Bar Overdenture Research Articles

Evaluation of patient satisfaction and maximum biting force of three differently constructed bars on two implants retaining mandibular overdenture - one year follow-up (a randomized controlled clinical trial)

BackgroundDifferent bar construction techniques will affect the bar passive fitness, which may induce stresses or strain on the implant and/or tightening screw and sequentially may affect the biting force and patient satisfaction.Aim of the studyThis clinical investigation assessed patient satisfaction and maximum biting force (MBF) using three differently constructed (conventional casting, milling, and 3D printing CAD/CAM techniques) cobalt-chromium (Co-Cr) bar-retained implants mandibular overdentures over a one-year period of follow-up.Materials and methodsThirty edentulous patients seeking for two implants bar-retained mandibular overdentures were randomly assigned into three groups as the following: Group I: 10 patients received a Co-Cr conventional casting bar, Group II: 10 patients received a Co-Cr CAD/CAM milled bar, and Group III: 10 patients received a Co-Cr CAD/CAM 3D-printed bar. All the bar groups were connected to two implants in the canine area bilaterally. Within the first two weeks following implant placement, patients received the definitive prosthesis. Patient satisfaction was evaluated by using the (OHIP-EDENT-19) questionnaire form after 6, and 12 months. Additionally, the maximum biting force was tested at after delivery, 3, 6, and 12 months for each group. The results were collected, tabulated, and statistically analyzed. Trial registration: This study was recorded on ClinicalTrials.gov retrospectively registered (ID: NCT06401187) on 30/04/2024.ResultsAfter one year follow up, regrading patient satisfaction the three groups showed no statistically significant difference. Although, the functional limitation domain was in favor of the milled bar. Regarding the maximum biting force, no statistically significant difference was found among three groups. However, at 12 mouths follow-up the milled bar showed statistically value.ConclusionWithin the limitations of this study, the conventional, milled and 3D printed bar overdentures groups can be used as a satisfactory treatment modality for edentulous mandible in terms of patient satisfaction and maximum biting force.

Prosthodontic rehabilitation with all-on-four implant treatment combined CAD/CAM prosthesis in an oral cancer patient: a case report

BackgroundThe microvascular free fibula (MFF) flap is a reliable treatment modality for mandibular reconstruction and is suitable for dental implant placement after oncologic surgery. The most common issue with the MFF flap is its limited bone height, which typically results in excessive interarch space and complicates prosthodontic therapy. Overcoming the physical limitations from tumor excision and reducing the treatment time for prosthodontic rehabilitation to improve quality of life are critical clinical challenges.Case PresentationA 64-year-old male with lower left gum and bilateral buccal cancer received a single-layer microvascular MFF flap to reconstruct a mandibular defect post-tumor excision. He underwent a bilateral modiolus Z-plasty combined with a skin flap debulking procedure to relieve oral contracture, achieving adequate mouth opening for prosthodontic rehabilitation. Scar tissue bands on the bilateral cheeks significantly affected retention and stability, hampering dental impression performance. The patient sought prosthodontic rehabilitation to enhance his chewing function and quality of life promptly. Prosthodontic rehabilitation with all-on-4 implant therapy, utilizing computer-aided design and computer-assisted manufacturing (CAD/CAM), was completed within one month.ConclusionThis case utilized the all-on-4 implant system to address the insufficient fibular height for conventional dental implant placements. Dental CAD/CAM was employed to mill custom prosthetic abutments and a large titanium framework for the implant bar overdenture, compensating for the excessive interarch space between the grafted fibula and maxilla. This treatment approach successfully shortened the prosthodontic rehabilitation time and overcame anatomical limitations.

An Innovative Technique for Assessment of Bone Change, Bite Force, and Retention of the Single-Implant-Supported Mandibular Overdenture: A Clinical Study

ABSTRACT This study is the first study to incorporate a novel approach to single-implant-retained mandibular overdenture with a bar attachment on a single implant in the symphysis region. The use of a single-implant-retained bar overdenture significantly improved patients’ chewing efficiency, indicating enhanced overdenture retention and stability Materials and Methods: Ten maxillary and mandibular completely edentulous patients were enrolled in the study. A complete denture was fabricated for them. On completion, bite force, retention force, and bone change were recorded. Bite force was recorded with the strain gauge, retention force with the force measurement gauge, and bone changes with radiographs Conclusion: Single-implant-supported bar mandibular overdenture (SISBOD) can be a suitable standard economic option for edentulous mandible and can greatly improve the quality of life of patients.

Effect of bar designs on peri implant tissues health in implant-supported removable prostheses: a systematic review

Different characteristics of bars (cross-sectional shape, diameter, distal extension etc.) lead to different biomechanical behavior (retention and stress) with implants and peri-implant tissues.Aim: To evaluate the impact of implant-supported removable prostheses bar designs in fully edentulous arch (in the maxilla and/or mandibula), with 4 implants or more, on the peri-implant soft and hard tissues.Two reviewers searched for observational studies, RCT and in vitro studies, published on five main databases and three from the grey literature, without restrictions on November 2023.Of the 3049 selected articles, four met the inclusion criteria. Four RCT evaluated peri-implant health tissues in full edentulous arches with 4 or 6 implants rehabilitated with implant bar overdentures. One prospective study with 5 years follow-up evaluated the success/survival rate of implants and implant bar overdentures. Overall, 261 subjects were enrolled in our systematic review with 1176 implants. Overdentures’ survival rate was 100%. There was a trend that plaque indices and gingival indices were low in all of the studies, however no statistical analysis was done due to the lack of information.Due to the lack of information in the included studies, we cannot confirm if bar characteristics affect the peri-implant tissues health.

Prosthetic Oral Rehabilitation with CAD/CAM Suprastructures in Patients with Severe Tissue Deficits: A Case Series.

This article presents the outcomes of prosthetic oral rehabilitation using CAD/CAM telescopic bar overdentures in patients with oral cancer (n = 3), severe facial trauma (n = 2), or various syndromes (n = 1), all suffering from severe tissue deficits and requiring complex and comprehensive oral rehabilitation. The aim was to assess the durability and functionality of implant-retained prosthetic structures, ensuring easy oral hygiene and minimizing specialized follow-up needs. The data for this study were sourced from a retrospective cohort at Helsinki University Hospital. The prosthetic reconstruction encompassed the Atlantis 2in1 and the Createch removable telescopic systems. Thus, 40 implants were placed (4 to 7 per patient), with prosthetic structures in the maxilla (n = 4 patients), in the mandible (n = 1), and in both jaws (n = 1). Two patients experienced no complications, two patients had part of the acrylic resin break, and one patient experienced loosening of the bar structure. All complications associated with prosthetic structures were successfully managed, and none of the implants were lost. The follow-up time ranged from 7 to 126 months. This rehabilitation is proved to be an effective solution for patients with complex oral conditions, facilitating both functional restoration and ease of maintenance. These findings underscore the importance of individualized treatment approaches in cases of tissue deficits.

Accuracy of Selective Laser Melted Bar Retaining Mandibular Implant-Assisted Overdenture: An In Vitro Comparison of Different Impression Materials and Techniques.

This study aimed to assess the accuracy of the marginal fit of 2 implant-supported overdenture bars fabricated with selective laser melting technology, using polyvinyl siloxane and vinyl siloxane ether impression materials and different impression techniques. Two implants with multi-unit abutments were inserted in a 3D-printed mandibular model and used as a reference model, then duplicated into a stone cast to fabricate custom trays for obtaining impressions with polyvinyl siloxane and vinyl siloxane ether impression materials, using both open and closed-tray techniques. This resulted in a total of 4 groups, each with 8 specimens. The impressions were poured and scanned, and 32 cobalt-chromium bars were fabricated using selective laser melting technology. Each bar was screwed onto one abutment of the reference model, and a standardized digital periapical radiograph of the opposite unscrewed side was taken; this process was repeated to the other abutment. The vertical misfit was measured at 3 predetermined positions on the unscrewed side, and 6 values per bar were recorded. The mean gap distance was measured, and the data were subjected to statistical analysis; the present study found that the open-tray technique with vinyl polyether siloxane impression material may offer improved accuracy for obtaining impressions for 2 implant-supported bars. The open-tray technique groups also showed better marginal fit than the closed-tray groups. However, further clinical research is required to confirm these findings.

Hybrid Prosthesis versus Overdenture: Effect of BioHPP Prosthetic Design Rehabilitating Edentulous Mandible.

To compare the BioHPP (biocompatible high-performance polymer) as a substructure for the hybrid prosthesis versus the BioHPP bar supporting and retaining implant overdenture by radiographic evaluation to identify bone height alteration around the implants and to evaluate satisfaction based on visual analoge scale questionnaire. Ill-fitting mandibular dentures were chosen for 14 fully edentulous male patients with adequate dental hygiene, enough interarch space, and free of systemic diseases and parafunctional habits. Patients who received new dentures (CDs) were randomly allocated into each group using computer software, and four interforaminal implants were inserted in parallel using a surgical guide. Three months after osseointegration, the patients received either CAD-CAM BioHPP framework hybrid prosthesis (Group I) or BioHPP bar supported and retained overdenture (Group II). Using digital preapical radiography, the bone loss is evaluated 6, 12, and 18 months after insertion. The subjective patient evaluation was done using a questionnaire based on the VAS includes five points for chewing, comfort, esthetics, speech, oral hygiene, and general satisfaction. The overall marginal bone loss (MBL) revealed that Group I (hybrid prosthesis) was more than Group II (bar overdenture) at all intervals in the anterior and posterior implants' mesial and distal surfaces. The patient satisfaction survey results showed that, after 18 months, the difference was statistically not significant between them all (P > 0.05) except for the comfort (for the overdenture group, 4.43 ± 0.53 while the fixed hybrid was 5.00 ± 0.00). BioHPP framework material is an alternative material for implant rehabilitation of edentulous mandible with minimal MBL in BioHPP bar overdenture compared to BioHPP hybrid prosthesis.

Fabrication of CAD-CAM custom-made bar clip for implant-supported overdentures using an intraoral scanner: A dental technique

This article describes a digital technique for fabricating individually designed overdenture bar clips. The patient was scanned intraorally using a Medit i700 scanner; the custom clip was designed using the Blender software program and milled from polyoxymethylene blocks. This low-cost technique offers more available options compared with traditional clips, improving the management of retention loss.

BioHPP Fixed Hybrid Prosthesis versus BioHPP Bar Overdenture as Treatment Options for Mandibular Edentulous Ridge (Prosthetic Maintenance and Patients’ Satisfaction)

BioHPP Fixed Hybrid Prosthesis versus BioHPP Bar Overdenture as Treatment Options for Mandibular Edentulous Ridge (Prosthetic Maintenance and Patients’ Satisfaction)

Implant-supported milled bar overdenture with two implant surgical guides

Implant-supported milled bar overdenture with two implant surgical guides

Resilient Stud Versus Bar Attachments for Inclined Implants Supporting Mandibular Overdentures. An In Vitro Study of Loading and Dislodging Strains.

To evaluate strain around resilient stud and bar attachments for inclined implants supporting mandibular overdentures during loading and dislodging. A mandibular edentulous model was printed using the laser sintering technique. Two vertical implants and two 30-degree distally inclined implants were placed in canine and premolar areas, respectively. Overdentures were attached to the implants with either a resilient stud (Locator, group 1) or a bar/clip (group 2) attachment. Three strain gauges were mounted at the buccal, lingual, and proximal surfaces of each implant. Microstrains were registered during vertical loading and dislodging force applications and compared between attachments (resilient stud and bar) and implant positions (vertical and inclined). For canine implants, bar overdentures recorded significantly higher microstrains than Locator overdentures during vertical loading. For premolar (inclined) implants, Locator overdentures recorded significantly higher microstrains than bar overdentures during vertical dislodging. For both groups (during loading) and the bar overdenture group (during dislodging), canine (vertical) implants showed significantly higher microstrains than premolar (inclined) implants. Within the limitations of this in vitro study, canine (vertical) implants may be at risk of increased stresses during loading if bar attachments are used for vertical and inclined implants supporting mandibular overdentures, and premolar (inclined) implants may be at risk of increased stresses during dislodging if Locator attachments are used. For both attachments, canine implants showed significantly higher microstrains than premolar implants during loading and dislodging.

Peri-implant tissue health and patient satisfaction of vertical versus inclined posterior implants used to support overdentures with bar attachments. A one-year randomized trial.

This study aimed to evaluate peri-implant tissue health and patient satisfaction of vertical and inclined posterior implants for mandibular bar overdentures. Thirty edentulous participants received four implants in the interforaminal area of the mandible. The patients were randomly assigned into two equal groups; (1) vertical group (control): all implants were inserted vertically parallel to each other. Inclined group (study): the anterior implants were placed vertically, and the posterior implants were tilted 30° distally. Hader bar attachment with two 7 mm-distal cantilevers (vertical group) and without cantilevers (inclined group) was used to connect the implants to mandibular overdentures. Peri-implant tissue health (Plaque [PL] and gingival [GI] indices, pocket depth [PD], and crestal bone loss [CBL]) were evaluated after denture insertion (T0), 6 (T6), and 12 (T12) months after insertion. Patient satisfaction was evaluated using a visual analog scale after 12 months. At T12, the vertical group showed significantly higher PL, PD, and CBL than the inclined group for anterior (p< 0.037) and posterior (p< 0.017) implants. The vertical group showed significantly higher GI than the inclined group for anterior implants (p= 0.003), and the inclined group showed significantly higher GI than the vertical group for posterior implants (p= 0.016). The inclined group showed significantly higher scores for general satisfaction (p= 0.049), prosthesis as a part of you (p= 0.013), appearance (p< 0.001), stability (p= 0.002), ease of cleaning (p< 0.001), and comfort (p= 0.001) than the vertical group. Inclined posterior implants used to support mandibular bar overdentures are recommended than vertical implants, as it was associated with improved patient satisfaction and peri-implant tissue health.

Within-patient evaluation of chewing efficiency and maximum bite force of conventional dentures, fixed prostheses, and milled bar overdentures used for All-on-4 implant rehabilitation of atrophied mandibular ridges: A short-term randomized trial.

This crossover study aimed to evaluate chewing efficiency and maximum bite force (BF) of conventional dentures, fixed prostheses, and milled bar overdentures (MO) used for All-on-4 implant rehabilitation of atrophied mandibular ridges. Sixteen edentulous participants with resorbed mandibular ridges received new conventional dentures (CD, control). Four implants were inserted after 3 months in the mandible using the All-on-4 protocol and loaded immediately with acrylic prosthesis. In a crossover manner, each patient had either fixed restoration (FR, 12 occlusal units) or MO (14 occlusal units) randomly in a crossover study design. Chewing efficiency was evaluated using the mixing ability test. The hue deviation (HD) of two-colored gum was calculated after being chewed for 5, 10, 20, 30, and 50 masticatory cycles. Maximum BF was evaluated using a BF device. HD and BF were measured after using CD, FR, and MO prostheses. For all groups, the highest HD (i.e., the lowest chewing efficiency) was noted with 5 strokes, followed by 10, 20, 30 strokes, and the lowest HD (i.e., the highest chewing efficiency) was noted with 50 strokes. For all number of chewing strokes, CD showed the highest HD, then FR, and MO recorded the lowest HD. The highest BF was observed with MO, then FR, and the lowest BF was noted with CD. Within the limitations of this short-term investigation, both FR and MO used for All-on-4 implant rehabilitation of patients with resorbed mandibular ridges improve masticatory efficiency and maximum BFs compared to CD. However, MO was associated with significantly higher chewing efficiency and maximum BFs than fixed prosthesis.

Masseter muscle activity of conventional denture, fixed prosthesis, and milled bar overdenture used for All-on-4 implant rehabilitation: A within-subject study.

to examine the electromyographic (EMG) activity of the masseter muscles in patients with conventional dentures and compare it to EMG activity of fixed prosthesis, and milled bar overdentures used to rehabilitate mandibular atrophied ridges according to the All-on-4 concept. Eighteen edentulous subjects with atrophied mandibles received complete dentures (CD, control). After 3months, four implants were installed between the mental foramina according to the "All-on-4" protocol and loaded immediately. After osseointegration, fixed prostheses (FPD) or milled bar overdentures (MBO) were given to the patients in random order. Primary (amplitude), and secondary (chewing rate, time of the masticatory cycle, time of masticatory burst, and masticatory time) outcomes were evaluated 3months after using CD, FPD, and MBO. The evaluations were made during mastication of carrot (hard) and cake (soft) foods. FPD and MBO were associated with a significantly higher (amplitude, time of masticatory cycle, and time of masticatory burst), and significantly lower (chewing rate and masticatory time) compared with conventional dentures. Primary and secondary outcomes did not differ between FPD and MBO. Carrot had significantly higher amplitude, chewing rate, time of masticatory burst, and masticatory time than cake, while cake had a significantly higher time of masticatory cycle than carrot. Within limitations of this study, milled bar overdentures for All-on-4 implant rehabilitation of atrophied mandible is not less efficient than fixed prostheses in terms of electromyographic activity of the masseter muscle. Both prostheses significantly improve muscle activity, chewing rate, time of masticatory cycle, time of masticatory burst, and masticatory time compared with conventional dentures.

Effect of Accelerating Aging on Retention and the Release Period of Clips in a Bar Retained Maxillary Implant Overdenture

Objectives: This study was made to detect the effect of accelerating aging on retention and measuring the release period of clips in a 2 and 3 bar retained maxillary implant overdenture. Materials and Methods: Four implants were placed in two maxillary edentulous epoxy models. One model had two bar attachments with two clips overdenture while the other model had three bar attachments with three clips in the overdenture. Retention and release period of the clips were checked before applying insertion removal cycles. Retention was measured using a universal testing machine after 540 cycles (6 months) and 1080 cycles (1 year) of insertion removal on a chewing simulator.Results and Conclusions: There was a significant difference in retention and release period between two bars and three bars implant retained maxillary overdentures. A significant difference was also seen in each group after accelerated aging. Therefore, the three bar implant retained overdenture had higher retention values than two bar. Retention loss occurred in both groups after the insertion removal cycles. Release period value was lower in two bar overdenture than three bar overdenture.

Milled Bar with PEEK and Metal Housings for Inclined Implants Supporting Mandibular Overdentures: 1-Year Clinical, Prosthetic, and Patient-Based Outcomes.

This investigation aimed to evaluate clinical, prosthetic, and patient-based outcomes of a milled bar with polyether ether ketone (PEEK) and metal housings for inclined implants supporting mandibular overdentures. Eighteen edentulous participants received four implants in the interforaminal area of the mandible (two vertically and two distally inclined), and implants were connected with milled bars. Overdentures were attached to the bars with PEEK female housing (test group). The control group consisted of participants who received milled bar overdentures with conventional metal housings but were case matched to the test group and served as a historical cohort. Clinical parameters (Plaque Index, Gingival Index, pocket depth, and bone loss) were measured at baseline, 6 months, and 12 months. Patient satisfaction (using visual analog scale) and prosthetic complications were recorded after 12 months. The control group showed a significantly higher plaque score and marginal bone resorption compared with the test group. The test group showed higher satisfaction with retention, stability, speech, and esthetics compared with the control group (P < .048). The test group showed a significantly lower incidence of female housing wear (P = .017), plastic clip wear (P < .001), and plastic clip fracture/renewal (P = .049) than the control group. No difference between groups was noted for other clinical, prosthetic, and patient-based outcomes. PEEK housing of a milled bar may be a successful alternative to conventional metal housing for inclined implants supporting mandibular overdentures, as it is associated with favorable clinical, prosthetic, and patient-based outcomes after 1 year.

Clinical and radiographic outcomes of stress-free implant (SFI) bars and Milled bars for early loaded implant supported mandibular overdentures. A one-year randomized trial

Objectives: The aim of the present trial was to compare clinical and radiographic outcomes of stress-free implant(SFI) bars and Milled bars for early loaded implant supported mandibular overdentures. Materials and methods:Ten completely edentulous participants were selected. Patients were allocated in 2 groups :group 1 include 5 patients who received milled bar overdentures, and group 2 include 5 patients who received SFI bar overdentures. Four implants were inserted according the flapless surgical protocol in canine and frist molar areas and early loaded by milled bar(group 1)or SFI bar(group2) 2weeks after implant placement. Plaque and gingival indeces, pocket depth, fixture stability, and peri-implant bone resorption were measured at base line, 6 and 12months after prostheis delivery. Results:The survival rate was 95% and 100% for milled bar and SFI bar groups respectively. Plaque index and pocket depth significantly increased with passage of time for milled bar group only and SFI bar showed no difference in these parameters between observation times. Bone loss increased from 6 to 12 months significantly in both groups. No significant difference in gingival index and fixture stability between observation times or between groups were noted. Milled bar group showed significant higher plaque, pocket depth, and bone resorption than SFI bar group after 6and 12months. Conclusion:Within the limitation of this randomized trial, it could be concluded that SFI bar is more advantageous for early loaded 4 implants supporting mandibular overdentures than milled bar as it was associated with decreased plaque accumulation, pocket depth and marginal bone resorption after one year.

Milled bar versus rigid telescopic attachment for mandibular implant supported overdentures. A study of patient satisfaction and oral health quality of life.

Aim: This investigation aimed to evaluate participant satisfaction and quality of life of Milled bar versus rigid telescopic attachment for mandibular implant supported overdentures. Materials and methods: Eight edentulous participants who unsatisfied with the retention and stability of existing mandibular prosthesis received 4 implants in the interforminal area of the mandible using computer guided flapless surgical approach. After 3 months, implants were connected to overdentures with rigid telescopic (n=4) or milled bar (n=4) attachments. After 3 months of addaptation, patient satisfaction was measured using Visual analouge scale and Oral health related quality of life (OHEQoL) was measured using Oral health impact profile (OHIP-14). Comparison of data between groups were made using MannWhiteny test. Results: Milled bar showed significant higher satisfaction with overdenture retention than telescopic overdentures, while the later showed significant higher satisfaction with overdenture cleaning compared to milled bar. No significant differnce between the attachments was noted regarding other questionaire of VAS. Regarding OHIP, telescopic overdentures showed higher satisfaction regarding pronounciation of sounds, and comfort on eating than milled bars. No significant differnce between overdentures were noted for other OHIP questions Conclusion: Within the limits of this study, both telescopic and milled bar mandibular overdentures achieve high patient satisfaction and oral health related quality of life. However, milled bar overdentures are advantageous in terms of overdenture retention and telescopic overdentures are advantageous in terms of cleaning, comfort on eating and pronunciation of sounds.

Satisfaction and Oral Health-Related Quality of Life of Different Attachments Used for Implant-Retained Overdentures in Subjects with Resorbed Mandibles: A Crossover Trial.

The aim of this crossover study was to evaluate patient satisfaction and oral health related-quality of life (OHRQoL) with different connectors used for implant-retained overdentures in subjects with resorbed mandibles. Eighteen edentulous patients with atrophied mandibular bone received traditional maxillary and mandibular dentures (control). After 3 months, two implants were inserted in the canine regions. Three months later, each patient received the following overdentures using a crossover design: (1) bar overdentures, (2) telescopic overdentures, and (3) stud overdentures. Patient satisfaction (primary outcome) was measured by visual analog scale (VAS). OHRQoL (secondary outcome) was measured by oral health impact profile (OHIP-14). Questions of VAS and OHIP-14 were evaluated after 3 months of using conventional dentures, bar overdentures, telescopic overdentures, and stud overdentures. For all questionnaires, conventional dentures recorded significantly lower satisfaction than implant overdentures. Stud overdentures showed significantly higher satisfaction with maxillary denture comfort, self-consciousness, and feeling that the prosthesis is a part of the patient compared with other attachments. Bar and telescopic overdentures showed higher satisfaction during biting of hard and soft foods, while telescopic and stud overdentures showed higher satisfaction with oral hygiene. No significant differences between attachments regarding other VAS and OHIP-14 questions were noted. Implant overdentures for subjects with mandibular bone resorption improved patient satisfaction and OHRQoL compared with traditional dentures regardless of the form of attachments. However, studs are more advantageous in terms of comfort with maxillary overdentures, self-consciousness, and feeling that the prosthesis is a part of the patient. Bar and telescopic attachments had more satisfaction during biting of soft and hard foods, while telescopic and stud attachments had more satisfaction with oral hygiene.

Immediate implant-supported full-arch hybrid prosthesis on an edentulous patient using a bar-retained overdenture in the mandible: Case Report.

The hybrid prosthesis is a very predictable treatment option that allows patients to recover their oral functionality. It is a good alternative to conventional treatments and overdentures. The present report describes controlled an 80 year old female patient with controlled hypertension, who came for consultation with a bar overdenture with attachment holders on two external hexagonal dental implants; an immediate loading hybrid prosthesis was installed over four mandibular dental implants.