Prosthodontic Reconstruction Research Articles

Clinical-statistical study on oral rehabilitation methods using dental implants.

The development of dental implantology is based on a thorough examination of the interaction of implants with the surrounding tissues, as well as methods of stimulating osteogenesis around implants. The most common approach to restore lost dentition in terms of function and aesthetics is now represented by implants. The objective of our study was to comparatively assess the efficiency of prosthetic treatments performed on implants alone versus on implants in conjunction with abutment teeth. The study was carried out over seven years (2016-2023), with evaluations at one, two, three, and five years. For this analysis, MedCalc® version 12.5.0.0 (MedCalc® Software, Mariakerke, Belgium) was utilised as the medical statistical software. When using dental implants and natural teeth abutments for prosthodontic reconstruction, the failure rates rise approximately 43 times when compared to dental implant rehabilitation; similarly, osteoporosis and diabetes mellitus increase failure rates by 32 and 20 times, respectively. Gingival inflammation is a frequent event (almost 50% frequency) observed during follow-up of patients who had prosthetic restoration using dental implants alone as well as implants and abutment teeth. For both groups, difficulties usually arise two years later.

Orthodontic and prosthodontic reatment of subgingival fractures of single-root teeth – a case study

<b>Introduction.</b> Combined orthodontic and prosthodontic treatment usually consists of three stages: pre-orthodontic, orthodontic and prosthodontic treatment. This study discusses the orthodontic and prosthodontic treatment stages of subgingival fractures of single-root teeth. The treatment is presented on the basis of the case involving the subgingival fracture of the upper right canine tooth in a 25-years old patient. <b>Aim.</b> The aim of this study is to present the results of the treatment involving the improvement in the function and aesthetics of the upper jaw, following the fracture. We focused specifically on the creation of proper conditions to implement an interdisciplinary treatment. The priority of such treatment is to uncover the contour of the fractured root. The success of the treatment depends on the degree of fracture confirmed by X-ray examinations, the length of the undamaged part of the root remaining in the bone and its anatomical structure. These factors influence the result of the endodontic treatment and the following prosthodontic restoration. <b>Materials and methods.</b> It is possible to uncover the contour of the fractured root by means, among others, of the application of a special orthodontic technique called extrusion. In the case of the treated patient, extrusion was performed by a fixed orthodontic device placed on the neighbouring teeth and a hook cemented in the canal of the fractured tooth. The extrusion was additionally supported by cutting periodontal fibres gradually. The orthodontic treatment involved 6 appointments and lasted 6 weeks from the placement of the fixed orthodontic device till the stage when the entire contour of the root’s bearing surface was revealed. Correct orthodontic therapy was necessary for a subsequent, successful, prosthodontic reconstruction. The prosthodontic treatment lasted 1 week and involved 2 appointments. It was performed in two stages: first, crown and root inlay was made of gold alloy (87%) and then, an aesthetic crown made of gold and porcelain (galvanic technique). <b>Results and discussion.</b> As a result of the combined treatment, it was possible to uncover the fractured root 2 mm above the bone plate of the alveolar process, and, consequently, to recreate the damaged tooth by means of a prosthodontic reconstruction. <b>Conclusions.</b> Combined orthodontic and prosthodontic treatment determines a successful prosthodontic reconstruction, thus restoring the function and aesthetic effect of the upper jaw and the whole oral cavity in a relatively short period of time.

Interdisciplinary approach of orthognathic surgery and prosthodontics for the treatment of jaw discrepancies

Nonsurgical orthodontic treatment is a choice for many cases of teeth malalignment, especially with the advances in orthodontic treatment. However, orthognathic surgery is sometimes recommended in cases with severe malocclusion, in patients with congenital disabilities, to treat patients with sleep apnea and for adding spaces for dental implants. Besides, it can be considered in patients with esthetic issues that need prosthodontic and restorative work. This paper aimed to show how involving a proper treatment plan using orthognathic surgery when patients required prosthodontic reconstruction maximized results and patient satisfaction compared with prosthetic reconstructions alone or with nonsurgical orthodontic treatment. The authors reported that four patients required prosthetic treatment. Each case had its own set of unique circumstances and challenges. The report showed the difference in treating these cases using nonsurgical orthodontic treatment or orthognathic surgery. Orthognathic surgery was indicated for the last reported case, showing a successful treatment and the patient reporting a high satisfaction level. Orthognathic surgery fastens and maximizes the result and satisfaction of cases with severe jaw discrepancies compared to prosthodontics alone or with nonsurgical orthodontic treatment. However, a proper treatment plan and work in a multidisciplinary team are required.

Complications Associated with Rehabilitation of a Unilateral Partially Edentulous Mandible with Inferior Alveolar Nerve Transposition and Implant Placement: A Clinical Report.

Rehabilitation of an edentulous posterior mandible to restore function and arch stability can be accomplished with a removable partial denture or an implant supported fixed partial denture. If the alveolus is severely resorbed, implant placement becomes challenging due to inadequate bone and the position of the inferior alveolar nerve. This report details a situation where a mandibular fracture occurred soon after inferior alveolar nerve (IAN) transposition and simultaneous implant placement. The prosthodontic reconstruction was completed using a fixed-dental prosthesis.

Implant-supported single zirconia crowns for posterior teeth using completely digital work-flow: A case report

Introduction. Planning fixed prosthodontic reconstruction can be challenging task in everyday practice. When the last tooth in dental arch is missing, a single implant-supported crown is recommended. With the evolution of digital technology, it became possible that these restorations can be made using completely digital approach. The aim of this case report was to present complete clinical procedure of making implant supported single zirconia crowns for posterior teeth using completely digital approach. Case report. A 53-year-old patient presented to the dental office with missing both first molars in the lower dental arch. The decision was made to make two implant-supported single screw-retained crowns, using digital approach. Intraoral scanning of the soft tissues and the implants? position was done using intraoral scanner Medit i500. The laboratory steps followed: computer-assisted design (CAD) and computer-assisted manufacturing (CAM) of zirconia crowns. Conclusion. Implant-supported single crowns for posterior teeth are an excellent solution for patients when the last tooth in dental arch is missing. Digital approach -from initial intraoral scanning (IOS), to designing the restoration in software and further processing of monolithic CAD/CAM generated crowns out of zirconia gives predictable, highly esthetic and functional results for implant-supported single crowns.

A case report on prosthodontic reconstruction for open-bite resulting from mandibular condylar tumor resection

A case report on prosthodontic reconstruction for open-bite resulting from mandibular condylar tumor resection

Biomechanical analysis of maxillary prosthodontic reconstruction using implants after resection for maxillary cancer

ObjectiveThis study analyzed stress distribution of the occlusal force in craniofacial structures around osseointegrated implants and in dental implants when maxillary reconstruction was performed using dental implants after maxillary resection. The resection because of maxillary cancer occur many physical changes such as aesthetic damage, dysarthria, and dysfunction. The patients’ quality of life (QOL) deteriorates by these changes. MethodsWe constructed a three dimensional solid model using Mimics® (Materialise) based on Digital Imaging and Communications in Medicine date (DICOM date) of the maxillofacial and cranial bones obtained from a computed tomography (CT) image of a patient with edentulous maxilla. ResultsThe following four defect region patterns were designed; right maxillary molar, hemimaxilla, full maxilla, and normal. Maxillary prostheses were designed with single implant in the zygomatic bone on the affected side and 1–2 implants in the maxillary alveolar bone on the affected or unaffected side based on All-on-4® treatment concept system. In case of hemi- and full-maxillary resection, our designs were not effective. ConclusionsWhen planning maxillary prostheses, the chewing ability and denture weight should be considered. We considered that these elements may be improved oral functions after surgery.

Oral health-related quality of life and implant therapy: A prospective multicenter study of preoperative, intermediate, and posttreatment assessment.

Loss of teeth is associated with a significant reduction in quality of life. The aim of this prospective multicenter study was to assess the impact of dental implants on oral health-related quality of life (OHRQoL). Patients with various kinds of indications for dental implants ranging from single-tooth loss to edentulous jaws were included. Quality of life related to dental implants was assessed through the Oral Health Impact Profile (OHIP-G 21), which has a score from 0 to 20 in healthy patients. In total, 8689 patients from 17 centers from 2009 to 2014 were enrolled in the study. The sex distribution was almost even (53.3% men, 46.7% women). The most frequent indications for the insertion of dental implants were free-end gaps (30.6%) and posterior single-tooth gaps (27%). In all, 12.4% of patients had an edentulous jaw. For all indications, patients reported significant changes in mean OHIP scores after prosthetic reconstruction. The most significant improvements in the OHIP score occurred in the groups of patients with edentulous jaws (pretreatment score: 42.3) after prosthodontic reconstruction (score: 24.8) and in the patient group with an anterior single-tooth gap (pretreatment score: 36.4) after prosthodontic reconstruction (score: 24.8). The insertion of dental implants and prosthodontic rehabilitation led to an improved OHRQoL for patients with all indications for dental implants, with the most significant improvements in patients with edentulous jaws and anterior single-tooth gaps.

A step ahead in post and core technique for patients with limited interarch space

The successful treatment of a badly broken down tooth with pulpal disease depends not only on a good endodontic therapy but also on a good prosthodontic reconstruction of the tooth following the root canal treatment. Often, we come across an endodontically treated tooth with little or no clinical crown. In such cases, a postspace is prepared into the canal for the cementation of post and an artificial crown structure called the core is prepared over it to support the fixed partial denture. Post and cores though commonly used now have their own limitations. Failures associated with these systems include the loss of retention of posts and fracture of roots or even root perforations. Moreover, placement of a post in situations with limited interarch space is a challenge for any dentist. The failure rate associated with the conventional techniques would be higher in these conditions. This case report discusses an alternative technique of restoration of a badly broken down endodontically treated tooth with a specially designed post and core attachment to provide the necessary resistance and retention form for the overlying prosthesis in patients with limited interarch space.

The influence of etiological factors in the occurence of diastema mediana.

Even from the distant past the aesthetic perception in an individual was diminished by the presence of gap between the central incisors. This condition is found under the term "dents du bonheur" or "lucky teeth" and is encountered even among world famous figures including Brigitte Bardot, Eliah Wood, Madonna, Zac Efron, Amy Winehouse and Elton John. The teeth gaps are still considered main reasons for dissatisfaction of the dental patients and reasons for the requirement of aesthetic treatment. The purpose of this study is to exhibit the influence of the etiological factors in the occurrence of diastema mediana classified according to the dominance of their occurrence expressed in percentage values. Materials of this investigation were 100 patients with diastema mediana from the following factors: inheritance, disproportion in the dental arches, inborn or acquired missing teeth, harmful oral habits, high insertion of the labial frenulum as well as mesiodens. After the diagnosis and evaluation of the etiological factor for diastema mediana was performed, a decision regarding the course of treatment was made in direction of the removal of the etiological factor at an early age and orthodontic treatment. The end of the orthodontic treatment in a group of the patients was the beginning of prosthodontic reconstruction. From our clinical investigation we came to the realization that in 49 patients (49%) the hereditary influence was a dominant factor, next followed disproportions and discrepancies in the dental arch in 14 (14%), inborn or acquired missing teeth in 11 patients (11%), harmful oral habits in 10 (10%), high frenulum insertion in 4 (4%), and pathological objects between central incisors, mesiodens, iatrogenic factors and periodontal disease, in 3 of the clinical cases (3%) each. We concluded that the occurrence of diastema mediana is multi-causal. The dominant place is occupied by the hereditary factors. With regard to the mutual relationship between the multitudes of factors in the occurrence of diastema mediana, the diagnosis should be made conciliary and the clinical treatment should be interdisciplinary including a prosthodontist, orthodontist and oral surgeon.

Esthetic mounting (OP1)을 사용하여 교합면 재구성을 시행한 증례

붕괴된 교합평면을 보철적으로 재구성하는 과정에 있어 face-bow와 교합기는 필수적으로 필요한 기구로 사용되어왔다. 일반적으로 Ear rod를 사용하는 face bow는 상악 정중선의 오차와 교합평면의 canting이 발생할 가능성이 있는데 이런 문제점을 해결하기위해 환자의 안면 정중선을 기준으로 하는 face bow가 개발되어왔다. Ear-bow를 이용한 mounting에서 종종 발생하는 오류를 보완하는 방법으로 환자 안면의 중심과 교합기의 중심을 일치시키려는 개념의 mounting technique이 시도되고 있으며 이를 esthetic mounting이라 한다. 이들 중 하나인OP finder 1(OP1)을 사용한 증례를 보고하고자 한다. A face-bow and an articulator have been used as crucial devices in a prosthodontic reconstruction of a collapsed occlusal plane. In order to avoid inaccuracy of median line in maxilla and the canted occlusal plane both of which may result from using a facebow with ear rods, a facebow that locate a patient's facial median line as reference line has been under development. A mounting technique that tries to bring a center of patient's face into line with the center of the articulator, called esthetic mounting, is currently employed to overcome the imprecision resulted from mounting with ear-bow transfer. We would like to study a case that used OP finder 1, one of the esthetic mounting techniques.

義歯床形態に考慮を要した下顎歯肉・頬粘膜癌切除後補綴症例

症例の概要：患者は73歳の女性で，左側下顎骨辺縁切除術ならびに腹部全層植皮術後の下顎骨部分欠損による植皮部陥凹部への食物の残渣を伴う咀嚼困難を主訴に来科した．ティッシュコンディッショナーを用いて顎欠損部に対する義歯床辺縁・床翼部の形態形成を行ったうえで下顎顎義歯を製作した．考察：機能時における頬粘膜と義歯床との間に緊密な接触が得られた結果，食物が植皮部の陥凹部に停滞することは消失し，咀嚼機能が改善したと考えられる．結論：植皮部の可動性が欠如している症例に対し，適切な義歯床形態を付与することにより，咀嚼機能を改善し良好な経過を得ることができた．

Factors Affecting Survival and Usefulness of Implants Placed in Vascularized Free Composite Grafts Used in Post–Head and Neck Cancer Reconstruction

Bone-containing vascularized grafts have been used successfully to reconstruct post-cancer surgical defects. Dental implants can be placed in these bone-containing grafts to allow implant-supported prosthodontic reconstruction of these patients. The aim of this study was to evaluate the survival of dental implants used in the rehabilitation of subjects treated with bone-containing vascularized grafts to compare usability of implants placed at the time of reconstruction and after healing. A cross-sectional study was undertaken to examine survival rates of implants placed in vascularized bone-containing grafts either immediately at the time of surgical reconstruction or after 3 months healing. Other factors such as graft type, whether radiation therapy was given, and implant type were recorded. A total of 41 patients had 145 implants placed in 47 vascularized bone-containing flaps. Increased failure rate of implants was seen in immediately placed implants. There was also a significant increase in the number of osseointegrated implants that were prosthodontically unusable or sub-optimally placed in the immediate placement group. Radiation therapy was associated with a significant increase in failure rate. Modern implant surfaces appeared to perform better than machined/turned surfaces. Graft donor site did not influence implant survival. This study demonstrated the difficulties encountered with immediate placement of dental implants at the time of post-cancer reconstructive surgery.

Osteochondroma of the Mandibular Condyle

Osteochondroma of the mandibular condyle in adults can be treated by surgical excision, condylectomy followed by costochondral graft or orthognathic surgery. Such complex treatment plan may not be appropriate for patients with old age, affected with chronic osteochondroma of the condyle. In this clinical report, we present a patient with osteochondroma of the condyle treated by surgical excision. The patient's postoperative occlusion was a contraindication for orthognathic surgery because of the severe abrasion of the teeth and the chronic compensation of the dentition to the deviated mandible. Surgical excision of the lesion was carried out under general anesthesia, and the remaining condylar head was salvaged as much as possible. No graft materials or posthodontic condyle reconstruction was carried out. Because there was no occlusal stop to secure the mandible in a centric relation position of the condyle, a stabilization splint was delivered to position the condyle in a relatively stable position. The stability of the condyle position was evaluated by follow-up cone beam computed tomographic scans of the pathologic and the contralateral condyle, along with clinical factors such as occlusal contact points and mandible movements assayed by ARCUSdigma (KaVo). After significant condylar position was achieved, full prosthodontic reconstruction was performed to both the patient's and the dentist's satisfaction.

Mandibular Implants: A Retrospective Single Private Surgical Practice Study

Background: Dental implants have revolutionised restorative dental care but this is complex surgical and prosthodontic treatment. Excellent results have been reported in many institutional studies with a small but acceptable failure rate. It is largely unknown which of these results translate directly into a private practice setting. Methods: All patients who have dental implants placed in the maxilla by a single oral and maxillofacial surgeon in private practice in over a 3 year period were included in this study. All implants were placed in a two stage approach. All the data was collected through retrospective review of patient files and radiographic assessment. Patient data included full demographics, referral source, type and site of implants placed, and adjunctive procedures. The outcome including any complications in the first phase between placement and uncovering were recorded. The restorative phase was performed by a variety of general dentists and prosthodontists, with patients being followed up in surgical outpatients post final prostheses being issued. In all cases the individual who referred the patient and performed the reconstruction had been present at the time of surgical implantation. The outcome, including any complications in the prosthodontic reconstruction phase was recorded. This data was recorded on a standardised data sheet and maintained and analysed using SPSS (Statistical Package for the Social Sciences, version 9.05, Chicago, IL). Where two different factors were compared, the 95% confidence interval (CI) of the difference between the survival rates was calculated. A difference was considered statistically significant on a 5% level when this confidence level did not contain 0. Results: 179 mandibular implants were placed in 57 patients. On review at three years 166 (93%) were successful with 13 implant failures. Of the implants which failed, nine of them failed in the first 6 months, and none after 18 months. There were a number of trends which did not reach statistical significance. Failures were more common in the following circumstances; in the posterior mandible (11 of 13), with older mark II & III version implants (12 of 13) and implants shorter than 8 mm. There was no correlation to medical conditions or smoking. An incidental finding was a correlation between those who smoked and had heart disease. (P<0.005)

Therapies most frequently used for the management of bruxism by a sample of German dentists

At present, there is little information available on how practicing dentists manage bruxism patients with respect to conservative, reversible techniques as compared to irreversible techniques. The purpose of this study was to determine the most commonly applied therapies used for the management of bruxism by German general dentists (GDs) and dental specialists. In addition, efforts were made to gather information on the knowledge and opinion of GDs and specialists regarding the role of occlusal interferences, in particular, on the development of sleep bruxism. A 13-item questionnaire was developed and mailed to all active members of the statutory dental insurance providers of the German North Rhine (n=5500; 2006 roster) and the German Westphalia-Lippe area (n=4984; 2006 roster). Group differences were statistically analyzed using chi-square tests for the qualitative variables and Mann-Whitney U tests for the quantitative variables (α=.05). Occlusal splints were by far the most frequently prescribed therapy for the management of bruxism, followed by relaxation techniques, occlusal equilibration, physiotherapy, and prosthodontic reconstruction. The occlusal stabilization splint with canine protected articulation was the splint type most often prescribed, whereas respondents used unadjusted soft splints for approximately 8% of their bruxism patients. Comparison of the opinions of all responding practicing dentists with that of experts in regard to the statement that "sleep bruxism is caused by occlusal interferences" showed a significant difference between the 2 groups (P=.021). Eighty-five percent of the experts disagreed with this statement, and only 47.7% of the practicing dentists had the same opinion as the experts. Most practicing dentists seem to concur with current scientific recommendations, and express the opinion that the management of bruxism should predominantly be conservative and reversible; however, the findings of the present survey reveal diverse differences between GDs and dental specialists concerning the most frequently prescribed therapies. Moreover, the discrepancies detected in some areas, such as the use of irreversible techniques or the use of unadjusted soft splints, emphasize the need to more promptly transfer new knowledge in the field of bruxism from researchers to practicing dentists.

Surgical and prosthodontic reconstruction of a gunshot injury of the mandible using dental implants and an acrylic resin fixed prosthesis: A clinical report

Gunshot injuries to the face can have serious esthetic and functional consequences. Few articles have described the comprehensive management, including surgical and prosthodontic phases of reconstruction, of patients with such injuries. This clinical report describes a 3-year follow-up of the maxillofacial rehabilitation of a gunshot injury to the left mandible using an iliac crest bone graft, dental implants, and an economical acrylic resin fixed prosthesis. The importance of a multidisciplinary approach and biomechanical considerations for implant positioning in posterior mandibular reconstructions are described. Various prosthetic designs and the choice of available prosthetic materials are also discussed.

Implant Rehabilitation for a Patient With Hallerman-Streiff Syndrome: A Case Report

Hallermann-Streiff syndrome is a rare genetic disorder characterized by craniofacial malformations, sparse hair, eye abnormalities, dental defects, degenerative skin changes, and short stature. The syndrome has many implications for dental treatment. Patients typically present with multiple missing and poorly formed teeth. The purpose of this case report is to discuss the overall management of a patient with Hallermann-Streiff syndrome by oral maxillofacial surgery, orthodontic treatment, and prosthodontic reconstruction.

Bone augmentation and biopsy: clinical report

A mixture of demineralized freeze-dried cortical bone and β-tricalcium phosphate covered by titanium-reinforced expanded polytetrafluoroethylene membranes was used for bone augmentation in an accident case in which a young female patient suffered anterior maxillary damage. Hydroxyapatite-coated implants were placed in the newly formed bone-like material before prosthodontic reconstruction. A biopsy suggests the bone-like material was essentially normal lamellar and woven bone. (Implant Dent 1996;5:251–254)

Autogenous mandibular bone grafts and osseointegrated implants for reconstruction of the severely atrophied maxilla: a preliminary report

The purpose of this study is to present results obtained with a new procedure for reconstruction of the severely atrophied maxillary alveolar ridge that involves the use of intramembranous corticocancellous bone grafts obtained from the mandibular symphysis fixed to the residual bone by endosseous implants. A total of 107 implants were installed in grafted regions in 26 patients. The follow-up period ranged from 6 to 32 months, with a mean of 16 months. In partially edentulous patients the bone grafts were fixed with implants to the residual bone as 1) onlay graft to the alveolar ridge (8 implants in 4 patients); 2) grafts to the nasal and/or sinus floor after a transoral exposure and elevation of the mucosa of the maxillary sinus and/or the nasal mucosa (33 implants in 11 patients); or 3) a combination of these two (5 implants in 2 patients). In totally edentulous patients, implants and grafts were used as a combination of grafting to both the alveolar ridge and nasal and/or sinus floor sites (61 implants in 9 patients). One hundred of 107 implants showed normal clinical and radiologic healing, whereas 7 implants in 4 patients (6.5%) were lost prior to loading. Seventeen patients have had the implants and bone grafts loaded by a prosthodontic reconstruction from 6 to 26 months (mean, 14 months) without loss of any implants. Postoperative marginal resorption of the onlay bone graft of less than 15% was observed. These findings suggest, that the previously observed rapid resorption of endochondral iliac crest onlay bone grafts and the number of lost implants can be significantly reduced if bone from the mandibular symphysis firmly anchored with titanium implants is used.