Case Study
This case documents the treatment of a 61-year-old male patient with generalized moderate to severe periodontitis who so · Dr. Sajid Baqai
This case documents the treatment of a 61-year-old male patient with generalized moderate to severe periodontitis who sought to replace failing dentition and discontinue use of removable partial dentures. Treatment involved extraction of all maxillary teeth, placement of four implants, bone grafting, fabrication of an immediate snap-on overdenture for the upper arch, and construction of a new mandibular partial denture with proper rest seats and clasping assemblies. The patient reported being very happy with the final restoration, including improved appearance and the ability to eat his favorite foods comfortably.
The patient was a 61-year-old male who presented with failing dentition and a strong desire to move away from conventional removable partial dentures. He was motivated to pursue treatment that would provide better retention, improved function, and long-term preservation of bone structure. The patient was generally cooperative throughout the treatment process, though scheduling follow-up appointments required coordination due to his frequent travel commitments.
The patient's primary complaint was that he wanted to get out of partials and no longer wanted to rely on his partial dentures. He was seeking a more stable, retentive solution that would restore function and aesthetics while eliminating the need for denture adhesives and providing a more comfortable, secure fit.
Clinical and radiographic examination revealed that the patient presented with generalized moderate to severe periodontitis affecting all of his remaining dentition. The upper dentition exhibited primarily severe periodontitis, with several periapical pathologies noted. Specifically, granulomas were identified under tooth number five and tooth number thirty-two. A cone beam CT scan was utilized to evaluate the three-dimensional imaging of available bone, assess any existing infections, and identify the location of sinuses and arteries. This imaging was essential for precise treatment planning and safe implant placement.
For the maxillary arch, two primary treatment options were discussed with the patient. The first option was a straightforward complete denture for the upper arch over a mandibular partial denture, representing a more conservative and economical approach. The second option involved placing four implants in the maxillary arch to support a snap-on denture, also over a mandibular partial denture. This second option was presented with the understanding that it would provide improved retention, eliminate the need for denture adhesives, and help preserve bone through the ongoing stimulation provided by the implants.
After reviewing both options, the patient chose to proceed with the snap-on denture supported by four implants in the upper arch. His decision was based on several factors: the desire for better retention of the denture, the goal of staying away from any denture adhesives, and the importance of maintaining as much bone as possible for the future success and longevity of the restoration. Additionally, the patient agreed to have a new partial denture fabricated for the mandibular arch. He was informed that while partial dentures can be constructed by different providers, proper fabrication with correct rest seats and clasping assemblies is essential to ensure patient comfort and function. This approach balanced immediate functional needs with long-term preservation of bone and supporting structures.
Treatment began with the extraction of all maxillary teeth. Following the extractions, collagen plugs were placed where necessary to assist with clotting and initial healing. On the same surgical appointment, bone grafting material was placed in the extraction sites, and four dental implants were positioned at tooth locations number four, six, eleven, and thirteen. The anteroposterior spread of the implants was planned to provide appropriate support and stability for the future prosthesis. Immediately following implant placement, the surgical sites were grafted and the implants were buried to allow for undisturbed healing.
An immediate denture was fabricated and inserted on the same day as the surgery to aid in healing and provide the patient with teeth during the integration period. The treatment plan called for four to six months of healing time to allow for proper osseointegration of the implants before final loading with the snap-on overdenture. Concurrently, impressions were taken for the mandibular arch, and the patient was provided with an interim lower partial denture for healing purposes while the final partial denture with proper rest seats and clasping assemblies was being fabricated.
The dentures were constructed using acrylic PMMA, a material well-suited for both immediate and definitive removable prosthetics. A cone beam CT scan was an integral part of the diagnostic and treatment planning process. This three-dimensional imaging allowed for detailed analysis of available bone volume, identification of any existing infections, and precise mapping of anatomical structures including sinuses and arteries. This level of detail was critical for safe and accurate implant placement and for determining the appropriate anteroposterior spread of the implants to ensure long-term stability and function of the prosthesis.
The primary challenge encountered during this case was related to the patient's frequent travel schedule. His commitments made it difficult to have him come in at the appropriate times for follow-up care and monitoring of healing progress. Despite this logistical difficulty, the patient managed to provide enough time during his visits for the case to be followed to successful completion. Coordination and clear communication regarding appointment timing were essential to keep the treatment on track.
The patient reported being very happy with his final snap-on overdenture on the upper arch. He expressed satisfaction with the appearance of the restoration and particularly appreciated the improved ability to eat ribs and other favorite foods that had been difficult with his previous partial dentures. He was also fitted with a new partial denture for the lower arch and came in for adjustments to ensure proper fit and comfort. Overall, the patient was very happy with his smile and his restored ability to chew, function, and smile confidently again.
This case illustrates that it is not always necessary to start a patient off with the most expensive treatments available. There is significant value in retaining natural teeth for as long as possible, as they improve the patient's proprioception and chewing ability. Natural teeth allow patients to use their neurosensory system to better understand what they are trying to eat or chew, how much chewing is required before food is ready to swallow, and when it is ready for swallowing. This sensory feedback is critical to effective function and patient satisfaction.
When natural teeth cannot be retained and implants are placed to support a prosthesis, it is important to recognize that with adequate healing time, implants can similarly allow the patient to regain that sensory knowledge. This restoration of proprioceptive feedback contributes to successful chewing and leads to a better prognosis for long-term function. Clinicians should consider not only the immediate functional and aesthetic outcomes but also the patient's long-term sensory experience and overall quality of life when planning treatment.
A snap-on denture is a removable denture that is supported by dental implants placed in the jawbone. Unlike a conventional denture that rests on the gums and may require adhesives for retention, a snap-on denture uses attachments that connect to the implants, providing much better stability and retention. This allows patients to eat a wider variety of foods comfortably and eliminates the need for denture adhesives.
Four implants were chosen to provide a balance between improved retention and bone preservation while remaining a more conservative and accessible treatment option compared to a full arch of implants. The four implants were positioned with an appropriate anteroposterior spread to provide stable support for the snap-on overdenture. This approach offered the patient significant functional improvement, better retention than a conventional denture, and the ability to maintain bone through implant stimulation, all while being more practical than more extensive implant treatment.
Bone grafting was performed simultaneously with the extractions and implant placement to help preserve the volume and contour of the ridge. When teeth are extracted, the surrounding bone naturally resorbs over time. By placing bone graft material at the time of extraction and around the newly placed implants, the goal is to maintain as much bone as possible. This supports the long-term success of the implants and provides a better foundation for the prosthesis, which was an important consideration for this patient.
In this case, the treatment plan called for four to six months of healing time to allow for proper osseointegration, which is the process by which the implants fuse with the surrounding bone. During this period, the implants were buried and covered with bone grafting material, and the patient wore an immediate denture to provide function and support healing of the soft tissues. Once the implants were fully integrated, the final snap-on overdenture was fabricated and attached to the implants.
Yes, partial dentures can be made very comfortable when they are properly designed and fabricated. The key is to ensure that the partial denture includes correct rest seats and clasping assemblies. Rest seats help distribute the forces of chewing evenly and prevent the partial from moving excessively, while properly designed clasps provide stable retention without putting excessive pressure on the remaining natural teeth. When these components are designed and placed correctly, patients can wear partial dentures comfortably and function well. In this case, a new mandibular partial denture was fabricated with these features to provide the patient with a comfortable and stable lower restoration.
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