[show abstract][hide abstract] ABSTRACT: This clinical report presents the reconstruction of a maxillary arch with a cement retained implant supported fixed prosthesis using a monolithic zirconia generated by CAD/CAM system on eight osseointegrated implants. The prosthesis was copy milled from an interim prosthesis minimizing occlusal adjustments on the definitive prosthesis at the time of delivery. Monolithic zirconia provides high esthetics and reduces the number of metal alloys used in the oral cavity.
The journal of advanced prosthodontics 05/2013; 5(2):209-17.
[show abstract][hide abstract] ABSTRACT: Injuries to the ear can result in partial or complete loss of the external ear. Resection of the external ear may be necessary secondary to malignant tumor or infection. This article discusses the diagnosis and management of acquired defects of the external ear. Because autogenous reconstruction is not always possible, both autogenous and prosthetic reconstruction are presented and the indications for both. This information should help guide the clinician in the decision-making process. In the hands of experienced clinicians, reconstruction of the external ear can result in an excellent outcome, with improved quality of life for the patient.
Oral and maxillofacial surgery clinics of North America 03/2013;
[show abstract][hide abstract] ABSTRACT: This article introduces a procedure that allows the clinician to verify the 3-dimensional spatial orientations of implant analogs in the definitive cast for a cement-retained, implant-supported prosthesis with engaging abutments. Multiple interlocking puzzle pieces are used with engaging interim abutments to verify the accuracy of the impression.
The Journal of prosthetic dentistry 03/2013; 109(3):192-7. · 1.22 Impact Factor
[show abstract][hide abstract] ABSTRACT: The transfer of composite tissue flaps by microvascular techniques has become the standard for reconstructing complex defects of the oral and maxillofacial regions. Despite advances in these techniques, sites reconstructed by free tissue transfer (free flaps) are often compromised by scarring, bulky tissue, and altered architecture. Dental rehabilitation is often impossible without endosseous implants to aid in stabilization and retention of prostheses. The most commonly used free flaps, however, have significant shortcomings with regard to implant placement, prosthetics, and maintenance. This article describes some site development and prosthetic techniques that can be applied to improve outcomes when dental implants are used in conjunction with free flap reconstruction.
Oral and maxillofacial surgery clinics of North America 08/2010; 22(3):407-18, vii.
[show abstract][hide abstract] ABSTRACT: This clinical report presents the treatment of an unfavorable bilateral maxillary defect with the use of an extraoral device to hold an interim obturator in place during tissue healing and maturation.
Journal of Prosthodontics 09/2008; 17(7):582-5. · 0.68 Impact Factor
[show abstract][hide abstract] ABSTRACT: Diabetes is an increasingly prevalent disease with oral health manifestations. While diabetes clearly has an affect on bone, its impact on the healing of bone associated with dental implants is not completely understood. The purpose of this study was to measure bone response to implants in uncontrolled and insulin-controlled diabetic rats.
One hundred and fifty-two rats were divided into control, diabetic, and insulin groups. Rats received streptozotocin (65 mg/kg) to induce diabetes; animals in the insulin group also received a subcutaneous slow-release insulin implant. Titanium alloy implants (1.5 x 8 mm) were placed in the proximal tibiae of animals. Implants were harvested at 2, 7, 14, and 24 days and examined histologically. Bone or bone-like tissue adjacent to implants was quantified as a percent. Data were compared using a two-way analysis is variance (ANOVA) with time and treatment as primary independent factors.
Time and treatment were significant factors in predicting bone response to implants (P<0.0001). Mean bone volume peaked at day 7 and decreased over time to day 24. Mean bone volume percent at 2, 7, 14, and 24 days (+/-SD) was 8.2 (+/-8), 22.9 (+/-8), 18.8 (+/-10), and 14.9 (+/-9), respectively. Mean total bone volume percent (adjusted for day) for control, diabetic, and insulin groups (+/-SD) was 12.4 (+/-9), 22.6 (+/-10), and 17 (+/-7), respectively. Bone volume adjacent to implants in diabetic rats was significantly greater than controls (P<0.05). Diabetic animals treated with insulin were not statistically different from controls.
Induction of diabetes with STZ is associated with increased bone response compared with controls. This response was mediated by treatment with insulin.
Clinical Oral Implants Research 11/2006; 17(5):495-500. · 3.43 Impact Factor
[show abstract][hide abstract] ABSTRACT: In an effort to make the implant overdenture more affordable for patients, a pricing package at the University of Alabama at Birmingham School of Dentistry was established. This package includes two implants, two dentures (upper and lower), and two implant abutments, all for $975. It is known as the "2-2-2" implant program. One concern regarding the program was whether patients would complete overdenture treatment or simply receive implants at this relatively low cost and have the implants restored outside the school. The purpose of this retrospective chart review was to determine how many patients in 2004 received implants as part of this program and how many of these patients completed overdenture treatment. Other data (age, distance from school, number of teeth at start of treatment, and gender) were collected to identify variables that might be associated with greater likelihood of completing overdenture treatment. In 2004, fifty-one patients received 102 implants as part of this program. Two patients had a failed implant prior to restoration (two of 102 implants), and one patient was referred to graduate prosthodontics for restoration. Of the remaining forty-eight patients, forty-one completed overdenture treatment (85 percent), and seven (15 percent) were lost to follow-up. The mean age of patients receiving this treatment was 60.7 years. The mean distance traveled to the school was 70.7 miles. While no variables showed significant predictive value, point estimates (estimate of the odds ratio) suggest that older patients and patients who travel greater distance to the school were less likely to complete treatment. The low-cost implant overdenture has been an important addition to our curriculum. The majority of patients who receive implants as part of this program complete overdenture treatment.
Journal of dental education 07/2006; 70(6):662-6. · 0.99 Impact Factor
[show abstract][hide abstract] ABSTRACT: The objective of this study was to determine changes in interdental papillae, alveolar bone loss, esthetics, and initial healing survival when 1-piece narrow-diameter implants were immediately loaded in sites with limited tooth-to-tooth spacing.
One-piece titanium alloy implants with a maximum diameter of 3.0 mm and a resorbable blast surface texture on a square-thread form were evaluated. Digital photographs were made at each clinical visit to assess soft tissue healing. Interproximal soft tissue fill of the embrasure was assessed with a modified Jemt index. Standardized radiographs were made at baseline (implant placement) and at 6 and 12 months postsurgery. Radiographic bone height was measured from a consistent landmark on the implant. A 1-sided t test was used to determine statistical differences of bone height.
Thirty-one implants were placed in 17 subjects. One implant had clinical mobility and was removed, for an overall survival rate of 96.7%. Mean bone height on the day of placement and restoration was 2.33 + 0.73 mm above the first thread. Mean bone height was 1.75 +/- 0.78 mm at 6 months postrestoration and 1.63 +/- 0.81 mm at 12 months postrestoration. There was a statistically significant loss of bone support over the initial 6 months (0.58 mm; P < .01), with no significant progression thereafter (0.12 mm; NS). Complete fill of papillae was found in 92% of maxillary lateral incisor sites and 60% of mandibular incisor sites.
The use of 1-piece narrow-diameter immediately loaded implants appears to be an effective prosthetic treatment for areas of limited space.
The International journal of oral & maxillofacial implants 23(2):281-8. · 1.91 Impact Factor