Healthcare
In the current paper, we will discuss the complications in removable implant prosthesis, fabrication, delivery, and function. For the purpose of understanding these topics better, we need to understand the basic concepts of dental implants first. A dental implant can be described as an artificial replacement of a tooth root which is placed in the jaw for the purpose of holding a replaced tooth or a bridge. Dental implants can be used as an option for the patients who had lost a tooth as a result of a periodontal disease, injury or any other reason.
Two different types of implants are: subperiosteal and endosteal. Endosteal also known as in- the- bone type of implants are used more commonly, these may include cylinders, screws or blades which are placed surgically into the jawbone. A single implant may hold more than one prosthetic tooth. This implant is usually used as a substitute for the patients who are having removable dentures and bridges. Subperiosteal or on the bone implants are situated on the top of the jaw along with a metal framework's post protruding out of the gum for better holding of the prosthesis. This particular type of implant is normally used for the patients who are not able to put on the conventional dentures and for those having a minimal bone height (American Academy of Periodontology, 2016).
Fabrication of Implant Prostheses
Edentulism can be considered as a disability and one of the major oral health issues all over the world. Replacement of a missing tooth with complete denture does not always restore the efficacy of mastication of natural dentition, even though fabricated and well designed removable dental prosthesis can and often do satisfy the patients who have both an acceptable amount of soft or hard tissues and adaptability. This phenomenon applies to millions of the edentulous patients. Worldwide increasing awareness, survival demand and implants' success and restoration have shifted options for the restoring of the edentulous mouth from conventional dentures to the implant assisted prostheses. Many research studies have brought forward the fact that the approaches for the restoration involving implants not only improves the denture bearing foundations but also improves the quality of life of the edentulous patient along with his confidence. Some factors which need to be considered while deciding on the type of implant restoration are: general health of the patient, the amount of bones present, support provided by the lips, smile line and length, special support, maxillomandibular ridge relationships, restorative space, aesthetics space, opposing of arch, parafunctional habits, maxillomandibular defects, oral hygiene of the patient, speech, economics, preferences of the patient, ease of fabrication or repair, presence of keratinized tissue, gag reflex of the patient, the recurrent sore spot and so on. For the purpose of providing an optimal plan of treatment for the patients, complete diagnostic evaluation is needed. The diagnostic evaluation should consist of the determination of the impact of all the factors discussed above. On the basis of the acquired information, a plan of treatment can be developed which best meets the desires and the oral and dental environment of the patient. The patient should be considered and treated holistically, keeping in mind all the factors which affect a choice between implant restoration to be assessed and decide with CT scan and wax trial denture. In order to obtain a satisfactory outcome of the treatment procedure fixed implant prostheses are best suited for the patients having minimal hard and soft tissue resorption, optimal maxilla-mandibular relationship and a very good oral and dental hygiene compliance (Massad, Ahuja, and Goodacre, 2015).
(Types of Dentures, 2016)
An article based on the analysis of the literature review conducted by Sadowsky emphasizes on the right number, splinted or non-splinted system of anchorage, length, distribution of implant, their maintenance and patient satisfaction of maxillary implant overdentures was put forward. A systematic literature review was conducted for obtaining evidence for the establishment of the criterion for treatment considerations of implant overdenture treatment of edentulous maxilla. The search consisted of Peer reviewed literary works which were completed using the Medline database between the years 1988 and 2006. The study focused on evidence controlled clinical trials, longitudinal experimental clinical studies, non-randomised controlled studies, longitudinal retrospective studies, and longitudinal prospective studies. The review used was general hierarchical classification. The articles which were not focused on, or had no impact on implant overdenture treatment of the maxilla were not included for the purpose of evaluation. The final search was conducted on 31st of December 2006. The symptoms which were included during the research were a dental implant, maxillary, and overdenture. The literature demonstrated a very limited number of randomised controlled trials and longitudinal prospective and retrospective studies which strongly supported treatment consideration premises for the implant overdenture treatment of the edentulous maxilla. The study thus concluded that within the limits of the systematic review, the treatment consideration recommendation posited given the available evidence. Better designed, longitudinal studies with more power are required for the establishment of definitive evidence-based treatment planning principles for the maxillary implant overdenture patient (Sadowsky, 2007).
Complications of Functioning
Various researchers have produced some commendable work on the subject of dental implants. In this paper, we will talk about the findings of such research workers and their studies. A study conducted by Peter Kiener and others aimed at evaluating the complications of the prosthesis with implant- supported maxillary overdentures. 41 patients were selected as subjects for the study. The mean age of these patients was 61 years. These patients were admitted consecutively for the purpose of treatment from the year 1991 to 1998. 173 ITI implants have been placed, almost 4 to 6 implants were either connected to a bar (thirty four overdentures) or with a single anchor (7 overdentures) provided support to the denture. Very few parties had lesser than 4 implants. The overdentures were of a horse- shoe design and they were reinforced by cast metal framework. The average time for observation was kept as 3.2 years. Regular assessment of peri-implant parameters and oral hygiene were done. Records were also maintained regarding prosthetic maintenance services. All the complication of processes which were encountered, were further grouped related to i) anchorage devices and implant components ii) structural failures and mechanical failures of dentures and iii) dentures related adjustments. The results of the study suggested that 5 of the implants were lost post loading, 3 of them failed to osseointegrate. Therefore, the overall rate of survival of implant was found to be 95.5 %. In total, 85 complications of the prosthesis were observed. The most common findings were retightening of adjustments and bar screw of bar retainers. Denture repairing was not frequent and was found to be closely related to a broken tooth. There were no denture fractures observed. Dentures were renewed twice, first time after implant loss of a patient. 39 of the overdentures were continuously worn by patients. Therefore, the overall stability of denture was 95%. The commonest findings in the very first year were irritation of the mucous and the need of occlusal adjustment. With progressive time, a relative dip in the complications was evident. Thus, the study concluded that planned maxillary overdentures which were supported by implants were a successful treatment option for a short term (Kiener et al., 2001).
A 10 year randomised, prospective, clinical trial was performed to investigate the outcomes of the treatment of all the edentulous patients who were subjected to be treated with the mandibular overdentures, retained by two endosseous implants compared to the conventional dentures among patients who were with or without the vestibuloplasty. The study included 151 edentulous patients with a simple height of mandible within the range of 8 to 25 millimetres. Among them, 62 patients were subjected to treatment having an overdenture which is retained by two implants. 59 patients were being treated with conventional dentures and 30 were being treated with the help of conventional dentures after pre-prosthetic vestibuloplasty. The patients who have received the conventional dentures, but actually wanted to go for implants were allowed to go for implant surgery after a period of 1 year from the initiation of treatment but they were analysed as per the original group into which they were initially included. The surgical and prosthetic care and aftercare was then scored accordingly during the ten years period of evaluation. Out of 151 patients, 133 could complete the ten years follow-up evaluation. Among them, 44% of the patients who got treated with the help of conventional dentures later switched within the period of 10- years to implant retained overdentures, against 16% of patients who were treated with conventional dentures after vestibuloplasty. On an average, a larger time investment and number of treatment sessions were required in patients who were treated with implant retained overdentures compared to the patients who were being treated with the conventional dentures. The study has concluded that the patients who were treated with an implant retained overdenture needed more treatment intervention and time of treatment than the patients who were treated with conventional dentures (McIntyre, 2007).
A systematic review including a meta-analysis was conducted to find the answer to the question if the type of implant prosthetics used affects the final outcomes of a completely edentulous arch. The conducted research aimed at assessing the impact of fixed or movable type of prosthetics, the survival of implants and their success outcomes. Different literary works were identified from the PubMed database; hand searching of significant and relevant journals was also performed. Different criterion was set for inclusion and exclusion of the selected studies. Finally, 72 studies were selected which reported oral implant, success or survival rate, crestal bone lost or levels and prosthesis success or differentiated maintenance by the arch and by the type of prostheses (removable or fixed). Upon analysis of the data, it was observed that only site specific, rather than being design specific implant survival for the mandibular fixed type of prosthesis groups had 6.6 percent higher implants survival rate than the maxillary fixed type of prostheses groups. The observation of higher implant failure for removal over fixed types of prosthesis groups in maxilla appears likely due to the deficiency in the preoperative bone volume of the removable prosthetic group. The study thus suggests that the survival of implants and their success may not get directly affected by the variations across the types of the prosthesis; demands of maintenance can be variable depending on the type of implant prosthesis, especially when it comes to overdenture attachments. The article further suggests the clinician to remain diligent while basing implant prosthodontic technique on the pre-established protocols (Bryant, Jankowski, and Kim, 2007).
Complications of prostheses were evaluated on 246 patients who were treated with five hundred and twenty eight implants over a period of 8 years in a private practice setting. The study consisted of 55 overdentures and two hundred and sixty five fixed partial dentures. Out of the two hundred and sixty five fixed fixed partial dentures, 231 were cemented and the rest 34 were screw retained. The frequency and the style of prosthetic incidences were recorded which included adjustment along with complications. Analysis of the data was done using Chi-square test for identification of the associated risk factors along with the complications. Over the study period of 8 years, one of the abutments was fractured and two of them became loose. This led to a cumulative implant component rate of success of 99.2 %. Patients who had removable prosthesis had higher number of complications than their counterparts having the fixed ones. 66% against11.5 %, the difference is huge and quite significant. The posterior fixed prosthesis had a higher number of complications than the anterior prostheses. The rate of difference in the complication rates for the cemented and the screw retained prosthesis were not significantly huge. The prostheses which had an extension cantilever had higher complications. In the overdenture group, the ball retained prostheses had significantly more complications than their bar retained counterparts. In the fixed partial dentures group the complications were not recurring, most of them occurred only during the initial 2 years. The complications rate did not go up along with time. In the overdenture group 1.3 incidents against each prostheses were noted. Incidents were recurring and the complication rate did not go down along with time. The study thus concludes that fixed prosthesis and the removable ones were associated with complications of variable frequency and are of different types. In the removable group, the attachments and predictable complications were easily manageable. The bar retained prosthesis had less number of complications than the ball retained ones. In the fixed partial dentures group, the complications were mostly limited and did not show an increase with time. The complications were mostly restricted to hind region only (Nadir et al., 2006).
(Diference between different types of Implants, 2016)
A systematic review of the incidences of technical and biological complications in the implant therapy reporting was done over the studies in a period range of 5 years in a prospective study approach. A thorough research of the articles in the Medline database was performed for the prospective study having a follow-up period of minimum 5 years. Data abstraction and screening were done independently by many reviewers. The complications which were assessed were: loss of implant, disturbance in the sensory input, complications of the soft tissue, peri-implantitis, loss of bone, fracture of the implant and other technical complications which are associated with superstructure and implant components. The complete search resulted in thirteen hundred and ten titles along with abstracts. Out of them, one hundred and fifty-nine have been selected for the purpose of full-text analysis. At last, fifty-one studies were considered. Upon meta-analysis of the studies, it was found that the loss of implant prior to the functional loading is expected to happen in almost 2.5 per cent of all the implants which are placed in the implant therapy. This includes more than one implant, and whenever the routine procedures are used. Loss of implant occurs in almost 2 to 3% of cases which supports fixed reconstruction. While being under overdenture therapy, less than 5% of implants are expected to be lost over a five-year period. Very few studies reported findings on the incidence of continuous sensory disturbance after implant surgery. A maximum number of studies which provided such a data reported the absence of very low incidence of this type of complication beyond the interval of 5 years. A number of complications related to soft tissue were reported for the patients who were treated with implants supporting overdentures. There was very limited information about the occurrence of peri-implantitis and about implants which exhibit bone loss. Fracture of the implant is a very rare complication and may occur in less than 1% of all cases of implants over a five-year period. The incidences of complications related to technicalities of implant components and superstructure were higher in the overdentures than in the fixed reconstructions. This study, hence concluded that the loss of implant was more frequently described by the biological complications which were observed in only 40 to 60%, and the technical complications were seen only in 60%- 80% of studies. The observations indicated that the data on incidences of technical and biological complications may be under looked and needs to be interpreted with due caution (Berglundh, Persson, and Klinge, 2002). Treatment of implant overdenture of the edentulous maxilla is found to be a challenging issue due to the inherent anatomy and biomechanical errors. The controversy persists as to the factors which are critical for implant and prosthesis success. Established criteria for the design of maxillary implant overdenture is still lacking.
Delivery of Implant Prosthesis
Another research conducted by E. Klemetti, aimed at determining if there were reasons for recommending a particular number of implants for retention or supporting the mandibular or maxillary overdentures. The study was based on literature searches which covered controlled trials which for randomised controlled clinical trials, meta-analysis, and some review articles which were published in English dental journals from the year 1990 to 2007. The research brought forward 1779 articles, out of which 182 studies were reviewed based on the Abstract and the ones which fell into the exclusion criterion were excluded. The 39 remaining complete articles were reviewed against the criterion for inclusion for the final selection. 11 reports which met the inclusion criteria were finally chosen for the review.
(Implant Delivery, 2016)
Three of them were for maxilla and 8 were for the mandible. On the basis of the obtained data, it can be concluded that patient satisfaction on the functioning of the prosthetics was independent of the number of implants. The type of attachment in mandible and overdenture having two implants with bar attachment has the least numbers of complications (KLEMETTI, 2008).
References
American Academy of Periodontology. (2016). Dental Implants | Perio.org. [online] Available at: https://www.perio.org/consumer/dental-implants [Accessed 22 Jun. 2016].
Berglundh, T., Persson, L. and Klinge, B. (2002). A systematic review of the incidence of biological and technical complications in implant dentistry reported in prospective longitudinal studies of at least 5 years. Journal of Clinical Periodontology, 29(s3), pp.197-212.
Bryant, S., Jankowski, D. and Kim, K. (2007). Does the type of implant prosthesis affect outcomes for completely edentulous arch'. International Journal of Oral and Maxillofacial Implants, 22, pp.117-139.
Diference between different types of Implants. (2016). [image] Available at: http://www.deardoctor.com/images/webcontent/fixed-dentures/implant-supported-dentures-vs-removable.jpg [Accessed 26 Jun. 2016].
Endosseus Implants. (2016). [image] Available at: http://dentalimplants.uchc.edu/images/about_implants/image_page19_endosseous.jpg [Accessed 24 Jun. 2016].
Implant Delivery. (2016). [image] Available at: http://milforddentures.co.nz/wp-content/uploads/2014/04/impression.jpg [Accessed 26 Jun. 2016].
Kiener, P., Oetterli, M., Mericske, E. and Mericske- Stern, R. (2001). Effectiveness of Maxillary Overdentures Supported by Implants: Maintenance and Prosthetic Complications. International Journal of Prosthodont, 14.
KLEMETTI, E. (2008). Is there a certain number of implants needed to retain an overdenture?. J Oral Rehabil, 35(s1), pp.80-84.
Massad, J., Ahuja, S. and Goodacre, C. (2015). Implants and Prosthetic Restorations: Clinical Considerations - Oral Health Group. [online] Oral Health Group. Available at: http://www.oralhealthgroup.com/features/implants-and-prosthetic-restorations-clinical-considerations/ [Accessed 24 Jun. 2016].
McIntyre, F. (2007). Implant-Retained Mandibular Overdentures Versus Conventional Dentures: 10 Years of Care and Aftercare. Yearbook of Dentistry, 2007, p.62.
Sadowsky, S. (2007). Treatment considerations for maxillary implant overdentures: A systematic review. The Journal of Prosthetic Dentistry, 97(6), pp.340-348.
Types of Dentures. (2016). [image] Available at: http://www.newwindsordentalimplants.com/editor/assets/D57C332B-4D1E-4F31-AA37-4A2FC85F3CDB.jpg [Accessed 26 Jun. 2016].
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