Distal-Extension Removable Partial Denture with Anterior Implant Prostheses: Case Report

전치부 임플란트 보철을 이용한 후방연장 국소의치 수복

  • Na, Hyun-Joon (Department of Prosthodontics, School of Dentistry, Chosun University) ;
  • Kang, Dong-Wan (Department of Prosthodontics, School of Dentistry, Chosun University) ;
  • Son, Mee-Kyung (Department of Prosthodontics, School of Dentistry, Chosun University)
  • 나현준 (조선대학교 치의학전문대학원 보철학교실) ;
  • 강동완 (조선대학교 치의학전문대학원 보철학교실) ;
  • 손미경 (조선대학교 치의학전문대학원 보철학교실)
  • Received : 2011.09.07
  • Accepted : 2011.12.25
  • Published : 2011.12.31

Abstract

In patients who used removable partial dentures for a long period of time, gradual alveolar bone resorption occurs in edentulous area. However, in residual teeth area, alveolar bone is maintained sound. This causes an imbalance in intermaxillary distance between a maxillae and a mandible which is intensified due to expansion in vertical and horizontal bone amount difference between the two area as time passes. As the result, this shows a substantial difference in vertical position according to the period of teeth loss even after residual teeth loss. As in this situation, a patient with bilaterally and anterio-posteriorly different intermaxillary distance, various prosthodontic problems can be caused in fixed implant prosthodontics and implant overdenture. This study shows a case in which implant-supported removable partial denture was fabricated considering residual alveolar bone height after teeth loss in a patient who had been using a distal extension removable partial denture for a long period of time. In anterior area with short intermaxillary distance, fixed prosthodontics were fabricated with implant placement and in posterior area with long intermaxillary distance, a removable partial denture was fabricated. Finally, a small number of implants were placed without additional surgery and economical and comfortable treatment results were shown.

오랜 기간 국소의치를 장착한 부분 무치악 환자에서, 치아가 결손된 부위는 점진적인 치조골의 흡수가 발생되는 반면, 잔존 지대치 부위는 치조골이 유지되어 있는 것을 볼 수 있다. 이는 차후 잔존 지대치를 상실한 후에도 치아 상실의 시점에 따라 수직적인 골 높이의 현저한 차이를 나타낸다. 이와 같이 전체 치아 발거 후 상하악 악간 거리가 좌우측 또는 전후방으로 다르게 나타나는 환자에서 임플란트를 이용한 고정성 보철물이나 임플란트 피개의치의 제작 시 여러 가지 보철적 문제가 야기될 수 있다. 본 논문은 구치부 결손으로 인해 오랫동안 국소의치를 사용했던 환자에서 치아 상실 후 잔존 치조골의 높이를 고려하여 임플란트 지지 국소의치를 제작한 증례로서 잔존 치조골 량이 많아 악간거리가 짧은 전치부는 임플란트를 식립하여 고정성 보철물로, 오랫동안 치조골의 흡수로 인해 악간거리가 긴 구치부는 국소의치로 수복하였다. 본 증례에서의 임플란트 지지 국소의치는 부가적인 수술이 없이 소수의 임플란트를 식립하고 환자에게 기존 보철물의 양식과 유사한 보철물을 제공함으로서 경제적이고 편안한 치료결과를 보여주었다.

Keywords

References

  1. Carlsson G.E. Late results of treatment with partial dentures. An investigation by questionnaire and clinical examination 13 years after treatment. J Oral Rehabil 1976;226-7.
  2. Bergman B, Hugoson A, Olsson C. Periodontal and prosthetic conditions in patients treated with removable partial dentures and artificial crowns. A longitudinal two-year study. Acta Odontol Stand 1971;29:621. https://doi.org/10.3109/00016357109026536
  3. Naert I, Quirynen M, van Steenberghe D et al. A six-year prosthodontics study of 509 consecutively inserted implants for the treatment of partial edentulism. J. Prosthet Dent 1992;67:236-245. https://doi.org/10.1016/0022-3913(92)90461-I
  4. Kapur KK. Veterans Administration Cooperative Dental Implant Study-Comparisons between fixed partial dentures supported by blade-vent implants and removable partial dentures. Part IV: Comparisons of patient satisfaction between two treatment modalities. J. Prosthet Dent 1991;66:517-530. https://doi.org/10.1016/0022-3913(91)90516-Y
  5. Jemt T, Lekholm U. Oral implant treatment in posterior partially edentulous jaws: a 5-year follow- up report. Int J Oral Maxillofac Implants 1993;8:635- 640.
  6. McGarry TJ, Nimmo A, Skiba JF et al. Classification system for partial edentulism. J Prosthodont 2002;11:181-193. https://doi.org/10.1053/jopr.2002.126094
  7. Von Wowern N, Stoltze K. Pattern of age related bone loss in mandibles. Scand J Dent Res 1980;88: 134-146.
  8. Keltjens HM, Kayser AF, Hertel R et al. Distal extension removable partial dentures supported by implants and residual teeth: Considerations and case reports. Int J Oral Maxillofac Implants 1993;8: 208-213.
  9. Carlsson, GE, Hedegard, B, Koivumaa, KK. Studies in partial denture prosthesis IV. Final results of a 4 year longitudinal investigation of dentogingivally supported partial dentures. Acta Odontol Stand 1965;23:443. https://doi.org/10.3109/00016356509021764
  10. Amet EM. A unique method combining teeth and endosseous implants for a stable removable prosthesis. J Oral Implantol 1993;19:216-220.
  11. Jackson TR. Removable partial dentures with natural root structure and osseointegrated fixtures. Dent Clin North Am 1990;34:711-728.
  12. Ganz SD. Combination natural tooth and implant- borne removable partial denture: A clinical report. J Prosthet Dent 1991;66:1-5. https://doi.org/10.1016/0022-3913(91)90341-S
  13. Carlsson GE, Hedegard B, Koivumaa KK. Studies in partial dental prosthesis. II. An investigation of mandibular partial dentures with double extension saddles. Acta Odont Scand 1961;19:215-237. https://doi.org/10.3109/00016356108997705
  14. Carlsson GE, Hedegard B, Koivumaa KK. Studies in partial dental prosthesis. III. A longitudinal study of mandibular partial dentures with distal extension saddles. Acta Odontol Scand 1962;20:95-119. https://doi.org/10.3109/00016356209026098
  15. Carlsson GE, Persson G. Morphologic changes of the mandible after extraction and wearing of dentures: a longitudinal, clinical, and x-ray cephalometric study covering 5 years. Odontol Revy 1967;18:27-54.
  16. Halterman SM, Rivers JA, Keith JD et al. Implant support for removable partial overdentures: A case report. Implant Dent 1999;8:74-78. https://doi.org/10.1097/00008505-199901000-00009
  17. Giffin KM. Solving the distal extension removable partial denture base movement dilemma: A clinical report. J Prosthet Dent 1996;76:347-349. https://doi.org/10.1016/S0022-3913(96)90536-3
  18. Witter DJ, van Elteren P, Kyser AF et al. The effect of removable partial dentures on the oral function in shortened dental arches. J Oral Rehabil 1989;16: 27-33. https://doi.org/10.1111/j.1365-2842.1989.tb01314.x
  19. Mitrani R, Brudvik JS, Phillips KM. Posterior implants for distal extension removable prostheses: A retrospective study. Int J Perio Restorat Dent 2003; 23:353-359.
  20. Kuzmanovic DV, Payne AGT, Purton DG. Distal Implants to modify the Kennedy classification of a removable partial denture: A clinical report. J Prosthet Dent 2004;92:8-11. https://doi.org/10.1016/j.prosdent.2004.04.010
  21. Ohkubo C, Kurihara D, Shimpo H et al. Effect of implant support on distal extension removable partial denture: in vitro assessment. J Oral Rehabil 2007;34: 52-56 https://doi.org/10.1111/j.1365-2842.2006.01641.x
  22. Ohkubo C, Kobayashi M, Suzuki Y et al. Effect of implant support on distal extension removable partial denture: in vivo assessment. Int J Oral Maxillofac Implants 2008;23:1095-1101.
  23. Grossmann Y, Nissan J, Levin L. Clinical effectiveness of implant-supported removable partial dentures: A review of the literature and retrospective case evaluation. J Oral Maxillofac Surg 2009;67: 1941-1946. https://doi.org/10.1016/j.joms.2009.04.081
  24. Wowern N, Gotfredsen K. Implant supported overdentures, a prevention of bone loss in edentulous mandibles?. Clin Oral Impl Res 2001;12:19-25 https://doi.org/10.1034/j.1600-0501.2001.012001019.x
  25. Crum RJ, Rooney GE Jr. Alveolar bone loss in overdentures: a 5-year study. J Prosthet Dent 1978; 40:610-613. https://doi.org/10.1016/0022-3913(78)90054-9
  26. DeBoer J. Edentulous implants: overdentures versus fixed. J Prosthet Dent 1993;69:386-390. https://doi.org/10.1016/0022-3913(93)90186-R
  27. Watson RM, Davis DM, Forman GH et al. Considerations in design and fabrication of maxillary overdenture. J Prosthodont 1991;4:232-239.
  28. Fanuscu MI, Caputo AA. Influence of attachment systems on load transfer of an implant-assisted maxillary overdenture. J Prosthodont 2004;13:214- 220. https://doi.org/10.1111/j.1532-849X.2004.04041.x
  29. Jacobs R, Schotte A, van Steenberghe D et al. Posterior jaw bone resorption in osseointegrated implant-supported overdentures. Clin Oral Implant Res 1992;3:63-70. https://doi.org/10.1034/j.1600-0501.1992.030203.x
  30. Jacobs R, van Steenberghe D, Nys M et al. Maxillary bone resorption in patients with mandibular implant-supported overdentures or fixed prostheses. J Prosthet Dent 1993;70:135-140. https://doi.org/10.1016/0022-3913(93)90008-C
  31. Lindquist LW, Carlsson GE, Jemt T. A prospective 15-year follow-up study of mandibular fixed prostheses supported by osseointegrated implants. Clinical results and marginal bone loss. Clin Oral Implants Res 1996;7:329-336. https://doi.org/10.1034/j.1600-0501.1996.070405.x
  32. Jang YJ, Emtiaz S, Tarnow DP. Single implant- supported crown used as an abutment for a removable cast partial denture: A case report. Implant Dent 1998;7:199-203. https://doi.org/10.1097/00008505-199807030-00007