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At least 1,171 records · Page 65Linked to original sources
PubMed2003

Clinical considerations and rationale for the use of simplified instrumentation in occlusal rehabilitation. Part 1: Mounting of the models on the articulator.

The development of an occlusal scheme with an appropriate number and location of occlusal contacts is of the utmost importance for the long-term success of any prosthetic rehabilitation. This, however, can be a time-consuming procedure. To avoid undue mistakes, a high degree of competence must be demonstrated by both the clinician and the technician. Especially when performing extensive rehabilitations, many operators believe that to have optimum control of the occlusal variables, it is necessary to employ rather sophisticated instruments and complicated procedures. This article presents a rationale for an approach that uses a simplified but sound instrumentation in the clinical and laboratory steps necessary to produce a successful prosthesis. In part 1, the registration of the spatial position of a patient's maxillary and mandibular arches is described.

Centric Relation↗
PubMedDate not supplied

Low-dose tomographic techniques for dental implant planning.

Image quality in preimplant computerized tomography (CT) examinations made with different radiation doses (40 to 280 mAs) and scanning modes (standard and helical axial, 15-degree angled, and frontal) and in conventional spiral tomography (Scanora) was compared. Mandibular canal and alveolar bone crest visibility was evaluated in images from mandibular jaw segments. Visibility was unaffected by radiation dose in CT examinations except in frontal scanning, where a small actual difference was statistically significant. Differences among CT scanning modes and between CT and conventional spiral tomography were highly significant. Low-dose mandibular preimplant tomography can be performed with CT using lower-than-normal radiation doses or with conventional spiral tomography.

Aged↗
PubMed2006

Management of lateral mandibular discontinuity by maxillary guidance.

Balance and symmetry of mandibular function is disturbed by loss of continuity of the mandible, which leads to altered mandibular movements and deviation of the residual fragment, as a consequence of which problems with chewing, swallowing, speech, and aesthetics develop. Methods such as maxillary fixation, and use of mandibular and palatal guidance have been used to reduce or eliminate the mandibular deviation. The aim of this study was to achieve a normal maxillomandibular relation in a patient with mandibular discontinuity. An acceptable maxillomandibular relation was obtained within 3 months with a maxillary guidance ramp prosthesis.

Adolescent↗
PubMed2005

Oral rehabilitation after mandibular reconstruction using an osteocutaneous fibula free flap with endosseous implants. Factors affecting the functional outcome in patients with oral cancer.

BACKGROUND: The development of endosseous implants and free vascularized bone grafting has permitted increased possibilities of oromandibular reconstruction in patients with oral cancer. In this study, a concept combining surgical and prosthodontic treatments for mandibular fibula free flap reconstruction after tumor surgery was made based on a classification of bone defects. A follow-up study was performed to evaluate the treatment concept for oral rehabilitation in order to identify possible factors which may influence the functional result. MATERIAL AND METHODS: A follow-up examination included 28 patients who underwent the ablative tumor surgery and mandibular reconstruction during a 4-year period. The follow-up protocol included clinical examination, radiological evaluation, and an interview using a standardized questionnaire. The timing of the study was set to allow for a minimum 2-year follow-up (mean 45 months). RESULTS AND CONCLUSION: At the time of examination, prosthesis-based oral rehabilitation was completed in six patients (21%), and the prosthodontic work was still unfinished in four other patients. The other 18 had no dental prosthetic rehabilitation. Thirteen patients received a total of 37 oral implants, and 23 implants were functionally loaded. No implant loss was recorded. Oral functions such as speech, diet tolerance and oral competence were not directly affected by the presence of dentures. A decisive factor affecting the oral function was the extent of soft-tissue loss. According to the classification described here, the extent of the mandibular defect did not correlate with oral functions. The application of oral implants seemed to be advantageous for the oral rehabilitation of patients who had undergone intraoral resections.

Bone Transplantation↗
PubMed1982

Prosthodontic rehabilitation for glossectomy patients.

Patients with oral carcinomas often have resection of the tongue, the floor of the mouth, or the bone of the mandible. Postoperatively, these patients encounter chewing, swallowing, and speech problems. Oral rehabilitation through prosthetic management can aid in alleviating these problems. Designs of the prosthesis vary according to patient needs. A "snap-on" tongue prosthesis or palatal augmentation prosthesis can be constructed. Total glossectomy patients require prosthetic intervention on a mandibular framework. Partial glossectomy patients require prosthetic augmentation on a maxillary framework. Through prosthetic management of this type, articulation and resonance are improved, food is more easily directed into the esophagus, tissues are protected and socialization is enhanced through improved appearance.

Deglutition↗
PubMed1987

An interim prosthesis for the glossectomy patient.

The use of a simple patient-held prosthesis for improving speech in a patient with mandible and tongue resections has been described. As subjectively perceived and objectively verified, speech intelligibility improved in a test patient. There were no apparent risks or lengthy therapy. The ease of fabrication and low cost indicate that this prosthesis may be of value in aiding the speech of glossectomy patients.

Aged↗
PubMed2001

The implant-supported milled-bar mandibular overdenture.

Osseointegrated dental implants have been proven successful in the treatment of edentulism. The predictability of the implant-supported prosthesis has also been established. Several techniques have been described for the successful restoration of the edentulous mandible: fixed-detachable prostheses with either the original Brånemark hybrid prosthesis design or conventional implant-supported fixed partial dentures, implant-retained overdentures, and implant-supported overdentures. However, in cases of advanced ridge resorption in which facial tissue support is needed from the flanges of the prosthesis or when a removable type of prosthesis is preferred by the patient, an implant-supported prosthesis is indicated. Electric discharge machining is often used in the fabrication of the bar for an implant-supported overdenture. This procedure is very costly and technique sensitive. An alternative procedure to fabricate a milled-bar implant-supported overdenture is described. This procedure is simple and uses inexpensive equipment and materials. The milled-bar minimizes lateral and rotational displacement. The overdenture incorporates attachments that provide retention, minimizing possible movement along the path of insertion. This type of prosthesis is available to a broad patient population, especially those with advanced ridge resorption, providing an excellent result at a reduced cost. J Prosthodont 2001;10:46-51.

Aged↗
PubMed2005

Mandibular distraction osteogenesis for endosseous dental implants.

Patients with complete or partial edentulism who have insufficient bone for endosseous dental implant treatment present a challenge for the dental practitioner. Alveolar distraction osteogenesis is a technique for creating bone and soft tissue, without the need for bone grafting and its potential complications. In this article, alveolar distraction osteogenesis is compared with traditional bone grafting techniques. A case is presented to illustrate successful bilateral mandibular vertical distraction osteogenesis with creation of adequate bone volume for endosseous implant-supported dental restoration.

Alveolar Bone Loss↗
PubMed1997

Repair of a transmandibular implant: clinical report.

The use of many currently available implant systems may be limited in patients with severe mandibular atrophy because of the lack of available bone in the symphyseal region. The transmandibular implant is a rigid box-frame structure that can distribute masticatory forces along a severely atrophied mandible with as little as 4 mm of vertical bone with an implant-borne prosthesis. Although the success rate of the transmandibular implant is favorable as compared with other systems, complications can occur after placement, including infection, partial extrusion, and fracture of a post. A case report of fractures of two posts at the necks and the bar approximately 18 months after placement is presented.

Aged↗
PubMed2000

[Long-term complications of radiotherapy after mandibular reconstruction with vascularized bnoe graft].

INTRODUCTION: The use of vascularised composite free flaps (VCFF) has become a widely accepted method for primary reconstruction of mandibular defects. Adjuvant or neo-adjuvant radiotherapy (RTH) increases susceptibility to trauma and infections. The aim of this study is to compare the incidence of local complications after mandibular reconstruction with vascularised composite free flaps, related to pre- or postoperative radiotherapy. The effects of these complications on functional rehabilitation with a dental prosthesis fixed on bone implants are also studied. METHODS: Between 1990 and 1999, 49 vascularised composite free flaps were used for mandibular reconstructions (41 iliac crest flaps and 8 fibula flaps). 31 patients (63%) underwent preoperative (8) or postoperative (23) radiotherapy. Short (6-12 months) and long-term (over 12 months) outcomes are analysed separately. The incidence of complications depending on the timing of radiotherapy (neo vs adjuvant) was compared. RESULTS: In the first 12 months the complication rates among the irradiated and non-irradiated patients were 26 and 11% respectively. During short-term evaluation complications were seen in 26% of the irradiated patients and 11% of the non-irradiated group. After 12 months the rate of complications rises to 45% for the irradiated and 18% for the non-irradiated patients. 27% of irradiated patients presented with fistula, 27% with exposed metallic plates and 9% developed osteoradionecrosis of the graft. Dental implants were inserted in 29 grafts, among which 9 had secondary radiotherapy. 90% of the non-irradiated patients and 56% of the irradiated patients chewed with the dental prosthesis fixed on bone implants. DISCUSSION: Regardless of pre- or postoperative timing, radiotherapy clearly augments complications, the incidence of which increases with time. Only in one patient did osteoradionecrosis necessitate removal of the dental prostheses. Inability to chew is linked more to the amount of resection of the mobile tongue than to complications of radiotherapy. We therefore recommend systematically placing dental implants during the initial surgery, unless large soft tissue resection preventing adequate swallowing is required.

Anastomosis, Surgical↗
PubMed2002

Mandibular osteoradionecrosis: reconstructive surgery.

Osteoradionecrosis of the mandible is a serious complication following radiotherapy of head and neck cancers. A retrospective study of 20 reconstructions of mandibular defects due to osteoradionecrosis was performed. Various osseocutaneous free flaps were used: upper lateral arm (n = 5), radial forearm (n = 1), iliac crest (n = 4) and fibula (n = 7). Four grafts had a condylar prosthesis, and for seven grafts fixation was accomplished with a reconstruction plate. In three patients the mandibular defect was reconstructed using a bridging plate only. We defined a successful reconstruction as a graft or plate that did not need removal. Success was noted in 15 out of 20 patients, giving an overall success rate of 75%. For the free grafts alone (n = 17), successful reconstruction was achieved in 15 patients (88%). Two fibular grafts were lost owing to exposure and infection, as well as all three alloplastic reconstructions. Minor postoperative complications were observed in 11 patients (58%).

Adult↗
PubMed1994

Vascularized bone flaps in oromandibular reconstruction. A comparative anatomic study of bone stock from various donor sites to assess suitability for enosseous dental implants.

OBJECTIVE: To identify donor sites from which vascularized bone may be harvested capable of accepting osseointegrated implants of the minimum dimensions required to ensure long-term implant stability. DESIGN: An anatomic study of the most commonly employed donor sites for vascularized bone in oromandibular reconstruction was conducted on 28 cadavers. SETTING: Academic tertiary referral center. PARTICIPANTS: Twenty-eight freshly embalmed, adult white cadavers (16 male, 12 female) were dissected. INTERVENTION: The ipsilateral fibula, iliac crest, radius, and lateral border of the scapula were harvested and multiply sectioned at predetermined sites. OUTCOME MEASURE: Implantability was determined for each section based on measurements of height, width, and cross-sectional area utilizing computer planimetry. RESULTS: The iliac crest was the most consistently implantable donor site, followed by the scapula, fibula, and radius (83%, 78%, 67%, and 21% of sections from each donor site satisfying the criteria for implantability). Consistent regional differences in implantability were encountered at each donor site except the scapula. CONCLUSIONS: Following ablation of oromandibular malignant neoplasms, restoration of stable retentive dentition is a prerequisite to a successful functional oral rehabilitation. This is best achieved with enosseous implants, capable of supporting a stable dental prosthesis, placed directly into vascularized bone flaps at the time of mandibular reconstruction. The implications of the results obtained in this study for gender, donor site selection, and orientation of the vascularized bone flap are discussed.

Aged↗
PubMed1990

[The surgical anatomy of the sublingual gland].

Because of its position, the sublingual gland is clinically important especially in the events of injuries and infections in the anterior part of the sublingual region. The morphology and relationships of this gland were studied by dissection methods applied on 80 fresh or formaldehyde fixed preparations of the mouth floor and of the tongue, which were partly (31 preparations) taken out together with the mandible. As for the shape of the gland, three main types were found: the cuneiform type which was the most frequent (71%), the pyramidal type which was less frequent (16%) and the fusiform type (13%) which comprised the case of a very elongated gland (up to 65 mm). The space in which the gland lied had four walls. Its internal wall consisted of the mylohyoid muscle and it comprised the hyoglossus muscle as well when the gland was very elongated. The inferior wall consisted of the mylohyoid muscle and sometimes it comprised also a narrow part of the superior surface of the geniohyoglossus muscle. An osseous depression on the internal side of the mandible represented the external wall of the sublingual gland space. The superior wall is clinically the most significant. It consists of the sublingual mucosa and a sublingual fold. This wall represents a main surgical access to the gland. In edentulous mandibles this mucous fold may be at the level of the upper mandibular border which may hinder the use of the lower dental prosthesis.

Humans↗
PubMedDate not supplied

Identification of axons in the peri-implant region by immunohistochemistry.

In the edentulous patient with a completely implant-supported prosthesis, periodontal ligament receptors are absent. However, the implant patient's mandibular function during mastication and clenching is significantly improved and can be similar to that of dentulous subjects. The underlying mechanisms that govern this proprioceptive control are not well understood. One possibility that has been explored only partially is that residual axonal elements in the peri-implant region may have a proprioceptive function. To survey the peri-implant region for axonal elements, this study utilized immunohistochemistry with neurofilament as the marker. Histologic sections of the peri-implant area from 12 implants placed in the mandibles of three dogs were examined for the presence of neurofilament. Two to three labeled sites per section in the peri-implant region were commonly found. However, the functional significance of these axons must be further evaluated before any conclusions regarding their role in proprioception can be made.

Alveolar Process↗
PubMedDate not supplied

Restoration of the atrophied posterior mandible with transverse alveolar maxillary/mandibular implants: technical note and case report.

Restoration of the atrophied posterior mandibular alveolus has been a surgical challenge in the past. Many treatment options have been published, each with unique shortcomings. This study will review and compare these techniques to a new type of implant, the transverse alveolar maxillary/mandibular implant (TAMMI). Using modified Nobel Biocare Brånemark System zygomatic implants that were shortened to 11.5, 13, 15, 18, 20, 22.5, or 25 mm, the authors reconstructed atrophied posterior mandibles. These TAMMIs were placed at a 45-degree angle, engaging both the crest of the ridge and the buccal cortex. Using TAMMIs, atrophied posterior mandibular alveoli as small as 9 mm have been successfully restored without complication to the inferior alveolar nerve.

Alveolar Bone Loss↗