A Clinical Comparison of ProstheticComplications of Implant-Supported

Overdentures With DifferentAttachment Systems

Cuneyt Karabuda, PhD,* Mehmet Yaltırık, PhD,† and Mehmet Bayraktar, PhD‡

Most industrialized countriesare experiencing a rapid de-cline in tooth loss. However,

tooth loss increases with age, so thatthe number of edentulous peoplewithin these societies will continue toincrease for several decades becauseof the increase in mean age.1 One ofthe main challenges faced by dentistshas been the ability to replace missingteeth to the satisfaction of their pa-tients. The problem of missing teeth iscompounded when all teeth are losteither to disease or simply old age.2

Complete maxillary and mandibulardentures have been the traditional stan-dard of care for edentulous patients formore than a century. Complete denturewearers are usually able to wear an up-per denture without problems, but maystruggle to eat with a complete lowerdenture because it is too mobile.1

Many of the problems reported byconventional complete denture wearerscan be eliminated when implants areused to support fixed prostheses or re-movable overdentures.3 Overdenturesare basically dentures that are placedover any existing teeth or even toothroots that have the advantage of beingintegrated into the bone.2 A number ofreported longitudinal studies confirmthe effectiveness of this treatment in the

mandible,4,5 even in patients with severealveolar bone loss,6 but results in themaxilla have been mixed.7,8

It has already been establishedthrough longitudinal clinical studies,structured reviews, and consensusconferences, that the survival of rootform titanium implants is very high inthe anterior mandible and that the in-cidence of surgical complications isvery low. Furthermore, it has beenshown that implants reduce the rate ofresorption of the residual ridge in theanterior mandible.1 An implant overden-ture provides stability of the prosthesis,and patients are able to reproduce a de-termined centric occlusion.9

The chewing efficiency with anoverdenture is improved by 20% whencompared with a complete denture.10

The maximum occlusal force of a den-ture patient may improve 300% withan implant-supported prosthesis.11

Atrophy of the edentulous maxillalimits the opportunities for implantplacement, and because of fine anddelicate trabecular bone with a thin oreven absent cortical plate, it is consid-ered unpredictable for stabilizing andsupporting dental implants.12 Closeproximity of the maxillary sinus mayfurther complicate maxillary implanttreatment in the posterior region, andextensive reconstructive proceduresare often needed before implant place-ment.13 In these situations, inserting 4implants in the anterior region of max-illa and fabricating an implant-supportedoverdenture may be a good treatmentoption.

*Associate Professor, Department of Oral Implantology,Faculty of Dentistry, Istanbul University, Istanbul, Turkey.†Associate Professor, Department of Oral Surgery, Faculty ofDentistry, Istanbul University, Istanbul, Turkey.‡Research Assistant, Department of Oral Implantology, Facultyof Dentistry, Istanbul University, Istanbul, Turkey.

ISSN 1056-6163/08/01701-074Implant DentistryVolume 17 • Number 1Copyright © 2008 by Lippincott Williams & Wilkins

DOI: 10.1097/ID.0b013e318166d88b

Objectives: The objective of thisclinical study was to evaluate theprosthetic complications of patientswith 2 to 4 implants splinted with around bar or with 2 to 4 unsplintedimplants with ball attachments dur-ing the follow-up period.

Methods: A total of 26 patientswere included in this study. Patientswere randomly provided with a roundbar or with ball attachments that wereused to retain overdentures. Duringfollow-up visits, the following pros-thetic complications were recorded:round bar fracture, fractured overden-ture, hygiene complications, abutmentscrew loose, worn O-ring or replace-ment of O-ring attachment, and frac-tured retention clip. The functioning

period of overdentures in the roundbar group ranged from 12 to 72months (mean 49), and from 12 to 40months (mean 23) in the ball attach-ment group.

Results: A total of 20 prostheticcomplications were recorded in bothgroups. No differences in prostheticcomplications were observed for 2 at-tachment systems.

Conclusion: Implant-supportedoverdentures with bar or ball attach-ments may be considered to be reli-able methods in the treatment of theedentulous individuals. (Implant Dent2008;17:74–81)Key Words: dental implants, over-denture, bar attachment, ball attach-ment, prosthetic complications

74 CLINICAL COMPARISON OF PROSTHETIC COMPLICATIONS OF IMPLANT-SUPPORTED OVERDENTURES

Ball and bar attachments are 2 mainsystems for retention in implant-supported overdentures. There are veryfew comparative studies regarding theirclinical outcomes and the possible com-plications of these 2 different attachmentsystems.14

The objective of this clinical studywas to evaluate the prosthetic compli-cations of the patients with 2 to 4implants splinted with round bar orwith 2 to 4 unsplinted implants withball attachments.

MATERIALS AND METHODS

A total of 26 patients with eden-tulous mandibles and maxillae, whoreceived prosthetic treatments be-tween 1998 and 2005, were includedin this study. At the beginning of treat-ment, all patients had conventionaldentures. Preoperative clinical and ra-diographic examinations were carriedout and dental-medical conditionsevaluated. Patients with serious sys-temic diseases were excluded. Thepreoperative examination includedpanoramic radiographs and clinicalexamination for the assessment ofbone volume and shape. For selectionof arch shapes, preoperative modelswere used; according to Izards archshape classification patients were di-vided into 2 groups.15 Patients withU-shaped arches had 2 implants andpatients with V-shaped arches re-ceived 4 implants in their mouth. Im-plants were placed according to themanufacturer’s surgical protocol. Atotal of 78 implants were placed (Ta-ble 1). Two failures occurred in thehealing period. In this case, the areaswere regrafted and implants placed af-ter 3 months of healing. The implantsystem was chosen randomly, but eachpatient received only 1 system. After 2to 4 months of healing, all patientsreceived implant-supported overden-ture prostheses. Patients were ran-domly provided with a round bar orwith ball attachments, which wereused to retain overdentures. Theround-bar group consisted of 10 pa-tients (3 men, 7 women), ranging inage from 48 to 79 years (mean 59years), having 38 implants. The ball-attachment group consisted of 16 pa-tients (6 men, 10 women), ranging in

age from 44 to 66 years (mean 54years), having 40 implants.

A bilaterally balanced occlusionconcept was applied to all overden-tures. The occlusion was controlled toprevent discrepancies. The patientswere recalled for clinical examinationsat 3, 6, and 12 months and annuallythereafter. The functioning period ofoverdentures in the round bar groupranged from 12 to 72 months (mean49), and from 12 to 40 months (mean23) in the ball-attachment group. Dur-ing follow-up visits, the followingprosthetic complications were re-corded: round bar fracture, fracturedoverdenture, hygiene complications,abutment screw loose, worn O-ring orreplacement of O-ring attachment, andfractured retention clip.

RESULTS

The healing period was completedwithout any complication, except for 2implants in one case. In this case, im-plants were explanted and the areas

were regrafted. After 3 months ofhealing, 2 implants were placed. Afterthe healing period, all implants wereloaded. Patient satisfaction was foundto be similar with both retentive sys-tems. All patients in both groups weremore comfortable after treatment thanbefore. Phonetic problems that wereinitially seen disappeared after a shortadaptation period. One of the patientsin the ball-attachment group wanted tohave a fixed prosthesis because ofdissatisfaction with the treatment.Prosthetic complications occurredduring the follow-up period are givenin Table 2. Most of the prostheticcomplications were related to the de-formation of ball sockets and retentionof ball clips in the ball-attachmentgroup. In the bar-attachment group,because of the difficulties in cleaningthe peri-implanter zone, perimucositiswere detected in some of the cases andby periodic follow-ups there was aslight decrease in hygiene problemsafter a year in function.

Table 1. Characteristics of Study Population

Patient Gender Age (y)Follow-Up

(mo) SystemNo.

ImplantType of

Attachment

1 Male 59 17 Camlog 4 Ball2 Female 68 44 ITI 2 Ball3 Male 60 12 ITI 2 Ball4 Female 58 24 ITI 2 Ball5 Female 59 10 ITI 2 Ball6 Female 62 60 MIS 2 Bar7 Male 53 17 MIS 2 Bar8 Female 65 65 MIS 2 Bar9 Male 64 24 Frialit 4 Bar

4 Bar10 Female 74 28 ITI 2 Ball11 Male 43 8 ITI 4 Bar

4 Ball12 Female 55 75 Frialit 2 Bar13 Male 59 14 ITI 2 Ball14 Female 47 52 Camlog 2 Ball15 Male 70 32 Camlog 2 Ball16 Male 64 72 Frialit 4 Ball17 Female 50 17 Mis 2 Bar18 Male 64 38 ITI 2 Ball19 Female 65 27 Camlog 2 Ball20 Female 58 10 Camlog 4 Bar21 Female 60 49 ITI 2 Ball22 Female 62 39 ITI 2 Ball23 Male 53 40 ITI 4 Ball24 Male 55 44 ITI 2 Bar25 Female 62 27 ITI 4 Bar26 Female 69 25 ITI 2 Ball

4 BarCamlog—ALTATEC GmbH, Wimsheim, Germany; MIS—Medical Implant System, Shlomi, Israel; ITI—Institut Straumann AG,Switzerland; Frialit-2—Dentsply Friadent Ceramed, Germany.

IMPLANT DENTISTRY / VOLUME 17, NUMBER 1 2008 75

DISCUSSION

The oral rehabilitation of edentu-lous patients with mild to severe resid-ual ridge resorption has been greatlyimproved because of implant dentistry.Since the middle of the 1980s, implant-supported overdentures have become arapidly expanding and a successfultreatment alternative in the rehabilitationof complete edentulism because of sim-ple laboratory procedures and cost ef-fectiveness.14 Ball attachments and barattachments are 2 main retainer systemsfor implant-supported overdentures, butvery few studies have compared theirclinical outcomes and prosthetic compli-cations that occurred during thefollow-up period.16,17

Timmerman et al reported an 8-yearrandomized controlled trial wherein 3groups of edentulous participants withatrophic mandibles wore 3 types of im-plant overdentures. One group receivedan implant-retained overdenture on 2implants with ball attachments (group1); 1 group received an implant-receivedoverdenture on 2 implants with a singlebar (group 2); and the final group worean implant-retained overdenture on 4implants with a triple bar (group 3).Forty-six-item questionnaire was com-pleted in 19 months and 8 years afterdelivery of the prosthesis.18 This studyshows that having more than 2 implantsdoes not lead to a more satisfied indi-vidual in terms of retention and comfortand social function. The results of thisstudy suggest that a mandibular over-denture retained by 2 implants intercon-nected with a single bar might be anadequate treatment option with provenstability in the long term.

In a prospective study of Payneand Solomons, they evaluated the hy-pothesis that mandibular implant-supported overdentures using more

than 2 implants splinted with multipleround bars would need unnecessaryprosthodontic maintenance. Fifty-nineconsecutive completely edentulouspatients had implants placed in theanterior mandible, and were dividedinto 3 design groups as follows: 2 im-plants to receive an unsplinted over-denture design (design 1), 2 implantsto receive a splinted overdenture de-sign using 1 round bar (design 2), and3 or 4 implants to receive a splintedoverdenture splinted with 2 or 3 roundbars (design 3).19 They suggested thatthe quantity of prosthodontic mainte-nance in design 3 would be greater thanthat in designs 1 and 2, but it did notoccur.19 And the prospective results in-dicate that 3 to 4 implant-supportedmultiple round bar overdentures maysuccessfully be used in edentulous pa-tients. There was no significant differ-ence in retentive clip activation orretentive clip fractures among 3 designtypes.19

Other study groups compared pa-tient satisfaction in groups of patientswith either bar- or ball-attachment andfound a comparable level of patientsatisfaction among their groups.20,21

Naert et al reported on patient sat-isfaction after 5 years among 3 groupsof patients who received bar-clip, ball-attachment, or magnet attachments.Although patients in the magnet groupstated that they would have preferred amore retentive attachment system, pa-tient satisfaction among the groupswas in the middle.22

Other aspects should also be con-sidered. Short-term results indicate thatball- and bar-retained overdentures on 2implants result in better maximum biteforce, chewing efficiency, clinical per-formance, maintenance, and repair re-

quirements than a complete traditionaldenture.23,24

In a comparative 5-year study,Gotfredsen and Holm evaluated peri-implant conditions and maintenancerequirements, and found 100% survivalrate for 2 implants bar- and ball-retainedoverdentures. They found no differencein bone loss or health of mucosa butmore technical complications and re-pairs in overdentures with bar attach-ments than ball attachments.25

van Kampen et al showed thatfunctional maintenance complicationsrelated to the attachments were ob-served in magnet and ball-attachmentonly during 3-month evaluation period,and the bar-clip attachment showed nomaintenance problem. They concludedthat variation in the necessary amount ofmaintenance with respect to ball attach-ment is largely caused by a variation incharacteristics of the ball abutments andmatrixs that are used.26

According to the present study,most of the patients were more comfort-able after treatment than before treat-ment, and all of them reported that theirfunctional, phonetic, and chewing abili-ties improved. And we found no differ-ence in prosthetic complications andrepairs among both groups. The maincomplications in the bar-attachmentgroup were hygiene complications be-cause of narrow space between bar andmucosa. According to our patients in thebar-attachment group, it is very difficultto clean the periabutment zone. But aftera year in function, they developed theircleaning skills and such problems havedisappeared. In the ball-attachmentgroup, overdenture fracture and reten-tion loss were the major complications.Retention loss depends on variation ofthe implant systems. In our study, 4 dif-ferent implant systems were used and allsystems had different matrix and patrixcomponents. The type of attachmentsystem in the ball-attachment groupcould affect the retention loss and com-plications caused by retention matrix.Also, a lack of parallelism of implantscould create retention loss because ofwear in the matrix part. van Kampen etal26 observed that all retention compli-cations occurred in subjects where theimplants were not perfectly parallel toeach other. Overdenture fracture couldhave occurred because of the lack of

Table 2. Prosthetic Complications Recorded During Follow-Up Period

Complications

Number of Complications

Ball AttachmentGroup

Bar-AttachmentGroup

Round bar fracture — 2Fractured overdenture 3 1Hygiene complications 1 4Retention clip activation or

O-ring replacement4 —

Abutment screw fracture 1 2Fractured retention clip 2 —

76 CLINICAL COMPARISON OF PROSTHETIC COMPLICATIONS OF IMPLANT-SUPPORTED OVERDENTURES

parallelism of implants in the currentstudy.

It has been stated that implantsplanned for use with overdenturesmust be parallel to one another to ob-tain attachment retention and preventpremature wear or fatigue of the in-volved components.27 Many cliniciansassume that ball attachments cannot beused when implants are not parallel,and they will attempt to use angledabutments, flexible attachments, andbar-clip assemblies to compensate inthese kind of situations.17

CONCLUSION

There is a consensus that implant-supported overdenture should be thefirst choice of care for edentulous in-dividuals. Implant-supported overden-tures are effective in reducing a widerange of denture complaints. Patientsstrongly preferred implant-supportedoverdentures with bar- or ball-attachmentsystems over conventional complete den-tures. These 2 attachment systems makepatients feel more secure. Implant system,implant position, parallelism of implants,arch shape, initial costs, and costs for re-pair are main parameters for choosing thetype of attachment systems. Some of theseparameters can also cause prosthetic com-plications in long-term. Further studies arerequired to determine the influence ofthese parameters on prosthetic complica-tions of implant-supported overdenturesover longer follow-up periods.

Disclosure

The authors claim to have no finan-cial interest in any company or any ofthe products mentioned in this article.

REFERENCES

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A 15-year study of osseointegrated im-plants in the treatment of edentulous jaw.Int J Oral Surg. 1981;10:385-416.

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6. Geertman ME, Boerrigter EM, vanWaas MAJ, et al. Clinical aspects of a mul-ticenter clinical trial of implant-retainedmandibular overdentures in patients withseverely resorbed mandibles. J ProsthetDent. 1996;75:194-204.

7. Engquist B, Bergendal T, Kallus T, etal. A retrospective multicenter evaluation ofosseointegrated implants supporting over-dentures. Int J Oral Maxillofac Implants.1988;3:129-134.

8. Adell R, Eriksson B, Lekholm U, etal. A long-term follow-up study of os-seointegrated implants in the treatment oftotally edentulous jaws. Int J Oral Maxillo-fac Implants. 1990;5:347-359.

9. Tallgren A. The reduction in faceheight of edentulous and partially edentu-lous subjects during long-term denturewear: A longitudinal roentgenographiccephalometric study. Acta Odontol Scand.1966;24:195-239.

10. Rissin L, House JE, Manly RS, et al.Clinical comparison of masticatory perfor-mance and electromyographic activity ofpatients with complete dentures, overden-tures and natural teeth. J Prosthet Dent.1978;39:508-511.

11. Sposetti VJ, Gibbs CH, AldersonTH, et al. Bite force and muscle activity inoverdenture wearers before and after at-tachment placement. J Prosthet Dent.1986;55:265-273.

12. Jaffin RA, Berman CL. The exces-sive loss of Branemark fixtures in type IVbone: A 5-year analysis. J Periodontol.1991;62:2-4.

13. Ulm CW, Solar P, Gisellmann B, etal. The edentulous maxillary alveolar pro-cess in the region of the maxillary sinus: Astudy of physical dimension. Int J OralMaxillofac Surg. 1995;24:279-282.

14. Karabuda C, Tosun T, Ermis E, etal. Comparison of 2 retentive systems forimplant supported overdentures: Soft tis-sue management and evaluation of patientsatisfaction. J Periodontol. 2002;73:1067-1070.

15. Izard: Orthodontie, OrthopedieDento-Facial, Sa: 146, 1951.

16. Naert I, Quirynen M, Hooghe M, etal. A comparative prospective study ofsplinted and unsplinted Branemark im-plants in mandibular overdenture therapy:A preliminary report. J Prosthet Dent.1994;71:486-492.

17. Mericske-Stern RD, Zarb GA. Clin-ical protocol for treatment with implant-supported overdentures. In: Bolender CE,Zarb GA, Carlsson GE, eds. Boucher’s

Prosthodontic Treatment for EdentulousPatients. St. Louis: Mosby; 1997:527.

18. Timmerman R, Stoker GT, Wismei-jer D, et al. An eight-year follow-up to arandomized clinical trial of participant sat-isfaction with three types of mandibularimplant-retained overdentures. J DentRes. 2004;83:630-633.

19. Payne AGT, Solomons YF. Man-dibular implant-supported overdentures: Aprospective evaluation of the burden ofprosthodontic maintenance with 3 differ-ent attachment systems. Int J Prosth-odont. 2000;13:246-253.

20. Walton JN, MacEntee MI, Glick N.One-year prosthetic outcomes with im-plant overdentures: A randomized clinicaltrial. Int J Oral Maxillofac Implants. 2002;17:391-398.

21. Davis DM, Packer ME. Mandibularoverdentures stabilized by Astra Tech im-plants with either ball attachments ormagnets: 5-year results. Int J Prosthodont.1999;12:222-229.

22. Naert I, Gizani S, Vuylsteke M, et al.A 5-year prospective randomized clinicaltrial on the influence of splinted and un-splinted oral implants retaining a mandibu-lar overdenture: Prosthetic aspects andpatient satisfaction. J Oral Rehabil. 1999;26:195-202.

23. van Kampen FM, van der Bilt A,Cune MS, et al. The influence of variousattachment types in mandibular implant re-tained overdentures on maximum biteforce and EMG. J Dent Res. 2002;81:170-173.

24. van Kampen FM, van der Bilt A,Cune MS, et al. Masticatory function withimplant supported overdentures. J DentRes. 2004;83:708-711.

25. Gotfredsen K, Holm B. Implant-supported mandibular overdentures re-tained with ball or bar attachments: Arandomized prospective 5-year study. IntJ Prosthodont. 2000;13:125-130.

26. van Kampen FM, Cune MS, vander Bilt A, et al. Retention and postinsertionmaintenance of bar-clip, ball and magnetattachments in mandibular implant over-denture treatment: An in vivo comparisonafter 3 months of function. Clin Oral Im-plants Res. 2003;14:720-726.

27. Landa LS, Cho SC, Froum SJ, etal. A prospective 2-year clinical evaluationof overdentures attached to nonsplintedimplants utilizing ERA attachments. PractProced Aesthet Dent. 2001;13:151-156.

Reprint requests and correspondence to:Cuneyt Karabuda, PhDDepartment of Oral ImplantologyFaculty of DentistryIstanbul UniversityCapa, Istanbul, TurkeyPhone: 90-212-5323218Fax: 90-212-5323254E-mail: zcuneyt@istanbul.edu.tr

IMPLANT DENTISTRY / VOLUME 17, NUMBER 1 2008 77

Abstract Translations

GERMAN / DEUTSCHAUTOR(EN): Cuneyt Karabuda, PhD, Mehmet Yaltırık,PhD, Mehmet Bayraktar, PhD. Schriftverkehr: CuneytKarabuda, Universitat Istanbul, zahnmedizinische Fakultat,Abteilung fur Oralimplantologie, Capa,Ystanbul,TURKEI.Telefon: � 90 212 5323218, Fax: � 90 212. 5323254.e-Mail: zcuneyt@istanbul.edu.trEin klinischer Vergleich der prothetischen Komplikationenbei Implantatgestutzten Prothesenuberbauten unter Ver-wendung unterschiedlicher Stutzzahnsysteme

ZUSAMMENFASSUNG: Zielsetzungen: Die vorliegendeklinische Studie zielte darauf ab, die moglichen prothetischenKomplikationen bei Patienten mit 2 bis zu 4 mit Hilfe einerrunden Schiene gestutzten Implantaten bzw. mit 2 bis zu 4ungeschienten Implantaten mit Ballstutzanbringungen im Verlaufdes Nachsorgezeitraums. Methoden: Insgesamt 26 Patienten nah-men an der Studie teil. Nach dem Zufallsprinzip wurden diePatienten mit einer runden Schiene oder mit Ballstutzapparaturenausgestattet, die zum Halten der Deckprothese eingesetzt wur-den. Wahrend der Nachsorgetermine wurden die nachfolgendenprothetischen Komplikationen offenbar: Fraktur der Rund-schiene, gebrochene Deckprothese, hygienische Komplika-tionen, Lockerung der Stutzzahnschrauben, abgenutzter O-Ringoder Ersetzung der O-Ringbefestigung sowie gebrochener Halt-clip. Die Funktionsdauer der Deckprothesen bei der mit Rund-schiene ausgestatteten Gruppe belief sich auf 12 bis 72 Monatebei einem Durchschnitt von 23 Monaten sowie auf 12 bis zu 40Monate mit einer durchschnittlichen Dauer von 23 Monaten beider mit Ballbefestigung ausgestatteten Versuchsgruppe. Ergeb-nisse: In beiden Gruppen wurden insgesamt 20 prothetischeKomplikationen aufgezeichnet. Es wurden keine Unterschiedebezuglich der zwei unterschiedlichen Befestigungslosungen inBezug auf die prothetischen Komplikationen festgestellt.Schlussfolgerung: Implantatgestutzte Deckprothesen mitSchienen- oder Ballbefestigung konnen als verlassliche Metho-den bei der Behandlung zahnloser Patienten angesehen werden.

SCHLUSSELWORTER: Zahnimplantate, Deckprothese,Schienenbefestigung, Ballbefestigung, prothetischeKomplikationen

SPANISH / ESPAÑOLAUTOR(ES): Cuneyt Karabuda, PhD, Mehmet Yaltırık,PhD, Mehmet Bayraktar, PhD. Correspondencia a: CuneytKarabuda, Istanbul University, Faculty of Dentistry, Depart-ment of Oral Implantology Capa,Ystanbul,TURKEY. Tele-fono: � 90 212 5323218, Fax: � 90 212 5323254.zcuneyt@istanbul.edu.trUna comparacion clınica de las complicaciones prosteticasde sobredentaduras apoyadas con implantes con diferentessistemas de sujetacion

ABSTRACTO: Objetivos: El objetivo de este estudio clınicofue evaluar las complicaciones prosteticas de pacientes con2 a 4 implantes entablillados con una barra redonda o con 2 a4 implantes sin entablillar con accesorios de bolas durante elperıodo de seguimiento. Metodos: Se incluyeron un total de26 pacientes en este estudio. Los pacientes recibieron al azarun accesorio con barra redonda o con bolas que se usaronpara retener las sobredentaduras. Durante las visitas deseguimiento, se anotaron las siguientes complicaciones pro-steticas; fractura de la barra redonda, sobredentadura frac-turada, complicaciones higienicas, tornillos flojos del pilar,juntas toricas gastadas o reemplazo de la junta torica y trabade retencion fracturada. El perıodo de funcionamiento de lassobredentaduras en el grupo de la barra redonda vario entre12 a 72 meses (termino medio 49) y desde 12 a 40 meses(termino medio 23) en el grupo de la bola. Resultados: Seanotaron un total de 20 complicaciones prosteticas en ambosgrupos. No se notaron diferencias en las complicacionesprosteticas en los dos sistemas de sujetacion. Conclusion:Las sobredentaduras apoyadas con implantes con barras obolas podrıan ser consideradas metodos confiables en eltratamiento de los individuos edentulosos.

PALABRAS CLAVES: Implantes dentales, sobredentadura,accesorio de barra, accesorio de bola, complicacionesprosteticas

PORTUGUESE / PORTUGUÊSAUTOR(ES): Cuneyt Karabuda, PhD, Mehmet Yaltırık,PhD, Mehmet Bayraktar, PhD. Correspondencia para:Cuneyt Karabuda, Istanbul University, Faculty of Dentistry,Department of Oral Implantology Capa, Istanbul, TURQUIA.Telefone: � 90 212 5323218, Fax: � 90 212 5323254.e-Mail: zcuneyt@istanbul.edu.trComparacao clınica das complicacoes proteticas de sobre-dentaduras suportadas por implantes com sistemas de at-tachment diferentes

RESUMO: Objetivos: O objetivo deste estudo clınico eraavaliar as complicacoes proteticas de pacientes com 2–4implantes esplintados com uma barra redonda ou com 2–4implantes nao-esplintados com attachments em forma deesfera durante o perıodo de acompanhamento. Metodos: Umtotal de 26 pacientes neste estudo. Os pacientes receberamaleatoriamente uma barra redonda ou attachments em formade esfera que foram usados para reter as sobredentaduras.Durante visitas de acompanhamento, as seguintes compli-cacoes proteticas foram registradas: fratura da barra redonda,sobredentadura fraturada, complicacoes higienicas, afrouxa-mento do parafuso de suporte, O-ring gasto ou substituicaodo attachment do O-ring e grampo de retencao fraturado. Operıodo de funcionamento das sobredentaduras no grupo dabarra redonda foi de 12 a 72 meses (media 49) e de 12 a 40

78 CLINICAL COMPARISON OF PROSTHETIC COMPLICATIONS OF IMPLANT-SUPPORTED OVERDENTURES

meses (media 23) no grupo de attachment em forma deesfera. Resultados: Um total de 20 complicacoes proteticasfoi registrado em ambos os grupos. Nenhuma diferenca emcomplicacoes proteticas foi observada para dois sistemas deattachment. Conclusao: As sobredentaduras suportadas porimplante com attachments em forma de barra ou esferapodem ser consideradas como metodos confiaveis no trata-mento dos indivıduos desdentados.

PALAVRAS-CHAVE: Implantes dentarios, sobredentadura,attachment em forma de esfera, complicacoes proteticas

RUSSIAN /������: Cuneyt Karabuda, ������ ��������, Meh-met Yaltırık, ������ ��������, Mehmet Bayraktar, ���-��� ��������. ����� ��� ���������� : CuneytKarabuda, Istanbul University, Faculty of Dentistry, Depart-ment of Oral Implantology Capa, stanbul, TURKEY.������: � 90 212 5323218, ����: � 90 212 5323254.zcuneyt@istanbul.edu.tr���� ��� ����� �������� � ����� ����� ����� ��������, ����������� ����-�����, ������� ����� �������

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TURKISH / TURKCEYAZARLAR: Dr. Cuneyt Karabuda, Dr. Mehmet Yaltırık,Dr. Mehmet Bayraktar. Yazyþma icin: Cuneyt Karabuda,Ystanbul Universitesi, Diþ Hekimliði Fakultesi, Oral Ymplan-toloji Ana Bilim Daly, Capa, Ystanbul, TURKYYE. Telefon:� 212 5323218, Faks: � 212 5323254, E-posta:zcuneyt@istanbul.edu.trDeðiþik ataþman sistemli, implantla desteklenenoverdenture’lerde protez komplikasyonlarynyn klinikkarþylaþtyrmasy

OZET: Amac: Bu klinik calısmanın amacı, takip suresi boy-unca 2–4 adet implantı yuvarlak bar ile splintlenmis hasta-larla, 2–4 adet kuresel atasmanlı splintlenmemis implantıolan hastalarda protez komplikasyonlarını degerlendirmekti.Yontem: Bu calısmaya toplam 26 hasta dahil edildi. Hastalar,rasgele olarak overdenture’lerin destegi icin yuvarlak bar yada kuresel atasmanların kullanıldıgı gruplara ayrıldı. Takipziyaretlerinde su protez komplikasyonları kaydedildi: yu-varlak bar kırıgı, overdenture’de kırık, hijyen komplikasyon-ları, abutman vidasının gevsemesi, eskimis O-halkası veyaO-halka atasmanının yenilenmesi ve destek klipinin kırıgı.Yuvarlak bar grubunda overdenture’lerin fonksiyonel suresi12 ile 72 ay arasında (ortalama 49 ay) degisirken, kureselatasman grubunda bu sure 12 ile 40 ay (ortalama 23) arasındaidi. Bulgular: Her iki grupta toplam 20 protez komp-likasyonu kaydedildi. Iki atasman sistemi arasında protezkomplikasyonları acısından farklılık saptanmadı. Sonuc: Barya da kuresel atasmanlı implant ile desteklenenoverdenture’ler, dissiz bireylerin tedavisinde guvenilir yon-temler arasındadır.

ANAHTAR KELYMELER: Dental implantlar, overdenture,bar atasman, kuresel atasman, protez komplikasyonları

IMPLANT DENTISTRY / VOLUME 17, NUMBER 1 2008 79

JAPANESE /

CHINESE /

80 CLINICAL COMPARISON OF PROSTHETIC COMPLICATIONS OF IMPLANT-SUPPORTED OVERDENTURES

KOREAN /

IMPLANT DENTISTRY / VOLUME 17, NUMBER 1 2008 81