Ball versus other attachments in mini implant retained overdenture: a systematic review and meta-analysis
Abstract Objectives Mini implant retained overdentures have been treated in edentulous patients with promising long-term results. However, various attachment systems in this process remain insufficiently investigated. This systematic review and meta-analysis aimed to compare the effects of the ball...
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BMC
2025-04-01
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| Series: | BMC Oral Health |
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| Online Access: | https://doi.org/10.1186/s12903-025-05961-z |
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| author | Zin Hnin Pwint Aung Pyae Phyo Win Thanapat Sastraruji Pathawee Khongkhunthian |
| author_facet | Zin Hnin Pwint Aung Pyae Phyo Win Thanapat Sastraruji Pathawee Khongkhunthian |
| author_sort | Zin Hnin Pwint Aung |
| collection | DOAJ |
| description | Abstract Objectives Mini implant retained overdentures have been treated in edentulous patients with promising long-term results. However, various attachment systems in this process remain insufficiently investigated. This systematic review and meta-analysis aimed to compare the effects of the ball and other attachments used in mini-implant overdentures. Marginal bone loss, bite force, implant survival rate, prosthetic maintenance, and complications were assessed. Materials and methods A systematic search was conducted across PubMed, Cochrane Library, and Scopus databases until 25th February 2025. This systematic review aimed to find studies that compare ball attachments with other attachment systems in mini dental implant (MDI) overdentures. The primary outcome was marginal bone loss, while the secondary outcomes were maximum bite force, implant survival rate, prosthetic maintenance, and complications. The risk of bias was assessed using the Cochrane risk-of-bias tool for RCTs, and a quantitative meta-analysis was performed. Results Of the 561 publications, six randomized clinical trials (101 participants, 234 mini-implants) met the inclusion criteria. Risk of bias assessment revealed three studies with a low risk of bias and three studies with some concerns for risk of bias. There was no significant difference in the marginal bone loss between the ball attachments and others (WMD = 0.15, 95% CI -0.50 to 0.81, p = 0.65), though ball attachments performed better than telescopic ones (P < 0.05) in subgroup analysis. No significant difference in bite force was found (WMD = -5.29, 95% CI -33.46 to 22.87, p = 0.71). Two-year survival rates were 90.9% for ball and 97.8% for bar attachments. The ERA® (Extra-Coronal Resilient Attachment) group required five interventions (sore spot adjustments, relining, nylon replacements), while the ball attachment group required only two (denture repair, nylon cap replacement) over the one-year follow-up period. Conclusions Within the limitations of the study, it can be concluded that ball, bar, and ERA® attachments yield similar outcomes in marginal bone loss while telescopic attachments show more statistically significant marginal bone loss (p < 0.05). The type of attachment does not significantly affect maximum bite force. PROSPERO registration number CRD42024610018. |
| format | Article |
| id | doaj-art-795862ccd8a8480b8550920a2764caec |
| institution | OA Journals |
| issn | 1472-6831 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Oral Health |
| spelling | doaj-art-795862ccd8a8480b8550920a2764caec2025-08-20T02:17:52ZengBMCBMC Oral Health1472-68312025-04-0125111410.1186/s12903-025-05961-zBall versus other attachments in mini implant retained overdenture: a systematic review and meta-analysisZin Hnin Pwint Aung0Pyae Phyo Win1Thanapat Sastraruji2Pathawee Khongkhunthian3Centre of Excellence for Dental Implantology, Faculty of Dentistry, Chiang Mai UniversityCho Thar Dental Clinic, North Okkalapa TownshipDental Research Centre, Faculty of Dentistry, Chiang Mai UniversityCentre of Excellence for Dental Implantology, Faculty of Dentistry, Chiang Mai UniversityAbstract Objectives Mini implant retained overdentures have been treated in edentulous patients with promising long-term results. However, various attachment systems in this process remain insufficiently investigated. This systematic review and meta-analysis aimed to compare the effects of the ball and other attachments used in mini-implant overdentures. Marginal bone loss, bite force, implant survival rate, prosthetic maintenance, and complications were assessed. Materials and methods A systematic search was conducted across PubMed, Cochrane Library, and Scopus databases until 25th February 2025. This systematic review aimed to find studies that compare ball attachments with other attachment systems in mini dental implant (MDI) overdentures. The primary outcome was marginal bone loss, while the secondary outcomes were maximum bite force, implant survival rate, prosthetic maintenance, and complications. The risk of bias was assessed using the Cochrane risk-of-bias tool for RCTs, and a quantitative meta-analysis was performed. Results Of the 561 publications, six randomized clinical trials (101 participants, 234 mini-implants) met the inclusion criteria. Risk of bias assessment revealed three studies with a low risk of bias and three studies with some concerns for risk of bias. There was no significant difference in the marginal bone loss between the ball attachments and others (WMD = 0.15, 95% CI -0.50 to 0.81, p = 0.65), though ball attachments performed better than telescopic ones (P < 0.05) in subgroup analysis. No significant difference in bite force was found (WMD = -5.29, 95% CI -33.46 to 22.87, p = 0.71). Two-year survival rates were 90.9% for ball and 97.8% for bar attachments. The ERA® (Extra-Coronal Resilient Attachment) group required five interventions (sore spot adjustments, relining, nylon replacements), while the ball attachment group required only two (denture repair, nylon cap replacement) over the one-year follow-up period. Conclusions Within the limitations of the study, it can be concluded that ball, bar, and ERA® attachments yield similar outcomes in marginal bone loss while telescopic attachments show more statistically significant marginal bone loss (p < 0.05). The type of attachment does not significantly affect maximum bite force. PROSPERO registration number CRD42024610018.https://doi.org/10.1186/s12903-025-05961-zMini-implantsOverdentureDenture precision attachmentMarginal bone lossSystematic reviewMeta-analysis |
| spellingShingle | Zin Hnin Pwint Aung Pyae Phyo Win Thanapat Sastraruji Pathawee Khongkhunthian Ball versus other attachments in mini implant retained overdenture: a systematic review and meta-analysis BMC Oral Health Mini-implants Overdenture Denture precision attachment Marginal bone loss Systematic review Meta-analysis |
| title | Ball versus other attachments in mini implant retained overdenture: a systematic review and meta-analysis |
| title_full | Ball versus other attachments in mini implant retained overdenture: a systematic review and meta-analysis |
| title_fullStr | Ball versus other attachments in mini implant retained overdenture: a systematic review and meta-analysis |
| title_full_unstemmed | Ball versus other attachments in mini implant retained overdenture: a systematic review and meta-analysis |
| title_short | Ball versus other attachments in mini implant retained overdenture: a systematic review and meta-analysis |
| title_sort | ball versus other attachments in mini implant retained overdenture a systematic review and meta analysis |
| topic | Mini-implants Overdenture Denture precision attachment Marginal bone loss Systematic review Meta-analysis |
| url | https://doi.org/10.1186/s12903-025-05961-z |
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