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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Fabricating a Soft Liner-Retained Implant-Supported Palatal Lift Prosthesis for an Edentulous Patient: A Case Report</title><author><name sortKey="Savabi, Omid" sort="Savabi, Omid" uniqKey="Savabi O" first="Omid" last="Savabi">Omid Savabi</name><affiliation><nlm:aff id="I1">Torabinejad Dental Research Center, Department of Prosthodontics, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran</nlm:aff></affiliation></author><author><name sortKey="Ataei, Ebrahim" sort="Ataei, Ebrahim" uniqKey="Ataei E" first="Ebrahim" last="Ataei">Ebrahim Ataei</name><affiliation><nlm:aff id="I2">Department of Restorative Dentistry, School of Dentistry, Shahid Sadoughi University of Medical Sciences, Yazd, Iran</nlm:aff></affiliation></author><author><name sortKey="Khodaeian, Niloufar" sort="Khodaeian, Niloufar" uniqKey="Khodaeian N" first="Niloufar" last="Khodaeian">Niloufar Khodaeian</name><affiliation><nlm:aff id="I3">Dental Implant Research Center and Department of Prosthodontics, School of Dentistry, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">22779013</idno><idno type="pmc">3388290</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3388290</idno><idno type="RBID">PMC:3388290</idno><idno type="doi">10.1155/2012/203547</idno><date when="2012">2012</date><idno type="wicri:Area/Pmc/Corpus">001B63</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">001B63</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Fabricating a Soft Liner-Retained Implant-Supported Palatal Lift Prosthesis for an Edentulous Patient: A Case Report</title><author><name sortKey="Savabi, Omid" sort="Savabi, Omid" uniqKey="Savabi O" first="Omid" last="Savabi">Omid Savabi</name><affiliation><nlm:aff id="I1">Torabinejad Dental Research Center, Department of Prosthodontics, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran</nlm:aff></affiliation></author><author><name sortKey="Ataei, Ebrahim" sort="Ataei, Ebrahim" uniqKey="Ataei E" first="Ebrahim" last="Ataei">Ebrahim Ataei</name><affiliation><nlm:aff id="I2">Department of Restorative Dentistry, School of Dentistry, Shahid Sadoughi University of Medical Sciences, Yazd, Iran</nlm:aff></affiliation></author><author><name sortKey="Khodaeian, Niloufar" sort="Khodaeian, Niloufar" uniqKey="Khodaeian N" first="Niloufar" last="Khodaeian">Niloufar Khodaeian</name><affiliation><nlm:aff id="I3">Dental Implant Research Center and Department of Prosthodontics, School of Dentistry, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran</nlm:aff></affiliation></author></analytic><series><title level="j">Case Reports in Dentistry</title><idno type="ISSN">2090-6447</idno><idno type="eISSN">2090-6455</idno><imprint><date when="2012">2012</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>This case report describes fabrication of a palatal lift prosthesis for a quadriplegic edentulous 30-year-old male with past head traumatic injury. We constructed an implant supported bar and used a soft-lining material for the maxillary palatal lift prosthesis to minimize the possibility of implant overloading and also provide a less complex and less expensive procedure for this patient.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Hongama, S" uniqKey="Hongama S">S Hongama</name></author><author><name sortKey="Ishikawa, M" uniqKey="Ishikawa M">M Ishikawa</name></author><author><name sortKey="Kawano, F" uniqKey="Kawano F">F Kawano</name></author><author><name sortKey="Ichikawa, T" uniqKey="Ichikawa T">T Ichikawa</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hardy, Jc" uniqKey="Hardy J">JC Hardy</name></author><author><name sortKey="Netsell, R" uniqKey="Netsell R">R Netsell</name></author><author><name sortKey="Schweiger, Jw" uniqKey="Schweiger J">JW Schweiger</name></author><author><name sortKey="Morris, Hl" uniqKey="Morris H">HL Morris</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Gibbons, P" uniqKey="Gibbons P">P Gibbons</name></author><author><name sortKey="Bloomer, H" uniqKey="Bloomer H">H Bloomer</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Schaefer, Ks" uniqKey="Schaefer K">KS Schaefer</name></author><author><name sortKey="Taylor, Td" uniqKey="Taylor T">TD Taylor</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Misch, Ce" uniqKey="Misch C">CE Misch</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mericske Stern, Rd" uniqKey="Mericske Stern R">RD Mericske-Stern</name></author><author><name sortKey="Taylor, Td" uniqKey="Taylor T">TD Taylor</name></author><author><name sortKey="Belser, U" uniqKey="Belser U">U Belser</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chase, Ww" uniqKey="Chase W">WW Chase</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Baysan, A" uniqKey="Baysan A">A Baysan</name></author><author><name sortKey="Parker, S" uniqKey="Parker S">S Parker</name></author><author><name sortKey="Wright, Ps" uniqKey="Wright P">PS Wright</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Wright, Ps" uniqKey="Wright P">PS Wright</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Bell, Dh" uniqKey="Bell D">DH Bell</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kawano, F" uniqKey="Kawano F">F Kawano</name></author><author><name sortKey="Koran, A" uniqKey="Koran A">A Koran</name></author><author><name sortKey="Asaoka, K" uniqKey="Asaoka K">K Asaoka</name></author><author><name sortKey="Matsumoto, N" uniqKey="Matsumoto N">N Matsumoto</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kawano, F" uniqKey="Kawano F">F Kawano</name></author><author><name sortKey="Kon, M" uniqKey="Kon M">M Kon</name></author><author><name sortKey="Koran, A" uniqKey="Koran A">A Koran</name></author><author><name sortKey="Matsumoto, N" uniqKey="Matsumoto N">N Matsumoto</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Jagger, Dc" uniqKey="Jagger D">DC Jagger</name></author><author><name sortKey="Harrison, A" uniqKey="Harrison A">A Harrison</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cain, Jr" uniqKey="Cain J">JR Cain</name></author><author><name sortKey="Mitchell, Dl" uniqKey="Mitchell D">DL Mitchell</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Powers, Jm" uniqKey="Powers J">JM Powers</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Prakash, V" uniqKey="Prakash V">V Prakash</name></author><author><name sortKey="D Ouza, M" uniqKey="D Ouza M">M D’Souza</name></author><author><name sortKey="Adhikari, R" uniqKey="Adhikari R">R Adhikari</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cavallaro, Js" uniqKey="Cavallaro J">JS Cavallaro</name></author><author><name sortKey="Tarnow, Dp" uniqKey="Tarnow D">DP Tarnow</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="case-report"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Case Rep Dent</journal-id><journal-id journal-id-type="iso-abbrev">Case Rep Dent</journal-id><journal-id journal-id-type="publisher-id">CRIM.DENTISTRY</journal-id><journal-title-group><journal-title>Case Reports in Dentistry</journal-title></journal-title-group><issn pub-type="ppub">2090-6447</issn><issn pub-type="epub">2090-6455</issn><publisher><publisher-name>Hindawi Publishing Corporation</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">22779013</article-id><article-id pub-id-type="pmc">3388290</article-id><article-id pub-id-type="doi">10.1155/2012/203547</article-id><article-categories><subj-group subj-group-type="heading"><subject>Case Report</subject></subj-group></article-categories><title-group><article-title>Fabricating a Soft Liner-Retained Implant-Supported Palatal Lift Prosthesis for an Edentulous Patient: A Case Report</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Savabi</surname><given-names>Omid</given-names></name><xref ref-type="aff" rid="I1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Ataei</surname><given-names>Ebrahim</given-names></name><xref ref-type="aff" rid="I2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Khodaeian</surname><given-names>Niloufar</given-names></name><xref ref-type="aff" rid="I3"><sup>3</sup></xref><xref ref-type="corresp" rid="cor1">*</xref></contrib></contrib-group><aff id="I1"><sup>1</sup>Torabinejad Dental Research Center, Department of Prosthodontics, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran</aff><aff id="I2"><sup>2</sup>Department of Restorative Dentistry, School of Dentistry, Shahid Sadoughi University of Medical Sciences, Yazd, Iran</aff><aff id="I3"><sup>3</sup>Dental Implant Research Center and Department of Prosthodontics, School of Dentistry, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran</aff><author-notes><corresp id="cor1">*Niloufar Khodaeian: <email>khodaeian@dnt.mui.ac.ir</email></corresp><fn fn-type="other"><p>Academic Editors: A. Markopoulos, A. Milosevic, and A. Sertgoz</p></fn></author-notes><pub-date pub-type="ppub"><year>2012</year></pub-date><pub-date pub-type="epub"><day>19</day><month>6</month><year>2012</year></pub-date><volume>2012</volume><elocation-id>203547</elocation-id><history><date date-type="received"><day>11</day><month>2</month><year>2012</year></date><date date-type="accepted"><day>12</day><month>4</month><year>2012</year></date></history><permissions><copyright-statement>Copyright © 2012 Omid Savabi et al.</copyright-statement><copyright-year>2012</copyright-year><license xlink:href="https://creativecommons.org/licenses/by/3.0/"><license-p>This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><abstract><p>This case report describes fabrication of a palatal lift prosthesis for a quadriplegic edentulous 30-year-old male with past head traumatic injury. We constructed an implant supported bar and used a soft-lining material for the maxillary palatal lift prosthesis to minimize the possibility of implant overloading and also provide a less complex and less expensive procedure for this patient.</p></abstract></article-meta></front><body><sec id="sec1"><title>1. Introduction</title><p>The possibility of survival from cerebrovascular accidents that were once fatal is increasing because of advances in medical sciences [<xref rid="B1" ref-type="bibr">1</xref>]. Speech disorders have been identified as a consequence of cerebrovascular accidents [<xref rid="B1" ref-type="bibr">1</xref>]. Paralytic dysarthria, a disorder of the nerve mechanism that controls orofacial function, often results in insufficient rhinopharyngeal closure [<xref rid="B2" ref-type="bibr">2</xref>].</p><p>In 1958, Gibbons and Bloomer [<xref rid="B3" ref-type="bibr">3</xref>] described the first successful palatal lift prostheses (PLPs) to treat paralytic dysarthria involving insufficient rhinopharyngeal closure. The purpose of PLP is to obtain rhinopharyngeal closure by displacing the soft palate to the level of normal palatal closure at the palatal plane [<xref rid="B4" ref-type="bibr">4</xref>]. This paper describes a technique for fabricating an implant-supported overdenture with palatal lift for an edentulous patient with past closed-head traumatic injury.</p></sec><sec id="sec2"><title>2. Case Report</title><p>A quadriplegic edentulous 30-year-old male with a history of head trauma caused by a car accident 3 years ago was referred for replacement of missing teeth. He had extracted all his teeth because of severe caries due to a 10-month coma and the jaw ankylosis resulting from the trauma. His chief complaint was inability of chewing, and mouth opening range was normal. After meticulous diagnostic survey, maxillary and mandibular overdentures were selected as the treatment plan. He had type 3, divisions A, D, C in different part of maxillary arch and type 1 division A in mandibular arch [<xref rid="B5" ref-type="bibr">5</xref>].</p><p> Eight implants (4.1 × 12 mm; ITI Dental Implant System, Straumann AG, Basel, Switzerland) were inserted in the maxilla and mandible according to surgical stents (<xref ref-type="fig" rid="fig1">Figure 1</xref>). A bar- (ITI Dental Implant System) retained maxillary overdenture and ball- (Rhein 83, Bologna, Italy) retained mandibular overdenture were processed using conventional procedures [<xref rid="B6" ref-type="bibr">6</xref>].</p><p>The patient's general condition improved after a year, and his speech therapist requested palatal lift prosthesis to correct the patient's hypernasal speech and also emphasized that his soft palate muscle activities may be corrected after a period of using palatal lift prosthesis.</p><p>To construct a new maxillary prosthesis with palatal lift, preliminary impression was made with irreversible hydrocolloid (Jeltrate, Alginate, Fast set, Dentsply Philadelphia, PA, USA) and a custom tray was fabricated with light cured resin (Triad VLC, Dentsply). Border molding in vestibules was performed by impression compound (Kerr, Orange, NJ, USA) and completed with the Iso Functional compound (GC Dental Corp., Tokyo, Japan) in the soft palate site. Final impression was made by polyether material, (Impergum F, 3M ESPE, St. Paul, MN, USA, <xref ref-type="fig" rid="fig2">Figure 2</xref>). An overimpression of the placed mandibular overdenture with irreversible hydrocolloid was also obtained. The impressions were poured with type III stone (Fujirock, GC Dental). After obtaining the maxillomandibular records with a record base and occlusion rim, the casts were transferred to a semiadjustable articulator (ARH type, Dentatus AB, Stockholm, Sweden) using a face-bow transfer (AEB face-bow, Dentatus AB). A protrusive record was made to set the articulator's condylar elements, and a lingualized occlusal schema was achieved. Denture teeth were arranged on the record base with an index to duplicate the same position of the first overdenture teeth. The trial arrangement was evaluated intraorally, for esthetics, occlusal vertical dimension, and centric relation. The 1 mm thickness vacuum heat-pressed polyethylene was adapted around the bar portion of maxillary cast as a spacer, and the prosthesis was processed using heat cure acrylic resin material (Triplex hot, Ivoclar Vivadent, Schaan, Liechtenstein). The 1 mm thick spacer was removed from the intaglio surface of the denture, and this area was lined with autopolymerizing resilient material (Mollosil, Detax, GmbH, Ettlingen, Germany). The denture was placed on the cast until the resilient material setting was completed (<xref ref-type="fig" rid="fig3">Figure 3</xref>). After delivery, denture care instructions were given to the patient. Patient was told to clean the tissue surface using soft cloth. Recall appointments were scheduled at 1 day, 1 week, 1 month, and every 6 months. The soft liner replacement was scheduled every 6 months, but the soft liner maintained its resiliency after a year, so it was replaced only once in 2 years. In this period the dentures were well maintained, and the patient was comfortable using them (<xref ref-type="fig" rid="fig4">Figure 4</xref>). His hypernasal speech was improved, and the patient returned to use his old denture.</p></sec><sec id="sec3"><title>3. Discussion</title><p>In 1961, Chase introduced the use of elastic impression material to relieve traumatic tissues [<xref rid="B7" ref-type="bibr">7</xref>]. Resilient liners, such as Molloplast (Detax, GmbH), are widely used as a cushion on the fitting surface of dentures in the management of traumatized oral mucosa, bony undercuts, patients with bruxism parafunctions, and ridge atrophy, as well as for congenital oral defects requiring obturation [<xref rid="B8" ref-type="bibr">8</xref>]. Soft lining materials provide even distribution of the functional load and avoid local concentrations of stress [<xref rid="B8" ref-type="bibr">8</xref>–<xref rid="B12" ref-type="bibr">12</xref>]. There are two main types of these materials: plasticized acrylics and silicone elastomers, differing in the percentage of cross-linking agents, catalysts, and fillers which are available in autopolymerizing and heat polymerizing forms [<xref rid="B13" ref-type="bibr">13</xref>].</p><p>Using a soft liner-retained implant-supported overdenture offers the restorative dentist a treatment option when the number, location, or angulation of dental implants placed may differ from the original treatment plan [<xref rid="B14" ref-type="bibr">14</xref>]. The presence of the soft lining material compensates for the volumetric contraction of the acrylic resin that occurs during processing [<xref rid="B15" ref-type="bibr">15</xref>]. This prevents the dental implant components from coming into contact with the acrylic resin and minimizes the possibility of overloading implants [<xref rid="B14" ref-type="bibr">14</xref>].</p><p>Adding palatal lift portion to maxillary overdenture increased the off-axis load to implants, so presence of soft lining material provides an even distribution of functional load and minimizes the possibility of implant overloading. Also, construction of implant-supported bar for retention and support distributes forces among the implants [<xref rid="B16" ref-type="bibr">16</xref>]. It is also a less complex and less expensive procedure. In addition, because the patient suffering from a head traumatic injury may demonstrate improved soft palate function with time [<xref rid="B4" ref-type="bibr">4</xref>], which makes the conventional overdenture treatment options possible, fabricating a less expensive prosthesis is preferred.</p><p>A set of parameters for successful unsplinted implant-retained maxillary overdenture treatment have been published [<xref rid="B17" ref-type="bibr">17</xref>] including denture flanges, light retention retainer, lingualized occlusal schema, maximum implant position spread, and a minimum of 4 parallel, rough-surfaced, long, wide implants placed in denser-type bone site. 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person-group-type="author"><name><surname>Prakash</surname><given-names>V</given-names></name><name><surname>D’Souza</surname><given-names>M</given-names></name><name><surname>Adhikari</surname><given-names>R</given-names></name></person-group><article-title>A comparison of stress distribution and flexion among various designs of bar attachments for implant overdentures: a three dimensional finite element analysis</article-title><source><italic>Indian Journal of Dental Research</italic></source><year>2009</year><volume>20</volume><issue>1</issue><fpage>31</fpage><lpage>36</lpage><pub-id pub-id-type="pmid">19336857</pub-id></element-citation></ref><ref id="B17"><label>17</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Cavallaro</surname><given-names>JS</given-names><suffix>Jr.</suffix></name><name><surname>Tarnow</surname><given-names>DP</given-names></name></person-group><article-title>Unsplinted implants retaining maxillary overdentures with partial palatal coverage: report of 5 consecutive cases</article-title><source><italic>International Journal of Oral and Maxillofacial Implants</italic></source><year>2007</year><volume>22</volume><issue>5</issue><fpage>808</fpage><lpage>814</lpage><pub-id pub-id-type="pmid">17974117</pub-id></element-citation></ref></ref-list></back><floats-group><fig id="fig1" position="float"><label>Figure 1</label><caption><p>(a) Occlusal view after implant placement in maxilla. (b) Occlusal view after implant placement in mandible.</p></caption><graphic xlink:href="CRIM.DENTISTRY2012-203547.001"></graphic></fig><fig id="fig2" position="float"><label>Figure 2</label><caption><p>(a) Alginate impression with a prefabricated tray corrected with impression compound for extending to the soft palate site. (b) Maxillary special tray after border molding. (c) Final impression of maxillary arch extending to the soft palate.</p></caption><graphic xlink:href="CRIM.DENTISTRY2012-203547.002"></graphic></fig><fig id="fig3" position="float"><label>Figure 3</label><caption><p>(a) Intaglio surface of the denture after spacer removal. (b) Intaglio surface of the denture after lining with resilient material.</p></caption><graphic xlink:href="CRIM.DENTISTRY2012-203547.003"></graphic></fig><fig id="fig4" position="float"><label>Figure 4</label><caption><p>(a) Occlusal view of maxillary bar attachment. (b) Occlusal view of mandibular ball attachment. (c) Frontal view of maxillary and mandibular denture in centric occlusion. (d) Maxillary denture and palatal lift portion in place.</p></caption><graphic xlink:href="CRIM.DENTISTRY2012-203547.004"></graphic></fig></floats-group></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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