36 Tika Rahardjo & Harry Laksono: Esthetic removable partial denture

Esthetic removable partial denture

1
Tika Rahardjo, 2Harry Laksono
1ProsthodontistPrivate Practitioner
2Department of Prosthodontics Faculty of Dentistry, Airlangga University

Surabaya, Indonesia
Corresponding authors: Tika Rahardjo, e-mail: [email protected]

ABSTRACT
Prosthetic rehabilitation of a partially edentulous patient can be established by using wide range of treatment opti-
ons. Magnetic attachment retained denture has always been considered beneficial for the patient, because it is gi-
ving a more esthetic and functional outlook to the denture. The following case report discusses removable partial
denture with no clasps showing by using magnetic attachment retained, thus increase esthetics. A 60-year-old male
patient came to Department of Prosthodontics, Airlangga University, for his esthetic problems and chewing inability.
Intraoral examination revealed teeth 14, 13, 12, 11, 21, 22, 23, 24, 28, and 46 remained at lower jaw. He never had
a denture and needed to make a new one. Clinical and radiographic examination along with the preliminary impress-
ion were taken. Teeth preparation and impression for magnet keeper, then cementation of magnet keeper on teeth
12 and 24. Functional impression for upper and lower jaw with individual tray. Denture delivery and one week after
followed by insertion of magnet EX 600 in the denture. It was concluded that magnetic attachment retained partial
denture could enhance the natural looking for the patient because it has no clasps showing.
Keyword: Magnetic retained, removable partial denture, overdenture

INTRODUCTION removable complete denture prosthesis. Study by

The esthetic impact of tooth loss can be highly Renner et al. said that 50% of the roots used as
significant and may be more of a concern to a pa- overdenture abutments remained immobile even
tient than loss of function. Restoring facial esthe- after 4 years.6
tics in a manner that maintains an appropriate ap- Magnetic attachments provide no vertical resi-
pearance can be a challenge and is a major factor liency while decreasing horizontal stress transmiss-
in restoration and maintenance decisions made ion to abutment.7 Magnet used in this study is MAG-
for various prosthetic treatments.1 FIT EX. Magfit utilizes a stainless steel casing her-
Tooth loss consequences consist of anatomi- metically sealed by microlaser welding to ensure
cally reduced ridge volume and physical anatomic excellent corrosion resistance. All Magfit magnetic
tools for mastication also the oral capacity for neuro- attachments are closed field in order to ensure that
muscular functions to manipulate food. Therefore the magnetic field leakage at the gingival margin
a denture may help increase their natural feeling is substantially below the accepted US Safety Stan-
of chewing. Conventional removable partial den- dard of 0,02T. The surface of the keeper is coated
ture (RPD), teeth or implant supported overdentur- with Cr-rich layer to protect it from oxidation during
es, fixed partial dentures, and implant supported the casting process. Magfit DX attachments have
fixed or partial dentures are the most preffered pros- ellipsoidal outer lip with an anti-rotation feature to
thetic treatment approach.2 However, the tradition- ensure firm fixation in the denture base.8
al retention systems such as metallic clasps, fre- The following case report discusses removable
quently used in these conventional removable den- partial denture with no clasps showing by using
tures, impose lateral forces on remaining abut- magnetic attachment retained.
ments, increase abrasive wear, and cause unaes- CASE
thetic appearance.3 A 60-year-old male patient came to Department
Famous statement of Devan4 dictum, It is es- of Prosthodontics, Teaching Hospital of Dental Fa-
sential to retain that is present originally in oral ca- culty, Airlangga University for his esthetic problems
vity than to replace what is lost due to any reason”. and chewing inability. Intraoral examination reveal-
Overdentures cover one or more teeth or dental im- ed teeth 15, 14, 12, 11, 21, 22, 23, 24, 28 remained
plants, restoring the entire dentition. They help pre- at upper jaw. At lower jaw only tooth 46 remained
serve natural teeth or roots that are often indicated with mobility grade 2 (Fig.1).
for extraction because of periodontal tissue loss.
Maintaining these teeth or roots enables a delay
in alveolar bone resorption and preserves perio-
dontal proprioception and masticating efficiency.5
Overdenture is a better option as compared to a Figure 1 Pre operative view: natural remaining teeth

DOI: 10.46934/ijp.v4i1.171
Indonesian Journal of Prosthodontics June 2023; 4(1): 36-39 37
Case

The clinical and radiographic examination re-

vealed that in the upper arch, the remaining teeth
at upper jaw had fractures, caries, and periodon-
tal tissue loss, and tooth 46 had mobility grade 2.
With the remaining teeth that cannot be used as A B C
abutments for fixed prosthetic treatment, it was de- Figure 3A,B Magnet cast keeper abutment impression, C
cided that overdenture could be the choice of treat- impression of lower ridge abutment for metal coping
ment. It was decided to perform a magnet-retained
water and dried thoroughly with endodontic aspira-
partial overdenture for maxillary arch and bare-root
tor and absorbent paper points. The casting was
complete overdenture for mandibular arch.
cemented using luting glass iononomer cement.
Denture was then fabricated by conventional
MANAGEMENT
material and methods. Preliminary impression of
Clinical and radiographic examination along with
maxillary and mandibular arches were made using
the preliminary impression using irreversible hydro-
impression compound irreversible hydrocoloid and
colloid (alginate) were taken on the first visit. The
cast poured in dental plaster (Fig.3). Acrylic cus-
next visit was to extract teeth 13, 14, 28 and root
tom tray with wax spacer was fabricated. An ad-
canal treatment for teeth 12, 24, 36; composite fil-
ditional wax spacer to the dimension of denture
ling for teeth 22, 23. Teeth color matched with Vita-
magnet, about 3x2 mm was placed over the root
pan shade guide.
face on preliminary cast. Final impression was
Impression of study cast of upper arch is taken
made while putting magnet on the cast keeper using
with polyvinylsiloxane (PVS) for preparation of ma-
PVS medium bodied consistency. Master cast was
king temporary crown. Teeth 11, 21 being prep-
poured in type IV dental stone and occlusal rims
ped for single crown. After the preparation of the
were made on the denture bases. Jaw relations
abutments, the impression was made by using a
were recorded and transferred to a semiadjusta-
PVS elastomeric impression material (reguler body)
ble articulator for arrangement of artificial teeth.
with putty/wash one step impression technique. Di-
Artificial teeth were mounted and tested in the oral
rect temporization made with Bis-acrylic compo-
cavity to check occlusion and esthetic results. The
site, then temporary single crown inserted (Fig.2).
dentures were manufactured and installed along
with single crown of teeth 11, 21 (Fig.4).

A B
Figure 2A Preparaton for single crown 11, 21, B impression
of crown preparation.

Abutment teeth 12, 24, 36 were endodontically A B

Figure 4A Denture insertion intra oral, B patient profile while
treated. The teeth were cut down to gum level (equi- wearing the new denture
gingival) and post space preparation for teeth 12,
24 was done up to 2/3rds of the length of the canal Patient was recalled after 1 day, 3 days, and 7
with gates glidden drill and. In order to prevent the days for evaluation. On recall it was observed that
movement of the post in the post space, an antiro- patient was satisfied with his new dentures and
tational notch was placed. Chamfer margin of 1 mm was able to masticate properly.
was made. To support the impression material in After 7 days of denture insertion, denture in 12,
the post space, a toothpick was placed in the post 24 region was scraped to make space for magnets
space. Lentospiral was used to coat the inner sur- and a hole made in the buccal flange adjacent to
face of the teeth by PVS light body. A pick up im- keeper’s location. The magnets were positioned on
pression was made with putty. Post space prepa- the keepers in the mouth. Resin was added to the
ration was done for teeth 12, 24 and tooth prepa- scraped area and the mandibular denture was pla-
paration to receive metal coping was done for 36. ced over the magnets in mouth under proper occlu-
Impression sent to dental laboratory for fabricating sion. After the resin was set, denture was removed
magnet cast keeper and metal coping (Fig.2). with the magnets picked up in the mandibular den-
After fabricating the posts, they were tried in the ture. Excess resin was trimmed and denture po-
patients mouth and verified for fit. The prepared lished. After polishing, the denture was again pla-
post space was thoroughly washed with distilled ced intra-orally and checked for comfort, occlusion

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38 Tika Rahardjo & Harry Laksono: Esthetic removable partial denture

and retention. Patient was instructed how to wear lar results reported that the presence of anterior
and remove the denture, denture maintenance and teeth in an RPD could influence patient’s satisfac-
oral hygiene as well. tion.20
Magnet used in this study is MAGFIT magnetic
DISCUSSION attachments developed by Aichi Steel Corporation
Tooth loss leads to difficulty in masticatory func- for the Toyota Group, which claimed to have the
tion and oral capacity for neuromuscular functions strongest retention with an ultra-compact size, no
to manipulate food also influences facial appear- corrosion due to Aichi Steel's precision micro-la-
ance and psychological condition.1 Treatment of ser welding technology enables a perfect hermetic
choice in this particular case was magnet-retained seal of the stainless steel outer casing which pro-
partial overdenture for maxillary arch and bare-root tects the magnet from corrosion in the oral environ-
complete overdenture for mandibular arch. Re- ment, and new magnetic materials technology.21
maining teeth had fine periodontal and gingival There are few types of magfit; Magfit DX and
attachment so it worth to be maintained.9 Endo- MAGFIT EX, these are cast coping type magnet.
dontically treated retained root can support a den- MAGFIT DX series is suitable especially for molars
ture and transmit masticatory pressures to the pe- where vertical space is limited. It has a thin disk-
riodontal ligament receptors. This improves the pa- type design with improved wear resistance.The el-
tient’s oral perception, also to prevent bone resorp- lipsoidal outer lip of the magnetic assembly pre-
tion.1,10 vents rotation to ensure firm fixation to the denture
Magnets had many advantages, such as ease base. It is 30% shorter than the EX series but wider
of placement, automatic reseating, constant reten- in diameter. Durability has been enhanced by in-
tion with many cycles, easy replacement, small size creasing the hardness of the magnetcasing. MAG-
with strong attractive forces, can be placed within FIT EX has a "sandwich type" structure with attrac-
prosthesis, dissipate lateral functional forces, less tive forces ranging 400-600 gf, which is compara-
need for parallel abutments, can be used for im- ble to the spring method. MAGFIT EX600W is re-
plant-supported prosthesis, ease of cleaning.11 commended for cases with regular space require-
In order to be an abutment for cast keeper, abut- ments. MAGFIT EX400W is suitable for cases with
ments must be prepped almost at the same height minimal space conditions as well as cases requi-
as surrounding ridge. Magnetic attachments pre- ring lower retention. MAGFIT EX is in rectangular
vent any lateral forces also it had easy applicati- shape, so it is prone to use in long or oval shaped
on.12 It has to be noticed that magnets increase retained root surface.12 MAGFIT EX600W is cho-
retention of partial or complete dentures and sen for this case because the dimensions (3,8 x
overdentures.13 it offers adequate retention and 2,8 mm) suitable for root surface of teeth 12, 24.
decreases the transmission of excessive forces After magnet insersion, patient was recalled to
to the remaining teeth.14,15 observe and evaluate denture. Patient was satis-
Conventional removable partial denture have fied with appearance of his new dentures and was
led to harm the periodontal tissue, and may able to masticate properly. There were no mucosal
contribute to carious lesion formation, also the inflammation. Denture is better in retention and sta-
appearance of clasps may interfere patient smile bility.The patient was instructed to control intra oral
and resulting in presence of wearing denture.16 hygiene by regularly brush abutment teeth with fluo-
Additionally, the magnetic overdentures are more ride toothpaste because clean and healthy perio-
stable and retentive than conventional partial den- dontal is what makes any treatment especially
tures, and they are easily removed and seated with- overdenture successful.12 Denture also had to clean
out the patient having to grapple with clasps and regularly with baby toothbrush that has really soft
complex paths of insertion, thereby improving es- bristles and liquid soap twice a day. Denture-wea-
thetics, function, and comfort.17 ring habit patient must follow is to remove denture
Based on denture design of RPD, Shala et al18 at bedtime and put into liquid denture cleanser.22,23
confirmed statistically significant difference (P= Almost 40% of patients no longer use their RPD
0,008) patient’s success of RPDs with attach- within 5 years because of factors such as socio-
ment compared with RPDs with claps which agree demographics, pain, and esthetics. Timely recall
with Owall,19 that considering patient’s satisfaction and maintenance are required for success.24 Pa-
were better when used combination with fixed par- tients are advised to control every 6 months so
tial dentures retained with attachment (93,8%) com- prosthodontic treatment can be optimal.25
pared with RPDs retained with claps (58,7%). Simi- It is concluded that regarding quality of dentu-

DOI: 10.46934/ijp.v4i1.171
Indonesian Journal of Prosthodontics June 2023; 4(1): 36-39 39
Case

res, patients are generally satisfied more with RPD of their advantages such as better aesthetic, reten-
with attachment based on level of aesthetics, re- tion, stability, stable occlusion, and chewing func-
tention, and chewing ability, because they prefer tion due to the conservation of proprioception feed-
not to show the anterior labial clasps of RPD. Mag- back. Also, the rate of the residual ridge resorption
net-retained partial overdenture may be preferred was decreased because of the transfer of com-
in the rehabilitation of partial edentulous patients pressive forces into the tensile forces by the pe-
to the conventional removable dentures, because riodontal ligament and better stress distribution.

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