[The atrophic maxilla. Rehabilitation by bone reconstruction, implants and permanent or removable dentures]. / De geresorbeerde bovenkaak. Rehabilitatie met behulp van botreconstructie, implantaten en vaste of uitneembare prothetische voorzieningen.

Maxillary bone reconstruction in combination with placement of endosseous dental implants is a new treatment modality for patients suffering from maxillary atrophy and difficulties with wearing removable prosthesis. Among 88 patients the experiences with and their satisfaction at parts of the treatment were investigated. Patients could express their appreciation in a 1-5 scale (1 = bad, 5 = good). The satisfaction at the total treatment was given the mean figure 4.1 +/- 0.9. Ninety percent of the patients would go through the treatment again when necessary.

[The Brånemark implant in the lower jaw. Experiences of edentate patients with a complete implant-supported bridge]. / Het Brånemark-implantaat in de onderkaak. Ervaringen van edentate patiënten met een volledige implantaatgedragen brug.

The Brånemark system for implant supported bridges has been carried out in Amsterdam since 1982. One hundred patients with a maxillary conventional full denture and a mandibular fixed tissue-integrated prosthesis were selected for this study. Before and long after the treatment, questionnaires were sent to these patients in order to gain information of their experiences. The treatment had greatly benefitted the patients, in spite of the problem of the loose lower denture in some cases was shifted to the upper jaw.

[Saliva and dentures]. / Speeksel en kunstgebit.

Saliva plays an important role in the functioning of full dentures. A prosthesis does not rest on bare mucous membranes but on an interposed salivary film. This pellicle, mainly consisting of mucin glycoproteins, protects the tissues from injury caused by the denture base. The retention of the complete upper denture, and in a lesser degree of the lower, is also dependent on the salivary layer between the denture base and the oral tissues. A combination of several physical factors results in an adhesion. In order to achieve an optimal effect of these adhesive forces, the manufacturing of the dentures as well as the long term aftercare should meet a number of requirements, described in this article.

Reconstruction of the severely resorbed mandible prior to vestibuloplasty or placement of endosseous implants. A 2 to 5 year follow-up.

Ninety-two patients underwent augmentation of the severely resorbed mandible using corticocancellous bone grafts in the symphysis and a mixture of autogenous cancellous bone chips and hydroxylapatite particles in the posterior area. This study, extending from 2 to 5 years, shows that predictable and stable results were achieved. The average loss of height measured at 3 reference points was approximately 20%. Slight sensory disturbance was present in 19 patients (23%). Benefits derived from augmentation of the atrophic mandible include: improvement of facial form due to the renewed support of the collapsed circumoral muscles, a decrease in the intermaxillary distance, and restoration of mandibular bone bulk that will accommodate endosseous implants of maximum size.

Dutch consensus on guidelines for superstructures on endosseous implants in the edentulous mandible.

This consensus report has been reached under the authority of the Dutch Society for Oral Implantology and the Dutch Society for Prosthetic Dentistry by a panel of Dutch dentists and prosthodontists (listed above) who are involved in the treatment of patients with oral implants, either via practice or via research. They were commissioned with a task to "formulate guidelines for the prosthetic treatment of edentulous patients receiving oral implants in the mandible".

Reconstruction of the severely resorbed mandible with interposed bone grafts and hydroxylapatite. A 2-3 year follow-up.

A follow-up study on 55 patients, who underwent an augmentation of their severely resorbed mandible, using a mixture of autogenous bone and HA-granules, is discussed. The method combines an interposed bone graft technique in the symphyseal area with a subperiosteal tunneling in the region posterior to the mental foramina. The results show a maximum height loss of approximately 30% in both the symphysis and the bicuspid-molar region after 2 to 3 years, from which most occurred in the first 6 months. The method is relatively safe with regard to potential nerve damage and provides excellent aesthetic results. The option for subsequent placement of implants is entirely possible.

The "three-piece" osteotomy and interpositional bone graft for augmentation of the atrophic mandible.

A study of 20 patients who underwent augmentation of an atrophic mandible by a "three-piece" osteotomy and interpositional bone graft technique is presented. The results show a reduced rate of bone resorption in the posterior regions and a reduced incidence of sensory nerve disturbances in comparison with previous visor/sandwich techniques.

Augmentation of the atrophic mandible with interposed bone grafts and particulate hydroxylapatite.

The use of hydroxylapatite mixed with autogenous bone to augment the area posterior to the mental foramen is described. This method is combined with an interposed bone graft technique in the symphyseal area. The clinical implications are discussed in relation to potential nerve damage, height to be gained, and effects on lip-chin profile, and the results in 29 patients are reported.

Recent developments in interpositional bone-grafting of the atrophic mandible.

A clinical study on 54 patients, who underwent augmentation of the atrophic mandible by interposed bone-grafts, but in whom routine follow-up vestibuloplasty was deliberately avoided, is presented. The results show a reduced rate of bone resorption in the anterior region and less interference with lip and chin sensibility. An additional study is included concerning the fate of the elevated ridge and associated bone-graft in the body region posterior to the mental foramen. Results suggest that the resorption pattern in this area is very similar to that of a subperiosteal bone-graft. Modification of surgical technique in this regard has produced encouraging results.

Mandibular vestibuloplasty using a free mucosal graft. A 2-7 year evaluation.

A long-term follow-up (7-2 years) of 152 patients who underwent a vestibuloplasty is presented. Special emphasis has been put on the condition of the graft, nerve disturbances and chin contour changes. As a result of this study, a mandibular vestibuloplasty procedure is recommended that has minimal side effects, and yet provides an adequate base on which to build a denture on.

A reappraisal of the interposed bone graft augmentation of the atrophic mandible.

A follow-up on 148 patients who had undergone an interposed bonegraft augmentation of the atrophic mandible is presented. The first group consisted of 38 patients who underwent surgery 4-6 years ago. The second group of 70 patients has a follow-up period of 3 to 4 years. The third group of 40 patients was followed up from 2 to 3 years postoperatively. The phenomenon of post-operative bone resorption which continues for many years postoperatively, is discussed. The high incidence of nerve disturbances as found in this study is regarded as unacceptable. The dissection of the mandibular nerve out of its canal (decompression) in order to avoid nerve damage during the operation is not found to be of any advantage. A modified technique is recommended to circumvent this problem.

Interposed bone-graft augmentation of the atrophic mandible (a progress report).

A follow-up study on 41 patients who had augmentation of the atrophic mandible by interposed bone graft is presented. Special emphasis has been put on the prosthetic implications. The rapid reduction in height measured postoperatively appeared almost to cease after 6 months. Some of the possible causes of this phenomenon are discussed.