This case report describes fabrication of a palatal lift prosthesis for a quadriplegic edentulous 30-year-old male with past head traumatic injury. We constructed an implant supported bar and used a soft-lining material for the maxillary palatal lift prosthesis to minimize the possibility of implant overloading and also provide a less complex and less expensive procedure for this patient.
The possibility of survival from cerebrovascular accidents that were once fatal is increasing because of advances in medical sciences [
In 1958, Gibbons and Bloomer [
A quadriplegic edentulous 30-year-old male with a history of head trauma caused by a car accident 3 years ago was referred for replacement of missing teeth. He had extracted all his teeth because of severe caries due to a 10-month coma and the jaw ankylosis resulting from the trauma. His chief complaint was inability of chewing, and mouth opening range was normal. After meticulous diagnostic survey, maxillary and mandibular overdentures were selected as the treatment plan. He had type 3, divisions A, D, C in different part of maxillary arch and type 1 division A in mandibular arch [
Eight implants (
(a) Occlusal view after implant placement in maxilla. (b) Occlusal view after implant placement in mandible.
The patient’s general condition improved after a year, and his speech therapist requested palatal lift prosthesis to correct the patient’s hypernasal speech and also emphasized that his soft palate muscle activities may be corrected after a period of using palatal lift prosthesis.
To construct a new maxillary prosthesis with palatal lift, preliminary impression was made with irreversible hydrocolloid (Jeltrate, Alginate, Fast set, Dentsply Philadelphia, PA, USA) and a custom tray was fabricated with light cured resin (Triad VLC, Dentsply). Border molding in vestibules was performed by impression compound (Kerr, Orange, NJ, USA) and completed with the Iso Functional compound (GC Dental Corp., Tokyo, Japan) in the soft palate site. Final impression was made by polyether material, (Impergum F, 3M ESPE, St. Paul, MN, USA, Figure
(a) Alginate impression with a prefabricated tray corrected with impression compound for extending to the soft palate site. (b) Maxillary special tray after border molding. (c) Final impression of maxillary arch extending to the soft palate.
(a) Intaglio surface of the denture after spacer removal. (b) Intaglio surface of the denture after lining with resilient material.
(a) Occlusal view of maxillary bar attachment. (b) Occlusal view of mandibular ball attachment. (c) Frontal view of maxillary and mandibular denture in centric occlusion. (d) Maxillary denture and palatal lift portion in place.
In 1961, Chase introduced the use of elastic impression material to relieve traumatic tissues [
Using a soft liner-retained implant-supported overdenture offers the restorative dentist a treatment option when the number, location, or angulation of dental implants placed may differ from the original treatment plan [
Adding palatal lift portion to maxillary overdenture increased the off-axis load to implants, so presence of soft lining material provides an even distribution of functional load and minimizes the possibility of implant overloading. Also, construction of implant-supported bar for retention and support distributes forces among the implants [
A set of parameters for successful unsplinted implant-retained maxillary overdenture treatment have been published [