The Role of Abutment-Attachment Selection in Resolving Inadequate Interarch Distance: A Clinical Report

A critical factor that needs to be evaluated during the diagnosis and treatment planning phase for patients seeking an implant-tissue-supported overdenture or metal-resin implant fixed denture is the presence of adequate interarch distance. The amount of interarch distance is critical to the selection of appropriate implant abutments and attachments for both implant-tissue-supported overdentures and metal-resin implant fixed complete dentures. This clinical report describes a patient with complications related to the failure to diagnose inadequate interarch distance, and the methods used to resolve the patient's chief complaint. A guide for abutment-attachment selection using one commercially available implant system is given.     

An alternative post-and-core method for patients with limited interarch space

BACKGROUND: The authors describe a technique for placement of a three-unit posterior fixed partial denture where one abutment lacked sufficient interarch space. CASE DESCRIPTION: This method involves the use of a cast post and core with a precision attachment soldered into the core to provide the necessary retention and resistance. The prosthesis is retained by a combination of cement and screw retention. CLINICAL IMPLICATIONS: This method is desirable when there is insufficient interarch space for a conventional post-and-core restoration. Achieving internal reinforcement by connecting the precision attachment to the residual root should provide the prosthesis with retention and added stability.     

Posterior segmental osteotomy with simultaneous endosseous implant placement to facilitate fixed reconstruction

The supra-eruption of the edentulous posterior maxilla may decrease interarch space, thus compromising the construction of an adequate fixed or removable prosthetic appliance (Henderson et al., 1985). The following case report illustrates a treatment which provides additional interarch space facilitating the restoration of the patient's dentition with a fixed prosthetic appliance. This arch space deficiency was corrected by performance of a unilateral posterior maxillary osteotomy with superior repositioning of this segment. Simultaneously, a hydroxylapatite-coated titanium endosteal dental implant was placed. Pre-operative considerations, the surgical procedure, and post-operative management of this problem are discussed.     

Augmentation of the atrophic edentulous mandible by a bilateral two-step osteotomy with autogenous bone graft to place osseointegrated dental implants

Extensive resorption of the mandible increases the interarch space and rehabilitation with traditional dentures is often unsatisfactory due to the superficialization of intraoral muscles. A study of 19 patients who underwent augmentation of an atrophic mandible using a bilateral two-step osteotomy and interpositional bone graft technique is presented. Three horizontal bone cuts (one in the intraforamina and two in the molar region) were made and jointed together by two short vertical bone cuts mesialy to the mental nerve. The cranial fragment was lifted and the iliac bone graft was interposed recreating the correct intermaxillary relationship. A broad vascular pedicle was maintained during surgery, ensuring nutrition from the lingual side, essential to reduce resorption of the bone graft and cranial fragment. 141 Biomet 3i Osseotite^® implants were placed. Patients were rehabilitated with a full-arch implant-supported fixed prosthesis or an implant-supported overdenture. This clinical study describes the resorption process over a 4 year follow-up. 3 of 19 suffered from persistent neurosensitive disturbances. In conclusion, bilateral two-step osteotomy in association with interpositional bone graft is a reliable surgical means to recreate the anatomical morphology of the mandible.     

The role of orthognathic surgery in the treatment of severe dentoalveolar extrusion

BACKGROUND: When mandibular molars are not replaced after extraction, the long-term problem of inadequate interarch space for either a fixed or removable prosthesis can occur. In the past, practitioners needed to decide whether to shorten the teeth, extract the supererupted maxillary molars to recapture space or leave the area unrestored. The authors present another option. CASE DESCRIPTION: A 61-year-old man was referred to a periodontist by his general dentist for placement of mandibular implants in the posterior sextant. Extreme supereruption of the maxillary dentoalveolar segment prevented restoration of the opposing edentulous area. An oral and maxillofacial surgeon performed a segmental osteotomy of the posterior right maxilla to gain needed interarch space. After the osteotomy was stabilized, the periodontist placed implants that were subsequently restored with a fixed prosthesis. CLINICAL IMPLICATIONS: The role of orthognathic surgery in treatment planning should not be overlooked in the comprehensive management of severe extrusion. It offers patients the opportunity to gain both function and esthetics that might otherwise be impossible.     

Surgical and prosthetic planning for a two-implant-retained mandibular overdenture: a clinical report

A 2-implant-retained mandibular overdenture is considered by some to be the standard of care for mandibular edentulism. Compared to a conventional complete denture, an implant-retained overdenture requires more thorough planning. Careful consideration is necessary regarding the 3-dimensional orientation of the implants to ensure adequate horizontal and vertical space for prosthetic components. This clinical report describes a patient with a compromised mandibular overdenture in whom the position of the existing implants yielded insufficient space for prosthetic components. This report describes the concepts for treatment planning prior to fabricating a new mandibular overdenture, including considerations for the surgical removal of the existing implants, alveoloplasty to create the necessary space for prosthetic components, and placement of the new implants to ensure an esthetic and functional prosthesis.     

Posterior maxillary segmental osteotomy for mandibular implants placement: case report

The loss of mandibular molars can result in a maxillary dentoalveolar extrusion, leading to an insufficient interarch space. In severe cases, this space must be regained before the prosthetic reconstruction of the opposite edentulous area. The posterior maxillary segmental osteotomy (PMSO) is a simple but precision technique to manage this problem; without which one can achieve a good surgical outcome but a poor final occlusion. The purpose of this paper was to present a case of PMSO for mandibular implant placement and to discuss the important steps.     

An alternative to conventional overdenture attachments with Molloplast-B: a technique

The use of Molloplast-B within the abutments of mandibular overdentures is an easy and inexpensive method for increasing retention and stability of dentures. The use of a retentive area prepared in natural tooth structure increases retentive capabilities for the overdenture patient. Unlike some silicone denture liners, Molloplast-B has shown an inhibitory effect to the growth of Candida albicans. Molloplast-B can be used in the conventional overdenture method or as described for an immediate overdenture. This type of overdenture can be relined easily to adjust for changes in mouth architecture. How well this material will retain its shape and consistency needs to be observed.     

Stabilized occlusion rims for small interarch spaces

This article describes three methods for fabricating stabilized occlusion rims for close interarch spaces. To utilize these methods, the dentist must anticipate the lack of space and request that the rims be fabricated by one of the methods outlined prior to the maxillomandibular relations appointment.     

颌间距离还是目标修复空间值——实测数值引导的无牙颌种植修复的临床决策

无牙颌患者选择种植修复方案时,不少医生忽视了应该在建后研判患者的颌间距离(垂直距离)或水平距离是否足够容纳种植上部结构及修复体等,再进行种植方案设计.而临床上常用的颌间距离(垂直距离)、水平距离的实测内涵和方法还有待明确,常用的术后目测估计除不准确外还易导致种植修复决策路径倒置,导致不少病例植入成功后出现了无法合理修...     

Assessing the space limitation inside a complete denture for implant attachments

Accurate determination of the space defined by the physiological contouring of a complete denture (before and after implant surgery) is required during the treatment-planning phase for an implant overdenture. This determination assists in formulating the proper surgical treatment plan and in selecting the appropriate independent implant overdenture attachment. This article presents a technique that provides clear, visual space limitation analysis of the removable prosthesis. The described method allows the clinician to determine the available space before the implant or attachment is placed.     

Mandibular Hader bar attachment overdenture wearers: A five-year longitudinal clinical evaluation by electromyographic analysis

IntroductionElectromyography is used to evaluate the muscle activity of temporalis and masseter muscles in a comparative clinical research on effectiveness of masticatory cycle by conventional overdenture and use of overdenture with Hader bar attachment for five years established on a scientific level and is first of its kind.AimThe purpose of this study is to determine the response of co-ordination of stomatognathic system and the functional status of long-term overdenture use, which can be recorded in EMG.Material and MethodsTen patients were treated with maxillary conventional complete denture and mandibular overdenture. Electrical activity of masseter and temporal muscles were obtained in 3 groups. (Gp. I) After insertion of conventional overdenture with copings; (Gp. II) Overdenture with Hader bar attachment and (Gp.III) five years of use of overdenture with Hader bar attachment.Results and conclusionThe mean and standard deviation for all the patients showed an increase in muscular activity of temporalis and masseter muscles after long-term rehabilitation (x = 0.405; 0.407 and s = 0.0668; 0.1344 respectively, p = 0.0042 and 0.0074 which is <0.05). This study concludes that overdenture with Hader bar system, after five years of function provide a sound justification for a viable alternative treatment modality to provide overdenture with attachment service to patients.     

Management of Challenging Esthetic Anterior Cases with Limited Restorative Space: A Clinical Report

With careful restorative planning and surgical placement, dental implants can be used to support and retain a wide range of esthetic prostheses. When implant planning or surgical executions are less than ideal, however, the resulting restorative space can be a significant obstacle to successful treatment. The aim of this article is to describe the use of a customized anterior bar to support a partial overdenture prosthesis for a youthful patient with a high smile line and a limited restorative space of 6 mm. Details of the treatment and an illustration of the customized design are also presented.     

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.     

Laboratory procedures for the maintenance of a removable partial overdenture

Laboratory procedures in support of maintenance therapy for a typical patient with a removable partial overdenture were described. These procedures consisted of the fabrication of a gold metal coping and the reline of the prosthesis with autopolymerizing acrylic resin. In designing the coping contours, the technician must consider the path of insertion of the prosthesis and the space requirement for the overlying resin tooth. Reproduction of the dowel preparation is facilitated by using a plastic dowel as part of the coping wax pattern. The removable partial overdenture was relined with autopolymerizing acrylic resin in a reline jig. Tooth-colored acrylic resin was used in the concavity formed by the overdenture abutment to enhance esthetics. The requirement of a coordinated effort between the dentist and the dental laboratory technician is critical to the successful treatment of the removable partial overdenture patient.     

A reliable index for correct positioning of precision attachments into an existing overdenture.

Limited space over abutment teeth may make incorporation of a precision attachment system within an existing overdenture technique sensitive. A special diagnostic index can be made to depict the available space within the prosthesis over the abutment teeth. This index is critical to determine the feasibility of attachment incorporation, as well as the selection and correct positioning of an appropriate attachment system. A method to improve predictability for precision attachment incorporation into an existing overdenture is described.     

Repair of a Removable Partial Denture Using Gold Occlusals

Limited interarch space causes maintenance problems with removable partial dentures. The problem of abrasion and breakage of acrylic resin teeth, the concomitant supraeruption of opposing natural teeth, and possible decrease of vertical dimension of occlusion can be prevented or minimized with cast-gold occlusals. Use of metal occlusals has been advocated on newly constructed removable partial dentures, but not on existing prostheses with severely worn or broken denture teeth. This article describes a repair procedure for a removable partial denture where minimal interarch distance resulted in wear and breakage of denture teeth. A thin, abraded denture tooth that had been repaired numerous times was prepared and covered with a cast gold restoration. The problem of abrasion and breakage of the acrylic resin tooth was solved and the service life of the prosthesis was extended.     

Posterior maxillary segmental osteotomy for restoring the mandible with dental implants: a clinical report

Posterior segmental collapse causes narrowing of interarch space and prevents adequate restoration in the posterior quadrant. Posterior maxillary segmental osteotomy (PMSO) is an alternative option that enables prosthodontic restoration with an implant-supported fixed partial denture. The following clinical report describes prosthodontic rehabilitation with fixed prostheses after a posterior maxillary segmental osteotomy for a patient with a partially edentulous mandible.     

三维有限元法对下颌种植覆盖义齿应力分布的分析

目的：分析种植义齿不同连接方式、即刻载荷式种植义齿、设置缓冲间隙对下颌种植覆盖总义齿应力分布的影响。方法：应用三维有限元法模拟正中开闭口运动中下颌种植覆盖总义齿的受力情况,分析种植义齿不同连接方法、即刻载荷式种植义齿、冲击载荷下缓冲间隙的设置对义齿应力分布的影响。结果：缓冲间隙的设置可以降低种植体内部、种植体软硬组织界面和义齿基托内应力的峰值,最易引起种植体侧方界面骨吸收的压应力峰值降低了约52%。螺丝固定的种植全口固定义齿有助于远期修复效果,即刻载荷式种植义齿初期稳定性尚待研究。结论：螺丝固定的种植全口固定义齿对设置缓冲间隙有利于保护种植体界面软硬组织的健康,防止义齿基托折裂,提高种植义齿的远期成功率。即刻载荷式种植义齿对种植义齿的远期成功率有一定的影响。     

Posterior segmental osteotomy of maxillary edentulous ridge: an alternative to vertical reduction

The posterior segmental maxillary osteotomy (PSMO) can be used as an alternative procedure to vertical reduction of the edentulous posterior maxilla. Surgical intrusion of the segment resulted in an adequate interarch space for prosthetic restoration without cortical bone loss and widening of the edentulous ridge and the mobilized keratinized mucosa as would be the case if vertical alveolar reduction had been performed.