Biomechanical Evaluation of Anterior Implant-Supported Fixed Bridges Combined with Distal-Extension Removable Partial Dentures

Tuzlalı, Mesut; Gül Aygün, Esma Başak; Kocacıklı, Mustafa; Şiriner Gümüş, Hilal; Baki, Nagehan

doi:10.15517/w62v5456

Authors

Mesut Tuzlalı Asst. Prof., Inonu University, Faculty of Dentistry, Department of Prosthodontics, Malatya/Türkiye. Author https://orcid.org/0000-0002-7602-8101
Esma Başak Gül Aygün Assoc. Prof., Çukurova University, Faculty of Dentistry, Department of Prosthodontics, Adana/Türkiye. Author https://orcid.org/0000-0002-9475-4035
Mustafa Kocacıklı Assoc. Prof., GaziUniversity, Faculty of Dentistry, Department of Prosthodontics, Ankara/Türkiye. Author https://orcid.org/0000-0002-2417-588X
Hilal Şiriner Gümüş Asst. Prof., Private Clinic, İstanbul/Türkiye. Author https://orcid.org/0000-0001-6690-7463
Nagehan Baki Asst. Prof., Inonu University, Faculty of Dentistry, Department of Prosthodontics, Malatya/Türkiye. Author https://orcid.org/0000-0002-3221-4543

DOI:

https://doi.org/10.15517/w62v5456

Keywords:

Dental implants; Clasp; Precision attachment; Bar; Locator®; Removable partial denture; Finite element analysis.

Abstract

This study compared the biomechanical performance of anterior two implant-supported fixed prostheses combined with distal-extension removable partial dentures (DERPDs) classified as Mandibular Kennedy Class I, incorporating metal clasps and extracoronal precision attachments, against conventional Locator®- and bar-attached implant overdenture prostheses under vertical and oblique bilateral posterior biting forces using three-dimensional finite element analysis. Four prosthetic designs with different retention systems were analyzed: an overdenture with a Locator® attachment, an overdenture with a bar attachment, an anterior implant-supported fixed bridge retaining a removable partial denture with clasp retention, and an anterior implant-supported fixed bridge retaining a removable partial denture with a precision attachment. Stress values and distributions were compared among the models using three-dimensional (3D) finite element analysis (FEA). Clasp attachments exhibited the lowest stress concentrations, while precision attachments showed the highest stress values. Overdentures with bar attachments demonstrated higher stress concentrations compared to Locator® attachments. Clasp-type attachments induced less stress on implants and peri-implant tissues while causing greater posterior tissue stress compared to extracoronal precision attachments in DERPDs. It can be considered a viable treatment for patients seeking an anterior implant-supported fixed bridge for esthetic and psychological reasons, and this can increase the patient's self-confidence.

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References

McGarry T.J., Nimmo A., Skiba J.F., Ahlstrom R.H., Smith C.R., Koumjian J.H., Arbree N.S. Classification system for partial edentulism. J Prosthodont. 2002; 11 (3): 181-93.

Sarka R.J. Complete dentures: are they out of phase with current therapy?. Compendium of Continuing Education in Dentistry (Jamesburg, NJ: 1995). 1996 Oct 1;17 (10): 940-2.

Carlsson G.E., Omar R. The future of complete dentures in oral rehabilitation. A critical review. Journal of oral rehabilitation. 2010; 37 (2): 143-56.

Jeganathan S., Ja P. Common faults in complete dentures: a review. Quintessence international. 1993; 24 (7): 483-7.

Massad J.J. A metal-based denture with soft liner to accommodate the severely resorbed mandibular alveolar ridge. The Journal of prosthetic dentistry. 1987; 57 (6): 707-11.

Singh D.R.K., Patil D.N.K., Datta D.A., Pattedar D.A., Billesh D.N.K. Impression techniques for management of flabby ridges in complete denture patients: A review of literature. International Journal of Applied Dental Sciences. 2022.

Higuchi K., Davó R., Liddelow G., Albanese M., Riveros N., Baden S., Rosenberg R. An adaptive prefabricated full-arch framework on three implants in the mandible: preliminary results. Clin Oral Implants Res. 2017; 28: 169.

Brånemark P.I., Engstrand P., Ohrnell L.O., Gröndahl K., Nilsson P., Hagberg K., et al. Brånemark Novum: a new treatment concept for rehabilitation of the edentulous mandible. Preliminary results from a prospective clinical follow-up study. Clin Implant Dent Relat Res. 1999; 1 (1): 2-16.

Maló P., Rangert B., Nobre M. "All-on-Four" immediate-function concept with Brånemark System implants for completely edentulous mandibles: a retrospective clinical study. Clin Implant Dent Relat Res. 2003; 5 Suppl 1:2-9.

Cordioli G., Majzoub Z., Castagna S. Mandibular overdentures anchored to single implants: A five-year prospective study. Journal of Prosthetic Dentistry. 1997; 78 (2): 159-65.

Thomason J.M. The McGill Consensus Statement on Overdentures. Mandibular 2-implant overdentures as first choice standard of care for edentulous patients. Eur J Prosthodont Restor Dent. 2002; 10 (3): 95-6.

Na H.-J., Kang D.-W., Son M.-K., editors. Distal-Extension Removable Partial Denture with Anterior Implant Prostheses: Case Report 2011.

Zitzmann N.U., Marinello C.P., Zitzmann N.U., Marinello C.P. Treatment plan for restoring the edentulous maxilla with implant-supported restorations: Removable overdenture versus fixed partial denture design. The Journal of Prosthetic Dentistry. 1999; 82 (2): 188-96.

Chronopoulos V., Sarafianou A., Kourtis S. The use of dental implants in combination with removable partial dentures: a case report. J Esthet Restor Dent. 2008; 20 (6): 355-64; discussion 65.

Giffin K.M. Solving the distal extension removable partial denture base movement dilemma: A clinical report. The Journal of Prosthetic Dentistry. 1996; 76 (4): 347-9.

Keltjens H.M., Kayser A.F., Hertel R., Battistuzzi P.G. Distal extension removable partial dentures supported by implants and residual teeth: considerations and case reports. Int J Oral Maxillofac Implants. 1993; 8 (2): 208-13.

Ganz S.D. Combination natural tooth and implant-borne removable partial denture: a clinical report. J Prosthet Dent. 1991; 66 (1): 1-5.

Battistuzzi P.G., van Slooten H., Kayser A.F. Management of an anterior defect with a removable partial denture supported by implants and residual teeth: a case report. Int J Oral Maxillofac Implants. 1992; 7 (1): 112-5.

George M.A. Removable partial denture design assisted by osseointegrated implants. J Calif Dent Assoc. 1992; 20 (1): 64-6.

Jang Y., Emtiaz S., Tarnow D.P. Single implant-supported crown used as an abutment for a removable cast partial denture: a case report. Implant Dent. 1998; 7 (3): 199-204.

Pellecchia M., Pellecchia R., Emtiaz S. Distal extension mandibular removable partial denture connected to an anterior fixed implant-supported prosthesis: A clinical report. Journal of Prosthetic Dentistry. 2000; 83 (6): 607-12.

Pinkerton M.D., Gargiulo A.V. An implant fixed bridge as replacement for a removable partial denture. CDS Rev. 1994; 87 (9): 17-20.

Budtz-Jørgensen E., Bochet G., Grundman M., Borgis S. Aesthetic considerations for the treatment of partially edentulous patients with removable dentures. Pract Periodontics Aesthet Dent. 2000; 12 (8):7 65-72; quiz 74.

de Carvalho W.R., Barboza E.P., Caúla A.L. Implant-retained removable prosthesis with ball attachments in partially edentulous maxilla. Implant Dent. 2001;10 (4): 280-4.

Halterman S.M., Rivers J.A., Keith J.D., Nelson D.R. Implant support for removable partial overdentures: a case report. Implant Dent. 1999; 8 (1): 74-8.

Kuzmanovic D.V., Payne A.G., Purton D.G. Distal implants to modify the Kennedy classification of a removable partial denture: a clinical report. J Prosthet Dent. 2004; 92 (1): 8-11.

McAndrew R. Prosthodontic rehabilitation with a swing-lock removable partial denture and a single osseointegrated implant: a clinical report. J Prosthet Dent. 2002; 88 (2): 128-31.

Mijiritsky E., Karas S. Removable partial denture design involving teeth and implants as an alternative to unsuccessful fixed implant therapy: a case report. Implant Dent. 2004; 13 (3): 218-22.

Mitrani R., Brudvik J.S., Phillips K.M. Posterior implants for distal extension removable prostheses: a retrospective study. Int J Periodontics Restorative Dent. 2003; 23 (4): 353-9.

Starr N.L. The distal extension case: an alternative restorative design for implant prosthetics. Int J Periodontics Restorative Dent. 2001; 21 (1): 61-7.

Uludag B., Celik G. Fabrication of a maxillary implant-supported removable partial denture: a clinical report. J Prosthet Dent. 2006; 95 (1): 19-21.

Gwon B., Jeon Y.-C., Jeong C.-M., Yun M.-J., Lee S.-H., Huh J.-B. Distal-extension removable partial denture with anterior implant supported fixed prostheses in a maxillary edentulous patient: Case report. The Journal of Korean Academy of Prosthodontics. 2018; 56: 375-83.

Kim S.M., Jeon Y.-C., Jeong C.-M., Yun M.-J., Huh J.-B. Esthetic removable partial denture with implants and resin clasp: Case report. The Journal of Korean Academy of Prosthodontics. 2015; 53: 58-65.

Bural C., Buzbas B., Ozatik S., Bayraktar G., Emes Y. Distal extension mandibular removable partial denture with implant support. Eur J Dent. 2016; 10 (4): 566-70.

Pellecchia M., Pellecchia R., Emtiaz S. Distal extension mandibular removable partial denture connected to an anterior fixed implant-supported prosthesis: a clinical report. J Prosthet Dent. 2000; 83 (6): 607-12.

Bae E.B., Kim S.J., Choi J.W., Jeon Y.C., Jeong C.M., Yun M.J., et al. A Clinical Retrospective Study of Distal Extension Removable Partial Denture with Implant Surveyed Bridge or Stud Type Attachment. Biomed Res Int. 2017; 2017: 7140870.

Zavanelli R., Mazaro J., Guilherme A., Magalhaes J., Cardoso L., Zavanelli A. Distal Extension Removable Partial Denture with Resilient Attachment Connected to an Anterior Fixed Implant-Supported Prosthesis: A Clinical Report. World Journal of Dentistry. 2012; 3: 87-90.

Ozel G.S., Ozyilmaz O.Y., Inan O. Stress Analysis of Implant-Supported Removable Partial Denture with Anterior Fixed Prostheses and Conventional Implant-Supported Overdentures in the Edentulous Mandible. Journal of Advanced Oral Research. 2022; 13 (1): 43-52.

Zarb G.A., Zarb F.L. Tissue integrated dental prostheses. Quintessence Int. 1985; 16 (1): 39-42.

Chee W.W.L., Jivraj S. Treatment planning of the edentulous mandible. British Dental Journal. 2006; 201: 337-47.

Celik G., Uludag B. Photoelastic stress analysis of various retention mechanisms on 3-implant-retained mandibular overdentures. The Journal of Prosthetic Dentistry. 2007; 97 (4): 229-35.

Padma S., Umesh S., Asokan S., Srinivas T. Bite force measurement based on fiber Bragg grating sensor. J Biomed Opt. 2017; 22 (10): 1-6.

Papavasiliou G., Kamposiora P., Bayne S.C., Felton D.A. 3D-FEA of osseointegration percentages and patterns on implant-bone interfacial stresses. Journal of Dentistry. 1997; 25 (6): 485-91.

Petropoulos V.C., Smith W., Kousvelari E. Comparison of retention and release periods for implant overdenture attachments. Int J Oral Maxillofac Implants. 1997; 12 (2): 176-85.

Pellizzer E.P., Verri F.R., Falcón-Antenucci R.M., Goiato M.C., Gennari Filho H. Evaluation of different retention systems on a distal extension removable partial denture associated with an osseointegrated implant. J Craniofac Surg. 2010; 21 (3): 727-34.

Sato Y., Tsuga K., Abe Y., Asahara S., Akagawa Y. Finite element analysis on preferable I-bar clasp shape. Journal of Oral Rehabilitation. 2001; 28 (5): 413-7.

Judy H.J.A. Studying the effect of the circumferential clasp arm design on stress distribution using three-dimensional finite element analysis. Mustansiria Dental Journal. 2018; 6 (1): 55-60.

Idzior-Haufa M., Pilarska A.A., Hȩdzelek W., Boniecki P., Pilarski K., Dorocka-Bobkowska B. A Comparison of Biomechanical Properties of Implant-Retained Overdenture Based on Precision Attachment Type. Materials. 2021;14.

El-Anwar M.I., Yousief S.A., Soliman T.A., Saleh M.M., Omar W.S. A finite element study on stress distribution of two different attachment designs under implant supported overdenture. Saudi Dent J. 2015; 27 (4): 201-7.

Rismanchian M., Dakhilalian M., Bajoghli F., Ghasemi E., Sadr-eshkevari P. Implant-retained mandibular bar-supported overlay dentures: a finite element stress analysis of four different bar heights. The Journal of oral implantology. 2012; 38 (2):133-9.

Pellizzer E.P., Verri F.R., Falcón-Antenucci R.M., Goiato M.C., Filho H.G. Evaluation of Different Retention Systems on a Distal Extension Removable Partial Denture Associated With an Osseointegrated Implant. Journal of Craniofacial Surgery. 2010; 21 (3).

Chronopoulos V., Sarafianou A., Kourtis S. The use of dental implants in combination with removable partial dentures. A case report. Journal of Esthetic and Restorative Dentistry. 2008 Dec; 20 (6): 355-64.

Teixeira F.M., de Assis Claro C.A., Neves A.C.C., de Mello Rode S., da Silva-Concílio L.R. Influence of Loading and Use of Occlusal Splint in Implant-Supported Fixed Prostheses. Journal of Craniofacial Surgery. 2012; 23: e477-e80.

Ozel G.S., Ozyilmaz O.Y., Inan O. Stress Analysis of Implant-Supported Removable Partial Denture with Anterior Fixed Prostheses and Conventional Implant-Supported Overdentures in the Edentulous Mandible. Journal of Advanced Oral Research. 2020;13: 43-52.

Mahshid M., Geramy A., Ejlali M., Sedaghat Monfared M., Rezvani Habib Abadi S. Effect of the Number of Implants on Stress Distribution of Anterior Implant-Supported Fixed Prostheses Combined with a Removable Partial Denture: A Finite Element Analysis. Journal of Dentistry (Tehran, Iran). 2014; 11: 335-42.

Della Bona Á., Borba M., Benetti P., Duan Y., Griggs J.A. Three-dimensional finite element modelling of all-ceramic restorations based on micro-CT. Journal of Dentistry. 2013; 41 (5): 412-9.

Ceddia M., Lamberti L., Trentadue B. FEA Comparison of the Mechanical Behavior of Three Dental Crown Materials: Enamel, Ceramic, and Zirconia. Materials (Basel). 2024; 17 (3).

Falcinelli C., Valente F., Vasta M., Traini T. Finite element analysis in implant dentistry: State of the art and future directions. Dental Materials. 2023 Jun 1; 39 (6): 539-56.

Taylor M., Prendergast P.J. Four decades of finite element analysis of orthopaedic devices: where are we now and what are the opportunities? Journal of biomechanics. 2015;48 (5): 767-78.

Trivedi S. Finite element analysis: A boon to dentistry. Journal of oral biology and craniofacial research. 2014; 4 (3): 200-3.