Abstract
The specific objectives of this study were to (1) develop and fabricate a unilateral subperiosteal implant which would remain stable under external loads applied through fixed prosthodontics and (2) develop an in vivo primate model which would be suitable for comparative testing of dental implants when studying tissue response to a particular material, design, and/or load. Forty surgical-grade cobalt-chromium (Vitallium) implants were placed in mandibular molar sites, bilaterally, in 20 stumptail monkeys. To accomplish initial immobility of the unilateral subperiosteal frame, the two premolar teeth immediately anterior to the edentulous site were prepared to accept united twin cast “sleeves” leaving the occlusal surface intact. The cast sleeves were attached with horizontal connector to the vertical permucosal post emanating from the subperiosteal portion of the frame. The horizontal connector was designed to receive a cast occlusion which was placed with a radiopaque composite resin. This design represents several important differences from those unilateral subperiosteal implants reported in the literature. Use of the casting eliminates the necessity for any temporary accessory splinting. Potential occlusal compromise is eliminated when the anatomic state is maintained in abutment teeth. The initial subocclusal fixation of implant frame to bone considered important during initial phases of healing is provided. The subperiosteal portion of the implant frame approximating bone carefully avoids encroachment of any peripheral muscle attachments in contrast to those previously used designs which attempt to utilize maximal extension internally. Host acceptance of this design over a 4-year period has been clinically successful. The results obtained offer possibilities in human treatment which warrant further study. This dental restorative procedure is an alternative to removable prostheses in carefully selected instances.
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