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 Table of Contents  
CASE REPORT
Year : 2017  |  Volume : 4  |  Issue : 2  |  Page : 128-131

Implant-retained overdenture as a standard treatment modality for severely resorbed mandibular ridges


Department of Prosthodontics, Christian Dental College, CMC and Hospital, Ludhiana, Punjab, India

Date of Web Publication14-Mar-2017

Correspondence Address:
Angleena Y Daniel
Department of Prosthodontics, Christian Dental College, CMC and Hospital, Ludhiana, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2348-3334.201992

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  Abstract 

Edentulous patients are a diverse group comprised those who are anatomically deficient, medically compromised, economically depressed, geriatric as well as the general population that, for a number of other reasons have been rendered edentulous. Satisfying a completely edentulous patient is always considered a difficult task. Various treatment options for rehabilitation of a completely edentulous patient are available: conventional complete dentures, overdentures, implant-supported overdenture, and full arch fixed implant-supported prosthesis. While the conventional denture may meet the needs of many patients, others require more retention, stability, function, and esthetics, especially in the mandible. With the continued advancements in dental implant therapy, it is becoming increasingly easier for the clinician to provide treatment solutions that can effectively meet functional, economic, and social expectations of each individual patient. This paper presents a case report of prosthetic rehabilitation of a completely edentulous patient with implant-retained overdenture.

Keywords: Endosseous implants, mandible, overdenture, retention


How to cite this article:
Daniel AY, Wadhwa SS, Vinod B. Implant-retained overdenture as a standard treatment modality for severely resorbed mandibular ridges. CHRISMED J Health Res 2017;4:128-31

How to cite this URL:
Daniel AY, Wadhwa SS, Vinod B. Implant-retained overdenture as a standard treatment modality for severely resorbed mandibular ridges. CHRISMED J Health Res [serial online] 2017 [cited 2017 Jul 27];4:128-31. Available from: http://www.cjhr.org/text.asp?2017/4/2/128/201992


  Introduction Top


Edentulism is a major problem among the population of the developing countries although the prevalence is declining and incidence of tooth loss is decreasing in these nations. The prevalence of edentulism in India varies from 60% to 69% from 25 years of age group and above.[1] The conventional treatment for edentulism comprises removable maxillary and mandibular complete denture. This treatment derives its support and retention from underlying residual alveolar ridge. Maxillary dentures are adapted with relative ease by the patient, whereas problems are observed for adapting to mandibular denture.[2] The mandibular denture retention is significantly influenced by reduced oral tissue volume due to accumulative residual ridge resorption. The edentulous mandible loses four times more bone volume than the edentulous maxilla, and on average, 0.4 mm of mandibular anterior vertical resorption occurs each year.[3],[4]

Implant-supported overdenture offers many practical advantages over conventional tooth-supported complete dentures and removable partial dentures. 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 vertical dimension of occlusion. This paper presents a case report of prosthetic rehabilitation of a partially edentulous patient with mandibular implant-supported overdenture and maxillary conventional complete denture.


  Case Report Top


A partially edentulous 57-year-old female patient in good general health reported to the Department of Prosthodontics, Christian Dental College and Hospital, Ludhiana, with chief complaint of inability to chew food properly. Clinical examination revealed severely resorbed mandibular residual ridge and moderately resorbed maxillary alveolar ridge with #31, 41 in the mandibular arch and 22, 23 teeth in the maxillary arch [Figure 1]. The patient was explained about the limitations of removable complete denture and benefits of implant-retained prosthesis. She opted for implant-retained overdenture for the mandible and conventional complete denture for the maxilla as this treatment plan fitted well into her financial limits too. The bone was assessed quantitatively and qualitatively at the planned implant sites from the DentaScan [Figure 2]a and [Figure 2]b. The bone in the intraforaminal region was sufficient to accommodate implants. Hence, implant-supported mandibular overdenture and conventional maxillary complete denture were planned, following extraction of the remaining teeth.
Figure 1: Pretreatment intraoral view

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Figure 2: (a and b) Qualitative and quantitative assessment of bone with Denta Scan

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Three endosseous implants (Leader TiXos Implant Internal Hex) 3.3 mm by 8.0 mm were surgically positioned at sites of #34, #41, and #44 locations with the aid of surgical guide [Figure 3]a. The mandibular and maxillary complete dentures were fabricated before extraction and implant placement. Moreover, duplicated mandibular denture was used as a surgical guide. The surgical cover screws were placed and primary closure was done [Figure 3]b. The two piece regular implants were used instead of conventional single piece overdenture implant. This treatment plan in future will allow placement of more number of implants depending on patient desire and affordability for fixed prosthesis.[5]
Figure 3: (a) Surgical positioning of implant site. (b) Implants covered with cover screw

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The patient was recalled after a week for suture removal and was advised not to wear mandibular prosthesis for a minimum of 2 weeks to facilitate initial healing without functional loading. Later, the patient was allowed to wear the relieved and relined prosthesis. Implants were allowed to integrate undisturbed in the bone for 4 months.

A second-stage surgery was performed and healing screws were placed. The patient was recalled after 21 days to permit gingival tissue maturation. The depth of each crevice was measured with the periodontal probe, following the removal of each healing screws. Overdenture abutments corresponding to the crevice depth were selected and temporarily connected to each implant. The attachments denture base component was snapped onto the abutment [Figure 4]a. A special tray was fabricated on a preliminary cast and border molded. Secondary impressions were made using medium viscosity polyvinyl siloxane [Figure 4]b. Jaw relations were recorded and complete wax try in was done.
Figure 4: (a) Laboratory analogs snapped onto the ball abutments. (b) Secondary impression

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Maxillary and mandibular dentures were processed and polished. The previously selected overdenture abutments were placed on their respective implants and tightened to 30 nm. Maxillary and mandibular dentures were inserted and occlusion was verified. The passive fit of mandibular denture was verified using pressure indicating paste, especially over the implant sites. To ensure the passive fit, the relief areas were enlarged 5 mm uniformly with a round bur. On inspection, there was not any attachment movement as the denture base was moved slightly on and off the tissues.

A piece of glove with a central hole along with an elastic chain was placed onto each overdenture abutment to act as a block-out during the pickup procedure of Normo IN-CAPS [Figure 5]a. The Normo IN-CAPS (leader, Teflon CAPS, pink-soft) were snapped onto the ball abutments to be picked up later in the denture base.
Figure 5: (a) The Normo IN-CAPS snapped onto the ball abutments. (b) Attachments transferred to the denture base

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The mandibular denture was dried and a separating medium (Vaseline) was applied around the receptor site in the mandibular denture which would aid in the easy removal of excess material. The tooth color self-cure acrylic resin (Ashwin Pvt. Ltd., Mumbai, Maharashtra, India) was used for pick up procedure due to contrast with denture base. It was mixed and placed in the relieved areas in the mandibular denture carefully. The denture was inserted and the patient was asked to close gently without clenching. The resin was allowed to polymerize fully before the denture was taken out and excess resin was removed [Figure 5]b. Denture was then placed into the mouth and retention was evaluated [Figure 6].
Figure 6: Posttreatment intraoral view

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  Discussion Top


The prosthodontic management to restore an edentulous arch comprises of a conventional complete denture, an implant over denture or an implant supported fixed prosthesis. The conventional removable complete denture derives its retention and support from remaining residual alveolar ridge, but many denture-wearing patients have a poor diet and cannot speak clearly due to lack of denture retention and stability.[6] Redford et al reported that more than 50% of conventional mandibular complete dentures face difficulties with retention and stability and pose significantly more patient problems than maxillary dentures. Mandibular implant overdenture treatment has gained considerable acceptance and has been recommended as the standard-of-care treatment when compared with conventional mandibular complete dentures.[7] In this case report, implant mandibular overdenture with ball attachment was used because, it is documented that ball attachment are less expensive, less technique sensitive (Naert et al., 1991), and easier to clean than bars (Cune et al., 1994) and less wear or fracture of the component than that of gold alloy bars (Schmitt and Zarb, 1998). It was also reported that the use of the ball attachment may be advantageous for implant-supported overdentures with regard to optimizing stress and minimizing denture movement (Tokuhisa et al., 2003). The approach in this report using ball attachments with healing abutments as supporting structure has an advantage of being incorporated at the chair side.


  Conclusion Top


The insufficiency of conventional denture treatment makes mandibular implant overdenture a preference to provide significant improvement in stability, retention, and quality of life in denture-wearing patients. Its relative simplicity, minimal invasiveness, predictability, efficacy, and affordability make it an especially attractive treatment option.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Shah N, Pandey RM, Duggal R, Mattur IP, Rajan K. Oral Health in India: A Report of the Multicentre Study Ministry of Health, Govt of India. WHO; 2007.  Back to cited text no. 1
    
2.
Mericske-Stern R. Treatment outcomes with implant-supported overdentures: Clinical considerations. J Prosthet Dent 1998;79:66-73.  Back to cited text no. 2
    
3.
Atwood DA, Coy WA. Clinical, cephalometric, and densitometric study of reduction of residual ridges. J Prosthet Dent 1971;26:280-95.  Back to cited text no. 3
    
4.
Tallgren A. The continuing reduction of the residual alveolar ridges in complete denture wearers: A mixed-longitudinal study covering 25 years. J Prosthet Dent 1972;27:120-32.  Back to cited text no. 4
    
5.
Misch CE. Contemporary Implant Dentistry. 3rd ed. St. Louis, MO: Mosby Elsevier; 2008.  Back to cited text no. 5
    
6.
Langer A, Michman J, Seifert I. Factors influencing satisfaction with complete dentures in geriatric patients. J Prosthet Dent 1961;11:1019-31.  Back to cited text no. 6
    
7.
Feine JS, Carlsson GE, Awad MA, Chehade A, Duncan WJ, Gizani S, et al. The McGill consensus statement on overdentures. Int J Oral Maxillofac Implants 2002;17:601-2.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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