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      In vitro study of the effect of implant position and attachment type on stress distribution of implant-assisted removable partial dentures

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          Abstract

          Background/purpose

          Implant assisted removable partial dentures (IARPDs) improved biomechanical behavior of removable partial dentures (RPDs), but information of the effect of attachment type and implant position is limited. This study aimed to investigate the effect of implant position and attachment type on the stress distribution of IARPDs.

          Material and methods

          Four implants, 10 mm in length and 4.1 mm in diameter, were bilaterally placed close to first premolar and second molar regions of a mandibular Kennedy class I model having artificial dentition from canine to canine, vertical to the occlusal plane. Five IARPDs were fabricated to accommodate locator and magnetic attachments. Strain gauges were placed on the model surface to measure the strain around implants during loading. Unilateral vertical loading was applied to the right first molar area with magnitude of 120 N and crosshead speed of 10 mm/min. Measurements were recorded under following conditions: premolar IARPDs with locator or magnetic attachments, molar IARPDs with locator or magnetic attachments. Two-way multiple analysis of variance was performed to compare the maximum principal strain (MPS) around the implants with a significance level of 0.05.

          Results

          Implant position had significant effect on the MPS of IARPD on loading and nonloading sides while attachment type only significant on nonloading side. Molar implants showed larger MPS than premolar implants with both locator and magnetic attachments during unilateral loading.

          Conclusion

          The stress distribution of the IARPD is significantly affected by implant position wherein anteriorly placed implants exhibit lower MPS than relatively posteriorly placed implants.

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          Most cited references35

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          Attachment systems for implant retained overdentures: a literature review.

          This article presents a comparison between different attachment systems used to retain and support maxillary and mandibular overdentures in completely edentulous patients. A literature review based on a MEDLINE search limited to English-language articles published from 1988 to the present was performed, and a large number of attachments available in the dental market were reviewed with regard to several factors, including: (1) implant survival rate, (2) marginal bone loss, (3) soft tissue complications, (4) retention, (5) stress distribution, (6) space requirements, (7) maintenance complications, and (8) patient satisfaction. These factors are considered essential for the successful outcome and good long-term prognosis of the prostheses. Selection criteria previously published in the literature are discussed as well. Product names and manufacturers are mentioned only if related to attachment systems, as they are cited in the original articles.
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            Complications associated with the ball, bar and Locator attachments for implant-supported overdentures.

            The purpose of this clinical study was to evaluate the complications associated with the different attachments used in implant-supported overdentures, including prosthetic problems and implant failures. A comparison of ball, bar and Locator (Zest Anchors, Inc, homepage, Escondido, CA, USA) attachments, in completely edentulous patients with two, three or four implants, was conducted. A total of 36 edentulous patients (20 female, 16 male) with a mean age of 66.3 years, were enrolled in the study. The patients were treated with 95 implants, for the prosthetic restoration of the maxilla or the mandible. The mean follow-up time was 41.17 months. Prosthetic complications including, fractured overdentures, replacements of O-ring attachment and retention clips, implant failures, hygiene problems, mucosal enlargements, attachment fractures, retention loss and dislodgement of the attachments were recorded and evaluated. The recall visits at 3, 6, 12 months and, annually thereafter. Fourteen complications in the ballattachment group and 7 complications in the bar group were observed. No complications were observed in the locator group. The difference was found to be as statistically significant (p=0,009). Six of the 95 implants had failed. Totally 39 implant overdentures were applied. Three prostheses were renewed because of fractures. Within the limits of the present study, it was concluded that the locator system showed superior clinical results than the ball and the bar attachments, with regard to the rate of prosthodontic complications and the maintenance of the oral function.
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              A comparison of three different attachment systems for mandibular two-implant overdentures: one-year report.

              There is a lack of clinical studies on the self-aligning attachment system (Locator(R); Zest Anchors, Inc. homepage, Escondido, CA, USA) for two-implant-retained overdentures in the edentulous mandible. Therefore, a comparison of the Locator with two traditional designs (a rotational gold matrix and a rubber O-ring type) in clinical 1-year use was conducted. From 2003 to 2007, 60 patients received two Osseotite(R) TG Standard implants (BIOMET 3i Implant Innovations, Palm Beach Gardens, FL, USA) in the intraforaminal area of the edentulous mandible. The implants were left unloaded for 3.5 months, randomized to three different attachment systems, and loaded through a mandibular overdenture. Twenty-three patients received a self-aligning attachment system (Locator) and 33 patients a ball attachment (Dal-Ro(R)[BIOMET 3i Implant Innovations]n = 25; TG-O-Ring(R)[Cendres & Metaux SA, Biel-Bienne, Switzerland]n = 8). After 12 months of delivery of the overdentures, the oral situation was evaluated: prosthodontic maintenance and biologic complications, subjective patients' experience, and oral health-related life quality (Oral Health Impact Profile [OHIP-G 49]). After 1-year of clinical service, 8 of 120 implants were lost (9.6%). The Locator system brought up 34 prosthetic complications, especially the need for change of the male parts or activation because of loss of retention. The TG-O-Ring patients showed 14 complications, most of them the change of the O-Rings. The patients with the Dal-Ro abutment had seven minor complications in 12 months of clinical use. Biologic complications and patients' oral health-related life quality showed no significant difference among the three experimental groups. Prosthodontic maintenance was restricted to loss of retention for all systems. Within the observation period of this study, the self-aligning attachment system showed a higher rate of maintenance than the ball attachments. The patients' oral health-related life qualities as well as the biologic parameters do not differ when using the three abutment systems.
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                Author and article information

                Contributors
                Journal
                J Dent Sci
                J Dent Sci
                Journal of Dental Sciences
                Association for Dental Sciences of the Republic of China
                1991-7902
                2213-8862
                15 March 2022
                October 2022
                15 March 2022
                : 17
                : 4
                : 1697-1703
                Affiliations
                [a ]Department of Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
                [b ]Department of Digital Dentistry, Tokyo Medical and Dental University, Tokyo, Japan
                [c ]Department of Oral Prosthetic Engineering, Tokyo Medical and Dental University, Tokyo, Japan
                Author notes
                []Corresponding author. Department of Digital Dentistry, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8549, Japan. Fax: +81 3 5803 4645. m.kanazawa.gerd@ 123456tmd.ac.jp
                Article
                S1991-7902(21)00284-1
                10.1016/j.jds.2021.11.018
                9588788
                36299337
                29723f13-af13-4b92-9b00-cc25a737e363
                © 2022 Association for Dental Sciences of the Republic of China. Publishing services by Elsevier B.V.

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 10 November 2021
                : 26 November 2021
                Categories
                Original Article

                dental attachments,implant-assisted removable partial denture,implant position,stress distribution,strain gauge

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