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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↗

Chewing and swallowing activity of masticatory muscles in patients with a complete upper and a partial lower denture.

The chewing and swallowing activity of jaw-closing muscles was studied longitudinally in 30 partially edentulous subjects who were provided with an immediate complete upper and a partial lower denture. Electromyographic recordings of the anterior temporal and masseter muscles were obtained during habitual chewing of apple and during swallowing of saliva and water, before final extractions and 7 weeks, 6 months, 1 year and 2 years after denture insertion. At the pre-treatment stage, when the patients were chewing with a residual anterior dentition, the mean voltages showed low values compared to findings reported in subjects with a complete natural dentition. After 6 months of denture use, the chewing forces showed significant increases in amplitude, and the increased force of contraction persisted to the 2-year stage. The recordings of swallowing revealed no significant changes in maximal mean voltage during the observation period. However, there was a significant increase in the duration of the swallows after 1 year of denture wearing, which might be related to stabilization of the complete upper denture due to continuing resorption of the maxillary ridge.

Adult↗

Changes in jaw relations, hyoid position, and head posture in complete denture wearers.

In a group of 18 partially edentulous patients provided with immediate complete dentures, changes in hyoid bone position and craniocervical posture were examined on cephalometric radiographs made during 1 year of denture use. The findings indicated that the changes in hyoid bone position largely followed the pattern of forward-upward rotation of the mandible due to ridge resorption. During this course the hyoid position in relation to the cervical spine showed a mean increase. The hyocervical changes, however, showed less variability than the hyomaxillary and hyomandibular changes. The posture of the head and cervical column showed no definite mean changes during the 1-year period. On the other hand, analysis of individual changes revealed that a pronounced decrease in mandibular inclination due to ridge resorption was associated with retroclination of the cervical column and decreased craniocervical angulation. These postural changes may be regarded as adaptive changes to a marked initial change in mandibular position.

Adult↗

Immediate function with the zygomatic implant: a graftless solution for the patient with mild to advanced atrophy of the maxilla.

PURPOSE: In many edentulous maxillae, posterior alveolar atrophy calls for bone grafting. Patient treatment acceptance is increased by eliminating grafting using tilted implants, especially the zygomatic implant in combination with immediate function. The purpose of this study was to evaluate a protocol for immediate function (within 2 hours) of 2 zygomatic and 4 standard implants (Nobel Biocare) supporting a fixed prosthesis in the completely edentulous maxilla. MATERIALS AND METHODS: This clinical study included 14 patients with 83 immediately loaded implants (28 bilateral zygomatic and 55 premaxillary implants) supporting a complete maxillary denture converted to a fixed provisional prosthesis immediately following the surgical procedure. After 6 months of use, a new fixed metal-supported prosthesis was fabricated. RESULTS: Fourteen patients treated with immediate loading of zygomatic implants were followed for at least 12 months. All patients reported minimization of postoperative pain and security during speech, animation, and mastication. No failures occurred during the follow-up period. DISCUSSION: The patients in the study could have been candidates for sinus grafting. With the present concept these patients benefited from a less invasive procedure (1 surgical procedure and no grafting) and immediate rehabilitation (prosthesis attached directly after surgery). CONCLUSION: The high survival rate, increase in patients' immediate functional ability, and reduction of morbidity following the surgical procedure render this procedure a viable treatment option for the completely edentulous maxilla.

Atrophy↗

Immediate loading of definitive implants in the edentulous mandible using a fixed provisional prosthesis: The denture conversion technique.

PURPOSE: This article presents a clinical technique for immediate implant loading in the completely edentulous mandible. MATERIALS AND METHODS: The protocol recommends the placement of 4 to 5 root-form implants in the anterior mandible between the mental foramina. Upon insertion the implants must have favorable primary stability. Abutments are added to the implants and the patient's lower denture is converted into an immediate load provisional fixed prosthesis. RESULTS: The denture conversion technique has been shown to provide predictable results for immediate implant loading in the edentulous mandible. The final prosthesis is fabricated upon integration of the implants in 3 months. CONCLUSION: The denture conversion technique offers several advantages because it may be used with most commercially available implant systems and it incorporates conventional implant components. Guidelines for patient selection, presurgical preparation, implant surgery, prosthesis fabrication, and postoperative care are reviewed.

Dental Abutments↗

[Immediate denture].

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Denture, Complete, Immediate↗