This document describes a case study of a 54-year-old male who received an implant-retained mandibular overdenture. A diagnostic workup was performed including radiographs to evaluate bone height and location of the mental foramen. Two implants were placed between the mental foramina. After osseointegration, abutments and gold caps were attached to the implants. The mandibular denture was fabricated with attachments to the gold caps, improving retention and stability over a conventional denture. Implant overdentures were found to enhance quality of life for patients with resorbed edentulous ridges.

1. DR. RITESH SHIWAKOTI
MScD PROSTHODONTICS
NAZIA MAJEED ZARGAR
JOURNAL OF OROFACIAL RESEARCH APRIL-JUNE 2013;3(2):152-156

2.  Rehabilitation of an atrophic edentulous jaw is still a
real challenge
 Maxilla is more frequent to get edentulous
 25% the width and 4 mm height of alveolus bone loss
occur in the first year after extraction
 Over a long term there is extensive bone loss even in
the denture wearers
 Bone loss occurs in the labial side thus shifting the
residual ridge to the lingual side
 Thus the atrophic jaw can be restored by endosteal
implants and this has become a revolutionary

3. Age : 54
Sex : Male
Chief complaint : ill fitting mandibular denture and
unsatisfied with it
Examination : upper and lower edentulous jaw with
resorption more on the mandible
Patient had no other medical disease
So, a maxillary conventional complete denture and a
mandibular removable implant overdenture is planned
as treatment.

4. 1. A diagnostic impression using alginate is made of the
edentulous mandibular ridge and poured
2. Two metal balls was placed on the premolar area of
the ridge and fixed with the help of carding wax
3. A template is fabricated over the metal balls using
autopolymerising resin

6.  This prepared template was then worn by the patient
while taking the panoramic radiograph so that the
distance between the mental foramen from the metal
balls could be determined

7. Location of the inferior alveolar nerve needs to be
evaluated prior to implant placement
Exact location of the mental foramen and the presence
or absence of the anterior loop needs to be determined
Evaluation of the available bone height

8.  The symphyseal height of the mandible was found to
be 20 mm
 The right metal ball is close to the right mental
foramen
 There is space between the left metal ball and the left
mental foramen

10.  Is was planned that the implant site be selected
between the mental foramen as there was optimum
symphyseal height and this region presents the
optimal density of the bone for implant support

11. Initially the number of implant was decided as four , two
between the mental foramen and two in the posterior
region , but due to the financial capability of the
patient only two implant was then decided
Right implant was decided to be placed at the place of
the right metal ball as its distance from the mental
foramen was optimum but the left implant was
decided 2 to 3 mm left to the metal ball
This implant area was marked in the template and a 4
mm diameter hole was made

12.  Patient was premedicated with antibiotics (Novamox
Cipla 1 gm , 1 hour before surgery)
 Surgery was performed using local anesthesia
 The template was placed in mouth and surgical mark
was made through the implant point hole with a BP
blade
 Supracrestal incisions were made and the buccal and
lingual full thickness mucoperiosteal flaps were raised

15.  Using the surgical template , Nobel Biocare Replace
tappered TiU implant 3.5*16 mm2 were placed at the
tooth 34 and 44 locations.
 Surgical cover screws were placed and the flaps
closed
 Patient was instructed to discontinue the use of
the lower denture for 2 week following surgery

17.  Sutures were removed after 2 weeks and the denture was
soft relined. This allowed the patient to wear the removal
prosthesis during the period of osteointegration without
transmitting excessive forces to the surgical site

18.  The second stage surgery was done after 4 months
according to the Brenmark protocol that states that dental
implant are to be submerged beneath the soft tissue at the
time of the placement and allowed to heal for least 3
month in the mandible
 Here the implant were exposed, the surgical cover screws
were removed and the site were irrigated with sterile
normal saline. Healing collar were placed, and the gingival
tissue were allowed to mature for 1 month for soft tissue
healing.

19.  Both the maxillary and the mandibular denture were
fabricated beforehand.
 A month after the placement of the healing collars a
ball abutments ( Nobel Biocare )of the collar height
0.5 mm were placed.
 Gold caps were placed on their respective ball
abutments and stabilized in the mouth with the help
of putty (Reprosil – dentsply)

21.  Two holes were made on the tissue surface of the
mandibular denture where gold caps would be
attached
 Na autopolymerizing resin was placed into the holes in
the mandibular denture and the denture was placed in
the mouth with the gold caps in place over the ball
abutments.
 The cold cure was allowed to set and then the denture
removed

22.  Gold caps were transferd to the tissue surface of the
mandibular denture. Excess of the cold cure was
removed
 The gold caps were tightened using its activator, to the
desired tightness
 The maxillary and mandibular complete denture were
inserted

25. On an atrophied edentulous ridge an implant
overdenture improves the quality of life of the patient.
An endosteal implant along with ball attachment could
be seen from the above case.
Panoramic x-ray plays an important role in guiding the
location for the implant placement.
This type of implant supported overdenture improves
the retention and stability of the denture.