A case report of a removable denture using magnetic attachments for a
missing mandibular molar with a decreased occlusal vertical dimension
followed up for 3 years
M. SoneDivision 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 aesthetics and function by using magnetic attachments.
As the 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.
Three years after the denture setting, the definitive prosthesis has been used without any problems, andthe magnetic attachment has had 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 (Eichner B3: missing mandibular molar) with a decreased OVD to restore aesthetics and function
by using 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 B3: missing mandibular molar). All fixed
prostheses were failed restorations with a marginal discrepancy that had been damaged by caries andperiodontal disease. The patient refused to wear a mandibular removable partial denture because ofdissatisfaction with a visible metal clasp on the anterior teeth. She was diagnosed with infraocclusion byanalysis of her OVD (Fig.1). We suggested that a mandibular removable overlay denture withcoping-type magnetic attachments and a maxillary removable partial denture with extracoronal-typemagnetic attachments and porcelain fused to metal crowns should be fabricated that would be acceptable
to the patient.

Fig.1 Intraoral view at the initial examination

Treatment Procedure
First, the prostheses with marginal discrepancies were removed (Fig.2), and temporary restorations
were placed. The 3 and 12 teeth were extracted because of severe caries. After pre-prosthetic treatment,
the OVD was increased using a treatment denture, and the patient obtained an adequate occlusal
relationship (Fig.3).

Fig.2 Intraoral views of removing theprostheses with marginal discrepancies

Fig.3 Intraoral views of inserted
temporary restorations and treatment
dentureAs definitive prostheses, a maxillary removable overlay denture with coping-type magnetic
attachments and a horseshoe plate as the major connector was fabricated (Fig.4), and a mandibular
removable partial denture with an extracoronal-type magnetic attachment was also fabricated (Fig.5).
The magnetic attachments used in this case report were GIGAUSS C400 ® (GC, Japan). The keepers ofthe magnetic attachments and magnetic assemblies were fixed with adhesive resin cement (Multilink®
Automix, Ivoclar Vivadent AG, Liechtenstein) (Figs.6 and 7). Figure 8 shows an intraoral view of thedefinitive prostheses.

Fig.4 Maxillary removable overlay denture

Fig.5 Mandibular removable denture

Fig.6 Occlusal view of abutment teeth

Fig.7 Extracoronal-type magneticattachments

Fig.8 Intraoral view of definitive prostheses

Outcome of Treatment
Three years after the denture setting, the definitive prostheses have been used without any problems,
and the magnetic attachments have had no clinically significant loss of retention (Fig.9).
In the interval, the remaining dentition, periodontal condition, and retentive forces of the prostheses
have been examined as part of the maintenance program (Fig.10).

Fig.9 Intraoral view ofthe definitive prostheses 3 years after treatment

Fig.10 Maintenance program

Efficiency of oral hygiene was evaluated using the Plaque Control Record (PCR) method. In this case,the PCR was 88.5% at the first visit and had improved to 20.8% (Fig.11) in the 3 years after treatment.
The Oral Health Impact Profile (OHIP) questionnaire is one of the most technically sophisticatedinstruments for assessing oral-health-related quality of life (OHRQoL). Additionally, the OHIP-14, ashort version of the OHIP, is seen as most appropriate for edentulous patients.2) The OHIP-14 total scorein this case was 41 at the patient’s first visit and, 3 years after setting the removable denture withmagnetic attachments, had improved to a score of 21 (Fig.12).

Fig.11 Plaque Control Record

Fig.12 Oral Health Impact Profile-14 for JapaneseConclusions
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 OVD reduction.

References
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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
F. Allen, D, Locker: A modified short version of the oral health impact profile for assessing
health-related quality of life in edentulous adults, Int J Prosthodont 15, 446-450, 2002.