N. Forna - Protetica Dentara Vol II-3 [PDF]

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Fig. 7.68.Aspecte ale etapelorde tratament (Cazuistica Dr. N. Forna)

7.66. Aspecte radiologiceale cazului

Fig. 7.67.Aspecteale etapelorde tratament (Cazuistica Dr. N.Forna)

Bio-Oss-uleste un substituent ososnatural,osteoinductiv, ce conduce la cregterea osoasdcontrolate la nivelul cAmpurilorproteticecaracterizatede afectareparodontaldsau pierderide substantd la nivelosos.Aceastaalegere terapeuticds-a bazat pe inducerea cregterii osoasela nivelulsitusului unde a fost grefat,deciziecorelatecu aplicarea membraneimetalicecare va fi un conformator ce se va adaptaviitorului volumal crestei(fig.7.68,7.69). Prolezarea imediatda fost o etapa importantapost implanto-augmentare, protezarea finalaredAndarmoniafacialS gi increderea pacientei in ea insdgi(fig. 7.70).

Fig. 7.69.Aspecte ale etapelor de tratament (Cazuistica Dr. N.Forna)

Fig. 7.70.Aspectulfinal al cazului

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Acestcaz clinicpoatefi considerat emblematicin ce privegtemodificarea scoruluinegativce rezultddincuantificaparametriifiecdrui rea ce caraclerizeazd suport?n parte,conferindcazuluiclinic favorabil. un prognostic

Un alt caz clinicne va indicain ce mdsurdo solulieterapeuticd ce conferd un prognostic mediumodificdscorulindicilorclinico-biologici ancoratiin teritoriulpozitival cuantificdrii.

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Abu Jar*ra NE $larrridaki*MM, MitlerHB, Fvnjuefipn*{tn{qrarth spseet*r implantrestor*iififlsih pafienfs:A laboratory 9:102-6,!00S. edenfu{ous technique^ J Prosthodont Agagnou-Varelzides A, Kornbrliful,TsamiA* et. el. Psltsrnsf forffi l*ss,in * *e/ecfd popalalianin DentOralEpidemiol" tSBfiAsc;I4{S}:349-5*, Sreece"Gcmmunrty 199S. W.E.$aunders sditor.Fhitadelphia, Ccmpany, Anusavise l(1.Ptu?lfp3 $nb'nmof$entafMeter?els. partialdenture:ctwbe" Frnsthet J Appfegate D€. Ifre ratianale of Dent19S0;10:891-$CI?" ApplegateSC. fssentralsof remavablepiltiel denfursprcstfiesfs.Ist ed. Philadelphia {FA}:W. B. Co,;1954. $aunders in an aduft Sw*dishpoputaAxellT, CIwallS. Prevalences af remavable denturesand edenfuJousness $wedDentJ. 1979;3(4):t 29-37. fr'on. BarryH. Radiatr,gic Anafs$ryof ftle"ieur*.1$S2Edition.Univcf PennFre*s" BaskerFlM,HarrisonA, Darenport JC, et. al. Partiatdenturedesignin generaldentalpractice-tCI yearsen.Br DenlJ. tPBSOstS;16${7}:245'9. Ns ab$tract available. BasseylE. Ifte prosfhetrcrequiramerrt of partialiyedentulouspaCr'ents d.sseen in LagoslJniversity Ieacftis##aspital.NigfiuartJ f{aspMed. partiatdenluredesrgn.J Fro*thodont. BeckerOM,KaiserFA, SoldfogelMH. Evolution cf remcva&Je 1994Sap;${3}J5S-6S. overderlt#res" A l*ngitudiaalprn*peclire$tudy.lfit Oral BcrgendalT, EnquistS. tffrplants'uffpoffBd -l 1998" lmplants 13:253-62, Maxillofac E*rgtnanF, Hugosscn. A & Olsson$.S, 6arfes,p,*riadfintalaftdprssttrelrcccndifisrf$ inpa#enfsfired study.J FrostheiDent.1982,4S;50S-514. withr*movablePadralden*/res. A 1fi-yearlongitudinal Avdelningen f$rprotetilt,Umei univerKlinisktkompendium. BergmanB. AvtegsarpfiNeltplattproties. sitet.1981.3:e ed. partial SissadaN F, fbr*lrim$ | & BarsoumW fiI. Gingivalrcsponsefo rariousfypesof removable denfures" J Feriodonl'1 974,45;S51 -659" BjornAL. OwailL Parliatedentulism and its prosthetisfreafrfi€ntA trequencystudywilhina $rsedistr population. available. SwedDentJ, 1979;3{1}:15-25. Noabstract BriflN, TrydeG, $tolteeK & El Gh*rnrawryE A" Scu/ogicclunges in theoralcavitycausedby renavJ FrosthetDent.1977,3S:138-148. ablepartialdenftIres. Sritt{rl.195?:Frcrninensana$saforen og ders anv*ndeJse. Tandlaegebladet 6t :215-?29. Prorninersanafyee landfaegeb}adef f{. 81.94-1,S7. Sritt 1$$7: to sparkerosion,J CanDentAs$oc Ifre miltedimptantbar:an alternativa BrudvikJ$, Chigurupatik. 6${8}:485-82002. inle4c*Jafe Apollonia, 2001 SurfuiV",FornaN.,lfteniS"" }linieaEi&rapiam'enta{rbipa4ra/e r*&$e, Editr"rrs fnfinsq $urluiV",FornaN. Cllnrcapi terapiaedentatiei Editura Apollonia 40CI4 , Wr|4iale Carlssonfr E" HagnarssonN & AstrandP, Ohengesin height*f the alvealarprocessin sds#lu/err$ 19S9, seg/??snl$ 0,$venskTandl*kartidning 6?:125-13S. MG.SthicalFeriadontolsgy, Stheditisn,WBSaundars frarranzaFA andNeurrman Qo.,1996. for Cornposra Liningof fremovaCazacuM",Antohahd.,RaclesC., VladA., FornaN. $ilicane'Sased *009' ble DantalPrcsfftesis, Journalof Cornposit* Materials, Cfadt$, Sarnbrnatinnfix*dlremovablainplanf proslhesisusing sparkarosfonfec$nology.lmplant society 2:1s-I6, 1$91. ar#fiblels in reabilttarsa orafd,Editur*Fe#srrnantica, 2009, Sracil"rnescu A., Fornali.l.lnfelrgen{a

371

2V. Ssttune,Terezhafmy,and Molfnari.FracticalJnfsclfonOpnlrolin Oendsfry-tnd editinn,William*& 1996. Wilkins, pa#falden2S. SurtisBA,CurtisTA, WagnildGW-FineenFC"lnsfdencesf nfl{o{rsclassesaf rernoyafrle Fleviewfilres.J PrasthetBant^1992*IanS7i5):$O*"7. 29" *avenportJ.C.,BaskerF.M.,lleathJ.Fl.,RalphJ.F.,GlantzF"O.C/aspdes,ign, SritishDentalJournal, vol.190"fSSt ss. **venporfJ. C., BaskerR. fu|.*HeathJ. *., HalphJ, F., GlsntsP. O., Hamrncnd F. Gonnecfors, Eritish Sent*lJournal" vCIl" t$0, 3001 31. S*venparl,l"C., SaekerFt.M., i{eathJ. R.,RalphJ. P.,GlantzP. 0". Harnmond F" tnftialprasthati* lreafinon|; FritishF*nlalJcurnal,vcf.190,20S1 *e, ilavenport"1.C., Ba*kerfl. M",FleathJ. fl., FtalphJ. F.,GlanteP, O., Hamrnond P. tndirectraf€nffon, British*entalJournal, vo*.190,?0Sl S$" ilavenportJ. fi", Besk*rfr. M.,H*athJ. H..ffalphJ. P.,filantr P. O",Hammand P. Iooffi preparafla4 BritishDentalJournal, vol.t90- 90S"1 34. Davenpo*J" C., Fa*kerE. M",HeathJ. Fl.,R#phJ. F.,GlanizP. O., Harnmand P. Eracingand reci^ procation, vol. 190,2001 BritishD€ntalJournal, S$. fiavh SM.Theroleofimp/anfsin{hefrsafir*nf ofede*ftr&uspafienfs.IntJ ProstllrdontS:42-50,19S. pros*resrswith a mitled ,J" lmplant-supparted A, A* flxd-removabte Davodi Nishimura Fl, Feumer S$. tor Hader rs$foretive maxlilh.J Pr+stheiDent optian tha edentulotls fiss$ebar and clrprsfefifions$ a 7S:?12-17,1997. Sf. DpnesFS. IAe ,Sp*ecfiGhain.Ifte Pftysicsartd Biotryyof $po*en Languaga,EN Pinssn,2nd EdiNY. tion.WtlFreemanandCompany, 3S. Dentrstry,Se*tal Fr*efce and ffm Oammunity, BA 8urk, $A Eklund,5th *dition, W8 $aunder$60., 1gsg" gS. DevlinH. tnt*grating p*sfenbrcrossns withpartialdenfure$, Briti$hilentfilJournal, vol 191.*001 Munksgaard, 2S07 4$. DragoC. frnp{anf Elackvvell Fesl*uration, parlieltplatpratetik. Klinisktkompendiurn. Institution*n tdr proletik,Karclinska 4'1. Ekanb6ck J" Auf;agbar institutet, 19S1. Huddinge, 48, EkteldtA" Christianssan tJ. et al" A retrospecffr/€ analysisof factorsassociafedwith multipl*implant 20S1. Rest2{5}:a62-7, fatlures in maxillae.*linOrallrnplants 43. FarmanAfl*nG., NqrtjeCIhristoffelJ", WoodfrcbertE. Aral andMaxillalacial Fi4gnosticImagrg;Mosby,199$ 44. FrankRP"Oonlrr#irgrpressuresduringcomplefsde'nfurein4pressians. FSNA1S70,335S-461. 45. Franh WR. tlankbdrfyirt deniis{E'desrgns o{ a removaHemaxillarypartraldanture.J FrosthetDent. 'l97$Feb;P${21\:17A-82. tla abstractavsilable. 4S. FrantaWFl. Vanalionsin a ramavablemaxitlarypartialdanturedesignby dantists.J Prosthetfrent. 1$7$ilec;S4{S}:0?5-33. 47. FsrnaN. Ialescnparea fn Fatamentul laqi,*001, edanlfiieipa$ialeln#nse,fiditura"Apollonia" 48. Forna N.. CIrel&eha$ildafibnbafween fraatity and Faradigm,flevista mediso-chirurgic*1fi, 200$ Vol11?,f*r"? {Aprilie-lunie) 49. FornaN., V" Sur*ui.*linim gi ler4plaSdenfdfeisia Fierderiida$uFsfenfdMaxilp-Fa*iald" Ed.ApoF lonia,lagi,l998 in th*Tharapyof PartialExtended S0. FnrnaN.,V"Burlui.#linicalGuide- LinesandPrincrples Edentation fcr FnglishLanguage Student$,*00J - Oursbook 51. FornaN. €vaft.r*rsa Hdituratrerniurg, ?007 S{Sdide$5n#fafaAfeoldte #in Fdpnfsfi€, 2SCI8. 52. FornaN. Irat*r de Fr*teti& fienta#, Editura",Gr.T.Popa", 53. FornaN.,Antohetfi. fteabititarea $ubefan{d, EdituraDemiurg, Fiardenforde 2S07,IS$N978-g7g-15t" 03s-3. 54. Ftrller,JfandDenehyGE.ConciseAenuiAnatomyandl$orphalagy, Srdedition,SV Mcsby;1999. 55. GartnerP. ffssen#elsof Oralffismlogya;ndEmkoy{qy,3rd edilion,Jen HousePublishing, Saltimore. 1W9.

Glan* F-S& $taffordG S" Ffiee#ssfcf s*me eompana*fson ttrewd$ sf mandibular SiJaferal free andsaddlsdentures. Oralfrehablt.1gg0.?:4AS-4SF. S?. G"Graber.#enrova&fe Padial&eafures. Cofar,4flas rf trenfa/fi/edicine. TtriemeVertr*g 1$g$ 58" HaischL, l{aRs*nC" oenlinaj€{pssffrsrestrf{i4gfr*m baltresf ssaf pr€parafi:ons rn mandibularcanines.J ProEthpdont 1SO3;p:70"8. S$" HansenCA, Jaarda MJ. Ireafmenfallernafivesfar a medifiedrcmbinatian*yndrarne.*en Dsn 1990.&8:182-137. 56.

60^ Harv*yWL, HoffmanW Jr. I*n-year studyol frendsin remoya&le prosffiodcntfcservlcs.J Fr*sthet Bent.'l9SSDec;S3{B}:$44-S. S1. HedegArd B & *inrneff0,Oenf*//abpr*torieteknik.Tandlfrkarf6rlaget, Stnekholm. 1$8"f , S:l4S-pE$. $8. l"{enderson & $tetfel.&fr#raaksnsFsmovabfeFartiatPrasftisdon#c$. Meshy1$Sg s3. HindelsGW lsaddisinbufion fn extensicn *addlepartialdentur*s. J FrosthetFentt:g!-1S0,ig$t. 64. ldotxuA?, Al-$hamraniSM. Peffernof toathlCIssi"r a selec{sdpputatianat King Saudl}niversity, Callegeof Fentistry" *iyadhKSAThe$audiilentalJournal1F$g;7:185-9" 65. lmaiY, $ato T, Mnri$, CIkamoto M" A f*lsforno4pframetric anatysisof &onedynamicsindefit{Jrs${lpportingtissueundercanffru;ouspressure. J Oralftehab,?$0p:f9: TZ-T\. 56" JemlToEonkK, et al. Fa#uresand wmplimfionsir #8 consecutivety inser$sd sysridenfirrss swpported be Brfinernad< imptants rnseverelyresonbed edenfu/ausnaxillae:A studylramprcsfle#cftaatrnent to firstannuatcheck-ap. IntJ OralMaxillofae lmplanlsi:i 62-7,"lgg2. *7" JemtT, CarlssonL. et *1.ln vfvc/oadffeasyrementson osseoinfegrrafedlmplanfs supportinE lixador pr:nsfftesfs: remorable a wmparativep#oisfudg IntJ OralMaxillafac tmplants 6:413-t,1991. s8. JemtT, ChaiJ. et al. A #-yearprospactivamultieenter {allow-upreporfon averdentures supported by *sseornfegrated implants. lntJ Ora[Maxitlofac trnplants 11:291-S.199S. $9. JemtT, l-ekholr*U. Implenftr€afrnenfin edsnfirousnaxillae:A 6 year toftowup rryn an pefients withdifferentdegrsp$ ntjaw resarptian.lrt J Sral Maxillofac lmBlants 10:303-'t1, 1gg$. -7n K Anusavice. Fhillip's$cienceot DentalMaterialc, 1Othedition,W.B"Sar:nders So., 1gg$. Ka*ber8. Atv*alarchanga*in relatianta rernovable pafiialdentures. lnt J Oral$urg. tgTT-S:3SB-3F4, 72. KartsenK. Avtagbare parti*lleptafeprufeser. NordiskKliniskOdontologi, EandV, kap"ZI-LV. 1SI&, Almquist& Wiksell,Stockholm. v2 KellerFE, TolrnanSE, €ckert$8. Maxifieryantrat-nasalfnkyanfogenous banegraftteoofistrwtionof 't4:TS?-E1, a earnpromised naxilla:A t$-y6a(ret$srytfueetudy.lntJ OralMaxillolac lrnplants 1ggg. 74. KefferE[, TohnanSE, Ec]tertSE. $u4gicafprosthatic rpccnsfrucfion of advancedrnaxiltary banecornpromisedwith aut$et.tougon{ayblochbonegraftsand osseointegrafed endosssousirnptants: A 't* yearstudyaf 32 consecutive patients.Int .JOralMaxillofac lmplants14:197-20$" 1ggg. KeflyE. Ghangescaussdby a mandibular removablepa{tiafdenturecpposinga maxiltarycampiete ds'nture. J Prosthet Dantig7g,2I:140-1$0, ?S. KennedyE. Partialdenturecsilstructisn. Brooklyn:Fentalltemscf lntere$tFubliehing Co. tB?B;38.10.lSS;3:47-51. 7v^ KennedyE. Partialdentureconstruction.l st ed.Brooklyn(NY):Sentalltemsof Intsreti 1spg. 7S' K*nnedyE. Partialdenture c#nstruction, ?nded.Srooklyn {NY}:Dentalltemsof lflterest;1944. 19. Klausfl., Rateitschak * CalarAf/asof fiental 8"M.,WolfH.F..l-tassE|M. Thomas,P#ricdlont#Wy Medlicine, ?ffiedilicn,Thieryle MedicalPublishers, lnc,newyork, lggg s0^ KordassS, GaertnerCh. I'hg viftuatarticulator---aoncept anddeval*pmant al Vn-tuatsfc arufysefft* dysfunctlon o{ dentalacclusion.In: LemkeHU.VannierMV,InernuraK, FarmanAG, Ssi K. editors" CornpulerAssistedRadlofagy and $urgery:Frccaedingsof the t5th lnternational Gongressand Exhibiiisn CARS*S01.Amsierdam, TheNetherlands: Elseviar$cience8.V.,20S1;S49-6f3. *1' Krol A.J,JacobsonTH, Finlsn FC. fieftfi'vablepartialdenlure designoutlinesyttabus.Indent, $an Rafael,California. 1$90. 8g' Krol,Jacobson andFinaen.Semopable Fartia!frenture fesrgA 7thEdition,lndent,1g$g.

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J Prss of tr&atmnntfsr ffie uombinsfio*syndronze, Lang*r Y, LauferBZ, frardeshl{$. Jldadatifiss 1995,4:7S-81. Inc.,2001. Livingston, $rdFdition,Churchill S4. LarsenWJ,lduman€mbryalogy, J ProsthetCIenl compasile. of tingualreslseafsin light-cured far preparation BF. LattaG. A technique 1988;60:1?7. sf sJinic*lvariabtes.EurJ S$. Lechner$K, ThamesSA" ffemsyafls Ffirt{fiIdenttrredesrgn:rhrpartarrce :127-9^ RestorDerit.1994Mar;2(S) Prosthodont #rplanfs'J SI. Lewls$, $harmaA, NishirnuraR. Traatmentof edentulausmaxillaewffhpssesinfegrst€d 1g$2. Prosthal Dent68:503-$, Editian,B.c. Decker,2000. Easisaf oentistry,Zrrd 88. Liebgott,ThaAnafamical *f cingulumr6sl s86fsin ircisorandcarinefeeffi.EurJ ProsSg. LikernanF, Ju*z*yk A. An examinatian 'tSgS; 1:1SS-?1. Uent Fleetor thodont SrdEdition,;Munksgaard, andtmptantDantistry. LanS.GlinicatPeriodontotogy s0. iffi;;K;;Cand 1998. gt . f-VonHH.Resrn-bonded restseafs.J FrosthetDent1985;53:36S-8' etched-meta, Co"-1994gZ. M K*ele.AnAffasof trenrelEadfrgr4pfiicAnafomy,4th Edition,WBSaunders gA. fiiacGregorAR.Mill+rTPG&FarahJW.$tressanalysisufpartinldentures.JDent"l9?S.$:125-13 design. J DentRas.19?0,49:359-3#. inpartialdenture distrihrlion M & GotoT. Lateralforce S4. Mabumoto g$. McArthurD. Senln*sas removable pa#latdenturea&ufnrenfs.Fart f; Toothrankandcanine incr' neilt 1986;5S:197'9" dence. J Prosthet g6. Mcoracksn lst ed,$t. Louis{MO}:C.V.MosbyCo.;19S0. csn$nrction. WL.Parfr€ldanlure gZ. Mericshs-Stern fi, OelteriiM, ct fil" A follow-upstudyof maxiltatyimplantssupporfirslan overdenture: lmplant$17:S78-SS,200?' resulb.IntJ OralMaxilt*tac andradisgrqptru Gtinical pafie$t 6lin Oral lmplFes gS. Mericeke-$tern af theedcnl#taff$ R.. TaylorTil, S**s*rlJ. Management 11{Suppl}:1 08-25,2000. Sg" MeskinLH,SrawnLJ. Freyalenssandpatternsof toothlossin U'S. ernployedad*lfandsenforpopuNoabstractavaitftble. J SentEduc"1988ilec;58{12}:6SS-S1. laffons,1SS5-*$. maxilla fo reftin.4hrng" imptants in thereeorbed splinted tr. Rigidty 1$CI.Nasrtl, Giaani$,v*n Steenberghe yaar:s. J FrosthetDent79:156'S4,1998. seriesof alinicatraprt* forup fa 4 ingorardenture:,4 A rrtainsdby Wlintsdand unsptintdimplants: ovefidenfur€s 1fi1. frfarhiTO,HevingaM, ei al. Maxiltary 2001. lmplants16:?59-ES, retraspttiv*study.IntJ OralMaxillofec Novartie, 19$7. Edition, or 2nd 102. NetterFH. Atlasal HurnafiAftatorny,lst 1934' J AnrOentAssoc21:1572'82, andcentricrelation. MH.fiestpositionaf mandible 1Sg. Niswonger Sfsurdarsand A*fusion, 3rd Edition.Mosbyof Temparamandibular 104. OkesonJF" ll,fanagemdnf 1993. Yearbook, A needlo focuson hygianic jCIS. OwalfB, Sudta-J0rgen*en E. *tal. ftamovablepanialdentur*desrgtn: 15:371'78,2ff0?. principles? lnt Prosthodont -J den{uresgonstrircfsdforpa$ent$it} 1il6. OwallfiE, TaylorFlL.4 surveyal dentitionsandremavabtep*rfial .i FrasthetSent.198SApr;SI{4}:4S5-7S. f{orfftAmenca" of F, Sayne,SC,F$lton,DA. Itreedmension# finiteefem*nlanalysis G- Kamposiora, 1OT.Papavasilicu prosthefr'c type, aftd aroundsingletooth implantsas a functionat bony supprt, $fress-distnbution ProsthFent1996;76:633-640^ duringfunctian.J toading patel acclusalrertisefdtfisn$ionusirryan averlay forfiF$fodng trreafnren{prcfoecf A Mg, Bencharit9" 10g. frxed restarafons.'aelinicalrepart,OpenOent exfpasive f* parfiald*nfureas an alferRafive remorrafile proeessJ 19915723 J. 200SGct3013:?1S-S.PMID: [FubM*d" in to parlialdenture oonnsslsd mandibularrernovable lrd,psllecchiaH, Emiiaz5. Fistalexlensrbn 10g. Fettecchia A clinicalrarr*t .i FrosihetOentS3:S0F1f,2000. anfeftsrfrx6dirytant suportedprosflt*srs. tr993" Surgery, SrdHd*tien, Maxittofacia! & Oral 110. Petsf$onLJ,et al. Contemporary padial petridig frddfi"/tsilfi,4review*{ in removabte d#fitare tr*,f*emptonTJ. Pedodanf*lconsiderations 111, 14:'tr 64-79,?0S1' lntJ Prasthodont titarature. *8"

1951. Dent1:98-'t11, values. J Prosthet 112, PoundE. Esfhaficdentures aN thekphonetic lmBrAnemark implants.Int J OralMaxillofac on 113. RangertB, JemtT, JorneusL. Forcesand moments plants4:241-7, 1989. 114. Rateitschak KH and EM.HF WolfandTM Hassell.ColarAtlasaf DentalMedicine1, Pertodontology, in theHSCLibrary). Thiemelnc.,1989(available on resery€ 2ndedition, averdentures: Clinicaland laboratory 115. $afinasTS, FingerlM. et al. Sparkension implant-supprted 1992. lmplanlDent1:246-51, techniques. partialdental ol removable 116. SatohY, MatsuzuM, YashiroJ. et. al. Sfiafsfca,obsenrafibns '/?,stheses. available. No abstract 1982 Jun;24(2):95-101. J NihonUniv$ch Dant. of ageto toothloss rn a chroniccare SL. Flelationship 117. SaundersFIHJr., $olomonES, Handelman No abstractavailable. tacility. SpecCareDentist.1982Jan-Feb;Z(1):25-30. 118. $aundersTR, GillisRE, DesjardinsRP. The maxillarycompletedentureopposingthe mandibular partialdenture: J ProsthetDent1979,41:124-128. Treatment mnsiderations. bilateraldistalertension approach.J ProsthetDent1985,54:664-671. sydroma:A traatment 119. SchmittSM.Combrhation Contemporary of OperativeDentistry-A 120. SchwaruRS. Fundamentals ftpraach,Znd Edilion,et al; Publishing Co., 2000" Quintessence Approach,2nd edition, of AperativeDentistry- A Cantemporary 121. SchwartzFS et al. Fundamentals 2002. Ouintessence. aux implantsden' 122. SchweikertE.O. Eridges avec extensionsmiltiples- Solutionde remplesement prolhese, 1995 no. mars, 89, fa#es,Lescahiersde syndromeaffiongdenturepatients.J Froslhet 123. ShenK, GoggloffRR.Prevalence of the combination Dent1989;62:642-il4. 124. Shilfingburg HTJr, GraceCS. Ihrbknessot enamelanddentin,J SouthCalifDentAssoc1973;41:33passim. 6, of FixedProsthodon' HT,Jr.,S Hobo,LD Whitsett,R Jacobi,$E Brackett,Fundamentals 125. $hillingburg 1997. fics,Chicago:Quintessence, Ottawa(ON);Queen'sPrinof Bartialdentureplanning. 126. Shillington GB.Handbook of thefundamentals ter;1957. Mosby,1993 secondedition, 127. SoamsJ.V.,Southan J.C.OralPathology* restorative designfor implantprosfhefib.lnt J Pecase:An alternative 128. StarrNL. Thedistalextension Dent2'l:61-7,2001. riodontics Restorative andWilkinsCo Edition;Williams 129. SfedmanbCancise MdicalDictionary,lllustrated,24th BritDentJ on plaqueaccumulation. 130. StiphoH D K, MurphyW M & AdamsD. Effocfof oralprosthesis 1978,145:47-50. partialdenturedesign.Quintessence Publishing Oo., 131. StrattonHJ,WiebeltFJ. An atlasof removable lllinois,1988. lnc.,Ohicago, Dentisfi,3rdedition,CVMosbyGo.,1985. of Operative 132. Sturdevant CM. Ifre ArtandScience (MO):C.V.MosbyCo.;1955. 1st St. Louis 133. Swenson M,TerkloL. Partialdenfure. ed. pattialdenture designsby commercialdentallabora' Maxiltary removable 134. SykoraO, Calikkocaoglu$. Noabstractavailable. foriss.J ProsthetDent.1970Jun;23(5):633-40. edition,Mosby,1998. andFunction,Sth Development, Structure 135. TenCateA. OralHistalogy, McGraw Hill,London,1970. Elasticig,3rd edition, 136. Timoshenko SP,Goodier JN. Iheoryof prosfhesis:a treatmentalternativefor removableimplant-supprted 137. TiptonPA. Themilledbar-retained 2002. maxilla.J EsthelRestorDenl14(4):208-16, theedentulous 1955,E9:873-885. 138. TrydeG & Brantenberg F. Densublinguale barre.Tandlaegebladet prosthesis. practical Dent A altemative. Quintessence 139. Van RoekelNB. l'he fixd-remavableimplant Tech49-61,1995. partialdentures: Survival of removable 140. Vermeulen AHBM,KeltjensHMAMet al. Ien-yearevaluation 76:267-72, 1996. J Prtosthet Dent ralesbasedan retreatment, notwearingand raplaeement

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of maior@nnectotsfor mrnauab/eprtial dentures.J Pros' l4t . WagnerA G & f*rwe ak F C, Camparfson thetDent.1982,47:242-245. 1999. 8thEdition,McGraw-Hill, 142. WeberJC. Sheare/sManuatof HumanDisseAion,, AlhEdition,CV MosbyCompany, and lnterpretation, - Principtes 143. Whiteand Pharoah.OratRadiotogy 2000. J Dent Res of the suport of prtiat derrturos. 14{. Wills D J & MandersonR D. Eiamechanic€l4speclt 1977,5:310-318. Fa0eng t'llh Rtition,CV Mosby, 14S. Za;6 GA, et.al. fuuche1sPrythadonticTreatnwrttbr Edentulaus 1997 if lixed ar removablelmptant'supportdprosfheses i46. ZiEmannNU, MarinalloCP, ?roatmentoutcf,lmes J ProsthetD€nt83:424'38,2000. P.anl: Patients'assessments. in the&entutousmateilla }eatrnenfoutcomesof fixedorremovabtelndant'saryorpdprosfheses 1'€?.'Zi2mannNU,MarineffoCF. 2000' J ProsthetCIent8&:42s93, nna{ina. ln he adentuteus Partll: Clinicalfindings" partial dentres an pdodontal effed of The removable M, t#). aaled6 DK, CelebicA,\Ialeji{c-PerzMc teetft.J Partodontal79:137-44,2t0?. healtholabu8nenltoe#iandnon-abufmant

27A.

PROTEZATOTATA

CAPITOLUL B

DAIE ltrffiAr0mrE Glt]trc[$ Hil||locfi0nAH 1AEIITIIIIIU1 I||I[1 proteti- trebuisd acfionezealternativ, Reugitaterapieide restaurare cAndasupra cd a edentafiilor totaleestelegatdde o cu- !esuturilorvii, cAnd asupra protezei,Tn noagtereamdnunfitda componentelor gi functiede uzuragi/saudeteriorarea acestostructurilorce alcdtuiesccAmpulprotetic. ra. De altfel,valoareaunuiprotetician conAcesta cuprinde totalitateaformatiunilor std in a gti mereucAndgi undesd intervianatomicecare vin in contactdirectsau nd:pe tesuturisaupe proteze, fiindcdmariindirectcu pieseleproteticegi care contr.i- le problemeale edentatului totalincepdubuie la menlinerea, protezelor gi fin pAndla sfArgisprijinulgi stabilitatea pd inserarea lor. tul vietiilui. Calitateagi particularitdfile individuale CAmpulproteticedentattotalprezintd ale tesuturilorcAmpuluiprotetictrebuie zonede sprijin9i zonede ?nchidere marevaluatecorect de la inceput,deoarece ginald. majoritatea nereugitelor in domeniusunt Zona de sprijineste formatd'dintr-o gi componentd consecintaunei examindriinsuficiente durd(osoasd),acoperitdde o superficiale a pacientului. Cu timpul,rutina fibromucoasd fixd,de multeori aderentdla gi desfdgurarea includediagnosticul rapidd substratulosos.Aceastdzondse numegte a procedurilor clinicedevineaproapeun de sprijin,deoarecepreiamajoritatea preact reflex. gi parafuncliilor siunilordin cursulfunctiilor Pentruca ,,citireacAmpuluiprotetic" sistemului stomatognat. sd se facdfdrddificultate intreagazondde sprijinsuportdsolici9i intr-untimpcAt mai redus,este necesarsd facemo incur- tdri verticale,orizontale9i de forfecare, siunein cAtevadiscipline de bazdca: ana- avAndo capacitate de receptiecu multmai tomia,fiziologia, tizicagi biodinamica. redusddecAtsuprafalaligamentard a periUnelenotiuniapa(inde anatomia de- odonfiului dinperioada de dentat. scriptivd(inserfii, traiecte);nu vom insista Indiferent de calitateauneiprotezetoasupralor decAtin mdsurastabiliriiunor tale, ea are un grad de mobilitatefafd de interrelatii. Vom descrieinsd detaliatacele cAmpul protetic.Denumireade protezd formaliunicare participdla armoniaunui mobildvinede la faptulcd poatefi inseratd gi dezinseratd ansamblu intreprotezegi lesuturile vii. de pe cdmp(de cdtrepurt5prote- torul ei), dar probabilgi de la mobilitatea in cursulterapieide restaurare ticd a unui edentattotal, practicianulva perpetuda acesteia.

379

Suprafafazonelorde sprijinla maxilar este aproapede doudori mai maredecAt la mandibuld. Estelesnede intelescd, in gi parafuncliilor, cursulfuncfiilor fo(ele receplionate de mandibuld suntdublepe unitateade suprafatdfafd de cele primitede maxilar. $tiindacestlucrune putemexplica mai ugor atrofiiledramatice,care apar la cAmpurileproteticemandibulareedentate total. Zonade inchideremarginaldeste situatdla periferia zoneide sprijin,fiindalcdtuitdde mucoasacareciptugegtefundurile (la mandibuld de sac vestibulare 9i lingual) precumgi dintr-opartea mucoaseimobile a obrajilor, limbiigi buzelorce vin in contact cu suprafeleleexterneale protezelor. De subliniatexistenfaunei ,,benzi" de mucoasdsituatdla grani[adintremucoasafixd gi cea mobild ce acoperdcrestelereziduale a fundurilor de sac,carepoartdnumelede mucoasdpasivmobilS.La maxilartrebuie remarcatdzonade trecerede la palatuldur penla palatulmoale,cu o valoaredecisivd tru inchidereamarginald totale a protezelor superioare. gi pAndla machetaDe la amprentare rea protezelortotale medicultrebuie sd urmdreascd treiobiective fundamentale: a. transmiterea cAtmaiselectivda fo(elor exercitatede bazeleprotezelorpe zonelede sprijin; b. conformareamarginilorprotezeiin argi lesuturile moniecu formaliunile de la periferiacAmpuluiprotetic(zonade ?nin menchideremarginald) cu implicatii tinereaprotezei; c. ob[inereaunui aspect esteticfinal al protezat,cAt mai pldcutgi individului

380

natural,printr-omontarecorespunzdtoarea dinlilorgi o DVOcorectd. I. CAMPUL PROTETICMAXILAR CAmpulproteticmaxilareste alcdtuit din fesuturiduregi moi,carevin in contact cu protezatotaldmaxilard:crestelerezidugi ale,tuberozitdtile maxilare, boltapalatind fibromucoasa oral5. A. ZONA DE SPRIJIN Zonade sprijinla maxilarare in medie o suprafafdde 25 cm2,iar cAnd,din diferitecauze,scadesub 10 - 15 cm2,ea poatefi augmentatd prindiverseprocedee. pe carele suportdsuntde aproPresiunile ximativ1,6kg/cm2. SUBSTRATUL OSOS Substratul ososal zoneide sprijineste alcdtuitdintr-oserie de formaliuniale osuluimaxilar.Procesulalveolar,denumit de Beltrami,,osdentar"(deoarecese dezvoltd gi dispareodatdcu dintii),se transformd in creastdrezidualdprin pierderea dintilor,cAnd alveolelerimAn goale (fig. 8.1).De aceea,in literatura de specialitate, se mai apeleazdgi la termenulde creasti alveolari reziduali sau creasti edentati. La maxilar,datoritddiferenfeidintre gi cea a circumferinta corpuluimaxilarelor arcadeialveolare,procesulde resorbtieal cresteialveolarerezidualeeste centripet (fis.8.2). Odatdajunsedentattotal,fiecarepacientprezintdo creastdedentatdcu o morfologieindividuald, in funcliede cronologia gi etiologiapierderiidintilor.Modulin care

s-aufdcutextracliile igi punegi el pecetea asupra morfologieicrestei edentate.De obicei,imediatdupd extractie,indlfimea cresteloralveolareeste mare iar ulterior, datoritdatrofiei, inSltimea lor se diminueazd. Deosebim cresteinalte(13 - 15 mm), medii(6 - 12 mm) 9i reduse(sub6 mm). Creastaalveolardrezidualdare o muchie (saucoamd),un versantintern(oral)9i un versantextern(vestibular).

creasta alveolard maxilari

Fig. 8.2. Atrofiacentripetda cresteialveolarerezidualela maxilar(schemd)

f fi h

i

Fig.8.1. Componentele dureale cAmpuluiedentat totalla maxilarulsuperior: A. cAmpproteticrecent edentat:a - gauraincisivd;b - alveoledentare;c os incisiv;d - procesulpalatinal osuluimaxilar;e suturapalatindmediand;f - suturapalatind transversd;g - lamaorizontalda osuluipalatin;h gaurapalatindposterioard(mare);i- spinanazald posterioard.B. componentele dure(schemd):a gauraincisivd;b - torusulpalatin;c - creasta zigomato-alveoIard; d - tuberozitateamaxilard; e gaurapalatindposterioard;f - cArligulapofizei pterigoidiene(76)

Versantulextern al crestei edentate poate fi neutru,retentivsau neretentiv.La maxilar, spre deosebirede mandibuld, creastaimbracdrar aspectulde ,,muchie de cutit",de obicei,pe sectiuneavandformd ovale,triunghiulard sau pdtratdrotunjitd. Cele mai apreciatecresteedentate,in practice,suntceleinalte,lategi neutre,fdrd gi exostoze.Extracfiile deniveldri caremenajeazdfesuturile din vecindtatea dintelui, conservAnd peretii alveolei gi septul interradicular, asociereaimplantelor de adila [ie, ca gi suturilepdrlilormoi, contribuie protezdrii. obtinerea unorcrestefavorabile Resorbtia 9i atrofiacresteloredentate la maxilaravanseazd in timp,fiindmai lentd la nivelulfrenuluilabialsuperiorgi la cel al frenurilor bucale.Ca gi arcadelenaturale, gi cresteleedentatemaxilarepot avea formediferite(fig.8.3):pentagon, ,,u",,,V", asimetrice etc. Morfologia diferitda creste(fig.8.4) influenlealor alveolare reziduale proteticmaxilar. zd retentivitatea cAmpului

t.\ til

L- +-J Fig.8.3. Diferiteformede crestealveolarereziduale:a - pentagon;b- in formdde ,,U";c- semielipsd; d - in formdde,,V";e - asimetricd.

wry -t*A

I

i

k

[*r b s

W ffi

W

de

c l

Fig.8.4. Variantede crestereziduale,privindindltlmeagi ldlimea(schemd):a - inaltd;b - medie; c - redusd;d - latd;e - medie;f - ingustd.

Este lesne de infeles cd o creastd gi redusd,cu un gradacedentatdTngustd centuatde resorbtie,oferd un prognostic protezdrii nefavorabil totale. in prelungireacresteloredentatese afldcAteo proeminenti(stAngd9i dreaptd) bineconturatd, denumitdtuberozitatemaxilari. Aceastaeste mai putin palpabild cAndmolarultrei superioresteprezent(fig. 8.5.A),devenindmult mai evidentddacd acestalipsegtesau a fost extras.Dinpunct are de vedereprbtetic,fiecaretuberozitate distalgi caudal(inferitrei poli:vestibular,

382

or). AtAt pentruamprentare, cAt gi pentru protezelor inserarea9i dezinserarea totale, mai importanfi sunt poliidistaligi vestibulari,care dacd sunt retentivi,pot crea dificultdti,impunAndu-se corectareachirurgiPolulinferiorpoatefi, unecal6a acestora. ori, foarte apropiatde creasta edentatd mandibulard, astfelincAt,la o DVOcorectd, spatiulproteticsd devindinsuficient. $i in aceastdsituafie,se apeleazdlao corecastfelincAtsd oblinemun tie chirurgicald, spatiuproteticminimde 4 mm. Tuberozitdfile maxilaretrebuieacope-

rite integralde baza protezelortotale.O tuberozitateresorbitdsau pa(ial distrusd sau distrusdin totalitate, in urmaextractiei laborioase a molarului doi gi/sautreisuperior,estelipsitdde valoareprotetice.

(hamulus pterygoideus).intre acesta gi polulposterioral tuberozitdfii se afldgantul pterigomaxilar, care trebuieinregistratde medicAi perceputde tehnician,fiind un reper importantin realizareainchiderii gi distalea promarginaleperituberozilare tezeitotale. lmportanladispunerii9i morfologiei reziduale, crestelor inclusiv a tuberozitdtilor maxilarepentru retentiaprotezelortotale superioare esteilustratd in fig.8.6.

*'*1

,r,---'-**,r-

n"

s.afilulpudcD.fiarilar

Fig.8.5. Maxilarulsuperior: a. vederelaterald (schemd)1. fata orbitard;2. canalulinfraorbitar;3. procesulzigomatic;4.orificiilealveolare;5. creasta zigomato-alveolard maxilart; 7. ; 6. tuberozitatea proceselealveolare;8. juga alveolaria;L spina nazaldanterioard;10.fosacanind;1f . incizura nazald;12.gaurasuborbitald;13.marginea suborbitard;14.procesulfrontal.b. maxilarsuperior stAng(76)

b Fig. 8.6. Retentiauneiprotezetotalela maxilareste datd de direc[iagi configuratiacrestelorgi tuberozitdtilormaxilare(schemd):a - sectiunein plan frontal:T-Tdistanladintreproeminentele maxime ale tuberozitdtilormaxilare;Z-M distanladintre zonelemarginaleale cAmpuluiprotetic.b - sectiune in plan sagital: T-l distanladintreproeminenta maximda tuberozitdliigi punctulde retentivitate maximda cresteirezidualein zona frontald;Z-M distanladintrezonelema.rginale ale cAmpuluiprotetrc.

in general,tuberozitdfile maxilarenu sufereprocesede atrofiegi resorbfieatAt O altdcomponentd a zoneide sprijin, de marcante,comparativcu crestelereziduale,de aceeamul[iautorile considerd la maxilar,estebolta palatind,consideratd maxilare, ca zonebiostatice de sprijin.Distalde tubero- gi ea, aldturide tuberozitd[ile Palatul zitdli,estesituatcArligulapofizeipterigoide fiind o zond de sprijinbiostaticd.

383

dur, suportulosos al boltiipalatine,este formatdin palatulprimargi cel secundar. Palatulprimar,la rAndulsdu, este format din oaseleincisive, iarpalatulsecundar din proceselepalatineale oaselormaxilaregi lameleorizontale aleoaselorpalatine. palatuluidur in alcdtuirea suntcuprinse: - doudoaseincisive; - doud procesepalatineale oaselor maxilare; - doui lameorizontale aleoaselorpalatine. Prinunireaoaselorincisivecu procesele palatineale maxilarelor, se formeazd suturaincisivd,care este o suturdtransversalS,situatdin treimeaanterioard a palatuluidur din dreptulincisivilor laterali, din stAnga9i dreapta. palatine Unireadintreprocesele maxi-

laregi lameleorizontale ale oaselorpalatine formeazdsuturapalatindtransversald, care este pozilionatdin dreptul felelor distaleale molarilor secunzisuperiori. Posteriorde aceastdsuturdtransversald, este situatdgaurapalatindposterioard sau gaura palatindmare (foramenpalatinummajor),la bazaproceselor Pringaualveolare. ra palatindmaretrecnerviipalatinianteriori gi pachetulvascularaferent.Localizarea gduriipalatinemarieste medialde pozilia pe arcadda molarului trei,la 0,5cm anteriposterioard or de marginea a boltiipalatine. in aceastdzond,baza protezeinu trebuie presiuni protesd.exercite asupracAmpului tic nefiindimportantd din punctde vedere protetic.Elocventdpentru cele descrise anterior estefig.8.7.

suturc p