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Abstract
There are different treatments for patients toothless totals. An
excellent alternative to low-cost rehabilitation and are highly
predictable overdentures on dental implants, providing comfort,
stability, and improve self-esteem of our patients compared to a
conventional complete removable dentures.
Summary
There are different treatments for the total toothless patients.
An excellent rehabilitation alternative at low cost and with
high predictability is an overdenture on dental implants, what
will offer comfort, stability and will be able to increase
the self-esteem of our patients in front of a conventional total
removable prosthesis.
Introduction
Patient rehabilitation toothless constituting a major challenge
for the dental rehabilitation. With the advance of science and
technology, we see that every day new techniques are developed
that seek to restore the masticatory function, aesthetics and
comfort, as best as possible.
A large number of removable denture wearers totals show
dissatisfaction with their treatment and seek a solution to
their problems functional, psychological and aesthetic. We, as
specialists in oral rehabilitation, we must be very pressing in
the evaluation of these patients from the outset that we consult.
We must give us the necessary time to conduct a full review. How
to walk, talk, postural position, general health status,
previous dental experiences, concerns, etc.. Are not minor
details, which will provide important background to solve a
future rehabilitation treatment.
Subsequent
to this, a complete extra-and intraoral examination, supported
by complementary examinations (articulated study models,
radiographs, CT, etc..), Will allow us to obtain a correct
diagnosis and determine a treatment plan is best possible,
achieving satisfactory results for patient and professional.
Currently, one of the best solutions we can give our total
patient toothless, is the prosthetic rehabilitation on
osseointegrated implants. (3) Within these prostheses,
overdentures supported by implants through a bar ignition system
(Hader) are a good alternative.
Overdenture
A removable prosthesis is a partial or total coating
characterized by fibromucosa and roots, teeth or implants
prepared for this purpose. (1)
The main indications for overdentures are:
Economics: It is generally recommended two implants in lower jaw
and four in the top. By using fewer implants prices are
diminished and are more accessible to patients.
Anatomical: If we need to provide support for facial, where
there is a marked atrophy of the alveolar.
Aesthetics: In comparison to the Ad-prosthesis
Modum System Novum or fixed prostheses, overdentures have
improved aesthetics, because they have no sides and allow the
exposure of any margin money.
Phonetics: the absence of pocket, can not escape the
characteristic whistling in other prosthetic implant.
Hygienic: For those cases that require easier access to oral
hygiene, such as in elderly patients with mobility problems.
Malformations: A misaligned skeletal sometimes makes it
difficult to make a fixed restoration.
No integration of some implants: In the case of some non-bony
implants, it does not allow the realization of a fixed
prosthesis, it is advisable to make an Overdenture.
Contraindications for an Overdenture are:
Patients' psicolábiles that have applied for fixed and
not to accept a removable prosthesis.
Patients with a mandibular alveolar atrophy so advanced
that the tooth nerve is very close to the alveolar crest.
Patients who do not tolerate food impaction under the
denture.
Within systems Anchorages for restraint or overdentures
are the following:
Bars
Spheres or balls
Magnets and Magnetic Systems
1. Rods: The rods are those that offer greater
predictability to our treatment should be first choice
for overdentures. In conducting bars must abide by
certain rules, such as:
a) parallel to the intercondylar axis, this will ensure
the application of vertical forces to the implant and
reduce the occurrence of lateral forces by decomposing
them into the movement of the prosthesis. (4) (Fig. 1)
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Fig 1. The bar
should be parallel to the intercondylar axis |
Therefore we must do our articulator
mounting with exact location of the hinge axis. A second
way to ensure its guidance is that the bar is
perpendicular to the bisector of the angle formed by
lines passing through the upper edges of the bone,
arising from the papilla retromolares.
(Fig. 2)
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Fig 2. Angle
bisector
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b) bar and line extensions: Being straight
avoiding the presence of rotational moments on implants. Has
been studied using the "finite element" that can be as
harmful, in terms of overloading of the implant, the lateral
extensions of the superstructure, leading in general to a
marginal bone resorption. (Figs. 3 and 4)
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Fig 3. Hader Bar
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Fig 4. Hader bar
and welded to cast pillars U.C.L.A.
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This bar (Dolder or Ackerman) can be round or
ovoid, welded to the cylinders of gold, only to be bolted to
the pillars.
(Fig. 5)
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5: Dolder bar |
c) participating in the bar and not in the
retention bracket. We must achieve a suitable technique for
printing functional, as if it were a conventional full
dentures, where support is given by the mucous membranes in
office. It is advisable also to leave a space between the
bar and the soft tissue to the patient to access their
health. (Fig. 6)
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Fig 6.
Biomechanical principles of the bar. |
The parallelism should be respected for that
rotate on the bar overdentures (hinge effect) when the jaws
come into occlusion. In this way we will have only vertical
forces on the implant and avoid lateral forces.
d) Length of the bar between 18 and 23 mm. ie, a separation
of the implants between 22 and 27 mm., which corresponds
approximately in the area of the canines. Require a greater
distance to a curved bar. By reducing the distance, however,
the implants were biomechanically behave as one, which
determines a marginal reduction in the appearance of lateral
forces.
e) The "clip" of retention, may be metal or plastic. The
metal clip you can go off in time, which sometimes can be
corrected, making a new prosthesis. Furthermore, the plastic
clip, it is easier to change, with the advantage of being
cheaper (2).
2. Balls: Attachments ball type ( "O-ring") offer a quick
and practical solution to our rehabilitation. Most of the
commercial houses that offer different types need only be "bolted"
on the implant. Unfortunately, the simplicity of this
solution results in the long run into trouble in the implant.
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Fig 7. Pillars O
`rings. |
This type of attachment tends to have,
despite the spacers, lateral and torsional forces on the
implant. This will result in a marginal bone resorption with
consequent loss of the implant, even if it is a bone of poor
quality, very frequent in the maxilla. This should make us
meditate before using this type of retention, reserved only
for cases where only one exists, or where the patient's oral
anatomy or the location of the implants to prevent us from
using a bar. (2)
3. Magnets: The magnets are acceptable biomechanical
behavior (Fig. 8), which do not transmit large lateral
forces, giving good retention. The problem with this type of
attachment is that the years have lost more than 50%
retention, because the magnets suffer corrosion when exposed
to a wet, especially the oral, almost a "zero restraint" to
few years of use. This is the main cause of failure of the
restraint magnetic. (2)
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Fig 8.
Open-field magnet. Pole adjacent to the
sensor does not generate a magnetic field
which spreads in all directions. |
As solution is useful, but should be
monitored and changed periodically. On this alternative,
still in the air the following questions: Can the magnet
with its magnetic fields affect osseointegration?
Will it affect our corrosion implant?
Nothing yet has been published.
With respect to the occlusion to be presenting this type
of rehabilitation, there is total agreement among the
authors: "occlusion bilateral balanced with freedom in
centric". In this way we ensure a stable, which favors
the use of biomechanically prosthetic device. These
patients should be subjected, after the treatment, a
thorough periodic inspection, to be evaluating each of
the prosthetic components. They should be instructed in
the techniques of oral hygiene. This is very important
to prevent inflammation of the gingiva or peri-emergence
of the hyperplastic gingiva. It is undoubtedly the use
of overdentures in implant prosthetic excellent long-term
solution, to our patients. (5)
Case Report
Male 68 years old.
Carrier removable upper and lower dentures
Edente upper part
Edente remaining lower part # 33
Expresses disagreement in his lower dentures
Treatment: Placement of 2 implants in the area of parts
# 33 and 43
(3.75 x 4 x 13mm and 13mm, respectively) for the
establishment of a system using bar overdentures Hader.
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9. Panoramic
radiograph and the placement of stickers for
the study of pre-surgical implants.
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Fig 10. Removal
of item # 33. Supracrestal linear incision
with medial and horizontal liberatrices
towards distal. Mucoperiosteal flap lifting.
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Fig 11.
Placement of the implant mechanically with
strawberry Stargrip (micro) zone Part # 43.
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Fig 12.
Panoramic x-ray control |
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Fig 13. Suture
for two-stage procedure
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Fig 14. Three
months after placement of implants
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Fig 15.
Attaching healing pillars which remain for
two weeks. |
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Fig 16. Placing
square cap transfers, which were acrylic
ferulizadas with low polymerization
shrinkage. |
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Fig 17. Initial
printing for the manufacture of the bar
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Fig 18. Impeller
nut height. Registration takes place and
takes up the vertical dimension of the
patient
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Fig 19. Hader
bar kit which contains two bars Hader
calcined (green), two (yellow), horses
(golden color) and standard clips (yellow).
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Fig 20. Location
of the two pillars U.C.L.A. burnt plastic on
the plaster model and the bar to be cast
with two clips mounted on two horses.
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Fig 21. Evidence
of the bar and making a second printing
directly from the bar, which placed two
screws interns. After this is done the joint
prosthesis and dental acrylic final.
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Fig 22. The bar
is screwed and torquea to 32 Ncm each pillar
UCLA Gutta-percha is placed in the inlets to
the screws.
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Fig 23.
Overdentures and partial dentures superior
inferior. |
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Fig 24. Noble
part of the prosthesis than with horses and
plastic clips which grasp the bar that is
screwed in the mouth. |
Conclusions:
Systems with overdentures Osseointegrated implants
have their indications and contraindications.
Present different types of anchors, of which the
highlight bar systems, their advantages and
disadvantages.
Another important point is to educate our patients
with hygiene standards to be met in the care of the
bar and make them aware of the periodic inspections
to be undertaken to achieve maintain health in the
tissues Periimplant.
Following strict protocols for the preparation of
the overdentures, and without neglecting their
maintenance, get the best results you want.
Acknowledgments:
Dr. Jose Valdivia, Juan Carlos López and Dr. Juan
Pablo Parrochia, who introduced me into the world of
Rehabilitation on Dental Implants.
Dr. Hector Norero, Dr. Jaime Acuña et al. And taught
me the surgical techniques in Oral Implantology.
My wife for their help and constructive criticism in
reviewing this work.
Bibliography
1. J. Cicero; Daudt W. Overdenture (overdentures).
Osseointegrated Implant Surgery and Prosthetics. 11:
179 - 202. 2003
2. Riveros N. E. Ramirez Indication and Planning
overdentures on osseointegrated implants. Dental
Information Portal on the Internet. http://www.dentalcolombia.com/docs/implantes/protesis/integra2.htm
3. F. Todesco, A. Bechelli, H. Romanelli: Total
toothless upper and lower. Contemporary Implant
Surgery and Prosthodontics. 17: 393-413. 2005.
4. Barrientos M. Removable prostheses and implants
in the elderly. Journal of Dental Technology. 71-79.
2002.
5. Pozo C. Osseointegrated implants in overdentures.
Journal of Dental Technology: 91-94. 2002.
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