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Load transfer by a maxillary distal-extension removable partial denture with cap and ring extracoronal attachments.

This study photoelastically compared the stress distribution characteristics of maxillary, bilateral, distal-extension removable partial dentures retained by light and heavy ERA extracoronal attachments. One prosthesis included supporting rests and the other had no rests. Both designs were tested with and without abutment splinting. The most favorable stress distributions were obtained with light retention elements, supporting rests, and splinting of the abutments. In this configuration the attachment prosthesis compared favorably in stress distribution with the maxillary I-bar retained removable partial denture in a previous study that used a comparable maxillae model.

Dental Prosthesis Retention↗

Fabrication of a new crown and provisional to an existing removable partial denture.

A method of fabricating a new crown to an existing removable partial denture is described. A press-form plastic shell made from the diagnostic cast provides the outer contours for the abutment tooth, while an acrylic resin coping is fabricated on a die to provide accurate internal adaptation. The acrylic resin coping is seated on the prepared abutment. Autopolymerizing acrylic resin is mixed and placed in the plastic shell that is then placed in the mouth over the coping, forming the acrylic resin crown pattern. The removable partial prosthesis is fitted over the crown pattern intraorally. The pattern is transferred back to the die, the margins are refined, and the casting is completed and finished, avoiding reduction of the established contours. The same plastic shell is used with tooth-shaded acrylic resin to construct a provisional crown directly in the mouth. This technique allows the patient to wear the removable partial denture while the laboratory procedures are completed.

Crowns↗

Tissue-integrated prostheses for edentulous patients with normal and abnormal jaw relationships.

Diagnosis and treatment planning are keys to successful prosthodontic rehabilitation. The increasing interest in the use of the tissue-integrated prosthesis to resolve the problems of edentulous patients indicates caution in the selection of patients for this procedure. Even if patients are identified who could potentially benefit, application of the concept must meet the needs of the patient. The treatment planning phase must include all professionals participating in patient management and must consider the best placement of fixtures to improve patient findings to an optimal degree. Although many patient factors must be considered in treatment planning, this article discussed application of the tissue-integrated prosthesis concept as it relates to jaw relationship. The tissue-integrated prosthesis must not compound or create retention and stability problems found with complete dentures. This article suggests treatment considerations in planning the tissue-integrated prosthesis for normal and abnormal jaw relationships.

Bone Resorption↗

Assisted retention of a hearing device in an implant-retained auricular prosthesis.

The use of bone-anchored hearing aids is not possible for all patients who wear an implant-retained auricular prosthesis. For some patients, the external ear canal cannot be occluded with a conventional hearing device. Currently manufactured hearing aids may not readily fit the contours of an implant-retained auricular prosthesis. This article describes a technique that allows a modular hearing aid device to be inserted into a custom "sleeve." With this device, the patient can take advantage of binaural cues.

Acrylic Resins↗

Results of knee arthroplasty using the cemented press-fit condylar prosthesis. Based on a preliminary report.

Although retention of the posterior cruciate ligament in total knee arthroplasty remains controversial, several prostheses exist for this purpose and have been reported to have varying results. This study examines the short-term follow-up results of 107 total knee arthroplasties using a cemented press-fit condylar prosthesis. The mean follow-up period was 2.5 years, and the mean postoperative knee score was 96 points. Radiolucent lines were infrequently found and were incomplete. At short-term follow-up, no problems were identified with the cemented press-fit condylar prosthesis.

Aged↗

Spark erosion fixed/detachable prosthesis for the completely edentulous maxilla.

A technique is described for restoration of the completely edentulous maxilla. From six to eight root-form implants are surgically placed in the edentulous maxilla. A hybrid overdenture is constructed by use of a two-degree tapered precision milled primary bar. A cast overdenture prosthesis is constructed over this bar, and precision attachments are spark-erosion-processed to the primary and secondary prosthetic components. The technology described in this article allows for an intimate fit of the various prosthetic components. This prosthetic protocol permits maximum retention and stability of the prosthesis and solves many problems which are encountered in the oral rehabilitation of the edentulous maxilla.

Adult↗

The effect of retention of the femoral neck and of cement upon the stability of a proximal femoral prosthesis.

Radiological measurements of downward femoral component migration are reported for 203 hips in the first 2 years following total hip arthroplasty. The femora differed with respect to the retention of the femoral neck--in 167 it was retained and in 36 it was damaged--and to the use of cement--142 hips were press-fits and 61 were cemented. Multivariate analysis demonstrated that both retention of the neck and the use of cement retarded migration (ie, increased stability) of the femoral component (P = .0003 and .0037, respectively).

Cementation↗

The hollow box maxillary obturator.

A case is reported assessing the problems encountered after surgical resection of the maxilla. The use of a hollow box obturator and details of its construction are described. The importance of skin grafting of the maxillary defect and use of available anatomical undercuts to optimise support and retention of the obturator is stressed. By provision of a lightweight hollow obturator, the weight of the prosthesis is kept to a minimum, helping retention, and allowing good resonance during speech. Initially the patient was to be assessed for an implant retained prosthesis, however, a satisfactory conventional prosthesis met the functional and aesthetic needs of the patient and avoided the need for further surgery for placement of implants.

Denture Design↗

A magnetically retained interim maxillary obturator.

A technique has been presented for the fabrication of a sectional interim maxillary obturator with retention augmented by a magnet. A tonogram revealed a 32 per cent decrease in hypernasality during speech when the prosthesis was worn (Fig. 12). The positive locking and continuous retentive quality of the prosthesis provided by the magnet permitted normal speech and mastication as well as an improved psychologic state during a very trying rehabilitation period.

Carcinoma↗

Tissue-supported implant overdentures.

Overdenture techniques can be modified for use with implants. Generally the implants, which replace the tooth roots, can be placed in a position to permit optimum retention and stability as well as enhancing esthetics. Bony undercuts, which at times are present with the retention of tooth roots, are not a problem when using implants. Various retentive schemes are available to retain the prosthesis and can be matched to the individual needs of patients in regard to retention, stability, and the ability to insert and remove prostheses. Two implants can adequately support an overdenture. The superstructure must be designed to enable the patient to maintain a healthy oral environment. The patient must understand and be able to perform required oral hygiene procedures. The use of overdentures over implants affords the dentist another option in meeting the needs of the patients.

Dental Clasps↗

Clinical complications of osseointegrated implants.

STATEMENT OF PROBLEM: There is no comprehensive review of the literature that identifies the complications reported in clinical dental implant studies. PURPOSE: This article attempted to determine the types of complications that have been reported and to provide data regarding their frequency. METHODS: All available clinical studies from 1981 to 1997, published in English or with English abstract, that presented success/failure data regarding implant treatment were evaluated to determine the types of reported complications and to quantify implant loss as it relates to type of prosthesis, arch, time, implant length, and bone quality. RESULTS: Greater implant loss occurred with overdentures than with other types of prostheses. There was greater loss in the maxilla than mandible with fixed complete dentures and overdentures, whereas little arch difference was noted with fixed partial dentures. Implant loss increased with short implants and poor bone quality. The time of implant loss (preprosthetic vs postprosthetic) varied with type of prosthesis. Surgical complications included neurosensory disturbance, hematoma, mandibular fracture, hemorrhage, and tooth devitalization. Initial and long-term marginal bone changes were identified. Peri-implant soft tissue complications included dehiscence, fistulas, and gingival inflammation/proliferation. Mechanical complications were screw loosening/fracture, implant fractures, framework, resin base and veneering material fractures, opposing prosthesis fractures, and overdenture mechanical retention problems. Some studies also presented phonetic and esthetic complications. CONCLUSIONS: Although the literature presents considerable information on implant complications, variations in study design and reporting procedures limited the available data and therefore precluded proper analysis of certain complications.

Dental Arch↗

Intracrown ring for crown and fixed partial denture abutments.

When a tooth prepared for a crown does not comply with the general principles of retention and resistance form, and it is not possible to correct it without damage to the biologic structures of the tooth, consideration must be given to the purpose of the crown, such as whether it is a single crown, a retainer for a fixed restoration, or a retainer for a fixed removable prosthesis with precision attachments. The crown prepared with receptacles for internal attachments will undoubtedly require more retention and resistance to dislodgment than a single crown because of forces that will be applied to it through the removable portion of the restoration. The purpose of this article is to present an alternative procedure that uses the intracrown ring, which provides additional retention for the abutment crown because of the compressible ring. The compressible ring is placed in the groove prepared in the lower third of the abutment during the crown preparation.

Crowns↗

An evaluation of auricular prosthesis using osseointegrated implants.

The purpose of this evaluation is to compare whether retention of auricular prostheses, through utilization of osseointegrated implants rather than by adhesive, provides any improvement in patient acceptance and prosthesis longevity. Forty-seven out of a total of 49 patients having facial prostheses, retained by means of Brånemark fixtures, were surveyed. Ease of retention was noted in 91% of the patients. Satisfaction with the shape of the prosthesis, colour and ease of positioning was 100, 85 and 98% respectively. None of the patients experienced skin irritation under the prosthesis and 94% of them wore their prosthesis daily. Of the 13 patients with previous prosthesis experience, 92% stated improved retention and all of them found ease of positioning and wearing comfort had improved. Durability was better in 62%, unchanged in 23% and worse in 15% of these 13 patients.

Adolescent↗

Brain abscess by mycotic and bacterial infection in a diabetic patient: clinical report and review of literature.

This report presents a case of lethal invasive mucormycosis, a rare fungal infection, which predominantly affects immunocompromised patients, and is reported in a 57-year-old female who presented with cerebral abscess. The patient, who had undiagnosed diabetes mellitus, presented with extensive right hemifacial deficiency of the bones and soft tissues consequent to surgical resection of the ethmoid-spheno-maxillo-orbital district after mucormycosis. A reconstruction with a pectoral pedunculated flap was performed. The maxillary swelling extended to the contiguous area, involving the palate and homolateral orbital floor. Mucous and cutaneous samples showed the presence of Aspergillus fumigatus, and diagnosis of rhinocerebral mucormycosis was made. The patients also presented with a right hemiplegia consequent to a cerebral abscess by Eikenella corrodens. The authors decided to position an intraoral prosthesis to restore palatal integrity and masticatory function and inserted four titanium fixtures for the retention of the bone-anchored facial prosthesis.

Aspergillus fumigatus↗