RESUMEN
PURPOSE: This review was conducted to provide information to support the establishment of clinical guidelines for the treatment of maxillary edentulism using implant-supported fixed dental prostheses. MATERIALS AND METHODS: Initial efforts were directed toward a systematic review with a defined PICO question: "For maxillary edentulous patients with dental implants treated using a fixed prosthesis, what is the impact of prosthesis design on prosthesis survival and complications?" Following a title search of more than 3,000 titles identified by electronic search of PubMed, 180 articles were identified that addressed the clinical evaluation of maxillary dental implant prostheses. The broad methodologic heterogeneity and clinical variation among reports precluded this approach for a systematic review. The information was extracted using a standardized extraction table by two pairs of investigators, and the reported outcomes were then summarized according to reported outcomes for implant prostheses supported by four, six, or eight implants using unitary or segmented prostheses. RESULTS: This review indicated that high prosthetic survival is observed using all approaches. The advantages of using fewer implants and a unitary prosthesis are revealed in the surgical phases, and complications commonly involve the fracture or detachment of acrylic teeth and reduced access for proper oral hygiene and related biologic complications. Using six implants typically involved grafting of posterior regions with advantages of reduced cantilevers and redundancy of implant support. Reduced prosthesis survival in these cases was associated with poor implant distribution. Segmented prostheses supported by six or more implants offered greater prosthetic survival, perhaps due to posterior implant placement. Advantages of a segmented prosthesis included pragmatic issues of accommodating divergent implants, attaining passive fit, combining prosthetic materials, and relative simplicity of repair. CONCLUSION: The existing literature demonstrated that maxillary edentulism may be treated successfully using alternative approaches involving four, six, or more implants. The procedural diagnostics, treatment, and maintenance for these different approaches all require advanced knowledge and careful communication among the therapeutic team. The prosthetic therapeutic success requires maintenance, repair, and possible multiple replacements within the patient's lifetime.
Asunto(s)
Implantes Dentales , Prótesis Dental de Soporte Implantado/métodos , Maxilar/cirugía , Boca Edéntula/rehabilitación , Diseño de Prótesis Dental , Retención de Prótesis Dentales/normas , Fracaso de la Restauración Dental , Humanos , Planificación de Atención al Paciente , Encuestas y CuestionariosRESUMEN
OBJECTIVES: To evaluate prosthetic parameters in the edentulous anterior maxilla for decision making between fixed and removable implant prosthesis using virtual planning software. MATERIAL AND METHODS: CT- or DVT-scans of 43 patients (mean age 62 ± 8 years) with an edentulous maxilla were analyzed with the NobelGuide software. Implants (≥3.5 mm diameter, ≥10 mm length) were virtually placed in the optimal three-dimensional prosthetic position of all maxillary front teeth. Anatomical and prosthetic landmarks, including the cervical crown point (C-Point), the acrylic flange border (F-Point), and the implant-platform buccal-end (I-Point) were defined in each middle section to determine four measuring parameters: (1) acrylic flange height (FLHeight), (2) mucosal coverage (MucCov), (3) crown-Implant distance (CID) and (4) buccal prosthesis profile (ProsthProfile). Based on these parameters, all patients were assigned to one of three classes: (A) MucCov ≤ 0 mm and ProsthProfile≥45(0) allowing for fixed prosthesis, (B) MucCov = 0-5 mm and/or ProsthProfile = 30(0) -45(0) probably allowing for fixed prosthesis, and (C) MucCov ≥ 5 mm and/or ProsthProfile ≤ 30(0) where removable prosthesis is favorable. Statistical analyses included descriptive methods and non-parametric tests. RESULTS: Mean values were for FLHeight 10.0 mm, MucCov 5.6 mm, CID 7.4 mm, and ProsthProfile 39.1(0) . Seventy percent of patients fulfilled class C criteria (removable), 21% class B (probably fixed), and 2% class A (fixed), while in 7% (three patients) bone volume was insufficient for implant planning. CONCLUSIONS: The proposed classification and virtual planning procedure simplify the decision-making process regarding type of prosthesis and increase predictability of esthetic treatment outcomes. It was demonstrated that in the majority of cases, the space between the prosthetic crown and implant platform had to be filled with prosthetic materials.
Asunto(s)
Simulación por Computador , Coronas , Toma de Decisiones , Diseño de Prótesis Dental , Prótesis Dental de Soporte Implantado , Arcada Edéntula/rehabilitación , Maxilar/cirugía , Anciano , Anciano de 80 o más Años , Implantación Dental Endoósea , Implantes Dentales , Estética Dental , Femenino , Humanos , Masculino , Persona de Mediana Edad , Modelos Anatómicos , Planificación de Atención al Paciente , Programas Informáticos , Cirugía Asistida por Computador , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Healthy, well-structured mucosa may clinically disguise atrophic jawbone in preimplant diagnosis. PURPOSE: To analyze bone width in relation to the complete ridge thickness comparing the anterior with the posterior edentulous maxilla. MATERIALS AND METHODS: Data of 52 patients (mean age 62 ± 9 years) who were edentulous for at least 1 year and who received implant treatment were analyzed. Computed tomography (CT) scans were obtained and virtually analyzed in perpendicular sections of 12 maxillary positions (central and lateral incisors, canines, premolars, and first molars) using an implant planning software. Absolute thickness of complete jaw, bone, and mucosa were digitally measured at crestal and basal ridge levels allowing for relative bone width (B-rel) calculation. RESULTS: Mean B-rel at crestal levels was lower than at basal levels (38.6% vs 51.5%, p < .001). Bone width increased significantly (p < .001) in the posterior maxilla at both levels, whereas the thickness of palatal and buccal mucosa was considerably stable. Mean basal B-rel ranged from 49% (6.2 ± 2.0 mm) at incisors to 59% (9.0 ± 2.3 mm) at first molars (p < .001). Mean proportion of regions showing B-rel < 50% were 43% at basal and 80% at crestal levels. CONCLUSIONS: The osseous volume of a large edentulous ridge might be clinically overestimated in preimplant diagnosis, as the relative bone width was generally lower than 50%. Clinicians can use the present results of the virtual bone and mucosa measurements to have a better first estimation of the osseous proportion depending on the maxillary area. However, up to date implant therapy for the edentulous maxilla requires CT-based prosthetically driven implant planning and preferably combination with guided implant placement by transferring planning information to a surgical template.
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Arco Dental/diagnóstico por imagen , Arcada Edéntula/diagnóstico por imagen , Maxilar/diagnóstico por imagen , Planificación de Atención al Paciente , Tomografía Computarizada por Rayos X/métodos , Proceso Alveolar/diagnóstico por imagen , Cefalometría/métodos , Tomografía Computarizada de Haz Cónico/métodos , Femenino , Humanos , Imagenología Tridimensional/métodos , Masculino , Persona de Mediana Edad , Mucosa Bucal/diagnóstico por imagen , Mucosa Bucal/patología , Tomografía Computarizada Multidetector/métodos , Paladar Duro/diagnóstico por imagen , Paladar Duro/patología , Interpretación de Imagen Radiográfica Asistida por Computador/métodos , Programas Informáticos , Interfaz Usuario-ComputadorRESUMEN
The aim of this study was to compare data on design and fabrication methods of removable partial dentures (RPDs) in two major cities in Greece. A questionnaire was sent to 150 randomly selected dental technicians. The participation rate was 79.3%. The anterior palatal strap, the lingual bar, and the Roach-type clasp arm designs were preferred. Half of the RPDs fabricated were retained using precision attachments. Differences between the two cities were observed in types of major maxillary connectors used, types of attachments and impression materials used, as well as the design of distal-extension RPDs. Postdoctoral education was found to have an impact on RPD fabrication. Despite the differences observed, design and fabrication of RPDs followed commonly used principles.
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Diseño de Dentadura , Dentadura Parcial Removible , Laboratorios Odontológicos , Alginatos/química , Aleaciones de Cromo/química , Abrazadera Dental , Materiales de Impresión Dental/clasificación , Técnica de Impresión Dental/instrumentación , Técnicos Dentales/educación , Ajuste de Precisión de Prótesis , Retención de Dentadura/instrumentación , Educación Continua , Grecia , Humanos , Polivinilos/química , Siloxanos/química , Propiedades de Superficie , Encuestas y Cuestionarios , Tecnología Odontológica/educaciónRESUMEN
INTRODUCTION: This audit reports on the oral and general health of patients who were treated in a dental consultation clinic of a geriatric hospital. MATERIAL AND METHODS: Dental and medical records were obtained from 112 female and 80 male patients (mean age, 83.7 ± 8.2 years) who attended a dental consultation. Data analysis included the general health [American Society of Anesthesiologists (ASA) classification, number of diagnoses, cognitive function] and dental state in the age strata 60-69, 70-79, 80-89 and 90-99 years. RESULTS: Seventy-four per cent of patients were aged over 80 years. The prevalence of ASA-P4 and P3 varied between age groups. Most patients (>86%) had more than three chronic diseases. Cognitive impairment was present in almost half of both older age cohorts (43 and 50%). Half of the patients (52%) were edentulous. In dentate patients, the average number of teeth was 12 ± 6 and differed in the maxilla significantly between age groups (p = 0.005). There was no significant association between dental state, ASA classification and systemic conditions. CONCLUSIONS: The profile of this cohort reflects a poor oral and general health status. The results underline the importance of an interdisciplinary consultation in a geriatric ward where oral health care is an integral part.
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Servicio Odontológico Hospitalario , Geriatría , Estado de Salud , Hospitales Especializados , Salud Bucal , Factores de Edad , Anciano , Anciano de 80 o más Años , Enfermedad Crónica , Trastornos del Conocimiento/clasificación , Estudios de Cohortes , Auditoría Odontológica , Femenino , Anciano Frágil , Evaluación Geriátrica , Humanos , Institucionalización , Arcada Parcialmente Edéntula/clasificación , Masculino , Maxilar/patología , Persona de Mediana Edad , Boca Edéntula/clasificación , Enfermedades Periodontales/clasificación , Estudios Retrospectivos , Factores Sexuales , SuizaRESUMEN
BACKGROUND: Resonance frequency analysis (RFA) is a noninvasive technique for the quantitative assessment of implant stability. Information on the implant stability quotient (ISQ) of transmucosally inserted implants is limited. PURPOSE: The aim of this investigation was to compare the ISQ of conventionally inserted implants by raising a muco-periostal flap with implants inserted using a flapless procedure. MATERIALS AND METHODS: Forty elderly patients with complete edentulous maxilla were consecutively admitted for treatment with implant-supported prostheses. A computer tomography was obtained for the computer-assisted implant planning. One hundred ten implants were placed conventionally in 23 patients (flap-group) and 85 implants in 17 patients by means of the flapless method (flapless-group) using a stereolithographic template. RFA measurements were performed after implant placement (baseline) and after a healing time of 12 weeks (reentry). RESULTS: All implants exhibited clinically and radiographically successful osseointegration. Bone level did not change significantly neither for genders nor type of surgical protocol. Mean ISQ values of the flapless-group were significantly higher at baseline (p < .001) and at reentry (p < .001) compared with the flap-group. The ISQ values were significantly lower at reentry compared with baseline for the flap-group (p = .028) but not for the flapless-group. This group showed a moderate, but insignificant increase. RFA measurements of males resulted in ISQ values that were thoroughly higher as compared with females at both time-points in both groups. Correlation between RFA and bone level was not found. CONCLUSIONS: The flapless procedure showed favorable conditions with regard to implant stability and crestal bone level. Some changes of the ISQ values that represent primary (mechanical) and secondary (bone remodeling) implant stability were observed in slight favor of the flapless method and male patients. In properly planned and well-selected cases, the minimal invasive transmucosal technique using a drill-guide is a safe procedure.