Electrognathographic evaluations of rehabilitated edentulous patients.

Braz Oral Res. 2007;21(4):355-361

Authors: Casselli H, Landulpho AB, Silva WA, Silva FA

This study investigated, through computerized electrognathographic evaluations (K6-I Diagnostic System, Myotronics-Noromed Inc., Tukwila, USA), the mandibular movement pattern of 16 patients rehabilitated with complete dentures presenting no symptoms of stomatognathic functional alterations. The patients were instructed to wear an intra-oral appliance for occlusal plane coverage over their usual superior denture and were then rehabilitated with new dentures preserving a free-way space of 3 mm. After sixty days, the occlusal vertical dimension was increased and the modified inferior dentures were used for another 60 days. The obtained results were submitted to the Tukey Test and to the Friedman test, depending on which variable was under consideration, both at a significance level of 5%. The data revealed a significant decrease in free-way space when the first and the last evaluations were compared. No significant differences were found during opening and closing. It was concluded that the presence of a free-way space at the end of the treatment confirms the importance of its existence for maintaining the balance of the masticatory system, assuming the occurrence of a postural repositioning.

PMID: 18060264 [PubMed - as supplied by publisher]

Spontaneous fracture of the mandibular genial tubercles. A case report.

Med Oral Patol Oral Cir Bucal. 2007 Dec;12(8):E599-601

Authors: Gallego L, Junquera L, Villarreal P, de Vicente JC

Fracture of the mandibular genial tubercles is an uncommon pathology affecting edentulous patients with severe maxillary atrophy. Usually occurs spontaneously which complicates the diagnosis. Their importance lies in the functional alterations, which occur as a consequence of the disinsertion of the genihyoid and genioglossus muscles. The treatment of fracture of the genial tubercles is controversial, including no surgical intervention, excision of the avulsed bone fragments, and muscular repositioning. There have been only 11 cases reported in the literature of this fracture, most of them spontaneous. We present a difficult diagnosis situation of spontaneous fracture of the genial tubercles in an 86-year-old edentulous female with a painful sublingual and submental hematoma and anterior cervical echimosis. Computerized Tomography should be made to confirm the diagnosis. Surgical treatment was not necessary, and follow-up at 6 months revealed complete symptomatic recovery, and full return of function.

PMID: 18059247 [PubMed - in process]

Positioning magnets on a multiple/sectional maxillofacial prosthesis.

J Contemp Dent Pract. 2007;8(7):101-7

Authors: Goiato MC, Fernandes AU, dos Santos DM, Barão VA

AIM: The aim of this report is to describe a quick and simple method of positioning retention magnets when deformed patients are rehabilitated with an oculopalpebral prostheses attached to a maxillary denture/obturator. BACKGROUND: In patients with deformities requiring complex rehabilitations, the use of magnets is the most efficient means of providing combined prostheses with retention quality and stability. Usually prostheses with magnets are in sections and have a magnet in each section. When the sections are put together properly, the magnets are attracted to each other and retain the sections. REPORT: An edentulous patient presented for a post-surgical evaluation of a maxillofacial prosthesis used to repair a partial maxillectomy and left orbital exoneration which removed all adjacent tissues leaving an open communication between the oral, nasal, and orbital cavities. The proposed treatment plan included construction of a maxillary complete denture with a palatal obturator and a mandibular complete denture. Magnets were used to attach the oculopalpebral prosthesis to the maxillary denture/obturator. SUMMARY: Use of retention magnets simplify the clinical and laboratorial phase, retains the denture, and makes it stable and comfortable for the patient. This treatment is one successful approach to the restoration of oral function and increases the patient's quality of life.

PMID: 17994161 [PubMed - in process]

Patients' self-perceived impacts and prosthodontic needs at the time and after tooth loss.

Braz Dent J. 2007;18(2):91-6

Authors: Teófilo LT, Leles CR

Studies on self-perception have demonstrated that tooth loss is associated with esthetic, functional, psychological and social impacts for individuals. However, not all subjects seek treatment immediately after tooth loss, even when desire for replacement is strongly expressed. The aim of this study was to evaluate the perception of patients submitted to tooth extraction about factors associated with tooth loss and prosthodontic treatment, at the time and after extraction. A convenience sample of 211 consecutive patients were clinically evaluated and answered to a questionnaire about perceived impacts and prosthodontic treatment needs. Data were collected at the time of extraction and after a 3-month time interval. Perceived impacts were high (21 to 76% at the time and 35 to 87% after extraction). From 72.5% patients who expressed intention of immediate replacement of edentulous spaces, only 8.1% had actually been treated. Financial limitation was considered the most important factor that restricted access to treatment. Bivariate statistical analysis showed association between immediate dental replacement and anterior tooth loss (p=0.00) and extension of edentulous space (p=0.01). Position of lost teeth was associated to perceived functional limitation (p=0.03). Worsened appearance was associated to tooth loss in the maxillary arch (p=0.02), and desire of prosthodontic treatment was associated to the extension of edentulous space (p=0.05). Perceived impacts were more frequent in women than men. It was concluded that although patients usually expressed prosthodontic treatment needs, clinical and financial issues are determinant factors for tooth replacement.

PMID: 17982545 [PubMed - in process]

Use of models in surgical predictability of oral rehabilitations.

Acta Cir Bras. 2007 Sep-Oct;22(5):387-95

Authors: Curcio R, Perin GL, Chilvarquer I, Borri ML, Ajzen S

PURPOSE: To evaluate the rehabilitation of edentulous mandibles with osseous integrated implants in immediate loading, using models in reverse planning. METHODS: A prospective study was performed on 14 patients with a total of 56 implants placed. It was proposed a technique for the rehabilitation of edentulous mandible with osseous integrated implants of immediate loading, using anatomical replicas derived from computerized tomography scan linked to the rapid prototyping technique of stereolithography in reverse planning, elaborating the definitive fixed prosthesis, with rigid union of the implants on the same day. The patients' mandible models were divided in two groups. In the first one, there were patients with edentulous mandible models and with models elaborated after exodontics procedures (Group 1). In the second (Group 2), patients with dentulous mandible models, which allow an evaluation of difficulty in the surgery. RESULTS: The proposed technique using anatomical models for the personalization of mandibles in immediate loading had 100% of less difficulty in the adaptation of the surgery guide while the dentulous models had 83,3% of more difficulty. CONCLUSION: The proposed technique using the mandible models in the rehabilitation of mandibles is feasible.

PMID: 17923960 [PubMed - in process]

Complete denture impression techniques: evidence-based or philosophical.

Indian J Dent Res. 2007 Jul-Sep;18(3):124-7

Authors: Singla S

Code of practice is dangerous and ever-changing in today's world. Relating this to complete denture impression technique, we have been provided with a set of philosophies--"no pressure, minimal pressure, definite pressure and selective pressure". The objectives and principles of impression-making have been clearly defined. Do you think any philosophy can satisfy any operator to work on these principles and achieve these objectives? These philosophies take into consideration only the tissue part and not the complete basal seat, which comprises the periphery, the tissues and the bone structure. Under such circumstances, should we consider a code of practice dangerous or should we develop an evidence-based approach having a scientific background following certain principles, providing the flexibility to adapt to clinical procedures and to normal biological variations in patients rather than the rigidity imposed by strict laws?

PMID: 17687175 [PubMed - indexed for MEDLINE]

Rehabilitation of a marginal mandibulectomy patient using a modified neutral zone technique: a case report.

Braz Dent J. 2007;18(1):83-6

Authors: Pekkan G, Hekimoglu C, Sahin N

Anterior edentulous areas usually display unusual soft tissue configurations and compromised bone support in patients with marginal mandibulectomy. There are several treatment modalities for these patients. A removable partial denture may be the treatment of choice. Maximum stability of the partial denture base for mandibulectomy patients may be accomplished by the application of the neutral zone concept, which helps providing stability to the base. This case report describes the fabrication of a removable partial denture for a patient with marginal mandibulectomy using a modified neutral zone technique.

PMID: 17639208 [PubMed - indexed for MEDLINE]

[Detection of masticatory muscle in bilateral distal-extension partially edentulous patients before and after prosthetic rehabilitation by surface electromyography]

Shanghai Kou Qiang Yi Xue. 2006 Oct;15(5):482-5

Authors: Yu CH, Chen YQ, Zhang FQ

PURPOSE: To analyze the difference of masticatory muscle in bilateral distal-extension partially edentulous patients before and after prosthetic rehabilitation by surface electromyography. METHODS: Twenty-seven bilateral distal-extension partially edentulous patients were randomly selected, and be detected before and after prosthetic rehabilitation by surface electromyography. During the detection, the amplitudes of the anterior temporalis and masseter muscle were registered. Using them, the asymmetry index of total, asymmetry index of the masseter, asymmetry index of the anterior temporalis and mastication index were calculated. Student's t test was used to analyze the results. RESULTS: The asymmetry index of total and asymmetry index of the masseter in group of one month after prosthetic rehabilitation increased significantly than that in the group before prosthetic rehabilitation (P < 0.05); The asymmetry index of total and asymmetry index of the anterior temporalis in group of three or six months after prosthetic rehabilitation decreased significantly than that in the group before prosthetic rehabilitation (P < 0.05); The mastication index decreased gradually after prosthetic rehabilitation, the difference was also be significant between group of three or six months after prosthetic rehabilitation and group before prosthetic rehabilitation (P < 0.05). CONCLUSIONS: After prosthetic rehabilitation, the equation and reservation of muscle's energy in bilateral distal-extension partially edentulous patients were significantly better than before. Whereas it costed more than three months for patients to adapt the dentures.

PMID: 17348219 [PubMed - in process]

[A preliminary study on the relationship between the wearing time of full denture and EMG in edentulous patients]

Shanghai Kou Qiang Yi Xue. 2006 Oct;15(5):466-8

Authors: Yang DL, Yu CH, Geng Y, Zhang FQ

PURPOSE: This study was aimed to analyze the relationship between the periods of wearing time of full denture and function of mastication in edentulous patients. METHODS: Electromyogram (EMG) was done at an initial time of wearing full denture for 30 patients (Group A) and at an interval of wearing full denture for more than 3 months for 32 patients (Group B). EMG activities were recorded for 2 pairs of muscles (anterior temporalis, masseter) by means of Medelec Synergy Electromyography. Student's t test was used for statistical analysis. RESULTS: EMG amplitude of Group A was significantly lower than that of Group B (left anterior temporalis P < 0.05, bilateral masseter P < 0.05). Group A has larger area than Group B (P < 0.05); No significant difference was found in asymmetry index between Group A and Group B (P > 0.05). CONCLUSION: The function of mastication in patients who wore full denture for short time has not been achieved as expected.

PMID: 17348215 [PubMed - in process]

Dental management of low socioeconomic level patients before radiotherapy of the head and neck with special emphasis on the prevention of osteoradionecrosis.

Braz Dent J. 2006;17(4):336-42

Authors: Bonan PR, Lopes MA, Pires FR, Almeida OP

Head and neck cancer patients need to receive dental care previously to radiotherapy. Even patients who regularly visit dental offices need special attention including prophylactic and curative treatments. The purposes of this study were to evaluate the dental status of Brazilian head and neck squamous cell carcinoma patients with low socioeconomic level as well as to discuss the dental treatment performed and the oral side effects of radiotherapy. Forty patients with head and neck squamous cell carcinoma received dental care and dental extractions prior to radiotherapy and were were followed up for a mean period of 28.7 months after the cancer treatment. Before radiotherapy, 28 patients were dentulous and 12 edentulous, and all of them had poor oral health and hygiene. The most common treatment performed were dental extraction and 23 patients had 8.6 teeth extracted on average. One out of 9 (11.1%) patients developed radiation caries and 5 out of 23 cases (21.3% - Group I) developed osteoradionecrosis, being only 1 case associated with previous dental extraction. Brazilian low-socioeconomic level patients with head and neck cancer were submitted to multiple dental extractions due to poor dental conditions and inadequate oral care. The dental treatment did not prevent osteoradionecrosis, which presumably presented a multifactorial etiology in most cases.

PMID: 17262149 [PubMed - indexed for MEDLINE]

Sinus lifting before Le Fort I maxillary osteotomy: a suitable method for oral rehabilitation of edentulous patients with skeletal class-III conditions: review of the literature and report of a case.

Head Face Med. 2007;3:2

Authors: Depprich RA, Handschel JG, Naujoks C, Hahn T, Meyer U, K&#xFC;bler NR

BACKGROUND: Functional rehabilitation of patients afflicted with severe mandibular and maxillary alveolar atrophy might be challenging especially in malformed patients. METHODS: Treatment planning using sinus lifting and implant placement before Le Fort I maxillary osteotomy in a patient with severe mandibular and posterior maxillary alveolar atrophy and skeletal class-III conditions due to cleft palate are described. RESULTS: A full functional and esthetic rehabilitation of the patient was achieved by a stepwise surgical approach performed through sinus lifting as the primary approach followed by implant placement and subsequent Le Fort I maxillary osteotomy to correct the maxillo-mandibular relation. CONCLUSION: Stabilisation of the maxillary complex by a sinus lifting procedure in combination with computer aided implant placement as preorthodontic planning procedure before Le Fort I maxillary osteotomy seems to be suitable in order to allow ideal oral rehabilitation especially in malformed patients.

PMID: 17204134 [PubMed]

Facial pain of cardiac origin: a case report.

Sao Paulo Med J. 2006 May 4;124(3):163-4

Authors: Franco AC, Siqueira JT, Mansur AJ

CONTEXT: Cardiac pain may radiate to the face and lead patients to seek dental care. Dentists may contribute towards the diagnosing of ischemic heart disease and thus refer patients for cardiological evaluation. CASE REPORT: A 50-year-old female patient was referred to a dentist for evaluation of a suspected temporomandibular disorder after repeated visits to medical emergency departments due to excruciating facial and left temporal pain associated with exertion. The pain would start in the chest and radiate to the neck, face and left temporal region. The patient's chief complaint was the facial pain; hence, she sought dental care. The dental examination revealed an edentulous upper jaw and partially edentulous lower jaw with full upper prosthetic set of teeth and decreased vertical dimension. X-ray of facial bones did not reveal any bone abnormalities. A diagnosis of temporomandibular disorder was made. However, she was referred for cardiological evaluation, since her pain was starting in the chest and because she had a past medical history of surgical treatment for coronary artery disease. A diagnosis of angina pectoris was made, the therapeutic regimen was optimized and her angina was brought under control.

PMID: 17119696 [PubMed - indexed for MEDLINE]

Factors influencing tooth shade selection for completely edentulous patients.

J Contemp Dent Pract. 2006 Nov 1;7(5):80-7

Authors: Esan TA, Olusile AO, Akeredolu PA

AIM: There is limited scientific information on the relationship between tooth shade, age, gender, and skin color in black Africans. This lack of knowledge may impact the ability of the prosthodontist to select artificial teeth for completely edentulous patients. This study explores the possibility of a relationship between tooth shade, gender, age, and skin color in a black African population. METHODS AND MATERIALS: A total of 212 individuals aged 15 to 79 years participated in this study. One investigator, calibrated for examining tooth shade, performed all examinations. A Vita-Lumin shade guide was used to examine either the maxillary right or left central incisor. One had to be sound for inclusion in the study. Tooth shades were divided into two categories according to value, and skin tones were divided into two categories (light, and dark). Chi-square analysis and Fisher's exact tests were used to analyze the data (P< 05). RESULTS: No statistically significant difference was found between tooth shade and skin color and the subjects' perception of their tooth shade. However, a statistically significant difference was found between age and tooth shade (P<.001). There was also a statistically significant difference in tooth shade between men and women. CONCLUSION: Within the limitations of this study, tooth shade value and skin color were not related. However, older adults and men are more likely to have darker teeth.

PMID: 17091143 [PubMed - indexed for MEDLINE]

Do patients have a preference for major connector designs?

J Contemp Dent Pract. 2006 Nov 1;7(5):71-9

Authors: Pallegama RW, Namano S, Aridome K, Baba K, Purnaveja S, Ohyama T

AIM: The aim of this research was to evaluate patients' preferences for resin analogs of four major connector designs formulated to have equal rigidity once fabricated in the same alloy. METHODS AND MATERIALS: Nineteen Kennedy Class I or II partially edentulous patients participated at two centers. The four major connector analogs (MCAs) were fabricated for each subject using light-polymerizing acrylic resin. The subjects were asked to wear each of them in the mouth for 30 seconds in six pairs in random order, and to report their preference for each pair. Based on these data, the four analogs were ranked in a descending preference order for each patient. Within-subject comparisons preferences were performed with the Friedman test, and the multiple comparisons were performed with the Wilcoxon Signed Ranks test for data of each sample independently. RESULTS: Statistically significant and consistent preference orders were revealed for both samples, and the thin and wide design was significantly preferred to the thick and narrow design. However, a higher variation was observed for the first preference of each subject. CONCLUSIONS: Subjects demonstrated a tendency to prefer thinner MCAs. However, the individual predilections of patients may not be an appropriate basis for an attempt to find a 'best design' applicable to all patients.

PMID: 17091142 [PubMed - indexed for MEDLINE]

Neurosensory disturbances after immediate loading of implants in the anterior mandible: an initial questionnaire approach followed by a psychophysical assessment.

Clin Oral Investig. 2006 Dec;10(4):269-77

Authors: Abarca M, van Steenberghe D, Malevez C, De Ridder J, Jacobs R

The aim of the study was to assess past and present neurosensory disturbances using a questionnaire and a psychophysical approach in patients treated with immediate loaded implants in the edentulous anterior mandible. A group of 65 patients (age range 30-84 years, mean 58 years, 30 women) was enrolled. All were treated by means of three immediately loaded implants (Branemark Novum System). A self-designed questionnaire was used for data collection. The response rate was 89%. Of the 58 responders, 33% (n=19) reported neurosensory disturbances after implant surgery. Nine of these patients (mean age 56 years, seven women) participated in an objective evaluation and were subjected to a psychological and several psychophysical tests. At the moment of the evaluation none of the nine patients still had clinical complaints. Psychological testing revealed no statistical differences between the patients, who had previously experienced subjective complaints, and the control group. Two-point discrimination and thermal sensation tests revealed no sensory lesions. The light touch sensation test at the lower lip indicated a more frequent reduction of tactility for the test group (p<or=0.03). Neurosensory disturbances can occur in the anterior region of the mandible after implant surgery.

PMID: 16937108 [PubMed - indexed for MEDLINE]

Oral healthcare for elderly: identifying the needs and feasible strategies for service provision.

Indian J Dent Res. 2006 Jan-Mar;17(1):11-21

Authors: Goel P, Singh K, Kaur A, Verma M

The aim of the present study was to assess the oral health practices, status and treatment needs of the rural elderly in national capital territory of Delhi. An effort was also made to identify patterns of utilization of dental services and test alternate strategies for service provision. A total of 96 elderly subjects (47 males and 49 females) in 5 rural areas were interviewed and clinically examined using Basic Oral Health Survey criteria of W.H.O. This was followed by a community trial in which the 5 villages were divided into control and test groups. Results of the survey found that both traditional as well as modern oral health practices co-exist in the rural community. Dental services were available to a majority (mostly through private sector), and edentulousness was a condition of primary concern among the elderly as a result of unmet treatment needs for dental caries and periodontal diseases. Age was a variable that was statistically significantly associated with edentulousness (p=0.005). Results of the community trial showed that higher utilization of care can be achieved by providing on-site dental care as compared to referring cases to tertiary care centers. Nevertheless provision of treatment alone is not a suitable policy recommendation since many elderly did not avail care even at on-site community dental health programmes that were operated free of cost. This emphasizes the need of health education over treatment in order to empower the elderly, especially the non-ambulatory patients, to practice prevention and develop favourable attitudes towards accepting prompt treatment at primary health care level.

PMID: 16900890 [PubMed - indexed for MEDLINE]

Dental and periodontal status and risk for progression of carotid atherosclerosis: the inflammation and carotid artery risk for atherosclerosis study dental substudy.

Stroke. 2006 Sep;37(9):2271-6

Authors: Schillinger T, Kluger W, Exner M, Mlekusch W, Sabeti S, Amighi J, Wagner O, Minar E, Schillinger M

BACKGROUND AND PURPOSE: Dental and periodontal disease are potentially involved in the pathogenesis of atherosclerosis. We investigated whether dental and periodontal status is associated with the presence and future progression of carotid stenosis. METHODS: We randomly selected 411 of 1268 participants from the prospective Inflammation and Carotid Artery Risk for Atherosclerosis Study and evaluated dental and periodontal status and oral hygiene at baseline measuring three World Health Organization-validated indices: DMFT (decayed, missing, filled teeth), SLI (Silness-L&#xF6;e Index), and CPITN (community periodontal index for treatment needs), respectively. The degree of carotid stenosis was measured by duplex ultrasound at baseline and after median 7.5 months (range=6 to 9 months) to identify patients with progressive carotid stenosis. RESULTS: DMFT (P<0.01), SLI (P=0.048), CPITN (P=0.007), and edentulousness (P=0.007) were associated with the baseline degree of carotid stenosis. Atherosclerosis progression was observed in 48 of 411 patients (11.7%). DMFT (adjusted odds ratio [OR]=1.11, 95% CI=1.01 to 1.22, P=0.032) and SLI (adjusted OR=1.77, 95% CI=1.09 to 2.79, P=0.021), but not CPITN (adjusted OR=1.51, 95% CI=0.89 to 2.45, P=0.16) were significant predictors of disease progression, irrespective of traditional cardiovascular risk factors and the baseline degree of stenosis. Edentulous patients had a significantly increased risk for disease progression as compared with patients with teeth (adjusted OR=2.10, 95% CI=1.06 to 4.16, P=0.33). CONCLUSIONS: Dental status, oral hygiene, and particularly tooth loss are associated with the degree of carotid stenosis and predict future progression of the disease.

PMID: 16888276 [PubMed - indexed for MEDLINE]

A cost-effectiveness analysis of implant overdentures.

J Dent Res. 2006 Aug;85(8):717-21

Authors: Zitzmann NU, Marinello CP, Sendi P

Placement of dental implants may improve the retention and stability of complete dentures in edentulous patients. Treatment costs, however, substantially increase with implant treatment. We therefore performed a stochastic cost-effectiveness analysis, comparing implant-supported over-denture prostheses (4 implants), implant-retained overdentures (2 implants), and complete dentures, from the patient's perspective in Switzerland, to assess whether implant treatment in the mandible represents value for money spent. Twenty patients were included in each treatment group and were followed up for three years. Health outcomes were expressed in Quality-adjusted Prosthesis Years, and dental health care costs and time costs were recorded in year 2000 Swiss Francs (CHF 100 = US dollars 61). The cost per Quality-adjusted Prosthesis Year gained for implant treatment was CHF 9100 (2 implants) and CHF 19,800 (4 implants) over 3 years. Over a ten-year period, these threshold ratios were reduced to CHF 3800 (2 implants) and CHF 7100 (4 implants) per Quality-adjusted Prosthesis Year gained.

PMID: 16861288 [PubMed - indexed for MEDLINE]

Two new clinical/laboratory protocols for CAD/CAM implant restorations.

J Am Dent Assoc. 2006 Jun;137(6):794-800

Authors: Drago CJ

BACKGROUND: Conventional casting technology has some disadvantages for dental laboratory technicians and restorative dentists, including porosity of restorations, miscasting and inaccuracy. It also is labor-intensive. Computer-aided design/computer-aided manufacturing (CAD/CAM) technology was developed in the late 1980s for dentistry, and it significantly reduced and/or eliminated problems associated with dental castings. The purpose of this article is to give readers an overview of the use of CAD/CAM technology for dental implants and illustrate two clinical protocols for that use. CLINICAL IMPLICATIONS: The CAD/CAM technology described in this article can reduce restorative dentists' chairside time associated with implant treatment in both edentulous and partially edentulous patients, can decrease costs without sacrificing accuracy or biocompatibility for both clinicians and dental laboratory technicians, and is available to dental laboratories without the capital expenses associated with purchasing new technology.

PMID: 16803809 [PubMed - indexed for MEDLINE]

Clinical management and microscopic characterisation of fatigue-induced failure of a dental implant. Case report.

Head Face Med. 2006;2:18

Authors: Capodiferro S, Favia G, Scivetti M, De Frenza G, Grassi R

BACKGROUND: Osseointegrated endosseous implants are widely used for the rehabilitation of completely and partially edentulous patients, being the final prosthodontic treatment more predictable and the failures extremely infrequent. A case of fracture of an endosseous dental implant, replacing the maxillary first molar, occurring in a middle-age woman, 5 years after placement is reported. MATERIALS AND METHODS: The difficult management of this rare complication of implant dentistry together with the following rehabilitation is described. Additionally, the authors performed an accurate analysis of the removed fractured implant both by the stereomicroscope and by the confocal laser scanning microscope. RESULTS AND DISCUSSION: The fractured implant showed the typical signs of a fatigue-induced fracture in the coronal portion of the implant together with numerous micro-fractures in the apical one. Three dimensional imaging performed by confocal laser scanning microscope led easily to a diagnosis of "fatigue fracture" of the implant. The biomechanical mechanism of implant fractures when overstress of the implant components due to bending overload is discussed. CONCLUSION: When a fatigue-induced fracture of an dental implant occurs in presence of bending overload, the whole implant suffers a deformation that is confirmed by the alterations (micro-fractures) of the implant observable also in the osseointegrated portion that is easily appraisable by the use of stereomicroscope and confocal laser scanning microscope without preparation of the sample.

PMID: 16792797 [PubMed]

A randomized controlled trial of implant-retained mandibular overdentures.

J Dent Res. 2006 Jun;85(6):547-51

Authors: Allen PF, Thomason JM, Jepson NJ, Nohl F, Smith DG, Ellis J

Evidence from randomized clinical trials of implant-retained overdentures is very limited at the present time. The aim of this study was to compare implant-retained mandibular overdentures and conventional complete dentures in a randomized controlled trial (RCT). Our a priori hypothesis was that implant-retained mandibular overdentures would be significantly better than conventional complete dentures. Edentulous patients (n = 118) were randomly allocated to either an Implant Group (n = 62) or a Denture Group (n = 56). Patients completed the Oral Health Impact Profile (OHIP) and a denture satisfaction scale pre-treatment and three months post-treatment. Upon completion of treatment, both groups reported improvement (p < 0.001, Wilcoxon Ranks Sum test) in oral-health-related quality of life and denture satisfaction. There were no significant post-treatment differences between the groups, but a treatment effect may be masked by application of "intention to treat" analysis. The OHIP change scores were significantly greater for patients receiving implants than for those who refused them.

PMID: 16723653 [PubMed - indexed for MEDLINE]

Torus palatinus and torus mandibularis in edentulous patients.

J Contemp Dent Pract. 2006 May 1;7(2):112-9

Authors: Al Quran FA, Al-Dwairi ZN

AIM: To determine the prevalence of tori in Jordanian edentulous patients, the sex variation in their distribution, and their clinical characteristics. METHODS: Three hundred and thirty eight patients were examined in the Prosthodontic Clinic in the Department of Restorative Dentistry at Jordan University of Science and Technology. The location, extent, and clinical presentation of tori were recorded related to the age and sex of patients. RESULTS: The overall prevalence of tori was 13.9%. The prevalence of torus palatinus was 29.8% (14/47), while that of torus mandibularis was significantly higher 42.6% (20/47). Both types of tori were associated with each other in 27.7% of cases (13/47). CONCLUSIONS: There was no significant difference in the prevalence of tori between males and females. There seems to be a strong association between mandibular and palatal tori.

PMID: 16685302 [PubMed - indexed for MEDLINE]

Nutrition counseling increases fruit and vegetable intake in the edentulous.

J Dent Res. 2006 May;85(5):463-8

Authors: Bradbury J, Thomason JM, Jepson NJ, Walls AW, Allen PF, Moynihan PJ

Edentulous denture-wearers eat fewer fruits and vegetables than do comparable dentate individuals. Improved chewing ability with new dentures has resulted in little dietary improvement, suggesting that dietary intervention is necessary. The objective of this randomized controlled trial was to have a positive impact upon dietary behavior of patients receiving replacement complete dentures through a tailored dietary intervention. Readiness to change diet (Stage of Change), intake of fruits, vegetables, and nutrients, and chewing ability were assessed pre-and 6 weeks post-intervention. The intervention group (n = 30) received two dietary counseling sessions; the control group (n = 28) received current standard care. Perceived chewing ability significantly increased in both groups. There was significantly more movement from pre-action into action Stages of Change in the intervention group, who had a greater increase in fruit/vegetable consumption (+209 g/d) than did the control group (+26 g/d) (P = 0.001). Tailored dietary intervention contemporaneous with replacement dentures can positively change dietary behavior.

PMID: 16632762 [PubMed - indexed for MEDLINE]

Oral health status and health-related quality of life: a systematic review.

J Oral Sci. 2006 Mar;48(1):1-7

Authors: Naito M, Yuasa H, Nomura Y, Nakayama T, Hamajima N, Hanada N

This study was conducted in order to identify the literature on oral health status and health-related QOL, review the findings systematically, and assess the association between them. We performed a literature search of reports published between January 1973 and June 2004, using five databases including MEDLINE. Only studies that used validated generic health-related QOL instruments were selected. The reviewers evaluated selected articles independently and resolved disagreements by consensus. A total of 1,726 articles were retrieved and seven were selected for the review; five observational studies and two intervention studies. Four studies showed significant associations between oral health status and health-related QOL. Temporomandibular disorders were highly associated with reduced health-related QOL. Poor oral status linked to both craniomandibular and cervical spinal pain was associated with increased impairment of health-related QOL. Dissatisfaction with the teeth and mouth, and a sensation of dry mouth contributed to reduce health-related QOL. Providing edentulous patients with implant-supported full dentures contributed to improve health-related QOL. Assessment of health-related QOL in relation to oral health with validated instruments remains insufficient. The present findings suggest that oral health status could affect health-related QOL in some settings; however, further evidence is needed to support this interpretation.

PMID: 16617194 [PubMed - indexed for MEDLINE]

The 'mini'-implant has arrived.

J Am Dent Assoc. 2006 Mar;137(3):387-90

Authors: Christensen GJ

There is no question that dental implants have been the most influential change in dentistry during the last half-century. In general, they are well-proven and highly useful. However, the diameter of standard implants (approximately 3.75 mm), along with the frequent need to graft bone to allow for their placement, have limited their use for those who most need implants. The introduction, approval and continuing observation of success of smaller-diameter mini-implants have stimulated use of implants in situations in which standard-sized implants could not have been used without grafting. The result has been more patients who have been served successfully at reduced cost with minimized pain and trauma--patients who could not have been treated with implants otherwise. Continuing research is needed for further verification of the acceptability of mini-implants.

PMID: 16570473 [PubMed - indexed for MEDLINE]

Evaluation of 80 implants subjected to immediate loading in edentulous mandibles after two years of follow-up.

Med Oral Patol Oral Cir Bucal. 2006 Mar;11(2):E165-70

Authors: Mart&#xED;nez-González JM, Barona-Dorado C, Cano-Sánchez J, Fernández-Cáliz F, Sánchez-Turrión A

AIM: An analysis is made of the clinical and radiological behavior of 80 implants with a new surface subjected to etching with a sulfuric and hydrofluoric acid solution followed by thermal treatment, and subjected to immediate loading in patients with lower overdentures. STUDY DESIGN: A prospective observational study was made of 20 patients with lower overdentures supported by four implants measuring 13 mm in length. All patients were included after the obtainment of informed consent, anamnesis, clinical examination and radiological study, with prior clinical elaboration of the lower dentures. RESULTS: Over two years of follow-up, no important plaque or tartar accumulation was observed (with Silness and Loe indexes of 0-1). Periodontal probing proved favorable, with no pocket depths of over 2 mm in any case. The radiological controls showed no implant failures during follow-up. No cervical bone loss was recorded in the first year in a large proportion of cases (65%), while reabsorption of the cervical half was observed in 10%, and of three-quarters of the cervical portion in the remaining 35%. Performance in the second year was compatible with the standard references--with losses of between 0.5-1.5 mm. CONCLUSIONS: Rehabilitation with lower overdentures should be regarded as a priority indication, and implantological treatment substitution by conventional and/or early resting periods should be considered.

PMID: 16505797 [PubMed - indexed for MEDLINE]

Longitudinal trends in the use of individualized radiographic examinations at dental schools in the United States and Canada.

J Dent Educ. 2006 Feb;70(2):160-8

Authors: Kantor ML

In the spring of 2002, a mail survey was conducted to determine the use of individualized radiographic examinations (selective radiography) for comprehensive care patients at all sixty-four U.S. and Canadian dental schools. Results from previous surveys were used to evaluate the long-term longitudinal trends. Among sixty-two schools (97 percent response rate), selective radiography was used by 34 percent of schools for dentulous adult patients, by 100 percent for edentulous adults, and by 28 percent for children. Having a credentialed chief of service increased the likelihood that selective radiography would be used for dentulous adults (odd ratio[OR]=2.36) and for children (OR=2.33). Selective radiography for dentulous adults increased from 2 percent of schools in 1977 to 36 percent in 1997 and leveled off thereafter. Between 1987 and 2002, selective radiography for edentulous adults was used at nearly all schools (96-100 percent) and for children at about a quarter of dental schools (22-28 percent). Among the sixty-one schools for which there are complete data since 1987, the continuous use of routine radiography was most common (39 percent of schools) for dentulous adult patients, whereas the continuous use of selective radiography was uncommon (7 percent).

PMID: 16478930 [PubMed - indexed for MEDLINE]

Compressive osteotomes for expansion and maxilla sinus floor lifting.

Med Oral Patol Oral Cir Bucal. 2006 Jan;11(1):E52-5

Authors: Calvo-Guirado JL, Saez-Yuguero R, Pardo-Zamora G

AIM: The aim of this article is to assess the efficiency of the technique for the posterior alveolar expansion and elevation of the upper maxillary alveolar ridge through the use of compressive osteotomes (Quirurgical Bontempi, Espa&#xF1;a) which have been specifically designed for Osseotite NT and Osseotite NT Certain of 3i implants (Implants Innovations, USA). MATERIALS AND METHODS: 24 adult patients (16 female and 12 male), who were selected according to Albrektsson's inclusion and exclusion criteria, took part in the study. All the patients presented bone deficiency in the width and height of the upper maxilla. 48 Osseotite implants were performed (four Osseotite Standard; six Osseotite NT; 38 NT Certain (3i, Implants Innovations, CA, USA)). Implant diameters were 4 mm in 44 cases and 5 mm in 4 cases with lengths varying between 11.5 (n = 4) and 13 mm (n = 44). The alveolar ridges of the 24 patients had initial widths from 1.5 mm to 5 mm and heights between 5 and 13 mm. Results: The data obtained were analysed using the SPSS 11.0 program. In the 48 areas treated with immediate implants, an increase in bone height of 6.75 mm -/+ 1.25 mm was achieved. In the case of the alveolar expansion for the 48 implants, the average was 3.2 mm -/+ 0.15 mm. CONCLUSIONS: The technique for alveolar expansion and elevation of the upper maxilla with compressive osseotomes can lead to a 100% success rate after a 9-month follow-up of the implants and insertion of prostheses. It is a highly predictable surgical procedure which allows implants to be performed at the same time as surgery, thus reducing the number of such interventions while recovering aesthetic and functional losses in the patient.

PMID: 16388295 [PubMed - indexed for MEDLINE]

Fiber-reinforced composite fixed partial denture to restore missing posterior teeth: a case report.

J Contemp Dent Pract. 2005 Nov 15;6(4):168-77

Authors: Rappelli G, Coccia E

In patients refusing implant surgery for psychological reasons, when minimal tooth reduction is desired, a fiber-reinforced composite inlay fixed partial denture (IFPD) can be used to replace missing teeth. In comparison to other restorative systems this conservative approach carries a lower risk of pulp exposure and/or periodontal inflammation, maintaining the health of supporting tissues. The purpose of this case report is to describe the clinical procedure for fabricating an IFPD with a pre-impregnated glass fiber system and a hybrid composite. Fiber-reinforced composite, in combination with adhesive techniques, appears promising for an IFPD. Further clinical investigation will be required to provide additional information on this technique.

PMID: 16299619 [PubMed - indexed for MEDLINE]

Application of oral implants to the general dental practice.

J Am Dent Assoc. 2005 Aug;136(8):1092-100; quiz 1165-6

Authors: Stanford CM

BACKGROUND: The use of dental implants has become a management strategy for replacing missing teeth. As new implant surface technologies develop and prosthetic options increase, the field of dental implantology continues to change. General dentists con sidering the use of this treatment modality in their practices should understand the vital role treatment planning plays in achieving predictable outcomes. OVERVIEW: This article reviews specific issues the general dentist typically faces when considering patients for single-tooth, partially-edentulous-arch and full-arch tooth replacement using dental implants. The author analyzes patient-based assessments, as well as diagnostic criteria and steps, to help practitioners predict patient-specific issues that may signal complications. He also discusses approaches for resolving complications. The article emphasizes the importance of careful evaluation in predicting patient-specific issues that can lead to gingival recession and suggests approaches to manage these situations. CONCLUSIONS AND CLINICAL IMPLICATIONS: Dental implants have become an increasingly common treatment option for missing dentition. Because innovations in implant surfaces continue to promote faster bone growth with better predictability, general dentists should be aware of the importance of treatment planning, assessment and teamwork in achieving successful outcomes.

PMID: 16161363 [PubMed - indexed for MEDLINE]

Response shift masks the treatment impact on patient reported outcomes (PROs): the example of individual quality of life in edentulous patients.

Health Qual Life Outcomes. 2005;3:55

Authors: Ring L, H&#xF6;fer S, Heuston F, Harris D, O'Boyle CA

BACKGROUND: Quality of life (QoL) is now established as an important outcome for evaluating the impact of disease, and for assessing the efficacy of treatments. However, individuals change with time and the basis on which they make a QoL judgement may also change, a phenomenon increasingly referred to as response shift. Here, the individual may change his or her internal standards, values, and/or conceptualization on the target construct as a result of external factors such as a treatment or a change in health status. This has important implications for assessing the effects of treatments as a change in QoL may reflect a response shift, a treatment effect, or a complex combination of both. In this study, we used an individualised quality of life (IQoL) measure, the SEIQoL, together with a then-test to determine whether response shift would influence the measurement of treatment efficacy in edentulous patients. METHODS: Data are reported here for the first phase of a randomised controlled clinical trial designed to assess the impact, on IQoL, of implant supported dentures compared with high quality conventional dentures. IQoL was measured using the SEIQoL-DW in 117 patients (mean age 64.8; 32% male) at baseline (T1) and 3 months (T2) after receiving high quality conventional dentures. The work was carried out in dental teaching hospitals in Dublin and Belfast. RESULTS: Unadjusted SEIQoL index scores revealed no significant impact of treatment at three months (baseline: 75.0; 3 months: 73.2, p = .33, n.s.). However, the then-test at 3 months revealed that patients retrospectively rated their baseline IQoL as significantly lower (P < .001) than they had rated it at the time (then-test baseline: 69.2). Comparison of the 3 month scores with this readjusted baseline indicated a significant treatment effect (then-test baseline: 69.2; 3 months: 73.2, p = 0.016). 81% of patients nominated at least one different IQoL domain at 3 months. CONCLUSION: The positive impact of denture treatment for edentulous patients on IQoL was seen only when response shifts were taken into consideration. The nature of the response shifts was highly complex but the data indicated a degree of re-conceptualization and reprioritisation. Assessment of the impact of treatments using patient-generated reports must take account of the adaptive nature of patients.

PMID: 16146573 [PubMed - indexed for MEDLINE]

Clinical and radiographic behaviour of 290 dental implants with a surface treated with hydrofluoric acid and passivated with hydrofluoric and nitric acid: early loading results after 2 years.

Med Oral Patol Oral Cir Bucal. 2005 Aug-Oct;10(4):355-61

Authors: Martínez-González JM, Barona-Dorado C, Cano-Sánchez J, Flórez-Rodríguez M, Cantero-Alvarez M

OBJECTIVE: This work presents the results of clinical and radiological behaviour, for 2 years, of 290 implants treated with a first etching with HF and a second etching with HF and HNO3 acids and that were loaded 8 weeks after insertion. EXPERIMENTAL DESIGN: It is a prospective study on 290 implants placed in 56 patients with an age range from 28 to 81. The selection was previously made through radiological study with panoramic and tomographic radiographs, followed by the implantological treatment with prosthetic loading and clinical (15 days, 1, 3 , 6, 12, 18 and 24 months) and radiological control (12 and 24 months). RESULTS: During the healing period, 11 implants failed, resulting in a CSR of 96.21%. After prostheses placement at 2 months, 4 implants were retired, successfully remaining 275 implants. CONCLUSIONS: The following and favourable results after the prosthetic loading of 179 implants (CSR of 98.56%), attest that early loading may and must be applied, after rigorous planning and case selection.

PMID: 16056190 [PubMed - indexed for MEDLINE]

Prosthodontic rehabilitation in Papillon-Lefevre syndrome: A case report.

J Indian Soc Pedod Prev Dent. 2005 Jun;23(2):96-8

Authors: Jain V, Gupta R, Parkash H

Papillon-Lefevre syndrome is a rare recessive genetic disorder. The clinical manifestations include palmar-plantar hyperkeratosis with precocious rapidly progressive periodontal disease that results in premature exfoliation of primary and permanent dentitions. Patients are often edentulous at an early age. Here is the report of prosthodontic rehabilitation of a case of Papillon-Lefevre syndrome in a 6-year-old child.

PMID: 16012214 [PubMed - in process]

Pain and inflammation in 41 patients following the placement of 131 dental implants.

Med Oral Patol Oral Cir Bucal. 2005 May-Jul;10(3):258-63

Authors: González-Santana H, Peñarrocha-Diago M, Guarinos-Carbó J, Balaguer-Martínez J

AIMS: To study pain and swelling in the first week after dental implant placement. MATERIAL AND METHODS: A total of 131 implants were placed in 41 patients (17 males and 24 females) under local anesthesia. Pain was scored by means of a verbal and visual analog scale (VAS), while swelling was evaluated by a verbal scale. RESULTS: Most patients who experienced pain reported the latter to be slight, with a peak intensity 6 hours after the operation in 41.5% of cases. A significant relation was observed between pain and the number of implants placed. Swelling was moderate in most patients who reported pain -- peak intensity of inflammation being recorded after 48 hours in 48.8% of cases. A significant association was observed between swelling and older patients, the placement of more than four dental implants, and operations in which sinus lift or bone regeneration procedures were carried out. Swelling was greater in patients with implants positioned in the posterior sector versus those placed in the anterior zone, and in those located at free extreme or totally edentulous patients, versus those placed in interdental spaces. CONCLUSIONS: Following implant placement, pain tends to be mild, with moderate inflammation. The latter is seen to be greater in older patients, in subjects receiving a larger number of implants, and in interventions involving regenerative techniques.

PMID: 15876971 [PubMed - indexed for MEDLINE]

Initial subgingival colonization of 'pristine' pockets.

J Dent Res. 2005 Apr;84(4):340-4

Authors: Quirynen M, Vogels R, Pauwels M, Haffajee AD, Socransky SS, Uzel NG, van Steenberghe D

The treatment of periodontitis/peri-implantitis involves the reduction/eradication of periopathogens. After therapy, beneficial and pathogenic species recolonize the subgingival area. The dynamics of recolonization and especially the role of the supragingival environment in this process are still not well-understood. This prospective, split-mouth study followed the early colonization of 'pristine' pockets created during implant surgery (16 partially edentulous patients), to record the time needed before a complex subgingival flora could be established with the supragingival area as the single source. Four subgingival plaque samples were taken from shallow and medium pockets around implants (test), and neighboring teeth (undisturbed microbiota as reference) 1, 2, and 4 wks after abutment connection. Checkerboard DNA-DNA hybridization and culture data revealed a complex microbiota (including several pathogenic species) in the pristine pockets within a wk, with a minimal increase in counts up to 4 wks. Analysis of these data demonstrated that, even with the supragingival environment as the single source for colonizing bacteria, a complex subgingival microbiota can develop within 1 wk.

PMID: 15790740 [PubMed - indexed for MEDLINE]

Peripheral giant cell granuloma. A report of five cases and review of the literature.

Med Oral Patol Oral Cir Bucal. 2005 Jan-Feb;10(1):53-7; 48-52

Authors: Chaparro-Avenda&#xF1;o AV, Berini-Aytés L, Gay-Escoda C

Peripheral giant cell granuloma (PGCG) is a relatively frequent benign reactive lesion of the oral cavity, originating from the periosteum or periodontal membrane following local irritation or chronic trauma. PGCG manifests as a red-purple nodule located in the region of the gums or edentulous alveolar margins, fundamentally in the lower jaw. The lesion can develop at any age, though it is more common between the fifth and sixth decades of life, and shows a slight female predilection. PGCG is a soft tissue lesion that very rarely affects the underlying bone, though the latter may suffer superficial erosion. The present study reviews 5 cases of PGCG, involving 3 males and 2 females between 19-66 years of age, and with presentation in the upper jaw in three cases. Two patients showed radiological concave depression images corresponding to bone resorption. Treatment consisted of resection and biopsy, using a carbon dioxide laser in 2 cases and a cold scalpel in the remaining 3. There were no relapses during postoperative follow-up (range 10 months to 4 years). The differential diagnosis of PGCG includes lesions with very similar clinical and histological characteristics, such as central giant cell granuloma, which are located within the jaw itself and exhibit a more aggressive behavior. Only radiological evaluation can establish a distinction. The early and precise diagnosis of these lesions allows conservative management without risk to the adjacent teeth or bone.

PMID: 15627908 [PubMed - indexed for MEDLINE]

Immediate loading of dental implants in the edentulous mandible.

J Am Dent Assoc. 2004 Nov;135(11):1543-9; quiz 1621-2

Authors: Castellon P, Blatz MB, Block MS, Finger IM, Rogers B

BACKGROUND: The authors review the literature regarding immediate implant loading in the anterior edentulous mandible, demonstrate the technique they currently use, review preliminary results and present an illustrative case. MATERIALS AND METHODS: The authors conducted a literature search using PUBMED and Ovid databases. They considered for review 31 articles in English from 1969 to 2003 that pertained to immediate loading of the anterior mandible. The authors developed a technique to provide a bar-supported prosthesis on the day of surgery. They treated five patients and followed them up for at least six months. The preliminary results are presented. RESULTS: This literature review demonstrated that immediate loading of anterior mandibular implants is an acceptable method, with predictable results. This case series demonstrates the potential for delivering a final bar on the day of surgery, based on the current evidence and clinical application. CONCLUSIONS AND PRACTICE IMPLICATIONS: The method described provides patients with immediate prosthetic restorations and a decreased treatment time compared with that for the traditional two-stage implant approach.

PMID: 15622658 [PubMed - indexed for MEDLINE]

Colonization by Porphyromonas gingivalis and Prevotella intermedia from teeth to osseointegrated implant regions.

Bull Tokyo Dent Coll. 2004 May;45(2):77-85

Authors: Takanashi K, Kishi M, Okuda K, Ishihara K

Colonization by periodontopathic bacteria is a risk factor for peri-implantitis. The purpose of this study was to investigate the colonization by black-pigmented anaerobic bacteria that occurs between the time before fixture installation and 6 months after inserting superstructures in implant treatment in partial edentulous cases. Dental plaque was serially collected from around the natural teeth and implants in 12 patients in whom a dental implant was indicated, and Porphyromonas gingivalis and Prevotella intermedia were detected using polymerase chain reaction (PCR). One month after connecting the abutment, the detection rate of P. gingivalis per site from around the implants was 63.7% and that of P. intermedia was 50.8%. Six months after superstructure setting, the detection rate per site of P. gingivalis from around the implants was 56.8% and that of P. intermedia was 41.1%. When chromosomal DNA segmentation patterns in the isolated P. gingivalis and P. intermedia were compared using pulsed field gel electrophoresis (PFGE), the patterns in the natural teeth were in accordance with those in the implants in 3 of 4 cases (75.0%) in P. gingivalis and all cases in P. intermedia. This finding suggested that bacterial colonization around implants occurred early after the implant region was exposed to the intraoral cavity and that the bacteria were transmitted from the area around the natural teeth.

PMID: 15536858 [PubMed - indexed for MEDLINE]

Edentulism and malnutrition in elderly patients.

Am J Clin Nutr. 2004 Nov;80(5):1453; author reply 1453-4

Authors: Desport JC

PMID: 15531706 [PubMed - indexed for MEDLINE]

[The change of F2 and B2 in patients with complete denture]

Shanghai Kou Qiang Yi Xue. 2004 Aug;13(4):259-61

Authors: Li J, Zhang FQ, Chen Y, Wang GM

PURPOSE: To study the clinic adaptive effect of speech articulation of patient with complete denture. METHODS: The sensitive utterance study was /zi/, /ci/, /si/, which was input into CSL directly before and after patient's restoration at the beginning, then at 1 week, 2 weeks, 4 weeks and 8 weeks, B2 of the utterance of 30 edentulous patients were measured by the computer. RESULTS: There were significant differences in F2 and B2 before and after patient's restoration. CONCLUSION: There is a definite regularity of speech articulation after restored with complete denture. CSL helps us to analyze speech articulation by visual accessing and provides basic theory of evaluation in clinical dental prosthetics.

PMID: 15349659 [PubMed - indexed for MEDLINE]

Modified approach to the bio-col ridge preservation technique: a case report.

J Contemp Dent Pract. 2004 Aug 15;5(3):82-96

Authors: Fowler EB, Whicker R

With today's esthetic conscious population, the day of simply extracting a tooth and replacing it at a later date is unacceptable to many patients. It is vital to preserve and maintain the edentulous ridge and normal gingival architecture, which often collapses after tooth extraction. As clinicians, we must have multiple techniques available to preserve or restore the function and esthetics when teeth are unrestorable. This case report describes a modified approach to the "Bio-Col Technique." This modification simplifies the procedure without compromising the esthetic result.

PMID: 15318260 [PubMed - in process]

Masticatory efficiency before and after surgery in oral cancer patients: comparative study of glossectomy, marginal mandibulectomy and segmental mandibulectomy.

J Oral Sci. 2004 Jun;46(2):113-7

Authors: Namaki S, Matsumoto M, Ohba H, Tanaka H, Koshikawa N, Shinohara M

This study evaluated the effect of oral cancer surgery on masticatory efficiency. Masticatory efficiency was measured using the ATP absorption method. Eating ability was measured using a questionnaire. Two groups were employed as controls: The "normal occlusion group" consisted of subjects who had a complete set of natural maxillary teeth opposed to mandibular teeth, and the "unilateral occlusion group" consisted of subjects who had lost their molar and premolar teeth on one side of the mandible as a result of caries or periodontal diseases. Three treatment groups, each of 6 patients, were studied: a glossectomy group, a marginal mandibulectomy group and a segmental mandibulectomy group. There were no differences in masticatory efficiency between two control groups. Masticatory efficiencies of the three oral cancer treatment groups were lower than in the unilateral occlusion group, even 12 months after surgery. Masticatory efficiency of the glossectomy group was significantly higher 12 months after surgery compared with pre-surgery. Masticatory and eating abilities of the marginal mandibulectomy group and the segmental mandibulectomy were reduced at 3 and 6 months after surgery. The masticatory efficiency 12 months after surgery was higher in the marginal mandibulectomy group than the segmental mandibulectomy group, although the difference was not statistically significant. The self assessed eating ability 12 months after surgery was significantly higher in the marginal mandibulectomy group than the segmental mandibulectomy group. These results suggest that discontinuation of the mandible may lead patients to eat only foods that do not require a substantial amount of chewing. Hence, the quality of life of patients in the marginal mandibulectomy group was considered to be better than that in the segmental mandibulectomy group.

PMID: 15287545 [PubMed - indexed for MEDLINE]

Implantology and the severely resorbed edentulous mandible.

Crit Rev Oral Biol Med. 2004;15(4):240-8

Authors: Stellingsma C, Vissink A, Meijer HJ, Kuiper C, Raghoebar GM

Patients with a severely resorbed edentulous mandible often suffer from problems with the lower denture. These problems include: insufficient retention of the lower denture, intolerance to loading by the mucosa, pain, difficulties with eating and speech, loss of soft-tissue support, and altered facial appearance. These problems are a challenge for the prosthodontist and surgeon. Dental implants have been shown to provide a reliable basis for fixed and removable prostheses. This has resulted in a drastic change in the treatment concepts for management of the severely resorbed edentulous mandible. Reconstructive, pre-prosthetic surgery has changed from surgery aimed to provide a sufficient osseous and mucosal support for a conventional denture into surgery aimed to provide a sufficient bone volume enabling implants to be placed at the most optimal positions from a prosthetic point of view. The aim of this paper is to review critically the literature on procedures related to the severely resorbed edentulous mandible and dental implant treatment. The study includes the transmandibular implant, (short) endosseous implants, and reconstructive procedures such as distraction osteogenesis, augmentation of the mandibular ridge with autogenous bone, and bone substitutes followed by the placement of implants. The number of patients participating in a study, the follow-up period, the design of the study, the degree of mandibular resorption, and the survival rate of the dental implants all are considered evaluation parameters. Although numerous studies have described the outcome results of dental implants in the edentulous mandible, there have been few prospective studies designed as randomized clinical trials that compare different treatment modalities to restore the severely resorbed mandible. Therefore, it is not yet possible to select an evidence-based treatment modality. Future research has to be focused on long-term, detailed follow-up clinical trials before scientifically based decisions in treating these patients can be made. This will contribute to a higher level of care in this field.

PMID: 15284188 [PubMed - indexed for MEDLINE]

Squamous cell carcinoma arising in an oral lichenoid lesion.

J Am Dent Assoc. 2004 Jun;135(6):754-9; quiz 796

Authors: Fatahzadeh M, Rinaggio J, Chiodo T

BACKGROUND: Oral lichen planus, or OLP, is a chronic inflammatory mucocutaneous disease that frequently involves the oral mucosa. Lichenoid dysplasia, or LD, refers to lesions that could be mistaken clinically for OLP but have histologic features of dysplasia and a true malignant predisposition. Published case reports of OLP conversion to squamous cell carcinoma, or SCC, have created a great deal of controversy about the true nature of OLP, highlighting the need to verify its clinical diagnosis histologically. CASE DESCRIPTION: The authors document the development of SCC in a 58-year-old woman with an oral lesion diagnosed clinically as OLP and described histologically as having lichenoid features with dysplastic changes. The time from the initial diagnosis of oral lichenoid lesions to the patient's return visit to the medical center with clinically evident cancer was three years and eight months. The SCC developed in the labial mucobuccal fold and left mandibular edentulous ridge, which had undergone multiple biopsy procedures. CLINICAL IMPLICATIONS: This case does not provide answers to the ongoing controversy about the innate propensity of OLP to become malignant. However, in view of both the common occurrence of OLP and unresolved issues regarding its premalignant potential, this case report illustrates the need for histologic confirmation and close follow-up of patients with clinical lesions that have lichenoid features.

PMID: 15270158 [PubMed - indexed for MEDLINE]

Effects of short-term adaptation to new complete dentures on perception thresholds for interocclusal thickness in experienced and non-experienced denture wearers.

Chin Med J (Engl). 2004 May;117(5):738-41

Authors: Nalbant AD

BACKGROUND: The ability of patients to discriminate thickness can change with time after the insertion of new complete dentures, and this adaptation may differ according to the experiences of the patients. If so, an education program to reinforce the oral functions may be needed. This study was to evaluate patients' ability to discriminate thickness by comparing experienced and non-experienced denture wearers after the insertion of new complete dentures. METHODS: Forty edentulous patients with a skeletal Class I jaw relationship without any temporomandibular disturbances were in the study. After insertion of new complete dentures, all patients were tested for discrimination threshold for interocclusal thickness. The thickness perception test was repeated on days 1, 7, and 30 after the insertion of new dentures. The discriminatory ability was assessed with steel and aluminium foils placed between the upper and lower central incisor teeth. The records included the duration of wearing dentures. The data were subjected to statistical analysis of two-way ANOVA, multiple comparison test and Student's t test. RESULTS: Discrimination of tactile ability significantly increased over 30 days in experienced denture wearers as compared with non-experienced patients (P < 0.001). The difference in thickness perception threshold was statistically significant between the two groups (P < 0.001). CONCLUSION: Adaptation and denture experience can affect thickness discrimination of complete denture wearers.

PMID: 15161544 [PubMed - indexed for MEDLINE]

Computational models of oral and craniofacial development, growth, and repair.

Adv Dent Res. 2003 Dec;17:61-4

Authors: Hammond P, Hutton T, Maheswaran S, Modgil S

This paper illustrates how biological and clinical problems stimulate research in biomedical informatics and how such research contributes to their solution. The computational models described use techniques from Logic Programming, Machine Learning, Computer Vision, and Biomathematics. They address problems in the development, growth, and repair of oral and craniofacial tissues arising in cell biology, clinical genetics, and dentistry. At the micro-level, the dynamic interaction of cells in the oral epithelium is modeled. At the macro-level, models are constructed of either the craniofacial shape of an individual or the craniofacial shape differences within and between healthy and congenitally abnormal populations. In between, in terms of scale, there are models of normal dentition and the use of computerized expert knowledge to guide the design of dental prostheses used to restore function in partially edentulous patients.

PMID: 15126209 [PubMed - indexed for MEDLINE]

Kinesiographic study of complete denture movement related to mucosa displacement in edentulous patients.

Pesqui Odontol Bras. 2003 Oct-Dec;17(4):356-61

Authors: Compagnoni MA, de Souza RF, Leles CR

The mucosa that covers the residual ridges of edentulous patients may present some distortion or displacement when occlusal loading is applied in complete dentures. This distortion and movement of the denture can result in acceleration of residual ridge resorption and loss of retention and stability. The aim of this study was to analyze the pattern of upper complete denture movement related to underlying mucosa displacement. A sample of 10 complete denture wearers was randomly selected, which had acceptable upper and lower dentures and normal volume and resilience of residual ridges. The kinesiographic instrument K6-I Diagnostic System was used to measure denture movements, according to the method proposed by Maeda et al.7, 1984. Denture movements were measured under the following experimental conditions: (A) 3 maximum voluntary clenching cycles and (B) unilateral chewing for 20 seconds. The results showed that under physiological load, oral mucosa distortion has two distinct phases: a fast initial displacement as load is applied and a slower and incomplete recovery when load is removed. Intermittent loading such as chewing progressively reduces the magnitude of the denture displacement and the recovery of the mucosa is gradually more incomplete.

PMID: 15107919 [PubMed - indexed for MEDLINE]

[Manufacture and application of the SJ-1 bolt attachment prosthesis]

Shanghai Kou Qiang Yi Xue. 1999 Jun;8(2):99-100

Authors: Zhang FQ, Zheng YL

OBJECTIVE:This study provided a method of manufacture and using for SJ-1 bolt attachment prostheses clinic application.METHODS:SJ-1 bolt attachment prostheses were applied to restorate 10 cases distal extension edentulous area.The patients had been observed for two years.RESULTS:Patients feel the bolt attachment RPDs comfortable,adaptive.CONCLUSION:This prosthesis was fine retention,masticator efficiency and aesthetics.

PMID: 15048282 [PubMed - as supplied by publisher]

[Clinical study of masticatory efficiency of removable partial denture with SJ-1 type bolt attachment]

Shanghai Kou Qiang Yi Xue. 2001 Jun;10(2):100-1

Authors: Dong HB, Zhang FQ

OBJECTIVE: Measurement and analysis of patients wearing dentures with SJ-1 type bolt attachments. METHODS: Select sixteen patients with free end edentulous spaces, restore with removable dentures using SJ-1 type bolt attachments,measure the masticatory efficiency using light-absorption method,and compare them with those of normal occlusion and traditional removable partial dentures. RESULTS: (1)One week after the dentures delivered,the average absorption value of these sixteen patients was 0.876,three weeks later 0.859,one month later 0.985. There was no significant difference among them. (2)Compared with those of normal occlusion, P>0.05,no significant difference;with those wearing traditional dentures, P<0.01,high significant difference. CONCLUSION: The matiscatory efficiency of the patients wearing dentures with SJ-1 type bolt attachments was much better than those of tradition al removable partial dentures.

PMID: 14994027 [PubMed]

[A clinical investigation into the effect of comfort denture adhesive on masticatory function with complete dentures]

Shanghai Kou Qiang Yi Xue. 2001 Sep;10(3):207-9

Authors: Zhao K, Cheng XR, Chen Q, Li SQ, Gao SH

OBJECTIVE: The purpose of this study was to evaluate the clinical effect of the new developed form of Comfort denture adhesive (Comfort DA). METHODS: 10 edentulous patients with complete dentures were selected for this study. The maximum biting force and masticatory efficiency were recorded before and after application of the adhesive to all the new and old dentures. Subjective test was also used to evaluate this adhesive in enhancing retention and stability of complete denture using the questionnaire way. RESULTS: The data indicated that significantly greater biting forces were generated with old dentures than with the new dentures. The major findings were that the adhesive produced a statistically significant improvement in the masticatory efficiency after application. Subjective views of the patients indicated that this tested product significantly improved denture retention, stability and had other favorable features. The time of adhesion was about 6 8 hours. CONCLUSION: The generally favorable clinical performance of the developed Comfort DA formulation indicated that it might be an efficacious denture adhesive.

PMID: 14993991 [PubMed]