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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 13  |  Issue : 6  |  Page : 1668-1671  

Assessment of the survival of a single implant-supported cantilever prosthesis in the anterior mandible


1 Department of Prosthodontics, Patna Dental College and Hospital, Patna, Bihar, India
2 Department of Community Medicine, GGS Medical College and Hospital, Faridkot, Punjab, India
3 Consultant Orthodontist, Dr. Kishor Bagalkot Dental Orthodontic And Implant Centre, Hubli, Karnataka State, India
4 Interns, Christian Dental College, Ludhiana, Punjab, India
5 Department of Periodontology, Desh Bhagat Dental College, Mandi Gobindgarh, Punjab, India

Date of Submission17-May-2021
Date of Decision26-May-2021
Date of Acceptance28-May-2021
Date of Web Publication10-Nov-2021

Correspondence Address:
Gagan Preet Singh
Department of Community Medicine, GGS Medical College and Hospital, Faridkot, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpbs.jpbs_403_21

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   Abstract 


Background: Implant dentistry has seen rapid and remarkable progress in recent years. The present study assessed the survival of a single implant-supported cantilever prosthesis (ISCP) in the anterior mandible. Materials and Methods: Sixty-four patients with missing mandibular anterior teeth of both genders were provided with a single implant and restored with cantilever screw-retained prosthesis. All were followed for 2.5 years for the implant and prosthetic success. Results: Age group of 20–30 years comprised 14 males and 10 females, 30–40 years had 10 males and eight females, 40–50 years had six males and seven females, and 50–60 years had four males and five females. The difference was nonsignificant (P > 0.05). A screw loosening was seen in total of 15 cases, in 1 at 12 months, 5 at 18 months, 2 at 24 months, and 7 at 30 months, and porcelain fracture was seen in total of eight cases, in 4 at 18 months, 1 at 24 months, and 3 at 30 months. The difference was statistically significant (P < 0.05). Conclusion: Screw-retained ISCP developed complications such as screw loosening and porcelain fracture.

Keywords: Cantilever, implant, screw


How to cite this article:
Kumari S, Singh GP, Bagalkot KB, Subramanium A, Isaac TK, Chandni. Assessment of the survival of a single implant-supported cantilever prosthesis in the anterior mandible. J Pharm Bioall Sci 2021;13, Suppl S2:1668-71

How to cite this URL:
Kumari S, Singh GP, Bagalkot KB, Subramanium A, Isaac TK, Chandni. Assessment of the survival of a single implant-supported cantilever prosthesis in the anterior mandible. J Pharm Bioall Sci [serial online] 2021 [cited 2022 Aug 13];13, Suppl S2:1668-71. Available from: https://www.jpbsonline.org/text.asp?2021/13/6/1668/330130




   Introduction Top


Implant dentistry has seen rapid and remarkable progress in recent years.[1] Several questions have been raised concerning materials as well as designs of both implants and implant abutments to achieve maximum clinical success rates.[2] One of the debates is the choice between screw- and cement-retained implant prostheses, which has long been discussed, but the best type of implant prosthesis remains controversial among practitioners.[3],[4]

Implant-supported fixed prosthesis (ISP) may be single or multiple implant-supported restorations and also cantilever prosthesis.[5] The appreciably high clinical success rate of single and multiple ISP restored with implant-protected occlusion in situations of adequate bone support has been well known. ISP with cantilever molar extensions is usually unilateral/full mouth restorations in the clinical conditions of resorbed maxillary or mandibular posterior ridges.[6],[7]

The use of implant-supported single crowns has become a well-established and preferred approach to compensate missing single teeth.[8] There are two different types of prosthetic restorations fixed on dental implants: screw-retained and cemented restorations. The choice of method is usually based on the clinician's preference.[9],[10] Retrievability is the main advantage of screw-retained crowns that would make it more favorable to many clinicians. Implant-supported screw-retained cantilever prosthesis in mandibular anterior region, which has been a treatment option for edentulous sites with inadequate mesiodistal space.[11] The present study assessed the survival of a single implant-supported cantilever prosthesis (ISCP) in the anterior mandible.


   Materials and Methods Top


The present study comprised 64 patients with missing mandibular anterior teeth of both genders. Those who gave their consent to be the part of the study were included. Ethical clearance for conducting study on patients in the department of prosthodontics, bridge, and crown work was initially obtained.

All enrolled patients had missing mandibular central incisors in the age range of 20–60 years of both genders. A thorough clinical examination was performed. Oral health and hygiene of patients were assessed. A single implant was used to replace the missing teeth and restored with cantilever screw-retained prosthesis. All the steps were performed by single prosthodontics following strict sterilization protocol. All were prescribed chlorhexidine mouth wash 2–3 times daily for 7 days. All were followed for 2.5 years for the implant and prosthetic success. Results thus obtained were subjected to statistical analysis. P < 0.05 was considered statistically significant.


   Results Top


[Table 1] and [Graph 1] show that age group 20–30 years comprised 14 males and 10 females, 30–40 years had 10 males and eight females, 40–50 years had six males and seven females, and 50–60 years had four males and five females. The difference was nonsignificant (P > 0.05).
Table 1: Age- and gender-wise distribution of patients

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[Table 2] and [Graph 2] show that screw loosening was seen in total of 15 cases, in 1 at 12 months, 5 at 18 months, 2 at 24 months, and 7 at 30 months, and porcelain fracture was seen in total of 8 cases, in 4 at 18 months, 1 at 24 months, and 3 at 30 months. The difference was significant (P < 0.05).
Table 2: Clinical outcome of implant-supported cantilever prosthesis

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   Discussion Top


The screw-retained restorations where the screw-access hole occupies more than 50% of the intercuspal occlusal table require an occlusal restorative material to cover the screw-access channel; these restorative materials are susceptible for wearing under functional forces and so the occlusal contacts will be less preserved than when using cement-retained restorations with intact occlusal surface.[12],[13] The factors that are affected by different methods of retention of the prostheses to the implants are ease of fabrication and cost, esthetics, access, occlusion, retention, incidence of loss of retention, retrievability, passivity of fit, restriction of implant position, effect on peri-implant tissue health, provisionalization, immediate loading, impression procedures, porcelain fracture, and clinical performance.[14] The choice of a screw-retained versus a cemented crown is a decision that involves several points of consideration. The clinician should have good awareness regarding the advantages and disadvantages of using a screw-retained versus a cemented crown.[15] The present study assessed the survival of a single ISCP in the anterior mandible.

In the present study, age group of 20–30 years comprised 14 males and 10 females, 30–40 years had 10 males and eight females, 40–50 years had six males and seven females, and 50–60 years had four males and five females. Nelluri et al.[16] conducted a study on 30 patients with missing both mandibular central incisors. A single implant was used to replace the missing teeth and restored with cantilever screw-retained prosthesis. Twenty-two patients were followed for 3 years for the implant and prosthetic success. Survival probability of the ISCP for the first 100 days was found to be 97.55%, for 200 days, it was 71.4%, for 250 days, it was 46%, and for 365 days, it was 3.9%, i.e., 20 prostheses had screw loosening after prosthetic loading. However, it increased to 95.2% at the end of 3 years.

We found that screw loosening was seen in total of 15 cases, in 1 at 12 months, 5 at 18 months, 2 at 24 months, and 7 at 30 months, and porcelain fracture was seen in total of 8 cases, in 4 at 18 months, 1 at 24 months, and 3 at 30 months. Aglietta et al.[17] assessed the survival rates of short-span implant-supported cantilever fixed dental prostheses and concluded that cantilevers showing not much detrimental effects and are a valid treatment modality. Kreissl et al.[18] in their study stated that, at the end of 5 years, a cumulative incidence of screw loosening was 6.7%, screw fracture was 3.9%, and porcelain fractures was 5.7% with single implant crowns. However, the complications with cantilever prosthesis were high, 68.6%.

Screw-retained restorations are associated with screw loosening complication, especially in single crown restoration. The frequency of screw loosening is reported to be between 5% and 65%. Using a mechanical torque instrument to tighten the screw to a recommended torque level (20–30 Ncm) has greatly diminished this prosthetic complication. Pjetursson et al.[19] conducted a systematic review and reported that the survival rate of metal-ceramic implant-supported fixed dental prosthesis was 96.4% after 5 years and 93.9% after 10 years. The most frequent complications over the 5-year observation period were fractures of the veneering material (13.5%), loss of access hole restoration (5.4%), abutment or screw loosening (5.3%), and loss of retention of the cemented prosthesis (4.7%).

Zurdo et al.[20] in a systematic review on the survival and complication rates of implant-supported fixed partial denture with cantilevers concluded that cantilever extension has minor technical complications and stated that limited data were available. However, the study does not specify anterior or posterior cantilevers.


   Conclusion Top


Authors found that screw-retained ISCP developed complications such as screw loosening and porcelain fracture.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

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Bhandari S. Designing both mandibular central incisors on one 3.0-mm single-piece implant: Five years' outcome. J Oral Implantol 2018;44:439-45.  Back to cited text no. 1
    
2.
Goodacre CJ, Bernal G, Rungcharassaeng K, Kan JY. Clinical complications with implants and implant prostheses. J Prosthet Dent 2003;90:121-32.  Back to cited text no. 2
    
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Shadid RM, Sadaqah NR, Abu-Naba'a L, Al-Omari WM. Porcelain fracture of metal-ceramic tooth-supported and implant-supported restorations: A review. Open J Stomatol 2013;3:411-8.  Back to cited text no. 3
    
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Katsavochristou A, Koumoulis D. Incidence of abutment screw failure of single or splinted implant prostheses: A review and update on current clinical status. J Oral Rehabil 2019;46:776-86.  Back to cited text no. 4
    
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Jain JK, Sethuraman R, Chauhan S, Javiya P, Srivastava S, Patel R, et al. Retention failures in cement-and screw-retained fixed restorations on dental implants in partially edentulous arches: A systematic review with meta-analysis. J Indian Prosthodont Soc 2018;18:201-11.  Back to cited text no. 5
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6.
Krishnan V, Tony Thomas C, Sabu I. Management of abutment screw loosening: Review of literature and report of a case. J Indian Prosthodont Soc 2014;14:208-14.  Back to cited text no. 6
    
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Kourtis S, Damanaki M, Kaitatzidou S, Kaitatzidou A, Roussou V. Loosening of the fixing screw in single implant crowns: Predisposing factors, prevention and treatment options. J Esthet Restor Dent 2017;29:233-46.  Back to cited text no. 7
    
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Hebel KS, Gajjar RC. Cement-retained versus screw-retained implant restoration: Achieving optimal occlusion and esthetics in implant dentistry. J Prosthet Dent 1997;77:28-35.  Back to cited text no. 9
    
10.
Michalakis KX, Hirayama H, Garefis PD. Cement-retained versus screw-retained implant restorations: A critical review. Int J Oral Maxillofac Implants 2003;18:719-28.  Back to cited text no. 10
    
11.
Misch CE. Dental Implant Prosthetics. St Louis, Mo: Mosby; 2005. p. 414-20.  Back to cited text no. 11
    
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Avivi-Arber L, Zarb GA. Clinical effectiveness of implant-supported single-tooth replacement: The toronto study. Int J Oral Maxillofac Implants 1996;11:311-21.  Back to cited text no. 12
    
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Gervais MJ, Wilson PR. A rationale for retrievability of fixed, implant-supported prostheses: A complication-based analysis. Int J Prosthodont 2007;20:13-24.  Back to cited text no. 13
    
14.
Chee W, Jivraj S. Screw versus cemented implant supported restorations. Br Dent J 2006;201:501-7.  Back to cited text no. 14
    
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Taylor TD, Agar JR. Twenty years of progress in implant prosthodontics. J Prosthet Dent 2002;88:89-95.  Back to cited text no. 15
    
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Nelluri VV, Roseme KM, Gedela RK. A 3-year prospective cohort study on mandibular anterior cantilever restorations associated with screw-retained implant-supported prosthesis: An in vivo study. J Indian Prosthodont Soc 2021;21:150-60.  Back to cited text no. 16
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17.
Aglietta M, Siciliano VI, Zwahlen M, Brägger U, Pjetursson BE, Lang NP, et al. A systematic review of the survival and complication rates of implant supported fixed dental prostheses with cantilever extensions after an observation period of at least 5 years. Clin Oral Implants Res 2009;20:441-51.  Back to cited text no. 17
    
18.
Kreissl ME, Gerds T, Muche R, Heydecke G, Strub JR. Technical complications of implantsupported fixed partial dentures in partially edentulous cases after an average observation period of 5 years. Clin Oral Implants Res 2007;18:720-6.  Back to cited text no. 18
    
19.
Pjetursson BE, Thoma D, Jung R, Zwahlen M, Zembic A. A systematic review of the survival and complication rates of implant-supported fixed dental prostheses (FDPs) after a mean observation period of at least 5 years. Clin Oral Implants Res 2012;23 Suppl 6:22-38.  Back to cited text no. 19
    
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Zurdo J, Romão C, Wennström JL. Survival and complication rates of implantsupported fixed partial dentures with cantilevers: A systematic review. Clin Oral Implants Res 2009;20 Suppl 4:59-66.  Back to cited text no. 20
    



 
 
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