Distal extension mandibular removable partial denture with implant support
Identifieur interne : 001C72 ( Pmc/Corpus ); précédent : 001C71; suivant : 001C73Distal extension mandibular removable partial denture with implant support
Auteurs : Canan Bural ; Begum Buzbas ; Sebnem Ozatik ; Gulsen Bayraktar ; Yusuf EmesSource :
- European Journal of Dentistry [ 1305-7456 ] ; 2016.
Abstract
This case report describes the fabrication of a distal extension removable partial denture (RPD) of a 65-year-old man with implant support. Loss of fibroelasticity of the peripheral tissues and reduced mandibular vestibular sulcular depth due to a previous surgical resection and radiotherapy at the right side were the main clinical factors that created difficulty for denture retention and stability. The fabrication of a mandibular RPD supported by anterior teeth and two bilaterally placed implants in the molar area to convert from Kennedy Class 1 design to Kennedy Class 3 implant-bounded RPD is reported. Retention and stability of the denture were improved with implant support on the distal extension site of the RPD. The common clinical problems about distally extended RPDs are lack of retention and stability due to the movement around the rotational axis. Dental implant placement to the distal edentulous site minimizes the potential dislodgement of the RPD is popular. Implant-supported RPD can be suggested as an advantageous and cost-effective treatment option for the partially edentulous patients.
Url:
DOI: 10.4103/1305-7456.195180
PubMed: 28042277
PubMed Central: 5166318
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PMC:5166318Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Distal extension mandibular removable partial denture with implant support</title><author><name sortKey="Bural, Canan" sort="Bural, Canan" uniqKey="Bural C" first="Canan" last="Bural">Canan Bural</name><affiliation><nlm:aff id="aff1">Department of Prosthodontics, Istanbul University Faculty of Dentistry, Istanbul, Turkiye</nlm:aff></affiliation></author><author><name sortKey="Buzbas, Begum" sort="Buzbas, Begum" uniqKey="Buzbas B" first="Begum" last="Buzbas">Begum Buzbas</name><affiliation><nlm:aff id="aff1">Department of Prosthodontics, Istanbul University Faculty of Dentistry, Istanbul, Turkiye</nlm:aff></affiliation></author><author><name sortKey="Ozatik, Sebnem" sort="Ozatik, Sebnem" uniqKey="Ozatik S" first="Sebnem" last="Ozatik">Sebnem Ozatik</name><affiliation><nlm:aff id="aff1">Department of Prosthodontics, Istanbul University Faculty of Dentistry, Istanbul, Turkiye</nlm:aff></affiliation></author><author><name sortKey="Bayraktar, Gulsen" sort="Bayraktar, Gulsen" uniqKey="Bayraktar G" first="Gulsen" last="Bayraktar">Gulsen Bayraktar</name><affiliation><nlm:aff id="aff1">Department of Prosthodontics, Istanbul University Faculty of Dentistry, Istanbul, Turkiye</nlm:aff></affiliation></author><author><name sortKey="Emes, Yusuf" sort="Emes, Yusuf" uniqKey="Emes Y" first="Yusuf" last="Emes">Yusuf Emes</name><affiliation><nlm:aff id="aff2">Department of Oral and Maxillofacial Surgery, Istanbul University Faculty of Dentistry, Istanbul, Turkiye</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">28042277</idno><idno type="pmc">5166318</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5166318</idno><idno type="RBID">PMC:5166318</idno><idno type="doi">10.4103/1305-7456.195180</idno><date when="2016">2016</date><idno type="wicri:Area/Pmc/Corpus">001C72</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">001C72</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Distal extension mandibular removable partial denture with implant support</title><author><name sortKey="Bural, Canan" sort="Bural, Canan" uniqKey="Bural C" first="Canan" last="Bural">Canan Bural</name><affiliation><nlm:aff id="aff1">Department of Prosthodontics, Istanbul University Faculty of Dentistry, Istanbul, Turkiye</nlm:aff></affiliation></author><author><name sortKey="Buzbas, Begum" sort="Buzbas, Begum" uniqKey="Buzbas B" first="Begum" last="Buzbas">Begum Buzbas</name><affiliation><nlm:aff id="aff1">Department of Prosthodontics, Istanbul University Faculty of Dentistry, Istanbul, Turkiye</nlm:aff></affiliation></author><author><name sortKey="Ozatik, Sebnem" sort="Ozatik, Sebnem" uniqKey="Ozatik S" first="Sebnem" last="Ozatik">Sebnem Ozatik</name><affiliation><nlm:aff id="aff1">Department of Prosthodontics, Istanbul University Faculty of Dentistry, Istanbul, Turkiye</nlm:aff></affiliation></author><author><name sortKey="Bayraktar, Gulsen" sort="Bayraktar, Gulsen" uniqKey="Bayraktar G" first="Gulsen" last="Bayraktar">Gulsen Bayraktar</name><affiliation><nlm:aff id="aff1">Department of Prosthodontics, Istanbul University Faculty of Dentistry, Istanbul, Turkiye</nlm:aff></affiliation></author><author><name sortKey="Emes, Yusuf" sort="Emes, Yusuf" uniqKey="Emes Y" first="Yusuf" last="Emes">Yusuf Emes</name><affiliation><nlm:aff id="aff2">Department of Oral and Maxillofacial Surgery, Istanbul University Faculty of Dentistry, Istanbul, Turkiye</nlm:aff></affiliation></author></analytic><series><title level="j">European Journal of Dentistry</title><idno type="ISSN">1305-7456</idno><idno type="eISSN">1305-7464</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>This case report describes the fabrication of a distal extension removable partial denture (RPD) of a 65-year-old man with implant support. Loss of fibroelasticity of the peripheral tissues and reduced mandibular vestibular sulcular depth due to a previous surgical resection and radiotherapy at the right side were the main clinical factors that created difficulty for denture retention and stability. The fabrication of a mandibular RPD supported by anterior teeth and two bilaterally placed implants in the molar area to convert from Kennedy Class 1 design to Kennedy Class 3 implant-bounded RPD is reported. Retention and stability of the denture were improved with implant support on the distal extension site of the RPD. The common clinical problems about distally extended RPDs are lack of retention and stability due to the movement around the rotational axis. Dental implant placement to the distal edentulous site minimizes the potential dislodgement of the RPD is popular. Implant-supported RPD can be suggested as an advantageous and cost-effective treatment option for the partially edentulous patients.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Goncalves, Tm" uniqKey="Goncalves T">TM Gonçalves</name></author><author><name sortKey="Campos, Ch" uniqKey="Campos C">CH Campos</name></author><author><name sortKey="Garcia, Rc" uniqKey="Garcia R">RC Garcia</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Zancope, K" uniqKey="Zancope K">K Zancopé</name></author><author><name sortKey="Abrao, Gm" uniqKey="Abrao G">GM Abrão</name></author><author><name sortKey="Karam, Fk" uniqKey="Karam F">FK Karam</name></author><author><name sortKey="Neves, Fd" uniqKey="Neves F">FD Neves</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Bortolini, S" uniqKey="Bortolini S">S Bortolini</name></author><author><name sortKey="Natali, A" uniqKey="Natali A">A 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Eur J Dent</journal-id><journal-id journal-id-type="iso-abbrev">Eur J Dent</journal-id><journal-id journal-id-type="publisher-id">EJD</journal-id><journal-title-group><journal-title>European Journal of Dentistry</journal-title></journal-title-group><issn pub-type="ppub">1305-7456</issn><issn pub-type="epub">1305-7464</issn><publisher><publisher-name>Medknow Publications & Media Pvt Ltd</publisher-name><publisher-loc>India</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">28042277</article-id><article-id pub-id-type="pmc">5166318</article-id><article-id pub-id-type="publisher-id">EJD-10-566</article-id><article-id pub-id-type="doi">10.4103/1305-7456.195180</article-id><article-categories><subj-group subj-group-type="heading"><subject>Case Report</subject></subj-group></article-categories><title-group><article-title>Distal extension mandibular removable partial denture with implant support</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Bural</surname><given-names>Canan</given-names></name><xref ref-type="aff" rid="aff1">1</xref><xref ref-type="corresp" rid="cor1"></xref></contrib><contrib contrib-type="author"><name><surname>Buzbas</surname><given-names>Begum</given-names></name><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Ozatik</surname><given-names>Sebnem</given-names></name><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Bayraktar</surname><given-names>Gulsen</given-names></name><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Emes</surname><given-names>Yusuf</given-names></name><xref ref-type="aff" rid="aff2">2</xref></contrib></contrib-group><aff id="aff1"><label>1</label>Department of Prosthodontics, Istanbul University Faculty of Dentistry, Istanbul, Turkiye</aff><aff id="aff2"><label>2</label>Department of Oral and Maxillofacial Surgery, Istanbul University Faculty of Dentistry, Istanbul, Turkiye</aff><author-notes><corresp id="cor1"><bold>Correspondence:</bold> Dr. Canan Bural Email: <email xlink:href="cbural@istanbul.edu.tr">cbural@istanbul.edu.tr</email></corresp></author-notes><pub-date pub-type="ppub"><season>Oct-Dec</season><year>2016</year></pub-date><volume>10</volume><issue>4</issue><fpage>566</fpage><lpage>570</lpage><permissions><copyright-statement>Copyright: © 2016 European Journal of Dentistry</copyright-statement><copyright-year>2016</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc-sa/3.0"><license-p>This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.</license-p></license></permissions><abstract><p>This case report describes the fabrication of a distal extension removable partial denture (RPD) of a 65-year-old man with implant support. Loss of fibroelasticity of the peripheral tissues and reduced mandibular vestibular sulcular depth due to a previous surgical resection and radiotherapy at the right side were the main clinical factors that created difficulty for denture retention and stability. The fabrication of a mandibular RPD supported by anterior teeth and two bilaterally placed implants in the molar area to convert from Kennedy Class 1 design to Kennedy Class 3 implant-bounded RPD is reported. Retention and stability of the denture were improved with implant support on the distal extension site of the RPD. The common clinical problems about distally extended RPDs are lack of retention and stability due to the movement around the rotational axis. Dental implant placement to the distal edentulous site minimizes the potential dislodgement of the RPD is popular. Implant-supported RPD can be suggested as an advantageous and cost-effective treatment option for the partially edentulous patients.</p></abstract><kwd-group><kwd>Dental implant</kwd><kwd>distal-extension removable partial denture</kwd><kwd>implant-supported removable partial denture</kwd><kwd>Kennedy Class I partial edentulous</kwd><kwd>locator attachment</kwd></kwd-group></article-meta></front><body><sec sec-type="intro" id="sec1-1"><title>INTRODUCTION</title><p>Common clinical problems about distal extension removable partial dentures (RPDs) are lack of retention and stability and unaesthetic appearance because of the clasps.[<xref rid="ref1" ref-type="bibr">1</xref><xref rid="ref2" ref-type="bibr">2</xref><xref rid="ref3" ref-type="bibr">3</xref><xref rid="ref4" ref-type="bibr">4</xref><xref rid="ref5" ref-type="bibr">5</xref><xref rid="ref6" ref-type="bibr">6</xref>]</p><p>Placing bilateral single dental implants in the molar area of the residual alveolar ridges is becoming a popular treatment choice while implants would effectively change the Kennedy Class 1 situation to a more favorable implant-supported Kennedy Class 3 configuration.[<xref rid="ref2" ref-type="bibr">2</xref><xref rid="ref4" ref-type="bibr">4</xref><xref rid="ref5" ref-type="bibr">5</xref><xref rid="ref7" ref-type="bibr">7</xref><xref rid="ref8" ref-type="bibr">8</xref><xref rid="ref9" ref-type="bibr">9</xref>] The retention and stability of the dentures are being improved with placing the implants bilaterally.[<xref rid="ref1" ref-type="bibr">1</xref><xref rid="ref2" ref-type="bibr">2</xref><xref rid="ref4" ref-type="bibr">4</xref>] Moreover, implant support decreases the resorption of the alveolar ridges and the need of relining procedures in the following years.[<xref rid="ref10" ref-type="bibr">10</xref><xref rid="ref11" ref-type="bibr">11</xref><xref rid="ref12" ref-type="bibr">12</xref>] As a result, this treatment modality could resolve intrusion movement problem of the RPD while reducing treatment costs compare with implant-supported fixed prosthesis and resulting in greater patient satisfaction.[<xref rid="ref2" ref-type="bibr">2</xref><xref rid="ref4" ref-type="bibr">4</xref><xref rid="ref5" ref-type="bibr">5</xref>]</p><p>There are different types of connection between the implants and the acrylic base of the RPD, such as implant cover screws, stress-breaking attachments, and healing caps.[<xref rid="ref1" ref-type="bibr">1</xref><xref rid="ref2" ref-type="bibr">2</xref><xref rid="ref3" ref-type="bibr">3</xref><xref rid="ref4" ref-type="bibr">4</xref><xref rid="ref5" ref-type="bibr">5</xref><xref rid="ref6" ref-type="bibr">6</xref><xref rid="ref7" ref-type="bibr">7</xref><xref rid="ref8" ref-type="bibr">8</xref><xref rid="ref9" ref-type="bibr">9</xref><xref rid="ref12" ref-type="bibr">12</xref>] Ball, locator or ERA attachments are the different types of stress-breaking attachments that have been applied to the implants in previous studies and some case reports.[<xref rid="ref1" ref-type="bibr">1</xref><xref rid="ref2" ref-type="bibr">2</xref><xref rid="ref3" ref-type="bibr">3</xref><xref rid="ref4" ref-type="bibr">4</xref><xref rid="ref5" ref-type="bibr">5</xref><xref rid="ref6" ref-type="bibr">6</xref><xref rid="ref8" ref-type="bibr">8</xref><xref rid="ref9" ref-type="bibr">9</xref><xref rid="ref10" ref-type="bibr">10</xref><xref rid="ref11" ref-type="bibr">11</xref><xref rid="ref12" ref-type="bibr">12</xref><xref rid="ref13" ref-type="bibr">13</xref><xref rid="ref14" ref-type="bibr">14</xref>] In addition, placement of only healing caps to function as vertical stopping has previously been reported.[<xref rid="ref1" ref-type="bibr">1</xref><xref rid="ref4" ref-type="bibr">4</xref><xref rid="ref5" ref-type="bibr">5</xref><xref rid="ref6" ref-type="bibr">6</xref><xref rid="ref8" ref-type="bibr">8</xref>]</p><p>This clinical report describes a mandibular implant-supported RPD in a patient who had tumor surgery and radiotherapy using a conventional RPD with lack of retention and stability.</p></sec><sec id="sec1-2"><title>CASE REPORT</title><p>A 65-year-old, both maxillary and mandibular partially edentulous, male was referred to the Department of Prosthetic Dentistry, Istanbul University, Faculty of Dentistry. The patient's chief complaints were reduced function and unaesthetic appearance because of missing teeth and the lack of retention and stability with his previous RPD.</p><p>The patient's medical history revealed that he had radiation therapy on the right sight of mandibular buccal shelf region at the head and neck area. At the extraoral examination, a scar tissue at the right buccal shelf area was observed due to the surgical tumor resection that was operated 25 years ago. In addition, loss of fibroelasticity of the right peripheral soft tissue and perioral region was discovered due to the radiotherapy while the left side indicated no abnormality [<xref ref-type="fig" rid="F1">Figure 1</xref>]. When a dental anamnesis was taken, the patient has reported that three maxillary teeth with severe mobility were extracted before application to the Department of Prosthetic Dentistry Clinic. The patient had no existing dentures for both jaws. He had difficulty in usage of his previous dentures due to lack of retention. Intraoral examination revealed that the patient had two maxillary central and lateral teeth with moderate mobility and five mandibular teeth, right lateral to left canine with no mobility [<xref ref-type="fig" rid="F2">Figure 2</xref>]. Reduced vestibular sulcus depth and a fibrous scar tissue were examined at the right buccal region. Radiographic examination using the existing panoramic X-ray showed that right maxillary canine and maxillary central incisor teeth were previously extracted. In addition, mandibular right first premolar with an existing periapical lesion was also decided to be extracted [<xref ref-type="fig" rid="F3">Figure 3</xref>].</p><fig id="F1" position="float"><label>Figure 1</label><caption><p>Extraoral view before prosthetic treatment (a). Scar tissue and loss of fibroelasticity at the right buccal shelf area due to the surgical tumor resection and radiotherapy (b). No indication of abnormality on the left sight (c)</p></caption><graphic xlink:href="EJD-10-566-g001"></graphic></fig><fig id="F2" position="float"><label>Figure 2</label><caption><p>Preoperative intraoral view. Tissue healing at the right maxillary region and 2 left maxillary teeth (a). Mandibular teeth before prosthetic therapy (b)</p></caption><graphic xlink:href="EJD-10-566-g002"></graphic></fig><fig id="F3" position="float"><label>Figure 3</label><caption><p>Preoperative panoramic X-ray view</p></caption><graphic xlink:href="EJD-10-566-g003"></graphic></fig><p>Three treatment options were presented to the patient.</p><p><list list-type="bullet"><list-item><p>Maxillary and mandibular conventional clasp-retained RPDs were rejected because of the patient's previous complaint about lack of retention and stability with his previous dentures</p></list-item><list-item><p>Maxillary and mandibular implant-supported fixed prostheses were rejected due to the financial limitations of the patient</p></list-item><list-item><p>Maxillary complete denture and mandibular implant-supported RPDs were chosen by the patient as an optimal treatment with the advantage of the increased retention and stability provided by the implants for the mandibular RPD. The cons and pros for the extraction of maxillary left central and lateral teeth were explained in details to the patient in terms of biomechanics and esthetics. The patient preferred the extraction of the remaining teeth, and the future fabrication of a maxillary complete denture was planned. Written informed consent before surgical and prosthetic treatment was obtained from the patient.</p></list-item></list></p><p>Under local anesthesia, mucoperiosteal flaps were elevated and two implants (4.1 mm diameter, 10 mm length; Straumann AG, Waldenburg, Switzerland) were placed in posterior region of the mandible, both on the right and left sides [<xref ref-type="fig" rid="F4">Figure 4</xref>]. Primary closure was obtained in both operation sites. Prophylactic antibiotics and nonsteroidal anti-inflammatory drugs were prescribed. Sutures were removed on the 7<sup>th</sup> postoperative day. At the end of 3 months, the osseointegration of the implants was checked on the panoramic radiograph [<xref ref-type="fig" rid="F5">Figure 5</xref>]. The healing of the mandibular distal edentulous sites seemed to be normal and gingival formers were placed [<xref ref-type="fig" rid="F6">Figure 6</xref>]. At this stage, two maxillary teeth were also extracted before the initiation of the prosthodontic therapy.</p><fig id="F4" position="float"><label>Figure 4</label><caption><p>Implant surgery on the right (a) and left (b) first molar area</p></caption><graphic xlink:href="EJD-10-566-g004"></graphic></fig><fig id="F5" position="float"><label>Figure 5</label><caption><p>Panoramic X-ray view. Osseointegration of the implants at the postoperative 3<sup>rd</sup> month</p></caption><graphic xlink:href="EJD-10-566-g005"></graphic></fig><fig id="F6" position="float"><label>Figure 6</label><caption><p>Intraoral view of implant site at the postoperative 3<sup>rd</sup> month. (a) right side (b) left side</p></caption><graphic xlink:href="EJD-10-566-g006"></graphic></fig><p>Preliminary impressions were made using an alginate impression material (Italgin Chromatic Alginate, BMS Dental, Capannoli, Italy) and individual impression trays for both maxilla and mandible were fabricated using autopolymerizing acrylic resin. After border molding on the maxillary tray, the final impression was made using a zinc oxide eugenol material (SS White, C/O Prima Dental Group, Gloucester, England). For the mandible, the locator abutments (H 3 mm, coated Ti alloy, Straumann AG, Basel, Switzerland) were torqued to the implants with a 25 N/cm [<xref ref-type="fig" rid="F7">Figure 7</xref>]. For the mandibular impression, impression copings were attached to the locator abutments. Cingulum rest seats were prepared on the mesial site of the mandibular right canine and between the mandibular first and second lateral incisors. After that, the final impression of the mandible was made using an addition silicone impression material (Dentasil A, DENTAC, Senden, Germany). Locator analogs were attached to the impression copings [<xref ref-type="fig" rid="F8">Figure 8</xref>] and the impression was poured [<xref ref-type="fig" rid="F9">Figure 9</xref>].</p><fig id="F7" position="float"><label>Figure 7</label><caption><p>Locator abutments connected to the implants (a) right side (b) left side</p></caption><graphic xlink:href="EJD-10-566-g007"></graphic></fig><fig id="F8" position="float"><label>Figure 8</label><caption><p>Final impression with impression copings attached with locator analogs</p></caption><graphic xlink:href="EJD-10-566-g008"></graphic></fig><fig id="F9" position="float"><label>Figure 9</label><caption><p>Working model with locator analogs</p></caption><graphic xlink:href="EJD-10-566-g009"></graphic></fig><p>RPD framework was designed on the mandibular cast with T-bar clasps on the terminal abutment teeth and a lingual plate as a major connector. The cingulum rests were fabricated on the rest seats [<xref ref-type="fig" rid="F10">Figure 10</xref>]. The framework at the implant abutment region was designed circular around the abutment, and the distance between the abutment and the framework was approximately 2 mm so as to support the denture base acrylic resin [<xref ref-type="fig" rid="F11">Figure 11</xref>]. The RPD was cast using a chromium-cobalt casting alloy (DFS, Ländenstrabe, Riedenburg, Germany).</p><fig id="F10" position="float"><label>Figure 10</label><caption><p>Cingulum rests designed on the mandibular anterior teeth</p></caption><graphic xlink:href="EJD-10-566-g010"></graphic></fig><fig id="F11" position="float"><label>Figure 11</label><caption><p>Removable partial denture framework with T-bar clasps on the terminal abutment teeth, lingual plate as a major connector and circular design around the implant abutments</p></caption><graphic xlink:href="EJD-10-566-g011"></graphic></fig><p>Artificial teeth (NT Optima, Toros Dental, Antalya, Turkey) setup was completed and tried in the mouth. The maxillary complete denture and mandibular RPDs were delivered to the patient Locator abutment matrix and black processing nylon insert were connected to the mandibular RPD using autopolymerizing acrylic resin (Self-cure acrylic, IMICRYL, Istanbul, Turkey). After polymerization, the denture was removed and the pink locator attachments were fitted [<xref ref-type="fig" rid="F12">Figure 12</xref>]. After delivery, the patient was recalled weekly for 4 weeks [<xref ref-type="fig" rid="F13">Figure 13</xref>]. The patient was satisfied with the function of his dentures as well as the improved esthetics [<xref ref-type="fig" rid="F14">Figure 14</xref>].</p><fig id="F12" position="float"><label>Figure 12</label><caption><p>Maxillary complete denture (a) and mandibular implant-supported removable partial denture with locator attachments in the intaglio surface (b)</p></caption><graphic xlink:href="EJD-10-566-g012"></graphic></fig><fig id="F13" position="float"><label>Figure 13</label><caption><p>Intraoral view 4 weeks after delivery</p></caption><graphic xlink:href="EJD-10-566-g013"></graphic></fig><fig id="F14" position="float"><label>Figure 14</label><caption><p>Extraoral view after prosthetic treatment (a). Right (b) and left side (c)</p></caption><graphic xlink:href="EJD-10-566-g014"></graphic></fig></sec><sec sec-type="discussion" id="sec1-3"><title>DISCUSSION</title><p>Bounding of the RPD with implants is a treatment option which combines the advantages of the implants and simplicity of the RPD system, with reducing the drawbacks of invasive attempt and cost of the implants more than two.[<xref rid="ref3" ref-type="bibr">3</xref>] In this case report, Kennedy Class 1 partial edentulousness was changed to an implant-bounded Kennedy Class 3 configuration.</p><p>The clinical factors (reduced fibroelasticity of the peripheral soft tissues, buccal scar tissue with a reduced sulcus depth of the right buccal area) that may negatively affect the denture's retention and stability are the indication of an implant-bounded RPD. These problems can be clinically resolved with a single implant on the distal edentulous sites that also improve the biomechanics of the prosthesis.[<xref rid="ref1" ref-type="bibr">1</xref><xref rid="ref3" ref-type="bibr">3</xref><xref rid="ref4" ref-type="bibr">4</xref>] Previous results suggest that by placing an implant to the distal extension site of the RPD, enhancement of distribution of the occlusal forces, movement of the posterior rotational axis to a distal position, shortening of the distal extension of the RPD, and reducing potential rotational movement of the RPD can be improved.[<xref rid="ref3" ref-type="bibr">3</xref><xref rid="ref15" ref-type="bibr">15</xref>] The tissueward and the opposite movement of the RPD were restricted by the method mentioned above, and as a result, retention and stability of the RPD are increased. At the recall appointments, the patient did not report any complaint about the movement of the implant-supported RPD when compared to his previous conventional clasp-retained RPD. The patient satisfaction was also improved when compared to the patient's previous clasp-retained conventional RPD.</p></sec><sec sec-type="conclusion" id="sec1-4"><title>CONCLUSION</title><p>Placement of bilateral implants can convert the RPD from tooth- and tissue-supported RPD to an implant-supported RPD. In the present report, movement of the RPD was reduced and therefore retention and stability was improved by the implants with locator abutments. Finally, the treatment plan can be suggested, especially in patients who could not effort the implant-supported fixed prosthesis.</p><sec id="sec2-1"><title>Declaration of patient consent</title><p>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. 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