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Reconstructive procedures for the severely resorbed mandibular edentulous ridge have historically involved the use of a variety of surgical procedures and biologic and nonbiologic materials with limited success. Since the introduction of osseointegrated fixtures to support tissue-integrated prostheses, the procedure has been applied to more complex clinical situations. The treatment of three patients with severe mandibular ridge resorption utilizing osseointegrated fixtures is described. [ABSTRACT FROM AUTHOR]

Most academic health sciences centers offer faculty leadership development programs (LDPs); however, the outcomes of LDPs are largely unknown. This article describes perspectives from our 12-year experience cultivating a formal faculty LDP within an academic health center and longitudinal outcomes of our LDP. Responding to faculty concerns from University of California San Francisco’s (UCSF) 2001 Faculty Climate Survey, UCSF established the UCSF-Coro Faculty Leadership Collaborative (FLC) in 2005. The FLC focused on building leadership skills using a cohort-based, experiential, interactive and collaborative learning approach. From 2005 to 2012, FLC has conducted training for 136 graduates over 7 cohorts with 97.6% completion rate. FLC faculty participants included 64% women and 13% underrepresented minority (URM). The proportions of graduates attaining leadership positions within UCSF such as deans or department chairs among all, URM, and women URM graduates were 9.6%, 33.3% and 45.5%, respectively. A 2013 online survey assessed 2005–2012 graduates’ perceived impacts from 8 months to 8 years after program completion and showed 91.7% of survey respondents felt the program both increased their understanding of UCSF as an organization and demonstrated the University’s commitment to foster faculty development. Qualitative results indicated that graduates perceived benefits at individual, interpersonal, and organizational levels. Though we did not directly assess impact on faculty recruitment and retention, the findings to date support cohort-based experiential learning in faculty leadership training development.

One hundred seven Brånemark implants were placed in 92 patients participating in an international multicenter trial on single-implant restorations at seven centers. The patients were followed for 5 years in a prospective study focusing on implant success and crown function. Plaque and gingival indexes, as well as probing depths, were recorded around teeth and implants. The marginal bone level at implants was determined from intraoral radiographs. Only three implants (2.8%) had been lost at the final annual checkup. During the follow-up period, a total of 17 patients dropped out or were excluded because of nonconformity with the protocol. Based on the remaining patients, a total of 86 implants were clinically and radiographically evaluated at the 5-year follow-up period, resulting in a cumulative success rate of 96.6% (71 implants) in the maxillae and 100% (15 implants) in the mandibles. Plaque and gingival indexes showed a similar pattern of good health around both natural teeth and titanium abutments. The marginal bone loss during the 5-year period did not exceed 1 mm as a mean for all implants analyzed. The most frequent complication recorded during the follow-up was loosening of the abutment fixation screw. The outcome of this study indicated that safe and highly predictable results can be obtained for 5 years when Brånemark implants are used to support single-tooth restorations.

After 3 years, 82 of the original 92 patients remain in this prospective multicenter study of single-tooth restorations supported by Brånemark implants. Since the 1-year follow-up, 6 more patients have been lost, but no additional implants have failed in those patients examined at the 3-year follow-up visit. After 1 year of function, 97.2% of the implants survived in 88 patients, and between the 1- and 3-year follow-up, 100% survived in 82 patients, giving a 3-year cumulative success rate of 97.2%. No changes were observed in the status of gingivitis, pocket depth, periodontal pocket bleeding index, and tooth and implant mobility from those reported after 1 year. Marginal bone resorption remained at a low level--less than 0.1 mm annually during the second and third years. Abutment screw loosening continued, but at a significantly reduced rate from that reported after 1 year. When used, gold rather than titanium abutment screws remained secure.

During a 78-month period at the Mayo Clinic, 1,778 Brånemark endosseous dental implants were placed in the edentulous or partially edentulous jaws of 353 consecutive patients who ranged in age from 8 to 82 years. The largest treatment category involved edentulous mandibles, which accounted for 53% of the total restorations. Approximately 76% of the threaded cylindrical implants supported 312 oral prostheses at the end of the study period. The implant survival rate was 97.8% in the mandible and 88.8% in the maxilla. Complications associated with this treatment included loss of implant anchorage in bone, soft tissue problems, and mechanical difficulties related to design and function of the prostheses. All complications were managed without loss of continuous function of the prostheses, except in four patients who resumed wearing a conventional removable maxillary complete denture. This experience demonstrates that Brånemark endosseous dental implants are predictable and can provide lasting integration under function when placed and loaded in accordance with the recommended protocol.

Over a 78-month period from 1983 to 1990 at the Mayo Clinic, 353 patients involving 407 jaws were restored with 1,778 Brånemark system implants supporting prostheses. Complications involved loss of implant anchorage, soft tissue problems, or mechanical problems. The most predominant complication involved soft tissues. There were 152 patients with loaded prostheses who had no complications and 37 with only one occurrence. Those seen in 160 patients with more than one occurrence were all conservatively managed, so that prosthesis use was only permanently discontinued in 4 patients, who returned to the use of a maxillary complete denture.

The design of the metal alloy framework in cantilevered sections of fixed tissue-integrated prostheses, is critical. Several cross-sectional designs have been advocated, including the popular L-shaped beam, which permits the economical use of space for tooth placement. The fatigue strengths of 15 L-shaped cantilevered framework sections of the same metal alloy were tested. The castings were divided into three groups of five according to vertical wall heights of 4, 5, and 6 mm. Fatigue durability of each sample was determined by counting the number of cycles of vertical forces required to induce catastrophic failure. Statistical analysis revealed significant differences between all three groups in the cycles counted at failure (p less than 0.0019). Fatigue strengths improved significantly with increasing vertical wall height of the L-shaped cantilevered frameworks. In addition, beam flexure was shown to be indirectly proportional to fatigue strength. Theoretical beam deflection was calculated and shown to correlate with the actual beam deflection during the testing. Theoretical calculations in static bending specific for a cross-sectional design may aid in the predictability of fatigue strength.

One hundred seven dental implants were inserted to support single tooth restorations in 92 patients participating in a prospective multicenter investigation. Only three implants (2.8%) were lost after 1 year of clinical function. Most of the remaining restorations were esthetically successful by using modified components. The gingival condition was healthy around the single crowns and coincided well with the clinical situation around the permanent teeth. The most obvious problem experienced during the first year was related to loose abutment screws. Twenty-six percent of the screws retaining crowns were retightened during the observation period, but the frequency of loose screws had a tendency to decrease as the study progressed.

Nine clinical centers using the Brånemark System participated in a prospective study of 159 partially edentulous patients between 18 and 70 years of age. Clinical parameters evaluated were plaque index, gingivitis, pocket depth, bleeding index, tooth mobility, and stomatognathic function. Initially, 558 fixtures were placed and 521 remained in the study following prosthesis placement (199 prostheses in 154 patients). Fixtures were lost or unaccounted for because of nonintegration prior to prosthesis fabrication (19), patient withdrawal (11), prosthodontic reasons (6), and failure during prosthetic procedures (1). Failure was primarily attributable to unfavorable bone quality, sex (more in males), and smaller fixture size. Complications and failure related to other patient characteristics are presented. After 1 year of a 5-year study, preliminary results suggest that a success rate equal to or better than that obtained with edentulous patients may be expected.

1. No significant difference existed between the MMPI means of the test group and the MMPI means of the Mayo Clinic patient group. 2. The means of the test group and the Mayo Clinic patient group deviated from the MMPI normative data. 3. No apparent change in personality of the test group was suggested by the MMPI. 4. A much larger percentage of the patients than expected failed to complete the initial MMPI. One patient refused, and four patients had a raw score of "cannot say" responses greater than 120, thus invalidating the test. 5. The changes in the means of the ACL scales of total number checked, autonomy, change, and abasement were significant (p less than .05). 6. The patient became more outgoing and optimistic, as measured by the ACL, during the immediate postoperative period. 7. Speech and mastication were problems for some patients even after prosthodontic rehabilitation. 8. Most of the rehabilitated patients resumed their normal social habits. 9. The patients in the study seemed to respond to the new situation according to their already existing personality structure.

Limitation of practice implies specialization and the delivery of services by a specialist who has been recognized for his expertise through formal advanced education, experience, and/or examination. Prosthodontists in limited practice are currently influenced by problems related to patient referrals, third-party payment for services, and competence certification. Perhaps the most significant problem in prosthodontics today is the need to succinctly define the parameters of prosthodontic practice in order to provide guidelines for assuring that such practices are limited to the defined specialty.

As an alternative to conventional removable dentures, osseointegrated dental implants can now be used in carefully selected edentulous or partially edentulous patients. The implant consists of a dental prosthesis and an anchorage unit made up of screw-connected components. The implantation procedure is performed in two phases: fixture installation and fixture uncovering and abutment connection. After completion of these surgical procedures, the dental prosthesis is fabricated and inserted. Follow-up examinations are scheduled at 1, 3, and 6 months and then annually thereafter. During a 2-year period at the Mayo Clinic, 358 osseointegrated dental fixtures were implanted in 70 patients. The overall success rate in this consecutive series of patients was 98%, and the associated complications were minimal and easily resolved.