Use of Cekapreci-Clix Post System for the Tooth Supported Mandibular Over Denture: A Case Report

Headnote

Abstract

Overdenture is a preventive prosthodontic concept requiring multidisciplinary approach involving periodontic, endodontic and prosthodontic intervention. Preventive prosthodontics underlines the importance of any procedure that can delay or eliminate future problems. The basic overdenture concept involves preservation of residual hard and soft tissues. Attachment retained overdentures help in retaining proprioception, distribution of masticatory forces and minimize trauma to abutments and soft tissues. They also mitigate ridge resorption and aid in improvement of esthetics. The following case report discusses the fabrication of mandibular overdenture supported with Preci-clix overdenture attachments.

Keywords: Overdenture; CekaPreci-clixpost; overdenture attachments.

Introduction

Prosthodontic rehabilitation of a patient with few remaining teeth is challenging. Any conservative treatment that can delay or eliminate future prosthodontic problems should be considered.1 Edentulous patients may have considerable difficulties while using their conventional complete dentures due to lack of retention, support, stability and the related compromise in chewing ability.2 Despite recent developments and higher success rates in the field ofimplantology, preservation of natural teeth or roots is more desirable and in agreement with De van's dictum. Overdenture is a complete or partial denture prosthesis supported partly by soft tissues and partly by retained natural teeth roots or implants and is a meaningful alternative when compared to conventional complete dentures. An improvement in retention, stability, support and masticatory efficiency is observed while preserving the alveolar bone and muscular patterns for jaw closure.1,3 In this case report, Preci-clix attachment is used in fabrication of over denture to rehabilitate mandibular arch.

Case report

A 56-year-old male patient reported for prosthetic evaluation with the chief complaint of multiple missing teeth and inability to chew food. No relevant medical history was reported. On oral examination 16,26, 35, 33,43 and 45 were present. Amongst them 16, 26 and 45 were grade 1 mobile with deep cervical abrasion. 33,43,35 presented with mild cervical abrasion (Figure 1). Radiographic examination did not reveal any additional information. Impressions were made and the diagnostic casts poured and mounted for further evaluation, revealing sufficient interocclusal space. Treatment plan was then formulated including extraction of 16,26 and 45; intentional root canal treatment for 33 and 43 followed by fabrication of conventional maxillary complete denture opposing CekaPreci-clix attachment retained mandibular over denture. 33 and 43 were selected as abutments for CekaPreci-clix attachments with 35 receiving only a short coping. Oral prophylaxis was done followed by extraction of 16, 26 and 45. Endodontic treatment was then performed for 33 and 43. Patient was then recalled for abutment teeth preparation. 35 was prepared to receive metal coping with 33 and 43 was prepared for receiving Ceka Preci-clix attachment.

Preparation of teeth

35 was prepared with rotary diamond burs to a length of 2 mm with a chamfer margin to receive short coping. Ceka Preci-Clix post kit contains pre-drilling bur, reamer, cavity bur, clix insertion tool, clix female and analogues. Ceka Preci-clix is a parallel-sided threaded post made of titanium. The titanium male and post as well as plastic female component are easily replaceable.

33,43 were reduced to about 1mm above the gingival margin. Post length was determined using intraoral peri-apical radiograph. Peaso reamers were used to remove gutta-percha leaving 3-5mm of gutta-percha apically. Then the canal was prepared with the 1227 pre-drilling bur. The 1228 cavity bur was then used to prepare the canal for the base of the post. Finally, the 1229 precision reamer was used to calibrate the canal for the diameter of the No. 1291 post and preparation of canal for both abutment teeth was completed (Figure 2).

Cementation of the post

Trial insertion of the posts was done to determine their fit. Preci-clix post was sandblasted prior to cementation. Bonding composite (Flourocore 2- Dentsply caulk, USA) was then coated over the post and root canal surface followed by insertion of Preci-clix post in the prepared canal. Later composite was cured at surface of the tooth with light curing unit. Root surface was polished with a fine sandpaper disk.

Short coping cementation on 35

Primary impressions were made with irreversible hydrocolloid impression and cast was poured. Indirect inlay wax (Kerr Co., Washington DC, USA) was used to make wax pattern for short coping for 35. Sprue wax was attached to the wax-up unit and casting performed. Fit of the coping was checked and then cemented on to the preparation with glass-ionomer cement (GC Co., Tokyo, Japan) (Figure 3). Mandibular impression was subsequently made with irreversible hydrocolloid and the cast poured.

Denture fabrication

Custom trays were prepared on the mandibular and maxillary primary casts. Prior to fabrication of mandibular custom tray, 2 layer thick wax spacer was adapted around the posts. Sectional border molding of the mandibular arch was then performed with green stick compound impression material followed by secondary impression with monophase addition silicone impression material (Reprosil, monophase; Dentsply International Inc., USA). No.l201D post analogue were then re-indexed into the recess within the mandibular secondary impression and master cast was poured (Figure 4). Sectional border molding for maxillary arch was done with green stick impression compound and secondary impression was recorded with zinc oxide eugenol impression paste and then poured to obtain master cast.

Metal housing with retention caps were placed over the posts on the mandibular master cast. Then metal housings were blocked out with wax prior to denture base and occlusion rim fabrication. Subsequently jaw relation was recorded followed by articulation ofthe master casts. Teeth arrangement followed by denture trial was done. Denture was fabricated following conventional curing technique. Trial dentures were flashed and dewaxing performed. After dewaxing, the analogues were blocked out with tin foil followed by conventional packing and curing. Dentures were finished and polished.

Incorporation of plastic female in mandibular denture

Black rubber space maintainers supplied in the kit were placed along with large tin spacers on the posts. 1222 Clix insertion tool was used to snap the Preci-Clix female onto the Clix housing. The mandibular denture was seated over the female components followed by placement of maxillary denture. Patient was guided to close his jaws in centric, and occlusal interference was checked for. In case of interference, the tissue surface of the mandibular denture overlying the female components was relieved and again verified for any remaining occlusal interference. Small amount of self-cure resin was then placed over the relieved area on the tissue surface of the mandibular denture. The denture was then inserted and material allowed to set with the dentures in occlusion.

After the resin set, the dentures were removed. The intaglio surface of the mandibular denture now had metal housing with retention caps buried within (Figure 5). The surface was then finished and polished. Black rubber space maintainer and tin spacer were removed. The dentures were inserted (Figure 6) and post insertion instructions given. The patient was recalled after 24 hours for further check-up.

Discussion

The use of teeth as overdenture abutments is beneficial to the patients.4 The psychological aspect of patients losing teeth has been well documented and should be considered during treatment planning.5 Patient selection is critical to the success of the treatment. The attitude of the patient to the treatment should be assessed. Only those who understand the limitations and benefits of attachments should be treated with attachment retained overdentures.

The decision must be made whether to retain the teeth as overdenture abutments. Selection of abutments at strategic location is critical for the success of treatment. Abutment teeth are prepared to create adequate space for the overlying denture. The shortened crown improves the crown-toroot ratio along with decreased mobility of the abutment teeth under an overdenture.6

The success of the overdenture treatment also depends upon the appropriate attachment selection for the particular case. Attachment selection is based on available buccolingual and interarch space, bone support, opposing dentition, clinical experience, personal preferences, ease of maintenance and cost.7 The use of attachments can redirect occlusal forces away from weak supporting abutments and onto soft tissue, or redirect occlusal forces toward stronger abutments and away from soft tissues. They act as shock absorbers or stress redirectors as well as provide superior retention.

CekaPreci-clix post is a stud attachment occupying less vertical space and the male units on the different teeth roots do not require parallelism. Its parallel sided thread design provides maximum retention. The ball and socket attachment of CekaPreci-clix allows rotation of the denture attachment.8 The snap fit of the denture in mouth provides the patient more comfort during functional movements. Small head of the attachment limits the amount of material that has to be removed from the denture to accommodate the attachment. The nylon cap provides 35 pounds of retention.9 It is a simple, chairside procedure, cost effective and user friendly for the patient's too.10,11

Conclusion

Lack of retention of mandibular complete denture is amongst the most common complaint among the complete denture patients. The concept of implant supported overdentures has become more popular with the development of osseointegrated dental implants, but not all patients are able to afford the treatment expenses. A tooth-borne overdenture is an alternative treatment option whenever few good teeth remain in the arch. The incorporation of attachments in overdentures provides a new dimension in treatment planning. Teeth that might be considered for extraction may be considered as long or short term alternatives to implant or total edentulousness.

References

References

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8. Ceka Attachment Preci-Line technique manual. Waregem (Germany) 2007.

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