Editorial Type:
Article Category: Case Report
 | 
Online Publication Date: 15 Jul 2025

Implant-Prosthetic Rehabilitation of the Edentulous Mandible in a Patient With Class III Malocclusion and a Retrognathic Maxilla

Dr med dent, Dr phil, MA, MSc,
PD Dr med dent,
Prof Dr med dent, MSc, MSc, and
Dr med dent
Page Range: 233 – 239
DOI: 10.1563/aaid-joi-D-24-00162
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Over the past few years, innovations in computer-aided design/computer-aided manufacturing (CAD/CAM) processes have allowed for manufacturing bar-retained constructions made of titanium or a cobalt-chrome alloy to secure the position of overdentures. Here, the authors demonstrate the challenges of implant-prosthetic mandibular rehabilitation of a male 71-year-old patient with a reconstructed left-sided clefting congenital deformity and class III malocclusion with anterior crossbite and retrognathic maxilla. This case illustrates that the rehabilitation of an edentulous mandible with 4 intraforaminal implants and a CAD/CAM-fabricated bar with an overdenture can offer satisfactory prosthetic rehabilitation. In the present case, a bar-retained construction was the rehabilitation concept of choice, meeting the patient’s request for restoration similar to the restorative concept in the maxilla and the correction of the reverse overjet in the anterior region.

Keywords: milled bar; anterior crossbite; unilateral cheilognathopalatoschisis; implant-prosthetic rehabilitation; bar-retained construction
Copyright: 2025
Figure 1.
Figure 1.

Clinical situation prior to implant-prosthetic restoration with a narrow alveolar ridge due to atrophy.

Figure 2.
Figure 2.

The initial clinical situation involved a removable denture that presented a significant frontal crossbite. Additionally, for maxillary restoration, there was a need for motivation and support in the patient’s oral hygiene practices due to plaque accumulation in the visible area of the bar in region #7.

Figure 3.
Figure 3.

Initial clinical situation in habitual intercuspidation of the 71-year-old patient (right lateral view) with protrusion of the lower lip.

Figure 4.
Figure 4.

X ray after removal of tooth #22. In region #22, overpressed root-filling material had healed apically in the bone and remained there as it showed no sign of inflammation.

Figure 5.
Figure 5.

Three-dimensional implant planning with cone beam tomography. The 3-dimensional reconstruction (bottom right) shows the skewness of the alveolar ridge in the anterior area. The sagittal image (top right) shows a basally sufficient bone width after resection of the narrow crestal bone. The dimensions of the required resection were noncritical regarding the vertical positioning of the implants to the oral floor.

Figure 6.
Figure 6.

Presurgical try-in of the wax-up with correction of the crossbite. Improved oral hygiene in the maxilla is documented due to prophylaxis treatment and a refresher on oral hygiene.

Figure 7.
Figure 7.

Orientation template for implant placement featuring lateral retention wings for intraoperative assessment of implant location and angulation in relation to the planned restoration.

Figure 8.
Figure 8.

Occlusal view following the complete resection of the tapered alveolar ridge and the insertion of 4 implants in regions #21, #23, #26, and #28. All implants are surrounded by residual bone. The bone material harvested during resection was utilized for labial augmentation to protect against resorption at the implant sites.

Figure 9.
Figure 9.

Postoperative control X ray.

Figure 10.
Figure 10.

Try-in of the milled bar with the prominent body of the tongue held back.

Figure 11.
Figure 11.

Mandibular restoration with activable retention elements before insertion.

Figure 12.
Figure 12.

Basal view of the overdenture.

Figure 13.
Figure 13.

Control X ray following bar insertion.

Figure 14.
Figure 14.

Frontal view of the final bite situation. The crossbite could be corrected prosthetically, and oral hygiene was successfully optimized.

Figure 15.
Figure 15.

Restoration inserted (view from the right side).

Contributor Notes

*Corresponding author, e-mail: hansulrich_brauer@za-karlsruhe.de
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