Comparison of Man Hours Utilized for Mandibluar Overdenture Treatment Retained by Single Implant with Bar Fabricated by CAD-CAM Process and Conventional Casting Processs – An Vivo Study

ABSTRACT

Introduction:

Both the population’s average life expectancy and the number of patients without teeth are rising. A 2012 epidemiological survey in India found that 30% of the population is edentulous. The rehabilitation process with a set of removable maxillary and mandibular complete dentures is the standard treatment for patients who are edentulous. This study is the first to incorporate and compare a novel approach to a single implant-retained mandibular overdenture with a bar attachment fabricated by CAD-CAM and a casting process on a single implant in the symphysis region.

Method:

Five maxillary and mandibular completely edentulous patients were enrolled in the study.

Results:

Significant difference was seen in the conventional laboratory time and CAD-CAM time as P < 0.05

Conclusion:

Compared to the conventional casting process, the single implant-supported bar mandibular overdenture (SISBOD) with a novel bar required fewer man hours and was more convenient.

INTRODUCTION

Due to the global increase in life expectancy and the increase in the elderly population, the elderly edentulous population has increased. The palliative therapy for edentulous patients is a set of removable complete dentures. Even though it is a cost-effective option for the elderly, the traditional denture has some drawbacks.[1]

Patients with edentulous conditions who receive complete dentures for rehabilitation frequently experience denture soreness, poor retention and instability, unclear pronunciation, and poor chewing efficiency. With no clear dominant cause identified, residual ridge resorption is an inevitable side effect of tooth loss and denture wear. Edentulous patients may encounter issues due to impaired load-bearing capacity as a result of accelerated bone resorption. In addition to pain when chewing, loss of retention, and instability of the complete denture, patients frequently complain of loose mandibular dentures.

The overdenture concept was developed in the 1960s as a solution to these issues. Implants that have undergone osseointegration have been used to increase denture support, stability, and retention. For patients with missing teeth, an overdenture supported by an implant is regarded as a workable treatment option.[2]

For the rehabilitation of edentulous jaws, implant-retained overdentures are frequently used because they can improve masticatory function, increase prosthesis retention rates, and decrease alveolar bone absorption by controlling neuromuscular adaptation.[3]

Two or more implant-retained mandibular overdentures can improve function and success rates in comparison to the typical complete denture. For edentulous patients, the York consensus statement advises placing at least two implants to support a mandibular overdenture.[4] However, this treatment strategy is expensive due to economic limitations, particularly among the growing elderly population in developing nations.[2] The idea of single implant-supported Bar overdenture (SISBOD) offers another option for elderly populations with increased retention stability and support to decrease the cost and length of treatment.

As a result, this treatment strategy is straightforward, low in morbidity, and economical. Such treatment in the Indian context may have an effect on all employed treatment modalities.

Over the past 25 years, the use of computer-aided design and manufacturing (CAD/CAM) technology has grown significantly in the dental industry. In restorative dentistry, CAD/CAM technology development has advanced significantly. Digital impressions, with their enormous advantages, and CAD-CAM will make digital intraoral scanning a standard procedure for the majority of dental restorative procedures in the future by addressing the various dental office issues.

Improved support, stability, and retention of mandibular single implant overdentures are the effects of this treatment strategy. We are comparing the number of man-hours needed to create a novel bar using the CAD-CAM process versus casting because the new bar attachment design produced by this process reduces chairside and laboratory work.

Hence, the proposed study compares man hours utilized between Novel Bar by CAD- CAM and Novel Bar by casting and also evaluates its efficacy and ease.

METHODOLOGY

The study was approved by the ethical committee of HKES’s S. Nijalingappa Institute of Dental Science and Research and carried out in the same institution.

Five Maxillary and mandibular completely edentulous individuals were enrolled. Pre-operatory radiographs were taken.

Primary impression was made of both edentulous arch using high fusing impression compound further custom tray fabricated with self-cure PMMA (poly methyl methacrylate), and border molding was made using low fusing green stick compound, and the secondary impression was made using zinc oxide eugenol paste jaw relation was recorded and teeth selection was conducted, teeth arrangement and try in performed.

Patient consent was obtained. The patient was premedicated, and a single midline endosseous implant (Touareg™-S, ADIN Dental Implant System, Tavor, Israel) was placed in the mandibular symphyseal region following the recommended surgical protocol.

Full thickness mucoperiosteal flap was raised under local anesthesia, and site was sequentially enlarged based on the diameter and length of the implant decided. The implant was torqued to 35 Ncm. Flap were approximated and 3/8 vicryl reverse circlet suture were placed. Post-operative instructions were given.

After 7 days, the sutures were removed. After 3 months, the impression was made with light body elastomeric impression material using an open tray technique. The next phase is laboratory work.

• Pouring of the impression and make putty index further attaching the Adin casting sleeve.

RESULTS

The data was analyzed by SPSS (21.0 version). Shapiro–Wilk test was used to check which variables were following normal distribution [Tables 1 and 2] and [Figure 1].

Table 1.

Mean Conventional laboratory time was found to be 177.12±3.7 min and 104.93±2.3 min for CAD-CAM

	Mean (min)	n	Std. deviation	Std. Error Mean
Conventional laboratory time	177.1260	5	3.70237	1.65575
CAD-CAM time	104.9343860	5	2.33100708	1.04245806
P				<0.001*

Significant if p<0.05

Table 2.

Significant difference was seen in the Conventional laboratory time and CAD-CAM time as P<0.05

	Mean (min)	Paired Differences				t	df	P
		Std. deviation	Std. Error Mean	95% Confidence interval of the difference
				Lower	Upper
Difference between Conventional laboratory time and CAD-CAM time	72.1916	5.001	2.23	65.9	78.4	32.2	4	0.001*

Inference: Paired t-test and P value indicate highly significant in Conventional and CAD-CAM time laboratory time as P<0.05. (Conventional laboratory time > CAD-CAM time)

Figure 1.

(a) Digitally designing of bar and (b) Novel bar showing digital CAD-CAM

DISCUSSION

It has been demonstrated that mandibular two-implant overdentures are superior to traditional dentures.[5] Patients who receive two-implant overdentures (as opposed to complete maxillary conventional dentures) have a significantly higher quality of life than patients who receive conventional complete dentures.

To improve retention, dentures are typically anchored to 2, 4, or 6 implants in the edentulous mandible. The minimum two-implant-supported mandibular implant overdenture has been acknowledged as the most effective treatment for edentulous people, according to McGill and York’s consensus.[6] There is enough evidence in the literature to support this finding.

There are many prospective studies that demonstrate the positive outcome and success rate of a single implant.[7] There are studies that demonstrate the effectiveness of a single immediately loaded implant in the mandibular symphyseal region.[8] In the current study, the single implant-supported mandibular overdenture with a ball attachment (SIROD) and the single implant-supported mandibular overdenture with a novel bar attachment (SISBOD) are compared for masticatory efficiency and patient satisfaction levels.

Incorporating and comparing a novel method for single implant-retained mandibular overdentures with a bar attachment made using a conventional and digital system in the symphysis region is unique to this study. The mandible’s anterior region received the implants. Due to its thicker cortical bone, reduced surgical risk from avoiding the inferior alveolar nerve and blood vessels, and larger tissue-supporting area to prevent implant overload, this area is the preferred location for single implant-retained overdentures.[9]

When compared to the traditional casting method, the promising results suggested that a single implant-bar retained overdenture with a novel prosthetic bar attachment made digitally was more convenient and quicker to make both chairside and in the lab.

It is crucial to maintain healthy tissue, perform routine hygienic checks, and educate patients on proper home care techniques. The clinician will be able to guarantee long-term maintenance and overall treatment success through continued evaluation through probing, radiographic assessment, and oral examination.

CONCLUSIONS

Therefore, this supports the use of SISBOD (single implant-supported mandibular overdenture with novel bar fabricated by digital fabrication) over the conventional casting method as a suitable treatment protocol for geriatric patients and economically underprivileged groups of the population. It also justifies the use of SISBOD over conventional casting method because it is more convenient and results are more accurate. Before the single implant-retained mandibular overdenture is advised for widespread use, additional long-term follow-up is required, but it does appear to be a helpful and valuable alternative treatment.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.