common clinical problems about distal extension removable partial dentures ( rpds ) are lack of retention and stability and unaesthetic appearance because of the clasps . placing bilateral single dental implants in the molar area of the residual alveolar ridges is becoming a popular treatment choice while implants would effectively change the kennedy class 1 situation to a more favorable implant - supported kennedy class 3 configuration . the retention and stability of the dentures are being improved with placing the implants bilaterally . moreover , implant support decreases the resorption of the alveolar ridges and the need of relining procedures in the following years . as a result , this treatment modality could resolve intrusion movement problem of the rpd while reducing treatment costs compare with implant - supported fixed prosthesis and resulting in greater patient satisfaction . there are different types of connection between the implants and the acrylic base of the rpd , such as implant cover screws , stress - breaking attachments , and healing caps . ball , locator or era attachments are the different types of stress - breaking attachments that have been applied to the implants in previous studies and some case reports . in addition , placement of only healing caps to function as vertical stopping has previously been reported . this clinical report describes a mandibular implant - supported rpd in a patient who had tumor surgery and radiotherapy using a conventional rpd with lack of retention and stability . a 65-year - old , both maxillary and mandibular partially edentulous , male was referred to the department of prosthetic dentistry , istanbul university , faculty of dentistry . the patient 's chief complaints were reduced function and unaesthetic appearance because of missing teeth and the lack of retention and stability with his previous rpd . the patient 's medical history revealed that he had radiation therapy on the right sight of mandibular buccal shelf region at the head and neck area . at the extraoral examination , a scar tissue at the right buccal shelf area in addition , loss of fibroelasticity of the right peripheral soft tissue and perioral region was discovered due to the radiotherapy while the left side indicated no abnormality [ figure 1 ] . when a dental anamnesis was taken , the patient has reported that three maxillary teeth with severe mobility were extracted before application to the department of prosthetic dentistry clinic . intraoral examination revealed that the patient had two maxillary central and lateral teeth with moderate mobility and five mandibular teeth , right lateral to left canine with no mobility [ figure 2 ] . reduced vestibular sulcus depth and a fibrous scar tissue were examined at the right buccal region . radiographic examination using the existing panoramic x - ray showed that right maxillary canine and maxillary central incisor teeth were previously extracted . in addition , mandibular right first premolar with an existing periapical lesion was also decided to be extracted [ figure 3 ] . scar tissue and loss of fibroelasticity at the right buccal shelf area due to the surgical tumor resection and radiotherapy ( b ) . tissue healing at the right maxillary region and 2 left maxillary teeth ( a ) . mandibular teeth before prosthetic therapy ( b ) preoperative panoramic x - ray view three treatment options were presented to the patient . maxillary and mandibular conventional clasp - retained rpds were rejected because of the patient 's previous complaint about lack of retention and stability with his previous denturesmaxillary and mandibular implant - supported fixed prostheses were rejected due to the financial limitations of the patientmaxillary complete denture and mandibular implant - supported rpds were chosen by the patient as an optimal treatment with the advantage of the increased retention and stability provided by the implants for the mandibular rpd . the cons and pros for the extraction of maxillary left central and lateral teeth were explained in details to the patient in terms of biomechanics and esthetics . the patient preferred the extraction of the remaining teeth , and the future fabrication of a maxillary complete denture was planned . maxillary and mandibular conventional clasp - retained rpds were rejected because of the patient 's previous complaint about lack of retention and stability with his previous dentures maxillary and mandibular implant - supported fixed prostheses were rejected due to the financial limitations of the patient maxillary complete denture and mandibular implant - supported rpds were chosen by the patient as an optimal treatment with the advantage of the increased retention and stability provided by the implants for the mandibular rpd . the cons and pros for the extraction of maxillary left central and lateral teeth were explained in details to the patient in terms of biomechanics and esthetics . the patient preferred the extraction of the remaining teeth , and the future fabrication of a maxillary complete denture was planned . written informed consent before surgical and prosthetic treatment was obtained from the patient . under local anesthesia , mucoperiosteal flaps were elevated and two implants ( 4.1 mm diameter , 10 mm length ; straumann ag , waldenburg , switzerland ) were placed in posterior region of the mandible , both on the right and left sides [ figure 4 ] . sutures were removed on the 7 postoperative day . at the end of 3 months , the osseointegration of the implants was checked on the panoramic radiograph [ figure 5 ] . the healing of the mandibular distal edentulous sites seemed to be normal and gingival formers were placed [ figure 6 ] . at this stage , two maxillary teeth were also extracted before the initiation of the prosthodontic therapy . implant surgery on the right ( a ) and left ( b ) first molar area panoramic x - ray view . osseointegration of the implants at the postoperative 3 month intraoral view of implant site at the postoperative 3 month . ( a ) right side ( b ) left side preliminary impressions were made using an alginate impression material ( italgin chromatic alginate , bms dental , capannoli , italy ) and individual impression trays for both maxilla and mandible were fabricated using autopolymerizing acrylic resin . after border molding on the maxillary tray , the final impression was made using a zinc oxide eugenol material ( ss white , c / o prima dental group , gloucester , england ) . for the mandible , the locator abutments ( h 3 mm , coated ti alloy , straumann ag , basel , switzerland ) were torqued to the implants with a 25 n / cm [ figure 7 ] . for the mandibular impression cingulum rest seats were prepared on the mesial site of the mandibular right canine and between the mandibular first and second lateral incisors . after that , the final impression of the mandible was made using an addition silicone impression material ( dentasil a , dentac , senden , germany ) . locator analogs were attached to the impression copings [ figure 8 ] and the impression was poured [ figure 9 ] . locator abutments connected to the implants ( a ) right side ( b ) left side final impression with impression copings attached with locator analogs working model with locator analogs rpd framework was designed on the mandibular cast with t - bar clasps on the terminal abutment teeth and a lingual plate as a major connector . the framework at the implant abutment region was designed circular around the abutment , and the distance between the abutment and the framework was approximately 2 mm so as to support the denture base acrylic resin [ figure 11 ] . the rpd was cast using a chromium - cobalt casting alloy ( dfs , lndenstrabe , riedenburg , germany ) . cingulum rests designed on the mandibular anterior teeth removable partial denture framework with t - bar clasps on the terminal abutment teeth , lingual plate as a major connector and circular design around the implant abutments artificial teeth ( nt optima , toros dental , antalya , turkey ) setup was completed and tried in the mouth . the maxillary complete denture and mandibular rpds were delivered to the patient locator abutment matrix and black processing nylon insert were connected to the mandibular rpd using autopolymerizing acrylic resin ( self - cure acrylic , imicryl , istanbul , turkey ) . after polymerization , the denture was removed and the pink locator attachments were fitted [ figure 12 ] . after delivery , the patient was recalled weekly for 4 weeks [ figure 13 ] . the patient was satisfied with the function of his dentures as well as the improved esthetics [ figure 14 ] . maxillary complete denture ( a ) and mandibular implant - supported removable partial denture with locator attachments in the intaglio surface ( b ) intraoral view 4 weeks after delivery extraoral view after prosthetic treatment ( a ) . bounding of the rpd with implants is a treatment option which combines the advantages of the implants and simplicity of the rpd system , with reducing the drawbacks of invasive attempt and cost of the implants more than two . in this case report , kennedy class 1 partial edentulousness the clinical factors ( reduced fibroelasticity of the peripheral soft tissues , buccal scar tissue with a reduced sulcus depth of the right buccal area ) that may negatively affect the denture 's retention and stability are the indication of an implant - bounded rpd . these problems can be clinically resolved with a single implant on the distal edentulous sites that also improve the biomechanics of the prosthesis . previous results suggest that by placing an implant to the distal extension site of the rpd , enhancement of distribution of the occlusal forces , movement of the posterior rotational axis to a distal position , shortening of the distal extension of the rpd , and reducing potential rotational movement of the rpd can be improved . the tissueward and the opposite movement of the rpd were restricted by the method mentioned above , and as a result , retention and stability of the rpd are increased . at the recall appointments , the patient did not report any complaint about the movement of the implant - supported rpd when compared to his previous conventional clasp - retained rpd . the patient satisfaction was also improved when compared to the patient 's previous clasp - retained conventional rpd . placement of bilateral implants can convert the rpd from tooth- and tissue - supported rpd to an implant - supported rpd . in the present report , movement of the rpd was reduced and therefore retention and stability was improved by the implants with locator abutments . finally , the treatment plan can be suggested , especially in patients who could not effort the implant - supported fixed prosthesis . the authors certify that they have obtained all appropriate patient consent forms . in the form the patient(s ) has / have given his / her / their consent for his / her / their images and other clinical information to be reported in the journal . the patients understand that their names and initials will not be published and due efforts will be made to conceal their identity , but anonymity can not be guaranteed . the authors certify that they have obtained all appropriate patient consent forms . in the form the patient(s ) has / have given his / her / their consent for his / her / their images and other clinical information to be reported in the journal . the patients understand that their names and initials will not be published and due efforts will be made to conceal their identity , but anonymity can not be guaranteed .
this case report describes the fabrication of a distal extension removable partial denture ( rpd ) of a 65-year - old man with implant support . 
 loss of fibroelasticity of the peripheral tissues and reduced mandibular vestibular sulcular depth due to a previous surgical resection and radiotherapy at the right side were the main clinical factors that created difficulty for denture retention and stability . 
 the fabrication of a mandibular rpd supported by anterior teeth and two bilaterally placed implants in the molar area to convert from kennedy class 1 design to kennedy class 3 implant - bounded rpd is reported . 
 retention and stability of the denture were improved with implant support on the distal extension site of the rpd . 
 the common clinical problems about distally extended rpds are lack of retention and stability due to the movement around the rotational axis . 
 dental implant placement to the distal edentulous site minimizes the potential dislodgement of the rpd is popular . 
 implant - supported rpd can be suggested as an advantageous and cost - effective treatment option for the partially edentulous patients .