Case Report

Innovative Treatment for Rehabilitating Patient Following

Maxillary Resection for Ameloblastoma with Magnet Retained,
Hollow, and Metal Reinforced Over Denture
Bommireddy Tejeswarreddy1*, Nagam Rajareddy2, P. Lakshmaiah3, Golla Hima Bindu2
Department of Prosthodontics, G. Pulla Reddy Dental College and Hospital, Kurnool, Andhra Pradesh, India.
1

2
Department of Prosthodontics, CKS Theja Institute of Dental Sciences and Research, Tirupathi, Andhra Pradesh, India.
3
Department of Prosthodontics, Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India.

Abstract
Maxillofacial defects compromise the appearance of patients and results in various psychological problems. The purpose of this case report is
to demonstrate the benefits of appropriately rehabilitating surgical resection of ameloblastoma with aggregate treatment protocol for enhancing
patient esthetics and function capabilities. In the present case, surgical removal of part of the palate and most of the teeth made the labial and
buccal mucosa more stretched and fibrous, thus compromising retention and stability of denture. With few teeth left in one quadrant, direct
retention from them deteriorates their health, so the magnets were used which offered definitive advantage of retention without excessive
deleterious stress acting on the abutments. As resection resulted in mid facial loss, reinforcing lip for esthetics with conventional denture adds
excessive weight; to overcome, this hollowness was incorporated in the anterior segment of the denture. Reinforcement of thin metal mesh
was done as denture opposes natural teeth in the mandible.

Keywords: Ameloblastoma, Magnet retained over denture, Metal reinforced denture.

Introduction and stability. Aramany classified maxillary defects based on

relation of the defect area to remaining abutment teeth. Present
Patients who underwent surgical resection in orofacial region
situation comes under class IV that is the defect crosses the
suffer from compromised esthetics and functional abilities such
midline and involves both sides of the maxillae. There are
as mastication, swallowing, and speech. The rehabilitation of
few teeth remaining which lie in a straight line.[2] Hence,
these patients with disabilities of the head and neck continues
direct retention from abutments expose them to destructing
to be a challenge. Maxillofacial defects result in facial
stresses so a unique magnet retained over denture was planned.
disfigurement, thus leading to psychological problems. This, in Dental magnetic attachment systems have been increasingly
turn, creates great difficulty in facing and accepting the social utilized in prosthodontics to improve the retention of over
consequences. Today, it is possible to restore most patients to denture. Recently, developed hard magnetic substances such
nearly normal form and function, enabling them to lead useful as samarium-cobalt and iron-neodymium-boron magnets
and productive lives.[1] Basic prosthodontic principles are (Fe14Nd2B) provide stronger magnetic force per unit size
followed during the fabrication of obturator prosthesis, while than the earlier open-field aluminum-nickel-cobalt magnets
taking extreme care of the more resilient and unsupported
tissues. Some principles need to be modified according to
the defect, the condition, and the position of the remaining Address for correspondence: Dr. Bommireddy Tejeswarreddy,
structures. The defect, in conjunction with the remaining Department of Prosthodontics, G. Pullareddy Dental College and Hospital,
Kurnool, Andhra Pradesh, India. Phone: +91-9985474733.
structures, must be used to provide support, retention, and
E-mail: [email protected]
stability to the prosthesis.
Received: Aug. 12, 2022; Accepted: Oct. 15, 2022; Published: Oct. 30, 2022
In cases with few teeth preserved which are restricted to one
quadrant, difficulties arise in acquiring adequate retention This is an open access journal, and articles are distributed under the terms of the Creative
Commons Attribution‑NonCommercial‑ShareAlike 4.0 License, which allows others to
remix, tweak, and build upon the work non‑commercially, as long as appropriate credit
Access this article online is given and the new creations are licensed under the identical terms.
Website:
www.jrad.co.in How to cite this article: Tejeswarreddy B, Rajareddy N, Lakshmaiah P,
Bindu GH. Innovative Treatment for Rehabilitating Patient Following Maxillary
DOI: Resection for Ameloblastoma with Magnet Retained, Hollow, and Metal
https://doi.org/10.53064/jrad.2022.13.6.301 Reinforced Over Denture. J Res Adv Dent 2022;13(6):76-79.

76 © 2022 Journal of Research and Advancement in Dentistry

 Tejeswarreddy B, et al.: Innovative Treatment for Rehabilitating Maxillary Resection Done for Ameloblastoma

which are susceptible to corrosion by the saliva and provide

weak retentive force.[3,4]
In the large maxillofacial defects and in severely resorbed
ridges, the available denture bearing area for support, stability,
and retention is less. To decrease the leverage forces, reduction
in weight of the prosthesis was recommended and was also
found beneficial.[5] In this case, resection caused mid facial
defect that resulted in concave profile. To restore profile, the
use of conventional design results in excessive weight of
the denture. Hollowness in the anterior segment solved the
problem.
An innovative technique of fabrication of magnet retained
over denture with hollowness in anterior segment and metal
Figure 1: Frontal view before and after insertion
reinforcement in posterior segment is illustrated here.

Case Report
A 58-year-old male patient was referred to department of
prosthodontics, CKS Theja Dental College, Tirupati. His
medical history revealed that he underwent surgical resection
in maxillary region as he was diagnosed with ameloblastoma.
Extraoral examination revealed that the patient has significant
bone loss in anterior maxillary region that resulted in concave
profile (Figures 1 and 2). Intraoral examination revealed
partially edentulous maxilla with resection extending to other
side of arch with remaining natural teeth (26, 27, and 28) in Figure 2: Lateral view before and after insertion
straight line, so this comes under typical Aramany class IV.
Palpation and orthopantomogram examination, diagnostic
impressions, revealed that maxillary bone was resected and
resorbed. To improve retention, stability of prosthesis and
to preserve long-term health of remaining abutments, an
aggregate treatment of magnet retained over denture with
hollowness in anterior region and metal reinforcement in
posterior segment was planned.
Clinical procedure
Endodontic treatment and preparation of abutment to
receive magnetic component
Abutment teeth (26, 27, and 28) were endodontically treated
and prepared with diamond rotary instruments (Shofu, Kyoto,
Japan) producing a chamfer finish line, and vertical height was
reduced such that it is 4 to 6 mm above the finish line in the 26,
27, and 2–3 mm in 28. Access cavity was prepared in 26 and Figure 3: Customized intraoral magnets cemented
27 region to receive conventional dental magnets (Ali brother
Electronics, Ritchie Street, Chennai, India). Then, magnets
with type III dental stone (Kalabhai Pvt Ltd, India). On the
were cut to required size using high speed hand piece and
cast obtained, wax patterns were fabricated, which were casted
diamond burs. Each magnet was cut approximately to fit the
to form metal copings. These metal coping were cemented to
prepared cavity and fit was verified. Now, magnets are ready to
their respective prepared abutments using type 1 GIC (GC
be cemented into their respective cavities. Prepared cavities are
Corporation, Tokyo, Japan) (Figure 4).
isolated and dried and magnets were cemented (Figure 3) with
an adhesive resin (RelyX U100, 3M ESPE, St Paul, MN, USA). Preparation of denture to receive counter magnetic
Excess cement was removed, sharp dentin edges rounded, and component
finally smoothened and polished. Impression of abutments Preliminary impressions of maxilla and mandible were made
and entire arch was made in irreversible hydrocolloid material in irreversible hydrocolloid material (Zelgan 2002, Dentsply)
(Zelgan 2002, Dentsply) using stock trays. Casts were poured using stock trays and cast prepared in dental stone (Kalabhai

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 Tejeswarreddy B, et al.: Innovative Treatment for Rehabilitating Maxillary Resection Done for Ameloblastoma

spacer. The cavity was cleaned and disinfected. Later, these

openings were closed with the autopolymerizing resin. The
dentures were, then, polished in usual manner. Before insertion
of denture counterpart of the magnet was secured on to their
respective abutments and necessary adjustment was done in
the denture to create room. After final adjustments, relining
was done with soft liner (GC Corporation, Tokyo, Japan) so
that magnets are embedded completely inside denture. All the
occlusal errors were corrected, insertion was done and post-
operative instructions were given. The patient was kept under
periodic recall. After 1 week, the patient reported an increase
in masticatory efficiency and seemed happy with the esthetics.
Figure 4: Metal copings cementation done
Discussion
Karson Pvt Ltd, Mumbai, India). Acrylic custom tray (DPI-RR This article highlights functional rehabilitation of maxillectomy
Cold Cure, DPI, Mumbai, India) with wax spacer (Modelling patient with magnet retained over denture. Magnets have
Wax No 2, Hindustan Dental Products, Hyderabad, India) generated great interest within dentistry, and their applications
was fabricated. Additional wax spacer was adapted over are numerous. The reason for their popularity in prosthodontics
the abutments. Border molding was done with low fusing since 1960’s is related to their small size and strong attractive
compound (DPI Pinnacle Tracing Stick, DPI, Mumbai, India), forces; these attributes allow them to be placed within
wax spacer removed, relief holes given and tray adhesive prostheses without being obtrusive in the mouth.[6] There are
was applied, and final impression was made using light body two different types of alloys used for the manufacture of small
silicone impression material (Aquasil, Dentsply). Master dental magnets. The first alloy used was cobalt-samarium
cast was prepared in dental stone (Kalabhai Karson Pvt Ltd, magnets introduced in the sixties. A second alloy based on iron-
Mumbai, India). Bite registration was done and transferred to neodymium-boron became available in the eighties.[7] Both
articulator. Teeth arrangement was done accordingly and trail these rare earth magnets have high attractive forces. However,
denture was evaluated in patient’s mouth. Before flasking they are brittle materials with a low corrosion resistance.[8] To
procedure master cast was duplicated using agar and on the overcome these problems, the magnets are encapsulated in
duplicated cast wax pattern was adapted for the fabrication of stainless steel, titanium, or palladium. If wear of this coating
metal reinforcement mesh. Later, casting procedure was done occurs, then the alloy will come into contact with saliva. The
and mesh was trimmed, finished, and checked for fit on the combination of saliva contact and wear has a deleterious
master cast. For creating hollowness in the anterior, maxillary effect on the corrosion resistance of the material[8] and may be
region interchangeable flasks were used. Trail dentures are increased by the presence of bacteria such as Streptococcus
processed in conventional manner until wax elimination sanguis.[9] This corrosion problem is well documented and can
procedure. Wax of 2 mm thickness was adapted on to master significantly affect the useful life span of intraoral magnets.[10]
cast and a second flask was used to invest modeling wax until This is the single most important area of research into the
wax elimination stage. Reinforcement mesh was secured on effectiveness of intraoral magnetic systems.
the master cast and cope was packed and processed with heat
polymerizing resin (DPI, Mumbai). The permanent record The effects on biological tissues have shown that static
base was left undisturbed on the master cast. Gauge piece with magnetic fields do not appear to result in any changes to
salt was rolled and placed on the master cast in the anterior the human dental pulp or gingival tissues adjacent to the
region, this acts as spacer. To harmonize the space for heat magnets. An in vitro study on osteoblasts failed to show any
cure resin, strips of modeling wax were placed on the ridge lap differences in the cell cultures when exposed to the static fields
area of acrylic teeth including the buccal and palatal surface associated with these magnets.[11] Magnetic retention offers
in the cope. The two halves of the flask were closed and, then, many advantages as it serves to dissipate lateral functional
reopened. The thickness of the wax was, then, assessed with forces. There is less need for parallel abutments as a rigid
line of insertion is not as critical. Furthermore, the technique
the help of the wax gauge and necessary modifications were
is simple, involving minimal time at the chair side and in the
done (spacer material was reduced wherever the wax was
laboratory. Magnets have been used as a retentive element
exposed or thinned out). This process was, further, repeated
for overdentures.[13,14] Hence, the use of magnet retained over
until the uniform thickness of the wax was achieved and
denture is planned in the current situation for long term health
thus ensured uniform space of 1.5–2 mm for the heat cure
of few abutments left.
acrylic resin. Wax strip was then removed from the acrylic
teeth. The heat polymerizing resin was then mixed, packed, Extreme resorption of the maxillary denture bearing
and processed. Small opening was made with a bur into the area may lead to problems with prosthetic rehabilitation.
denture base distal to most posterior teeth to remove the Regular maxillary denture fabrication in this patient may

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 Tejeswarreddy B, et al.: Innovative Treatment for Rehabilitating Maxillary Resection Done for Ameloblastoma

result in heavy denture that may lead to decreased retention motivation, or poor prognosis, conventional retainers are
and resistance.[15] To decrease the leverage, reduction in the unsuitable.
weight of the prosthesis would be beneficial. It improves the
cantilever mechanics of suspension and overtaxing of the References
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