Current status of dental implants: a periodontal perspective.
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This article presents a procedure for refining margins of provisional implant crowns. This procedure uses an analog of the implant and abutment. This procedure allows functional and esthetic considerations such as emergence profiles, symmetry, diastemas, embrasures, size, contours, position, angulation, and relation to other teeth to be evaluated.
The aim of this study was to compare the complication rate of two implant systems with different prosthodontic concepts: rigid conical or resilient support of the suprastructure. In 66 patients, 138 ITI implants were inserted whereas 31 patients received a total of 50 IMZ implants. Over an average observation period of 3.5 years (range from 0.5 to 8 years), not only was implant survival recorded, but also prosthodontic complications such as screw loosening, fractures of screws, inserts (intramobile elements, intramobile connectors) and abutments, as well as fractures of metal framework and veneers. With the ITI system, 28.8% of all devices placed exhibited such problems during the observation period. With the IMZ system, this rate was significantly higher (P < 0.05), in that 77.4% of all reconstructions required a repair at some point. The various complications were divided into those occurrences which affected only the suprastructure, i.e., failures of frameworks, veneers, bar devices or other retentive elements, and those which involved implant components per se, such as screws and abutment components. In the first category, adverse effects occurred more frequently with ITI-supported prostheses (15.1%) versus IMZ suprastructures (6.4%). Regarding complications with implant components, the rate with IMZ components was considerably higher (71%) compared with ITI (13.5%). This was mainly due to the presence of intramobile elements (IME) and connectors (IMC) in the IMZ system. In this retrospective study, precise fitting, non-resilient abutment components leading to rigid connections of suprastructures, proved to be clinically more successful than resilient anchoring components.
Magnetic resonance imaging is used more and more frequently as a diagnostic tool. Because high magnetic fields are used, knowledge on how these will affect implanted material and the patient is of great importance. Ferromagnetic properties of implant materials are seldom described by the manufacturer, but a doctor requesting magnetic resonance imaging of a patient must know about these properties. Not only is the composition of an alloy important, but also the size and shape of the metallic material as well as its position in the body. Implants from the Brånemark System were tested; findings indicated that the implants were not influenced when exposed to magnetic resonance imaging. The artifacts caused by the implants were minor and did not jeopardize the evaluation of the scans. However, magnet keepers attached to the implants were found to cause major artifacts and must be removed before an implant patient is referred for a magnetic resonance imaging examination.
Bilateral migration of teeth into the coronoid process in a patient with ectodermal dysplasia has not been reported in the literature except one report in which severe hypodontia and bilaterally ectopic impacted teeth in the coronoid processes of a nonsyndromic patient occurred. This article presents a 15-year-old female with hypohidrotic ectodermal dysplasia who had surgical removal of bilaterally impacted teeth in the coronoid process and was rehabilitated with a dental implant-retained fixed prosthesis in the mandible and over-denture in the maxilla.
Finite element analysis (FEA) was employed to assess patterns of stress in bone adjacent to an implant after application of loads through an attached distal extension cantilever. Under all loading conditions, the highest stresses occurred at the distal cervical bone margin adjacent to the cantilever. In clinical studies, this is not consistently the site of the greatest bone changes seen radiographically. This suggests that extrapolation of FEA studies to clinical implantology should be approached with caution until further data become available on both mechanical properties of bone and patterns of bone remodelling induced by defined functional stresses in mandible and maxillae.
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A solution to the problem of missing posterior teeth is presented. The prerequisite for solving this problem is that the remaining teeth must be positioned in one form or another in a triangle, as one can see in Figs. 2, 3 and 4. The tripod effect, in connection with the controlling effect of the mechano-receptors in the periodontal ligaments of the remaining abutment teeth, permit us to construct a functional fixed prosthesis. The feather-edged or knife-edged preparation technique creates long axial walls. Together with the parallel prepared abutment teeth, this must be viewed as the main-retentive feature for fixed prostheses with multiple cantilevers. In extreme situations, where one is uncertain about the outcome of a case, provisional laboratory fabricated restorations are excellent for evaluating the stability of the cross-arch splinted teeth. The whole bridge occasionally shows some mobility. As long as the mobility shows no increase over a period of time, and does not interfere with the patient's chewing ability, a permanent bridge with multiple cantilevers can be inserted. I usually include no more than three cantilevered pontics on each side of the arch in a multiple cantilevered bridge. A second molar is not replaced by a third cantilevered pontic. Its position in the arch may cause an overly strong lever action on the fixed prosthesis.
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The clinical analysis of 462 patients (154 men and 308 women) with problems of implant therapy done at other clinics is reported. They visited the clinic for oral implant of the Tokyo Medical and Dental University Hospital during the period from January 1996 to March 2002. The results were as follows: 1) The majority of the patients (76.6%) were 40 to 69 years of age. 2) Of the total patients, 26.8% had been referred from the other outpatient clinics in our hospital, 14.7% from private dental offices and 2.6% from attending doctors. 3) There were 361 patients with complications related to the implant therapy. Seventy-six patients asked for second opinions concerned about a diagnosis or treatment recommendation. Thirty patients required maintenance of the implants. 4) The most common complications observed were peri-implantitis (184 cases). Prosthodontic complications (72 cases) included framework/resin/veneering material fractures, screw loosening and fractures. There were implant fractures in 21 cases, sensory disturbance in 20 cases, problems related to sinus in 13 cases, problems of connected teeth in 30 cases and phonetic/esthetic complications in 10 cases. 5) The types of problem implants were osseointegrated implants (196 cases), alumina-ceramic implants (74 cases), metallic blade-type implants (35 cases), pin-type implants (10 cases), subperiosteal implants (6 cases) and other implants.
This article is designed to help an athletic team dentist treat dental athletic injuries with implants. The different emergency situations that the team dentist will face are discussed, and an attempt is made to group the most likely implants that he or she may encounter. Advantages and disadvantages of each of the implant groups available are discussed in relation to the particular type of bone morphology resulting from athletic dental injuries. Currently, there are 58 root-form implants being sold, with new ones coming out monthly. The athletic team dentist is interested primarily in immediate single-tooth replacement systems, which can be classified into single-tooth blades and root forms. The latter groups can be subdivided into press-fit, cylindrical hollow baskets, cylindrical screws, and cylindrical fin-shaped implant systems. Certain implants systems have been selected, and their advantages and disadvantages described in detail. In addition, similar implants of each type are presented. Some implants which have more efficient prosthetic and delivery systems are mentioned. Several early devices are discussed as well, because the team dentist may encounter one of these in his practice. This paper will serve as a guide for the dentist who assumes the responsibility of treating athletic injuries with the use of dental implants.
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PURPOSE: Evaluation of prosthetic complication was performed on 236 patients treated with 528 implants in an 8-year private practice experience. MATERIALS AND METHODS: The study sample included 55 overdentures (ODs) and 265 fixed partial dentures (FPDs). Among the latter, 231 FPDs were cemented and 34 were screw-retained. The type and frequency of prosthetic incidents were recorded, including adjustments and complications. Statistical analysis was performed using a chi-square test to identify risk factors associated with complications. RESULTS AND DISCUSSION: Over this period, 1 abut ment fractured and 2 became loose, leading to a cumulative implant component success rate of 99.2%. Patients with removable prostheses had more complications than those with fixed ones, 66.0% versus 11.5%; the difference was significant (P < .001). Posterior fixed prostheses had more complications than anterior ones, 11.0% versus 0%; however, the difference was not significant (P = .16). The complication rates for cemented and screw-retained prostheses did not differ significantly (10.4% versus 5.9%; P = .61). Prostheses with an extension cantilever had more complications, 29.4% versus 7.9%; the difference was significant (P = .01). In the OD group, the ball-retained prostheses had a significantly higher rate of complications than the bar-retained ones (77.5% versus 42.9%; P = .04). In the FPD group, complications were not recurrent; most occurred during the first 2 years, and the rate of complications did not increase with time. In the OD group, 1.3 incidents per prosthesis were recorded. Incidents were often recurrent, and the rate of complications did not decrease with time. CONCLUSIONS: Removable and fixed prostheses were associated with complications at different frequencies and of different types. In the removable group, adjustments and foreseeable complications were numerous, recurrent, and usually easy to manage. Bar-retained prostheses had fewer complications than ball-retained ones. In the fixed group, complications were limited in number and did not increase with time. Complications were restricted to the posterior region.