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LETTER TO THE EDITOR
Year : 2013  |  Volume : 2  |  Issue : 3  |  Page : 227-228

Two-implant lower jaw over dentures as an alternative to conventional


Department of Prosthodontics, CKS Teja Institute of Dental Sciences, Tirupathi, Andhra Pradesh, India

Date of Web Publication29-Aug-2013

Correspondence Address:
B Madan Mohan Reddy
6-12-5/E5, Kanaka Bhushan Layout, Tirupathi - 517 501, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2277-8632.117207

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How to cite this article:
Reddy B M, Padmaja B I, Reddy NR, Suneel M. Two-implant lower jaw over dentures as an alternative to conventional. J NTR Univ Health Sci 2013;2:227-8

How to cite this URL:
Reddy B M, Padmaja B I, Reddy NR, Suneel M. Two-implant lower jaw over dentures as an alternative to conventional. J NTR Univ Health Sci [serial online] 2013 [cited 2019 Dec 11];2:227-8. Available from: http://www.jdrntruhs.org/text.asp?2013/2/3/227/117207

Sir,

A 52-year-old female patient presented with a history of difficulty in mastication for the past 3 months. On examination and with thorough case history, she was found to have lost all teeth due to dental caries and periodontal problems. Patient was using conventional denture and not satisfactory due to several problems like difficulty in mastication and speech and majorly with insufficient retention of the lower denture. Radiographic examination was carried out for adequate bone support or any pathology of the bone.

Edentulous patients with dentures, particularly those who have adapted to the treatment poorly, can encounter severe psychological and social consequences. [1] Treating this condition with dentures or complete implants does not address all the deficiencies caused by tooth loss or satisfy cosmetic needs and are expensive. Fortunately, there is another option to dentures or complete implants, the lower jaw two-implant over denture. [2] In a sense; it is a combination of both denture and dental implant. Two dental implants, strategically placed, instead of the four or more needed to support a fixed bridge are sufficient to support a "traditional" lower denture. The denture is modified to fit on this new "platform" and placed over the two implants; hence, the term "over denture." [3]

Treatment plan was, fabrication of conventional maxillary denture with two implants in canine position of the lower jaw for fabrication of over denture on implants. Diagnostic impressions were made with alginate (chromatic jeltrate - dentsply) and cast prepared with type III dental stone for both upper and lower and mounted on the mean value articulator to analyze the inter arch distance. Bone mapping procedure was carried out to assess the width of the bone. Surgical splint made with clear acrylic is fabricated on the diagnostic cast.

Patient was suggested for all laboratory tests that are necessary for placement of implants though the patient has given a history of no abnormality. Following prophylactic course of antibiotics the patient was administered 2% of xylocaine with 1:200,000 epinephrine inferior alveolar, lingual, and buccal nerve blocks at the proposed site. With standard conditions of asepsis and sterility crestal incision was made with No. 15 Bard-Parker blades and handle and a full thickness flap was raised to access the alveolar bone. The exact position of the implant was marked using the surgical template.

Pilot drill was used first before initial drill is used. Paralleling tool was used to check the parallelism of the implants on both sides and final drill of required implant length and diameter was used as per the manufacturer's instructions [Figure 1]. After osteotomy, an endosseous root form single stage implant of size D3.3 and L10 TRX-BA of Hi-Tech implant system inserted to the final position and flap repositioned and sutures placed. [4] Patient was called after 3 months of healing period and radiograph was taken to analyze osseointegration [Figure 2]. Primary impression has made for both upper and lower jaw with alginate and cast poured with dental stone and special tray fabricated with double layer of spacer wax on the implant area. Border molding carried out and an impression made with elastomeric medium body material (dentsply). Cast poured with die stone and temporary denture base is fabricated. Wax occlusal rims were made for both upper and lower and jaw relations are recorded. Jaw relations are transferred to conventional three point articulator and mounted. Teeth arrangement was carried out and checked in patient's mouth and conventional flasking was carried out. Finishing and polishing of the denture is carried out. Once the denture is fabricated then suitable amount of acrylic ditch is made in the denture exactly was implants were present. Steel housing and elastic sleeve were placed on the implant and self-cure monomer and polymer are mixed and placed in the ditch made on the denture and kept on the implant. [5] Maxillary denture is placed in the oral cavity and asked the patient to bite in normal centric occlusion. Excess acrylic is removed and finishing and polishing is carried out and patient education and motivation is carried out how to place and remove the denture and regarding maintenance of the prosthesis. Post-operative follow-up is carried out for every 15 days and the patient was very much happy with the prosthesis as there was good retention and stability with the prosthesis and in particular lower prosthesis [Figure 3]. This case has been reported because of its novel treatment methodology.
Figure 1: Paralleling tool

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Figure 2: Implants after osseointegration

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Figure 3: Post-operative

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  References Top

1.Van Waas MA, Jonkman RE, Kalk W, Van't Hof MA, Plooij J, Van Os JH. Differences two years after tooth extraction in mandibular bone reduction in patients treated with immediate overdentures or with immediate complete dentures. J Dent Res 1993;72:1001-4.  Back to cited text no. 1
    
2.Batenburg RH, Meijer HJ, Raghoebar GM, Vissink A. Treatment concept for mandibular overdentures supported by endosseous implants: A literature review. Int J Oral Maxillofac Implants 1998;13:539-45.  Back to cited text no. 2
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3.Dodge CA. Prevention of complete denture problems by use of "overdentures". J Prosthet Dent 1973;30:403-11.  Back to cited text no. 3
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4.Thayer HH, Caputo AA. Effects of overdentures upon remaining oral structures. J Prosthet Dent 1977;37:374-81.   Back to cited text no. 4
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5.Quinlivan JT. An attachment for overlay dentures. J Prosthet Dent 1974;32:256-61.  Back to cited text no. 5
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  [Figure 1], [Figure 2], [Figure 3]



 

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