Immediate and delayed loading of two-piece reduced-diameter implants with locator-analog attachments in edentulous mandibles: One-year results from a randomized clinical trial examining clinical outcome and patient expectation

Patient-reported outcome measures and prosthetic events in implant-supported mandibular overdenture patients after immediate versus delayed loading: A systematic review and meta-analysis

STATEMENT OF PROBLEM

Immediately loaded mandibular overdentures are clinically acceptable treatment options that have gained popularity because their use shortens the treatment duration. However, whether the immediate loading of dental implants can match the prosthetic events, satisfaction, and quality of life of delayed loading is still unclear.

PURPOSE

The purpose of this systematic review and meta-analysis was to compare the prosthetic events, satisfaction, and quality of life of immediate versus delayed loading implants in patients rehabilitated with mandibular overdentures.

MATERIAL AND METHODS

This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and was registered at The International Prospective Register of Systematic Reviews (PROSPERO) (CRD42021258187). Electronic searches were carried out by 2 independent reviewers in the PubMed/MEDLINE, Cochrane Library, and Web of Science databases up to May 2021. Only randomized clinical trials and prospective studies with at least 10 participants that compared immediate versus delayed loading were selected. A meta-analysis was performed by using the RevMan 5 software program for complications and maintenance outcomes.

RESULTS

Seven articles were included in the qualitative analysis, and 4 were included in the quantitative analysis. The meta-analysis demonstrated no significant difference between immediate and delayed loading for prosthetic complications (RR=1.71; 95% CI=0.67-4.37; I2=85%, P=.27) or maintenance (RR=1.92, 95% CI=0.44-8.28; I2=94%, P=.38).

CONCLUSIONS

Although the prosthetic complications and maintenance were more likely to favor the delayed loading group, available evidence showed no statistical difference for prosthetic complications and maintenance between immediate loading and delayed loading in mandibular overdentures.

Impact of dental prosthetic treatment and patients' expectations on the seven domains and four-dimensional scale of the Oral Health Impact Profile

BACKGROUND

Recently, recommendations were given for a new scoring of the Oral Health Impact Profile (OHIP). The original seven domain structure should be replaced by a four-dimensional scale.

OBJECTIVES

To investigate the effect of dental prosthetic treatment on the seven domains and the four-dimensional scale of the OHIP-G49/53 questionnaire.

METHODS

Seventy four patients were grouped according their pre- and post-treatment situation and the type of treatment they received. Patients completed the OHIP-G49/53 questionnaire before prosthetic treatment (T0), and at 1 week (T1), 3 months (T2) and 6 months (T3) after treatment. Treatment effects on the seven domains and the four dimensions of the OHIP scale were analysed, and the oral health-related quality of life (OHRQoL) was measured. Patients' expectations of their prosthetic treatment were also evaluated. Data were analysed using two-way Mixed ANOVA, regression analysis, and Cronbach's alpha test with a level of significance of α ≤ .017.

RESULTS

OHRQoL significantly improved following prosthetic treatment compared with baseline. The largest improvement was found between T0 and T1 evaluations (all p ≤ .001). Unlike the seven-domain scale, the four OHIP dimensions demonstrated further significant improvements across the T1/T2/T3 evaluations (all p ≤ .017). Different pre-treatment findings had different treatment effects on the four OHIP dimensions and seven OHIP domains. Patients' expectations were mainly fulfilled.

CONCLUSION

Compared with the seven-domain scale, the four dimensions showed significant follow-up changes, suggesting the four dimensions are suitable for evaluating treatment effects up to 6 months. Clinically meaningful effects of dental prosthetic treatment can be sensitively measured using the four-dimensional OHIP scale.

The Influence of Health Behavior on Immediate Loading Implant Success and Patient Satisfaction In The Complete Edentulous Treatment

Objective: The cases of edentulous treatment are increasing in Turkey. The patients are less satisfied with the health care facilities of the public sector health institutes. The government of Turkey is facing critical challenges for medical reforms in the public sector to improve the living standards of the public. The objective of current research is to determine the influence of health behavior on immediate loading implant success and patient satisfaction in complete edentulous treatment. Method: A Likert scale questionnaire is employed and the response rate of this research is 71%. The population of this research is the patients visiting different clinics for edentulous treatment and loading implant success. Results: The research findings demonstrate the satisfaction of the patients and implant success is influenced by the health behavior of patients. Conclusion: The model of this research is enrichment in the knowledge of the edentulous treatment of the patients. The practical implications of this research are outstanding to influence the satisfaction of the edentulous treatment patients who are getting the treatment of loading implant success. The research has certain limitations that are straightforwardly presented with future directions to enrich the knowledge of edentulous treatment by the research work of scholars in health care.

Expected and perceived burdens in patients receiving mandibular overdentures retained by one or two implants

PURPOSE

This study aimed to assess patients' expected burdens before treatment and their perceived burdens after the surgical and prosthodontic procedures of mandibular overdenture treatment and to evaluate factors influencing patients' perceptions.

METHODS

Data were collected from 47 participants enrolled in a randomized clinical trial comparing mandibular overdentures retained by one or two implants. A 20-item questionnaire measured on a four-point Likert scale covering the surgical and prosthetic treatment procedures was used to assess the patients' perception of the procedural burdens before (expected burdens) and immediately after (experienced burdens) each procedure. Operators' perceptions of intercurrences associated with the procedures were also assessed as an independent variable.

RESULTS

Low levels of perceived burdens were observed both before and after treatment. The mean overall scores of 1.65 ± 0.46 and 1.53 ± 0.33 for expected and experienced burdens, respectively, indicated that most items ranged between "not burdensome at all" and "somewhat burdensome." Significant differences between expected and experienced burdens were found for eight items (p < 0.001). Considering the treatment stages, expected burdens scored higher in the pre-surgical, surgical, and prosthetic stages and lower in the post-surgical phase than experienced burdens. Overall, the experienced burdens were significantly affected by the expected burdens (p < 0.001) and operator's perceived burdens (p = 0.045).

CONCLUSIONS

Treatments were associated with low levels of perceived burdens related to surgical and prosthodontic procedures and were highly correlated with the expected burdens before treatment. However, patients tend to overestimate the expected burdens before treatment, especially for surgical procedures.

Unsplinted Attachments and Patient-Reported Outcome Measures (PROMs) in 2-Implant-Retained Mandibular Overdentures: A Systematic Review

Introduction

The purpose of this review is to compare randomized clinical trials evaluating the patient-reported outcome measures (PROMs) using different unsplinted attachment systems in 2-implant-retained mandibular overdentures (2IRMODs). A focus question (as per PICOS) was set as follows: does one particular unsplinted attachment system (I) compared with another (C) result in better patient-reported outcomes (O) in two-implant-retained mandibular overdentures (P) using randomized controlled trials (S)?

Materials and Methods

A literature search was conducted in the PubMed MEDLINE and Cochrane Central Register of Controlled Trials (CENTRAL) databases between November 2010 and October 2020. Only randomized controlled trials (RCTs) on 2IRMOD using unsplinted attachment systems measuring patient-centered outcomes were selected. A total of 171 studies were identified in initial search, and 27 studies were shortlisted for full-text evaluation. A total of 5 studies were included for a systematic review. The risk of bias was evaluated using Cochrane Risk of Bias Tool 2.0 (RoB 2.0). Meta-analysis could not be performed as different studies evaluated different patient-reported outcomes, namely, satisfaction, quality of life, complications, preferences, or combinations of these.

Results

A total of 23 patients received low-profile (self-aligning) attachments (in 2 studies), 69 patients received standard ball attachments (in 5 studies), 25 patients received telescopic (or conus) attachments (in 2 studies), and 20 patients received mini-ball attachments (in 1 study). Two studies compared ball attachments and low-profile attachments and revealed similar satisfaction and quality of life (QoL). Two studies compared ball attachments with telescopic attachments and revealed less patient satisfaction in telescopic attachments. A single study compared mini-ball attachments with standard ball attachments and showed no difference in patient-reported outcomes. Three studies were found to have a low risk of bias, and the remaining two studies had a high risk of bias.

Conclusions

The standard ball, mini-ball, and low-profile attachments have no influence on PROMs in the normal interarch space. Inconclusive results were found in studies that evaluated PROMs using ball attachments versus telescopic attachments.

Patient's perception of timing concepts in implant dentistry: A systematic review

Protocols for implant dentistry, most frequently include periods until healing of the extraction sockets and osseointegration of the implant. Deductional thinking imply that patients would prefer if treatment time in implant dentistry were reduced.

AIM

What is the patient perception of immediate or early implant placement or loading in comparison with traditional, delayed placement, and/or loading assessed by patient-reported outcome measures, as evidenced in randomized controlled clinical trials or prospective controlled studies?

MATERIAL AND METHODS

A systematic review was performed following the PRISMA guidelines with a literature search up to June 30. All hits were imported into Rayyan online software and analyzed by two authors for eligibility. Cochrane RoB2.0 and Newcastle-Ottawa Scale were used to evaluate risk of bias in the individual studies.

RESULTS

Of the initially 1439 articles, 76 underwent full-text analysis and finally 40 articles, representing 35 cohort studies, were included. The quality evaluation demonstrated some concerns among most of the studies.

CONCLUSION

a) There is no strong evidence to support that the time for implant placement or loading of implant-supported single or short-span reconstructions or overdentures influence patients´ discomfort, satisfaction with function or esthetics or overall satisfaction with the implant treatment. b) There is some evidence that studies including edentulous patients rehabilitated with implant-supported full-arch FDPs demonstrate more satisfied patients with immediate than for the early or delayed loaded implant reconstructions after short time, but the difference is not clear one year after treatment.

Implant-prosthetic rehabilitation of patients with severe horizontal bone deficit on mini-implants with two-piece design-retrospective analysis after a mean follow-up of 5 years

BACKGROUND

As a consequence of tooth loss due to trauma or extraction, a reduced alveolar crest volume limits the deployment of standard implants in certain patient cases. For this reason, minimal-invasive treatment with mini-dental implants (MDI) might be an option to allow implant treatment even in cases with severe horizontal bone loss without augmentation measures. The aim of this retrospective cohort study was to investigate clinical and radiological implant, as well as patient-related parameters after treatment with MDI.

RESULTS

Clinical and radiological records of 19 female (82.6%) and 4 male patients (17.4%) (N = 23), who received 52 mini-dental implants with a two-piece design in a single surgical center between November 2011 and October 2018, were retrospectively analyzed. Implants were submitted to conventional loading on different types of screwed superstructures. Crestal bone loss was measured on standardized periapical radiographs. Patient-related outcome parameters (PROMs) were recorded during follow-up period. Mean clinical and radiological follow-up was 69.6 months (5.8 years) and 51.6 months (4.3 years), respectively. Three implants were lost in two patients, leading to an implant survival rate of 94.2%. Mean radiological crestal bone loss was 1.6 mm. Both amount of peri-implant recession and crestal bone loss were significantly correlated (r = 0.65; p < 0.001). Likewise, a significant correlation was observed between deeper probing depths and increased peri-implant bone loss (r = 0.41; p = 0.012). Alveolar ridges with a reduced alveolar crest width were significantly correlated with higher peri-implant bone loss as well (r = - 0.33; p = 0.011). No prosthetic complications were reported during follow-up. Extent of midfacial recession and papilla height loss had a significant negative impact on most of the PROMs.

CONCLUSIONS

Treatment with MDI seems to be a successful alternative treatment option, especially for elderly patients with reduced crest width at implant sites. Due to the good clinical results and high survival and success rates, this treatment option was associated with high patient satisfaction. Despite the promising results, particular consideration should be given to appropriate treatment planning in these patients due to the strong correlation between peri-implant soft-tissue parameters, crestal bone loss, and reduced alveolar crest width.

Immediate vs conventional loading of mandibular overdentures: A comprehensive systematic review and meta-analysis of randomized controlled trials

Clinicians treating overdenture patients need to know if immediate loading and conventional loading results in similar outcomes. This study aimed to perform a systematic literature search of studies comparing immediate and conventional loading of mandibular overdentures irrespective of the number of implants and conduct a meta-analysis of implant failure and marginal bone loss (MBL). A literature search of PubMed, ScienceDirect, Ovoid, Springer, and Google Scholar databases was performed for randomized controlled trials (RCTs) comparing immediate vs conventional loading of mandibular overdentures. The primary outcome was implant failure and the secondary outcome was marginal bine loss (MBL). A descriptive analysis was performed for other outcomes. Thirteen trials were included. Only one trial compared the immediate and delayed loading of single implant-supported overdenture. Seven trials used two implants, one trial used three implants while four trials used four implants. Meta-analysis indicated no statistically significant difference in implant failure and MBL between immediate and conventional loading of two-implant and four-implant supported overdentures. Descriptive analysis indicated no difference in peri-implant tissue indices, implant stability, and quality of life outcomes between the two loading protocols.There may be no difference in implant failure and MBL with immediate loading or conventional loading of two and four-implant supported mandibular overdentures. Literature review indicates that there may be no difference in peri-implant tissue indices, implant stability, and QoL outcomes between the two loading protocols. The overall quality of evidence is moderate. Further, adequately powered RCTs are required to strengthen the evidence.

Are There Alternatives to Invasive Site Development for Dental Implants? Part I

Edentulous sites are often characterized by inadequate bone volume for dental implant therapy. Bone augmentation procedures for site development involve longer healing period and are often invasive, costly, and associated with postoperative morbidity. This article discusses alternatives to invasive bone grafting procedures that are often used to develop implant sites. Owing to the broad nature of this topic, it is presented in two articles. In part I, the use of short and narrow-diameter implants are discussed. Part II reviews the use of tilted as well as fewer implants to support a prosthesis.

Masticatory function of conventional complete denture wearers changing to 2-implant retained mandibular overdentures: clinical factor influences after 1year of function

PURPOSE

Evaluate how clinical factors related to conventional complete denture (CCD) wearers, can influence masticatory function (MF) of totally edentulous patients before and after one-year transitioning to implant-retained mandibular overdentures (IMO).

METHODS

Forty patients using CCD were rehabilitated with IMO and their MF was evaluated by: (i) ST_X50: theoretical aperture through which 50% of the weight of the particles would pass; (ii) STB: distribution homogeneity of the crushed particles. The clinical parameters analyzed were: atrophy, retention, stability, facial type, anteroposterior skeletal discrepancy, and type of loading. The statistical association was tested through crude and adjusted logistic regression.

RESULTS

IMO promoted improvements in the MF, irrespective of the clinical parameters. CCD wearers with poor retention had 86% less chance of achieving a good ST_X50. STB was associated with stability, facial type, and anteroposterior discrepancy. Subjects with poor mandibular CCD stability had a 76% lower chance of achieving a good test food homogenization, whereas brachyfacial individuals were 1.3 times more likely to have a good STB. Class II patients had an 89% lower chance of having a good homogenization of the particles as CCD users and after transition to IMO.

CONCLUSIONS

CCD users with poor retention achieved an inferior ST_X50. The STB performance can be compromised by poor stability or Class II characteristics, while brachyfacial individuals achieve better homogenezation of the food bolus. Although the transition to IMO improved the masticatory function, the anteroposterior discrepancy still maintained an association with STB, as Class II individuals still presented difficulties homogenizing food.