Association of Periodontal Disease and Edentulism With Hypertension Risk in Postmenopausal Women.

BACKGROUND: Multiple cross-sectional epidemiologic studies have suggested an association between periodontal disease and tooth loss and hypertension, but the temporality of these associations remains unclear. The objective of our study was to evaluate the association of baseline self-reported periodontal disease and edentulism with incident hypertension. METHODS: Study participants were 36,692 postmenopausal women in the Women's Health Initiative-Observational Study who were followed annually from initial periodontal assessment (1998-2003) through 2015 (mean follow-up 8.3 years) for newly diagnosed treated hypertension. Cox proportional hazards regression with adjustment for potential confounders was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS: Edentulism was significantly associated with incident hypertension in crude (HR (95% CI) = 1.38 (1.28-1.49)) and adjusted (HR (95% CI) = 1.21 (1.11-1.30)) models. This association was stronger among those <60 years compared to ≥60 years (P interaction 0.04) and among those with <120 mm Hg systolic blood pressure, compared to those with ≥120 mm Hg (P interaction 0.004). No association was found between periodontal disease and hypertension. CONCLUSIONS: These findings suggest that edentulous postmenopausal women may represent a group with higher risk of developing future hypertension. As such improved dental hygiene among those at risk for tooth loss as well as preventive measures among the edentulous such as closer blood pressure monitoring, dietary modification, physical activity, and weight loss may be warranted to reduce disease burden of hypertension. Further studies are needed to clarify these results and further elucidate a potential role of periodontal conditions on hypertension risk.

Chronological Age as Factor Influencing the Dental Implant Osseointegration in the Jaw Bone.

The objectives of this study were to evaluate osseointegration of dental implant in the jaw bone in the young and elderly population and comparing the results to assess indicators and risk factors as age for the success or failure of dental implants. A retrospective study of 107 implants (Impladent, LASAK, Czech Republic) was prepared. The patients at implants surgery were divided in three groups. The patients were followed-up for a 7-year period. We evaluated osseointegration from long term point of view as a change of marginal bone levels close to dental implant. Marginal bone levels were recorded and analysed with regard to different patient- and implant-related factors. An influence of chronological age on change of marginal bone levels during 6-year retrospective study vas evaluated. The study examined 47 patient charts and 107 implants from the Second Faculty of Medicine, Charles University and University Hospital Motol. We proved that young healthy patients with long bridges or Branemarks have the same progression of marginal bone levels changes. The chronological age hasn't therefore direct influence on the osseointegration from long term point of view. But we found that the length of dental suprastrucure-prosthetic construction negatively influences marginal bone changes, though these results weren't statistically significant. More extensive dental implant suprastrucure undergoes smaller osseointegration. On the other hand the length of dental suprastrucure (prosthetic construction) negatively influences dental osseointegration in both groups of patient.

The Lip-Tooth-Ridge Classification: A Guidepost for Edentulous Maxillary Arches. Diagnosis, Risk Assessment, and Implant Treatment Indications.

Prosthetic rehabilitation of the edentulous maxilla is known to be challenging and requires meticulous planning. The purpose of this article is to describe a novel classification system, the Lip-Tooth-Ridge (LTR), that offers a guidepost for treatment planning the edentulous maxilla for fixed or removable prostheses. This tool will help clinicians identify the final prosthetic design and will provide a case-specific risk assessment guide regarding two different areas. A high (HER) or low (LER) esthetic risk will be determined based on lip dynamics, as well as a high or low structural risk according to the prosthetic space availability.

Navigation System Approach in Zygomatic Implant Technique.

In some patients, the resolution of severe maxillary atrophies can be hardly achieved without the use of zygomatic implants. Although many scientific studies have already demonstrated the excellent immediate stability in long term, the use of zygomatic implants is not yet widespread. Among the complications of this technique, the most threatening is the risk of damaging the eyeball or the maxillary nerve.The use of the navigator system as a surgical aid for implant placement allows to control, at any time, the position of the drill in the bone, avoiding any injury to ocular and nervous structures. The authors present a clinical report which shows a patient affected by a very severe form of post-traumatic maxillary atrophy that has been solved through the of zygomatic implants placement using the "Implant Bone Navigation" system. This procedure allows both to cut down the risks on ocular and nervous structures of the maxilla and also to reach excellent rehabilitation results in such severely compromised patients.

Dental implants and immediate loading: multivariate analysis of success factors.

OBJECTIVES: The authors had for aim to examine factors potentially influencing the success of immediate implant placement and loading. MATERIALS AND METHODS: One hundred and ninety-five consecutive patients (16.5 to 80.4 years of age) were provided with 310 prostheses supported by 896 immediately loaded implants. The mean follow-up was 27.5 months. Univariate and multivariate Cox regression was performed to analyze potential modifiers of implant success. RESULTS: The overall implant success rate was 96.7%. The statistically significant modifiers of success on multivariate analysis (P<0.05) were duration of functional use (P<0.001), type of superstructure (P<0.001), implant-abutment connection (P<0.001), and maxilla versus mandible (P=0.026). None of the other investigated factors (age, gender, implant location/design/length) were statistically significant modifiers of success. DISCUSSION: Our study results demonstrate high success rates for immediately loaded implants whatever types and superstructure used. Prosthetic designs and their implementation have a significant effect on the success rate of implant-supported restoration, with adjusted hazard ratios of up to 51. Maxilla versus mandible was the only significant non-external modifier when using an adjusted hazard ratio of 2.75.

Incidence and prevalence of dental-periodontal conditions and edentation in Moldavia.

UNLABELLED: The proper rehabilitation of the partially extended edentulous patient should lead to a state of balance between the components of the stomatognathic system and the therapeutic option selected for an as long as possible. AIM: To outline the importance of a holistic biological perspective on the body-stomatognathic system relationships and the need for complex rehabilitation in view of obtaining a long lasting balance. MATERIAL AND METHODS: 3340 individuals from urban and rural areas of Iasi County were evaluated. The evaluation was based on the correlation of physical exam with data from a specially drafted questionnaire aimed at determining oral health behavior pattern, a sine-qua-non condition for a clear identification of oral conditions specific to the study area. RESULTS: General health status was poor in 72.1% of the subjects from rural areas as compared to 27.9% in those from rural areas, with cardiovascular diseases ranking first but with higher rates in urban than in rural areas. In urban areas, odontal lesions were the most common and had a higher prevalence in 2012 than in the previous years, followed by the periodontal lesions with the same ascending trend in 2012. CONCLUSIONS: Continuity with regard to the prophylaxis of general and oral conditions in the lasi County in both rural and urban areas is a must, health education being essential for improving population health.

Análise crítica das construções protéticas, fixas e removíveis,sobre implantes em pacientes edentados: [revisão] / Critical analysis of the fixed and removable implant prosthesis on implants in edentulous patients: [review]

A osseointegração é, sem sombra de dúvida, a responsável pelo notável avanço tecnológico, mudança deconceitos filosóficos e condução de planejamentos voltados à reabilitação oral, como também, pela disseminaçãoe propagação dos conhecimentos, interferindo sobremaneira nas demais áreas da Odontologia contemporânea.Os implantes osseointegrados são cada vez mais utilizados para substituir dentes perdidos em várias situações, desde a perda de um único dente até em casos de completo edentulismo. A reabilitação de pacientes desdentados com próteses fixas ou overdentures removíveis é um processo complexo e desafiador. Existem fatores cruciais para a decisão de uma prótese fixa ou removível para se obter estética, fonética, promover conforto e função. Além disso, o resultado do tratamento está relacionado à taxa de sobrevivência dos implantes, à manutenção do osso marginal, à saúde do tecido periimplantar, à longevidade dos componentes protéticos e da prótese em si. Esse estudo buscou analisar as vantagens e desvantagens das reabilitações protéticas sobre implantes, fixas e removíveis, para pacientes totalmente desdentados.

Doubtless, osseointegration is the major responsible for the remarkable technological advance, changing philosophical concepts and guiding treatment plans related to oral rehabilitation. It also contributes to knowledge spread and diffusion, interfering in other areas of contemporary dentistry. Osseointegrated implants are widelyused to replace lost teeth in many situations, since the loss of a single tooth to completely edentulous archcases. Rehabilitation of edentulous patients by using fixed or removable implant-supported prostheses is a complex and challenging procedure. There are crucial factors involved at the decision of whether fixed or removable implant prosthesis should be planned to acquire optimal esthetics, phonetics, comfort, and function. In addition, the treatment result is related to implant survival, crest bone loss, soft tissue health, prosthesis's components longevity and prosthesis longevity itself. The aim of the present study is analyze the advantages and disadvantages of prosthetic rehabilitation of completely edentulous patients with fixed or removable implants.

Screening of edentulous patients in a dental school population using the prosthodontic diagnostic index.

PURPOSE: The aim of this study was to classify a number of completely or partially edentulous patients who attended undergraduate clinics at the Dental School of Athens using the prosthodontic diagnostic index (PDI) to identify the complexity of the cases treated by the students. BACKGROUND: There is a scarcity of studies, concerning prosthodontic patients and screening them according to a classification system such as the PDI. MATERIAL AND METHODS: The survey was conducted on 181 patients who attended the clinics for treatment. The PDI categorised the patients into four classes (Class I-IV) according to the severity of certain diagnostic findings. RESULTS: From the 110 completely edentulous patients, 27 patients were in Class I, 21 in Class II, 15 in Class III and 47 in Class IV. From the 71 partially edentulous patients, two were in Class I, 17 in Class II, 29 in Class III and 23 in Class IV. CONCLUSION: Our results showed that the majority of patients were categorised in Class III (partially edentulous) and IV (completely edentulous). This indicates the need to introduce a proper screening tool, such as the PDIs, during the initial examination, to achieve a successful treatment.

Use of personal computers for Gothic arch tracing: analysis and evaluation of horizontal mandibular positions with edentulous prosthesis.

STATEMENT OF PROBLEM: Determining mandibular position for an edentulous patient raises the question of whether to emphasize centric relation or muscular position. This challenge results from the lack of a convenient procedure for quantifying the horizontal mandibular position, which can be determined by a variety of methods. PURPOSE: This study analyzed and evaluated the horizontal mandibular positions produced by different guidance systems. MATERIAL AND METHODS: Twenty-six edentulous subjects with no clinical evidence of abnormality of temporomandibular disorder were selected. Horizontal position data for the mandible obtained by gothic arch tracing was loaded into a personal computer by setting the sensor portion of a digitizer into the oral cavity to serve as a miniature lightweight tracing board. By connecting this with a digitizer control circuit set in an extraoral location, each mandibular position was displayed in a distinguishable manner on a computer display in real time, then recorded and analyzed. RESULTS: The gothic arch apex and tapping point varied, depending on body position. In the supine position, the gothic arch apex and the tapping point were close to the mandibular position determined by bilateral manipulation. CONCLUSION: This system provides effective data concerning mandibular positions for fabrication of dentures.

Aspectos del diagnóstico en prostodoncia / Diagnostic aspects in prosthodontics

El éxito de una rehabilitación est basado en un correcto diagnóstico, plan de tratamiento y ejecución. Durante el diagnóstico se debe tener en claro que el sistema de sutentación del pilar dentario es distinto al del pilar artificial (implante). Los h bitos juegan un rol importante en los tratamientos

Surgical considerations and possible shortcomings of host sites.

Outcomes of implant therapy are based on diagnostic, surgical, and prosthetic procedures. Factors that are important to implant success with Brånemark system surgical protocols that are addressed in this article include patient selection, minimal bone dimensions needed for implant placement, desired implant position, and bone augmentation and grafting procedures.

Future therapeutic directions for management of the edentulous predicament.

The 1982 Toronto Conference on Tissue-Integrated Prostheses introduced the technique of osseointegration to the academic dental community. Subsequently, prosthodontists have played a leading role in the educational and clinical development of implant-supported fixed and removable prostheses for the treatment of the edentulous jaw. The success rates of treatment in the mandible have been replicated in many parts of the world and results are rewarding when compared with conventional complete denture therapy. Unfortunately, treatment results in the maxilla do not parallel those in the mandible and the shortfall requires the development of alternative strategies in diagnosis, treatment planning, surgery, and prosthetic management. As these treatment concepts become an everyday practice reality, osseointegrated implants have predictably found their way into the curriculum of all dental specialties. However, in many localities, the role of the prosthodontist in continuing education and research and development has become diluted as other areas of dentistry realize the enormous potential for treatment with osseointegrated implants. Accordingly, prosthodontists need to reevaluate their clinical mind-set if the specialty is to provide a lead role in future therapeutic endeavors.

Problems associated with implant rehabilitation of the edentulous maxilla.

Implant rehabilitation of the edentulous maxilla is one of the most challenging endeavors that faces the restorative dentist. Comprehensive diagnosis and precise evaluation of the patient's needs followed by appropriate treatment planning provide the restorative dentist with the necessary tools to satisfy patient expectations and the realization that this patient would greatly benefit from this treatment or that the patient should be referred to a prosthodontist for further evaluation. Not enough emphasis can be placed on adequate placement of the implants by the surgeon. As with any rehabilitation, aesthetics are of prime importance to the patient, and proper occlusion confers longevity to the prosthesis. Whether a removable or fixed implant-supported prosthesis is fabricated, every step is crucial and is reflected in the final product. When all sequences of treatment are properly executed, the successful implant rehabilitation of the maxilla is one of the most gratifying procedures for both the restorative dentist and the patient.

The nonsubmerged osseointegrated dental implant.

Implant patients are seeking means of restoring their health and appearance with minimal side effects. Dental implant surgery must react to these demands by continuing to develop minimally invasive implant surgery techniques, imaging that customizes surgical procedures, and materials and drugs that reduce surgical costs and complications, shorten recovery, and increase the longevity of components, enabling patients to live active lifestyles. Nonsubmerged osseointegrated implants fit nicely into the future of dental surgery.

The implant-supported prosthesis for the edentulous arch: design considerations.

STATEMENT OF PROBLEM: Edentulous patients who require implant-supported prostheses have diverse jaw anatomy and functional, esthetic, and economic concerns. Four main prosthetic designs have been used to meet these needs. PURPOSE: In this article, the fixed ceramometal, fixed detachable, overdenture, and fixed removable prostheses are discussed with emphasis on indications and limitations. An in-depth diagnosis and informed treatment planning will maximize implant success and patient satisfaction.

Pre-surgical dental implant assessment by magnetic resonance imaging.

The use of magnetic resonance imaging (MRI) for pre-surgical implant assessment of available bone in the maxilla and mandible is described. An acrylic surgical template with suitable MRI reference markers allows potential implant sites, as chosen on the MR images, to be accurately identified at surgery. MRI is a tomographic modality capable of giving accurate information on the three-dimensional relationships of all the relevant anatomic structures. Our results show that MRI is reasonably tolerant of artifacts caused by metal pins and amalgam fillings. Unlike computerized tomography (CT) and other x-radiographic techniques, MRI uses no ionizing radiation, and is capable of angulating and offsetting its scan plane at will. Good bone detail is available because cancellous bone yields a strong signal from the marrow fat, while cortical bone and dental enamel are dark. The excellent anatomic detail provided by thin-slice high-resolution MRI allows for assessment of the suitability of sites to receive an implant in terms of bone quality and thickness, and the relative position of the site to important structures such as the inferior dental nerve and nasal sinuses. The MRI technique used is described in detail. The principles underlying image contrast are outlined where appropriate and examples shown. To date, we have used MRI in conjunction with rotational panoramic x-rays (OPG) to plan 26 implants (21 maxillary, 5 mandibular) in 12 patients.