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Distal implants to modify a removable partial denture
Spa features added to dentistry Background.—Not every dentist is impressed with nontraditional approaches to dentistry, yet many dentists are turning routine checkups into something special. Efforts are being made to create a dental office that is more inviting, with these changes producing what is termed “spa dentistry.” Definition.—Spa dentistry refers to a facility whose dental program is strictly supervised by a licensed dentist but where services are provided that integrate the treatments offered in a spa with traditional and nontraditional dental treatment. Spa dentistry may be as simple as a redesigned waiting room or the addition of scented candles, but it can be as elaborate as having on-site massage therapists or facials being done during time-consuming procedures. Other services that are offered include paraffin wax, aromatherapy, and microdermabrasion. The goal is to make dentistry kinder and gentler for all patients, but especially to provide a calm atmosphere for anxious patients. Dental staff members benefit from the less-stressful environment also. Status.—Spa dentistry was first introduced in 1978 by the Holistic Dental Association. In more recent years, the idea has been promoted by the American Academy of Cosmetic Dentistry. More than 50% of the 427 practicing dentists surveyed in 2003 offered some degree of spa or office amenity in their practice. In addition, the University of the Pacific Dental School has now added a course on spa
dentistry. The International Dental Spa Association has been formed to join dental and spa organizations. Discussion.—Spa dentistry is becoming more widespread, but it is not for every dentist or every patient. Offering facials or aromatherapy to enhance patients’ experience can be soothing to anxious patients or those who have dreaded the dentist’s office in the past. The concept is being discussed at many levels, with a positive reception perhaps because of its emphasis on the consumer. Dentists now have the option of a traditional or a nontraditional approach to delivering dental care to patients.
Clinical Significance.—We’ve come a long way from a one-chair office over the drugstore. Many practices now offer comforts usually found in day spas to enhance their patients’ perception of their appointment. Other providers continue to favor a more traditional approach. Both approaches are valid.
Garvin J: Spa dentistry. AGD Impact Aug/Sep:16-19, 2004 Reprints available from the Academy of General Dentistry. Fax your request to Jo Posselt (312/440-4261) or e-mail AGDJournal @agd.org
Prosthodontics Distal implants to modify a removable partial denture Background.—Bilateral distal extension partial dentures can be challenging, as support is needed from the teeth, mucosa, and residual alveolar ridges. Various destructive forces can act on the abutment teeth and the posterior mandibular residual alveolar ridges. Freestanding single dental implants may help with the difficulties and offer a cost-effective option. The use of a mandibular implantsupported chromium-cobalt removable partial denture
(RPD) with a combination of bilateral single molar implants and metal ceramic crowns was reported. Case Report.—Man, 66, was partially dentate and required treatment for severe wear of his maxillary anterior teeth. The wear had created a poor appearance and reduced function. Cost considerations led to the choice of a combination of RPDs retained by metal ceramic restora-
Volume 50 • Issue 2 • 2005 93
Fig 2.—Pretreatment radiograph. (Reprinted from Kuzamanovic DV, Payne AGT, Purton DG: Distal implants to modify the Kennedy classification of a removable partial denture: A clinical report. J Prosthet Dent 92:8-11,2004.Copyright 2004,with permission from The Editorial Council of The Journal of Prosthetic Dentistry.)
Fig 4.—Modified channel-shoulder-pin and RPD framework. (Reprinted from Kuzamanovic DV, Payne AGT, Purton DG: Distal implants to modify the Kennedy classification of a removable partial denture: A clinical report. J Prosthet Dent 92:8-11, 2004. Copyright 2004, with permission from The Editorial Council of The Journal of Prosthetic Dentistry.)
Fig 5.—Lingual surface of mandibular canine restorations. (Reprinted from Kuzamanovic DV, Payne AGT, Purton DG: Distal implants to modify the Kennedy classification of a removable partial denture: A clinical report. J Prosthet Dent 92:8-11, 2004. Copyright 2004, with permission from The Editorial Council of The Journal of Prosthetic Dentistry.)
tions and precision attachments and implant-supported RPDs. The patient had edentulous areas in both arches with compromised physiologic abutment support. The need for extracoronal restorations and adjunctive therapy was foreseen. His occlusion was severely compromised and required re-establishment of the occlusal vertical dimension. He had localized bleeding on periodontal probing, generalized calculus, and localized gingival recession. For some teeth, the furcation was involved. Periapical radiolucencies, external root resorption, and inadequate root
94 Dental Abstracts
Fig 6.—A, Healing caps replaced with patrices. B, Gold matrix inclusion. (Reprinted from Kuzamanovic DV, Payne AGT, Purton DG: Distal implants to modify the Kennedy classification of a removable partial denture: A clinical report. J Prosthet Dent 92:8-11, 2004. Copyright 2004, with permission from The Editorial Council of The Journal of Prosthetic Dentistry.)
and oral hygiene was maintained throughout this interim prosthesis stage. After 20 weeks with the provisional restorations and interim acrylic resin partial dentures, treatment focused on placing definitive crowns and chromium-cobalt RPDs. The RPD for the mandibular arch was a modification of the intracoronal attachment method of the channel-shoulder-pin system (Fig 4), and metal-ceramic restorations were used on both mandibular canines (Fig 5). To improve the esthetics, labial surface porcelain staining was chosen. Threemillimeter healing caps that remained to provide support in the area of the distal extension of the partial denture were replaced after a month with definitive patrices (Fig 6). Splinted metal ceramic restorations, single metal ceramic restorations, and a chromium-cobalt RPD retained by extracoronal precision attachments were used to restore the maxillary arch. A canine-protected articulation was also placed (Fig 7). The patient was counseled regarding home care for the restorations. At a 2-year recall visit, the only prosthodontic maintenance needed was simple activation of the gold matrices of the mandibular RPD to re-establish retention on the patrices.
Fig 7.—A, Maxillary RPD at 2-year recall. B, Mandibular RPD at 2-year recall. (Reprinted from Kuzamanovic DV, Payne AGT, Purton DG: Distal implants to modify the Kennedy classification of a removable partial denture: A clinical report. J Prosthet Dent 92:8-11, 2004. Copyright 2004, with permission from The Editorial Council of The Journal of Prosthetic Dentistry.)
canal treatment of some teeth were found on radiographic evaluation (Fig 2). The initial treatment included scaling, root planing, oral hygiene instruction, restorative dentistry, and extraction of the teeth that were compromised periodontally and endodontically. In addition, carious lesions received treatment and failed restorations were replaced. Endodontic treatment of the maxillary right canine and lateral incisor was also performed. With treatment, the Kennedy classification of the partially edentulous arch changed from Class I, or tooth–tissue-supported, to Class III, or tooth–implantsupported. Crown lengthening procedures were performed, then provisional crowns were cemented 20 weeks later. Following the principle of canine-protected articulation, interim maxillary and mandibular acrylic resin partial dentures were inserted at the appropriate occlusal vertical dimension. Monitoring of wear facets, mastication, speech,
Discussion.—The mandibular arch restoration required a combination of bilateral single molar implants, a chromium-cobalt RPD, and crowns with a modified use of the channel-shoulder-pin system. For the maxillary arch restoration, splinted metal-ceramic crowns and a conventional RPD retained by extracoronal precision attachments was needed. Freestanding, bilateral distal single implants gave support and retention to the mandibular RPD and proved cost-effective for the patient. The mandibular RPD was thus converted from being tooth-tissue supported to being tooth-implant supported.
Clinical Significance.—Presented is a costeffective use of implants to convert a freeend prosthesis to one that is tooth-implant supported. Load on the few remaining teeth was thus reduced.
Kuzamanovic DV, Payne AGT, Purton DG: Distal implants to modify the Kennedy classification of a removable partial denture: A clinical report. J Prosthet Dent 92:8-11, 2004 Reprints available from AGT Payne, Dept of Oral Rehabilitation, School of Dentistry, Univ of Otago, PO Box 647, Dunedin 9003, New Zealand 9003; fax: + 64 3 479 5079; e-mail: alan.payne@dent .otago.ac.nz
Volume 50 • Issue 2 • 2005 95
dentistry. The International Dental Spa Association has been formed to join dental and spa organizations. Discussion.—Spa dentistry is becoming more widespread, but it is not for every dentist or every patient. Offering facials or aromatherapy to enhance patients’ experience can be soothing to anxious patients or those who have dreaded the dentist’s office in the past. The concept is being discussed at many levels, with a positive reception perhaps because of its emphasis on the consumer. Dentists now have the option of a traditional or a nontraditional approach to delivering dental care to patients.
Clinical Significance.—We’ve come a long way from a one-chair office over the drugstore. Many practices now offer comforts usually found in day spas to enhance their patients’ perception of their appointment. Other providers continue to favor a more traditional approach. Both approaches are valid.
Garvin J: Spa dentistry. AGD Impact Aug/Sep:16-19, 2004 Reprints available from the Academy of General Dentistry. Fax your request to Jo Posselt (312/440-4261) or e-mail AGDJournal @agd.org
Prosthodontics Distal implants to modify a removable partial denture Background.—Bilateral distal extension partial dentures can be challenging, as support is needed from the teeth, mucosa, and residual alveolar ridges. Various destructive forces can act on the abutment teeth and the posterior mandibular residual alveolar ridges. Freestanding single dental implants may help with the difficulties and offer a cost-effective option. The use of a mandibular implantsupported chromium-cobalt removable partial denture
(RPD) with a combination of bilateral single molar implants and metal ceramic crowns was reported. Case Report.—Man, 66, was partially dentate and required treatment for severe wear of his maxillary anterior teeth. The wear had created a poor appearance and reduced function. Cost considerations led to the choice of a combination of RPDs retained by metal ceramic restora-
Volume 50 • Issue 2 • 2005 93
Fig 2.—Pretreatment radiograph. (Reprinted from Kuzamanovic DV, Payne AGT, Purton DG: Distal implants to modify the Kennedy classification of a removable partial denture: A clinical report. J Prosthet Dent 92:8-11,2004.Copyright 2004,with permission from The Editorial Council of The Journal of Prosthetic Dentistry.)
Fig 4.—Modified channel-shoulder-pin and RPD framework. (Reprinted from Kuzamanovic DV, Payne AGT, Purton DG: Distal implants to modify the Kennedy classification of a removable partial denture: A clinical report. J Prosthet Dent 92:8-11, 2004. Copyright 2004, with permission from The Editorial Council of The Journal of Prosthetic Dentistry.)
Fig 5.—Lingual surface of mandibular canine restorations. (Reprinted from Kuzamanovic DV, Payne AGT, Purton DG: Distal implants to modify the Kennedy classification of a removable partial denture: A clinical report. J Prosthet Dent 92:8-11, 2004. Copyright 2004, with permission from The Editorial Council of The Journal of Prosthetic Dentistry.)
tions and precision attachments and implant-supported RPDs. The patient had edentulous areas in both arches with compromised physiologic abutment support. The need for extracoronal restorations and adjunctive therapy was foreseen. His occlusion was severely compromised and required re-establishment of the occlusal vertical dimension. He had localized bleeding on periodontal probing, generalized calculus, and localized gingival recession. For some teeth, the furcation was involved. Periapical radiolucencies, external root resorption, and inadequate root
94 Dental Abstracts
Fig 6.—A, Healing caps replaced with patrices. B, Gold matrix inclusion. (Reprinted from Kuzamanovic DV, Payne AGT, Purton DG: Distal implants to modify the Kennedy classification of a removable partial denture: A clinical report. J Prosthet Dent 92:8-11, 2004. Copyright 2004, with permission from The Editorial Council of The Journal of Prosthetic Dentistry.)
and oral hygiene was maintained throughout this interim prosthesis stage. After 20 weeks with the provisional restorations and interim acrylic resin partial dentures, treatment focused on placing definitive crowns and chromium-cobalt RPDs. The RPD for the mandibular arch was a modification of the intracoronal attachment method of the channel-shoulder-pin system (Fig 4), and metal-ceramic restorations were used on both mandibular canines (Fig 5). To improve the esthetics, labial surface porcelain staining was chosen. Threemillimeter healing caps that remained to provide support in the area of the distal extension of the partial denture were replaced after a month with definitive patrices (Fig 6). Splinted metal ceramic restorations, single metal ceramic restorations, and a chromium-cobalt RPD retained by extracoronal precision attachments were used to restore the maxillary arch. A canine-protected articulation was also placed (Fig 7). The patient was counseled regarding home care for the restorations. At a 2-year recall visit, the only prosthodontic maintenance needed was simple activation of the gold matrices of the mandibular RPD to re-establish retention on the patrices.
Fig 7.—A, Maxillary RPD at 2-year recall. B, Mandibular RPD at 2-year recall. (Reprinted from Kuzamanovic DV, Payne AGT, Purton DG: Distal implants to modify the Kennedy classification of a removable partial denture: A clinical report. J Prosthet Dent 92:8-11, 2004. Copyright 2004, with permission from The Editorial Council of The Journal of Prosthetic Dentistry.)
canal treatment of some teeth were found on radiographic evaluation (Fig 2). The initial treatment included scaling, root planing, oral hygiene instruction, restorative dentistry, and extraction of the teeth that were compromised periodontally and endodontically. In addition, carious lesions received treatment and failed restorations were replaced. Endodontic treatment of the maxillary right canine and lateral incisor was also performed. With treatment, the Kennedy classification of the partially edentulous arch changed from Class I, or tooth–tissue-supported, to Class III, or tooth–implantsupported. Crown lengthening procedures were performed, then provisional crowns were cemented 20 weeks later. Following the principle of canine-protected articulation, interim maxillary and mandibular acrylic resin partial dentures were inserted at the appropriate occlusal vertical dimension. Monitoring of wear facets, mastication, speech,
Discussion.—The mandibular arch restoration required a combination of bilateral single molar implants, a chromium-cobalt RPD, and crowns with a modified use of the channel-shoulder-pin system. For the maxillary arch restoration, splinted metal-ceramic crowns and a conventional RPD retained by extracoronal precision attachments was needed. Freestanding, bilateral distal single implants gave support and retention to the mandibular RPD and proved cost-effective for the patient. The mandibular RPD was thus converted from being tooth-tissue supported to being tooth-implant supported.
Clinical Significance.—Presented is a costeffective use of implants to convert a freeend prosthesis to one that is tooth-implant supported. Load on the few remaining teeth was thus reduced.
Kuzamanovic DV, Payne AGT, Purton DG: Distal implants to modify the Kennedy classification of a removable partial denture: A clinical report. J Prosthet Dent 92:8-11, 2004 Reprints available from AGT Payne, Dept of Oral Rehabilitation, School of Dentistry, Univ of Otago, PO Box 647, Dunedin 9003, New Zealand 9003; fax: + 64 3 479 5079; e-mail: alan.payne@dent .otago.ac.nz
Volume 50 • Issue 2 • 2005 95