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ESTABLISHED CLINICAL APPLICATIONS OF OSSEOINTEGRATION

In the field of oral surgery, the most common application of osseointegration has been the dental and oral reconstruction of patients who have lost teeth. The anatomical and functional rehabilitation after the loss of teeth implies replacement of the teeth and part of the surrounding tissues because the loss of teeth results in involution of periodontal tissues. Osseointegration has been used for the replacement of missing single teeth, for the restoration of the partially edentulous segment of the mouth, and for the reconstruction of the completely edentulous patient by means of implant-supported fixed bridges or removable overdentures that attach to an implant-supported framework

Continued development and adaptation of surgical and prosthetic procedures has allowed rehabilitation even of patients with extensive loss of alveolar jawbone, including discontinuities of the jaw skeleton, whether congenital, posttraumatic, or after tumor surgery. Autologous bone grafts have proven beneficial in many of these situations in combination with bone-anchored devices. Requirements on precise fitting of prosthetic superstructures exceed those for devices anchored to 178 Journal of Rehabilitation Research and Development Vol. 38 No. 2 2001 teeth, since the osseointegrated fixtures do not adapt to a misaligned prosthetic framework by changing their position in the jawbone. This, on the other hand, means that fixtures can be used in orthodontic procedures. There has been a rapid development in orthodontic applications of dental implants to provide anchorage for orthodontic, orthopaedic, and orthognathic movements. One recent young patient with extensive oligodontia has undertaken a program of several steps . The initial step was the replacement of the missing mandibular dentition anterior to the molar teeth by implant-anchored bridgework. Subsequently, implants were placed in the missing maxillary cuspid areas to initially provide anchorage for orthodontic realignment of the premolar teeth and to thereafter provide support for freestanding single-tooth implant restorations. Pterygoid plate maxillary fixtures were used to provide distal support for the bridgework.