Ecole Liégeoise d'Occlusodontologie et de Prothèse Implantaire
Liège, Belgium

 

THE TREATMENT OF SEVERE EDENTATION AT THE LOWER JAW

 

The tripod stabilizing frame

 

A Speciality from LIEGE (Belgium)

 

( Simple solutions for complicated cases, accessible to the majority of patients )

 

For twenty years before,

the ECOLE LIEGEOISE D' OCCLUSODONTOLOGIE et de PROTHESE IMPLANTAIRE,
or (translated)
the LIEGE's SCHOOL for OCCLUSODONTOLOGY and IMPLANT's PROSTHESIS,

to private teaching, not to be confused with the Department of Implantology connected to the Academic Hospital Centre ( C.H.U.), has finalized simple formulas enabling the invalids of edentation, more particularly the oldest ones, to recuperate comfort associated to the occluso-functional stability necessary for the harmonious working of the jaws.

It is FINISHED..., MOVABLE and UMCONFORTABLE DENTAL PLATES !

Indeed, if the well-realized upper prosthesis gives satisfaction in more than 80 % of cases to the patients, who have been equipped for a long time and progressively adapted, the lower prosthesis without attachments remains unstable in spite of artificial adhesive and quickly finishes to the scraps.

Since its foundation in 1983, the "ECOLE LIEGEOISE d'OCCLUSODONTOLOGIE et de PROTHESE IMPLANTAIRE" has marked its interest and has become specialized in difficult cases, that is the disabilities of patients deprived of enough bone to enable the necessary retentions to maintain their prosthesis in the mouth during the mastication process.

Parallel to the work of the SWEDISH SCHOOL and very much before the installation of specialised centres in this field, Professor STREEL, the founder of the BELGIAN SCHOOL, got, after a stay in the U.S.A. in 1981, interested by the placement of implants in the posterior area of the mandible (bone of the lower jaw)

It is necessary to know that these regions are quickly deprived of teeth because of premature caries at the level of the decidous teeth, where cares have been neglected.

The tooth of 6 years or first molar of the definitive dentition is indeed in direct connection with the second decidous tooth, the last one of the decidous dentition. It will be damaged quicker than the anterior teeth which appear much later.

The loss of the posterior teeth inevitably provokes a bascule of the previous teeth and is at the begining of occlusal problems, which are the consequence of a bad gearing of antagonist teeth (fig. 1).

These diseases, or "pathological dysclusions" of the teeth, have particularly been studied at the BELGIAN SCHOOL, called "E.L.O.P.I.", which has progressively taken benefits from years of the clinical experience of more than 80 european specialists who have been taking part in our meetings since the "DENTAL CONGRESS of the "Principauté de Liège's MILLENIUM"" in 1980.

So, high tech studies about dental malocclusions (1) (2) and long experience permits to the E.L.O.P.I.'s SCHOOL to define reliable solutions for each type of edentulous jaws, avoiding all together the great majority of diseases which are responsible of problems observed in cases of prothesis reconstructions with implants.

(1) Occlusion : closing mechanism. Retailled (french) informations at http://occlusion.be/
(2) Dental malocclusion : noxious contacts between antagonist teeth during the movements of swallowing and mastication.

Indeed, many are the patients suffering from various disorders coming from the bucco facial environment (headache, vertigo, migraine, neuralgias, etc.) Patients who have been shifted around from specialist to specialist without giving any importance to the muscle cramps issued from dental malocclusions, responsible for the majority of these symptoms and are easy to treat with the efficiency through simple and cheap procedures.

Indeed, if a perfectly realized treatment of gums by a PERIODONTIC is not sufficient to definitely resolve the problem of gums loosening around a tooth, it is not credible, that the use of dental implants is the miracle solution to solve all the cases of edentation and that only one type of implant can answer to all preoccupations in this matter, as many young practitioners seem to think today.

Many failures have indeed been noticed, including in easyest cases, when the practitioner was not preoccupied enough about the impact of the implants on the functioning of the jaws.

It is obvious evident that we can not demand from an implant more than from a tooth, placed in the same place and which had to be taken off.

If the cylinder-conical screw (fig. 2) has been particularly studied by the team of Professor BRÅNEMARK who has demonstrated the bio compatibility (3) of titanium and who has imagine accurate techniques enabling osseointegration, it is a pity that this form only gives good service in ± 50 % of cases.

Fig. 2. " HARPOON " Implant
(STREEL R., E.L.O.P.I., Liège, Belgique)

(3) Bio compatibility : acceptation by living human body of the intrusion of foreign material.

Indeed, to treat a patient with this type of implants, it is necessary to have a sufficient quantity of alveolar bone, which is often the case in the anterior area of the jaw, particularly at the lower jaw, where the placement of screw implants seems the best solution to insure the fixation of fixed prosthesis.

The consistency of the residual bone at the lower jaw is indeed more important when the involution's process is older.

Without any anatomical obstacles, the anterior part of the edentulous mandible enables the placement of implants to all patients in good health, even very old ones, who will appreciate all the advantages of comfortable mastication.

If a big number of completely edentulous patients can benefit in financially accessible conditions from the advantages of implants with simplified formulas, the studies realized in the school of professor STREEL, which interest many foreign specialized centers, have allowed to finalize implants adapted to the involution's process (4), result of long time extraction in the posterior area of the lower jaw where it is impossible to find enough bone to place any screw implants.

(4) Involution bone's process : progressive erosion of the alveolar bone, result of the loss of teeth and their alveolar support (fig. 3).

Fig. 3. Edentulous mandibles

To avoid the problems observed in the case of short cut prosthesis, completed behind by cantilever beam as recommended by the Swedish School (fig. 4), the implants of E.L.O.P.I.'s School (fig. 5) insure in all cases posterior anchorage, indispensable for the stability of prosthesis and for the harmonious functioning of temporo-mandibular joints, with a serious economy of very expensive Swedish's implants.

 
Fig. 4. Prosthesis with cantilever beam.
(© BRÅNEMARK P.-I., Swedish School)
Fig. 5. Tripod stabilizing Frame. - Confer : Fig. 9.
(© STREEL R., E.L.O.P.I., Liège, Belgium)

The use of these implants of a new conception which were created twenty years ago to enable in many cases resolving the problems of stability of upper prosthesis which falls down easily when they are not supported by rigid structures at the antagonist jaw and, particularly, when the patients have lost, for a long time, the teeth of the posterior stabilising area at the mandible and when the teeth at the anterior sector have egressed, inverting the occlusal curve in spite of functioning and aesthetic (Fig. 6 et 7).

 

Fig. 6. Mandible : lost teeth, lost alveolar bone and lost of any posterior anchorage.

 

Fig. 7. Working model. Removable prothesis clipsed on the tripod stabilizing frame.

 

Fig. 8. Mandible : implants and tripod stabilizing frame.

 

 
Fig. 9. Mandible. Tripod stabilizing frame. - Back to Figure 5 : click here.

 

Fig. 10. Mandible. Fixed prothesis (" bridge ") on a tripod stabilizing frame.

 

CONCLUSION.

 

    The realization of tripod stabilizing frames, battle horse of the Liège School of Occlusodontology and Implant Prothesis, enables solving the problems of instability of the prosthesis realized at the lower jaw in case of severe distal lost teeth and to postpone the placement of implants at the upper jaw which is a more complicated procedure which is not tackled here.

 

Ecole Liégeoise d'Occlusodontologie et de Prothèse Implantaire
"E. L. O. P. I."
Rue Saint Séverin, 34
B-4000 Liège
Tél. +32 4 223 75 56
Fax : +32 4 221 06 54
Mél. E.L.O.P.I.

 

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