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.     

Patient expectations of oral implant-retained prostheses in a UK dental hospital

STATEMENT OF PROBLEM: The loss of the natural dentition leads to severe functional impairment in many edentulous adults. A prosthesis retained and supported by osseointegrated dental implants may provide a satisfactory solution for people who have lost all their natural teeth. However, little information is available as to what patients requesting implants expect of implant-retained prostheses. AIM: The aim of this study was to assess the expectations of a group of edentulous patients requesting implant therapy. METHOD: The study included two groups: (1) a group of edentulous adults who requested implant therapy ('implant group'); and (2) an edentulous control group, of similar age and gender distribution as the implant group, receiving conventional complete dentures. Following a clinical and radiographic examination of the patients, data were collected using validated questionnaires. Both groups made a subjective assessment of current dentures. The implant group also completed a questionnaire which assessed expectations of implant-retained prostheses. RESULTS: Baseline satisfaction with current dentures was low in both groups, with the implant group being significantly less satisfied with comfort and stability of their mandibular dentures. Perceived ability of the implant group to chew hard foods was less than the control group. The implant group's expectations of an implant-retained prosthesis were significantly greater than for a conventional denture. CONCLUSION: Careful assessment of patient expectation of implant therapy is essential to determine appropriate treatment need, and to highlight unrealistic expectations.     

Maintenance requirements of implant-supported fixed prostheses opposed by implant-supported fixed prostheses, natural teeth, or complete dentures: a 5-year retrospective study

PURPOSE: The purpose of this study was to compare the maintenance requirements of implant-supported fixed prostheses with cantilever arms in edentulous jaws when opposed by fixed prostheses of similar design, by natural teeth, or by complete dentures. MATERIALS AND METHODS: The maintenance requirements for the 5-year follow-up period were obtained by examining the dental records of 37 people. Six were provided with fixed prostheses in both arches, 22 with a fixed prosthesis in the mandible opposed by a complete denture, and 9 with a fixed prosthesis opposed by natural teeth. Everyone was treated with Nobel Biocare implants using standard implant and prosthetic protocols. RESULTS: The denture teeth and acrylic resin were repaired on 44 occasions in the group with implants in both jaws, on 14 occasions in the group with implants opposed by natural teeth, and twice in the group in which the implants were opposed by a complete denture. The group with implants in both jaws was more likely to fracture the gold-alloy framework, which occurred on six occasions. The group with implants in both jaws was significantly different from the other two groups in relation to higher incidence of fracture of the teeth and gold-alloy framework. CONCLUSION: The maintenance requirements of implant-supported fixed prostheses with cantilever arms opposed by fixed prostheses of similar design were much greater than when opposed by natural teeth or complete dentures.     

Cantilever fixed prostheses utilizing dental implants: a 10-year retrospective analysis.

OBJECTIVE: The dental literature has been unclear about long-term success of fixed cantilever prostheses supported by dental implants. The disappointing results reported when cantilever fixed partial dentures (FPDs) are supported with natural teeth are not directly applicable to implant cantilever FPDs. This article reports on 10 years of implant-retained fixed prostheses primarily in the maxillary arch using the ITI dental implant system. METHOD AND MATERIALS: Sixty cantilever prostheses using 115 ITI dental implants on 36 patients were placed and monitored over a 10-year period. RESULTS: No implant fractures, abutment fractures, porcelain fractures, prosthesis fractures, soft tissue recession, or radiographic bone loss were recorded. All 60 cantilevered prostheses remain in satisfactory function. CONCLUSION: Positive, long-term results, using implant-retained cantilever FPDs can be achieved by: (1) using a rough surface implant of 4.1 mm or greater; (2) using an implant/abutment design that reduces stacked moving parts and reduces the implant-to-crowns ratio; and (3) using a cementable prosthesis design that eliminates the need for occlusal screw retention.     

Maintenance requirements of implant-supported fixed prostheses opposed by implant-supported fixed prostheses, natural teeth, or complete dentures: A 5-year retrospective study.

Purpose

The purpose of this study was to compare the maintenance requirements of implant-supported fixed prostheses with cantilever arms in edentulous jaws when opposed by fixed prostheses of similar design, by natural teeth, or by complete dentures.

Materials and Methods

The maintenance requirements for the 5-year follow-up period were obtained by examining the dental records of 37 people. Six were provided with fixed prostheses in both arches, 22 with a fixed prosthesis in the mandible opposed by a complete denture, and 9 with a fixed prosthesis opposed by natural teeth. Everyone was treated with Nobel Biocare implants using standard implant and prosthetic protocols.

Results

The denture teeth and acrylic resin were repaired on 44 occasions in the group with implants in both jaws, on 14 occasions in the group with implants opposed by natural teeth, and twice in the group in which the implants were opposed by a complete denture. The group with implants in both jaws was more likely to fracture the gold-alloy framework, which occurred on six occasions. The group with implants in both jaws was significantly different from the other two groups in relation to higher incidence of fracture of the teeth and gold-alloy framework.

Conclusion

The maintenance requirements of implant-supported fixed prostheses with cantilever arms opposed by fixed prostheses of similar design were much greater than when opposed by natural teeth or complete dentures.     

Interim Prosthesis Options for Dental Implants

Dental implants have become a popular treatment modality for replacing missing teeth. In this regard, the importance of restoring patients with function during the implant healing period has grown in recent decades. Esthetic concerns, especially in the anterior region of the maxilla, should also be considered until the definitive restoration is delivered. Another indication for such restorations is maintenance of the space required for esthetic and functional definitive restorations in cases where the implant site is surrounded by natural teeth. Numerous articles have described different types of interim prostheses and their fabrication techniques. This article aims to briefly discuss all types of implant‐related interim prostheses by different classification including provisional timing (before implant placement, after implant placement in unloading and loading periods), materials, and techniques used for making the restorations, the type of interim prosthesis retention, and definitive restoration. Furthermore, the abutment torque for such restorations and methods for transferring the soft tissue from interim to definitive prostheses are addressed.     

Implant prosthodontics: from single tooth to complex cases

Types of commonly used implant prostheses have been described and illustrated, including single tooth replacements, multiple tooth replacement fixed prostheses, implant and soft-tissue-supported removable complete dentures, implant-supported removable complete dentures, and fixed-detachable complete dentures.     

Neuromuscular coordination of masticatory muscles in subjects with two types of implant-supported prostheses

OBJECTIVES: To compare the electromyographic (EMG) characteristics of masticatory muscles in patients with fixed implant-supported prostheses and implant overdentures. MATERIAL AND METHODS: Nineteen subjects aged 45-79 years were examined. Fourteen were edentulous and had been successfully rehabilitated with (a) maxillary and mandibular implant-supported fixed prostheses (seven patients); (b) mandibular implant overdentures and maxillary complete dentures (seven patients). Five control subjects had natural dentition or single/partial (no more than two teeth) tooth or implant fixed dentures. Surface EMG of the masseter and temporal muscles was performed during unilateral gum chewing and during maximum teeth clenching. To reduce biological and instrumental noise, all values were standardized as percentage of a maximum clenching on cotton rolls. RESULTS: During clenching, temporal muscle symmetry was larger in control subjects and fixed implant-supported prosthesis patients than in overdenture patients (analysis of variance, P=0.005). No differences were found in masseter muscle symmetry or in muscular torque. Muscle activities (integrated areas of the EMG potentials over time) were significantly larger in control subjects than in implant-supported prosthesis patients (P=0.014). In both patient groups, a poor neuromuscular coordination during chewing, with altered muscular patterns, and a smaller left-right symmetry than in control subjects were found (P=0.05). No differences in masticatory frequency were found. CONCLUSION: Surface EMG analysis of clenching and chewing showed that fixed implant-supported prostheses and implant overdentures were functionally equivalent. Neuromuscular coordination during chewing was inferior to that found in subjects with natural dentition.     

Ankylos种植系统在前牙美学区种植修复体会

目的：应用Ankylos系统种植修复于前牙,观察其临床疗效。方法：选取36例前牙缺失的患者,采用直径为3.5mm标准A型Ankylos植体种植牙齿48颗,钴铬合金烤瓷冠修复。术后随访1周~18月,通过临床及X线检查,观察种植体周围牙龈组织的健康状况以及修复体与基台的稳定性,调查患者主观满意度,进行分析与评价。结果：全冠修复后,1枚植体上部基台因角度较大而转动、1颗烤瓷冠崩瓷外,其余均稳定牢固,无种植体周围炎及基台松动情况,术后1年内骨吸收小于1mm,患者主观满意率高,成功率97．8％。结论： Ankylos 种植系统应用于治疗前牙缺失成功率较高,并可获得较好的修复及美学效果。     

Electromyographic analysis of masticatory and neck muscles in subjects with natural dentition, teeth-supported and implant-supported prostheses

Objectives: To compare the electromyographic (EMG) characteristics of masticatory and neck muscles in patients with natural dentition, teeth‐supported prostheses and implant‐supported prostheses. Materials and methods: Twenty‐five subjects aged 40–80 years were examined. Five patients had maxillary and mandibular implant‐supported fixed prostheses; five patients had mandibular implant‐supported fixed prosthesis and maxillary removable complete denture; seven patients had implant‐supported fixed prosthesis (one arch) and natural dentition or full‐arch tooth‐fixed prosthesis (one arch); and eight control subjects had natural dentition or single tooth‐fixed prostheses. Surface EMG of masseter, temporal and sternocleidomastoid muscles was performed during maximum teeth clenching and unilateral gum chewing. Interarch dental contacts were assessed with shim stocks. Results: All groups had similar interarch dental contacts (P>0.05). During clenching, patients with maxillary and mandibular implant‐supported fixed prostheses had unbalanced standardized masseter and temporalis anterior activities (74%), with significantly larger values found in the other patients and control subjects (all mean values larger than 86%, P=0.017). All patients chewed with significantly larger muscular potentials than control subjects (on average, 1434–2100 μV s vs. 980 μV s, P=0.04), and had altered muscular patterns (left side, P=0.021). The patients with one arch with natural dentition/tooth fixed prostheses had chewing muscular patterns similar to the control subjects. Conclusions: Clenching with the analyzed prostheses was performed with a relative increment of temporalis activity. Neuromuscular coordination during chewing was larger in patients who maintained their teeth or dental roots, independently from the number of dental contacts.     

Perceptual Changes in the Anterior Maxilla after Placement of Endosseous Implants

Background: The innervation of skin and oral mucosa plays a major physiologic role in exteroception. It is also of interest clinically, as illustrated by sensory changes after neurosurgical procedures. Purpose: The goal of this study was to assess the perception of mechanical stimuli applied to the anterior maxilla in denture wearers and subjects rehabilitated with osseointegrated implants compared with that in subjects with a natural dentition. Materials and Methods: Five groups of subjects were selected and tested in the maxillary region only. Test groups included patients with a complete denture, an implant‐supported fixed prosthesis (full or partial), or a single‐tooth replacement. Light‐touch sensation and two‐point discrimination were performed on the buccal side of the alveolar mucosa and vibrotactile function was determined for natural teeth, full dentures, or implant‐supported prostheses. Results: For light‐touch sensation, no significant differences could be found between the groups. For two‐point discrimination, full‐denture patients showed higher threshold levels than the other groups. The threshold levels for vibrotactile function were higher in both full dentures and implant‐supported prostheses compared with natural dentitions. Conclusion: Natural dentitions offer superior vibrotactile function compared to any other dental status. Full dentures often show a stronger deterioration of the (vibro)tactile function compared with implant‐supported prostheses.     

Food selection and perceptions of chewing ability following provision of implant and conventional prostheses in complete denture wearers

The loss of natural teeth compromises chewing efficiency, and edentulous patients often have a diet that is deficient in fibre and vitamins. Prostheses that are retained on implants offer the possibility of overcoming some of the limitations of conventional dentures in terms of chewing efficiency. The aim of this study was to test the hypothesis that improvement in satisfaction with oral prostheses would result in improved food selection in edentulous patients. This prospective study involved three groups, namely (i) subjects who requested and received implants to stabilise a complete fixed or removable prosthesis (IG, n = 26), (ii) edentulous subjects who requested implant prostheses, but received conventional dentures (CDG1, n = 22), and (iii) edentulous subjects who requested and received conventional dentures (CDG2, n = 35). Data were collected using validated questionnaires pre- and postoperatively. Prior to treatment, all subjects were asked whether they ate a variety of hard and soft foods, to indicate the degree of difficulty they experienced when chewing these foods, and to rate their satisfaction with various aspects of their maxillary and mandibular complete dentures. Following the completion of treatment, subjects completed the questionnaires again. Pre- and postoperative data were compared. Subjects who received implant prostheses reported significant improvement in chewing hard and soft foods. CDG2 subjects also reported improvement, but CDG1 subjects reported no change or even deterioration following treatment. Despite reported improvement in satisfaction with comfort and ability to chew food, 30-50% of IG and CDG2 subjects still avoided eating foods such as carrot and apple. This suggests that, in the absence of tailored dietary advice, apparently successful prosthetic rehabilitation does not necessarily result in a satisfactory diet.     

后牙种植单冠修复后局部咬合变化的四年前瞻性临床研究

目的:定量分析后牙种植单冠修复后4年患者口内局部 力分布与咬合时间的变化规律,为种植修复体的咬合设计、调整和长期维护提供参考。 方法:前瞻性收集2012年12月至2013年12月于北京大学口腔医学院·口腔医院修复科行后牙种植单冠修复的患者,分别于修复后2周和3、6个月以及1、2、3、4年复查,采用...     

Replacement of missing teeth in a southern region of Vietnam — a descriptive dental laboratory study

Aim : To explore whether tooth replacement in a southern region of Vietnam is in line with the primary health care approach, aiming at health services for all people at affordable costs. Methods : Tooth replacement was investigated by means of prostheses as delivered by four dental laboratories of which the output was considered representative. Information was based on dental casts related to the prostheses. Results : Prostheses replaced almost all missing teeth, irrespective of the types (interrupted or shortened dental arches) and numbers of missing teeth in the dental arch they were made for. Acrylic removable partial dentures were the most common prostheses delivered (65% of removable partial dentures). Conclusion : It cannot be stated that dental arch conditions in this study were representative for the southern Vietnamese population. However, it is concluded that dental practitioners tend to provide complete dental arches by tooth replacements. This morphologically based approach might introduce over treatment. In line with primary oral health care, a functionally oriented treatment management, including the shortened dental arch concept, should be implemented.     

种植修复中的牙合学问题

口腔种植修复技术的出现,为口腔修复提供了新的临床途径。种植修复中的咬合问题不仅对恢复美观及功能有着重要影响,还关乎种植的成败。在种植修复前需考虑天然牙与种植体存在的差异,并根据缺失牙范围、设定的修复体类型等对种植修复进行有针对性的咬合设计。本文旨在对种植义齿修复相关牙合学问题进行探讨。     

Dental implants: a survey of patients' attitudes

This study measured the psychologic attitudes of patients to implant prostheses and compared their status before and after therapy. Questionnaires were mailed to 95 patients with implants placed and restored at a university dental school. The implants had been in position for an average of 2.2 years. The patients had previously worn removable complete or partial dentures. Different questions addressed eating, speaking, relationships, employment, social life, esthetics, maintenance, and overall dental health. Sixty-one questionnaires were returned (64%). Satisfaction with the implant prosthesis was significantly greater than for the denture (p less than 0.0001). Responses to individual questions indicated that confidence was improved (88%), implants were worth the trouble (97%), the procedure would be worth repeating (89%), and overall dental health was improved (98%). This survey suggests that patients' attitudes toward their dental health improve significantly after treatment with implant prostheses.     

BLB种植系统在前牙修复中的美学评价

目的：探讨BLB种植系统在前牙缺失修复中的美学效果。方法：对86例前牙缺失的病人共植入BLB种植体169枚,术后4个月修复,并分别于修复后0,6,12个月由患者与随访医生对修复体的外形、颜色、牙龈形态、色泽、丰满度、龈缘曲线、牙间乳头高度、修复体与邻牙的协调性八个方面进行评价。结果：86例患者,修复后0,6,12个月满意度分别为92．6％、94．9％和95％。结论：BLB种植系统操作简单,基台可调磨,应用于前牙区修复可以获得较好的美学效果。     

Functional and esthetic considerations for single-tooth Ankylos implant-crowns: 8 years of clinical performance

PROBLEM: Following the loss of an anterior natural tooth, the mucogingival complex begins to collapse. The early placement of endosseous dental implants can prevent or reduce the extent of this collapse. If there is a long interval between the loss of the natural tooth and the placement of the implant prosthetic replacement, this collapse tends to increase significantly. PURPOSE: This paper will report on the clinical success of this implant product in the fabrication of esthetic, functional, and harmonious replacements for missing single, natural teeth for a period of 8 years. METHOD: A total of 275 single Ankylos implant tooth restorations in the anterior and posterior jaw regions were placed and monitored for 8 years. Of these, 264 implants were restored using the titanium Balance abutments, and only 11 were restored using ceramic abutments. The final restorations were either metal-ceramic or full-ceramic crowns and were cemented with glass ionomer cement. RESULTS: The survival rate was 98.2%, with only 5 implants being lost during the healing phase. There were no other implant losses in the postloading period that averaged 3.2 years. To date, there have been no mechanical complications associated with the prosthetic components (ie, screw loosening, screw breaking, or crown breaking) for either the titanium or the ceramic abutments. CONCLUSIONS: Experience with the Ankylos system with single-tooth replacement indications may be considered positive with regard to the esthetic and functional results of the treatment. The lack of mechanical complications and problems with the hard and soft tissue in the loading phase of the implants suggests the functional safety of the tapered connection between implant and abutment.     

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口腔种植修复技术的出现,为口腔修复提供了新的临床途径。种植修复中的咬合问题不仅对恢复美观及功能有着重要影响,还关乎种植的成败。在种植修复前需考虑天然牙与种植体存在的差异,并根据缺失牙范围、设定的修复体类型等对种植修复进行有针对性的咬合设计。本文旨在对种植义齿修复相关学问题进行探讨。     

Distribution of acid-etched, fixed, and removable prostheses in dental patients

This report describes the pattern of tooth replacement for a random sample of adult dental patients in a major urban area in the northeastern United States. The data were collected by using a practitioner-based epidemiologic monitoring system that had been established with the local dental society. Nearly 90% of the randomly selected dentists collected the data on all adult patients seen during a 1-week period. The 2069 patients examined were predominantly regular users of dental care with a relatively even distribution across 10-year age groups. There was a slight preponderance of women in the sample (55%). There were no significant differences between men and women in terms of mean numbers of missing teeth. Overall, 92% were dentulous in both arches, 6% were edentulous in one arch, and 2% were totally edentulous. When the space was available for replacement, molars and premolars showed the lowest percentages of replacement in both arches for each age group. Overall, 14.4% of the replaced teeth were replaced by a fixed partial denture, of which acid-etched fixed partial dentures contributed 0.6% and conventional fixed partial dentures the remaining 13.8%. Removable prostheses replaced 85.6% of the missing teeth. The proportion of fixed replacements was highest in the youngest age groups and the proportion of removable replacements was dominating in the older age groups. Acid-etched fixed partial dentures were found most frequently in the youngest and oldest age groups.