Patel, Nupur
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Publication Bond Strength of Different Self-Adhesive Resin Cements to Zirconia(2021-06-30) Patel, Nupur; Anadioti, Eva; Conejo, Julial; Ozer, Fusun; Mante, Francis; Blatz, MarkusObjectives: The purpose of the study was to compare the shear bond strength of five self-adhesive resin cements used to bond zirconia. Methods: Seventy-two KATANA Zirconia STML (n=12) specimens were sectioned and sintered in an induction furnace (CEREC SpeedFire, Dentsply Sirona, Germany). Specimen surfaces were ground finished with 800 grit silicon carbide abrasive with cooling water and cleaned with ultrasonication in alcohol. Specimens were air-particle abraded with 50 μm aluminum oxide at 2.8 bar pressure. Cylindrical composite resin specimens (2.1 mm in diameter, 3 mm in height) were bonded to the zirconia samples with self-adhesive resin cements Panavia SA Universal (PSA), TheraCem (TCM), SpeedCem 2.0 (SCM), RelyX Unicem 2 (RCM), PermaCem 2.0 (PCM) and dual-cure multi-step composite resin cement Panavia V5 (control, PV5, after application of ceramic primer) following manufacturers’ instructions. A load of 1000 g was applied to the composite cylinders during bonding in an alignment apparatus, then light cured for 80 s. Samples were stored in distilled water at 37° C for 24 h, then subjected to 10,000 thermal cycles. Shear bond strength was determined using a universal testing machine at a crosshead speed of 0.5 mm/min expressed in MPa. The fractured surfaces of specimens were inspected with a stereo microscope and classified as 8 adhesive, cohesive, or mixed failures. One-way ANOVA test and Tukey test were applied for statistical analysis. Results: Shear bond strength values [MPa] were for PSA 8.64 (1.78 SD), TCM 9.05 (2.64 SD), SCM 8.54 (1.92 SD), RCM 7.60 (1.26 SD), PMC 7.59 (1.10 SD) and PV5 9.59 (1.55 SD). One-way ANOVA test revealed no statistically significant differences in shear bond strength between the resin cements tested (p>0.05). Pair wise comparison using Tukey test revealed that the shear bond strength using RCM was statistically lower than that using PV5 (p<0.05). Conclusions: According to the results of this in vitro study, self-adhesive resin cements can achieve shear bond strengths to zirconia that are comparable multi-step resin cements. In routine clinical application, self-adhesive resin cements can be a user- friendly, less technique sensitive alternative for bonding Zirconia restorations following the APC concept.Publication Comprehensive Evaluation and Optimization of Maxillofacial Reconstruction Techniques: Integrating 'Jaw in a Day' Procedure and Fibula Free Flap Surgical Reconstruction(2025-05-19) Diana Heeryang Joo; Chang, Brian Myungwoo; Patel, Nupur; Panchal, Neeraj; Huh, Yoon-HyukBackground: Jaw-in-a-Day (JIAD) procedures with fibula free flap (FFF) reconstruction offer immediate aesthetic and functional rehabilitation for maxillofacial defects. However, postoperative trismus and prosthetic complications remain common, particularly in patients undergoing radiation therapy. This study investigated key anatomical and therapeutic predictors of trismus and their implications for prosthetic planning in JIAD cases. Methods: A mixed-methods design was utilized, comprising (1) a systematic review of trismus in head and neck cancer patients, (2) a retrospective CBCT morphometric analysis of mandibular anatomy, and (3) a prospective clinical cohort study comparing trismus severity among control, FFF-only, and FFF with radiation therapy (FFF+RT) groups. The systematic review was registered in PROSPERO (CRD420250651084) and conducted per PRISMA guidelines. Both CBCT and clinical components received IRB approval from the University of Pennsylvania. Results: The review identified radiation dose—particularly >50 Gy to masticatory muscles—as a major risk factor, with trismus incidence peaking around six months post-treatment. IMRT was associated with lower trismus rates than conventional RT, and structured jaw exercises showed preventive benefits. Clinical data confirmed significantly reduced jaw mobility in the FFF+RT group. CBCT analysis revealed consistent mandibular dimensions, supporting prosthesis height estimation and surgical planning. Finger-width assessments correlated strongly with objective measurements. Conclusion: Trismus risk in JIAD patients is driven by radiation exposure, anatomical variation, and reconstructive technique. Integrating morphometric analysis, functional screening, and preventive strategies into treatment planning may improve long-term outcomes. These findings underscore the importance of individualized, interdisciplinary approaches in optimizing complex jaw reconstruction.Publication Investigating the maximum bite force and speech intelligence in patients requiring prosthetic rehabilitation(2025-06-13) Gupta, Aditi; Patel, Nupur; Lee, Jason D; Mante, Francis K.; Chang, Brian MObjective: Tooth loss leads to reduced occlusal contact area, altered jaw biomechanics, and diminished neuromuscular coordination, impairing both masticatory function and speech clarity. Edentulous patients often adapt by modifying food choices or swallowing behavior and may experience persistent phonetic disturbances. Maximum bite force is a validated measure of masticatory system performance, while speech intelligibility reflects the functional integration of a prosthesis within the oral cavity. This study aimed to objectively evaluate maximum bite force and speech intelligence among completely edentulous patients rehabilitated with different types of dental prostheses, compared to individuals with full natural dentition. Methods: A cross-sectional study was conducted with 60 participants divided into six groups: **(A)** Hybrid Prosthesis (at least one arch) **(B)** Implant-Retained Overdentures (IROD) in both arches **(C)** Maxillary Complete Removable Dental Prosthesis (CRDP) with Mandibular IROD **(D)** Implant Bar-Supported Prosthesis (at least one arch) **(E)** Maxillary and Mandibular CRDP **(F)** Full Natural Dentition (control group) IRB approval (Protocol #857207) and informed consent were obtained. Maximum bite force was recorded using a bilateral molar bite force transducer. Participants performed three maximal-effort bites per side; total and unilateral bite force data were analyzed. Speech intelligence was evaluated using a standardized dental articulation passage. A speech intelligibility scorer calculated the percentage of recognized words, averaged across three trials. Results: Group F (Full Natural Dentition) exhibited the highest mean bite force (752.03 N), followed by Groups A (522.97 N), B (294.12 N), C (174.23 N), D (162.17 N), and E (72.13 N). Fold increases over Group E (complete dentures) were 10.4× (F), 7.3× (A), 4× (B), 2.4× (C), and 2.25× (D). Repeated-measures ANOVA confirmed that total bite force was significantly higher than unilateral values (1.5–1.8× greater). Males had significantly higher bite force than females (p < 0.01). Speech intelligibility scores followed a similar gradient. Group F had the highest score (85.67%), followed by Groups A (70.13%), D (62.73%), C (58.17%), B (56.52%), and E (54.63%). Statistically significant differences were observed between Group E and Groups B, C, and D (p < 0.005). Fixed prostheses (Groups A and D) outperformed removable designs (Groups B, C, and E) in both bite force and speech performance. The superior speech outcomes associated with fixed prostheses are likely due to greater palatal stability and optimized tongue space. No gender-based differences were observed for speech scores. Correlation analysis revealed moderate positive relationships between bite force and speech intelligence across prosthetic groups. Stronger masticatory capacity was associated with improved phonetic clarity in fixed and implant-retained prosthesis users, whereas weaker bite forces in complete denture users correlated with reduced intelligibility. Conclusion: This study underscores the importance of assessing both masticatory and phonetic outcomes in prosthodontic rehabilitation. The findings establish a functional gradient of bite force across prosthetic designs: **Full Natural Dentition > Hybrid Prosthesis > IROD > Bar-Supported Prosthesis > CRDP + Mandibular IROD > CRDP.** Complete removable dental prosthesis exhibited only one-tenth the bite force of full natural dentition. Masticatory function improved 2.4× with a mandibular IROD, 4× with IROD in both arches, and 7.3× with a hybrid prosthesis. Fixed prostheses also yielded higher speech intelligibility, attributed to improved tongue space and palatal contours. While gender influenced bite force, it had no effect on speech. Bite force transducers and intelligibility scorers offer practical, objective tools to guide treatment planning, monitor rehabilitation success, and support evidence-based prosthodontic care.