Restoration of Periodontally Compromised Dentitions Using Telescopic Full-Arch Retrievable Prosthesis Supported by Tooth-Implant Combination: A Long-Term Retrospective Study

Advanced periodontal disease is often associated with severe loss of tooth support, necessitating prosthetic rehabilitation to restore function and esthetics. For tooth-supported restorations, periodontally compromised teeth may need to be extracted due to early failure from functional overload. For tooth/implant-supported restorations, implants can be used to reduce the overload on teeth and to avoid tooth extraction, bone augmentation, or other risks associated with implant placement. The aim of this retrospective study was to evaluate the long-term outcomes of full-arch, retrievable, telescopic-retained prostheses (TRPs) on teeth and implants according to survival rate analyses and technical and biologic complications in full-mouth rehabilitation of periodontally compromised dentitions. A total of 18 periodontally compromised patients (7 women, 11 men) with a mean age of 46.8 years (SD: 6.3 years; range: 32 to 64 years) were selected to receive supplementary implants with the aim of extensive prosthetic support in combined tooth/implant TRPs and annually evaluated for technical and/or biologic failures/complications. After a follow-up period of 15 years, all prostheses were in function. Complication rates were low, and maintenance services were limited to minor interventions. Combined tooth/implant TRPs improve prosthetic support and offer successful function over the long term in patients with periodontally compromised dentition.

[MORFOHISTOHIMICHNA EVALUATION OF REHABILITATION PATIENTS WITH GENERALIZED PERIODONTAL DISEASE AGAINST CORONARY HEART DISEASE]

Un the basis of morphological studies examined the effectiveness of complex pathogenetic treatment of generalized periodontal disease with the use of products based on natural ingredients: dental paste "Fitopasta-3K" and drug "plantain juice" for the local treatment and drugs "Granules quercetin" and "Energoton" for systemic treatment. Established that one of the important mechanisms of complex pathogenetic treatment is the effect on energy metabolism of periodontal tissues, including the reduction of tissue hypoxia, metabolic stabilization was observed structural changes navkolozubnyh tissues. It should be noted positive effects of integrated treatment on the whole body.

A minimally invasive approach to restore function and esthetics in periodontally involved teeth

The objective of dental treatment is the elimination of the etiologic factors, the rehabilitation of function and esthetics, and, when possible, the maintenance of vitality and structure of the natural dentition. After the loss of the periodontal support, as a consequence of periodontal disease, it may be necessary to splint the residual teeth in order to improve their stability, and sometimes it is also necessary to modify the morphology to optimize the final esthetic outcome. In many periodontally treated teeth, prosthodontic treatment on the residual dentition will be required with an important loss of tooth structure as an unavoidable consequence. This procedure frequently requires endodontic treatment of the residual abutments in order to obtain the necessary space for replacement materials. Similar objectives could however be achieved through an alternative therapy where the esthetic remodeling of the teeth and the closure of the interproximal spaces is obtained with composite resin materials. The objective of this article is to present an alternative protocol to optimize the functional and esthetic result of periodontally treated cases, where the most frequent complication is the increased length of the clinical crown. This is obtained by utilizing a different conservative approach, which has as its main objective the stabilization of the residual teeth, the maintenance of their vitality, and the achievement of the best esthetic result possible.

Immediate implants and immediate loading in periodontally compromised patients-a 3-year prospective clinical study

To avoid the necessity of a removable provisional prosthesis, and therefore preserve the patient's functional outcome, esthetics, and quality of life, a clinical protocol was developed to approach periodontally compromised patients presenting a full-arch irreversibly lost dentition: full-arch extraction and immediate replacement with a provisional acrylic resin implant-supported fixed partial denture (FPD). A total of 23 periodontally compromised patients (11 women, 12 men; 4 smokers, 4 controlled diabetics) were included in this study. Pretreatment casts were taken and vertical dimension of occlusion was determined. In most patients, 6 Straumann implants were distributed along the arch according to the surgical guide or bone availability, with the most distal ones in the maxilla slightly tilted so they could emerge more distally. A total of 168 implants (146 Straumann, 10 Nobel Biocare, 8 Biomet 3i, and 4 Lifecore) were placed (83 in the maxilla, 85 in the mandible). Of those in the maxilla, 74 were loaded immediately (implant stability quotient mentor [ISQm] > 70) and 9 placed with delayed loading (ISQm =/< 70). Of the 85 implants placed in the mandible, all were loaded immediately (ISQm > 70). If an FPD had not been fabricated already, impressions were taken during surgery to do so. The prosthesis was then adapted (cemented or screwed) to the 6 implants within the first 48 hours postsurgery. After 2 months, definitive impressions were taken, and a definitive porcelain-fused-to-metal implant-supported 12-element FPD was fabricated and cemented or screwed to all 6 implants. Of the 168 implants, 108 were immediate implants and 159 immediately loaded. Only 2 implants (1 in the mandible, 1 in the maxilla) did not osseointegrate. This yields a 3-year cumulative survival rate of 98.74% (98.65% in the maxilla, 98.82% in the mandible). From a total of 26 immediately loaded prostheses (12 in the maxilla, 14 in the mandible), 6 were cemented and 20 screw-retained. The 3-year cumulative survival rate was 100%. Immediate loading in mandibular and maxillary periodontally compromised patients presents itself as a predictable technique with a 100% cumulative survival rate for provisional and definitive prosthetic rehabilitations.

Restorative options for the periodontal patient

Periodontal and restorative dentistry are mutually important facets of clinical dentistry. Today's clinicians have many treatment options at their disposal, including biotolerant restorative materials and implants, to maintain periodontal health. It is crucial for the clinician to understand the biologic principles that form the foundation for restorative reconstruction of the periodontally involved tooth. This article discusses new techniques and trends in the critical management of the restorations, particularly at the gingival margins, and explores the role of implant dentistry as an option for the restorative plan of the periodontal patient.

[Rehabilitation of a periodontally compromised dentition with implant-supported zirconia bridges. Case report]

Clinical aspects of reconstruction with fix prosthesis and dental implants in a patient with a history of periodontitis is shown. A successful stabilization and rehabilitation of the periodontally involved dentition can be achieved with tooth-worn crown and bridge reconstructions. From a functional and aesthetic point of view the result may not be satisfying due to mobility and overlength of the teeth and open approximal spaces. Today, dentist and patient have often to weigh if teeth shall be maintained or replaced by dental implants. Thereby, both must be aware of the fact that in complex cases long-term success and aesthetic outcome may be difficult to predict. An intense discussion with the patient on his expectations, invasive treatment, risks with regard to biologic and prosthetic aspects is mandatory and must be based on the best scientific evidence available. The present case report shows different considerations and describes a radical solution which meets the patient's needs and is based on modern CAD-CAM technology.

The periodontal prosthesis mode of transition to an implant-supported dentition

In recent years, implant-supported reconstructions have become a welcome alternative to dentures for those who have lost their natural dentition. While the benefits of the final implant-supported reconstruction may be obvious, the planning and execution of therapy to achieve this result may be bewildering to many dentists. Four main modes of transfer have evolved: an uncontrolled or "haphazard" transition; the traditional "dentures first" mode, an immediate transition, and a staged transition. This article proposes an additional mode of transition called periodontal prosthesis, which has the potential to make the transition process smoother and more predictable while providing optimal retention of alveolar supporting structures and generating optimal esthetics.

[Ten years of experience with the complex periodontal and orthodontic rehabilitation of patients with periodontal diseases]

In periodontal diseases where the loss of periodontal tissue is very extensive, displacement of the teeth may be observed. In the interest of complete healing, periodontal treatment must be followed by orthodontic treatment in such patients. If the basic rules relating to adult patients with a reduced, but healthy periodontium are adhered to, the orthodontics can be carried out with certainty in adults who have been rehabilitated from a periodontal aspect. An improved long-term result may be observed in the patients who participate in such complex rehabilitation. Teeth that have been restored to their correct position are not only aesthetically more attractive, but also function more appropriately, are easier to keep clean, and can be treated more simply.

The use of porcelain laminate veneers and a removable gingival prosthesis for a periodontally compromised patient: A clinical report

Periodontal disease may lead to tooth and tissue loss that can result in esthetic problems. Combined periodontal/prosthodontic treatment for patients with advanced periodontal disease is well documented. This clinical report illustrates a method of treatment for advanced tissue loss in an esthetic area using porcelain laminate veneers and a removable gingival prosthesis.

Teeth in a day. The Branemark Novum system

The Branemark Novum system is a one-day treatment of the edentulous or periodontally hopeless mandibular dentition. There are four drill templates and eight drill guides that precisely position three implants which are totally parallel and level. A prefabricated lower bar is placed on the three implants, and an upper bar fits on the lower bar. The restorative dentist has previously selected denture teeth and recorded the vertical dimension of occlusion. The case is waxed up, adjusted, processed and delivered in one day.

Implant-supported fixed prostheses for the rehabilitation of periodontally compromised dentitions: a 3-year prospective clinical study

BACKGROUND

The application of a strict hygiene maintenance care protocol following rehabilitation of periodontally compromised dentitions by means of tooth-supported fixed partial dentures has demonstrated excellent long-term treatment outcome.

PURPOSE

A clinical and radiographic study was performed to document and evaluate the short- and medium-term result of occlusal rehabilitation by means of implant-supported fixed prostheses (ISFPs) in patients treated for advanced periodontal disease.

MATERIALS AND METHODS

Forty-three consecutive patients were included. All patients were referred because of advanced periodontal disease. Before the implant therapy was initiated, periodontal treatment was performed and the outcome evaluated during at least a 6-month period. An individual maintenance care program was designed for each patient. All 125 implants were placed using a two-stage surgical approach. Following installation of the ISFPs, all patients underwent a baseline examination including evaluation of oral hygiene, periodontal or peri-implant conditions, and radiographs. These examinations were repeated annually during the 3-year observation period.

RESULTS

No single implant was lost during the 3-year follow-up period. The percentages of plaque-harboring surfaces and bleeding units on probing were found to be low (< 10%), and no soft-tissue complications were recorded. The mean marginal bone resorption during the observation period amounted to 0.21 mm. In a few patients, apposition of marginal bone was observed. Bone loss amounting to 0.5 mm or less was found around 81% of the implants (101/125 implants). The amount of bone loss around the remaining 24 implants (19%) varied between 0.5 and 2.0 mm.

CONCLUSIONS

The present clinical trial demonstrates that, at least during a 3-year period, the ISFP is an acceptable and predictable treatment option for rehabilitation in patients who have lost their teeth because of periodontal disease. This observation seems to be valid in edentulous and partially dentate jaws. A prerequisite to reach such a favorable treatment outcome is possibly the combination of the strict maintenance care program and the careful design of the ISFPs.

Patient evaluation of treatment with fixed implant-supported partial dentures

The aim of this study was to analyse the patient evaluation of functional treatment outcome in 40 periodontally compromised patients who received implant-supported prostheses (ISPs) as part of the total treatment. The treatment protocol comprised periodontal treatment, extraction of teeth with poor prognosis, placement of dental titanium implants, and after healing, insertion of fixed ISPs. Five of the patients became edentulous in one jaw after extraction of all teeth and received a complete ISP, whereas 35 patients became partially edentulous after extraction of some teeth, 12 receiving a partial ISP on > or = 3 implants, and 23 one on two implants. The follow-up period was on average 1.8 years after the connection of the prostheses, which provided the patients a dentition with a mean of 12 occluding dental units. The first author (S.-W. Yi) performed all implant treatment. Patients' opinions on oral functions--mastication, phonetics, oral hygiene, chewing comfort and aesthetics--were evaluated by means of a questionnaire both before implant installation and at the last follow-up. A control group of 30 subjects with a healthy dentition of 14 occluding natural pairs of teeth answered the same questionnaire on one occasion. A great majority of the patients were extremely satisfied with the oral function after treatment and experienced the ISPs as 'natural teeth'. There was no significant difference between the three treatment groups and the control group for mastication, phonetics, chewing comfort and aesthetics. Patients with ISPs reported a small but significantly greater difficulty with oral hygiene procedures than the controls with natural teeth. Most patients said that they would undergo the treatment again, if necessary, and recommend it to others. It was concluded that the rehabilitation of the periodontally compromised patients, including ISPs on osseointegrated dental titanium implants, resulted in subjectively improved and satisfactory oral function.

Long-term follow-up of cross-arch fixed partial dentures in patients with advanced periodontal destruction. Evaluation of the supporting tissues

The aim of the study was to evaluate the periodontal conditions in patients treated more than 10 years ago for advanced periodontal disease and rehabilitated with cross-arch fixed partial dentures (FPDs). Of 50 randomly selected patients, 34 subjects carrying 43 FPDs agreed to participate in a clinical and radiographic follow-up examination. The FPDs were divided into three groups on the basis of prosthesis design (end abutments, unilateral cantilever, and bilateral cantilevers) and amount of supporting tissues at the time of bridge installation. Seventy per cent of the FPDs were found to be unchanged, whereas the rest had been modified due to various complications leading to extraction of one or more of the abutment teeth. Six FPDs (14%) had been partially replaced by FPDs anchored to osseointegrated dental implants. A total of 21 (8%) of the original 274 abutment teeth had been extracted. Longitudinal changes in the amount of periodontal support were minimal over the average of 15 years of follow-up. FPD design or initial amount of supporting tissues was found not to have significant influence on longitudinal changes in periodontal conditions. It was concluded that combined periodontal and prosthodontic treatment of patients with advanced loss of periodontal support may provide a high rate of long-term successful outcome, provided proper adequate periodontal and prosthetic treatment and maintenance care are given.

The successful use of osseointegrated implants for the treatment of the recalcitrant periodontal patient

This study reports the successful use of osseointegrated implants to replace teeth in patients whose periodontal disease has been categorized as recalcitrant. It includes partially and totally endentulous jaws. A total of 309 implants placed by two periodontists practicing in traditional office settings were included in the survey. Of the 132 mandibular implants, 4 failed, for a success rate of 97%; and 3 of the 177 maxillary implants failed, for a success rate of 98%. There were 21 implants placed in 1985; 38 in 1986 and 1987; 185 from 1988 to 1990; 42 in 1991; and 23 in 1992. The report includes 42 mandibular and 50 maxillary prostheses, none of which has failed. One female mandibular case was converted from 2 posterior free-standing to a full arch prosthesis when the anterior teeth failed periodontally. These results demonstrate that individuals with a strong susceptibility to periodontal disease can be treated successfully with osseointegrated implants.

Patient preference regarding 4 types of periodontal therapy following 3 years of maintenance follow-up

It has been shown that certain types of periodontal therapy result in greater post-therapy gingival recession. It has been suggested that this recession may lead to maintenance complications for patients. This study evaluated patient perceptions 3 years following the completion of 4 types of periodontal therapy (coronal scaling (CS), root planing (RP), modified Widman surgery (MW), and flap with osseous resectional surgery (FO)). 75 individuals completed split-mouth therapy and 3 years of maintenance follow-up. An interview survey of all patients categorized their perception for each treatment of their mouth concerning difficulty in cleaning, sensitivity to temperature, general "feeling" of the region, prevalence of localized symptoms, food retention, comfort of oral examination, and attitude toward repeating therapy. Responses to questions showed no statistically significant differences between treatment regions. Patterns demonstrated that FO-treated regions were perceived to have less food retention, but were more difficult to clean. It was generally found that at the end of 3 years of maintenance, patients felt their mouths were "normal", they experienced few localized symptoms, and were very willing to repeat any of the treatment regimens if necessary.

Prosthetic reconstruction of dentitions seriously compromised by periodontal disease

Dentitions seriously compromised by periodontal disease are often in need not only of cause-related periodontal therapy of high quality but also of relevant prosthetic rehabilitation. Contrary to traditional claims, clinical investigations published during the last 2 decades demonstrate that, if adequately treated and controlled, such dentitions can carry fixed, cross-arch bridges on an extremely reduced amount of periodontium, with a good long-range prognosis. It has also been shown that a markedly reduced but healthy and favourably distributed periodontium supporting such constructions can withstand occlusal forces of considerable magnitude. Another controversial topic, related to fixed bridges, involves indications and contra-indications for cantilever segments. Some clinical investigations demonstrate a markedly increased risk of failure if the fixed bridge is provided with cantilever units, while other controlled studies with defined specifications on the design of the constructions exhibit a high success rate after 8 years or more also for bridgework where 2 or 3 cantilever units are included. The force pattern along cantilever segments of both tooth-supported and implant-supported bridges has been extensively studied. The results show that the force distribution depends not only on the occlusal contact pattern and the dimensioning of the cantilever beam, but also on the type of prosthetic construction in the opposite jaw occluding with the cantilever segment. The free-standing, implant-supported bridge has recently become an important treatment modality for rehabilitation of the partially edentulous jaw, and follow-up studies demonstrate a high success rate.(ABSTRACT TRUNCATED AT 250 WORDS)

[Prosthetic rehabilitation of periodontal cases]

The rehabilitation of a periodontal patient not only must achieve a condition of health, but also a good masticatory function and an acceptable esthetic. Therapy of such patients often involves a multidisciplinary approach. The correct succession of these treatments influences the result of the case. A case is presented to illustrate the treatment sequence in period-prosthetic cases.

[Maintenance therapy. Review of the literature]

The periodontal literature contains a paucity of articles dealing with the maintenance of periodontal health after active treatment. The difficulty in doing long term clinical studies relates to the lack of compliance among patients. Well controlled maintenance programs are the main consideration in obtaining a good prognosis over the long term.

Immediate esthetic treatment for anterior teeth: report of cases

Prompt restoration of function and esthetic appearance of dentition can avoid psychological stress and functional problems. Surgical procedures that require long-term bone deposition and soft-tissue healing can accompany periodontal and orthodontic reinforcement, but other less invasive, immediate, intermediate, and final treatment plans can be initiated with good results.

[The evaluation and rehabilitation of the abutment teeth of fixed partial dentures]

Thorough evaluation of all structures that might contribute support to a prosthesis must certainly include natural teeth, since their number, location in the arch, individual position, mobility, vitality, crown-to-root ratio, root size and shape, susceptability to caries and pathologie involvement. One of the most important observations affecting treatment planning involves the condition of the occlusal plane of the remaining natural teeth. The use of periodontally weakened teeth as abutments is often debated but the prognosis of periodontal therapy and thus the possibility of using periodontally diseased teeth for prosthesis include: 1. The extention of the disease involvement. 2. Duration and progression. 3. Causative factors, including occlusal, bone level, pocket-dept and furcation involvement and 4. Attitude, cooperation and determination to provide home care. The development and the maintenance of bacterial plaque on the teeth is considered as a primary factor that causes inflammation and effects the Biological future of fixed prosthesis.

Suggested solutions for common problems in clinical periodontics

This short report offers solutions for three common clinical problems. Based on their experience, the authors suggest using a "spoon" type partial denture for the temporary replacement of maxillary anterior teeth. The denture is unique in that it has no clasps and does not contact the marginal gingiva. Also, conventional posterior curets have been modified by lengthening the shanks 5 mm while retaining the original dimensions of the working tip in order to reach relatively inaccessible areas more easily. Finally, to increase the utility of Orban knives in making primary inverse bevel flap incisions, the blade has been lengthened by 5 mm.

The role of occlusion for the stability of fixed bridges in patients with reduced periodontal tissue support

The present investigation reports how occlusion may be utilized to establish and maintain stability of fixed bridges in patients with markedly reduced periodontal tissue support. The material consisted of 20 adult patients, aged 27-69, with advanced periodontal breakdown, often in combination with extensive loss of teeth. After periodontal treatment, the patients were rehabilitated with fixed bridges, whose stability was evaluated once a year for 2 to 6 years. The results show that permanent stability of bridgework can be obtained in patients where there is a minimum of remaining periodontal tissue support, even in combination with marked hypermobility of individual abutment teeth. The stability was achieved by proper treatment of the diseased periodontal tissues, and by establishment of stable occlusion in the intercuspal position. When there was a risk of bridge mobility on excursive movements of the mandible, balancing contacts were established for the prevention of migration, tilting and increasing mobility. The study also shows that cantilever pontics can be used to achieve and maintain the stability of fixed bridgework.