Implant-supported overdentures: a valuable restorative alternative

This paper raises some issues for discussion and debate concerning the nature of research within a mental health setting. Research, no matter what form it takes, is always an intervention. Sensitivity to various concerns surrounding research is required of the mental health worker. Participatory research, which is seen as empowering participants, has become popular in mental health programmes. Attention needs to be paid, however, to the meaning of participation and the process of decision-making. Researchers are often uncomfortable with shedding their "objective informer" stance and adopting a position that requires social action. Some of this has to do with the epistemological view taken by the researcher. This paper suggests that the knowledge produced in research is a social construction created in interaction between the researcher and participants and has a multiplicity of potential meanings. The instrumental, conceptual and persuasive uses of research are discussed, and two intervention-type research procedures (needs assessment and evaluation) are critically reviewed. It is concluded that research, as with all other interventions, should be carefully planned, implemented, monitored and evaluated.     

Implant-supported overdenture therapy: a retrospective study

All patients (n = 46) treated with implant-supported overdentures at the Department of Prosthetic Dentistry, Dental and Medical Health Centre, Halmstad, Sweden, from 1986 to 1993 were studied. The clinical examination was completed in 1994. The material was divided into two subgroups: Group A had been initially treatment planned for an implant-supported overdenture, and Group B had been planned for fixed prostheses but because of loss of implants before loading, treatment with a fixed prosthesis was not possible. The authors present their experience and patient reactions to overdenture therapy in two defined groups of patients. The implant failure rate before loading for Group A (n = 12) was 15% (six implants out of 39), and the rate before loading for Group B (n = 29) was 43.6% (68 implants out of 156). After prosthodontic treatment in Group A, the implant success rate after loading was 87.9%, and the overdenture stability was 84.6%. In group B, 17 implants placed in the maxillae were lost after overdenture therapy, which resulted in an implant success rate of 79.3%. A total of eight overdentures, all of which had been placed in the maxillae, were lost, resulting in an overdenture stability of 73.3%. In this study "change of retentive clips" was the predominant prosthodontic complication related to the overdentures, especially in Group B. Most of these complications (62%) occurred in patients with clinical signs of bruxism. Patient reactions to treatment with an overdenture were positive regarding esthetics for both groups. More negative views were recorded in Group B than in Group A in response to function and retention of the overdenture.     

The attachment system in fledgling relationships: An activating role for attachment anxiety.

Is it sensible to study attachment dynamics between potential romantic partners before they share a full-fledged attachment bond? The present data indicate that such an approach may reveal novel insights about initial attraction processes. Four studies suggest that the state-like experience of attachment anxiety has functional implications within fledgling (i.e., desired or undeveloped) romantic relationships, well before the formation of an attachment bond. Studies 1 and 3 reveal that attachment anxiety directed toward a particular romantic interest is elevated before (in comparison with after) participants report being in an established relationship. Studies 2 and 3 demonstrate that such partner-specific attachment anxiety predicts attachment-relevant outcomes in fledgling relationships, including proximity seeking, safe haven, secure base, passionate love, and other approach behaviors. These associations were reliable above and beyond (and were typically as strong as or stronger than) the effect of sexual desire. Finally, Study 4 presents evidence that partner-specific attachment anxiety may cause several of these attachment-relevant outcomes. Attachment anxiety seems to be a normative experience and may signal the activation of the attachment system during the earliest stages of romantic relationships. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Removable partial overdentures

A technique for applying the overdenture concept to removable partial denture construction has been presented. Endodontically treated abutments are prepared with cast gold posts and copings over which removable partial dentures with conventional components are fabricated. No special materials or complicated laboratory techniques are required, and the maintenance and repair problems of precision attachments are avoided. A variety of potential uses and advantages of the technique are discussed.     

Implant-supported single-tooth replacements: risk of implant and prosthesis failure

Data from 236 patient cases of implant-supported single-tooth replacements in the maxillary anterior region were sequentially recorded and documented. The time in situ ranged from a minimum of five to a maximum of 19 years. Twenty-two implants failed during the observation period. The causes of such failure were peri-implantitis, implant fracture, and trauma. The probability of success according to the Kaplan-Meier method decreased to 0.89 over a period of 10 years. The failure rate for implants replacing lateral incisors was lower than that for implants replacing central incisors. Seventy-six cases were clinically documented for 10 years or more. In 15 cases, replacement of the prosthetic superstructure was necessary during the 10-year period. The course of therapy and clinical follow-up care is described by a multi-state distribution.     

Activation of the attachment system in adulthood: Threat-related primes increase the accessibility of mental representations of attachment figures.

Three studies explored the effects of subliminal threat on the activation of representations of attachment figures. This accessibility was measured in a lexical decision task and a Stroop task following threat- or neutral-word primes, and was compared with the accessibility of representations of other close persons, known but not close persons, and unknown persons. Participants also reported on their attachment style. Threat primes led to increased accessibility of representations of attachment figures. This effect was specific to attachment figures and was replicated across tasks and experiments. Attachment anxiety heightened accessibility of representations of attachment figures even in neutral contexts, whereas attachment avoidance inhibited this activation when the threat prime was the word separation. These effects were not explained by trait anxiety. The discussion focuses on the dynamics of attachment-system activation in adulthood. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Observations on 25 patients treated with ball-retained overdentures using the Astra Tech implant system

Twenty-five adult patients with fully edentulous jaws, aged from 44 to 80 years were treated with seventy-one 3.5 mm diameter Astra Tech dental implants in the parasymphseal region. The length of these implants varied from 9 mm to 15 mm. Either two or three implants were inserted, subsequently exposed after a minimum period of 3 months, abutments and ball attachments placed. Full lower dentures incorporating gold alloy housings for ball-attachments were constructed. The average time that the implants were in situ was 4 years and 2 months, ranging from 1 year 3 months to 5 years and 7 months. Of the 71 implants placed, 67 achieved osseointegration-a success rate of 94%. The main complication was that of the ball-attachments becoming loose.     

Implant-supported prostheses for treatment of adults with cleft palate

Six adult patients with cleft palate, ranging in age from 47 to 78 years, were treated with self-tapping titanium implants. Twenty-three implants, 7 to 15 mm in length, were placed. Of these, one (4%) was 7 mm, eight (35%) were 10 mm, nine (39%) were 13 mm, and five (22%) were 15 mm. Time between stage I and stage II implant surgeries was 5 to 14 months, averaging 8.3 months. Time from stage II surgery to the present is 1.5 to 5 years, averaging 3 years. Of the 23 implants placed, 21 (91%) achieved osseointegration. One (4%) implant was not used prosthetically. Two (9%) 10 mm implants failed to integrate in one patient. All patients were treated with a maxillary complete denture or overdenture. Five (83%) required the addition of a pharyngeal section for speech enhancement.     

Implant retained overdentures in mandibular reconstruction: a case report

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.     

Adolescent mothering: child-grandmother attachment

This study explored the involvement of maternal grandmothers with children of adolescent mothers and child-grandmother attachment. In a sample of 32 children whose grandmothers were involved in child care, 44% were securely attached to mothers and 72% securely attached to grandmothers. Of the 18 children insecurely attached to mothers, 82.4% were securely attached to grandmothers. A significant relationship existed between attachment security and the time the child was with grandmother, sleeping time excluded. In contrast, time with mother was not related. Based on attachment theory, findings are presented and implications for nursing practice are made.     

Introduction to the special section on attachment and psychopathology: 2. Overview of the field of attachment

An improved system for amplification of hepatitis C virus genome (HCV) was developed based on a multiplex nested polymerase chain reaction format. Two sets of oligonucleotide primers were used simultaneously. One was derived from the conserved sequences in the 5' non-coding region of the viral genome which can bind to the viral genome of all genotypes. The other set of primers was designed from a sequence in the nonstructural-5 region of HCV. HCV genotypes 1 and 3 can be differentiated by the banding patterns of amplified DNA products. All of 39 samples containing the HCV genotype 1 could be amplified with primers in the 5' non-coding region only, whereas 92% of those with genotype 3 could be amplified by both primer sets. In addition, HCV RNA can be detected in 81% of 84 anti-HCV-positive blood donors and in 0% of 34 anti-HCV-negative cases. Of the HCV RNA-positive specimens, 69% showed genotype 1-like patterns while 31% showed genotype 3-like patterns. The detection rate of HCV RNA in this study was much higher than that in our previous report due to the improvement of new primers which can detect all genotypes of the virus. In conclusion, this improved amplification system is a sensitive method for rapid identification of HCV RNA in clinical specimens that can simultaneously differentiate the two most common genotypes of HCV found in Thailand.     

Dynamic processes underlying adult attachment organization: Toward an attachment theoretical perspective on the healthy and effective self.

Contemporary attachment theory is inspiring a burgeoning literature on adult attachment. This literature offers counseling psychology a compelling framework for understanding the healthy and effective self. In this article, the authors review studies probing the cognitive processes, affect self-regulatory dynamics, and relationship behaviors associated with secure (primary) and insecure (secondary) adult attachment strategies. They then offer a portrait of the healthy, effective personality that is consistent with theory and research on adult attachment. Finally, in an effort to understand key characteristics of successful movement toward the healthy and effective self, the authors review empirical extensions of attachment theory to the therapeutic context. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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.     

Parental attachment styles of late adolescents: Qualities of attachment relationships and consequences for adjustment.

Lack of a self-report measure of late adolescent parental attachment style has threatened to hinder expansion of the empirical basis of attachment theory. Two studies were undertaken that provided evidence of validity for a new classification of parental attachment style from patterns of scores on the Inventory of Parent and Peer Attachment (G. C. Armsden & M. T. Greenberg, 1987). Discriminant function analyses differentiated among secure, ambivalent, and avoidant attachment with 2 empirically derived dimensions, which paralleled the essential attachment functions theorized by M. D. S. Ainsworth (1989). Overall, insecurely attached late adolescents reported greater depression, anxiety, and worry than their securely attached counterparts. For women but not for men, insecure attachment was associated with diminished college adjustment and lower intimacy development. These results portend the promise of investigations of parental attachment style to elucidate contributions of parental attachment to late adolescent development and adjustment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparison of the effect of different occlusal forms in mandibular implant overdentures

STATEMENT OF PROBLEM: Posterior tooth form selection for implant overdentures is made according to personal preference and experience using the concepts of conventional complete denture prosthodontics. PURPOSE: This study (1) compared the masticatory efficiency of three occlusal forms, 0 degrees, 30 degrees, and lingual contact (lingualized occlusion), in subjects with mandibular implant overdentures, and (2) determined their effects on the implant supporting tissues. MATERIAL AND METHODS: Eight patients who had four root form implants in the mandibular symphysis area connected with a Hader bar were selected. Maxillary and mandibular dentures were constructed for each patient with interchangeable posterior segments and the three occlusal forms were tested. The masticatory efficiency for each posterior tooth form was assessed with objective food tests and a subjective patient preference questionnaire. Periodic evaluation of implant-supporting tissues also was performed. RESULTS: Reliability analysis showed that all R1 coefficients were > or =0.80 (<0.001), indicating high subject consistency between multiple chewing efficiency trials. MANOVA analysis indicated a significant difference in chewing efficiency among the three occlusal forms (p < 0.001). The 0 degree occlusal form was associated with a significantly higher number of chewing strokes compared with 30 degrees or lingualized occlusal forms. The different occlusal forms were not found to have a clinically detrimental effect on the peri-implant soft or hard tissues. CONCLUSION: Chewing efficiency tests and patient preference ratings showed that 30 degree teeth and lingual contact provided better chewing efficiency than 0 degree teeth. None of the tested occlusal forms showed any clinical or radiographic detrimental effect on the implant-supporting tissues.     

Cartilage-ligament attachment of the ulnar head

We report a case of a cyst of maxillary in a patient suffering from sickle-cell anemia. A review of literature and therapeutic management is exposed.     

Theraplay: Child therapy for attachment fostering.

Many adults enter psychotherapy complaining of problems with self-esteem. As we come to understand better the origins of this sense of vulnerability it becomes increasingly clear that the quality of early parent-child relationships can range from esteem-enhancing to esteem-jeopardizing. This paper describes two techniques: one, the Marschak Interaction Method (MIM) for clinical assessment of the parent-child relationship and two, Theraplay, for therapeutic intervention into these relationships which are at risk for generating low self-esteem in the child. A sample case is presented and the kinds of cases for which Theraplay is appropriate or inappropriate are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)