Temporary Prosthesis Research Articles

Influence of the Interimplant Distance on Crestal Bone Resorption and Bone Density: A Histomorphometric Study in Dogs

The position of gingival soft tissues depends on the position and health of the underlying alveolar bone. The aim of this study was to evaluate the influence of different interimplant distances on crestal bone resorption after prosthetic restoration with a 5-mm distance between the contact point and the bone crest. The mandibular bilateral premolars of six dogs were extracted and, after 12 weeks, each dog received eight implants, totaling 48 implants in the experiment. Two pairs, one in each hemiarch, were separated by 2 mm (group 1) and two by 3 mm (group 2). After 12 weeks, the implants received temporary acrylic prostheses. After 4 more weeks, metallic crowns substituted the temporary prostheses. After 4 more weeks, the animals were sacrificed, and their hemimandibles were removed, dissected, and processed. For groups 1 and 2, respectively, the mean of interimplant bone resorption (IIBR) analyzed histologically was 2.03 and 1.98 mm (P >or=0.05), and the mean of the distal extension bone resorption was 2.04 and 1.92 mm for groups 1 and 2, respectively (P >or=0.05). The crestal bone resorption between the implants was 0.13 mm (P >or=0.05) for both groups. The mean of IIBD for groups 1 and 2 was 79% and 80%, respectively. When the IIBD was compared to the distal extension bone density for group 1 (79% and 64%) and group 2 (80% and 62%), statistically significant differences were obtained for both groups (P <or=0.05). The distances of 2 and 3 mm between implants do not result in statistically significant differences in crestal bone resorption around implant surfaces in dogs. The bone density is enhanced when loading is present at the interimplant area.

The early mobilization of the elderly amputee.

A policy of early mobilization of elderly leg amputees using a simple temporary prosthesis has been assessed in the context of a district general hospital. Close cooperation between members of the hospital management team, adequate rehabilitation facilities and close liaison with the limb-fitting centre and domiciliary services were found to be essential to support this policy. Of 42 elderly amputees, 34 were supplied as early as possible with temporary prostheses. Nearly 80 per cent of them were able to walk without assistance on discharge from hospital care. Delays in discharge were mainly for socio-domestic reasons. Early prosthetic mobilization in this aged and often frail group of patients led to a reduced morbidity and mortality. There was improved morale in patients and staff, rapid clearance of acute surgical beds and the all-important early achievement of domestic mobility and independence for the amputee.

Chairside Preparation of Provisional Restorations

Increasing demands are placed on the oral and maxillofacial surgeon to perform early or immediate loading of dental implants due to demands and expectations of the referring doctor and patients. In order to provide the patient with an immediately loaded, functioning implant, the surgeon should consider incorporating the fabrication of the temporary restoration as an additional service for their implant patients. The armamentarium necessary for the oral and maxillofacial surgeon to deliver a temporary restoration will be described. The materials and components needed to provide this service will be listed and a sequence of steps to easily accomplish the fabrication of a temporary crown will be presented. Temporary crowns cemented onto temporary or permanent implant abutments are ideal for the management of gingival contours. Initial soft tissue healing around the contours of the temporary crown, even with minimally invasive techniques, provides many advantages for the patient. There is less likelihood of gingival scarring, which minimizes the incidence of gingival recession and the patient is restored to normal form and function immediately. The fabrication of the temporary prosthesis by the oral and maxillofacial surgeon provides benefits for the surgeon, restorative doctor, as well as, the patient. By working closely with his or her restorative colleagues, the surgeon will be able to provide his or her implant patients with immediate return to form and function intraorally with minimum effort.

Immediate/Early Function of Brånemark System® TiUnite™ Implants in Fresh Extraction Sockets in Maxillae and Posterior Mandibles: An 18‐Month Prospective Clinical Study

The advantages of placing implants in fresh extraction sockets and putting them in immediate/early function are many. A predicable protocol opens the possibility of performing a single surgical procedure, giving the patient a temporary prosthesis immediately, and minimizing the shrinkage of hard tissue and soft tissue recession. The aim of the present study was to develop a strict protocol for and to evaluate the feasibility of immediate/ early function on implants placed in fresh extraction sockets located in maxillae and posterior mandibles, including defects around the implants treated according to a regenerative procedure. Nineteen patients were treated after tooth extraction according to an immediate function protocol and were observed for 18 months. Fifty Mk IV TiUnite (Nobel Biocare AB, Göteborg, Sweden) implants were installed in partially edentulous areas in maxillae (n = 17) and posterior mandibles (n = 5). Implants were installed directly into the alveoli, and the temporary prostheses were connected immediately after surgery (n = 11) or within 7 days, that is, an "early function" procedure (n = 11). Thirteen implants did not require any type of regenerative procedure, whereas the remaining 37 implants had filling with autogenous bone, 4 of which also had a resorbable membrane. Standardized intraoral radiographs were taken for evaluation of marginal bone level, and 38 of the implants were systematically checked by resonance frequency analysis. All patients were followed for 18 months, and none of the 50 implants failed. However, one implant showed signs of failure after 6 weeks, but once the occlusal load was removed, the implant regained its stability completely, no longer demonstrated symptoms, and could be used successfully for prosthetic rehabilitation. The mean value of the implant stability quotient was 60 at baseline (range 45-75) and 63 after 6 months (range 46-75). The marginal bone resorption was 0.9 mm (SD 1.1 mm; n = 48) 18 months after implant insertion (1 year after final prosthesis). The immediate placement of implants into fresh extraction sockets combined with immediate/early function procedures seems to be a safe and reliable procedure when using a strict protocol.

Ambulation on Postoperative Day 1 after Bilateral Transtibial Amputations: A Case Report and Literature Review

In Brief Few patients experiencing traumatic injuries require bilateral transtibial amputations, limiting data outlining the best rehabilitation process. Severe trauma to the lower extremities after motor vehicle crashes that require amputation tend to occur to young, healthy individuals. Patients with chronic vascular and diabetic complications account for 80% of the lower extremity amputations performed in the United States. The authors report a patient who was standing in his temporary prosthesis the day after bilateral amputations and was fitted with permanent prosthesis 8 weeks later, about 6 months sooner than has been described. This accelerated rehabilitation greatly reduced the overall cost of the patient’s care and returned him to full function much faster. This case report highlights the utility of accelerated rehabilitation with rigid postoperative dressings in the treatment of a young traumatic bilateral amputee to minimize the time to weightbearing and walking, and the fitting of the preparatory prostheses. Severe trauma to the lower extremities after motor vehicle crashes that require amputation tend to occur to young, healthy individuals. The authors report a patient who was standing in his temporary prostheses the day after bilateral amputations and was fitted with permanent prostheses 8 weeks later, about 6 months sooner than has been described. This accelerated rehabilitation greatly reduced the overall cost of the patient’s care and returned him to full function much faster.

Appareillage précoce par manchon silicone avec attache terminale après amputation vasculaire sous le genou : évaluation par score de marche du devenir fonctionnel

Purpose. – To assess by a specific questionnaire the functional outcome of patients with below-the-knee amputation after early prosthetic fitting by the ICEROSS silicone liner, which had demonstrated improvement of stump healing and length of hospital stay. Patients and methods. – In this retrospective study, walking ability was assessed by a specific score resulting from answers on a questionnaire. The outcome variables were walking inside and outside, transfer from sitting, climbing stairs, and use of walking aids. Following amputation, the ICEROSS system was used for compression therapy, then for temporary prosthesis. The questionnaire was administered at the fitting stabilized state. Results. – Twenty-nine of 51 patients who underwent trans-tibial amputation were included: 5 women (mean age 72.8 ± 4.1 years) and 24 men (mean age: 69 ± 7.4 years). The mean total score was 14.5/20 (good functional outcome) for the 22 unilateral amputees and 7.2/20 (intermediate result) for the seven bilateral amputees. Previous studies concerning functional outcome with other contact casts (without a silicon liner with a bolt) had shown similar results. Conclusion. – Despite its beneficial initial effect, early fitting by the ICEROSS system did not improve walking ability at the steady functional state, which is more linked to advanced age and comorbidities.

保存困難な歯を修復して欠損歯列のこう合を回復した症例

A 45-year-old female presented with the chief complaint of masticatory disturbance and spontaneous pain at the mandibular left second molar. Her maxillary left first and second molars, and mandibular right first and second molars were missing and the edentulous arches had been left untreated for a long period. In this patient who lacked occlusal support, occlusal reconstruction was done using a temporary prosthesis. Prosthodontic treatment with minimum tooth extraction required several years. Taking aesthetics into consideration, the maxillary right lateral incisor was used as a support for a removable partial denture. The small perforation was sealed successfully with an adhesive resin (4-META/MMA-TBB resin) in order to restore the mandibular left first molar. The occlusal reconstruction for partially edentulous arches without occlusal support took several years. Informed consent and cooperation between patient and dentist were indispensable for the satisfactory results in this case.

Immediate Loading With Mini Dental Implants in the Fully Edentulous Mandible

The use of immediate loaded prostheses is not recommended for at least 2 weeks to prevent implants from premature loading. In addition, immediate removable prostheses are negated for at least 4 weeks at the site of guided bone regeneration or bone graft. However, patients are often not pleased with limited diets and the unaesthetic appearance during the healing period without a denture between implant placement and final prosthesis. Mini dental implants provide stable and esthetic temporary prostheses immediately after implant placement and bone grafts. The use of mini dental implants is simple and cost effective because the patient's old denture is used as a provisional prosthesis. This article shows the success of 27 mini dental implants that were placed for 11 mandibular fully edentulous patients.

Early Function of Splinted Implants in Maxillas and Posterior Mandibles, Using Brånemark System® Tiunite™ Implants: An 18‐Month Prospective Clinical Multicenter Study

Immediate or early loading of implants placed in maxillas and posterior mandibles has been a concern as bone density is often low in these areas, making it difficult to establish good initial implant stability. By adapting implant design and insertion protocols, however, high initial implant stability may be achieved in these regions. Further, a modified implant surface texture has been proved to help in maintaining stability during the initial healing period. The aim of the present study was to investigate the clinical performance of oxidized titanium implants (TiUnite, Nobel Biocare AB, Gothenburg, Sweden) when used for early function in the maxilla and in the posterior mandible, locations where the bone density often is low. A further aim was to evaluate the marginal bone level at oxidized implants and compare it with that of machined-surface implants used in a previous study. Thirty-one patients were consecutively included in the study, and 37 edentulous areas in maxillas and posterior mandibles were treated. Bruxism and uncontrolled periodontal disease were exclusion criteria. Temporary prostheses were generally placed within 9 days but not after 16 days from implant placement. A previous study applying the same study design and clinical protocol but using machined-surface implants was used for comparisons. Of the 111 implants installed, 1 failed, giving an overall survival rate of 99.1% after 18 months. The prosthesis survival was 100%. The marginal bone resorption was 0.8 mm (standard deviation [SD], 1.0), as opposed to 1.6 mm (SD, 1.3) in the previous study with machined-surface implants, but was not statistically significantly different (p = .10). The present clinical protocol (aiming at high primary stability) and the use of oxidized titanium implants for early functional loading in the maxilla and the posterior mandible resulted in a high implant survival rate and a favorable marginal bone level during a follow-up of 18 months. The difference in marginal bone resorption between the oxidized implants in the present study and the machined implants from a previous investigation with the same study design was not statistically significant.

Interventions for replacing missing teeth: different times for loading dental implants.

To minimize the risk of implant failure, osseointegrated oral implants are conventionally kept load-free during the healing period. During healing removable prostheses are used, however many patients find these temporary prostheses rather uncomfortable and it would be beneficial if the healing period could be shortened without jeopardizing implant success. Nowadays immediate and early loaded implants are commonly used in mandibles of good bone quality. It would be useful to know whether there is a difference in success rates between immediately or early loaded implants compared with conventionally loaded implants. To test the null hypothesis of no difference in the clinical performance between osseointegrated implants loaded at different times 1 year after loading. The Cochrane Oral Health Group's Trials Register, The Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE were searched. Handsearching included several dental journals. Authors of all identified trials, an internet discussion group and 55 oral implant manufacturers were contacted to find unpublished randomized controlled trials (RCTs). The last electronic search was conducted on 2 February 2004. All RCTs of root-form osseointegrated oral implants having a follow up of at least 1 year comparing the same osseointegrated root-form oral implants loaded at different times. Data were independently extracted, in duplicate, by two reviewers. Authors were contacted for details of randomization and withdrawals and a quality assessment was carried out. The Cochrane Oral Health Group's statistical guidelines were followed. Seven RCTs were identified and five trials including 124 patients in total were suitable for inclusion. Implants have been either immediately loaded after insertion (2 to 3 days), early loaded (6 weeks) or conventionally loaded (3 to 8 months) in edentulous mandibles of adequate bone quality and shape. On a patient, rather than per implant basis, there were no statistically significant differences for prosthesis failures, implant failures and marginal bone loss on intra-oral radiographs. While it is possible to successfully load oral implants immediately after their placement in mandibles of adequate bone density and height of carefully selected patients, it is yet unknown how predictable this approach is. More well designed RCTs are needed to understand how predictable immediate and early loading are. Such trials should be simply designed and should be reported according to the CONSORT guidelines (http://www.consort-statement.org/). It is suggested that priority should be given to trials assessing the effectiveness of immediately loaded implants rather than early loaded ones.

A cost-effective, adjustable, femoral socket, temporary prosthesis for immediate rehabilitation of above-knee amputation.

Early ambulation after lower extremity amputation has profound benefits on the functional, psychological outcomes and enhanced prosthetic compliance among this clientele. The various potential risks of immobility--pain, oedema, muscle atrophy, phantom sensations, contractures, aerobic de-conditioning, and the like, are reduced due to early ambulation. Moreover, it assists in accelerated wound healing, preservation of postural reflexes and, above all, achievement of better psychological well-being. Though such benefits have been observed in the history of prosthetic rehabilitation, a cost-effective prosthesis for such an early management among Third World nations is still unavailable. Therefore, this article is an attempt to present an indigenously developed temporary prosthesis designed to make the above benefits possible at a lower cost. This prosthesis helps in myriad ways--immediate prosthetic fitting, early weight bearing, early ambulation--and also has the added advantage of being adjustable to anthropological variations. The ischial weight bearing, lateral opening socket reduces the pressure and shear over the stump, thus avoiding stump complications. This increases the prosthetic acceptance by the client due to early involvement in the rehabilitation. Above all, it is cost effective and comfortable, thus enhancing compliance and superior outcome in prosthetic rehabilitation, especially among the clients in Third World nations.

Temporary Prosthetic Fitting over Tibial Stump Lengthening Device

Lengthening of short amputation stumps has become an accepted, though uncommon, treatment for amputees. The time taken to lengthen the bone and wait until it has become sufficiently strong to remove the external fixator takes many months, during which time the patient is without a functional prosthesis. We describe the need and process of fabricating a temporary prosthesis, which is worn around the fixator to enhance the rehabilitation process in a patient who underwent lengthening of his short transtibial stump.

Interventions for replacing missing teeth: different times for loading dental implants.

To minimize the risk of implant failure, osseointegrated oral implants are conventionally kept load-free during the healing period. During healing removable prostheses are used, however many patients find these temporary prostheses rather uncomfortable and it would be beneficial if the healing period could be shortened without jeopardizing implant success. Nowadays immediate and early loaded implants are commonly used in mandibles of good bone quality. It would be useful to know whether there is a difference in success rates between immediately or early loaded implants compared with conventionally loaded implants. To test the null hypothesis of no difference in the clinical performance between osseointegrated implants loaded at different times one year after loading. The Cochrane Oral Health Group Trials Register, The Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE were searched. Handsearching included several dental journals. Authors of all identified trials and 55 oral implant manufacturers were contacted to find unpublished RCTs. The last electronic search was conducted on 8 May 2002. All RCTs of root-form osseointegrated oral implants having a follow-up of one year comparing the same osseointegrated root-form oral implants loaded at different times. Data were independently extracted, in duplicate, by two reviewers. Authors were contacted for details of randomization and withdrawals and a quality assessment was carried out. The Cochrane Oral Health Group's statistical guidelines were followed. Only three RCTs were identified and two trials including 68 patients in total were suitable for inclusion in this review. Implants have been either immediately loaded after insertion (two to three days), early loaded (six weeks) or conventionally loaded (three to eight months) in edentulous mandibles of adequate bone quality and shape. On a patient, rather than per implant basis, there were no statistically significant differences for prosthesis failures, implant failures and marginal bone loss on intra-oral radiographs. While it is possible to successfully load oral implants immediately after their placement in mandibles of adequate bone density and height of carefully selected patients, it is yet unknown how predictable this approach is. More well designed RCTs are needed to understand how predictable immediate and early loading are. Such trials should be simply designed and should be reported according to the CONSORT guidelines (http://www.consort-statement.org/). It is suggested that priority should be given to trials assessing the effectiveness of immediately loaded implants rather than early loaded ones.

Rush pin technique for temporary antibiotic-impregnated cement prosthesis for infected total hip arthroplasty

A technique is described for intraoperative fabrication of an antibiotic-impregnated temporary prosthesis using a rod pin as an endoskeleton. The technique has the advantage of the availability of numerous rod lengths and diameters, which allows the surgeon to produce a custom component with a wide range of lengths and offsets. The technique has been used successfully in many cases over a 5-year period. Copyright 2002, Elsevier Science (USA). All rights reserved.

The supply and fitting of a temporary breast prosthesis

The supply and fitting of a temporary breast prosthesis

The supply and fitting of a temporary breast prosthesis.

The fitting of soft breast prostheses is an essential nursing duty on breast cancer surgery wards, but it appears to be performed on an ad hoc basis, without evidence-based guidelines. A diagnosis of breast cancer carries enormous implications for the patient in terms of physical and psychological health. For this reason, it is vital that nurses respond sensitively to these needs and assist women to cope with the changes in body image. This includes ensuring that knowledge underpins practice when fitting the soft breast prosthesis. This article outlines a 12-point plan devised by the authors, giving guidance on how to fit temporary breast prostheses.

Disarticulation resections of the mandible: A prospective review of 16 cases

Purpose: This article provides a review of the disarticulation resection of the mandible for various benign and malignant tumors and non-neoplastic processes. In so doing, the author proposes a classification to describe extension of pathology into the condylar region, thereby requiring its sacrifice. Recommendations are also proposed for preservation versus sacrifice of the meniscus when performing a disarticulation resection of the mandible. Finally, complications are evaluated in this type of mandibular resection. Patients and Methods: This review is based on the author's accumulated clinical data obtained from performing disarticulation resections on 16 patients who presented with 10 different pathologic diagnoses. Disarticulation resections are performed for 3 different patterns of extension of pathologic processes into the condylar region, designated as type I, type II, and type III by the author. These designations reflect the radiographic involvement of the condyle or subcondylar region of the mandible by the pathologic entity. The designations of type II and type III extensions are diagnosis dependent, whereas type I extension is independent of diagnosis. Results: Five patients in this series presented with type I condylar extension, 2 patients presented with type II condylar extension, and 9 patients presented with type III condylar extension. The meniscus required sacrifice in 3 of the 16 patients. Complications occurred in 3 of 16 patients and included 1 dislocation of the plate into the middle cranial fossa, 1 dislocation of the plate inferiorly and posteriorly to the mastoid process, and 1 cutaneous exposure of the plate. Conclusions: Disarticulation resections are rarely required variants of segmental resection of the mandible, and they are required by a variety of pathologic processes of the jaws and contiguous structures. The placement of a reconstruction bone plate with an affixed condylar prosthesis is well tolerated by patients and is associated with few complications. These reconstruction bone plates favorably support facial form, symmetry, and occlusion such that many patients delay their definitive bony reconstruction. Because these condyles are temporary prostheses, the surgeon should consider their removal with bony reconstruction of the disarticulation defect as soon as possible after the ablative surgery. © 2002 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 60:176-181, 2002

Measurement of Socket Discomfort???Part I: Pressure Sensation

The purpose of the study was to determine the feasibility of quantifying pressure-related socket discomfort by using psychophysical methods. The first experiment involved the application of known uniform pressure to the residual limbs of three transtibial amputees. Category ratio scales were used to measure sensations of pressure, pain, and perceived discomfort. The second experiment involved altering the geometry at the fibula head and distal tibia of the subjects’ fitted PTB sockets with wafers of varying thickness and use of the same three scales to measure response to the variations in local point-specific pressures. Two of the subjects had more than 32 years of experience with PTB sockets, whereas the third subject had just been fitted with a temporary prosthesis. Results indicated that response functions for global uniform pressure varied among the subjects but were similar for the modifications at specific locations. Both experienced amputees reported constant pressure sensations between 10 and 40 mm Hg of applied uniform global pressure, whereas the inexperienced subject reported a linear increase in pressure sensation over the same range. Pressure and discomfort sensations appeared to be isolated subjectively and assigned different magnitudes among subjects, creating unique response functions for each subject. Possible explanations for unique uniform global pressure response functions could involve years of experience using a PTB socket, residual limb tissue thickness, and morphology or the way in which the amputation surgery was performed. For pressure variations at the fibula head and distal tibia, pressure sensation and perceived discomfort were highly correlated and appeared not to be distinct sensations. Response functions were similar among subjects. Psychophysical measurement could be adapted for use in a clinical setting during the fitting process and offer researchers additional tools for evaluating alternative socket designs and materials. The methods permit the patient to communicate discomfort sensations more precisely and provide the prosthetist with additional insight into the patient’s perception of quality of socket fit.

Measurement of Socket Discomfort???Part II: Signal Detection

The purpose of the study was to demonstrate how the psychophysical theory of signal detection (SDT) can be applied to the process of fitting sockets and used to model the ability of patients to make judgments concerning the expectation of discomfort problems when uncertainty exists. For experimental purposes, a signal was defined as the ability of a patient to detect aspects of socket geometry that could lead to discomfort or tissue breakdown after initial fitting. An experiment was designed that consisted of varying the check socket geometries for three transtibial amputees by inserting 1.6-mm and 2.6-mm thick wafers at the distal tibia and fibula head and asking the subjects to report the degree of certainty they had regarding the discomfort the socket might produce after a day of use. In addition, psychophysical category ratio scales were used to measure the magnitudes of the pressure, discomfort, and pain perceived by the subjects for each experimental condition. Two of the subjects were experienced prosthesis users, and the third was an inexperienced individual in the process of being fitted for a first temporary prosthesis. One experienced subject indicated with maximum certainty that any alteration which reduced relief at the distal tibia and fibula head by even 0.6 mm, the thinnest insert in the experiment (a pressure-sensing element), would produce intolerable discomfort. However, the other two subjects provided good experimental data representing a range of uncertainties, and receiver operating characteristic (ROC) curves were fitted to their responses. The curves for the inexperienced subject for the weakest signals presented (1.6-mm thickness) indicated performance no better than pure guessing, but performance improved for the thicker wafers (2.6-mm thickness). The ROC curves for the remaining experienced subject indicated much less uncertainty with the thinnest wafer and nearly perfect signal detection for the thicker wafer. Possible explanations for these results are presented. The paper also discusses how the probabilities associated with the four possible outcomes of the judgment task—hit, miss, correct rejection, and false alarm—are dependent on the relative costs and benefits of the outcomes.

Provisional implants: surgical and prosthetic aspects.

Although numerous technological advances have improved the ability of implant practitioners to successfully reconstruct dental implants, providing patients with teeth during the immediate postsurgical period has remained problematic. One solution has been the development of temporary implants. Such provisional implants eliminate the need for a tissue-borne prosthesis that may interfere with the healing of the submerged conventional implants and/or grafting material. This article describes the methodology for placing immediate provisional implants. Three alternative approaches to fabrication of the temporary prosthesis are discussed, and the results of 12 cases are reviewed.