PORCELAIN UPPER TEETH AND PLASTIC LOWER TEETH REDUCE DENTURE SORE SPOTS.
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This article is the first of a series of four. Each one summarizes the clinical and technical prosthetic stages of different types of restorations. This article describes in detail the fabrication of a complete fixed prosthesis using screw type osseointegrated implants.
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1. The load capacity of complete upper dentures objectively proved greater than that of lower dentures. 2. The load capacity and, consequently, the stability of position of the lateral area of upper dentures objectively diminished with advancing time of wearing, but increased in the lower jaw. 3. The stability of complete dentures is not determined exclusively by the quality of the denture bearing tissue. 4. The measured stability of position of complete dentures did not correspond with the subjective impression of full function; in general, this was stated to be as good as ever by all patients.
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The purpose of this article is to highlight the clinical problems encountered in the treatment of edentulous patients with atrophic (flat) mandibular ridges. With provision of complete dentures in general dental practice in mind, an impression technique is described and illustrated. The specific objective of the technique discussed is that patients, for whom implant treatment is not a realistic' option, may have improved denture function of their lower complete dentures.
Today, Japan as a society is aging. The average life expectancy of Japanese people is approximately 80 years. One result of this is that preservation of masticatory functions in elderly people has become increasingly important from the viewpoint of quality of life. In the future, the use of dentures in facilitating masticatory functions as a substitute for teeth that are lost during the aging process will assume greater significance. Accordingly, appropriate evaluation and judgment of complete dentures for edentate jaws is crucial. This study was designed to elucidate the effects of the craniofacial form in complete denture wearers on the mode of activity of gnathic functions. First, subjects wearing complete dentures in both the upper and lower jaws were instructed to carry out vertical clenching, and bite force direction was determined. These data were then related to the subject's craniofacial morphology. These results suggest that the bite force direction in complete denture wearers is not affected by gender differences, but is closely associated with lateral craniofacial morphology, and that appropriate setting of occlusal plane and the occluded vertical dimension is extremely important in the preparation of complete dentures.
Clinical experience in the prosthetical care of edentulous patients shows that primarily patients wearing dentures for the first time express the desire, after a few months, to have original denture adhesion restored. Especially for complete lower dentures diminishing adhesion is unfavorable. Measurements regarding the adhesive strength of complete lower dentures of 34 patients showed that adhesive strength is decreasing. This was measured and statistically evaluated in this investigation. 33 percent of the original adhesive strength is lost within 6 months. With originally strong adhesion (2, 000 p) this reduction is more drastic than with originally small adhesion (200 p). It was not possible to establish that adhesive strength is declining preferably as a result of a specific anatomic situation.
STATEMENT OF PROBLEM: Complete dentures typically fracture along the midline due to crack initiation and propagation from stressed areas. Therefore, it is important to characterize the magnitude and direction of maximum stresses developed in the midline of dentures. PURPOSE: The purpose of this pilot study was to determine the midline stress field of a mandibular complete denture under different loading conditions, and to compare this with the corresponding field of a maxillary denture to identify whether significant differences in maximum stresses between these 2 stress fields are responsible for the higher rate of failure seen clinically in maxillary dentures. MATERIAL AND METHODS: The identical casts used in this study were fabricated with commercial molds. Two complete acrylic resin dentures (1 maxillary and 1 mandibular) that were used in a previous study were selected as prototype dentures for this study. The mandibular acrylic denture was used to fabricate a 2-piece mold from silicone (upper half) and polymethyl methacrylate (PMMA) sheets (lower half) that was subsequently used to produce 3 identical mandibular complete dentures. The single maxillary acrylic denture was used to load the mandibular dentures. A rosette strain gauge was cemented onto the midline of each of the 3 mandibular dentures. The test conditions, including the fabrication of the casts used to induce loads, simulation of oral mucosa, loading procedure, strain measurement, and stress calculations, were identical to those used in a previous investigation of maxillary complete dentures to allow a direct comparison between maxillary and mandibular dentures. The Mann-Whitney test (alpha=.05) was used to quantify the differences in the stress magnitudes between maxillary and mandibular complete dentures. RESULTS: The stresses in the mandibular denture differed both qualitatively and quantitatively from those in the maxillary denture. The midline stress field of the mandibular complete denture was characterized by 2 low compressive principal stresses and a low maximum shear stress, whereas the corresponding stress field of the maxillary complete denture was characterized by a high principal tensile stress and a high shear stress. These differences between the stresses of maxillary and mandibular dentures were statistically significant (P<.001). CONCLUSION: The differences in stress patterns between mandibular and maxillary complete dentures as determined by this study, which also used data from a previous study, may be the primary reason why maxillary dentures fracture more often than mandibular dentures.
An 11-year clinical research study was conducted with both unloaded bulk hydroxyapatite implants and loaded hydroxyapatite-coated titanium implants. A total of 102 submerged bulk hydroxyapatite implants were placed after extraction of teeth to maintain the volume of the residual alveolar ridge by their physical presence. All 21 implants under fixed partial dentures and 51 of 81 implants under lower complete dentures remained submucosal. A total of 71 hydroxyapatite-coated titanium implants were connected with permucosal superstructures by use of a two-stage method. Modifications in design and in implantation technique were required. This long-term research indicates that cylindrical hydroxyapatite implants are reliable devices as natural tooth root substitutes that bond directly to bone instead of simply being osseointegrated.
The Astra Implant System (AIS) is a biologically sound and simple way of providing stability for the complete lower denture where anatomical changes have made retention, stability and comfort difficult to achieve. An ongoing clinical study has been undertaken where 20 patients have been provided with magnet retained overdentures using this implant system. This represented a total of 70 implants placed. Seven implants were removed from four patients (three at exposure, one infection). The remaining implants have been followed up for 12 to 25 months and are considered to have achieved successful osseointegration. All the patients in the study are successfully wearing a lower denture retained by magnets. The overall success rate for the implants placed is 90% but if implants less than 9 mm in length are excluded from the results then the success rate is 97.7%.