Tipo de edentulismo parcial bimaxilar y su asociación con el nivel socioeconómico-cultural / Type of bimaxillary partial edentulism and its association with socioeconomic cultural level

Introducción: El edentulismo parcial es una condición final a la presencia de caries dental relacionado con diversos factores sociales, demográficos y culturales. Actualmente, existen escasos estudios que valoren el estado de edentulismo parcial y su asociación con el nivel socioeconómico-cultural. Objetivo: Determinar la frecuencia del tipo de edentulismo parcial bimaxilar según la Clase de Kennedy y su posible asociación con el nivel socioeconómico-cultural en los pacientes de la clínica de la Facultad de Odontología de la Universidad Nacional Mayor de San Marcos del año 2016. Material y Métodos: Estudio descriptivo, observacional y transversal. La muestra estuvo conformada por 100 pacientes adultos edéntulos parciales seleccionados aleatoriamente que fueron evaluados mediante una encuesta y un examen clínico oral. La encuesta estuvo conformada por los datos sobre el nivel socioeconómico-cultural. El examen clínico se evaluó con un odontograma para determinar el tipo de edentulismo según la clasificación de Kennedy. Resultados: El tipo de edentulismo parcial más frecuente fue la Clase III de Kennedy en la arcada maxilar (50 por ciento) y en la mandibular (49 por ciento), los portadores pertenecían en gran medida al nivel socioeconómico-cultural medio (83 por ciento). No se evidenció una asociación estadísticamente significativa entre el nivel socioeconómico-cultural y el tipo de edentulismo parcial según la Clase de Kennedy en ambas arcadas dentarias. Conclusiones: En la población estudiada existe una mayor frecuencia de edentulismo parcial bimaxilar Clase III de Kennedy y una preponderancia del nivel socioeconómico-cultural medio. Sin embargo, no existe asociación entre el tipo de edentulismo parcial según la Clase de Kennedy y el nivel socioeconómico-cultural(AU)

Introduction: Partial edentulism is a final condition to the presence of dental caries related to various social, demographic and cultural factors. Currently, there are few studies that assess the state of partial edentulism and its association with the socioeconomic cultural level. Objective: To determine the frequency of the type of bimaxillary partial edentulism according to Kennedy´s Class and its possible association with the socioeconomic cultural level in patients treated in the clinic of the Faculty of Dentistry of the National University of San Marcos in 2016. Material and methods: A descriptive, observational and cross-sectional study was conducted. The sample consisted of 100 randomly selected partial edentulous adult patients who were evaluated by means of a survey and an oral clinical examination. The survey was made up of the data that relate socioeconomic cultural level. The clinical examination was evaluated with an odontogram to determine the type of edentulism according to Kennedy´s classification. Results: The most frequent type of partial edentulism was Kennedy's Class III in the maxillary arch (50 percent) and in the mandible (49 percent), which was mainly present in patients that belonged to the average socioeconomic cultural level (83 percent). There was no statistically significant association between the socioeconomic cultural level and the type of partial edentulism according to Kennedy´s Class in both dental arches. Conclusions: In the studied population, there is a greater frequency of partial bimaxilar edentulism according to Kennedy's Class III and a preponderance of the socioeconomic cultural level. However, there is no association between the type of partial edentulism according to Kennedy´s Class and the socioeconomic cultural level(AU)

Clinical factors in prosthodontic treatment of children with genetic defects.

BACKGROUND: Prosthodontic treatment of children with genetic disorders is an area that is rarely examined in the current specialist literature. Few prosthodontists will undertake treatment of such patients, who will more often be referred to an orthodontic specialist. After examining the 4 cases of children with genetic disorders described in this paper, it can be concluded that when a prosthodontist includes a few additional procedures in the treatment process, he or she can successfully help such patients. OBJECTIVES: The aim of this paper is to indicate the clinical difficulties faced by prosthodontists who undertake prosthodontic rehabilitation of children with genetic disorders. MATERIAL AND METHODS: The paper is based on data collected during the prosthodontic treatment of 4 children, aged 5-12 years with genetic defects, and analysis of the body of work concerning these defects and their treatment. RESULTS: Presentation of guidelines for the prosthodontic treatment process and creation of dentures for treated children based on extended procedures. CONCLUSIONS: A prosthodontist is a crucial person in a team of specialists treating disorders within the face among children with a genetic predisposition. A basic knowledge of orthodontics and psychology facilitates the treatment. Prosthetic restoration in the treatment group does not always require complicated operations. Individualization of the tools for downloading orthodontic impressions, designing denture elements and an increased number of checkups are the additional procedures. For the clinician, the emotional aspect of the treatment is the main impediment. Maintaining a good relationship with a patient and his or her caregivers requires interpersonal skills.

Natural history of periodontitis: Disease progression and tooth loss over 40 years.

OBJECTIVES: To assess long-term attachment and periodontitis-related tooth loss (PTL) in untreated periodontal disease over 40 years. MATERIAL AND METHODS: Data originated from the natural history of periodontitis study in Sri Lankan tea labourers first examined in 1970. In 2010, 75 subjects (15.6%) of the original cohort were re-examined. RESULTS: PTL over 40 years varied between 0 and 28 teeth (mean 13.1). Four subjects presented with no PTL, while 12 were edentulous. Logistic regression revealed attachment loss as a statistically significant covariate for PTL (p < .004). Markov chain analysis showed that smoking and calculus were associated with disease initiation and that calculus, plaque, and gingivitis were associated with loss of attachment and progression to advanced disease. Mean attachment loss <1.81 mm at the age of 30 yielded highest sensitivity and specificity (0.71) to allocate subjects into a cohort with a dentition of at least 20 teeth at 60 years of age. CONCLUSIONS: These results highlight the importance of treating early periodontitis along with smoking cessation, in those under 30 years of age. They further show that calculus removal, plaque control, and the control of gingivitis are essential in preventing disease progression, further loss of attachment and ultimately tooth loss.

Implant-prosthetic rehabilitation of hemimaxillectomy defects with CAD/CAM suprastructures.

BACKGROUND: Patients with hemimaxillectomy defects after tumor surgery can alternatively be rehabilitated with dental obturators or microvascular flaps. When general medical or oncologic conditions do not permit microvascular surgery, dental obturators are the only solution, yet retention for edentulous patients is often poor. The aim of this study was to evaluate whether CAD/CAM suprastructures supported by implants placed in both residual alveolar ridges and contralateral zygomatic bone could enhance obturator stability and improve functional outcomes. MATERIALS AND METHODS: Five edentulous patients with class IId hemimaxillectomy defects were included in the study. Implant-retained reconstructions were planned to support cross-arch CAD/CAM milled suprastructures. Patients had to rate their restorations on a 100-mm visual analogue scale before and after treatment. Additional evaluation was performed using the Oral Health Impact Profile (OHIP-EDENT) questionnaire. RESULTS: In the 5 patients, 7 conventional implants were placed in the remaining zygomatic bone and 16 in the remaining contralateral alveolar ridge. After 4 months of submerged healing, CAD/CAM suprastructures were fabricated that connected all respective implants with each other. All of the prosthetic restorations were removable and bar-retained. They all achieved good defect closure and showed significant improvements concerning general satisfaction (p = 0.0343), stability (p < 0.0001), ability to chew (p = 0.0077), esthetics (p = 0.0173) and foreign body sensation (p = 0.0207). According to the OHIP-EDENT questionnaire (p = 0.0036) the improvements were significant. During the observation period of 29.4 months, no mechanical or biological complications occurred. CONCLUSION: The CAD/CAM suprastructures improved retention in all treated patients without any complications.

Process-based approach to modeling recurrent-event data explicated on the basis of occurrences of tooth losses in two different prosthetic treatment concepts.

BACKGROUND: In studies comparing different prosthetic treatment concepts the repeated loss of teeth was chosen as the primary outcome. The resulting data appear to represent a data structure of recurrent events. However, the application of an existing method for recurrent events is far from straightforward. Often only the first event or the final state is analyzed using Kaplan-Meier survival statistics, thereby giving a great deal of information away. METHODS: The paper presents a strategy for the analysis of recurrent data using a previously published study on the influence of different prosthetic treatment concepts for the shortened dental arch on tooth loss. A method based on cumulative sample history functions of recurrent events was adjusted for tooth loss. The shapes of these cumulative functions suggest a time dependency of the recurrence rate. To keep the model as simple as possible, a tripartite Poisson process (which assumes piecewise time-independent rates) was fitted to the cumulative mean functions stratified by treatment. RESULTS: Within the middle interval of the three-phasic process, the treatment effects differ significantly, which is interpreted as a delay of tooth loss due to the use of one type of prosthesis (fixed) compared with the other (removable). CONCLUSIONS: An analysis based on cumulative history functions is based on process, therefore, temporally changing characteristics are better captured than in methods for survival analyses. The presented approach offers useful new insight into the temporal behavior of ongoing tooth loss after prosthetic treatment. TRIAL REGISTRATION: The trial has been registered at controlled-trials.com under ISRCTN97265367 (registration date 4 April 2008).

Técnica alternativa y simple de rehabilitación oral con prótesis removible para una paciente con epidermolisis bullosa distrófica: reporte de caso clínico / Aternative and simple oral rehabilitation technique using a removable prosthesis for a patient with epidermolysis bullosa dystrophica: a case report

La epidermolisis bullosa es una enfermedad de origen genético caracterizada por una marcada fragilidad de la piel y las mucosas, resultando en la aparición de lesiones vesiculobullosas y/o desprendimientos tisulares de aparición espontánea o, más comúnmente, como consecuencia de roce mecánico. La formación de cicatrices con retracción tisular genera a nivel oral obliteración vestibular, anquiloglosia y microstomía, complicándose la rehabilitación odontológica y, en particular, la protésica. El presente artículo describe una alternativa protésica, simple y económica, para una paciente desdentada parcial con epidermolisis bullosa distrófica recesiva.

Epidermolysis bullosa is a rare genetic disease that is characterised by the formation of blisters and erosions on the skin and mucous membranes following minor traction or trauma. Oral manifestations of the disease include obliteration of the vestibule, ankyloglossia, and microstomia. Oral rehabilitation, and prosthetic rehabilitation, in particular, is a challenge. This article describes a simple, inexpensive prosthetic alternative for a partially edentulous patient with recessive dystrophic epidermolysis bullosa.

Immediate implants after enucleation of an odontogenic keratocyst: an early return to function.

An odontogenic keratocyst is a unique cyst because of its locally aggressive behavior, high recurrence rate, and characteristic histologic appearance. In this article we present the case of a 22-year-old male patient with a large odontogenic keratocyst and describe his treatment with immediate dental implants.

Prosthetic rehabilitation of a patient with bilateral cleft lip and palate using osseointegrated implants and extracoronal resilient attachments: a case report.

This case study reports on the prosthetic rehabilitation of a patient with an unrepaired bilateral cleft lip and palate using osseointegrated implants, extracoronal resilient attachments, a combination of metal-ceramic cement-retained fixed partial restorations, and removable prosthesis. Preoperative clinical examination of a 32-year-old woman with bilateral cleft lip and palate revealed a large oronasal communication, hyperplastic soft tissue surrounding the hard palate defect, and a severely resorbed alveolar ridge. A maxillary obturator prosthesis supported by implants and retained with an extracoronal resilient attachment was designed to cover the oronasal communication in the hard palate and fulfill the patient's functional and aesthetic requirements. The patient has been wearing the prosthesis for 1 year. Her speech quality has greatly improved, and her aesthetic and functional expectations have been met.

Esthetic removable partial denture design in replacing maxillary anterior teeth.

Prosthodontic rehabilitation of missing maxillary anterior teeth requires special consideration to restore function and esthetics. This case report describes the prosthodontic management of a patient who lost three maxillary incisors due to a motor vehicle accident. A rotational path removable partial denture was constructed, for which a proximal undercut was created by means of a composite buildup to provide the retention for the prosthesis.

Implant-supported oral rehabilitation of a patient with systemic lupus erythematosus: case report and review of the literature.

Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease with multisystemic involvement. Immune-suppressive drugs used in the treatment of the disease can increase the risk of infection and delay healing, which are of concern in dental-treatment procedures. Because of the involvement of the salivary glands, the composition and amount of saliva released are usually altered in patients with SLE. Significantly lowered salivary flow rate causes difficulties during dental procedures and makes it difficult to maintain oral hygiene and conserve both fixed and removable prostheses. This case report presents a patient who had an extremely dry mouth and oral lesions due to SLE and describes how oral rehabilitation was achieved with implant-supported fixed dentures. To the best of our knowledge, this is the first report of the use of oral implants in a patient with SLE. Dental practitioners should consider dental implants as a preferred treatment choice in the oral rehabilitation of patients with SLE.

[Epidemiological aspects of frontal edentation of child and adolescent]. / Aspecte epidemiologice ale edentatiei frontale la copil si adolescent.

UNLABELLED: Increasingly frequency of frontal edentation of children and adolescents, mainly because of dental caries and its complications and other diseases requires closer analysis and a reconsideration of therapeutic attitudes that must be carefully adapted and refined. AIM: To study the establishment of prevalence and incidence of child and adolescent frontal edentation, identifying its etiology and prospects of restoration of morpho-functional parameters affected, anchored in temporary or permanent solutions, according to age and morpho-functional development of the patient. MATERIAL AND METHODS: We studied a group composed of 450 patients, aged between 8 and 19 years of age, diagnosed with frontal edentation of different etiologies. RESULTS: The two most common causes which are involved in producing edentation are odontal injuries and chronic periodontal disease. CONCLUSION: Etiology of frontal edentation has an esential part in the anatomoclinical shape of edentation, without evading the impact on bio-psycho-social dimension of this clinical entity. The size of the edentation, the emotional impact for the child, and the medical aspects are very important in the decision of the right treatment for longtime.

[Clinical effects of ridge augmentation with the half-columnar shaped mandibular bone block for the placement of dental implants].

OBJECTIVE: To evaluate the treatment effects of the half-columnar shaped mandibular block bone onlay grafting technique for augmentation of the resorbed maxillary anterior alveolar ridge after single tooth missing. METHODS: A total of 15 sites of 14 patients received ridge augmentation surgeries. The recipient sites were prepared with trephines, the half-columnar shaped bone blocks were harvested from the ramus and external oblique ridges with trephines according to diameters of the recipient sites. The bone blocks were placed as lateral onlay grafts on recipient beds and secured by means of titanium screws. Particulate bone was added and absorbable membranes were used to stabilize and protect the grafts. After a mean interval of 4.5 months of healing the flaps were re-opened, the screws were removed and non-submerged implants were placed. The width and height of the alveolar ridges were recorded. After 3 months, implant-supported crowns were provided to the patients. One year later, the peri-impant condition and the marginal bone resorption on the proximal sites were observed. RESULTS: Mean lateral augmentation obtained at the time of bone grafting was (3.8 + or - 0.8) mm, 5 out of 15 sites exhibited a mean of 3 mm of vertical augmentation. The mean healing time was 4.5 months, the mean percentage of horizontal and vertical bone resorption in the mean time were 8% and 7% respectively. No major complications were recorded at donor sites. No implant was lost during the study period. Clinical parameters and probing depth (< or = 4 mm) demonstrated the presence of a healthy peri-implant mucosa after 1 year of prosthetic reconstruction. The clinical and radiographic bone observations showed no more than 1.2 mm of resorption after bone graft and implant placement. CONCLUSION: The half-columnar shaped mandibular bone graft (from the ramus and external oblique ridge) is a promising technique for bone augmentation in localized alveolar ridge defects after single tooth missing. This procedure offers easy access, good bone quantity for localized repair, low morbidity, decreased complaints of postoperative sensory disturbances or discomfort, minimal graft resorption, and a shorter healing time as compared with other methods for bone repair.

Long-term outcomes for cross-arch stabilizing bridges in periodontal maintenance patients--a retrospective study.

BACKGROUND: Cross-arch bridges are used to stabilize teeth for patients with reduced periodontal support. Little is known about technical or biological complications, whether teeth and implants can be combined in this type of bridge and the long-term effects on tooth loss. MATERIALS AND METHODS: All patients treated in a specialist periodontal practice who received cross-arch stabilizing bridgework and were subsequently maintained for at least 7 years were included in the study. The patients were selected from all patients who underwent initial periodontal therapy after 1986 in a Norwegian periodontal practice. The bridges were assessed for biological and technical complications. Bridges retained by teeth or by a combination of teeth and implants were included in the study. RESULTS: Ninety-four rigid fixed bridges (77 teeth supported, 17 teeth and implant supported) in 80 patients (46 females, 34 males) were observed for an average of 10 years (range 7-22 years). In four patients, a bridge became loose and had to be re-cemented, and in one case the metal framework of a bridge fractured and the bridge had to be remade. In total, eight abutment teeth were lost from five patients but no implant abutments were lost. Overall, a higher rate of tooth loss was observed for patients provided with stabilizing bridges compared with control maintenance patients not treated with bridgework (p<0.0001); however, the rates in both groups were very low. CONCLUSION: Cross-arch stabilizing bridges constructed for periodontal patients as part of their periodontal maintenance therapy had few complications and were associated with low rates of abutment tooth loss. Combining teeth and implants did not affect the performance of these bridges.

Why do some people lose teeth across their lifespan whereas others retain a functional dentition into very old age?

OBJECTIVES: To analyse the importance of caries, periodontitis, and medical and psychosocial factors for risk of becoming edentulous across their lifespan and to examine factors critical for retaining functional dentition into very old age. METHODS: From the longitudinal population-based Octogenarian Twin study which analysed psychosocial and health variables, 357 individuals aged 82 + in 1995-1998 were collected. Information about number of teeth, decayed and filled surfaces percentage and periodontal disease experience were drawn from dental records. Reasons for and time of edentulousness were recorded. RESULTS: Outcome varied - depending on perspective and factors for losing or retaining teeth. Significant factors for losing teeth varied over the lifespan. Losing teeth early in life was related to lower social class; in middle age, to lower education; and in old age, to poor lifestyle factors and low social class. Caries constituted the main reason for tooth loss (about 55%). This increased substantially in the >80 year age-group (75%). Maintaining a functional dentition into old age was significantly associated with non-smoking, more education, being married and good periodontal health. CONCLUSION: It is important to apply life-span and cohort perspectives to oral health and disease. In our sample of persons born before World War I, caries was the main reason for losing all teeth, with substantially increased prevalence by age. Lifestyle factors were significant for losing and for retaining teeth. Periodontal condition had a significant influence on the likelihood of retaining functional dentition, and also when taking psychosocial variables into account.

[Prosthetic rehabilitation after osteonecrosis of the jaws due to histiocytosis X and treatment with bisphosphonates apropos of a case]. / Réhabilitation prothétique après ostéonécrose des maxillaires due à une histiocytose X et un traitement aux bisphosphonates à propos d'un cas.

Bisphosphonates are involved in the occurrence of Osteonecrosis of Jaws (ONJ), which is a complication of these treatments. This osteonecrosis concern the alveolar bone and develops generally after an oral surgery. It can however occur spontaneously without preliminary dental extraction. Other risk factors could play potentiates the risk of ONJ. This osteonecrosis results in an osseous exposure in patient treated or having been treated by bisphosphonates, without any cervico-facial irradiation. Actually, no treatment has been the proof of its effectiveness. Preventives measures of ONJ in oral cavity are the best method before, during and after administration of bisphosphonates. In this article, we present the clinical case of a patient with histiocytois treated by bisphosphonates and having developed ONJ. The selection criteria of the prosthetic rehabilitation as well as the techniques used are detailed.

Implant supported prosthesis in a patient with progeria: case report.

Prosthodontic rehabilitation can be accomplished with fixed, overdenture, complete, or implant-retained prostheses. Dental treatment overcomes the patient's functional, psychological, esthetic and phonation problems. Remaining healthy teeth may allow the dentist to fabricate a removable partial overdenture, fixed partial prosthesis or implant - supported prosthesis. The retention of a number of abutments helps maintain a positive ridge form with greater height and volume of the alveolar bone, improving masticatory performance, as well as providing a more stable prostheses. Dental patients who have medical problems need many treatment procedures. Multidisciplinary treatment planning is invaluable for patient's dental health. Progeria is a rare genetic condition where symptoms resembling aspects of aging are manifested at an early age. characteristic clinical findings of Progeria disease include abnormalities of the skin and hair in conjunction with characteristic facial features and skeletal abnormalities. The characteristic facies show protruding ears, beaked nose, thin lips with centrofacial cyanosis, prominent eyes, frontal and parietal bossing with pseudohydrocephaly, midface hypoplasia with micrognathia and large anterior fontanel. The other reported anomalies are dystrophic nails, hypertrophic scars and hypoplastic nipples. The findings that are nearly interested in dentistry are delayed dentition, anodontia, hypodontia, or crowding of teeth. This article presents the multidisciplinary dental treatment planning includes surgical, endodontic and prosthetic treatment of a patient with a history of progeria. In this case complete-arch fixed prostheses in both maxilla and mandible, supported by a combination of implants and teeth are reported.

Oral rehabilitation using pre-shaped Epitec fixation systems after extensive maxillary tumor surgery.

Reconstruction of maxillary defects represents a major challenge for reconstructive surgeons. The authors describe two cases of malignant tumor on the maxilla that were successfully repaired using the immediate installation of prostheses supported with an Epitec-system during maxilla reconstruction. The Epitec-plates provided a strong retention source for the maxillodental prosthesis. To reduce the operation time and improve conformity to the remaining bone shape, a craniofacial skull model was fabricated using stereo-lithographic techniques. After trimming the model to simulate segmental resection, Epitec-plates were shaped to match the defect. A united Epitec-plate was fixed to the remaining bone immediately and easily after tumor resection. An immediate maxillary prosthesis was placed and was functional at the end of surgery. The Epitec-system provides effective materials for immediate prosthesis of extensive maxillary defects.

Diagnosis and treatment of familial cherubism characterized by early onset and rapid development.

Cherubism is a benign maxillary bone dysplasia of childhood, usually showing an autosomically dominant inheritance with variable penetrance and spontaneously resolving after puberty. Only maxillary bones are affected and develop pseudocystic osteolytic lesions. This article presents an early and rapidly evolving familial case of cherubism. The 3-year-old child underwent conservative curettage of lesions, with a conservative approach that allowed a normal permanent dentition in adolescence. Family history revealed that the father had been treated for similar lesions between 14 and 21 years of age, but the late treatment caused edentulism. In conclusion, although cherubism represents a benign and localized maxillary dysplasia, it requires prompt surgical but conservative treatment and careful follow-up to avoid permanent lesions, that is, malocclusion and/or edentulism.

[Removable partial dentures in maxillo-facial prosthetics]. / De frameprothese in de maxillofaciale prothetiek.

In maxillo-facial prosthodontics, removable partial dentures are still widely used for tooth replacement, but also for the replacement of bone and soft tissue or for soft tissue support. The original indication range has partially been taken over by implant-supported prostheses, especially in cases involving congenital defects. Despite this trend, removable partial dentures are still the treatment of choice in head and neck oncology rehabilitation and in cleft and trauma patients.