Implant-supported Dentures Research Articles

OP014: Prosthetic rehabilitation in oncologic patients treated with microvascular free fibula flap for mandibular reconstruction: A series of 24 patients

Purpose Mandibular reconstruction with microvascular free fibula flap (MFFF) is widely used after oncologic resection as it allows functional and aesthetical restoration of the mandibular arch and implant-retained prostheses. The aim of the series is to propose a decisional tree diagram to choose the type of prosthesis through clinical experience and review of the literature. Material and method Patients treated with MFFF and prosthetically rehabilitated were included. Number of osteotomies, number of implants, type of prosthesis, follow up after the placement of prosthesis, pre-implant surgery and peri-implant complications were reported. Subjective criteria such as patient’s satisfaction and improvement of masticatory function were collected. Results Twenty-four patients were included. Number of osteotomies ranges from 0 (9 patients) to 2 (2 patients). Four patients underwent preimplantation surgery on soft tissues and 3 on bone. Seventy-four implants were placed, 4 remained unloaded, and 1 was lost before loading. Ten patients had implant-supported dentures and 14 had fixed prostheses. Prosthetic follow-up was over 5 years for 15 patients and under 1 year for 1 patient. Peri-implant complication was hyperplasia for 7 patients. Patients’ satisfaction was good and masticatory improvement was moderate. Discussion Prosthetic rehabilitation on MFFF evolutes to fixed prosthesis. Nonetheless, it is more complicated to realize, and requires a sufficient number of implants. Peri-implant complications such as hyperplasia seem to occur more often. Implant-retained dentures seem preferable in case of important aesthetical alteration, although fixed hybrid “Branemark like” prosthesis remain a good alternative. Improvement of mastication is more important in patients with large rehabilitations but remain quite disappointing. Finally, one should wonder whether dental restoration is necessary in case of small lateral flaps.

Patient‐reported outcomes of maxillary implant‐supported overdentures compared with conventional dentures

The aim of the present prospective clinical study was to compare patient-reported outcomes for maxillary conventional dentures and maxillary implant-supported dentures. Twenty-one patients (6 women and 15 men) being edentulous in the maxilla and encountering problems with their existing dentures were included. Twelve patients (4 women and 8 men) received a new set of conventional dentures, due to insufficient dentures. In nine patients (2 women and 7 men), the existing dentures were adjusted by means of relining or rebasing. All patients received implant-supported dentures on two retentive anchors. In total, 42 implants were inserted in the anterior maxilla. The participants rated their satisfaction on their existing conventional dentures, 2months after insertion of new conventional dentures and 2months after insertion of implant-supported dentures. Thereby, patients responded to questionnaires capturing the oral health impact profile (OHIP) using visual analog scales. Seven domains (functional limitation, physical pain, psychological discomfort, physical, psychological and social disability and handicap) were assessed. Higher scores implied poorer patient satisfaction. In addition, the questionnaire involved the evaluation of cleaning ability, general satisfaction, speech, comfort, esthetics, stability, and chewing ability. Higher scores implied higher patient satisfaction. Patient satisfaction significantly increased for implant-supported dentures compared with old dentures in all seven OHIP subgroups, as well as for cleaning ability, general satisfaction, ability to speak, comfort, esthetics, and stability (P<0.05). The comparison of new conventional dentures and implant-supported dentures revealed a statistically significantly increased satisfaction for functional limitation (difference of 33.2mm), psychological discomfort (difference of 36.7mm), physical disability (difference of 36.3mm), and social disability (difference of 23.5mm), (P<0.05). Additionally, general satisfaction, chewing ability, speech, and stability significantly improved in implant-supported dentures (P<0.05). Within the limits of this study, maxillary dentures retained by two implants provided some significant short-term improvements over conventional dentures in oral- and health-related quality of life.

Loosening torque of prosthetic screws in metal–ceramic or metal–acrylic resin implant-supported dentures with different misfit levels

The aim of this study was to evaluate the effect of the prosthesis material (metal–acrylic resin or metal–ceramic) on loosening torque of the prosthetic screws in an implant-supported mandibular denture under two levels of vertical misfit. Ten frameworks were fabricated with commercially pure titanium, and five of them received acrylic resin and acrylic artificial teeth as veneering material and the other five were veneered with porcelain. Two levels of vertical fit were also created by fabricating 20 cast models to obtain four experimental groups according to the prosthesis material and misfit: Group 1 (metal–acrylic resin prosthesis with a passive fit); Group 2 (metal–acrylic resin prosthesis with a non-passive fit); Group 3 (metal–ceramic prosthesis with a passive fit); and Group 4 (metal–ceramic prosthesis with a non-passive fit). Two hundred prosthetic titanium-alloy screws were divided in 40 sets (five screws per set, n=10). After 24h, the loosening torque of the screws was evaluated using a digital torque meter. The results were submitted to two-way ANOVA analysis of variance followed by a Tukey's test (α=0.05). The mean values and standard deviations for each group were G1=7.05 (1.64), G2=5.52 (0.90), G3=6.46 (1.34), and G4=4.35 (0.99). Overall, the prosthesis material and misfit factors showed a statistically significant influence on the loosening torque (p<0.05). Metal–ceramic prosthesis and misfits decreased the loosening of the torque of the prosthetic screws.

Updated Clinical Considerations for Dental Implant Therapy in Irradiated Head and Neck Cancer Patients

An increasing number of reports indicate successful use of dental implants (DI) during oral rehabilitation for head and neck cancer patients undergoing tumor surgery and radiation therapy. Implant-supported dentures are a viable option when patients cannot use conventional dentures due to adverse effects of radiation therapy, including oral dryness or fragile mucosa, in addition to compromised anatomy; however, negative effects of radiation, including osteoradionecrosis, are well documented in the literature, and early loss of implants in irradiated bone has been reported. There is currently no consensus concerning DI safety or clinical guidelines for their use in irradiated head and neck cancer patients. It is important for health care professionals to be aware of the multidimensional risk factors for these patients when planning oral rehabilitation with DIs, and to provide optimal treatment options and maximize the overall treatment outcome. This paper reviews and updates the impact of radiotherapy on DI survival and discusses clinical considerations for DI therapy in irradiated head and neck cancer patients.

Oral rehabilitation using customized intra-radicular Dalbo attachments

Teeth may be lost because of trauma, caries, periodontal disease, congenital defects and iatrogenic treatment. Tooth loss has a negative impact on masticatory function, esthetics and self-image. Fixed partial dentures, removable partial dentures, complete dentures and implant-supported dentures can replace missing teeth comfortably and esthetically, but it is not known whether they differ in their ability to reconstruct the masticatory function, phonetics and esthetics and preserve the residual bone ridge. Despite recent developments in dental implantology, the conservative approach to root preservation is still valid. In view of increased root caries rate in the elderly arid lax oral hygiene habits of the most overdenture wearers, placing protective copings on root abutments, when economically feasible, is the preferred method of treatment. Retention of overdentures is increased by including stud attachments in the abutments. Incorporation of cast metal frameworks is recommended to prevent base fractures. Clinical Relevance to Interdisciplinary Dentistry With some patients, the operating dentist alone cannot accomplish the correction, but may require the assistance of other dental disciplines. This case report describes an interdisciplinary approach for the coordinated treatment of a patient with badly broken down and missing teeth. The patient's functional and esthetic expectations were successfully met with interdisciplinary treatments, including Oral prophylaxis followed by treatment for benign migratory glossitis. Endodontic treatment for two grossly carious teeth. Cast partial dentures for the maxilla and mandible.

Preoperative Gingival Conditioning as a Guide for Implant Installation and to achieve Proper Dentogingival Contours

A successful esthetic outcome for implant-supported dentures depends on the careful manipulation of peri-implant tissue as well as the precise placement of the implant. In addition, careful surgical and prosthetic planning is essential for esthetically important areas, especially in partially edentulous cases. This study describes a clinical case that presented absent maxillary central incisors in which prior prosthetic planning was used to perform provisional restorations, that was used to condition the gingival tissues and guide implant installation. These procedures made it possible to achieve a dentogingival contour, interdental papillae, and an emergence profile in the edentulous area. The techniques outlined here proved to be sufficient and support the peri-implant tissues to create a more esthetic final prosthesis.

Oral health‐related quality of life is important for patients, but what about populations?

To review population-based research into oral health-related quality of life. Narrative review of selected publications. In the 1970s, there were two incentives to assess nonclinical aspects of health: (i) a desire to understand the impacts of disease on individuals' quality of life; and (ii) a search for population-level measures that might better quantify the impact of health care systems on populations. Dental researchers responded to those incentives, creating dozens of questionnaires that assess individuals' ratings of subjective oral health and quality of life. This has been a boon for clinical dental research, for example, by showing marked improvements in subjective oral health in patients receiving implant-supported dentures. Also, health surveys show poorer subjective oral health among disadvantaged population groups. However, the same measures show only modest benefits of general dental care. Furthermore, several population surveys show that today's young adults, who grew up with widespread exposure to preventive dental programs, have poorer subjective oral health than earlier generations that experienced unprecedented levels of oral disease. Yet to materialize is the hope that 'socio-dental indicators' of subjective oral health might provide a meaningful metric to demonstrate population-level benefits of dental care. A fundamental limitation is that population health is a contextual measure, not merely the aggregated health status of individuals within the population. While researchers have successfully broken with clinical dogma by assessing subjective dimensions of individuals' oral health, they have failed to explicitly ask people to assess the oral health of the community in which they live.

Implant-supported dentures in rehabilitation of head and neck cancer patients

Implant-supported dentures in rehabilitation of head and neck cancer patients

Do implant-supported dentures facilitate efficacy of eating more healthily?

Edentulous persons have poor diet quality demonstrating a need for dietary intervention. Implant-supported mandibular overdentures (IODs) have functional advantages over conventional dentures (CD), but whether they enhance the ability to eat more healthily following dietary advice is unknown. ObjectivesThis study aimed to compare the effectiveness of dietary intervention between IODs and CD patients. MethodsEdentulous adults (28 IOD and 26 CD) received customised dietary advice. The percentage contribution of dietary fats, carbohydrate and protein to energy (kcal) intake, dietary intakes of fibre, fruits, vegetables and antioxidants, and plasma antioxidants were assessed pre- and at 3 and 6 months post-dietary intervention. ResultsBoth groups increased fruit and vegetable intake at 3 and 6 months following dietary intervention but intakes between groups did not differ. The IOD group had reduced % energy from total fat at 3 and 6 months and from saturated fat at 3 months. The CD group had reduced % energy from saturated by 6 months. The IOD group had a significantly lower % energy intake from saturated fat at 3 months and higher intake of non-starch polysaccharide (NSP) compared with the CD group. Both groups showed improvements in serum antioxidant status but the IOD group had significantly higher plasma antioxidant capacity post intervention compared with the CD group. ConclusionsDietary intervention benefits denture patients. IOD patients showed moderately greater dietary improvements compared with conventional denture patients.

A Method for Fabrication of Implant-Supported Fixed Partial Dentures

Abstract When restoring a partially edentulous arch with an implant-supported fixed partial denture, the optimal fit and function of the final restoration depend on the fabrication of an accurate impression and the registration of the interocclusal relationship. The present case report presents a method for the fabrication of impressions and the registration of the interocclusal relationship for implant-supported partial dentures. The described method allows the accurate transfer of the implant position and the registration of the interocclusal relationship using transfer key and electroformed gold copings. The key and copings were used to transfer the intraoral implant position to the cast, to position the abutments intraorally, and to facilitate the fabrication of the final partial denture.

FINITE ELEMENT ANALYSIS OF PROVISIONAL STRUCTURES OF IMPLANT-SUPPORTED COMPLETE PROSTHESES.

The use of provisional resin implant-supported complete dentures is a fast and safe procedure to restore mastication and aesthetics of patients soon after surgery and during the adaptation phase to the new denture. This study assessed stress distribution of provisional implant-supported fixed dentures and the all-on-four concept using self-curing acrylic resin (Tempron) and bis-acrylic resin (Luxatemp) to simulate functional loads through the 3D finite element method. The Solidworks software was used to build 3D models, using acrylic resin (Tempron - A) and bis-acrylic resin (Luxatemp - B) for denture captions. Two loading patterns were applied on each model: 1) right unilateral axial loading of 150 N on the occlusal surfaces of posterior teeth; 2) oblique loading vector of 150 N at 45 degrees. The results showed that higher stress was found on the bone crest below oblique load application with maximum value of 187.57 MPa on model A and 167.45 MPa on model B. It was concluded that model B improved stress distribution on the denture compared to model A.

Relevance of Variations in the Opposing Dentition for the Functionality of Fixed and Removable Partial Dentures: A Systematic Review

The aim of this systematic review was to evaluate the functionality of fixed and removable partial dentures as test interventions in relation to variations in the opposing dentition and their prosthetic restoration. The abstracts identified in the respective databases were screened independently by two investigators. RCTs and uncontrolled studies were considered, provided the patients were included consecutively and the confounding variables were adequately monitored. Seventeen papers were included. The study and publication quality was assessed using a “biometric quality” tool showing an overall poor quality. The reported outcomes, such as survival rates, were in each case obtained from a single study. Two possible trends could be deduced for the endpoint longevity: (a) the first trend in favor of removable partial dentures, compared to fixed partial dentures, with a fully edentulous opposing arch fitted with a removable prosthesis; (b) the second trend in favor of implant-supported partial dentures, compared to conventionally fixed partial dentures, with natural opposing dentition or with a removable partial denture in the opposing arch. No evidence could be generated as to whether, and if so how, variations in the opposing dentition have a bearing on the decision to fit a partially edentulous arch with a fixed or removable partial denture.

Telescopic overdentures with cercon primary coping and gold galvano secondary coping

Overdenture treatment provides an esthetic and functional result that allows proper access for hygiene and maintenance. In addition, with their improved strength, zirconia ceramics may be used to restore removable partial denture abutments in areas previously limited to metal or metal-ceramic restorations. The electroforming process makes for a viable, convenient, and economic alternative to cast metal substructures. However, limited data are available on the use of telescopic crowns on implants. Compared with the use of fixed implant-supported dentures, this treatment modality may improve esthetics and oral hygiene access, reduce the need for implants, and provide sufficient denture support in cases where single abutments have failed. Furthermore, the high retention obtained with telescopic crowns leads to good mastication and phonetics.

Stress analysis of a fixed implant-supported denture by the finite element method (FEM) when varying the number of teeth used as abutments

ObjectivesIn some clinical situations, dentists come across partially edentulous patients, and it might be necessary to connect teeth to implants. The aim of this study was to evaluate a metal-ceramic fixed tooth/implant-supported denture with a straight segment, located in the posterior region of the maxilla, when varying the number of teeth used as abutments. Materials and MethodsA three-element fixed denture composed of one tooth and one implant (Model 1), and a four-element fixed denture composed of two teeth and one implant (Model 2) were modeled. A 100 N load was applied, distributed uniformly on the entire set, simulating functional mastication, for further analysis of the SEQV (Von Mises) principal stresses, which were compared with the flow limit of the materials. ResultsIn a quantitative analysis, it may be observed that in the denture with one tooth, the maximum SEQV stress was 47.84 MPa, whereas for the denture with two teeth the maximum SEQV stress was 35.82 MPa, both located in the region between the pontic and the tooth. ConclusionLower stresses were observed in the denture with an additional tooth. Based on the flow limit of the materials, porcelain showed values below the limit of functional mastication.

Implant-based dental rehabilitation in reconstructed mandible – problems and solutions

Microvascular free fibula transfer is accepted as the gold standard in jaw reconstruction following ablative surgery. Apart from fibula, other free bone flaps are also used in select situations. With the emphasis shifting to the quality of life in the post-treatment phase, dental rehabilitation has acquired an unprecedented importance. Implant-supported dentures are certainly the best way to achieve this.

Clinical assessment of masticatory efficiency in the rehabilitation of edentulous patients

Rehabilitation of edentulous patients has been a constant concern in dentistry. Several studies have reported a reduction in the masticatory function in these patients. Osseointegrated implants have been used in order to obtain better masticatory efficiency, but more studies are needed to confirm these results. Aim: To evaluate the masticatory function of patients with conventional dentures and implant-supported dentures. Methods: A double-blinded controlled clinical study was conducted. The sample was composed of 60 patients divided into three groups: G1 with 20 patients with conventional upper (maxillary) and lower (mandibular) complete dentures, G2 with 20 patients with mandibular overdentures and upper (maxillary) complete dentures, and G3 with 20 patients with lower fixed implant-supported complete dentures (protocol). Objective data were collected through the masticatory efficiency test performed by the colorimetric method with the beads, in which capsules of a synthetic material enclosing fuchsine-containing granules were used. Results: A statistically significant difference was found for masticatory efficiency between groups G1 and G2 (pd”0.05) and between G1 and G3 (pd”0.05), and there was no statistically significant difference between G2 and G3 (pe”0.05). Conclusions: The results suggest that placement of osseointegrated implants in complete denture wearers improves their masticatory efficiency.

Double-Barrel Fibula Vascularized Free Flap With Dental Rehabilitation for Mandibular Reconstruction

The vascularized free fibula flap has become the most popular reconstruction method after mandibular resection because of adequate bone graft length and acceptance of dental implants. However, using 1 fibula bone may produce a height discrepancy between the native mandible and the grafted fibula that results in subsequent difficulty in wearing conventional dentures or osteointegrated implants. Several options can be used to resolve this problem such as delayed onlay bone graft, iliac bone reconstruction, fibula distraction, and double-barrel fibula flap graft. This article describes the reconstruction of segmental mandible defects with the double-barrel fibula flap and denture rehabilitation. This procedure was used in 7 patients. A donor site fibula corresponding to at least twice the length of the mandibular defect was harvested. Double-barrel free fibula grafting was performed in 6 patients for primary reconstruction and 1 patient for secondary reconstruction, including 3 cases of osteocutaneous flap with skin islands in the reconstruction of a composite defect from a malignant tumor. Prosthodontic treatment was completed in all 7 patients. Four patients received secondary implant-supported dental reconstruction, and 3 patients who received radiation (6,000 cGy) after graft surgery had conventional removable partial dentures. Microvascular fibula transfers were completely successful, and all skin paddles survived without necrosis. The original mandibular contour was maintained by a reconstruction plate; the reconstruction mandibular length was 6.5 to 10 cm, the reconstruction height of the double-barrel fibula was 3.0 to 3.8 cm, and all patients were satisfied with the postoperative facial esthetics and chewing function from the implant-supported denture and removable partial prostheses. Mandibular segmental defects can be esthetically and functionally reconstructed by a double-barrel vascularized fibula flap that not only matches the height of the native mandible but also allows osteointegrated dental implantation for dental rehabilitation.

Oral implants in dependent elderly persons: blessing or burden?

Implant-supported (partial) dentures may raise problems in patients who have become dependent on others for daily oral health care. Dental hygienists and general dental practitioners, as well as care providers, volunteer aiders and even health care insurance companies, should anticipate the growing demand for specific oral health care for patients provided with implant-supported (partial) dentures. To report three cases of dependent patients and to present recommendations to prevent or resolve implant-related oral problems. The three case reports are demonstrating that implant insertion in (dependent) elderly people needs careful consideration. When considering implant treatment, some questions should be raised: (1) Is the treatment appropriate in contributing to the patient's well-being and quality of life? (2) Is the treatment the most suitable treatment? (3) Does the treatment integrate with the patient's oral health care plan? (4) Is the patient sufficiently cooperative? (5) Is the patient supported by a well-functioning oral (self) care assisting network? (6) Is it possible for the patient to regular see an oral health care professional and is oral health care easily accessible in cases of an emergency? Dependent elderly people can benefit from oral implants, providing that adequate oral health care and aftercare can be provided. When indicated, removal of the anchorage structure is easily performed by putting the implants to sleep. All implant patients should be provided with an 'implant passport'. Regular information and instruction for care providers about the oral condition of the patient are essential.

Avoiding Osseous Grafting in the Atrophic Posterior Mandible for Implant-Supported Fixed Partial Dentures: A Report of 2 Cases

Bone atrophy occurs after tooth extraction in the posterior mandible, placing the mandibular canal and its neural, arterial, and venous contents closer to the osseous facial aspect and the coronal crest. This proximity places the structure in danger of damage when dental implants are surgically placed to support fixed or removable prostheses. Several options are available to treat these areas for implant-supported fixed and removable complete or partial dentures. Osseous grafting and ridge expansion are surgical options that enable acceptance of standard sized dental implants but have serious morbidities. Additionally, vertical osseous augmentation is not predictable at this time. Narrow diameter dental implants can be placed to avoid the mandibular canal, but some bone volume situations preclude this. Very wide and very short (6.5 × 5 mm) dental implants may be placed at an angle in atrophic sites to successfully support fixed partial dentures. An anterior guidance occlusal scheme may be used in maxillary dentate patients or group function in maxillary complete denture patients. A 100 micron occlusal relief in fixed partial dentures in dentate patients may be required to account for natural tooth intrusion and to prevent occlusal overload of the implant-supported partial denture.

Poster Board Number: 48: Fibular Vertical Distraction in Reconstructed Mandible for Implant-Supported Dental Rehabilitation

Poster Board Number: 48: Fibular Vertical Distraction in Reconstructed Mandible for Implant-Supported Dental Rehabilitation