Effect of the attachment system on the biomechanical and clinical performance of overdentures: A systematic review.

STATEMENT OF PROBLEM: Overdentures can improve the quality of life of elderly patients compared with conventional complete dentures. Different attachment systems can be used to retain these prostheses, but which system results in better function, mechanical performance, and patient comfort is unclear. PURPOSE: The purpose of this systematic review was to evaluate randomized clinical trials to compare overdentures supported by either bar and clip or ball and O-ring attachments for retention, masticatory efficiency, bone loss, and patient satisfaction. MATERIAL AND METHODS: A literature search was conducted in the PubMed and Web of Science databases. From 163 studies, 16 randomized clinical trials were included in this systematic review based on the inclusion and exclusion criteria. The risk of bias was evaluated according to the RevMan software Risk of Bias Table (RoB Table), and only the studies with a low or intermediate risk of bias were included in the review. RESULTS: From the limited number of studies, the attachment type did not affect the masticatory quality of the patients, bone loss marginal to the implants, or the degree of patient satisfaction. However, overdentures with the bar and clip attachment tended to have higher initial retention than the ball and O-ring system. CONCLUSIONS: Both the bar and clip and ball and O-ring attachment systems presented similar clinical performance regarding mechanical and functional properties and patient satisfaction.

The Use of the Digital Smile Design Concept as an Auxiliary Tool in Aesthetic Rehabilitation: A Case Report.

The digital smile design is a practical diagnosis method that can assist the clinician to visualize and measure dentogingival discrepancies. This clinical report aims to present the associated steps, from the diagnosis of the alterations diagnosis through to the final aesthetic result. A 37-years-old female patient presented as her main complaint the tooth form and colour discrepancies. Applying the digital smile design principle, the necessary measures for a harmonic smile correction could be accurately determined. The initial diagnosis led to a wax up of the master cast that was duplicated in acrylic resin directly in the mouth. This temporary restoration guided the periodontal surgery and the final pressed ceramic crown restoration. We conclude that the digital smile design concept seems to be a useful tool to achieve a satisfactory aesthetic result.

Restoration of the Occlusal Vertical Dimension with an Overlay Removable Partial Denture: A Clinical Report.

The process of tooth loss throughout life associated with severe occlusal wear may pose a challenge in the rehabilitation of partially edentulous arches. In these cases, many therapeutic procedures are necessary because each tooth must be restored to obtain the correct anatomical contour and recover the occlusal vertical dimension (OVD). A removable partial denture (RPD) with occlusal/incisal coverage, also known as an overlay RPD, is an alternative treatment option with fewer interventions, and, consequently, lower cost. This clinical report reviews the principles involved in the clinical indication for an overlay RPD, as well as the necessary planning and execution, to discuss the feasibility and clinical effectiveness of this treatment, identifying the indications, advantages, and disadvantages of this procedure through the presentation of a clinical case. The overlay RPD can be an alternative treatment for special situations involving partially edentulous arches in patients who need reestablishment of the OVD and/or realignment of the occlusal plane, and it can be used as a temporary or definitive treatment. The main advantages of this type of treatment are its simplicity, reversibility, and relatively low cost; however, further studies are needed to ensure the efficacy of this treatment option.

Stress Distribution Around Dental Implants Placed at Different Depths.

INTRODUCTION: The progressive bone loss at the neck of dental implant is a clinical concern since it affects the maintenance of dental aesthetics. The current study evaluated the influence of insertion depth, prosthetic connection, and type of loading on the stress distribution around dental implants, using photoelastic evaluation. MATERIALS AND METHODS: A total of three blocks of photoelastic resin for each type of implant connection (external hexagon, external hexagon flattened, internal hexagon, and Morse taper) were built. Each block differed in the position of the implant platform in relative to the upper margin of the block: I (2 mm below), II (at the same level), and III (2 mm above). A force of 100 N was applied to both straight and tilted abutments. Totally, 4 selected points were evaluated at 1 side of the implant. Quantitative data were collected for the statistical analysis. RESULTS: A multiple linear regression showed the relation between the stress distribution and the insertion depth. For all the implant types, both with straight and tilted abutments, group I presented the lowest stress concentration around the fixture when compared with group II and III (P < 0.05). CONCLUSIONS: Within the limitations of this study, it could be concluded that the deeper the insertion, the lower the stress concentration.

Bone guide for maxillary reconstruction: a case report.

Scientific development and increasing technological progress in the field ofdentistry have allowed the use of many resources in theoral rehabilitationplanning. In complex cases, in order to achieve projected final results,many procedures should be undertakenpriorto implant surgery. Prosthetic rehabilitation planningand bone graft procedures canbetter restorethe functional, aesthetic, social and emotional needs of the patient. This clinical case report shows the oral conditions of a woman who underwent several surgical proceduresfor maxillary reconstruction with autogenous bone grafts from the iliac crest. In this case, a bone volume guide was made to evaluate the bone volume requirement for correct labial support for metalloceramic fixed prosthesis. After graft integration, dental implantsurgery was performed. After the osseointegration period, the prostheses was fabricated and installed on the implants, thus concluding the oral rehabilitation. In conclusion, the bone guide was a fundamental tool for final aesthetic outcome predictability.

Connecting accuracy of interchanged prosthetic abutments to different dental implants using scanning electron microscopy

The present study evaluated the interchangeability of prosthetic components for external hexagon implants by measuring the precision of the implant/abutment (I/A) interface with scanning electron microscopy. Ten implants for each of three brands (SIN, Conexão, Neodent) were tested with their respective abutments (milled CoCr collar rotational and non-rotational) and another of an alternative manufacturer (Microplant) in randomly arranged I/A combinations. The degree of interchangeability between the various brands of components was defined using the original abutment interface gap with its respective implant as the benchmark dimension. Accordingly, when the result for a given component placed on an implant was equal to or smaller then that gap measured when the original component of the same brand as the implant was positioned, interchangeability was considered valid. Data were compared with the Kruskal-Wallis test at 5% significance level. Some degree of misfit was observed in all specimens. Generally, the non-rotational component was more accurate than its rotational counterpart. The latter samples ranged from 0.6-16.9 µm, with a 4.6 µm median; and the former from 0.3-12.9 µm, with a 3.4 µm median. Specimens with the abutment and fixture from Conexão had larger microgap than the original set for SIN and Neodent (p<0.05). Even though the latter systems had similar results with their respective components, their interchanged abutments did not reproduce the original accuracy. The results suggest that the alternative brand abutment would have compatibility with all systems while the other brands were not completely interchangeable.

O presente estudo avaliou a intercambiabilidade dos componentes protéticos de implantes de hexágono externo medindo-se a precisão da interface implante/pilar com microscopia eletrônica de varredura. Foram utilizados dez implantes para cada uma de três marcas (SIN, Conexão, Neodent) com seus respectivos pilares (base metálica de CoCr , rotacional e não rotacional) e um de marca alternativa (Microplant) em um arranjo com todas as combinações de implante/pilar possíveis. O valor de referência para a intercambiabilidade das várias marcas de componentes foi definido pela diferença do pilar original para com seu respectivo implante. Dessa maneira, a intercambiabilidade foi considerada válida quando o resultado para um dado pilar colocado sobre um implante fosse igual ou menor que a diferença medida quando o pilar da mesma marca do implante fora posicionado. Os dados foram comparados pelo teste de Kruskal-Wallis com nível de significância de 5%. Um grau de desajuste foi observado em todos os espécimes. De uma maneira geral, o pilar anti-rotacional foi mais preciso do que o rotacional. Estes variaram de 0,6-16,9 µm, com mediana 4,6 µm; enquanto o anti-rotacional foi de 0,3-12,9 µm, com mediana de 3,4 µm. Os espécimes com o pilar e o implante Conexão tiveram uma diferença maior que o conjunto original para SIN e Neodent (p<0,05). Apesar destes últimos apresentarem resultados semelhantes com seus respectivos pilares, quando trocados não mantiveram a mesma precisão original. Os resultados sugerem que a marca alternativa seria a única que apresentaria compatibilidade com todos os sistemas, enquanto as outras marcas não seriam completamente intercambiáveis.

Connecting accuracy of interchanged prosthetic abutments to different dental implants using scanning electron microscopy.

The present study evaluated the interchangeability of prosthetic components for external hexagon implants by measuring the precision of the implant/abutment (I/A) interface with scanning electron microscopy. Ten implants for each of three brands (SIN, Conexão, Neodent) were tested with their respective abutments (milled CoCr collar rotational and non-rotational) and another of an alternative manufacturer (Microplant) in randomly arranged I/A combinations. The degree of interchangeability between the various brands of components was defined using the original abutment interface gap with its respective implant as the benchmark dimension. Accordingly, when the result for a given component placed on an implant was equal to or smaller then that gap measured when the original component of the same brand as the implant was positioned, interchangeability was considered valid. Data were compared with the Kruskal-Wallis test at 5% significance level. Some degree of misfit was observed in all specimens. Generally, the non-rotational component was more accurate than its rotational counterpart. The latter samples ranged from 0.6-16.9 µm, with a 4.6 µm median; and the former from 0.3-12.9 µm, with a 3.4 µm median. Specimens with the abutment and fixture from Conexão had larger microgap than the original set for SIN and Neodent (p<0.05). Even though the latter systems had similar results with their respective components, their interchanged abutments did not reproduce the original accuracy. The results suggest that the alternative brand abutment would have compatibility with all systems while the other brands were not completely interchangeable.

Intercambialidade de componentes protéticos em diferentes marcas de implantes / Evaluation of the connecting accuracy of interchanged prosthetic abutments to different dental implants using scanning electron microscopy

O presente estudo avaliou a intercambiabilidade dos componentes protéticos de implantes de hexágono externo medindo-se a precisão da interface implante/pilar (I/P) com microscopia eletrônica de varredura. Foram utilizados dez implantes para cada uma de três marcas (SIN, Conexão, Neodent) com seus respectivos pilares (base metálica de CoCr , rotacional e não rotacional) e um de marca alternativa (Microplant) em um arranjo com todas as combinações de I/P possíveis. O valor de referência para a intercambiabilidade das várias marcas de componentes foi definido pela diferença do pilar original para com seu respectivo implante. Dessa maneira, a intercambiabilidade foi considerada válida quando o resultado para um determinado pilar colocado sobre um implante fosse igual ou menor que a diferença medida, quando o pilar da mesma marca do implante foi posicionado. Um grau de desajuste foi observado em todos os espécimes. De uma maneira geral, o pilar antirrotacional foi mais preciso do que o rotacional. Estes variaram de 0,6 16,9m, com mediana 4,6m, enquanto o antirrotacional foi de 0,3 12,9m, com mediana de 3,4m. Os espécimes com o pilar e o implante Conexão tiveram uma diferença maior que o conjunto original para SIN e NEO (p<0,05). Apesar de estes últimos apresentarem resultados semelhantes com seus respectivos pilares, quando trocados, não mantiveram a mesma precisão original. Os resultados sugerem que a marca alternativa seria a única que apresentaria compatibilidade com todos os sistemas, enquanto as outras marcas não seriam completamente intercambiáveis.

The present study evaluated the interchangeability of prosthetic components for external hexagon implants by measuring the precision of the implant/abutment (I/A) interface using scanning electron microscopy. Ten implants for each of three brands (SIN, Conexão, Neodent) were tested with their respective abutments (milled CoCr collar rotational and non-rotational) and that of an alternative manufacturer (Microplant) in randomly arranged I/A combinations. The degree of interchangeability between the various brands of components was defined using the original abutment interface gap with its respective implant as the benchmark dimension. Accordingly, when the result for a given component placed on an implant was equal to or smaller then that gap measured when the component of the same brand as the implant was positioned, interchangeability was considered valid. Some degree of maladjustment was observed on all specimens. Generally, the non-rotational component was more accurate than its rotational counterpart. The latter samples ranged from 0.6 16.9m, with a median of 4.6m; the former from 0.3 12.9m, with a median of 3.4m. Specimens with the abutment and fixture from Conexão had larger microgap than the original set for Sin and Neodent (p<0.05). Even though the latter systems had similar results with their respective components, their interchanged abutments did not reproduce the original accuracy. The results suggest that the alternative brand abutment would have compatibility with all systems while the other brands were not completely interchangeable.