The role of orthodontics in the regeneration of the degenerated dentition.

The demand for regeneration of a degenerated dentition has been increasing as a result of the development of societies, where the life expectancy is increasing and fighting age-related changes is in focus. Whereas removable dentures were acceptable and considered a norm earlier, patients do, to an increasing degree,demand fixed prosthetics; consequently, the development of implants has had an important impact. The balance in the chewing organ will change with time, due to age-related changes within the bone and the loss of teeth due to caries or periodontal disease, and malocclusions may develop or aggravate. The re-establishment of an aesthetical and functional satisfactory solution cannot be reached by replacing teeth by fixed prosthodontics and implants. The aim of this update was threefold: firstly, to demonstrate that age-related changes, often unnoticed by both the patient and the general dentist, can lead to degeneration of the dentition; secondly, to explain how an interdisciplinary approach can make regeneration of even severe degeneration possible; and finally, to show the importance of the general dentist in the maintenance of the obtained results. Treatments should not aim for short-term results but focus on maintainable results.

[MORFOHISTOHIMICHNA EVALUATION OF REHABILITATION PATIENTS WITH GENERALIZED PERIODONTAL DISEASE AGAINST CORONARY HEART DISEASE].

Un the basis of morphological studies examined the effectiveness of complex pathogenetic treatment of generalized periodontal disease with the use of products based on natural ingredients: dental paste "Fitopasta-3K" and drug "plantain juice" for the local treatment and drugs "Granules quercetin" and "Energoton" for systemic treatment. Established that one of the important mechanisms of complex pathogenetic treatment is the effect on energy metabolism of periodontal tissues, including the reduction of tissue hypoxia, metabolic stabilization was observed structural changes navkolozubnyh tissues. It should be noted positive effects of integrated treatment on the whole body.

Immediate implants and immediate loading in periodontally compromised patients-a 3-year prospective clinical study.

To avoid the necessity of a removable provisional prosthesis, and therefore preserve the patient's functional outcome, esthetics, and quality of life, a clinical protocol was developed to approach periodontally compromised patients presenting a full-arch irreversibly lost dentition: full-arch extraction and immediate replacement with a provisional acrylic resin implant-supported fixed partial denture (FPD). A total of 23 periodontally compromised patients (11 women, 12 men; 4 smokers, 4 controlled diabetics) were included in this study. Pretreatment casts were taken and vertical dimension of occlusion was determined. In most patients, 6 Straumann implants were distributed along the arch according to the surgical guide or bone availability, with the most distal ones in the maxilla slightly tilted so they could emerge more distally. A total of 168 implants (146 Straumann, 10 Nobel Biocare, 8 Biomet 3i, and 4 Lifecore) were placed (83 in the maxilla, 85 in the mandible). Of those in the maxilla, 74 were loaded immediately (implant stability quotient mentor [ISQm] > 70) and 9 placed with delayed loading (ISQm =/< 70). Of the 85 implants placed in the mandible, all were loaded immediately (ISQm > 70). If an FPD had not been fabricated already, impressions were taken during surgery to do so. The prosthesis was then adapted (cemented or screwed) to the 6 implants within the first 48 hours postsurgery. After 2 months, definitive impressions were taken, and a definitive porcelain-fused-to-metal implant-supported 12-element FPD was fabricated and cemented or screwed to all 6 implants. Of the 168 implants, 108 were immediate implants and 159 immediately loaded. Only 2 implants (1 in the mandible, 1 in the maxilla) did not osseointegrate. This yields a 3-year cumulative survival rate of 98.74% (98.65% in the maxilla, 98.82% in the mandible). From a total of 26 immediately loaded prostheses (12 in the maxilla, 14 in the mandible), 6 were cemented and 20 screw-retained. The 3-year cumulative survival rate was 100%. Immediate loading in mandibular and maxillary periodontally compromised patients presents itself as a predictable technique with a 100% cumulative survival rate for provisional and definitive prosthetic rehabilitations.

[Rehabilitation of a periodontally compromised dentition with implant-supported zirconia bridges. Case report]. / Sanierung eines parodontal geschädigten Gebisses mit implantatgetragenen Zirkoniumdioxidbrücken. Ein Fallbericht.

Clinical aspects of reconstruction with fix prosthesis and dental implants in a patient with a history of periodontitis is shown. A successful stabilization and rehabilitation of the periodontally involved dentition can be achieved with tooth-worn crown and bridge reconstructions. From a functional and aesthetic point of view the result may not be satisfying due to mobility and overlength of the teeth and open approximal spaces. Today, dentist and patient have often to weigh if teeth shall be maintained or replaced by dental implants. Thereby, both must be aware of the fact that in complex cases long-term success and aesthetic outcome may be difficult to predict. An intense discussion with the patient on his expectations, invasive treatment, risks with regard to biologic and prosthetic aspects is mandatory and must be based on the best scientific evidence available. The present case report shows different considerations and describes a radical solution which meets the patient's needs and is based on modern CAD-CAM technology.

Restoration of Periodontally Compromised Dentitions Using Telescopic Full-Arch Retrievable Prosthesis Supported by Tooth-Implant Combination: A Long-Term Retrospective Study.

Advanced periodontal disease is often associated with severe loss of tooth support, necessitating prosthetic rehabilitation to restore function and esthetics. For tooth-supported restorations, periodontally compromised teeth may need to be extracted due to early failure from functional overload. For tooth/implant-supported restorations, implants can be used to reduce the overload on teeth and to avoid tooth extraction, bone augmentation, or other risks associated with implant placement. The aim of this retrospective study was to evaluate the long-term outcomes of full-arch, retrievable, telescopic-retained prostheses (TRPs) on teeth and implants according to survival rate analyses and technical and biologic complications in full-mouth rehabilitation of periodontally compromised dentitions. A total of 18 periodontally compromised patients (7 women, 11 men) with a mean age of 46.8 years (SD: 6.3 years; range: 32 to 64 years) were selected to receive supplementary implants with the aim of extensive prosthetic support in combined tooth/implant TRPs and annually evaluated for technical and/or biologic failures/complications. After a follow-up period of 15 years, all prostheses were in function. Complication rates were low, and maintenance services were limited to minor interventions. Combined tooth/implant TRPs improve prosthetic support and offer successful function over the long term in patients with periodontally compromised dentition.

The periodontal prosthesis mode of transition to an implant-supported dentition.

In recent years, implant-supported reconstructions have become a welcome alternative to dentures for those who have lost their natural dentition. While the benefits of the final implant-supported reconstruction may be obvious, the planning and execution of therapy to achieve this result may be bewildering to many dentists. Four main modes of transfer have evolved: an uncontrolled or "haphazard" transition; the traditional "dentures first" mode, an immediate transition, and a staged transition. This article proposes an additional mode of transition called periodontal prosthesis, which has the potential to make the transition process smoother and more predictable while providing optimal retention of alveolar supporting structures and generating optimal esthetics.

[Ten years of experience with the complex periodontal and orthodontic rehabilitation of patients with periodontal diseases]. / Fogágybetegek komplex parodontoógiai és orthodonciai kezelésével szerzett 10 éves tapasztalataink.

In periodontal diseases where the loss of periodontal tissue is very extensive, displacement of the teeth may be observed. In the interest of complete healing, periodontal treatment must be followed by orthodontic treatment in such patients. If the basic rules relating to adult patients with a reduced, but healthy periodontium are adhered to, the orthodontics can be carried out with certainty in adults who have been rehabilitated from a periodontal aspect. An improved long-term result may be observed in the patients who participate in such complex rehabilitation. Teeth that have been restored to their correct position are not only aesthetically more attractive, but also function more appropriately, are easier to keep clean, and can be treated more simply.

METHODS OF INTEGRATING AESTHETIC REHABILITATION INTO THE TREATMENT PLAN OF ELDERLY PATIENTS.

UNLABELLED: Dental aesthetics represents a synonym for modern, cutting edge dentistry as it is a simultaneous mixture of art and science. The materials and the technology nowadays provide the resources for achieving extremely accurate and physiognomic restorations regardless of the amplitude of the intervention needed; consequently the treatment must respect the oral health and the optimal functioning of the dental-maxillary apparatus. One of the treatment phases that precede the final result, one step ahead in the treatment, is represented by the temporary restoration. The purpose of the paper consists in assessing the importance of restoring a patient's facial aesthetics--a key element for treatment success, while going through the phases that precede the final result. MATERIAL AND METHOD: The study includes 88 patients aged between 60-90 years (median age--75 years), treated at the Department of Oro-dental Diagnosis and Gerontostomatology, between January 2012 and December 2013. The patients requested the restoration of the functions affected by odontal coronary lesions, periodontal disease or edentation, malocclusion, cranial mandibular malrelations, and unsuccessful or deteriorated odontal or prosthetic treatments. RESULTS: Dental aesthetics implies a detailed assessment of each individual case because the long term success of the beautiful result achieved depends of the optimal state of health and functionality of the entire system. The final project in the cases studied was transformed into temporary restoration and afterward into permanent restoration. CONCLUSIONS: The use of temporary prosthesis within the treatment plan is important for the patient as it contributes at maintaining his social life active and also at developing the correct techniques for providing the proper hygiene for the restored elements.

Suggested solutions for common problems in clinical periodontics.

This short report offers solutions for three common clinical problems. Based on their experience, the authors suggest using a "spoon" type partial denture for the temporary replacement of maxillary anterior teeth. The denture is unique in that it has no clasps and does not contact the marginal gingiva. Also, conventional posterior curets have been modified by lengthening the shanks 5 mm while retaining the original dimensions of the working tip in order to reach relatively inaccessible areas more easily. Finally, to increase the utility of Orban knives in making primary inverse bevel flap incisions, the blade has been lengthened by 5 mm.

The successful use of osseointegrated implants for the treatment of the recalcitrant periodontal patient.

This study reports the successful use of osseointegrated implants to replace teeth in patients whose periodontal disease has been categorized as recalcitrant. It includes partially and totally endentulous jaws. A total of 309 implants placed by two periodontists practicing in traditional office settings were included in the survey. Of the 132 mandibular implants, 4 failed, for a success rate of 97%; and 3 of the 177 maxillary implants failed, for a success rate of 98%. There were 21 implants placed in 1985; 38 in 1986 and 1987; 185 from 1988 to 1990; 42 in 1991; and 23 in 1992. The report includes 42 mandibular and 50 maxillary prostheses, none of which has failed. One female mandibular case was converted from 2 posterior free-standing to a full arch prosthesis when the anterior teeth failed periodontally. These results demonstrate that individuals with a strong susceptibility to periodontal disease can be treated successfully with osseointegrated implants.

Implant-supported fixed prostheses for the rehabilitation of periodontally compromised dentitions: a 3-year prospective clinical study.

BACKGROUND: The application of a strict hygiene maintenance care protocol following rehabilitation of periodontally compromised dentitions by means of tooth-supported fixed partial dentures has demonstrated excellent long-term treatment outcome. PURPOSE: A clinical and radiographic study was performed to document and evaluate the short- and medium-term result of occlusal rehabilitation by means of implant-supported fixed prostheses (ISFPs) in patients treated for advanced periodontal disease. MATERIALS AND METHODS: Forty-three consecutive patients were included. All patients were referred because of advanced periodontal disease. Before the implant therapy was initiated, periodontal treatment was performed and the outcome evaluated during at least a 6-month period. An individual maintenance care program was designed for each patient. All 125 implants were placed using a two-stage surgical approach. Following installation of the ISFPs, all patients underwent a baseline examination including evaluation of oral hygiene, periodontal or peri-implant conditions, and radiographs. These examinations were repeated annually during the 3-year observation period. RESULTS: No single implant was lost during the 3-year follow-up period. The percentages of plaque-harboring surfaces and bleeding units on probing were found to be low (< 10%), and no soft-tissue complications were recorded. The mean marginal bone resorption during the observation period amounted to 0.21 mm. In a few patients, apposition of marginal bone was observed. Bone loss amounting to 0.5 mm or less was found around 81% of the implants (101/125 implants). The amount of bone loss around the remaining 24 implants (19%) varied between 0.5 and 2.0 mm. CONCLUSIONS: The present clinical trial demonstrates that, at least during a 3-year period, the ISFP is an acceptable and predictable treatment option for rehabilitation in patients who have lost their teeth because of periodontal disease. This observation seems to be valid in edentulous and partially dentate jaws. A prerequisite to reach such a favorable treatment outcome is possibly the combination of the strict maintenance care program and the careful design of the ISFPs.

Immediate esthetic treatment for anterior teeth: report of cases.

Prompt restoration of function and esthetic appearance of dentition can avoid psychological stress and functional problems. Surgical procedures that require long-term bone deposition and soft-tissue healing can accompany periodontal and orthodontic reinforcement, but other less invasive, immediate, intermediate, and final treatment plans can be initiated with good results.

Overdenture abutments and reduced periodontium in elderly patients. A retrospective study.

Among elderly patients attending a private office, a large number was seen having only few remaining teeth with advanced reduction of periodontal support. The long-term effect of overdenture rehabilitation within a mean observation time of 5.9 years (2 to 10 years) could be assessed in 109 patients (average age 74.1 years) wearing a total of 125 overdentures. After completion of treatment, 76% had regularly followed the maintenance care program. The degree of bone loss of the selected abutment teeth was assessed by means of radiographs. 56% showed a highly reduced periodontal support with bone loss of more than 50% of the root length. No, or moderate loss of periodontal support was found in only 9.5%. The overdentures were initially retained by 359 cast gold copings. Biologic and technical failures were registered for 54 copings and examined with regard to the reduction of periodontal support of the abutment teeth. Repair and treatment were prescribed for 30 copings, including guided tissue regeneration for 6 abutments. Twenty-four abutment roots with copings were extracted. Although most biologic failures were encountered in abutment teeth with severe reduction of the periodontium, the failure rate was not statistically higher for these abutments.

Teeth in a day. The Branemark Novum system.

The Branemark Novum system is a one-day treatment of the edentulous or periodontally hopeless mandibular dentition. There are four drill templates and eight drill guides that precisely position three implants which are totally parallel and level. A prefabricated lower bar is placed on the three implants, and an upper bar fits on the lower bar. The restorative dentist has previously selected denture teeth and recorded the vertical dimension of occlusion. The case is waxed up, adjusted, processed and delivered in one day.

The prosthetic management of gingival aesthetics.

Periodontal disease, trauma, and congenital defects can result in both soft tissue and hard tissue defects that can present with aesthetic problems. The management of these problems may be limited to prevention or surgical management which can result in significant morbidity especially if a second surgical site for grafting is utilised. This article describes the various prosthodontic techniques to improve gingival aesthetics using contemporary materials such as gingivally coloured composite and gingivally coloured porcelain in addition to more traditional materials such as standard prosthetic acrylic.

A minimally invasive approach to restore function and esthetics in periodontally involved teeth.

The objective of dental treatment is the elimination of the etiologic factors, the rehabilitation of function and esthetics, and, when possible, the maintenance of vitality and structure of the natural dentition. After the loss of the periodontal support, as a consequence of periodontal disease, it may be necessary to splint the residual teeth in order to improve their stability, and sometimes it is also necessary to modify the morphology to optimize the final esthetic outcome. In many periodontally treated teeth, prosthodontic treatment on the residual dentition will be required with an important loss of tooth structure as an unavoidable consequence. This procedure frequently requires endodontic treatment of the residual abutments in order to obtain the necessary space for replacement materials. Similar objectives could however be achieved through an alternative therapy where the esthetic remodeling of the teeth and the closure of the interproximal spaces is obtained with composite resin materials. The objective of this article is to present an alternative protocol to optimize the functional and esthetic result of periodontally treated cases, where the most frequent complication is the increased length of the clinical crown. This is obtained by utilizing a different conservative approach, which has as its main objective the stabilization of the residual teeth, the maintenance of their vitality, and the achievement of the best esthetic result possible.

Restorative options for the periodontal patient.

Periodontal and restorative dentistry are mutually important facets of clinical dentistry. Today's clinicians have many treatment options at their disposal, including biotolerant restorative materials and implants, to maintain periodontal health. It is crucial for the clinician to understand the biologic principles that form the foundation for restorative reconstruction of the periodontally involved tooth. This article discusses new techniques and trends in the critical management of the restorations, particularly at the gingival margins, and explores the role of implant dentistry as an option for the restorative plan of the periodontal patient.

Periodontal status of teeth restored with crowns and their contralateral homologues, Valdivia. Chile / Estado periodontal de dientes rehabilitados con prótesis fija unitaria y sus homólogos contralaterales, Valdivia - Chile

To determine periodontal status of fixed single prostheses (FSP) installed in 2013 at Austral University of Chile, and its contralateral homologue (CH). Methods: A group of patients with FSP installed during 2013, who met the selection criteria and agreed to participate in the study were evaluated. Probing depth, attachment level; bleeding on probing and dental plaque index for each FSP and CH were measured in 2014; biological width invasion was also evaluated. One FSP and one CH were measured per patient, and in 6 sites for each tooth. Results: Seventy-four patients were evaluated. The majority were women (73 percent); posterior teeth accounted for 63.5 percent. The majority of participants had history of previous periodontal disease (85.1 percent), of which 58.7 percent was Periodontitis. Six of the patients with a history of gingivitis progressed to periodontitis (23.07 percent); while 100 percent of patients with no history of periodontal disease maintained their condition. Only 4 of the FSP evaluated showed biological invasion width. Discussion: Similar results were found for FSP and CH teeth with respect to probing depth, clinical attachment level and bleeding on probing. However, a difference in relation to dental plaque index was observed: positive in 58.1percent CH and positive in 29.7 percent FSP. Under the conditions of this study, it is concluded that the periodontal status of teeth with FSP does not differ from CH...

Objetivo: Determinar el estado periodontal de los dientes rehabilitados con prótesis fija unitaria (PFU) realizadas el año 2013 en Universidad Austral de Chile, y la de su homólogo contralateral (HCL). Material y método: Se evaluaron los pacientes con PFU realizadas durante el 2013 que cumplieron con los criterios de selección y aceptaron participar. Se midió durante el año 2014: profundidad al sondaje, nivel de inserción, sangramiento al sondaje e índice de placa para cada PFUy HCL; y se consignó invasión del ancho biológico. Se midió una PFU y un HCL por cada paciente, y 6 sitios por cada diente. Se utilizó estadística descriptiva. Resultados: Se evaluaron 74 pacientes de los cuales 73 por ciento fueronmujeres. El 63,5 por ciento de los dientes evaluados fueron posteriores. El 85,1 por ciento tenía antecedentes de enfermedad periodontal previa, de los cuales el 58,7 por ciento correspondió aPeriodontitis. De los pacientes con antecedentes de gingivitis, 6 progresaron a periodontitis (23,07 por ciento); mientras que el 100 por ciento de los pacientes sin antecedentes de enfermedad periodontal mantuvieron su condición. Sólo 4 de las PFU evaluadas tenían Invasión del ancho biológico.Discusión: Se encontraron resultados similares entre PFU y HCL para las variables profundidad al sondaje,nivel de inserción clínica y sangramiento al sondaje. Sinembargo, hubo diferencias en índice de placa, positivo en un 58,1 por ciento de los HCL y en un 29,7 por ciento, de las PFU. Bajo las condiciones del presente estudio se concluye que el estado periodontal de los dientes rehabilitados con PFU no difiere del estado de los HCL...