[(Semi-)precision attachments for cast metal frame removable partial dentures]. / (Semi)precisieverankering bij frameprothesen.

When compared to a conventional attachment, a (semi)precision attachment for a cast metal frame removable partial denture can perform a number of functions better. Proper assessment of the condition of the abutment teeth is needed for an adequate indication. Selecting the type of (semi-)precision attachment is primarily determined by the available maxillomandibular space, the crown length as well as the possibility of adequate oral self-care. With regard to technical characteristics, (semi-)precision attachments are classified according to measures of freedom. The distinct types are cast intra- and extra-coronal, adhesive and overdenture (semi-)precision attachments. With the lapse of time, some wear of the different parts of an attachment may occur, requiring specific subsequent care. Whether or not in combination with oral implants, (semi-)precision attachments often offer patients improved self-confidence and self-image. However, the relatively high cost is a barrier to apply (semi-)precision attachments widely.

[Dissertations 25 years after date 16. The mutilated dentition]. / Proefschriften 25 jaar na dato 16. Het gemutileerde gebit.

The lack of scientific basis for the treatment of mutilated dentition and the lack of a correlation between the loss of molar teeth and oral function were the reasons for carrying out a doctoral research project into mutilated dentitions. According to the thesis, loss of teeth was increased with age and loss of teeth followed a similar pattern in all socio-economic classes. No correlation was found between the number of teeth lost and oral function. Only a weak correlation could be demonstrated between the number of occluding pairs of maxillary and mandibular teeth and subjective chewing ability. Subsequent clinical trials and questionnaire studies revealed that, basically, hardly any convincing reason is available for prosthetic replacement of posterior teeth, providing the presence of 3 occluding pairs of maxillary and mandibular teeth. On the strength of scientific evidence available, one may assume that a sound dentition containing at least 20 teeth, maxillary and mandibular frontal teeth and premolars, is satisfactory functionally and aesthetically. For these cases, any reason for prosthetic replacement is absent.

[Repair of tooth wear; restorative-prosthetic aspects]. / Herstel van tandslijtage. Restauratief-prothetische aspecten.

Tooth wear is considered to be the third major threat to dental health in the industrialized parts of the world next to caries and periodontal disease. Bruxism can be a cause for excessive tooth wear. Thanks to the successes in the prevention and early treatment of the infectious dental diseases, dentitions last longer as result of which tooth wear is becoming more and more of a problem in the preservation of a physiologic dentition throughout live. Furthermore there seems to be an increasing tendency for the occurrence of severe tooth wear at very early ages. Early recognition of possible contributing factors for tooth wear by the dental team is of utmost importance to enhance success in treating the problem. Prevention of ongoing damage to the remaining tooth structure must be the starting point of every treatment plan. Repair of tooth wear is in many cases a challenge from a restorative/prosthetic perspective: esthetic and phonetic aspects play an important role along with the restorative and prosthetic choices as well as functional considerations the clinician has to deal with.

[Preventive prosthetics and gnathology]. / Preventieve prothetiek en gnathologie.

In daily practice the dentist is constantly confronted with dentitions which do not measure up to the (idealized) parameters of a theoretically ideal occlusion. In many cases there is a healthy situation which should be maintained. Changes to the occlusion and/or prosthetic treatment should only take place if they are predicted, beforehand to contribute to solving relevant problems. Clinical application of preventive measures in relation to the function of the masticatory system as well as prosthetic treatment are discussed.

Prevalence in the Dutch adult population and a meta-analysis of signs and symptoms of temporomandibular disorder.

A nationwide survey of oral conditions, treatment needs, and attitudes toward dental health care in Dutch adults was carried out in 1986. One of the aims of the study was to assess the prevalence of signs and symptoms of temporomandibular disorder (TMD). A sample of 6577 persons (from 15 to 74 yr of age), stratified for gender, age, region, and socio-economic status, was contacted. Of this sample, 4496 persons participated in the behavioral part of the study, of whom 3526 were examined clinically. The TMD prevalence was based on (1) perceived signs and symptoms of TMD and (2) clinical examination of joint sounds, deviation, and pain on mandibular movements. A total of 21.5% of the Dutch adult population perceived some dysfunction, and 44.4% showed clinically assessed signs and symptoms of TMD. In nearly all age groups, the signs and symptoms of TMD appeared more in women than in men. Agreement between the results of the clinical examination and the anamnestic dysfunction index was significant (p < 0.0001); however, the Pearson's correlation coefficient was low (r = 0.29). The odds-value (risk-ratio) that subjects who perceived signs and symptoms of TMD would present with clinically assessed signs and symptoms of TMD was 2.3. The results of the survey were compared with results of a meta-analysis performed on 51 TMD prevalence studies. The analysis revealed (1) a perceived dysfunction rate of 30% and (2) a clinically assessed dysfunction of 44%, both based on compound samples of, respectively, over 15,000 (23 studies) and over 16,000 (22 studies) randomly selected subjects.

Distal extension removable partial dentures supported by implants and residual teeth: considerations and case reports.

The traditional treatment for an edentulous maxilla opposed by a partially edentulous mandible with a complete denture and a distal extension removable partial denture is fundamentally inadequate. Continuing resorption of alveolar bone under the denture base of the removable partial denture causes changes in the occlusal plane. Consequently, overloading of the anterior maxillary region occurs, usually leading to increased bone resorption in the anterior maxillary ridge. Placement of implants beneath the distal extension denture base of the removable partial denture can result in a stable and durable occlusion. Two patients in whom the use of implants combined with a cast metal removable partial denture provided occlusal stability and improved functional comfort are presented.