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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 16  |  Issue : 4  |  Page : 189-196

Evaluation of bilateral mandibular distal extension implant supported overdenture retained by two clasp assemblies


Department of Prosthodontics, Faculty of Dentistry, Tanta University, Tanta, Egypt

Date of Submission02-Feb-2019
Date of Acceptance30-Nov-2019
Date of Web Publication28-Feb-2020

Correspondence Address:
Reda F. Radwan
Department of Prosthodontics, Faculty of Dentistry, Tanta University, Tanta
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/tdj.tdj_10_19

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  Abstract 

Purpose
Clinically evaluate the effect of clasp design on tissue health around abutment teeth and implants assisting mandibular bilateral distal extension removable partial overdenture. M&M: 12 partially edentulous patients with mandibular bilateral free end saddle opposed by almost dentulous intact maxilla with the first premolars. Two dental implants were inserted at the first molar areas to support a bilateral distal extension partial overdenture with lingual bar as major connector. According to clasp design patients are divided in two groups. Group I: six patients for whom removable partial overdentures were retained with O-ring attachment to the implants and RPI clasp to the first premolar abutment teeth. Group II: six patients for whom removable partial overdentures were retained with O-ring attachment to the implants and conventional Aker clasp to the abutment teeth.
Clinical evaluation
Gingival index, probing depth and teeth mobility together with radiographic evaluation for alveolar bone loss around both implants and abutments using Digora for Windows were carried out immediately at insertion, 3, 6, and 9 months after insertion.
Results
After the first 3 months gingival index and probing depth increased significantly in both groups within the physiological limit while at the end of ninth month after insertion, no statistically significant difference between two groups. Differences between two groups regarding mobility and alveolar bone loss around abutment teeth through all the study periods, there is no statistically significance difference between the two groups. Regarding mobility and alveolar bone loss around implants through all the study periods, there is no statistically significant difference between results.
Conclusion
Presence of bilateral posterior implants reduce most problems of mandibular Kennedy class I such as preservation of abutment teeth, reduction of alveolar bone loss around the abutments and reduction the problems of rigid (Aker) clasp.

Keywords: aker clasp, bilateral mandibular distal extension, bilateral mandibular, clasp assemblies, implant, RPI clasp


How to cite this article:
Radwan RF, El Gendy AA, El-Segai AA, Abdalla SM. Evaluation of bilateral mandibular distal extension implant supported overdenture retained by two clasp assemblies. Tanta Dent J 2019;16:189-96

How to cite this URL:
Radwan RF, El Gendy AA, El-Segai AA, Abdalla SM. Evaluation of bilateral mandibular distal extension implant supported overdenture retained by two clasp assemblies. Tanta Dent J [serial online] 2019 [cited 2020 Mar 28];16:189-96. Available from: http://www.tmj.eg.net/text.asp?2019/16/4/189/279726


  Introduction Top


The distal extension partial denture is supported and retained by natural teeth at one end of the denture base segment and on which a portion of the functional load is carried by the residual alveolar ridge[1]. The bilateral distal extension removable partial denture has always been associated with number of problems such as retention, stability, support and discomfort upon loading, most of these problems could be attributed to absence of posterior abutment[2]. Patient lacking mandibular posterior teeth as (Kennedy class I) is frequently present in the dental clinics and require more accurate prosthodontics rehabilitation for preserving the remaining teeth and residual ridge[3].

The difference in resiliency between the mucosa and the periodontal ligament present a considerable challenge, as support is needed from natural teeth, mucosa and residual alveolar ridges, many investigators suggested different approaches to balance the loads distributed among the teeth and ridge such as making functional impressions, periodic rebasing of the prosthetic seat, use of stress releasing clasps and splinting of the distal support abutments[4].

None of the management options appear to provide an ideal solution to Kennedy class I cases, possible solution to this clinical challenge were the use of single implants placed bilaterally at the molar areas beneath distal extension base which reduce lateral stress of the abutments minimize the resultant denture displacement and reduce ridge resorption[5].

Dental implants placed in the posterior site modify the Kennedy classification of partially edentulous arches by converting class I into class III to overcome the numerous problems associated with removable partial dentures in addition to achieving a higher level of patient satisfaction[6].

As the different retainers influenced the occlusal load distribution, the type of retainer is important for a long-term successful restoration[7]. This study was aimed to clinically evaluate the effect of different clasp designs on the tissue health around the abutment teeth and distal implants supporting the mandibular bilateral distal extension removable partial overdenture.


  Materials and Methods Top


Twelve healthy partially edentulous male patients their age ranged from 30 to 50 years were selected from the outpatient clinic of Prosthodontics Department.

Surgical procedures

The surgical guide stent was inserted in the patient's mouth and the probe was used to form bloody points to mark the proposed site for implant placement. Standardized surgical minimally invasive flapless approach according to Becker and Kaiser[8] was followed for proper osteotomy. Postoperative panoramic radiograph was done to every case after fixture insertion. After 3 months of osseointegration removable partial overdenture was constructed [Figure 1].
Figure 1: Surgical guide stent.

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Prosthetic procedures

The removable partial denture design on the surveyed study was identified to determinate rest positions, major connector and the extension base boarder. The design of the mandibular removable partial denture was the same for all groups; the only difference was in the type of direct retainer used. Preparation of abutment teeth (reshaping, occlusal rest seat and proximal plate preparation)

  1. In group I:the prosthesis is retained by RPI clasp.
  2. In group II:prosthesis is retained by conventional Aker clasp.[9]


Final impression was made using rubber base condensation silicon type impression material (hydrogum extra fast setting alginate, Zhermack, Italy) then poured with type II dental stone. The metal framework was cheeked in the patient mouth. An altered cast procedure according to Leupold and Kratochvil[10] to improve tissue support for removable partial denture. Chair-side pick-up procedure was done according to Banton and Henry[11].

Clinical evaluation

Gingival index (GI), probing depth (PD), and mobility three clinical evaluations were assessed around natural abutments and implants immediately at insertion, 3, 6, and 9 months after removable partial overdenture loading.

The gingival index

The gingival tissues around the implants were isolated and gently dried by a piece of gauze. For each abutment, the buccal and lingual surfaces were individually scored. This was done according to the gingival scores described by Loe and Silness[12].

Probing depth

According to Ramfojord[13], PD measurements were taken at six-points measuring mesial, middle, and distal from the buccal and the lingual aspect.

Mobility

According to Meredith et al.[14]:

  1. The entire measuring procedure was took a round 4 s.
  2. The periotest was correctly positioned, perpendicular to the long axis of the ball abutment or the abutment tooth to be sure of obtaining valid and meaningful measurement.


Radiographic evaluation

An assessment of the bone quantity at the implant site was done with the help of intra-oral periapical radiographs obtained by the long cone paralleling technique to minimize the distortion and standardized results using the film holders (Rinn XCP, TPC; Advanced Technology Inc., USA). All patients will expose to periapical radiographs and digital panoramic radiographs for comparison at insertion, 3, 6, and at 9 months. By using film holder to standardize the results, Digora sensor was inserted into Digora scanner (Soredex Inc., Tuusula, Finland) for processing [Figure 2],[Figure 3],[Figure 4].
Figure 2: Both side fixtures insertion and cover screw tightened in its place.

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Figure 3: Panoramic radiograph of postoperative fixture.

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Figure 4: Ball abutment insertion.

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Reference lines for abutment and implants

All patients were registered into the program and tabulated to compare the results [Digora for Windows, version 2.7 (DFW)]. Following steps were done for abutments and implants for both groups [Figure 5].
Figure 5: Digital periapical radiograph for group I present the alveolar bone loss around abutment and implant from insertion, 3, 6 and 9 months..

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  1. Horizontal line was drown at the apex of abutment tooth and implant with 40 mm (software will calibrate the distance for standardization).
  2. Mesial and distal vertical line (B and C) was drowning around the mesial and distal aspect of implant and abutments from most superior point of alveolar bone height (point D) to the reference line (line A).
  3. A minimum of two readings were made for each implant and two reading were made for each abutment for both groups and the average values were used to calculate the amount of crystal bone loss. The results obtained were subjected to statistical analysis using Student's unpaired t test.


    1. Reference line.
    2. Line B to determine.
    3. The measurement from the most superior the bone–implant contact to the reference point from distal side.
    4. Line C to determine the measurement from the most superior the bone–implant contact to the reference point from mesial side.
    5. Point D, the most superior bone–implant contact. The point where we start the measuring.



      Results Top


    Gingival index

    [Table 1] and [Table 2].
    Table 1: Gingival Index scores around abutments in both groups through all study period

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    Table 2: Gingival index scores around implants in both groups through all study period

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    Probing depth

    Propping depth was demonstrated in [Table 3] and [Table 4].
    Table 3: Comparison between two groups regarding probing depth around implants

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    Table 4: Probing depth scores around implants in both groups through all study period

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    Mobility

    Mobility was recorded and mentioned in [Table 5] and [Table 6].
    Table 5: Mobility (PTVs) scores around abutments in both groups through all study period

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    Table 6: Comparison between two groups regarding mobility (PTVs) around implants through all study period

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    Radiographic evaluation

    Radiographic evaluation recorded Alveolar bone loss as shown in [Table 7] and [Table 8].
    Table 7: Alveolar bone loss around abutment teeth for both groups through all study period

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    Table 8: Alveolar bone loss around implants for both groups through all study period

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      Discussion Top


    The mandibular distal extension RPDs have many problems which can be overcome with the placement of implants at the first molar areas, the implant assisted removable partial denture serves as a cost-effective, prosthetic solution for partially edentulous patients who are not candidates for extensive fixed implant supported restorations[15].

    This study was aimed to evaluate the effect of clasp designs clinically and radiographically on the abutment teeth and distal implants regarding GI, PD, mobility and alveolar bone loss. As different retainers influence the occlusal load distribution with long-term successful restoration[16].

    Different retainers of RPDs will have different effects on abutments and residual ridges. Rigid retainers (Aker clasps) produced less damage to the residual ridges and much stresses to the abutments, while flexible retainers (RPI clasps) were found to create greater stress concentrations on the residual ridges and less stresses to the abutments[17]. The use of dental implant to Kennedy class I cases control the excessive torque forces that may act on the abutment[18].

    The RPI clasp fulfills the requirements or proper clasp design, and minimizes stress on the abutment tooth. The rest, located on the mesial occlusal surface of the abutment tooth, acts as the point of rotation and exerts a mesial force on the tooth rather than a distal displacing force. Pressure exerted on the extension base moves the proximal plate tissue ward without torque the tooth. The (I) bar also moves mesiogingivally away from the tooth under masticatory load[9].

    Aker (circumferential clasp) would appear to be the most simple and versatile clasp suitable for the mandibular first premolars. Excellent bracing qualities and easy to design and construct. Presence of soft tissue undercuts buccally often precludes the use of RPI clasp, the Aker clasp was able to resist lateral forces[9].

    The O-ring is perhaps the most popular attachment available to the dental implant to increase the retention of partial overdentures as well as conventional overdentures. Compressive loading of implant O-ring attachments assemblies must occur only in conjunction with tissue loading; otherwise, forces may develop can be destructive to the implant, the abutment, the tissue, and the prosthesis[19].

    Clinical evaluation parameters include: GI according to Loe and Sinless[12], PD according to Ramfojord[13] and mobility test together with radiographic evaluation for alveolar bone loss around both implants and abutments using Digora for Windows software were carried out immediately at insertion, 3, 6 and 9 months after insertion.

    Digora system was consider one of the reliable and versatile technology due to good image quality and easy to use and reduce exposure time which expand the diagnostic and image referral possibilities of radiology in dentistry[20].

    Regarding to GI the increase of GI after 3 months of insertion was statistically significant in both groups this may be correlated to increased plaque accumulation, this was in agreement with Karoussis et al.[21] and Amaral et al.[22].

    While at the sixth month the increase was not statistically significant up to ninth months. This result was in agreement with Alam-Eldeen[23], he concluded that, regardless the type of the retainer used with natural abutments, GI and PD have no significant differences effect on implants and natural abutment teeth.

    This result was in agreement with Saleh[24], who study the effect of two different clasps, Aker clasp and reverse Aker clasp on tissue health around abutment teeth and implants assisting mandibular bilateral removable partial overdenture, the results was no statistically significant differences between results in regard oral tissue health around the abutment teeth and implants located in the first molar area.

    Another explanation for this result may be related to the first contact of the denture to the patient's soft tissue, which may be combined with some inflammation in the mucosa and periodontium supporting structure[25].

    In this study, with time, in both groups, PD of the abutment teeth and implants there was no statistically significant differences after 9 months, this may be attributed to the sufficient oral hygiene instruction after insertion and continuous recall appointment, and this was in agreement with Mekkawy[26], Eugenio et al.[27] and Gerber et al.[28].

    Also our results for pocket depth are in agreement with Abo Elnaga[29], she was compered between two groups group I retained with O-ring attachment and group II retained with dome shape abutment she found that, no statistically significance difference in PD around abutment teeth and implants regardless type of attachment used with implants.

    Almost all the fixtures were successfully osseointegrated all over the follow-up period, that there is no mobility, no pain and the fixtures were surrounded by normal bone tissue in intimate contact with their surfaces this was in agreement with Zancopé et al.[30].

    I-bar and circumferential clasps did not differ significantly in terms of success rates after 60 month.

    The differences between the mobility of the abutments and implants in both groups were not statistically significant differences throughout the observation period, these results are in agreement with Miller and Grasso[31], and Kapura et al.[32], Naert et al.[33] and Jorge et al.[34] they measure the mobility to the abutment and implants after the insertion of the prosthesis and the result was a more stable prosthesis associated with a progressive osseointegration process.

    Also the results were in agreement with Aparicio et al.[35] they were study implant stability and evaluated that there were direct correlation between decreased negative periotest values and osseointegration.

    The amount of peri-implant bone loss agrees with the findings obtained by Albrektsson et al.[36] who proposed criteria for implant survival and success, in which marginal bone level changes in the first year should be less than 1 mm, and annual bone loss should be less than 0.2 mm.

    In this study, crestal bone resorption related to implant and abutments in both groups after 9 months follow up did not exceed 1 mm, hence implants were considered successful this were in agreement with Piao and Koak[37] and Mahrous[38].

    The placement of a bilateral distal implants to assist and retain a RPD can prevent most of abutment teeth problems associated with conventional RPD and reduce marginal bone loss this were in agreement with Bortolini et al.[39] and Chronopoulos et al.[40].

    Continuous recall for checkup the occlusion and partial denture fit is necessary. Also, the oral hygiene instruction is very important factors for long-term successful restoration[41].


      Conclusion Top


    Through ready established data, the use of rigid (Aker clasps) can cause significant changes regarding to GI, PD, mobility and alveolar bone loss to abutment teeth when used as a direct retainers in case of bilateral mandibular free end saddle cases when compared with gingival approaching resilient retainers (RPI clasps). Our results concluded that, the placement of a bilateral distal implants in case of mandibular bilateral free end saddle reduce most problems of direct retainers on the abutments when adequate oral hygiene instructions, careful prosthetic treatment planning and regular recall appointments were done. Despite these favorable clinical findings, it is important to mention that, future long-term investigations are needed before definite conclusions [Figure 6],[Figure 7],[Figure 8],[Figure 9],[Figure 10].
    Figure 6: Digital periapical radiograph for group II present the alveolar bone loss around abutment and implant from insertion, 3, 6 and 9 months.

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    Figure 7: Implant reference lines and points.

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    Figure 8: The mean values of gingival index in both groups around abutment and implants at the different intervals of the follow-up period.

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    Figure 9: The mean values of probing depth in both groups around abutments and implants at the different intervals of the follow-up period.

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    Figure 10: The mean values of mobility (PTVs) scores for both groups around abutments and implants at the different intervals of the follow-up period.

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    Financial support and sponsorship

    Nil.

    Conflicts of interest

    There are no conflicts of interest.



     
      References Top

    1.
    Nathalie P, Neal M, Jacques P. The glossary of prosthodontic terms. J Prosthetic Dent 2017; 9:e51  Back to cited text no. 1
        
    2.
    Wilson H. Dental technology and materials for students. Oxford Blackwell Sci Pub 1987; 8:372.  Back to cited text no. 2
        
    3.
    Mitrani R, Brudvik J, Phillips K. Posterior implants for distal extension removable prostheses a retrospective study. Int J Periodontics Restorative Dent 2003; 4:353–359.  Back to cited text no. 3
        
    4.
    Carr A, Brown D. Removable partial dentures in McCracken's removable partial prosthodontics. J Dent Technol 2011; 12:311–315.  Back to cited text no. 4
        
    5.
    Ohkubo. Effect of implant support on distal extension removable partial dentures in vitro assessment. J Oral Rehabil 2007; 1:52–56.  Back to cited text no. 5
        
    6.
    Mijiritsky E. Implants in conjunction with removable partial dentures a literature review. Implant Dent 2007; 2:146–154.  Back to cited text no. 6
        
    7.
    Shahmiri R, Aarts JM, Bennani V, Das R, Swain MV. Strain distribution in a Kennedy Class I implant assisted removable partial denture under various loading conditions. Int J Dent 2013; 4:11.  Back to cited text no. 7
        
    8.
    Becker CM, Kaiser DA. Surgical guide for dental implant placement. J Prosthet Dent 2000; 2:248–251.  Back to cited text no. 8
        
    9.
    Krol A. (Rest, proximal plate, I bar) clasp retainer and its modifications. Dent Clin North Am 1973; 17:631–649.  Back to cited text no. 9
        
    10.
    Leupold RJ, Kratochvil FJ. An altered-cast procedure to improve tissue support for removable partial denture. J Prosthet Dent 1965; 15:672–678.  Back to cited text no. 10
        
    11.
    Banton B, Henry MD. Overdenture retention and stabilization with ball and socket attachment principles and techniques. J Dent Technol 1997; 7:14–20.  Back to cited text no. 11
        
    12.
    Loe H, Silness J. Periodontal disease in pregnancy prevalence and severity. Acta Odont Scand 1963; 21:533.  Back to cited text no. 12
        
    13.
    Ramfojord S. The periodontal index (PDI). J Periodont 1967; 38:602.  Back to cited text no. 13
        
    14.
    Meredith G, Silva L, Lauser N. Resonance frequency analysis of implants subjected to immediate or early functional occlusal loading. Successful vs. failing implants. Clin Oral Implants Res 2004; 15:428–434.  Back to cited text no. 14
        
    15.
    Canan B, Begum B, Sebnem O, Gulsen B, Jusuf E. Distal extension mandibular removable partial denture with implant support. Eur J Dent 2016; 4:566–570.  Back to cited text no. 15
        
    16.
    David J, Sebastien G, Nathalie P, Neal M, Jacques P. A retrospective clinical study of implant retained prosthetic partial dentures: a follow up investigation. J Implant 2014; 4:38–43.  Back to cited text no. 16
        
    17.
    Igarashi Y, Ogata A, Kuroiwa A, Wang CH. Stress distribution and abutment tooth mobility of distal-extension removable partial dentures with different retainers. J Oral Rehabil 1999; 2:111–118.  Back to cited text no. 17
        
    18.
    Bural C, Buzbas B, Ozatik S. Distal extension mandibular removable partial denture with implant support. Eur J Dent 2016; 4:566–570.  Back to cited text no. 18
        
    19.
    Winkler S, Plematti J, Rothman A, Siamos G. An overview of the o-ring implant overdenture attachment clinical report. J Oral Implantol 2002; 2:82–89.  Back to cited text no. 19
        
    20.
    Mamoru W, Keiichi N, Toshiki O. Digital subtraction technique for evaluation of oeri-implant bone change in digital dental imaging. Bull Tokyo Dent Coll 2006; 47:57–64.  Back to cited text no. 20
        
    21.
    Karoussis I, Salvi G, Heitz-Mayfield L, Bragger U, Lang N. Association between periodontal and periimplant conditions: a 10-year prospective study. Clin Oral Implants Res 2004; 15:1–7.  Back to cited text no. 21
        
    22.
    Amaral B, Gomes S, Roncalli A, Carreiro A, Almeida E. A clinical follow-up study of the periodontal conditions of RPD abutment and non-abutment teeth. J Oral Rehabil 2010; 7:545–552.  Back to cited text no. 22
        
    23.
    Alam-Eldeen H. The effect of attachments versus telescopic crowns in tooth- implant supported Kennedy Class I partial denture on the abutments. Cairo, Egypt: Cairo University; 2011.  Back to cited text no. 23
        
    24.
    Saleh A. Abutment tissue health as related to clasp design in implant assisted mandibular distal extension removable partial overdentures. Mansoura, Egypt: Mansoura University; 2014.  Back to cited text no. 24
        
    25.
    Dubravka Z, Asja C, Melita P. The effect of removable partial denture on periodontal health of abutment and non abutmentteeth. J Periodontal 2002; 2:137–144.  Back to cited text no. 25
        
    26.
    Mekkawy M. Bone level changes in single mandibular implant retained overdenture. Alexandria, Egypt: Alexandria University; 2002.  Back to cited text no. 26
        
    27.
    Eugenio R, Nicola M, Matteo L, Diego V. Therapy of peri-implantitis with resective surgery, a 3-year clinical trial on rough screw-shaped oral implants. Part I: clinical outcome. Clin Oral Implant Res 2005; 16:1–9.  Back to cited text no. 27
        
    28.
    Gerber J, Balmer G, Salvi N, Lang J. Bleeding on probing and pocket probing depth in relation to probing pressure and mucosal health around implants. Clin Oral Implant Res 2009; 50:75.  Back to cited text no. 28
        
    29.
    Abo Elnaga M. Effect of implant supported bilateral free end saddle partial denture on the supporting structure of its principle abutments. Mansoura Dent J 2010; 4:566–570.  Back to cited text no. 29
        
    30.
    Zancopé K, Karam F, Neves F. Placement of a distal implant to convert a mandibular removable Kennedy class I to an implant-supported partial removable Class III dental prosthesis: a systematic review. J Prosthet Dent 2015; 113:528–533.  Back to cited text no. 30
        
    31.
    Miller E, Grasso J. Removable partial prosthodontics. Philadelphia: Williams and Wilkins; 1981.  Back to cited text no. 31
        
    32.
    Kapura K, Dent R, Hasse A. A randomized clinical trial of two basic removable partial denture designs. Part I: comparisons of five-year success rates and periodontal. J Prosthet Dent 1994; 3:268–282.  Back to cited text no. 32
        
    33.
    Naert I, Duyck J, Quirynen M, Jacobs R, van Stenberg D. Part I: a longitudinal clinical evaluation, Biologic outcome of implant-supported restorations in the treatment of partial edentulism. Clin Oral Implants Res 2002; 13:381–389.  Back to cited text no. 33
        
    34.
    Jorge J, Giampaolo ET, Vergani CE. Clinical evaluation of abutment teeth of removable partial denture by means of the periotest method. J Oral Rehab 2007; 3:222–227.  Back to cited text no. 34
        
    35.
    Aparicio C, Lang N, Rangert B. Validity and clinical significance of biomechanical testing of implant/bone interface. Clin Oral Imp Res 2006; 2:2–7.  Back to cited text no. 35
        
    36.
    Albrektsson T, Worthington P, Eriksson A. The long-term efficacy of currently used dental implants: A review and proposed criteria of success. Int J Oral Maxillofac Implants 1986; 13:11–25.  Back to cited text no. 36
        
    37.
    Piao C, Koak S. Marginal bone loss around three different implant systems: radiographic evaluation after 1 year. J Oral Rehab 2009; 10:748.  Back to cited text no. 37
        
    38.
    Mahrous A. Implant supported distal extension over denture retained by two types of attachments. A comparative radiographic study by cone beam computed tomography. J Int Oral Health 2015; 5:5–10.  Back to cited text no. 38
        
    39.
    Bortolini S, Franchi A, Coggiola A, Consolo U. Implant-retained removable partial dentures: an 8-year retrospective study. J Prosthodont 2011; 20:168–172.  Back to cited text no. 39
        
    40.
    Chronopoulos V, Sarafianou A, Kourtis S. The use of dental implants in combination with removable partial dentures. A case report. J Esthet Restorat Dent 2008; 6:355–364.  Back to cited text no. 40
        
    41.
    Merickse-Stern R. Clinical evaluation of overdenture restorations supported by osseointegrated titanium implants: a retrospective study. Int J Oral Maxillofac Implants 1990; 5:375–383.  Back to cited text no. 41
        


        Figures

      [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10]
     
     
        Tables

      [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]



     

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