The International Journal of Prosthodontics

Purpose: This article reports on a retrospective study on patients with a diagnosis of amelogenesis imperfecta and on their prosthodontic management, oral health status, and attitudes toward their condition. Materials and Methods: The study comprised 15 patients and consisted of a clinical evaluation and questionnaire. Clinical examination included records of types of restorations and cements used, rating of restoration quality, as well as complications and periodontal variables. Results: The 15 patients had a total of 213 prosthetic restorations. The median age of the restorations was 60 months. Following the California Dental Association's system, all restorations were rated as acceptable to excellent, with one exception. During the follow-up period, four (2%) restorations had been recemented and 16 (8%) restorations had been redone, five (2%) because of porcelain fractures and 11 (5%) because of caries; two (1%) endodontic treatments were performed after prosthetic restoration. Plaque and Bleeding Indices were 28% and 21%, respectively, while pocket depths of more than 3 mm were found at 7% of all tooth surfaces. All patients judged their condition as having affected them negatively. However, after prosthodontic rehabilitation, patients experienced an improvement in self-esteem. Conclusion: Patients with severe clinical manifestations of amelogenesis imperfecta obtained extensive prosthodontic treatment at an early age. The restorations had in general performed well, and all patients were affected positively as a result.

Purpose: The survival rate of splinted and unsplinted provisional implants for anchoring removable interim overdentures, as well as handling and maintenance of the interim dentures, was evaluated. Materials and Methods: Eighteen edentulous maxillae were provided with 72 provisional implants for anchoring interim overdentures. For 10 patients, 40 unsplinted implants were used with conical copings to retain the provisional prostheses, while for 8 patients 32 implants had a splinted bar architecture for supporting the interim prostheses. Failure rate of provisional implants, as well as handling and behavior of the anchored interim overdentures, was followed until definitive prosthetic restoration and compared between groups. Results: Eighteen (25.0%) of the 72 provisional implants were prematurely lost. The loss rate of unsplinted implants (37.5%) was significantly higher than that of splinted implants (9.3%). Patient handling and maintenance of maxillary interim overdentures during the follow-up period was found to be easier with the splinted bar-retained method than with the unsplinted prosthodontic method. Conclusion: Placement of provisional implants fulfilled the requirements for initiating immediate prosthetic rehabilitation and showed that removable interim overdentures can be adequately stabilized and provide added patient comfort and satisfaction. The results suggest benefits of the splinted retention modality over the unsplinted method because of advantages regarding failure rate, patient handling, and interim denture maintenance.

Purpose: The aim of this retrospective report was to evaluate the treatment outcome of oral rehabilitation with dental implants in oligodontia patients. Materials and Methods: Thirteen oligodontia patients treated with dental implants were examined clinically and radiographically (follow-up 3 ± 2 years, range 1 to 8 years). In addition, patient-mediated concerns of satisfaction, treatment experience, and level of impairment of oral functions were assessed with questionnaires. Results: In general, all patients were satisfied with the implant treatment and experienced the treatment as nonaggravating. There was significant functional improvement, with an implant survival rate of 86% and 96% for the maxilla and mandible, respectively. Conclusion: Dental implants can play an important role in the oral rehabilitation of patients with oligodontia. Patients were generally satisfied with the overall treatment experience and reported significant functional improvement. Implant survival rate was comparable with previous reports.

Purpose: This study investigated the influence of hard and resilient polymerized acrylic resin base materials on the blood flow of the supporting underlying mucosa of mandibular denture wearers during different denture-wearing periods. Materials and Methods: Measurements were carried out on 20 complete denture wearers, 10 with hard bases and 10 with soft ones. The mucosal blood flow underlying the dentures was measured bilaterally in the canine and molar regions using a laser Doppler flowmeter. Baseline measurements were performed before denture wearing and after the dentures were worn for 1 week, 1 month, 3 months, and 6 months. Results: Mean blood flow to the mucosa after 1 week was significantly lower in the measured regions than that obtained before the dentures were worn. Blood flow in the canine region returned to almost normal levels 6 months after beginning to wear complete dentures. However, blood flow in the molar region of the denture wearers in the hard base group increased after 6 months, whereas blood flow values did not return to the levels recorded before denture insertion in the soft lining group. Conclusion: It appears that wearing dentures hinders blood flow to denture-supporting tissues, even when soft liners are used.

Purpose: Severely worn and broken down teeth present clinical treatment planning dilemmas. Extreme examples of worn teeth present in patients suffering from bulimia nervosa and dentinogenesis imperfecta. Bulimia nervosa typically presents early in adult life with a myriad of clinical features and a most important dental sign of eroded palatal surfaces on the maxillary teeth. Dentinogenesis imperfecta is a relatively uncommon disorder that presents with varying severity of unsupported enamel and results in teeth more susceptible to wear. Materials and Methods: Dental treatment for both conditions when wear has resulted in the complete loss of the tooth can either be directed toward restoring remaining tooth tissue or extraction and replacement with implants or dentures. This article presents the clinical management of three case histories, each with one or more severely broken down teeth, which were restored with adhesively retained crowns. Results: Treatment lasted nearly 10 years in one patient and failed after 6 years in another. The third patient was treated more recently. Conclusion: All three case histories serve as examples of using adhesive cements to retain indirect restorations as a possible prosthodontic management strategy.

Purpose: Adhesive cementation reduces the need for macroretentive preparation for crowns. This study investigated the survival and clinical rating of monolithic computer-aided design/manufacturing (CAD/CAM) ceramic crowns bonded to preparations with reduced macroretention, hypothesizing that adhesion would compensate for reduced retention geometry. Materials and Methods: Two-hundred eight posterior CAD/CAM-generated crowns from feldspar block ceramic were adhesively bonded in 136 patients in three preparation groups: classic (100% stump height, n = 70); reduced (reduced stump height or irregular stump, n = 52); and endo (absent stump but pulp chamber retention cavity, n = 86). Crowns were examined at baseline and after 55 ± 15 months using modified USPHS criteria. Plaque and bleeding of gingiva around the crowns were assessed. Results: Cumulative Kaplan-Meier survival of crowns on premolars/molars was: classic = 97.0%/94.6%; reduced = 92.9%/92.1%; and endo = 68.8%/87.1%, confirming the hypothesis for classic, reduced, and endo molars as well as for classic and reduced premolars. A significant difference was found between classic and endo premolar crowns, rejecting the hypothesis for endo preparation on premolars. Plaque and bleeding indices were significantly lower for crowned teeth than for controls. Conclusion: The survival of classic and reduced crowns was rated adequate for premolars and molars. Endo preparation appeared acceptable for molar crowns but inadequate for premolar crowns.

Purpose: This controlled clinical trial evaluated the clinical performance of a new resin-bonded fixed partial denture (FPD) system and compared the clinical performance with that of conventional FPDs. Materials and Methods: Resin-bonded FPDs replaced 12 single anterior and 9 premolar missing teeth in 20 healthy patients. Conventional three-unit FPDs (metal-ceramic crowns or complete cast-metal crowns) replaced 10 single anterior and 10 single posterior missing teeth in 20 age-matched controls. Retention, marginal integrity, periodontal condition of the FPDs, esthetics and hygiene of pontics, and secondary caries were clinically evaluated immediately, 1 month, and 2 years after cementation. Results: After 2 years, no failure was observed in the resin-bonded or conventional FPDs because of debonding from the abutment teeth. All clinical results evaluated for both groups were satisfactory or acceptable. No secondary caries was found in either group. Fisher's exact test and/or continuity-corrected chi-square test showed no significant differences of satisfactory rates between the resin-bonded and conventional FPDs for all variables evaluated. Conclusion: Short-term clinical results indicate that resin-bonded FPDs may be used as fixed prostheses to replace lost single anterior or premolar teeth with minimum preparation of abutment teeth. This restoration did not adversely influence pulpal or periodontal health. However, a 2-year clinical trial for a new FPD can only provide preliminary data, and longer term observations are clearly necessary.

Purpose: The aim of this study was to investigate whether gender-dependent associations exist between signs of temporomandibular disorders (TMD) and occlusal support. Materials and Methods: Stratified by gender, the data of 2,963 35- to 74-year-old participants from the epidemiologic Study of Health in Pomerania were used in logistic regression analyses with temporomandibular joint (TMJ) tenderness and muscle tenderness as the dependent variables. Occlusal support was classified according to the Eichner index, a classification system based on occluding pairs of teeth. The final model was adjusted for bruxism, age, and various sociodemographic data. Results: Logistic regression analyses revealed increased odds ratios for TMJ tenderness in men with loss of all four molar and premolar supporting zones (odds ratio 3:9) and without antagonist contact (odds ratio 2:7). Significant relationships in men were also found between muscle tenderness and loss of one (odds ratio 2:1), three (odds ratio 2:1), or four supporting zones (odds ratio 2:7), and loss of any tooth contact (odds ratio 2:3). In women, significant associations between occlusal support and TMD signs were absent. Subjects with bruxism were more likely to have TMJ tenderness (odds ratio women 2:0, men 1:9). In women, an additional relationship existed between bruxism and muscle tenderness (odds ratio 1:7). The following habits showed no significance: gum chewing, unilateral chewing, and lip/tongue/cheek biting. Conclusion: Only in men was the loss of occlusal support significantly associated with muscle and TMJ tenderness. The association between bruxism and TMD signs supports the theory that repetitive adverse loading of the masticatory system may cause functional disturbances.

The following abstracts were selected from the invited keynote papers and abstracts presented at the 2004 Annual Meeting of the International Society for Maxillofacial Rehabilitation by the IJP editor-in-chief and editorial board member John Beumer. Space limitations precluded the publication of all presentation abstracts. In the future, the IJP will not routinely publish abstracts of papers presented at meetings of its sponsoring organizations. It is felt that they belong in, and form, an integral part of such meetings' annual and/or biennial scientific program publications.