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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Stress distribution patterns of implant supported overdentures-analog versus finite element analysis: A comparative <italic>in-vitro</italic> study</title><author><name sortKey="Satpathy, Soumyadev" sort="Satpathy, Soumyadev" uniqKey="Satpathy S" first="Soumyadev" last="Satpathy">Soumyadev Satpathy</name><affiliation><nlm:aff id="aff1">Department of Prosthodontics, V.S. Dental College and Hospital, Bengaluru, Karnataka, India</nlm:aff></affiliation></author><author><name sortKey="Babu, C L Satish" sort="Babu, C L Satish" uniqKey="Babu C" first="C. L. Satish" last="Babu">C. L. Satish Babu</name><affiliation><nlm:aff id="aff1">Department of Prosthodontics, V.S. Dental College and Hospital, Bengaluru, Karnataka, India</nlm:aff></affiliation></author><author><name sortKey="Shetty, Shilpa" sort="Shetty, Shilpa" uniqKey="Shetty S" first="Shilpa" last="Shetty">Shilpa Shetty</name><affiliation><nlm:aff id="aff1">Department of Prosthodontics, V.S. Dental College and Hospital, Bengaluru, Karnataka, India</nlm:aff></affiliation></author><author><name sortKey="Raj, Bharat" sort="Raj, Bharat" uniqKey="Raj B" first="Bharat" last="Raj">Bharat Raj</name><affiliation><nlm:aff id="aff1">Department of Prosthodontics, V.S. Dental College and Hospital, Bengaluru, Karnataka, India</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">26929521</idno><idno type="pmc">4762336</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4762336</idno><idno type="RBID">PMC:4762336</idno><idno type="doi">10.4103/0972-4052.165324</idno><date when="2015">2015</date><idno type="wicri:Area/Pmc/Corpus">000698</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000698</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Stress distribution patterns of implant supported overdentures-analog versus finite element analysis: A comparative <italic>in-vitro</italic> study</title><author><name sortKey="Satpathy, Soumyadev" sort="Satpathy, Soumyadev" uniqKey="Satpathy S" first="Soumyadev" last="Satpathy">Soumyadev Satpathy</name><affiliation><nlm:aff id="aff1">Department of Prosthodontics, V.S. Dental College and Hospital, Bengaluru, Karnataka, India</nlm:aff></affiliation></author><author><name sortKey="Babu, C L Satish" sort="Babu, C L Satish" uniqKey="Babu C" first="C. L. Satish" last="Babu">C. L. Satish Babu</name><affiliation><nlm:aff id="aff1">Department of Prosthodontics, V.S. Dental College and Hospital, Bengaluru, Karnataka, India</nlm:aff></affiliation></author><author><name sortKey="Shetty, Shilpa" sort="Shetty, Shilpa" uniqKey="Shetty S" first="Shilpa" last="Shetty">Shilpa Shetty</name><affiliation><nlm:aff id="aff1">Department of Prosthodontics, V.S. Dental College and Hospital, Bengaluru, Karnataka, India</nlm:aff></affiliation></author><author><name sortKey="Raj, Bharat" sort="Raj, Bharat" uniqKey="Raj B" first="Bharat" last="Raj">Bharat Raj</name><affiliation><nlm:aff id="aff1">Department of Prosthodontics, V.S. Dental College and Hospital, Bengaluru, Karnataka, India</nlm:aff></affiliation></author></analytic><series><title level="j">The Journal of the Indian Prosthodontic Society</title><idno type="ISSN">0972-4052</idno><idno type="eISSN">1998-4057</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>Aims and Objectives:</title><p>The aim of this study was to asses & compare the load transfer characteristics of Ball/O-ring and Bar/Clip attachment systems in implant supported overdentures using analog and finite element analysis models.</p></sec><sec id="st2"><title>Methodology:</title><p>For the analog part of the study, castable bar was used for the bar and clip attachment and a metallic housing with a rubber O-ring component was used for the ball/O-ring attachment. The stress on the implant surface was measured using the strain-gauge technique. For the finite element analysis, the model were fabricated and load applications were done in a similar manner as in analog study.</p></sec><sec id="st3"><title>Results:</title><p>The difference between both the attachment systems was found to be statistically significant (<italic>P</italic><0.001).</p></sec><sec id="st4"><title>Conclusion:</title><p>Ball/O-ring attachment system transmitted lesser amount of stresses to the implants on the non-loading side, as compared to the Bar-Clip attachment system. When overall stress distribution is compared, the Bar-Clip attachment seems to perform better than the Ball/O-ring attachment, because the force was distributed better.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Tokuhisa, M" uniqKey="Tokuhisa M">M Tokuhisa</name></author><author><name sortKey="Matsushita, Y" uniqKey="Matsushita Y">Y Matsushita</name></author><author><name sortKey="Koyano, K" uniqKey="Koyano K">K Koyano</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Menicucci, G" uniqKey="Menicucci G">G Menicucci</name></author><author><name sortKey="Lorenzetti, M" uniqKey="Lorenzetti M">M Lorenzetti</name></author><author><name sortKey="Pera, P" uniqKey="Pera P">P Pera</name></author><author><name sortKey="Preti, G" uniqKey="Preti G">G Preti</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="John, J" uniqKey="John J">J 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<front><journal-meta><journal-id journal-id-type="nlm-ta">J Indian Prosthodont Soc</journal-id><journal-id journal-id-type="iso-abbrev">J Indian Prosthodont Soc</journal-id><journal-id journal-id-type="publisher-id">JIPS</journal-id><journal-title-group><journal-title>The Journal of the Indian Prosthodontic Society</journal-title></journal-title-group><issn pub-type="ppub">0972-4052</issn><issn pub-type="epub">1998-4057</issn><publisher><publisher-name>Medknow Publications & Media Pvt Ltd</publisher-name><publisher-loc>India</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">26929521</article-id><article-id pub-id-type="pmc">4762336</article-id><article-id pub-id-type="publisher-id">JIPS-15-250</article-id><article-id pub-id-type="doi">10.4103/0972-4052.165324</article-id><article-categories><subj-group subj-group-type="heading"><subject>Original Article</subject></subj-group></article-categories><title-group><article-title>Stress distribution patterns of implant supported overdentures-analog versus finite element analysis: A comparative <italic>in-vitro</italic> study</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Satpathy</surname><given-names>Soumyadev</given-names></name><xref ref-type="aff" rid="aff1"></xref><xref ref-type="corresp" rid="cor1"></xref></contrib><contrib contrib-type="author"><name><surname>Babu</surname><given-names>C. L. Satish</given-names></name><xref ref-type="aff" rid="aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Shetty</surname><given-names>Shilpa</given-names></name><xref ref-type="aff" rid="aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Raj</surname><given-names>Bharat</given-names></name><xref ref-type="aff" rid="aff1"></xref></contrib></contrib-group><aff id="aff1">Department of Prosthodontics, V.S. Dental College and Hospital, Bengaluru, Karnataka, India</aff><author-notes><corresp id="cor1"><bold>Address for correspondence:</bold> Dr. Soumyadev Satpathy, Department of Prosthodontics, V.S. Dental College and Hospital, Bengaluru - 560 004, Karnataka, India. E-mail: <email xlink:href="soumyadevster@gmail.com">soumyadevster@gmail.com</email></corresp></author-notes><pub-date pub-type="ppub"><season>Jul-Sep</season><year>2015</year></pub-date><volume>15</volume><issue>3</issue><fpage>250</fpage><lpage>256</lpage><history><date date-type="received"><day>18</day><month>1</month><year>2015</year></date><date date-type="accepted"><day>24</day><month>5</month><year>2015</year></date></history><permissions><copyright-statement>Copyright: © 2015 The Journal of Indian Prosthodontic Society</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-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.</license-p></license></permissions><abstract><sec id="st1"><title>Aims and Objectives:</title><p>The aim of this study was to asses & compare the load transfer characteristics of Ball/O-ring and Bar/Clip attachment systems in implant supported overdentures using analog and finite element analysis models.</p></sec><sec id="st2"><title>Methodology:</title><p>For the analog part of the study, castable bar was used for the bar and clip attachment and a metallic housing with a rubber O-ring component was used for the ball/O-ring attachment. The stress on the implant surface was measured using the strain-gauge technique. For the finite element analysis, the model were fabricated and load applications were done in a similar manner as in analog study.</p></sec><sec id="st3"><title>Results:</title><p>The difference between both the attachment systems was found to be statistically significant (<italic>P</italic><0.001).</p></sec><sec id="st4"><title>Conclusion:</title><p>Ball/O-ring attachment system transmitted lesser amount of stresses to the implants on the non-loading side, as compared to the Bar-Clip attachment system. When overall stress distribution is compared, the Bar-Clip attachment seems to perform better than the Ball/O-ring attachment, because the force was distributed better.</p></sec></abstract><kwd-group><title>Key Words</title><kwd>Ball/O-ring</kwd><kwd>Bar-Clip</kwd><kwd>finite element analysis</kwd><kwd>implant retained overdenture</kwd><kwd>overdenture attachments</kwd><kwd>strain gauges</kwd></kwd-group></article-meta></front><body><sec sec-type="intro" id="sec1-1"><title>INTRODUCTION</title><p>The ability to replace lost teeth with osseointegrated implants has improved the quality of life.[<xref rid="ref1" ref-type="bibr">1</xref>] The advantages of implant retained prostheses include improved mastication, increased passive tactile sensitivity, better retention compared to the conventional ones.[<xref rid="ref15" ref-type="bibr">15</xref>] A minimum of two implants in anterior mandible, generally in the canine region, followed by rehabilitation with implant retained overdenture is the WHO guideline for rehabilitation of any completely edentulous patient.[<xref rid="ref14" ref-type="bibr">14</xref><xref rid="ref15" ref-type="bibr">15</xref><xref rid="ref16" ref-type="bibr">16</xref><xref rid="ref17" ref-type="bibr">17</xref><xref rid="ref27" ref-type="bibr">27</xref><xref rid="ref37" ref-type="bibr">37</xref><xref rid="ref38" ref-type="bibr">38</xref><xref rid="ref42" ref-type="bibr">42</xref>]</p><p>The commonly used forms of anchorage include ball attachments and clips on a bar connecting the implants. It is important to ascertain whether implants need to be splinted together or whether freestanding implants alone can withstand the loads.[<xref rid="ref7" ref-type="bibr">7</xref><xref rid="ref9" ref-type="bibr">9</xref><xref rid="ref11" ref-type="bibr">11</xref><xref rid="ref12" ref-type="bibr">12</xref><xref rid="ref13" ref-type="bibr">13</xref>] The prognosis of the implants depends on the ability of the attachments to dissipate the stresses transmitted through them by the superstructures.[<xref rid="ref6" ref-type="bibr">6</xref><xref rid="ref7" ref-type="bibr">7</xref>]</p><p>Because of technical difficulties, <italic>in vivo</italic> measurements of forces with the transducers mounted directly on the implants are rare. Hence, <italic>in vivo</italic> models are fabricated, wherein strain gauges are used to measure the amount of stress being transferred to the implants, by the superstructure.[<xref rid="ref58" ref-type="bibr">58</xref><xref rid="ref60" ref-type="bibr">60</xref><xref rid="ref61" ref-type="bibr">61</xref>]</p><p>The present <italic>in vivo</italic> study compared the load transfer characteristics of Ball/O-ring and Bar/Clip attachment systems, using analog and finite element analysis models.</p><p>The objectives of this study were to compare the following:</p><p><list list-type="bullet"><list-item><p>To evaluate load transfer characteristics of Ball/O-ring and Bar/Clip attachment systems in implant retained overdentures using analog models</p></list-item><list-item><p>To evaluate load transfer characteristics of Ball/O-ring and Bar/Clip attachment systems in implant retained overdentures using finite element analysis models</p></list-item><list-item><p>To compare the load transfer characteristics of Ball/O-ring and Bar/Clip attachment systems in implant supported overdentures obtained from analog and finite element analysis models.</p></list-item></list></p></sec><sec sec-type="materials|methods" id="sec1-2"><title>MATERIALS AND METHODS</title><p>This study was carried out in two parts:</p><p><list list-type="bullet"><list-item><p>Fabrication of analog model, followed by load application and analysis</p></list-item><list-item><p>Fabrication of the finite element analysis model, followed by load application and analysis.</p></list-item></list></p><sec id="sec2-1"><title>Methodology of analog model fabrication, load application and analysis</title><sec id="sec3-1"><title>Fabrication of study models</title><p>Edentulous mandibular models were made from heat-cured polymethylmethacrylate resin. Implant analogs were placed in the canine region and retained with resin cement. Implant supported overdentures of heat polymerized polymethylmethacrylate were fabricated to be placed on the previously fabricated models [<xref ref-type="fig" rid="F1">Figure 1</xref>].</p><fig id="F1" position="float"><label>Figure 1</label><caption><p>Implants with the load cells placed in the canine region</p></caption><graphic xlink:href="JIPS-15-250-g001"></graphic></fig></sec><sec id="sec3-2"><title>Implants and attachments</title><p>A castable hader bar of length 22 mm and clip length 16 mm was used for the Bar-Clip attachment. This hader bar and clip attachment system was attached to the implant analogs placed earlier. A metallic housing with a rubber O-ring component and a ball abutment fixed to the implant analogs were used for the Ball/O-ring attachment [<xref ref-type="fig" rid="F2">Figure 2</xref>].</p><fig id="F2" position="float"><label>Figure 2</label><caption><p>Bar attachment in place</p></caption><graphic xlink:href="JIPS-15-250-g002"></graphic></fig></sec></sec><sec id="sec2-2"><title>Loading procedure</title><p>The denture after being placed on the model, with each attachment in place, loads were applied in the region of the occlusal surfaces of the second premolar and first molar region using a universal testing machine. Loads were increased gradually from 0 to 100 N in 10 N steps [<xref ref-type="fig" rid="F3">Figure 3</xref>].</p><fig id="F3" position="float"><label>Figure 3</label><caption><p>Attachment of strain gauges around the implants and loading point</p></caption><graphic xlink:href="JIPS-15-250-g003"></graphic></fig></sec><sec id="sec2-3"><title>Methodology of finite element model fabrication, load application and analysis</title><sec id="sec3-3"><title>Step 1: Obtaining the computed tomography scan images</title><p>A spiral computed tomography scan image of 3 mm sections of a 60-year-old completely edentulous male patient was obtained.</p></sec><sec id="sec3-4"><title>Step 2: Finite element modeling of mandible, denture, mucosa and implants</title><p>The implant analogs used for the <italic>in-vitro</italic> study were scanned and used to design the implants to be placed in the canine regions of the finite element model. Ball/O-ring and Bar/Clip attachment systems were fabricated using three-dimensional finite element meshing, using similar dimensions and mechanical properties as that of the analog model attachments.</p></sec><sec id="sec3-5"><title>Step 3: Incorporating mechanical properties in the finite element model</title><p>Mechanical properties such as Young's modulus and Poisson's ratio of mandible, denture, mucosa and implants are used for further analysis. All materials included in the finite element models were considered to be isotropic, homogeneous, and linearly elastic.</p></sec><sec id="sec3-6"><title>Step 4: Applying loads and constraints</title><p>Following the meshing of the mandible, implant supported overdenture and implant models, and incorporating the material properties, the models were constrained at the base [<xref ref-type="fig" rid="F4">Figure 4</xref>].</p><fig id="F4" position="float"><label>Figure 4</label><caption><p>Loads and boundary conditions in Finite element analysis model</p></caption><graphic xlink:href="JIPS-15-250-g004"></graphic></fig></sec></sec><sec id="sec2-4"><title>Loading procedure</title><p>Loading was done incrementally from 0 to 100 N, increasing in 10 N increments for both Bar/Clip and Ball/O-ring attachment systems. The loading was done both unilaterally in the region of second premolar and first molar and also bilaterally in the same regions.</p><p>The results of the data obtained were compared and subjected to statistical analysis using one-way analysis of variance.</p></sec></sec><sec sec-type="results" id="sec1-3"><title>RESULTS</title><sec id="sec2-5"><title>Results and statistical analysis obtained from analog model study procedure</title><p>Influence of load (in Newton) on the stresses being taken up by each implant was found to be significant (<italic>P</italic> < 0.001) [<xref ref-type="table" rid="T1">Table 1</xref>]. The amount of the applied loads being transferred by each attachment into the implant when compared was found to be significant (<italic>P</italic> < 0.05). Higher stresses were recorded in Ball/O-ring on the side of applied load, followed by Bar/Clip and with Bar/Clip on the nonloaded side, respectively. Lower stress levels were recorded in Ball O-ring with implant on the nonloaded side [<xref ref-type="fig" rid="F5">Figure 5</xref>].</p><table-wrap id="T1" position="float"><label>Table 1</label><caption><p>Comparison between both the attachment systems in dissipating the forces applied on them</p></caption><graphic xlink:href="JIPS-15-250-g005"></graphic></table-wrap><fig id="F5" position="float"><label>Figure 5</label><caption><p>Effect of load (in Newtons) on stress (Microvolts)</p></caption><graphic xlink:href="JIPS-15-250-g006"></graphic></fig></sec><sec id="sec2-6"><title>Results and statistical analysis obtained from finite element analysis study procedure</title><sec id="sec3-7"><title>Ball/O-ring attachment system</title><p>Red region indicates region of high-stress region while blue indicates region of low-stress concentration. In case of unilateral loading, it can be seen that stresses developed in the implant closest to the loading area are more [<xref ref-type="fig" rid="F6">Figure 6</xref>].</p><fig id="F6" position="float"><label>Figure 6</label><caption><p>Von Mises stress due to unilateral loading for ball attachment system</p></caption><graphic xlink:href="JIPS-15-250-g007"></graphic></fig><p>Whereas when bilateral loads are applied, it can be seen that Von Mises stresses are developed on both sides almost equally [<xref ref-type="fig" rid="F7">Figure 7</xref>].</p><fig id="F7" position="float"><label>Figure 7</label><caption><p>Von Mises stress due to bi-lateral loading for Ball/O-ring attachment</p></caption><graphic xlink:href="JIPS-15-250-g008"></graphic></fig></sec><sec id="sec3-8"><title>Bar/Clip attachment system</title><p>In case of unilateral loading, it can be seen that stress is developed on both the sides, although loading is unilateral [<xref ref-type="fig" rid="F8">Figure 8</xref>]. With bi-lateral load application, more or less uniform state of stresses was found to develop on both the sides [<xref ref-type="fig" rid="F9">Figure 9</xref>].</p><fig id="F8" position="float"><label>Figure 8</label><caption><p>Von Mises stress due to unilateral loading for Bar/Clip attachment</p></caption><graphic xlink:href="JIPS-15-250-g009"></graphic></fig><fig id="F9" position="float"><label>Figure 9</label><caption><p>Von Mises stress due to bilateral loading for Bar/Clip attachment</p></caption><graphic xlink:href="JIPS-15-250-g010"></graphic></fig></sec></sec></sec><sec sec-type="discussion" id="sec1-4"><title>DISCUSSION</title><p>An implant supported overdenture is subjected to various types of axial and nonaxial stresses, including the masticatory forces. The resultant of these forces is transmitted through the superstructure and the attachments to the implants and may lead to concentration of stresses in the different parts of the implants.[<xref rid="ref12" ref-type="bibr">12</xref>]</p><p>Cost is an important factor that determines the placement of implants. By reducing the number of implants required to support an overdenture, the cost can be considerably reduced. Two instead of four implants in the mandible can also offer an almost equal amount of stability to the denture.</p><p>The assumption that unfavorable loading of implants may lead to bone resorption has been neither confirmed nor rejected. Therefore, is it necessary to learn more about naturally occurring forces <italic>in vivo</italic>. Because of technical difficulties, <italic>in vivo</italic> measurements of forces with the transducers mounted directly on the implants are rare.[<xref rid="ref61" ref-type="bibr">61</xref>] In the present study, stress on the implant surface was measured using a strain-gauge technique and finite element analysis models.</p><p>The two most commonly used attachments in implant retained overdentures are the Ball/O-ring and Bar/Clip attachment systems. The need was to compare the stress distribution capabilities of the attachment systems so that clinicians can make an informed choice.[<xref rid="ref1" ref-type="bibr">1</xref><xref rid="ref2" ref-type="bibr">2</xref><xref rid="ref3" ref-type="bibr">3</xref><xref rid="ref4" ref-type="bibr">4</xref><xref rid="ref5" ref-type="bibr">5</xref><xref rid="ref6" ref-type="bibr">6</xref><xref rid="ref8" ref-type="bibr">8</xref><xref rid="ref10" ref-type="bibr">10</xref>]</p><p>It was found that on ipsilateral loading, with Ball/O-ring, the strain was concentrated on the loading side implant. The stress on the loading side implant was small when the load was slight because of the secondary splinting that occurs with ball attachments. The Bar/Clip attachment, on the contrary, produced higher stress on the nonloading side implant when compared with the Ball/O-ring attachment because of the primary splinting effect even at low pressure. Our results were consistent with previous studies that noted that the axial force on the loading-side implant was minimal with the Ball/O-ring attachment.[<xref rid="ref1" ref-type="bibr">1</xref><xref rid="ref3" ref-type="bibr">3</xref><xref rid="ref5" ref-type="bibr">5</xref><xref rid="ref6" ref-type="bibr">6</xref><xref rid="ref10" ref-type="bibr">10</xref><xref rid="ref18" ref-type="bibr">18</xref><xref rid="ref19" ref-type="bibr">19</xref><xref rid="ref20" ref-type="bibr">20</xref><xref rid="ref21" ref-type="bibr">21</xref>]</p><p>This may be the result of the stress-absorbing effect of the rubber O-ring component. Under our experimental condition, in which a ball attachment was used, minimum amount of force was transmitted to the implant body. The force may have been absorbed at the rubber O-ring component and anchor head connection. Therefore, in the long term, prosthetic complications such as screw loosening or the need to replace O-ring matrices may occur.[<xref rid="ref22" ref-type="bibr">22</xref><xref rid="ref34" ref-type="bibr">34</xref><xref rid="ref35" ref-type="bibr">35</xref><xref rid="ref41" ref-type="bibr">41</xref><xref rid="ref43" ref-type="bibr">43</xref><xref rid="ref44" ref-type="bibr">44</xref>]</p><p>When comparison was done between Ball/O-ring and Bar/Clip attachment systems under unilateral and bilateral loading conditions, similar to the methodology followed under analog model with the finite element analysis models, it was observed that for unilateral loading, the Bar/Clip attachment dissipated less force as compared to Ball/O-ring.[<xref rid="ref6" ref-type="bibr">6</xref><xref rid="ref8" ref-type="bibr">8</xref><xref rid="ref10" ref-type="bibr">10</xref><xref rid="ref23" ref-type="bibr">23</xref><xref rid="ref24" ref-type="bibr">24</xref><xref rid="ref25" ref-type="bibr">25</xref><xref rid="ref26" ref-type="bibr">26</xref>] Whereas when the same model was subjected to bilateral loading, it was observed that the Ball/O-ring attachment configuration dissipated less forces compared to the Bar/Clip attachment. However, if one looks at the overall stress distribution, the Bar/Clip attachment system seems to perform better than the Ball/O-ring attachment system, as the forces are distributed better.[<xref rid="ref22" ref-type="bibr">22</xref><xref rid="ref28" ref-type="bibr">28</xref><xref rid="ref29" ref-type="bibr">29</xref><xref rid="ref30" ref-type="bibr">30</xref><xref rid="ref31" ref-type="bibr">31</xref><xref rid="ref32" ref-type="bibr">32</xref><xref rid="ref33" ref-type="bibr">33</xref>]</p><p>The models had been fabricated to simulate an experimental condition to compare the stress distribution capabilities of Ball/O-ring and Bar/Clip attachment systems, wherein, the implant length and diameter, location in the model, attachment type and dimensions were standardized for both analog and finite element analysis. Ball/O-ring attachment system may be considered a favorable attachment system, when the expected amount of force on the superstructure is in the low, but as we consider the superstructure being subjected to higher amount of stresses, the Bar/Clip attachment system can be considered more favorable, due to it's potential to dissipate the stresses uniformly between both the implants with its splinting effect.[<xref rid="ref36" ref-type="bibr">36</xref><xref rid="ref39" ref-type="bibr">39</xref><xref rid="ref40" ref-type="bibr">40</xref><xref rid="ref46" ref-type="bibr">46</xref><xref rid="ref47" ref-type="bibr">47</xref><xref rid="ref48" ref-type="bibr">48</xref>] As most of the stresses in a Ball/O-ring attachment system is primarily absorbed around the implant on the side of loading, if it is subjected to high amount of stresses over increased periods of time, it may lead to screw loosening and subsequent failure.[<xref rid="ref45" ref-type="bibr">45</xref><xref rid="ref49" ref-type="bibr">49</xref><xref rid="ref50" ref-type="bibr">50</xref><xref rid="ref57" ref-type="bibr">57</xref><xref rid="ref61" ref-type="bibr">61</xref>]</p><p>Excessive loading of the implants has been related to marginal bone loss, failure of osseointegration, and failure of implant and/or prosthetic superstructure component.</p><p>The implant-bone interface is rigid and transmits all loads directly to the adjacent bone. This condition produces a high level of stresses which can be counterproductive for long-term survival of the implants. Therefore, emphasis has been put on force transmission by each attachment system.[<xref rid="ref62" ref-type="bibr">62</xref><xref rid="ref63" ref-type="bibr">63</xref><xref rid="ref64" ref-type="bibr">64</xref>]</p><p>In this present study, the vital anisotropic tissues were considered isotropic. The loads applied were static whereas dynamic loading is seen during the masticatory function. Finite element analysis is based on mathematical calculations which are based on simulation of the structure in its environment. But living tissues are beyond the confines of set parameters and values since biology is not a compatible entity. The study did not take into consideration the resilient soft tissue covering the ridge.</p><p>Newer attachment systems such as locator attachments can be taken up as future studies to evaluate the stress patterns generated in such attachments.</p></sec><sec sec-type="conclusion" id="sec1-5"><title>CONCLUSION</title><p>Within the limitations of this study, following conclusions were drawn:</p><p><list list-type="bullet"><list-item><p>It was observed that for unilateral loading case, Bar/Clip attachment dissipated less force compared to Ball/O-ring and for bilateral it was observed that the Ball/O-ring implant configuration dissipated less force compared to the Bar/Clip attachment case</p></list-item><list-item><p>Analysis of the results obtained from both, analog and finite element analysis models were taken into consideration and it can be concluded that the Ball/O-ring attachment system may be considered a favorable attachment system, when the expected amount of force on the 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