Accurate planning for the framework design of removable partial dentures requires careful analysis of the diagnostic cast with a dental surveyor to determine the optimal path of placement. Some techniques described in the literature are helpful in reorienting the same cast on the surveyor, including the tripod marking method; however, there is a possibility of introducing human errors during marking and repositioning of the tripod points on to the different casts at the same location. Other techniques, which do not require markings on the cast to reorient different casts of the same patient, need specific devices or trays. This article suggests the direct use of a putty-elastomeric orientation index that can be preserved and used multiple times while reorienting different casts of the same patients at various laboratory steps. A putty elastomeric impression material is mixed and adapted on to the diagnostic cast, covering key teeth areas of the cast and incorporating the analyzing rod of the surveyor. Thus there is no need to use a special device or the tray to reorient different casts.
Bilateral cleft lip/cleft palate is associated with nasal deformities typified by a short columella. The presurgical nasoalveolar molding (NAM) therapy approach includes reduction of the size of the intraoral alveolar cleft as well as positioning of the surrounding deformed soft tissues and cartilages. In a bilateral cleft patient, NAM, along with columellar elongation, eliminates the need for columellar lengthening surgery. Thus the frequent surgical intervention to achieve the desired esthetic results can be avoided. This article proposes a modified activation technique of the nasal stent for a NAM appliance for columellar lengthening in bilateral cleft lip/palate patients. The design highlights relining of the columellar portion of the nasal stent and the wire-bending of the nasal stent to achieve desirable results within the limited span of plasticity of the nasal cartilages. With this technique the vertical taping of the premaxilla to the oral plate can be avoided.
This case report demonstrates sequential periodontic, orthodontic and prosthodontic treatment modalities to save and restore deep horizontally fractured maxillary central incisor. The location of fracture was deep in the mucosa which reveals less than 2 mm of tooth structure to receive the crown. The procedures like surgical crown lengthening, endodontic post placement, orthodontic forced eruption, core build-up and metal-ceramic crown restoration were sequentially performed to conserve the fractured tooth. Forced eruption is preferred to surgical removal of supporting alveolar bone, since forced eruption preserves the biologic width, maintains esthetics, and at the same time exposes sound tooth structure for the placement of restorative margins.