Removable partial denture design involving teeth and implants as an alternative to unsuccessful fixed implant therapy: a case report

Various dental implants have been used, and high success rates have been reported. However, as their uses increase, implant failures have been reported. There are partially edentulous patients with an initial treatment plan of an implant-supported fixed partial denture. At times, one or more strategic implants fail to osseointegrate. In situations where financial, systemic, or local conditions preclude the use of a fixed partial denture, a well constructed removable partial denture can be an excellent treatment alternative. It has been reported that prosthesis support can be improved with the use of osseointegrated dental implants, with improved preservation and maintenance of existing hard and soft tissues around dental implants. This article describes the prosthodontic rehabilitation of a partially edentulous patient by the use of a removable partial denture design involving teeth and implants as an alternative to unsuccessful fixed implant therapy. This treatment option solved a difficult clinical problem derived from the failure of two strategic implants and provided the patient with an esthetic and functional prosthesis.     

Prosthetic management of edentulous mandible using endosseous implants and overdentures

The choice of a suitable prosthesis for a specific case is determined to a great extent by the underlying residual bone as well as the mucosa. Also of significance are the expectations and demands of the patient from the prosthesis. The following case report discusses the rehabilitation of a complete edentulous mandibular arch with an implant retained mandibular over denture. CLINICAL SIGNIFICANCE: Implant retained fixed or removable prostheses are good treatment options in patients who have a compromised edentulous foundation.     

Multidisciplinary Management of Limited Interocclusal Space: A Clinical Report

Prosthetic management of partial edentulism can be challenging with the presence of limited interocclusal space. The extrusion of opposing teeth combined with the alveolar extrusion of the edentulous areas reduces the space needed for fabricating a removable or fixed prosthesis when edentulous areas are present in the maxilla. This clinical report describes the treatment provided to a patient who presented with a limited interocclusal space on the posterior right quadrant. Before prosthetic rehabilitation, mandibular right posterior teeth were intruded, and the maxillary right posterior alveolar crest was reduced by alveoloplasty. After gaining adequate space, prosthetic rehabilitation was completed with a maxillary removable partial denture. During the 2‐year follow‐up period, the patient's chewing functions and physical appearance improved, and no complications occurred.     

Attachment‐Retained Gingival Prosthesis for Implant‐Supported Fixed Dental Prosthesis in the Maxilla: A Clinical Report

The rehabilitation of edentulous maxillae is a complex procedure due to the involvement of esthetic and functional requirements. A trial maxillary denture can be used to identify the need for adequate upper lip support when replacing removable complete dentures by implant‐fixed dental prostheses. This clinical report describes the outcome of the rehabilitation of an edentulous atrophic maxilla with unfavorable maxillomandibular relationship and deficient upper lip support. A trial denture was fabricated and used to diagnose the need for a prosthesis capable of restoring the upper lip support. The reduced upper lip support was also confirmed by a lateral cephalogram. The patient was rehabilitated by an implant‐fixed dental prosthesis associated with an attachment‐retained gingival prosthesis. The case presented shows that when loss of upper lip support is detected and the patient does not wish to undergo further surgical reconstruction procedure, the retention of a gingival prosthesis using a ball attachment is a satisfactory treatment option.     

Ten-year survival rates of teeth adjacent to treated and untreated posterior bounded edentulous spaces

STATEMENT OF PROBLEM: Failure to replace a single missing posterior tooth may lead to a variety of dental problems, which may ultimately result in tooth loss. However, little is known about the fate of the adjacent teeth if a missing posterior tooth is not replaced. PURPOSE: This retrospective study evaluated the survival of teeth adjacent to treated and untreated posterior bounded edentulous spaces. MATERIAL AND METHODS: Data were obtained from electronic treatment records from the Kaiser Permanente Dental Care Program, Portland, Ore. A final sample of 317 patients who met the study inclusion criteria was identified. Each bounded edentulous space was placed in 1 of 3 treatment categories: untreated, restored with a fixed partial denture, or restored with a removable partial denture. Subsequent treatment and the status of the teeth adjacent to the bounded edentulous space were followed through December 1999. Ten-year Kaplan-Meier survival estimates were generated for each treatment group, and differences in survival were evaluated with the log-rank chi-square test (alpha=.05). RESULTS: There was a significant difference in survival among the 3 treatment categories (P=.005). Spaces restored with a fixed partial denture had longer 10-year survival estimates (92%) than those that remained untreated (81%). Spaces restored with a removable partial denture had the poorest 10-year survival rate (56%). CONCLUSION: Under the conditions and selection bias associated with this retrospective study, the survival of teeth adjacent to a single posterior edentulous space was negatively associated with removable partial denture placement compared with no treatment or the use of a fixed partial denture.     

A Viable Treatment Alternative in Distal Extension Cases: A Case Report

Dentures requiring support from teeth, the mucosa and the underlying alveolar ridges are subjected to many forces that adversely effect the abutment teeth and the residual ridges during functional and parafunctional activity. A number of designs of the framework and the direct retainers were used to improve the comfort and acceptance of the patient wearing a removable partial denture. Attachment retained removable partial denture is one of the viable treatment alternative through which significant number of patients could be benefited. In this particular case of distal extension, attachment retained removable partial denture was chosen as a treatment modality. This article provides an overview and a simplified approach to this treatment through a case report and the criteria followed for selection of the particular attachments for treating the patient.

     

Strategic Use of Telescopic Retainers and Semi-rigid Precision Attachments in a Geriatric Patient: A Case Report

The rehabilitation of medically compromised elderly patients with long span partially edentulous arches has been a tremendous challenge for dentists. Proper dental management requires a commitment to provide the best treatment despite the compromised oral conditions. The aim of this paper is to describe the prosthetic rehabilitation of an elderly patient who presented with chief complaints of gagging sensation while using upper denture, loose upper and lower dentures and difficulty in eating food. Patient was rehabilitated using removable partial denture with semi-rigid attachments in the maxillary arch and telescopic prosthesis in the mandibular arch. Use of semi precision attachments helped in increasing the retentive ability of the maxillary prosthesis, even in the presence of only few abutments. Fabrication of a telescopic denture is a technique sensitive procedure but it offers advantages like bilateral splinting effect in long span partially edentulous arches, reduced effective crown–root ratio, maintenance of proprioception and transfer of forces along the long axis of the abutments. Although the management was complex but it improved patient’s esthetics, oral function and social confidence.

     

三种固位体义齿修复Kennedy第一和第二类牙列缺损疗效观察

目的评价太极扣义齿、精密附着体义齿和卡环固位体义齿修复Kennedy第一类和第二类牙列缺损的临床效果。方法收集Kennedy第一类和第二类牙列缺损修复患者823例,随机选择其中太极扣义齿、精密附着体义齿和卡环固位体义齿修复患者各63例,电话联系随访复查,检查患者基牙牙周状况及义齿组织面下黏膜,通过问卷调查获取患者的主观评价,并将结果进行对比研究。结果患者对太极扣义齿、精密附着体义齿的主观评价高于对卡环固位体义齿的主观评价;在舒适度、美观方面太极扣义齿优于精密附着体义齿。戴用3种义齿患者的口腔检查结果差异无统计学意义。结论太极扣义齿比较适合修复Kennedy第一类和第二类牙列缺损。     

The use of implants in the occlusal rehabilitation of a partially edentulous patient: a clinical report

This article describes the occlusal rehabilitation of a partially edentulous patient who did not want a removable partial denture. Implants and extensive fixed restorations were used to restore posterior support and treat severely worn dentition, respectively. The treatment offered the patient a functional and esthetic result.     

Fixed-removable partial denture

The technique and rationale have been presented for the fixed-removable partial denture. This type of denture has qualities of both the fixed partial denture and the removable partial denture and is indicated where the abutments would support a fixed partial denture but a severe defect is present in the edentulous space.     

The Use of Implants to Improve Removable Partial Denture Function

The oral rehabilitation with conventional removable partial dentures in Kennedy class I patients allows continuous bone resorption, dislodgment of the prosthesis during the mastication caused by the resilience of the mucosa, and rotation of the prosthesis. Thus, the associations of distal implants become an attractive modality of treatment for these patients. This case report presented an association of removable partial dentures, milled crowns and osseointegrated implants to rehabilitate a partial edentulous patient. A removable partial denture associated with implants and metal-ceramic milled crowns can offer excellent esthetics, and will improve function and biomechanics, at a reduced cost.

     

Prosthetic restoration of the anterior edentulous space.

The dentition of partially edentulous patients with an anterior modification space may be restored in several ways. If a removable partial denture is selected as the treatment of choice, denture tooth selection, direct retainer display, and anterior-posterior rotation may be sources of concern for the patient and dentist. A way to overcome the treatment problems associated with these partially edentulous patients is use of a Hader bar and clip-retained removable partial denture with the attachment of an anterior porcelain-fused-to-metal facade. This article describes this treatment option and the technique for fabrication.     

MK1附着体在老年患者单侧远中游离缺失修复中的临床应用

目的：评价MK1附着体修复老年患者单侧远中游离缺失的临床效果。方法：采用MK1附着体为23例单侧后牙游离缺失的老年患者进行修复治疗,经过8-44个月的随访,从主观感受、临床及X线检查评价修复效果。结果：所有患者对MK1附着体义齿的美观舒适性、固位力、咀嚼效能均感到满意;21例患者认为其摘戴方便。经配对t检验,MKl附着体义齿与原可摘义齿相比在美观舒适性、固位力、咀嚼效能方面均有明显优势（P〈0．05）;而在摘戴方面基本没有差别妒〉0．05）。2例患者出现了牙龈炎症,牙周治疗后炎症消失。3例患者进行了义齿可摘部分的重衬,其余患者基牙及缺牙区牙槽嵴无异常。结论：MK1附着体义齿稳定及固位性能良好,是一种较理想的修复老年患者单侧后牙游离缺失的修复体。     

Wear of resin denture teeth in partial removable dental prostheses

PurposeTo investigate occlusal wear of resin denture teeth in partial removable dental prostheses worn by partially edentulous patients.MethodsThirty patients with partial removable dental prostheses were included in the study. Thirty-two patients with complete dentures served as a reference group. Occlusal wear after two years was evaluated indirectly using gypsum casts and a three-dimensional laser-scanner device. Overall wear of complete occlusal surfaces and maximum wear of occlusal contact areas were measured. Patient and prosthesis data were analyzed using univariate and multiple linear mixed models.ResultsOverall wear of denture teeth in partial removable dental prostheses was 91 (SD 85) μm, and maximum wear of occlusal contact areas was 329 (SD 204) μm (means and standard deviations). Average and maximum wear values for teeth in complete dentures were both lower than those for teeth in partial removable dental prostheses. However, differences between wear of different types of denture did not reach statistical significance after adjustment for gender, type of tooth, dental status of the opposing jaw, and antagonist material. Statistical analysis revealed that wear was greater for denture teeth occluding with ceramic crowns and/or fixed partial dentures as antagonists.ConclusionsResin denture teeth in partial removable and complete dental prostheses are subjected to clinically important occlusal wear that might destabilize occlusion and cause further problems. Patient-related factors and dental status affect wear behavior and should be taken into consideration when treating patients with removable dentures.     

数字化印模在无牙颌中应用的研究进展

数字化印模是一种高效、便捷的新兴印模技术,近年来在固定冠、种植牙,可摘局部义齿中都展现了良好的准确度以及临床疗效,同时简化了临床诊疗的繁琐流程,提高了患者舒适度.无牙颌印模制取一直是临床诊疗的关键与难点,数字化印模在无牙颌患者修复中的应用逐渐增多.该文将从无牙颌数字化印模的分类、准确度研究以及临床扫描策略进行综述,为无...     

Prosthetic rehabilitation in the elderly inhabitants of Helsinki, Finland

The aim of this study was to document the number of remaining natural teeth, to examine the prosthetic rehabilitation and to evaluate further prosthetic treatment needs among a representative sample of 76–86-year-old inhabitants of Helsinki. The edentulous made up 46% (168) of the subjects, 40% of the men and 48% of the women. Of these edentulous, 94% (158) wore complete dentures in both jaws, 2% wore only a maxillary denture, and 4% wore no dentures at all. One edentulous subject had an implant-supported overdenture in the lower jaw. More than half (54%) of all subjects had 1–32 natural teeth left. These dentate subjects had 47% (mean 13·2, excluding the wisdom teeth) of their natural teeth remaining. Of the remaining teeth, 13% (mean 1·8) were crowned and 5% (mean 0·6) were indicated to be extracted. Among the dentate, 37% (mean 10·4) of their natural teeth were missing and replaced by some type of fixed or removable prosthesis. Eleven per cent (mean 3·1) of missing teeth had not been replaced and were considered not to need prosthetic replacement. However, 5% (mean 1·3) of the missing teeth without prosthetic replacement were judged to need a prosthesis. Among the dentate, 37% wore a complete denture in one jaw; 34% of the dentate subjects used acrylic removable partial dentures (ARPD), and 19% used metallic removable partial dentures (MRPD). Of the dentate, 45% had crowns and fixed bridges. Altogether, 25% wore some kind of combination of fixed and removable prosthesis, whereas 14% had no type of prosthetic rehabilitation at all. The age of the current prosthesis varied from less than one year to over 50 years. Of all the subjects, 37% (6% of the edentulous and 63% of the dentate) had experienced inadequate prosthetic rehabilitation.     

In vivo evaluation of occlusalcontact area and maximum bite force in patients with various types of implant-supported prostheses

Abstract

Objective. To determine the effects of various implant retained and/or supported prostheses on number of occlusal contacts (NOC), occlusal contact area (OCA)and maximum bite force (BF). Patients and methods: In total, 56 patients were included in the study; five test groups and two control groups. The patients in the treatment groups received implant-supported/retained prosthesis; over-dentures retained with two individual attachments in occlusion with complete denture, with four individual attachments in occlusion with complete denture, with four individual attachments in occlusion with fixed partial dentures or natural dentition, 6-implant retained fixed bridges in occlusion with natural dentition and 8-implant retained fixed bridges in occlusion with natural dentition. The patients in control group 1 were wearing conventional complete maxillary and mandibular dentures, whereas in control group 2 they had fixed full-arch porcelain-fused to metal restorations prostheses for both arches. Dental Pre-scale was used measure the NOC, BF and OCA. Results. There was no statistically significant difference between the treatment and control groups, among the groups with regards to NOC. OCA demonstrated different results among the removable and fixed reconstruction groups. With regards to BF, removable dentures supported with four implants showed higher bite force values than controls and two implant over-dentures. Also, a fixed reconstruction using eight implants showed higher BF values than a fixed reconstruction using six implants. Conclusion. Use of implants for removable dentures and fixed reconstructions improve occlusal contact area and bite force.     

非游离端可摘义齿与固定义齿牙槽骨承力的变形分析

目的：观察非游离端可摘义齿与固定义齿受载前后基牙牙槽骨的变形。方法：选用新鲜人尸离体上下颌骨，制备左下第一恒磨牙缺失模型，先后用铸造三臂卡环为固位体的可摘义齿及整铸双端固定桥对缺失区进行修复。以垂直向均匀加载和集中加载两种方式，用电子散斑干涉技术比较分析基牙牙槽骨受载前后的变形分布。结果：两种修复体都可以使基牙牙槽骨的离面位移减少，以固定修复后基牙牙槽骨的离面位移减少得较为显著。结论：两种设计都有其合理性，以固定义齿修复对于改善牙槽骨的力学状况优于铸造三臂卡环为固位体的活动义齿     

All in One: A Case Report

To plan and execute the rehabilitation of a decimated occlusion is probably one of the most intellectually and technically demanding tasks faced by any restorative dentist. This clinical report describes a multidisciplinary approach for complete oral rehabilitation of a patient with few remaining natural teeth. The treatment included the use of a complete denture, removable partial denture, fixed partial denture and implants for restoring the patient’s esthetics and function.     

Veterans Administration Cooperative Dental Implant Study — Comparisons between fixed partial dentures supported by blade-vent implants and removable partial dentures. Part I: Methodology and comparisons between treatment groups at baseline

This study was conducted to determine whether fixed partial dentures supported by dental implants provide an acceptable alternative to conventional removable partial dentures in patients with Kennedy class I or class II edentulous conditions. The acceptability of the new treatment will be based on success rates, impact on the health of the remaining dentition, masticatory performance, patient satisfaction, and maintenance care and cost. The study was planned also to provide comparisons between two designs commonly used by dentists for fabricating removable partial dentures. The designs differed only in terms of the type of the retainer (clasp type) and tooth support (rest location).A total of 272 patients with Kennedy class I and class II edentulous conditions were assigned on a random basis to one of the treatment groups, 134 to receive a removable partial denture and 138 a fixed partial denture supported by a blade-vent implant. All of the patients were medically screened and met prespecified criteria for oral hygiene, bone support for abutment teeth, and size of the residual ridge.Thirty-four patients were eliminated from the study before completion of their treatment. An additional six patients with early implant failures were reentered in the study and followed up as a separate group. The remaining 232 patients received comprehensive dental care, including removable partial dentures for 118 and fixed partial dentures for 114 patients.A series of examinations, radiographs, masticatory performance tests, patient satisfaction, food selection questionnaires, and dietary history were completed before initiation of the treatment, 16 weeks after the insertion of an RPD or an implant, and thereafter at 6-, 18-, 36-, and 60-month intervals. In addition, patients were seen at 6-month intervals for a recall dental examination, oral prophylaxis, plaque instructions, radiographic survey of the implant, and any needed dental treatment.The randomization stratification approach produced two treatment groups with comparable age, number of remaining maxillary and mandibular teeth, type of opposing dentition, and percent of patients with Kennedy class I and class II edentulous conditions. The mean scores of bone support, tooth mobility, and sulcular depths of abutment teeth were also similar. Significant but comparable improvements in oral hygiene and sulcular depth occurred in the two groups after treatment. The periodontal health scores at the 16-week interval serve as the baseline to measure subsequent changes in periodontal health. This prospective longitudinal study with prespecified criteria for implant and removable partial denture failure should provide reliable estimates of failure rates, number and types of complications, maintenance care needs, and total costs for the two treatment modalities and the two RPD designs.