Implant-supported Oral Rehabilitation Research Articles

TENTING POLE ABUTMENT TECHNIQUE FOR THE EASY RECONSTRUCTION OF SEVERELY RESORBED ALVEOLAR RIDGES

Dental implant-supported oral rehabilitation is a widely used procedure in modern dentistry. However, implant placement on an atrophic alveolar ridge remains a challenging task due to the insufficient quantity and poor quality of bone. To address this issue, various surgical techniques have been employed to overcome vertical bone deficiency at implant sites, including guided bone regeneration (GBR) using non-resorbable barrier membranes or titanium mesh, onlay block grafting with intraosseous or extraosseous bone blocks, distraction osteogenesis, sandwich osteotomy with an interposition bone graft, and the ramus split bone technique. These surgical procedures are not without their drawbacks, however. They can be technically challenging, require longer surgery times, and result in significant postoperative patient discomfort. Additionally, because the implants are not placed simultaneously, the patient's edentulous healing period is prolonged. The utilization of tenting pole implants and abutments in conjunction with GBR procedure is a safe and effective technique for advanced ridge augmentation. This procedure has minimal complications. Future investigations are required to validate the effectiveness of this technique.

Reconstruction of comminuted jaw with iliac crest graft and implant-supported prostheses – case report

Comminuted jaw fractures represent a challenge in terms of treatment. The advancement of fixation techniques and materials has contributed to the surgeon providing faster treatment and less complication. Even so, cases that present severe mandibular fragmentation require additional therapies, such as the use of bone grafts and dental implants, in order to recover function, aesthetics and anatomy of the mandible. This work aims to report a case of comminuted mandibular body fracture, which was treated with reconstruction, initially by rigid internal fixation, and secondly, by iliac bone graft and implant-supported oral rehabilitation. Although studies in the literature demonstrate that autogenous grafts show significant resorption, they are still considered the gold standard, and allow an ideal basis for obtaining osseointegration of dental implants. Thus, we concluded that the use of the autogenous bone graft coming from the iliac crest and rehabilitation with implants can be a satisfactory option for functional and aesthetic repair of patients who presented high impact fractures, and developed significant bone defects.

Implant-supported oral rehabilitation in oncology patients: a retrospective cohort study.

Oral rehabilitation after treatment for head and neck cancer can be challenging. Implant-supported rehabilitation can considerably improve oral health-related quality of life, but there is a dearth of contemporary evidence of reported outcomes and trends in this cohort. In this study we retrospectively investigated the outcomes of 115 patients (376 dental implants) with a mean (range) follow up of 3.91(0.11-12.76) years. We considered survival of the implants, percentage of those used for prosthetic rehabilitation, time from diagnosis to placement and restoration, additional operations involving soft-tissue revision, and the effects of radiotherapy, chemotherapy, and reconstructive flaps on these outcomes. Implant survival was 97%. A total of 32% of patients had radiotherapy with a mean dose of 61Gy. A total of 94% of cases were restored with all the implants placed. Computed coefficients from a multinomial logistic regression model suggested that a trend towards radiotherapy, implant placement in the graft, and placement in the maxilla had a negative influence on success, but this was not significant (p>0.05). The placement of implants in a reconstructive flap was strongly associated with the need for soft tissue revision. The approach used (placement during primary cancer resection or after) significantly influenced the time to placement and restoration (p=0.016). These data suggest a local trend towards earlier placement of implants (during primary cancer resection) resulting in earlier restorative rehabilitation. Outcome data show that the survival of implants is comparable to that in non-oncological cases, and that radiotherapy and location of the implant have less influence on implant survival than previous studies have suggested.

Electromyographic Evaluation of Jaw Muscles in Edentulous Patients with Implant-Supported Prosthesis

The purpose of this study was to evaluate the effect of implant-supported oral rehabilitation in the mandible on the electromyographic (EMG) activity during chewing in completely edentulous individuals. Material and methods: Twelve completely edentulous patients were selected for this study, being six females and six males, aged 55 to 65 years old. The patients were divided into three groups according to the treatment protocol; (GI) All the completely edentulous patients had conventional maxillary and mandibular complete denture, (GII) six patients had two mandibular implants supported overdenture at the canine region and (GIII) six patients had one mandibular implant supported over-denture at the symphesial area. All patients were submitted to EMG evaluation of the masseter, and the temporalis muscles, after three months of placement of the conventional prosthesis and after three months of both implant-supported systems by using different textures of foods. The recordings data were analyzed using One Way ANOVA followed by post hoc analysis using LSD test.P< 0.05 was considered statistically significant. Results: the highest EMG activity of the masseter and temporalis muscles was recorded by chewing soft and hard foods in GI, while the reduction of muscular activity after implant supported oral rehabilitation was seen. No significant differences in the analyzed EMG parameters were found between the patients in GII and GIII. Conclusion: mandibular implant-supported prosthesis in edentulous individuals revealed a decrease in EMG amplitude for the masseter and temporalis muscles during chewing, which may indicate adaptation to new conditions of stability provided by support of the complete denture in the mandibular arch

Mandibular Regional Anatomical Landmarks and Clinical Implications for Ridge Augmentation.

Mandibular ridge augmentation via guided bone regeneration in the atrophic mandible is considered one of the most challenging scenarios for implant-supported oral rehabilitation. Uneventful wound healing has clearly demonstrated its impact on the final regenerative outcome. Soft tissue management must be precise and adequate to attain flap-free wound closure. Accordingly, it demands exhaustive insight and expertise to avoid damaging the neighboring structures. The cadaver study described herein discusses the mandibular morphologic landmarks (ie, musculature, vascularization, innervation, and salivary glands) necessary to safely perform regenerative procedures in the atrophic mandibular ridge, such as vertical ridge augmentation and dental implant surgery. The potential intraoperative complications are presented, as well as clinical implications of which the clinician must be aware to prevent adverse surgical events during regenerative surgery and implant placement in this anatomical region.

Autogenous bone harvesting from iliac crest and symphysis for implant reconstruction

Horizontal and vertical bone resorption may be seen after tooth loss in the maxilla and mandible. The deficient edentulous ridge may interfere with the insertion of implants of adequate length placed in the correct position and with the ideal inclination. The severe alveolar bone resorption or pneumatisation of the maxillary sinus makes it difficult to perform the conventional dental implantation procedure. Functional implant-supported oral rehabilitation is increasingly being used as a restoration strategy for fully and partially edentulous patients, whenever sufficient bone volume is available. Implant-supported restoration is possible even in severely resorbed jaws using a reconstruction technique with bone augmentation that includes vascularised or nonvascularised bone grafting and tissue regeneration techniques. Standard donor sites for free autogenous bone-graft techniques are: the chin or ramus mandible, the iliac crest, the tibia and the calvaria. Advantages of intraoral mandibular sources include easy access, low morbidity, short healing periods, minimal graft resorption, and maintenance of high bone density; side effects include possible postoperative sensory disturbances and discomfort. Calvaria and iliac crest donor areas are most commonly used in cases of extensive alveolar ridge augmentation. The iliac crest generally supplies large quantities of corticocancellous bone. In this report, we present autogenous bone graft harvesting of 48 patients (40 iliac anterior crest, 8 symphysis) for facial reconstructive surgery.

Implant-supported Oral Rehabilitation in Child with Ectodermal Dysplasia - 4-year Follow-up.

Ectodermal dysplasia (ED) is an anomaly determined by genetic factors that alter ectodermal structures such as skin, hair, nails, glands, and teeth. Children affected by this condition require extensive, comprehensive, and multidisciplinary treatment. An 8-year-old female patient visited the Dentistry Clinic of the Federal University of Santa Catarina with the chief complaint of multiple missing teeth. The mother reported that the patient had ED. Clinical and radiographic examination revealed the congenital absence of several primary and permanent teeth and tooth germs. Subsequent oral rehabilitation comprised the application of a maxillary denture and mandibular implant-supported fixed prosthesis. The child was also supplied with a wig for further enhancement of esthetics aimed at improving her emotional wellbeing. Psychological follow-up and speech therapy were also provided. After 4 years of follow-up, implant-supported oral rehabilitation has proved to be a satisfactory treatment option, allowing restoration of masticatory, phonetic, and esthetic function, as well as an improvement in the patient's self-esteem and social wellbeing.

Esthetic Outcome of Emergence Profile in a Single Tooth Implant Restoration

ABSTRACT In the past two decades, replacement of missing teeth with implant-supported prostheses has become a widely accepted treatment for oral rehabilitation of partially or fully edentulous patients. With the growing use of implant-supported oral rehabilitation in the partially edentulous patient and single tooth restoration, the emphasis has now changed toward achieving predictable esthetic success, particularly in the maxillary anterior region and patients who may show the peri-implant soft tissue when smiling and speaking. Establishing a soft tissue contour with intact interproximal papillae around implant-retained restoration is challenging, and failure to achieve these harmonious relationships of soft tissue around the implant may lead to unesthetic appearance. In the following case report, the patient presented with an unfavorable tissue contour around an implant restoration. Reshaping of soft tissue was planned. A combination of two surgical techniques was used, which includes a papilla reconstruction and interpositional graft for achieving desired esthetic for a single-stage implant. Following this, sequential molding of marginal gingival tissue was carried out using provisional restoration to obtain an emergence profile. How to cite this article Shambharkar VI, Kadoo P, Raut A, Sonare SR. Esthetic Outcome of Emergence Profile in a Single Tooth Implant Restoration. Int J Prosthodont Restor Dent 2016;6(2):43-46.

Computer Planning and Bone Density Evaluation of Jaws Reconstructed With Bone Grafts From Living Donors

Bone augmentation to reconstruct atrophic jaws provides the base for sufficient functional and aesthetic implant-supported oral rehabilitation. Although autografts are the standard procedure for bone grafting, the use of homolog bone provides a reasonable alternative because it is safe, cheap, and available in adequate amount. Five patients were grafted with femur bone derived from living donors, and in 2 of them, 16 implants were inserted after 6 months. Pearson χ test was used to investigate the difference in bone density (BD) between native and grafted bone and between peri-implant and bone far from fixtures. The BD of the grafted bone is about double that of the native bone. Peri-implant BD is higher than BD far from fixtures, demonstrating that implant loading increase BD. Computed tomography is a valuable and accurate preoperative and follow-up method to obtain information about bone quality and quantity (ie, volume of available bone). Femur graft has a high density that improves under loading, thus suggesting that early implant loading should be performed whenever possible. However, a larger implant series and a longer observation period are mandatory to have a stronger support to these preliminary data.

Relationships Between the Gonial Angle and Mandibular Ramus Morphology in Dentate Subjects: A Panoramic Radiophotometric Study

Analysis of dental panoramic radiographs (DPRs) is an indispensable diagnostic tool for dental implants both pre and post operation. Many studies on linear and angular morphometry of the mandibular body have been conducted, but those on the mandibular ramus have not yet been reported. The purpose of this study was to investigate the differences in the morphometric parameters of the mandibular ramus between high and low gonial angles (GAs) on DPRs as well as between genders, and to determine the relationships between GA and variables of the mandibular ramus morphometry. The DPRs of 156 dentate subjects (78 for each gender) with more than 15 teeth present, a mean age of 49.54 years, and a mean number of teeth of 26.20 were examined. The films were divided into the following 2 groups of GA: less than 120° (low gonial angle, LGA) and more than 125° (high gonial angle, HGA) in both the right and left sides. The parameters for Ar'-Go, MaF-Go, RW, and RD in the LGA group were significantly larger than those in the HGA group in both men and women, but that for the ramus angle (RA) was significantly smaller in the LGA group than in the HGA group. Significant gender differences in the 2 GA groups were recognized with respect to the Ar'-Go, MaF-Go, RW, and RD parameters. Significant negative low and moderate correlations were found between GA and the Ar'-Go, MaF-Go, RW, and RD variables, whereas significant positive low correlation was found between GA and the RA variable. Within the limits of this study, the analysis of the mandibular ramus morphometry on DPRs in terms of GA size and gender was found to be useful for devising a highly predictive and strategic plan for implant-supported oral rehabilitation.

Free Gingival Graft Immobilization: A Pilot Study on a Newly Designed Stent

The presence of adequate gingiva with firm attachment to the underlying periosteum and bone is important for the overall long-term success of implant-supported oral rehabilitation. In the presence of an atrophic edentulous mandible, peri-implant soft tissue management is a challenging task. Therefore, mucosal grafts are sometimes necessary in patients with insufficient attached gingiva around abutments. Immobilization of this graft is mandatory for its survival. The study design included 5 edentulous patients with inadequate attached gingival zone, all candidates for implant surgery and free gingival graft. In the first surgery the implants were inserted, and in the second operation a free gingival graft was obtained from the palate and sutured to the mandibular site. A newly designed stent was applied for the stabilization of the graft. Two to 3 weeks after the second surgery, the stents were removed and the attached gingival width was measured. Long-term evaluations were performed to follow the survival of the graft. All grafts were intact at the time of stent removal. In all cases, the long-term evaluations revealed adequate attached gingiva around the implant. It may be concluded that immobilization of free gingival graft in the recipient site increases its success rate and its survival rate. The application of the newly designed stent can serve as a proper and easy immobilizer for peri-implant soft tissue management.

Autogenous calvarium bone grafting as a treatment for severe bone resorption in the upper maxilla: A case report

Atrophic maxilla rehabilitation has been the subject of several studies for decades; despite this, there are still many different therapeutic choices for the best way to treat maxillary resorption in order to enable implant placement and integration. These possibilities include the optimal use of remaining bone structures, such as the pterygoid processes or zygomatic arch, which involves using zygomaticus and pterygoid implants in combination with standard implants placed in the residual bone; alternatively, regenerative techniques, alveolar bone expansion/distraction or bone grafting techniques may be used. Severe maxillary atrophy has a multifactorial aetiology; the most important factors being long evolution edentulism, hyperpneumatization of the maxillary sinus, post-traumatic deficit, bone loss after surgery (tumours, cysts) and periodontal problems or infection. In this report, we present a clinical case of onlay block reconstruction in an atrophic maxilla with harvested cranial calvarium bone grafts for successful future implant-supported oral rehabilitation.

Electromyographic evaluation of mastication and swallowing in elderly individuals with mandibular fixed implant-supported prostheses

This study evaluated the effect of implant-supported oral rehabilitation in the mandible on the electromyographic activity during mastication and swallowing in edentulous elderly individuals. Fifteen patients aged more than 60 years were evaluated, being 10 females and 5 males. All patients were edentulous, wore removable complete dentures on both dental arches, and had the mandibular dentures replaced by implant-supported prostheses. All patients were submitted to electromyographic evaluation of the masseter, superior orbicularis oris muscles, and the submental muscles, before surgery and 3, 6 and 18 months postoperatively, using foods of different textures. The results obtained at the different periods were analyzed statistically by Kruskal-Wallis non-parametric test. Statistical analysis showed that only the masseter muscle had a significant loss in electromyographic activity (p<0.001), with a tendency of similar response for the submental muscles. Moreover, there was an increase in the activity of the orbicularis oris muscle during rubber chewing after treatment, yet without statistically significant difference. Mandibular fixed implant-supported prostheses in elderly individuals revealed a decrease in electromyographic amplitude for the masseter muscles during swallowing, which may indicate adaptation to new conditions of stability provided by fixation of the complete denture in the mandibular arch.

Fibula free flap reconstruction of the mandible in cancer patients: Evaluation of a combined surgical and prosthodontic treatment concept

The final goal of mandibular reconstruction following ablative surgery for oral cancer is often considered to be dental implant-supported oral rehabilitation, for which bone grafts should ideally be placed in a suitable position taking subsequent prosthetic restoration into account. The aim of this study was to evaluate the efficacy of a standardized treatment strategy for mandibular reconstruction according to the size of the bony defect and planned subsequent dental prosthetic rehabilitation. Data of 56 patients, who had undergone such a systematic mandibular fibula free flap reconstruction, were retrospectively analyzed. Early complications were observed in 41.5% of the patients but only in those who had been irradiated. Late complications were found in 38.2%. Dental implant survival rate was 92%, and dental prosthetic treatment has been completed in all classes of bony defects with an overall success rate of 42.9%. The main reasons for failure of the complete dental reconstruction were patients' poor cooperation (30.4%) and tumour recurrence (14.3%) followed by surgery-related factors (10.8%) such as implant failure and an unfavourable intermaxillary relationship between the maxilla and the mandible. A comparison of our results with the literature findings revealed no marked differences in the complication rates and implant survival rates. However, a systematic concept for the reconstructive treatment like the method presented here, plays an important role in the successful completion of dental reconstruction. The success rate could still be improved by some technical progress in implant and bone graft positioning.

Reconstruction of the severely atrophic mandible using calvarial split bone grafts for implant-supported oral rehabilitation

This article describes reconstruction of the severely atrophic mandible using calvarial bone grafts for implant-supported prosthetic oral rehabilitation. The study aim was to evaluate the efficacy of the treatment by determining implant survival and complication rates, and the extent of the postoperative graft resorption. Ten patients who underwent the treatment were followed clinically and radiologically using panoramic radiographs and CT scans during a mean postoperative period of 30 months. Good bone healing was observable 6 months postoperatively. The height reduction measured on panoramic radiographs was insignificant (mean 0.68 mm). Only minor complications occurred. Implant survival was 95%. Prosthodontic treatment was successfully performed in all cases, resulting in an improvement of oral function. Histological analysis of 1 bone biopsy showed minimal resorptive changes in otherwise very dense bone. Augmentation using calvarial grafts is a promising treatment alternative for the severely atrophic mandible.