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PubMed1997

Prosthodontic treatment for patients with large mandibular defects; porous hydroxyapatite grafts.

It is difficult for both prosthodontists and their patients with large marginal defects to achieve a satisfactory prosthodontic result, because retention, support, and stability of the prosthesis are limited and recovery of esthetics is unsatisfactory owing to large mandibular defects. Alveolar ridge augmentation therapy is performed to compensate for such problems. We have experienced a good prognosis of prosthodontic treatment for over 10 years in two patients with large marginal defects of the partially edentulous mandible, who had undergone grafting of porous hydroxyapatite blocks to their bone defects. It has been reported that porous hydroxyapatite blocks are unsuitable for edentulous patients, because the mucosa covering the hydroxyapatite block is too thin and delicate to support dentures. We, therefore, designed the denture to prevent concentration of occlusal stress on the mucosa. In both of these two cases, we achieved recovery of occlusal function and esthetics by affixing denture to the large marginally resected defect augmented with a graft of porous hydroxyapatite block.

Adult↗
PubMed1985

Hydroxyapatite for alveolar ridge augmentation: indications and problems.

The increased use of hydroxyapatite for augmentation of residual alveolar ridges has created some problems in the subsequent fabrication of complete denture prostheses. Although hydroxyapatite appears to be an effective substitute for resorbed alveolar ridges, its use is not indicated for all patients. In addition, the premise that "if a little is good, a lot is better" does not apply. The following conclusions can be drawn. Augmentation should not be considered if vestibular extension will provide acceptable results. Placement of hydroxyapatite should improve the contour and amount of the residual alveolar ridge. Use as little as possible to accomplish the goal. Preprosthetic surgery should permit vertical as well as horizontal extension of the denture. Augmentation should not result in the need to use lining mucosa to support a complete denture. Vestibular extensions are indicated for most augmented alveolar ridges. The relative strength of the strong arch should not be increased in prognathic or retrognathic ridge relationships. Preprosthetic surgery should be a combined surgical-prosthodontic treatment endeavor. If a foundation is created that cannot be used effectively for the support, retention, and stability of an intended prosthesis, little benefit is provided for the patient. Small variations in intended treatment can significantly increase success of the prosthesis (Fig. 13). Unfortunately, the relative ease of hydroxyapatite placement has led to its use in patients who do not require augmentation and augmentation in amounts and regions that are not conducive to improving denture success. A coordinated effort between the surgeon and the prosthodontist will usually result in treatment that provides the best potential foundation for a specific patient.

Alveolar Ridge Augmentation↗
PubMed2001

Vacuum-formed tooth position record as an index for the fabrication of an endosseous implant-supported prosthesis.

An endosseous implant-supported prosthesis usually requires a metal substructure and/or retentive elements in addition to the prosthetic teeth and soft tissue substitute. It is crucial that the metal substructure and all of the prosthetic components of an implant-supported prosthesis be confined within the contour of the prosthesis. This article describes a procedure for fabricating an index to record and maintain the anatomic contour of the trial denture to the master cast.

Acrylic Resins↗
PubMedDate not supplied

Two-unit cantilevered resin-bonded fixed partial dentures--a retrospective, preliminary clinical investigation.

PURPOSE: The aim of this study was to retrospectively evaluate the clinical retention and abutment movement of 2-unit cantilevered resin-bonded fixed partial dentures (FPD) that were inserted at Prince Philip Dental Hospital in Hong Kong. MATERIALS AND METHODS: Of 45 patients who were identified from a hospital computer search after receiving a 2-unit cantilevered resin-bonded FPD, 31 were clinically examined (33 FPDs). For each patient the following data were recorded: gender, age, cementation date, endodontic treatment if performed, bone support, tooth mobility, and FPD tipping or drifting. Data about any debonds with subsequent treatment and patient satisfaction on a 10-point scale were also recorded. RESULTS: The mean service life for the 33 prostheses was 30 +/- 18 months, with a range of 72 days to 67 months. One prosthesis debonded, resulting in a clinical retention rate of 97%. No rotation, drifting, or tipping was observed for any of the prostheses during the short period of this study. CONCLUSION: Two-unit cantilevered resin-bonded FPDs are successful in the short term, but further research is required to determine if they offer a viable alternative to fixed-fixed resin-bonded FPD designs.

Adolescent↗
PubMed1992

Theoretical analysis of the fatigue life of fixture screws in osseointegrated dental implants.

Metal fatigue failure of the gold screw used to retain a fixed prosthesis to Brånemark osseointegrated fixtures/abutments has been analyzed theoretically. Mechanical engineering principles show the importance of appropriate preload being applied through the gold screw to the gold cylinder and abutment. The significance of the screw design and necessity of applying the correct torque to achieve a long fatigue life for the screw are also described. The consequence of misalignment of a gold cylinder to an abutment is discussed.

Dental Abutments↗
PubMed2003

[Dental feats 1. An implant-supported orbital prosthesis after ablative tumor surgery].

Extraoral implants are used with increasing frequency, in order to provide retention for facial prostheses. Facial prostheses can replace lost extraoral hard and soft tissues using acrylic or silicone materials. The surgeon, maxillofacial prosthodontist and dental technician are facing particular treatment considerations and practical problems. Some of these are demonstrated and discussed in this article by means of a case-report. A patient received an orbital prosthesis which obtains its retention from implants, placed in the lateral orbital rim.

Facial Bones↗
PubMed1993

Application of hydroxyapatite-coated implants as support for palatal lift prostheses in edentulous patients with cleft palate: a clinical report.

A palatal lift prosthesis (PLP) is a prosthetic speech aid used to compensate for palatopharyngeal incompetence. However, it requires dental abutments to facilitate its function. In two edentulous patients with cleft palate, hydroxyapatite-coated dental implants were used to increase PLP retention. In both cases, palatopharyngeal closure was obtained and PLP function was deemed effective, as determined by speech evaluation and nasal air flow measurements, for more than 3 years. This treatment is useful for enhancing the retention of a PLP in patients who have few or no remaining natural tooth abutments.

Adult↗
PubMedDate not supplied

Designing clasps for the asymmetric distal extension removable partial denture.

Retentive clasp components can be created to minimize torquing forces on abutment teeth incorporated in the support and retention of bilateral distal extension removable partial dentures. Functional movement of the combined tooth-mucosa-borne prosthesis about the axis of rotation necessitates consideration of retentive element design modifications, particularly as they relate to bilateral asymmetric distal extension situations.

Dental Abutments↗
PubMed1976

New types of synthetic infusion solutions. III. Elimination and retention of poly-[N-(2-hydroxypropyl)methacrylamide] in a test organism.

The elimination and retention of a new, fully synthetic plasma prosthesis of Czechoslovak origin under the working name of Duxon (poly[N-(2-hydroxypropyl)methacrylamide]) was investigated in experiments on rabbits by using a 14C-labeled polymer. Results published earlier on elimination have been confirmed and extended. Retention was examined after repeated application. The effect of molecular weight prevailed both in elimination and in retention. Polymers of lower molecular weights, which possess a good therapeutical effect, are not permanently deposited in the organism.

Acrylic Resins↗
PubMed1983

Overdentures in the maxillofacial prosthetics practice. Part I: The cancer patient.

The myriad of interacting disciplines and treatments for patients suffering from oral cancer can dramatically influence the planning for dental treatment. Retention of periodontally involved or structurally hopeless teeth is often necessary, if not required, in the rehabilitation phase, making the integration of overdentures into the treatment plan a viable consideration. The potential for increased retention and stability of the final prosthesis with the use of such abutments may be the most critical factor in providing a successful prosthesis. Whether the ultimate prosthesis is temporary or definitive, simple or highly complex, the compromised oral cancer patient will often benefit from the use of overdentures.

Denture Design↗
PubMed1994

Technique to restore unfavorably inclined implants.

Unfavorable inclination of implants is a common problem that may compromise esthetics, phonetics, and function of the implant-supported fixed prosthesis. Several methods have been reported to compensate for malaligned implants; however, most techniques are complicated and expensive. A technique that combines a custom abutment from a hexed UCLA-type plastic burn-out pattern and a manually threaded setscrew hole is a relatively inexpensive and uncomplicated approach to eliminate problems caused by unfavorable implant inclination. This article describes the procedures for fabrication of an implant-supported fixed prosthesis with the use of this technique.

Dental Abutments↗
PubMed1998

An esthetically attractive twin-flex clasp for removable partial dentures.

The cosmetic appearance of a removable partial denture is of great importance to both the patient and the dentist. Traditional facial clasp arms are usually unsightly. Other options are expensive and/or technically difficult, and may require time-consuming maintenance. Furthermore, when these clasps are broken, replacement of the entire removable partial denture may be required. This article describes a procedure for making a simple but effective twin-flex clasp. The clasp has excellent esthetics and can be readily adjusted or replaced.

Dental Clasps↗
PubMed1996

A new stainless steel clasp for partial dentures.

After experiencing drawbacks from using stainless steel wire for clasps, as opposed to wrought gold, I began experimenting with various clasp designs. The new design makes use of stainless steel's physical properties while overcoming some of its obstacles.

Dental Clasps↗
PubMed2001

Tooth preparations for complete crowns: an art form based on scientific principles.

STATEMENT OF THE PROBLEM: No recent literature has reviewed the current scientific knowledge on complete coverage tooth preparations. PURPOSE: This article traces the historic evolution of complete coverage tooth preparations and identifies guidelines for scientific tooth preparations. MATERIAL AND METHODS: Literature covering 250 years of clinical practice was reviewed with emphasis on scientific data acquired during the last 50 years. Both a MEDLINE search and an extensive manual search were used to locate relevant articles written in English in the last 50 years. RESULTS: Teeth should be prepared so that they exhibit the following characteristics: 10 to 20 degrees of total occlusal convergence, a minimal occlusocervical dimension of 4 mm for molars and 3 mm for other teeth, and an occlusocervical-to-faciolingual dimension ratio of 0.4 or greater. Facioproximal and linguoproximal line angles should be preserved whenever possible. When the above features are missing, the teeth should be modified with auxiliary resistance features such as axial grooves or boxes, preferably on proximal surfaces. Finish line selection should be based on the type of crown/retainer, esthetic requirements, ease of formation, and personal experience. Expectations of enhanced marginal fit with certain finish lines could not be validated by recent research. Esthetic requirements and tooth conditions determine finish line locations relative to the gingiva, with a supragingival location being more acceptable. Line angles should be rounded, and a reasonable degree of surface smoothness is desired. CONCLUSIONS: Nine scientific principles have been developed that ensure mechanical, biologic, and esthetic success for tooth preparation of complete coverage restorations.

Bicuspid↗
PubMed1993

The edentulous mandible opposing maxillary natural teeth: treatment considerations utilizing implant overdentures.

The restoration of the edentulous mandible opposing all or part of the maxillary natural dentition with implant overdentures is described. There are many situations in which the maxillary teeth opposing an edentulous mandible can and should be retained. Mandibular implant overdentures can be utilized as long as health considerations, morphologic features of the resorbed mandible, and maxillomandibular jaw relationships are satisfactory.

Alveolar Bone Loss↗
PubMed1994

Within-subject comparisons of implant-supported mandibular prostheses: psychometric evaluation.

In a within-subject cross-over clinical trial, psychometric and functional measurements were taken while 15 completely edentulous subjects wore mandibular fixed prostheses and long-bar removable implant-supported prostheses. In this paper, the results of a psychometric assessment are presented. Eight subjects first received the fixed bridge and seven the removable type. After having worn a prosthesis for a minimum of two months, subjects responded to psychometric scales that measured their perceptions of various factors associated with prostheses. They also chewed test foods while masticatory activity was recorded. The prostheses were then changed and the procedures repeated. At the end of the study, patients were asked to choose the prosthesis that they wished to keep. Patients assigned significantly higher scores, on visual analogue scales, to both types of implant-supported prostheses than to their original conventional prostheses for all factors tested, including general satisfaction. However, no statistically significant differences between the two implant-supported prostheses were detected except for the difficulty of chewing carrot, apple, and sausage. For these foods, the fixed prostheses were rated higher. Subjects' responses to category scales were consistent with their responses to the visual analogue scales. These results suggest that, although patients find the fixed bridge to be significantly better for chewing harder foods, there is no difference in their general satisfaction with the two types of prostheses.

Adaptation, Psychological↗
PubMed1994

Within-subject comparisons of implant-supported mandibular prostheses: choice of prosthesis.

Although previous studies have demonstrated that implant-supported prostheses are more satisfactory and efficient for edentulous patients than are conventional prostheses, until now no investigation has directly compared different types of implant-supported prostheses. We carried out a within-subject cross-over clinical trial with fixed and long-bar removable implant-supported mandibular prostheses. Fifteen subjects were randomly divided into two groups. One group received the fixed prosthesis first, while the other first received the removable. After a two-month adaptation period, psychometric measurements of various aspects of the prostheses and physiological tests of masticatory efficiency were carried out. The prostheses were then changed, and the procedures repeated. At the end of the study, subjects chose the prosthesis they wished to keep. In this paper, we report on the data gathered at this last appointment. Eight subjects chose the fixed (F group), and seven chose the removable (R group). Both groups rated stability and ability to chew with the fixed as significantly better than with the removable. However, the R group rated ease of cleaning as the most important factor governing their decision, followed by esthetics and stability. The F group considered stability to be the most important factor in their decision, followed by chewing ability and ability to clean. There was a tendency for the removable to be chosen by older subjects (+50 years). These results suggest that patients choose fixed or removable implant-supported prostheses for specific reasons, and that patient attitudes should be considered when the design of a prosthesis is being planned for an individual patient.

Adaptation, Psychological↗