Bacteriological evaluation for one-and two-piece implant design supporting mandibular overdenture
Identifieur interne : 000742 ( Pmc/Corpus ); précédent : 000741; suivant : 000743Bacteriological evaluation for one-and two-piece implant design supporting mandibular overdenture
Auteurs : Ahmed Abdelwahed ; Ahmed I. Mahrous ; Mohamed Farouk Abadallah ; Hani Asfour ; Hussien A. Aldawash ; Ebaa I. AlaghaSource :
- Nigerian Medical Journal : Journal of the Nigeria Medical Association [ 0300-1652 ] ; 2015.
Abstract
This study evaluated and compared the bacteriological effect of two-piece implants and one-piece implants in complete overdenture cases on supporting structures.
Ten male completely edentulous patients were selected and randomly divided into two equal groups according to the implant design and surgical technique for this study; Group 1: Patients were rehabilitated with complete mandibular overdenture supported by two-piece implants one on each side of the lower arch following two-stage surgical technique and Group 2: Patients were rehabilitated with complete mandibular overdenture supported by one-piece implants one on each side. Evaluation was made at the time of insertion, 6, 12, and 18 months after overdenture insertion, by measuring bacteriological changes around implants abutments.
Complete overdenture supported by one-piece implants showed better effect on the bacteriological changes as compared to that supported by two-piece implants.
Complete overdenture supported by one-piece implants one on each side of the lower arch showed better effect on the bacteriological changes than using the same prosthesis supported by two-piece implants.
Url:
DOI: 10.4103/0300-1652.171623
PubMed: 26903697
PubMed Central: 4743289
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Bacteriological evaluation for one-and two-piece implant design supporting mandibular overdenture</title><author><name sortKey="Abdelwahed, Ahmed" sort="Abdelwahed, Ahmed" uniqKey="Abdelwahed A" first="Ahmed" last="Abdelwahed">Ahmed Abdelwahed</name><affiliation><nlm:aff id="aff1">Department of Prosthodontics, Faculty of Dental Medicine, Future University, Egypt</nlm:aff></affiliation></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="aff2">Department of Restorative, Al-Farabi Collages, Jeddah, KSA</nlm:aff></affiliation></author><author><name sortKey="Abadallah, Mohamed Farouk" sort="Abadallah, Mohamed Farouk" uniqKey="Abadallah M" first="Mohamed Farouk" last="Abadallah">Mohamed Farouk Abadallah</name><affiliation><nlm:aff id="aff3">Department of Prosthodontics, Faculty of Oral and Dental Medicine, Cairo University, Egypt</nlm:aff></affiliation></author><author><name sortKey="Asfour, Hani" sort="Asfour, Hani" uniqKey="Asfour H" first="Hani" last="Asfour">Hani Asfour</name><affiliation><nlm:aff id="aff4">Department of Microbiology and Parasitological, Faculty of Medicine, King Abdul-Aziz University, KSA</nlm:aff></affiliation></author><author><name sortKey="Aldawash, Hussien A" sort="Aldawash, Hussien A" uniqKey="Aldawash H" first="Hussien A." last="Aldawash">Hussien A. Aldawash</name><affiliation><nlm:aff id="aff2">Department of Restorative, Al-Farabi Collages, Jeddah, KSA</nlm:aff></affiliation></author><author><name sortKey="Alagha, Ebaa I" sort="Alagha, Ebaa I" uniqKey="Alagha E" first="Ebaa I." last="Alagha">Ebaa I. Alagha</name><affiliation><nlm:aff id="aff2">Department of Restorative, Al-Farabi Collages, Jeddah, KSA</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">26903697</idno><idno type="pmc">4743289</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4743289</idno><idno type="RBID">PMC:4743289</idno><idno type="doi">10.4103/0300-1652.171623</idno><date when="2015">2015</date><idno type="wicri:Area/Pmc/Corpus">000742</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000742</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Bacteriological evaluation for one-and two-piece implant design supporting mandibular overdenture</title><author><name sortKey="Abdelwahed, Ahmed" sort="Abdelwahed, Ahmed" uniqKey="Abdelwahed A" first="Ahmed" last="Abdelwahed">Ahmed Abdelwahed</name><affiliation><nlm:aff id="aff1">Department of Prosthodontics, Faculty of Dental Medicine, Future University, Egypt</nlm:aff></affiliation></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="aff2">Department of Restorative, Al-Farabi Collages, Jeddah, KSA</nlm:aff></affiliation></author><author><name sortKey="Abadallah, Mohamed Farouk" sort="Abadallah, Mohamed Farouk" uniqKey="Abadallah M" first="Mohamed Farouk" last="Abadallah">Mohamed Farouk Abadallah</name><affiliation><nlm:aff id="aff3">Department of Prosthodontics, Faculty of Oral and Dental Medicine, Cairo University, Egypt</nlm:aff></affiliation></author><author><name sortKey="Asfour, Hani" sort="Asfour, Hani" uniqKey="Asfour H" first="Hani" last="Asfour">Hani Asfour</name><affiliation><nlm:aff id="aff4">Department of Microbiology and Parasitological, Faculty of Medicine, King Abdul-Aziz University, KSA</nlm:aff></affiliation></author><author><name sortKey="Aldawash, Hussien A" sort="Aldawash, Hussien A" uniqKey="Aldawash H" first="Hussien A." last="Aldawash">Hussien A. Aldawash</name><affiliation><nlm:aff id="aff2">Department of Restorative, Al-Farabi Collages, Jeddah, KSA</nlm:aff></affiliation></author><author><name sortKey="Alagha, Ebaa I" sort="Alagha, Ebaa I" uniqKey="Alagha E" first="Ebaa I." last="Alagha">Ebaa I. Alagha</name><affiliation><nlm:aff id="aff2">Department of Restorative, Al-Farabi Collages, Jeddah, KSA</nlm:aff></affiliation></author></analytic><series><title level="j">Nigerian Medical Journal : Journal of the Nigeria Medical Association</title><idno type="ISSN">0300-1652</idno><idno type="eISSN">2229-774X</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>This study evaluated and compared the bacteriological effect of two-piece implants and one-piece implants in complete overdenture cases on supporting structures.</p></sec><sec id="st2"><title>Materials and Methods:</title><p>Ten male completely edentulous patients were selected and randomly divided into two equal groups according to the implant design and surgical technique for this study; Group 1: Patients were rehabilitated with complete mandibular overdenture supported by two-piece implants one on each side of the lower arch following two-stage surgical technique and Group 2: Patients were rehabilitated with complete mandibular overdenture supported by one-piece implants one on each side. Evaluation was made at the time of insertion, 6, 12, and 18 months after overdenture insertion, by measuring bacteriological changes around implants abutments.</p></sec><sec id="st3"><title>Results:</title><p>Complete overdenture supported by one-piece implants showed better effect on the bacteriological changes as compared to that supported by two-piece implants.</p></sec><sec id="st4"><title>Conclusion:</title><p>Complete overdenture supported by one-piece implants one on each side of the lower arch showed better effect on the bacteriological changes than using the same prosthesis supported by two-piece implants.
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<front><journal-meta><journal-id journal-id-type="nlm-ta">Niger Med J</journal-id><journal-id journal-id-type="iso-abbrev">Niger Med J</journal-id><journal-id journal-id-type="publisher-id">NMJ</journal-id><journal-title-group><journal-title>Nigerian Medical Journal : Journal of the Nigeria Medical Association</journal-title></journal-title-group><issn pub-type="ppub">0300-1652</issn><issn pub-type="epub">2229-774X</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">26903697</article-id><article-id pub-id-type="pmc">4743289</article-id><article-id pub-id-type="publisher-id">NMJ-56-400</article-id><article-id pub-id-type="doi">10.4103/0300-1652.171623</article-id><article-categories><subj-group subj-group-type="heading"><subject>Original Article</subject></subj-group></article-categories><title-group><article-title>Bacteriological evaluation for one-and two-piece implant design supporting mandibular overdenture</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Abdelwahed</surname><given-names>Ahmed</given-names></name><xref ref-type="aff" rid="aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Mahrous</surname><given-names>Ahmed I.</given-names></name><xref ref-type="aff" rid="aff2">1</xref><xref ref-type="corresp" rid="cor1"></xref></contrib><contrib contrib-type="author"><name><surname>Abadallah</surname><given-names>Mohamed Farouk</given-names></name><xref ref-type="aff" rid="aff3">2</xref></contrib><contrib contrib-type="author"><name><surname>Asfour</surname><given-names>Hani</given-names></name><xref ref-type="aff" rid="aff4">3</xref></contrib><contrib contrib-type="author"><name><surname>Aldawash</surname><given-names>Hussien A.</given-names></name><xref ref-type="aff" rid="aff2">1</xref></contrib><contrib contrib-type="author"><name><surname>Alagha</surname><given-names>Ebaa I.</given-names></name><xref ref-type="aff" rid="aff2">1</xref></contrib></contrib-group><aff id="aff1">Department of Prosthodontics, Faculty of Dental Medicine, Future University, Egypt</aff><aff id="aff2"><label>1</label>Department of Restorative, Al-Farabi Collages, Jeddah, KSA</aff><aff id="aff3"><label>2</label>Department of Prosthodontics, Faculty of Oral and Dental Medicine, Cairo University, Egypt</aff><aff id="aff4"><label>3</label>Department of Microbiology and Parasitological, Faculty of Medicine, King Abdul-Aziz University, KSA</aff><author-notes><corresp id="cor1"><bold>Address for correspondence:</bold> Dr. Ahmed I. Mahrous, Building No. 111, 17th Street, New Cairo, Cairo, Egypt. E-mail: <email xlink:href="drahmedimahrous@gmail.com">drahmedimahrous@gmail.com</email></corresp></author-notes><pub-date pub-type="ppub"><season>Nov-Dec</season><year>2015</year></pub-date><volume>56</volume><issue>6</issue><fpage>400</fpage><lpage>403</lpage><permissions><copyright-statement>Copyright: © 2015 Nigerian Medical Journal</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>Background:</title><p>This study evaluated and compared the bacteriological effect of two-piece implants and one-piece implants in complete overdenture cases on supporting structures.</p></sec><sec id="st2"><title>Materials and Methods:</title><p>Ten male completely edentulous patients were selected and randomly divided into two equal groups according to the implant design and surgical technique for this study; Group 1: Patients were rehabilitated with complete mandibular overdenture supported by two-piece implants one on each side of the lower arch following two-stage surgical technique and Group 2: Patients were rehabilitated with complete mandibular overdenture supported by one-piece implants one on each side. Evaluation was made at the time of insertion, 6, 12, and 18 months after overdenture insertion, by measuring bacteriological changes around implants abutments.</p></sec><sec id="st3"><title>Results:</title><p>Complete overdenture supported by one-piece implants showed better effect on the bacteriological changes as compared to that supported by two-piece implants.</p></sec><sec id="st4"><title>Conclusion:</title><p>Complete overdenture supported by one-piece implants one on each side of the lower arch showed better effect on the bacteriological changes than using the same prosthesis supported by two-piece implants.
</p></sec></abstract><kwd-group><kwd>One-piece dental implants</kwd><kwd>overdentures</kwd><kwd>two-piece dental implants</kwd></kwd-group></article-meta></front><body><sec sec-type="intro" id="sec1-1"><title>INTRODUCTION</title><p>Overdenture is defined as a removable partial or complete denture that covers and rests on one root of natural teeth and/or dental implants. Aprosthesis that covers and is partially supported by natural teeth, natural tooth roots and or dental implant is called also overlay denture, overlay prosthesis, and superimposed prosthesis.<xref rid="ref1" ref-type="bibr">1</xref></p><p>Overdentures supported by implants were the development of well-researched implant systems, providing a predictable success rate that made such restoration feasible. Recently, new one-piece implant design has been fabricated and consequently the implant surgical technique has been changed into one-stage technique with its benefits for the patients and either immediate or progressive loading protocols were used for prosthetic appliances.<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></p><p>It is conceivable that implant materials, which are chosen because of their “friendliness” to tissue cells, offer particularly favorable grounds for bacterial adhesion and availability of “cell-friendly” surfaces for microbial colonization. Adhesion-mediated infections developing on implanted biomaterials respond poorly to antimicrobial treatment and often require that the device be removed.<xref rid="ref6" ref-type="bibr">6</xref></p><p>Dental implants, however, can be designed in such a way that the surfaces on which bacterial colonization occurs may be reached from the exterior. Thus, in contrast to internal implants, there is a possibility for control of bacterial colonization on exposed surfaces and a potential for treatment of infectious conditions of peri-implant tissues.<xref rid="ref6" ref-type="bibr">6</xref><xref rid="ref7" ref-type="bibr">7</xref></p><p>In a study, it was found that the microflora associated with stable osseointegrated implants serving successfully as abutments for overdentures was investigated, and 50% of the organisms cultured were facultatively anaerobic <italic>cocci, Staphylococci</italic>, and the rest were facultatively anaerobic rods. Repeated microbiological and clinical data were collected along 5 years after implantation. No significant time trends were noted. Separate samples taken within the same patient from different sites showed a similar composition of the microflora.<xref rid="ref8" ref-type="bibr">8</xref><xref rid="ref9" ref-type="bibr">9</xref></p><p>The role of microorganisms in the development of peri-implant pathology has also been investigated in animals. Differences in the presence of putative periodontal pathogens on titanium implants and teeth were determined in animals in experimental gingivitis and in peri-implantitis/periodontitis situation. Similar colonization patterns were seen on implants and teeth.<xref rid="ref10" ref-type="bibr">10</xref><xref rid="ref11" ref-type="bibr">11</xref></p></sec><sec sec-type="materials|methods" id="sec1-2"><title>MATERIALS AND METHODS</title><p>Ten completely edentulous male patients with age ranged from 50 to 60 years were selected from the outpatient clinic, Prosthodontics Department, Faculty of Dentistry October 6 University. Consent forms were signed by all patients selected for this work before the treatment. The patients after preparation to receive an overdenture were randomly divided into two equal groups according to implant designs; 1<sup>st</sup> group and the patients in this group received mandibular overdenture supported by two-piece implant system using delayed loading prosthetic technique. The 2<sup>nd</sup> group and patients in this group received mandibular overdenture supported by one-piece implant system.</p><sec id="sec2-1"><title>Surgical procedures for implant placement</title><p><list list-type="bullet"><list-item><p>Surgical stent constructed using transparent acrylic resin on duplicated study cast</p></list-item><list-item><p>Threaded endosseous implant system (titanium plasma spray) coating root form with 13 mm length and 3.9 mm diameter were used for all patients</p></list-item><list-item><p>The implant was inserted manually and observing the correct insertion angle [<xref ref-type="fig" rid="F1">Figure 1</xref>]</p></list-item><list-item><p>4 months after implant placement, all patients were recalled. For Group 1, the abutments were inserted in place and attached to the fixture using abutment screw, and for Group 2, the patients were ready for prosthetic procedures.</p></list-item></list></p></sec><sec id="sec2-2"><title>Prosthetic procedures</title><p><list list-type="bullet"><list-item><p>Upper and lower primary impressions were made for all patients followed by a secondary impression that was made for the lower arch in the preconstructed special tray after proper border molding</p></list-item><list-item><p>Centric occluding relation following the interocclusal wax wafer technique was made and a try in stage was made successfully</p></list-item><list-item><p>The denture was processed, laboratory remounted, finished, polished, and delivered to the patient in the usual manner after clinical remounting [<xref ref-type="fig" rid="F2">Figure 2</xref>].</p></list-item></list></p><p>The insertion appointment (considered as zero readings), 6, 12, and 18 months of postinsertion successively considered as follow-up periods.</p><fig id="F1" position="float"><label>Figure 1</label><caption><p>Manual insertion of implant</p></caption><graphic xlink:href="NMJ-56-400-g001"></graphic></fig><fig id="F2" position="float"><label>Figure 2</label><caption><p>Final denture in patient mouth</p></caption><graphic xlink:href="NMJ-56-400-g002"></graphic></fig><p>A swap sample was taken from area around the implants by means of sterile swap, transferred and immersed in reduced transport media; all samples were carefully homogenized without aeration into 1 mm of saline and centrifuged for 30 s.</p><p><list list-type="bullet"><list-item><p>One plate from each media was aerobically incubated at 37°C.</p></list-item><list-item><p>Films were prepared from various colonies, stained with Gram's stain, and examined</p></list-item><list-item><p>Certain organisms required special tests as <italic>Staphylococcus aureus</italic>, which was further identified by coagulase test done through the tube method</p></list-item><list-item><p>Catalase production to differentiate between <italic>Staphylococci</italic> and <italic>Streptococci</italic>.<xref rid="ref12" ref-type="bibr">12</xref></p></list-item></list></p><p>Visible colonies of each organism were counted in every plate, and the number of colonies-plate was multiplied by the corresponding dilution factor and by 10 to determine the total colony forming units per ml of suspension.</p></sec></sec><sec sec-type="results" id="sec1-3"><title>RESULTS</title><p>Comparison between Group 1 (two-piece implants) and Group 2 (one-piece implants) regarding Staphylococcal bacteria:</p><sec id="sec2-3"><title></title><sec id="sec3-1"><title>Staphylococci</title><p>At 6, 12, and 18 months, the mean values of staphylococcus count around the implants revealed significant difference revealed between the two studied groups [<xref ref-type="fig" rid="G1">Graph 1</xref>].</p><fig id="G1" position="float"><label>Graph 1</label><caption><p><italic>Staphylococcus</italic> count changes in the two groups</p></caption><graphic xlink:href="NMJ-56-400-g003"></graphic></fig></sec></sec></sec><sec sec-type="discussion" id="sec1-4"><title>DISCUSSION</title><p>Using the sterile swap in taking specimen from the area around the implant abutment would help in direct spreading the specimens on the culture plates, and the biochemical reactions were carried out to differentiate the microscopically resembled microorganisms. Films were stained with gram stain to see the morphology of the organism and its reaction to Gram's stain. Coagulase test was carried out through the tube method to identify <italic>S. aureus</italic>. Catalase production to differentiate between <italic>Staphylococci</italic> and <italic>Streptococci</italic>.<xref rid="ref12" ref-type="bibr">12</xref></p><p>Regarding Group1, the microgap, which is the most effective factor for bacterial colonization at this critical area around implant, provides a good media for inflammation around implant neck and subsequently leads to bone resorption, and regarding Group2(one-piece implant), the design eliminates the microgap and that decrease the possibility for bacterial colonization.<xref rid="ref13" ref-type="bibr">13</xref></p><p>Despite strict oral hygiene measures and patient instructions about proper cleansing of the prosthesis and implant neck area along the 18 months follow-up period, there is tiny unreachable areas, especially in the microgap area at fixture-abutment connection, regarding Group 1 that area cannot be reached by the patient especially the subgingival portion of implant neck; that subsequently increase the possibility for bacterial colonization and that may explain significant difference in bacterial count around the implants between the two groups as regarding the four main types of bacteria that had been examined in the study (<italic>Staphylococci, Streptococci</italic>, L. bacilli, anaerobes).<xref rid="ref14" ref-type="bibr">14</xref><xref rid="ref15" ref-type="bibr">15</xref></p></sec><sec sec-type="conclusions" id="sec1-5"><title>CONCLUSION</title><p>Within the limitation of the results of this study, it could be concluded that the complete mandibular overdentures supported by two osseointegrated one-piece implant design showed better effect on bacteriological changes around the implants abutments when compared with two-piece implant design.</p><sec id="sec2-4"><title>Financial support and sponsorship</title><p>October Sixth University, Egypt-Future University, Egypt-Al-Farabi Colleges, KSA.</p></sec><sec id="sec2-5"><title>Conflicts of interest</title><p>There are no conflicts of interest.</p></sec></sec></body><back><ack><title>Acknowledgment</title><p>Dr. Hoda Amr Mohie El-din, Professor of Removable Prosthodontics, Department of Prosthodontics, Faculty of Oral and Dental Medicine, Cairo University, Egypt.</p></ack><ref-list><title>REFERENCES</title><ref id="ref1"><label>1</label><element-citation publication-type="journal"><article-title>Academy of prosthetic terms. 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