UNIVERSIDADE ESTADUAL PAULISTA

“JÚLIO DE MESQUITA FILHO”

Instituto de Ciência e Tecnologia

Campus de São José dos Campos

ORIGINAL ARTICLE DOI: https://doi.org/10.4322/bds.2023.e3736

Braz Dent Sci 2023 Apr/Jun;26 (2): e3736

Prosthetic maintenance assessment for implant ﬁxed complete

dentures and implant overdentures: a randomized clinical trial

Avaliação da manutenção protética para próteses totais ﬁxas suportadas por implantes e

Overdentures

: um ensaio clínico

randomizado

Nesma Mohamed AWAAD

, Marwa Abdelaal ELSADEK



Doaa Mahmoud ELKADY



1 - Cairo University, Faculty of Dentistry, Prosthodontic Department, Faculty of Dentistry, Cairo University, Cairo, Egypt

How to cite: Awaad NM, Elsadek MA, El Kady DM. Prosthetic maintenance assessment for implant xed complete dentures and implant

overdentures: a randomized clinical trial. Braz Dent Sci. 2023;26(2): e3736. https://doi.org/10.4322/bds.2023.e3736

ABSTRACT

Objective: The rehabilitation choice for the edentulous patients usually lies between the xed and removable

prosthetic options. The treatment decisions are affected by many factors where complications and maintenance

needs are both considered crucial factors, in addition to the cost effectiveness of the chosen treatment.

Material and Methods: This study was applied on 44 edentulous patients, where 22 patient for each group

were enrolled in the outpatient clinic of prosthodontics, Cairo University as per a set of eligibility criteria. Four

inter-foraminal implants were installed for all eligible participants. Three months later, healing abutments

were used for soft tissue preparation prior to the fabrication of the nal prosthesis. A prosthetic treatment

option was then randomly allocated to obtain two equal groups via computer generated randomization

program; Group. A received telescopic implant overdentures, and Group. B received screw retained dentures.

All Complications (Screw loosening or fracture, tooth or denture base fracture and mucositis) were reported

after overdenture insertion along the follow up period (1, 6, 9 and 12 months respectively). Results: The

frequency of the screw loosening for hybrid overdentures where (59.1%) compared to (27.3%) of telescopic

prosthesis at 12 months follow up period (p=0.035), mucositis reporting at 6m interval had shown the highest

frequency in both groups (Group A (54.5%), Group B (81.8%), (p=0.045), all other reported complications

that lack statistical signicance either within the same group or between both groups at different time intervals.

Conclusion: Both treatment modalities; telescopic implant overdenture and hybrid xed screw-retained are

reliable for restoring the completely edentulous arches, the decision whether to make a xed or removable

implant denture shall be guided with the patient preference together with the dentist assessment in relation

to the patient’s state of general and oral health.

KEYWORDS

Dental prosthesis; Implant-supported, Denture; Overlay; Dental prosthesis design; Maintenance/standards.

RESUMO

Objetivo: A escolha da reabilitação para pacientes edêntulos geralmente recai entre próteses xas e removíveis.

As decisões de tratamento são afetadas por muitos fatores onde as complicações e as necessidades de manutenção

são consideradas critérios cruciais, além do custo-efetividade do tratamento escolhido. Material e Métodos:

Este estudo foi aplicado em 44 pacientes edêntulos, onde 22 pacientes para cada grupo foram matriculados no

ambulatório de prótese dentária da Universidade do Cairo de acordo com um conjunto de critérios de elegibilidade.

Quatro implantes interforaminais foram instalados para todos os participantes elegíveis. Três meses depois,

pilares de cicatrização foram utilizados para preparação dos tecidos moles antes da fabricação da prótese nal.

Uma opção de tratamento protético foi então alocada aleatoriamente para obter dois grupos iguais por meio de

Braz Dent Sci 2023 Apr/Jun;26 (2): e3736

Awaad NM et al.

Prosthetic maintenance assessment for implant fixed complete dentures and implant overdentures: a randomized clinical trial

Awaad NM et al.

Prosthetic maintenance assessment for implant ﬁxed complete

dentures and implant overdentures: a randomized clinical trial

INTRODUCTION

The implant-supported overdentures provided

a long-term successful and satisfying restoration

when used to rehabilitate an edentulous jaw [1,2].

Other patients with similar oral conditions would

prefer xed treatment modality aiming to increase

their self-esteem and decrease their anxiety.

The clinical decision among different prosthetic

options commonly relied on the available bone

quantity and quality, the number, location and

implant distribution, the available inter-arch distance

and maxilla-mandibular relationship in addition to

the nature of the opposing occlusion [3,4].

Different attachments as bar, ball, and

magnetic attachments together with telescopic

crowns were suggested to connect the

overdentures to the dental implants [5].

The usage of the telescopic retainers were

expanded to include the implant retained

prostheses. These retainers provided an excellent

retention arising from the frictional t between

the abutment and the sleeve. They also reported

better force distribution and axial transfer for the

occlusal loads that minimize the rotational torque

on the abutment thus preserving the underlying

alveolar bone [6].

When compared to other attachments,

the studies showed more favorable gingival

conditions of the telescopic overdentures above

the bar-blocked implants resulting from the better

cleansing abilities of the telescopic over-denture

that in turn lead to less plaque accumulation [7,8].

Regarding maintaining requirement, the telescopic

attachments showed less prosthetic maintaining

than the bar attachment [9].

On the other hand, “All-on four concept” which

was developed by Paulo Malo using the straight

and angled multi-unit abutments, to retain an

immediately loaded full arch restoration with only

four implants was encouraged by many studies for

the rehabilitation of both arches

However, the

main descriptions were limited to the survival rates,

implant failures and technical complications [10].

All-on-four treatment concept offers a

predictable way for treating the edentulous jaw

especially the atrophic cases where patients

refuse the regenerative procedures, however, the

current evidence is limited due the scarcity of the

information referred to methodological quality,

a lack of adequate follow-up [11].

There are two types of complications in implant

prosthesis; biologic and prosthetic. The biologic

complications refer to the disorders in the implant

function that disturb the supporting peri-implant

tissues resulting in the mucositis or peri-implantitis

in severe conditions, the technical complications

refer to subjecting the implant, implant parts

and/or the superstructures to a damage such as

the screw loosening, attachment wear, fracture

to part of the prosthesis or some of its teeth [12].

The prosthetic complications after the insertion

of the nal prosthesis may or may not lead to the

implant loss, but may lead to an increase demand

for the repair and maintenance [13].

This study aimed to assess whether the

telescopic overdenture as a removable prosthesis

randomização gerada através programa de computador. O Grupo A recebeu

overdentures

de implantes telescópicos

e o Grupo B recebeu dentaduras xas parafusadas sobre os implantes. Todas as complicações (afrouxamento

ou fratura do parafuso, fratura da base do dente ou da prótese e mucosite) foram relatadas após a inserção da

overdentures

ao longo do período de acompanhamento (1, 6, 9 e 12 meses, respectivamente). Resultados: A

frequência do afrouxamento do parafuso para

overdentures

híbridas (59,1%) em comparação com (27,3%) da

prótese telescópica no período de acompanhamento de 12 meses (p=0,035), o relato de mucosite no intervalo

de 6 meses mostrou a maior frequência em ambos os grupos (Grupo A (54,5%), Grupo B (81,8%), p=0,045,

todas as outras complicações relatadas foram sem signicância estatística dentro do mesmo grupo ou entre os

dois grupos em intervalos de tempo diferentes. Conclusão: Ambas as modalidades de tratamento;

overdentures

sobre implantes telescópicos e próteses híbridas xas parafusadas são conáveis para reabilitar as arcadas

completamente edêntulas. A decisão de fazer uma prótese xa ou removível sobre implantes deve ser guiada

pela preferência do paciente juntamente com a avaliação do dentista em relação ao estado geral do paciente e

sua saúde bucal.

PALAVRAS-CHAVE

Prótese dental; Prótese suportada por implante;

Overlay

; Desenho de prótese dentária; Manutenção/padrão.

Braz Dent Sci 2023 Apr/Jun;26 (2): e3736

Awaad NM et al.

Prosthetic maintenance assessment for implant fixed complete dentures and implant overdentures: a randomized clinical trial

Awaad NM et al.

Prosthetic maintenance assessment for implant ﬁxed complete

dentures and implant overdentures: a randomized clinical trial

would necessitate performing maintaining work

at a frequency similar to that with a screw

retained hybrid overdenture as a xed prosthesis.

MATERIAL AND METHODS

Ethical approval

This study was approved by the ethical

committee; faculty of dentistry, Cairo University

with the approval No. 31922.

Sample size calculation

This power analysis utilized the frequency of

implant complications as the primary outcome.

Based upon the results of Ragheb et al. [14]; the

proportions of the complications were 0.407 and

0.037 in the two groups, respectively. Using alpha

(α) level of (5%) and Beta (β) level of (20%) i.e.,

power = 80%; the minimum estimated sample

size was 19 implants per group. The sample

size was increased to twenty-two implants per

group to compensate for a drop-out rate of 30%

after two years. The sample size calculation was

performed using G*Power Version No. 3.1.9.2.

Patients’ enrollment

Only male Patients were engaged in the study

from the Outpatient Clinic of the Prosthodontics

Department, Faculty of Dentistry, Cairo University.

All of which were dissatised with their previous

denture experience and are seeking better retention

to their mandibular denture. The patients received

verbal and written information about the study

procedures and a written informed consent was

signed prior their participation in the study.

During their involvement in the study, the

patients passed through a thorough history and

clinical examination. Factors that might interfere

with tissue healing and implant Osseointegration

were excluded among which were systemic diseases

that interfere with the bone quality, normal healing

mechanism, osseointegration of the implants or

proper bone response to the applied forces [15].

The irradiated patients were also excluded

from the study as the implants placed in the

irradiated bone showed signicantly lower survival

rates, risk of osteoradionecrosis, obliteration of

ne vasculature and progressive brosis [16].

Heavy smoker (more than 20 cigarette/day)

were excluded, as smoking is a signicant factor

that may lead to the implant failure due to its

adverse impact on the immune cells and tissue

reparative capacity along with the signicant

increased risk of failure [17].

Also, the patients with the parafunctional

habits as the bruxism and clenching were

excluded in order to avoid undue stresses that

might affect the implant’s success. Those with

TMJ disorders were excluded to avoid any

degree of muscular incoordination which might

overload the implant and the prosthesis [18].

The male patients were selected to avoid the

female hormonal changes such as the calcium

insufciency and osteoporosis which have a high

prevalence among the females and might affect

the Osseointegration of the placed implants [19].

The patients selected had completely

edentulous maxillary and mandibular arches

with normal maxilla-mandibular relationship

to facilitate the implant insertion and avoid the

implants overloading [20].

Each patient was evaluated for a proper

restorative space not less than 15 mm to allow

a proper space for the attachment and the

over-denture [21].

The patients were selected with the adequate

buccolingual width of the keratinized mucosa

equal to or greater than 5 mm over the crest

of the lower ridge; its presence was correlated

with less plaque accumulation and mucosal

inammation [22]. All the patients were selected

with a good physical and psychological condition

to tolerate the conventional implant surgical

protocol and commit to the follow-up schedule.

The panoramic radiograph was taken for

each patient to assess the bone height and

location of the nearby vital structure in the areas

planned to receive the implants followed by CBCT

imaging for the accurate Implant planning.

Study design

This study is a randomized clinical trial,

which was approved by the Ethics Committee of

Scientic Research of Cairo University.

In this study, all the participants had to install

four interforaminal implants to receive either the

telescopic over-denture or screw retained denture.

Before the prosthetic phase, both groups

were randomly assigned as per a computerized

random allocation program where the data of

Braz Dent Sci 2023 Apr/Jun;26 (2): e3736

Awaad NM et al.

Prosthetic maintenance assessment for implant fixed complete dentures and implant overdentures: a randomized clinical trial

Awaad NM et al.

Prosthetic maintenance assessment for implant ﬁxed complete

dentures and implant overdentures: a randomized clinical trial

randomization were entered by the secretary

of the department who neither participated in

recruitment nor in examination procedures.

The randomization and allocation concealment

were guaranteed as the randomization table was

locked with the study coordinator who wasn’t

involved in any clinical intervention. The operator

was informed about the treatment modality in a

sealed enveloped delivered by the secretary of the

department before the impression procedures.

The data collection was performed by the

study coordinator, blinding of the operator or

data collector was not applicable due to the

clear difference between the two prostheses, but

collected data was coded prior to sending to the

statistician (Blinded statistician).

Surgical and prosthetic procedure

A preoperative CBCT scan was taken for

the participant’s mandibular arch with a scan

appliance (Duplicated from his previous denture)

with (PLANMECA Pro max 3D mid CBCT

machine). The resultant image was obtained as

DICOM le (Digital imaging and communications

in medicine) on a compact disc. The virtual

planning was made using blue-sky software (Blue

sky Bio, LLC. planning software).

The surgical steps were explained for all the

participants and an informed consent was signed

before the surgery. All the patients were instructed

to rinse their mouth with an antimicrobial mouth

wash (Chlorohexidine, Kahira pharma and chem.

Ind. Co. Cairo, Egypt) three times daily starting

two days before the surgery and one hour before

surgery. The patient was also pre-medicated

by a prophylactic antibiotic (2 gm amoxicillin-

clavulanic) 1 hour before surgery.

The mental and lingual nerve block

(Artinibsa, Spain) were given bilaterally adjacent

to the dental implant installation sites. Surgical

stent was used to mark the bleeding points

by using a periodontal probe opposing to the

proposed implants sites.

The mid-crestal incision was made slightly

behind the location of the implant placement via

blade 15 (Swan Morton England) with the buccal

realizing incisions for an easy release of the ap

without laceration. A complete flap retraction

was made by using a suitable size mucoperiosteal

elevator (Martin Germany). The sequential drilling

with copious irrigation guided by the path initially

created by the pilot drill was made. A parallel pin

was then used to guide the next site drilling.

The root form tapered threaded dental

implants (Neo Biotech Co. Ltd, Seoul, Korea)

were installed with 3.5/11.5 mm for the anterior

and 3.5/10 mm for posterior sites after which

primary stability was checked. The interrupted

sutures were done using 000 silk sutures (/0 silk

braided Shandong Weigao Co. LTD) for the ap

closure. The analgesic drugs (Ibuprofen 600 mg,

Knoll AG, Ludwigshafen, Germany) was prescribed

every 8 hours for the next three days to control

post-operative pain and reduce the inammation.

Participants were instructed to rinse with

0.2% chlorohexidine antimicrobial mouthwash

three times daily starting the day after the

surgery. The sutures were removed 7 days later,

and the dentures were relieved adjusted with soft

liner opposite the previous surgical site. (Dura

Base Worth, Illinois 60482)

Three months later, the surgical stent

was used to relocate the implants position for

uncovering. The inltration anesthesia was given

to the patient and small crestal incision was made

for each implant sites then slightly widened by

a small mucoperiosteal elevator till the covering

screw was seen, unscrewing was made using

the screwdriver and the healing abutment was

screwed with the collar height 5 mm to allow a

proper gingival healing around the implants prior

making the impression as shown in Figure 1.

Prosthetic fabrication stage

The impression was made with an open

tray splinted implant level impression technique.

The healing abutments were removed, and

impression copings were inserted and screwed

in position. After splinting, the impression was

taken using putty and light consistency silicon

impression material (Zeta plus Zhermack, Italy)

on a modied stock tray.

The impression was checked, and analogues

were screwed in place over the copings before

pouring the impression. A verication Jig was

prepared over the resulted cast and used to

check implant’s positions inside the patient

mouth. The lack of the passivity during the

insertion of the impression copings were dealt

with via copings separation and reseating over

the implants. They were then reattached using

Duralay (Duralay GC AMERICA INC.3737, ALSIP

Braz Dent Sci 2023 Apr/Jun;26 (2): e3736

Awaad NM et al.

Prosthetic maintenance assessment for implant fixed complete dentures and implant overdentures: a randomized clinical trial

Awaad NM et al.

Prosthetic maintenance assessment for implant ﬁxed complete

dentures and implant overdentures: a randomized clinical trial

IL 60803 USA), and impression was repeated.

According to randomization, either a telescopic

implant supported overdenture (Group A), or a

screw retained denture (Group B) was fabricated

for each case as shown in Figures 2 and 3.

After the prosthetic insertion, participant

were recalled according to a follow up schedule

(1, 6, 9 and 12 months respectively)

During the follow-up period, prosthetic

complications were grouped and their frequency

was documented as per the type of prosthesis.

Both the prosthetic and biological aspects were

included.

Group A: For telescopic overdenture (Screw

loosening, screw fracture, tooth wear, teeth

fracture and/or separation, acrylic fracture and/or

separation, mucositis, relining need for the denture

and coping retention loss was seen for this group)

Group B: For screw retained denture (Screw

loosening, screw fracture, tooth wear, teeth

fracture and/or separation, acrylic fracture and/or

separation, mucositis) patients were recalled each

month for the rst 6 months and each 3 months

the rest of the study period unless the patient

complained, he was then seen immediately. Each

complication was documented with stating the

frequency of its occurrence, any complication was

managed and repaired. Figures 4 and 5, Table I.

Figure 1 - Healing abutments in position.

Figure 3 - Screw retained denture inside the patient’s mouth.

Figure 4 - Mucositis under screw retained denture.

Figure 5 - Acrylic fracture from screw retained denture group.

Figure 2 - Telescopic primary coping inside the patient’s mouth and

ﬁtting surface of the telescopic implant overdenture.

Braz Dent Sci 2023 Apr/Jun;26 (2): e3736

Awaad NM et al.

Prosthetic maintenance assessment for implant fixed complete dentures and implant overdentures: a randomized clinical trial

Awaad NM et al.

Prosthetic maintenance assessment for implant ﬁxed complete

dentures and implant overdentures: a randomized clinical trial

Table I - Frequency of maintenance in diﬀerent groups

Variables

Maintenance Need

Group A (Telescopic Overdenture) Group B (Screw retained)

P-value

N % n %

Screw Loosening

1 m

No 22 100 20 90.9

0.152 ns

Yes 0 0 2 9.1

6 m

No 18 81.8 12 54.5

0.055 ns

Yes 4 18.2 10 45.5

9 m

No 17 77.3 17 77.3

1 ns

Yes 5 22.7 5 22.7

12 m

No 16 72.7 9 40.9

0.035*

Yes 6 27.3 13 59.1

Total

No 8 36.4 4 18.2

0.181 ns

Yes 14 63.6 18 81.8

Screw Fracture

1 m

No 22 100 22 100

1 ns

Yes 0 0 0 0

6 m

No 22 100 21 95.5

0.317 ns

Yes 0 0 1 4.5

9 m

No 22 100 22 100

1 ns

Yes 0 0 0 0

12 m

No 22 100 22 100

1 ns

Yes 0 0 0 0

Total

No 22 100 21 95.5

0.317 ns

Yes 0 0 1 4.5

Tooth Fracture

1 m

No 22 100 22 100

1 ns

Yes 0 0 0 0

6 m

No 21 95.5 20 90.9

0.554 ns

Yes 1 4.5 2 9.1

9 m

No 22 100 22 100

1 ns

Yes 0 0 0 0

12 m

No 22 100 22 100

1 ns

Yes 0 0 0 0

Total

No 21 95.5 20 90.9

0.554 ns

Yes 1 4.5 2 9.1

Acrylic base

fracture

1 m

No 22 100 22 100

1 ns

Yes 0 0 0 0

6 m

No 22 100 21 95.5

0.317 ns

Yes 0 0 1 4.5

9 m

No 22 100 22 100

1 ns

Yes 0 0 0 0

12 m

No 22 100 22 100

1 ns

Yes 0 0 0 0

Total

No 22 100 21 95.5

0.317 ns

Yes 0 0 1 4.5

*; signiﬁcant (p<0.05), ns; non-signiﬁcant

Braz Dent Sci 2023 Apr/Jun;26 (2): e3736

Awaad NM et al.

Prosthetic maintenance assessment for implant fixed complete dentures and implant overdentures: a randomized clinical trial

Awaad NM et al.

Prosthetic maintenance assessment for implant ﬁxed complete

dentures and implant overdentures: a randomized clinical trial

RESULTS

The mean and standard deviation values

were calculated for each group in each test. Data

were explored for normality using Kolmogorov-

Smirnov and Shapiro-Wilk tests, data showed

non-parametric distribution.

Mann Whitney test was used to compare

between the two groups in non-related samples.

The signicance level was set at P ≤ 0.05.

The statistical analysis was performed with IBM®

SPSS® Statistics Version No. 20 for Windows.

Prosthetic maintenance assessment

I- Screw looseness:

During the rst month, 6 months and 9 months

there was no statistically significant difference

Variables

Maintenance Need

Group A (Telescopic Overdenture) Group B (Screw retained)

P-value

N % n %

Mucositis

1 m

No 19 86.4 19 86.4

1 ns

Yes 3 13.6 3 13.6

6 m

No 10 45.5 4 18.2

0.045*

Yes 12 54.5 18 81.8

9 m

No 12 54.5 9 40.9

0.371 ns

Yes 10 45.5 13 59.1

12 m

No 16 72.7 14 63.6

0.522 ns

Yes 6 27.3 8 36.4

Total

No 5 22.7 1 4.5

0.082 ns

Yes 17 77.3 21 95.5

Relining of over-

denture

1 m

No 22 100 - -

Yes 0 0 - -

6 m

No 22 100 - -

Yes 0 0 - -

9 m

No 20 90.9 - -

Yes 2 9.1 - -

12m

No 20 90.9 - -

Yes 2 9.1 - -

Total

No 18 81.8 - -

Yes 4 18.2 - -

Loss of coping

retention

1 m

No 22 100 - -

Yes 0 0 - -

6 m

No 22 100 - -

Yes 0 0 - -

9 m

No 22 100 - -

Yes 0 0 - -

12 m

No 18 81.8 - -

Yes 4 18.2 - -

Total

No 18 81.8 - -

Yes 4 18.2 - -

*; signiﬁcant (p<0.05), ns; non-signiﬁcant

Table I - Continued...

Braz Dent Sci 2023 Apr/Jun;26 (2): e3736

Awaad NM et al.

Prosthetic maintenance assessment for implant fixed complete dentures and implant overdentures: a randomized clinical trial

Awaad NM et al.

Prosthetic maintenance assessment for implant ﬁxed complete

dentures and implant overdentures: a randomized clinical trial

between (Group A) and (Group B) where (

=0.152),

(

=0.055), and (

=1) respectively where the

highest frequency was found in (Group B), and the

least frequency was found in (Group A).

At 12 months, there was a statistically

signicant difference between (Group A) and

(Group B), where (

=0.035), where the highest

frequency was found in (Group B),

Through the follow up period, the

screw looseness reveled a non-statistically

signicant difference between (Group A) and

(Group B), where (

= 0.181). With the highest

frequency was found in (Group B), while the least

frequency was found in (Group A).

II- Screw fracture:

Throughout the whole follow up records

(1, 6, 9 and 12 m), there were no statistically

signicant difference between (Group A) and

(Group B) (p= 1). (p= 0.317). (p= 1). (p= 1)

respectively). This Resulted in an overall non-

statistically signicant difference between the

two groups (p= 0.317) with relatively higher

frequency in (Group B).

II- Tooth fracture:

No statistically signicant difference was

reported between (Group A) and (Group B), after

1, 6, 9 and 12 months (

= 1). (

= 0.554). (

= 1)

and (

= 1) respectively). Both groups showed the

same frequency, except after 6 months where the

higher frequency was found in (Group B). Total

values showed non-statistically significant

difference between the two groups (

=0.554)

despite (Group B) showed more incidence of

occurrence.

III- Acrylic Base Fracture:

There was no statistically signicant difference

between (Group A) and (Group B) in 1, 6 , 9, and

12 months ((

= 1). (

=0.317). (

= 1) and (

= 1)

respectively). Both groups exhibited no fracture

in the acrylic base at all time periods except

after 6 months when (Group B) reported single

incidence of occurrence.

At the end of the follow-up period, there

was no statistically signicant difference between

(Group A) and (Group B) (

= 0.317).

IV- Mucositis:

A month after insertion, there was no

statistically significant difference between

(Group A) and (Group B) (

= 1). Both groups

showed the same frequency.

After 6 months, there was a statistically

significant difference between (Group A)

and (Group B) where (

=0.045) with higher

incidence in (Group B). after 9 and 12 months,

there was no statistically signicant difference

between (Group A) and (Group B) (

= 0.371).

and (

=0.522) respectively, where the higher

frequency was found in (Group B). with a total

result of non-statistically signicant difference

between both groups (

= 0.082).

In all complications for all time periods, there

were no statistically signicant difference between

(Group A) and (Group B). Group B reported

relatively a higher incidence over Group A, and

signicantly higher incidence for screw loosing at

(12 m) and mucositis at (6 m).

DISCUSSION

The difference in the tissue response

between the xed screw retained denture and

telescopic removable overdenture is due to the

nature of each type and accessibility for the oral

hygiene measures, where the removable type is

much more accessible by the patient to a proper

massage and clean the underneath mucosa even

if it is compared to the hygienic type of the screw

retained denture which requires a dentist visit

to perform a deep cleaning of the underneath

mucosa [23]. Therefore, the patient is only

able to rinse and use the dental floss, which

reflects the results of this study considering

the biological complication as mucositis where

it was signicantly higher for Group B than in

Group A with statistically signicant difference

in the rst 6 months due to the mucosal covering

with less accessibility to the oral hygiene which

increases the mucositis unless the patient was

meticulously care about his oral hygiene.

Although the screw retained prosthesis,

including the hybrid prostheses, have the

advantages of easy retrievability, but screw

hole affecting the esthetics and bulkiness of the

overlying restoration and the patient still needs

the dentist to remove the prosthesis [24], but

when comparing with the removable prosthesis

removal and insertion is much easier for both the

patient and dentist.

Considering the mechanical complication

in terms of the screw loosening, screw fracture,

Braz Dent Sci 2023 Apr/Jun;26 (2): e3736

Awaad NM et al.

Prosthetic maintenance assessment for implant fixed complete dentures and implant overdentures: a randomized clinical trial

Awaad NM et al.

Prosthetic maintenance assessment for implant ﬁxed complete

dentures and implant overdentures: a randomized clinical trial

teeth fracture and acrylic fracture in the xed

screw retained denture; are usually occurred

because of the prosthesis and tissue response to

the applied forces [25].

Abutment screw looseness frequency was

more in Group B than in Group A, but with the

statistically non- signicant difference, which

can be due to the transmission of chewing

forces to the implant -abutment interface where

the energy in turns transmitted to the screws

which may lead to its loosening in addition to

the passivity which cannot be totally obtained

in any prosthesis. The superstructure of the

implant retained prosthesis misfit is a result

of the accumulative distortions that occurred

during the whole procedure of the nal prosthesis

fabrication, which is known as the distortion

equation, Theoretically, the total passive t can

be achieved if the summation of this distortion

equation was zero [26]. Also the decient preload

on the screws, over tightening of the screws

may cause stripping, screw distortion and/

or excessive occlusal load from parafunction,

occlusal interferences, or exceedingly long

cantilevers [27].

Other studies showed that the prosthetic

maintenance/complication were more in

removable types of the implants retained

overdentures than the xed ones [14]. As for

the prosthetic maintenance requirement found

in the telescopic implant retained overdentures

especially after 12 months was the loss of the

retention between the primary & secondary

copings resulting from the wear happened between

both copings due to the loss in the retentive

mechanism of the removable overdenture’s

attachments as prosthetic complication [28,29].

Recently Secondary coping of the telescopic

crowns can be fabricated by one of these

generation of polymers as Poly Ether Ketone-

Ketone (PEKKTON) and Poly Ether-Ether Ketone

(PEEK), these are the two most well-known of

the family Pol aryl ether ketone PEEK which

overcomes the wear happens between similar

coping materials [30].

Relining required for the overdentures

happens in four cases; two cases needed relining

after 9 months, other two cases at 12 months

due to the undesirable forces transmitted to

the denture bearing area, which led to the bone

resorption atrophy of the denture bearing area

overtime [31]. Rigid telescopic abutments and

the height of the telescopic attachments in the

implant overdentures had a marked impact

on the lateral force on the implants and the

transmitted force to the denture bearing area,

which may be attributed to the need for relining

in some patients depending on the type of both

the supporting structure and its quality together

with the masticatory forces which differ from a

patient to another [32].

Acrylic base Fracture of the prosthesis was

found with the xed screw retained type more

when found with the removable telescopic

implant overdentures, which can be due to the

attachment mechanism of the acrylic resin with

the metallic framework, which may be related

to the poor chemical bonding of the acrylic resin

to base metal alloys, which can results in the

microleakage and bond failure [33]. In this study

resin fracture occurred due to the improper usage

of the prosthesis with 1 patient who stated that

he used the denture to cut a hard object.

Tooth fracture in Group B with a higher

frequency than Group A, but with non-statistically

significant difference, which may be due to

the improper utilization of the denture by the

patient for putting hard objects inside his mouth

which was revealed by taking the history from

the patients. Some studies reported fracture of

anterior acrylic teeth more than posterior ones.

Incidence of the tooth fracture varies in the

studies from low incidence to a frequent ones that

may be due to the different follow-up periods or

patient’s behaviors [34].

CONCLUSION

Both treatment modalities; telescopic

implant overdenture and hybrid fixed screw-

retained are reliable for restoring the completely

edentulous arches. Regarding to the prosthetic

complications and maintenance; screw retained

showed a higher incidence than telescopic

overdenture in abutment screw loosening and

fracture. Also, screw retained showed a higher

incidence of mucositis, while relining was

more evidenced in the telescopic overdentures.

Therefore, the decision whether to make a xed

or removable implant denture shall be guided

with the patient preference together with the

dentist opinion in relation to the patient’s general

and oral health state.

Braz Dent Sci 2023 Apr/Jun;26 (2): e3736

Awaad NM et al.

Prosthetic maintenance assessment for implant fixed complete dentures and implant overdentures: a randomized clinical trial

Awaad NM et al.

Prosthetic maintenance assessment for implant ﬁxed complete

dentures and implant overdentures: a randomized clinical trial

Acknowledgements

The authors are grateful to DR Nancy

El-Shafaey, the statistician, who made the

statistics for the development of this manuscript.

Author’s Contributions

NMA: Conceptualization, data curation.

MAE : Writing – Original Draft Preparation

DME: Methodology , Writing – Review &

Editing.

Conict of Interest

The authors have no proprietary, nancial,

or other personal interest of any nature or type

in any product, service, and/or company that is

presented in this article.

Funding

This research did not receive any specic

grant from funding agencies in the public,

commercial, or not-for-prot sectors.

Regulatory Statement

This study was conducted in accordance with

all the provisions of the local human subject’s

oversight committee’s guidelines and policies of

the ethical committee; Faculty of Dentistry, Cairo

University.

The approval code for this study is: 31922.

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(Corresponding address)

Nesma Mohamed Awaad

Cairo University, Faculty of Dentistry, Prosthodontic Department

Email: nesmaawaad@dentistry.cu.edu.eg

Date submitted: 2022 Dec 11

Accept submission: 2023 Apr 17