ABSTRACT
Full-arch and partial reconstruction is demanding for the clinician and a challenge for the patient. Traditionally, teeth are extracted, and implants are placed; the patient wears a provisional removable prosthesis during implant osseointegration. The patient is left to deal with a difficult transition from a fixed dentition to a removable one, albeit temporarily. This drastic alteration can generate functional, emotional, and esthetic changes for the patient, thereby making a difficult time even more challenging. Reconstructing the dentition through a staged approach has been documented and involves strategic extractions along with the placement of several implants, but leaves select abutment teeth for a fixed provisional prosthesis. This allows for the provisional prosthesis to be tooth-supported during implant integration and later converted to an implant-supported prosthesis. In this manner, the patient will benefit from a fixed provisional prosthesis throughout the treatment process. A staged approach is contingent upon a thorough periodontal and prosthetic evaluation and work-up. Success requires proper communication between the periodontist, surgeon, restorative dentist, laboratory, and patient. A team approach is necessary for success. The protocol, advantages, and disadvantages for a staged approach to a full-arch implant-supported reconstruction are discussed. The authors also present a case to show how the staged approach can be used for sextant or quadrant rehabilitation.
Subject(s)
Dental Implantation, Endosseous/methods , Dental Prosthesis, Implant-Supported , Adult , Alveolar Ridge Augmentation , Bone Transplantation , Denture, Partial, Temporary , Female , Humans , Osseointegration , Patient Care Planning , Patient Care Team , Periodontitis/therapy , Tooth ExtractionABSTRACT
Periodontitis is the most common lytic bone disease and one of the first clinical manifestations of diabetes. Diabetes increases the risk of periodontitis. The aim of the present study was to examine mechanisms by which diabetes aggravates periodontitis. Ligature-induced periodontitis was examined in Goto-Kakizaki rats with type 2 diabetes. A tumor necrosis factor (TNF)-specific-inhibitor, pegsunercept, was applied to diabetic rats after the onset of periodontal disease. Interferon-γ (IFN-γ), TNF-α, interleukin-1 ß (IL-1ß), fibroblast growth factor-2 (FGF-2), transforming growth factor beta-1 (TGFß-1), bone morphogenetic protein-2 (BMP-2), and BMP-6 were measured by real-time RT-PCR, and histological sections were examined for leukocyte infiltration and several parameters related to bone resorption and formation. Inflammation was prolonged in diabetic rats and was reversed by the TNF inhibitor, which reduced cytokine mRNA levels, leukocyte infiltration, and osteoclasts. In contrast, new bone and osteoid formation and osteoblast numbers were increased significantly vs. untreated diabetic animals. TNF inhibition in diabetic animals also reduced apoptosis, increased proliferation of bone-lining cells, and increased mRNA levels of FGF-2, TGFß-1, BMP-2, and BMP-6. Thus, diabetes prolongs inflammation and osteoclastogenesis in periodontitis and through TNF limits the normal reparative process by negatively modulating factors that regulate bone.
