Esthetic rehabilitation of a severely worn dentition with minimally invasive prosthetic procedures (MIPP)

Restorative treatment of the severely worn dentition is typically indicated to replace deficient tooth structure, limit the advancement of tooth destruction, improve oral function, and enhance the appearance of the teeth. Minimizing removal of additional tooth structure while also fulfilling the desire of patients to have highly esthetic restorations can present a prosthetic challenge when the existing tooth structure is already diminished. This article presents a comprehensive minimally invasive prosthetic treatment approach using a lithium disilicate all-ceramic material for the esthetic rehabilitation of a severely worn dentition for a female patient diagnosed with S?jgren syndrome.     

Single-session treatment of a major complication of dens invaginatus: a case report.

Dens invaginatus is a dental malformation that may give rise to several complications. Caries of the invagination can severely weaken the whole tooth, making it susceptible to fracture. Subgingival fractures are major complications threatening tooth survival and usually require periodontal/orthodontic/prosthetic treatment if long-term viability is to be ensured. This article describes a case of single-session restoration of a fractured invaginated tooth by means of endodontic treatment followed by fragment reattachment.     

Prosthetic epidemiology

The need for an epidemiological method which focuses upon the problems of missing teeth, tooth spaces and prosthetic treatment is emphasized. From the prosthetic viewpoint the distinction between missing teeth and tooth spaces must be made and examples are given to show that up to 20 per cent of missing teeth do not give rise to tooth space. The presentation of the prosthetic parameters per tooth is recommended using the six alternatives: tooth present; tooth missing (open space); tooth missing (closed space); tooth replaced by pontic in fixed bridge, by removable partial denture, or by complete denture. In the presentation of the mean number of existing teeth, fixed bridge pontics should be included as they serve as natural teeth both aesthetically and functionally. Data on removable dentures, or edentulism without denture wearing, should be presented in such a way that comparisons at jaw level as well as at person level can be made. A system for this is described. The method may be used in industrialized countries where there is much prosthetic treatment as well as in developing countries with few health services. Comparisons will still be meaningful.     

截根术牙半切除术及术后不同修复设计对牙周膜内应力分布影响的研究——二维有限元分析

临床工作中常采用截根术半切除术以保留重度牙周炎及牙根纵裂的牙齿,本文利用二维有限元法分析了截根术、牙半切除术及术后不同修复设计治疗后患牙牙周膜内应力分布的变化情况.结果发现:牙半切除术较截根术更符合患牙的保健要求;术后进行合理的修复对患牙取得远期疗效有利.从而为临床工作中究竞采取何种术式及术后采取何种修复设计提供了理论基础.     

The influence of residual ridge resorption patterns on implant fixture placement and tooth position. 2. Presurgical determination of prosthesis type and design.

The incorporation of prosthetic information into a presurgical implant treatment plan is essential to provide accurate guidelines for fixture placement by the surgeon. Part I of this article presented a modified surgical technique that enables the restorative dentist to construct a prosthesis compatible with the final tooth position. Part II describes a technique in which a computer profile image is used to identify the determinants of the optimal final tooth position and discusses the impact of these determinants on the prosthetic design. Guidelines that could be used to predict the final prosthetic design are also presented.     

Interdisciplinary treatment planning for orthodontic‐prosthetic implant anchorage in a partially edentulous patient

Successful orthodontic treatment is characterized by optimal anchorage control. Teeth or groups of teeth are united to counteract biomechanical reactive forces during orthodontic treatment. These classic anchorage control mechanisms are less efficient or even non-existent in partially edentulous patients who are missing multiple posterior teeth. However, osseointegrated oral implants ad modum Br-vemark can provide optimal anchorage control for orthodontic tooth alignment and rehabilitation of occlusion through prosthetic implant restorations. Careful multidisciplinary planning based on complex diagnostic wax setup casts to determine exact implant location and orientation in line with future orthodontic tooth displacements and prosthetic implant crown restorations is the most important step in the overall treatment planning.     

Use of biofunctional prosthetic system following partial maxillary resection: a clinical report

This clinical report describes the prosthodontic rehabilitation of an edentulous patient with a maxillary defect using the biofunctional prosthetic system. The Biofunctional Prosthetic System brand denture includes a comprehensive technique for impressions, record taking, tooth placement, fabrication and processing. The advantage of this technique is to provide patients with optimal form, function, and aesthetics in complete dentures. This system is based on a team effort and systematic approach to removable prosthetic treatment.     

The double-inlay technique: a new concept and improvement in design

Gold and ceramic have long been used in prosthetic dentistry. In the posterior region, it is possible to use both materials with the double-inlay technique to add the strength of metal to the esthetics of ceramic. The problem, however, remains the volume of tooth reduction required to avoid ceramic fracture. This article describes a modification of the double-inlay technique that makes use of a pin system. This modified technique permits good retention while avoiding excessive tooth reduction.     

Surgical extrusion of a cervically root-fractured tooth after apexification treatment

A case is reported in which an incisor fractured below the alveolar crest 6 months after completion of apexification treatment was surgically extruded for prosthetic coronal restoration. After the surgical procedure, a dowel post was placed in the root canal, a core was built using glass-ionomer cement, and a porcelain veneer crown restoration was completed. The 24-month follow-up examination after surgical, endodontic, and prosthetic treatments showed that the tooth was clinically and radiographically healthy and functioned well.     

A Multidisciplinary Approach to the Management of a Subgingivally Fractured Tooth: A Clinical Report

Anterior tooth fracture is the most common type of trauma occurring to the dental tissues. Teeth fracturing at or below the gingival level usually have a poor prognosis, with extraction of the tooth being the most probable outcome. Clinical crown lengthening followed by prosthetic rehabilitation is a promising approach toward such cases. The clinical report presented here explains in detail the various treatment modalities available for such cases with special emphasis on orthodontic extrusion/forced eruption.     

Implant overdentures: a new standard of care for edentulous patients current concepts and techniques

While most implant-based treatment has historically focused on fixed prosthetic tooth replacement,. the multitude of benefits to the edentulous population from implant overdentures is overwhelming in improved function, emotional stability, physical health, and esthetics. Although there still remains a lack of consistency in techniques, prosthetic design, and attachment systems, these aspects have been proven less important to successful outcomes than once thought. This article presents a simplified approach to patient evaluation, treatment planning decisions, attachment selection, and technique.     

The tilted molar: a prosthetic and periodontal dilemma.

The tilted molar presents both prosthetic and periodontal problems. Typically, the loss of a lower first molar or second premolar produces a space and allows the molar, distal to the space, to tilt mesially. The major tilting force is produced by the opposing occlusion. Although a tightly locked occlusion can prevent excessive movement, once the tooth begins to tilt, the vector of force tends to increase the tilting. The severity of both prosthetic and periodontal problems is directly related to the amount of tilting and treatment becomes complex when adjacent teeth begin to migrate.     

Repair of tooth wear; restorative-prosthetic aspects

Tooth wear is considered to be the third major threat to dental health in the industrialized parts of the world next to caries and periodontal disease. Bruxism can be a cause for excessive tooth wear. Thanks to the successes in the prevention and early treatment of the infectious dental diseases, dentitions last longer as result of which tooth wear is becoming more and more of a problem in the preservation of a physiologic dentition throughout live. Furthermore there seems to be an increasing tendency for the occurrence of severe tooth wear at very early ages. Early recognition of possible contributing factors for tooth wear by the dental team is of utmost importance to enhance success in treating the problem. Prevention of ongoing damage to the remaining tooth structure must be the starting point of every treatment plan. Repair of tooth wear is in many cases a challenge from a restorative/prosthetic perspective: esthetic and phonetic aspects play an important role along with the restorative and prosthetic choices as well as functional considerations the clinician has to deal with.     

Decoronation – a conservative method to treat ankylosed teeth for preservation of alveolar ridge prior to permanent prosthetic reconstruction: literature review and case presentation

Abstract –  Avulsed teeth that are stored extraorally in a dry environment for >60 min generally develop replacement root resorption or ankylosis following their replantation due to the absence of a vital periodontal ligament on their root surface. One negative sequelae of such ankylosis is tooth infra-positioning and the local arrest of alveolar bone growth. Removal of an ankylosed tooth may be difficult and traumatic leading to esthetic bony ridge deformities and optimal prosthetic treatment interferences. Recently a treatment option for ankylosed teeth named 'de-coronation' gained interest, particularly in pediatric dentistry that concentrated in dental traumatology. This article reviews the up-to-date literature that has been published on decoronation with respect to its importance for future prosthetic rehabilitation followed by a case presentation that demonstrates its clinical benefits.     

Revisiting Tooth Preservation in Prosthodontic Therapy

Dental implants have been established as long‐term supports for tooth replacements, and they have profoundly altered treatment concepts of traditional prosthodontics. The use of teeth as prosthetic abutments is revisited relative to implants as predictable support mechanisms for fixed and removable prostheses. The purpose of this review is to appraise tooth preservation in a different manner while considering implants as additional and even preferred support mechanisms for dental prostheses. Data reviewed in this article include a comparison of implants and traditional prostheses and their effects on abutment teeth, the use of periodontally and endodontically compromised teeth as abutments, and prosthetic complications potentially created by healthy remaining teeth. The evidence presented suggests that the longstanding objective of tooth preservation during prosthetic treatment be appended to include the use of dental implants for fixed/removable prostheses, and to avoid or remove teeth presenting as liabilities that diminish the overall prognosis. Patients are not well served if they are faced with biologic, economic, and psychological burdens associated with ongoing revisions of dental rehabilitations using natural teeth. Dentists must use all means available to carefully evaluate remaining teeth to determine if they benefit or impair proposed prosthetic outcomes.     

Central incisor loss after delayed replantation following avulsion: a contemporary restorative and adjunctive orthodontic management approach

Abstract – Delayed replantation of an avulsed tooth may result in rapid root resorption or, more frequently, dental ankylosis with subsequent bone substitution. If this process develop slowly, it is possible to observe that tooth loss is characterized by a well conserved alveolus with regard to bone preservation, particularly in vertical dimension. This clinical case reports a dental trauma of a central incisor in a young boy characterized by tooth avulsion and its delayed replantation. After 10 years, dental ankylosis of the incisor was recorded and the patient underwent a prosthetic‐orthodontic rehabilitation using CAD‐CAM technology and no‐prep veneers.     

Clinical management of a complicated crown-root fracture: a case report

This report describes the clinical procedures involved in the treatment of a complicated crown-root fracture in the maxillary left central incisor with a wide open apex of a 10-year-old male patient, due to fall from his own height. Post-trauma treatment comprised cervical pulpotomy and adhesive tooth fragment reattachment. After 1 year, clinical and radiograph examinations showed pulp necrosis and an associated periapical lesion. Endodontic therapy with calcium hydroxide-base intracanal dressing, root canal filling and orthodontic extrusion were performed. Extrusion was completed within approximately 16 weeks and the tooth was restored with a post-core system and a prosthetic crown. After a 3 years of follow-up, there was no evidence of apical periodontitis and the tooth was satisfactory both esthetically and functionally.     

Mechanical aspects of a Br?nemark implant connected to a natural tooth: an in vitro study.

Mechanical in vitro tests of the Br?nemark implant disclose that the screw joint which attaches the prosthetic gold cylinder and the transmucosal abutment to the fixture forms a flexible system. This inherent flexibility seems to match well the vertical mobility of a supporting tooth connected to the implant. Calculations of vertical load distribution based on measured flexibility data demonstrate that the forces are shared almost equally between tooth and implant even without taking the flexibility of the surrounding bone or the prosthesis into account. The therapy of a single Br?nemark implant connected to a natural tooth should be considered without any additional element of a flexible nature. Mechanical tests and theoretical considerations, however, indicate that the transverse mobility of the connected tooth should be limited and that the attachment of the prosthesis to the tooth should be of a rigid design to avoid gold-screw loosening.     

Principles and implications of site preservation for alveolar ridge development

The extraction of a tooth normally results in the loss of ridge height and width. Often, clinicians are faced with the management of edentulous sites that are less than optimal for prosthetic rehabilitation and implant restoration due to considerable alveolar ridge collapse after tooth removal. Site preservation using bone grafts or substitutes with and without a membrane maintain ridge dimensions and contours. However, some clinicians believe that such procedures are over-treatment. This paper reviews the concepts and indications for site preservation following tooth extraction for the purpose of facilitating implant placement and conventional prosthetic restoration.     

Reattachment of a fractured maxillary tooth: a case report.

A 14-year-old male patient reported with a horizontal fracture of almost the entire crown of a maxillary incisor, extending subgingivally at the palatal side. After root canal therapy and electrosurgery, the tooth fragment was reattached using a total-etch dentin-bonding system and a hybrid composite. Due to enamel cracks and the necessity for more retention, the labial surfaces of the teeth were veneered with a micro-filled composite. The clinical situation of the reattached teeth was confirmed successful by radiographic and photographic assessment after 1, 3, 6, and 12 months. The restoration of an anterior tooth with original tooth fragment in young patients has advantages over conventional composite or prosthetic restorations. However, reattached teeth with fracture extending subgingivally, require long-term follow-up.