Retention and load transfer characteristics of implant-retained auricular prostheses

PURPOSE: The use of osseointegrated implants for maxillofacial prostheses reduces the need for adhesives, provides for a more stable and more esthetic prosthesis with thinner margins, and results in increased patient acceptance and confidence. The purpose of this study was to compare the retention and load transfer characteristics of differently designed implant-retained auricular prostheses. MATERIALS AND METHODS: A photoelastic model was fabricated of the auricular-temporal region of a human skull. Craniofacial implants 3.75 mm in diameter and 4 mm long were embedded in locations typically selected to retain auricular prostheses. Two retention mechanisms were evaluated on the implants: a Hader bar with 3 clips and the use of 3 Locator attachments. The retentive capacity of the prostheses was determined on an Instron test machine. Initial retention and changes with multiple removals were examined. Dislodgment forces were applied to each retentive device in the field of a circular polariscope. Resulting stresses were monitored and recorded photographically. RESULTS: The highest initial retention demonstrated by the Locator device was 12.4 +/- 0.9 lb, and the highest retention value for the Hader bar with clips was 7.5 +/- 1.1 lb. All attachments decreased in retention after multiple removals. The Locator devices produced higher peri-implant stresses compared to the Hader bar-with-clips design. CONCLUSIONS: Since higher retention is associated with higher stresses, results of this study suggest that a balance between retention and stress production is necessary in selecting a retention mechanism for the specific requirements of the patient being treated. The Locator attachment was correlated with higher retention values as well as with higher peri-implant stress compared to the Hader bar-and-clip attachment design. Retention decreased and then stabilized after multiple