The Role of the Dental Implant in RPD_JC.pptx

RPD and Dental Implants

1. The Role of the Dental Implant in Removable Partial Dentures - Hakan Bilhan Presented by - Dr. Shuchi Jain Department of Prosthodontics MDS 1 year

2. Author – Hakan Bilhan Journal name – Springer International Publishing, Switzerland Year – 2024 Volume – 2 Issue – 1 Page – 223 - 241 Impact factor – 4.2 Indexing – Researchgate , Crossref , Pubmed , Google Scholar, Science Direct About the article

3. Introduction Implant‐supported removable partial dentures (ISRPDs) have been suggested as a minimally invasive approach for partially edentulous patients without compromising implant success while improving patients quality of life and satisfaction. 3

4. The ISRPDs provide cost‐effective treatment . This treatment option not only increases the retention of the prosthesis and limits lateral and vertical displacement of the removable partial denture, but it also distributes masticatory forces more effectively along the prosthesis and the adjacent teeth. 4 Tribst J, de Araújo R, Ramanzine N, Santos N, Dal Piva AO, Borges A, et al. Mechanical behavior of implant assisted removable partial denture for Kennedy class II. Journal of Clinical and Experimental Dentistry. 2020;e38–45.

5. In cases where fixed rehabilitation is not possible, a few dental implants placed in strategically important positions could help prevent the movement around a fulcrum axis and bring biomechanic advantages by providing vertical support. 5

6. The placement of an implant beneath a distal extension denture base could be a way to slow down bone resorption and maintain ridge height . 6 Turkyilmaz I. Use of distal implants to support and increase retention of a removable partial denture: a case report.2009

7. By the elimination of clasps, the esthetic expectations of patients can be satisfied. At the same time, the reduced displacement of the dentures has resulted in better tissue tolerability and options for RPD use have increased. 7

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9. Obviously, the Kennedy Class IV in extremely long anterior edentulous spans creates a challenge for the prosthodontist, too. A limited number of implants can help prevent visible retentive elements. 9

10. Different Treatment Modalities with Dental Implant UseD as RPD Support 10

11. Kennedy Class I and/or II Situation A popular location for the placement of the implant is in the posterior end, around the second molar area . On the other hand, some prefer the location next to the tooth neighboring to the free end as the most suitable position. 11

12. In the case of a Kennedy Class I situation, where canines are missing and only the central and lateral incisors are present, implants in the canine positions can have several important roles: support, retention without visible elements, and protection of the remaining teeth. 12

13. This solution allows delivery of a provisional or permanent RPD without clasp showing and later changing to a fixed bridge after adding the necessary implants further posteriorly. 13

14. Due to insufficient indirect retention causing the shift of the most posterior part of the RPD resulting in food trapping, patients may feel discomfort in Kennedy Class II situations. An implant placed distal to the last abutment tooth may help prevent this inconvenience. 14

15. If the visible clasp is not an issue and the distal abutment is a dependable tooth such as the canine, the implant can also be placed in the second molar position. 15

16. In cases where the edentulous span is wide and covers unilaterally a whole quadrant, two implants should be taken into account. 16

17. The mid-span location is not common, but it may also be considered. 17

18. Placing four implants may be considered a bit too luxurious in a Kennedy Class I situation and can be criticized but delineates a very good transitional situation for a later fixed solution. 18

19. ( a, b ) Implants placed in the area of the second molars would change the Kennedy class i situation to a more favorable Kennedy class iii 19

20. Kennedy Class III Situation Implants in Kennedy's class 3 can be used for several purposes, such as: Shortening a too-long edentulous space, In case of unreliable compromised weak abutments (e.g., root canal treated or post-cored teeth), or When clasps are to be eliminated. 20

21. The best position for the implants in these cases is adjacent to the abutment teeth. However, it should be known that implants are only used seldom in Kennedy III cases. 21

22. Kennedy Class IV Situation 22 In extreme Kennedy Class IV cases, a few dental implants could give the dentures a very reliable stability as well as retention.

23. indications for IARPD s When the remaining dentition is unfavorable to be used as abutment teeth/the patient does not wish to lose all the teeth. In cases where implants are placed gradually in a certain period and there is a time interval where a transitional RPD is needed. Advanced ridge resorption in edentulous areas, making additional stability and retention measures necessary. In cases where surgical augmentation procedures for placement of all needed implants are contraindicated. 23

24. In cases where the clasps should not be visible and the denture base is desired to be smaller. In cases where the jaw relation is inconvenient and the placement of the artificial teeth in an Intercuspal position (e.g., too far buccally) threatens the denture stability. Patient desires. 24

25. Contraindications for IARPD s : Cases where no surgery may be performed. Patients not able to use any removable denture. Situations where interocclusal or interarch distance does not allow the placement of an implant attachment. 25

26. Advantages of IARPD s : Enhanced esthetics by elimination of clasps and compensation for loss of supporting tissues (assuring better lip & cheek support). Change of the fulcrum axis position possible. The forces on remaining teeth may be reduced. In free-end partially edentulous arch situations, vertical support may be increased. 26

27. Improved retention and stability. The arrangement of the insertion path is less problematic with implant abutments. Reduced pressure or trauma on supporting tissues. Reduced tissue coverage. 27

28. Preservation of the bone around implants through delayed alveolar atrophy in edentulous areas. Compared to complete edentulism, the remaining teeth help preserve the proprioception. It may reduce the need for indirect retention. 28

29. DISAdvantages of IARPD s : Increased cost & treatment time (Osseointegration period). Additional surgical interventions. A multidisciplinary approach is necessary. The treatment is more technique-sensitive. In some instances, the denture production stages may be more complicated. 29

30. WEAK POINTS Good diagrammatic representation. Well explained. Enough number of references. STRONG POINTS CRITICAL ANALYSIS Less explanation related to Kennedy’s Class IV situation. No explanation on RPD designing & principles. 30

31. CONCLUSION There is no consensus on the most favorable implant position in a Kennedy Class I or II situation. While some recommend the second molar position (most distally position) to transform the situation to a much more comfortable Kennedy Class III case, others suggest a more central position such as the first molar position against a tendency to displacement. Choose the implant position, taking cognizance of the available bone volume. 31

32. In a distally placed implant situation, a clasp has to be used at the most distal abutment tooth. Suppose the most distal abutment tooth is an incisor. In that case, the strategy of transforming to a Kennedy Class III situation has to be given up and the implant position chosen at the most mesial part of the edentulous span. This brings an esthetic advantage and protects the generally weaker roots of incisors from lateral overload. 32

33. TAKE AWAY MESSAGE The main aim is to reduce the length of the edentulous space, move the fulcrum more distally, and if possible eliminate a clasp via a suitably positioned dental implant. 33

34. REFERENCES Olcay Şakar . Removable Partial Dentures. Springer Nature; 2024. ‌ Hakan Bilhan . The Role of the Dental Implant in Removable Partial Dentures. Springer eBooks. 2024 Jan 1;223–41. Turkyilmaz I. Use of distal implants to support and increase retention of a removable partial denture: a case report.2009 . Tribst J, de Araújo R, Ramanzine N, Santos N, Dal Piva AO, Borges A, et al. Mechanical behavior of implant assisted removable partial denture for Kennedy class II. Journal of Clinical and Experimental Dentistry. 2020;e38–45. 34

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