Scientific Foundation SPIROSKI, Skopje, Republic of Macedonia Open Access Macedonian Journal of Medical Sciences. 2021 Mar 08; 9(D):47-53. https://doi.org/10.3889/oamjms.2021.5829 eISSN: 1857-9655 Category: D - Dental Sciences Section: Prosthodontics Evaluation of Maximum Biting Force in Two Different Attachment Systems (Bollard vs. Ball and Socket) Retaining Mandibular Overdenture: A Split-mouth Design Reham Tharwat Kamal Elbeheiry*, Gehan Fekry Mohamed, Amr Mohamed Ismail Badr ¹Department of Removable Prosthodontics, Faculty of Dentistry, Minya University, Minya, Egypt Abstract Edited by: Aleksandar Iliev AIM: The study was conducted to evaluate maximum biting force (MBF) in two different attachment systems (bollard Citation: Elbeheiry RTK, Mohamed GF, Badr AMI. Evaluation of Maximum Biting Force in two different a vs. ball and socket attachment) retaining mandibular overdenture using a split-mouth design. attachment systems (Bollard vs. Ball and Socket) Retaining Mandibular Overdenture: A Split-mouth Design. SUBJECTS AND METHODS: Twelve completely edentulous patients received complete dentures and after Open Access Maced J Med Sci. 2021 Mar 08; 9(D):47-53. adaption of the patient with the new denture, 24 implants were inserted in the canine region using two-stage surgical https://doi.org/10.3889/oamjms.2021.5829 Key words: Bollard; Ball and socket; technique and conventional loading protocol. Six patients received the Bollard attachment at the right side and the Maximum biting force Ball and Socket at the left side. Moreover, the other six patients received the bollard attachment at the left side and *Correspondence: Reham Tharwat Kamal Elbeheiry, the ball and socket attachment at the right side. Each patient was treated according to split-mouth design. Insertion Department of Removable Prosthodontics, Faculty of Dentistry, Minya University, Minya, Egypt. of each of the attachment type was assigned randomly. Using occlusal force meter instrument, MBF was measured E-mail: [email protected] immediately after loading (0), after 6 months (6), and after 12 months (12). Received: 01-Feb-2021 Revised: 16-Feb-2021 Accepted: 26-Feb-2021 RESULTS: Significant statistical differences (p < 0.05) were obvious in in MBF between Attachment (1) and Copyright: © 2021 Reham Tharwat Kamal Elbeheiry, Attachment (2) immediately after loading (0 months), after 6 months (6) and after 12 months (12) follow-up visits. Gehan Fekry Mohamed, Amr Mohamed Ismail Badr Funding: This research did not receive any financial CONCLUSION: Mandibular implant retained overdenture received Bollard abutment that retained with the denture by support Conflict of Interest: The authors declared that they have the help of resilient liner “Retention.sil”* without housing have higher biting forces than mandibular implant retained no conflict of interest. overdenture with ball abutment where the plastic house was picked up by monomer free self-cured acrylic resin. Open Access: This is an open-access article distributed under the terms of the Creative Commons Attribution- NonCommercial 4.0 International License (CC BY-NC 4.0) Introduction mucosa. Various attachments have been advocated for retaining overdentures to implants. The commonly used types are bars, ball and sockets, locators, magnets, OT Edentulism is defined as “the state of being equators, and telescopic crowns [6]. without any natural permanent teeth. It is an irreversible The advantages of ball and socket attachment condition that is evident in age groups of 65 years and are simplicity in design, ease of use and maintenance, older and was previously considered part of the normal low cost, varying degrees of retention, wide range of aging process [1]. movement, great patient satisfaction, and used to The glossary of implant dentistry, define implant- increase retention of implant overdenture prostheses retained prosthesis as any prosthesis that is completely with regard to optimizing stress and minimizing denture or partially supported by implant or implants [2]. movement [7]. The Bollard (Poller) is a new resilient The clinical outcome of implant retained telescopic attachment employed in implant supported overdenture is significantly better than that achieved removable denture cases [8]. with conventional dentures, especially when patients The use of long-term soft denture lining are experiencing technical problems because of (LTSDLs) is characterized by markedly improved speech compromised prosthesis retention or stability. Mostly, and ability to chew, significantly reduced feelings of pain efficient retention and stability are easily achieved by and oral soreness under the dentures, better retention a fixed restoration or using overdenture’s attachments and stability of the dentures, an increase in psychological instead of depending on the physical means of retention comfort and longer denture wearing times [9], [10], [11]. with conventional dentures [3], [4], [5]. Retention.Sil was introduced according to its The design of implant-supported overdentures chemical composition that is based on Polyvinylsiloxane varies according to the method of attachment and (PVS) that has three options according to the amount of support to be desired from implant and ridge detachment force desired (200, 400, and 600 gf) [12]. Open Access Maced J Med Sci. 2021 Mar 08; 9(D):47-53. 47 D - Dental Sciences Prosthodontics The maximum biting force (MBF) is considered be 16 mm height and 5 mm width at least, inter-arch to be the force that generated by the greatest effort of space not <22 mm, Angle’s Class I maxillomandibular the mandibular teeth against the maxillary teeth when relationship, and no tempromandibular joint disorders. the jaw is closed under the effect of the jaw muscles as Moreover, the following exclusion criteria: Patients a result of the coordination between the components with bad habits (i.e., Bruxism), heavy smokers, alcohol of the masticatory system. Masticatory muscles such consumption patient, patients on long-term steroids or as Masseter, Temporalis, and Medial Pterygoid play an immunosuppressive drugs or bisphosphonates, and important role in the closure of the jaw and hence the patients who received radiotherapy to the head or neck biting forces [13], [14]. region. The masticatory force is an important Twelve complete dentures were constructed indicator of the functional state of all the masticatory following the conventional denture fabrication procedures. system. The biting forces are used to understand the Primary impressions were taken with irreversible biomechanical principles of masticatory system and hydrocolloid material (Cavex CA37, Normal Set, feedback of prosthetic treatment. Furthermore, the Holland) to obtain study casts. Final impressions using MBF measurement is very important for the treatment a border molded autopolymerizing acrylic special trays of dysfunction of the stomatognathic system [15]. (Palapress Vario Heraeus Kulzer, Hanau, Germany) and Their measurement indicates, quantitatively, the non-eugenol Zinc-oxide and eugenol (Cavex impression muscular efficiency of the dental tightening, thereby paste, Holland) to obtain the master casts. enabling effective detection of possible masticatory Waxing-up of the metal framework making alterations [16], [17]. Their values are influenced by into consideration not to cover the site of the canine many factors. Individual characteristics, the recording in both sides. Investing and casting with base-metal device, bruxist individuals, and the posture of the alloy were made according to the manufacturer’s individual’s head are some of these factors [14], [18]. instructions. Intraoral metal framework try-in and jaw This variable is directly related to individuals’ quality relation were done. The master casts were mounted of life since the greater the masticatory capacity and on a semi-adjustable articulators (HANAU, Wide; efficacy, the better the food fragmentation will be and Whip Mix Corporation, Farmington Ave, Louisville, the better the digestion [19]. Furthermore, the maximum KY, USA). For mounting the maxillary casts, face bow occlusal force can significantly increase with the use of records were used. For mounting the mandibular casts, LTSDLs [20], [21]. centric relation records with (check-bite technique) at the proper vertical dimension. Protrusive and lateral The aim of the study was to evaluate MBF in records were taken to adjust the condylar and lateral two different attachment systems (Bollard a vs. Ball and guidance of the articulator. Artificial acrylic teeth Socket attachment) retaining mandibular overdenture (Vitapan; Vita Zahnfabrik, Badackingen, Germany) using a split-mouth design. were set in bilateral occlusal balance. Overcontoured waxing up was made at the canine area in both sides. Intraoral waxed try-in was done. Flasking and wax elimination were Subjects and Methods accomplished. Packing of the overdenture was done using heat-cured acrylic resin (Acrostone, WHW, England). After that, the processing was accomplished Patient selection and pre-surgical with the conventional method. The dentures were procedures delivered to the patients after finishing and polishing. All treatment procedures, complications, Patients were given instructions for denture and treatment outcomes were explained for patients. hygiene. After 1 week, denture inspection and occlusal Informed consent that lay down by research ethics adjustments were made and clinical remounting during committee at Faculty of Dentistry-Minya University was