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Zhurakivska K, Luciano R, Caponio VCA, Lo Russo L, Muzio LL, Mascitti M, Troiano G. Cost/effectiveness analysis of treatment options for the rehabilitation of the total edentulous mandible. J Oral Rehabil 2023; 50:400-409. [PMID: 36704998 DOI: 10.1111/joor.13423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/05/2023] [Accepted: 01/17/2023] [Indexed: 01/28/2023]
Abstract
BACKGROUND Several solutions are available for the rehabilitation of edentulous jaws. Each treatment option is characterised by specific advantages and drawbacks. OBJECTIVE The aim of this research was to perform a cost-effectiveness (CE) analysis of the main rehabilitative solutions of totally edentulous mandibles. METHODS Decision tree models were built using TreeAge Pro Healthcare 2021 software to compare the following strategies: Conventional Denture (CD), Overdenture retained by two implants (OD-2), Overdenture retained by a bar on two implants (ODbar), Overdenture retained by 4 mini-implants (ODmini) and Fixed denture supported by 4 implants (FD). Costs were estimated using data from public rate tables. Effectiveness measures were obtained from a meta-analysis of literature data, normalising the different scales in 0-1 range. A value of 30 000€ per 1 normalised utility points was set as threshold of willingness to pay (WTP). Probabilistic sensitivity analysis (PSA) with 1000 Monte Carlo Simulations was performed to characterise uncertainty. RESULTS Total costs ranged between 1804,40€ for CD and 10 008,80€ for FD rehabilitations, with an effectiveness of 0,69 and 0,95 normalised points (0-1 scale) for the two solutions. The ODbar resulted to be the most CE strategy at the established WTP value, with the highest Net Monetary Benefit (22 001,20€), followed by the OD-2 rehabilitation (21 866,80€). PSA analysis confirmed the dominance of OD-2 and ODbar strategies, confirming a net separation from the other alternatives. CONCLUSION OD stabilised by 2 implants could represent a good rehabilitative solution for patients with edentulous mandible, being a good trade-off in terms of costs and effectiveness. Nevertheless, a standardised measure of oral health-related quality of life is needed to obtain more reliable results.
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Affiliation(s)
- Khrystyna Zhurakivska
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Rossella Luciano
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | | | - Lucio Lo Russo
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Lorenzo Lo Muzio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Marco Mascitti
- Department of Clinical Specialistic and Dental Sciences, Marche Polytechnic University, Ancona, Italy
| | - Giuseppe Troiano
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
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Mo A, Hjortsjö C, Jokstad A. Maxillary overdenture on three implants retained by low-profile stud attachments - A prospective cohort study. J Oral Rehabil 2022; 49:1069-1079. [PMID: 36029151 PMCID: PMC9826172 DOI: 10.1111/joor.13364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 07/05/2022] [Accepted: 08/22/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Clinical data are needed on long-term outcomes of removable implant-supported prostheses in the fully edentulous maxilla as a function of the number of implants, effects of the attachment system and other clinical variables. OBJECTIVE To restore individuals with an edentate maxilla with a metal-reinforced removable prosthesis without palatal coverage retained by low-profile stud attachments on three implants. METHODS The regional ethics committee approved a prospective cohort study that included all consecutive patients treated in a private speciality clinic. Primary outcomes were patients reported, that is denture satisfaction scale and oral health-related quality of life - OHIP-20. Secondary outcomes were implant- (bone loss, implant complications and peri-implant conditions) and prosthesis-related (prosthesis complications, maintenance needs and mucosa condition). RESULTS Thirty-two study participants were recruited between March 2007 and October 2016 and followed for a minimum of five years. According to Kruskal-Wallis tests, the OHIP-20 and Denture Satisfaction Scale questionnaire pre-treatment scores differed significantly. After an average of 6.7 years, peri-implant bone loss of more than 2 mm was observed on 17% of all implants, while no or minor bone loss was seen on 38%. The estimated success of implants was 0.95 at 168 months. The estimated success of the prosthesis, that is no adverse events or need for any repairs, was 0.55 at 156 months. CONCLUSION The positive findings in the current clinical study strengthen the notion that for many individuals with an edentulous maxilla, a removable prosthesis retained by three implants fitted with low-profile stud-attachment is a reliable technical solution.
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Affiliation(s)
- Arild Mo
- Department of Clinical Dentistry, Faculty of Health SciencesUiT The Arctic University of NorwayTromsøNorway
| | - Carl Hjortsjö
- Department of Prosthetic Dentistry and Oral FunctionInstitute of Clinical Dentistry, University of OsloOsloNorway
| | - Asbjørn Jokstad
- Department of Clinical Dentistry, Faculty of Health SciencesUiT The Arctic University of NorwayTromsøNorway
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Evaluation of Retention, Wear, and Maintenance of Attachment Systems for Single- or Two-Implant-Retained Mandibular Overdentures: A Systematic Review. MATERIALS 2022; 15:ma15051933. [PMID: 35269164 PMCID: PMC8911844 DOI: 10.3390/ma15051933] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 02/20/2022] [Accepted: 03/01/2022] [Indexed: 12/04/2022]
Abstract
Attachment systems (AS) enhance retention and stability by anchoring the overdentures to implants. Since 2002, the McGill consensus statement recommends the 2-implant-retained overdentures as the standard choice for edentulous mandible (2-IRMO). Considering the large number of AS available, it remains difficult for a practitioner to make a reasoned choice. A systematic review was conducted in PubMed/Medline and carried out independently by three authors, on retention, wear, and maintenance of AS used clinically or in vitro specifically for 1- or 2-IRMO. The 45 selected studies include 14 clinical and 31 in vitro studies. The risk of bias was evaluated according to the revised Cochrane risk of bias tool for randomized trials (RoB 2). The initial retention force of the cylindrical system is higher than the ball system. The retention loss, related to the wear of the retention device, is responsible for the most common need of maintenance, requiring activation or replacement. Plastic retention devices wear out faster and more significantly than metal ones, implying a worse time behavior of cylindrical systems, but their maintenance rate is similar. Neither system appears categorically superior. Cylindrical systems provide higher initial retention than ball ones; this advantage reduces over time with wear without affecting their need for maintenance.
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Possebon APDR, Schuster AJ, Chagas-Júnior OL, Pinto LDR, Faot F. Prosthetic aftercare, mastication, and quality of life in mandibular overdenture wearers with narrow implants: A 3-year cohort study. J Dent 2021; 115:103880. [PMID: 34740638 DOI: 10.1016/j.jdent.2021.103880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 10/23/2021] [Accepted: 10/28/2021] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES This cohort study investigated clinical, functional, and quality of life outcomes, along with prosthetic maintenance events in mandibular overdenture (MO) wearers for 3 years. METHODS Thirty MO wearers with narrow diameter implants (NDIs) and locking taper stud abutments (Facility-Equator system) were annually monitored by registering the visible plaque index (VPI), peri‑implant inflammation (PI), calculus presence (CP), probing depth (PD), bleeding on probing (BOP), secondary implant stability (ISQ), marginal bone loss (MBL), masticatory performance and dental impact in daily life (DIDL) questionnaire domains. Multilevel mixed-effects linear regression was performed to analyse changes over time. Chi-square tests were performed to analyse the relationship between the appearance of prosthetic complications and maintenance occurrences. The survival rate of patients with NDIs was calculated using the Kaplan-Meier test. RESULTS Twenty-six individuals attended all follow-ups, the survival rate of 83.3% in the first year was maintained, and no one implant was lost over the 3-year period. There were significant differences for PD between 1 and 3 years (p ≤ 0.01) and between 2 and 3 years for PI (p ≤ 0.01), GI (p ≤ 0.01), ISQ (p = 0.02), and MBL (p ≤ 0.01). All masticatory performance outcomes showed significant differences (p ≤.01). Prosthetic maintenance events decreased significantly over time. Appearance, general performance, and eating and chewing domains presented high effect sizes. CONCLUSION Continued changes were observed in the clinical parameters of MO users over the 3-year period. In addition, most functional parameters, except for particle homogenization, improved significantly over time. The positive impact on quality of life is likely related to the significant reduction in prosthetic maintenance events. CLINICAL SIGNIFICANCE Periodic returns to assess peri‑implant tissues and MO maintenance should be performed to ensure the success of rehabilitation to assure improvements in masticatory function and oral health-related quality of life.
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Affiliation(s)
| | | | - Otacílio Luiz Chagas-Júnior
- Department of Oral and Maxillofacial Surgery and Maxillofacial Prosthodontics, School of Dentistry, Federal University of Pelotas, RS, Brazil
| | - Luciana de Rezende Pinto
- Department of Restorative Dentistry, School of Dentistry, Federal University of Pelotas, RS, Brazil
| | - Fernanda Faot
- Department of Restorative Dentistry, School of Dentistry, Federal University of Pelotas, RS, Brazil.
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Evaluation of Stress Distribution on all-on-four Concept and Conventional Implant Designs: 3D Finite Element Analysis. BALKAN JOURNAL OF DENTAL MEDICINE 2021. [DOI: 10.2478/bjdm-2021-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Summary
Background/Aim: The objective of this study was to evaluate the stress distribution on implants and supporting bone tissue in All-on-Four and conventional designs in edentulous mandible by using 3D finite element analysis.
Material and Methods: The different five models were designed according to All-on-Four concept and conventional implant placement designs. While the first two models were involved in All-on-Four concept with two long implants, the remaining models were designed by conventional approaches with three implants in different location and length. After the modelling procedures, a load of masticatory force was applied and the stresses were evaluated.
Results: It has been observed that principal stresses in both cortical and spongious bone tissue were concentrated in models of All-on-Four design. Less principal stress levels were found in models of conventional design. Similarly, von Mises stress values on implant surfaces were found to be higher in All-on-Four concept.
Conclusions: In severely resorbed mandible, the use of conventional implant placement is recommended. Although All-on-Four design seems to be a reasonable alternative for edentulous mandible, evidence-based results of this approach should be supported by long-term follow-up studies.
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van der Moolen PL, Post BJ, Slot DE, van der Weijden FA. Outcome of peri-implant maintenance care in patients with an implant-supported lower denture-A 3.5-year retrospective analysis. Clin Implant Dent Relat Res 2021; 23:236-243. [PMID: 33463040 PMCID: PMC8247953 DOI: 10.1111/cid.12963] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 10/05/2020] [Accepted: 10/30/2020] [Indexed: 12/20/2022]
Abstract
Background Implant‐supported overdentures represent a successful treatment for edentulous patients. As early diagnosis, detection and supportive care are considered key factors for the prevention of peri‐implant diseases, consistent maintenance of these implants is becoming increasingly relevant. Purpose This retrospective analysis evaluated a cohort of edentulous patients with a mandibular implant‐supported overdenture over a period of 3.5 years during which the peri‐implant tissues were assessed. Materials and Methods A total of 108 patients that had consistently adhered to the annual maintenance appointments was selected. The clinical peri‐implant pocket probing depth (PiPPD) and peri‐implant bleeding on probing score (PiBOP) were investigated. Data from the 3.5‐year follow‐up were compared to data from the baseline assessment. Results A 100% implant survival was reported after 3.5 years. The mean PiBOP showed a significant decrease over time (P = .028). The mean PiPPD was found significantly deeper for male patients both at baseline (P = .004) and 3.5‐year follow‐up (P < .001). Besides, the PiPPD for locator anchorages was found significantly deeper compared to ball anchorages at the 3.5‐year follow‐up (P = .026). Conclusion In those patients that adhered to the annual maintenance visits during the 3.5 years after implant surgery a stable peri‐implant condition was observed. As future consideration, the comparison of the clinical outcomes of patients participating in the maintenance program with those that did not would make this observation even more meaningful.
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Affiliation(s)
- Pieter Leo van der Moolen
- Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ben Jeroen Post
- Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Dagmar Else Slot
- Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Fridus August van der Weijden
- Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Clinic for Implantology Utrecht, Utrecht, The Netherlands
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Boyce RA. Prosthodontic Principles in Dental Implantology: Adjustments in a Coronavirus Disease-19 Pandemic-Battered Economy. Dent Clin North Am 2021; 65:135-165. [PMID: 33213707 PMCID: PMC8180388 DOI: 10.1016/j.cden.2020.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
More patients are requesting fixed prosthesis to replace missing teeth. More than 5 million dental implants are placed annually in the United States. This number will decrease in 2020 owing to the coronavirus disease-19 pandemic. The edentulous patient has a decreased quality of life. Prosthodontic rehabilitation/reconstruction of edentulism improves overall quality of life. Patient-reported outcome measures are subjective reports of patients' perceptions of their oral health status and the impact that it has on their quality of life. This chapter contains a variety of prosthodontic principles for the reader to help satisfy the needs and expectations of the patient.
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Affiliation(s)
- Ricardo A Boyce
- The Brooklyn Hospital Center, 121 Dekalb Avenue, Box 187, Brooklyn, NY 11201, USA; New York University, College of Dentistry, New York, NY, USA.
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Pinheiro MA, Meira IA, Magno MB, Maia LC, Rodrigues Garcia RC. Masticatory function improvement with the use of mandibular single-implant overdentures in edentulous subjects: a systematic literature review. MINERVA STOMATOLOGICA 2020; 69:256-268. [PMID: 32945635 DOI: 10.23736/s0026-4970.20.04327-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION In this systematic review, several masticatory function parameters assessed during mandibular single-implant overdenture (SIO) use were compared to pre- SIO placement values in edentulous patients with aim of contributing to a consensus regarding denture treatment options. EVIDENCE ACQUISITION This study was registered a priori in the PROSPERO database (CRD42018106567). Two independent reviewers carried out electronic searches in eight databases, without language or time frame limitations, to collate clinical studies comparing masticatory function of edentulous patients before versus after SIO installation with the implant placed on the mandibular midline. Risk of bias was assessed with a before-and-after tool and evidence certainty level was evaluated with the Grading of Recommendations Assessment, Development and Evaluation program. EVIDENCE SYNTHESIS Eleven studies were included in this review (1 prospective, 3 crossover trials, 4 randomized clinical trials, 2 paired clinical trials, and 1 pilot). Enrolled patients were mostly over 60 years old; all patients were using conventional complete dentures (CD) prior to SIO installation. Masticatory performance, masticatory efficiency, bite force, and muscle activity were improved after the SIO placement compared to during mandibular CD use. Mandibular movement and masticatory ability data were inconclusive. Most of the studies had low risk of bias, but all had very low certainly level ratings due to methodological heterogeneity. CONCLUSIONS Placement of SIO improves masticatory function, as reflected mostly by masticatory performance and efficiency data, relative to CD use. Further studies comparing dental rehabilitation options, including SIOs, are needed to improve the quality of evidence in the literature.
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Affiliation(s)
- Mayara A Pinheiro
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Ingrid A Meira
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Marcela B Magno
- Department of Paediatric Dentistry and Orthodontic, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Lucianne C Maia
- Department of Paediatric Dentistry and Orthodontic, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Renata C Rodrigues Garcia
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil -
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Matthys C, De Vijlder W, Besseler J, Glibert M, De Bruyn H. Cost-effectiveness analysis of two attachment systems for mandibular overdenture. Clin Oral Implants Res 2020; 31:615-624. [PMID: 32212393 PMCID: PMC7386928 DOI: 10.1111/clr.13599] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 03/05/2020] [Accepted: 03/12/2020] [Indexed: 11/29/2022]
Abstract
Objectives This study analysed the cost‐effectiveness of two different attachments for the 2‐implant overdenture (2IOD) in edentulous mandibles. Materials and methods When considering alternative treatments, cost‐effectiveness analysis is an important factor for stakeholders (patient, clinician, social security, insurance company, etc.). A general practice population (n = 116) was treated between 2003 and 2013 with a mandibular 2IOD with 2 different ball/stud attachment systems, one spherical (Group D) and one cylindrical (Group L). Patient well‐being was assessed with OHIP‐14‐Total (OHIP‐14‐T), at intake and annually up to 5 years, to calculate the health effect. Initial and maintenance costs of both treatments were inventoried. The cost‐effectiveness was compared. Annual discount rates of 4% and 1.5% were applied to future costs and health outcomes, following Dutch guidelines. Prices were adjusted to the year 2003. To offset the uncertainty in relevant input parameters, a sensitivity analysis was performed using bootstrap analysis. Significance was set at p < .05. Results The health effect was 6.36 (SD 5.32) for Group D and 8.54 (SD 5.63) for Group L. The sum of the discounted costs up to 5 years was EUR 4,210.98 (SD 634.75) for the D and EUR 3,840.62 (SD 302.63) for the Group L (p = .005). The bootstrapping reports that L abutment clearly dominates the D abutment in terms of cost‐effectiveness. Conclusions The 2IOD on the L abutment is dominant compared to the 2IOD on D abutment, in a 5‐year perspective.
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Affiliation(s)
- Carine Matthys
- Clinic for Removable Prosthodontics, Faculty of Medicine and Health Sciences, Dental School, Ghent University, Ghent, Belgium
| | - William De Vijlder
- Department of Economics, Faculty of Economics and Business Administration, Ghent University, Ghent, Belgium
| | - Jos Besseler
- Besseler Dental Clinic, Enschede, The Netherlands
| | - Maarten Glibert
- Department of Periodontology and Oral Implantology, Faculty of Medicine and Health Sciences, Dental School, Ghent University, Ghent, Belgium
| | - Hugo De Bruyn
- Department of Periodontology and Oral Implantology, Faculty of Medicine and Health Sciences, Dental School, Ghent University, Ghent, Belgium.,Department of Dentistry- Implantology & Periodontology, University Medical Center, Research Institute Health Sciences, Nijmegen, The Netherlands
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Sharaf M, Bakry E, Abdall M. A comparison of the retentive force of ball and socket attachment versus magnet attachment in mandibular overdentures: A randomized control trial. J Int Oral Health 2020. [DOI: 10.4103/jioh.jioh_20_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Ortensi L, Martinolli M, Borromeo C, Ceruso FM, Gargari M, Xhanari E, Tallarico M. Effectiveness of Ball Attachment Systems in Implant Retained- and Supported-Overdentures: A Three- to Five-Year Retrospective Examination. Dent J (Basel) 2019; 7:dj7030084. [PMID: 31480546 PMCID: PMC6784476 DOI: 10.3390/dj7030084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 07/31/2019] [Accepted: 08/14/2019] [Indexed: 02/03/2023] Open
Abstract
Purpose: To evaluate implant and prosthetic survival rates, complications, patient satisfaction, and biological outcomes of patients rehabilitated with a ball attachment system for implant retained- and supported-overdentures (IOV), which was in function for 3 to 5 years. Methods: This retrospective study evaluated data collected from patients treated between April 2001 and May 2018 with IOV on splinted and non-splinted implants and a ball attachment system. Patients were followed for 36 to 206 months (mean follow-up was 128.1 ± 51.9 months). Data were collected at the 3- and 5-year follow-up examination. Outcome measures were implant and prosthetic survival rates, technical complications, marginal bone loss (MBL), oral health impact profile (OHIP), and periodontal parameters (bleeding on probing and plaque index). Results: A total of 46 patients (16 males and 30 females) with 124 implants were included in this study. Twenty-five implant-retained overdentures were delivered on 53 unsplinted implants, while the other 21 patients received an implant-supported overdentures and the implants were splinted. At the five-year follow-up examination, one implant and one prosthesis failed in the unsplinted group, resulting in a cumulative survival rate of 97.8% at the patient level. Two minor technical complications were experienced. Conclusions: Implant overdenture retained or supported by ball attachment systems showed high implant and prosthetic survival and success rates. A low number of complications, high patient satisfaction, and successful biological parameters were experienced in the mid-term follow-up. Data need to be confirmed by further randomized trials.
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Affiliation(s)
| | | | | | | | - Marco Gargari
- Department of Clinical Science and Translational Medicine, University of Rome, Tor Vergata, 00100 Rome, Italy
| | - Erta Xhanari
- Department of Implantology and Prosthetic Aspects, Aldent University, 1001 Tirana, Albania
- Private Practice, 1001 Tirana, Albania
| | - Marco Tallarico
- Department of Implantology and Prosthetic Aspects, Aldent University, 1001 Tirana, Albania
- Private Practice, 00151 Rome, Italy
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Rehabilitation of an Extremely Edentulous Atrophic Maxilla with a Pseudoskeletal Class III Relationship. Case Rep Dent 2019; 2019:5696837. [PMID: 31179133 PMCID: PMC6501258 DOI: 10.1155/2019/5696837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 04/01/2019] [Indexed: 11/24/2022] Open
Abstract
The skeletal class III relationship presents complex dentoalveolar problems, requiring multidisciplinary treatment. In edentulous people, severe atrophy of the jawbone simulates the clinical appearance of a skeletal class III relationship (pseudoskeletal class III), which presents major problems for rehabilitation. This article describes the rehabilitation of a 67-year-old patient with a pseudoskeletal class III relationship. The mandible was restored with two implant-supported bar-retained overdentures using clips for retention. The extremely atrophic maxilla was restored with a combination of sinus augmentation, implant placement, and classic prosthodontic treatment using an electroformed mesostructured overdenture with swivel lock attachments on an implant-supported bar. By performing minimal augmentative and implant surgeries and using the possibilities and advantages of classic prosthetic dentistry, the clinical situation described here could be managed and the atrophic maxilla could be rehabilitated.
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13
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Splinted versus unsplinted overdenture attachment systems - no difference in clinical outcomes. Evid Based Dent 2019; 20:28-29. [PMID: 30903127 DOI: 10.1038/s41432-019-0006-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Data sources PubMed/Medline, Scopus and Cochrane databases supplemented by hand searches in the journals; Clinical Oral Implants Research, Journal of Oral Rehabilitation, The Journal of Prosthetic Dentistry, Journal of Prosthodontics and Journal of Dentistry.Study Selection Randomised controlled clinical trials (RCTs), prospective studies with ≥ ten participants and follow-up periods ≥ six months, published in English, and comparing splinted and unsplinted attachment systems within the same study.Data extraction and synthesisTwo investigators independently performed the electronic search; of which one collected the data while the other investigator verified it. A third investigator was involved in cases of disagreement. The Kappa test was also used to determine the inter-examiner agreement. The risk of bias was analysed using the Cochrane Risk of Bias Tool and the Newcastle-Ottawa scale.Results Nine studies were included; six RCTs, two prospective studies and one crossover study, involving the placement of 984 implants in 380 patients and a mean follow-up period of five years. All implants were placed in the mandibular arch. The included studies demonstrated a low or unclear risk of bias. Both splinted and unsplinted attachment systems performed similarly, with no statistically significant differences present in marginal bone loss, complications and implant survival.Conclusions The choice of attachment system does not seem to influence marginal bone loss, the incidence of complications or implant survival in mandibular overdentures.
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Payne AGT, Alsabeeha NHM, Atieh MA, Esposito M, Ma S, Anas El‐Wegoud M. Interventions for replacing missing teeth: attachment systems for implant overdentures in edentulous jaws. Cochrane Database Syst Rev 2018; 10:CD008001. [PMID: 30308116 PMCID: PMC6516946 DOI: 10.1002/14651858.cd008001.pub2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Implant overdentures are one of the most common treatment options used to rehabilitate edentulous patients. Attachment systems are used to anchor the overdentures to implants. The plethora of attachment systems available dictates a need for clinicians to understand their prosthodontic and patient-related outcomes. OBJECTIVES To compare different attachment systems for maxillary and mandibular implant overdentures by assessing prosthodontic success, prosthodontic maintenance, patient preference, patient satisfaction/quality of life and costs. SEARCH METHODS Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 24 January 2018); Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 12) in the Cochrane Library (searched 24 January 2018); MEDLINE Ovid (1946 to 24 January 2018); and Embase Ovid (1980 to 24 January 2018). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials on 24 January 2018. No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA All randomised controlled trials (RCTs), including cross-over trials on maxillary or mandibular implant overdentures with different attachment systems with at least 1 year follow-up. DATA COLLECTION AND ANALYSIS Four review authors extracted data independently and assessed risk of bias for each included trial. Several corresponding authors were subsequently contacted to obtain missing information. Fixed-effect meta-analysis was used to combine the outcomes with risk ratios (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, with 95% confidence intervals (95% CI). We used the GRADE approach to assess the quality of evidence and create 'Summary of findings' tables. MAIN RESULTS We identified six RCTs with a total of 294 mandibular overdentures (including one cross-over trial). No trials on maxillary overdentures were eligible. Due to the poor reporting of the outcomes across the included trials, only limited analyses between mandibular overdenture attachment systems were possible.Comparing ball and bar attachments, upon pooling the data regarding short-term prosthodontic success, we identified substantial heterogeneity (I2 = 97%) with inconsistency in the direction of effect, which was unexplained by clinical or methodological differences between the studies, and accordingly we did not perform meta-analyses for this outcome. Short-term re-treatment (repair of attachment system) was higher with ball attachments (RR 3.11, 95% CI 1.68 to 5.75; 130 participants; 2 studies; very low-quality evidence), and there was no difference between both attachment systems in short-term re-treatment (replacement of attachment system) (RR 1.18, 95% CI 0.38 to 3.71; 130 participants; 2 studies; very low-quality evidence). It is uncertain whether there is a difference in short-term prosthodontic success when ball attachments are compared with bar attachments.Comparing ball and magnet attachments, there was no difference between them in medium-term prosthodontic success (RR 0.84, 95% CI 0.64 to 1.10; 69 participants; 1 study; very low-quality evidence), or in medium-term re-treatment (repair of attachment system) (RR 1.75, 95% CI 0.65 to 4.72; 69 participants; 1 study; very low-quality evidence). However, after 5 years, prosthodontic maintenance costs were higher when magnet attachments were used (MD -247.37 EUR, 95% CI -346.32 to -148.42; 69 participants; 1 study; very low-quality evidence). It is uncertain whether there is a difference in medium-term prosthodontic success when ball attachments are compared with magnet attachments.One trial provided data for ball versus telescopic attachments and reported no difference in prosthodontic maintenance between the two systems in short-term patrix replacement (RR 6.00, 95% CI 0.86 to 41.96; 22 participants; 1 study; very low-quality evidence), matrix activation (RR 11.00, 95% CI 0.68 to 177.72; 22 participants; 1 study; very low-quality evidence), matrix replacement (RR 1.75, 95% CI 0.71 to 4.31; 22 participants; 1 study; very low-quality evidence), or in relining of the implant overdenture (RR 2.33, 95% CI 0.81 to 6.76; 22 participants; 1 study; very low-quality evidence). It is uncertain whether there is a difference in short-term prosthodontic maintenance when ball attachments are compared with telescopic attachments.In the only cross-over trial included, patient preference between different attachment systems was assessed after only 3 months and not for the entire trial period of 10 years. AUTHORS' CONCLUSIONS For mandibular overdentures, there is insufficient evidence to determine the relative effectiveness of different attachment systems on prosthodontic success, prosthodontic maintenance, patient satisfaction, patient preference or costs. In the short term, there is some evidence that is insufficient to show a difference and where there was no evidence was reported. It was not possible to determine any preferred attachment system for mandibular overdentures.For maxillary overdentures, there is no evidence (with no trials identified) to determine the relative effectiveness of different attachment systems on prosthodontic success, prosthodontic maintenance, patient satisfaction, patient preference or costs.Further RCTs on edentulous cohorts must pay attention to trial design specifically using the same number of implants of the same implant system, but with different attachment systems clearly identified in control and test groups. Trials should also determine the longevity of different attachment systems and patient preferences. Trials on the current array of computer-aided designed/computer-assisted manufactured (CAD/CAM) bar attachment systems are encouraged.
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Affiliation(s)
- Alan GT Payne
- Northland Prosthodontics LtdPrivate practice17 Rust AvenueTown CentreWhangareiNorthlandNew Zealand0110
| | - Nabeel HM Alsabeeha
- RAK Dental Centre, Ministry of Health and PreventionRas Al‐KhaimahUnited Arab Emirates
| | - Momen A Atieh
- School of Dentistry, University of OtagoSir John Walsh Research InstituteDunedinNew Zealand
| | - Marco Esposito
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of ManchesterCochrane Oral HealthJR Moore Building, Oxford RoadManchesterUKM13 9PL
| | - Sunyoung Ma
- School of Dentistry, University of OtagoSir John Walsh Research InstituteDunedinNew Zealand
| | - Marwah Anas El‐Wegoud
- Egyptian Center for Evidence Based Medicine (ECEBM)8 Masaken Hayet El Tadrees Ain Shams University, El Khalifa El Maamoun St.CairoEgypt11646
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