Using two surgical protocols to restore the edentulous patient with implant-supported overdentures

Long-term success rates are reported for dental implant systems using both the two-stage and one-stage surgical protocols. Although the one-stage offers several advantages, prudent diagnosis is a key factor for selecting the appropriate surgical protocol. This article will review the relevant literature for both protocols and will illustrate their use in patient treatment.

Preprosthetic surgery

Patients who require complete and removable partial dentures may find the adaptation process quicker and easier after certain pre-prosthetic surgical procedures. Incorporating selected surgical procedures into a treatment plan for removable dentures could be the determining factor between success and failure of the prosthesis. The rationale in pre-prosthetic surgery is to provide the patient an adequate restoration to function with a minimum of surgical morbidity. This article describes various procedures and considerations for their use.

Management of temporomandibular disorders in a restorative practice

Various disorders related to the masticatory muscles or to the temporomandibular joints may be encountered in a restorative dental practice. Most of them can be managed by the restorative dentist whose primary interest may not lie in the area of temporomandibular disorders. The term temporomandibular disorders is used in this discussion to denote the group of diseases of the masticatory system that involves primarily the temporomandibular joints, the masticatory muscles, and the occlusion of the teeth. The learning objective of this article is to describe temporomandibular disorders encountered in general practice. Managing these disorders in the general practice of restorative dentistry is not difficult and adds to the comfort of the patient and possibly to the success of the restorations.

Hydroxyapatite-coated cylindrical implants in the posterior mandible: 10-year observations

A total of 443 hydroxyapatite-coated cylindrical implants were placed into the posterior mandibles of consenting patients from July 1985 through December 1991. Implants were placed into ridges that had sufficient bone volume. Implants were also placed in ridges with thin bone, grafted bone, or immediate extraction sites, which occasionally resulted in increased morbidity. All were followed yearly with clinical and radiographic examinations. Life table analyses were performed using SAS software. Ten-year cumulative survival and nonmorbid (based on bone loss criteria) rates were determined for the four posterior tooth locations and for all posterior locations combined. Cumulative survival for implants was 0.858 +/- 0.056 in the first premolar region, 0.833 +/- 0.041 for the second premolar region, 0.785 +/- 0.041 for the first molar region, and 0.718 +/- 0.064 for the second molar region. When all posterior mandibular locations were taken together, the cumulative survival was 0.793 +/- 0.025. Cumulative nonmorbid rates were 0.816 +/- 0.056 for the first premolar, 0.729 +/- 0.049 for the second premolar, 0.600 +/- 0.046 for the first molar, and 0.507 +/- 0.066 for the second molar. The cumulative nonmorbid rate was 0.646 +/- 0.028 for all sites combined. Comparisons between sites indicated that the second molar site had statistically more morbidity than did the other three sites. Most of the problems were identified with 8-mm-long implants, especially in the second molar location. Clinical parameters, including the presence of keratinized gingiva and a hygienic restoration, were associated with survival. Both mechanical and inflammatory compromise were found to be reasons for implant failure.

Spark erosion implant-supported overdentures: clinical and laboratory techniques

Overdentures can be utilized effectively in treatment plans involving implants. Usually soft tissue support is necessary, which requires a conventional denture base. Implant-supported overdentures do not require conventional denture base extension unless necessitated by functional or esthetic considerations. With fixed-detachable hybrid dentures, flanges can often interfere with home care procedures. Spark erosion overdentures meet the requirements for esthetics, phonetics, retention, and support and also allow accessibility for proper patient oral hygiene. This article reviews the advantages and disadvantages of the spark erosion overdenture and provides guidelines for the fabrication of this type of prosthesis.

The Integral Implant System: prosthetic considerations

Patients who are totally edentulous and who have been doomed to discomfort, pain, and dysfunction because of the inability to use complete dentures have been rehabilitated using various implant systems. Implants should only be considered after exhaustive medical history taking and diagnostic wax-ups. A variety of prosthetic techniques can be employed to restore various forms of edentulism. The Integral Implant System has proven to be a highly successful foundation to restore the patient to optimum function.

Hydroxyapatite-coated implants in maxillofacial prosthetics

The use of implants provides a secure, comfortable, and emotionally satisfactory attachment of the patient to the prosthesis. It is anticipated that patients who are willing to undergo placement of implants would have a greater commitment to continued use of their prostheses. Clearly, there is a greater affinity between a patient and his or her prosthesis when the attachment is an intimate one. The use of implants, then, could reverse functional deficiencies and raise the quality of the patient's post-disease life.

Biointegrated hydroxylapatite-coated dental implants: 5-year clinical observations

The clinical results of 772 biointegrated hydroxylapatite-coated titanium dental implants are discussed. The longest radiographic follow-up was done at 5 years, with a success rate of greater than 95%. Supporting animal research with other titanium implants is also provided.

Dental implants: a survey of patients' attitudes

This study measured the psychologic attitudes of patients to implant prostheses and compared their status before and after therapy. Questionnaires were mailed to 95 patients with implants placed and restored at a university dental school. The implants had been in position for an average of 2.2 years. The patients had previously worn removable complete or partial dentures. Different questions addressed eating, speaking, relationships, employment, social life, esthetics, maintenance, and overall dental health. Sixty-one questionnaires were returned (64%). Satisfaction with the implant prosthesis was significantly greater than for the denture (p less than 0.0001). Responses to individual questions indicated that confidence was improved (88%), implants were worth the trouble (97%), the procedure would be worth repeating (89%), and overall dental health was improved (98%). This survey suggests that patients' attitudes toward their dental health improve significantly after treatment with implant prostheses.

Integral implant-prosthodontic considerations

Components of the Integral implant system, prosthodontic methods, and uses for the implant system have been described. The system is most effective in the restoration of edentulous areas of the maxillary and mandibular arches.

Provisional restorations in maxillofacial prosthetics

A variety of provisional prostheses for the maxillofacial prosthetic patient have been described. Each patient is different, and the prosthesis chosen will vary with the severity and type of defect acquired by that patient. Psychological, functional, and physiologic factors are prime in the immediate treatment of such patients.

Salvaging the restoration

Current concepts of salvaging large restorations and repairing crowns have been presented. Repair of restorations in the mouth is indicated in specific instances. The procedures described, when properly used, can result in a considerable savings both in time and expense to the dentist and the patient.

Prosthetic considerations in reconstructive implantology

Diagnosis and treatment planning are essential prior to the placement of any dental implant. An overview of prosthodontic considerations in the restoration of such implants is presented in this article. Concepts for both the edentulous and partially edentulous mouth are discussed.

Hydroxylapatite alveolar ridge reconstruction: clinical experiences, complications, and technical modifications

Results of the reconstruction of 228 deficient alveolar ridges (208 patients) using hydroxylapatite with or without autogenous cancellous bone over a six-year period are reported. Complications included erosion, mental nerve neuropathy, migration and displacement of particles, overfill, and loose material. Modified techniques are presented that minimize the occurrence of these complications in Class III and IV ridge-deficient patients.

Symposium on semiprecision attachments in removable partial dentures. Trouble-shooting, repairs, and relining

Semiprecision attachments are used in the construction of removable partial dentures. Where utilized, these attachments afford bracing to the denture. Methods have been described to ensure the longevity and adequacies of such attachments, and techniques have been presented to guarantee such maintenance.

Modifications of the superstructure for the staple implant

Two techniques have been described to expedite fabrication and reduce the cost of prostheses made for staple implants. The techniques permit placement of a simulated transosseous pin within the master cast. At the time of denture placement in technique No. 1, the coping-bar attachment assembly is cemented (Fig. 12). In technique No. 2 the superstructure is placed over the transosteal pins and secured between the locknuts to maintain the base of the lower locknut 1.5 mm from the crest of the alveolar ridge (Fig. 13). Technique No. 2 permits removal of the superstructure as desired. Patients should be instructed in proper oral hygiene and denture care.

Prosthodontic management of the hydroxylapatite denture patient: a preliminary report

A 4-year study and evaluation of nonresorbable hydroxylapatite to augment different alveolar ridges has been reported. The technique used resulted in improved contour, height, and width of the alveolar ridge. It was found that denture comfort improved with ridge augmentation as this allowed improved stability, support, and preservation of the ridge. Patient satisfaction was correlated to both surgical and prosthodontic success with the use of hydroxylapatite. The state and health of the tissues were found to be improved with the use of hydroxylapatite or hydroxylapatite and bone marrow. The prosthetic and surgical procedures were found to be easier to perform, and they produced more permanent and superior results than those previously experienced with only bone grafts and other alloplasts.

A new semiadjustable articulator. Part IV: an investigation of three semiadjustable articulators

In this study the compensating angle on the Hanau XP-51 articulator was found to be proportional to the magnitude of the intercondylar distance. Further, eccentric movement of the Hanau 130-7, the Hanau XP-51, and the Whipmix articulators, at the cusp level, followed that displayed by the control articulator when guided by straight condylar elements. For restoration to function harmoniously in the patient's mouth they must be made on an instrument that can accurately reproduce selected movements of the mandible. The choice of articulator depends upon the precision with which the dentist wishes to work. The mechanisms of articulators should be precise, easy to adjust, and simple to understand.

A new semiadjustable articulator. Part III. An investigation of the capability of the Hanau XP-51 articulator

A new semiadjustable articulator, the Hanau XP-51, was investigated by comparing its movements at the cusp level to those of a Stuart articulator when guided by straight condylar elements. No clinical trial was undertaken in this investigation, and no mandibular movements were registered on the Stuart articulator for transfer to the Hanau XP-51 articulator. A method of comparison and mathematical formulae were described whereby specific angles were calculated for both articulators. All tabulated angles were correlated by determining the least-squares slope of the observed angular variation as a function of the three independent variables in a computerized program. The standard deviation from these was calculated for each articulator, and the differences were found to be very small. It was concluded that the experimental Hanau XP-51 articulator could reproduce specific movements made by the Stuart articulator. Further, the adjustable posterior wall within the condylar housing was found to compensate for the lack of an adjustable intercondylar distance on this articulator.

Optical method for articulator comparison and study of occlusal determinants

A method of articulator comparison and a technique demonstrating the effects of three occlusal determinants were demonstrated and proved successful. The techniques used could be used in dental research circumstances and in dental schools as a means to study the determinants of occlusion.