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[Needs and current research directions of biological regenerative medicine in prosthodontic practice--to attain reliable and sophisticated dental implant therapy].

Appropriate dental implants are known to improve the quality of life in totally and partially edentulous patients, as well as to prevent future tooth loss, and so prosthetic treatment modalities have drastically changed recently with reconstruction therapy. However, dental implant therapy did not win the confidence of the dental community in the early developmental stage, until osseointegration between titanium and surrounding bone tissue was discovered and the modality utilizing osseointegration became reliable and produced durable treatment outcomes for long-term function. On the other hand, the biological mechanism of osseointegration has not been clarified yet and the time required for osseointegration is still long, e.g. three to four months. As well, when the implant is applied in the upper posterior region, the acquisition of osseointegration and the long-term survival of the implant are still not clinically adequate. Therefore, to reduce the time required for osseointegration and to regenerate enough alveolar bone mass in the target implantation site, the oral implant modality must be made more useful and potent as one of the treatment options for partial and total edentulism. With this background, we have studied biological strategies for reducing the time required for osseointegration and for regenerating enough alveolar bone mass, e.g., investigation of the specific genes for osseointegration between titanium and bone, nano-level surface modification of the titanium, biodegradable apatite foam for alveolar bone regeneration, application of bone formation-related growth factors with biological scaffold, and autologous cell transplantation of bone marrow derived mesenchymal stem cells. In this article, we review the current status of regenerative medicine being applied in prosthodontics and discuss our future research direction.

Alveolar Process↗

A 15-year clinical evaluation of fixed prosthodontics.

The purpose of the present study was to examine failures of fixed prosthodontics during a period of 15 years and to evaluate the quality of those bridges remaining after this period of time. The study group consisted of 102 patients who received 108 bridges made by the senior students at the Dental Faculty. University of Oslo, in 1967/68. All bridges were made of type-3 casting gold and heat-cured acrylic veneering. The mean age of the patients at the beginning of the study was 48 years. Of the original group of 102 patients, 88 attended the clinical examination after 5 years, 71 after 10 years, and 55 after 15 years. Of the 343 abutment teeth 25% were root-filled and restored with post and core. During the 15 years' observation period 26 bridges were lost or had to be remade because of failures. The mean time of service for these bridges were 10.5 years. The failure rate was 4% after 5 years, 12% after 10 years and 32% after 15 years. A modification of the CDA rating system was used for evaluation of the clinical quality of the restorations after 15 years. Between 5% and 14% of the units were recorded as 'not acceptable' for the different characteristics evaluated.

Acrylic Resins↗

Prosthodontic rehabilitation in Papillon-Lefevre syndrome: a case report.

Papillon-Lefevre syndrome is a rare recessive genetic disorder. The clinical manifestations include palmar-plantar hyperkeratosis with precocious rapidly progressive periodontal disease that results in premature exfoliation of primary and permanent dentitions. Patients are often edentulous at an early age. Here is the report of prosthodontic rehabilitation of a case of Papillon-Lefevre syndrome in a 6-year-old child.

Child↗

[Study on prosthodontic procedure in patients with unilateral cleft lip and palate--effects of various extensions of splint on tooth-borne ability of teeth adjacent to the cleft].

It is mandatory that the prosthodontic devices for the cleft palate patients not only prevent the relapse of the corrected arch and teeth by orthodontic and/or surgical intervention but also equilibrate the tooth-borne ability between the upper and the lower jaw. The purpose of this paper is to set up a criterion for the extension of the splint from the point of the tooth-borne ability. Four patients with unilateral cleft lip and palate were examined for the maximal biting force at the tooth adjacent to the cleft in each alveolar segment in the case of various extensions of the splints. The findings were as follows: 1. The maximal biting force increased significantly in every splint, compared with the non-splint. 2. The maximal biting force increased significantly in the splints where the neighbouring tooth in the same segment was involved, compared with that in the splints where only the tooth adjacent to the cleft was involved, even if the tooth in another segment increased in number for splinting. 3. The maximal biting force did not increase significantly in most splints where three teeth in the same segment were involved, compared with that in the splints where two teeth in that segment were involved.

Adult↗

The outcome of implant-supported fixed prostheses from the prosthodontic perspective: proposal for a classification protocol.

PURPOSE: This article proposes a classification protocol for reporting the outcome of implant-supported fixed partial dentures. MATERIALS AND METHODS: A review of the literature revealed a contrast between the accepted criteria for assessing and presenting the outcome of osseointegrated implants and the deficient and misleading assessment and presentation of the outcome of the prostheses supported by these implants. A classification protocol comprising 6 well-defined fields with objective standards that accounts for retreatment as well as failure is proposed. This protocol has been applied where possible to reports on the outcome of fixed partial dentures in several published articles. RESULTS: In all cases there was a stark difference between the authors' claims of success and the outcome according to the 6-field protocol. It is accepted that the outcome of a given prosthesis does not necessarily correspond to the outcome of the overall prosthodontic treatment, as the latter also involves an assessment of outcome as perceived by the patient and accounts for planned revisions. CONCLUSION: If adopted, the proposed protocol would allow meaningful comparisons between prosthesis designs and between different implant systems' capacities to support such designs. It would also assist in evaluating the cost-effectiveness of implant-supported treatments.

Classification↗

Surgical-prosthodontic reconstruction of advanced maxillary bone compromise with autogenous onlay block bone grafts and osseointegrated endosseous implants: a 12-year study of 32 consecutive patients.

During a 12-year period (1984 to 1997), 32 consecutive patients with advanced maxillary bone compromise received surgical-prosthodontic rehabilitation. The most frequent procedure used was maxillary augmentation with a free nonvascularized autogenous onlay block bone graft, and the average time of prosthesis function was 67 months. Twenty-eight patients underwent a 1-stage procedure, in which endosseous implants were placed simultaneously for internal rigid skeletal fixation of the onlay bone graft, and 4 patients underwent a 2-stage procedure, in which endosseous implants were placed secondarily 6 months after complete healing of the previously placed onlay bone graft, which initially was stabilized by titanium miniplates and lag screws. Treatment success was evaluated separately for the first 7 consecutively treated patients (developmental group) and for the next 25 consecutive patients (routine group). Assessment was made of implant survival relative to etiology of bone loss, implant type and length, type of prosthesis, type of opposing occlusion, type of surgical procedure, and presence of discontinuity. The implant survival rate was 91% in the 25 routine patients and 65% in the 7 developmental patients. Implant type and length, prosthesis type, opposing occlusion, and the presence or absence of discontinuity significantly impacted treatment outcome. Onlay block bone graft success (96%) in all 32 treated patients and prosthetic success (96%) in the last 25 patients was recorded.

Adolescent↗

Treatment outcomes in implant therapy: the influence of surgical and prosthodontic experience.

In this retrospective study reviewing 30 months of treatment, 53 partially or completely edentulous patients were provided with implant-supported restorations. The restorative aspects of the therapy were undertaken by an experienced prosthodontist who had just begun involvement with implant rehabilitation techniques. Patients were treated in two centres, 21 in a major teaching institution (Group A) and 32 in a private practice (Group B). In Group A, the implants were placed by experienced oral and maxillofacial surgeons just beginning involvement in implant techniques. The implants of the Group B patients were placed by surgeons with a minimum of 2 years implant experience. It appeared that the surgeon's experience had a major impact on the failure probability of unloaded implants. Loading conditions and the design of the prosthesis may be the decisive determinants for the probability of success with loaded implants. The hazards of extensive cantilevered extensions were demonstrated. The results suggest that those entering implant prosthodontics should not expect their early work to match the results obtained from established centres.

Adult↗

Techniques of past served well by new prosthodontic technology, materials.

During the past 15 years, advances in laboratory technology, prosthetic teeth, and materials have provided the practicing clinical dentist with many new options for the treatment of the removable prosthodontic patient. Some of these advances which allow improved quality of care for the patient as well as increased convenience for the dentist and technician will be presented. Additionally, some of the research available on these products will be discussed in an attempt to aid the practitioner in exploring the option of incorporating these advances into their clinical practice.

Acrylic Resins↗

Predictable elastomeric impressions in advanced fixed prosthodontics: a comprehensive review.

Despite advances in dental material technology, the predictable procurement of accurate impressions for the fabrication of complex fixed prosthodontic restorations remains an elusive objective. The technical challenges and potential negative sequelae are exponentially magnified in advanced applications that involve multiple abutments and preparatory phases. A protocol for consistently achieving accurate impressions with the use of polyether impression materials and automatic instrumentation is presented and illustrated with multiple clinical examples. The technique is capable of yielding reliable results in extensive cases and requires minimal support from auxiliary personnel.

Alginates↗

Prosthodontic decision making among general dentists in Sweden. II: The choice between fixed and removable partial dentures.

PURPOSE: The purpose of this study was to describe how dentists evaluated various items related to a treatment choice between fixed partial dentures (FPD) and removable partial dentures (RPD), and to determine if the differences could be explained by dentist-related variables ("social and demographic attributes," "job situation," and "attitudes"). MATERIALS AND METHODS: Questionnaires were sent to a random sample of 2,059 Swedish general dentists, with a response rate of 76%. In the questionnaire, the choice between FPDs and RPDs in a clinical situation was presented. The dentists were asked to mark on 14-item visual analogue scales the relative importance he or she gave the different items. The items were analyzed through principal components analysis, where a 3-factor solution was obtained; the factors were labeled as "time," "health," and "comfort." The factors were run as dependent variables in multiple regression analyses. RESULTS: Great individual variations were seen, but the differences between groups of dentists were small. The items evaluated as most important were "patient's wish," "condition of possible abutment teeth," and "prognosis for delivered treatment." Male dentists gave significantly greater importance to the "health" factor compared to female dentists. The attitudinal variable "patient information" showed significant associations with all 3 factors in the multivariate models. CONCLUSION: Great individual differences were seen regarding the importance of the various items. In multiple regression models, several independent variables showed significant associations, most interestingly the attitudinal variable "patient information." Low explanatory (R2) values indicate that it is necessary to capture more variables of importance for the prosthodontic decision-making process.

Age Factors↗

Fixed prosthodontics in adults in Jönköping, Sweden in 1983 and 1993. An epidemiological study of prevalence and choice of material.

The aim of the study was to assess the prevalence of fixed prostheses, i.e. single crowns and fixed partial dentures, in adults 20-80 years old in two cross-sectional studies carried out in 1983 and 1993 and to analyse whether the choice of material for fixed prostheses had changed during this time period. The material comprised 586 and 593 individuals. A descriptive analysis of number of individuals with fixed prostheses was made concerning the number of crowns and pontics, the distribution in the jaws, and the materials used. The prevalence of individuals with fixed prostheses was shown to increase with age both in 1983 and 1993. In 1993 the number of individuals with fixed prostheses was slightly lower than in 1983 (44 and 48 percent respectively). There was no difference according to gender. The proportion of individuals with fixed prostheses was lower or almost unchanged in the 20-, 30-, 40-, 50-, 60-, and 80-year-olds in 1993 compared to 1983. In the 70-year-olds, however, the proportion of individuals with fixed prostheses was considerably higher in 1993 compared to 1983. Most individuals with fixed prostheses had a small number of crowned teeth, and about half of the individuals had not more than four crowned teeth. Likewise most individuals with pontics had a small number of pontics. The distributions of crowned teeth and pontics in the jaws were similar in 1983 and 1993. Pontics and crowns were more frequent in the upper than in the lower jaw. Crowns made of porcelain or metal ceramic had increased by 1993 in the 30-80 year age groups, and the study thus confirms general clinical experience that porcelain and metal ceramic are more often the materials of choice in fixed prosthodontics in adults today.

Adult↗

Immediately loaded mandibular implant bar overdenture: a surgical and prosthodontic rationale.

Classical guidelines for osseointegration include a long healing time, during which functional load should be avoided. However, the long healing period might impose an intolerable situation on some patients, especially in the completely edentulous situation. Studies on immediately loaded implant-supported prostheses in completely edentulous patients have been reported, exhibiting high success rates comparable to conventionally loaded implants. This article describes the surgical and prosthodontic procedure for the immediately loaded mandibular implant bar overdenture as well as its clinical rationale.

Dental Implantation, Endosseous↗

Prosthodontic decision making among general dentists in Sweden. III: The choice between fixed partial dentures and single implants.

PURPOSE: The purpose of this study was to describe how dentists evaluated the importance of various items related to a treatment choice between fixed partial dentures (FPD) and single implants, and to analyze if the differences could be explained by dentist-related variables such as social and demographic attributes, job situation, and attitudes. MATERIALS AND METHODS: Questionnaires were sent to a random sample of 2,059 Swedish general dentists, with a response rate of 76%. In the questionnaire, the choice between an FPD and a single-implant restoration in a clinical situation was presented. Fifteen items were constructed and the dentists were asked to mark on visual analogue scales the relative importance he or she gave the different items. The items were analyzed through principal components analysis, where a three-factor solution was obtained; the factors were labeled as "time," "health," and "comfort." The factors were run as dependent variables in multiple regression analyses. RESULTS: The items evaluated as most important were "prognosis for delivered treatment" and "patient's wish." Large individual differences were seen, but the differences between groups of dentists were small. Male dentists considered the "health" and the "comfort" factors to be more important compared to female dentists. The attitudinal variable "patient information" was significantly associated with the "time" factor and, inversely, with the "comfort" factor. CONCLUSION: Differences between individuals were great, but between groups of dentists the differences were only minor. Multivariately, the attitudinal variable "patient information" showed significant associations with the "time" and the "comfort" factors. Dentist-related variables explained little of the variations. The results further indicated a low personal knowledge concerning implant treatments. Psychologic methods might explain more of the individual differences in prosthodontic decision making, but these are not easily used in a questionnaire study.

Alveolar Process↗

Communication during prosthodontic treatment--dentist, patient, and dental nurse.

PURPOSE: This study described and explored verbal communication during prosthodontic treatment. MATERIALS AND METHODS: Sixty-one patients and 15 dentists participated. Sixty-one prosthetic treatment periods, during which fixed tooth- or implant-supported prostheses were placed, were followed. One visit during each treatment period was audio recorded. The recorded verbal communication was analyzed with the Roter Interaction Analysis System-dental. The inter-rater reliability was 95% to 97% for utterance classification and kappa = 0.71 to 0.78 for categorization definition. RESULTS: There were 43,663 utterances available for analysis. Of those, 59% was dentist communication, 28% was patient communication, and 10% was dental nurse communication. Other persons, e.g., dental technicians, contributed with 3%. The dentist-patient communication contained more task-focused than socioemotional behaviors. Female patients used socioemotional talk to a greater extent than did the male patients. Dentists and patients of different genders communicated more overall, especially male dentists with female patients. The age difference between dentist and patient had no effect on the amount or type of communication. The dental nurse talked slightly more with male patients. CONCLUSION: When different genders met there was more communication, and the talk was more socioemotional when the patient was female.

Adult↗

Prosthodontic management of periodontally compromised patient.

The fabrication and placement of a conventional immediate denture following extraction of periodontally compromised, non-restorable remaining teeth is a method that is frequently used to help restore form and function in an esthetically pleasing manner. This technique demands knowledge in applied basic sciences and prosthodontic principles. Accurate diagnosis and scrupulous treatment planning help the dentist address the patient's needs.

Contraindications↗

Immediate placement and provisionalization of maxillary anterior single implants: a surgical and prosthodontic rationale.

Maintaining the existing gingival architecture of a failing maxillary anterior tooth is essential in achieving an optimal aesthetic result. Immediate implant placement has been advocated to minimize tissue loss following extraction. The incorporation of a customized temporary abutment and immediate fixed provisionalization facilitates maintenance of the gingival architecture for optimal aesthetics and eliminates the need for a removable provisional prosthesis during the healing phase. This article describes the surgical and prosthodontic approach of this procedure as well as its clinical rationale.

Acrylic Resins↗

Predictable peri-implant gingival aesthetics: surgical and prosthodontic rationales.

Bone resorption following maxillary anterior tooth extraction is common and often compromises gingival tissue levels for the implant restoration. The creation of predictable peri-implant aesthetics requires proper understanding and preservation of the osseous and gingival tissue surrounding the failing tooth. This article addresses the various factors that affect the predictability of peri-implant gingival aesthetics in anterior single-tooth replacement. The surgical and prosthodontic procedures for maintenance of peri-implant aesthetics are also presented using an ovate pontic tooth on a removable partial denture following immediate extraction and implant placement.

Adult↗

Outcomes of implant prosthodontic treatment in older adults.

Older adults are expected to account for an increasingly disproportionate number of individuals needing oral implant prostheses. However, this biotechnology was initially studied for predominantly middle-aged edentulous patients, not elderly people. High rates of success and minimal crestal bone loss have been reported for oral implants mainly in this group. The results of studies at the University of Toronto now clearly support earlier reports that older adults respond to oral implants in the same manner as younger adults, despite their tendency for systemic illness, including osteoporosis. However, unfavourable jawbone quantity and quality, particularly atrophy of the maxilla, impaired implant success. Furthermore, placement of implants in sites that had been edentulous for shorter periods was associated with greater crestal bone loss, a finding that may have implications for younger adults undergoing such treatment. The major decision-making challenge in managing depleted dentitions and complete edentulism in an aging society now lies in differentiating the treatment outcomes, especially patient-mediated assessments (including economic analyses), of the various prosthodontic options available for older adults.

Aged↗