Comparison between complete denture and implant-retained overdenture: effect of different mucosa thickness and resiliency on stress distribution

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Comparison of stress distribution between complete denture and implant-retained overdenture-2D FEA

The aim of this study was to compare the stress distribution induced by posterior functional loads on conventional complete dentures and implant-retained overdentures with different attachment systems using a two-dimentional Finite Element Analysis (FEA-2D). Three models representative of edentulous mandible were constructed on AutoCAD software; Group A (control), a model of edentulous mandible supporting a complete denture; Group B, a model of edentulous mandible supporting an overdenture over two splinted implants connected with the bar-clip system; Group C, a model of edentuluos mandible supporting an overdenture over two unsplinted impants with the O-ring system. Evaluation was conducted on Ansys software, with a vertical force of 100 N applied on the mandibular left first molar. When the stress was evaluated in supporting tissues, groups B (51.0 MPa) and C (52.6 MPa) demonstrated higher stress values than group A (10.1 MPa). Within the limits of this study, it may be conclued that the use of an attachment system increased stress values; furthermore, the use of splinted implants associated with the bar-clip attachment system favoured a lower stress distribution over the supporting tissue than the unsplinted implants with an O-ring abutment to retain the manibular overdenture.

THE EFFECT of E-GLASS FIBERS and ACRYLIC RESIN THICKNESS on FRACTURE LOAD IN A SIMULATED IMPLANT-SUPPORTED OVERDENTURE PROSTHESIS

Statement of problem. Implant overdenture prostheses are prone to acrylic resin fracture because of space limitations around the implant overdenture components.Purpose. The purpose of this study was to evaluate the influence of E-glass fibers and acrylic resin thickness in resisting acrylic resin fracture around a simulated overdenture abutment.Material and methods. A model was developed to simulate the clinical situation of an implant overdenture abutment with varying acrylic resin thickness (1.5 or 3.0 mm) with or without E-glass fiber reinforcement. Forty-eight specimens with an underlying simulated abutment were divided into 4 groups (n=12): 1.5 mm acrylic resin without E-glass fibers identified as thin with no E-glass fiber mesh (TN-N); 1.5 mm acrylic resin with E-glass fibers identified as thin with E-glass fiber mesh (TN-F); 3.0 mm acrylic resin without E-glass fibers identified as thick without E-glass fiber mesh (TK-N); and 3.0 mm acrylic resin with E-glass fibers identified as thick with E-glass fiber mesh (TK-F). All specimens were submitted to a 3-point bending test and fracture loads (N) were analyzed with a 2-way ANOVA and Tukey's post hoc test (alpha=.05).Results. The results revealed significant differences in fracture load among the 4 groups, with significant effects from both thickness (P<.001) and inclusion of the mesh (P<.001). Results demonstrated no interaction between mesh and thickness (P=.690). The TN-N: 39 +/- 5 N; TN-F: 50 +/- 6.9 N; TK-N: 162 +/- 13 N; and TK-F: 193 +/- 21 N groups were all statistically different (P<.001).Conclusions. The fracture load of a processed, acrylic resin implant-supported overdenture can be significantly increased by the addition of E-glass fibers even when using thin acrylic resin sections. on a relative basis, the increase in fracture load was similar when adding E-glass fibers or increasing acrylic resin thickness. (J Prosthet Dent 2011;106:373-377)

THE SERVICE LIFE of IMPLANT-RETAINED OVERDENTURE ATTACHMENT SYSTEMS

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Retention force and fatigue strength of overdenture attachment systems

This study evaluated retention force and fatigue resistance of two overdenture attachment systems. Twenty samples (O-ring and Bar-Clip) from two manufacturers (Conexao Sistemas de Protese and Lifecore Biomedical) were prepared and divided into four groups: (i) Conexao/O-ring; (ii) Conexao/Bar-Clip; (iii) Lifecore/O-ring and (iv) Lifecore/Bar-Clip, with five samples in each group. They were submitted to mechanical fatigue test using a servohydraulic machine performing 5500 cycles of insertion and removal (f=0.8 Hz), immersed in artificial saliva. Retention force values were obtained three times (0, 3000 and after 5500 cycles) simulating the clinical service, using a tensile strength at 1 mm min(-1) and load cell of 1 kN. Data were analysed with analysis of variance and Tukey's test at 5% level. Results showed that Conexao/Bar-Clip specimens had significantly higher retention values than Lifecore/Bar-Clip (44.61 and 18.44 N, respectively), Conexao/O-ring specimens had significantly lower values than Lifecore/O-ring (13.91 and 19.75 N, respectively). Conexao/Bar-Clip values were always significantly higher than those of Conexao/O-ring group (44.61 and 13.91 N, respectively). Lifecore (O-ring and Bar-Clip) presented similar values (19.75 and 18.44 N, respectively). The systems evaluated showed satisfactory retention force values, before and after fatigue testing. Conexao/Bar-Clip specimens presented the highest values. A 5-year simulation of insertion and removal did not decrease retention values or fracture components.

Overdenture as a restorative option for hypocalcified-hypoplastic amelogenesis imperfecta: a case report.

AIM: The aim of this report is to describe the restorative treatment of an 18-year-old patient diagnosed with autosomal recessive hypocalcified-hypoplastic amelogenesis imperfecta (AI). BACKGROUND: Esthetic and functional rehabilitations in AI cases are challenging and should consider individual aspects, such as age, socioeconomic status, AI type, and intraoral condition. REPORT: AI was diagnosed in an 18-year-old patient. SUMMARY: Considering the short length of crowns and roots, patient life expectancy, minimal invasiveness, amount of treatment time required, and lower costs, oral rehabilitation with overdentures provided an adequate functional and esthetic rehabilitation of the patient. CLINICAL SIGNIFICANCE: This report demonstrated overdentures to be a viable, relatively inexpensive, and non-invasive treatment choice of a patient with AI with concerns about treatment longevity, invasiveness, cost, esthetics, and long-term maintenance.

Retention strength of cobalt-chromium vs nickel-chromium titanium vs Cp titanium in a cast framework association of removable partial overdenture

Aim: There is little information considering the framework association between cast clasps and attachments. The aim of this study was to evaluate the retention strength of frameworks match circumferential clasps and extra resilient attachment cast in three different alloys (cobalt-chromium, nickel-chromium titanium and commercially pure titanium), using two undercut (0.25 and 0.75 mm) and considering different period of time (0, 1/2, 1, 2, 3, 4 and 5 years). Methods: Using two metallic matrices, representing a partially edentulous mandibular right hemiarch with the first molar crown, canine root and without premolars, 60 frameworks were fabricated. Three groups (n = 20) of each metal were cast and each group was divided into two subgroups (n = 10), corresponding the molar undercut of 0.25 mm and 0.75 mm. The nylon male was positioned at the matrix and attached to the acrylic resin of the prosthetic base. The samples were subjected to an insertion and removal test under artificial saliva environment. Results: The data were analyzed and compared with ANOVAs and Tukey's test at 95% of probability. The groups cast in cobaltchromium and nickel-chromium-titanium had the highest mean retention strength (5.58 N and 6.36 N respectively) without significant difference between them, but statistically different from the group cast in commercially pure titanium, which had the lowest mean retention strength in all the periods (3.46 N). The association frameworks using nickel-chromium-titanium and cobalt-chromium could be used with 0.25 mm and 0.75 mm of undercut, but the titanium samples seems to decrease the retention strength, mainly in the 0.75 mm undercut. The circumferential clasps cast in commercially pure titanium used in 0.75 mm undercuts have a potential risk of fractures, especially after the 2nd year of use. Conclusion: This in vitro study showed that the framework association between cast clasp and an extra resilient attachment are suitable to the three metals evaluated, but strongly suggest extra care with commercially pure titanium in undercut of 0.75 mm. Clinical significance: Frameworks fabricated in Cp Ti tend to decrease in retentive strength over time and have a potential risk of fracture in less than 0.75 mm of undercut.

Five-year follow-up of modified implant-supported overdenture in an iliac crest autograft failure: Clinical report

The treatment of extensive pathologic lesions in the jaw, most of the time, can generate rehabilitation problems to the patient. The solid ameloblastoma is a locally invasive odontogenic tumor with a high recurrence rate. Its treatment is aggressive and accomplished through resection with safety margin. The criterion standard for reconstruction is autogenous bone, but it can provide a high degree of resorption, causing inconvenience to the patient because of lack of rehabilitative option. This study aimed to describe a patient with ameloblastoma treated through resection and reconstruction with autogenous bone graft, in which, after an extensive resorption of the graft was made, a modified bar was applied to support a prosthetic implant overdenture. Copyright © 2013 by Mutaz B. Habal, MD.

Avaliação eletromiográfica dos músculos masseter e temporal, força de mordida e qualidade de vida em pacientes desdentados antes, durante e após a instalação e adaptação de novas próteses - total maxilar e overdenture mandibular sobre implante

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Aspectos clínicos influentes no planejamento das próteses sobre implantes tipo overdenture e protocolo

The aim of his study was to review the current scientific literature in order to discuss the surgical, prosthetics and psychological/psychosocial aspects during the treatment planning of edentulous patients, when a total fixed prosthesis or overdenture is indicated. To identify studies to take part in this review, a search was conducted for the following databases: PubMed, Dentistry and Oral Sciences Source, Journals@Ovid, SpringerLink, Wiley Online Library, Nature (NPG), Oxford Journals. It was used as descriptors: total fixed prostheses and overdentures. Inclusion criteria were: clinical articles, clinical case reports, case series, literature reviews and systematic reviews that addressed the study and comparison of total fixed prostheses and overdentures for a surgical- prosthetic planning. Exclusion criteria were: laboratory and in vitro studies and those whose first language was not English or Portuguese. Of a total of 454 articles, after an analysis according to inclusion and exclusion criteria, 76 articles were selected. During an implantsupported prosthesis rehabilitation with dental in edentulous patients, the use of alternative procedures appear to be effective when compared to more invasive surgical techniques, and thus, the amount of dental implants possible to install associated with prosthetic issues such as lip support, smile line, quantity and quality of mucosa, phonetics, etc., will allow an appropriate treatment planning to each clinical case

Sistemas de retenção O'ring e barra-clipe em overdenture mandibular

The dissatisfaction of the treatment with mandibular complete dentures in edentulous patients has been a constant problem in Dentistry. Often, the absence of stability and retention, resultants of a physiologic condition and alveolar ridge resorption, bring reduction of chewing force, speech problems and social life interference. In these cases, the rehabilitation over osseointegrated implants can be an effective and safe alternative of treatment. When it is not possible to put implants in appropriate number and disposition, it is necessary to make a simple and low costing prosthetic planning, which makes resurge the overdentures. Various implant supported attachment systems for overdentures have been developed in the dental market. Thus, intending to facilitate the professional choice, this study review the literature about attachment systems O’ring and bar- clip in its following aspect: retention level, stress distribution, hygiene complications and patient satisfaction.

Resonance frequency analysis of overdenture retainer implants with immediate loading

Objective: To evaluate 16 patients of both sexes with lower overdenture and upper complete dentures, by analysing the resonance frequency of the initial and late stability of implants used to retain the overdenture under immediate loading. Background: Oral rehabilitation treatment with complete dentures using implants has been increasingly more common among the specialists in the oral rehabilitation area. This is an alternative for obtaining retention and stability in treatments involving conventional complete dentures, where two implants are enough to retain the overdenture satisfactorily. Materials and methods: The Osstell (TM) Mentor device was used for the analysis in the initial period (primary stability), 3 and 15 months after the installation of the lower overdenture (secondary stability). The statistical analysis was performed with the repeated measures model (p < 0.01). Results: The implant stability quotients were observed to increase after 15 months of the rehabilitating treatment. Conclusion: The use of overdentures over two lower implants should become the treatment of choice for individuals who have a fully edentulous mandible.

WEAR OF MATRIX OVERDENTURE ATTACHMENTS AFTER ONE TO EIGHT YEARS OF CLINICAL USE

Statement of problem. Matrices of unsplinted attachment systems are generally reported to be the weak component of implant overdentures, often requiring frequent maintenance. Clinical wear results in reduced retention of the prosthesis, requiring activation or renewal of the matrix to restore the initial level of retention. Purpose. The purpose of this retrospective study was to measure the wear of the matrix of a ball attachment after various periods of clinical wear. Material and methods. Seventy specimens of 3 groups of matrices of ball attachments that had been in use for mean periods of 12.3 months (1Y group, n=26), 39.0 months (3Y group, n=28) and 95.6 months (8Y group, n=16) were retrieved from 35 patients (2 specimens per patient) and measured on a coordinate measuring machine equipped with a touch trigger probe. Ten unused matrices were used as controls (CTRL group). The external and internal matrix diameters and deviations from circularity were measured. For the various time periods, the decreases in matrix thickness were calculated and compared with controls. Kruskal-Wallis 1-way ANOVA by ranks, followed by the Mann-Whitney post hoc tests, were conducted to test for differences in median values among groups (alpha=.05). Results. For the internal upper diameter of the matrices tested, the Kruskal-Wallis and Mann-Whitney tests revealed significant differences for the 3 groups compared to the controls. For group 1Y, a significant difference (P<.001) of the internal upper diameter was found compared to the CTRL group. Compared to the controls, the nonparametric analyses for groups 3Y and 8Y showed significant differences for the internal upper diameter (P<.001) and deviations from circularity (P<.001). For groups 1Y, 3Y and 8Y, matrix thickness losses were 07, 47 and 70 pm, respectively. Conclusions. Within the limitations of this study, it was observed that one year of clinical wear had limited effect on the ball attachment matrices. Three to 8 years of clinical use resulted in a significant decrease of matrix thickness, especially at the tip of the retentive lamellae. (J Prosthet Dent 2012;107:191-198)

Valutazione dello spostamento tridimensionale degli impianti in giovani pazienti affetti da EDs riabilitati con overdenture implanto-supportati

Ectodermal Dysplasias syndrome (EDs) are a heterogeneous group of inherited disorders characterized by dysplasia of tissues of ectodermal origin. Complete or partial anodontia are the most frequent dental findings. Prosthetic rehabilitation is recommended from functional, esthetic, and psychological points of view. Because of the anatomical abnormalities of existing teeth and alveolar ridges, conventional prosthetic rehabilitation in young patient is often difficult. Five growing patients (age 9 to 11 years) with oligo- or anodontia were prosthetically rehabilitated. Panoramic film and Cone Bean Computerized Tomography were performed and a resin model of mandibular bone was made. Despite a remarkable multi-dimensional atrophy of the alveolar bone, the insertion of two tapered implants was possible. After a submerged healing period of 2 month, the implants were exposed and abutment connection was performed. Implants were connected with an expansion bar that permits mandibular growth and prosthetic retention. A removable prosthesis was constructed with ball attachments. Mandibular growth was followed and evaluated using the expansion guide and cephalometric radiographs. Mandibular growth in sagittal and transverse direction had no adverse effects on implant position. The expansion bar permitted the undisturbed growth of the mandible. After 4.5 years of follow-up, this study showed that Implant-supported overdenture may improve oral function, phonesis and esthetics. The mandibular rotation accompanying growth had not caused a significant problem relative to the angulation and migration of the implants. Implants can be successfully placed, restored and loaded in growing EDs patients. The cephalometric analysis supported that EDs patients show midface hypoplasia with a class III tendency, which can be avoided by early rehabilitation. Thanks to the good stability and retention of the implant-supported overdenture, patients considered the prostheses as comparable to natural teeth.