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PubMedDate not supplied

[Prosthetic rehabilitation by removable prostheses with distribution of force by means of wires in Kennedy 4th class cases].

Prosthetic rehabilitation in cases of Kennedy class 4th, particularly when the from gap is extensive, presents problems of both aesthetic (lack of front teeth) and functional nature that are not easy to solve. On one side a mixed dental and mucosa support must be obtained while on the other over-loading of the abutment teeth must be avoided by distributing force axially and unformly. This is done by using a special type of prosthesis described here where force is distributed by means of wires. Cases treated like this and followed up have shown positive results as regards both clinical and mechanical results.

Adult↗

PubMedDate not supplied

Oral rehabilitation with implant-retained prostheses following ablative surgery and reconstruction with free flaps.

Ablative surgery of the oral tissues may result in significant facial deformity, poor oral function, and psychologic detriment. Immediate surgical reconstruction with vascularized free flaps has become increasingly popular, but the oral rehabilitation of these patients with conventional dental prostheses is usually unsuccessful. The results and clinical experiences of treating a group of 17 patients with ablative surgery, immediate reconstruction with free flaps, and restoration with mandibular implant-retained prostheses are presented after follow-up periods of 6 months to 7 years. Most patients expressed a high degree of satisfaction with their prostheses. General principles and guidelines for the provision of this effective treatment modality are discussed.

Adolescent↗

PubMedDate not supplied

High frequency jet ventilation in complete oral rehabilitation.

High frequency jet ventilation (HFJV) has been used recently as an alternative to conventional endotracheal intubation in bronchoscopy and laryngoscopy procedure. The objective of this study was to define the applicability of the system to dental procedures performed on healthy and medically compromised patients. A total of seventeen pediatric patients ranging in age from twenty-eight months to fourteen years were included. The results of this study indicate that this technique is most beneficial for non-extraction cases, especially those with coagulation disorders or significant airway abnormalities. Routine use of this technique is not generally recommended. The physical characteristics of the smaller diameter soft catheter used in HFJV exemplify the advantages of this technique.

Adolescent↗

PubMed1994

[Functional and esthetic reconstruction of complex facial defects after tumor resection and trauma].

Nowadays, free revascularized myocutaneous and osteomyocutaneous flaps are available as grafts of high biological value, which allow functional and esthetic rehabilitation after tumor resection and trauma. The use of these flaps however must be considered carefully, since these techniques require a good general physical condition of the patient for extensive surgery and a considerable operation time. Therefore we consider these flaps as adequate solely in cases of poor recipient site conditions after previous irradiation or chronic infection, in cases of extensive scar formation and in large bone and soft tissue defects. In these cases revascularized grafts from the iliac crest have proven to be useful in mandibular reconstruction while scapular grafts has been useful in restorations of the midface.

Bone Transplantation↗

PubMed2005

An evaluation of the San Francisco Department of Human Services Welfare Dental Program.

OBJECTIVE: To evaluate the welfare-to-work San Francisco Personal Assisted Employment Services (PAES) Dental Program. METHODS: A cohort of 377 study participants in the novel PAES Dental Program were followed through their baseline examination, rehabilitative dental treatment, follow-up exam, and completion of patient satisfaction survey. A framework of structure, process, and outcome measures was used to evaluate the success of the Dental Program. Chi square test, logistic regression, and paired t-test were used to analyze the levels of participation and satisfaction in the program. RESULTS: Of the 377 study participants, 265 (70%) completed their rehabilitative dental treatment. Those who completed their dental treatment had more missing teeth and fewer decayed teeth at baseline than those who did not complete their treatment. High levels of patient satisfaction were reported for the Dental Program. Ninety-seven percent of 173 respondents felt that they had been treated with respect, 92% were satisfied with the scheduling of their appointments, 91% were satisfied with their Dental Program experience, and 90% felt that their chief complaint had been solved. CONCLUSION: The PAES Dental Program provided high levels of patient satisfaction for process and outcome measures.

Adult↗

PubMed2000

Reconstruction of the pediatric maxilla and mandible.

BACKGROUND: The creation of osseous defects in the upper and lower jaws in children is an uncommon occurrence. It is therefore likely that a head and neck reconstructive surgeon will accumulate only limited experience in restoring such defects. We have reviewed 7 pediatric bone-containing microvascular free flap reconstructions in 6 patients for reconstruction of the upper or lower jaws. Three patients were available for long-term follow-up to evaluate the effect of osseous free flap reconstruction on function and growth and development of the donor site. DESIGN: Retrospective review. SETTING: Academic tertiary referral center for otolaryngology. PATIENTS AND METHODS: Six pediatric patients ranging in age from 8 to 16 years underwent 2 fibular, 4 scapular, and 1 iliac free flap procedure for restoration of 2 maxillary and 5 mandibular defects from 1992 to 1997. Three of the 6 patients were available for long-term follow-up to assess the postoperative donor site function in an effort to determine the effect of this surgery on long-term donor site morbidity and development. RESULTS: Two patients were lost to follow-up, and 1 died secondary to complications related to distant metastatic disease. Three of 6 patients were observed for 2 years 6 months, 4 years, and 4 years 2 months, respectively. Two of the 3 patients who were observed long term have undergone full dental rehabilitation and currently maintain a regular diet and deny pain with mastication or deglutition. One patient did not require dental rehabilitation. All 3 patients demonstrate gross facial symmetry and normal dental occlusion. Assessment of the fibular donor site demonstrated normal limb length and circumference. The patients denied pain or restriction to recreational activity. Scapular donor sites demonstrated normal range of motion, strength, and shoulder stability. CONCLUSIONS: Free flap reconstruction of the pediatric maxilla and mandible requires harvesting bone from actively growing donor sites. We have found no evidence of functional deficit after bone harvest from the fibular or scapular donor sites. Patients demonstrate normal growth at the donor sites, and symmetry of the mandible and maxilla is preserved.

Adolescent↗

PubMed2002

[Implantology in oromaxillofacial surgery].

Since the last 30 years endosseous implants are a well established treatment technique in maxillofacial surgery. Implants are used in the rehabilitation of patients having lost parts of maxilla or mandible due to tumor surgery, or which due to radiotherapy have problems tolerating mucosa-borne dentures. The implant borne prosthesis will aid to regain live quality to those patients. Improvement of live quality is also the result when epithetic reconstructions of soft tissue defects in the face are stabilized by extraoral implants. Aim of the paper is to give an overview on important implant related pathophysiological osseous healing patterns, discuss methods to influence these processes, to show correction possibilities for the bony bed and highlight their indications as well as to inform about clinical experiences with endosseous implants.

Dental Implantation, Endosseous↗

PubMed1979

[Possibilities and limits of prosthetic rehabilitation of the reduced dentition].

The initial findings are crucial for determining the time and the extent of possible prosthetic treatment. The patients to be fitted with a prosthesis are divided into several groups, on the basis of the present state and the reaction of the masticatory organ to external irritation, into resistant and insufficient states. The topography (not the number) of abutment teeth, the relationship of the edentulous parts of the jaw to the number of remaining teeth, the extent and the course of future prosthetic surfaces, the possibility of the equilibrium and distribution of force, the antagonistic relationship of the teeth with each other and hygienic factors limit the prosthetic possibilities. The free-end saddle represents a particular problem in the fitting of a dental prosthesis; its variant forms are discussed and, on the basis of many years of successful controls, the possibility and the limitations for the fitting of prostheses were pointed out.

Biomechanical Phenomena↗

PubMed1992

[The fundamental method of preventive prosthodontics: complex rehabilitation of the masticatory organ].

The most effective prosthetic prophlaxis could be the prevention of causes leading to tooth extractions. As now the caries and periodontal preventions are not efficient enough we are obligated to deal with the consequences of tooth loss. Even the loss of a single tooth might cause disfunctions in the masticatory system. Besides the well known consequences, like diminished masticatory, phonetic functions and esthetical problems we have to face to the consequences related to morphological changes in the dentition leading to difficulties in prosthodontic treatment planning and tooth preparation. So, the most important step in prosthodontic prophylaxis is the early replacement of the lost tooth. The early prosthetic reconstruction can only be prophylactic if it does not interfere with the normal hygienic procedures in the oral cavity. Consequently it is very important to consider all the possible factors affecting the oral hygiene during our prosthetic treatment planning. We should also consider the basic gnatological principles in designing the occlusal surface of crowns and pontics to avoid any traumatic occlusal forces related to our would be reconstructions.

Humans↗

PubMedDate not supplied

Oral rehabilitation of young adults with amelogenesis imperfecta.

PURPOSE: This article describes the restorative management of two patients in whom the diagnosis of amelogenesis imperfecta was not made until young adulthood. MATERIALS AND METHODS: Amelogenesis imperfecta is a variable developmental abnormality of the tooth enamel that affects relatively few persons. Previous case reports have focused largely on the early management of children and young adolescents. However, some patients may not be diagnosed correctly or may not request dental treatment until they are older, as with the two cases presented. In some instances, parents fail to appreciate the importance of early intervention. RESULTS: Both patients required intensive preventive therapy and extensive restorative treatment over several years. The correct sequencing of treatment phases was required to achieve relief of pain and provide satisfactory function and esthetics. CONCLUSION: The two cases presented illustrate the degree of complexity that extended restorative treatments can involve, especially following severe tooth wear and poor bonding of restorations to the affected enamel.

Adolescent↗

PubMed1999

[Masticatory rehabilitation of tumor patients by endosseous implants. 10 year analysis].

A total of 409 implants was inserted into 83 consecutive patients, who had tumor-related intraoral resections of soft tissue and bone. A life table analysis was used to determine the survival rate of the implants placed over a period of 13 years. Log rank tests and a Cox regression analysis were employed to identify relevant effects of surgical parameters on implant survival. A total of 38 implant failures were encountered. Most of the losses (n = 16) occurred during the first year of functional loading. The cumulative, overall survival rate of implants was 56.5%. Previous radiation therapy, insertion into grafted bone or original jaw bone, and insertion into microsurgically revascularized grafts did not significantly affect the survival rates. In the Cox regression, only the timing of implant placement was significantly related to the survival rate in the group of patients with bone grafts (P = 0.0197), with a lower survival rate of 36.2% of primary inserted implants and 67.1% survival in the group with secondary implant placement.

Bone Transplantation↗

PubMed2005

[On the indications for and morbidity of segmental resection of the mandible for squamous cell carcinoma in the lower oral cavity].

BACKGROUND: Segmental resection of the mandibula in oral cancer surgery leads to both functional and aesthetic problems. The decision to preserve or resect the mandible depends on the vicinity of the lesion to the bone. Consequently, based on the rules of safety margins to all planes that are recommended for soft tissues, each lesion that is closer than 10 mm to the mandible needs resection of the bone. PATIENTS AND METHODS: To establish data-based treatment modalities, a retrospective study was initiated and the results from all preoperative staging investigations of 152 patients with intraoral squamous cell carcinoma who underwent continuity or marginal resection of the mandible were evaluated. The histological outcome of the resected bone was compared to the staging results. Functional rehabilitation and long-term follow-up including survival rates were evaluated. The study reports on typical complications following segmental resection such as fracture of the reconstruction plate and demonstrates experiences with secondary microsurgical reconstructive surgery. RESULTS: Mainly in cases of stage T1 and T2 carcinomas which are closer than 10 mm to the bone and clinically do not show any infiltration to the mandible, a marginal resection seems to be adequate. The decision about the extension of mandibular resection can be based on intraoperative cross sectional investigation of the periosteum. The survival rate of patients with intraoral carcinomas close to the mandible who underwent marginal mandibulectomy seems to be the same as in cases of continuity resection. A more conservative management of mandibular resection seems to be adequate and a data-based concept to standardize therapy of mandibular resection is presented.

Aged↗

PubMedDate not supplied

Pathways in multidisciplinary oral health care as a tool to improve clinical performance.

PURPOSE: To investigate the optimization of multidisciplinary and interdisciplinary oral health care through the introduction of pathways. MATERIALS AND METHODS: A prospective randomized clinical trial was carried out in a tertiary referral academic institution. Ninety-one patients admitted for multidisciplinary oral health care from January 1, 2001, to March 31, 2003, were randomized to the test group (n = 50) or to the control group (n = 41). Pathways were implemented by means of the Medical Patient Management program, a computerized planning and coordination system specifically developed for a population with multidisciplinary oral rehabilitation needs. The efficiency of pathways in interdisciplinary oral health care was assessed. RESULTS: Statistically significant differences between test and control groups were found for variables regarding the process of care, such as "number of planned versus actual disciplines," "length of planned versus actual treatment," and "average length of a treatment session." For variables regarding patient satisfaction, significant differences between test and control groups were found for questions regarding patient involvement with the treatment and patient satisfaction with the outcome of multidisciplinary treatment. Regarding practitioner satisfaction, the results of the questionnaire indicate that implementation of pathways into everyday clinical practice is desired but remains difficult. CONCLUSION: The findings of this study show that the implementation of pathways in multidisciplinary oral health care improved some aspects of the process of care and increased patient satisfaction. The predictive capability of the Medical Patient Management program in managing oral health care has been demonstrated.

Attitude of Health Personnel↗

PubMed1999

Oral rehabilitation using dental implants and guided bone regeneration.

The advent of osseointegrated dental implants focused initially on functional rehabilitation. Interest today centres on aesthetics and the philosophical ideal of replicating nature. Implants can be placed beyond resorbed anatomic limitations where the final prosthesis should be, rather than within the pre-existing resorbed bone. In order to achieve this, the following must be considered: implant positioning, adequate bone support and the overlying soft tissue envelope. Common techniques to modify the surgical environment include different methods of bone grafting and regeneration, ridge expansion and sinus augmentation. With the advent of growth factors like bone-morphogenetic proteins, restoration of bony contours will become more predictable. Soft tissue management techniques include tissue expansion and contouring, gingiva grafts and advancement or rotational flaps. Though some of these procedures can be done concurrently with implant placement, a secondary surgical procedure is often required. Ideal implant positioning involve establishing correct orientation in all dimensions. Due consideration should also be given to occlusion and harmony of the final restoration with the adjacent dentition.

Bone Regeneration↗

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↗

PubMed1999

[Oral rehabilitation of tumor patients with endosseous implants. Implant success with special reference to peri-implant tissue].

In a prospective study, the influence of the status of the peri-implant hard and soft tissues on the success of enosseous dental implants in tumor patients was assessed. Out of 59 tumor patients with 261 implants, treated between July 1988 and August 1996, a pool of 23 patients with 99 implants provided with dentures for at least 1 year was obtained. Eighteen of these patients suffered from a squamous cell carcinoma of the oral cavity. Seventeen patients underwent preoperative radiation (40 Gy). A total of 68 out of 99 implants were inserted into autologous bone transplanted to reconstruct the mandible. In order to assess the peri-implant hard and soft tissues, the Hygiene Index, the Sulcus Bleeding Index, the Gingiva Index, the pocket-probing depth. the peri-implant bone resorption, and the periotest were used. The results in the tumor patients were compared with the results in a pool of nontumor patients. Tumor patients had significantly worse periimplant parameters than nontumor patients. The peri-implant pocket-probing depth proved to have significant influence on the success rate. The overall success rate was 77.8%.

Adult↗

PubMed2002

[Primary "swallowing" function in relation to cleft type after 18 years of interdisciplinary therapy].

PURPOSE: The aim of today's interdisciplinary treatment of clefts is complete aesthetic and functional rehabilitation of the patient. But is it possible to also achieve a physiological swallowing pattern? MATERIAL AND METHODS: At the Rostock cleft center patients are treated by an interdisciplinary approach from their day of birth until their 18th year of life. Tongue position during swallowing was investigated in 117 consecutive patients. They were assigned to four groups. The control group consisted of 197 age-matched patients receiving non-cleft orthodontic treatment. RESULTS: Patients with clefts of only the primary or only the secondary palate achieved physiological swallowing in 87% or 88% of cases at the age of 18. Of the unilateral CLP cases, 74% also had a physiological swallowing pattern, but in patients with bilateral complete clefts this pattern could be observed in only 46%. In comparison, 95% of non-cleft patients achieved a physiological swallowing pattern following orthodontic and speech treatment at the age of 18. The so-called anterior swallowing pattern was the pathological pattern found most often in cleft and non-cleft patients. CONCLUSION: In most cleft patients interdisciplinary treatment leads to a physiological swallowing pattern. Only patients with bilateral clefts of lip and palate have a critical prognosis. They need special care and attention.

Adolescent↗

PubMed2001

Prosthetic treatment need in a representative German sample.

Regarding declining resources epidemiological data on needs for oral rehabilitation are required. Within the framework of an oral health survey a non-stratified two-stage random sample was taken to represent the over 14-year-old population of Saxony/Germany. The participation rate was 55%. Normative need was determined by dental assessment and guidelines developed in a consensus process, subjective prosthetic treatment need by self-complete questionnaire. About 97% of the realized sample could be planned within the guidelines. About 81% had normative prosthetic treatment need. Compared with the rate of normative need the rate of subjective need (13%) was considerably lower (chi(2) P < 0;01). Different predictive parameters of subjective need were identified by logistic regression. Besides other factors subjective need was associated with giving dentist's recommendation as significant reason for prosthetic restorations [odds ratio (OR)=5;43], not believing that the own teeth were all right (OR=0;17), and the existence of prosthetic restorations (OR=3;87 for fixed restorations; OR=4;05 for removable dentures). The guidelines proved their suitability to assess normative prosthetic treatment need in oral health surveys. Further research is necessary to find adequate options for including patients' preferences in an adequate need definition.

Adult↗