Association of fixed partial denture and gingival prosthesis as alternative approach to recover esthetics and function in anterior maxillary region

Tooth replacement in the maxillary anterior region is especially difficult when the loss includes significant amounts of the residual ridge and the soft tissue. Several techniques are available, such as dental implants or fixed partial denture, and bone and gingival grafts or gingival prostheses, respectively. This article showed a clinical case of an elderly who was treated with a collarless metal-ceramic fixed partial denture and acrylic removable gingival prosthesis to recover the esthetics in the maxillary anterior region. The association of a metal-ceramic fixed denture and gingival prosthesis was an excellent alternative in cases when surgical procedures are contraindicated. © 2012 Japan Prosthodontic Society.

Maxillary Rehabilitation Using Fixed and Removable Partial Dentures with Attachments: A Clinical Report

Despite requiring dental crown preparation and possible root canal treatment, besides the difficulty of clinical and laboratory repairs, and financial burden, the association between fixed (FPD) and removable partial dentures (RPD) by means of attachments is an important alternative for oral rehabilitation, particularly when the use of dental implants and FPDs is limited or not indicated. Among the advantages of attachment-retained RPDs are the improvements in esthetics and biomechanics, as well as correction of the buccal arrangement of anterior teeth in Kennedy Class III partially edentulous arches. This article describes the treatment sequence and technique for the use of attachments in therapy combining FPD/RPD. © 2013 by the American College of Prosthodontists.

Failures in the rehabilitation treatment with removable partial dentures

Background. Despite being functional and having aesthetic benefits, the acceptance of patients regarding the use of removable partial dentures (RPDs) has been low. In part, this is due to the deleterious effects that causes discomfort to the patient. Success depends not only on the care expended by the patient, including daily care and oral hygiene, but also on common goals set by their professional and clinical staff, aiming beyond aesthetics, to incorporate issues of functionality and the well-being of patients. Methods and results. For rehabilitation treatment with RPDs to reach the desired level of success without damaging the support structure, all the steps (diagnose, cavity preparation, adaptation of the metal structures, functional of distal extension and posterior follow-up) in the rehabilitative treatment should be carefully developed. A literature review was carried out, searching through MEDLINE (PubMed) articles published between 1965 and December 2012 including clinical trials and reviews about the use of RPDs. Conclusions. This study describes factors that lead to failures and complications in oral rehabilitation through the use of RPDs and suggests possible solutions.

Clinical evaluation of failures in removable partial dentures

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

Evaluation of Stress Patterns Produced by Implant-Retained Overdentures and Implant-Retained Fixed Partial Denture

The purposes of this study were to photoelastically measure the biomechanical behavior of 4 implants retaining different cantilevered bar mandibular overdenture designs and to compare a fixed partial denture (FPD). A photoelastic model of a human edentulous mandible was fabricated, which contained 4 screw-type implants (3.75 x 10 mm) embedded in the parasymphyseal area. An FPD and 3 overdenture designs with the following attachments were evaluated: 3 plastic Hader clips, 1 Hader clip with 2 posterior resilient cap attachments, and 3 ball/O-ring attachments. Vertical occlusal forces of 100 N were applied between the central incisor and unilaterally to the right and left second premolars and second molars. Stresses that developed in the supporting structure were monitored photoelastically and recorded photographically. The results showed that the anterior loading, the overdenture with 3 plastic Hader clips, displayed the largest stress concentration at the medium implant. With premolar loading, the FPD and overdenture with 3 plastic Hader clips displayed the highest stresses to the ipsilateral terminal implant. With molar loading, the overdenture with 3 ball/O-ring attachments displayed the most uniform stress distribution in the posterior edentulous ridge, with less overloading in the terminal implant. It was concluded that vertical forces applied to the bar-clip overdenture and FPD created immediate stress patterns of greater magnitude and concentration on the ipsilateral implants, whereas the ball/O-ring attachments transferred minimal stress to the implants. The increased cantilever in the FPD caused the highest stresses to the terminal implant.

Overlay removable partial dentures for a patient with ectodermal dysplasia: A clinical report

The orofacial characteristics of ectodermal dysplasia include anodontia or hypodontia, hypoplastic conical teeth, underdevelopment of the alveolar ridges, frontal bossing, a depressed nasal bridge, protuberant lips, and hypotrichosis. Patients with this disease often need complex prosthetic treatment. The options for a definitive treatment plan may include fixed, removable, or implant-supported prostheses, singly or in combination. However, financial constraints and other priorities can prevent patients from choosing the most desirable treatment. This clinical report describes the diagnosis and treatment of ectodermal dysplasia in an 18-year-old man. The treatment included interim removable partial dentures fabricated to establish an acceptable therapeutic occlusal vertical dimension, followed by definitive overlay removable partial dentures and composite restorations.

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.

Aesthetic rehabilitation of oligodontia in primary dentition with adhesive partial denture

The primary teeth are essential for bone development and establishment of the arches on occlusion. Thus, the congenitally absence of teeth may trigger a shift in the balance of the occlusion, promoting disharmony in the structures of the maxilla-mandibular system. However, some interventions are possible to be performed in these cases even in pediatric patients, to redirect growth, preventing growth deviations and reestablishing the aesthetic. The aim of this paper is to report the treatment of a 4-year-old child presenting congenitally absence of mandibular central and lateral incisors and maxilla lateral incisors, which consequently compromises aesthetics, occlusal function, and the development and the functional growth of the bones. The oral rehabilitation was performed with an adhesive partial denture, which was able to restore the aesthetic and the occlusal function, therefore being a viable alternative in the treatment of this patient of little age.

Quality of life and satisfaction of patients wearing implant-supported fixed partial denture: a cross-sectional survey of patients from Aracatuba city, Brazil

ObjectivesThe aim of this study was to evaluate the quality of life and satisfaction of patients wearing implant-supported fixed partial dentures.Materials &methodsA total of 106 patients were selected and submitted to clinical examination and collection of the demographic data for evaluation of the implant-supported fixed dentures conditions. All participants agreed to answer to the Oral Health Impact Profile (OHIP-EDENT) questionnaire and another questionnaire about satisfaction with the implant-supported prostheses. The patients were classified into the following three groups for statistical analysis: patients wearing splinted implant-supported prosthesis (E), patients wearing single implant-supported prosthesis (U), and patients wearing single implant-supported prosthesis associated with splinted prosthesis (E+U). Kruskal-Wallis test was used to compare the answers between the groups, and a logistic regression model was measured to verify the relation between variables of the patients and the questionaries'items.ResultsThere were significant differences among groups (P=0.006) for discomfort during surgery itself of the satisfaction questionnaire. The marital status, groups, and hygiene condition were significant mainly for physical pain item.ConclusionsIt was concluded that the patients presented high level of satisfaction and quality of life for the most of the items evaluated as well as the groups showed similar results.

Prosthetic rehabilitation of a patient after a partial mandibulectomy

The treatment of orofacial tumors may cause facial deformities by losses of structures that affect basic functions, i.e. feeding, speech, and the reduction of patient self-steam. A white male patient was diagnosed with epidermoid cancer on the mandibular alveolar ridge with infiltration staging IV A. The patient was submitted to a mandibulectomy associated with a complete extraction of mandibular teeth. For rehabilitation, a conventional denture for the mandibular arch and a removable partial denture for the maxillary arch were fabricated. A correct occlusal adjustment and a satisfactory amount of alveolar bone was favorable for conventional dentures of the prostheses bases improve their retention and stability. After one year of follow-up, the patient was adapted to the prostheses, satisfied with their retention, and reported an improvement on his feeding. The prosthetic rehabilitation of patients after a partial mandibulectomy is essential for their self-steam. Conventional dentures may have their retention and stability improved if they are well fabricated, recorded and have a balanced occlusion. A correct occlusal adjustment and an adequate retention of the prostheses bases may improve their retention and stability. Patients without xerostomy and with a satisfactory amount of alveolar bone may have a favorable prognosis for conventional dentures.

Oral rehabilitation of severely worn dentition using an overlay for immediate re-establishment of occlusal vertical dimension

The aim of this study was to describe the treatment used in an elderly patient presenting with bruxism and dental erosion, with good gingival health and bone support, but with decreased occlusal vertical dimension (OVD). The oral rehabilitation of elderly patients presenting with bruxism in association with tooth erosion has been a great challenge for dentists. The loss of OVD, the presence of occlusal instability and the absence of an effective anterior guide due excessive dental wear, can damage stomatognathic system (SS) biology, the function and the aesthetics. In the first treatment stage, an overlay removable partial denture (ORPD) was fabricated for the immediate re-establishment of function and aesthetics. After a 2-month follow up, with the patient presenting no symptoms, a second rehabilitation stage was accomplished, with fixed and removable prostheses. Oral rehabilitation with an ORPD was able to re-establish the SS biology, but a correct diagnosis and treatment plan are essential for success. The ORPD is a non-invasive and reversible restoring modality for general dentists that allow the re-establishment of the patient's immediate aesthetics and function at low cost.

Influence of microwave disinfection on the dimensional stability of intact and relined acrylic resin denture bases

Statement of problem. Microwave irradiation has been suggested as a method to disinfect denture bases. However, the effect of microwave heating on the dimensional stability of the relined denture bases is unknown.Purpose. The purpose of this study was to evaluate the dimensional stability of intact and relined acrylic resin denture bases after microwave disinfection.Material and methods. A standard brass cast simulating an edentulous maxillary arch was machined and used to fabricate 2- and 4-mm-thick denture bases (n=200), which were processed with heat-polymerized acrylic resin (Lucitone 550). The 2-mm thick-specimens (n=160) were relined with 2 mm of autopolymerizing resin (Tokuso Rebase Fast, Ufi Gel Hard, Kooliner, or New Truliner). Distances between 5 removable pins on the standard brass cast were measured with a Nikon optical comparator, and the area (mm(2)) formed by the distance between 5 pins was calculated and served as baseline. During fabrication, the pins were transferred to the intaglio surface of the specimens. Differences between the baseline area and those subsequently determined for the specimens were used to calculate the percent dimensional changes. The intact and relined denture bases were divided into 4 groups (n=10) and evaluated after: polymerization (control group P); 1 cycle of microwave disinfection (MW); daily microwave disinfection for 7 days (control group MW7); water storage for 7 days (WS7). Microwave irradiation was performed for 6 minutes at 650 W. Data were analyzed using 2-way ANOVA followed by Tukey's test (alpha=.05).Results. Intact specimens and those relined with Kooliner and New Truliner showed increased shrinkage after 1 (P=.05, .018, and .001, respectively) and 7 (P <.001, .003, and <.001, respectively) cycles of microwave disinfection. With the exception of specimens relined with Kooliner, intact specimens showed greater shrinkage than the relined specimens after 7 cycles of microwave disinfection.Conclusions. Microwave disinfection produced increased shrinkage of intact specimens and those relined with New Truliner and Kooliner.

Bonding strength between a hard chairside reline resin and a denture base material as influenced by surface treatment

Direct relining of dentures made with hard chairside reline resins is faster than laboratory-processed reline systems and the patient is not without the prosthesis for the time necessary to perform the laboratory procedures. However, a weak bond between the autopolymerizing acrylic reline resins and the denture base material has been observed. This study evaluated the effect of six different surface treatments on the bond strength between a hard chairside reline acrylic resin and ia heat-cured acrylic resin. Specimens of the heat-cured acrylic resin were divided into seven groups. one of these groups remained intact. In the other groups, a 10-mm square section was removed from the centre of each specimen. The bonding surfaces were then treated with (i) methyl methacrylate monomer, (ii) isobutyl methacrylate monomer, (iii) chloroform, (iv) acetone, (v) experimental adhesive and (vi) no surface treatment-control group. Kooliner acrylic resin was packed,into the square sections and polymerized. The bonding strength was evaluated by a three-point loading test. The results were submitted to one-way analysis of variance (ANOVA) followed by a Tukey multiple range test at a 5% level of significance. No significant difference was found between the surface treatment with Lucitone 550 monomer or chloroform, but both were stronger than the majority of the other groups. The bond strength provided by all the surface treatments was lower than that of the intact heat-cured resin.

Evaluation of partially dentate patients' knowledge about caries and periodontal disease

Objective: This investigation evaluated the knowledge of dental caries and periodontal disease among removable partial denture (RPD) wearers.Method: A total of 127 partially dentate patients participated in this observational study. A structured questionnaire, which included eight questions referring to knowledge about aetiology and prevention of dental caries and periodontal disease, was developed in the local language (Portuguese) and used to collect the data of all the partial denture wearers. A descriptive analysis of data was performed by means of drafting tables.Results: The results demonstrated that 68.5% of patients interviewed had previously received information about oral health care. With regard to bacterial plaque, it was observed that only 34.6% reported having knowledge of this. Whereas, in relation to caries, 76.4% of the interviewees replied that they knew the meaning of this. Nevertheless, 28.3% referred to caries as a whole in the teeth, 16.5% as bad teeth and 9.4% bacteria/creatures on the teeth. Only 17.3% of the partially edentulous patients evaluated were shown to know what disease of the gingiva was.Conclusion: By means of the methodology applied, it could be concluded that the patients who wore RPDs presented deficient knowledge with regard to the prevention, aetiology and development of dental caries and periodontal disease.