Photoelastic stress analysis of various retention mechanisms on 3-implant-retained mandibular overdentures

Statement of problem. There are various stress transfer studies of 2- or 4-implant-retained mandibular overdenture designs. However, the influence of various types of attachments and implant inclination on stress distribution of 3-implant-retained mandibular overdenture designs has not been sufficiently assessed. Purpose. The purpose of this study was to compare the load transfer characteristics of 4 attachment systems for 3-implant-retained mandibular overdenture designs for vertically oriented and inclined implants. Material and methods. Two photoelastic mandibular models were fabricated having 3 screw-type implants (3.7 X 14 mm with 4.8-mm diameter abutment platform) embedded in the interforaminal region. In the first model, the implants were parallel to each other and vertically oriented. In the second model, 1 implant in the midline was vertically oriented, and the other 2 implants were positioned 20 degrees divergent from the center implant. Four retention mechanisms were studied for each model-the Locator, Swissplus ball, Bredent bar, and Bredent bar-ball. The bar design connected the 3 implants, and the bar-ball design used the bar in a similar fashion but additionally incorporated distally placed ball attachments. A vertical force of 135 N was applied unilaterally to the central fossa of the right first molar. The resultant stresses that developed in the Supporting structure were monitored photoelastically and recorded photographically. Results. For the splinted and unsplinted 3-implant-retained overdenture designs evaluated, moderate and low level stresses were observed with different attachment systems. For both the vertically oriented and inclined implants, the bar-ball attachment system produced the lowest stress level. Conclusions. For vertical and inclined implant designs, lowest stress was transferred to all implants with the bar-ball attachment system, while moderate stresses were observed in implants on the loaded side with unsplinted attachment systems. The highest stress level observed with all attachment systems was moderate. For the vertical implant design, the observed stresses were distributed to all implants except with the ball attachment system, which demonstrated little discernible stresses on the non-loaded side implant.