1. Topic: Implant therapy outcomes, prosthetic aspects
ReferencesReferences
ConclusionsConclusions
Case reportCase report
DENTAL IMPLANTS AS STRATEGIC ABUTMENTS TO IMPROVE
FIXED PROSTHESES’S FUNCTION AND ESTHETICS
FOUNDOUKAS DIMOSTHENIS
DENTAL SURGEON (private practice)
KATERINI GREECE dfound@otenet.gr
PSN-EAO101-259
AbstractAbstract
Presented at the 19th Annual Scientific Meeting of the European Association of Osseointegration – 6-9 October 2010, GlasgowPresented at the 19th Annual Scientific Meeting of the European Association of Osseointegration – 6-9 October 2010, Glasgow
The absence of some teeth can force the dentist to plan removable partial
dentures in order to solve prosthetic rehabilitation. The use of dental
implants can give the necessary fixation of fixed bridges instead of
removable dentures, offering the patients optimal mastication ability and
excellent esthetics.
In our clinical case presentation, a patient with excessive teeth abrasion
(attrition) and upper lateral teeth lost was treated with implants at the
anodontia area and manufacture of crowns and bridges for reconstruction
of the lost vertical dimension. Our patient achieved an improvement in daily
oral activities and the quality of the life was increased.
Osseo integrated implants become extremely valuable treatment option in
oral and maxillofacial reconstruction.
The patient, a 63-year-old man, came to our clinic for dental treatment with
teeth-shortening problems and poor facial esthetics. On clinical examination
excessive loss of dental substances in the insical and occlusal areas and
upper lateral anodontia were revealed. In the pretreatment, by means of a jaw
interference guide device, cast models mounted on a semi-adjustable
articulator and in cast waxing evaluation, the lost vertical dimension (VD)
was estimated to be 7 mm. In planning the treatment, the patient demanded a
fixed prosthetic solution and we suggested the use of implants to restore the
lateral anodontia. The treatment plan consisted of establishing a correct
vertical dimension with fixed implants and natural tooth-supported crowns
and bridges. After the period of the necessary implant (ANKYLOS B11)
osseointegration, temporary metal-acrylic fixed prosthesis was applied at
the increased vertical dimension, improving facial aesthetics and phonetics.
The patient wore the temporary prosthesis to confirm his adaptation to his
new vertical dimension. The occlusion was checked and refinements made
as appropriate. On future visits to our surgery, minor acrylic substance lost
was recorded. The patient expressed satisfaction at the improved
mastication ability, good, natural esthetics and continued to demonstrate
excellent oral hygiene. Finally, after 4 months, ceramic fused to metal crowns
and bridges constructed at the new location and an occlusal device (splint)
was strongly suggested the patient to wear every night.
Full mouth rehabilitation of severe cases of tooth wear is a complex
treatment. This situation may be either a functional or aesthetic deficit, but
usually a combination of both. The choice between a fixed or removable
approach to tooth replacement is crucial. The success of prosthetic
rehabilitation can be variable and depend on various factors. Clinicians will
increasingly face such problems as more natural teeth are retained into
older age and patients' aesthetic demands and expectations rise.
Bruxism is one of the most prevalent, complex, and destructive dental
functional disorders. The effects of bruxism are multiple and diverse and
include TMJ pain and dysfunction, tooth wear, mobility, abrasion, loss of
and damage to supporting structures, disturbance of esthetics, and oral
discomfort. Altering the vertical dimension by increasing the interarch
distance is common in oral rehabilitation. Alteration of VD is an acceptable
procedure in patients with implant-supported fixed restorations, but
precautions should be taken to prevent mechanical problems such as
porcelain fractures or screw loosening. The alteration of VD can provide a
biologically compatible adjunct to treatment, enhancing esthetic tooth
display, improve lip support, establish anatomic harmony and improve
phonetics. Such considerations can improve dentofacial esthetics, create
improved visual proportions in facial height, and provide an important
treatment modality for force management of the masticator system.
The use of implants in such cases plays a strategic role allowing the
dental clinician to be able to meet the patient’s demands and offering a
fixed prosthesis instead of a removable one.
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