Journal of Dental Implants
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Table of Contents
CASE REPORT
Year : 2019  |  Volume : 9  |  Issue : 2  |  Page : 83-86

Esthetic rehabilitation of a partially edentulous patient with implants and tooth-supported fixed prosthesis


Department of Oral Implantology, A.B. Shetty Memorial Institute of Dental Sciences, Mangalore, Karnataka, India

Date of Web Publication13-Jan-2020

Correspondence Address:
Dr. Harsh Desai
22,Green Avenue Row Houses, Ghod Dod Road, Surat, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdi.jdi_6_18

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   Abstract 

Functional limitation, compromised esthetics, and poor quality of life are few of the consequences of missing teeth. Partial edentulism can be treated by either fixed or removable prosthesis. In compromised abutment situations, tooth-supported fixed dental prostheses are not indicated and patient satisfaction is low with a removable prosthesis. In such cases, implant-supported fixed dental prostheses help in restoring both the function and esthetic demands of the patient. The present case report describes a case of full-mouth rehabilitation in a partially edentulous situation with implant and tooth-supported restoration.

Keywords: Fixed dental prosthesis, full-mouth rehabilitation, implants


How to cite this article:
Shetty M, Kalra R, Desai H, Hegde R. Esthetic rehabilitation of a partially edentulous patient with implants and tooth-supported fixed prosthesis. J Dent Implant 2019;9:83-6

How to cite this URL:
Shetty M, Kalra R, Desai H, Hegde R. Esthetic rehabilitation of a partially edentulous patient with implants and tooth-supported fixed prosthesis. J Dent Implant [serial online] 2019 [cited 2020 Jan 19];9:83-6. Available from: http://www.jdionline.org/text.asp?2019/9/2/83/275701


   Introduction Top


Prof. Per-Ingvar Brånemark rightly said, “Nobody should die with their teeth in a glass of water.”

Tooth loss results in incompetent oral function, positional changes in the natural teeth, loss of structural balance, and poor esthetics. The goal of the modern-day dentistry is to re-establish the patient's function, esthetics, speech, and comfort.[1] This can be accomplished by a fixed or removable prosthesis. Tooth-supported fixed prostheses, however, cannot be used in cases where posterior abutment teeth are absent. Removable prosthesis does not serve the function as adequately as their fixed counterparts. Alternatively, endosseous osseointegrated implants provide successful and predictable outcomes improving the quality of life, esthetics, and function.[2],[3],[4]

This clinical report describes the use of osseointegrated dental implants for the rehabilitation of a partially edentulous patient.


   Case Report Top


A 68-year-old female patient reported to the outpatient department of the department of prosthodontics, with the chief complaint of inability to eat food and poor esthetics due to missing multiple anterior teeth.

The patient had a history of prior extractions, over the past 10 years, owing to mobility (suggestive of generalized periodontitis). On intraoral examination, the teeth present included 11, 12, 13, 14, 21, 32, 33, 34, and 35. Gingival recession Class II (Miller's Classification, 1985) was noted with 32. Generalized spacing was noted between all the remaining maxillary teeth [Figure 1], [Figure 2], [Figure 3]. An orthopantomograph (OPG) was done using a radiographic stent which showed good bone support for the remaining natural teeth and adequate bone height for implant placement at all sites except at 16 region, where the bone height was only 5 mm [Figure 4].
Figure 1: Maxillary partially dentate arch

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Figure 2: Mandibular partially dentate arch

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Figure 3: Overclosure due to loss of posterior teeth and generalized spacing in the maxillary arch

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Figure 4: Preoperative orthopantomograph

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Following oral prophylaxis, intentional root canal treatment was done with respect to 11, 21, 13, 14, and 32. Maxillary and mandibular diagnostic impressions were made, and casts were mounted on a semi-adjustable articulator for treatment evaluation.

The implant placement was planned in two phases, the maxillary jaw followed by the mandible. The surgical procedures were performed under aseptic conditions and prophylactic antibiotic coverage. Local anesthesia was injected and a midcrestal incision was placed in the region of 15–17 and 22–26, respectively. A full-thickness mucoperiosteal flap was reflected, and sequential osteotomies were performed using Tri-Spade drills (Ankylos Surgical kit, Dentsply Sirona York, Pennsylvania, United States) according to manufacturer's protocol. Indirect sinus lift was performed in the region of 16 using an osteotome. The implants were torqued to 35 Ncm (Ankylos, Dentsply, Germany) in the region of 16 (3.5 mm × 8 mm), 15 and 26 (3.5 mm × 9.5 mm), and 23 and 25 (3.5 mm × 11 mm) (Ankylos, Dentsply, Germany) [Figure 5] and [Figure 6] Nonresorbable 3-0 silk sutures (Ethicon Sutures, J&J Medical Devices, USA) were used for the closure of the flap.
Figure 5: Two implants in the regions of 15 and 16

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Figure 6: Three implants in the regions of 23, 25, and 26

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The patient was asked to continue antibiotics along with the prescribed analgesics (paracetamol 500 mg) and chlorhexidine mouthwash for 5 days. She was recalled for a checkup for suture removal.

The second surgical stage was done after 3 weeks, and the aforementioned presurgical steps were performed. Midcrestal incision was placed in the region of 42–46 and 36, and a full-thickness mucoperiosteal flap was reflected. Sequential osteotomies were done using a 2-mm pilot drill and a 3.5-mm trispade drill at 850 rpm (Ankylos Surgical Kit) in the region of 46, 43, 42, and 36. The implants were placed in the regions of 46, 43, 42, and 36 (3.5 mm × 9.5 mm) (Ankylos, Dentsply, Germany) [Figure 7] and [Figure 8]. Nonresorbable 3-0 silk sutures (Ethicon, India) were placed for the approximation of the flap. The patient was asked to continue amoxicillin 500 mg and paracetamol 500 mg for 5 days.
Figure 7: One implant placed in the 36 region

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Figure 8: Three implants placed in the 42, 43, and 46 regions

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Prosthetic phase

The patient was recalled after 6 weeks, and OPG was done to check for implant osseointegration. Crown preparations were done with 11, 21, 13, 14, and 32 to receive porcelain-fused-to-metal (PFM) full-coverage restorations. Regular sulcus formers (Ankylos, Dentsply, Germany) were placed according to the available gingival height, and the patient was recalled after a week for making maxillary and mandibular single-stage, implant-level impressions with polyvinyl siloxane (Aquasil putty and light body, Dentsply, Germany). Polyvinyl siloxane-based gingival mask (GI-Mask, Coltene, Altstätten, Switzerland) was applied, and the impression was poured with die stone type IV (Ultrarock, Kalabhai Karson Private Limited, Mumbai, Maharashtra, India). Abutment selection was done using Ankylos abutment selection guide, and jig trial was done in the following appointment to check for accuracy of the impression. The vertical dimension and centric relation were recorded and transferred to a semi-adjustable articulator. The metal trial was done and assessed in the patient to ensure an accurate fit. PFM crowns were fabricated in physiologic occlusion and were cemented using zinc phosphate cement (De Tray Zinc, Dentsply Sirona York, Pennsylvania, United States) [Figure 9]. OPG was taken to ensure no residual cement around the implants. Postcementation instructions were given regarding the maintenance therapy [Figure 10]. At 6-month follow-up, OPG revealed healthy implants and no complications [Figure 11].
Figure 9: Final prostheses in occlusion

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Figure 10: Postcementation orthopantomograph

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Figure 11: Orthopantomograph at 6-month follow-up

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   Conclusion Top


The aim of prosthetic reconstructions is to preserve and restore health, esthetics, and function. The procedure explained in this clinical report for the rehabilitation of the edentulous patient resulted in accurately fitted, esthetic, and functionally efficient prosthesis. There were various treatment options for this patient. The fixed restoration provides the psychological advantage of acting and feeling similar to the natural teeth. The removable prostheses such as removable partial denture or overdenture do not provide similar patient satisfaction compared to an implant-supported fixed prosthesis. In this case, rehabilitation of the remaining natural teeth was also done to improve the esthetics. Not only function but a good smile also help in improving the quality of life and give a boost in self-confidence. In the index patient, an organized approach to occlusal reconstruction and esthetic rehabilitation with both implant and tooth-supported fixed restorations was implemented to obtain desired patient satisfaction.

Declaration of patient consent

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

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Emami E, de Souza RF, Kabawat M, Feine JS. The impact of edentulism on oral and general health. Int J Dent 2013;2013:7.  Back to cited text no. 1
    
2.
Pavel K, Seydlova M, Dostalova T, Zdenek V, Chleborad K, Jana Z, et al. Dental implants and improvement of oral health-related quality of life. Community Dent Oral Epidemiol 2012;40:65-70.  Back to cited text no. 2
    
3.
Patel N, Vijayanarayanan RP, Pachter D, Coulthard P. Oral health-related quality of life: Pre-and post-dental implant treatment. Oral Surg 2015;8:18-22.  Back to cited text no. 3
    
4.
AlZarea BK. Oral health related quality-of-life outcomes of partially edentulous patients treated with implant-supported single crowns or fixed partial dentures. J Clin Exp Dent 2017;9:e666-71.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11], [Figure 2]



 

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