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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 3  |  Issue : 1  |  Page : 17-20

Effect of the vitality of the overdenture abutment tooth on stability of the tooth


Department of Dental Health, Al Baha University, Al Bahah, Kingdom of Saudi Arabia

Date of Web Publication18-Jan-2016

Correspondence Address:
Khalid Ahmad Omar Arafa
Department of Dental Health, Faculty of Applied Medical Sciences, Al Baha University, PO Box 7273-Unit No. 2, Al Bahah - 65536 - 3047
Kingdom of Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1658-6816.174293

Clinical trial registration ISRCTN10675141

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  Abstract 

Objective: This study aimed to examine the effect of overdenture over vital and nonvital abutment teeth on teeth stability (teeth mobility and attachment loss).
Materials and Methods: An experimental, parallel design was used and the study was conducted over a 12-month period (December 2013 to November 2014). Thirty patients who voluntarily opted to participate in this study were recruited; the first group received overdenture over vital abutment teeth while the second group received overdenture over nonvital abutment teeth. Attachment loss and teeth mobility were periodically evaluated after 3 months, 6 months, and 12 months. The data were then analyzed by a computerized method [Statistical Package for Social Sciences (SPSS) version 20].
Results: Overdenture over vital abutment teeth showed lower attachment loss and teeth mobility, compared to the overdenture over nonvital abutment teeth. These differences were statistically significant.
Conclusion: It was concluded that the overdenture over vital abutment teeth was more stable, with a lower incidence of tooth mobility and less attachment loss than overdentures placed on nonvital teeth.

Keywords: Attachment loss, abutment teeth, tooth vitality


How to cite this article:
Arafa KO. Effect of the vitality of the overdenture abutment tooth on stability of the tooth. Saudi J Oral Sci 2016;3:17-20

How to cite this URL:
Arafa KO. Effect of the vitality of the overdenture abutment tooth on stability of the tooth. Saudi J Oral Sci [serial online] 2016 [cited 2019 Mar 20];3:17-20. Available from: http://www.saudijos.org/text.asp?2016/3/1/17/174293


  Introduction Top


Overdentures are removable prosthesis placed over prepared abutment teeth or implants and have been shown to have an acceptable durability . [1] When placed over natural teeth,the teeth provide good stability for the dentures giving the patients a sense of proprioception. This also gives patients the assurance that the teeth will not move around, thus preventing the need for denture adhesives. [2] The use of overdentures in patients with dentures not only eases the soreness of bearing tissues and nonstable dentures but also increases the function, comfort, and psychological well-being without the need of extensive fixed restoration. [3],[4]

While implants have gained popularity over natural teeth as abutments for overdentures they are not without drawbacks. Generally, a minimum of four implants are required in the maxilla for partial coverage of the palate. Furthermore compromised preoperative bone can reduce the success of implants; requiring the implants to have a lower number, reduced length, diameter, and angulation to improve outcomes. [5],[6],[7]

Alveolar bone loss can be associated with different factors including age, sex, anatomy of the facial bones, metabolism, oral health and hygiene, systemic health, diet, underlining systematic diseases, medications, and the period during which the patient has been edentulous. [8],[9],[10],[11] Regardless of these factors the retention of the natural teeth can reduce the rate of alveolar bone loss.

Previous studies have shown that the overdenture, as a treatment technique, was developed in order to keep the rest of the alveolar bone by holding the natural teeth. However, the teeth selected as abutments are prone to decay and periodontal disease, which led to the use of non-vital teeth as abutments for overdentures. [12]

While many aspects of overdentures have been studied, the impact of tooth vitality on the stability of the abutment tooth has received little attention. The aim of this study was to compare the stability of vital abutment teeth for overdentures with the stability of non-vital overdenture abutment teeth. over vital teeth to the effect of the overdenture over nonvital abutment teeth.


  Materials and Methods Top


The study was conducted in the Dental Clinic, Faculty of Dentistry at Al-Azhar University, Assiut Branch in Egypt over a 12-month period (December 2013 to November 2014). A parallel study design was used with 15 patients in each group.

The study was conducted on 30 patients. The patients were all males aged 59 years and above who were partially edentulous, and were wearing their third lower denture. Patients with systemic diseases were excluded from this study. All patients had a class I maxillomandibular relationship and were instructed to use toothbrushes and dental floss silk to maintain oral hygiene.

The patients were randomly divided into two groups of 15 patients each. The first group comprised of patients given overdentures over vital abutment teeth while the second group received overdentures over endodontically treated non-vital abutment teeth. Both the groups were then periodically evaluated after 3 months, 6 months, and 12 months in order to note the attachment loss and tooth mobility of the abutment teeth.

The root-supported overdentures were fabricated to determine periodontal and/or occlusal collapse. Some teeth were corrected to support and/or keep the prosthesis. [13] Preparation of the abutment teeth was implemented as follows: The crown of each tooth was reduced 2-3 mm above the free gingival margin, proceeding labially and lingually until dome-shaped. Preparation was obtained with a chamfer finishing line placed subgingivally. The crest of the dome shape was placed over the long axis of the abutment, and the sharp points were rounded.

This study was approved by the Dental Health Department of the Faculty of Applied Medical Sciences, Albaha University. The consent forms were signed by all participants. The experiment was conducted with the understanding and consent of the human subject. The study was undertaken according to the principles of the Helsinki Declaration, and no harm was done to any participants. The study was registered with the International Standard Randomised Controlled Trials Number (ISRCTN) registry with ID ISRCTN10675141.

The data was collected from the two groups in the form of a questionnaire, which included demographic characteristics and an observation checklist for attachment loss and teeth mobility. Attachment loss was measured according to Ramfjord (1967) who defines the measurement of attachment loss from the gingival margin to the cementoenamel junction (CEJ). [14] Clinical attachment loss (CAL) refers to the measurement of the loss of the position of the soft tissue in relation to the CEJ, which is a fixed point that does not change throughout life. CAL was assessed by both the probing depth and the gingival margin level. [15] The measurement of tooth mobility was done according to the criteria proposed by Everett and Sten (1969): First degree mobility of 0 mm (Class I), a second degree mobility of up to 1 mm (Class II), and a third degree mobility more than 1 mm (Class III) was recorded as per the criteria.[16] The tooth mobility was assessed by using the ends of two dental instrument handles (probe or mirrors). The mobility measurements were then graded into classes I, II, and III. [17]

The data were then analyzed by the Statistical Package for Social Sciences (SPSS) version 20 (IBM corp. Armonk NY, USA). The chi-square test was used to test the differences in patients' demographic characteristics in the two groups. The independent t-test was used to identify the differences between the two groups. For each group, a paired sample t-test was used to measure the differences before and after the intervention. All values were tabulated as an average (mean) with standard deviation (SD) and/or percent. P values less than 0.05 were considered to be significant at a level of confidence of 95%.


  Results Top


The patients who participated in this study were homogenous with regard to the demographic characteristics. There were insignificant differences in the variables such as age, education level, and years of being edentulous (P > 0.05) [Table 1].
Table 1: Characteristics of group 1 and group 2 patients who participated in the study

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[Table 2] and [Figure 1] show the attachment loss (expressed in mm) in both the first group (vital teeth) and the econd group (nonvital teeth). There was a significant increase in attachment loss over time. It also showed that the increase in attachment loss in patients with nonvital teeth was significantly higher than in patients with vital teeth. The table also that tooth mobility was higher in the second group (nonvital abutment) than in the first group (with vital abutment teeth).
Table 2: Comparing the means and standard deviations between the attachment loss for the first group of vital abutment teeth and second group with nonvital abutment teeth at different times

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Figure 1: Flowchart of the study

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[Table 3] and [Figure 2] show the abutment teeth mobility in the first and second groups. There were also significant increases over time regarding the abutment teeth mobility (expressed in mm). It also showed that the increase in the second group was significantly higher than the first group.
Table 3: Comparing the means and standard deviations of the tooth mobility between the first group of vital abutment teeth and the second group with nonvital abutment teeth at different times

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Figure 2: Comparing the means of attachment loss and tooth mobility between group 1 and group 2 at different times

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  Discussion Top


The findings show that there were significant increases in attachment loss over time in non-vital teeth as compared to vital teeth. A study conducted by Gulizio in 2005 to compare alveolar bone loss in the anterior segment area with conventional complete dentures to overdenture over a 5-year period, concluded that there was a significant decrease in alveolar bone loss in cases with overdentures, as compared to conventional complete dentures. [7] Krennmair in 2006 in a study on edentulous patients with facial aesthetics and associated structures found that it was necessary to place teeth in a more anterior position such that the residual ridge could provide a sufficient facial support than an overdenture (i.e., flanges and acrylic base); this was because the horizontal resorption of soft and hard tissues or loss due to trauma or disease was more prominent to be compensated in these structures. [18] In addition, Bryant in 2007 found no differences that were statistically significant in the bone loss of the premaxillary areas tested; this was due to the implant prosthesis type present in completely edentulous subjects. Moreover, bone grafting limitations to augment the missing tissues are well-known. [19]

Regarding teeth mobility, this study showed that the abutment teeth mobility and bone height in the first group with vital abutment was less than the second group. Grageda showed that a single implant mandibular overdenture has additional advantages including being less expensive and invasive and also increasing the level of satisfaction and quality of life. [20]

This study was similar to a review study conducted to assess the various factors for the feasibility of a fixed cantilever bridge; the findings of that review showed that the loading levels in non-vital teeth were double that of the vital teeth. [21] However, regarding the importance of abutment teeth, some researchers reported that successful abutments depend on the appropriate selection of vital or nonvital teeth, depending on the diagnosis and treatment plan. [22]

The strengths of this study include the comparison of two different methods of overdenture and also the length of the evaluation period (12 months). The study limitations were that the study was conducted among only 30 patients; such studies would yield more useful results if conducted on a larger sample size with complete randomization all over the Kingdom of Saudi Arabia.


  Conclusion Top


From this study, it was concluded that the overdenture over vital abutment teeth resulted in less teeth mobility and less attachment loss than that of nonvital teeth.

Financial support and sponsorship

Nil.

Conflicts of interest

I declare that this study is my work and it has not been submitted to any other journal. I also declare that I have no conflict of interest related to this study.

 
  References Top

1.
Petropoulos VC, Mante FK. Comparison of retention and strain energies of stud attachments for implant overdentures. J Prosthodont 2011;20: 286-93.  Back to cited text no. 1
    
2.
Mosby. Mosby's Dental Dictionary. 2 nd Ed. Mosby, Maryland Heights MI; 2004. p. 64.  Back to cited text no. 2
    
3.
Quirynen M, Alsaadi G, Pauwels M, Haffajee A, van Steenberghe D, Naert I. Microbiological and clinical outcomes and patient satisfaction for two treatment options in the edentulous lower jaw after 10 years of function. Clin Oral Implant Res 2005;16:277-87.  Back to cited text no. 3
    
4.
Kim Y, Oh TJ, Misch CE, Wang HL. Occlusal considerations in implant therapy: Clinical guidelines with biomechanical rationale. Clin Oral Implants Res 2005;16:26-35.  Back to cited text no. 4
    
5.
Shor A, Goto Y, Shor K. Mandibular two-implant-retained overdenture: Prosthetic design and fabrication protocol. Compend Contin Educ Dent 2007;28:80-9; quiz 101.  Back to cited text no. 5
    
6.
Vogel R. Clinical technique to simplify overdenture success. Implant Realities 2006;1:19-20.  Back to cited text no. 6
    
7.
Gulizio MP, Agar JR, Kelly JR, Taylor TD. Effect of implant angulation upon retention of overdenture attachments. J Prosthodont 2005;14:3-11.  Back to cited text no. 7
    
8.
Kreisler M, Behneke N, Behneke A, d'Hoedt B. Residual ridge resorption in the edentulous maxila in patients with implant-supported mandibular overdentures: An 8-years retrospective study. Int J Prosthodont 2003; 16:265-300.  Back to cited text no. 8
    
9.
Carlsson GE. Responses of jawbone to pressure. Gerodontology 2004; 21:65-70.   Back to cited text no. 9
    
10.
Smith BJ. Implant overdentures: The standard of care for edentulous patients. Br Dent J 2005;199:180.  Back to cited text no. 10
    
11.
Gulizio MP, Agar JR, Kelly JR, Taylor TD. Effect of implant angulation upon retention of overdenture attachments. J Prosthodont 2005;14:3-11.  Back to cited text no. 11
    
12.
Shankar YR, Srinivas K, Surapaneni H, Reddy SV. Prosthodontic treatment using vital and non vital submerged roots-two case reports. J Clin Diagn Res 2013;7:2396-9.  Back to cited text no. 12
    
13.
Brkovic-Popovic S, Stanisic-Sinobad D, Postic SD, Djukanovic D. Radiographic changes in alveolar bone height on overdenture abutments: A longitudinal study. Gerodontology 2008;25:118-223.  Back to cited text no. 13
    
14.
Ramfjord S, Ash MM. Occlusion. 3 rd ed. Philadelphia, London: WB Saunders Co.; 1983. p. 211-5.  Back to cited text no. 14
    
15.
Wolf HF, Rateitschak-Pluss EM, Rateitschak KH. Color Atlas of Dental Medicine: Periodontology. 3 rd ed. New York: Thieme; 2005. p 282-86.  Back to cited text no. 15
    
16.
Everett FG, Stern IB. When is tooth mobility an indication for extraction. Dent Clin North Am 1969;13:791-9.  Back to cited text no. 16
[PUBMED]    
17.
Reddy MS, Palcanis KG, Geurs NC. A comparison of manual and controlled-force attachment-level measurements. J Clin Periodontol 1997;24:920-6.   Back to cited text no. 17
    
18.
Krennmair G, Weinländer M, Krainhöfner M, Piehslinger E. Implant-supported mandibular overdentures retained with ball or telescopic crown attachments: A 3-year prospective study. Int J Prosthodont 2006;19: 164-70.  Back to cited text no. 18
    
19.
Bryant SR, MacDonald-Jankowski D, Kim K. Does the type of implant prosthesis affect outcomes for the completely edentulous arch? Int J Oral Maxillofacial Implants 2007;22(Suppl):117-39.  Back to cited text no. 19
    
20.
Grageda E, Rieck B. Metal-reinforced single implant mandibular overdenture retained by an attachment: A clinical report. J Prosthet Dent 2014;111:16-9.  Back to cited text no. 20
    
21.
Sharma A, Rahul GR, Poduval ST, Shetty K. Assessment of various factors for feasibility of fixed cantilever bridge: A review study. ISRN Dent 2012; 2012:259891.  Back to cited text no. 21
    
22.
Prasad DK, Hegde C, Bardia A, Prasad DA. Questionable abutments: General considerations, changing trends in treatment planning and available options. J Interdiscipl Dent 2013;3:12-7.  Back to cited text no. 22
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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