In the field of dentistry, clinicians are aware that implant placement requires considerable pre-operative planning and surgical skills. The relationship between the support available and the amount of mechanical load is well established.8 The amount of mechanical load that a particular region or the entire dentition will be subjected to is mainly dependent on the amount of available bone. The support around the teeth also varies with the size and shape of the roots. This is particularly so in patients with severe periodontal disease. If the loss of periodontal support is severe, conventional fixed bridges may not provide sufficient support to resist the functional load. Implant-supported prostheses can be used successfully to replace missing teeth in such compromised patients.9 In addition, implant therapy for partially edentulous patients offers a long-term solution for restoring missing teeth and improving their oral health. For example, in the posterior regions of the maxilla, where the teeth are extremely mobile, a more durable permanent prosthesis can be achieved through the use of implant-supported prostheses.2 This may be of particular interest to the partially edentulous patients who cannot afford immediate implant placement, who are physically and/or medically compromised, or who suffer from a risk of sinus perforation during sinus lift procedures.10
Our patient was not a candidate for implant treatment. The primary reason behind the loss of her posterior teeth was tooth decay. Immediate implant placement and fixation was not indicated because of the patient’s anatomical conditions. It was therefore decided to work on her removable partial denture with the addition of palatal arm attachments to improve both support and retention. The patient had mild amount of bone loss but the vital bone height was adequate to accommodate adequate amount of mechanical load. In the anterior maxilla, the presence of teeth contributed to adequate bone volume. The patient presented a slightly open bite, which was probably due to the excessive anterior overjet. The presence of teeth also contributed to aesthetics. The patient wanted to retain her existing denture. Patients have a tendency to keep their existing dentures unless there is a compelling reason to change, such as a removable partial denture becoming loose or uncomfortable. Thus, the addition of palatal attachments to the existing denture would provide her with an improved retention and stability. The patient had no systemic disease that could compromise the healing of the palatal wounds. The patient was on long-term medication for hypertension and her blood pressure was within normal range.
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