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 »  Home  »  Dental Implant 3  »  The Adaptation of Implant-Supported Superstructures to the Alveolar Crest: A Follow-Up of 49 Cases
The Adaptation of Implant-Supported Superstructures to the Alveolar Crest: A Follow-Up of 49 Cases
Discussion - References.

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DISCUSSION.
The idea of close adaptation of the superstructure to the alveolar crest is aimed at getting an improved esthetic solution and improving the phonetic function of the patient. The patients in our study were able to function well socially and felt that the prostheses were a natural continuation of the alveolar process. Another important functional improvement is that there is no food impaction between the alveolar process and the superstructure. The difficulty with the present design of bridge construction is that it is difficult to make a visual examination of the fixtures without removing the bridge. Logically, it should be much more difficult to clean the area, but the patients did not experience difficulty. The patients performed 90% of their dental oral hygiene with rotating brushes and the rest with superfloss instruments. None of the patients have had pain from the gingival tissue. Instead, they experienced a very comfortable situation.
Visual inspection of the areas performed annually for up to six years has demonstrated gingival mucosal health. The reconstruction of the alveolar crest to a normal configuration to compensate for the loss of bone tissue with a superstructure closely adapted to the soft tissues has had a positive effect on the patients. The very low failure rate, despite difficult cases with deficient bone volume in both the mandible and the maxilla, is favorable for our method.
When measuring the marginal bone height in the radiographs, we found that marginal bone loss was more advanced in the maxilla and that even in five-year follow-up the bone reduction was almost negligible in the mandible. The bone situations in our maxillary cases consisted of very thin narrow ridges with just enough bone to perform conventional implant surgery. In many cases, threads were left exposed on the palatal side. Exposed threads could explain a more rapid marginal bone loss. Remodeling of the bone could account for some of the bone loss in these cases. However, major loss was found in just a couple of patients, indicating that perhaps systemic factors could be influential. The close adaptation of the superstructures does not mean that we create an impossible situation for the patient. However, when comparing the results in our study with longitudinal 15-year studies, the figures are compatible. The clinical and radiographic examinations support this prosthetic design. It also seems that the patients were more able to keep the closely adapted reconstructions hygienic than they were when a space was created between the alveolar crest and the superstructure (Fig. 1). Since the beginning of our study, making these superstructures it has become more routine.

References.

Preiskel HW, Tsolka P. Treatment outcomes in implant therapy:   the influence of surgical and prosthodontic experience. Int J Prosthodont.   1995;8:273- 279.
  James RA, Schultz RC. Hemidesmosomes and the adhesion of junctional epithelial   cells to metal implants. A preliminary report. Oral Implantol. 1974;4:294-   302.
  Schlegel D, Reichart PA, Pfaff U. Experimental bacteremia to demonstrate   the barrier function of epithelium and connective tissue surrounding oral endosseous   implants. Int J Oral Surg. 1978;7: 569-572.
  Quirynen M, Nart I, van Steenberghe D, et al. The cumulative failure rate   of the Branemark system in the overdenture, the fixed partial and the fixed   full prosthesis design: A prospective study on 1273 fixtures. J Head Neck   Pathol. 1991;10:43-53.
  Jemt T. Failures and complications in 391 consecutively inserted fixed prosthesis   supported by Branemark implants in edentulous jaws: A study of treatment from   the time of prosthesis placement to the first annual check-up. Int J Oral   Maxillofac Implants. 1991;6:270-276.
  Balshi TJ, Ekfeldt A, Stenberg T, et al. Three-year evaluation of Branemark   implants connected to angulated abutments. Int J Oral Maxillofac Implants.   1997;12:52-58.
  Adell R, Lekholm U, Rockler B, et al. A 15-year study of osseointegrated   implants in the treatment of the edentulous jaws. Int J Oral Surg. 1981;10:387-   416.
  Hansson BO. Success and failure of osseointegrated implants in the edentulous   jaw. Swed Dent J. 1977;1(Suppl 1).
  Haraldsson T, Carlsson GE. Bite force and oral function in patients with   osseointegrated oral implants. Scand J Dent Res. 1977;85:200-208. Adell   R, Eriksson B, Lekholm U, et al. A long-term follow-up study of osseointegrated   implants in the treatment of totally edentulous jaws. Int J Oral Maxillofac   Implants. 1990;5:347-359. Axelsson P, Lindhe J. Effect of controlled oral   hygiene procedures on caries and periodontal disease in adults. J Clin Periodontol.   1978;5:133-151.
  Lindhe J, Nyman S. The effect of plaque control and surgical pocket elimination   on the establishment and maintenance of periodontal health. A longitudinal study   of periodontal therapy in cases of advanced periodontal disease. J Clin   Periodontol. 1975;2:67-77.
  Lekholm U, Adell R, Lindhe J, et al. Marginal tissue reaction at osseointegrated   fixtures (II). A cross-sectional retrospective study. Int J Oral Maxillofac   Surg. 1986;15:53-61.
  Teixeira ER, Sato Y, Akagawa Y, et al. Correlation between mucosal inflammation   and marginal bone loss around hydroxyapatite-coated implants: A 3-year cross-sectioned   study. Int J Oral Maxillofac Implants. 1997;12:74-81.
  Schakleton JL, Carr L. Branemark fixed implant-supported prosthesis: A review   of prosthetic problems. J Dent Assoc S Afr. 1995;49:293-298. Carlsson B,   Carlsson GE. Prosthodontic complications in osseointegrated dental implant   treatment. Int J Oral Maxillofac Implants. 1994;9:90-94.
  Tallgren A. The continuing reduction of the residual alveolar ridges in complete   denture wearers: a mixedlongitudinal study covering 25 years. J Prosthet   Dent. 1972;27:120-132.
  Rangert B, Jemt T, Jorneus L. Forces and moments on Branemark implants.   Int J Oral Maxillofac Implants. 1989;4:241-247.
  Cawood JI, Howell RA. A classification of the edentulous jaws. Int J   Oral Maxillofac Surg. 1988;17:232-236.
  Lekholm U, Zarb GA. Patient selection and preparation. In: Branemark   PI, Zarb GA, Albrektsson T (eds). Tissue Integrated Prosthesis. Osseointegration   in clinical dentistry. Chicago: Qintessence, 1985:199-209.
  Adell R, Lekholm U, Rockler B, et al. A 15-year study of osseointegrated   implants in the treatment of the edentulous jaw. Int J Oral Surg. 1981;10:387-   416.