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Prosthetic complications in an implant-retained mandibular overdenture population: initial analysis of a prospective study.

STATEMENT OF PROBLEM: The clinical success of implant-retained, tissue-supported mandibular overdenture prostheses has been documented. However, few studies have evaluated the return visits and associated cost required to maintain these prostheses. PURPOSE: The purpose of this investigation was to evaluate the amount of maintenance required to provide acceptable and satisfactory implant-retained mandibular overdentures in a prospective clinical trial. MATERIAL AND METHODS: Fifty-eight patients received new maxillary and mandibular complete dentures followed by placement of microthreaded/TiOBlast implants in the mandibular left and right canine regions. At 3 months, ball abutments were placed, and the mandibular prostheses were relined to receive Dalla Bona-type ball housings (baseline). Prostheses were prospectively evaluated, and adjustments were made at 3-, 6-, 12-, 24-, and 36-month recall visits and at nonscheduled visits for 9 types of prosthetic complications. RESULTS: Of 58 patients, 6 required no adjustments. The remaining 52 patients made 327 return visits (including 194 nonscheduled visits) for prosthesis and/or abutment adjustments. One hundred and fifteen practitioner hours were required to provide prosthetic solutions to patient concerns at the return visits. The total estimated cost for all professional and laboratory services was $12,624.00 ($218.00 per patient). CONCLUSION: Although mandibular implant-supported overdentures with Dalla Bona-type ball attachments are an acceptable treatment option for edentulous patients, routine maintenance is required to ensure successful long-term outcomes.

Adult↗

Planning the transition to a comprehensive implant rehabilitation: a case report--Part I.

When the edentulous condition has existed for many years, extensive ridge resorption may complicate the ability to function with a conventional prosthesis. Implant therapy in conjunction with bone augmentation procedures may provide new options for the predictable restoration of the edentulous state. However, complex implant reconstruction may place considerable stress on the patient's ability to function throughout therapy. Providing stable interim prostheses and smooth transitions between procedures may alleviate the problem. This can be accomplished only with extensive diagnosis, treatment planning, and the judicious use of transitional prostheses. The first part of this case report focuses on the planning stages of a complex implant dental rehabilitation.

Aged↗

Implant support for removable partial overdentures: a case report.

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.

Adult↗

Combination syndrome: treatment with dental implants.

Occlusal plane problems are often not evaluated adequately. They can be left untreated or improperly treated. This article reviews one such problem known as Combination Syndrome. The treatment method described involves using a fixed mandibular prosthesis over implants that have been placed immediately after dental extractions.

Alveoloplasty↗

Rehabilitation of maxillary edentulism with implant-supported milled-bar prostheses.

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.

Dental Alloys↗

Changes in masticatory movement parameters within the chewing period in young dentate persons and patients rehabilitated with bridges supported by implants in the mandible.

Experiments were carried out to study changes in masticatory movements in the chewing sequence of young dentate persons and complete denture wearers rehabilitated with bridges on osseo-integrated implants (OIB) in the lower jaw. Two test foods were used in the dentate group (apple, bread) and bread in the OIB group. A computer-based opto-electronic system (Selspot) was employed to record and analyse all single chewing cycles, regarding parameters reflecting, chewing rhythm, mandibular velocity and displacement. The different parameters were tested both intra- and inter-individually versus the series of the single and overall chewing cycles in the masticatory sequences respectively. The results indicated that different subjects performed different patterns of mastication within the chewing period when chewing the same type of food. Different test foods (texture, size) also seemed to affect the chewing pattern in a different way, e.g. mandibular displacement showed an obvious reduction when chewing apple, probably due to the bigger size of the bolus. The inter- and intra-individual analysis showed in some parameters discrepancies implying problems in analysing the chewing pattern within the chewing sequence without using both methods.

Adult↗

Parotid salivary flow rates in two patients during immediate denture treatment.

Parotid salivary flow rates in response to chewing or citric acid stimulation were studied in two patients who had their last maxillary teeth extracted and immediately replaced with complete dentures. The patients were monitored 6 months from the last week before extraction. Parotid salivary flow rate in response to chewing was increased after insertion of the denture. For one of the patients a particularly high output from the parotid gland was found 2 weeks after treatment. Throughout the experiment, parotid salivary flow was higher on the chewing side than on the contralateral side. At the end of the experimental period the dentures were relined. Salivary flow measured immediately after relining was lower than prior to this procedure. An increased salivary response was also observed during citric acid stimulation after transition from the dentate to the denture wearing state. This increase was more marked if the patients had their dentures in situ when the gustatory provocations were performed. It is concluded that parotid salivation increases during masticatory and gustatory stimulation in patients subjected to total extraction and immediate complete denture treatment, and that the presence of a complete denture per se appears to act as an additional mechanical stimulus in the salivary reflexes.

Citrates↗

Long-term observations of extensive fixed partial dentures on mandibular canine teeth.

Twelve patients were followed for 15 years after treatment with a 12-unit cantilever fixed partial denture on the mandibular canines opposite to a complete maxillary denture. Four constructions failed and had to be removed but four were still in function after 15 years. Four patients died during the observation period still wearing their constructions. Endodontic complications, pulpal necrosis and loss of retention of posts were the most frequent, while caries and periodontal lesions were rare. The maintenance costs over the years were fairly low even compared to maintenance costs for patients treated with implants. Extensive mandibular cantilever fixed partial dentures may be used in the rehabilitation of patients with a very reduced dentition and a history of difficulties adapting to removable dentures.

Adult↗

Management of the maxilla after alveolar ridge augmentation with hydroxylapatite when opposed by mandibular implants.

Maxillary ridge augmentation and vestibuloplasty are often adjuncts to mandibular implant reconstructions. Careful management of the augmented ridge after surgery is critical to the success of the maxillary prosthesis and osseointegration of the mandibular implant. A technique is described for alteration of an existing maxillary complete denture after ridge augmentation. Precautions regarding prosthesis function during the osseointegration phase of different types of mandibular reconstructions are noted. Technique and rationale for denture flange modification when a prosthesis is rebased for a patient who received simultaneous vestibuloplasty and ridge augmentation are described.

Alveolar Bone Loss↗

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↗

A maxillary implant overdenture that utilizes angle-correcting abutments.

Placement of dental implants to enhance complete denture stability and retention is a well-accepted treatment modality. Most implant overdenture abutments and related components require parallelism within approximately 10 degrees to function properly. Non-parallel implant placement as a result of flared maxillary bone may preclude the use of conventional implant overdenture abutments, requiring the use of costly custom abutments or bar prostheses. A case report is presented that illustrates the use of a new, 2-piece, angled overdenture abutment to accommodate non-parallel implant placement.

Aged↗

Risk factors associated with denture stomatitis in the United States.

BACKGROUND: This study reports denture stomatitis (DS) prevalence from a large USA probability sample from the National Health and Nutrition Examination Survey, 1988-1994 (NHANES III). METHODS: Oral examinations were performed on 3450 individuals 18-90+ years of age (mean: 59.2; SD: 0.50 years), 57.7% male and 42.3% female. Multivariable logistic regression models were fitted for DS using sociodemographic, denture quality, blood analytes, alcohol and tobacco use, history of diabetes, and current antibiotic use as covariates. Odds ratios (OR), adjusted for other covariates in each model (AOR) are presented. RESULTS: Of 3450 removable denture wearers, 963 (27.9%) had DS. DS prevalence was associated with wearing maxillary (AOR: 6.20) and mandibular (AOR: 5.21) complete dentures continuously; smoking >/=15 cigarettes day (maxillary complete: AOR = 1.31; mandibular complete: AOR = 1.50; maxillary partial: AOR = 2.04); vitamin A deficiency (mandibular complete: AOR = 5.97; maxillary partial: AOR = 5.67; mandibular partial: AOR = 24.42). Maxillary dentures with inadequate relines had approximately half the OR of DS than those with adequate relines (maxillary complete: AOR = 0.42; mandibular complete: AOR = 0.50). CONCLUSIONS: Denture stomatitis prevalence is associated with the amount of tissue covered by dentures, low vitamin A levels, cigarette smoking, and constant denture wear.

Adolescent↗

Cinefluoroscopic study of long-term changes of bolus position and chewing cycle duration after fixed prosthetic treatment.

Some chewing parameters were studied in 12 patients with a complete maxillary denture and a 12-unit fixed mandibular denture anchored to the two canines. Registration by means of fluoroscopy were made before, 1 month after, and in four patients 13 yr after treatment. The mean velocity of the mandible during chewing increased after the prosthetic treatment and remained stable for meat during the observation period. At the first registration, before treatment, the bolus was most frequently located in the anterior region. After completion of the prosthetic rehabilitation, the bolus was mainly located to the lateral segments during chewing of the test foods, namely meat and bread. The recordings were almost identical 13 yr later. Despite a very reduced periodontal support, posterior cantilevered segments were satisfactorily used in comminution and the patients seemed to be unaware of the forces exerted on the remaining teeth.

Adult↗

A retrospective evaluation of treatments with implant-supported maxillary overdentures.

BACKGROUND: Considerably lower success rates have been presented for implant-supported overdentures in the maxilla compared with the mandible. PURPOSE: The aim of the study was to report the outcome of implant-supported maxillary overdentures from one clinic. METHODS: All patients treated with implant-supported maxillary overdentures in the Department of Prosthetic Dentistry, Central Hospital, Skövde, Sweden, between 1993 and 2002 were identified from patient charts and included in the study. All patients had a rigid cast gold alloy bar designed with ball attachments retaining an overdenture. RESULTS: Twenty-seven subjects were included, of whom 13 were originally planned for overdenture treatment (group 1) and the other 14 for a fixed prosthesis (group 2). The mean observation period was 5.7 years for subjects in group 1 and 5.5 years for those in group 2. One hundred forty-five implants were placed, and the majority of the failures were diagnosed as early ones and were found in group 2. The cumulative implant survival rate after 5 years was 77% in group 1 and 46% in group 2. The probability of having implant failure was almost three times higher among subjects in group 2 compared with subjects in group 1. Most technical and biologic complications were related to the retention system. CONCLUSION: Maxillary implant-supported overdentures show a high implant failure rate, but fewer implant failures occurred for patients originally planned for overdenture treatment.

Aged↗

Clinical decision making in evaluating patients: a process study.

A volunteer patient was examined by five dentists experienced in caring for geriatric patients. The patient and dentist interaction was videotaped and reviewed to evaluate a previously generated hypothesis regarding the diagnosis process. This descriptive study suggests that dentists experienced in geriatric care did assess and evaluate a wide range of patient characteristics. However, they did not follow the previously hypothesized process in arriving at an appropriate treatment plan. Instead, they relied heavily on past experiences with similar situations. The possible implications of this process for treatment planning and teaching of geriatric dentistry are discussed.

Aged↗

The dental management of a patient with a cocaine-induced maxillofacial defect: a case report.

There are several dental complications associated with cocaine abuse, including adverse reactions to dental anesthetics, post-operative bleeding, and cellulitis, which can lead to necrosis of orbital, nasal, and palatal bones. Following is a report of the initial treatment rendered to a patient who had destroyed most of her hard palate over a ten-year period of cocaine abuse. There are no classic socio-economic or educational profiles for abusers of cocaine. Drug abuse victims may present as patients in any dental office. Though there are certain classic physiological and psychological symptoms of their condition, they may not display symptoms at all.

Candidiasis, Oral↗

Mandibular overdenture treatment. Case report.

Complete mandibular dentures have a significantly lower success rate compared with complete maxillary dentures. Overdentures are feasible alternatives in many instances in attempting to achieve an optimal clinical result. The case of a 56-year-old female patient requiring prosthetic rehabilitation is discussed. A complete maxillary denture and a complete mandibular overdenture were constructed.

Denture, Complete, Upper↗