Biomedical subjects
Publications and source records attributed to Sheldon Winkler.
A case history is presented of a patient who fabricated 3 prostheses from autopolymerizing acrylic resin intended for fingernail augmentation and then cemented them into her mouth with super glue. Patients must be warned not to attempt self-treatment for esthetics with self-fabricated prostheses because severe adverse and irreversible hard and soft tissue reactions may occur.
Dental students achieved a high identification rate for darker shades (P14 and P24) on the Portrait IPN shade guide, which represent the highest chroma and lowest value in the grayish and reddish yellow hue groups. A high identification rate was also obtained for P32, representing the lowest chroma and highest value in the reddish gray hue group. The data suggest that dental students had the most difficulty determining the correct hue group for unmarked shade tabs. Incorrect responses tended to remain in the same value and chroma range but were selected in a different hue group.
A procedure is described for conversion of an existing removable partial denture into a complete denture using autopolymerizing tooth-colored acrylic resin, acrylic resin denture repair material, and a clear matrix template. The shape, color, and position of the lost natural teeth may be duplicated in the transitional denture, minimizing the psychological concerns of the patient regarding esthetics and social impact. Because the patient is never without teeth, an appropriate healing time can occur before fabrication of the definitive prosthesis.
Although Dr Milus M. House is credited with devising a method to describe the mental classification of complete denture patients, a review of the literature raises questions regarding the origin of the system. Dr Ewell Neil should have received credit for developing the classification system attributed to Dr House. The contribution of Dr House appears to be a detailed expansion of the classification and the subsequent popularization of the system.
Masticatory forces cause fatigue to cement-retained crowns and abutments and may adversely effect retention. The relation between the number of load cycles and the retentive forces is important. This study evaluated the effect of compressive cyclic loading on the retentive forces of a temporary cement used to retain implant crowns and the relationship between load cycles and retentive forces. Ten castings and implant abutments were cemented with zinc oxide-eugenol temporary cement. The retentive force necessary to dislodge the casting from the abutment was determined before and after the application of 2 Hz of vertical off-axis 3-mm sinusoidal-type compressive cyclic loading between 20 and 130 N for 500000, 1000000, and 5000000 cycles. These forces were equivalent to approximately 6 months, 1 year, and 5 years of human mastication. Data before and after the applied loading were analyzed with a paired sample t test (alpha = 0.05). The retentive forces of the 3 groups were analyzed by 1-way analysis of variance and post hoc by Scheffé multiple comparison (alpha = 0.05). The relation of the loading and the altered retentive forces were analyzed with the Pearson correlation coefficient. Compressive cyclic loading reduced the retentive forces significantly in all groups (P = .000). The retentive forces were reduced 16.75%, 18.73%, and 19.68% during the applied loading cycles of 500000, 1000000, and 5000000. All reduced retentive forces were not significantly different (P = .792). Although cyclic loading reduced the retentive forces, the increased cycles had little relationship (R = 0.119) to the decreased retentive forces of the temporary cement. The relationship between occlusal loading and retentive force can influence the choice of a temporary cement for a particular clinical situation.
An interim denture technique is presented describing the fabrication of an esthetic prosthesis that is used for short periods of time. The prosthesis conditions the patient for the acceptance of an artificial substitute for missing natural teeth until more definitive prosthodontic therapy can be provided. All the teeth in the arch are extracted simultaneously, and the interim prosthesis is inserted immediately thereafter. The prosthesis duplicates the morphology, color, and position of the extracted teeth. This technique satisfies a great need of socially and business-active patients because there is no interruption in their activities and no change in facial esthetics. Two case histories are presented.
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PROBLEM: Repetitive microstrains, which occur at the bone-implant interface during function, can lead to implant loss. In an attempt to improve survival by directing the stresses during function away from the dense cortical bone and toward the resilient trabecular bone, the Ankylos implant was developed with a roughened, progressive thread and a smooth cervical collar. The highly polished collar reduces the stresses in areas of the crestal bone. A precisely machined Morse taper prevents rotation of the abutment on the implant and eliminates the microgap present in many 2-stage implant systems. Clinical studies of other implants at different clinical research centers have demonstrated varying degrees of survival. PURPOSE: The purpose of this paper was (1) to assess the overall clinical survival of this new implant design and (2) to compare implant stability (ie, Periotest values [PTVs]) over time with other implants. METHOD: The investigation represented a comprehensive, multicentered, international clinical study conducted over a period of 6 years. It was conducted under an Investigational Device Exemption (IDE) protocol that was reviewed and accepted in the United States by the Food and Drug Administration (FDA). Over 1500 implants were placed and restored, and follow-up data were gathered for a period of up to 3 to 5 years. RESULTS: Over 44% of the clinical research centers reported no failures (100% survival). A total of 63% of the centers had none or only 1 failure during the study. One center reported 6 failures in 1 patient, which were not related to the implant design. Overall survival for implants in function for 3 to 5 years was 97.5%. Using failure criteria of earlier studies of other implants, 5-year survival was 98.3%. Higher handpiece speeds were associated with an increase in the number of failures. This new design produced a slightly more resilient trabecular bone-implant complex with a difference of about 1 PTV in all bone densities when compared with other implants. CONCLUSIONS: The following conclusions can be made: (1) the implant design was effective under all clinical conditions; (2) no significant and unexpected complications or risk factors were evident; (3) survival was found to be excellent; and (4) this implant is well suited for use in the restoration of masticatory function and esthetics in patients with missing natural teeth.
One of the most serious and prevalent problems associated with the restorative aspect of dental implants is loosening and fracturing of screws. Implant screws should be retightened 10 minutes after the initial torque application as a routine clinical procedure to help compensate for the settling effect. Mechanical torque gauges should be used instead of hand drivers to ensure consistent tightening of implant components to torque values recommended by implant manufacturers.
The lower labial bar is rarely indicated as a major connector for a removable partial denture. It can be used satisfactorily when large mandibular tori interfere with conventional lingual bar placement or when the lower teeth are severely lingually tipped and placement of a lingual bar is not possible.
This article describes how a man attempted to repair damage to his maxillary teeth with super glue. Such action is discouraged, however, because of possible adverse reactions in the hard and soft tissues.
The purpose of this study was to determine whether varying the preload on the implant-abutment complex would affect screw loosening under simulated loading conditions. Abutment screws in sample models were tightened to 25, 30, 35, and 40 N-cm. One group of samples was allowed to stand for 3 hours after being torqued and then loosened. Another group of samples was retorqued after 10 minutes with the same initial torque value and then allowed to stand for 3 hours before loosening. For the load group of samples, the abutments were torqued into place, retorqued after 10 minutes, and a load applied for 3 hours before loosening. Cyclic loading was carried out using a servo-hydraulic testing machine with the values cycled between 1 and 26 pounds and the load applied directly to the abutments. Analysis of variance, analysis of covariance, and linear regression analysis was performed. Within the parameters of this in vitro investigation, the following recommendations can be made: (1) retightening abutment screws 10 minutes after the initial torque applications should be routinely performed and (2) increasing the torque value for abutment screws above 30 N-cm can be beneficial for abutment-implant stability and to decrease screw loosening.
The O-ring is used to increase retention of implant complete and partial overdenture prostheses. They possess a number of advantages, including ease of use and maintenance, low cost, and possible elimination of a superstructure bar. O-rings wear over time, gradually lose retention, and must be replaced periodically. It is essential that O-ring abutments be parallel to each other. Two cases are presented showing the use of O-rings with a complete mandibular implant overdenture and a maxillary removable partial denture.
The introduction of intraoral endosseous implants was inevitably followed by their external use in maxillofacial prosthodontics. Bar and clip attachments provide satisfactory retention for auricular prostheses, although the bar may inhibit patient hygiene by limiting access to the defect area. A simple clinical and laboratory technique to enhance the retention of an implant-retained auricular prosthesis is described, with custom-made stud attachments used for retention. Improved access for hygiene is provided. A clinical case is presented.
Resorption of the alveolar ridges after tooth extraction can mandate site development (preparation) by augmentation, grafting, or both before implants can be placed. The fabrication of successful implant prostheses generally can be accomplished only if the artificial teeth are placed in the same position as was occupied by the natural teeth they are replacing. A knowledge of resorption patterns is necessary for satisfactory implant placement.