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 Table of Contents  
CASE REPORT
Year : 2020  |  Volume : 15  |  Issue : 3  |  Page : 484-487

Rehabilitation of completely edentulous patient using implant supported overdenture


1 Department of Prosthodontics, Sharad Pawar Dental College, Datta Meghe Institute of Medical Sciences (Deemed to be University) ,Wardha, Maharashtra, India
2 Department of Oral Surgery, Sharad Pawar Dental College, Datta Meghe Institute of Medical Sciences (Deemed to be University) ,Wardha, Maharashtra, India

Date of Submission25-Apr-2020
Date of Decision15-May-2020
Date of Acceptance10-Jun-2020
Date of Web Publication1-Feb-2021

Correspondence Address:
Dr. Ruchika Mandhane
Department of Prosthodontics, Sharad Pawar Dental College, Sawangi (Meghe), Wardha, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdmimsu.jdmimsu_159_20

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  Abstract 


The prosthetic rehabilitation of the completely edentulous patient with resorbed mandibular ridge has always been a major challenge. Conventional maxillary and mandibular dentures have been the traditional standard of care. In the situation of resorbed mandibular ridge patient with conventional mandibular denture report difficulties such as lack of retention, stability, support, and inability to masticate. Implant-supported overdenture has become a boon in such condition. The number of implants to be placed depends on the amount of bone available. Various attachment systems are available for implant-retained overdenture, i.e., bar attachment, stud abutment, magnetic attachment, locator attachment, and many more. This case report describes a design and fabrication technique of the implant-retained overdenture using three freestanding mandibular implants with stud abutment and O-ring attachment.

Keywords: Attachment systems and stud abutment, conventional denture, implant-retained overdenture


How to cite this article:
Mandhane R, Dhamnade M, Mistry R, Ghavat C. Rehabilitation of completely edentulous patient using implant supported overdenture. J Datta Meghe Inst Med Sci Univ 2020;15:484-7

How to cite this URL:
Mandhane R, Dhamnade M, Mistry R, Ghavat C. Rehabilitation of completely edentulous patient using implant supported overdenture. J Datta Meghe Inst Med Sci Univ [serial online] 2020 [cited 2021 Feb 28];15:484-7. Available from: http://www.journaldmims.com/text.asp?2020/15/3/484/308547




  Introduction Top


Prosthetic management of edentulous patient has long been a major challenge for dentistry. Adaptation to wearing complete denture is a complex process and must be considered from both somatic and psychologic standpoints. Restoration of severely resorbed mandibular ridges requires modification in the conventional complete denture treatment. These modifications may be the different impression procedures for the mandibular ridge, neutral zone, or retaining the denture using implant.[1] Implant-supported overdenture is the preferable treatment of choice in such cases if all the other conditions, i.e., quality and quantity of bone, oral hygiene, and economic conditions of the patient permits. Removable implant-retained restorations might be considered a better treatment option to fixed in patients with excessive ridge resorption.[2] Depending on their support, we may classify them in: (a) Implant-retained overdentures if the denture is supported by tissues and are retained on the implants, and (b) Implant-supported overdenture, if support and retention are due to the implants that behave as a fixed denture but the patient can remove it for an adequate oral hygiene.[3]

This case report describes a design and fabrication technique of the implant-retained overdenture using three freestanding mandibular implants with stud abutment and O-ring attachment.


  Case Report Top


A 72-year-old male patient [Figure 1] reported to the Department of Prosthodontics and Crown and Bridge with the chief complaint of difficulty in mastication due to missing teeth. Clinical examination revealed completely edentulous maxillary ridge [Figure 2]a and resorbed mandibular ridge [Figure 2]b. Past medical history of the patient was not significant. The orthopantomograph finding showed the presence of sufficient bone height and width [Figure 3]. Thus implant retained overdenture was planned with three freestanding implants (A, C, and E position) with independent stub abutment and O-ring attachment (ball and socket attachment). The treatment plan was divided into two phases:
Figure 1: Preoperative picture

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Figure 2: (a) Maxillary ridge, (b) mandibular ridge

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Figure 3: Preoperative orthopantomograph

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  1. Surgical phase


  2. Under antibiotic prophylaxis and standard aseptic protocol preparation was done. Local anesthesia with lignocaine was used to give mental nerve block of both the right and left side. The full-thickness mucoperiosteal flap was reflected [Figure 4]a and pilot drill was made in A, C, and D position. Once bone drills were complete, implants (Osteem) of dimension 3 mm × 11 mm were placed and cover screw was tightened [Figure 4]b. Resorbable sutures were given and the patient was prescribed with medications for 5 days. After 3 months osseointegration was evaluated using radiograph [Figure 4]c and then second stage surgery was done and healing abutment was placed.
    Figure 4: (a) Mucoperiosteal flap retraction. (b) implants placed in A, C, and E region. (c) Postoperative orthopantomograph

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  3. Prosthetic phase


  4. Maxillary and mandibular dentures were fabricated using traditional techniques [Figure 5]. At the day of insertion, the gingival former [Figure 6] was replaced with the stud abutment (gingival height 3 mm) using O-ring driver. The stud abutment was covered with a yellow O-ring and retainer cap set. These retainer caps were marked with a hematoxylin pencil and a mandibular denture was placed. The markings were transferred to the intaglio surface of the denture thus giving the position of the stud abutment. Using no. 6 bur the acrylic from the intaglio surface of the denture was trimmed thus providing space for the retainer cap [Figure 7]a. After creating room for resin the denture was again placed on the abutments and the presence of enough space for resin and retainer cap was evaluated using disclosing paste. This pickup space was half-filled with self-cure autopolymerizing resin and the denture was then carefully placed over those abutments. For equalization of pressure and proper positioning of the denture, the patient was asked to close the mouth in centric relation with light contact. After the polymerization of resin, the denture was removed, now at this time, the retainer cap along with yellow O-ring is picked up in the mandibular denture. The excess of the resin was removed using acrylic trimming bur and the denture was finished and polished [Figure 7]b. Occlusion was verified again in centric relation [Figure 7c]. Post insertion instruction was given to the patient along a soft single tufted brush to keep attachment plaque free. The patient was trained to place and remove the prosthesis properly. The patient was satisfied with his dentures [Figure 8].
Figure 5: Second stage surgery gingival former placed

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Figure 6: Definative prosthesis

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Figure 7: (a) Acrylic resin trimmed from the intaglio surface of the mandibular denture. (b) Retainer caps in placed and mandibular denture finished and polished. (c) Definitive prosthesis in occlusion

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Figure 8: Postoperative photograph

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  Discussion Top


The rate of resorption for both the maxillary and mandibular ridge is different,[4] whereas the mandibular ridge resorbs at the faster rate. Resorbtion rate of the mandibular ridge is 0.2–0.3 mm annually which is four times more than that of the maxillary ridge. The implant-retained overdenture is being increasingly utilized in both general and specialist practice. There are various attachment systems such as magnets, stud abutment, locator abutment, bar attachment, and many more.[5] The implants can either be splinted with the bar or can be left independently.[6] Implants are splinted by a customized bar, the fabrication of which requires additional laboratory step and increase the cost of the treatment which is not feasible for some patients. If in future, the abutment failure occurs the entire bar along with the denture has to be replaced. These all the shortcomings of the bar attachment were overcome by the stud abutment.[7] No additional laboratory step is required and with wear of the component only ring or abutment can be replaced without replacing the entire denture. In the O-ring and retainer cap set three colors of O-rings [Figure 9] are present depending on the retentive force required (yellow: 4N, red: 6N, and black: Used for laboratory fabrication of the denture). The retainer cap set can be incorporated in denture either chairside or in the laboratory. With time the retentive forces of the ring decrease thus periodic changing of the rings is required.[8],[9],[10],[11]
Figure 9: Stud abutment along with retainer cap and O rings

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  Conclusion Top


Rehabilitation of severely resorbed edentulous mandible ridge has always been a challenging task. Among various treatment options available an implant-retained overdenture with stud abutment is a simple, cost-effective solution for restoring edentulous mandible. An implant-retained overdenture requires meticulous treatment planning. Post insertion instructions are to be given properly to the patient. Maintainance phase is important with this treatment choice.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Rastogi I. Management of Highly Resorbed Mandibular Ridge; in International Journal of Dental and Health Sciences 2014;1:512-22.  Back to cited text no. 1
    
2.
Laverty DP, Green D, Marrison D, Addy L, Thomas MB. Implant retention systems for implant-retained overdentures. Br Dent J 2017;222:347-59.  Back to cited text no. 2
    
3.
Martinez–Lage-Azorin JF, Segura-Andres G, Faus Lopez J, Agustin-Panadero R. Rehabilitation with implant-supported overdentures in total edentulous patients: A review. J Clin Exp Dent 2013;e267-72.  Back to cited text no. 3
    
4.
Bergman B, Carlsson GE. Clinical long-term study of complete denture wearers. J Prosthet Dent 1985;53:56-61.  Back to cited text no. 4
    
5.
Prasad DK, Prasad Da, Buch M. Selection of attachment systems in fabricating an implant supported overdenture. J Dent Implant 2014;4:176.  Back to cited text no. 5
  [Full text]  
6.
Timmerman R, Stoker GT, Wismeijer D, Oosterveld P, Vermeeren JI, van Waas MA, et al. An eight-year follow-up to a randomized clinical trial of participant satisfaction with three types of mandibular implant-retained overdentures. J Dent Res 2004;83:630-3.  Back to cited text no. 6
    
7.
Boudrias OP, Chehade A. Two-implant overdentures with ball attachments: A step-by-step approach. In: Feine JS, Carlsson GE, editors. Implant Overdentures: The Standard of Care for Edentulous Patients. Carol Stream, Ill: Quintessence Publishing Co; 2003;129-43.  Back to cited text no. 7
    
8.
Sonawane A, Sonawane A. Mds. Evaluating Salivary PH, Uric Acid, & C-Reactive Protein Levels in Completely Edentulous Patients before and after Wearing Complete Dentures Incorporated with and without 7.5% Chitosan Nanoparticles' – An Interventional Study. European Journal of Molecular and Clinical Medicine 2020;7:2132-37.  Back to cited text no. 8
    
9.
Bathiya A, Pisulkar SK. Comparative Evaluation of Effectiveness of Progressive Occlusal Equilibration Using Conventional and Computerized Analysis on Crestal Bone Loss around Single Implant in Posterior Region. Eur J Mol Clin Med 2020;7:2073-84.  Back to cited text no. 9
    
10.
Shelke AU, Dhadse PV. Assessment and Comparison of Periostin Levels in Peri-Implant Sulcular Fluid as a Biomarker in Healthy Peri-Implant Sites and Sites with Periimplant Mucositis and Peri-Implantitis. European Journal of Molecular and Clinical Medicine 2020;7:2009-16.  Back to cited text no. 10
    
11.
Shilpa B, Vasudevan S, Bhongade M, Baliga V, Pakhare V, Dhadse P. Evaluation of Survival of 8 Mm-Length Implants in Posterior Resorbed Ridges: A Pilot Study. J Indian Soc Periodontol 2018;22:334-39. Available from: https://doi.org/10.4103/jisp.jisp_368_17. [Last accessed on 2020 Jan 11].  Back to cited text no. 11
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9]



 

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