overdentures

2. DR DEEPA PM
IMPLANT SUPPORTED OVERDENTURES

3. CONTENTS
• Introduction
• Development of overdentures
• Indications and Contra-Indications
• Advantages and Disadvantages
• Prosthetic options in implant dentistry
• Treatment options for mandibular implant overdenture
• Mandibular Implant Site Selection
• Overdenture movement
• Treatment plan for completely edentulous maxilla

4. CONTENTS
• Overdenture attachment
• Mandibular Implant overdenture design and fabrication
• Step by step procedure for fabrication of implant supported
over denture
• Complications
• Maintenance
• Conclusion

5. Overdenture treatment is
a notion which precludes
the inevitability of
“floating plastic” in
edentulous mouths.
( George Zarb).
INTRODUCTION

6. Conventional denture
Extraction of badly
broken teeth Decreased support
Decreased Retention
Increase bone
resorption Absence of Proprioceptive
response

7. • For decades, natural teeth have
been retained in the mouths to
support/retain overdentures and
preserve bone.
• Overdentures supported by
implants have a higher probability
of success than overdentures
supported by the roots of natural
teeth (Mericske-Stern, 1994)

8. DEFINITION
• An overdenture is defined as a removable prosthesis that
covers the entire occlusal surface of a root or implant
( Harold W Preiskel).
• Any removable dental prosthesis that covers and rests on one
or more remaining natural teeth, the roots of natural teeth,
and/or dental implants; a dental prosthesis that covers and is
partially supported by natural teeth, natural tooth roots,
and/or dental implants (GPT-8).

9. DEVELOPMENT OF OVERDENTURES
• In 1856, Ledger described a prosthesis resembling an
overdenture. His restorations were referred to as “Plates
covering fangs”.
• In 1861 a conference held in Connecticut, increased the
awareness of the value of such roots in supporting a covering
denture.
• In 1888 Evans had described a method of using roots actually
to retain restorations.

10. • In 1896 Essig had prescribed a telescopic like coping. At the
same time Peeso also described a removable telescopic
prosthesis.
• In 1909 a great blow was delivered by William Hunter by way
of his “focal sepsis theory”.
• In 1976 Rothman stated that Hunter’s comments gave
dentistry a black eye.

11. PROSTHETIC OPTIONS IN IMPLANT DENTISTRY
Type Definition
FP-1 Fixed prosthesis; replaces only the crown, looks like a natural tooth.
FP-2 Fixed prosthesis; replaces the crown and a portion of the root; crown contour appears
normal in the occlusal half but is elongated or hypercontoured in the gingival half.
FP-3 Fixed prosthesis; replaces missing crown and gingival color and portion of the edentulous
site; prosthesis most often uses denture teeth and acrylic gingiva, but may be porcelain to
metal.
RP-4 Removable prosthesis; overdenture supported completely by implant.
RP-5 Removable prosthesis; overdenture supported by both soft tissue and implant.

12. INDICATIONS FOR IMPLANT SUPPORTEDOVERDENTURE TREATMENT
• Severe morphologic compromise of denture supporting
areas that significantly undermine denture retention.
• Poor oral muscular coordination
• Low tolerance of mucosal tissues
• Parafunctional habits leading to recurrent soreness
and instability of prosthesis.

13. • Unrealistic prosthodontic expectations .
• Active or hyperactive gag reflexes.

14. CONTRAINDICATIONS
•Recent myocardial infarction
• Valvular prosthesis
•Severe renal disorder
•Treatment-resistant diabetes
•Generalized secondary osteoporosis

15. •Chronic and severe alcoholism
•Treatment – resistant osteomalacia
•Radiotherapy in progress
•Severe hormone deficiency
•Drug addiction
•Heavy smoking habits

16. ADVANTAGES OF IMPLANT-SUPPORTED PROSTHESIS:
• Minimum anterior bone loss; prevents bone loss
• Improved esthetics
• Improved stability (reduces or eliminates prosthesis movement)
• Improved occlusion (reproducible centric relation occlusion)
• Decrease in soft tissue abrasions
• Improved chewing efficiency and force

17. • Improved retention
• Improved support
• Improved speech
• Reduced prosthesis size (eliminates palate flanges)
• Improved maxillofacial prosthesis

18. CONVENTIONAL DENTURES v/s IMPLANT OVERDENTURES
•Patient satisfaction increased when mandibular implant
overdentures were used instead of conventional complete dentures
(Burns, 1995;Boerrigter, 1995).
•Implant overdentures generally offer the advantages of improved
comfort, support, retention, and stability.
•Annual bone resorption is more pronounced in patients who wear
conventional complete dentures than implant overdentures
(Jacobs, 1993).

19. NATURALTOOTHOVERDENTURES v/s IMPLANT OVERDENTURES
Overdentures supported by implants have a higher probability of
success than mandibular overdentures supported by the roots of
natural teeth (Mericske-Stern, 1994).

20. IMPLANT OVERDENTURE V/S FIXED
PROSTHESIS
1. A smaller number of implants are required and that
decreases the cost.
(Johns, 1992; Cune, 1994).
2. It is possible to provide better support of the facial soft
tissues
(Johns,1992; Cune, 1994; Mericske-Stern, 1998).
3. There is improved phonetics for completely edentulous patients.
(Jemt,1992; Smedberg, 1993; Cune, 1994; Mericske-Stern, 1998).
4. Patients have enhanced access for oral hygiene .
(Johns, 1992; Mericske-Stern, 1998).
5. There is a better result when unfavorable jaw relationships are present
(Cune, 1994).
6. When there is an opposing complete denture, it will be more stable;
particularly when there is a resorbed residual ridge (Johns, 1992; Hutton,
1995).
7. It is easier to make modifications to the prosthesis base
(Mericske-Stern,1998).
8. There is better access for inspection of the surgical site when
surgically created oral defects are present
(Mericske-Stern, 1998).

21. DISADVANTAGES OF OVERDENTURES
• Does not satisfy the psychologic need of these patients
• It requires proper plaque control and denture hygiene.
• It is more costly compared to complete dentures.
• They are bulkier than many other restorations.
• More load to the prosthesis ,
• The lack of sufficient interarch space makes an overdenture
system more difficult to fabricate and more prone to
component fatigue and fracture.

22. OVERVIEWOF TREATMENT PLANNING
•Medical evaluation
•Dental evaluation
•Formulation of treatment plan

23. MEDICAL EVALUATION
•Medical history (like heart disease, hepatitis, AIDS)
•Vital signs
•Complete blood count
•Urinalysis
•Chest X-ray and Electrocardiogram

24. DENTAL EVALUATION
• Dental history
• Clinical evaluation
• Diagnostic records
• Patient expectations

25. FORMULATIONOF TREATMENT PLANNING
•Diagnostic records
•Transitional prosthesis
•Surgical/fixture placement
•Surgical / fixture connection
•Definitive restoration
•Maintenance

26. OVERDENTURE MOVEMENT: (PM)
Misch (1985)
• PM 0 : No movement of prosthesis, requires implant support
similar to fixed prosthesis
• PM 2: Prosthesis with hinge motion
• PM 3: Prosthesis with hinge and apical motion
• PM 4: Allows movement in four directions
• PM 6: All ranges of prosthesis movement

27. REMOVABLE PROSTHESES
• There are two types of removable prostheses, depending on the
amount of implant support.

28. REMOVABLE PROSTHESES-4(RP-4)
•Completely supported by the implants
•The restoration is rigid when inserted
• Overdenture attachments usually connect the
removable prosthesis to a low-profile tissue bar or
superstructure that splints the implant abutments.
• Usually five implants in mandible and six to eight
implants in the maxilla are required.
•Denture teeth and the acrylic bulk are required for the
restoration.
• Requires a more lingual and apical implant placement
in comparison with FP-1 and FP-2 prosthesis.

29. REMOVABLE PROSTHESES-5 (RP-5)
• A removable prosthesis combining implant and
soft tissue support.
• Two anterior implants, independent of or splinted
in the canine region
• Three splinted implants in the premolar and
central areas , or
• Four implants splinted with a cantilevered bar.
• Primary advantage of an RP-5 restoration is the
reduced cost.

30. MANDIBULAR IMPLANT SITE SELECTION

31. OPTION DESCRIPTION REMOVABLE PROSTHESIS TYPE 5

32. OVERDENTURE OPTION 1:( OD-1)

33. OVERDENTURE OPTION 2 (OD-2)

34. OVERDENTURE OPTION 3(OD-3)

35. OVERDENTURE OPTION 3 (OD-3B)

36. OVERDENTURE OPTION 4(OD-4)

37. OVERDENTURE OPTION 5(OD-5)

38. ARCH FORMS

39. HIDDEN CANTILEVER
• It is that portion of the cantilever that extends beyond the connecting
bar. If the prosthesis does not rotate at the end of the bar to load the
soft tissue, a hidden cantilever exists.
The teeth on the final restoration usually do not extend beyond the bar.
This helps prevent a hidden cantilever, which may extend beyond
this position.

40. MAXILLARY OVERDENTURE
• Only two treatment options are available.
• Independent implants are not an optionbecause bone quality
and force direction are severely compromised.
• Cantilever bars are usually not recommendedfor the same
reasons.
• The crown height space:
• 15 mm- anterior space
• 12 mm- posterior space

41. COMPARISON OF MAXILLARY AND MANDIBULAR
OVERDENTURES
• Jemt et al reported survival rates of 94.5% for implants and
100% for prosthesis in mandible whereas, 72.4% for implants
and 77.9% for prosthesis in maxilla.
• High failure rates were due to poor density and quantity of bone
with characteristic cluster failure pattern.
• Misch followed 75 maxillary IODs for 10 years with 97% implant
survival and 100% prosthesis survival.
• Greater implant number and key implant positions reduce
failure and decrease risk

42. MAXILLARY RP- IMPLANT OVERDENTURE

43. MAXILLARY RP- IMPLANT OVERDENTURE

44. ALL ON 4 CONCEPT
Dental implants Art and Science, 2nd edition Charles Babbush

45. ALL ON 4 CONCEPT
• Optimal number of four implants for
supporting an edentulous jaw with a
complete arch prosthesis.
• The concept benefits from posterior tilting
of the two distal implants with a maximum
of a two teeth distal cantilever in the
prosthesis.
Dental implants Art and Science, 2nd edition Charles Babbush

46. ALL ON-4 CONCEPT- Tilted abutments
• The implant support is moved posteriorly.
• The implant length can then be increased.
• The maxillary implant follows a dense bone structure(the anterior wall
of the maxillary sinus) and reaches high density bone in the anterior
maxilla, enhancing the primary stability.
• The desired position of the implants is determined from the prosthetic
point of view.
• A favourable inter-implant distance and small cantilevers are possible.
Dental implants Art and Science, 2nd edition Charles Babbush

47. ALL ON 4 HYBRID
Dental implants Art and Science, 2nd edition Charles Babbush

48. ALL ON 4 EXTRA MAXILLA
Dental implants Art and Science, 2nd edition Charles Babbush

49. ALL ON 4 CONCEPT ADVANTAGES
• Elimination of bone grafting procedures:
1. Shorter treatment plan,
2. Less patient morbidity,
3. Decreased cost,
4. Immediate restoration.
• Increase in A-P spread more stable prosthesis.
• Elimination or shortening of cantilevers.
• Avoidance of various anatomic structures.
• Fewer implants to support the prosthesis.
Maxillary All on Four Therapy using Angled Implants, Dent Clin N Am 55(2011) 779-794

50. SINGLE IMPLANT SUPPORTED OVERDENTURE
• High implant success rate have been achieved by using 2 or
more implants to anchor an overdenture (Stephan et al.,
2007; Bergendal and Engquist, 1998; Chiapasco et al., 2001;
Payne et al., 2001).
• Because mandible is hinge-like and its buttressing lingual
bone is shock absorbing, use of 2 implants is optimal for
support and retention of overdenture and also some
researches know this as a standard for edentulous mandible
(Lee and Agar, 2006; Sadowsky and Caputo, 2004).

51. • Yet many patients could not receive implants treatment
because of financial problems and with regard to a recent
studies that report immediate loaded single implant retained
overdenture as a safe, reliable and cost effective treatment
(Chiapasco et al., 2001; Liddelow and Henry, 2007, 2010;
Kronstrom and Davis, 2010).

52. SINGLE IMPLANTRETAINEDMANDIBULAR OVERDENTUREWITHIMMEDIATE
LOADING(CASE REPORT)
Fariborz Vafaee,et al
Research Journal of Medical Sciences
Year: 2011 | Volume: 5 | Issue: 5 | Page No.: 273-275
Marginal bone loss was comparable to delayed loading of
implant and was 0.5 mm at 6 month, that was acceptable (Misch
and Bidez, 2008). There were no signs of BOP and probe depth
were not abnormal (3 mm).

53. ATTACHMENT SYSTEMS FOR MANDIBULAR SINGLE-IMPLANT
OVERDENTURES: AN IN VITRORETENTIONFORCE INVESTIGATION
ON DIFFERENT DESIGNS.
Alsabeeha N, Atieh M, Swain MV, Payne AG.
Int J Prosthodont. 2010 Mar-Apr;23(2):160-6
.• Six different attachment systems used for mandibular single-
implant overdentures, including two prototype large ball
attachment designs.
• Mandibular single-implant overdentures are a successful
treatment option for older edentulous adults with early
loading protocol using implants of different diameters and
with different attachment systems.

54. THANK YOU

55. GOOD MORNING

56. OVERDENTURE ATTACHMENTS
Overdenture restorations
Bar-retained
Conical
abutment
Direct abutment
Non-hexed
Abutment-retained
Supra-snap
abutment
Principles and practice of implant dentistry; Charles Weiss,1st edition.

57. OVERDENTURE ATTACHMENTS
(Based on resiliency)
• Rigid Non- Resilient Attachments: ex: Screw retained hybrid
overdenture .
• Restricted Vertical Resilient Attachments: prosthesis can
move up and down with no lateral, tipping or rotary
movement.
• Hinge Resilient Attachments: resists lateral tipping,
rotational and skidding forces. Ex: Hader bar or any other
kind of round bar can provide hinge resiliency.
Clinical and laboratory manual of implant overdenture , Hamid R Shafie

58. OVERDENTURE ATTACHMENTS
(Based on resiliency)
• Combination Resilient Attachments: Allow unrestricted
vertical and hinge movements ex: Dolder bar joint.
• Rotary Resilient Attachments: prosthesis can provide vertical
hinge and rotary movements.
• Universal Resilient Attachments: provide vertical, hinge,
translation and rotation movements. Ex: Magnetic
attachments.
Clinical and laboratory manual of implant overdenture , Hamid R Shafie

59. ATTACHMENT SELECTION CRITERIA
• Available bone.
• Patient’s prosthetic expectations.
• Financial ability of the patient to cover treatment costs.
• Personal choice and clinical expertise of the dentist.
• Experience and technical knowledge of the lab technicians.
Clinical and laboratory manual of implant overdenture , Hamid R Shafie

60. • Stud attachment
– Dalbo attachments
– Ceka attachment
– Rothermann attachment
• Bar attachment
– Dolder bar
– Hader bar

61. • Male component projects from
implant
Intra radicular
• Male element forms part of the denture
base and engages a specially produced
depression within the root contour
Extra radicular
STUD ATTACHMENTS
Harold W Prieskel. Overdentures made easy

62. O-RING OR BALL ATTACHMENT
• Doughnut shaped, synthetic
gasket
• Ability to bend with resistance
and return to their approximate
original shape
• Attaches to a post with a groove
or undercut area for O-ring

63. • Advantages:
-Ease of changing attachment
-Wide range of movement
-Low cost
-Different degrees of retention
- Possible elimination of time and cost of superstructure

64. • Classification of O-ring
1. Static
2. Dynamic – one of the most
resilient or mobile types of
attachment

65. PARTS OF O-RING ATTACHMENT
1. Metal encapsulator- permits easy replacement,
Internal cavity- an undercut region that houses
ring. Stainless steel is recommended
2. O-ring post- made up of machined titanium alloy
It has a head, neck and body.
Head is wider than neck.
3.O - ring – variety of diameters.( 3 sizes)
larger the diameter , easier it is to place the O-
ring within the encapsulator greater the
retention.

66. • O-ring hardness: Measured with durometer
ranges from 0-100 in a shore A scale
softest O-rings are usually 30-40
hardest are- 80-90.
• O-ring materials
Nitrileand Flurocarbon is one of the more widely used
elastomers.

67. TROUBLESHOOTING
1. Extrusion and Nibbling
Cause: when O-ring materials are too soft or ring is too large
Solution: use harder O-ring material
install a properly sized O-ring

68. 2. Spiral failure
Cause: when certain segments of O-ring
slide while other segments
simultaneously roll.
Solution: evaluation of the post to ensure
that it is not out of round, increasing O-
ring Hardness and making sure that
patient uses lubricant daily

69. 3. Abrasion :
Cause: -bruxism
- lifting and seating of
overdenture as nervous habit
- rough metal surface
Solution: use recommended metal
finishes

70. 4. Compression set:
Cause:
-Para-functional clenching of the
prosthesis
- selection of an elastomer with poor
compression set
Solution: remove prosthesis at night,
reduce O-ring hardness

71. 5. Installation damage;
Cause: -sharp edges on the encapsulator, or
on the O-ring post head,
-too large an O-ring for encapsulator
-twisting of the O-ring, too small O-ring
for post
Solution: intallation of properly sized O-
ring using lubrication during assembly.

72. DALBO STUDATTACHMENT
Rigid unit
Ball and socket unit
(Vertical and rotational
movement)
Nylon ring – protects the lamella
  Retention – altering the positions of
free ends of the lamella

73. ROTHERMANECCENTRICATTACHMENT
Button shaped attachment
Patrix – eccentric cylinder with
undercut or groove
Matrix– Clip or clasp arm
Activation : Bending the clasp
arm towards center
Resilient unit
Rigid units

74. ZEST ANCHOR ATTACHMENT
Polyethylene – Nylon stud
Matrix
Funnel shaped tube
Instrumentation kit
Advantages :
Reduce vertical space
requirement
Loads are transferred
more apically.

75. CEKA ATTACHMENT
Ceka revax
Extra radicular
Patrix – metal ring
Matrix– attachment pin
(split metal post)

76. DOLDERBAR
Egg shapedbar in cross section
Open sided sleeve
Two sizes 3.5mm x 1.6mm,
3.0mm x 2.2mm
Spacer – degree of movement

77. MOVEMENTSSEENIN DOLDERBAR

78. HADERBAR
Helmut Haderin 1960
Available as a prefabricated plastic pattern
Notable feature
 Resin / plastic sleeve
 No spacer- more support
English,Donnel& Staubli(1992)HaderEDSsystem
System with 3mm height (8.3mm).

79. Clips with metal encapsulator
Advantage
Prefabricated plastic pattern – no need for soldering.
Precise fit, simplicity, versatility

80. Advantages of barattachments :
Rigidly splint the teeth
Provides good retention, stability and support
Provides cross arch stabilization
Positioned close to the alveolar bone (exhibit less leverage)
Disadvantages:
Bulk of bar
Plaque accumulation
Wearing
Soldering procedure
Manual dexterity

81. IMPRESSION TECHNIQUES

82. INDIRECT (CLOSED-TRAY)
TRANSFER TECHNIQUE

83. • Step 1
Note : if working with multiple implants, remove one healing
abutment at a time to place the impression coping.
IMPRESSION TECHNIQUE

84. Step2
• Place impression (tapered)coping…
• Once it is seated…
 A radiograph / a non-abrading explorer used to assure that the
impression coping is fully seated.

85. Step3
 Block out the hex holes
Step 4
 Verify fit of tray

86. Step 5
Once impression material is fully set, remove tray.

87. • Step 6 Remove impression coping…
• Attach the appropriate replica to the impression coping.

88. Step7
• Reinsert impression coping into the impression. The cut out area on the
impression coping should align perfectly into impression.

89. Step8
Createsoft tissue model
 After applying lubricant, soft
tissue replica material placed
around analog
Step 9
 Fabricate working cast

90. DIRECT (OPEN-TRAY)
TRANSFER TECHNIQUE / PICK-UP
IMPRESSION TECHNIQUE

91.  Custom impression tray / select a stock tray and mold
the border with greenstick compound material
Custom tray : Make a full-arch impression of the
Healing Collars or Surgical Cover Screws, edentulous
areas and remaining dentition and fabricate primary
cast.
 Block out the areas above the Healing Collars or
Surgical Cover Screws with base plate wax to simulate
the positions of the implant transfers that will be
used.
 Fabricate the custom impression tray with auto
polymerizing or light-cure tray resin.
TRAY SELECTION

92. • This transfer procedure requires a custom
tray or modified stock tray with screw access
holes in the areas occlusal to the implants
• Create an opening above the implant areas to
allow for access to the Direct Transfer
screws.

93. Step 1
 Remove Healing Abutment
Step 2
 Place Pick-up Coping
 Radiographic ally verify correct
seating of the coping.
IMPRESSION TECHNIQUE

94. Step 3
 Verify screw/tray clearance
Step 4
 Make full-arch impression
 unscrew and remove all the retaining
screws.
Then remove tray, capturing
the transfers in the impression

95. Step 5
 Attach analog to Pick-up Coping
Step 6
 Create soft tissue model
Step 7
 Fabricate working cast

96. STEPBY STEPPROCEDUREFORFABRICATIONOF IMPLANTSUPPORTEDOVERDENTURE

104. OCCLUSAL CONSIDERATIONS
• The most common implant treatment, which includes a
traditional soft tissue supported complete denture, is a
maxillary denture opposing a mandibular implant supported
restoration.
• The occlusal scheme for this condition:
1. Raises the posterior occlusal plane,
2. Uses a medial positioned lingualized occlusion, and has a
bilateral balanced scheme.
• Whether the mandibular restoration is FP-1, FP-2, FP-3, RP-
4, or RP-5, the maxillary denture follows these guidelines.

105. • The mandibular implant supported restoration may exert
greater force on the premaxilla than a mandibular denture
and cause accelerated bone loss.
• Therefore modification of the occlusal scheme aims at
protecting the premaxilla under a maxillary denture by the
total elimination of anterior contacts with the mandibular
anterior teeth in centric occlusal relation.

106. MAINTENANCE

108. COMPLICATIONS
• While procedural complications can and do occur during the
fabrication phase of prosthodontic treatment following abutment
connection, most are technique-related and are usually reversible.
• Following the placement of a completed prosthesis, the loss of
implant anchorage or soft tissue or mechanical complications may
also occur.

109. • The loss of anchorage or nonintegration is generally the
latent result of
- surgical trauma,
- contamination,
- or prosthesis overload.
Clinical experience has shown that precise, atraumatic, sterile
surgical technique is essential for osseointegration.

110. • Among other causes, loss of
anchorage attributed to fixed
prosthesis function can result
from an
1. Ill-fitting metal frame,
2. Overextended cantilevers,
3. Or a poorly conceived occlusal
scheme .

111. INADEQUATE TORQUE APPLICATION
• Amount of torque suggested by the manufacturers on the
abutment screw range from 20 to 35 N/cm and a torque
wrench is required to obtain a more consistent value

112. INADEQUATE FRAMEWORK ABUTMENT INTERFACE

113. OCCLUSAL DISCREPANCY AND JAW RELATION
• Occlusal forces should be shared evenly by all implants .
• Occlusal adjustments during lab remounts , as well as
intraorally during insertion of prosthesis.

114. • Destructive screw loosening as well as fracture of the
screw may take place due to destructive forces .

115. FRAMEWORK FRACTURE

116. CONCLUSION
• Implant overdentures borrow several principles from tooth
supported overdentures.
• The advantage relates to the ability to place rigid, healthy
abutments in anterior positions of choice.
• The retention and stability achievable with the implant
overdenture may far exceed that otherwise obtained with
successful conventional treatment.
• The dentist should design the overdenture to satisfy the
patient’s desires and anatomical limitations predictably.

117. REFERENCES
• Carl E. Misch. Dental implant prosthodontics.
• Babbush. Dental implants: principles and practice
• Hamid Shafie. Clinical and laboratory manual for implant
overdentures
• Harold Prieskel. Overdentures made easy
• Charles M. Weiss. Principles and Practice of Implant
Dentistry. Mosby Publication.

118. • Mericke-Stern R, Hofman J, Wedig A, etal. In vivo measurements of
maximum occlusal force and minimal pressure threshold on
overdentures supported by implants or natural roots: a comparative
study. Part I. Int J Oral Maxillofac Implants 1993; 8:641-649.
• Jemt T, Book K, Lindén B, Urde G. Failures and complications in 92
consesecutively inserted overdentures supported by Brånemark
implants in severely resorbed edentulous maxillae: A study from
prosthetic treatment to first annual check-up. Int J Oral Maxillofac
Implants 1992;7:162-167.

119. • Burns DR, Under JW, Elswick Jr. RK, Beck DA. Prospective clinical
evaluation of mandibular implant overdentures: Part I – retention,
stability, and tissue response. J Prosthet Dent 1995;73:354-363.
• Burns DR, Unger JW, Elswick Jr. RK, Giglio JA. Prospective clinical
evaluation of mandibular implant overdentures: Part II – patient
satisfaction and preference. J Prosthet Dent 1994;73:364-369.
• Johns RB, Jemt T, Heath MR, Hutton JE, McKenna S, McNamara DC,
van Steenberghe D, Taylor R, Watson RM, Herrmann I. A multicenter
study of overdentures supported by Brånemark implants. Int J Oral
Maxillofac Implants 1992;7:513-522.

120. • Cune MS, de Putter C, Hoogstraten J. Treatment outcome
with implant-retained overdentures: Part I – Clinical findings
and predictability of clinical treatment outcome. J Prosthet
Dent 1994;72:144-151.

121. THANK YOU