Anterior Implants Research Articles

Four-implant-supported fixed prosthesis and milled bar overdentures for rehabilitation of the edentulous mandible: A 1-year randomized controlled clinical and radiographic study.

The purpose of this study was the clinical and radiographic evaluation of four-implant-supported fixed prostheses and milled bar overdentures for rehabilitation of the edentulous mandible. Thirty-six edentulous participants received four implants in the mandible (two vertical implants in the canine/lateral incisor area and two distally inclined implants anterior to the mental foramina) using flapless surgery. The implants were loaded with the mandibular dentures in the same day after necessary modifications. Three months after implant placement, participants were randomly allocated to one of two groups: (1) the overdenture group, where participants received milled bar overdentures; or (2) the fixed group, where participants received ceramo-metal fixed prostheses. Plaque and gingival indices, pocket depth, implant stability (using Osstell device), and marginal bone resorption (using standardized intraoral radiographs) were evaluated at the time of prosthesis insertion (T0), and 6 (T6) and 12 (T12) months after insertion. The implant survival rate was 100% for both groups. Plaque Index, Gingival Index, pocket depth, implant stability, and bone resorption significantly increased by time for anterior (P < .001) and posterior (P < .018) implants. Fixed prostheses showed significantly higher Plaque Index, Gingival Index, and pocket depth than milled bar for anterior (P < .001) and posterior (P < .037) implants. No significant differences in implant stability and bone resorption between groups were noted. For fixed prostheses, anterior implants showed significantly higher Plaque Index, Gingival Index, and pocket depth than posterior implants (P < .001) after 12 months. However, no significant differences in implant stability and bone resorption between anterior and posterior implants were noted for both groups. Both fixed prostheses and milled bar prostheses could be used successfully for immediately loaded four-implant rehabilitations of the edentulous mandible, as they were associated with favorable clinical and radiographic outcomes after 1 year. However, milled bar may be more advantageous than fixed prostheses in terms of reduced plaque/gingival indices and probing depth.

Using the surgical guide for impression-free digital bite registration in the edentulous maxilla\u2014a technical note

Studies reporting on the application of digital bite registration for fully edentulous patients rehabilitated with dental implants are scarce. This article describes a technique for intraoral digital registration of the occlusal vertical dimension in a fully edentulous maxilla to be rehabilitated with a fixed implant prosthesis. Following fully guided placement of six maxillary implants, the surgical stent duplicating the existing upper full denture was securely fixed on two anterior implants and sectioned along the center line of the hard palate. An intraoral scanner was used for the digital impression of the maxilla and dentate mandible. The occlusal vertical dimension was registered on each side using the contralateral part of the surgical guide along with the scanbodies on each side. The procedure allowed for the precise digital mounting of the digitized jaws. The maxilla was restored with a full-arch implant-supported prosthesis.

The pattern of increasing intraocular pressure after phakic anterior chamber intraocular Lens Implantation

&#x0D; &#x0D; &#x0D; Background: Phakic intraocular lenses (IOL) are being used to correct refractive errors. We studied the pattern of increasing Intraocular Pressure (IOP) after Phakic Anterior chamber intraocular lens implantation as the risk after surgery. Methods: Sixty eyes of 30 patients were enrolled. All eyes underwent the same protocol with IOP examination before surgical procedure, and during follow up (one day after, 2 weeks, 1 month, 2 months and 3 months) after implantation of phakic IOL anterior chamber. All results were analyzed statistically using SPSS 16 statistics software. Correlation between parameter were analyzed using the wilcoxon test. &#x0D; Results: Median IOP before surgery were 14.00 mmHg (IOP), during follow up 17.00 mmHg (IOP I), 16.00 mmHg (IOP II) , 17.00 mmHg (IOP III), 15.00 mmHg (IOP IV), 15.00 mmHg (IOP V). The increasing of IOP between pre surgery and follow up a day after was found to correlate significantly (p=0.03), there were increasing of IOP after 2 weeks, a month, 2 and 3 months but no significant difference. &#x0D; Conclusion: There were significant of increasing IOP before surgery compare to a day after surgery,then the pattern of increasing IOP tend to be stable. There were no significant increasing of IOP during 3 months follow up. &#x0D; &#x0D; &#x0D;

Restoration-type Outcome of Freehand Implant Placement in Single Edentulous Gaps: An Observational Study

To determine the restoration-type outcome of implants placed freehanded in single edentulous gaps. Forty-nine implant analogs present in working models of 46 patients representing implants placed freehand with no surgical guides in single edentulous gaps were included in this study. Each model was scanned using an optical scanner and a cone beam-CT. Simplant Pro18 software was used to create a virtual tooth replacing the missing tooth in the scanned model. Two virtual implants were created; one superimposed on the implant analog of the model and a second in relation to the virtual crown with its long axis passing through the cingulum or perpendicular to the occlusal table of the virtual crown. Measurement of angular deviation in the position of the placed implant from that of the planned implant was calculated. The average deviation in the position of placed implants was 9.78 ± 6.47 degrees angular deviation. There was no statistically significant difference in the extent of angular deviation between maxillary and mandibular implants. Whereas, there was a statistically significant difference between anterior and posterior implants. Clinically, 70.57% of the placed anterior implants, 29.41% of premolar implants, and 20% of molar implants need to be restored with cement-retained crowns. For single edentulous gaps, the potential for a cement-retained implant crown is significantly higher with freehand implant placement in the anterior than in the posterior regions. With freehand implant placement in anterior single edentulous gaps, the potential for a cement-retained implant crown outcome is significantly higher than in posterior gaps. Maximum precision in implant treatment planning and placement is required in this region of the mouth to achieve optimum results. How to cite this article: Ashy LM. Restoration-type Outcome of Freehand Implant Placement in Single Edentulous Gaps: An Observational Study. J Contemp Dent Pract 2019;20(11):1274-1278.

Regenerative surgical flap to maintain interdental papilla around dental implant

The modified surgical flap technique for placement of implant in the anterior maxilla has been described. The flap design has been used to achieve optimal soft-tissue contour for implant restoration. A modification in the surgical technique has been employed with the intention to preserve the interdental papilla, which is the key to the maintenance of hygiene and esthetics around anterior implants. This, in turn, prevents black triangles and improves soft-tissue contours. The modified surgical flap method maintains both functional and esthetic values.

Clinical and Radiographic Evaluation of Early Loaded Maxillary Anterior Implants: Three-Year Follow-up.

The aim of this study was to evaluate clinical and radiologic results up to 3 years in patients treated with early loading of anterior implants supporting single-tooth all-ceramic restorations. Twenty-four patients were treated with 29 screw-type implants in the anterior maxilla. The implants were evaluated by clinical and radiographic parameters. Clinical parameters Plaque Index (PI), Sulcus Bleeding Index (BI), peri-implant probing depth (PD), and marginal bone loss (MBL) were recorded. At the recall examinations, all implants were successfully integrated, demonstrating healthy peri-implant soft tissues as documented by standard clinical parameters. No biologic complications were observed. There was no statistically significant increase in MBL between the baseline and recall stages (P > .05). Early loaded maxillary anterior implants supporting single-tooth restorations reveal successful clinical and radiographic outcomes when treatment steps were performed.

Effect of different fixed detachable implant supported prosthesis materials on the stresses induced on the supporting structures

Objectives: This study was conducted to evaluate the effect of different implant supported fixed detachable prosthesis materials (chrome cobalt-acrylic and BioHPP (Bio-High Performance Polyether)) on the stresses induced on the supporting structures.Materials and methods: A maxillary completely edentulous resin cast was 3d printed with four implant sites (two straight anterior implants and two tilted posterior implants), mucosal space for mucosa simulation and vertical slots for strain gauges which were 1mm distal to the two distal implants. Four implant analogues were placed in their sites. Multiunit abutments were secured to the implants, then fixed detachable prostheses were fabricated. In this study two models were conducted: Group (A): Complete implant supported chrome cobalt-acrylic fixed detachable prosthesis. Group (B): Complete implant supported BioHPP fixed detachable prosthesis. Strain gauges were supplied with fully encapsulated grids and attached wires. Micro strains were recorded at each site of the strain gauges with enough time elapsed between each testing. The applied load started from 0 up to 100N. T test was used for comparison between the groups, at a significance level of P ≤0.05. Results: Group A (chrome cobalt- acrylic prosthesis) showed higher induced stresses on supporting structures compared to group B (BioHPP) during bilateral, unilateral, and oblique loading. Independent T test showed statistically significant difference between the studied groups, P value was <0.05.Conclusion: Unilateral loading was more traumatic to the implants as compared to bilateral loading. BioHPP prosthesis has damping effect as it transferred less stresses to the supporting structures compared to chrome cobalt- acrylic prosthesis.

The Root Membrane Technique: A Retrospective Clinical Study With Up to 10 Years of Follow-Up.

Immediate implant placement in conjunction with intentional root retention is a recently introduced technique, but the majority of existing documentation is limited to short-term reports with low level of evidence. Hence, the aim of this study was to document the long-term clinical and radiographic results of the root membrane technique. This retrospective study reports on clinical results of the root membrane technique for periodontal ligament-mediated immediate implant placement with up to 10 years of follow-up from 3 private dental practices. Anterior implants placed with immediate loading from January 2006 to December 2016 were assessed. Kaplan-Meier estimators were computed for reporting of implant success and survival. A sample of 182 patients (82 men and 100 women, age range: 18-83 years) received 250 immediate implants (230 maxilla, 20 mandible) after the root membrane concept and followed-up for a mean of 49.94 months (±32.5). Overall, 5 implant failures were recorded for a 10-year cumulative patient-level implant survival rate of 96.5%. Considering mechanical and biological complications, the 10-year cumulative implant success rate was 87.9%. Within the limits of the retrospective design, the root membrane technique showed long-term success rates comparable to those of conventional immediate implants.

Marginal bone height changes around maxillary and mandibular implants supportin g All on four fixed detachable prosthesis. One-year prospective study

Purpose of the study: The aim of the present study was to investigate the marginal boneheight changes around maxillary and mandibular implants supporting all on four fixed detachableprosthesis after one year follow upMaterials and methods: six completely edentulous patients (4 males and 2 females) receivednew conventional maxillary and mandibular dentures and were asked to wear them for 3 monthsto enhance adaptation. Four implants were inserted in the maxillary (between the nasal sinuses)and mandibular (between the mental foramina) arch of each patient according to the All On fourprotocol. Implants were immediately loaded with provisional dentures after connection of multiunitabutments, and after 3 months of osseointegration temporary dentures were replaced by fixedceramo-metal prosthesis. Vertical marginal bone loss (VBL) was evaluated at the time of fixedhybrid prosthesis insertion, 6 and 12 months later using standardized peri-apical radiographs.Results: Maxillary anterior implants recorded significant higher VBL (P ≤ 0.005) thanmandibular implants after 6 months and 12 months of prosthesis insertion. Also, the maxillaryanterior implants showed significant VBL (P ≤ 0.005) than the posterior implants. For the posteriorimplants, no significant difference in VBL was observed between the maxillary and mandibularimplants. For the mandibular implants, no significant difference in VBL between the anterior andposterior implants was observed.Conclusion: Within the limitation of this short-term study, taking the small patient cohort intoaccount, it could be concluded that maxillary anterior implants supporting all on four fixed hybridprosthesis are at increased risk for marginal bone loss compared to maxillary posterior implants ormandibular implants.

Cesarean scar pregnancy; Diagnosis and management between 2003 and 2015 in a single center

ObjectivesWe aimed to evaluate diagnosis and management of an ectopic pregnancy developing in a previous cesarean scar. Materials and methodsBetween March 2003 and October 2015, total 64 cases of cesarean scar pregnancy (CSP) were retrospectively reviewed. The cliniscal characteristics, diagnosis, various methods of treatment and clinical outcomes were analyzed. ResultsThe mean gestational age at diagnosis was 6.5 ± 1.1 weeks and the number of previous cesarean section was 1.6 ± 0.6. The main ultrasonographic findings included anterior implantation of gestational sac within the previous CS scar and thinning of anterior myometrium (average: 3.0 ± 2.0 mm). Excluding 6 cases that were lost to follow up after diagnosis, 58 patients underwent first line treatment. The treatment was successful with first line therapy alone in 32 patients (55.2%). Emergency hysterectomy was necessary in 4 cases during following up of first line treatment. In 22 patients who underwent second line treatment, all of them were successfully treated with no additional treatment. ConclusionsMTX treatment alone as first line treatment showed low success rate (41.3%). Wedge resection (100%) and hysteroscopy (66.7%) were relatively safe and they were the most successful treatment modalities in this study. Dilatation and curettage as first and second line treatment had about 20% and 16.7% risk of emergency hysterectomy due to severe hemorrhage respectively. Therefore, surgical modalities with direct visualization excluding dilatation and curettage seem to be more safe and successful than medical treatment using MTX alone. Early precise diagnosis and management of CSP will be very important to minimize the extent of treatment and thus improve clinical outcomes of the patients.

Immediate loading at single crowns and 2-unit bridges supported by implants installed in a healed alveolar bony ridge or immediately after tooth extraction. An experimental study in dogs.

To evaluate presumptive differences in osseointegration at implants installed in healed sites or extraction sockets, supporting either crowns or bridges that were functionally loaded or left unloaded. In six dogs, the mesial roots of the first mandibular molars were treated endodontically. Bilaterally, the teeth were hemisected, and the distal roots extracted. First and second mandibular premolars were extracted as well. After 3months, the mandibular third and fourth distal roots were extracted after endodontic treatment of the mesial roots. Four implants were installed bilaterally, two in the healed sites corresponding to the second premolar and first molar regions, and two into the extraction sockets. Cobalt-chrome single crowns were prepared and installed in the two most anterior implants, and bridges at the two most posterior implants, bilaterally. A 3-unit bridge was applied to the premolars in the upper jaw only at the loaded sites. All prostheses had a flat occlusal surface and contacts in centric occlusion only at the loaded sites. Three months later, biopsies were retrieved for histological analysis. Higher levels of osseointegration and bone density were observed at the unloaded sites, both at implants installed in healed and post-extraction sites. However, only at implants installed in the post-extraction sites and supporting single crowns, the difference in bone-to-Implant contact was statistically significant. In implant installation immediately following extraction or delayed after three months, osseointegration and bone density were not affected by occlusal contact schemes.

Problem Solving Guidelines for Aesthetically Compromised Maxillary Anterior Implant Restorations

Problem Solving Guidelines for Aesthetically Compromised Maxillary Anterior Implant Restorations

Interim restoration using dynamic abutments to re-treat a single-implant crown with a labial angulation: A clinical report

The cause of some peri-implant problems may be primarily attributable to the design of the prosthesis. A screw-retained interim implant may be advisable for reversibility and to avoid peri-implant cement, although screw retention may be difficult for maxillary anterior implants with a labial angulation. In the treatment described, a interim screw-retained crown was attached to a dynamic abutment with a lingual screw access hole to obtain a correctly fitting restoration.

Regenerative surgical therapy for peri-implantitis using deproteinized bovine bone mineral with 10% collagen, enamel matrix derivative and Doxycycline-A prospective 3-year cohort study.

There is limited evidence regarding the long-term efficacy of regenerative treatment for peri-implantitis. The aim of this study was to evaluate a combination therapy of deproteinized bovine bone mineral with 10% collagen (DBBMC), enamel matrix derivative (EMD) and Doxycycline in the regeneration of bone defects associated with peri-implantitis. Thirty patients diagnosed with peri-implantitis (BoP/suppuration, probing depth greater than 4mm, minimum radiographic bone loss of 20%, at least 2years in function) were enrolled in the study. Clinical measurements included probing depths, recession, radiographic bone fill, gingival inflammation and bleeding on probing/suppuration. Following surgical access and debridement, the implant surfaces were decontaminated with 24% EDTA for 2min, and the bone defects were filled with a combined mixture of DBBMC, EMD and Doxycycline powder. The defects were covered with connective tissue grafts where necessary. Clinical measurements were recorded after 12, 24 and 36months. The mean probing depth and bone loss at the initial visit was 8.9mm (±1.9) and 6.92mm (±1.26), respectively. Both mean probing depth and bone loss reduced significantly from baseline to 3.55mm (±0.50) and 2.85mm (±0.73) at 12months, 3.50 (±0.50) and 2.62mm (±0.80) at 24months and 3.50mm (±0.50) and 2.60mm (±0.73) at 36months. 56.6% of the implants were considered successfully treated (according to Successful Treatment Outcome Criterion: PD<5mm, no further bone loss >10%, no BoP/suppuration, no recession >0.5mm for anterior implants and >1.5mm for posterior implants) after 36months. Regenerative treatment of peri-implantitis using a combined mixture of DBBMC, EMD and Doxycycline achieved promising results. The benefits of this protocol incorporating EMD should be tested in randomized clinical trials.

Stresses generated by two zygomatic implant placement techniques associated with conventional inclined anterior implants

PurposeTo make a comparative evaluation, by means of the finite element method, of the stress generated on supporting tissues and prosthetic system components, using zygomatic implants with the exteriorized and extramaxillary techniques, and different placement positions, associated either with inclined anterior implants, or those without inclination.Materials and methodsEight (8) tridimensional models were created to represent the clinical situations being researched, using the dataset of scanned images of an edentulous model. The implants and prosthetic components were photographed on millimeter paper and inserted into Rhinoceros 3D modeling computer software. From the measurements made on the image, the virtual models were made. The application force was distributed on the occlusal surface of the working side of the left maxillary first molar, first and second premolars, and incisal regions of the central incisor, simulating the occlusal load during mastication, in a total of 150 N.ResultsThe extramaxillary technique presented considerable variation in increased tension on the prosthesis screws and bone tissue. In the exteriorized technique, the highest tension values occurred in the region of the ridge, and the lowest, on the zygomatic process; the absence of cantilever reduced the stress on bone tissue in almost all regions.ConclusionThe exteriorized technique was shown to be more favorable to the distribution of stresses on the micro-unit screws and bone tissue, with the model with zygomatic implant placed in the region of the first molar and inclined anterior implant presenting the best results.

In Vivo Tooth-Supported Implant Surgical Guides Fabricated With Desktop Stereolithographic Printers: Fully Guided Surgery Is More Accurate Than Partially Guided Surgery

Desktop stereolithographic printers combined with intraoral scanning and implant planning software promise precise and cost-effective guided implant surgery. The purpose of the present study was to determine the overall range of accuracy of tooth-supported guided implant surgery using desktop printed stereolithographic guides. A cross-sectional study comparing fully and partially guided implant surgery was conducted. Preoperative cone beam computed tomography (CBCT) and intraoral scans were used to plan the implant sites. Surgical guides were then fabricated using a desktop stereolithographic 3-dimensional printer. Postoperative CBCT was used to evaluate the accuracy of placement. Deviations from the planned positions were used as the primary outcome variables. The planning software used, implant systems, and anterior/posterior positions were the secondary outcome variables. The differences between the planned and actual implant positions in the mesial, distal, buccal, and lingual dimensions and buccolingual angulations were determined, and the accuracy was compared statistically using the 1-tail F-test (P=.01), box plots, and 95% confidence intervals for the mean. Sixteen partially edentulous patients requiring placement of 31 implants were included in the present study. The implant deviations from the planned positions for mesial, distal, buccal, and lingual dimensions and buccolingual angulations with the fully guided protocol (n=20) were 0.17±0.78mm, 0.44±0.78mm, 0.23±1.08mm, -0.22±1.44mm, and -0.32°±2.36°, respectively. The corresponding implant deviations for the partially guided protocol (n=11) were 0.33±1.38mm, -0.03±1.59mm, 0.62±1.15mm, -0.27±1.61mm, and 0.59°±6.83°. The difference between the variances for fully and partially guided surgery for the distal and angulation dimensions was statistically significant (P=.006 and P<.001, respectively). No statistically significant difference was found between the software programs. Anterior implants had less variation in deviation than posterior implants. Fully guided implant surgery is more accurate than partially guided implant surgery. Implant positional deviation is influenced by implant location but not implant systems or software. If possible, clinicians should use guided surgery protocols that allow placement of implants through a surgical guide.

First-trimester detection of abnormally invasive placenta in high-risk women: systematic review and meta-analysis.

The primary aim of this systematic review was to ascertain whether ultrasound signs suggestive of abnormally invasive placenta (AIP) are present in the first trimester of pregnancy. Secondary aims were to ascertain the strength of association and the predictive accuracy of such signs in detecting AIP in the first trimester. An electronic search of MEDLINE, EMBASE, CINAHL and Cochrane databases (2000-2016) was performed. Only studies reporting on first-trimester diagnosis of AIP that was subsequently confirmed in the third trimester either during operative delivery or by pathological examination were included. Meta-analysis of proportions, random-effects meta-analysis and hierarchical summary receiver-operating characteristics curve analysis were used to analyze the data. Seven studies, involving 551 pregnancies at high risk of AIP, were included. At least one ultrasound sign suggestive of AIP was detected in 91.4% (95% CI, 85.8-95.7%) of cases with confirmed AIP. The most common ultrasound feature in the first trimester of pregnancy was low implantation of the gestational sac close to a previous uterine scar, which was observed in 82.4% (95% CI, 46.6-99.8%) of cases. Anechoic spaces within the placental mass (lacunae) were observed in 46.0% (95% CI, 10.9-83.7%) and a reduced myometrial thickness in 66.8% (95% CI, 45.2-85.2%) of cases affected by AIP. Pregnancies with a low implantation of the gestational sac had a significantly higher risk of AIP (odds ratio, 19.6 (95% CI, 6.7-57.3)), with a sensitivity and specificity of 44.4% (95% CI, 21.5-69.2%) and 93.4% (95% CI, 90.5-95.7%), respectively. Ultrasound signs of AIP can be present during the first trimester of pregnancy, even before 11 weeks' gestation. Low anterior implantation of the placenta/gestational sac close to or within the scar was the most commonly seen early ultrasound sign suggestive of AIP, although its individual predictive accuracy was not high. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Peer review report 1 on “Stresses Generated By Two Zygomatic Implant Placement Techniques Associated With Conventional Inclined Anterior Implants”

Peer review report 1 on “Stresses Generated By Two Zygomatic Implant Placement Techniques Associated With Conventional Inclined Anterior Implants”

COMPARISON OF BONE HEALING AROUND NANO TOPOGRAPHY DENTAL IMPLANT VERSUS CONVENTIONAL IMPLANT

INTRODUCTION: Implant surface characteristics differ greatly among various Implants. Early bone healing around the implant surface can be crucial in determining various treatment plans and outcomes. OBJECTIVES: Comparison of early bone healing between two commercially available implants one with a nanotopographical surface and one with a conventionally treated surface in the maxillary anterior region of the oral cavity using cone beam CT. MATERIALS AND METHODS: Seven patients were selected from Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Alexandria University where patients were indicated for bilateral maxillary anterior implants as delayed Implantation with a total of 14 implants divided into two groups: Study group: Seven implants with a nanotopographic surface. Control group: Seven implants with a conventional surface. Bone density was measured according to gray scale using CBCT and dedicated software pre-operatively and at four and six weeks postoperatively. RESULTS: For control group implants the average mean and standard deviation of bone density of the placed implants at four weeks postoperatively was 1010.02 ± 142.59 Hounsfield units and 1104.4 ± 152.9 HU at six weeks post-operatively. While for study group implants the average mean and standard deviation of bone density of the placed implants at four weeks post-operatively was 1208.04 ± 145.82 HU and 1328.85 ± 160.41 HU at six weeks post-operatively. After comparing these results, it was shown that the average mean and standard deviation of bone density of all implants of the study group is greater than the average mean and standard deviation of bone density of all implants of the control group, which results in p-value of <0.001 which is statistically significant. CONCLUSIONS: There is a significant increase in the early bone healing around nanotopographic dental implants as opposed to conventionally chemically modified implants. KEY WORDS: Surface treatment, nanotopographic implants, chemically modified implants, early bone healing, cone beam CT, Hounsfield Units.

Effect of Attachment Type on Implant Strain in Maxillary Implant Overdentures: Comparison of Ball, Locator, and Magnet Attachments. Part 1. Overdenture with Palate.

Implant overdentures with attachments have been used in clinical practice and the effect of attachments on implant strain has been frequently reported. However, most studies have focused on mandibular overdentures; there are few reports on maxillary overdentures. The purpose of this study was to examine the influence of attachment type on implant strain in maxillary overdentures under various implant configurations. A maxillary edentulous model with implants and experimental overdentures were fabricated. Four strain gauges were attached to each implant, positioned in anterior, premolar, and molar areas. Three types of unsplinted attachments-ball, locator, and magnet-were set on the implants under various implant configurations. A vertical occlusal load of 98 N was applied through the mandibular complete denture, and implant strain was compared using the Kruskal-Wallis test. Ball attachments caused the greatest amount of strain, while magnet attachments caused the least amount under all conditions. For all attachments, two anterior implants caused significantly more strain than four implants (P < .05). No significant difference was observed between subtypes in four-implant configurations except when using locator attachments. When using unsplinted attachments for maxillary implant overdentures, magnet attachments are recommended to reduce implant stress. Using only two implants, especially two anterior implants, is not recommended regardless of attachment type.