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Recordings of the masticatory efficiency and occlusal perception of thickness were performed to study the oral function of partially edentulous patients treated with fixed prostheses on osseointegrated implants. There are obvious methodological advantages when using patients treated with fixed retrievable prostheses supported by implants in studies related to masticatory function since these prostheses are easily removed. This allows immediate recording of the ntasncarory function after removing significant areas of support which represents a new study approach.

Participants in this study had a mean masticatory efficiency of 49.2% with an individual range from 23.8% to 67.1%. Results from a previous study on healthy, completely dentate individuals show a higher mean masticatory efficiency (70%). This difference is statistically significant (P <= 0.01). The difference could be explained by the use of composite resin for the occlusal surface of the prostheses, providing less pronounced cusps, or by the implants themselves. However, the difference between naturally dentate persons and this study group can be related to the difference in the number of teeth on the occiusal table. This has been shown to be an important factor in masticatory efficiency, and most of the patients in this study did not have second or third molars.

The removal of the partial implant- supported restorations resulted in a dramatic decrease of masticatory efficiency in all participants in the present study. This reduced function indicates that the partial prostheses are taking an active part during mastication. The partial prostheses in the present study were two-, three, four-unit restorations, and all of them covered the areas of first and second premolars and first molars. The molar has been suggested to be of great importance during mastication. The decrease in masticatory efficiency after removing the prostheses confirmed the importance of those teeth in mastication. Furthermore, in those patients for whom the treatment included partial implant-supported prostheses on both sides of the jaw, the decrease of masticatory efficiency after removing the second partial prosthesis was even more obvious, indicating that the role of those prostheses in the patient's masticatory efficiency is ofgreat importance. Hence, the masticatory system of these patients could possibly give better values of masticatory efficiency, if an adaptation period followed the new condition. However, it has been stated that the best guarantee for good masticatory efficiency is a reasonable number of healthy teeth. The superiority of fixed prostheses over conventional removable dentures in combination with the findings of this study confirms that fixed prostheses supported by osseointegrated implants could possibly be a better alternative for treating partially edentulous patients. Int J Oral Maxillofac Implatns 190; 5; 107-111.

The burden of illness among maxillofacial patients is based less on their numbers and more on the enormous impact of the anatomic and functional losses that affect virtually every aspect of these individual's lives. Whether through an accident of birth, trauma, or aggressive ablative surgery, these people present the prosthodontic community with its ultimate challenge. How successful have we been in the treatment of maxillofacial prosthetic patients? And can we document this success in a convincing manner?

Despite the apparent advantages provided by implants to the maxillofacial patient, complete documentation of these benefits is lacking in the literature. This review uses existing published material as a basis to discuss the efficacy of implant use in maxillofacial prosthetics and the biologic rationale of the procedures. The use of implants with bone-anchored hearing aids; in maxillofacial surgery; and in maxilliary, mandibular, and facial defects is presented.

A major subgroup of maxillofacial patients has had therapeutic radiation in addition to surgery. Can implants safely and predictably be placed in radiated bone? Do implants already in bone represent an unacceptable risk when radiation is planned? Common sense suggests that the period between chemotherapy sessions would be the preferred time to place implants, but no long term clinical studies can be found to address this issue. Despite the lack of understanding and the risks involved, implants have been intelligently applied to provide enormous benefit among maxillofacial patients.

Implants originally developed in the dental context are finding their way into purely surgical applications. In orthopedic surgery, the principle of osseointegration has been applied to bone-fixation plate systems that replace the traditional AO plate, commonly used in mandibular reconstruction surgery. For those who cannot tolerate the conventional hearing aid, implant supported hearing aids become a medium for sound transmission through the skull to the inner ear.

We do not need sophisticated health measurement instruments to show that our maxillofacial patients are vastly improved with the help of implants. However, many of the other old problems remain and still limit long term success. The problems of facial prosthetic materials still cause patient dissatisfaction with the prosthesis, limit their psychological and social rehabilitation, and result in substantial costs in repeated remakes.

Reliable and valid patient-based evidence of treatment success is needed. Teachers and researchers in prosthodontics must use properly designed trials with valid, reliable, and responsive outcome measures.

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