The Effect of the Length and Distribution of Implants for Fixed Prosthetic Reconstructions in the Atrophic Posterior Maxilla: A Finite Element Analysis.

In this study, different prosthetic designs that could be applied instead of advanced surgical techniques in atrophic maxilla were evaluated with finite element analysis. Atrophic posterior maxilla was modeled using computer tomography images and four models were prepared as follows: Model 1 (M1), two implants supporting a three-unit distal cantilever prosthesis; Model 2 (M2), two implants supporting a three-unit conventional fixed partial denture; Model 3 (M3), three implants supporting three connected crowns; and Model 4 (M4), two implants supporting two connected crowns. Implants 4 mm in width and 8 mm or 13 mm in length were used. A linear three-dimensional finite element programme was used for analysis. The maximum principle stress (tensile) and minimum principle stress (compressive) were used to display stress in cortical and cancellous bones. The von Mises criteria were used to evaluate the stress on the implants. M1 was found to be the most risky model. The short dental arch case (M4) revealed the lowest stresses among the models but is not recommended when one more implant can be placed because of the bending forces that could occur at the mesial implant. In M2 and M3, the distal implants were placed bicortically between the crestal and sinus cortical plates, causing a fall of the stresses because of the bicortical stability of these implants.

Limbus Vertebra Presenting with Inflammatory Low Back Pain: A Case Report.

Limbus vertebra is a condition characterized by marginal interosseous herniation of the nucleus pulposus, and causes non specific symptoms like low back pain, back pain, muscle spasms and radiculopathy. It is frequently confused with vertebral fracture, infection, schmorl nodule or tumour because it has not a spesific symptom. It usually causes mechanical low back pain rather than inflammatory low back pain. We reported a patient presented with inflammatory low back pain and diagnosed with anterior limbus vertebra because it is rare and the patient has atypical clinical presentation.

Clinical and Radiographic Evaluation of Marginal Bone Changes around Platform-Switching Implants Placed in Crestal or Subcrestal Positions: A Randomized Controlled Clinical Trial.

BACKGROUND: It has been reported in many articles that marginal bone resorptions are prevented by platform-switching design. However, what occurs when these implants are placed in the apical position is not completely known. PURPOSE: This report describes a randomized controlled clinical trial study that aims to test the hypothesis that less resorption will occur when platform-switching implants are placed 1 mm below bone level. MATERIALS AND METHODS: A total of 56 randomly selected implants were inserted bilaterally, either 1 mm below bone level (test group, 28 implants) or at bone level (control group, 28 implants) of the patients' posterior regions. Marginal bone resorptions were examined through periapical radiographies taken with the parallel technique at the time of crown cementation and the third, sixth, 12th, and 36th months after prosthetic loading. The modified plaque index, gingival index, bleeding on probing, and probing depths were used for follow-up periodontal care of the implants. RESULTS: After 3 years, the mean radiographic vertical bone loss in the control group was significantly lower than in the test group (0.56 ± 0.35 mm and 1.21 ± 1.05 mm, respectively) (p < .01). In terms of periodontal indexes, there were no statistically significant differences between the two groups (p > .05). No peri-implantitis or peri-implant mucositis was observed around the test or control implants. CONCLUSIONS: More marginal bone resorptions occurred after the third year of loading in implants placed 1 mm below bone level. However, the resorptions did not reach the implants thread. In the control group, the first bone implant contact was placed under the level of the first threads. Therefore, the present randomized clinical trial confirmed the hypothesis that placing platform-switching implants 1 mm below bone level reduced marginal bone loss. It can be noted that to reduce resorption, platform-switching implants should be placed below bone level.

Sinus Augmentation With Platelet-Rich Fibrin in Combination With Bovine Bone Graft Versus Bovine Bone Graft in Combination With Collagen Membrane.

The purpose of this study was to compare the efficacy between the use of bovine bone graft material and platelet-rich fibrin (PRF) mixture (test group) and bovine bone graft material and collagen membrane combination (control group) in 2-stage maxillary sinus augmentation. According to specific inclusion/exclusion criteria, patients treated between 2008 and 2012 were selected. Panoramic radiographs were used for radiologic assessments. To evaluate the relationship between sinus-graft height and each implant, the bone level (BL) was divided by implant length (IL). To evaluate the change in the height of grafted sinus, the grafted sinus floor above the lowest part of the original sinus height (GSH) was divided by the original sinus height (OSH). Samples taken during implant surgery were used for histologic and histomorphometric analyses. Twenty-five patients, 32 augmentation surgeries, and 66 one-stage implants were included in the study. No implant loss or complication was observed in either group. There were no statistical differences according to new bone formation (P = .61) and biomaterial remnant (P = .87). During the evaluation period, the test group showed statistically less change in the BL/IL ratio (P = .022). The difference of GSH/OSH ratio was found to be insignificant between groups (P = .093). It was observed that the grafted sinus covering the implant apex and sinus floor was above the original sinus height in both groups. It may be concluded from this study that both combinations can be successfully used for sinus augmentation. Further studies evaluating different graft materials and PRF combinations in the early phases of healing would be beneficial.

Effects of Light-Emitting Diode Photobiomodulation Therapy and BioOss as Single and Combined Treatment in an Experimental Model of Bone Defect Healing in Rats.

The present study assesses histopathologically and histomorphometrically the effects of light-emitting diode (LED) photobiomodulation therapy (LPT) on bone healing in BioOss-filled femoral defects of rats. It has been reported that LPT modulates cellular metabolic processes, leading to an enhanced regenerative potential for biological tissues. Thirty-six male Wistar rats with femoral bone defects were divided into 4 groups: defect group (empty bone defect, without application of LPT), graft group (bone defect filled with BioOss, without application of LPT), (defect+LPT) group (empty bone defect, with application of LPT), and (graft+LPT) group (bone defect filled with BioOss, with application of LPT). An OsseoPulse LED device (wavelength: 618 nm; output power: 20 mW/cm(2)) was initiated 24 hours postsurgery and performed every 24 hours for 7, 14, and 21 days. The LPT-applied and BioOss-filled defects presented a higher amount of new bone formation with trabeculae formation. These defects showed statistically significant lower values of inflammation severity, and fewer remnants of biomaterial were present. Within the limitations of this study, LPT has positive effects on bone healing histopathologically and histomorphometrically for the defects filled with BioOss 3 weeks after the rats' femora injury.

Antibacterial Activity of As-Annealed TiO2 Nanotubes Doped with Ag Nanoparticles against Periodontal Pathogens.

It is important to develop functional transmucosal implant surfaces that reduce the number of initially adhering bacteria and they need to be modified to improve the anti-bacterial performance. Commercially pure Ti sheets were anodized in an electrolyte containing ethylene glycol, distilled water and ammonium fluoride at room temperature to produce TiO2 nanotubes. These structures were then annealed at 450°C to transform them to anatase. As-annealed TiO2 nanotubes were then treated in an electrolyte containing 80.7 g/L NiSO4 ·7H2O, 41 g/L MgSO4 ·7H2O, 45 g/L H3BO3, and 1.44 g/L Ag2SO4 at 20°C by the application of 9 V AC voltage for doping them with silver. As-annealed TiO2 nanotubes and as-annealed Ag doped TiO2 nanotubes were evaluated by SEM, FESEM, and XRD. Antibacterial activity was assessed by determining the adherence of A. actinomycetemcomitans, T. forsythia, and C. rectus to the surface of the nanotubes. Bacterial morphology was examined using an SEM. As-annealed Ag doped TiO2 nanotubes revealed intense peak of Ag. Bacterial death against the as-annealed Ag doped TiO2 nanotubes were detected against A. actinomycetemcomitans, T. forsythia, and C. rectus indicating antibacterial efficacy.

Implant positioning errors in freehand and computer-aided placement methods: a single-blind clinical comparative study.

PURPOSE: Simultaneous insertion of multiple implants may exhibit suboptimal positions, especially in edentulous jaws considered for a fixed restoration. The aim of this study was to compare the incidence of and confounding factors in implant positioning errors related to the use of freehand and computer-aided treatment methods. MATERIALS AND METHODS: A total of 353 implants were placed in 54 patients with at least one edentulous jaw using freehand and computer-aided methods involving 16 mucosa- and 12 bone-supported single- and multiple-type stereolithographic surgical guides. At the stage of prosthesis delivery, a blinded examiner evaluated seven positioning error criteria. Results were analyzed by chi-square test and logistic regression. RESULTS: Interproximal emergence (OR = 2.82, P < .0001), insufficient interimplant distance (OR = 1.42, P < .0001), and improper parallelism (OR = 1.24, P = .001) errors were significantly higher in implants placed by the freehand method. The highest probability of positioning error (88%) was associated with the use of the freehand method, whereas the lowest (6%) was associated with single-type, mucosa-supported guides with other significant confounding factors. CONCLUSION: Utilizing computer-aided methods may alleviate the occurrence of implant positioning errors that are frequently associated with the freehand method. The use of software planning with enhanced viewing capabilities and single-type, mucosa-supported stereolithographic surgical guides in suitable patients minimizes errors.

Conventional multi-slice computed tomography (CT) and cone-beam CT (CBCT) for computer-aided implant placement. Part II: reliability of mucosa-supported stereolithographic guides.

PURPOSE: Deviations of implants that were placed by conventional computed tomography (CT)- or cone beam CT (CBCT)-derived mucosa-supported stereolithographic (SLA) surgical guides were analyzed in this study. MATERIALS AND METHODS: Eleven patients were randomly scanned by a multi-slice CT (CT group) or a CBCT scanner (CBCT group). A total of 108 implants were planned on the software and placed using SLA guides. A new CT or CBCT scan was obtained and merged with the planning data to identify the deviations between the planned and placed implants. Results were analyzed by Mann-Whitney U test and multiple regressions (p < .05). RESULTS: Mean angular and linear deviations in the CT group were 3.30° (SD 0.36), and 0.75 (SD 0.32) and 0.80 mm (SD 0.35) at the implant shoulder and tip, respectively. In the CBCT group, mean angular and linear deviations were 3.47° (SD 0.37), and 0.81 (SD 0.32) and 0.87 mm (SD 0.32) at the implant shoulder and tip, respectively. No statistically significant differences were detected between the CT and CBCT groups (p = .169 and p = .551, p = .113 for angular and linear deviations, respectively). CONCLUSIONS: Implant placement via CT- or CBCT-derived mucosa-supported SLA guides yielded similar deviation values. Results should be confirmed on alternative CBCT scanners.

Conventional multi-slice computed tomography (CT) and cone-beam CT (CBCT) for computer-assisted implant placement. Part I: relationship of radiographic gray density and implant stability.

PURPOSE: The relationship of conventional multi-slice computed tomography (CT)- and cone beam CT (CBCT)-based gray density values and the primary stability parameters of implants that were placed by stereolithographic surgical guides were analyzed in this study. MATERIALS AND METHODS: Eighteen edentulous jaws were randomly scanned by a CT (CT group) or a CBCT scanner (CBCT group) and radiographic gray density was measured from the planned implants. A total of 108 implants were placed, and primary stability parameters were measured by insertion torque value (ITV) and resonance frequency analysis (RFA). Radiographic and subjective bone quality classification (BQC) was also classified. Results were analyzed by correlation tests and multiple regressions (p < .05). RESULTS: CBCT-based gray density values (765 ± 97.32 voxel value) outside the implants were significantly higher than those of CT-based values (668.4 ± 110 Hounsfield unit, p < .001). Significant relations were found among the gray density values outside the implants, ITV (adjusted r(2) = 0.6142, p = .001 and adjusted r(2) = 0.5166, p = .0021), and RFA (adjusted r(2) = 0.5642, p = .0017 and adjusted r(2) = 0.5423, p = .0031 for CT and CBCT groups, respectively). Data from radiographic and subjective BQC were also in agreement. CONCLUSIONS: Similar to the gray density values of CT, that of CBCT could also be predictive for the subjective BQC and primary implant stability. Results should be confirmed on different CBCT scanners.

Efficacy of quick-release lornoxicam versus placebo for acute pain management after dental implant surgery: a randomised placebo-controlled triple-blind trial.

AIM: To assess the efficacy of quick-release lornoxicam (LNX) on patient-reported acute pain after dental implant surgery. MATERIALS AND METHODS: The study included subjects in good general health, aged 18 to 65 and scheduled to receive a maximum of three implants in the same quadrant. Participants received either 8 mg LNX or placebo and were asked to use the medications in case of pain in the first 120 min after implant surgery. Assessment of efficacy was performed using self-assessment questionnaires for the evaluation of pain intensity and pain relief for 12 h post dosing. Patients were also asked to record the rescue analgesic number. Evaluation of patient satisfaction was assessed using a 7-point scale. Safety was evaluated by the incidence of adverse events. RESULTS: A total of 83 (LNX/placebo, 42/41) patients who met the inclusion criteria and finished the evaluation period were included in the study. The proportion of patients experiencing postoperative pain was significantly lower in the LNX-treated group compared to the placebo group. Patients in the LNX group reported significantly higher pain relief scores than the placebo group. Twenty-nine patients in the placebo group and 6 patients in the LNX group used rescue analgesics. The number of used rescue analgesics was 1.024 ± 0.79 and 0.167 ± 0.43 in the placebo and LNX groups, respectively. The level of patient satisfaction was significantly higher in the LNX-treated patients (P = 0.007). No adverse events were reported during the study period. CONCLUSIONS: Quick-release LNX is effective in postoperative acute pain control and has a high safety profile following dental implant surgery.

Bacteremia following dental implant surgery: Preliminary results

Objectives: The aims of this study were to investigate the incidence of bacteremia, bacteriology and antibiotic susceptibility against to causative bacteria associated with dental implant installation. Study Design: 30 generally healthy patients were enrolled in this study. Blood samples were collected at baseline and at 30 minutes after dental implant installation and 24 hours after dental implant surgery. Blood samples were cultured in a BACTEC system. The isolated bacteria were identified using conventional methods. Antimicrobial sensitivity tests were performed by disc diffusion. Results: No bacteria were isolated at the baseline and 24 hours after surgery, whereas the prevalence of bacteremia at 30 minutes after dental implant installation was 23%. The isolated bacteria species were Staphylococcus epidermidis, Eubacterium spp., Corynebacterium spp. and Streptococcus viridans. The Staphylococcus epidermidis, which was isolated in three patients, was found to be resistant to penicillin which is first choice of manyclinicians. Conclusion: Our findings suggest that installation of dental implants can produce bacteremia. Within the limitations of this study, it can be speculated that the resistance of antibiotics may compromise the routine prophylaxis against infective endocarditis. Therefore use of blood cultures and antibiograms may be suggested in risky patients.The outcome of the present study should be verified using a larger patient group with varying conditions (AU)

Bacteremia following dental implant surgery: preliminary results.

OBJECTIVES: The aims of this study were to investigate the incidence of bacteremia, bacteriology and antibiotic susceptibility against to causative bacteria associated with dental implant installation. STUDY DESIGN: 30 generally healthy patients were enrolled in this study. Blood samples were collected at baseline and at 30 minutes after dental implant installation and 24 hours after dental implant surgery. Blood samples were cultured in a BACTEC system. The isolated bacteria were identified using conventional methods. Antimicrobial sensitivity tests were performed by disc diffusion. RESULTS: No bacteria were isolated at the baseline and 24 hours after surgery, whereas the prevalence of bacteremia at 30 minutes after dental implant installation was 23%. The isolated bacteria species were Staphylococcus epidermidis, Eubacterium spp., Corynebacterium spp. and Streptococcus viridans. The Staphylococcus epidermidis, which was isolated in three patients, was found to be resistant to penicillin which is first choice of many clinicians. CONCLUSION: Our findings suggest that installation of dental implants can produce bacteremia. Within the limitations of this study, it can be speculated that the resistance of antibiotics may compromise the routine prophylaxis against infective endocarditis. Therefore use of blood cultures and antibiograms may be suggested in risky patients. The outcome of the present study should be verified using a larger patient group with varying conditions.

Evaluation of 316 narrow diameter implants followed for 5-10 years: a clinical and radiographic retrospective study.

OBJECTIVES: Narrow diameter implants (NDIs; diameter >3.75 mm) are useful in replacement of missing incisor teeth and when the bucco-lingual width of the edentulous crest is insufficient. The present study evaluated the success and survival rates, peri-implant parameters, mechanical and prosthetic post-loading complications of NDIs followed over a 10-year period. MATERIAL AND METHODS: Three hundred and sixteen NDIs were inserted into 139 patients and restored with 120 prostheses. Clinical and radiographic assessment data were collected during recall visits. Implant success (SC), cumulative survival rate (CSR), marginal bone loss (MBL), peri-implant conditions and prosthetic complications were assessed. Cox proportional hazards regression analysis, Kaplan-Meier survival curves with the log-rank test and life table analysis were used to evaluate the outcome of NDIs within comparable subgroups. MBL and peri-implant parameters measured annually were further analyzed. RESULTS: The mean follow-up time was 9.1 years (range: 60-124 months). Twelve implants were lost in the healing phase and two during function. The mean MBL in the maxilla and the mandible was 1.32 +/- 0.13 and 1.28 +/- 0.3 mm, respectively, after 10 years. SC and CSR were 91.4% and 92.3%, respectively, after 124 months. Smoking and posterior localization were associated with an increased risk of failure. Cement loosening (16.8%) was the most common prosthetic complication. No implants were fractured. CONCLUSIONS: NDIs can be used with confidence where a regular diameter implant is not suitable. MBL around NDIs occurred predominantly within 2 years of loading and was minimal thereafter. Further studies are required to clarify the possible risks associated with smoking and posterior placement.

Implant surgery using bone- and mucosa-supported stereolithographic guides in totally edentulous jaws: surgical and post-operative outcomes of computer-aided vs. standard techniques.

OBJECTIVES: The aim of this study was to compare the surgical and post-operative outcomes of a computer-aided implant surgery performed by bone- and mucosa-supported stereolithographic (SLA) guides against the standard technique. MATERIAL AND METHODS: Multiple- and single-type SLA guides from two commercial manufacturers were produced and a total of 341 implants were placed to 52 patients using the standard technique (Control group), bone- (bone-supported guide [BSG] group) and mucosa-supported SLA guides (Flapless group) in 21, 16 and 15 patients, respectively. Surgical duration (min), number of analgesics (tablets) as well as hemorrhage, difficulty in mouth opening (or trismus) and other incidences were recorded. Pain and swelling was assessed using the visual analog scale (VAS). Parametric and non-parametric tests were used for statistical analysis (P<.05). RESULTS: The mean surgery duration (23.53+/-5.48 min) and the number of analgesics consumed (four tablets) in the Flapless group were lower than those in the control (68.71+/-11.4 min and 10 tablets) and BSG groups (60.94+/-13.07 min and 11 tablets, P<0.01). The change in pain scores (VAS) and the number of analgesics consumed in time were statistically significant (P<0.01 and 0.05, respectively) and the Flapless group reported a lower pain score than the BSG (P<0.01) and Control groups (P<0.001). The Flapless group experienced less hemorrhage (chi(2)=4.12, P=0.041 on the day of surgery) and fewer instances of trismus (chi(2)=6.91, P=0.031 the day after surgery). The differences in early-term failures were not statistically significant between the groups (log-rank test: P=0.782). CONCLUSION: The use of mucosa-supported single SLA guides for flapless implant placement may help reduce the surgery duration, pain intensity, related analgesic consumption and most other complications typical in the post-implant surgery period. However, there are particular drawbacks in both guide types and further studies are required to confirm the prosthodontic conformity and long-term success of implants placed using computer-assisted techniques.

Accuracy of two stereolithographic guide systems for computer-aided implant placement: a computed tomography-based clinical comparative study.

BACKGROUND: Stereolithographic surgical guides provide significant benefits during the simultaneous placement of multiple implants with regard to the final prosthetic plan. However, deviation from the planning poses a significant risk. Deviations of implants that were placed by bone-, tooth-, and mucosa-supported stereolithographic surgical guides were examined in this study. METHODS: After enrolling 54 eligible patients, 294 implants were planned on cone-beam computerized tomography CB(CT)-derived images. Sixty guides, both single- and multiple-type, were produced using two commercial systems. Mucosa-supported guides were fixed with osteosynthesis screws. Implants were inserted, and at the end of osseointegration period, a new CB(CT) scan was performed. Preoperative planning was merged with the new CB(CT) data to identify the deviations between the planned and placed implants for each support type and manufacturer. The Kruskal-Wallis and Mann-Whitney U tests were used for comparison (P <0.05). RESULTS: There were no damage-related complications in any critical anatomy. Implants that were placed by bone-supported guides had the highest mean deviations (5.0 degrees +/- 1.66 degrees angular, and 1.70 +/- 0.52 mm and 1.99 +/- 0.64 mm for implant shoulder and tip, respectively), whereas the lowest deviations were measured in implants that were placed by mucosa-supported guides (2.9 degrees +/- 0.39 degrees angular, and 0.7 +/- 0.13 mm and 0.76 +/- 0.15 mm for implant shoulder and tip, respectively). CONCLUSIONS: Computer-aided planning and manufacturing surgical guides in accordance with CB(CT) images may help clinicians place implants. Rigid screw fixation of a single guide incorporating metal sleeves and a special drill kit further minimizes deviations.

Injectable calcium phosphate cement as a bone-graft material around peri-implant dehiscence defects: a dog study.

PURPOSE: Peri-implant dehiscence defects occur frequently after dental implant placement. Various graft materials and techniques are proposed for treatment. In this study, an injectable calcium phosphate cement (Augmentech, Wetzlar, Germany) applied to a peri-implant defect was investigated. MATERIALS AND METHODS: Standardized buccal dehiscence defects (5.8 x 3.8 mm) were surgically created after implant site preparation in the right proximal tibiae of 5 beagle dogs. Fifteen stepped cylindrical implants (13 x 3.8 mm diameter) were inserted (3 per dog), and Augmentech injectable calcium phosphate cement was injected into the dehiscences. The bone at the distal side of the implant was left intact to serve as a control. Postsurgically, each dog received double staining of 2 fluorescent labels for estimation of bone cell activity at baseline and after 11 weeks of healing. The animals were sacrificed after 12 weeks. Dissected blocks were processed for histologic, histomorphometric, and fluorescence microscopic analysis, ie, percentage of bone-to-implant contact (BIC) and percentage linear bone height (LBH) were measured. Student t and Mann Whitney U tests were used for statistical analysis (P < .05). RESULTS: Healing was uneventful in all dogs. Augmentech injectable calcium phosphate cement showed good space maintenance and osteoconductive properties with no foreign body reaction. BIC was 34.42 (- 19.88) and 37.00 (- 21.33) (P = .375), while LBH was 84.23 (- 19.73) and 96.10 (- 6.66) (P = .125) for test and control sites, respectively. CONCLUSION: Within the limits of the present study, it was concluded that Augmentech injectable calcium phosphate cement may be a suitable material for the treatment of buccal dehiscence defects around dental implants.

Comparison of analgesic and anti-inflammatory efficacy of selective and non-selective cyclooxygenase-2 inhibitors in dental implant surgery.

BACKGROUND: The analgesic and anti-inflammatory efficacy of tenoxicam and meloxicam were evaluated in this double-masked, randomized, prospective study by analyzing pain scores and the need for rescue-analgesic agents following dental implant surgery. METHODS: One hundred patients, in whom 241 dental implants were placed, were divided into two groups. For 4 days beginning the day before surgery, the first group received meloxicam, 15 mg daily, and the second group received tenoxicam, 20 mg daily, followed by 1 hour preoperatively and for 2 days thereafter. Pain intensity was rated by the subjects based on a visual analog scale on the operation day and on the following 6 days. The patients were recommended to use a rescue analgesic if the pain score was > or =4. Postoperative complications, such as edema, hematoma, infection, severe pain, paresthesia, or gastrointestinal complaints, were also noted. RESULTS: Statistical analysis revealed that 54% of patients in the tenoxicam group and 66% of patients in the meloxicam group used rescue analgesics on day 1. However, the difference between the groups was not significant (chi(2) = 1.05; P = 0.30). The relationship between the reduction of consumption and time was not significant in either group (Z = 0.84; P = 0.40). The relationship between the use of rescue analgesics and the number of implants placed was not significant. Among patients who reported postoperative complications, there was not a statistically significant difference between the groups (chi(2) = 0.04; P = 0.84). CONCLUSION: Meloxicam and tenoxicam exhibited a similar analgesic and anti-inflammatory efficacy in the present investigation.

Comparison of 2 retentive systems for implant-supported overdentures: soft tissue management and evaluation of patient satisfaction.

BACKGROUND: The aim of the present study was to compare the peri-implant soft tissue health status of implants supporting overdentures with bar attachments or ball attachments in the mandible, as well as patient satisfaction with these attachment types. METHODS: The study included a Dolder bar group with 18 cases (43 implants) and a ball attachment group with 18 cases (51 implants). The mean function period in the Dolder bar group was 49 months (range: 12 to 72 months) and in the ball attachment group, the mean was 23 months (range: 12 to 40 months). Implants were clinically evaluated by using a modified plaque index (mPI), modified sulcus bleeding index (mSBI), and probing depths. Patient satisfaction with the treatment was recorded using a questionnaire. RESULTS: mPI, probing depth, and mSBI did not statistically differ between groups (Mann-Whitney U test, P > 0.05). Patient satisfaction was similar with both retentive systems. CONCLUSION: Within the limits of this study, we concluded that there was no significant difference between the 2 attachment types used for implant-supported overdentures with respect to the soft tissue health status or patient satisfaction.