Group 2 ITI Consensus Report: Prosthodontics and implant dentistry

OBJECTIVES

Working Group 2 was convened to address topics relevant to prosthodontics and dental implants. Systematic reviews were developed according to focused questions addressing (a) the number of implants required to support fixed full-arch restorations, (b) the influence of intentionally tilted implants compared to axial positioned implants when supporting fixed dental prostheses (FDPs), (c) implant placement and loading protocols, (d) zirconia dental implants, (e) zirconia and metal ceramic implant supported single crowns and (f) zirconia and metal ceramic implant supported FDPs.

MATERIALS AND METHODS

Group 2 considered and discussed information gathered in six systematic reviews. Group participants discussed statements developed by the authors and developed consensus. The group developed and found consensus for clinical recommendations based on both the statements and the experience of the group. The consensus statements and clinical recommendations were presented to the plenary (gathering of all conference attendees) and discussed. Final versions were developed after consensus was reached.

RESULTS

A total of 27 consensus statements were developed from the systematic reviews. Additionally, the group developed 24 clinical recommendations based on the combined expertise of the participants and the developed consensus statements.

CONCLUSIONS

The literature supports the use of various implant numbers to support full-arch fixed prostheses. The use of intentionally tilted dental implants is indicated when appropriate conditions exist. Implant placement and loading protocols should be considered together when planning and treating patients. One-piece zirconia dental implants can be recommended when appropriate clinical conditions exist although two-piece zirconia implants should be used with caution as a result of insufficient data. Clinical performance of zirconia and metal ceramic single implant supported crowns is similar and each demonstrates significant, though different, complications. Zirconia ceramic FDPs are less reliable than metal ceramic. Implant supported monolithic zirconia prostheses may be a future option with more supporting evidence.

Assessment of health-related quality of life in Turkish patients with facial prostheses

Background

Facial prostheses are intended to provide a non-operative rehabilitation for patients with acquired facial defects. By improving aesthetics and quality of life (QOL), this treatment involves reintegration of the patient into family and social life. The aim of this study was to evaluate the perception of QOL in adult patients with facial prostheses and to compare this perception with that of a control group.

Methods

The study participants consisted of 72 patients, who were divided into three equal-sized groups according to the type of prosthesis (OP- orbital prosthesis, AP- auricular prosthesis, NP - nasal prosthesis) and 24 healthy control participants without any congenital or acquired deformity of face or body. Clinical and socio-demographic data were gathered from each person’s medical chart. Participants completed the Turkish version of the World Health Organization Quality of Life Instrument, Short Form (WHOQOL-BREF). Descriptive statistics, independent sample t-tests, Pearson's chi-square test, ANOVA, ANCOVA, and Pearson correlation were used to analyse the data.

Results

Compared with the control participants, patients with NP scored lower on the all domains of QOL and all three patient groups had lower scores on overall QOL and its domains of physical and environmental health. Patients with OP reported significantly lower physical health scores than those with AP, while patients with NP reported significantly lower overall QOL and psychological health scores than those with AP. Female patients had lower environmental domain scores than did male patients. The patient’s age and income correlated with social relationships QOL, while the patient’s income and the age of facial prosthesis were correlated with environmental QOL.

Conclusion

Patients with facial prostheses had lower scores in overall QOL, physical and environmental health domains than the control participants. Socio-demographic and clinical characteristics such as age, gender, income, localization of the defect, and age of facial prosthesis were associated with patients’ QOL. These findings may provide valuable information about the specific health needs of these patients that may affect their well-being. Further studies are needed to confirm these results. Use of the WHOQOL-BREF may provide valuable information for determining patients’ needs and priorities as well as for planning and developing comprehensive prosthetic rehabilitation programs.

Effect of colored beverages on the color stability of feldspathic porcelain subjected to various surface treatments

OBJECTIVE

To investigate the effects of porcelain treatment techniques on the color change of feldspathic porcelain before and after exposure to distilled water, coffee, red wine, and cola and examine the surface texture of the porcelain with field-emission SEM.

MATERIALS AND METHODS

Test specimens were prepared in the form of discs 15 mm in diameter by 2-mm thick and divided into four groups: Naturalglaze, dual-ion exchange, overglaze and polishing. The specimens were prepared according to their group and stored in red wine, coffee, and cola. After removal, the specimens were dipped in distilled water. Color measurements were made with a spectrophotometer, and color differences were determined using the CIE-LAB system. Statistical analysis was made with SPSS 13.5.

RESULTS

Immersion time and types of surface treatment were significant factors for color stability (P < .01).

A preoperative appliance for a newborn with cleft palate

Cleft palate is a commonly observed congenital maxillofacial defect. One of the most important problems with clefts is the interference with feeding. An affected infant cannot produce negative pressure in the oral cavity and therefore cannot move the bolus backward to the pharynx. To obtain better nutritional intake prior to surgical correction, a palatal lift obturator is recommended. In this clinical report, a modified technique of obturator fabrication is presented. The new method uses a piece of tulle, a flexible and durable material that is frequently used in theater attire. With the help of this material, the bulb part is connected to the plate as a labile piece, and this connection acts like a natural velopharyngeal extension. Additionally, because of the softer property of the silicone elastomer, the posterior pharyngeal wall is less irritated.

Facial defects restored with extraoral implant-supported prostheses

A facial defect results in cosmetic, functional, and psychologic problems and acts as a difficult and challenging procedure for the maxillofacial surgeon and the prosthodontist. Retention of a facial prosthesis is an important key in the patient's satisfaction and acceptance. The introduction of extraoral implant applications have been accepted as an advanced retention method. The purpose of this article is to report the results from our clinical experience with patients wearing facial prostheses anchored to extraoral ITI implants (Straumann, AG, Basel, Switzerland).

Facilitation of facial prosthesis placement with tattoo markers: A clinical report

Proper repeatable alignment of an adhesive-retained auricular prosthesis may be a difficult challenge. Usually anatomical undercuts, tissue remnants, and scars are used as references to secure a facial prosthesis and provide retention and stability. Repeated application may be hindered when none of these references is present. This clinical report describes a method of using tattoo marks as references to repeatably align the facial prosthesis of a patient with a skin flap reconstruction.

Improved edge strength in a facial prosthesis by incorporation of tulle: a clinical report

This clinical report describes the use of tulle for increasing the tear resistance of a facial prosthesis. By incorporating tulle, a prosthesis' margins may be more stable, more resistant to tearing, and less likely to deform while adhesive, cosmetics, and cleaning agents are applied and removed.