The use of implants in the occlusal rehabilitation of a partially edentulous patient: A clinical report
Identifieur interne : 005480 ( Istex/Corpus ); précédent : 005479; suivant : 005481The use of implants in the occlusal rehabilitation of a partially edentulous patient: A clinical report
Auteurs : Norsiah Yunus ; Hadijah Abdullah ; Firdaus HanapiahSource :
- The Journal of Prosthetic Dentistry [ 0022-3913 ] ; 2001.
English descriptors
- KwdEn :
- Abdullah, Abutment, Adequate bone, Alternative treatment, Anterior guidance, Branemark, Centric, Ceramic veneers, Clinical evaluation, Clinical report, Dentistry, Dentition, Denture, Distal cantilever, Edentulous, Edentulous jaws, Edentulous patient, Hanapiah, Implant, Implant placement, Incisor, Lekholm, Mandibular, Mandibular incisors, Mandibular prostheses, Mandibular teeth, Maxillary, Maxillary incisors, Maxillofac, Natural teeth, Occlusal, Occlusal reconstruction, Occlusal rehabilitation, Occlusal view, Oral hygiene, Oral maxillofac implants, Osseointegrated, Osseointegrated implants, Partial denture, Partial dentures, Patient treatment, Permanent stages, Posterior support, Print subscribers, Prosthesis, Prosthet, Prosthet dent, Prosthetic, Prosthetic dentistry, Removable, Severe loss, Subscriber, Subscriber account number, Vertical dimension, Vertical overlap, Yunus.
- Teeft :
- Abdullah, Abutment, Adequate bone, Alternative treatment, Anterior guidance, Branemark, Centric, Ceramic veneers, Clinical evaluation, Clinical report, Dentistry, Dentition, Denture, Distal cantilever, Edentulous, Edentulous jaws, Edentulous patient, Hanapiah, Implant, Implant placement, Incisor, Lekholm, Mandibular, Mandibular incisors, Mandibular prostheses, Mandibular teeth, Maxillary, Maxillary incisors, Maxillofac, Natural teeth, Occlusal, Occlusal reconstruction, Occlusal rehabilitation, Occlusal view, Oral hygiene, Oral maxillofac implants, Osseointegrated, Osseointegrated implants, Partial denture, Partial dentures, Patient treatment, Permanent stages, Posterior support, Print subscribers, Prosthesis, Prosthet, Prosthet dent, Prosthetic, Prosthetic dentistry, Removable, Severe loss, Subscriber, Subscriber account number, Vertical dimension, Vertical overlap, Yunus.
Abstract
Abstract: This article describes the occlusal rehabilitation of a partially edentulous patient who did not want a removable partial denture. Implants and extensive fixed restorations were used to restore posterior support and treat severely worn dentition, respectively. The treatment offered the patient a functional and esthetic result. (J Prosthet Dent 2001;85:540-3.)
Url:
DOI: 10.1067/mpr.2001.115875
Links to Exploration step
ISTEX:A99716A9CE434A50A50276C66BB438D98A6C36D0Le document en format XML
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Implants and extensive fixed restorations were used to restore posterior support and treat severely worn dentition, respectively. The treatment offered the patient a functional and esthetic result. (J Prosthet Dent 2001;85:540-3.)</p></abstract></profileDesc><revisionDesc><change when="2001">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/document/A99716A9CE434A50A50276C66BB438D98A6C36D0/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Elsevier doc found" wicri:toSee="Elsevier, no converted or simple article"><istex:xmlDeclaration>version="1.0" encoding="utf-8"</istex:xmlDeclaration><istex:docType PUBLIC="-//ES//DTD journal article DTD version 5.0.1//EN//XML" URI="art501.dtd" name="istex:docType"><istex:entity SYSTEM="gr1" NDATA="IMAGE" name="gr1"></istex:entity><istex:entity SYSTEM="gr2" NDATA="IMAGE" name="gr2"></istex:entity><istex:entity SYSTEM="gr3" NDATA="IMAGE" name="gr3"></istex:entity><istex:entity SYSTEM="gr4" NDATA="IMAGE" name="gr4"></istex:entity><istex:entity SYSTEM="gr5" NDATA="IMAGE" name="gr5"></istex:entity><istex:entity SYSTEM="gr6" NDATA="IMAGE" name="gr6"></istex:entity><istex:entity SYSTEM="mmc1" NDATA="APPLICATION" name="mmc1"></istex:entity><istex:entity SYSTEM="mmc2" NDATA="APPLICATION" name="mmc2"></istex:entity><istex:entity SYSTEM="mmc3" NDATA="APPLICATION" name="mmc3"></istex:entity></istex:docType><istex:document><article docsubtype="fla" xml:lang="en"><item-info><jid>YMPR</jid><aid>92324</aid><ce:pii>S0022-3913(01)92324-8</ce:pii><ce:doi>10.1067/mpr.2001.115875</ce:doi><ce:copyright type="other" year="2001">Editorial Council of The Journal of Prosthetic Dentistry</ce:copyright></item-info><ce:floats><ce:e-component id="mmc1"><ce:caption><ce:simple-para id="sp0010">Simplified Chinese PDF</ce:simple-para></ce:caption><ce:link locator="mmc1"></ce:link><ce:alt-e-component><ce:caption><ce:simple-para id="sp0015">Simplified Chinese PDF</ce:simple-para></ce:caption></ce:alt-e-component></ce:e-component><ce:e-component id="mmc2"><ce:caption><ce:simple-para id="sp0020">Traditional Chinese PDF</ce:simple-para></ce:caption><ce:link locator="mmc2"></ce:link><ce:alt-e-component><ce:caption><ce:simple-para id="sp0025">Traditional Chinese PDF</ce:simple-para></ce:caption></ce:alt-e-component></ce:e-component><ce:e-component id="mmc3"><ce:caption><ce:simple-para id="sp0030">Portuguese PDF</ce:simple-para></ce:caption><ce:link locator="mmc3"></ce:link><ce:alt-e-component><ce:caption><ce:simple-para id="sp0035">Portuguese PDF</ce:simple-para></ce:caption></ce:alt-e-component></ce:e-component></ce:floats><head><ce:article-footnote><ce:label>☆</ce:label><ce:note-para><ce:sup>a</ce:sup>Lecturer, Department of Prosthetic Dentistry.</ce:note-para></ce:article-footnote><ce:article-footnote><ce:label>☆☆</ce:label><ce:note-para><ce:sup>b</ce:sup>Lecturer, Department of Conservative Dentistry.</ce:note-para></ce:article-footnote><ce:article-footnote><ce:label>★</ce:label><ce:note-para><ce:sup>c</ce:sup>Lecturer, Department of Oral and Maxillofacial Surgery.</ce:note-para></ce:article-footnote><ce:article-footnote><ce:label>★★</ce:label><ce:note-para>Reprint requests to: Dr Norsiah Yunus, Faculty of Dentistry, University of Malaya, 50603 Kuala Lumpur MALAYSIA, Fax: (60)3-7967-4535, E-mail: norsiah@um.edu.my</ce:note-para></ce:article-footnote><ce:article-footnote><ce:label>♢</ce:label><ce:note-para>J Prosthet Dent 2001;85:540-3</ce:note-para></ce:article-footnote><ce:title>The use of implants in the occlusal rehabilitation of a partially edentulous patient: A clinical report</ce:title><ce:author-group><ce:author><ce:given-name>Norsiah</ce:given-name><ce:surname>Yunus</ce:surname><ce:degrees>BDS, MSc<ce:sup>a</ce:sup></ce:degrees></ce:author><ce:author><ce:given-name>Hadijah</ce:given-name><ce:surname>Abdullah</ce:surname><ce:degrees>BDS, MSc<ce:sup>b</ce:sup></ce:degrees></ce:author><ce:author><ce:given-name>Firdaus</ce:given-name><ce:surname>Hanapiah</ce:surname><ce:degrees>BDS, MSc<ce:sup>c</ce:sup></ce:degrees></ce:author><ce:affiliation><ce:textfn>Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia</ce:textfn></ce:affiliation></ce:author-group><ce:abstract><ce:section-title id="st0010">Abstract</ce:section-title><ce:abstract-sec><ce:simple-para id="sp0040">This article describes the occlusal rehabilitation of a partially edentulous patient who did not want a removable partial denture. Implants and extensive fixed restorations were used to restore posterior support and treat severely worn dentition, respectively. The treatment offered the patient a functional and esthetic result. (J Prosthet Dent 2001;85:540-3.)</ce:simple-para></ce:abstract-sec></ce:abstract></head><body><ce:sections><ce:para id="p0010">The successful long-term use of osseointegrated implants to treat edentulousness<ce:cross-refs refid="bib1 bib2"><ce:sup>1,2</ce:sup></ce:cross-refs> has expanded its application to partially edentulous patients. Patients who are intolerant of or psychologically dissatisfied with removable partial dentures<ce:cross-refs refid="bib3 bib4"><ce:sup>3,4</ce:sup></ce:cross-refs> and have sufficient bone volume may opt for alternative treatment with the use of implants to replace the missing dentition. Implant treatment is also indicated for those patients who have compromised dentition that requires complete oral rehabilitation. Successful restoration with implant-supported prostheses has been reported in the treatment of patients with extreme occlusal attrition.<ce:cross-refs refid="bib5 bib6"><ce:sup>5,6</ce:sup></ce:cross-refs> A short-term clinical evaluation by Ericsson et al<ce:cross-ref refid="bib7"><ce:sup>7</ce:sup></ce:cross-ref> revealed that no significant biomechanical problems existed when implants were used in combination with the remaining teeth as abutments for fixed partial dentures (FPDs) in periodontally compromised dentition.</ce:para><ce:para id="p0015">This article describes the occlusal rehabilitation of a partially edentulous patient. Implants and extensive fixed restorations were used to restore posterior support and treat severely worn dentition, respectively. The treatment offered the patient functional and esthetic results.</ce:para><ce:section id="s0010"><ce:section-title id="st0015">Clinical report</ce:section-title><ce:para id="p0020">A 66-year-old man presented with complaints of difficulty chewing and a recently fractured maxillary left central incisor. He had not previously worn a removable partial denture. An extraoral examination suggested that he had a reduced face height. There was severe loss of tooth structure from the lingual cusps of the maxillary teeth, with almost total loss of the left central incisor crown (Fig. 1).<ce:display><ce:figure id="f0010"><ce:label>Fig. 1</ce:label><ce:caption><ce:simple-para id="sp0045">Occlusal view shows worn appearance of all unrestored maxillary teeth.</ce:simple-para></ce:caption> <ce:link locator="gr1"></ce:link></ce:figure></ce:display>The mandibular teeth showed less severe tooth wear, but the canines were tilted mesially, resulting in poor canine guidance in lateral excursion (Fig. 2).<ce:display><ce:figure id="f0015"><ce:label>Fig. 2</ce:label><ce:caption><ce:simple-para id="sp0050">Extent of tooth wear in remaining dentition was less in mandible than in maxilla.</ce:simple-para></ce:caption> <ce:link locator="gr2"></ce:link></ce:figure></ce:display>There was also evidence of cervical abrasion and gingival recession of the canines with a caries lesion affecting the left canine. The occlusion in intercuspal position showed an excessive anterior vertical overlap (Fig. 3), and in protrusion, contact was found on the remaining incisors.<ce:display><ce:figure id="f0020"><ce:label>Fig. 3</ce:label><ce:caption><ce:simple-para id="sp0055">Frontal view at initial presentation shows excessive anterior vertical overlap and uneven occlusal plane.</ce:simple-para></ce:caption> <ce:link locator="gr3"></ce:link></ce:figure></ce:display>The occlusal plane was uneven, and the vertical dimension of occlusion (VDO) was reduced secondary to loss of posterior support and broken-down teeth. Radiographic examination revealed extensive caries that involved the maxillary FPD first premolar abutment and an early furcation involvement of the left mandibular molar. There was adequate bone in the posterior edentulous mandibular segments for implant placement (Fig. 4).<ce:display><ce:figure id="f0025"><ce:label>Fig. 4</ce:label><ce:caption><ce:simple-para id="sp0060">Panoramic radiograph reveals adequate bone quantity in mandible for implant placement.</ce:simple-para></ce:caption> <ce:link locator="gr4"></ce:link></ce:figure></ce:display></ce:para><ce:para id="p0025">Diagnostic casts were mounted in centric relation in a semiadjustable articulator with the use of an arbitrary face-bow transfer and mandibular record base. Occlusal adjustment of the casts and a diagnostic wax-up that included the edentulous segments were carried out in the laboratory to achieve the desired tooth contour and occlusion at an increased VDO of 3 mm, measured at the incisors. The conventional method of evaluating a patient's tolerance to an increased VDO is to provide a removable partial denture that replaces the missing teeth. Because the patient did not want to have a removable prosthesis, provisional fixed restorations on the natural teeth and the implants were planned.</ce:para><ce:para id="p0030">Six titanium implants (Branemark, Nobel Biocare, Gotenberg, Sweden), 3 in each posterior segment, were placed as recommended after a 2-stage surgical protocol.<ce:cross-ref refid="bib8"><ce:sup>8</ce:sup></ce:cross-ref> Standard abutments were connected 3 weeks after surgical exposure. This type of conventional supragingival abutment was used to allow easier access for oral hygiene; esthetics were less of a concern in the posterior mandibular segments. At the provisional FPD insertion stage, the most distal implant in the left mandible was found not to have integrated and was removed. Because the patient did not wish to undergo surgery to replace the lost implant, a distal cantilever was unavoidable.</ce:para><ce:para id="p0035">The maxillary restoration included a new FPD to replace the existing one, with the right canine as the mesial abutment and the first premolar extracted. Cast post and cores were constructed on the endodontically treated incisors. Endodontic therapy was elected because severe loss of coronal dentin made it impossible to obtain adequate retention without using the root canals. The right lateral incisor was endodontically treated because of periapical involvement. These teeth and the remaining maxillary and mandibular teeth were prepared for metal-ceramic crown restorations.</ce:para><ce:para id="p0040">The preparation of all the teeth was performed in stages. The teeth were provisionally restored with long-term laboratory-fabricated heat-polymerized provisional prostheses. The less severely worn mandibular incisors were restored conservatively with composite (Filtex Z250, 3M Dental Products, St Paul, Minn.), and the anterior guidance was developed on the provisionally restored maxillary incisors. Other treatment options for the mandibular incisors were discussed with the patient. The fixed implant-retained provisionals were comfortable and ensured posterior stability during the period established to evaluate the patient's tolerance to the newly established VDO.</ce:para><ce:para id="p0045">After a satisfactory trial period of 3 months, final impressions were made in polyether impression material (Impregum, ESPE Dental AG, Seefeld, Germany). Centric jaw relation was registered at the VDO established by the provisionals. Anterior guidance was provided to the technician through mounted diagnostic casts of the provisional restorations. The framework castings were evaluated for fit intraorally before porcelain application. The restorations were luted with zinc polycarboxylate cement (Poly F, Dentsply, Surrey, United Kingdom). The implant-retained FPDs were attached to the abutments with gold screws, and the access holes were filled with light-polymerized composite. The occlusion was developed with maximum intercuspation in centric relation position at an increased VDO. The centric stops on the maxillary incisors were located on the metal surfaces of the ceramic metal-crowns because the opposing teeth were natural (Fig. 5).<ce:display><ce:figure id="f0030"><ce:label>Fig. 5</ce:label><ce:caption><ce:simple-para id="sp0065">Occlusal view of completed maxillary restorations.</ce:simple-para></ce:caption> <ce:link locator="gr5"></ce:link></ce:figure></ce:display>A canine-protected occlusion with protrusive disclusion was established to reduce lateral forces on the mandibular implant-supported prostheses.</ce:para><ce:para id="p0050">At a follow-up appointment, the mandibular incisors were prepared for ceramic veneers because the patient wished to improve their appearance. The patient was placed on a strict recall schedule for hygiene follow-up and monitoring of the changes in the implant bone level. The restorations were in function successfully for 2 years without any problems. At 2.5 years, as a result of fracture, both ceramic veneers on the mandibular central incisors were replaced with ceramic-metal crowns (Fig. 6).<ce:display><ce:figure id="f0035"><ce:label>Fig. 6</ce:label><ce:caption><ce:simple-para id="sp0070">Frontal view 2.5 years after implant placement. Use of standard abutments facilitated oral hygiene.</ce:simple-para></ce:caption> <ce:link locator="gr6"></ce:link></ce:figure></ce:display></ce:para></ce:section><ce:section id="s0015"><ce:section-title id="st0020">Discussion</ce:section-title><ce:para id="p0055">Extensive prosthodontic reconstruction of a patient with severe tooth wear and a long edentulous span can be a great challenge, as it involves the commitment of both the dentist and the patient. Complete reconstruction has the advantage of allowing one to idealize the occlusion. A simple treatment option available for worn dentition is to restore it with overlay removable partial dentures.<ce:cross-refs refid="bib9 bib10 bib11"><ce:sup>9-11</ce:sup></ce:cross-refs> This is a cost-effective treatment,<ce:cross-ref refid="bib10"><ce:sup>10</ce:sup></ce:cross-ref> and because the dentures are removable, the patient can easily perform oral hygiene. However, patients tend to dislike removable dentures because they are bulky and uncomfortable and lack stability; this is especially true with distal extension restorations.</ce:para><ce:para id="p0060">Balshi and Wolfinger<ce:cross-ref refid="bib5"><ce:sup>5</ce:sup></ce:cross-ref> described the occlusal rehabilitation of a patient with loss of posterior support and tooth wear; the remaining teeth were sacrificed and replaced with a complete-arch implant-supported fixed detachable prosthesis. In the patient treatment presented here, an organized approach to occlusal reconstruction with fixed restorations was implemented, and osseointegrated implants were used to support the mandibular prostheses. The use of implants eliminated the need for removable partial dentures in both the provisional and permanent stages. The natural teeth were retained, and implants were placed because the teeth had a favorable prognosis and adequate bone for implants existed in the posterior edentulous spans. It was also easier to achieve a good passive fit on a short-span partial denture than on a more complex cross-arch framework. Sacrificing the remaining teeth, which could be considered a radical approach, might have been traumatic to the patient. Furthermore, with the reported high survival rate of implants in the posterior mandible<ce:cross-ref refid="bib12"><ce:sup>12</ce:sup></ce:cross-ref> and favorable long-term continuous prosthesis stability,<ce:cross-refs refid="bib13 bib14"><ce:sup>13,14</ce:sup></ce:cross-refs> this procedure offered a rational treatment option for a patient with a long posterior edentulous span.</ce:para><ce:para id="p0065">A distal cantilever on the left, implant-supported FPD was unavoidable because of the loss of an implant. The decision not to connect the prosthesis to the distal natural tooth was made because of the guarded prognosis of the tooth. The loss of a natural tooth, if it is splinted to the implants, inevitably will result in alteration of the design or the need to remake the prosthesis. The potential risk of biomechanical complication with tooth-implant connections (because of the difference in their mobility<ce:cross-ref refid="bib15"><ce:sup>15</ce:sup></ce:cross-ref>) had to be considered as well. Apparent tooth intrusion has been reported when natural teeth are attached to implants in fixed restorations.<ce:cross-ref refid="bib16"><ce:sup>16</ce:sup></ce:cross-ref> However, there is also the possibility of occlusal overloading of the 2 implants; this concern had to be monitored closely.</ce:para></ce:section><ce:section id="s0020"><ce:section-title id="st0025">Summary</ce:section-title><ce:para id="p0070">In the patient treatment presented, an organized approach to occlusal reconstruction with fixed restorations was implemented, and osseointegrated implants were used to support the mandibular prostheses. 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type="alternative" lang="en" contentType="CDATA"><title>The use of implants in the occlusal rehabilitation of a partially edentulous patient: A clinical report</title></titleInfo><name type="personal"><namePart type="given">Norsiah</namePart><namePart type="family">Yunus</namePart><namePart type="termsOfAddress">BDS, MSca</namePart><affiliation>Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Hadijah</namePart><namePart type="family">Abdullah</namePart><namePart type="termsOfAddress">BDS, MScb</namePart><affiliation>Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Firdaus</namePart><namePart type="family">Hanapiah</namePart><namePart type="termsOfAddress">BDS, MScc</namePart><affiliation>Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="Full-length article" authority="ISTEX" authorityURI="https://content-type.data.istex.fr" valueURI="https://content-type.data.istex.fr/ark:/67375/XTP-1JC4F85T-7">research-article</genre><originInfo><publisher>ELSEVIER</publisher><dateIssued encoding="w3cdtf">2001</dateIssued><copyrightDate encoding="w3cdtf">2001</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><abstract lang="en">Abstract: This article describes the occlusal rehabilitation of a partially edentulous patient who did not want a removable partial denture. Implants and extensive fixed restorations were used to restore posterior support and treat severely worn dentition, respectively. The treatment offered the patient a functional and esthetic result. (J Prosthet Dent 2001;85:540-3.)</abstract><note>aLecturer, Department of Prosthetic Dentistry.</note><note>bLecturer, Department of Conservative Dentistry.</note><note>cLecturer, Department of Oral and Maxillofacial Surgery.</note><note>Reprint requests to: Dr Norsiah Yunus, Faculty of Dentistry, University of Malaya, 50603 Kuala Lumpur MALAYSIA, Fax: (60)3-7967-4535, E-mail: norsiah@um.edu.my</note><note>J Prosthet Dent 2001;85:540-3</note><relatedItem type="host"><titleInfo><title>The Journal of Prosthetic Dentistry</title></titleInfo><titleInfo type="abbreviated"><title>YMPR</title></titleInfo><genre type="journal" authority="ISTEX" authorityURI="https://publication-type.data.istex.fr" valueURI="https://publication-type.data.istex.fr/ark:/67375/JMC-0GLKJH51-B">journal</genre><originInfo><publisher>ELSEVIER</publisher><dateIssued encoding="w3cdtf">200106</dateIssued></originInfo><identifier type="ISSN">0022-3913</identifier><identifier type="PII">S0022-3913(00)X0010-8</identifier><part><date>200106</date><detail type="volume"><number>85</number><caption>vol.</caption></detail><detail type="issue"><number>6</number><caption>no.</caption></detail><extent unit="issue-pages"><start>525</start><end>630</end></extent><extent unit="pages"><start>540</start><end>543</end></extent></part></relatedItem><identifier type="istex">A99716A9CE434A50A50276C66BB438D98A6C36D0</identifier><identifier type="ark">ark:/67375/6H6-9NSM86V5-Q</identifier><identifier type="DOI">10.1067/mpr.2001.115875</identifier><identifier type="PII">S0022-3913(01)92324-8</identifier><accessCondition type="use and reproduction" contentType="copyright">©2001 Editorial Council of The Journal of Prosthetic Dentistry</accessCondition><recordInfo><recordContentSource authority="ISTEX" authorityURI="https://loaded-corpus.data.istex.fr" valueURI="https://loaded-corpus.data.istex.fr/ark:/67375/XBH-HKKZVM7B-M">elsevier</recordContentSource><recordOrigin>Editorial Council of The Journal of Prosthetic Dentistry, ©2001</recordOrigin></recordInfo></mods><json:item><extension>json</extension><original>false</original><mimetype>application/json</mimetype><uri>https://api.istex.fr/document/A99716A9CE434A50A50276C66BB438D98A6C36D0/metadata/json</uri></json:item></metadata><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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