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Management of Lose Mandibular Denture: A Case Report

Article  in  Indian Journal of Forensic Medicine and Toxicology · March 2021

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 Indian Journal of Forensic Medicine & Toxicology, October-December 2020, Vol. 14, No. 4  8109

Management of Lose Mandibular Denture: A Case Report

Abhilash Mohapatra1, Radha Prasanna Dalai2, Debarchita Sarangi3,

Subhrajeet Narayan Sahoo4, Upsana Dhar5
1
Professor, Department of Prosthodontics, 2Senior Lecturer, Department of Public Health Dentistry, 3Senior
Lecturer, Department of Prosthodontics, 4Senior Lecturer, Department of Orthodontics, 5Post Graduate Trainee,
Institute of Dental Sciences, Siksha ‘O’ Anusandhan (Deemed to be University), Bhubaneswar, Odisha, India

Abstract
A lose mandibular denture is the most common problem reported by complete denture patients. So to
improve retention and stability we support the denture by placing two implants. In this case report,a patient
with a lose mandibular denture is rehabilitated with two mandibular implants. The final prosthesis was stable
well retained and esthetically pleasing.

Keywords:  Overdenture, Implant, O ring attachment.

Introduction report three implants are placed with ball and socket
attachment which support a mandibular overdenture.
For a complete denture to be a successful prosthesis
is dependent on various factors like denture bearing Case Report: A 68-year-old male patient reported
area, psychological assessment of patient and previous to the department of prosthodontics with a chief
experience with dentist1,2. So the challenge for complaint of ill-fitting mandibular denture. The patient
prosthodontists is that it not only replaces teeth but also had no significant medical history and his dental history
the soft tissue. The usual problem with complete denture included extraction of teeth due to periodontitis. The
patients is retention of mandibular denture, so treatment patient was using a conventional denture for the past
option for it is implant-supported overdenture. So in this five years and due to non-retention of mandibular
era of implant dentistry mandibular implant overdenture denture the patient wants a new prosthesis. On clinical
has become the new standard for the treatment of examination the mandibular ridge exhibited a significant
edentulous mandible. So for practitioners this treatment degree of resorption and all other parameters like size
option is the most reliable definite treatment option. shape of maxillary ridge and condition of mucosa
Advantage of implant-supported denture is maintenance were found to be normal & healthy (Figure 1). But on
of bone volume and increased retention and stability. evaluation of denture it was found that extension of
denture flange was inadequate, retention & stability
The most popular attachment used for overdentures
was poor. Orthopantomograph was advised to evaluate
are locators and ball and socket overdenture. In this case
bone availability and architecture (Figure 2). The inter
ridge distance was assessed and it was decided to give
stud attachment. So for this patient a treatment plan of
conventional complete denture for the maxillary arch
and 3 implant-supported overdenture for mandibular
Corresponding Author: arch5. This treatment plan was explained to the patient
Abhilash Mohapatra and approved by him.
Professor, Department of Prosthodontics, Crown
& Bridge, Institute of Dental Sciences, Siksha ‘O’
Anusandhan (Deemed to be University), Bhubaneswar,
Odisha, India
e-mail: abhilashmohaptra@soa.ac.in
8110  Indian Journal of Forensic Medicine & Toxicology, October-December 2020, Vol. 14, No. 4

Figure 1. Mandibular ridge of paitent

Figure 2. Orthopantomograph

Figure 3. Clear auto polymerizing acrylic resin surgical template

Treatment procedure: Conventional maxillary and denture was duplicated by using laboratory-grade
mandibular dentures with bilateral balanced occlusal silicon, using clear auto polymerizing acrylic resin to be
schemes were fabricated for the patient. The mandibular used as a surgical template (Figure 3). The vertical space
 Indian Journal of Forensic Medicine & Toxicology, October-December 2020, Vol. 14, No. 4  8111
analysis was done and it was found to be 12 mm which
falls in class II category6 (Ahuja S & Cagna DR). So
stud with ball and socket attachment was decided for the
patient. Adin (TouregNP) implants of 11.5mm length
and 3.75 mm diameter were selected. Implant surgery
was carried out in two-stage protocol, first implants were
placed with the help of a surgical guide in B, D, E region
and loading of the implant was done after three months.
Two implant-retained overdenture is a very reliable
therapy for patients with edentulous mandible7. But in
the present case as the ridge is resorbed in the posterior
region and space is not adequate for the bar prosthesis,
three stud attachments were planned.
Figure 4. Secondary stage surgery
Implants should be placed as parallel to each other
as possible to increase the prognosis of the prosthesis.
For this the surgical stent was used to do the initial
drilling and all the osteotomy sites were checked with
paralleling pins. After completion of prescribed drilling
sequence implants were placed in prepared sites.
Surgical cover screw was placed and primary closure Figure 5. Polished & trimmed pick up
of flaps was done. The patient was told not to wear the
lower denture for two weeks after surgery and cleanse
the mouth with disinfectant mouthwash. After removal
of suture the intaglio surface of denture was relieved
and tissue conditioners were applied. The conditioner
distributed the occlusal forces to the denture bearing
area without transmitting it to the surgical sites. Three
months later the second stage surgery was done and
healing abutments were placed and left for 15 days to
help in maturation of gingival tissue. At this procedure
the denture is again relined. After completion of 15
days the ball and socket overdenture abutments of
2mm diameter & 2 mm height were placed.(Figure 4)
For blockout of the stud attachment a rubber dam was Figure 6. Postoperative photograph
placed and then O rings (RS-2664, yellow) were placed.
The second mandibular denture which was prepared First the patient was trained on how to place and
previously was loaded with pressure indicating paste remove the denture followed by home care instructions.
and placed on abutments to check the position of implant The patient was recalled after 24 hours and then after six
abutments. The number 6 bur was used to relieve the month and radiographs were taken. The patients were
intaglio surface to accommodate the metal housing of advised to clean the attachment with the unituft brush.
the O ring. The complete passive seating of the denture And it was found that the patient was comfortably using
was verified and then only GC pattern resin is loaded the overdenture for the last 3 years.
in prepared surface and the patient was asked to bite
on the lower denture with the upper denture in centric Discussion
relation position with a very light occlusal pressure. The Full mouth rehabilitation of an edentulous patient
pick up once fully cured was removed and trimmed and can be with fixed with 6 to 8 implant for a normal ridge,
polished. (Figure 5). and all on 4 in compromised ridge condition. And for
removable it can be hybrid prosthesis with 4 implants
and overdenture with 3 or 2 implants in place. Ideally
8112  Indian Journal of Forensic Medicine & Toxicology, October-December 2020, Vol. 14, No. 4
for overdenture when adequate interocclusalspace of 15 dentures not retained by implants—a multicentre
mm (class I6) is present then implants splinted by bar randomized clinical trial. British Journal of Oral
and held by clip is the treatment of choice8. As bar has and Maxillofacial Surgery. 1995;33(5):282-8.
proven to be a longterm successful treatment option for 2. Naert I, Gizani S, Vuylsteke M, Van Steenberghe
patients who require a high degree of retention and have D. A 5-year prospective randomized clinical trial
no undercuts9. Recent articles have shown that even if on the influence of splinted and unsplinted oral
bar attachments allow rotational movement, a higher implants retaining a mandibular overdenture:
load is transferred to the implants, as it is difficult to prosthetic aspects and patient satisfaction. Journal
anatomically place the implants in a position to get pure of oral rehabilitation. 1999;26(3):195-202.
rotational movement11. And bar and clip is an expensive
3. Zarb GA. Oral motor patterns and their relation to
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1982;47(5):472
The study on stress distribution between stud 4. Davis D. Role of implants in the treatment of
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attachment can be used with existing dentures and also 5. Naert I, Alsaadi G, van Steenberghe D, et al. A
it offers off-axis or angles nylon inserts to accommodate 10-year randomized clinical trial on the influence
non-ideal implant position12. So in this case three free- of splinted and unsplinted oral implants retaining
standing implants were placed in B,D,E position. Two mandibular overdentures: peri-implant outcome.
implants supported overdenture was avoided to restrict Int J Oral Maxillofac Implants. 2004;19:695–702.
the PM6 type movement, as the posterior residual ridge
6. Ahuja S, Cagna DR. Classification and management
was resorbed. And due to financial constrain the patient
of restorative space in edentulous implant
was not ready for a fixed implant bridge. Overdenture
overdenture patients. May 2011, the Journal of
patients have been studied to have a masticatory efficiency
prosthetic dentistry 105(5):332-7.
in chewing cycles similar to natural teeth13. And it
already a proven fact that in comparison to conventional 7. Krennmair G, Waldenberger O. Clinical analysis
overdenture the comfort and satisfaction of patients is of wide-diameter frialit-2 implants. Int J Oral
quite high14. So the success of mandibular overdenture Maxillofac Implants. 2004 Sep-Oct;19(5):710–715
is quite high even after 10 years of function14. 8. Van Kampen F, Cune M, van der Bilt A, Bosman
F. Retention and postinsertion maintenance of bar-
Conclusion clip, ball and magnet attachments in mandibular
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Treatment option will vary from individual patients
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but considering the anatomical condition and financial
2003;14:720–726
constrain the treatment options has to be devised to give
a predictable result. Implant-supported overdenture has 9. Naert I, Quirynen M, Hooghe M, Van Steenberghe
become a standard treatment option with edentulous D. A comparative prospective study of splinted
patients. As long term clinical studies have shown that and unsplinted Branemark implants in mandibular
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Conflict of Interests: None 10. Bergendal T, Engquist B. Implant-supported
Ethical Permission: Approved overdentures: a longitudinal prospective study. Int
J Oral Maxillofac Implants. 1998;13:253–262.
Funding: Nil 11. Petropoulos VC, Smith W, Kousvelari E.
Comparison of retention and release periods for
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 Indian Journal of Forensic Medicine & Toxicology, October-December 2020, Vol. 14, No. 4  8113
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