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This technique was developed to overcome some of the difficulties experienced by the dentist in construction and maintenance of an implant denture. Laboratory construction time is greatly reduced in both the subperiosteal and the implant prosthesis. The greatest advantages of the technique are accurate and positive construction and predictable results.
Several factors have been presented that must be evaluated when selecting an appropriate posterior pontic design. Because of the controversy that exists with regard to using posterior denture base pontics, a long-span fixed partial denture was followed for 14 months. Results indicate that tissue health can be maintained, while tissue proliferation is inevitable. There is no one posterior pontic design that can be used to satisfy all requirements. Optimal pontic design can be accomplished only if each situation is evaluated on an individual basis and an appropriate design selected. Further controlled longitudinal clinical research of pontic design is mandatory for expansion of the ability to predict optimal prognosis.
The history of the nonlocking type of intracoronal semiprecision rest has been traced from its origins with Neurohr in 1930, up to its present use as the Thompson dowel rest. The advantages of the use of this deep rest design and the clasp arm design for primary retention have been discussed. The Blatterfein modification of the lingual clasp arm has been introduced to overcome the problems of breakage and lack of stabilization which are present with the Thompson, Van Dam, and Wands designs.
This article reviews the history and types of double crown retainers, known in clinical terms as telescope crowns. It compares rigidly interlocked and resilient retainers, where the design allows for movement between the primary and secondary components of the unit. The nature of the relationship between the components determines the relationship between the removable denture, the remaining dentition, and the edentulous ridge. The resiliency or rigidity of the telescope retainers depends on the configuration of the primary and secondary components and is applied accordingly to prosthodontic requirements and clinical assessment.
An alternative to the complete denture, the transitional prosthesis, the overdenture, and some tooth-splinting clasped partial dentures has been presented. The convertible periodontal prosthesis has many of the advantages of the overdenture, but few of the disadvantages such as palatal coverage, the appearance of a denture, and the psychologic effect. Preliminary observations over a 7-year period indicate that the periodontal condition of the abutment teeth improves. A case for periodontal worthiness of this method of periodontal prosthesis can be made.
The rationale of designing a seimprecision or precision distal-extension removable partial denture and the justification of ridge loading in distal-extension ridge impression techniques have been presented. The effectiveness of existing impression techniques in securing firm seats for abutment castings, accurate border extension of the denture base, and loading of the ridge mucosa has been evaluated. A technique has been described that overcomes the limitations of existing impression techniques for semiprecision and precision distal-extension removable partial dentures.
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Telescope crowns used in removable partial dentures reduce the destructive horizontal and rotational occlusal forces by directing them more axially and less traumatically than other retainers. These properties are combined with excellent conditions for cross-arch and multiple abutment splinting. If one of the abutment teeth needs extracting, the denture can be repaired with acrylic resin simply by remaking the secondary crown into a pontic. The single copings can be easily cleaned due to the good accessibility around their gingival margins. They also protect the abutment teeth against caries and thermal irritation. Soldering of the primary copings or their connection with accessory bars is not necessary in rigidly constructed telescope crowns, because the secondary crowns incorporated in the superstructure provide sufficient rigidity. In addition, the splinted copings often cause inflammatory gingival hyperplasia because the solder joints are too close to the gingival margins, preventing proper hygiene maintenance. The taper configuration or vertical height of the coping, which determines the amount of load transferred to each abutment, can be planned to suit each tooth's condition and designated function in the restoration. In a fixed restoration, the load is always evenly distributed among all the abutment teeth regardless of their condition, because the crowns are permanently cemented to them. In the telescope denture, the amount of force can be individually regulated by modifying the form and leverage of the retainers, according to their position, bone support, and occlusal conditions.
Entirely tooth-supported removable dentures with telescope crowns may be considered a good alternative to a fixed restoration of the whole dental arch. They provide a rigid splinting and stable occlusion and offer a better safety factor owing to their removability and their lesser dependence on each single abutment. Also they are applicable when parallelism among the abutments does not permit making a fixed restoration. Furthermore they can be cemented in stages, decreasing the risk of washout later. Psychologically, they are well tolerated by patients.
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This technique provides one solution to the problem of using tilted abutment teeth for a fixed partial denture. It provides good retention without excessive tooth destruction and without excessive contour in the completed restoration.
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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.
A technique was described for using ceramometal restorations in a broken-stress fixed prosthesis. Although somewhat complicated in the laboratory phase, the procedure produces an extremely esthetic result.