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QUINTESSENCE INTERNATIONAL
Overdentures represent a valuable and reli-
able alternative for completely edentulous
patients.1,2 Patients wearing overdentures
have demonstrated a significant increase in
their chewing ability, nutritional status, emo-
tional stability, and esthetics.3–6 Moreover, the
rigid anchorage of a mandibular overdenture
with a bar combines the prosthodontic
advantages of a removable and fixed pros-
thesis.7 However, a disadvantage of treat-
ment with overdentures is the time necessary
for healing before the insertion of the defini-
tive prosthesis.4 Usually, the matrices of the
bar or the freestanding attachments are con-
nected 3 to 6 months after implant insertion.2
Subsequently, a series of interventions
aimed at the relining of the prosthesis are
needed to maintain the stability and cleanli-
ness of the denture with no impairment of
the implant healing.
Early and immediate loading of dental
implants has been shown to result in very
good histologic and clinical results. Recently,
several authors have focused on the possibil-
ity of an immediate loading of dental implants
supporting overdentures to minimize the
delay between the surgical and prosthetic
phases.1,8–10 Immediate loading means to
place the final or provisional prosthetic
restoration within 48 hours of the surgical
procedure, and, therefore, it is a potentially
cost- and time-saving procedure. Early load-
ing did not negatively affect osseointegration
in mandibular overdentures,11 and no differ-
ences in the results between conventionally
loaded and immediately loaded implants
supporting overdentures were found.4
A new treatment concept for immediate loadingof implants inserted in the edentulous mandible
Tammaro Eccellente, MD, DDS1 /Michele Piombino, MD, DDS2 /
Adriano Piattelli, MD, DDS3 /Vittoria Perrotti, DDS, PhD3 /
Giovanna Iezzi, DDS, PhD3
Objectives: Retention of mandibular complete dentures on two or four interforaminal
implants is considered the most reliable procedure in implant therapy. There are different
retention elements available for all implant systems. The aim of the present study was to
clinically evaluate patients with a mandibular overdenture supported by the Ankylos
SynCone system (Dentsply). Method and Materials: Thirty-nine patients were treated with
156 implants. The treatment method was based on immediate loading of four interforami-
nal implants without the use of a bar retainer. The denture was placed on and retained by
prefabricated conical crowns that were inserted into the existing denture base by direct
intraoral polymerization immediately after surgery and supported by the corresponding
conical primary implant abutments. Results: The cumulative implant survival rate was
98.7% (two failures), while the prosthesis survival rate was 100%. After a total observation
of 30.3 months (range 12 to 60 months), all other implants presented healthy peri-implant
soft tissue conditions showing low value of clinical parameters. Conclusion: This method
facilitates secondary splinting of the inserted complete denture. The conical crowns con-
cept presented here resulted in stable complete denture retention, reduced the denture
base, and improved oral hygiene. (Quintessence Int 2010;41:489–495)
Key words: complete dentures, dental implants, edentulous mandible, immediate loading,
overdentures, prefabricated telescopic restorations
1Private Practice, Naples, Italy.
2Private Practice, Caserta, Italy.
3Dental School, University of Chieti-Pescara, Chieti, Italy.
Correspondence: Prof Adriano Piattelli, Via F. Sciucchi 63, 66100
Chieti, Italy. Fax: 11-39-0871-3554076. Email:[email protected]
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QUINTESSENCE INTERNATIONAL
Eccel lente et a l
In 1997, Chiapasco et al12 published a mul-
ticenter retrospective study on 904 immedi-
ately loaded implants retaining mandibular
overdentures. The overall survival rate (SRR,
ie, implants still in place at the end of the fol-
low-up) was 96.9% with a mean follow-up of
6.4 years. Subsequently, the same group con-
ducted a series of prospective studies inwhich they demonstrated that the overall sur-
vival and success rates (SCR, ie, good clinical
and radiologic outcome) were comparable
with those obtained with a two-stage proce-
dure.13,14 In a clinical study with two immedi-
ately loaded implants supporting a ball
attachment retaining mandibular overden-
tures, a survival rate of 100% was reported
after 1-year follow-up.2 A stable and retentive
prosthesis may allow proper healing of the
immediately loaded implants by reducing
excessive micromotion.2 The Ankylos
SynCone conical crown system (Dentsply
Friadent) could potentially provide adequate
and constant retentive force to retain implant-
supported overdentures.15
The aim of the present study was to clini-
cally evaluate patients with mandibular over-
dentures supported by the AnkylosSynCone
system.
METHOD AND MATERIALS
Between January 2002 and November
2005, 39 consecutive patients with edentu-
lous mandibles were treated with 156
Ankylos implants (Dentsply Friadent) placed
by two oral surgeons (T.E. and M.P.) in a pri-
vate practice. Table 1 shows the dimensions
of the examined implants. The patient popu-
lation consisted of 21 women (53.8%) and 18
men (46.2%). Age at implant placement
ranged between 42 and 82 years, and the
mean age was 62.3 years. Twenty-eight
patients were smokers. All participants
signed an informed consent form. The inclu-
sion criteria were sufficient bone volume
(minimum bone height of 12 mm, minimumbone width of 5 mm) for the insertion of four
interforaminal implants and a completely
edentulous mandible needing a total rehabil-
itation. Exclusion criteria were systemic
diseases likely to compromise the implant
surgery, uncontrolled diabetes, leukocyte
dysfunction, chemotherapy, drug and alco-
hol abuse, and psychiatric contraindications.
Preoperative panoramic radiograph and
computerized axial tomography (Fig 1) were
used for the surgical evaluation of the selected
sites for each patient. Local anesthesia wasinduced by infiltration of mepivacaine buccal-
ly and lingually in the canine regions in the
mandible. A midcrestal incision was made in
the keratinized mucosa, and a flap was raised
to expose the bone. The sites were prepared
according to the standard procedure for
Ankylos implants, and four clinically stable
implants were placed in each patient (Fig 2).
All implants were inserted at least 1 mm
below the crestal bone (range 1 to 3 mm).
Fig 1 Preoperative computerized axial tomography.
Diameter
Length (mm) 3.5 mm 4.5 mm
9.5 5 111 66 28
14 54 2
Total 125 31
Tabl e 1 Dimension and distribution of implants
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QUINTESSENCE INTERNATIONAL
Eccel lente et a
Sixty-two implants were immediately
placed after tooth extraction, 21 implants were
inserted after 4 to 10 weeks, and 73 were
inserted after 6 months or more. Autogenous
bone grafts without barrier membranes were
used to fill the original peri-implant bonedefects that frequently occurred when placing
immediate or delayed implants. Following
implant placement, the SynCone abutments
(Dentsply Friadent) were screwed to the
implants before suturing (Fig 3). A muco-
periosteal flap closure was performed using
interrupted or horizontal mattress sutures.
The SynCone abutments were manufactured
with a precise fit to prefabricated secondary
conical copings. These prefabricated copings
were polymerized into the denture base
directly in the mouth of the patients (Fig 4).Postsurgical treatment was administered
with amoxicillin 2 g daily for 7 days, with 100
mg nimesulide twice daily for 3 days, and
chlorhexidine digluconate solution 0.12%
twice daily for 1 minute for oral hygiene. Oral
hygiene instructions were provided. Patients
were instructed to wear the fixed denture
continuously and consume a soft diet. One
week after surgery, the denture was taken
out by the dental clinician, the sutures were
removed, and the denture was again contin-
uously worn for a further 6 weeks, except for
examination by the clinician, if needed. After
these 6 weeks, the denture was removed
again by the clinician to check the implants
and the condition of peri-implant soft tissues;it was then cleaned and reinserted. For
another 2 to 4 weeks, the denture was taken
out by the clinician weekly. Nutritional limita-
tions were also lifted after these 4 weeks.
Approximately 10 weeks after implant place-
ment, the patients were instructed to take out
and put in the denture at least once per day.
Twenty-five patients received a new den-
ture (18 with metallic framework) after a heal-
ing period of 4 to 6 months.
The dentition in the opposing maxilla was
as follows: 6 patients with complete denture,12 patients with fixed restorations, and 21
patients with partial removable dentures.
The modified Sulcus Bleeding Index
(mSBI) and modified Plaque Index (mPI)16
were recorded 2 months after surgery and at
various intervals during the observation peri-
od. Panoramic radiographs were taken at
implant placement, after 6 and 12 months,
and at different time intervals during the
observation period (Fig 5).
Fig 2 Clinical view of four interforaminal implantsafter insertion.
Fig 3 The SynCone abutments in situ beforesuturing.
Fig 4 The SynCone copings are polymerized intothe denture base directly in the mouth of the
patients.
Fig 5 Postoperative radiograph.
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QUINTESSENCE INTERNATIONAL
Eccel lente et a l
Technical complications were recorded.
Patient satisfaction was evaluated 4 weeks
after surgery and 1 year later.
RESULTS
No sensory disturbance was recorded fol-
lowing surgery. Two implants were removed
for mobility during the healing period (Table
2). The cumulative implant survival rate was
98.7% (Table 3), while the prosthesis survival
rate was 100%. After a total observation of
30.3 months (range 12 to 60 months), all
other implants presented healthy peri-
implant soft tissue conditions showing lowvalue of clinical parameters (mSBI = 1; mPI =
1) (Figs 6 and 7). Swelling or suppuration
were not observed. Radiographic examina-
tion showed excellent bone healing and sta-
ble crestal bone level. Most bone loss was
observed 6 months after implantation in
immediate and delayed implants. Ninety-two
implants (59.7%) showed bone contact close
or above the implant-abutment connection
after the total observation period.
During the observation period, abutment
screw loosening occurred in two cases (in 2
patients). Fourteen partial breaks of the den-
ture base (in 10 patients) occurred and were
quickly repaired. Most patients were satisfied
about the time and modality of treatment. Two
patients were not satisfied with the esthetics
of the rehabilitation. All other patients the
appreciated function, esthetics, and retention
of the restoration (Tables 4 and 5).
DISCUSSION
Previous reports have described a method
that uses four implants rigidly connected by a
U-shaped bar.12,14,17–20 This technique allows
good stabilization of the implants despite the
immediate loading. Thus, implants seem not
to be exposed to movements that may com-
promise osseointegration. The objective of
using a mandibular overdenture is a high
implant survival, preservation of crestal bone,
and high patient satisfaction.21 The use of a
fixed restoration to treat an edentulous
mandible can be impeded by anatomical fac-
tors or financial problems, and overdentures
may represent a more affordable treatment.1
The success of the overdenture treatment isrelated to the primary stability, prosthetic
design, and control of the occlusal forces.2
Recently, clinical studies have demonstrated a
high percentage of implant and prosthesis
survival rates. Gotfredsen et al22 reported a
98% implant and 100% prosthesis survival rate
at a 5-year recall, with excellent maintenance
of marginal bone and absence of mucositis.
Krennmair et al7 found a cumulative survival
rate of 99%, with excellent peri-implant con-
ditions, healthy soft tissues, good oral
hygiene, acceptable peri-implant marginalbone loss, low incidence of prosthodontic
maintenance, and high patient satisfaction.
The results of the present study were in
agreement with these studies with a cumula-
tive implant survival rate of 98.7%.
The Ankylos SynCone conical crown sys-
tem consists of four implants inserted and
immediately loaded in the mandibular inter-
foraminal area.15 Bone quality, a host-related
factor, is believed to be the strongest predictor
Implant Reason
Time of length Time of for
Sex/age Site implantation (mm) failure failure
Female/70 y Right first Immediate 14 8 wk Mobilitypremolar
Male/71 y Right lateral Late 11 6 wk Mobility
incisor
Table 2 Failure analysis
Time Implant at Failures Success Cumulative
interval interval Implants during rate survival
(y) start Dropouts at risk interval (%) (%)
0–1 156 0 0 2 98.7 98.7
1–2 154 0 0 0 100 98.7
2–3 110 0 0 0 100 98.7
3–4 70 0 0 0 100 98.74–5 38 0 0 0 100 98.7
Table 3 Life table
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QUINTESSENCE INTERNATIONAL
Eccel lente et a
Fig 6 Clinical and radiographicviews 6 months after treatment.
Fig 7 Clinical and radiographicviews 5 years later.
of outcome in immediate loading.23–27 Misch
and Degidi28 have reported that most immedi-
ately loaded implants are placed in anatomi-
cal sites with bone quality D1 or D2. It is
well-known that the mandible (especially the
interforaminal region) has a better bone quali-
ty than the maxilla, and this fact was probably
why several reports were available regarding
immediately loaded implants inserted in the
mandible with a high survival rate.29,30
In the system used in the present study,
abutments and conical crowns with a 4-degree
inclination were provided. The complete pro-
cedure may be executed in the dental office
without the use of a dental laboratory. Indeed,
it consists of the implant insertion and abut-
ment connection; subsequently, the gold
matrices were inserted on the abutments and
polymerized in the prosthetic base directly in
the patient’s mouth. The entire procedure
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(surgery and prosthodontics) lasted no more
than 2 to 3 hours. The conical retention was
stable as shown in the present study, where a
100% prosthesis survival rate was achieved
and few prosthetic complications occurred.
Moreover, no mucosal support of the final
prosthesis was needed, because the pros-
thesis was supported by only the implants, a
situation similar to a full-arch restoration.15
CONCLUSION
This method facilitates secondary splinting of
the inserted complete denture. The conical
crowns concept presented resulted in stable
complete denture retention, reduced denture
base, and improved oral hygiene. Its advan-
tages were its low cost, fast realization, high
stability of prosthetic restoration, and easy
management of the prosthetic phases.
ACKNOWLEDGMENTS
This work was partially supported by the National
Research Council (CNR), Rome, and by the Ministry of
the Education, University, Research (MIUR), Rome, Italy.
REFERENCES
1. Liddelow GJ, Henry PJ. Prospective study of imme-
diately loaded single implant-retained mandibular
overdentures: Preliminary one-year results.
J Prosthet Dent 2007;97:S126–S137.
2. Marzola R, Scotti R, Fazi G, Schincaglia GP. Immediate
loading of two implants supporting a ball attach-
ment–retained mandibular overdenture: A prospec-
tive clinical study. Clin Implant Dent Relat Res 2007;
9:136–143.
3. Vogel RC. Implant overdentures: A new standard of
care for edentulous patients. Current concepts and
techniques. Compend Contin Educ Dent 2008;29:
270–276.
QUINTESSENCE INTERNATIONAL
Eccel lente et a l
How do you evaluate the . . . Insufficient Sufficient Excellent Not evaluable
. . . operative phase? 3 27 7 2
. . . postoperative phase? 2 16 21 0
. . . phonetics? 2 17 20 0
. . . masticatory function? 0 12 27 0
. . . esthetics? 2 16 21 0
. . . denture stability? 0 13 26 0
. . . self–oral hygiene? 0 14 24 1
Tabl e 5 Patient satisfaction 12 months later (n = 39)
How do you evaluate the . . . Insufficient Sufficient Excellent Not evaluable
. . . operative phase? 5 21 13 0
. . . postoperative phase? 3 18 18 0
. . . phonetics? 5 22 9 3
. . . masticatory function? 2 18 8 11
. . . esthetics? 3 17 12 7
. . . denture stability? 0 17 18 4
. . . self–oral hygiene? 11 13 4 11
Table 4 Patient satisfaction 4 weeks after surgery (n = 39)
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QUINTESSENCE INTERNATIONAL
Eccel lente et a
4. Kawai Y, Taylor JA. Effect of loading time on the suc-
cess of complete mandibular titanium implant
retained overdentures: A systematic review. Clin
Oral Implants Res 2007;18:399–408.
5. Patsiatzi E, Malden N, Ibbetson R. A radiographic
review of bone levels around Calcitek dental
implants supporting mandibular overdentures:
Preliminary results at 3 to 6 years. Eur J Prosthodont
Restor Dent 2006;14:169–173.
6. De Bruyn H, Besseler J, Raes F, Vaneker M. Clinical
outcome of overdenture treatment on two nonsub-
merged and nonsplinted Astra Tech Microthread
implants. Clin Implant Dent Relat Res 2009;11:81–89.
7. Krennmair G, Krainhofner M, Piehslinger E. Implant-
supported mandibular overdentures retained with
a milled bar: A retrospective study. Int J Oral
Maxillofac Implants 2007;22:987–994.
8. Stephan G, Vidot F, Noharet R, Mariani P. Implant-
retained mandibular overdentures: A comparative
pilot study of immediate versus delayed loading
after two years. J Prosthet Dent 2007;97:S138–S145.
9. Peñarrocha M, Boronat A, Garcia B. Immediate load-
ing of immediate mandibular implants with a full-
arch fixed prosthesis: A preliminary study. J Oral
Maxillofac Surg 2009;67:1286–1293.
10. Alsabeeha N, Atieh M, Payne AG. Loading protocols
for mandibular implant overdentures: A systematic
review with meta-analysis. Clin Implant Dent Relat
Res 2009 (in press).
11. De Smet E, Duyck J, Vander Sloten J, Jacobs R, Naert
I. Timing of loading—immediate, early or delayed—
in the outcome of implants in the edentulous
mandible. A prospective clinical trial. Int J Oral
Maxillofac Implants 2007;22:580–594.
12. Chiapasco M, Gatti C, Rossi E, Haefliger W,
Markwalder TH. Implant-retained mandibular over-
dentures with immediate loading. A retrospective
multicenter study on 226 patients. Clin Oral
Implants Res 1997;8:48–57.
13. Chiapasco M, Abati S, Romeo E, Vogel G. Implant-
retained mandibular overdentures with Branemark
System MKII implants: A prospective comparative
study between delayed and immediate loading. Int
J Oral Maxillofac Implants 2001;16:37–46.
14. Chiapasco M, Gatti C. Implant-retained mandibular
overdentures with immediate loading: A 3- to 8-
year prospective study on 328 implants. Clin
Implant Dent Relat Res 2003;5:29–38.
15. Zhang RG, Hannak WB, Roggensack M, Freesmeyer
WB. Retentive characteristics of Ankylos SynCone
conical crown system over long-term use in vitro.
Eur J Prosthodont Restor Dent 2008;16:61–66.
16. Mombelli A, van Osten MAC, Schurch E, Lang NP. The
microbiota with successful or failing osseointegrat-
ed implants. Oral Microbiol Immunol 1987;2:
145–151.
17. Degidi M, Piattelli A, Iezzi G, Carinci F. Retrospective
study of 200 immediately loaded implants retain-
ing 50 mandibular overdentures. Quintessence Int
2007;38:281–288.
18. Gatti C, Chiapasco M. Immediate loading of Brane-
mark implants: A 24-month follow-up of a compar-
ative prospective pilot study between mandibular
overdentures supported by conical transmucosal
and standard MK II implants. Clin Implant Dent
Relat Res 2002;4:190–199.
19. Romeo E, Chiapasco M, Lazza A, et al. Implant-
retained mandibular overdentures with ITI
implants. Clin Oral Implants Res 2002;13:495–501.
20. Gatti C, Haefliger W, Chiapasco M. Implant-retained
mandibular overdentures with immediate loading:
A prospective study of ITI implants. Int J Oral
Maxillofac Implants 2000;15:383–388.
21. Cooper LF, Moriarty JD, Guckes AD, et al. Five-year
prospective evaluation of mandibular overdentures
retained by two microthreaded, Tioblast nonsplint-
ed implants and retentive ball anchors. Int J Oral
Maxillofac Implants 2008;23:696–704.
22. Gotfredsen K, Holm B. Implant-supported mandibu-
lar overdentures retained with ball or bar attach-
ments: A randomized prospective 5-year study. Int J
Prosthodont 2000;13:125–130.
23. Jaffin R-A, Kumar A, Berman CL. Immediate loading
of implants in partially and fully edentulous jaws:
A series of 27 case reports. J Periodontol 2000;71:
833–838.
24. Degidi M, Piattelli A. Immediate functional and non-
functional loading of dental implants: A 2- to 60-
month follow-up study of 646 titanium implants.
J Periodontol 2003;74:225–241.
25. Degidi M, Piattelli A. Comparative analysis study of
702 dental implants subjected to immediate func-
tional loading and immediate nonfunctional load-
ing to traditional healing periods with a follow-up
of up to 24 months. Int J Oral Maxillofac Implants
2005;20:99–107.
26. Degidi M, Piattelli A. 7-year follow-up of 93 immedi-
ately loaded titanium dental implants. J Oral
Implantol 2005;31:25–31.
27. Degidi M, Piattelli A, Felice P, Carinci F. Immediate
functional loading of edentulous maxilla: A 5-year
retrospective study of 388 titanium implants.
J Periodontol 2005;76:1016–1024.
28. Misch CE, Degidi M. Five-year prospective study of
immediate/early loading of fixed prostheses in
completely edentulous jaws with a bone
quality–based implant system. Clin Implant Dent
Relat Res 2003;5:17–28.
29. Stricker A, Gutwald R, Schmelzeisen R, Gellrich NG.
Immediate loading of 2 interforaminal dental
implants supporting an overdenture: Clinical and
radiographic results after 24 months. Int J Oral
Maxillofac Implants 2004;19:868–872.
30. Mericske-Stern R, Probst D, Fahrländer F,
Schellenberg M. Within-subject comparison of two
rigid bar designs connecting two interforaminal
implants: Patients’ satisfaction and prosthetic
results. Clin Implant Dent Relat Res 2009;11:
228–232.
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