Journal of Oral Rehabilitation 2006 33; 313–315
Implant-retained overdenture following hemiglossectomy: a
10-year clinical case report
Y . T A I R A * , J . S E K I N E †, T . S A W A S E * & M . A T S U T A *
†
Rehabilitation and Division of Oral and Maxillofacial Surgical Reconstruction and Functional Restoration, Nagasaki University, Nagasaki,
Japan
SUMMARY A clinical evaluation of an implant-sup-
ported overdenture placed in the edentulous man-
dible after hemiglossectomy is described. The
deltopectoral flap covering the mandibular ridge
was replaced with a free mucosal graft. Four Bråne-
mark system implants were inserted into the anter-
ior part of the mandible, but one of the four fixtures
did not show osseointegration. The superstructure
was designed as a spaced round bar-attachment
supported by three implants so as to retain the
complete overdenture. In addition to the metal clip,
Introduction
When a patient has a compromised residual ridge
anatomy as a result of pre-prosthodontic surgery, it is
sometimes difficult to achieve comfortable function and
aesthetics (1, 2). This challenge has been addressed to a
certain extent in oral tumour patients after jaw resec-
tion and following rehabilitation with dental implants
(3–6). In such cases, the implant-supported overden-
ture has the advantage of improved function associated
with minimum movement, when compared with the
conventional complete denture (7, 8). The movement
of the overdenture also depends on the shape of the
bar-attachment and the number of implants that are
splinted (9).
Various osseointegrated implant systems are applic-
able to the fabrication of implant-supported overden-
ture, and the cumulative survival rates for Brånemark
and ITI systems supporting overdentures have been
reported to be 94Æ5% for 5 years (10) and 95Æ7%
for 7 years (11) respectively. Some patients prefer
removable implant-supported prostheses to fixed
ª 2006 Blackwell Publishing Ltd
*Division of Fixed Prosthodontics and Oral
a silicone-based soft denture liner material was
applied in the female portion of the attachment so
as to prevent the attachment from making a clat-
tering noise upon mastication. Although the over-
denture required adjustment at regular intervals,
the treatment was successful both aesthetically and
functionally for up to at least 10 years.
KEYWORDS: dental implant, overdenture, attach-
ment, tongue carcinoma
Accepted for publication 20 August 2005
implant-supported prostheses because of ease of
cleaning and improved aesthetics (12). It is essential
to maximize the quality of prosthetic components so as
to satisfy the expectations of patients.
Previously, we reported a 2-year case of oral reha-
bilitation by means of Brånemark system* for a patient
with tongue carcinoma (13). The present report des-
cribes the longer term follow-up of this patient.
Case report
A 52-year-old male with the chief complaint of a
tongue ulcer was referred to our hospital. Based on
the diagnosis of squamous cell carcinoma on the right-
hand side of the tongue, radiation therapy (Linac
X-ray†) of 40 Gy and hemiglossectomy were selected
as a course of treatment. Following the excision of the
carcinoma, the defect in the tongue, oral floor and
mandible was reconstructed using the deltopectoral
*Nobel Biocare, Göteborg, Sweden.
†
Siemens AG, Munich, Germany.
doi: 10.1111/j.1365-2842.2006.01633.x
314 Y . T A I R A et al.

flap. Eleven years later, a lesion resulting from

inflammatory hypertrophic change of the deltopectoral
flap was surgically removed.
When the patient was seen in the prosthodontic
division of our hospital, he requested treatment to
restore occlusal function. Thereby, a treatment plan
using dental implants was developed.
Fifteen months before surgical placement of the
implant, the deltopectoral flap was replaced with free
palatal mucosa. Four months before implant surgery,
hyperbaric oxygen therapy was employed on 15 occa-
sions so as to prevent osteoradionecrosis of the irradi-
ated mandible. A total of four implant fixtures
Fig. 1. Intraoral view 1 year after completion of the superstruc-
(Brånemark system*) were inserted into the interfora- ture. The fat and skin of the deltopectoral flap were replaced with
minal region of the mandible. This treatment was free palatal mucosa. The superstructure was designed as an
performed 13 years after the last radiation therapy. The overdenture retained with a bar-attachment.
fixtures were 4Æ1 mm in diameter and 13–15 mm in
length. Six months post-implant placement, abutment
connection was performed. However, one fixture did
not show osseointegration, and was removed to allow
bone healing.
While the overdenture was being constructed, a
temporary denture with an underlying tissue condi-
tioner‡ was worn. Following the second implant
surgery, a bar-attachment was fabricated using a
round-shaped dolder bar with two clips* (Fig. 1).
While using the completed overdenture, the patient
complained of a clattering noise made by the bar-
attachment upon mastication. A silicon-based soft
Fig. 2. Radiographs of the Brånemark system* implant and the
denture liner (Sofreliner Medium Soft or Sofreliner
superstructure 10 years after the completion of the superstruc-
Tough Medium§ was, therefore, applied into the space ture.
between the attachment-bar and metal clip. This
resolved the patient’s concern. At 6-monthly check-
ups, the overdenture was adjusted and the soft denture there was no excessive loss of the marginal bone level
liner material was renewed. Neither drug nor radio- (Fig. 2), and the overdenture functioned well.
therapy was used during the follow-up period.
Based on published criteria (14), implants are con-
Discussion
sidered successful if (i) radiographic evaluation reveals
no more than 1Æ0 mm of marginal bone loss during the This report describes a case of oral rehabilitation using
first year of loading and no more than 0Æ2 mm resorp- an implant-supported overdenture. The surgically
tion per year in subsequent years; (ii) no peri-implant induced defect had initially been reconstructed using
pathosis or radiolucency is observed; and (iii) severe a deltopectoral flap. However, when a fixture is
soft tissue infections, persistent pain, paraesthesia and installed through a deltopectoral flap, the soft tissue
discomfort are absent. According to these criteria, the around the implant is movable (15), and hair grows and
implant-supported overdenture in the present case was keratinous tissue derived from the deltopectoral flap
considered successful over the 10 years of follow-up; make the tissue difficult to clean. Therefore, so as to
prevent peri-implantitis, we removed the fat and skin of
‡
Shofu Inc., Kyoto, Japan. the deltopectoral flap, and replaced the tissue with a
§
Tokuyama Dental, Corp., Tokyo, Japan. free gingival graft (16). To decrease the likelihood of

ª 2006 Blackwell Publishing Ltd, Journal of Oral Rehabilitation 33; 313–315

 IMPLANT FOLLOWING HEMIGLOSSECTOMY
infection around the implant, the two-phase implant
system was employed. Failure of one of the four
implants in this clinical case may have been due to
the previous radiation that was applied to the tongue
carcinoma (17–20).
The spaced round bars fixed onto three implants
allow minimum movement of the overdenture on
mastication. Moreover, the use of soft denture liner
decreased the clattering noise associated with the bar-
attachment. The gap observed between the resin and
the soft denture liner material may have been due to
the deterioration of the soft denture liner and the
limitation of the adhesive bonding.
The present report suggests that a favourable prog-
nosis and aesthetics can be achieved using an implant-
supported overdenture, even in patients that have
undergone irradiation therapy for tongue carcinoma in
addition to reconstructive surgery using a deltopectoral
flap.
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Correspondence: Yohsuke Taira, Division of Fixed Prosthodontics and
Oral Rehabilitation, Nagasaki University Graduate School of Biomed-
ical Sciences, 1-7-1, Sakamoto, Nagasaki 852-8588, Japan.
E-mail: yohsuke@net.nagasaki-u.ac.jp