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 Table of Contents  
CASE REPORT
Year : 2015  |  Volume : 7  |  Issue : 1  |  Page : 22-24

A 4-year follow-up of rehabilitation of atrophied edentulous mandible with implant-supported overdenture


1 Department of Prosthodontics, Sri Aurobindo College of Dentistry, Indore, Madhya Pradesh, India
2 Department of Conservative Dentistry, Sri Aurobindo College of Dentistry, Indore, Madhya Pradesh, India

Date of Web Publication7-Jul-2015

Correspondence Address:
Jatin Agarwal
A/9, Basant Vihar Colony, Behind Satya Sai School, AB Road, Indore - 452 010, Madhya Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2249-4987.160173

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  Abstract 

Conventional complete dentures primarily rely on residual alveolar ridge and mucosa for support and retention. Patients with poor mandibular ridge foundation usually suffer from inadequate denture retention and stability. In such cases, implant-supported overdenture treatment provides improved prosthesis retention and support and thus greatly increasing patient's acceptance toward prosthesis as when compared to conventional dentures. The present case report describes a successful rehabilitation of resorbed mandibular ridge with an overdenture supported by two implants.

Keywords: Atrophied mandible, ball attachment, immediate implant placement, implant overdenture


How to cite this article:
Agarwal J, Agarwal RS. A 4-year follow-up of rehabilitation of atrophied edentulous mandible with implant-supported overdenture. J Oral Res Rev 2015;7:22-4

How to cite this URL:
Agarwal J, Agarwal RS. A 4-year follow-up of rehabilitation of atrophied edentulous mandible with implant-supported overdenture. J Oral Res Rev [serial online] 2015 [cited 2019 Oct 15];7:22-4. Available from: http://www.jorr.org/text.asp?2015/7/1/22/160173


  Introduction Top


The goal of prosthetic dentistry is to restore normal function, comfort, and esthetics regardless of the atrophy or disease of the stomatognathic system. However, the more is the edentulous span, the more arduous this goal becomes with traditional dentistry. In an edentulous condition, especially with resorbed mandibular ridge, it becomes very difficult to achieve this goal with conventional complete denture therapy.

The recent thrust toward the use of dental implants to retain and support mandibular dentures has helped to fulfill the functional requirements of the patient with this challenging condition. [1],[2],[3] Several treatment options with the implant have been described for mandibular edentulous patients. [4] Two dental implants are usually considered the minimal number necessary for mandibular implant overdenture treatment. [5] In this case report, patient with resorbed edentulous mandible was successfully rehabilitated using two dental implants placed in the interforaminal region with ball abutments opposing conventional maxillary complete denture.


  Case Report Top


A 62-year-old female patient reported with a chief complaint of ill-fitting acrylic partial dentures and difficulty in chewing. There was mucosal soreness in the mandibular anterior region. The remaining natural teeth present were periodontally compromised and carious. Clinical and radiographic examination [Figure 1] revealed severe alveolar bone loss in the mandibular posterior region while the maxillary residual ridge was judged to be adequate for denture support. There were no compromising systemic considerations.
Figure 1: Preoperative radiograph

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Accordingly, the treatment plan comprising mandibular implant-supported overdenture and conventional maxillary denture was formulated then informed consent was obtained from the patient.


  Procedure Top


Under local anesthesia, mandibular teeth were extracted, and immediate implant placement was done in the extraction sockets of left canine and right lateral incisor [Figure 2]a and b]. The implants were of dimensions 4.3 mm diameter and 13 mm length of Nobel Biocare Replace Select (RP). The initial stability achieved was 35 Ncm. The sutures (4-0 vicryl) were placed, and postoperative instructions were given. The patient was kept under antibiotic and analgesic cover, and chlorhexidine mouthwash was prescribed. In the next appointment (after 7 days), remaining maxillary teeth were extracted under local anesthesia and sutures were removed from the mandibular arch. After the healing phase, the complete denture was fabricated with the conventional method. Care was taken to relieve the mandibular denture at the site of implant placement. The patient was recalled at the 1-month interval, and clinical and radiographic assessment was done, which was found to be satisfactory.
Figure 2: (a) Immediate implant placement in interforaminal region. (b) Postoperative radiograph

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After 4 months, second stage surgery was performed; the cover screws of implants were exposed using a laser (soft tissue diode laser, Picasso, USA). The cover screws were replaced with a healing abutment (Nobel Biocare RP) of dimension 4.3 mm diameter and 3 mm collar height. Necessary adjustments were made in the denture. After 7 days, the healing abutments were replaced with ball abutments of 2 mm collar height and tightened with a torque wrench to 15 Ncm [Figure 3]a]. Vent holes were created in the denture to accommodate the gold cap ball abutment insert. With these gold caps seated on the abutment and the denture in place, the self-curing acrylic resin was introduced into the denture vent and allowed to cure with the patient biting in centric relation. The modified surfaces of the denture were then finished and polished [Figure 3]b]. The denture was then inserted into the patient's mouth for occlusal equilibration. Recall visits were made initially at 3 months interval for 1-year [Figure 4]. Subsequently, the patient was recalled for follow-up on a yearly basis. The clinical and radiographic assessments have so far been favorable and patient feedback positive [Figure 5]a and b].
Figure 3: (a) Ball abutments tightened to implants. (b) Gold cap ball abutment insert secured in mandibular denture

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Figure 4: Complete denture prosthesis in centric occlusion

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Figure 5: (a) Four years follow-up radiograph. (b) Ball abutments in place showing no gingival recession or thread exposure

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  Discussion Top


Implant-supported overdenture provides many benefits over conventional denture therapy. These include decreased bone resorption, reduced or eliminated prosthesis movement, better esthetics, improved tooth position, better occlusion including improved occlusal load direction, increased occlusal function, and maintenance of the occlusal vertical dimension. Redford et al. demonstrated that conventional mandibular complete denture produces significantly more patient problems than maxillary complete dentures, primarily because of poor prosthesis retention. [6]

In the present case report, two implants were placed in the interforaminal region to provide retention and stability to the overdenture. Additional implants may improve prosthesis support, but retention and stability, are not significantly improved. [5],[7] The anterior mandible has demonstrated a high predictability for implant-tissue integration, and consequently, there is little need for planning the placement of additional implants in anticipation of potential implant integration failure. [7] Tooth borne mandibular overdenture was also not considered because of the compromised periodontal condition of the remaining natural teeth. The ball abutments were chosen as they are cost effective and less technique sensitive, as compared to bar attachment which requires more inter-ridge space. Moreover, it has been reported that ball abutments are more advantageous with regard to optimizing stress and minimizing denture movement. [8]


  Conclusion Top


Implant-supported overdenture provides a strong return for the investment in treatment time and expense. The clinical outcome of this treatment is significantly better than that achieved with conventional mandibular dentures, especially when patients are experiencing technical problems because of compromised prosthesis retention and stability.

Financial support and sponsorship

Nil.

Conflict of interest

There are no conflicts of interest.

 
  References Top

1.
Adell R, Eriksson B, Lekholm U, Brånemark PI, Jemt T. Long-term follow-up study of osseointegrated implants in the treatment of totally edentulous jaws. Int J Oral Maxillofac Implants 1990;5:347-59.  Back to cited text no. 1
    
2.
Engquist B, Bergendal T, Kallus T, Linden U. A retrospective multicenter evaluation of osseointegrated implants supporting overdentures. Int J Oral Maxillofac Implants 1988;3:129-34.  Back to cited text no. 2
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3.
Naert I, Quirynen M, Hooghe M, van Steenberghe D. A comparative prospective study of splinted and unsplinted Brånemark implants in mandibular overdenture therapy: A preliminary report. J Prosthet Dent 1994;71:486-92.  Back to cited text no. 3
    
4.
Sadowsky SJ. Treatment considerations for maxillary implant overdentures: A systematic review. J Prosthet Dent 2007;97:340-8.  Back to cited text no. 4
    
5.
Zarb GA, Schmitt A. The longitudinal clinical effectiveness of osseointegrated dental implants: The Toronto study. Part II: The prosthetic results. J Prosthet Dent 1990;64:53-61.  Back to cited text no. 5
    
6.
Redford M, Drury TF, Kingman A, Brown LJ. Denture use and the technical quality of dental prostheses among persons 18-74 years of age: United States, 1988-1991. J Dent Res 1996;75:714-25.  Back to cited text no. 6
    
7.
Burns DR. Mandibular implant overdenture treatment: Consensus and controversy. J Prosthodont 2000;9:37-46.  Back to cited text no. 7
    
8.
Tokuhisa M, Matsushita Y, Koyano K. In vitro study of a mandibular implant overdenture retained with ball, magnet, or bar attachments: Comparison of load transfer and denture stability. Int J Prosthodont 2003;16:128-34.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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Abstract
Introduction
Case Report
Procedure
Discussion
Conclusion
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