title: The in vitro effect of different implant angulations and cyclic dislodgement on the retentive properties of an overdenture attachment system.
abstract: BACKGROUND
  The retentive capacity of ball attachments may be altered by a change in implant angulations.
  
  
  OBJECTIVE
  The purpose of this in vitro study was to investigate the effect of cyclic dislodgement on the retention of an overdenture attachment system when 2 implants were placed at angulations of 0, 5, 10, 15, and 20 degrees.
  
  
  METHODS
  Twelve acrylic resin blocks were fabricated and divided into 6 groups of 2 pairs each. In each of the 6 groups, 1 acrylic resin block was used to house the implants (block A), while the other (block B) was used to house the overdenture attachments. Two implants positioned at 0/0 degrees, with a standard plastic component(white) designed for 0-degree angulations, served as a control (CTRL), while the other 5 pairs of implants were placed in 5 different angulations: 0D: 0/0 degrees, 5D: 5/5 degrees, 10D: 10/10 degrees, 15D: 15/15 degrees, 20D: 20/20degrees (n=5). The extended range (green color) attachment was used for all groups except the control group. Implants(4.3 mm x 13 mm, internally hexed) were placed in blocks B. All angled implants were mesially tilted. Thirty pairs of attachments (Locator) were used. Dislodging cycles were applied to the overdenture attachment system. The initial retentive forces among the groups were not identical. The cycles required for the retentive forces of the attachments to decrease from the initial values to 60 N, and then to 40 N and 20 N, were recorded for standardization purposes.One-way ANOVA and Tukey HSD tests were used to analyze the difference in retention loss among the 6 groups(alpha=.05). A regression analysis (alpha=.05) was also performed to investigate the relationship between the implant angulation,the retentive force, and the logarithm of the number of cycles required for ball attachment retention decrease.
  
  
  RESULTS
  The 1-way ANOVA and the Tukey HSD tests revealed significant differences for the number of cycles required by different implant angulation groups for the initial retentive values to decrease to 60 N, 40 N, and 20 N (P<.001).The 0D and 5D groups required the longest time for retention loss, while 20D and CTRL groups demonstrated the shortest time for retention loss. The results of the regression analysis of the logarithmic number of cycles on retentive force and implant angulation demonstrated a significant effect (P<.001).
  
  
  CONCLUSIONS
  Implant angulations negatively affect attachment retention longevity. (J Prosthet Dent 2009;102:140-147)
authors.affiliation: Department of Operative Dentistry and Prosthodontics, Division of Graduate and Postgraduate Prosthodontics, Tufts University School of Dental Medicine.
authors.forename: Suhail Ali
authors.initials: SA
authors.lastname: Al-Ghafli
authors.forename: Konstantinos X
authors.initials: KX
authors.lastname: Michalakis
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Hirayama
authors.forename: Kiho
authors.initials: K
authors.lastname: Kang
mesh_terms: D000704:Analysis of Variance; D000044:Dental Abutments; D003758:Dental Implantation, Endosseous / Q000379:methods*; D015921:Dental Implants; D019094:Dental Prosthesis, Implant-Supported / Q000295:instrumentation*; D019232:Dental Restoration Failure; D003799:Dental Stress Analysis; D003834:Denture Precision Attachment; D003781:Denture Retention / Q000295:instrumentation / Q000379:methods*; D003828:Denture, Overlay; D006801:Humans; D013314:Stress, Mechanical
chemical_list: D015921:Dental Implants