Management of biomechanical complication of implant-supported restoration of a patient with combination syndrome: a case report

Anterior Hyperfunction by Mandibular Anterior Teeth: A Narrative Review

"Combination syndrome", defined by Kelly in 1972, is a challenging condition observed in a patient with an edentulous maxilla and a partially edentulous mandible with only mandibular anterior teeth. "Anterior hyperfunction syndrome" is regarded as a synonym of combination syndrome and was first described in 1994. Although these terms have been well known, the definition of "anterior hyperfunction" has not been described yet. This narrative review focused on anterior hyperfunction and discussed the etiology and the clinical managements. An electronic bibliographic search for this literature review was conducted in addition to the review of our clinical cases. The previous reports indicated that combination syndrome with all five features was rarely observed. The patients with anterior hyperfunction generally showed the loss of posterior occlusal supports and the loss of vertical dimension of occlusion. To manage anterior hyperfunction, these conditions should be improved using conventional removable prostheses and implant-supported prostheses. Anterior hyperfunction is attributed to mandibular anterior teeth and some interventions for mandibular anterior teeth are required in many cases. Additionally, it must be noted that implant-supported prostheses may lead to anterior hyperfunction. In conclusion, comprehensive approaches for the remaining teeth and the prostheses will be required to manage this complex condition.

Applications of maxillary tuberosity block autograft

OBJECTIVE

Autogenous bone grafts are considered the gold standard due to their compatibility and osteogenic potential to induce new bone formation through osteogenesis, osteoinduction, and osteoconduction. The aim of this paper was to describe clinical applications of the maxillary tuberosity block autograft in small and moderate localized defects of the alveolar process around implants and teeth.

CLINICAL CONSIDERATIONS

Maxillary tuberosity is often used as a particulate graft for augmentation of deficient alveolar ridge or maxillary sinus prior to or simultaneously with implant insertion, but not as a bone block graft. The maxillary tuberosity block autograft may also provide a valuable bone source for challenging situations such as immediate implant placement into types II and III extraction sockets, treatment of horizontal and vertical bone defects with simultaneous implantation, reconstruction of circumferential defects around implants, and preservation of alveolar ridge.

CONCLUSIONS

The advantages of the maxillary tuberosity include intraoral corticocancellous autogenous graft with fewer intraoperative difficulties, no need for donor site restoration, less morbidity, and an excellent correction of localized alveolar ridge defects.

CLINICAL SIGNIFICANCE

Within the limitations of the presented case reports, the use of maxillary tuberosity block autograft has shown to be successful in alveolar ridges augmentation that lack both width and height.

Case Report: Treating Severe Atrophic Maxillary Arch with Horizontal Ridge Augmentation

A deficient maxillary edentulous ridge volume can be augmented by onlay grafting technique for implant placement to support fixed hybrid screw retained prosthesis. Various techniques have been used to correct defective bone. These augmentation techniques include inlay and onlay grafts, bone splitting osteotomy, and distraction osteogenesis, among others. Successful reconstruction depends on multiple biological factors as well as patient compliance. Here, I report a case of ridge augmentation using onlay cortico-cancellous particulate bone grafting, resorbable collagen membrane, and bone tac pins, followed by surgical implant placement with multiunit abutments to support the fixed prosthesis.

Temporomandibular disorder treatment in a patient wearing removable prostheses: A case report

AIM

The purpose of this intervention was to treat the patient, a 51-year-old woman, who was wearing a maxillary denture and a mandibular bilateral distal-extension partial denture (both unfit) and was suffering from temporomandibular disorder (TMD).

METHODOLOGY

The treatment suggested was to construct a superior repositioning splint (SRS), and after remission of the symptomatology, fabricate new dentures.

RESULTS

The occlusal splint was effective and the symptomatology ceased after about five months of treatment. The new dental prostheses were made and followed up for 10 years with no return of the pain.

CONCLUSIONS

SRS and subsequent construction of new dentures after remission of the symptomatology was an effective treatment for TMD in the case described.

Signs of Combination Syndrome and removable partial denture wearing

Introduction: Combination Syndrome (CS) is a pathological condition observed in maxillary complete denture (CD) and mandibular removable partial denture (RPD) wearers. Purpose: The aim of this study was to observe and measure the prevalence of CS signs in treatment-seeking wearers of maxillary CD associated or not with RPD (mandibular Kennedy Class I). The association between RPD wearing and the number of CS clinical signs was also evaluated. Material and method: The sample included 62 patients seen at the Department of Dentistry, Federal University of Rio Grande do Norte (UFRN). A clinical oral examination was conducted to assess the presence of specific clinical signs of CS as described by Kelly (1972): bone resorption in the maxillary anterior region, tuberosity overgrowth, palatal papillary hyperplasia, extrusion of mandibular anterior teeth and bone resorption in the mandibular posterior region. The chi-square test at the 95% level of significance was used to test the association between dependent and independent variables. Result: Mandibular resorption was the most frequent complication (93.5%). There was a statistically significant difference between RPD wearers and non-wearers with regard to extrusion of mandibular anterior teeth (p = 0.045). Conclusion: Within the limitations of the present study, a high prevalence of CS clinical signs was observed, but no association between RPD wearing and syndrome characteristics was found.

Scanning electron microscopy observations of osseointegration failures of dental implants that support mandibular overdentures

AIM

: Investigating possible failure causes of mandibular implants after their immediate loading with an overdenture retained with bilateral bar attachments, using scanning electron microscope.

PATIENTS AND METHODS

Twenty edentulous male patients were included in the present study. Each patient had 2 fixtures inserted in the canine and the first molar areas on each side of the mandible. After abutments screwing, the 2 fixtures on the same side were splinted with a bar, and immediately loaded with an overdenture. Implants mobility was assessed on weekly basis. Failed implants were removed, and examined by scanning electron microscope.

RESULTS

The failed implants, removed after 4 weeks of treatment, showed an intimate contact of mineralized and osteoid tissues with dense collagen-rich matrix in the apical third of implants. Furthermore, newly developed bone was observed at the same area in implants removed after 7 weeks. However, there was no evidence of such growth at the middle and/or cervical thirds in either case.

CONCLUSION

Lack of osseointegration at the middle and cervical thirds of the root could be a possible cause of implant failure. Early loading by an overdenture retained with bilateral bars is considered a major contributing factor to incomplete osseointegration of the supporting implants.

Rehabilitation of reabsorbed maxillae with implants in buttresses in patients with combination syndrome

PURPOSE

To assess the success and marginal bone loss, after 1 year of loading, of implants placed in anatomic buttresses of atrophic maxillae to rehabilitate patients with combination syndrome.

MATERIALS AND METHODS

A case series retrospective study of 22 patients with combination syndrome who were treated with implants in anatomic buttresses in the atrophic maxilla was performed. The inclusion criteria were Classes IV and V Cawood and Howell maxillary atrophy, rehabilitation with implants placed in anatomic buttresses, the presence of anterior remnant teeth in the mandible, and a minimum follow-up of 12 months after implant loading. The criteria of Buser et al were used to evaluate implant success, and marginal bone loss was measured on periapical radiographs. Statistical analysis was performed to relate implant success and marginal bone loss to gender, degree of maxillary atrophy, implant technique, and prosthesis type.

RESULTS

A total of 18 patients fulfilled the inclusion criteria. A total of 117 implants were placed; 32 were placed with the conventional technique in the alveolar ridges with enough height and width, 35 were positioned palatally, 30 were tilted in the frontomaxillary buttress, 10 were placed in the pterygomaxillary area, 6 were placed in the nasopalatine canal, and 4 were zygomatic implants. The follow-up ranged from 1 to 7 years after implant loading. Of the 117 implants, 7 failed, for an implant success rate of 94%. The mean marginal bone loss was 0.63 mm. A statistically significant relation was found between bone loss and implant placement technique and the level of maxillary atrophy, being greater in tilted implants and in Class V Cawood and Howell maxillary atrophy.

CONCLUSIONS

Implants in anatomic buttresses allow rehabilitation of atrophic maxillae in patients with combination syndrome. The implant success rate was high, and a mean marginal bone loss of 0.63 mm was recorded.