Immediate versus Non-immediate Loading Protocols for Reduced-diameter Implants Supporting Overdentures: A Systematic Review and Meta-analysis.

OBJECTIVE: This systematic review aimed to compare the influence of immediate and non-immediate loading protocols on overdentures retained by reduced-diameter implants(≦3.5mm). METHODS: Electronic databases, including MEDLINE (via PubMed), Embase and the Cochrane Central Register of Controlled Trials were searched for randomized controlled trials (RCTs) comparing clinical outcomes of immediately and nonimmediately loaded reduced-diameter implants supported overdentures. The risk of bias within and across the studies and the certainty of evidence were assessed by RoB 2.0 and GRADE, respectively. Sensitivity analysis was performed by eliminating studies at high risk of bias, and repeating the data synthesis employing the randomeffect model. Subgroup analyses were conducted based on the implant diameter and the length of follow-up. RESULTS: Six RCTs with 255 patients were included in this systematic review. The meta-analyses found similar implant survival rates between immediate and nonimmediate loaded implants in mini implant (RR=0.98; 95% CI=0.95, 1.01; p=0.12) and narrow implant subgroups (RR=0.99, 95% CI=0.94, 1.03, p =0.56), as well as in short-term (RR=0.98, 95% CI=0.97, 1.00, p =0.11) and long-term (RR=0.97, 95% CI=0.93, 1.01, p =0.09) follow-up subgroups. Additionally, marginal bone loss (MBL) showed no statistically significant difference between the loading protocols in the subgroup of long-term follow-up (MD=0.03; 95%CI=-0.16, 0.23; p=0.74). Three RCTs investigating peri-implant parameters found relatively higher modified plaque index and probing depth in reduced-diameter implant under immediate loading. CONCLUSION: Compared with non-immediate loading, the immediately loading protocol can achieve comparable survival rates and MBL in reduced-diameter implant retained overdentures.

Use of mini implants for the two-implant retained mandibular overdenture: A prospective study.

Background: The two-implant retained mandibular overdenture utilizing nonsplinted implants is a proven treatment modality for completely edentulous patients. However, a lacuna still exists regarding the suitability of mini dental implants for this purpose. The purpose of the study was to evaluate implant stability and crestal bone loss in single-piece mini dental implants loaded with immediate or conventional loading protocols to retain a mandibular overdenture. Method: Twenty-four completely edentulous patients were rehabilitated using conventional maxillary complete denture and a mandibular two-implant retained overdenture utilizing nonsplinted single piece mini implants. The implants were loaded with immediate or conventional loading protocols. Implant stability (with Periotest TM) and crestal bone loss (with radiovisiograph and radiographic grid) were evaluated at the time of loading and at one, two, and six months after loading. Statistical analysis was done with the Independent Samples "t" test and One-Way ANOVA. Results: Mean Periotest Values observed were significantly more negative in implants loaded with the conventional loading protocol. Crestal bone loss was significantly lesser in the immediate loading protocol but was still higher than the requisite 1.5 mm postulated by established criteria. Conclusion: Two single-piece nonsplinted mini implants may be sufficient to retain a mandibular overdenture utilizing the immediate loading protocol. Further studies with a longer duration of observation and larger sample size are required.

The effect of ball versus locator attachment system on the performance of implant supported overdenture: A systematic review.

Objective: This systematic review was aimed to compare ball and locator attachment system on the basis of clinical and biomechanical performance of implant supported overdenture as well as biological and patient related outcomes. Material and methods: Open and free electronic and manual searches were performed in digital databases including MEDLINE via PubMed, the Cochrane Database of Clinical Trials, and Scopus along with some other reliable sources. From the 667 retrieved records, 11 full-text controlled trials were included in this study. Risk of bias was assessed according to RoB 2.0 except for one RCT (economic evaluation), only assessed by CASP checklist. Results: From the 11 retrieved studies, total 183 locator and 219 ball attachments were identified in 452 subjects of 30 yrs-95 yrs of age. Studies provided data about prosthodontic complications or maintenance (replacement or the activation of matrix and patrix part, loss of retention, fracture and relining of the prosthesis, fracture of the attachment and the survival probability), oral health impact profile, soft tissue parameters and periodontal complications, marginal bone loss, patient related outcome and cost of the attachment systems. Only 5 studies were assessed at low risk bias, while other 6 at moderate to high risk of bias. Conclusion: Locator attachment system show lesser complications including loss of retention and lower maintenance appointments, lesser soft tissue, and periodontal complications than the ball attachment. Ball is better in terms of cost effectiveness. In other related outcomes, no significant differences were noted between ball and locator attachment.

Assessment of Quality of Life and Supporting Structures in Implant Retained Mandibular Overdenture: A 5-Year Cohort Study.

Aim: To assess oral health-related quality of life (OHRQoL), marginal bone loss (MBL), and changes in soft tissue including probing pocket depth and implant stability in 2 implants retained mandibular overdentures during 5 years follow-up periods. Methods: Forty completely edentulous patients with age 51-64 years were recruited for that longitudinal cohort study. Complete dentures were performed for all participants. Two implants (3.6 × 11.5 mm) were installed in the canine areas of the mandible. OHRQoL and MBL measures were performed every 1 year for 5 years, while clinical measures were made every 6 months for 60 months. Data were examined using repeated ANOVA and Friedman test. Results: Thirty-seven patients had 74 implants; with mean age 56 ± 3.6 years; 43% females (n = 16) and 57% males (n = 21) accomplished the study. There were statistically significant differences in OHRQoL, MBL, and changes in soft tissue, including probing pocket depth and implant stability in 2 implants retained mandibular overdentures during 5 years follow-up periods, p ≤ 0.05. Conclusion: Mandibular overdentures retained by 2 implants provide a positive long-term effect on OHRQoL, MBL, probing pocket depth, and implant stability.

Evaluation of Retention, Wear, and Maintenance of Attachment Systems for Single- or Two-Implant-Retained Mandibular Overdentures: A Systematic Review.

Attachment systems (AS) enhance retention and stability by anchoring the overdentures to implants. Since 2002, the McGill consensus statement recommends the 2-implant-retained overdentures as the standard choice for edentulous mandible (2-IRMO). Considering the large number of AS available, it remains difficult for a practitioner to make a reasoned choice. A systematic review was conducted in PubMed/Medline and carried out independently by three authors, on retention, wear, and maintenance of AS used clinically or in vitro specifically for 1- or 2-IRMO. The 45 selected studies include 14 clinical and 31 in vitro studies. The risk of bias was evaluated according to the revised Cochrane risk of bias tool for randomized trials (RoB 2). The initial retention force of the cylindrical system is higher than the ball system. The retention loss, related to the wear of the retention device, is responsible for the most common need of maintenance, requiring activation or replacement. Plastic retention devices wear out faster and more significantly than metal ones, implying a worse time behavior of cylindrical systems, but their maintenance rate is similar. Neither system appears categorically superior. Cylindrical systems provide higher initial retention than ball ones; this advantage reduces over time with wear without affecting their need for maintenance.

Marginal Bone Loss around Implant-Retaining Overdentures versus Implant-Supported Fixed Prostheses 12-Month Follow-Up: A Retrospective Study.

Few studies have compared marginal bone loss (MBL) around implant-retaining overdentures (IODs) vs. implant-supported fixed prostheses (FPs). This study evaluated the mean MBL and radiographic bone-implant interface contact (r-BIIC) around IODs and implant-supported FPs. We also investigated osseointegration and MBL around non-submerged dental implants. We measured the changes between the MBL in the mesial and distal sites immediately after prosthetic delivery and after one year. The mean MBL and its changes in the IOD group were significantly higher. The mean percentage of r-BIIC was significantly higher in the FP group. MBL and its changes in males were significantly higher in the IOD group. The percentage of r-BIIC was significantly higher in the FP group. MBL in the lower site in the IOD group was significantly higher. Regarding MBL, the location of the implant was the only significant factor in the IOD group, while gender was the only significant predictor in the FP group. Regarding the r-BIIC percentage, gender was a significant factor in the FP group. We concluded that non-submerged dental implants restored with FPs and IODs maintained stable bone remodeling one year after prosthetic delivery.

Differences in self-perceived OHRQoL between fully dentate subjects and edentulous patients depending on their prosthesis type, socio-demographic profile, and clinical features.

OBJECTIVES: This observational cross-sectional study aimed to evaluate and compare the oral health-related quality of life (OHRQoL) and clinical performance between dentate subjects and edentulous patients restored with conventional dentures or implant overdentures. METHODS: 85 edentulous patients were grouped as follows: Group-1 (CD): conventional denture wearers (n = 42), and Group-2 (IO): implant-retained overdenture wearers (n = 43). For the OHRQoL comparisons, a control group of subjects with a healthy natural dentition (Group-3, ND; n = 50) was included. Participants completed three validated questionnaires (OHIP-14sp, OHIP-20sp, and QoLIP-10). Socio-demographic data, prosthesis-related factors, clinical condition of the mouth, and patient subjective evaluations, were gathered. Descriptive and non-parametric probes were run (α = 0.05). RESULTS: The ND group was the most unsatisfied (OHIP-14sp; p ≤ 0.001). The OHIP-20sp attributed significantly worse Psychological disability (p = 0.029) and Handicap (p = 0.027) to CD wearers when compared to IO wearers. The CD group showed the significantly highest need for relining (p = 0.041), and the lowest retention (p = 0.011). The OHIP-14sp disclosed a significantly worse OHRQoL for those volunteers who had a job (p = 0.003), a basic education instead of a secondary one (p = 0.022), and no partner (p = 0.006). CONCLUSIONS: The overall OHRQoL was comparable for both prosthodontic groups, being modulated by socio-demographic and prosthesis-related features. Nonetheless, CD wearers presented prosthetic complications more frequently. CLINICAL SIGNIFICANCE: While dentate subjects were the most critical about their oral condition and its repercussion in their life, implant overdenture wearers tended to observe a better OHRQoL and clinical performance compared to conventional denture wearers.

Influence of marginal bone resorption on two mini implant-retained mandibular overdenture: An in vitro study.

PURPOSE: To investigate the biomechanical effect of marginal bone resorption (MBR) on the mandibular mini implant (MI)-retained overdenture (MI-OD) on the edentulous model. MATERIALS AND METHODS: The experimental mandibular edentulous model was modified from a commercial model with 2 mm thick artificial soft tissue under denture base. Two MIs (Φ2.6 mm × 10 mm) were bilaterally placed between the lateral incisor and the canine area and attached with magnetic attachments. Three groups were set up as follows: 1) alveolar bone around the MI without MBR (normal group), 2) with MBR to 1/2 the length of the implant (resorption group), and 3) complete denture (CD) without MI (CD group). Strain around the MI, pressure near the first molar area, and displacement of denture were simultaneously measured, loading up to 50 N under bilateral/unilateral loading. Statistical analysis was performed using independent-samples t test and one-way ANOVA (α=.05). RESULTS: The strain around the MI with MBR was approximately 1.5 times higher than that without MBR. The pressure in CD was higher than in MI-ODs (P <.05), while there was no statistical difference between the normal and resorption group (P >.05). Similarly, the CD demonstrated a greater displacement of the denture base than did the MI-ODs during bilateral and unilateral loadings (P <.05). CONCLUSION: The strain around the MI with MBR was approximately 1.5 times higher than that without MBR. The pressure on posterior alveolar ridge and denture displacement of MI-ODs significantly decreased compared to CDs, even when MBR occurs. Bilateral balanced occlusion was recommended for MI-ODs, especially when MBR occurred.

Effects of immediate and delayed loading protocols on marginal bone loss around implants in unsplinted mandibular implant-retained overdentures: a systematic review and meta-analysis.

BACKGROUND: Immediate loading has recently been introduced into unsplinted mandibular implant-retained overdentures for the management of edentulous patients due to their increasing demand on immediate aesthetics and function. However, there is still a scarcity of meta-analytical evidence on the efficacy of immediate loading compared to delayed loading in unsplinted mandibular implant-retained overdentures. The purpose of this study was to compare the marginal bone loss (MBL) around implants between immediate and delayed loading of unsplinted mandibular implant-retained overdentures. METHODS: Randomized controlled trials (RCTs), controlled clinical trials (CCTs), and cohort studies quantitatively comparing the MBL around implants between immediate loading protocol (ILP) and delayed loading protocol (DLP) of unsplinted mandibular overdentures were included. A systematic search was carried out in PubMed, EMBASE, and CENTRAL databases on December 02, 2020. "Grey" literature was also searched. A meta-analysis was conducted to compare the pooled MBL of two different loading protocols of unsplinted mandibular overdentures through weighted mean differences (WMDs) with 95% confidence intervals (95% CIs). The subgroup analysis was performed between different attachment types (i.e. Locator attachment vs. ball anchor). The risk of bias within and across studies were assessed using the Cochrane Collaboration's tool, the Newcastle-Ottawa scale, and Egger's test. RESULTS: Of 328 records, five RCTs and two cohort studies were included and evaluated, which totally contained 191 participants with 400 implants. The MBL of ILP group showed no significant difference with that of DLP group (WMD 0.04, CI - 0.13 to 0.21, P > .05). The subgroup analysis revealed similar results with Locator attachments or ball anchors (P > .05). Apart from one RCT (20%) with a high risk of bias, four RCTs (80%) showed a moderate risk of bias. Two prospective cohort studies were proved with acceptable quality. Seven included studies have reported 5.03% implant failure rate (10 of 199 implants) in ILP group and 1.00% failure rate (2 of 201 implants) in DLP group in total. CONCLUSIONS: For unsplinted mandibular implant-retained overdentures, the MBL around implants after ILP seems comparable to that of implants after DLP. Immediate loading may be a promising alternative to delayed loading for the management of unsplinted mandibular implant-retained overdentures. PROSPERO registration number: CRD42020159124.

General health status of Dutch elderly receiving implant-retained overdentures: A 9-year big data cross-sectional study.

BACKGROUND: Very little information is available on the general health of elderly who are provided with an implant-retained overdenture (IOD). PURPOSE: The general health status of three groups of elderly (≥75 years) were compared: those with a natural dentition (ND), those treated with an implant-retained overdenture (IOD), and those wearing a conventional denture (CD). MATERIALS AND METHODS: Data on healthcare costs were obtained from records of Dutch health insurers that are collected by Vektis. Data on general health (chronic diseases, medication use, and polypharmacy) were acquired for elderly patients with a ND, an IOD, and a CD in 2009 and 2017. Data on the general health of elderly who received an IOD were also acquired from 2010 through 2016. RESULTS: On average, the general health of elderly who received an IOD was comparable to general health of elderly with a ND and was better than the general health of elderly with a CD (lower prevalence of diabetes, cardiac disease, and hypertension). The general health profile of elderly receiving an IOD was consistent during all years. CONCLUSIONS: The general health of elderly with a ND or IODs is better than those with CDs.

Crestal Bone Changes and Patient Satisfaction with Single Implant-Retained Mandibular Overdentures with Dalla Bona and Locator Attachments with Immediate Loading Protocols. A Randomized Controlled Clinical Study.

PURPOSE: There is no enough evidence present on the success of single implant-retained mandibular overdentures (SIMO) with Dalla Bona and Locator attachments. This study aims to compare crestal bone loss and patient satisfaction with SIMO with Dalla Bona and Locator attachment following immediate loading protocols. MATERIAL AND METHODS: Twelve patients included in Group 1 received immediate SIMO with Dalla Bona attachments, and another twelve patients in Group 2 received immediate SIMO with Locator attachments in the mid symphyseal region. The follow-up was scheduled at 6 and 12 months after implant placement. The patient satisfaction with the denture was evaluated with the visual analog scale (VAS) score. The data obtained were statistically analyzed with the independent student t-test for intergroup comparison and repeated measures of ANOVA followed by Bonferroni's Post hoc analysis for intragroup comparison of mean crestal bone loss at a different time interval. RESULTS: Ten patients each in both the groups were available for follow-up. Crestal bone loss at 6 months follow-up for Dalla Bona group was 0.42 ± 0.10 mm on the mesial side and 0.43 ± 0.14 mm on the distal side and at 1 year 1.54 ± 0.16 mm on the mesial side and 1.66 ± 0.13 mm on the distal side. The mean crestal bone loss at 6 months follow-up for Locator group was 0.48 ± 0.16 mm on the mesial side and 0.45 ± 0.11 mm on the distal side and at 1 year was 1.71 ± 0.22 mm on mesial side and 1.74 ± 0.28 mm on the distal side. There was difference in bone loss at 6 months (mesial: 0.06 mm, p = 0.327; distal:0.02 mm; p = 0.726) and at 1 year (mesial: 0.17 mm, p = 0.063; distal: 0.08 mm; p = 0.423) in between two groups but the difference was statistically insignificant. There was a significant difference found in the VAS score for patient satisfaction with SIMO with Dalla Bona attachments and Locator attachments at 6 months (54.2 vs. 51.8, p = 0.005) and 1 year (60.6 vs. 55.2, p = 0.005). CONCLUSIONS: Patient satisfaction with SIMO with Dalla Bona attachments was higher during the follow-up. SIMO with Dalla Bona attachments had less crestal bone loss and less prosthetic complications when compared to Locator attachments, although the difference in the bone loss was statistically insignificant.

Computerised occlusal analysis of mini-dental implant-retained mandibular overdentures: A 1-year prospective clinical study.

Occlusal analysis is a substantial tool for the functional improvement evaluation after using implant-retained overdenture comparing to complete denture without dental implant retaining. To evaluate occlusal pattern, chewing force distribution in mini-dental implant-retained mandibular overdentures by computerised occlusal analysis system and to compare patient satisfaction after 1-year function. Thirty-one patients wearing complete dentures were included in the study. Prior to mini-dental implant-retained treatment, all patients were assessed for occlusion and force distribution using computerised occlusal analysis system (T-Scan® ), and then, all patients received two mini-dental implant-retained mandibular overdentures. Mini-dental implants were immediately loaded using low vertical profile attachments (Equator® ). T-Scan® was used to evaluate chewing force and force distribution at 1 day, 3 months, 6 months and 12 months. The patient satisfactions before implant placement and after 1 year were evaluated using questionnaires which included satisfaction of denture quality, psychosocial behaviour and chewing efficiency modified from the validated questionnaires. Clinical evaluation of two mini-dental implant-retained mandibular overdentures showed 100% success rate after 1 year. T-Scan® demonstrated that maximum occlusal contact force increased continuously. The force distribution; the tooth contact number increased over the period. At 1-year follow-up, overall patient satisfaction was significantly greater than before receiving mini-dental implant treatment (P < .001). Using computerised occlusal analysis, mini-dental implants improve complete denture function significantly in terms of maximum occlusal contact force, tooth contact number without the impairment of force distribution. The oral function of the patients has been enhanced.

A low-profile universal attachment system with housing welded to metal reinforcement framework to retain mandibular implant overdenture: A clinical report.

Literature has proved that implant-retained overdenture is one of the best prosthetic options in the rehabilitation of complete edentulism. Tissue-supported implant-retained overdentures have been an appropriate treatment modality for atrophic mandibular ridges. In this case report, the patient presented with Class I maxillomandibular relationship and Class II Prosthodontic Diagnostic Index. The patient was concerned about esthetics as well as the retention of the lower denture. Taking into consideration the above concerns, an implant-retained mandibular overdenture was the chosen treatment modality. There are numerous attachment systems that have been used to improve the retention, stability, and support of implant-retained overdenture. Every attachment system has its own set of advantages. The OT Equator is a new line of low-profile attachment which is a radically modified OT-CAP Normo. The rationale for using this attachment is that it is considered the smallest attachment system available with the least overall dimension. It is a resilient and self-aligning attachment system which can be used in limited inter-arch space situation. OT equator derives its name from the OT Dental Laboratory (Bologna, Italy) used as a brand name. Considering these advantages, this was the chosen attachment and proved beneficial in terms of both patient satisfaction and the overall success of the treatment.

Blood Flow Alterations in the Anterior Maxillary Mucosa as Induced by Implant-Retained Overdenture.

PURPOSE: Blood flow disturbance from functional pressure may lead to ischemia and accumulation of metabolites leading to residual ridge resorption (RRR) underneath complete dentures. The purposes of this study were to determine the effect of mandibular complete denture (CD) and implant-retained overdenture (IRO) on blood flow disturbance in the opposing denture bearing-mucosa of maxillary CD and to compare the blood flow disturbance to RRR of the anterior maxilla. MATERIALS AND METHODS: The test group included 9 participants rehabilitated by maxillary CD opposing mandibular IRO, while the control group consisted of 4 participants with CDs. Blood flow was measured by laser Doppler flowmetry (LDF) after denture removal for 0, 30, 60, and 90 minutes. RRR was quantified as reduction in bone volume a year post-treatment. The measurement of blood flow was then compared to the quantification of RRR. RESULTS: The mean blood flow measure for the IRO group was significantly lower than CD after immediate denture removal and 30 minutes later. After 60 minutes, the mean difference was not significant between groups, and at 90 minutes, the mean blood flow of both groups equalized to reach a steady state of 377 BPU. The mandibular IRO had reduced the initial blood flow measure in the opposing anterior maxilla mucosa to almost a quarter (103 BPU) of the steady state value (377 BPU) compared to the CD, which reduced it to only about one half (183 BPU), suggesting greater blood flow disturbance in the IRO group. This result is in tandem with the greater reduction of bone volume observed in the IRO group, which was 7.3 ± 1.3% after a year, almost three times higher than CD group at 2.6 ± 1.7%. CONCLUSION: IRO may cause significantly higher blood flow disturbance than CD and may have contributed to greater RRR in the anterior maxilla.

Prosthetic rehabilitation of edentulous mandible with two-implant retained fixed hybrid prosthesis: A case report.

Removable complete dentures have been the most costeffective treatment option for edentulous jaws since decades. However, certain problems are encountered by the patients such as stability of the lower dentures resulting in poor masticatory efficiency. Ridge resorption and inadequate bony support are the long-term complications comprising the stability of the denture and patient finding it difficult to control denture movement during speaking and eating reducing patient compliance. Mandibular implant retained over dentures or hybrid dentures have shown to be better alternatives in terms of retention, stability and patient satisfaction. Two implants provide cost-effective, stabilized and comfortable treatment options. The present case report discusses the management of the patient with compromised dentition in which all teeth were extracted followed by conventional upper complete denture and lower two implant supported fixed hybrid dentures with splinted bar attachment.

Effects of different numbers of mini-dental implants on alveolar ridge strain distribution under mandibular implant-retained overdentures.

PURPOSE: To investigate the strains around mini-dental implants (MDIs) and retromolar edentulous areas when using different numbers of MDIs in order to retain mandibular overdentures. MATERIALS AND METHODS: Four different prosthetic situations were fabricated on an edentulous mandibular model including a complete denture (CD), and three overdentures, retained by four, three or two MDIs in the interforaminal region with retentive attachments. A static load of 200N was applied on the posterior teeth of the dentures under bilateral or unilateral loading conditions. The strains at the mesial and distal of the MDIs and the retromolar edentulous ridges were measured using twelve strain gauges. Comparisons of the mean microstrains among all strain gauges in all situations were analyzed. RESULTS: The strain distribution determined during bilateral loading experienced a symmetrical distribution; while during unilateral loading, the recorded strains tended to change from compressive strains on the loaded side to tensile strains. Overall, the number of MDIs was found to be passively correlated to the generated compressive strain. The highest strains were recorded in the four MDIs followed by three, two MDIs retained overdenture and CD situations, respectively. The highest strain was found around the terminal MDI. CONCLUSIONS: The use of a low number of MDIs tends to produce low strain values in the retromolar denture-bearing area and around the terminal MDIs during posterior loadings. However, when using a high number of MDIs, the overdenture tends to have more stability during function.

Implant-retained overdenture with CM LOC ® Pekkton® in maxillary edentulous patient

Treatment options for edentulous patients are complete denture and implant prosthesis. A two implant-retained overdenture can be considered the first treatment in the edentulous mandible, but there is no clear consensus of treatment for edentulous maxilla. Implant-retention/support overdenture shows better retention and stability than complete denture and is less expensive and more esthetic than implant-supported fixed prosthesis. CM LOC® Pekkton® attachment is a solitary type attachment and evaluated to have excellent abrasion resistance and retention with a female part made of poly-ether-ketone-ketone. Meanwhile, SR Ivocap system is injection molding method and discussed to show few changes in the vertical dimension of denture and have excellent fracture resistance. In this case, we restored maxillary arch with a four implant-retained overdenture using CM LOC® Pekkton® and SR Ivocap system, and mandibular arch with a removable partial denture. Through this procedure, satisfactory outcomes were achieved both in functional and esthetic aspects.

The implant retained overdenture by Locator attachments on the edentulous mandible using Parallel guide KIT®: a case report

Overdenture using dental implants could improve the problems of conventional complete denture function which are pain during mastication, insufficient retention and stability. Locator attachment used widely for implant-retained overdenture has advantages that it needs the smallest vertical space and also its nylon male cap allows personalized retention for each case. However its retention force decreases rapidly with function rather than the bar and ball attachment. So, implant fixture should be positioned as parallel as possible.

Oral aesthetic-related quality of life of muco-supported prosthesis and implant-retained overdenture wearers assessed by a new, short, specific scale (QoLDAS-9).

OBJECTIVES: To validate a new questionnaire for evaluating the 'Oral aesthetic-related quality of life (OARQoL)' of prosthetically restored patients. 'OARQoL' assesses the impact of the self-perceived dental aesthetics on patients' well-being. METHODS: The 'Quality of Life associated with Dental Aesthetic Satisfaction (QoLDAS)' index was designed. After a pilot trial, 70 patients were distributed into two groups depending on their type of prosthetic rehabilitation: Group 1 (CD; n=34): muco-supported complete dentures, and Group 2 (IO; n=36): implant-retained overdentures. Patients answered the QoLDAS and the Oral Health Impact Profile (OHIP-20sp) questionnaires, and reported their satisfaction on a visual analogue scale (VAS). Socio-demographic and prosthesis-related factors were registered. Psychometric properties of the QoLDAS were investigated. Correlations between both indices were explored using the Spearman's rank test. Descriptive and non-parametric probes were run to evaluate the effect of the study variables on the OARQoL (α=0.05). RESULTS: The QoLDAS-9 was reliable and valid. The factor analysis confirmed the existence of three dimensions and meaningful inter-correlations among the nine finally included items. Both scales were inversely correlated. The self-reported aesthetic and functional satisfaction and the education level significantly modulated the OARQoL as measured with the QoLDAS-9. CONCLUSIONS: The QoLDAS-9 confirmed its psychometric capacity for assessing the OARQoL of CD and IO wearers. Both groups showed comparably high OARQoL. Superior education degrees lead to lower OARQoL. CLINICAL SIGNIFICANCE: The QoLDAS-9 may be recommended for anticipating the effect of prosthetic restorations on OARQoL. CD and IO are predictable treatment options for improving the aesthetic self-perception of edentulous patients.

Simplified Technique for Incorporating a Metal Mesh into Record Bases for Mandibular Implant Overdentures.

Mandibular implant-retained overdentures have become the standard of care for patients with mandibular complete edentulism. As part of the treatment, the mandibular implant-retained overdenture may require a metal mesh framework to be incorporated to strengthen the denture and avoid fracture of the prosthesis. Integrating the metal mesh framework as part of the acrylic record base and wax occlusion rim before the jaw relation procedure will avoid the distortion of the record base and will minimize the chances of processing errors. A simplified method to incorporate the mesh into the record base and occlusion rim is presented in this technique article.