Moustafa Abdou Elsyad

Fatma Ahmad El-Waseef

Yasmeen Fathy Al-Mahdy
Mohammed Mohammed
Fouad

Authors affiliations:
Moustafa Abdou Elsyad, Fatma Ahmad El-Waseef,
Mohammed Mohammed Fouad, Removable
Prosthodontics, Faculty of Dentistry, Mansoura
University, Eldakahlia, Egypt
Yasmeen Fathy Al-Mahdy, Removable
Prosthodontics, Faculty of Dental Medicine,
Al-Azhar University, Cairo, Egypt
Corresponding author:
Moustafa Abdou Elsyad
Removable Prosthodontic Department
Faculty of Dentistry
Mansoura University
Eldakahlia, Egypt
Tel.: +0572353238
Fax: +502260173
e-mail: m_syad@mans.edu.eg

A comparison of mandibular denture

base deformation with different
impression techniques for implant
overdentures

Key words: deformation, denture base, implant, impression, overdenture

Abstract
Purpose: This study aimed to evaluate mandibular denture base deformation along with three
impression techniques used for implant-retained overdenture.
Materials and methods: Ten edentulous patients (five men and five women) received two implants
in the canine region of the mandible and three duplicate mandibular overdentures which were
constructed with mucostatic, selective pressure, and definitive pressure impression techniques. Ball
abutments and respective gold matrices were used to connect the overdentures to the implants. Six
linear strain gauges were bonded to the lingual polished surface of each duplicate overdenture at
midline and implant areas to measure strain during maximal clenching and gum chewing.
Results: The strains recorded at midline were compressive while strains at implant areas were
tensile. Clenching recorded significant higher strain when compared with gum chewing for all
techniques. The mucostatic technique recorded the highest strain and the definite pressure
technique recorded the lowest. There was no significant difference between the strain recorded
with mucostatic technique and that registered with selective pressure technique. The highest strain
was recorded at the level of ball abutments top with the mucostatic technique during clenching.
Conclusion and recommendation: Definite pressure impression technique for implant-retained
mandibular overdenture is associated with minimal denture deformation during function when
compared with mucostatic and selective pressure techniques. Reinforcement of the denture base
over the implants may be recommended to increase resistance of fracture when mucostatic or
selective pressure impression technique is used.

Date:
Accepted 19 November 2011
To cite this article:
Elsyad MA, El-Waseef FA, Al-Mahdy YF, Fouad MM. A
comparison of mandibular denture base deformation with
different impression techniques for implant overdentures.
Clin. Oral Impl. Res. 24 (Suppl. A100), 2013, 127133
doi: 10.1111/j.1600-0501.2011.02395.x

2012 John Wiley & Sons A/S

The most common implant-retained overdenture design is two splinted or free-standing

implants placed in the interforaminal region
of the mandible (Feine et al. 2002). In such
case, the prosthesis retention is provided by
the implants, and most of the support is
gained from the mucosal coverage of the
alveolar ridge (Mericske-Stern et al. 2000;
Klemetti et al. 2003).
Masticatory stresses distributed to the
mandible depend on several variables among
which the differences in impression procedures (Regli & Gaskill 1954). Because of resilience difference, equitable load sharing
between the implants and mucosa may be
related to the selected impression technique
(Uludag & Celik 2006; Uludag et al. 2008).
Several authors addressed the debate regarding the pressure applied while making the
impression for complete dentures. The frequently used impression techniques are mu-

costatic (non-pressure), definite pressure and

selective pressure impression techniques
(Boucher 1951; Bohannan 1954; Collett 1965,
1970; Heart & Rahn 1980). The mucostatic
technique records the alveolar mucosa in undisplaced form. Such an impression does not
cover enough area and may affect border seal
resulting in loss of retention and stability of
the denture (LeVan 1952; Bohannan 1954).
The definite pressure technique records the
mucosa in a compressive (displaced) state so
as to achieve stability and retention in occlusal function. However, the compressed tissue
tend to displace the dentures in an attempt
to return to their original form (Boucher
1951; Collett 1965; Heart & Rahn 1980). The
selective pressure technique directs the
forces to the primary denture bearing areas of
the ridge and relieves non-stress bearing areas
(Boucher 1964; Collett 1970; Zarb et al.
1990). The previous techniques may be also

127

Elsyad et al
Mandibular denture base deformation

used with the impression of implant overdentures (Zarb & Jansson 1985; Schroder 1991).
The ability of the denture base to resist
deformation encountered from masticatory
loads is an important factor in the prevention
of denture fracture (Beyli & von Fraunhofer
1981). Fracture of overdenture bases tend to
occur more frequently in areas adjacent to
the implant(s) retaining a mandibular overdenture due to inadequate thickness of
acrylic resin around the attachments (Duncan et al. 2000; Rodrigues 2000; Chaffee
et al. 2002; Gonda et al. 2007, 2010).
Several in vitro (Prombonas & Vlissidis
2006; Gonda et al. 2007) and in vivo (Regli &
Kydd 1953; Regli & Gaskill 1954; Swoope &
Kydd 1966) studies evaluated mandibular
complete denture base deformation using
strain gauges. However, it has been difficult
to simulate the intraoral conditions (e.g., the
direction of the force exerted by jaw muscles
or the viscoelasticity of the ridge mucosa)
accurately in vitro which may affect the
results of pressure distribution under denture
bases (Kubo et al. 2009).
The aim of this study was clinical evaluation of mandibular denture base deformation
with different impression techniques for
implant-retained overdenture. We hypothesized that choice of proper impression technique can reduce deformation and fracture of
the overdenture bases.

Material and methods

Study design

Ten patients (five men and five women) with

mean age of 62.3 years were selected from a
previous trial (Elsyad et al. 2011) and enrolled
in this study following their acceptance of
the faculty committees duly approved and
explained research protocol and a signed
informed consent. The selected patients were
required to have a good general condition,
moderately to slightly resorbed alveolar
ridges covered with healthy even displaceable
mucosa (tested with a burnisher) and normal
ridge relation. For all patients, new maxillary
and mandibular complete dentures were constructed. Acrylic resin teeth of 20 degree cusp
angle (Vitapan;Vita Zahnfabrik, Bad Sackingen, Germany) were arranged using the bilateral balanced occlusal concept. Patients were
encouraged to wear the new dentures for at
least 2 months prior to implant surgery to
enhance neuromuscular adaptation. Each
patient then received two implants (Implant
Direct LLC, Spectra System TM Screw Plant
Calabasas, CA, USA) in the canine region of

128 |

the mandible using standardized 2- stage submerged surgical approach. The healing abutments were placed 3 months after surgery,
and then replaced with ball abutments
(Implant Direct LLC) of appropriate height
(according to the peri-implant mucosal thickness) 2 weeks later.
Final overdenture impressions

Mandibular preliminary impression was

made with irreversible hydrocolloid material
(CA 37; Cavex Holland BV, Haarlem, Netherlands) and poured to obtain a diagnostic cast
on which three custom trays were fabricated
with an open area in the implant region
using autopolymerizing acrylic resin (GC;
GC United Kingdom Ltd. Newport Pagnell,
UK.). Impression transfer copings with long
fixation screw were threaded into the
implants (Zarb & Jansson 1985). For each
patient, three different impression techniques
were made by the same prosthodontist with
48 h interval to allow mucosal recovery
(Kydd & Daly 1982):
(a) Mucostatic impression technique (Boucher 1951; LeVan 1952; Bohannan 1954;
Schroder 1991):
The custom tray was fabricated with 1-mm
wax spacer and two stoppers bilaterally at
second premolar and second molar regions.
The custom tray was border molded with
plastic impression compound (Impression
Compound; Kerr Italia S.pA, Salerno, Italy).
Final impression for the mandiblular ridge
was made with light body polyvinylsiloxane
material (Speedex, Coltene/Whaledent Inc.,
Cuyahoga Falls, OH, USA) (Fig. 1).

(Cavex Outline; Cavex Holland BV) using finger pressure. The tray was removed from the
mouth, excess impression material was
cleaned from open areas with sharp scalpel,
and the tray was replaced carefully in the
mouth. The light body material was injected
around the impression copings while applying finger pressure to the distal portion of the
tray (Fig. 2).
(c) Selective pressure impression technique
(Boucher 1964; Collett 1970; Zarb et al.
1990):
The custom tray was fabricated on the
residual ridge that was relieved by adding a
thin layer of melted baseplate wax except on
the primary stress bearing areas (i.e., buccal
shelves) and aluminum foil was burnished
over the wax (Fig. 3). The tray was border
molded and the impression was completed as
with the definite pressure technique.
For all impression techniques, the transfer
copings were picked up to the polished surface of the tray with autopolymerizing acrylic
resin (Gregory-Head & LaBarre 1999) which
also supports the light-body material (Fig. 4).
Implant analogs were attached to the impression coping with the long fixation screw and
the final impressions were poured with extrahard stone (ZETA, Orthodontic Stone;
WhipMix. Corp, Louisville, KY, USA). Ball
abutment replicas were screwed into implant

(b) Definite pressure impression technique

(Boucher 1951; Collett 1965; Heart &
Rahn 1980; Zarb & Jansson 1985):
The custom tray was fabricated without
spacers or stoppers. After border molding, the
impression of the alveolar mucosa was made
with a zinc oxide eugenol impression paste

Fig. 2. Definite pressure impression technique.

Fig. 1. Mucostatic impression technique.

Fig. 3. Tin foil spacer for selective pressure impression

technique.

Clin. Oral Impl. Res. 24 (Suppl. A100), 2013 / 127133

2012 John Wiley & Sons A/S

Elsyad et al
Mandibular denture base deformation

Fig. 4. Picking up of the transfer coping to the polished

surface of the tray.

Fig. 5. Strain gauge positions on the lingual surface of

mandibular overdenture.

analogs and the respective gold matrices

(Implant Direct LLC) were placed on the
replicas.

& Kydd 1966; Gonda et al. 2007). The fine

lead wires were brought through the interproximal acrylic resin between artificial
teeth.

Denture duplication

Strain gauge calibration

The polished and occlusal surfaces of mandibular denture were replicated with aid of a
silicone key (Coltoflax; Coltene AG, Altstatten, Switzerland). The silicone key was repositioned against each final cast. Acrylic resin
teeth of the same size were replaced in the
mold in their respective positions, and molten baseplate wax (Tenatex; Associated Dental Products, Wiltshire, UK) was poured into
the intervening space to form a similar contour and bulk in the duplicate dentures. The
three wax mandibular dentures were processed at the same time by the same technician using an acrylic resin (Paladon 65;
Heraeus Kulzer, Hanau, Germany) in accordance with the specifications of the manufacturer.

Before in vivo measurements, each duplicate

overdenture was returned to a duplicate mandibular acrylic model. A calibration experiment to the gauges was made to assess the
linearity of the gauges and the repeatability
of force measurements. Using a loading
device (LLOYD LRX; LLOYD instruments
Ltd., Fareham, Hampshire, UK), a cyclic load
ranging from 10 to 50 N was applied five
times in 10-N steps on a metal bar positioned
on the occlusal surface of mandibular denture at first molar areas to age the gauges.
The purpose of aging was to minimize hysteresis, a lagging or retardation of the effect
when forces acting upon a body are changed
(Akca et al. 2009). Each gauge was wired separately to connecting terminals of a multichannel digital bridge amplifier (Tinsely
precision instruments, Model 8692, RH1
3LG, Surrey, UK). A personal computer was
interfaced with the bridge amplifier to record
output signals.

Strain measurements
Strain gauge fixation

Six linear strain-gauges (type: KFG-1-120-C111L1M2R; KYOWA electronic instruments

CO.,
Ltd.,
Tokyo,
Japan;
resistance
119.6 0.4% O; gauge length: 1 mm; gauge
factor: 2.08 1%; Lot no. Y4058S) were
bonded to the lingual polished surface of each
duplicate mandibular overdenture using a
cyanoacrylate adhesive (CC-33A, EP-34B.,
KYOWA electronic instruments CO., Ltd.).
The long axes of the gauges were oriented in
the mesio-distal direction and parallel to the
incisal edges of the anterior teeth (Fig. 5).
Gauge positions were at midline (Ch1 and
Ch2) and opposite to implants (Ch3and Ch4
at right side and Ch5and Ch6 at left side).
The long axes of the upper gauges (Ch1, Ch3,
and Ch5) located at level of ball abutments
top and long axes of lower gauges (Ch2, Ch4,
and Ch6) located 5 mm lower to that of
upper gauges (Regli & Gaskill 1954; Swoope
2012 John Wiley & Sons A/S

Strain gauge measurements

The gauges were isolated from moisture in

the oral environment with a Chloroprene
rubber coating material (HAMATITE-Y., KYOWA electronic instruments CO., Ltd.). To
eliminate temperature effects, each active
gauge was connected to a corresponding element of an identical dummy gauge (cemented on an acrylic plate) in a half Wheatstone
bridge. The resulted six half bridge circuits
were connected to terminals of the multichannel strainmeter. Strain registrations were
performed during maximal voluntary clenching and during gum chewing. The test subjects were asked to perform a set of
consecutive five maximum bites which
lasted 2-s with 5-s relaxation periods. After
another longer relaxation period the test sub-

129 |

jects were told to perform a set of consecutive gum chewing cycles on the right
(working) side which lasted 10 s with 10 min
relation period (Stafford & Glantz 1991; Ferrario et al. 2004). Each set was repeated five
times for each situation (clenching and gum
chewing) and the mean was subjected to statistical analysis. The strain measurements
were made in the following sequence; mucostatic, selective pressure, and definite pressure techniques in three consecutive sessions
separated by 1 day interval to avoid subject
fatigue and prevent mucosal soreness.
Statistical analysis

For between-impression and between-channel

comparisons, KruskalWallis test was used. If
significant differences were detected, Bonferroni method was used to correct the P-values
for paired comparisons of multiple testing.
MannWhitney test was used to compare
strains produced by clenching and chewing
and to determine gender-based difference in
recorded strains. All statistical analyses were
performed with SPSS V. 17 (SPSS, Chicago,
IL, USA). A P-value <0.05 was considered to
be statistically significant.

Results
Microstrains recorded at different channels
during strain gauge calibration are shown in
Fig. 6. Male subjects produced higher strains
at all channels than females; however, the
difference was not significant. Microstrain
values at midline (Ch1 and Ch2), at right
implant area (Ch3 and Ch4) and at left
implant area (Ch5 and Ch6) during clenching
and gum chewing are presented in Tables 1
and 2, respectively. The recorded strains at
Ch1 and Ch2 were compressive in nature,
while strain values at Ch3, Ch4, Ch5, and
Ch6 were tensile in nature. With exception
of strain obtained at Ch1 and Ch6 during
gum chewing, strain recorded at all channels

Fig. 6. The linear relationship between force applied

and microstrain recorded during strain gauge calibration.

Clin. Oral Impl. Res. 24 (Suppl. A100), 2013 / 127133

Elsyad et al
Mandibular denture base deformation

Table 1. Microstrain values obtained at different channels with different impression techniques during clenching

Table 2. Microstrain values obtained at different channels with different impression techniques during gum chewing

130 |

Clin. Oral Impl. Res. 24 (Suppl. A100), 2013 / 127133

2012 John Wiley & Sons A/S

Elsyad et al
Mandibular denture base deformation

Table 3. Comparison of micro strain values between impression techniques

Accurate studies of functional deformations of

overdentures, can only be made in experiments performed under clinical conditions
(Glantz & Nilner 1997). The degree of denture
deformation during function is affected by personal factors such as general health, muscular
power, fatigue, and pain thresholds and anatomical factors such as the size of the denture
bearing area, and thickness of the soft tissues
(Obeid et al. 1982). The use of within patient
study design and adequate rest periods
between measurements to prevent fatigue and
mucosal soreness helped to minimize the
effect of these factors on strain measurements.
The small size of strain gauges and their
minimal interference during function make
them ideal for measuring deformation under
clinical conditions. However, the gauges have

to be sealed effectively from the oral tissues

to prevent short circuits which occur when
strain gauges are exposed to saliva and they
must be adhered firmly to the surface of the
appliance (Stafford & Glantz 1991). By using
the waterproof coating and the adhesive provided by the stain gauge manufacture, these
limitations were overcome. Semi-anatomic
teeth were used with duplicate mandibular
dentures as Swoope & Kydd (1966) found that
reduction of cusp angle of posterior teeth
resulted in a significant decrease in the denture base deformation.
Since this was the first study that evaluates
strain on implant-retained mandibular overdenture surface in vivo, it was not possible to
compare the results directly with results of
other studies. Clenching recorded significant
higher strain when compared to gum chewing
for all impression techniques. This observation may be attributed to the increased activity of masticatory muscles during maximum
voluntary clenching when compared with
unilateral chewing (Fontijn-Tekamp et al.
2000; Ferrario et al. 2004). The strain recorded
at midline was compressive in nature. A similar finding was observed in in vitro (Prombonas & Vlissidis 2006) and in vivo (Regli &
Gaskill 1954) studies conducted on mandibular complete denture. For all impression techniques, the greatest strain was recorded on
the overdenture surface at the level of ball
abutments top and was tensile in nature. This
finding agreed with previous in vitro studies
(Dong et al. 2006; Gonda et al. 2007) in which
the authors reported greatest strain close to
the top of overdenture coping. The increased
tensile strain at level of abutment top may be
due to ball abutments act as a fulcrum during
functional loading of ball retained mandibular
overdenture. Such strains may produce cyclic
deformation and fatigue failure of overdenture
acrylic resin. Subsequently, denture fracture
might occur from crack initiation and propagation (Darbar et al. 1994; Prombonas & Vlissidis 2006). In a finite element study,
Assuncao et al. (2009) observed highest stress
concentration on the O/ring system capsule
over the implants upon loading. They attributed the increased stress to the denture intrusion and contact between the O/ring capsule
and ball abutments.
The strain recorded with mucostatic or
selective pressure techniques was significantly higher than that recorded with definite pressure technique. The relief provided
in the impression tray over the entire supporting tissues (with mucostatic technique)
or over the non-stress bearing areas (with
selective pressure technique) causes a mini-

131 |

Clin. Oral Impl. Res. 24 (Suppl. A100), 2013 / 127133

Loading

Ch1

Ch2

Ch3

Ch4

Ch5

Ch6

Clenching
Gum chewing

0.019
0.059

0.002
0.032

0.003
0.012

0.005
0.004

0.001
0.001

0.005
0.062

Number in each cell indicates P-value of KruskalWallis test.

Table 4. Comparison of micro strain values between clenching and gum chewing
Impression technique

Ch1

Ch2

Ch3

Ch4

Ch5

Ch6

Mucostatic
Selective pressure
Definite pressure

0.046
0.028
0.010

0.028
0.046
0.356

0.043
0.027
0

0.039
0.028
0

0.043
0.041
0.001

0.023
0.003
0.002

Number in each cell indicates P-value of MannWhitney test.

Table 5. Multiple comparisons of micro strain values between different channels

Clenching

Ch1Ch2
Ch1Ch3
Ch1Ch4
Ch1Ch5
Ch1Ch6
Ch2Ch3
Ch2Ch4
Ch2Ch5
Ch2Ch6
Ch3Ch4
Ch3Ch5
Ch3Ch6
Ch4Ch5
Ch4Ch6
Ch5Ch6

Gum chewing

Mucostatic

Selective
pressure

Definite
pressure

Mucostatic

Selective
pressure

Definite
pressure

<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
1
<0.001
<0.001
1
<0.001

<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
0.052
<0.001
<0.001
1
<0.001

<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
1
<0.001
<0.001
1
<0.001

0.003
<0.001
<0.001
<0.001
0.005
<0.001
<0.001
<0.001
<0.001
0.001
0.048
<0.001
<0.001
0.596
0.003

0.413
<0.001
0.001
0.001
0.002
<0.001
<0.001
<0.001
<0.001
0.003
0.001
0.001
0.021
1
0.003

0.700
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
0.001
0.008
<0.001
1
0.299
0.042

Number in each cell indicates P-value of Bonnferroni test.

during clenching and gum chewing demonstrated significant differences between

impression techniques (KruskalWallis test,
P < 0.035) (Table 3). Mucostatic technique
recorded the highest strain while the definite
pressure technique recorded the lowest
(Tables 1 and 2). There was no significant difference between strain recorded with mucostatic and selective pressure technique
(Bonferroni).
Clenching recorded significant higher
strain (MannWhitney test, P < 0.05) at all
channels (except Ch2 with definite pressure
technique) when compared with gum chewing for all impression techniques (Table 4).
There was a significant difference in strain
recorded between different channels for all
impression techniques at both loading conditions (KruskalWallis test, P < 0.001). The
highest strain was recorded at Ch3 with mucostatic technique during clenching while
the lowest strain was recorded at Ch6 with
definite pressure technique during gum
chewing. Between-channel comparisons (Bonferroni) showed a significant difference
(P < 0.05) for all channels except between
2012 John Wiley & Sons A/S

Ch3 and Ch5 (during clenching) and between

Ch4 and Ch6 (during clenching and gum
chewing) for all impression techniques
(Table 5).

Discussion

Elsyad et al
Mandibular denture base deformation

mal soft tissue displacement during impression procedure (LeVan 1952; Bohannan
1954; Collett 1970; Zarb et al. 1990). When
the mucosa is stressed under the pressure
of mandibular overdenture bases during
function, the fluid interchanged with the
surrounding
unstressed
mucoperiosteum
(Kydd & Daly 1982), the epithelial ridges
were decreased in depth and flattened, connective tissue papillae were obliterated and
the fibers became orientated horizontally
(Kydd et al. 1969, 1971). Subsequently, the
mucoperiosteum of the residual ridges demonstrated a reduction in thickness (Kydd
et al. 1969). Even with relatively small
occluding forces, Kydd et al. (1971) reported
that the denture can be intruded into the
supporting mucosa by 20% of its thickness.
As a result of mucosal thickness reduction
and denture intrusion, the stresses are concentrated over the implant abutments due
to the difference in resiliency between the
implants and ridge mucosa (Assuncao et al.
2009). Such stresses are increased as the
resiliency of mucosa increases (Ichikawa
et al. 1996; Assuncao et al. 2009) leading to
an increase in denture base deformation
over implant abutments. This explanation

concurred with the findings of El Ghazali

et al. (1989) who reported 2090% reduction
of denture deformation through removal of
soft mobile tissues.
In contrast, the definite pressure technique
is associated with greater soft tissue displacement during the impression procedure as no
relief was provided in the tray over supporting structures (Boucher 1951; Collett 1965;
Heart & Rahn 1980). Therefore, during function, minimal soft tissue displacement under
the distal extension bases occurs and functional loads is distributed, optimally,
between the supporting structures and the
implants (Uludag & Sahin 2006). However,
the constant pressure from the denture is
conducive to resorptive changes in basal tissues due to interference with the local circulation (Collett 1970).

Conclusion

Source of support

Within the limits of this in vivo study

regarding the small sample size, it could be
conservatively concluded that:

Nil. Conflict of interest: none declared.

Darbar, U.R., Huggett, R. & Harrison, A. (1994)

Stress analysis techniques in complete dentures.
Journal of Dentistry 22: 259264.
Dong, J., Ikebe, K., Gonda, T. & Nokubi, T. (2006)
Influence of abutment height on strain in a mandibular overdenture. Journal of Oral Rehabilitation 33: 594599.
Duncan, J.P., Freilich, M.A. & Latvis, C.J. (2000)
Fiber-reinforced
composite
framework
for
implant-supported overdentures. Journal of Prosthetic Dentistry 84: 200204.
El Ghazali, S., Glantz, P.O., Strandman, E. & Randow, K. (1989) On the clinical deformation of
maxillary complete dentures. Influence of denture-base design and shape of denture-bearing tissue. Acta Odontologica Scandinavica 47: 6976.
Elsyad, M.A., Al-Mahdy, Y.F. & Fouad, M.M. (2011)
Marginal bone loss adjacent to conventional and
immediate loaded two implants supporting a ballretained mandibular overdenture: a 3-year randomized clinical trial. Clinical Oral Implants
Research, doi: 10.1111/j.1600-0501.2011.02173.x.
Feine, J.S., Carlsson, G.E., Awad, M.A., Chehade, A.,
Duncan, W.J., Gizani, S., Head, T., Lund, J.P., MacEntee, M., Mericske-Stern, R., Mojon, P., Morais, J.,
Naert, I., Payne, A.G., Penrod, J., Stoker, G.T. Jr,
Tawse-Smith, A., Taylor, T.D., Thomason, J.M.,
Thomson, W.M. & Wismeijer, D. (2002) The McGill consensus statement on overdentures. Montreal,
Quebec, Canada. May 2425, 2002. International
Journal of Prosthodontics 15: 413414.
Ferrario, V.F., Tartaglia, G.M., Maglione, M., Simion, M. & Sforza, C. (2004) Neuromuscular coor-

dination of masticatory muscles in subjects with

two types of implant-supported prostheses. Clinical Oral Implants Research. 15: 219225.
Fontijn-Tekamp, F.A., Slagter, A.P., Van Der Bilt,
A., Van, T.H.M.A., Witter, D.J., Kalk, W. & Jansen, J.A. (2000) Biting and chewing in overdentures, full dentures, and natural dentitions.
Journal of Dental Research 79: 15191524.
Glantz, P.O. & Nilner, K. (1997) Biomechanical
aspects on overdenture treatment. Journal of Dentistry 25(Suppl 1): S2124.
Gonda, T., Ikebe, K., Dong, J. & Nokubi, T. (2007)
Effect of reinforcement on overdenture strain.
Journal of Dental Research 86: 667671.
Gonda, T., Maeda, Y., Walton, J.N. & MacEntee,
M.I. (2010) Fracture incidence in mandibular
overdentures retained by one or two implants.
Journal of Prosthetic Dentistry 103: 178181.
Gregory-Head, B. & LaBarre, E. (1999) Two-step
pick-up impression procedure for implantretained overdentures. Journal of Prosthetic Dentistry 82: 615616.
Heart, C.M. & Rahn, A.O. (1980) Text Book of
Complete Denture, 3rd edition, 190. Philadelphia,
PA: Iea&Febiger, Philadelphia:199.
Ichikawa, T., Horiuchi, M., Wigianto, R. & Matsumoto, N. (1996) In vitro study of mandibular
implant-retained overdentures: the influence of
stud attachments on load transfer to the implant
and soft tissue. International Journal of Prosthodontics 9: 394399.
Klemetti, E., Chehade, A., Takanashi, Y. & Feine,
J.S. (2003) Two-implant mandibular overdentures:

Definite pressure impression technique for

implant-retained mandibular overdenture
is associated with minimal denture deformation during function when compared to
mucostatic or selective pressure technique.
The greatest denture deformation with all
impression techniques occured over
implant areas at level of ball abutment top
during clenching and was tensile in nature.
Reinforcement of the denture base over
the implants may be recommended to
increase resistance of base fractures over
the implants when mucostatic or selective pressure impression technique
was used for implant-retained overdenture.

References
Akca, K., Kokat, A.M., Sahin, S., Iplikcioglu, H. &
Cehreli, M.C. (2009) Effects of prosthesis design
and impression techniques on human cortical
bone strain around oral implants under load.
Medical Engneering and Physics 31: 758763.
Assuncao, W.G., Barao, V.A., Tabata, L.F., de Sousa,
E.A., Gomes, E.A. & Delben, J.A. (2009) Comparison between complete denture and implantretained overdenture: effect of different mucosa
thickness and resiliency on stress distribution.
Gerodontology 26: 273281.
Beyli, M.S. & von Fraunhofer, J.A. (1981) An analysis of causes of fracture of acrylic resin dentures.
Journal of Prosthetic Dentistry 46: 238241.
Bohannan, H.M. (1954) A critical analysis of the
mucostatic principle. Journal of Prosthetic Dentistry 4: 232241.
Boucher, C.O. (1951) A critical analysis of mid-century impression techniques for full dentures.
Journal of Prosthetic Dentistry 1: 472491.
Boucher, C.O. (1964) Swensons Complete Dentures, 5th edition, 124134. St. Louis: The C. V.
Mosby Company.
Chaffee, N.R., Felton, D.A., Cooper, L.F., Palmqvist,
U. & Smith, R. (2002) Prosthetic complications in
an implant-retained mandibular overdenture population: initial analysis of a prospective study.
Journal of Prosthetic Dentistry 87: 4044.
Collett, H.A. (1965) Complete denture impressions.
Journal of Prosthetic Dentistry 15: 603614.
Collett, H.A. (1970) Final impressions for complete
dentures. Journal of Prosthetic Dentistry 23: 250
264.

132 |

Clin. Oral Impl. Res. 24 (Suppl. A100), 2013 / 127133

2012 John Wiley & Sons A/S

Elsyad et al
Mandibular denture base deformation

simple to fabricate and easy to wear. Journal of

Canadian Dental Association 69: 2933.
Kubo, K., Kawata, T., Suenaga, H., Yoda, N., Shigemitsu, R., Ogawa, T. & Sasaki, K. (2009) Development of in vivo measuring system of the
pressure distribution under the denture base of
removable partial denture. Journal of Prosthodontic Research 53: 1521.
Kydd, W.L. & Daly, C.H. (1982) The biologic and
mechanical effects of stress on oral mucosa. Journal of Prosthetic Dentistry 47: 317329.
Kydd, W.L., Daly, C.H. & Wheeler, J.B. 3rd (1971)
The thickness measurement of masticatory
mucosa in vivo. International Dental Journal 21:
430441.
Kydd, W.L., Stroud, W., Moffett, B.C. Jr & Tamarin,
A. (1969) The effect of mechanical stress on oral
mucoperiosteum of dogs. Archives of Oral Biology 14: 921933.
LeVan, M.M. (1952) Basic principles of impression
making. Journal of Prosthetic Dentistry 2: 26 35.
Mericske-Stern, R.D., Taylor, T.D. & Belser, U.
(2000) Management of the edentulous patient.
Clinical Oral Implants Research. 11(Suppl 1): 108
125.

2012 John Wiley & Sons A/S

Obeid, A.A., Stafford, G.D. & Bates, J.F. (1982) Clinical studies of strain behaviour of complete dentures. Journal of Biomedical Engneering 4: 4954.
Prombonas, A.E. & Vlissidis, D.S. (2006) Comparison of the midline stress fields in maxillary and
mandibular complete dentures: a pilot study.
Journal of Prosthetic Dentistry 95: 6370.
Regli, C.P. & Gaskill, H.L. (1954) Denture base
deformation during function. Journal of Prosthetic Dentistry 4: 548554.
Regli, C.P. & Kydd, W.L. (1953) A preliminary
study of the lateral deformation of metal base
dentures in relation to plastic base dentures. Journal of Prosthetic Dentistry 3: 326 330.
Rodrigues, A.H. (2000) Metal reinforcement for
implant-supported mandibular overdentures. Journal of Prosthetic Dentistry 83: 511513.
Schroder, A. (1991) Principles of the superstructure.
In: Schroder, A., Sutter, F. & Krekleler, G., eds.
Oral Implantology, 312319. New York: George
Thieme Verlag Stuttgart.
Stafford, G.D. & Glantz, P.O. (1991) Intraoral strain
gauge measurements on complete dentures:
a methodological study. Journal of Dentistry 19:
8084.

Swoope, C.C. & Kydd, W.L. (1966) The effect of

cusp form and occlusal surface area on denture
base deformation. Journal of Prosthetic Dentistry
16: 3443.
Uludag, B. & Celik, G. (2006) An alternative
impression technique for implant-retained overdentures. Journal of Prosthetic Dentistry 96: 377
378.
Uludag, B., Celik, G. & Goktug, G. (2008) Prosthetic solution for unfavorably inclined maxillary
implants: a case report. Journal of Oral Implantology 34: 111114.
Uludag, B. & Sahin, V. (2006) A functional impression technique for an implant-supported overdenture: a clinical report. Journal of Oral
Implantology 32: 4143.
Zarb, G.A., Bolender, C.L., Hickey, J.C. & Carlsson,
G.E. (1990) Bouchers Prosthetic Treatment of
Edentulous Patients, 10th edition, 225238. St
Louis: CV Mosby Co.
Zarb, G.A. & Jansson, T. (1985) Prosthodontic procedures. In: Branemark, P.I., zarb, G.A. & Albrektsson, T., eds. Tissue Integrated Prostheses
Osseointegration in Clinical Dentistry, 251270.
Chicago, IL, USA: Quintessence Publishing Co.
Inc.

133 |

Clin. Oral Impl. Res. 24 (Suppl. A100), 2013 / 127133