ABSTRACT: To review the literature on mandibular single-implant overdentures (opposing complete maxillary dentures), and present surgical and prosthodontic perspectives of a novel approach for this treatment option.
An electronic search through the databases of Pubmed, Embase and Medline using the linked key words 'mandibular single implant overdentures' was performed. The search was limited to English language articles published up to August 2008. Hand searches through articles retrieved from the electronic search, peer-reviewed journals and recent conference proceedings were also conducted.
A limited number of reports were identified on mandibular single-implant overdentures (opposing maxillary complete dentures). They comprised of case-series reports, short-term prospective trials and current randomized-controlled clinical trials. Different loading protocols with different implant systems have been used, but always with regular diameter implants. Specific anatomical and vascular dangers of the mandibular midline symphysis are identified including a novel surgical approach using a currently available short, wide diameter tapered implant. In addition, the prosthodontic rationale for using a larger attachment system (incorporating a platform switch) for mandibular single-implant overdentures is described.
The review reveals that there is a lack of published randomized clinical trials using mandibular single-implant overdentures, opposing maxillary complete dentures. Without the evidence from randomized clinical trials, routine use of this novel approach cannot be recommended, compared with using regular diameter implants and matching attachment systems.
Clinical Oral Implants Research 05/2009; 20(4):356-65. · 2.51 Impact Factor
ABSTRACT: Mandibular overdentures are a successful treatment option for the edentulous patients with long-term predictable outcomes, using conventional loading protocols. Currently, both early and immediate loading protocols for mandibular implant overdentures are prevalent in the literature.
A systematic review and meta-analysis of the current published literature on comparative studies using conventional versus either early and/or immediate loading protocols for mandibular implant overdentures.
The review was carried out in accordance with the QUOROM (Quality of Reporting of Meta-Analyses) guidelines. The PICO (Population, Intervention, Comparisons, Outcomes) format was used in conjunction with predefined inclusion criteria. A literature search of PubMed (1969-October 2008), EMBASE (1998-October 2008), the Cochrane Database of Systematic Reviews, and the Cochrane Controlled Trial Register was conducted. In addition, hand searching through refereed dental journals was also performed for the years 2000 to 2008. The meta-analysis was conducted by using the MIX software v.1.7 (Kitasato Clinical Research Center, Kanagawa, Japan).
A total of 191 studies were identified through the electronic search. After full-text screening and cross-matching with the predefined inclusion criteria, only 10 studies with a minimum follow-up of 2 years were eligible for inclusion in this review. Of the 10 included studies, seven have compared the outcome of conventional versus early loading of implants supporting mandibular overdentures. The remaining three studies, on the other hand, compared the outcome of conventional versus immediate loading. The meta-analysis revealed no significant difference in the outcome between conventional and either early (p = .72) or immediate (p = .08) loading of implants supporting mandibular implant overdentures.
Short-term outcomes of early or immediate loading protocols for mandibular implant overdentures achieved comparable success to conventional loading ones. No evidence was found of long-term studies to support or refute either early or immediate loading protocols for mandibular implant overdentures.
Clinical Implant Dentistry and Related Research 05/2009; 12 Suppl 1:e28-38. · 3.53 Impact Factor
ABSTRACT: The aim of this study was to investigate the retentive force of six different attachment systems used for mandibular single-implant overdentures, including two prototype large ball attachment designs.
Two prototype ball attachments of larger dimensions (7.9 and 5.9 mm) and four commercially available ball and stud attachments of standard dimensions (2.25 and 4.0 mm) were evaluated on three identical test casts resembling an edentulous mandible with severe residual ridge resorption. Five samples from each attachment system (n=30) were connected to three different implants (8.0-mm wide diameter, 3.75-mm regular diameter, and 4.0-mm regular diameter). An Instron testing machine with a computer software package was used to deliver a vertical dislodging force at a cross-head speed of 50 mm/min to each overdenture sample from the anterior direction. A total of 300 pull tests were conducted (50 per attachment system). The maximum load (retentive force) required to separate each overdenture from the supporting implant was then measured.
The highest retentive force (36.97+/-2.23 N) was achieved with the 7.9-mm prototype ball attachment design, followed in a decreasing order by the 5.9-mm prototype ball attachment design (32.06+/-2.59 N), the standard 2.25-mm ball attachment (17.32+/-3.68 N), Locator white (12.39+/-0.55 N), Locator pink (9.40 N+/-0.74 N), and Locator blue (3.83+/-0.64 N). A statistically significant difference (P<.0001) was found between all attachments.
Attachment systems of larger dimensions provided higher retentive forces for mandibular single-implant overdentures. Further in vitro and in vivo research is necessary to determine prosthodontic outcomes with these attachments in edentulous patients prior to their routine clinical use internationally.
The International journal of prosthodontics 23(2):160-6. · 1.38 Impact Factor