Journal of Dental Implant Research 2022; 41(3): 64-73  https://doi.org/10.54527/jdir.2022.41.3.64
Evaluating the clinical and radiographic outcomes of mini-implant versus conventional implant-supported overdentures: A three-year randomized control prospective study
Anusar Gupta, Niraj Mishra, Pooran Chand , Saumyendra Vikram Singh , Raghuwar Dayal Singh , Bhaskar Agarwal, Deeksha Arya , Anupama Pathak
Department of Prosthodontics King George’s Medical U niversity, Lucknow U . P, India
Correspondence to: Saumyendra Vikram Singh, https://orcid.org/0000-0002-2452-8286
Department of Prosthodontics King George’s Medical University, 2/273 Viram Khand, Gomti Nagar, Lucknow U.P 226010, India. Tel: +9415470702, Fax: +0522-4238653, E-mail: saumyendravsingh@rediffmail.com
Received: May 10, 2022; Revised: July 27, 2022; Accepted: August 29, 2022; Published online: September 30, 2022.
© The Korean Academy of Implant Dentistry. All rights reserved.

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Purpose: This in vivo study compared the clinical and radiographic outcomes of the mini-implant-supported overdenture and conventional implant-supported overdenture. The objectives of the study were to evaluate the pocket depth, crestal bone loss, and implant stability using a periotest and to measure patient satisfaction based on the oral health impact profile EDENT questionnaire in conventional and mini-implants supported overdentures.
Materials and Methods: One hundred and seventy-four subjects above 40 years of age were recruited and randomized into two groups on a 1:1 basis: Group 1-mini-implant supported overdentures (2.5 mm diameter×11 mm length) and Group 2-conventional implant-supported overdentures (3.3 mm diameter×11 mm length). Crestal bone loss was measured from the baseline to 12 months and from 12 to 36 months. The pocket depth and implant stability using a Perio test device were measured at 12 months and 36 months. Finally, the patient satisfaction based on the oral health impact profile EDENT questionnaire in conventional and mini-implants supported overdentures was recorded.
Results: There was no significant difference (P<0.05) in the pocket depth and crestal bone loss between the groups at 12 months and 36 months. Similarly, there was no significant difference in the perio-test values between the groups at 12 and 36 months. No significant (P<0.05) differences in physical pain, psychological discomfort, and disability were noted.
Conclusions: Both conventional and mini-implant-supported overdentures have similar outcomes with respect to the pocket depth, crestal bone loss, implant stability, and overall quality of life of the patient.
Keywords: Mini-implants, Overdentures, Perio-test
INTRODUCTION

Complete edentulism is an irreversible condition, in which the oral health-related quality of life is decreased leading to compromised chewing efficiency, poor nutrition, and general body health. Previously conventional complete dentures were the only treatment option for the edentulous arches. This treatment modality remained popular for many years. But due to the detrimental long-term sequelae of wearing complete dentures that include inevitable bone resorption and reduced chewing efficiency over a period of time1), a conventional complete denture is no longer a treatment of choice.

It has been reported that more than 50% with mandibular complete dentures have problems with stability and retention2). However, implants can be used to improve the functionality as well as the quality of life in patients with poor retention and stability of conventional complete dentures3,4). Full-mouth prosthesis can range from implant-supported fixed prosthesis to implant-supported overdentures. However, there are certain disadvantages of implant-supported full mouth fixed prosthesis over implant-supported overdentures like economical constraints, systemic conditions not allowing invasive surgical procedures, oral conditions like decreased bone width and height, poor bone quality to support a large number of implants, due to which the latter is preferred5-8).

Hence, implant-supported overdentures have emerged as a promising treatment modality in these situations9). The major advantages of implant-supported overdenture include minimal bone resorption with enhanced chewing efficiency10,11). It has been found that patients with complete dentures need 1.5 to 3.6 times more chewing strokes than patients with implant-supported overdentures12).

An implant used for overdenture can be a conventional implant or a mini-implant. The length of the conventional and mini-implants can be the same, the only difference is in their diameter. The narrow diameter of these implants allows their easy placement in narrow or resorbed ridges.

A conventional implant can provide good long-term success. However, conventional implants also have some limitations, like they can’t be placed in narrow ridges without performing ridge augmentation surgery, can’t be placed in patients with chronic systemic diseases13). Moreover, the cost of conventional implants is also an important factor that deters the patient from having an implant-supported overdenture13-17). It has been reported that implant overdentures with two implants were 7 times costlier than a conventional denture18). However, it has been found that mandibular overdentures retained by two mini-implants are more cost-effective than two or four conventional implant-retained overdentures19). In these situations, mini-implants may provide an alternative option for rehabilitation. Mini implants are less invasive and technically easier compared to conventional implants. They require minimal osteotomy procedures regarding stabilization and loading20,21). Mini implants offer better results in patients dissatisfied with conventional dentures or in patients where standard implants cannot be placed due to local or systemic reasons22-25).

The number of implants supporting the overdentures can also vary, like 2 implants or 4 implants can be used to support an overdenture. However, it has been found that bone loss, patient satisfaction, and complications related to implants are not related to the number of implants supporting the overdenture26). The survival rate of mini-implant-supported overdenture has been observed up to 94.2%21). Also, when compared to conventional implant-supported overdentures mini-implants provide better patient satisfaction27). Overdentures rehabilitated with short and narrow implants have high clinical and radiographic success28,29). Survival rates of implant-supported mandibular overdentures in frail elderly patients also is reported to be high even after two decades despite compromised oral hygiene30).

Despite numerous advantages of mini-implants over conventional implants, their predictable use for overdenture prosthesis has not been well established as studies have also reported the low survival rate of mini-implants as compared to conventional implants25).

Therefore, the purpose of this study was to compare and evaluate the clinical and radiographic outcomes as well as to measure the patient satisfaction level in patients of mini-implant versus conventional implant-supported overdenture.

MATERIALS AND METHODS

1. Study design

It was a randomized control prospective study. Ethical clearance from the committee of King George Medical University, Lucknow (India) was obtained (Ref No.-72nd ECM Thesis II-B-Thesis/P36). An informed consent form was signed by every patient who participated in this study, all were willing for follow-up.

2. Participants, settings and eligibility criteria

Participants were recruited from the subjects coming to the department of Prosthodontics and Dental Materials, King George’s Medical University, (U.P.), Lucknow. Inclusion criteria: 1) Edentulous patients above the age of 40 years, 2) Patients edentulous for minimum of six months and maximum 1 years, 3) Edentulous patients not wearing complete dentures, 4) Free from any medical conditions that might interfere with implant placement and/or osseointegration, 5) Non-smokers, 6) Had enough bone volume without the need to use any bone grafts. Minimum bone width for placement of mini-implant/implant should be 1 mm on each side of the implant at the crest and the height should be 2 mm more than the implant length, so only those patients who have minimum bone width of 5.5 mm and height of 13.5 mm at B and D locations on the mandibular ridge were included31). Average span of edentulism was eight months.

1) Exclusion criteria

1) Insufficient interocclusal distance for implant placement and restoration, 2) Patient on any medication that influences bone metabolism, 3) Patients undergoing chemotherapy and/or radiotherapy.

3. Randomization

Computer-generated randomization was used as a method for randomization. It was an open label trial. Participants were divided into two intervention groups on a 1:1 basis. Two intervention groups were Group 1- mini-implant supported over-dentures (11 mm and 2.5 mm) and Group 2- conventional implant supported overdentures (11 mm and 3.3 mm) (Fig. 1).

Figure 1. Consort flow diagram. Time of assessment was 12 months and 36 months.

4. Intervention

200 patients were screened to be included in the study, out of which 15 patients did not meet the inclusion criteria and 11 declined to participate due to many reasons like long follow-up, fear of surgery, multiple visits, illness, transfer from sites etc. Hence, 174 subjects were included in the study. None of the patients drop-out over a 3-year period, and there was no implant failure by conventional standards. Single piece conventional and mini dental implants of suitable size (MYRAID Equinox Snap Implant, Equinox Medical Technologies, BV, Amersfoort, Netherland) were placed in patients of both the groups (n=87). Assuming 80% power and 5% significance level, the sample was calculated32).

5. Data collection

Data collection was done over a period of 3 years, first after 12 months of implant placement and then after 36 months of implant placement. At each visit following values were recorded- crestal bone loss, pocket depth, implant stability and pre-validated oral health impact profile EDENT questionnaire. EDENT questionnaire detects the impact of oral health on the quality of life of patients who wear total prostheses33). The OHIP-EDENT is a 19-question survey, grouped as seven subscales or domains: functional limitation, physical pain, psychological discomfort, physical disability; psychological disability, social disability, and handicap. It is specific to edentulous patients and presents questions addressing masticatory capacity, pleasure in eating, level of comfort and assuredness while wearing the prosthesis, and relationship problems, among others. For every question there is choice of three answers: (0)=Never; (1)=Sometimes; (2)=Almost always.

6. Study methodology

Detailed patient history along with the pre-operative clinical and radiographic assessment of all the patients (Orthopantomogram, Denta scan, and Intra oral periapical Radiographs) was carried out. Implants/ mini-implants were placed in mandibular anterior region at B and D location with D2 bone density (850 to 1,250 Hounsfield units) belonging to Division B category34). All selected patients were randomly allocated to either the mini-implant supported overdenture group or the conventional implant supported overdenture group. For the patients in mini-implant supported overdenture group, length and width of mini-implant patients were 11 mm and 2.5 mm respectively and for the conventional implant overdenture group the length and width of implant was 11 mm and 3.3 mm respectively.

Complete dentures were fabricated with a bilaterally balanced occlusal scheme following standard procedures. Then the mandibular complete dentures were duplicated in clear acrylic resin with metal sleeves placed at B and D location. Bone width and height have been measured by radiographic stent using a Denta scan. The same radiographic stent was used as a surgical template. Then the implant/ mini-implant was placed corresponding to B and D location depending upon the group to which the patient belongs. Torque achieved ranged from 30 to 32 Ncm.

Following implant placement, the complete denture was discontinued for 1 month. Following this, early loading of mini-implants was done, and housing was incorporated with acrylic.

Pocket depth was assessed around conventional and mini-implants supported overdenture by using a graduated pressure sensitive probe (Vivacare TPS, Vivadent, Schaan, Lichtenstein). Probing depth was measured at the mid-buccal, mid-lingual, mid-mesial and mid-distal surfaces of all the implants and the mean value for the scored surfaces for each implant was calculated.

The crestal bone loss by digital Orthopantomogram using ‘J’ software around conventional implants supported overdentures and mini-implants supported overdentures. Assessment of crestal bone loss from baseline to 12 months and from 12 to 36 months was evaluated by registering a reference point on the implant surface on the x-ray image. The distance between the highest point of the bone at the implant bone interface to the point of the selected reference point was measured digitally on both sides (mesial and distal) using digital Orthopantomogram by Image J software. The mean value was then calculated for each patient.

Additionally, the implant stability by Periotest (MEDIZINTECHNIK GULDEN BENSHEIM, Germany) in conventional implants supported overdentures and mini-implants overdenture was also established. The Periotest unit is composed of measurement and control electronic devices with a flexible connection to a probe. The probe contains a rod weighing 8 grams that taps the implant 20 times in 5 seconds35,36). A visual and acoustic signal is then given. An intergroup comparison has been done among mini-implant supported overdenture group and implant supported overdenture group.

Finally, the patient satisfaction based on oral health impact profile EDENT questionnaire in conventional implants supported overdentures and mini-implants supported overdentures was recorded37,38).

7. Statistical analysis

Statistical analysis was done by using Statistical Package for Social Sciences (version 25.0) (SPSS Inc., Chicago, IL, USA). Chi-square test was used for the analysis of the data for satisfaction with complete dentures. P-value of less than 0.05 was considered statistically significant.

RESULTS

There was no significant difference (P>0.05) in the right and left crestal bone-mesial and distal level between the groups from baseline to 12 months and from 12 to 36 months. Similarly, there was no significant (P>0.05) difference in the right and left implant perio test-mesiodistal and labiolingual level between the groups at 12 months, and 36 months. Likewise, there was no significant (P>0.05) difference in the right and left pocket depth-mesial, distal, labial and lingual level between the groups at 12 months and 36 months . There was no significant (P>0.05) difference in the bone loss and implant perio test between the groups from 12 months to 36 months. The comparison of pocket depth between the groups had no significant (P>0.05) difference at 12 months and 36 months. The mean change in the pocket depth from 12 months to 36 months in Group 1 and Group 2 was statistically significant. No significant (P>0.05) difference in physical pain, psychological discomfort and disability.

The mean change in the crestal bone loss in Group 1 was 0.36±0.12 and in Group 2, this was 0.33±0.12. The mean change in the crestal bone loss was significant (P=0.0001) in both the groups being higher in Group 1 than Group 2 (Table 1). The mean change in implant perio test was 0.08±0.30 at 12 months and -0.26±0.37 at 36 months in Group 1 and in Group 2 this value was -0.02±0.27 and -0.02±0.27 respectively (Table 2). The mean change in the pocket depth value was 1.05±0.35 at 12 months and 1.26±0.27 at 36 months for Group 1 and 0.97±0.35 at 12 months and 1.23±0.25 at 36 months for Group 2 (Table 3). There was no significant (P>0.05) difference in physical pain, psychological discomfort, psychological disability, social disability and total score between the groups (Table 4).

Table 1 . Comparison of bone loss from baseline to 12 months and from 12 to 36 months in Groups

GroupsMean changeP-value1
Group 1 (Mini)0.36±0.120.0001*
Group 2 (Conv.)0.33±0.120.0001*

1Paired t-test, *Significant.


Table 2 . Comparison of implant perio test from 12 months to 36 months

Groups12 months36 months


Mean changeP-value1Mean changeP-value1
Group 1 (Mini)−0.08±0.300.17−0.26±0.370.001*
Group 2 (Conv.)−0.02±0.270.61−0.12±0.470.15

1Paired t-test, *Significant.


Table 3 . Comparison of pocket depth from 12 months to 36 months

Groups12 months36 months


Mean changeP-value1Mean changeP-value1
Group 1 (Mini)1.05±0.350.0001*1.26±0.270.001*
Group 2 (Conv.)0.97±0.350.0001*1.23±0.250.001*

1Paired t-test, *Significant.


Table 4 . Comparison of quality of life between the groups

Group 1 (Mini) (n=29)Group 2 (Conv.) (n=29)P-value1
Functional0.00±0.000.00±0.00-
Physical pain0.44±0.630.23±0.250.11
Psychological discomfort1.85±0.521.46±0.790.10
Physical disability0.00±0.000.00±0.00-
Psychological disability0.10±0.300.07±0.250.09
Social disability0.31±0.470.26±0.150.10
Handicap0.00±0.000.00±0.00-
Total2.67±0.861.98±0.950.07

1Mann-Whitney U test.


DISCUSSION

Edentulous patients suffer from social, physical, functional and psychological limitations39-41). Bone resorption after tooth loss leads to decrease in the size of the denture-bearing area, thereby reducing denture stability, which causes insufficient retention of the lower denture13) causes challenges in providing a satisfactory solution for patient’s oral health problems2).

According to the McGill Consensus statement on overdentures, implant-supported overdentures have proved to be superior to conventional dentures42). Increase in bite force, chewing efficiency, and patient satisfaction has been noted in patients implants supported overdenture wearer during the follow-up of 5 years10,27).

In the present study, ball attachments were used as a part of single piece mini dental implants. Godfredsen and Holm43), compared implant retained overdentures and reported twice as many complications developed with the bar attachment than the ball and socket. MacEntee44), investigated outcome with a bar or ball attachment and reported that most complications developed in the first year with 90% of repairs occuring with the ball and socket45).

Mini-implants were used in this study to retain the Complete Dentures in edentulous mandibular arches. Their reduced diameter (<3.0 mm) enabled insertion in narrow ridges. Moreover, the insertion procedure was simpler and faster, as reduced series of drills were required. Survival rates of mini-implants were favourable when used for mandibular overdentures27).

The primary requisite that leads to the success of implant surgery is obtaining implant primary stability. If an implant is not sufficiently stable at the time of placement, micromotion may occur. The normal healing process may then be disrupted, and a capsule of fibrous tissue may form, resulting in mobility of the implant and its subsequent clinical failure46).

Insertion torque can provide assessment of bone quality as a function of density and hardness, either subjectively in experienced hands or quantitatively by electronic drill devices which measure the torque required to insert implant in the bone47). Ottoni et al.48) in their study, suggested that a minimum of 32 Ncm insertion torque was necessary for implants to achieve osseointegration.

Following implant placement, an increase in stability results from the regeneration and remodelling of bone at the implant-tissue interface. Once bone has formed at the interface, the requirements for success change: an implant now needs to be able to effectively distribute loads transmitted by the intraoral prosthesis to which it is attached46,49). Hence early loading treatment protocol was used instead of immediate loading.

From the outcomes of the present study, using mini dental implants seems to be a treatment option as predictable as using standard diameter implants. Alveolar bone is critical to the establishment of the biological width50). The development and the location of the biological width relative to the implant and the alveolar crest become all the more important when a minimal alveolar bone is available to house the implant due to anatomical restrictions arising from structures such as the sinus floor, inferior alveolar canal, and the mental foramen or when the implant is placed in areas of aesthetic concern. Subsequent crestal bone loss around implants after placement may produce unfavourable crown: implant ratios or expose metal collars.

In the present study, the results of crestal bone loss showed statistically insignificant difference (Table 1). The changes in the bone height observed in the study may be because the implants were placed in the inter-foraminal region where bone quality is favourable. The above results were in confinement to the results obtained in the studies of Zarone et al.51) and Astrand et al.52) that deal with the use of mini-implants or narrow diameter implants as an implant treatment.

Because of the severely resorbed alveolar arch in the mandibles with high floor of the mouth in all of the patients investigated, the panoramic radiograph was the only X-ray technique which could be applied in these patient situations, as intraoral films could not be positioned parallel to the implant axis without causing considerable discomfort to the subject53). Gomez-Roman et al.54) found no significant difference in the accuracy of measurement between intraoral periapical and Orthopantomogram whereas other studies focused on the suitability of panoramic radiographs. Moreover, Gomez-Roman et al.54) demonstrated that measurements aided by digital image processing methods are reliable and achieve a higher degree of precision than the visual metric method53,55).

The Periotest method is based on the empirical finding that the greater the implant solidity, the higher the deceleration of the tapping rod that touches the implant36,56). Advantages of Periotest device are: it can offer reproducible findings by measuring the levels of subclinical mobility using an ultrasonically vibrating tool, it can successfully assess implant stability status56). However, the Periotest device has certain disadvantages also like, it cannot reliably detect the amount of crestal bone loss, and bony osseointegration56).

In the present study, no statistically significant difference was observed in the periotest values of two mini dental implants with the conventional implant group at both 12 and 36 months in edentulous mandibular arches (Table 2). The results obtained were in line with the results obtained by Romeo et al.57) In sequence of the Split Mouth Model Design, statistically insignificant difference was found between the implants placed in the left canine region and the right canine region from baseline to 6 months.

The probing depth (PD) is generally measured by using a William’s Periodontal Probe. It is the first probe to be used to assess probing depth of a pocket. It has the following markings- 1, 2, 3, 5, 7, 8, 9, 10 mm58). Pressure sensitive probes produce most accurate results when compared to other periodontal probes59). Although the values showed higher values in mini-implant group than in conventional implants, but there was a statistically insignificant difference between mini- implant and conventional implant group.

The results of the present study were in collaboration to the results obtained in the study of the Mostafa Omran et al60). In this study, he concluded that the mean value of the pocket depth of the first group was higher than the second group with no statistically significant difference.

Measuring PD is an appropriate method to detect deleterious changes in the peri-implant environment and should be performed every 3 to 4 months for 1 year after prosthesis delivery. Probing depth is not only important in measuring increase in sulcus depth but also allows evaluation of several peri-implant parameters like tissue consistency, bleeding, and presence of exudate at the same time and at the same site61-65).

The oral health impact profile EDENT questionnaire33) was filled by the patient 36 months after prosthesis delivery. It has been used previously to compare the satisfaction of edentulous individuals treated with implant supported overdentures and fixed prostheses, and to assess the technical condition of these treatments in terms of patient satisfaction.

Result was statistically insignificant between Group 1 (mini) and Group 2 (conv.) patients. Although, scoring depicts satisfaction inclination more towards Group 2 (conv.). The results of this study suggest that conventional or implant-stabilized prostheses can have a positive impact on the health-related quality of life of edentulous patients. Improvement was possible with patients who preferred implant-stabilized prostheses but instead were treated with conventional techniques, but not to the same extent as with patients who received their desired treatment. Although expectations of implant therapy were high, they do not appear to have significantly affected the level of patient satisfaction with the outcome of treatment; thus, patient expectations appear not to be a good predictor of treatment outcome. Oral-specific health status measures helped identify the degree of impairment, disability, and handicap experienced by edentulous patients66). The literature indicates that implant-supported overdentures in the mandible provide predictable results with improved stability, retention, function and patient satisfaction compared with conventional dentures67).

However, this study has evaluated the implant stability, crestal bone, soft tissue changes (pocket depth) along with questionnaire in mini dental implants placed in edentulous mandibular arches through the 36 months follow up period, further studies are needed in controlled clinical trials before this approach can be used routinely.

CONCLUSION

Within limitations of the study and based on the results obtained, following conclusions have been drawn:

1.There was insignificant difference in the crestal bone loss between mini-implant supported overdenture group and conventional implant supported overdenture group both from baseline to 12 months and from 12 to 36 months interval.

2.There was insignificant difference in Periotest implant stability results between mini-implant supported overdenture group and conventional implant supported overdenture group both at 12 months and 36 months interval.

3.There was insignificant difference in pocket depth between mini-implant supported overdenture group and conventional implant supported overdenture group both at 12 months and 36 months interval.

4.Difference in patient satisfaction level was statistically insignificant between mini-implant supported overdenture group and conventional implant supported overdenture group at 36 months.

References
  1. Bilhan H, Geckili O, Ergin S, Erdogan O, Ates G. Evaluation of satisfaction and complications in patients with existing complete dentures. J Oral Sci 2013;55:29-37.
    Pubmed CrossRef
  2. Pan S, Dagenais M, Thomason J M, Awad M, Emami E, Kimoto S. Does mandibular edentulous bone height affect prosthetic treatment success? J Dent 2010;38:899-907.
    Pubmed CrossRef
  3. Cardoso RG, Melo LA, Barbosa GA, Calderon PD, Germano AR, Mestriner W Junior, et al. Impact of mandibular conventional denture and overdenture on quality of life and masticatory efficiency. Braz Oral Res 2016;10;30:e102.
    CrossRef
  4. Bhat S, Chowdhary R, Mahoorkar S. Comparison of masticatory efficiency, patient satisfaction for single, two, and three implants supported overdenture in the same patient: A pilot study. J Indian Prosthodont Soc 2016;16:182-6.
    Pubmed KoreaMed CrossRef
  5. Naert I, Gizani S, Vuylsteke M, van Steenberghe D. A 5-year randomized clinical trial on the influence of splinted and unsplinted oral implants in the mandibular overdenture therapy. Part I: Peri-implant outcome. Clin Oral Implants Res 1998;9:170-7.
    Pubmed CrossRef
  6. Jemt T and Stålblad PA. The effect of chewing movements on changing mandibular complete dentures to osseointegrated overdentures. J Prosthet Dent 1986;55:357-61.
    CrossRef
  7. Attard N, Wei X, Laporte A, Zarb GA, Ungar WJ. A cost minimization analysis of implant treatment in mandibular edentulous patients. Int J Prosthodont 2003;16:271-6.
  8. Walmsley AD and Nilner K. Overdentures--when and how. J Dent 1997;25 Suppl 1:S1-3.
    CrossRef
  9. Boerrigter EM, Geertman ME, Van Oort RP, Bouma J, Raghoebar GM, van Waas MA, et al. Patient satisfaction with implant-retained mandibular overdentures. A comparison with new complete dentures not retained by implants--a multicentre randomized clinical trial. Br J Oral Maxillofac Surg 1995;33:282-8.
    CrossRef
  10. Bakke M, Holm B, Gotfredsen K. Masticatory function and patient satisfaction with implant-supported mandibular overdentures: a prospective 5-year study. Int J Prosthodont 2002;15:575-81.
  11. Carl E. Misch. Generic root form component terminology. Carl. E Misch. Contemporary implant dentistry. 2013:26-37.
  12. Geertman ME, Slagter AP, van Waas MA, Kalk W. Comminution of food with mandibular implant-retained overdentures. J Dent Res 1994;73:1858-64.
    Pubmed CrossRef
  13. Kumari P, Verma M, Sainia V, Gupta R, Gill S. Rehabilitation of resorbed mandibular ridges using mini implant retained overdentures: A case series with 3 year follow-up. J Indian Prosthodont Soc 2016;16:221-6.
    Pubmed KoreaMed CrossRef
  14. Gupta R, Gupta N, Weber KK. Dental Implants. 2020 Aug 11. Treasure Island (FL): StatPearls Publishing; 2021.
  15. Assunção WG, Zardo GG, Delben JA, Barão VA. Comparing the efficacy of mandibular implant-retained overdentures and conventional dentures among elderly edentulous patients: satisfaction and quality of life. Gerodontology 2007;24:235-8.
    Pubmed CrossRef
  16. Mundt T, Polzer I, Samietz S, Grabe HJ, Messerschmidt H, Dören M, et al. Socioeconomic indicators and prosthetic replacement of missing teeth in a working-age population--results of the Study of Health in Pomerania (SHIP). Community Dent Oral Epidemiol 2009;37:104-15.
    Pubmed CrossRef
  17. Clavero J and Lundgren S. Ramus or chin grafts for maxillary sinus inlay and local onlay augmentation: comparison of donor site morbidity and complications. Clin Implant Dent Relat Res 2003;5:154-60.
    Pubmed CrossRef
  18. Nagda SJ. Challenges of edentulism. J Indian Prosthodont Soc 2007;7:1.
    CrossRef
  19. Roy S, Maji S, Paul R, Bhattacharyya J, Goel P. A comparison of cost and cost-effectiveness analysis of two-implant-retained overdentures versus other removable prosthodontic treatment options for edentulous mandible: A systematic review. J Indian Prosthodont Soc 2020;20:162-70.
    Pubmed KoreaMed CrossRef
  20. Flanagan D. Immediate placement of multiple mini dental implants into fresh extraction sites: a case report. J Oral Implantol 2008;34:107-10.
    CrossRef
  21. Balaji A, Mohamed JB, Kathiresan R. A pilot study of mini implants as a treatment option for prosthetic rehabilitation of ridges with sub-optimal bone volume. J Maxillofac Oral Surg 2010;9:334-8.
    Pubmed KoreaMed CrossRef
  22. M.A. Elsyad. Patient satisfaction and prosthetic aspects with mini-implants retained mandibular overdentures. A 5-year prospective study, Clin. Oral Implants Res 2016;27:926-33.
    Pubmed CrossRef
  23. A.S. Bidra and K. Almas. Mini implants for definitive prosthodontic treatment: a systematic review. J. Prosthet. Dent 2013;109:156-64.
    CrossRef
  24. Preoteasa, M. Imre, C.T. Preoteasa. A 3-year follow-up study of overdentures retained by mini-dental implants. Int. J. Oral Maxillofac. Implants 2014;29:1170-6.
    Pubmed CrossRef
  25. R.F. de Souza, A.B. Ribeiro, M.P. Della Vecchia, L. Costa, T.R. Cunha, A.C. Reis, et al. Mini vs. standard implants for mandibular overdentures: a randomized trial. J. Dent. Res 2015;94:1376-84.9,11-13.
    Pubmed CrossRef
  26. Roccuzzo M, Bonino F, Gaudioso L, Zwahlen M, Meijer HJ. What is the optimal number of implants for removable reconstructions? A systematic review on implant-supported overdentures. Clin Oral Implants Res 2012;23 Suppl 6:229-37.
    Pubmed CrossRef
  27. Sivaramakrishnan G and Sridharan K. Comparison of patient satisfaction with mini-implant versus standard diameter implant overdentures: a systematic review and meta-analysis of randomized controlled trials. Int J Implant Dent 2017;3:29.
    Pubmed KoreaMed CrossRef
  28. Kovacic I, Persic S, Kranjcic J, Lesic N, Celebic A. Rehabilitation of an Extremely Resorbed Edentulous Mandible by Short and Narrow Dental Implants. Case Rep Dent 2018;20:7597851.
    Pubmed KoreaMed CrossRef
  29. Lemos CA, Verri FR, Batista VE, Júnior JF, Mello CC, Pellizzer EP. Complete overdentures retained by mini implants: A systematic review. J Dent 2017;57:4-13.
    Pubmed CrossRef
  30. Bakker MH, Vissink A, Meijer HJA, Raghoebar GM, Visser A. Mandibular implant-supported overdentures in (frail) elderly: A prospective study with 20-year follow-up. Clin Implant Dent Relat Res 2019;21:586-92.
    Pubmed KoreaMed CrossRef
  31. Carl E. Misch. Available bone and dental implant treatment plans. Carl. E Misch. Contemporary Implant Dentistry. 2013:178-99.
  32. Hayes RJ and Bennett S. Simple sample size calculation for cluster-randomized trials. Int J Epidemiol 1999;28:319-26.
    Pubmed CrossRef
  33. Allen F and Locker D. A modified short version of the oral health impact profile for assessing health-related quality of life in edentulous adults. Int J Prosthodont 2002;15:446-50.
  34. Carl E. Misch. Rationale for implants. Carl. E Misch. Contemporary Implant Dentistry. 2008:48-9.
  35. Berthold C, Holst S, Schmitt J, Goellner M, Petschelt A. An evaluation of the Periotest method as a tool for monitoring tooth mobility in dental traumatology. Dent Traumatol 2010;26:120-8.
    Pubmed CrossRef
  36. Schulte W, d'Hoedt B, Lukas D, Maunz M, Steppeler M. Periotest for measuring periodontal characteristics--correlation with periodontal bone loss. J Periodontal Res 1992;27:184-90.
    Pubmed CrossRef
  37. Omran M, Abdelhamid A, Elkarargy A, Sallom M. Mini-Implant Overdenture Versus Conventional Implant Overdenture (A Radiographic and Clinical Assessments). J Am Sci 2013;9:89-97.
  38. Gargari M, Prete V, Pujia M, Ceruso FM. Development of patient-based questionnaire about aesthetic and functional differences between overdentures implant-supported and overdentures tooth-supported. Study of 43 patients with a follow up of 1 year. Oral Implantol (Rome) 2013;19;5:86-91.
  39. Sharma AJ, Nagrath R, Lahori M. A comparative evaluation of chewing efficiency, masticatory bite force, and patient satisfaction between conventional denture and implant-supported mandibular overdenture: An in vivo study. J Indian Prosthodont Soc 2017;17:361-72.
    Pubmed KoreaMed CrossRef
  40. Shah RJ, Diwan FJ, Diwan MJ, Chauhan VJ, Agrawal HS, Patel GC. A study of the emotional effects of tooth loss in an edentulous Gujarati population and its association with depression. J Indian Prosthodont Soc 2015;15:237-43.
    Pubmed KoreaMed CrossRef
  41. Gandhi PV, Kalsekar BG, Patil AA, Kandi NS. A low-profile universal attachment system with housing welded to metal reinforcement framework to retain mandibular implant overdenture: A clinical report. J Indian Prosthodont Soc 2019;19:374-8.
    Pubmed KoreaMed CrossRef
  42. Thomason JM, Kelly SA, Bendkowski A, Ellis JS. Two implant retained overdentures--a review of the literature supporting the McGill and York consensus statements. J Dent 2012;40:22-34.
    Pubmed CrossRef
  43. Gotfredsen K and Holm B. Implant-supported mandibular overdentures retained with ball or bar attachments: a randomized prospective 5-year study. Int J Prosthodont 2000;13:125-30.
  44. MacEntee MI, Walton JN, Glick N. A clinical trial of patient satisfaction and prosthodontic needs with ball and bar attachments for implant-retained complete overdentures: three-year results. J Prosthet Dent 2005;93:28-37.
    Pubmed CrossRef
  45. van Kampen FM, van der Bilt A, Cune MS, Bosman F. The influence of various attachment types in mandibular implant-retained overdentures on maximum bite force and EMG. J Dent Res 2002;81:170-3.
    Pubmed CrossRef
  46. Mesa F, Munoz R, Noguerol B, Luna J, Galindo P, O' Valle F. Multivariate study of factors influencing primary dental implant stability. Clin Oral Impl Res 2008;19:196-200.
    Pubmed CrossRef
  47. Venkatakrishnan C.J, Bhuminathan S, Chandran C. R. Dental Implant Insertion Torque aand Bone Density-Short Review. Biomed Pharmacol J 2017;10.
    CrossRef
  48. Ottoni JM, Oliveira ZF, Mansini R, Cabral AM. Correlation between placement torque and survival of single-tooth implants. Int J Oral Maxillofac Implants 2005;20:769e776.
  49. Misch CE, Perel ML, Wang HL, Sammartino G, Moreno GM, Trisi P. Implant Success, Survival, and Failure: The International Congress of Oral Implantologists (ICOI) Pisa Consensus Conference. J Implant Dent 2008;17:5-9.
    Pubmed CrossRef
  50. Hänggi MP, Hänggi DC, Schoolfield JD, Meyer J, Cochran DL, Hermann JS. Crestal bone changes around titanium implants. Part I: A retrospective radiographic evaluation in humans comparing two non-submerged implant designs with different machined collar lengths. J Periodontol 2005;76:791-802.
    Pubmed CrossRef
  51. Zarone F, Sorrentino R, Vaccaro F, Russo S. Prosthetic treatment of maxillary lateral incisor agenesis with osseointegrated implants: a 24-39-month prospective clinical study. Clin Oral Implants Res 2006;17:94-101.
    Pubmed CrossRef
  52. Astrand P, Engquist B, Dahlgren S, Gröndahl K, Engquist E, Feldmann H. Astra Tech and Brånemark system implants: a 5-year prospective study of marginal bone reactions. Clin Oral Implants Res 2004;15:413-20.
    Pubmed CrossRef
  53. Heckmann SM, Schrott A, Graef F, Wichmann MG, Weber HP. Mandibular two-implant telescopic overdentures. Clin Oral Implants Res 2004;15:560-9.
    Pubmed CrossRef
  54. Gomez-Roman G, d'Hoedt B, Axmann D, Schulte W. Visual-metric measurement of peri-implant bone defects on radiographs - a reliability Study. Zeitschrift fur Zahnarztliche Implantologie 1996;12:104-9.
  55. Weber HP, Crohin CC, Fiorellini JP. A 5-year prospective clinical and radiographic study of non-submerged dental implants. Clin Oral Implants Res 2000;11:144-53.
    Pubmed CrossRef
  56. Cranin AN, DeGrado J, Kaufman M, Baraoidan M, DiGregorio R, Batgitis G, et al. Evaluation of the Periotest as a diagnostic tool for dental implants. J Oral Implantol 1998;24:139-46.
    CrossRef
  57. Romeo E, Lops D, Amorfini L, Chiapasco M, Ghisolfi M, Vogel G. Clinical and radiographic evaluation of small-diameter (3.3-mm) implants followed for 1-7 years: a longitudinal study. Clin Oral Implants Res 2006;17:139-48.
    Pubmed CrossRef
  58. Romeo E, Chiapasco M, Lazza A, Casentini P, Ghisolfi M, Iorio M, et al. Implant-retained mandibular overdentures with ITI implants. A comparison of 2-year results between delayed and immediate loading. Clin. Oral Impl. Res 2002;13:495-501.
    Pubmed CrossRef
  59. Al Shayeb KN, Turner W, Gillam DG. Accuracy and reproducibility of probe forces during simulated periodontal pocket depth measurements. Saudi Dent J 2014;26:50-5.
    Pubmed KoreaMed CrossRef
  60. Omran M, Abdelhamid A, Elkarargy A, Sallom M. Mini-Implant Overdenture Vs. Conventional Implant Overdenture (A Radiographic and Clinical Assessments). Journal of American Science 2013;9:89-97.
  61. Rams TE and Slots J. Comparison of two pressure sensitive periodontal probes and a manual periodontal probe in shallow and deep pockets. Int J Periodontics Restorative Dent 1993;13:521-9.
  62. Lang NP, Karring J, Lindhe J. Proceedings of the 3rd European Workshop on Periodontology (Implant Dentistry). Quintessence 1999;220-1.
  63. Proceedings of the 3rd ITI Consensus Conference. J Oral Maxillofac Implants 2004;9(suppl):118-20.
  64. American Academy of Periodontology-Position Paper. J Periodontol 2003;74:1395-401.
    Pubmed CrossRef
  65. Proceedings of the 1st European Workshop on Evidence-based Reconstruction Dentistry. Clin Oral Implants Res 2007;18:51,51.
  66. Allen PF, McMillan AS, Walshaw D. A patient-based assessment of implant-stabilized and conventional complete dentures. J Prosthet Dent 2001;85:141-7.
    Pubmed CrossRef
  67. Doundoulakis JH, Eckert SE, Lindquist CC, Jeffcoat MK. The implant-supported overdenture as an alternative to the complete mandibular denture. J Am Dent Assoc 2003;134:1455-8.
    Pubmed CrossRef


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