edentulous maxilla meaning

Fig 6-1e Cross section through the jaw in region 13. a structure of bowlike or curved outline. First, the template is used to drill holes for the canines and the first or second premolars. This female patient with an edentulous maxilla had a complete removable denture that was causing her a lot of trouble. Fig 6-5f Superstructure with distal cantilever, incorporated after 1 year. Even if full rehabilitation of the masticatory organ cannot be achieved, this form of restoration has also proved itself scientifically reliable. The overall contours of the residual ridge (Fig 6-12n), but particularly the zones of vertical augmentation in the left premolar region (Fig 6-12q), appeared to have improved markedly relative to baseline (see Fig 6-12f). The canines were left in situ until the new prosthetic restoration was fabricated, so that they could continue to secure the overdenture (Fig 6-6f). Fig 6-12a Cantilever fixed bridge in the mandible after 5 years of functional use. After this, beds were drilled for implants 13 and 24 using sleeves that had been adjusted relative to one another, and these implants were placed. The insertion mounts were then replaced with stabilization abutments and two further implants inserted into regions 14 and 23 (Fig 6-9h). If the incisal edges and occlusal surfaces of the teeth are reasonably intact, the template can be supported on the dentition of the opposing jaw, like a prosthesis (Fig 6-2b). Without augmentation of the posterior maxilla (sinus floor elevation), implant placement is usually possible only in the anterior maxilla, where the bone supply tends to be sufficient. Here, three implants were inserted on the right side and five on the left, all with primary stability, and fitted with healing abutments directly afterwards (Fig 6-10b). The impression for the prosthetic restoration was taken once the correct positioning of the impression copings was checked on the radiograph (Fig 6-11u). Dentulous; Edentulous; Distance; Edentulous; Maxillary sinus; Orthopantomogram. The patient is happy not only about her securely fitting prosthesis and the absence of a plate covering her palate, but also that the cost involved was reasonable (Fig 6-3l). To ensure that the template remains uncluttered, the author prefers to place the drill holes in positions 1, 3, 5, 6 and 7 (Fig 6-1c). Fig 6-3f Milled non-noble alloy bar connector. The palateless prosthesis was stabilized on the bar connector that had been milled at the same time, and additionally “locked on” with two MK1 attachments (Figs 6-3g and 6-3h). The foil was filled with a material for provisional restoration (eg, Protemp; 3M ESPE) and held in place by biting down until the material hardens. Fig 6-12i The residual ridge lies slightly below the level of the palate. Five weeks after exposure, a fabricated continuous bar connector was screwed on to the six implants (Fig 6-6g). Before the operation, the existing crowns had to be removed from the posterior teeth and the latter prepared accordingly. Moreover, the implants had to be placed further palatally than originally planned (Fig 6-7e). In contrast, the overdenture in the mandible had been stabilized with the aid of two implants and a bar. The thermoplastic foil, which had been prepared in advance, was tried in. Fig 6-6h Retaining elements in the prosthesis. Fig 6-11r Stable gingival situation after 3 weeks. https://medical-dictionary.thefreedictionary.com/edentulous+dental+arch. However, if the old restoration does not meet the expectations of either the patient or the dentist, the teeth will need to be set up again according to the principles of full mouth rehabilitation and also duplicated, to allow the optimal implant positions to be determined. Moreover, a stable bone situation is apparent from the follow-up panoramic radiograph taken after 5 years (Fig 6-6k). Following extensive block and infiltration anesthesia (it is extremely difficult to top up the anesthesia with the template in situ), the template was placed into the mouth with the occlusion rim. A panoramic radiograph was taken as a check after augmentation (Fig 6-12o). A CT or CBCT scan is then performed on the patient while he or she bites down. For the treatment course, see pages 473–479. However, the actual positioning of an implant usually takes place in the cross-sectional image. The provisional could not be extended with cantilevers at the distal ends to avoid the risk of excess loading of the implants. One or two additional perforations can be made in the plastic along the palatine suture, assuring stable placement of the template on screws driven into the palate (Fig 6-2a). Absence of teeth from a portion of the mandible and/or maxilla. U.S. National Library of Medicine (0.00 / 0 votes)Rate this definition: Jaw, Edentulous, Partially. Fig 6-12g Vertical augmentation is required. The completed dental prosthesis was finished and polished by the laboratory technician (Fig 6-9k) and attached to the implants in the mouth with screws. Conclusions: On the same day of surgery, it is possible to successfully rehabilitate the edentulous maxilla with a fixed, permanent prosthesis supported by an intraoral welded titanium framework. Fig 6-11m Attached gingiva gained from the palate at the time of implant exposure. Närhi TO(1), Geertman ME, Hevinga M, Abdo H, Kalk W. Author information: (1)Department of Prosthodontics, Institute of Dentistry, University of Turku, Turku, Finland. When performing an implant exposure operation in the anterior region of the edentulous maxilla, the surgeon can use a technique that allows the keratinized gingiva to be transplanted in the labial/buccal direction. Key words dental implants, edentulous mandible, edentulous maxilla, overdentures, systematic review Background and aim: There is now overwhelming evidence from systematic reviews that a two-implant overdenture is the first choice of treatment for the edentulous mandible. In an implant-supported restoration of the edentulous maxilla, the esthetic aspects involved in treating the anterior teeth combine with the functional aspects of restoring the posterior teeth. Fig 6-1j Planned positions for 10 implants. Fig 6-12n Residual ridge 1 year after augmentation. Fig 6-9l Treatment completion; the screw access holes have been sealed off. These screws act as guidance pins, clearly defining the position of the template relative to the maxilla when it is inserted. The flap is secured with sutures in the interdental spaces and distally of the implants (Fig 6-4c). Fig 6-6e The retained tooth following extraction. Both extraction and implant placement took place under general anesthesia. A postoperative panoramic radiograph was taken after implant placement (Fig 6-12t). Thanks to the accurate 3D diagnosis, it proved possible to place the 10 implants in the bone with good stability in the preoperatively planned positions (Fig 6-1k). Consequently, the implant threads were exposed on both the labial/buccal and palatal sides. Introduction. Fig 6-9i Inserted implants following removal of the template. However, shifting the implant slightly in the buccal direction allows it to be anchored more evenly in the bone that has been augmented following sinus elevation (Fig 6-1h). 1. the first branchial arch, being the rudiment of the maxillary and mandibular regions; it also gives rise to the malleus and incus. This female patient had an edentulous maxilla and wished to be fitted with a fixed restoration right from the start. Fig 6-12s Implants placed on the palatal and buccal sides of the crest. For early restoration or loading in the partially dentate maxilla, the ITI Consensus recommended a fixed prosthesis: “Implant number and distribution are dependent on patient circumstances, including bone quality and quantity, number of missing teeth, condition of When closed, the attachments were flush with the palate plate, so that they were virtually undetectable by the tongue (Fig 6-3i). Fig 6-11h Augmentation material stabilized with the membrane. After 5 years in situ, the front view of the denture is satisfactory, apart from the visible metal parts (Fig 6-5g). However, both maxillary sinuses showed pronounced pneumatization, so the bone supply in the anterior maxilla was very limited (Fig 6-7b). Severe residual ridge atrophy: sinus floor elevation and vertical augmentation prior to implant placement. The abutments prepared in advance in the laboratory were screwed on in pairs and incorporated into the dental prosthesis with Pattern Resin (GC America) (Fig 6-9j). The panoramic and axial sections provide the best spatial orientation. The implants were ready for exposure after 6 months (Fig 6-3d). The future is bright for management of the edentulous maxilla. A hybrid prosthesis or a cantilever fixed implant bridge with a shortened dental arch (up to the first molar) can be incorporated. In addition to the template, the titanium pins used to attach the membrane (in this case, regions 13 and 16, buccal side in the axial section) during sinus elevation also provide good spatial reference points (Fig 6-1j). Sinus floor elevation, implant placement and lateral augmentation. The preserved facets also provide better spatial reference points for the surgeon. Following the CT and panoramic radiograph analysis, the implant positions were established according to prosthetic aspects and taken into account in a custom-made template (Fig 6-5a). Alveolar insufficiency may also refer to the bone quality. This female patient with an edentulous maxilla was having problems with her complete denture, particularly with the fact that it covered the palate (Fig 6-3a). Changes in the edentulous maxilla in persons wearing implant-retained mandibular overdentures. Gingival deficit between the anterior implants. On the left side, the implants were already faintly visible through the unattached mucosa (Fig 6-11o). In anatomy, any vaulted or archlike structure. Fig 6-11n Fixing the gingiva into place with sutures. However, the continuing progression of the atrophy of the mandibular residual ridge had since caused the implants to become exposed, and the mobile mucosa around the implants may require surgical intervention. Therefore, the accumulated mean marginal bone loss was 0.57 mm (SD = 0.21 m; N = 153). The patient is very satisfied with the fixed restoration of both mandible and maxilla (Fig 6-7k). Fig 6-6b Panoramic radiograph with template. Fig 6-6k Stable bone situation at the same point in time. the edentulous or partially dentate maxilla. Edentulous maxillary fixed rehabilitation using dental implants is challenging and requires meticulous planning because of anatomic variations and the importance of facial and dental esthetics. 1.Extraction of the impacted tooth and implant placement, 2.Exposure, extraction and definitive prosthetic loading. The sutures were removed around 2 and 3 weeks after sinus elevation (Fig 6-12k). In an implant-supported restoration of the edentulous maxilla, the esthetic aspects involved in treating the anterior teeth combine with the functional aspects of restoring the posterior teeth. The mean IC diameter in (c) showed results of 2.84 mm for dentulous maxilla and 3.56 mm for edentulous maxilla; in (d), it was 4.28 mm for dentulous maxilla and 5.40 mm for edentulous maxilla. Atypical treatment course – problematic baseline situation, Removable restoration – incidental finding by CT imaging. Fig 6-12b Severely atrophied maxilla with anterior flabby ridge. With the patient still biting down lightly, three holes were drilled through the horizontal sleeves and the template secured to the jaw with three pins. It was only possible to insert four implants here, placing them not in line but alternately on the palatal and buccal side of the crest, to leave sufficient space between them (Fig 6-12s). Comparison of different intraoral scanning techniques on the completely edentulous maxilla: An in vitro 3-dimensional comparative analysis Author links open overlay panel Fernando Zarone MD, DDS a Gennaro Ruggiero DDS b Marco Ferrari MD, DMD, PhD c Francesco Mangano DDS, PhD d Tim Joda DMD, MSc, PhD e Roberto Sorrentino DDS, MSc, PhD f The definitive fixed restoration was fabricated after the patient had worn the fixed provisional for 1 year (Fig 6-5e). If the bone situation is good, it is sometimes possible to insert implants following extraction and load them immediately with a provisional restoration. Sutures were used to bring the soft tissue of the palate much closer to the tissue surrounding the implants (Fig 6-11n). Fig 6-12k Clinical situation at the time of suture removal. However, the diagnostic investigations for the patient’s restoration revealed an incidental finding. Provided the tooth set-up is correct, this prosthesis can be used as a basis for fabricating the implant template. This was followed by saliva-proof closure of the operation site. The two halves of the membrane were attached at both the apical and coronal ends with titanium pins (Fig 6-3c). The provisional is then taken out of the foil, shaped and reincorporated (Fig 6-10e). Only then were the beds for the remaining implants drilled (Fig 6-7d). Toljanic JA, Ekstrand K, Baer RA, Thor A. The postoperative panoramic radiograph shows the positions of the implants and the extent of sinus elevation (Fig 6-11i). Fig 6-7j Gold crown 24 fitted at the patient’s request. On close inspection, however, we found that the solid substructure was covered only with unattached mucosa on the labial side (Fig 6-11l). The incision was made on the palatal side, to allow keratinized gingiva to be transposed toward the labial/buccal vestibule. The drilled holes provide good reference points in both CT and CBCT imaging without producing artifacts. It needed to lie over the implant abutments and the patient’s own teeth without tension and be supported by the opposing dentition when the patient was biting down (Fig 6-10d). Materials and Methods: All patients included in this study presented with completely or partially edentulous maxillae with any … The follow-up radiograph after 4 years of functional use shows a stable bone situation around the implants (Fig 6-3k). The condition of the prosthesis is also satisfactory (Fig 6-6j). Fig 6-7d Stabilization of the template with the direction indicators. If the position of the template has been defined with the mouth closed, its position should remain stable when the mouth is opened. This staggered placement also ensured better distribution of the masticatory forces over the prosthetic superstructure. At the time of incorporation of the prosthesis 2 months later, nothing identifiable remained of the soft tissue deficit created after the exposure (Fig 6-3f). Fig 6-1a Radiographic template – prosthesis duplicated in clear plastic. Fig 6-3d Postoperative panoramic radiograph. Yet the edentulous maxilla has the lowest implant survival for either fixed or removable implant restorations compared with mandibular prostheses with this treatment approach." Fig 6-2b The template is stabilized by the mandibular dentition. Materials and methods: A total of 552 Brånemark System implants were placed in immediate extraction or healed sites; a mean number of 10 implants were placed per patient. After only one operation, the patient was able to leave the clinic immediately with a fixed restoration. Fig 6-11c Implantation performed concomitantly with sinus elevation. She was fully fit, with no pain or swelling (Fig 6-9m). Implant placement was planned using SimPlant, based on the up-do-date CBCT scan (Fig 6-12p). In accordance with the SimPlant planning, five implants were inserted into the augmented bone on the left side (Fig 6-12r). Edentulism is a disabling condition affecting tens of millions of individuals in the United States and many more worldwide. The bar connector and the mucosal situation remain stable 5 years after the implants were loaded with the prosthesis (Fig 6-6i). Fig 6-12e Pronounced malocclusion in the right anterior maxilla. Fig 6-7h Angled abutments to correct the inclination of the implants. In fact, the time of implant exposure offers the best opportunity of correcting this, by transplanting keratinized gingiva from the palate to the vestibule in the form of a pedunculated graft (Fig 6-11m). Over the subsequent weeks, it could be replaced with a long-term provisional. A bony residual ridge is now present only in the molar region, whereas only a mobile flabby ridge remains in the anterior and premolar region (Fig 6-12b). Any structure resembling a bent bow or an arc. The two distal implants in regions 14 and 24 were inserted with a slight tilt in the mesial direction, to prevent contact with the maxillary sinus. The maxillary sinus was prepared first, after which the implant beds were drilled and the three mesial implants fully inserted. Six implants were inserted into the anterior maxilla (Fig 6-3b). Fig 6-12u Residual ridge before exposure. Fig 6-1i Unsuitable implant bed in region 21. Conversely, no significant inter-operator differences were observed in errors in the intraoral scanning of either the left … In region 13, for example, a slight inclination palatally is sufficient to ensure that the implant is anchored in the bone (Fig 6-1f). The zone of attached gingiva around the implants had a positive effect on their long-term prognosis. The final photo shows the dental prosthesis after 4 years of functional use (Fig 6-9n). The gain in bone mass is clearly apparent in the 3D reconstructions (compare Figs 6-12l and 6-12m). This meant that it had to be removed. Fig 6-12v Palatal incision made for implant exposure. Following periosteal slitting and marked mobilization of the mucoperiosteal flap, the operation site was closed with Gore-Tex 4-0 and Mopylen 6-0 sutures (W. L. Gore and Associates and Resorba, respectively). Fig 6-2c Stabilization screws driven into the palate. This is a time-consuming but also very effective method, and should form part of standard diagnosis. Fig 6-12f Pronounced malocclusion in the left anterior maxilla. The augmentation of the cavity in the maxillary sinus and the vertical augmentation were performed with Bio-Oss and a Bio-Gide membrane. Bio-Gide (Geistlich) membranes were used to cover the augmentation. An average of four to six implants also is used to support bar overdentures. The cantilever implant bridge replacing teeth 16 to 26 was screwed onto the implants with occlusal screws (Fig 6-7i). If an incision on the palatal side of the residual ridge is planned, the surgical template can be supported not only on the tuberosities, but also on the palate (Fig 6-2a). Within the next 2 weeks, the deficient regions distal from the implants normally fill completely with granulation tissue (Fig 6-4d), Cantilever implant bridge on nine implants. Since the dimensions of the bone in the posterior maxilla were still sufficient to anchor implants with primary stability, implant placement was performed in the same session as sinus elevation (Fig 6-11c). Fig 6-9d Implants placed into the definitive cast. Fig 6-2d Additional stabilization with the direction indicators. Keywords. She wanted to have a securely fixed and palateless prosthesis. A removable prosthesis with an open palate with direct attachments to the implants or with a connecting bar requires the support of four dental implants. The uniform distribution of thicker bone around the implant ensures a better supply of nutrients to the tissue. This female patient, who had had an edentulous maxilla for many years, was having a lot of trouble with her uncomfortable complete denture. The panoramic radiograph shows a currently stable bone situation, along with the extent of the cantilevers (Fig 6-5h). Its further purpose is to suggest a reliable and evidence-based protocol for immediate implant loading of full-arch prostheses in the maxilla. With the template stable, the remaining bone beds are prepared and checked with more direction indicators (Fig 6-2e). Following the extraction, the implants were successfully inserted into region 21 and five further positions, as planned. timo.narhi@utu.fi Definition of jaw, edentulous in the Definitions.net dictionary. Fig 6-7l Stable bone situation at the same point in time. The bone was also augmented over the screw threads exposed on the palatal side (Fig 6-11g). This was followed by augmentation with the harvested bone chips and Bio-Oss (Geistlich). Planning and carrying out implant treatment in the edentulous maxilla is a more difficult and more extensive process than that involved in any other indication. In most patients with a Class I maxilla, who have lost their teeth with minimal bone loss, the labial bone has an irregular contour. In this region, vertical augmentation was to be performed as well as sinus floor elevation (Fig 6-12g). Fig 6-3e Exposure. Three weeks after exposure, the soft tissue situation on both sides was stable (Figs 6-11r and 6-11s). The lateral incisors and the first premolars can then be positioned between the existing holes as required. Since the template did not stay in place securely due to the high proportion of unattached mucosa, it was stabilized further with direction indicators once the first two beds were drilled. During implant placement, the palatal mucosa was dissected away, the tooth divided and removed. After bone augmentation in the posterior maxilla, where the masticatory forces are at their most powerful, implants can be placed there in accordance with static principles. The three-dimensional (3D) visualization in the CT scan allowed the position of this tooth to be accurately determined. The augmentation material was covered with a membrane 30 × 40 mm in size, divided into two halves. • Ideal or minimally compromised • Edentulous areas are confined to a single arch • It does not compromise the physiologic support of the abutment • Includes any anterior maxillary span that does not exceed two incisors, any anterior mandibular span that does not exceed four missing incisors and any posterior span that does not exceed two premolars or one premolar and a molar The technique known as sinus floor elevation, or simply sinus floor elevation, has become an established way of creating a firm “foundation” in this region (see page 383). This increases the length of the flap in both directions and covers the distal implants on the buccal side (Fig 6-4b). The custom-made surgical template with the desired implant positions was fabricated in the laboratory and placed into the operation site following flap reflection (Fig 6-7c). The residual ridge had atrophied greatly during the 15 years’ use of the complete denture and was narrower than the diameter of the implants. As with the single-tooth template, the drill holes can be opened out on the labial/buccal side while preserving the tooth facets as much as possible (Fig 6-2b). Sinus floor elevation and implant placement in a single session. Fig 6-1h Implant 26 has been shifted slightly in the buccal direction. Because of a lack of experimental reports regarding edentulous maxilla, we decided to evaluate the survival rate of immediately loaded dental implants in this area. MATERIAL AND METHODS CT- or DVT-scans of 43 patients (mean age 62 ± 8 years) with an edentulous maxilla were analyzed with the NobelGuide software. Following healing and exposure, the implants were fitted with EsthetiCone and angled abutments (Fig 6-7g). The deliberate inclination of implants 13 and 25 to avoid the maxillary sinus was compensated for by using abutments angled at 17 degrees (Fig 6-7h). PURPOSE: Successful immediate loading of implants in the edentulous maxilla has been previously reported. The first step was to perform sinus elevation on both sides of the maxilla. At the same time, however, the masticatory apparatus loses most of its sensitivity (as there is no periodontal feedback), so that mechanical complications, such as fractures or the prosthesis teeth snapping off, are not uncommon (Figs 6-8a and 6-8b). Fig 6-4d The distal gingival deficits have filled with granulation tissue. Fig 6-11o The implants shimmering through the mucosa. Titanium pins as spatial reference points. All five treatment modalities discussed-onlay bone grafting, GBR, Le Fort I interpositional grafting, maxillary sinus augmentation, and/or nasal floor inlay grafting or the combination approach-can be successfully used to augment edentulous maxillary ridge with high implant SRs. Fig 6-6d Side view of the tooth in cross section. Above all, this means resolving the question of how the masticatory forces in the molar region (the center of occlusal force) are to be absorbed. Fig 6-12r Implants in the left maxilla following insertion. After this, the template can be stabilized further with the direction indicators, which prevent it from rotating (Fig 6-2d). the edentulous maxilla is particularly challenging with regard to augmentation because of anatomic limita-tions, such as the nasal floor, maxillary sinus, resorption pattern, and interarch relationship.4,5 Implant survival rates (SRs) are generally lower in the maxilla than in the mandible, especially in the posterior maxilla where Fig 6-10d Try-in of the thermoplastic foil. Filling of the bone defect was followed by tight suturing of the wound (Fig 6-10c). Fig 6-11g Palatal augmentation was also necessary. Bone augmentation was performed with a mixture of Bio-Oss and bone chips, not only on the labial/buccal but also the palatal side (Fig 6-7f). The stabilization screws are driven into the palate through the perforations. Comprehensive evaluation of the edentulous maxilla is further complicated by the fact that both bone and soft tissue loss can begin before tooth removal as a result of generalized periodontitis—which often causes the appearance of “long teeth.” Edentulous patients may present with intact alveolar bone volume, missing only the clinical crowns. Patients with fixed implant-supported prostheses in both mandible and maxilla often generate enormous masticatory forces, as the restorations are very stable and can take high loads. Because the mean enlargement of the support polygon with tilted implants compared to straight implants is unknown, the aim of this study was to evaluate the increase of the surface area of this polygon, which results from the use of tilted distal implants in comparison to straight implants with different lengths in the edentulous maxilla. The resultant data are fed into a planning program, eg, SimPlant (Dentsply) in Digital Imaging and Communications in Medicine (DICOM) format. To begin with, it is advantageous to plan more implants than will actually be needed. With the aid of the template, implant analogs were inserted into the definitive cast at the exact positions where implants were to be placed in the maxilla later on (Fig 6-9d). Fig 6-12j The residual ridge has been augmented by approx 4 mm in the vertical direction. Because of the extreme atrophy (Fig 6-12l), a 1-year healing period was scheduled after sinus elevation and ridge augmentation, before implant placement could take place (Fig 6-12m). The distal locking attachments hold the palateless denture securely in place (Fig 6-6h). In the SimPlant program, the maxilla can be visualized in three planes: axial, panoramic or cross-sectional, and also as a 3D reconstruction (Fig 6-1d). 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