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Upper Dentures (upper + denture)

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Medical Sciences	100%

Selected Abstracts

The Marius Implant Bridge: Surgical and Prosthetic Rehabilitation for the Completely Edentulous Upper Jaw with Moderate to Severe Resorption: A 5-Year Retrospective Clinical Study

CLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, Issue 2 2002
Yvan Fortin DDS
ABSTRACT Background: Patients seeking replacement of their upper denture with an implant-supported restoration are most interested in a fixed restoration. Accompanying the loss of supporting alveolar structure due to resorption is the necessity for lip support, often provided by a denture flange. Attempts to provide a fixed restoration can result in compromises to oral hygiene based on designs with ridge laps. An alternative has been an overdenture prosthesis, which provides lip support but has extensions on to the palate and considerations of patient acceptance. The Marius bridge was developed as a fixed bridge alternative offering lip support that is removable by the patient for hygiene purposes, with no palatal extension beyond normal crown-alveolar contours. Purpose: Implant-supported restorative treatment of completely edentulous upper jaws, as an alternative to a complete denture, is frequently an elective preference, and it requires significant patient acceptance beyond the functional improvement of chewing. Patients with moderate to severe bone resorption and thin ridges present additional challenges for adequate bone volume and soft-tissue contours. The purpose of this investigation was to develop a surgical and prosthetic implant treatment protocol for completely edentulous maxillae in which optimal lip support and phonetics is achieved in combination with substantial implant anchorage without bone grafting. Materials and Methods: The Marius bridge is a complete-arch, double-structure prosthesis for maxillae that is removable by the patient for oral hygiene. The first 45 consecutive patients treated by one person (YF) in one center with this concept are reported, with 245 implants followed for up to 5 years after prostheses connection. Results: The cumulative fixture survival rate for this 5-year retrospective clinical study was 97%. Five fixtures failed before loading, in five different patients, and two fixtures in the same patient failed at the 3-year follow-up visit. None of the bridges failed, giving a prostheses survival rate of 100%. The complications were few and mainly prosthetic: nine incidences of attachment component complications, one mesobar fracture, and three reports of gingivitis. All complications were solved or repaired immediately, with minimal or no interruption of prostheses use. Conclusions: Satisfactory medium-term results of survival and patient satisfaction show that the Marius bridge can be recommended for implant dentistry. The technique may reduce the need for grafting, because it allows for longer implants to be placed with improved bone anchorage and prostheses support. [source]

Does platelet-rich plasma promote remodeling of autologous bone grafts used for augmentation of the maxillary sinus floor?

CLINICAL ORAL IMPLANTS RESEARCH, Issue 3 2005
Gerry M. Raghoebar
Abstract: The aim of this study was to evaluate the effect of platelet-rich plasma (PRP) on remodeling of autologous bone grafts used for augmentation of the floor of the maxillary sinus. In five edentulous patients suffering from insufficient retention of their upper denture related to a severely resorbed maxilla, the floor of both maxillary sinus was augmented with an autologous bone graft from the iliac crest. Randomly, PRP was added to the bone graft used to augment the floor of the left or right sinus (split-mouth design). Three months after the reconstruction, bone biopsies were taken with a trephine from the planned implant sites (N=30). Subsequently, three implants were placed in the left and right posterior maxilla. Microradiograms were made of all biopsies (N=30), whereafter the biopsies were processed for light microscopic examination. In addition, clinical parameters were scored. Wound healing was uneventful, clinically no difference was observed between the side treated with PRP or not. Also microradiographical and histomorphological examination of the biopsies revealed no statistical difference between the PRP- and non-PRP side. One implant placed in the PRP side of the graft was lost during the healing phase. Implant-retained overdentures were fabricated 6 months after implantation. All patients functioned well (follow-up 20.2±4.3 months). In this study, no beneficial effect of PRP on wound healing and bone remodeling was observed. It is posed that PRP has no additional value in promoting healing of grafted non-critical size defects. Résumé Le but de cette étude a été d'évaluer l'effet du plasma riche en plaquettes sur le remodelage de greffons osseux autogènes utilisés pour l'épaississement du plancher sinusal. Chez cinq patients édentés souffrant d'une rétention insuffisante de leur prothèse supérieure en relation avec un maxillaire sévèrement résorbé, les planchers sinusaux des deux maxillaires ont étéépaissis avec un greffon d'os autogène provenant de la crête iliaque. Au hasard, du plasma riche en plaquettes (PRP) a été ajouté au greffon osseux utilisé pour épaissir le plancher du sinus gauche ou droit (modèle de bouche divisée). Trois mois après la reconstruction, des biopsies osseuses ont été obtenues avec un trépan des sites planifiés pour placer des implants (N=30). Ensuite, trois implants ont été placés dans les parties maxillaires gauches et droites. Des microradiogrammes des 30 biopsies ont été effectuées, ces dernières ont ensuite été utilisées pour l'examen au microscope optique. De plus, des paramètres cliniques ont été enregistrés. La guérison a été parfaite, cliniquement aucune différence n'a été observée entre les sites traités avec PRP ou sans. L'examen microradiographique et histomorphologique des biopsies n'a révélé aucune différence significative entre les sites PRP et non-PRP. Un implant placé dans le site PRP du greffon a été perdu durant la phase de guérison. Des prothèses retenues sur implants ont été fabriquées six mois après l'insertion des implants. Tous les patients ont une mise en fonction excellente après un suivi de 20±4,3 mois. Dans cette étude, aucun effet bénéfique additionnel du PRP sur la guérison et le remodelage osseux n'a été observé. Le PRP n'aurait aucune valeur supplémentaire à promouvoir la guérison dans ce type d'opération. Zusammenfassung Das Ziel dieser Studie war, den Einfluss von plättchenreichem Plasma auf die Remodellierung von autologen Knochentransplantaten, welche für die Augmentation des Sinusbodens vom Sinus maxillaris verwendet wurden, auszuwerten. Bei 5 zahnlosen Patienten, welche aufgrund einer stark resorbierten Maxilla über einen ungenügenden Halt der Oberkieferprothese klagten, wurde der Sinus maxillaris mit autologem Knochen vom Beckenkamm augmentiert. Zufällig wurde dem Knochen, der zur Augmentation des rechten oder linken Sinusbodens verwendet wurde, plättchenreiches Plasma (PRP) hinzugefügt (unterschiedlich behandelte Seiten). Drei Monate nach der Augmentation wurden mittels Hohlfräsen Biopsien an den geplanten Implantatlokalisationen entnommen (N=30). Danach wurden je drei Implantate in die rechte und linke posteriore Maxilla eingesetzt. Von allen Biopsien wurde Mikroröntgenbilder angefertigt (N=30), danach wurden die Biopsien für die lichtmikroskopische Untersuchung aufgearbeitet. Zusätzlich wurden klinische Parameter aufgenommen. Die Wundheilung war unauffällig. Klinisch konnten keine Unterschiede zwischen den mit und ohne PRP behandelten Seiten beobachtet werden. Ebenso ergab die mikroradiographische und histomorphometrische Untersuchung der Biopsien keine statistisch signifikanten zwischen der PRP und nicht-PRP Seite. Ein Implantat, welches in eine PRP Seite eingesetzt worden war, ging während der Einheilphase verloren. Die implantatgetragenen Hybridprothesen wurden 6 Monate nach Implantation angefertigt. Alle Patienten funktionierten problemlos (Beobachtungszeit bis 20.2±4.3 Monate). In dieser Studie konnte kein positiver Einfluss des PRP auf die Wundheilung und die Knochenremodellierung beobachtet werden. Es wird vermutet, dass PRP keinen zusätzlichen Effekt bei der Förderung der Heilung von Transplantaten in Defekten mit nicht-kritischer Grösse hat. Resumen La intención de este estudio fue evaluar el efecto del plasma rico en plaquetas en el remodelado de injertos de hueso autólogo usado para aumento del suelo del seno maxilar. Se aumentó el suelo de ambos senos maxilares con injertos de hueso autólogo de la cresta iliaca en 5 pacientes edéntulos que padecían de insuficiente retención de su dentadura superior relacionada con un maxilar severamente reabsorbido. Aleatoriamente, se añadió plasma rico en plaquetas (PRP) al injerto óseo usado para aumentar el suelo del seno derecho o izquierdo (diseño de boca partida). Tres meses tras la reconstrucción, se tomaron biopsias de hueso con un trépano de los lugares de implantes planificados (N=30). Subsecuentemente se colocaron tres implantes en el maxilar posterior derecho e izquierdo. Se hicieron microrradiogramas de todas las biopsias (N=30), posteriormente las biopsias se procesaron para microscopía óptica. Además se tomaron parámetros clínicos. La cicatrización de la herida tuvo lugar sin incidentes. Clínicamente no se observó diferencia alguna entre el lado tratado con PRP o no. Tampoco el examen microrradiográfico e histomorfológico de las biopsias revelaron diferencias estadísticamente significativas entre los lados con o sin PRP. Un implante colocado en el lado del PRP se perdió durante la cicatrización. Las dentaduras implantorretenidas se fabricaron a los seis meses de la implantación. Todos los pacientes funcionaron bien (seguimiento de 20.2±4.3 meses). En este estudio no se observó ningún efecto beneficioso del PRP sobre la cicatrización y sobre el remodelado óseo. Se plantea que el PRP no tiene ningún valor adicional en promover la cicatrización de defectos no críticos injertados. [source]

An infection control protocol: effectiveness of immersion solutions to reduce the microbial growth on dental prostheses

JOURNAL OF ORAL REHABILITATION, Issue 5 2003
A. C. Pavarina
summary, This investigation evaluated the effectiveness of an infection control protocol for cleansing and disinfecting removable dental prostheses. Sixty-four dentures were rubbed with sterile cotton swab immediately after they had been taken from patients' mouths. Samples were individually placed in the culture medium and immediately incubated at 37 ± 2 °C. The dentures were scrubbed for 1 min with 4% chlorhexidine, rinsed for 1 min in sterile water and placed for 10 min in one of the following immersion solutions: 4% chlorhexidine gluconate, 1% sodium hypochlorite, Biocide (iodophors) and Amosan (alkaline peroxide). After the disinfection procedures, the dentures were immersed in sterile water for 3 min, reswabbed and the samples were incubated. All samples obtained in the initial culture were contaminated with micro-organisms. All the lower dentures immersed in Biocide showed positive growth, and the upper dentures were positive for growth in six of eight dentures. The 4% chlorhexidine gluconate, 1% sodium hypochlorite and Amosan solutions have been proved effective to reduce the growth of the micro-organisms in the 10 min immersion period. The protocol evaluated in this study seems to be a viable method to prevent cross-contamination between dental personnel and patients. [source]

Differences in chewing strategies used by edentate people

JOURNAL OF ORAL REHABILITATION, Issue 9 2002
M. R. HEATH
Aim:, To examine, in detail, the different masticatory measures that contribute to individual chewing strategies of edentate people. Measures:, Variables relating to displacement and force were derived using a new three dimensional implant force transducer, a mucosal pressure transducer and measurements of mandibular movements. Materials:, Five edentate subjects with conventional upper dentures and lower dentures stabilized on two dental implants. The subjects chewed unilaterally on their preferred chewing side. Seven foods were chewed , almond, fruit pastille, chewing gum and four different meats. Analysis:, The data were analysed by separating each sequence into cycles and ,phases' of cycles for which variables were derived. Results:, As expected, the results showed greater differences between subjects than between foods. From the five subjects, four basic strategies were identified in response to the different foods: one subject primarily modulated force, one subject modulated the number of cycles, two subjects modulated force and the number of cycles and one subject showed little modulation at all. As part of these strategies many striking differences between subjects were observed, e.g. one subject showed little modulation of her ,default' chewing pattern for different foods, yet one subject modulated the number of force and manipulation cycles, the force strategy (forces increasing through sequences) and swallow thresholds. Conclusion:,People appear to develop different strategies to compensate for chewing difficulty by modulating speed, the number of cycles and/or penetration forces. [source]

Socioeconomic indicators and prosthetic replacement of missing teeth in a working-age population,Results of the Study of Health in Pomerania (SHIP)

COMMUNITY DENTISTRY AND ORAL EPIDEMIOLOGY, Issue 2 2009
Torsten Mundt
Abstract,,, Objectives:, To analyse the possible effects of the socioeconomic status (SES) on the prosthetic replacement of missing teeth in working-age people and to explore the role of potential confounders. Methods:, Cross-sectional data were collected from 2310 German adults aged 30,59 years. The relationship between each of the three SES indicators (education, income, and occupational status) and dental prostheses were examined by multinomial logistic regression analyses. For that, partially dentate participants with suboptimal and no replacement of missing teeth were compared with partially dentate participants having optimal replacement. Potential confounders (age, sex, dental status, social network and social support) were entered if their inclusion in the model led to ,10% change in the coefficient of interest. Results:, Social network and social support did not meet the criterion for confounding. In the maxilla, having no replacement was positively associated with lower categories for each of the three SES indicators [Odds ratios (OR) between 1.6 and 2.1; 95% confidence intervals (CI) between 1.1 and 3.4]. Low occupational status was the single predictor for suboptimal dental prostheses (OR = 3.2; 95% CI: 1.6,6.2). In the mandible, occupational status showed no association with the prosthetic status, whereas low educational level and low household income were determinants for having no replacement (OR = 1.9 and 1.9, 95% CI: 1.0,3.5 and 1.1,3.0, respectively). Low household income was the single determinant for suboptimal replacement of missing teeth (OR = 2.4, 95% CI = 1.1,5.2). Conclusion:, The findings may indicate the relevance of the financing of prosthodontic treatment. The strong association between various forms of upper dentures and occupational prestige can be seen as key contributing concept to how individuals, characteristics affect the outcome in prosthodontic care. [source]