Removable partial prostheses for the elderly

Elderly partially edentulous patients can have teeth replaced with removable or fixed prostheses supported by mucosa, teeth, or implants. Age per se does not influence which option is best. Instead, the relative health of the patient, dental tissues, and the patient's finances determine treatment. A three-level index of these factors, the PTF index, is proposed to assist in the decision-making for treatment. Removable partial prostheses (RPPs) can be indicated for all patients because RPPs offer esthetic, versatile, noninvasive, and reversible features. They are particularly indicated when remaining teeth are questionable. If teeth are lost, they can be more easily added to existing RPPs compared with fixed prostheses. Six changes to ideal designs are illustrated in this article for prostheses with a compromised dentition, to make continued prosthetic service simpler.     

An alternative restorative method for regional odontodysplasia: case report

A 5-year-old Caucasian male presented with early loss of multiple deciduous teeth. All the characteristics were consistent with the diagnosis of regional odontodysplasia (ROD). Significant initial findings included premature loss of multiple primary mandibular teeth and some malformed permanent teeth. The affected teeth showed hypoplastic enamel and dentin, short roots, and wide pulp chambers, and were localized in the mandibular dentition. Treatment objectives for this patient were to provide improved esthetics, restored chewing function, and space maintenance by the construction of a temporary prosthetic restoration. However, with limited tooth support and an unusual occlusal pattern, it is difficult to obtain satisfactory retention and esthetics with traditional prosthetic techniques. In this article we introduce an alternative method for fabricating a custom removable denture and discuss the prognosis of the malformed permanent dentition and further treatment plan.     

A case of hyperodontia with twenty-two supernumeraries: its surgical-orthodontic treatment

A 10.1-year-old boy showed no permanent teeth, with the exception of the lower central incisors. An x-ray examination revealed that eruption of the permanent dentition was obstructed by 1 deciduous supernumerary and 22 permanent supernumeraries ectopically. Treatment consisted of the following steps: (1) extracting all deciduous and supernumerary teeth; (2) waiting for the roots of the permanent teeth to develop and fitting two temporary partial prostheses; (3) assisting eruption of the permanent teeth by removing the bone that covers the remaining teeth and applying crowns to stimulate the eruption; and (4) bringing the permanent teeth into occlusion with orthodontic treatment. The problem of limiting treatment time was made more difficult by the amount of repositioning needed to bring the teeth into occlusion and by delayed root formation. Therefore the orthodontist decided to use extreme caution in applying forces; as a result, treatment time was lengthened. Success was due to good teamwork between the surgeon with an orthodontic background and the orthodontist, who was familiar with surgical procedures.     

The Orthosystem--a new implant system for orthodontic anchorage in the palate

The present report describes the design and first clinical experiences of a newly developed endosseous orthodontic implant anchor system (Orthosystem, Institut Straumann, Waldenburg, Switzerland) for palatal anchorage. The 1-piece fixture made of titanium consists of a screw-type endosseous implant body (sandblasted, acid-etched, diameter 3.3 mm, lengths: 4 and 6 mm), a cylindrical polished transmucosal neck and an abutment. Clamp-caps provide attachment of square commercially available orthodontic wires (0.032 x 0.032 inch, SS) to the abutment (transpalatal bars). In a pilot study 1 fixture (implant body length: 6 mm) was inserted into the midsagittal anterior palatal region in each of 6 adult patients with Angle class II malocclusion (distocclusion 7 to 8 mm, overjet: approximately 9 mm). The treatment plan included extraction of the first maxillary premolars and retraction of the anterior teeth based on maximum anchorage of the posterior teeth without using compliance-dependent anchorage aids (headgear, class II elastics). Due to the design of the fixture only 1 simple surgical procedure was required for insertion (nonsubmerged method, 1-stage surgery). Accordingly the need for surgical exposure of the abutment for connection and wire insertion was eliminated. Thus, inconvenience to patients was reduced to a minimum. The patients are now at varying active treatment stages. The course of treatment of the most advanced case is described. Evaluation of the clinical and radiological findings after 12 months of treatment (3 months implant healing, 9 months active orthodontic treatment which is equal to the implant loading period) revealed no implant mobility/dislocation, favourable peri-implant soft tissue conditions, no marked mesial movement (approximately 0.5 mm) of the implant/transpalatal bar supported posterior teeth, and 8 mm retraction of the anterior teeth. Retrieval of the fixture and post-operative wound healing were uncomplicated. In the treatment of this case, no compliance-dependent extraoral anchorage was used, and the well aligned mandibular dentition was not bonded provide anchorage support (class II elastics).     

Clinical study on the cell kinetics of gastric cancer using bromodeoxyuridine labeling index--its relations with DNA ploidy pattern and epidermal growth factor

The prime objective of dental care is maintaining a natural functional dentition for life. It is expected that a growing group of adults will keep their dentition into old age. Although routine prosthodontic care will still be important in the future the treatment strategy for older adults and elderly people with a reduced dentition does require a different approach. The traditional approach in prosthetic therapy was guided primarily by morphological criteria aimed at preservation of complete dental arches, which resulted in emphasis on quantity in dental care. Nowadays requirements such as aesthetics and functional comfort are considered more important and more easily achieved. In the presented principles for treatment planning the importance of a thorough preliminary treatment is stressed. Furthermore, needs for tooth replacement are discussed and guidelines are given for a preventive prosthodontic treatment approach in severely broken-down dentitions and edentulous patients.     

Periodontal, implant, and prosthetic treatment for advanced periodontal disease

This article reports a case that involved a challenge in multidisciplinary decision making. A patient presented with severe periodontal disease and the need for prosthetic rehabilitation for purposes of tooth replacement and the stabilization of periodontally compromised teeth. The initial diagnosis revealed that the treatment regimen would require periodontic, endodontic, and orthodontic treatment, as well as dental implants. This case report demonstrates teamwork and a sequential approach to a complex case in a postgraduate clinical setting.     

Clinical case report: an improved technique for using dental implants as orthodontic anchorage

The use of endosseous implants as intra-oral anchorage to facilitate orthodontic treatment has been reported in the literature for some years, first in rabbits and dogs, and then in adult human patients. The implants were generally used solely for the purpose of anchorage. This paper reports the successful application of orthodontic forces utilizing dental implants to achieve tooth movement. The implants were subsequently used as fixtures in a pre-determined plan to support a fixed prosthesis. A clinical example demonstrates how implants may serve dual roles, for anchorage and then for fixed prosthetic support. The principles involved in using dental implants as part of a multi-disciplinary approach to dental treatment are illustrated.     

Chewing performance before and after rehabilitation of post-canine teeth in man

Missing teeth are often replaced by fixed or removable prosthodontic appliances to improve masticatory function. However, there have been few studies directly determining the influence of prosthodontic treatment on masticatory function. Our aim was to obtain information on the objective and subjective masticatory function of partially edentulous subjects before and after prosthetic restoration. In this way, the improvement of the masticatory function as a result of the treatment could be quantified. The objective and subjective masticatory function of a group of 15 subjects was determined before and after replacement of an average of 3.1 post-canine teeth. The results were compared with data from a control group of 26 subjects having a complete dentition. The total number of occluding post-canine teeth increased as a result of the prosthodontic treatment, yielding a significantly improved objective masticatory function. The average masticatory performance was found to approach the level of the control group if all occlusal units of the longest posterior side were replaced. Subjects with an incomplete dentition tended to chew predominantly on the side of the longest posterior arch. The average subjective masticatory function improved as a result of the treatment. The appreciation of the masticatory function after treatment was equal to that of the control group, despite an average of 2.7 missing teeth. However, no correlation was found between the additional number of occlusal units and the change in subjective masticatory performance. Rehabilitation of post-canine teeth restores some objective masticatory function and leads to an increased appreciation of the masticatory function, although no correlation was found between the changes in objective and subjective masticatory function.     

A modified, lingually supported cantilevered Herbst appliance

This new, fixed-functional appliance/Herbst/Bioprogressive system is designed for patient comfort and mandatory compliance. It also combines the positive clinical effects of four fixed-functional systems. It allows rapid palatal expansion of the upper arch, alveolar uprighting of the lower arch, upper and lower incisor alignment, and sagittal correction of Class II malocclusions to occur simultaneously with one appliance fixed in both arches. It is indicated for use in growing patients with skeletal Class II malocclusions. The ideal timing for treatment is the late mixed dentition. Being able to remove the appliance after one year with the upper second bicuspids erupting slightly Class III so the clinician can immediately begin fixed finishing mechanics would be ideal. This new Herbst design will reduce the frequency of orthognathic surgery and upper bicuspid extraction to camouflage Class II malocclusions. At the same time, it gives total control to the clinician in treating some more difficult, non-compliant patients. Fixed-functional appliances, which improve treatment efficiency and treatment results and provide for patient comfort, while at the same time give the treating clinician almost total control of the three planes of facial growth will open new doors for orthodontic treatment and research in the next century.     

Guided tissue regeneration using bioresorbable membranes: what is the limit in the treatment of combined periapical and marginal lesions?

The maintenance of single teeth may often be of crucial importance for the prognosis of the total dentition. In such cases, as when a single tooth supports a fixed partial denture, a special effort should be made to maintain that tooth. This study reports the treatment of six such terminal cases. The results of a combination of local and systemic antibiotics and the use of guided tissue regeneration with resorbable membranes and grafting material is demonstrated. After defect debridement and root planing, the defects were filled with Biostite (Coletica), and Paroguide (Coletica) membranes were placed. The results at reentry demonstrated the efficacy of these treatments, and all six treatments were considered successful. The influence of the individual components used in treatment is discussed.     

The aesthetic composite bridge

New developments are constantly introduced in the search for the optimal treatment modality to restore a single anterior tooth. The patient attention has shifted to aesthetics of the restoration, biocompatibility of the dental materials utilized, conservative preparation of the teeth to be restored, and the retention of intact adjacent dentition. The learning objective of this article is to review the methods currently utilized and to present a recently introduced treatment modality--the two-component bridge, which combines the strength and resiliency of composite resin with the aesthetic advantages of porcelain. The technology of the material is reviewed, the predominantly lingual tooth preparation procedures are outlined, and the bridge try-in is described. The advantages of the two-component bridge are presented along with the contraindications and suggestions of careful case selection. Three cases with congenitally missing maxillary lateral incisors in youthful patients are presented to supplement the theoretical outline and to describe and illustrate the clinical procedure.     

Are mu-opioid receptors involved in the control of endothelin-1 release from the pituitary gland in normal and dehydrated rats?

A stereognostic ability test was performed in 60 patients. Forty patients were rehabilitated by means of osseointegrated implants. One group consisted of 20 patients with fixed prostheses on implants in both the upper and lower jaws. The other 20 patients had a maxillary denture while in the mandible an overdenture was retained by means of two implants connected by a bar. They were compared to a group of 20 subjects (controls) with a non-restored natural dentition. For the stereognostic ability test, subjects had to recognise ten different test pieces by manipulating them with two antagonistic incisor teeth, avoiding any contact with other oral structures. Both response time and percentage accuracy of recognition were evaluated. The present findings indicated that subjects with an overdenture on implants did not score significantly different from those with an implant-supported fixed prosthesis. In contrast, subjects with teeth had a significantly better stereognostic ability. The percentage of correct responses was 52% for overdentures, 56% for fixed prostheses on implants and 75% for natural dentitions. From these results, it could be concluded that the stereognostic ability is impaired in subjects rehabilitated with osseointegrated implants by about one-third to one-quarter compared to subjects with natural teeth.     

A combination porcelain/fiber-reinforced composite bridge: a case report

In the search for an optimal treatment to restore the aesthetically prominent maxillary anterior dentition, new materials are continually introduced. The attention of the patients has shifted from function to aesthetics, biocompatibility of the materials utilized, and conservative preparation of teeth to be restored. To fulfill patient expectations, an advanced treatment modality has recently been developed. It combines porcelain with composite resin, thereby integrating the strength and resilience of composite resin with the aesthetic advantages of porcelain. To achieve this combination, bundles of fibers are impregnated with resin in the fabrication phase of the material. The learning objective of this article is to briefly review the past methods of fabricating a 3-unit prosthesis in the maxillary anterior region and describe the recently introduced treatment alternative.     

Polyethylene ribbon and fixed orthodontic retention and porcelain veneers: solving an esthetic dilemma

The patient, a 58-year-old woman, had started orthodontic treatment to correct spacing between the maxillary anterior teeth 6 year prior to presentation with a chief complaint of tooth discoloration and spacing. The treatment had consisted of the use of a removable appliance to retract the maxillary anterior teeth. The patient continued to wear the appliance sporadically. When she presented, the maxillary incisors were in primary occlusal trauma with Grade 2 mobility. The patient discontinued wearing the appliance. The periodontal condition was addressed with initial therapy. As part of the treatment plan to stabilize the maxillary anterior teeth and provide the patient with an esthetic result, it was decided to do a limited occlusal adjustment of the maxillary anterior teeth to control fremitus, and to place a fixed, composite resin, polyethylene ribbon-reinforced splint, using a facial approach. The esthetic restoration of these teeth was accomplished with bonded porcelain veneers.     

Biochemical and histological changes in blood, erythrocytes and tissue of rats on feeding Dryopteris juxtaposita fern

One tenet of successful orthodontic therapy is to complete treatment without decalcification, hypocalcification, or discoloration of the natural dentition. Fluoride application has been shown to reduce demineralization of enamel. The purpose of this study was to see if fluoride could be incorporated into enamel before orthodontic bracketing without adversely affecting bond strength. Forty extract adolescent human premolars were randomly divided into two equal groups with 20 teeth each. Group 1 served as control group, and group 2 (experimental) was immersed in 1.23% acidulated phosphate fluoride for 4 minutes after acid etching. The buccal surfaces of all 40 teeth were then bonded with the same type of metal bracket and debonded with an Instron machine. The debonding interface was observed with scanning electron microscopy (SEM). The mapping was calculated with energy dispersive x-ray spectrometry. The results showed that the bond strength of group 1 was significantly greater than that of group 2. The enamel detachment (enamel fracture) was found in the experimental group only. Although the application of acidulated phosphate fluoride to a tooth can prevent dental decay or decalcification, the bond strength decreases and enamel detachment is found after debonding. The result shows that the application of acidulated phosphate fluoride after acid etching enamel has an adverse effect on orthodontic bond strength of human enamel.     

Expansion

Expansion of dental arches has been in practice for a long time and will be around for years to come. Correct diagnosis along with familiarity of the appliance to be used will enhance the results of orthodontic treatment. The NPE incorporates many of the functions that exist in several different appliances. It can be used for maxillary corrections, crossbites, distal rotation and expansion of molars, molar stabilization, auxiliary placement for habit correction, intrusion of molars, three-way Saggital with utility arch, as an aid in Class II correction retainer, etc. It can be used in primary dentition, mixed dentition, adult dentition, cleft palate patients, surgery cases, Class III cases, and TMJ cases. Most patients can benefit from the use of this one appliance. I will continue to use the NPE and possibly discover more uses for it as I work with it.     

Follow-up of two cases of Papillon-Lefèvre syndrome and presentation of two new cases

Periodontitis resulting from Papillon-Lefèvre Syndrome has been known to cause early loss of primary dentition with subsequent involvement of the permanent dentition. In this study, two Papillon-Lefèvre Syndrome patients were followed for 3 years after initial treatment and improvement of their periodontal condition. In addition, two new cases of Papillon-Lefèvre Syndrome are presented. The follow-up treatment of the first two patients included monitoring the oral hygiene and performing ultrasonic scaling. Their present clinical appearance is very satisfactory. The periodontal condition of the third (new) patient was brought under control by extracting the involved deciduous teeth under antibiotic coverage, and by scaling and root planing the already erupted permanent teeth as well as by maintaining a high standard of oral hygiene. In the fourth case, all permanent teeth had erupted and the periodontium had already been severely destroyed. Actinobacillus actinomycetemcomitans was not detected by microbiologic examination after the periodontal conditions improved, except in the fourth case. Western blot analysis showed that the three first three patients had positive antibody response to the same antigens of Actinobacillus actinomycetemcomitans. Phagocytosis by polymorphonuclear neutrophil leukocytes) had not decreased, but the expression of surface receptors of polymorphonuclear neutrophil leukocytes was within the normal limits.     

The influence of splinting procedures on the periodontal and peri-implant tissue damping characteristics. A longitudinal study with the Periotest device

The aim of the present study was to evaluate the capability of the Periotest device in detecting and monitoring functional changes in the periodontal as well as in the pari-implant damping characteristics. In the first part of this study, 107 teeth were splinted by means of 40 full acrylic fixed prostheses (AFP) and another 37 teeth were splinted by means of 14 ceramometallic fixed prostheses (C-MFP). The Periotest measurements of individual teeth were done the day the fixed prostheses were cemented temporary (PTV 1), and again after a mean observation period of 27.4 days (PTV 2). In the 2nd part, 78 osseointegrated two-stage implants were splinted by means of 23 full acrylic fixed prosthesis (AFP) and other 18 implants were left without it. Using the same abutment length, Periotest measurements were performed, at abutment connections and before installation of the final prosthesis. In a 3rd part, using both implants and teeth as abutments, 29 osseointegrated implants were connected with 25 abutment teeth by means of 7 AFP. The measurements were performed at the beginning of the prosthetic treatment and 2, 4 and 6 weeks later. After splinting teeth by means of AFP for the observation period, no statistically significant reduction in PTVs was found. When on the other hand, a C-MFP was used, PTV 2 showed a significant reduction. The PTVs at abutment connection went down after a period of time, during which some implants were interconnected by means of an AFP and others were not.(ABSTRACT TRUNCATED AT 250 WORDS)     

Polyvinyl siloxane template aids in recontouring natural teeth opposing single dentures

This article describes a procedure that provides proper reduction of natural teeth opposing complete dentures. By use of a polyvinyl siloxane prosthetic template, natural dentition can be reduced to a more favorable plane, which will facilitate denture construction. This procedure will eliminate the risk of arbitrary grinding and will minimize guesswork through guided intraoral reduction.