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PubMed1997

[Removable prostheses with controlled distribution of forces on endosseous implants].

The differentiated behaviour of dental abutments and alveolar mucosal tissues following functional loading has always created design problems in the field of removable partial prostheses. This situation of disequilibrium is particularly clear when natural piers are replaced by osteointegrated implants which are by definition unable to adapt to the masticatory load. In order to avoid this different behaviour, the authors feel it is advisable to use a removable partial prosthesis fitted with telescopic retention, defined as "controlled distribution of the forces", which can transfer the functional masticatory load to the osteointegrated implants and alveolar mucosal structures in a harmonious, balanced and homogeneous manner. The authors give a detailed description of the structure and working of this particular type of prosthesis, highlighting its advantages, namely: 1) controlled distribution of occlusal forces to osteointegrated implants and alveolar osteomucosal structures; 2) reduced number of implants required (2 are sufficient); 3) stability of prosthesis comparable to a fixed structure; 4) possibility of removing the latter with the advantage of maintaining oral hygiene around implants; 5) reduced size of prosthesis. Given that this type of prosthesis has been designed, realized and fitted to natural piers, with optimal clinical results, by the Dental Implant Department of the Dentistry Clinic of Turin University since 1969, the authors affirm that this prosthetic structure is particularly suitable in cases of edentulism with advanced maxillary atrophy.

Dental Implantation, Endosseous↗
PubMed1997

In vitro and in vivo studies of a polyester arterial prosthesis with a warp-knitted sharkskin structure.

The present study was undertaken to assess the performance of a new knitted and gelatin-sealed polyester vascular graft that is believed to have greater dimensional stability than current commercial devices. Samples of the uncrimped, crimped, and sealed prosthesis were submitted to a series of in vitro and in vivo trials. Four commercial polyester knitted devices were included as controls for the in vitro tests, which included measurements of the textile and yarn structure and physical, chemical, and thermal properties of the graft, such as water permeability, dilatation, suture retention strength, melting point, and crystallinity index. The in vivo evaluation involved implanting the prototype device as a canine thoraco-abdominal bypass for periods ranging from 4 h to 1 year and assessing the biocompatibility, biofunctionality, and biostability of the explanted specimens. The warp-knitted structure of the prototype device has a unique sharkskin stitch that confers a superior dilatation resistance and suture retention strength to the prosthesis. The animal trial demonstrated that the gelatin ensures initial hemostasis without preclotting. The gelatin is bioresorbed during the first 2 weeks of implantation, which generates a temporary, moderate, acute inflammatory response. An external capsule of granulomatous tissue and an internal collagen capsule are formed between the first and third month. Analysis of the textile and physical properties of the explanted prostheses confirmed there was neither dilatation nor significant changes in structure or mechanical performance during implantation, thus confirming the biostability of this new prototype device and opening the way for clinical trials.

Anastomosis, Surgical↗
PubMed2004

Urethral device in women with chronic urinary retention: an alternative to self-catheterization?

OBJECTIVE: To assess the efficacy and safety of a new urethral prosthesis in the management of chronic urinary retention in women as an alternative to intermittent or indwelling catheterization. METHODS: Between May 1999 and July 2000, 60 women with chronic urinary retention were prospectively enrolled in the study. The prosthesis was inserted under local anaesthesia. A magnetic control unit activates the urethral device to achieve micturition. Duration of the experience, complications and compliance were evaluated. RESULTS: Thirty patients were satisfied with the device. Discontinuation occurred in the first two weeks following implantation in 50% of cases. Bladder migration of the prosthesis occurred in two cases, urinary leakage around the device in four patients, spontaneous expulsion in two women and cystitis was diagnosed in two cases. CONCLUSION: This intraurethral prosthesis is an attractive, simple technique for use as an alternative to catheterization. Some untoward events and technical complications explained the number of discontinuations.

Adult↗
PubMed1993

A retrospective study of 66 titanium cranioplasties.

A review was undertaken to assess the outcome of treatment in 66 patients for whom a titanium prosthesis was provided for the repair of a calvarium defect. While many aspects were satisfactory, certain disappointing features led to a prospective pilot study which enabled the following problems to be identified: (a) poor communication between neurosurgeon and prosthetist; (b) difficulties in establishing the margins of the defect; (c) orientation of the prosthesis, and (d) marginal retention. All were overcome with an agreed protocol.

Esthetics↗
PubMed2004

Masticatory function with implant-supported overdentures.

The type of attachment that is used in implant-supported mandibular overdentures may influence the retention and stability of the prosthesis and, thus, masticatory function. In this within-subject cross-over clinical trial, we examined the hypothesis that greater retention and stability of the overdenture improve the masticatory function. Eighteen edentulous subjects received 2 oral implants, a new overdenture, and, successively, 3 different suprastructure modalities: magnet, ball, and bar-clip. Masticatory performance, masticatory efficiency, and swallowing threshold were measured. The masticatory function significantly improved after implant treatment with each of the 3 attachments. We observed small differences in masticatory function among the 3 attachment types: slightly better masticatory performance with ball and bar-clip than with magnet attachments. The number of chewing cycles until swallowing hardly decreased after implant treatment. We conclude that significantly better masticatory performance, combined with a slightly smaller number of chewing cycles after implant treatment, results in smaller food particles being swallowed.

Adult↗
PubMed2001

Implant-retained removable prosthesis with ball attachments in partially edentulous maxilla.

This clinical report presents a restorative option for the partially edentulous maxilla utilizing an implant-retained removable partial denture without retentive clasps. This approach required (1) fewer patient visits and laboratory procedures; (2) the use of minimal number of implants; (3) lower financial obligations; and (4) no sinus elevation surgery. The use of O-ring attachments provided excellent retention and stability. The detachable prosthesis over implants allows easier oral hygiene by the patient and provides superior esthetics and phonetics in cases involving advanced ridge resorption.

Bone Resorption↗
PubMedDate not supplied

Dimensional accuracy and retentive strength of a retrievable cement-retained implant-supported prosthesis.

The purpose of this research project was to compare the fit of a retrievable cement-retained implant-supported framework to that of a traditional wax and cast, screw-retained framework and to test the strength of the cemented restoration. Ten telescopic frameworks were luted to gold cylinders with a bis-GMA resin cement. The control group consisted of 10 frameworks fabricated with traditional wax and casting techniques directly to the gold cylinders. Frameworks were analyzed for distortion in the z-axis using scanning electron microscopy and a single screw test. Results demonstrated that the retrievable cement-retained group had a decreased gap distance and improved angular distortion (statistical significance P < .01) compared to the control group. Retentive strength measurements for the cement-retained group with a direct pull-out test revealed a mean pull-out force of 65.7 kg. Three of the 5 samples surpassed the tensile strength of the gold retaining screws (76 kg). Cement-retained restorations demonstrated superior fit in the z-axis and angular distortion compared to traditional wax and cast screw-retained frameworks. Retentive tests support a simplified technique of clinically luting telescopic implant-supported frameworks with adequate retentive strength.

Bisphenol A-Glycidyl Methacrylate↗
PubMedDate not supplied

A review of clinical and technical considerations for fixed and removable implant prostheses in the edentulous mandible.

PURPOSE: The aim of the present article is to review some of the technical treatment options for implant prostheses restoring the edentulous mandible, mainly based on the Brånemark system. MATERIALS AND METHODS: Clinical and technical aspects are discussed for the three established concepts: (1) implant-supported fixed prosthesis, (2) removable implant-supported overdenture, and (3) combined implant-retained and soft tissue-supported overdenture prosthesis. RESULTS: The framework of an implant-supported fixed screw-retained prosthesis can be processed in gold, Co-Cr alloy, or titanium with casting, laser-welding, or milling techniques. To improve the stability and retention of a conventional complete denture, one to four implants are indicated, and unsplinted (single attachments) or splinted designs (bar systems) can be applied. The design of the overdenture prosthesis must be carefully planned according to the requirements to ensure adequate stability and optimal form, contour, and esthetics, and the patient's best comfort. CONCLUSION: A large variety of different treatment modalities exist for both the fixed and removable mandibular implant prosthesis. Clinical and technical aspects should be considered at the beginning of the treatment to: (1) select the optimal implant position, (2) establish an adequate number of functional units, (3) select the appropriate retainers, and (4) apply the best technique for framework processing and veneering.

Dental Alloys↗
PubMed1986

Knee biomechanics and total knee replacement.

The biomechanics of the knee joint provide an important basis for the rationale in the design and selection of appropriate total knee arthroplasty. This article examines knee biomechanics in terms of patient function, prosthesis design, cruciate ligament retention, alignment, and fixation of the tibial component. While design and surgical technique for total knee replacement progress, a better understanding of the characteristics of joint loading, stress distribution, and the biologic response of bone to stress will provide the potential to improve both function and implant longevity.

Biomechanical Phenomena↗
PubMedDate not supplied

Results of treatment of 20 patients with implant-retained auricular prostheses.

A prospective study of 20 patients receiving rehabilitation for a missing external ear revealed the failure of three flanged implants in a total of 60 placed for the support of a prosthesis and 10 for retention of a bone-anchored hearing aid. Factors limiting an optimal outcome were health of the cutaneous cuff around the abutments, bonding of the silicone ear to the acrylic-resin substructure, and the ability to minimize disfigurement of a congenitally deformed face.

Acrylic Resins↗
PubMed2006

Fabrication of custom clips for bar-and-clip attachments for implant-supported overdentures.

Bar-and-clip attachments for dental implants are a common and versatile device for improving the retention and stability of a removable prosthesis. Manufactured clips may be unsubstantial and may not always fit or provide the desired amount of retention for the bar. The purpose of this article is to describe a technique for custom fabrication of clip attachments. The wax pattern of the clips is fabricated and then cast in dental gold alloy. The gold clips are then cut to an appropriate size that will allow for a variety of clinical applications.

Dental Casting Technique↗
PubMed1992

Crown behaviour during cementation.

Complete seating of restorations during cementation is hindered by the need for excess cement to be expressed. It has been shown that postcementation seating is usually worse than precementation seating. Techniques have been developed to minimize this problem, including venting, die spacing and limiting cement placement, and these techniques are reviewed. The behaviour of the crown during cementation is considered, and consequences of crown cementation are discussed.

Cementation↗
PubMed1999

Reconstruction of the irradiated contracted socket with an expanded superficial temporalis fascial flap.

PURPOSE: To describe the reconstruction of an irradiated contracted socket with an expanded superficial temporalis fascial flap and oral mucosa. METHODS: A superficial temporalis fascial flap was first expanded with tissue expansion techniques and then rotated into the orbit to revascularize the socket. The mucosal surface of the socket was secondarily grafted with buccal and hard palate mucosa. RESULTS: The expanded superficial temporalis fascial flap was used to revascularize the socket for grafting with hard palate and buccal mucosa. This resulted in the successful retention of an ocular prosthesis. CONCLUSION: The expanded superficial temporalis fascial flap is a useful technique in reconstruction of the contracted socket.

Child, Preschool↗
PubMed2000

Bleaching and temporomandibular disorder using a half tray design: a clinical report.

A maxillary soft, custom-fitted tray was fabricated for a patient to perform nightguard vital bleaching. Treatment was interrupted after the patient experienced pain in the temporomandibular joint area shortly after wearing the bleaching prosthesis. The tray was trimmed so the labial, incisal and buccal cusps were covered and Sc) the patient had complete tooth-to-tooth contact in the maximum intercuspal position. The prosthesis proved to be retentive even without the presence of the bleaching material. The thick, sticky bleaching material was contained in the half tray design and the tray was held in place. The patient was able to continue the bleaching process for the 2-week duration necessary to achieve successful lightening of the teeth without further TMD symptoms.

Adult↗
PubMed1999

Achieving an even thickness in heat-polymerized permanent acrylic resin denture bases for complete dentures.

Permanent denture bases form the fitting surface of a denture and are constructed on a master cast, in heat-polymerized acrylic resin. These bases are strong and rigid and demonstrate both the fit and retention of the final prosthesis. General recommendations suggests a thickness of between 1.5 to 3 mm for these bases. The normal procedure for producing such a denture base is to manually adapt materials to the cast, in their plastic state, before processing. Such procedures are liable to distortion and variation in the thickness of the resultant denture base and may be unreliable. This article describes a method for achieving a consistent thickness in a heat-polymerized, permanent, acrylic resin denture base through the use of a vacuum-formed, thermoplastic blank as a template. The method is simple, and results in a denture base with a consistent even thickness.

Acrylic Resins↗
PubMed1987

Infected total knee arthroplasty. A protocol for management.

All cases of deep wound infection following total knee arthroplasty presented to the senior author between April 1977 and February 1984 were reviewed in an attempt to develop a protocol for salvaging a functional, painless knee. Two of 23 knees were eliminated because of extensive soft tissue loss. The remaining 21 infected total knee arthroplasties were analyzed. A determination of the chronicity of the infection and an evaluation of any radiolucencies were essential in determining the type of treatment used. Three distinct methods of surgical management were identified: radical debridement with retention of the initial prosthesis, one-stage reimplantation, and two-stage reimplantation. A functional uninfected total knee arthroplasty was salvaged in 18 of 21 patients, with an average follow-up period of 46 months.

Adult↗
PubMed2000

[Clinical anophthalmos. Cosmetic outcome after 2 years therapy with an orbital expander for stimulating orbital growth].

BACKGROUND: Congenital anophthalmos is a rare condition in which intervention in an early age can stimulate orbital expansion. The therapeutic goal was to allow retention of a suitable prosthesis and to maximise facial symmetry. METHODS AND PATIENTS: We report on 3 anophthalmic newborn male patients, of which one presented with microphthalmos in the other eye as well as associated systemic disorders. Solid moulded shapes were adapted and manufactured out of methylmethacrylate to increase expansion of orbital soft tissue and bone. The moulding of the orbita was performed by silicone made of two components under general anaesthesia during the first two years of life. The following day the solid shapes were fitted in the outpatient department. They were increased in size when they started to rotate within the orbit or when the eyelids were relatively loose around the solid shape. The initial insertion of the orbital expander was performed in the first weeks after birth and was repeated every 3 to 6 weeks within the first year of life. The degree of orbital expansion was determined by measurements of the horizontal eyelid length, the volume of the solid shapes, by measuring the volume in cm3 of water displaced by the shape after submerging it in a cylinder of water and assessment of the cosmetic aspect. RESULTS: Within 8 months of therapy a horizontal eyelid lengthening to 10 mm and an increase of the volume of the orbital expander from 1.5 cm3 to 6 cm3 was achieved in patient 1. After 20 months of therapy patient 2 showed symmetry of the face and the horizontal eyelid length. In patient 3 therapy started 3 years late and after 2 years only a horizontal eyelid lengthening of 3 mm and a suboptimal symmetry of the face was achieved. CONCLUSION: Our own experience suggests that early prosthetic fittings are necessary for an ideal cosmetic outcome. Motivation and cooperation of the parents is an important factor to achieve optimal results.

Anophthalmos↗