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Combined intra and extra oral defects can be stated as those facial defects which have an intraoral communicating route. Midfacial defects are aptly classified into 2 major categories by Marunick et al. 1 as midline midfacial defects in which the nose and / or upper lip defects are included; and the second major group was lateral defects in which the cheek and orbital defects are categorized. However, defects which include combinations of the above-mentioned defects are in existence. Midfacial defects which are acquired, present themselves often with severe disfigurement of structures and hence show impaired function. It is a meticulous task to rehabilitate the defects which are caused as a result of cancerous lesion resection as they are huge. Such post resection lesions frequently are rehabilitated by a facial prosthesis to maintain function as well as the appearance in the normal form. In adjunction to the facial prosthesis, an intraoral prosthesis which constitutes of an obturator is also required to regain the natural speech and pattern of swallowing. Fabrication of such facial prosthesis not only requires the artistic capability but also excellent clinical decision making of the prosthodontist. Mode of retention of the combined prosthesis should also be kept in mind while fabricating as it is also a difficult task to retain them because of the size and weight of the same. Moreover the prosthesis should also be secured in its place with these aids which can also prove as a challenge. This case report states rehabilitating a large surgically resected midfacial defect with the assistance of a “3-piece prosthesis” which constitutes a sectional intraoral obturator along with maxillary and mandibular extraoral facial prosthesis.

IntroductionThe main purpose of the study was to assess and compare bone mineral density (BMD) at prospective implant sites in the mandible in type 2 diabetes mellitus (T2DM) and non-diabetic patients using cone beam computed tomography (CBCT). Material and methodologyA total of 40 patients were included in this type of cross-sectional study. They were divided into two groups, A and B, according to their haemoglobin A1c values. Group A consisted of patients with HbA1c between the range of 6.1%-8% and group B had patients with no history of T2DM. CBCT scans were made of the mandibular arches of both the patients to evaluate the BMD at lingual and buccal cortical plates and the trabecular regions in two successive slices with the assistance of PlanMeca Romexis software (PlanMeca Romexis®, Helsinki, Finland). The Shapiro-Wilk test was used to determine the normality of continuous data. The Mann-Whitney U test was used to compare the groups. ResultsThere were no differences that were statistically significant between the two cohorts according to the Mann-Whitney U test at buccal cortical plate points 1 and 2. However, the diabetes group's mean bone density at implant sites-A, B, C, D, and E at trabeculae points 1 and 2 was considerably (7p>0.001) lower than the nondiabetic groups. The mean bone density of the diabetes group was marginally but significantly (p=0.009) lower than the non-diabetic group at lingual cortical plates. ConclusionIndividuals with type 2 diabetes mellitus show significantly lower bone mineral density in the lingual cortical plate and trabecular region, however, implant therapy can be performed with certain mentioned guidelines in such regions. In the buccal cortical region, the bone mineral density is seen to be unaffected.

All efforts to save the natural teeth should be made during restoration to achieve optimum functionality and aesthetics. Tooth loss is associated with appetite loss and loss of nutritional values. Thus, rehabilitating complete or partial edentulous conditions contributes to improvement in the functioning of the masticatory system. In the latter case of partially dentate condition, the natural teeth present preserve the residual ridges. Extraction of teeth causes alveolar ridge resorption. Poor foundation or ridge form donot provide support for the denture bases which is the factor of utmost consideration for stabilisation of the denture bases. In these instances, use of the telescopic dentures may be indicated. A telescopic denture retains and preserves the natural teeth beneath it. Every dentist aims at preserving the natural and restoring the lost. Preservation of the remaining teeth in turn preserves the natural proprioception mechanism, was thus followed and applied in this case report in which a 25-year-old female patient with diabetic history and on medication since past four years, presented with multiple missing teeth in December 2019. After thorough evaluation, the patient was treated by Marburg double crown system or synonymously termed as telescopic denture opposing the tooth supported overdenture. Follow-up and recall schedule was then explained and operator noted a satisfactory response from the patient. Consecutive follow-ups were maintained.