Ectodermal dysplasia in adulthood: the restorative difficulties and management

Ectodermal dysplasia can result in a number of oral problems. As the condition is usually diagnosed in childhood, multidisciplinary specialist dental care at an early age may minimize the long-term dental complications. This article describes the restorative management of an adult patient suffering from ectodermal dysplasia for whom such support was not available, resulting in the provision of complex and highly invasive restorative treatment in adult life to provide a functional and aesthetically acceptable dentition. The various treatment options that were considered are discussed together with the details of the treatment provided.     

Hygiene, maintenance, and prosthodontic concerns for the infirm implant patient: clinical report and discussion

Hygiene techniques and prosthetic maintenance procedures are illustrated for an infirm implant patient who is unable to communicate verbally or in written modes. Potential problems are discussed as they pertain to long-term patients who are in nursing homes, domiciles, or hospital wards. The issue of modifying a prosthesis to enhance the ease of providing oral hygiene care is examined.     

Diagnosis and treatment planning for implant dentistry

Dental implants are well-established in dentistry and allow the restorative dentist to offer patients the best that dentistry has to offer. Through examination, radiographs, and study models, the restorative dentist and implant surgeon can develop a treatment plan. Comprehensive diagnosis and treatment planning involve much more than a clinical exam--they require an investigation involving past, present and future dental therapy.     

Practicing implant dentistry profitably

The success of dental implants has opened up countless treatment possibilities for restorative dentists to offer to their patients. Just as our clinical paradigms have had to change because of this new technology, so too must our paradigms concerning the way we communicate with our patients change if we are to get them to say "yes" to treatment that we know that they need. Success in clinical treatment using implants requires a systematic approach. A systematic approach to communicating with your patients will allow you to have the same high degree of success with treatment acceptance that is possible with dental implants. The key to the systems we have discussed is Relationship Centered Care. A relationship is fostered and enhanced through a Comprehensive Examination Process, a structured Consultation Process utilizing the influencing process and Financial Arrangements that allow the patient to receive what they want while the office maintains the profitability that it needs. A system for calculating rational fees can be utilized that allows the practice to have control over an area that traditionally was controlled by anecdotal factors. The Pride Institute has developed this material and is presenting it to the profession so that restorative dentists can truly practice implant dentistry profitably.     

Maintenance and treatment of the ailing and failing implant

Due to the pathologic nature of oral bacteria, the partially edentulous implant patient is at a greater risk than the fully edentulous. Peri-implantitis and/or retrograde peri-implantitis can result in ultimate loss of the implant fixture. It is important that the implant dentist understand the difference between the ailing implant, the failing implant, and the failed implant. This article discusses the pathologic diseases that affect dental implants and how to treat the "infected" implant (degranulation and detoxification) for titanium and hydroxylapatite-coated implants. Implant maintenance, including hand or motorized brushes, flosses, and oral rinses (chlorhexidine, 0.2%) will also be presented.     

Prevalence and predictors of work related respiratory symptoms in workers exposed to organic dusts

Treatment of initial caries, albeit an everyday occurrence for the dental practitioner, presents considerable demands of patient assessment and diagnosis. Whatever decisions are made--to restore caries or to attempt to arrest its progress--the adoption of a maintenance program is of paramount importance. Patient motivation, in respect to dietary control and satisfactory oral hygiene, is central to a successful outcome, and in the future, practice management programs may include RAC as a diagnostic aid. New methods of caries management are more dynamic than traditional methods and place restoration of the lesion toward the bottom of the list of possible treatments, with the biologic rather than the mechanistic approach being a priority. However, the teaching of RAC in dental schools and the third-party funding of diagnostic tests and diagnosis are also required to reflect the increasing complexity of management of initial caries. If restorative intervention is indicated following diagnosis and RAC, treatment of initial caries should involve a minimal-intervention adhesive technique.     

The dental care of the psychiatric patient

The dental care of the psychiatric patient requies careful observatio and history taking. Medications used in the treatment of psychiatric illnesses demand care in treatment planning and prescibing. The nature and sequellae of many psychiatric conditions have a direct bearing on the clinical picture presented by the patient and the success of dental care. Implementation of care must have a significant component of flexibility in terms of treatment outcomes and the time and method of providing treatment. Particular emphasis must be placed uppon the establishment of effective oral hygiene programmes. The psychiatric patient suffers not only from a socially debilitating disease but also from society's opprobrium. With a modicum of effort, the dental profession can rise above that.     

Managing malrelated arches and limited vertical space for implant-supported overdentures: a case report

Advancements in implant therapy have expanded the prosthetic options available to treat edentulous patients. The dental professional must be able to accurately diagnose the status of the intraoral environmental in order to provide the patient with appropriate treatment and a suitable restorative result. Skeletal relationships, arch malalignment, implant angulation, and ridge morphology must be evaluated during initial treatment planning and incorporated into the definitive prosthetic result. This case report demonstrates the application of an implant-supported prosthesis to address the various complications presented in the treatment of edentulous patients.     

Treatment planning of the elderly implant patient

The prevalence of partial and complete edentulism in the older adult patient and the predictability of specific types of dental implants obligates the dental health professional to consider the fabrication of implant-related prostheses as an alternative treatment option. Special emphasis is placed in this article on the provision of clip-bat overdentures in the treatment of the fully edentulous patient and their relative advantages compared to a fixed-hybrid prosthesis.     

Affordable implant prosthetics using a screwless implant system

Many dentists have been reluctant to place dental implants because they have found that most implants are costly and time-consuming to place and have long-term maintenance problems. Most of these problems are caused by using screws to connect the abutment to the implant, the crown to the abutment or both. The use of a screwless implant system and conventional prosthetics, the author contends, can make implant dentistry affordable, versatile and easy to incorporate into all general dental practices.     

A systematic approach to definitive planning for osseointegrated implant prostheses

Thoughtful design selection is crucial for the perpetual success of any dental implant restoration. This article reviews treatment considerations specific to the postsurgical presentation of the implant patient. Deviations from the originally planned design may be necessary at this time. Indications for the selection of specific prosthetic modalities are offered in a sequence of paradigms to support the cognitive skills of the inexperienced clinician.     

Tripodal mandibular subperiosteal implant: basic sciences, operational procedures, and clinical data

A tripodal mandibular subperiosteal dental implant is a three piece cast metal framework that fits on the residual ridge beneath the periosteum and provides support for a dental prosthesis by means of posts or other mechanisms protruding through the oral mucosa. This implant is indicated in patients with advanced atrophy of the mandible where the unstable alveolar bone has completely disappeared, leaving in place the more stable basal bone with specific anatomical contours. The authors present their experience of 317 cases carried out in three different centers related to this implant modality and underline the importance of the basic anatomic, physiologic, and medical knowledge required to optimize the results.     

The prevention and management of oral barotrauma

The recent increase in the popularity of scuba diving has emphasised the role of the dentist in the prevention and treatment of oral barotrauma. Pain and injury to oral structures can result from rapid changes in pressure gradients, and involve enclosed spaces such as the sinuses, exposed dentinal tubules, or root canals. Three patients provide clinical examples of dental barotrauma and highlight the need for an awareness that some patients are divers who need meticulous restorative dentistry.     

Radiographic modalities for diagnosis and treatment planning in implant dentistry

Early in the development of implant technology it became apparent that conventional dental imaging techniques were limited for evaluating patients for implant surgery. During the treatment planning phase, the recipient bed is routinely assessed by visual examination and palpation, as well as by periapical and panoramic radiology. These two imaging modalities provide a two-dimensional image of mesial-distal and occlusal-apical dimensions of the edentulous regions where implants might be placed. When adequate occlusal-apical bone height is available for endosteal implants, the buccal-lingual width and angulation of the available bone are the most important criteria for implant selection and success. However, neither buccal-lingual width nor angulation can be visualized on most traditional radiographs. Although clinical examination and traditional radiographs may be adequate for patients with wide residual ridges that exhibit sufficient bone crestal to the mandibular nerve and maxillary sinus, these methods do not allow for precise measurement of the buccolingual dimension of the bone or assessment of the location of unanticipated undercuts. For these concerns, it is necessary to view the recipient site in a plane perpendicular to a curved plane through the arch of the maxilla or mandible in the region of the proposed implants. Implant dentists soon recognized that, for optimum placement of implants, cross-sectional views of the maxilla and mandible were the ideal means of providing necessary pre-operative information. Today, the two most often employed and most applicable radiographic studies for implant treatment planning are the panoramic radiograph and tomography. Although distortion can be a major problem with panoramic radiographs, when performed properly they can provide valuable information, and are both readily accessible and cost efficient. To help localize potential implant sites and assist in obtaining accurate measurements, it is recommended that surgical stents be used with panoramic radiographs. In simple cases, where a limited number of implants are to be placed, panoramic radiography and/or tomography may be used to obtain a view of the arch of the jaw in the area of interest. For complex, cases, where multiple implants are required, the CT scan imaging procedure is recommended. Because of its ability to reconstruct a fully three dimensional model of the maxilla and mandible, CT provides a highly sophisticated format for precisely defining the jaw structure and locating critical anatomic structures. The use of CT scans in conjunction with software that renders immediate "treatment plans" using the most real and accurate information provides the most effective radiographic modality currently available for the evaluation of patients for oral implants. To follow patients after implant surgery, DSR can be helpful by addressing the limitations of other radiographic modalities in detecting postoperative changes. By eliminating unchanged information, DSR allows the clinician's eye to focus on actual changes that have occurred between the recordings of two images.     

The use of osteotomes for sinus augmentation at the time of implant placement

The placement of endosseous dental implants is often hampered by the loss of alveolar bone. In the posterior maxilla, the presence of the maxillary sinus and less-dense bone present additional obstacles to successful implant placement. Existing methods of subantral augmentation require extensive surgical manipulation, often including a second surgical site for harvesting autogenous bone. The development of surgical osteotomes has facilitated the placement of implants in areas of minimal alveolar bone height in the posterior maxilla. This article describes the osteotome technique for sinus augmentation at the time of implant placement and presents a short-term evaluation of 34 implants placed in 18 patients.     

Single-stage surgery for implant placement: a retrospective study

Single-stage implant placement surgery offers patients a number of advantages. These include reduced cost and time commitments and greater comfort, function, and convenience. This article reports on the results of using a single-stage technique with 58 patients fitted with 240 implants. No implant failures were detected in any patients prior to the final attachment of a Dolder bar. Among the 27 patients and the 125 implants followed for a longer period of time, 99.2% exhibited no signs of implant mobility or pain. Indicators of gingival health and oral hygiene ranged in quality from acceptable to ideal.     

Dentoalveolar morphology: evaluation of natural root form versus cylindrical implant fixtures

The function of implant-supported restorations is now routinely achieved. As a result, the emphasis in restorative implant dentistry has shifted from function to aesthetics and the biocompatibility of the materials utilized. The learning objective of this article is to review the three major components essential to achieving natural aesthetics in implant-supported restorations--hard tissue dynamics, soft tissue dynamics, and dental aesthetics. Particular emphasis is directed to the dentoalveolar anatomy and morphology. Analysis of the tooth root morphology and dimensions has resulted in the design and fabrication of restorative components with dimensions that closely resemble the natural tooth anatomy and aesthetics. A system of transmucosal abutments has been designed, and its utilization is presented in this review.     

Functional endoscopic sinus surgery: preoperative assessment and postoperative evaluation

Long-term success of dental implants depends largely on the continued health of peri-implant hard and soft tissues and an appropriate force distribution on the implants. Since dental implants are accepted as viable and, in some cases, ideal restorative options, all members of the dental team are faced with the task of maintaining implant health. This review outlines the current understanding of implant health and disease and presents recommendations for the treatment and management of diseased implants.     

Problems associated with the atrophic mandible

A range of treatment options has been presented regarding the use of dental implants to rehabilitate patients who otherwise have compromised function using conventional tissue-borne prostheses. This patient population offers significant challenges to both the surgeon and the prosthodontist. Generally speaking, IODs retained on two or more endosteal osseointegrated implants; transosteal, subperiosteal, ramus frame implant-supported and implant-retained prostheses, and a totally implant-supported design offer options to treat the severely atrophic mandible. When bone support or volume is so lacking that augmentation procedures are required, bone grafting can be considered as a treatment option. The state-of-the-art of implant treatment for the atrophic mandible offers to the dental professional and patient a variety of options. Thus far, it is too early to make specific recommendations as to which treatment offers the best option for each patient. It is fair to say that the ISP remains the gold standard against which other treatments can be compared.     

The Spline implant interface: analysis and initial clinical experiences

A new implant with a spline-shaped interface (Spline) was recently introduced. A common and preferred method of connecting two cylinders in many fields of industry, the Spline offers implant dentistry improved strength and precision compared to earlier and current implant connection designs. A comparative engineering analysis of the Spline and the major implant interfaces is offered, including the possible clinical implications. Initial surgical and restorative experiences with cement and screw-retained prostheses are presented in case reports.