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The atrophic edentulous mandible is treated successfully with a mandibular staple bone plate. The lower denture must be tissue-borne with retention and stability provided by the implant. An attachment with stress-breaking capability is necessary for the success of the reconstruction.
Extracoronal Resilient Attachment (ERA) implant-supported overdentures, Class I, Division 1 or Division 3 prostheses, provide an exceptionally stable and retentive prosthetic design for edentulous patients with osseointegrated implants. The ERA System uses either an individual female implant abutment or plastic female patterns that can be incorporated into a bar. The male portion of the attachment is a nylon piece of varying retentive quality. The attachment is resilient, stable, and can be easily serviced.
The dentition of partially edentulous patients with an anterior modification space may be restored in several ways. If a removable partial denture is selected as the treatment of choice, denture tooth selection, direct retainer display, and anterior-posterior rotation may be sources of concern for the patient and dentist. A way to overcome the treatment problems associated with these partially edentulous patients is use of a Hader bar and clip-retained removable partial denture with the attachment of an anterior porcelain-fused-to-metal facade. This article describes this treatment option and the technique for fabrication.
This study photoelastically compared the stress distribution characteristics of maxillary, bilateral, distal-extension removable partial dentures retained by light and heavy ERA extracoronal attachments. One prosthesis included supporting rests and the other had no rests. Both designs were tested with and without abutment splinting. The most favorable stress distributions were obtained with light retention elements, supporting rests, and splinting of the abutments. In this configuration the attachment prosthesis compared favorably in stress distribution with the maxillary I-bar retained removable partial denture in a previous study that used a comparable maxillae model.
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.
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It has been asserted that the average height of natural teeth in Mediterranean Latin populations is relatively short and that these teeth are of insufficient size to host standard attachments manufactured by different companies. The occlusogingival height of 159 potential abutment teeth from 50 Spanish patients was measured and compared to the sizes of intracoronal and extracoronal attachments available from one manufacturer. Twenty-one abutments (13% of the sample) were smaller than the smallest intracoronal attachment available. Eighty-seven percent of the abutments in the sample would have allowed the use of an attachment. However, only 11% of the sample would have allowed the use of a large intracoronal or medium extracoronal attachment, and none would have been able to host a large extracoronal attachment. In addition, 35% of the sample could only have accepted a small intracoronal attachment. In such cases, the capacity for retention would have to be carefully evaluated.
Primary splinting of fixtures with bar attachments has proved to be clinically effective for overdentures on osseointegrated implants in the edentulous mandible. However, in vitro investigations indicate that a more favourable force transfer to the individual fixtures can be attained by secondary splinting of four implants with conical double crowns. This observation could be confirmed in the present study by measurement of implant deflection in a model of the mandible by means of interferometric optical holography. Telescope crowns with conical interface brought about functionally more even movement characteristics of the implants compared to rigid or jointed bar attachments. Moreover, the conical double crowns always ensured a stable position of the denture in contrast to jointed attachments. These results underscore the need to test conical double crowns clinically as anchors for overdentures on osseointegrated implants.
PURPOSE: The purpose of this work was to report on the use of implant-stabilized overdentures in the mandible using the Astra Tech implant system with either ball attachments or magnets as the retentive mechanism. MATERIALS AND METHODS: Mandibular overdentures that used ball attachments on 2 implants were provided for 13 edentulous patients; 12 edentulous patients were provided with mandibular overdentures with magnet retention, using 2 implants in 10 patients and 3 implants in 2 patients. Once they were comfortable, the participants were placed on annual recall. Any other visits were initiated by the patients. Detailed records were kept for all visits. At the annual recall the following parameters were monitored: plaque levels, mucosal health, marginal bone levels, and the patients' assessment of the treatment. The patients were followed for 5 years. RESULTS: There was no statistical difference between the 2 groups for mucosal health and postinsertion maintenance. The magnet group had more abutment surfaces covered with plaque. Statistical analysis of the patients' subjective assessment of their treatment showed that the magnet group was less comfortable and chewing was less effective. CONCLUSION: The results indicate that both ball attachments and magnets used on isolated Astra Tech implants in the mandible are viable treatment options. Both attachment mechanisms provided patient satisfaction, although the ball attachments were better in this respect than the magnets.
PURPOSE: The aim of this study was to compare the retention and stability of the Nobel Biocare standard ball (NBS), Nobel Biocare 2.25-mm-diameter ball (NB2), Zest Anchor (ZA), Zest Anchor Advanced Generation (ZAAG), Sterngold ERA orange (SEO), and Sterngold ERA white (SEW) attachments on an implant-retained overdenture model. MATERIALS AND METHODS: The attachments were tested using 2 permanently placed Brånemark System implants on a test model that was attached to an Instron machine (crosshead speed 50.8 mm/minute). Each attachment had one part embedded in a denture-like housing and the other part screwed into the implants. Dislodging tensile forces were applied to the housings in 3 directions simulating function: vertical, oblique, and anterior-posterior. Eight tests were done in 3 directions with 6 samples of each attachment. The dislodging forces generated measurements of the peak load (maximum dislodging force). A 1-way analysis of variance followed by the Tukey studentized range test was used to determine groups that were significantly different. All tests for significance were carried out at the .05 level of significance. RESULTS: Results showed the ZAAG attachment to be the most retentive for the peak load measurement when subjected to vertically directed forces, with mean values and standard deviations of 37.2 +/- 5.5 N. The next most retentive attachment was the NBS, followed by the SEO, NB2, SEW, and ZA. For obliquely directed forces, the ZAAG attachment was the most retentive, with mean values and standard deviations of 27.2 +/- 4.2 N. The next most retentive was the NBS, followed by the NB2, SEO, ZA, and SEW. For anterior-posteriorly directed forces, results showed the NBS had the highest measured retentive force, with mean values and standard deviations of 34.6 +/- 18.8 N, but this was not statistically different from the NB2 and ZAAG; this was followed by the SEO, SEW, and ZA. DISCUSSION: There has been a marked resurgence in the treatment of patients with overdentures using implant attachments as retentive devices. The maximum force developed (a measure of retention) as the implant stud attachments were resisting removal from the implant abutments was determined. CONCLUSIONS: Based on the present study, the clinician may be able to make empirical decisions on attachment selection, depending on the amount of retention desired and the specific clinical situation.
PURPOSE: The aim of the present study was to evaluate implant survival, peri-implant conditions, and prosthodontic maintenance requirements for implant-supported mandibular overdentures in atrophic mandibles retained with ball or resilient telescopic crown attachments during a 3-year period. MATERIALS AND METHODS: Twenty-five patients with edentulous mandibles each received 2 Camlog root-form dental implants in the mandibular interforaminal (canine) region. The denture attachment system was chosen randomly; 13 patients received ball attachments and 12 patients received resilient telescopic crowns. Implant survival, implant mobility (Periotest values), and peri-implant conditions such as bone resorption, pocket depth, Plaque Index, Gingiva Index, Bleeding Index, and Calculus Index values were assessed for each implant. In addition, detailed prosthodontic maintenance was evaluated during the follow-up period and the 2 retention modalities were compared. RESULTS: There were no differences in implant survival, implant mobility (Periotest values), and peri-implant conditions between the 2 retention modalities. During the 3-year period significantly more complications/interventions for maintenance purposes were registered in the ball group (62 interventions) than in the telescopic crown group (26 interventions; P < .01). CONCLUSION: The results indicate that both ball attachments and resilient telescopic crowns used on isolated implants in the edentulous mandible are viable treatment options. Implant success and peri-implant conditions did not differ between ball attachments and telescopic crowns used as retention modalities for implant overdentures, but the frequency of technical complications was significantly higher with ball attachments than with resilient telescopic crowns.
Even with the most careful planning, situations arise that require sophisticated treatment alternatives. The Milled Bar, of which the spark erosion bar is one type, is described in detail. A two-degree tapered meso (primary) bar with anterior friction pins attached to osseointegrated implants provides frictional retention when supporting a secondary bar with swivel lock attachments. The two components of the prosthesis are accurately associated with each other using spark erosion and plasma arc welding technology.
In a crossover experimental design, a prospective clinical study was performed with 17 subjects with existing complete dentures. After data collection, two implants were placed bilaterally in the anterior mandible. Conventional dentures were modified into implant overdentures by use of O-ring and magnet attachments. Each attachment was maintained with each subject for 6 months. Subjects responded to patient satisfaction and preference questionnaires about the conventional denture and each attachment. Subjects were satisfied with both attachment overdentures but showed a strong preference for the O-ring. Both attachments resulted in a significant increase in patient satisfaction when compared with the conventional denture.
This article concerns a subject that has been very perplexing to dentists attempting to provide superior removable prosthetic services. The techniques in this article have been developed, tried, and proven over 42 years of clinical practice. Adequate impressions for partial denture construction when crowns that have been fitted to the mouth are included as part of the master cast. The dilemma of having already cemented crowns with attachments on them can be a problem. An easy technique has been developed for analog production in these cases.
Although the Lew attachment was originally developed to provide retention for overdentures fabricated in conjunction with subperiosteal implants, these attachments can also be used with other types of implants. Two cases are presented to describe the use of Lew attachments, one with a conventional subperiosteal implant, and the other with 4 endosteal implants and an implant connecting bar.
There are still some difficulties in prosthetic reconstruction of cleft lip and palate patients with conventional prostheses or implant retained prostheses. The most common difficulties are insufficient alveolar bone quality and quantity, inadequate soft tissue, and abutment teeth. The patient we report on was a 23-year-old man with a clinical diagnosis of right incomplete cleft lip and palate combined with midface dysplasia. The maxillary six anterior teeth were reconstructed. The maxillary right central incisor and canine were used as abutments for an extracoronal resilient attachment (ERA) retained removable partial overdenture. The STERN ERA SYSTEM is a hinged resilient attachment with an ideal stress breaking characteristic, a good retentive function, and easy chairside replacement. The 2-year follow-up examination revealed an adequate esthetic appearance with good retention and stability of the prosthesis. A removable partial overdenture using the teeth adjacent to the cleft area as abutments with an adequate attachment design is an alternative method for prosthetic reconstruction of cleft lip and palate deformity.
Treatment with removable partial dentures (RPDs) is an affordable solution for anterior or posterior tooth loss. In determining a proper treatment solution, it is important for the clinician to consider the patient's aesthetic expectations, socioeconomic situation, and the prognosis for the prosthesis and remaining dentition. This article presents guidelines to optimize the aesthetic result of this treatment and considers framework and clasp concepts; rotational path design; minimal extension of the denture bases; auxiliary attachments or retentive bars; and implants for retention and support of RPDs.