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T w o i m p l a n t s s u p p o r t i n g a m a n d i b u l a r o v e r d e n t u r e Fig. 1 Fig. 1 Preoperative radiograph. ment, according to the respective functional and esthetic requirements. Impressions were taken, a master cast was poured, occlusal registrations were taken, and a wax-up was prepared and tried in. The conventional removable denture was de- livered one week before the surgery and used as a guide for the implant placement. On the day of the surgery, a single dose of an antibiotic (2 g of amoxicillin or 600 mg of clindamycin if allergic to penicillin) was administered 1 h before implant placement and continued for six days after sur- gery. Immediately before surgery, the partici- pants rinsed with a 0.2% chlorhexidine mouth- wash for 1 min. Local anesthesia was administered with a 4% articaine solution with 1:100,000 epi- nephrine (Ubistein, 3M ESPSE, Seefeld, Germany). Minimally invasive mucoperiosteal flaps, without releasing incisions, were elevated. Then, the im- plants were placed in the interforaminal region of the mandible according to a one-stage ap- proach.14 Each participant received two implants (Osstem TSIII, Osstem, Seoul, South Korea), placed according to a previously published surgi- cal protocol, recommended by the manufacturer, in order to achieve an insertion torque of at least 35 N cm.15 After surgery, the patients were in- structed to avoid brushing and trauma at the surgical site. A cold and soft diet was recom- mended for ten days. Smokers were recommend- ed to avoid smoking for three days postoperatively, and oral hygiene instructions were given. Anal- gesics (600 mg of ibuprofen) were prescribed as needed. Sutures (if present) were removed after ten days. The prosthetic procedures were begun eight weeks after implant placement. The healing abutments were unscrewed, the implant con- nections were cleaned and the newest low- profile direct implant overdenture attachments (OT Equator, Rhein83, Bologna, Italy; Fig. 2) were screwed on to the implants, using the OT Equator square screwdriver (Rhein83), with a torque range of 22–25 N cm. The cuff heights ranged from 0.5 to 7.0 mm, depending on the height of the transition zone of each implant, easily measured using the color-coded millime- ter Cuff Height Measurer Gauge (Rhein83) after healing abutment removal. Afterward, spaces to accept the female housing steel cage were prepared in the fitting surface of the new re- movable complete mandibular denture. Silicone protective discs (Rhein83) were placed over the OT Equator attachments (Fig. 3). Extra-soft (yellow, 600 g) or soft (pink, 1,200 g) retentive caps were placed in to the female steel housing, attached to the OT Equator and finally fixed to the denture using self-cured acrylic resin while the patient held the dentures in centric occlu- sion, chairside. After complete polymerization, the denture was picked up and silicone discs removed. Acrylic excess was trimmed and the denture was refined and polished (Fig. 4). One month after prosthesis delivery, the retentive caps were replaced with a stronger type (violet, 2,700 g; Fig. 5). The occlusion was developed to deliver a lingualized occlusion in centric relation with balanced contacts during function, avoid- ing any premature contacts (Figs. 6a & b). 54 Volume 3 | Issue 2/2017 Journal of Oral Science & Rehabilitation