Цель исследования-всесторонняя оценка нашего опыта непосредственного имплантационного протезирования с использованием нового способа «Трефойл», применяющегося при атрофии альвеолярной части нижней челюсти в боковых отделах. Материал и методы. Нами проведено клиническое и параклиническое обследование 29 пациентов (20 женщин и 9 мужчин). Возраст пациентов составил от 47 до 88 лет (среднее значение-65,45±9,7). Пациенты анкетировались с использованием анкет о состоянии здоровья и о качестве жизни-GOHAI (до лечения и спустя 6 нед после). Всем пациентам проводилось введение трех имплантатов Nobel Трефойл CC с усилием не менее 35 Н/см. В качестве каркаса конструкции «Трефойл» использовали стандартную балку (NobelBiocare). Для фиксации уточненного с помощью проверочной шины положения фиксирующих винтов в каркасе имплантационного протеза проводили микроплазменную сварку аппаратом Primotec Phazer mx (Германия) или «МОЛНИЯ 4.1» круговым способом. Для того чтобы сравнить результаты опросов GOHAI до и после операции, применили критерий t-Стьюдента для зависимых выборок. Были сформулированы статистические гипотезы: H0-результаты опроса GOHAI до операции не отличаются от результатов опроса GOHAI после операции; H1-результаты опроса GOHAI до операции отличаются от результатов опроса GOHAI после операций. Результаты. Через 18 мес сохранны были 98,85% имплантатов. В послеоперационном периоде спустя 6 мес мы измеряли пространство между телом протеза и слизистой оболочкой. Пространство оказывалось незначительным-от 1,23 до 3,45 мм (1,99±0,67 мм). Результаты опроса GOHAI после операции статистически достоверно отличаются от результатов опроса пациентов до операции. Если провести анализ средних значений по выборке, то можно утверждать, что средний результат по опросу GOHAI до операции (29,86) значительно ниже среднего по опросу GOHAI после операции (54,93). Заключение. Метод имплантационного протезирования «Трефойл» имеет высокие показатели сохраняемости имплантатов и протезов и дает хорошие результаты, обеспечивая высокий уровень качества жизни пациентов. Этот способ имплантационного протезирования является перспективным стандартом в геронтостоматологии, особенно для маломобильных пациентов.
Relevance. Immediate implant placement with immediate temporisation is method of choice in case of central incisors extractions. In nowadays there are many protocols aimed on optimisation of the immediate prosthetic result. Some of them are based on using CAD/CAM technology, others stress the importance of peri-implant grafting procedures as a means of clinical success. The aim of the study is to analyse tactic of treatment in cases of immediate implant prosthetic replacement of maxilla central incisors using assessment of clinical example and elaboration of the optimal treatment option. Materials and methods. We conducted the evaluation of the 54 year old male patient with the use of clinical and paraclinical examination methods (OPG, CBCT). Implant placement in the position of the teeth 1.1, 2.1 was performed utilising new NobelParallel Conical Connection TiUltra (NobelBiocare, USA) 4.3*13 mm followed by implant supported Procera Zirconia prosthesis. We used international indices PES and it’s modification WES for the assessment of the achieved results. Results. The final result received following scores: PES index = 7, WES index = 8. Conclusion. Choice of implant design is a major influencing factor on the immediate implant placement prognosis. Utilising Nobel Active implant in the described clinical situation combining its placement with grafting of the connective tissue taken from the tuberosity area led to the decrease in total treatment time and achievement of the superior esthetic and functional result.
BACKGROUND: Ectodermal dysplasia is a rare genetic condition affecting the development and homeostasis of two or more ectodermal structures, including hairs, teeth, nails, and some glandular organs. The prevalence is 1.621.9 per 100000. The teeth are affected in 79% of cases. Patients with ectodermal dysplasia have a low level of quality of life affected by unemployment, utilization of removable dentures, and a constant dry mouth condition. The main rehabilitation method of the masticatory-phonic elements for the patient with ectodermal dysplasia is conventional removable prosthodontics. The main treatment objective for these patients is to restore the missing elements of the masticatory-phonic apparatus for normalizing mastication, speech, deglutition, and creating optimal aesthetics. This approach can lead to restoring social activity by the increase of a patients quality of life. A clinical case report of patient M., 20 years old, is presented in this article. Treatment was completed one year ago. CLINICAL CASE: The rehabilitation strategy included producing screw-retained full ceramic opposing prostheses supported by six implants in the upper and lower jaws. DISCUSSION: The choice restoration method of the masticatory-phonic elements for patients with ectodermal dysplasia is prosthodontic treatment with the fabrication of ordinary removable dentures. Early attempts of implant treatment of patients with such conditions led to a low percentage of implant survival. In most works dedicated to treating patients with ectodermal dysplasia, the fabrication of implants supported by a metal resin hybrid prosthesis with acrylic teeth sets is the final rehabilitation. We decided to produce an implant supported by a zirconia ceramic prosthesis with partial layering for patient M. It was feasible because, first of all, his growth was finished, and also this decision gives us the possibility to fabricate a high quality implant supported by a prosthesis enabling optimum function with an unlimited service period. After finishing treatment, 100% of implants and prostheses last one year. CONCLUSION: It is necessary to engage all available clinic diagnostic, planning, therapeutic, and preventive resources to achieve a high aesthetic and functional result of the dental rehabilitation of patients with ectodermal dysplasia. Implementing implant supported prosthetic rehabilitation of such patients after reaching 17 years of age has to be the treatment of choice that could help achieve stable and reliable results. It might also foster social adaptation that would enable high quality of life.
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