Implant Retained Auricular Prosthesis with a Modified Hader Bar: A Case Report

Auricular prostheses for defects of external ear are retained either by mechanical means or implants. All implant retained prostheses are retained by various means such as bar and clip, magnetic attachments or a combination of bar, clip and magnets. The commonest problem encountered with the bar and clip system is loosening of the clip after 3–4 months. When magnets are used as retaining component they tend to corrode over a period of time. So various alternative retention methods which possess good retentive qualities, ease of reparability and patient friendly were tried. In the present case a newly modified Hader bar design which can act as an additional retentive feature apart from the clip is employed to increase retention. The major advantages in the modified Hader bar system were that only two implants were employed, the additional loops in the Hader bar prevented micro movements and the retentive acrylic locks were easy to repair if broken. The modified Hader bar has anti-rotational slots which prevents the sliding or rotation of the prosthesis which gave new confidence to the patient who was otherwise worried of inadvertent displacement of the ear prosthesis while playing.     

A clinical comparison of prosthetic complications of implant-supported overdentures with different attachment systems

OBJECTIVES: The objective of this clinical study was to evaluate the prosthetic complications of patients with 2 to 4 implants splinted with a round bar or with 2 to 4 unsplinted implants with ball attachments during the follow-up period. METHODS: A total of 26 patients were included in this study. Patients were randomly provided with a round bar or with ball attachments that were used to retain overdentures. During follow-up visits, the following prosthetic complications were recorded: round bar fracture, fractured overdenture, hygiene complications, abutment screw loose, worn O-ring or replacement of O-ring attachment, and fractured retention clip. The functioning period of overdentures in the round bar group ranged from 12 to 72 months (mean 49), and from 12 to 40 months (mean 23) in the ball attachment group. RESULTS: A total of 20 prosthetic complications were recorded in both groups. No differences in prosthetic complications were observed for 2 attachment systems. CONCLUSION: Implant-supported overdentures with bar or ball attachments may be considered to be reliable methods in the treatment of the edentulous individuals.     

Cement-retained superstructure for a metal-resin fixed complete denture

This article describes a method of fabricating a metal-resin fixed complete denture using a cemented acrylic resin superstructure over a metal bar that is screw-retained. The primary advantage of this design over traditional designs is that there are no screw access openings in the acrylic resin or denture teeth. Advantages include improved esthetics, ease of fabrication and tooth arrangement, simplification of procedures, and the opportunity to easily replace worn teeth when necessary.     

Mandibular implant-retained overdenture with magnets: a case report

Implant-retained overdentures can be a simple treatment option to restore the edentulous mandible. Retention can be achieved via studs, linked bar system or magnets. Success rates using the different retention mechanisms have been reported to be high. However, long-term prospective studies on implant-retained overdentures are limited. This paper reports on a patient who has successfully worn a mandibular implant-retained overdenture with magnets for 12 years.     

种植体与杆卡式附着体用于义耳修复

将３只骨融合式螺旋种植体植入耳缺损区，采用杆卡式附着体作为种植上的部结构和义耳的固体装置，解决义耳固位，这种固位方式具有固位可靠，取戴方便，便于自洁，利于局部组织健康等优点，特别是在对抗侧向力方面具明显的优越性，是目前义耳修复最佳的固位方式。     

Vacuum-formed matrix as a guide for the fabrication of craniofacial implant tissue bar-retained auricular prostheses

Craniofacial implant-retained auricular prostheses usually require a tissue bar and/or retentive elements in addition to the prosthetic ear. Complete coverage of the tissue bar and retentive elements in a given bulk of prosthetic material is sometimes difficult to achieve, but it is crucial to ensure that all the prosthetic components are kept within the contour of the auricular prosthesis to maintain esthetics and form. This article describes a method for fabrication of auricular prostheses with all the elements predictably confined within the anatomic contour of the prostheses. (J Prosthet Dent 1998;79:711-14.)     

Alter Steg, neuer Halt

Over the years fixed or removable prostheses are subject to wear due to function and parafunction just like the natural dentition. In implant-supported removable dentures attrition of polymer teeth and a reduction of the vertical dimension as well as wear of attachments and subsequent loss of retention may be observed. The reactivation of worn male components of Vario-Soft 3 attachments of an individually milled square bar by means of newly cast retention elements and the manufacture of a hybrid denture are presented by a case example.     

Computer-aided design and manufacturing construction of a pilot guide for a bone-anchored epithesis to replace an absent pinna

Bone-anchored epitheses have acquired an important role in auricle reconstruction. The purpose of this technical note is to present a fully in-house digital workflow for the design and three-dimensional (3D) printing of an optimal ear epithesis guide. Two hemifacial microsomia patients with grade IV microtia were treated accordingly. The upper dental arch was optically scanned and a cone beam computed tomography scan of the cranium was obtained. The composite and soft tissue models created were exported into 3D sculpting software. The unaffected ear was virtually mirrored onto the affected side and two ideal implant positions were defined in relation to bone thickness, contralateral symmetry, and housing of the retaining bar. A bite wafer was virtually designed on the upper dental arch and connected to the mirrored ear. The pilot guide was 3D-printed and allowed for correct positioning and orientation during surgery. The prosthetic pinna was manufactured in a conventional way. A bar with retaining clips was used to anchor the prosthetic pinna. Clinically satisfactory results were obtained in two grade IV microtia cases. The fully digital workflow presented to design and 3D-print an optimal ear epithesis guide offers a good alternative to the existing techniques.     

Fabrication of a craniofacial implant surgical and treatment planning guide

A procedure is described to fabricate a surgical guide to assist in the placement of craniofacial implants for prosthetic auricular rehabilitation. An impression is made of the defect, and a wax pattern of the missing ear is completed and evaluated on the patient. The definitive wax prosthesis is processed in acrylic resin. An occlusal maxillary splint is also fabricated. The occlusal splint and the acrylic resin ear are joined together using an extraoral acrylic resin bar. The resulting surgical guide provides proper orientation of the acrylic resin ear while remaining securely attached to the maxillary arch. This surgical guide can also be utilized for pretreatment radiographic examination.     

Periodontal attachment loss due to applying force by tongue piercing

This report describes lingual cortical plate loss of the two lower central incisors with second degree mobility in an 18.5-year-old patient. Seven millimeters of clinical attachment losses were detected. For the last 4.5 years, the patient has worn a tongue ornament. The spheres were pressed directly against the periodontal lesion. The metal bar was bent as empirical evidence of the excessive force. Dental practitioners should educate their patients about the risk of oral piercing.     

Craniofacial osseointegration: Technique for bar and acrylic resin substructure construction for auricular prostheses

Retention of auricular prostheses with adhesives is frequently problematic. Craniofacial osseointegrated implants have become an accepted biotechnique used in auricular reconstruction. This article describes a procedure for bar and acrylic resin substructure construction that allows for the incorporation of desired features. The most common means of retaining auricular prostheses is with bar and clip systems. For auricular prostheses, two implants are placed with the bar designed to minimize torquing on the implants and to facilitate hygiene. Additionally, the bar should not have to be removed from the patient when new prostheses are to be constructed. The procedure provides for a more biomechanically effective bar construction and efficient means of constructing replicate acrylic resin substructures.     

Home care maintenance protocol for ear prostheses

Hygienic home care maintenance for patients who have received a maxillofacial prosthesis is very important in order to secure a long-term success of a facial rehabilitation. Craniofacial implant therapy requires a specific protocol to care for the peri-implant tissues and material used for the prosthesis. This article presents the maintenance and care protocol for proper follow-up management of a maxillofacial ear prosthesis. Home care methods for the prosthesis hygiene are described, including: the insertion and the disconnection of the ear prosthesis, hygiene of the bar abutments before and after postdefinitive connection to the craniofacial fixtures, washing of the device, professional follow-up.     

Scanning Electron Microscopy Observations of Failures of Implant Overdenture Bars: A Case Series Report

Background: Soldered or cast bars are used as a standard of care in attachment systems supporting maxillary and mandibular implant overdentures. When failures of these bars occur, currently there is a lack of evidence in relation to their specific etiology, location, or nature. Purpose: To investigate the failure process of a case series of six failed soldered bars, four intact soldered bars, and one intact cast milled bar, which had been supporting implant overdentures. Materials and Methods: A total of 11 different overdenture bars were removed from patients with different configuration of opposing arches. A failed bar (FB) group (n = 6) had failed soldered overdenture bars, which were recovered from patients following up to 2 years of wear before requiring prosthodontic maintenance and repair. An intact bar (IB) group (n = 5) had both soldered bars and a single cast milled bar, which had been worn by patients for 2 to 5 years prior to receiving other aspects of prosthodontic maintenance. All bars were examined using scanning electron microscopy to establish the possible mode of failure (FB) or to identify evidence of potential failure in the future (IB). Results: Evidence of a progressive failure mode of corrosion fatigue and creep were observed on all the FB and IB usually around the solder areas and nonoxidizing gold cylinder. Fatigue and creep were also observed in all the IB. Where the level of corrosion was substantial, there was no evidence of wear from the matrices of the attachment system. Evidence of an instantaneous failure mode, ductile and brittle overload, was observed on the fracture surfaces of all the FB, within the solder and the nonoxidizing gold cylinders, at the solder/cylinder interface. Conclusion: Corrosion, followed by corrosion fatigue, appears to be a key factor in the onset of the failure process for overdenture bars in this case series of both maxillary and mandibular overdentures. Limited sample size and lack of standardization identify trends only but prevent broad interpretation of the findings.     

Spark erosion fixed/detachable prosthesis for the completely edentulous maxilla.

A technique is described for restoration of the completely edentulous maxilla. From six to eight root-form implants are surgically placed in the edentulous maxilla. A hybrid overdenture is constructed by use of a two-degree tapered precision milled primary bar. A cast overdenture prosthesis is constructed over this bar, and precision attachments are spark-erosion-processed to the primary and secondary prosthetic components. The technology described in this article allows for an intimate fit of the various prosthetic components. This prosthetic protocol permits maximum retention and stability of the prosthesis and solves many problems which are encountered in the oral rehabilitation of the edentulous maxilla.     

Effectiveness of maxillary overdentures supported by implants: maintenance and prosthetic complications

PURPOSE: The aim of this study was to evaluate the prosthetic complications with implant-supported overdentures in the maxilla. MATERIALS AND METHODS: Forty-one patients (mean age 61 years) were consecutively admitted for treatment from 1991 to 1998. A total of 173 ITI implants were placed. Four to six implants either connected with a bar (34 overdentures) or with single anchors (seven overdentures) supported the denture, and only a few parties had fewer than four implants. The overdentures had a horseshoe design and were reinforced by a cast-metal framework. The mean observation time was 3.2 years. Oral hygiene and periimplant parameters were regularly assessed, and records were kept of prosthetic maintenance service. All prosthetic complications encountered were classified related to (1) implant components and anchorage devices, (2) mechanical and structural failures of dentures, or (3) denture-related adjustments. RESULTS: Three implants did not osseointegrate, and five implants were lost after loading. Thus, the overall survival rate of the implants was 95.5%. Altogether, 85 prosthetic complications were encountered. The most frequent finding was retightening of the bar screw and adjustments of the bar retainers. Repair of dentures was not frequent and was mostly related to broken teeth. No fracture of dentures was observed. Renewal of dentures occurred twice, once after loss of all implants in one patient. Thirty-nine overdentures had been continuously worn; thus, the overall denture stability was 95%. Mucosal irritation and need for occlusal adjustment were the most frequent findings in the first year. Over time, a decrease of complications was observed. CONCLUSION: Planned maxillary overdentures supported by implants are a successful treatment modality on a short-term basis.     

Partial denture failures: A long-term clinical survey.

An assessment of 150 partial dentures which had been worn from 1966 onwards by 64 patients, revealed that 65 per cent had been replaced or could not be worn. Several dentures had been replaced four or more times. Posterior free-end saddle dentures were often not worn, and there was obvious evidence of oral tissue damage when partial dentures were worn. Failures were especially high with acrylic resin partials, and stress-breaker cobalt-chromium frame designs, whereas maxillary plate designs had the lowest failures. However, few partial dentures survived for more than 5–6 years. There is a need for more stringent selection of patients for partial dentures, to whom the biological consequences must be fully explained.     

Patient preference for light-cured composite bite splint compared to heat-cured acrylic bite splint

BACKGROUND: Heat-cured acrylic has been the most commonly used material for construction of bite splints. Although effective, its processing involves several steps and is time consuming. Furthermore, acrylic splints distort easily if not kept in water when not worn for long periods of time. A newly developed light-cured composite material is now being used for bite splint fabrication. The composite material offers benefits in ease and speed of construction, has minimal warping and distortion, and has proven patient acceptance. The aim of this study was to determine if patient satisfaction with the composite splint was as good as, or preferential to, the acrylic splint. METHODS: Both a composite and an acrylic bite splint were fabricated for each of 10 patients. The splints were worn alternately on a nightly basis and were adjusted as needed after the first week. After 3 weeks, each patient completed a questionnaire regarding the properties of each splint and any preferences they had in reference to fit, comfort, and other parameters of satisfaction. RESULTS: All of the patients were able to wear at least one of the splints comfortably. All 10 preferred the composite splint over the acrylic splint, agreeing that it felt more natural and was more comfortable to wear. CONCLUSIONS: The light-cured composite bite splint is preferable from the patient's perspective to the heat-cured acrylic bite splint. The composite splint is rapidly constructed on the original model, easily seated, and comfortably worn. Other properties of composite material also make it preferable for long-term use. Future studies are necessary to evaluate the functional differences between the composite and acrylic splint.     

Localized periodontitis as a long-term effect of oral piercing: a case report

Recent years have seen a dramatic increase in the number of published articles on short-term complications of oral piercing, possibly reflecting an increase in the popularity of this practice. Long-term effects of oral piercing, however, have had minimal documentation. This case report of a 28-year-old woman with piercing of the tongue and lower lip demonstrated localized severe periodontitis as a destructive long-term outcome related to oral piercing. The patient reported that she had worn 2 tongue rings and a mandibular labrette (lip piercing) in the form of a bar for 12 years. Plaque and calculus accumulation, severe inflammation, tooth mobility, severe horizontal radiographic bone loss, and deep pocketing were observed in teeth affected by the jewelry.     

Clinical comparison of two mandibular major connector designs: The sublingual bar and the lingual plate

Two mandibular removable partial dentures, one with a sublingual bar and one with a lingual plate as the major connector, were constructed for 10 patients. Both were made using the same impression and were identical except for the design of the major connector. The two major connector designs were evaluated by the patients at the conclusion of the study. Eight of the 10 patients preferred the lingual plate and nine of the 10 found both designs satisfactory. One patient indicated a strong preference for the sublingual bar over the lingual plate and another found both designs equally acceptable. We have concluded from the final data that the sublingual bar compares favorably with the lingual plate in patient acceptance and should be considered as a viable design alternative when a lingual plate is not indicated.     

前牙磨耗牙色修复材料的选择

牙齿磨耗是一种不同于龋病、外伤或发育性异常所导致的牙齿硬组织表面缺损,其发生率较高.前牙磨耗主要影响美观及发音,前牙磨耗修复是常见的临床问题,若以美观为导向,常运用复合树脂及陶瓷等牙色材料进行修复.由于磨耗牙自身化学成分、微观形貌的改变及牙色修复材料性能的差异等诸多因素的影响,前牙磨耗牙色修复材料的具体选择是口腔修复学领域研究的热点之一,至今仍在不断研究探索,现就前牙磨耗复合树脂及陶瓷牙色修复材料的选择作一综述.