Oral Prosthetic Rehabilitation Research Articles

Clinical observation of implant immediate loading in periodontitis patients

To evaluate the clinical performance of implants placed immediately after extraction of remaining teeth due to severe periodontitis and immediately loaded for prosthetic oral rehabilitation. Twelve patients in need of complete maxillary or mandibular rehabilitations due to severe periodontitis were enrolled in this study and received periodontal treatment for management of periodontitis. The remaining teeth were extracted, debridement around the periodontally compromised sites was performed. The implants were inserted under guidance by a surgical template, and a prefabricated screwed-retained provisional restoration was immediately delivered on implants. Definitive prostheses were inserted after 6 months. Clinical and radiographic analyses were performed at 1, 6, 12, 24 months. A total of 84 implants were placed, 50 in the maxilla and 34 in the mandible. Thirty-two implants were placed directly in extraction sockets. Four implants in 3 patients failed within the first 6 months, resulting in a total implant survival rate of 95% (80/84). The survival rate was 92% (46/50) in the maxilla, 100% (34/34) in the mandible. Prosthetic success was 100%. All the failures occured in the first 6 months and no failure in the next two years of follow-up. The mean bone level change at 1 and 2 year were (-1.12 ± 0.18) mm and (-1.28 ± 0.14) mm. There were no significant differences in insertion torque and alveolar bone loss between the post-extraction sites and healed sites. The immediate protocols in periodontally compromised maxilla or mandibular contributed to a satisfactory prosthetic success during the 2-year follow-up.

Immediate Loading of Implants Placed With the Osteotome Technique: One‐Year Prospective Case Series

There is limited information regarding marginal bone-level changes around immediately loaded implants placed with the osteotome technique. The aim of this case series is to prospectively evaluate the clinical and radiographic outcome of immediately loaded implants placed with the osteotome technique over a 12-month period. Eighteen patients in need of oral prosthetic rehabilitation that included single implant placement in positions #4 to #13 and/or #20 to #29 participated in this prospective trial. A modified implant installation procedure with an under preparation of the implant bed using the osteotome technique and immediate loading of the implant was performed. Clinical examinations were performed at 2 weeks, 6 months, and 12 months of follow-up. Radiographic examinations were performed at implant installation and at the 6- and 12-month follow-up visits. One implant failed to integrate and was removed at 3 months after implant installation. Four of 20 implants had insertion torque value >35 Ncm. The mean marginal bone loss was -0.09 mm at the 6-month and -0.19 mm at the 12-month follow-up visits. The present case series indicates that implants placed with the osteotome technique and immediately loaded did not demonstrate a high insertion torque and exhibited minimal marginal bone loss.

Resection of a primary oral malignant melanoma and rehabilitative management using nasolabial flap: a case report

The primary malignant melanoma is a rare neoplasm of melanocytic origin in the oral cavity. Only about 1% of all melanomas arise in the oral mucosa and these account for 0.5% of all oral malignancies This report describes an oral malignant melanoma occurring in the right maxilla of a 73-year-old patient. The interdisciplinary management using a nasolabial flap and prosthetic oral rehabilitation procedure is described. The nasolabial flap technique offers the possibility of an immediate reconstruction of the maxillary defect and obviated problems with speech, swallowing, and permitted oral intake. As a supplementary benefit, the resection area can support the prosthetic rehabilitation.

Simulation of the effect of dental modifications on facial soft tissues: a 3D stereophotogrammetric study

Several dental treatments can change dental position, and modify lip support in the space. Current methods do not allow a non-invasive quantitative assessment of 3D lip dimensions and position, and no simulations of treatment effects can be made. In the current study we devised a method for the detection of the 3D dentolabial positions during simulated orthodontic and prosthetic dental treatments. The dental arches of 10 adult healthy subjects were reproduced with stone models, and 1and 2-mm thick resin blocks were modeled on the maxillary frontal teeth (from canine to canine) to simulate a prosthetic or orthodontic treatment. The facial soft tissues of the subjects with closed mouth were obtained using a 3D stereophotogrammetric imaging system (Vectra-3D, Canfield Scientific, Inc., Fairfield, NJ, USA), without/ with the two resin thicknesses. The relevant faces were superimposed, and the spatial displacements of selected facial landmarks without/ with the thicknesses were calculated. Additionally, upper and lower labial areas were individualized, and the relevant global distances without/ with the thickness were obtained. Average displacements ranged from 0.39 (sn landmark with the 1-mm thickness) to 1.62 mm (left side ch landmark with the 2-mm thickness). On average, ch and cph landmarks had the largest displacements. In all occasions, the larger movements were obtained with the 2-mm thickness, but the difference was significant only for the ls and cph landmarks (p<.05). The upper lip area had average anterior displacements of 0.28 (1-mm thickness) and 0.5 mm (2-mm thickness; p=.007), while the lower lip area had posterior displacements in 6 (1-mm thickness) and 4 subjects (2-mm thickness). In conclusion, the method devised in the current study allowed a 3D quantitative assessment of the effect of a simulated dental treatment without submitting the subjects to invasive or dangerous examinations. The method could be usefully employed for orthodontic treatment planning in children and adolescents, as well as for simulations of prosthetic oral rehabilitation in adults.

Prosthetic Rehabilitation of Edentulous Ridges Following Alveolar Distraction Osteogenesis: Clinical Report of Three Cases

Patients with complete edentulism who have insufficient bone for endosseous dental implant treatment present a challenge for dental practitioners. Distraction osteogenesis of the edentulous alveolar ridges is a process for augmentation of atrophic alveolar bone before dental implant placement. This clinical report describes the use of distraction osteogenesis and rehabilitation of patients with a fixed or removable implant-supported prosthesis to treat mandibular defects. Two female patients with segmental alveolar atrophy at the posterior regions of mandible and one female patient with defect at the anterior region of mandible were treated using distraction devices. However, lingual tipping of the distraction vector occurred during the distraction phase in patient 1. The morphology of the alveolar bone was also analyzed in relation to the planned implant position. After a consolidation period of 12weeks on average, radiologic observation suggested that there was sufficient bone formation for implant installation. In all patients, implant-supported fixed or removable prosthetic oral rehabilitation was successfully performed, and the clinical and radiologic findings were satisfactory. After 4years of follow-up, no functional or esthetic difficulties with the implants and restorations were noted. These case reports suggest that although alveolar distraction osteogenesis seems to be an effective technique for augmenting atrophic alveolar bone for creating bone and soft tissue, complications may occur after surgical procedures.

A fala nas diferentes modalidades de reabilitação oral protética em idosos

speech production in different modalities of oral prosthetic rehabilitation. to study the speech production of subjects submitted to different oral rehabilitation modalities. 36 elderly individuals (average = 68 years) of both gender were evaluated. Participants were divided in three groups: 13 subjects with natural teeth (A); 13 edentate using maxillary and mandibular conventional dentures (B); and 10 edentate using maxillary conventional dentures and mandibular implant-supported prosthesis (C). Prosthesis stability was evaluated by a dentist and speech samples were analyzed by five speech-language pathologists. In order to determine the frequency of speech sound alterations, the Percentage of Correct Consonants (PCC) was used. few individuals presented speech alterations. Group C presented a higher occurrence of speech alterations (23.08%). Locked articulation was present in all groups; the reduction in lip movement was observed for groups A and B; exaggerated articulation and absence of saliva control was observed for group C. A smaller Percentage of Correct Consonants value was observed for the linguodental phonemes, in groups B and C, followed by the alveolar phonemes. Group A presented the majority of individuals with no speech alterations. On the other hand, for groups B and C, lips and tongue projection was frequently observed. No statistical difference was found between the groups. Most of the individuals in group B presented unsatisfactory prosthesis stability, but no association was identified between speech alterations and prosthesis stability. despite the small sample, the results of the study suggest that individuals using dentures present alterations in linguodental and alveolar phonemes. The type of prosthesis and its stability do not seem to interfere in speech production.

Geriatric forensics: A dentist′s perspective and contribution to identify existence of elder abuse among his patients

Aims and Objectives:To identify existence of elder abuse among the patients seeking prosthetic rehabilitation of missing teeth.Materials and Methods:This study was conducted on 300 patients aged 65 years and above. It included 238 males and 62 females. A questionnaire prepared by a psychologist was used to evaluate the patient in various aspects of neglect.Results:The results revealed that 40% of the total subjects that were studied were suffering from neglect in one way or the other.Conclusion:The results conclude that elder negligence was highly prevalent in elder patients who report to the dental office seeking oral prosthetic rehabilitation.

Cirurgia Para-protética

The para-prosthetic surgery is a surgical act often necessary in patients with oral prosthetic rehabilitation or removable prosthesis candidates. Its objective is to increase the denture bearing area, improve retention, eliminate soft tissue pathology, as well as inteferences and/or regularization of the prosthesis bearing hard tissues, thru a proper surgical technique.The para-prosthetic surgeries more often used are alveolar ridge regularization, torus removal and soft tissue changes.The authors intend to do a brief bibliographic revision of several types of para-prosthetic surgeries and illustrate them with clinical examples.

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.

Bi‐directional distraction osteogenesis of the alveolar bone using an extraosseous device

In alveolar distraction, the bone segment tends to incline palatally or lingually, making rigid control of the segments difficult. The aim of this study was to evaluate the usefulness of a newly developed bi-directional extraosseous alveolar distractor (Medartis V2-Alveolar distractor) for pre- and perioperative vector management. Seven patients with segmental alveolar atrophy following traumatic tooth loss were treated using the distraction device. The patients were followed up clinically and radiologically. Preoperatively, the initial vector for distraction was determined using CT by measuring the cross-section of the bone. The morphology of the alveolar bone was also analyzed in relation to the planned implant position. Postoperatively, the rate of osteogenesis was monitored with plane radiographs and CT scan. All cases had bone deficit at the anterior surface of the alveolar ridge, showing a typical inclination of the long axis of the bone. Using the distractor, vertical distraction and positioning of the segments with labial orientation was possible. After a consolidation period of 12 weeks on average, sufficient bone formation for implant installation was radiologically observable. Histologic and histomorphometric analysis of one bone biopsy showed very dense mineralized bone (area fraction=78%) with a multidirectional, complex architecture. Implant-supported prosthetic oral rehabilitation was successfully performed in all cases. All complications observed in this study were related to the bone deficiency at the anterior surface of the alveolar process. If the technique can be improved, this type of bi-directional distraction is a promising method for alveolar bone repair.

《歯科補綴における再生医療の方向性》骨再生の臨床―口腔外科的立場から―

Bone augmentation or the alveolar ridge augmentation procedure is inevitable for functional and esthetic prosthetic oral rehabilitation. In this article, conventional alveolar ridge augmentation methods are clinically demonstrated and are reviewed with reference to literature. In addition, distraction osteogenesis (DO), which has drawn considerable attention as a regenerative medicine, was clinically demonstrated. Then, the conventional augmentation methods and distraction are compared. Indications, advantages, and disadvantages of conventional augmentation methods including bone grafts, guided bone regeneration (GBR) and GBR with titanium micromesh (TIME technique) are demonstrated. Next, the mechanisms, indications, and advantages of DO are demonstrated and compared with conventional methods. Although conventional augmentation methods are well established, there are some problems including donor site morbidity and risks of wound dehiscence and infection. DO seems to have advantages compared to conventional augmentation methods. However, there still have some clinical problems such as difficulty in vector control and technique sensitivity. For less morbidity and better efficacy in alveolar ridge bone augmentation, tissue engineering offers potential in the future. However, further basic and clinical study will be necessary for clinical application.

Mandibular Discontinuity Reconstruction with Composite Grafts

SUMMARY Composite bone grafts (free autogenous cor- ticocancellous iliac bone and titanium endos- seous implants) have been successful in the treatment of mandibular discontinuity of various etiologies with follow-up for as long as 7 years in 18 patients. This surgical treatment has allowed final oral prosthetic rehabilitation with a bone-anchored fixed rather than a soft tissue- supported removable prosthesis. This treatment advance has provided superior functional and aesthetic improvement over our previous mandibular discontinuity reconstructive efforts. A careful, meticulous surgical technique is required for bone graft harvesting, donor site preparation, and endosseous implant insertion. Specific soft-tissue procedures are selectively required prior to bone grafting or before or after endosseous implant placement, particularly in patients who exhibit postradiation or postsurgical deficits in soft-tissue quality or quantity. Donor and recipient site cell (osteo- cyte) viability is preserved by controlling heat production during osseous surgery. A two-stage procedure (bone grafting followed 6 months later by implant placement) is physiologically and practically sound and has given predictable results to date. Long-term dental prosthesis function will theoretically occur if undisturbed implant healing and proper biomechanical implant loading are provided. Long-term composite graft stability, predictability, and retention will become clearer with further basic and clinical research.

Oral rehabilitation by prosthetic restoration after maxillectomy for malignant tumors

In maxillectomy patients, speech intelligibility between before and after insertion of prostheses has been reviewed by many investigators. Speech intelligibility was not related to the size of the defect, but rather to the defect region. Speech intelligibility was considerably improved by the use of prostheses 11 . A great difference could not be found in escape rate from the nasal cavity between before and after insertion of prostheses, but there was a remarkable change in the spirometer. Postmaxillectomy functions are also easily restored by prosthetic oral rehabilitation, necessary to aid surgical procedure.