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The problem of an abutment tooth that has become carious and an inadequate support for a CSC prosthesis has been presented. The advantages and disadvantages of the various routine restorative techniques have been discussed. A detailed procedure for restoring a carious abutment tooth that also requires periodontal surgery was described.
Possible contingencies for future natural tooth loss that can and should be built into prostheses have been reviewed. These contingencies provide a measure of security to the patient and the dentist when attempting to maintain teeth that appear to have a guarded prognosis. Without a contingency these questionable teeth would be extracted early in therapy from fear that a completely new prosthesis would have to be made if they were lost at a later time. In maintaining more natural teeth, the patient has better function, more occlusal and vertical support, longer maintenance of the alveolar ridge, more support for the prosthesis, and more remaining teeth to share all the forces. This approach of building in contingencies for future tooth loss allows the patient and the dentist the freedom to attempt therapy on abutments with a guarded prognosis with little financial risk.
The problem of achieving a common path of insertion for a fixed partial denture when a tilted posterior abutment is involved can usually be solved by well planned tooth preparation in conjunction at times with intentional endodontic therapy. When tooth preparation alone cannot solve the problem, the mechanical solutions of the locked attachment and the telescopic retainer are available and must be considered. Other problems involved with the tilted abutment, adjacent tilted teeth, space reduction, supraversion of the antagonist, and the problem of a long-span fixed partial denture were discussed.
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Patients with advanced Duchenne type muscular dystrophy present unique occlusal problems for the dentist. Prosthetic treatment can aid their function and nutrition during the late stages of illness.
The complete mouth reconstruction of a periodontally compromised dentition is a tremendous challenge. Although the treatment is complex, the rewards can be satisfying. In some cases, the use of telescopic copings overcomes several of the problems associated with periodontal prosthetic treatment. This article reviews the advantages and disadvantages in the use of telescopic copings in restorative dentistry.
Eighty-nine patients were evaluated longitudinally for a 10-year period to assess the periodontal health of overdenture abutments and the effectiveness of the overdenture treatment. Of the original group, 28 patients returned for the 10-year recall. Sixty-six of the 77 overdenture abutments were present. Seven of the 11 abutment teeth extractions were because of caries and four were the result of periodontal disease. Most of the abutments have progressively lost attached tissue. Other periodontal indices remained fairly constant. Most of the patients were satisfied with the treatment even though the periodontal assessment was less than ideal.
Forty-six patients who had shown chronic maladaptive behavior in using complete dentures were treated with osseointegrated implant-supported prostheses. Forty patients needed mandibular treatment, three patients needed treatment in the maxillae, and three required treatment in both dental arches. At the most recent data collection (4 to 9 years after surgical placement of the implants), the 49 dental arches remained successfully treated with 44 implant-supported fixed partial dentures and five implant-supported overdentures. The efficacy of the osseointegration technique in maladaptive prosthetic patients is demonstrated in this descriptive study.
A technique for constructing a maxillary removable partial overdenture using the Silicoater system has been described.
The prosthesis described in this article allowed restoration of occlusal height by means of an onlay removable partial denture and composite resin bonded veneers. Reasons for its selection are: 1. It is a reversible procedure. 2. The patient can easily clean any plaque accumulation due to supragingival margins. 3. The cost to the patient was much lower than that of a fixed prostheses. 4. Chair time is less than with a fixed prosthesis. 5. Tooth structure remains relatively unaltered except for recontouring prior to onlay construction. 6. Repairs are easily done. 7. The onlays of the removable partial denture transfer the occlusal load on the abutment teeth along their long axes. 8. The procedure is less stressful and fatiguing to the patient than that involving a fixed prosthesis.
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The development of dental implants has led to an expansion of indications and to perfection of implantation methods and implant systems. Angulation problems due to anatomic limitations, however, still remain. The indications for the use of angled Bonefit I.T.I. implants are described.
Mandibular prostheses supported by implants placed between the mandibular foramina restrict the length of the distally cantilevered components to minimize torque-related stress to the supporting implants. Additional posterior implants used as abutments with rigid attachments better distribute occlusal forces and reduce cantilever torque to the anterior implants. Because of the phenomenon of mandibular flexure, these posterior implants could be subjected to stress-induced microdamage to the bone-implant interface. The use of posterior abutments for support of the cantilever without connection reduces the potential hazard of stress-induced microdamage.
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In an uncontrolled retrospective recall study of 57 patients treated with conical crown retained dentures, 60 restorations (37 in the maxillae and 23 in the mandible jaw) with a mean wearing time of 30.1 months (range 4 to 76) were evaluated. Of the 248 abutments, eight (3.2%) had been lost. Clinically healthy mucosa was seen in 35 jaws. The marginal fit of the copings was judged to be good. No caries or new restorations were observed in 44 patients. Thirteen patients had 19 surfaces with new restorations and 20 surfaces with caries lesions. Of these 39 surfaces, 38 were located subgingivally.
An easy, one-appointment procedure for the modification and conversion of a failed 10-unit FPD into a complete interim overdenture has been described. The benefits to the patient and advantages to the dentist have been noted.