- Email: [email protected]
Magnet-retained overdentures
Clinical Significance.—Direct composite buildups are good choices when maximally conservative, esthetic corrections are needed for anterior teeth. As compared with laminate veneers and ceramic crowns, they offer a good balance of minimal invasiveness, esthetic results, clinical effort, and survival.
Wolff D, Kraus T, Schach C, Pritsch M, Mente J, Staehle HJ, et al: Recontouring teeth and closing diastemas with direct composite buildups: A clinical evaluation of survival and quality parameters. J Dent 38:1001-1009, 2010 Reprints available from D Wolff, Dept of Conservative Dentistry, School of Dental Medicine, Ruprecht Karls Univ, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; fax: þ49 6221 565074; e-mail: [email protected]
Implants Magnet-retained overdentures Background.—The use of open-field magnets made from aluminum-nickel-cobalt alloys fell into disfavor when clinicians found they corroded rapidly in saliva. Their attractive force was also weaker than the strength of mechanical attachments, limiting their usefulness. Recent improvements in magnet alloys have expanded their usefulness in prosthodontics, with the potential for significant patient satisfaction levels for magnet-retained mandibular implant overdentures. Alloys of the rare earth elements samarium cobalt (SmCo) and neodymium iron boron (NdFeB) have been used for newer, closed-field magnetic systems. The magnetic force is stronger and more stable than previous versions, with the field or flux contained within the magnetkeeper unit. In addition, the newer magnets are enclosed in a metal capsule that protects them from corrosion in the mouth. However, it is still advisable to avoid using magnetic systems for patients who are allergic to nickel.
Fig 1.—Clinical appearance 1 year after attachment of denture with magnets. (Courtesy of Ceruti P, Bryant SR, Lee J-H, et al: Magnet-retained implant-supported overdentures: Review and 1-year clinical report. J Can Dent Assoc 76:a52, 2010.)
146
Dental Abstracts
Patient satisfaction with the older magnetic systems was generally high even though they were associated with less stability and comfort than mechanical systems. Levels of satisfaction with more durable and stronger magnetic systems should be more sustainable than levels with mechanical attachments if the retention of the magnetic systems is greater than that of the mechanical devices. Clinically neither magnetic nor mechanical attachment systems disturb the surrounding gingiva or periodontium. Short-term results indicate greater accumulations of microbial plaque around magnetic attachments than around mechanical ones, perhaps because of the emergence profile of the magnet. Magnetic attachments tend to be shorter than mechanical attachments, making them useful in cases with restricted interocclusal space and difficult esthetic situations. A moderate divergence of alignment can be tolerated with the magnetic systems, compared with a minimal level
Fig 2.—A, Magnet (on top) with keeper (abutment and screw) and, B, assembled magnet-keeper unit. (Courtesy of Ceruti P, Bryant SR, Lee J-H, et al: Magnet-retained implant-supported overdentures: Review and 1-year clinical report. J Can Dent Assoc 76:a52, 2010.)
Fig 3.—Clinical application of MAGFIT magnetic attachment. A, The keeper abutments are placed on the implants. B, The magnet capsules are positioned on the keepers. C, Acrylic resin is added to attach the magnets. D, Resin extruded during intraoral placement of the denture. E, Magnets are attached to the denture base. (Courtesy of Ceruti P, Bryant SR, Lee J-H, et al: Magnet-retained implant-supported overdentures: Review and 1-year clinical report. J Can Dent Assoc 76:a52, 2010.)
allowed by mechanical systems. For patients with physical disabilities, the magnet-retained dentures are easy to place and remove. Magnets and keepers can cause distortion during magnetic resonance imaging of the head and neck, so patients with magnet-retained dentures should remove them before these procedures. The risk for patient injury during magnetic resonance imaging is minimal. An investigation of magnet-retained dentures was undertaken to document the clinical experience and monitor the benefits and limitations of the MAGFIT rare-earth magnetic system. Patient satisfaction was noted. Method.—A total of 17 patients were included, with all but one having several years’ experience with
Table 1.—Overall Satisfaction with Mandibular Complete Dentures Retained by Magnet Attachments on Implants Time point; mean VAS score* Previous implant attachments
Ball or bar None
No. of patients
16 1
Baseline
6 months after magnets
12 months after magnets
68/100 34/100
85/100 83/100
93/100 91/100
* VAS = visual analogue scale, where 0 = very unsatisfied and 100 = very satisfied. (Courtesy of Ceruti P, Bryant SR, Lee J-H, et al: Magnet-retained implant-supported overdentures: Review and 1-year clinical report. J Can Dent Assoc 76:a52, 2010.)
implant-supported overdentures. Each patient had two separate magnetic attachments and two implants that retained a mandibular complete denture. The keepers remained above the mucosa (Fig 1), and opposing surfaces of the keeper and magnetic capsule were domed to permit rotation and pivoting as the denture moved (Fig 2). Autopolymerizing methyl methacrylate was used to attach the magnetic capsules to the denture base (Fig 3). Level of patient satisfaction was measured at baseline, 6 months, and 1 year using a standardized visual analog scale. Results.—The 16 patients with existing mechanical ball or bar attachments gave the magnetic systems a mean overall satisfaction score of 68 out of 100 at baseline and 93 after 12 months (Table 1). The patient who had no implant attachments previously rated them as 34 at baseline and 91 after 12 months. Discussion.—Patients were highly satisfied with the magnet-keeper attachments for their complete dentures in the first year of use. The durability of the new magnetic systems remains to be determined.
Clinical Significance.—Mandibular implant overdentures are readily retained using magnetic attachment systems. Their use is easy and relatively free of complications, with the promise for long-term durability.
Volume 56
Issue 3
2011
147
Ceruti P, Bryant SR, Lee J-H, et al: Magnet-retained implant-supported overdentures: Review and 1-year clinical report. J Can Dent Assoc 76:a52, 2010
Reprints available from R Bryant, Faculty of Dentistry, Univ of British Columbia, 2199 Wesbrook Mall, Vancouver, BC V6T 1Z3; e-mail: [email protected]
Medical Management Oral and gastrointestinal health Background.—Risk assessment is essential during dental hygiene encounters. In this article, gastrointestinal (GI) disorders that are most often seen in young adults coming for dental hygiene and how to reduce oral complications associated with these disorders have been outlined, focusing specifically on the pharmacologic aspects of care. Case Report.—A 36-year-old woman visited a dentist about 18 months before and recently went to a new dental office for dental hygiene because her previous dentist retired. She stated that she loved her previous dental hygienist because she was gentle and could perform her care quickly. She also stated that her time is very valuable to her and added, ‘‘How long do you think this visit will take today? I just want a cleaning—nothing else.’’ She reported that her teeth appear to have a heavy yellow film and that she has a ‘‘funny’’ aftertaste in her mouth. She denied any significant cardiovascular, respiratory, musculoskeletal, hepatic, or renal problems, but was treated successfully for a peptic ulcer and is currently taking prescription strength omeprazole to ensure continuous healing of the ulcer and for long-term maintenance. She attributed her heartburn and gastric pain, which occur several times a week, to stress related to her job. She reported having tension headaches that were previously treated with 400 mg of ibuprofen, but had discontinued that drug on the advice of her gastroenterologist and was currently on over-the-counter acetaminophen. She also had seasonal allergies in the fall for which she takes loratadine, as needed. She uses hormonal contraception. Her vital signs are within normal limits. Her dental history included fluoridated water and regular preventive care until the age of 18 years. She has routine dental checkups once a year. Occlusal restorations are present on all her first molars, and she has a crown on tooth number 15. Her third molars were removed at the age of 16 years. She has been diagnosed with mild to moderate gingivitis and needs to improve her brushing technique and frequency of brushing. She flosses several times a week and uses a mouthwash when she feels that she needs it. Her previous dental hygienist recommended periodontal therapy to manage her gingivitis, but she refused because she lacked dental insurance. Her intraoral examination revealed generalized moderate gingivitis; dry, friable mucosa; and a red buccal mucosa
148
Dental Abstracts
and oropharynx with mild ulcerations on the tonsillar pillars. There was generalized bleeding on probing, probing depths of 2 to 5 mm, and localized 6-mm pockets. She had no recession or new carious lesions, but her molar teeth showed mild erosion and there was heavy supragingival plaque at the gingival margin on the facial surfaces of all her anterior teeth, the buccal surfaces of her maxillary molars, and the lingual surfaces of her mandibular teeth. A slight ledge of supragingival calculus runs along the lingual surfaces of her mandibular anterior teeth. She showed no evidence of pathologic conditions or caries on four vertical bitewing radiographs, but there was mild, early horizontal bone loss interproximally between teeth number 14 and number 15. The dental hygienist’s risk factor assessment yielded several possibilities. Systemically, the patient has had peptic ulcer disease, which could have redeveloped because of inadequate treatment or stress. She also has tension headaches for which she self-medicates. Her oral health is compromised by altered taste and xerostomia, erosion of enamel, moderate plaque-induced gingivitis, local periodontitis, mucosal burns from gastric acid, poor oral hygiene, and lack of motivation to make changes. Systemic Risk Reduction.—Strategies to reduce her systemic disease risks include medical consultation with her gastroenterologist to address the continuing gastric pain and acid secretion. She also should have her headaches evaluated to determine their frequency, triggers, and appropriate treatment in light of her GI complaints. She should be advised that headaches are a common side-effect associated with the antihistamine she takes for seasonal allergies. The combination drug therapy chosen to manage her peptic ulcer disease is only effective in about 80% of cases. Adding bismuth subsalicylate as an antibacterial agent against Helicobacter pylori may help in eradicating this causative organism. Post-treatment testing can confirm eradication. New regimens are also being developed. The use of nonsteroidal anti-inflammatory drugs, such as ibuprofen, contributes to GI disease, causing both GI ulceration and bleeding. The use of proton pump inhibitor agents, such as esomeprazole, can help reduce the risk of
Wolff D, Kraus T, Schach C, Pritsch M, Mente J, Staehle HJ, et al: Recontouring teeth and closing diastemas with direct composite buildups: A clinical evaluation of survival and quality parameters. J Dent 38:1001-1009, 2010 Reprints available from D Wolff, Dept of Conservative Dentistry, School of Dental Medicine, Ruprecht Karls Univ, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; fax: þ49 6221 565074; e-mail: [email protected]
Implants Magnet-retained overdentures Background.—The use of open-field magnets made from aluminum-nickel-cobalt alloys fell into disfavor when clinicians found they corroded rapidly in saliva. Their attractive force was also weaker than the strength of mechanical attachments, limiting their usefulness. Recent improvements in magnet alloys have expanded their usefulness in prosthodontics, with the potential for significant patient satisfaction levels for magnet-retained mandibular implant overdentures. Alloys of the rare earth elements samarium cobalt (SmCo) and neodymium iron boron (NdFeB) have been used for newer, closed-field magnetic systems. The magnetic force is stronger and more stable than previous versions, with the field or flux contained within the magnetkeeper unit. In addition, the newer magnets are enclosed in a metal capsule that protects them from corrosion in the mouth. However, it is still advisable to avoid using magnetic systems for patients who are allergic to nickel.
Fig 1.—Clinical appearance 1 year after attachment of denture with magnets. (Courtesy of Ceruti P, Bryant SR, Lee J-H, et al: Magnet-retained implant-supported overdentures: Review and 1-year clinical report. J Can Dent Assoc 76:a52, 2010.)
146
Dental Abstracts
Patient satisfaction with the older magnetic systems was generally high even though they were associated with less stability and comfort than mechanical systems. Levels of satisfaction with more durable and stronger magnetic systems should be more sustainable than levels with mechanical attachments if the retention of the magnetic systems is greater than that of the mechanical devices. Clinically neither magnetic nor mechanical attachment systems disturb the surrounding gingiva or periodontium. Short-term results indicate greater accumulations of microbial plaque around magnetic attachments than around mechanical ones, perhaps because of the emergence profile of the magnet. Magnetic attachments tend to be shorter than mechanical attachments, making them useful in cases with restricted interocclusal space and difficult esthetic situations. A moderate divergence of alignment can be tolerated with the magnetic systems, compared with a minimal level
Fig 2.—A, Magnet (on top) with keeper (abutment and screw) and, B, assembled magnet-keeper unit. (Courtesy of Ceruti P, Bryant SR, Lee J-H, et al: Magnet-retained implant-supported overdentures: Review and 1-year clinical report. J Can Dent Assoc 76:a52, 2010.)
Fig 3.—Clinical application of MAGFIT magnetic attachment. A, The keeper abutments are placed on the implants. B, The magnet capsules are positioned on the keepers. C, Acrylic resin is added to attach the magnets. D, Resin extruded during intraoral placement of the denture. E, Magnets are attached to the denture base. (Courtesy of Ceruti P, Bryant SR, Lee J-H, et al: Magnet-retained implant-supported overdentures: Review and 1-year clinical report. J Can Dent Assoc 76:a52, 2010.)
allowed by mechanical systems. For patients with physical disabilities, the magnet-retained dentures are easy to place and remove. Magnets and keepers can cause distortion during magnetic resonance imaging of the head and neck, so patients with magnet-retained dentures should remove them before these procedures. The risk for patient injury during magnetic resonance imaging is minimal. An investigation of magnet-retained dentures was undertaken to document the clinical experience and monitor the benefits and limitations of the MAGFIT rare-earth magnetic system. Patient satisfaction was noted. Method.—A total of 17 patients were included, with all but one having several years’ experience with
Table 1.—Overall Satisfaction with Mandibular Complete Dentures Retained by Magnet Attachments on Implants Time point; mean VAS score* Previous implant attachments
Ball or bar None
No. of patients
16 1
Baseline
6 months after magnets
12 months after magnets
68/100 34/100
85/100 83/100
93/100 91/100
* VAS = visual analogue scale, where 0 = very unsatisfied and 100 = very satisfied. (Courtesy of Ceruti P, Bryant SR, Lee J-H, et al: Magnet-retained implant-supported overdentures: Review and 1-year clinical report. J Can Dent Assoc 76:a52, 2010.)
implant-supported overdentures. Each patient had two separate magnetic attachments and two implants that retained a mandibular complete denture. The keepers remained above the mucosa (Fig 1), and opposing surfaces of the keeper and magnetic capsule were domed to permit rotation and pivoting as the denture moved (Fig 2). Autopolymerizing methyl methacrylate was used to attach the magnetic capsules to the denture base (Fig 3). Level of patient satisfaction was measured at baseline, 6 months, and 1 year using a standardized visual analog scale. Results.—The 16 patients with existing mechanical ball or bar attachments gave the magnetic systems a mean overall satisfaction score of 68 out of 100 at baseline and 93 after 12 months (Table 1). The patient who had no implant attachments previously rated them as 34 at baseline and 91 after 12 months. Discussion.—Patients were highly satisfied with the magnet-keeper attachments for their complete dentures in the first year of use. The durability of the new magnetic systems remains to be determined.
Clinical Significance.—Mandibular implant overdentures are readily retained using magnetic attachment systems. Their use is easy and relatively free of complications, with the promise for long-term durability.
Volume 56
Issue 3
2011
147
Ceruti P, Bryant SR, Lee J-H, et al: Magnet-retained implant-supported overdentures: Review and 1-year clinical report. J Can Dent Assoc 76:a52, 2010
Reprints available from R Bryant, Faculty of Dentistry, Univ of British Columbia, 2199 Wesbrook Mall, Vancouver, BC V6T 1Z3; e-mail: [email protected]
Medical Management Oral and gastrointestinal health Background.—Risk assessment is essential during dental hygiene encounters. In this article, gastrointestinal (GI) disorders that are most often seen in young adults coming for dental hygiene and how to reduce oral complications associated with these disorders have been outlined, focusing specifically on the pharmacologic aspects of care. Case Report.—A 36-year-old woman visited a dentist about 18 months before and recently went to a new dental office for dental hygiene because her previous dentist retired. She stated that she loved her previous dental hygienist because she was gentle and could perform her care quickly. She also stated that her time is very valuable to her and added, ‘‘How long do you think this visit will take today? I just want a cleaning—nothing else.’’ She reported that her teeth appear to have a heavy yellow film and that she has a ‘‘funny’’ aftertaste in her mouth. She denied any significant cardiovascular, respiratory, musculoskeletal, hepatic, or renal problems, but was treated successfully for a peptic ulcer and is currently taking prescription strength omeprazole to ensure continuous healing of the ulcer and for long-term maintenance. She attributed her heartburn and gastric pain, which occur several times a week, to stress related to her job. She reported having tension headaches that were previously treated with 400 mg of ibuprofen, but had discontinued that drug on the advice of her gastroenterologist and was currently on over-the-counter acetaminophen. She also had seasonal allergies in the fall for which she takes loratadine, as needed. She uses hormonal contraception. Her vital signs are within normal limits. Her dental history included fluoridated water and regular preventive care until the age of 18 years. She has routine dental checkups once a year. Occlusal restorations are present on all her first molars, and she has a crown on tooth number 15. Her third molars were removed at the age of 16 years. She has been diagnosed with mild to moderate gingivitis and needs to improve her brushing technique and frequency of brushing. She flosses several times a week and uses a mouthwash when she feels that she needs it. Her previous dental hygienist recommended periodontal therapy to manage her gingivitis, but she refused because she lacked dental insurance. Her intraoral examination revealed generalized moderate gingivitis; dry, friable mucosa; and a red buccal mucosa
148
Dental Abstracts
and oropharynx with mild ulcerations on the tonsillar pillars. There was generalized bleeding on probing, probing depths of 2 to 5 mm, and localized 6-mm pockets. She had no recession or new carious lesions, but her molar teeth showed mild erosion and there was heavy supragingival plaque at the gingival margin on the facial surfaces of all her anterior teeth, the buccal surfaces of her maxillary molars, and the lingual surfaces of her mandibular teeth. A slight ledge of supragingival calculus runs along the lingual surfaces of her mandibular anterior teeth. She showed no evidence of pathologic conditions or caries on four vertical bitewing radiographs, but there was mild, early horizontal bone loss interproximally between teeth number 14 and number 15. The dental hygienist’s risk factor assessment yielded several possibilities. Systemically, the patient has had peptic ulcer disease, which could have redeveloped because of inadequate treatment or stress. She also has tension headaches for which she self-medicates. Her oral health is compromised by altered taste and xerostomia, erosion of enamel, moderate plaque-induced gingivitis, local periodontitis, mucosal burns from gastric acid, poor oral hygiene, and lack of motivation to make changes. Systemic Risk Reduction.—Strategies to reduce her systemic disease risks include medical consultation with her gastroenterologist to address the continuing gastric pain and acid secretion. She also should have her headaches evaluated to determine their frequency, triggers, and appropriate treatment in light of her GI complaints. She should be advised that headaches are a common side-effect associated with the antihistamine she takes for seasonal allergies. The combination drug therapy chosen to manage her peptic ulcer disease is only effective in about 80% of cases. Adding bismuth subsalicylate as an antibacterial agent against Helicobacter pylori may help in eradicating this causative organism. Post-treatment testing can confirm eradication. New regimens are also being developed. The use of nonsteroidal anti-inflammatory drugs, such as ibuprofen, contributes to GI disease, causing both GI ulceration and bleeding. The use of proton pump inhibitor agents, such as esomeprazole, can help reduce the risk of