JDSOR

Divya UK Jha et al 10.5005/jp-journals-10039-1136

Review Article

An Evaluation of Attachments: Implant-supported

Overdentures
1
Divya UK Jha, 2Mukesh K Singhal, 3Chandana Nair, 4Gopi N Dubey, 5Anshika Agarwal
6
Sankey K Badiya, 7Rumneet Kaur Billing

ABSTRACT of retention provided.1 It is very important for the clini-

The implant-supported overdenture attachments are used com-
monly, i.e., clips/bar, ball, magnets, locator, and telescopic crown
attachments. This review article presents basic information
between the different attachment systems used to retain and
support the maxillary and mandibular implant overdentures in
completely edentulous patients. It is based on a dental journal
search limited to English-language articles published from 1990
to date. The article discloses the introductory information and
advantages of aforesaid attachment systems. It also discusses
the comparisons among the implant survival rate, marginal bone
loss, soft tissue complications, retention, stress distribution, space
requirements, maintenance complications, and patient satisfaction
against the mentioned attachment systems. This is concluded from
the presentation, and it completely highlights that the use of ball
and locator system has overall advantage over the other systems.
Keywords: Attachment systems, Denture Precision attachments,
Implant-supported overdentures, Removable overdentures.
How to cite this article: Jha DUK, Singhal MK, Nair C,
Dubey GN, Agarwal A, Badiya SK, Billing RK. An Evaluation of
Attachments: Implant-supported Overdentures. J Dent Sci Oral
Rehab 2016;7(4):174-177.
Source of support: Nil
Conflict of interest: None
INTRODUCTION
The necessity of suffering from uncomfortable dentures
was eliminated by the introduction of dental implants
in the early 1980s. The problem of lack of stability and
retention, especially in the mandibular denture, has
been solved by the fabrication of overdenture prosthesis.
Implant-supported overdentures (IODs) are considered
one of the best options for this. The attachment systems
are considered the pillars of overdenture treatment.
An overdenture attachment permits movement during
function and removal from the mouth. Ideally, the attach-
ment should offer the possibility of controlling the degree
cian to have a good knowledge of the various attachment
systems, their advantages and disadvantages, and indi-
cations and contraindications for achieving long-lasting
stable results.2 The present review article discusses the
bar/clip (Fig. 1), ball (Fig. 2), magnet, locator (Fig. 3), and
telescopic crown (Figs 4A and B) attachments.
MATERIALS AND METHODS
The data presented in this review article has been collected
from various previously published articles and case reports
comparing the different attachment systems and periodi-
cally checking the longevity and patient satisfaction for
each attachment system on the basis of implant survival
rate, marginal bone loss, soft tissue complications, reten-
tion, stress distribution, space requirements, maintenance
and complications, and patient satisfaction. These publi-
cations were accessed by a thorough search of the dental
e-journals available for IODs, attachment systems, and
removable overdentures.
The data collected from various journals have been tab-
ulated as Table 1—bar/clip3-7; Table 2— ball3-5,7; Table 3—
magnet4,5; Table 4—locator3-5,8,9; and Table 5—telescopic
crown.4,5,10
From the above tabulated data, we can see the supe-
riority of locator attachment over the other types of
attachment systems.8,9 This difference between the in vitro
studies and clinical trials leads us to the conclusion that
the ball attachment still stays the most economical and
well-suited attachment system for all.

1,5
Postgraduate Student (1st Year), 2Professor and Head
3
Professor, 4Senior Lecturer, 6Postgraduate Student (3rd Year)
7
Postgraduate Student (4th Year)
1-7
Department of Prosthodontics, Crown & Bridge, Institute of
Dental Sciences, Bareilly, Uttar Pradesh, India
Corresponding Author: Divya UK Jha, Postgraduate Student
(1st Year), Department of Prosthodontics, Crown & Bridge
Institute of Dental Sciences, Bareilly, Uttar Pradesh, India
Phone: +917417504460, e-mail: divj2323@gmail.com
Fig. 1: Bar/clip attachment

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An Evaluation of Attachments: Implant-supported Overdentures

Fig. 2: Ball attachment Fig. 3: Locator attachment system

A B
Figs 4A and B: (A) Telescopic attachment over implant, and (B) denture fabricated on attachment

DISCUSSION The locator attachment system is the latest attach-

Conventional dentures rely upon the residual alveolar
ridge and mucosa for support and retention.11 Many
patients have problems adapting to their complete
dentures, especially to the mandibular prosthesis.12,13
Attachment stabilizes the prosthesis and the patient is
able to consistently reproduce a determined-centric occlu-
sion.12 The review of trends in IOD research examined the
performance of attachment systems, comparisons, and
outcomes in both clinical and in vitro settings. The in vitro
studies generally utilized multiple attachment systems
that showed significant differences among them while
the clinical studies generally evaluated only one attach-
ment system with no significant findings.14 This analysis
of the literature showed that there is a large discrepancy
between the study designs and the outcomes between the
clinical and in vitro studies for IOD.14 Most of the common
findings seen in the IOD research are as follows.
The observation period for clinical studies ranged
from 0.5 to 20 years with a mean of 3.6 years. Articles
involving two mandibular implants were the most
common. Ball attachment was the most common attach-
ment compared, followed by bar and magnet.14
Journal of Dental Sciences and Oral Rehabilitation, October-December 2016;7(4):174-177
ment system; therefore, it has been a gradual increase in
the clinical and in vivo studies regarding this attachment
system.4 Mahajan et al8 describes the various advantages
of locator attachment system in a severely atrophied
mandibular arch due to locator’s low-profile in vivo study.
Turk et al9 performed an in vivo study comparing
retention of ball and locator attachment, using four dental
implants and two polyethylene blocks. Ball attachments
showed significant retention loss after 100, 200, 400,
500, 1500, and 4000 cycles, and the locator attachments
showed significant retention loss after 100, 200, 300, 500,
and 3000 cycles. Attachment retention forces from 5 to
7 Ncm are sufficient to stabilize over dentures (OVDs)
during function. Based on this information, the retention
forces of both attachment systems tested in the study
would be acceptable after 4.5 years (mean of 9.7 Ncm for
ball attachments and 21.7 Ncm for locator attachments
after 5000 insertion–separation cycles). Classified as
attachment with resilient patrix, the locator attachment
system has showed increased retention, lesser space
requirement, and better ease of insertion due to its self-
aligning fit. But there is lack of significant superiority to
the ball attachment in the clinical studies.
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Divya UK Jha et al

Table 1: Bar/clip attachment

Implant Maintenance
Attachment survival Marginal Soft tissue Stress Space and Patient
system rate bone loss complications Retention distribution requirements complications satisfaction
Bar/clip No Mean Hyperplasia More Higher stress A distance of Most frequent Good
correlation marginal of the mucosa retentive distribution than 10–12 mm repair involves
found bone loss of covering the when ball attachment from the crest retentive clips
0.3 mm in residual ridge subjected but decreased of the ridge to (25%)
first year has to vertical in comparison incisal edge Adjustment
been noted and oblique to telescopic of retaining
forces attachment sleeve around
Distributes Rigid bars bar and
tourqing contribute to load fracture
forces more sharing between
evenly implants

Table 2: Ball attachment

Implant
Attachment survival Marginal Soft tissue Stress Space Maintenance and Patient
system rate bone loss complications Retention distribution requirements complications satisfaction
Ball No No Does not Satisfactory Under A distance More appointments after Good
correlation significant affect the vertical of 10–12 insertion required for
found loss seen peri-implant forces, mm from flange adjustment
condition minimum the crest of Maintenance of ball
stress the ridge to screws is high
transferred incisal edge Need for the stud part to
to implant be retightened
Matrix of single implant
attachments are changed
with higher frequency

Table 3: Magnet attachment

Implant
Attachment survival Marginal Soft tissue Stress Space Maintenance and Patient
system rate bone loss complications Retention distribution requirements complications satisfaction
Magnet No No Plaque Least Less Has low More appointments Less
correlation significant accumulation retentive excessive profile after insertion required satisfaction
found loss seen is highest attachments forces are for flange adjustment due to
Unreliable transmitted Maintenance of frequent
and weak to the magnet keepers is high complications
retention implant Need for the magnet
part to be retightened
Corrosion of the
magnetic keeper

Table 4: Locator attachment

Implant Maintenance
Attachment survival Marginal Soft tissue Stress and Patient
system rate bone loss complications Retention distribution Space requirements complications satisfaction
Locator No No Does not Dual retention Satisfactory A minimum space Higher Good
(attachment correlation significant affect the (mechanical of 8.5 mm require percentage of
with resilient found loss seen peril-implant plus frictional) Available in multiple retention loss
partix) condition After 5000 vertical height due to wear
insertion– options starting as
separation cycle low as 2.0 mm
shows better Excellent for cases
retention than with angulations
ball attachments problem and low
occlusal space

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An Evaluation of Attachments: Implant-supported Overdentures

Table 5: Telescopic crown attachment

Implant Maintenance
Attachment survival Marginal Soft tissue Space and Patient
system rate bone loss complications Retention Stress distribution requirements complications satisfaction
Telescopic No No Does not Frictional significant amounts Cannot be – Good
crown correlation significant affect the retention of masticatory forces used in cases
found loss seen peri-implant shows an are transferred to the where there
condition increase in supporting implant, is decrease
retention while a minimum interarch
with use masticatory loading space
is transferred to the
residual alveolar
ridge

CONCLUSION 4. Trakas T, Michalakis K, Kang K, Hirayama H. Attachment

Clinicians tend to use attachment system based on pref-
erence, rather than scientific evidence, due to high rate
of success of dental implants regardless of attachment
system. However, such decisions should be based on a
hierarchy of scientific evidence where different study
designs provide results of varying “strength.”15 The
various in vitro studies have shown a significant positive
response to the locator attachment system.14 Hence, it can
be concluded that ball attachment system still has higher
clinical superiority due to the fact that it is more economi-
cal, is easily available for overdenture, there is compara-
tive ease in fabrication of denture with it, and laboratory
procedure for attaching ball attachments provides more
durable and long-lasting prosthesis compared to chair-
side procedure.16 These attachments are more reliable
and acceptable by the patient.17 Further clinical studies
that can validate in vitro research should be encouraged
to address this discrepancy between the two areas.
ACKNOWLEDGMENTS
I, Divya UK Jha, would like to acknowledge my husband
Dr Gopi Nath Dubey and our parents for their kind
support. I am also thankful to Dr MK Singhal, Head of
the Department, Institute of Dental Sciences, Bareilly, for
his constant guidance and support. I am also grateful to
Dr Chandana Nair and Dr Anshika Agrawal for their help
in writing this article.
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