Oral health and oral implant status in edentulous patients with implant‐supported dental prostheses who are receiving long‐term nursing care

Aim: The aim of this study was to investigate oral health and oral implant status in a group of edentulous patients receiving long‐term residential or nursing care (LTC), all of whom had implant‐supported fixed or removable dental prostheses. Material and methods: A dental examination was performed on a total of 3310 patients receiving LTC and from this population 35 edentulous patients in whom dental implants had been placed formed the cohort for this study. All examinations were performed by a specialist in hospital dentistry and took place in the patients’ own home environment. Oral health was assessed by means of a protocol which evaluated oral hygiene status, possible oral mucosal inflammation and oral mucosal friction levels. Any problems with the implant‐supported prosthesis, implant mobility or other complications were also assessed. In addition, patients were asked about any oral symptoms and their usual oral hygiene procedures. Results: About half of the subjects (17/35) were registered as having no/mild inflammation with 18 of 35 having moderate/severe inflammation. Twelve of the 35 patients had good/acceptable oral hygiene and 23 of 35 had poor/bad oral hygiene. Twenty‐one of the 35 patients depended on help from the nursing personnel for their daily oral hygiene procedures. Obvious problems with food impaction were noted in 11 patients. A total of 229 implants had been placed in 43 jaws supporting 40 full arch‐fixed prostheses and three implant‐borne overdentures. There was no evidence of mobility or fractures of either the implants or the prostheses. Fifteen implants showed some exposed screw threads. Pus was exuding from one implant site and general peri‐implant gingival hyperplasia was noted in two patients. Twenty‐four patients were completely satisfied with the function and appearance of their implant‐supported prostheses. Two patients were totally dissatisfied. Conclusion: This study indicates that oral implant therapy can be considered as a treatment of choice in elderly patients, even if oral hygiene is sub‐optimal.     

Implant-supported palatal lift prosthesis in a patient with velopharyngeal incompetence: a case report

doi: 10.1111/j.1741‐2358.2011.00561.x Implant‐supported palatal lift prosthesis in a patient with velopharyngeal incompetence: a case report Objective: To describe the use of dental implants in the treatment of velopharyngeal incompetence. Background: Velopharyngeal incompetence is characterized by the inability to contract the tissues of the soft palate. The most common causes are neuromuscular problems resulting from concussion and degenerative conditions of the central nervous system. Materials and methods: The treatment using palatal lift prosthesis is well established in the literature; however, reports on the use of osseointegrated implants are scarce. Rehabilitation using only this type of fibromucosal support is difficult in edentulous patients, since the prosthesis has a palatal lift extension. Results: The implants provided retention and stability to the prosthesis, improving swallowing and speech and contributing to improve the patient’s quality of life. Conclusion: This article reports the rehabilitation of a patient with a totally edentulous maxilla with velopharyngeal incompetence using an implant‐retained palatal lift prosthesis.     

The effect of different attachment systems with implant‐retained overdentures on maximum bite force and EMG

doi: 10.1111/j.1741‐2358.2010.00389.x The effect of different attachment systems with implant‐retained overdentures on maximum bite force and EMG Objective: To compare the effect of different attachment systems with implant‐retained overdentures on maximum bite force and muscle activity using electromyography (EMG). Background: Denture retention and stability is of considerable interest in prosthetic dentistry. Materials and methods: Thirty‐five patients were examined: 15 edentulous patients treated with mandibular implant‐retained overdentures (MIRO) and maxillary dentures (MCD) (two implant‐ball attachment) (BC); 10 edentulous patients treated with MIRO and MCD (four implants‐bar attachments) (BRC); 10 patients with edentulous mandibular treated with MIRO and maxillary fixed partial dentures (MFPD) (two implant‐ball attachments) (BF). Before implant placement all patients received new dentures. After using these dentures for 3 months the maximum bite force and electrical activity of masseter muscle were measured. Two or four implants were then inserted into the intraforaminal region. After osseointegration periods, patients were treated with MIRO which duplicated their dentures and after three months the measurements were repeated. The data were collected and statistically analysed. Results: Muscle activity and chewing ability increased in the second period of measurements. Also chewing time was significantly decreased at the first measurements. The highest muscle activity was observed in the group of patients treated with group BF. Conclusion: The EMG values of the masseter muscle significantly increased when an implant attachments was used in the overdenture.     

Implant‐retained thumb prosthesis with anti‐rotational attachment for a geriatric patient

doi:10.1111/j.1741‐2358.2009.00283.x
Implant‐retained thumb prosthesis with anti‐rotational attachment for a geriatric patient This report presents the use of a dental implant with an anti‐rotational attachment for the retention of a thumb prosthesis. A retention system was manufactured with an attachment (UCLA) screwed into the implant with a two‐bar system that was cast in metallic silver palladium. A substructure made from heat‐cured acrylic resin was joined to the retention system by clips to join the thumb to the finger (bar clip) in the cast with implant rejoinder. The silicone material, Silastic‐MDX 44210, was used to achieve function and aesthetics. Following osseointegration, no skin problems were observed. Whilst the implant‐retained digital prosthesis presented some motor limitations, it allowed the patient to return to entertainment and achieve social conviviality.     

Mechanical response comparison in an implant overdenture retained by ball attachments on conventional regular and mini dental implants: a finite element analysis

This study investigates the bone/implant mechanical responses in an implant overdenture retained by ball attachments on two conventional regular dental implants (RDI) and four mini dental implants (MDI) using finite element (FE) analysis. Two FE models of overdentures retained by RDIs and MDIs for a mandibular edentulous patient with validation within 6% variation errors were constructed by integrating CT images and CAD system. Bone grafting resulted in 2 mm thickness at the buccal side constructed for the RDIs-supported model to mimic the bone augmentation condition for the atrophic alveolar ridge. Nonlinear hyperelastic material and frictional contact element were used to simulate characteristic of the ball attachment-retained overdentures. The results showed that a denture supported by MDIs presented higher surrounding bone strains than those supported by RDIs under different load conditions. Maximum bone micro strains were up to 6437/2987 and 13323/5856 for MDIs/RDIs under single centric and lateral contacts, respectively. Corresponding values were 4429/2579 and 9557/5774 under multi- centric and lateral contacts, respectively. Bone micro strains increased 2.06 and 1.96-folds under single contact, 2.16 and 2.24-folds under multiple contacts for MDIs and RDIs when lateral to axial loads were compared. The maximum RDIs and MDIs implant stresses in all simulated cases were found by far lower than their yield strength. Overdentures retained using ball attachments on MDIs in poor edentulous bone structure increase the surrounding bone strain over the critical value, thereby damaging the bone when compared to the RDIs. Eliminating the occlusal single contact and oblique load of an implant-retained overdenture reduces the risk for failure.     

Implant‐supported overdenture in an elderly patient with Huntington’s disease

doi:10.1111/j.1741‐2358.2009.00343.x
Implant‐supported overdenture in an elderly patient with Huntington’s disease Huntington’s disease is a hereditary, progressive, neuro‐degenerative disorder characterised by increasingly severe motor impairment, cognitive decline and behavioural manifestations leading to functional disability. Dyskinesia and hyperkinesia of the tongue and the peri‐oral musculature make it impossible for the patient to wear a conventional complete denture, despite an adequate alveolar ridge. The present paper reports on a patient with Huntington’s disease who was rehabilitated with a mandibular overdenture supported by two endosteal implants. One year follow‐up examination showed that the prosthesis was stable and there was considerable improvement in the patient’s masticatory function.     

Prosthetic rehabilitation of a patient with mandibular resection prosthesis using mini dental implants (MDIs)--case report

Physical disfigurement and functional impairments associated with facial trauma are a challenge to a prosthodontist, because even novel sophisticated surgical reconstructive techniques fail to provide adequate support for dental resection prosthesis. Therefore, different endosseous implants are often used as prosthesis-supporting elements. Manufacturers of dental implants have recently presented mini dental implants (MDIs) with diameter of only 1.8-2.4 mm. These implants allow very suitable prosthetic solutions within the range of their indications due to good osseointegration success rates, simple surgical technique, and immediate loading possibility. In this report, a case was presented for prosthetic rehabilitation including implantation of two Sendax type (IMTEC, Ardmore, Oklahoma, USA) MDIs in mental region, to obtain better retention and stability of the mandibular resection prosthesis and to improve function, phonation and aesthetics. The use of these implants, among aforementioned preferences, is also very cost-effective, so this implantation possibility should be taken into consideration during prosthetic treatment planning.     

The influence of implant number and attachment type on maximum bite force of mandibular overdentures: a retrospective study

doi: 10.1111/j.1741‐2358.2010.00421.x
The influence of implant number and attachment type on maximum bite force of mandibular overdentures: a retrospective study Aim: Assessment of the influence of such factors as attachment type, number of implants, gender and age of patients on maximum bite force (MBF). Material and methods: Sixty‐two edentulous patients (32 females, 30 males; aged 64.03 ± 10.07 years, range 42–90 years) with mandibular implant overdentures with various attachment types were included in the study and their MBFs were recorded. The results were evaluated statistically at a significance level of p < 0.05. Results: The MBF in male patients was found to be statistically significantly (p < 0.05) higher than in female patients. No statistically significant differences (p > 0.05) were found with respect to age groups, attachment types and number of implants supporting the mandibular overdentures. Conclusion: Within the limitations of this study, it is concluded that independent of the number applied, dental implants increase MBF in edentulous patients. While males show higher bite force, patient age and attachment type seem not to play an important role.     

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

doi:10.1111/j.1741‐2358.2009.00317.x
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.     

Elders with implant overdentures: a 22-year clinical report

doi: 10.1111/j.1741‐2358.2012.00628.x Elders with implant overdentures: a 22‐year clinical report Objective: To report on the long‐term survival and prosthodontic maintenance of two edentulous adults with mandibular overdentures supported by hydroxyapatite (HA)‐coated implants. Background: Mandibular implant overdentures are a successful treatment option with positive impact on the quality of life of elderly edentulous adults. Long‐term survival of the implants requires continued rigorous prosthodontic maintenance. Clinical report: Two elderly edentulous adults with mandibular overdentures supported by 2 HA‐coated implants were presented for prosthodontic rehabilitation after 22 years of placement. The implants were osseo‐integrated and surviving at presentation based on accepted criteria. The mandibular implant overdentures suffered recurrent loss of retention and stability. Prosthodontic treatment involving the replacement of defective attachment systems and construction of new sets of mandibular implant overdentures opposing complete maxillary dentures is presented. Conclusion: The long‐term survival of mandibular 2‐implant overdentures requires continued prosthodontic maintenance. A conservative approach in the rehabilitation of two older edentulous adults with mandibular 2‐implant overdentures was described including proper selection of attachment systems.     

Clinical feasibility of mandibular implant overdenture retainers submitted to immediate load

Gerodontology 2010; doi: 10.1111/j.1741‐2358.2010.00374.x
Clinical feasibility of mandibular implant overdenture retainers submitted to immediate load Introduction: Millions of people around the world do not have access to the benefits of osseointegration. Treatments involving oral rehabilitation with overdentures have been widely used by specialists in the oral medicine field. This is an alternative therapy for retention and stability achievement in total prosthesis with conventional treatment, and two implants are enough to establish a satisfactory overdenture. Objective: The objectives of the study were to evaluate 16 patients of both sexes, with an average age of 47.4 ± 4 years, using electromyographic analysis of masseter and temporal muscles and analyse the increase of incisive and molar maximal bite force with their existing complete dentures and following mandibular implant overdenture therapy to assess the benefits of this treatment. Materials and methods: For these tests, the Myosystem‐BR1 electromyograph and the IDDK Kratos dynamometer were used. Statistical analysis was performed using the repeated measures test (SPSS 17.0). Results: A decrease in electromyographic activity during the rest, lateral and protrusion movements and increase of the maximal incisive and molar bite force after 15 months with a mandibular implant overdenture was observed. Conclusion: All the patients in this study reported a considerable improvement in the masticatory function and prostheses stability following treatment. It is possible to propose that the use of mandibular implants overdenture should become the selected treatment for totally edentulous patients to facilitate oral function and quality of life.     

The influence of implant number and abutment design on the biomechanical behaviour of bone for an implant-supported fixed prosthesis: a finite element study in the upper anterior region

It is always recommended to use more implants for supporting a prosthesis in the immediate loading condition than in the classical two-stage treatment procedure. By means of the finite element (FE) method, the influence of the number of implants used in immediately loaded fixed partial prosthesis (FPP) on the load distribution was investigated, considering the abutment geometry. Two 3D FE models were studied employing four implants to support a FPP in the premaxilla. One model was designed with straight abutments and the other with 20°-angled abutments. The results concerning implant displacements, stresses and strains were compared with those of two implant-supported FPPs, obtained in a previous study. A noticeable reduction in the determined biomechanical bone loading was observed with the use of more implants in supporting an immediately loaded prosthesis. This study confirms that the use of additional numbers of implants in an immediately loaded prosthesis is highly recommended.     

Testicular prosthesis in a Quarterhorse stallion: a case report

A testicular prosthesis was surgically removed from the scrotum of a Quarterhorse stallion presented for evaluation of a large, firm, unilateral scrotal mass. The prosthesis was constructed from methyl methacrylate moulded around a roll of fiberglass casting tape. The prosthesis had been surgically implanted in the scrotum approximately 4 yr prior to presentation in order to give the appearance of 2 testicles in the scrotum for showing and breeding purposes. The horse had been used to successfully breed mares prior to presentation and produced 4.046 x 10(9) progressively motile, morphologically normal spermatozoa in an ejaculate collected 4 mo after surgery to remove the prosthesis. Ethical issues raised by this case are discussed.     

Self-reported denture hygiene of a sample of edentulous attendees at a University dental clinic and the relationship to the condition of the oral tissues

Objectives: This article aims to evaluate the habits of hygiene and usage of a sample group of Brazilian wearers of complete dentures. Design: This study has a cross‐sectional design. Setting: It was performed in the dental clinic of the University of Mogi das Cruzes. Subjects: A sample group of 236 complete denture wearers was selected. Intervention: The individuals were interviewed and clinically examined. Main outcome measures: Most commonly used hygiene habits were assessed and recorded. Possible relationships between habits and oral conditions were also assessed. Results: Dental treatment was sought by 43.6% 10 years after their last dental appointment, 77.5% declared they had been given no instructions regarding the hygiene of their dentures, only 22.9% said they had been instructed about oral hygiene, and 91.9% stated they had not been told to return for periodical review visits. Denture stomatitis was found in 42.4%, although 89% of these patients presented with no symptoms; 98.7% of the group brushed their dentures; 27.1% regularly immersed their dentures in chemical products; 26.3% removed their dentures overnight. A positive relationship was observed between the lack of recommendations regarding oral and denture cleansing and the presence of denture‐related stomatitis and hyperplasia. Family income and periodicity of visits to the dentist were also found to be related. Conclusion: Mechanical cleaning is the most prevalent method of hygiene. Self‐reported lack of guidance to oral care was statistically related to inflammatory oral conditions. Future research is necessary to clarify possible causal role between these factors.