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Upper Jaw (upper + jaw)

Distribution by Scientific Domains

Medical Sciences	72%
Life Sciences	22%

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]

Initial pattern of angiogenesis and bone formation following lateral ridge augmentation using rhPDGF and guided bone regeneration: an immunohistochemical study in dogs

CLINICAL ORAL IMPLANTS RESEARCH, Issue 1 2010
Frank Schwarz
Abstract Objectives: To evaluate (i) the effects of rhPDGF-BB on localized ridge augmentation using a natural bone mineral (NBM), and (ii) the influence of a collagen membrane (CM) on factor activity. Materials and methods: Chronic-type alveolar ridge defects (n=4 dogs) were randomly allocated in a split-mouth design as follows: upper jaw: NBM+rhPDGF-BB+CM (test) vs. NBM+rhPDGF-BB (control), and lower jaw: NBM+rhPDGF-BB+CM (test) vs. NBM+CM (control). After 3 weeks, dissected blocks were prepared for immunohistochemical (angiogenesis , TG) and histomorphometrical analysis [e.g. augmented area (AA), mineralized , (MT), non-mineralized tissue (NMT) (mm2)]. Results: Lower jaw: TG and mineralization of AA mainly originated from the defect borders. Test sites revealed a pronounced TG antigen reactivity and higher AA and MT values (mean and median). Upper jaw: control sites revealed a dislocation of AA in caudal direction, but also an improved vascularization in the peripheral wound area. While MT values (median) appeared to be comparable in both groups, AA, NMT, and NBM values (mean and median) tended to be higher at test sites. Conclusions: It was concluded that (i) rhPDGF-BB soak-loaded on NBM might have the potential to support bone formation at chronic-type lateral ridge defects, and (ii) the application of CM did not seem to interfere with the factor activity, but ensured a stabilization of the graft particles. To cited this article: Schwarz F, Ferrari D, Podolsky L, Mihatovic I, Becker J. Initial pattern of angiogenesis and bone formation following lateral ridge augmentation using rhPDGF and guided bone regeneration: an immunohistochemical study in dogs. Clin. Oral Impl. Res. 21, 2010; 90,99. [source]

A new specimen of Helicoprion Karpinsky, 1899 from Kazakhstanian Cisurals and a new reconstruction of its tooth whorl position and function

ACTA ZOOLOGICA, Issue 2009
O. A. Lebedev
Abstract A new Helicoprion bessonowi Karpinsky, 1899 (Chondrichthyes, Eugeneodontiformes) specimen from the Artinskian of Kazakhstan is described. This is the southernmost occurrence of this species in the Cisurals area. Its presence suggests a biogeographical link for this species between the Cisurals and Japan. Residue obtained from chemical preparation of the sample included numerous scales and several teeth, which are tentatively assigned to Helicoprion. This assumption is based upon morphological similarity of the scales to those known in other eugeneodontiforms. Campodus -like teeth might be part of the lateral dentition of Helicoprion. A new reconstruction of the interaction of the lower tooth whorl with the upper jaw dentition is suggested and its function is discussed. It is proposed that there was no symphysial whorl in the upper jaw but its role was played by a rigid cover formed by a series of small teeth at the palatoquadrates. Microscopic study of the tooth crown surface revealed scratch marks, which might have resulted from pressing the food object against the upper jaw. Using extant odontocetans as an ecological model led to a conclusion that helicoprionids most likely fed on cephalopods and to some extent on fish. This assumption is based upon the concentration of functional dentition in the area of the lower jaw symphysis in both groups of animals. [source]

Oral hygiene and the need for treatment of the dependent institutionalised elderly

GERODONTOLOGY, Issue 2 2006
Sylvie Montal
Objective:, To assessing the oral hygiene and treatment needs of a geriatric institution in southern France. Background:, For various reasons, the care demand from elderly people is low and difficult to determine, whereas their oral status would need long and complicated treatments. Materials and methods:, From 2003 to 2004, a cross-sectional study of 321 elderly patients was conducted at several geriatric services of Montpellier, France. The clinical evaluation of dental status was recorded together with medical information. Dental and prosthetic hygiene, status of dentures, caries experience, dependence conditions and treatment needs were evaluated. Results:, The prevalence of edentulism was 27%, with no gender difference (23% of the men and 29% of the women). Among them, 16.7% (upper jaw) and 18.1% (lower jaw) were totally edentulous with no denture. The mean number of decayed and missing teeth was 3.7 for men and 2.8 for women and 21.5 for men and 21.0 for women, respectively. The mean number of filled teeth was 0.8 for men and 1.3 for women, with no statistical difference according to gender for the three indexes. Most of the subjects needed prostheses (53%), 45.1% extractions and 30.6% conservative treatments. Only 2.4% did not need any treatment. Conclusion:, The prevalence of edentulism was relatively low, while the need for prosthodontic rehabilitation, especially for men, was still very high. The dental hygiene was globally inadequate. This evaluation emphasises the care demand and the need for help in oral hygiene procedures for the dependent institutionalised elderly. [source]

Coronally advanced flap: a modified surgical approach for isolated recession-type defects: Three-year results

JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 3 2007
M. De Sanctis
Abstract Background: Various modifications of the coronally displaced flap have been proposed in the literature with the attempt of treating gingival recession with uneven predictable results. The goal of the present study was to evaluate the effectiveness with respect to root coverage of a modification of the coronally advanced flap procedure for the treatment of isolated recession-type defects in the upper jaw. Methods: Forty isolated gingival recessions with at least 1 mm of keratinized tissue apical to the defects were treated with a modified approach to the coronally advanced flap. The main change in the surgical procedure consisted in the modification of flap thickness and dimension of surgical papillae during flap elevation. All recessions fall into Miller class I or II. The clinical re-evaluation was performed 1 year and 3 years after the surgery. Results: At the 1-year examination, the average root coverage was 3.72±1.0 mm (98.6% of the pre-operative recession depth) and 3.64±1.1 mm (96.7%) at 3 years. The gain in probing attachment amounted to 3.65±1.10 mm at 1 year and to 3.70±1.09 mm at 3 years. The average increase of keratinized tissue between the baseline and the 3-year follow-up amounted to 1.78±0.90 mm. All changes of keratinized tissue (difference between baseline and 1 year, baseline and 3 years, and between 1 and 3 years) were statistically significant. Conclusion: The modified coronally advanced surgical technique is effective in the treatment of isolated gingival recession in the upper jaw. [source]

Acellular dermal matrix allograft used to gain attached gingiva in a case of epidermolysis bullosa

JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 11 2003
Eralp Buduneli
Abstract Background: Epidermolysis bullosa (EB) is an acquired disease or inherited as either autosomal dominant or recessive with an incidence of 1/50,000. The prominent clinical characteristic of the disease is the development of bullae or vesicles in mucosa or skin in response to minor trauma. Aim: A female patient with a dystrophic type of EB had been put in a maintenance regimen after completion of the initial phase of periodontal therapy and followed for 7 years. The purpose of this report is to document acellular dermal matrix allograft application to increase the width of the attached gingiva in this patient experiencing difficulty in chewing and performing plaque control due to the dramatic loss of attached gingiva after 7 years of supportive periodontal therapy. Methods: Under local anaesthesia and antibiotic coverage, the acellular dermal matrix allograft was applied in the anterior region of the upper jaw in order to increase the width of attached gingiva, thereby improving patient comfort. Results: The healing was uneventful and a significant gain in attached gingiva dimensions was observed 9 months after the periodontal surgery. The procedure avoided a second surgical site, provided satisfactory results from an aesthetic point of view, and improved patient comfort. Conclusion: Acellular dermal matrix allograft may be regarded as an alternative in the treatment of EB cases to increase the width of attached gingiva and facilitate maintenance of the dentition. Zusammenfassung Hintergrund: Die Epidermolysis bullosa (EB) ist eine erworbene oder eine autosomal dominant oder rezessiv vererbte Krankheit mit einer Incidenz von 1:50,000. Die hervorstechenden klinischen Symptome dieser Erkrankung sind die Entwicklung von Blasen oder Vesikeln in der Mukosa oder in der Haut auf geringste Traumen. Ziel: Eine Frau mit dem dystrophischen Typ von EB wurde in der Erhaltungsphase seit 7 Jahren geführt, nachdem die initiale Phase der parodontalen Therapie beendet worden war. Der Zweck dieser Studie ist die Dokumentation der Applikation eines azellulären Hautmatrixtransplantats für die Verbreiterung der fest angewachsenen Gingiva bei dieser Patientin, die nach 7 Jahren der erhaltenden parodontalen Therapie Probleme beim Kauen und bei der Durchführung der Plaquekontrolle durch einen starken Verlust an fest angewachsener Gingiva hatte. Methoden: Unter lokaler Anästhesie und antibiotischer Abschirmung wurde das azelluläre Hautmatrixtransplantat in die anteriore Region des Oberkiefers appliziert, um die Breite der fest angewachsenen Gingiva zu vergrößern und so das Befinden der Patientin zu verbessern. Ergebnisse: Die Heilung war komplikationslos, und ein signifikanter Gewinn an fest angewachsener Gingiva 9 Monate nach der parodontalen Operation wurde beobachtet. Die Methode vermied eine zweite chirurgische Region, erbrachte zufriedenstellende Ergebnisse aus ästhetischer Sicht und verbesserte das Befinden der Patientin. Schlussfolgerung: Das azelluläre Hautmatrixtransplantat kann als eine Alternative in der Behandlung von EB betrachtet werden, um die Breite der fest angewachsenen Gingiva zu vergrößern und zur Möglichkeit der Erhaltung der Dentition beizutragen. Résumé La bullose épidermolysie (EB) est une maladie contractée ou héritée qui peut être aussi bien autosomale dominante que récessive avec une fréquence de 1/50,000. La caractéristique clinique importante de la maladie est le développement de bulles ou de vésicules au niveau de la muqueuse ou de la peau comme réponse à un traumatisme mineur. Une femme avec un type dystrophique de EB a été placée dans un régime de maintenance après la fin de la phase initiale du traitement parodontal et suivie durant sept années. Le but de ce rapport est de documenter le placement d'un allographe de la matrice dermique acellulaire visant à augmenter la largeur de la gencive attachée chez cette patiente qui avait des problèmes aux niveaux masticatoire et du contrôle de la plaque dentaire vu la perte dramatique de la gencive attachée après sept années de maintenance parodontale. Sous anesthésie locale et sous couverture antibiotique, l'allographe de la matrice dermique acellulaire a été placé dans la région antérieure de la mâchoire supérieure pour augmenter la largeur de la gencive attachée afin d'améliorer le confort de la patiente. La guérison s'est déroulée sans problème et un gain significatif de gencive attachée a été observé neuf mois après la chirurgie parodontale. Ce processus chirurgical élimine la nécessité d'avoir un site donneur, apporte des résultats satisfaisants du point de vue esthétique et améliore le confort du patient. L'allographe de la matrice dermique acellulaire peut donc être considéré comme une alternative dans le traitement des cas de EB afin d'augmenter la largeur de la gencive attachée et faciliter le maintien de la dentition. [source]

Development of the cypriniform protrusible jaw complex in Danio rerio: Constructional insights for evolution

JOURNAL OF MORPHOLOGY, Issue 7 2010
Katie Lynn Staab
Abstract Studies on the evolution of complex biological systems are difficult because the construction of these traits cannot be observed during the course of evolution. Complex traits are defined as consisting of multiple elements, often of differing embryological origins, with multiple linkages integrated to form a single functional unit. An example of a complex system is the cypriniform oral jaw apparatus. Cypriniform fishes possess an upper jaw characterized by premaxillary protrusion during feeding. Cypriniforms effect protrusion via the kinethmoid, a synapomorphy for the order. The kinethmoid is a sesamoid ossification suspended by ligaments attaching to the premaxillae, maxillae, palatines, and neurocranium. Upon mouth opening, the kinethmoid rotates as the premaxillae move anteriorly. Along with bony and ligamentous elements, there are three divisions of the adductor mandibulae that render this system functional. It is unclear how cypriniform jaws evolved because although the evolution of sesamoid elements is common, the incorporation of the kinethmoid into the protrusible jaw results in a function that is atypical for sesamoids. Developmental studies can show how biological systems are assembled within individuals and offer clues about how traits might have been constructed during evolution. We investigated the development of the protrusible upper jaw in zebrafish to generate hypotheses regarding the evolution of this character. Early in development, the adductor mandibulae arises as a single unit. The muscle divides after ossification of the maxillae, on which the A1 division will ultimately insert. A cartilaginous kinethmoid first develops within the intermaxillary ligament; it later ossifies at points of ligamentous attachment. We combine our structural developmental data with published kinematic data at key developmental stages and discuss potential functional advantages in possessing even the earliest stages of a system for protrusion. J. Morphol. 2010. © 2010 Wiley-Liss, Inc. [source]

Inferring parrotfish (Teleostei: Scaridae) pharyngeal mill function from dental morphology, wear, and microstructure

JOURNAL OF MORPHOLOGY, Issue 10 2006
Andrew Carr
Abstract Morphology, occlusal surface topography, macrowear, and microwear features of parrotfish pharyngeal teeth were investigated to relate microstructural characteristics to the function of the pharyngeal mill using scanning electron microscopy of whole and sectioned pharyngeal jaws and teeth. Pharyngeal tooth migration is anterior in the lower jaw (fifth ceratobranchial) and posterior in the upper jaw (paired third pharyngobranchials), making the interaction of occlusal surfaces and wear-generating forces complex. The extent of wear can be used to define three regions through which teeth migrate: a region containing newly erupted teeth showing little or no wear; a midregion in which the apical enameloid is swiftly worn; and a region containing teeth with only basal enameloid remaining, which shows low to moderate wear. The shape of the occlusal surface alters as the teeth progress along the pharyngeal jaw, generating conditions that appear suited to the reduction of coral particles. It is likely that the interaction between these particles and algal cells during the process of the rendering of the former is responsible for the rupture of the latter, with the consequent liberation of cell contents from which parrotfish obtain their nutrients. J. Morphol. © 2006 Wiley-Liss, Inc. [source]

Prosthodontic decision-making: what unprompted information do dentists seek before prescribing treatment?

JOURNAL OF ORAL REHABILITATION, Issue 1 2010
R. OMAR
Summary, This study explored the nature of the unprompted information that clinicians seek before making a treatment decision and whether this decision corresponded with the clinical parameters of the case. Interns, general practitioners (GP) and prosthodontists (n = 70, mean age 33 years, range 23,68) were presented with a written vignette of partial edentulism that included two spaces and were invited to ask any questions for the purpose of making a treatment recommendation. A list of 48 potential question/answer items was available to the interviewer, of which 38 were asked. These were then allotted to four thematic categories. Mean number of questions asked did not differ significantly amongst groups, although prosthodontists asked significantly more questions in the ,clinical and radiographic information' category than GPs (P = 0·0001) and interns (P = 0·003). The relationship between a prescribed treatment and questions asked was tested by dichotomizing all recommendations into ,possible' or ,not possible' based on the authors' knowledge of the actual case history. There were no significant differences amongst the groups in the frequency of prescribing ,possible' treatment (Pearson chi-square 0·083 and 0·108 for upper and lower spaces, respectively), but those who prescribed ,possible' treatment asked significantly more questions in the ,clinical and radiographic information' category, specifically about bone adequacy in the edentulous areas: upper jaw (P = 0·0001) and lower jaw (P = 0·003). It may be concluded that prosthodontists generally opted for more ,possible' treatments, as well as seeking items of information that seemed to improve the chance of making recommendations that conformed to the actual case characteristics. [source]

Treatment with removable partial dentures: a longitudinal study.

JOURNAL OF ORAL REHABILITATION, Issue 5 2003
Part II
summary The aim of this study was to evaluate the effectiveness of an oral rehabilitation by removable partial denture (RPD). Between 1983 and 1994, 629 patients were provided with an RPD at the Dental School of the Université catholique de Louvain. All the RPDs were constructed with a cobalt,chromium framework. All the treatments were provided by dental students under the supervision of clinical instructors. At recall time (1998,2000), 269 patients could not be reached neither by telephone nor by mail and 27 had died. Consequently, 333 patients were called for clinical examination and 254 of these (76·3%) actually attended. For a total of 292 RPDs checked 1893 persistent teeth were listed, with 804 serving as abutments; more than half (57·6%) of these were crowned, for which 51 debondings were recorded. For the period of observation we listed 79 abutments lost (37 at the upper jaw and 42 at the lower jaw), i.e. 9·8% of the total number of abutments. No relation could be established between the type of the abutments (natural or crowned teeth) and the losses observed (Test of Mantel-Haenszel: P=0·9496). In the upper jaw, the percentage of abutments lost was significantly higher in the presence of free-end edentulous areas as compared with bounded edentulous areas (Test of Mantel-Haenszel: P=0·0002); this difference does not appear for the lower jaws (P=0·9558). If we deduct the 25 abutments related with the 11 non-worn RPDs and the 79 abutments lost, no change becomes apparent for 92·2% of the maxillary abutments and for 85·8% of the mandibular abutments. For the 1089 other teeth, we observed the loss of 40 teeth and the appearance of caries or new fillings for 95 teeth. The fractures of cast clasps represent 3·4%. [source]

Which cranial regions reflect molecular distances reliably in humans?

AMERICAN JOURNAL OF HUMAN BIOLOGY, Issue 1 2009
Evidence from three-dimensional morphology
Knowledge of the degree to which various subsets of morphological data reflect molecular relationships is crucial for studies attempting to estimate genetic relationships from patterns of morphological variation. This study assessed the phylogenetic utility of six different human cranial regions, plus the entire cranium. Three-dimensional landmark data were collected for 83 landmarks from samples of skulls from 14 modern human populations. The data were subsequently divided into anatomical regions: basicranium, upper face, mandible, temporal bone, upper jaw, cranial vault, and a subset of points from around the entire cranium. Depictions of population molecular distances were calculated using published data on microsatellites for the same or closely related populations. Distances based on morphological variation of each of the anatomical regions were compared with molecular distances, and the correlations assessed. The morphology of the basicranium, temporal bone, upper face, and entire cranium demonstrated the highest correlations with molecular distances. The morphology of the mandible, upper jaw, and cranial vault, as measured here, were not significantly correlated with molecular distances. As the three-dimensional morphology of the temporal bone, upper face, basicranium, and entire cranium appear to consistently reflect genetic relationships in humans, especially with more reliability than the cranial vault, it would be preferable to focus on these regions when attempting to determine the genetic relationships of human specimens with no molecular data. Am. J.Hum. Biol., 2009. © 2008 Wiley-Liss, Inc. [source]

Anaesthetic properties of Propiscin (Etomidaat) and 2-phenoxyethanol in the common carp (Cyprinus carpio L.), neural and behavioural measures

AQUACULTURE RESEARCH, Issue 11 2009
Bert Lambooij
Abstract The objective of the study was to evaluate the anaesthetic effects of Propiscin (2% etomidate) and 2-phenoxyethanol on common carp (Cyprinus carpio L.) by observing neural and behavioural measures. When exposed to the anaesthetic agent, the carp lost equilibrium after approximately 90 s of exposure. They did not breathe and the controls did not respond to tail pinch or prick or 6 V at the skin of the upper jaw. A shift to lower frequencies on the electroencephalogram (EEG) and computing fast Fourier transformation was observed when exposed to water containing Propiscin or 2-phenoxyethanol. Heart rate was reduced after placement in the water containing an anaesthetic agent. It may be concluded from our results that common carp were immobilized and sedated, when exposed to water containing 2 mL L,1 Propiscin and immobilized and anaesthetized in water containing 0.5 mL L,1 2-phenoxyethanol. In addition, the use of EEG provides for a sound assessment of exposure of carp to these anaesthetics. [source]

Fixed Implant-Supported Prostheses in Elderly Patients: A 5-Year Retrospective Study of 133 Edentulous Patients Older than 79 Years

CLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, Issue 4 2004
Ingela Engfors DDS
ABSTRACT Background: An increasing number of elderly patients are treated with implants, but results for the elderly patient in terms of implant success and adaptation to implant prostheses are contradictory. Objective: To retrospectively study the 5-year clinical and radiologic performances of fixed implant-supported prostheses placed in edentulous elderly patients and to compare those results with the results of using similar prostheses in a control group of younger patients. Materials and Methods: The study group comprised 133 edentulous patients who were 80 or more years of age and who were consecutively treated with fixed implant-supported prostheses between January 1986 and August 1998. Altogether 761 Brånemark System® implants (Nobel Biocare AB, Göteborg, Sweden) were placed in 139 edentulous jaws. The control group comprised 115 edentulous patients who were younger than 80 years and who were treated consecutively from March 1996 to November 1997 with similar prostheses. In this group 670 implants were placed in 118 edentulous jaws. Information was collected from all postinsertion visits, including the fifth annual checkup, and changes of marginal bone levels were analyzed from intraoral radiographs. Results: The 5-year cumulative survival rate (CSR) for implants in the maxilla was 93.0% in the study group and 92.6% in the control group; the corresponding CSRs for implants in the mandible were 99.5% and 99.7%. The most common complications for patients in the study group were soft tissue inflammation (mucositis) and cheek and lip biting (p < .05) whereas resin veneer fractures were the most common complications for the control group. Overall 5-year marginal bone loss for the study group was 0.7 mm (standard deviation [SD], 0.45) in the upper jaw and 0.6 mm (SD, 0.50) in the lower jaw. Differences in bone levels and bone loss between the two groups did not reach significant levels (p > .05). Conclusions: Implant treatment in the elderly patients showed treatment results comparable to those observed in younger age groups. However, indications of more problems with adaptation could be observed and were reflected in more postinsertion problems. Cleaning problems and associated soft tissue inflammation (mucositis) as well as tongue, lip, and cheek biting were significantly more often observed among the elderly patients (p < .05). [source]

Initial pattern of angiogenesis and bone formation following lateral ridge augmentation using rhPDGF and guided bone regeneration: an immunohistochemical study in dogs

Clinical Experiences of Computer Numeric Control-Milled Titanium Frameworks Supported by Implants in the Edentulous Jaw: A 5-Year Prospective Study

CLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, Issue 4 2004
Anders Örtorp DDS
ABSTRACT Background: Few long-term follow-up studies on treatment concepts using computer numeric control-milled titanium frameworks have been conducted. Objective: To evaluate the clinical and radiographic performance of implant-supported prostheses provided with computer numeric control-milled titanium frameworks in the edentulous jaw and to compare their performance during the first 5 years of function with that of prostheses provided with conventional cast gold alloy frameworks. Materials and Methods: A consecutive group of 126 edentulous patients were randomly provided with 67 prostheses with titanium frameworks (test group) in 23 upper jaws and 44 lower jaws and with 62 conventional prostheses with gold alloy castings (control group) in 31 upper jaws and 31 lower jaws. Clinical and radiographic 5-year data were collected for the test and control groups. Results: The frequency of problems was low, and clinical and radiologic performances were similar in both groups. In the test group, the 5-year cumulative survival rates (CSRs) were 94.9% and 98.3% for implants and titanium prostheses, respectively. The respective corresponding CSRs for the control group were 97.9% and 98.2%. More loaded implants were lost in the maxillas in the test group (p < .01), but this difference was not significant on the patient/prosthesis level (p > .05). Smokers lost more implants than nonsmokers lost (p < .01). Similar survival rates were observed for implants in the mandible. One prosthesis was lost in each group because of the loss of implants. Metal fractures were seen only in the control group, and resin veneer fractures were more frequent in the maxilla in the gold alloy group (p < .05). In the test group, the mean marginal bone loss was 0.5 mm (SD, 0.44) in the maxilla and 0.4 mm (SD, 0.50) in the mandible. A similar pattern of bone reaction was observed in the control group. Mean marginal bone loss was similar for smokers and nonsmokers (p > .05). Conclusion: Computer numeric control-milled titanium frameworks are a viable alternative to gold alloy castings in the edentulous jaw and present clinical and radiologic performances similar to those of conventional gold alloy frameworks during the first 5 years of function. [source]

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

Comparison between jaw bone augmentation by means of a stiff occlusive titanium membrane or an autologous hip graft: a retrospective clinical assessment

CLINICAL ORAL IMPLANTS RESEARCH, Issue 5 2006
Liene Molly
Abstract Objectives: Patients in need of bone augmentation procedures can be treated with a traditional hip graft or by neogenesis under a stiff occlusive titanium membrane, custom-fit on the basis of CT-scan data. Material and methods: Eighteen patients treated by means of a hip graft (H) were compared with 11 patients using a full titanium membrane (M) for the rehabilitation of upper jaws. In the H group, 17 patients (62 implants) in the anterior region (Ha) and 14 patients (23 implants) in the posterior region (Hp) were included. In the M group, nine patients (30 implants) in the anterior region (Ma) and seven patients (16 implants) in the posterior region (Mp) were included. Results: In group Ha, the CFR was 13.3% after 14 years compared with group Ma where the CFR was 17.4% after 9 years. In group Hp, the CFR was 22.8% after 16 years compared with group Mp where the CFR was 23.4% after 6 years. The marginal bone loss for group Ha after 20 years was 2.7 mm, for group Ma it was not even 1 mm after 9 years; for group Hp, it was 2.5 mm after 15 years compared with less than 1 mm after 3 years in group Mp. Conclusions: The success rate of alveolar ridge augmentation therapy is lower than in a classical approach. These augmentation procedures, however, show acceptable results. The titanium membrane augmentation leads to less marginal bone loss probably because neo-formed bone has a better chance to adapt its mineralization to occlusal forces encountered. This technique could offer improvement if membrane exposure can be avoided. [source]

Reconstruction of maxillary and mandibular defects using prefabricated microvascular fibular grafts and osseointegrated dental implants , a prospective study

CLINICAL ORAL IMPLANTS RESEARCH, Issue 5 2004
Claude Jaquiéry
Abstract: The fibular flap can be used for a variety of indications. Recently, the treatment of four patients with severely atrophied upper jaws using a method to prefabricate the vascularized fibular graft has been published. This technique consists of a two-stage operation procedure that allows simultaneous prosthodontic rehabilitation and immediate placement of dental implants. In this paper eight patients with 29 ITI implants (Straumann AG, Waldenburg, Switzerland) who had reconstruction of either the upper or lower jaw are presented. The aim of the study was (i) to evaluate the behavior of the newly formed soft tissue around implants inserted in the fibula by applying periodontal parameters, (ii) to monitor prospectively the integration of the implants in the fibular graft, and (iii) to assess the osseous integration of the fibular graft used for reconstruction of the upper or lower jaw. Two implants failed during the observation time because of avascular bone at the distal end of the fibular graft. Stabilization of the graft, however, was never compromised. Due to the prefabrication firmly attached gingiva-like soft tissue could be provided preventing periimplant soft tissue inflammation and facilitating oral hygiene. After 1 year of observation the mean attachment level was similar to implants placed in original bone whereas vertical bone loss measured radiographically was lower in the present study. This may indicate that the remodeling of a bicortical bone requires a longer period of time compared with the bone of the alveolar crest. The prospective 1-year results are promising but long-term evaluation of periodontal and radiological parameters are required. Résumé Le lambeau péroné peut être utilisé pour une variété d'indications. Récemment le traitement de quatre patients avec une atrophie sévère des mâchoires supérieures et utilisant une méthode pour préfabriquer un greffon péroné vascularisé a été publié. Cette technique consiste en une opération en deux étapes qui permet la réhabilitation prothétique simultanée et le placement immédiat des implants dentaires. Dans ce rapport huit patients avec 29 implants ITI (Straumann AG, Waldenburg, Switzerland) ont eu une reconstruction de la mâchoire supérieure ou inférieure. Le but de cette étude a été 1) d'évaluer le comportement des tissus mous nouvellement formés autour des implants insérés dans le péroné en appliquant les paramètres parodontaux, 2) de suivre d'une manière prospective l'intégration des implants dans le greffon péroné et 3) d'examiner l'intégration osseuse de l'implant péroné utilisé pour la reconstruction de ces mâchoires. Deux implants ont échoué durant la période d'observation parce que l'os alvéolaire n'était pas vasculariséà la partie distale du greffon. La stabilisation du greffon n'a cependant jamais été compromise. La préfabrication d'un tissu ressemblant à de la gencive préfabriquée a permit d'éviter l'inflammation gingivale et de faciliter l'hygiène buccale. Après une année d'observation le niveau d'attache moyen était semblable au niveau des implants placés dans l'os original tandis que la perte osseuse verticale mesurée radiographiquement était inférieure dans l'étude présente. Ceci peut indiquer que le remodelage de l'os bicortical requiert une période plus importante comparée à l'os du rebord alvéolaire. Ces résultats prospectifs à une année sont encourageants mais l'évaluation à long terme des paramètres parodontaux et radiologiques reste encore nécessaire. Zusammenfassung Der Fibula-Lappen kann bei einer Vielzahl von Indikationen angewendet werden. Kürzlich wurde eine Publikation über die Behandlung von vier Patienten mit stark atrophierten Oberkiefern mittels vorfabrizierten vaskularisierten Fibula transplantaten veröffentlicht. Diese Technik besteht aus einer Operation in zwei Phasen, welche die Sofortimplantation von dentalen Implantaten und gleichzeitige prothetische Rekonstruction erlaubt. In diesem Artikel werden acht Patienten mit 29 Implantaten (Straumann AG, Waldenburg, Switzerland), bei welchen entweder eine OK- oder UK-Rekonstruktion durchgeführt wurde, präsentiert. Das Ziel der Studie war (i) das Verhalten des neu gebildeten Gewebes um die Implantate, welche in die Fibula eingesetzt worden waren mittels parodontalen Parametern zu untersuchen, (ii) die Integration der Implantate in das Fibula-Transplantat prospektiv aufzuzeichnen und (iii) die ossäre Integration des für die Rekonstruktion des OK oder UK verwendeten Fibula-Transplantats zu ermitteln. Zwei Implantate zeigten während der Beobachtungsperiode Misserfolge wegen avaskulärem Knochen an den distalen Enden des Fibula-Transplantats. Die Stabilisierung des Transplantats war jedoch niemals beeinträchtigt. Durch die Vorfabrizierung konnten gut angewachsene gingiva-ähnliche Weichgewebe geschaffen werden, welche eine periimplantäre Entzündung der Weichgewebe verhinderten und die Mundhygiene erleichterten. Nach einer Beobachtungszeit von einem Jahr war das mittlere Attachmentniveau ähnlich dem von Implantaten, welche in alveolären Knochen inseriert worden waren, während der radiologisch gemessene Knochenverlust in der vorliegenden Studie geringer war. Dies könnte ein Indiz dafür sein, dass die Remodellierung eines bikortikalen Knochens im Vergleich zum Alveolarknochen längere Zeit benötigt. Die prospektiven Resultate nach einem Jahr sehen vielversprechend aus, aber es muss eine Auswertung der parodontalen und radiologischen Parameter über einen längeren Zeitraum durchgeführt werden. Resumen El colgajo peroneal puede ser usado para una variedad de indicaciones. Recientemente se ha publicado el tratamiento de cuatro pacientes con maxilares superiores severamente atróficos usando un método para prefabricar el injerto peroneal vascularizado. Esta técnica consiste en un procedimiento de operación de dos fases que permite la rehabilitación prostodóntica y la colocación inmediata de implantes dentales simultáneamente. En este artículo se presentan ocho pacientes con 29 implantes ITI (Strauman AG, Waldenburg) teniendo una reconstrucción de tanto el maxilar superior como del inferior. La intención del presente estudio fue (i) evaluar el comportamiento de del tejido blando neoformado alrededor de los implantes insertados en la tibia aplicando parámetros periodontales, (ii) monitorizar prospectivamente la integración de los implantes en el injerto perineal y (iii) valorar la integración ósea del injerto perineal usado para la reconstrucción del maxilar superior o inferior. Dos implantes fracasaron durante el periodo de observación debido a hueso sin vascularización en el final distal del injerto perineal. De todos modos, la estabilización del injerto no se vio nunca comprometida. Debido a la prefabricación se pudo suministrar un tejido blando tipo encía adherida previniendo inflamación del tejido blando periimplantario y facilitando la higiene oral. Tras un año de observación el nivel de inserción medio fue similar a los implantes insertados en las áreas de hueso original mientras que la pérdida de hueso vertical medida radiograficamente fue menor en el presente estudio. Esto puede indicar que el remodelado de un hueso bicortical requiere un periodo mas largo de tiempo comparado con el hueso de la cresta alveolar. Los resultados prospectivos de un año son prometedores pero se requieren evaluaciones de los parámetros periodontales y radiológicos a largo plazo. [source]

Implant-supported fixed prostheses in the edentulous maxilla

CLINICAL ORAL IMPLANTS RESEARCH, Issue 3 2004
A 2-year clinical, radiological follow-up of treatment with non-submerged ITI implants
Abstract Objectives: To evaluate the survival rate of non-submerged solid-screw ITI dental implants with a rough (titanium plasma sprayed, TPS) surface in the edentulous maxilla after 1 and 2 years of loading. Material and method:, Twenty-five patients (mean age 64 years) with edentulous upper jaws received five,seven implants and, after a mean healing time of 6.9 months, screw-retained implant-supported fixed prostheses. A total of 146 ITI solid screw TPS implants were inserted. The diameter of 56% of the implants was smaller (3.3 mm) than the standard (4.1 mm) and the diameter of the rest (44%) was standard. The bone quantity of the majority of the patients was low and the bone quality poor. Clinical parameters were registered at baseline and at two annual follow-ups. Radiological examinations and assessments were also made at these times. Results: Mean marginal bone level at baseline was measured at a point 4.52 mm (range 1.45,7.70, SD 1.2) apical of the reference point. Mean bone loss from baseline to 1 year of loading was 0.24 mm (SD 0.9, P=0.002) and from 1 year to 2 years of loading 0.15 mm (SD 0.4, P<0.001). Five implants failed, four of which were early failures prior to loading. One implant failed shortly after bridge installation. The cumulative survival rate was 96.6% after 1 and 2 years. Conclusion: ITI TPS solid-screw implants in combination with fixed prostheses had successful survival rates and were found to be a viable treatment alternative in the edentulous maxilla. Résumé Le but de cette étude a été d'évaluer le taux de survie d'implants dentaires ITI vis solides non-enfouis avec une surface TPS (titane plasma-spray) au niveau du maxillaire édenté après une ou deux années de mise en charge. Vingt-cinq patients d'un âge moyen de 64 ans avec des mâchoires supérieures édentées ont reçu de cinq à sept implants et, après un temps de guérison moyen de 6,9 mois, des prothèses fixées vissées à ces implants (ISFP). Un total de 146 implants TPS ITI vis pleines ont été insérés. Le diamètre de 56% des implants étaient plus petits (3,3 mm) que le reste des implants qui avaient un diamètre standard (4,1 mm). La longueur des implants variait de 6 à 16 mm. La quantité osseuse de la majorité des patients était faible et la qualité osseuse pauvre. Des paramètres cliniques ont été enregistrés lors de l'examen initial et après deux années. Des examens radiographiques ont également été effectués à ces moments. Le niveau osseux marginal moyen lors de l'examen initial a été mesuréà un point 4,52 mm (de 1,45 à 7,70 mm : SD 1,2 mm) en apical du point de référence. La perte osseuse moyenne entre l'examen de départ et un an après la mise en charge était de 0,24 mm (SD 0,9; p=0,0002) et entre la première et la deuxième année de 0,15 mm (SD 0,4; p<0,001). Cinq implants ont échoué, dont quatre avant la mise en charge. Un implant a échoué peu de temps après le placement du bridge. Le taux de survie cumulatif après une ou deux années était de 96,6%. Les implants ITI TPS vis pleines avec des prothèses fixées avaient des taux de survie excellents et représentaient un traitement alternatif de qualité pour les patients édentés du maxillaire supérieur. Zusammenfassung Ziele: Die Ueberlebensrate von transmukosalen dentalen ITI-Vollschraubenimplantaten mit einer rauen Oberfläche (titanplasmabeschichtet, TPS) im zahnlosen Oberkiefer nach 1 und 2 Jahren Belastung auszuwerten. Material und Methoden: Fünfundzwanzig Patienten (mittleres Alter 64 Jahre) mit zahnlosen Oberkiefern erhielten 5,7 Implantate und nach einer mittleren Einheilzeit von 6.9 Monaten wurden verschraubte festsitzende implantatgetragene Rekonstruktionen (ISFPs) eingesetzt. Insgesamt wurden 146 ITI-Vollschraubenimplantate eingesetzt. Der Durchmesser von 56% dieser Implantate war kleiner (3.3 mm) als der Standard (4.1 mm) und der Durchmesser der restlichen 44% war Standard. Bei der Mehrzahl der Patienten war die Knochenmenge gering und die Knochenqualität schlecht. Die klinischen Parameter wurden bei der Ausgangsuntersuchung und bei den zwei Nachuntersuchungen in jährlichen Abständen aufgenommen. Bei diesen Untersuchungen wurden auch radiologische Auswertungen durchgeführt. Resultate: Das marginale Knochenniveau zum Zeitpunkt der Ausgangsuntersuchung wurde an einem Punkt 4.52 mm (Bandbreite 1.45,7.70, SD 1.2) apikal des Referenzpunktes gemessen. Der mittlere Knochenverlust von der Ausgangsuntersuchung bis 1 Jahr nach Belastung betrug 0.24 mm (SD 0.9, P=0.002) und zwischen 1 und 2 Jahren nach Belastung betrug er 0.15 mm (SD 0.4, P>0.001). Fünf Implantate zeigten Misserfolge, vier davon waren Frühmisserfolge vor Belastung. Ein Implantat versagte kurz nach der Eingliederung der Brücke. Die kummulative Ueberlebensrate nach 1 und 2 Jahren betrug 96.6%. Schlussfolgerung: ITI TPS Vollschraubenimplantate in Kombination mit festsitzenden Rekonstruktion zeigten erfolgreiche Ueberlebensraten und scheinen eine überlebensfähige Behandlungsalternative im zahnlosen Oberkiefer darzustellen. Resumen Objetivos: Evaluar el índice de supervivencia de implantes ITI roscados macizos no sumergidos con una superficie rugosa (pulverizada con plasma de titanio, TPS) en el maxilar edéntulo tras 1 o 2 años de carga. Material y Métodos: Veinticinco pacientes (edad media 64 años) con maxilares superiores edéntulos recibieron 5,7 implantes y, tras un periodo de cicatrización medio de 6.9 meses, una prótesis fija atornillada implantosoportada (ISFPs). Se insertaron un total de 146 implantes ITI roscados macizos. El diámetro del 56% de los implantes fue menor (3.3 mm) que el estándar (4.1 mm) y el diámetro del resto (44%) fue estándar. La cantidad de hueso de la mayoría de los pacientes fue baja y la calidad de hueso baja. Los parámetros clínicos se registraron al inicio y en los exámenes anuales de seguimiento. También se realizaron exámenes radiológicos y valoraciones en estos momentos. Resultados: El nivel medio de hueso marginal al inicio se midió en un punto 4.52 (rango 1.45,7.70, SD 1.2) apical al punto de referencia. La pérdida de hueso desde el inicio hasta 1 año de carga fue de 0.24 mm (SD 0.9, P=0.002) y de 1 año a 2 años de carga fue de 0.15 mm (SD 0.4, P<0.001). Cinco implantes fracasaron al poco de instalar los puentes. El índice acumulativo de supervivencia fue del 95%. Conclusión: Los implantes roscados macizos ITI TPS en combinación con prótesis fijas tuvieron unos índices de supervivencia exitosos y se encontró que eran una alternativa de tratamiento viable en el maxilar edéntulo. [source]

Clinical outcome of 103 consecutive zygomatic implants: a 6,48 months follow-up study

CLINICAL ORAL IMPLANTS RESEARCH, Issue 1 2004
Chantal Malevez
Abstract: The purpose of this study was to evaluate retrospectively, after a period of 6,48 months follow-up of prosthetic loading, the survival rate of 103 zygomatic implants inserted in 55 totally edentulous severely resorbed upper jaws. Fifty-five consecutive patients, 41 females and 14 males, with severe maxillary bone resorption were rehabilitated by means of a fixed prosthesis supported by either 1 or 2 zygomatic implants, and 2,6 maxillary implants. This retrospective study calculated success and survival rates at both the prosthetic and implant levels. Out of 55 prostheses, 52 were screwed on top of the implants, while 3 were modified due to the loss of standard additional implants and transformed in semimovable prosthesis. Although osseointegration in the zygomatic region is difficult to evaluate, no zygomatic implant was considered fibrously encapsulated and they are all still in function. This study confirms that the zygoma bone can offer a predictable anchorage and support function for a fixed prosthesis in severely resorbed maxillae. Résumé Le but de cette étude a été d'évaluer rétrospectivement, après une période de six à 48 mois après la mise en charge prothétique, le taux de survie de 103 implants zygomatiques insérés chez 55 édentés complets avec mâchoires supérieures extrêmement résorbées. Cinquante-cinq patients (41 femmes et quatorze hommes) avec une résorption osseuse maxillaire très sévère ont été soignés à l'aide d'une prothèse fixée supportée par un ou deux implants zygomatique et deux à six implants maxillaires. Cette étude rétrospective a calculé le taux de survie et le taux de succès tant au niveau prothétique et qu'implantaire. Des 55 prothèses, 52 ont été vissées sur les implants tandis que trois ont été modifiées vu la perte d'implants standards supplémentaires et transformées en prothèses semi-amovibles. Bien que l'ostéoïntégration dans la région zygomatique soit difficile àévaluer, aucun implant zygomatique n'a été considéré comme encapsulé fibreusement et ils sont encore tous en fonction. Cette étude confirme que l'os zygomatique peut offrir un ancrage prévisible et unun support de support pour une prothèse fixée dans les cas de maxillaires fortement résorbés. Zusammenfassung Die klinischen Ergebnisse von 103 Implantaten im Jochbein. Eine Langzeitstudie über 6,48 Monate. Das Ziel dieser Studie war es, bei 55 vollständig zahnlosen und massiv resorbierten Oberkiefern die Überlebensrate von 103 Implantaten im Jochbein retrospektiv zu untersuchen. Die Beobachtungszeit betrug 6,48 Monate nach prothetischer Versorgung. 55 Patienten, 41 Frauen und 14 Männer, die eine ausgedehnte Knochenresorption des Oberkiefers zeigten, wurden mit einer festsitzenden Brücke versorgt, die von 1,2 Implantaten im Jochbein und 2,6 weiteren Oberkieferimplantaten getragen wurde. Diese retrospektive Studie errechnete Erfolgsrate und Überlebensrate sowohl der prothetischen Rekonstruktion, wie auch der Implantate. Von den 55 Brücken waren 52 auf den Implantaten verschraubt, und 3 infolge Verlust von Standardimplantaten zu bedingt abnehmbaren Brücken umgebaut. Obwohl die Osseointegration in der Region des Jochbeins schwierig zu beurteilen ist, musste keines dieser Implantate als bindegewebig eingeheilt bezeichnet werden und alle sind immer noch in Funktion. Diese Arbeit belegt, dass der Knochen des Jochbeins ein voraussagbare Verankerung und Haltefunktion für eine festsitzende Brücke bei massiv resorbierten Oberkiefern liefern kann. Resumen La intención de este estudio fue evaluar retrospectivamente, tras un periodo de 6,48 meses de seguimiento de carga prostética, el índice se supervivencia de 103 implantes zigomáticos insertados en 55 maxilares superiores edéntulos severamente reabsorbidos. Se rehabilitaron 55 pacientes consecutivos, 41 mujeres y 14 hombres, con reabsorción ósea severa del maxilar, por medio de una prótesis fija soportada por 1 o 2 implantes zigomáticos, y de 2 a 6 implantes maxilares. Este estudio retrospectivo calculó los índices de éxito y supervivencia tanto a nivel de la prótesis como del implante. De las 55 prótesis, 52 se atornillaron sobre los implantes mientras que 3 se modificaron debido a la perdida de implantes estándar adicionales y se transformaron en prótesis semimóviles. Aunque la osteointegración en la región zigomática es difícil de evaluar, no se consideró a ningún implante zigomático como fibrosamente encapsulado y están aún en función. Este estudio confirma que el hueso zigomático pude ofrecer un anclaje predecible y función de soporte para una prótesis fija en el maxilar severamente reabsorbido. [source]