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Onclin P, Boven GC, Vissink A, Meijer HJ, Raghoebar GM. Maxillary implant overdentures retained with bars or solitary attachments: A 5-year randomised controlled trial. J Prosthodont Res 2023; 67:400-409. [PMID: 36261342 DOI: 10.2186/jpr.jpr_d_22_00076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
Purpose To compare the 5-year follow-up outcomes of maxillary overdentures retained by bars or solitary attachments.Methods Fifty consecutively selected fully edentulous patients experiencing problems with their conventional denture received four implants and were randomly allocated to receive a maxillary overdenture with either bar- or solitary attachment retention. Marginal bone level change (primary outcome), implant- and overdenture survival rate, clinical- and patient related outcome measures were recorded at baseline, and after 1 and 5 years. Biological and technical complications were recorded throughout the entire follow-up period.Results After 5 years, the mean marginal bone level change was higher in the solitary attachment group (-1.41±1.38mm, P=0.024) than in the bar group (-0.99±0.96mm). Also, fewer implants survived in the solitary attachment group (89.5%, P=0.027) than in the bar group (96.3%). The overdenture survival rate was 95.0% and 91.3% in the bar and solitary attachment group, respectively. Although the clinical and patient related outcomes were favourable and did not differ significantly between the groups, the peri-implantitis incidence was 25.8% in the solitary attachment group and 5.1% in the bar group. Any technical complications were minor.Conclusions In maxillary 4-implant overdenture therapy, the marginal bone level, implant survival rate and the number of complications are better with bar attachments than with solitary attachments. Both groups' clinical and patient related outcome measure scores were equal throughout the entire follow-up period.
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Affiliation(s)
- Pieter Onclin
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - G Carina Boven
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Arjan Vissink
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Henny Ja Meijer
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Implant Dentistry, Dental School, University of Groningen, University Medical Center, Groningen, The Netherlands
| | - Gerry M Raghoebar
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Wendler F, Diehl L, Shayanfard P, Karl M. Implant-Supported Overdentures: Current Status and Preclinical Testing of a Novel Attachment System. J Clin Med 2023; 12:jcm12031012. [PMID: 36769661 PMCID: PMC9917696 DOI: 10.3390/jcm12031012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 01/22/2023] [Accepted: 01/26/2023] [Indexed: 01/31/2023] Open
Abstract
Numerous attachment systems exist for implant-supported overdentures, with each having specific limitations in terms of retention, cost, wear, maintenance and cleanability. A retrospective analysis of patients restored with implant-supported overdentures using bars, telescopic crowns and Locator-type attachments was performed and the patients were interviewed. An in vitro strain gauge study compared telescopic crowns, Locator-type attachments and a novel flexible attachment system employing a shape memory alloy (NiTi) with respect to peri-implant strain development during insertion, loading and removal of an overdenture. A significantly lower number of attachment-related complications was observed in bars as compared to telescopic crowns (p = 0.00007) and Locator-type attachments (p = 0.00000), respectively. Greater overall patient satisfaction was noted in bar-retained restorations while Locator-type attachments led to lower levels of satisfaction regarding prosthesis retention. In vitro, telescopic crowns caused maximum strain development during prosthesis insertion and loading, while during removal this was observed in Locators with white retentive inserts. NiTi attachments caused significantly lower strain development during insertion as compared to telescopic crowns (p = 0.027). During loading, NiTi attachments caused significantly lower strain development than Locators with blue retentive inserts (p = 0.039). During removal, NiTi attachments caused significantly less strain development as compared to Locators with white retentive inserts (p = 0.027). Positional discrepancies between male and female attachment parts affected the retention and reaction force between both components, which may be minimized by using the novel NiTi attachment system. This may be beneficial in terms of component wear and implant loading.
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Affiliation(s)
- Frank Wendler
- Institute of Materials Simulation, Department of Materials Science, Friedrich-Alexander University Erlangen-Nürnberg, 90762 Fürth, Germany
| | - Lisa Diehl
- Department of Prosthodontics, Saarland University, 66421 Homburg, Germany
| | - Pejman Shayanfard
- Institute of Materials Simulation, Department of Materials Science, Friedrich-Alexander University Erlangen-Nürnberg, 90762 Fürth, Germany
| | - Matthias Karl
- Department of Prosthodontics, Saarland University, 66421 Homburg, Germany
- Correspondence: ; Tel.: +49-6841-162-4900
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Bouhy A, Lamy M, Altaep Y, Lambert F. Maxillary implant overdenture retained by four unsplinted attachments and opposed by a natural or fixed dentition: Five-year clinical outcomes. A prospective case series. Clin Oral Implants Res 2023; 34:285-296. [PMID: 36692949 DOI: 10.1111/clr.14033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/09/2022] [Accepted: 12/06/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVES The objective of this study was to assess, over a period of 5 years, implant prosthesis and patient-reported outcomes of complete dentures retained by four implant-supported attachments in the edentulous maxilla facing either natural teeth or fixed rehabilitation in the lower jaw. MATERIALS AND METHODS Implant, prosthodontic and patient-related outcomes were assessed in 30 patients at 1, 3 and 5 years. Prosthodontic survival, complications or maintenance events as well as implant survival were recorded. Patient-reported outcome measures (PROMs) were evaluated with the Oral Health Impact Profile (OHIP-20) questionnaire and a visual analogue scale (VAS) before implant placement (baseline) and during the follow-up period. RESULTS After 5 years, three patients dropped out, 21 implants failed, and four overdentures were replaced leading to a prosthesis survival rate of 85.2% (95% CI: 71.8%-98.6%) and an implant survival rate of 80.6% (95% CI: 73.1%-88.0%). Prosthodontic success rate decreased from 86.2% to 74% between the 1st and the 3rd year and reached 63% after 5 years. OHIP results improved significantly from baseline to 1 year (p < .0001) and to 3 years (p = .036), but, at 5 years, the improvement was no longer significant when compared to baseline (p = .12). The overall VAS score remained significantly higher up to 5 years (p < .001). CONCLUSION A substantial number of prosthetic complications and replacements occurred over the 5-year follow-up. After 5 years, the OHIP-20 deteriorated and reached again the baseline level. Nonetheless, the VAS results suggest significantly increased patient satisfaction after implant-supported retention was provided for the removable prostheses.
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Affiliation(s)
- Alice Bouhy
- Department of Removable Prosthodontics, CHU of Liège, University of Liège, Liège, Belgium.,Dental Biomaterial Research Unit, University of Liège, Liège, Belgium
| | - Marc Lamy
- Department of Removable Prosthodontics, CHU of Liège, University of Liège, Liège, Belgium.,Dental Biomaterial Research Unit, University of Liège, Liège, Belgium
| | - Yaman Altaep
- Dental Biomaterial Research Unit, University of Liège, Liège, Belgium.,Department of Periodontology and Oral Surgery, CHU of Liège, University of Liege, Liège, Belgium
| | - France Lambert
- Dental Biomaterial Research Unit, University of Liège, Liège, Belgium.,Department of Periodontology and Oral Surgery, CHU of Liège, University of Liege, Liège, Belgium
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Slot W, Raghoebar GM, Cune MS, Vissink A, Meijer HJA. Maxillary overdentures supported by four or six implants in the anterior region: 10-year randomized controlled trial results. J Clin Periodontol 2023; 50:36-44. [PMID: 36122912 PMCID: PMC10091759 DOI: 10.1111/jcpe.13726] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 08/26/2022] [Accepted: 09/15/2022] [Indexed: 11/30/2022]
Abstract
AIM To evaluate bar-supported maxillary implant overdenture treatment when supported by either four or six implants after 10 years. MATERIALS AND METHODS Edentulous subjects with maxillary denture complaints and ample bone volume to facilitate implants in the anterior region of the maxilla were planned for implant overdenture treatment, randomized to receive either four implants (n = 25) or six implants (n = 25) and subsequently evaluated after 10 years of function. Outcome variables included peri-implant bone-level changes, implant and overdenture survival, complications, presence of plaque, calculus and bleeding, degree of peri-implant inflammation, probing depth and patient satisfaction. Differences between the groups and between evaluation periods were tested with a Student's t-test. RESULTS Fourteen patients with totally 72 implants were lost to follow-up. Two patients from the six-implant group experienced implant loss (four implants), resulting in 96.1% implant survival in this group versus 100% survival in the four-implant group. Clinical, radiographical and patient-reported outcome measures did not differ statistically significant between the two groups. Patients from both groups were generally quite satisfied with the result after 10 years. CONCLUSIONS Similar and favourable outcomes are seen in bar-supported maxillary overdentures on either four or six anteriorly placed implants after a 10-year evaluation period.
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Affiliation(s)
- Wim Slot
- Dental School, Department of Implant Dentistry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gerry M Raghoebar
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marco S Cune
- Dental School, Department of Restorative Dentistry and Biomaterials, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Oral and Maxillofacial Surgery, Prosthodontics and Special Dental Care, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Oral and Maxillofacial Surgery, Prosthodontics and Special Dental Care, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Arjan Vissink
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Henny J A Meijer
- Dental School, Department of Implant Dentistry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Minervini G, Cervino G, Chaturvedi S, Franco R, di Francesco F, Fiorillo L, Cicciù M. Advanced method of rehabilitating edentulous Jaws: A review of telescopic denture. Technol Health Care 2022; 31:791-807. [PMID: 36617805 DOI: 10.3233/thc-220641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Edentulism conducts to a recognized impairment of oral function with both aesthetic and psychological changes. These patients suffer from a multiplicity of problems with their dentures, such as insufficient stability, retention and pain during mastication. The rehabilitation of a part edentulous patient can be established using a wide range of prosthetic treatment options. The overdenture treatment uses a removable total denture that overlies retained teeth, tooth roots, or dental implants. In the literature it was shown that patients with removable overdentures supported and retained either by tooth roots or implants have more predictable prosthodontic outcomes. OBJECTIVE The aim of this review is to provide an overview on the overdenture with a focus on the tooth-supported telescopic overdenture. METHODS The literature research was performed in the Scopus, Web of Science, and Pubmed electronic databases. Document type was limited to papers written in English, without time restrictions. The Review was recorded in the international PROSPERO (International Prospective Register of Systematic Reviews) database with the following number CRD42022326415. RESULTS A total of 256 articles published were found from electronic searches, Two independent reviewers carried out the screening and the selection process for the studies. First, duplicate citations were eliminated. Then, the two Authors independently screened the retrieved articles by title and abstract of each citation to determine its suitability for inclusion. Finally, 13 full-text articles satisfied the inclusion criteria. CONCLUSION Prostheses supported by Frictional telescopic crowns offer an effective treatment alternative for patients with Severely reduced dentitions who do not want implant treatment or complete dentures.
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Affiliation(s)
- Giuseppe Minervini
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Gabriele Cervino
- School of Dentistry, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Saurabh Chaturvedi
- Department of Prosthetic Dentistry, College of Dentistry, King Khalid University, Abha, Saudi Arabia
| | - Rocco Franco
- Department of Biomedicine and Prevention, University of University of Rome "Tor Vergata", Rome, Italy
| | - Fabrizio di Francesco
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Luca Fiorillo
- School of Dentistry, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Marco Cicciù
- School of Dentistry, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
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Implant Survival Rate and Prosthetic Complications of OT Equator Retained Maxillary Overdenture: A Cohort Study. PROSTHESIS 2022. [DOI: 10.3390/prosthesis4040057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
(1) Background: The overdenture is a complete denture, an implant-supported prosthesis, that the patient can remove at home for the usual oral hygiene procedures, thanks to a simple and intuitive anchoring system. Clinically, the execution of this rehabilitation for the lower arch is often favored, but when it is necessary to limit the extension of the palate in the upper arch, it can represent the least invasive and economic solution. The aim of the study is to analyze post-loading implant loss for implant-supported prostheses in the edentulous upper jaw. (2) Methods: This retrospective study was carried out on patients who received a superior overdenture on four implants for rehabilitation. A total of 42 patients were included in this study and initially evaluated clinically and radiographically. The follow-up period for patients after delivery of the upper overdenture is between 48 and 72 months. A total of 168 implants were inserted and monitored in this period. Clinical and radiographic tests were carried out on all 168 implants, with constant re-evaluation. (3) Results: The overall implant survival rate is 92.9%, a value that corresponds to those present in the literature in previously published studies. There were few prosthetic complications, mainly the detachment of anterior prosthetic teeth. (4) Conclusions: Most of these complete prostheses, which as antagonist had another previously made overdenture on four or on two implants, achieved excellent success rates in this study at 72 months.
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Onclin P, Speksnijder CM, Meijer HJA, Vissink A, Raghoebar GM. The performance of two-implant overdentures in the atrophic maxilla: a case series with 1-year follow-up. Int J Implant Dent 2022; 8:64. [PMID: 36484878 PMCID: PMC9733741 DOI: 10.1186/s40729-022-00460-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 11/12/2022] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To assess the implant and prosthesis survival rates, the clinical, radiographical and patient-related outcome measures, and the masticatory performance of maxillary overdentures supported by two implants in patients with an atrophic maxilla. METHODS In this case series, 15 consecutive patients who were eligible for maxillary implant overdenture therapy, but who had insufficient bone volume to place at least four implants and were unwilling to be treated with reconstructive surgery were asked to participate. After giving consent, participants received two implants in the maxilla under local anaesthesia. After 3 months of osseointegration, a maxillary overdenture with palatal coverage and solitary attachments was fabricated. Implant and overdenture survival, marginal bone level change, clinical outcome measures, masticatory performance and patient-related outcomes were evaluated at baseline and 1 year after overdenture placement. RESULTS Fourteen out of 15 participants completed the follow-up period of 12 months. Implant and overdenture survival rate were 89.3% and 85.7%, respectively. Change in marginal bone level (- 0.5 ± 0.7 mm), change in probing depth (0.0 ± 1.0 mm), and clinical outcomes were favourable. Masticatory performance and patient-related outcomes improved significantly compared to baseline. Complications were minimal. CONCLUSIONS Within the limitations of this study, it can be concluded that patients with extreme resorption of the maxilla that are unwilling to be treated with reconstructive surgery, benefit from two-implant maxillary overdentures retained by solitary attachments in terms of improved masticatory functioning and denture satisfaction. However, they have relatively high risk of implant loss. TRIAL REGISTRATION UMCG Trial Register (RR201900060), registered 22 January 2019.
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Affiliation(s)
- Pieter Onclin
- grid.4494.d0000 0000 9558 4598Department of Oral and Maxillofacial Surgery, University Medical Center Groningen and University of Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - Caroline M. Speksnijder
- grid.7692.a0000000090126352Department of Oral-Maxillofacial Surgery, Prosthodontics and Special Dental Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Henny J. A. Meijer
- grid.4494.d0000 0000 9558 4598Department of Oral and Maxillofacial Surgery, University Medical Center Groningen and University of Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands ,grid.4494.d0000 0000 9558 4598Department of Implant Dentistry, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Arjan Vissink
- grid.4494.d0000 0000 9558 4598Department of Oral and Maxillofacial Surgery, University Medical Center Groningen and University of Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - Gerry M. Raghoebar
- grid.4494.d0000 0000 9558 4598Department of Oral and Maxillofacial Surgery, University Medical Center Groningen and University of Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
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Mo A, Hjortsjö C, Jokstad A. Maxillary overdenture on three implants retained by low-profile stud attachments - A prospective cohort study. J Oral Rehabil 2022; 49:1069-1079. [PMID: 36029151 PMCID: PMC9826172 DOI: 10.1111/joor.13364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 07/05/2022] [Accepted: 08/22/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Clinical data are needed on long-term outcomes of removable implant-supported prostheses in the fully edentulous maxilla as a function of the number of implants, effects of the attachment system and other clinical variables. OBJECTIVE To restore individuals with an edentate maxilla with a metal-reinforced removable prosthesis without palatal coverage retained by low-profile stud attachments on three implants. METHODS The regional ethics committee approved a prospective cohort study that included all consecutive patients treated in a private speciality clinic. Primary outcomes were patients reported, that is denture satisfaction scale and oral health-related quality of life - OHIP-20. Secondary outcomes were implant- (bone loss, implant complications and peri-implant conditions) and prosthesis-related (prosthesis complications, maintenance needs and mucosa condition). RESULTS Thirty-two study participants were recruited between March 2007 and October 2016 and followed for a minimum of five years. According to Kruskal-Wallis tests, the OHIP-20 and Denture Satisfaction Scale questionnaire pre-treatment scores differed significantly. After an average of 6.7 years, peri-implant bone loss of more than 2 mm was observed on 17% of all implants, while no or minor bone loss was seen on 38%. The estimated success of implants was 0.95 at 168 months. The estimated success of the prosthesis, that is no adverse events or need for any repairs, was 0.55 at 156 months. CONCLUSION The positive findings in the current clinical study strengthen the notion that for many individuals with an edentulous maxilla, a removable prosthesis retained by three implants fitted with low-profile stud-attachment is a reliable technical solution.
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Affiliation(s)
- Arild Mo
- Department of Clinical Dentistry, Faculty of Health SciencesUiT The Arctic University of NorwayTromsøNorway
| | - Carl Hjortsjö
- Department of Prosthetic Dentistry and Oral FunctionInstitute of Clinical Dentistry, University of OsloOsloNorway
| | - Asbjørn Jokstad
- Department of Clinical Dentistry, Faculty of Health SciencesUiT The Arctic University of NorwayTromsøNorway
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