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  Table of Contents 
CASE REPORT
Year : 2020  |  Volume : 23  |  Issue : 9  |  Page : 1328-1331

Rehabilitation of the completely edentulous young patient with the “Malo Bridge”: A case report


1 Department of Prosthodontics, Faculty of Dentistry, Karadeniz Teknik University, Trabzon, Turkey
2 Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Karadeniz Teknik University, Trabzon, Turkey
3 Turkish Republic Ministry of Health, Directorate of Health Service, Ankara, Turkey

Date of Submission09-Apr-2020
Date of Acceptance20-Apr-2020
Date of Web Publication10-Sep-2020

Correspondence Address:
Dr. A Gulnar
Department of Prosthodontics, Faculty of Dentistry, Karadeniz Teknik University, Trabzon - 61080
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njcp.njcp_170_20

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   Abstract 


It is possible to rehabilitate fully edentulous patients with implantsupported fixed or removable prostheses; however, implantsupported fixed prostheses are the gold standard for patients who not prefer to use removable dentures. This case report, prosthetic rehabilitation of a completely edentulous young patient with an implantsupported fixed hybrid prosthesis using the “Malo Bridge” technique is described. A 18 years old male patient was referred to the clinic with complaints of tooth loss, aesthetics, function, and phonetic. A total of 5 implants were placed in both the jaws. Considering that screw holes may cause aesthetic problems due to the Class III occlusion, these problems have been solved with the implant-supported hybrid prosthesis called Malo bridge. With the Malo Bridge design, the patient's aesthetic, functional and phonetic loss was eliminated, patient comfort and quality of life were improved, and patient expectations were met. It is a viable treatment option to rehabilitate completely edentulous jaws with a cross relationship and increase interarch distance using Malo Bridge to support a fixed prosthesis.

Keywords: Dental implant, hybrid prosthesis, iliac greft, Malo-Bridge


How to cite this article:
Gulnar A, Altintas S H, Yilmaz O, Ates G. Rehabilitation of the completely edentulous young patient with the “Malo Bridge”: A case report. Niger J Clin Pract 2020;23:1328-31

How to cite this URL:
Gulnar A, Altintas S H, Yilmaz O, Ates G. Rehabilitation of the completely edentulous young patient with the “Malo Bridge”: A case report. Niger J Clin Pract [serial online] 2020 [cited 2020 Sep 24];23:1328-31. Available from: http://www.njcponline.com/text.asp?2020/23/9/1328/294675




   Introduction Top


Tooth loss causes impairment of chewing, speech functions and aesthetic concerns, especially in young patients.[1] Alveolar bone loss can cause difficulties in prosthetic treatment planning.[2],[3]

In terms of completely edentulous crests, implant-supported prostheses can be divided into fixed and removable restorations.[4] The necessity of combining the advantages of screw-type and cemented-type prostheses has led to the development of new prosthetic techniques. Single or multiple-cemented structures on the milling abutment and screwed frameworks are known as the “Malo Bridge”.[5],[6],[7] The Malo Bridge allows not only for the reconstruction of teeth, but also the rehabilitation of soft tissues, gums, and all of the masticatory system.[7]


   Case Report Top


A 15-year-old male patient with a history of aggressive periodontitis was referred [Figure 1] to the clinic. The treatment plan proposed the extraction of all teeth. Following extraction and healing, the patient was referred to the Prosthodontic Department for full prosthetic rehabilitation. Intraoral and radiological assessment revealed loss of the maxillary and mandibular teeth. Mandibular prognathism (classified as Angle Class III) and an increased inter arch distance were determined. Detailed history revealed no systemic or genetic disease.
Figure 1: Preoperative panoramic radiograph showing aggressive periodontitis

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Surgical treatment

On the basis of panoramic radiographs (OPTG) and cone beam computed tomography (CBCT) examinations [Figure 2], an implant-supported fixed prosthesis was planned after iliac grafting and healing. Alveolar bone augmentation was performed on both jaws with a corticocancellous bone graft harvested from the iliac bone under general anesthesia [Figure 3]. No complications were encountered during the 6 month follow-up period. A total of 10 dental implants (Bego, Gmbh& Co KG, Germany) were subsequently inserted (3.25 mm in diameter and 10 mm in length for the maxilla, and 3.25 mm in diameter and 11.5 mm in length for the mandible) [Figure 4]. After a 4 month osseointegration period, the patient was referred for prosthetic treatment.
Figure 2: (a,b,c,d), Axial and transverse CBCT images sections of upper and lower jaw

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Figure 3: Panoramic view of the jaws after graft fixation

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Figure 4: Postoperative panoramic radiograph after implant surgery

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Prosthetic treatment

After establishing vertical and horizontal jaw relations, we decided to produce an implant-supported hybrid prosthesis with the Malo Bridge technique [Figure 5] consisting of a Cr-Co framework with a prepared tooth form on custom abutments [Figure 6]. A temporary complete denture [Figure 7] was made to help design the framework by determining the vertical size and centric relationship. Once the patient's approval had been obtained, a first impression was taken with alginate, and an individual open impression tray was prepared on the cast model. Open impression posts were fixed with the pattern resin (GC Pattern Resin, GC Dental Industrial Corp, Tokyo, Japan), and the final impression was taken simultaneously with A type silicone polyvinyl siloxane (Variotime Dynamix Heavy Tray, Light Body) by applying a double mixing technique. The passive fit of the stone verification jig and screw-retained trial complete denture was checked using the Sheffield test and radiographs. The computer framework design (Aadva IOS, GC, Tokyo, Japan) was prepared from the Cr-Co block by scanning the previously made temporary complete denture and integration into the program [Figure 8]. Virtual prepared teeth forms including the first molar were prepared on the Cr-Co framework. The gingival part was shaped using pink composite resin (Gradia GC, Tokyo, Japan) for a better aesthetic appearance. Permanent crowns were prepared from zirconium [Figure 9]. The adaptation of the metal frameworks was checked inside the mouth. The passive fit of the prosthesis was examined using the Sheffield test and OPTG. The screws were torqued to 15 N to ensure a passive fit in the final session.[8] Zirconium crowns were cemented separately with resin cement to the prepared tooth shaped framework. Screw cavities were closed with pink composite resin [Figure 10]. The patient's aesthetic, functional and phonetic problems were resolved using an implant-supported fixed hybrid prosthesis known as the Malo Bridge, and his quality of life was significantly improved. The patient was highly satisfied with the final prosthesis. No problems were encountered during 6-month follow-up.
Figure 5: Open tray implant impression

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Figure 6: (a,b), Intraoral view of the custom abutments

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Figure 7: (a,b), Intraoral view of temporary complete dentures

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Figure 8: Transfers of temporary complete dentures to computer software and preparation of the framework

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Figure 9: Extraoral views of the Cr-Co framework and zirconium crowns

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Figure 10: (a,b,c), Final occlusion

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   Discussion Top


The young patient in this case had become entirely endentulous from periodontal causes and experienced aesthetic, functional, and phonetic difficulties. Compared with removable dentures, implant-supported fixed dentures are the first treatment option in resected/reconstructed jaws and may be advantageous in preventing further bone loss.[4]

In cases in which the crest anatomy is not appropriate, a bone graft should be inserted before implant placement.[4] Complications such as donor site issues and graft resorption may occur following iliac bone grafts. Autogenous bone grafts are regarded as the gold standard for increasing the amount of bone and soft tissue.[2],[3],[9],[10]

Owing to the Class III relationship between the arches, we predicted that the screw hole points in the anterior region would create an aesthetic problem. These disadvantages were eliminated using the Malo Bridge design in this case, and the screw gaps were filled with the help of pink composite resin. Hybrid prostheses are usually formed by screwing a rigid framework to implants with acrylic resin and plastic teeth. The denture may have either a milled titanium or cast-gold framework. The fact that titanium is lighter than Cr-Co makes it particularly important in this type of atrophic crest. The production of the Cr-Co framework with CAD/CAM by milling eliminates shrinkage or deformation of the metal during the casting process in the lost wax technique.[6] In this case, the Cr-Co framework was preferred for purely economic reasons.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Acknowledgments

We are most grateful to Universal Dental Studio and to Haluk Demir Taşdemir.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Çekiç I, Ergün G, Yılmaz D. Aşırırezorbe alt veüstdişsizarkların implant destekliprotetikrehabilitasyonu. TürkiyeKlinikleri J Dental Sci 2007;13:71-7.  Back to cited text no. 1
    
2.
Tamer Y, Somay SD, Pektaş ZÖ. Otojeniliakkemiklegreft lenenatrofikmaksillanın 4 implant üstüzirkonyumsabitprotezlere kontrüksiyonu: Olgusunumu. Selçuk Dent J 2017;4:84-8.  Back to cited text no. 2
    
3.
Schaaf H, Lendeckel S, Howaldt HP, Streckbein P. Donor site morbidity after bone harvesting from the anterior iliac crest. Oral Surg Oral Med Oral Pathol Oral RadiolEndod 2010;109:52-58.  Back to cited text no. 3
    
4.
Siadat H, Khojasteh A, Beyabanaki E. Reconstruction of a mandibular defect with Toronto bridge following tumor resection and bone graft: A case report. Front Dent 2019;16:153-7.  Back to cited text no. 4
    
5.
Saadat F, Mosharraf R. Prosthetic management of an extensive maxillary alveolar defect with an implant-supported restoration. J Dent (Tehran) 2013;10:256-63.  Back to cited text no. 5
    
6.
Montero J, Paula CM, Albaladejo A. The “Toronto prosthesis”, an appealing method for restoring patients candidates for hybrid overdentures: A case report. J Clin Exp Dent 2012;4:e309-12.  Back to cited text no. 6
    
7.
Malo P, Nobre MA, Lopes A. The rehabilitation of completely edentulous maxillae with different degrees of resorption with four or more immediately loaded implants: a 5-year retrospective study and a new classification. Eur J Oral Implantol 2011;4:227-43.  Back to cited text no. 7
    
8.
Dilber E, Aral CA, Yavuz MS, Işık EN. CAD/CAM ileüretilen titanium altyapılıhibritprotezuygulaması: Olgusunumu. J Dent Fac Atatürk Uni 2016;16:36-41.  Back to cited text no. 8
    
9.
Bayram B ve ark. Donörsahaolarakkullanılan anterior iliakkrestinmorbiditesinindeǧerlendirilmesi. J Dent Fac Atatürk Uni, 2012;22:52-6.  Back to cited text no. 9
    
10.
Chiapasco M, Zaniboni M, Rimondini L. Autogenousonlay bone grafts vs. alveolar distraction osteogenesis for the correction of vertically deficient edentulous ridges: A 2-4 year prospective study on humans. Clin Oral Impl Res 2007;18:432-40.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10]



 

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