Magnetic Attachment Retained Complete Overdenture as Treatment for Maintaning Alveolar Ridge Height – A case report

Overdenture magnetic attachments are designed to treat patients experiencing complications from tooth loss due to aging, with issues like alveolar ridge resorption and reduced oral function. The novel Magteeth™ magnetic attachment system has undergone innovation compared to previous magnet attachment describing an improved efficiency in denture magnetic attraction. A 76-year-old female patient came to Department of Prosthodontic Clinic, Universitas Airlangga Dental Hospital to restore masticatory function and improve smile aesthetics. The clinical and radiographic evaluation revealed multiple missing teeth, specifically tooth numbers 18, 17, 15, 12, 11, 21, 22, 24, 26, 28, 37, 36, 35, 46, 47, and 48. Furthermore, there were chronic apical periodontitis, specifically gangrene radix, noted on teeth 16, 14, 13, 23, 27, 34, 38, and 44, and resorbed alveolar ridge on the missing tooth region. We use the Magteeth™ novel magnetic attachment in this case for the maxillary complete overdenture on tooth 25 to improve retention, and mandibular metal frame partial denture to ensure optimal function and patient satisfaction throughout the treatment process. Surface treatment on Magteeth™ root keeper and magnet is essential in denture and magnet integration. The novel Magteeth™ magnetic attachment is manage to overcome loss of retention problem during slight denture movements caused by chewing conventional attachments, which was the major disadvantage from the predecessor. Overall, the patient expresses satisfaction with the treatment in terms of both functionality and aesthetics.

Background: Overdenture is a partial or complete denture that has support from natural tooth roots that have been treated with endodontic treatment. Retain the remaining teeth prevent resorption of alveolar ridge. An overdenture with a magnetic attachment can be used to increase the retention of the denture. The magnets transfer the occlusal load to the bone through the periodontal ligament of retained roots that are attached with remaining root structure Objectives: This case report is aimed to report the step-by-step treatment of complete denture mandibula and complete overdenture maxilla with magnetic attachment retained design Case Report: A 62-year-old female visited the Prosthodontic Clinic of Dentistry Faculty, Airlangga University with a chief complaint of difficulty in eating. Clinical examination shown partial edentulous in the mandibula. The remaining teeth were 18, 14, 23, 25 and 43. Case management: After thorough observation from the clinical presentation and radiographic, magnetic attachment was planned on 14 in order to retain the remaining tooth and improving retention and stabilization of the maxillary denture. Conclusion: Magnetic maxilla overdenture is able to provide support, stability and retention.

Bone loss and teeth

Perte osseuse et dents

Recently, a newly developed magnetic attachment with stress breaker was used in retentive components in overdentures. Excessive lateral stress has a more harmful effect on natural teeth than axial stress, and the magnetic attachment with stress breaker is expected to reduce lateral forces on abutment teeth and protect it teeth from excessive stress. However, the properties of this retainer have not yet been determined experimentally. This study compares the lateral forces on abutment teeth for three retainers under loading on the denture base in a model study. A mandibular simulation model is constructed to measure lateral stress. Three types of retentive devices are attached to the canine root. These devices include the conventional root coping, the conventional magnetic attachment and the new magnetic attachment with stress breaker. For each retentive device, load is generated on the occlusal table of the model overdenture, and the lateral stress on the canine root and the displacement of the overdenture measured. The magnetic attachment with stress breaker does not displace the denture and exhibits lower lateral stress in the canine root than conventional root coping and magnetic attachments.

Lingualized occlusion is applied to patients with alveolar ridge resorption, and it is considered that this occlusion is functionally useful and should be applied to cases with alveolar ridge resorption. However, selection criteria supported by evidence for what conditions of the alveolar ridge lingualized occlusion should be selected do not exist. For that reason, we conducted an investigation on choosing lingualized occlusion. As a result, no differences were noted in subjects with a good alveolar ridge condition while a sufficient lingualized occlusion effect was obtained in subjects with a poor alveolar ridge condition, suggesting that efficient mastication could be attained. The following indexes were examined as the criteria for applying lingualized occlusion: The ratio of the residual alveolar ridge should be less than approximately 0.5, in which the distance between the inferior border of the mental foramen and the superior border of the mandibular bone should be less than half the distance between the inferior border of the mental foramen and the inferior border of the mandibular bone. The supporting area of the denture base should be less than approximately 2,000 mm(2). Though the effect can be expected when applying lingualized occlusion under these criteria, they are one standard, and cannot be applied in all cases. In clinical cases, it is important to grasp the local and the whole-body conditions of the patient in order to choose denture occlusion.

Alveolar ridge resorption after tooth extraction is a frequently observed phenomenon that may either decrease the predictability of dental implant placement or impair the final esthetic results.1,2 Better understanding of the biologic process behind extraction-socket healing has led to the development of techniques to preserve the natural architecture of the alveolus after extraction, such as immediate implant placement in fresh sockets and the use of osseous graft materials.3It is now known that resorption will especially target the buccal plate if the socket is not grafted immediately after dental extraction,3,4 thereby increasing the risk for facial soft tissue recession.4 Even when minimal, such resorption usually has significant adverse clinical effects, particularly in the esthetic zone. Despite successful osseointegration of a dental implant, an anterior implant restoration may be judged to be a failure if the soft tissue appearance is poor.5–8 Surgical techniques meant to preserve natural bone and soft tissue contours after tooth extraction are thus of great interest to contemporary clinicians, especially true if an implant is placed and provisionalized immediately after tooth extraction.Numerous studies have focused on immediate functional loading of dental implants to minimize the delay between the surgical and prosthetic treatment phases.9,10 This technique is increasingly being applied when replacing teeth in the maxillary anterior region, where esthetic outcomes are important.11–17 However, some studies12,15,16 have reported that recession of the marginal peri-implant mucosa may occur after immediate implant placement. This recession, in turn, may adversely affect the final esthetic outcome.Factors that have been reported to influence the frequency and extent of marginal mucosal recession include the tissue biotype,17 the condition and thickness of the facial bone,18 and the orofacial position of the implant shoulder.19,20 Connecting a provisional crown immediately after implant insertion8,21 and grafting of the facial peri-implant marginal defect with bone or bone substitutes21–23 also have been cited as factors. In addition to these parameters, an experimental study24 showed that the facial socket wall, which is composed almost entirely of bundle bone, may be susceptible to resorption in the vertical and horizontal planes. Such crestal bone resorption may lead to recession of the facial marginal mucosa.Any alteration of the soft or hard tissues may impair the final esthetic outcome of immediately loaded implants in the anterior area. To better preserve the alveolar ridge and maintain optimal soft tissue contours, we previously introduced a novel buccal plate preservation (BPP) technique.25,26This simple surgical technique may help to prevent recession of the facial wall of the extraction socket without interfering with the healing process. It involves placement of particulate bone-graft material underneath the soft tissues in a surgically created pouch adjoining the buccal plate. It thus maintains optimal soft tissue contours and predictably provides a solid base for optimal esthetics and functional replacement of a missing tooth. Although we originally used this technique in the wake of tooth extraction when a delayed implant placement was planned, it also can be used effectively in conjunction with immediate implant placement and provisionalization, as the following case report illustrates.The 66-year-old male patient was referred by his dentist for extraction of a left central incisor whose root had fractured (Figures 1 and 2). The treatment plan included rehabilitation with an implant-supported restoration with immediate placement after extraction and immediate provisionalization. The patient's past medical and social history were noncontributory, and he had good oral hygiene.The incisor was extracted atraumatically in 2 pieces. The socket was thoroughly debrided to remove residual granulation tissue (Figure 3). A straight periosteal elevator was used to carefully perform limited soft tissue dissection in a full-thickness manner, creating a pouch on the vestibular aspect of the middle of the socket facial to the buccal plate (Figure 4). This dissection started coronally, at the marginal bony ridge of the extraction socket, and slowly proceeded in the apical direction, using small mesiodistal movements. Extreme care was paid to avoid tearing the soft tissue. Once the dissection had advanced beyond the mucogingival line to approximately two-thirds the depth of the socket, a curved periosteal elevator was used to expand the pouch in the mesiodistal direction. The goal was to stretch the soft tissues away from the underlying bony plate (Figure 5), and no attempts were made to decorticate the buccal plate.Granules (500-1000 μm) of bovine sintered xenograft (Endobon Xenograft Granules, BIOMET 3i, Palm Beach Gardens, Fla) were rehydrated with saline and placed in the pouch using a syringe. The bone-graft material was then compressed with a small surgical curette, and more graft material was added and compressed until adequate filling of the pouch was achieved without overstretching the soft tissues. The quantity used was approximately 0.1 cm3 and normally is <0.2 cm3, regardless the size of the tooth. Care was taken to avoid the migration of the graft material too far apically, where the mucosa is more flexible and thin, although should migration occur, the graft material can be repositioned using manual pressure. The final appearance of the soft tissue should exaggerate the appearance of the root eminence of the tooth before extraction. This is done to counteract some dispersion and exfoliation of the graft (Figure 6).A 13 mm length × 4-mm-diameter tapered implant (BIOMET 3i, Palm Beach Gardens) was then placed according to the manufacturer's protocol, engaging the native bone above the alveolus, slightly palatal from the buccal plate (Figure 7). Additional xenograft material was placed in the gap between the buccal bone and the implant surface. After the completion of the surgical procedure, the position of the implant was transferred to a model with an impression pick-up that was connected to the surgical stent with self-curing resin. A healing abutment was then screwed to the implant, and the patient was dismissed with instructions to consume only a liquid diet and return in the afternoon for delivering of the provisional.A custom abutment and resin crown were fabricated immediately and delivered to the patient (Figure 8) a few hours after the surgical procedure. No sutures were required, and no attempt was made to coronally reposition the flap. The patient was maintained on the liquid diet for the next 2 wk. Chlorhexidine gluconate oral rinse also was prescribed for 2 wk to enhance plaque control. After 3 months, the final restoration was delivered (Figures 9 and 10).The appearance and the contours of the ridge were well maintained, after extraction. A convexity on the buccal aspect of the extraction area, giving an illusion of root eminence, was achieved, laying the ground for a good functional and esthetic replacement of the missing tooth with an implant-supported prosthesis.Extraction sockets are self-healing defects. In a relatively short time, the void left by the root of the extracted tooth is filled by new bone.1 As this biophysiologic phenomenon occurs, however, the architecture of the edentulous ridge may change adversely due to buccal bone resorption. Such changes may jeopardize implant placement or lead to an unfavorable esthetic final result.2 Although the degree of bone loss is neither certain nor constant, varying among individuals and anatomic situations, most alveolar width and height resorption occurs in the first 6 months after extraction.2When clinicians face situations where immediate implant placement is not indicated, two options have existed: (1) allow the socket to heal naturally without grafting or (2) graft the socket. Natural healing without grafting increases the risk of hard tissue loss, soft tissue loss, or both, especially on the buccal plate due to resorption. Grafting the socket requires a longer healing time before implant placement.We have developed a third option, namely, grafting not inside the socket but externally to the buccal plate in a surgically created pouch.25,26 This technique can only be applied when the natural architecture is intact and the buccal plate is present. In a 4-wall intact socket, this approach is aimed at optimizing the ability of the bone graft to improve regeneration and maintain or improve labial and buccal contours without interfering with the natural healing capability of the alveolus after extraction. The rationale behind it is that slowly resorbing or nonresorbing particles of bovine xenograft get incorporated in the soft tissues, thereby preventing recession and enhancing the soft tissue appearance of the edentulous ridge.Bovine xenograft has been shown to have a very low resorption rate in many different sites. This tendency may be regarded as less than ideal in potential implant-placement sites, but according to several studies, once incorporated in bone, the particles may help prevent resorption of the newly regenerated area in the long term.27,28 It also has been shown that in the esthetic area, regenerating the facial aspect of the buccal plate with a nonresorbable membrane and bovine xenograft may prevent bone remodeling from taking place at the head of the implant and causing soft tissue recession and other esthetic complications.18,29 The latter approach consists of a full guided bone regeneration procedure aiming to overbuild the bone around the neck of the implant and thus prevent bone resorption. This procedure is requiring the membrane removal and a later stage.The possibility of immediately connecting a provisional restoration to implants placed into fresh extraction sites has been extensively investigated.30–37 Some case reports have found a 100% 12-month survival rate for immediate, nonfunctional restorations of single-tooth postextraction implants.30–32 Favorable peri-implant tissue responses also have been reported around such implants, along with results that were clinically and radiographically comparable to those achieved after a conventional delayed protocol. Several uncontrolled prospective studies also have investigated the immediate functional loading of postextraction implants in edentulous mandibles33–35 or in partially edentulous sites.34Connecting a provisional crown immediately after implant insertion8,21 has been reported among the many factors that can influence the frequency and extent of marginal mucosal recession. In addition to these factors, an experimental study24 showed that the facial socket wall, which is composed almost entirely of bundle bone, may be susceptible to resorption in the vertical and horizontal planes. Such crestal bone resorption may lead to recession of the facial marginal mucosa. Any alteration of the soft or hard tissues may impair the final esthetic outcome of immediately loaded anterior implants.In 4-wall extraction sockets, the buccal plate preservation technique described in this article may help to maintain or improve the appearance and contours of the ridge after tooth extraction, laying the ground for a good functional and esthetic replacement of the missing tooth with an implant-supported prosthesis. The procedure also can enhance the soft tissue appearance when implant placement and loading are indicated immediately after tooth extraction. Although the preliminary results of using this technique are promising, further investigation is warranted to confirm its efficacy; understand the biology underlying it; and identify factors that may influence it, such as the thickness of buccal plate after extraction, presence of contiguous teeth, type of bone graft with or without membrane, and position of the implant.

When tooth is extracted because of deep caries, severe periodontal disease, trauma etc., alveolar ridge resorption happen inevitably. Alveolar ridge resorption after tooth extraction makes implant placement difficult. To overcome these alveolar bone deficiencies, additional procedures such as GBR, Block bone graft, Ridge splitting or Distraction osteogenesis is needed. In case of severe horizontal bone loss (Seibert classification, Class I), implant placement is usually done with Block bone graft or GBR procedure. Unlike these two procedures, the ridge splitting converts non-contained defect to contained defect that are favorable to be healed. Also ridge splitting have advantages such as the maintenance of buccal plate and rapid healing by the strong local metabolism. In these two cases, it is ascertained that implant placement with ridge splitting procedure is effective in the severely atrophied alveolar ridge.

Magnets have been used widely in the field of dentistry for many years with some success, as they can be manufactured in small dimensions as retentive devices in overdenture technique, maxillofacial prosthesis, and obturators. These magnets are attached with remaining root structure or osseointegrated implants which transfer the occlusal load to the bone through the periodontal ligament of the retained roots, thereby prevent resorption of remaining alveolar bone proper and inter-radicular bone present around the roots. In this article, the use of magnetic assembly in fabrication of mandibular overdenture on retained roots and a conventional maxillary removable partial denture is discussed. Magnetic assembly consists of magnet and coping with a keeper on the remaining tooth structure since magnetic attachments can provide support, stability, and retention.Clinical Relevance to Interdisciplinary DentistryThe present article demonstrates the rehabilitation of partially edentulous patient with the help of magnetic assembly mandibular overdenture and maxillary conventional removable partial denture. Clinical presentation showed few remaining teeth in relation to the mandibular ridge. A multidisciplinary approach was adopted to retain the remaining teeth in the mandibular arch with the help of endodontic treatment (root canal treatment) followed by prosthetic rehabilitation.

There are numerous factors that can impact both the correction of jaw deficiencies and the success of a particular grafting material, including the histology and density of both the maxillary and mandibular bones and the grafting material itself. This study compares the clinical outcomes of grafted augmentations of the horizontal alveolar ridge of the anterior maxilla using mandibular symphysis onlay bone that was admixed with either injectable platelet-rich fibrin (i-PRF) or xenografts. Twelve adult patients with horizontal maxillary alveolar ridge deficiency were randomly divided into two groups of six patients each. Group I received mandibular symphysis onlay bone grafts mixed with i-PRF, while Group II received mandibular symphysis onlay bone grafts admixed with xenografts (InterOss anorganic cancellous granules). CBCT scans were used to measure alveolar ridge width and bone density both preoperatively and at 6-month follow-up. Both groups showed improvements in alveolar ridge width and bone density. The increase in measured bone width and density after 6 months in Group II was significantly greater than that in Group I (p = 0.040). Horizontal alveolar ridge augmentation using an onlay chin graft in combination with xenografts was successful and offered adequate bone quantity and quality.

Background: In dental prosthetics many advances have been achieved, but the great problem is still having with us: that is the resorption of the residual alveolar ridge and managing or preventing the secondary soft tissue changes brought on by bone loss. Objective: To evaluate the rate of resorption of alveolar ridge height of maxillary anterior arch in patients treated with immediate partial denture. Materials and Methods: This observational comparative study was conducted in the Department of Prosthodontics, Bangabandhu Sheikh Mujib Medical University for the duration of one year. On the basis of inclusion criteria patients were initially included in the study. A written informed consent was obtained from every patient. Study sample divided equally into two groups, Group A and Group B. Each group consists of 15 patients. Group A patients were treated with extraction of teeth followed by immediate denture prosthesis and group B patients were treated with extraction of teeth, but not provided by any prosthesis. Data were collected on the basis of alveolar bone resorption in the period of 1 month, 3 months and 6 months of extraction on a predesigned data collection sheet. Results: Mean vertical height at one month follow up was 25.48 (±2.41) mm in group A and 23.43 (±2.85) mm in group B which was statistically significant. Mean vertical height at three month follow up was 23 (±1.33) mm in group A and 22 (±2.99) mm in group B which was statistically significant. Mean vertical height of alveolar bone at six month follow up was 22.5 (±2.71) mm in group A and 21.5 (±3.18) mm in group B which was also statistically significant. Conclusion: Patient treated with immediate partial denture following extraction of teeth shows less alveolar bone resorption than patients treated without immediate partial denture.

Magnets have been used widely in the field of dentistry for many years with some success, as they can be manufactured in small dimensions as a retentive devices in overdenture technique, maxillofacial prosthesis and obturators. These magnet attachment attached to osseointegrated implants which transfer the occlusal load to the bone, thereby prevent resorption of remaining alveolar bone and improves the retention and stability of the denture. Magnetic assembly consist of magnet and ferromagnetic metal keeper. More recently, magnets have been made from alloys of the rare earth elements samarium and neodymium, which provides stronger magnetic force per unit size. Magnets are sealed by means of the latest laser lasing techniques thus protect magnet from corrosion in oral cavity. The present article demonstrates the rehabilitation of completely edentulous patient with the help of implant supported mandibular overdenture with magnet attachment and conventional maxillary denture.

Tooth extraction triggers alveolar ridge resorption, and when this resorption is extensive, it can complicate subsequent reconstructive procedures that use dental implants. Clinical data demonstrate that the most significant dimensional changes in the ridge occur soon after tooth extraction. Here, we sought to understand whether a correlation existed between the rate at which an extraction socket heals and the extent of alveolar ridge resorption. Maxillary molars were extracted from young and osteoporotic rodents, and quantitative micro–computed tomographic imaging, histology, and immunohistochemistry were used to simultaneously follow socket repair and alveolar ridge resorption. Extraction sockets rapidly filled with new bone via the proliferation and differentiation of Wnt-responsive osteoprogenitor cells and their progeny. At the same time that new bone was being deposited in the socket, tartrate-resistant acid phosphatase–expressing osteoclasts were resorbing the ridge. Significantly faster socket repair in young animals was associated with significantly more Wnt-responsive osteoprogenitor cells and their progeny as compared with osteoporotic animals. Delivery of WNT3A to the extraction sockets of osteoporotic animals restored the number of Wnt-responsive cells and their progeny back to levels seen in young healthy animals and accelerated socket repair in osteoporotic animals back to rates seen in the young. In cases where the extraction socket was treated with WNT3A, alveolar ridge resorption was significantly reduced. These data demonstrate a causal link between enhancing socket repair via WNT3A and preserving alveolar ridge dimensions following tooth extraction.

Background: Edentulousness resulting from extraction of teeth often leads to psychological problem and social isolation of the patient. The patient has to adapt to the situation with respect to speech, chewing, swallowing, and so forth. A smooth transition from dentulousness to edentulousness is the result of immediate over denture with a few retained teeth. Purpose: to report overdenture prevents alveolar ridge bone absorption, stabilizes a denture, and makes the typical sensory function to be looked closer to natural teeth. Case: A 79-year-old female complaint of missing multiple teeth and desire to replace them. Extraoral examination and temporomandibular joint movement were normal. Five teeth (12,11,21,22,34) exhibited grade II mobility with diagnosis apical chronic periodontitis. Radiographic examination is an overview of diffuse radiolucent on the apical on the teeth 17,13,12,11,21,22,34. Case Management: First, make a diagnostic impressions of the maxillary and mandibular with irreversible hydrocolloid then poured in dental stone. After that, the final impressions were taken and poured in dental stone, casts mounted on articulators. Bite registration was done after using bite rim and bite registration material. The next step is setting up the artificial teeth then tried to the patient. Five teeth (12,11,21,22,34) were trimmed from the casts on the functional model. The patients tooth 12, 11, 21,22 and 34 were reduced to a dome shape only 2 mm above gingival margin then restored with GIC on the surface. The denture was then placed immediately after reduced. Discussion: The selected abutments teeth were reduced to a dome shape only 2 mm above gingival margin. This will create adequate space for the overlying artificial denture tooth and denture base. Also, it reduces the lateral stresses and lever action of the tooth. The retained tooth roots, used for overdenture, transfers occlusal forces to the alveolar bone through the periodontal ligament and maintain alveolar ridge morphology. Conclusion: Overdenture can be used to prevents alveolar ridge bone absorption, stabilizes a denture, and makes the typical sensory function to be looked closer to natural teeth.

To evaluate the effect of hyperlipidemia on the healing of bone defects. Apolipoprotein E (ApoE)-deficient mice and wild-type (WT) C57BL/6J mice were fed with an atherogenic high-fat diet (HFD) or a standard chow diet (as control) for 6 weeks. Blood samples were collected to evaluate serum lipid levels. Closed bone defects and open tooth extraction wounds were then created in the mandibles of these animals. One or two weeks after surgery, animals were euthanized. Micro-CT analysis and histomorphometric analysis were conducted to evaluate the healing of bone defects and the alveolar ridge resorption. Bone regeneration of closed bone defects was considerably delayed in the hyperlipidemic Apoe-/- mice and WT mice. No obvious difference was detected in the new bone formation of the tooth extraction wounds. The HFD-fed mice showed more prominent reduction in the lingual alveolar ridge height of the tooth extraction wounds when compared with the control group. Hyperlipidemia results in delayed bone regeneration in large closed bone defects. Although tooth extraction wounds are small and normally regenerated in a hyperlipidemic microenvironment, the prominent reduction in the alveolar ridge height is also a challenge for future restoration of the dentition.