Original article

Prevention of trauma to soft tissues from opposing dental implants in completely edentulous patients: Kunwarjeet Singh1 and Nidhi Gupta2 1

Department of Prosthodontics, Institute of Dental Studies and Technologies, Ghaziabad, Uttar Pradesh, India; 2Department of Pedodontics and Preventive Dentistry, Institute of Dental Studies and Technologies, Ghaziabad, Uttar Pradesh, India

doi: 10.1111/ger.12131 Prevention of trauma to soft tissues from opposing dental implants in completely edentulous patients: Objective: To suggest a technique to prevent trauma of the edentulous ridge from opposing dental implants when prosthesis kept out during night. Background: In modern dentistry, implant-supported overdentures are commonly fabricated to minimise the problems associated particularly with mandibular conventional removable denture such as the lack of retention or stability, decreased chewing efficiency, difficulties in speech and soft tissue abrasion. The patients wearing two implant-retained overdentures that are mainly soft tissues supported-implantretained overdentures are advised to keep prosthesis out of the oral cavity during night to allow the tissues to rest and remain healthy. Few of such patients might complaint about trauma of the opposing soft tissues by the dental implants when prosthesis is kept out. Materials and methods: A thermoplastic resin mouthguard was fabricated by adapting the modelling wax over the abutments on the master cast from thermoplastic resin sheets. The wax was removed and guard was filled with chemically cure permanent silicone soft liner and immediately placed in the patient mouth. Conclusion: The trauma caused by dental implants to the opposing edentulous ridge was effectively managed by soft thermoplastic resin mouthguard filled with permanent silicone soft liner. Keywords: dental implants, mouthguard, silicone soft liner, trauma of soft tissues. Accepted 14 April 2014

Introduction In modern dentistry, two implant-supported overdentures (Fig. 1) that are mainly soft tissues supported and implant-retained prostheses are commonly fabricated to improve most of the problems associated with the mandibular conventional dentures. Just like, the patients wearing the complete and removable partial dentures are advised to remove the prosthesis during night for at least 6–8 h to allow the tissues to rebound and rest1; similarly, the patients with two implantsupported overdentures are advised to keep prosthesis out of the oral cavity during night to allow the soft tissues to rest and remain healthy. Some patients might complaint about trauma of opposing edentulous ridge by the dental implant attachments during night (Fig. 2) or trauma of the lip when implants are placed more labial to the ridge. 288

It has been found that the remaining mandibular natural teeth causes the trauma of the opposing edentulous ridge when the prosthesis is left out

Figure 1 Edentulous mandible with two implants.

© 2014 John Wiley & Sons A/S and The Gerodontology Association. Published by John Wiley & Sons Ltd, Gerodontology 2015; 32: 288–290

Prevention of trauma to soft tissues

Figure 2 Ball abutments in contact with opposing tissues during swallowing.

during night, which can be effectively managed by fabricating the soft thermoplastic resin night guard2. The trauma of the opposing soft tissues by the dental implants can be prevented by fabricating a thermoplastic resin night guard filled with permanent soft liner.

Procedure 1. Make a mandibular impression by single-step putty wash technique (putty – Aquasil soft putty/ regular set, Dentsply, Germany and light body – Aquasil LV, Dentsply, Germany) after replacing ball abutments with impression coping to replicate the exact position of the implants. 2. Pour the impression in dental stone to obtain the cast with ball abutment analogue. 3. Adapt the modelling wax over and in between the abutment in arch form and 3–4 mm distal to the abutments (Fig. 3). 4. Place a clear thermoplastic resin sheet of 1 mm in thickness in the vacuum adapter and heat until the material sags ¾ inches below the frame holder. Lower the frame until the material contacts the modelling wax. Maintain this position for 15–20 s. Move the frame to its lowest position

Figure 3 Modelling wax adapted and shaped on the cast over implant analogues to create space for the soft liner.

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and turn on vacuum for 10 s. Remove the cast and chill in ice water. 5. Trim the excess material according the shape of the modelling wax with the help of heated blade and curved scissor. Remove the wax from the mouthguard to create the space for the permanent silicone soft liner (Fig. 4). 6. Mix the equal length of the base and catalyst of the autoploymerising permanent silicone soft liner (Ufi gel P, Voco Germany), fill the mouthguard and immediately place it over the ball abutments in the patient’s mouth. Hold the guard with soft liner in proper position until the soft liner set. Remove the guard and trim the excess material (Fig. 5). Again place it in the patient mouth and evaluate the retention and stability of the mouthguard (Fig. 6). Ask the patient about any discomfort and instruct the patient to maintain good oral hygiene.

Discussion The implant ball abutments usually do not cause trauma to the opposing soft tissues, but few patients with nocturnal habits, such as clenching, might complaint about the trauma of the edentulous ridge by the implants when the patients keep the

Figure 4 Thermoplastic resin mouthguard.

Figure 5 Mouthguard with permanent silicone soft liner.

© 2014 John Wiley & Sons A/S and The Gerodontology Association. Published by John Wiley & Sons Ltd, Gerodontology 2015; 32: 288–290

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K. Singh, N. Gupta

Figure 6 Mouthguard edentulous ridge.

in

contact

with

opposing

prosthesis out of the oral cavity during the night. Some patients in which implants are more labially placed to the ridge complaint about the trauma of the lip tissues by the ball abutments. Such problems can be effectively managed by fabricating a resilient thermoplastic resin mouthguard over the modelling wax adapted on the abutments on the

References 1. Zarb GA, Bolender CL, Carlsson GE. Single Complete Dentures Opposing Natural or Restored Teeth: Boucher’s Prosthodontic Treatment for Edentulous Patients, 11th edn. St. Louis, Missouri: Mosby, 1997: 460.

cast. The modelling wax was adapted in arch form to provide a proper shape to the mouthguard to minimise any discomfort to the patient and also provide the space for the soft liner that helps in the retention and stability of the mouthguard and minimise the loading of the implants by its cushioning effect. Resilient mouthguard is also effectively used to prevent the trauma of opposing edentulous ridge by the remaining natural teeth3. Patient should be motivated to maintain good oral hygiene to prolong the resilient effect of the guard. This resilient soft liner guard can effectively manage the discomfort/trauma of the opposing tissues by implant attachments, when the prosthesis is kept out during night.

Conflict of interest None.

2. Singh K, Aeran H, Gupta N. Prevention of trauma to edentulous ridge from the opposing natural teeth. Gerodontology 2012; 29: 1129–32. 3. Williamson RT. Occlusal guard for the maxillary edentulous patient. J Prosthet Dent 1999; 82: 116.

Correspondance to: Dr Kunwarjeet Singh, Department of Prosthodontics, Institute of Dental Studies and Technologies Modinagar, Ghaziabad, Uttar Pradesh (201201), India. Tel.: 9868086829 E-mail: [email protected]

© 2014 John Wiley & Sons A/S and The Gerodontology Association. Published by John Wiley & Sons Ltd, Gerodontology 2015; 32: 288–290

Prevention of trauma to soft tissues from opposing dental implants in completely edentulous patients.

To suggest a technique to prevent trauma of the edentulous ridge from opposing dental implants when prosthesis kept out during night...
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