Evaluation of stress distribution characteristics on various bar designs of three-implant-supported mandibular overdentures

Year 2017, , 8 - 13, 02.01.2017

Emre Tokar , Serdar Polat , Bülent Uludağ

https://doi.org/10.17214/gaziaot.273903

Abstract

Objective: Implant-supported-overdentures, instead of conventional complete dentures, are frequently recommended to rehabilitate patients having edentulous mandible. The aim of this study was to evaluate the stress distribution characteristics of mandibular implant-supported overdentures with four different bar attachment designs.

Materials and Method: A photoelastic mandibular model with three implants (3.75 mm - 13 mm) placed at the interforaminal region was generated from a cast of an edentulous mandible. Four mandibular bar overdenture designs were fabricated: bar-clip, bar-galvano, bar-locator, and bar-ceka. Axial vertical loads (135 N) were applied to the central fossa of the right first molar area for each overdenture design. Stress concentrations were recorded photographically and analyzed visually.

Results: The tested bar attachment designs revealed low and moderate stress levels. The lowest stress was observed with the bar-clip design, followed by bar-locator, bar-ceka, and bar-galvano designs.

Conclusion: The loads were distributed to all of the implants. Studied designs experienced moderate stress levels around the loaded side implant. Bars with distally placed stud attachments and surface treatment with electroforming seems to increase stress levels around the implants.

Keywords

Dental stress analysis, denture, overlay, denture precision attachment, implant-supported dental prosthesis

Üç-implant-destekli mandibular overdenture protezlerde çeşitli bar tasarımlarının stres iletim karakterlerinin değerlendirilmesi

Abstract

Amaç: Dişsiz mandibulaya sahip hastaların tedavisinde implant-destekli overdenture protezler konvansiyonel tam protezlerin yerine sıklıkla tercih edilmektedirler. Bu çalışmanın amacı, dört farklı bar tutucu tasarımına sahip üç-implant-destekli mandibular overdenture protezlerin stres iletim karakterlerini incelemektir.

Gereç ve Yöntem: Dişsiz mandibular bir modelden interforaminal bölgesine üç implantın (3.75 mm - 13 mm)  yerleştirildiği bir fotoelastik mandibular model hazırlandı. Bu model üzerine dört farklı bar tasarımı olan mandibular overdenture yapıldı: bar klips, bar-galvano, bar-locator ve bar-ceka. Her bir overdenture tasarımında, sağ birinci molar dişin santral fossasına vertikal yükleme (135 N) yapıldı. Stres konsantrasyonları fotoğrafik olarak kaydedildi ve görsel olarak analiz edildi.

Bulgular: Çalışmada kullanılan bar tutucu tasarımları düşük ve orta derecelerde stres gösterdi. En düşük stres bulgusu bar klips tasarımında bulunurken, bar-locator, bar-ceka ve bar-galvano tasarımları bunu takip etti.

Sonuç: Uygulanan yükler bütün implantlara dağıtılmıştır. Çalışmada değerlendirilen tasarımlar yükleme yapılan taraftaki implantın çevresinde orta derecede strese sebep olmuştur. Bar tutucunun distallerine stud tutucu uygulaması ve elektroforming yüzey işlemi implantların çevresindeki stresi arttırabilir.

Keywords

Dental stres analizi, hassas tutuculu protez, implant-destekli diş protezi, protez, geçmeli

References

• Sadowsky SJ, Caputo AA. Effect of anchorage systems and extension base contact on load transfer with mandibular implant-retained overdentures. J Prosthet Dent 2000;84:327-34.
• Mazaro JV, Filho HG, Vedovatto E, Pellizzer EP, Rezende MC, Zavanelli AC. Evaluation of stress patterns produced by implant-retained overdentures and implant-retained fixed partial denture. J Craniofac Surg 2011;22:2153-7.
• Begg T, Geerts GA, Gryzagoridis J. Stress patterns around distal angled implants in the all-on-four concept configuration. Int J Oral Maxillofac Implants 2009;24:663-71.
• Assuncao WG, Barao VA, Tabata LF, Gomes EA, Delben JA, dos Santos PH. Biomechanics studies in dentistry: bioengineering applied in oral implantology. J Craniofac Surg 2009;20:1173-7.
• Ochiai KT, Williams BH, Hojo S, Nishimura R, Caputo AA. Photoelastic analysis of the effect of palatal support on various implant-supported overdenture designs. J Prosthet Dent 2004;91:421-7.
• Pigozzo MN, Lagana DC, Sesma N, Souza GF, Ichi AL. Photoelastic stress analysis in mandibular bone surrounding bar-clip overdenture implants. Braz Oral Res 2014;28:1-8.
• Naert I, Quirynen M, Hooghe M, van Steenberghe D. A comparative prospective study of splinted and unsplinted Branemark implants in mandibular overdenture therapy: a preliminary report. J Prosthet Dent 1994;71:486-92.
• Takeshita S, Kanazawa M, Minakuchi S. Stress analysis of mandibular two-implant overdenture with different attachment systems. Dent Mater J 2011;30:928-34.
• Trakas T, Michalakis K, Kang K, Hirayama H. Attachment systems for implant retained overdentures: a literature review. Implant Dent 2006;15:24-34.
• Tokuhisa M, Matsushita Y, Koyano K. In vitro study of a mandibular implant overdenture retained with ball, magnet, or bar attachments: comparison of load transfer and denture stability. Int J Prosthodont 2003;16:128-34.
• Menicucci G, Lorenzetti M, Pera P, Preti G. Mandibular implant-retained overdenture: Finite element analysis of two anchorage systems. Int J Oral Maxillofac Implants 1998;13:369-76.
• Manju V, Sreelal T. Mandibular implant-supported overdenture: an in vitro comparison of ball, bar, and magnetic attachments. J Oral Implantol 2013;39:302-7.
• Dashti MH, Atashrazm P, Emadi MI, Mishaeel S, Banava S. The effects of two attachment types on the stresses introduced to the mandibular residual ridge: a 3D finite element analysis. Quintessence Int 2013;44:585-90.
• Daas M, Dubois G, Bonnet AS, Lipinski P, Rignon-Bret C. A complete finite element model of a mandibular implant-retained overdenture with two implants: comparison between rigid and resilient attachment configurations. Med Eng Phys 2008;30:218-25.
• Tokar E, Uludag B. Load Transfer Characteristics of Various Designs of Three-Implant-Retained Mandibular Overdentures. Int J Oral Maxillofac Implants 2015;30:1061-7.
• Federick DR, Caputo AA. Effects of overdenture retention designs and implant orientations on load transfer characteristics. J Prosthet Dent 1996;76:624-32.
• Uludag B, Polat S. Retention characteristics of different attachment systems of mandibular overdentures retained by two or three implants. Int J Oral Maxillofac Implants 2012;27:1509-13.
• Doukas D, Michelinakis G, Smith PW, Barclay CW. The influence of interimplant distance and attachment type on the retention characteristics of mandibular overdentures on 2 implants: 6-month fatigue retention values. Int J Prosthodont 2008;21:152-4.
• Michelinakis G, Barclay CW, Smith PW. The influence of interimplant distance and attachment type on the retention characteristics of mandibular overdentures on 2 implants: Initial retention values. Int J Prosthodont 2006;19:507-12.
• Meijer HJ, Kuiper JH, Starmans FJ, Bosman F. Stress distribution around dental implants: influence of superstructure, length of implants, and height of mandible. J Prosthet Dent 1992;68:96-102.
• Holmgren EP, Seckinger RJ, Kilgren LM, Mante F. Evaluating parameters of osseointegrated dental implants using finite element analysis--a two-dimensional comparative study examining the effects of implant diameter, implant shape, and load direction. J Oral Implantol 1998;24:80-8.
• Himmlova L, Dostalova T, Kacovsky A, Konvickova S. Influence of implant length and diameter on stress distribution: a finite element analysis. J Prosthet Dent 2004;91:20-5.
• Celik G, Uludag B. Effect of the Number of Supporting Implants on Mandibular Photoelastic Models with Different Implant-Retained Overdenture Designs. J Prosthodont 2014;23:374-80.
• Pesqueira A, Goiato M, Gennari-Filho H, Monteiro D, Dos Santos D, Haddad M et al. The use of stress analysis methods to evaluate the biomechanics of oral rehabilitation with implants. J Oral Implantol 2014;40:217-28.
• Gotfredsen K, Berglundh T, Lindhe J. Bone reactions adjacent to titanium implants subjected to static load of different duration. A study in the dog (III). Clin Oral Implants Res 2001;12:552-8.
• Celik G, Uludag B. Photoelastic stress analysis of various retention mechanisms on 3-implant-retained mandibular overdentures. J Prosthet Dent 2007;97:229-35.
• Alsabeeha NH, Payne AG, Swain MV. Attachment systems for mandibular two-implant overdentures: a review of in vitro investigations on retention and wear features. Int J Prosthodont 2009;22:429-40.
• Heckmann SM, Winter W, Meyer M, Weber HP, Wichmann MG. Overdenture attachment selection and the loading of implant and denture-bearing area. Part 2: A methodical study using five types of attachment. Clin Oral Implants Res 2001;12:640-7.
• Sadowsky SJ, Caputo AA. Stress transfer of four mandibular implant overdenture cantilever designs. J Prosthet Dent 2004;92:328-36.
• Fanuscu MI, Caputo AA. Influence of attachment systems on load transfer of an implant-assisted maxillary overdenture. J Prosthodont 2004;13:214-20.
• Heckmann SM, Winter W, Meyer M, Weber HP, Wichmann MG. Overdenture attachment selection and the loading of implant and denture-bearing area. Part 1: In vivo verification of stereolithographic model. Clin Oral Implants Res 2001;12:617-23.
• Mericske-Stern RD, Taylor TD, Belser U. Management of the edentulous patient. Clin Oral Implants Res 2000;11 Suppl 1:108-25.
• Batenburg RH, Meijer HJ, Raghoebar GM, Vissink A. Treatment concept for mandibular overdentures supported by endosseous implants: A literature review. Int J Oral Max Impl 1998;13:539-45.
• Setz JM, Wright PS, Ferman AM. Effects of attachment type on the mobility of implant-stabilized oveudentures - An in vitro study. Int J Prosthodont 2000;13:494-9.
• Thomason JM, Feine J, Exley C, Moynihan P, Muller F, Naert I, et al. Mandibular two implant-supported overdentures as the first choice standard of care for edentulous patients--the York Consensus Statement. Br Dent J 2009;207:185-6.
• Feine JS, Carlsson GE, Awad MA, Chehade A, Duncan WJ, Gizani S, et al. The McGill Consensus Statement on Overdentures. Montreal, Quebec, Canada. May 24-25, 2002. Int J Prosthodont 2002;15:413-4.
• Thomason JM, Kelly SA, Bendkowski A, Ellis JS. Two implant retained overdentures--a review of the literature supporting the McGill and York consensus statements. J Dent 2012;40:22-34.