Clinical and Radiographic Evaluation of Median Lingualized Occlusion in Implant Retained Mandibular Complete Overdenture
Identifieur interne : 000336 ( Pmc/Corpus ); précédent : 000335; suivant : 000337Clinical and Radiographic Evaluation of Median Lingualized Occlusion in Implant Retained Mandibular Complete Overdenture
Auteurs : Hussien A. Ismail ; Salah A. Yousief ; Ahmed I. Mahrous ; Ahmed Abdelwahed Shaban ; Saleh Nasser Azzeghaiby ; Dareen AljehaniSource :
- Journal of International Oral Health : JIOH [ 0976-7428 ] ; 2015.
Abstract
The purpose of this study was to evaluate clinically and radiographically median lingualized occlusion in implant-retained mandibular complete overdenture.
Ten completely edentulous male patients were participated in this study. Each patient received two implants in the intraforaminal area of the edentulous mandible that were left unloaded for 4 months. Patients were received conventional maxillary complete denture and implant mandibular overdenture with ball and socket attachment. The posterior teeth were set according to median lingualized occlusion scheme. All patients were evaluated clinically and radiographically immediately after denture insertion, 6 and 12 months of overdenture insertion.
The results revealed significant differences in probing depth, gingival index, plaque index, and marginal bone height between the different follow-up periods. With the limitation of this study, and according to the results of the mean marginal bone loss and the other peri-implant parameters after 1 year of loading.
The implant retained overdenture with the median lingualized occlusal scheme may be recognized as being acceptable according to the general implant success rates and criteria.
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PubMed: 26225096
PubMed Central: 4516061
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Clinical and Radiographic Evaluation of Median Lingualized Occlusion in Implant Retained Mandibular Complete Overdenture</title><author><name sortKey="Ismail, Hussien A" sort="Ismail, Hussien A" uniqKey="Ismail H" first="Hussien A" last="Ismail">Hussien A. Ismail</name><affiliation><nlm:aff id="aff1">Assistant Professor, Department of Removable Prosthodontics, Al-Farabi Collages, Jeddah, Kingdom of Saudi Arabia</nlm:aff></affiliation></author><author><name sortKey="Yousief, Salah A" sort="Yousief, Salah A" uniqKey="Yousief S" first="Salah A" last="Yousief">Salah A. Yousief</name></author><author><name sortKey="Mahrous, Ahmed I" sort="Mahrous, Ahmed I" uniqKey="Mahrous A" first="Ahmed I" last="Mahrous">Ahmed I. Mahrous</name><affiliation><nlm:aff id="aff1">Assistant Professor, Department of Removable Prosthodontics, Al-Farabi Collages, Jeddah, Kingdom of Saudi Arabia</nlm:aff></affiliation></author><author><name sortKey="Shaban, Ahmed Abdelwahed" sort="Shaban, Ahmed Abdelwahed" uniqKey="Shaban A" first="Ahmed Abdelwahed" last="Shaban">Ahmed Abdelwahed Shaban</name><affiliation><nlm:aff id="aff4">Lecturer, Department of Removable Prosthodontics, Faculty of Dental Medicine, Future Uni, Egypt</nlm:aff></affiliation></author><author><name sortKey="Azzeghaiby, Saleh Nasser" sort="Azzeghaiby, Saleh Nasser" uniqKey="Azzeghaiby S" first="Saleh Nasser" last="Azzeghaiby">Saleh Nasser Azzeghaiby</name><affiliation><nlm:aff id="aff3">Assistant Professor, Department of Restorative Sciences, Al-Farabi College of Dentistry and Nursing, Jeddah, Kingdom of Saudi Arabia</nlm:aff></affiliation></author><author><name sortKey="Aljehani, Dareen" sort="Aljehani, Dareen" uniqKey="Aljehani D" first="Dareen" last="Aljehani">Dareen Aljehani</name><affiliation><nlm:aff id="aff5">Head, Department of Operative, Al-Farabi Dental College, Riyadh, Kingdom of Saudi Arabia</nlm:aff></affiliation><affiliation><nlm:aff id="aff6">Assistant Professor, Department of Orthodontics, Al-Farabi Dental College, Riyadh, Kingdom of Saudi Arabia</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">26225096</idno><idno type="pmc">4516061</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4516061</idno><idno type="RBID">PMC:4516061</idno><date when="2015">2015</date><idno type="wicri:Area/Pmc/Corpus">000336</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000336</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Clinical and Radiographic Evaluation of Median Lingualized Occlusion in Implant Retained Mandibular Complete Overdenture</title><author><name sortKey="Ismail, Hussien A" sort="Ismail, Hussien A" uniqKey="Ismail H" first="Hussien A" last="Ismail">Hussien A. Ismail</name><affiliation><nlm:aff id="aff1">Assistant Professor, Department of Removable Prosthodontics, Al-Farabi Collages, Jeddah, Kingdom of Saudi Arabia</nlm:aff></affiliation></author><author><name sortKey="Yousief, Salah A" sort="Yousief, Salah A" uniqKey="Yousief S" first="Salah A" last="Yousief">Salah A. Yousief</name></author><author><name sortKey="Mahrous, Ahmed I" sort="Mahrous, Ahmed I" uniqKey="Mahrous A" first="Ahmed I" last="Mahrous">Ahmed I. Mahrous</name><affiliation><nlm:aff id="aff1">Assistant Professor, Department of Removable Prosthodontics, Al-Farabi Collages, Jeddah, Kingdom of Saudi Arabia</nlm:aff></affiliation></author><author><name sortKey="Shaban, Ahmed Abdelwahed" sort="Shaban, Ahmed Abdelwahed" uniqKey="Shaban A" first="Ahmed Abdelwahed" last="Shaban">Ahmed Abdelwahed Shaban</name><affiliation><nlm:aff id="aff4">Lecturer, Department of Removable Prosthodontics, Faculty of Dental Medicine, Future Uni, Egypt</nlm:aff></affiliation></author><author><name sortKey="Azzeghaiby, Saleh Nasser" sort="Azzeghaiby, Saleh Nasser" uniqKey="Azzeghaiby S" first="Saleh Nasser" last="Azzeghaiby">Saleh Nasser Azzeghaiby</name><affiliation><nlm:aff id="aff3">Assistant Professor, Department of Restorative Sciences, Al-Farabi College of Dentistry and Nursing, Jeddah, Kingdom of Saudi Arabia</nlm:aff></affiliation></author><author><name sortKey="Aljehani, Dareen" sort="Aljehani, Dareen" uniqKey="Aljehani D" first="Dareen" last="Aljehani">Dareen Aljehani</name><affiliation><nlm:aff id="aff5">Head, Department of Operative, Al-Farabi Dental College, Riyadh, Kingdom of Saudi Arabia</nlm:aff></affiliation><affiliation><nlm:aff id="aff6">Assistant Professor, Department of Orthodontics, Al-Farabi Dental College, Riyadh, Kingdom of Saudi Arabia</nlm:aff></affiliation></author></analytic><series><title level="j">Journal of International Oral Health : JIOH</title><idno type="ISSN">0976-7428</idno><idno type="eISSN">0976-1799</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="st1"><title>Background:</title><p>The purpose of this study was to evaluate clinically and radiographically median lingualized occlusion in implant-retained mandibular complete overdenture.</p></sec><sec id="st2"><title>Materials and Methods:</title><p>Ten completely edentulous male patients were participated in this study. Each patient received two implants in the intraforaminal area of the edentulous mandible that were left unloaded for 4 months. Patients were received conventional maxillary complete denture and implant mandibular overdenture with ball and socket attachment. The posterior teeth were set according to median lingualized occlusion scheme. All patients were evaluated clinically and radiographically immediately after denture insertion, 6 and 12 months of overdenture insertion.</p></sec><sec id="st3"><title>Results:</title><p>The results revealed significant differences in probing depth, gingival index, plaque index, and marginal bone height between the different follow-up periods. With the limitation of this study, and according to the results of the mean marginal bone loss and the other peri-implant parameters after 1 year of loading.</p></sec><sec id="st4"><title>Conclusion:</title><p>The implant retained overdenture with the median lingualized occlusal scheme may be recognized as being acceptable according to the general implant success rates and criteria.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Sugerman, Pb" uniqKey="Sugerman P">PB Sugerman</name></author><author><name sortKey="Barber, Mt" uniqKey="Barber M">MT Barber</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Schulte, W" uniqKey="Schulte W">W Schulte</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Misch, Ce" uniqKey="Misch C">CE Misch</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Miyata, T" uniqKey="Miyata T">T Miyata</name></author><author><name sortKey="Kobayashi, Y" uniqKey="Kobayashi Y">Y Kobayashi</name></author><author><name sortKey="Araki, H" uniqKey="Araki H">H Araki</name></author><author><name sortKey="Ohto, T" uniqKey="Ohto T">T Ohto</name></author><author><name sortKey="Shin, K" uniqKey="Shin K">K Shin</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kim, Y" uniqKey="Kim Y">Y Kim</name></author><author><name sortKey="Oh, Tj" uniqKey="Oh T">TJ Oh</name></author><author><name sortKey="Misch, Ce" uniqKey="Misch C">CE Misch</name></author><author><name sortKey="Wang, Hl" uniqKey="Wang H">HL Wang</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ky, Ke" uniqKey="Ky K">KE Ky</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Anne, S" uniqKey="Anne S">S Anne</name></author><author><name sortKey="Guillaume, D" uniqKey="Guillaume D">D Guillaume</name></author><author><name sortKey="Marwan, D" uniqKey="Marwan D">D Marwan</name></author><author><name sortKey="Paul, L" uniqKey="Paul L">L Paul</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Reitz, Jv" uniqKey="Reitz J">JV Reitz</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Vygandas, R" uniqKey="Vygandas R">R Vygandas</name></author><author><name sortKey="Hiroshi, M" uniqKey="Hiroshi M">M Hiroshi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mombelli, A" uniqKey="Mombelli A">A Mombelli</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Misch, Ce" uniqKey="Misch C">CE Misch</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Roynesdal, A" uniqKey="Roynesdal A">A Roynesdal</name></author><author><name sortKey="Amundrud, B" uniqKey="Amundrud B">B Amundrud</name></author><author><name sortKey="Hann S, H" uniqKey="Hann S H">H Hannæs</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Behneke, A" uniqKey="Behneke A">A Behneke</name></author><author><name sortKey="Behneke, A" uniqKey="Behneke A">A Behneke</name></author><author><name sortKey="Hoedt, B" uniqKey="Hoedt B">B Hoedt</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Sahin, S" uniqKey="Sahin S">S Sahin</name></author><author><name sortKey="Cehreli, Mc" uniqKey="Cehreli M">MC Cehreli</name></author><author><name sortKey="Yalcin, E" uniqKey="Yalcin E">E Yalçin</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Misch, Ce" uniqKey="Misch C">CE Misch</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ismail, E" uniqKey="Ismail E">E Ismail</name></author><author><name sortKey="Assad, A" uniqKey="Assad A">A Assad</name></author><author><name sortKey="Badawy, M" uniqKey="Badawy M">M Badawy</name></author><author><name sortKey="Mohamed, S" uniqKey="Mohamed S">S Mohamed</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Misch, Ce" uniqKey="Misch C">CE Misch</name></author><author><name sortKey="Wang, Hl" uniqKey="Wang H">HL Wang</name></author><author><name sortKey="Misch, Cm" uniqKey="Misch C">CM Misch</name></author><author><name sortKey="Sharawy, M" uniqKey="Sharawy M">M Sharawy</name></author><author><name sortKey="Lemons, J" uniqKey="Lemons J">J Lemons</name></author><author><name sortKey="Judy, Kw" uniqKey="Judy K">KW Judy</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kumar, Na" uniqKey="Kumar N">NA Kumar</name></author><author><name sortKey="Agrawal, G" uniqKey="Agrawal G">G Agrawal</name></author><author><name sortKey="Agrawal, A" uniqKey="Agrawal A">A Agrawal</name></author><author><name sortKey="Sreedevi, B" uniqKey="Sreedevi B">B Sreedevi</name></author><author><name sortKey="Kakkad, A" uniqKey="Kakkad A">A 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<front><journal-meta><journal-id journal-id-type="nlm-ta">J Int Oral Health</journal-id><journal-id journal-id-type="iso-abbrev">J Int Oral Health</journal-id><journal-id journal-id-type="publisher-id">JIOH</journal-id><journal-title-group><journal-title>Journal of International Oral Health : JIOH</journal-title></journal-title-group><issn pub-type="ppub">0976-7428</issn><issn pub-type="epub">0976-1799</issn><publisher><publisher-name>Dentmedpub Research and Printing Co</publisher-name><publisher-loc>India</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">26225096</article-id><article-id pub-id-type="pmc">4516061</article-id><article-id pub-id-type="publisher-id">JIOH-7-5</article-id><article-categories><subj-group subj-group-type="heading"><subject>Original Research</subject></subj-group></article-categories><title-group><article-title>Clinical and Radiographic Evaluation of Median Lingualized Occlusion in Implant Retained Mandibular Complete Overdenture</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Ismail</surname><given-names>Hussien A</given-names></name><xref ref-type="aff" rid="aff1">1</xref><xref ref-type="corresp" rid="cor1"></xref></contrib><contrib contrib-type="author"><name><surname>Yousief</surname><given-names>Salah A</given-names></name><xref rid="ref2" ref-type="bibr">2</xref><xref rid="ref3" ref-type="bibr">3</xref></contrib><contrib contrib-type="author"><name><surname>Mahrous</surname><given-names>Ahmed I</given-names></name><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Shaban</surname><given-names>Ahmed Abdelwahed</given-names></name><xref ref-type="aff" rid="aff4">4</xref></contrib><contrib contrib-type="author"><name><surname>Azzeghaiby</surname><given-names>Saleh Nasser</given-names></name><xref ref-type="aff" rid="aff3">3</xref></contrib><contrib contrib-type="author"><name><surname>Aljehani</surname><given-names>Dareen</given-names></name><xref ref-type="aff" rid="aff5">5</xref><xref ref-type="aff" rid="aff6">6</xref></contrib></contrib-group><aff id="aff1"><label>1</label>Assistant Professor, Department of Removable Prosthodontics, Al-Farabi Collages, Jeddah, Kingdom of Saudi Arabia</aff><aff id="aff2"><label>2</label>Lecturer, Department of Crown and Bridge, Faculty of Oral and Dental Medicine, Assuit Branch, Al Azhar Uni, Egypt</aff><aff id="aff3"><label>3</label>Assistant Professor, Department of Restorative Sciences, Al-Farabi College of Dentistry and Nursing, Jeddah, Kingdom of Saudi Arabia</aff><aff id="aff4"><label>4</label>Lecturer, Department of Removable Prosthodontics, Faculty of Dental Medicine, Future Uni, Egypt</aff><aff id="aff5"><label>5</label>Head, Department of Operative, Al-Farabi Dental College, Riyadh, Kingdom of Saudi Arabia</aff><aff id="aff6"><label>6</label>Assistant Professor, Department of Orthodontics, Al-Farabi Dental College, Riyadh, Kingdom of Saudi Arabia</aff><author-notes><corresp id="cor1"><bold><italic>Correspondence:</italic></bold> Ismail HA. Department of Removable Prosthodontics, Al-Farabi Collages, Haramain Road, Jeddah 21512, Kingdom of Saudi Arabia. Tel.: +966-596930008, Fax: 920009112. Email: <email xlink:href="hussien_eldwash@yahoo.com">hussien_eldwash@yahoo.com</email></corresp></author-notes><pub-date pub-type="ppub"><year>2015</year></pub-date><volume>7</volume><issue>Suppl 1</issue><fpage>5</fpage><lpage>8</lpage><history><date date-type="received"><day>15</day><month>2</month><year>2015</year></date><date date-type="accepted"><day>18</day><month>4</month><year>2015</year></date></history><permissions><copyright-statement>Copyright: © Journal of International Oral Health</copyright-statement><copyright-year>2015</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc-sa/3.0"><license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><abstract><sec id="st1"><title>Background:</title><p>The purpose of this study was to evaluate clinically and radiographically median lingualized occlusion in implant-retained mandibular complete overdenture.</p></sec><sec id="st2"><title>Materials and Methods:</title><p>Ten completely edentulous male patients were participated in this study. Each patient received two implants in the intraforaminal area of the edentulous mandible that were left unloaded for 4 months. Patients were received conventional maxillary complete denture and implant mandibular overdenture with ball and socket attachment. The posterior teeth were set according to median lingualized occlusion scheme. All patients were evaluated clinically and radiographically immediately after denture insertion, 6 and 12 months of overdenture insertion.</p></sec><sec id="st3"><title>Results:</title><p>The results revealed significant differences in probing depth, gingival index, plaque index, and marginal bone height between the different follow-up periods. With the limitation of this study, and according to the results of the mean marginal bone loss and the other peri-implant parameters after 1 year of loading.</p></sec><sec id="st4"><title>Conclusion:</title><p>The implant retained overdenture with the median lingualized occlusal scheme may be recognized as being acceptable according to the general implant success rates and criteria.</p></sec></abstract><kwd-group><kwd>Dental implant</kwd><kwd>median lingualized occlusion</kwd><kwd>overdenture</kwd></kwd-group></article-meta></front><body><sec sec-type="intro" id="sec1-1"><title>Introduction</title><p>Some of completely edentulous patients have difficulty to wear complete mandibular denture owing to poor support and retention precipitated by advanced bone resorption, xerostomia, loss of attached keratinized tissue and neuromuscular degeneration. Several methods of treatment for this category of patients have been done for both patients’ satisfaction and performance. Some of these methods are the implant-supported mandibular overdenture retained by bar-clip attachments, ball attachments as well as mandibular overdenture retained by magnets.<xref rid="ref1" ref-type="bibr">1</xref></p><p>Dental implants are ankylosed to surrounding bone. Moreover, the crestal bone around dental implants may act as a fulcrum point for lever action when a force (bending moment) is applied. Clinical success of dental implants can be achieved by bio-mechanically controlled occlusion.<xref rid="ref2" ref-type="bibr">2</xref>,<xref rid="ref3" ref-type="bibr">3</xref></p><p>Literature have claimed to control occlusal overload that may lead to bone loss and subsequently failure of implants.<xref rid="ref4" ref-type="bibr">4</xref></p><p>Control of implant occlusion is so important to ensure minimal and even stress distribution to the osseointegrated abutment fixtures, which cannot move to compensate for possible occlusal and other technical discrepancies so optimal implant load and success can be achieved.<xref rid="ref5" ref-type="bibr">5</xref></p><p>Different types of occlusal forms and posterior teeth arrangements have been used in implant-supported prostheses. There are many controversial opinions concerning the occlusal design and pattern.<xref rid="ref6" ref-type="bibr">6</xref></p><p>In the median lingualized implant retained overdenture, it was emphasized that during the entire lateral movement posterior teeth on both the working side and the balancing side are in contact. This concept was advocated to be used for patients with maxillary complete denture and mandibular implant overdenture; because of its ability to direct the forces of mastication vertically onto the supporting structures, it is a simple concept and can be easily arranged and verified.<xref rid="ref7" ref-type="bibr">7</xref>,<xref rid="ref8" ref-type="bibr">8</xref></p><p>The purpose of this study was to evaluate clinically and radiographically completely edentulous patient rehabilitated by implant-retained mandibular complete overdenture with median lingualized occlusion.</p></sec><sec sec-type="materials|methods" id="sec1-2"><title>Materials and Methods</title><p>Ten completely edentulous male patients free from any local or systemic disease that may contraindicate or affect the prognosis of implants were participated in this study. Each patient received two self-tapping root-form titanium dental implants (13 mm length and 3.4 mm diameter) in the mandibular inter-foraminal region that were left submerged and unloaded for 4 months.</p><p>After osseointegration period of 4 months, the implants were exposed and connected to the healing abutments. The patients were then received conventional maxillary complete denture and mandibular overdenture with ball and socket attachments. The dentures posterior teeth were set according to the median lingualized occlusal scheme (Figures <xref ref-type="fig" rid="F1">1</xref> and <xref ref-type="fig" rid="F2">2</xref>).</p><fig id="F1" position="float"><label>Figure 1</label><caption><p>Two ball attachments secured in patient mouth.</p></caption><graphic xlink:href="JIOH-7-5-g001"></graphic></fig><fig id="F2" position="float"><label>Figure 2</label><caption><p>Denture with median lingualized occlusion in the patient mouth.</p></caption><graphic xlink:href="JIOH-7-5-g002"></graphic></fig><p>Clinical and radiographic evaluations were recorded immediately after overdenture insertion and after 6 and 12 months interval follow-up periods.</p><p>The clinical evaluation included probing depth, gingival bleeding index, plaque index, percussion index, and mobility index.</p><p>Digital panoramic radiographs were taken for each patient by using the same machine for the assessment of crestal bone level (BL).</p><p>Data analysis was performed with one-way analysis of variance ANOVA and <italic>t</italic>-test as a function of the follow-up period. Statistical analysis was performed using the software Graph pad Prism-4 statistics for Windows.</p></sec><sec sec-type="results" id="sec1-3"><title>Results</title><p>During the follow-up period, all patients were satisfied regarding denture stability, retention, and esthetics. Percussion on implants revealed Score 0 = high percussion sound throughout the whole follow-up periods. No movement was found in the implants throughout the whole follow-up period. Results of probing pocket depth, gingival index (GI), plaque index (PI), and bone height (BH) changes were summarized in <xref ref-type="fig" rid="F3">Graph 1</xref>.</p><fig id="F3" position="float"><label>Graph 1</label><caption><p>The clinical and radiographic parameters at the different follow-up periods.</p></caption><graphic xlink:href="JIOH-7-5-g003"></graphic></fig><sec id="sec2-1"><title>Probing pocket depth</title><p>The mean and slandered deviation values of probing depth at time of insertion (BL), 6 and 12 months follow-up periods were 1.042 ± 0.32, 1.379 ± 0.394, and 1.688 ± 0.73, respectively. The result of the paired sample <italic>t</italic>-test of the probing depth mean values revealed significant differences from 6 months to BL, 12 months to BL, and from 12 to 6 months.</p></sec><sec id="sec2-2"><title>Gingival index</title><p>The mean and slandered deviation values of GI at BL, 6 and 12 months follow-up periods were 0.0, 0.515 ± 0.17 and 0.816 ± 0.32, respectively. The result of the paired sample <italic>t</italic>-test of the GI mean values revealed significant differences from 6 months to BL and 12 months to BL while there was no significant difference from 6 to 12 months.</p></sec><sec id="sec2-3"><title>Plaque index</title><p>The mean and slandered deviation values of PI at BL, 6 and 12 months follow-up periods were 0.0, 0.817 ± 0.3 and 1.261 ± 0.37, respectively. The result of the paired sample <italic>t</italic>-test of the PI mean values revealed significant differences from 12 months to BL and 12 to 6 months while there was no significant difference from 6 months to BL.</p></sec><sec id="sec2-4"><title>BH</title><p>The mean and slandered deviation values of BH at the time of insertion, 6 and 12 months follow-up periods were 13.85 ± 0.08, 13.35 ± 0.14, and 13 ± 0.14 respectively. The result of the paired sample <italic>t</italic>-test of the BH mean values for ML revealed significant differences from baseline to 6 months, 6 months to 12 months, and from baseline to12 months.</p></sec></sec><sec sec-type="discussion" id="sec1-4"><title>Discussion</title><p>The implant overdenture occlusion is a critical component of success dental implants. In this study two fixtures were implanted in the anterior part of the mandible between the two mental foramina, this region usually presents the optimal bone quality and quantity for implant support. It is entirely formed of dense, thick cortical plates, and dense trabecular bone. Overdentures were attached to the two implants by means of ball and socket attachment. This type of attachment allows a rotation and translation of the overdenture.<xref rid="ref9" ref-type="bibr">9</xref>,<xref rid="ref10" ref-type="bibr">10</xref></p><p>As suggested in literature, an occlusal contact on a buccal cusp may be an offset load when the implant is under the central fossa, and the buccal cusp is cantilevered from the implant body. The angled buccal cusp also will introduce an angled load to the implant body. Hence, it was considered in a median lingualized occlusal scheme that the ideal primary occlusal contacts to be resided within the diameter of the implant, within the central fosse. Secondary occlusal contacts to be remained within 1 mm of the periphery of the implant to decrease moment loads.<xref rid="ref11" ref-type="bibr">11</xref></p><p>The results of this study revealed that there were statistically significant differences in the mean probing depth within all periods of this study. The results revealed that the probing depths were <1 mm during the entire period of this study. These results were in agreement with Roynesdal <italic>et al</italic>, concluded that a probe penetration of approximately 3 mm is an indicator of successful implants. The author added that if there are pockets deeper than 3 mm, an inflammatory process may take place at the bottom of the defect.<xref rid="ref12" ref-type="bibr">12</xref></p><p>The gingival and index scores showed statically significant differences during 1 year evaluation period. A mild gingival inflammation was observed. These results agree with Behneke <italic>et al</italic>. who explained that the increasing incidence of remarkable plaque deposits and gingival inflammation could be attributed to the difficulty of the patients in maintaining a high level of oral hygiene.<xref rid="ref13" ref-type="bibr">13</xref></p><p>All implants introduced in this study did not show any signs of mobility. Mobility index records showed zero score during all following up periods of this study. This finding may reveal that all implants exhibited better initial stability that promoted successful osseointegration. Consequently, the recorded score may reflect better anchorage of implants to the surrounding bone. Percussion solid ringing sounds that were observed indicating direct contact between the bone and implants, i.e., successful osseointegration.<xref rid="ref14" ref-type="bibr">14</xref>,<xref rid="ref15" ref-type="bibr">15</xref></p><p>Under ideal conditions, the implant should lose minimum bone; however, it is not possible to quantify how much bone loss indicates health or absolute failure. In general, if more than one-half of the implant height has lost crestal bony contact, the implant is at significant risk and considered a failure, regardless of the original amount of implant-bone contact.<xref rid="ref15" ref-type="bibr">15</xref></p><p>The crestal bone area is usually a significant indicator of implant health. In the present study, the slight crestal bone loss was observed around all implants. The mean peri-implant marginal bone loss after 6 months of this study was statistically significant around all implants - 0.5 ± 0.13 mm. This is relatively closer to the values of the mean marginal bone loss obtained by Ismail <italic>et al</italic>.<xref rid="ref16" ref-type="bibr">16</xref></p><p>The amount of bone loss in the first 6 months was more than that of the second 6 months of the observation period; this is in agreement with Misch.<xref rid="ref11" ref-type="bibr">11</xref> Who reported that more crestal bone occurred during the first 6 months healing period. However, the cause of this bone loss may be related to the post-surgical bone modeling and remodeling that controlled by the mechanical environment of strain. Remodeling allows the implant interface to adapt to its biomechanical situation.</p><p>The use of proper prosthesis design could account for the lack of mobility change as it has been shown that proper design is effective in transmitting the horizontal loads, by their reducing the stress placed on individual implants.<xref rid="ref11" ref-type="bibr">11</xref>,<xref rid="ref17" ref-type="bibr">17</xref>,<xref rid="ref18" ref-type="bibr">18</xref> Hence, according to the results of these study the chosen occlusal scheme considered successful.</p></sec><sec sec-type="conclusions" id="sec1-5"><title>Conclusions</title><p>With the limitation of this study, and according to the results of the mean marginal bone loss and the other peri-implant parameters after 1 year of loading. 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