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Visual labels to facilitate hygiene around implant-supported complete fixed dental prostheses
Visual labels to facilitate hygiene around implant-supported complete fixed dental prostheses Rafael Murgueitio, DDS,a Jaime Dussan, DDS,b Hector Rios, DDS, MS, PhD,c and Gustavo Avila-Ortiz, DDS, MS, PhDd School of Dentistry, University of Valle, Cali, Colombia; Colegio Odontológico Colombiano (UNICOC), School of Dentistry, Cali, Colombia; University of Michigan School of Dentistry, Ann Arbor, Mich; The University of Iowa College of Dentistry, Iowa City, Iowa This article reports a protocol for facilitating the oral hygiene and maintenance of supporting tissues in patients who wear implant-supported complete fixed dental prostheses. Small notches are placed on the acrylic resin below the prosthesis flange where the hygiene instrument should be inserted. These notches are filled with colored composite resin (blue) so that patients can see the sites of interest, which contributes to adequate plaque control and long-term periimplant health. (J Prosthet Dent 2014;112:1588-1590) Implant-supported complete fixed dental prostheses (ICFP) are considered a successful treatment for those patients who have lost all of their teeth on one or both dental arches.1,2 Some of the advantages of ICFPs are an increase in stability and retention, and a favorable cost-benefit ratio because these prostheses can be provided with a relatively small number of implants.3 The original ICFP designs were characterized by the fabrication of the prosthesis over titanium abutments that emerged between 2 and 4 mm above the mucosal margin.4 This design resulted in a substantial gap below the prosthesis to facilitate patient oral hygiene; however, it also led to esthetic and phonetic problems as well as food trapping.5 Current ICFPs are fabricated with a modified design and with different materials and laboratory techniques.6-8 One of the most significant modifications is the removal of the wide space between the base of the prosthesis and the mucosa in an attempt to improve esthetics and phonetics. Unfortunately, this improvement usually
occurs at the expense of accessibility for plaque control. Bacterial plaque in a susceptible host is a recognized etiologic factor for periimplant mucositis and periimplantitis.9,10 Furthermore, most ICFPs are provided for the elderly, a segment of the population that is sometimes less able to perform adequate oral hygiene. Therefore, all patients with an ICFP should be educated as to proper oral hygiene strategies.11,12 The purpose of this report is to propose the design and incorporation of visual labels into the prosthesis to facilitate oral hygiene performance around ICFPs.
TECHNIQUE 1. Carry out the appropriate planning of the ICFP design from the beginning of the treatment sequence, including appropriate spaces for different oral hygiene appliances, such as floss, interproximal toothbrushes, and rubber tips (Fig. 1).
2. During the process of prosthesis evaluation, verify the spaces for the insertion of hygiene devices with a periodontal probe (Hu-Friedy Mfg Co) (Fig. 2A). 3. Make a superficial notch (without perforating the prosthesis) 1 mm above each space with a diamond high-speed rotary instrument. (no. 2 round; Komet Brasseler GmbH & Co) (Fig. 2B). 4. Fill the notch with blue lightpolymerized composite resin (LC Block-Out Resin; Ultradent Products Inc) (Fig. 2C) and photopolymerize for 1 minute. 5. Engrave a small arrow on top of the distal extension cantilevers with the same diamond rotary cutting instrument, fill it with blue composite resin, and photopolymerize for 1 minute. The arrow indicates the direction in which the dental hygiene instrument should be inserted (Fig. 3A). 6. Finally, instruct the patient how to use the instruments that will aid his or her specific hygiene needs (Fig. 3B).
a
Adjunct Professor, School of Dentistry, University of Valle. Adjunct Professor, UNICOC, School of Dentistry. c Assistant Professor, Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry. d Assistant Professor, Department of Periodontics, The University of Iowa College of Dentistry. b
The Journal of Prosthetic Dentistry
Murgueitio et al
December 2014
1 Metal framework designed with spaces for introduction of hygiene instruments. A, B, Verify appropriate spaces for hygiene instruments. C, Contour definitive prosthesis base to avoid accumulation of food residue.
2 A, Determine most-appropriate location for hygiene instrument insertion. B, Make superficial notch with diamond rotary cutting instrument. C, Fill notch with low-viscosity blue pigmented light-polymerized composite resin and photopolymerize.
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1590
Volume 112 Issue 6
3 A, Verify dental floss access through grooves marked with blue light-polymerized composite resin. B, For patients with difficulty using dental floss, spaces must be wider to facilitate insertion of proxibrush.
CONCLUSION To facilitate plaque control and maintain long-term periimplant tissue health, spaces that will allow for the insertion of oral hygiene devices should be incorporated into the design of the ICFP. Labeling the areas for instrument access and direction provides visual instructions for the patients.
REFERENCES 1. Branemark PI, Zarb GA, Albrektsson T. Tissue-integrated prostheses. Osseointegration in clinical dentistry. Chicago: Quintessence; 1985. p. 175-86. 2. Astrand P, Ahlqvist J, Gunne J, Nilson H. Implant treatment of patients with edentulous jaws: a 20-year follow-up. Clin Implant Dent Relat Res 2008;10:207-17. 3. Gallucci GO, Doughtie CB, Hwang JW, Fiorellini JP, Weber HP. Five-year results of fixed implant-supported rehabilitations with distal cantilevers for the edentulous mandible. Clin Oral Implants Res 2009;20: 601-7.
4. Van Steenberghe D, Lekholm U, Bolender C, Folmer T, Henry P, Herrmann I, et al. The applicability of osseointegrated oral implants in the rehabilitation of partial edentulism: a prospective multicenter study on 558 fixtures. Int J Oral Maxillofac Implants 1990;5:272-81. 5. Jemt T. Failures and complications in 391 consecutively inserted fixed prostheses supported by Branemark implants in edentulous jaws: a study of treatment from the time of prosthesis placement to the first annual checkup. Int J Oral Maxillofac Implants 1991;6:270-6. 6. Drago C, Howell K. Concepts for designing and fabricating metal implant frameworks for hybrid implant prostheses. J Prosthodont 2012;2:413-24. 7. Almasri R, Drago C, Siegel S, Hardigan P. Volumetric misfit in CAD/CAM and cast implant frameworks: a university laboratory study. J Prosthodont 2011;20:1-8. 8. Hjalmarsson L, Smedberg J, Pettersson M, Jemt T. Implant-level prostheses in the edentulous maxilla: a comparison with conventional abutment-level prostheses after 5 years of use. Int J Prosthodont 2011;24:158-67. 9. Quirynen M, Van Assche N. Microbial changes after full-mouth tooth extraction, followed by 2-stage implant placement. J Clin Periodontol 2011;38:581-9.
The Journal of Prosthetic Dentistry
10. Pjetursson BE, Tan K, Lang NP, Chan E. A systematic review of the survival and complication rates of fixed partial dentures (FPDs) after an observation period of at least 5 years. Clin Oral Implants Res 2004;15: 625-42. 11. Pavel K, Seydlova M, Dostalova T, Zdenek V, Chleborad K, Zvarona J. Dental implants and improvement of oral health-related quality of life. Community Dent Oral Epidemiol 2012;40(suppl 1):65-70. 12. Real-Osuna J, Almendros-Marques N, GayEscoda C. Prevalence of complications after the oral rehabilitation with implantsupported hybrid prostheses. Med Oral Patol Oral Cir Bucal 2012;17:116-21. Corresponding author: Dr Rafael Murgueitio Cra 35A no. 3bis-65, Cali COLOMBIA E-mail: [email protected] Acknowledgments The authors thank Angela Castillo (language translator) and Tania Orozco (graphic art designer) for their contribution in this article. Copyright ª 2014 by the Editorial Council for The Journal of Prosthetic Dentistry.
Murgueitio et al
occurs at the expense of accessibility for plaque control. Bacterial plaque in a susceptible host is a recognized etiologic factor for periimplant mucositis and periimplantitis.9,10 Furthermore, most ICFPs are provided for the elderly, a segment of the population that is sometimes less able to perform adequate oral hygiene. Therefore, all patients with an ICFP should be educated as to proper oral hygiene strategies.11,12 The purpose of this report is to propose the design and incorporation of visual labels into the prosthesis to facilitate oral hygiene performance around ICFPs.
TECHNIQUE 1. Carry out the appropriate planning of the ICFP design from the beginning of the treatment sequence, including appropriate spaces for different oral hygiene appliances, such as floss, interproximal toothbrushes, and rubber tips (Fig. 1).
2. During the process of prosthesis evaluation, verify the spaces for the insertion of hygiene devices with a periodontal probe (Hu-Friedy Mfg Co) (Fig. 2A). 3. Make a superficial notch (without perforating the prosthesis) 1 mm above each space with a diamond high-speed rotary instrument. (no. 2 round; Komet Brasseler GmbH & Co) (Fig. 2B). 4. Fill the notch with blue lightpolymerized composite resin (LC Block-Out Resin; Ultradent Products Inc) (Fig. 2C) and photopolymerize for 1 minute. 5. Engrave a small arrow on top of the distal extension cantilevers with the same diamond rotary cutting instrument, fill it with blue composite resin, and photopolymerize for 1 minute. The arrow indicates the direction in which the dental hygiene instrument should be inserted (Fig. 3A). 6. Finally, instruct the patient how to use the instruments that will aid his or her specific hygiene needs (Fig. 3B).
a
Adjunct Professor, School of Dentistry, University of Valle. Adjunct Professor, UNICOC, School of Dentistry. c Assistant Professor, Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry. d Assistant Professor, Department of Periodontics, The University of Iowa College of Dentistry. b
The Journal of Prosthetic Dentistry
Murgueitio et al
December 2014
1 Metal framework designed with spaces for introduction of hygiene instruments. A, B, Verify appropriate spaces for hygiene instruments. C, Contour definitive prosthesis base to avoid accumulation of food residue.
2 A, Determine most-appropriate location for hygiene instrument insertion. B, Make superficial notch with diamond rotary cutting instrument. C, Fill notch with low-viscosity blue pigmented light-polymerized composite resin and photopolymerize.
Murgueitio et al
1589
1590
Volume 112 Issue 6
3 A, Verify dental floss access through grooves marked with blue light-polymerized composite resin. B, For patients with difficulty using dental floss, spaces must be wider to facilitate insertion of proxibrush.
CONCLUSION To facilitate plaque control and maintain long-term periimplant tissue health, spaces that will allow for the insertion of oral hygiene devices should be incorporated into the design of the ICFP. Labeling the areas for instrument access and direction provides visual instructions for the patients.
REFERENCES 1. Branemark PI, Zarb GA, Albrektsson T. Tissue-integrated prostheses. Osseointegration in clinical dentistry. Chicago: Quintessence; 1985. p. 175-86. 2. Astrand P, Ahlqvist J, Gunne J, Nilson H. Implant treatment of patients with edentulous jaws: a 20-year follow-up. Clin Implant Dent Relat Res 2008;10:207-17. 3. Gallucci GO, Doughtie CB, Hwang JW, Fiorellini JP, Weber HP. Five-year results of fixed implant-supported rehabilitations with distal cantilevers for the edentulous mandible. Clin Oral Implants Res 2009;20: 601-7.
4. Van Steenberghe D, Lekholm U, Bolender C, Folmer T, Henry P, Herrmann I, et al. The applicability of osseointegrated oral implants in the rehabilitation of partial edentulism: a prospective multicenter study on 558 fixtures. Int J Oral Maxillofac Implants 1990;5:272-81. 5. Jemt T. Failures and complications in 391 consecutively inserted fixed prostheses supported by Branemark implants in edentulous jaws: a study of treatment from the time of prosthesis placement to the first annual checkup. Int J Oral Maxillofac Implants 1991;6:270-6. 6. Drago C, Howell K. Concepts for designing and fabricating metal implant frameworks for hybrid implant prostheses. J Prosthodont 2012;2:413-24. 7. Almasri R, Drago C, Siegel S, Hardigan P. Volumetric misfit in CAD/CAM and cast implant frameworks: a university laboratory study. J Prosthodont 2011;20:1-8. 8. Hjalmarsson L, Smedberg J, Pettersson M, Jemt T. Implant-level prostheses in the edentulous maxilla: a comparison with conventional abutment-level prostheses after 5 years of use. Int J Prosthodont 2011;24:158-67. 9. Quirynen M, Van Assche N. Microbial changes after full-mouth tooth extraction, followed by 2-stage implant placement. J Clin Periodontol 2011;38:581-9.
The Journal of Prosthetic Dentistry
10. Pjetursson BE, Tan K, Lang NP, Chan E. A systematic review of the survival and complication rates of fixed partial dentures (FPDs) after an observation period of at least 5 years. Clin Oral Implants Res 2004;15: 625-42. 11. Pavel K, Seydlova M, Dostalova T, Zdenek V, Chleborad K, Zvarona J. Dental implants and improvement of oral health-related quality of life. Community Dent Oral Epidemiol 2012;40(suppl 1):65-70. 12. Real-Osuna J, Almendros-Marques N, GayEscoda C. Prevalence of complications after the oral rehabilitation with implantsupported hybrid prostheses. Med Oral Patol Oral Cir Bucal 2012;17:116-21. Corresponding author: Dr Rafael Murgueitio Cra 35A no. 3bis-65, Cali COLOMBIA E-mail: [email protected] Acknowledgments The authors thank Angela Castillo (language translator) and Tania Orozco (graphic art designer) for their contribution in this article. Copyright ª 2014 by the Editorial Council for The Journal of Prosthetic Dentistry.
Murgueitio et al