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Prosthodontics - A Quarterly Newsletter on Dental Specialties
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Easier implant placement

New technologies enable a less invasive treatment plan for placing implants in compromised bone, scientists publishing in the November 2012 issue of the Journal of Prosthetic Dentistry reported.

Typical treatment options for rehabilitating the posterior maxilla when this region of the jaw has insufficient bone can be a turn-off for patients. The invasive nature of sinus elevation and bone grafting, as well as the expense, are primary disincentives. In addition, clinicians seeking a high probability of success must plan a two-stage procedure and delayed implant placement.

Hypothesizing that a minimally invasive alternative could be effective, scientists at the University of Rome Tor Vergata pursued testing their theory. A substantive share of their reasoning included consideration of previous research showing that 3-dimensional computer-guided technology made treatment planning easier by facilitating placement with high accuracy and low invasiveness.

To investigate, researchers used imaging guided surgery, CAD/CAM-produced titanium and zirconia abutments and immediate-loaded partial fixed dental prostheses anchored to both straight and tilted implants in 27 patients. They also examined marginal bone loss around both axial and tilted implants.

Follow-up visits were scheduled for one, two, six and 16 weeks after implants were inserted and then annually for up to three years. Radiographic evaluations of marginal bone levels and loss were performed at one and three years after implant insertion to determine efficacy of the treatment.

Survival rates were 96.3 percent for implants and 100 percent for prosthesis among the 37 zirconia ceramic FDPs supported by a combination of axial and tilted implants performed on 27 participants observed for at least three years.

In this study, marginal bone loss was not significantly affected by tilting the implants, which coincided with the results of other researchers who have analyzed specific postoperative complications in the posterior maxilla.

Chipping of the veneer did occur in three of the 37 porcelain fused to zirconia prostheses for a success rate of 91.9 percent, but did not require replacement.

Because it was designed as a single cohort study, the primary limitation of the study was its lack of a control group, authors said in discussion, adding that some preliminary and generalizable conclusions can be drawn.

Referring to the CAD/CAM protocol authors described for rehabilitating the posterior atrophic maxilla, they concluded, "This technique is a viable, minimally invasive alternative to sinus floor augmentation. The use of guided surgery to place both axial and tilted implants produces predictable results and reduces the invasive nature of the surgery."

Authors also found that tilting the implants does not adversely affect the final outcome when necessary prerequisites are heeded.

http://www.sciencedirect.com/science/journal/00223913



Consulting Editor: Lars O. Bouma, DDS
Diplomate, American Board of Prosthodontics
 

 
Dental implants and cancer patients

An increasing number of reports show the successful use of dental implants during oral rehabilitation of head-and-neck cancer patients undergoing tumor surgery and radiation therapy.

But it's critical for health care professionals to be aware of the "multidimensional risk factors for these patients" when planning oral rehabilitation with dental implants, noted a review of the literature published in the August issue of the Journal of Prosthodontics.

A team of scientists from the University of Detroit Mercy School of Dentistry and the University of Michigan School of Dentistry authored the report http://onlinelibrary.wiley.com.

"Implant-supported dentures are a viable option when patients cannot use conventional dentures due to adverse effects of radiation therapy, including oral dryness or fragile mucosa, in addition to compromised anatomy," said the researchers.

They cautioned, however, that "negative effects of radiation, including osteoradionecrosis, are well documented in the literature, and early loss of implants in irradiated bone has been reported." Cancer of the oral cavity and pharynx, the largest group of head-and-neck cancers, is the ninth most common cancer in U.S. males. About 40,000 new cases will be diagnosed in the coming year, with a 5-year survival rate of 57 percent.

The Michigan group's search of the literature noted that the negative effects of radiotherapy (RT) on dental implant therapy were "undeniable."

They added, "Meticulous treatment planning along with careful postoperative oral examination and good coordination with oncologic specialists cannot be overemphasized. It is also important for the dental profession to keep abreast of the latest available RT technologies."

Keeping occlusal photos in patient records

When complications such as screw loosening or fracture occur with implants, the restoration may need to be removed, repaired and reinserted.

To remove cement-retained restorations, clinicians must access the abutment screw from the occlusal surface of the tooth. The dental literature includes research from various authors about the best ways to locate its position.

Scientists from India, publishing in the May 2013 issue of the Journal of Prosthetic Dentistry, describe a procedure for saving the occlusal photograph of such restorations, including the access points, in the form of a computer file. Its advantages include the ability to then transfer the file to the patient's e-mail or social networking account for easy retrieval if needed.

The authors cite observations from other researchers, including: "With this technique, no physical storage space is required to preserve the patient records in the form of casts, vacuum formed matrix or putty index. Neither staining of the ceramic crown nor complex photograph editing is required."

http://www.prosdent.org
http://www.ncbi.nlm.nih.gov/pubmed/23684287

News You Can Use
Live-patient prosthodontics courses at Annual Session
image: Annual Session Logo

The ADA Annual Session in New Orleans this fall will include nine courses on various aspects of fixed and removable prosthodontics. These courses include three live-patient Education-in-the-Rounds, presented by Drs. Gordon Christensen, Gregory Folse and Joseph Massad.

Other speakers in the prosthodontics area include Drs. Jean-Francois Bedard, Lawrence Wallace and Stephen Alouf.

The ADA's 2013 Annual Session will take place Oct. 31 to Nov. 3 in New Orleans. To explore this year's educational program, visit http://eventscribe.com/2013/ADA/aaSearchByCategory.asp?h=Browse by Category

For more information on Annual Session and to register, visit www.ada.org/session.

'JADA Live' seminars to explore 3D imaging

image: JADA logo

"JADA Live," a series of live continuing education seminars introduced last year, continues this fall with two programs on 3D imaging in dentistry.

Sponsored by the publishers of The Journal of the American Dental Association, two full-day CE events will feature dental experts offering the best and latest information to help dentists provide better care for their patients. Participants can earn up to seven hours of CE credit for each seminar through the ADA Continuing Education Recognition Program.

One seminar will take place this month, with a second scheduled for early October:

  • "Dentistry in the Digital Age: Unlock Your Practice Potential,"
    Friday, Sept. 27, 9 a.m. – 5:30 p.m.,
    Houston Crown Plaza River Oaks,
    2712 Southwest Fwy.,
    Houston, Texas 77098;
    713-523-8448;
    topics will include an overview of dental technology; digital radiography for you, your practice and your patients; 3D dentistry—the final piece of the digital puzzle.
  • An encore presentation (with some variations) of "Dentistry in the Digital Age: Unlock Your Practice Potential,"
    Friday, Oct. 4, 9 a.m. – 5:30 p.m.,
    Omni Nashville Hotel,
    250 Fifth Ave. S,
    Nashville, Tenn. 37201;
    615-782-5300;
    topics will include an overview of dental technology; digital radiography for you, your practice and your patients; 3D dentistry—the final piece of the digital puzzle; and 3D imaging in the treatment of sleep apnea and craniofacial pain.
Fees for these seminars vary by location and membership status. For more information and to register visit www.jadalive.org. These independent CE activities are supported in part by DEXIS, Gendex, Henry Schein Dental, Instrumentarium, i-CAT, KaVo, Marus, Pelton & Crane and SOREDEX.

Brochures on prosthodontic care available from ADA

image: W106 and W173 Brochures

Using the promo code 13433E, dentists can get a 10 percent discount on products ordered from the ADA Catalog, including discounts on two best-selling brochures related to prosthodontics: "Single Tooth Implant" and "Removable Partial Dentures." The discount is available through Oct. 31, 2013.

Single Tooth Implant (W173). Although nothing replaces a natural tooth, dental implants can come close. This brochure reviews the reasons to replace a missing tooth and illustrates the structure of a single implant. It describes the benefits of implants, updated steps of placement and healing, and who is a good candidate for implant therapy. It also underscores that good oral hygiene is vital to the success of the implant. The six-panel brochure is available in packs of 50 to members for $26; retail price is $39.

http://catalog.ada.org/productcatalog/623/Implants/Your-Single-Tooth-Implant/W173

Removable Partial Dentures (W106). This educational brochure for new partial denture wearers shows patients how to get the best performance from their partials. The brochure details the importance of replacing missing teeth and shows the basic structure of partials. It offers tips on getting used to partials, as well as on eating and speaking with them. It also encourages patients to visit their dentist for any necessary adjustments and repairs, and reminds wearers that it's important to maintain good oral hygiene for their remaining natural teeth. The eight-panel brochure is available in packs of 50 to members for $27; retail price is $40.50.

http://catalog.ada.org/productcatalog/129/Restorative/Removable-Partial-Dentures/W106

Both brochures, along with a wide variety of other patient education materials, are available at www.adacatalog.org. Volume discounts also are available.

You can order online or by calling the ADA Members Service Center at 1-800-947-4746. Remember to use promo code 13433E to save 10 percent on all ADA Catalog products.

Product Spotlight
Reducing treatment time with digital dentistry
by Dean H. Saiki, DDS and Grant Bullis, director of Implant R&D and Digital Manufacturing

The objective of the treatment plan was to improve patient comfort and chewing function by replacing the existing mandibular denture with a screw-retained fixed implant bridge.

Editorial and Advertising Policies
Any statements of opinion or fact are those of the authors and do not necessarily reflect the views of the American Dental Association. Neither the ADA nor any of its subsidiaries have any financial interest in any products mentioned in this publication. Any reference to a product or service, whether in advertisements or otherwise, is not intended as an endorsement or as approval by the ADA or any of its affiliated organizations unless accompanied by an authorized statement that such approval or endorsement has been granted.

All matters pertaining to advertising should be addressed to the advertising sales manager, Sales and Marketing Department, American Dental Association, Publishing Division, 211 E. Chicago Ave., Chicago, Ill 60611, 1-312-440-2740, fax 1-312-440-2550. All advertising appearing in ADA publications must comply with official published standards of the American Dental Association, a copy of which is available on request.

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