Influence of overdenture abutment tooth contour on the periodontium: a preliminary report

The effect of overdenture abutment tooth contour on plaque retention and periodontal health was evaluated in four patients over a 1-year period. Each patient had mandibular canines with similar periodontal support; however, one abutment was dome shaped while the other had 2 mm of natural peripheral root contour coronal to the ginvival margin. Eight parameters of periodontal health were measured, and no significant differences between different contours were observed after 1 year. Furthermore, irrespective of overdenture abutment contour, no deterioration in periodontal status occurred. Two subjects had significant wear of the overdenture abutments after 1 year. Further evaluation of more subjects over a longer period of time is indicated.     

Periodontal considerations of the removable partial overdenture

1. An overdenture, whether complete or partial, is an excellent mode of treatment in the mutilated dentition for the preservation of the residual ridge. 2. Selection of patients for an overdenture should be based on past history of dental neglect, the status of the teeth and their periodontium, including present oral hygiene status, and patient motivation. The patients with a history of dental neglect, poor oral hygiene, and lack of motivation in having the teeth and the periodontium restored to health as well as strict compliance to a home-care regimen and recall schedule are not good candidates for treatment with an overdenture. 3. The choice of teeth or roots to serve as overdenture abutments must include their periodontal evaluation, which should consist of a detailed periodontal examination, diagnosis, prognosis, and treatment when this is indicated, including chemical protection (fluoride gel) and an oral hygiene regimen tailored to individual needs. 4. The knowledge and expertise in the selection and implementation of appropriate periodontal treatment modalities is of paramount importance in restoring optimum periodontal health to the overdenture abutments before overdenture fabrication. 5. The maintenance phase of the overdenture abutments as well as of the existing natural teeth is of critical importance in the preservation of health of these abutments and teeth. This maintenance phase should consist of periodic recalls based on individual needs; a detailed periodontal evaluation, including patient's motivation and status of oral hygiene and denture hygiene; and detection of caries. If necessary, appropriate periodontal and/or restorative therapy should be performed, and oral hygiene measures reinforced. This will ensure longevity of both abutment teeth or roots and of the existing natural teeth resulting in a long-term success of an overdenture. 6. Because there is evidence of high incidence of periodontal disease and dental caries in overdenture wearers, and because this evidence is attributed mainly to lack of motivation and compliance of adequate oral hygiene as well as to frequency of recall visits, patients should be made aware of the importance of their role in the maintenance phase of treatment and in the factors that lead to ultimate success of overdenture therapy. 7. With (a) proper selection of the patient and the abutment teeth, (b) adequate periodontal and restorative health and treatment to ensure optimum health prior to RPOD construction, (c) a well-designed home-care regimen and frequency of recalls, and (d) proper execution of maintenance care, changes for long-term success of overdenture therapy will be much improved.     

Effect of controlled oral hygiene in overdenture wearers: a 3-year study.

The effect of controlled oral hygiene was studied in 35 overdenture patients involving 80 abutments over a period of 3 years. Intensive instruction and motivation in oral hygiene care were carried out prior to prosthodontic treatment and two to four times yearly during the study period. The initial dental and periodontal conditions were very poor, with a mean loss of proximal bone adjacent to the abutments of 62% +/- 17%. During the study period, it was possible to maintain mean plaque index scores of 0.40 to 0.70 and mean gingival index scores of 0.90 to 0.98 adjacent to the abutments. There was spontaneous regression of 4- to 5-mm periodontal pockets, whereas deeper pockets persisted. There was no relationship between the patients' initial plaque index score and the oral and denture hygiene observed during the study. The results of the study showed that it was possible to maintain teeth as overdenture abutments in elderly patients initially having a poor dental and periodontal status.     

太极扣附着体在全口覆盖义齿修复中的临床应用

目的：评价太极扣附着体在全口覆盖义齿修复中的临床效果。方法：选择符合适应证的患者18例,男8例,女10例,年龄65-77岁。对基牙进行完善的根管治疗和牙周治疗,制作以太极扣覆盖义齿附着体为固位体的覆盖义齿。病人修复后定期复查,追踪随访,通过对患者满意度的调查和基牙牙周健康程度进行评估。结果：戴用义齿后进行1-4年的随访,患者对义齿的美观性、咀嚼功能、固位性、舒适度进行评价,总满意率为92．2％,经χ2检验,与戴牙后1个月比较无显著性差异（P〉0．05）。4例基牙出现不同程度的松动,牙周袋深度显著加深（P〈0．01）。所有义齿都在继续使用中。结论：在全口覆盖义齿修复中太极扣附着体义齿是一种美观、经济、固位稳定好的修复方式。     

Prognosis of overdenture abutments in elderly patients with controlled oral hygiene. A 5 year study

summary The effect of controlled oral hygiene was studied in 31 elderly overdenture patients involving 72 abutments over a period of 5 years. Intensive instruction and motivation in oral hygiene care were carried out prior to prosthodontic treatment and two to four times yearly during the study period. The initial dental and periodontal conditions were very poor, with a mean loss of proximal bone adjacent to the abutments of 61%. During the study period, it was possible to maintain mean plaque index scores of 0.45−0.73 and mean gingival index scores of 0.89−0.95 adjacent to the abutments. There was no relationship between the patients' initial plaque index score and the oral and denture hygiene observed during the study. There was spontaneous regression of 4–5 mm periodontal pockets, whereas deeper pockets persisted. Seven abutments were extracted due to periodontal complications. Caries was a minor problem which could be controlled by hygienic measures, topical fluoride or fillings. The present study has shown that it was possible to maintain teeth as overdenture abutments to a large extent in elderly patients initially having a poor dental and periodontal status.     

覆盖义齿基牙的短期临床观察

目的：对覆盖义齿的基牙进行短期临床观察。方法：对30例覆盖义齿修复患者半年及1年后回访观察。结果：下颌基牙及非银汞充填覆盖基牙更易存积菌斑及结石,并出现牙龈问题。结论：对于能保持良好口腔卫生的患者,覆盖义齿是一种较好的选择。     

Management of misangulated implants for a maxillary overdenture with spherical abutments: a clinical report

Misangulated and malpositioned implants pose a significant challenge for the prosthodontic treatment of edentulous patients. Most reports of maxillary overdenture patients have described the use of a bar to splint malaligned implants, followed by successful fabrication of the prosthesis. Few reports have discussed the use of individual abutments in such situations. This clinical report describes the successful use of spherical/ball abutments for the management of 4 malaligned implants in the edentulous maxilla for an overdenture. The rationale and technique for the use of spherical abutments for overdenture fabrication in such situations are described.     

Five‐year multicenter study of magnetic attachments used for natural overdenture abutments

The purpose of this study was to examine a longitudinal clinical performance of magnetic attachments used for natural overdenture abutments. The study included 131 patients who had used removable prostheses (complete overdentures 31%, partial dentures 69%) more than 5 years (40–90 years old) with 211 magnetic attachments on natural abutments (Magfit 400 or 600; Aichi Steel co., Aichi, Japan) treated in 15 clinics using a standardized protocol. Analyses were performed on the degree of patient satisfaction regarding retention, complications of magnets (corrosion, detachment from denture base), abutments (pain during mastication, periodontal pocket formation, inflammation, mobility), and dentures (fracture etc.). Ninety‐seven percent of patients were satisfied with the retention and stability of their dentures. No corrosion of magnet was observed, and 19 magnets were detached. Most frequent complication of abutments was periodontal pocket formation (52%), followed by the inflammation (29%), increase in mobility (27%) and pain (4%). Magnetic attachment on natural tooth abutments provided a viable and long‐term treatment option.     

Prospective 3-year study of cross-arch fixed partial dentures in patients with advanced periodontal disease.

STATEMENT OF PROBLEM: Several choices exist for the treatment of advanced periodontal disease. One is a combined periodontal and prosthetic treatment that includes cross-arch fixed partial dentures (FPDs). However, the outcomes of such therapy have been reported mainly from studies in Scandinavian countries. PURPOSE: The aims of this study were: (1) to longitudinally evaluate, after periodontal and prosthodontic treatment that included cross-arch FPDs, treatment outcomes in Korean patients who suffered from severe periodontitis; and (2) to evaluate the patients' treatment assessments and the FPDs after 3 years. MATERIAL AND METHODS: This survey included 39 Korean patients provided with 50 FPDs. Clinical and radiographic examinations were performed at the time of delivery of the FPDs and at the 3-year follow-up examinations. The prostheses were divided into 3 groups according to design (end abutments, unilateral cantilever, and bilateral cantilevers) and the amount of supporting tissues at the time of insertion. On average, only 26% of the total original periodontal tissue remained at the time of insertion. The FPDs consisted of 11 to 14 units, with a mean of 5 to 7 abutments in the 3 groups. The mean periodontal ligament area of the abutments was 79% of the total ligament area of the replaced teeth. RESULTS: At the 3-year follow-up examination, the FPDs were stable in all patients, who in general displayed good oral hygiene and had healthy periodontal conditions. The change in periodontal ligament area over the 3-year observation period was negligible (1 mm(2) per dental unit) and showed no statistically significant difference in relation to FPD design. Most patients were satisfied with the function of their FPDs with respect to mastication, phonetics, hygiene, esthetics, and chewing comfort. A few patients stated that they were careful with the FPDs and avoided certain foods (for example, raw peanuts and grilled squid) because they felt insecure with the cantilever segments. Most patients reported that they would choose the same treatment again. CONCLUSION: Patients with advanced periodontal disease demonstrated successful outcomes over a 3-year period and reported satisfaction with combined periodontal and restorative treatment that included cross-arch FPDs.     

A maxillary implant overdenture that utilizes angle-correcting abutments

Placement of dental implants to enhance complete denture stability and retention is a well-accepted treatment modality. Most implant overdenture abutments and related components require parallelism within approximately 10 degrees to function properly. Non-parallel implant placement as a result of flared maxillary bone may preclude the use of conventional implant overdenture abutments, requiring the use of costly custom abutments or bar prostheses. A case report is presented that illustrates the use of a new, 2-piece, angled overdenture abutment to accommodate non-parallel implant placement.     

磁性附着体覆盖义齿与传统可摘局部义齿对比观察

目的:对比磁性附着体覆盖义齿和传统可摘局部义齿修复的临床效果。方法:选择下颌kennedyⅠ类牙列缺损且余留牙较少的患者,为其中13例患者制作磁性附着体覆盖义齿,12例患者制作传统可摘局部义齿,对患者的满意度和基牙牙周健康情况进行3年随访。结果:磁性附着体覆盖义齿患者的满意度和基牙的牙周情况均好于传统可摘局部义齿。结论:磁性附着体覆盖义齿对下颌kennedyⅠ类牙列缺损且余留牙较少患者的修复效果较好。     

A prospective evaluation of Frialoc implants with ball-abutments in the edentulous mandible: 1-year results

Several surgical and prosthetic concepts for the treatment of patients with mandibular atrophy and related lower denture problems are proposed and described in the literature. The present study discusses and evaluates the use of a new single-stage implant and overdenture with ball-attachment for this purpose. This study evaluates the clinical performance of the implants and abutments and addresses surgical and prosthetic complications that were encountered. Eighteen fully edentulous patients received two, single-stage Frialoc implants (Friadent, Mannheim, Germany). The implants were left to osseointegrate for 3 months and were subsequently provided with ball-abutments and loaded through a mandibular overdenture. After 1-year of clinical service, two implants were lost, which accumulated to a 1-year survival rate of 93.9% (SE 4.2%). Patient satisfaction was high, and prosthetic complications and postinsertion maintenance were minimal. Three abutments loosened, one of which subsequently broke after 5 months of loading. Retightening of the attachment (gold matrix) was performed on seven occasions in four patients. Soft tissue response was excellent. Although minor hypertrophy of the peri-implant mucosa was observed, hardly any marginal bone loss between baseline and 1-year observations occurred. Short-term results indicate that mandibular implant overdenture treatment by means of two ball-abutments, using Frialoc implants and prosthetic components, leads to good clinical results, both from an objective and a subjective perspective.     

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目的评价太极扣附着体用于牙列缺损修复的临床效果。方法选择2006年4月至2011年9月北京黄寺美容外科医院总装备部牙科中心拟行覆盖义齿修复的牙列缺损患者25例,对基牙进行完善的根管治疗和牙周治疗,制作以太极扣附着体为固位体的覆盖义齿。患者戴用义齿后每半年复诊1次,追踪随访,通过对口内、X线的检查和修复体的戴用情况评估患者的满意度。结果戴用义齿后随访1—4年,21例患者对义齿的美观性、稳固性、咀嚼功能及牙周健康均感到满意,4例患者出现牙龈炎和牙槽骨吸收问题。结论太极扣附着体覆盖义齿是一种美观、经济、固位稳定好的修复方式。     

下颌磁性附着体覆盖全口义齿的临床疗效观察

目的：调查磁性附着体覆盖全口义齿修复的临床效果。方法：对9例磁性附着体患进行义齿满意度问卷调查分析，并检查患基牙临床指征及牙周微生态的情况。结果：患对磁性附着体义齿固位稳定功能满意度最高；基牙的微生物组成与正常值相比有一定的变化，但戴牙前后基牙临床指标无明显变化。结论：适当的修复以及良好的口腔卫生条件下，下颌磁性附着体覆盖全口义齿是一种有效、可行的修复方式。     

磁性附着体在下颌全口覆盖义齿中的临床应用

目的：观察磁性附着体的临床应用效果。方法：用Ｍａｇｆｉｔ ＥＸ－６００磁性附着体为１０名患者制作下颌全口覆盖义齿,粘固磁体前后进行固体力和咀效率测试,并观察基牙情况,结果：粘固磁体后固位力及咀效率明显提高,观察的６个月内,基牙松动度和牙周指标明显好转。结论;磁性附着体对改善义齿的功能有显著作用。     

Abutment tooth loss in patients with overdentures

BACKGROUND: Since the 1960s, the use of natural teeth as overdenture abutments has become part of accepted clinical practice. Several longitudinal studies have been conducted, but tooth loss has not been reported to be a significant problem. The aim of this study was to identify the incidence and causes of tooth loss in a prospective cohort study of subjects wearing overdentures. METHODS: The study, conducted between 1973 and 1994, evaluated 273 subjects (62.3 percent male) with a mean age of 59.6 years. RESULTS: Of the 273 subjects with 666 abutments, 74 lost 133 abutments. The most common cause of tooth loss was periodontal disease (29.3 percent) followed by periapical lesions (18.8 percent) and caries (16.5 percent). Through logistic regression, the authors found that subjects who lost teeth were more likely to have medical problems that could cause soft-tissue lesions of the oral mucosa, were less likely to use fluoride daily and were less likely to return for yearly recall visits. The authors found 22 vertical fractures in 17 subjects. Chi2 analysis revealed that overdenture teeth in the maxillary arch that were opposed by natural teeth were more likely to experience vertical fractures. CONCLUSIONS: In a study that followed up some patients for as long as 22 years, the rate of tooth loss was 20.0 percent. Many of these failures could have been prevented if patients had practiced better oral hygiene. CLINICAL IMPLICATIONS: The findings suggest that if a dentist recommends overdenture therapy, the patient needs to be examined regularly to reduce the risk of experiencing caries and periodontal disease. Also, if the abutments are in the maxilla and are opposed by natural teeth, the dentist should consider using thimble crowns to reduce the risk of vertical fractures.     

A two-year longitudinal study of the periodontal health status of overdenture patients

Eleven patients who were treated with maxillary or mandibular overdentures or both were recalled at 6-month intervals and studied for a period of 2 years A periodontist evaluated the periodontal health status of the abutment teeth at initial placement of the overdenture and at all subsequent recalls using standardized periodontal indices. Statistical comparisons of the data from initial examination to the 2-year recall were made to assess the periodontal health status of roots supporting overdentures.Periodic, regular recall of patients treated with overdentures is one of the most important factors in the maintenance of the integrity of the root stumps and attachment apparatus, particularly since the roots supporting mandibular overdentures are at greater risk periodontally than those supporting maxillary overdentures. Measurements of pocket depth and width of attached gingivae seem to be the most definitive criteria to determine the status of the attachment apparatus in overdenture patients. With frequent recall, overdentures appear to be a successful method of treatment.     

Magfit磁性附着体在老年患者全口覆盖义齿的应用体会

目的:通过对老年患者单颌全口覆盖义齿中应用磁性附着体的病例进行总结和分析,对其修复效果作出评价。方法:回顾了我科67例老年患者单颌全口覆盖义齿中应用共84副磁性附着体的病例,并跟踪随访2-5年。结果:经随访观察,所有患者对这类义齿的固位、外观、舒适性、坚固性均较满意。仅1颗基牙继发龋(1.2%,1/84),3副磁体出现脱落(3.6%,3/84),23颗基牙有牙龈炎(27.4%,23/84),未出现基牙松动,脱落。结论:磁性附着体利于保留老年患者余留牙根,提高义齿固位力,在老年患者单颌全口覆盖义齿中可取得良好的修复效果。     

Effect of using soft liner on bone density around the abutments supporting complete lower overdenture.

The effect of lower acrylic overdentures lined with soft liner on bone density around the abutment was studied on 14 patients divided into two equal groups. Group I patients using lower acrylic overdenture lined with soft liner. The abutments selected in each patient were two canines and two posterior. Bone density was measured from periapical radiographs made at denture insertion and after one year of denture use, for each abutments, using an accurate densitometer. The results showed decrease in bone density in the crestal alveolar bone around the abutments through the one year study period. patient using superstructure lined with soft liner showed less bone density than those using acrylic overdenture. The results of these study reached the conclusion that the resiliency of soft liner reduces the load applied over the overdenture abutments and in turn reduces alveolar bone changes.     

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目的评价磁性附着体在全口覆盖义齿中的临床应用效果。方法对2012年11月至2013年11月于沈阳市和平区牙病防治所就诊的17例牙列缺损患者,以Magfit Ex400/Ex600磁性附着体为固位装置行全口覆盖义齿修复。共制作了22件全口覆盖义齿,使用了52枚磁性附着体。随访6~18个月,对义齿的固位效果进行评价,并对应用磁性附着体后义齿出现的问题进行观察。结果 17例患者的22件全口覆盖义齿,固位效果满意16件、良好4件、改善2件。随访中2例患者出现了龈缘炎、1例患者磁体从义齿中脱落、1例患者义齿树脂托出现裂纹,均经适当处理后义齿继续使用。结论磁性附着体能有效改善全口覆盖义齿的临床修复效果,为患者更好提供舒适性、咀嚼功能等主观感受,有利于牙周组织健康。