Fundamental Surgical and Prosthetic Principles of Mandibular Implant Assisted Prostheses

  • Samer Abi Nader
  • Samer Mesmar


The introduction of dental implants has dramatically changed the lives of many edentulous patients by providing a mechanism of anchorage that contributes to stabilizing the mandibular denture during function. This has provided a variety of new options for the treatment of complete upper and lower edentulism (Emami et al., Periodontol 66:119–31, 2014).

This chapter will discuss the fundamental principles and differences between the implant-retained and implant-supported mandibular dentures. The implant-retained overdenture presents a unique clinical situation that requires distinct surgical and prosthetic considerations to help optimize the clinical outcome (Kimoto et al., Clin Oral Implants Res 20:838–43, 2009). A multitude of stud-type attachment systems are available today to provide retention and stability for the mandibular complete implant-retained denture. A description of the various morphological characteristics and the impact that they have on the retention and wear behavior of stud attachments will be reviewed. This chapter will also cover the basic surgical and prosthetic principles that underline the planning of implant-supported removable and fixed mandibular prosthesis.


  1. 1.
    Atwood DA. Reduction of residual ridges: a major oral disease entity. J Prosthet Dent. 1971;26(3):266–79.PubMedCrossRefGoogle Scholar
  2. 2.
    Tallgren A. Alveolar bone loss in denture wearers as related to facial morphology. Acta Odontol Scand. 1970;28(2):251–70.PubMedCrossRefGoogle Scholar
  3. 3.
    Attard NJ, Zarb GA. Long-term treatment outcomes in edentulous patients with implant-fixed prostheses: the Toronto study. Int J Prosthodont. 2004;17(4):417–24.PubMedGoogle Scholar
  4. 4.
    Feine JS, Carlsson GE, Awad MA, Chehade A, Duncan WJ, Gizani S, et al. The McGill consensus statement on overdentures. Mandibular two-implant overdentures as first choice standard of care for edentulous patients. Gerodontology. 2002;19:3–4.PubMedCrossRefGoogle Scholar
  5. 5.
    Thomason JM, Feine J, Exley C, Moynihan P, M€uller F, Naert I, Ellis JS, Barclay C, Butterworth C, Scott B, Lynch C, Stewardson D, Smith P, Welfare R, Hyde P, McAndrew R, Fenlon M, Barclay S, Barker D. Mandibular two implant-supported overdentures as the first choice standard of care for edentulous patients–the York consensus statement. Br Dent J. 2009;207:185–6.PubMedCrossRefGoogle Scholar
  6. 6.
    Thomason JM, Kelly SA, Bendkowski A, Ellis JS. Two implant retained overdentures—a review of the literature supporting the McGill and York consensus statements. J Dent. 2012;40:22–34.PubMedCrossRefGoogle Scholar
  7. 7.
    Naert I, Alsaadi G, van Steenberghe D, Quirynen M. A 10-year randomized clinical trial on the influence of splinted and unsplinted oral implants retaining mandibular overdentures: peri-implant outcome. Int J Oral Maxillofac Implants. 2004;19(5):695–702.PubMedGoogle Scholar
  8. 8.
    Thomason JM, Lund JP, Chehade A, Feine JS. Patient satisfaction with mandibular implant overdentures and conventional dentures 6 months after delivery. Int J Prosthodont. 2003;16:467–73.PubMedGoogle Scholar
  9. 9.
    Raghoebar GM, Meijer HJ, Stegenga B, van’t Hof MA, van Oort RP, Vissink A. Effectiveness of three treatment modalities for the edentulous mandible. A five-year randomized clinical trial. Clin Oral Implants Res. 2000;11:195–201.PubMedCrossRefGoogle Scholar
  10. 10.
    Kordatzis K, Wright PS, Meijer HJ. Posterior mandibular residual ridge resorption in patients with conventional dentures and implant overdentures. Int J Oral Maxillofac Implants. 2003;18:447–52.PubMedGoogle Scholar
  11. 11.
    Attard N, Wei X, Laporte A, Zarb GA, Ungar WJ. A cost minimization analysis of implant treatment in mandibular edentulous patients. Int J Prosthodont. 2003;16(3):271–6.PubMedGoogle Scholar
  12. 12.
    Naert I, Quirynen M, Theuniers G, van Steenberghe D. Prosthetic aspects of osseointegrated fixtures supporting overdentures. A 4-year report. J Prosthet Dent. 1991;65(5):671–80.PubMedCrossRefGoogle Scholar
  13. 13.
    Kimoto S, Pan S, Drolet N, Feine JS. Rotational movements of mandibular two-implant overdentures. Clin Oral Implants Res. 2009;20(8):838–43.PubMedCrossRefGoogle Scholar
  14. 14.
    Critchlow SB, Ellis JS. Prognostic indicators for conventional complete denture therapy: a review of the literature. J Dent. 2010;38(1):2–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Awad MA, Lund JP, Dufresne E, Feine JS. Comparing the efficacy of mandibular implant retained overdentures and conventional dentures among middle-aged edentulous patients: satisfaction and functional assessment. Int J Prosthodont. 2003;16(2):117–22.PubMedGoogle Scholar
  16. 16.
    Oda K, Kanazawa M, Takeshita S, Minakuchi S. Influence of implant number on the movement of mandibular implant overdentures. J Prosthet Dent. 2017;117(3):380–5.PubMedCrossRefGoogle Scholar
  17. 17.
    Emami E, de Souza RF, Bernier J, Rompré P, Feine JS. Patient perceptions of the mandibular three-implant overdenture: a practice-based study. Clin Oral Implants Res. 2015;26(6):639–43.PubMedCrossRefGoogle Scholar
  18. 18.
    Petropoulos VC, Smith W. Maximum dislodging forces of implant overdenture stud attachments. Int J Oral Maxillofac Implants. 2002;17:526–35.PubMedGoogle Scholar
  19. 19.
    Burns DR, Unger JW, Elswick RK Jr, Beck DA. Prospective clinical evaluation of mandibular implant overdentures: Part I: retention, stability, and tissue response. J Prosthet Dent. 1995;73(4):354–63.PubMedCrossRefGoogle Scholar
  20. 20.
    Petropoulos VC, Smith W, Kousvelari E. Comparison of retention and release periods for implant overdenture attachments. Int J Oral Maxillofac Implants. 1997;12(2):176–85.PubMedGoogle Scholar
  21. 21.
    Van Kampen F, Cune M, van der Bilt A, Bosman F. Retention and postinsertion maintenance of bar-clip, ball and magnet attachments in mandibular implant overdenture treatment: an in vivo comparison after 3 months of function. Clin Oral Implants Res. 2003;14(6):720–6.PubMedCrossRefGoogle Scholar
  22. 22.
    Naert I, Gizani S, Vuylsteke M, Van Steenberghe D. A 5-year prospective randomized clinical trial on the influence of splinted and unsplinted oral implants retaining a mandibular overdenture: prosthetic aspects and patient satisfaction. J Oral Rehabil. 1999;26(3):195–202.PubMedCrossRefGoogle Scholar
  23. 23.
    Chung KH, Chung CY, Cagna DR, Cronin RJ Jr. Retention characteristics of attachment systems for implant overdentures. J Prosthodont. 2004;13:221–6.PubMedCrossRefGoogle Scholar
  24. 24.
    Leung T, Preiskel HW. Retention profiles of stud-type precision attachments. Int J Prosthodont. 1991;4(2):175–9.PubMedGoogle Scholar
  25. 25.
    Lehmann KM, Arnim FV. Studies on the retention forces of snap-on attachments. Quintessence Dent Technol. 1978;7:45–8.Google Scholar
  26. 26.
    Geckili O, Cilingir A, Erdogan O, Kesoglu AC, Bilmenoglu C, Ozdiler A, Bilhan H. The influence of momentary retention forces on patient satisfaction and quality of life of two-implant-retained mandibular overdenture wearers. Int J Oral Maxillofac Implants. 2015;30(2):397–402.PubMedCrossRefGoogle Scholar
  27. 27.
    Abi Nader S, de Souza RF, Fortin D, De Koninck L, Fromentin O, Albuquerque Junior RF. Effect of simulated masticatory loading on the retention of stud attachments for implant overdentures. J Oral Rehabil. 2011;38(3):157–64.PubMedCrossRefGoogle Scholar
  28. 28.
    Nguyen CT, Masri R, Driscoll CF, Romberg E. The effect of denture cleansing solutions on the retention of pink locator attachments: an in vitro study. J Prosthodont. 2010;19(3):226–30.PubMedCrossRefGoogle Scholar
  29. 29.
    You W, Masri R, Romberg E, Driscoll CF, You T. The effect of denture cleansing solutions on the retention of pink locator attachments after multiple pulls: an in vitro study. J Prosthodont. 2011;20(6):464–9.PubMedCrossRefGoogle Scholar
  30. 30.
    Jabbour Z, Fromentin O, Lassauzay C, Abi Nader S, Correa JA, Feine J, de Albuquerque Junior RF. Effect of implant angulation on attachment retention in mandibular two-implant overdentures: a clinical study. Clin Implant Dent Relat Res. 2014;16(4):565–71.PubMedCrossRefGoogle Scholar
  31. 31.
    Fromentin O, Picard B, Tavernier B. In vitro study of the retention and mechanical fatigue behavior of four implant overdenture stud-type attachments. Pract Periodontics Aesthet Dent. 1999;11:391–7.PubMedGoogle Scholar
  32. 32.
    Gamborena JI, Hazelton LR, NaBadalung D, Brudvik J. Retention of ERA direct overdenture attachments before and after fatigue loading. Int J Prosthodont. 1997;10:123–30.PubMedGoogle Scholar
  33. 33.
    Fromentin O, Lassauzay C, Nader SA, Feine J, de Albuquerque RF Jr. Wear of matrix overdenture attachments after one to eight years of clinical use. J Prosthet Dent. 2012;107(3):191–8.PubMedCrossRefGoogle Scholar
  34. 34.
    Fromentin O, Lassauzay C, Nader SA, Feine J, de Albuquerque RF Jr. Wear of ball attachments after 1 to 8 years of clinical use: a qualitative analysis. Int J Prosthodont. 2011;24(3):270–2.PubMedGoogle Scholar
  35. 35.
    Pigozzo MN, Mesquita MF, Henriques GE, Vaz LG. The service life of implant-retained overdenture attachment systems. J Prosthet Dent. 2009;102(2):74–80.PubMedCrossRefGoogle Scholar
  36. 36.
    Emami E, Michaud PL, Sallaleh I, Feine JS. Implant-assisted complete prostheses. Periodontol 2000. 2014;66(1):119–31.PubMedCrossRefGoogle Scholar
  37. 37.
    Brånemark PI, Engstrand P, Ohrnell LO, Gröndahl K, Nilsson P, Hagberg K, Darle C, Lekholm U. Brånemark Novum: a new treatment concept for rehabilitation of the edentulous mandible. Preliminary results from a prospective clinical follow-up study. Clin Implant Dent Relat Res. 1999;1(1):2–16.PubMedCrossRefGoogle Scholar
  38. 38.
    De Kok IJ, Chang KH, Lu TS, Cooper LF. Comparison of three-implant-supported fixed dentures and two-implant-retained overdentures in the edentulous mandible: a pilot study of treatment efficacy and patient satisfaction. Int J Oral Maxillofac Implants. 2011;26(2):415–26.PubMedGoogle Scholar
  39. 39.
    De Bruyn H, Kisch J, Collaert B, Lindén U, Nilner K, Dvärsäter L. Fixed mandibular restorations on three early-loaded regular platform Brånemark implants. Clin Implant Dent Relat Res. 2001;3(4):176–84.PubMedCrossRefGoogle Scholar
  40. 40.
    Apostolakis D, Brown JE. The anterior loop of the inferior alveolar nerve: prevalence, measurement of its length and a recommendation for interforaminal implant installation based on cone beam CT imaging. Clin Oral Implants Res. 2012;23(9):1022–30.PubMedCrossRefGoogle Scholar
  41. 41.
    Maló P, de Araújo Nobre M, Lopes A, Ferro A, Gravito I. All-on-4® treatment concept for the rehabilitation of the completely edentulous mandible: a 7-year clinical and 5-year radiographic retrospective case series with risk assessment for implant failure and marginal bone level. Clin Implant Dent Relat Res. 2015;(17 Suppl 2):e531–41.Google Scholar
  42. 42.
    Rangert B, Jemt T, Jörneus L. Forces and moments on Branemark implants. Int J Oral Maxillofac Implants. 1989;4(3):241–7.PubMedGoogle Scholar
  43. 43.
    Romeo E, Storelli S. Systematic review of the survival rate and the biological, technical, and aesthetic complications of fixed dental prostheses with cantilevers on implants reported in longitudinal studies with a mean of 5 years follow-up. Clin Oral Implants Res. 2012;(23 Suppl 6):39–49.Google Scholar
  44. 44.
    Elsyad MA, Hegazy SA, Hammouda NI, Al-Tonbary GY, Habib AA. Chewing efficiency and electromyographic activity of masseter muscle with three designs of implant-supported mandibular overdentures. A cross-over study. Clin Oral Implants Res. 2014;25(6):742–8.PubMedCrossRefGoogle Scholar
  45. 45.
    Papaspyridakos P, Chen CJ, Chuang SK, Weber HP, Gallucci GO. A systematic review of biologic and technical complications with fixed implant rehabilitations for edentulous patients. Int J Oral Maxillofac Implants. 2012;27(1):102–10.PubMedGoogle Scholar
  46. 46.
    Attard NJ, Zarb GA, Laporte A. Long-term treatment costs associated with implant-supported mandibular prostheses in edentulous patients. Int J Prosthodont. 2005;18(2):117–23.PubMedGoogle Scholar
  47. 47.
    Abi Nader S, Eimar H, Momani M, Shang K, Daniel NG, Tamimi F. Plaque accumulation beneath maxillary All-on-4™ implant-supported prostheses. Clin Implant Dent Relat Res. 2015;17(5):932–7.PubMedCrossRefGoogle Scholar
  48. 48.
    Sadowsky SJ, Hansen PW. Evidence-based criteria for differential treatment planning of implant restorations for the mandibular edentulous patient. J Prosthodont. 2014;23(2):104–11.PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Restorative Dentistry, Faculty of DentistryMcGill UniversityMontrealCanada
  2. 2.Division of ProsthodonticsMcGill University Health CentreMontrealCanada

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