[The retention prosthesis].
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Dental Prosthesis↗
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Implant bar design, the next generation.
The rationale for implant-supported overdenture therapy is discussed with emphasis on diagnosis (why) and consequential therapy (how). After the conventionally available bar designs are discussed, the newer CEKA bar is discussed. This design of the next generation enables individualization of the essential functions of an implant bar, namely occlusal support, lateral stability and retention.
Dental Implantation, Endosseous↗
A long-term follow-up study of non-submerged ITI implants in the treatment of totally edentulous jaws. Part I: Ten-year life table analysis of a prospective multicenter study with 1286 implants.
In this prospective multicenter study, non-submerged ITI implants were followed in order to evaluate their long-term prognosis in fully edentulous jaws. A total of 1286 implants were inserted in 233 consecutive patients and, after a healing period of three to six months, the successfully integrated implants were restored with 163 overdentures and 95 fixed full-arch bridges. This prospective study not only calculated the 10-year cumulative survival and success rates for the 1286 implants by life table analysis, but also evaluated the actual survival and success rates for 498 implants after at least five years of functional loading. In addition, cumulative success rates were calculated for implant subgroups according to implant length and location. Additional analyses were performed to evaluate the estimated and actual survival and success rates of the implants in relation to various prosthetic rehabilitation techniques. The 10-year cumulative survival and success rates were 95.9% and 92.7%, respectively. The actual 5-year survival and success rates of the first 498 implants that were inserted were 97.7% and 95.0%, respectively. The analysis of implant subgroups showed slightly more favourable cumulative success rates for 12 mm long implants (93%), in comparison to 10 mm and 8 mm long implants (91.6% and 89.6%, respectively). The cumulative success rate for mandibular implants (approximately 94%) was also more favourable than that for maxillary implants (approximately 91%). Patients who were loaded with both maxillary and mandibular prostheses maintained success rates well above 90%; while only implants that were inserted to support maxillary overdentures that were retained by Dolder bars showed a success rate below 90%.
Adult↗
The transmandibular implant: a 5- and 15-year single-center study.
PURPOSE: Fifty-eight patients (average age, 60 years) with gross mandibular atrophy had transmandibular implants inserted between 1984 and 1988. This study reports on their progress at 5 and 15 years. PATIENTS AND METHODS: In both 1991 and 2000, 50 cases were reviewed, with the other 8 lost to follow-up. Detailed surveys, using exactly the same format, were conducted to determine the outcome of transmandibular implant treatment. The records were reviewed and surviving patients with transmandibular implants were examined. RESULTS: An overall success rate of 80% in 1991 had fallen to 56% by 2000, with a total of 22 implants being removed. CONCLUSION: Factors involved in failure were age and medical infirmity of the patients, gross mandibular atrophy, and the use of several surgeons, in particular, trainees. This survey shows that the TMI has a progressive long-term failure rate and that extreme care needs to be taken in both patient selection and implant placement.
Adult↗
Brånemark System Wide Platform implants for single molar replacement: clinical evaluation of prospective and retrospective materials.
BACKGROUND: The use of oral implants for single tooth replacement has become a predictable treatment modality. As single tooth loss is most common in posterior areas of the jaws, the use of the protocol is of specific interest in those regions. New implant designs aimed at this purpose have also been introduced. PURPOSE: The aim of the study was to present the outcomes for wide diameter implant treatment when being used in posterior areas of the jaws. MATERIALS AND METHODS: This paper presents the 3-year results of a prospective multicenter study (three clinics; n = 38 implants) and the 1-year results from a retrospective multicenter study (two clinics; n = 20 implants) on wide diameter implants for single molar replacement. Based on the hypothesis that dense bone in posterior mandibles would benefit from careful surgery and longer remodeling time, the influences of surgical technique and healing time on implant success and bone resorption were particularly addressed. RESULTS: The outcome demonstrated a good predictability for Brånemark System Wide Platform implants, at least short term, when used as single molar support (prospective group cumulative success rate [CSR] = 92% after 3 years; retrospective group CSR = 95% after 1 year). The increased mechanical strength of the wide platform implant/abutment complex also turned out to be important for mechanical stability. CONCLUSIONS: The study indicated that it was important to carefully perform surgery in posterior mandibles in order to preserve and optimally use the existing dense bone. It was suggested that from bone healing and remodeling aspects, posterior mandibles may be more demanding to handle than corresponding areas of maxillae.
Adult↗
Implant angulation and position and screw or cement retention: clinical guidelines.
The choice between cement and screw retention in implant prosthodontics may be a matter of personal preference or dictated by specific clinical situations. As set of clinical guidelines based on implant angulation and arch position and clinical considerations are presented to aid the clinician in determining the most appropriate method of retention for implant prostheses.
Cementation↗
Comparative study of retentive anchor systems for overdentures.
OBJECTIVES: This study aimed to evaluate the retention on two or four implants of eight resilient and nonresilient retentive anchors used in overdentures. METHOD AND MATERIALS: Eight groups of retentive anchors were used: Dyna and Shiner (magnets); Dalla Bona and O-Ring (balls); Ceka Revax and Zaag attachments (studs); the cast bar (Dolder type) system with plastic clips; and the milled bars system. These specimens with their respective overdentures were prepared on two similar acrylic resin models with four implants (3.75 x 13 mm). Ten tensile strength tests (Instron) were performed on each group at a speed of 3 mm per minute. The statistical analysis (one-way analysis of variance, Tukey's HSD test) was considered significant. RESULTS: The pull force values ranged between 0.400 and 3.800 daN (International System of Units). There was a significant difference in retention in favor of the milled bars in comparison with the Ceka Revax, Hader bars, Zaag attachments, O-Ring, and Dyna groups, and a marginally significant difference compared with the Dalla Bona group. There was a highly significant difference with the Shiner magnets. CONCLUSION: The milled bar system was the most retentive anchor, with the Dalla Bona, Ceka Revax, Hader Bar, Zaag attachment, and O-Ring groups being the second most retentive. The least retentive groups were the Shiner and Dyna magnets. Proper abutment placement in the mandible and the correct selection of the retentive anchor will improve overdenture retention.
Analysis of Variance↗
Overdenture retention and stabilization with ball-and-socket attachments: principles and technique.
Implant attachments of various designs are used to retain, stabilize and sometimes support overdentures. Tissue supported overdentures stabilized and retained by two to four implants are often the restorations of choice due to patient preference, limitations in finances, insufficient available bone to accommodate a greater number of implants, or needed improvements in esthetics, phonetics and oral hygiene. Female retentive sockets in the overdenture base that snap onto male ball abutments offer such advantages as reduction in hydraulic resistance to coupling, lower functional stress on the implants, retention that can be adjusted downward, easy component replacement and only relatively parallel abutments.
Dental Abutments↗
Retention forces and seating discrepancies of implant-retained castings after cementation.
PURPOSE: The purpose of this in vitro study was to evaluate the influence of cement type and application technique on seating discrepancies and retention forces of noble alloy castings cemented on titanium abutments. MATERIALS AND METHODS: Eugenol-free zinc oxide (Freegenol), zinc phosphate (Harvard), glass ionomer (KetacCem), polycarboxylate (Durelon), and self-adhesive resin (RelyX Unicem) cements were used. The inner surfaces of the castings were either completely coated or half-coated with cement. Abutments were used as delivered with a machined surface for the first part of the study. Groups of 8 castings were cemented in both ways. For the second part of the study, the abutments were air-abraded (aluminum oxide, 50 microm particle size), and groups of 8 completely coated castings were cemented with all cements. Marginal discrepancies were measured before and immediately after cementation. Tensile tests were conducted to measure the retention forces. Statistical analysis was performed with pair-wise comparison using the Wilcoxon rank sum test modified by Bonferroni-Holm. RESULTS: Change in seating discrepancies did not differ significantly among the different application techniques. The median retention forces for completely-coated castings were 177 N for eugenol-free zinc oxide, 346 N for zinc phosphate, 469 N for glass ionomer, 813 N for polycarboxylate, and 653 N for self-adhesive resin. With respect to retention force, 3 significantly different groups (P < .05) were identified: (1) zinc oxide, (2) zinc phosphate/glass ionomer, and (3) polycarboxylate/self-adhesive resin. No differences in retention between the 2 coating techniques were found for any cement. However, air abrading the abutments resulted in increased retention of the castings for some of the cements. CONCLUSIONS: Half-coating of the restorations with cements did not result in reduced retention values compared to the complete coating technique, but air abrasion resulted in increased retention with some cements.
Air Abrasion, Dental↗
Laboratory processing of housing-retained attachments for implant-supported overdentures.
The use of a metal housing-retained attachment for implant-supported overdentures: (1) facilitates easy removal and replacement of a matrix attachment during routine recall examinations, and (2) ensures correct alignment and retention to the implant-supported bar assembly. This article describes a laboratory technique for processing the bar assembly (without allowing acrylic resin to seep under it) with the master cast invested in the metal flask. The technique ensures a precise fit of retentive attachments at the delivery of the overdenture to the patient.
Dental Abutments↗
Effects of attachment type on the mobility of implant-stabilized overdentures--an in vitro study.
PURPOSE: To stabilize overdentures, a wide range of attachments to implants is suggested. Although there is evidence that denture stability is an important factor for patient satisfaction, there are no data on how these attachments may reduce denture mobility. It was the purpose of this study to compare the effects of different types of attachments on the mobility of implant-stabilized overdentures in vitro, designing a measurement device that could also be used in vivo. MATERIALS AND METHODS: On an acrylic model with 2 implants in the canine areas, magnets were fixed to one of the implant abutments. Four Hall-effect devices were attached to the denture opposite the magnet, which allowed contact-free measurements of denture movements. RESULTS: In vitro experiments loading an overdenture showed very small, largely insignificant differences in denture mobility when different bar or ball attachments were used. Geometric aspects of load application were more important than the choice of attachment. CONCLUSION: The measurements gave no guide to the choice of an attachment. The similarity of the attachments must be confirmed by in vivo measurements.
Analysis of Variance↗
The lateral fixation screw in implant dentistry.
This clinical report presents a means of retaining implant supported superstructures using lateral fixation screws (Novadent). 244 lateral fixation screws have been used for the retention of a variety of restorations including single teeth, short span and full arch bridgework as well as overdenture bars. Over a period of observation of 4 years, the authors have found the restorations to have effective retention, ease of retrievability, good aesthetics and occlusal contours.
Dental Implants, Single-Tooth↗
The ERA implant-supported overdenture.
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.
Dental Abutments↗
Retention of teeth and placement of implants in the partially edentulous maxilla: the decision-making process.
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Dental Implantation↗
ITI implants and Dolder bars in the treatment of large traumatic defect of mandible: a clinical report.
The development of more sophisticated implant techniques to produce satisfying results improves the precise planning of both the surgical phase of the implantation and the following prosthetic rehabilitation. Ball and bar attachments are the main retainer systems for implant-bearing overdentures to achieve a successful treatment in the partial or full edentulism. In this clinical report, a 23-year-old male patient, presented with a large traumatic defect in the anterior mandible, was treated with ITI implant and ITI Dolder bar combinations. The reason to prefer this kind of treatment depends on the highest retention capacity and cleaning facilities of the system.
Adult↗
Screw versus cemented implant supported restorations.
Implant supported restorations can be attached to implants with screws or can be cemented to abutments which are secured to implants with screws. Screw retained implant restorations are the authors' preferred method of securing restorations to implants. This article will be written from this perspective and the advantages and disadvantages of each method of retention will be discussed under the following headings: Aesthetics, Retrievability, Retention, Implant placement, Passivity, Provisionals, Occlusion, Immediate loading, Impression procedures, Long term treatment planning.
Cementation↗
Effect of screw hole filling on retention of implant crowns.
The screw access channels of 15 degrees angled Esthetic Abutments (Brånemark System) were either (a) completely filled with a vinyl polysiloxane impression material (Memosil), (b) partially filled with Memosil or (c) had lower portion filled with Memosil and the remainder with composite resin. The force required to remove a temporarily cemented restoration was measured. The removal force was significantly reduced with the channel completely filled with Memosil compared to those partially filled with Memosil (p<0.01) or with composite resin placed over Memosil (p<0.01). The method selected to fill the screw access channel of an implant abutment can be a significant factor affecting retention of a cemented restoration.
Dental Abutments↗
Alternative method for retention and removal of cement-retained implant prostheses.
This article describes a simple, quick, and economical technique that makes use of a light-polymerized resin system to facilitate the retention and removal of cement-retained implant prostheses.
Cementation↗