The document discusses various treatment options for edentulous patients, including full dentures, implant-supported prostheses, grafting techniques like sinus augmentation to increase bone for posterior maxillary implants, and graftless options like short implants, tilted implants, and zygoma implants. Successful treatment requires considering factors like a patient's bone quality and quantity, forces from occlusion, aesthetics, and costs. Both graft and graftless techniques can provide effective treatment for edentulism, but outcomes depend on the individual clinical situation.
This document provides an overview of implant supported overdentures, including definitions, history, indications, contraindications, advantages, disadvantages, treatment options, and procedures. Key points discussed include:
- Overdentures are removable prostheses that cover natural tooth roots, implants, or both for support.
- Implant supported overdentures have better outcomes than conventional dentures or overdentures supported only by natural tooth roots.
- Treatment options depend on factors like jaw, bone quality, number of implants, and can involve bar-retained or independent attachments.
- Procedures involve medical evaluation, treatment planning, transitional dentures, surgical placement, attachment connection, and definitive prosthesis fabrication
This document discusses obturators used for acquired maxillary defects. It begins by defining an obturator and reviewing the history of obturators dating back to Ambroise Pare in the 1540s. It then covers classifications of maxillary defects, designs of obturators for different defect classes, functions of obturators, materials used, and considerations for fabrication. The document emphasizes that obturators are designed to close tissue openings, restore oral function, and rehabilitate patients with maxillary defects through adequate support, retention and stability.
This document provides an overview of Gothic arch tracing techniques used to record centric relation. It defines key terms and discusses the history and evolution of graphic recording methods from early needle point tracings to modern extraoral and intraoral tracers that produce Gothic arch tracings. The conventional extraoral technique is described in 12 steps, from mounting the tracers to making centric and protrusive plaster records. Intraoral tracings are noted to be smaller and harder to observe during tracing compared to extraoral methods.
The document discusses immediate dentures, which are dentures fabricated and inserted immediately following tooth extraction. It describes the different types of immediate dentures, including conventional/classic immediate dentures, interim immediate dentures, labial flange dentures, partial flange dentures, and flangeless/socketed dentures. The advantages of immediate dentures include maintaining a patient's appearance without teeth, providing a bandage effect to extraction sites, and allowing easier adaptation to dentures during healing. However, immediate dentures also present challenges like reduced retention from undercuts caused by remaining posterior teeth.
1. A tooth supported overdenture is a removable partial or complete denture that covers and receives support from one or more remaining natural teeth or dental implants.
2. It provides advantages like ridge preservation, improved retention, stability and support compared to conventional complete dentures.
3. Tooth supported overdentures can be classified based on the type of abutment preparation (coping vs non-coping) and the timing of placement (immediate, interim or definitive).
An altered cast procedure to improve tissue supportCPGIDSH
The document discusses an altered cast technique for removable partial dentures. The technique involves making an impression of the edentulous ridge after the metal framework is cast. This refined impression is used to alter the edentulous areas of the master cast, accurately reproducing the supporting tissues. This provides correct denture base extension and favorable physiologic support when seated. The technique offers benefits like reducing adjustments and preserving residual ridges by improving stress distribution. Two case examples demonstrate using the altered cast technique for mandibular and maxillary removable partial dentures.
The document discusses overdentures, which are removable partial or complete dentures that cover and rest on one or more remaining natural teeth, tooth roots, or dental implants. Key points include:
- Retaining natural teeth can preserve alveolar bone and periodontal receptors important for function.
- Abutment teeth are prepared with short copings or left uncovered, and attachments may be added to improve retention.
- Overdentures can improve retention, stability, support and proprioception compared to conventional dentures.
- Proper case selection and maintenance are important for long term success.
Fixed partial dentures transmit forces through the abutments to the periodontium. Failures are due to poor engineering, the use of improper materials, inadequate tooth preparation, and faulty fabrication. Of particular concern to prosthodontist is the selection of teeth for abutments. They must recognize the forces developed by the oral mechanism, and resistance.
Successful selection of abutments for fixed partial dentures requires sensitive diagnostic ability. Thorough knowledge of anatomy, ceramics, the chemistry and physics of dental materials, metallurgy, Periodontics, phonetics, physiology, radiology and the mechanics of oral function is fundamental.
This document provides an overview of implant supported overdentures, including definitions, history, indications, contraindications, advantages, disadvantages, treatment options, and procedures. Key points discussed include:
- Overdentures are removable prostheses that cover natural tooth roots, implants, or both for support.
- Implant supported overdentures have better outcomes than conventional dentures or overdentures supported only by natural tooth roots.
- Treatment options depend on factors like jaw, bone quality, number of implants, and can involve bar-retained or independent attachments.
- Procedures involve medical evaluation, treatment planning, transitional dentures, surgical placement, attachment connection, and definitive prosthesis fabrication
This document discusses obturators used for acquired maxillary defects. It begins by defining an obturator and reviewing the history of obturators dating back to Ambroise Pare in the 1540s. It then covers classifications of maxillary defects, designs of obturators for different defect classes, functions of obturators, materials used, and considerations for fabrication. The document emphasizes that obturators are designed to close tissue openings, restore oral function, and rehabilitate patients with maxillary defects through adequate support, retention and stability.
This document provides an overview of Gothic arch tracing techniques used to record centric relation. It defines key terms and discusses the history and evolution of graphic recording methods from early needle point tracings to modern extraoral and intraoral tracers that produce Gothic arch tracings. The conventional extraoral technique is described in 12 steps, from mounting the tracers to making centric and protrusive plaster records. Intraoral tracings are noted to be smaller and harder to observe during tracing compared to extraoral methods.
The document discusses immediate dentures, which are dentures fabricated and inserted immediately following tooth extraction. It describes the different types of immediate dentures, including conventional/classic immediate dentures, interim immediate dentures, labial flange dentures, partial flange dentures, and flangeless/socketed dentures. The advantages of immediate dentures include maintaining a patient's appearance without teeth, providing a bandage effect to extraction sites, and allowing easier adaptation to dentures during healing. However, immediate dentures also present challenges like reduced retention from undercuts caused by remaining posterior teeth.
1. A tooth supported overdenture is a removable partial or complete denture that covers and receives support from one or more remaining natural teeth or dental implants.
2. It provides advantages like ridge preservation, improved retention, stability and support compared to conventional complete dentures.
3. Tooth supported overdentures can be classified based on the type of abutment preparation (coping vs non-coping) and the timing of placement (immediate, interim or definitive).
An altered cast procedure to improve tissue supportCPGIDSH
The document discusses an altered cast technique for removable partial dentures. The technique involves making an impression of the edentulous ridge after the metal framework is cast. This refined impression is used to alter the edentulous areas of the master cast, accurately reproducing the supporting tissues. This provides correct denture base extension and favorable physiologic support when seated. The technique offers benefits like reducing adjustments and preserving residual ridges by improving stress distribution. Two case examples demonstrate using the altered cast technique for mandibular and maxillary removable partial dentures.
The document discusses overdentures, which are removable partial or complete dentures that cover and rest on one or more remaining natural teeth, tooth roots, or dental implants. Key points include:
- Retaining natural teeth can preserve alveolar bone and periodontal receptors important for function.
- Abutment teeth are prepared with short copings or left uncovered, and attachments may be added to improve retention.
- Overdentures can improve retention, stability, support and proprioception compared to conventional dentures.
- Proper case selection and maintenance are important for long term success.
Fixed partial dentures transmit forces through the abutments to the periodontium. Failures are due to poor engineering, the use of improper materials, inadequate tooth preparation, and faulty fabrication. Of particular concern to prosthodontist is the selection of teeth for abutments. They must recognize the forces developed by the oral mechanism, and resistance.
Successful selection of abutments for fixed partial dentures requires sensitive diagnostic ability. Thorough knowledge of anatomy, ceramics, the chemistry and physics of dental materials, metallurgy, Periodontics, phonetics, physiology, radiology and the mechanics of oral function is fundamental.
This document discusses surveyed crowns used for combined fixed and removable partial denture cases. It describes the treatment sequence including mounting diagnostic casts, creating a diagnostic wax-up to determine tooth preparations and restorative contours, making tooth preparations and provisional restorations, taking final impressions, and the laboratory procedures for the surveyed crown fabrication such as performing a wax-up and establishing the path of insertion for the removable partial denture.
Attachments in implant retained overdentures/ cosmetic dentistry trainingIndian dental academy
Indian Dental Academy: will be one of the most relevant and exciting
training center with best faculty and flexible training programs
for dental professionals who wish to advance in their dental
practice,Offers certified courses in Dental
implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic
Dentistry, Periodontics and General Dentistry.
This document discusses provisional restorations and their requirements. It defines provisional restorations as temporary restorations designed to enhance function and aesthetics until definitive treatment. Provisional restorations must meet biological, mechanical, and aesthetic requirements. Biologically, they must protect the pulp, maintain periodontal health, and provide positional stability. Mechanically, they must resist functional loads and removal forces. Aesthetically, they must match the tooth's color, shape, and texture. The document discusses various materials used for provisional restorations including acrylic resins, bis-acryl composites, and light-cured resins.
The document describes the altered cast technique, which is a modification of the functional impression technique used in removable partial dentures. It involves making a functional impression to capture the displaced shape of the residual ridge under load. The edentulous area is then cut out from the original master cast. The framework and functional impression are seated on the modified master cast. Stone is poured into the impression to create an altered, or corrected, cast reflecting the displaced ridge shape under load. This ensures uniform support of the denture base in the functional form of the residual ridge.
The document discusses the components and function of dental implants. There are two main components: fixtures, which interface with bone, and abutments, which connect to fixtures and support prosthetics. Accessories include cover screws, gingival formers, implant analogues, and impression copings. Fixtures integrate with bone via osseointegration. Abutments connect prosthetics like crowns or bridges to fixtures. Together, the components replace missing teeth and preserve bone through osseointegration.
MANAGEMENT OF SEVERELY RESORBED RIDGES Kate Maundu
Flabby ridges occur due to excessive load and bone resorption, resulting in mobile tissue. Management includes conservative approaches like tissue rest and massage, denture modifications, and tissue conditioning. Impression techniques aim to support flabby tissue without displacement. Surgical techniques can provide firm tissue but risk further resorption. Implants avoid tissue support. Severely resorbed ridges have multiple etiological factors and require extensive denture modifications or surgery to improve support and retention.
Attachments in removable partial prosthesishamide norouzi
An attachment is a connector used in removable and fixed prosthodontics that consists of two parts: a female part attached to a tooth, implant, or ridge that acts as a retainer, and a male part attached to the prosthesis. Attachments are classified based on their location, fabrication method, retention mechanism, and degree of movement allowed. Key factors to consider when selecting an attachment include the condition of the abutment teeth and ridge, space available, and the patient's dexterity. Common attachment types include intracoronal, extracoronal, stud, bar, and telescopic attachments.
Centric relation is the most posterior position of the mandible in relation to the maxilla, from which lateral movements can be made. It is a reproducible position that serves as a reliable guide for developing occlusion in complete dentures. There are various methods for recording centric relation, including functional methods like the needle house method and excursive methods using intraoral or extraoral tracings. Establishing accurate centric relation is important for proper functioning, aesthetics, and comfort of complete dentures.
Obturator prosthesis for management of maxillary defectspriyanka konda
Obturators are prosthetic devices used to close congenital or acquired defects of the hard palate and/or soft palate. The document provides a history of obturators dating back to the 1530s and discusses their objectives, uses, design considerations, types including for congenital and acquired defects, and recent techniques. Key points are that obturators are designed for retention, stability, and support and that there are various types including immediate surgical, hollow bulb, inflatable, and magnet retained obturators. Recent techniques discussed 3D printing of obturators.
The human mandible can be related to the maxilla in several positions in the horizontal plane. Among these centric relation is a significant position, because of its usefulness in relating the dentulous and edentulous mandible to maxilla, where the teeth , muscles and temporomandibular joint function in harmony. It is a position of occluso-articular harmony.
The document discusses one-stage and two-stage implant placement procedures. In a two-stage procedure, implants are placed and submerged under soft tissue and allowed to heal for 2-6 months before being exposed in a second surgery. In a one-stage procedure, the implant or abutment emerges through soft tissue at initial placement. The document outlines the steps for implant site preparation, placement, flap closure, post-operative care, and second-stage exposure surgery in a two-stage approach.
Fluid control and Soft tissue management in ProsthodonticsVinay Kadavakolanu
Fluid control and soft tissue management are important for maintaining a dry operating field during dental procedures. Moisture can be generated from saliva, blood, water, and gingival crevicular fluid. Both mechanical and chemical methods are used to control fluids. Mechanical methods include rubber dams, high volume suction, saliva ejectors, cotton rolls, and retraction cords. Chemical methods use anti-sialagogues or local anesthetics administered systemically, or vasoconstrictors and astringents applied topically via retraction cords. Recent advances allow for improved visibility, access, and infection control during procedures through advances in fluid control techniques.
This document discusses lingualized occlusion for removable prosthodontics. It begins by providing background on the search for ideal denture occlusion and defines lingualized occlusion. Key points include:
- Prof. Alfred Gysi first introduced the concept of lingualized occlusion in 1927 using maxillary teeth with single linear cusps fitting into shallow mandibular depressions.
- Lingualized occlusion aims to maintain esthetics and food penetration of anatomic teeth while providing the mechanical freedom of non-anatomic teeth. It utilizes anatomic maxillary teeth and modified non-anatomic mandibular teeth.
- The document outlines the evolution and advantages of lingualized occlusion and provides principles for its use in
The document discusses the benefits of meditation for reducing stress and anxiety. Regular meditation practice can help calm the mind and body by lowering heart rate and blood pressure. Studies have shown that meditating for just 10-20 minutes per day can have significant positive impacts on both mental and physical health over time.
This document discusses concepts and techniques related to occlusal rehabilitation. It covers topics such as centric relation, anterior guidance, restoring anterior and posterior teeth, and solving various occlusion problems. The Pankey-Mann-Schuyler philosophy advocates establishing stable centric stops, proper anterior guidance in harmony with jaw movements, disclusion of posterior teeth in protrusion, and non-interference of teeth during lateral excursions. The document provides guidelines for determining tooth contours and positions to achieve optimal function, stability, and aesthetics.
1. The functionally generated pathway technique involves recording the paths of tooth movement during excursive jaw motions using wax or other materials.
2. This recording is used to develop the occlusal morphology for dental restorations like crowns, ensuring optimal occlusion during all jaw motions.
3. Studies have found that the functionally generated pathway technique results in restorations with better functional articulation compared to conventional single casting techniques, with less adjustment needed and higher patient satisfaction.
An occlusal splint is a removable dental appliance that covers the biting surfaces of the teeth in one dental arch. There are several types of occlusal splints classified based on their design and intended use. The main types include permissive splints, non-permissive splints, and anterior repositioning splints. Occlusal splints are used to treat temporomandibular joint disorders by relaxing the jaw muscles, supporting the jaw in an optimal position, and reducing forces on the teeth and jaw joints.
This document discusses the neutral zone in complete dentures. It defines the neutral zone as the area in the mouth where forces from the tongue pressing outward are balanced by forces from the cheeks and lips pressing inward. It describes the muscles involved and how their forces influence tooth position and denture stability. It also discusses how the edentulous mouth changes over time, increasing the importance of properly recording the neutral zone for complete denture fabrication.
This document discusses precision attachments used in removable prosthodontics. It begins with an introduction and history, then covers definitions, classifications, indications, advantages and disadvantages. It describes the selection process for abutment teeth and attachments, including requirements. It examines intracoronal and extracoronal attachments in detail, discussing various types such as the Chayes attachment, O-ring attachment, and bar attachments. It explores the role of attachments in breaking stress and their mechanics of retention. In conclusion, precision attachments can provide improved function, retention and aesthetics for removable partial dentures when the appropriate abutment teeth and attachment are selected.
The treatment of maxillary transverse deficiency in post-pubertal patients has been an area of disagreement among orthodontists. Much of the controversy is over the timing of when it is appropriate for these patients to be referred to an oral and maxillofacial surgeon for an adjunctive surgical procedure or whether traditional orthodontic mechanics should be attempted. The decision, therefore, by an orthodontist of when to refer a patient for surgery
appears to be an individual one. The question then becomes which of the three basic surgical procedures would be most appropriate for the patient. Specifically, consideration must be given to surgically assisted rapid palatal expansion, segmental LeFort I osteotomy, or mandibular midline osteotomy with constriction.
This document discusses preprosthetic surgery and its role in preparing an ideal foundation for complete dentures. It defines preprosthetic surgery as procedures designed to facilitate prosthodontic care. The goals of preprosthetic surgery are to modify the oral environment to be disease-free and provide adequate bony and soft tissue support. Surgical procedures described include alveolar ridge correction/extension, frenectomy, tori removal, and vestibuloplasty to deepen vestibular depth. Patient evaluation and treatment planning is important to determine the appropriate surgical interventions needed to establish an optimal ridge form and tissue support for denture retention.
This document discusses surveyed crowns used for combined fixed and removable partial denture cases. It describes the treatment sequence including mounting diagnostic casts, creating a diagnostic wax-up to determine tooth preparations and restorative contours, making tooth preparations and provisional restorations, taking final impressions, and the laboratory procedures for the surveyed crown fabrication such as performing a wax-up and establishing the path of insertion for the removable partial denture.
Attachments in implant retained overdentures/ cosmetic dentistry trainingIndian dental academy
Indian Dental Academy: will be one of the most relevant and exciting
training center with best faculty and flexible training programs
for dental professionals who wish to advance in their dental
practice,Offers certified courses in Dental
implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic
Dentistry, Periodontics and General Dentistry.
This document discusses provisional restorations and their requirements. It defines provisional restorations as temporary restorations designed to enhance function and aesthetics until definitive treatment. Provisional restorations must meet biological, mechanical, and aesthetic requirements. Biologically, they must protect the pulp, maintain periodontal health, and provide positional stability. Mechanically, they must resist functional loads and removal forces. Aesthetically, they must match the tooth's color, shape, and texture. The document discusses various materials used for provisional restorations including acrylic resins, bis-acryl composites, and light-cured resins.
The document describes the altered cast technique, which is a modification of the functional impression technique used in removable partial dentures. It involves making a functional impression to capture the displaced shape of the residual ridge under load. The edentulous area is then cut out from the original master cast. The framework and functional impression are seated on the modified master cast. Stone is poured into the impression to create an altered, or corrected, cast reflecting the displaced ridge shape under load. This ensures uniform support of the denture base in the functional form of the residual ridge.
The document discusses the components and function of dental implants. There are two main components: fixtures, which interface with bone, and abutments, which connect to fixtures and support prosthetics. Accessories include cover screws, gingival formers, implant analogues, and impression copings. Fixtures integrate with bone via osseointegration. Abutments connect prosthetics like crowns or bridges to fixtures. Together, the components replace missing teeth and preserve bone through osseointegration.
MANAGEMENT OF SEVERELY RESORBED RIDGES Kate Maundu
Flabby ridges occur due to excessive load and bone resorption, resulting in mobile tissue. Management includes conservative approaches like tissue rest and massage, denture modifications, and tissue conditioning. Impression techniques aim to support flabby tissue without displacement. Surgical techniques can provide firm tissue but risk further resorption. Implants avoid tissue support. Severely resorbed ridges have multiple etiological factors and require extensive denture modifications or surgery to improve support and retention.
Attachments in removable partial prosthesishamide norouzi
An attachment is a connector used in removable and fixed prosthodontics that consists of two parts: a female part attached to a tooth, implant, or ridge that acts as a retainer, and a male part attached to the prosthesis. Attachments are classified based on their location, fabrication method, retention mechanism, and degree of movement allowed. Key factors to consider when selecting an attachment include the condition of the abutment teeth and ridge, space available, and the patient's dexterity. Common attachment types include intracoronal, extracoronal, stud, bar, and telescopic attachments.
Centric relation is the most posterior position of the mandible in relation to the maxilla, from which lateral movements can be made. It is a reproducible position that serves as a reliable guide for developing occlusion in complete dentures. There are various methods for recording centric relation, including functional methods like the needle house method and excursive methods using intraoral or extraoral tracings. Establishing accurate centric relation is important for proper functioning, aesthetics, and comfort of complete dentures.
Obturator prosthesis for management of maxillary defectspriyanka konda
Obturators are prosthetic devices used to close congenital or acquired defects of the hard palate and/or soft palate. The document provides a history of obturators dating back to the 1530s and discusses their objectives, uses, design considerations, types including for congenital and acquired defects, and recent techniques. Key points are that obturators are designed for retention, stability, and support and that there are various types including immediate surgical, hollow bulb, inflatable, and magnet retained obturators. Recent techniques discussed 3D printing of obturators.
The human mandible can be related to the maxilla in several positions in the horizontal plane. Among these centric relation is a significant position, because of its usefulness in relating the dentulous and edentulous mandible to maxilla, where the teeth , muscles and temporomandibular joint function in harmony. It is a position of occluso-articular harmony.
The document discusses one-stage and two-stage implant placement procedures. In a two-stage procedure, implants are placed and submerged under soft tissue and allowed to heal for 2-6 months before being exposed in a second surgery. In a one-stage procedure, the implant or abutment emerges through soft tissue at initial placement. The document outlines the steps for implant site preparation, placement, flap closure, post-operative care, and second-stage exposure surgery in a two-stage approach.
Fluid control and Soft tissue management in ProsthodonticsVinay Kadavakolanu
Fluid control and soft tissue management are important for maintaining a dry operating field during dental procedures. Moisture can be generated from saliva, blood, water, and gingival crevicular fluid. Both mechanical and chemical methods are used to control fluids. Mechanical methods include rubber dams, high volume suction, saliva ejectors, cotton rolls, and retraction cords. Chemical methods use anti-sialagogues or local anesthetics administered systemically, or vasoconstrictors and astringents applied topically via retraction cords. Recent advances allow for improved visibility, access, and infection control during procedures through advances in fluid control techniques.
This document discusses lingualized occlusion for removable prosthodontics. It begins by providing background on the search for ideal denture occlusion and defines lingualized occlusion. Key points include:
- Prof. Alfred Gysi first introduced the concept of lingualized occlusion in 1927 using maxillary teeth with single linear cusps fitting into shallow mandibular depressions.
- Lingualized occlusion aims to maintain esthetics and food penetration of anatomic teeth while providing the mechanical freedom of non-anatomic teeth. It utilizes anatomic maxillary teeth and modified non-anatomic mandibular teeth.
- The document outlines the evolution and advantages of lingualized occlusion and provides principles for its use in
The document discusses the benefits of meditation for reducing stress and anxiety. Regular meditation practice can help calm the mind and body by lowering heart rate and blood pressure. Studies have shown that meditating for just 10-20 minutes per day can have significant positive impacts on both mental and physical health over time.
This document discusses concepts and techniques related to occlusal rehabilitation. It covers topics such as centric relation, anterior guidance, restoring anterior and posterior teeth, and solving various occlusion problems. The Pankey-Mann-Schuyler philosophy advocates establishing stable centric stops, proper anterior guidance in harmony with jaw movements, disclusion of posterior teeth in protrusion, and non-interference of teeth during lateral excursions. The document provides guidelines for determining tooth contours and positions to achieve optimal function, stability, and aesthetics.
1. The functionally generated pathway technique involves recording the paths of tooth movement during excursive jaw motions using wax or other materials.
2. This recording is used to develop the occlusal morphology for dental restorations like crowns, ensuring optimal occlusion during all jaw motions.
3. Studies have found that the functionally generated pathway technique results in restorations with better functional articulation compared to conventional single casting techniques, with less adjustment needed and higher patient satisfaction.
An occlusal splint is a removable dental appliance that covers the biting surfaces of the teeth in one dental arch. There are several types of occlusal splints classified based on their design and intended use. The main types include permissive splints, non-permissive splints, and anterior repositioning splints. Occlusal splints are used to treat temporomandibular joint disorders by relaxing the jaw muscles, supporting the jaw in an optimal position, and reducing forces on the teeth and jaw joints.
This document discusses the neutral zone in complete dentures. It defines the neutral zone as the area in the mouth where forces from the tongue pressing outward are balanced by forces from the cheeks and lips pressing inward. It describes the muscles involved and how their forces influence tooth position and denture stability. It also discusses how the edentulous mouth changes over time, increasing the importance of properly recording the neutral zone for complete denture fabrication.
This document discusses precision attachments used in removable prosthodontics. It begins with an introduction and history, then covers definitions, classifications, indications, advantages and disadvantages. It describes the selection process for abutment teeth and attachments, including requirements. It examines intracoronal and extracoronal attachments in detail, discussing various types such as the Chayes attachment, O-ring attachment, and bar attachments. It explores the role of attachments in breaking stress and their mechanics of retention. In conclusion, precision attachments can provide improved function, retention and aesthetics for removable partial dentures when the appropriate abutment teeth and attachment are selected.
The treatment of maxillary transverse deficiency in post-pubertal patients has been an area of disagreement among orthodontists. Much of the controversy is over the timing of when it is appropriate for these patients to be referred to an oral and maxillofacial surgeon for an adjunctive surgical procedure or whether traditional orthodontic mechanics should be attempted. The decision, therefore, by an orthodontist of when to refer a patient for surgery
appears to be an individual one. The question then becomes which of the three basic surgical procedures would be most appropriate for the patient. Specifically, consideration must be given to surgically assisted rapid palatal expansion, segmental LeFort I osteotomy, or mandibular midline osteotomy with constriction.
This document discusses preprosthetic surgery and its role in preparing an ideal foundation for complete dentures. It defines preprosthetic surgery as procedures designed to facilitate prosthodontic care. The goals of preprosthetic surgery are to modify the oral environment to be disease-free and provide adequate bony and soft tissue support. Surgical procedures described include alveolar ridge correction/extension, frenectomy, tori removal, and vestibuloplasty to deepen vestibular depth. Patient evaluation and treatment planning is important to determine the appropriate surgical interventions needed to establish an optimal ridge form and tissue support for denture retention.
The maxillary sinuses were first illustrated and described by Leonardo Da Vinci in 1489 and later documented by the English anatomist Nathaniel Highmore in 1651.
The maxillary sinus, or antrum of Highmore, lies within the body of the maxillary bone and is the largest and first to develop of the paranasal sinuses.
Shape- a pyramid-shaped cavity; base- adjacent to the nasal wall; apex- pointing to zygoma.
Size- insignificant until eruption of permanent dentition; average dimensions of adult sinus- 2.5–3.5 cm wide, 3.6–4.5 cm tall, and 3.8–4.5 cm deep; estimated volume of approximately 12–15 cm.
Extent- Anteriorly, extends to canine and premolar area. sinus floor usually has its most inferior point near the first molar region.
Dental Implants Procedures and ComplicationsBALAKRISHNA341
This document discusses dental implants, including the stages of implant placement and factors considered during treatment planning and surgery. It describes the preoperative examination, implant placement procedures such as flap design and bone drilling, and factors such as healing time and abutment selection. Key stages include preoperative examination and planning, implant placement surgery, and maintenance of implants after restoration. Success relies on maintaining the health of the implant environment through regular recalls and cleaning.
This document provides information on preprosthetic surgery procedures. It discusses the causes of edentulous bone loss over time which can negatively impact denture stability and retention. It describes various surgical techniques like alveoloplasty to recontour alveolar ridges, tori removal, frenectomy and vestibuloplasty to deepen vestibular sulci. The aim of these procedures is to provide adequate bony and soft tissue support for removable dentures. It explains how to examine patients, evaluate radiographs and plan different intraoral surgeries like genial tubercle reduction, mylohyoid ridge reduction and maxillary tuberosity reduction. Potential complications of these surgeries are also summarized.
- An implant-supported overdenture is a removable denture that is partially supported by dental implants. It can provide improved function, esthetics, lip support and speech compared to conventional dentures.
- Overdentures supported by implants have a higher success rate than those supported only by natural tooth roots. A minimum of two implants is recommended to support a mandibular overdenture.
- Treatment planning for implant overdentures involves medical and dental evaluations to determine a patient's suitability and the appropriate type of prosthesis based on their clinical situation.
This document discusses implant site preparation and assessment. It covers evaluating bone quality and quantity, classifying alveolar ridge defects, and assessing risk factors. Both hard and soft tissue augmentation procedures are described, including guided bone regeneration using grafts and membranes. Autogenous bone grafts from sites like the mandibular symphysis are discussed, along with harvesting techniques and factors for success. The goal of implant site preparation is to develop adequate bone volume and quality for implant placement and long term function.
This document discusses various techniques for mandibular reconstruction after resection for tumors or injuries. The goals of reconstruction are to restore mandibular continuity, alveolar bone height, facial contours and function. Options include reconstruction plates, non-vascularized bone grafts for smaller defects, and microvascular free flaps for larger defects or those needing implant placement. The fibula and scapula flaps are commonly used, providing adequate bone stock. Proper classification of defect type and immediate versus delayed reconstruction must be considered to achieve optimal aesthetic and functional outcomes.
This document provides an overview of dental implants including:
1. Definitions of dental implants and their purpose in retaining prosthetics.
2. The basic parts of a modern dental implant including the implant, abutment screw, and healing cap.
3. Popular implant systems from manufacturers like Nobel Biocare and 3i.
4. The concept of osseointegration and theories of implant-bone integration.
5. The surgical technique for placing implants including drilling protocols and healing periods.
6. Advanced techniques like sinus lifts and bone grafting to support implants.
This presentation includes brief history, classification and definition of overdentures and explains in details about the various tooth supported overdentures. It explains about bar attachments, ball attachments, telecsopic dentures etc.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Implant related complications and failureJignesh Patel
This document discusses complications related to dental implants. It begins by discussing surgical complications such as hemorrhage, hematoma, neurosensory disturbances, and implant malposition. It then discusses biological complications affecting the peri-implant soft tissues, such as inflammation, recession, and progressive bone loss which can lead to peri-implantitis. Mechanical complications are also summarized, including screw loosening/fracture and implant fracture.
Split ridge and expansion techniques are effective for the correction of moderately resorbed edentulous ridges in selected cases.
Transverse expansion is based on osseous plasticity obtained by corticotomy. It progressively allows for an adequate transversal intercortical diameter large enough to insert one or several dental implants.
The gap created by sagittal osteotomy expansion undergoes spontaneous ossification, following a mechanism similar to that occurring in fractures.
This document discusses anterior and posterior open bites, including their definitions, causes, and management approaches. Anterior open bite is defined as a lack of overlap of the front teeth, while posterior open bite is a space between back teeth when biting. Causes of anterior open bite include skeletal growth patterns, soft tissue factors like tongue position, habits like digit sucking, localized developmental issues, and sometimes mouth breathing. Management can involve removing causes, orthodontic treatment like headgear or appliances, or in severe cases, surgery. Posterior open bite has a less clear etiology but may relate to vertical growth, eruption issues, or unilateral condylar hyperplasia in rare cases.
Diagnosis and treatment planning in implants 2./prosthodontic coursesIndian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
This study evaluated the efficacy of using periotomes for single-rooted nonsurgical tooth extractions compared to traditional extraction techniques. 100 patients were randomly assigned to have a tooth extracted using either a periotome (test group) or traditional methods using forceps (control group). The results found that extractions using periotomes took less time, resulted in less post-extraction pain reported by patients on a visual analogue scale over 7 days, required less analgesic consumption, and caused fewer gingival lacerations compared to traditional methods. The study concluded that the use of periotomes can help reduce post-extraction discomfort compared to conventional extraction techniques.
The document discusses the stress treatment theorem for implant therapy, which focuses on evaluating biomechanical stress and understanding how stress impacts treatment systems and implants over time. It examines various factors that influence stress, such as prosthesis design, patient forces, bone density, implant positioning and number, implant size, and available bone. The document also outlines different implant designs and their advantages for managing stress.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler Community Health Nursing A Canadian Perspective, 5th Edition TEST BANK by Stamler Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Study Guide Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Studocu Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Course Hero Community Health Nursing A Canadian Perspective, 5th Edition Answers Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Course hero Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Studocu Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Study Guide Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Ebook Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Questions Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Studocu Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Stuvia
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Muscles of Mastication by Dr. Rabia Inam Gandapore.pptx
Treatment of the edentulous patient
1. Treatment of the Edentulous
Patient
Krishnan Parthasarathi
omsaustralia@wordpress.com
2. Background
• Edentulism has significant effect on masticatory efficiency and QoL
• Patients treated with Complete Dentures have significantly more bony
resorption of the alveolus than those who have had partial dentures
or over dentures.
From Calwood and Howell ‘88
I. Dentate
II. Immediately post extraction
III. Well rounded ridge of adequate height and
width
IV. Knife Edge, with adequate height but not
width
V. Flat Ridge inadequate height or width
VI. Depressed ridge with loss of basal bone
3. Background II
• Pattern of resorption not consistent
• Basal bone does not change shape often but alveolar bone does
• Ant Mandible: loss of height and width
• Post Mandible: Loss of height mainly
• Anterior maxilla: loss of width 2X height
• Posterior Maxilla: loss of height and width (buccal)
5. • Aesthetics
• Type of Support
• Fixed or Removable
• Fixed options usually ceramic/porcelain based
• Removable Options – implant supported overdentures, implant retained, tissue supported over
dentures.
• Removables methods include bar and clip, magnets, ball attachments, locater
• Amount of Resorption and Inter-arch Space
• Number of Implants
• Decision made on Quality of bone, anticipated force to be placed on restoration, relationship between
residual ridge, and dental arch
• Generally 4-8 for fixed 4-6 for removable
• Implant Distribution
• Round arch 3 implants in pre maxilla v 2 in square / triangular. Do you need to cantilever anterior
teeth?
• Equidistant, and splinting (cross-arch)
• Cost
Considerations I
6. Maxilla Considerations - Aesthetic
• Lip and Facial Support
• Tooth loss, ridge loss
• Emergence of teeth /implants (should be <45degrees to vertical) (lip
movement)
• Teeth may have to be setup anterior to the ridge due to resorption.
• With more resorption, you need more flange
• Facial Profile
• Concave face with upturned nose is most difficult, as bulking out will
worsen the look.
7. Maxilla Aesthetic Considerations II
Smile Line and Lip Length
• Normal is 75% - 100% tooth show
on smiling.
• IF the patient smiles, and you can
see ridge, it’s difficult to manage.
• Incisal edge position
• Need to show 0.2mm show
8. Maxillary overdenture
• 4 implants (bar)
• 6 implants if poor bone, high forces.
• Implants >10mm in length, textured
• Bar, load sharing seems to increase success (but not large studies)
• More maintenance
• No difference in patient satisfaction cf fixed prosthesis?
9. Posterior Maxillary bone – the problem
• You need to have implants with at least 2cm AP Spread
• At least 10mm for distal implant length
• 6 or more implants (Although all-on-four concept exists in maxilla)
10. Solution to the Maxillary Problem
• Graft Options
• Sinus Augmentation
• Onlay Grafting
• Graft less options
• ‘Summers sinus lift’?
• Short Implants
• “Bedrossian solutions 2011’
11. Graft Option - Sinus Augmentation I
• Can be used with immediate placement (if>5mm) or delayed implant
placement (4months post)
• Can be done with immediate loading if torque > 30nM (from all on
four data – Patzelt 2013, Soto-Penazolo 2017)
• Summers lift
• May only give small amount of additional height (? <4mm)
• Perforations may occur
• Early loading may not be as successful
• Lateral Window
• Greater flexibility
• Lefort with Marrow and block graft
12. Graft Option - Sinus Augmentation II
• Options for grafting – Autogenous
bone Allograft (DBx), Xenograft
Allopast(HA, tricalcium phosphate,
Fabbaro 2004)
• All have about equivocal efficacy.
• ? Autogenous graft with rough implants
slightly better survival (94% v 90%)
• Comparing Autogenous Sites
• Intraoral sites (tuberosity, buttress,
chin, ramus, zygoma) lower resorption
(11-14%) cf Illiac graft. Chin Graft best
(Klijn 2010)
• Particulate v block bone equivalent TBV,
but block better histologically
• Studies (Nissan 2011) using block
freeze dried block bone seem to show
equivocal result to autogenous bone.
13. Graft Option - Other 1
• Onlay, Sandwhich (inlay), DO,
• Block Augmentation
• more successful horizontal than vertical (more walls / less pressure?).
• Intramembranous superior to endochondral
• Sandwhich (lefort 1)technique
• difficult to maintain sinus lining, invasive, still need iliac crest harvest, expensive
• Alveolar distraction
• No donor site
• Techinically difficult
• Need 6 -8mm of bone
• Infection, need to over correct, multiple appointments, techinuque sensitive
• Esposito 2009 – Short implants have less failure than vertically augmented ridges,
• but you need enough bone to start,
• goes againgst all-on four principles of long distal implant.
• Need wider implants (?5mm) so you need enough space between implants and ridge width
14. Is Grafting worth it?
• Esposito 2014 shows equivalent results with grafting v short implants
(5mm – 8.5mm).
• Shwartz 2015 – 6mm implants
• Lots of articles out there but bias of mixing mandibular and maxillary short
implants (bone type)
• Also lots of pilots and short follow ups.
• Thoma 2015 attempted a systematic review, but too heterogenous group to
compare – Jury still out, but rising evidence for short implants.
• Esposito 2014 – Type of Implants – Smooth have less peri-implantitis,
but more early loss cf rough implants.
16. Graftless – All-on-four
• All-on-four (Chan Den Clin 2015)
• Based on branemark studies.
Originanlly 4-6 vertical implants
• 10 yr survival of originals approx. 80%
for maxilla (90% for mandible)
• Matteson showed possible with 10mm
height 4mm wide ridge
• Krekmanov started using posterior
tilted implants for increased a-p distr
• Angulation of 30-45 degrees allow 10-
12 teeth per arch
17. Graftless – All-on-4 II
• “Shelf All-on Four”
• Jensen 2010.
• Bony reduction to allow implants to be placed
as a “M”
• Interocclusal distance of 22mm
• Angulation of implants 30 degrees
18. Graftless – Tilted implants
• As predictable as upright implants (patzelt 2013, Soto-penazolo 2017)
• Del Fabro 2012
• No difference in loss, bone loss, loosening of prothetic c.f straight implants
• Typically 25-30 degreesin mandible, and 30-45degrees in maxilla
• Implant failure in first year is 1-25%, failure of OI 28%.
• Maxillary failure > Mandible (RR 2.49)
• ? Overload of distal implant, leading to loss
19. Graftless - Zygoma Implants
Traditionally (Branemark) used in combination with for axial implants in premaxilla.
Success rate is clinically 90%
20. Graftless - Zygoma Implants
• Yates 2014 – Survival rate 86%
• Chrcanovic 2013 (Systematic review)
• 4,556 ZIs in 2,161 patients with 103 failures.
• The 12-year CSR was 95.21%.
• Most failures were detected within the 6-month postsurgical period (when placing
abutments).
• Studies (n = 26) that exclusively evaluated immediate loading showed a statistically lower ZI
failure rate than studies (n = 34) evaluating delayed loading protocols (P = .003).
• Studies (n = 5) evaluating ZIs for the rehabilitation of patients after maxillary resections
presented lower survival rates.
• The probability of presenting postoperative complications with ZIs was as follows: sinusitis,
2.4% (95% confidence interval [CI], 1.8-3.0); soft tissue infection, 2.0% (95% CI, 1.2-2.8);
paresthesia, 1.0% (95% CI, 0.5-1.4); and oroantral fistulas, 0.4% (95% CI, 0.1-0.6). However,
these numbers might be underestimated, because many studies failed to mention the
prevalence of these complications.
22. Mandibular Overdenture
Advantages Disadvantages
Over Denture Fewer implants – decreased cost
Can have more bulk for improved facial aesthetics
Good access for hygiene
Improved stability with upper complete denture
Easier to modify base
Better tolerated than complete dentures
Implant loss similar to other implant therapies in
the mandible (2.5% pror to loading, 5.6% post
loading)
Higher incidence of complications.
High number of repairs
goodachre 2017 in fonseca
23. Overdenture - How many implants?
• 1 – Is it sufficient? Rocking.
• 2 – can be individual or with bar
• 3 – with bar
• 4 – no difference in outcome cf 2 in general.
• These conditions include the presence of a large V-shaped anterior ridge,
reduced flanges due to high muscle attachments, increased occlusal forces
(dentate maxilla present or parafunctional habits present), atrophic ridges
that require implants of less than 3.5 mm in width or less than 8 mm in
length, and patients with an extreme gag reflex.
• In Mandible no difference bar v no bar (cf maxilla)
24. Mandibular Graft Techniques - Horizontal
• Horizontal Defects
• Add to buccal surface usually
• Want 7-8mm posteriorly (to accommodate 5mm implants)
• Anteriorly atleast 4mm for 3mm implants
• Bicuspid zone atleast 6mm for 4mm implants
• Can use block graft or particulate graft
• Cordaro – 23% loss in horizontal block bone grafts at 6 months
• Esposito 2009 – no dfiferencce between autogenous (chin, bioss). Use of
resorbably v non-resorbably screws prp
25. Mandibular Graft Techniques – Vertical 1
• Posterior Mandible
• Vertical Defects most common and challenging
problem for two reasons: 1) IAN presence, 2) the
common pattern of height loss is vertical
• Block grafts
• 42% resorption at 6 months (cordaro 2002)
• (so if you want 4mm, you need an 8mm graft!).
• Particulate graft
• Resorption May be reduced if use titanium mesh to
reduce resorption, but have have to protect from
exposure and infection for 6 weeks.
• Use implant to pack against and maintain height ( Marx
2002)
26. Mandibular Graft Techniques – Vertical 2
• Alternatives: DO, Sandwich technique, Short Implants, Angled implants, Nerve
lateralisation
• DO seems to allow more height gain + less tension? But more technically demanding, and
demanding of patients. Atleast two surgeries – distraction placement, removal and implant.
• Sandwich/inlay technique- Simion 92. less height gained, also problems with exposure with
soft tissue under tension. Can gain up to 5mm with either technique. This also takes two
surgeries for split alone and third for implant. Esposito 2009
• Short implants seem to have less failures short term than grafting.
• Most of these except for DO and short implants seem to have a common
theme problem – soft tissue envelope deficiency or pressure causing
resorption.
• Nerve lateralization – still need to read about this. BSSO v window?
• Has very high rate of parasthetsia – need to read to confirm number
27. Mandibular graftless techniques
• Short implants, mini implants (still need to read ? Only for tissue
supported)
• Short implants have very high success rates comparable with traditional atleast at
short time points Grant 2009 JOMS,
• Traditional all-on-4
• Good success rate 93.2% for mandible
• All-on-4 shelf:
• flatten ridge, but need atleast 10mm over MN
• Implants need to be atleast 20mm apart
• All-on-4 with tilted implants: “ V4 implant”
• For when there is 5-7mm of arch
• Implants are 30 degrees to sagittal plane.