Implant-supported Removable Partial Denture Research Articles

A case of implant-supported removable partial denture in a patient with mandibular unilateral residual tooth

A case of implant-supported removable partial denture in a patient with mandibular unilateral residual tooth

Implant-Supported Removable Partial Denture: An Approach to Rehabilitate Maxillary Kennedy Class I

Patients with maxillary Kennedy Class I are frequent visitors to the dental office, the missing of posterior teeth makes the control of the movement of removable partial dentures difficult due to the axis of rotation and the different resiliencies between the supporting structures. The use of implants in association to the conventional metal frame denture provides favorable long-term stability and retention, good clinical outcomes in terms of occurrence of complications and maintenance. In this clinical case, a patient with a maxillary Kennedy Class I was rehabilitated using a 3 implants to support metallic removable partial denture. A three dimensional (3D) surgical guide was used for the well-placement of the strategic implants and ball attachments were tightened as connectors between implant and denture. The patient was satisfied after 4-years of follow-up and reported good occlusal stability, esthetic and functional satisfaction.

Stress Analysis of Implant-Supported Removable Partial Denture with Anterior Fixed Prostheses and Conventional Implant-Supported Overdentures in the Edentulous Mandible

Aim: To compare new design implant-supported removable partial dentures retained with anterior fixed prosthesis with a conventional locater and bar attached implant overdenture prostheses retained by two or four implants via photoelastic stress analysis. Materials and Methods: Seven edentulous mandibuler acryclic models prepared and divided into two main groups; two to four implant models, subgroup separation as stated; for two implant models overdenture with locator attachment, crown design retained removable prosthesis with clasp retention, bridge design retained removable prosthesis with clasp retention, bridge design retained removable prosthesis with precision attachment retention; and for four implant models prosthesis with bar attachment overdenture, fixed bridge design retained removable prosthesis with clasp retention, fixed retained removable prosthesis with precision attachment retention. A 300 N load was applied to the first premolars. Photoelastic stress analysis method that is a specific method concerning stress visualization, and does not require statistical analysis, was used. The stress distributions were seen in optically using a poloriscope. Results: In the models with two implant-retained removable partial dentures, the stress distribution was found to be lower than that with the four implant-retained removable partial dentures. Nonsplinted implants caused high stress around the distal implant on the loading side. Conclusion: The stress loads were transmitted to other implants by splinting. Implant-supported removable partial dentures with an anterior fixed prosthetic design show lower stress distributions compared with bar retained prosthesis. These dentures appear to be advantageous in terms of stress transmission.

In Vitro Assessment of the Effect of Implant Position on Biomechanical Behaviors of Implant-Supported Removable Partial Dentures in Kennedy Class II Condition.

The purpose of this study was to investigate the effects of implant position and loading position on biomechanical behaviors using implant-supported removable partial denture (ISRPD) models in a simulated Kennedy class Ⅱ partially edentulous mandible. Three types of Kennedy class Ⅱ mandibular acrylic resin models (a conventional RPD without support by an implant—CRPD; models with an implant placed at first molar (#46)—MP-ISRPD— and second molar (#47)—DP-ISRPD) were used to measure vertical displacement of the RPD, mesio-distal displacement of the abutment tooth, and bending moment of the abutment tooth and implant under one-point loading. The variables at three respective loading points (#45, #46 and #47) were compared statistically. Vertical displacement was suppressed in ISRPDs compared to the CRPD, and significant effects were identified under loading at the implant position. The largest meiso-distal displacement was observed in MP-ISRPD under #47 loading. Bending moments of the abutment tooth and implant were significantly higher in MP-ISRPD than in DP-ISPRD. In MP-ISRPD, a higher bending moment of the abutment tooth under #45 and #47 loading was detected, although the bending moment in DP-ISRPD was almost zero. The results of this study suggested that MP-ISRPD shows the specific biomechanical behaviors, although DP-ISRPD might provide biomechanical benefits under all one-point loading conditions.

The biological and Mechanical Behavior of the Standard Implant under Removable Partial Dentures: Systematic Review

Background: The implant-supported removable partial denture appears to be an interesting alternative for cases where the implant-supported fixed prosthesis is contraindicated whether it is for medical, local, or financial reasons. The objective of this systematic review is to evaluate the biological and mechanical behavior of the implant under a removable partial denture.Methods: A literature search was conducted on the following databases: Pubmed [Medline], Science Direct, and Cochrane Library. Research was limited to publications in English and French during the period from 01/1/2007 to 27/03/2020.Results: Of the 334 citations initially identified, 22 articles met our inclusion criteria, assessing the implant survival rate, patient satisfaction, and the occurrence of implant and prosthetic complications. As well as the evaluation of the stress distribution on the three support surfaces of this prosthesis. Finally, the evaluation of implant localization. The results showed a high rate of implant survival, the occurrence of some prosthetic complications. Stable and acceptable bone resorption over the long term. Better stress distribution at the implant and the bone.Conclusion: The biological and mechanical behavior of the implant under this type of prosthesis appears to be viable in the short, medium, and long term. Although this association between implantology and partial prosthesis seems promising, additional studies are needed to spread this practice still reserved for some specific cases.

An implant-supported removable partial denture: A viable option to rehabilitate partially edentulous geriatric patients

Esthetics, phonetics mastication, and preservation of remaining alveolar bone are the goals of a prosthodontist while rehabilitating a patient with removable partial dentures (RPDs). Dental implants provide better retention, stability, and esthetics for partial dentures when compared to conventional tooth and tissue-supported partial dentures. They are predictable, meet the patient's expectations, and improve quality of life. Over the decades, there have been tremendous advancements in implant dentistry. This clinical report presents a case where the patient was rehabilitated with implant-supported RPDs in both maxillary and mandibular arches.

Dental Rehabilitation for Free Fibula Flap-Reconstructed Mandible with Scar Contracture: A Technical Note

Dental rehabilitation with osseointegrated implants in reconstructed mandibles is a common procedure, but the technique still requires improvement, especially in its reliability and technical simplification. We herein report dental rehabilitation of a free fibula-reconstructed mandible with scar contracture. A vestibuloplasty technique with application of a polyglycolic acid (PGA) sheet is described. The implants were inserted into a viable fibula flap with severe scar contracture of the overlying epithelium resulting from vascular instability in skin paddle. Only the fibula periosteum was sutured after implant insertion; exposed surfaces were covered with a combination of PGA sheet and fibrin sealant. The area with PGA sheet coverage gradually healed with moderate contracture. The epithelium around the almost implants became immobilized. The implant-supported removable partial denture with custom titanium bar was acceptable. Dental rehabilitation is possible for reconstructed mandibles with severe scar contracture. Application of a PGA sheet may be useful for vestibuloplasty in patients with reconstructed mandibles.

Hora est 10. Implantaat ondersteunde frame­prothesen in een Kennedy klasse I-situatie in de onderkaak

Implant-supported removable partial dentures in the mandible often cause problems, which means that patients wear their dentures seldom if at all. A solution is to place implants that the dentures can be snapped onto. There is, however, no consensus about the best position of the implants in the mandible yet. In addition, it is worthwhile to balance the cost of treatment with its effectiveness. In a randomised cross-over clinical trial involving 30 patients with a shortened dental arch, the implant-supported removable partial denture in the mandible was evaluated based on the experience of the patient, mean time of wearing, chewing ability and the clinical and radiographic parameters in relation to 2 different implant positions: 2 in the pre-molar region or 2 in the molar region. The cost-effectiveness of both treatments was also evaluated. From the patient's point of view, the implant-supported removable partial dentures are best supported by implants placed in the molar region. The research also revealed, however, that significantly more bleeding occurred around implants placed in the molar region and from a clinical perspective placement in the pre-molar region would have preference. The cost-effectiveness of the treatment with an implant-supported removable partial denture depends on the choice of outcome measurement and monetary threshold.

Three-dimensional finite element analysis of implant-assisted removable partial dentures

Statement of problemWhether the implant abutment in implant-assisted removable partial dentures (IARPDs) functions as a natural removable partial denture (RPD) tooth abutment is unknown. PurposeThe purpose of this 3-dimensional finite element study was to analyze the biomechanical behavior of implant crown, bone, RPD, and IARPD. Material and methodsFinite element models of the partial maxilla, teeth, and prostheses were generated on the basis of a patient’s computed tomographic data. The teeth, surveyed crowns, and RPDs were created in the model. With the generated components, four 3-dimensional finite element models of the partial maxilla were constructed: tooth-supported RPD (TB), implant-supported RPD (IB), tooth-tissue-supported RPD (TT), and implant-tissue-supported RPD (IT) models. Oblique loading of 300 N was applied on the crowns and denture teeth. The von Mises stress and displacement of the denture abutment tooth and implant system were identified. ResultsThe highest von Mises stress values of both IARPDs occurred on the implants, while those of both natural tooth RPDs occurred on the frameworks of the RPDs. The highest von Mises stress of model IT was about twice that of model IB, while the value of model TT was similar to that of model TB. The maximum displacement was greater in models TB and TT than in models IB and IT. Among the 4 models, the highest maximum displacement value was observed in the model TT and the lowest value was in the model IB. ConclusionsFinite element analysis revealed that the stress distribution pattern of the IARPDs was different from that of the natural tooth RPDs and the stress distribution of implant-supported RPD was different from that of implant-tissue-supported RPD. When implants are used for RPD abutments, more consideration concerning the RPD design and the number or location of the implant is necessary.

Distal extension mandibular removable partial denture with implant support

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.

Load distribution on abutment tooth, implant and residual ridge with distal-extension implant-supported removable partial denture

PurposeThe aim of this study was to evaluate the effect of implant location on load distribution in the abutment tooth, implant and residual ridge with a distal-extension implant-supported removable partial denture (ISRPD). MethodsA mandibular unilateral distal-extension edentulous simulation model was used. Implants were inserted at the second premolar (mesial implant) and second molar (distal implant) positions in the edentulous area. An experimental ISRPD was fabricated of acrylic resin with a cobalt-chromium alloy framework. Loads on the implants and abutment tooth were measured with piezoelectric force transducers. The load on the residual ridge was measured with pressure-sensitive film. A vertical load of 100N was applied at the first molar region. Measurements were made under the following three conditions: with conventional removable partial denture (CRPD), with mesial-implant-supported removable partial denture (MISRPD), and with distal-implant-supported removable partial denture (DISRPD). In each condition, the unused implants were made inactive by eliminating contact with the inner surface of the denture. ResultsThe load on the abutment tooth was greatest with DISRPD, followed by CRPD and MISRPD (P<0.01). The load on the implant was greater with DISRPD than with MISRPD (P<0.01). The load on the residual ridge was lowest with DISRPD, followed by MISRPD and CRPD (P<0.01). ConclusionsThis experimental study provided quantitative data regarding the effect of implant location on load distribution with ISRPDs. Further investigation regarding the effect of denture design on the load distribution is needed for determining the proper implant location of ISRPD.

Prosthetic rehabilitation of marginal mandibulectomized patient using implant-supported removable partial denture

Surgical management of oral cancer results in compromised masticatory and swallowing function which affects patient in social and psychological aspects due to reduced phonetic ability and facial deformity, thus, it is imperative to provide applicable prosthetic treatment to overcome such complications. This clinical study describes rehabilitation of a patient with squamous cell carcinoma treated with marginal mandibulectomy and implantation on preserved posterior portion of mandible to provide stability and support for subsequent denture treatment. Kennedy class IV removable partial denture has provided satisfactory results in esthetics and function. Bone level stability around implants was reported to be maintained during eight months of clinical observation. (J Korean Acad Prosthodont 2016;54:126-31)

Implant-Supported Removable Partial Denture Improves the Quality of Life of Patients with Extreme Tooth Loss.

This study aimed to evaluate oral health-related quality of life (OHRQoL) in partially dentate subjects, presenting extreme tooth loss in posterior region with missing post-canines, comparing the use of conventional removable partial dentures (RPDs) and implant-supported RPDs. OHRQoL was measured using the Brazilian version of the Oral Health Impact Profile. Twelve subjects presenting maxillary total and mandibular Kennedy Class I edentulism (mean age 62.6±7.8 years) first received complete maxillary dentures and conventional mandibular free-end RPDs. After two months, the subjects had their OHRQoL assessed. Osseointegrated implants were inserted bilaterally in the mandibular first molar regions, and after four months ball abutments were placed to support the free-end RPD. Two months later, the patients had their OHRQoL reassessed. Wilcoxon signed-rank test was used to evaluate differences in OHRQoL (α=0.05). Results showed improvement in all OHIP-49 domains (p<0.05) after associating implants to the RPD. The mandibular implant-supported free-end RPD significantly improved OHRQoL.

Prosthetic recovery utilizing residual dental implants: A case report involving a unilateral milled-bar-magnet attachment combination

Few options for functional recovery using residual dental implants are available after removal of disintegrated implants. This report describes the application of a maxillary implant-supported removable partial denture (RPD) retained by a unilateral milled-bar-magnetic attachment combination fixed to the remaining two implants as an alternative for functional recovery without surgery. A custom milled-bar with keepers was fixed to the two remaining unparallel unilateral implants in a 78-year-old woman who visited our department after dental implant treatment. Although 2 of the 4 initial implants were lost, additional surgery was unfeasible; thus, a magnetic RPD with a clasp on the ipsilateral second molar was placed. Peri-implant infection and bone resorption did not occur in the 4 years after implant-supported RPD placement. In the present case, a custom milled-bar-magnetic attachment and a clasp combination have been effective for retaining an implant-supported RPD even with an inadequate unilateral design.

다수의 임플란트발거로 임플란트 고정성 보철이 실패한 환자에서의 잔존 임플란트를 이용한 부분 가철성 국소의치 수복증례

부분 무치악을 수복하는 데 있어서 선택할 수 있는 치료의 옵션으로는 전통적인 국소의치와 임플란트 지지-고정성 보철물 등이 있다. 하지만, 환자의 전신적 또는 구강의 상태(수술적인 술식이 제한되는 전신병력, 지지조직의 부족 그리고 골유착에 실패한 임플란트)와 치료비용에 대한 허용 정도에 따라 모든 옵션이 항상 가능한 것은 아니다. 가철성 국소의치는 임플란트 고정성 보철물에 비해 구강위생 관리 및 상,하악 악간관계의 부조화를 수정하기에 편리한 장점이 있다. 최근에는 전략적 위치에 임플란트를 식립하여 기존 악궁 형태에서는 제한되는 국소의치 디자인의 한계를 개선할 수 있는 임플란트지지형 RPD(Implant Supported Removable Partial Denture)가 새로운 방안으로 대두되고 있다. ISRPD는 전략적 위치에 임플란트를 식립하여 역학적인 한계를 극복할 수 있을 뿐 만 아니라 전악의 임플란트지지형 고정성 보철이 제한되는 환자에서 보다 경제적이고 현실적인 보철적 해결책이 될 수 있다. 따라서, RPD를 이용한 보철계획 수립시 전략적 위치에서의 임플란트의 사용은 고전적인 가철성 국소 의치에서보다 유지력과 안정성을 증진시키고 구강위생관리 또한 용이하여 환자의 적응도를 높이는 방안으로 고려될 수 있다. 본 증례는 상악 양측 구치부의 임플란트 고정성 보철,하악의 bar-type overdenture를 사용중이던 59세 남성환자에서 상악 #15i임플란트의 abutment screw fracture와 임플란트의 골유착 실패로 인한 다수 임플란트를 발거 후 남은 #15i,24i,25,26,i의 잔존 임플란트와 #23 자연치를 활용해 상악에 ISRPD를 적용한 경우이다. #23 surveyed crown, #24i=25i=26i surveyed bridge 및 #15i에 gold coping을 제작하여 국소의치의 지지와 유지,안정을 도모하였다.최종 보철물을 장착하고 2년간 주기적인 follow up 통해 예후를 관찰중이며 지대치로 사용한 임플란트에서 screw loosening이나 파절, 골흡수 등의 증상은 현재까지 관찰되지 않았다. There are several treatment options for rehabilitation of partial edentulism including the use of conventional or implant-retained fixed prostheses. However, such prosthetic options cannot always be possible because of compromised general and oral health (i.e. loss of supporting tissues, medical reasons, extensive surgical protocol and osseointegration failure of dental implant) as well as the affordability of patients. In some cases, removable partial denture provides easier access for oral hygiene procedures and the ability to correct discrepancies in dental arch relationships than implant fixed prosthesis. Recently, Implant Supported Removable Partial Denture (ISRPD) where to place dental implant in strategic position has been suggested to improve the limitation and shortcomings of conventional RPD. ISPRD can overcome mechanical limition of conventional RPD by placing implant in a favorable position and can be cost-effective, prosthetic solution for partially edentulous patients who are not immediate candidates for extensive, fixed implant supported restorations. Incorporation of dental implants to improve the RPD support and retention and to enhance patient acceptance should be considered when treatment planning for RPD. In this case, 59 years old male patient who received dental treatment of implant fixed prosthesis on both side of the upper jaw and implant overdenture on lower jaw showed implant abutment screw fracture on #15i and osseointegration failure on multiple number of implants. After removing failed implants, we planned ISRPD using #15i,24i,25i,26i and #23 natural tooth for RPD abutment. We fabricated #23 surveyed crown,#24i=25i=26i surveyed bridge and #15i gold coping for support,retention and stability for RPD. Periodic follow up check for 2years has been performed since the ISRPD delivery to the patient. No sign of screw loosening, fracture or bone resorption around abutment implants were detected.

Restoration of a partially edentulous patient with an implant-supported removable partial denture: a case report.

The aim of this report is to present and discuss the clinical procedure of an implant-supported removable partial denture for a partially edentulous patient who exhibited a severely resorbed ridge and a collapsed vertical stop. The 67-year-old partially edentulous patient presented with a lack of vertical stop and an advanced transverse arch discrepancy. For the maxilla, an implant-supported removable partial denture was fabricated on bilateral distal implant abutments. The mandibular arch was restored with an implant-supported fixed partial denture, since it was expected to function more properly than a removable partial denture. This clinical report demonstrates a successful treatment approach to restore oral function and appearance for the patient.

インプラント支持可撤性ブリッジの適用による下顎部分欠損症例の補綴治療

インプラント支持可撤性ブリッジの適用による下顎部分欠損症例の補綴治療

Clinical application of stress-breaking ball attachment for implant overdenture

PatientThe patient was a 62-year-old partially edentulous woman with missing bilateral premolars and molars in the mandibular jaw. The patient selected implant supported-removable partial denture rehabilitation. Implants were placed bilaterally at the distal extension of the denture base in order to minimize denture displacement. The stress-breaking ball (SBB) attachment consists of a flat-top ball head male and O-ring rubber female. The female was covered by a silicone housing with three amounts of space to allow three kinds of settlement (0.3mm, 0.5mm, and 0.7mm); they were selected by thickness or pressure displacement of the mucosa and occlusal force. After the healing period, the SBB attachments (0.3mm) were placed on the implants, and the implant-supported removable partial denture was then conventionally fabricated. The delivered denture had sufficient retention and appropriate stress breaking. DiscussionThe advantages of SBB attachments over conventional attachments are as follows: (1) they prevent the implant from excessive occlusal force, (2) they are ready-made, (3) they show appropriate retention, and (4) they can be easily mounted on the denture base. The disadvantages of these attachments are as follows: (1) they are approximately 1mm higher than conventional ball attachments and (2) the retentive force cannot be adjusted. ConclusionThe use of a stress-breaking attachment for implant overdenture rehabilitation should be considered so that the occlusal force is equally distributed between the alveolar ridge and the implants.

Mandibular implant‐supported removable partial denture with distal extension: a systematic review

The aim of this article is to investigate patient satisfaction, survival rate of implants, and prosthetic complications or maintenance for rehabilitation with removable partial dentures associated with implants in mandibular Kennedy class I and II cases. A systematic literature review was conducted by three independent reviewers including articles published from January 1981 through September 2011. Medline and Cochrane Library electronic databases were used in addition to hand searching to assess clinical outcomes for mandibular implant-supported removable partial denture with distal extension. This review yielded 1751 records that were narrowed down to 5. The studies revealed implant survival rates ranging from 95% to 100% with one failure reported of 98 implants. The removable partial dentures associated with implant in mandibular free-end arches showed some complications and need of repair for relining, pitting of the healing abutment, replacement of resilient component of the attachment, damage in framework, screw loosening and damage in acrylic denture base. Patient satisfaction was evaluated through a five-point questionnaire, and results ranged between 4.12 and 5.0, considering 1 as the least favourable situation. The literature review showed increase in patient satisfaction and high survival rates of implants associated with mandibular removable partial dentures with distal extensions. However, some complications and need of prosthetic repair were reported. Although this treatment approach could represent a low-cost and beneficial rehabilitation for free-end mandibular ridges, the lack of controlled and randomised well-designed clinical trials suggests further studies with more representative samples to validate the outcomes of this treatment modality.

An implant-supported removable partial denture for a patient with post-inflammatory scar contracture caused by burn complications: a clinical report

The scars and contracture around the oral-facial region may cause difficulty in prosthodontic treatment to restore esthetics and function for the patients, who suffered severe burns. This article presents a technique that uses a fixed partial denture prepared with a conventional milling technique and an attachment to support anterior cantilever removable partial denture, thereby providing a more esthetically acceptable and functional result.