Rigidly splinted implants in the resorbed maxilla to retain a hinging overdenture: A series of clinical reports for up to 4 years
Identifieur interne : 007963 ( Istex/Corpus ); précédent : 007962; suivant : 007964Rigidly splinted implants in the resorbed maxilla to retain a hinging overdenture: A series of clinical reports for up to 4 years
Auteurs : I. Naert ; S. Gizani ; D. Van SteenbergheSource :
- The Journal of Prosthetic Dentistry [ 0022-3913 ] ; 1998.
English descriptors
- KwdEn :
- Abutment, Abutment connection, Abutment installation, Abutment length, Attachment level, Baseline, Bone loss, Bone quality, Conventional denture, Dentistry, Denture, Edentulous, Edentulous maxilla, First year, Gizani, Hinging, Hinging overdenture, Hyperplasia, Implant, Latest control, Loading time, Marginal bone level, Marginal bone loss, Maxilla, Maxillary, Maxillary overdentures, Maxillofac, Maxillofacial surgery, Mucositis, Naert, Oral maxillofac implants, Oral pathology, Osseointegrated, Osseointegrated fixtures, Osseointegrated implants, Overdenture, Overdentures, Periotest, Prosthesis, Prosthesis design, Prosthet dent, Prosthetic, Prosthetic dentistry, Prosthetic dentistry naert, Resorbed maxillae, Revax, Revax attachments, Soft tissue complications, Splinted, Steenberghe.
- Teeft :
- Abutment, Abutment connection, Abutment installation, Abutment length, Attachment level, Baseline, Bone loss, Bone quality, Conventional denture, Dentistry, Denture, Edentulous, Edentulous maxilla, First year, Gizani, Hinging, Hinging overdenture, Hyperplasia, Implant, Latest control, Loading time, Marginal bone level, Marginal bone loss, Maxilla, Maxillary, Maxillary overdentures, Maxillofac, Maxillofacial surgery, Mucositis, Naert, Oral maxillofac implants, Oral pathology, Osseointegrated, Osseointegrated fixtures, Osseointegrated implants, Overdenture, Overdentures, Periotest, Prosthesis, Prosthesis design, Prosthet dent, Prosthetic, Prosthetic dentistry, Prosthetic dentistry naert, Resorbed maxillae, Revax, Revax attachments, Soft tissue complications, Splinted, Steenberghe.
Abstract
Abstract: Statement of problem. The results of the implant overdenture treatment in the maxilla remains inferior to those in the mandible. Different reasons have been alluded to, such as bone quality and quantity, number of implants, as well as the prosthesis design. Purpose.To investigate the latter, a new design for the rehabilitation of the resorbed maxillae was set up. Material and methods. Thirteen patients were selected and provided with four endosseous maxillary implants, splinted with a rigid-cast bar. Results. After a mean loading time of 3 years, six implants were lost; three at abutment and another three shortly after abutment connection, resulting in a cumulative success rate of 88.6% at year 4. A mean marginal bone loss of 0.3 mm was observed within the first year. After the first year, the marginal bone level, the attachment level, and the Periotest scores hardly changed. The main prosthetic complication was the frequent need to renew or to activate the attachments. A strong improvement in patient satisfaction was observed when compared with the old conventional denture. Conclusions. Within the limits of this study, the outcome confirmed that, on a medium-term base, implant-retained hinging overdentures on four implants were promising. (J Prosthet Dent 1998;79:156-64.)
Url:
DOI: 10.1016/S0022-3913(98)70210-0
Links to Exploration step
ISTEX:F57B838B61131BAAA35A4658719AC7FE010928C0Le document en format XML
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Van Steenberghe</name><affiliation><mods:affiliation>Faculty of Medicine, Catholic University of Leuven, Leuven, Belgium</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:F57B838B61131BAAA35A4658719AC7FE010928C0</idno><date when="1998" year="1998">1998</date><idno type="doi">10.1016/S0022-3913(98)70210-0</idno><idno type="url">https://api.istex.fr/document/F57B838B61131BAAA35A4658719AC7FE010928C0/fulltext/pdf</idno><idno type="wicri:Area/Istex/Corpus">007963</idno><idno type="wicri:explorRef" wicri:stream="Istex" wicri:step="Corpus" wicri:corpus="ISTEX">007963</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a" type="main" xml:lang="en">Rigidly splinted implants in the resorbed maxilla to retain a hinging overdenture: A series of clinical reports for up to 4 years</title><author><name sortKey="Naert, I" sort="Naert, I" uniqKey="Naert I" first="I." last="Naert">I. 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Van Steenberghe</name><affiliation><mods:affiliation>Faculty of Medicine, Catholic University of Leuven, Leuven, Belgium</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">The Journal of Prosthetic Dentistry</title><title level="j" type="abbrev">YMPR</title><idno type="ISSN">0022-3913</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="1998">1998</date><biblScope unit="volume">79</biblScope><biblScope unit="issue">2</biblScope><biblScope unit="page" from="156">156</biblScope><biblScope unit="page" to="164">164</biblScope></imprint><idno type="ISSN">0022-3913</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0022-3913</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Abutment</term><term>Abutment connection</term><term>Abutment installation</term><term>Abutment length</term><term>Attachment level</term><term>Baseline</term><term>Bone loss</term><term>Bone quality</term><term>Conventional denture</term><term>Dentistry</term><term>Denture</term><term>Edentulous</term><term>Edentulous maxilla</term><term>First year</term><term>Gizani</term><term>Hinging</term><term>Hinging overdenture</term><term>Hyperplasia</term><term>Implant</term><term>Latest control</term><term>Loading time</term><term>Marginal bone level</term><term>Marginal bone loss</term><term>Maxilla</term><term>Maxillary</term><term>Maxillary overdentures</term><term>Maxillofac</term><term>Maxillofacial surgery</term><term>Mucositis</term><term>Naert</term><term>Oral maxillofac implants</term><term>Oral pathology</term><term>Osseointegrated</term><term>Osseointegrated fixtures</term><term>Osseointegrated implants</term><term>Overdenture</term><term>Overdentures</term><term>Periotest</term><term>Prosthesis</term><term>Prosthesis design</term><term>Prosthet dent</term><term>Prosthetic</term><term>Prosthetic dentistry</term><term>Prosthetic dentistry naert</term><term>Resorbed maxillae</term><term>Revax</term><term>Revax attachments</term><term>Soft tissue complications</term><term>Splinted</term><term>Steenberghe</term></keywords><keywords scheme="Teeft" xml:lang="en"><term>Abutment</term><term>Abutment connection</term><term>Abutment installation</term><term>Abutment length</term><term>Attachment level</term><term>Baseline</term><term>Bone loss</term><term>Bone quality</term><term>Conventional denture</term><term>Dentistry</term><term>Denture</term><term>Edentulous</term><term>Edentulous maxilla</term><term>First year</term><term>Gizani</term><term>Hinging</term><term>Hinging overdenture</term><term>Hyperplasia</term><term>Implant</term><term>Latest control</term><term>Loading time</term><term>Marginal bone level</term><term>Marginal bone loss</term><term>Maxilla</term><term>Maxillary</term><term>Maxillary overdentures</term><term>Maxillofac</term><term>Maxillofacial surgery</term><term>Mucositis</term><term>Naert</term><term>Oral maxillofac implants</term><term>Oral pathology</term><term>Osseointegrated</term><term>Osseointegrated fixtures</term><term>Osseointegrated implants</term><term>Overdenture</term><term>Overdentures</term><term>Periotest</term><term>Prosthesis</term><term>Prosthesis design</term><term>Prosthet dent</term><term>Prosthetic</term><term>Prosthetic dentistry</term><term>Prosthetic dentistry naert</term><term>Resorbed maxillae</term><term>Revax</term><term>Revax attachments</term><term>Soft tissue complications</term><term>Splinted</term><term>Steenberghe</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Abstract: Statement of problem. The results of the implant overdenture treatment in the maxilla remains inferior to those in the mandible. Different reasons have been alluded to, such as bone quality and quantity, number of implants, as well as the prosthesis design. Purpose.To investigate the latter, a new design for the rehabilitation of the resorbed maxillae was set up. Material and methods. Thirteen patients were selected and provided with four endosseous maxillary implants, splinted with a rigid-cast bar. Results. After a mean loading time of 3 years, six implants were lost; three at abutment and another three shortly after abutment connection, resulting in a cumulative success rate of 88.6% at year 4. A mean marginal bone loss of 0.3 mm was observed within the first year. After the first year, the marginal bone level, the attachment level, and the Periotest scores hardly changed. The main prosthetic complication was the frequent need to renew or to activate the attachments. A strong improvement in patient satisfaction was observed when compared with the old conventional denture. Conclusions. Within the limits of this study, the outcome confirmed that, on a medium-term base, implant-retained hinging overdentures on four implants were promising. (J Prosthet Dent 1998;79:156-64.)</div></front></TEI><istex><corpusName>elsevier</corpusName><keywords><teeft><json:string>implant</json:string><json:string>abutment</json:string><json:string>prosthetic</json:string><json:string>prosthesis</json:string><json:string>overdenture</json:string><json:string>denture</json:string><json:string>maxilla</json:string><json:string>naert</json:string><json:string>overdentures</json:string><json:string>steenberghe</json:string><json:string>oral maxillofac implants</json:string><json:string>maxillofac</json:string><json:string>abutment connection</json:string><json:string>maxillary</json:string><json:string>gizani</json:string><json:string>osseointegrated</json:string><json:string>dentistry</json:string><json:string>revax</json:string><json:string>hinging</json:string><json:string>splinted</json:string><json:string>periotest</json:string><json:string>mucositis</json:string><json:string>prosthetic dentistry</json:string><json:string>osseointegrated implants</json:string><json:string>latest control</json:string><json:string>first year</json:string><json:string>edentulous</json:string><json:string>attachment level</json:string><json:string>edentulous maxilla</json:string><json:string>prosthet dent</json:string><json:string>prosthesis design</json:string><json:string>revax attachments</json:string><json:string>oral pathology</json:string><json:string>marginal bone level</json:string><json:string>baseline</json:string><json:string>hyperplasia</json:string><json:string>prosthetic dentistry naert</json:string><json:string>soft tissue complications</json:string><json:string>resorbed maxillae</json:string><json:string>conventional denture</json:string><json:string>maxillofacial surgery</json:string><json:string>marginal bone loss</json:string><json:string>bone loss</json:string><json:string>osseointegrated fixtures</json:string><json:string>maxillary overdentures</json:string><json:string>loading time</json:string><json:string>abutment installation</json:string><json:string>bone quality</json:string><json:string>hinging overdenture</json:string><json:string>abutment length</json:string></teeft></keywords><author><json:item><name>I. Naert DDS, PhD,a</name><affiliations><json:string>Faculty of Medicine, Catholic University of Leuven, Leuven, Belgium</json:string></affiliations></json:item><json:item><name>S. Gizani DDS, MDS,b</name><affiliations><json:string>Faculty of Medicine, Catholic University of Leuven, Leuven, Belgium</json:string></affiliations></json:item><json:item><name>D. van Steenberghe MD, PhDc</name><affiliations><json:string>Faculty of Medicine, Catholic University of Leuven, Leuven, Belgium</json:string></affiliations></json:item></author><arkIstex>ark:/67375/6H6-G7M91PL9-5</arkIstex><language><json:string>eng</json:string></language><originalGenre><json:string>Full-length article</json:string></originalGenre><abstract>Abstract: Statement of problem. The results of the implant overdenture treatment in the maxilla remains inferior to those in the mandible. Different reasons have been alluded to, such as bone quality and quantity, number of implants, as well as the prosthesis design. Purpose.To investigate the latter, a new design for the rehabilitation of the resorbed maxillae was set up. Material and methods. Thirteen patients were selected and provided with four endosseous maxillary implants, splinted with a rigid-cast bar. Results. After a mean loading time of 3 years, six implants were lost; three at abutment and another three shortly after abutment connection, resulting in a cumulative success rate of 88.6% at year 4. A mean marginal bone loss of 0.3 mm was observed within the first year. After the first year, the marginal bone level, the attachment level, and the Periotest scores hardly changed. The main prosthetic complication was the frequent need to renew or to activate the attachments. A strong improvement in patient satisfaction was observed when compared with the old conventional denture. Conclusions. Within the limits of this study, the outcome confirmed that, on a medium-term base, implant-retained hinging overdentures on four implants were promising. (J Prosthet Dent 1998;79:156-64.)</abstract><qualityIndicators><refBibsNative>true</refBibsNative><abstractWordCount>200</abstractWordCount><abstractCharCount>1303</abstractCharCount><keywordCount>0</keywordCount><score>8.385</score><pdfWordCount>3985</pdfWordCount><pdfCharCount>26058</pdfCharCount><pdfVersion>1.3</pdfVersion><pdfPageCount>9</pdfPageCount><pdfPageSize>612 x 792 pts (letter)</pdfPageSize></qualityIndicators><title>Rigidly splinted implants in the resorbed maxilla to retain a hinging overdenture: A series of clinical reports for up to 4 years</title><pmid><json:string>9513101</json:string></pmid><pii><json:string>S0022-3913(98)70210-0</json:string></pii><genre><json:string>research-article</json:string></genre><serie><title>Osseointegration in clinical dentistry.</title><language><json:string>unknown</json:string></language><pages><first>199</first><last>209</last></pages></serie><host><title>The Journal of Prosthetic Dentistry</title><language><json:string>unknown</json:string></language><publicationDate>1998</publicationDate><issn><json:string>0022-3913</json:string></issn><pii><json:string>S0022-3913(05)X7049-4</json:string></pii><volume>79</volume><issue>2</issue><pages><first>156</first><last>164</last></pages><genre><json:string>journal</json:string></genre></host><namedEntities><unitex><date><json:string>1998</json:string><json:string>2</json:string><json:string>3</json:string><json:string>4</json:string><json:string>9</json:string></date><geogName></geogName><orgName><json:string>Biomaterials Research Group</json:string><json:string>Department of Prosthetic Dentistry, School of Dentistry, Oral Pathology and Maxillofacial Surgery</json:string><json:string>Belgium Statement</json:string><json:string>Department of Periodontology, School of Dentistry, Oral Pathology and Maxillofacial Surgery</json:string></orgName><orgName_funder></orgName_funder><orgName_provider></orgName_provider><persName><json:string>Professor</json:string><json:string>Baseline</json:string><json:string>V. 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Gizani</json:string><json:string>The</json:string><json:string>D. van Steenberghe</json:string></persName><placeName><json:string>Germany</json:string><json:string>Antwerp</json:string><json:string>Heidelberg</json:string><json:string>Leuven</json:string><json:string>Sweden</json:string><json:string>Belgium</json:string></placeName><ref_url></ref_url><ref_bibl><json:string>Palmqvist et al.</json:string><json:string>Hutton et al.</json:string><json:string>Lothigius et al.</json:string><json:string>Smedberg et al.</json:string></ref_bibl><bibl></bibl></unitex></namedEntities><ark><json:string>ark:/67375/6H6-G7M91PL9-5</json:string></ark><categories><wos><json:string>1 - science</json:string><json:string>2 - dentistry, oral surgery & medicine</json:string></wos><scienceMetrix><json:string>1 - health sciences</json:string><json:string>2 - clinical medicine</json:string><json:string>3 - dentistry</json:string></scienceMetrix><scopus><json:string>1 - Health Sciences</json:string><json:string>2 - Dentistry</json:string><json:string>3 - Oral Surgery</json:string></scopus><inist><json:string>1 - sciences appliquees, technologies et medecines</json:string><json:string>2 - sciences biologiques et medicales</json:string><json:string>3 - sciences medicales</json:string></inist></categories><publicationDate>1998</publicationDate><copyrightDate>1998</copyrightDate><doi><json:string>10.1016/S0022-3913(98)70210-0</json:string></doi><id>F57B838B61131BAAA35A4658719AC7FE010928C0</id><score>1</score><fulltext><json:item><extension>pdf</extension><original>true</original><mimetype>application/pdf</mimetype><uri>https://api.istex.fr/document/F57B838B61131BAAA35A4658719AC7FE010928C0/fulltext/pdf</uri></json:item><json:item><extension>zip</extension><original>false</original><mimetype>application/zip</mimetype><uri>https://api.istex.fr/document/F57B838B61131BAAA35A4658719AC7FE010928C0/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/F57B838B61131BAAA35A4658719AC7FE010928C0/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a" type="main" xml:lang="en">Rigidly splinted implants in the resorbed maxilla to retain a hinging overdenture: A series of clinical reports for up to 4 years</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>ELSEVIER</publisher><availability><p>©1998 Editorial Council of The Journal of Prosthetic Dentistry</p></availability><date>1998</date></publicationStmt><notesStmt><note>aProfessor, Department of Prosthetic Dentistry, School of Dentistry, Oral Pathology and Maxillofacial Surgery, Biomaterials Research Group.</note><note>bAssistant Professor, Department of Prosthetic Dentistry, School of Dentistry, Oral Pathology and Maxillofacial Surgery.</note><note>cProfessor, Department of Periodontology, School of Dentistry, Oral Pathology and Maxillofacial Surgery. Grantholder Brånemark Chair in Osseointegration.</note><note>Reprint requests to: Dr. I. E. Naert, Department of Prosthetic Dentistry, School of Dentistry, Oral Pathology and Maxillofacial Surgery, Capucijnenvoer 7, B-3000 Leuven, BELGIUM</note><note>10/1/85866</note></notesStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a" type="main" xml:lang="en">Rigidly splinted implants in the resorbed maxilla to retain a hinging overdenture: A series of clinical reports for up to 4 years</title><author xml:id="author-0000"><persName><forename type="first">I.</forename><surname>Naert</surname></persName><roleName type="degree">DDS, PhD,a</roleName><affiliation>Faculty of Medicine, Catholic University of Leuven, Leuven, Belgium</affiliation></author><author xml:id="author-0001"><persName><forename type="first">S.</forename><surname>Gizani</surname></persName><roleName type="degree">DDS, MDS,b</roleName><affiliation>Faculty of Medicine, Catholic University of Leuven, Leuven, Belgium</affiliation></author><author xml:id="author-0002"><persName><forename type="first">D.</forename><surname>van Steenberghe</surname></persName><roleName type="degree">MD, PhDc</roleName><affiliation>Faculty of Medicine, Catholic University of Leuven, Leuven, Belgium</affiliation></author><idno type="istex">F57B838B61131BAAA35A4658719AC7FE010928C0</idno><idno type="DOI">10.1016/S0022-3913(98)70210-0</idno><idno type="PII">S0022-3913(98)70210-0</idno></analytic><monogr><title level="j">The Journal of Prosthetic Dentistry</title><title level="j" type="abbrev">YMPR</title><idno type="pISSN">0022-3913</idno><idno type="PII">S0022-3913(05)X7049-4</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="1998"></date><biblScope unit="volume">79</biblScope><biblScope unit="issue">2</biblScope><biblScope unit="page" from="156">156</biblScope><biblScope unit="page" to="164">164</biblScope></imprint></monogr></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>1998</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>Statement of problem. The results of the implant overdenture treatment in the maxilla remains inferior to those in the mandible. Different reasons have been alluded to, such as bone quality and quantity, number of implants, as well as the prosthesis design. Purpose.To investigate the latter, a new design for the rehabilitation of the resorbed maxillae was set up. Material and methods. Thirteen patients were selected and provided with four endosseous maxillary implants, splinted with a rigid-cast bar. Results. After a mean loading time of 3 years, six implants were lost; three at abutment and another three shortly after abutment connection, resulting in a cumulative success rate of 88.6% at year 4. A mean marginal bone loss of 0.3 mm was observed within the first year. After the first year, the marginal bone level, the attachment level, and the Periotest scores hardly changed. The main prosthetic complication was the frequent need to renew or to activate the attachments. A strong improvement in patient satisfaction was observed when compared with the old conventional denture. Conclusions. Within the limits of this study, the outcome confirmed that, on a medium-term base, implant-retained hinging overdentures on four implants were promising. 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Grantholder Brånemark Chair in Osseointegration.</ce:note-para></ce:article-footnote><ce:article-footnote><ce:label>★★</ce:label><ce:note-para>Reprint requests to: Dr. I. E. Naert, Department of Prosthetic Dentistry, School of Dentistry, Oral Pathology and Maxillofacial Surgery, Capucijnenvoer 7, B-3000 Leuven, BELGIUM</ce:note-para></ce:article-footnote><ce:article-footnote><ce:label>♢</ce:label><ce:note-para><ce:bold>10/1/85866</ce:bold></ce:note-para></ce:article-footnote><ce:title>Rigidly splinted implants in the resorbed maxilla to retain a hinging overdenture: A series of clinical reports for up to 4 years</ce:title><ce:author-group><ce:author><ce:given-name>I.</ce:given-name><ce:surname>Naert</ce:surname><ce:degrees>DDS, PhD,<ce:sup>a</ce:sup></ce:degrees></ce:author><ce:author><ce:given-name>S.</ce:given-name><ce:surname>Gizani</ce:surname><ce:degrees>DDS, MDS,<ce:sup>b</ce:sup></ce:degrees></ce:author><ce:author><ce:given-name>D.</ce:given-name><ce:surname>van Steenberghe</ce:surname><ce:degrees>MD, PhD<ce:sup>c</ce:sup></ce:degrees></ce:author><ce:affiliation><ce:textfn>Faculty of Medicine, Catholic University of Leuven, Leuven, Belgium</ce:textfn></ce:affiliation></ce:author-group><ce:abstract><ce:section-title>Abstract</ce:section-title><ce:abstract-sec><ce:simple-para><ce:bold>Statement of problem.</ce:bold> The results of the implant overdenture treatment in the maxilla remains inferior to those in the mandible. Different reasons have been alluded to, such as bone quality and quantity, number of implants, as well as the prosthesis design. Purpose.To investigate the latter, a new design for the rehabilitation of the resorbed maxillae was set up. <ce:bold>Material and methods.</ce:bold> Thirteen patients were selected and provided with four endosseous maxillary implants, splinted with a rigid-cast bar. <ce:bold>Results.</ce:bold> After a mean loading time of 3 years, six implants were lost; three at abutment and another three shortly after abutment connection, resulting in a cumulative success rate of 88.6% at year 4. A mean marginal bone loss of 0.3 mm was observed within the first year. After the first year, the marginal bone level, the attachment level, and the Periotest scores hardly changed. The main prosthetic complication was the frequent need to renew or to activate the attachments. A strong improvement in patient satisfaction was observed when compared with the old conventional denture. Conclusions. Within the limits of this study, the outcome confirmed that, on a medium-term base, implant-retained hinging overdentures on four implants were promising. (J Prosthet Dent 1998;79:156-64.)</ce:simple-para></ce:abstract-sec></ce:abstract></head><body><ce:sections><ce:para><ce:display><ce:textbox><ce:textbox-body><ce:sections><ce:para><ce:bold>CLINICAL IMPLICATIONS</ce:bold> Within the limits of this study, the use of implant-retained hinged overdentures on four implants showed promise as a restoration to consider for the resorbed maxillae.</ce:para></ce:sections></ce:textbox-body></ce:textbox></ce:display></ce:para><ce:para>The outcome of implant-retained mandibular overdentures in many studies have indicated high success rates.<ce:cross-refs refid="bib1 bib2 bib3 bib4 bib5 bib6 bib7"><ce:sup>1-7</ce:sup></ce:cross-refs> However, the overdenture treatment in the maxilla seems to have less favorable results, and several studies have highlighted the contrast between maxillary and mandibular implant success rates under these conditions.<ce:cross-refs refid="bib1 bib4 bib7 bib8 bib9 bib10 bib11 bib12"><ce:sup>1,4,7-12</ce:sup></ce:cross-refs> Furthermore, overdenture treatment in the maxilla is associated with a higher incidence of mucosal problems.<ce:cross-ref refid="bib4"><ce:sup>4</ce:sup></ce:cross-ref></ce:para><ce:para>Maxillary overdentures can be the optimal treatment when phonetic, esthetic, or financial problems are present<ce:cross-refs refid="bib9 bib11"><ce:sup>9,11</ce:sup></ce:cross-refs> or when insufficient bone volume prevents an archwise placement of a sufficient number of implants to carry a fixed prosthesis.<ce:cross-ref refid="bib13"><ce:sup>13</ce:sup></ce:cross-ref> The reported success rates varied from 70% to 94%. Several factors have been proposed to explain these differences, such as number and length of implants, prosthesis design, bone quality, and quantity.<ce:cross-refs refid="bib1 bib4 bib7 bib8 bib11 bib14"><ce:sup>1,4,7-9,11,14</ce:sup></ce:cross-refs></ce:para><ce:para>A prospective study was undertaken to investigate whether the outcome of a new design for the hinging overdenture to restore the resorbed maxilla would alleviate the mentioned drawbacks. The rationale to use such a design was inspired by Smedberg et al.,<ce:cross-ref refid="bib15"><ce:sup>15</ce:sup></ce:cross-ref> who showed loading benefits by using such a design. This article relates the up to 4 years results.</ce:para><ce:section><ce:section-title>Material and Methods</ce:section-title><ce:section><ce:section-title>Patients selection</ce:section-title><ce:para>Thirteen patients who were edentulous in the maxillary jaw were recruited on the basis of complaints about retention problems with their denture. Their ages ranged from 39 to 67 years (mean, 59 years) and the edentulous period ranged from 1 to 25 years (mean, 16 years). According to the Lekholm and Zarb<ce:cross-ref refid="bib16"><ce:sup>16</ce:sup></ce:cross-ref> index, the jaw bone quality in the anterior area of the jaw was rated 2 and 3 for 2 and 11 patients, respectively. Bone quantity, in the anterior area, was rated class B, C, and D in 5, 7, and 1 patients, respectively. All but one patient had an Angle Class I jaw relationship. The latter had an Angle Class II relationship. Of the 13 patients, 8 had a full or partial dentition in the mandible, 1 had an overdenture on two implants, 2 an implant-supported fixed prosthesis, and 2 had a full denture.</ce:para><ce:para>Exclusion criteria were sufficient bone to harbor archwise more than four implants, which would lead to a proposal of fixed prosthesis to the patient, psychological problems with the acceptance of a removable denture, gagging reflexes, less than 1 year of an edentulous maxilla, and administrative or physical reasons that would affect the surgical procedure or constitute a hindrance for the planned follow-up period. At recruitment, a thorough oral and radiographic examination was performed for all patients. Besides, the medical status was recorded as well as the oral history that included the evaluation of the old denture.</ce:para></ce:section><ce:section><ce:section-title>Surgical procedures</ce:section-title><ce:para>Four screw-shaped commercially pure titanium implants (Brånemark system, Nobel Biocare AB, Göteburg, Sweden) were placed in each patient, according to a standard surgical protocol.<ce:cross-ref refid="bib17"><ce:sup>17</ce:sup></ce:cross-ref> From the total of 53 placed implants, 19 were standard 3.75 mm and 26 were 4 mm diameter; 8 of the 3.75 mm diameter implants were self-tapping. The distribution of the implants, according to their length and the mean interimplant distance, measured from the center of the implant, are presented in Table I.
<ce:display><ce:table colsep="0" rowsep="0" frame="topbot"><ce:label>Table I</ce:label><ce:caption><ce:simple-para>(A) Distribution of the number of implants according to their length.</ce:simple-para></ce:caption><tgroup cols="2"><colspec colname="col1" colsep="0"></colspec><colspec colname="col2" colsep="0"></colspec><thead><row rowsep="1" valign="bottom"><entry colsep="1">Implant length (mm)</entry><entry>Number of implants</entry></row><row rowsep="1" valign="bottom"><entry colsep="1">7</entry><entry>1</entry></row><row rowsep="1" valign="bottom"><entry colsep="1">10</entry><entry>14</entry></row><row rowsep="1" valign="bottom"><entry colsep="1">13</entry><entry>17</entry></row></thead><tbody><row rowsep="1"><entry colsep="1">15</entry><entry>20</entry></row><row><entry colsep="1">18</entry><entry>1</entry></row></tbody></tgroup></ce:table></ce:display><ce:display><ce:figure><ce:caption><ce:simple-para>(B) Mean interimplant distance</ce:simple-para></ce:caption> <ce:link locator="gr1"></ce:link></ce:figure></ce:display></ce:para><ce:para>The abutment installation was performed 6 to 8 months (mean: 6.6 months) after implant installation. The abutment length varied from 1 to 5.5 mm. EsthetiCone abutments and standard abutments (Brånemark system, Nobel Biocare AB) were used. Their selection was based on a 1 to 2 mm supragingival distance from their shoulder toward the gingiva.</ce:para></ce:section><ce:section><ce:section-title>Prosthodontic procedures</ce:section-title><ce:para>The four installed implants in each patient were splinted with a rigid-cast bar according to the design of Lothigius et al.<ce:cross-ref refid="bib18"><ce:sup>18</ce:sup></ce:cross-ref> On top of it, a hinging overdenture was adapted. Retention of the superstructure was ensured by two attachments (Revax Ceka NV, Antwerp, Belgium), placed distally to the terminal abutments (Fig. 1).
<ce:display><ce:figure id="fig2"><ce:label>Fig. 1</ce:label><ce:caption><ce:simple-para>Rigid-cast bar splinting four implants is provided with three occlusal rests (one mesial and two distal), allowing hinging of overdenture and leading to improved load transfer toward implants.</ce:simple-para></ce:caption> <ce:link locator="gr2"></ce:link></ce:figure></ce:display>The superstructure was fabricated as a friction-free cobalt-chromium (Co-Cr) framework on top of the bar, retained by the key components of the precision attachments. All but one overdenture had full palatal coverage to improve sharing of the loads between implants and hard palate (Fig. 2).
<ce:display><ce:figure><ce:label>Fig. 2</ce:label><ce:caption><ce:simple-para>Overdenture fabricated with friction-free Co-Cr framework and provided with two Revax precision attachments to retain overdenture.</ce:simple-para></ce:caption> <ce:link locator="gr3"></ce:link></ce:figure></ce:display>The exception was due to the emphatic request of the patient.</ce:para><ce:para>To allow hinging of the overdenture, the bar was provided with three elevated areas (rests), approximately 1 mm in height, one mesial and two distal (<ce:cross-ref refid="fig2">Fig. 1</ce:cross-ref>). When a positive load was applied in the molar area (Fig. 3), the two distal rests aimed to act as the fulcrum to allow hinging of the prosthesis.
<ce:display><ce:figure><ce:label>Fig. 3</ce:label><ce:caption><ce:simple-para>When positive load is applied in molar areas, two distal rests act as fulcrum, and prosthesis may hinge around imaginary line connecting latter.</ce:simple-para></ce:caption> <ce:link locator="gr4"></ce:link></ce:figure></ce:display>The idea was to transmit the occlusal forces, mainly in the vicinity of those implants. When negative forces are applied, the mesial rest acts as fulcrum and the two attachments come into action to retain the overdenture (Fig. 4).
<ce:display><ce:figure><ce:label>Fig. 4</ce:label><ce:caption><ce:simple-para>When negative forces are applied, mesial rest acts as fulcrum, and two attachments come into action, to retain overdenture.</ce:simple-para></ce:caption> <ce:link locator="gr5"></ce:link></ce:figure></ce:display>Much care was taken to provide contact of the prosthesis on the three rests simultaneously with distal mucosal support. However, there is no current evidence-based information available to support this mentioned claim. Nevertheless, it is the intention of our group to provide an answer based on strain gauge recording in the future.</ce:para><ce:para>Finally, all overdentures were carefully evaluated for proper occlusion and articulation, both in the articulator and intraorally. A simultaneous contact was aimed for maximal occlusion over all teeth. The articulation pattern depended on the antagonistic status. When dentate, a canine rise was used; when edentulous, a balanced articulation was the choice.</ce:para><ce:para>Patients were scheduled for follow-up visits 1 week after prosthesis insertion and 4, 6, 12, 24, 36, and 48 months after abutment installation.</ce:para></ce:section><ce:section><ce:section-title>Implant assessment</ce:section-title><ce:para>An implant was considered a failure if: (1) a peri-implant radiolucency could be detected on intraoral radiographs with the paralleling technique, (2) the implant showed signs or symptoms of pain or infection, and (3) it showed the slightest sign of mobility. Implant rigidity was assessed by means of the Periotest device (Siemens AG, Bensheim, Germany). Life-table analysis was used to express implant success rate.<ce:cross-ref refid="bib19"><ce:sup>19</ce:sup></ce:cross-ref></ce:para></ce:section><ce:section><ce:section-title>Peri-implant parameters</ce:section-title><ce:para>At each follow-up visit, the following peri-implant parameters were measured:
<ce:list><ce:list-item><ce:label>1.</ce:label><ce:para>Presence or absence of plaque on the abutments was scored at four sites by visual inspection. The range per abutment varied from 0 to 4.</ce:para></ce:list-item><ce:list-item><ce:label>2.</ce:label><ce:para>Presence or absence of mucosal bleeding after 20 seconds was scored at the same four sites by running a Merritt-B periodontal probe (Hu-Friedy, B Ofrictin GmbH, Heidelberg, Germany) 1 mm into the peri- implant sulcus parallel with the axial wall of the abutment. The range per abutment varies from 0 to 4.</ce:para></ce:list-item><ce:list-item><ce:label>3.</ce:label><ce:para>Pocket probing depth (PD) by using a Merritt-B periodontal probe at six sites around each abutment, namely, mesiovestibular, mesiooral, distovestibular, distooral, midvestibular, and midoral.</ce:para></ce:list-item><ce:list-item><ce:label>4.</ce:label><ce:para>Recession (REC), defined as the distance between the marginal mucosal and the top of the abutment. The recession was measured at the same six sites as the probing depth.</ce:para></ce:list-item><ce:list-item><ce:label>5.</ce:label><ce:para>Attachment level (AL) was defined as the sum of PD plus REC minus the abutment length. Positive values mean that the tip of the probe is located below the implant-abutment junction and vice versa. To allow comparison with the radiographically determined marginal bone level, only the mean of each of the two pairs of the proximal PD and REC measurements was used.</ce:para></ce:list-item><ce:list-item><ce:label>6.</ce:label><ce:para>The marginal bone level (MBL) was evaluated mesially and distally from intraoral radiographs with the long-cone paralleling technique. As a reference point, the abutment-implant junction was used. All radiographic measurements were performed by the same investigator to optimize the reproducibility. From previous experiences, the intraexaminer's reliability is 0.2 mm (SE: 0.07; SD: 0.42).<ce:cross-ref refid="bib20"><ce:sup>20</ce:sup></ce:cross-ref></ce:para></ce:list-item><ce:list-item><ce:label>7.</ce:label><ce:para>The implant bone rigidity was evaluated with the Periotest device (Siemens, Bensheim, Germany). The Periotest values (PTV) were only taken into consideration when two consecutive measurements did not deviate more than one unit from each other. The meaning of this measurement has been previously described in detail.<ce:cross-ref refid="bib21"><ce:sup>21</ce:sup></ce:cross-ref></ce:para></ce:list-item></ce:list></ce:para><ce:para>For the measurements of all the above mentioned peri-implant parameters, the bar was removed each time.</ce:para></ce:section><ce:section><ce:section-title>Prosthetic parameters</ce:section-title><ce:para>The following prosthetic parameters were considered: (1) Mechanical complications of both the implant and the attachment components were recorded at each follow-up and for the time periods in between. (2) Soft tissue complications (mucositis, soreness, ulcer decubitus, and hyperplasia) were recorded at each follow-up. The site where it occurred was also noted.</ce:para><ce:para>Patients' satisfaction was rated on a questionnaire. The answers were given on an ordered scale ranging from 1 (very bad) to 9 (excellent).</ce:para></ce:section></ce:section><ce:section><ce:section-title>Results</ce:section-title><ce:section><ce:section-title>Patient drop-out and follow-up</ce:section-title><ce:para>Except for two patients who lost two or more implants in the first 7 months, another patient died before follow-up year 2. Eventually, the first year follow-up included 11, the second year 9, and the third and the fourth years follow-up included 7 patients each. The mean loading time for the implants at the end of the observation period was 3 years (range 1 to 4).</ce:para></ce:section><ce:section><ce:section-title>Implant failures</ce:section-title><ce:para>Implant failures were concentrated in three patients. The first patient lost two implants, one at abutment installation, and the other was diagnosed 7 months after abutment connection. The second patient lost three implants, one at the time of abutment connection and two were diagnosed at the 6 months recall. These two patients refrained from further surgery and the remaining implants were put to sleep. The third patient lost one implant at the time of abutment connection but was replaced by another one and healed uneventfully. From a total of 53 implants, 6 failed, which lead to a cumulative success rate of 88.6% at year 4 (Table II).
<ce:display><ce:table colsep="0" rowsep="0" frame="topbot"><ce:label>Table II</ce:label><ce:caption><ce:simple-para>Life-table analysis for implant success from implant installation up to 4 years of loading</ce:simple-para></ce:caption><tgroup cols="5"><colspec colname="col1" colsep="0"></colspec><colspec colname="col2" colsep="0"></colspec><colspec colname="col3" colsep="0"></colspec><colspec colname="col4" colsep="0"></colspec><colspec colname="col5" colsep="0"></colspec><thead><row rowsep="1" valign="bottom"><entry colsep="1">Interval</entry><entry colsep="1">Number of implants at the beginning of each interval</entry><entry colsep="1">Number of failed implants during that interval</entry><entry colsep="1">Interval success rate (%)</entry><entry>Cumulative success rate (%)</entry></row></thead><tbody><row rowsep="1"><entry colsep="1">Implant placement</entry><entry colsep="1">53</entry><entry colsep="1">0</entry><entry colsep="1">100</entry><entry>100</entry></row><row rowsep="1"><entry colsep="1">Abutment installation</entry><entry colsep="1">53</entry><entry colsep="1">3</entry><entry colsep="1">94.3</entry><entry>94.3</entry></row><row rowsep="1"><entry colsep="1">0-6 months after surgery II</entry><entry colsep="1">50</entry><entry colsep="1">2</entry><entry colsep="1">96</entry><entry>90.5</entry></row><row rowsep="1"><entry colsep="1">7-12 months after surgery II</entry><entry colsep="1">48</entry><entry colsep="1">1</entry><entry colsep="1">97.9</entry><entry>88.6</entry></row><row rowsep="1"><entry colsep="1">13-18 months after surgery II</entry><entry colsep="1">37</entry><entry colsep="1">0</entry><entry colsep="1">100</entry><entry>88.6</entry></row><row rowsep="1"><entry colsep="1">19-24 months after surgery II</entry><entry colsep="1">37</entry><entry colsep="1">0</entry><entry colsep="1">100</entry><entry>88.6</entry></row><row rowsep="1"><entry colsep="1">25-30 months after surgery II</entry><entry colsep="1">29</entry><entry colsep="1">0</entry><entry colsep="1">100</entry><entry>88.6</entry></row><row rowsep="1"><entry colsep="1">31-36 months after surgery II</entry><entry colsep="1">29</entry><entry colsep="1">0</entry><entry colsep="1">100</entry><entry>88.6</entry></row><row rowsep="1"><entry colsep="1">37-42 months after surgery II</entry><entry colsep="1">29</entry><entry colsep="1">0</entry><entry colsep="1">100</entry><entry>88.6</entry></row><row><entry colsep="1">43-48 months after surgery II</entry><entry colsep="1">28</entry><entry colsep="1">0</entry><entry colsep="1">100</entry><entry>88.6</entry></row></tbody></tgroup></ce:table></ce:display></ce:para></ce:section><ce:section><ce:section-title>Peri-implant outcome</ce:section-title><ce:para>Four months after abutment connection, both mean plaque and bleeding index scored 0.1 (SD: 0.5), whereas at the last control, the corresponding values were 0.1 (SD: 0.6) and 0.2 (SD: 0.7), respectively. Table III depicts the individual patient responses and the means (SD) for PDs and RECs over time.
<ce:display><ce:table colsep="0" rowsep="0" frame="topbot"><ce:label>Table III</ce:label><ce:caption><ce:simple-para>Individual pocket probing depths and recessions and attachment levels</ce:simple-para></ce:caption><tgroup cols="9"><colspec colname="col1" colsep="0"></colspec><colspec colname="col2" colsep="0"></colspec><colspec colname="col3" colsep="0"></colspec><colspec colname="col4" colsep="0"></colspec><colspec colname="col5" colsep="0"></colspec><colspec colname="col6" colsep="0"></colspec><colspec colname="col7" colsep="0"></colspec><colspec colname="col8" colsep="0"></colspec><colspec colname="col9" colsep="0"></colspec><thead><row rowsep="1" valign="bottom"><entry colsep="1">Patient</entry><entry colsep="1">Baseline PPD/REC</entry><entry colsep="1">6 months PPD/REC</entry><entry colsep="1">12 months PPD/REC</entry><entry colsep="1">24 months PPD/REC</entry><entry colsep="1">36 months PPD/REC</entry><entry colsep="1">48 months PPD/REC</entry><entry colsep="1">Attachment level at baseline</entry><entry>Attachment level at the latest control</entry></row></thead><tbody><row rowsep="1"><entry colsep="1">1*</entry><entry colsep="1">/</entry><entry colsep="1">/</entry><entry colsep="1">/</entry><entry colsep="1">/</entry><entry colsep="1">/</entry><entry colsep="1"></entry><entry colsep="1">/</entry><entry>/</entry></row><row rowsep="1"><entry colsep="1">2*</entry><entry colsep="1">/</entry><entry colsep="1">/</entry><entry colsep="1">/</entry><entry colsep="1">/</entry><entry colsep="1">/</entry><entry colsep="1">/</entry><entry colsep="1">/</entry><entry>/</entry></row><row rowsep="1"><entry colsep="1">3</entry><entry colsep="1">4.2/1</entry><entry colsep="1">4.1/1.1</entry><entry colsep="1">3.3/1.7</entry><entry colsep="1">3/1.1</entry><entry colsep="1">4/2</entry><entry colsep="1">4/1.4</entry><entry colsep="1">1.2</entry><entry>1.4</entry></row><row rowsep="1"><entry colsep="1">4*</entry><entry colsep="1">4.3/0.6</entry><entry colsep="1">4.1/0.7</entry><entry colsep="1">4.0/0.9</entry><entry colsep="1">/</entry><entry colsep="1">/</entry><entry colsep="1">/</entry><entry colsep="1">1.4</entry><entry>1.4</entry></row><row rowsep="1"><entry colsep="1">5</entry><entry colsep="1">4.1/1.6</entry><entry colsep="1">4.3/2.9</entry><entry colsep="1">4.4/1.2</entry><entry colsep="1">4.7/1.4</entry><entry colsep="1">4.6/1.4</entry><entry colsep="1">5.1/0.8</entry><entry colsep="1">1.7</entry><entry>1.9</entry></row><row rowsep="1"><entry colsep="1">6</entry><entry colsep="1">4.0/0.0</entry><entry colsep="1">4.1/0.0</entry><entry colsep="1">3.7/0.4</entry><entry colsep="1">4.0/0.2</entry><entry colsep="1">4.8/−0.8</entry><entry colsep="1">4.1/0.8</entry><entry colsep="1">0.8</entry><entry>1.6</entry></row><row rowsep="1"><entry colsep="1">7</entry><entry colsep="1">4.4/0.4</entry><entry colsep="1">4.6/0.5</entry><entry colsep="1">4.5/0.4</entry><entry colsep="1">4.5/0.3</entry><entry colsep="1">4.5/0.1</entry><entry colsep="1">4/1.1</entry><entry colsep="1">1.5</entry><entry>1.8</entry></row><row rowsep="1"><entry colsep="1">8</entry><entry colsep="1">4.0/1.3</entry><entry colsep="1">3.4/0.9</entry><entry colsep="1">3.5/0.5</entry><entry colsep="1">3.5/1.4</entry><entry colsep="1">3.9/0.7</entry><entry colsep="1">3.4/1</entry><entry colsep="1">1.9</entry><entry>1</entry></row><row rowsep="1"><entry colsep="1">9</entry><entry colsep="1">3.4/1.1</entry><entry colsep="1">3.3/1.2</entry><entry colsep="1">3.2/1.4</entry><entry colsep="1">3.4/1.4</entry><entry colsep="1">3.1/0.8</entry><entry colsep="1">2.6/1.3</entry><entry colsep="1">1</entry><entry>0.4</entry></row><row rowsep="1"><entry colsep="1">10</entry><entry colsep="1">3.0/2.0</entry><entry colsep="1">3.0/1.7</entry><entry colsep="1">2.7/1.7</entry><entry colsep="1">2.3/1.5</entry><entry colsep="1">3/1.7</entry><entry colsep="1">2.6/1</entry><entry colsep="1">1.5</entry><entry>0.1</entry></row><row rowsep="1"><entry colsep="1">11°</entry><entry colsep="1">2.8/0.4</entry><entry colsep="1">2.8/0.4</entry><entry colsep="1">2.5/0.4</entry><entry colsep="1">3/0.6</entry><entry colsep="1"></entry><entry colsep="1"></entry><entry colsep="1">0.2</entry><entry>0.6</entry></row><row rowsep="1"><entry colsep="1">12°</entry><entry colsep="1">4.1/0.0</entry><entry colsep="1">4.1/0.6</entry><entry colsep="1">5.2/1.4</entry><entry colsep="1">3.5/0.4</entry><entry colsep="1"></entry><entry colsep="1"></entry><entry colsep="1">−0.2</entry><entry>−0.5</entry></row><row rowsep="1"><entry colsep="1">13°</entry><entry colsep="1">2.8/1.1</entry><entry colsep="1">2.5/1.2</entry><entry colsep="1">2.6/0.8</entry><entry colsep="1"></entry><entry colsep="1"></entry><entry colsep="1"></entry><entry colsep="1">−0.6</entry><entry>−1.1</entry></row><row rowsep="1"><entry colsep="1"><ce:bold>Mean</ce:bold></entry><entry colsep="1"><ce:bold>3.7/0.8</ce:bold></entry><entry colsep="1"><ce:bold>3.6/1</ce:bold></entry><entry colsep="1"><ce:bold>3.6/1</ce:bold></entry><entry colsep="1"><ce:bold>3.5/1.1</ce:bold></entry><entry colsep="1"><ce:bold>3.9/0.8</ce:bold></entry><entry colsep="1"><ce:bold>3.6/1</ce:bold></entry><entry colsep="1"><ce:bold>1</ce:bold></entry><entry><ce:bold>0.7</ce:bold></entry></row><row rowsep="1"><entry colsep="1"><ce:bold>SD</ce:bold></entry><entry colsep="1"><ce:bold>±0.6/±0.6</ce:bold></entry><entry colsep="1"><ce:bold>±0.7/±0.7</ce:bold></entry><entry colsep="1"><ce:bold>±0.8/±0.5</ce:bold></entry><entry colsep="1"><ce:bold>±0.7/±0.6</ce:bold></entry><entry colsep="1"><ce:bold>±0.7/±0.9</ce:bold></entry><entry colsep="1"><ce:bold>±0.9/±0.2</ce:bold></entry><entry colsep="1"><ce:bold>±0.8</ce:bold></entry><entry><ce:bold>±0.9</ce:bold></entry></row><row><entry namest="col1" nameend="col9"></entry></row></tbody></tgroup><ce:legend><ce:simple-para>The figures of PPD and REC correspond to the mean of 16 measurements (2 × mes + 2 × dis × 4 implants).</ce:simple-para><ce:simple-para>The figures of AL are calculated according to the formula (PPD + REC) - abutment length.</ce:simple-para><ce:simple-para>*Patients who dropped out of study.</ce:simple-para><ce:simple-para>°Patients who had not yet passed the 24, 36, or 48 months of follow-up.</ce:simple-para></ce:legend></ce:table></ce:display>Four months after abutment connection (baseline) and at the latest control, the mean AL were 1 mm (SD: 0.8) and 0.7 mm (SD: 0.9), respectively. The mean annual AL change, the first year excluded, was 0.2 mm (<ce:italic>n</ce:italic> = 7 patients).</ce:para><ce:para>Table IV illustrates the individual and mean (SD) marginal bone level at the baseline (abutment connection) up to the last control.
<ce:display><ce:table colsep="0" rowsep="0" frame="topbot"><ce:label>Table IV</ce:label><ce:caption><ce:simple-para>Individual marginal bone level responses</ce:simple-para></ce:caption><tgroup cols="8"><colspec colname="col1" colsep="0"></colspec><colspec colname="col2" colsep="0"></colspec><colspec colname="col3" colsep="0"></colspec><colspec colname="col4" colsep="0"></colspec><colspec colname="col5" colsep="0"></colspec><colspec colname="col6" colsep="0"></colspec><colspec colname="col7" colsep="0"></colspec><colspec colname="col8" colsep="0"></colspec><thead><row rowsep="1" valign="bottom"><entry colsep="1">Patient</entry><entry colsep="1">Baseline</entry><entry colsep="1">4 months</entry><entry colsep="1">6 months</entry><entry colsep="1">12 months</entry><entry colsep="1">24 months</entry><entry colsep="1">36 months</entry><entry>48 months</entry></row></thead><tbody><row rowsep="1"><entry colsep="1">1*</entry><entry colsep="1">/</entry><entry colsep="1">/</entry><entry colsep="1">/</entry><entry colsep="1">/</entry><entry colsep="1">/</entry><entry colsep="1">/</entry><entry>/</entry></row><row rowsep="1"><entry colsep="1">2*</entry><entry colsep="1">/</entry><entry colsep="1">/</entry><entry colsep="1">/</entry><entry colsep="1">/</entry><entry colsep="1">/</entry><entry colsep="1">/</entry><entry>/</entry></row><row rowsep="1"><entry colsep="1">3</entry><entry colsep="1">1.9</entry><entry colsep="1">2.1</entry><entry colsep="1">2.6</entry><entry colsep="1">2</entry><entry colsep="1">2.0</entry><entry colsep="1">2.3</entry><entry>2.6</entry></row><row rowsep="1"><entry colsep="1">4*</entry><entry colsep="1">1.9</entry><entry colsep="1">2.2</entry><entry colsep="1">2.5</entry><entry colsep="1">2.6</entry><entry colsep="1">/</entry><entry colsep="1">/</entry><entry>/</entry></row><row rowsep="1"><entry colsep="1">5</entry><entry colsep="1">0.9</entry><entry colsep="1">1.5</entry><entry colsep="1">1.5</entry><entry colsep="1">1.8</entry><entry colsep="1">2.6</entry><entry colsep="1">2.8</entry><entry>2.6</entry></row><row rowsep="1"><entry colsep="1">6</entry><entry colsep="1">2.1</entry><entry colsep="1">2.2</entry><entry colsep="1">2.1</entry><entry colsep="1">2.3</entry><entry colsep="1">2.2</entry><entry colsep="1">2.3</entry><entry>2.2</entry></row><row rowsep="1"><entry colsep="1">7</entry><entry colsep="1">3.3</entry><entry colsep="1">3.1</entry><entry colsep="1">3.0</entry><entry colsep="1">3.3</entry><entry colsep="1">2.7</entry><entry colsep="1">2.6</entry><entry>2.5</entry></row><row rowsep="1"><entry colsep="1">8</entry><entry colsep="1">1.7</entry><entry colsep="1">1.8</entry><entry colsep="1">1.7</entry><entry colsep="1">1.7</entry><entry colsep="1">2.0</entry><entry colsep="1">1.8</entry><entry>2.2</entry></row><row rowsep="1"><entry colsep="1">9</entry><entry colsep="1">1.1</entry><entry colsep="1">1.7</entry><entry colsep="1">1.7</entry><entry colsep="1">1.8</entry><entry colsep="1">1.9</entry><entry colsep="1">1.8</entry><entry>1.8</entry></row><row rowsep="1"><entry colsep="1">10</entry><entry colsep="1">1.2</entry><entry colsep="1">1.5</entry><entry colsep="1">1.8</entry><entry colsep="1">2.2</entry><entry colsep="1">1.9</entry><entry colsep="1">2.2</entry><entry>1.8</entry></row><row rowsep="1"><entry colsep="1">11°</entry><entry colsep="1">1.5</entry><entry colsep="1">1.6</entry><entry colsep="1">1.6</entry><entry colsep="1">1.7</entry><entry colsep="1">1.8</entry><entry colsep="1"></entry><entry></entry></row><row rowsep="1"><entry colsep="1">12°</entry><entry colsep="1">1.2</entry><entry colsep="1">1.6</entry><entry colsep="1">1.7</entry><entry colsep="1">1.6</entry><entry colsep="1">1.8</entry><entry colsep="1"></entry><entry></entry></row><row rowsep="1"><entry colsep="1">13°</entry><entry colsep="1">1.7</entry><entry colsep="1">1.7</entry><entry colsep="1">1.7</entry><entry colsep="1">1.6</entry><entry colsep="1"></entry><entry colsep="1"></entry><entry></entry></row><row rowsep="1"><entry colsep="1"><ce:bold>Mean</ce:bold></entry><entry colsep="1">1.7</entry><entry colsep="1"><ce:bold>1.9</ce:bold></entry><entry colsep="1"><ce:bold>1.9</ce:bold></entry><entry colsep="1"><ce:bold>2</ce:bold></entry><entry colsep="1"><ce:bold>2.1</ce:bold></entry><entry colsep="1"><ce:bold>2.2</ce:bold></entry><entry><ce:bold>2.2</ce:bold></entry></row><row rowsep="1"><entry colsep="1"><ce:bold>SD</ce:bold></entry><entry colsep="1"><ce:bold>±0.7</ce:bold></entry><entry colsep="1"><ce:bold>±0.5</ce:bold></entry><entry colsep="1"><ce:bold>±0.5</ce:bold></entry><entry colsep="1"><ce:bold>±0.3</ce:bold></entry><entry colsep="1"><ce:bold>±0.4</ce:bold></entry><entry colsep="1"><ce:bold>±0.3</ce:bold></entry><entry><ce:bold>±0.3</ce:bold></entry></row><row><entry namest="col1" nameend="col8"></entry></row></tbody></tgroup><ce:legend><ce:simple-para>The figures correspond to the mean of 8 measurements (mes + dis × 4 implants). *Patients who dropped out of study. °Patients who had not yet passed the 24, 36, or 48 months of follow-up.</ce:simple-para></ce:legend></ce:table></ce:display>At 4 months and the latest control, the mean MBL located 1.9 mm and 2.1 mm, respectively, below the implant-abutment junction. The average annual bone loss, the first year excluded, was 0.2 mm (<ce:italic>n</ce:italic> = 7 patients).</ce:para><ce:para>Table V summarizes the individual and mean (SD) Periotest values from baseline (abutment connection) up to the latest control.
<ce:display><ce:table colsep="0" rowsep="0" frame="topbot"><ce:label>Table V</ce:label><ce:caption><ce:simple-para>Individual Periotest responses</ce:simple-para></ce:caption><tgroup cols="8"><colspec colname="col1" colsep="0"></colspec><colspec colname="col2" colsep="0"></colspec><colspec colname="col3" colsep="0"></colspec><colspec colname="col4" colsep="0"></colspec><colspec colname="col5" colsep="0"></colspec><colspec colname="col6" colsep="0"></colspec><colspec colname="col7" colsep="0"></colspec><colspec colname="col8" colsep="0"></colspec><thead><row rowsep="1" valign="bottom"><entry colsep="1">Patient</entry><entry colsep="1">Baseline</entry><entry colsep="1">4 months</entry><entry colsep="1">6 months</entry><entry colsep="1">1 year</entry><entry colsep="1">2 year</entry><entry colsep="1">3 year</entry><entry>4 year</entry></row></thead><tbody><row rowsep="1"><entry colsep="1">1*</entry><entry colsep="1">/</entry><entry colsep="1">/</entry><entry colsep="1">/</entry><entry colsep="1">/</entry><entry colsep="1">/</entry><entry colsep="1">/</entry><entry>/</entry></row><row rowsep="1"><entry colsep="1">2*</entry><entry colsep="1">/</entry><entry colsep="1">/</entry><entry colsep="1">/</entry><entry colsep="1">/</entry><entry colsep="1">/</entry><entry colsep="1">/</entry><entry>/</entry></row><row rowsep="1"><entry colsep="1">3</entry><entry colsep="1">−5</entry><entry colsep="1">−3</entry><entry colsep="1">−3</entry><entry colsep="1">−2</entry><entry colsep="1">−3</entry><entry colsep="1">−3</entry><entry>−2</entry></row><row rowsep="1"><entry colsep="1">4*</entry><entry colsep="1">−2</entry><entry colsep="1">−2</entry><entry colsep="1">−2</entry><entry colsep="1">−1</entry><entry colsep="1">/</entry><entry colsep="1">/</entry><entry>/</entry></row><row rowsep="1"><entry colsep="1">5</entry><entry colsep="1">−2</entry><entry colsep="1">−1</entry><entry colsep="1">−2</entry><entry colsep="1">−1</entry><entry colsep="1">0</entry><entry colsep="1">0</entry><entry>−2</entry></row><row rowsep="1"><entry colsep="1">6</entry><entry colsep="1">−3</entry><entry colsep="1">−2</entry><entry colsep="1">−3</entry><entry colsep="1">−3</entry><entry colsep="1">−3</entry><entry colsep="1">−4</entry><entry>−2</entry></row><row rowsep="1"><entry colsep="1">7</entry><entry colsep="1">−3</entry><entry colsep="1">−4</entry><entry colsep="1">−4</entry><entry colsep="1">−4</entry><entry colsep="1">−5</entry><entry colsep="1">−5</entry><entry>−4</entry></row><row rowsep="1"><entry colsep="1">8</entry><entry colsep="1">1</entry><entry colsep="1">1</entry><entry colsep="1">2</entry><entry colsep="1">1</entry><entry colsep="1">1</entry><entry colsep="1">0</entry><entry>1</entry></row><row rowsep="1"><entry colsep="1">9</entry><entry colsep="1">−2</entry><entry colsep="1">−2</entry><entry colsep="1">−2</entry><entry colsep="1">−5</entry><entry colsep="1">−6</entry><entry colsep="1">−3</entry><entry>−3</entry></row><row rowsep="1"><entry colsep="1">10</entry><entry colsep="1">−2</entry><entry colsep="1">−2</entry><entry colsep="1">−1</entry><entry colsep="1">−2</entry><entry colsep="1">−2</entry><entry colsep="1">−2</entry><entry>−1</entry></row><row rowsep="1"><entry colsep="1">11°</entry><entry colsep="1">0</entry><entry colsep="1">−2</entry><entry colsep="1">−2</entry><entry colsep="1">−1</entry><entry colsep="1">−1</entry><entry colsep="1"></entry><entry></entry></row><row rowsep="1"><entry colsep="1">12°</entry><entry colsep="1">+2</entry><entry colsep="1">−1</entry><entry colsep="1">−1</entry><entry colsep="1">−1</entry><entry colsep="1">−1</entry><entry colsep="1"></entry><entry></entry></row><row rowsep="1"><entry colsep="1">13°</entry><entry colsep="1">−2</entry><entry colsep="1">−3</entry><entry colsep="1">−3</entry><entry colsep="1">−5</entry><entry colsep="1"></entry><entry colsep="1"></entry><entry></entry></row><row rowsep="1"><entry colsep="1"><ce:bold>Mean</ce:bold></entry><entry colsep="1"><ce:bold>(−1.7)</ce:bold></entry><entry colsep="1"><ce:bold>(−1.9)</ce:bold></entry><entry colsep="1"><ce:bold>(−1.9)</ce:bold></entry><entry colsep="1"><ce:bold>(−2.2)</ce:bold></entry><entry colsep="1"><ce:bold>(−2.2)</ce:bold></entry><entry colsep="1"><ce:bold>(−2.4)</ce:bold></entry><entry><ce:bold>(−1.8)</ce:bold></entry></row><row rowsep="1"><entry colsep="1"><ce:bold>SD</ce:bold></entry><entry colsep="1"><ce:bold>(±2.0)</ce:bold></entry><entry colsep="1"><ce:bold>(±1.3)</ce:bold></entry><entry colsep="1"><ce:bold>(±1.6)</ce:bold></entry><entry colsep="1"><ce:bold>(±1.9)</ce:bold></entry><entry colsep="1"><ce:bold>(±2.2)</ce:bold></entry><entry colsep="1"><ce:bold>(±1.9)</ce:bold></entry><entry><ce:bold>(±1.5)</ce:bold></entry></row><row><entry namest="col1" nameend="col8"></entry></row></tbody></tgroup><ce:legend><ce:simple-para>The figures correspond to the mean of 8 measurements (2 × 4 implants). *Patients who dropped out of study. °Patients who had not yet passed the 24, 36, or 48 months of follow-up.</ce:simple-para></ce:legend></ce:table></ce:display>The mean PTV at baseline and at the latest control were ±1.7 and +1.9, PT units, respectively. The individual and average PTV values hardly changed over time.</ce:para></ce:section><ce:section><ce:section-title>Prosthetic outcome</ce:section-title><ce:para>Of the 13 treated patients, 2 had to refrain from the overdenture after early loss of two or more implants. These patients were helped with conventional prostheses.</ce:para><ce:para>The most frequent prosthetic complications were replacement and reactivation of Revax attachments. In addition, one denture was remade, shortly after prosthesis delivery, because of technical shortcomings of the Co-Cr framework. Some minor prosthetic complications were observed such as wear of the Revax attachments and gold screw untightening (Table VI).
<ce:display><ce:table colsep="0" rowsep="0" frame="topbot"><ce:label>Table VI</ce:label><ce:caption><ce:simple-para>Number of prosthetic complications occurring over the whole observation period</ce:simple-para></ce:caption><tgroup cols="2"><colspec colname="col1" colsep="0"></colspec><colspec colname="col2" colsep="0"></colspec><thead><row rowsep="1" valign="bottom"><entry colsep="1"></entry><entry>Number of prosthetic complications</entry></row></thead><tbody><row rowsep="1"><entry colsep="1">Wear of Revax attachment</entry><entry>3</entry></row><row rowsep="1"><entry colsep="1">Untightening of gold screw</entry><entry>1</entry></row><row rowsep="1"><entry colsep="1">Activation of Revax attachment</entry><entry>10</entry></row><row rowsep="1"><entry colsep="1">Replacement of Revax attachment</entry><entry>17</entry></row><row><entry colsep="1">Prosthesis remake</entry><entry>1</entry></row></tbody></tgroup></ce:table></ce:display></ce:para><ce:para>Mucositis and hyperplasia were the most frequently observed soft tissue complications (Table VII).
<ce:display><ce:table colsep="0" rowsep="0" frame="topbot"><ce:label>Table VII</ce:label><ce:caption><ce:simple-para>Number of patients in whom soft tissue complications were observed with old and new dentures</ce:simple-para></ce:caption><tgroup cols="4"><colspec colname="col1" colsep="0"></colspec><colspec colname="col2" colsep="0"></colspec><colspec colname="col3" colsep="0"></colspec><colspec colname="col4" colsep="0"></colspec><thead><row rowsep="1" valign="bottom"><entry colsep="1"></entry><entry colsep="1">Old denture</entry><entry colsep="1">Prosthesis insertion</entry><entry>Latest control</entry></row></thead><tbody><row rowsep="1"><entry colsep="1">Mucositis</entry><entry colsep="1">3</entry><entry colsep="1">3</entry><entry>4</entry></row><row rowsep="1"><entry colsep="1">Soreness</entry><entry colsep="1">1</entry><entry colsep="1">1</entry><entry>0</entry></row><row rowsep="1"><entry colsep="1">Ulcer decubitus</entry><entry colsep="1">1</entry><entry colsep="1">1</entry><entry>1</entry></row><row><entry colsep="1">Hyperplasia</entry><entry colsep="1">0</entry><entry colsep="1">1</entry><entry>6</entry></row></tbody></tgroup></ce:table></ce:display>Hyperplasia was mainly observed around the implants, whereas mucositis was observed all over the alveolar ridge (Fig. 5).
<ce:display><ce:figure><ce:label>Fig. 5</ce:label><ce:caption><ce:simple-para>Frequency distribution of location of denture supporting mucosa complications in different palatal areas.</ce:simple-para></ce:caption> <ce:link locator="gr6"></ce:link></ce:figure></ce:display>Figure 6 illustrates the results of the questionnaire of the old and new denture rated on an ordered scale from 1 (very bad) to 9 (excellent).
<ce:display><ce:figure><ce:label>Fig. 6</ce:label><ce:caption><ce:simple-para>Mean scores of answers from ordered scale ranging from 1 (very bad) to 9 (excellent) for old conventional denture and for new overdenture at latest control.</ce:simple-para></ce:caption> <ce:link locator="gr7"></ce:link></ce:figure></ce:display></ce:para></ce:section></ce:section><ce:section><ce:section-title>Discussion</ce:section-title><ce:para>This study indicates that the clinical outcome of implant-retained overdenture design in resorbed maxillae, when archwise placement of the implants is impossible without the use of grafting techniques, is promising on a short-term basis. Splinting the implants and the use of a minimal number (<ce:italic>n</ce:italic> = 4) of implants seem to favor the outcome. All but one implant failed at abutment connection or soon after and probably were never well-integrated.</ce:para><ce:para>Six implants failed within three patients and the reason is quite obvious for two of them. In the first patient, two implants were lost, one at abutment connection and the other soon after. This patient suffered from an undiagnosed thrombocytopenia at implant placement. This bleeder disease is known to negatively influence wound healing processes. In the second patient, three implants were lost. These losses occurred in a patient who has been associated with an important dehiscence that had to be dealt with by means of a guided tissue procedure at the time of implant placement. Exposure of the membrane urged early removal of it, which may explain the nonintegration of one implant at abutment connection. The two other losses occurred before the 6-month recall and were probably lost as a result of overload of the nonmineralized interface because the remaining implants failed to adequately support the prosthesis. In the third patient, the reason for its failure was not clear.</ce:para><ce:para>Other studies on implant-retained overdentures show high losses even after 4 years.<ce:cross-refs refid="bib7 bib22"><ce:sup>7,22</ce:sup></ce:cross-refs> The often compromised bone texture of the maxilla and the limited volume contribute more unfavorably in the maxilla than in the mandible.<ce:cross-ref refid="bib7"><ce:sup>7</ce:sup></ce:cross-ref> Hutton et al.<ce:cross-ref refid="bib6"><ce:sup>6</ce:sup></ce:cross-ref> reported that the risk of overdenture treatment failure is nearly nine times larger in the maxilla than in the mandible.</ce:para><ce:para>It is important to point out that the more favorable results in this study must have to do with the number of implants that were rigidly splinted. Indeed, when the data were compared with those of a group of five patients who received treatment in our center with maxillary overdentures on two unconnected implants with ball attachments or magnets, the absolute success rate was only 40% after a mean loading time of 6.4 years (range, 3 to 8 years). These data are updated and are part of a study published previously, where an excessive marginal bone loss was found around those implants.<ce:cross-ref refid="bib10"><ce:sup>10</ce:sup></ce:cross-ref></ce:para><ce:para>The MBL hardly changed after 1 year of loading, which is in contrast with previous studies in which marginal bone loss was reported to be severe.<ce:cross-refs refid="bib7 bib10 bib22"><ce:sup>7,10,22</ce:sup></ce:cross-refs> Palmqvist et al.<ce:sup>23</ce:sup> made the same observations when a rigid connection was used. On the other hand, the stable bone apposition over time sharply contrasts again with the mean marginal bone loss of the “retrospective group” that was 4.71 mm over a 6-year period<ce:cross-ref refid="bib10"><ce:sup>10</ce:sup></ce:cross-ref> (Fig. 7).
<ce:display><ce:figure><ce:label>Fig. 7</ce:label><ce:caption><ce:simple-para>Radiographs at abutment connection and of same implants 6 years later. Severe bone loss results. These radiographs are representative for five patients treated in late 1980s by means of two unconnected implants in maxilla retaining overdenture.</ce:simple-para></ce:caption> <ce:link locator="gr8"></ce:link></ce:figure></ce:display>Except for the number and the rigid connection, the treatment modalities in this retrospective study were comparable to those currently reported. This is in contrast with observations in the anterior part of the mandible where there is no need to splint two implants that retain a hinging overdenture.<ce:cross-ref refid="bib20"><ce:sup>20</ce:sup></ce:cross-ref></ce:para><ce:para>Periotest values revealed stable rigidity of the implant-bone interface. The higher PTV values when compared with mandibular implants may be explained by the difference in density between the mandibular and maxillary bone characteristics.<ce:cross-ref refid="bib21"><ce:sup>21</ce:sup></ce:cross-ref></ce:para><ce:para>The peri-implant attachment levels presented small changes over time. The annual changes in marginal bone level and attachment level were within the same range. It has been previously reported that AL and MBL were highly correlated.<ce:cross-refs refid="bib24 bib25"><ce:sup>24,25</ce:sup></ce:cross-refs></ce:para><ce:para>Mucositis and gingival hyperplasia were observed in denture supporting areas as previously reported.<ce:cross-refs refid="bib4 bib7 bib26"><ce:sup>4,7,26</ce:sup></ce:cross-refs> Hyperplasia was mostly observed around the implants, whereas mucositis was present in various maxillary sites. These complications may be explained by the excellent retention of the denture preventing a sufficient amount of saliva to enter the area underneath the denture. This favors an overgrowth of bacteria leading to denture stomatitis.<ce:cross-refs refid="bib27 bib28"><ce:sup>27,28</ce:sup></ce:cross-refs> Although the patients were clearly advised to remove their denture during night, only half of them did. This confirms observations of overdenture wearing in the mandible.<ce:cross-ref refid="bib20"><ce:sup>20</ce:sup></ce:cross-ref></ce:para><ce:para>The improvement in patients' satisfaction between the old conventional denture and the implant-retained overdenture was impressive. The new prosthesis design inspired by Lothigius et al. <ce:cross-ref refid="bib18"><ce:sup>18</ce:sup></ce:cross-ref> was tested because the implants are splinted with the same rigidity as in fixed full prostheses. The disadvantage of this design lies in the frequent need to replace the Revax attachments, in addition to the higher technical demands for the laboratory phase.</ce:para></ce:section><ce:section><ce:section-title>Conclusions</ce:section-title><ce:para>The following conclusions were drawn from this study.
<ce:list><ce:list-item><ce:label>1.</ce:label><ce:para>The peri-implant outcome for the group with four splinted implants in the maxilla displayed a stable situation over time. Implant losses were concentrated at or around the time of abutment connection only.</ce:para></ce:list-item><ce:list-item><ce:label>2.</ce:label><ce:para>Hyperplasia around the implants and mucositis were the most common soft tissue complications.</ce:para></ce:list-item><ce:list-item><ce:label>3.</ce:label><ce:para>The new prosthesis design needs frequent change or activation of the Revax attachments and increased technical skills to proceed well.</ce:para></ce:list-item></ce:list></ce:para></ce:section></ce:sections><ce:acknowledgment><ce:section-title>Acknowledgements</ce:section-title><ce:para>We are indebted to Ceka NV, Antwerp, Belgium, for their support for prosthesis component delivery.</ce:para></ce:acknowledgment></body><tail><ce:bibliography><ce:section-title>References</ce:section-title><ce:bibliography-sec><ce:bib-reference id="bib1"><ce:label>1</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>B</ce:given-name><ce:surname>Engquist</ce:surname></sb:author><sb:author><ce:given-name>T</ce:given-name><ce:surname>Bergendal</ce:surname></sb:author><sb:author><ce:given-name>T</ce:given-name><ce:surname>Kallus</ce:surname></sb:author><sb:author><ce:given-name>U.</ce:given-name><ce:surname>Linden</ce:surname></sb:author></sb:authors><sb:title><sb:maintitle>A retrospective multi-center evaluation of osseointegrated implants supporting overdentures</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Int J Oral Maxillofac Implants</sb:maintitle></sb:title><sb:volume-nr>3</sb:volume-nr></sb:series><sb:date>1988</sb:date></sb:issue><sb:pages><sb:first-page>129</sb:first-page><sb:last-page>134</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib2"><ce:label>2</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>I</ce:given-name><ce:surname>Naert</ce:surname></sb:author><sb:author><ce:given-name>M</ce:given-name><ce:surname>De Clercq</ce:surname></sb:author><sb:author><ce:given-name>G</ce:given-name><ce:surname>Theuniers</ce:surname></sb:author><sb:author><ce:given-name>E.</ce:given-name><ce:surname>Schepers</ce:surname></sb:author></sb:authors><sb:title><sb:maintitle>Overdentures supported by osseointegrated fixtures for the edentulous mandible: a 2.5 year report</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Int J Oral Maxillofac Implants</sb:maintitle></sb:title><sb:volume-nr>3</sb:volume-nr></sb:series><sb:date>1988</sb:date></sb:issue><sb:pages><sb:first-page>191</sb:first-page><sb:last-page>196</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib3"><ce:label>3</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>I</ce:given-name><ce:surname>Naert</ce:surname></sb:author><sb:author><ce:given-name>M</ce:given-name><ce:surname>Quirynen</ce:surname></sb:author><sb:author><ce:given-name>G</ce:given-name><ce:surname>Theuniers</ce:surname></sb:author><sb:author><ce:given-name>D.</ce:given-name><ce:surname>van Steenberghe</ce:surname></sb:author></sb:authors><sb:title><sb:maintitle>Prosthetic aspects of osseointegrated fixtures supporting overdentures. 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The results of the implant overdenture treatment in the maxilla remains inferior to those in the mandible. Different reasons have been alluded to, such as bone quality and quantity, number of implants, as well as the prosthesis design. Purpose.To investigate the latter, a new design for the rehabilitation of the resorbed maxillae was set up. Material and methods. Thirteen patients were selected and provided with four endosseous maxillary implants, splinted with a rigid-cast bar. Results. After a mean loading time of 3 years, six implants were lost; three at abutment and another three shortly after abutment connection, resulting in a cumulative success rate of 88.6% at year 4. A mean marginal bone loss of 0.3 mm was observed within the first year. After the first year, the marginal bone level, the attachment level, and the Periotest scores hardly changed. The main prosthetic complication was the frequent need to renew or to activate the attachments. A strong improvement in patient satisfaction was observed when compared with the old conventional denture. Conclusions. Within the limits of this study, the outcome confirmed that, on a medium-term base, implant-retained hinging overdentures on four implants were promising. (J Prosthet Dent 1998;79:156-64.)</abstract><note>aProfessor, Department of Prosthetic Dentistry, School of Dentistry, Oral Pathology and Maxillofacial Surgery, Biomaterials Research Group.</note><note>bAssistant Professor, Department of Prosthetic Dentistry, School of Dentistry, Oral Pathology and Maxillofacial Surgery.</note><note>cProfessor, Department of Periodontology, School of Dentistry, Oral Pathology and Maxillofacial Surgery. Grantholder Brånemark Chair in Osseointegration.</note><note>Reprint requests to: Dr. I. E. Naert, Department of Prosthetic Dentistry, School of Dentistry, Oral Pathology and Maxillofacial Surgery, Capucijnenvoer 7, B-3000 Leuven, BELGIUM</note><note>10/1/85866</note><relatedItem type="host"><titleInfo><title>The Journal of Prosthetic Dentistry</title></titleInfo><titleInfo type="abbreviated"><title>YMPR</title></titleInfo><genre type="journal" authority="ISTEX" authorityURI="https://publication-type.data.istex.fr" valueURI="https://publication-type.data.istex.fr/ark:/67375/JMC-0GLKJH51-B">journal</genre><originInfo><publisher>ELSEVIER</publisher><dateIssued encoding="w3cdtf">199802</dateIssued></originInfo><identifier type="ISSN">0022-3913</identifier><identifier type="PII">S0022-3913(05)X7049-4</identifier><part><date>199802</date><detail type="volume"><number>79</number><caption>vol.</caption></detail><detail type="issue"><number>2</number><caption>no.</caption></detail><extent unit="issue-pages"><start>115</start><end>244</end></extent><extent unit="pages"><start>156</start><end>164</end></extent></part></relatedItem><identifier type="istex">F57B838B61131BAAA35A4658719AC7FE010928C0</identifier><identifier type="ark">ark:/67375/6H6-G7M91PL9-5</identifier><identifier type="DOI">10.1016/S0022-3913(98)70210-0</identifier><identifier type="PII">S0022-3913(98)70210-0</identifier><accessCondition type="use and reproduction" contentType="copyright">©1998 Editorial Council of The Journal of Prosthetic Dentistry</accessCondition><recordInfo><recordContentSource authority="ISTEX" authorityURI="https://loaded-corpus.data.istex.fr" valueURI="https://loaded-corpus.data.istex.fr/ark:/67375/XBH-HKKZVM7B-M">elsevier</recordContentSource><recordOrigin>Editorial Council of The Journal of Prosthetic Dentistry, ©1998</recordOrigin></recordInfo></mods><json:item><extension>json</extension><original>false</original><mimetype>application/json</mimetype><uri>https://api.istex.fr/document/F57B838B61131BAAA35A4658719AC7FE010928C0/metadata/json</uri></json:item></metadata></istex></record>Pour manipuler ce document sous Unix (Dilib)
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