Search

Purpose: The study goal was to evaluate the incidence of patients older than 40 years who required third molar removal., Patients and Methods: Two prospective 5-year studies were compared over a 10-year period of 1992 to 1997 and 1997 to 2002. The study was initiated to evaluate how the large increase in the older population with longer life expectancies is reflected in the third molar population., Results: In 1997, 10.5% of patients requiring third molar surgery were 40 years or older. In 2002, 17.3% of patients were 40 years or older., Conclusions: It is well known that patients 40 years and older have increased risk in removal of third molars. It is concluded that 1 patient in 5 in the high-risk category is in a very high risk category. The risk to patients and to the profession can be dramatically reduced by considering early removal of abnormal third molars.

Background: This study quantifies the changes in bone height of the posterior area of the edentulous mandible when the load of complete dentures is borne entirely by anteriorly placed osseointegrated implants., Methods: Thirty-three patients, of whom there were radiographs from the beginning of implant loading and from a follow-up visit at least three years later (a mean of 6.6 years later), were included in the study. Working with panoramic radiographs, the authors took height measurements in the premolar area (15 millimeters distal to the most distal implants). A valid correction factor was available because implants of known length were proximal to the area being evaluated., Results: The authors calculated descriptive statistics using means, standard deviations, medians and proportions as appropriate. A P-value of less than .05 was considered significant. Of the 33 subjects, most showed increases in bone height--29 (87.9 percent) on the right side and 28 (84.9 percent) on the left side. The mean change in all subjects was +1.0 mm (range -0.8 to +3.3 mm). A comparison of mandibular height at implant placement vs. follow-up showed a statistically significant increase bilaterally (P < .001)., Conclusions: This study demonstrates that dentures for edentulous mandibles that are borne totally by implants in the anterior area conserve or enhance the bone of the posterior portion of the mandible. An important future study should test the effect of implant-assisted restorations for the edentulous mandible that load the posterior ridge (a bar clasp, for example)., Clinical Implications: One of the considerations in planning treatment for the edentulous mandible should be the preserving effect of totally implant-borne restorations vs. the continued resorption of the body of the mandible with conventional dentures.

Osseointegrated implants placed prior to maxillary downgrafting were utilized to stabilize the repositioned maxilla and interpositional bone graft. Eleven-month follow-up revealed complete healing of the 1.5-cm osteotomy gap and no maxillary relapse. Implant stabilization may be one solution to the relapse associated with inferior repositioning of the maxilla.

The fixture impression method presented permits the construction of a master cast after stage I surgery, enabling the dentist and dental technician to make a provisional crown before stage II surgery. At stage II surgery the surgeon can place the provisional crown instead of a classic abutment or healing cylinder. This eliminates the need for the patient to visit the restorative dentist immediately after stage II surgery for the making of a provisional crown, which can be a scheduling and logistic problem. In addition, better soft tissue contour is possible at stage II surgery, as the premade provisional crown can be shaped to the desired dimensions in the laboratory for ideal esthetics. The soft tissue will adapt to the predetermined surface dimensions during initial healing. Ideal soft tissue contours are present and stable when the final impression is made, which enables better esthetics to be developed for the permanent fixture-retained single-tooth restoration.

This modification of the LeFort I osteotomy places the horizontal bony cut higher and into the dense cortical bone of the maxillozygomatic complex. It gives greater stability and also provides a more solid bony base for intraosseous wiring of the mobilized segment. This usually eliminates the need for dento-osseous or maxillomandibular fixation, and the segments appear to solidify more quickly. Over the last year, we have used this technique in 23 cases (four maxillary advancements, seven one-piece maxillary intrusions, and 12 segmental maxillary intrusions) with very favorable results. This modification has given us greater control and stability, especially in combined maxillary and mandibular osteotomies.

This first of two articles describes a modified distolingual splitting technique for removal of impaction of various classes. The second article evaluates the efficacy of the technique by reporting and comparing the incidence of postoperative sequelae with earlier research findings. In this technique, the lingual soft tissue is not separated from the bone. In addition, the fragmented lingual bone attached to the periosteum is not removed. The procedure is best performed with the patient under sedation or general anesthesia.