Evaluation of the quality of life and satisfaction in patients using complete dentures versus mandibular overdentures. Systematic review and meta-analysis

Full-mouth rehabilitation of a patient with implant-supported fixed dental prostheses using CAD-CAM frameworks

Conventional complete denture wearers often complain of lack of stability and overall discomfort with their prostheses. The advent of dental implants and advanced prosthetic methods have greatly improved this struggle for edentulous patients. The utilisation of computer-aided design and computer-aided manufacturing (CAD-CAM) technology has only further enhanced the capabilities of dental practitioners to rapidly and accurately restore edentulism. This report details the advantages of using CAD-CAM technology compared to analogue methods for titanium framework design and fabrication. It discusses the decrease in framework distortions, ease of communication with laboratories, and amount of time saved from the implementation of this technology. The results of this clinical report suggest that fixed dental prostheses with titanium frameworks fabricated using the software and scanner presented in this report fit accurately and may be a viable option to restore edentulous arches.

Single mandibular implant study - impact on dietary habits after 5 years of observation in patients with immediate and delayed loading protocols

OBJECTIVES

Single midline implants in the edentulous mandible can be used to support existing complete dentures to improve patients' satisfaction and masticatory efficiency. The impact on patients' dietary habits and the influence of the loading protocol of the implants was the subject of this study.

MATERIALS AND METHODS

In this prospective randomized clinical trial, edentulous patients with existing complete dentures in both jaws were treated with a single midline implant in the mandible. In group A, the implants were loaded immediately, in group B the loading was delayed after three months. Patients were asked to report on their nutritional intake before implant placement and 12, 24 and 60 months after loading using a standardized two-part questionnaire.

RESULTS

Nutritional intake regarding the frequency of consumption of the requested food items did not change significantly during the 60-months study period, regardless of the loading protocol. In contrast, the second part of the questionnaire revealed that after 60 months, there was a significant decrease in avoidance of food, that had a coarse and hard texture in both groups. This significant decrease was observable in the group A in the first 12 and 24 months and in the group B after 60 months.

CONCLUSION

A change in the patients' dietary habits due to the insertion of a single midline implant in the mandible to support the existing complete denture cannot be observed, independently to the loading protocol.

CLINICAL RELEVANCE

Improving the chewing efficiency by single midline implants in the edentulous mandible does not lead to a change in dietary habits.

Effect of implant angulation and patrice on the retention of overdenture attachment systems: An in vitro study

PURPOSE

To test the retention of two different overdenture attachment matrices and straight abutments when implants are placed at 0-, 15-, and 30-degree diverging angulations as well as the retention of 15-degree-angled abutments to correct the overall angulation to 0-degrees.

MATERIALS AND METHODS

Matching aluminum blocks were machined to incorporate two dental implants at 0-degree, 15-degree, and 30-degree relative angulations and overdenture attachments to simulate a two-implant overdenture. At 0-degree, 15-degree, and 30-degree implant angulation, straight abutments were studied. At 30-degree implant angulation, an additional group was compared utilizing 15-degree angulated abutments that corrected the overall implant angulation to 0-degrees. A custom-designed testing apparatus that allowed automated insertion and removal of the simulated overdenture was designed, with three independent testing stations, each consisting of one simulated arch and one simulated overdenture base. The baseline and residual retention forces after 30,000 dislodging cycles of the simulated overdenture were measured. One-way ANOVA was used to compare retention differences among different color patrices within the 0-, 15-, and 30-degree implant angulation groups followed by Tukey's multiple comparison test. Two sample t-tests were used to compare 0-degree versus 15-degree implant groups with straight abutments and 30-degree implant groups with straight abutments versus 30-degree implant groups with angulated abutments.

RESULTS

Regardless of implant angulation or abutment correction, the change in retention exhibited by the Novaloc system after testing was not statistically significant for all patrice types (p > 0.05); however, the change in retention exhibited by the Locator system was statistically significant for the tested group (p = 0.0272). In both the Novaloc and Locator systems, the baseline and final retention values provided by the different patrices were significantly different except for the white and green Novaloc patrices in the 15-degree divergent implant group which did not meet the specified level of significance (p = 0.0776).

CONCLUSION

Within the limitations of this study, implant angulations upto 15 degrees do not affect differential change in retention of Novaloc patrices. There is no difference between Novaloc white inserts (light retention value) and green inserts (strong retention values) when implants diverge upto 15 degrees. When Novaloc straight abutments were placed on implants diverging by 30 degrees, blue extra-strong retention inserts outperformed yellow medium retention inserts by maintaining a higher retention value after 30,000 cycles. When utilizing Novaloc 15-degree angulated abutments that correct the overall implant angulation to zero degrees, the red light retentive patrice provides steady retention. Finally, the Locator-green patrice system provides greater retention than the comparable Novaloc-blue patrice combination; however, it also loses more retention after 30,000 cycles.

Early Loading of Two Implants Supporting Mandibular Overdentures in Geriatric Edentulous Patients: A 12-Year Follow-Up Study

Background: This study aims to show the clinical outcomes of implants supporting mandibular overdentures in edentulous patients. Methods: Mandibular edentulous patients were diagnosed with an oral examination, panoramic radiograph, and diagnostic casts for intermaxillary relations and treated with overdentures over two implants. After two-stage surgery, implants were early loaded with an overdenture at 6 weeks. Results: Fifty-four patients (28 females and 24 males) were treated with 108 implants. Thirty-two patients (59.2%) had a previous history of periodontitis. Twenty-three patients (46%) were smokers. Forty patients (74.1%) suffered from systemic diseases (i.e., diabetes, cardiovascular diseases). The clinical follow-up of the study was 147.8 ± 10.4 months. The clinical outcomes showed a global success of 94.5% of implants. Fifty-four overdentures were placed in the patients over the implants. The mean marginal bone loss was 1.12 ± 0.34 mm. Nineteen patients (35.2%) showed some kind of mechanical prosthodontic complication. Sixteen implants (14.8%) were associated with peri-implantitis. Conclusions: Based on the clinical results obtained, we can determine that the treatment of elderly edentulous patients with mandibular overdentures through the early loading of two placed implants is a successful implant protocol.

Cost/effectiveness analysis of treatment options for the rehabilitation of the total edentulous mandible

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.

Evaluation of the quality of life and satisfaction in patients using complete dentures versus mandibular overdentures. Systematic review and meta-analysis

Background

The World Health Organization (WHO) recognizes edentulism as a physical impairment that results in a negative impact in the daily activities.

Objective

The study aimed to compare the satisfaction and the quality of life, in patients treated with implant retained overdentures with two mandibular implants (IOD) against those with mandibular conventional complete dentures (CCD).

Methods

Different search strategies were used to screen for articles in Pubmed/Medline, Cochrane Library and Scielo of the last 17 years (2003–2020). The keywords used were: “quality of life OR satisfaction” AND “complete denture OR conventional denture” AND “overdenture OR implant retained.”

Results

Six articles and two more were added by manual search. The population was 400 in the CCD and 412 for IOD. The mean age was 64.3 ± 6.41 years. The group was comprised of 283 men and 427 women. The scores obtained in the visual analog scale (VAS) before and after the treatment were statistically significant in favor of the IOD for overall satisfaction, (WMD: 12.329; 95% CI: 4.873 to 19.784, p‐value = 0.001), comfort, speech and stability. For esthetics and chewing there was non‐significant improvement while hygiene worsened for the IOD. For the comparison after the treatment between both treatment modalities a statistically significant improvement was found in overall satisfaction (WMD: 14.408; 95% CI: 8.589 to 20.226, p‐value < 0.001), comfort, speech, chewing and stability in favor of the IOD but not in esthetics or hygiene.

Conclusions

This systematic review and meta‐analysis show the superiority of the IOD, despite is not achieved in all aspects.