Five-year multicenter study of magnetic attachments used for natural overdenture abutments

Clinical parameters that affect performance and patient satisfaction of root-retained overdentures: A systematic review of randomised controlled clinical trials

OBJECTIVE

To evaluate clinical parameters that affect the performance of root-supported overdentures (ROD) and to identify the possible factors that may affect it.

BACKGROUND

ROD still serve as an alternative and successful treatment plan nowadays for partially edentulous patients. Nonetheless, there is not yet conclusive evidence about their clinical evaluation.

MATERIALS AND METHODS

A search strategy was developed following a PIO (Population, Intervention, Outcome) framework including an electronic search in the following databases: PubMed, Cochrane Library and Scopus. The systematic search included only randomised controlled clinical trials (RCTs), published until January 2023 in English language and was performed by two independent reviewers. Quality assessment of the included studies was conducted according to the Cochrane Risk of Bias tool.

RESULTS

The final selection of studies included 11 RCTs. Clinically relevant variables derived from this search were: Complications, with caries being the most frequently reported, periodontal aspects and bone changes around abutment teeth. Additionally, methods and clinical suggestions for the maintenance of these restorations and patient-related outcomes were assessed. According to the risk of bias assessment, nine studies were considered of high risk, whereas only 2 of low risk. A meta-analysis was not feasible.

CONCLUSION

Within the limitations of this systematic review, ROD remain a viable treatment plan, offering better denture stability and bone preservation around abutment teeth and high patient satisfaction. Thorough oral hygiene and regular follow-ups are of utmost importance. Further well-designed RCTs are necessary for firmer conclusions.

Efficacy of tooth-supported compared to implant-supported full-arch removable prostheses in patients with terminal dentition. A systematic review

AIMS

To compare tooth- (TSRP) and implant-supported (ISRP) removable prostheses in terms of abutment and prosthesis survival (PICO 1) and estimated cumulative survival of teeth/implants and prostheses (PICO 2) at ≥12-month post-prosthesis delivery in patients with stage IV periodontitis.

MATERIALS AND METHODS

Five databases were searched to identify RCTs, CCTs, single arms, prospective cohort studies, case series and retrospective studies. Duplicate screening was performed, and ranges for abutment and prosthesis survival were calculated.

RESULTS

Twenty-six studies were included in the qualitative assessment. Only one study with critical risk of bias comparing the two treatment modalities reported similar survival rates at 2 years. Overall, prospective studies on ISRPs indicated an implant survival rate ranging from 96.4% to 100% and a prosthesis survival rate of 100% with a follow-up from 12 to 54 months. Prospective studies on TSRPs indicated a tooth survival ranging from 85.71% to 100% at 1- to 10-years follow-up.

CONCLUSIONS

The available evidence is of poor quality, and it does not allow to make robust conclusions on the efficacy of these rehabilitations in stage IV periodontitis patients. Particularly for TSRPs, careful patient selection is crucial and a certain number of biological and prosthetic complications should be expected.

Biological and technical complications in root cap-retained overdentures after 3-15 years in situ: a retrospective clinical study

OBJECTIVES

This retrospective clinical study investigates the frequency of biological and technical complications in patients rehabilitated by natural root-retained overdentures (RODs) with cast post-and-cores (root caps) wearing precision attachments and analyses factors influencing complication rates (e.g. oral hygiene routines).

MATERIALS AND METHODS

Patients formerly treated with RODs were invited for a cost-free clinical visit to evaluate their intraoral status. Furthermore, they were interviewed and patient records were screened for complications occurring since denture delivery. Statistical models include descriptive analyses, Fisher's exact test, odds ratios, and a multivariate regression model.

RESULTS

A total of 114 patients wearing 128 RODs with a total of 280 abutment teeth were evaluated (mean service time: 7.9 years). Technical complications occurred in 68.8% of the RODs, with matrix loosening being the most frequent complication (50.1%). Biological complications occurred in 53.9% of all RODs, with the presence of denture stomatitis being the most common biological complication (38.3%). The presence of denture stomatitis was significantly higher in the maxilla relative to the mandible (p = 0.0029), in subjects cleaning their dentures less than twice a day (p < 0.001), in subjects regularly using CHX-containing products (p = 0.036) and in subjects with a plaque index > 40% (p < 0.001).

CONCLUSIONS

Root cap-retained overdentures with precision attachments are a viable treatment option in partially dentate subjects, even over long-term periods. However, high complication rates should be expected.

CLINICAL RELEVANCE

Establishing good oral hygiene is a decisive factor in preventing complications in RODs. Furthermore, CHX-containing products may not be recommended for routine domestic use.

Atmospheric pressure plasma jet treatment enhances the effect of Alloy Primer on the bond strength between polymethyl methacrylate and stainless steels: application for retention of magnetic attachment to resin denture base

Magnetic attachment system is used to embed in polymethyl methacrylate (PMMA) resin denture base to improve denture stability. However, dislodgement of magnetic attachments from denture base is a major clinical problem. This study is to evaluate the bond strength between PMMA and stainless steel using metal primer and atmospheric pressure plasma jet (APPJ) treatment. Stainless steel discs were treated with Single Bond Universal Adhesive; Palfique Universal Bond; Alloy Primer; heat treatment with Alloy Primer; and 10-s, 20-s, and 30-s APPJ treatment with Alloy Primer. The shear bond strength between PMMA and surface-treated stainless steel was measured using universal testing machine. The effects of N₂ flow rate (60, 50, 40, 30 SLM), thermal cycling, and air quenching on shear bond strength were also investigated. The surface of each disc was examined using X-ray photoelectron spectroscopy and a goniometer. Finally, the temperature of plasma with various N₂ flow rates was measured and the optical emission spectra of the plasma were measured using spectrometer. Alloy Primer produced the highest bond strength. APPJ treatment was effective at enhancing bond strength by cleaning the surface of contaminants. Moreover, APPJ treatment with air quenching increased surface O^2-/OH- and Fe₂O₃/FeOOH ratios, reducing the negative influence of thermal cycling on bond strength. Alloy Primer with 20 s of APPJ treatment with a 50-SLM N₂ flow rate and air quenching was the most effective at increasing bond strength.

Loss of natural abutment teeth with cast copings retaining overdentures: a systematic review and meta-analysis

PURPOSE

To analyze the available evidence in the English, German and Japanese literature on the survival and complications of natural teeth with cast copings used to retain overdentures (ROD).

STUDY SELECTION

A systematic search strategy was conducted using MeSH terms and pre-defined criteria. Two groups of researchers searched Pubmed, CENTRAL, Embase (English, German), Ichushi-web (Japanese) as well as hand searching. Data were extracted independently by the two groups. The estimated frequency of abutment tooth loss was calculated from data on the number of lost teeth and exposure time. A meta-analysis was conducted to estimate the annual frequency of abutment tooth loss across all included studies.

RESULTS

A total of 4791 eligible studies from PubMed, Embase, and CENTRAL. An additional 316 articles were identified from the Ichushi-Web plus another 131 articles from additional sources. From those manuscripts, 19 reported relevant outcome data that was then extracted. The pooled data included a total of 1954 abutment teeth with a combined total exposure time of 9098 years. The estimated linear rate of loss was 1.76 %/year (95 %CI 1.13; 2.72). Caries and periodontal infections were identified as the most common reasons for abutment tooth loss.

CONCLUSIONS

Natural tooth retained overdentures often constitute the last resort before edentulism and might aid in this transition, especially in very old patients with reduced adaptive capacities. Given correct design, preparation and aftercare, RODs with cast copings, still are a valid treatment option in partially edentulous patients.

Reinforcement in removable prosthodontics: a literature review

Removable prosthodontics are often associated with mechanical troubles in daily use, such as fracture or deformation. These troubles render prostheses unusable and reduce wearers' QOL. Various reinforcements are used to prevent such problems, but consensus on reinforcement has not been reached. This review aimed to summarise the effects of reinforcement and to propose favourable reinforcement based on material, design and position in the prostheses. Initially, 139 articles were selected by electronic and manual searches. After exclusion of 99 articles based on the exclusion criteria, 40 articles were finally included in the review. Electronic searches were performed for articles published from 2005 to 2015 in PubMed, EMBASE, MEDLINE and Cochrane Library, and manual searches were performed in 10 journals relevant to the topic of removable prosthodontics. For in vitro studies, certain dental alloys and fibres were mainly used. Their forms were different, including complicated forms in dental alloys and various forms in fibres. The materials were examined for mechanical properties like fracture strength, flexural strength and elastic modulus and compared with one another or without reinforcement. There were a few clinical studies and one longitudinal study. Cast metal reinforcement seemed to be most favourable in terms of fracture toughness and stiffness. The most favourable forms differed depending on the prostheses, but placement around thin and deformable areas was effective. However, randomised or longitudinal clinical reports and comparative clinical studies on the use of reinforcement were still lacking and such studies are necessary in the future.

Corrosion behaviours of the dental magnetic keeper complexes made by different alloys and methods

The keeper and cast dowel–coping, as a primary component for a magnetic attachment, is easily subjected to corrosion in a wet environment, such as the oral cavity, which contains electrolyte-rich saliva, complex microflora and chewing behaviour and so on. The objective of this in vitro study was to examine the corrosion resistance of a dowel and coping-keeper complex fabricated by finish keeper and three alloys (cobalt–chromium, CoCr; silver–palladium–gold, PdAu; gold–platinum, AuPt) using a laser-welding process and a casting technique. The surface morphology characteristics and microstructures of the samples were examined by means of metallographic microscope and scanning electron microscope (SEM). Energy-dispersive spectroscopy (EDS) with SEM provided elements analysis information for the test samples after 10% oxalic acid solution etching test. Tafel polarization curve recordings demonstrated parameter values indicating corrosion of the samples when subjected to electrochemical testing. This study has suggested that massive oxides are attached to the surface of the CoCr–keeper complex but not to the AuPt–keeper complex. Only the keeper area of cast CoCr–keeper complex displayed obvious intergranular corrosion and changes in the Fe and Co elements. Both cast and laser-welded AuPt–keeper complexes had the highest free corrosion potential, followed by the PdAu–keeper complex. We concluded that although the corrosion resistance of the CoCr–keeper complex was worst, the keeper surface passive film was actually preserved to its maximum extent. The laser-welded CoCr– and PdAu–keeper complexes possessed superior corrosion resistance as compared with their cast specimens, but no significant difference was found between the cast and laser-welded AuPt–keeper complexes. The Fe-poor and Cr-rich band, appearing on the edge of the keeper when casting, has been proven to be a corrosion-prone area.

Fixation of magnet assembly to denture base using alternative resins

The fixation strengths between conventional/modified magnetic assemblies and denture base resins were evaluated using six alternative resins. Magnetic assemblies with three different undercut wings were prepared. Soft lining materials with added PMMA resin polymer, two photopolymerization denture relining resins, an experimental resin, and a temporary filling resin were used to fix the magnetic assemblies to the denture bases. As a control, a commercially available magnetic assembly without undercut wings and a conventional autopolymerized resin were also prepared. After surface treatments, the magnetic assemblies were fixed using fixation resins, and tensile strengths and attractive forces were measured using an autography. The experimental resin and the temporary filling resin showed retentive forces comparable to those of conventional autopolymerized resins. Although the experimental resin demonstrated satisfactory fixation strengths, it should be necessary to improve its mechanical strength. The temporary filling resin could be used as a permanent fixation material.

Clinical performance and satisfaction of removable prostheses with self-adjusting magnetic attachments

STATEMENT OF PROBLEM

Conventional magnetic attachments have rigid assemblies and are unable to compensate for the movement of the prosthesis under function, which may result in the deepening of periodontal pockets and an increase in the mobility of abutment teeth.

PURPOSE

The purpose of this study was to evaluate the clinical performance and satisfaction of participants with removable prostheses with self-adjusting magnetic attachments that allow vertical and rotational movement.

MATERIAL AND METHODS

The clinical performance of 17 prostheses with 22 self-adjusting magnetic attachments in 16 participants was analyzed for a mean of 3.1 years. Periodontal indices, including probing pocket depth and tooth mobility, were measured at denture placement (baseline) and from 0.5 to 5 years after insertion. Control data were obtained from the remaining teeth, which were restored by resin or metal coping. Prosthetic parameters, including the reduction of retention in self-adjusting magnetic attachments, reline, or fracture of dentures, were also recorded. A visual analog scale questionnaire on participant satisfaction with stability, comfort, and cleaning of the prostheses was completed. The Wilcoxon signed rank test and 1-way analysis of variance (α=.05) were performed on data collected at the time of prostheses placement and final follow-up evaluation.

RESULTS

No significant differences were found in terms of probing pocket depth and tooth mobility between the baseline and postinsertion data for self-adjusting magnetic attachments and control teeth. Retention in all prostheses was stable, without reduction. Higher visual analog scale scores for "easy cleaning" were noted.

CONCLUSIONS

No significant difference between baseline and postinsertion was noted regarding the periodontal condition of self-adjusting magnetic attachments and control teeth with resin or metal coping materials.