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PubMed1995

Modalities of treatment for the combination syndrome.

A series of destructive changes occurring in the jaws of patients wearing a complete maxillary denture opposed by a mandibular distal extension removable partial denture have been described as the combination syndrome. However, the syndrome does not occur in all patients. Those patients who have not developed signs of the combination syndrome and whose mandibular anterior teeth are well preserved and not overerupted may be treated conservatively with a mandibular removable partial denture. A properly designed removable partial denture that distributes occlusal stresses over hard and soft tissues minimizes the risk of developing the combination syndrome. Nevertheless, the overdenture seems to provide a more predictable prognosis, especially for patients who already have the combination syndrome or whose mandibular anterior teeth are structurally or periodontally compromised or overerupted. The treatment modality is determined by the apparent potential of the patient to develop the combination syndrome and by the condition of the remaining mandibular anterior teeth.

Alveolar Bone Loss↗
PubMed2000

The partial overdenture in management of anterior apertognathia: a clinical report.

A patient with anterior apertognathia presented with an unserviceable maxillary removable partial denture. The unique pattern of partial edentulism was treated with a partial overdenture restoration of the bar attachment design. The final prosthesis was stable, well retained, and esthetic, serving as a conservative alternative to a surgical-orthognathic plan of treatment.

Adult↗
PubMed2005

Occlusal considerations in implant therapy: clinical guidelines with biomechanical rationale.

Due to lack of the periodontal ligament, osseointegrated implants, unlike natural teeth, react biomechanically in a different fashion to occlusal force. It is therefore believed that dental implants may be more prone to occlusal overloading, which is often regarded as one of the potential causes for peri-implant bone loss and failure of the implant/implant prosthesis. Overloading factors that may negatively influence on implant longevity include large cantilevers, parafunctions, improper occlusal designs, and premature contacts. Hence, it is important to control implant occlusion within physiologic limit and thus provide optimal implant load to ensure a long-term implant success. The purposes of this paper are to discuss the importance of implant occlusion for implant longevity and to provide clinical guidelines of optimal implant occlusion and possible solutions managing complications related to implant occlusion. It must be emphasized that currently there is no evidence-based, implant-specific concept of occlusion. Future studies in this area are needed to clarify the relationship between occlusion and implant success.

Biomechanical Phenomena↗
PubMed2005

Human ex vivo bone tissue strains around immediately loaded implants supporting maxillary overdentures.

PURPOSE: To evaluate ex vivo bone tissue strains around maxillary implants supporting immediately loaded bar-retained overdentures. MATERIAL AND METHODS: Ninety degree two-element rosette strain gauges were bonded on the labial bone of four ITI dental implants placed in the maxillary anterior region of four completely edentulous maxilla of fresh human cadavers. The installation torque value (ITV) of each implant was measured by a custom-made torque wrench and resonance frequency analyses (RFAs) were undertaken. A bar-retained overdenture was fabricated for each cadaver, and two miniature load cells were integrated in the first molar region of the overdentures for controlled loading experiments. Strain measurements were performed at a sample rate of 10 kHz and under a maximum load of 100 N, simultaneously monitored from a computer connected to a data acquisition system. Finally, removal torque values (RTVs) of the implants were measured. RESULTS: RFA values did not mirror ITVs, while RTVs of implants were slightly lower than the ITVs. Any correlation could not be obtained between RFA values and ITVs or RTVs. Maximum strains around loaded implants ranged between -100 and -550 microepsilon under 25-100 N. The axial and lateral strain values of posterior implants of both sides were higher than those of anterior implants under all loads (P<0.05). CONCLUSION: Because occlusal forces in humans tend to decrease because of age-related factors, maximum strains around immediately loaded implants supporting maxillary overdentures fall within physiologic levels.

Aged↗
PubMed2006

A systematic review of marginal soft tissue at implants subjected to immediate loading or immediate restoration.

OBJECTIVES: The objective of this systematic review was to critically evaluate marginal soft-tissue aspects at implants subjected to immediate loading or immediate restoration. METHODS: An electronic Medline search from 1966 up to August 2005 was conducted to identify prospective and retrospective studies on immediate implant loading. The search strategy was complemented by hand searching in peer-reviewed journals. Studies reporting on soft-tissue aspects at implants subjected to immediate loading or immediate restoration and with a follow-up time of at least 1 year were included. Assessment of identified studies and data extraction was performed independently by two reviewers. An attempt was made to isolate and categorize studies with similar protocols in order to identify trends and relevant factors. Variables that were considered included marginal and interproximal soft-tissue stability, marginal plaque accumulation, probing depth, bleeding on probing, peri-implant mucositis and peri-implantitis. RESULTS: From an initial yield of 581 titles, 240 articles were selected for text analysis, finally resulting in 17 studies that met the inclusion criteria. Six studies on immediate implant loading or restoration were controlled studies, whereas the remainder was prospective case series. Seven studies reported on a 1-year data, and the longest follow-up within the included studies was 4 years. The total number of patients treated within the 17 studies was 432 including a total 706 implants studied. Overall, the articles reported on many different procedures and follow-up times, time points and evaluated soft-tissue parameters varied considerably between the different articles. CONCLUSION: Within the limits of the evaluated data it can be cautiously concluded that once immediately loaded or restored implants integrate successfully, they appear to show a soft-tissue reaction with regard to periodontal as well as morphologic aspects comparable with those of conventionally loaded implants. However, follow-up periods are generally short, number of patients and/or implants per study are few, and most studies present only limited data on peri-implant soft-tissue evaluation. More accurate long-term studies with a stronger study design (i.e., RCT) reporting more detailed on treatment and follow-up protocols are required to allow for proper comparisons and conclusions.

Dental Implantation, Endosseous↗
PubMed1997

A comparison of patient satisfaction and dentist evaluation of overdenture therapy.

It has been argued that the retention of some teeth in the jaws as overdenture abutments prevents negative feelings about the loss of natural teeth. This study set out to evaluate how satisfied a group of patients were with wearing overdentures, and to compare their subjective evaluations with those of a dentist using objective criteria to examine the prostheses. A questionnaire was developed using questions adapted from several other studies. It was pretested, modified and used on all patients who were members of a longitudinal study of overdentures that started in 1974, and who returned on recall. At the end of 9 months, 101 subjects had completed the questionnaire and examination. The mean age of the patients was 65.9 years with an age range of 35 to 88 years. There were 68 men and 33 women in this study and 62 of them were satisfied with their dentures; 33 were satisfied, but felt they had some faults. Only 6 were unhappy about wearing the overdentures. The average length of time the dentures had been worn was 6.9 years, with a range of 1 to 15 years. The most frequent complaints were loss of retention (65.4%) and discomfort (62.2%) of the mandibular dentures. A number of correlations were evaluated and some significant relationships were found between dentist and patient evaluation of the dentures. The best predictor of patient satisfaction with denture wearing was the patient's perception of retention and appearance. In the maxilla the patient's ability to chew and the dentist's evaluation of occlusion were also significant predictors. In the mandible the only other factors apart from retention and appearance were patient comfort and age.

Adult↗
PubMed2006

Dental findings and rehabilitation in familial osteodysplasia (Anderson type): a case report.

Familial osteodysplasia is a disorder of osteogenesis with an autosomal recessive pattern of inheritance which predominantly affects facial bones. No recent case had been reported, particularly from a dental point of view since the syndrome was first described by Anderson et al (JAMA 1972;220:1687-93). A 23-year-old male with familial osteodysplasia was presented in maxillofacial and dental aspects with clinical and radiological manifestations including malocclusion, abnormal teeth alignment, impacted teeth, shape disturbances including uncompleted coronal formation, root shortening with bulbous form, high angled mandible and elongation of the corpus of mandible. Recognition of the syndromal features prior to any dental intervention is of paramount importance because of increased inclination to spontaneous mandibular fractures. Hence, no surgical intervention was performed for impacted teeth. Following the extractions of severely mobile teeth, a definitive restoration was fabricated as distal-extension removable partial dentures with conus crown telescopic system. The aesthetic and functional outcome was satisfactory for the patient. In conclusion, dentists appear to play an important role in the recognition of familial osteodysplasia, based on maxillofacial and dentoalveolar findings. Awareness of the syndromal features, especially of spontaneous fractures, would detect the limitations for dental interventions and treatment planning.

Adult↗
PubMed2001

Nonsubmerged implants in the treatment of the edentulous lower jaw: a 5-year prospective longitudinal study of ITI hollow screws.

BACKGROUND: Although most implant systems have been designed for a two-stage surgical technique, a one-stage surgical technique has always been advocated for the ITI Dental Implant System (Straumann AG, Waldenburg, Switzerland). A new generation of ITI implants was presented in 1988 and included a hollow cylinder, a hollow screw, and a solid screw. PURPOSE: The goal of this study was to evaluate the one-stage surgical technique in connection with the ITI hollow screw in a longitudinal study over 5 years. MATERIALS AND METHODS: Forty-six patients with edentulous lower jaws were supplied with ITI hollow-screw implants. Patients who requested an overdenture (n = 18) had four implants inserted; those who requested a fixed bridge (n = 28) had five to six implants. The patients have been followed annually for 5 years. There was a dropout of three patients (6.5%); one patient did not want to cooperate, one moved from the area, and one was deceased. The clinical examinations included bridge removal for evaluation of the individual implant stability in connection with the 1-, 3-, and 5-year examinations. Radiographic examinations were performed with intraoral radiographs and the long-cone technique. RESULTS: The survival rate after 5 years was 95.7%. The success rate (in which implants undergoing treatment of peri-implantitis were not counted as successes) was 91.4%. The mean marginal bone loss between the baseline and the 1-year examination was 0.1 mm and between the 1- and 5-year examinations was 0.1 mm. These changes in marginal bone level were not significant. CONCLUSIONS: The success rate of ITI hollow-screw implants in the edentulous mandible was 91.4% after a 5-year observation period. There was no significant change in mean bone level between the loading of the implants and the 5-year examination. Peri-implantitis was diagnosed in three patients with poor oral hygiene, and it affected six implants. Five of these failed in spite of treatment.

Adult↗
PubMed2003

Implant-retained mandibular overdentures with immediate loading: a 3- to 8-year prospective study on 328 implants.

PURPOSE: The purpose of this study is to evaluate prospectively survival and success rates of implants placed in the interforaminal area of edentulous mandibles and immediately loaded with an implant-supported overdenture. MATERIALS AND METHODS: Eighty-two patients, 33 males and 49 females, aged between 42 and 87 years (mean age 58.6 yr), presenting edentulous mandibles were rehabilitated with an implant-supported overdenture in the mandible. Three hundred twenty-eight screw-type osseointegrated implants (164 Ha-Ti, Mathys Dental, Bettlach, Switzerland; 84 ITI Dental Implant System, Straumann Institute, Waldenburg, Switzerland; 40 Brånemark Conical, Nobel Biocare AB, Gothenburg, Sweden; 40 Frialoc, Friatec, AG Mannheiti, Germany), were placed in the intraforaminal area of the mental symphysis (4 implants per patient). Immediately after implant placement, a U-shaped gold or titanium bar was fabricated and implants were rigidly connected with the bar and immediately loaded with an implant-retained overdenture. Success rate of implants was evaluated clinically and radiographically every year after the loading of the prostheses according to the following parameters: (1) absence of clinical mobility of implants tested individually after bar removal, (2) absence of periimplant radiolucency evaluated on panoramic radiographs, (3) absence of pain and radiologic or clinical signs of neural lesion, and (4) periimplant bone resorption mesial and distal to each implant less than 0.2 mm after the first year of prosthetic load. RESULTS: Of 328 implants placed, 296 were followed up from a minimum of 36 months to a maximum of 96 months, with a mean follow-up of 62 months. Seven implants in 6 different patients were removed owing to loss of osseointegration, whereas 18 implants, although still osseointegrated, did not fulfill success criteria due to bone resorption > 0.2 mm/year after the first year of loading. Despite implant losses, all patients maintained their bars supporting overdentures, although in 6 patients they were supported by 3 instead of 4 implants. The only patient who lost 2 implants received 2 new implants, which survived normally. Therefore, the absolute success and survival rates were 91.6% and 97.6%, respectively, whereas the cumulative survival and success rates of implants obtained with a life table analysis were 96.1% and 88.2%, respectively. CONCLUSIONS: Results of this study seem to demonstrate that survival and success rates of immediately loaded implants placed in the intraforaminal area of the mandible and rigidly connected with a bar through an implant-supported overdenture are consistent with those reported in the international literature as far as delayed loading is concerned after 3 years of loading. After longer observation times, this study demonstrated that, while survival rates of implants and bar-supported overdentures are still consistent with results published in the international literature pertaining to delayed loading, a moderate decrease in success rates of implants was found. Nevertheless, it must be stressed that this decrease (88.8 and 90.4% after a 7- to 8-year observation period for Ha-Ti and ITI implants) is related only to two implant systems; no data are available for the other two implant systems because of the shorter follow-up period.

Adult↗
PubMed2003

3-year prospective multicenter study on one-stage implant surgery and early loading in the edentulous mandible.

BACKGROUND: The long-term success rates achieved in dental implantology suggest that flexibility might well exist within the various implant systems to a degree that an altered protocol (ie, one-stage surgery and immediate or early loading) can be performed under controlled conditions. However, before variations of the protocol can be considered for general use, they must be subjected to critical analysis, particularly with respect to the predictability of osseointegration, alteration of soft tissue barrier, and relative change in bone height around the implants. PURPOSE: The aim of this prospective multicenter study was to evaluate implant survival and periimplant conditions around endosseous implants placed in a one-stage surgical procedure and early loading. MATERIALS AND METHODS: A total of 170 implants were placed in 40 patients with mandibular edentulism and were functionally loaded within 6 weeks with overdentures (n = 30) or fixed prostheses (n = 10). All patients and prosthetic constructions were evaluated according to a standardized protocol during 3 years of follow-up. Cumulative implant survival rates were calculated, and implant loss in relation to implant size and bone quality and quantity were evaluated. Furthermore, the protocol included assessment of clinical (plaque and bleeding scores, prosthesis stability) and radiographic parameters. RESULTS: Over a period of 3 years, the implant survival rate was 93% for both implants and prostheses (fixed or removable). No implants were lost after the first year of loading. The periimplant tissues were in a healthy condition. Mean marginal bone resorption from the time of loading to the 3-year follow-up was 0.41 mm (SD 0.52). CONCLUSIONS: From this study it may be concluded that early loading results in good implant survival and proper periimplant health in edentulous mandibles.

Adult↗
PubMed2003

Immediately loaded bar-connected implants with an anodized surface inserted in the anterior mandible in a patient treated with diphosphonates for osteoporosis: a case report with a 12-month follow-up.

BACKGROUND: It has been suggested that tooth loss is greater in the osteoporotic patient population. Only a few cases have been reported in the literature about the use of dental implants in patients with osteoporosis. Diphosphonates are stable analogs of pyrophosphate, a physiologic regulator of calcification and bone resorption. Multiple implant failures have been reported in a patient undergoing treatment with diphosphonates. Recently, several clinical and experimental reports have shown that immediate loading of dental implants is possible in selected situations. PURPOSE: The aim of this case report was to present the clinical outcome of immediate loading of implants in a patient undergoing diphosphonate treatment for osteoporosis. MATERIALS AND METHODS: In a 65-year-old patient undergoing diphosphonate treatment for osteoporosis, four implants were inserted in the anterior mandible. The implants were connected with a bar supporting an overdenture and were then loaded the same day. RESULTS: No problems occurred in the postoperative period. At 1-year follow-up, all four of the implants appeared to be clinically osseointegrated, and no mobility was present. Minimal bone resorption was present around all implants. CONCLUSIONS: Our case report points to the fact that, contrary to what has been reported in the literature, it is possible to successfully insert and load immediately after surgery dental implants in a patient undergoing diphosphonate treatment for osteoporosis.

Aged↗
PubMedDate not supplied

Emergency dentures and esthetics.

Accidents occur in life and when they affect the dentition, whether natural, artificial, or a combination, they can result in a feeling of dread and despair in the patient. The thought of appearing not only in public with business and social acquaintances, but also in private with family members can be reprehensible. This article discusses the use of visible light-cured denture base materials that can be used to alleviate the fear these patients display in being exposed to socio-esthetic intercourse when becoming suddenly partially edentate. The method of use and three patients' photographic essay presentations are discussed.

Acrylic Resins↗
PubMedDate not supplied

The use of tricalcium phosphate to preserve alveolar bone in a patient with ectodermal dysplasia: a case report.

The prosthodontic management of the child with ectodermal dysplasia is made difficult because of the under-development of the alveolar ridges. This paper describes a case where tricalcium phosphate was placed in sockets immediately following the extraction of the primary incisor teeth to help maintain alveolar bone width, offering a valuable alternative treatment option in the prosthodontic management of the child patient with ectodermal dysplasia.

Alveolar Bone Loss↗
PubMed1997

Periodontal and prosthetic therapy in severely advanced periodontitis by the use of the crown sleeve coping telescope denture. A longitudinal case report.

The crown and sleeve-coping (CSC) telescope denture is a removable prosthesis that is supported by both selectively retained teeth and the residual ridge or mucosa. Limited information regarding longitudinal studies of the CSC telescope denture has been reported as to the response of the abutments and their surrounding periodontal tissues to this type of design. The authors have documented a longitudinal ten-year follow-up of a case which was considered 'hopeless' for oral rehabilitation because of advanced periodontitis. The CSC telescope denture used in this case resulted in a significant improvement to the remaining dentition. The beneficial results of this form of treatment can be considered for a wide variety of clinical applications for the severely advanced periodontitis case.

Alveolar Bone Loss↗
PubMed2002

Immediate or transitional complete dentures: gerodontic considerations.

Ageing society is a worldwide phenomenon, especially in western countries, were the proportion of the aged population reaches about 20%. Of this group about 50% constitute what is termed the old-old frail persons who suffer drastic physiological changes which exacerbate difficulties in classic dental and prosthetic treatments. Epidemiological surveys point out that many of the elderly present with about 12-14 teeth with bad periodontal conditions that should be extracted. As a result, special strategies have to be elaborated to give an appropriate solution to specific medical and prosthetic conditions. Transitional procedures are necessary to assure the smooth change between removable partial dentures and complete dentures. Even when implant supported dentures are planed this transition period is necessary. Clinical decision making is crucial to avoid stress to these medically compromised patients.

Aged↗