Rehabilitation of extremely atrophic edentulous mandible in elderly patients with associated comorbidities: a case report and proof of concept

Abstract

Background Oral rehabilitation of the atrophic mandible is, most of the time, a challenging procedure, especially in elderly patients with associated comorbidities. Case presentation This clinical report describes the rehabilitation of an extremely atrophic mandible using an overdenture supported by four splinted implants, two of which are placed in the interforaminal region and the other two bypassing the inferior alveolar nerve at the level of the antegonial notch. A passive-fit bar structure splinting the four inserted implants was designed to compensate for mandibular flexure, to reduce the amount of strain on the implants, and avoid bone resorption and prosthetic failure. The 14-month postoperative cone-beam computed tomography (CBCT) and the clinical follow-up showed the bilateral integrity of the inferior alveolar nerve and the successful restoration of the atrophic edentulous mandible with a significant improvement in the patient’s quality of life. Conclusions The applied technique depicts several benefits such as a minimally invasive approach, reduced number of surgical interventions, reduced total treatment time, reduced treatment costs, and higher psychological acceptability.

Treatment Complications of Head and Neck Cancers and Rehabilitation Measures: A Narrative Review

“…Geriatric patients who are edentulous are not ideal candidates for any noteworthy dental rehabilitation following ablative surgery due to severely atrophic mandible. The mandible usually lacks adequate residual bone for holding endosseous implants for fixed dentures and lacks sufficient alveolar ridge or sulci to support traditional removable dentures [ 15 , 16 ]. Ultimately, these patients will experience suboptimal oral function, leading to a lower QoL.…”

Analytical Modeling of the Interaction of a Four Implant-Supported Overdenture with Bone Tissue

“…In one study, a great deal of evidence for the successful functioning of this type of orthopedic prosthesis was reported with its early assembly for 48 h to 3 months from the moment of placement of four implants in the mandibular dentition or six implants in the maxilla [ 15 ]. Bar retaining overdentures have a number of advantages, for example, the removable overdenture can be reliably fixed, the patient can easily remove and install the overdenture on the bar, the hygienic care of the prosthesis and bar is simple; the conditionally removable bar can be removed and replaced with a new one, the installed overdenture does not move while eating, and thus does not cause discomfort and inconvenience [ 16 , 17 ]. Usually, an orthopedic structure with a bar retaining system is placed in several clinical and laboratory stages [ 18 ]: After planning the orthopedic treatment, implants are placed.…”

Biomechanical evaluation of implant system fixed dentures support in atrophic maxilla

“…Due to technological advances, research indicates that rehabilitation with implants of atrophic mandible offers a minimally invasive approach, reduced number of surgical interventions, reduction of the total treatment time, reduced treatment costs and increased acceptability 4,5 . Some authors noted that treatment planning and delivery was facilitated and optimized with the aid of digital technologies (CAD/CAM) 6 , since it allowed the reduction of complications during the installation of implants and in prosthetic rehabilitation with reduction of risks, costs, number of treatment sessions 7 .…”