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Journal of Oral Science & Rehabilitation No. 2, 2017

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 Table 1 ) s r a e y ( e g A 64 82 68 x e S F F F Patient 1 Patient 2 Patient 3 i g n k o m S s t n a l p m I h t g n e l m m 7 s t n a l p m I h t g n e l . m m 5 8 s t n a l p m I h t g n e l m m 0 1 s t n a l p m I i e d w m m 5 3 s t n a l p m . I i e d w m m 4 ≥ s t n a l p m I t n a l p m i d e l i a F s i s e h t s o r p d e l i a F ) m m ( L B M 0 T P H O I 1 T P H O I I B I P 0 4 0 0 4 0 4 0 0 0.16 71.0 22.0 0/16 1/16 0 4 2 2 0 2 2 0 0 0.26 63.0 21.0 1/16 0/16 0 4 0 2 2 0 4 0 0 0.19 68.0 16.0 0/16 2/16 Patient 4 72 F 0 4 0 0 4 0 4 0 0 0.32 64.0 18.0 0/16 0/16 Total 4F/0M 0 16 2 4 10 2 14 0 0 1/64 3/64 (1.6%) (4.7%) Mean ± SD 71.5 ± 7.7 0.23 ± 0.07 66.5 ± 3.7 19.3 ± 2.8 MBL = Marginal bone loss; OHIP = Oral health impact profile; T0 = Baseline; T1 = One year after definitive prosthesis delivery; BI = Bleeding index; PI = Plaque index; SD = Standard deviation. Table 1 Characteristics and results of included patients/implants. the first alternative treatment for the completely edentulous mandible.19, 20 Nevertheless, the placement of at least four implants of standard length may allow the delivery of an overdenture supported by a CAD/CAM titanium bar and a low-profile attachment system,21 avoiding any bearing area on the soft tissue and reducing the denture base extension.22 The OT Equator for bars exists in two types, castable and prefabri- cated (threadable). In the present study, the prefabricated shape was used. This type of at- tachment is initially of higher cost, but it is highly wear resistant, its surface being of titanium nitride. Furthermore, it is easy to replace, if needed. A fixed dental prosthesis on four implants may be a possible alternative to a mandibular overdenture on four implants and supported by a CAD/CAM titanium bar with a low-profile attachment system. Nevertheless, it is associ- ated with higher marginal bone loss, high fre- quency of complications and poor plaque con- trol, particularly in extremely atrophic patients.23–26 In the present study, a trend of minimum marginal bone loss and good peri- odontal parameters was observed within the one-year follow-up, demonstrating that a good level of hygiene can be expected using this fixed-removable solution. Similar to with a fixed dental prosthesis, patient satisfaction significantly improves owing to an improve- ment in esthetics and masticatory function. Moreover, the prosthetic flanges of a fixed- removable solution allow for full lip and cheek support. Conclusion Within the limitations of this study, a mandibu- lar overdenture on four implants and supported by a CAD/CAM titanium bar with a low-profile attachment system can be considered an effec- tive and predictable option for patients with Cawood and Howell Class VI atrophic mandibles. Minimum marginal bone remodeling, good peri- odontal parameters and patient satisfaction can be expected. Competing interests MT is the Research Project Manager at Osstem AIC, Italy. However, this study was self- supported. Hence, the authors declare no con- flicts of interest. Journal of Oral Science & Rehabilitation Volume 3 | Issue 2/2017 39

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