Systematic Review of Prosthetic Maintenance Requirements for Implant-Supported Overdentures

CosmORAL Oral and Dental Health Polyclinics, Ankara, Turkey.
The International journal of oral & maxillofacial implants (Impact Factor: 1.45). 01/2010; 25(1):163-80.
Source: PubMed


To evaluate prosthetic maintenance requirements for implant-retained/supported overdentures via a review of the literature.
Using the combined search terms "implant and overdenture," "implant-supported overdenture," "implant-retained overdenture," and "implant-anchored overdenture," along with specific inclusion and exclusion criteria, eligible articles between 1997 and 2008 (up to April 1) were retrieved from PubMed, EMBASE, OVID, the Cochrane Library databases, and seven journals by hand-searching. The initial search yielded 3,120 titles, and 287 articles were assigned to full-text analysis. Upon classification of the prosthetic complications with regard to the jaws treated and the attachment systems used, within- and between-group comparative frequency analyses were undertaken with the Kruskal-Wallis test or the Mann-Whitney U test at P < .05.
A total of 49 articles were included. Within- and between-group evaluations with regard to jaw treated as well as the attachment systems used showed that the frequency of complications did not change over time (P > .05). The differences detected were more matrix replacements after 5 years in the maxilla and mandible and more matrix replacements and patrix fractures after the first year in the mandible (P < .05). Among the attachment systems, a dislodged, worn, or loose matrix or its respective housing was more common in the ball-attachment group after the first year (P < .05). Prosthetic complications for all types of attachments were comparable (P > .05), except for the differences in peri-implant or interabutment mucosal enlargement rates after 1 year.
Prosthetic maintenance requirements for overdentures on both jaws seem to be comparable. The impact of attachment system on the prosthetic outcome is negligible.

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    • "Although infrequent, mechanical failures with bar-supported overdentures have been reported. Besides the prosthesis itself, loosening of the anchoring clips and fractures of the bar and especially the extension cantilevers do occur [23] [27]. "
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    ABSTRACT: Fractures of distal bar extensions, supporting a mandibular overdenture, do occur with significant functional and economic consequences for the patient. This study therefore aims to evaluate the effect of different bar cross-sectional shapes and surfaces, bar extension lengths and the placement of a support rib under the distal bar extension on fracture resistance. The 2nd moment area and static strength were calculated for 11 frequently used bar designs using finite element analysis (FEA). For two specific designs (Ackermann round 1.8 mm and Dolder Y-macro, the former with and without a support rib) additional physical static and fatigue strength tests were included. The FEA static strength data corresponded well to the 2nd moment area (a similar ranking when maximum allowed force was considered). The application of a rib support (Ackermann 1.8 mm) and limitations of the bar extension length (6 mm for the Ackermann 1.8 mm, 8 mm for the Dolder Y-macro) allowed the bars to exceed 5 × 10(6) cycles of 120 and 250 N respectively, before fracture. The region of highest stresses in FEA corresponded well with the locations of the fractures observed in static- and fatigue testing. With some simple guidelines/modifications, the number of bar extension fractures can be reduced significantly. This study focusses on distal bar extensions which improve the positioning of an implant supported overdenture. By combining laboratory testing and finite element simulations we aim to: (1) explain why fractures occur (dependent on physical characteristics of the bar), and (2) give clinical guidelines on how to prevent such fractures. Copyright © 2015. Published by Elsevier Ltd.
    No preview · Article · Jun 2015 · Journal of dentistry
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    • "Various types of attachment systems are currently available to restore implant-supported overdenture (IOD). Clinicians have selected IOD attachment systems based on factors such as durability, patient demand, cost effectiveness, technical simplicity, and retention [1]. The successful outcome of IOD therapy is well-documented [2,3], and different types of attachment systems have been compared regarding implant survival, marginal bone loss, soft tissue, retention, stress distribution, maintenance, and complications [4]. "
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    ABSTRACT: The purpose of this review is to examine the performance of attachments used in implant-supported overdenture (IOD) in both clinical and in vitro settings and report the compiled findings, comparisons, and trends in the research literature. Articles published in PubMed on IOD attachment systems and performance were reviewed. Non-original articles were excluded. For each article included, the type of study, number of implants, number of attachment systems, and study outcome were recorded. Of the 283 articles found, 158 met the inclusion criteria. Ninety-four articles were clinical studies and 64 articles were in vitro studies. Studies on retention were the most common for in vitro studies, and four or more attachment systems were compared in most articles with significant differences in outcome. A clinical outcome of one attachment system was most common for clinical studies, while most studies had neutral outcomes overall. Ball attachment was the most commonly tested IOD attachment system. The trend in the literature showed that there is a large discrepancy between the study designs and outcomes between the clinical and the in vitro studies for IOD. Further clinical studies that can validate in vitro research should be encouraged to address this discrepancy between the two areas.
    Full-text · Article · Feb 2013 · Journal of periodontal & implant science
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    ABSTRACT: High bending moments acting on osseointegrated implants due to transverse forces are believed to be potential contributors to mechanical implant failure. Theoretically, the rigidity of a system comprised of five implants would seem to counter these moments more effectively than one with only three implants. To study this, we built an experimental model comprised of five Brånemark implants embedded in an acrylic mandibular edentulous arch and connected by a metal framework. This lower prosthesis was mounted with an opposing maxillary complete denture in nonbalanced lingualized occlusion on a semiadjustable articulator. Eccentric static bites were simulated by fixing the dentures at 1.5 mm left and right working side (WS) and balancing side (BS) positions, respectively, and loading the upper member of the articulator with 50 N. The distal right implant abutment was transformed into a loadcell by bonding four strain gauges at 90 degrees intervals across its surface. Three 10-second static load ramps were carried out for each of 4 experiments: (1) WS loadcell with five implants, (2) BS loadcell with five implants, (3) WS loadcell with three implants, and (4) BS loadcell with three implants. Transverse bending moments were found to be significantly higher on the WS for the three-implant prosthesis as compared to the five-implant design (1.469 Ncm for five implants vs 2.151 Ncm for three implants; p = 0.001, Student's t-test). This difference was insignificant on the BS (0.532 Ncm for five implants vs 0.521 Ncm for three implants; p = 0.34). These results suggest that a higher number of mandibular implants may decrease the bending moments affecting mandibular fixed-detachable prostheses during unilateral biting tasks.
    Preview · Article · Feb 1998 · Journal of Oral Implantology
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