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Restoring an edentulous mandibular arch opposing maxillary natural dentition with conventional occlusal schemes historically has proven to be extremely difficult. Using a noninterceptive anterior and posterior occlusal concept with a myostatic peripheral border extent provides a means to enhance stability of the mandibular prosthesis.
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Proper treatment sequencing is critical when a patient requires multiple fixed restorations in conjunction with a removable partial and complete denture. The vertical dimension, centric relation, and horizontal occlusal plane must be determined first, followed by a diagnostic wax-up that incorporates linear occlusal concepts to prevent anterior hyperfunction. A more predictable treatment outcome is possible when individual components are defined clearly.
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A restoration that is frequently prescribed to provisionally restore the single unit edentulous space is the removable acrylic partial prosthesis. The Rochette bridge design provides an effective alternative when confronted with this clinical situation. The adaptable nature of this technique means that it can be utilised in a variety of clinical situations with success. The greatest benefits are seen in clinical situations where simple and aesthetic alteration of the pontic dimensions during treatment is necessary. It can also be used in long-term provisional situations where, if a removable acrylic partial prosthesis was used, multiple adjustments or remakes would be necessary. This paper presents three case reports where this technique has been utilised with distinctive advantages over a provisional removable partial acrylic prosthesis.
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As experience with implants has grown, the aesthetic expectations of both dentists and patients has increased. Controlled placement techniques can benefit the aesthetic result, but anatomic constraints and procedural limitations may prevent ideal implant placement. This article reviews guidelines to proper placement of implants and presents surgical and restorative approaches to correction of improper positioning. The key to a successful, aesthetically pleasing reconstruction lies in careful case planning and communication.
Three cases are presented that illustrate the potential for accelerating the healing phase with fixture-based treatment. Depending on the clinical circumstances, techniques may include radical alveolectomy, the use of fresh extraction sockets, and fixture placement in inter-radicular bone.
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Reduction of the size of food platform of a distal extension removable partial denture has been recommended to decrease functional load on the abutment teeth and residual ridges. The purpose of this study was to investigate the influence of shortening food platform on masticatory performance. Eight subjects unilaterally missing mandibular molars participated in the study. A unilateral design was used for the denture framework. The length of the food platform was changed as follows. Initially, (A) was adjusted so that the distal end of the platform was in accordance with the distal end of maxillary second molar. Next, the platform was shortened successively to 15 mm (B) and 10 mm (C). Subjects were asked to masticate 2-colored wax cubes to evaluate masticatory performance. Mixing Ability Index was calculated from the color mixture and the form of masticated cubes. Repeated measures one-way ANOVA indicated significant difference of Mixing Ability Index among platforms (P < 0.0001). The Dunnett's test indicated no significant difference between A (1.27 +/- 0.29) and B (1.36 +/- 0.29), and a significant difference between A and C (0.89 +/- 0.30), (P < 0.001). Masticatory performance decreased significantly when the length of food platform was shortened to 10 mm.
There are many fixed options for replacing a single anterior tooth, including implants; conventional full coverage; porcelain-fused-to-metal, all-ceramic, and fiber-reinforced composite designs; and minimal preparation designs that utilize lingual wing frameworks made from metal, ceramic, or fiber-reinforced composite. All of these approaches require at least two visits; however, it is possible to replace a missing anterior tooth in a single visit by using adhesive techniques with resin composite and fiber-reinforced resin composite materials. This approach has been developed and refined with a bridge created at chairside, using a prefabricated fiber-reinforced composite framework. This framework consists of a pontic substructure that is shaped to support a resin composite pontic, with one or two wings used to attach the pontic substructure to either the lingual or facial surfaces of the abutment teeth. This article describes a chairside technique for replacing a maxillary central incisor by using a prefabricated fiber-reinforced framework.
PURPOSE: The objectives of this thesis were to compare the clinical and material performance of implant-supported titanium frameworks with gold-alloy frameworks in the edentulous jaw and to test a digitized impression technique to optimize material characteristics and clinical and laboratory procedures. MATERIALS AND METHODS: Two different kinds of laser-welded titanium frameworks and one type of digitized computer numeric controlled (CNC)-milled titanium framework for the edentulous jaw were evaluated and compared with gold-alloy frameworks in two clinical 5-year follow-up studies. The CNC frameworks were also evaluated and compared with gold-alloy frameworks in two experimental studies according to fit, preload, and surface roughness. Furthermore, a digitized photogrammetric technique for recording implant positions in the edentulous jaw was experimentally tested and compared with two conventional impression techniques. RESULTS: Laser-welded titanium frameworks had a lower success rate after 5 years in function than gold-alloy frameworks. The 5-year performance of CNC frameworks was similar to that of gold-alloy frameworks. The fit and precision of implant-supported CNC frameworks was significantly better compared with gold-alloy frameworks. Applications of veneering material did not significantly affect the fit of the titanium frameworks. The preload of CNC frameworks was similar to that of gold-alloy frameworks, both exhibiting significantly decreased preloads after repeated tightening. The preloads of titanium frameworks were similar before and after veneering. Unloaded milled titanium screw sites had significantly rougher surfaces than loaded sites, and loaded gold screws had rougher surfaces than unloaded. No correlation between surface of the screw joints and preload of veneered titanium frameworks was observed. The precision of photogrammetric impressions was comparable to that of conventional impression techniques. CONCLUSIONS: Implant-supported CNC-milled titanium frameworks are a viable alternative to gold-alloy castings in the edentulous jaw, and because a digital platform is used to manufacture these titanium frameworks, photogrammetric impressions can be made.
PURPOSE: To evaluate in vitro, the effect of different external bleaching agents on the susceptibility of enamel against toothbrushing abrasion. METHODS: 96 bovine enamel specimens were embedded in acrylic resin, polished and covered with tape except for a 1.4 x 10 mm window. The samples were divided into eight groups (A-H), 12 specimens each (A-G) were treated with seven different home-bleaching (A: Whitestrips, B: Rapid White, C: Opalescence 10%, D: Opalescence PF 15%) and in-office-bleaching agents (E: Opalescence Extra, F: Opalescence Quick, G: Opalescence Extra Boost) according to manufacturers' instructions. Before and after each individual bleaching treatment the samples were brushed 40 times in an automatic brushing machine using a slurry containing artificial saliva and fluoridated toothpaste. The control group (Group H) was not bleached, but also brushed. After each cycle the specimens were stored in artificial saliva for 24 hours. RESULTS: After 20 cycles loss of enamel was determined by profilometry, resulting in the following values (mean +/- standard deviation) which were statistically analyzed: Group A: (0.169 microm +/- 0.035), Group B (11.108 microm +/- 0.655), Group C (0.207 microm +/- 0.042), Group D (0.154 microm +/- 0.028), Group E (0.081 microm +/- 0.015), Group F (0.084 microm +/- 0.018), Group G (0.087 microm +/- 0.014), Group H (0.076 microm +/- 0.012). Group B differed significantly from the other groups (r = 0.001). Samples of Groups C, D and A showed a significant difference compared to the control H (r = 0.001). Statistical analysis revealed no significant difference between enamel loss of Groups E, F, G and the Control H. It could be proven that toothbrushing abrasion of bleached enamel may be increased depending on the bleaching agent and application form used. Nevertheless, with the exception of bleaching treatment with Rapid White, toothbrushing abrasion of bleached enamel seems to be clinically less relevant.
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