Attitudes of general dental practitioners to the maintenance of Locator retained implant overdentures.

INTRODUCTION: Locator retained implant overdentures are associated with a high incidence of prosthodontic complications. This study investigated whether general dental practitioners (GDPs) were willing to maintain these prostheses in primary dental care. METHOD: A questionnaire was distributed to all GDPs referring patients for an implant assessment to the Charles Clifford Dental Hospital, Sheffield between 1 January 2012 and 30 June 2012. RESULTS: Ninety-four out of one hundred and forty-six questionnaires were returned (response rate: 64%). Thirteen GDPs (14%) were able to identify the Locator attachment system from clinical photographs. Eighty-two GDPs (87%) would adjust the fit surface of a Locator retained implant overdenture. Twenty-three GDPs (25%) would replace a retentive insert, 18 GDPs (19%) would tighten a loose abutment, 68 GDPs (72%) would debride abutments and 25 GDPs (27%) would remake a Locator-retained implant overdenture. Forty-seven GDPs (50%) felt that the maintenance of these prostheses was not their responsibility. The main barriers identified to maintenance by GDPs were a lack of training, knowledge and equipment. Seventy GDPs (74%) would like further training in this area. CONCLUSIONS: GDPs are not familiar with the Locator attachment system and are reluctant to maintain implant retained overdentures. GDPs would like further training in this area.

Treatment of the edentulous atrophic maxilla using zygomatic implants: evaluation of survival rates over 5-10 years.

The aim of this retrospective observational cohort study was to analyse and report the 5-10-year survival rates of endosseous zygomatic implants used in the rehabilitation of the atrophic maxilla. Forty-three consecutive zygomatic implant placements in 25 patients were evaluated over a 5-10-year period. All zygomatic implant surgery was carried out under general anaesthesia. Nobel Biocare zygomatic machined-surface implants were used, and placement was undertaken using the modified sinus slot method. The main outcome measures and determinants for success were survival of the restored implants and the proportion of originally planned prostheses delivered to patients. Of the 25 patients treated, 12 were male and 13 were female; 19 were non-smokers, and the mean age at time of surgery was 64 years. Patients were treatment-planned for implant-retained bridgework, a removable prosthesis retained by fixed cast gold or milled titanium beams, or magnet-retained removable prostheses. A combination of zygomatic and conventional implants was used in all but one patient. In this study it was shown that the overall success rate for zygomatic implants was 86%, with six of the implants either failing to integrate or requiring removal due to persistent infection associated with the maxillary sinus. All patients received their planned prosthesis, although in six cases the method of retention required modification. This study illustrates that zygomatic implants are a successful and important treatment option when trying to restore the atrophic maxilla, with the potential to avoid additional augmentation/grafting procedures and resulting in a high long-term success rate.

Formation of interdental soft tissue defects after surgical treatment of periodontitis.

This study monitored the development and repair of interdental soft tissue defects following surgical treatment of periodontitis in 21 patients. Open flap curettage was performed at 100 interdental areas with follow-up examinations 1, 3, and 6 months later. Interdental gingival contours were assessed both clinically and indirectly with silicone elastomer impressions from which stone models were obtained; defect depths were then calculated using the Reflex Microscope. Two types of defect were identified at the 1-month follow-up: 13 interdental clefts (mean depth, 1.8 mm); and 30 craters, (mean depth, 1.6 mm). Although clefts tended to persist, craters showed a strong tendency to repair. Thus, at the 6-month follow-up, the depths of clefts and craters were 1.3 mm and 0.7 mm respectively. The development of soft tissue defects did not appear to be related to the use of a periodontal dressing nor did the existence of an underlying bone defect appear to be of etiological importance. Pre-operative probing depths, however, were positively associated with the occurrence of soft tissue craters (P = 0.02). Pre-operatively, the overall mean probing depth and frequency of bleeding on probing were 5.3 mm and 100% respectively. At 6 months, these values were reduced to 2.0 mm and 22%. When clefts, craters, and interdental areas with no soft tissue defect were compared, no significant differences in probing depth reduction or frequency of bleeding were observed at any time point.(ABSTRACT TRUNCATED AT 250 WORDS)

The deep overbite: prevention of trauma.

An understanding of the mechanisms by which deep overbite trauma develops will allow interception at an early age of those cases most at risk. Measures may then be taken to prevent progression to the stage where treatment becomes difficult.