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Evaluation of transitional implant stabilized overdentures:
a case series report
C. OHKUBO*, M. KOBAYASHI\u2020, Y. SUZUKI\u2021, J. SATO\u00a7, T. HOSOI\u00b6 &
K. S. KURTZ**
*Department of Removable Prosthodontics, Tsurumi University School of Dental Medicine, Yokohama, Japan,
\u2020Department of Removable Prosthodontics, Tsurumi University School of Dental Medicine, Yokohama, Japan, \u2021Department of Removable

Prosthodontics, Tsurumi University School of Dental Medicine, Yokohama, Japan,\u00a7Division of Maxillo-facial Oral Implant, Tsurumi University School of Dental Medicine, Yokohama, Japan,\u00b6Department of Removable Prosthodontics, Tsurumi University School of Dental Medicine, Yokohama, Japan and**International Program in Prosthodontics, New York University College of Dentistry, New York , NY, USA

SUMMARYTransitional implants (TI) can immedi-

ately improve the stability and retention of existing unstable mandibular complete dentures. This study evaluated the improvement of mandibular com- plete denture stability and retention with the use of TI. Three TIs were placed in the intraforaminal region of the edentulous mandible of seven patients (three men, four women; mean age 69\u00c67 years). The patients\u2019 existing mandibular complete dentures were immediately modi\ufb01ed to TI-stabilized over- dentures. Their masticatory movements (mandibu- lar movements during mastication) were measured using a commercially available tracking device (BioPACK, Bioresearch, Japan), both before TI placement and about 1 month after delivery of the TI-stabilized overdentures. The mean time of each chewing phase (opening, closing, and occluding) and coef\ufb01cients of variation were calculated. The

patients also completed a questionnaire about the foods they could chew and indicated on a 100 mm Visual Analog Scale (VAS) their personal levels of comfort, ease of chewing, speech, and stability. For masticatory movements, there were no signi\ufb01cant differences (P > 0\u00c605) between the TI-stabilized overdentures and existing complete dentures. How- ever, the number of foods that could be chewed increased, and the stability and comfort were repor- ted as improved with the TI-stabilized overden- tures. Using TIs, the stability and comfort of the existing mandibular complete dentures studied in this report could be immediately improved.

KEYWORDS: transitional implant, overdenture, com-
plete denture, masticatory movements, denture
stability
Accepted for publication 10 September 2005
Introduction

Treatment with osseointegrated dental implant- retained overdenture prostheses is a well-accepted and highly predictable treatment modality for edentulous patients (1\u20135). If a suf\ufb01cient number of implants are placed, improved ef\ufb01ciency of implant-retained and supported overdentures can be obtained (6\u20138). How- ever, this protocol requires certain healing periods based on the implant surface and implant type (9). Some edentulous patients whose chief complaints are related to discomfort, instability and lack of retention of

the mandibular complete denture may not be receptive to an extended treatment time (10). Some patients request immediate treatment to solve their problems.

Transitional implants (TIs) were developed to support provisional \ufb01xed restorations during osseointegration of de\ufb01nitive implants and are usually placed simulta- neously at the time of de\ufb01nitive implant placement (11\u201315). They are generally removed prior to place- ment of the \ufb01nal implant prosthesis (13, 15). The primary treatment goal of TIs is to serve as \ufb01xed abutments for provisional prostheses during osseointe- gration of the de\ufb01nitive implants. Other uses of TIs

\u00aa2006 Blackwell Publishing Ltd
doi: 10.1111/j.1365-2842.2005.01580.x
Journal of Oral Rehabilitation200633; 416\u2013422

include stabilization of existing dentures, protection of osseous graft sites, and as vertical stops for tissue supported prostheses during the healing period (15). In the TI system used in this investigation, three imme- diate provisional implants (IPIs)* were placed for each patient, and IPI copings were \ufb01t on the existing denture bases (16).

Some studies have shown that the prognosis is good for immediate loading with de\ufb01nitive implants (17\u201321). However, TI-stabilized overdentures (TIOD) should be used in cases in which immediate loading cannot be app- lied and a healing period is needed. Such cases include the placement of fewer than four de\ufb01nitive implants, and cases involving poor bone quality, history of radiation therapy in the orofacial region and bone grafting.

The purpose of this investigation was to compare the converted TI-stabilized overdentures with existing con- ventional mandibular complete dentures (22, 23). TI-retained overdentures were fabricated by converting the existing mandibular complete dentures of seven mandibular edentulous patients. To observe the stability of the TI-stabilized overdentures (24\u201328), masticatory movements (mandibular movements during chewing) were measured before and after TI placement, and the patients were questioned about the function of each denture.

Materials and methods

Seven healthy patients (three men, four women; mean age 69\u00c67 years) participated voluntarily in this study (Table 1). The criteria of patient selection included the absence of any systematic contraindications to implant surgery, and the presence of suf\ufb01cient bone (>14 mm length) between the mental foramina. The existing prostheses were acrylic resin mandibular complete den-

tures (CD) that were <5 years old. The primary complaints among the patients were related to the instability and lack of retention of the mandibular dentures. The approval of the Ethical Committee for Human Clinical Research at the Tsurumi University School of Dental Medicine (no. 026) was procured, and a signed informed consent form was obtained from all patients before the initiation of treatment.

Modi\ufb01cation to TI-stabilized overdentures

Two to 3 weeks before IPI* placement, masticatory movements were measured using the existing mandib- ular CD, and questionnaires about comfort and chew- ing were completed to evaluate the existing CD without TI (24\u201327).

Using surgical guides, three IPIs were placed in the interforaminal region following the manufacturer\u2019s recommendations (Fig. 1a). Two or four de\ufb01nitive implants were to be placed in the future (16). The parallelism of the IPIs was con\ufb01rmed, and if necessary, the IPI heads (abutment portion of the IPI) were adjusted using the system\u2019s bending tool to establish parallelism (15, 16). The intaglio surface of the existing complete denture was relieved and free of contact with the IPI heads. Suf\ufb01cient denture base resin was removed to accommodate the IPI copings (Fig. 1b). After the IPI copings were \ufb01tted on the IPI heads, the clearance between the copings and the seating of the denture base of the CD was veri\ufb01ed\u2020(Fig. 1c; 16). Polymethylmeth- acrylate acrylic resin\u2021was placed in the hollowed surface of the CD. The CD was then seated over the IPIs in the proper original position using occlusal force until the resin completely polymerized. After the excess acrylic resin was trimmed and polished, the TIOD was delivered to the patient (Fig. 1d). Three to 4 weeks after the TIOD was delivered and the denture adjust- ments were \ufb01nalized, the masticatory movements were measured, and the questionnaires were again completed by the patients to evaluate the TIOD.

Measurement of masticatory movements
Masticatory movements were measured with a com-
mercially available tracking device\u00a7(28). A small
Table 1.Characteristics of seven patients participating in this
study
Patient
Age (years)
Gender
Maxirary arch
M. S
56
Man
CD
A. K
72
Woman
CD
T. A
60
Woman
CD
A. Y
74
Man
CD
S. I
76
Woman
PD
T. K
76
Woman
CD
I. K
74
Woman
CD
*Nobel Biocare, Goteborg, Sweden.

\u2020Fit-checker, GC, Tokyo, Japan.
\u2021Uni-fast II, GC, Tokyo, Japan.
\u00a7BioPACK, Bioresearch, Japan.

E V A L U A T I O N O F T I - S T A B I L I Z E D O V E R D E N T U R E S 417
\u00aa2006 Blackwell Publishing Ltd,Journal of Oral Rehabilitation33; 416\u2013422

magnet (13\u00b7 6\u00b7 4 mm) was attached to the lower surface of the anterior tooth region of both CDs and TIODs at the midlines. The test food used was one piece of fresh gummy candy\u00b6(approximately 4 gm). All chewing was performed on the side preferred by each patient and proceeded at the patient\u2019s own pace until swallowing (24\u201327). This process was repeated three times per denture. The data were calculated utilizing the BioPACK system.

The middle of the chewing cycle, i.e.10 strokes from the initial 10\u201319 strokes in the chewing cycle, was selected to compare masticatory movements. Each individual activity was identi\ufb01ed, and the mean time and standard deviation of each phase (namely, the opening phase, closing phase and occluding phase) were measured. A coef\ufb01cient of variation (CV; %) for each individual activity and each phase was then calculated from the standard deviation divided by the mean time (24\u201327). This measurement was repeated three times before and after IPI placement.

All data obtained were analyzed with the SPSS statistical package**. Wilcoxen signed rank tests were used to compare the CD and TIOD at a signi\ufb01cance level ofa\u00bc 0\u00c61.

Questionnaire about comfort
After measurements of the masticatory movements, all
patients completed a questionnaire about the foods

they could chew when the existing CD and the TIOD were worn. This questionnaire classi\ufb01ed 19 foods (including traditional Japanese foods) that were ranked from one to \ufb01ve according to the hardness of the food. These foods ranged from tender (soft) foods (i.e. Tofu and rice gruel; no. 1) to tough (hard) foods (i.e. pickled radish, peanuts, and hard rice crackers; no. 5). After chewing these foods while wearing each prosthesis, the patients indicated one of three categories: (i) could chew, (ii) could not chew and (iii) never eaten.

In addition, questionnaires based on the 100 mm Visual Analog Scale (VAS) method (29, 30) were \ufb01lled out by the subjects to assess their personal opinion based on eight factors: comfort, \ufb01tness, stability, ease of removal, speech, sucking, swallowing and chewing (Fig. 2).

Results
The mean time with SD and CV (%) for each individual
activity and their phases are shown in Fig. 3a,b. There
Fig. 1.(a) Using a surgical guide,
three immediate provisional implants
(IPI) were placed following manu-
facturer recommendations in the

interforaminal region. (b) IPI coping (c) IPI copings are placed on the IPI heads (d) IPI copings were embedded in the intaglio surface of the existing complete denture so that the copings were \ufb01tted on the IPI heads with

polymethylmethacrylate resin.
Comfort
In general, are you comfort with your lower prosthesis?
Not at all
comfortable
Totally
comfortable
X
65mm
Fig. 2.Example of a visual analog scale translated into English.

The distance from the end of the horizontal line on the left to the mark with an \u2018X\u2019 made by the subject was measured in millimetres.

\u00b6Meiji, Japan.
**Version 10\u00c60, SPSS Inc., Chicago, IL, USA.
C. OHKUBOet al.
418
\u00aa2006 Blackwell Publishing Ltd,Journal of Oral Rehabilitation33; 416\u2013422

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