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PubMed1983

Mandibular reconstruction using a special plate. Animal experiments and clinical application.

The use of a variety of procedures and techniques for mandibular reconstruction suggest that no satisfactory solutions have been found with regard to restoration of functional stability, joint function and masticatory function. In view of the varied clinical problems involving restoration of mandibular function, we developed our own reconstruction plate, a condylar prosthesis, and a reconstruction plate with a condylar head. The U-shaped notches of the reconstruction plate permitted universal adaptation of the plates by means of special pliers. The most important result of the animal experiments was the achievement of stability under functional stress. This made intermaxillary fixation unnecessary. The preliminary experience in our clinical cases with the reconstruction plate showed a reduction of masticatory disability. The clinical results corresponded well with those of the animal experiments, and thus confirmed the value of the experimental model chosen.

Adolescent↗
PubMed1997

Replacement of missing mandibular lateral incisors with a single pontic all-ceramic prosthesis: a case report.

The conventional approach for replacing congenitally missing mandibular lateral incisors dictates the placement of either a conventional porcelain-fused-to-metal (PFM) bridge, Maryland bridge, or fiber-reinforced composite veneer bridge. However, several appearance-related disadvantages have been reported in the use of a prosthesis which incorporates a metal substructure. To address these limitations, metal-free restorative alternatives have been recently developed to expand the clinical options when fabrication of these prostheses is indicated. The learning objective of this article is to present the utilization of a single pontic all-ceramic resin-bonded bridge to replace congenitally missing mandibular lateral incisors, where the existing mesiodistal spaces were narrow and the abutment teeth exhibited insufficient substance for the conventional treatment modality.

Adult↗
PubMed1992

Multicenter evaluation of temporomandibular joint Proplast-Teflon disk implant.

Seven oral and maxillofacial surgeons from all U.S. American Association of Oral and Maxillofacial Surgeons districts participated in a retrospective study of Proplast II Teflon interpositional implants that were placed after meniscectomy in 680 TMJs (465 patients) and followed from 6 to 76 months. At longest follow-up a relatively high number (85.9%) 584 of 680 implants were in place with an average weighted follow-up of nearly 32 months. Of these 584 joints, a very high number, 540, (92.4%) were asymptomatic, however, 224 asymptomatic and 25 symptomatic joints with the implants in place exhibited some degree of condyle resorption that included 45 with malocclusion. In the worst case scenario, if condylar resorption is indicative of a worn Proplast II Teflon interpositional implant, then 364 (54%) of the 680 implants may fail. Failure rates per year range from Vitek's reported 3% to an average 18% clinician report in the literature. Higher rates are reported by individual clinicians, and our recent in vitro wear tests of Proplast II Teflon interpositional implants suggest an in vivo service life of only 3 years. Because no one has reported follow-up beyond 5 years, the long term performance and survival of any of these implants is doubtful. Asymptomatic patients should be evaluated yearly with tomography, CT, or MRI. Symptomatic patients should be evaluated every 4 to 6 months. Implant removal should be recommended if occlusal changes or condyle/fossa articular bone changes are active past the time of expected remodeling from surgery. This report summarizes the success/failure incidence from the literature and makes recommendations on follow-up, removal, and repair surgery.

Aluminum Oxide↗
PubMedDate not supplied

Surgical reconstruction of TMJ.

Certain situations and pathological processes that arise with temporomandibular joint destruction can only be resolved with surgical reconstructive procedures in order to attempt a functional and anatomical rehabilitation of this joint. Many of these situations can be surgically treated with the patient's own autologous tissues. However, in some patients reconstruction is complex and the use of autologous tissues is unadvisable whereas reconstruction utilizing alloplastic materials may be an appropriate alternative. The following report describes 4 clinical cases in which autologous grafts or Christensen joint prosthesis are employed in temporomandibular joint reconstruction.

Adult↗
PubMed2001

The Hong Kong Bridge Protocol. Immediate loading of mandibular Brånemark fixtures using a fixed provisional prosthesis: preliminary results.

BACKGROUND: The Brånemark System Classic is well documented for its successful and predictable results in dental implant rehabilitation. However, the classic two-stage protocol is associated with problems, such as long treatment time and high treatment cost. To overcome these problems, new developments, including early functional loading protocol and Brånemark System Novum, have been introduced by various groups of researchers. In Hong Kong, a protocol has been developed to immediately load the Brånemark System fixtures with a fixed provisional prosthesis. PURPOSE: The goal of this prospective study was to present the Hong Kong Bridge protocol and report the short-term evaluation of this protocol in a group of patients who had undergone dental implant treatment for their edentulous mandibles. MATERIALS AND METHODS: Twenty-seven consecutive patients being treated at the Hong Kong Osseointegration Implant Centre between June 1998 and December 2000 were included in this study. A total of 123 Brånemark System fixtures were installed and regularly followed up for 3 to 30 months. The prosthesis stability and the marginal bone level were regularly evaluated clinically and radiographically, respectively, after the implant surgery. RESULTS: Fifteen of the 27 patients had been followed up for 1 year or longer. Two patients with eight fixtures were withdrawn from the study. Two of the 115 remaining fixtures failed, resulting in an overall implant survival rate of 98.3%. The mean marginal bone change was reported on 49 fixtures that had passed the 1-year review. The mean marginal bone loss was 0.60 mm (p < .05) after 1 year of functional loading. CONCLUSIONS: To load the mandibular Brånemark System fixtures immediately according to the Hong Kong Bridge protocol was a predictable and simple method with good results during this preliminary study period.

Adult↗
PubMed1994

[Temporomandibular joint reconstruction with free rib and iliac crest bone transplants].

From 1981-1992 we reconstructed the temporomandibular joint in 42 patients. In 33 cases reconstruction followed tumour resection of the mandible, almost advanced squamous cell carcinomas of the retromolar region. Primary reconstruction was made by an alloplastic condylar prosthesis combined with a plate for mandibular reconstruction. 2 years after first treatment secondary reconstruction followed by transplantation of a free iliac bone graft. In some cases a new condylus was formed using autogenous rib graft or allogenous cartilage. Result was adequate and painless oral aperture. For reconstruction after ankylosis, arthrosis or arthritis we use a autogenous costochondral graft. 9 patients received such treatment. In 5 or 9 cases with severe ankylosis we prefer a two-time-approach: after resection of the ankylosis we first fix an alloplastic implant (Palacos) at the skull base for distraction of the scar. Two or three years later we do secondary reconstruction with a costochondral graft. The final result strongly depends on functional postoperative treatment and the compliance of the patient.

Adolescent↗
PubMedDate not supplied

A two-dimensional stress analysis comparing fixed prosthodontic approaches to the tilted molar abutment.

A two-dimensional finite element method was used to analyze the changes in mechanical behavior of the supporting structures when a fixed prosthesis replaced a mandibular first molar. In the unrestored situation, as the degree of bone resorption increased there was a corresponding increase in stress in the periodontium. Tilting of the molar abutment induced additional stress on the mesial side of the root. The presence of a fixed prosthesis markedly reduced the magnitude and distribution of stress in the periodontium. The mechanical advantage obtained by a fixed prosthesis was greater in the situation of a tilted second molar with reduced bone support than with higher bone levels.

Alveolar Bone Loss↗
PubMed2005

Strains recorded in a combined tooth-implant restoration: an in vivo study.

Implant-supported fixed prosthesis is a treatment option to restore missing teeth. Occasionally, it is necessary to connect teeth and implants as abutments for these restorations. Whether such restorations can be recommended is a matter of debate. This in vivo study measured strains involved in connecting implants to a natural tooth and compared rigid and nonrigid tooth/implant connections. A patient was treated with mandibular unilateral fixed prosthesis supported by two implants and one proximal tooth. Strain gauges were cemented to the experimental framework restoration. Recordings were obtained from the restorations while the patient bit on a wooden stick on the day of placement and after 2 weeks in function, using both rigid and nonrigid attachment connections. A significant difference was found in horizontal deformation of the tooth/crown between day 1 and 2 weeks later. Vertical deformations were smaller than horizontal ones. After applying biting forces, horizontal and vertical deformations were maintained. Strain recorded in a clinical setting revealed mostly horizontal strains generated in a combined tooth/implant device. These strains were maintained after a 2-week recording. Within the limitation of this study, combined tooth/implant restorations could be a potential complication and could cause an intrusion of a natural abutment regardless of the type of connection (rigid or nonrigid).

Bite Force↗
PubMed1999

Hinged mandibular removable complete denture for post-mandibulectomy patients.

The presence of excessive lingual undercuts after mandibulectomy and surgical reconstruction is a rare clinical condition and presents unique prosthodontic challenges. The goals of prosthodontic treatment include: providing lip support, improving articulation, reducing drooling, and regaining favorable esthetics. This article describes the fabrication of a hinged removable mandibular complete denture prosthesis using a sectional impression tray technique and a custom-made hinge mechanism. Clinical and laboratory procedures of the prosthetic treatment are described, and the advantages and disadvantages are reviewed.

Acrylic Resins↗
PubMed1978

Primary reconstruction of the mandible with a wire mesh prosthesis.

A stainless steel wire mesh prosthesis was used as a primary mandibular replacement in 102 patients following resection of malignant neoplasms arising in the head and neck. In 67 patients the prosthesis was considered successful. Failure of the host to tolerate the prostheses was associated with history of previous irradiation, extensive resections, and the loss of distant skin flaps used for coverage of the prosthesis. But the prosthesis is tolerated by the host in 90% of the cases if it is inserted in a non-irradiated bed, covered with local tissues, and the resection is limited to the maxillo-oral complex only.

Follow-Up Studies↗