J Dent Rehabil Appl Sci.  2019 Mar;35(1):37-45. 10.14368/jdras.2019.35.1.37.

Maxillary complete denture and mandibular All-on-4 implant restoration considering maintenance: a case report

• Kim SY
• Kwon EY
• Jung KH
• Jeon HM
• Kang ES
• Yun MJ

• KMID: 2450924
• DOI: http://doi.org/10.14368/jdras.2019.35.1.37

Abstract

In the case of edentulous patients, the total amount of occlusal force is dispersed by the keratinized gingiva during mastication, in result, causing lower masticatory and chewing efficiency. In particular, the mandibular area has more side effects such as pain than the maxilla has. It gets worse when the patient has more absorption of alveolar bone, but the implant treatment is often interrupted due to the existence of the inferior alveolar nerve. In this case, a patient treated with the all-on-4 method by placing the implant in the anterior part of mandible and with the conventional complete denture for the maxilla has maintained without complications and was satisfied with the restoration both functionally and esthetically.

Keyword

all-on-4; mandibular edentulous patient; tilted implant

MeSH Terms

Absorption
Bite Force
Denture, Complete*
Gingiva
Humans
Mandible
Mandibular Nerve
Mastication
Maxilla
Methods

Figure

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  Fig. 1 Pre-operate panoramic radiograph showing alveolar bone loss due to periodontal problem.

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  Fig. 2 (A, B) intraoral view after extraction of tooth and implant surgery, (C) Provisional denture, (D) Panoramic view after surgery.

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  Fig. 3 Impression taking. (A, B) Definitive impression taking and master cast fabrication for conventional maxillary complete denture, (C, D) Fixture level impression taking and mandibular cast fabrication.

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  Fig. 4 (A) Recording of maxillomandibular jaw relationship using wax rim, (B) Mandibular model with the same size of healing abutments in the mouth, (C) Wax dentures of artificial tooth arrangement, (D) Mandibular wax denture placed on the model with the healing abutments.

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  Fig. 5 Mandibular full-contour wax-up entirely connected anterior abutments and designed to cemented with the posterior abutments.

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  Fig. 6 (A) Screw connected posterior abutment wax-ups, (B) Mandibular wax-up model above the posterior abutment wax-ups, (C) Frontal view of maxillomandibular wax model, (D, E, F) Intraoral views of wax model try in.

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  Fig. 7 (A) Connection of posterior CCM abutments in the mouth, (B) Try-in of cut-back framework which remained occlusal contact points on functional cusps of bilateral mandibular first molars, (C, D) Making on the site of lack of cutback, (E) Definitive inter-arch jaw relation taking.

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  Fig. 8 Definitive prosthesis. (A) Metal occlusal surfaces on maxillary molars, (B) Posterior casted abutments, (C) Approach of implant driver on the final prosthesis, (D) Occlusal view of mandibular prosthesis, (E) Lingual view of mandibular prosthesis.

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  Fig. 9 Try-in view of Definitive prosthesis.

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  Fig. 10 (A) First day of provisional denture, (B) Day of definite restoration delivery, (C) One year after delivery, Change and improvement of smile line.

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  Fig. 11 Panoramic view after 3 years. No significant changes were observed.

Reference

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