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PubMed2002

Implant prosthodontics in medically challenged patients: the University of Toronto experience.

A series of prospective studies started in the mid-1980s at the University of Toronto have provided evidence of the efficacy and effectiveness of implants in the treatment of the fully and partially edentulous patients. These studies have focused primarily on treatment outcomes at the surgical and prosthodontic levels, with an overall failure rate of 7.7% over a 20-year period. Because a considerable proportion of these failures (4.2%) occurred before insertion of the prosthesis, and because osseointegration is essentially a wound-healing process, factors that interfere with healing, including systemic conditions, may contribute to implant failure. This paper reviews studies on the impact of selected systemic conditions, including osteoporosis, cardiovascular diseases, diabetes mellitus, and hypothyroidism, as well as smoking behaviour, on the success or survival of oral implants in patients treated in the Implant Prosthodontic Unit at the University of Toronto.

Cardiovascular Diseases↗
PubMed2002

Implant prosthodontic management of posterior partial edentulism: long-term follow-up of a prospective study.

OBJECTIVE: This paper reports on the long-term outcome of implant-supported posterior-zone prostheses in the first 35 consecutive, partially edentulous patients treated in the Implant Prosthodontic Unit (IPU) at the University of Toronto, Toronto, Ontario. METHODS: A total of 106 Brånemark dental implants were placed in 46 posterior edentulous spans in 35 patients for the management of multiple missing teeth; the patients were followed prospectively. Treatment planning principles involved a minimum of 2 or 3 implants at each edentulous site and scrupulous occlusal prosthodontic designs. RESULTS: The overall survival of posterior implants was 94%. No factors in the patients' history adversely affected implant survival. CONCLUSIONS: This clinical update suggests that the use of Brånemark implants in the rehabilitation of patients who are partially edentulous in the posterior zone is highly effective and that survival of the implants is excellent.

Adult↗
PubMed1997

[A prosthodontic concept using implants in the resorbed edentulous maxilla].

For the treatment of the atrophic edentulous maxilla implant supported overdentures provide the opportunity to obtain proper lip support, speech and cleanliness. A superstructure with high rigidity is needed for an optimal distribution of occlusal loading, to ensure good prognosis for implant survival. A prosthodontic concept using a hybrid construction meets these criteria. It consists of a cast and precision-milled mesostructure fixed to the implants, over which that a removable cast prosthodontic device is placed to which the teeth are attached. It is essential to follow a strict treatment protocol to obtain a good and predictable result.

Alveolar Bone Loss↗
PubMed1999

Management of anterior spacing with orthodontics and prosthodontics.

Closing maxillary and mandibular diastemas is facilitated by a multidisciplinary approach involving orthodontics and prosthodontics. This case study demonstrates the management of a discrepancy in maxillary and mandibular anterior tooth widths. The problem is resolved by limited orthodontic treatment followed by porcelain laminate veneers. Anterior spacing is one of the major reasons adults seek esthetic treatment. Multidisciplinary treatment (periodontics, orthodontics and/or prosthodontics) is often indicated for an optimal result.

Adult↗
PubMedDate not supplied

Long-term prosthodontic follow-up and revisional treatment of patients with cleft lip and palate: case presentation.

PURPOSE: The purpose of this article is to draw attention to the need for regular life-long follow-up care of cleft lip and palate patients to maintain adequate masticatory function, speech, and esthetics, thereby supporting psychosocial function. MATERIALS AND METHODS: Initial and revisional prosthodontic treatments over a period of 32 years in a patient with a bilateral cleft lip and palate are described. RESULTS: Despite an initial dentition of poor health and prognosis and suboptimal patient cooperation, it was possible to arrive at an improved clinical and radiologic state of oral health by the end of the observation period. CONCLUSION: Regular life-long prosthodontic follow-up with adequate maintenance and revisional treatments should be regarded as an essential part of the long-term care for subjects with clefts.

Adult↗
PubMed1997

Prosthodontic treatment for patients with large mandibular defects; porous hydroxyapatite grafts.

It is difficult for both prosthodontists and their patients with large marginal defects to achieve a satisfactory prosthodontic result, because retention, support, and stability of the prosthesis are limited and recovery of esthetics is unsatisfactory owing to large mandibular defects. Alveolar ridge augmentation therapy is performed to compensate for such problems. We have experienced a good prognosis of prosthodontic treatment for over 10 years in two patients with large marginal defects of the partially edentulous mandible, who had undergone grafting of porous hydroxyapatite blocks to their bone defects. It has been reported that porous hydroxyapatite blocks are unsuitable for edentulous patients, because the mucosa covering the hydroxyapatite block is too thin and delicate to support dentures. We, therefore, designed the denture to prevent concentration of occlusal stress on the mucosa. In both of these two cases, we achieved recovery of occlusal function and esthetics by affixing denture to the large marginally resected defect augmented with a graft of porous hydroxyapatite block.

Adult↗
PubMed2002

Screening of fixed prosthodontic dentures after five years of use in relation to material and construction.

The aim of this study was to screen patients with fixed prosthodontic appliances that were in oral cavity for a period of 5 years or more and to assess clinically and radiologically root caries, gingival recession, pocket formation, alveolar ridge resorption, as well as gingival (GI) and plaque index (PI). The aim also was to find out the differences between materials and constructions, between abutment and non-abutment teeth, and to find out the need for replacement. A total of 260 patients and their orthopantomograms were examined, with a total of 2,265 teeth, 610 being bridge abutments and 246 being crowns. The most frequent were metal+ acrylic veneer crowns or bridges. Root caries was found under the abutments in 10-20%; however abutments with ceramic crowns had the lowest percentage of caries (p < 0.01). Alveolar ridge resorption, pocket formation deeper than 3 mm and gingival recession of various degree was found in 50% of the cases, again with the lowest percentage of ceramic-fused-to-metal appliances (p < 0.01). Pocket depth was registered in significantly higher percentage in metal-acrylic veneer appliances compared to natural teeth (p < 0.01), while there was no significant difference between metal-ceramic appliances and natural teeth (p > 0.05). Although the worst findings were recorded for metal- + acrylic veneer crowns for PI, no significant difference existed between crowns of different material or non-abutment teeth (p > 0.05). There was statistically significant difference between abutments with metal + acrylic veneer crowns, full metal crowns, metal ceramic crowns and non-abutments for GI scores. Higher percentage of scores 0 and 1 was recorded for metal ceramic crowns and non-abutments and significantly higher percentage of scores 2 and 3 was recorded for metal + acrylic veneer crowns and full metallic crowns. Almost 50% of metal-ceramic abutments had no pathologic findings. Almost 30% of the patients needed replacement, or even some abutments to be extracted and therefore a new prosthodontic appliance.

Dental Implants↗
PubMedDate not supplied

Prosthodontic status among old adults in Pomerania, related to income, education level, and general health (results of the Study of Health in Pomerania, SHIP).

PURPOSE: The aim of the study was to evaluate associations among prosthetic status, socioeconomic factors, and general health of subjects aged 55 to 79 years. The data were taken from the Study of Health in Pomerania (SHIP). MATERIALS AND METHODS: Socioeconomic information (age, sex, education level), medical information (number of diseases), and details on smoking and alcohol consumption were obtained. Prosthetic status in the maxilla and mandible was classified into complete denture (CD), removable partial denture (RPD), > or = 10 natural teeth or teeth replaced with fixed prosthodontics (10T+), and < or = nine natural teeth including fixed prosthodontics (9T-). RESULTS: The data of 1,877 subjects were evaluated. CDs in the maxilla were more frequent than in the mandible. RPDs were more frequent in the mandible and in the group aged 65 to 74 years. Of the individuals with a low education level, 47% had a CD in the maxilla, and only 21% had 10T+. However, of subjects with a high education level, 22% had a CD in the maxilla, and 54% had 10T+. The odds ratio of having a CD in the maxilla increased to 11.9 at the age of 75 to 79 years, compared to 0.6 at the age of 55 to 59 years. Logistic regression analyses showed that the risk of wearing a CD was significantly associated with old age, low education level, low income, smoking, and alcohol abuse, whereas the number of diseases (used as an indicator of general health) was not. CONCLUSION: Alcohol abuse, smoking, low education level, low income, and old age were significant predictors of wearing CDs.

Age Factors↗
PubMedDate not supplied

Computer-assisted maxillofacial prosthodontics: a new treatment protocol.

PURPOSE: This article presents a new treatment protocol in maxillofacial prosthodontics. MATERIALS AND METHODS: A case report of a patient suffering from an orbital defect after tumor resection is presented. To explain the treatment protocol, the procedure of fabricating an implant-retained orbital prosthesis for this patient is discussed. RESULTS: After tumor resection, implants were placed and a prosthesis was made based on both a CT scan and computer-supported technology. CONCLUSION: The integration of several existing techniques in and outside the field of maxillofacial prosthodontics led to a treatment protocol that was shown to be beneficial in the presented case and others.

Eye Neoplasms↗
PubMed2003

Use of mandibular implant overdentures: treatment policy in prosthodontic specialist clinics in Sweden.

The aim was to examine the use of mandibular implant overdentures in Swedish prosthodontic specialist clinics. Questionnaires related to treatment with mandibular implant overdentures during 2001 were sent to the heads of the 30 prosthodontic specialist clinics of the Public Dental Health Service in Sweden. Completed questionnaires were received from 28 (93%). The number of treatments with mandibular implant overdentures varied much among the clinics (0 to 22). Seven clinics had not performed any such treatment, and the median number was 2. The number of fixed implant-supported prostheses was much higher (median value 17, range 4 to 100). The correlation between the number of implant overdentures and fixed implant-supported prostheses in edentulous mandibles was weak (r = 0.33; P = 0.10). The most common anchorage system was ball attachments on two unsplinted implants. The most common reason for the choice of the overdenture treatment was the reduced cost, whereas the patient's main wish to improve denture retention came next. The question whether the demand for implant overdentures had increased during the last few years, was answered with "no" by 19, with "yes" by 5 and with "don't know" by 4 clinics. All but one responded that their attitude to implant overdentures had not changed after the introduction of free pricing in Swedish dentistry. It can be concluded that compared to the rapidly increasing international use of mandibular implant overdentures, this treatment of edentulous patients is rare in Sweden, where fixed implant-supported prostheses still are predominant.

Dental Clinics↗
PubMed2003

The partially edentulous patient: fixed prosthodontics or implant treatment options.

The replacement of missing teeth by conventional fixed partial dentures or by implant supported prostheses occupies a major portion of the average restorative and prosthodontic practice. New materials, techniques, and technologies are constantly being added to our armamentarium. The demand for fixed prosthodontic patient services will continue to grow. It is the ultimate duty of the provider of these services to utilize an evidence-based rationale when determining the best possible treatment for the partially edentulous patient.

Dental Implants, Single-Tooth↗
PubMed2003

Implant prosthodontics: what next?

Treatment concepts that are "ideal" from a medical perspective, representing an excellent simulation of missing tissues (alveolar ridge, teeth), are not automatically tantamount to high treatment cost and difficult clinical procedures. An analysis of different treatment concepts has shown that relatively simple implant-borne solutions are made possible by preserving and integrating elements of the residual dentition; by not including complicated and technically elaborate constructions (such as screw fixation, attachments, splints); and by using prefabricated components (abutments shaped extraorally; conical crowns). In this context, there cannot be a single clear-cut answer to the question, "Implant prosthodontics: What next?"; it can be answered only in terms of probabilities. There is one certainty: implant prosthodontics is here to stay, whatever its path and whatever its destination, and it will become established as an essential--a constituent part of current-day dental practice. As so often happens with medical progress, what once was a very specialized treatment modality is becoming a standard procedure. The concomitant cost reduction will allow us to apply treatment concepts that include implant procedures in a much larger number of cases than today.

Alveolar Ridge Augmentation↗
PubMedDate not supplied

A simplified technique for making an interocclusal record in fixed prosthodontics.

A technique for using flowable composite resin for making interocclusal records in cases involving fixed prosthodontics is described. The precise relation of maxillary and mandibular casts is an essential step in developing accurate occlusion in fixed prosthodontics. This technique consists of direct intraoral fabrication of transfer copings and an interocclusal record using flowable, light-activated composite resin. The technique is simple, does not require advance preparation and can be done during the final impression appointment.

Composite Resins↗
PubMedDate not supplied

Implant-prosthodontic treatment for special care patients: a case series study.

PURPOSE: The aim of the study was to assess implant survival and complications with implants and prostheses in patients exhibiting a variety of systemic diseases and congenital defects. MATERIALS AND METHODS: Patients with specific medical conditions are regularly treated at the Department of Prosthodontics, University of Bern, Switzerland. All those who had received implant-prosthodontic treatment during the past 12 years were reexamined for this study. Among these patients the following diseases were observed: cleft lip/palate (n = 8), Down syndrome (n = 3), Sjogren syndrome and scleroderma (n = 2), ectodermal dysplasia (n = 4), developmental retardation (n = 2), chronic leukemia (n = 2), lichen planus (n = 1), cerebral palsy (n = 1), deaf-muteness (n = 1), amyotrophic lateral sclerosis (n = 1). At the time of the treatment the mean age was 55.6 years. ITI implants had been placed according to a standard protocol with local anesthesia, except for one patient in whom full anesthesia was used. One hundred three implants were loaded and supported a total of 34 fixed or removable prostheses. All patients were appointed to a regular maintenance care program. In the context of the present study, all but 1 patient were reexamined clinically. New radiographs were obtained, and the implants and prostheses assessed. Additional information was obtained from regular records in the patients' charts. RESULTS: Three implants were lost in the healing phase, and 1 implant was replaced. Only 1 patient with 4 implants was lost from the study (she had passed away). The survival rate of the loaded implants was 100%. In 1 patient, peri-implant bony defects were detected around all 3 intraforaminal implants. The prosthetic plan was maintained in all patients, and they continued to wear the originally planned type of prosthesis. Complications included insufficient hygiene, soft tissue hyperplasia, extraction of remaining teeth, and minor maintenance or repair of the prostheses. CONCLUSIONS: So far, the mostly unknown implications and possible risks for the process of osseointegration and long-term maintenance in patients with such rare diseases and defects has resulted in a rather restricted application of implants. However, from the present results, it appears that implants can successfully be placed and maintained. This is ascribed in part to a strict maintenance care program provided by the caregivers and to a high compliance of the patients who participated in this program to perform good oral hygiene.

Adult↗
PubMedDate not supplied

Fixed prosthodontics centric relation registration technique using resin copings.

The registration of an accurate centric relation is one of the most critical steps in a prosthodontic rehabilitation, yet it sometimes is an uncertain procedure. A technique using resin copings, each supporting an occlusal contact, is presented. By careful, selective addition of resin, the centric relation recording can be controlled. The technique requires a pattern of abutments to provide stability, and is, therefore, primarily applicable to fixed prosthodontics. Nonetheless, it is versatile enough to accommodate a variety of clinical situations.

Dental Occlusion, Centric↗
PubMed1989

The Transosteal implant in the prosthodontic reconstruction of the edentulous mandible.

It is the purpose of this article to review transosteal implants, specifically the Mandibular Staple Bone Plate and the Transmandibular Implant, in regard to their clinical prosthodontic applications. In addition, those aspects of prosthodontic treatment shared will be highlighted and the differences in the techniques will be reviewed.

Dental Implantation, Endosseous↗
PubMedDate not supplied

[Prosthodontic treatment to patients with deep overbite].

After a literature review concerning the special needs in the prosthodontic rehabilitation of patients with deep over-bite, the problems and solutions are described and discussed. The prosthodontic rehabilitation of two cases follows and is described step by step.

Dentures↗
PubMed1979

Considerations in fixed prosthodontics.

More than any other treatment procedure, the success of removable partial denture prosthodontics depends upon planning and coordination of treatment. It is essential that both the patient and the dentist understand and agree upon the approach to be taken. Fixed prosthodontic restorations are often the foundation upon which the removable partial denture is constructed, and their contribution to the overall success cannot be minimized.

Crowns↗