.

Intraoral implants
Currently only the endosteal implants are used in both intraoral and
extra

oral

sites. Edentulous

patients

with

partial

maxillectomy defects:

Placement of implants has a dramatic effect on the function of the prosthesis.

Implants provide retention, stability & support.
IMPLANT SITE:
Number of implants and their location is determined by the nature of the
defect and available bone sites. The most ideal location for implants in
edentulous

total maxillectomy patients is residual premaxilla. This

site

is

preferred because the anterior maxillary segment is opposite to the most

retentive position of the defect located along the posterior lateral wall. In
addition a satisfactory volume and density of bone can be found in the
premaxilla in most patients.
The

maxillary tuberosity site

is

considered only

when

there

is

insufficient bone in the residual premaxilla as the bone is not very dense.
The edentulous posterior alveolar process may serve as an alternative site for

implant placement if there is at least 10mm of bone available beneath the maxillary
sinus.
RETENTION BAR DESIGN:
In most cases implants are united with a rigid precision fitted bar with
retentive elements attached to it. Implants are placed in the cuspid region and
the retentive bar is arranged so it is perpendicular to the midline and
parallel to the occlusal plane.
When occlusal load is applied posteriorly, the prosthesis is compressed
into the denture bearing surfaces and retention clips allow the prosthesis to
rotate freely around the bar . This design allows most occlusal forces to be
directed along the long axis of implants. Such design is possible when hard palate
is intact.

If entire premaxilla remains then the number of implants, their

distribution and the design of retention bar follows more conventional

prosthodontics principle. Implants can be placed in two cuspid sites. Hader bar can
be used for retention.
Maxillary defects with only one or both tuberosity remains are
particularly difficult to restore. 'O' ring type of attachments are preferred
because they allow the prosthesis to rotate in multiple directions when either
an occlusal load is delivered or when the prosthesis drops as a result of
gravity.
IMPLANTS IN MANDIBULAR DISCONTINUITY DEFECT
In

mandible resection

patients

if

implants

are to

be

placed,

consideration should be given to place implants in the opposing edentulous

mandible. The unilateral occlusal loads, increased lateral forces tend to

dislodge conventional complete denture. Two implant placed in the cuspid

position will provide necessary retention and stability.
IMPLANT SITE AND NUMBER:
Only available region is symphyseal region. Minimum 2 implants
should be placed not only for retention also for better stability as unilateral
envelope

of

motion

and

mastication compromise stability of denture.

Implants could not be placed close to the border of the resected mandible
because the bone in this region may be necrotic and poorly vascularised. If
only two implants are to be placed they should be 15 mm apart to
accommodate

the

retention

bar

apparatus. They should

be

placed

perpendicular to the occlusal plane.

The bar should be design in such a way that it is parallel to the axis
of rotation of the prosthesis when occlusal forces are applied on the normal
side. With this design the prosthesis will rotate freely around the bar minimizing
the torquing forces.
MAGNETS
In dentistry both attractive and repulsive properties of magnet are
used. Magnetic repulsion has been used to limit the displacement of dentures
by the incorporation of magnets into posterior segments, like poles in
opposition. Attractive forces have been employed by implantation of magnets
within alveolar bone, root or soft tissue, unlike magnetic poles being included
in the overlying denture.
One of the earliest magnets was paired Alnico. It is a permanent magnet
alloy of iron, cobalt, Nickel and aluminum. It was used to maintain the seating of
maxillary and mandibular complete dentures with the help of its mutual

repulsion of like poles. The magnets were embedded in the bases of the dentures
with like poles oriented toward each other. But the disadvantage of this system
was the large size required to achieve adequate repulsive force to retain the
dentures in place when the jaws were apart. Hence, mutually attractive
forces of paired magnets were used as retentive aid for sectional dentures,
maxillofacial prostheses, obturators and complete dentures.
Open- field systems :
In these systems a magnetic field is experienced outside the specimen, since
the magnet is encased in a non magnetic housing. Because of fear over the
effects of magnetic fields on the soft tissues, a soft magnetic material, Pdco-Ni alloy , was developed for use in the root face. It was found to be the
most corrosion resistant. The advantage of these alloys is that the root element
possesses no permanent magnetic properties; thus, no magnetic fields are
experienced within the oral environment once the dentures are removed.
Other softmagnetic material used for root keepers have included Magnetic stainless
steel, Permendur (an alloy of iron and cobalt), Nd-Cr- Mo alloy . An open field
System consists of a cylindrical magnet with open ends. It can be either paired
or single
Close-field systems:
Many commercial system are now there of closed-field type; these attempt
to reduce the magnetic field effects in the oral cavity. The magnetic
attachment incorporate soft magnetic material (such as ferritic or martensitic
stainless steel or a Pd-Co-Ni alloy) that connect the poles of a magnet so the
external field is shunted through the path of less resistance, reducing
external field in situ.

Attachment of closed field magnets is more efficient because both the

north and south poles can be used for attachment to the keeper (in hopefield system, only one Pole is used) and the keepers can contain the magnetic
flux. Although these systems generally provide a higher retentive force than
a similarly sized open-field system, the retention reduced rapidly with
increasing separation.

The first closed-field design was the