Post on 02-Jul-2015
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DR. RITESH SHIWAKOTI
MScD PROSTHODONTICS
NAZIA MAJEED ZARGARJOURNAL OF OROFACIAL RESEARCH APRIL-JUNE 2013;3(2):152-156
Rehabilitation of an atrophic edentulous jaw is still a real challenge
Maxilla is more frequent to get edentulous
25% the width and 4 mm height of alveolus bone loss occur in the first year after extraction
Over a long term there is extensive bone loss even in the denture wearers
Bone loss occurs in the labial side thus shifting the residual ridge to the lingual side
Thus the atrophic jaw can be restored by endostealimplants and this has become a revolutionary
Age : 54
Sex : Male
Chief complaint : ill fitting mandibular denture and unsatisfied with it
Examination : upper and lower edentulous jaw with resorption more on the mandible
Patient had no other medical disease
So, a maxillary conventional complete denture and a mandibular removable implant overdenture is planned as treatment.
1. A diagnostic impression using alginate is made of the edentulous mandibular ridge and poured
2. Two metal balls was placed on the premolar area of the ridge and fixed with the help of carding wax
3. A template is fabricated over the metal balls using autopolymerising resin
This prepared template was then worn by the patient while taking the panoramic radiograph so that the distance between the mental foramen from the metal balls could be determined
Location of the inferior alveolar nerve needs to be evaluated prior to implant placement
Exact location of the mental foramen and the presence or absence of the anterior loop needs to be determined
Evaluation of the available bone height
The symphyseal height of the mandible was found to be 20 mm
The right metal ball is close to the right mental foramen
There is space between the left metal ball and the left mental foramen
Is was planned that the implant site be selected between the mental foramen as there was optimum symphyseal height and this region presents the optimal density of the bone for implant support
Initially the number of implant was decided as four , two between the mental foramen and two in the posterior region , but due to the financial capability of the patient only two implant was then decided
Right implant was decided to be placed at the place of the right metal ball as its distance from the mental foramen was optimum but the left implant was decided 2 to 3 mm left to the metal ball
This implant area was marked in the template and a 4 mm diameter hole was made
Patient was premedicated with antibiotics (NovamoxCipla 1 gm , 1 hour before surgery)
Surgery was performed using local anesthesia
The template was placed in mouth and surgical mark was made through the implant point hole with a BP blade
Supracrestal incisions were made and the buccal and lingual full thickness mucoperiosteal flaps were raised
Using the surgical template , Nobel Biocare Replace
tappered TiU implant 3.5*16 mm2 were placed at the tooth 34 and 44 locations.
Surgical cover screws were placed and the flaps closed
Patient was instructed to discontinue the use of the lower denture for 2 week following surgery
Sutures were removed after 2 weeks and the denture was soft relined. This allowed the patient to wear the removal prosthesis during the period of osteointegration without transmitting excessive forces to the surgical site
The second stage surgery was done after 4 months according to the Brenmark protocol that states that dental implant are to be submerged beneath the soft tissue at the time of the placement and allowed to heal for least 3 month in the mandible
Here the implant were exposed, the surgical cover screws were removed and the site were irrigated with sterile normal saline. Healing collar were placed, and the gingival tissue were allowed to mature for 1 month for soft tissue healing.
Both the maxillary and the mandibular denture were fabricated beforehand.
A month after the placement of the healing collars a ball abutments ( Nobel Biocare )of the collar height 0.5 mm were placed.
Gold caps were placed on their respective ball abutments and stabilized in the mouth with the help of putty (Reprosil – dentsply)
Two holes were made on the tissue surface of the mandibular denture where gold caps would be attached
Na autopolymerizing resin was placed into the holes in the mandibular denture and the denture was placed in the mouth with the gold caps in place over the ball abutments.
The cold cure was allowed to set and then the denture removed
Gold caps were transferd to the tissue surface of the mandibular denture. Excess of the cold cure was removed
The gold caps were tightened using its activator, to the desired tightness
The maxillary and mandibular complete denture were inserted
On an atrophied edentulous ridge an implant overdenture improves the quality of life of the patient.
An endosteal implant along with ball attachment could be seen from the above case.
Panoramic x-ray plays an important role in guiding the location for the implant placement.
This type of implant supported overdenture improves the retention and stability of the denture.