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F i x e d - r e m o v a b l e s o l u t i o n f o r a t r o p h i c m a n d i b l e s Fig. 6 Metallic counterpart of the overdenture. Fig. 6 was conventionally fabricated on to the CAD/ CAM titanium bar as a counterpart (Fig. 6). Fi- nally, the overdenture was finished, sealing the borders to minimize food impaction and saliva and air leakage. The titanium bar was screwed at the abutment level according to the manu- facturer’s instructions, and the fixed-removable solution was delivered (Figs. 7a–c). All of the patients were then enrolled in a standard im- plant recall program. Oral hygiene maintenance was checked and radiographs were taken early after final prosthesis delivery. Occlusion was checked at every appointment (Figs. 8a & b). O u t c o m e m e a s u r e s The primary outcome measures were the fol- lowing: – Success rates of the implants and prosthesis: An implant was considered a failure if it pre- sented with any mobility, assessed by tapping or rocking the implant head with the metallic handles of two instruments, progressive mar- ginal bone loss or infection, and any mechan- ical complications rendering the implant un- usable, although still mechanically stable in the bone. A prosthesis was considered a failure if it needed to be replaced with another pros- thesis. – Complications: Any biological (pain, swelling, suppuration, etc.) and/or mechanical (screw loosening, fracture of the framework and/or the veneering material, etc.) complications were evaluated. – Marginal bone levels: The levels were as- sessed using intraoral digital periapical ra- diographs (Digora Optime, SOREDEX; pho- tostimulable phosphor imaging plate, size 2, pixel size of 30 μm, resolution of 17 lp/mm) at implant placement (baseline) and one year after loading. Intraoral radiographs were taken with the paralleling technique by means of a periapical radiograph with a com- mercially available film holder (Rinn XCP, Dentsply Rinn, Elgin, Ill., U.S.). The radio- graphs were accepted or rejected for evalu- ation based on the clarity of the implant threads. All readable radiographs were up- loaded to an image analysis software package (DfW 2.8, SOREDEX) that was calibrated using the known length or diameter of the dental implants and displayed on a 24 in. LCD screen (iMac, Apple, Calif., U.S.) and evalu- ated under standardized conditions (ISO 12646:2004). The marginal bone levels were determined from linear measurements per- formed by an independent calibrated exam- iner on each periapical radiograph, from the mesial and distal margin of the implant neck to the most coronal point where the bone appeared to be in contact with the implant. – Patient satisfaction with function and esthet- ics was assessed using a scale of 1–10, where 36 Volume 3 | Issue 2/2017 Journal of Oral Science & Rehabilitation