Total Edentulism Research Articles

Telemedicine consulting in the patient preparation and planning of prosthetic tooth replacement

In the management of edentulous spaces, there is a permanent need of a dentist-prosthetician in charge to consult other specialists. Modern telemedicine, based on powerful computer and telecomunication systems, offers an adequate answer to these challenges, being able to transfer and obtain clinical data and consultation information over large distances. Using smartphone or a computer, the teleconsultant acces the system, downloads and review the data and photographs and gave suggestions. The system then enables direct, real time contact with the consultant, chat, or directs them to contact each other by phone. We presented telemedicine consulting in the patient preparation and planning of prosthetic tooth replacement in 3 cases with different teleconsultation requirements: the first case for prosthetic rehabilitation of his upper teeth, the second one for prosthetic management of his partial edentulousness and "a growth on his gums" in the vestibular region of the frontal teeth and the third one for prosthetic management of total edentulousness of her upper jaw. We used the system of telemedicine in dentistry, established at the Faculty of Medicine in Kosovska Mitrovica. The operation was based on the computer application system XPA3 Online, computer networking and mobile smartphone network. All consultations were succefull with no need for further procedures in regional center. The use of a mobile smartphone has brought about the mobility and availability of teleconsultant specialists in an extent never seen before. Prostheticians are thus able to offer better service to their patients and improve the quality of management of partially or totally edentulous patients, especially in rural areas.

Total Reconstruction of the Atrophic Maxilla with Intraoral Bone Grafts and Biomaterials: A Prospective Clinical Study with Cone Beam Computed Tomography Validation

To perform a preliminary validation with cone beam computed tomography (CBCT) of the combined use of intraoral bone blocks and biomaterials for total reconstruction of the atrophic maxilla. Consecutive cases of total edentulism of the maxilla (Cawood and Howell classes IV or V) treated with bilateral sinus floor elevation, mandibular bone block grafts, and biomaterials were evaluated prospectively. Implants were placed 14 to 16 weeks after grafting. Each patient received a CBCT scan preoperatively, immediately after bone augmentation, and at reentry. A three-dimensional reconstruction of the maxilla with volumetric calculations was obtained at each stage. Fourteen patients participated. Successful graft integration occurred in all cases, with no major complications. Mean preoperative volume was 11,312 mm3. Mean postoperative volume was 19,997 mm3 immediately after surgery and 19,042 mm3 before implant insertion. The average percentage volumetric increase between the preoperative condition and the situation at reentry was 71.99%. One hundred eight implants were inserted. Immediate loading was possible with 81 implants in 10 patients. The rehabilitation of the severely resorbed maxilla remains a formidable challenge. The results of this study suggest that the use of mandibular bone blocks in combination with biomaterials is an effective, reliable procedure for the rehabilitation of the severely resorbed maxilla. Significant volume increases and adequate stability of the augmented areas at reentry were found with CBCT analysis. The grafted bone provided sufficient mechanical support to permit provisionalization and immediate loading. This technique enabled the restoration of function and esthetics with a fixed rehabilitation at 4 months.

Need and Demand of Removable Dentures by Jordanian Adults and Relationship to Socioeconomic Factors

Aim: In Jordan, there is no available studies that investigated the association between complete edentulism and socioeconomic factors. The aim of this study therefore was to assess the need and demand for complete and partial dentures by Jordanian adults and assess the relationship between socio-demographic variables with complete edentulism. Materials and Methods: The study group consisted of 600 patients. A pilot-tested questionnaire was presented to the participants The variable studied were: age, gender, education status, economic status, smoking status, dental health insurance and dental preventive attitude. Results: The results showed that 173 patients (28.9%) were allocated in the 51-60 age bands in contrast to 73 subjects (12.16%) from the 61-70 age group. Among the 600 subjects, 403 (67.17%) needed complete dentures (308 needed upper and lower, 95 needed single complete dentures). Removable partial dentures were needed by 197 (32.8%) of subjects. Of the patients with no education112 of 308 patients applied for upper and lower complete dentures compared to 18/197 subjects who needed removable partial dentures and 20/95 subjects who needed single complete dentures. Among the 259 subjects with low monthly income of 150 JD, 210 (68.2%) subjects needed upper and lower complete dentures, There was no significant difference in denture demand among patients with dental health insurance (p>0.05). Sixty-five subjects of the 348 with no preventive attitude needed partial dentures in a significant comparison to 283 (81%) who applied for complete dentures (p<0.05). Over 65% of the subjects were smokers with over 74% of them required removable complete dentures. Conclusion: It is concluded that in addition to addressing the non-disease factors, dental education should be targeted at the un-educated population, and low-income groups to reduce the rate of total edentulism.

Socioeconomic Factors and Complete Edentulism in North Karnataka Population

Complete edentulism is the terminal outcome of a multifactorial process involving biological factors and patient related factors. Tooth loss associated with periodontal disease and caries has an apparent impact on an individual's quality of life, and has been associated with lower levels of satisfaction with life and a lower morale. The rate of total edentulism is said to be increasing in developing countries and this had been attributed mainly to the high prevalence of periodontal diseases and caries. The distribution and prevelance of complete edentulism between developed and less developed countries may be associated with a complex interrelationship between cultural, individual, attitude, behavior, dental attendance, etiopathogenesis of edentulism, access to care and socioeconomic factors. The purpose of this study was to assess the relationship between socio-demographic factors and edentulism. In order to plan for future oral health care provisions for the society, collecting epidemiological data on oral health particularly related to prosthodontics and its related issues are very important.

Five-Year Results of Implants Inserted Into Freeze-Dried Block Allografts

The purpose of this study was to evaluate the outcome after 5 years of allografts as bone growth material and success of implants inserted in fresh-frozen allograft bone. A total of 20 patients were operated and 41 onlay block freeze-dried allografts (calvarial and iliac crest) were inserted for bone augmentation. A total of 64 dental implants were performed in a two-stage procedure. Four patients had total edentulism and 16 had partial edentulism. A total of 41 onlay block allografts were used to augment atrophic maxillae and mandibles in 20 patients. In five cases, there were horizontal and vertical augmentations. Exposure of bone allograft occurred in three cases during the first 6 weeks; all of them located in the posterior area. There were no postoperative effects in any of the cases. Fracture was observed in one case, the remaining bone was adequate to place the implants. Sixty-two dental implants were placed at second stage surgery. There was no loss of implants. The use of fresh-frozen allogenic bone blocks can be considered as being reliable for reconstruction of maxillomandibular defects.

Closure of persistent oro-nasal fistula with removable obturator denture

Introduction. Cleft lip and cleft palate are relatively common congenital deformities. Patients with clefts require multidisciplinary treatment approach and a team which may include a maxillofacial surgeon, orthodontist, speech therapist, pediatrician, prosthetician, psychologist, as well as the relevant experts who may be of help in restoring the function of the orofacial system. Case report. The paper describes a case of prosthetic rehabilitation of an edentulous female patient with oronasal fistula, after multiple surgical interventions performed in various medical institutions in order to treat her cleft primary and secondary palate. Conclusion. Well planned prosthetic treatment of adult patients with cleft palate and total edentulousness can produce satisfactory results in view of both function and esthetics.

One‐Year Results of a Clinical and Radiological Prospective Multicenter Study on NEOSS® Dental Implants

NEOSS® (Neoss Ltd., Harrogate, UK) dental implant system was introduced on the clinical arena in 2003. It is important that novel implant systems are systematically evaluated in a multicenter setting. The aim of this study was to follow a large number of consecutively treated patients, with NEOSS dental implant system, both clinically and radiographically. The current report constitutes the 1-year data of a planned 5-year study. The study included a total of 177 patients treated with 590 NEOSS implants at 13 clinics in Sweden. The material was composed of 72 males and 105 females treated for single, partial, and total edentulism. Clinical, radiographic, and subjective evaluations were performed. Out of 590 implants, 13 early failures have been reported, corresponding to a 1-year cumulative survival rate (CSR) of 97.8%. Evaluation of function and esthetics at the 1-year visit resulted in 100% success for function and 98% success for the esthetic outcome. The mean marginal bone loss was 0.6 mm (SD 1.1) after 1 year in clinical function. No adverse effects of the NEOSS dental implants were reported, and complications were few and similar to those reported for implant treatment in general. The CSR in the present study was 97.8%. No adverse effects of the NEOSS implants were reported, and complications during the study period were few and similar to those reported to for other well-documented implants system. Based on the present data, we conclude that NEOSS dental implant is a safe and predictable implant system. However, the high number of dropouts in the radiological evaluation must be considered when interpreting the data.

DEGREE OF PROMINENCE OF PALATAL EXOSTOSIS AND SPECIFICITIES OF FABRICATION OF TOTAL PROSTHESIS

Torus palatinus (TP) is a benign, slow-growing bony protrusion of varying shape and size, most commonly situated along the sutura mediana in the frontal or back third of the hard palate. A large discrepancy in the resilience of its musocal envelope and adjacent mucosa (resilient zones by Shroeder), especially in cases with large protrusions, can bring about the problems in the manufacture of total prostheses and especially in wearing them („rocking“, fracture of the prosthesis along the palatal midline, injury to the mucosa in the region of TP, etc.). This paper presents in extenso the plan of the administered prosthetic treatment of a female patient aged 62 years, admitted to the clinic because of total edentulousness of the upper jaw and a very distinct TP. After clinical examination and necessary consultations with an oral surgeon, using the method of selective decompression of TP during the functional imprint acquisition, an upper total prosthesis was manufactured with a small chamber in the region. Possible complications mentioned above were thus avoided, and the patient adapted to the prosthesis completely after one common reocclusion and two control visits. Acta Medica Medianae 2011;50(1):54-59.

China's oral care system in transition: lessons to be learned from Germany.

AimThe objective of this discussion paper is to investigate whether the experience gained through the German paradigm shift in dental care can be of benefit in China's deliberations on the introduction of universal dental care for its people.MethodologyA comparison of representative oral health outcome data from China and Germany, two countries at different stages in their development, is presented here in order to analyse whether the findings meet expected outcome and confirm the presumption that more developed countries perform better.ResultsThe epidemiological comparison reveals surprising findings concerning the severity of dental diseases and, in particular, missing teeth per person in adults and rates of total edentulousness in seniors. In all of these areas German adults and seniors show significantly inferior outcomes compared with the Chinese population. The main reason for these striking discrepancies, as it turned out, is the decisive role played by the treatment philosophies and strategies of German dentists.Conclusion and recommendationsIf dentists take a less interventionist approach, checking as well as treating dental diseases with preventive and strictly tooth-preserving methods, dental treatment results in oral health. Under these conditions it can be assumed that modern dentistry is generally good for the teeth. These findings are important for developing countries that are seeking to integrate dental care into their health care system. On the basis of long-term experience from highly industrialized Western countries and especially from Germany we will attempt to put forward proposals for creating an effective and efficient dental care system in China.

Perda dentária em uma população rural e as metas estabelecidas pela Organização Mundial de Saúde

This study aimed to report the dental loss in a rural population, evaluating the contribution of socioeconomic and behavioral variables and comparing the results with the goals of the World Health Organization (WHO) for 2000 and 2010. A total of 473 residents had been examined using the methodology, codes and criteria according to WHO guidelines. The results were processed using the Epibuco program and the chi-square test (p<0.05) were used to compare the number of teeth lost with the variables studied. From the total of people examined, 17.8% were total edentulous as well as 8% and 50.9% of the examined of the age groups of 35 to 44 and 65 to 74 years-old, respectively. Initiating precociously in his population, the dental loss advanced considerably with the age, being the situation much distant of the goals established by WHO for 2010. Chi-square test revealed statistically significant differences among the number of teeth lost by the interviewed with 35 years-old or more in relation to education level, housing and self-perception of the speak quality. The development of oral health attention programs becomes necessary, in order to reduce the actual damages and to prevent the continuity of this trend of mutilation.

A Retrospective Study on 287 Implants Installed in Resorbed Maxillae Grafted with Fresh Frozen Allogenous Bone

Several studies have been performed to evaluate the clinical outcome of implants inserted into maxillae grafted with autogenous bone but few reports have focused on maxillae grafted with fresh-frozen allogenous bone (FFAB). The purpose of this study is to retrospectively evaluate the clinical outcome of implants installed in resorbed maxillae augmented with FFAB. A total of 69 patients whom had been treated with FFAB grafts to their maxillae and implant placement 4 to 6 months later were retrospectively evaluated. Edentulism was total and partial in 22 and 47 cases, respectively. A total of 287 implants of various systems had been used. A life table analysis was performed. Marginal bone loss was calculated in radiographs. Five of the 287 implants were lost, giving a survival rate (SVR) of 98.3% over a mean follow-up time of 26 months. The marginal bone resorption at the implants was 1.68 mm (SD = 0.44) after 1 year and 1.85 mm (SD = 0.98) after 4 years. The cumulative success rate based on defined criteria was 96% in the first year but decreased to 40% at 4 years because of marginal bone loss. The Kaplan-Meier algorithm demonstrated a better outcome for female patients, removable dentures, and total edentulism. No differences were detected among diameters, lengths, and implant site. Implants placed in FFAB showed a high SVR similar to that reported in previous studies on maxillae grafted with autogenous iliac crest bone. Although our data point to more marginal bone loss in partially edentulous patients and for fixed prosthetic restorations, the use of FFAB for reconstruction of the atrophic jaw prior to implant placement can be considered as a reliable alternative to autogenous bone.

Immediate/Early Loading of Zygomatic Implants: Clinical Experiences after 2 to 5 Years of Follow‐up

Conventional prosthetic treatment of the edentulous and resorbed maxilla with zygomatic implants is a lengthy procedure. Today, immediate/early loading is a clinical reality and it is possible that such protocols could be used also for zygomatic implants. The aim of the present study is to report on the clinical outcomes of immediate/early loading of zygomatic implants for prosthetic rehabilitation of edentulous and severely resorbed maxillary cases. A total of 47 zygomatic and 129 regular implants were placed in 25 consecutive patients with total (N = 23) or partial (N = 2) edentulism in the maxilla. The patients had less than 4 mm of available bone height and width distal to the canine pillars. Straight and angulated abutments and impression copings were attached to the implants during surgery. Impressions and bite registrations were made and 19 patients received a bridge within 24 hours and six patients were rehabilitated within 5 days. Screw-retained full arch restorations were used in 23 patients and cemented in 2 patients. The patients were instructed for a soft diet during 4 months. Follow-up controls were performed at 1, 4, and 12 months and thereafter annually. All patients were followed for at least 2 years and up to 5 years in function. All zygomatic implants were stable during the follow-up (cumulative survival rate 100%). One regular implant placed in the pterygoid plate failed after 52 months of loading (cumulative survival rate 99.2%). Apart from fracture of one abutment screw and of anterior teeth in five patients, no other complications were noted. Within the limitations of the present study, it is concluded that immediate/early loading is a viable treatment modality for prosthetic rehabilitation of the severely resorbed maxilla using zygomatic and conventional implants.

Numerical Simulations of the Global Behaviour of Implant Supported or Retained Dental Prostheses

In spite of the recent efforts concerning prevention and treatment of dental diseases, total edentulism remains an important world health problem, even in industrialized countries. Different solutions to mandibular total edentulism are available from the classical removable denture to the implant supported prostheses. The aim of the present work is to compare, through finite element simulations, two distinct types of prosthetic solutions. The first one is an implant-supported prosthesis (ISP) using a “All-On-Four” base and the second one is a mandibular implant-retained overdenture (IRO) using two implants. A foodstuff situated on molar is modelled to simulate the mastication force. An orthotropic behaviour is assumed inside the symphyseal area. The results of the simulations show a strong influence of the prosthetic solution type on the stress and strain repartition in the implant and peri-implant bone. This can be explained by the difference of load transfer to bone between those two configurations. Indeed, in the implant-supported prosthesis, the totality of the mastication force is directly transmitted to peri-implant bone whereas the implant-retained solution benefits from a large participation of mucosa to the global load transfer from overdenture to bone.

A Novel Decision‐Making Process for Tooth Retention or Extraction

Implant-supported restorations have become the most popular therapeutic option for professionals and patients for the treatment of total and partial edentulism. When implants are placed in an ideal position, with adequate prosthetic loading and proper maintenance, they can have success rates >90% over 15 years of function. Implants may be considered a better therapeutic alternative than performing more extensive conservative procedures in an attempt to save or maintain a compromised tooth. Inadequate indication for tooth extraction has resulted in the sacrifice of many sound savable teeth. This article presents a chart that can assist clinicians in making the right decision when they are deciding which route to take. Articles published in peer-reviewed English journals were selected using several scientific databases and subsequently reviewed. Book sources were also searched. Individual tooth- and patient-related features were thoroughly analyzed, particularly when determining if a tooth should be indicated for extraction. A color-based decision-making chart with six different levels, including several factors, was developed based upon available scientific literature. The rationale for including these factors is provided, and its interpretation is justified with literature support. The decision-making chart provided may serve as a reference guide for dentists when making the decision to save or extract a compromised tooth.

Mandibles Grafted With Fresh-Frozen Bone: An Evaluation of Implant Outcome

In the last decade several studies have been performed to evaluate the clinical outcome of implants inserted into grafted mandibles with autologous bone, but none is available on mandibles grafted with fresh-frozen bone. Thus, we planned a retrospective study on a series of implants inserted into homologue fresh-frozen bone to evaluate their clinical outcome. Twenty-one patients were operated on, 28 onlay grafts were inserted into the mandible, and 63 implants placed. Patients had total and partial edentulism in 11 and 10 cases, respectively. The mean follow-up was 20 months. No or reduced crestal bone resorption was considered an indicator of success rate to evaluate the effect of several host-, implant-, and occlusal-related factors. The difference between the implant-abutment junction and the bone crestal level was defined as the implant abutment junction (IAJ) and calculated at the time of operation and during follow-up by means of radiographs. Delta IAJ, the difference between theIAJ at the last check-up and the IAJ recorded just after the operation, were stratified according to variables of interests. Kaplan-Meier algorithm and Cox regression were then performed to detect those variables statistically associated with the delta IAJ. Only 2 of 63 implants were lost (i.e., survival rates = 96.8%) and no differences were detected among the studied variables. On the contrary, Cox regression showed that prosthetic restoration (i.e., removable dentures) was the only factor correlated with a statistically significant lower delta IAJ (i.e., reduced crestal bone loss) and thus a better clinical outcome. Implants inserted into mandibles grafted with fresh-frozen bone allografts have high survival rates and success rate, which are comparable with those obtained with autologous iliac crest bone grafts.

S316: Basic Surgical and Prosthetic Aspects of Implant-Supported Overdentures

Total edentulism has been noted in 5% of adults who are 40-44 years old. This percentage gradually increases to almost 42% in seniors. By the time the baby boomers reach ages 65 and higher, it is expected that the number of fully edentulous patients will become even higher.

S411: Basic Surgical and Prosthetic Aspects of Implant-Supported Overdentures

Total edentulism has been noted in 5% of adults who are 40-44 years old. This percentage gradually increases to almost 42% in seniors. By the time the baby boomers reach ages 65 and higher, it is expected that the number of fully edentulous patients will become even higher. The majority of general dentists are still fabricating conventional complete removable dentures for their fully edentulous patients. However, many of the patients experience instability of the lower denture and progressive loss of alveolar ridge. The implant supported overdenture is a cost effective treatment modality for the edentulous patient. Education on how to evaluate and treat patients for an implant supported overdenture is paramount in providing excellent care without generating excessive expenses. One of the reasons contributing to the lack of interest among restorative dentists to offer implant supported overdentures is the availability of over two hundred different implant attachments. This creates confusion regarding the choice of attachment for each clinical situation. Implant supported overdentures should be standard of care for all of the fully edentulous patients. Conventional removable complete denture should be offered to patients only if there is a medical or dental contraindication for implant placement. Discussion will focus on:a)Guidelines for patient selection, indications and contraindications for implant-supported overdentureb)Biomechanical analysis of different implant-supported overdenturesc)Attachment selection guideline for implant-supported overdenturesd)Various occlusal schemes for implant-supported overdenturese)Maximizing the communication between oral surgeon, restorative dentist and lab technicianf)Surgical considerations for immediate implant placement and loading in fixed detachable implant supported overdentureg)Common surgical mistakes in implant overdenture surgeries, reasons and solutionsh)Surgical considerations associated with implant overdentures utilizing mini implants.

Dental state, prosthodontic treatment and chewing ability – a study of five cohorts of 70‐year‐old subjects

The aim was to study the relationship between dental state, prosthetic rehabilitation and chewing ability in 70-year-old subjects examined between 1971 and 2001. Five birth cohorts born in 1901/1902 (I), 1906/1907 (II), 1911/1912(III), 1922 (V), and 1930 (VI) were examined at 70 years of age. The number of participants in the odontological cohorts varied between 386 and 583. The prevalence of total edentulism changed from 51% in cohort I to 7% in cohort VI. The proportion of subjects using removable dentures decreased from 76% to 17%, whereas those with >or=20 teeth increased from 13% to 65%. The prevalence of subjects with fixed partial dentures increased from 26% to 58%. Of the 70-year-old subjects examined in 2001, 5% had implant-supported restorations. The self-assessed chewing ability showed only weak associations with dental state, and there was no significant cohort trend. When all cohorts were pooled together, 80% considered their chewing ability good, 16% less good and 4% poor. Among the edentulous subjects, more individuals complained about poor chewing ability in the last two cohorts than in the first three. It was concluded that there were great differences in dental state between the five cohorts of 70-year-old subjects examined from 1971 to 2001. Edentulism and wearing of removable dentures decreased substantially, whereas the proportion of subjects with fixed partial dentures showed a marked increase. In spite of the improved dental state, the self-assessed chewing ability exhibited only minor variation over time.

Finite element analysis of a mandibular implant-retained overdenture

In spite of the recent efforts concerning prevention and treatment of dental diseases, total edentulism remains an important world health problem, even in industrialized countries. Different soluti...

《再生医療と歯科補綴学の接点》補綴治療における再生医療のニーズと現時点での研究動向―確実かつ質の高いインプラント治療をめざして―

Appropriate dental implants are known to improve the quality of life in totally and partially edentulous patients, as well as to prevent future tooth loss, and so prosthetic treatment modalities have drastically changed recently with reconstruction therapy. However, dental implant therapy did not win the confidence of the dental community in the early developmental stage, until osseointegration between titanium and surrounding bone tissue was discovered and the modality utilizing osseointegration became reliable and produced durable treatment outcomes for long-term function. On the other hand, the biological mechanism of osseointegration has not been clarified yet and the time required for osseointegration is still long, e.g. three to four months. As well, when the implant is applied in the upper posterior region, the acquisition of osseointegration and the long-term survival of the implant are still not clinically adequate. Therefore, to reduce the time required for osseointegration and to regenerate enough alveolar bone mass in the target implantation site, the oral implant modality must be made more useful and potent as one of the treatment options for partial and total edentulism. With this background, we have studied biological strategies for reducing the time required for osseointegration and for regenerating enough alveolar bone mass, e.g., investigation of the specific genes for osseointegration between titanium and bone, nano-level surface modification of the titanium, biodegradable apatite foam for alveolar bone regeneration, application of bone formation-related growth factors with biological scaffold, and autologous cell transplantation of bone marrow derived mesenchymal stem cells. In this article, we review the current status of regenerative medicine being applied in prosthodontics and discuss our future research direction.