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Krishan K Kapur

Publications and source records attributed to Krishan K Kapur.

8 recordsLinked to original sources
PubMed2006

Efficacy of conventional and implant-supported mandibular resection prostheses: study overview and treatment outcomes.

STATEMENT OF PROBLEM: While surgical restoration of mandibular resections has advanced dramatically with free-flap techniques, oral function and patient perceptions of function, as well as treatment outcomes, often indicate significant impairment. PURPOSE: This longitudinal prospective study was designed to determine whether conventional prostheses (CP) or implant-supported prostheses (IP) and current surgical reconstructive procedures restore patients' oral functions and quality of life to their status prior to segmental mandibulectomy with immediate fibula free-flap reconstruction. Study design and implementation, characteristics of the study sample, treatment completion rates, and selected presurgical and postsurgical functional and perceptual outcomes are presented. MATERIAL AND METHODS: Forty-six subjects were enrolled. Longitudinal evaluations of medical and dental histories, oromaxillofacial examinations, questionnaires, and sensory and functional tests were planned before and after surgery and after CP and IP treatment. Sample characteristics are described with descriptive statistics and comparisons of subject responses to questionnaire items at entry and postsurgical intervals were made with Fisher exact tests (alpha=.05). RESULTS: Conventional prostheses were completed in 33 of 46 subjects, and 16 of 33 CP subjects were treated with IP. Reasons for noncompletion of IP were recurrent/metastatic disease (16), refusal of implant therapy (7), lost to follow-up (4), treatment with a reconstruction plate (1), excessive radiation at implant sites (1), and death (1). All 16 recurrences/metastases occurred within 13 months of surgery. Only 3 of the 58 implants placed in 17 participants were considered failures. One failed due to lack of integration 31 weeks following placement, and 2 were buried due to unacceptable positioning for prosthetic restoration during denture fabrication. The remaining 55 implants were successful at final evaluation, ranging from 58 to 123 weeks following implant placement (mean duration=78.9 +/- 16.0 weeks). CONCLUSIONS: While 72% (33/46) of the subjects enrolled were able and willing to complete treatment with CP, only 35% (16/46) completed IP treatment. Careful consideration must be given to selection of the type of prosthetic rehabilitation and the timing of implant placement if an IP is planned.

Adult↗
PubMed2006

Masticatory and swallowing threshold performances with conventional and implant-supported prostheses after mandibular fibula free-flap reconstruction.

STATEMENT OF PROBLEM: Significant strides in microvascular surgical techniques allow predictable restoration of bony and soft tissue orofacial defects. In combination with prosthetic rehabilitation, varying degrees of improvement in esthetics, speech intelligibility, and swallowing have been noted; however, the relative impact of conventional and implant-supported prostheses on restoration of masticatory function are not known. PURPOSE: The purpose of this study was to determine whether conventional or implant-supported dental prostheses and current surgical reconstructive procedures restore patients' masticatory function to presurgical levels. MATERIAL AND METHODS: Of the 46 subjects enrolled in this study, 23 (7 edentulous and 16 partially dentate) completed conventional prosthesis (CP) treatment and masticatory evaluation, and of these, 15 (3 edentulous and 12 partially dentate) completed treatment and evaluation with an implant-supported prosthesis (IP). Standardized masticatory performance tests with peanuts and carrots as the test food were made on the defect and nondefect sides. Tests of swallowing threshold performance were made with carrots as the test food. Statistical analysis included repeated-measures analysis of variance (ANOVA) with post hoc Tukey HSD tests (alpha=.05). RESULTS: Masticatory function at entry was markedly compromised. Further performance declines were noted following surgery (PS) on both the defect and nondefect sides. Restoration with CP and IP produced improvements (significant for defect side only, P<.05) in performance over the PS interval and were not significantly different from performances at entry prior to surgery. In addition, the performance on the defect side with the IP was significantly greater than the performance with the CP (P<.001). CONCLUSION: Impairment in masticatory ability remains following free-flap reconstruction prior to prosthetic rehabilitation. Both CP and IP may provide improved masticatory ability, permitting patients to regain the functional level they possessed prior to surgical intervention. The IP may contribute to greater support and stability of the prosthesis, resulting in increased use for mastication and superior performance on the defect side compared to the CP.

Bone Transplantation↗
PubMed2002

A randomized clinical trial comparing the efficacy of mandibular implant-supported overdentures and conventional dentures in diabetic patients. Part V: food preference comparisons.

STATEMENT OF PROBLEM: The functional benefits of replacing old dentures with new conventional mandibular dentures or implant-supported overdentures has not been fully determined. PURPOSE: This study assessed the impact of these 2 types of replacement dentures on the food choices of diabetic patients. MATERIAL AND METHODS: A total of 68 diabetic patients with original complete dentures participated in this study. Diabetes was controlled with insulin in 38 patients (IT) and without insulin in 30 patients (NIT). All subjects received conventional maxillary dentures; 25 received mandibular conventional dentures (CD), and 43 received overdentures with plastic clips and a Hader bar attached to 2 osseointegrated implants (IOD). Subjects rated their perceptions of taste acceptability, texture acceptability, and chewing ease on a 4-point nominal scale and eating frequency on a 5-point scale for 13 specific foods at baseline (with original dentures) and at 6 months post-treatment completion (PTC). Fisher exact tests were used to compare the change in percentage distributions of responses with treatment. A 2 x 2 x 2 repeated-measures analysis of variance (ANOVA) was performed to compare mean scores between the 2 denture groups, 2 diabetic groups, and 2 time intervals for each of the 13 foods and 4 questions related to food acceptability. RESULTS: At baseline, no significant differences were found between the frequency distributions of responses in the CD and IOD groups or the IT and NIT groups for all 52 comparisons. With both types of study dentures, a higher percentage of patients perceived deterioration rather than improvement in function. When percentage distributions based on actual positive or negative change (treatment effect) in patient responses were compared, significant differences were found for 3 of the 52 responses, in favor of the IOD group. ANOVA demonstrated significant mean differences for 4 of the 52 comparisons. CONCLUSION: Both types of study dentures resulted in declines in the perceived taste and texture acceptability of almost all test foods. Declines in perceived chewing ease and eating frequency were more common and greater in the CD than in the IOD group. Both types of study dentures failed to affect food choices, as evidenced by declines or limited improvement in the perceived frequency with which most foods were eaten.

Aged↗
PubMedDate not supplied

Comparisons of chewing difficulty of consumed foods with mandibular conventional dentures and implant-supported overdentures in diabetic denture wearers.

PURPOSE: This study compared the chewing difficulty of foods in diets of denture wearers with mandibular conventional and implant-supported overdentures. MATERIALS AND METHODS: One-week dietary logs were evaluated for 58 subjects with controlled diabetes at baseline with their original dentures and with new dentures 6 months after treatment completion. Subjects received new maxillary and mandibular complete dentures, 21 with mandibular conventional dentures and 37 with implant-supported overdentures. A 10-point chewing difficulty rating scale (10 for most difficult-to-chew foods) was used to rate food items in the dietary logs. RESULTS: ANOVA showed no differences between the chewing difficulty mean scores for all foods consumed either at baseline or posttreatment for the two groups. However, the mean scores for the combined consumption frequency of difficult-to-chew foods (6 to 10) showed a significant decrease following treatment with both types of dentures. This decline did not differ significantly between the denture types. With original dentures, more than 91% of subjects consumed foods with chewing difficulty scores of 6 to 10 at least seven times per week. With study dentures, only 21% maintained this level of consumption, with the frequency decreasing to four to six times per week in 24% and one to three times per week in 43% of subjects. The declines in consumption frequency of more difficult to chew foods with study dentures were in a higher percentage of subjects in the implant than in the conventional group. CONCLUSION: After 7 months of adaptation to new dentures, patients consumed fewer difficult-to-chew foods than with their original dentures. This decline was more frequent with mandibular implant-supported overdentures than with conventional dentures. Dietary counseling should be considered as part of implant and complete denture therapy.

Adaptation, Physiological↗