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Azpiazu-Flores FX, Lee DJ, Mata-Mata SJ, Zheng F. Rehabilitation of a patient with mandibular flexure using contemporary glass-infiltrated high performance CAD-CAM polymers: A clinical report with 1-year follow-up. J Prosthet Dent 2024; 132:477-483. [PMID: 36828729 DOI: 10.1016/j.prosdent.2022.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/14/2022] [Accepted: 12/14/2022] [Indexed: 02/24/2023]
Abstract
Mandibular flexure is a phenomenon generated by the action of the muscles of mastication and other muscles in the head and neck region which can lead to prosthetic and biological complications such as pain, material fracture, and bone loss around dental implants. To avoid such complications, dividing the mandibular prostheses into 3 short-span prostheses or sectioning at the midline has been suggested. This clinical report presents the management of an edentulous patient with clinically detectable mandibular flexure treated with a 1-piece metal-free complete arch implant-supported prosthesis.
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Affiliation(s)
- Francisco X Azpiazu-Flores
- Former Graduate student, Advanced Prosthodontics Program, The Ohio State University, Columbus, Ohio; Assistant Professor, Department of Restorative Dentistry, Dr. Gerald Niznick College of Dentistry, University of Manitoba, Winnipeg, Canada.
| | - Damian J Lee
- Associate Professor, Division of Restorative and Prosthetic Dentistry, College of Dentistry, The Ohio State University, Columbus, Ohio; Director of the Advanced Prosthodontics Program, Division of Restorative and Prosthetic Dentistry, College of Dentistry, The Ohio State University, Columbus, Ohio
| | - Severino J Mata-Mata
- Former Graduate student, Advanced Prosthodontics Program, The Ohio State University, Columbus, Ohio; Private Practitioner and Assistant Professor, Facultad de Odontologia, Universidad Francisco Marroquin, Ciudad de Guatemala, Guatemala
| | - Fengyuan Zheng
- Clinical Associate Professor, Department of Restorative Sciences, Division of Prosthodontics, University of Minnesota School of Dentistry, Minneapolis, Minn
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Azpiazu-Flores FX, Mata-Mata SJ, Lee DJ. Detection of mandibular flexure with a dental plaster verification device: A clinical report with video recording. J Prosthet Dent 2023; 130:807-810. [PMID: 35465960 DOI: 10.1016/j.prosdent.2022.01.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 11/18/2022]
Abstract
Mandibular flexure is a phenomenon characterized by a reduction of the arch width caused by the action of various muscular groups involved during mastication. When flexure is pronounced and teeth or dental implants are rigidly splinted, mandibular flexure leads to a biomechanical environment detrimental to the longevity of the restoration. This clinical report presents the use of a dental plaster device as a diagnostic tool to determine the extent of mandibular flexure in an edentulous patient treated with a mandibular fixed complete denture.
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Affiliation(s)
- Francisco X Azpiazu-Flores
- Former Graduate Student, Advanced Prosthodontics Program, The Ohio State University, Columbus, Ohio; Assistant Professor, Department of Restorative Dentistry, Dr Gerald Niznick College of Dentistry, University of Manitoba, Winnipeg, Canada.
| | - Severino J Mata-Mata
- Former Graduate Student, Advanced Prosthodontics Program, The Ohio State University, Columbus, Ohio; Private practice, Ciudad de Guatemala, Guatemala
| | - Damian J Lee
- Assistant Professor and Director of the Advanced Prosthodontics Program, Division of Restorative and Prosthetic Dentistry, College of Dentistry, The Ohio State University, Columbus, Ohio
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Ananya, Rani P, Sinha T, Prakash J. Maxillary Cast Partial Denture and Mandibular Implant-Supported Metal-Ceramic Prosthesis With a Split Framework to Compensate for Mandibular Flexure: A Case Report. Cureus 2023; 15:e49071. [PMID: 38130512 PMCID: PMC10733657 DOI: 10.7759/cureus.49071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2023] [Indexed: 12/23/2023] Open
Abstract
The goal of modern dentistry is to restore optimum oral health, function, and comfort for a patient. For an implant-supported fixed prosthesis, these goals cannot be met if the biomechanical factors governing the success of the prosthesis are overlooked. Mandibular flexure is one such factor that needs to be considered, especially when implants are being placed posterior to the interforaminal region. If not, it can lead to problems like increased stress, bone resorption, poor fit of the prosthesis, screw loosening, and patient discomfort. The use of a split-framework prosthesis is one of the measures that could be taken to decrease the stress, ensure a passive fit of the framework, and long-term maintenance of patient comfort and function. This case report describes the oral rehabilitation of a patient using a maxillary cast partial denture and mandibular split framework fixed prosthesis to compensate for mandibular flexure.
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Affiliation(s)
- Ananya
- Prosthodontics, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Priya Rani
- Prosthodontics, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Tushar Sinha
- Prosthodontics, Rajendra Institute of Medical Sciences, Ranchi, IND
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Ay N, Yildirimturk Dogan S, Sirin Y. The biomechanical stability of miniplate osteosynthesis configurations in bilateral mandibular angle fractures. J Oral Sci 2023; 65:265-269. [PMID: 37648469 DOI: 10.2334/josnusd.23-0164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
PURPOSE The present study investigated the biomechanical stability of three miniplate osteosynthesis configurations used for internal fixation of bilateral mandibular angle fracture (BMAF). METHODS Standard fracture lines were created in 72 polyurethane mandibles and stabilized with 2.0-mm, 4-hole standard titanium miniplates and monocortical screws. The group descriptions and miniplate configurations were: 2Plates (1-1), 3Plates (1-2) and 4Plates (2-2). The mandibles were subjected to either incisal or molar loads (from both sides in the 3Plates group) up to a force of 120 N. The displacements of the constructs were recorded at each force increment of 10 N. ANOVA and Tukey's post-hoc tests were used for statistical analysis. RESULTS The 2Plates group showed higher displacement under both loading conditions (P < 0.05 for each). The same group reached displacement levels of 1 mm and 3 mm during molar loading and 1 mm, 3 mm, and 5 mm during incisal loading at lower force magnitudes relative to others (P < 0.05 for each). CONCLUSION Bone-plate constructs for BMAFs stabilized with three or four standard miniplates are more likely to provide similar resistance when subjected to incisal or molar loads, in contrast to the two-miniplate configuration, which is relatively more prone to displacement.
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Affiliation(s)
- Nida Ay
- Graduate School of Health Sciences, Department of Oral and Maxillofacial Surgery, Istanbul University
| | | | - Yigit Sirin
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Istanbul University
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El Charkawi H, Nassar HI, Abdelaziz MS. Retrospective digital study of mandibular flexure in patients with long-span fixed restorations supported by natural teeth. BMC Res Notes 2023; 16:203. [PMID: 37697386 PMCID: PMC10494340 DOI: 10.1186/s13104-023-06486-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 08/30/2023] [Indexed: 09/13/2023] Open
Abstract
PURPOSE This retrospective study aims to evaluate the mandibular flexure on a long-span rigid fixed prosthesis supported by natural teeth. MATERIALS AND METHODS Nine patients (five males and four females) were included in this study who had long-span rigid mandibular fixed prostheses for long-term (10-15 years) that have led to radiographic changes around the supporting teeth. The mandibular flexure was measured digitally after adhering reference markers to the prostheses. Intraoral scans were obtained at the minimum and maximum mouth openings before and after splitting the preexisting prostheses. The distances between the markers were measured, and mandibular flexure was calculated. RESULTS This study showed a significant deviation (narrowing) of the mandible before and after splitting the rigid fixed prostheses (P value < 0.05). CONCLUSION Digital analysis of the data collected from the patients in this retrospective study indicated that deviations occur during mandibular flexure. CLINICAL RELEVANCE Splitting the full arch prosthesis could prevent the negative consequences of mandibular flexure on restorations. Trial registration The study was registered on clinicaltrials.gov with registration number NCT05617274 (15/11/2022).
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Affiliation(s)
- Hussein El Charkawi
- Department of Prosthodontics, Faculty of Oral and Dental Medicine, Future University in Egypt, Fifth Settlement, End of 90 Street, New Cairo, Egypt
| | - Hossam I Nassar
- Department of Prosthodontics, Faculty of Oral and Dental Medicine, Future University in Egypt, Fifth Settlement, End of 90 Street, New Cairo, Egypt
| | - Medhat Sameh Abdelaziz
- Department of Prosthodontics, Faculty of Oral and Dental Medicine, Future University in Egypt, Fifth Settlement, End of 90 Street, New Cairo, Egypt.
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Gao J, Jiang L, Zhao B. Median mandibular flexure-the unique physiological phenomenon of the mandible and its clinical significance in implant restoration. Front Bioeng Biotechnol 2023; 11:1238181. [PMID: 37744259 PMCID: PMC10513439 DOI: 10.3389/fbioe.2023.1238181] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 08/29/2023] [Indexed: 09/26/2023] Open
Abstract
Mandibular flexure, characterized by unique biomechanical behaviors such as elastic bending and torsion under functional loading, has emerged as a crucial factor in oral clinical diagnosis and treatment. This paper presents a comprehensive review of the current research status on mandibular flexure, drawing insights from relevant studies retrieved from the PubMed database (www.ncbi.nlm.nih.gov/pubmed), including research conclusions, literature reviews, case reports, and authoritative reference books. This paper thoroughly explores the physiological mechanisms underlying mandibular flexure, discussing different concurrent deformation types and the essential factors influencing this process. Moreover, it explores the profound implications of mandibular flexure on clinical aspects such as bone absorption around dental implants, the precision of prosthesis fabrication, and the selection and design of superstructure materials. Based on the empirical findings, this review provides crucial clinical recommendations. Specifically, it is recommended to exert precise control over the patients mouth opening during impression-taking. Those with a high elastic modulus or bone-tissue-like properties should be prioritized when selecting superstructure materials. Moreover, this review underscores the significance of customizing framework design to accommodate individual variations in facial morphology and occlusal habits. Future research endeavors in this field have the potential to advance clinical diagnosis and treatment approaches, providing opportunities for improvement.
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Affiliation(s)
| | | | - Baohong Zhao
- Center of Implantology School and Hospital of Stomatology, China Medical University, Liaoning Province Key Laboratory of Oral Diseases, Shenyang, China
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Caggiano M, D’Ambrosio F, Acerra A, Giudice D, Giordano F. Biomechanical Implications of Mandibular Flexion on Implant-Supported Full-Arch Rehabilitations: A Systematic Literature Review. J Clin Med 2023; 12:5302. [PMID: 37629344 PMCID: PMC10455661 DOI: 10.3390/jcm12165302] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/03/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Mandibular flexion (MF) is a complex biomechanical phenomenon, which involves a deformation of the mandible, due mainly to the contraction of the masticatory muscles, and it can have numerous clinical effects. The deformation of the lower jaw caused by mandibular flexion is generally very small, and it is often overlooked and considered irrelevant from a clinical point of view by many authors; however, it should be important to remember that median mandibular flexure (MMF) has a multifactorial aetiology. The main aim of the current systematic review is to highlight the different factors that can increase MF in order to help clinicians identify patients to whom they should pay more attention. As a secondary outcome, we wanted to analyse the preventive measures and suitable techniques to be adopted to minimise the negative effects of this phenomenon on oral fixed rehabilitations. METHODS The review, which was carried out in accordance with the "Preferred Reporting Items for Systematic reviews and Meta-Analyses" (PRISMA) flowchart, was recorded in the "International Prospective Register of Systematic Reviews" (PROSPERO). As research questions, "Patient/Population, Intervention, Comparison and Outcomes" (PICO) questions were employed. Using the ROBINS-I technique, the risk of bias in non-randomised clinical studies was evaluated. RESULTS The initial electronic search identified over 1300 potential articles, of which 54 studies were included in this systematic review. Information regarding the relationship between MF and individual factors, mandibular movements, impression taking, and fixed rehabilitations were obtained. CONCLUSIONS The studies included in this systematic review showed that MF is greater during protrusive movements, in the posterior areas of the lower jaw, and in patients with brachial facial type, greater jaw length; small gonial angle; and less density, length, and bone surface of the symphysis. The biomechanical effects of mandibular flexion on fixed restorations are debated. Prospective clinical and radiological observational studies should be conducted to evaluate the potential short-, medium-, and long-term consequences of MF.
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Affiliation(s)
- Mario Caggiano
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via Allende, Baronissi, 84081 Salerno, Italy; (F.D.); (D.G.); (F.G.)
| | | | - Alfonso Acerra
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via Allende, Baronissi, 84081 Salerno, Italy; (F.D.); (D.G.); (F.G.)
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Hourfar J, Kinzinger GSM, Frye L, Lisson JA. Effects of fixed functional orthodontic treatment in hypodivergent and hyperdivergent class II patients-a retrospective cephalometric investigation. Clin Oral Investig 2023; 27:4773-4784. [PMID: 37351654 PMCID: PMC10415434 DOI: 10.1007/s00784-023-05105-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 06/05/2023] [Indexed: 06/24/2023]
Abstract
OBJECTIVE To compare skeletal and dentoalveolar changes after orthodontic treatment of class II malocclusion in patients with hypodivergent and hyperdivergent growth patterns through cast splint fixed functional appliances (FFA). MATERIALS AND METHODS N = 42 out of n = 47 patients with mandibular plane angles < 34° or ≥ 34° were divided into a hypodivergent (n = 24) and a hyperdivergent (n = 18) group. All patients received a single-step mandibular advancement protocol through an FFA. Lateral cephalograms were analyzed after initial leveling and alignment (T1) and immediately after FFA removal (T2). The therapeutic effect was calculated through comparison with age-matched controls from a growth survey. Statistical significance was set at p < 0.05. RESULTS Hypodivergent and hyperdivergent patients showed different treatment outcomes, but significant differences existed only for overbite and interincisal angle. Nearly all measurements suggested similar treatment-related changes for both groups with exception for dentoalveolar parameters. CONCLUSION Treatment with FFA causes similar skeletal and dentoalveolar effects in hypodivergent and in hyperdivergent patients. The correction of overjet and molar relationship is mainly caused by dentoalveolar changes. CLINICAL RELEVANCE Hyperdivergent patients do not respond unfavorably to FFA treatment compared to hypodivergent patients. Lower incisor protrusion occurs more pronounced in hypodivergent patients. The growth pattern ought to be considered when choosing FFA for class II treatment.
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Affiliation(s)
- Jan Hourfar
- Department of Orthodontics, Saarland University, 66424, Homburg, Saar, Germany
| | | | - Linda Frye
- Department of Orthodontics, Saarland University, 66424, Homburg, Saar, Germany
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Tu Y, Zhao X, Zhao G, Ding Q, Sun Y, Zhang L. Assessment of physiological posterior-tooth displacement under habitual occlusal force by intraoral scanning using implant-supported crowns as the reference. J Prosthet Dent 2023:S0022-3913(23)00422-5. [PMID: 37500342 DOI: 10.1016/j.prosdent.2023.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 06/22/2023] [Accepted: 06/22/2023] [Indexed: 07/29/2023]
Abstract
STATEMENT OF PROBLEM Studies that have used digital methods to quantitatively evaluate physiological tooth displacement under occlusal force are sparse. PURPOSE The purpose of this clinical study was to measure physiological posterior tooth displacement under occlusal force by intraoral scanning and reverse engineering technology by using implants as the reference. MATERIAL AND METHODS A total of 14 participants received 15 implant-supported single mandibular first molar crowns. The surface data of maxillary and mandibular posterior teeth (U1 and L1) and the buccal occlusal data in the maximum intercuspal position (MIP) with habitual occlusal force were obtained by using an intraoral scanner (TRIOS 3, v20.1.2). The U1 and L1 data were segmented into single teeth, which were then aligned to the buccal occlusal data by using the "best-fit alignment" command to build the data under occlusal force (U2 and L2). U1 and L1 data were compared with U2 and L2 data to calculate the centroid and functional cusp vertex displacements and the long axis deflections of the second premolars and second molars, taking the first molar as the reference. The medians, and first quartile (Q1), third quartile (Q3) of the above data were reported, and the Shapiro-Wilk and Wilcoxon tests were used to analyze the differences (α=.05). RESULTS Under occlusal force, the median (Q1, Q3) centroid displacements of posterior teeth ranged from 61 (52, 101) μm to 146 (80, 186) μm; the functional cusp vertex displacements ranged from 82 (62, 117) μm to 146 (98, 189) μm, and the long axis deflections ranged from 0.45 (0.25, 0.87) degrees to 1.03 (0.52, 1.41) degrees. Mandibular second premolars displaced lingually, mesially, and apically; mandibular second molars displaced distally and apically; and maxillary second premolars and second molars displaced lingually and apically. CONCLUSIONS A digital method taking implant-supported single crowns as the reference was used to demonstrate physiological posterior-tooth displacement under habitual occlusal force.
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Affiliation(s)
- Ya Tu
- Graduate student, Department of Prosthodontics, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, PR China
| | - Xiaole Zhao
- Graduate student, Department of Prosthodontics, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, PR China
| | - Guangpu Zhao
- Graduate student, Department of Prosthodontics, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, PR China
| | - Qian Ding
- Attending Physician, Department of Prosthodontics, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, PR China.
| | - Yuchun Sun
- Professor, Center of Digital Dentistry, Department of Prosthodontics, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & NHC Research Center of Engineering and Technology for Computerized Dentistry, Beijing, PR China
| | - Lei Zhang
- Professor, Department of Prosthodontics, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, PR China
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Londono J, Schoenbaum TR, Varilla Ortiz AV, Franco-Romero G, Villalobos V, Carosi P, Mijiritsky E, Pozzi A. Mandibular Flexure and Its Significance: An In Vivo Cone Beam-Computed Tomography Proof-of-Concept Study. J Clin Med 2023; 12:4149. [PMID: 37373841 PMCID: PMC10299314 DOI: 10.3390/jcm12124149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/11/2023] [Accepted: 06/16/2023] [Indexed: 06/29/2023] Open
Abstract
The aim of this study was to assess intra-arch mandibular dimensional changes that may occur during mouth opening using cone beam-computed tomography (CBCT). Fifteen patients in need of any type of treatment whose execution considered a pre- and post-CBCT assessment consented and were enrolled. CBCTs were taken with the following settings: 90 kV, 8 mA, field of view (FOV) 140 by 100 mm (height and diameter), Voxel size 0.25 mm (high resolution). The pre-CBCT was executed in the maximum mandibular opening (MO), while the post-CBCT was in the maximum intercuspation (MI). A thermoplastic stent with radiopaque fiducial markers (steel ball bearings) was fabricated for each patient. Measurements were made using radiographic markers between contralateral canines and contralateral first molars and between ipsilateral canines and first molars on both sides. Paired t-tests were performed to evaluate the difference between open and closed positions on these four measurements. In the MO position were registered a significative tightening of the mandible at the canine (-0.49 mm, SD 0.54 mm; p < 0.001) and molar points (-0.81 mm, SD 0.63 mm; p < 0.001) and a significative shortening of the mandible on the right (-0.84 mm, SD 0.80 mm; p < 0.001) and left sides (-0.87 mm, SD 0.49 mm; p < 0.001). Within the study limitations, mandibular flexure determined a significant shortening and tightening between maximum intercuspation to maximum opening positions. Mandibular dimensional changes should be considered in light of other patient factors in the treatment planning of implant positioning and long-span complete arch implant-supported fixed prostheses in order to avoid technical complications.
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Affiliation(s)
- Jimmy Londono
- Ronald Goldstein Center for Esthetic and Implant Dentistry, Department of Restorative Sciences, Dental College of Georgia, Augusta, GA 30912, USA;
| | - Todd R. Schoenbaum
- Department of Restorative Sciences, Dental College of Georgia, Augusta, GA 30912, USA; (T.R.S.); (V.V.)
| | | | - Guillermo Franco-Romero
- Stomatology and Oral Rehabilitation Residency Program, Benemerita Universidad Autonoma de Puebla, Puebla 72000, Mexico;
| | - Vanessa Villalobos
- Department of Restorative Sciences, Dental College of Georgia, Augusta, GA 30912, USA; (T.R.S.); (V.V.)
| | - Paolo Carosi
- Department of Clinical Sciences and Translational Medicine, School of Dentistry, University of Tor Vergata, 00133 Rome, Italy;
| | - Eitan Mijiritsky
- The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
- Head and Neck Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6139001, Israel
| | - Alessandro Pozzi
- Ronald Goldstein Center for Esthetic and Implant Dentistry, Department of Restorative Sciences, Dental College of Georgia, Augusta, GA 30912, USA;
- Department of Clinical Sciences and Translational Medicine, School of Dentistry, University of Tor Vergata, 00133 Rome, Italy;
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Karre S, Kattadiyil MT, Lozada JL, AlHelal A. Complications Associated with Metal Resin Fixed Complete Dentures Based on Implant Distribution. J Prosthodont 2023; 32:125-131. [PMID: 35420238 DOI: 10.1111/jopr.13518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 03/23/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To compare prevalence and type of complications associated with metal resin fixed complete dentures based on implant distribution. MATERIALS AND METHODS This retrospective study included data collected for a period of 12 years for patients treated with maxillary and mandibular implant-supported fixed complete dentures at Loma Linda University School of Dentistry. In total, 223 patient's charts were reviewed which included 100 maxillary and 123 mandibular fixed complete dentures. Implant distribution and prevalence of complications associated with each implant-supported fixed complete denture were documented. Tooth delamination, the most common complication associated with fixed complete dentures, was compared between 2 implant distribution groups in each arch. Covariates including age, sex, opposing arch, cantilever occluding units, and number of implants were evaluated to determine their association with tooth delamination. Data and hypotheses were statistically analyzed using descriptive statistics along with logistic regression model. All tests of hypotheses were considered statistically significant at an alpha level of 0.05. RESULTS In the maxillary arch, some effect of the prevalence of tooth delamination was seen for the group that had implants placed posterior to canine eminence but it was not statistically significant. Denture tooth delamination had the highest prevalence among complications irrespective of implant distribution. Significant denture tooth delamination was seen for patients with opposing fixed complete dentures in comparison to patients with removable opposing arch prostheses. CONCLUSIONS Implant distribution is not a significant factor related to metal resin fixed complete dentures. Opposing fixed complete dentures have a significantly higher association with denture tooth delamination.
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Affiliation(s)
- Shivani Karre
- Advanced Dental Education Program in Prosthodontics, School of Dentistry, Loma Linda University, Loma Linda, CA
| | - Mathew T Kattadiyil
- Advanced Dental Education Program in Prosthodontics, School of Dentistry, Loma Linda University, Loma Linda, CA
| | - Jaime L Lozada
- Advanced Dental Education Program in Prosthodontics, School of Dentistry, Loma Linda University, Loma Linda, CA
| | - Abdulaziz AlHelal
- Advanced Dental Education Program in Prosthodontics, School of Dentistry, Loma Linda University, Loma Linda, CA.,Department of Prosthetic Dental Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
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Gao J, Li X, He J, Jiang L, Zhao B. The effect of mandibular flexure on the design of implant-supported fixed restorations of different facial types under two loading conditions by three-dimensional finite element analysis. Front Bioeng Biotechnol 2022; 10:928656. [PMID: 36105608 PMCID: PMC9465293 DOI: 10.3389/fbioe.2022.928656] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/22/2022] [Indexed: 11/13/2022] Open
Abstract
Objective: Investigating the biomechanical effects of mandibular flexure (MF) on the design of implant-supported fixed restorations in edentulous jaws of different facial types. Methods: Three-dimensional finite element models were established to analyze mandibular displacement and stress distribution of implant-supported fixed restorations (four or six implants, different implant numbers and sites, and the design of the superstructure across the dental arch in one or two or three pieces, under the loading conditions of maximum opening or right unilateral molar occlusion) in mandibular edentulous patients of three different facial types (brachyfacial, mesofacial, and dolichofacial types). Results: The brachyfacial type presented higher mandibular flexure and stress in the overall restorative system, followed by the mesofacial and dolichofacial types. During jaw opening and occlusal movements, the one-piece framework showed the lowest bone stress values surrounding the anterior implants and gradually increased to the distal position, and the three-piece framework showed the highest stress values for peri-implant bones. Also, the split framework could greatly increase the stress on abutments and frameworks. Moreover, fixed implant prostheses with cantilevers can generate high amounts of biomechanical stress and strain on implants and surrounding bones. The bone surrounding the anterior implant increased in stress values as the most distal implants were more distally located regardless of frameworks. The zirconia framework demonstrated higher stresses than the titanium framework. Conclusion: The design of edentulous fixed implant-supported restorations can be optimized for facial types. For patients of the brachyfacial type or with high masticatory muscle strength, the non-segmented framework without a cantilever provides an optimal biomechanical environment.
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Affiliation(s)
- Jing Gao
- Center of Implantology School and Hospital of Stomatology, China Medical University, Liaoning Province Key Laboratory of Oral Diseases, Shenyang, China
| | - Xuejing Li
- Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Department of Prosthodontics, School and Hospital of Stomatology, Tongji University, Shanghai, China
| | - Jing He
- Center of Implantology School and Hospital of Stomatology, China Medical University, Liaoning Province Key Laboratory of Oral Diseases, Shenyang, China
| | - Lulu Jiang
- Center of Implantology School and Hospital of Stomatology, China Medical University, Liaoning Province Key Laboratory of Oral Diseases, Shenyang, China
- *Correspondence: Lulu Jiang, ; Baohong Zhao,
| | - Baohong Zhao
- Center of Implantology School and Hospital of Stomatology, China Medical University, Liaoning Province Key Laboratory of Oral Diseases, Shenyang, China
- *Correspondence: Lulu Jiang, ; Baohong Zhao,
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Gülsoy M, Tuna SH, Pekkan G. Evaluation of median mandibular flexure values in dentulous and edentulous subjects by using an intraoral digital scanner. J Adv Prosthodont 2022; 14:32-44. [PMID: 35284055 PMCID: PMC8891685 DOI: 10.4047/jap.2022.14.1.32] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/23/2021] [Accepted: 01/25/2022] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Mandibular flexure is a crucial phenomenon that may affect the success of rigid bilateral mandibular prosthetic treatment. The aim of this study was to determine the amount of median mandibular flexure (MMF) that occurs during mouth opening from anterior to posterior mandible in seven different regions, in different age and gender groups of both dentulous and edentulous subjects, using an intraoral digital scanner. MATERIALS AND METHODS In this study, the mandibular arch of 56 dentulous and 35 edentulous individuals were scanned with an intraoral scanner at both the minimum mouth opening (MnMO) and the maximum mouth opening (MxMO). MMF values were calculated by subtracting the distance value at the MxMO from the distance between the reference points at the MnMO at seven different mandibular regions of dentulous and edentulous subjects. In addition, the left and right side MMF values were measured. All data were analyzed statistically (α = .05). RESULTS MMF value increased linearly from anterior to posterior mandible in both dentulous and edentulous individuals. The differences in MMF values were not statistically significant according to side (left/right), age, or gender (P > .05). No significant differences were found between the mean MMF values of the same region in both dentulous and edentulous individuals (P > .05). CONCLUSION MMF was seen in different regions of the mandibles of both edentulous and dentulous individuals measured at the MxMO. Mandibular flexure should be considered for the success and prognosis of the long-span and rigid prostheses.
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Affiliation(s)
- Merve Gülsoy
- Department of Prosthodontics, Faculty of Dentistry, Süleyman Demirel University, Isparta, Turkey
| | - Süleyman Hakan Tuna
- Department of Prosthodontics, Faculty of Dentistry, Süleyman Demirel University, Isparta, Turkey
| | - Gürel Pekkan
- Department of Prosthodontics, Faculty of Dentistry, Tekirdag Namik Kemal University, Tekirdag, Turkey
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Thongpoung S, Masaki C, Nodai T, Munemasa T, Mukaibo T, Kondo Y, Hosokawa R. A new mandibular deformation index predicts amount of bone deformation in edentulous patients treated with an implant-supported fixed prosthesis. J Prosthodont Res 2021; 66:582-588. [PMID: 34924491 DOI: 10.2186/jpr.jpr_d_21_00145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
PURPOSE The present study was performed to examine the mandibular deformation during mouth opening in edentulous patients, treated with an implant-supported fixed prosthesis using strain gauges, and identify factors affecting deformation. METHODS Twenty patients with a fully edentulous mandible who received either 4 or ≥6 implants were included. The distal-most implants were placed mesial to the mental foramen (premolar region) in patients with 4 implants and distal to the mental foramen (molar region) in patients with ≥6 implants. Mandibular deformation during mouth opening was measured using strain gauges in two directions: anteroposterior direction and lateral direction between the distal-most implants on the left and right sides (arch width). The mandibular anatomy was evaluated using computed tomography. RESULTS Arch width reduction between the left and right implants during mouth opening ranged from 47.38 to 512.80 µm; the range of deformation was 0.12 to 15.14 µm in the anteroposterior direction. Furthermore, a significant positive correlation was noted between arch width reduction in the premolar region and the ratio between the symphyseal bone height and width (P = 0.0003, r = 0.72). CONCLUSION The reduction in arch width was higher in the molar region than in the premolar region during mouth opening. Moreover, the reduction could be high in the mandibular symphyseal bone because of its greater height and lesser width. The ratio between the symphyseal bone height and width is defined as the mandibular deformation index (MDI) and is used to predict the rate of mandibular bone deformation.
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Affiliation(s)
- Sirapat Thongpoung
- Division of Oral Reconstruction and Rehabilitation, Kyushu Dental University Graduate School, Japan.,Department of Prosthodontics, College of Dental Medicine, Rangsit University, Pathum Thani, Thailand
| | - Chihiro Masaki
- Division of Oral Reconstruction and Rehabilitation, Kyushu Dental University Graduate School, Japan
| | - Tomotaka Nodai
- Division of Oral Reconstruction and Rehabilitation, Kyushu Dental University Graduate School, Japan
| | - Takashi Munemasa
- Division of Oral Reconstruction and Rehabilitation, Kyushu Dental University Graduate School, Japan
| | - Taro Mukaibo
- Division of Oral Reconstruction and Rehabilitation, Kyushu Dental University Graduate School, Japan
| | - Yusuke Kondo
- Division of Oral Reconstruction and Rehabilitation, Kyushu Dental University Graduate School, Japan
| | - Ryuji Hosokawa
- Division of Oral Reconstruction and Rehabilitation, Kyushu Dental University Graduate School, Japan
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Mohamed LA, Khamis MM, El-Sharkawy AM, Fahmy RA. Evaluation of immediately loaded mandibular four vertical versus tilted posterior implants supporting fixed detachable restorations without versus with posterior cantilevers. Oral Maxillofac Surg 2021; 26:373-381. [PMID: 34455503 DOI: 10.1007/s10006-021-00993-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 07/21/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Distally inclining posterior implants may be technically challenging in certain situations. The presence of a posterior cantilever can also exert unfavorable forces on supporting implants. The aim of the present study was to evaluate and compare peri-implant soft and hard tissues around 4 mandibular interforaminal implants having tilted posterior implants with posterior cantilevers, versus vertical implants, 2 in the interforaminal region and 2 in the first molar regions, without posterior cantilevers. All implants supported full-arch fixed detachable restorations opposing complete dentures. MATERIAL AND METHODS A total of 80 implants were placed flapless in the mandibles of 20 edentulous participants. Four implants were placed for every participant, who were randomly assigned into 2 equal groups. Axial group implants were vertically aligned, with 2 implants in the interforaminal area and 2 in the molar area. Tilted group implants have 2 anterior axial and 2 posterior distally inclined implants. Interim screw-retained prostheses converted from pre-existing dentures were immediately fabricated and loaded on the same day of surgery. After awaiting period of 3 months, all participants received fixed detachable metal acrylic resin definitive restorations. A follow-up protocol of 3, 6, and 12 months was scheduled to assess the modified gingival index, modified plaque index, peri-implant probing depth, implant stability, and marginal bone level and bone density changes. RESULTS No statistically significant differences (P > .05) were found in the modified gingival index, modified plaque index, peri-implant probing depth, implant stability, bone density, and marginal bone level between the axial and tilted implant groups after the 1-year follow-up period. CONCLUSION Placing 4 flapless immediately loaded implants in mandibular edentulous patients that supported full-arch fixed restorations provided high implant and prosthodontic success rates whether posterior implants were tilted with posterior cantilevers or vertically aligned without posterior cantilevers. TRIAL REGISTRATION Pan African Clinical Trial Registry database, PACTR201907776166846. Registered 3 July 2019, www.pactr.org .
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Affiliation(s)
| | - Mohamed Moataz Khamis
- Prosthodontic Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt.
| | | | - Rania Abdelaziz Fahmy
- Oral Medicine and Periodontology, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
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16
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Dmd CS, Bidra AS. Management of Fractured Zirconia Complete Arch Fixed Implant-Supported Prosthesis Caused by Misfit Due to Diverse Implant Components: A Case Report. J Prosthodont 2021; 30:465-472. [PMID: 33570229 DOI: 10.1111/jopr.13348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2021] [Indexed: 11/27/2022] Open
Abstract
Recently, monolithic zirconia complete-arch fixed implant-supported prosthesis (CAFIP) has been shown to be an effective means of managing patients with edentulism or terminal dentition. Prosthetic complications have been reported to be rare, as long as there is proper treatment planning, prosthetic space and careful attention during fabrication of the prosthesis. Few reports exist in the literature that have described the management of patients with fractured zirconia CAFIP. This case report describes the successful management of a female patient with a midline fracture of a monolithic zirconia CAFIP supported by 6 dental implants in the mandibular arch. The fractured prosthesis had adequate prosthesis thickness with no distal cantilever, and opposed a similar prosthesis in the maxilla. However, upon careful analysis, diverse implant components were identified as the primary contributory factor to prosthetic misfit, and subsequent fracture. This is a new factor that requires attention by clinicians and dental laboratory technicians due to the increased prevalence of patients with preexisting dental implants. This article describes the considerations related to diverse implant components and connections from different implant manufacturers, choice of favorable implant-abutment design, technique for mitigation, and importance of passive fit for zirconia CAFIP.
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Affiliation(s)
| | - Avinash S Bidra
- Department of Reconstructive Sciences, University of Connecticut Health Center, Farmington, CT, USA
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17
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Schmidt A, Klussmann L, Schlenz MA, Wöstmann B. Elastic deformation of the mandibular jaw revisited-a clinical comparison between digital and conventional impressions using a reference. Clin Oral Investig 2021; 25:4635-4642. [PMID: 33442777 PMCID: PMC8310469 DOI: 10.1007/s00784-021-03777-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 01/04/2021] [Indexed: 11/27/2022]
Abstract
Objectives Due to the partly strongly differing results in the literature, the aim of the present study was to investigate a possible deformation of the mandible during mouth opening using an intraoral scanner (IOS) and a conventional impression for comparison with a reference aid. Materials and methods Four steel spheres were reversibly luted in the mandibular (n = 50) with a metallic reference aid at maximum mouth opening (MMO). Two digital impressions (Trios3), at MMO and at slightly mouth opening SMO and a conventional impression (Impregum), were taken as the measuring accuracy of the reference structure was already known. Difference between MMO-SMO for digital impressions and deviations between digital and conventional (SMO) were calculated. Furthermore, the angle between the normal vectors of two constructed planes was measured. Statistical analysis was performed with SPSS25. Results Deviations for linear distances ranged from −1 ± 3 μm up to 17 ± 78 μm (digital impressions, MMO-SMO), from 19 ± 16 μm up to 132 ± 90 μm (digital impressions, SMO), and from 28 ± 17 μm up to 60 ± 52 μm (conventional impressions, SMO). There were no significant differences for digital impressions (MMO-SMO), and there were significant differences between the conventional and digital impressions at SMO. Conclusions Based on the results of the present study, no mandibular deformation could be detected during mouth opening with regard to the digital impressions. The results were rather within the measuring tolerance of the intraoral scanner. Clinical relevance Based on the present study, no deformation of the mandibular during mouth opening could be observed at the level previously assumed. Therewith related, dental techniques related to a possible mandibular deformation therefore should be reconsidered.
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Affiliation(s)
- Alexander Schmidt
- Department of Prosthodontics, Dental Clinic, Justus Liebig University, Schlangenzahl 14, 35392, Giessen, Germany.
| | - Leona Klussmann
- Department of Prosthodontics, Dental Clinic, Justus Liebig University, Schlangenzahl 14, 35392, Giessen, Germany
| | - Maximiliane A Schlenz
- Department of Prosthodontics, Dental Clinic, Justus Liebig University, Schlangenzahl 14, 35392, Giessen, Germany
| | - Bernd Wöstmann
- Department of Prosthodontics, Dental Clinic, Justus Liebig University, Schlangenzahl 14, 35392, Giessen, Germany
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Meira JBC, Landgraf H, Shinohara EH, Luz JGC, Ballester RY. A new way of evaluating the biomechanics of the mandible with freedom in three axes in space: Technical note. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, MEDICINE, AND PATHOLOGY 2018. [DOI: 10.1016/j.ajoms.2018.03.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Stilwell C. Mandibular Implant Overdentures: Treatment and Medico-Legal Considerations. Prim Dent J 2017; 6:28-35. [PMID: 29258637 DOI: 10.1308/205016817822230265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The concept of a two-implant overdenture as the minimum standard of care or first choice treatment for the edentulous mandible was first proposed in 2002 and has since been backed by an overwhelming body of evidence supporting greater patient satisfaction and improved quality of life. This article examines the implant overdenture concept and its various options and discusses best practice from both the patient's and a medico-legal standpoint.
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Annual review of selected scientific literature: Report of the committee on scientific investigation of the American Academy of Restorative Dentistry. J Prosthet Dent 2017; 118:281-346. [DOI: 10.1016/j.prosdent.2017.04.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 04/27/2017] [Accepted: 04/27/2017] [Indexed: 01/19/2023]
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21
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A retrospective cephalometric investigation of two fixed functional orthodontic appliances in class II treatment: Functional Mandibular Advancer vs. Herbst appliance. Clin Oral Investig 2017; 22:293-304. [DOI: 10.1007/s00784-017-2111-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 03/20/2017] [Indexed: 10/19/2022]
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Split-Framework in Mandibular Implant-Supported Prosthesis. Case Rep Dent 2015; 2015:502394. [PMID: 26770841 PMCID: PMC4681794 DOI: 10.1155/2015/502394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Revised: 11/08/2015] [Accepted: 11/23/2015] [Indexed: 11/17/2022] Open
Abstract
During oral rehabilitation of an edentulous patient with an implant-supported prosthesis, mandibular flexure must be considered an important biomechanical factor when planning the metal framework design, especially if implants are installed posterior to the interforaminal region. When an edentulous mandible is restored with a fixed implant-supported prosthesis connected by a fixed full-arch framework, mandibular flexure may cause needless stress in the overall restorative system and lead to screw loosening, poor fit of prosthesis, loss of the posterior implant, and patient's discomfort due to deformation properties of the mandible during functional movements. The use of a split-framework could decrease the stress with a precise and passive fit on the implants and restore a more natural functional condition of the mandible, helping in the longevity of the prosthesis. Therefore, the present clinical report describes the oral rehabilitation of an edentulous patient by a mandibular fixed implant-supported prosthesis with a split-framework to compensate for mandibular flexure. Clinical Significance. The present clinical report shows that the use of a split-framework reduced the risk of loss of the posterior implants or screws loosening with acceptable patient comfort over the period of a year. The split-framework might have compensated for the mandibular flexure during functional activities.
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