RESUMEN
The coordinated management of gingival and esthetic problems is important in dentistry. In addition, the most difficult variable to control in the treatment of anterior esthetics is the soft tissue. This article discusses the relationship between the surrounding soft tissue and the emerging crown form. The authors introduce a soft-tissue index model technique that will help the technician in fabricating the final crown with a form similar to the provisional. In this case report, provisional crowns are fabricated with enough tissue support to provide for an optimal crown-gingival interface. The present case demonstrates how to manage the gingival margin in the provisional stage and how to transfer the provisional and soft tissue to the laboratory model.
Asunto(s)
Coronas , Estética Dental , Gingivectomía , Adulto , Restauración Dental Provisional , Femenino , Humanos , Incisivo , MaxilarRESUMEN
Because of the inconsistent results of periodontal and prosthetic therapy, periodontists may choose to treat maxillary molar furcation involvements (FI) with poor root morphology utilizing a root resection technique (RRT). In addition, poor root morphology of the remaining root following RRT is usually considered a high risk factor for long-term periodontal and prosthetic success. The purpose of this retrospective study was to investigate the differences in the clinical periodontal parameters between molar abutments with and without molar root separation and/or resection (RSR) before and after periodontal and prosthetic therapy, using a crown and sleeve-coping telescopic denture (CSCTD). A total of 85 molars (47 maxillary and 38 mandibular) were treated in 25 subjects. There were 33 abutments without root separation/resection and 52 abutments with RSR. Forty-three CSCTD were placed, 23 in the maxillary arch and 20 in the mandibular arch. The mean observation period was 6.7+/-1.9 years (range, 5 to 13 years). The plaque index, gingival index, probing depth, clinical attachment level, and alveolar bone change were recorded. The differences in these parameters before and after periodontal and prosthetic therapy between the advanced furcation-involved molars with and without RSR were evaluated. The results revealed a remarkable improvement in the periodontal parameters in advanced Class II and Class III FI in molars with RSR as compared to those without RSR. It was, therefore, concluded that molar abutments with RSR in conjunction with a specifically designed telescopic device provide a modified approach for treating molars with advanced Class II and III FI.
Asunto(s)
Coronas , Prótesis de Recubrimiento , Defectos de Furcación/cirugía , Diente Molar/cirugía , Raíz del Diente/cirugía , Adulto , Pérdida de Hueso Alveolar/clasificación , Pérdida de Hueso Alveolar/terapia , Pilares Dentales , Índice de Placa Dental , Femenino , Estudios de Seguimiento , Defectos de Furcación/tratamiento farmacológico , Defectos de Furcación/terapia , Humanos , Estudios Longitudinales , Masculino , Mandíbula , Maxilar , Persona de Mediana Edad , Pérdida de la Inserción Periodontal/clasificación , Pérdida de la Inserción Periodontal/terapia , Índice Periodontal , Bolsa Periodontal/clasificación , Bolsa Periodontal/terapia , Periodontitis/clasificación , Periodontitis/terapia , Estudios RetrospectivosRESUMEN
Although average measurements of the biologic zone do not necessarily reflect any one clinical situation, they do establish a basis upon which clinical decisions can be made. Clinical impressions, human autopsy material, and animal studies support the concept of a biologic width. Impingement on the attachment in a susceptible host has shown adverse reactions, including gingival inflammation and alveolar bone loss. The concept is clinically important in determining the extent of osseous surgery necessary in the exposure of sound tooth structure. If the implant-abutment interface is considered to be similar to a subgingival crown margin, its importance in relation to peri-implant inflammatory disease is readily apparent. In the presence of inflammation, it is likely that epithelial migration would occur to a level apical to that source. Clinical observations indicate that, once the biologic attachment is invaded around the implant, the gingival reactions are similar to those found around natural teeth, whether the tissue is of the thick flat or thin scalloped type.
Asunto(s)
Implantación Dental Endoósea , Pérdida de la Inserción Periodontal/etiología , Periodontitis/etiología , Periodoncio/anatomía & histología , Tejido Conectivo/anatomía & histología , Implantación Dental Endoósea/efectos adversos , Implantes Dentales , Inserción Epitelial/anatomía & histología , Estética Dental , Encía/anatomía & histología , Recesión Gingival/etiología , Humanos , Planificación de Atención al Paciente , Periodoncio/patología , Diente/anatomía & histologíaRESUMEN
This study presents a new classification of molar furcation involvement based on the root trunk and horizontal and vertical attachments, and relates them to guidelines in diagnosis, prognosis, and treatment of molar furcation involvements. The type of root trunk were classified on the basis of the ratio of vertical dimension of root trunk to root length as types A, B, and C. Based on the results of this study, the authors conclude that consideration of the root trunk type as well as the horizontal and vertical attachment loss in the classification of molar furcation involvements may facilitate prognosis, diagnosis, and treatment planning.
Asunto(s)
Pérdida de Hueso Alveolar/patología , Defectos de Furcación/clasificación , Diente Molar/patología , Raíz del Diente/patología , Defectos de Furcación/diagnóstico , Defectos de Furcación/terapia , Humanos , Odontometría , PronósticoRESUMEN
A revised stage-two technique, suitable for the severely resorbed mandible, is described. The objective is to eliminate mucosal mobility around the peri-implant area. This is achieved by means of a technique that limits the detachment of the lingual flap, augments the band of attached masticatory mucosa with a free gingival graft, deepens the vestibule, and prevents the reattachment of the muscles by means of a postsurgical stent.
Asunto(s)
Resorción Ósea/cirugía , Implantación Dental Endoósea/métodos , Arcada Edéntula/cirugía , Enfermedades Mandibulares/cirugía , Resorción Ósea/rehabilitación , Trasplante Óseo/métodos , Pilares Dentales , Músculos Faciales/cirugía , Encía/trasplante , Humanos , Arcada Edéntula/rehabilitación , Enfermedades Mandibulares/rehabilitación , Mucosa Bucal/cirugía , Oseointegración , Stents , Colgajos Quirúrgicos , VestibuloplastiaRESUMEN
This is a case report of a patient presenting to our clinic with a chief complaint of occlusal changes, but no clear-cut diagnosis of local origin could be found. The patient later was diagnosed with acromegaly. This rare systemic disease, caused by a slow-developing tumor of the pituitary gland, induces changes in various vital organs. Among them is a change in occlusion that can bring the patient to the dentist first. Dental professionals may be the first health care providers to see the signs and symptoms of acromegaly, and thus have the first opportunity to correctly diagnose this serious disease. This case demonstrates the importance of taking a thorough medical history and making a careful diagnosis before any dental treatment is recommended or undertaken.
Asunto(s)
Acromegalia/diagnóstico , Acromegalia/etiología , Maloclusión/etiología , Neoplasias Hipofisarias/complicaciones , Anciano , Diagnóstico Diferencial , Femenino , Humanos , Neoplasias Hipofisarias/diagnóstico , Neoplasias Hipofisarias/cirugíaRESUMEN
The crown and sleeve-coping (CSC) telescope denture is a removable prosthesis that is supported by both selectively retained teeth and the residual ridge or mucosa. Limited information regarding longitudinal studies of the CSC telescope denture has been reported as to the response of the abutments and their surrounding periodontal tissues to this type of design. The authors have documented a longitudinal ten-year follow-up of a case which was considered 'hopeless' for oral rehabilitation because of advanced periodontitis. The CSC telescope denture used in this case resulted in a significant improvement to the remaining dentition. The beneficial results of this form of treatment can be considered for a wide variety of clinical applications for the severely advanced periodontitis case.
Asunto(s)
Coronas , Diseño de Dentadura , Prótesis de Recubrimiento , Arcada Parcialmente Edéntula/rehabilitación , Periodontitis/terapia , Pérdida de Hueso Alveolar/terapia , Pilares Dentales , Raspado Dental , Retención de Dentadura , Dentadura Parcial Removible , Estudios de Seguimiento , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Rehabilitación Bucal , Pérdida de la Inserción Periodontal/terapia , Aplanamiento de la Raíz , Curetaje SubgingivalRESUMEN
The objective of the present study was to evaluate the long-term effectiveness of clinical trials of ultrasonic scaling performed solely by a periodontist. A total of 51 individuals (27 males and 24 females) ranging in age from 21 to 61 years with moderate to advanced periodontitis were investigated following baseline assessments included gingival index (GI), plaque index (PlI), probing pocket depths (PPDs), and probing attachment levels (PALs). The individuals were subjected to active supra- and subgingival ultrasonic scaling by a periodontist alone following meticulous oral hygiene instruction. The results revealed a significant (p < 0.001) reduction of mean GI and PlI scores. In addition, a significant and sustained reduction of mean PPDs (p < 0.001) as well as significant sustained gain of mean PALs (p < 0.001) with initial PPDs of 4-6 mm and > or = 7 were greater than those sites with initial PPDs of 1-3 mm at each time interval. Basically, there exists a greater reduction of mean PPDs and greater gain of mean PALs on the buccal and lingual sites than those on the mesial and distal sites at each time interval.
Asunto(s)
Placa Dental/diagnóstico por imagen , Raspado Dental , Periodontitis/terapia , Terapia por Ultrasonido , Adulto , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Pronóstico , UltrasonografíaRESUMEN
As single-tooth replacement becomes an accepted part of daily practice, demands for optimum esthetics in implant-supported crowns increase. Most healing abutments and transfer copings are round and do not simulate the normal cross section of anterior teeth, resulting in unnatural sulcular form around implant abutments. This article presents a simple and economical method to develop and reproduce an optimum emergence profile in the implant crown using standard Nobelpharma components.
Asunto(s)
Coronas , Implantes Dentales de Diente Único , Encía , Adulto , Pilares Dentales , Implantación Dental Endoósea/métodos , Diseño de Prótesis Dental , Estética Dental , Femenino , Humanos , Cicatrización de HeridasRESUMEN
Using endosseous implants to replace missing teeth is a highly predictable process when the precepts defined by Brånemark are followed. The question of whether or not to extract periodontally compromised teeth, however, remains controversial. This article presents a case report illustrating some of the concerns involved when treating a patient with a combination of natural teeth and implants, and proposes several compelling questions regarding the treatment decisions made in this case.
Asunto(s)
Implantación Dental Endoósea/métodos , Prótesis Dental de Soporte Implantado , Periodontitis/cirugía , Toma de Decisiones , Dentadura Parcial Fija , Femenino , Humanos , Maxilar , Persona de Mediana Edad , Pérdida de la Inserción Periodontal/etiología , Periodontitis/complicaciones , Colgajos Quirúrgicos , Extracción DentalRESUMEN
In an effort to provide realistic clinical information from a "real-world" environment, the present retrospective study was undertaken to assess outcome failures after implant placement in a dental school clinical training center. A database was kept of the clinical information and was analyzed according to established parameters for implant outcomes. The demographics showed that over a period of 6 years, 80 different operators with a wide range of clinical experience had inserted 1,263 implants in a diverse patient pool of 380 individuals. Analysis of the outcomes showed a cumulative survival rate of 91.3%. The time of explantation, the type, size, and location of implants lost, and failure rates in smoking patients were also analyzed. The results indicated that the use of implants by operators with different levels of experience did not affect favorable outcomes.
Asunto(s)
Implantación Dental Endoósea , Implantes Dentales , Adulto , Anciano , Fracaso de la Restauración Dental , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Fumar/efectos adversos , Insuficiencia del TratamientoRESUMEN
The purpose of the present study was to examine and evaluate the effect of clinical trials of non-surgical periodontal therapy (NSPT) by ultrasonic scaling alone for three years. A total of 51 individuals (27 males; 24 females) ranging in age from 21 to 61 years with moderately to extremely advanced periodontitis were studied following baseline assessments which included gingival index, plaque index, probing pocket depths, and probing attachment levels (PALs). The patients were subjected to NSPT by using supra- and subgingival scaling with ultrasonic instrumentation alone. The results showed that this therapy resulted in a pronounced and significant reduction (p < 0.001) of gingival inflammation and dental plaque formation for the 3 years of study. In addition, a significant reduction of probing depth as well as an obvious gain of PALs were found greater in sites with initial depth of 4-6 mm and 7 mm or more (p < 0.001) than those in sites with initial probings of 1-3 mm (p > 0.05) at each survey time point.
Asunto(s)
Placa Dental/diagnóstico por imagen , Periodontitis/terapia , Terapia por Ultrasonido , Adulto , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , UltrasonografíaRESUMEN
The anterior single-tooth implant restoration may be one of the most demanding procedures in dentistry. The edentulous area, implant anatomy, and implant component anatomy are just some of the factors that should be evaluated. Bone dimension, restorative dimension, and their relationship must also be considered. This article will review presurgical treatment planning for the anterior single-tooth implant restoration.
Asunto(s)
Implantación Dental Endoósea , Implantes Dentales , Diseño de Prótesis Dental , Arcada Parcialmente Edéntula/cirugía , Diente Artificial , Proceso Alveolar/patología , Pilares Dentales , Humanos , Incisivo , Planificación de Atención al Paciente , Periodoncio/patologíaRESUMEN
Periodontal prosthesis can be defined as "those restorative and prosthetic endeavors that are absolutely essential in the treatment of advanced periodontal disease". The sequence of therapy is planned so that the basic contributing factors of inflammation and trauma from occlusion are brought under control. Experimental and clinical research over the last decade has shifted the focus of periodontics towards increased use of guided tissue membrane techniques. Today, as a result of the longitudinal studies on the viability of endosseous implantology, implants used as an integral part of Periodontal Prosthesis now offer the patient and dentist a more stable and predictable restoration. These articles focus on the comprehensive treatment of the partially edentulous situation. The first two parts address diagnosis, treatment planning and treatment sequencing in the overall management of the compromised dentition.