JICDRO is a UGC approved journal (Journal no. 63927)

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ARTICLE
Year : 2009  |  Volume : 1  |  Issue : 2  |  Page : 33-38

Use of transitional implants for immediate loading in mandibular complete dentures- A case report


1 Professor & H.O.D., Department of Oral & Maxillofacial Surgery, M.G.V.S Dental College & Hospital, Nasik, India
2 Professor & H.O.D., Department of Periodontics & Oral Implantology, Dr. D. Y. Patil Dental College and Hospital, Pimpri, Pune, India
3 Postgraduate Student, Department of Periodontics, Dr. D. Y. Patil Dental College and Hospital, Pimpri, Pune, India

Date of Web Publication4-Mar-2011

Correspondence Address:
Seema Bhoosreddy
Professor & H.O.D., Department of Oral & Maxillofacial Surgery, M.G.V.S Dental College & Hospital, Nasik
India
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Source of Support: None, Conflict of Interest: None


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   Abstract 

After the placement of implants in areas in which several teeth have been lost, both the clinician and the patient face many difficulties, particularly during healing. If no prosthesis is provided, the patient's quality of life suffers. If a removable prosthesis is provided for optimum mastication and speech, many complicated adjustments of the denture may become necessary during healing, and the possibility of osseointegration failure increases. It has been reported that for implants to become osseointegrated, they must heal in the absence of functional loads for 4 to 6 months. To address the need for undisturbed healing and patient demand for uninterrupted immediate function and esthetics, the transitional implant system has been developed. This case report describes the use of transitional implants to support a removable mandibular overdenture. The transitional implant system is a sound and economical method of immediate patient restoration that allows for the protected healing of submerged implants.


How to cite this article:
Bhoosreddy S, Deshmukh V, Kishore A. Use of transitional implants for immediate loading in mandibular complete dentures- A case report. J Int Clin Dent Res Organ 2009;1:33-8

How to cite this URL:
Bhoosreddy S, Deshmukh V, Kishore A. Use of transitional implants for immediate loading in mandibular complete dentures- A case report. J Int Clin Dent Res Organ [serial online] 2009 [cited 2020 Mar 31];1:33-8. Available from: http://www.jicdro.org/text.asp?2009/1/2/33/77276


   Introduction Top


According to the literature and the documented surgical and restorative protocols for submerged and nonsubmerged implants, healing in the absence of functional loads for a period of 4 to 6 months is necessary to achieve osseointegration [1],[2] . In addition, a 2-week healing period is recommended before placing a removable prosthesis in the edentulous area, and the prosthesis must then be relined with a soft-tissue liner every 3 weeks until placement of the definitive prosthesis. For most edentulous patients, the extended wait creates discomfort and inconvenience. As a result, some patients might be reluctant to pursue implant therapy [3] .

To overcome this problem, some clinicians advocated connecting and loading the implants immediately after surgery. This technique is well documented for the implant-retained mandibular overdenture and for the mandibular fixed prosthesis [4] . In these situations, clinicians should be cautious when electing to deviate from the present protocol (eg, 4 to 6 months of undisturbed healing). To address the need for undisturbed healing and patient demand for uninterrupted immediate function and esthetics, the Transitional Implant System has been developed. The transitional implant system is a sound and economical method of immediate patient restoration that allows for the protected healing of submerged implants. This system uses commercially pure titanium transitional implants and can be used in conjunction with the common screw-type implant. This article describes the use of transitional implants to support a mandibular overdenture.


   Case Report Top


A 60-year-old male patient complained of a loosened mandibular overdenture. Patient wanted to have better stability of his existing denture and he demanded to leave the dental office with something which would allow him to chew properly. After reviewing the functional and aesthetic expectations of the patients, clinical and radiographical analysis was done to establish an accurate diagnosis.

Orthopantomograph [Figure 1]A did not suggest any contraindication to implant placement and various laboratory values were within the normal range. Classification of bone quality and dimension was established and integrated in the diagnostic procedure. Treatment plan was formulated and discussed with the patient. Informed consent was taken from the patient. It was decided to place two permanent implants and two transitional implants to prevent any transmucosal load during the 6 months of healing.

Following the surgical protocol, local anaesthesia was administered in the mandibular anterior region and a mid crestal incision was taken followed by raising a full thickness mucoperiosteal flap[Figure 1]B. The width of the bone where the implant was planned to be placed was measured using a osteometer[Figure 1]C. Drill sequence was started using pilot drill and following that paralleling pins were used to check the accuracy of implant angulation. Subsequently following the drill sequence protocol, 2 permanent dental implants (3.3x13mm) were placed [Figure 1]D-F. At the same time, two transitional implants were placed adjacent to it[Figure 1]G. Sutures were given to approximate the edges[Figure 1]H. After primary closure, a sterilized separating paper was slipped over transitional implants to provide protection against contamination and to prevent acrylic from becoming entangled with the suture tags [Figure 2]A. The adjustments were made in the mandibular denture [Figure 2]B and grooves were made in the denture to incorportate plastic copings to adapt to the head of the implant. [Figure 2]C Post operative antibiotics (Amoxicillin 500 mg) and analgesics (Ibuprofen-Paracetamol) were prescribed three times daily starting from 1 hour after surgery up to 5 days . Patient was instructed to use 0.2% chlorhexidine mouthrinse for 1 minute twice daily and to avoid any trauma to the operated area. Patient was scheduled for the follow up visits .Patient left the dental office with a satisfied smile on his face.
Figure 1 A-H

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Figure 2 A-C

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   Discussion Top


Immediate or early stage loading of the implant during osseointegration limits bone growth and maturation. To provide sufficient time to establish bone integration, loading of the implant should be delayed. Because these factors influence the results of implantation, Transitional implant system appear to be an effective means for achieving osseointegration of implant fixtures.

The primary function of the transitional implant system is to absorb masticatory stress during the healing phase, ensuring stress-free maturation of the bone surrounding the submerged implants™. The system continues to expand broadly into diverse applications, such as stress-free maturation of bone grafts, provisionalization of fully and partially edentulous patients, temporary repairs of failing key abutments, and as anchors for orthodontic treatment. In addition to permitting uninterrupted healing of the implant site and/or bone-grafted ridge, the transitional support allows the patient to enjoy a stable prosthesis that will mimic the final restoration [3] .

The decision of whether to utilize transitional implants is made during the initial phase of treatment planning with the patient and the restorative team. Comprehensive medical and dental history is recorded, including any physical deficiencies and functional and aesthetic expectations. Clinical and radiographic examinations are completed, and an accurate diagnosis is established. These procedures include diagnostic casts, face-bow transfers, diagnostic waxing of the hard and soft tissues, periodontal assessment, tomographs, and panoramic radiographs, all of which are used for the selection of the optimal site or sites for the proposed implant placement. Classification of the bone quality and dimension is established and integrated in the diagnostic procedures. Placement Protocol using a diagnostic wax up, jaw dimensions and intraoral relationships are studied to determine the quantity of bone that requires replacement, and surgical templates are prepared and marked for transitional implant location. For visual orientation, the transitional implants can be placed strategically in shallow prepared sites; angulation can be corrected when drilling the channels. Aprotective spacer is placed on the drill shank as a marker for the intended depth, and the osteotomy is created with the profile drill. The transitional implant may be placed initially with a right angle handpiece and driver, and the fixture is tightened with a manual socket key. The transitional implant fixtures can be adjusted chairside and visually aligned.

The thin transitional implants (anchors) are placed next to the definitive implant fixtures, and the elevated overdenture is assembled. Arrangements for the immediate provisional and the eventual definitive prostheses are made simultaneously during treatment planning. The transitional implant system are easily removed by simply unscrewing them when the final abutments are seated. This causes only a minor injury to the implant site and produces no patient discomfort [3] . The transitional implant system is designed to allow the chair side fabrication of restorations for immediate function and patient comfort. The procedure is fairly simple, but it is paramount that practitioners master the detailed sequence of the procedure.

Advantages of transitional implant system are: 1) Provides uninterrupted healing of the implant site and/or bone grafted ridge, 2) Prevents the premature loading of the definitive implant fixtures, 3) Eliminates the requirement of removable appliances during the healing phase, 4) Permits the patient to utilize a provisional restoration with form and function similar to those of the definitive prosthesis. Disadvantages of Transitional Implant system: 1) Excessive loading or placement of the transitional implant fixtures in bone of inadequate volume may result in potential fracture or premature loss of the implant fixture, 2) Placement of transitional implants in close proximity to the definitive implant fixtures may prevent complete integration with existing hard tissues, 3) Another disadvantage of the technique is the amount of chair time required, especially with an inexperienced operator. However, the system provides components for fabrication of the provisional restoration in the laboratory, thus reducing chair time. If the transitional implant systems are not perfectly aligned, the manufacturer provides a bending instrument to correct any misalignment. However, excessive bending may cause failure of the implant.


   Conclusion Top


If removable prostheses are not provided over wide edentulous areas during osseointegration, no patient can escape diminished esthetics and function. Transitional implant system serve to provide the patients with a comfortable provisional restoration.Until further studies demonstrate that immediate loading is a predictable and practical approach in every clinical situation, the transitional implant system is a sound and economical solution. In addition, there is no urgent timetable to complete the permanent restoration, which can be planned to accommodate office schedules and patient availability. Patient compliance and oral hygiene can be evaluated to provide important information regarding the design and the prognosis of the final restoration. Finally, it allows the clinician to test the form and function as well as the esthetics and phonetics of the definitive prosthesis early in the provisional phase. However, further longitudinal studies and long-term clinical evaluation are required to determine the efficacy and acceptance of the system in future.[7]

 
   References Top

1.Adell R, Lekholm U, Rockier B, et al: A 15-year study of osseointegrated implants in the treatment oftheedentulousjaw.IntJOralSurg 10(6):387-416,1981.  Back to cited text no. 1
    
2.BranemarkP-I: Osseointegration andits experimental background. JProsthetDent50(3):399-410, 1983.  Back to cited text no. 2
    
3.Khaled Bohsali: Modular transitional Implants to support the Interim maxillary Overdenture Compendium/October 1999 Vol. 20, No. 10:975-983  Back to cited text no. 3
    
4.Chiapasco M, Gatti C, Rossi E, et al: Implant-retained mandibular overdenture with immediate loading. A retrospective multicenter study on 226 consecutive cases. Clin Oral Implants Res 8(l):48-57,1997  Back to cited text no. 4
    
5.Paul S,Petrugaro: Fixed temporization & bone augmented ridge stabilization with transitional implants 1997,1071-1080;Implant report.  Back to cited text no. 5
    
6.Gottehrer NR, Singer G: Preliminary stabilization of full denture implant patients. Dent Today 15(7):56-60,1996.  Back to cited text no. 6
    
7.Nagata M, Nagaoka S, Mukunoki O: The efficacy of modular transitional implants placed simultaneously with implant fixtures. Compend Cont Educ Dent 20( 1): 39-44,1999  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2]



 

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