An eight-year follow-up to a randomized clinical trial of participant satisfaction with three types of mandibular implant-retained overdentures.

Studies have shown that mandibular implant overdentures significantly increase satisfaction and quality of life of edentulous elders. Improved chewing ability appears to have a positive impact on nutritional state. Therefore, it is important to determine the best design of this prosthesis over the long term. In this randomized controlled trial, three groups of edentulous participants with atrophic mandibles wore 3 types of implant overdentures. During an eight-year follow-up, only seven of the 110 participants had dropped out of this study. Almost all participants were still satisfied with their overdentures. Participant satisfaction concerning retention and stability of the mandibular overdenture had decreased significantly in the two-implant ball attachment group, whereas the opinion of participants in the single- and triple-bar groups was still at the same level. The long-term results suggest that a mandibular overdenture retained by 2 implants with a single bar may be the best treatment strategy for edentulous people with atrophic ridges.

[Three treatment modalities for mandibular overdentures on implants. Clinical and radiological aspects]. / Drie behandelingsmethoden met implantaten in de edentate onderkaak. Klinische en röntgenologische aspecten.

The results are presented of 3 treatment modalities for overdentures on implants in the mandible: 2 implants with ball attachment, 2 implants interconnected with a bar and 4 implants interconnected with bars. The patients, in total 110, were at random treated and evaluated 3, 9 and 19 months after insertion of the implants. Six implants were lost out of 283 implants during the osseointegration period. There were hardly any differences found between the groups with respect to the clinical and radiologic parameters. De first group showed less bleeding around the implants after 19 months then the other groups. Around the medial implants there was significantly more bone resorption then around the distal implants and the implants in the other groups. No conclusions can be drawn with respect to the best treatment modality since the period of evaluation is too short and the other parameters like patients' experiences are not included.

[Multidisciplinary management of trauma patients. Role of the maxillofacial surgeon]. / De multidisciplinaire opvang van traumapatiënten. De rol van de kaakchirurg.

The approach of patients with multiple trauma is considered to be complicated. Many (non)medical disciplines are involved. This article describes the treatment in the early post-traumatic period and the organisation of the care in both the pre-hospital and hospital phase. Special attention is given to the treatment of patients with maxillofacial injuries. The task of the oral and maxillofacial surgeon in particular when dealing with facial injuries is described.

Clinical and radiological results of patients treated with three treatment modalities for overdentures on implants of the ITI Dental Implant System. A randomized controlled clinical trial.

In a randomized controlled clinical trial carried out at the Ignatius teaching hospital in Breda, The Netherlands, 110 edentulous patients with severe mandibular bone loss were treated with implants of the ITI Dental Implant System using 3 different treatment strategies: a mandibular overdenture supported by either 2 implants with ball attachments, 2 implants with an interconnecting bar, or by 4 interconnected implants. In this study, results of clinical and radiographic parameters were evaluated and compared over a period of 19 months after implant placement. A total of 283 ITI Dental Implants were placed. Six implants (2%) were lost during the osseointegration period. No further implant losses occurred after that. At the 19 month evaluation mean values and standard deviations for bleeding index were 0.51 +/- 0.5 (bleeding incidence = 70%) and for plaque index they were 0.46 +/- 0.5 (plaque incidence = 45%). The mean values and standard deviations for probing depth and loss of attachment were 2.7 +/- 1.1 mm and 0.26 +/- 0.6 mm respectively. The radiographic evaluation showed a mean bone loss of 1.5 mm +/- 0.26 after 19 months for all the implants. In cases with 4 interconnected implants there was significantly more bone loss around the central 2 implants (2.1 +/- 0.31 mm) in comparison with the lateral 2 (1.4 +/- 0.25 mm). No significant correlations were found between plaque and bleeding indices and bone loss.

A skull base epidermoid cyst causing the symptoms of a craniomandibular disorder.

This article describes a case report of a 52 year old patient with a ten year history of orofacial pain who was misdiagnosed with a craniomandibular disorder (CMD) and trigeminal neuralgia. After a epidermoid cyst in the skull base had been diagnosed and removed the complaints diminished and finally disappeared.

[Long term results of overdentures supported by one-stage ITI-implants]. / Langetermijnresultaten van overkappingsprothesen op één-fase ITI-implantaten.

OBJECTIVE: To evaluate the long-term outcome of overdenture treatment in edentulous patients who received dental implants and an overdenture in the mandible. DESIGN: The patients, endentulous in upper and lower jaw, were treated with 218 one face ITI implants, inserted in the interforaminal part of the mandible and evaluated during the first 80 months after insertion of the implants. SETTING: The patients were asked to fill out a questionnaire concerning denture satisfaction and social comfort. The medical files were used for evaluating the aftercare. RESULTS: 7 implants were lost during the period of 80 months. A minimum of surgical and prosthetic aftercare was necessary to maintain the implants and overdentures. The patient satisfaction of the dentures was high, as well as the social comfort, and there was no significant difference between the results after 19 and 80 months. Complaints about the upper dentures were hardly present. CONCLUSION: Implants inserted in the interforaminal part of the mandible are successful. Oral and social comfort is high and less aftercare is necessary, when a strict recall protocol is taken into account.

[Reconstruction of the severely resorbed mandible using autologous bone and implants. An evaluation after 5 years]. / Reconstructie van de geresorbeerde onderkaak met autoloog bot en implantaten. Een evaluatie na vijf jaar.

OBJECTIVE: Evaluation of edentulous patients with severely resorbed mandibles simultaneously treated with bone out of the iliac crest and implants. DESIGN: Prospective. MATERIAL: Thirty-one females between 42 and 61 years of age, were surgically treated and provided with a bar construction or attachments with an overdenture. METHODS: Orthopantomograms were made after 3, 6, 12, 24 and 60 months. Bone resorption was measured mesial and distal from each implant. RESULTS: Eight implants out of 78 inserted implants were lost. The average bone resorption was 0.6 mm after 3 months and 4.4 mm after 60 months. In some patients no bone resorption was found; in other patients the augmented bone was completely lost. CONCLUSION: The described surgical treatment did not give reliable results.

Patients' perception of sensory disturbances of the mental nerve before and after implant surgery: a prospective study of 110 patients.

In a randomized controlled clinical trial 110 edentulous patients with severe mandibular bone loss have been treated with ITI-dental implants using three different treatment strategies: (1) a mandibular overdenture supported by two implants with ball attachments, (2) two implants with an interconnecting bar or (3) by four interconnected implants. As implant surgery involves elevation of the mucoperiosteum, bone remodelling at the implant site and insertion of implants close to the mental foramen, altered sensations of the mental nerve caused by the surgery are to be expected. An altered sensation of the lower lip can also be caused by pressure of an ill-fitting lower denture on the mental foramen, or in the case of severe bone loss of the alveolar ridge, on the alveolar nerve itself. This article presents the results of the patients' perception of the sensation of their lower lip before, 10 days after and 16 months after implant surgery in the mandible. It shows that 25% of the patients describe a sensory disturbance before treatment. This 25% also showed high scores on the Hopkins Symptoms Check List indicating a tendency to somatize complaints. Eleven percent of the patients report a sensory disturbance in the lower lip 10 days after surgery. Ten percent report a sensory disturbance 16 months after surgery of which one third also reported a disturbance before the treatment. This implies the risk of a sensory disturbance of the lower lip to be a possible complication after implant surgery. Therefore patients must be informed about this phenomenon before treatment.

Patient satisfaction with implant-supported mandibular overdentures. A comparison of three treatment strategies with ITI-dental implants.

In a randomized, controlled clinical trial, 110 edentulous patients with atrophic mandibles were treated with International Team for Oral Implantology-dental implants using three different treatment strategies: a mandibular overdenture supported by two implants with ball attachments, two implants with an interconnecting bar, or four interconnected implants. The patients' opinions and their social functioning were evaluated by means of a questionnaire directly before and 16 months after treatment. Before treatment most patients had complaints about the retention of their mandibular denture. Sixteen months after treatment almost all patients were generally satisfied with their dentures. Since no significant difference was found between the three treatment strategies, it was concluded that simple implant treatment such as an overdenture retained by two ball attachments is sufficient.

One-step reconstruction of the severely resorbed mandible with onlay bone grafts and endosteal implants. A 5-year follow-up.

The severely resorbed mandibles (Cawood and Howell class VI) of 31 female patients were reconstructed with a corticocancellous bone graft with ITI implants in a one-step procedure. After 12-16 weeks, a combined mucosally and implant-supported overdenture was made by an experienced prosthodontist. After 3, 6, 12, 24, and 60 months, orthopantomograms were made, and the height of the bone was measured mesial and distal of each implant. The overall bone resorption rate was almost 50%, but it varied around each implant. Eight of 78 implants were lost. Bone resorption occurred in an unpredictable way. The technique used can no longer be recommended.

Overdentures supported by ITI implants: a 6.5-year evaluation of patient satisfaction and prosthetic aftercare.

This study reviews the long-term outcome of overdenture treatment in 64 completely edentulous patients who received 218 one-stage ITI implants during the period 1982 until 1988. The evaluation time averaged a period of 80 months, ranging from 66 to 119 months. The results indicate that no implants were lost during this period and that a minimum of surgical and prosthetic treatment was necessary to maintain the overdentures. Patient satisfaction was high and had not significantly changed in comparison with an earlier study on the same group of patients after a mean period of 18 months. The assumption that there would be significantly more complaints about retention of the maxillary denture is not affirmed by this study.

[Dental ITI-implants in the Netherlands: The evaluation of 2454 implants]. / ITI-implantaten in Nederland. Evaluatie van 2454 implantaten.

Between 1982 and January 1991, 2454 ITI Bonefit implants were placed in 841 patients. The clinical data were gathered from the departments of oral and maxillo-facial surgery at hospitals in Breda, Leiderdorp and Zwolle, the Netherlands. The follow-up ranges from one year to 9.5 years. A total of 48 implants were lost (2%).

[Treatment of dento-skeletal anomalies. Class II occlusion]. / Behandeling van dento-skelettale afwijkingen. De Klasse II-occlusie.

With the combination of orthodontics and oral surgery a skeletal distorelation can be treated with a predictable result. A prerequisite for this is a good mutual consultation, in which information for the patient has a central role. To guarantee this a seven-steps procedure is developed and described. Essential aspects of presurgical and postsurgical orthodontics are discussed. Possibilities of surgical correction are described.

Patient satisfaction with overdentures supported by one-stage TPS implants.

Sixty-four edentulous patients with severe conventional denture problems who had been treated with 218 one-stage titanium plasma sprayed (TPS) screw implants and new overdentures were clinically evaluated and questioned on their experiences with treatment up to 6 years after implant insertion. The results demonstrated that only seven of the implants had failed during this period, resulting in a success rate of 97%. Most of the patients (95%) were satisfied with their new overdentures, and almost all patients (98%) found that their new dentures fit comfortably. Only 3% of the patients treated would not recommend that others undergo similar treatment.

Osteomyelitis of the jaws in pycnodysostosis.

Pycnodysostosis is a rare sclerosing bone disorder in which osteomyelitis of the jaws is a frequent complication. Treatment of osteomyelitis of the jaws in pycnodysostosis is difficult and may lead to large resections. A review of the literature and 3 new cases in which osteomyelitis was successfully treated by a combined surgical and antibiotic approach, are reported.

Indications for reduction of tongue in surgical treatment of mandibular prognathism.

The literature suggests that the tongue plays an important role in the recurrence after operative correction of mandibular prognathism. To prevent such a recidivism a reduction of tongue can be considered. However, it is difficult to decide how the tongue is involved. Size, strength and function are difficult to measure, and the literature on this subject is not concerned with these properties. A number of methods are given with which an impression can be acquired about the above-mentioned properties of the tongue. Special attention is paid to the type of the ostectomy, and the arguments for this procedure are exemplified by the investigation of 75 patients in whom a surgical correction of mandibular prognathism was performed. It is concluded that tongue reduction is more readily indicated preparatory to correction of mandibular prognathism by a modified Kole procedure than before correction by means of a stepped ostectomy or an Obwegeser-Dal Pont procedure.