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 Table of Contents  
CASE REPORT
Year : 2016  |  Volume : 8  |  Issue : 4  |  Page : 249-251

Preventing alveolar ridge resorption by rehabilitating with fenestrated and overdenture in aggressive periodontitis


1 Department of Prosthodontics, ITS Dental College, Greater Noida, Uttar Pradesh, India
2 Department of Prosthodontics, Santosh Dental College, Ghaziabad, Uttar Pradesh, India
3 Department of Prosthodontics, Himachal Dental College, Sunder Nagar, Himachal Pradesh, India

Date of Web Publication27-Dec-2016

Correspondence Address:
Arpana Arora
H.No. 502, 4th Floor, Magadh Tower, I.P. Apartments, Sec-30-33, Faridabad - 121 003, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0976-4003.196806

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  Abstract 

Aggressive periodontitis, is characterized by severe loss of attachment and destruction of alveolar bone around one or more permanent teeth during the period of pubescence. It is currently believed that a combination of bacteriologic and immunologic factors are of major importance in the etiology of this disease. The objective of this study was to point out the importance of early patient presentation, correct diagnosis, and proper prosthodontic management of the disease condition by the dentist. Our case was an 18-year-old male and his clinical and radiographic findings were typical for generalized juvenile periodontitis. Treatment consisted of thorough training in techniques of plaque control, scaling and root planing and administration of tetracycline 250 mg every six hours for three weeks. Preservation of facial countours and replacement of missing teeth with overdenture and fenestrated denture. There was significant improvement of these clinical parameters six months after treatment, and replacement of the missing teeth improved their appearance as expected. The psychotherapy offered gave the patients positive psychological effects that further restored their ability to socialize in their environment, which added to their positive experience of life. Longer follow-ups will add more knowledge about the treatment modalities for rehabilitation of aggressive periodontitis patients.

Keywords: Aggressive periodontitis, alveolar bone, localized juvenile periodontitis


How to cite this article:
Arora A, Sharma R, Samra RK. Preventing alveolar ridge resorption by rehabilitating with fenestrated and overdenture in aggressive periodontitis. Indian J Dent Sci 2016;8:249-51

How to cite this URL:
Arora A, Sharma R, Samra RK. Preventing alveolar ridge resorption by rehabilitating with fenestrated and overdenture in aggressive periodontitis. Indian J Dent Sci [serial online] 2016 [cited 2021 Feb 26];8:249-51. Available from: http://www.ijds.in/text.asp?2016/8/4/249/196806


  Introduction Top


Aggressive periodontitis affects systemically healthy individuals <30 years of age although patients may be older. Aggressive periodontitis may be universally distinguished from chronic periodontitis by the age of onset, the rapid rate of disease progression, nature, and composition of the associated subgingival microflora, alteration in the host immune response, and familial aggregation of diseased individuals.[1] If not diagnosed and treated at an early stage, generalized aggressive periodontitis causes rapid destruction of the tooth-supporting structures leading to loss of alveolar bone and teeth up to 60%.[2] It is a multifactorial disease where the interplay of microbiological, genetic, immunological, and environmental/behavioral risk factors play an important role in the onset, course, and severity of the disease. The emotional effects of tooth loss are devastating for some patients and have a negative impact on their life.[3] Preservation of facial contours and replacement of missing teeth with overdenture and fenestrated denture is the treatment of choice in prosthetic management along with psychological and periodontal therapy.


  Case Report Top


An 18-year-old boy reported for the replacement of some missing teeth in the maxillary and mandibular arch [Figure 1]. Missing teeth were 11, 12, 13, 17, 21, 22, 31, 32, 37, 41, 42, and 47. Period of edentulism was approximately 2 years and the patient's medical history was nonsignificant.
Figure 1: Missing teeth in maxillary and mandibular arch.

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Oral examination revealed the mean pocket depth was about 7 mm and Grade 3 mobility in relation with mandibular right canine and first premolar and left first molar. The radiographs revealed almost total loss of the alveolar bone in relation with mandibular right canine and first premolar and left first molar. Radiographic measurements indicated that all of the teeth were affected.

A complete course of laboratory tests including glucose tolerance, urinalysis, and routine blood tests was normal. Culture for Actinobacillus actinomycetemcomitans was positive. Neutrophil chemotaxis was normal, but monocyte chemotaxis was significantly suppressed. Based on the history, clinical examination, and radiographic findinds, a diagnosis of generalized aggressive periodontitis was made according to the criteria given by the American Academy of Periodontology, 1999 classifiaction.

Treatment consisted of periodontal, prosthodontic, and psychiatric management. With periodontal opinion, mandibular right canine and first premolar and left first molar were extracted. The periodontal treatment consisted of through training in techniques of plaque control, scaling, and root planing, curettage was done around all remaining teeth and administration of tetracycline 250 mg every 6 h for 3 weeks.

In the prosthodontic management, a fenestrated maxillary denture and a mandibular overdenture were planned. Mandibular right second premolar, first molar, and mandibular left second molar were selected as abutments. These teeth were prepared with a chamfer finish line buccally, lingually, and proximally for the metal coping [Figure 2]. Impressions were made with addition silicone (Aquasil, Dentsply, India) with two-step technique. The metal copings were cemented with the glass ionomer cement (Ketac™ Cem Radiopaque Permanent Glass Ionomer Luting Cement, 3 M ESPE, United States) [Figure 3].
Figure 2: Teeth prepared for coping.

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Figure 3: Metal copings cemented on the abutments.

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Maxillary and mandibular primary impressions were made with alginate impression material (Zelgan Plus Dentsply, India). With self-cure acrylic resin (Quick Ashvin Rapid Repair, India), special trays were made covering the teeth after adapting a modeling wax spacer (Y Dent MDM Corporation, Delhi, India) of double wax sheet thickness over the teeth and single sheet thickness over the relief areas. Secondary impressions were made with addition silicone putty and light body (Aquasil, Dentsply) using two-step technique. Maxillary temporary denture base was made covering the whole of the maxillary arch except for the occlusal and cervical portion of the remaining natural teeth. Mandibular temporary denture base was made covering the abutments. Occlusal wax bite rims were made on temporary denture bases and jaw relations were recorded. Teeth arrangement and try in were done, and the dentures were cured with heat-cured acrylic resin (Lucitone 199 Denture Base Resin Powder Liquid, Dentsply) [Figure 4]. Maxillary fenestrated and mandibular overdenture was inserted in the patient's mouth [Figure 5].
Figure 4: Acrylized maxillary fenestrated denture and mandibular overdenture.

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Figure 5: Acrylized maxillary fenestrated denture and mandibular overdenture placed.

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The psychotherapy was carried out at three different levels by a psychotherapist: Individual, group, and conjoint family psychotherapy. No medication was prescribed during the therapy. During individual psychotherapy, counseling was performed on a one-on-one basis to elicit the patient's attitude and to help the patient understand the effect of the disease and its prognosis. In group therapy, the aim was to bring about changes in the behavior and personality to hasten their rehabilitation in the community. The conjoint-family psychotherapy is to make the patient's family aware of the disease and psychological condition of the patient and to encourage them to provide support during the course of treatment.

Patient was recalled after 6 and 12 months. Patient was brushing his teeth regularly, maintaining oral hygiene. The overdenture and fenestrated denture replacing the missing teeth improved patient's appearance and self-confidence as expected. The psychotherapy added to their positive experience of life.


  Discussion Top


Complete edentulous state affects the oral and general health as well as the patient's quality of life. The satisfactory treatment outcome of patients rehabilitated with complete denture relies on the retention and stability of the prostheses. Redford et al. demonstrated that more than 50% of conventional mandibular denture had a problem with retention and stability and that the mandibular denture had more problems than the maxillary dentures, primarily because of poor prosthetic retention.[4] Bone maintenance is the most significant advantage of tooth born overdenture because the maintenance of bone volume and vertical height can produce increased prosthetic retention and stability. It also gives patient better functions, comfort, and control because of proprioception.[5] Long copings were preferred because the maxillomandibular distance was 20 mm and the available clinical crown height was 5–8 mm, and thus the root canal was not necessary. The tooth supported overdentures have the disadvantage of incidence of caries, so the need for extra measures for maintaining oral hygiene and frequent reviews was there. Treatment with tetracycline showed satisfactory results.[6]

A fenestrated denture was better than the removable acrylic partial denture, considering its advantages such as preservation of labial fullness, retention, taking more support from tissues rather than from periodontally compromised teeth, and patient's acceptance. It gave better support and esthetics in morphologically compromised dental arches. Overdentures provided a sound prosthetic rehabilitation by enhancement of patient acceptance of the denture.

Psychotherapy has a very positive effect on the attitude and behavior of the patient and should be continued depending on the psychological status of the patient. A recent study reported that psychotherapy offered to a generalized aggressive periodontitis patient had a positive psychological effect that restored their ability to socialize in their environment, contributing to their positive experiences in life, which enhanced the role of special psychological care in a multidisciplinary approach in the treatment of a case of generalized aggressive periodontitis.[7],[8] This study was done to point out the importance of early patient presentation, correct diagnosis, and proper management of the disease condition by the dentist.


  Conclusion Top


The typical clinical features of localized aggressive periodontitis and generalized aggressive periodontitis patients in our environment are late presentation with gross periodontal tissue breakdown. It is a challenge for prosthodontist to conserve the facial contours and function with minimum tooth loss which might have a favorable effect on the adolescent psychologically. Longer follow-ups will add more knowledge about the treatment modalities for rehabilitation of aggressive periodontitis patients.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Hart TC. Genetic risk factors for early-onset periodontitis. J Periodontol 1996;67:355-61.  Back to cited text no. 1
    
2.
Page RC, Altman LC, Ebersole JL, Vandesteen GE, Dahlberg WH, Williams BL, et al. Rapidly progressive periodontitis. A distinct clinical condition. J Periodontol 1983;54:197-209.  Back to cited text no. 2
    
3.
Davis DM, Fiske J, Scott B, Radford DR. The emotional effects of tooth loss: A preliminary quantitative study. Br Dent J 2000;188:503-6.  Back to cited text no. 3
    
4.
Redford M, Drury TF, Kingman A, Brown LJ. Denture use and the technical quality of dental prostheses among persons 18-74 years of age: United States, 1988-1991. J Dent Res 1996;75:714-25.  Back to cited text no. 4
    
5.
Jain DC, Hegde V, Aparna IN, Dhanasekar B. Overdenture with accesspost system: A clinical report. Indian J Dent Res 2011;22:359-61.  Back to cited text no. 5
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6.
Gordon JM, Walker CB, Murphy JC, Goodson JM, Socransky SS. Concentration of tetracycline in human gingival fluid after single doses. J Clin Periodontol 1981;8:117-21.  Back to cited text no. 6
    
7.
Dosumu OO, Dosumu EB, Arowojolu MO, Babalola SS. Rehabilitative management offered Nigerian localized and generalized aggressive periodontitis patients. J Contemp Dent Pract 2005;6:40-52.  Back to cited text no. 7
    
8.
Roshna T, Nandakumar K. Generalized aggressive periodontitis and its treatment options: Case reports and review of the literature. Case Rep Med 2012;2012:535321.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]


This article has been cited by
1 Prosthetic rehabilatiton of aggressive periodontitis patients: a case series
Shraddha Sahni,Akhil G Rathi,Usha M Radke
Clinical Dentistry. 2019; : 24
[Pubmed] | [DOI]



 

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