Within-Subject Comparison of Maxillary Implant-Supported Overdentures with and without Palatal Coverage

Maxillary and mandibular overdentures retained by two unsplinted narrow-diameter titanium-zirconium implants - A clinical pilot study

OBJECTIVES

To evaluate the survival rates and marginal bone loss of narrow-diameter titanium-zirconium implants supporting complete maxillary and mandibular overdentures up to 3 years after loading.

MATERIALS AND METHODS

Ten completely edentulous patients who were dissatisfied with their complete dentures were enrolled. Two narrow-diameter implants were placed in the canine region of the maxilla and mandible. After second-stage surgery, implant-supported overdentures (palatal-free) attached by parallel alignable stud-attachments were placed. Patients were followed periodically for up to 36 months. Standardized radiographs were taken at baseline, 12 and 36 months to analyze mean marginal bone level changes around the implants.

RESULTS

The Kaplan-Meier survival rates were 100% for mandibular and 68.0% (SE ± 10.9%) for maxillary implants at 36 months (p = .008). Six maxillary implants failed after loading; no mandibular implants were lost. Five implants failed due to loss of osseointegration. One implant fractured. The mean marginal bone level changes around the analyzed implants (n = 28, 9 patients) were -0.71 ± 0.82 mm in the mandible and -2.08 ± 1.52 mm in the maxilla at the 36-month follow-up. The difference in marginal bone level changes between the maxilla and mandible was significant (p = .019) at the 12- and 36-month follow-ups.

CONCLUSION

Two narrow-diameter titanium-zirconium implants with stud-attachments showed a highly satisfactory outcome in the mandible. The maxillary implants showed a high failure rate and significantly more bone loss over time than the mandibular implants. The minimal concept of two implants and an overdenture should be limited to the edentulous mandible.

Complete denture palatal rugae design impact on satisfaction and quality of life

OBJECTIVES

To compare the impact of three complete denture palatal rugae designs on participants' satisfaction and oral-health-related quality of life.

BACKGROUND

Complete dentures palatal rugea are usually polished to a smooth finish, which can affect the patient's adaptation. Roughening or keeping an opening in the rugae area to replicate the natural sensation of the palatal rugae has been suggested but lacks clinical evidence.

METHODS

This randomised crossover trial included participants with complete dentures randomly allocated to six sequences. Each sequence alternated between polished, roughened, and open rugae designs. Participants evaluated general and domain-specific satisfaction (eating, taste, speaking, phonetics, and ease of cleaning) on a 100-mm visual analogue scale. They also completed the Oral Health Impact Profile for Edentulous Patients (OHIP-EDENT) and indicated their preferred design at the end. Repeated-measure ANOVA compared satisfaction, and one-way ANOVA with Tukey's test compared OHIP-EDENT scores.

RESULTS

Forty-two participants were randomised. Seven dropped out. General satisfaction ratings were comparable for the polished (Mean = 80.2, SD = 19.7) and roughened designs (Mean = 79.5, SD = 20.2). However, the open design had a significantly lower satisfaction rating (Mean = 41.1, SD = 32.2). OHIP-EDENT scores for the open design (Mean = 44.9, SD = 17.5) were significantly worse than those for the polished (Mean = 36.1, SD = 12.7) and roughened designs (Mean = 36.2, SD = 13.3). Two-thirds of the participants chose the polished design. One-third chose the roughened design; of those, 83% were first-time denture wearers.

CONCLUSIONS

Complete dentures with polished and roughened rugae designs were perceived similarly. Both designs could be recommended based on the patient's preference. However, the open design should be avoided due to negative perception.

Articulation distortion in Mandarin-speaking individuals with complete arch maxillary implant-supported fixed dental prostheses

STATEMENT OF PROBLEM

Implant-supported fixed dental prostheses (IFPs) have been increasingly used to restore edentulous jaws, yet few studies have utilized acoustic analysis for objective evaluation of postrestoration speech outcomes.

PURPOSE

The purpose of this clinical study was to assess speech articulation in edentulous individuals before and after the provision of IFPs by combining the results of subjective evaluations and objective acoustic analysis parameters.

MATERIAL AND METHODS

The study included thirty-four individuals who had an edentulous maxilla and had been provided with an IFP for over 6 months, along with 6 dentate controls. Acoustic analysis was conducted, and mean opinion scores (MOS) were rated from recordings. The participants were interviewed about perceived speech changes. Changes in the parameters were evaluated using the paired t test or Wilcoxon signed-rank test (α=.05). A comparison between dentate controls and edentulous individuals (with or without prostheses) was made using an independent t test or Mann-Whitney U test (α=.025).

RESULTS

Following restoration, the center of gravity (CoG) changes occurred in 11 of 12 consonants in edentulous individuals (P<.05). Prosthesis use allowed the CoG of all affricates and fricatives to appear larger and closer to control values. Before restoration, the CoG of 9 of 12 consonants in edentulous individuals differed from controls (P<.01); after restoration, this reduced to 3 out of 12 (P<.01). MOS improved in 10 of 12 consonants (P<.01), nearing a score of 4. Despite restoration, the CoG of alveolo-palatals [tɕh], [tɕ], and [ɕ] remained different from controls (P<.01). Most participants were satisfied with the improvement, with few reporting discomfort with alveolars [s] and [tsh].

CONCLUSIONS

IFPs can enhance speech in edentulous individuals, yet articulation distortions of alveolar and alveolo-palatal consonants persist. The improper palatal shape of IFPs or an abrupt joint between the IFP and atrophic natural bone may contribute to these distortions.

A 5-Year Satisfaction Outcome Study of Patients Receiving Six-Implant-Supported Fixed Prosthesis

The aim of the study was to analyze the satisfaction of patients treated with a protocol of six-implant-supported fixed prosthesis (6IFP) throughout 5 years of service. This retrospective study collected the data of all patients who had full-arch rehabilitations using 6IFP and followed them for 5 years. After applying the research inclusion/exclusion strategy, 37 cases were finally included in the study. All the patients had no previous complete dentures because they were partially edentulous, not interested in pursuing complete denture rehabilitation, had immediate dental extractions, implantation used the 2-stage protocol, and there was minor peri-implant socket grafting. Cases with severe bone loss that required extensive grafting were excluded. A total number of 222 implants were placed in the maxillary or mandibular arches in a total of 37 patients. The data presented the satisfaction outcomes concerning mastication, phonetics, and comfort during the first 5 years of the recall plan. The former was achieved based on the clinical record reviews, follow-up visits, and recall phone calls at the preoperative stage as well as annually thereafter. The mean satisfaction rate was 94.5%, with a mean record of 8.21 ± 1.7 out of 10, there was no gender predilection significance, and no age range variation significance was validated. Regarding the smoking status, the t-test score exhibited no significant effect on phonetics and mastication (p = 0.12, p = 0.16, respectively), whereas comfort was found to be significantly affected (p = 0.03). The comfort level was found to be slightly less at the immediate postoperative period among smokers when compared to non-smokers. In conclusion, partially edentulous patients who received the rehabilitation plan of arch dental extractions, six immediate implantations, and delayed prosthetic loading were found to be highly satisfied.

"Longitudinal Oral Health-Related Quality of Life in maxillary mini dental implant overdentures after 3 years in function"

OBJECTIVES

Longitudinal evaluation of Oral Health-Related Quality of Life (OHRQoL) during treatment of flaplessly placed, one-piece mini-dental-implants (MDIs) for maxillary overdentures is rarely investigated, nor is the impact of MDI failures.

MATERIAL AND METHODS

This multicenter prospective cohort study evaluated the 3-year outcome of 5-6 MDIs in the edentulous maxilla in patients above 50 years with dentate mandible. Provisional dentures were provided before final prosthetic connection was established at 6 months. Postoperative discomfort was assessed using a visual analogue score (VAS). OHRQoL was investigated using the Oral Health Impact Profile (OHIP)-14 at baseline (preoperatively), postoperatively, post-prosthetic connection and after 3 years in function.

RESULTS

164 (78.4%) of the 204 placed MDIs were still in situ after 3 years, in 29/31 patients. Two patients lost 5/6 MDIs resulting in two prosthetic failures (6.45%). With regard to pain, a score of 4.1/10 (SD 2.8) was recorded on day 1, and 1.1/10 (SD 1.7) on day 7. A decrease in total OHIP-14 scores was observed postoperatively (15.6; SD 12.8) as compared to baseline (21.3; SD 13.1), with improvement of OHRQoL. Furthermore, this was statistically significant at connection of the final prosthesis (7.3; SD 6.7) (p = .006). The OHIP-14 improved less (p = .011) when experiencing one or more implant losses (9.5; SD: 9.85), in comparison with no implant loss (20.7; SD: 13.97). A failure of one MDI did not affect OHIP-14 score (p = .658); however, multiple failures did (p = .007).

CONCLUSION

Maxillary MDI overdenture treatment yields significant OHRQoL improvement when at least 5 MDIs survive, preserving functional comfort.

Maxillary implant overdenture retained by four unsplinted attachments and opposed by a natural or fixed dentition: One-year clinical outcomes

OBJECTIVES

The aim of this prospective study was to evaluate the implant, prosthesis, and patient-reported outcomes of maxillary removable prostheses retained by 4 implant-supported study abutments after a follow-up period of 1 year in patients with natural teeth or a fixed rehabilitation in the mandible.

MATERIALS AND METHODS

A total of 30 patients were included, and all received 4 implants in the upper maxilla. After 12 weeks, the prostheses were connected to the implant with unsplinted attachments. The implant and prosthodontics outcomes were assessed over a follow-up period of 1 year. Patient-reported outcome measures (PROMs) were evaluated with the Oral Health Impact Profile (OHIP-20) questionnaire and an adaptation of the McGill Denture Satisfaction Instrument using a visual analogue scale (VAS).

RESULTS

A single patient dropped out. At the post-operative 12-week follow-up, 79.3% (95% CI: 64.6%-94.1%) of the patients displayed peri-implant mucosa hyperplasia and 69.0% (95% CI: 52.1%-85.8%) showed pain. After 1 year, 16 implants failed in 10 patients, leading to an implant survival rate of 86.2% (95% CI: 79.0%-92.5%), and the mean peri-implant bone loss was 1.01 ± 0.77 mm (95% CI: 0.85-1.16 mm). The prosthesis survival rate was 96.6% (95% CI: 82.2%-99.9%). The OHIP-20 and VAS scores both improved significantly from baseline to 1 year (p < .001).

CONCLUSION

The implant survival rate was lower compared to the literature for the upper maxilla. Despite the encountered problems, PROMs showed significant improvement with the implant overdenture retained by 4 unsplinted implants compared to conventional dentures.

Bar versus ball attachments for maxillary four-implant retained overdentures: A randomized controlled trial

OBJECTIVES

To compare the clinical treatment outcomes of maxillary four-implant retained overdentures with either splinted (bar) attachments or non-splinted (ball) attachments.

MATERIAL AND METHODS

Forty participants who were dissatisfied with their existing conventional maxillary complete dentures were included in this randomized controlled trial. Six months after implant placement, a definitive prosthesis was inserted. Implant success, condition of peri-implant tissue, prosthodontic maintenance and complications, and patient satisfaction were assessed. Outcomes were recorded at baseline, prosthesis delivery, and at 3 and 12 months following prosthesis delivery, and a statistical analysis was performed.

RESULTS

Thirty-two of the forty patients completed the 1-year follow-up and had their treatment outcomes evaluated. The mean marginal bone loss after 1 year of loading was 0.34 ± 0.88 mm, and there were no significant differences between the two groups. Plaque index, gingival index and bleeding on probing were significantly higher in the bar group (p<.001), and the implant success rate of the bar group was significantly lower than that of the ball group (p=.028). The most frequent prosthodontic maintenance and complication issue was the need to change the bar clip or O-ring as a result of retention loss. Patient satisfaction did not differ between the two groups except for aesthetics at 3 months.

CONCLUSIONS

Within the limitations of this study, the maxillary 4-implant retained overdenture exhibited predictable results regardless of the attachment systems (ball or bar) in the 1-year follow-up period. The bar group was more vulnerable than the ball group with respect to maintaining peri-implant tissue health.

Retrospective cohort analysis of maxillary overdentures retained by unsplinted implants

STATEMENT OF PROBLEM

Implant therapy involving an unsplinted 2-implant-retained overdenture is well defined as a successful treatment for a patient with an edentulous mandible. However, a similar unsplinted implant therapy supporting a maxillary overdenture is not well characterized.

PURPOSE

The purpose of this retrospective study was to evaluate maxillary overdentures retained by 4 unsplinted implants measuring implant survival, overdenture survival, and patient-reported outcomes.

MATERIAL AND METHODS

Participants who had received an unsplinted implant-retained maxillary overdenture were included in the study. Participants presented for one denture recall appointment, during which comprehensive examination, including radiographs, was performed and clinical findings were recorded. Participants also completed the Oral Health Impact Profile-49 (OHIP-49) and a 20-item visual analog scale (VAS) satisfaction questionnaire. Nonparametric statistical tests were used to compare OHIP-49 and VAS scores across age, sex, time since overdenture insertion, mandibular dental status, smoking status, maxillary mucosal health, and overdenture hygiene.

RESULTS

For the 44 participants, 3 of 4 implants failed in 1 individual. The cumulative implant survival rate was 98% (97.7% patient level). No prosthetic failures (that is, overdenture replacement) occurred, indicating a 100% prosthesis survival rate. The mean ±standard deviation OHIP-49 severity score was 23.6 ±26.0, and the mean ±standard deviation total VAS score was 179.2 ±29.4. Increased age was associated with lower OHIP-49 severity score (P=.036), and participants with unhealthy oral mucosa or denture stomatitis demonstrated significantly higher OHIP-49 severity scores (P=.003).

CONCLUSIONS

In this retrospective evaluation, unsplinted implant-retained maxillary overdenture therapy was associated with high implant and prosthetic survival, as well as high patient satisfaction and quality of life. Age, sex, maxillary mucosal health, and mandibular dental status resulted in significant differences with respect to oral health-related quality of life and patient satisfaction, indicating that this treatment option may be ideal for certain patients.

The number of implants required to support a maxillary overdenture: a systematic review and meta-analysis

PURPOSE

The number of implants needed to support a maxillary overdenture is still a controversial issue. The aim of this systematic review was to investigate the number of implants required to support a maxillary overdenture in order to obtain optimal treatment outcomes in terms of implant survival, overdenture longevity and patient satisfaction.

STUDY SELECTION

Pubmed and EMBASE databes were systematically searched and complemented by hand searching from 2000 to 2017. The Prisma statement and a PICOS approach were adopted. All selected articles provided at least two-year follow-up and 10 totally edentulous patients. Survival rate of implants and overdentures were statistically analyzed according to number of implants and according to splitting technique, employing non-parametric Fisher Test for unpaired data. For the pooled analysis of implant failures, the odds ratio between group of 4 splinted implants and group of more than 4 splinted was calculated.

RESULTS

A total of 28 articles were included. Data analysis of the included studies showed that the survival rate of implants appeared higher in ≥ 4 implants group, whereas the high survival rate of overdentures and patient satisfaction were not significantly influenced by the number of implants.

CONCLUSIONS

The findings of our analysis indicate that overall the most frequent tendency is to place at least four implants, splinted or unsplinted, in order to ensure a higher survival rate of implants. However, the relationship between overdenture survival, the patient's quality of life, and the number of implants required to support a maxillary overdenture has yet to be clarified.

Prosthodontic Management of a Patient with Moebius Syndrome: A Clinical Report

Moebius/Mӧbius Syndrome (MS) is an extremely rare congenital disorder characterized by uni- or bilateral palsy of the abducens (VI) and the facial (VII) nerves, causing facial paralysis. Dysfunction of cranial nerves III through XII is common, most often the glossopharyngeal (IX) and hypoglossus (XII). Afflicted individuals seeking prosthodontic care, particularly removable prosthetics, present multiple challenges related to inherent facial and tongue muscle weakness and microstomia. Other extraoral anomalies may include congenital multiple arthrogryposis and malformations of the upper and lower limbs. This clinical report describes the rehabilitation of a patient with Moebius Syndrome using a maxillary 2-implant retained overdenture and mandibular partial removable denture prosthesis.

Satisfaction and quality of life with palatal positioned implants in severely atrophic maxillae versus conventional implants supporting fixed full-arch prostheses

Background

To evaluate satisfaction and quality of life in patients with palatal positioned implants supporting fixed full-arch prostheses to rehabilitate edentulous maxillae with horizontal atrophy and compare them with conventional well-centered implants placed in non-atrophic supporting fixed full-arch prostheses.

Material and Methods

A clinical retrospective study was performed of patients that were rehabilitated with full-arch fixed implant-supported maxillary prostheses and had a minimum follow-up of 5 years after implant loading. Patients were divided into 2 groups: patients with class IV maxilla according to Cawood and Howell and treated with palatal positioned implants (test) and with class III maxilla and treated with implants well-centered in the alveolar ridge and completely surrounded by bone (control). Ten-cm visual analogue scales (VAS) (range 1-10) and the OHIP-14 (Oral Health Impact Profile) questionnaire were used respectively to estimate patient satisfaction and quality of life after implant therapy. Statistical analysis was performed applying Mann-Whitney Test using alpha set at 0.05.

Results

Mean global and specific satisfaction – except for self-esteem – were superior for the test group than the control group, although differences were not statistically significant. Regarding quality of life, the reported incidence of problems was lower in the test group for all the studied ítems except for ‘problems at work’. However, differences were not statistically significant in any case.

Conclusions

Despite the limitations of the study (retrospective and nonrandomized design) the results suggest that the prosthesis design needed to rehabilitate palatally positioned implants (more coverage of palate) does not lead to lower satisfaction and quality of life of patients, compared to patients treated with implants placed centered and conventional design prostheses that do not cover the palate.

Key words:Atrophic maxilla, palatal implants, satisfaction, quality of life.