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This retrospective study assessed implant and prosthodontic treatment outcomes of patients suffering from rheumatic disorders such as rheumatoid arthritis (RA) and connective tissue diseases (CTDs).This study included 22 patients (all women) suffering from autoimmune rheumatic disorders such as isolated RA (n = 16), RA with concomitant CTDs (n = 5), or isolated CTDs (n = 1). Overall, 89 implants were placed for rehabilitations such as single-tooth replacement (n = 8), fixed partial dentures (n = 14), complete dentures (n = 5), and overdentures (n = 2), and were evaluated after a mean of 42.6 +/- 25.2 months. The cumulative implant survival and success rates and peri-implant conditions (marginal bone loss, pocket depth, Plaque Index, Gingival Index, Bleeding Index, and Calculus Index) were evaluated with a special focus on RA and CTDs. In addition, incidence and type of prosthodontic maintenance were evaluated.A high implant survival rate was noted during follow-up with a cumulative 3-year implant success rate of 96.1%. Patients with RA demonstrated acceptable marginal bone resorption (mean: 2.1 +/- 0.5 mm) and good soft tissue conditions, while CTD patients showed increased bone resorption (mean: 3.1 +/- 0.7 mm). This was especially noted in scleroderma patients, as were major peri-implant soft tissue alterations (Bleeding Index) in patients suffering from Sjogren syndrome.A high implant and prothodontic success rate can be anticipated even for patients suffering from autoimmune rheumatic disorders such as RA and CTDs. A scrupulous maintenance program that includes optimal oral hygiene could assist in ensuring stable long-term results for CTD patients with more vulnerable soft tissue conditions. Int J Prosthodont 2010;23:22-28.

Removable maxillary prostheses (n = 31) rigidly retained on either a one-piece anteriorly located milled bar fixed on four implants located in the anterior maxillary region (group 1, n = 15) or on two bilaterally placed milled bars fixed on six to eight implants located in the posterior maxillary region (group 2, n = 16) were evaluated for prosthodontic maintenance and the calculated bar-generated supporting area. Comparisons of the incidence of prosthodontic maintenance and the supporting area generated by the bars did not differ between groups. Evident advantages were noted for the anterior concept (group 1) with regards to surgical, technical, and prosthodontic aspects, suggesting a preference for this approach versus the more intricate and complex posterior concept (group 2) under particular circumstances and on appropriate indication.

The aim of the present study was to evaluate the prosthodontic maintenance required for mandibular overdentures supported by 4 implants and splinted with either a round bar and resilient overdenture anchorage or a milled bar with rigid anchorage over a 5-year period.In a randomized prospective trial, 51 edentulous patients received 4 mandibular interforaminal implants to support an overdenture and maxillary complete dentures. For the implant-supported overdentures (IODs), bar architecture and denture stabilization were chosen randomly; 25 patients received round bars (group 1) and resilient anchorage and 26 patients received milled bars (group 2) and rigid anchorage. The prosthodontic maintenance required for the IODs and opposing dentures were evaluated during a 5-year follow-up period and compared between the 2 retention modalities used for IODs.Forty-six patients (22 in group 1, 24 in group 2) were available for a 5-year follow-up (dropout rate: 9.8%). Prosthodontic maintenance efforts were significantly greater (P.01) with the round bar design (group 1) than with the overdentures stabilized with milled bars (group 2). In group 1, prosthodontic maintenance efforts were more frequent in the early phase of use (1 to 2 years), as compared with an evenly distributed incidence over the 5-year period with the rigid milled bar system. Major prosthetic complications (IOD remaking, bar fracture) were only seen in cases without metal-reinforced frameworks (group 1).When 4 interforaminal implants are used to anchor mandibular overdentures, the design of the anchorage system will significantly affect prosthodontic maintenance efforts and complication rates. Rigid anchorage using milled bars and a metal-reinforced denture framework required less prosthodontic maintenance, ie, for clip activation/fracture, than resilient denture stabilization using multiple round bars without a rigid denture framework.

The aim of this retrospective study was to present the results of implants and natural teeth used as combined abutments to support maxillary telescopic prostheses.Between 1997 and 2004, 22 patients with residual maxillary teeth underwent prosthodontic rehabilitation with supplementary implant placement of implant-tooth-supported telescopic prostheses. A total of 60 supplementary implants (mean: 2.9 implants; SD: 1.6; range: 1 to 5 per patient) were placed in strategic position and connected with 48 natural abutment teeth (mean: 2.2 teeth; SD: 0.9; range: 1 to 4 per patient) using telescopic crowns. The follow-up registration included implant and natural tooth survival rates and peri-implant and periodontal parameters, along with prosthodontic maintenance. Natural tooth abutments were additionally followed to compare their periodontal parameters at baseline to the follow-up examination.After a mean of 38 months (12 to 108 months) no implants or natural tooth abutments were lost (survival rate: 100%). There was no fracture, endodontic treatment, loss, or intrusion of natural teeth used for telescopic abutments. Implant abutments showed high stability and excellent periimplant soft tissue conditions. Natural tooth abutments used for double crowns also showed uneventful progress. A low rate of prosthodontic maintenance was seen, with implant screw abutment loosening as the most severe complication (3 of 60 implants; 5%).On the basis of this retrospective clinical review, the following conclusions were drawn: (1) successful function over a prolonged period and a minor complication rate of implant-tooth-supported telescopic maxillary dentures may be anticipated, and (2) the great variety of treatment modalities offered by tooth-implant support for telescopic prostheses appears to be useful as a treatment option for the maxilla in elderly patients.

The aim of the present study was to evaluate implant survival, peri-implant conditions, and prosthodontic maintenance requirements for implant-supported mandibular overdentures in atrophic mandibles retained with ball or resilient telescopic crown attachments during a 3-year period.Twenty-five patients with edentulous mandibles each received 2 Camlog root-form dental implants in the mandibular interforaminal (canine) region. The denture attachment system was chosen randomly; 13 patients received ball attachments and 12 patients received resilient telescopic crowns. Implant survival, implant mobility (Periotest values), and peri-implant conditions such as bone resorption, pocket depth, Plaque Index, Gingiva Index, Bleeding Index, and Calculus Index values were assessed for each implant. In addition, detailed prosthodontic maintenance was evaluated during the follow-up period and the 2 retention modalities were compared.There were no differences in implant survival, implant mobility (Periotest values), and peri-implant conditions between the 2 retention modalities. During the 3-year period significantly more complications/interventions for maintenance purposes were registered in the ball group (62 interventions) than in the telescopic crown group (26 interventions; P.01).The results indicate that both ball attachments and resilient telescopic crowns used on isolated implants in the edentulous mandible are viable treatment options. Implant success and peri-implant conditions did not differ between ball attachments and telescopic crowns used as retention modalities for implant overdentures, but the frequency of technical complications was significantly higher with ball attachments than with resilient telescopic crowns.

The survival rate of splinted and unsplinted provisional implants for anchoring removable interim overdentures, as well as handling and maintenance of the interim dentures, was evaluated.Eighteen edentulous maxillae were provided with 72 provisional implants for anchoring interim overdentures. For 10 patients, 40 unsplinted implants were used with conical copings to retain the provisional prostheses, while for 8 patients 32 implants had a splinted bar architecture for supporting the interim prostheses. Failure rate of provisional implants, as well as handling and behavior of the anchored interim overdentures, was followed until definitive prosthetic restoration and compared between groups.Eighteen (25.0%) of the 72 provisional implants were prematurely lost. The loss rate of unsplinted implants (37.5%) was significantly higher than that of splinted implants (9.3%). Patient handling and maintenance of maxillary interim overdentures during the follow-up period was found to be easier with the splinted bar-retained method than with the unsplinted prosthodontic method.Placement of provisional implants fulfilled the requirements for initiating immediate prosthetic rehabilitation and showed that removable interim overdentures can be adequately stabilized and provide added patient comfort and satisfaction. The results suggest benefits of the splinted retention modality over the unsplinted method because of advantages regarding failure rate, patient handling, and interim denture maintenance.