[Conservative therapy of incontinence]. / Konservative Therapie der Inkontinenz.

Conservative therapy of faecal incontinence includes normalisation of colonic function, restauration of damaged anal skin and exercising methods. The most successful of those seems to be Biofeedback with good short time results up to 92% patients without further complaints, the long time results still being up to 67%. Prognosis depends on neuropathy, age and ability of perception and compliance. Passive electrostimulation replaces the damaged nerve and therefore has to be done lifelong. Increasing anal resting pressure seems to be a possible result.

A stress-releasing intracoronal attachment for extension base removable partial dentures.

Intracoronal retainer systems incorporated into splinted abutment restorations help force distribution. The additional torque introduced by the extension-based removable partial denture is applied over multiple abutments rather than to single abutment teeth. A fixed-removable prosthesis is proposed as a solution to this situation. The Thompson dowel nonlocking semiprecision attachment system is the intracoronal retainer of choice for distal extension denture bases. It allows controlled rotation or stress relief of the removable component by minimizing detrimental transfer of traumatic forces to the abutment teeth. The design and fabrication of the manufactured version of this retainer system is described.

Multiple implants for first molar prosthodontics.

Problems that can occur when single implants are utilized to restore first molar teeth include the frequent loosening of screws, as well as screws and/or implant breakage. These may result from torquing and rotational movements of the prosthesis during masticatory and parafunctional mandibular movements. When sufficient bone and mesio-distal restorative space is present, the placement of two implants should be considered.

Sinus-lift graft: using the maxillary sinuses to support implants.

Often, the posterior region of the maxilla lacks the alveolar bone necessary to maintain an implant-supported prosthesis. The authors outline a procedure to augment the maxillary ridge using a composite alloplastic bone graft. The procedure also enables the practitioner to place implants at the time of the graft, reducing the surgical and healing time for the patient. Within six to 12 months of the bone graft, the patient can wear a fixed, implant-supported prosthesis. The authors report that patients who have been treated with this procedure have maintained stable implant prostheses for over five years.

A comparison of hydrogen/oxygen and natural gas/oxygen torch soldering techniques.

The tensile strength of connectors joining bars of palladium-silver alloy and formed using hydrogen/oxygen flame soldering was compared to those formed using conventional gas/oxygen soldering. As-cast specimens served as the control. No significant differences were found between the as-cast, hydrogen/oxygen flame soldered, or the natural gas/oxygen flame soldered specimens.

Provisional and definitive prostheses following sinus lift and augmentation procedures.

Sinus lift and augmentation procedures with simultaneous insertion of cylindrical root form implants can be used to treat the atrophic posterior maxilla. The long-term use of a second stage provisional prosthesis is emphasized. The recommended metal-reinforced acrylic resin provisional restoration allows treatment and/or removal of a failing implant and progressive loading before fabrication of the definitive prosthesis. Modifications in prosthesis fabrication after sinus lift surgery and augmentation procedures are discussed.

First-stage fixed provisional restorations for implant prosthodontics.

Combination metal-and-acrylic-resin fixed provisional prostheses can be used in implant dentistry as an alternative to a removable provisional prosthesis. They may be fabricated in the laboratory and inserted on the day of fixture placement to ensure that the patients may return to their normal lifestyles with minimal discomfort or interruption in function and esthetics. These interim restorations may be used in free-standing as well as hybrid types of implant supported prostheses. The materials used and techniques of fabrication are described.

Prosthodontic solutions for compromised implant placement.

The various clinical and laboratory procedures for use of auxiliary prefabricated metal screw retention, castable plastic telescopic, and custom laboratory-fabricated systems are presented as adjuncts to implant-supported restorative procedures. These devices aid in the fabrication of predictable and retrievable screw-retained, fixed-detachable implant-supported prostheses for various conditions and combinations of support. Ancillary screw systems are also useful in solving cosmetic problems when implant placement compromises this goal.

Augmenting the maxillary sinus for implants: report of 27 patients.

A method for restoring the posterior portion of the maxilla with a simultaneous composite alloplastic sinus lift graft and placement of press-fit implants is presented. Sinus grafting is needed because of minimal remaining alveolar bone. The composite graft material uses a combination of demineralized freeze-dried cortical bone and Interpore 200 hydroxyapatite. Since 1987, 45 sinus grafts with simultaneous placement of 111 root-form implants have been performed for 27 patients. None of the 76 restored implants have been lost. Complications were encountered in 2 patients (4 sinuses) who were heavy smokers. Antibiotics were administered, symptoms subsided, and the implants integrated.

Clinical management of abutments with intracoronal attachments.

A method of preparing teeth to accommodate intracoronal attachments is presented. The resulting prosthesis incorporates a fixed partial denture with physiologically contoured crowns and a removable partial denture with a precisely determined path of insertion. These techniques stress the importance of surveyed diagnostic casts and coordinated tooth preparations for artificial crowns to facilitate treating complex cases.

Presurgical prosthetics and surgical templates.

An overview has been presented of the prosthodontic procedures used prior to the first stage of implant surgery, the procedures used between the first and second stages of surgery, and the prosthetic appliances fabricated prior to insertion of the definitive implant prosthesis. In addition, the need for suggestions to the surgeon for optimal implant fixture placement using surgical templates has been discussed. The design and fabrication of a preferred mandibular surgical template has been presented. In addition, it has been recommended that the surgeon and restorative dentist should employ a team approach to implantology for the best results.

Provisional restorations in fixed partial prosthodontics.

Concepts and techniques for fabrication of various types of provisional fixed restorations have been described. The problems created by less than optimal construction are presented. The clinician must decide which type of fixed provisional appliance is desirable or required in various situations. The same fixed provisional restoration cannot be suitable in every situation. The dentist must be able to evaluate and select which type of interim fixed prosthesis should be constructed for the various cases that present in their offices.

Provisional prosthodontic appliances in the combination fixed-removable reconstruction.

Various combination fixed-removable prostheses have been presented. The construction of the combined provisional prostheses permits the clinician to establish the desired occlusal harmony, esthetics, and jaw relationships, as well as optimal management of the patient. The provisional template allows the clinician to determine patient reaction and response prior to construction of the definitive prostheses. This leads to better clinician-patient rapport and patient satisfaction. Also, it minimizes postinsertion adjustments.

Prefabricated metal intracoronal semiprecision attachments for removable partial dentures.

The inaccuracies of the casting and fitting processes associated with semiprecision intracoronal attachment systems may compromise the fit of the completed prosthesis. The objective of using metal prefabricated intracoronal semiprecision attachments is to improve the adaptation between the matching attachment surfaces used in the fabrication of removable partial dentures. In milled dovetail or waxed dowel rests, the attachment of one side is completed and the other is cast to match. The prefabricated attachment system presented uses a matching component cast directly against the precast metal rest-mandrel. This reduces the inaccuracies resulting from waxing, investing, and casting.

A modification of the Thompson dowel rest for distal-extension removable partial dentures.

A prefabricated Thompson dowel rest semiprecision attachment system for distal-extension removable partial dentures deserves consideration in the treatment planning of periodontally involved dentitions. It is a system that provides for rotation and therefore stress-breaking with controlled movement. Many other stress-breaking systems provide for rotation without specific control. In addition, the Thompson dowel rest system is the only stress-breaker that is intracoronal not extracoronal. This prefabricated system offers facilitation of laboratory procedures, eliminates the need for utilization of gold for dowels, reduces the size of the rest seats, and aids in the preservation of the integrity of the hard and soft supporting tissues.

Precision attachments.

This article presents an overview of the techniques and rationale of the various impression procedures employed in the fabrication of the removable portion of a combination fixed and removable reconstruction.

Impression procedures for the removable component of a combination fixed and removable prosthesis.

Several impression techniques for the removable component have been presented to help the dentist select impression procedures and materials appropriate to individual intraoral conditions confronted when constructing intracororonally retained removable partial dentures in combination fixed--removable reconstructions.

Locking types of semiprecision attachments.

An overview of the various locking types of semiprecision rests was presented along with several methods for their use in partial denture construction. By using the attachments selectively, the dentist should be able to direct the technician in their construction. All the types and systems presented serve the functions of retention, bracing, and support, which are the requirements for any removable partial denture retainer system.