Locator Attachments Research Articles

Implant-Supported Complete Denture with Locator Attachments

Implant-Supported Complete Denture with Locator Attachments

Assessment of Ball versus locator attachment for immediately loaded two Trabecular Implants supported mandibular over denture- One year randomized clinical trial

Assessment of Ball versus locator attachment for immediately loaded two Trabecular Implants supported mandibular over denture- One year randomized clinical trial

Oral health self-perception, maximum bite force and masticatory efficiency in patients with overdentures with different attachment systems-A crossover study.

The literature is unclear about how the different attachment systems for overdentures impact the maximum bite force, the masticatory efficiency and how this impact in the oral health self-perception in patients. To evaluate the effect of two attachment systems (O-ring and Locator) for mandibular overdenture using single implant on quality of life, maximum bite force (BF) and masticatory efficiency (ME). Twenty-eight completely edentulous denture wearers with a mandibular symphysis implant were randomly selected and allocated into two groups in a crossover study, considering O-ring and Locator attachment types. The quality of life and self-perception of oral health were assessed using the Oral Health Impact Profile (OHIP-Edent) and Geriatric Index of Determination of Oral Health (GOHAI) questionnaires, respectively. BF was measured using a gnathodynamometer and ME by chewing silicone cubes and almonds in different numbers of cycles. There was no difference between the attachment systems about self-perceived oral health and impact on quality of life (p > .05). The O-ring-type system obtained a significantly higher BF than the locator-type system (p = .04). Regardless of the food chewed, no statistically significant difference was observed with the type of attachment (p > .05). The ME was directly proportional to the masticatory cycles only for almonds (p < .01). Locator and O-ring inserts had a similar impact on patients' quality of life, self-perception of oral health and ME. Additionally, the O-ring system exhibited superior properties in the BF.

Four locator attachments of mandibular implant-retained overdentures with two different distributions: A 10-year retrospective preliminary study of residual alveolar ridge changes.

There is little information on the long-term function of the four Locator attachment of the mandibular implant retained overdenture (OD), particularly with different distributions. To compare the effect of different four inter-foraminal implant distributions retaining a mandibular OD after 10 years of function on posterior mandibular ridge resorption (PMandRR), anterior maxillary ridge resorption (AMaxRR), and the amount of marginal bone loss (MBL) around all four implants. Twenty-two participants with total edentulism who had worn mandibular OVDs retained by four inter-foraminal implants for 10 years of functional life were selected for this study. They were divided into two groups based on implant distribution: Group I with a quadrilateral distribution (QD) of implants and Group II with a linear distribution (LD) of implants. PMandRR, AMaxRR, and MBL around implants were measured. After 10 years of function, PMandRR was significantly higher in the LD group than in the QD group (p < 0.001*). There was no significant difference in AMaxRR between the QD and LD groups (p = 0.431). The QD group showed a significantly greater amount of MBL around dental implants when compared with the LD group (p = 0.002*). The LD of implants demonstrates more PMandRR compared with the QD. The QD of implants demonstrates a greater amount of MBL around dental implants compared with the LD. Both implant distributions demonstrate the same effect on the AMaxRR. MBL around implants remained within normal accepted values after 10 years of function.

Long-term follow-up of a patient with Parkinson’s disease under nursing care after replacement of fixed implant-supported prostheses with an implant overdenture: a case report

BackgroundIn older patients with progressive neurodegeneration, replacing fixed implant-supported prostheses (FIP) with implant overdentures (IOD) has been proposed to prevent future mucosal injury and create an oral environment that is easier for caregivers to clean. However, there have been no reports on the progress after replacing FIP with IOD. In this report, we present the progress of an older patient with Parkinson’s disease in whom FIP was replaced with IOD.Case presentationAn 81-year-old male patient with Parkinson’s disease presented to our outpatient clinic with bruxism and crossbites. FIPs, with five Brånemark system implants, were placed in the bilateral lower molars. The FIP was replaced with an IOD with two locator attachments to create an oral environment that was easier for caregivers to clean and allow easy recovery of masticatory function if residual teeth were fractured in the care environment. As his systemic condition deteriorated, treatment was changed from outpatient to in-home visits. During dental care visits, professional oral cleaning and denture repair were continued, and good nutritional status was maintained. However, the patient developed cholecystitis and was hospitalized. During hospitalization, gastrostomy was performed because he developed aspiration pneumonia. After discharge from the hospital, the patient remained in bed all day and could not wear an IOD, resulting in buccal mucosa ulceration due to abrasion of the locator abutment. We decided to replace the abutment with cover screws; however, not all the implants could sleep submucosally. Although regular oral cleaning was resumed, new ulcers developed even when cover screws were installed. Additionally, swelling and drainage were observed at the peri-implant mucosal site where peri-implantitis had once occurred during an outpatient visit. The patient was readmitted to the hospital for a urinary tract infection, and subsequent visits were abandoned.ConclusionsBy replacing FIP with IOD in an older patient with Parkinson’s disease, we addressed a barrier to caregiver-provided oral management. The removable prosthesis facilitated smooth oral care by caregivers and functional recovery in the event of trouble with residual teeth. However, it could not completely avoid the recurrence of buccal mucosal ulcers or peri-implantitis.

Marginal bone loss in ball versus locator attachments in implant-retained overdentures: systematic review and meta-analysis.

This systematic review compares the impact of ball and locator attachments on marginal bone loss in implant-retained overdentures in completely edentulous patients. Following PRISMA guidelines, health science librarians completed literature searches from inception to 17 March 2023 in seven databases. There were 15,686 items exported to EndNote from Embase.com, CINAHL (EBSCO), Cochrane Library, Ovid MEDLINE-ALL, PubMed, Scopus, and Web of Science. Hand-searching added four more articles. After deduplication, 6,756 items were screened for eligibility. Twenty-nine studies were assessed by full text, of which ten studies, involving 424 subjects, were included in the review. Risk of bias assessment was conducted using the Cochrane risk-of-bias tool and the Newcastle-Ottawa scale. A meta-analysis was performed to synthesize and analyze the collective data from the selected studies. The included studies used diverse methodologies, implant systems, and loading protocols. Most studies reported no significant difference in marginal bone loss between ball and locator attachments. The meta-analysis revealed high heterogeneity. The results of this systematic review suggest that ball and locator attachments exhibit similar performance in terms of marginal bone loss in implant-retained overdentures. However, the limited number, risk of bias, and heterogeneity of studies highlight the need for standardized research designs and larger sample sizes in future investigations to draw more definitive conclusions.

Mandibular Overdentures When Treating Failing Dentition With Immediate Prosthetic Loading.

Patients may present with failing mandibular dentition either involving the entire arch, partial arch that currently has a partial denture to replace the prior missing teeth or wearing a full denture. Finances may limit restoration of the arch with an All-on-X concept and the patient's goals are a stable prosthesis that does not move whenconcept and the patient's goals are a stable prosthesis that does not move when eating or speaking is the patient's expressed goal. Overdentures can fulfil that goal and provide a stable restored arch at a lower treatment cost than treatment with a fixed hybrid prosthesis. Traditionally, when these type cases have been treated, the remaining dentition has been extracted, depending on availability of bone, implants are placed. Those typically were left to osseointegrate and loaded several months later with a delayed loading approach. This requires relining the denture and the patient having a loose, non-stable prosthesis during that healing phase. An alternative approach utilizes immediate activation of the implants with overdenture attachments thus, providing an immediate stable retentive full arch mandibular removable prosthesis (overdenture) by immediate activation of overdenture attachments (ie.Locators) aids the patient in their goals without delays in treatment. This article will present two case examples of mandibular arches with failing dentition related to caries and periodontal issues and their treatment with immediate implant placement and loading with Locator attachments. Long-term follow-up of 1-year 8-months in one case and 33-months in the other case demonstrate crestal bone stability with this immediate overdenture loading protocol.

The impact of chewing force simulation on stress distribution of implant retained mandibular overdenture with locator attachment system having matrix of PEEK versus nylon insert

The current study investigates the impact of chewing force simulation on stress strain distribution of Mandibular overdentures retained with locator attachment system having matrix of PEEK versus nylon insert. Twenty completely edentulous mandibular digitally printed models were fabricated with beds for two implants, which had been inserted in the estimated canine positions with two grooves mesial and distal at each implant site for the attachment of the strain gauges for each model. Nova loc group NLG with ten implant assisted mandibular complete overdentures were fabricated over ten printed models with nova loc attachments while locator group LG had ten implant assisted mandibular complete overdentures over ten printed models with locator attachments of same retaining force and geometric height. Bilateral vertical load was applied with a universal testing machine and strain induced to the implants was measured around the two implants medially and distally in each group using strain gauges pre &amp; post one year simulated functional aging. Student t test was used for comparing the two types of attachments while paired t test was used for comparison of strain induced to the implants after one year of functional aging, with probability level p &lt; 0.05 is considered statistically significant. Individual statistical analysis of the data revealed increase in the number of measured strains for both attachments which was statistically significant for locator. Comparing the two groups, significant increase for the locator attachment after one year simulated functional aging was detected compared to nova loc. Within the limitations of this study, one year simulated functional aging seems to cause disturbance in the load conveyed to the supporting structures of mandibular implant assisted overdenture retained with locator in contrast to nova loc that showed more resistance to aging process, thus nova loc attachment transmit less stresses than locator attachment to the surrounding implants supporting structures specially after time of service related to its combined materials superior physical properties.

Prosthetic Management of Malpositioned Implant in RPD Case Report

Removable dentures in classe I KENNEDY APPLEGATE remain an essential prosthetic challenge as support is required from the teeth, the mucosa, and the underlying residual ridges. Dental implants can improve denture retention, stability, and support in distal extension removable partial denture. However, a malpositioned implant can complicate tooth/implant-supported condition. This case report describe a 66-year-old female patient treated with maxillary implant -supported removable partial denture (RPD). Both the implants were placed in first premolar site. However, the implant on the left side presented severe facial inclination. We suggest that the discharge of the prosthetic edge with using a laboratory non retentive nylon Patrice’s on the Intaglio of metal housing locator attachment can solve the problem of denture insertion.

Stress analysis of short implants assisting partial overdenture with two types of attachment for maxillary kennedy class I

Purpose This study’s goal was to figure out how much stress is placed on nearby short implants using two types of attachment for assisting partial overdenture for maxillary Kennedy Class I. Materials and methods To assess the microstrains caused by the short implant, this in-vitro study employed strain gauge technology using two types of attachment for assisting partial overdenture for maxillary Kennedy Class I. Five epoxy resin models in each group in the position of the first molar in both sides was implanted into different groups, group A: one implant 5 mm length with 4.8 mm diameter, group B: one implant 5 mm length with 6.2 mm diameter. A ball and socket attachment was implanted in the left side and a locator attachment was placed in the right side of the implant. The force is directed vertically by the post of the universal testing machine. 1. The loading device base and a static 200 N vertical load measurement in a horizontal plane. 2. Oblique load measurement: A static 40 N oblique load was applied to the surface of a wooden segment that was oblique and made an angle of 45° with the applied force. To guarantee the repeatability of the data, the load was applied six times for each model, vertically and obliquely, with a minimum of five minutes between measurements. Results Total microstrain measured around implants with locator attachments on vertical and oblique load in group A was greater than group B, as was total microstrain measured around implants with ball and socket attachment on vertical and oblique load in group A. Total microstrain recorded around small diameter implants in group A were higher than total microstrain recorded around wide diameter implants in group B on vertical and oblique load. Conclusions The higher strain was recorded around implants with ball attachments than implants with locator attachments. Regarding to microstrain recorded in each group under vertical and oblique load, using wide diameter short implants is better as less microstrains were recorded.

Comparison of peri-implant bone level in mandibular implant overdenture retained by locator attachment with varying retentive insert materials: A retrospective study

Comparison of peri-implant bone level in mandibular implant overdenture retained by locator attachment with varying retentive insert materials: A retrospective study

Clinical Peri-Implant Parameters and Marginal Bone Loss for Early Mandibular Implant Overdentures: A Follow-Up of 60 Months.

Background and Objectives: Despite the identified benefits of early implant loading, studies have questioned its advantages compared to delayed loading in edentulous patients. This study aimed to evaluate clinical peri-implant parameters and marginal bone loss around early placed and loaded mandibular implant overdentures with a 60-month follow-up. Materials and Methods: In this prospective cohort study, 43 patients were enrolled to receive 86 early loading sub-crestal dental implants through prosthetic guides. Implant overdentures were supported by two isolated implant locator attachments between two mental foramens. Clinical peri-implant parameters, including plaque index (PI), bleeding index (BI), peri-implant pocket depth (PIPD), and marginal bone loss (MBL) were evaluated using standardized techniques at 1, 12, 24, 36, 48, and 60 months follow-up. At 60 months, complications associated with implant overdentures (IOD's) were noted. The mean comparison of peri-implant clinical parameters was performed through ANOVA test. A p-value of ≤0.05 was taken as significant. Results: Out of the total 43 enrolled patients, 8 patients were lost during follow-up; as a result, 35 patients completed the 5 years follow-up. The mean values of PI, BI, and PIPD increased with no statistical difference (p > 0.05). For marginal bone loss, an increase in the mean values was noted at different time intervals with statistical differences (p < 0.001). The most common complications noted were loosening of the abutment, occlusal adjustment, retentive locator loosening and replacement, and relining of the denture. Conclusions: Early placement of IODs failed to prevent bone loss over time and was associated with complications, predominantly consisting of abutment loosening, occlusal adjustments, broken retentive locator components, relining, and rebasing.

3D-printed custom tray for maxillofacial implant assisted partial denture.

This technique presents a new fabrication workflow for a three-dimensional (3D) printed custom tray, which duplicates the morphology of the treatment denture for maxillofacial prostheses using an intraoral scanner, computer-aideddesign (CAD) software, and a 3D printer. A 70-year-old man underwent reconstruction of segmental mandibulectomy for mandibular osteoblastoma, followed by implant placement and secondary surgery. During the surgical treatment, a treatment denture was fabricated to restore oral function and determine the morphology of the definitive denture. To create the definitive denture with the same morphology as the treatment denture a custom tray was fabricated with the denture morphology after chairside adjustments. The oral cavity was scanned using an intraoral scanner, and the data acquired were imported into general-purpose CAD software, adjusted, and imported into a 3D printer to produce the custom tray. This was fitted into the patient's mouth without any issues, and closed tray impressions were made with impression caps for the locator attachments on the implant body. The morphology of the treatment denture was replicated in the definitive denture by making a silicon impression of the cameo surface at the fabrication of the cast after impression making. In this technique, the morphology of the treatment denture was transferred accurately to the definitive implant partial denture by leveraging existing digital technology. This method represents a practical approach for partial denture fabrication, including maxillofacial defects with complex denture configurations.

Evaluation of masticatory efficiency and OHRQoL in implant-retained overdenture with different numbers of implant in the edentulous mandible: a one-year follow-up prospective study

PurposeThe aim of this article is to evaluate to the masticatory function performance and Oral Health-related Quality of Life (OHRQoL) in implant-retained overdenture compared with different implant number placements in the edentulous mandible.MethodsFrom 2013 to 2015, each patients received 3 implants (iSy-Implant, Camlog, Wimsheim, Germany) in intraforaminal mandible (34, 41/31, 44). After operation, inserted implants were gradually loaded and incorporated into an overdenture with a self-aligning attachment system (Locator abutments) in 3 + 3 + 3 months. Five checked points were performed chewing cycle test with multicolored chewing gum and OHIP-G14 questionnaire and a sum score questionnaire as following: pre-operation, one implant load (41/31), two implants loaded (33,43), three implants loaded and 1-year follow up.ResultA total of 10 patients with 30 implants were placed, the survival rate of the implants was 100% within 1-year follow-up. Regarding the masticatory function analysis, for the higher number of chewing cycles, the higher mixing rate was observed. After 1 year, the inter-mixing rate without significant changes was found compared to the time after three implants were loaded with attachment system. The mean value of OHIP-G14 was 30.4 preoperatively, 21.1 after loading the first locator, 10.7 after loading two locator abutments, and 3.2 after loading all three locator abutments. After 1 year, OHIP-G14 was 2.6 without significantly changed. The mean of the sum score was 15.5 preoperatively, 27.8 after activation of the first locator, 39.4 after activation of two locators, 46.2 after activation of all three locators, and 47.3 after 1 year. An increase of 0.7 sum score units per time point was observed. No significance was detectable, analogous to OHIP-G14, compared to the time of activation of all three locator setups (p-value = 0.22).ConclusionsA significant improvement in masticatory function performance and OHRQoL was evaluated with the increasing number of implants with locator attachment in edentulous mandible. With the investigation of the OHIP-G14 and sum score, the results of patient report outcome might be associated with the increase in the number of implants.Graphical abstract

Over-Denture Attachment Systems: Systematic Review with Meta-Analysis

Current scientific growths for implant over-denture attachments. We focused on the following topics: attachment systems, retention of various attachments, stress distribution with different attachments, the design and fabrication of attachments, digital techniques in over denture attachments, and the effects of attachments in two-implant health. We found that plastic resin is commonly used for ball and bar attachments, whereas nylon resin is commonly used in locator attachments. The locator system offers a valuable attachment option for implant-retained over denture. Attachment retention reduces while lateral force increases with implant inclination in over denture. The higher the retention of an over-denture attachment, the higher the transferred stresses. Additionally, clip loading produces more stress in implants and precision elements than bar-retained dentures.

Retentive Behavior of Locator versus Ball Attachments on Parallel versus Non-Parallel Implants

Several factors determine the retention force in removable implant-retained overdentures using prefabricated ball- or locator-type attachment systems. In this context, it was the goal of this in vitro study to examine the effect of implant angulation and female part alignment. Two model situations with two parallel or 12° tilted implants were fabricated onto which locator or ball attachments could be mounted. Simulated prostheses (n = 5) were made as antagonist parts and the assemblies were positioned in a universal testing machine for repeatedly (three times per female attachment) quantifying retention force. Statistical analysis was based on Shapiro–Wilk tests, Levene tests, ANOVAs, Tukey’s HSD tests and Welch t-tests, with the level of significance set at p &lt; 0.05. With tilted implants, the retention force of locators was significantly diminished (p &lt; 0.004) by at least 21%, while with ball attachments, a maximum reduction of 8% was noted, with only yellow inserts showing a significant difference (p = 0.040) compared with the parallel situation. Not aligning female retentive components on tilted implants for achieving a common path of insertion in ball anchors had only a minor effect on retentive force (6.5% increase as compared with aligned female parts), which was not statistically significant (p = 0.100). Not being able to establish a common path of insertion in locator attachments affects retention force. Ball anchors allow for aligning female retentive components, but due to the spherical structure of the male component this seems not even to be necessary.

Harmony in attachment: A case report of tooth-supported overdenture using locator attachment

The over-denture is a frequently employed treatment for elderly patients who have two or more remaining teeth in the arch. The presence of these remaining teeth contributes to the preservation of the alveolar ridge, provides sensory feedback, and enhances the stability and retention of the denture. This is in contrast to conventional complete dentures, where stability and retention are typically improved by utilizing coping or attachments over the remaining portions of the teeth. The incorporation of these remaining teeth significantly enhances the overall stability and retention of the denture. This case report presents prosthetic rehabilitation of a partially dentulous mandibular arch with a tooth supported overdenture with extra coronal attachments aimed to attain normal structure and functionality.

Evaluation of Peri-Implant Parameters and Functional Outcome of Immediately Placed and Loaded Mandibular Overdentures: A 5-year Follow-up Study.

To evaluate the peri-implant parameters of immediately placed and loaded mandibular overdentures over a 5-year follow-up period. All subjects who had been advised and planned for two-implant mandibular overdenture treatment were included in this study. The peri-implant parameters -including plaque index (PI), bleeding index (BI) and peri-implant pocket depth (PIPD) as well as marginal bone loss (MBL) - were assessed. In addition, prosthodontic parameters including abutment-, implant- and denture-related complications were assessed. Patients were evaluated at follow-up visits, scheduled at 1, 12, 24, 36, 48, and 60 months. The data distribution was analysed with the Shapiro-Wilk test. Data within follow-up categories were compared using ANOVA and the Tukey-Kramer test. A p-value < 0.05 was considered statistically significant. Among the 32 participants, 19 were males and 13 were females, with a mean age of 60.5 ± 7.33. The mean plaque index (PI), bleeding index (BI) and peri-implant pocket depth (PIPD) varied over time. However, no statistically significant difference was observed in the plaque index, bleeding index and peri-implant pocket depth over time (p > 0.05). The mean value at baseline was found to be -0.9 ± 0.3. The values increased over time, with the highest value observed at 60 months 2.6 ± 0.7, which was statistically significant (p < 0.001). Immediately placed and loaded mandibular implant overdentures using two un-splinted implants with locator attachments showed acceptable PI, BI and PIPD at the 5-year follow-up. Statistically significantly greater marginal bone loss was observed from baseline to follow-up, but it was within acceptable limits. A moderate number of restorative and abutment complications were observed during the follow-up of IODs.

Effect of Ridge Splitting of Mandibular Knife Edge Ridges with Two-implant Retained Overdenture with Locator Attachments on Peri-implant Bone Level and Posterior Ridge Resorption: A One-year Preliminary Study.

This study was conducted to evaluate peri-implant bone height changes and posterior ridge resorption by using two-implant retained polyetheretherketone (PEEK) overdentures with locator attachments following expansion of mandibular knife edge ridges by ridge splitting. Eighteen patients were selected for ridge splitting followed by expansion, implant placement, and bone graft application. Six months later, the fabrication of PEEK overdentures retained by locator attachments was accomplished. Friedman test, Wilcoxon signed-rank test, and Spearman correlation were used to evaluate the changes over time. Peri-implant bone height loss increased significantly with the advance of time between 6 and 12 months following denture insertion. Posterior area index changes were significant over time when measured at the time of denture insertion and twelve months following denture insertion. The effect of using PEEK as overdenture base material retained with two locator attachments allowed sharing the load between the peri-implant bone anteriorly and residual ridge posteriorly in cases with ridge splitting technique. Using PEEK as an overdenture base material is a successful means of bone preservation. How to cite this article: Helmy MA, El-Shaheed NH, El Waseef FA, et al. Effect of Ridge Splitting of Mandibular Knife Edge Ridges with Two-implant Retained Overdenture with Locator Attachments on Peri-implant Bone Level and Posterior Ridge Resorption: A One-year Preliminary Study. J Contemp Dent Pract 2023;24(11):834-839.

Comparative evaluation of masticatory efficiency, clinical performance, and patient satisfaction of single implant-retained mandibular overdenture versus conventional complete denture: A prospective in vivo study.

The aim of this within-subject prospective clinical study was to investigate the scope of single implant mandibular overdenture by assessing its masticatory efficiency, clinical performance, and patient satisfaction compared to conventional complete dentures. Prospective In Vivo Study. This prospective in vivo study was conducted in the Department of Prosthodontics and Crown and Bridge, Christian Dental College, Ludhiana. A total of 12 completely edentulous patients received a single implant in the mandibular anterior midline region. After the healing period, the conventional maxillary and mandibular dentures were fabricated. 15 days post insertion of the conventional dentures, patients were evaluated for masticatory efficiency, clinical performance including retention and stability, and patient satisfaction. To evaluate the masticatory efficiency blue raspberry and original pink "Hubba Bubba tape gum" were used as a test food. Colorimetric analysis was done to assess variance of hue. To assess clinical performance, retention, and stability of the mandibular denture was recorded using a digital force gauge and was tabulated as per CU-modified Kapur's criteria. OHIP-14 index was used to assess patient satisfaction. After evaluation of the parameters of conventional dentures, the denture was converted into an implant-retained mandibular denture by chairside conversion with locator attachments. 15 days post-implant loading, parameters of the implant retained mandibular overdenture were assessed again followed by statistical analysis. The masticatory efficiency was assessed using a paired t-test. The patient satisfaction was sequentially assessed with Wilcoxon signed rank test and thereafter paired t-test was used to compare between conventional complete denture and overdenture. Clinical performance was assessed using the Wilcoxon signed rank test. The masticatory efficiency of single implant mandibular overdenture was higher than that of conventional complete dentures. The clinical performance of the overdenture was higher than that of the conventional denture. Stability being a time-dependent parameter might need longer follow-ups for further conclusions. Patient satisfaction with single implant retained overdenture was significantly higher than conventional complete dentures. Single implant mandibular overdenture has improved masticatory efficiency, clinical performance, and patient satisfaction compared to conventional complete dentures.