in vitro, FEM measure stress distribution and its relationship with pain on knife-edge ridge base on various occlusion schemes in complete dentures.

Utilization of robusta coffee bean extract (Coffea canephora) as an alternative herbal in applied dentistry

Muhammad Dani Anko Putra — 2025-01-02

Background: Indonesia is a major producer of Robusta coffee, which has variations in chemical qualities such as caffeine, polyphenols, flavonoid compounds, tannins, alkaloids, and chlorogenic acid. Research shows that Robusta coffee bean extract has potential in dental applications. The importance of Robusta coffee as an agricultural commodity and source of active ingredients with health benefits, especially in dental care. Objectives: This literature review aims to evaluate the effectiveness of Robusta coffee as oral herbal medicine. An electronic search was carried out on PubMed, Science Direct, and Google Scholar with manual search from 2018 to 2024 following the PRISMA 2020 guidelines. The review incorporated studies related to the utilization of Robusta coffee bean extract that can be applicable for oral health care. Conclusion: Robusta coffee bean extract has significant potential as an active material in dental health care, with clear antibacterial, antioxidant, and wound-healing abilities. Robusta coffee bean extract-based products as oral herbal medicine can give significant advantages to oral health. Further research is needed to optimize its use in health products.

Improved retention of ocular prosthesis with modified shallow socket impression technique

Andri sinulingga — 2025-01-02

ABSTRACT

Background: The long-term use of a custom ocular prosthesis that is not replaced could cause a shallow socket. These changes affect the size of the socket. In fact, the custom ocular prosthesis becomes loose.

Objectives: Modify the impression by duplicating the old custom ocular prosthesis as a special tray for obtaining an accurate impression of the socket and reducing clinical visits.

Case Report:. A 42-year-old woman came to Dental Hospital Universitas Sumatera Utara with the chief complaint that the custom ocular prosthesis was easy to fall off and painful during movement. She has worn the ocular prosthesis for over 30 years, fabricating it five times. However, the last ocular prosthesis lasted for 10 years. The definitive impression was prepared by duplicating the custom ocular prosthesis, and this special tray was modified by adding a rod with a light body material due to its low viscosity. As a result of using the special tray, a more accurate impression can be made due to the small size of the rod.

Conclusion: The impression technique with a modified tray from the duplicated old custom ocular prosthesis can record the eye socket in detail and produces a retentive custom ocular prosthesis.

Obturator with hollow bulb after hemimaxillectomy – A Case Report

Cynthia Gunawan — 2025-01-02

Hemimaxillectomy will create oro-nasal communication which can affect the function of swallowing, masticatory, speech, aesthetic and psychological. This case report describes a method of prosthodontic management of maxillary defects using an obturator prosthesis with a hollow bulb. A 15-year-old male patient was diagnosed with central giant cell granuloma, therefore hemimaxillectomy was performed by ENT doctors at RSUP Dr. Sardjito. He has a surgical obturator that was inserted by a prosthodontist immediately after the surgery. Three weeks after surgery, soft tissues were ready to be made an interim obturator. Seven months later, he came to RSGM Prof. Soedomo with a complaint the old obturator is difficult to adapt. Intraoral examination revealed a large palate defect in the right palate durum segment (Aramany's class II type maxillary defect) and half of the right maxilla is missing. A definitive obturator using metal combination acrylic with a hollow bulb was made to cover the maxillofacial defect and replaced missing teeth. That prosthesis can cover the defects of the maxilla so the patient can speak well, and the function of masticating and swallowing can be restored.

Keywords: surgical obturator, definitive obturator, hollow bulb

Case management of young patients with temporomandibular Osteoarthritis joint disorders using stabilization splint,self-therapy, and chondroitin sulfate-glucosamine supplements

Hanna Mentari Uliani — 2025-01-02

Introduction: Osteoarthritis (OA) is a disorder of the temporomandibular joint which results in permanent changes to TMJ. Scissors bite and bad habits are one of the etiological factors of OA. OA causes deviation when opening the mouth, limitations of mouth opening, and joint crepitus sounds. Use of stabilization splints (SS), physical therapy, and consumption of chondroitin sulfate-glucosamine supplements aimed at reducing joint pain, relaxing TMJ muscle, and preventing joint damage. Case report: A 22-year-old female patient came to North Sumatera of Dental Hospital with complaints stiff jaw when opening her mouth, especially in the morning. Complaints of pain occurred since skelling treatment 3 years ago. Clinical examination showed scissors bite and a habit of chewing on the right side. Palpation of the right anterior temporalis muscle revealed familiar pain and joint crepitus sound. Based on DC/TMD assessment, the patient had OA where the mouth opening is 35 mm without pain and 38 mm with pain accompanied by a left deviation of 1.5 mm. On CBCT examination there was flattening on the TMJ surface. Treatment is carried out by using SS every day and consuming chondroitin sulfate-glucosamine supplements once a day accompanied by self-therapy. Self-therapy is carried out alone by practicing opening and closing the jaw for 15 minutes every day. After 6 months is obtained without assisted mouth opening of 36 mm to 41 mm. There is no pain on palpating muscles but there is still a crepitus sound when opening and closing the mouth. Conclusion: Treatment of OA with SS, self-therapy, and consumption of Chondroitin Sulfate-Glucosamine supplements is effective in reducing TMJ joint pain and muscle stiffness through chondroitin stimulation mechanism so that prevents further degenerative processes.

Keywords: Temporomandibular joint disorder, Osteoarthritis, Stabilization splints, Cone beam computed tomography, Chondroitin sulfate-glucosamine.

Prosthetic rehabilitation of a post evisceration patient with Non-Fabricated ocular prosthesis: A case report

Herman Jaya Atmaja — 2025-01-02

The disability associated with the loss of eye can cause significant physical and emotional problems in sufferers. Rehabilitation of patients with eyeball loss requires an eye prosthesis that can restore optimal cosmetic and psychological function. Eye prostheses can be made from non-fabricated acrylic resin. In this case report, a 23-year-old female patient came to the RSGM Prof. Soedomo, Faculty of Dentistry, Gadjah Mada University with complaints of missing left eye since 8 years ago with a diagnosis of phthisis bulbi. The results of the clinical examination showed that the conjunctiva was in good health and there was no infection. The treatment in this case was the manufacture of non-fabricated ocular prostheses made of acrylic resin. Custom-made ocular prostheses provide satisfactory results thereby improving psychology and emotional as well the social aspect.

Prosthetic rehabilitation of nasomaxillary defect with TAD retained surgical obturator followed by hollow bulb definitive obturator and immediate lower denture

Agustinus Kenny Wijaya — 2025-01-02

The integrity and functionality of the oral cavity may be compromised by nasomaxillary defects, such as speech, mastication, deglutition, and esthetics. Early prosthodontic rehabilitation can improve quality of life and lessen the psychological harm caused by the surgical treatment. A 70-years-old female patient was referred to the Department of Prosthodontics RSUP Dr. Sardjito Yogyakarta with chief complaints of nasal obstruction, and right-side swelling of the face. Extraoral examination revealed facial asymmetry due to swelling of the right buccal region. On intraoral examination, showing a large, firm mass extending from right palate to the midline. A multidisciplinary approach with ENT is required for the surgical treatment. A surgical obturator was made before the surgery, and immediately inserted after with TAD as a retention device. Three months later, a hollow bulb obturator and immediate lower denture was fabricated so the functional capabilities of speech, mastication, deglutition, and esthetics can be restored.

Keywords: surgical obturator, maxillofacial prostheses, definitive obturator, hollow bulb

Tooth-supported overdenture retained with metal medium copings: A case report

I Gede Made Hadi Nugraha Arisukra — 2025-01-02

Overdenture is removable denture used to replace missing teeth and cover or rest on one or more remaining natural teeth in the mouth. The concept of overdenture is a positive means for delaying the process of complete edentulism and helps in reducing bone resorption. Selection of teeth to be retained by looking at periodontal tissue and history of dental caries. Tooth-supported overdenture using coping can be made with short coping, medium coping, or long coping. Metal copings can be used on teeth that have decreased alveolar bone support but are still strong, also covering dentin tubules. On this report, A 62-year-old man patient reported having the chief complaint of difficulty in chewing food and speaking due to missing teeth in the upper and lower arch. This case report describes prosthodontic rehabilitation of a mandibular partially edentulous arch with tooth-supported overdenture using metal medium copings which aim to provide sensory response with further stability and retention to the denture. The patient was satisfied with the treatment outcome. For elderly edentulous patient with few remaining teeth, a tooth-supported overdenture is one of the best and most practical, feasible, and comfortable treatment alternatives.

Custom-Made of ocular prosthesis for post enucleation: A Case Report

Dian Novita Sari — 2025-01-02

Ocular prosthesis is part of a whole rehabilitative treatment plan after surgery. Stock ocular prosthesis, are premade, come in a range of colours and sizes with a right and left standard shape, and inexpensive to manufacture. The disadvantage is not being able to fit completely in the eye socket. To address this issue, the patients require a suitable prosthesis to enhance their living standards. A 75-year-old male patient came to RSGM UGM Prof. Soedomo using a stock ocular prosthesis. Complained that his ocular prosthesis loose and uncomfortable. The treatment plan was making custom-made ocular prosthesis using acrylic resin. The treatment procedure comprises minting the individual eye by using an individual tray; making the model of wax sclera followed by trying on the wax sclera pattern to the patient eye socket and continuing the acrylic resin process of sclera followed by trying on the eye socket, and then determining the location and iris diameter to draw the iris and pupil. The final step is inserting the ocular prosthesis into the patient’s eye socket. One week after insertion, the patient felt comfortable and has no complaints. Ocular prosthesis help improve the patient’s quality of life.

Keywords: Custom-made ocular prosthesis, Rehabilitation, Enucleation

Acupressure gua sha and massage with kutus-kutus oil accompanied using a stabilization splint in patients with temporomandibular disorder

Nanda Iswa Maysfera — 2025-01-02

ABSTRACT

Background: The most common temporomandibular disorder (TMD) is characterized by disc displacement with reduction (DDWR). Despite its typical signs such as clicking, DDWR has complex symptomatic characteristics, thus; conservative treatment including occlusal splint and physical therapy are commonly performed. Physical therapy, such as acupressure using acupuncture points and massage, is an alternative to DDWR treatment.

Objectives: This paper aims to explain the DDWR treatment using stabilization splints and acupressure therapy using gua sha accompanied by a massage with Kutus-Kutus oil.

Case report: A 36-years-old male patient arrived at USU Dental Hospital with complaints of clicking right jaw and feeling pain in zygomatic and mandibular area. The patient has been experiencing pain under stress and during periods of high activity for the past six months. This pain is often accompanied by clenching of the jaw, particularly when the patient is worried or concentrating, and the patient tends to sleep on one side. Upon clinical examination, a sound was detected in the right temporomandibular joint (TMJ). The patient was able to open their mouth to a width of 34 mm without experiencing pain, although there was a noticeable deviation to the right. No pain was reported in the joint area during mouth opening. Radiographic examination revealed that the right and left mandibular condyles were positioned anterior to the articular tubercle. For symptomatic treatment, stabilization splints were used in conjunction with physical therapy, which included acupressure gua sha and massage with Kutus-Kutus oil. The use of a stabilization splint caused the patient to experience discomfort during clenching, which gradually led to the cessation of this detrimental habit. This intervention helped to reduce pain and eliminate the clicking sounds associated with TMJ disorder.

Conclusion: the combined use of acupressure gua sha, massage with Kutus-Kutus oil, and a stabilization splint can effectively alleviate the pain and clicking symptoms in patients with TMJ disorder.

Keywords: TMJ disorder, stabilization splint, acupressure, gua sha, massage

Management of TMD in patient with canted occlusal and asymmetry

Fitrya Dyah Wijayanti — 2025-01-02

Facial asymmetry can disturb not only appearance but also function. The most characteristic of the TMJ internal derangement (ID) is the disc displacement in patient with face asymmetry. To report the successful treatment of TMJ ID in class 2 malocclusion with canted occlusal plane and facial asymmetry. A 22-year-old male patient came refer by the Orthodontics Department with chief complaints of slanted jaw and bite, soreness, tension in front of right ear region. History of closed lock on his right jaw and had clicking on his left. He’s a daytime bruxer. Clinical examination showed visible canting in the occlusal plane, reciprocal clicking in the left TMJ, limited movement and deviation when opening and closing the mouth. Based on panoramic x-ray, the left mandibular ramus was longer than the right. The DC-TMD diagnosis is disc displacement with reduction on the left and disc displacement without reduction without limited opening on the right TMJ. A stabilization appliance (SA) was fabricated for him. Patient was instructed to do jaw exercise, and physical-self regulation (PSR). Patient was also told that emotional stress, and bad habit should be reduced. After 4 months using the SA, and doing the jaw exercise and PSR, the patient showed significant improvement. Soreness and tension had disappeared, and facial asymmetry was getting better. Patient then was referring to Orthodontic Department to treat his malocclusion. SA, jaw exercise and PSR were a good treatment choice to manage the TMJ ID.

Keywords: facial asymmetry, TMJ internal derangement, disc displacement

Disinfection effect of chlorhexidine and castor oil based on usage time on the impact strength of denture base heat polymerized acrylic resin

Reza Dimansyah Azis Montahir — 2025-01-02

Heat polymerized acrylic resin is the most frequently used type of acrylic resin because it has several advantages. Heat polymerized acrylic resin dentures must be disinfected to maintain cleanliness and prevent diseases caused by wearing unclean dentures.. The chemical method is a good and easiest method to do by immersing the dentures in a disinfecting solution. The immersion will clean the surface of the denture and reach the undercut area of the denture. Chlorhexidine and castor oil are ingredients that have substances that can clean dentures, but the content in these materials has an influence on the properties of dentures, one of which is mechanical properties. This study aimed to know the effect of disinfection of chlorhexidine and castor oil based on time of use on the impact strength of heat polymerized acrylic resin denture bases with simulations of 3, 4, and 5 years. The sample was tested using a Charpy Impact Tester to determine the impact strength value. This study showed that there was an effect of castor oil on the impact strength of heat polymerized acrylic resin, but the change still above the minimum value, so this can be suggested as a disinfection material.

Effect of immersion in green tea (camellia sinensis) solution on the transverse strength of heat cured acrylic resin base

Rizky Amalia — 2025-01-03

Objective: To determine the effect of tea solution on the transverse strength of heat cured acrylic resin base.

Methods: This study was a laboratory experimental study with post test only with control group design using plate-shaped heat cured acrylic resin samples with a size of 65 mm × 10 mm × 2,5 mm as many as 24 samples. These samples were divided into 6 groups, namely 3 treatment groups immersed in green tea soluble for 3 days, 5 days, and 8 days, and 3 control groups immersed in artificial saliva for 3 days, 5 days, and 8 days. The transverse strength of each group was measured using a Universal Testing Machine (Galdabini). The results were analyzed by Two Way ANOVA test and LSD test.

Results: The results of the Two-Way ANOVA test showed a significant difference between immersion in artificial saliva and green tea solution, namely p = 0,000 (p < 0,05). LSD test results showed significant differences between the three immersion duration groups. Between immersion for 3 and 8 days and immersion for 5 and 8 days, the probability value of p = 0,000 (p < 0,05) was obtained. While between immersion for 3 and 5 days, the probability value of p = 0,001 (p < 0,05) was obtained.

Conclusion: There is an effect of soaking in green tea solution on the transverse strength of heat cured acrylic resin bases.