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.

Radiographic Screening of Patients in a Dental School using the Prosthodontic Diagnostic Index.

INTRODUCTION: Organization of the findings associated with various diagnostic aids plays a key role in formulating the treatment plan of the patients undergoing dental and medical treatment. Enhanced consistency in diagnosing and classifying prosthodontic patients is the basic purpose of various classification systems. Hence, we planned this study to classify partially edentulous patients and completely dentate patients at the undergraduate clinics using the prosthodontic diagnostic index (PDI). MATERIALS AND METHODS: This study included classification of 13,599 edentulous patients who attended the clinics of undergraduate students of all the levels. Screening of all the patients was done radiographically with a digital orthopantomograph (OPG), and the data were saved in the computer system. The intraoral periapical radiographs (IOPA) taken for all the affected areas were also saved in the system. Based on the OPG and IOPA, the patients were classified into various classes. All the data of the patients were recorded and analyzed. RESULTS: Total number of patients screened was 17,220, out of which 3,621 were under 18 years of age and were excluded from the study. Most of the patients belonged to the age group of 31 to 45 years: 5,360 (39.4%) patients (3,817 [43.0%] males and 1,543 [32.5%] females) were class I; 2,730 (20.0%) patients (1,729 [19.5%] males and 1,001 [21.1%] females) were class II; 4,576 (33.7%) patients (2,835 [32.0%] males and 1,741 [36.8%] females) were class III; and 933 (6.9%) patients (483 [5.5%] males and 450 [9.5%] females) were class IV. CONCLUSION: There is a need to introduce PDI as a screening tool during the initial examination of the patient and to achieve a proper distribution of the patients among various levels of students, interns, and postgraduates. CLINICAL SIGNIFICANCE: Introduction of PDI will improve the treatment planning and prognosis of edentulous patients.

Validation of Therapeutic Anatomy-Oriented Classification in Endosseous Dental Implant Treatment: A Pilot Study.

BACKGROUND: The purpose of the study was to validate a newly proposed therapeutic anatomically based clinical and radiological classification for dental implant treatment. METHODS: Eighty-one patients with at least 1 edentulous jaw segment (EJS) from 2 dental clinics were included in this study. Both clinical and radiological parameters were assessed in aesthetic and nonaesthetic zones. The data were then compared at preoperative, intraoperative, and postoperative (subdivided into early and late stage) study stages. RESULTS: Based on the hard and soft tissue support, EJSs were divided into 3 types. The outcomes were then validated at preoperative, intraoperative, and early postoperative stages. Data were then analyzed using paired sample t test and the Wilcoxon signed ranks test. No statistically significant difference (P > 0.05) was identified between any the measurements. CONCLUSIONS: The proposed therapeutic anatomically based clinical and radiological classification for the dental implant treatment seems to be reproducible, objective, and helpful in planning dental implant treatment. Future studies with a larger sample size are needed to further validate the outcome obtained in this pilot study.

Implant-prosthodontic classification of the edentulous jaw for treatment planning with fixed rehabilitations.

PURPOSE: This study aimed to develop a classification of edentulous jaws for use as a diagnostic tool during implant-prosthodontic treatment planning. MATERIALS AND METHODS: The morphology of 200 fully edentulous alveolar ridges (100 maxillae, 100 mandibles) was assessed with cone beam computed tomography. Generic implants (length: 8 mm; diameter: 4.1 mm) were used. To develop the classification system, the feasibility of virtually placing the implants without vertical ridge augmentation was considered. Potential implant sites were evaluated in terms of ridge width and described as either type A (no horizontal augmentation required) or type B (horizontal augmentation required). A descriptive statistical analysis of subjects' age, sex, and arch classification was performed. RESULTS: In total, 880 implants were virtually planned. Based on alveolar ridge height, four arch patterns were identified (C1 to C4), providing a basis for prosthodontic planning with either removable or fixed implant-supported restorations. The frequencies of each category were as follows: C3 (n = 62, 62%), C4 (n = 16, 16%), C2 (n = 12, 12%), and C1 (n = 10, 10%) for the maxilla and C3 (n = 36, 36%), C4 (n = 31, 31%), C1 (n = 24, 24%), and C2 (n = 9, 9%) for the mandible. CONCLUSION: The proposed classification of the edentulous arch represents a useful tool for communication between clinicians when planning implant-supported rehabilitations.

Complete arch site classification for all-on-4 immediate function.

Complete arch immediate function of dental implants requires a treatment protocol that takes advantage of residual areas of cortical bone for the apical fixation of implants. A site and jaw bone classification is proposed that has been in use since 2006 for all stages of atrophy for both jaws. The use of the classification is strictly for immediate function based on specific cortical bone sites in the facial skeleton to assist practitioners in diagnosis, treatment planning, and interdisciplinary communication, as well as to reduce human error in patient management. A recent series of 100 consecutive arches that were treated according to this classification is presented.

Classification of the alveolar ridge width: implant-driven treatment considerations for the horizontally deficient alveolar ridges.

Among many techniques advocated for the horizontally deficient alveolar ridges, ridge-split has many advantages. Here, treatment management strategies of the horizontally collapsed ridges, especially the ridge-split approach, are discussed and a clinically relevant implant-driven classification of the alveolar ridge width is proposed, with the goal to assist an operator in choosing the proper bone augmentation technique. Comparison and advantages of two commonly used techniques, ridge-split and block bone graft, are presented.

Clinical importance of recipient site characteristics for vertical ridge augmentation: a systematic review of literature and proposal of a classification.

This review evaluated the characteristics of vertical alveolar defects that were augmented via onlay bone grafting or guided bone regeneration. Information regarding the anatomic site, type of edentulism, and defects' dimensions were extracted. The experiments differed vastly in the description of the defects' features. Aiming to mitigate the confounding effect of recipient site's morphology in future experiments, a classification of vertically deficient recipient sites is proposed.

Maximum dislodging forces of mandibular implant-assisted removable partial dentures: in vitro assessment.

PURPOSE: The initial retention of implant-assisted removable partial dentures (IARPDs) is unknown. The purpose of this in vitro study was to compare maximum dislodging forces of distal extension mandibular IARPD with two different attachments and three clasp designs. MATERIALS AND METHODS: A simulated class I partially edentulous mandible was prepared with two screw-type 3.75 × 12 mm implants in the first molar regions and 2 metal-ceramic crowns on distal abutments. Fifteen bilateral distal extension frameworks were conventionally fabricated in three clasp designs (suprabulge, infrabulge, no clasp). Locator attachments were connected to the 15 denture bases with autopolymerized resin. Each specimen was subject to four types of retention pulls (main, anterior, posterior, unilateral pull) five times with a universal testing machine. Locator attachments were replaced with O-ring attachments, and the same procedure was performed. Therefore, the study groups included: IRPD with Locator attachment and suprabulge clasp (group 1), IRPD with Locator attachment and infrabulge clasp (group 2), IRPD with Locator attachment and no clasp (group 3), IRPD with O-ring attachment and suprabulge clasp (group 4), IRPD with O-ring attachment and infrabulge clasp (group 5), IRPD with O-ring attachment and no clasp (group 6). Data were analyzed using one-way ANOVA, two-way ANOVA, and Tukey tests. RESULTS: The highest mean value was 22.99 lb for prostheses with a Locator attachment and suprabulge clasp. The lowest retentive values were recorded for IARPDs with O-ring attachments. CONCLUSION: The results of this in vitro study suggest that the precise selection of attachments with or without clasp assemblies may affect the clinical success of mandibular IARPDs.

Quantity and quality analysis of dental prosthodontics among retirement age residents from nursing homes in different regions of Latvia and retirement age patients from dental clinic in Riga.

INTRODUCTION: The quality of life is closely related with condition of oral health, influence of subjective factors on the whole human body and patients perception of their oral health. In spite of the fact that the most part of Latvian retirement age residents use low-quality dentures and assess them satisfactory, these patients often have problems associated with quality of dentures. The aim of the present study was to evaluate oral health status, prosthodontics indicators and patients satisfaction with oral health among Latvian retirement age residents. PATIENTS AND METHODS: There were examined 465 retirement age volunteers (170 men and 295 women), 116 of them in dental clinic Sandent (Riga, 24.9% - control group), 137 (29.5%) in nursing homes in Zemgale and 212 (45.6%) in nursing homes in Kurzeme (Zemgale and Kurzeme are districts of Latvia). There were assessed quantity of prosthodontics among patients with partial defects of dental arches, there were estimated quality of dentures and patients satisfaction with existing prosthodontics. RESULTS: Oral health indicators among Latvian retirement age population are better than the same indicators among elderly residents of nursing homes. Among nursing homes residents with partial edentulousness in most of cases in oral cavities remained only few residual teeth which needed treatment. Removable and fixed dental prostheses used by nursing homes residents do not meet denture's quality criteria. Self-evaluation of dentures quality among retirement age residents of nursing homes is better and not correspond with existing dentures quality. CONCLUSIONS: In Latvia the quantity of prosthodontics in respect of partial removable dentures among the retired who regularly visit a dentist does not significantly differ from European retirement age population's dental prosthodontics quantity. Dental prosthodontics indicators of residents of nursing homes in Latvia are unsatisfactory (p<0.001). In retirement age population self-evaluation with quality of dentures is higher than actually existing.

Factors associated with self-assessed masticatory ability among community-dwelling elderly Japanese.

UNLABELLED: Self-assessed masticatory ability has been shown to be significantly related to general health among elderly persons. OBJECTIVE: To identify oral factors associated with the self-assessed masticatory ability. BASIC RESEARCH DESIGN: Cross-sectional study. PARTICIPANTS: A total of 736 community-dwelling elderly persons. MAIN OUTCOME MEASURES: Data on background factors and the self-assessed masticatory ability were collected by questionnaire. An intraoral examination examined the pattern of posterior occluding pairs of natural teeth (POPs), the WHO Community Periodontal Index of Treatment Needs (CPI) and denture-related factors such as use of dentures, pain when using dentures and stability and retention of dentures. Chi-squared tests examined the relationships between the self-assessed masticatory ability and the background factors and oral conditions. Ordinal regression models were constructed with the self-assessed masticatory ability as the dependent variable and oral conditions as the principal independent variables, to adjust for the potential confounding variables. RESULTS: Self-assessed impairment of masticatory ability was associated with lost POPs (p < 0.001) and CPI (p = 0.012). In the participants with lost POPs, self-assessed impairment of masticatory ability was associated with not using dentures and pain when using dentures (p < 0.001). In the totally edentulous subjects, impairment of masticatory ability was not associated with stability and retention of dentures (p = 0.070). CONCLUSIONS: Factors affecting self-assessed masticatory ability include the pattern of POPs, periodontal status, denture use and pain when using dentures.

Implant assessment.

UNLABELLED: Meticulous planning in implant dentistry is essential in order to achieve a predictable and successful outcome for both the operator and the patient. This paper summarizes the important aspects of planning, including factors related to clinical and radiographic examination and the use of study models. CLINICAL RELEVANCE: This paper has relevance to practitioners carrying out implant treatment and also to colleagues who are likely to refer patients for implants.

Oral status, oral hygiene, and patient satisfaction in the elderly with dental implants dependent on substantial needs of care for daily living.

Using osseointegrated implants to replace teeth is a routine procedure today. This study investigated oral status, oral hygiene habits, and patient satisfaction in elderly with dental implants who were dependent on substantial support for daily living. Twenty-six persons over the age of 65 who were dependent on supportive care were examined. Data collected included the number of teeth and implants, plaque scores, bleeding on probing, and oral hygiene habits. Self-perceived knowledge about managing their implants and satisfaction with the implants was recorded. Subjects had a total of 148 natural teeth and 144 implants. Only a few signs of oral disease were found and the tissues around implants were healthier than around natural teeth. No correlations between oral hygiene habits and plaque scores or bleeding were found. A majority of the subjects were satisfied with their implants. Dental implants have satisfactory function even in individuals who are elderly and have substantial needs for supportive care.

Assessing oral health promotion determinants in active Greek elderly.

OBJECTIVE: To explore older adults' patterns and risk behaviours to be invoked in the allocation of strategies to promote oral health. BACKGROUND: to dental services is determined by factors that serve as barriers to or enablers of older adults' behaviour and attitudes towards oral health. Appropriate oral health promotion activities are of particular importance among the elderly in altering oral health behaviour through education, prevention and health protection. METHODS: A cross-sectional study was conducted among 108 dentate elderly subjects. They were attending a University Prosthetic Dentistry Clinic in Greece as patients seeking treatment. Participants underwent a clinical examination and an interview. RESULTS: Data extracted revealed that cost and no disease awareness were the most frequently mentioned barriers to regular dental visits. Most of the participants presented low level of income and education and reduced presence of adverse dental health symptoms compared with the actual oral health status. Besides some predisposing factors, enabling and need variables significantly affected access to dental care services, participants' number of remaining teeth and as a consequence oral health status. CONCLUSION: Profiling older adults' demographics, economic, social and cultural status and their attitudes and beliefs could further contribute in developing universal activities and strategies for oral health promotion so as ageing challenges are favoured.

The rehabilitation of completely edentulous maxillae with different degrees of resorption with four or more immediately loaded implants: a 5-year retrospective study and a new classification.

PURPOSE: To report the long-term outcome of immediately loaded implants in the rehabilitations of completely edentulous maxillae with different classifications. The secondary aim was to evaluate the influence of possible explanatory variables on the incidence of biological and mechanical complications. MATERIAL AND METHODS: In total, 221 patients were consecutively included and classified into four groups that allowed implant placement in a vertical position: Group 1 (bone available up to first molar), Group 2 (bone available up to second premolar), Group 3 (bone available up to first premolar) and Group 4 (bone available up to canine). Outcome measures were prosthesis and implant survival, and biological and mechanical complications. RESULTS: A total of 995 implants were placed. Eighteen patients (8% of the sample) dropped out of the study. After 5 years, three patients lost their prosthesis due to implant failures, giving a survival rate of 98.6%; 25 patients lost 41 implants, giving a survival rate of 88.7% (25/221) and an implant-specific survival rate of 95.8% (41/995). According to the edentulism classification, the patient-specific survival rate after 5 years was 78.6% for Group 1, 89.3% for Group 2, 92.4% for Group 3 and 91.7% for Group 4. In total, 129 biological complications occurred affecting 129 implants (13%) in 66 patients (30%). Smoking was identified as a risk factor for the incidence of biological complications with an OR of 3.03 (95% CI 2.03-4.56; P < 0.0001), while 'gender' (male; OR = 0.56; 95% CI 0.37-0.85; P = 0.007) was a factor that had a protective effect. A total of 170 mechanical complications occurred, affecting 170 implants (17%) in 71 patients (38%). Bruxism was identified as a risk factor for the incidence of mechanical complications with an OR of 60.95 (95% CI 21.40-173.54; P < 0.0001), while a Group 2 edentulism classification had a protective effect for the incidence of mechanical complications with an OR of 0.22 (95% CI 0.07-0.71; P = 0.011). CONCLUSIONS: It is a viable treatment option to rehabilitate completely edentulous maxillae using four implants or more to support a fixed prosthesis.

Analysis of the association of IL1B(C-511T) polymorphism with dental implant loss and the clusterization phenomenon.

OBJECTIVES: Endosteous dental implants consist in the treatment of choice to replace tooth loss. The knowledge that implant loss tends to cluster in subsets of individuals may indicate that host immune-inflammatory response is influenced by genetic factors. Interleukin-1 (IL-1) is a key mediator of inflammatory processes and functional polymorphisms in IL1 gene could be candidate genetic risk factors to study susceptibility to implant failure. The objective of this study was to investigate the association between IL1B (C-511T) genetic polymorphism and dental implant loss in a Brazilian population and its influence in the clusterization phenomenon. MATERIAL AND METHODS: The sample composed of 277 unrelated, both gender, mean age 53.63 ± 11.14 years individuals, divided into test group - 92 subjects with implant loss, and control group - 185 subjects with no implant loss. Patients' socioeconomic profile and clinical variables were investigated. Genomic DNA from oral mucosa was analyzed by polymerase chain reaction-restriction fragment length polymorphism. RESULTS: There was significant difference between the groups in medical treatment (P=0.040), edentulism (P=0.019), and mean number of placed implants (P=0.001). There was difference between groups with and without implant loss neither considering genotypes (P=0.279) nor alleles (P=0.168) for IL1B (C-511T) polymorphism. When individuals showing up to one implant failure (n=254) were investigated vs. patients presenting multiple implant loss (n=23), no difference was either observed between groups for genotype (P=0.083) and allele (P=0.838) frequencies. CONCLUSIONS: The borderline association of the study polymorphism with implant loss suggests further IL1 haplotype analysis to elucidate the global involvement of IL-1 proteins in the modulation of the osseointegration process.

Degenerative changes in human temporomandibular joints in relation to occlusal support.

OBJECTIVE: Controversy exists concerning the etiological factors behind degenerative changes in the temporomandibular joints (TMJs). Tooth attrition, occlusal support, food consistency, ageing, gender and genetics are some possible causative factors that have been discussed in the literature. The aim of this study was to examine contemporary human skull material for possible relations between degenerative form and surface changes in the TMJs in relation to occlusal support. MATERIAL AND METHODS: The material consisted of 259 human skulls from 170 males and 89 females, with an age range of 18-100 years. RESULTS: Dental status was in general poor, and 22% of skulls were edentulous. Form and surface changes of both the condyles and the temporal components were more common in the present material compared to that in most previous studies. In males, irrespective of age, only weak and clinically insignificant correlations could be found between degenerative TMJ changes and occlusal support. In women, however, the correlations between these variables were in general much stronger, especially at higher ages. CONCLUSIONS: The present findings do not lend support to the hypothesis that loss of occlusal support is a causative factor for degenerative changes in the TMJs in male subjects. In women, such a correlation was obvious in the present sample, at least at higher ages. It can be speculated that hormonal factors play a role in the sex difference found.

A classification system of patients for esthetic fixed implant-supported prostheses in the edentulous maxilla.

Edentulous maxillary fixed rehabilitation using dental implants is challenging and requires meticulous planning because of anatomic variations and the importance of facial and dental esthetics. This article reviews the application of facial esthetics, lip support, smile lines, residual ridge position, tooth proportions, and tooth positions for different types of patients. Based on these parameters, a simple new classification system is proposed to classify patients into four categories, which will help facilitate an easier diagnostic and communicative system. It will also enable the clinician to understand when and why gingiva-colored prosthetic material is needed. Using this classification system, a stepwise method of diagnosis and management techniques are described in detail for each of the four classes. The proposed classification system has been based on an analysis of various successfully treated patients with a minimum follow-up period of 2 years.

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.

Improved denture retention in patients with retracted tongues.

BACKGROUND: Patients who wear mandibular dentures and hold their tongues in retracted positions alter the dimensions of the sublingual space and disrupt the peripheral seal that is needed for optimal denture retention. The authors studied whether retention could be improved if patients moved their tongues from a retracted resting position to an ideal resting position. METHODS: The authors observed and classified the mandibular residual ridge morphologies of 85 participants who wore complete dentures. The authors recorded and compared the retention of the mandibular denture before and after repositioning the tongue to the ideal resting position. RESULTS: When the participants' tongues were in a retracted resting position, the average retention of the mandibular denture was 75.38 gram weight (+/- 81.83 standard deviation [SD]). After participants repositioned their tongues to the ideal resting position, the average retention of the mandibular denture was 118.89 gw (+/- 93.00 SD), an increase of 57.73 percent. CONCLUSIONS: In all morphological classes, when participants held their tongues in the ideal resting position, the average mandibular denture retention increased by 57.73 percent, a statistically significant improvement compared with when participants held their tongues in a retracted resting position. CLINICAL IMPLICATIONS: Clinicians are encouraged to evaluate carefully the tongue resting position in all patients who wear dentures, help create reasonable therapeutic expectations by informing patients about the significant effect that tongue position will have on future denture retention and provide helpful neuromuscular training for patients with retracted-tongue habits.