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CASE REPORT
Year : 2013  |  Volume : 2  |  Issue : 4  |  Page : 292-295

Full mouth rehabilitation with fixed implant-supported prosthesis: A case report


1 Department of Prosthodontics, Chadalavada Krishna Srinivasa Teja Institute of Dental Sciences, Tirupati, Andhra Pradesh, India
2 Department of Oral Medicine, Priyadarshini Dental College, Tiruvallur, Tamilnadu, India
3 Department of Periodontics, Chadalavada Krishna Srinivasa Teja Institute of Dental Sciences, Tirupati, Andhra Pradesh, India

Date of Web Publication26-Nov-2013

Correspondence Address:
Motupalli Sunil
Department of Prosthodontics,Chadalavada Krishna Srinivasa Teja Institute of Dental Sciences, Tirupati, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2277-8632.122177

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  Abstract 

Teeth are important structures in the oral cavity with many associated functions. Loss of teeth may be inevitable due to several reasons. Replacement of teeth should be done to restore the functions like mastication, phonetics, and esthetics. In present day, many treatment options are available, among them treatment with implants had evolved as a major choice. Among all types of implants, endosseous implants had gained more importance than any other type of implants. In present case report, patient wearing conventional denture was successfully treated with implant-supported prosthesis.

Keywords: Abutments, fixed prosthesis, implants, osseointegration, osteotomy site


How to cite this article:
Sunil M, Reddy BM, Reddy TS, Reddy NR. Full mouth rehabilitation with fixed implant-supported prosthesis: A case report. J NTR Univ Health Sci 2013;2:292-5

How to cite this URL:
Sunil M, Reddy BM, Reddy TS, Reddy NR. Full mouth rehabilitation with fixed implant-supported prosthesis: A case report. J NTR Univ Health Sci [serial online] 2013 [cited 2020 Apr 8];2:292-5. Available from: http://www.jdrntruhs.org/text.asp?2013/2/4/292/122177


  Introduction Top


Loss of teeth is accompanied by lot of adverse aesthetic and biomechanical sequelae. This predicament is worst when the entire periodontal ligament support is lost and patient becomes completely edentulous. Dentists consequently became profoundly aware of time-dependent relationship between form and functional changes in the masticatory system. Such knowledge helped nurture the development of new materials and knowledge about the relationships between esthetics, occlusion, and patients personalities. [1] Although a favorable treatment outcome often was achieved, few patients were not able to tolerate removable complete dentures. This failure is neither an indictment of one's professional skills, nor necessarily a condemnation of the patient's response to the clinician's efforts.

It must be accepted that many patients who wear complete dentures will experience considerable difficulty in adapting to their prostheses, while few patients may be adaptive for several years but become maladaptive as a result of regressive tissue changes and others may be perfectly adaptive but regret that this is their only treatment option. Some patients simply cannot wear dentures at all, and their quality of life is profoundly affected by their predicament. Clinical experience and some research have confirmed that there are physiological as well as psychological contributions to the maladaptiveness. Treatment for these patients usually entails considerable efforts of both clinical technical variety and emotional supportive variety.

The ideal goal of modern dentistry is to restore the patient to normal contour, function, comfort, aesthetics, speech, and health. Implant dentistry has the ability to achieve this ideal goal regardless of the atrophy, disease, or injury of the stomatognathic system. As a result of continued research, diagnostic tools, treatment planning, implant designs, materials and techniques; predictable success is now a reality for the rehabilitation of many challenging clinical situations.

Successful osseointegration enables the dentist and edentulous patient to consider one of two alternatives to the traditional complete dentures, such as implant-supported fixed or overdenture prosthesis. Implant-supported fixed prosthesis is an ideal cure for maladaptive patients. [1]

Decision to treat an edentulous arch with an implant-supported fixed prosthesis is influenced by five crucial considerations. [1]

  • Number of implant abutments.
  • Location of implants.
  • Quality of the host sites.
  • Quantity of the host bone sites or the amount of residual ridge reduction.
  • Amount of circum oral activity or generosity of patients smile line.



  Case Report Top


A male patient of age 58 years had reported to the outpatient wing of our department, with a chief complaint of missing tooth in both maxillary and mandibular arches. Patient wants to have fixed prosthesis as he was not happy with conventional denture [Figure 1] and [Figure 2]. Proper case history was recorded for the patient including medical history which was noncontributory, with relevant laboratory tests, dental and oral examination. Diagnostic impressions and casts were prepared. Thorough examination was done and patient was motivated for implant prosthesis. Bone mapping was done to evaluate the width of bone, by using orthopantamograph (OPG), length of available bone was calculated and appropriate sized implants are selected [Figure 3]. Surgical template was prepared for both maxilla and mandible, and the position of implants was decided prior to the surgery by placing a drill on the implant.
Figure 1: Maxillary preoperative photograph

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Figure 2: Mandibular preoperative photograph

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Figure 3: Bone mapping and preoperative radiograph

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Surgical phase

Two-stage surgical protocol was planned and patient was asked to have antibiotics and analgesics prior to surgery. Mucoperiosteal flap was elevated all over the maxilla and template was placed on the crest of the ridge with bur pilot drill is carried out [Figure 4] and [Figure 5]. Paralleling tools are placed and checked for angulations of the implant. Sequential drills were used and implants were placed in the osteotomy site and wrenched into the site until all threads are buried. Cover screws were placed and suturing was done [Figure 6]. Postoperative care has been administered with antibiotics, analgesics, and mouthwash. Maintenance of oral hygiene and ice pack if needed was suggested. Similar procedure was followed for mandible and suturing was carried out [Figure 7]. After 3 months, patient was recalled and postoperative OPG was made and checked for proper osseointegration. After confirming osseointegration, flap was elevated and covering screws are removed and per mucosal extension was placed and waited for week for healing to take place [2] [Figure 8].
Figure 4: Elevating flap in maxilla

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Figure 5: Initial drill in position

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Figure 6: Before placing the cover screws

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Figure 7: Cover screws placed in mandibular arch

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Figure 8: Placment of per mucosal extensions

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Prosthetic phase

After healing, per mucosal extensions were removed and impression analogues were placed. Open tray impression was made with elastomeric impression material and impression analogues are loosened. Implant analogue was threaded to the impression analogue in the impression tray and cast was poured. Abutment was placed on the cast and mounting was done. Metal trial was carried out, later ceramic build up was done and final prosthesis was fabricated and checked in oral cavity and final cementation was done [Figure 9]. Postoperative oral hygiene instructions were given to the patient and proper follow-up was done. [3]
Figure 9: Final prosthesis in position

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  Discussion Top


Treatment of partial and total edentulism with dental implants has evolved into a predictable procedure for majority of patients and is expected to play a significant role in oral rehabilitation. Surgical placement of dental implants is a well-documented treatment for edentulism. [4] Treatment success rates are high and postoperative complications were relatively modest. Successful implant treatment involves osseointegration of implants that are placed in ideal positions for fabrication of a dental prosthesis. [5] Periodic clinical assessment of the implant fixture, prosthesis, and surrounding tissue is critical for clinical success. In the present case, patient was called for every 3, 6, and 12 months, professional removal of supragingival and subgingival deposits on a regular basis was done [Figure 10].
Figure 10: Six months postoperative radiograph

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  Conclusion Top


Availability of a fixed treatment option is a remarkable advance in prosthodontics. It is one of the dentistry's most gratifying treatment modalities, but it demands considerable skill and judgement and a high degree of patient commitment and understanding. In present case report, the patient was fully satisfied with the treatment outcome compared to his previous conventional denture.

 
  References Top

1.George AJ. The Edentulous Predicaments. In: Zarb, editor. Text book of prosthodontic Treatment for Edentulous Patients, 12 th ed. Noida: Elsevier publishers; 2004. p. 3-5.  Back to cited text no. 1
    
2.Adell R, Lekholm U, Rockler B, Branemark PI. A 15-year study of osseointegrated implants in the treatment of edentulous jaw. Int J Oral Surg 1981;10:387-416.  Back to cited text no. 2
    
3.Kim Y, Oh TJ, Misch CE, Wang HL. Occlusal considerations in implant theraphy: Clinical guidelines with biomechanical rationale. Clin Oral Implants Res 2005;16:26-35.  Back to cited text no. 3
[PUBMED]    
4.Adell R, Errikson B, Lekholm U, Branemark 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. 4
    
5.Jacobs R, Andriansens A, Verstreken K, Seutens P, van Steenberghe D. Predictability of a three-dimensional planning system for oral implant surgery. Dentomaxillofac Radiol 1999;28:105-11.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10]


This article has been cited by
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Hye-sung Kim,Han-A Cho,Young youn Kim,Hosung Shin
BMC Oral Health. 2018; 18(1)
[Pubmed] | [DOI]



 

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Discussion
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