Implant-supported Overdentures Research Articles

Budget Impact Analysis: Digital Workflow Significantly Reduces Costs of Implant Supported Overdentures (IODs).

Budget Impact Analysis: Digital Workflow Significantly Reduces Costs of Implant Supported Overdentures (IODs).

Prosthetically Driven Approach to Post-Ablative Maxilla Rehabilitation with an Implant-Supported Overdenture: A Case Report

This clinical report details the prosthetic rehabilitation of a patient following maxillary ablation to remove a peripheral giant cell granuloma. After a hemimaxillectomy, the defect was reconstructed with a fasciocutaneous radial free flap. Implant placement was digitally planned using the dual scanning technique, and implants were inserted with the aid of an acrylic surgical guide. After implant osseointegration, a removable implant-supported overdenture with an electroplated secondary structure retained on a titanium bar was fabricated. At the 3-year follow-up, peri-implant tissues remained healthy, showing only mild gingival hyperplasia around the bar, while no prosthesis retention loss or significant technical complications were observed. In conclusion, the reconstruction of the moderate maxillary defect using a soft-tissue flap provided satisfactory functional and esthetic outcomes, significantly enhancing patient satisfaction. However, the limited bone availability necessitated precise implant planning to ensure adequate biomechanical support for the overdenture.

Removable dental prostheses for patients with Sjögren's syndrome

Sjögren's syndrome (SS) is a chronic autoimmune condition primarily affecting the salivary and lacrimal glands, leading to pronounced dry mouth (xerostomia) and dry eyes. These symptoms create unique challenges for SS patients requiring removable dental prostheses, as the lack of saliva significantly impacts the retention, comfort, and overall effectiveness of these devices. Without adequate saliva, prosthetic retention diminishes, and patients frequently experience issues such as mucosal irritation and increased susceptibility to infections. To address these issues, tailored material choices are critical in designing effective prosthetic solutions. Soft liners, moisture-retentive acrylics, and antimicrobial coatings are among the innovations improving both retention and comfort for SS patients. The aesthetic and functional outcomes of prosthetic solutions are also essential considerations. Enhanced retention mechanisms, such as implant-supported overdentures, not only improve masticatory performance but also aid in preserving the patient’s facial profile and lip support. Advanced materials offering translucency and color stability contribute to a more natural appearance, which is critical for patient satisfaction. The maintenance of these prostheses requires specific care routines to mitigate microbial buildup and tissue irritation. Specialized cleaning agents and salivary substitutes help maintain hygiene and reduce discomfort, while regular follow-up visits enable timely adjustments to accommodate tissue changes and extend the prosthesis lifespan. Implementing a comprehensive approach that considers material selection, functional and aesthetic outcomes, and maintenance strategies can greatly enhance the quality of life for SS patients. By understanding and addressing the specific needs associated with xerostomic conditions, dental professionals can provide prosthetic solutions that offer both reliability and comfort in this challenging context. Regular patient education and diligent care routines remain essential to ensure the long-term success and durability of removable dental prostheses for individuals with SS.

O-Ring and Bar-Clip: A Comparative Analysis of Retention in Overdenture Prostheses - A Systematic Review.

Mandibular implant-supported overdentures (IODs) show higher retention than conventional complete dentures. However, there is no consensus on the best attachment to ensure resistance to vertical displacement. The most used are o-ring and bar-clip. This systematic review answered "Which type of attachment for overdenture prosthesis provides higher retention: o-ring or bar-clip? The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was followed and registered in the International Prospective Register of Systematic Reviews (PROSPERO). The search was applied to 5 databases and grey literature. The selection process occurred in two blinded steps by the reviewers following the eligibility criteria: a randomized clinical trial comparing retention between o-ring and bar-clip in IODs. The risk of bias was analyzed by RoB II. 206 articles were found, and after removing the duplicates 136 were evaluated by title and abstract of which 24 were selected for full reading, 5 met the eligibility criteria, and all had a high risk of bias. The bar-clip provided higher retention than o-ring in four studies. The bar-clip system provides a higher retention rate than the o-ring. In addition, the selection of attachment systems is dependent on the patient's anatomical-functional and economic conditions.

The effect of attachment systems and denture cleaning methods on microbial biomass and composition in implant-supported overdentures: an experimental study

ObjectiveThis research endeavors to scrutinize the influence of attachment systems and denture cleaning methodologies on microbial biomass and composition within the realm of implant-supported overdentures, a crucial consideration for patients with dentition defects necessitating such prosthetic solutions.Subjects and methodsEmploying five polymethyl methacrylate specimens designed to emulate the fitting surfaces of traditional dentures and implant-supported overdentures. Following the polishing of each specimen and the quantification of its roughness, co-cultivation with three distinct microbial strains ensued, culminating in ultrasonic cleaning in water. The bar-clip group, differentiated by the depth of attachment, underwent cleaning employing four diverse methods. Biomass quantities were meticulously recorded both pre and post cleaning interventions, with subsequent data analysis via t-testing and one-way ANOVA, maintaining a significance level of α = 0.05.ResultsThe bar-clip groups demonstrated an elevated degree of microbial adhesion, with the deeper locator group exhibiting heightened biomass residue post-cleaning, indicative of increased cleaning complexity. Ultrasonic cleaning predominantly targeted biofilm and deceased bacteria, whereas chemical cleaners primarily reduced the quantity of viable bacteria. The synergistic application of ultrasonics and chemical cleaning treatments yielded the minimal biomass residue.ConclusionIn contemplating the utilization of dentures milled by dental computer-aided design/manufacturing systems, meticulous pre-use surface polishing is imperative. The extent of biofilm adhesion correlates with the chosen attachment system. This study advocates for the incorporation of ultrasonic cleaning in conjunction with chemical cleaning solutions to optimize the removal of biofilm and live cellular entities in the context of implant-supported overdentures.

Evaluation and Comparison of Stresses Between All-on-4 and All-on-6 Treatment Concepts With Three Different Prosthetic Materials in the Maxilla: A Finite Element Analysis Study.

This study aimed to evaluate the comparative analysis of stresses on and around implants and surrounding cortical bone using three different prosthetic materials in hybrid prosthesis using the all-on-4 technique and all-on-6 technique in the maxilla using finite element analysis (FEA). An in vitro FEA study was conducted where a three-dimensional (3D) model of an edentulous maxilla and four different models of the mandible were built using ANSYS software version 18 (Ansys, Inc., Canonsburg, Pennsylvania, United States). Group A comprised the all-on-4 technique where two vertical implants were placed in the lateral incisor area, and two tilted implants at 30o were placed in the second premolar area, whereas group B included the all-on-6 technique, where four vertical implants were placed in the central incisor and canine area, along with two tilted implants in second premolar area. Subsequently, prosthetic materials such as acrylic, porcelain fused to metal (PFM), and zirconia were studied. Four different opposing arch materials were made: natural teeth (A1 and B1), complete dentures (A2 and B2), implant-supported overdentures (A3 and B3), and hybrid prosthesis (A4 and B4). The von Mises stresses were recorded at the implant and cortical bone to summarize the effect of occlusal loads on the maxillary bone using the all-on-4 and all-on-6 techniques. In the all-on-4 technique, on evaluating stresses on implants, it was revealed that acrylic consistently demonstrated lower stress magnitudes in comparison to zirconia and PFM. The stress levels escalate from 38.72 MPa in model A1 to 72.43 MPa in model A4. Zirconia endured the most substantial stresses, ranging from 53.64 MPa (A1) to 84.87 MPa (A4). Similar results were obtained for the stresses on the cortical bone and for the all-on-6 technique. However, the stresses were lower in the all-on-6 technique than in the all-on-4 technique. The lowest stress values across all prosthetic materials were recorded when the maxillary arch was restored with acrylic teeth along with a titanium bar opposing natural dentition. The least stresses were noticed in the all-on-6 technique with acrylic prosthetic material opposing the natural dentition. As the all-on-6 treatment concept showed the most favorable biomechanical behavior, it can be considered a viable alternative for moderate atrophic maxillary rehabilitation.

Should our older, edentulous patients live with their teeth sitting in a glass of water?

Over 20 years ago, the McGill consensus statement stated that a mandibular two-implant overdenture should be the first choice of care for our edentulous patients. We have around three million edentulous patients in England and Wales currently, many over the age of 60, and many of whom are not able to wear a satisfactory set of complete dentures, let alone able to eat a normal diet. In 2009, the York consensus statement produced by the British Society of Prosthodontics concluded that "a substantial body of evidence is now available demonstrating that patients' satisfaction and quality of life with implant-supported overdentures in the mandible is significantly greater than conventional dentures". So, why has the NHS ignored these important scientific papers and left our older population in a state of dental neglect? This discussion paper will consider some of the facts and suggest that there may, potentially, be some solutions.

Mandibular Implant-Supported Overdentures Using Telescopic Crowns and Immediate Loading Protocol: A 2-Year Prospective Follow-up Study.

Implant-supported overdentures have been an effective treatment method for edentulous mandibles. However, the loading time after implant placement is still controversial. The purpose of this study was to evaluate the outcome of implant-supported overdentures using telescopic crowns for the treatment of edentulous patients with immediate loading protocol. This study was conducted on 22 edentulous mandibular patients visiting the Department of High Technique, National Hospital of Odonto - Stomatology, Ho Chi Minh City, Vietnam for prosthodontic rehabilitation. Each patient received four interforaminal implants. Immediate loading protocol was applied, and Ankylos Syncone copings systems was used to connect the prosthesis and the implants. The survival rate of implants and prostheses, as the primary outcome, were evaluated at 6 months, 01 year, and 02 years post-surgery. Peri-implant tissue condition, peri-implant bone loss, and patient satisfaction were the secondary outcomes. The implant survival rate was 98.9% with 01 failed implant. The peri-implant bone loss changes after 6 months, 01 year, and 02 years were 0.07 ± 0.22 mm, 0.12 ± 0.3 mm, and 0.15 ± 0.2 mm, respectively. No gingival hyperplasia was recorded. The prosthesis survival rate was 86.4% with 1 fractured overdenture, 1 overdenture relining and 1 abutment fracture. Mandibular rehabilitation using implant-supported overdenture with telescopic crowns and immediate loading protocol showed high survival rates of both implant and prosthesis in 2-year follow-up.

Evaluation of effect of low-level laser therapy on alleviation of pain in patients with implant-supported mandibular overdenture: A pilot study

Aim: Rehabilitation of edentulous jaws with implant-supported overdenture has achieved a comprehensive acclamation across the globe due to compromised retention and stability in conventional complete dentures. In dentistry, low-level laser therapy (LLLT) has become a viable treatment option for lowering inflammation, easing pain, and speeding up wound healing. This study aimed to evaluate the effect of LLLT on alleviation of pain in patients with two implant-supported mandibular overdentures. Study Setting and Design: This study was carried out in the Department of Prosthodontics at Index Institute of Dental Sciences, Indore, Madhya Pradesh. Completely edentulous patients willing for implant-supported mandibular overdenture and who gave consent, were enrolled. Materials and Methods: A total of ten implants were placed in five patients with completely edentulous mandibular arch willing for implant-supported mandibular overdenture. Individuals from the outpatient division of Department of Prosthodontics, Crown & Bridge, Index Institute of Dental Sciences, Indore were chosen as patients. Bilateral implants were inserted into the mandible at locations B and D. On the experimental side, low-level laser therapy (wavelength 810 nm) was administered immediately following implant insertion and on the third day. Over the course of 72 hours, pain after surgery was assessed using visual analogue scale (VAS) values, beginning at baseline. Statistical Analysis Used: The Mann-Whitney U test was used for statistical analysis of the intergroup pain alleviation scores. Results: The results showed that on intergroup comparison, the experimental side exhibited significantly reduced VAS pain scores relative to the control side (P<0.05). Conclusion: LLLT can be used as a promising adjuvant therapy to lower the degree and duration of pain after undergoing dental implant surgery.

Effect of denture materials on substructures for implant-supported overdenture

Effect of denture materials on substructures for implant-supported overdenture

Scalp-Split Technique: A Concept of Bone Splitting and Expansion for Thin Alveolar Ridges to Place Dental Implants.

Bone expansion is when the existing bone at the implant site is split and separated to create a gap to widen it. This article introduces a novel concept of bone expansion for the ultrathin alveolar ridges to place dental implants with zero wastage of existing natural bone in long-term edentulous arches. Instead of using twist drills and piezo surgery kits, the bone is split with a surgical scalpel blade to prevent natural bone wastage. The split helps to expand the bone horizontally by using expanders to accommodate the smaller diameter implants. This technique was applied to 12 individuals to rehabilitate their atrophic edentulous mandibles to facilitate the implant-supported overdentures, and it revealed that all the cases achieved successful osseointegration after placing implants following this method. The scalp-spilt technique is promising for providing implant-retained or implant-supported prostheses over ultrathin edentulous alveolar ridges.

Effects of Loading Forces, Loading Positions, and Splinting of Two, Three, or Four Ti-Zr (Roxolid®) Mini-Implants Supporting the Mandibular Overdentures on Peri-Implant and Posterior Edentulous Area Strains.

Clinical indications for the Ti-Zr alloy (Roxolid®) mini-implants (MDIs) in subjects with narrow ridges are still under review. The aim was to analyze peri-implant and posterior edentulous area strains dependent on the MDI number, splinting status, loading force, and loading position. Six models were digitally designed and printed. Two, three, or four Ti-Zr MDIs, splinted with a bar or unsplinted (single units), supported mandibular overdentures (ODs), loaded with 50-300 N forces unilaterally, bilaterally, and anteriorly. The artificial mucosa thickness was 2 mm. Strain gauges were bonded on the vestibular and oral peri-implant sides of each MDI, and on the posterior edentulous area under the ODs. Loadings were performed through the metal plate placed on ODs' artificial teeth (15 times repeated). Arithmetic means with standard deviations and the significance of the differences (MANOVA, Sheffe post hoc) were calculated. Different MDI numbers, loading positions, forces, and splinting elicited different peri-implant microstrains. In the two-MDI models, 300 N force during unilateral loading elicited the highest microstrains (almost 3000 εμ on the loaded side), which can jeopardize bone reparation. On the opposite side, >2500 εμ was registered, which represents high strains. During bilateral loadings, microstrains hardly exceeded 2000 εμ, indicating that bilateral chewers or subjects having lower forces can benefit from the two Ti-Zr MDIs, irrespective of splinting. However, in subjects chewing unilaterally, and inducing higher forces (natural teeth antagonists), or bruxers, only two MDIs may not be sufficient to support the OD. By increasing implant numbers, peri-implant strains decrease in both splinted and single-unit MDI models, far beyond values that can interfere with bone reparation, indicating that splinting is not necessary. When the positions of the loading forces are closer to the implant, higher peri-implant strains are induced. Regarding the distal edentulous area, microstrains reached 2000 εμ only during unilateral loadings in the two-MDI models, and all other strains were lower, below 1500 εμ, confirming that implant-supported overdentures do not lead to edentulous ridge atrophy.

Immediate rehabilitation of a palatal defected edentulous patient by implant-supported overdenture: a case report

BackgroundImmediate rehabilitation is a considerable therapeutic challenge but is necessary for edentulous patients with oronasal fistulas, especially those with inadequate residual bone and a history of radiotherapy.Case presentationWe report a rare case of a 63-year-old patient who was missing the majority of his maxillary teeth and who had a defect due to palatal mucoepidermoid carcinoma resection. The patient also received radiotherapy twice within one year postoperatively. An implant-supported prosthesis with an obturator was fabricated immediately.ConclusionThis technique improved patients’ oral function, enhanced the aesthetic effect, and increased their confidence.

Rehabilitation of the Large Maxillary Defect with the Zygomatic Implant-supported Bar-retained Overdenture

Abstract For both the patient and the dentist, prosthetic rehabilitation of acquired maxillary defects is a significant issue. These flaws lower a person’s quality of life by impairing their appearance and functionality. The patient who underwent subtotal bilateral maxillectomy due to mucormycosis is shown in this clinical report to have a successful recovery with an overdenture supported by zygomatic implants. This case report demonstrates that zygomatic implant-supported overdenture is a realistic, predictable, and cost-effective treatment option for a patient with a large maxillary defect.

Assessment of Retention and Stability for Mandibular Implant-supported Overdenture with Ball Attachment at Different Implant Locations: An In Vitro Study

Assessment of Retention and Stability for Mandibular Implant-supported Overdenture with Ball Attachment at Different Implant Locations: An In Vitro Study

A Questionnaire-based Study on Impression Materials and Techniques for Complete Denture Construction among Dentists Practicing in Central/Western Regions of Libya

Background: The success of complete dentures mainly depends on impression-making accuracy; thus, dentists need to select the proper impression materials and techniques to achieve optimal outcomes. Objective: To determine the favoured impression materials and techniques used for complete denture construction among dentists practicing in the Central/Western regions of Libya. Materials and Methods: This study was conducted between July 2023 and September 2023. The questionnaire was comprised of 30 questions, which were divided into two parts including; 11 questions for demographic and professional attitude and 19 questions focused on professional steps of complete denture fabrication for edentulous patients. Results: The response rate for this questionnaire was (66%). It was revealed that (96.1%) of respondents used only irreversible hydrocolloid (alginate) as an ideal option for primary impressions. In response to the same question for final impressions, (45.8%) of participants exhibited that polyvinylsiloxane was the favourite choice. Regarding custom trays, (41.7%) of practitioners preferred using light-cured acrylic resin as a custom tray to take definitive impressions. (87.4%) of prosthodontists border molded the custom tray in sections by (81.9%), using modelling plastic impression compound by (92.1%). The most used philosophy for final impression making was the mucostatic impression technique by (50.4%), while (37.0%) used selective pressure and (12.6%) selected muco-compressive. Implant-supported overdenture was discussed as an alternative treatment by (65.4%). The obtained data was statistically analyzed using SPSS 28. Conclusion: This study reflects a diversity of opinion among Libyan dentists during the construction of complete dentures. The most commonly used material for primary impression was irreversible hydrocolloid (alginate) and for final impression was polyvinylsiloxane, which coincides with professional practices worldwide. Modelling plastic impression compound was the most preferred material for border molding. The mucostatic technique was the predominantly used impression philosophy for final impression making.

Maxillary and mandibular overdentures retained by two unsplinted narrow-diameter titanium-zirconium implants - Aclinical pilot study.

To evaluate the survival rates and marginal bone loss of narrow-diameter titanium-zirconium implants supporting complete maxillary and mandibular overdentures up to 3 years after loading. Ten completely edentulous patients who were dissatisfied with their complete dentures were enrolled. Two narrow-diameter implants were placed in the canine region of the maxilla and mandible. After second-stage surgery, implant-supported overdentures (palatal-free) attached by parallel alignable stud-attachments were placed. Patients were followed periodically for up to 36 months. Standardized radiographs were taken at baseline, 12 and 36 months to analyze mean marginal bone level changes around the implants. The Kaplan-Meier survival rates were 100% for mandibular and 68.0% (SE ± 10.9%) for maxillary implants at 36 months (p = .008). Six maxillary implants failed after loading; no mandibular implants were lost. Five implants failed due to loss of osseointegration. One implant fractured. The mean marginal bone level changes around the analyzed implants (n = 28, 9 patients) were -0.71 ± 0.82 mm in the mandible and -2.08 ± 1.52 mm in the maxilla at the 36-month follow-up. The difference in marginal bone level changes between the maxilla and mandible was significant (p = .019) at the 12- and 36-month follow-ups. Two narrow-diameter titanium-zirconium implants with stud-attachments showed a highly satisfactory outcome in the mandible. The maxillary implants showed a high failure rate and significantly more bone loss over time than the mandibular implants. The minimal concept of two implants and an overdenture should be limited to the edentulous mandible.

A comparative evaluation of retention capacity of different dental implant supported overdenture attachment systems- An in vitro study

The most common way to treat full edentulism is with a complete denture. In the mandible as opposed to the maxilla, there is greater worry over the durability and retention of a traditional complete denture. The mandibular arch's decreased surface area for support and retention is the main cause of this. For a fully edentulous mandible, implant-supported overdentures are a reliable course of treatment.This in-vitro study aimed at comparing the retentive capacity of Ball, Locator and OT Equator Implant supported overdenture attachment system when subjected to 14600 cycles of insertion and de-insertion.Fifteen mandibular dentures were fabricated with heat polymerized polymethyl methacrylate resin to test the retentive capacity of Ball, Locator and OT Equator attachment system. Metal housing with retentive nylon caps were picked up in all the sample using cold cure acrylic resin. The samples were subjected to fatigue testing and only monodirectional force was applied. Ball, Locator and OT Equator attachment system sample were subjected to 14,600 insertion/ de insertion cycle on Universal Testing Machine and data was recorded and statistical analysis was done. All the three groups showed significant differences. The retentive capacity of the Ball attachments lasts longer than that of the Locator and Equator attachments. After ten years of use, All three systems continue to have clinically acceptable retention.

All-On-4 Implant with Hybrid Prosthesis Opposing Implant Supported Overdenture- A Case Report

Implant-supported prosthetic solutions have revolutionized the field of dental rehabilitation, particularly for patients with extensive edentulism or failing dentition. Among these, the All-on-4 implant technique has gained popularity due to its ability to provide and aesthetic restoration with fewer implants and reduced surgical complexity. However, challenges such as insufficient bone volume or poor bone quality in the edentulous maxilla or mandible may necessitate alternative approaches to ensure long-term success and patient satisfaction. One such approach involves the integration of a hybrid prosthesis with All-on-4 implant concept opposing an implant-supported overdenture. This hybrid solution combines the stability and support of dental implants with the comfort and versatility of removable prostheses, offering a balance between fixed and removable options. Key aspects covered include the selection of appropriate candidates for this treatment modality, diagnostic imaging techniques for precise implant placement, surgical protocols for achieving optimal osseointegration and soft tissue management, prosthetic fabrication processes including material selection and occlusal considerations, postoperative care and maintenance strategies to ensure long-term success. Through a comprehensive examination of current literature, clinical case studies, and expert opinions, this case report aims to provide clinicians with valuable insights into the rationale, planning, execution, and outcomes of utilizing a hybrid prosthesis with All-on-4 implant concept opposing an implant-supported overdenture. By understanding the indications, advantages, limitations, and clinical nuances of this treatment approach, dental professionals can effectively address the diverse needs and preferences of edentulous or near-edentulous patients, ultimately improving their quality of life and oral health outcomes. Keywords: All-on-4 implants, hybrid prosthesis, implant-supported overdenture, prosthetic rehabilitation, bone quality, patient satisfaction.

Analysis of Satisfaction Levels in Completely Edentulous Patients Treated with Different Configurations of Implant- Supported Prostheses.

To evaluate and compare patient satisfaction levels in edentulous patients treated with different configurations of implant-supported prostheses as well as previous prosthesis experiences before implant treatment. A study population of 142 patients was identified and separated into four treatment groups: group 1 comprised 43 patients treated with an implant-supported overdenture in the mandible and conventional complete denture in the maxilla; group 2 comprised 32 patients treated with implant-supported overdentures in the maxilla and mandible; group 3 comprised 26 patients treated with an implant-supported overdenture in the mandible and a fixed prosthesis in the maxilla; and group 4 comprised 41 patients treated with implant-supported maxillomandibular fixed restorations. Questionnaires asking about masticatory performance, pronunciation, comfort, and social ability were used to evaluate treatment outcomes. The patients in group 4 were significantly more satisfied regarding masticatory performance than other treatment modalities. Visual analog scale (VAS) scores for comfort and social ability were similar in groups 3 and 4 and significantly higher than those in groups 1 and 2. The patients who used a conventional removable prosthesis before implant treatment were more satisfied with their implant-supported prosthesis regarding social ability (P = .03). The treatment design of an implant-supported fixed prosthesis in the maxilla and implant overdenture in the mandible provided a comparable level of satisfaction with maxillomandibular fixed prosthesis for edentulous patients. This combination served as a practical solution especially for patients with mandibular atrophy who would require extensive surgeries to support maxillomandibular fixed prostheses. In the maxilla, patient satisfaction with an implantsupported overdenture was not superior to that with a conventional prosthesis. Note that previous removable prosthesis experience may influence social comfort for patients.