3种修复方式修复游离端缺失的临床比较

［摘要］ 目的 探讨3种修复方式修复游离端缺失的特点及临床效果。方法 本组资料共181例,其中74例行可摘局部义齿修复,45例行精密附着体义齿修复,62例行种植义齿修复。随访6~60个月后,评价咀嚼效率、成功率、稳固性、患者满意率。结果 种植牙修复咀嚼效率93.5％、成功率98.4%、稳固率98.4%、满意率98.4%,精密附着体咀嚼效率88.8％、成功率91.1%、稳固率86.7%、满意率86.7% ,可摘局部义齿咀嚼效率78.4％、成功率82.4%、稳固率70.3%、满意率71.6%。结论 种植修复在游离端缺失的修复中具有明显的优势,精密附着体能获得较为理想的修复效果,可摘局部义齿修复效果均比前两者差。     

软衬材料在下颌双侧游离缺失修复中的应用研究

目的:观察软衬材料在下颌双侧游离缺失可摘局部义齿中的应用效果。方法:选择38例牙槽嵴重度吸收的下颌双侧游离缺失患者,随机分为两组。实验组在可摘局部义齿中引入软衬材料对义齿进行衬垫处理,对照组接受常规可摘局部义齿修复。检测两组义齿戴用1个月、1年及2年时的咀嚼效率,同时采用满意度问卷调查获取患者的主观评价。结果:与对照组比较,实验组义齿各个时期的咀嚼效率均获得明显改善(P<0.05),舒适程度及咀嚼功能的满意度亦高于对照组(P<0.05)。结论:软衬材料的应用可提高下颌双侧游离缺失可摘局部义齿的满意度,改善患者的咀嚼效率,取得良好的修复效果。     

Orthodontic and prosthetic rehabilitation of unilateral free-end edentulous space

Most patients prefer fixed dentures, even in the presence of uni and bilateral free-end saddle. The most suitable treatment for this is an implant or implant-supported prosthetic restoration. A combined prosthetic and orthodontic treatment with distalization of a posterior tooth towards the edentulous region is an alternative approach. This study involved a 34.3 year old female patient who had a free-end edentulous space on the left mandibula and missing 1st and 3rd molars on the right mandibula. The patient was offered both a removable partial denture and implant treatment options. A detailed explanation of her situation and suitable treatments were given but she refused both options. Therefore, an alternative combined treatment involving prosthodontic and orthodontic disciplines was performed. The second premolar tooth was distalized orthodontically and used as a distal bridge abutment. After 65 months, prosthetic restoration was functional and abutment teeth and periodontium were pathology free, and the patient was satisfied with the results.     

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.     

Number of implants for mandibular implant overdentures: a systematic review

PURPOSE

The aim of this systematic review is to address treatment outcomes of Mandibular implant overdentures relative to implant survival rate, maintenance and complications, and patient satisfaction.

MATERIALS AND METHODS

A systematic literature search was conducted by a PubMed search strategy and hand-searching of relevant journals from included studies. Randomized Clinical Trials (RCT) and comparative clinical trial studies on mandibular implant overdentures until August, 2010 were selected. Eleven studies from 1098 studies were finally selected and data were analyzed relative to number of implants.

RESULTS

Six studies presented the data of the implant survival rate which ranged from 95% to 100% for 2 and 4 implant group and from 81.8% to 96.1% for 1 and 2 implant group. One study, which statistically compared implant survival rate showed no significant differences relative to the number of implants. The most common type of prosthetic maintenance and complications were replacement or reattaching of loose clips for 2 and 4 implant group, and denture repair due to the fracture around an implant for 1 and 2 implant groups. Most studies showed no significant differences in the rate of prosthetic maintenance and complication, and patient satisfaction regardless the number of implants.

CONCLUSION

The implant survival rate of mandibular overdentures is high regardless of the number of implants. Denture maintenance is likely not inflenced substantially by the number of implants and patient satisfaction is typically high again regardless os the number of implants.     

纯钛铸造支架可摘局部义齿的临床应用对比研究

目的：对比研究纯钛铸造支架、钴铬合金支架、塑料基托可摘局部义齿修复的临床疗效。方法：选择90件肯氏I类设计修复义齿,分别用三种义齿修复方法,戴用后半年～2年进行临床观察。结果：钝钛铸造支架叮摘局部义齿质量轻,佩戴舒适,咀嚼功能良好。结论：纯钛铸造支架可摘局部义齿可获得良好的临床效果。     

Mandibular Kennedy Class I implant‐tooth‐borne removable partial denture: a systematic review

Summary The purpose of this systematic review is to evaluate the use of implant‐tooth‐borne removable partial dentures in prosthetic rehabilitation of Kennedy Class I partially edentulous arches. A comprehensive search was performed in MEDLINE, EMBASE, Cochrane Oral Health Group’s Trials Register, Cochrane Central Register of Controlled Trials, UK National Research Register, Australian New Zealand Clinical Trials Registry (ANZCTR), conference proceedings and abstracts up to 25 August 2009. Searching the reference list of the selected articles and hand searching of several journals were also performed. A total of nine studies were included. Of these, two were randomized, three were retrospective and four were case reports. All but two had a low reporting quality (level IV on a four‐level hierarchy of evidence). Nevertheless, the improvement in function, aesthetics and stability has been demonstrated in all studies with minimal prosthetic care. Within the limitations of this study, implant‐assisted/supported removable partial denture may provide a simple, economical and less invasive treatment modality. The predictability of such approach in the management of bilateral distal‐extension situation is, however, still questionable. A higher quality of published studies namely with a focus on long‐term randomized clinical trials are needed.     

球帽固位下颌双种植体覆盖义齿修复效果的前瞻性研究

目的 评价球帽固位的下颌双种植体覆盖义齿的临床修复效果及其修复并发症。 方法 对下颌牙槽骨重度萎缩的10例无牙颌患者,在前牙区与中线等距平行植入2枚种植体,3个月后采用球帽附着体固位方式制作下颌种植覆盖义齿。在覆盖义齿戴入后1周、1年、2年、3年进行随访,评价种植体边缘骨吸收情况、种植体周围软组织健康状况、患者满意度及义齿并发症情况。 结果 10例两球帽固位的下颌种植覆盖义齿经过3年观察,种植体存留率100%,边缘骨吸收<1 mm,种植体周围软组织健康,患者满意度显著提高且维持稳定,义齿无重衬或折断现象,义齿并发症主要是球帽附着体O型圈的置换或固位金属簧的固位力再激活,修理频次0.67次/(年·人)。 结论 在种植体植入位置、方向合适的情况下,球帽附着体固位的下颌双植体覆盖义齿,可获得长期稳定的临床修复效果。     

Clinical outcome of removable prostheses supported by mini dental implants. A systematic review

Introduction: For many years, edentulous patients have had no other option than conventional dentures to reestablish their oral function. To avoid the need for bone graft surgery, some professionals have suggested the use of mini dental implants (MDIs) to support prostheses. The MDIs are narrow implants, ranging approximately from 1.8 to 2.9?mm in diameter. Recently, the promising results of mini implants regarding osseointegration and patient satisfaction have led clinicians to accept them as a definitive treatment option. Objective: Therefore, the proposition of this systematic review was to assess information on the outcomes of MDIs supporting removable prostheses. Methods:The PubMed and Cochrane databases were searched for articles published before September 2017, which yielded a total of 774 studies for analysis. After exclusion and inclusion criteria, 22 prospective studies were included in this systematic review. Results: Most mini implants were placed in a flapless single-stage surgery and loaded immediately. Most studies reported failures in the first year and prosthetic complications. The mean survival rate of the selected studies was 95.6%, and mean follow-up was 22.8 months. Conclusion: The MDI-supported removable prostheses successfully improved patients’ chewing and speaking ability, quality of life, and satisfaction, suggesting that MDIs are a viable and safe option to support removable prostheses in the mandibular arch.     

种植修复下颌磨牙游离缺失满意度的纵向研究分析

目的:纵向比较下颌磨牙游离缺失患者在未修复、活动义齿修复及种植义齿修复后的主观评价。方法:对40例戴用过活动义齿,现已完成种植义齿修复的下颌磨牙游离缺失患者,采取种植修复前自测问卷和种植修复后自测问卷形式,由患者本人填写。结果:种植义齿在咀嚼、语言、舒适性、固位等方面的满意度得分更高。结论:种植义齿是修复下颌磨牙游离缺失的最满意选择,活动义齿和未修复状态的满意度无显著意义。     

Efficacy of a posterior implant support for extra shortened dental arches: a biomechanical model analysis

The purpose of this study was to test the efficacy of utilizing implants underneath distal free-end denture bases to establish a stable occlusal support for extreme shortened dental arches (ESDA). The authors constructed a two-dimensional finite element model of the ESDA where only lower anterior teeth remain. Posterior occlusal support was provided by a fixed partial denture with an osseointegrated implant (IFPD), fixed cantilever partial denture (CFPD), or a removable partial denture with or without an implant underneath (IRPD and RPD). A dentate mandible model was the control. When muscle vectors simulating clenching force were applied, stress levels on the temporal bone surface area under each configuration were compared, to evaluate the efficacy in establishing the occlusal support. The largest stress increase in temporal bone was found in the ESDA situation followed by the RPD. The least amount of stress increase was found with the IFPD followed by IRPD when the implant was placed in the molar region. The stress increase with IRPD was about 20-45% of the amount with RPD. Our results suggest that IFPD provides most favourable and stable occlusal support, however, IRPD with a single posterior implant also provide stable occlusal support with reducing the stress levels in the temporomandibular joint.     

老年人牙缺失临床修复治疗的分析

目的了解老年修复患者的口腔情况及修复特点。方法对1 166例60岁以上老年人牙缺失患者作修复治疗,分析缺牙及修复情况。结果1 166例患者平均缺牙10.25颗。牙缺失数上领>下领,磨牙>双尖牙>切牙>尖牙。1 166例患者中1 120例作可摘义齿修复,其中游离端缺失约占58%0 46例作固定义齿修复。结论老年修复患者具有缺牙数目多,游离端缺失多,余牙磨耗严重,食物嵌塞多,余留牙松动及残根多等特点;修复以可摘义齿为主,可适当行固定义齿修复。修复治疗时尽量发挥尖牙、已治疗的残根及健康第三磨牙的作用。     

Use of an Immediate Provisional Implant to Support a Full-Arch Interim Restoration: A Clinical Report

The use of provisional implants as the sole or adjunct mean of stabilization for interim fixed partial dentures has gained popularity in implant prosthodontic treatment. These implants can be used between submerged implants during the healing phase to provide support for interim fixed or removable partial dentures. In this clinical report, a provisional implant used to provide support for a full-arch fixed interim restoration is described. Positioned between adjacent conventional implants, the provisional implant was placed during the same surgical procedure. As a result, an immediate acrylic fixed partial denture supported by natural teeth and the provisional implant provided a comfortable and esthetic interim restoration during the osseointegration period.     

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.

     

An analysis of the implant‐supported overdenture in the edentulous mandible

This investigation examined the cumu‐lative survival rate of the implant‐supported overdenture using two types of attachments in patients treated at Show Chwan Memorial Hospital Implant Center from 1992 to 2006. Fifty‐one patients (30 men and 21 women) were treated with mandibular implant‐supported overdentures. Attachment systems used were the Hader bar with bilateral, cast ERA attachments (Group A, 31 patients with 15 men and 16 women, 134 implants) and the Hader bar with bilateral, distal extension cantilevers (Group B, 20 patients with 15 men and 5 women, 85 implants). Two hundred and four implants remained at the end of the follow‐up period. Among failed implants, 10 implants were in Group A (failure rate: 10/134 = 7·5%), whereas five implants were in Group B (failure rate: 5/85 = 5·9%). Sixty‐six point seven per cent (10/15) of failed implants were placed in the distal anterior mandible, and 33·3% (5/15) were placed in the middle anterior mandible. Survival was also examined with respect to condition of the opposing arch. Patients wearing a maxillary removable partial denture had the highest implant failure rate (5/51 = 9·8%), whereas the failure rate of the maxillary complete denture group was only 5·7%. The most frequent need for maintenance was wear over patrix component of ERA or Hader clip (n = 56). Eight patients experienced connector fracture between ERA and Hader bar, and one experienced distal extension cantilever fracture. The implant‐supported overdenture can be an effective and reliable alternative to the conventional complete mandibular denture. Fewer prosthetic complications were seen in overdentures retained with distal extension cantilever attachments.     

Influence of mandibular free-end partial edentulism on the force exerted on maxillary anterior teeth

PurposeThe purpose of this study was to determine the influence of mandibular free-end partial edentulism and the wearing of removable partial dentures in the partially edentulous area on the force exerted on maxillary anterior teeth.MethodsA commercially available jaw model with exchangeable teeth was used. Seven experimental conditions of mandibular free-end edentulism were set up and a distal extension removable partial denture to replace missing posterior teeth was fabricated. Strain gauges were attached to the root surface of the maxillary left central incisor, canine, first premolar and first molar, and the force exerted on them was calculated based on the calibration coefficient. An occlusal load of 49 N was applied and the forces were compared with the Kruskal–Wallis test (P < 0.05).ResultsThe force exerted on the maxillary anterior teeth increased significantly as the number of remaining teeth decreased. The force exerted on the maxillary anterior teeth decreased significantly with use of a removable partial denture.ConclusionsWhen the number of remaining teeth decreases in mandibular free-end partial edentulism, the burden on the maxillary anterior teeth increases. Our findings suggest that for patients with mandibular free-end partial edentulism, wearing a removable partial denture is effective in preserving the remaining teeth by reducing excessive stress.     

Long-term results of mandibular reconstruction with autogenous bone grafts and oral implants after tumor resection

Objectives: (a) To evaluate retrospectively the clinical outcome of non‐vascularized bone grafts used for the reconstruction of mandibular defects following tumor resection; (b) to evaluate the clinical outcome of implants and implant‐supported prostheses placed in the reconstructed areas; and (c) to evaluate patients' satisfaction regarding function and esthetics after oral rehabilitation. Material and methods: In a 9‐year period (1995–2003), 29 patients affected by mandibular tumors involving to tooth bearing areas were treated by means of tumor resection and immediate or delayed reconstruction with autogenous non‐revascularized calvarial or iliac bone grafts. Among these patients, 16 patients were selected for dental rehabilitation of the lost dentition with implant‐supported 3fixed prosthese333s. For to 7 months later, the patients received 60 oral implants for the prosthetic rehabilitation of the reconstructed edentulous areas. Results: No total failure of the graft was observed, while partial loss of the graft was observed in one patient. The mean follow‐up of patients after the start of prosthetic loading of implants treated was 94 months (range: 36–132 months). Two patients dropped out of the follow‐up after 3 and 4 years of observation, respectively. Two implants were removed due to loss of osseointegration, while two implants, although still integrated, presented peri‐implant bone resorption values higher than those proposed by Albrektsson et al. for successful implants. Cumulative survival and success rates of implants were 96.7% and 93.3%, respectively. Conclusion: Results from this study demonstrated that bone defects following resection of mandibular tumors can be predictably reconstructed with autogenous bone grafts taken from the calvarium or the anterior iliac crest. It has also been shown that the long‐term survival and success rates of implants placed in the reconstructed areas (96.7% and 93.3%, respectively) may guarantee an excellent prognosis of implant‐supported prostheses.     

Quality of life assessment of bone-anchored fixed partial denture patients with unilateral mandibular distal-extension edentulism.

STATEMENT OF PROBLEM: Dental implants are expanding their use among partially edentulous patients. However, whether implants can promote the quality of life (QOL) of these patients has not been sufficiently examined. PURPOSE: This study compared the QOL level among implant denture, removable partial denture, and no restoration patients with distal extension type unilateral mandibular edentulism. MATERIAL AND METHODS: Three groups (n = 12 each) of subjects with unilateral mandibular distal-extension edentulism who were matched for age, sex, and missing teeth were studied. The groups were (1) implant denture, (2) removable partial denture, and (3) no restoration. QOL levels of these 3 groups were compared using a self-administered questionnaire with 3 major subscales: oral condition, general condition, and dental treatment. RESULTS: The implant denture group showed higher oral condition related QOL score than the other groups. There was no significant difference in oral condition-related QOL scores between the removable partial denture and no restoration groups. There was no significant difference in the general condition related QOL score and dental treatment-related score among the 3 groups. CONCLUSION: In unilateral mandibular distal extension edentulous patients, oral-condition-related QOL levels for dental implant patients were higher than those of removable partial denture or no restoration patients. The QOL levels of the removable partial denture patients were almost identical to those of no restoration patients.     

Long-term observations of extensive fixed partial dentures on mandibular canine teeth

summary Twelve patients were followed for 15 years after treatment with a 12-unit cantilever fixed partial denture on the mandibular canines opposite to a complete maxillary denture. Four constructions failed and had to be removed but four were still in function after 15 years. Four patients died during the observation period still wearing their constructions. Endodontic complications, pulpal necrosis and loss of retention of posts were the most frequent, while caries and periodontal lesions were rare. The maintenance costs over the years were fairly low even compared to the maintenance costs for patients treated with implants. Extensive mandibular cantilever fixed partial dentures may be used in the rehabilitation of patients with a very reduced dentition and a history of difficulties in adapting to removable dentures.