Surgical and prosthetic planning for a two-implant-retained mandibular overdenture: a clinical report

A 2-implant-retained mandibular overdenture is considered by some to be the standard of care for mandibular edentulism. Compared to a conventional complete denture, an implant-retained overdenture requires more thorough planning. Careful consideration is necessary regarding the 3-dimensional orientation of the implants to ensure adequate horizontal and vertical space for prosthetic components. This clinical report describes a patient with a compromised mandibular overdenture in whom the position of the existing implants yielded insufficient space for prosthetic components. This report describes the concepts for treatment planning prior to fabricating a new mandibular overdenture, including considerations for the surgical removal of the existing implants, alveoloplasty to create the necessary space for prosthetic components, and placement of the new implants to ensure an esthetic and functional prosthesis.     

Mandibular implant overdenture treatment: Consensus and controversy

A literature review of implant overdenture treatment for the edentulous mandible is presented. The report focuses on the knowledge base for this treatment modality, in an effort to distinguish between areas that are well characterized and enjoy a higher level of consensus among practitioners as compared with those that are more controversial and not clearly understood.     

Mandibular overdenture treatment. Case report

Complete mandibular dentures have a significantly lower success rate compared with complete maxillary dentures. Overdentures are feasible alternatives in many instances in attempting to achieve an optimal clinical result. The case of a 56-year-old female patient requiring prosthetic rehabilitation is discussed. A complete maxillary denture and a complete mandibular overdenture were constructed.     

Mandibular implant-retained overdenture with magnets: a case report

Implant-retained overdentures can be a simple treatment option to restore the edentulous mandible. Retention can be achieved via studs, linked bar system or magnets. Success rates using the different retention mechanisms have been reported to be high. However, long-term prospective studies on implant-retained overdentures are limited. This paper reports on a patient who has successfully worn a mandibular implant-retained overdenture with magnets for 12 years.     

A randomized clinical trial comparing two mandibular implant overdenture designs: 3-year prosthetic outcomes using a six-field protocol

PURPOSE: This clinical trial tested the null hypothesis that there would be no difference in prosthetic maintenance for two-implant mandibular overdentures retained by either a bar-clip mechanism or ball attachments. Prosthetic outcomes are reported over 3 years using a six-field protocol. MATERIALS AND METHODS: One hundred edentulous participants received new maxillary complete dentures and a mandibular two-implant overdenture (IOD), with random assignment to either a bar and metal clip or two ball attachments (titanium alloy matrix and spring) for retention. Eighty-seven subjects were available for follow-up after 3 years. RESULTS: Almost three times as many bar-clip dentures (63%) were rated successful compared to the ball attachment design. Two percent of the participants in each group died over the course of the study, while 15% of the bar-clip and 8% of the ball IOD subjects were lost to follow-up. More than three times as many ball attachment IODs (60%) required retreatment in the form of excessive repairs, and twice as many of the ball attachment design (8%) required replacement. The ball attachment IOD was significantly more likely to require patrix tightening or matrix replacement, while the bar-clip design was more likely to require activation of the matrix. CONCLUSION: Using the criteria of a six-field protocol for implant overdenture outcomes, the bar-clip IOD was a significantly more successful prosthesis, requiring less maintenance than the titanium alloy matrix and spring ball attachment IOD employed in this study. The null hypothesis was therefore defeated.     

Fibronectin on prosthetic denture fabrication

It is well known that fibronectin adheres to various oral bacteria and shows affinity to various components. Thus the existence fibronectin which is present in the salivary flow, acquired pellicle and dental plaque, was investigated in used acrylic resin dentures with a direct immunohistochemical fluorescent technique using antihuman fibronectin goat serum which was labeled with fluorescein isothiocyanate (FITC). It was found that fibronectin frequently was present on the surface of acrylic resin dentures.     

Mandibular Hader bar attachment overdenture wearers: A five-year longitudinal clinical evaluation by electromyographic analysis

IntroductionElectromyography is used to evaluate the muscle activity of temporalis and masseter muscles in a comparative clinical research on effectiveness of masticatory cycle by conventional overdenture and use of overdenture with Hader bar attachment for five years established on a scientific level and is first of its kind.AimThe purpose of this study is to determine the response of co-ordination of stomatognathic system and the functional status of long-term overdenture use, which can be recorded in EMG.Material and MethodsTen patients were treated with maxillary conventional complete denture and mandibular overdenture. Electrical activity of masseter and temporal muscles were obtained in 3 groups. (Gp. I) After insertion of conventional overdenture with copings; (Gp. II) Overdenture with Hader bar attachment and (Gp.III) five years of use of overdenture with Hader bar attachment.Results and conclusionThe mean and standard deviation for all the patients showed an increase in muscular activity of temporalis and masseter muscles after long-term rehabilitation (x = 0.405; 0.407 and s = 0.0668; 0.1344 respectively, p = 0.0042 and 0.0074 which is <0.05). This study concludes that overdenture with Hader bar system, after five years of function provide a sound justification for a viable alternative treatment modality to provide overdenture with attachment service to patients.     

Mandibular nerve neurosensory impairment after dental implant surgery: management and protocol

More than 70% of dentists have experienced patients with postoperative paresthesia/dysesthesia or anesthesia as a result of dental procedures. The most common nerve affected is the mandibular nerve, which may be injured during either implant surgery or bone grafting procedures. However, no organized protocol directed specifically for general dentists, or for the vast majority of specialists, has been published. The protocol presented in this article is divided into 5 periods: during surgery (1) nerve injury is suspected or (2) known nerve transection, post-operative period (3) 1 week and (4) 12 weeks. The appropriate treatment (pharmacology, monitoring, etc.) for each period is suggested, including the referral to a nerve specialist when appropriate.     

Multisectional mold for fabrication of prosthetic ears.

The use of a multisectional stone mold is advocated for the fabrication of prosthetic ears. Less force is required in the deflasking procedure with this technique, reducing the risk of fracturing the mold or tearing the prosthesis. This technique requires more time and care in the flasking procedure. Convergence of the sections is of particular importance. The potential for multiple section lines may result in a need for more surface finishing of the prosthesis.     

Use of a flexible cast for fabrication of multiple post-coping overdenture restorations

Direct intraoral fabrication of multiple post-coping restorations for an overdenture in the same arch can be a time-consuming chairside clinical procedure. In addition, accurate intraoral fabrication of resin patterns with intracrevicular margins is not always possible as a result of limited access. This article presents a direct-indirect method that uses an elastic cast for fabrication of multiple post-coping restorations with intracrevicular margins. Custom post patterns are fabricated directly in the root canal with autopolymerizing resin (Duralay). An impression is made of the remaining tooth structure, which also includes the post patterns, and a flexible cast is poured chairside. The cast is available within 6 to 8 minutes of impression making and can be trimmed similar to a stone die. The procedure also provides flexibility that allows separation of the cast from the impression without fracture of the custom post pattern or cast. The fabrication of the post-coping restoration can be completed in the laboratory, or if necessary, completed chairside and verified intraorally, before dismissing the patient.     

Implant-retained overdenture design for the malpositioned mandibular implants

In the rehabilitation of the edentulous mandible, implant-retained overdenture represents a viable and cost-effective treatment. Successful prosthetic integration of this treatment relies on the accurate 3-dimensional position and angulation of the implant fixtures. If these requirements are not fulfilled, implant malposition occurs and negative effects on the function, esthetics, and structural integrity of the prosthesis may follow. Implant malposition commonly results from poor planning, surgical error, inaccuracies in the radiographic/surgical template fabrication, and the instability of the template during surgery. Potential solutions for implant malposition include surgical re-treatment or prosthetic compensation in the form of an altered design of the final prosthesis. This article presents a prosthetic design of an overdenture for malpositioned implants in the anteroposterior plane. Prosthetic compensations included relocating the attachment mechanism into the bulk of the overdenture with the help of an interconnecting implant bar and a metal reinforcing framework for the overdenture.     

A three-appointment alternative treatment protocol for fabricating an implant-supported milled bar overdenture

This article describes an alternative impression technique for the fabrication of an implant-supported bar overdenture using the duplicated satisfactory interim denture as a custom tray for the implant-level impression. The primary advantage of this technique is that all the information needed for the definitive prosthesis fabrication is obtained from the interim denture and then transferred to the laboratory in a single appointment. However, this technique may be contraindicated for severely misaligned implants that require extensive reduction of the duplicated denture.     

Long-term prosthetic aftercare of direct vs. indirect attachment incorporation techniques to mandibular implant-supported overdenture

Objective: The aim of this long‐term study was to compare the need for prosthetic aftercare of direct vs. indirect attachment incorporation techniques to mandibular implant‐supported overdenture. Materials and methods: Forty‐five consecutive patients were included (130 implants were placed). Treatment was randomly allocated, resulting in 22 patients (group A) to be treated with direct ball attachment incorporation and 23 patients (group B) to be treated with indirect ball attachment incorporation. All patients were treated by experienced oral‐maxillofacial surgeons/periodontists and experienced prosthodontists/residents. From the first day that the patients visited the clinic up to 20 years after the first treatment session, all surgical or prosthetic therapeutic interventions were recorded. The recorded data for the present study included the number of aftercare visits and dental treatment received (pressure sores relieve, liner changes due to loss of retention and attachment replacement due to wear). Results: The mean follow‐up was 93±57 months. No implants were lost. Statistical analysis revealed a statistically significantly (P<0.001) greater need for prosthetic interventions in group B vs. group A. The mean number of visits dedicated to – pressure sores relieve (7.04±1.4 vs. 3.63±0.84); liner exchange due to loss of retention (3.6±1.3 vs. 1.09±1.06) was significantly higher in group B. Attachment replacement due to wear occurred only in group B (11/23 – 47.8%). Conclusion: The direct technique for attachment incorporation in mandibular implant‐supported overdentures using ball attachments is superior to the indirect technique from the aftercare perspective during a long‐term evaluation period. To cite this article:
Nissan J, Oz‐Ari B, Gross O, Ghelfan O, Chaushu G. Long‐term prosthetic aftercare of direct vs. indirect attachment incorporation techniques to mandibular implant‐supported overdenture.
Clin. Oral Impl. Res. 22 , 2011; 627–630
doi: 10.1111/j.1600‐0501.2010.02026.x     

Mandibular complete denture versus single‐implant overdenture: a systematic review of patient‐reported outcomes

The single‐implant mandibular overdenture (SIMO) has been proposed as an alternative for edentulous patients who are poorly adapted to their dentures due to low retention and stability of the conventional mandibular complete denture (CD). However, there is a lack of evidence regarding the effectiveness of SIMO, which can be measured by examining patient perception of treatment effects. The aim of this systematic review was to assess the comparative results of CD and SIMO treatments using patient‐reported outcome measures. A literature search was carried out in PubMed, Scopus and Cochrane Central databases. The search included studies published up to July 2017. The focus question was: ‘Do single‐implant mandibular overdentures improve patient‐reported outcomes compared to conventional complete dentures in edentulous patients?’ Eligible studies were randomised clinical trials (RCT) and prospective studies. After initial screening for eligibility and full‐text analysis, 11 studies were included for data extraction and quality assessment (five parallel‐group RCTs, two crossover RCTs and four prospective studies). All studies reported marked improvement in satisfaction with the dentures and quality of life measures after SIMO treatment, irrespective of variations in implant treatment protocols and retention systems. Methodological considerations revealed a lack of evidence from RCTs on the comparative effectiveness of the two treatment strategies. Hence, although available evidence suggests considerable improvement in patient‐reported outcomes following the insertion of a single implant to retain a mandibular denture, further well‐designed comparative studies between SIMO and CD are required to improve the level of evidence and to support the indication of SIMO treatment in routine practice.