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The Journal of Prosthetic Dentistry Sep 2021The fracture incidence of implant-supported overdentures is more frequent in the area of attachment because of stress concentration and denture deformation in this area....
STATEMENT OF PROBLEM
The fracture incidence of implant-supported overdentures is more frequent in the area of attachment because of stress concentration and denture deformation in this area. How E-glass fiber reinforcement can address this problem is unclear.
PURPOSE
The purpose of this in vitro study was to evaluate the influence of unidirectional E-glass fiber reinforcement on the mid-line denture base strains of single implant-supported overdentures.
MATERIAL AND METHODS
An experimental acrylic resin cast was constructed with a single implant placed in the mid-line area and a ball attachment screwed to the implant. Twenty-four experimental overdentures were constructed and divided into 4 groups: group AP fabricated from autopolymerizing acrylic resin without fiber reinforcement, group APF fabricated from autopolymerizing acrylic resin with unidirectional E-glass fiber reinforcement running over the residual ridge and the ball matrix, group HP fabricated from heat-polymerized acrylic resin without fiber reinforcement, and group HPF fabricated from heat-polymerized acrylic resin with unidirectional E-glass fiber reinforcement running over the residual ridge and the ball matrix. A biaxial rosette strain gauge was attached to the incisor areas of each overdenture above the attachment level (Ch1, Ch2) and to a multichannel digital strain meter. A static vertical load of 100 N was applied to the first molar area bilaterally by using a universal testing device during strain measurement procedures. The differences in the mean strain and deflection values among the investigated groups were evaluated for statistical significance using 1-way analysis of variance (ANOVA) with the Tukey post hoc multiple comparison (α=.05).
RESULTS
The type of acrylic resin did not have a statistically significant effect on the mean strain values among groups (P=.350), while the reinforcement did significantly affect them (P<.001). The interaction between reinforcement and acrylic resin was not statistically significant (P=.552). Both strain gauge channels in group APF and group HPF recorded significantly lower strain values by almost 50% than those of group AP and group HP (P<.05).
CONCLUSIONS
Unidirectional E-glass fiber reinforcement placed over the residual ridge and implant attachment significantly reduced denture base strains and deformation of single implant-supported overdentures.
Topics: Dental Implants; Dental Prosthesis, Implant-Supported; Dental Stress Analysis; Denture Bases; Denture, Overlay; Glass; Materials Testing; Stress, Mechanical
PubMed: 32958304
DOI: 10.1016/j.prosdent.2020.05.018 -
Compendium of Continuing Education in... Feb 2022Patients who require transitioning from natural teeth to dental implants present a unique challenge to clinicians. When evaluating decisionmaking processes, clinicians...
Patients who require transitioning from natural teeth to dental implants present a unique challenge to clinicians. When evaluating decisionmaking processes, clinicians must determine the best restorative treatment options for the patient. Fixed and removable treatment options may both become ideal possibilities for a patient, depending on the patient's clinical presentation. Patients who are interested in fixed options but may not have the financial resources to be able to afford this more expensive alternative often may choose removable overdenture solutions. This article discusses ideal treatment planning strategies for patients interested in dual-arch overdenture restorations and reviews a clinical case describing this treatment.
Topics: Clinical Protocols; Dental Implants; Dental Prosthesis, Implant-Supported; Denture, Overlay; Humans; Patient Care Planning
PubMed: 35077188
DOI: No ID Found -
The Journal of Contemporary Dental... Jul 2022The purpose of the study was to evaluate the stress on the implant and to assess the denture displacement for locator and bar and clip attachment types in...
AIM
The purpose of the study was to evaluate the stress on the implant and to assess the denture displacement for locator and bar and clip attachment types in implant-assisted obturators.
MATERIALS AND METHODS
A maxillary edentulous experimental model with a maxillectomy defect was made along with an opposing edentulous mandibular model with self-cure acrylic. Two endosseous implants were placed in the maxillary model. Corresponding obturator complete denture was fabricated for the maxillary model and a complete denture for the mandibular. The attachments were positioned on the implants in maxillary model, and their sleeve/clip was placed on intaglio surface of the dentures. The mounted articulator was placed on a loading apparatus, and force was incrementally applied to it. The strain and displacement for both the attachment types were measured and compared using Digital Image Correlation (DIC).
RESULTS
Locator attachment showed the least stress and minimal displacement as compared to bar and clip attachment.
CONCLUSION
The stresses around the implants and displacement of the obturator are affected by the attachment type used. It was found that bar and clip (splinted) showed the maximum stresses around the implant and maximum denture displacement. Locator attachment is the better choice over bar and clip because of its additional retentive features.
CLINICAL SIGNIFICANCE
The advantage of using DIC over the conventional strain gauge analysis is that a full-field data of displacement and strain can be obtained instead of getting a mean value on the small surface where the strain gauge is positioned.
Topics: Humans; Denture, Overlay; Denture Retention; Dental Prosthesis, Implant-Supported; Mouth, Edentulous
PubMed: 36440515
DOI: No ID Found -
The Journal of Prosthetic Dentistry Nov 2023Standard-diameter dental implants are not always applicable because of anatomic limitations of the residual ridge. Thus, mini-implants have been increasingly used and... (Meta-Analysis)
Meta-Analysis Review
STATEMENT OF PROBLEM
Standard-diameter dental implants are not always applicable because of anatomic limitations of the residual ridge. Thus, mini-implants have been increasingly used and offer an alternative. However, data regarding prosthetic complications, maintenance factors, and clinical outcomes are limited.
PURPOSE
The purpose of this systematic review and meta-analysis was to compare prosthetic complications and maintenance events and clinical outcomes in residual ridges rehabilitated with mandibular implant overdentures (IODs) by using standard implants or mini-implants.
MATERIAL AND METHODS
Nine electronic databases were searched. Quantitative analyses to measure the risk ratio (RR) and standardized mean difference (SMD) were applied. Those methods were used to assess prosthetic complications and maintenance events (abutment adjustments, replacement of retentive element, occlusal adjustment, and overdenture fracture) and clinical outcomes related to postoperative pain, probing depth (PD), plaque index (PI), marginal bone loss (MBL), and implant survival rate.
RESULTS
Altogether, 7 publications were selected. Mini-implants presented reduced abutment adjustments (RR 0.23 [0.07, 0.73], P=.01), replacement of retentive element (RR 0.41 [0.31, 0.54], P<.001), occlusal adjustment (RR 0.53 [0.31, 0.91], P=.02), and overdenture fracture (RR 0.46 [0.23, 0.94], P=.03) compared with standard implants. Additionally, mini-implants presented lower values for PI at 6 months (SMD -0.27 [-0.47, -0.08], P=.006) and 12 months (SMD -0.25 [-0.46, -0.05], P=.01). No additional tangible differences were noted.
CONCLUSIONS
Mini-implants might be an alternative choice based on the number of prosthetic complications and maintenance events. This was also confirmed by the comparable clinical data between standard implants and mini-implants.
Topics: Humans; Dental Implants; Denture, Overlay; Dental Prosthesis, Implant-Supported; Alveolar Bone Loss; Mandible
PubMed: 35120735
DOI: 10.1016/j.prosdent.2021.11.010 -
Journal of Prosthodontic Research Oct 2021Purpose To clarify the rate of posterior residual ridge resorption (PRRR) in different denture treatments and the factors that can affect PRRR.Study selection A...
Purpose To clarify the rate of posterior residual ridge resorption (PRRR) in different denture treatments and the factors that can affect PRRR.Study selection A bibliographical electronic search was conducted on MeSH, Web of Science, and Ovid databases. Hand searching was also conducted. Longitudinal studies recording the average rate of PRRR in the mandible were included. The effect size was calculated based on the mean rate of PRRR with standard deviation and group size. The random-effects analysis was used to perform meta-analyses across qualified studies.Results A total of 2245 eligible studies were collected from the MeSH, Web of Science, and Ovid databases and hand searching. In the end, 19 studies met the inclusion criteria and were extracted. The average rate of PRRR in different mandibular denture treatments was assessed in this systematic review. The mean combined effect size was -1.05 ± 0.5 (95% confidence interval [CI]: -3.18-1.08) between four-implant overdentures and two-implant overdentures. The combined effect size was -0.01 ± 0.22 (95% CI: -0.93-0.82) between complete dentures and two-implant overdentures. Body mass index, number of dentures used, denture wearing habit, impression technique, artificial tooth material, and peri-implant bone resorption showed no significant effect on the rate of PRRR. Gender, denture material, and relining frequency showed a significant effect on the rate of PRRR.Conclusions This review summarized different average rates of PRRR in mandibular denture treatments. Meta-analyses have reported that four-implant overdenture treatments can lower the rate of PRRR compared to two-implant overdenture treatments. However, there was no significant difference in the treatment effect between the complete denture and two-implant overdenture treatments.
Topics: Bone Resorption; Dental Prosthesis, Implant-Supported; Denture, Complete; Denture, Overlay; Humans; Mandible
PubMed: 33281173
DOI: 10.2186/jpr.JPR_D_20_00075 -
Clinical Implant Dentistry and Related... Aug 2021Implant-supported overdentures (IODs) have been reported to increase patients' oral health-related quality of life (OHRQoL) in comparison with conventional dentures... (Review)
Review
BACKGROUND
Implant-supported overdentures (IODs) have been reported to increase patients' oral health-related quality of life (OHRQoL) in comparison with conventional dentures (CDs); however, the conclusiveness of evidence on the clinical effectiveness and value for money of IODs versus CDs remains unclear.
PURPOSE
To review how the added value of IODs is demonstrated in the literature.
MATERIALS AND METHODS
MEDLINE, EMBASE, and the Cochrane Database were searched for randomized control trials, controlled clinical trials, and prospective cohort studies containing evaluations of the economic and health benefits and costs of IODs. Information about the clinical effectiveness, such as magnitude of bite forces or chewing efficacy, OHRQoL, costs, and cost-effectiveness of IODs, was extracted.
RESULTS
A total of 17 articles were included, reporting 15 economic evaluations: 11 cost-utility analyses (CUAs), 2 of which were combined with a cost-effectiveness analysis (CEA), and 2 cost-benefit analyses (CBAs). Seven CUAs used the Oral Health Impact Profile (OHIP) questionnaire while four used satisfaction questionnaires to assess the OHRQoL. One study applied quality-adjusted prosthesis years (QAPYs) for this purpose. The CBAs expressed both the beneficial outcome and the costs of the IOD in monetary terms. The included studies employed a large variety of economic evaluation methods, which limited cross-study comparability.
CONCLUSIONS
On the basis of existing economic evaluations, IODs have frequently been suggested to be a cost-efficient treatment alternative to CDs; however, the comparability between the various economic evaluation studies was limited due to the different outcome measures used. In addition, it remains unclear whether the additional health benefits of IODs outweigh the higher costs. This is largely dependent on the decision maker's valuation of oral health outcomes. Future research is encouraged to further elucidate patient willingness to pay for IODs and the societal return on investing in IODs more generally.
Topics: Dental Implants; Dental Prosthesis, Implant-Supported; Denture, Overlay; Humans; Patient Satisfaction; Prospective Studies; Quality of Life
PubMed: 34268866
DOI: 10.1111/cid.13027 -
Journal of Prosthodontics : Official... Dec 2021This review aimed to identify the reported intraoral scanning applications in fabricating different types of removable prostheses in the field of prosthodontics. (Review)
Review
PURPOSE
This review aimed to identify the reported intraoral scanning applications in fabricating different types of removable prostheses in the field of prosthodontics.
METHODS
A comprehensive electronic search was performed using the PubMed and MEDLINE databases. This review included in vitro studies and clinical reports published between January 2013 and March 2021. The main keywords were as follows: intraoral scanning, digital impression, computerized digital impression, removable prosthesis, chairside computer-aided design/computer-assisted manufacturing, digital complete denture, digital immediate complete denture, digital interim complete denture, digital removable partial denture, digital removable overdenture, digital obturator, digital occlusal splints, and digital maxillofacial prostheses.
RESULTS
In total, 33 papers (22 clinical reports, 8 papers focused on dental techniques, and 3 clinical studies) were included in the final analysis.
CONCLUSIONS
The efficiency of using intraoral scanning in the field of removable prosthodontics was documented. However, there is a need for more clinical studies to identify intraoral scanning-usage protocols and to yield reliable and valid data.
Topics: Computer-Aided Design; Dental Impression Technique; Denture, Overlay; Denture, Partial, Removable; Prosthodontics
PubMed: 34043266
DOI: 10.1111/jopr.13395 -
Clinical Oral Implants Research Aug 2023To report the 1-year implant survival/success and peri-implant outcomes of mandibular overdentures retained by four titanium-zirconium mini implants (Straumann® Mini... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To report the 1-year implant survival/success and peri-implant outcomes of mandibular overdentures retained by four titanium-zirconium mini implants (Straumann® Mini Implant System), and to assess how surgery and loading protocols influence these outcomes.
MATERIALS AND METHODS
A 2 × 2 factorial randomized clinical trial (RCT) tested the combined effects of two loading protocols (immediate or delayed) and two surgical approaches (flapless or flapped) on the success/survival of the mini implants, and peri-implant parameters (plaque, bleeding, sulcus depth, gingival position, and marginal bone loss). Outcomes were assessed up to 1-year after loading, and generalized estimating equations (GEEs) were used to analyze longitudinal and within-patient clustered data.
RESULTS
Two hundred and ninety-six implants were placed in 74 patients. The implant survival/success rates after 1 year were 100%, and no major biological complications were observed. After 1-year, descriptive data suggest no noticeable changes in plaque scores, whilst a reduction in bleeding scores at the 6-month and 1-year follow-ups compared to baseline. Good longitudinal stability was observed for the probing depth and gingival margin height measures. Overall mean marginal bone loss was 0.68 (±0.68) mm after 3 months and 0.89 (±0.75) mm after 1-year. The flapless protocol showed better results on soft tissue stability and health but a slightly higher risk for marginal bone loss.
CONCLUSION
The results of this RCT suggest that mandibular overdentures retained by this novel mini implant system represent a safe and predictable treatment option as confirmed by implant survival/success and peri-implant outcomes, even when flapless surgery and immediate loading protocols are adopted.
Topics: Humans; Dental Implants; Titanium; Zirconium; Denture, Overlay; Dental Implantation, Endosseous; Immediate Dental Implant Loading; Mandible; Dental Prosthesis, Implant-Supported; Treatment Outcome; Follow-Up Studies; Alveolar Bone Loss
PubMed: 37254798
DOI: 10.1111/clr.14102 -
The Journal of Contemporary Dental... Nov 2021The purpose of this review is to compare randomized clinical trials evaluating the peri-implant tissue outcomes using different unsplinted attachment systems in two... (Review)
Review
AIM
The purpose of this review is to compare randomized clinical trials evaluating the peri-implant tissue outcomes using different unsplinted attachment systems in two implant-retained mandibular overdentures.
BACKGROUND
Literature lacks information on various unsplinted attachment systems and their effect on peri-implant tissue health. A focus question (as per PICOS) was set as follows: Does one particular unsplinted attachment system (I) compared with another (C) results in better peri-implant outcomes (O) in two implant-retained mandibular overdentures (P) using randomized controlled trials (RCTs) (S)? The literature search was conducted in the PubMed, MEDLINE and Cochrane Central Register of Controlled Trials (CENTRAL) databases between January 2011 and December 2021. The keywords used were "denture, overlay," "denture," "overlay" AND "dental prosthesis, implant supported," "dental implants," "dental implant abutment design" AND "jaw, edentulous," "mouth, edentulous" AND "mandible." Only RCTs on two implant-retained mandibular overdentures using unsplinted attachment systems measuring peri-implant tissue outcomes with minimum 1-year follow-up were selected. In total, 224 studies were identified in initial search, and 25 were shortlisted for full-text evaluation. Four studies were included for systematic review upon considering inclusion and exclusion criteria. The risk of bias was evaluated using Cochrane Risk of Bias Tool 2.0 (RoB 2.0).
REVIEW RESULTS
A total of 41 patients received ball attachments (in 3 studies), 36 patients received low-profile attachments (in 3 studies), 16 patients received magnet attachments (in 1 study), and 13 patients received telescopic attachments (in 1 study). All four studies used standard sized implants, however, differed in implant manufacturers. Two studies which compared ball attachments low-profile attachments revealed-similar peri-implant tissue health parameters but differed in crestal bone-level changes. One study compared ball with telescopic attachments and revealed similar results in crestal bone-level changes and all four peri-implant tissue health parameters. Single study compared magnets with low-profile attachments and shown lesser bone loss with magnet attachments. Single study was judged to have low risk of bias, single with some concerns, and remaining two to have high risk of bias.
CONCLUSION
Gingival index and bleeding index of the patients were not influenced by any of the unsplinted overdenture attachment (stud, magnet, telescopic) system. Inconclusive results found among the studies evaluated comparing crestal bone loss and plaque index.
CLINICAL SIGNIFICANCE
This review manuscript has simplified comparative analysis of different unsplinted attachment systems used in two implant mandibular overdentures to help clinicians choose correct system in such situation.
Topics: Dental Prosthesis, Implant-Supported; Denture Retention; Denture, Overlay; Humans; Jaw, Edentulous; Mandible; Randomized Controlled Trials as Topic
PubMed: 35343463
DOI: No ID Found -
Journal of Prosthodontics : Official... Feb 2023Primary retention and gradual loss of retention of different attachment systems are important key factors in proper attachment selection; however, studies on attachment...
PURPOSE
Primary retention and gradual loss of retention of different attachment systems are important key factors in proper attachment selection; however, studies on attachment retention show a wide range of retention values concerning the same attachment system. This in vitro study uses a novel approach that utilizes a digitally designed and 3D-printed reinforced overdenture, which has a digitally determined geometric center, in order to standardize results for future research and clinical work. This study aims to evaluate initial retention along with the gradual loss of retention at different time intervals between three types of stud attachments, retaining a digitally designed, reinforced mandibular overdenture after 5475 cycles simulating 5 years of attachment usage.
MATERIALS AND METHODS
An epoxy model of an ACP Class I (American College of Prosthodontists) edentulous mandible was constructed. A fully computer-designed surgical guide was employed after virtual denture design to place two implants according to prosthetically driven implant placement protocol. A metal meshwork with tissue stops was designed digitally to reinforce the denture and to carry the geometric center. The meshwork was incorporated into the denture-intaglio surface, which was planned for attachment pickup. Forty-eight digitally designed and metal-reinforced 3D-printed dentures were divided into four groups (12 dentures for each group). Loss of retention was measured to compare two novel Locator attachments (12 pairs of Locator R-TX, 12 pairs of Locator F-TX medium and low retention, with 12 pairs of ball and socket). Each group was subjected to an insertion and removal fatigue test resembling 5 years of patient usage. Retention values were recorded using a universal testing machine.
RESULTS
Locator F-TX medium and low retention showed loss of retention by 91.93% and 92.91%, after fatigue testing equivalent to 2 and 3 years of use, respectively. Ball and socket and Locator R-TX showed loss of retention by 19.87% and 26.31%, respectively, after fatigue testing equivalent to 5 years of use.
CONCLUSIONS
Locator R-TX attachment systems showed promising retention for implant overdentures compared to ball and socket attachments. The proposed digital technique of denture reinforcement is capable of standardizing results for research and clinical work.
Topics: Humans; Denture, Overlay; Denture Retention; Dental Prosthesis, Implant-Supported; Dental Stress Analysis; Mandible; Dental Implants
PubMed: 35344237
DOI: 10.1111/jopr.13516