George A. Zarb

The longitudinal clinical effectiveness of osseointegrated dental implants: The Toronto study. Part III: Problems and complications encountered

Two hundred seventy-four implants were placed in 49 dental of 46 consecutively treated patients. The success rate for individual implants in this study, 4 to 9 years after placement, was 89.05% and for the prosthetic treatment it was 100%. Problems, and complications were observed and recorded at stage I surgery, between stage I and stage II surgery, at stage II surgery, and in the healing period that followed. Also noted were the complications subsequent to prosthodontic treatment and during the years of follow-up. Virtually al of the problems encountered were iatrogenic in nature. These clinical results indicate a safe retrievable technique with negligible associated morbidity.

The longitudinal clinical effectiveness of osseointegrated dental implants: The Toronto study. Part II: The prosthetic results

Forty-six patients who had shown chronic maladaptive behavior in using complete dentures were treated with osseointegrated implant-supported prostheses. Forty patients needed mandibular treatment, three patients needed treatment in the maxillae, and three required treatment in both dental arches. At the most recent data collection (4 to 9 years after surgical placement of the implants), the 49 dental arches remained successfully treated with 44 implant-supported fixed partial dentures and five implant-supported overdentures. The efficacy of the osseointegration technique in maladaptive prosthetic patients is demonstrated in this descriptive study.

The longitudinal clinical effectiveness of osseointegrated dental implants: The Toronto study. Part I: Surgical results

In this prospective study, 46 edentulous patients who had undergone traditional denture optimization therapy without success were treated with osseointegrated implants according to the surgical protocol described by Dr. P.I. Branemark. Two hundred seventy-four implants were placed in 49 dental arches--43 mandibles and six maxillae. At the time of writing, 4 to 9 years after insertion of the implants, 244 or 89.05% remained osseointegrated. Of the 262 implants in place more than 5 years, 232 or 88.55% were still integrated. The implant success criteria developed in this clinical study endorsed the predictably favorable outcome of the Branemark technique.

Assessment of clinical treatment of patients with temporomandibular joint dysfunction

1 emporomandibular joint dysfunctions are fairly common occurrences and are comprehensively documented in the dental literature. Several authors maintain that inadequate dentitions and unsatisfactory occlusions are the most frequent causes of temporomandibular joint disorders. l-4 Other investigators, while noting that hyperfunction may give rise to myofascial pain, assert that temporomandibular joint disturbances are usually related to dysfunction of the masticatory muscles and/or to emotional disorders.5-10 The objective of this investigation was to assess, from a clinical point of view, the history, symptomatology, clinical findings, radiographic appearance, dental status, treatment, and longitudinal follow-up of patients suffering from functional temporomandibular joint disturbances. This article is a preliminary report based on a 30 to 36 month follow-up of a sample of treated patients. For each patient, an assessment was made of (1) the chief complaint and its duration, (2) the onset of pain and associated joint activity, (3) bruxing and/or clenching activity, (4) the medical history findings, (5) the emotional state, (6) subjective symptoms, (7) clinical findings, (8) pain distribution, (9) the occlusal/prosthetic status, (10) the occlusion, (11) a charting of the existing teeth, carious lesions, periodontal status, attrition, facets, and the like, (12) full-mouth and Panorex radiographs, (13) the treatment prescribed, (14) the time interval in obtaining relief, (15) the permanent treatment plan, and (16) referral consultations.

The Brånemark osseointegrated implant

This work updates clinical research on the Branemark implant; it covers recent applications and emphasizes soft tissue response, biologic perspectives and oral rehabilitation.

The edentulous milieu

D ental disease as a consequence of tooth loss has plagued mankind for several centuries. As a result prosthodontics and oral surgery justifiably boast of an ancient, if not always distinguished, heritage. The Phoenicians and Egyptians, for example, have left evidence of fixed prostheses that consisted of carved ivory teeth attached with gold wire to adjacent natural teeth. Few dentists appreciate what the first complete dentures really looked like and what kept them in place. Still fewer know that Queen Elizabeth I used rolls of cloth to pad out her lips or that the American presidential world cruise was ruined for President Grant by the loss of his teeth overboard. Slightly over 100 years ago, artificial teeth were so insecure that they were commonly removed during eating. For reasons of delicacy, many a lady wearing dentures did much of her eating in the privacy of her bedroom. The modern dental era reflects a profound awareness that the preservation of function of the masticatory system is best served by the conservation and protection of tissues that remain. Our professional objective has been to avoid, or at worst delay, Shakespeare’s description of that “last scene of all”: the one “that ends this strange eventful history, (is) second childishness and mere oblivion, saris teeth, saris eyes, saris taste, sans everything.“t To most of our patients, the loss of a few teeth is mutilating and provides a strong incentive to seek dental care to preserve and restore normal speech, masticatory function, and a socially acceptable appearante. To most dentists the loss of teeth poses an even greater mutilation: the destruction of part of the facial skeleton and the distortion of the morphology and function of soft tissues (Figs. 1 and 2). Fig. 1. A and B, Total tooth loss almost invariably leads to advanced bone loss. This undermining of integrity of facial skeleton distorts overiying soft tissue. This is evident in soft tissue shadow in A and in frontal and profile appearance of patients seen in Fig. 2.

Crestal bone loss proximal to oral implants in older and younger adults

STATEMENT OF PROBLEM Older adults often have bone loss and may be at risk of bone resorption around oral implants. PURPOSE This study tested the hypothesis that there is no difference in crestal bone loss proximal to oral implants in the complete implant prosthesis sites of older and younger adults. MATERIAL AND METHODS Two groups of 35 complete dental implant prosthesis sites (23 screw-retained fixed prostheses and 12 bar-retained overdentures) were selected by matching sites in 32 older adults (60 to 74 years old with 166 Bränemark implants) to sites in 34 younger adults (29 to 49 years old with 162 Bränemark implants) on the basis of possible confounding factors including gender, prosthetic design, implant number, arch, year of surgery, and opposing dentition. Statistical comparisons (Mann-Whitney test at P<.05) were made of mean crestal bone level at loading and mean annual crestal bone loss during the first year, first to fourth year, after first year, and after fourth year of loading with periapical radiographic measurements of the vertical distance in millimeters from the apical edge of the implant collar to the most apical initial point of contact between the implant and bone. RESULTS No significant differences were found between the groups. Mean bone levels at loading were 1.4 mm below the collar in both groups and mean annual crestal bone loss after the first year of loading was 0.04 mm/y in both groups. However, significant differences were found between some old and young subgroups stratified by arch and prosthetic design. CONCLUSION Within the limitations of this study, elders should expect no more rapid bone resorption around oral implants in edentulous jaws than that seen in young adults.

Osseointegration for elderly patients: The Toronto study

Successful osseointegration promises a virtual panacea for the edentulous predicament. However, the impact of this technique on specific age groups is far from clear. In an attempt to determine the efficacy and effectiveness of implant-supported prostheses in geriatric patients, the treatment outcomes of elderly patients already included in ongoing clinical trials were assessed. The following preliminary observations were made: (1) being elderly is not a contraindication to long-term implant survival; (2) successful osseointegration can be maintained irrespective of a patients oral hygiene performance; and (3) diverse prosthesis designs appear feasible.

The notion of implant-supported overdentures

This article presents a brief review of the methods and techniques to manage the maladaptive edentulous patient. A discussion of the inclusion and exclusion criteria and treatment outcome measures associated with published prospective osseointegrated implant studies are included and specific therapy options are suggested. It is concluded that there is a need for less invasive, less expensive, less complex, and equally effective treatment options such as the implant-supported overdenture for the maladaptive edentulous patient.

Oral motor patterns and their relation to oral prostheses.

The mechanism of support for oral prostheses varies qualitatively and quantitatively, depending on the type of prosthesis worn. Some prostheses are partially supported by natural teeth, and others rely for their support on the residual tissues, mucosa, alveolar bone. Nondental prosthetic support demonstrates progressive longitudinal changes and poses special problems for the denture wearer. In this review, the masticatory system is considered as a biomechanical interaction of three components: function/dysfunction adaptive responses, and TMJs. It appears that oral behavior is related to all three components, but its role is not completely understood.