Implant-supported Overdentures Research Articles

СРАВНИТЕЛЬНАЯ ОЦЕНКА ПОКАЗАТЕЛЕЙ БИОЭЛЕКТРИЧЕСКОЙ АКТИВНОСТИ МЫШЦ У ПАЦИЕНТОВ СО СЪЕМНЫМИ ПОКРЫВНЫМИ ПРОТЕЗАМИ С ОПОРОЙ НА ИМПЛАНТАТЫ ПРИ ПОЛЬЗОВАНИИ В ТЕЧЕНИЕ 12 МЕСЯЦЕВ

Subject. A comparative assessment of the state of the stomatognathic system on the example of the bioelectrical activity of temporal and masticatory muscles in patients who used removable implant-supported overdentures with bar fixation system, made by two different methods: traditional and using digital methods of treatment planning and manufacturing was carried out.
 Objectives. To compare the changes of bioelectrical activity of temporal and masticatory muscles in patients with removable implant-supported overdentures made by two different methods: traditional and digital, who used dentures for a long time (12 months).
 Methods. Bioelectrical activity and symmetry of temporal and masseter muscles were investigated clinically by surface electromyography. Electromyography was performed in five probes: Rest, Light CO, Natural Swallowing, Maximal Volitional Clench (MVC) and Clench on Cotton Rolls (MVCCR).
 Results. In patients using overdentures produced in traditional way, no normal values of muscle activity were observed in any of the probes at the end of the study. In patients who used overdentures, made with the use of digital technologies, we noted a decrease of bioactivity of the muscles in the probes of Rest and Light CO, and an increase of biopotentials in the probes of MVC and MVCCR. The values obtained at the end of the study were characterized as normal or acceptable.
 Conclusions. The application of a digital method of treatment planning and fabrication of removable implant-supported overdentures with a bar fixation system allows to achieve more physiological values of temporal and masticatory muscles biopotentials, which can be interpreted as recovery of the functional integrity of the stomatognathic system.

Bacterial accumulation of different telescopic crowns: (PEEK) versus Cobalt-Chromium telescopes in implant-supported mandibular overdenture.

Bacterial accumulation of different telescopic crowns: (PEEK) versus Cobalt-Chromium telescopes in implant-supported mandibular overdenture.

Implant-supported overdenture with horizontal insertion for treating the edentulous atrophic maxilla: A case series

Statement of problemRehabilitation of edentulous patients with severe maxillary atrophy is a clinical challenge. Although several treatment options are available, the implant-supported overdenture has been widely advocated. However vertical insertion implant-supported overdentures have drawbacks, including wear, aging, and the continuous maintenance of retention systems. Whether an implant-supported overdenture with a horizontal insertion pathway can overcome these problems is unclear. PurposeThe purpose of this observational study was to determine the clinical and biological behavior of a new type of implant-supported overdenture with a horizontal insertion pathway over a mean clinical follow-up period of 6 years. Material and methodsTen study participants with an atrophic maxilla underwent rehabilitation with horizontal overdentures supported by 6 implants. Follow-up visits were scheduled at 3 months, 6 months, and annually thereafter. The variables analyzed were implant and prosthetic survival, peri-implant tissue behavior, mechanical complications, and patient satisfaction. ResultsThe follow-up period ranged from 5 to 8 years, mean ±standard deviation 6.3 ±1.2 years. A total of 60 implants and 10 horizontal overdentures were placed. The clinical survival of the implants was 98.3% (mean peri-implant bone loss, 1.3 ±0.4 mm) and was 80% of the prostheses. Overall, mean patient satisfaction as assessed with a visual analog scale was 7.4, with 8.5 for esthetics and 9.5 for function. ConclusionsThe horizontal implant-supported overdenture provided a functional alternative to conventional prostheses.

Evaluation of Changes in the Mechanical Properties of O-Ring in One Piece and Two Piece Ball Retained Implant Supported Overdentures: A Three-Year Retrospective Study.

The O-rings in ball retained overdentures deteriorate with time and need replacement to restore the retentive quality. We evaluated retrospectively the mechanical properties of O-rings after 3 years in function in 1 and 2-piece implant-supported overdentures. The O-rings were retrieved from one-piece (Myriad snap, Equinox-Straumann, 3.3 × 13 mm) and 2-piece (Neo Biotech, 3.3 × 13 mm) implant-supported overdenture patients. A total of 16 pairs of matrices were tested for wear, type of damage, and elasticity using Pin on Disc method, USB Digital Camera in 30× zoom and Universal Tensile Machine, respectively. The statistical analysis for independent groups were done with the Mann-Whitney U test. Assessment of used O-rings showed 84% more wear in the 2-piece system with an abrasive type of damage while 46% wear in the 1-piece system with a compressive type of damage. The O-rings in 1-piece system showed increase in elongation and maximum displacement to 2% and 7%, respectively, whereas the 2-piece system showed decrease in elongation and maximum displacement by 13% and 6%, respectively. In 1-piece system, the loss of retention was more with slow wear rate, and in 2-piece system, the wear resistance of O-rings decreased due to increased stiffness. Further studies to evaluate the changes in O-ring with increased sample size and at interval 1 year will pave way for insight into the progressive changes in the mechanical properties of an O-ring.

Rationale for a novel attachment system for implant-supported overdentures.

To quantify the effect of support stiffness on the retention forces of telescopic crowns and to evaluate a prototype attachment system incorporating a nickel-titanium element. In the first part of the study, telescopic crowns were fabricated employing standard laboratory procedures. For six combinations of telescopic crowns, the separation force was determined while varying the stiffness of their supporting implants. In the second study part, an in vitro mandibular model with three interforaminal implants was equipped with strain gauges and extensometers. Two prostheses either employing cylindrical telescopic crowns or prototype attachments were fabricated and statically loaded on the model using either the midline or the left canine or both canine implants for support while strain in the peri-implant area and prosthesis displacement were recorded. Statistical analysis of both study parts was based on pairwise comparisons with the level of significance set at α = .05. With one exception (P = .161), for each assembly of two telescopic crowns, the separating force was always dependent on the stiffness of the supporting implants. With 3 exceptions out of a total of 14 comparisons for peri-implant strain and prosthesis displacement, the use of the prototype attachments always led to significantly lower mean values compared to the use of cylindrical telescopes (P < .00). The individual retention force of telescopic crowns on implants should be set at a lower level compared to telescopic crowns on natural abutments. Incorporating a nickel-titanium element into attachment systems for implant-supported removable prostheses reduces peri-implant strain and may facilitate the use of telescopic crowns.

Immediate Loading of Four Guided Unsplinted Narrow Implants Supporting a Maxillary Overdenture: A Minimally Invasive Approach

Little evidence is available on the loading protocols for implant-supported overdentures in the treatment of the edentulous maxilla. There are only a few case-reports available to document the feasibility of immediate loading for maxillary overdenture, and the majority of the publications include the use of splinted implants. This paper presents a case report of immediately loaded narrow diameter implants supporting a maxillary overdenture using Locator abutments. A 64-year-old, fully edentulous patient presented with a maxillary complete removable denture. A dual cone beam computed tomography scan was obtained, and the surgical planning was performed. Four 3.3 mm diameter implants were placed at the lateral incisor and second premolar positions, using a guided and flapless approach. Locator abutments were placed, and the denture was connected immediately. The patient was instructed not to remove the prosthesis for 1 week and to follow a soft diet regimen for 2 weeks. Clinical and radiographic evaluation showed positive results at 12 months, with neither prosthetic nor implant complications. This is a proof of principle case report, which demonstrates the possibility of immediately loading four guided narrow diameter implants supporting a maxillary overdenture using a Locator retention system.

Cost and complications associated with implant-supported overdentures with a resilient-attachment system: A retrospective study

Statement of problemImplant-supported overdentures with a splinted or nonsplinted attachment system have been a successful treatment option for edentulous mandibles with excessive hard tissue resorption. Currently, the 2 most common treatment approaches for an implant overdenture uses either a bar attachment system (splinted) or resilient (LOCATOR)-attachment system (nonsplinted). The LOCATOR-attachment system is often chosen for the lower initial cost. However, whether the ongoing maintenance costs of the LOCATOR-attachment system increase the overall cost of this system is unclear. PurposeThe purpose of this retrospective study was to investigate the frequency of maintenance procedures, complications, and costs associated with the LOCATOR-supported overdenture treatment. Material and methodsThe retrospective data of 75 patients who had received implant-supported overdentures with LOCATOR-attachments at the University of Colorado School of Dental Medicine in the previous 10 years were collected and screened to evaluate the number of maintenance visits, type of complications, and cost (actual fees for the service) of the maintenance visits. The data were analyzed, and the mean values calculated. ResultsThe average number of maintenance visits was 7.7 in the mean observation time of 5.2 years. Replacement of the attachment was the most frequent complication (63%). The average maintenance cost charged to the patient for maintenance was 56.2% ($795) of the initial cost over the average 5.2 years of follow-up. The average total maintenance cost (actual fees for the service) was 95.4% ($1349) of the initial cost over the average of 5.2 years of follow-up. The average maintenance cost adjusted or lost over the 5.2 years follow-up was 39.2%. ConclusionsThe 5-year costs for the maintenance of mandibular overdentures with a LOCATOR-attachment system were equal to or higher than the initial cost of the treatment. The number of maintenance visits and the cost were higher for patients who were older than 75 years

Outcome of peri-implant maintenance care in patients with an implant-supported lower denture-A 3.5-year retrospective analysis.

BackgroundImplant‐supported overdentures represent a successful treatment for edentulous patients. As early diagnosis, detection and supportive care are considered key factors for the prevention of peri‐implant diseases, consistent maintenance of these implants is becoming increasingly relevant.PurposeThis retrospective analysis evaluated a cohort of edentulous patients with a mandibular implant‐supported overdenture over a period of 3.5 years during which the peri‐implant tissues were assessed.Materials and MethodsA total of 108 patients that had consistently adhered to the annual maintenance appointments was selected. The clinical peri‐implant pocket probing depth (PiPPD) and peri‐implant bleeding on probing score (PiBOP) were investigated. Data from the 3.5‐year follow‐up were compared to data from the baseline assessment.ResultsA 100% implant survival was reported after 3.5 years. The mean PiBOP showed a significant decrease over time (P = .028). The mean PiPPD was found significantly deeper for male patients both at baseline (P = .004) and 3.5‐year follow‐up (P < .001). Besides, the PiPPD for locator anchorages was found significantly deeper compared to ball anchorages at the 3.5‐year follow‐up (P = .026).ConclusionIn those patients that adhered to the annual maintenance visits during the 3.5 years after implant surgery a stable peri‐implant condition was observed. As future consideration, the comparison of the clinical outcomes of patients participating in the maintenance program with those that did not would make this observation even more meaningful.

Influence of Conventional Complete Dentures and Different Attachment Types in Implant-Supported Overdentures on Quality of Life and Nutritional Status in Edentulous Geriatric Patients.

To determine whether the use of implant-supported overdentures (IODs) with different attachments influences the Mini Nutritional Assessment (MNA) and Geriatric Oral Health Assessment Index (GOHAI) scores in edentulous patients > 65 years of age. The MNA and GOHAI were administered to 54 edentulous patients > 65 years of age (mean age = 68.35 ± 4.1 years) before treatment (A) and 6 months after treatment (B): 10 with maxillary + mandibular conventional complete dentures (CDs); 10 with a maxillary conventional CD + mandibular magnetic-retained IOD; 12 with a maxillary conventional CD + mandibular ball-retained IOD; 12 with a maxillary conventional CD + mandibular Locator-retained IOD; and 10 with a maxillary conventional CD + mandibular bar-retained IOD. Statistical differences between treatment types were evaluated using one-way analysis of variance and paired-sample t tests. The correlation between MNA and GOHAI scores was determined using Pearson correlation analysis (α = .05). The difference between mean GOHAI-A and GOHAI-B scores was statistically significant for each type of denture (P < .005). The difference between the mean MNA-A and MNA-B scores was statistically significant for all types of denture except for conventional CDs (P < .05). There was a statistically significant positive correlation between MNA and GOHAI scores (P < .01). Regardless of the type of denture used, treatment of edentulous geriatric patients is important for improving nutritional status and self-rated oral health.

How the initial retentive force of implant-supported overdentures can be affected with splinted and unsplinted attachments systems

The aim of this study was to evaluate the retention of implant-supported overdentures with different attachment systems. In this in vitro study edentulous model with 2 Straumann implant in symphyseal region was used to make an overdenture with different attachment systems. (Dolder bar with 1 and 3 metal clips, Hader bar with 1 and 3 plastic clips, ball on bar with 2 and 4 plastic caps, Locator, Rhein plastic caps and Eleptical matrix). Retention values were recorded by universal testing machine with a cross speed of 50.8 mm/min in vertical, posteroanterior, and lateral direction. Repeated measure ANOVA and Duncan tests were used for the data analysis (α =0.05). There was a statistically significant difference between the retention values of studied attachments in different dislodgment directions (P < 0.05). The highest and lowest retention were recorded for 4 balls on bar (56.71 N) and Rhein pink caps (27.89 N) in the vertical direction. Three metal clips (61.43 N) and Rhein pink cap (24.77 had the highest and lowest retention force in the posteroanterior direction. In the lateral direction, 4 balls on bar (62.68 N) and 1 plastic clip (32.27 N) showed the highest and lowest retention, respectively. If the higher retention force has been considered for implant-supported overdenture attachment selection, the clinician can use splinted bar or ball on bar superstructure.

An alternative technique for fabrication of a tooth-supported removable partial overdenture: A case report

Overdenture is one of the recommended treatment methods for elderly patients with few remaining teeth and deeply resorbed ridges. Root retained under the denture base maintains more alveolar ridge resorption, which provides sensory feedback and improves the stability of the dentures. In addition, after endodontic therapy, the use of copings (short/long) and braces on the remaining teeth improves denture protection. This case report aimed to describe prosthodontic rehabilitation of a tooth-supported removable partial denture using a Locator attachment.A 48-year-old woman presented to the Faculty of Dentistry, University of Malaya, complaining looseness and repeated fracture of her denture, which led to difficulty in eating and chewing. She presented with Kennedy Classification II modification 1 on the maxilla with 23 and 24. The treatment plan was to provide her with maxillary cobalt–chromium overdenture using the Locator attachment system. The abutment teeth were designed, prefabricated using Locator, and were attached to the root of 23. Esthetics was achieved, and the patient reported satisfactory outcome.The present case report signifies that few remaining teeth are effectively preserved to support tooth-retained overdenture. This treatment approach was chosen considering the patient’s favorable inter ridge distance and economic status rather than full extractions accompanied by a complete denture or implant-supported overdenture. This technique using a Locator attachment on a natural tooth can be an alternative method in prosthodontic rehabilitation of a partially edentulous adult patient with a distinct approach to meet the needs, esthetics, and psychological well-being of the patient.

Cost-Effectiveness of Maxillary Implant-Supported Overdentures Compared to Complete Dentures and Implant-Supported Fixed Dental Prostheses-A Systematic Review

Purpose: Implant-supported restorations are well-documented treatments from a clinical perspective. Analysis of their cost-effectiveness is however limited, especially for implant-supported overdentures. The objective of this systematic review was to assess the literature on cost-effectiveness regarding maxillary implant-supported overdentures compared to complete dentures and fixed implant-supported restorations.

Different Interventions for Rehabilitation of the Edentulous Maxilla with Implant-Supported Prostheses: An Overview of Systematic Reviews.

To synthesize evidence derived from systematic reviews (SRs) on different interventions for rehabilitation of the edentulous maxilla with implant-supported restorations. A protocol-oriented search was established to address the PICO question: What is the current evidence regarding rehabilitation of the edentulous maxilla with different implant-supported prostheses in terms of implant and prosthesis survival? The primary outcomes were implant and prosthesis survival rates evaluated from SRs of clinical studies including adult patients with complete edentulism of the maxilla and comparing different implant-supported rehabilitation strategies. Methodologic quality of the SRs was assessed with the AMSTAR-2 tool. The final selection process led to the inclusion of 36 SRs that were grouped as: (1) addressing maxillae with sufficient bone to place implants; (2) addressing maxillae with insufficient bone to place implants; and (3) comparing different types of prosthesis, number of implants, patient-reported outcomes, and economic evaluations. The literature describes four or more implants as suitable for full-arch fixed prostheses and implant-supported overdentures; in both cases, the overall survival rate is > 95%. Mini-implants present very high short-term failure rates (> 30%). Poor description of technical complications, adjustments, and maintenance and corresponding costs precluded a cost-effectiveness analysis. No implant-supported rehabilitation of the edentulous maxilla (fixed or removable) should be supported on fewer than four implants. A one-piece full-arch fixed dental prosthesis can be supported by a minimum of two anterior axial plus two posterior distally tilted implants or by six to eight axial implants symmetrically distributed through the posterior and anterior regions of the arch. Four to six implants is the advised number to support an overdenture. The use of mini-implants in the maxilla is inadvisable.

Mandibular implant-supported overdenture: A systematic review and meta-analysis for optimum selection of attachment system.

Aim:This systematic review aimed to compare different attachment systems used in mandibular implant supported overdentures by assessing outcomes such as prosthodontic maintenance and complication, peri implant tissue changes, retention, and patient satisfaction for optimum selection of attachment system.Settings and Design:This systematic review conducted following Preferred Reporting Items for the Systematic Review and Meta Analysis (PRISMA) guidelines.Materials and Methods:A systematic electronic literature search was conducted through PubMed, The Cochrane Central Register of Controlled Trials (Central), and Science direct. A hand search was also performed for individual journals and reference lists of selected studies. Randomized controlled clinical trials and crossover clinical trials from 2010 to 2020 with follow up of more than 1 year were included. The Cochrane Collaboration's tool was used for assessing the risk of bias of included studies.Statistical Analysis Used:The statistical meta analysis was performed using Review Manager (RevMan) [computer program]. Version 5.4. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboation, 2020.Results:Six studies that met the inclusion criteria possess the low risk of bias with follow up of more than 1 year were included in this systematic review. Out of four outcomes, meta analysis was performed for prosthodontic maintenance and peri implant tissue changes. Due to the limited availability of data, retention and patient satisfaction were reviewed systematically without meta analysis. The result of meta analysis for ball versus magnet attachment showed statistically significant differences in prosthodontic complications and maintenance, and ball attachment reported fewer complications than the locator attachment (risk ratio [RR] =0.55, confidence interval [CI] =95%, P = 0.03). Peri implant tissue changes were analyzed in the included studies as probing depth and marginal bone loss. The result of meta analysis for probing depth showed no statistically significant difference between bar versus telescopic type of attachment (RR = 0.20, CI = 95%, P = 0.74). The meta analysis results for marginal bone loss showed no statistically significant difference between bar versus telescopic type of attachment (mean difference = 0.35, CI = 95%, P = 0.10).Conclusion:It can be concluded from the current review that bar attachment provided the most superior retention. The telescopic attachment system not only showed the most favorable patient's satisfaction but also reported the least peri implant mucosal changes. The ball attachment system is a favorable choice for limited inter arch space and parallel implant placement.

A case report of an implant-supported overdenture after resection for mandibular gingival carcinoma with simultaneous implant placement

症例の概要：患者は71歳の男性．下顎左側臼歯部歯肉の糜爛を主訴に来院した．検査の結果，糜爛部は悪性腫瘍であった．全身麻酔下で下顎辺縁切除術およびインプラント埋入術を同時に施行した後，インプラントオーバーデンチャーを作製した．

A Comparison Between Fixed and Removable Mandibular Implant-Supported Full-Arch Prostheses: An Overview of Systematic Reviews.

To evaluate the current literature and provide clinical recommendations related to the number of implants, implant characteristics, loading protocols, survival rates, biologic and mechanical complications, patient satisfaction, and financial considerations for mandibular implant-supported full-arch prostheses. A PubMed/MEDLINE search for literature published between January 1, 1980 and February 8, 2019, was performed for systematic reviews on this topic. The PICO question was: In mandibular fully edentulous patients treated with implant full-arch prostheses, is there any difference between fixed and removable implant prostheses in terms of implant and prosthesis survival rates? Only systematic reviews with or without meta-analyses were included. The findings varied based on the type of implant full-arch prosthesis. High survival rates for implants and prostheses have been reported for fixed and removable implant full-arch prostheses in the mandible. Immediate loading procedures present with high survival rates for both fixed and removable prostheses. There are differences in the number of implants, implant characteristics, complications, and financial implications between these two types of prostheses, which clinicians need to account for as part of the treatment planning process. Implant-supported overdentures and implant-supported fixed complete dentures represent clinically successful treatment approaches. In cases where both treatment options are indicated, patient expectations and cost should be the determining factors for selecting a treatment modality.

A case report of implant-supported overdenture for an edentulous patient with severe ridge resorption of the mandible

A case report of implant-supported overdenture for an edentulous patient with severe ridge resorption of the mandible

Transition of a Misch removable prosthesis-5 to a fixed prosthesis-3: From a removable to a fixed complete denture

An implant-supported denture is used when a person does not have any teeth in the jaw but has enough bone to support implants. Treatment options can be broadly divided into the fixed implant-supported prosthesis and removable implant-supported prosthesis (overdenture). However, when such completely edentulous patients who are already rehabilitated using removable implant-supported overdentures report for a fixed prosthesis, then it becomes a challenging situation. This article describes the challenges involved in the transition of one such patient rehabilitated previously using a RP-5 prosthesis to a fixed FP-3 prosthesis.

Fabrication of a customized impression metal jig for an implant-supported overdenture with a milled bar

The use of computer-aided design/computer-aided manufacturing technology simplifies the laboratory and clinical steps for the fabrication of implant prostheses. It also reduces additional costs for the prosthetic components and technical procedures. This article describes a modified impression technique using an impression metal jig to enhance the accuracy of final impression and also to eliminate the need for the try-in of resin pattern of the milled bar.

The effects of bone remodeling on biomechanical behavior in a patient with an implant-supported overdenture

This study aimed to clarify the effects of bone remodeling on biomechanical behavior in a patient with a mandibular implant-supported overdenture by comparing computed tomography-based finite element analyses (CT-FEA) with two time points of CT data. The present FEA was based on CT data collected from a 62-year-old female subject, who wore a mandibular implant overdenture supported by four dental implants with bar attachment. Two kinds of FE models were constructed from CT data taken at two time points: pre-implantation (Original-model) and 12 years post-implantation (Aged-model). FE models consisted of patient-specific model geometry and heterogeneous material properties. The deviation analysis was carried out to assess the changes in bone mass over a period of 12 years. The results show an averaging of intraosseous stress and strain energy density between the implant regions in the Aged-model. The results of the morphological assessments demonstrated that the bone mass and quality had significantly changed over 12 years. Area-specific bone resorption was also observed at the bone surrounding each implant. The combined findings indicate that the averaging of mechanical variables was due to chronological changes in bone morphology, suggesting adaptation to mechanical loads by peri-implant bone remodeling.