A case report of a removable denture using magnetic attachments for a
missing mandibular molar with a decreased occlusal vertical dimension
followed up for 9 years
M. Sone，D. Matsumoto, N. Koyama, F. Narumi, T. Matsukawa, S. Uchida, S. Somekawa, K. Takahashi,
M. Suzuki, Y. Miyoshi, D. Sakamoto, K. Okamoto, and S. Ohkawa
Division of Removable Prosthodontics, Department of Restorative and Biomaterials Sciences, Meikai
University School of Dentistry

Abstract
This case report describes our establishment of an appropriate OVD for a patient with a decreased
OVD to restore the aesthetics and function by the use of magnetic attachments.
As a definitive prosthesis, a maxillary removable overlay denture with coping-type magneticattachments and a horseshoe plate as the major connector was fabricated, and a mandibular removablepartial denture with an extracoronal-type magnetic attachment was also fabricated.
Nine years after the denture setting, the definitive prosthesis has been used without serious problems,
and the magnetic attachment has no clinically significant loss of retention.

Introduction
To maintain a harmonious craniofacial system, it is essential to establish an appropriate occlusal
vertical dimension (OVD). 1) This case report describes our establishment of an appropriate OVD for apatient (missing mandibular molar) with a decreased OVD to restore the aesthetics and function by theuse of magnetic attachments.

Clinical History
The patient, a 59-year-old female, complained of aesthetic dissatisfaction and masticatory dysfunction.
The patient had a partially edentulous maxilla (Eichner classification :B3, Disease type classification at
Japan Prosthodontic Society :1-Ⅰ LevelⅠand Occlusal-triangle :area A) (Figs.1, 2, and 3). All fixed
prostheses were failed restorations with marginal discrepancies and damaged by caries and periodontal
disease. The patient refused to wear a mandibular removable partial denture because of dissatisfaction
with a visible metal clasp on the anterior teeth. She was diagnosed with infraocclusion by analysis ofOVD.

Fig.1 Intraoral view at the first visit

Fig.2 X-ray photographs at the first visit

BOP
Mobility
PCR
EPP(mm)Location
Location
EPP(mm)PCR
Mobility○1

1848○2○1322 234 212
422 364 323
17 16 1547 46 45○11444○1○
1322 223
333
322 323333
13 12 11 21 22 23 24 25
43 42 41 31 32 33 34 35
223 222 212 222
212 343333 212 111 222
322 323
01

11026
36343
444
27
3728
380

Fig.3 Periodontal disease examination at the first visit

Treatment Procedure
First, the prosthesis with the marginal discrepancy was removed (Fig.4), and temporary restorations
were placed. The 3 and 12 teeth were extracted because of severe caries. After preprosthetic treatment,
the OVD was increased by the use of the treatment denture, and the patient obtained an adequate
occlusal relationship (Figs.5 and 6).

Fig.4 Intraoral views ofremoving the prosthesis

Fig.5 Occlusal reconstructionof denture

Fig.6 Intraoral views ofinserting temporary
restorations

As a definitive prosthesis, a maxillary removable overlay denture with coping-type magnetic
attachments and a horseshoe plate as the major connector was fabricated , and a mandibular removablepartial denture with an extracoronal-type magnetic attachment was also fabricated. The magnetic
attachments used in this case report were GIGAUSS C400® (GC, Japan). The keepers of the magnetic
attachment and magnetic assemblies were fixed with adhesive resin cement (Multilink® Automix,Ivoclar Vivadent, Liechtenstein) (Figs.7 and 8). Figure. 9 shows an intraoral view of the definitive
prosthesis.

Fig.7 Maxillary removable overlay denture
and the magnetic attachment

Fig.8 Mandibular removable denture
and the magnetic attachment

Fig.9 Intraoral view with definitive prostheses

Outcome of Treatment
Presently, 9 years and 6 months have passed since the definitive prosthesis was set(Fig.9). During thattime, maintenance was initially carried out every month; however, after 3 years, at the request of theperson, it was reduced to every 3 months. The results of the most recent treatment of periodontal disease
examination showed no significant change in both periodontal pockets and tooth mobility compared tothe end of the definitive prostheses. The results of examination during the most recent treatment ofperiodontal disease showed no significant change in periodontal pockets or tooth mobility as comparedto the end of the definitive prosthesis setting. The results of dental X-ray photographs showedenlargement of the periodontal ligament cavity of the left support tooth from the middle of the mandible(Fig.10). In addition, gingival recession of #34 was recognized in the oral cavity, and significant bitewear of the artificial tooth of #35 was recognized (Fig.11). From the inquiry result that the remaining
part of the maxillary abutment tooth was biased to the left side and the habitual chewing side was on theleft, it was inferred that this was caused over time because the burden of the bite force was larger thanthat of the right side.

Fig. 9 Intraoral view with definitive
prosthesis at 9 years after treatment

Fig.10 X-ray photographs at 9 years Fig.12 Degradation over timeafter treatment

The elution amount of glucose in the masticatory function test 3 years after the operation was 121
mg/dl, but increased to 150 mg/dl after 9 years and 6 months (Fig.12).
Additionally, the score of OHRQoL using OHIP-142) decreased over time, and treatment results wereobtained with high patient satisfaction (Fig.13).

（ m g/dl）
20015050

12115040

術前First visit
3年経過時
3years later
9年6か月経過時
9 yearsand 6 months
later

4130

100

2050

1003years
later
3年経過時

9 yearsand 6 months later
9年6か月経過時

Fig.12 The masticatory function test

21100

Fig.13 Oral Health Impact Profile-14 for JapaneseConclusions
A magnetic attachment could be provided as a useful retentive appliance for alleviating patientcomplaints regarding aesthetics and function. It is difficult to maintain an ideal combination of aesthetics
and functionality because the design of a final prosthesis is complex. Therefore, continuous follow-up isnecessary with occlusal adjustment and relining of the denture base to prevent any reduction of theOVD.

References
1.

2.

M. Sone, Y. Kawakami, F. Okutsu, T. Matsukawa, Y. Toyota, R. Negoro, S. Shimokawara, K.
Okamoto, and S. Ohkawa: A case report of Occlusal Reconstruction with Overdentures Using
Magnetic Attachments, JJ Mag Dent, 23(2), 1-3, 2014
Allen F, Locker D: A modified short version of the oral health impact profile for assessing
healthrelated quality of life in edentulous adults, Int J Prosthodont 15, 446-450, 2002.