Association de la Piézographie et de l'implantologie dans la gestion d'un cas d'édentement complet mandibulaire à crête résorbée

Lack of retention and stability are the main complaints in complete removable mandibular dentures due to the continuous bone resorption in edentulous subjects. Several therapeutic alternatives can be recommended in order to improve the prosthetic balance. The piezographic technique proves to be one of the most efficient techniques in these situations. It allows an optimal prosthetic integration in the functional corridor of this prosthesis. Today, the implant solution appears to be a determining factor in the successful treatment of this type of edentulism. It enhances the retention of complete removable mandibular prostheses.In this work, a clinical illustration of a similar case will be treated with a complete mandibular denture using these two therapeutic solutions combined.

Comparative observations of lingualized occlusion and monoplane occlusion in the treatment of severe atrophy of edentulous mandible

The patient who has severely absorbed residual ridges, treatments are challenging to satisfy many factors: support, retention, stability, etc. The neutral zone or monoplane occlusion with non-anatomical tooth would be helpful to get additional retention and stability. The monoplane occlusion has been used long time because it can eliminate horizontal forces and many other advantages. The lingualized occlusion was introduced to improve chewing efficiency and esthetics. But from a stability aspect, it seems controversy between monoplane occlusion and lingualized occlusion. This case report shows the results of the treat two flat residual ridge patients using functional impression; piezography, and made 2 other dentures with monoplane and lingualized occlusion that patient can select denture.

Complete denture rehabilitation of fully edentulous patient with severe bone resorption and class II jaw relation using piezography / 대한치과보철학회지

Piezography, prosthetic space recorded by pronunciation, can be used as a reference for arrangement of artificial teeth and polishing surface of a denture. In this case, a 67 year old female patient was presented for new dentures. Old dentures had class II relationship and poor retention. For fabrication of stable dentures, using piezography and lingualized occlusion was planned. After taking impressions with conventional method, conventional denture bases with wax rim were fabricated. Then, additional mandibular denture base was fabricated for piezography. With fast setting silicon impression material, piezography was recorded by using six pronunciations, 'si', 'so', 'me', 'te', 'de', and 'mu'. According to the piezographic space, mandibular artificial teeth were arranged and modified for lingualized occlusion. As a result, the patient was satisfied with new dentures functionally and esthetically.

Reporte clínico: registro piezográfico de la zona neutra, en un paciente con espasmos musculares involuntarios / Clinical report: piezographyc record of the neutral zone in a complete edentulous patient with involuntary muscle spasms

Toda función del sistema estomatognático involucra la acción sinérgica de la musculatura paraprotética, representada por estructuras complejas tales como lengua, labios, mejillas y piso de boca. Al rehabilitar a través de prótesis completas no siempre se considera la influencia de la dinámica muscular, y menos aún cuando alguna de estas estructuras presenten alguna patología, por ejemplo, el compromiso del nervio facial que genera espasmos musculares involuntarios. En tal situación, la ubicación de los dientes y la forma de las superficies pulidas pueden llegar a ser decisivos entre éxito o fracaso de la rehabilitación. Se sabe que los implantes oseointegrados proveen retención, soporte y estabilidad, sin embargo existen situaciones especiales en que no es posible acceder a este tipo de tratamiento, tanto por razones médico quirúrgicas o costos asociados. En este estudio se ha utilizado un registro Piezográfico de la Zona Neutra en un paciente con compromiso del nervio facial que genera espasmos musculares involuntarios del lado afectado, obteniéndose una rehabilitación protésica basada en la apropiada relación entre superficie protésica externa y tejidos circundantes, mejorando requisitos funcionales tales como retención y estabilidad. Se ha utilizado el sistema de tomografía computarizada Cone Beam, con el objetivo de evidenciar el registro piezográfico. Los resultados obtenidos con estas prótesis piezográficas demuestran ser superior en factores como comodidad y fonoarticulación pero inferior en eficiencia masticatoria comparada con la técnica convencional.

Every function of the stomatognathic system involves the synergistic action of the musculature around the prosthesis, consisting of complex and individual structures such as tongue, lips, cheeks and mouth floor. When planning and making complete prostheses, the muscular dynamic is not always considered. This can generate instability of the device during function, the location of the artificial teeth is made arbitrarily on the top and middle parts of the flange, and the configuration of the polished areas is made according to mechanistic concepts. This factor takes more relevance in patients with severe atrophy of their residual flanges, where the prosthetic stability can be a decisive factor between the success or failure of the rehabilitation. It is known that the osseointegrated implants provide retention, support and stability. However, there are special situations in which it is not possible to access to this type of treatment, both for medical surgical reasons or associated costs. In this study, a Piezographyc record of the Neutral Zone was used in a patient with facial nerve involvement generating involuntary muscle spasms of the affected side. A prosthetic rehabilitation based on the appropriate relation between external prosthetic surface and surrounding tissues was obtained, improving functional requirements such as retention and stability. The computerized tomographic Cone Beam system was used, with the objective to show the piezographic record. The results obtained with these piezographic prostheses prove to be superior in factors like comfort and speech articulation, but inferior in masticatory efficiency, where the conventional technique is still better.