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A new implant position registration technique utilizing an autoclavable thermoplastic material is described. This technique, which has been in use since 1994, allows the clinician to fabricate a provisional restoration for insertion at stage II surgery to enhance the soft tissue contour and the aesthetics of the final restoration.
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BACKGROUND: The advantages of placing implants in fresh extraction sockets and putting them in immediate/early function are many. A predicable protocol opens the possibility of performing a single surgical procedure, giving the patient a temporary prosthesis immediately, and minimizing the shrinkage of hard tissue and soft tissue recession. PURPOSE: The aim of the present study was to develop a strict protocol for and to evaluate the feasibility of immediate/ early function on implants placed in fresh extraction sockets located in maxillae and posterior mandibles, including defects around the implants treated according to a regenerative procedure. MATERIALS AND METHODS: Nineteen patients were treated after tooth extraction according to an immediate function protocol and were observed for 18 months. Fifty Mk IV TiUnite (Nobel Biocare AB, Göteborg, Sweden) implants were installed in partially edentulous areas in maxillae (n = 17) and posterior mandibles (n = 5). Implants were installed directly into the alveoli, and the temporary prostheses were connected immediately after surgery (n = 11) or within 7 days, that is, an "early function" procedure (n = 11). Thirteen implants did not require any type of regenerative procedure, whereas the remaining 37 implants had filling with autogenous bone, 4 of which also had a resorbable membrane. Standardized intraoral radiographs were taken for evaluation of marginal bone level, and 38 of the implants were systematically checked by resonance frequency analysis. RESULTS: All patients were followed for 18 months, and none of the 50 implants failed. However, one implant showed signs of failure after 6 weeks, but once the occlusal load was removed, the implant regained its stability completely, no longer demonstrated symptoms, and could be used successfully for prosthetic rehabilitation. The mean value of the implant stability quotient was 60 at baseline (range 45-75) and 63 after 6 months (range 46-75). The marginal bone resorption was 0.9 mm (SD 1.1 mm; n = 48) 18 months after implant insertion (1 year after final prosthesis). CONCLUSION: The immediate placement of implants into fresh extraction sockets combined with immediate/early function procedures seems to be a safe and reliable procedure when using a strict protocol.
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OBJECTIVES: This in vitro study evaluated the fracture load of interim FPDs made with various materials and pontic heights. The hypothesis was that different materials and pontic heights result in different fracture resistance. METHODS: Groups of interim FPDs were fabricated with prosthodontic resin materials on two abutments with two different pontic heights (4.3 and 5.8 mm) and a pontic width of 4 units (19 mm) (n = 3). The following materials were tested: (1) a thermoplastic polymer (Promysan Star), (2) Promysan Star with a veneering composite (Vita Zeta), (3) a non-impregnated polyethylene fiber reinforced resin (Ribbond) with a veneering composite (Sinfony), (4) an impregnated fiber reinforced composite system (Targis/Vectris), and (5) a conventional poly methyl methacrylate (PMMA) (Biodent K+B, control group). After 5000 thermocycles, the FPDs were temporarily fixed with a provisional cement on the corresponding abutments and tested for fracture strength. One-way and two-way ANOVA and Bonferroni-Dunn's multiple comparison tests were performed for the statistical analysis (alpha = 0.05). RESULTS: The mean fracture strength ranged from 83.0 to 625.9 N for a pontic height of 4.3 mm and from 97.2 to 893.7 N for a pontic height of 5.8 mm. Vectris/Targis FPDs of both pontic heights exhibited significantly superior fracture resistance compared to the corresponding Promysan, Promysan/Vita Zeta, Ribbond/Sinfony and Biodent groups. Except Biodent FPDs, fracture resistance of FPDs with a pontic height of 4.3 mm showed no significant differences compared to a pontic height of 5.8 mm for each material. SIGNIFICANCE: Material type of the FPDs has a significant influence on the fracture strength, whereas pontic height has no significant effect (except control group).
An interim denture technique is presented describing the fabrication of an esthetic prosthesis that is used for short periods of time. The prosthesis conditions the patient for the acceptance of an artificial substitute for missing natural teeth until more definitive prosthodontic therapy can be provided. All the teeth in the arch are extracted simultaneously, and the interim prosthesis is inserted immediately thereafter. The prosthesis duplicates the morphology, color, and position of the extracted teeth. This technique satisfies a great need of socially and business-active patients because there is no interruption in their activities and no change in facial esthetics. Two case histories are presented.
We evaluated the effectiveness of a dentist-implemented intervention in which brief escape from dental treatment was provided to manage disruptive child behavior during restorative dental treatment. Within a multiple baseline design across subjects, 4 children, aged 3 to 7 years, were provided temporary escape from dental treatment contingent upon brief periods of cooperative behavior. Disruptive behavior decreased when the appropriate escape contingency was used at least 80% of the time. The escape contingency required no more time than traditional management procedures (e.g., tell-show-do, reprimands and loud commands, restraint) to bring disruptive behavior under control. Independent ratings by two dentists provided social validation of the efficacy of the escape contingency.
Many patients attend their dentist for advice, and often treatment, for tooth wear. Poor appearance and inadequate function are the most common presenting complaints but occasionally treatment is needed for acute or chronic pain or sensitivity. Although patients often prefer a fixed replacement for the missing tooth structure this is not always possible or appropriate. This article presents the practical aspects of managing patients with advanced tooth wear using removable partial dentures.
PURPOSE: Polymers used in interim fixed partial dentures (FPD) have recently been reinforced with fibers. The aim of this study was to determine the influence of the position of the fiber reinforcement on the fracture resistance of interim FPDs. In addition, the influence of quantity of fibers and the length of span of the FPD on the fracture resistance was investigated. MATERIALS AND METHODS: FPDs were fabricated from a resin mixture of polyethylmethacrylate powder and n-butylmethacrylate liquid. Five FPDs from each group were made, and the FPDs were stored in water for 30 days before testing. The FPDs in the control group were unreinforced, and in the other groups the FPDs were reinforced either with two or three unidirectional continuous glass-fiber reinforcements and one woven glass-fiber reinforcement. Different quantities of fibers were used and the fibers were placed in different locations in the FPD. The load was applied to the FPD by a steel ball placed in the cavity in the middle fossa of the pontic tooth. RESULTS: The load required to fracture the unreinforced FPDs varied from 372 to 1061 N. Mean fracture load of reinforced FPDs varied from 508 to 1297 N. One-way analysis of variance showed that the length of span and the quantity of fibers significantly affected the fracture load (P < 0.001, n = 5). By lengthening the span of the FPD, the reinforcing effect of glass fibers became more obvious. CONCLUSION: The results of this study suggest that the effectiveness of glass-fiber reinforcement is most evident in interim FPDs with long spans and that the positioning of reinforcement considerably influences the strength of the FPD.
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The purpose of this research is to evaluate the clinical problems associated with microleakage of different restorative materials. We have compared the microleakage when we restore Class II cavities in primary molars with amalgams and with posterior composite resins. The results of this study suggest that posterior composite resins present more frequently pulp inflammation, necrosis, marginal discoloration and secondary marginal caries. This factors mus to be considered when we choose a material for temporary restoration.
Provisional restorations are fabricated to protect the prepared tooth structure during the period between tooth preparation and insertion of the definitive restoration. These restorations are also referred to in the literature as interim, temporary, or provisional restorations (prostheses). Such restorations should be uncomplicated and inexpensive to fabricate in a short period of time. Several laboratory and clinical techniques for the fabrication of provisional restorations have been described in the literature, such as the indirect technique, direct technique, and indirect-direct techniques for both single and multiple unit restorations. This article describes a step by step clinical technique for the fabrication of a direct provisional restoration to satisfy the issues of esthetics, patient comfort, speech and function, maintenance of periodontal health, and maxillomandibular relationships while wearing the restoration.
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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.
Immediate loading of dental implants can reduce treatment time and management concerns, thus increasing patient acceptance. This paper reports the authors' preliminary experience with partially edentulous patients having received non-occlusally loaded provisional restorations within 24 hours of surgery, compared to patients treated according to an early loading protocol. The present data suggest that implant supported fixed partial prostheses can be immediately non-occlusally loaded and restored with a predictability similar to early loaded implants.
The case history of a six-year-old girl who underwent endodontic treatment by a non recommended technique. It was decided to perform integral treatment anew, this time with techniques and materials adequate for the restoration and renewal of temporary dentition.