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Table of Contents
CASE REPORT
Year : 2021  |  Volume : 5  |  Issue : 1  |  Page : 52-55

Implant supported fixed partial denture is a viable fixed option to distal extension edentulous spaces


Department of Prosthodontics, SRM Dental College, Chennai, Tamil Nadu, India

Date of Submission16-Sep-2020
Date of Decision29-Nov-2020
Date of Acceptance06-Dec-2020
Date of Web Publication16-Feb-2021

Correspondence Address:
Ahila Singaravel Chidembaranathan
Department of Prosthodontics, SRM Dental College, Ramapuram, Chennai - 600 089, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/SDJ.SDJ_30_20

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  Abstract 


Background: Rehabilitating the partial edentulous space, especially in the distal extension area, is a daunting task for the prosthodontist. If the opposing arch has natural teeth or a fixed partial denture (FPD), the maxillary or mandibular distal extension edentulous spaces can be restored with either attachment-retained removable dental prosthesis or implant-supported fixed dental prosthesis.
Case Report: A 55-year-old male presented with missing 17, 23, 24, 25, 26, and 27 in the maxillary posterior region with an implant-supported FPD in 43, 44, and 45 regions and 36 and 37 were treated for root canal. The clinical condition was diagnosed as Kennedy Class I in the maxillary posterior region and Kennedy Class II partial edentulous space in mandible. The treatment options given to the patient were either a removable partial denture or an implant-supported FPD. As the patient preferred the fixed dental prosthesis, the case was successfully managed with implant-supported fixed dental prosthesis in the distal extension partial edentulous area. Conclusion: Implant-supported fixed dental prosthesis is the only effective treatment for distal extension edentulous space for persons who desire to have a fixed prosthesis.

Keywords: Distal extension, fixed partial denture, implant, partial edentulous space


How to cite this article:
Chidembaranathan AS, Tah R, Muthukumar B. Implant supported fixed partial denture is a viable fixed option to distal extension edentulous spaces. Sci Dent J 2021;5:52-5

How to cite this URL:
Chidembaranathan AS, Tah R, Muthukumar B. Implant supported fixed partial denture is a viable fixed option to distal extension edentulous spaces. Sci Dent J [serial online] 2021 [cited 2021 Jun 21];5:52-5. Available from: https://www.scidentj.com/text.asp?2021/5/1/52/309543




  Background Top


Distal-extension removable partial dentures (RPDs) possess complex biomechanics and can be either unilateral or bilateral. The movement of the prosthesis in multiple directions depends on the residual ridge shape and the overlying soft-tissue resilience.[1] If treatment is not designed properly, the therapeutic procedure can lead to severe problems such as injury to the periodontium of the abutment teeth due to the lack of proper adaptation of the denture bases to the support tissues.[2]

There are several treatment options are available for rehabilitation of partial edentulous area including the use of conventional or implant-retained fixed prostheses. However, such prosthetic options are very difficult because of compromised general and oral health such as loss of supporting tissues or medical reasons or an extensive surgical protocol as well as the treatment cast.[3] Distal extension RPDs (Kennedy Class I and II) have been connected with several problems such as limited stability, retention, and masticatory efficiency.[4],[5],[6],[7]

In addition, a high percentage of denture failure has been reported in the literature because of caries and periodontal disease, poor retention, and stability and did not attain the patient satisfaction and comfort.[6],[8] Placing two distal implants has been recommended by Brudvik to convert the removable dental prosthesis option into a fixed dental prosthesis.[4] This case report describes a rehabilitation of a case with maxillary bilateral distal extension, Kennedy's Class 1 with an implant-supported fixed partial denture (FPD).


  Case Report Top


A 55-year-old male presented to the Department of Prosthodontics at Sri Ramaswamy Memorial (SRM) Dental College, Ramapuram, Chennai, India with a chief complaint of six missing teeth in the maxillary right and left back teeth region. On clinical examination, it was found that 17, 23, 24, 25, 26, and 27 teeth were missing in the maxillary posterior region and an implant-supported fixed dental prosthesis FPD was present in the 43, 44, and 45 teeth regions and 36 and 37 were treated for root canal. The clinical condition was diagnosed as Kennedy Class I in the maxilla and Kennedy Class II partial edentulous space in mandible. The treatment options given to the patient were a cast partial denture or an implant-supported FPD. Since the patient had natural teeth on the left side of the mandible, the patient preferred a fixed dental prosthesis with three implants. The treatment was started after obtaining informed consent from the patient.


  Treatment Procedure Top


  1. Diagnostic impressions were made with irreversible hydrocolloid impression material (Zelgan Plus, Dentsply, India Pvt Ltd) then poured with dental stone. Diagnostic casts were obtained and mounted on a mean value articulator. Bone mapping was conducted and the plant was placed
  2. The prosthetic phase of treatment was started after 6 months of osseointegration of the implant; then, the impression post was placed [Figure 1], and a definitive impression was made with putty and a light body (Aquasil, Dentsply Intl, New York) using the single-stage method of impression making. The lab analog was placed in the impressions and poured with Type IV gypsum product. (Kalabhai, Ultrarock Die Stone, Mumbai, India) [Figure 2]. Bite registration was done with putty silicone material (Aquasil, Dentsply Intl, New York, USA), and the casts were articulated in a mean value articulator [Figure 3]
  3. The implant abutment was placed over the lab analog; then, the milling was done after analyzing the parallelism using a surveyor and the occlusal clearance [Figure 4]. Wax patterns were fabricated for metal coping for metal ceramic FPD, and the casting procedure was done [Figure 5]
  4. The fit of the framework was verified in the definitive cast as well as in the patient's mouth [Figure 6]. Ceramic buildup was completed after sand blasting
  5. The metal ceramic FPD was luted with Glass ionomer Type 1 luting cement (GC, Gold label, India), and the denture was inserted [Figure 7]. The patient was reviewed after 24 h for a postinsertion check.
Figure 1: Impression coping placed on 23, 25, and 27 implants

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Figure 2: A working cast with lab analog

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Figure 3: Articulated cast with interocclusal record

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Figure 4: Working cast with milled abutment

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Figure 5: Wax pattern for fixed partial denture

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Figure 6: Metal try-in

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Figure 7: Postoperative intraoral view

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  Discussion Top


Planning treatment of partially edentulous arches with free ends is one of the most challenging situations in clinical practice. Literature showed that RPDs supported and retained by distal implants provide adequate retention, stability, support, provide comfort, and allow the patient to live like normal. Furthermore, case studies reported with a denture fixed on the top of implants; it is possible to fit shorter implants since there is no lever arm in the crown portion.[9]

For rehabilitation of patients with distal extension of partially edentulous arches, an implant-supported FPD would be the optimal treatment option, but, due to surgical and financial limitations, many patients are reluctant for an implant-supported partial dental prosthesis.[10] Hence, the treatment was planned with three implants in the distal extension space. A number of safety measures can be employed during treatment such as increasing implant support or using a staged implant placement (tripodization). Placing the fixtures in a tripod fashion (with the central implant offset buccally) rather than in a straight line tends to reduce the flexing moments and biomechanical complications such as screw and abutment loosening and fractures of components of the implant abutment screw complex. For rehabilitation of patients with large edentulous areas, fixed-type prostheses usually require more implants for support than removable prostheses. Thus, the treatment becomes extraordinarily expensive and complicated.


  Conclusion Top


The aim of prosthetic rehabilitation is to preserve and restore health, esthetics, and function. For patients with a partially edentulous space and missing single or multiple teeth in a distal extension space, implant-supported prosthesis has become the treatment of choice.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Silva MA, Consani RL, Oliveira GJ, Reis JI, Fontanari LA, Reis JM. Association between association between implants and removable partial dentures: Review of the literature. Rev Sul Bras Odontol 2011;8:88-92.  Back to cited text no. 1
    
2.
Todescan R. Atlas de Prótese Parcial Removível. Santos: São Paulo; 1996. p. 345.  Back to cited text no. 2
    
3.
Douglass CW, Watson AJ. Future needs for fixed and removable partial dentures in the United States. J Prosthet Dent 2002;87:9-14.  Back to cited text no. 3
    
4.
Brudvik JS. Implants and removable partial dentures. In: Brudvick JS, editor. Advanced Removable Partial Dentures. Chicago: Quitnessence Publishing Co; 1999. p. 153-9.  Back to cited text no. 4
    
5.
Jepson NJ, Thomason JM, Steele JG. The influence of denture design on patient acceptance of partial dentures. Br Dent J 1995;178:296-300.  Back to cited text no. 5
    
6.
Vermeulen AH, Keltjens HM, Van't Hof MA, Kayser AF. Ten-year evaluation of removable partial dentures: Survival rates based on retreatment, not wearing and replacement. J Prosthet Dent 1996;76:267-72.  Back to cited text no. 6
    
7.
Wetherell JD, Smales RJ. Partial denture failures: A long-term clinical survey. J Dent 1980;8:333-40.  Back to cited text no. 7
    
8.
Wöstmann B, Budtz-Jørgensen E, Jepson N, Mushimoto E, Palmqvist S, Sofou A, et al. Indications for removable partial dentures: A literature review. Int J Prosthodont 2005;18:139-45.  Back to cited text no. 8
    
9.
Asvanud C, Morgano SM. Restoration of unfavorably positioned implants for a partially edentulous patient by using an overdenture retained with a milled bar and attachments: A clinical report. J Prosthet Dent 2004;1:6-10.  Back to cited text no. 9
    
10.
Shakeel SK. Removable prosthesis using extracoronal precision attachment. Gulf Med J 2013;2:126-129.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]



 

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Background
Case Report
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