Effects of mandibular fixed implant-supported prostheses on masticatory and swallowing functions in completely edentulous elderly individuals

Purpose: To evaluate the effect of oral rehabilitation with immediately loaded fixed implant-supported mandibular prostheses on chewing and swallowing in elderly individuals. Materials and Methods: Fifteen completely edentulous patients aged more than 60 years (10 women and rive men), wearing removable dentures in both arches, had a mandibular denture replaced by an implant-supported prosthesis. All individuals were evaluated before surgery and again 3, 6, and 18 months later with regard to mastication and swallowing conditions. Examinations entailed an interview, evaluation of tactile sensitivity of the face, and observation of food intake, masticatory type, formations of bolus, and pain during mastication. The swallowing evaluation comprised observation of clinical signs related to the oral and pharyngeal stages of swallowing, as well as the presence of oral residue. The findings of different evaluations before and 3, 6, and 18 months after the surgical-prosthetic procedure were statistically compared by analysis of variance for repeated measurements at a significance level of 5%. Results: The questionnaire revealed a reduction in complaints of masticatory and swallowing disturbances, a decreased need for liquid ingestion, and reduced choking and coughing. Clinical evaluations showed improved oral function and bolus propulsion for both solid and paste-consistency foods; pain during mastication was also resolved. Conclusion: Treatment with mandibular implant-supported dentures had positive effects on the clinical aspects of mastication and swallowing in elderly individuals.

Photoelastic analysis of the influence of residual ridge inclination in conjugated class i mandibular prostheses with different attachment systems

Objectives: The aim of this study was to evaluate the stress distribution in mandibular free-end removable partial dentures (RPD) associated with FPD in the abutment teeth considering different inclinations of the residual ridge: (1) horizontal and (2) distal descending ridges and two designs of free-end RPD with different attachment systems were tested: (1) clasp and (2) system ERA. Methods. Axial loads (100 N) were applied on the teeth of the RPD. The images were recorded and the stress distribution was evaluated through photoelastic fringes. Results. In general, the distal descending ridge presented more photoelastic fringes in the region of the roots of the abutment teeth while the horizontal ridge exhibited higher compression in the base of the prosthesis. In the horizontal ridge, the denture with clasp presented more favourable stress distribution than the denture with the system ERA. In the distal descending ridge, the denture with the system ERA relieved the region of the abutment teeth and overloaded the residual ridge. Conclusion: The horizontal ridge presented more favourable performance; the dentures with clasp exhibited better performance for both ridges evaluated; the denture with the system ERA presented better results in the distal descending ridge. © 2013 Informa Healthcare.

Removable Partial Dentures: Use of Rapid Prototyping

The CAD/CAM technology associated with rapid prototyping (RP) is already widely used in the fabrication of all-ceramic fixed prostheses and in the biomedical area; however, the use of this technology for the manufacture of metal frames for removable dentures is new. This work reports the results of a literature review conducted on the use of CAD/CAM and RP in the manufacture of removable partial dentures.

Effect of cantilever length and framework alloy on the stress distribution of mandibular-cantilevered implant-supported prostheses

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Planning for Immediate Loading of Implant-Supported Prostheses: Literature Review

The aim of this study was to present the factors that influence planning for immediate loading of implants through a literature review for treatment success. Research was conducted in the PubMed database including the key words immediate implant loading, implant-supported prostheses, and implant planning for studies published from 2000 to 2011. Forty-eight articles were used in this review to describe the indications and counterindications, presurgical planning, and technologies available for planning of this treatment alternative.

Influence of Cusp Inclination on Stress Distribution in Implant-Supported Prostheses. A Three-Dimensional Finite Element Analysis

Purpose: The aim of this study was to assess the influence of cusp inclination on stress distribution in implant-supported prostheses by 3D finite element method.Materials and Methods: Three-dimensional models were created to simulate a mandibular bone section with an implant (3.75 mm diameter x 10 mm length) and crown by means of a 3D scanner and 3D CAD software. A screw-retained single crown was simulated using three cusp inclinations (10 degrees, 20 degrees, 30 degrees). The 3D models (model 10d, model 20d, and model 30d) were transferred to the finite element program NeiNastran 9.0 to generate a mesh and perform the stress analysis. An oblique load of 200 N was applied on the internal vestibular face of the metal ceramic crown.Results: The results were visualized by means of von Mises stress maps. Maximum stress concentration was located at the point of application. The implant showed higher stress values in model 30d (160.68 MPa). Cortical bone showed higher stress values in model 10d (28.23 MPa).Conclusion: Stresses on the implant and implant/abutment interface increased with increasing cusp inclination, and stresses on the cortical bone decreased with increasing cusp inclination.

Influence of the Connector and Implant Design on the Implant-Tooth-Connected Prostheses

Purpose:The purpose of this study was to evaluate stress transfer patterns between implant-tooth-connected prostheses comparing rigid and semirigid connectors and internal and external hexagon implants.Materials and Methods:Two models were made of photoelastic resin PL-2, with an internal hexagon implant of 4.00 x 13 mm and another with an external hexagon implant of 4.00 x 13 mm. Three denture designs were fabricated for each implant model, incorporating one type of connection in each one to connect implants and teeth: 1) welded rigid connection; 2) semirigid connection; and 3) rigid connection with occlusal screw. The models were placed in the polariscope, and 100-N axial forces were applied on fixed points on the occlusal surface of the dentures.Results:There was a trend toward less intensity in the stresses on the semirigid connection and solid rigid connection in the model with the external hexagon; among the three types of connections in the model with the internal hexagon implant, the semirigid connection was the most unfavorable one; in the tooth-implant association, it is preferable to use the external hexagon implant.Conclusions:The internal hexagon implant establishes a greater depth of hexagon retention and an increase in the level of denture stability in comparison with the implant with the external hexagon. However, this greater stability of the internal hexagon generated greater stresses in the abutment structures. Therefore, when this association is necessary, it is preferable to use the external hexagon implant.

Photoelastic Analysis of Cemented or Screwed Implant-Supported Prostheses With Different Prostheses Connections

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Longitudinal study of the influence of removable partial denture and chemical control on the levels of Streptococcus mutans in saliva

Some studies have evaluated the salivary levels of mutans streptococci (MS) in removable partial denture (RPD) users. Saliva samples (2.0 mL) were obtained from 31 patients in six periods: (T0): immediately before installation of RPD; (T8): 8 days after T0; (T48): 48 days after T0; (T92): 92 days after T0; (T140): 140 days after T0 and (T189): 189 days after T0. The samples were vortexed and serially diluted from 10(-1) to 10(-6) in 0.05 m phosphate buffer (pH 7.4). From each dilution, 0.025 mL was plated on Mitis Salivarius Bacitracin (MSB). The plates were incubated in 5% CO2 at 37 degreesC for 72 h. There was an increase (t -test, P < 0.05) in the number of MS between periods T0 and T48 (mean/s.d., CFU mL(-1) of saliva): T0: 2.26/4.43 x 10(6) and T48: 0.47/1.48 x 10(8) . After this, intensive treatment with CHX was accomplished in 29 patients. Saliva samples were obtained after treatment in four periods: (T24 h): 24 h after T0; (T14): 14 days after T24 h; (T28): 28 days after T24 h, and (T63): 63 days after T24 h. The number of MS in saliva did not decrease (t -test, P > 0.05). A new CHX formulation was applied in 15 patients. Saliva samples were obtained in periods: (T0): before new CHX application; (T24 h): 24 h after T0 and (T82): 82 days after T0. The new CHX reduced MS levels in saliva: (mean/s.d., CFU mL(-1) of saliva): T0: 6.64/8.47 x 10(6) and T24 h: 3.2/4.27 x 10(5) (sign rank, P < 0.05). In conclusion, there was a significant increase in the number of MS in saliva after the installation of RPD. The intensive treatment with a properly formulated CHX was effective in the reduction of MS, between 24 h and 82 days after its application.

Orbital Implants Insertion to Improve Ocular Prostheses Motility

The objectives of this study were, through a literature review, to point the differences between orbital implants and their advantages and disadvantages, to evaluate prosthesis motility after orbital implants are inserted, and to point the implant wrapping current risks. Sixty-seven articles were reviewed. Enucleation implants can be autoplastics or alloplastics and porous (including natural and synthetic hydroxyapatite [HA]) or nonporous (silicone). Hydroxyapatite is the most related in the literature, but it has disadvantages, too, that is, all orbital implants must be wrapped. Exposure of the porous orbital implant can be repaired using different materials, which include homologous tissue, as well as autogenous graft, xenograft, and synthetic material mesh. The most used materials are HA and porous polyethylene orbital implant. The HA implant is expensive and possibly subject corals to damage, different from porous polyethylene orbital implants. Porous implants show the best prosthesis motility and a minimum rate of implants extrusion. Implant wraps can facilitate smoother entry of the implant into the orbit and allow reattachment of extraocular muscles. They also serve as a barrier between the overlying soft tissue and the rough surface of the implant, protecting implants from exposure or erosion.

Influence of Ridge Inclination and Implant Localization on the Association of Mandibular Kennedy Class I Removable Partial Denture

The aim of this study was to evaluate the tendency of displacement of the supporting structures of the distal extension removable partial denture (DERPD) associated to the implant with different inclinations of alveolar ridge and implant localizations through a two-dimensional finite-element method. Sixteen mandibular models were fabricated, presenting horizontal, distally descending, distally ascending, or descending-ascending ridges. All models presented the left canine and were rehabilitated with conventional DERPD or implant-retained prosthesis with the ERA system. The models were obtained by the AutoCAD software and transferred to the finite-element software ANSYS 9.0 for analysis. A force of 50 N was applied on the cusp tips of the teeth, with 5 points of loading of 10 N. The results were visualized by displacement maps. For all ridge inclinations, the assembly of the DERPD with distal plate retained by an anterior implant exhibited the lowest requisition of the supporting structures. The highest tendency of displacement occurred in the model with distally ascending ridge with incisal rest. It was concluded that the association of the implant decreased the displacement of the DERPD, and the anterior positioning of the implant associated to the DERPD with the distal plate preserved the supporting structures for all ridges.

Retention Systems to Implant-Supported Craniofacial Prostheses

Osseointegrated implants in craniofacial reconstructions improve prostheses retention and stability and comfort and safety for a patient. According to biomechanical principles, the treatment success regarding osseointegration maintenance depends on an adequate surgical technique associated to a retention system that provides favorable tension distribution to implants. Furthermore, patient expectation, esthetics, function, and anatomic limitations must be evaluated during treatment planning. Therefore, the aims of this study were to present available retention systems to implant-supported craniofacial prosthesis and to highlight the advantages, indications, and limitations. A literature review was conducted through a MEDLINE search. Sixteen articles and 2 textbooks met the inclusion criteria and were included in the review. It was concluded that the success of craniofacial rehabilitation with implants depends on an adequate surgical technique and an adequate selection of a retention system.

Photoelastic Stress Analysis of Different Attachment Systems on Implant-Retained and Conventional Palatal Obturator Prostheses

Background: Considering that an increasing number of patients are victims of mutilator surgical resections, these studies are important for treatment success of rehabilitation of patients presenting oronasal communication.Purpose: The aim of this study was to assess the stress distribution through photoelasticity in palatal obturator prostheses with different attachment systems for implants.Methods: Two photoelastic models were obtained from an experimental maxillary model presenting an oronasal communication. One model was fabricated without implant, and the other with 2 implants 10 mm in length inserted in the left crest. Four colorless palatal obturator prostheses were fabricated. One prosthesis presented no attachment system, whereas the remaining prostheses were adapted to 3 attachment systems. The assembly was positioned in a circular polariscope for application of axial load.Results: The results were based on photographic records of stress in the photoelastic model submitted to loading. The records revealed higher stress concentration on the bar-clip system followed by the O'ring/bar-clip and O'ring systems, respectively. A homogeneous stress distribution was observed on the photoelastic model with the mucous-supported prosthesis.Conclusions: The attachment systems generated different characteristics of stress distribution that was concentrated surrounding the implants. The bar-clip system exhibited the highest stress concentration on the alveolar crest.

Prevalence of removable partial dentures users treated at the Aracatuba Dental School - UNESP

Objectives: The aim of this study was to evaluate the frequency of removable partial dentures (RPD) at the Aracatuba Dental School.Methods: The study was conducted by analysing 412 clinical history of patients attended at the RPD clinics in the period from 2000 to 2007.Results: 412 charts were analysed: 148 (35.9%) men and 264 (64.1%) women. The mean age was 53.8 years (men) and 52.4 years (women). A total of 556 dentures were made; of these, 233 (41.90%) were maxillary and 323 (58.09%) were mandibular dentures. The most frequent Kennedy classification found was Class III (maxilla) and Class I (mandible). In the maxilla, 55% (126) of the major connectors were of the anterior-posterior palatal bar, while in the mandible, 64% (202) were the lingual bar. As regards the claps, 401 were circumferential and 318 were bar claps.Conclusion: The mean age of the patients was 52.9 years with higher prevalence of female patients; the most frequent Kennedy's classification was Class I in mandible and Class III in maxilla; the most common major connector was anterior-posterior palatal bar for maxilla and lingual bar for mandible; the circumferential clasps were the most common retainer used in both jaws.

Three-Dimensional Finite Element Analysis of Vertical and Angular Misfit in Implant-Supported Fixed Prostheses

Purpose: Three-dimensional finite element analysis was used to evaluate the effect of vertical and angular misfit in three-piece implant-supported screw-retained fixed prostheses on the biomechanical response in the peri-implant bone, implants, and prosthetic components. Materials and Methods: Four three-dimensional models were fabricated to represent a right posterior mandibular section with one implant in the region of the second premolar (2PM) and another in the region of the second molar (2M). The implants were splinted by a three-piece implant-supported metal-ceramic prosthesis and differed according to the type of misfit, as represented by four different models: Control = prosthesis with complete fit to the implants; UAM (unilateral angular misfit) = prosthesis presenting unilateral angular misfit of 100 pm in the mesial region of the 2M; UVM (unilateral vertical misfit) = prosthesis presenting unilateral vertical misfit of 100 pm in the mesial region of the 2M; and TVM (total vertical misfit) = prosthesis presenting total vertical misfit of 100 pm in the platform of the framework in the 2M. A vertical load of 400 N was distributed and applied on 12 centric points by the software Ansys, ie, a vertical load of 150 N was applied to each molar in the prosthesis and a vertical load of 100 N was applied at the 2PM. Results: The stress values and distribution in peri-implant bone tissue were similar for all groups. The models with misfit exhibited different distribution patterns and increased stress magnitude in comparison to the control. The highest stress values in group UAM were observed in the implant body and retention screw. The groups UVM and TVM exhibited high stress values in the platform of the framework and the implant hexagon, respectively. Conclusions: The three types of misfit influenced the magnitude and distribution of stresses. The influence of misfit on peri-implant bone tissue was modest. Each type of misfit increased the stress values in different regions of the system. INT J ORAL MAXILLOFAC IMPLANTS 2011;26:788-796