William E. LaVelle

Longevity of fixed partial dentures

STATEMENT OF PROBLEM The anticipated length of service and reasons for replacement of fixed partial dentures (FPDs) are a frequent inquiry by patients. Previous reports have provided limited information on material and techniques used in restoration or standards in evaluations of restorations at delivery. PURPOSE This study determined the reasons for failure and length of service for FPDs delivered with specific clinical, radiographic, and laboratory procedures. METHODS A clinical and retrospective chart review was conducted on all patients with FPDs who were treated in the prosthodontic clinic at the University of Iowa Hospital for routine dental hygiene recalls during a 6-month period. Fifty patients were examined with a total of 89 FPDs. Of the 89 FPDs, 13, or 15%, were identified as failures or had been replaced because of failure. Dental caries was the most frequent cause of failure (38%), followed by periapical involvements (15%), perforated occlusal surfaces (15%), fractured post and cores (8%), defective margins (8%), fractured teeth (7%), and porcelain failures (8%). The mean length of service for failed FPDs ranged from 16.0 years, because of failure from dental caries, to 4.1 years, because of a fractured post and core. RESULTS A linear regression model of years in service against number of failed FPDs indicated that the number of years in service provided no information on predictability of failure for FPDs. CONCLUSIONS This study supported previous reports of dental caries as the primary cause for failure of FPDs, but specific radiographic, clinical, and laboratory procedures can increase the length of service of these restorations.

Palatal lift prostheses for treatment of palatopharyngeal incompetence

It appears that the palatal lift prosthesis is an effective prosthesis to improve palatopharyngeal incompetence in selected patients. Despite the inconvenience and problems associated with a prosthesis, this procedure is indicated for selected patients who have anatomically normal palates that are dysfunctional. The ultimate benefit of the palatal lift prostheses to the speech of the patients is not the subject of this report. However, it should be noted that many patients can benefit from speech therapy after a satisfactory prosthetic result has been achieved.

Condylar reconstruction: Treatment planning

Abstract The treatment planning of a patient with false ankylosis, severe malocclusion, and a bird-face appearance is presented. The fabrication of the condylar head prosthesis was facilitated by the use of tomograms. The principles of tomography and its clinical application are discussed. The condylar head prostheses cast in ticonium with the shanks coated with porous Proplast material provided and have maintained the position of the mandible in an acceptable occlusion and improved facial appearance.

Bilateral Maxillectomy and Midfacial Reconstruction

Extensive bilateral midfacial defects including the upper jaw, palate, and sinuses present a formidable reconstructive challenge. Prosthetic restorations require a solid anchor point to be successful, since orofacial motion would otherwise cause instability of the prosthesis. We report on a series of eight patients who underwent transmalar placement of a Steinmann pin at the time of definitive tumor resection. The Steinmann pin was used immediately to securely anchor a prosthesis to the skull base. The maximum follow-up time is 9 years. The Steinmann pin has remained firmly anchored without significant loosening in six of these eight patients, and no major complications have resulted from its use. In conclusion, the transmalar Steinmann pin is an effective and immediate single-stage method of permanently retaining a midface prosthesis.

Implant-supported prostheses for treatment of adults with cleft palate

Six adult patients with cleft palate, ranging in age from 47 to 78 years, were treated with self-tapping titanium implants. Twenty-three implants, 7 to 15 mm in length, were placed. Of these, one (4%) was 7 mm, eight (35%) were 10 mm, nine (39%) were 13 mm, and five (22%) were 15 mm. Time between stage I and stage II implant surgeries was 5 to 14 months, averaging 8.3 months. Time from stage II surgery to the present is 1.5 to 5 years, averaging 3 years. Of the 23 implants placed, 21 (91%) achieved osseointegration. One (4%) implant was not used prosthetically. Two (9%) 10 mm implants failed to integrate in one patient. All patients were treated with a maxillary complete denture or overdenture. Five (83%) required the addition of a pharyngeal section for speech enhancement.

Prosthodontic rehabilitation of the partially edentulous trauma patient by using osseointegrated implants

Osseointegrated dental implants provide a viable alternative of tooth replacement. Although certain patients may greatly benefit from this method of treatment, implants are not a panacea. Success is the culmination of good case selection, thoughtful treatment planning, meticulous clinical and technical attention to detail, and proper maintenance care.

Coated versus non-Proplast-coated endosseous blade-vent dental implants

In order to determine the efficacy of applying Proplast to dental endosseous bladevent implants, this material was coated on half of sixteen such implants which were bilaterally placed in the mandibles of eight rhesus monkeys. No difference in the clinical acceptability could be ascertained between the two groups. Histologic examination revealed a loose connective tissue layer around the noncoated implants which was not evident around the coated ones.

Construction of a maxillary orthopedic prosthesis for simultaneous maxillary expansion and obturation.

An effective means of obtaining maxillary expansion and obturation was presented. By use of split palatal orthopedic prosthesis incorporating a posterior fanscrew with an obturator, two patients showed improved speech, cosmetic appearance, and oral physiology while gaining the desired alignment of the maxillary segments before further surgery.

Grand Rounds at the University of Iowa

Dr. Fred Holt, Resident: I would like to present the first patient, an 87year-old female, who is in reasonably good health with the exception of well compensated congestive heart failure and bilateral cataracts. Her present problem started about a year ago when she contracted Bells palsy on the left side. She was not seen by an otolaryngologist at that time, and it was not clear what treatment, if any, was given, but over the ensuing months her facial function gradually returned. This was accompanied by pain over the left ear which was occasionally quite severe. As her facial motion returned, she noticed increased tearing of her left eye, which started about eight months ago. The lack of motion was replaced by a virtually continuous contracture of muscles of the left side of her face, so that the corner of her mouth was drawn upward, and her eyelids were drawn together. She had cataract surgery 35 years ago on the right eye, with an unsuccessful result so that this eye was essentially blind. With the excessive tearing in the left eye, associated with contracture of the orbicularis oculi muscle which tended to close the lid, she had di5culty seeing. She was referred by an ophthalmologist to determine what might be done for the spasm and tearing, correction of which would be necessary prior to any cataract surgery.