Clinical evaluation of implants retaining edentulous maxillary obturator prostheses
Identifieur interne : 000C45 ( Istex/Corpus ); précédent : 000C44; suivant : 000C46Clinical evaluation of implants retaining edentulous maxillary obturator prostheses
Auteurs : E. D. Roumanas ; R. D. Nishimura ; B. K. Davis ; J. Beumer IiiSource :
- The Journal of Prosthetic Dentistry [ 0022-3913 ] ; 1997.
English descriptors
- KwdEn :
- Adequate alveolar bone, Anterior, Anterior implants, Ball attachment system, Bone graft, Bone height, Bone loss, Case report, Clinical mobility, Clinical report, Defect, Dentistry, Differential pattern, Dramatic effect, Edentulous maxillary resection patients, Edentulous maxillectomy patient, Final restoration, First year, Frequency distributions, Functional implants, Graft, Graft procedure, Graft procedures, Immediate implant placement, Immediate placement, Implant, Implant failures, Implant location, Implant placement, Implant site, Implant sites, Implant status, Implant surgery, Implant survival rate, Implant survival rates, Implant threads, Intact withdrawals, Limited accessibility, Many years, Maxillary, Maxillary obturator, Maxillary obturators, Maxillary resection patients, Maxillectomy, Maxillectomy defect, Maxillectomy defects, Maxillectomy patients, Maxillofac, Maxillofacial prosthetics, Medical center, Mesial, Nonirradiated group, Number2 roumanas, Obturator, Oral implants, Oral maxillofac implants, Oral maxillofac surg, Osseointegrated implants, Overall survival rate, Patient charts, Patient death, Patient population, Posterior alveolus, Posterior implants, Posterior sites, Prosthesis, Prosthet dent, Prosthetic, Prosthetic dentistry, Pterygoid plates, Radiation status, Radiograph, Recurrence, Removable prosthodontics, Resection, Retentive elements, Retrospective analysis, Roumanas, Severe bone loss, Sinus, Surgical, Surgical defect, Surgical defect type, Surgical resection, Survival rates, Tissue bars, Titanium implants, Tumor resection, Vertical bone loss.
- Teeft :
- Adequate alveolar bone, Anterior, Anterior implants, Ball attachment system, Bone graft, Bone height, Bone loss, Case report, Clinical mobility, Clinical report, Defect, Dentistry, Differential pattern, Dramatic effect, Edentulous maxillary resection patients, Edentulous maxillectomy patient, Final restoration, First year, Frequency distributions, Functional implants, Graft, Graft procedure, Graft procedures, Immediate implant placement, Immediate placement, Implant, Implant failures, Implant location, Implant placement, Implant site, Implant sites, Implant status, Implant surgery, Implant survival rate, Implant survival rates, Implant threads, Intact withdrawals, Limited accessibility, Many years, Maxillary, Maxillary obturator, Maxillary obturators, Maxillary resection patients, Maxillectomy, Maxillectomy defect, Maxillectomy defects, Maxillectomy patients, Maxillofac, Maxillofacial prosthetics, Medical center, Mesial, Nonirradiated group, Number2 roumanas, Obturator, Oral implants, Oral maxillofac implants, Oral maxillofac surg, Osseointegrated implants, Overall survival rate, Patient charts, Patient death, Patient population, Posterior alveolus, Posterior implants, Posterior sites, Prosthesis, Prosthet dent, Prosthetic, Prosthetic dentistry, Pterygoid plates, Radiation status, Radiograph, Recurrence, Removable prosthodontics, Resection, Retentive elements, Retrospective analysis, Roumanas, Severe bone loss, Sinus, Surgical, Surgical defect, Surgical defect type, Surgical resection, Survival rates, Tissue bars, Titanium implants, Tumor resection, Vertical bone loss.
Abstract
Abstract: Purpose. Fabricating a maxillary obturator can be challenging. Placement of implants can have a dramatic effect on the stability and retention of the prosthesis in the edentulous maxillectomy patient. This article provides clinical retrospective analysis of osseointegrated implants used to retain maxillary obturators. Material and Methods. Patient charts and radiographs were reviewed to determine implant status, bone loss patterns, and implant survival rates. Twenty-six patients were included with 102 implants placed, from which there were 19 intact withdrawals (implants lost because of recurrent disease or patient death), five implants with unknown status, 24 implant failures, and 54 functional implants. Results. The overall survival rate for implants in this patient population was 69.2%. The percent implant survival rate was 63.6% for the irradiated group (67.0% before radiation, 50.0% after radiation) and 82.6% for the nonirradiated group. Implants located in anterior sites demonstrated statistically significant differences in annual bone height changes compared with posterior sites. Conclusions. The majority of implant failures (18 of 24) occurred either at stage II surgery or before loading. Implants placed during tumor resection, implants placed within the maxillectomy defects, and implants receiving postoperative radiation demonstrated low survival rates. (J Prosthet Dent 1997;77:184-90.)
Url:
DOI: 10.1016/S0022-3913(97)70233-6
Links to Exploration step
ISTEX:195EF19E5EE3A711D11D0F6B16DF880EA141027DLe document en format XML
<record><TEI wicri:istexFullTextTei="biblStruct"><teiHeader><fileDesc><titleStmt><title xml:lang="en">Clinical evaluation of implants retaining edentulous maxillary obturator prostheses</title><author><name sortKey="Roumanas, E D" sort="Roumanas, E D" uniqKey="Roumanas E" first="E. D." last="Roumanas">E. D. Roumanas</name><affiliation><mods:affiliation>University of California, Los Angeles, School of Dentistry, Los Angeles, and City of Hope National Medical Center, Duarte, Calif</mods:affiliation></affiliation></author><author><name sortKey="Nishimura, R D" sort="Nishimura, R D" uniqKey="Nishimura R" first="R. D." last="Nishimura">R. D. Nishimura</name><affiliation><mods:affiliation>University of California, Los Angeles, School of Dentistry, Los Angeles, and City of Hope National Medical Center, Duarte, Calif</mods:affiliation></affiliation></author><author><name sortKey="Davis, B K" sort="Davis, B K" uniqKey="Davis B" first="B. K." last="Davis">B. K. Davis</name><affiliation><mods:affiliation>University of California, Los Angeles, School of Dentistry, Los Angeles, and City of Hope National Medical Center, Duarte, Calif</mods:affiliation></affiliation></author><author><name sortKey="Beumer Iii, J" sort="Beumer Iii, J" uniqKey="Beumer Iii J" first="J." last="Beumer Iii">J. Beumer Iii</name><affiliation><mods:affiliation>University of California, Los Angeles, School of Dentistry, Los Angeles, and City of Hope National Medical Center, Duarte, Calif</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:195EF19E5EE3A711D11D0F6B16DF880EA141027D</idno><date when="1997" year="1997">1997</date><idno type="doi">10.1016/S0022-3913(97)70233-6</idno><idno type="url">https://api.istex.fr/document/195EF19E5EE3A711D11D0F6B16DF880EA141027D/fulltext/pdf</idno><idno type="wicri:Area/Istex/Corpus">000C45</idno><idno type="wicri:explorRef" wicri:stream="Istex" wicri:step="Corpus" wicri:corpus="ISTEX">000C45</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a" type="main" xml:lang="en">Clinical evaluation of implants retaining edentulous maxillary obturator prostheses</title><author><name sortKey="Roumanas, E D" sort="Roumanas, E D" uniqKey="Roumanas E" first="E. D." last="Roumanas">E. D. Roumanas</name><affiliation><mods:affiliation>University of California, Los Angeles, School of Dentistry, Los Angeles, and City of Hope National Medical Center, Duarte, Calif</mods:affiliation></affiliation></author><author><name sortKey="Nishimura, R D" sort="Nishimura, R D" uniqKey="Nishimura R" first="R. D." last="Nishimura">R. D. Nishimura</name><affiliation><mods:affiliation>University of California, Los Angeles, School of Dentistry, Los Angeles, and City of Hope National Medical Center, Duarte, Calif</mods:affiliation></affiliation></author><author><name sortKey="Davis, B K" sort="Davis, B K" uniqKey="Davis B" first="B. K." last="Davis">B. K. Davis</name><affiliation><mods:affiliation>University of California, Los Angeles, School of Dentistry, Los Angeles, and City of Hope National Medical Center, Duarte, Calif</mods:affiliation></affiliation></author><author><name sortKey="Beumer Iii, J" sort="Beumer Iii, J" uniqKey="Beumer Iii J" first="J." last="Beumer Iii">J. Beumer Iii</name><affiliation><mods:affiliation>University of California, Los Angeles, School of Dentistry, Los Angeles, and City of Hope National Medical Center, Duarte, Calif</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">The Journal of Prosthetic Dentistry</title><title level="j" type="abbrev">YMPR</title><idno type="ISSN">0022-3913</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="1997">1997</date><biblScope unit="volume">77</biblScope><biblScope unit="issue">2</biblScope><biblScope unit="page" from="184">184</biblScope><biblScope unit="page" to="190">190</biblScope></imprint><idno type="ISSN">0022-3913</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0022-3913</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adequate alveolar bone</term><term>Anterior</term><term>Anterior implants</term><term>Ball attachment system</term><term>Bone graft</term><term>Bone height</term><term>Bone loss</term><term>Case report</term><term>Clinical mobility</term><term>Clinical report</term><term>Defect</term><term>Dentistry</term><term>Differential pattern</term><term>Dramatic effect</term><term>Edentulous maxillary resection patients</term><term>Edentulous maxillectomy patient</term><term>Final restoration</term><term>First year</term><term>Frequency distributions</term><term>Functional implants</term><term>Graft</term><term>Graft procedure</term><term>Graft procedures</term><term>Immediate implant placement</term><term>Immediate placement</term><term>Implant</term><term>Implant failures</term><term>Implant location</term><term>Implant placement</term><term>Implant site</term><term>Implant sites</term><term>Implant status</term><term>Implant surgery</term><term>Implant survival rate</term><term>Implant survival rates</term><term>Implant threads</term><term>Intact withdrawals</term><term>Limited accessibility</term><term>Many years</term><term>Maxillary</term><term>Maxillary obturator</term><term>Maxillary obturators</term><term>Maxillary resection patients</term><term>Maxillectomy</term><term>Maxillectomy defect</term><term>Maxillectomy defects</term><term>Maxillectomy patients</term><term>Maxillofac</term><term>Maxillofacial prosthetics</term><term>Medical center</term><term>Mesial</term><term>Nonirradiated group</term><term>Number2 roumanas</term><term>Obturator</term><term>Oral implants</term><term>Oral maxillofac implants</term><term>Oral maxillofac surg</term><term>Osseointegrated implants</term><term>Overall survival rate</term><term>Patient charts</term><term>Patient death</term><term>Patient population</term><term>Posterior alveolus</term><term>Posterior implants</term><term>Posterior sites</term><term>Prosthesis</term><term>Prosthet dent</term><term>Prosthetic</term><term>Prosthetic dentistry</term><term>Pterygoid plates</term><term>Radiation status</term><term>Radiograph</term><term>Recurrence</term><term>Removable prosthodontics</term><term>Resection</term><term>Retentive elements</term><term>Retrospective analysis</term><term>Roumanas</term><term>Severe bone loss</term><term>Sinus</term><term>Surgical</term><term>Surgical defect</term><term>Surgical defect type</term><term>Surgical resection</term><term>Survival rates</term><term>Tissue bars</term><term>Titanium implants</term><term>Tumor resection</term><term>Vertical bone loss</term></keywords><keywords scheme="Teeft" xml:lang="en"><term>Adequate alveolar bone</term><term>Anterior</term><term>Anterior implants</term><term>Ball attachment system</term><term>Bone graft</term><term>Bone height</term><term>Bone loss</term><term>Case report</term><term>Clinical mobility</term><term>Clinical report</term><term>Defect</term><term>Dentistry</term><term>Differential pattern</term><term>Dramatic effect</term><term>Edentulous maxillary resection patients</term><term>Edentulous maxillectomy patient</term><term>Final restoration</term><term>First year</term><term>Frequency distributions</term><term>Functional implants</term><term>Graft</term><term>Graft procedure</term><term>Graft procedures</term><term>Immediate implant placement</term><term>Immediate placement</term><term>Implant</term><term>Implant failures</term><term>Implant location</term><term>Implant placement</term><term>Implant site</term><term>Implant sites</term><term>Implant status</term><term>Implant surgery</term><term>Implant survival rate</term><term>Implant survival rates</term><term>Implant threads</term><term>Intact withdrawals</term><term>Limited accessibility</term><term>Many years</term><term>Maxillary</term><term>Maxillary obturator</term><term>Maxillary obturators</term><term>Maxillary resection patients</term><term>Maxillectomy</term><term>Maxillectomy defect</term><term>Maxillectomy defects</term><term>Maxillectomy patients</term><term>Maxillofac</term><term>Maxillofacial prosthetics</term><term>Medical center</term><term>Mesial</term><term>Nonirradiated group</term><term>Number2 roumanas</term><term>Obturator</term><term>Oral implants</term><term>Oral maxillofac implants</term><term>Oral maxillofac surg</term><term>Osseointegrated implants</term><term>Overall survival rate</term><term>Patient charts</term><term>Patient death</term><term>Patient population</term><term>Posterior alveolus</term><term>Posterior implants</term><term>Posterior sites</term><term>Prosthesis</term><term>Prosthet dent</term><term>Prosthetic</term><term>Prosthetic dentistry</term><term>Pterygoid plates</term><term>Radiation status</term><term>Radiograph</term><term>Recurrence</term><term>Removable prosthodontics</term><term>Resection</term><term>Retentive elements</term><term>Retrospective analysis</term><term>Roumanas</term><term>Severe bone loss</term><term>Sinus</term><term>Surgical</term><term>Surgical defect</term><term>Surgical defect type</term><term>Surgical resection</term><term>Survival rates</term><term>Tissue bars</term><term>Titanium implants</term><term>Tumor resection</term><term>Vertical bone loss</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Abstract: Purpose. Fabricating a maxillary obturator can be challenging. Placement of implants can have a dramatic effect on the stability and retention of the prosthesis in the edentulous maxillectomy patient. This article provides clinical retrospective analysis of osseointegrated implants used to retain maxillary obturators. Material and Methods. Patient charts and radiographs were reviewed to determine implant status, bone loss patterns, and implant survival rates. Twenty-six patients were included with 102 implants placed, from which there were 19 intact withdrawals (implants lost because of recurrent disease or patient death), five implants with unknown status, 24 implant failures, and 54 functional implants. Results. The overall survival rate for implants in this patient population was 69.2%. The percent implant survival rate was 63.6% for the irradiated group (67.0% before radiation, 50.0% after radiation) and 82.6% for the nonirradiated group. Implants located in anterior sites demonstrated statistically significant differences in annual bone height changes compared with posterior sites. Conclusions. The majority of implant failures (18 of 24) occurred either at stage II surgery or before loading. Implants placed during tumor resection, implants placed within the maxillectomy defects, and implants receiving postoperative radiation demonstrated low survival rates. (J Prosthet Dent 1997;77:184-90.)</div></front></TEI><istex><corpusName>elsevier</corpusName><keywords><teeft><json:string>implant</json:string><json:string>maxillary</json:string><json:string>obturator</json:string><json:string>resection</json:string><json:string>maxillectomy</json:string><json:string>implant placement</json:string><json:string>prosthetic</json:string><json:string>mesial</json:string><json:string>prosthesis</json:string><json:string>radiograph</json:string><json:string>bone loss</json:string><json:string>posterior implants</json:string><json:string>prosthetic dentistry</json:string><json:string>anterior implants</json:string><json:string>roumanas</json:string><json:string>maxillofac</json:string><json:string>dentistry</json:string><json:string>radiation status</json:string><json:string>prosthet dent</json:string><json:string>graft</json:string><json:string>sinus</json:string><json:string>surgical</json:string><json:string>survival rates</json:string><json:string>oral maxillofac implants</json:string><json:string>osseointegrated implants</json:string><json:string>implant survival rate</json:string><json:string>patient population</json:string><json:string>posterior sites</json:string><json:string>recurrence</json:string><json:string>defect</json:string><json:string>functional implants</json:string><json:string>severe bone loss</json:string><json:string>surgical resection</json:string><json:string>removable prosthodontics</json:string><json:string>maxillofacial prosthetics</json:string><json:string>nonirradiated group</json:string><json:string>medical center</json:string><json:string>maxillary obturator</json:string><json:string>immediate implant placement</json:string><json:string>oral implants</json:string><json:string>maxillary obturators</json:string><json:string>patient death</json:string><json:string>implant failures</json:string><json:string>anterior</json:string><json:string>intact withdrawals</json:string><json:string>titanium implants</json:string><json:string>maxillary resection patients</json:string><json:string>number2 roumanas</json:string><json:string>graft procedures</json:string><json:string>edentulous maxillary resection patients</json:string><json:string>retrospective analysis</json:string><json:string>implant surgery</json:string><json:string>tissue bars</json:string><json:string>ball attachment system</json:string><json:string>implant sites</json:string><json:string>surgical defect type</json:string><json:string>maxillectomy defects</json:string><json:string>frequency distributions</json:string><json:string>tumor resection</json:string><json:string>bone height</json:string><json:string>maxillectomy defect</json:string><json:string>vertical bone loss</json:string><json:string>overall survival rate</json:string><json:string>implant location</json:string><json:string>implant threads</json:string><json:string>implant site</json:string><json:string>posterior alveolus</json:string><json:string>implant survival rates</json:string><json:string>implant status</json:string><json:string>surgical defect</json:string><json:string>first year</json:string><json:string>clinical mobility</json:string><json:string>differential pattern</json:string><json:string>retentive elements</json:string><json:string>many years</json:string><json:string>graft procedure</json:string><json:string>adequate alveolar bone</json:string><json:string>immediate placement</json:string><json:string>bone graft</json:string><json:string>final restoration</json:string><json:string>limited accessibility</json:string><json:string>patient charts</json:string><json:string>maxillectomy patients</json:string><json:string>case report</json:string><json:string>edentulous maxillectomy patient</json:string><json:string>dramatic effect</json:string><json:string>clinical report</json:string><json:string>oral maxillofac surg</json:string><json:string>pterygoid plates</json:string></teeft></keywords><author><json:item><name>E.D. Roumanas DDSa</name><affiliations><json:string>University of California, Los Angeles, School of Dentistry, Los Angeles, and City of Hope National Medical Center, Duarte, Calif</json:string></affiliations></json:item><json:item><name>R.D. Nishimura DDSb</name><affiliations><json:string>University of California, Los Angeles, School of Dentistry, Los Angeles, and City of Hope National Medical Center, Duarte, Calif</json:string></affiliations></json:item><json:item><name>B.K. Davis DMD, MSc</name><affiliations><json:string>University of California, Los Angeles, School of Dentistry, Los Angeles, and City of Hope National Medical Center, Duarte, Calif</json:string></affiliations></json:item><json:item><name>J. Beumer, III DDS, MS d</name><affiliations><json:string>University of California, Los Angeles, School of Dentistry, Los Angeles, and City of Hope National Medical Center, Duarte, Calif</json:string></affiliations></json:item></author><arkIstex>ark:/67375/6H6-PCQ2Q4BJ-S</arkIstex><language><json:string>eng</json:string></language><originalGenre><json:string>Full-length article</json:string></originalGenre><abstract>Abstract: Purpose. Fabricating a maxillary obturator can be challenging. Placement of implants can have a dramatic effect on the stability and retention of the prosthesis in the edentulous maxillectomy patient. This article provides clinical retrospective analysis of osseointegrated implants used to retain maxillary obturators. Material and Methods. Patient charts and radiographs were reviewed to determine implant status, bone loss patterns, and implant survival rates. Twenty-six patients were included with 102 implants placed, from which there were 19 intact withdrawals (implants lost because of recurrent disease or patient death), five implants with unknown status, 24 implant failures, and 54 functional implants. Results. The overall survival rate for implants in this patient population was 69.2%. The percent implant survival rate was 63.6% for the irradiated group (67.0% before radiation, 50.0% after radiation) and 82.6% for the nonirradiated group. Implants located in anterior sites demonstrated statistically significant differences in annual bone height changes compared with posterior sites. Conclusions. The majority of implant failures (18 of 24) occurred either at stage II surgery or before loading. Implants placed during tumor resection, implants placed within the maxillectomy defects, and implants receiving postoperative radiation demonstrated low survival rates. (J Prosthet Dent 1997;77:184-90.)</abstract><qualityIndicators><score>8.009</score><pdfWordCount>3657</pdfWordCount><pdfCharCount>22935</pdfCharCount><pdfVersion>1.3</pdfVersion><pdfPageCount>7</pdfPageCount><pdfPageSize>576 x 792 pts</pdfPageSize><refBibsNative>true</refBibsNative><abstractWordCount>196</abstractWordCount><abstractCharCount>1428</abstractCharCount><keywordCount>0</keywordCount></qualityIndicators><title>Clinical evaluation of implants retaining edentulous maxillary obturator prostheses</title><pmid><json:string>9051607</json:string></pmid><pii><json:string>S0022-3913(97)70233-6</json:string></pii><genre><json:string>research-article</json:string></genre><serie><title>Advanced Osseointegration surgery: applications in the maxillofacial region</title><language><json:string>unknown</json:string></language><pages><first>267</first><last>275</last></pages></serie><host><title>The Journal of Prosthetic Dentistry</title><language><json:string>unknown</json:string></language><publicationDate>1997</publicationDate><issn><json:string>0022-3913</json:string></issn><pii><json:string>S0022-3913(05)X7037-8</json:string></pii><volume>77</volume><issue>2</issue><pages><first>184</first><last>190</last></pages><genre><json:string>journal</json:string></genre></host><namedEntities><unitex><date><json:string>1997</json:string><json:string>1985</json:string></date><geogName></geogName><orgName><json:string>University of California, Los Angeles</json:string><json:string>Attachments International Inc.</json:string><json:string>Hope National Medical Center, Duarte, Calif</json:string></orgName><orgName_funder></orgName_funder><orgName_provider></orgName_provider><persName><json:string>Krishan Kapur</json:string><json:string>Total</json:string><json:string>R. D. Nishimura</json:string><json:string>City</json:string><json:string>B. K. Davis</json:string></persName><placeName><json:string>San Mateo</json:string><json:string>Chicago</json:string><json:string>Calif.</json:string></placeName><ref_url></ref_url><ref_bibl><json:string>Albrektsson et al.</json:string></ref_bibl><bibl></bibl></unitex></namedEntities><ark><json:string>ark:/67375/6H6-PCQ2Q4BJ-S</json:string></ark><categories><wos><json:string>1 - science</json:string><json:string>2 - dentistry, oral surgery & medicine</json:string></wos><scienceMetrix><json:string>1 - health sciences</json:string><json:string>2 - clinical medicine</json:string><json:string>3 - dentistry</json:string></scienceMetrix><scopus><json:string>1 - Health Sciences</json:string><json:string>2 - Dentistry</json:string><json:string>3 - Oral Surgery</json:string></scopus><inist><json:string>1 - sciences appliquees, technologies et medecines</json:string><json:string>2 - sciences biologiques et medicales</json:string><json:string>3 - sciences medicales</json:string></inist></categories><publicationDate>1997</publicationDate><copyrightDate>1997</copyrightDate><doi><json:string>10.1016/S0022-3913(97)70233-6</json:string></doi><id>195EF19E5EE3A711D11D0F6B16DF880EA141027D</id><score>1</score><fulltext><json:item><extension>pdf</extension><original>true</original><mimetype>application/pdf</mimetype><uri>https://api.istex.fr/document/195EF19E5EE3A711D11D0F6B16DF880EA141027D/fulltext/pdf</uri></json:item><json:item><extension>zip</extension><original>false</original><mimetype>application/zip</mimetype><uri>https://api.istex.fr/document/195EF19E5EE3A711D11D0F6B16DF880EA141027D/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/195EF19E5EE3A711D11D0F6B16DF880EA141027D/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a" type="main" xml:lang="en">Clinical evaluation of implants retaining edentulous maxillary obturator prostheses</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>ELSEVIER</publisher><availability><p>©1997 Editorial Council of The Journal of Prosthetic Dentistry.</p></availability><date>1997</date></publicationStmt><notesStmt><note>a Adjunct Assistant Professor, Section of Removable Prosthodontics, School of Dentistry, University of California, Los Angeles, and Director, Maxillofacial Prosthetics, City of Hope National Medical Center.</note><note>b Assistant Professor, Section of Removable Prosthodontics, University of California, Los Angeles, School of Dentistry.</note><note>c Former Resident, Maxillofacial Prosthetics, School of Dentistry, University of California, Los Angeles.</note><note>d Chairman, Section of Removable Prosthodontics and Director, Maxillofacial Prosthetics, School of Dentistry, University of California, Los Angeles.</note><note>Reprint requests to: Dr. Eleni D. Roumanas UCLA School of Dentistry 10833 Le Conti Ave., CHS A0-156 Los Angeles, CA 90095-1668</note><note>0022-3913/97/$5.00 + 0 10/1/78672</note><note type="content">Table I: Status of 102 implants in 26 patients by type of surgical defect</note><note type="content">Table II: Frequency distributions of surviving implants by their location and radiation status</note><note type="content">Table III: Mean number of exposed threads at 18 months for implants located in anterior and posterior sites</note><note type="content">Table IV: Comparisons of mean mesial and distal bone height changes for implants located in anterior and posterior sites</note></notesStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a" type="main" xml:lang="en">Clinical evaluation of implants retaining edentulous maxillary obturator prostheses</title><author xml:id="author-0000"><persName><forename type="first">E.D.</forename><surname>Roumanas</surname></persName><roleName type="degree">DDSa</roleName><affiliation>University of California, Los Angeles, School of Dentistry, Los Angeles, and City of Hope National Medical Center, Duarte, Calif</affiliation></author><author xml:id="author-0001"><persName><forename type="first">R.D.</forename><surname>Nishimura</surname></persName><roleName type="degree">DDSb</roleName><affiliation>University of California, Los Angeles, School of Dentistry, Los Angeles, and City of Hope National Medical Center, Duarte, Calif</affiliation></author><author xml:id="author-0002"><persName><forename type="first">B.K.</forename><surname>Davis</surname></persName><roleName type="degree">DMD, MSc</roleName><affiliation>University of California, Los Angeles, School of Dentistry, Los Angeles, and City of Hope National Medical Center, Duarte, Calif</affiliation></author><author xml:id="author-0003"><persName><forename type="first">J.</forename><surname>Beumer, III</surname></persName><roleName type="degree">DDS, MS d</roleName><affiliation>University of California, Los Angeles, School of Dentistry, Los Angeles, and City of Hope National Medical Center, Duarte, Calif</affiliation></author><idno type="istex">195EF19E5EE3A711D11D0F6B16DF880EA141027D</idno><idno type="DOI">10.1016/S0022-3913(97)70233-6</idno><idno type="PII">S0022-3913(97)70233-6</idno></analytic><monogr><title level="j">The Journal of Prosthetic Dentistry</title><title level="j" type="abbrev">YMPR</title><idno type="pISSN">0022-3913</idno><idno type="PII">S0022-3913(05)X7037-8</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="1997"></date><biblScope unit="volume">77</biblScope><biblScope unit="issue">2</biblScope><biblScope unit="page" from="184">184</biblScope><biblScope unit="page" to="190">190</biblScope></imprint></monogr></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>1997</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>Purpose. Fabricating a maxillary obturator can be challenging. Placement of implants can have a dramatic effect on the stability and retention of the prosthesis in the edentulous maxillectomy patient. This article provides clinical retrospective analysis of osseointegrated implants used to retain maxillary obturators. Material and Methods. Patient charts and radiographs were reviewed to determine implant status, bone loss patterns, and implant survival rates. Twenty-six patients were included with 102 implants placed, from which there were 19 intact withdrawals (implants lost because of recurrent disease or patient death), five implants with unknown status, 24 implant failures, and 54 functional implants. Results. The overall survival rate for implants in this patient population was 69.2%. The percent implant survival rate was 63.6% for the irradiated group (67.0% before radiation, 50.0% after radiation) and 82.6% for the nonirradiated group. Implants located in anterior sites demonstrated statistically significant differences in annual bone height changes compared with posterior sites. Conclusions. The majority of implant failures (18 of 24) occurred either at stage II surgery or before loading. Implants placed during tumor resection, implants placed within the maxillectomy defects, and implants receiving postoperative radiation demonstrated low survival rates. (J Prosthet Dent 1997;77:184-90.)</p></abstract></profileDesc><revisionDesc><change when="1997">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/document/195EF19E5EE3A711D11D0F6B16DF880EA141027D/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Elsevier doc found" wicri:toSee="Elsevier, no converted or simple article"><istex:xmlDeclaration>version="1.0" encoding="utf-8"</istex:xmlDeclaration><istex:docType PUBLIC="-//ES//DTD journal article DTD version 5.0.1//EN//XML" URI="art501.dtd" name="istex:docType"><istex:entity SYSTEM="gr1" NDATA="IMAGE" name="gr1"></istex:entity><istex:entity SYSTEM="gr2" NDATA="IMAGE" name="gr2"></istex:entity><istex:entity SYSTEM="gr3" NDATA="IMAGE" name="gr3"></istex:entity><istex:entity SYSTEM="gr4" NDATA="IMAGE" name="gr4"></istex:entity><istex:entity SYSTEM="gr5" NDATA="IMAGE" name="gr5"></istex:entity></istex:docType><istex:document><article docsubtype="fla" xml:lang="en"><item-info><jid>YMPR</jid><aid>78672</aid><ce:pii>S0022-3913(97)70233-6</ce:pii><ce:doi>10.1016/S0022-3913(97)70233-6</ce:doi><ce:copyright type="other" year="1997">Editorial Council of The Journal of Prosthetic Dentistry.</ce:copyright></item-info><ce:floats><ce:table id="tab1" colsep="0" rowsep="0" frame="topbot"><ce:label>Table I</ce:label><ce:caption><ce:simple-para>Status of 102 implants in 26 patients by type of surgical defect</ce:simple-para></ce:caption><tgroup cols="10"><colspec colname="col1" colsep="0"></colspec><colspec colname="col2" colsep="0"></colspec><colspec colname="col3" colsep="0"></colspec><colspec colname="col4" colsep="0"></colspec><colspec colname="col5" colsep="0"></colspec><colspec colname="col6" colsep="0"></colspec><colspec colname="col7" colsep="0"></colspec><colspec colname="col8" colsep="0"></colspec><colspec colname="col9" colsep="0"></colspec><colspec colname="col10" colsep="0"></colspec><thead><row><entry></entry><entry namest="col2" nameend="col10" align="right" rowsep="1"><ce:bold>Number of implants</ce:bold></entry></row><row><entry></entry><entry align="right"></entry><entry align="right"></entry><entry namest="col4" nameend="col5" align="right" rowsep="1"><ce:bold>Intact withdrawals</ce:bold></entry><entry namest="col6" nameend="col7" align="right" rowsep="1"><ce:bold>Unknown status</ce:bold></entry><entry namest="col8" nameend="col9" align="right" rowsep="1"><ce:bold>Known status</ce:bold></entry><entry colname="col10" align="right"></entry></row><row rowsep="1"><entry><ce:bold>Type of defect</ce:bold></entry><entry align="right"><ce:bold>No. of patients</ce:bold></entry><entry align="right"><ce:bold>Implants placed</ce:bold></entry><entry align="right"><ce:bold>Pt. death</ce:bold></entry><entry align="right"><ce:bold>Recurrence</ce:bold></entry><entry align="right"><ce:bold>Buried</ce:bold></entry><entry align="right"><ce:bold>Unexposed</ce:bold></entry><entry align="right"><ce:bold>Failed</ce:bold></entry><entry align="right"><ce:bold>Functional</ce:bold></entry><entry align="right"><ce:bold>Total</ce:bold></entry></row></thead><tbody><row><entry>Total maxillectomy</entry><entry align="right">17</entry><entry align="right">63</entry><entry align="right">7</entry><entry align="right">6</entry><entry align="right">1</entry><entry align="right">1</entry><entry align="right">12</entry><entry align="right">36</entry><entry align="right">48</entry></row><row><entry>Partial maxillectomy</entry><entry align="right">5</entry><entry align="right">22</entry><entry align="right">6</entry><entry align="right">0</entry><entry align="right">0</entry><entry align="right">0</entry><entry align="right">6</entry><entry align="right">10</entry><entry align="right">16</entry></row><row><entry>Total palatectomy</entry><entry align="right">2</entry><entry align="right">7</entry><entry align="right">0</entry><entry align="right">0</entry><entry align="right">1</entry><entry align="right">0</entry><entry align="right">5</entry><entry align="right">1</entry><entry align="right">6</entry></row><row><entry>Soft palatectomy</entry><entry align="right">2</entry><entry align="right">10</entry><entry align="right">0</entry><entry align="right">0</entry><entry align="right">2</entry><entry align="right">0</entry><entry align="right">1</entry><entry align="right">7</entry><entry align="right">8</entry></row><row><entry>Total</entry><entry align="right">26</entry><entry align="right">102</entry><entry align="right">13</entry><entry align="right">6</entry><entry align="right">4</entry><entry align="right">1</entry><entry align="right">24</entry><entry align="right">54</entry><entry align="right">78</entry></row><row><entry namest="col1" nameend="col10"></entry></row></tbody></tgroup><ce:legend><ce:simple-para><ce:italic>Pt.,</ce:italic> Patient.</ce:simple-para></ce:legend></ce:table><ce:table id="tab2" colsep="0" rowsep="0" frame="topbot"><ce:label>Table II</ce:label><ce:caption><ce:simple-para>Frequency distributions of surviving implants by their location and radiation status</ce:simple-para></ce:caption><tgroup cols="13"><colspec colname="col1" colsep="0"></colspec><colspec colname="col2" colsep="0"></colspec><colspec colname="col3" colsep="0"></colspec><colspec colname="col4" colsep="0"></colspec><colspec colname="col5" colsep="0"></colspec><colspec colname="col6" colsep="0"></colspec><colspec colname="col7" colsep="0"></colspec><colspec colname="col8" colsep="0"></colspec><colspec colname="col9" colsep="0"></colspec><colspec colname="col10" colsep="0"></colspec><colspec colname="col11" colsep="0"></colspec><colspec colname="col12" colsep="0"></colspec><colspec colname="col13" colsep="0"></colspec><thead><row><entry></entry><entry namest="col2" nameend="col13" align="right" rowsep="1"><ce:bold>Surviving implants</ce:bold></entry></row><row><entry></entry><entry namest="col2" nameend="col4" align="right" rowsep="1"><ce:bold>7</ce:bold></entry><entry namest="col5" nameend="col7" align="right" rowsep="1"><ce:bold>11</ce:bold></entry><entry namest="col8" nameend="col10" align="right" rowsep="1"><ce:bold>5</ce:bold></entry><entry namest="col11" nameend="col13" align="right" rowsep="1"><ce:bold>23</ce:bold></entry></row><row><entry></entry><entry namest="col2" nameend="col4" align="right" rowsep="1"><ce:bold>No radiation</ce:bold></entry><entry namest="col5" nameend="col7" align="right" rowsep="1"><ce:bold>Before radiation</ce:bold></entry><entry namest="col8" nameend="col10" align="right" rowsep="1"><ce:bold>After radiation</ce:bold></entry><entry namest="col11" nameend="col13" align="right" rowsep="1"><ce:bold>Total</ce:bold></entry></row><row rowsep="1"><entry><ce:bold>Implant site</ce:bold></entry><entry align="right"><ce:bold>Known status</ce:bold></entry><entry align="right"><ce:bold>Implants funct</ce:bold></entry><entry align="right"><ce:bold>% Survived</ce:bold></entry><entry align="right"><ce:bold>Known status</ce:bold></entry><entry align="right"><ce:bold>Implants funct</ce:bold></entry><entry align="right"><ce:bold>% Survived</ce:bold></entry><entry align="right"><ce:bold>Known status</ce:bold></entry><entry align="right"><ce:bold>Implants funct</ce:bold></entry><entry align="right"><ce:bold>% Survived</ce:bold></entry><entry align="right"><ce:bold>Known status</ce:bold></entry><entry align="right"><ce:bold>Implants funct</ce:bold></entry><entry align="right"><ce:bold>% Survived</ce:bold></entry></row></thead><tbody><row><entry>Anterior</entry><entry align="right">13</entry><entry align="right">11</entry><entry align="right">84.6</entry><entry align="right">10</entry><entry align="right">8</entry><entry align="right">80.0</entry><entry align="right">4</entry><entry align="right">1</entry><entry align="right">25.0</entry><entry align="right">27</entry><entry align="right">20</entry><entry align="right">74.1</entry></row><row><entry>Posterior</entry><entry align="right">10</entry><entry align="right">8</entry><entry align="right">80.0</entry><entry align="right">29</entry><entry align="right">19</entry><entry align="right">65.5</entry><entry align="right">6</entry><entry align="right">5</entry><entry align="right">83.3</entry><entry align="right">45</entry><entry align="right">32</entry><entry align="right">71.1</entry></row><row><entry>Defect</entry><entry align="right">0</entry><entry align="right">0</entry><entry align="right">0.0</entry><entry align="right">4</entry><entry align="right">2</entry><entry align="right">50.0</entry><entry align="right">2</entry><entry align="right">0</entry><entry align="right">0.0</entry><entry align="right">6</entry><entry align="right">2</entry><entry align="right">33.3</entry></row><row><entry>Total</entry><entry align="right">23</entry><entry align="right">19</entry><entry align="right">82.6</entry><entry align="right">43</entry><entry align="right">29</entry><entry align="right">67.0</entry><entry align="right">12</entry><entry align="right">6</entry><entry align="right">50.0</entry><entry align="right">78</entry><entry align="right">54</entry><entry align="right">69.2</entry></row><row><entry namest="col1" nameend="col13"></entry></row></tbody></tgroup><ce:legend><ce:simple-para><ce:italic>funct,</ce:italic> Functioning.</ce:simple-para></ce:legend></ce:table><ce:table id="tab3" colsep="0" rowsep="0" frame="topbot"><ce:label>Table III</ce:label><ce:caption><ce:simple-para>Mean number of exposed threads at 18 months for implants located in anterior and posterior sites</ce:simple-para></ce:caption><tgroup cols="10"><colspec colname="col1" colsep="0"></colspec><colspec colname="col2" colsep="0"></colspec><colspec colname="col3" colsep="0"></colspec><colspec colname="col4" colsep="0"></colspec><colspec colname="col5" colsep="0"></colspec><colspec colname="col6" colsep="0"></colspec><colspec colname="col7" colsep="0"></colspec><colspec colname="col8" colsep="0"></colspec><colspec colname="col9" colsep="0"></colspec><colspec colname="col10" colsep="0"></colspec><thead><row><entry></entry><entry namest="col2" nameend="col10" align="center" rowsep="1"><ce:bold>No. of implant threads exposed</ce:bold></entry></row><row><entry></entry><entry namest="col2" nameend="col4" align="center" rowsep="1"><ce:bold>Mesial</ce:bold></entry><entry namest="col5" nameend="col7" align="center" rowsep="1"><ce:bold>Distal</ce:bold></entry><entry namest="col8" nameend="col10" align="center" rowsep="1"><ce:bold>Average (mesial-distal)</ce:bold></entry></row><row rowsep="1"><entry><ce:bold>Implant site</ce:bold></entry><entry align="center"><ce:bold>N</ce:bold></entry><entry align="center"><ce:bold>Mean</ce:bold></entry><entry align="center"><ce:bold>SD</ce:bold></entry><entry align="center"><ce:bold>N</ce:bold></entry><entry align="center"><ce:bold>Mean</ce:bold></entry><entry align="center"><ce:bold>SD</ce:bold></entry><entry align="center"><ce:bold>N</ce:bold></entry><entry align="center"><ce:bold>Mean</ce:bold></entry><entry align="center"><ce:bold>SD</ce:bold></entry></row></thead><tbody><row><entry>Anterior</entry><entry align="center">17</entry><entry align="center">3.74</entry><entry align="center">2.51</entry><entry align="center">17</entry><entry align="center">3.91</entry><entry align="center">2.57</entry><entry align="center">17</entry><entry align="center">3.82</entry><entry align="center">2.49</entry></row><row><entry>Posterior</entry><entry align="center">29</entry><entry align="center">1.22</entry><entry align="center">1.69</entry><entry align="center">29</entry><entry align="center">1.66</entry><entry align="center">2.05</entry><entry align="center">29</entry><entry align="center">1.44</entry><entry align="center">1.76</entry></row><row><entry>Total</entry><entry align="center">46</entry><entry align="center">2.15</entry><entry align="center">2.35</entry><entry align="center">46</entry><entry align="center">2.49</entry><entry align="center">2.48</entry><entry align="center"></entry><entry align="center"></entry><entry align="center"></entry></row></tbody></tgroup></ce:table><ce:table id="tab4" colsep="0" rowsep="0" frame="topbot"><ce:label>Table IV</ce:label><ce:caption><ce:simple-para>Comparisons of mean mesial and distal bone height changes for implants located in anterior and posterior sites</ce:simple-para></ce:caption><tgroup cols="10"><colspec colname="col1" colsep="0"></colspec><colspec colname="col2" colsep="0"></colspec><colspec colname="col3" colsep="0"></colspec><colspec colname="col4" colsep="0"></colspec><colspec colname="col5" colsep="0"></colspec><colspec colname="col6" colsep="0"></colspec><colspec colname="col7" colsep="0"></colspec><colspec colname="col8" colsep="0"></colspec><colspec colname="col9" colsep="0"></colspec><colspec colname="col10" colsep="0"></colspec><thead><row><entry></entry><entry namest="col2" nameend="col10" align="center" rowsep="1"><ce:bold>No. of threads exposed/year</ce:bold></entry></row><row><entry></entry><entry namest="col2" nameend="col4" align="center" rowsep="1"><ce:bold>Mesial</ce:bold></entry><entry namest="col5" nameend="col7" align="center" rowsep="1"><ce:bold>Distal</ce:bold></entry><entry namest="col8" nameend="col10" align="center" rowsep="1"><ce:bold>Average (mesial-distal)</ce:bold></entry></row><row rowsep="1"><entry><ce:bold>Implant site</ce:bold></entry><entry align="center"><ce:bold>N</ce:bold></entry><entry align="center"><ce:bold>Mean</ce:bold></entry><entry align="center"><ce:bold>SD</ce:bold></entry><entry align="center"><ce:bold>N</ce:bold></entry><entry align="center"><ce:bold>Mean</ce:bold></entry><entry align="center"><ce:bold>SD</ce:bold></entry><entry align="center"><ce:bold>N</ce:bold></entry><entry align="center"><ce:bold>Mean</ce:bold></entry><entry align="center"><ce:bold>SD</ce:bold></entry></row></thead><tbody><row><entry><ce:bold>Anterior</ce:bold></entry><entry align="center">17</entry><entry align="center">0.84</entry><entry align="center">0.96</entry><entry align="center">17</entry><entry align="center">0.61</entry><entry align="center">0.52</entry><entry align="center">17</entry><entry align="center">0.73</entry><entry align="center">0.61</entry></row><row><entry><ce:bold>Posterior</ce:bold></entry><entry align="center">27</entry><entry align="center">0.31</entry><entry align="center">0.82</entry><entry align="center">27</entry><entry align="center">0.26</entry><entry align="center">0.53</entry><entry align="center">27</entry><entry align="center">0.28</entry><entry align="center">0.65</entry></row><row><entry><ce:bold>Total</ce:bold></entry><entry align="center">44</entry><entry align="center">0.52</entry><entry align="center">0.90</entry><entry align="center">44</entry><entry align="center">0.39</entry><entry align="center">0.54</entry><entry align="center"></entry><entry align="center"></entry><entry align="center"></entry></row></tbody></tgroup></ce:table></ce:floats><head><ce:article-footnote><ce:label>☆</ce:label><ce:note-para><ce:sup>a</ce:sup> Adjunct Assistant Professor, Section of Removable Prosthodontics, School of Dentistry, University of California, Los Angeles, and Director, Maxillofacial Prosthetics, City of Hope National Medical Center.</ce:note-para></ce:article-footnote><ce:article-footnote><ce:label>☆☆</ce:label><ce:note-para><ce:sup>b</ce:sup> Assistant Professor, Section of Removable Prosthodontics, University of California, Los Angeles, School of Dentistry.</ce:note-para></ce:article-footnote><ce:article-footnote><ce:label>★</ce:label><ce:note-para><ce:sup>c</ce:sup> Former Resident, Maxillofacial Prosthetics, School of Dentistry, University of California, Los Angeles.</ce:note-para></ce:article-footnote><ce:article-footnote><ce:label>★★</ce:label><ce:note-para><ce:sup>d</ce:sup> Chairman, Section of Removable Prosthodontics and Director, Maxillofacial Prosthetics, School of Dentistry, University of California, Los Angeles.</ce:note-para></ce:article-footnote><ce:article-footnote><ce:label>♢</ce:label><ce:note-para><ce:italic>Reprint requests to:</ce:italic> <ce:small-caps>Dr. Eleni D. Roumanas</ce:small-caps> UCLA <ce:small-caps>School of Dentistry 10833 Le Conti Ave., CHS A0-156 Los Angeles, CA 90095-1668</ce:small-caps></ce:note-para></ce:article-footnote><ce:article-footnote><ce:label>♢♢</ce:label><ce:note-para>0022-3913/97/$5.00 + 0 <ce:bold>10/1/78672</ce:bold></ce:note-para></ce:article-footnote><ce:title>Clinical evaluation of implants retaining edentulous maxillary obturator prostheses</ce:title><ce:presented>Presented at The Academy of Prosthodontics annual meeting, Newport Beach, Calif., May 1996.</ce:presented><ce:author-group><ce:author><ce:given-name>E.D.</ce:given-name><ce:surname>Roumanas</ce:surname><ce:degrees>DDS<ce:sup>a</ce:sup></ce:degrees></ce:author><ce:author><ce:given-name>R.D.</ce:given-name><ce:surname>Nishimura</ce:surname><ce:degrees>DDS<ce:sup>b</ce:sup></ce:degrees></ce:author><ce:author><ce:given-name>B.K.</ce:given-name><ce:surname>Davis</ce:surname><ce:degrees>DMD, MS<ce:sup>c</ce:sup></ce:degrees></ce:author><ce:author><ce:given-name>J.</ce:given-name><ce:surname>Beumer</ce:surname><ce:suffix>III</ce:suffix><ce:degrees>DDS, MS <ce:sup>d</ce:sup></ce:degrees></ce:author><ce:affiliation><ce:textfn>University of California, Los Angeles, School of Dentistry, Los Angeles, and City of Hope National Medical Center, Duarte, Calif</ce:textfn></ce:affiliation></ce:author-group><ce:abstract><ce:section-title>Abstract</ce:section-title><ce:abstract-sec><ce:simple-para><ce:bold>Purpose.</ce:bold> Fabricating a maxillary obturator can be challenging. Placement of implants can have a dramatic effect on the stability and retention of the prosthesis in the edentulous maxillectomy patient. This article provides clinical retrospective analysis of osseointegrated implants used to retain maxillary obturators.</ce:simple-para><ce:simple-para><ce:bold>Material and Methods.</ce:bold> Patient charts and radiographs were reviewed to determine implant status, bone loss patterns, and implant survival rates. Twenty-six patients were included with 102 implants placed, from which there were 19 intact withdrawals (implants lost because of recurrent disease or patient death), five implants with unknown status, 24 implant failures, and 54 functional implants.</ce:simple-para><ce:simple-para><ce:bold>Results.</ce:bold> The overall survival rate for implants in this patient population was 69.2%. The percent implant survival rate was 63.6% for the irradiated group (67.0% before radiation, 50.0% after radiation) and 82.6% for the nonirradiated group. Implants located in anterior sites demonstrated statistically significant differences in annual bone height changes compared with posterior sites.</ce:simple-para><ce:simple-para><ce:bold>Conclusions.</ce:bold> The majority of implant failures (18 of 24) occurred either at stage II surgery or before loading. Implants placed during tumor resection, implants placed within the maxillectomy defects, and implants receiving postoperative radiation demonstrated low survival rates. (J Prosthet Dent 1997;77:184-90.)</ce:simple-para></ce:abstract-sec></ce:abstract></head><body><ce:sections><ce:para><ce:display><ce:textbox><ce:textbox-body><ce:sections><ce:para><ce:bold><ce:italic>Placement of implants at surgical resection is not advised because of the high recurrence and mortality rates. Implants that are irradiated after placement demonstrate low survival rates. Implants placed within the surgical defect have a low probability of survival and are difficult to restore and maintain.</ce:italic></ce:bold></ce:para></ce:sections></ce:textbox-body></ce:textbox></ce:display></ce:para><ce:para>Prosthetic rehabilitation of maxillectomy defects is effective, and surgical reconstruction is usually not indicated. Presurgical planning by the prosthodontist and surgeon is essential. A favorable defect must be designed at the time of tumor removal to provide proper support and sufficient retention and stability of the obturator for the prosthesis to function adequately. In dentate patients, these requirements are easily met by relying on the remaining dentition, retentive tissue undercuts, and support areas within the defect. However, the fabrication of a maxillary obturator for an edentulous patient can be challenging. The obturator exhibits varying degrees of movement depending on the amount and contour of the remaining palatal shelf, height of the residual alveolar ridge, size of the defect, and availability of undercuts. Placement of implants can have a dramatic effect on the stability and retention of the prosthesis in the edentulous maxillectomy patient.</ce:para><ce:para>The successful application of osseointegrated implants for retention of maxillary obturators has been documented. <ce:cross-refs refid="bib1 bib2 bib3 bib4 bib5 bib6 bib7"><ce:sup>1-7</ce:sup></ce:cross-refs> These isolated patient reports provide minimal data on long-term implant status and survival rates. Therefore this study provided retrospective analysis that was undertaken to assess the status of implants in edentulous maxillary resection patients treated with implant-retained obturators.</ce:para><ce:section><ce:section-title>MATERIAL AND METHODS</ce:section-title><ce:para>The patients were treated at the University of California, Los Angeles and City of Hope Maxillofacial Clinics over a 10-year period, beginning in 1985. The patient group was composed of 18 women and 8 men, aged 37 to 81 years. The defect types included 17 total maxillectomies, five partial maxillectomies, two total palatectomies, and two soft palatectomies. For these 26 patients a total of 102 titanium screw-type implants (NobelBiocare USA, Chicago, Ill.) were placed. Implant surgeries were performed by three oral-maxillofacial surgeons. The primary implant sites included the remaining premaxilla, tuberosity, and the posterior alveolus. In four patients implants were located within the maxillectomy defect.</ce:para><ce:para>The sites used were the zygomatic arches, pterygoid plates, or horizontally at the cut edge of the anterior hard palate. Ten patients received immediate implant placement (38 implants) at initial tumor resection, whereas the remaining 16 patients received delayed implant placement (64 implants).</ce:para><ce:para>Three patients required sinus lift and graft procedures. <ce:cross-refs refid="bib8 bib9"><ce:sup>8,9</ce:sup></ce:cross-refs> Free, nonvascularized autologous iliac, genial, or calvarial bone was used as graft material. One patient underwent immediate implant placement during the sinus grafting procedure. In the remaining two patients, an 8-month healing period was allowed for the graft before implant placement.</ce:para><ce:para>Prosthodontic restoration of these patients was mainly accomplished by two clinicians according to the following guidelines. Six to 8 months were allowed for osseointegration to occur. The length of this period varied on the basis of the patient's radiation status. At stage II implant surgery, soft tissue procedures were performed as necessary to provide a thin layer (2 to 4 mm) of attached periimplant tissues. If adequate space was not available for conventional abutments, direct implant connection was made with custom-cast abutments (UCLA Abutments, Attachments International Inc., San Mateo, Calif.). <ce:cross-ref refid="bib10"><ce:sup>10</ce:sup></ce:cross-ref> All tissue bars were cast in segments, indexed in the mouth, and then soldered to ensure an accurate and passive fit. A pickup impression was made to generate the master cast for fabrication of the final prosthesis. Whenever possible the implants were splinted together with a tissue bar. The Extracoronal resilient attachment (ERA) attachment (APM Sterngold, Attleboro, Mass.), Hader bar (APM Sterngold), and Brånemark ball attachment system (NobelBiocare USA) were used for retention ( <ce:cross-ref refid="fig1">Fig. 1, <ce:italic>A</ce:italic> and <ce:italic>B</ce:italic></ce:cross-ref> ).
<ce:display><ce:figure id="fig1"><ce:label>Fig. 1</ce:label><ce:caption><ce:simple-para>Common tissue bar designs used in maxillary resection patients. <ce:bold>A,</ce:bold> Use of ERA resilient attachment in anterior aspect of bar adjacent to defect. <ce:bold>B,</ce:bold> Either ERA or Hader bar may be used posteriorly.</ce:simple-para></ce:caption> <ce:link locator="gr1"></ce:link></ce:figure></ce:display>The Brånemark ball attachment system was also used in patients with lone-standing implants ( <ce:cross-ref refid="fig2">Fig. 2, <ce:italic>A</ce:italic> and <ce:italic>B</ce:italic></ce:cross-ref> ) or in situations with inadequate space for a tissue bar.
<ce:display><ce:figure id="fig2"><ce:label>Fig. 2</ce:label><ce:caption><ce:simple-para><ce:bold>A,</ce:bold> Brånemark ball attachment is used in patients with lone-standing implants. Patient has total palatectomy defect, including soft palate, with only right tuberosity remaining. <ce:bold>B,</ce:bold> Use of single implant helps retain posterior aspect of obturator.</ce:simple-para></ce:caption> <ce:link locator="gr2"></ce:link></ce:figure></ce:display></ce:para><ce:para>Patient charts were reviewed for surgical dates, defect types, radiation status, implant sites, implant lengths, dates of implant insertion, and completion of prosthetic rehabilitation. Follow-up appointment entries were checked for reports of complications, implant failures, and other pertinent comments.</ce:para><ce:section><ce:section-title>Radiographic assessment</ce:section-title><ce:para>All existing panoramic and periapical radiographs were evaluated to determine the mesial and distal height of periimplant bone. Radiographs were not standardized. The bone height was measured by counting the number of exposed threads in one-half units. The date of the radiographs was converted to the closest 6-month interval from the date of stage II surgery. For a number of patients radiographs were not available or not readable for various 6-month intervals that included the baseline interval. Thus two approaches were taken to estimate the bone change and interpret the radiographic data: (1) the mesial and distal bone heights on the radiograph were estimated the closest to 18 months after stage II implant surgery and provided the mean number of exposed threads for all functional implants at this period; (2) the change in bone height and the number of years between the first and last available radiographs were determined for each implant to ascertain mean bone loss per year for the functional implants.</ce:para></ce:section><ce:section><ce:section-title>Implant survival rates and location</ce:section-title><ce:para>Implant survival was defined as the absence of clinical implant mobility, radiographic periimplant radiolucencies, and signs and symptoms of pain or infection. Neither the level nor the rate of vertical bone loss was used as a criterion for implant failure. In situations that demonstrated severe bone loss the tissue bars were removed to evaluate implant mobility. Implants that were unexposed, buried, or considered intact withdrawals (because of patient death or recurrence of tumor) were not included in calculating survival rates. Thus the survival rate represents the ratio of functioning implants to the total number of implants with known status expressed as a percentage.</ce:para><ce:para>Implant location was categorized as (1) anterior, positioned mesial to the maxillary right and left canines; (2) posterior, positioned distal to the canine sites; and (3) defect, placed within the maxillectomy defect.</ce:para></ce:section><ce:section><ce:section-title>Radiation status</ce:section-title><ce:para>The radiation status groups were categorized as (1) no radiation, (2) radiation before implant placement, (3) radiation after implant placement. The dose to tumor for the irradiated groups ranged from 5000 to 7400 cGy. Isodose curves were not referenced to specifically calculate dose to bone at each of the implant sites.</ce:para></ce:section></ce:section><ce:section><ce:section-title>RESULTS</ce:section-title><ce:para><ce:cross-ref refid="tab1">Table I</ce:cross-ref> shows the status of 102 implants in 26 patients categorized by the surgical defect type.
<ce:float-anchor refid="tab1"></ce:float-anchor>Three patients with 13 implants died before stage II surgery. An additional three patients had recurrence of their tumor, which necessitated further surgical resection and resulted in the removal of six implants. Of the remaining 83 implants, one patient with one implant has not yet undergone stage II surgery, and four implants in three patients were buried.</ce:para><ce:para><ce:cross-ref refid="tab2">Table II</ce:cross-ref> shows the frequency distributions and percent survival rates by implant location and radiation status for 78 implants with known status.
<ce:float-anchor refid="tab2"></ce:float-anchor>A total of 24 implants failed in 12 patients. Among these failures, 18 occurred before implant loading; the remaining 6 failed within 18 months after loading. The implant survival rate for the total sample of 78 implants with known status was 69.2%. The survival rates were 74.1% and 71.1% for the anterior and posterior implants, respectively, compared with only 33.3% for implants placed within the surgical defects. The combined implant survival rate for the irradiated group was 63.6% (67.0% before radiation, 50.0% after radiation), in contrast to 82.6% for the nonirradiated group.</ce:para><ce:para><ce:cross-ref refid="tab3">Table III</ce:cross-ref> shows mean number of implant threads exposed 18 months after stage II surgery for implants located in anterior and posterior sites.
<ce:float-anchor refid="tab3"></ce:float-anchor>The mean number of threads “above” the mesial bone level was 2.15 ± 2.35 for 46 sites with available radiographic data; the mean number “above” the distal bone level was 2.49 ± 2.48. The average of the mesial and distal bone levels was 3.82 ± 2.49 for the anterior implants and 1.44 ± 1.76 for the posterior implants. Anterior implants demonstrated a 2.7 times greater number of exposed threads than posterior implants.</ce:para><ce:para><ce:cross-ref refid="tab4">Table IV</ce:cross-ref> shows the mean increase in the number of exposed threads per year.
<ce:float-anchor refid="tab4"></ce:float-anchor>The rate of bone loss was 2.6 times greater around implants in the anterior region (mean = 0.73 ± 0.61; <ce:italic>n</ce:italic> = 17) than around those in the posterior region (mean = 0.28 ± 0.65; <ce:italic>n</ce:italic> = 27). The radiographic follow-up period for these implants ranged from 6 to 66 months, and 32 of the implants had been functioning for >2 years.</ce:para></ce:section><ce:section><ce:section-title>DISCUSSION</ce:section-title><ce:para>This article presents a retrospective clinical analysis; therefore many uncontrolled variables exist, including age, sex, configuration of the surgical defect, implant site, implant length, radiation status, time of implant placement, and prosthetic design. The number of implants used and their location is limited by the nature of the defect and the available bony sites. The premaxillary segment is a key site for implant placement because of the quantity of bone. Implants in the anterior maxilla, however, demonstrated an accelerated rate of bone loss 2.6 times greater than that of implants in the posterior maxilla ( <ce:cross-ref refid="fig3">Fig. 3, <ce:italic>A</ce:italic> and <ce:italic>B</ce:italic></ce:cross-ref> ).
<ce:display><ce:figure id="fig3"><ce:label>Fig. 3</ce:label><ce:caption><ce:simple-para><ce:bold>A,</ce:bold> Severe bone loss around necks of maxillary anterior implants was common finding in this patient population. Rate of bone loss appeared to slow down in second year, and implants demonstrated severe bone loss functioned for many years without failure. <ce:bold>B,</ce:bold> For this patient implants have functioned for 56 months and are currently without signs of clinical mobility.</ce:simple-para></ce:caption> <ce:link locator="gr3"></ce:link></ce:figure></ce:display>The mean number of exposed threads per year was 0.73 in anterior implants and 0.28 in the posterior implants. Each thread is approximately 0.6 mm; thus the estimated bone loss per year was 0.44 mm and 0.17 mm for the anterior and posterior implants, respectively. The criteria for success, as proposed by Albrektsson et al., <ce:cross-ref refid="bib11"><ce:sup>11</ce:sup></ce:cross-ref> stipulate that vertical bone loss be <0.2 mm annually after the implant's first year of service. By these criteria many of our anterior implants would have been considered failures. However, many of these implants have functioned for years without evidence of clinical mobility. The limited data and lack of standardization of radiographs in this retrospective analysis posed serious limitations on the assessment of periimplant bone height changes. The greater adverse response of anterior implants needs to be further examined by controlled clinical trials.</ce:para><ce:para>The differential pattern of bone loss between anterior and posterior implants may be related to load. <ce:cross-ref refid="bib12"><ce:sup>12</ce:sup></ce:cross-ref> In most instances, uniting the implants with a rigid precision-fitted bar with retentive elements attached to the bar was preferred. These retentive elements should direct the occlusal forces along the axis of the implants. The tissue bar designs that were used in these patients may not accommodate to the multiple axes of rotation that develop from bolus manipulation and other functional movements. The result may be the delivery of nonaxial loads to the implants. These loads are probably magnified by the rather long lever arms present as a consequence of the maxillary resection and may cause a resorptive remodeling response of the bone around implant necks. This pattern of bone loss has been observed and described by others. <ce:cross-refs refid="bib13 bib14"><ce:sup>13,14</ce:sup></ce:cross-refs> The implants should be relied on only for retention. Close adaptation and maximal extension of the obturator within the defect are recommended to improve the stability and support of the prosthesis. This approach may minimize the amount of lateral forces that are delivered to the implants.</ce:para><ce:para>Implants in the posterior alveolus demonstrated more favorable patterns of bone loss; however, implant placement in these sites is often limited by sinus pneumatization and excessive alveolar ridge resorption. A sinus lift and graft procedure may be performed and implants placed either immediately or later. Three patients underwent sinus lift and graft procedures that used either calvarial, genial, or iliac crest bone grafts. The success rate of implants placed in sinus grafted beds in maxillary resection patients stands to be determined. From the three patients in this group, one died before stage II surgery and another patient had received high-dose radiation (7940 cGy external beam plus brachytherapy), which may have contributed to the failure of four of five implants. The third patient had a sinus lift procedure with bone graft harvested from the chin followed by immediate placement of four implants ( <ce:cross-ref refid="fig4">Fig. 4, <ce:italic>A, B</ce:italic> , and <ce:italic>C</ce:italic></ce:cross-ref> ).
<ce:display><ce:figure id="fig4"><ce:label>Fig. 4</ce:label><ce:caption><ce:simple-para><ce:bold>A,</ce:bold> , Sinus lift and graft procedure with bone harvested from patient's chin. Adequate alveolar bone (4 to 5 mm) must be present to stabilize implants if immediate placement is attempted. <ce:bold>B,</ce:bold> Panoramic radiograph demonstrates position of implants and bone graft. <ce:bold>C,</ce:bold> Implants have functioned for 28 months and are stable.</ce:simple-para></ce:caption> <ce:link locator="gr4"></ce:link></ce:figure></ce:display>Adequate alveolar bone (4 to 5 mm) was present in this patient to stabilize the implants. These implants are currently stable and still function after 28 months.</ce:para><ce:para>Free bone grafts rely on the vasculature of the surrounding tissues, which may be severely diminished by radiation; thus alternate implant sites may be considered. Four patients had 12 implants placed in secondary sites, including the zygoma, pterygoid plates, and horizontally between the cortices of the anterior hard palate. All these implants were placed immediately at tumor resection. Two of the patients had recurrence of their tumors within the first year, and further surgical resection necessitated the removal of five implants. Four implants failed and one was buried. Only two of the 12 implants underwent final restoration. These implants were located in the zygoma and posed a variety of complications and compromises from limited accessibility and undesirable angulation ( <ce:cross-ref refid="fig5">Fig. 5, <ce:italic>A</ce:italic> and <ce:italic>B</ce:italic></ce:cross-ref> ).
<ce:display><ce:figure id="fig5"><ce:label>Fig. 5</ce:label><ce:caption><ce:simple-para><ce:bold>A,</ce:bold> Implants in zygoma pose various complications because of limited accessibility, excessive thickness of overlying soft tissues, and undesirable implant angulation. Poor angulation prohibited effective use of these implants for retention of obturator. <ce:bold>B,</ce:bold> Tissue bar incorporated magnets parallel to axis of movement of obturator in attempt to reduce unfavorably directed forces delivered to implants.</ce:simple-para></ce:caption> <ce:link locator="gr5"></ce:link></ce:figure></ce:display>Multiple soft tissue procedures were required to create a zone of attached tissues around the implants. Additionally, the patient was unable to visualize the implants, making hygiene maintenance difficult and problematic.</ce:para><ce:para>Immediate implant placement at surgical resection is generally not recommended. Ten patients received 38 implants at surgical resection. Only 29% of these implants survived and underwent final restoration, in contrast to 67% of implants placed later. A greater number of immediately placed implants either failed or were withdrawn from the study because of patient death or cancer recurrence. In >75% of patients with head and neck cancer, recurrences are noted within the first 2 years. The overall 5-year survival rate for patients with cancer of the oral cavity and maxillary sinuses is 40% and 25%, respectively. <ce:cross-ref refid="bib15"><ce:sup>15</ce:sup></ce:cross-ref> The high rate of unused implants caused by patient mortality or recurrence of tumor clearly indicates that immediate implant placement may not be cost effective. In addition, a large number of maxillectomy patients will receive postoperative radiation therapy. Although postoperative doses are relatively low (usually around 5000 cGy), dose enhancement caused by backscatter may increase the dose at the bone implant interface by as much as 15%. <ce:cross-refs refid="bib16 bib17"><ce:sup>16,17</ce:sup></ce:cross-refs> In our group, patients who received radiation after implant placement demonstrated the poorest implant survival rate (50%).</ce:para><ce:para>The implant survival rate for the overall irradiated group was 63.6% versus 82.6% for the nonirradiated group, a trend similar to that observed by other investigators. <ce:cross-refs refid="bib18 bib19 bib20 bib21"><ce:sup>18-21</ce:sup></ce:cross-refs> The low implant survival rate in patients receiving radiation is expected because radiation effects on bone are known to compromise healing capacity and alter bone remodeling.</ce:para><ce:para>Implants enhance the retention of large maxillary obturators and improve the function and quality of life of edentulous maxillary resection patients. Controlled, prospective studies are necessary so better decisions can be made regarding placement and use of implants in this patient population.</ce:para></ce:section><ce:section><ce:section-title>CONCLUSIONS</ce:section-title><ce:para>Edentulous maxillectomy patients can benefit from implants. Many factors such as radiation status, available bony sites, and surgical procedures may influence implant prognosis and design of the obturator components.</ce:para><ce:para>The anterior maxillary segment is a key site for implant placement; however, anterior implants displayed an accelerated rate of bone loss almost threefold greater than that of posterior implants. Many of these implants functioned for many years without signs of clinical implant mobility. This differential pattern of bone loss between anterior and posterior implants may be related to load, which indicates that anterior implants are subjected to a greater level of stress.</ce:para><ce:para>Placement of implants at surgical resection is not advised because of the high recurrence and mortality rates within this patient population. Implants that were irradiated after placement demonstrated low survival rates. Implants placed within the surgical defect have a low probability of survival and are difficult to restore and maintain.</ce:para></ce:section></ce:sections><ce:acknowledgment><ce:section-title>Acknowledgements</ce:section-title><ce:para>We thank Dr. Krishan Kapur for help in data assessment in preparing this manuscript.</ce:para></ce:acknowledgment><ce:appendices><ce:section><ce:section><ce:section-title>CONTRIBUTING AUTHOR</ce:section-title><ce:para><ce:bold>J. A. 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type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">R.D.</namePart><namePart type="family">Nishimura</namePart><namePart type="termsOfAddress">DDSb</namePart><affiliation>University of California, Los Angeles, School of Dentistry, Los Angeles, and City of Hope National Medical Center, Duarte, Calif</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">B.K.</namePart><namePart type="family">Davis</namePart><namePart type="termsOfAddress">DMD, MSc</namePart><affiliation>University of California, Los Angeles, School of Dentistry, Los Angeles, and City of Hope National Medical Center, Duarte, Calif</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">J.</namePart><namePart type="family">Beumer, III</namePart><namePart type="termsOfAddress">DDS, MS d</namePart><affiliation>University of California, Los Angeles, School of Dentistry, Los Angeles, and City of Hope National Medical Center, Duarte, Calif</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="Full-length article" authority="ISTEX" authorityURI="https://content-type.data.istex.fr" valueURI="https://content-type.data.istex.fr/ark:/67375/XTP-1JC4F85T-7">research-article</genre><originInfo><publisher>ELSEVIER</publisher><dateIssued encoding="w3cdtf">1997</dateIssued><copyrightDate encoding="w3cdtf">1997</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><abstract lang="en">Abstract: Purpose. Fabricating a maxillary obturator can be challenging. Placement of implants can have a dramatic effect on the stability and retention of the prosthesis in the edentulous maxillectomy patient. This article provides clinical retrospective analysis of osseointegrated implants used to retain maxillary obturators. Material and Methods. Patient charts and radiographs were reviewed to determine implant status, bone loss patterns, and implant survival rates. Twenty-six patients were included with 102 implants placed, from which there were 19 intact withdrawals (implants lost because of recurrent disease or patient death), five implants with unknown status, 24 implant failures, and 54 functional implants. Results. The overall survival rate for implants in this patient population was 69.2%. The percent implant survival rate was 63.6% for the irradiated group (67.0% before radiation, 50.0% after radiation) and 82.6% for the nonirradiated group. Implants located in anterior sites demonstrated statistically significant differences in annual bone height changes compared with posterior sites. Conclusions. The majority of implant failures (18 of 24) occurred either at stage II surgery or before loading. Implants placed during tumor resection, implants placed within the maxillectomy defects, and implants receiving postoperative radiation demonstrated low survival rates. (J Prosthet Dent 1997;77:184-90.)</abstract><note>a Adjunct Assistant Professor, Section of Removable Prosthodontics, School of Dentistry, University of California, Los Angeles, and Director, Maxillofacial Prosthetics, City of Hope National Medical Center.</note><note>b Assistant Professor, Section of Removable Prosthodontics, University of California, Los Angeles, School of Dentistry.</note><note>c Former Resident, Maxillofacial Prosthetics, School of Dentistry, University of California, Los Angeles.</note><note>d Chairman, Section of Removable Prosthodontics and Director, Maxillofacial Prosthetics, School of Dentistry, University of California, Los Angeles.</note><note>Reprint requests to: Dr. Eleni D. Roumanas UCLA School of Dentistry 10833 Le Conti Ave., CHS A0-156 Los Angeles, CA 90095-1668</note><note>0022-3913/97/$5.00 + 0 10/1/78672</note><note type="content">Table I: Status of 102 implants in 26 patients by type of surgical defect</note><note type="content">Table II: Frequency distributions of surviving implants by their location and radiation status</note><note type="content">Table III: Mean number of exposed threads at 18 months for implants located in anterior and posterior sites</note><note type="content">Table IV: Comparisons of mean mesial and distal bone height changes for implants located in anterior and posterior sites</note><relatedItem type="host"><titleInfo><title>The Journal of Prosthetic Dentistry</title></titleInfo><titleInfo type="abbreviated"><title>YMPR</title></titleInfo><genre type="journal" authority="ISTEX" authorityURI="https://publication-type.data.istex.fr" valueURI="https://publication-type.data.istex.fr/ark:/67375/JMC-0GLKJH51-B">journal</genre><originInfo><publisher>ELSEVIER</publisher><dateIssued encoding="w3cdtf">199702</dateIssued></originInfo><identifier type="ISSN">0022-3913</identifier><identifier type="PII">S0022-3913(05)X7037-8</identifier><part><date>199702</date><detail type="volume"><number>77</number><caption>vol.</caption></detail><detail type="issue"><number>2</number><caption>no.</caption></detail><extent unit="issue-pages"><start>109</start><end>230</end></extent><extent unit="pages"><start>184</start><end>190</end></extent></part></relatedItem><identifier type="istex">195EF19E5EE3A711D11D0F6B16DF880EA141027D</identifier><identifier type="ark">ark:/67375/6H6-PCQ2Q4BJ-S</identifier><identifier type="DOI">10.1016/S0022-3913(97)70233-6</identifier><identifier type="PII">S0022-3913(97)70233-6</identifier><accessCondition type="use and reproduction" contentType="copyright">©1997 Editorial Council of The Journal of Prosthetic Dentistry.</accessCondition><recordInfo><recordContentSource authority="ISTEX" authorityURI="https://loaded-corpus.data.istex.fr" valueURI="https://loaded-corpus.data.istex.fr/ark:/67375/XBH-HKKZVM7B-M">elsevier</recordContentSource><recordOrigin>Editorial Council of The Journal of Prosthetic Dentistry., ©1997</recordOrigin></recordInfo></mods><json:item><extension>json</extension><original>false</original><mimetype>application/json</mimetype><uri>https://api.istex.fr/document/195EF19E5EE3A711D11D0F6B16DF880EA141027D/metadata/json</uri></json:item></metadata></istex></record>Pour manipuler ce document sous Unix (Dilib)
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