Immediate implantation of a pure titanium implant into an extraction socket: report of a pilot procedure.

The conventional osseointegration protocol calls for waiting up to 12 months for ossification of an extraction socket to heal before placing an endosseous implant. In this study the possibility of placing a pure titanium implant directly into an extraction socket immediately after extraction was investigated. A pure titanium Nobelpharma 10-mm implant was placed into a central incisor extraction socket of a stump-tailed monkey and allowed to heal for a period of 6 months, followed by functional loading of the implant. The implant was osseointegrated on a clinical and histological level. This pilot study suggests that pure titanium implants have the potential to integrate when placed immediately after extraction of the teeth and warrants further investigation.

Immediate implantation of pure titanium implants into extraction sockets of Macaca fascicularis. Part I: Clinical and radiographic assessment.

Immediate implants have the advantages of few surgical exposures, short treatment time, and maintenance of alveolar bone height and width. The purpose of this study was to compare immediate implants with conventional implants (implants placed into ossified extraction sites) in adult monkeys. Forty-eight implants were placed and allowed to heal for a 6-month period. Following a 7-month loading period, the monkeys were sacrificed, and implant sections were evaluated histologically. Clinical and radiographic measurements showed few significant differences between immediate and control implants.

Immediate implantation of pure titanium implants into extraction sockets of Macaca fascicularis. Part II: Histologic observations.

The purpose of this study was to evaluate immediate implants with implants placed in ossified extraction (control) sites. Histologic observation of immediate and control implants showed similar levels of bone integration at the light microscopic level using ground-section and decalcified thin-section histologic methods. Both histologic methods provided similar information in relation to determination of hard and soft tissue components measured at the interface. The percentage of bone integration was similar in different anatomic regions of the oral cavity. Bone patterns peripheral to the interface region differed, suggesting that special consideration be given to implants placed in the posterior regions of the maxilla and mandible.

Removable partial overdentures for special patients.

Removable partial overdentures are an option that should be considered by every dentist who is involved with cosmetic dentistry or dentistry for the older adult. The rationale, indications, and technique have been described for providing an aesthetic, functional prosthesis that is also conservative in nature. The reversibility of the procedure allows the patient the opportunity to pursue other forms of treatment should the result not meet his or her expectations. For appropriately selected special patients, the results can be extremely gratifying for both the patient and dentist.

Oral yeasts, mucosal health, and drug use in an elderly denture-wearing population.

Drug use among the elderly may be a factor in oral mucosal pathology and the prevalence of oral yeasts. This study was designed to evaluate the relationship between oral yeast, denture-bearing mucosal health and drug use, especially drugs with known hyposalivatory side effects. There was an inverse relationship between denture-bearing mucosal health, and hyposalivatory drug use r = -0.41 P less than 0.04. Use of drugs with a hyposalivatory side effect was related to increased numbers of Candida glabrata but not Candida albicans in saliva and at denture stomatitis and denture sore sites.

An evaluation of terminal hinge position and neuromuscular position in edentulous patients. Part II. Duplicate mandibular dentures.

The purpose of Part II of this study was to determine whether or not a denture fabricated to the neuromuscular position (NMP) could be as functional as one fabricated to the terminal hinge position (THP). Two mandibular dentures were fabricated for each of six edentulous subjects, one to the THP and one to the NMP, along with only one maxillary denture each. The subjects had no prior knowledge of the two mandibular dentures in order to determine the clinical significance of a difference in the two positions. These results were evaluated by clinical methods. It was concluded that the NMP is clinically acceptable for intercuspation of artificial teeth on complete dentures.

Completed bases for removable dentures.

A technique for the fabrication of completed bases for removable dentures has been described. The artificial stone mounting casts and completed bases must be kept free of debris at all times to allow for accurate seating of the bases on the casts. The completed bases must be kept in water when not in use between patient appointments.

An evaluation of terminal hinge position and neuromuscular position in edentulous patients. Part I. Maxillomandibular recordings.

The purpose of this investigation was to obtain information about the terminal hinge position (THP) and the neuromuscular position (NMP) in the edentulous population. The difference between the two positions was evaluated anteroposteriorly and mediolaterally to determine horizontal differences and reproducibility between days. In 25 edentulous subjects, five recordings were made at the neuromuscular position with no dentist guidance and five recordings at the terminal hinge position with dentist guidance; on a second day, the recordings were repeated. The differences between positions were evaluated by statistical methods. It was concluded that: (1) there is a discrepancy between the THP and the NMP for all edentulous subjects examined, (2) the NMP is anterior and medial or lateral to the THP, and (3) the NMP is not as reproducible as the THP.

Predoctoral removable prosthodontics education.

As the 21st century is approached, changes are occurring that directly relate to removable prosthodontics at the undergraduate level. Edentulism will continue to decline, although the need for complete dentures will diminish slowly because of the replacement needs for the existing edentulous population. In the short- to medium-term future, partial edentulism will increase in the older population at the expense of total edentulism. Therefore, the need for removable partial dentures will increase, but subsequently will decline. In the long-term, tooth loss, regardless of etiology, will be reduced. However, the replacement of lost teeth is unlikely to disappear completely as a needed dental service. With 73% of dental schools reporting inadequate or marginal numbers of complete denture patients, Meskin and Entwistle have identified a shortage of patients needing removable prostheses. On the other hand, 50% of the schools report a surplus of removable partial denture patients. Dental school curriculum time related to prosthodontics has declined significantly over the past 20 years. However, over the past 10 years it has risen slightly. Techniques that are taught in dental schools are frequently not being used in practice. Yet the practitioner's interest in removable prosthodontics as it relates to new techniques and materials remains high according to a 1988 survey of Academy of General Dentistry members. Removable prosthodontics was rated first in regards to continuing education courses desired by its members. There are two basic objectives stated in the prologue of the Council on Dental Education Directive on Accreditation Standards. First, faculties are ultimately responsible for the quality of care rendered to the patient population by students.(ABSTRACT TRUNCATED AT 250 WORDS)

Considerations for planning for and fabricating complete dentures.

During the past year, studies have been completed to advance our knowledge of the diagnosis and treatment of the edentulous patient. The need for pretreatment radiographs on every edentulous patient is not always indicated. Advances in preprosthetic surgery help to improve the predictability of these procedures. New techniques for establishing the vertical dimension of occlusion may allow this to become a more objective measurement. Evaluation of dental materials for use with complete dentures continues, with soft liners and the use of microwave energy for curing denture resin just two areas of interest. A recent study showed a very high prevalence of signs and symptoms of craniomandibular disorders among complete denture wearers. Methods for its treatment are discussed. The use of increased infection control procedures in the dental office and laboratory have created a need to evaluate the effects of disinfecting agents on the dental prosthesis. The removable complete denture remains an effective alternative for the replacement of missing teeth.

The efficacy of topical anesthetics in reducing intraoral discomfort.

The purpose of this investigation was to compare the effectiveness of three gels in reducing discomfort due to denture irritation. Forty-five subjects experiencing denture soreness were randomly selected. A double-blind format was used. Two of the gels contained 20% of the known pain reliever, while the third gel contained 10%. An unweighted-means and a least-squares analysis of variance were done for the type of gel and pretreatment pain. The results show that the gels were effective in reducing perceived pain for 66% of the subjects. As a result of the analyses, no significant differences were found between gels.

Influence of overdenture abutment tooth contour on the periodontium: a preliminary report.

The effect of overdenture abutment tooth contour on plaque retention and periodontal health was evaluated in four patients over a 1-year period. Each patient had mandibular canines with similar periodontal support; however, one abutment was dome shaped while the other had 2 mm of natural peripheral root contour coronal to the ginvival margin. Eight parameters of periodontal health were measured, and no significant differences between different contours were observed after 1 year. Furthermore, irrespective of overdenture abutment contour, no deterioration in periodontal status occurred. Two subjects had significant wear of the overdenture abutments after 1 year. Further evaluation of more subjects over a longer period of time is indicated.

The cosmetic overdenture.

A technique has been described to show how a deviated midline, missing lateral incisor, and diastema were corrected with a cosmetic overdenture for a patient who is a professionl model. Irreversible procedures were unnecessary on an otherwise acceptable and functional dentition.

Verification of centric relation.

This article discusses the clinical uses of Centric Check Points in the edentulous and partially edentulous patient. It details the technique for centric verification, and the correction procedure if an error is discovered.

Overdentures for acquired and congenital anomalies: 1. Complete dentures.

Overdenture principles can be applied to dentitions that are relatively complete without preparation or alteration of the existing teeth. Such overdentures may cover the traditional denture-bearing tissues as well as the unaltered remaining teeth. The primary advantages derived are reversibility, simplicity, and cost effectiveness. The primary indications are restoration of congenital and acquired anomalies. A detailed clinical and laboratory technique for fabricating these overdentures is presented. Effective restorations require care and attention to detail using the principles of conventional prosthodontics. No special equipment or material is needed. Two patient histories are presented, illustrating use of the technique.

Overdentures for acquired and congenital anomalies: 2. Partial overdentures.

The use of complete overdentures for the restoration of acquired and congenital anomalies has been advocated for many years. This therapeutic approach can provide an esthetic and functional restoration for missing, malformed, or discolored dentition. For some patients, tissue coverage similar to a complete denture is disconcerting, especially when the majority of the teeth are present. The removable partial overdenture provides a functional, esthetic, and economical alternative. A technique is described for the fabrication of the partial overdenture for acquired and congenital anomalies.

Fracture strength of full-contoured ceramic crowns and porcelain-veneered crowns of ceramic copings.

This is vitro study compared the fracture strength of Dicor ceramic crowns with a 1 mm axial wall thickness and a 2 mm occlusal thickness with Dicor copings veneered with Vitadur-N or Dicor-Plus porcelain to create similar contours. Tooth preparations for complete crowns were made on human molars with a 10-degree total convergence and a 1 mm shoulder. The artificial crowns were internally etched, given an application of silane, and cemented with a dual-cured resinous cement. After thermocycling, each sample was loaded to failure with a vertical load on the occlusal surface. There were no significant differences in fracture strength between full-contour Dicor crowns and crowns of copings veneered with either Vitadur-N or Dicor-Plus porcelain.

Accurate mounting casts for complete dentures.

An accurate and efficient method to fabricate mounting casts for complete dentures has been presented. Well-made mounting casts are required to accurately transfer the jaw relation records made in the mouth to an articulator.