Successful emergency medical service training with virtual field trips using video during the COVID-19 pandemic: the Official Development Assistance Project in Uzbekistan / 한국의학교육

Purpose@#The coronavirus disease 2019 pandemic saw many restrictions on the provision of emergency medical service (EMS) training through actual field trips (AFTs), requiring a search for alternatives. This study aimed to assess trainees’ reactions to virtual field trips (VFTs) and determine the characteristics of instructional design for successful VFTs using edited videos and expert interviews. @*Methods@#This study evaluated Uzbekistan trainees’ reactions to the VFT of EMS training using questionnaires in three categories: satisfaction, relevance, and engagement. Factors of satisfaction and dissatisfaction were identified through open-ended questions. @*Results@#A total of 286 trainees responded to the survey during 15 educational sessions conducted from 2020 to 2022. The trainees’ responses to the VFT were positive. Overall mean scores were 4.65±0.49, 4.63±0.50, and 4.63±0.50 out of 5 points for satisfaction, relevance, and engagement, respectively. The trainees reported that the most interesting and helpful videos concerned the introduction of an EMS training curriculum and the observation of training facilities, such as the simulation centers of educational institutes. The leading causes of satisfaction were (1) authenticity of the VFTs, (2) easy-to-understand content, and (3) relevance to the job. The trainees suggested that Uzbek or Russian voice-overs would be better than subtitles in the video clip for focusing on VFT. @*Conclusion@#In situations where AFTs are not available, VFTs using edited videos and expert interviews are a good alternative to EMS education. Based on these results, it is possible that AFTs could be replaced by VFTs using qualified videos with designed instructions as a distance learning method under specific conditions.

Prenatal Exposure to High Cortisol Induces ADHD-like Behaviors with Delay in Spatial Cognitive Functions during the Post-weaning Period in Rats

High levels of cortisol in blood are frequently observed in patients with major depressive disorders and increased cortisol level induces depressivelike symptoms in animal models. However, it is still unclear whether maternal cortisol level during pregnancy is a critical factor resulting in neuropsychiatric disorders in offspring. In this study, we increased cortisol level in rats by repetitively injecting corticosterone subcutaneously (Corti.Mom, 20 mg/kg/day) during pregnancy and evaluated the behavioral patterns of their pups (Corti.Pups) via forced swimming (FS), open field (OF), elevated plus maze (EPM) and Morris water maze (MWM) tests during the immediate post-weaning period (postnatal day 21 to 25). In results, corticosterone significantly increased plasma cortisol levels in both Corti.Moms and Corti.Pups. Unlike depressive animal models, Corti.Pups showed higher hyperactive behaviors in the FS and OF tests than normal pups (Nor.Pups) born from rats (Nor.Moms) treated with saline. Furthermore, Corti.Pups spent more time and traveled longer distance in the open arms of EPM test, exhibiting higher extremity. These patterns were consistent with behavioral symptoms observed in animal models of attention deficit hyperactivity disorder (ADHD), which is characterized by hyperactivity, impulsivity, and inattention. Additionally, Corti.Pups swam longer and farther to escape in MWM test, showing cognitive declines associated with attention deficit. Our findings provide evidence that maternal cortisol level during pregnancy may affect the neuroendocrine regulation and the brain development of offspring, resulting in heterogeneous developmental brain disorders such as ADHD.

A prospective clinical of lithium disilicate pressed zirconia and monolithic zirconia in posterior implant-supported prostheses: A 24-month follow-up / 대한치과보철학회지

PURPOSE: The purpose of this study was to compare the clinical outcomes of lithium disilicate ceramic pressed zirconia prostheses and monolithic zirconia prostheses and to investigate the complications after two years of follow-up in posterior edentulous site. MATERIALS AND METHODS: A total 17 patients (male: 12, female: 5) were treated with 60 posterior fixed implant-supported prostheses (LP. lithium disilicate ceramic pressed zirconia prostheses: n = 30, MZ. monolithic zirconia prostheses: n = 30). After 24-month, clinical examination of Implant survival rate, marginal bone resorption, probing depth, plaque index, bleeding index, calculus and complications were evaluated. RESULTS: There were no failed implants and all implants were normal in function without mobility. Marginal bone resorption was lower in LP group than MZ group at 12-month (P < .05), and 12-month probing depth and calculus deposit in LP group were significantly higher than MZ group (P < .05). Most common complications in MZ were marginal bone resorptions more than 1.5.mm and 2 chipping occurred in LP group. CONCLUSION: Within the limitations of the present study, lithium disilicate ceramic pressed zirconia is considered as a predictable treatment option as much as monolithic zirconia in posterior fixed implant-supported prostheses.

Effect of Sending Educational Video Clips via Smartphone Mobile Messenger on Bowel Preparation before Colonoscopy

BACKGROUND/AIM: We aimed to evaluate the efficacy of sending educational video clips via smartphone mobile messenger (SMM) on enhancing bowel preparation before colonoscopy. METHODS: This was a prospective, endoscopist-blinded, randomized controlled study. Patients in the SMM group received two video clips sent via SMM that explained the diet and regimen for bowel preparation, whereas those in the control group did not receive any video clips. We compared the quality of bowel preparation between the two groups, which was assessed by an endoscopist using the Ottawa scale. RESULTS: Between August and November 2014, 140 patients in the SMM group and 141 patients in the control group underwent colonoscopic examination. The total Ottawa score of the SMM group was significantly lower than that of the control group (5.47±1.74 vs. 5.97±1.78, p=0.018). These results were particularly prominent in the younger age group; the total Ottawa score of patents in the SMM group aged <40 years was significantly lower than that of patients in the control group aged <40 years (5.10±1.55 vs. 6.22±2.33, p=0.034). CONCLUSIONS: We demonstrated that sending educational video clips via SMM could result in better bowel preparation, especially in the younger age group.

Technical Consideration for Coiling of Ruptured Proximal Posterior Inferior Cerebellar Artery Aneurysm

OBJECTIVE: Surgical obliteration of ruptured aneurysm of the proximal posterior inferior cerebellar artery (PICA) is challenging because of limited surgical accessibility. In recent years, coil embolization is the first-choice treatment for these lesions. However, coil embolization is not always easy in ruptured PICA aneurysm owing to the variable anatomical diversity of its shapes, its relationship to the parent artery, its low incidence, and accordingly, lesser neurointerventionist experience.METHODS: The parent artery and microcatheter for easier navigation and the embolization technique for stable coiling were identified.RESULTS: This study aimed to identify the more appropriate approach route, microcatheter, and strategies for an easier and safer, and more durable coil embolization in the treatment of lesions in the proximal PICA.CONCLUSION: Coil embolization for aneurysmal subarachnoid hemorrhage due to a ruptured proximal PICA remains a challenge, but with the appropriate coiling plan, it can be treated successfully.

Awareness and attitude on international emergency medicine: a resident survey

OBJECTIVE: International emergency medicine (IEM) is a rapidly growing field in emergency medicine (EM). However, there are few studies of the interest and attitude of EM residents on this subject in Korea. The aim of this study was to assess the awareness of IEM and determine feasibility of adoption as an EM residency program. METHODS: A structured on/off-line survey was distributed to all current first to third grade EM residents in Korea (year 2016–2017). Ninety-two hospitals with residency programs and 463 residents were identified as potential survey candidates. The survey consisted of 20 questionnaires including binary yes/no and multiple choice questions. RESULTS: The response rate was 37.1% (172/463). The proportion of residents who have interest in IEM was 62.8% (108/172); 76.2% (131/172) respondents answered that they wanted to participate in IEM/global health activities during their residency. Approximately two thirds (68.6%, 118/172) reported that they plan to participate in any IEM activity even after graduation. More than half (56.4%, 97/172) agreed that the inclusion of IEM/global health training in their residency might be necessary and it may help them to guide their future careers after their training (68.6%, 118/172). A total of 144 respondents (83.7%) indicated lack of time during their residency mostly, absence of an IEM program (47.1%, 81/172), and lack of information on IEM (31.4%, 54/172). CONCLUSION: IEM is of interest to Korean EM residents. On the other hand, formal education and training offered to residents is limited in Korea. Korean Society of Emergency Medicine should start discussions on how to adopt a global IEM agenda, and reflect on a resident training program.

Implant assisted removable partial denture with implant surveyed crown: A 20-month follow-up case report / 대한치과보철학회지

Traditional options for posterior edentulous treatment include removable partial dentures and implant fixed prostheses. Recently, the concept of implant assisted removable partial denture, in which two treatments are fused, has been introduced in consideration of systemic health and patient's needs, costs, residual alveolar bone status and so on. Implant assisted removable partial denture has the advantage of increasing the retention and stability of the denture and improving its esthetics in cases of large bone defects or biomechanical disadvantages. In addition, it is possible to strategically place the implants in a site where the alveolar bone is relatively sufficient, thereby overcome the limit of the conventional removable partial denture design as well as reducing the burden on a wide range of implant surgery. Cost reduction is also expected. In this case, the patient was treated by placing the implant in both premolar sites of the mandible and fabricating the distal extension removable partial denture with the implant fixed prosthesis as an abutment. After delivering the definitive prosthesis, the patient showed satisfaction with the masticatory function and esthetics. and has been regularly followed-up for more than one year. The following 20-months follow-up case report describes the design of an implant-assisted-removable partial denture (IARPD) in which two cementretained implant crowns used to provide support and stability.

Full mouth rehabilitation of the patient with crossed occlusion using implant fixed prosthesis: A case report / 대한치과보철학회지

Crossed occlusion can be treated either by overdenture and telescopic denture or by placing an implant at the edentulous area to reestablish the support on the occlusion. If alveolar bony support is sufficient and an the environment where an implant is inserted is favorable to restoring the masticatory and aesthetic function of a patient, the implant-supported fixed prosthesis can provide more definitive occlusal support and more aid for other oral functions. In this case report, a patient with a severe residual alveolar bone resorption following the extraction of teeth and who had a crossed occlusion was treated with sinus bone graft and alveolar bone augmentation in order to place the implants at prosthetically position. The definitive restoration was made to reflect the patient's occlusal and aesthetic function using the CAD/CAM double scanning method. Finally, the treatment had the masticatory and aesthetic function adequately restored, which is reported here.

Distal-extension removable partial denture with anterior implant supported fixed prostheses in a maxillary edentulous patient: Case report / 대한치과보철학회지

Clinicians are faced with many difficulties when planning prosthodontic restorations with implants in a complete edentulous patient. When planning fixed implant prosthetics, it is often necessary to have additional surgery due to highly reduced alveolar bone, as well as high treatment costs and long-term treatment durations can be required. In addition, lack of interocclusal space can be a problem when planning implant supported overdentures. In this study, we planned to place a small number of implants on the anterior maxilla and used them as the abutments for distal-extension removable partial dentures on the posterior side in a maxillary fully edentulous patient. This would reduce the possibility of additional invasive operations such as alveolar bone graft, shorten the treatment time, and be relatively easy for elderly patients to burden. In this case, the patient was provided with a distal-extension removable partial denture and anterior implant fixed prostheses, which was similar to the previous one, and showed good adaptation, and chewing efficiency and esthetics was recovered.

Technical Consideration for Coiling of Ruptured Proximal Posterior Inferior Cerebellar Artery Aneurysm

OBJECTIVE: Surgical obliteration of ruptured aneurysm of the proximal posterior inferior cerebellar artery (PICA) is challenging because of limited surgical accessibility. In recent years, coil embolization is the first-choice treatment for these lesions. However, coil embolization is not always easy in ruptured PICA aneurysm owing to the variable anatomical diversity of its shapes, its relationship to the parent artery, its low incidence, and accordingly, lesser neurointerventionist experience. METHODS: The parent artery and microcatheter for easier navigation and the embolization technique for stable coiling were identified. RESULTS: This study aimed to identify the more appropriate approach route, microcatheter, and strategies for an easier and safer, and more durable coil embolization in the treatment of lesions in the proximal PICA. CONCLUSION: Coil embolization for aneurysmal subarachnoid hemorrhage due to a ruptured proximal PICA remains a challenge, but with the appropriate coiling plan, it can be treated successfully.

Nobiletin attenuates neurotoxic mitochondrial calcium overload through K⁺ influx and ΔΨ(m) across mitochondrial inner membrane

Mitochondrial calcium overload is a crucial event in determining the fate of neuronal cell survival and death, implicated in pathogenesis of neurodegenerative diseases. One of the driving forces of calcium influx into mitochondria is mitochondria membrane potential (ΔΨ(m)). Therefore, pharmacological manipulation of ΔΨ(m) can be a promising strategy to prevent neuronal cell death against brain insults. Based on these issues, we investigated here whether nobiletin, a Citrus polymethoxylated flavone, prevents neurotoxic neuronal calcium overload and cell death via regulating basal ΔΨ(m) against neuronal insult in primary cortical neurons and pure brain mitochondria isolated from rat cortices. Results demonstrated that nobiletin treatment significantly increased cell viability against glutamate toxicity (100 µM, 20 min) in primary cortical neurons. Real-time imaging-based fluorometry data reveal that nobiletin evokes partial mitochondrial depolarization in these neurons. Nobiletin markedly attenuated mitochondrial calcium overload and reactive oxygen species (ROS) generation in glutamate (100 µM)-stimulated cortical neurons and isolated pure mitochondria exposed to high concentration of Ca²⁺ (5 µM). Nobiletin-induced partial mitochondrial depolarization in intact neurons was confirmed in isolated brain mitochondria using a fluorescence microplate reader. Nobiletin effects on basal ΔΨ(m) were completely abolished in K⁺-free medium on pure isolated mitochondria. Taken together, results demonstrate that K⁺ influx into mitochondria is critically involved in partial mitochondrial depolarization-related neuroprotective effect of nobiletin. Nobiletin-induced mitochondrial K⁺ influx is probably mediated, at least in part, by activation of mitochondrial K⁺ channels. However, further detailed studies should be conducted to determine exact molecular targets of nobiletin in mitochondria.

Chronic Ca²⁺ influx through voltage-dependent Ca²⁺ channels enhance delayed rectifier K⁺ currents via activating Src family tyrosine kinase in rat hippocampal neurons

Excessive influx and the subsequent rapid cytosolic elevation of Ca²⁺ in neurons is the major cause to induce hyperexcitability and irreversible cell damage although it is an essential ion for cellular signalings. Therefore, most neurons exhibit several cellular mechanisms to homeostatically regulate cytosolic Ca²⁺ level in normal as well as pathological conditions. Delayed rectifier K⁺ channels (I(DR) channels) play a role to suppress membrane excitability by inducing K⁺ outflow in various conditions, indicating their potential role in preventing pathogenic conditions and cell damage under Ca²⁺-mediated excitotoxic conditions. In the present study, we electrophysiologically evaluated the response of IDR channels to hyperexcitable conditions induced by high Ca²⁺ pretreatment (3.6 mM, for 24 hours) in cultured hippocampal neurons. In results, high Ca²⁺-treatment significantly increased the amplitude of IDR without changes of gating kinetics. Nimodipine but not APV blocked Ca²⁺-induced IDR enhancement, confirming that the change of I(DR) might be targeted by Ca²⁺ influx through voltage-dependent Ca²⁺ channels (VDCCs) rather than NMDA receptors (NMDARs). The VDCC-mediated I(DR) enhancement was not affected by either Ca²⁺-induced Ca²⁺ release (CICR) or small conductance Ca²⁺-activated K⁺ channels (SK channels). Furthermore, PP2 but not H89 completely abolished I(DR) enhancement under high Ca²⁺ condition, indicating that the activation of Src family tyrosine kinases (SFKs) is required for Ca²⁺-mediated I(DR) enhancement. Thus, SFKs may be sensitive to excessive Ca²⁺ influx through VDCCs and enhance I(DR) to activate a neuroprotective mechanism against Ca²⁺-mediated hyperexcitability in neurons.

Accuracy of several implant bite registration techniques: an in-vitro pilot study

PURPOSE: This study evaluated the accuracies of different bite registration techniques for implant-fixed prostheses using three dimensional file analysis. MATERIALS AND METHODS: Implant fixtures were placed on the mandibular right second premolar, and the first and second molar in a polyurethane model. Aluwax (A), Pattern Resin (P), and Blu-Mousse (B) were used as the bite registration materials on the healing abutments (H) or temporary abutments (T). The groups were classified into HA, HP, HB, TA, TP, and TB according to each combination. The group using the bite impression coping was the BC group; impression taking and bite registration were performed simultaneously. After impression and bite taking, the scan bodies were connected to the lab analogs of the casts. These casts were scanned using a model scanner. The distances between two reference points in three-dimensional files were measured in each group. One-way ANOVA and Duncan's test were used at the 5% significance level. RESULTS: The smallest distance discrepancy was observed in the TB group using the temporary abutments. The Blu-Mousse and HP groups showed the largest distance discrepancy. The TB and BC groups showed a lower distance discrepancy than the HP group (P=.001), and there was no significant difference between the groups using the temporary abutments and healing abutments (P>.05). CONCLUSION: Although this study has limitations as an in-vitro investigation, the groups using the temporary abutments to hold the Blu-Mousse record and bite impression coping showed greater accuracy than the group using the healing abutments to hold the pattern resin record.

Evaluation of Marginal and Internal Integrity of Modified Resin-Bonded Fixed Partial Dentures: An In Vitro Study

PURPOSE: The purpose of this study was to evaluate the microleakage of various types of resin-bonded fixed partial dentures (RBFPDs) after artificial aging. MATERIALS AND METHODS: Forty models with missing first molar were fabricated using artificial resin teeth and were divided into four groups: Group A, conventional RBFPDs design; Group B, modified RBFPDs design; Group C, assembled 3-piece RBFPDs design; and Group D, assembled 3-piece RBFPDs with different occlusal rest positions. Half of the specimens underwent chewing simulation process (240,000 cycles, 50 N load, 1.7 Hz) and thermocycling (temperatures 5℃~55℃, dwelling time 30 seconds) and the remaining 20 specimens didn't receive any treatment. All the specimens were immersed in 2% methylene blue solution for 24 hours to evaluate microleakage, and were sectioned at the middle part of abutment teeth. To evaluate the microleaskage, a dye penetration was calculated. RESULT: With artificial aging, cyclic loading and thermocycling, a 3-piece RBPFD and a 2-piece RBPFD using original tooth undercuts have significantly lower microleakge (P<0.05) compared to the conventional design of RBPFD and modified RBPFD. CONCLUSION: Within the limit of this experiment, the assembled RBFPDs exhibited a smaller microleakage than the conventional RBFPDs, implying that the assembled RBFPDs can be more effective for reducing the dislodgement of the RBFPDs.

Full Arch Restoration through Orthognathic Surgery after Implantation on the Patients with Mandibular Prognathism and Loss of Posterior Teeth: A Case Report

In case of loss of many teeth due to dental caries or periodontal disease, improvement of masticatory function and aesthetics can be obtained through implant treatment. However, if the patient does not have a normal intercondylar relationship, it is difficult to achieve an ideal occlusal relationship with only prosthetic treatment. In particular, oral reconstruction with orthodontic treatment or orthognathic surgery is necessary for patients with mandibular prognathism. However, if the posterior occlusion collapses due to severe caries or periodontal disease, orthognathic surgery may be difficult. The occlusal vertical stop is very important for the stability of the mandibular position during occlusal reconstruction through orthognathic surgery. The patient in this case had posterior occlusion collapsed due to the caries of a large number of posterior teeth, and showed mandibular prognathism and long face. We planned a full arch restoration with orthognathic surgery and extracted the hopeless teeth. To secure the vertical stop required for orthognathic surgery, the implant was placed before surgery. After the orthognathic surgery and the final prosthesis application, the results were satisfactory for the improvement of the aesthetics and the restoration of the masticatory function.

Comparison of the fit of cast gold crowns fabricated from the digital and the conventional impression techniques

PURPOSE: The purpose of this study was to compare the fit of cast gold crowns fabricated from the conventional and the digital impression technique. MATERIALS AND METHODS: Artificial tooth in a master model and abutment teeth in ten patients were restored with cast gold crowns fabricated from the digital and the conventional impression technique. The forty silicone replicas were cut in three sections; each section was evaluated in nine points. The measurement was carried out by using a measuring microscope and I-Soultion. Data from the silicone replica were analyzed and all tests were performed with α-level of 0.05. RESULTS: 1. The average gaps of cast gold crowns fabricated from the digital impression technique were larger than those of the conventional impression technique significantly. 2. In marginal and internal axial gap of cast gold crowns, no statistical differences were found between the two impression techniques. 3. The internal occlusal gaps of cast gold crowns fabricated from the digital impression technique were larger than those of the conventional impression technique significantly. CONCLUSION: Both prostheses presented clinically acceptable results with comparing the fit. The prostheses fabricated from the digital impression technique showed more gaps, in respect of occlusal surface.

Radiographic basal ganglia abnormalities secondary to nonketotic hyperglycemia with unusual clinical features

A 77-year-old woman was admitted to a local clinic for altered consciousness and presented with a suspected basal ganglion hemorrhage detected on brain computed tomography. The patient was stuporous, but her vital signs were stable. Her initial blood glucose was 607 mg/dL, and a hyperdense lesion was found in the right basal ganglion on brain computed tomography. T1-weighted magnetic resonance imaging revealed high signal intensity in the right basal ganglion. Electroencephalography showed no seizure activity. The patient was treated with a fluid infusion, and serum glucose level was controlled with insulin. The patient gradually recovered consciousness and was alert within 24 hours as serum glucose level normalized. The basal ganglion lesion caused by hyperglycemia was not accompanied by involuntary limb movement. This is the first report of a patient presenting with decreased consciousness and typical neural radiographic changes associated with nonketotic hyperglycemia but without movement abnormalities.

Utility of the Rapid Emergency Medicine Score (REMS) for Predicting Hospital Mortality in Severely Injured Patients

PURPOSE: We evaluated the power of the Rapid Emergency Medicine Score (REMS) for predicting hospital mortality in trauma patients. Then, we compared the REMS with two other scoring systems, the Emergency Trauma Score (EMTRAS) and the Injury Severity Score (ISS) for predicting prognosis. METHODS: We examined data from a prospectively collected registry in a single trauma center from January 2010 to November 2011. Patients enrolled in the registry were trauma patients who were predicted to have an ISS>15 or who required urgent multiple surgical consultations as soon as possible. Pediatric patients (<18-years-old) who were referred after initial care or death on arrival, and those with injuries due to burns, asphyxia, or drowning were excluded. The study population was divided into two subgroups according to hospital mortality, and the differences in clinical characteristics and calculated scores were examined. The odds ratio (OR) of REMS for predicting In-hospital mortality was calculated and the prognostic power of the three scoring systems for predicting hospital mortality by drawing receiver operating characteristic (ROC) curves was compared. RESULTS: A total of 103 patients were included in the analysis. Of these, 44 died during hospitalization. All three prognostic scores were significantly higher in the hospital mortality subgroup. The OR of the REMS for predicting hospital mortality was 1.35 (p<0.001). The areas under the ROC curves of the REMS, EMTRAS, and ISS were 0.815 (95% confidence interval [CI], 0.727-0.884), 0.872 (95% CI, 0.793-0.930), and 0.693 (95% CI, 0.595-0.780), respectively. The area under the ROC curve of the REMS was not different from that of the EMTRAS or ISS. CONCLUSION: The REMS showed good prognostic power for predicting hospital mortality in severely injured patients. Consecutive prospective studies are warranted to determine the utility of this scoring system for trauma patients.

A Study on Heuristic Transportation Routes of Patients with Acute Dysbarism for the Best Prognosis

PURPOSE: Acute dysbarism is a potentially lethal injury associated with environmental medicine. Therefore, prompt treatment, including transportation of victims, is important for the best prognosis. The aim of this study was to examine transportation routes of patients with acute dysbarism for the best prognosis in Korea. METHODS: Geography of South Korea was analyzed using the geographic information system (GIS). The study examined two scenarios using transportation analysis, which relies on a GIS base and pressure variation during air and ground transportation. Given the practical assumptions, we propose some heuristic transportation routes based on the simulation of altitude, transportation time, and availability of related factors. RESULTS: Currently, transportation by ground to the treatment facilities always passes high altitude areas above 152 feet. Also, available helicopters for air transportation could not approach the treatment facilities due to the limitation of flying distance and insufficiency of medical staff and treatment equipment. Altitude variation and delayed time were identified during the period of transportation by ground from Ganneung or Incheon to Tongyoung. Heuristic algorism through the above facts recommends air transport along coasts as the best method for transportation from Ganneung or Incheon to Tongyoung. CONCLUSION: In Korea, transportation by ground was not expected to result in the best prognosis for patients with acute dysbarism. Transportation by air should be considered first as the method of transportation. Also, for the best treatment of patients with acute dysbarism, additional treatment facilities need to be established in the west coast region.

Clinical evaluation of mandibular implant overdentures via Locator implant attachment and Locator bar attachment

PURPOSE: The aim of this study was to evaluate the clinical findings and patient satisfaction on implant overdenture designed with Locator implant attachment or Locator bar attachment in mandibular edentulous patients. MATERIALS AND METHODS: Implant survival rate, marginal bone loss, probing depth, peri-implant inflammation, bleeding, plaque, calculus, complications, and satisfaction were evaluated on sixteen patients who were treated with mandibular overdenture and have used it for at least 1 year (Locator implant attachment: n=8, Locator bar attachment: n=8). RESULTS: Marginal bone loss, probing depth, plaque index of the Locator bar attachment group were significantly lower than the Locator implant attachment group (P.05). The replacement of the attachment components was the most common complication in both groups. Although there was no correlation between marginal bone loss and plaque index, a significant correlation was found between marginal bone loss and probing depth. CONCLUSION: The Locator bar attachment group indicates lesser marginal bone loss and need for maintenance, as compared with the Locator implant attachment group. This may be due to the splinting effect among implants rather than the types of Locator attachment.