Abstract
For many patients, loss of teeth is the beginning of a period of dental disability.Bone resorption, concomitant retention, drawback of dentures, associated difficulties of pain, diminished chewing function and changed facial appearance, are the common problems.Poor satisfaction with dentures is associated with poor denture stability.
However the percentage of edentulous
... read more
adults has declined over the past 30 years, the need and demand for complete dentures will increase until 2020, as the baby boom generation matures into the upper age groups.
An overview of pre-prosthetic techniques for treatment of the edentulous mandible is given. Moreover, instalment of dental implants in order to preserve edentulous bone and improvement of the retention of the dental prosthesis are mentioned. Although advanced implant technology with better performance of short implants might provide opportunities for patients with atrophic mandibles, reconstruction of the lost (bony) tissues to physiological proportions is still an attractive goal for restoring function and aesthetics. As such, there is a prominent place for mandibular bone augmentation techniques. Augmentation with (autologous) bone, gives the possibility of implant placement.
One of the main reasons for practicing vertical distraction osteogenesis (VDO) is the avoidance of a bone graft and the possible related donor-site morbidity. The goal of VDO is to regenerate bone tissue by slowly lifting the upper segment from the basal segment. VDO offers the possibility of a pedicled flap, allowing for periosteal blood supply. Formation of new bone in the distraction gap is related to ingrowth and the presence of blood vessels. However, a minimum of bone height should be present, to allow splitting of the bone in a upper and basal segment.
In this thesis different distraction devices for VDO are described. Moreover complications associated to VDO are mentioned.
It can be concluded thatdistraction osteogenesis, with respect to the limitations as described, can be a successful method for restoring atrophic mandibles, in order to gain sufficient bone volume, to allow implant placement.
As the extent of residual ridge resorption in the mandible is one of the most important factors, that has increased dissatisfaction with lower complete dentures, it is important to inhibit the progression of resorption by preventing tooth loss or by using implant-retained dentures. Besides, it has been proven, that there is a significant improvement in satisfaction and health-related quality of life in patients, who receive implant-retained dentures. Therefore, it is of extreme importance to monitor the edentulous patient. Waiting too long, until the bone height is diminished to a level, that an augmentation procedure can no longer be circumvented, must be avoided.
show less
