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This clinical report highlights some of the problems in providing a suitable prosthesis for a patient who suffers from systemic sclerosis. A conventional removable partial denture may not have been suitable because of the lack of denture bearing area, changing peripheral seal, and insufficient teeth to support and retain the denture. An implant-retained FPD overcame these difficulties. One would hope that, with regular maintenance and monitoring, quoted prosthesis success of 15 years can be achieved.

Purpose: This pilot study evaluated potential relationships between dental status and various sociodemographic variables in the age group segment of the United States population at greatest risk for the disruption of dental function due to treatment of an oral cavity cancer., Methods: The Dental Health Supplement of the 1989 National Health Interview Survey was used to evaluate the self-reported status of natural dentition and prior dental rehabilitation among the population of persons 45 years or older., Results: Sociodemographic variables, which showed a significant association with status of natural dentition, were level of income and occupation at lower income levels (p < 0.05). Increased levels of prior dental rehabilitation were significantly associated with lower age, female gender, increased level of income, and occupation (p < 0.05). Occupations that required social interaction had the highest levels of both status of natural dentition and prior dental rehabilitation (p < 0.05)., Conclusions: Overall dental status after treatment of oral cancer may be related to the occupational status of many persons. Sociodemographic factors that influence the dental rehabilitation needs of individual patients after treatment of an oral cancer should be considered in policy decisions affecting accessibility of dental rehabilitative care. A follow-up, survey study that would further define the identified relationships between a person's demographic status and dental rehabilitation needs is recommended.

Oral rehabilitation is commonly difficult in cases of ectodermal dysplasia because the affected individuals are quite young when they are evaluated for treatment. Most affected children require extensive dental treatment in order to restore their appearance and help them develop a positive self-image. This article reviews the dental management of the disorder, including its psychosocial aspects and timing of different modalities.

Aim: To explore the range of reactions to, and feelings about, tooth loss., Method: In this qualitative study, 50 edentulous people undergoing routine prosthetic dental care were interviewed privately using a reflexive, in-depth technique. All the interviews were tape-recorded and transcribed. The transcripts were scrutinised to identify the common themes related to tooth loss. Interpreter bias was minimised by two researchers scrutinising the transcripts independently., Results: The participants had a mean age of 69.9 years (range 51 to 86) and had been edentulous for a mean of 18.4 years (range 0.25 to 57 years). The main themes identified in reaction to tooth loss were: bereavement, lowered self-confidence, altered self-image, dislike of appearance, an inability to discuss this taboo subject, a concern about prosthodontic privacy, behaving in a way that keeps the tooth loss secret, altered behaviour in socialising and forming close relationships, premature ageing, and lack of preparation., Conclusion: Tooth loss can be disabling and handicapping. It has a profound impact on the lives of some people, even those who are apparently coping well with dentures. The profession needs to consider how it can prepare people for the effects of tooth loss.

Older adults present special problems for the dentist trying to establish or reestablish esthetics. Periodontal diseases are of concern for this population since tooth loss from these widespread problems increases with age. In general, this loss occurs because of increased exposure time to pathogenic bacteria, not some change inherent in the body brought on by the aging process. The profession has begun to place more emphasis on systemic risk factors and their role in modifying periodontal inflammation. The current thinking is that bacteria are necessary to initiate and sustain periodontal diseases, but the clinical manifestation is dictated to a significant extent by systemic factors. Smoking, diabetes, and being positive for the interleukin-1 genotype predispose the patient to developing more severe disease. For those older adults who lose teeth, dental implants have emerged as reliable replacements, and concerns about placing these devices in patients who have lost teeth as a result of periodontitis appear to be largely unfounded.

Using the literature on the subject, an assessment was made of the state of the oral health in rural population: dental state, periodontal diseases, state and needs for prosthetic rehabilitation. The articles presents possible causes of this state of things.

The loss of teeth is an extremely traumatic and upsetting experience. The accompanying feelings of grief and loss are compounded by the inherent inadequacies of complete dentures. It is hardly surprising that many edentulous people and their dentists have searched long and hard for a viable alternative. This article places in perspective the shift that has occurred in the therapeutic paradigm of treatment as a result of osseointegrated implant therapy.

Statement of Problem: It is important to evaluate the long-term clinical performance of resin-bonded fixed partial dentures and extracoronal attachments for removable prostheses., Purpose: A prospective, long-term clinical study was conducted to evaluate the success of resin-bonded fixed partial dentures since 1985 and of resin-bonded extracoronal attachments from 1987., Methods: Until 1993, a total of 130 resin-bonded fixed partial dentures had been seated in 101 patients, as well as 12 removable partial dentures (RPDs) with 24 extracoronal retainers in 10 patients. The clinical treatment protocol and the laboratory procedures were standardized. By the end of 1993, it was possible to reexamine 98 patients with a total of 127 resin-bonded fixed partial dentures and all 10 patients with removable partial dentures. The average time in function for the resin-bonded fixed partial dentures at the time of examination was 3.4 years and 2.3 years for the removable restorations., Results: During the period of observation, one retainer failed on six of the resin-bonded fixed partial dentures, which represents a failure rate of 4.7%. Debonding of extracoronal attachments was recorded for 8.3% of the total number of retainers., Conclusion: The resin-bonded fixed partial denture technique can be considered to be a clinically reliable method of treatment, and permits the expansion of indications beyond a classical three-unit resin-bonded fixed partial denture. Long-term clinical success of removable partial dentures with resin-bonded extracoronal retainers warrants additional clinical studies.

The elderly have both the greatest level of need for prosthodontic services of any age group, and the greatest degree of complicating dental, medical, and behavioral factors. Issues arise in daily practice of whether or not to replace a missing tooth or teeth for a patient of advanced age and a wide variety of challenges-dental/oral and others-face the dentist who is considering replacing some or all of an older person's teeth. This article focuses on clinical approaches and techniques that have proven particularly important and useful for providing prosthodontic care to the older adult.

In 1977 78, a baseline study group of 449 Finnish adults aged 30 years and over was examined in an urban area with a very high supply of dental services. The follow-up study in 1988 represents longitudinal data on 297 of these adults. In 1989 a new sample of persons aged 30-39 years was also obtained to provide cross-sectional information comparable to that of the corresponding age group in the 1977-78 survey. At baseline in 1977-78, the prevalence of total tooth loss was 19.4% for adults aged 30 years and over. The corresponding figures for maxillary and mandibular edentulousness alone were 16.7% and 0.4% respectively. Ninety-four percent of totally edentulous and 89.6% of single-arch edentulous subjects were prosthetically rehabilitated. In the follow-up study, 7.7% of the originally dentate women and 6.7% of men had lost the rest of their teeth. For the new totally edentulous subjects the mean number of teeth lost was 5.7 (s 3.45), most of which were incisors. In the follow-up study, 89% of the new edentulous subjects had already been edentulous in the maxilla at baseline. Among 30-39-year-olds the proportions of upper-arch and totally edentulous subjects in 1977-78/1989 were 6.7%/0.8% and 2.2%/0.8% respectively (P=0.024 for the difference between the time points). In the light of the repeated cross-sectional study, we can conclude that edentulism is very uncommon in the 30-39-year age group in this urban area.

Due to its corrosion resistance and biocompatibility, titanium appears to be an alternative material for implant-supported restorations. However, due to technological difficulties, the clinical application of titanium in implant restorations has been limited. Only after recent progress in technology could the clinical use of ceramo-metal titanium restorations be recommended. The therapeutic repertoire for treating patients with missing teeth has been significantly expanded by modern implant methods. Osseointegrated prostheses have become an integral part of restorative therapy also for periodontally compromised dentitions. This article presents 2 case reports for the use of ceramo-metal implant-supported titanium cast prostheses for restorative treatment of periodontally compromised patients requiring comprehensive treatment involving periodontal, functional, orthodontic and prosthodontic therapy. Favourable clinical results have been obtained and a complication-free service of these reconstructions has been documented throughout a 12- to 24-month observation period. These observations suggest that implant-supported ceramo-metal titanium prostheses may be a valuable part of restorative therapy for periodontally compromised dentitions in that they facilitate restorations with optimal biocompatibility. However, controlled clinical studies are needed to establish the long-term serviceability of these titanium restorations.

This study reports the results of implant therapy involving a sinus membrane lift as well as conventional implant therapy in 24 periodontally compromised patients who were treated during the period between June 1990 and May 1995. Patients were included on the basis of being in need of at least 2 implants, 1 of which was to be placed in the maxillary sinus region, and at least 3 mm bone height was required in the sinus region. Following fenestration of the lateral sinus wall and lifting of the sinus membrane sinus implants were inserted as described for conventional implants. Annual follow-up visits included recording of plaque, probing pocket depth and bleeding on probing, and recording of the radiographic distance from the implant shoulder to the alveolar crest in mm. The Astra, Astra sinus, ITI, and ITI sinus were observed for an average of 30.8, 29.9, 29.4 and 25.3 months, respectively. Of the 80 implants inserted 1 Astra and 2 ITI had failed at 11-12 months and 1 ITI had failed at 42 months. The Kaplan-Meier estimate of the proportion of non-failed implants at 36 months were 100%, 95%, 91%, and 86% for the Astra, Astra sinus, ITI, and ITI sinus implants, respectively. Of the Astra, Astra sinus, and ITI implants, 71-82% remained free from bone-loss > or = 1.5 mm at 36 months, whereas this was the case for only 29% of the ITI sinus implants. About 80-90% of the implants remained free from plaque; 65-86% remained free from bleeding; and 44-80% remained free from pockets > or = 4 mm. These results indicate that the sinus lift technique can be used successfully in periodontally compromised patients.

Occasionally, clinicians are faced with a situation in which a solitary tooth between two bridges requires extraction. When this type of situation occurs, we must ponder the dilemma of how to replace the missing tooth. Options include placing an implant where the tooth was extracted or remaking one large multiunit bridge. Implants are not always possible or practical, and remaking a multiunit bridge that involves the abutments of the two existing bridges can be challenging and becomes much more expensive to the patients. The overcasting technique is a treatment modality that offers a solution in these particular situations.

This study presents the outcome of single-tooth restorations supported by Astra Tech single-tooth implants followed for 2 years. Forty-seven implants were placed in the same number of patients. Forty-three patients attended the second recall visit, and none of the evaluated implants have been removed. The mean marginal bone loss after 2 years of service was 0.31 (SD = 0.48) mm. Overall, few complications were recorded during the 2-year period, the most frequent of which were loose crowns (7).

Ectodermal dysplasia can result in a number of oral problems. As the condition is usually diagnosed in childhood, multidisciplinary specialist dental care at an early age may minimize the long-term dental complications. This article describes the restorative management of an adult patient suffering from ectodermal dysplasia for whom such support was not available, resulting in the provision of complex and highly invasive restorative treatment in adult life to provide a functional and aesthetically acceptable dentition. The various treatment options that were considered are discussed together with the details of the treatment provided.

It is generally to be found that decrease of occlusal vertical dimension, worn occlusive surface of remaining teeth without opposite teeth and loss of intercusping position (ICP), etc. in the patients with majority teeth missing. In western countries, fixed restorations (including implant dentures) are routinely used for the patients with majority teeth missing in order to rehabilitate occlusion. The authors applied occlusal theory, combining with the clinical facilities and used one-piece casting base and functional impression technique for rehabilitation of occlusion. The purpose of this article was to summarize clinical experiences, to explore the relative problems concerning rehabilitation for patients with majority teeth missing.

In the restoration of a single anterior edentulous space with a dental implant, there are three transmucosal elements that could be used within the Nobel Biocare system: the CeraOne abutment, the Estheticone abutment with a nonrotating gold cylinder, and the CerAdapt abutment. This article describes a procedure to modify the CeraOne cylindric titanium abutment with titanium ceramics to achieve an anatomically shaped transmucosal element that does not show evidence of the metal through thin gingival tissue.

Statement of Problem: Treatment of tooth loss in the anterior maxilla can involve difficult functional, esthetic, and psychologic problems, especially in young patients with otherwise good dentition., Purpose: The purpose of this study was to provide a preliminary comparative evaluation of two implants (ITI and Astra) in single-tooth restorations., Material and Methods: This prospective study of 102 single-tooth replacements with 56 ITI and 46 Astra dental implants was performed in 82 patients at the Finnish Student Health Service Foundation. One Astra implant was lost before loading. The overall survival rate of the implants was 97.8% for Astra implants and 100% for the ITI system. After the initial healing period of at least 6 months, the remaining 101 implants (56 ITI, 45 Astra) were free of periimplant infection and revealed no detectable mobility. Radiographs did not reveal signs of periimplant radiolucencies. All 101 implants received single-tooth crowns., Results: Periimplant parameters and acceptable implant function were examined and demonstrated satisfactory results with preestablished clinical parameters and radiographs at 1 year. During the observation time the mean marginal bone loss was 0.13 mm with Astra implants and 0.11 mm with ITI implants. Subjectively all patients were satisfied with their single-tooth restorations supported by either ITI or Astra dental implants., Conclusion: The favorable results of this short-term study support the application of the two implant systems for single-tooth restorations, especially in the anterior region of the maxilla.

The early loss of permanent teeth following trauma or congenital aplasia may be corrected by orthodontic or prosthetic means, sometimes combined with implant therapy. The orthodontic solution results usually in different anatomic, functional, and esthetic problems. Prosthetic and implant procedures, on the other hand, are very demanding and require long-term maintenance. Considering these limitations, a comprehensive diagnostic and treatment plan is mandatory to achieve the most satisfactory clinical result. Modern restorative modalities, such as recontouring, bleaching, and resin composite bonding, may improve the final clinical result after orthodontic space closure. In more difficult situations, veneers and crowns may also be indicated.

Missing anterior teeth are being replaced by implant-supported restorations quite frequently in modern dentistry. Providing the patient with a temporary prosthesis prior to or following implant fixture placement must satisfy established esthetic and functional criteria. When orthodontic treatment is included as part of the overall treatment effort, additional considerations include the retention and stabilization of newly established tooth positions. This article describes the fabrication, use and advantages of a provisional anterior prosthesis that replaces missing teeth prior to or following implant placement.

The aim of restorative dentistry in high-risk groups tends to shift over time from the preservation of complete dental arches towards the preservation of functional dental arches, using a functionally oriented approach. An example of this approach, aimed at limited treatment goals, is the shortened dental arch (SDA) concept. The objective of this study was to investigate dentists' attitudes to the SDA concept in general practice. A questionnaire seeking information pertaining to the attitudes and application of the SDA concept in clinical practice was sent to all dentally qualified members of staff in the field of restorative dentistry in the Nijmegen School of Dentistry (n = 64). From a 64% response, it was found that all but one of the respondents view the SDA concept as having a useful place in clinical practice. Although the respondents indicated only regular or occasional use of SDA in < 10% of patients, the outcome of SDA management was generally satisfactory or at least sufficient, notably in the care of special category patients. The findings support the view that the SDA concept has a role in contemporary clinical practice.

Pre-prosthetics, as a part of orthodontic treatment in adults has gained increasing importance during recent years. Through coordinated orthodontic, prosthetic and periodontal treatment plans, patients with partial dentition can be offered further treatment possibilities. Such planning would allow for fixed prosthetic treatment possibilities and the survival of critical teeth. They would provide for better aesthetics and avoid functional disturbances. The aim of the present study was to present reports of patients treated by coordinated work at the Dental School of Hamburg University. In patients with partial dentition, premolars were uprighted and distally moved and molars were extruded to be used as abutments for fixed prosthetic reconstructions. Following trauma, the position of the remaining anterior teeth was improved to provide for optimal aesthetics after prosthetic treatment. Extraction of a subalveolarly fractured tooth is avoided through root extrusion and post-core reconstruction. The results demonstrate the advantages of pre-prosthetic treatment as regards stability, aesthetics and function. With the help of pre-prosthetic orthodontic treatment, complicated treatment situations could be handled more successfully than would have been the case without such treatment.

The majority of Finnish adults have lost one, some or all of their teeth. The prosthetic replacement of missing teeth has thus been an important element of adult dental care. However, there have been no longitudinal studies focusing on the development of oral health among the Finnish adult population in terms of further tooth loss. A baseline sample from 1977-78 was selected from the city of Turku to represent the adult population aged 30 years and over. Ten years later, a follow-up examination was carried out on this baseline study group. A new sample of persons aged 30-39 years was also obtained to provide cross-sectional information, allowing comparisons between this study group and the youngest age-group of the 1977-78 study. In 1977-78, 52 per cent of all subjects had 20 or more remaining teeth. The mean number of missing teeth was 15.8 (SD 11.05) and the corresponding median 12 teeth. The number of missing teeth was on average higher in the older age-groups (P < 0.001). Women had more missing teeth than men (P < 0.01). In the ten-year follow-up study, the mean number of lost teeth was 1.5 (SD 2.32) and the median one tooth. The average number of lost teeth increased with age (P < 0.01). The rate of tooth loss was highest for those with 10 to 19 teeth at baseline, second highest for those with one to nine teeth and lowest for those with 20 to 32 teeth (P < 0.001). The reasons most often reported for tooth extraction were tooth mobility, pain and prosthetic treatment. In the cross-sectional study groups of persons aged 30-39 years, the proportion of subjects with a complete natural dentition of 28 to 32 teeth was 63.4 per cent in 1989, compared with 40.0 per cent ten years earlier. The average number of missing teeth was lower in 1989 than in 1977-78 (mean 4.7, SD 3.81 vs. mean 7.8, SD 6.92; P < 0.001). In both cross-sectional examinations women had a higher mean number of missing teeth than men. However, the difference between the genders was statistically significant only in 1977-78 (P < 0.01). Among the age-group of 30-39 years, there has been a considerable improvement in retention of natural teeth during the ten-year interval. However, among the middle-aged and elderly population reduced dentition was common; in addition, extraction was still used as a dental treatment especially among persons with reduced dentition. This suggests that the need for prosthetic replacement of lost teeth will continue to play a role in adult dental care in Finland for some decades to come.

The fewer the remaining teeth, the more difficult is prosthetic rehabilitation in the old patient. In the case of patients with disordered motoricity or mental disturbances, as well as those who refuse implants, or in whom implants are not possible for health reasons, the stepwise adaption of existing prostheses should be given preference over the provision of completely new dentures.

An adolescent patient who loses a permanent first molar presents a clinical challenge for the practitioner. The ideal space maintainer should not only maintain the edentulous space, but it should also maintain inter-arch integrity. An esthetic, inexpensive unilateral space maintainer has been designed for the replacement of a permanent first molar in an adolescent patient. The appliance has demonstrated high patient satisfaction, as well as, a good clinical result. This appliance is designed to remain in place until the patient is old enough to receive an implant or a more permanent prosthetic replacement.

This retrospective study aims to identify factors that contribute to either a poor or excellent treatment result in implant-overdenture treatment. A total of 375 implants, in an equal number of patients were included in the study. A clinical examination was performed by 2 observers. Gingival health and oral hygiene were assessed and additional complications were noted, including implant loss. 2 outcome variables, STATUS1 and STATUS2, were constructed that were different with respect to treatment outcome, representing a poor and an excellent result, respectively. Patient variables such as age, gender, medical status and prosthetic history were collected pre-operatively with a questionnaire. Life table analyses were used to test subsets of patient and treatment variables for differences in survival distribution, both for poor or excellent results. With regard to predictors of poor results; implants in the upper jaw were associated with a poorer outcome than those placed in the lower jaw (p = 0.01). When more than 2 implants were placed, the quality of survival was also impaired (p = 0.03). Interestingly, implants in patients with a self-proclaimed history of tooth loss due to periodontitis appear to have a far poorer treatment outcome than implants placed in patients without such a history (p = 0.01). No other variables could be related to a poor result after 3 years. None of the variables could predict an excellent treatment outcome.

In 24 patients with missing molar teeth in the upper and/or in the lower jaw, 32 premolars were distalized. The mean orthodontic distalizing distance was 9.4 mm (SD 2.6). After distalization all these teeth served as posterior abutments for fixed restorations. The investigation period ranged between 2.5 to 14.1 years, average 9.6 years (SD 3.2). The clinical examination criteria were sensitivity, mobility, probing depth, sulcus bleeding index; the radiologic criteria were root resorption (lateral and apical) marginal bone level and axial position. None of the 32 premolar abutments were lost during investigation period. All the teeth maintained their vitality. The measured probing depths and sulcus bleeding indices were low. Of the teeth tested 40.6% revealed localized lateral root resorption on the pressure side; the average postorthodontic depth of root resorption was 0.7 mm (SD 0.3), and the length 2.3 mm (SD 0.6). The follow-up examination revealed a partial repair of the lateral root lesions. The extent of apical root resorption amounted to 0.9 mm (SD 1.1). The marginal bone level showed a bone loss of 0.5 mm mesially and 0.2 mm distally. The findings confirm that the distalized premolar functioning as a posterior bridge abutment represents a prognostically favorable alternative to an implant.

A method for prosthetic repair of dentition defects due to loss of one tooth is proposed. A standard plastic tooth is fixed to the tooth limiting the dentition defect by means of composite filling material. A cavity similar to Black's class-III cavity is formed in the artificial tooth.

Edentulism is often reported after treatment for malignancy of oral cavity. The resulting deformities from loss of teeth and bone create a "social invalid" with difficulties in articulation and mastication. Prosthetic rehabilitation was difficult because of two problems: the risk of osteoradionecrosis development and local anatomic modifications. The introduction of osseointegrated implants improved results of oromandibular reconstruction. A preliminary report of nineteen Branemark implants of seven patients is reported here. Implants have been in place and functioning for a period of one to four years. No major complication occurred and osseointegration permitted good oral rehabilitation. Placement of osseointegrated implants in osteomyocutaneous flaps and in irradiated bone is discussed.

Orthognathic surgery in patients with missing teeth can be divided into two categories. In the first case after tooth loss, specially designed bridging is required using the prosthesis already in place. In the second case in patients with congenital deficiencies, usually sequellae of cleft palate, there is a wider range of therapeutic options which are discussed on the basis of observed cases.

The general aim of the thesis was to study single-tooth replacements with implants using a recently developed prosthodontic concept, CeraOne. More specifically, the aims were to present prosthodontic procedures and early clinical experiences of CeraOne, and to study the following: the acceptance and the rejection of referred patients, the mechanical strength of the complete implant post and of superstructures on the CeraOne abutment, the treatment outcome from an on-going prospective clinical investigation, the effect of guided tissue regeneration when using e-PTFE membranes in narrow alveolar ridges, and finally, the outcome from treatments by general practitioners (GPs) who had performed the complete care of the single-tooth patient. The acceptance and the rejection of patients were studied on 184 patients, and the conclusions were based on data from referral, case history, clinical examination, and therapy planning. External trauma, root fractures, and congenitally missing teeth were the main reasons for lost or missing teeth in referred patients, while anatomical limitations were the most frequent reasons for the rejections. The mechanical strength was determined after testing in an Instron universal testing machine. The abutment screw was shown to be the weakest link, while a satisfactory safety margin against fractures was observed for the metal-ceramic and the all-ceramic crowns. It was also shown that the all-ceramic ¿ crown could resist bending moments up to a level that was more than three times as high as the one at which the porcelain crown fractured. In the clinical prospective study, the results from treatments of 57 patients (65 implants) were reported after two years and from 34 patients (37 implants) after three years. Favourable survival rates were shown for the implants (97.3% at 3-4 years) and, as a mean, only a small bone loss around the implants and the adjacent teeth was observed. The conical implants, however, showed a higher degree of bone los in comparison to the other implants. The CeraOne prosthodontic concept was simple to sue because of prefabricated components, and favourable aesthetic and clinical short-term results were achieved. Problems of screw loosening and fistulas were avoided and the cementation of the crown and the subgingival placement of the abutment shoulder did not cause any soft tissue recession. Fifteen patients (20 implants) with a suspected need of guided tissue regeneration were selected for the study using e-PTFE membranes. After treatment and at the second stage surgery, it was shown that most of the primarily exposed implant surfaces at this time were covered by a newly formed tissue with signs of osteoid activity.(ABSTRACT TRUNCATED AT 400 WORDS)

Elderly partially edentulous patients can have teeth replaced with removable or fixed prostheses supported by mucosa, teeth, or implants. Age per se does not influence which option is best. Instead, the relative health of the patient, dental tissues, and the patient's finances determine treatment. A three-level index of these factors, the PTF index, is proposed to assist in the decision-making for treatment. Removable partial prostheses (RPPs) can be indicated for all patients because RPPs offer esthetic, versatile, noninvasive, and reversible features. They are particularly indicated when remaining teeth are questionable. If teeth are lost, they can be more easily added to existing RPPs compared with fixed prostheses. Six changes to ideal designs are illustrated in this article for prostheses with a compromised dentition, to make continued prosthetic service simpler.

The use of osseointegrated implants is an accepted procedure for the treatment of total and partial edentulism and offers good predictability of long-term success. For the last several years, this procedure has also been used for single-tooth replacement following loss of teeth for traumatic, periodontal, and carious lesions. This paper reports the clinical experience of 47 patients treated for a single-tooth replacement. Sixty-seven screw-type standard, self-tapping implants and mini-implants were placed. The results were similar to those for complete and partial osseointegrated prostheses. The total implant survival rate was 94.4%. Two implants were lost as a result of suppuration caused by membrane exposure, while another was lost after loading. The results suggest that single-tooth replacement using osseointegrated implants provides predictable success.

The severely reduced dentition is a continual challenge to the treatment planning skills of the restorative dentist. This paper examines the need for treatment in the context of oral function, social requirements and related disease processes. The philosophy for management should be based on sound knowledge of the outcomes of treatment options. This paper highlights the relevant factors to be assessed in treatment planning for the severely reduced dentition.

The histological examination plays an important role in the determination of the clinical use of hydroxylapatite ceramics (HA). In the presented case, the periodontally compromised tooth was removed and the alveolus filled with HA and covered by Lyodura. 20 months later a blade type of implant was inserted, which was surrounded with HA again. At the time of the operation a biopsy was taken, and the subsequent histological examination showed a complete osseous healing.

The aim of any prosthesis is to restore function and aesthetics by replacing the missing tooth with minimal risks to adjacent tissues. The options presently available to the patient for the replacement of a missing single tooth include the removable partial denture, partial and full coverage bridgework, resin-bonded bridgework and the single-tooth implant prosthesis. The relative merits and guidelines for successful application of these treatment modalities are presented.

The functional and aesthetic rehabilitation of a single missing anterior tooth presents a surgical and prosthetic challenge. This article describes reconstructive and restorative techniques applied to the rehabilitation of such a case, using an osseointegrated implant, guided bone regeneration, mucogingival preprosthetic plastic surgery, and an all-ceramic restoration. The learning objective of this article is to enhance the knowledge of single-tooth implant restorative approaches and procedures.

The correct treatment of a single missing maxillary anterior tooth in the aesthetically prominent area has become more challenging. The missing tooth can today be replaced by one of three prosthodontic treatment modalities--conventional fixed bridge, resin-bonded bridge, and single-tooth implant. The most important factors to be considered are the predictability of aesthetics, the preservation of the enamel shield and the dentinal and pulpal tissue, and the preservation of the periodontium and the alveolar bone. The learning objective of this article is a critical discussion of these three modalities as a replacement of a missing anterior single tooth to aid in selection of the most appropriate treatment in each individual clinical case.

The evolution of denturism in many parts of the world may present a serious challenge to the oral health of many patients. Recent demands by denturists for permission to provide a full removable prosthodontic service directly to the public has met some success. This article reviews the health hazards associated with removable partial dentures, and presents the biologic arguments against the expansion of denturist activities to treatment that repeatedly tests the knowledge and skills of the most experienced dentists.

Resin-retained bridges can be used as the definitive treatment, as well as for interim treatment. Compared with conventional fixed prostheses, there are some advantages which make this treatment especially useful in traumatized dentition. The ultra conservative approach makes the adhesive bridge a standard treatment option in cases of uncertain prognostic factors. However, in such specific situations as traumatized dentition some complicating factors may be present. These complicating factors must be recognized and eliminated to create situations in which this kind of restoration can be successful. Therapeutic and patient-related factors are discussed using data from longitudinal clinical studies. Available clinical information indicates the anterior adhesive bridge to a 'permanent restoration'. However, a benefit-cost analysis is necessary to weigh the value of this restorations.

Orthodontic closure and autotransplantation of teeth are valid treatment alternatives for young individuals with missing anterior teeth. These alternatives have, however, different indications and the choice should be based upon a comprehensive evaluation and diagnosis of the individual. Problems and limitations should be emphasized before treatment in order for the patient to have realistic expectations. The treatment plan will ultimately result from an evaluation of short- and long-term biologic and esthetic considerations. Indications, treatment principles and key factors in the treatment procedure are outlined in this overview. If transplantation is to be part of the treatment plan, the donor tooth which has the best prognosis should be selected.

The prime objective of dental care is maintaining a natural functional dentition for life. It is expected that a growing group of adults will keep their dentition into old age. Although routine prosthodontic care will still be important in the future the treatment strategy for older adults and elderly people with a reduced dentition does require a different approach. The traditional approach in prosthetic therapy was guided primarily by morphological criteria aimed at preservation of complete dental arches, which resulted in emphasis on quantity in dental care. Nowadays requirements such as aesthetics and functional comfort are considered more important and more easily achieved. In the presented principles for treatment planning the importance of a thorough preliminary treatment is stressed. Furthermore, needs for tooth replacement are discussed and guidelines are given for a preventive prosthodontic treatment approach in severely broken-down dentitions and edentulous patients.

This study involved 12 patients with chronic adult periodontitis in which 1 or 2 lower incisors had to be extracted due to extreme bone loss. The resulting diastemata were closed by means of the acid-etch technique. Patient's own teeth were used as pontics after endodontic treatment. They were connected to a metal framework by means of composite and this restoration was anchored to the rest dentition. Radiographical analysis (no further bone loss around abutment teeth) as well as clinical parameters indicated the long-term successful periodontal reaction to this treatment. The low number of losses illustrated the longevity (mean = 8 years and 3 months) of the rehabilitation.