Orthopedic treatment employing modern technologies in a completely edentulous patient: A clinical case

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INTRODUCTION

Dental prosthetic rehabilitation in completely edentulous patients can be challenging. Insufficient fixation of removable dentures is a relevant and extensively discussed issue in dentistry [1, 2]. The main challenges are associated with alveolar ridge atrophy and a significant reduction in bone volume, which considerably decreases the stability of removable dentures. These changes frequently cause discomfort when using dentures, hinder chewing, and reduce quality of life [3–5]. Insufficient fixation and stabilization of dentures can result in soft tissue irritation, inflammation, and accelerated abrasion. Dental implantation is an effective prosthetic rehabilitation option for completely edentulous patients. Implant-supported restorations considerably improve chewing and speaking abilities, as well as smile esthetics. Moreover, they help patients quickly adjust to wearing dentures [6–8]. Prior to planning implant-supported prosthetic rehabilitation, the patient’s general and dental health should always be assessed [9].

CASE DESCRIPTION

Patient P., female, 56 years old, presented with complaints of impaired chewing ability and poor fixation of a removable denture that was manufactured three years earlier. On examination, the denture showed changes in color and attrition of prosthetic teeth (Fig. 1).

 

Fig. 1. Complete laminar denture used by the patient

Рис. 1. Полный съемный пластиночный протез, используемый пациенткой

 

Implant-supported prosthetic rehabilitation was planned in collaboration with a dental surgeon. Several factors determining treatment success had to be addressed, including the patient’s general condition, baseline clinical presentation, bone and soft tissue status at the planned implantation site, and the severity of atrophy. A surgical guide was used for precise implant placement, in order to minimize surgical complications, as well as ensure the required direction of a bone canal and correct placement of the implants.

Four Straumann implants (Straumann Holding AG, Switzerland) were installed to replace teeth 1.5, 1.1, 2.2, and 2.5. A complete denture was adjusted taking into account the optimal interalveolar space. Six months later, screw-retained multi-unit abutments were placed (Fig. 2).

 

Fig. 2. Multi-unit abutments fixed on implants

Рис. 2. Мультиюнит абатменты зафиксированы на имплантатах

 

Cone beam computed tomography findings confirmed good implant osseointegration (Figs. 3, 4).

 

Fig. 3. Cone beam computed tomography slices 6 months after implant placement (implants in the area of teeth 1.1 and 2.2 are visualized)

Рис. 3. Срезы конусно-лучевых компьютерных томограмм через 6 мес. после имплантации (визуализированы имплантаты в области зубов 1.1, 2.2)

 

Fig. 4. Cone beam computed tomography slices 6 months after implant placement (implants in the area of teeth 1.5 and 2.5 are visualized)

Рис. 4. Срезы конусно-лучевых компьютерных томограмм через 6 мес. после имплантации (визуализированы имплантаты в области зубов 1.5, 2.5)

 

Impressions were taken from the abutment level using A-type silicone impression material. The interalveolar space was measured with occluded teeth while wearing a removable denture. Cast models were produced in a dental laboratory. The casts were scanned, and a prosthetic bar was modeled (Fig. 5). Figs. 6 and 7 present scans of the maxilla with artificial gingiva modeling and the implant shaft position.

 

Fig. 5. Cast model scan of the completely edentulous maxilla Titanium bar modeling stage

Рис. 5. Скан гипсовой модели беззубой верхней челюсти. Этап моделирования титановой балки

 

Fig. 6. Cast model scan of the completely edentulous maxilla Artificial gingiva placement stage to assess the fit of the bar

Рис. 6. Скан гипсовой модели беззубой верхней челюсти. Этап наложения искусственной десны с целью контроля посадки балки

 

Fig. 7. Maxilla scan with artificial gingiva modeling and implant shaft position

Рис. 7. Скан верхней челюсти с моделировкой искусственной десны и расположением шахты имплантатов

 

The prosthetic bar was milled from a titanium block using a milling machine. Then, the ExoCad software (Exocad, Germany) was used for virtual modeling of a removable denture with prosthetic teeth, taking into account abutment positions (Figs. 8–10).

 

Fig. 8. Modeling a removable denture with prosthetic teeth, taking into account abutment positions Front view

Рис. 8. Моделирование съемного протеза с искусственными зубами с учетом расположения абатментов. Фронтальная проекция

 

Fig. 9. Modeling a removable denture with prosthetic teeth, taking into account abutment positions. Occlusal view

Рис. 9. Моделирование съемного протеза с искусственными зубами с учетом расположения абатментов. Окклюзионная проекция

 

Fig. 10. Modeling a removable denture with prosthetic teeth, taking into account abutment positions. Gingival view

Рис. 10. Моделирование съемного протеза с искусственными зубами с учетом расположения абатментов. Гингивальная проекция

 

These data were used to produce a temporary removable denture (a prototype of the future zirconium structure) by milling the denture base with prosthetic teeth from polymethyl methacrylate. The titanium bar was glued into place, and the temporary denture was fitted. Figs. 11–13 present photos of the patient before and after temporary denture placement. The lower face height and facial esthetics were restored.

 

Fig. 11. Photo of the patient before temporary denture placement

Рис. 11. Фотография пациентки до установки временной конструкции в полости рта

 

Fig. 12. Photo of the patient after temporary denture placement, with mouth closed

Рис. 12. Фотография пациентки с закрытым ртом после установки временной конструкции

 

Fig. 13. Photo of the patient’s smile after temporary denture placement

Рис. 13. Фотография улыбки пациентки после установки временной конструкции

 

Occlusal contacts were adjusted, and the position of the mandible was captured using a silicone impression material (Figs. 14, 15).

 

Fig. 14. Fixing the new jaw relation. Full-face photo

Рис. 14. Фиксация нового соотношения челюстей. Фронтальная фотография

 

Fig. 15. Fixing the new jaw relation. Side-face photo

Рис. 15. Фиксация нового соотношения челюстей. Боковая фотография

 

The new parameters, taking into account the adjusted occlusion, allowed modeling and milling of a permanent structure from a zirconium dioxide block (Figs. 16, 17).

Occlusal contacts were adjusted, and the permanent denture was placed (Fig. 18).

 

Fig. 16. Milled permanent structure from a zirconium dioxide block

Рис. 16. Фрезерованная постоянная конструкция из блока диоксида циркония

 

Fig. 17. Permanent structure try-in on a cast model

Рис. 17. Примерка постоянной конструкции на гипсовой модели

 

Fig. 18. Patient’s smile after permanent denture placement

Рис. 18. Улыбка пациентки после установки постоянной конструкции

 

CONCLUSION

The paper presents a successful case of temporary and permanent implant-supported prosthetic rehabilitation in a patient with completely edentulous maxilla. Innovative solutions ensured denture stability while also improving chewing abilities and smile esthetics.

ADDITIONAL INFO

Authors’ contribution. Thereby, all authors made a substantial contribution to the conception of the work, acquisition, analysis, interpretation of data for the work, drafting and revising the work, final approval of the version to be published and agree to be accountable for all aspects of the work. Personal contribution of the authors: N.S. Robakidze — analysis of theoretical and practical results; E.D. Zhidkikh — planning of practical work, consultation during research; V.M. Oromyan — performing the main volume of practical work, registration of results.

Funding source. The treatment of the patient was carried out on the basis of the Educational And Clinical Dental Center of the Northwestern State Medical University named after I.I. Mechnikov.

Disclosure of potential conflict of interest of the authors. The authors declare that there is no potential conflict of interest requiring disclosure in this article.

Informed consent to publication. The authors received the written consent of the patient to publish medical data and photographs.

Acknowledgments. The authors are grateful to the secondary medical staff of the Educational and Clinical Dental Center of the Northwestern State Medical University named after I.I. Mechnikov for their assistance in providing treatment.

ДОПОЛНИТЕЛЬНАЯ ИНФОРМАЦИЯ

Вклад авторов. Все авторы подтверждают соответствие своего авторства международным критериям ICMJE (все авторы внесли существенный вклад в разработку концепции, проведение исследования и подготовку статьи, прочли и одобрили финальную версию перед публикацией). Вклад распределен следующим образом: Н.С. Робакидзе — анализ теоретических и практических результатов; Е.Д. Жидких — планирование практической работы, консультация при проведении исследования; В.М. Оромян — выполнение основного объема практической работы, оформление результатов.

Источник финансирования. Лечение пациентки проведено на базе учебно-клинического стоматологического центра ФГБОУ ВО «Северо-Западный государственный медицинский университет им. И.И. Мечникова» Министерства здравоохранения Российской Федерации.

Раскрытие потенциального конфликта интересов авторов. Авторы заявляют об отсутствии потенциального конфликта интересов, требующего раскрытия в данной статье.

Информированное согласие на публикацию. Авторы получили письменное согласие пациента на публикацию медицинских данных и фотографий.

Благодарности. Авторы признательны среднему медицинскому персоналу учебно-клинического стоматологического центра ФГБОУ ВО «Северо-Западный государственный медицинский университет им. И.И. Мечникова» Министерства здравоохранения Российской Федерации за помощь в оказании лечения.

Sobre autores

Natalia Robakidze

North-Western State Medical University named after I.I. Mechnikov

Email: rona24@list.ru
ORCID ID: 0000-0003-4209-5928
Código SPIN: 6653-2182

MD, Dr. Sci. (Medicine), professor

Rússia, 191015, Saint Petersburg, Kirochnaya st., 41

Evgeniy Zhidkikh

North-Western State Medical University named after I.I. Mechnikov

Email: evzhidkikh@yandex.ru
ORCID ID: 0009-0007-3512-8169
Código SPIN: 1263-3259

MD, Cand. Sci. (Medicine)

Rússia, 191015, Saint Petersburg, Kirochnaya st., 41

Vagan Oromyan

North-Western State Medical University named after I.I. Mechnikov

Autor responsável pela correspondência
Email: vagan-oromyan@szgmu.ru
ORCID ID: 0009-0002-0366-303X
Código SPIN: 2078-9155

MD, Cand. Sci. (Medicine)

Rússia, 191015, Saint Petersburg, Kirochnaya st., 41

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