Effect of mandibular bone atrophy on maxillary and mandibular bone remodeling and quality of life with an implant-retained mandibular overdenture after 3 years.

STATEMENT OF PROBLEM: The medium-term effect of an implant-retained mandibular overdenture on bone remodeling in the maxilla and posterior mandible of edentulous patients and the effects on quality of life have not been established. PURPOSE: The purpose of this prospective observational clinical study was to evaluate the 3-year effects of implant-retained mandibular overdentures on oral-health-related quality of life (OHRQoL) and bone remodeling in different regions of the maxilla and mandible in participants with atrophic or nonatrophic mandibles. MATERIAL AND METHODS: Twenty-six edentulous participants received 2 narrow-diameter implants in the anterior mandible. Mandibular bone atrophy was categorized from presurgical panoramic radiographs according to the Cawood and Howell criteria. OHRQoL was assessed by using the OHIP-EDENT questionnaire. Participants were evaluated annually for 3 years to measure the marginal bone loss and bone area of the posterior mandible, and the anterior and posterior regions of the maxilla were assessed annually through panoramic radiographs. The data were analyzed by using a mixed-effects linear regression to estimate time-dependent trends and a mixed-effect linear regression model to verify differences between groups. The Pearson correlation coefficients between bone variables and 3-year OHIP-EDENT outcomes were calculated. RESULTS: In the third year, atrophic participants had a significantly lower marginal bone loss (0.02 mm) than nonatrophic participants (-0.39 mm) (P=.030). Differences were also found in the functional limitation (nonatrophic=1.82 ±1.75, atrophic participants=1.92 ±1.54; P=.018) and handicap domains (nonatrophic=0.36 ±0.54, atrophic participants=0.08 ±0.27; P=.003). For nonatrophic participants, comparisons between baseline and 3-year outcomes showed significant bone resorption as indicated by the area ratio in the anterior maxilla (P=.035), posterior maxilla (P=.022), and posterior mandible (P=.009). Conversely, the bone area of the anterior maxilla (P=.019) decreased in atrophic participants between baseline and year 1, while the bone area of the anterior maxilla and posterior mandible increased (P<.001) between years 1 and 3. Higher effect sizes were observed in the OHRQoL domains of the atrophic participants. CONCLUSIONS: Bone atrophy influenced both the OHRQoL profile and bone remodeling profile in different regions of the mandible and maxilla in mandibular overdenture users. In atrophic participants, bone tissue in both jaws responded positively to overdenture use, with bone apposition after the first year and bone area preservation in the anterior maxilla, posterior mandible, and peri-implant regions after 3 years of follow-up.

Surgical and prosthetic rehabilitation of siblings with Witkop tooth and nail syndrome using zygomatic implants: a familial case series of 3 patients with up to 15-year follow-up.

Witkop tooth and nail syndrome is a rare, autosomal dominant type of ectodermal dysplasia that can have significant effects on dentition, including hypoplastic and malformed dentition and significantly atrophic maxillas. Endosseous implants have become one possible solution to replace missing teeth, although their use in areas where bone is sparse becomes challenging. Due to the severe atrophy of the maxillary alveolus, extensive preprosthetic surgeries including orthognathic surgery, extensive bone grafting, and sinus floor augmentations have been recommended prior to placement of endosseous dental implants. Although this treatment has shown favorable outcomes, it requires multiple surgical procedures, contributing to a prolonged treatment course and increased morbidity. An alternative treatment of atrophic maxillas in patients with ectodermal dysplasia includes the use of zygomatic implants. This familial case series discusses 3 siblings, all previously diagnosed with Witkop Syndrome, who underwent comprehensive preprosthetic surgery and prosthetic rehabilitation using zygomatic implants with a follow-up period up to 15 years.

Factors associated with edentulism in individuals with chronic kidney disease undergoing hemodialysis: a cross-sectional study / Fatores associados ao edentulismo em indivíduos com doença renal crônica em hemodiálise: um estudo transversa

Introduction: Chronic kidney disease (CKD) is a progres-sive condition characterized by structural or functional abnormalities of the kidney. CKD may be associated with several oral alterations, such as higher prevalence rate of dental caries, periodontal disease, xerostomia, candidiasis and burning mouth. The aim of the study was to identify risk factors associated with edentulism in adults with CKD undergoing hemodialysis. Methods: A cross-sec-tional study was conducted with 650 individuals aged 18 to 90 years undergoing hemodialysis in southeastern Brazil. Oral clinical examination and administration of a questionnaire addressing demographic characteristics and dental history were performed. The study received approval from the Human Research Ethics Committee of UFMG. Findings: A total of 183 participants were eden-tulous (28.2%). Individuals with less schooling (OR = 3.99; 95% CI: 2.34-6.79), those who had not been to a dentist in the previous six months (OR = 2.49; 95% CI: 1.52-4.08), those who rated their own smile as excellent or good (OR = 2.00; 95% CI: 1.35-2.97) and those with some mucosal alteration (OR = 4.17; 95% CI: 2.83-6.13) had a greater chance of belonging to the edentulous group. Discussion: The present findings can contribute to the establishment of public health policies aimed at guiding dental care programs for individuals with chronic kidney disease that take into account the specific needs of this population. Conclusion: Edentulism was associated with low schooling, a lack of dental care in the previous six months, a positive self-perception of one's smile and alterations in the oral mucosa.

Introdução: A doença renal crônica (DRC) é uma condição caracterizada por anormalidades estruturais ou funcionais do rim. A DRC pode estar associada a diversas alterações bucais, como maior prevalência de cárie dentária, doença periodontal, xerostomia, candidíase e queimação bucal. O objetivo deste estudo foi identificar os fatores de risco associados ao edentulismo em indivíduos com DRC em tratamento com hemodiálise. Materiais e Métodos: Foi realizado um estudo transversal com 650 indivíduos de 18 a 90 anos em hemodiálise no sudeste do Brasil. Foi realizado exame clínico oral e aplicação de questionário abordando características demográficas e histórico odontológico. O estudo foi aprovado pelo Comitê de Ética em Pesquisa em Seres Humanos da UFMG. Resultados: Um total de 183 participantes eram edêntulos (28,2%). Indivíduos com menor escolaridade (OR = 3,99; IC 95%: 2,34-6,79), aqueles que não foram ao dentista nos últimos seis meses (OR = 2,49; IC 95%: 1,52-4,08), aqueles que avaliaram o seu próprio sorriso como excelente ou bom (OR = 2,00; IC 95%: 1,35-2,97) e aqueles com alguma alteração de mucosa (OR = 4,17; IC 95%: 2,83-6,13) tiveram maior chance de pertencer ao grupo de edêntulos. Discussão: Os presentes achados podem contribuir para o estabelecimento de políticas públicas de saúde voltadas a nortear programas de atenção odontológica à pessoa com doença renal crônica que atendam às necessidades específicas dessa população. Conclusão: O edentulismo esteve associado à baixa escolaridade, falta de atendimento odontológico nos últimos seis meses, sorriso autoavaliado positivo e alterações mucosas.

Factores asociados al desdentamiento en adolescentes / Factors associated with teeth loss in adolescents

Fundamento: la pérdida de dientes puede afectar a las personas de cualquier edad es más frecuente en el adulto mayor, aunque en la actualidad se ha incrementado el número de jóvenes que desde edades tempranas, presentan dientes perdidos. Objetivo: identificar los factores asociados al desdentamiento en los adolescentes del municipio Cifuentes. Métodos: se realizó un estudio epidemiológico descriptivo de corte transversal en el Municipio Cifuentes desde septiembre de 2015 hasta marzo de 2017. El universo lo constituyó la población con edades entre 12 y 18 años conformados por un total de 465 estudiantes, de ellos se seleccionaron 180 mediante un muestreo probabilístico por conglomerados estratificado bietápico. Resultados: el desdentamiento en los adolescentes tuvo una prevalencia de 17,2 porciento lo que coincidió con el número de pacientes que presentaban obturaciones, la higiene bucal regular estuvo presente en el 51,7 porciento mientras que en el 58,2 porciento de los adolescentes las pérdidas dentarias fueron asociadas a la caries dental. Conclusiones: dentro de los factores asociados a dicho fenómeno cabe destacar: la edad, la presencia de obturaciones y la higiene bucal. La principal causa de desdentamiento fue la caries dental(AU)

Background: the loss of teeth can affect people of any age and although this is more frequent in the elder, presently it has increased the number of young persons that from early ages, present lost teeth. Objective: to identify the associated factors to the tooth loss in teenagers of the municipality of Cifuentes. Methods: a descriptive epidemic study of traverse court was carried out in the Municipality of Cifuentes from September, 2015 to March, 2017.The universe of population was constituted for ages between 12 and 18 years conformed by a total of 465 students, of them 180 were selected by means of a probabilistic sampling by two-stage stratified conglomerates. Results: the loss of teeth in the adolescents was of 17.2 percent same to the number of filled, the oral hygiene to regulate it was present in 51.7 percent also in the 58.2 percent the cause of teeth loss was a dental caries.Conclusions: among the factors associated to this phenomenon it is necessary to highlight: the age, the presence of filled and oral hygiene. The main cause of teeth loss was a dental cavity(AU)

Oral rehabilitation of the cancer patient: A formidable challenge.

Rehabilitation of oral functions following surgery on the jaws is a goal that is often difficult to achieve. Removable dentures supported by remaining teeth or gum are often unstable and seldom satisfactory. On the other hand, endosseous (dental) implants offer a mechanism to provide stability to the dentures. This review, discusses factors related to the tumor, patient, treatment, and physicians which impact upon the feasibility and success of dental implants in patients with oral cancer.

Prosthetic rehabilitation for a patient treated for embryonal rhabdomyosarcoma.

A female patient, now aged 17 years, was diagnosed with rhabdomyosarcoma (RMS) in the right pterygopalatine fossa when she was 3 years old. The RMS was successfully treated by excision, but the subsequent radiation and polychemotherapy resulted in the complete anesthesia of the distribution area of the right trigeminal nerve and loss of vision in the right eye. The patient also experienced pain in the mandibular joints and masticatory muscles. Panoramic radiographs displayed a multiple agenesia of the permanent teeth and underdeveloped apices. Treatment involved the fabrication of a complete maxillary denture. A removable device was fabricated to evaluate her response to an occlusal vertical dimension increase of 6 mm and provide a stable intercuspal position. After wearing the prosthesis for 6 months, the patient reported that she was completely free of symptoms.

[Prosthodontic treatment of edentulous patients with postoperative mandibular defects of oncological origin]. / Osobennosti ortopedicheskogo lecheniia patsientov s polnym otsutstviem zubov i posleoperatsionnymi defektami verkhnei cheliusti onkologicheskogo geneza.

The aim of the study was clinical and bacteriological approbation of improved obturator dentures with soft lining. The study involved 116 patients (68 females and 48 males aged 47-78) with edentulous jaws and side palatal defect of oncological origin. Improved elastic obturator maxilla dentures in patients with palatal defects proved to have better stability and provides better comfort effectively preventing inflammation of prosthetic bed soft tissues.

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.

Use of osseointegrated implants in the intermaxillary suture: a new possibility for the prosthetic rehabilitation of atrophic maxillae.

Patients with atrophy of the maxillae, generally the elderly, are usually difficult to handle clinically, mainly due to the lack of retention, stability, and masticatory effectiveness of the total removable prosthesis. A new technique involving osseointegrated implants that are parallel to each other and arranged in the intermaxillary suture seems to provide great advantages over the current options for oral rehabilitation. This technique is quick and effective, being performed with local anesthesia and without a bone graft, and still presents low morbidity and cost.

Provision of a swing lock denture for a patient with Gorlin Goltz syndrome.

Swinglock dentures are used relatively infrequently but in cases of compromised anatomy or where the pattern of tooth loss is unfavourable, they provide a useful removable partial denture design option. The aim of this article is to provide a clear summary of the clinical and technical considerations necessary when providing a Swinglock denture.

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 status and treatment needs among patients attending the prosthodontic department in a dental institute in India.

This cross-sectional study was planned to evaluate the prosthetic status and treatment needs among patients who reported to the department of prosthodontics in Institute of Dental Sciences, Belgaum. A proforma was designed consisting of questions on sociodemographic factors like age, sex, socioeconomic status and a clinical examination was carried out according to the dentition status and treatment needs using a mouth mirror and a Community Periodontal Index Probe (CPI probe). All the patients who reported to the department of prosthodontics in Institute of Dental Sciences, Belgaum in a period of 2 months, with at least one missing tooth (excluding third molars) were included in the study. There was a statistically highly significant difference between gender and age according to reasons for tooth loss, while there was no statistically significant difference between reasons for tooth loss and socioeconomic status. 58.3% of males and 59.5% of females required complete removable dental prosthesis. A statistically highly significant difference was obtained between age and type of prosthesis required by the patient. There was no statistically significant difference between socioeconomic status and the type of prosthesis required by the patient. The prosthetic status of the population was low with 65.8% of the patients needing prostheses.

Oral rehabilitation of adult twins with severe lack of bone due to hypohidrotic ectodermal dysplasia--a 12-month follow-up.

PURPOSE: Patients with x-linked hypohidrotic ectodermal dysplasia (XLHED, OMIM 305100) often present with exceptional oral conditions, because alveolar ridges can remain severely hypotrophic due to oligo- or anodontia in the primary and/or permanent dentition. This can seriously disable a young person physically and psychologically, and lead to sociopsychological isolation. PATIENTS AND METHODS: The oral rehabilitation of fraternal male twins with XLHED, one with severe hypodontia and the other with anodontia is described. The treatment of both patients comprised augmentation of the jaws using bicortical corticocancellous bone blocks from the medial aspect of the anterior hip, delayed implantation, and restoration of the occlusion with bar-retained overdentures. The multidisciplinary team approach included an oral and maxillofacial surgeon, a prosthodontist, and a speech therapist. RESULTS: After uneventful healing, the 12-month follow-up showed that sufficient osseointegration of the implants for optimized function was obtained by creating adequate de novo bone volume in the underdeveloped jaw regions. Full regular masticatory function was achieved, and esthetics were improved considerably in both patients. CONCLUSION: Augmentation and implant placement prior to prosthetic rehabilitation appears to be a suitable treatment option for adult patients with XLHED.

Osseointegration and guided bone regeneration in ectodermal dysplasia patients.

Dental and surgical implant treatment for patients affected by ectodermal dysplasia syndrome can be very complicated. The guided bone regeneration (GBR) membrane technique together with bone grafting is used to facilitate the placement of osseointegrated implants in a prosthetically guided position. Two groups with the same bony anatomical features were assessed. The first consisted of 13 ectodermal dysplasia patients in whom 66 implants with bone grafts and membranes were inserted. In the second control group, 120 implants with GBR were placed in 20 patients. The implants were assessed at the second stage of surgery, and at a follow-up after 1, 2, and 3 years of functional loading. There was no statistically significant difference in the osseointegration rate between the two groups. Despite the anatomical defects associated with the decreased occlusal vertical dimension and the reduced edentulous alveolar ridges, both in height and width, osseointegrated implants together with GBR and bone grafts can be used successfully in patients with ectodermal dysplasia syndrome.

Implant-retained feeding aid prosthesis for a patient following total glossectomy and laryngectomy: a clinical report.

This clinical report describes the prosthetic management of a patient following total glossectomy and total laryngectomy that severely compromised his oral function, caused facial disfigurement, and limited the patient's quality of life. A feeding aid prosthesis was designed to address the patient's chief complaint of difficulty in feeding and mastication. The prosthesis was designed as an implant-retained overdenture with a lingual metal plate to facilitate food introduction into the oropharynx. This treatment improved mastication, appearance, and the quality of the patient's social life.

A method using vestibulo-sulcoplasty combining a split-thickness skin graft and a palatal keratinized mucosa graft for peri-implant tissue secondary to oral cancer surgery.

Twelve patients presented with oral submucosal fibrosis and loss of keratinized gingiva in a compromised vestibule of a severely deficient mandibular edentulous ridge secondary to oral cancer surgery. They received implant rehabilitation with a total of 49 fixtures without major bone graft augmentation. To overcome vestibular compromise, soft tissue management consisting of simultaneous vestibulo-sulcoplasty, split-thickness skin graft (STSG), and palatal keratinized mucosa graft (KMG) was performed as a second stage when healing abutment was transferred to replace the cover screw of the dental implant. Postoperative follow-up of all patients consisted of clinical and radiographic examinations for an average of 4 years, revealing good stability of implant fixtures with a 91.8% success rate and generally healthy peri-implant tissue, the latter with an average sulcus depth of 2.9 +/- 0.6 mm. Satisfactory results were also demonstrated regarding improved morphology of the vestibule, cosmetics, and prosthetic functionality. Vestibulo-sulcoplasty combining STSG and palatal KMG offers a stable and convenient method for rebuilding peri-implant tissue without need for bone grafting in selected patients who have compromised atrophic ridges secondary to cancer surgery.

Dental implants in a young patient with Papillon-Lefevre syndrome: a case report.

A case is reported of dental implant placement in a 13-year-old patient diagnosed with Papillon-Lefevre Syndrome. Two titanium dental implants were placed in the mandible for an implant-retained denture after the patient complained of having an unstable prosthesis. Follow-up radiographs showed successful osseointegration and preservation of alveolar bone 1 year after implant placement and the continual wearing of a functional dental prosthesis.

Treatment of advanced periodontal destruction with immediately loaded implants and simultaneous bone augmentation: a case report.

BACKGROUND: Advanced periodontal destruction is often associated with extraction of the teeth. Oral rehabilitation in these cases may include the traditional prosthetic restoration or an implant-supported reconstruction. Immediately loaded implants present an alternative treatment modality using a bar in the anterior mandible, along with the placement of higher numbers of implants, which are connected with a fixed prosthetic reconstruction. METHODS: This clinical case report presents the surgical and prosthetic rehabilitation in a patient who had lost all teeth due to advanced periodontal bone destruction. Six implants were placed in the upper and lower jaw each. Some implants required guided bone regeneration in conjunction with autologous bone grafting. All of the implants were connected with their abutments, and a temporary fixed restoration was placed immediately after surgery. The final metalloceramic-fixed reconstruction was cemented after 6 weeks of loading. RESULTS: All of the implants were osseointegrated and showed no clinical signs of mobility or infection. Mobility values were evaluated during healing and were found to be reduced. Radiological findings showed a stable peri-implant bone level during the total 18-month loading observation period. CONCLUSIONS: This case report presents an alternative treatment concept for the oral rehabilitation in a patient with advanced periodontal destruction. The concept of immediate loading of implants might provide a better opportunity to meet patient needs than more traditional treatment modalities.