Vijay Ebenezer¹, R. Balakrishnan², Vigil Asir³, Swarna Priya⁴

¹ Hod and Professor, Department of Oral and Maxillofacial Surgery , Sree Balaji Dental College and Hospital, Bharath University, Pallikaranai, chennai, 600100 ²Professor, Department of Oral and Maxillofacial Surgery, Sree Balaji Dental College and Hospital, Bharath University, Pallikaranai, Chennai-600100 ³Senior Lecturer, Department of Oral and Maxillofacial Surgery , Sree Balaji Dental College and Hospital, Bharath University, Pallikaranai, chennai, 600100 ⁴Senior Lecturer, Department of Oral and Maxillofacial Surgery , Sree Balaji Dental College and Hospital, Bharath University, Pallikaranai, chennai, 600100

DOI : https://dx.doi.org/10.13005/bpj/709

Abstract

Dental implants were  initiated in 1922 by Branemark, who and associates described the relationship between titanium implant and bone which termed osteointegration, defined as the direct structural and functional connection between living bone and the surface of an implant¹ .This clinical review is to  evaluate of  the effectiveness  of implants placed in severly atrophic   mandible.

Keywords

Atrophic Maxilla; Mandible; Implants; Osseointegration

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Copy the following to cite this article: Ebenezer V, Balakrishnan R, Asir V, Priya S. A Case Report - Implant Placement In Resorbed Alveolus. Biomed Pharmacol J 2015;8(October Spl Edition)

Copy the following to cite this URL: Ebenezer V, Balakrishnan R, Asir V, Priya S. A Case Report - Implant Placement In Resorbed Alveolus. Biomed Pharmacol J 2015;8(October Spl Edition). Available from: http://biomedpharmajournal.org/?p=3716>

Introduction

Bone loss that takes place in the edentulous alveolar ridge over time often impedes the use of standard implant placement protocols, and calls for alternative or additional procedures².   This case report supports the theory of   increased  patient acceptance of the rehabilitation procedure by using graftless solutions or nonautogenous sources of graft material. In cases of mild to moderate resorption, shorter and narrower implants^3-5 as well as angled implant placement ^6-9 may be effective strategies to avoid bone grafting  are usually followed, in this case bone augmentation or split ridge  was  not used rather, sequential osteotome with drill bits of required size was done ,with care not to cause fracture to the mandible.

Case Report

A 77 yr old  female  patient reported with a chief complaint of pain on her temperomandibular joint for past eight months . History reveals that pt is a denture wearer for past  29 years . Her Last  dentures were fabricated  11 yrs back.  Patient complaints of floating denture in  relation to  mandible . On intra oral clinical examination , the ridge exhibited  knife -edge ridge in maxilla and mandible and increased  vertical dimensions.  Patient was advised  OPG (fig 1)  which   revealed  severe atrophic edentulous maxilla and mandible ,this case was considered to be “complex” both in terms of the surgical and restorative aspects. On routine examination, pt was did not have any systemic disorders , patients  blood pressure was 130/90mmhg. treatment planning was done . Since the patient  had problem with the mandible  , implant retained prosthesis was planned,  patient was informed in detail about the procedure and informed consent was taken. routine blood investigations were done . Under local anesthesia , dental implants were placed in relation to 34 and 44 region in between the mental foramina. Care was taken not to fracture the mandible since its severely  atrophic.  primary stability was achieved, cover screw  were placed. After six months OPG was taken (fig 2) , radiograph   revealed no abnormality . Ball abutments was placed and denture retained prosthesis was  given. Patient had regular follow up , with which patient did not have any complaints in occlusion  nor in  pain of  temperomandibular  joint

Figure 1: Pre Operative Opg Click here to view full figure

 

Figure 2: Post Operative Opg Click here to view full figure

 

Discussion

Autogenous bone remains the “Gold Standard” for grafting. The autogenous graft may be harvested from many intra-oral sites. The maxillary tuberosity, anterior nasal spine, and zygomatic buttress have been reported for the upper jaw^10,11,12. The mandibular  symphysis, ascending  ramus, coronoid process, and horizontal ramus are useful sites from the lower jaw ¹³ , but autogenous bone grafts needs patient consent and some  do not accept  harvesting bone from the donor site ,in this case elderly patient did not accept for any augmentation ,  following this  there are more chances of secondary infection  following the grafts and  non healing of donor site. Thus  implants were placed without an grafts , through which fair prognosis of the implant was achieved. In this case of severe atrophy of  the maxilla and mandible , the implant was placed in the mandible without any  Alveolar ridge reconstruction  or  Spilt ridge bone augmentation.  thus consuming less time and providing accepted results in elderly patients.

Standard Implant placement protocol  with suitable individual modification according to bon quality in surgeons  hand can obviate the need for extended surgical procedure.

Reference

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