J Korean Acad Prosthodont.  2012 Oct;50(4):330-335. 10.4047/jkap.2012.50.4.330.

Full mouth rehabilitation of an oligodontia patient with intellectual disability based on shortened dental arch concept: a case report

• You JW
• Heo SJ
• Kim SK
• Koak JY

• KMID: 2195477
• DOI: http://doi.org/10.4047/jkap.2012.50.4.330

Abstract

Shortened dental arch (SDA) as a treatment goal is the concept that stable occlusion and enough masticatory force can be achieved by restoration to the second premolars when the situation is not favorable. SDA could be applied both natural teeth and implant supported fixed prostheses. This case dealt with a patient who has grade 2 intellectual disability and a lot of missing teeth. Because of intellectual disability, patient cooperation during treatment could not be expected. Therefore every treatment should be done under general anesthesia. In addition to that, ridge resorption around molar area was severe and there were maxillary sinus pneumatization and maxillary sinusitis which increased failure probability. SDA concept was adopted to reduce risk factor and minimize general anesthesia. After the treatment, functional and esthetic improvement was achieved and oral hygiene was fortified by periodic recall check and education.

Keyword

SDA; Intellectual disability; Full mouth rehabilitation

MeSH Terms

Anesthesia, General
Bicuspid
Bite Force
Dental Arch
Humans
Intellectual Disability
Maxillary Sinus
Maxillary Sinusitis
Molar
Mouth
Mouth Rehabilitation
Oral Hygiene
Patient Compliance
Prostheses and Implants
Risk Factors
Tooth

Figure

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  Fig. 1 Initial photo (frontal view). Loss of VD, supraeruption of #15, dento-alveolar protrusion and severe resorption of mandibular molar region can be observed.

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  Fig. 2 Initial photo (upper and lower occlusal view. A: maxilla, B: mandible). Bucco-lingual resorption of edentulous region, remaining caries of mandibular anterior teeth and the fistula in the labial gingiva of #42 can be observed.

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  Fig. 3 Initial panoramic view. Resorption of alveolar bone and maxillary sinus pneumatization can be observed.

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  Fig. 4 Diagnostic wax-up. Supraeuption of #15 and dentoalveolar protrusion of mandibular anterior teeth could be identified and the necessity of gingivectomy of #23 and CLP of #15, 31, 32, 33, 41 was verified.

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  Fig. 5 CT image of maxilla. Narrow ridge and inadequate length of height around #14 and maxillary sinusitis can be observed.

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  Fig. 6 CT image of mandible. Despite enough height, narrow width of alveolar bone made GBR necessary.

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  Fig. 7 Implant surgery. GBR was done at both maxilla and mandible (A: maxilla, B: mandible).

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  Fig. 8 Gingevectomy of #23, CLP of #15, 31, 32, 33, 42 and extraction of #42.

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  Fig. 9 Healing after gingivectomy and CLP. Relatively regular gingival height and enough clinical crown length of mandibular anterior teeth were attained.

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  Fig. 10 Tooth preparation and customized abutment.

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  Fig. 11 Provisional restoration.

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  Fig. 12 Bite registration. Pattern resin copings which were relined by bite material at one side were connected remaining provisional restorations at the other side and vice versa.

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  Fig. 13 Coping try-in.

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  Fig. 14 Final restoration (frontal view).

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  Fig. 15 Final restoration (upper and lower occlusal view).

Reference

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