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| CASE REPORT |
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| Year : 2021 | Volume
: 8
| Issue : 3 | Page : 208-211 |
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Transition of failed cement-retained prosthesis to screw-retained implant prosthesis
Nirmal Kurian, Sumir Gandhi, Harit Talwar, Angleena Y Daniel, Kevin George Varghese
Department of Prosthodontics, Christian Dental College, CMC, Ludhiana, Punjab, India
| Date of Submission | 04-Jul-2020 |
| Date of Decision | 22-Oct-2020 |
| Date of Acceptance | 17-Aug-2021 |
| Date of Web Publication | 04-Mar-2022 |
Correspondence Address:
Nirmal Kurian
Department of Prosthodontics and Crown & Bridge, Christian Dental College, CMC Ludhiana, Punjab
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/cjhr.cjhr_86_20
Prosthesis failures in cement-retained implant restorations can be managed by transforming the restorations into screw-retained prosthesis to meet the current implant treatment philosophies for large full-arch reconstructions. The challenges involved in this case report multiplied due to unavailability of components for older systems of implants and had to be managed with a framework which permits engagement of implant and abutment level connection simultaneously. The case report highlights the transition of failed cement-retained prosthesis to screw-retained prosthesis for predictable future retrievability and enhanced clinical performance.
Keywords: Cement-retained prosthesis, dental implants, implant impressions, multiunit abutments, screw-retained prosthesis, verification jigs
How to cite this article:
Kurian N, Gandhi S, Talwar H, Daniel AY, Varghese KG. Transition of failed cement-retained prosthesis to screw-retained implant prosthesis. CHRISMED J Health Res 2021;8:208-11 |
How to cite this URL:
Kurian N, Gandhi S, Talwar H, Daniel AY, Varghese KG. Transition of failed cement-retained prosthesis to screw-retained implant prosthesis. CHRISMED J Health Res [serial online] 2021 [cited 2022 May 28];8:208-11. Available from: https://www.cjhr.org/text.asp?2021/8/3/208/339052 |
| Introduction | |  |
The concept of implant therapy has achieved a highly predictable status and has been witnessing rapid growth and popularity.[1] The implant treatment concepts that were once deemed right for its time are becoming obsolete owing to a remarkable evolution in materials and designs in implant components and techniques. The management of failures or complications of older implant prostheses proves to be a challenge when the implants are still well osseointegrated, but the prosthesis has failed. Such cases are a challenge as the aim of treatment focuses on to rehabilitate patients with concepts that are conforming to the contemporary treatment philosophies and will make the prosthesis sustainable for prolonged periods. The case report showcases management of failed cement-retained prosthesis by transition to an improved screw-retained prosthesis for predictable future clinical performance.
| Case Report | | |
The patient, 70-year-old male, reported to the department of prosthodontics with dislodged anterior six-unit porcelain fused to a metal prosthesis. On examination, a fractured implant segment along with abutment was cemented within the dislodged six-unit PFM bridge and poor occlusal relationship with occlusal wear off of ceramics on all crowns intraorally. Orthopantogram (OPG) confirmed a fracture of the implant in the maxillary left premolar [Figure 1]. To improve the existing intraoral situation, a new screw-retained implant prosthesis was planned with addition of newer implants in key areas such as maxillary canine (#23) and posteriors (#15, 26) to have better stress distribution among implants. The existing implant systems (Leader) were a decade old with nonavailability of multiunit components. Post cone beam computed tomography evaluation, newer implants (Osstem) were placed at #23 (3.5 mm × 11.5 mm), #26 (3.5 mm × 11.5 mm), #14 (3.5 mm × 11.5 mm), and multiunit abutments placed [Figure 1]. After 4 months of waiting period, prosthodontics reconstruction phase was initiated. At the first visit, a primary open-tray impression was made with a stalk tray using polyvinylsiloxane light body - putty combination (Flexceed, GC India). The impression copings for three newer implants were connected at abutment level and older implants were connected at implant level. This was due to the availability of multiunit abutments on newer implants and absence of components for older systems. A pattern resin (GC Corporation, Tokyo, Japan) implant verification jig connecting implant impression coping on the primary cast was fabricated in the laboratory [Figure 2]. The jig was sectioned between implant impression copings and re-attached intraorally when impression copings were attached to implants. The segments were joined intraorally on the addition of pattern resin in spaces between the segments to make one single piece jig. The final impression with polyvinylsiloxane addition silicone light body - putty material – was made with custom tray and the master cast was poured [Figure 3], [Figure 4], [Figure 5]. Record bases were fabricated and the accuracy of impression was further validated at jaw relation stage. Jaw relations were recorded and wax try-in was done and the patient was satisfied with esthetics. A titanium metal framework connecting newer implants at abutment level and older implants at implant level was fabricated [Figure 6]. The fit of framework was validated with OPG. Final prosthesis with individual porcelain fused to metal crowns on framework was seated and tightened to satisfactory torque [Figure 7] and [Figure 8]. The prosthesis achieved better esthetics, occlusion, and function on immediately post insertion and is being re-evaluated every 6 months as part of regular follow-up. | Figure 1: Orthopantogram revealing fractured dental implant (encircled in red) at #24 site
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 | Figure 2: Implant verification jig fabricated and segmented between individual impression copings
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 | Figure 7: Orthopantogram showing passive fit of metal framework on implant level and abutment level combination
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| Discussion | | |
The most common causes of prosthetic failures in long-span cement-retained implant restorations are poor occlusion and consequences of excess luting cement.[2] It has been shown that incomplete removal of cement may result in peri-implant inflammation, soft-tissue swelling, soreness, bleeding or exudation on probing, and resorption of peri-implant bone. The solution for these clinical situations is using screw-retained restorations.[3],[4],[5],[6] In spite of all the proposed techniques to improve the retrievability of cement-retained restorations, screw retention becomes more necessary in extensive cases where prosthesis needs more maintenance.[7] Large, full-arch implant reconstructions are generally preferred to be screw retained because complications in these long-span prostheses are more common than those of short-span ones[1],[8] The main advantage of screw-retained restorations is the predictable retrievability that can be achieved without damaging the restoration or fixture.[9] Therefore, the prosthodontic components can be adjusted, the screws can be refastened, and the fractured components can be repaired with less time and at lower cost than would be the case with cement-retained restorations and that was prima facie the reason to plan a screw-retained prosthesis for the patient.[1] The failed implant was fractured at midsection and invasive procedures to retrieve it was of no use as newer implant sites were different and fractured implant site showed no pathology. The case report highlights the use of unsplinted open-tray impression with stalk trays at the first visit and fabrication of implant verification jig from laboratory for the second visit.[10] The use of laboratory fabricated jig will result in a significant reduction in chairside time for the patient, less consumption of pattern resin for the clinician, and eventually improves the accuracy of implant impressions. The final impression involved a custom open-tray impression technique using a segmented verification jig which was splinted intraorally to compensate for polymerization shrinkage associated with pattern resin to further enhance the accuracy of the final impression.[8],[10] The unavailability of multiunit abutments for older systems of implant dictated the need for a combination of implant level and multiunit abutment level, which with the aid of appropriate impression technique enabled a passive fit of framework and increased implant number further enhanced stress distribution among implants.
| Conclusion | | |
Management of failures in implant prosthesis is challenging and will necessitate the introduction of present-day treatment strategies to make the final prosthesis sustainable for prolonged periods. Transition from cement-retained to screw-retained prosthesis will result in predictable retrievability for future maintenance and improved clinical performance of implant prosthesis.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8]
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