Journal of Oral Implantology February 2013 - (Page 115)

CASE REPORT Edentulous Maxillary Arch Fixed Implant Rehabilitation Using a Hybrid Prosthesis Made of Micro-CeramicComposite: Case Report Onur Geckili, PhD, DDS* Hakan Bilhan, PhD, DDS Gulsum Ceylan, PhD, DDS Altug Cilingir, PhD, DDS The prosthetic treatment of patients with an edentulous maxilla opposing mandibular natural teeth is one of the most challenging endeavors that face clinicians. Occlusal forces from the opposing natural teeth may cause fractures in the maxillary prosthesis and also result in advanced bone loss of the edentulous maxilla. With the presence of extreme gagging reflex, the treatment may become more complicated. This article describes and illustrates the 2-stage surgical and prosthetic treatment of a patient with an edentulous maxilla opposing natural teeth. In the beginning, the patient was treated with 4 implants and a maxillary implant-supported overdenture. The extreme gagging reflex and the occlusal forces from the mandibular natural teeth obligated the team a second stage surgical and prosthetic treatment, which included increasing the number of implants after bilateral sinus lifting in the posterior maxilla and fabricating a maxillary fixed hybrid prosthesis made of micro-ceramic composite that yielded a satisfactory result. Key Words: hybrid prosthesis, dental implant, sinus floor elevation INTRODUCTION P atients with an edentulous maxilla opposing mandibular natural teeth may experience problems with maxillary complete dentures (MCD).1,2 The ability of the patient to generate heavy occlusal forces due to the existence of opposing natural teeth may cause the implacable fractures on the MCD.2–4 It is assumed by several authors that there may be an association of the unsuitability of the denture bearing tissues to resist high occlusal forces from the opposing natural teeth and advanced bone loss of the residual alveolar ridges.1,2 In addition, malpositions of the opposing natural teeth decrease the stability and may cause loosenFaculty of Dentistry, Department of Prosthodontics, Istanbul University, Istanbul, Turkey. * Corresponding author, e-mail: geckili@istanbul.edu.tr DOI: 10.1563/AAID-JOI-D-10-00040 ing of the MCD.1–3 Other rarely seen factors such as an extreme gagging reflex may also influence the treatment outcomes.5 The exaggerated gag reflex is a somatic natural response in which the body attempts to eliminate instruments or agents from the oral cavity by muscle contraction at the base of the tongue and the pharyngeal wall.6 The patient who gags may present with a range of disturbing reactions, from simple contraction of palatal or circumoral musculature to spasm of the pharyngeal structures, together with vomiting.6,7 Overextended borders of a prosthesis, particularly the posterior aspect of the MCD can impinge on the ‘‘trigger zones’’ and produce gagging.6 Some patients cannot tolerate any foreign subject from entering the oral cavity even if the denture does not have overextended borders.7 Dental implants offer an effective rehabilitative treatment for the patients with an edentulous maxilla opposing mandibular natural teeth. With the use of implant-supported Journal of Oral Implantology 115

Table of Contents for the Digital Edition of Journal of Oral Implantology February 2013

Could the Fountain of Youth Be All in Your Bones?
Vertical Bone Augmentation With Simultaneous Implant Placement Using Particulate
Evaluation of the Bone Healing Process Utilizing Platelet-Rich Plasma Activated by Thrombin
Effect of Model Parameters on Finite Element Analysis of Micromotions in Implant Dentistry
Peri-Implant Defect Augmentation With Autogenous Bone: A Study in Beagle Dogs
Would Nitric Oxide be an Effective Marker for Earlier Stages of Peri-Implant Disease? An
The Effect of Different Surface Treatments on Cement-Retained Implant-Supported
Effect of Rotating Osteotomes on Primary Implant Stability—An In Vitro Investigation
Horizontal Augmentation Through the Ridge-Split Procedure: A Predictable Surgical
The Bis-Acryl Stent
Clinical, Histological, and Histomorphometrical Analysis of Maxillary Sinus Augmentation
A Technique to Salvage a Single Implant-Supported Fixed Dental Prosthesis Having a
Ridge Expansion and Immediate Placement With Piezosurgery and Screw Expanders in
Pterygoid Implants for Maxillofacial Rehabilitation of a Patient With a Bilateral Maxillectomy
Technology in Maxillary Premolar Region: A New Strategy for Soft Tissue Management
Fracture of Anterior Iliac Crest Following Bone Graft Harvest in an Anorexic Patient: Case
A Technique for Constructing a New Maxillary Overdenture to a Nonretrievable Implant
Edentulous Maxillary Arch Fixed Implant Rehabilitation Using a Hybrid Prosthesis Made of

Journal of Oral Implantology February 2013