Here is my article on implant over denture published in Dental Practice journal, south east Asia edition. I believe this article will help both the dentists and well as the needy patients to understand the quality life after the implant supported over dentures. For more information and to consult for the similar or any implant procedure pls write me at my id drajaydentalclinic@gmail.com you can also visit my websites to know more about our implant treatment options and implant training programs. our websites are www.dentalimplantclinicindia.com and www.implanttrainingindia.com

1. implantology section
Quality life for elderly edentulous
patients with implant overdentures
AJAY VIKRAM SINGH, SUNITA SINGH & ALEJANDRO VIVAS ROJO
INTRODUCTION
The prosthetic management of the completely edentulous patient has long been a major
challenge for dentistry. The conventional
edentulous ridge supported dentures, well
over centuries, has been the traditional standard of care for these patients but most
patients could not achieve the satisfactory
comfort with the conventional dentures and
suffer with several problems such as inadequate retention and stability, inability to chew
and eat, soft tissue abrasions, continuous
bone loss, phonetics problem, longer adaptation period, teeth setting in the neutral zone
causing altered maxillofacial relations.
Hence, the implant-retained overdentures
can be one of the ultimate options for these
patients because it offers several benefits over
the conventional ridge supported dentures
such as improved function, improved retention and stability, reduced size prosthesis,
improved chewing efficiency, decreased soft
tissue abrasion, improved maxillofacial prosthesis, and prevention of further ridge loss.
While most implant-based treatment has
historically been focused on fixed implant
supported prosthesis, the implant overdenture offers several benefits over fixed implant
prosthesis to the edentulous patients in terms
of improved function, physical health, and
esthetics, lower treatment cost, less invasive
procedures (no bone augmentation procedures are usually required), easy maintenance
and repair. The implant overdentures have
only fewer disadvantages over the fixed prosthesis such as psychological feeling of bearing
removable prosthesis, regular maintenance,
relining, change of components, food
impaction under the prosthesis, and loss of
ridge in the posterior segment where the
implants have not been placed.
A step by step proper evaluation and treatment planning for the patients seeking
implant retained prosthesis has been shown
to result in an improved quality of life for
patients and predictable results leading to
clinical success. The indication for implant
prosthesis may be limited due to inadequate
FIG 1: Facial Appearance of the patient during his first
appointment
FIG 2: Clinical evaluation showing multiple missing
teeth and periodontitis, generalized attrition, and
abfractions in the remaining teeth
FIG 3: Preoperative radiograph showing need for
extraction and replacement of all teeth
FIG 4: Case planned using CT planning software to
place adequately long implants
FIG 5: Teeth are extracted and implants are immediately placed into the extraction sockets
quantity and structure of the bone.
Enhancement of esthetic appearance and
facial morphology through replacement of
lost hard and soft tissues may be proven easier, if not more effective, with removable overdentures than with conventional fixed prosthesis, with possibly decreased costs and less
22 Dental Practice // May-June 2013 // Vol 11 No 6
surgical intervention.
When the patient seeking a full mouth
prosthesis enters the clinic so many factors
“which are very important” should be evaluated before reaching a decision for that particular prosthesis. These factors include age of
the patient, medical problems, physical
health, his or her ability to undergo grafting
procedures, ridge form, soft tissue situation,
maxilla-mandibular relation, cause of teeth
loss, bone density and availability to insert
implants, number of implants required to
provide fixed or removable prosthesis,
patient’s expectations from the final prosthesis, patient’s ability to maintain the prosthesis, and cost affordability to the patient.
There is abundance of literatures presenting a variety of treatment options, case
reports, and clinical techniques over the past

2. FIG 6 & 7: Peri-implant socket spaces are grafted, transgingival healing abutments are immediately placed on top
of implants and sutures are placed to approximate the soft tissue
FIG 8: Healing after 6 weeks
FIG 9: Denture
FIG 10: Posterior teeth are extracted one week before
the denture placement
30 years, but there is a general consensus
about the treatment protocols and long term
documented benefits of implant overdentures. In the author’s clinical practice, this
treatment option has become the most
rewarding care for the edentulous elderly
patients with increased life expectancy and
chewing benefits. Although there still remains
a lack of consistency in terms of techniques,
prosthetic design, and attachment systems,
these aspects have been proven less important
to successful outcomes than once thought.
there was almost complete loss of vertical
bone dimension in the posterior maxilla due
to long time edentulism in the region and
sinus pneumatization. In the mandibular
posterior segments the teeth were intact but
showed large osseo-defects which mandate
the grafting procedures to place adequately
sized implants in the region (Figure 3). In the
anterior maxilla, the teeth number 21, 22,
and 23 showed exposed canals with tooth
number 21 showing periapical radiolucency
in the radiograph but teeth were asymptomatic clinically.
After clinical and radiographic evaluations, the authors reached the decision for the
extraction of all remaining teeth and placement of full mouth prosthesis. Now to present various replacement options, the patient
was evaluated for his physical health, medical
problems, and financial status to bear the
treatment cost. On general evaluation and
medical history, it was found that the patient
was fit for the dental implant procedure. To
confirm medical fitness, blood investigations
were done for general blood picture, blood
sugar level (random), thyroxin along with
blood pressure and ECG.
Various options were now offered to the
patient for teeth replacement. Keeping in
mind various aspects such as his age, poor
oral hygiene maintenance habit, heavy bite
CASE REPORT
Examination and Treatment Planning
A 70 year old male patient reported at our
clinic for the replacement of a few missing
teeth and treatment of his periodontically
diseased teeth (Figure 1). On clinical evaluation, it was found that the patient had lost a
couple of his teeth because of periodontitis
and remaining teeth showed signs of periodontal disease such as periodontal pockets
and mobility. It was also found that the
patient has generalized attrition and abfractions due to heavy bite forces on the teeth
(Figure 2). On radiographic evaluation
(panoramic radiograph), the periodontal
bone loss was found with most of the remaining teeth. An abundant bone height was seen
in the anterior segment of both arches but
forces and inadequate bone in posterior segments to insert implants, affordability and
patient’s expectations from the new prosthesis, the implant retained over denture was
finalized as the definitive treatment option.
To evaluate the exact bone dimensions
and bone density, the CT planning was done
for the patient using Implant 3D software so
that adequately long and wide implants can
be inserted with minimal surgical intervention and stabilized into the cortex to achieve
adequate initial stability (Figure 4). Based on
CT planning, placement of three long
implants (3.75 x 18) in the anterior mandible
and four implants (3.75 x 18) in the anterior
maxilla immediately into the extraction sockets were planned. After the dental hygiene
appointments for scaling and root planing to
eradicate the deep pockets and minimize
infection to the implants, the case was scheduled for the implant surgery. The patient was
prescribed tab Valium 5mg at night before
the surgery for sound sleep and tab
Augmentin (1 gm) one hour before the
implant surgery.
CLINICAL PROCEDURES
The anterior teeth were extracted with minimal trauma to the alveolar bone and soft tissue and the granulation tissue was curetted
out from the sockets. The extraction sockets
were irrigated with parental form of clindamycin to kill all the residual pathogens in
the sockets before implant osteotomy preparations. The implant osteotomies were prepared through the sockets to reach the basal
bones (nasal floor and base of the mandible).
All the implants were stabilized into the cortex to achieve high initial stability (more than
40 Ncm), hence the transmucosal abutments
were immediately screwed on top of implants
(transgingival implant placement/ single
stage implant surgery). The periimplant socket spaces were grafted using synthetic bone
Dental Practice // May-June 2013 // Vol 11 No 6
23

3. implantology section
FIG 11 & 12: Healing abutments are removed and replaced with ball attachments
FIG 13 & 14: Plastic caps are seated into the metal cap
plastic ball caps; female part are seated into
the metal ball caps (Figures 13 & 14). The ball
caps are seated on top of ball attachments in
the mouth (Figure 15). The tissue surface of
the denture is hollowed at the site of implants
to accommodate the ball caps (Figure 16).
The dentures are tried in the mouth for their
complete seating over the ball caps (Figure
17). A piece of rubber dam sheath is placed
under the metal balls to avoid the self cure
resin to get flow and locked into the undercuts (Figure 18). The self cure acrylic resin is
mixed and filled into the tissue surface of the
dentures and dentures are seated in the
mouth in the correct occlusion (Figure 19).
Authors would like to mention here that the
separating media (petroleum jelly) was
applied over the denture except the tissue
surface to avoid sticking of the acrylic over
the teeth and flanges. Once the acrylic hardens, the dentures were removed from the
mouth. The ball caps came out embedded
within the tissue surface of the dentures
(Figure 20). The palatal extension of maxillary denture is removed and flanges are short-
FIG 15: Caps are placed onto the ball attachments in
patient’s mouth
FIG 16 & 17: Tissue surface of the denture is hollowed to make space of the ball caps
substitute (HA+ β-Tcp). No barrier membrane was used. The sutures were placed to
approximate the tissue to fasten healing and
to prevent loss of graft (Figure s5-7).
Posterior teeth were extracted but a couple of
teeth which were in occlusion were left to
maintain the same chewing efficiency and
also to record the same jaw relations for denture fabrication. Patient was put on antibiotics and analgesics only for 3 days postoperatively. An interim removable prosthesis was
given to the patient for his anterior segments
which got stabilized onto the healing abutments.
Patient was recalled after 6 weeks for the
denture fabrication, when soft tissue was
healed and implant achieved secondary sta-
bility into the bone (Figure 8). Impressions
were made and bite registration was done.
Maxillary and mandibular models were articulated using semi adjustable articulators,
teeth removed from the models and teeth setting was done. The final denture was fabricated in the laboratory (Figure 9). Patient was
recalled and the remaining teeth were extracted. When the extraction sockets got primarily healed in a weeks time, patient was recalled
for the final denture delivery (Figure 10).
The transmucosal healing abutments are
removed from the implants and replaced
with the appropriate sized ball abutments;
male part (Figures 11 & 12). The ball attachments are finally tightened to 35Ncm using
torque ratchet to avoid future loosening. The
24 Dental Practice // May-June 2013 // Vol 11 No 6
ened (Figure 21). The dentures are finished
and polished and seated over the implants in
the mouth (Figure 22 & 23). A post-loading
panoramic radiograph was done to evaluate
the accurate seating of the denture components (Figure 24). The patient experienced an
outstanding satisfaction in denture retention,
stability, chewing efficacy, improved maxillofacial relations (improved appearance) from
day one after placing the implant retained
dentures in mouth (Figure 25).
CONCLUSION
Conventional ridge supported dentures
have been used as the only standard of care
for decades but implant supported overdenture offers numerous benefits over the

4. FIG 18: Piece of rubber dam is placed to block the
undercuts under the ball caps
FIG 19: Self cure resin is filled into the denture and
dentures are seated in mouth in occlusion over the
ball caps
FIG 21: Palatal extension and denture flanges are
removed
FIG 22 & 23: Finally finished and polished dentures seated in the patient’s mouth
patient evaluation, treatment planning,
ideal communication among surgical, laboratory, and restorative colleagues, implant
overdentures provide simple, predictable,
and cost-effective treatment to edentulous
patients. Additionally, they provide the
FIG 20: Dentures are removed from the mouth after
the acrylic has set carrying the ball caps embedded
within the dentures
benefits of esthetics, phonetics, bone preservation, increased comfort, better psychosocial state, and enhanced nutrition, all resulting in an improved quality of life.
For a complete list of references, email
info@dental-practice.biz
About the AUTHORS
FIG 24: Post loading radiograph
FIG 25: A satisfied patient with great satisfaction after
using implant over dentures
conventional dentures in terms of
improved retention, improved chewing efficacy, improved maxillofacial relations,
improved speech, reduced size prosthesis
and much more. Through meticulous
Dr. Ajay Vikram Singh after his graduation in dentistry
and receiving PG. certificate training in Implantology from
India, received advanced level implant training at various
centers and continuing education programmes in USA. He
also received continuing education in implantology at the
School of Dentistry, The University of Queensland in
Australia. Currently, He is an internationally acclaimed
mentor, speaker and researcher in the field of implantology. He has spoken as the key note speaker in the various national and international implant conferences in
India and abroad. Besides being the active member of
various prestigious implant associations, he is the fellow
and Diplomate of international congress of implantology
(ICOI). He is the founder president of International
Academy of Implant Dentistry. Dr. Ajay has authored a
dental implant book Title “Clinical Implantology”
Published worldwide with “Elsevier”. Dr. Ajay is the
founder of International Implant Training Centre (IITC),
Agra where he trains several dentists from India and
abroad in basic and advanced level implantology. Dr. Ajay
does the private practice at Dr. Ajay Dental Clinic &
Research Centre, Agra. He can be reached at drajaydentalclinic@gmail.com
Dr. Sunita Singh received continuing education in esthetic
and implant dentistry, and fixed orthodontics at various
centers in India and USA. She has attended and presented
in many national and international dental conferences.
She has received training in Cosmetic Dentistry from
Washington University (USA). She is a member of
American College of Prosthodontists in USA. She is a
member of various prestigious implant associations and
has co-authored the text book in implantology title
“Clinical Implantology”. She has been practicing with Dr.
Ajay Vikram Singh since 2003 at Dr. Ajay Dental Clinic and
Research Center, Agra.
Alejandro Vivas Rojo. DDS Ms. (Venezuela) is an Oral and
Maxillofacial Surgeon. Member, American Association of
Oral and Maxillofacial Surgery. He is attending Surgeon at
Hospital dos Lusiadas; Oral and Maxillofacial Service.
Lisbon-Portugal.
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