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The various proposed etiologies for root intrusion in tooth-implant combination cases are discussed. Clinical examples of root intrusion are illustrated. Advantages and disadvantages of nonrigid connector and coping/suprastructure techniques are presented.
Rapid, accurate seating of screw-retained implant abutment heads, where timing is controlled by internal or external hex designs, can be readily accomplished with individual, custom-cast abutment head location devices. The devices are especially useful when the abutment head-implant body complex is to be permanently cemented. The use and design of abutment seating jigs for single tooth implants and completely implant or implant and natural tooth-supported prostheses are described.
Once the decision has been made to construct a maxillary implant-supported overdenture prosthesis, implant location and number are important determining factors for palatal design. Eight clinical scenarios are described. Four cases require full palatal coverage, and four cases permit modified palatal coverage. Only two, with an increased number of implants and more posterior locations, permit a completely open palatal design similar to fixed prostheses.
A stable occlusal plane is achieved with the combination of two maxillary, implant-supported milled bars securing an overdenture and bilateral, mandibular-fixed partial dentures. Overdenture retention is enhanced with attachments. Guide planes assure proper alignment of the overdenture for easy patient insertion and improved prosthesis stability. A reliable technique for verifying the accuracy of the master cast is also presented.
Functional stability and the preservation of remaining alveolar bone are primary, and often elusive, goals when restoring the partially edentulous arch. The incorporation of dental implants for the partial support of removable prostheses offers a practical adjunct in the fulfillment of these objectives. Planning for complex courses of treatment that include dental implants requires close coordination between the surgeon and the restorative dentist. Decisions that deal with type, location, size, number of implant fixtures, and design of the prosthesis are critical. All of these areas must be discussed and established as acceptable to the patient and each clinician before the initiation of treatment. In this report, we present a course of patient treatment in which a removable partial denture is supported by natural remaining teeth in conjunction with osseointegrated implants.
This article reviews the development of staple bone plates for mandibular reconstruction over the past 25 years. A case study utilizing the Smooth Staple Implant System in a severely resorbed mandible is presented. Benefits of this system include reduction of the surgical operating and reconstruction time, elimination of the need to harvest a bone graft, the ability to create a functional prosthesis within 24 to 48 hours of the implant surgery, and increased cost-effectiveness.
A single appointment fabrication of an emergency overdenture is described. The technique was used in the treatment of a failed implant-supported fixed bridge that was unable to be reinserted due to fractured components and a lack of passive fit. This technique may also be used for the treatment of a failing natural dentition as well as an implant prosthesis.
This article reports the 5-year interim results of an independently monitored, prospective, multicenter clinical trial of a bone quality-based implant design. At six study centers, 495 implants were placed in 151 cases with an average follow-up period of 1.6 years (range: 1.0-3.6 years) after prosthesis delivery. The majority of the implants were placed in D2 or D3 bone to support fixed partial dentures or implant-supported overdentures. Using strict success criteria, there were three implant failures, resulting in a cumulative 99.5% success rate according to Kaplan-Meier survival analysis. Radiographic analysis revealed a mean bone loss of 0.06 mm at 1 year and a bone gain of 0.04 mm at 2 years after prosthesis loading. There were no statistical differences in the results by center, implant type, bone density, area of the mouth, or prosthesis type. The results of this 5-year study revealed a high success rate and limited crestal bone loss in all bone densities by the use of an implant specifically designed for the varying biomechanical conditions and bone quality associated with the human maxilla and mandible.
Implantology has allowed more options for rehabilitation of complete and partially edentulous patients. The professional should describe all possible alternatives to the patient, addressing all the positive and negative aspects of each possibility, such as treatment time, complexity of surgical procedures, and the final cost. The patient should select the best cost-benefit relationship because fixed prostheses are often not the option of choice for the patient. The aim of this article is to present one possible treatment option for the completely edentulous patient by use of implants to support and retain a removable complete or partial prosthesis. The clinical situations were rehabilitated by the use of a milled bar screwed to the implants to support a removable prosthesis with attachments and a milled metallic groove, which provide many advantages to the patient.
This report constitutes a long-term study of 100 saddle-bridges applied by the author during the years 1958-1973. The aim of the investigation has been to assess the prognosis for this form of therapy. The probability that a saddle-bridge will still be functioning completely, without repair, after 5 years is 93%, and after 10 years (as also after 12 years) 83%. Only 12% of the appliances had been removed 12 years after the application. The risk of defects is about the same during the first 5-year period after the application as it is during the second and the third 5-year periods. A comparison between saddle-bridges applied before and after 1965 shows no demonstrable difference as regards the 5-year prognosis in spite of modifications with respect to range of indication and therapy. The causes of the defects have been divided into biological and technical. During the first 5-year period technical defects appear to be in the majority, whereas during the later stages, biological defects predominate. Background factors such as sex, the age of the patient, length of saddle, localization in the jaw do not prove to have any appreciable importance for the prognosis. There is, on the other hand, a significantly better prognosis when the opposing jaw is furnished with the patient's own teeth and/or fixed bridges than with a removable denture. The author points out that from the result of the study, the saddle-bridge has such a good long-term prognosis that its range of application for fixed constructions should be considerably extended.
In a previous paper (Murray 1978) some of the problems associated with currently employed preoperative assessment aids were discussed. Techniques were described for establishing the occlusal vertical dimension of occlusion, and support for the upper lip. The incorporation of these treatment planning aids in the prosthodontic rehabilitation of two adult cases, with class III malocclusions, is reported.
Severe hypodontia is thought to be caused by hereditary and environmental factors. It has a population incidence of 0.3% in the permanent dentition, being much rarer in the deciduous dentition. The management of patients suffering from this condition is described, including the use of conservative, prosthodontic and orthodontic procedures.
Forty abutment teeth with pathological mobility were splinted with telescoped removable bridges. During the first 4 weeks the bridges were fixed. From the beginning of the fifth week they were removed once a day. Mobility was measured prior to placing the bridges and at 4 and 10 weeks intervals. Average mobility of the abutment teeth and the control unsplinted teeth did not change significantly during the experimental period.
The retentive and stress characteristics of a magnetically retained partial overdenture were studied. The retentive properties were compared to those of an I-bar and Zest Anchor retained overdenture. The magnetically retained partial denture uniformly distributed stress to the supporting structures and exhibited significantly greater retention than that of the I-bar, but less than that of the Zest Anchor. Based on these observations, the magnetically retained denture should be considered as an option to be used instead of or in conjunction with other types of partial overdentures.
The purpose of this study was to perform longitudinal measurement of forces transmitted from the denture base to retainers of lower distal-extension removable partial dentures with a conus crown telescopic system. The experimental denture was embedded with a force-detecting unit which could detect a change in lateral and vertical forces transmitted from denture base to retainers at the same time. Forces were measured during chewing of food on several separate occasions from the insertion of new dentures to about 3 months after. Max.ver (maximal mean value of vertical force) and Max.lat (maximal mean value of lateral force) were calculated from the peak level of all strokes of chewing of food at the minimum of the interocclusal distance. The results are summarized as follows: (i) There were no significant changes of Max.ver and Max.lat; (ii) There were no significant differences of Max.ver between subjects the value of which was about 20 N; (iii) There were significant differences of Max.lat between subjects the value of which was less than 15 N.
The purpose of this study was to examine longitudinal changes of the occlusal force distribution in lower distal-extension removable partial dentures with the conus crown telescopic system. Occlusal force applied to the denture and forces transmitted to the retainers were measured on several separate occasions from the insertion of new dentures to about 3 months after. The occlusal force distribution ratio to the retainers was calculated when a load of 20 N was applied to the denture. The results are summarized as follows: (i) The more posterior the loading point of occlusal force, the smaller was the ratio. When the occlusal force was applied to the most anterior artificial tooth, the ratio was 65-100% of the occlusal force. (ii) As the denture wearing time proceeded, the ratio was decreased. The smaller the ratio, the greater was the rate of its decrease.
The aim of this study was to evaluate denture satisfaction over a 1 year period after extraction of the last teeth. Seventy-four patients who required immediate denture therapy in the mandible were randomly treated, (1) with complete immediate dentures (22); (2) with immediate overdentures on two lower canines without attachments (26); or (3) with immediate overdentures on two lower canines provided with Dyna direct magnetic attachments, inserted on the abutments 9 months after treatment (26). Denture satisfaction was estimated by means of questionnaires, filled out by each patient at certain periods, starting before treatment and ending 1 year after denture insertion. After 1 year approximately 85% of the patients in the three groups were satisfied with their dentures, had got used to them and could eat well. This phenomenon was constant over the whole first year period. No differences in denture satisfaction were found between the three groups. It can be concluded that although patients who receive immediate complete dentures might experience a lot of discomfort during the first year of edentulousness, they are satisfied, in general, with their dentures independent of the treatment procedure.
In order to evaluate the possibility of using endosseal implants (ITI Dental Implant System) and implant-retained prostheses for 65-year-old patients from a medium-sized Finnish city, 431 such patients were examined by means of panoramic radiographs. The population represents 61% of the total age group in the city (born in 1923). The possibility to construct a prosthesis, anchored on implants, was evaluated in three different groups. It was shown that in group I (edentulous maxilla and mandible, 256 patients) all male and 97% of female subjects could have been treated with implant-retained over-dentures in the lower jaw. Corresponding figures in the upper jaw were 62% for males and 59% for females. In patients with edentulous maxilla and dentulous or partially edentulous mandible (group II, 84 subjects) implant-retained overdenture in the maxilla could have been possible in 52% of male and 43% of female participants. In subjects with own teeth left in both jaws (group III, 91 participants) some kind of implant-retained bridge or single implants could have been constructed in 70% in maxilla and in 92% in mandible.