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Biomedical subjects
Publications and source records attributed to Thomas J Salinas.
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Patients afflicted with congenitally missing teeth are a unique patient population for consideration of treatment with osseointegrated implants. Frequently, these patients have limited development of the alveolar process and differences in spatial position relative to the opposing arch, which places emphasis on ancillary treatment with orthodontics and oral surgery. A thorough diagnostic workup should include an interdisciplinary approach to ensure optimal treatment and timing of treatment in those who are developing. This article outlines considerations for treating these types of patients and scenarios of treatment paths frequently taken to restore the partially dentate and edentulous to esthetics and function.
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The replacement and restoration of missing single teeth with dental implants are routine procedures. However, because of the relatively short clinical history of this procedure in dentistry, custom-tailored protocols for this procedure do not exist. This article will outline the various surgical and restorative steps involved in the treatment planning, fabrication, and delivery of single-implant restoration, and will critically analyze the existing clinical concepts and provide recommendations based on a contemporary approach. As data for and experience with this procedure increase the same general guidelines for all types of implant restorations may not apply. Emphasis will be placed on differentiating between the various types of single-implant restorations, comparing and contrasting the differences between the different types of single-implant restorations, and revising some of the existing concepts of this treatment modality.
The choice to replace a single missing tooth can be based on the primary decision that the restorability of the tooth is in doubt. Many teeth are decimated by incipient or recurrent caries, trauma, endodontic complications, or periodontal disease which requires extraction. It is our objective to familiarize the participant with literature comparing success rates of fixed partial dentures and single-tooth implant restorations and a repertoire of prosthodontic techniques used in replacement of single missing teeth with osseointegrated dental implants. The fixed partial denture (FPD) has been regarded as the standard of care for some time in replacement of single and multiple missing teeth. Many studies surveying long term survival have been compiled and analyzed to arrive at a generalized outcome. Most of these studies arrive at common conclusions. Studies surveying success of single-tooth implant-supported restorations are not comparably abundant nor survey for comparable time as those for FPDs. Although, many of the outcomes are statistical survival estimates such as Kaplan-Meier survival tables, implant restorations in partially dentate patients are a predictable means of tooth replacement. There are certain factors which make FPD more appropriate and conversely factors which make an implant restoration more appropriate. Indications and contraindications for each treatment scenario will also be reviewed based on the literature and clinical experience. It is hoped that the practitioner will be able to appropriately identify those cases in which either an FPD or an implant restoration is the appropriate treatment option.
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Traditional methods of fabricating orbital prostheses rely on the "lost wax" technique to produce a realistic representation of the sculpted pattern produced in the defect. The usual constituents of the mold that reproduces the subtleties of the palpebral fissure are often minute, making them prone to fracture and subsequent dissolution by repeated attempts at pressing each prosthesis. The following method provides a mold resistant to these problems with light-polymerized resin surrounding the palpebral part of the orbital mold.
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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.
Periodontal attachment loss in the maxillary anterior region can often lead to esthetic and functional clinical problems including disproportional and elongated clinical crowns, visible interdental embrasures, and altered linguoalveolar-labiodental consonant production. Assuming fixed prosthetic reconstructions will be chosen to treat these areas, it becomes a hygienic compromise to fill these areas in with porcelain. In the presence of these problems, an acrylic resin gingival veneer is an easily constructed, inexpensive, and practical device to optimize the esthetic and functional outcome in these special situations while permitting cleansibility of the prosthesis and supporting tissues. This article presents a step-by-step technique for the fabrication of a gingival veneer.
ABM/P-15 is a combination of a natural anorganic bovine-derived hydroxyapatite matrix (ABM) and a synthetic cell-binding peptide (P- 15; PepGen P- 15) that has shown the capacity to encourage substantial clinical fill of periodontal infrabony defects. Human histology following its use has not been evaluated on pathologic root surfaces. A maxillary lateral incisor with advanced adult periodontitis that was treatment planned for extraction was treated with sulcular incisions, full-thickness flap reflection, debridement of granulomatous tissue from the defect, placement of a notch in the root at the apical extent of calculus, mechanical root planing, brief cleansing with citric acid, grafting with ABM/P-15, wound closure with sutures, and placement of a periodontal dressing. Biweekly to monthly recalls were made until removal of a small block section biopsy at about 6 months. Histologic evaluation of the region coronal to the apical edge of the calculus notch showed evidence of regeneration (new cementum, bone, and periodontal ligament). Graft particles were still present at 6 months, but no evidence of root resorption, ankylosis, or untoward inflammation was seen. This case report fulfills the proof of principle that use of ABM/P-15 can result in periodontal regeneration on previously diseased root surfaces in humans.
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