Prosthetic complications in fixed endosseous implant-borne reconstructions after an observations period of at least 40 months.

One hundred and seventy-two fixed reconstructions (317 prosthetic units), made on 283 ITI implants in 105 patients (age range 25-86 years) with a minimum follow-up period of 40 months, were taken into the study to analyse technical complication rate, complication type and costs for repair. The mean evaluation time was 62.5 +/- 25.3 months. Eighty were single crowns and 92 different types of fixed partial dentures (FPDs). In 45 cases the construction was screw retained and in 127 cases cemented with zinc phosphate cement or an acrylic-based cement. Complications occurred after a minimum period of 2 months and a maximum period of 100 months (mean: 35.9 +/- 21.4 months). Fifty-five prosthetic interventions were needed on 44 constructions (25%) of which 88% in the molar/premolar region. The lowest percentage of complications occurred in single crowns (25%), the highest in 3-4 unit FPDs (35%) and in FPDs with an extension (44%). Of the necessary clinical repair, 36% was recementing and 38% tightening the screws. Of all interventions, 14% were classified as minor (no treatment or <10 min chair time), 70% as moderate (>10 min but <60 min chair time) and 14% as major interventions (>60 min and additional costs for replacement of parts and/or laboratory). For seven patients the additional costs ranged from euro 28 to euro 840. Bruxing seemed to play a significant role in the frequency of complications. Longer constructions seemed to be more prone to complications. The relatively high occurrence of technical complications should be discussed with the patient before the start of the treatment.

Comparison of clinical profiles and treatment outcomes of an elderly and a younger temporomandibular patient group.

STATEMENT OF PROBLEM: Older temporomandibular disorder patients with more general complications and health problems may have a different clinical profile and be likely to react less favorably to conservative treatment. PURPOSE: This retrospective study compared the clinical profiles of a young (20 to 30 years) and an older (50 to 70 years) group of patients with pain and dysfunction in the temporomandibular region and to analyze treatment outcomes. METHODS: Clinical profiles and treatment outcomes were studied with a standardized protocol and the Helkimo Pain and Dysfunction Index up to 1 year after initial examination. RESULTS: Younger and older patients with temporomandibular disorder differed only in pain intensity at initial examination, but the outcome of conservation treatment was equally successful. CONCLUSION: Conservative treatment resulted in a significant alleviation of pain and dysfunction in almost 85% of patients. Both the younger and the older patient groups benefitted from this treatment protocol and therefore can be treated in the same fashion.

[Periodontal aspects of cementation: materials, technics and their biologic reactions]. / Aspects parodontaux du scellement: matériaux, techniques et leur reaction biologique.

Cementation of crowns and bridges has an influence on the health of marginal periodontal structures. Ideally, the marginal discrepancy should be less than 50 microns which has been considered clinically acceptable. With discrepancies larger than 80 microns, the bleeding tendency and sulcus fluid flow rate increased. A shoulder-bevel preparation results in the smallest marginal discrepancy. Cytotoxicity of cements has been studied in cultures of gingival cells and fibroblasts. Composite has always a more pronounced cytotoxicity as compared to glass-ionomers and zinc phosphate cements. However, large differences exist in cytotoxicity between materials of the same group. Erosion of the cement leads to leakage of toxic materials and the formation of niches colonised by oral plaque bacteria. A number of clinical recommendations are made to minimize the effect of cements and cementation on the periodontal structures.

Signs of temporomandibular disorders in patients with horizontal mandibular deficiency.

This study assessed the relationship between temporomandibular disorders (TMD) and malocclusion in a group of 102 patients with horizontal mandibular deficiency who had elected mandibular advancement surgery. The prevalence of TMD as reflected by the overall Craniomandibular Index, Dysfunction index, and Muscle index scores was within the range of non TMD populations (mean Craniomandibular Index = 0.14; mean Dysfunction index = 0.12; mean Muscle index = 0.15). Forty-two percent of the patients exhibited essentially no signs of TMD, 7.8% had primarily muscle tenderness to palpation, 36.3% had joint sounds with or without temporomandibular joint tenderness, and 13.7% had combined muscle-joint signs. There were no convincing correlations among any of the cephalometric variables and Craniomandibular Index, Dysfunction index, and Muscle index scores. A subgroup of 30 of this patient population was evaluated both before and during orthodontic treatment just prior to surgery. No statistically significant changes were found in Craniomandibular Index, Dysfunction index, or Muscle index scores. Thus, a period of orthodontic treatment in these patients does not appear to increase the probability of TMD.