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Intrusion phenomenon in combination tooth-implant restorations: a review of the literature.

STATEMENT OF PROBLEM: Controversy regarding the connection of implants to natural teeth in fixed partial dentures has emerged in response to clinical reports of intrusion of the natural teeth. Although theories have been proposed to explain this phenomenon, the cause of the intrusion remains unknown. Numerous longitudinal studies have demonstrated that teeth can be successfully connected to implants. The use of rigid connectors, or nonrigid connectors with the keyway on the implant, are described as mechanisms to prevent intrusion of the natural tooth. PURPOSE: This article reviews the literature that pertains to this subject and includes treatment modalities that may be helpful in preventing intrusion.

Animals↗

New telescopic crown design for removable partial dentures.

STATEMENT OF PROBLEM: Special technical skills and experiences are required to fabricate a telescopic crown to provide adequate retention with precise frictional retention ("conus friction force") between coping and telescope. It is also difficult to control clinically alterations of retentive forces after prolonged usage. PURPOSE: This study examined an innovative telescopic crown system for removable partial dentures that can be fabricated without special technical skill or experience and readily adjusted retentive forces. The retention of telescopic crowns was investigated after repeated insertion/separation tests. MATERIAL AND METHODS: Ten telescopic crowns were constructed to evaluate retentive forces. Each telescopic crown was adjusted to provide a retentive force of approximately 9.8 N. Each telescopic crown was then subjected to 10,000 insertion/separation cycles, and retentive force of each telescopic crown was recorded initially and after every 1,000 cycles. The retentive force of each telescopic crown was re-adjusted after these measurements to provide a retentive force of approximately 9.8 N. The retentive force was recorded a second time after each 1,000 insertion/separation cycles up to 10,000 cycles. RESULTS: Retention of the telescopic crowns gradually diminished, depending on the number of insertion/separation cycles. The mean retentive force after 10,000 insertion/separation cycles was over 2 N. All 10 telescopic crowns were re-adjusted to exert a retentive force of 9.8 N after the initial 10,000 cycles, and the retentive force also diminished on the second 10,000 cycles. CONCLUSIONS: Reduction of retention was dependent on insertion/separation cycles. This new telescopic crown with reduced retention could be easily readjusted. Readjusted retentive forces were at least equivalent to the initial retention.

Analysis of Variance↗

The fixed mandibular implant: a 6-year review.

In a review of 102 consecutive cases of the fixed mandibular implant there were no failures; all appeared clinically to be osseointegrated and functioning well. There were an unexpected number of gingival infections and instances of inflammatory gingival hyperplasia, but these have been reversible and manageable. A change in sleeve nut design has improved gingival health. The Fixed Mandibular Implant (Hall Reconstructive Systems, Carpinteria, CA) offers immediate denture stability and function, and provides the opportunity for a fixed, fixed removable, or overdenture prosthetic reconstruction.

Adult↗

Early results from reconstruction of severely atrophic (Class VI) maxillas by immediate endosseous implants in conjunction with bone grafting and Le Fort I osteotomy.

This report presents our experience with 12 consecutive patients treated by the method of SAILER19, comprising bone grafting to the floor of the nose and the maxillary sinus after a Le Fort I inferior repositioning of the maxilla followed by immediate implantation of endosseous implants. The corticocancellous grafts were harvested from the iliac crest. Fifty-nine implants were inserted in the bone grafts and eight in the adjacent nongrafted bone. Fourteen implants (21%) had to be removed because of nonintegration, of which 10 had been placed in two patients. The follow-up ranged from 11 to 24 months. No implants have been lost after loading. Six patients received fixed prostheses, and four overdentures. The importance of complete preoperative positional stability of the bone grafts and implants is emphasized.

Adult↗

Evaluation of satisfaction of denture wearers with the transmandibular implant.

121 edentulous patients with severe resorption of the mandible (average 10.0 mm, measured in frontal area) who received a transmandibular implant were evaluated from 2 to 8 years after insertion of the implant. Patients' opinion about the implant and denture function after insertion were evaluated using a questionnaire. The results showed that most of the patients (91%) were satisfied because of improved denture function. There were few complaints about looseness, pain and difficulty with chewing. 96% of the patients considered their implant as being a valuable adjunct to denture retention.

Adult↗

Retention.

This article describes the mechanisms for retaining RPDs and considers the different types of direct retainer. The factors influencing the effectiveness of retentive clasps and governing the choice of clasp are discussed.

Dental Clasps↗

Restoration of the edentulous maxilla.

A case is presented which highlights the problems encountered when using an implant-stabilised overdenture in an edentulous upper jaw, opposed by a natural dentition.

Aged↗

Posterior bridges retained by resin-bonded cast metal inlay retainers: a report of 60 cases followed for 6 years.

Between May 1989 and July 1994, 60 adhesive fixed partial posterior dentures retained by resin-bonded cast metal inlays were placed under controlled conditions. The influence of various prognostic factors on the event free and overall service duration was investigated with univariate and multivariate analysis. The majority of the failures (16 of 18) were caused by loss of adhesion at the metal cement interface and were observed either as debonding of the restorations completely or dislodgement of a single retainer. The other two failures appeared as secondary caries. Univariate analysis demonstrated that, retainer type, approximal configuration and dentine exposition had no effect on the event free service duration. On the other hand, gingival finishing level and luting agent were found to have an effect. Univariate testing was also conducted for the overall service duration and none of the variables were found to have an effect. Multivariate Cox Regression Analysis was performed to estimate the influence of categorical covariates: type of retainer, approximal preparation modification, gingival finishing level, preparation depth and luting agent on survival rates of event free and overall service duration. Luting agent was found to be the single independent prognostic variate (P < 0.0001) for the event free service duration and the other covariates were rejected. For overall service duration, none of the variables were found to be effective.

Adolescent↗

Treatment with removable partial dentures: a longitudinal study. Part II.

The aim of this study was to evaluate the effectiveness of an oral rehabilitation by removable partial denture (RPD). Between 1983 and 1994, 629 patients were provided with an RPD at the Dental School of the Université catholique de Louvain. All the RPDs were constructed with a cobalt-chromium framework. All the treatments were provided by dental students under the supervision of clinical instructors. At recall time (1998-2000), 269 patients could not be reached neither by telephone nor by mail and 27 had died. Consequently, 333 patients were called for clinical examination and 254 of these (76.3%) actually attended. For a total of 292 RPDs checked 1893 persistent teeth were listed, with 804 serving as abutments; more than half (57.6%) of these were crowned, for which 51 debondings were recorded. For the period of observation we listed 79 abutments lost (37 at the upper jaw and 42 at the lower jaw), i.e. 9.8% of the total number of abutments. No relation could be established between the type of the abutments (natural or crowned teeth) and the losses observed (Test of Mantel-Haenszel: P=0.9496). In the upper jaw, the percentage of abutments lost was significantly higher in the presence of free-end edentulous areas as compared with bounded edentulous areas (Test of Mantel-Haenszel: P=0.0002); this difference does not appear for the lower jaws (P=0.9558). If we deduct the 25 abutments related with the 11 non-worn RPDs and the 79 abutments lost, no change becomes apparent for 92.2% of the maxillary abutments and for 85.8% of the mandibular abutments. For the 1089 other teeth, we observed the loss of 40 teeth and the appearance of caries or new fillings for 95 teeth. The fractures of cast clasps represent 3.4%.

Chromium Alloys↗