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At least 991 records · Page 55Linked to original sources
PubMed2006

[Functional recovery with prosthetic management for segmental resection of the mandible without reconstruction].

PATIENT: The patient, a 54-year-old male, consulted the Oral Surgery Department of Iwate Medical University Hospital with a complaint of a mass in the left oral base in June 1992. In September 1992, the patient was diagnosed as having cancer in the left mandibular base, and the tumor was excised by resection of the entire cervical region on the left side. Since radiation osteonecrosis in the left mandible and mandibular fracture were detected, segmental excision of the left mandible was performed in March 1993. Although the postoperative course was good without reconstruction, the patient consulted the Second Prosthetic Department to achieve functional recovery in February 1996. This patient had no occlusal contact between the maxilla and mandible because the mandible shifted to the affected side. After fixation of a mandibular prosthetic appliance for the defective mandible, a palatal plate for the maxilla in occlusal contact with the mandibular dentition and mandibular prosthetic appliance were fixed in November 1997. After fixation of a new mandibular prosthetic appliance and dentures for the maxilla with palatal ramp in April 2001, masticatory function was observed to have improved with control of the mandible. DISCUSSION: To prevent the mandibular shift and improvement of the masticatory function, a palatal plate with a palatal ramp in the occlusal contact region was fixed, and a balance of the masticatory muscles could be maintained. An evaluation of the level of improvement in the masticatory function and the pronunciation function indicated that the mandibular prosthetic appliance and palatal plate with a palatal ramp in the occlusal contact region increased the kind of food that the patient could take. Moreover, by enlarging the narrow Donders space, the pronunciation was improved. CONCLUSIONS: Fixation of a palatal plate with a palatal ramp in the occlusal contact region without reconstruction of the mandibular bone was useful for the control of mandibular deviation to the affected side and improvement of the masticatory function.

Dental Prosthesis↗
PubMedDate not supplied

The influence of mandibular dentition on implant failures in bone-grafted edentulous maxillae.

PURPOSE: To evaluate the influence of mandibular dentition on the performance of maxillary implants prior to definitive prosthesis attachment in maxillae that have been reconstructed with autogenous bone grafts. MATERIALS AND METHODS: A retrospective review of 90 consecutive patients, 31 men and 59 women, with a mean age of 57.4 years, was conducted. All patients underwent treatment planning to receive endosseous implants in the edentulous maxilla in conjunction with autogenous bone grafting. During the time from implant and/or bone graft placement until placement of the definitive restorations in the maxillae, the mandibular dentitions were recorded and categorized into 6 groups based upon the presence and distribution of teeth. RESULTS: Of 643 implants placed, 118 (18.4%) were lost between implant placement and definitive prosthesis placement. The type of mandibular dentition was significantly associated with implant failure during this time interval (P < .001). In particular, the patients with implants opposing unilateral occlusal support showed the highest rate of implant failure (43.8%, or 28 of 64 implants). Implants that opposed a mandibular implant-supported fixed prosthesis demonstrated an implant failure rate of 14.3% (10 of 70), and in patients with a removable mandibular denture, the implant failure rate was 6.2% (4 of 65 implants failed). The overall mean patient follow-up was 64.2 months. At 60 months, the cumulative implant failure rate based on the Kaplan-Meier method was 20.2%. DISCUSSION: Unfavorable concentration of forces on the maxilla may contribute to increased risk of implant failure. CONCLUSION: Effort should be made to create a favorable occlusion in the mandible, with attention being paid to broad distribution of occlusal contacts.

Adult↗
PubMed2004

Modifications of the inverted T-shaped silicone implant for treatment of temporomandibular joint ankylosis.

PURPOSE: Inverted T-shaped silicone implants have been used for reconstruction of ankylosed temporomandibular joints for 10 years. As the implant is custom made during the operation, dimensional adjustments according to individual need are routine. MATERIAL AND METHOD: A new modification to increase the stability of the inverted T-shaped silicone implant is presented. The modification consists of a middle process on the long arm of the T-shaped silicone implant, the first of which was inserted into the medullary cavity of the mandibular ramus. This modification further stabilizes the implant position and helps prevent its displacement. The modification was used on difficult cases such as bilateral ankylosis, osteotomies below the condylar notch or incompliant patients. This modification was used in six patients. RESULTS: No dislocation, nor extrusion of the implant or re-ankylosis of TMJ was observed.

Adolescent↗
PubMed2002

In vivo mandibular elastic deformation during clenching on pivots.

Lower rigidly connected long span bridges supported by natural abutments or implants sometimes become loose, come off, or fracture after a period of usage. Many reasons have been discussed for these failures. However, few researchers have shown the influence of mandibular elastic deformation on the abutments, although this influence is likely to produce a distortion force between the abutment and prosthesis. Therefore, this study measured the elastic deformation of the human mandibular arch during clenching on pivots by using charge-coupled device (CCD) cameras and an image analysing system. When the subjects clenched on the canines (unilaterally or bilaterally) or bilateral second molars, no mandibular deformation was found; whereas when the subjects clenched on the unilateral second molars, the mandibular arch on the non-pivot side moved upward and inward and the straight line distances between the right and left measurement points decreased by 0.2 mm. The magnitude of deformation is smaller than the depressible limit of periodontal membrane. This suggests that the influence of mandibular deformation on the connected prosthesis is negligible in the case of the natural root supported long span bridge but should probably be considered in the case of the implant supported bridge.

Adult↗
PubMed1991

The transmandibular implant: prosthodontic treatment considerations.

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.

Acrylic Resins↗
PubMed2006

Rehabilitation of oral function in head and neck cancer patients after radiotherapy with implant-retained dentures: effects of hyperbaric oxygen therapy.

Surgical treatment of malignancies in the oral cavity and subsequent radiotherapy often result in an anatomic and physiological oral condition unfavorable for prosthodontic rehabilitation. The objective of this prospective study was to assess the effect of hyperbaric oxygen therapy on treatment outcome (condition of peri-implant tissues, implant survival, oral functioning and quality of life) of prosthodontic rehabilitation with implant-retained lower dentures in radiated head and neck cancer patients 6 weeks and 1 year after placing the new dentures. The treatment outcome was assessed in a group of 26 head neck cancer patients who were subjected to radiotherapy after tumour surgery. Standardized questionnaires were completed and clinical and radiographic assessments were performed. After randomization, endosseous Brånemark implants were placed in the anterior part of the mandible either under antibiotic prophylaxis (13 patients) or under antibiotic prophylaxis combined with pre and postsurgery hyperbaric oxygen (HBO) treatment (13 patients). In the HBO and non-HBO group eight implants (implant survival 85.2%) and three implants (implant survival 93.9%) were lost, respectively. Peri-implant tissues had a healthy appearance in both groups. Osteoradionecrosis developed in one patient in the HBO group. All patients functioned well with their implant-retained lower denture. The quality of life related to oral functioning and denture satisfaction were improved to a comparable extent in the HBO and non-HBO group. Implant-retained lower dentures can improve the quality of life related to oral functioning and denture satisfaction in head and neck cancer patients. Adjuvant hyperbaric oxygen therapy could not be shown to enhance implant survival in radiated mandibular jaw bone.

Aged↗
PubMed1996

[New endoprostheses for the condylar process of Russian manufacture].

Experience gained in repair of the mandibular condylar processes with titanium endoprostheses in 6 patients (8 endoprostheses) is presented. The defects were due to improperly healing fractures, ankylosis of the temporomandibular processes, and cancer. Two variants of endoprostheses differing by the fixing device are proposed. One variant is intended for replacement of defects of the condylar process only, the other permits the use of various titanium constructions to replace bone tissue defects in the branch, angle, and body of the jaw after its resection. Good immediate and late results (followed up for up to 14 months) demonstrate the efficacy of the proposed method.

Adult↗
PubMed2000

The fate of osseointegrated implants in patients following oral cancer surgery and mandibular reconstruction.

BACKGROUND: The feasibility of implant treatment in patients after oral ablative tumor surgery and defect reconstruction has not yet been investigated in terms of the requisite high standards of success assessment. A report on this topic must address not only implant survival but implant health, bone response, soft tissue health, failure pattern, and time of failure, as well. METHODS: From June 1990 through December 1997, 90 patients received 320 dental implants after oral tumor resection and immediate soft tissue reconstruction. Included in the study were 45 patients with 162 implants loaded for at least 1 year. Regular follow-up for 6 years consisted of detailed medical history and evaluation of periodontal parameters. Out of this population, 10 vascularized iliac bone grafts for mandibular reconstruction containing loaded implants were selectively evaluated for bone loss. RESULTS: The assessment of pocket probing depths, plaque accumulation, bleeding disposition, implant mobility by means of the Periotest method applied to the restoration type, horizontal and vertical (peri-implant) bone loss according to x-ray findings, causes and time of implant loss, and subjective statements offered results comparable to those found in healthy subjects examined with periodontal success parameters. CONCLUSION: Prosthetic restoration of patients after oral ablative tumor surgery followed by hard and soft tissue reconstruction can be achieved with dental implants with similar long-term efficacy as found in healthy subjects adhering to internationally established requirements.

Adult↗
PubMed1992

Occlusal considerations in periodontal prosthetics.

The objectives in establishing a physiologic occlusion for periodontal-prosthetic patients are: (1) the minimization of lateral forces on the teeth and (2) the direction of forces along the long axis of the roots. Functional precision of occlusion is not an objective for this type of patient; rather, stability, with freedom of movement, is the goal. This paper gives an in-depth discussion of these objectives and provides an additional look at dental implant therapy and occlusion.

Dental Articulators↗
PubMed1996

[Orbito-maxillo-facial rehabilitation with osteointegrated prostheses].

This investigation was conducted to evaluate 20 cases of implant-retained prosthetic rehabilitation (mean follow-up of 35 months). Ear, nose, orbit and complex defects of the face have been restored. Our main indication was reconstruction in cancer patients after tumor surgery (n = 14). Rehabilitation was also performed in traumatic disorders (n = 3) and congenital aural malformations (n = 3). Fifty seven titanium fixtures have been implanted with an integration success rate of 98%. We also report 6 cases of maxillary or mandibulary functional rehabilitation. The use of osteointegrated implants to provide support for maxillo-facial prosthesis is a new and valuable technique when reconstructive plastic surgery is not envisageable.

Adult↗
PubMed2001

Condylar prostheses in head and neck cancer reconstruction.

OBJECTIVE: To discuss the use of condylar prostheses after mandibular resection for tumor. DESIGN: Case series and literature review. SETTING: Tertiary referral center. PATIENTS: Four patients underwent condylar reconstruction with metallic condylar prostheses after hemimandibulectomy for either squamous cell cancer or Ewing sarcoma. MAIN OUTCOME MEASURE: Complications related to the condylar prostheses. RESULTS: Clinical and radiological follow-up in these patients revealed several complications, including exposure or extrusion of the prosthesis and migration of the prosthesis into the epitympanum, resulting in profound sensorineural hearing loss owing to bony destruction of the cochlea. Two of our patients required removal of the mandibular hardware because of the seriousness of the complications, and 1 of the 2 underwent reconstruction of the condyle with a fibular free flap. CONCLUSIONS: Metallic condylar prostheses in the setting of tumor resection and reconstruction involve significant risks. Autogenous materials, such as vascularized bone grafts, should be used whenever possible.

Carcinoma, Squamous Cell↗
PubMedDate not supplied

Primary reconstruction of the mandible after resection for oral cancer.

Forty-seven patients with cancer of the lower half of the oral cavity underwent primary restoration of mandibular continuity with a threaded wire after "en bloc" resection. The overall 3 years tolerance rate of the wire calculated according to the actuarial method is 0.29. Preoperative radiotherapy and inclusion of the wire into silastic reduced tolerance of the prosthesis. The occurrence of an oral fistula required removal of the wire.

Fistula↗
PubMed1999

Finite element stress analysis on the effect of splinting in fixed partial dentures.

STATEMENT OF PROBLEM: Long-span fixed partial dentures usually require splinting of multiple abutments to overcome mechanical problems associated with the long edentulous span. Most information and indications for the use of multiple splinted abutments have been empirically derived. PURPOSE: This study analyzed the stress levels in the teeth and supporting structures of a fixed prosthesis and ascertained how the addition of multiple abutments in a fixed prosthesis modifies the stresses and their deflection. MATERIAL AND METHODS: The finite element method was used to analyze mechanical behaviors of a prosthesis and its supporting structures when a fixed prosthesis with several designs replaced a mandibular second premolar and a first molar. Variations of the standard finite element model were made by changing the number of splinted teeth and the level of bone support. RESULTS: A reduction of stress and deflection was observed in the supporting structures when a fixed partial denture was fabricated and teeth were splinted together. Increasing the number of splinted abutments did not reveal a proportional reduction of stress in the periodontium. Stress concentrations were seen in the connectors of prosthesis and in the cervical dentin area near the edentulous ridge. CONCLUSION: Increasing the number of the splinted abutment did not compensate for the mechanical problems of a long-span fixed partial denture sufficiently.

Alveolar Bone Loss↗
PubMed1985

Masticatory movements in patients treated with fixed prosthesis on osseointegrated dental implants in the mandible.

Mandibular movements were recorded by means of an optoelectronic system (Sel spot) in 16 complete denture wearers before and after insertion of tissue integrated prostheses in the mandible. Analysis of the single chewing cycle revealed an obvious increase in mandibular velocity and displacement after rehabilitation. The duration of the occlusion phase was also significantly shortened, probably due to the stabilization of the occlusion provided by the fixed implant bridge.

Computers↗
PubMedDate not supplied

Implant treatment in the edentulous mandible: a prospective study on Brånemark system implants over more than 20 years.

PURPOSE: This prospective investigation studied the clinical and radiographic performance of mandibular fixed prostheses supported by osseointegrated implants over more than 20 years. MATERIALS AND METHODS: A total of 273 standard Brånemark implants (10 mm long) were placed in 47 patients between 1978 and 1982. Clinical and radiographic data collected at several examinations over the 20-year observation period have been reported previously. This study presents the outcome of the latest follow-up after 20 to 23 years. RESULTS: Thirty patients (64%; 75% of those still alive) attended the 20-year follow-up examination. Three implants were lost during the entire observation period, and the 20-year implant cumulative survival rate was 98.9%. All patients had continuous prosthesis function, but two had their mandibular prostheses remade during the 20 years. No implants or prostheses were lost or fractured during the last 5 years, and only a few prosthodontic complications were noted. The mean bone level was 1.6 mm (SD 0.90) below the reference point after 20 years, and mean bone loss was 0.2 mm (SD 0.22) between the 15- and 20-year follow-ups. Thirty-seven implants (24%) showed more than two exposed threads at the 15-year follow-up examination, but only four implants (3%) presented pain and/or bone loss exceeding one thread (0.6 mm) during the last 5 years. CONCLUSION: The successful treatment result after 15 years continued up to more than 20 years in function. During the last 5 years, a majority of the implants with several exposed implant threads could be maintained without any complications, and the frequency of implants showing signs of ongoing peri-implantitis was less than 3%.

Adult↗