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Biomedical subjects

Regina Mericske-Stern

Publications and source records attributed to Regina Mericske-Stern.

At least 19 recordsLinked to original sources
PubMed2006

Reconstruction of the severely atrophic mandible using calvarial split bone grafts for implant-supported oral rehabilitation.

OBJECTIVES: This article describes reconstruction of the severely atrophic mandible using calvarial bone grafts for implant-supported prosthetic oral rehabilitation. The study aim was to evaluate the efficacy of the treatment by determining implant survival and complication rates, and the extent of the postoperative graft resorption. STUDY DESIGN: Ten patients who underwent the treatment were followed clinically and radiologically using panoramic radiographs and CT scans during a mean postoperative period of 30 months. RESULTS: Good bone healing was observable 6 months postoperatively. The height reduction measured on panoramic radiographs was insignificant (mean 0.68 mm). Only minor complications occurred. Implant survival was 95%. Prosthodontic treatment was successfully performed in all cases, resulting in an improvement of oral function. Histological analysis of 1 bone biopsy showed minimal resorptive changes in otherwise very dense bone. CONCLUSION: Augmentation using calvarial grafts is a promising treatment alternative for the severely atrophic mandible.

Aged↗
PubMed2006

[Rehabilitation of an abraded occlusion with Procera-ZrO2 all-ceramic crowns. A case report].

The rehabilitation of a patient with advanced tooth wear by means of Procera ZrO2 ceramic crowns is described. A healthy, 60 year old patient complained about front teeth esthetics and impaired function due to reduced tooth height. He was aware of bruxism and wished full mouth rehabilitation. The clinical examination showed that tooth wear was generalized, but most teeth could be maintained in both jaws. A staged procedure was planned, starting with a splint therapy and a provisional fixed prosthesis to reestablish correct vertical dimension of occlusion (VDO) and stable occlusal contacts. The new ZrO2 material with the Procera technique was chosen to restore all teeth in both jaws, except the mandible front teeth. In the second treatment phase, crown lengthening of the maxillary front teeth was performed and one implant placed to replace a maxillary premolar. After final tooth preparation, impression taking and bite registration the ZrO2 crown-copings were scanned, processed and completed by veneering. A flat occlusal scheme with stable front teeth guidance was established. The advantage of the presented treatment is the esthetic result in combination with a material of high mechanical and biological quality.

Bruxism↗
PubMed2006

[The SPI implant system: clinical experience and one-year results].

The new Swiss implant system SPI became available three years ago and is used in combination with fixed and removable prosthetic reconstructions. In a pilot study the clinical procedures were evaluated and data of prosthetic complications of maintenance service were collected. 25 patients participated in the study with a total of 79 SPI implants during the time period from 2003-2004. 37 implants were located in the maxilla and 42 implants in the mandible. Two implants failed during the healing period, but no loaded implant was lost. Thus, the survival rate was 97.5% (77/79). 44 implants supported a fixed prosthesis, including nine single crowns and 33 implants were used in combination with removable partial denture. Four implants were used with ball anchor retention, 29 with bar support. The ELEMENT implant with the low implant shoulder allows very good esthetics. Prosthetic complications and maintenance service during the first year of function was comparable with other implant systems. Since the design of the abutment screws, healing caps and screwdriver was changed, the system has become easier in its application.

Crowns↗
PubMed2006

[Anterior teeth esthetics with the SPI implant system].

Replacement of maxillary front teeth with a fixed, implant supported partial denture with a high laugh line is a demanding procedure. For an optimal esthetic result, no deficiency of bone or soft tissue is acceptable. Submerged implant healing has often been recommended for better predictability in esthetically demanding situations. This case report shows the rehabilitation with a fixed implant supported reconstruction in the upper front and a single implant supported crown in the premolar region. Teeth had to be extracted because of apical lesions, periodontal the gingiva. The technique of delayed, submerged implant placement in the region of 11, 21 and 22 was applied and in the region of 15 a transmucosal implant healing. With a fixed, implant supported partial denture the mucosa in the upper front was conditioned. Ten months after implantation the definitive screwed, fixed partial denture on SPI ELEMENT implants was successfully integrated. In the region 15 a single crown transversally screwed was fixed on a SPI ONE TIME implant. Radiographic data two years after implantation showed a well established periimplant crestal bone level. No prosthetic complications had occurred since the insertion of the reconstruction twelve months ago.

Crowns↗
PubMed2006

Transcrestal sinus floor elevation: report of a case series.

The technique of the osteotome-mediated transcrestal sinus floor elevation is described in a series of case reports. Fifty-five patients received a total of 66 implants over a period of 6 years. Bio-Oss was added in more than 60% of cases to increase the stability of the lifted area. The surgical procedure appeared to be a safe method that was well supported by the patients. It was applied for different prosthetic indications in partially and completely edentulous situations. The survival rate of the implants during the healing phase was 98.5%, and it was 100% after loading. The patients' responses to the Summers technique were evaluated by means of short interviews and visual analog scales (VAS), and the answers were compared with those from a group of patients who had received implants in the same location during the same period but without the osteotome technique. The answers regarding pain were not different between the groups. However, significantly more patients who had received the implants by means of the osteotome technique judged the surgical procedure as highly uncomfortable. It is concluded that patients need to be well prepared for the procedure.

Adult↗
PubMed2006

[Implant-supported bridges in the edentulous jaw. Clinical aspects of a simple treatment concept].

Clinical aspects of a simple treatment concept with fixed prostheses in the edentulous jaw are described. Fixed implant-supported reconstructions in the edentulous jaw require multiple implants, are technically complex, aesthetically demanding and metal-ceramic solutions are expensive. Specific surgical techniques to enhance the hard and soft tissue conditions become often necessary. Thus the bar-supported overdenture may be preferred, because problems with aesthetics and alveolar ridge deficiencies can be solved more easily and the number of implants is reduced. Both, the "All-on-Four" technique and the "Procera implant bridge" are simple type of fixed prostheses, comparable to overdentures or complete dentures with regard to design and technology. They present a cost-effective alternative, with predictable aesthetics and optimum passive fit.

Acrylic Resins↗
PubMed2006

Specialisation and specialist education in prosthetic dentistry in Europe.

This presentation reports on the results of a meeting of prosthodontists from selected European countries. The aim of the meeting was to analyse and promote specialisation and specialist education in Prosthetic Dentistry in Europe. Representatives for Europe were selected from the European Prosthodontic Association (EPA) board, the Education and Research Committee of International College of Prosthodontists (ICP), countries with a legally recognised speciality, countries without a recognised speciality but organised training programmes and countries with neither of these situations. Data about specialisation and specialist training in Prosthodontics in Europe was scrutinised and discussed. The programmes for countries with specialist training had relatively similar content, mostly of three years duration. There was strong agreement that a recognised speciality raises the level of care within the discipline for both specialists and non-specialists. In several of the countries where a speciality had been introduced it had been initiated by pressure from public health planning authorities. The conclusions are that from a professional viewpoint an advancement of the speciality over Europe would develop the discipline, improve oral health planning and quality of patient care. A working group for harmonisation was recommended.

Education, Dental, Graduate↗
PubMed2005

Oral rehabilitation after mandibular reconstruction using an osteocutaneous fibula free flap with endosseous implants. Factors affecting the functional outcome in patients with oral cancer.

BACKGROUND: The development of endosseous implants and free vascularized bone grafting has permitted increased possibilities of oromandibular reconstruction in patients with oral cancer. In this study, a concept combining surgical and prosthodontic treatments for mandibular fibula free flap reconstruction after tumor surgery was made based on a classification of bone defects. A follow-up study was performed to evaluate the treatment concept for oral rehabilitation in order to identify possible factors which may influence the functional result. MATERIAL AND METHODS: A follow-up examination included 28 patients who underwent the ablative tumor surgery and mandibular reconstruction during a 4-year period. The follow-up protocol included clinical examination, radiological evaluation, and an interview using a standardized questionnaire. The timing of the study was set to allow for a minimum 2-year follow-up (mean 45 months). RESULTS AND CONCLUSION: At the time of examination, prosthesis-based oral rehabilitation was completed in six patients (21%), and the prosthodontic work was still unfinished in four other patients. The other 18 had no dental prosthetic rehabilitation. Thirteen patients received a total of 37 oral implants, and 23 implants were functionally loaded. No implant loss was recorded. Oral functions such as speech, diet tolerance and oral competence were not directly affected by the presence of dentures. A decisive factor affecting the oral function was the extent of soft-tissue loss. According to the classification described here, the extent of the mandibular defect did not correlate with oral functions. The application of oral implants seemed to be advantageous for the oral rehabilitation of patients who had undergone intraoral resections.

Bone Transplantation↗
PubMed2005

Radiographic analysis of the transcrestal sinus floor elevation: short-term observations.

BACKGROUND: There are some limitations for implant placement in the posterior maxilla when there is an extended sinus. Various techniques for sinus floor elevation allow an increase in implant length. PURPOSE: The aim of the present radiographic study was to assess the augmented site in the sinus around implants that were installed by means of an osteotome-mediated transcrestal sinus floor elevation. MATERIALS AND METHODS: Thirty-three patients with 44 implants were available. In 39% of the implants the sinus floor elevation was performed exclusively with bone chips. Bone fill material (Bio-Oss, Geistlich Söhne AG, Wolhusen, Switzerland) was additionally used to increase the volume and stability of the lifted area at 61% of the implants. The visibility and morphology of the augmentation were assessed and compared by means of intraoral radiography (long-cone technique). RESULTS: All implants were stable and were considered to be successful when they were reexamined in the context of the present study. The mean residual bone height was 5.78 +/- 1.4 mm. The increase of the implant length as compared to the original bone height resulted in a mean value of 3.87 +/- 2.0 mm. The volume and density of the lifted area were more visible if Bio-Oss was added. A shrinkage and/or condensation of the grafted material was visible at 37% of the implants after a minimum loaded period of 200 days. Equally, a decreased visibility of the original sinus floor was noted at 61% of implants. The formation of a cortical bone layer at the apex of the implants was detected at 35% of implants. CONCLUSIONS: The surgical procedure appears to be a safe method with rare complications. Radiographic assessment of the augmentation procedure proved to be difficult, and measurements are not fully reliable.

Bone Regeneration↗
PubMed2005

Detection and measurements of soluble intercellular adhesion molecules at implants and teeth: a comparative study.

BACKGROUND: Adhesion molecules on endothelial cells and in the periodontal tissues control the immigration and retention of cells. The level of soluble intercellular adhesion molecules (sICAMs) has been used as a marker of the severity and/or extent of the inflammatory process in a wide range of pathologies, including periodontitis. PURPOSE: This study was designed to detect and compare sICAM-1 at teeth and implants in relation to clinical periodontal and periimplant parameters. METHOD: Regular recall patients with (1) implants and teeth, (2) implants, and (3) teeth were examined. Samples of sulcus fluid were collected from teeth and implants. The concentration of sICAM-1 was measured by enzyme-linked immunoabsorbent assay. Periodontal parameters were recorded after sampling. RESULTS: The range of measured sICAM-1 was large (from below 100 to 1,200 ng/mL). The concentration of sICAM-1 was not different for teeth and implants but was significantly elevated in sites with positive bleeding on probing (BoP), namely, 571 ng/mL at teeth and 529 ng/mL at implants compared with 150 ng/mL and 169 ng/mL, respectively, with negative BoP. The regression analysis showed that the concentration of sICAM-1 was highly associated with positive BoP but was not dependent on the fluid volume. CONCLUSIONS: A similarity of the sulcus fluid at teeth and implants was observed with regard to the detection of sICAM-1.

Adult↗
PubMed2004

Extensive augmentation of the alveolar ridge using autogenous calvarial split bone grafts for dental rehabilitation.

Free autogenous iliac bone is the most commonly used graft material for an extensive alveolar ridge reconstruction. The application of iliac bone, however, is associated with problems, such as transplant loss resulting from postoperative infection and late bone resorption. A bone-graft material more suitable than iliac bone is therefore still needed. This paper describes a concept for alveolar-ridge reconstruction using calvarial split bone, and the related surgical techniques. Clinical and radiological follow-up examinations were undertaken to evaluate the potential benefit of calvarial split bone in alveolar-ridge reconstruction. Between 1999 and 2002, 13 patients with a mean age of 54 years (range 31-70 years) underwent surgery, seven patients in the maxilla and six in the mandible. In four cases, wound dehiscence occurred postoperatively. In one of these cases, the dehiscence was associated with a local infection. However, no bone transplants were lost. After a mean follow-up time of 19.6 months, bone resorption, measured radiologically, was minimal. Endosseous dental implants were successfully installed and maintained. Satisfactory prosthetic rehabilitation was achieved in all patients. Our preliminary experience suggests that calvarial split bone may be regarded as a promising alternative to autogenous iliac bone in connection with extensive augmentation of the alveolar ridge.

Adult↗
PubMed2004

[Limits of total prostheses in resected patients. Case report].

The prosthetic treatment of patients with oral defects after tumor resection by means of complete dentures is demanding and difficult. In the past various surgical procedures were performed for corrections of the alveolar ridges and defects, with unpredictable results and poor prognosis. The intraoral situation often resulted in difficulties of wearing complete dentures. Nowadays oral implants offer better treatment possibilities to these patients with compromised oral structures. Due to the specific anatomical conditions standardized treatment modalities and procedures are sparse and not documented. Individual treatment planning along with the use of implants may favor a positive treatment outcome of the prosthetic reconstruction, providing satisfactory function. On the basis of a case report the authors present the implant prosthodontic reconstruction of a patient who was unable to wear a complete denture after a partial resection of the maxilla due to an oral tumor.

Aged↗
PubMed2004

[Implant prosthesis rehabilitation after maxillofacial injuries--case report].

The dental and oral rehabilitation of patients with severe trauma that involves the oral cavity is demanding and challenging. Recently, advanced surgical techniques and innovations in oral implantology led to more sophisticated treatment modalities that may better fulfill the patients needs in special situations. Young people rather often suffer from accidents--at school and during leisure activities--in a period of their life that has a great impact on their physical, mental and personal development. Thus, the wish for a quick functional and esthetical rehabilitation contrasts with the complex clinical situation and the compromised oral conditions. All persons involved in the rehabilitation process--including the patient--must seek for the best solution that takes into account treatment time, invasivity of procedures and patients morbidity. Further, it is also observed that insurances very much stress the reduction of cost and the simplicity of treatment. This will also influence the treatment planning and the sequence of the procedures as shown by the following case.

Accidental Falls↗
PubMed2003

[Prosthetic rehabilitation in ectodermal dysplasia. Case report].

The oral and dental rehabilitation of patients with ectodermal dysplasia is a demanding and complex process. Close cooperation of medical and dental specialists is is mandatory. The individual age related situation and aspects of social integration have to be considered, when doing treatment planning for these patients. A major problem is the highly reduced number of teeth, the impaired development of the jaws and the dysplastic alteration of the teeth. The prosthodontic rehabilitation of a young girl with the congenital disease of ectodermal dysplasia is presented and discussed.

Adult↗
PubMed2002

Retention mechanisms and prosthetic complications of implant-supported mandibular overdentures: long-term results.

BACKGROUND: Although many studies report high survival rates of mandibular implants supporting an overdenture, complications with prostheses and the need for prosthetic maintenance are not so well documented. PURPOSE: The purpose of the present study was to analyze three categories of prosthetic complications in relation to the type of retention mechanism for overdenture connection to the implants (ie, rigid or resilient). MATERIALS AND METHODS: One hundred nineteen patients with a total of 258 implants participated in the study. They had been monitored regularly during an observation period of 5 to 15 years (mean 9.3 yr). Seventy-five patients had a resilient retention device (ball anchors or a round clip bar); 44 patients had a rigid bar with or without distal extensions. The incidence and rate of complications were calculated for the overall- and for the 2- and 5-year observation periods. Comparisons were made between the three categories of maintenance and the two types of retention. A Kaplan-Meier analysis was applied for calculations of changes of the retention mechanism. RESULTS: The mean number of complications per overdenture during the entire observation period was 3.5; this did not differ statistically between the two retention groups. Some significant differences were found only for the 2- and 5- year period. Broken, loose, or lost female parts were more frequently observed with resilient devices, as were repairs and relining of the resin denture base, whereas tightening of bar retainers was more typical with rigid bars. A change from a resilient retention device to a rigid bar was performed more often than vice versa but not at a statistically significant level. CONCLUSION: Although these long-term results do not indicate a significant difference between the retention groups, a slight superiority of the rigid bar is suggested.

Adult↗
PubMedDate not supplied

A follow-up study of maxillary implants supporting an overdenture: clinical and radiographic results.

PURPOSE: Studies of maxillary overdentures supported by endosseous implants often show a high implant failure rate. The aim of the present investigation was to evaluate clinically and radiographically non-submerged implants supporting an overdenture in the maxilla. MATERIALS AND METHODS: Forty-one patients were consecutively admitted for treatment. The standard procedure was to place 4 implants and to mount a U-shaped bar for overdenture connection. When the overdenture was delivered to the patients, peri-implant parameters were recorded and radiographs were taken. All patients were required to follow a maintenance care program. In the context of this study, all patients were clinically examined and the peri-implant parameters were compared. Crestal bone loss was analyzed using linear radiographic measurements. A life table analysis was applied to calculate the cumulative survival rate (CSR). RESULTS: Three implants failed in the early healing phase, and 3 patients lost 6 implants during the loading period. The 5-year CSR of all implants was 94.2%. The peri-implant parameters gave evidence of healthy soft tissues and good oral hygiene. The increases in probing depths and attachment loss were significant (P < .05). The mean marginal crestal bone loss was about 0.7 mm and was statistically significant at mesial and distal sites (P < .001). DISCUSSION: The correlation between clinical attachment loss and crestal bone loss was not significant. Pronounced marginal bone loss was found around some implants. CONCLUSION: In planned maxillary overdenture treatment, it is possible to achieve a satisfactory survival rate of the implants.

Adult↗
PubMedDate not supplied

Clinical evaluation of small-diameter ITI implants: a prospective study.

PURPOSE: Dental implants with a reduced diameter are designed for specific clinical situations, such as placement of implants where bone width is narrow or between adjacent teeth that have only a narrow space between them. They are particularly useful when replacing small teeth such as lateral maxillary and mandibular incisors. The aim of the present study was the clinical evaluation of 2-part ITI implants (full-body screws with a 3.3-mm diameter). MATERIALS AND METHODS: One hundred forty-nine partially or completely edentulous patients received a total of 298 2-part ITI implants over a 10-year period. After a standard healing period (3 to 6 months), the implants were restored with fixed restorations such as single crowns or fixed partial or complete prostheses or overdentures. Complete prosthesis or overdenture in the edentulous jaw was the predominant type of restoration. All patients followed a strict maintenance program, with regular recalls at least once a year. The survival rate of the implants was analyzed, and prosthetic complications were assessed. RESULTS: Three implants were lost during the healing phase on account of peri-implant infection. Two implant body fractures with an osseous length of 8 mm were observed (one after 2 years of observation, the other after 6 years). Four implants exhibited transient peri-implant inflammation that was treated successfully by interceptive therapy. The cumulative 5-year survival rate of the implants was 98.7% (96.6% after 6 years). Prosthetic complications were mostly limited to loose occlusal screws and sore spots caused by the denture base. DISCUSSION: Within the limited observation period, failures of small-diameter implants were infrequent. Prosthetic complications were not dependent on the use of small-diameter implants. CONCLUSION: The use of 3.3-mm ITI implants appears to be predictable if clinical guidelines are followed and appropriate prosthetic restorations are provided. However, fatigue fracture may occur after a long period of function.

Adult↗