Customized implant abutment copings to achieve biologic, mechanical, and esthetic objectives.

Fixed restorations for patients with implant-supported abutments frequently produce an unsatisfactory mechanical, biologic, or esthetic compromise. Pure titanium transmucosal abutments have biologic advantages, and factory-milled abutments for the comparable implant interface have mechanical advantages. The ultimate restorative objective is to satisfy the patient's desire for an esthetic restoration. This can generally be accomplished with precisely positioned implants; however, compromised locations need to be corrected with modified abutments. The use of customized copings fabricated by casting to pure titanium abutments can satisfy all three criteria, and may in some situations be the restorative procedure of choice. The clinical and laboratory procedures involved in achieving these criteria are described in detail.

A survey of natural tooth abutment intrusion with implant-connected fixed partial dentures.

To elicit information about the phenomenon of intrusion of natural tooth abutments in implant-connected prostheses, a survey was distributed to clinicians with varied experience. Although practitioners with more experience in fabricating implant-supported dentures connected to natural teeth reported fewer instances of intrusion, it cannot be concluded that this observation is significant. The cause of intrusion is probably multifactorial, and respondents suggested several possible causative factors: disuse atrophy, debris impaction, impaired rebound memory, and mechanical binding. Because apical migration of abutment teeth affects occlusion and oral hygiene, the authors make several recommendations for treatment planning for patients who have natural dentition adjacent to proposed implant sites.

Guidelines for a scientific presentation.

Guidelines for a projected scientific presentation can assist the speaker in preparing an effective audiovisual presentation. This article highlights the factors that improve the quality of an audiovisually assisted presentation and enhance successful communication.

The role of operatory and laboratory personnel in patient esthetic consultations.

Sophisticated esthetic restorative dentistry cannot routinely be developed without close coordination with laboratory personnel. Direct communication between operatory and laboratory personnel and the patient is an integral requirement for predictable results. By effectively delegating many preparatory procedures to laboratory personnel, the efficiency and quality control of operatory procedures can be greatly enhanced. Coordination of each operatory procedure with the appropriate preliminary, concurrent, and subsequent laboratory procedures can provide the patient, technician, and dentist with a mutually appreciated functional and esthetic result.

Comparison of the multiphasic dysfunction profile with lateral transcranial radiographs.

Lateral transcranial radiographs of 926 patients were analyzed for condylar position, TMJ space, and obvious condylar morphologic changes. Differences in condylar position and joint space variations were noted between men and women. An increase in nonconcentric condylar position, joint space variations, and condylar morphologic changes were found with advancing age. There was a significant correlation of condylar position, joint space variations, and condylar morphology with mandibular dysfunction profile scores. Mandibular dysfunction is manifested by a wide range of signs and symptoms, none of which is always present with the disorder. Although TRs are limited in their total diagnostic value, their use in discerning major TMJ changes serves as an important adjunct in the examination and diagnosis of mandibular dysfunction.

The prevalence of mandibular dysfunction. Part II: A multiphasic dysfunction profile.

The frequency of occurrence of 20 signs and symptoms commonly associated with mandibular dysfunction was used to numerically rate the clinical severity of mandibular dysfunction. Some signs and symptoms had a clearly direct relationship whereas other signs demonstrated a diminished direct relationship, no relationship, or an inverse relationship in advanced dysfunction stages. Further study is needed to determine if there exists an exact relationship of some clinical signs to mandibular dysfunction.

The prevalence of mandibular dysfunction. Part I: Sex and age distribution of related signs and symptoms.

This study concludes the following: 1. Mandibular dysfunction is extensive. 2. Age and sex differences are apparent with various signs and symptoms. 3. Women and younger patients tend to respond positively more often than men and older patients to questions relating to subjective TMJ and muscle symptoms. 4. Objective TMJ and occlusal signs show little age or sex differentiation. 5. Positive responses to questions regarding bruxism were more common in men. 6. Age and sex differences in the prevalence of mandibular dysfunction may be influenced by the method of investigation (anamnestic versus clinical examination) and by the signs and symptoms selected to be representative of this disorder. When compared with the findings of earlier investigations, the conclusions suggest that social, cultural, psychologic, sex, and age differences contribute to the responses to questions pertaining to mandibular dysfunction. However, this may not be an accurate reflection of the prevalence of mandibular dysfunction since the objective signs do not show the age and sex differences that the subjective symptoms indicate. Therefore, additional studies are needed to correlate all data to establish a more reliable profile of both signs and symptoms of mandibular dysfunction.

The frequency of parafunctional occlusal habits compared with the incidence of mandibular displacement.

Acomparison was made in this study of the prevalence of mandibular displacement in varying degrees of complexity with the incidence of parafunctional occlusal habits and some sequelae. The prevalence of occlusal habits in all patients was high but became greater with the increased complexity of the mandibular displacement, especially an asymmetrical slide from RCP to IP. The mulifactorial etiology of parafunctional occlusal habits and their sequelae tends to make the relationships more complex than a simple "cause and effect" and therefore must be considered.

Maximum mandibular opening in patients with and without a history of TMJ dysfunction.

It was shown that there was no direct connection between maximum jaw opening and a history of TMJ symptoms (Fig. 7). An accurate diagnosis requires the evaluation of a wide range of signs and symptoms through both a history and a clinical examination.

The prevalence and magnitude of mandibular displacement in a survey population.

The prevalence and magnitude of mandibular displacement from RCP to IP in a principally adult sample was evaluated. The findings and their possible clinical significance were discussed.

Comparison of the efficacy of a questionnaire, oral history, and clinical examination in detecting signs and symptoms of occlusal and temporomandibular joint dysfunction.

A comparison of three methods of obtaining information relating to some TMJ signs and symptoms has been made. The taking of an oral history by this examiner was shown to be the least reliable. The acquisition of data by this verbal process is a clinically sophisticated and difficult medical procedure and a major source of error is the bias or preconception that a clinician brings to his observations. Far more effective was a written, self-administered patient questionnaire, which proved quite reliable in detecting the presence of some occlusal habits. This study indicates that the initial use of a self-administered patient questionnaire, even in the hands of an inexperienced dentist, will ensure that certain essential data are obtained and recorded and will result in the discovery that a substantial number of patients have signs and symptoms of occlusal and TMJ dysfunction. The most objective method is of course the direct clinical examination. A combination of these three methods of obtaining information is recommended as an important part of routine occlusal and TMJ examinations.