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Case Report
Distal extension mandibular removable partial
denture with implant support
Canan Bural1, Begum Buzbas1, Sebnem Ozatik1, Gulsen Bayraktar1, Yusuf Emes2

1
Department of Prosthodontics, Istanbul University
Faculty of Dentistry, Istanbul, Turkiye,
Correspondence: Dr. Canan Bural 2
Department of Oral and Maxillofacial Surgery, Istanbul
Email: [email protected] University Faculty of Dentistry, Istanbul, Turkiye

ABSTRACT
This case report describes the fabrication of a distal extension removable partial denture (RPD) of a 65‑year‑old man with
implant support. Loss of fibroelasticity of the peripheral tissues and reduced mandibular vestibular sulcular depth due to a
previous surgical resection and radiotherapy at the right side were the main clinical factors that created difficulty for denture
retention and stability. The fabrication of a mandibular RPD supported by anterior teeth and two bilaterally placed implants
in the molar area to convert from Kennedy Class 1 design to Kennedy Class 3 implant‑bounded RPD is reported. Retention
and stability of the denture were improved with implant support on the distal extension site of the RPD. The common clinical
problems about distally extended RPDs are lack of retention and stability due to the movement around the rotational axis. Dental
implant placement to the distal edentulous site minimizes the potential dislodgement of the RPD is popular. Implant‑supported
RPD can be suggested as an advantageous and cost‑effective treatment option for the partially edentulous patients.

Key words: Dental implant, distal-extension removable partial denture, implant‑supported removable partial denture,
Kennedy Class I partial edentulous, locator attachment

INTRODUCTION the need of relining procedures in the following

years. [10‑12] As a result, this treatment modality
Common clinical problems about distal extension could resolve intrusion movement problem of the
removable partial dentures (RPDs) are lack of retention RPD while reducing treatment costs compare with
and stability and unaesthetic appearance because of implant‑supported fixed prosthesis and resulting in
the clasps.[1‑6] greater patient satisfaction.[2,4,5]

Placing bilateral single dental implants in the molar There are different types of connection between the
area of the residual alveolar ridges is becoming a implants and the acrylic base of the RPD, such as
popular treatment choice while implants would implant cover screws, stress‑breaking attachments,
effectively change the Kennedy Class 1 situation to a and healing caps.[1‑9,12] Ball, locator or ERA attachments
more favorable implant‑supported Kennedy Class 3 are the different types of stress-breaking attachments
configuration.[2,4,5,7‑9] The retention and stability of that have been applied to the implants in previous
the dentures are being improved with placing the studies and some case reports.[1-6,8-14] In addition,
implants bilaterally.[1,2,4] Moreover, implant support
decreases the resorption of the alveolar ridges and This is an open access article distributed under the terms of the Creative
Commons Attribution‑NonCommercial‑ShareAlike 3.0 License, which allows
others to remix, tweak, and build upon the work non‑commercially, as long as the
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For reprints contact: [email protected]

Website: How to cite this article: Bural C, Buzbas B, Ozatik S, Bayraktar G,

www.eurjdent.com Emes Y. Distal extension mandibular removable partial denture with im-
plant support. Eur J Dent 2016;10:566-70.

DOI: 10.4103/1305-7456.195180

566 © 2016 European Journal of Dentistry | Published by Wolters Kluwer - Medknow

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Bural, et al.: Implant‑supported RPD

placement of only healing caps to function as vertical

stopping has previously been reported.[1,4‑6,8]

This clinical report describes a mandibular

implant‑supported RPD in a patient who had tumor
surgery and radiotherapy using a conventional RPD
with lack of retention and stability.

CASE REPORT
a b c
A 65‑year‑old, both maxillary and mandibular partially Figure 1: Extraoral view before prosthetic treatment (a). Scar tissue and
loss of fibroelasticity at the right buccal shelf area due to the surgical
edentulous, male was referred to the Department of tumor resection and radiotherapy (b). No indication of abnormality
Prosthetic Dentistry, Istanbul University, Faculty on the left sight (c)
of Dentistry. The patient’s chief complaints were
reduced function and unaesthetic appearance because
of missing teeth and the lack of retention and stability
with his previous RPD.

The patient’s medical history revealed that he had

radiation therapy on the right sight of mandibular
buccal shelf region at the head and neck area. At a b
the extraoral examination, a scar tissue at the right Figure 2: Preoperative intraoral view. Tissue healing at the right
maxillary region and 2 left maxillary teeth (a). Mandibular teeth before
buccal shelf area was observed due to the surgical prosthetic therapy (b)
tumor resection that was operated 25 years ago. In
addition, loss of fibroelasticity of the right peripheral
soft tissue and perioral region was discovered due
to the radiotherapy while the left side indicated no
abnormality [Figure 1]. When a dental anamnesis was
taken, the patient has reported that three maxillary
teeth with severe mobility were extracted before
application to the Department of Prosthetic Dentistry
Clinic. The patient had no existing dentures for both
jaws. He had difficulty in usage of his previous
dentures due to lack of retention. Intraoral examination Figure 3: Preoperative panoramic X-ray view
revealed that the patient had two maxillary central
and lateral teeth with moderate mobility and five
• Maxillary complete denture and mandibular
mandibular teeth, right lateral to left canine with
implant‑supported RPDs were chosen by the
no mobility [Figure 2]. Reduced vestibular sulcus
patient as an optimal treatment with the advantage
depth and a fibrous scar tissue were examined at
of the increased retention and stability provided
the right buccal region. Radiographic examination
using the existing panoramic X‑ray showed that right by the implants for the mandibular RPD. The cons
maxillary canine and maxillary central incisor teeth and pros for the extraction of maxillary left central
were previously extracted. In addition, mandibular and lateral teeth were explained in details to the
right first premolar with an existing periapical lesion patient in terms of biomechanics and esthetics. The
was also decided to be extracted [Figure 3]. patient preferred the extraction of the remaining
teeth, and the future fabrication of a maxillary
Three treatment options were presented to the patient. complete denture was planned. Written informed
• Maxillary and mandibular conventional consent before surgical and prosthetic treatment
clasp‑retained RPDs were rejected because of was obtained from the patient.
the patient’s previous complaint about lack of
retention and stability with his previous dentures Under local anesthesia, mucoperiosteal flaps were
• Maxillary and mandibular implant‑supported elevated and two implants (4.1 mm diameter, 10 mm
fixed prostheses were rejected due to the financial length; Straumann AG, Waldenburg, Switzerland)
limitations of the patient were placed in posterior region of the mandible, both

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Bural, et al.: Implant‑supported RPD

on the right and left sides [Figure 4]. Primary closure made using a zinc oxide eugenol material (SS White,
was obtained in both operation sites. Prophylactic C/O Prima Dental Group, Gloucester, England). For the
antibiotics and nonsteroidal anti‑inflammatory mandible, the locator abutments (H 3 mm, coated Ti alloy,
drugs were prescribed. Sutures were removed on Straumann AG, Basel, Switzerland) were torqued to the
the 7th postoperative day. At the end of 3 months, implants with a 25 N/cm [Figure 7]. For the mandibular
the osseointegration of the implants was checked on impression, impression copings were attached to the
the panoramic radiograph [Figure 5]. The healing of locator abutments. Cingulum rest seats were prepared
the mandibular distal edentulous sites seemed to be on the mesial site of the mandibular right canine and
normal and gingival formers were placed [Figure 6]. between the mandibular first and second lateral incisors.
At this stage, two maxillary teeth were also extracted After that, the final impression of the mandible was made
before the initiation of the prosthodontic therapy. using an addition silicone impression material (Dentasil
A, DENTAC, Senden, Germany). Locator analogs were
Preliminary impressions were made using an alginate attached to the impression copings [Figure 8] and the
impression material (Italgin Chromatic Alginate, BMS impression was poured [Figure 9].
Dental, Capannoli, Italy) and individual impression
trays for both maxilla and mandible were fabricated RPD framework was designed on the mandibular cast
using autopolymerizing acrylic resin. After border with T‑bar clasps on the terminal abutment teeth and
molding on the maxillary tray, the final impression was

a b
Figure 4: Implant surgery on the right (a) and left (b) first molar area Figure 5: Panoramic X-ray view. Osseointegration of the implants at
the postoperative 3rd month

a b
Figure 6: Intraoral view of implant site at the postoperative 3rd month. a b
(a) right side (b) left side Figure 7: Locator abutments connected to the implants (a) right side
(b) left side

Figure 8: Final impression with impression copings attached with

locator analogs Figure 9: Working model with locator analogs

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Bural, et al.: Implant‑supported RPD

a lingual plate as a major connector. The cingulum and simplicity of the RPD system, with reducing
rests were fabricated on the rest seats [Figure 10]. the drawbacks of invasive attempt and cost of the
The framework at the implant abutment region was implants more than two.[3] In this case report, Kennedy
designed circular around the abutment, and the Class 1 partial edentulousness was changed to an
distance between the abutment and the framework implant‑bounded Kennedy Class 3 configuration.
was approximately 2 mm so as to support the denture
base acrylic resin [Figure 11]. The RPD was cast using The clinical factors  (reduced fibroelasticity of the
a chromium‑cobalt casting alloy (DFS, Ländenstrabe, peripheral soft tissues, buccal scar tissue with a
Riedenburg, Germany). reduced sulcus depth of the right buccal area) that
may negatively affect the denture’s retention and
Artificial teeth (NT Optima, Toros Dental, Antalya, stability are the indication of an implant‑bounded
Turkey) setup was completed and tried in the mouth. RPD. These problems can be clinically resolved
The maxillary complete denture and mandibular RPDs with a single implant on the distal edentulous
were delivered to the patient Locator abutment matrix sites that also improve the biomechanics of the
and black processing nylon insert were connected to prosthesis. [1,3,4] Previous results suggest that by
the mandibular RPD using autopolymerizing acrylic placing an implant to the distal extension site of the
resin (Self‑cure acrylic, IMICRYL, Istanbul, Turkey). RPD, enhancement of distribution of the occlusal
After polymerization, the denture was removed and forces, movement of the posterior rotational axis to
the pink locator attachments were fitted [Figure 12]. a distal position, shortening of the distal extension
After delivery, the patient was recalled weekly for of the RPD, and reducing potential rotational
4  weeks  [Figure  13]. The patient was satisfied with movement of the RPD can be improved.[3,15] The
the function of his dentures as well as the improved tissueward and the opposite movement of the RPD
esthetics [Figure 14].

DISCUSSION
Bounding of the RPD with implants is a treatment
option which combines the advantages of the implants

Figure 11: Removable partial denture framework with T-bar clasps on

the terminal abutment teeth, lingual plate as a major connector and
circular design around the implant abutments

Figure 10: Cingulum rests designed on the mandibular anterior teeth

a b
Figure 12: Maxillary complete denture (a) and mandibular implant-
supported removable partial denture with locator attachments in the
intaglio surface (b) Figure 13: Intraoral view 4 weeks after delivery

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Bural, et al.: Implant‑supported RPD

a b c
Figure 14: Extraoral view after prosthetic treatment (a). Right (b) and left side (c)

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