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At each X locus, the brothers either have the same allele concordance of the allele with the trait or alternate alleles non-concordance. The left-hand table shows the possible outcomes for a study of 40 pairs of brothers. The higher the ratio of concordant to non-concordant pairs, the greater the evidence of linkage. The odds ratio is the probability of obtaining a particular observed concordance ratio , divided by the probability of obtaining that ratio at random.

The right-hand table shows a hypothetical experimental result for a series of 21 marker loci A - U mapped in linear order to the X chromosome. Each of 40 pairs of brothers are genotyped at each locus and scored as having concordant or discordant alleles. The aim of this clinical report was to develop a set of principles to use during diagnosis and treatment planning for ideal implant positioning and promotion of an optimal patient-centered outcome.

An IOD is a useful choice for diagnosis of an edentulous mandible and residual ridge resorption, as well as an unstable, non-retentive, and poorly fitting denture [4]. The aim of such treatment is to improve patient quality of life by providing a functional dentition for the mandible in order to increase the ability to chew harder foods, while concurrently producing a long-lasting and durable prosthesis.

Al-Ghafli, et al. To achieve an ideal outcome, implants should be placed as parallel as possible to each other directly below artificial teeth. In addition, since complete denture mandibular movement must occur when the tongue is moved in a superior or anterior direction, a lever effect is created to lift the complete denture based on the line across the crest of the alveolar ridge between the two implants acting as a fulcrum line.

To reduce such movement, implants should be placed in a manner so as to yield only limited movement of the denture around the fulcrum line Figure 1A, B. This treatment objective requires a more distal placement position, within the anatomical opportunities and constraints of each case, in order to move the fulcrum line in a distal manner.

Figure 1 A,B: When the implant point of attachment becomes the point of action with tongue thrusting, the fulcrum is the anterior alveolar crest blue and the lever where force is applied is the anterior lingual surface of the artificial crown red Figure 1A. To reduce denture turning, the implant should be placed as far as possible from the fulcrum point Figure 1B. Figure 1 C: Relationship between line of alveolar crest blue and artificial crown red. Zone 1 is the area anterior to the line from the artificial crown to alveolar crest.

Zone 2 is the area where the line of the artificial crown and alveolar crest come together. Zone 3 is the area lingual from the artificial crown and positioned against the alveolar crest. Figure 1 D,E,F: Each zone has individual characteristics. In proportion to the coronal section of each zone, an implant cannot be placed directly below the artificial crown in Zone 1 Figure 1D or 3 Figure 1F. Furthermore, the thickness of the denture space is thin in Zone 1 and 3. In contrast, an implant can be placed just below the artificial crown in Zone 2 Figure 1E , because of adequate thickness for the attachment.

In our proposed model, the mandibular arch is divided into 3 zones Zone 1, 2, 3 according to the relationship between the alveolar crest and artificial tooth position Figure 1C. Furthermore, the denture attachment housing space is usually smaller in Zone 1, resulting in maintenance challenges and complications such as denture fracture, denture deformation, and weak denture retention Figure 1D. Zone 2 is the area in which the artificial teeth are positioned so as to come together close to or directly over the alveolar crest.

Implants positioned in this zone can be placed under the artificial teeth. Since the fulcrum line lies below the artificial teeth, there is less rotational movement of the denture during tongue movement, allowing the patient to masticate more effectively and eat more challenging foods. If sufficient bone quality and quantity is present in Zone 2, it is the preferred site for parallel bilateral implant placement Figure 1E. Zone 3 is the area in which the artificial teeth are positioned lingual from the alveolar crest and implants in this zone cannot be placed directly below them Figure 1F.

Following diagnostic procedures to determine the desired artificial tooth position and availability of bone for implant placement, the mandible can be zoned according to the aforementioned classification system and optimal implant placement in Zone 2 is preferred.

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This classification system is particularly helpful because it has prognostic value, with implants placed in Zone 2 predicted to yield a better prognosis and patient-centered outcome. A year-old man came to our dental clinic with poor chewing function while using a mandibular removable complete denture. During the clinical examination, it was noted that the patient was wearing a Kennedy Class I removable partial denture on the maxillary arch with sufficient stability Figure 2A, B. However, the mandibular complete denture was non-retentive, and the patient stated that he could not eat hard foods.

The sore of OHIP questionnaire test was 33 points. This score suggested his huge stress and unsatisfaction about his mandibular prosthesis. For obtaining additional diagnostic information, computerized tomography CT scanning was performed with the patient wearing the removable denture Figure 2C. It was determined that the patient had large Zone 1 and Zone 3 areas Figure 2D. Sagittal CT imaging Fig. In addition, the implants could be placed parallel to each other in the Zone 2 region.

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Figure 2A: Occlusal view of mandible showing resorbed mandibular ridge. Figure 2B: Occlusal view of maxilla. Figure 2C: CT image showing occlusal view of mandible with removable denture. The line of the artificial crown solid line different from that of the alveolar crest broken line. Figure 2 D,E: Zone 1, 2, and 3 are classified according to the relationship between the line of the alveolar crest and artificial crown Figure 2D. Sagittal CT imaging Figure 2E revealed adequate bone for implant placement, though the thickness of the denture attachment housing space was thin in Zone 1.

We were able to place the implant just below the artificial crown in Zone 2. There was insufficient bone volume for the implant placement in Zone 3. A minimum of approximately 12 mm of vertical restorative space crest of bone to occlusal plane is considered necessary to provide assistance for a mandibular implant over a denture [6]. Therefore, the estimated attachment space was more than 15 mm above the implant, and 3 mm in both the buccal and lingual directions in this case.

Treatment planning included placement of 2 implants in Zone 2. With use of a surgical guide, 2 endosseous implants, each measuring 4. Eight weeks later, a second surgical procedure was performed during which the implants were exposed, and final abutments placed.

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During subsequent visits, minor denture adjustments were performed as necessary. At 1- and 2-year post-placement examinations, no complications were observed, and the patient reported that the previous poor chewing function had been completely resolved Figure 2F, G, H, I. The sore of OHIP questionnaire test was 5 points. Against the score of before treatment 33 points , his satisfaction about his prosthesis was quite improved. Figure 2 F: Oral findings obtained 2 years after treatment. The final prosthesis was an implant-supported and retained mandibular complete denture, as opposed to a conventional mucosa tooth-supported partial denture.

Figure 2 G: Final appearance of prosthetic restoration and mucosal surface. Figure 2 H: Intraoral view showing attachment devices mounted onto the implants. Figure 2 I: Radiological appearance of prosthetic field after insertion of dental implants and their osseous integration. Note the parallel positioning of the 2 implants. A year old man came to us in with a chief complaint of lack of denture stability and inability to properly chew food. During the clinical examination, we observed a bilateral cantilever removable partial denture on the maxillary arch, which had sufficient stability, support, and retention Figure 3A, B.

CT scanning was performed to assist in the diagnosis and treatment plan process.

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The sore of OHIP questionnaire test before treatment was 24 points. This score suggested unsatisfaction about his mandibular prosthesis. In the mandibular arch, the patient had a large Zone 1, while the Zone 3 area was negligible Fig. Sagittal CT images Figure3D revealed that sufficient bone volume for implant placement was present in Zone 1, though denture thickness attachment housing space was minimal, and complications such as denture fracture and deformation of the denture would likely develop even if implants could be placed in Zone 1.

Sagittal CT imaging of the Zone 2 area revealed sufficient bone volume for implant placement and that they could be placed below the artificial teeth. Furthermore, implants could be placed parallel to each other in Zone 2. The estimated attachment space was greater than 15 mm in the vertical, and 3 mm in the buccal and lingual directions.

With a surgical guide, 2 endosseous implants measuring 4. Final Locator abutments were then placed, along with housings related to the attachments and denture directly in the mouth Figure 3E, F, G.

Denture adjustments were performed as necessary. At the 2-year evaluation of the prosthesis Figure 3H, I, J, K , the chief complaints of the patient were totally resolved, and no complications had occurred. Against the score of before treatment 24 points , his satisfaction about his prosthesis was quite improved. Figure 3A: Frontal view obtained prior to treatment, without mandibular denture. Figure 3B: Occlusal view of mandible. Figure 3 C,D: CT image showing occlusal view of mandible with removable denture.

Zone 1 and 2 were classified based on the relationship between the line of the alveolar crest and the artificial crown Figure 3C. There was no Zone 3 in this patient. Sagittal CT imaging Figure 3D revealed that adequate bone for implant placement existed, though the thickness of the denture attachment housing space was thin in Zone 1.