The profile prosthesis: an aesthetic fixed implant-supported restoration for the resorbed maxilla.

This article discusses a method for the predictable fabrication of fixed detachable maxillary reconstructions that abut and precisely follow the gingival contours--regardless of implant angulation or position. The technique reorders the traditional implant protocol and delays abutment selection until the definitive tooth position has been established. In this manner, final abutment selection and framework design become a single, integrated process that results in improved aesthetics, reduced angulation difficulties, and elimination of the phonetic concerns traditionally associated with fixed maxillary prostheses.

Ten-year results for Brånemark implants immediately loaded with fixed prostheses at implant placement.

This investigation was initiated to develop a method to provide patients with a fixed provisional prosthesis placed at the time of implant placement. Sixty-three standard 3.75-mm Nobel Biocare implants of varying lengths were placed into mandibular sites in 10 patients and followed for up to 10 years. Twenty-eight implants were immediately loaded at implant placement, providing support for fixed provisional prostheses, while 35 adjacent implants were allowed to heal submerged and stress-free. Following a 3-month healing period, the submerged implants were exposed and definitive reconstruction was accomplished. All 10 prostheses supported by 28 implants placed into immediate function at the time of implant placement were successful during the 3-month healing period. Of these 28 implants placed into immediate function, 4 ultimately failed. Of the 35 submerged implants, all are osseointegrated and in function to date. Life-table analysis demonstrates an overall 10-year survival rate of 93.4% for all implants. The 10-year life-table analysis of survival is 84.7% for immediately loaded implants and 100% for submerged implants. Statistical analysis of the submerged versus immediately loaded implants demonstrates failure rates for immediately loaded implants to be significantly higher (P = .022 by the log rank test). These data demonstrate that although mandibular implants can be successfully placed into immediate function in the short term to support fixed provisional prostheses, long-term prognosis is guarded for those implants placed into immediate function distal to the incisor region.

Implant dentistry: where are we now?

Dental implants can dramatically change a patient's self-esteem and quality of life. But too few people receive implants because of the cost and lack of education in this growing field. More training, systems standardization and practice guidelines will improve implant treatment availability.

Education in implant dentistry.

Currently, relatively few dentists are qualified to practice implant dentistry; the demand for dental implants may soon exceed the profession's capacity to deliver this type of treatment. Accordingly, there is a salient need for national standards of education in the field. Implant education varies widely for practicing dentists, postdoctoral students, and predoctoral students. Although many schools are starting to teach implant dentistry in their predoctoral curricula, clinical and laboratory experience is limited. There are not enough trained professors, funding for new departments is limited, and change is often met with resistance. It is anticipated that within the decade, schools will establish departments, divisions, or sections dedicated to education in implant dentistry, despite these obstacles.

Monitored anesthesia care for dental implant surgery: analysis of effectiveness and complications.

The optimal method of providing safe and effective sedation for outpatients undergoing lengthy dental operations is unclear. We provided monitored anesthesia care (conscious sedation) for 102 consecutive dental implant procedures, using intravenous midazolam and fentanyl as primary pharmacologic agents. Midazolam was administered by multiple, intermittent injection or via continuous infusion. The dose of midazolam required for the induction of sedation ranged from 3.4 +/- 1.6 mg to 4.0 +/- 2.0 mg. Maintenance of adequate sedation required a mean midazolam administration rate of 4.0 +/- 2.1 mg/h to 5.1 +/- 2.1 mg/h, and a mean fentanyl administration rate of 54 +/- 29 mcg/h to 60 +/- 27 mcg/h. Continuous monitoring allowed for rapid detection and treatment of 40 separate hemodynamic and respiratory problems. There was no evidence of patient injury, and all patients returned home on the day of surgery. A post-operative telephone survey revealed that 65% of patients had complete amnesia for operative events, 96% were satisfied with monitored anesthesia care, and 94% would desire a similar anesthetic technique for future procedures.

Immediate fixed interim prostheses supported by two-stage threaded implants: methodology and results.

Restoring patients with implant-supported fixed-detachable bridges according to the protocol established by Brånemark necessitates a period of several months when complete dentures must be worn to allow for a stress-free healing period of the implants. For many patients, especially when they still have some natural teeth remaining, this is unacceptable. An approach was developed that overcomes these limitations, offering an alternative to the transitional removable approach. Five or six Nobelpharma fixtures were placed between and two additional fixtures were placed distolingual to the foramina. Abutments were connected at implant insertion to these two fixtures and to one fixture in the symphyseal region. The remaining fixtures were allowed to heal in the conventional manner. A previously constructed mandibular denture was converted to a fixed bridge supported by these three implants. This method was successfully applied in seven patients who were reconstructed with mandibular fixed-detachable bridges without ever wearing a removable prosthesis. The overall, long-term implant therapy was not adversely affected by this technique.

Dental implants. State of the art, state of the science.

Analysis of epidemiologic studies reveals that even with advances in preventive dentistry, edentulism continues to be a pressing problem especially in a rapidly expanding senior population. As an alternative to traditional removable dentures, dental implants can provide fixed support for crowns and bridges. A recent National Institutes of Health Consensus Development Conference revealed significant growth in implant technology and established that, although a complex treatment alternative, implants can function for 10 years or more. Continued development in basic and clinical research, federal regulations, professional education, public awareness, insurance, and marketing will shape the future of the field.

Immobilization of baboons (Papio anubis) using ketamine and diazepam.

Ketamine (10mg/kg body weight) was administered intramuscularly in 10 baboons (Papio anubis). Subsequently, a combination of ketamine (10mg/kg body weight) and diazepam (7.5 mg) was administered intramuscularly. Results indicated that using diazepam concurrently with ketamine suppressed or eliminated the epileptoid movements characteristic of anesthesia with ketamine used alone.

Bone maintenance: implant versus transplant.

Bone maintenance based on various attachment mechanisms is the key to tooth-root replacement safety and efficacy. The dental implant has broad applicability based on design, but demonstrates progressive peri-implant bone loss. The allogeneic tooth transplant, significantly less applicable because of size, is antigenic and rejected by bone-replacement root resorption. Since the predictability and survival times of these implant and transplant modalities are similar and there is less residual bone loss with the transplant, it is suggested that for clinical situations such as the fresh extraction socket, where there is room, the allotransplant, rather than implant, is the root-replacement of choice.