Purpose This study came to compare the results of biofeedback retraining biofeedback (BFB), botulinum toxin botulinum type A (BTX-A) injection and partial division of puborectalis (PDPR) in the treatment of anismus patients. Patients and Methods Consecutive patients treated for anismus fulfilled Rome II criteria for functional constipation at our institution were evaluated for inclusion. Participants were randomly allocated to receive BFB, BTX-A injection, and PDPR. All patients underwent anorectal manometry, balloon expulsion test, defecography, and electromyography activity of the anal sphincter. Follow up was conducted weekly in the first month then monthly for about 1 year. Study variables included clinical improvement, patient satisfaction, and objective improvement. Results Sixty patients with anismus were randomized and completed the study. The groups differed significantly regarding clinical improvement at 1 month (50% for BFB, 75%BTX-A injection, and 95% for PDPR, P=0.006) and differences persisted at 1 year (30% for BFB, 35%BTX-A injection, and 70% for PDPR, P=0.02). Constipation score of the patients significantly improved postPDPR and BTX-A injection. Manometric relaxation was achieved significantly in the three groups.Conclusion Biofeedback retraining has a limited therapeutic effect, BTX-A injection seems to be successful for temporary treatment but PDPR is found to be an effective with lower morbidity in contrast to its higher success rate in treating anismus.

Background: There are different modalities of treatment for mandibular edentulous. This study aimed to evaluate marginal bone loss in implant retained mandibular overdenture using bullard versus ball and socket abutments clinically. Methods: twelve completely edentulous patients were selected from the Outpatient Clinic of the Prosthodontic department, Minia University, and were randomly allocated to two equal groups Ball & socket and Bullard abutments mandibular overdenture. All patients received 2 implants, 3.5 mm in diameter and 10 mm in length, were inserted in canine region. In the first group, prosthesis was retained by ball and socket attachments while in the second group, prosthesis was retained by Bullard attachment. For each patient in both groups marginal bone loss was assessed clinically by periodontal probe at time of denture delivery, then six and twelve months later. Results: The results showed marginal bone loss in both groups with significant increase in ball and socket group. Conclusions: Within the limitations of this study bullard abutments had advantages over ball & socket in terms of marginal bone loss among all follow up periods.

Background: There are different modalities of treatment for mandibular edentulous. This study aimed to evaluate marginal bone loss in implant retained mandibular overdenture using bullard versus ball and socket abutments clinically. Methods: twelve completely edentulous patients were selected from the Outpatient Clinic of the Prosthodontic department, Minia University, and were randomly allocated to two equal groups Ball & socket and Bullard abutments mandibular overdenture. All patients received 2 implants, 3.5 mm in diameter and 10 mm in length, were inserted in canine region. In the first group, prosthesis was retained by ball and socket attachments while in the second group, prosthesis was retained by Bullard attachment. For each patient in both groups marginal bone loss was assessed clinically by periodontal probe at time of denture delivery, then six and twelve months later. Results: The results showed marginal bone loss in both groups with significant increase in ball and socket group. Conclusions: Within the limitations of this study bullard abutments had advantages over ball & socket in terms of marginal bone loss among all follow up periods.