Journal of Dental Implants
   About JDI | Search | Ahead of print | Current Issue | Archives | Instructions | SubscribeLogin 
Users Online: 741  Wide layoutNarrow layoutFull screen layout Home Print this page  Email this page Small font size Default font size Increase font size


 
 
Table of Contents
CASE REPORT
Year : 2012  |  Volume : 2  |  Issue : 1  |  Page : 65-70

Telescopic overdentures with cercon primary coping and gold galvano secondary coping


1 Goma Dental Clinic and Implant Center, Chakkar, Shimla, Himachal Pradesh, India
2 NK Aggarwal's Dental Clinic, Chandigarh, India

Date of Web Publication24-May-2012

Correspondence Address:
Amandeep Goma
Goma Dental Clinic and Implant Center, Chakkar, Shimla, Himachal Pradesh - 171 005
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-6781.96580

Rights and Permissions
   Abstract 

Overdenture treatment provides an esthetic and functional result that allows proper access for hygiene and maintenance. In addition, with their improved strength, zirconia ceramics may be used to restore removable partial denture abutments in areas previously limited to metal or metal-ceramic restorations. The electroforming process makes for a viable, convenient, and economic alternative to cast metal substructures. However, limited data are available on the use of telescopic crowns on implants. Compared with the use of fixed implant-supported dentures, this treatment modality may improve esthetics and oral hygiene access, reduce the need for implants, and provide sufficient denture support in cases where single abutments have failed. Furthermore, the high retention obtained with telescopic crowns leads to good mastication and phonetics.

Keywords: Dental implants, electroformed crowns, implant abutments, removable dentures, telescopic crowns, zirconia


How to cite this article:
Goma A, Aggarwal N K. Telescopic overdentures with cercon primary coping and gold galvano secondary coping. J Dent Implant 2012;2:65-70

How to cite this URL:
Goma A, Aggarwal N K. Telescopic overdentures with cercon primary coping and gold galvano secondary coping. J Dent Implant [serial online] 2012 [cited 2019 Dec 12];2:65-70. Available from: http://www.jdionline.org/text.asp?2012/2/1/65/96580


   Introduction Top


Various implant-supported restorations have been used successfully for several decades to rehabilitate edentulous patients. Telescopic crowns are a common treatment modality used to connect dentures to natural teeth. Although previous findings indicate that telescopic crowns can be placed successfully on implants to support overdentures, only limited data are available on this treatment approach.

Overdenture treatment provides an esthetic and functional result that allows proper access for hygiene and maintenance. In addition, with their improved strength, zirconia ceramics may be used to restore removable partial denture abutments in areas previously limited to metal or metal-ceramic restorations. The electroforming process makes for a viable, convenient, and economic alternative to cast metal substructures and was described previously for fabrication of secondary crowns of maxillary implant-supported telescopic overdentures opposing a mandibular implant-supported telescopic overdenture.

Telescopic crowns are widely used on natural teeth to support dentures and allow easy access around the abutment for oral hygiene, as well as easy handling of the overdenture. However, limited data are available on the use of telescopic crowns on implants. Compared with the use of fixed implant-supported dentures, this treatment modality may improve esthetics and oral hygiene access, reduce the need for implants, and provide sufficient denture support in cases where single abutments have failed. Furthermore, the high retention obtained with telescopic crowns leads to good mastication and phonetics. In the following case report, the whole procedure of telescopic overdenture with gold secondary coping is presented. Four implants were placed in symphyseal areas of mandibular bone and subsequently were loaded using telescopic crowns as attachments for implant-supported overdentures.

This article describes fabrication of zirconium primary copings to provide retention for a mandibular telescopic overdenture in a patient. In maxilla, six implants in 3, 4, 5 regions are advised, and in mandible, four symphyseal implants are advised. Even if implants are not parallel, this technique is used, and can be used with any implant system with maxilla and mandible.

Six months after the extraction of all nonsalvageable teeth, four implants were inserted into the mandible of one patient. These implants were restored 4 months later using telescopic crown-supported dentures. Bleeding on probing (BOP), plaque index (PI), clinical attachment Probing Attachment Level (PAL), and radiographic bone level were evaluated over 2 years. All implants remained in function over the 2-year evaluation period. Radiography showed stable bone levels for all implants. No changes in BOP or PI (range 2-4% for both parameters) were observed over this time. We conclude that telescopic crowns can be used successfully as attachments for overdentures supported by implants in regenerated bone.

Zirconia copings for individual implant abutments were fabricated in computer-aided design and computer-aided manufacturing (CAD/CAM) and used as primary crowns. Electroformed gold copings were used as secondary telescopes. All maxilla supraconstructions were fabricated. Patient was monitored during a 2-year period; all teeth and implants survived, and no biological or mechanical complications occurred. The peri-implant and periodontal conditions were healthy. Galvanoforming technology is the preferable means of fabricating secondary crowns. The combination of these techniques and materials results in a prosthetic reconstruction of high quality, good fit, and biocompatibility. Long-term studies of large populations are necessary to investigate the clinical properties of the material utilized in this type of construction.

Advantages: (1) The distribution of force on the abutment; (2) the provision of a foundation for effective oral hygiene and maintenance of periodontal health; (3) the arrangement of teeth in the desired position; (4) circumvention of several augmentative measures in the soft and hard tissues for esthetic reasons; (5) achievement of favorable esthetics, even when there is substantial recession of the periodontal tissue or severe atrophy of the jaw; (6) creation of a gum-free structure in the maxilla; (7) longevity of the structure (e.g. veneers can be reapplied at any time and the structure remains in place even if one of the abutment teeth or implants is lost); and (8) avoidance of augmentative measures if gingival and/or peri-implant recessions arise before the construction is fabricated or while it is being worn since recessions can be covered by the lip shield.

Disadvantages: (1) High costs and technical requirements; (2) the need for the dental technician to master the individual steps for creating such constructions; and (3) any psychological burden experienced by the patient provided with a removable construction.


   Materials and Methods Top


Four months after implant placement, the mandible was restored with telescopic crown-retained removable dentures. Impressions were taken with individual acrylic trays (the open-tray impression technique was used for implant cases) using a polyether impression material (Impregum Penta Soft, 3M ESPE). Casts were mounted on a semi-adjustable articulator using the face-bow technique and check-bite registration. A wax-up was created and used as an orientation tool for the patient and surgeon, as well as for further planning of rehabilitation.

After the models were created, the tooth abutments were scanned using construction software and a scanner, and the primary telescopes were fabricated and milled as zirconia copings. Zirconia copings should have a definitive collar, perfectly parallel surface with 2°-3° taper, and have to be highly polished. An insertion key of resin (Pattern Resin, GC Dental Products Corp., Tokyo, Japan) and a metal wire of 0.3 mm diameter were manufactured and used for an oral try-in of the primary telescope on the abutment to determine precision of fit and direction of insertion [Figure 1]a-f.
Figure 1: (a) After the models were created, the tooth abutments were scanned using construction software and a scanner, and the primary telescopes were fabricated and milled as zirconia copings. (b) Secondary telescopic crowns: As secondary telescopes, electroformed pure gold copings with a thickness of 0.25 mm were fabricated (AGC Galvanogold, Au 99.9%) are used which have full contact. (c) After that, the tertiary framework was made which connected all the implants and also had least space between the gold copings and the framework. (d, e) Zirconia copings should have a definitive collar, perfectly parallel surface with 2°– 3° degree taper and have to be highly polished. (f) An insertion key of resin (Pattern Resin, GC Dental Products Corp.) and a metal wire 0.3 mm in diameter were manufactured and used for an oral try-in of the primary telescope on the abutment to determine precision of fit and direction of insertion

Click here to view


Secondary telescopic crowns: As secondary telescopes, electroformed pure gold copings with a thickness of 0.25 mm were fabricated (AGC Galvanogold, Au 99.9%, Pink city Labs, Jaipur, India). After this, the tertiary framework was made which connected all the implants and also had least space between the gold copings and the framework. It should have two to three openings for excess resin to flow out. The framework stayed away from the ridge by at least 1.5 mm. Lab also sends the acrylic special tray for pickup impression.

[Figure 1]b: Zirconia copings were CAD/CAM created and finished zirconia coping.

[Figure 1]c-e: Fit-in of the zirconia copings. Zirconia implant abutments as primary telescopes with secondary gold copings as secondary telescopes.

[Figure 1]f: An insertion key of resin (Pattern Resin, GC Dental Products Corp.) and a metal wire 0.3 mm in diameter.

Remove all the formers and seat abutments one by one with or without insertion key/jig [Figure 2].
Figure 2: Remove all the formers and seat abutments one by one with or without insertion key/jig

Click here to view


Try placing all the copings in series. If gold copings are seated on the primary coping, there is no need to pull it out. Check primary and secondary coping fittings and try seating of the framework over the copings. It should be active and not tight. Then, cement the primary copings over tightened/ratcheted abutments with GIC [Figure 3] and [Figure 4].
Figure 3: Check primary and secondary coping fittings and try seating of the framework over the copings. It should be active and not tight. Then, cement the primary copings over tightened/ratcheted abutments with GIC Glass ionomer cement

Click here to view
Figure 4: Try placing all the copings in series. If gold copings are seated on the primary coping, there is no need to pull it out.Check primary and secondary coping fittings and try seating of the framework over the copings. It should be active and not tight. Then cement the primary copings over tightened/ratcheted Abutments with GIC

Click here to view


Alloy primer is used over outer surface of gold coping and inner surface of tertiary framework. Apply bond of PANAVIA 21(Kuraray Dental) America, Inc./Rely X U100 (3M) on both surfaces.Mix paste and put adequate quantity inside the framework and place it in the mouth. Use light cure to activate the curing and wait for chemical curing to complete [Figure 5] and [Figure 6].
Figure 5: Alloy primer is used over outer surface of gold coping and inner surface of tertiary framework. Apply bond of PANAVIA 21 (Kuraray Dental)/Rely X U100 (3M) on both surfaces

Click here to view
Figure 6: (a, b) Mix paste and put adequate quantity inside the framework and place it in the mouth. Use light cure to activate the curing and wait for chemical curing to complete. (c) Once cured, remove the framework to check the seating of gold copings and remove the excess

Click here to view


Once cured, remove the framework to check the seating of gold copings and remove the excess [Figure 6]c.

Now take the pickup impression. Pickup has to be taken in a material like polyether using special tray. Inject material below framework and take pickup impression. In this, the entire framework gets picked up [Figure 7]a and b.
Figure 7: (a) Lab also sends the acrylic special tray for pickup impression. (b) Now take the pickup impression. Pickup has to be taken in a material like polyether using a special tray. Inject material below framework and take pickup impression. In this, the entire framework gets picked up

Click here to view


Ask lab to pour models using pattern resin and plaster [Figure 8].
Figure 8: Ask lab to pour models using pattern resin and plaster

Click here to view


Now the cast arrives from lab with framework and gold copings on which take jaw relations and trial [Figure 9]a and b.
Figure 9: (a and b) Now the cast arrives from lab with framework and gold copings on which take jaw relations and trial

Click here to view


Finally, proceed for final denture preferably with injection molding technique [Figure 10]a-c.
Figure 10: (a– c) Finally proceed for final denture preferably with injection molding technique

Click here to view



   Case Report Top


A 59-year-old woman was referred to the private office of one of the authors for implant treatment in March 2009. Her main concern was pain and tooth mobility. The patient had avoided dental treatment for the previous 10 years owing to dental phobia. Advanced chronic periodontitis was diagnosed, and the prognosis for the remaining mandibular dentition was poor. In contrast to these teeth, maxiallary teeth were in a healthy state. The nonsalvageable mandibular teeth were extracted, and few maxillary teeth were restored. Four implants (Alpha Bio (Israel).) were placed in areas numbered 32, 33, 42, and 43.

Prosthetic restoration

Four months after implant placement, the implants were loaded. The mandible was restored with telescopic crown-retained removable dentures [Figure 10]a-c. Titanium abutments were used (Alpha Bio) to fabricate the zirconia primary copings and customized zirconia served as primary telescopes [Figure 1]c. As secondary telescopes, electroformed pure gold copings with a thickness of 0.25 mm were fabricated (AGC Galvanogold, Au 99.9%). For supraconstruction castings, a CoCrMo alloy was used. The electroformed gold copings were fixed in the implant supraconstructions using a self-curing compomer cement. For supraconstruction veneering, we used a lightly cured indirect ceramic polymer (Rely X U100 3M) and composite artificial teeth.

Medication and postoperative care

The patient was prescribed an analgesic (diclofenac 100 mg, once daily for 4 days), a systemic antibiotic (cefuroxime 500 mg, once daily for 7 days), and a 0.1% chlorhexidine digluconate rinse (chlorhexamed fluid, twice daily). The patient was instructed to start these medications 1 day before undergoing extractions and/or implant surgery. The surgical sutures were left in for 1 week. After surgery, the patient was enrolled in a maintenance program consisting of semi-annual follow-up appointments. At the follow-up visits, oral hygiene instructions were given and debridement was performed followed by polishing. The first maintenance visit, which was used as the baseline examination (BSL), was performed 3 months after placement of the supraconstruction.


   Results Top


A total of four implants, placed 6 months after tooth extraction, were observed over 2 years. Implants were loaded 4 months after placement using telescopic crowns as attachments for the implant-supported overdentures. All implants remained functional throughout the 5-year observation period.


   Discussion Top


Telescopic crowns have been used successfully for several decades to connect dentures to natural teeth and/or implants. The telescopic crown concept ensures maximally favorable masticatory force transmission, which always takes place axial to the abutments. Retention occurs through the force of friction. Regarding the use of telescopic crowns with implant-supported overdentures, only limited data are available; however, the results so far indicate that this treatment modality can lead to predictable long-term treatment outcomes.


   Further Reading Top


  1. Eisenburger M, Gray G, Tschernitschek H. Long-term results of telescopic crown retained dentures-a retrospective study. Eur J Prosthodont Restor Dent 2000;8:87-91.
  2. Beschnidt SM, Chitmongkolsuk S, Prull R. Telescopic crown retained removable partial dentures: review and case report. Compend Contin Educ Dent 2001;22:927-32.
  3. Hoffmann O, Beaumont CH, Tatakis DN, Zafiropoulos G-G. Telescopic crowns as attachments for implant supported restorations: A case series. J Oral Implantol 2006;32:291-9.
  4. Behrend F. Gold electroforming system: GES restorations. J Dent Technol 1997;14:31-7.
  5. Biewer ZP. Development of the G.E.S. electroforming technique: biocompatible, corrosion-free production of telescopic crowns. J Dent Technol 1999;16:24-9.
  6. Zafiropoulos GG, Hoffmann O Five year study of implant placement in regenerated bone and rehab with telescopic crown retained dentures. J Oral Implantol 2009;35:303-9.
  7. Nickenig HJ, Spiekermann H, Wichmann M, Andreas SK, Eitner S. Survival and complication rates of combined tooth implant-supported fixed and removable partial dentures. Int J Prosthodont 2008;21:131-7.
  8. Zafiropoulos GG, Rebbe J, Thielen U, Deli G, Beaumont C, Hoffmann O. Zirconia removable telescopic dentures retained on teeth or implants for maxilla rehab. A three year observation. J Oral Implantol 2010;36:455-65.
  9. Mengel R, Kreuzer G, Lehmann KM, Flores-de-Jacoby L. A telescopic crown concept for the restoration of partially edentulous patients with aggressive generalized periodontitis: A 3-year prospective longitudinal study. Int J Periodontics Restorative Dent 2007;27:231-9.
  10. Buser D, Ingimarsson S, Dula K, Lussi A, Hirt HP, Belser UC. Long-term stability of osseointegrated implants in augmented bone: A 5-year prospective study in partially edentulous patients. Int J Periodontics Restorative Dent 2002;22:108-17.



    Figures

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



 

Top
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
   Introduction
    Materials and Me...
   Case Report
   Results
   Discussion
   Further Reading
    Article Figures

 Article Access Statistics
    Viewed20851    
    Printed278    
    Emailed7    
    PDF Downloaded3972    
    Comments [Add]    

Recommend this journal