The transmandibular implant: prosthodontic treatment considerations.

The transmandibular implant (TMI) is a type of transosteal implant designed for use in the edentulous mandible. The implant is composed of a gold-based alloy. The TMI is a loaded implant in that the prosthesis is supported by the implant. A transitional type of prosthesis, for insertion following surgery can be made either by altering the patient's existing mandibular complete denture or by making a new denture. The completed prosthesis is retained by clips held in the mandibular denture with autopolymerizing acrylic resin. The clips engage Dolder bar segments, which are a part of the implant suprastructure, and provide the necessary retention for the mandibular complete denture.     

Risk factors for dental implant inflammation--a literature review

Replacing missing teeth with osseointegrated dental implants is a predictable technique as evidanced by overall 5-years survival rate that range between 93% to 97%. Few studies, however have adressed the history and frequency of inflammatory complication associated with dental implant. Inflammatory complications are the main cause of failure of dental implants. In this review we classified the inflammatory complications to acute and chronic and to those limited to the hard tissue, to the soft tissue or both. The incidence of the complications is discussed with an emphasis on their risk factors.     

Periodontal considerations in removable partial denture treatment: a review of the literature

PURPOSE: A critical review of the literature on the periodontal considerations in removable partial denture (RPD) treatment is presented. MATERIALS AND METHODS: A MEDLINE search was conducted for studies pertaining to the effects of RPDs on the periodontal tissues during the various phases of prosthetic treatment. The review included both in vivo and in vitro studies. RESULTS: The use of RPDs leads to detrimental qualitative and quantitative changes in plaque. There seems to be a lack of information regarding the effects of RPDs on the status of periodontally compromised abutments. A number of studies, mainly in vitro, have failed to agree on the ideal RPD design. Clinical trials have shown that if basic principles of RPD design are followed (rigid major connectors, simple design, proper base adaptation), periodontal health of the remaining dentition can be maintained. CONCLUSION: Removable partial dentures do not cause any adverse periodontal reactions, provided that preprosthetic periodontal health has been established and maintained with meticulous oral hygiene. Frequent hygiene recalls and prosthetic maintenance are essential tools to achieve a good long-term prognosis. More prospective clinical trials are needed on the effect of RPDs on the condition of periodontally involved abutment teeth.     

Disinfection of prosthodontic impression materials: a literature review

With the steadily growing frequency of AIDS, many dental researchers and clinicians have become more interested in disinfection and sterilization procedures. Impressions made in the clinic are potential contamination pathways. All patients may be considered as potentially infectious and the impressions must be treated the same as those made on so-called high-risk patients. Zinc oxide-eugenol, polysulfide and silicone rubber, and probably polyether materials are compatible with effective disinfectant solutions. The solutions do not substantially diminish the dimensional stability and the sharpness of surface detail reproduction of these impression materials. Impression compound as well as reversible and irreversible hydrocolloid, however, are not compatible with effective disinfectant solutions.     

Reinforcement in removable prosthodontics: a literature review

Removable prosthodontics are often associated with mechanical troubles in daily use, such as fracture or deformation. These troubles render prostheses unusable and reduce wearers’ QOL. Various reinforcements are used to prevent such problems, but consensus on reinforcement has not been reached. This review aimed to summarise the effects of reinforcement and to propose favourable reinforcement based on material, design and position in the prostheses. Initially, 139 articles were selected by electronic and manual searches. After exclusion of 99 articles based on the exclusion criteria, 40 articles were finally included in the review. Electronic searches were performed for articles published from 2005 to 2015 in PubMed, EMBASE, MEDLINE and Cochrane Library, and manual searches were performed in 10 journals relevant to the topic of removable prosthodontics. For in vitro studies, certain dental alloys and fibres were mainly used. Their forms were different, including complicated forms in dental alloys and various forms in fibres. The materials were examined for mechanical properties like fracture strength, flexural strength and elastic modulus and compared with one another or without reinforcement. There were a few clinical studies and one longitudinal study. Cast metal reinforcement seemed to be most favourable in terms of fracture toughness and stiffness. The most favourable forms differed depending on the prostheses, but placement around thin and deformable areas was effective. However, randomised or longitudinal clinical reports and comparative clinical studies on the use of reinforcement were still lacking and such studies are necessary in the future.     

颌骨放疗区种植修复及其并发症防治的研究进展

手术结合放射治疗是口腔颌面部肿瘤的常规治疗手段。近年来,越来越多的患者选择种植牙修复口腔颌面部术后缺失的牙齿。种植体与周围骨组织形成良好的骨结合是种植牙成功的关键。然而,放疗后颌骨组织会遭受一定的损伤,影响种植体的骨结合成功率,增加并发症的风险。该文就颌骨放疗区种植修复及其并发症防治的研究进展作一综述。     

New paradigms in prosthodontic treatment planning: a literature review

New treatment modalities have expanded the choices available to prosthodontists and their patients. At the same time, an explosion of data has called into question the validity and efficacy of certain forms of traditional prosthodontic treatment. Together, these factors have greatly complicated the treatment-planning process. The purpose of this article is to provide a framework for the prosthodontic treatment-planning process that incorporates the latest evidence-based information available. A review of the literature was undertaken through a Medline search. Articles published in English from 1975 through 2001 were evaluated; selected articles were chosen for review on the basis of a subjective judgment of their relevancy and significance to the clinician.     

Treatment considerations for maxillary implant overdentures: a systematic review

STATEMENT OF PROBLEM: Implant overdenture treatment for the edentulous maxilla is challenging due to inherent anatomic and biomechanical problems. Moreover, controversy persists as to factors critical for implant and prosthetic success. Established criteria for design of the maxillary implant overdenture are lacking. PURPOSE: This article reviews the literature on maxillary implant overdentures with an emphasis on number, length, and distribution of implants, splinted or unsplinted anchorage systems, maintenance, and patient satisfaction. MATERIAL AND METHODS: A systematic review of the literature was undertaken seeking evidence to establish criteria for treatment considerations for implant overdenture treatment of the edentulous maxilla. A search of English language peer-reviewed literature was completed using Medline between the period of 1988 to 2006, focusing on evidence-based research. This was supplemented with a manual search of selected journals and textbooks. Randomized controlled clinical trials, nonrandomized controlled studies, longitudinal experimental clinical studies, longitudinal prospective studies, and longitudinal retrospective studies were favored in the review, using a general hierarchical classification. Articles that did not focus on or have an impact on implant overdenture treatment on the maxilla were excluded from the evaluation. The last search was conducted on December 31, 2006. Key terms included maxillary, dental implant, and overdenture. RESULTS: The literature demonstrates a limited number of randomized controlled trials and longitudinal prospective and retrospective studies to strongly support treatment consideration premises for the implant overdenture treatment of the edentulous maxilla. CONCLUSIONS: Within the limits of this systematic review, treatment consideration recommendations have been posited given the available evidence. Better designed, longitudinal studies with higher power are required to establish definitive evidence-based treatment planning principles for the maxillary implant overdenture patient.     

A review of clinical and technical considerations for fixed and removable implant prostheses in the edentulous mandible

PURPOSE: The aim of the present article is to review some of the technical treatment options for implant prostheses restoring the edentulous mandible, mainly based on the Br?nemark system. MATERIALS AND METHODS: Clinical and technical aspects are discussed for the three established concepts: (1) implant-supported fixed prosthesis, (2) removable implant-supported overdenture, and (3) combined implant-retained and soft tissue-supported overdenture prosthesis. RESULTS: The framework of an implant-supported fixed screw-retained prosthesis can be processed in gold, Co-Cr alloy, or titanium with casting, laser-welding, or milling techniques. To improve the stability and retention of a conventional complete denture, one to four implants are indicated, and unsplinted (single attachments) or splinted designs (bar systems) can be applied. The design of the overdenture prosthesis must be carefully planned according to the requirements to ensure adequate stability and optimal form, contour, and esthetics, and the patient's best comfort. CONCLUSION: A large variety of different treatment modalities exist for both the fixed and removable mandibular implant prosthesis. Clinical and technical aspects should be considered at the beginning of the treatment to: (1) select the optimal implant position, (2) establish an adequate number of functional units, (3) select the appropriate retainers, and (4) apply the best technique for framework processing and veneering.     

A survey of the removable prosthodontic clinical experience of dental students

A survey was sent to every dental school in the contiguous United States and Puerto Rico to solicit answers to 15 questions concerning various aspects of the prosthodontic education of the dental student. It was found that student clinical experiences differed significantly among the regions in terms of the total number of prosthodontic patients treated per student. Fees also differed significantly among the regions.No comment was made on the possible effects of denturism on either the type of patient or the number of removable prosthodontic patients available for treatment by dental students.Concerning the difficulty in securing the various types of patients, all categories were mentioned as being somewhat in short supply, although the greatest shortage was complete denture patients. There was no universally recognized solution to the shortage of patients, although lowering of fees and substitution of requirements were mentioned most frequently.Pertaining to the presence or absence of a strict requirement system, the vast majority of schools reported use of at least some type of requirement system, though not necessarily a strict one.     

Computer-guided implant planning using a preexisting removable partial dental prosthesis

Converting a conventional removable partial dental prosthesis (RPDP) into an implant-assisted removable partial dental prosthesis (IARPDP) may be facilitated by using data from the intaglio surface of the RPDP for proper implant placement. This procedure can be done by connecting the data from the intaglio surface of the RPDP to the residual ridge data of the cone beam computed tomography scan with implant planning software. However, although a misplaced implant under an RPDP can cause various complications, as yet, no technique has connected the information on a patient’s existing RPDP to the implant planning software. This article presents computer-guided implant planning, using a patient’s existing RPDP.     

Clinical performance of removable dental prostheses in the moderately reduced dentition: a systematic literature review

Objectives

Evidence-based therapeutic recommendations for removable dental prostheses are still lacking. The aim of the present study was a systematic review and meta-analysis of the survival rates of removable dentures in the moderately reduced dentition.

Materials and methods

In 2014, a systematic literature search in established medical databases (MEDLINE, EMBASE, BIOSIS, SciSearch, Cochrane, FIZ Technik Web) and a hand search of relevant dental journals were conducted. The search terms were relevant MeSH terms, free search terms, and combinations of the two. The search included RCTs, prospective and retrospective studies on survival rates of removable dental prostheses in the moderately reduced dentition with at least 15 participants, an observation period of at least 2 years, and a dropout rate of less than 25 %. The selection of relevant publications was carried out at the title, abstract, and full-text level by at least two of the authors involved. The publications included were tabulated and analyzed.

Results

Of the original 12,994 matches, 1923 were analyzed by title, 650 by abstract, and 111 according to the full text. The final review included 19 publications, of which 6 were multiple publications. Cast-metal framework dentures exhibited failure rates of between 33 and 50 % after 5 years. One study with a 25-year observation period reported failure rates of 50 %. Better results were obtained with proper pretreatment and a good recall scheme. Bilateral attachment prostheses showed failure rates of between 11 and 30 % after 5 years. Unilateral attachment prostheses showed failure rates of 75 % after 5 years. Double-crown prostheses dentures show failure rates of 0 to 21.7 % after 3 to 6 years.

Conclusions

Heterogeneous study designs and data analyses rendered a meta-analysis impossible, so that an evaluation at the highest level of evidence could not be performed.

Clinical relevance

Within the limitations of this study, it would be correct to state that removable dental prostheses, given suitable pretreatment and follow-up regimes, can provide satisfactory solutions. Based on only one paper, they revealed acceptable results even over a very long observation period (25 years).