J Korean Acad Prosthodont.  2019 Jul;57(3):271-279. 10.4047/jkap.2019.57.3.271.

Implant overdenture of mandible with severe unilateral atrophy: Report of two cases

• Kim SY
• Kwon EY
• Jung KH
• Jeon HM
• Baek YJ
• Yun MJ
• Huh JB

• KMID: 2453782
• DOI: http://doi.org/10.4047/jkap.2019.57.3.271

Abstract

There are several unfavorable conditions regarding alveolar bone condition that may compromise the denture patient's satisfaction. Chewing efficiency may not be satisfactory when alveolar bone is deficient, and the denture stability could hardly be achieved when alveolar bone shape is irregular. Implant overdenture can be useful to provide satisfactory denture experience compared to conventional denture. The attachment for implant overdenture can be classified into bar attachment and solitary attachment. When the positions of the implants are in the mandibular anterior region, bar attachment may be favorable to obtain a rigid support of the entire denture. When implants are distributed both on anterior and posterior region, a solitary attachment could be considered for ease of removal and maintenance. This report presents implant overdenture cases with the patients that had unilateral mandibular alveolar bone atrophy conditions. Different abutments were chosen based on the individual patient's mandibular alveolar bone condition and the treatments were successful in terms of patient satisfaction.

Keyword

Alveolar bone loss; Implant overdenture; Implant surgical guide; Milled bar; Locator; Magnet

MeSH Terms

Alveolar Bone Loss
Atrophy*
Denture Retention
Denture, Overlay*
Dentures
Humans
Mandible*
Mastication
Patient Satisfaction

Figure

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  Fig. 1 Pre-operative panoramic radiograph of the 1st case showing severe bone loss on the right side of the mandible.

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  Fig. 2 (A) Duplicated denture template for diagnosis containing six radiopaque materials, (B) Panoramic section of dental computed tomography, (C) Coronal sections at four sites, (D) Indications on the model of selected placement position, (E) Surgical guide with holes on three selected sites.

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  Fig. 3 (A) Maxillary wax denture and mandibular tooth arrangement, (B) Evaluation of diagnostic wax dentures, (C) Mounted cast with maxillary wax denture showing mandibular alveolar bone resorption, (D) Space evaluation for bar design using putty index, (E) Fabricated milled bar pattern, (F) Casted milled bar with locator attachment.

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  Fig. 4 (A, D, E) Definitive prosthesis, (B) Extraoral photograph after placement of prosthesis, (C) Intraoral view of milled bar.

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  Fig. 5 Post-operative panoramic radiograph of the 1st case after 1 year.

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  Fig. 6 Pre-operative panoramic radiograph of the 2nd case showing severe mandibular bone loss, especially on the right side.

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  Fig. 7 Diagnostic arrangement of mandibular tooth on the computer aided design (CAD). (A, B) Occlusal, (C) Right, (D) Frontal and (E) Left view.

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  Fig. 8 Planning of implant placement on the implant planning software. (A, B) Panoramic section. Three sites were selected to avoid inferior alveolar nerve canal, (C) CT stereoscopic view showing implant fixture exposure on alveolar bone, (D) Stereoscopic view with reduced concentration.

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  Fig. 9 Definite restoration. (A) Occlusal view of maxilla with removable denture after replacement of artifitial teeth on the left side, (B) One magnetic and two locator attachments, (C) Occlusal view of mandible, (D) Intraoral frontal view, (E, F) Mandibular denture.

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  Fig. 10 (A) Post-operative extraoral photograph, (B) Panoramic view of the 2nd case.

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