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1.
After cancer treatment in the head and neck area, mastication and speech are often affected. Some of the problems encountered can be solved by adequate dental rehabilitation. However, dental rehabilitation is often compromised for various reasons. The change in anatomy due to surgery often results in lack of denture-bearing mucosa. The effects of radiotherapy on the salivary glands and the mucosa result in dry oral tissue and diminished retention of removable dentures. Osseointegrated oral implants can help to solve these problems. Although implant treatment for patients with cancer of the head and neck is covered by the Dutch national health insurance, and there is therefore no financial obstacle, implants have not, so far, been widely used with these patients. In order to establish the possible reasons for this, an analysis was performed. Retrospective data on 95 consecutive patients were collected from records. The indication for the use of oral osseointegrated implants was reviewed. Analysis of the data showed that 45% did not need specific prosthetic rehabilitation. An indication for the use of osseointegrated implants was found in 25% of the patients. For various reasons, only 3% actually received implants. In striving to completely rehabilitate a cancer patient, the possible use of osseointegrated oral implants should be evaluated before the initial oncological treatment begins. The insertion of implants during the initial surgical procedure should be considered more often, with a view to reducing the number of surgical procedures.  相似文献   

2.
ML Nevins  JL Gartner-Sekler 《Canadian Metallurgical Quarterly》1997,18(5):469-74, 476, 478-9; quiz 480
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.  相似文献   

3.
STATEMENT OF PROBLEM: From the dental professional's standpoint, implant rehabilitation offers dramatically improved treatment alternatives to orally disabled patients. However, what a patient perceives as important to their function and satisfaction with their prostheses may be quite different from what the dentist believes are significant health-related improvements. PURPOSE: To resolve this problem, a series of investigations were designed to measure satisfaction and performance in groups of patients who wore various types of prostheses supported by endosseous titanium implants. MATERIAL AND METHODS: Methods are described for assessing treatment efficacy and population needs, including measures of perceived levels of disability, health-related quality of life, and functional capacity. RESULTS: The findings highlight patient factors that have not been considered before and appear to contribute to the success of prosthetic rehabilitation for the edentulous patient. CONCLUSION: Patient-centered approaches to the assessment of treatment efficacy are highly relevant to today's prosthodontists, whose goals are the improvement of function and quality of life for their patients.  相似文献   

4.
The authors report their experience in the surgical and prosthetic rehabilitation of three patients affected by sequelae of cleft lip and palate, with residual alveolar cleft and absence of maxillary anterior teeth. The patients were treated by means of late secondary bone grafting of the alveolar cleft, followed by the insertion of endosseous titanium plasma-sprayed implants (IMZ). After a further healing period (6-12 months) fixed dental prostheses were constructed. Preliminary results from this series have shown how dental prostheses supported by endosseous implants in grafted alveolar clefts are a very reliable possibility in dental rehabilitation of this malformation.  相似文献   

5.
The process of rehabilitation of the amputee begins before any surgical intervention. It embodies a team concept with the patient at the core. Evaluation of the appropriate amputation level involves a number of parameters and input from all the team members. Goals are modified as the rehabilitation progresses. The involvement of family and/or significant other is crucial for a positive outcome. Whether or not the patient is a prosthetic candidate, the rehabilitation process is designed to achieve maximum independence, and an improved quality of life.  相似文献   

6.
LF Cooper 《Canadian Metallurgical Quarterly》1997,18(3):271-6, 278, 280-1; quiz 282
Modern restorative dentistry is confronted with many challenges related to implant use in the craniofacial region, such as attempting to place implants in esthetically critical sites or anatomically limiting regions of the jaw. To assure a successful implant placement that is satisfactory to both the patient and the dentist, four key areas need to be improved: diagnostic procedures, surgical procedures and outcomes, esthetic results, and prosthetic complications. This article discusses how an integrated approach to these areas can improve clinical practice.  相似文献   

7.
Opportunities to increase prosthetic treatment efficiency by means of applying osseointegrated implants of traditional and prospective types are analysed. A technique of mathematical modelling of the interaction between implants and jaw bone is exposed. The numerical model and applied program, developed on the basis of finite element method, enabling to analyse a stress strain state of the bone and to determine extreme safe loads on implants are described. It is shown, that the most loaded zone is a layer of the compact bone directly contiguous to the neck of the implant. That is in good agreement with the results of clinical research, according to which just this zone has the highest percentage of complications. Methods for further optimisation of implants and prosthetic structures for the purpose to perfect the techniques of prosthetic treatment are discussed.  相似文献   

8.
Restorative considerations are critical to the long-term success of fixed implant-supported prostheses, especially in the posterior quadrants of the partially edentulous patient. The parafunctional habit of bruxism must be identified and addressed. The restoration should dictate implant placement. Control of forces directed upon the prosthesis and implants is critical to long-term success. Anatomic limitations to implant placement and surgical procedures to correct these deficiencies must be considered for their impact on the prosthetic restoration. Nonaxial forces or bending moments should be minimized by the use of an adequate number, position and alignment of implants; by control of the occlusion; and by design of the prosthesis. The patient must understand the risks, limitations, costs and time commitments of implant restorations prior to treatment.  相似文献   

9.
The relative risk of age, sex, underlying diagnosis, corticosteroid usage, diabetes mellitus, and major nonprosthetic infection for the development of multiple prosthetic infections was assessed retrospectively. Deep infection occurred in 174 replacement arthroplasties in 145 patients between 1981 and 1993. Patients with rheumatoid arthritis had a significantly larger number of implants per patient (P < .001). Twenty-seven of 145 patients developed a second prosthetic infection, for an overall incidence of 19%. Of these 27, the underlying diagnoses were rheumatoid arthritis in 19, osteoarthritis in 6, neuropathic arthritis in 1, and systemic lupus erythematosus in 1. Rheumatoid arthritis and the occurrence of a major nonprosthetic infection (sepsis) were found to be highly associated with the development of a second prosthetic infection (P < .001 and P = .0001, respectively). In those rheumatoid patients with multiple infections, there was a significantly larger proportion with American Rheumatism Association class III and IV function than those with a single prosthetic infection (P = .0002). In 14 of the 27 cases of more than one prosthetic infection, the infected implants presented clinically within the same month. Ten of these 14 had an associated nonprosthetic infection. It is therefore not possible to accurately calculate the risk that one infected arthroplasty poses to other implants.  相似文献   

10.
11.
This case report describes the clinical and laboratory procedures used in the rehabilitation of a patient treated for oral cancer with surgery and radiation therapy. During surgery, a large portion of the mandible was removed and reconstructed with a bone graft. Following therapy, the patient was left with poor esthetics and difficulties with mastication and speech. The goal of prosthodontic treatment was to improve esthetics and restore function. This was successfully achieved through the placement of dental implants and the construction of an implant retained overdenture. A bar was employed to split the implants together and an O-ring system was chosen for retention. The decision to use this type of prosthesis and attachment selection was based on the patient's dental history, esthetic demands, and the need for stress distribution.  相似文献   

12.
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.  相似文献   

13.
Our data do not demonstrate that a prehospital intraosseous infusion protocol will improve the outcome of prehospital pediatric patients with cardiac arrest. The number of patients in our study is too small to allow us to draw a conclusion as to the effect of intraosseous infusion on altering survivability of pediatric cardiac arrest in the prehospital setting. More study is necessary to determine whether there might be a group of pediatric patients with cardiac arrest or hypovolemic shock who could potentially benefit in a prehospital setting from this procedure.  相似文献   

14.
Valve thrombosis is one of the most serious complications after prosthetic valve replacement. We report the use of tissue-type plasminogen activator (t-PA) in the treatment of a patient with thrombosed aortic and mitral valves. Thrombolysis resulted in immediate hemodynamic improvement and resolution of congestive heart failure, thereby avoiding surgical intervention. Based on our experience, thrombolysis with t-PA is an effective alternative in the treatment of thrombosed prosthetic valves.  相似文献   

15.
There are many anatomic and biomechanical factors that define the structure and function of the normal glenohumeral joint. These factors influence the design and function of the prosthetic shoulder. Our best efforts in shoulder design should reflect an attempt to reproduce the normal structure-function relationships of the natural glenohumeral joint. Prosthetic design must also take into account the variable anatomic abnormalities associated with the pathologic condition. Prosthetic designs should attempt to facilitate the surgical correction of this pathology, with the goal of reproducing normal anatomy. Optimal prosthetic reconstruction of the shoulder is dependent on prosthetic design, prosthetic soft tissues, postoperative healing and rehabilitation, and the long-term biologic response to the implant. The success of any prosthetic reconstruction is dependant on many factors, and in some cases, normal anatomy and function cannot be achieved entirely by prosthetic design.  相似文献   

16.
The possibility of placing endosseous implants in the edentulous maxilla is frequently reduced by inadequate bone volume of the residual ridge. In totally edentulous maxillae with knife-edge conformation, insufficient thickness is frequently associated with insufficient height of the residual ridge in the posterior maxilla because of pneumatization of the maxillary sinuses. This surgical method combines grafting of the maxillary sinuses, onlay grafts on the buccal side of maxillary posterior segments, and sagittal osteotomy of the anterior maxilla with interpositional bone grafts. Five to six months after maxillary reconstruction, Br?nemark implants were placed and, after osseointegration occurred, implant-supported dental prostheses were fabricated. Three patients have been treated with this method and 22 implants have been placed. The mean follow-up after final prosthetic rehabilitation has been 16 months; survival rate has been 100%. Despite the small number of patients and the short follow-up, preliminary results have shown very promising results.  相似文献   

17.
The feasibility of implant treatment in patients after oral ablative tumor surgery has not yet been investigated with consideration of the requisite high periodontal standards. A report on this topic has to deal not only with implant survival but also with implant health, bone response, soft tissue health, failure pattern, time of failure, and ease of restoration. For the assessment of an implant system, an overview must be accomplished that takes into account the different restorations used and their interaction with the implant system that was used. This study presents the Bone-Lock implant system (Howmedica Leibinger GmbH, Freiburg, Germany) in a retrospective investigation after 5 years of follow-up with special emphasis on the prosthetic restorations used following resection of oral malignancies. From early in 1990 through June 1996, we inserted 210 dental endosteal Bone-Lock implants (58 patients) after oral tumor resectioning. Included in the study were 45 patients with 162 implants and prosthetic restorations that had been loaded for 1 year (dentures retained by telescopic or bar-clip or ball attachments, implant-supported prostheses, tooth-to-implant connected bridges). Regular follow-up consisted of evaluation of the Plaque Index (Silness and L?e) and of the Sulcus Bleeding Index (L?e), measurements of pocket probing depth, implant mobility (by means of the Periotest method), bone resorption (according to X-ray findings), and a questionnaire that registered patient satisfaction. The results were evaluated for each restoration and were compared with baseline standards. The overall 5-year survival rate was 83.2%. For implants that had been in place for over 365 days, the survival rate was 93%. The investigation showed that after resection of oral malignancies, patients could be treated with dental implants and superstructures with long-term efficacy similar to that found in healthy subjects considering internationally accepted standards. Implant treatment in tumor patients appeared to offer the most positive periodontic results when use of bar-clip or telescope-retained overdentures was involved. The patient satisfaction level with the described prosthodontic treatment was satisfactory.  相似文献   

18.
Clinical evaluations of a new porous-surfaced implant concept (Endopore) in a large population of fully and partially edentulous patients are reported, and a technique of spreading buccal and lingual plates with osteotomes to place these implants in proximity to the sinus of the posterior maxilla is described. Three-dimensional, interconnecting pores on this implant's bone interface surface give a great surface area for bone engagement. When the maxilla is prepared by this spreading procedure, these implants can be successfully placed in areas having limited available bone. Our success rates are 97.0% for implants stabilizing a mandibular overdenture and 94.8% for implants placed in partially edentulous patients. Many times, sinus lift or other augmentation procedures can be avoided in the maxilla and mandible, allowing for less patient morbidity and for an implant reconstruction that is more affordable for the patient.  相似文献   

19.
We examined the association between prosthetic nonbreast implants and selected malignant neoplasms, connective tissue disorders, and neurologic diseases. We conducted a case-control study from an insurance claims database. We selected controls who had diseases for which no association with implants have been claimed or reported. Data were analyzed using both tabular and polytomous regression analysis methods, including methods to account for the large number of comparisons. All analyses exhibited positive associations between implants (both silicone and metal) and neurologic conditions, especially idiopathic progressive neuropathy and Meniere syndrome, as well as the expected associations with arthritic conditions. There also was an unexpected negative association between metal implants and brain tumors. In conclusion, further studies of prosthetic implants and neurologic diseases appear warranted. These studies should obtain medical histories to control for possible confounding effects of drug treatments associated with implant surgery.  相似文献   

20.
The use of oral implants opened a wide range of prosthetic treatment possibilities in edentulous patients. Although the reported success rates of oral implants are high, failures do occur. This paper reviews the current knowledge about the aetiology, the signs and symptoms and the possible influencing factors of implant failure. Possible causes of implant failure are thought to be infection of the periimplant tissues, occlusal overload, or a combination of both. Nevertheless, pinpointing one of these as the aetiological factor in a particular case is difficult and should be handled reluctantly. Although the cause might seem obvious, influencing factors could play a role as well. Gaining insight into these processes might stimulate the adoption of preventive action and therefore increase the predictability of the treatment outcome with oral implants.  相似文献   

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