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Implant-retained overdenture following hemiglossectomy: a
10-year clinical case report
Y. TAIRA*, J. SEKINE\u2020, T. SAWASE* & M. ATSUTA**Division of Fixed Prosthodontics and Oral
Rehabilitation and\u2020Division of Oral and Maxillofacial Surgical Reconstruction and Functional Restoration, Nagasaki University, Nagasaki,
SUMMARYA clinical evaluation of an implant-sup-

ported overdenture placed in the edentulous man- dible after hemiglossectomy is described. The deltopectoral \ufb02ap covering the mandibular ridge was replaced with a free mucosal graft. Four Bra\u02da ne- mark system implants were inserted into the anter- ior part of the mandible, but one of the four \ufb01xtures did not show osseointegration. The superstructure was designed as a spaced round bar-attachment supported by three implants so as to retain the complete overdenture. In addition to the metal clip,

a silicone-based soft denture liner material was applied in the female portion of the attachment so as to prevent the attachment from making a clat- tering noise upon mastication. Although the over- denture required adjustment at regular intervals, the treatment was successful both aesthetically and functionally for up to at least 10 years.

KEYWORDS: dental implant, overdenture, attach-
ment, tongue carcinoma
Accepted for publication 20 August 2005

When a patient has a compromised residual ridge anatomy as a result of pre-prosthodontic surgery, it is sometimes dif\ufb01cult to achieve comfortable function and aesthetics (1, 2). This challenge has been addressed to a certain extent in oral tumour patients after jaw resec- tion and following rehabilitation with dental implants (3\u20136). In such cases, the implant-supported overden- ture has the advantage of improved function associated with minimum movement, when compared with the conventional complete denture (7, 8). The movement of the overdenture also depends on the shape of the bar-attachment and the number of implants that are splinted (9).

Various osseointegrated implant systems are applic- able to the fabrication of implant-supported overden- ture, and the cumulative survival rates for Bra\u02da nemark and ITI systems supporting overdentures have been reported to be 94\u00c65% for 5 years (10) and 95\u00c67% for 7 years (11) respectively. Some patients prefer removable implant-supported prostheses to \ufb01xed

implant-supported prostheses because of ease of cleaning and improved aesthetics (12). It is essential to maximize the quality of prosthetic components so as to satisfy the expectations of patients.

Previously, we reported a 2-year case of oral reha- bilitation by means of Bra\u02da nemark system* for a patient with tongue carcinoma (13). The present report des- cribes the longer term follow-up of this patient.

Case report

A 52-year-old male with the chief complaint of a tongue ulcer was referred to our hospital. Based on the diagnosis of squamous cell carcinoma on the right- hand side of the tongue, radiation therapy (Linac X-ray\u2020) of 40 Gy and hemiglossectomy were selected as a course of treatment. Following the excision of the carcinoma, the defect in the tongue, oral \ufb02oor and mandible was reconstructed using the deltopectoral

*Nobel Biocare, Go\u00a8 teborg, Sweden.
\u2020Siemens AG, Munich, Germany.
\u00aa2006 Blackwell Publishing Ltd
doi: 10.1111/j.1365-2842.2006.01633.x
Journal of Oral Rehabilitation200633; 313\u2013315

\ufb02ap. Eleven years later, a lesion resulting from in\ufb02ammatory hypertrophic change of the deltopectoral \ufb02ap was surgically removed.

When the patient was seen in the prosthodontic division of our hospital, he requested treatment to restore occlusal function. Thereby, a treatment plan using dental implants was developed.

Fifteen months before surgical placement of the implant, the deltopectoral \ufb02ap was replaced with free palatal mucosa. Four months before implant surgery, hyperbaric oxygen therapy was employed on 15 occa- sions so as to prevent osteoradionecrosis of the irradi- ated mandible. A total of four implant \ufb01xtures (Bra\u02da nemark system*) were inserted into the interfora- minal region of the mandible. This treatment was performed 13 years after the last radiation therapy. The \ufb01xtures were 4\u00c61 mm in diameter and 13\u201315 mm in length. Six months post-implant placement, abutment connection was performed. However, one \ufb01xture did not show osseointegration, and was removed to allow bone healing.

While the overdenture was being constructed, a temporary denture with an underlying tissue condi- tioner\u2021was worn. Following the second implant surgery, a bar-attachment was fabricated using a round-shaped dolder bar with two clips* (Fig. 1).

While using the completed overdenture, the patient complained of a clattering noise made by the bar- attachment upon mastication. A silicon-based soft denture liner (Sofreliner Medium Soft or Sofreliner Tough Medium\u00a7was, therefore, applied into the space between the attachment-bar and metal clip. This resolved the patient\u2019s concern. At 6-monthly check- ups, the overdenture was adjusted and the soft denture liner material was renewed. Neither drug nor radio- therapy was used during the follow-up period.

Based on published criteria (14), implants are con- sidered successful if (i) radiographic evaluation reveals no more than 1\u00c60 mm of marginal bone loss during the \ufb01rst year of loading and no more than 0\u00c62 mm resorp- tion per year in subsequent years; (ii) no peri-implant pathosis or radiolucency is observed; and (iii) severe soft tissue infections, persistent pain, paraesthesia and discomfort are absent. According to these criteria, the implant-supported overdenture in the present case was considered successful over the 10 years of follow-up;

there was no excessive loss of the marginal bone level
(Fig. 2), and the overdenture functioned well.

This report describes a case of oral rehabilitation using an implant-supported overdenture. The surgically induced defect had initially been reconstructed using a deltopectoral \ufb02ap. However, when a \ufb01xture is installed through a deltopectoral \ufb02ap, the soft tissue around the implant is movable (15), and hair grows and keratinous tissue derived from the deltopectoral \ufb02ap make the tissue dif\ufb01cult to clean. Therefore, so as to prevent peri-implantitis, we removed the fat and skin of the deltopectoral \ufb02ap, and replaced the tissue with a free gingival graft (16). To decrease the likelihood of

Fig. 1.Intraoral view 1 year after completion of the superstruc-

ture. The fat and skin of the deltopectoral \ufb02ap were replaced with free palatal mucosa. The superstructure was designed as an overdenture retained with a bar-attachment.

Fig. 2.Radiographs of the Bra\u02danemark system* implant and the
superstructure 10 years after the completion of the superstruc-
\u2021Shofu Inc., Kyoto, Japan.
\u00a7Tokuyama Dental, Corp., Tokyo, Japan.
Y. TAIRAet al.
\u00aa2006 Blackwell Publishing Ltd,Journal of Oral Rehabilitation33; 313\u2013315

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