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The average age of patients seeking dental care is increasing. Presented here is an example of the challenges dentists will face in treating an older patient population. With the correct equipment, management of prosthodontic problems is within the scope of all dentists.
In this series of articles, the faculty of the University of Southern California New Odontic Seminar have taken the 25 years of documented treatment of sample patient "A.K." and used it as a foundation on which to base discussion of the concepts and technology that have developed in prosthodontic treatment planning. Each of the contributing authors was asked, "What are your thoughts retrospectively if you were to treat the patient A.K. in your practice today?" And, since all dentists are challenged with evidence-based treatment planning, each author was also asked "On what evidence in the literature do you base your treatment planning for patients who need prosthetic therapy?" Dentistry's experience with long-term success of endodontics, periodontics, and implant dentistry is expressed in the presentations discussing when an implant may be better suited for a prosthetic abutment than a restored tooth.
Just prior to the advent of the branemark implant, the Harvard consensus on implantology condemned all maxillary implants. While implant utilization has skyrocketed in the last few years integration of implants in the maxilla is a persistent problem and even the branemark implant enjoys a lower success rate in this bone. These observations underscore the higher failure rate of the maxillary implant and suggest the need for development of a new implant design configuration that would favour long term successful integration despite the attenuated maxillary attributes. Such is the intent of the ostial implant. The basic considerations concerning this device, its bioengineering, experimental performance and clinical trials are discussed elsewhere. The purpose of this paper is to describe clinical prosthodontic applications of this implant system.
PURPOSE: The present material reports on prosthodontic complications in a trial of 51 patients with prostheses supported by single-stage implants over a period of 36 months. MATERIALS AND METHODS: One hundred eighty-six single-stage implants were placed in 51 patients over a 3-year period in 2 carefully controlled prospective clinical trials. Nineteen of the patients (103 implants) were completely edentulous and restored with a maxillary complete denture and a mandibular fixed-detachable complete prosthesis. Single metal-ceramic crowns or fixed partial dentures were fabricated for the remaining 32 patients (83 implants). The fixed restorations were either screw-retained or cemented. RESULTS: All patients/implants were followed for a minimum of 3 years. Complications in the edentulous patients included fracture of denture teeth, fracture of the maxillary denture, and occlusal screw loosening. Occlusal screw loosening and loss of the resin composite access plug were the only complications observed in the patients treated with screw-retained restorations. No complications were found in the patients restored with cemented restorations on solid abutments. DISCUSSION: Problems with prostheses were very common in the completely edentulous patients (13 of 19 patients encountered complications), possibly a result of increased bite force or inadequate laboratory technique. Tooth fractures were seen more frequently in men than in women. Complications occurred in only 5 of the 32 partially edentulous patients. CONCLUSION: Complications were associated with laboratory-related procedures rather than the implant system itself.
This report describes one phase of a long-term comparative implant investigation involving 20 of 120 endosseous implants placed in 30 adult mongrel dogs. Fixed prostheses involving 16 of the 20 (4 control implants) two-stage ceramic endosseous implants have been provided using routine prosthodontic procedures and the limited prosthetic components available for the Bioceram Series II implant system. The prostheses have proven to be functional with minimal maintenance. To date, after 1 year of follow-up, 2 of the two-stage implants have exhibited problems caused by fracture of the hexagonal collar. None of the implants to date has been lost and none of the fixed prostheses has required re-cementation or any other type of maintenance other than normal hygiene. Clinical evaluation suggests continued implant and prosthesis serviceability after 1 year in function.
Surgical procedures for the prosthodontic patient have advanced greatly over the last decade. Both the aesthetics and function of the final restoration can be greatly enhanced by various surgical procedures. Some are very predictable, and others are still in the developmental stages. This review is divided into three basic categories: aesthetic root coverage; crown lengthening; and ridge augmentation procedures.
If we have learned anything from our experiences with all-ceramic systems such as Cerestore, Cerapearl, and even Dicor, it is that it takes years to uncover the strengths, weaknesses, and limitations of new materials and technologies. Manufacturers' initial claims for fit, strength, esthetics, biocompatibility, wear characteristics, and clinical performance should be viewed as preliminary until supported by independent laboratory and clinical studies. Laboratory testing alone may not provide sufficient insight into the relative strengths and weaknesses of products or assure comparable performance in the commercial dental laboratory or the ultimate testing arena, the oral environment. Moreover, the diversity of the new materials and techniques discussed demonstrates the breadth and depth of the technologic changes in dental biomaterials. The rate at which these dental products enter the marketplace and their sheer number alone are indeed staggering. Furthermore, these advances are not emerging from any single nation but from manufacturers all around the world (Japan, Germany, as well as the United States), indicating our international reliance on one another. Clearly, the decade of the 1990s is emerging as an exciting period in the development of biomaterials in comprehensive fixed prosthodontics and dentistry in general.
Structured clinical decision analysis in dentistry in fixed prosthodontics, as in any branch of dentistry, allows the practitioner to think through more clearly the problems at hand based on the clinical data and extenuating factors presented by the patient. This discipline of decision making is intended to complement the experience level and educational background of the clinician in assisting him or her through the decision process. Additionally, CDA helps the clinician define not only the pre-existing condition of the patient prior to irreversible therapy, but also which treatment strategies may best be suited for that individual over an extended period. The systematic nature of decision analysis stimulates the focusing of one's attention on those factors considered to be germane to the overall complexity of the case and, at the same time, excluding those factors having little or no influence on its final outcome. With further implementation of computerized databases and procedural outcome probabilities based on clinical and laboratory studies as well as the clinical experience of those choosing to use it, the future for structured, formalized clinical decision analysis seems quite promising.
The restorative needs of older dental patients challenge the ingenuity, anatomic knowledge, artistic skills, occlusal philosophies, and material knowledge of the clinician. Achieving the most secure foundation while simultaneously eliminating imperfections and incorporating a design that promotes good oral hygiene and a natural and attractive appearance are significant contributors to a patient's welfare. The treatment decision regarding fixed prosthodontics for elderly patients requires the balancing of two opposing arguments: 1. In patients who are older, and who are perhaps medically or physically compromised, and, in addition, who may be on a limited budget (or perceived limited budget), it is important to fabricate dental prostheses that are as good as possible to minimize the likelihood that the prosthesis will need to be remade in the future when the patient is likely to be even more compromised financially, medically, or physically, and also to minimize the stress on the patient of accommodating to something that is less than an optimal dental solution. 2. Patients in this age group often anticipate financial strain in the future, perhaps realistically in view of the increasing percent of older adults who are institutionalized (5% of persons 65 years old or older, 20% of persons 80 years old or older). Also, many are reluctant to invest large amounts of money in their teeth when they are already quite elderly and realize they may not live long enough to make the investment "worthwhile." Educating the patient regarding average life expectancy is sometimes helpful, but the experience of many clinical dentists is that many elderly persons either do not believe the numbers, require greater certainty in their "investments," or do not place as high a value on their dental health as they do other aspects of their lives (in a context in which there are more needs than resources to pay for them). Finally, many older adults, contrary to the popular bumper sticker, are trying to preserve as many resources for their children and grandchildren as possible. The final decision should be made with sensitivity to the overall needs of the patient, and with the assistance of a well-informed patient or other responsible party.
Economic, esthetic, and concerns of tooth preservation are important when considering bonded composite resin for the partially edentulous patient's prosthetic rehabilitation. This article has described the clinical success of the use of bonded composite resin in removable prosthodontics. Composite resin may be used in daily clinical practice for the restoration of abutment teeth in contour, vertical support, and re-establishment of a patient's vertical dimension.
Some of the most difficult problems to resolve in daily clinical practice are those where there is interaction of various pathogenic factors, with consequent complication of the therapeutic solutions. Combined treatments based on sound diagnosis of the case and appropriate decision making to organize the therapeutic procedures in sequence are the best way of dealing with such situations. This article describes the case of a woman who was pregnant at the beginning of the treatment and had active periodontitis and angle Class II molar malocclusion because of loss of maxillary and mandibular teeth. She had had maxillofacial surgery years before with average results, had lost teeth because of caries, and was seeking a solution to her problems that would be both esthetically pleasing and functional. A system that combined odontologic decision making with phased periodontal, orthodontic, and prosthodontic treatment was adopted, leading to a stable, esthetic, and functional solution that fulfilled the patient's requirements.
During the past 30 years, there has been a growth of implant courses in dental schools at the predoctoral level to meet a burgeoning demand. At the same time, there has been a concomitant reduction in curriculum time devoted to clinical and technical aspects of complete denture construction. There will be a sizable cohort of patients with limited natural dental landmarks seeking implant reconstructions that may be difficult for the general practitioner to restore. This article reviews basic prosthodontic principles and procedures that are important to understand when designing an implant prosthesis.
OBJECTIVE:Clinical study was made on curative effect of medium to severe periodontal diseases as well as those complicated with partial edentulism by conical telescopic removable denture.METHODS:14 cases of medium to severe periodontal diseases and these complicated with partial edentulism were treated with prosthodontic methods after comprehensive periodontal therapy.Examinations of both before and following prosthetic restoration of 3,12,14 months were made.Bacterial plague index,gingival index,tooth movability and masticatory efficiency were recorded,analysed and compared. RESULTS:Periodontal plague attachment was under effective control through this way,which also eliminated periodontal trauma thus preventing the relapse of periodontal diseases.Further more it can diminish tooth movability and improve masticatory efficiency continuously as time goes on.CONCLUSION:Conical telescopic removable denturs is an effective prosthetic method in treating medium to severe periodontal diseases.
This review covers recent literature on prosthodontic aspects of osseointegrated implants. Long-term prognosis, diagnosis and treatment planning, and clinical impression techniques and fabrication technology are discussed.
In conventional terms, prosthodontic treatment becomes necessary when a patient has missing and/or broken-down teeth. Part I of this two-part series of papers reviews the available evidence for a traditional therapeutic model that seeks purposefully to reconstitute lost morphology, with specific reference to older, partially dentate people, at the population level. Furthermore, because anterior and premolar teeth are indispensable to a number of prime oral functions in most societies, the question of need for replacement relates essentially to that of molar teeth. Research findings are presented which cast doubt on many of the assertions made for the mandatory replacement of all posterior teeth. Specifically, there appears to be a lack of compelling evidence that dental arch integrity is a prerequisite for optimal oral health and function, and favours the prognosis of the remaining dentition. Wide variability in the effects of posterior tooth loss on occlusal stability indicates a 'wait-and-see' management approach rather than immediate replacement, while reported chewing sufficiency in people with reduced but well-distributed dentitions, and a lack of association between the level of posterior support and temporomandibular disorders, further undermine the traditional premise for the mandatory replacement of posterior teeth, specifically molars. With the parallel recognition that the assessment of treatment need must take a broader view of peoples' functional concerns arising from their tooth loss, as well as weighing the cost/benefit ratio of treatment, Part II will compare the merits of the traditional model with the documented functional benefits that a more limited, less morphologically-driven approach may have for the growing, older sector of society.
PURPOSE: Realistic appraisals of time and costs are crucial for research grants and financing of clinical studies by sponsors, but little is known about the time actually needed for clinical data collection in dental studies. This survey evaluated the net time of patient contact necessary for collection and documentation of clinical data to establish an empirical base for more efficient study management and budgeting. MATERIALS AND METHODS: The time needed for the clinical examination of 41 prosthodontic patients in systematic follow-up was recorded. Examination covered dental status, oral hygiene status, and quality assessment of restorations by modified CDA criteria. Completion of the case report forms, data check, and provisions for data retrieval were also included. The recorded times were analyzed to obtain empirical estimates of the time actually needed for specific examination blocks and to detect potential variables of influence. RESULTS: Predominant time records were 5 to 10 minutes for dental status (according to status complexity) or hygiene. The time needed for CDA ranking showed a linear correlation to the number of units, approximately 1 minute each. Documentation times were similar to the total contact times of all examination blocks, between 15 and 30 minutes per patient. CONCLUSION: The overall time for collection and documentation of retrievable data is considerable (about 30 minutes, up to 1 hour). The data provide an empirical base for sound managing and budgeting of follow-up periods in clinical investigations, which is of major importance for the quality of clinical data, and thus for the success and value of clinical investigations.
AIM: Contact allergy is a postponed reaction of hypersensitivity where a localised cutaneous or mucosal lesion occurs due to a recurrent contact with an allergen. Placement of a fixed or removable prosthetic replacement into the oral cavity causes corrosive processes on the surface of the restoration and discharge of ions, which as haptens can induce allergic reactions. The purpose of this study was to examine occurrence of allergies to basic and auxiliary restorative dental materials in patients with lichen, stomatitis and stomatopyrosis by means of an epicutaneous allergy test. METHODS: The study included 32 patients with a fixed and/or removable replacement and 7 patients with one of the mentioned diagnoses, but without any replacement. Testing was conducted using a standard method (patch test), and hypersensitivity to 13 most common allergens in prosthodontics was examined. RESULTS: The research results revealed higher frequency of positive allergic reactions in persons with the mentioned diseases and with a restoration. Patients with lichen indicated positive patch test in the majority of cases. The allergens of nickel, cobalt and chromium demonstrated the highest score of positive results, and negative score was found for dibutylphthalate and HH mix. Stomatopyrosis was more common in persons with hypersensitivity to chromium. A lower incidence of positive allergic reactions to epoxide resins was found in female than in male subjects. CONCLUSIONS: The epicutaneous (patch) test performed in the subjects examined in this study, showed that the majority of positive reactions was caused by mixes of nickel, cobalt and chromium; however, unwanted reactions also to other auxiliary materials used in dental practice should also be considered.
Panavia, a composite resin luting agent containing phosphate monomers, bonds chemically to air-abraded base metal alloys and is particularly suited for cementing resin-bonded retainers. Another adhesive methodology (Silicoater system) incorporates a pyrolytically applied silica layer to metal substrates to promote bonding of a resin adhesive. The object of this study was to compare prosthodontic adhesive systems that incorporated the Silicoater system and/or Panavia. The results showed that the surface treatment that provided significantly higher shear bond strengths was the Silicoater system and a layer of unfilled resin. A second test evaluated use of Panavia as a metal opaquing material beneath laboratory light-curing resins. Results showed that Panavia Opaque material was displaced peripherally during placement of overlying laboratory composite resin veneers. This resulted in an uneven intermediate layer of Panavia.