J Dent Rehabil Appl Sci.  2017 Dec;33(4):321-328. 10.14368/jdras.2017.33.4.321.

Implant-retained overdenture with CM LOC ® Pekkton® in maxillary edentulous patient

• Hong MG
• Shin SY

• KMID: 2405546
• DOI: http://doi.org/10.14368/jdras.2017.33.4.321

Abstract

Treatment options for edentulous patients are complete denture and implant prosthesis. A two implant-retained overdenture can be considered the first treatment in the edentulous mandible, but there is no clear consensus of treatment for edentulous maxilla. Implant-retention/support overdenture shows better retention and stability than complete denture and is less expensive and more esthetic than implant-supported fixed prosthesis. CM LOC® Pekkton® attachment is a solitary type attachment and evaluated to have excellent abrasion resistance and retention with a female part made of poly-ether-ketone-ketone. Meanwhile, SR Ivocap system is injection molding method and discussed to show few changes in the vertical dimension of denture and have excellent fracture resistance. In this case, we restored maxillary arch with a four implant-retained overdenture using CM LOC® Pekkton® and SR Ivocap system, and mandibular arch with a removable partial denture. Through this procedure, satisfactory outcomes were achieved both in functional and esthetic aspects.

Keyword

implant-retained overdenture; maxillary overdenture; Pekkton; CM LOC® attachment; SR Ivocap system

MeSH Terms

Consensus
Denture, Complete
Denture, Overlay*
Denture, Partial, Removable
Dentures
Female
Fungi
Humans
Mandible
Maxilla
Methods
Prostheses and Implants
Vertical Dimension

Figure

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  Fig. 1 Panoramic radiograph before treatment. Furcation involvement on #36 and periapical radiolucency on #13, 22, 23, 36, and 42 were observed

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  Fig. 2 Cone beam computed tomography (CBCT) views with radiographic stent before guided bone regeneration. (A) Area #14, (B) #12, (C) #22, (D) #24. Width and height of alveolar bone of #14, 12, 22 and 24 were insufficient. It was seen that the buccal side of the alveolar bone in area #14 was absorbed severely

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  Fig. 3 Panoramic view after implant installation. Implants placed in area #14, 12, 22, and 24 with guided bone regeneration were shown

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  Fig. 4 Intraoral view after implant installation. Healing abutments were placed after secondary surgery and diameter of all healing abutments was 4.8 mm

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  Fig. 5 Maxillary custom tray fabrication for final impression. Space for transfer impression coping at anterior region was observed

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  Fig. 6 Final impression taking for implant-retained overdenture of maxilla with seating CM LOC® Pekkton® attachment analog. Because transfer impression copings were not parallel to each other, CM LOC® Pekkton® attachments were used to compensate for inclination of non-parallel implants

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  Fig. 7 Taking the facebow transfer

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  Fig. 8 Polymerization of denture using SR Ivocap system. Injection pressure was 6 bar and polymerization time was 35 minutes in 100°C water

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  Fig. 9 Installation of retention part of CM LOC® Pekkton® attachment with retention insert, extra-low by direct method intraorally. Slot in the insert that might act as a buffer for insert not to be broken or torn was observed

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  Fig. 10 Intraoral views with definitive dentures. (A) Maxillary occlusal view, (B) Right lateral view, (C) Frontal view, (D) Left lateral view, (E) Mandibular occlusal view. Major connector was linguoplate, direct retainers were RPA clasps on #35 and 44 and rests were occlusal rests on #35, 34 and 44 and lingual rest on #43. Bilateral balanced occlusion was achieved

Reference

References

1. DeBoer J. Edentulous implants: overdenture versus fixed. J Prosthet Dent. 1993; 69:386–90. DOI: 10.1016/0022-3913(93)90186-R.

2. Feine JS, Carlsson GE, Awad MA, Chehade A, Duncan WJ, Gizani S, Head T, Lund JP, MacEntee M, Mericske-Stern R, Mojon P, Morais J, Naert I, Payne AG, Penrod J, Stoker GT Jr, Tawse-Smith A, Taylor TD, Thomason JM, Thomson WM, Wismeijer D. The McGill Consensus Statement on Overdentures Montreal, Quebec, Canada. May 2425 2002. Int J Prosthodont. 2002; 15:413–4. PMID: 12170858.

3. Ekfeldt A, Johansson LA, Isaksson S. Implant-supported overdenture therapy: a retrospective study. Int J Prosthodont. 1997; 10:366–74. PMID: 9484047.

4. Parel SM, Phillips WR. A risk assessment treatment planning protocol for the four implant immediately loaded maxilla: preliminary findings. J Prosthet Dent. 2011; 106:359–66. DOI: 10.1016/S0022-3913(11)60147-9.

5. Chan MF, Närhi TO, de Baat C, Kalk W. Treatment of the atrophic edentulous maxilla with implantsupported overdentures: a review of the literature. Int J Prosthodont. 1998; 11:7–15. PMID: 9588985.

6. Trakas T, Michalakis K, Kang K, Hirayama H. Attachment systems for implant retained overdentures: a literature review. Implant Dent. 2006; 15:2434. DOI: 10.1097/01.id.0000202419.21665.36. PMID: 16569958.

7. Passia N, Ghazal M, Kern M. Long-term retention behaviour of resin matrix attachment systems for overdentures. J Mech Behav Biomed Mater. 2016; 57:88–94. DOI: 10.1016/j.jmbbm.2015.11.038. PMID: 26705935.

8. El Bahra S, Ludwig K, Samran A, Freitag-Wolf S, Kern M. Linear and volumetric dimensional changes of injection-molded PMMA denture base resins. Dent Mater. 2013; 29:1091–7. DOI: 10.1016/j.dental.2013.07.020. PMID: 24001949.

9. Strohaver RA. Comparison of changes in vertical dimension between compression and injection molded complete dentures. J Prosthet Dent. 1989; 62:716–8. DOI: 10.1016/0022-3913(89)90599-4.

10. Gharechahi J, Asadzadeh N, Shahabian F, Gharechahi M. Dimensional changes of acrylic resin denture bases: conventional versus injectionmolding technique. J Dent (Tehran). 2014; 11:398405.

11. Uzun G, Hersek N. Comparison of the fracture resistance of six denture base acrylic resins. J Biomater Appl. 2002; 17:19–29. DOI: 10.1177/0885328202017001597. PMID: 12222755.

12. Mericske-Stern RD, Taylor TD, Belser U. Management of the edentulous patient. Clin Oral Implants Res. 2000; 11:108–25. DOI: 10.1034/j.1600-0501.2000.011S1108.x. PMID: 11168261.

13. Zou D, Wu Y, Huang W, Wang F, Wang S, Zhang Z, Zhang Z. A 3-year prospective clinical study of telescopic crown, bar, and locator attachments for removable four implant-supported maxillary overdentures. Int J Prosthodont. 2013; 26:566–73. DOI: 10.11607/ijp.3485. PMID: 24179972.

14. Närhi TO, Hevinga M, Voorsmit RA, Kalk W. Maxillary overdentures retained by splinted and un-splinted implants: a retrospective study. Int J Oral Maxillofac Implants. 2001; 16:259–66. PMID: 11324214.

15. Nissan J, Oz-Ari B, Gross O, Ghelfan O, Chaushu G. Long-term prosthetic aftercare of direct vs. indirect attachment incorporation techniques to mandibular implant-supported overdenture. Clin Oral Implants Res. 2011; 22:627–30. DOI: 10.1111/j.1600-0501.2010.02026.x. PMID: 21070382.

16. Whang SW, Chung MK. Comparative tensile bond strength of heat-cured, cold-cured, and light cured denture base resins bonded to continuous-pressure injection type denture base resin. J Korean Acad Prosthodont. 1993; 31:385–93.