The effect of chewing movements on changing mandibular complete dentures to osseointegrated overdentures.
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A detailed technique has been presented for the fabrication of a fixed prosthesis supported by osseointegrated titanium implants. The fixed prosthodontic technique is based on the original Swedish procedure. Several new dental products have been added, and some refinements in technique have been made in an effort to consistently produce a fixed prosthesis that fits, functions, and satisfies today's esthetically conscious patient. Branemark's tissue-integrated prosthesis (TIP, Bofors Nobelpharma, Inc.) is the only dental implant system with two decades of high-quality longitudinal clinical experience. A fixed prosthesis supported by osseointegrated implants offers a treatment modality that is predictably successful (Fig. 21).
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This technique offers the following advantages: The disks allow the castings to be placed with a minimum amount of torque or tension. The casting can be removed from the frame for cleaning at scheduled appointments. Removal of the casting permits evaluation of the fixation of each implant.
A method of solving some problems inherent with osseointegrated implant prosthesis has been presented. A removable flange can reestablish lip support or block escape of unwanted air while allowing the access necessary for competent hygiene procedures. Overdentures may be indicated to provide the prosthetic gingival surface necessary for adequate food control or speech.
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A prosthesis devised for a young adult patient with a remaining cleft is described. This prosthesis would be effective for similar patients because it has the advantages of both fixed and removable partial dentures, a design acceptable to the patient, better hygiene because of easy insertion and removal, simple construction, and a moderate cost.
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Bone loss around osseointegrated titanium fixtures supporting mandibular fixed prostheses has been measured by means of stereoscopic intraoral radiography. Forty-six patients treated with the osseointegration implant method according to Brånemark have been followed for an observation period of up to 6 years. The bone loss was small, approximately 0.5 mm during the first postsurgical year and thereafter 0.06 to 0.08 mm annually. Poor oral hygiene and clenching of teeth significantly influenced bone loss. More bone was lost around the medial fixtures than around the more posterior ones.
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This article presented the treatment of the edentulous maxillary arch by using the Core-Vent implant system. The Core-Vent implant system can provide a suitable foundation for the support of a fixed or removable prosthesis. The results of the 17-year Branemark study as reported by Niznick indicates that "implants placed within the last 5 years of the study demonstrated a 95% success in the upper jaw and a 99% success in the lower jaw with success being defined as the maintenance of osseointegration." Niznick reported "that the clinical results achieved with the Swedish osseointegrated implants fulfill and exceed the criteria set by the 1978 Harvard Conference on dental implants (5 years success in 75%) but the implant procedure and prosthetic application lack the simplicity, versatility, and economy to serve as a viable alternative to conventional dentistry." As implant techniques become widely used, the cost of such procedures should become more affordable. Important modifications of implant systems should provide greater reliability and longevity of the restorations.
A repair technique for a fractured solder joint in a multiple-unit fixed partial denture has been presented. The advantages of this technique include (1) retention of part of an existing restoration; (2) provision of additional support to minimize future fracture; (3) removal of the implant crown for periodic evaluation and/or treatment; and (4) retention of a fixed partial denture where a removable prosthesis might otherwise be needed. The primary disadvantage of this technique is the time and expense associated with implant placement.
A technique for constructing a provisional removable partial denture before and during construction of an anterior splint bar prosthesis is described. The provisional prosthesis is easily adapted to fit the splint bar prosthesis after it is cemented in place. The technique assures that the patient will enjoy the benefits of a well-fitting and esthetic provisional restoration through all phases of construction of the splint bar and the final removable partial denture.
The transmandibular implant (TMI) is a type of transosteal implant designed for use in the edentulous mandible. The implant is composed of a gold-based alloy. The TMI is a loaded implant in that the prosthesis is supported by the implant. A transitional type of prosthesis, for insertion following surgery can be made either by altering the patient's existing mandibular complete denture or by making a new denture. The completed prosthesis is retained by clips held in the mandibular denture with autopolymerizing acrylic resin. The clips engage Dolder bar segments, which are a part of the implant suprastructure, and provide the necessary retention for the mandibular complete denture.
A method for making an improved index for the waxed stage of Branemark implant-retained frameworks is described. The index improves visibility of the tooth and abutment cylinder relationship permitting the optimization of framework dimensions and contour.