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 Table of Contents  
CASE REPORT
Year : 2021  |  Volume : 13  |  Issue : 6  |  Page : 1759-1762  

Distally edentulous maxillary left-sided arch with pneumatized sinus area restored with corticobasal implants - A case report


1 Consultant, Department of Oral and Maxillofacialsurgeon, Krishna Dental Clinic, Erode, Tamil Nadu, India
2 Senior Lecturer, Department of Prosthodontics, KSR Institute of Dental Science and Research, Tiruchengode, Tamil Nadu, India
3 Consultant, Department of Orthodontist, Krishna Dental Clinic, Erode, Tamil Nadu, India
4 Professor, Department of Oral and Maxillofacial surgery, KSR Institute of Dental Science and Research, Tiruchengode, Tamil Nadu, India
5 Private practioner, Krishna dental clinic, Erode, Tamil Nadu, India

Date of Submission12-Feb-2021
Date of Decision22-Feb-2021
Date of Acceptance22-Apr-2021
Date of Web Publication10-Nov-2021

Correspondence Address:
K A Biju
Senior Lecturer, Department of Prosthodontics, KSR Institute of Dental Science and Research, Tiruchengode, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpbs.jpbs_75_21

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   Abstract 


Restoration of severely atrophied ridges with conventional implants requires extensive surgical procedures which are totally expensive, and it also involves a great deal of postoperative discomfort to a patient. In such situations, basal implants come to rescue for rehabilitation where it utilizes the cortical bone for anchorage. The availability of several designs of these implants that exist today has made basal implantology flexible enough to accommodate any situation. This article is a case report of the patient whose maxillary arch was fully rehabilitated with endodontically treated teeth and fixed partial denture. The remaining edentulous region in the maxillary left side was treated with corticobasal implants and was rehabilitated with a fixed PFM prosthesis. The above-mentioned case has a follow-up of 3 years, and still, the implant-supported prosthesis provides better function for the patient.

Keywords: Basal implant, conventional implants, corticobasal implants, peri-implantitis


How to cite this article:
Radhakrishnan S, Biju K A, Anbuselvan GJ, Chinnannan M, Sivakumar KD. Distally edentulous maxillary left-sided arch with pneumatized sinus area restored with corticobasal implants - A case report. J Pharm Bioall Sci 2021;13, Suppl S2:1759-62

How to cite this URL:
Radhakrishnan S, Biju K A, Anbuselvan GJ, Chinnannan M, Sivakumar KD. Distally edentulous maxillary left-sided arch with pneumatized sinus area restored with corticobasal implants - A case report. J Pharm Bioall Sci [serial online] 2021 [cited 2022 Aug 16];13, Suppl S2:1759-62. Available from: https://www.jpbsonline.org/text.asp?2021/13/6/1759/330145




   Introduction Top


Restoring a missing tooth and recreating a healthy smile, comfort, and function are the major roles of prosthetic rehabilitation. Earlier, removable partial denture was the most frequently used. However, due to discomfort and inefficiency in chewing food, patients had changed their preference to get a fixed prosthesis. As Dr. Stefan Ihde says, “No one should be denied implant treatment as they do not have enough bone.”

Earlier, rehabilitating distally edentulous patients with a fixed prosthesis was an impossible task. Nowadays, dental implants have taken a major role in the replacement of missing teeth. However, conventional implants have certain limitations depending on the quality of bone, available bone width and height, adjacent anatomical areas, etc. These implants mostly achieve their stability from the crestal bone, but these areas are less dense in nature and are more prone for the primary site of infection. If a proper surgical protocol is not followed, it might lead to infection and failure of implants and also it was not advised for moderately or severely atrophied ridges. To overcome these issues, Dr. Jean-Marc Julliet developed the first single-piece implant in 1972. In the 1980s, Dr. Gerard Scortecci introduced an improved basal implant of disk type with its own set of cutting tools. Based on this design, many dentists from Germany have developed the basal osseointegrated (BOI) implant. Later, Dr. Stefhen Idhe in 2005 introduced bending areas in the vertical shaft.[1]

Basal implants receive their anchorage from the cortical bone which was deeper and in which the resorption rate is very minimal. These sites are not frequently prone for infection. Basal implants are similar to the orthopedic implants since these implants receive their primary stability from the cortical bone. These implants should be immediately loaded within 72 h.[2] With basal implants, patients with severely atrophied ridges are rehabilitated with fixed ceramic prosthesis in mouth, which was earlier considered as an impossible task even with the use of conventional implants without any augmentation procedure.[3] The maxillary posterior region has a higher amount of hindrance by the maxillary sinus. Usually, there will be less amount of bone available in the maxillary posterior region; once if the patient had extracted the teeth and if it is not replaced at the earliest, maxillary sinus may pneumatize and there will be less amount of bone available for the implant. In such case, conventional implants cannot be planned without a sinus lift or any secondary surgical procedure. However, in basal implantology, cortical region in the sinus area, i.e., palatine bone, which has more density of cortical area, was used for primary stability. Hence, if a proper engaging of cortical bone is done with basal implants, they provide a higher range of success rate.

This article is a case report of the patient in which the maxillary arch was fully rehabilitated with endodontically treated teeth and fixed partial denture. The remaining edentulous region in the maxillary left side was treated with corticobasal implants and was rehabilitated with ceramic bridge. The above case has a follow-up of 3 years, and still, it provides better function for the patient.


   Case Report Top


A 58-year-old female patient reported to our private dental clinic with a chief complaint of poor facial appearance and difficulty in chewing food. On examination, there were multiple missing teeth in both right and left sides of the maxillary arch. The patient was diagnosed as partially edentulous maxillary arch. According to the Kennedy's Classification, the existing patient condition comes under Class II Modification 1. Natural teeth present were maxillary anteriors from canine to canine and right side maxillary first molar. All the existing natural teeth were periodontally sound and there was no mobility present, but the teeth were attrited. The patient had no relevant medical history or systemic illness. Treatment options explained to the patient were endodontic treatment of the existing natural teeth and using those teeth as abutment; rehabilitation of the right side of the maxillary arch was done from the left side canine to the right side maxillary first molar. Maxillary second molar was not replaced because cantilever prosthesis can cause levering effect to the abutment, and moreover, till first molar, it would provide a more sufficient function for mastication. For the left side of the maxillary arch, precision attachment – a removable type of prosthesis – was advised since the condition was a distally edentulous region. A fixed option with corticobasal implants – compressive implants (GenXT company implants) – was also advised for the replacement for the left-sided distally edentulous region. The patient was not willing for the removable type of prosthesis they demanded for fixed option, and so, corticobasal implants were planned for the fixed type of replacement. Here, the conventional implants were not advised because of the lack of availability of the bone present in the site of osteotomy. In case if planned for a conventional implant, there will be a need for the secondary surgery such as sinus lift procedure and bone grafting, and either immediate placement or delayed placement of implant and loading of the prosthesis would be done. Then, the treatment cost would become more. Hence, as cost-effective factor and to avoid the secondary surgical procedures, corticobasal implants were advised. Local anesthesia was achieved using lidocaine 2% with adrenaline 1:100,000. After that, soft tissue cleaning with antiseptic betadine solution (water based) was done. Flapless surgical osteotomy site preparation was done using the sequential-calibrated drills recommended by the manufacturer. One long single-piece basal implant with a diameter of 3.5 mm and a length of 16 mm (GenXT dental implant system) was placed in the region of 24, and two compressive implants with a diameter of 3.5 mm × 16 mm length (GenXT dental implant) were placed in the region of 27 [Figure 1]. The implant abutment was bent to a favorable position so that the forces are distributed equally. Immediately after surgery, final impression was taken for the final prosthesis using addition of silicone putty with light body material. Within 72 h, final prosthesis with metal ceramic restoration was cemented using luting glass ionomer cement [Figure 2], [Figure 3], [Figure 4]. A very good result of treatment was achieved with high patient satisfaction. A yearly review was done, and now, the patient has the follow-up of 3 years.
Figure 1: Postoperative orthopantomogram

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Figure 2: Postoperative intraoral – front view

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Figure 3: Postoperative intraoral – left lateral view

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Figure 4: Postoperative intraoral – right lateral view

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   Discussion Top


Implant treatment options were the recent upcoming procedure in fixed rehabilitation. This implant procedure relies mainly on the available bone width and height (at least 13–15 mm length and 5–7 mm width).[3] In case if these criteria are not sufficed, then placing a conventional implant would be a robust. In the past few decades, two implant system protocol and design were used for rehabilitating the patients with minimal or atrophied ridge, i.e., mini implants and basal implants over which basal implants are being used frequently to manage those kind of situation.

Basal implants are dental implants that solely depend on the basal cortical portion of the jaw bone for retention. Earlier, disc implants were used which was a technique-sensitive procedure because the surgical procedure was totally different from the conventional implant system. The modern basal implant system has a sophisticated yet simple design, surgical protocol and it provides a prosthetically friendly system. These modernized developments and the need to avoid grafting procedures have provoked several practitioners around the globe to widely use basal implantology in their day-to-day practice. So far, this system provides a fairly good result.[3]

Major advantages in the basal implantology are that it utilizes the basal cortical bone for retention. The masticatory forces are transferred in the vertical direction, and also, it provides lesser chances of peri-implantitis evidence. It also provides better result in medically compromised patients with diabetes or patients having chronic periodontitis. Basal implants are mostly indicated for thin ridges where ridge augmentation procedures have failed or where the bone height is insufficient.[6] Basal implants are contraindicated in patients with medical conditions such as recent myocardial infarction, cerebrovascular stroke, immunocompromised patients on chemotherapy, and antiplatelets.

Literature review suggests that steps taken for the restoration of completely or partially edentulous maxilla and mandible with basal implants as immediate loading procedures showed reduction in costs and treatment time by about 50% with a successful osseointegration of 98% when examined clinically and radiographically. In patients with atrophied ridge, the bone available in the horizontal plane was utilized with the use of BOI implants and was loaded immediately. Alternative methods such as zygoma and pterygoid implants can also be considered in atrophied maxillary ridges.[7]

Thus, the strategy of implant protocols has changed the possibilities of dental implantology worldwide. The bone augmentation procedure such as sinus lift have become avoidable today because of the availability of sufficient native bone for anchoring these implants even if the necessary vertical bone is missing in most of the patients.[4] However, it cannot be denied that basal implantology fits the principle “Primum nihil nocere” i.e., “First Do No Harm.” [8]


   Conclusion Top


Basal implantology is a treatment of choice with new broad indications and almost no limitations. Conventional concepts in implantology sometimes require all types of bone augmentation procedures for subsequent placement of implants. However, basal implantology does not include any augmentation.[5]

In addition to that, flapless approach with minimal surgical intervention (thin mucosal penetration) not only minimizes postoperative discomfort and pain but also avoids any swelling.

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.



 
   References Top

1.
Tha TP, Ganapathy D, Jain AR. Basal implants-A review. Drug Invention Today, 2018 Nov 02;10.  Back to cited text no. 1
    
2.
Ihde S. Comparison of basal and crestal implants and their modus of application. Smile Dent J 2009;4:36-6.  Back to cited text no. 2
    
3.
Gupta AD, Verma A, Dubey T, Thakur S. Basal osseointegrated implants: Classification and review. Int J Contemp Med Res 2017;4:2329-35.  Back to cited text no. 3
    
4.
Gaur V, Doshi A, Ihde S, Fernandes G, Lysenko V. Immediate Loading of Implants in the Partially Edentulous Maxilla: A Case Report of a Novel Technique with Strategic Implants. IOSR J Dent Med Sci (IOSR-JDMS) 2018;17:34-40.  Back to cited text no. 4
    
5.
Otoum A, Bsoul T. Basal screw implantology without sinus lifting. Pakistan Oral Dent J 2014 Sep 30;34(3).  Back to cited text no. 5
    
6.
Yadav RS, Sangur R, Mahajan T, Rajanikant AV, Singh N, Singh R. An alternative to conventional dental implants: Basal implants. Rama Univ J Dent Sci 2015;2:22-8.  Back to cited text no. 6
    
7.
Panwar CD, Navneet SL, Mandlik CD, Manab LC. Fixed rehabilitation of missing maxillary molar using immediately loaded basal disk implant: A case report. . International Journal of Medical Research and Pharmaceutical Sciences 2018;5(2).  Back to cited text no. 7
    
8.
Nair C, Bharathi S, Jawade R, Jain M. Basal implants-A panacea for atrophic ridges. J Dent Sci Oral Rehabil 2013 Mar 02:1-4.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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