RESUMEN
PURPOSE: This study aimed to investigate the impact of preradiation tooth loss in patients with head and neck cancer. MATERIALS AND METHODS: Records of 397 (partially) dentate patients who were referred for preradiation oral screening were included. Number and location of teeth lost and occluding pairs lost were determined for different tumor locations. RESULTS: The majority of patients (54%) were affected by tooth loss. Proportion of teeth lost, their location, and proportion of occluding pairs lost were not evenly distributed across tumor locations. The highest proportions of teeth were removed with oral tumors (maxilla: 25%; mandible: 47%). For preradiation preventive extractions only, ie, not taking into account teeth that were lost due to ablative surgery, tooth loss in the mandible was still not evenly distributed across tumor locations, but tooth loss in the maxilla and occluding pairs lost were. CONCLUSIONS: Tumor location affects preradiation tooth loss, though this is primarily a consequence of ablative surgery rather than a consequence of preradiation dental extraction decisions. Since patients with oral cavity tumors are affected most by preradiation tooth loss, treatment planning with regard to functional rehabilitation is desirable for this patient group in particular.
Asunto(s)
Neoplasias de Cabeza y Cuello/radioterapia , Extracción Dental/métodos , Pérdida de Diente/etiología , Anciano , Neoplasias de Cabeza y Cuello/cirugía , Humanos , Neoplasias Laríngeas/radioterapia , Neoplasias Laríngeas/cirugía , Neoplasias Mandibulares/radioterapia , Neoplasias Mandibulares/cirugía , Neoplasias Maxilares/radioterapia , Neoplasias Maxilares/cirugía , Persona de Mediana Edad , Neoplasias de la Boca/radioterapia , Neoplasias de la Boca/cirugía , Neoplasias Nasales/radioterapia , Neoplasias Nasales/cirugía , Planificación de Atención al Paciente , Neoplasias Faríngeas/radioterapia , Neoplasias Faríngeas/cirugía , Dosificación Radioterapéutica , Neoplasias de las Glándulas Salivales/radioterapia , Neoplasias de las Glándulas Salivales/cirugíaRESUMEN
AIM: To determine effects of integrated dental care in older nursing home residents. METHODS: In three nursing homes offering integrated dental care, we studied the oral treatment need of 355 residents older than 70 years. To determine effects of integrated care, we discriminated between short-stay residents (≤6 months) and long-term residents (>6 months). RESULTS: Treatment need, determined intraorally by two dentists, remains high among short-stay residents (78%) and long-term residents (67%). The association between treatment need and length of stay was not significantly affected by indication for stay (somatic vs. psychogeriatric). All dentate residents needed oral treatment, except one long-term resident. However, among edentulous residents, particularly with a psychogeriatric indication for stay, treatment need appeared to reduce significantly in time, from 74% to 57%. CONCLUSION: Despite integrated dental care, oral treatment need remains in virtually all dentate residents and more than half of edentulous residents.
Asunto(s)
Cuidado Dental para Ancianos/organización & administración , Necesidades y Demandas de Servicios de Salud , Casas de Salud , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Países BajosRESUMEN
PURPOSE: To determine whether clinical findings-bleeding on probing, pocket depth, recession, and bacterial sampling-correlate with histologic outcomes in relatively healthy peri-implant soft tissues in people. MATERIALS AND METHODS: In this cross-sectional study, a convenience sample of 20 edentulous subjects received two endosseous mandibular implants each. The abutments were either zirconia (ZrO2) or titanium (Ti) (nonsubmerged implant placement, within-subject comparison, leftright randomization). Sulcular bacterial sampling and assessment of probing pocket depth, recession, and bleeding on probing were performed 3 months postsurgery. Mucosal biopsy specimens were obtained, and the blood vessel density and a score on an inflammation grading scale were determined. RESULTS: Simple linear and linear regression models revealed that the clinical or microbiologic parameters were not associated with either of the histologic parameters. The soft tissues impressed as healthy, regardless of the abutment material. CONCLUSIONS: The peri-implant mucosa around ZrO2and Ti abutments was considered healthy in most situations when examined histologically after 3 months but showed variation in clinical and microbiologic parameters.
Asunto(s)
Diseño de Implante Dental-Pilar , Materiales Dentales , Periodoncio/patología , Adulto , Anciano , Bacterias/clasificación , Biopsia/métodos , Células del Tejido Conectivo/patología , Estudios Transversales , Placa Dental/microbiología , Femenino , Fibroblastos/patología , Estudios de Seguimiento , Recesión Gingival/clasificación , Humanos , Inflamación , Arcada Edéntula/rehabilitación , Arcada Edéntula/cirugía , Masculino , Mandíbula/cirugía , Persona de Mediana Edad , Índice Periodontal , Bolsa Periodontal/clasificación , Bolsa Periodontal/microbiología , Periodoncio/irrigación sanguínea , Periodoncio/microbiología , Titanio/química , Circonio/químicaRESUMEN
AIM: To evaluate the effect of two different abutment designs on soft tissue healing and the stability of the mucosal margin in vivo. MATERIALS AND METHODS: Twenty-nine subjects received two, non-adjacent endosseous implants in the esthetic zone. Subsequently, conventional (control) and curved abutments (experimental) were placed in combination with a temporary restoration (left-right randomization). Plaster models of the healed sites were made to assess the stability of the soft tissues at baseline and after 6 weeks. To measure deseating force, a dontrix gauge was used while removing the abutments after 6 weeks. RESULTS: Although visually, differences in the transmucosal area were observed, the differences in marginal recession and in deseating force between abutments from the experimental and the control group never reached a statistically significant level. In general, some gain in soft tissue height was seen in both groups. Angled abutments elicited recession at all buccal sites (P = 0.003-0.02). CONCLUSION: Abutments with a circumferential groove do not lead to a different response of the mucosal margin compared with a regular abutment, and are no more resistant upon removal than regular abutments after 6 weeks of function.
Asunto(s)
Pilares Dentales , Implantes Dentales , Diseño de Prótesis Dental , Mucosa Bucal/fisiología , Cicatrización de Heridas/fisiología , Adolescente , Adulto , Implantación Dental Endoósea , Técnica de Impresión Dental , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Propiedades de Superficie , Resultado del TratamientoRESUMEN
AIM: To compare the health of the soft tissues towards zirconia and titanium abutments in man, as observed using histological data. MATERIAL AND METHODS: Twenty patients received two mandibular implants with either a zirconia or titanium abutment (split mouth study design, left-right randomization). After 3 months soft tissue biopsies were prepared for histological evaluation. They were subjected to blind evaluation. The number of blood vessels per surface unit and an inflammation grading scale score ranging from 1 to 4 were determined. RESULTS: Paired samples from 17 patients were suitable for analysis, 3 with unsevered implant-abutment connections and 14 solely containing soft tissue. All showed a well-keratinized stratified squamous epithelium which was continuous with the barrier (junctional) epithelium that faced the abutment surface. The normal epithelial build-up could be recognized with little signs of inflammation. No statistically significant difference in tissues adjacent to zirconia and titanium abutment surfaces were seen with respect to vascular density (20.5 SD 4.4 and 20.7 SD 3.2) or inflammation grading scale scores (3.2 SD 0.7 versus 3.1 SD 0.7). CONCLUSION: No differences in soft tissue health were seen in peri-implant mucosa adjacent to zirconia and titanium abutment surfaces.
Asunto(s)
Pilares Dentales , Materiales Dentales/farmacología , Prótesis Dental de Soporte Implantado , Prótesis de Recubrimiento , Mucosa Bucal/efectos de los fármacos , Adulto , Anciano , Implantes Dentales , Femenino , Encía/efectos de los fármacos , Humanos , Arcada Edéntula/rehabilitación , Masculino , Mandíbula , Persona de Mediana Edad , Método Simple Ciego , Titanio/farmacología , Circonio/farmacologíaRESUMEN
The purpose of this study was to determine the dental treatment needs of the residents in nursing homes (NHs) where integrated dental care has been offered without financial barriers. The dental status and surgical, prosthetic, restorative, and periodontal treatment needs were determined for 432 residents (average age 78.8 years) in three Dutch NHs. Although the subjects had no complaints, 72% had dental treatment needs. It was determined that treatment was necessary for 64% of the edentulous subjects (N = 316), 100% of the partially dentate subjects (N = 76), and 87% of the fully dentate subjects (N = 40). We concluded that when residents can no longer carry out oral hygiene independently, it is very difficult for them to maintain a level of oral health where their dental treatment needs have been met, especially for dentate residents.
Asunto(s)
Prestación Integrada de Atención de Salud , Atención Odontológica , Evaluación de Necesidades , Casas de Salud , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Queilitis/terapia , Prótesis Dental/estadística & datos numéricos , Restauración Dental Permanente/estadística & datos numéricos , Raspado Dental/estadística & datos numéricos , Odontólogos , Dentición , Humanos , Arcada Parcialmente Edéntula/rehabilitación , Persona de Mediana Edad , Boca Edéntula/rehabilitación , Países Bajos , Personal de Enfermería , Salud Bucal , Higiene Bucal , Curetaje Subgingival/estadística & datos numéricos , Extracción Dental/estadística & datos numéricos , Adulto JovenRESUMEN
AIM: To compare the early bacterial colonization and soft tissue health of mucosa adjacent to zirconia (ZrO(2)) and titanium (Ti) abutment surfaces in vivo. MATERIALS AND METHODS: Twenty edentulous subjects received two endosseous mandibular implants. The implants were fitted with either a ZrO(2) or a Ti abutment (non-submerged implant placement, within-subject comparison, left-right randomization). Sulcular bacterial sampling and the assessment of probing pocket depth, recession and bleeding on probing were performed at 2 weeks and 3 months post-surgery. Wilcoxon matched-pairs, sign-rank tests were applied to test differences in the counts of seven marker bacteria and the clinical parameters that were associated with the ZrO(2) and Ti abutments, at the two observation time points. RESULTS: ZrO(2) and Ti abutments harboured similar counts of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythia, Peptostreptococcus micros, Fusobacterium nucleatum and Treponema denticola at 2 weeks and 3 months. Healthy clinical conditions were seen around both ZrO(2) and Ti abutments at all times, without significant differences in most clinical parameters of peri-implant soft tissue health. Mean probing depths around Ti abutments were slightly deeper than around ZrO(2) abutments after 3 months (2.2 SD 0.8 mm vs. 1.7 SD 0.7 mm, P=0.03). CONCLUSIONS: No difference in health of the soft tissues adjacent to ZrO(2) and Ti abutment surfaces or in early bacterial colonization could be demonstrated, although somewhat shallower probing depths were observed around ZrO(2) abutments after 3 month.
Asunto(s)
Bacterias/crecimiento & desarrollo , Pilares Dentales/microbiología , Implantes Dentales/microbiología , Materiales Dentales/química , Periodoncio/patología , Titanio/química , Circonio/química , Adulto , Anciano , Aggregatibacter actinomycetemcomitans/crecimiento & desarrollo , Carga Bacteriana , Bacteroides/crecimiento & desarrollo , Femenino , Estudios de Seguimiento , Fusobacterium nucleatum/crecimiento & desarrollo , Hemorragia Gingival/clasificación , Recesión Gingival/clasificación , Humanos , Carga Inmediata del Implante Dental , Arcada Edéntula/cirugía , Masculino , Mandíbula/cirugía , Persona de Mediana Edad , Peptostreptococcus/crecimiento & desarrollo , Bolsa Periodontal/clasificación , Periodoncio/microbiología , Porphyromonas gingivalis/crecimiento & desarrollo , Prevotella intermedia/crecimiento & desarrollo , Estudios Prospectivos , Treponema denticola/crecimiento & desarrolloRESUMEN
PURPOSE: The aim of this study was to evaluate patient satisfaction and clinical and prosthetic outcomes of two-implant mandibular overdenture treatment with different attachment types after 10 years of function. MATERIALS AND METHODS: In a crossover clinical trial, 18 edentulous subjects with complaints regarding their mandibular dentures received two implants and a new denture with magnet, ball-socket, or bar-clip attachments that were applied in a random order. At the end of the experiment, the attachment type of their choosing was fitted in the overdenture. After 10 years, 7 subjects with a ball-socket and 7 subjects with a bar-clip attachment were available for evaluation. The same questionnaire from 10 years before was completed, and subjects were asked to express their overall appreciation of their dentures on a visual analog scale (VAS). Six scales of denture complaints were constructed. Mean scale and VAS scores between initial evaluation and after 10 years were compared. In addition, marginal probing depths, Bleeding Index, and radiographic marginal bone loss were assessed. RESULTS: There was no marked difference in satisfaction between subjects with ball-socket- and bar-clip-retained two-implant mandibular overdentures at initial evaluation and after 10 years of function. CONCLUSION: Patients' appreciation of their implant-retained denture was and remained high over time. Clinical parameters revealed healthy mucosal conditions and stable marginal bone levels, determined radiographically. Probing depths around implants provided with ball-socket attachments were slightly shallower than those with bar-clip attachments after 10 years of function (P < .05).
Asunto(s)
Implantes Dentales , Prótesis Dental de Soporte Implantado , Diseño de Dentadura , Retención de Dentadura/instrumentación , Dentadura Completa Inferior , Prótesis de Recubrimiento , Adulto , Pérdida de Hueso Alveolar/clasificación , Pérdida de Hueso Alveolar/diagnóstico por imagen , Estudios Cruzados , Diseño de Prótesis Dental , Femenino , Estudios de Seguimiento , Hemorragia Gingival/clasificación , Humanos , Magnetismo/instrumentación , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Índice Periodontal , Bolsa Periodontal/clasificación , Radiografía , Propiedades de Superficie , Resultado del TratamientoRESUMEN
BACKGROUND: Remodeling of onlay grafts combined with implants to the mandible results in predictable changes in the graft's radiographic density. We studied the relationship between changes in radiographic density and trabecular structure during the first year after onlay grafting with simultaneous implant placement to the mandible. PURPOSE: The aim of this study was to evaluate changes in bone structure after onlay grafting. MATERIALS AND METHODS: Standardized extraoral radiographs were taken regularly of 16 mandibular sides. Bone structure was measured using the Carl Zeiss Vision KS 400 3.0 imaging system. The parameters studied were trabecular area and perimeter, cavity area and perimeter, end points, branching points, skeleton length, branch angle and direction, and texture. RESULTS: No differences were found between measurements ventrally versus dorsally of the implant, nor close to versus away from the implant. Early cortical changes suggest partial resorption and formation of a more complex structure. In the fourth quarter after surgery, progressive resorption is seen in the graft's upper cortex. In the graft's upper spongiosa, most parameters indicate bone formation during the first postoperative year. Loading-induced structure changes could not yet be found. CONCLUSION: The technique can be used to study changes in the architecture of bone grafts. Changes found in the graft's architecture are in accordance with changes in bone density.
Asunto(s)
Pérdida de Hueso Alveolar/cirugía , Aumento de la Cresta Alveolar/métodos , Remodelación Ósea , Trasplante Óseo/fisiología , Implantación Dental Endoósea , Mandíbula/anatomía & histología , Anciano , Análisis de Varianza , Densidad Ósea , Prótesis Dental de Soporte Implantado , Análisis del Estrés Dental , Prótesis de Recubrimiento , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador , Arcada Edéntula/rehabilitación , Masculino , Mandíbula/diagnóstico por imagen , Mandíbula/cirugía , Persona de Mediana Edad , Radiografía , Estadísticas no ParamétricasRESUMEN
This study aims to identify distinctive dentofacial characteristics of hypodontia patients. For this purpose, 189 young hypodontia patients (cases) were divided into subgroups, based on criteria from literature. Normalised differences between cases and controls were calculated for various parameters of dentofacial form. Subsequently, cluster analysis was applied to disclose subsets of hypodontia patients with distinctive dentofacial features. The ANB angle, interincisal angle and lower anterior face height were consistently significantly different amongst the subsets. Four clusters of patients with an increasing number of missing teeth and distinctive dentofacial characteristics could be identified. Patients in cluster 1 display a high-angle facial pattern. Patients in clusters 2 and 3 exhibit markable dentoalveolar characteristics (a relatively small and a large interincisal angle, respectively). Patients in cluster 4 exhibited notable sagittal-skeletal discriminative features predominantly because of a retrognathic maxilla. The smallest nasolabial angle and lower anterior face height were seen in this cluster. It is concluded that the anterior-posterior relationship between the jaws, the interincisal angle and the lower anterior face height are discriminative parameters of dentofacial form in hypodontia patients. Patients with hypodontia can be clustered in four groups, each with distinctive vertical-skeletal, dentoalveolar and sagittal-skeletal characteristics. This categorisation of patients with hypodontia into meaningful groups may be useful for treatment planning, interdisciplinary communication and as a means of identifying groups of patients that qualify for reimbursement of costs. Other dental factors should be appreciated as well during restorative clinical decision making in patients with hypodontia.
Asunto(s)
Anodoncia/patología , Cefalometría/estadística & datos numéricos , Cara/anatomía & histología , Desarrollo Maxilofacial , Adolescente , Análisis de Varianza , Anodoncia/clasificación , Anodoncia/complicaciones , Niño , Análisis por Conglomerados , Femenino , Humanos , Masculino , Odontometría , Retrognatismo/complicaciones , Dimensión VerticalRESUMEN
PURPOSE: A retrospective study on the performance of endosseous implants in a population of patients with severe epilepsy and additional motor and/or intellectual impairments was performed. MATERIALS AND METHODS: All residents of an inpatient center for persons affected by severe, refractory epilepsy and multiple disabilities who received endosseous implants between 1991 and April 2007 were included in the study. Implant survival was analyzed using the Kaplan-Meier method. A subset of patients who were treated between 1991 and 2004 was invited to participate in a clinical and radio?graphic evaluation in 2004 and 2005. RESULTS: A total of 61 patients were treated between 1991 and April 2007 (n=134 implants). Three of these implants in three different patients failed during the observation period, demonstrating an estimated probability of functional implant survival of 97.6% (SE 1.4%) after 16 years. In patients who were seen during the clinical evaluation in 2004 (n=76 implants), only mild inflammation of the peri-implant mucosa was generally observed (Gingival-Bleeding Index=1), despite the fact that the level of oral hygiene was considered inadequate around 55 of 76 implants (72%). Obvious signs of drug-induced gingival hyperplasia in relation to the implants were not observed. Probing depths averaged approximately 2 mm. Stable marginal bone levels were observed on the radiographs. CONCLUSIONS: Dental implant treatment in a population of patients with severe epilepsy and additional disabilities seems to be a viable treatment option. Implant loss is rare. Although adequate plaque control was not feasible in all patients, marginal bone levels remained stable.