What is the evidence on the added value of implant-supported overdentures? A review

Budget Impact Analysis: Digital Workflow Significantly Reduces Costs of Implant Supported Overdentures (IODs)

BACKGROUND

For edentulism, an implant supported removable complete overdenture (IOD) is an attractive solution to restore patients' chewing capacity, aesthetics, and self‐esteem, however, treatment is expensive and time consuming.

PURPOSE/AIM

To estimate the decline in costs for digitally designed and CAD/CAM fabricated IODs (3D‐IODs) compared to conventionally fabricated IODs (C‐IODs) at comparable general health related quality of life (GHRQoL).

MATERIALS AND METHOD

A randomized crossover study enrolled 36 fully edentulous patients, in whom six maxillary implants were placed together with two mandibular implants, if not already present. At the start of the study, a set of C‐IODs and 3D‐IODs was fabricated for each patient. All patients wore each IOD‐type for 1 year: first the 3D‐IOD and the second year a C‐IOD, or vice versa. At all three‐time points patients general QoL was assessed using the EQ‐5D‐5L questionnaire as well as the SF‐36 from which the SF‐6D was obtained, to research the anticipation of no significant difference. To enable cost consequence analysis (CCA), both costs made within healthcare and patient costs were assessed. Subsequently, a budget impact analysis (BIA) was performed to demonstrate the potential savings.

RESULTS

No differences in general GHRQoL were seen between C‐IOD (M = 0.840, SD = 0.177) and 3D‐IOD (M = 0.837, SD = 0.156) (paired t‐test (N = 31): p = 0.880). With respect to the total costs for a complete IOD, however, the digital approach showed a reduction in initial total costs of 14.2% (€4700.33 vs. €4030.61: p < 0,001), in treatment time of 41.1% (309 vs. 182 min: p < 0.001), and in number of treatment sessions of 47.1% (5.68 vs. 3.0: p < 0.001). For repairs for an IOD in both the upper and lower jaw, the C‐IOD and 3D‐IOD scored similar for treatment time as well as additional costs.

CONCLUSION

Implementing a 3D workflow in the production of IOD's supplies patients with a high‐quality 3D‐IOD at lower costs.

TRIAL REGISTRATION

NL‐OMON44248 https://onderzoekmetmensen.nl/en/trial/44248.

A retrospective study on patient satisfaction and Oral Health-Related Quality of Life with fixed 4- or 6-implant supported prostheses over 3-7 years

OBJECTIVES

To compare patients' satisfaction and oral health-related quality of life (OHRQoL) in edentulous patients treated by All-on-4 and All-on-6 implant-supported fixed prostheses rehabilitation over 3-7 years.

METHODS

All patients (n = 125) were divided into short-term (3-5 years, n = 71) and long-term (5-7 years, n = 54) follow-up groups. Patients' satisfaction was examined in a cross-sectional survey. OHRQoL and psychological impact were evaluated using the Oral Health Impact Profile (OHIP). Comparison of All-on-4 and All-on-6, including OHIP values, satisfaction scores, treatment duration and complications, were analyzed using the Chi-square test and the Mann-Whitney U test. Potential influence of patient-related factors on patient-reported outcome measures (PROMs) were analyzed via the Mann-Whitney U test, the Kruskal-Wallis test and multiple regression analyses. Power calculation was conducted in R Studio.

RESULTS

Both All-on-4 and All-on-6 follow-up groups showed high scores in total satisfaction and PROMs, including chewing comfort, aesthetics, cleanability, and stability, with no significant difference (p > 0.05). Meanwhile, no significant differences were observed in the OHIP scores between two groups in both follow-up durations (p > 0.05). However, in patients with 3-5 years follow-up, All-on-4 group had significantly lower phonetic satisfaction scores than All-on-6 group (p < 0.05). Additionally, during both follow-up periods, All-on-4 patients exhibited notably superior psychological effect in contrast to All-on-6 patients (p < 0.05).

CONCLUSIONS

Edentulous patients treated by four or six implant-supported fixed prostheses showed same high satisfaction in oral health-related quality of life in both 3-5 years and 5-7 years follow-ups.

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.

Maxillary overdenture on three implants retained by low-profile stud attachments - A prospective cohort study

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.

Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

The Scientific Investigation Committee of the American Academy of Restorative Dentistry offers this review of the 2021 dental literature in restorative dentistry to inform busy dentists regarding noteworthy scientific and clinical progress over the past year. Each member of the committee brings discipline-specific expertise to coverage of this broad topical area. Specific subject areas addressed, in order of the appearance in this report, include COVID-19 and the dental profession (new); prosthodontics; periodontics, alveolar bone, and peri-implant tissues; implant dentistry; dental materials and therapeutics; occlusion and temporomandibular disorders; sleep-related breathing disorders; oral medicine and oral and maxillofacial surgery; and dental caries and cariology. The authors focused their efforts on reporting information likely to influence daily dental treatment decisions with an emphasis on future trends in dentistry. With the tremendous volume of dentistry and related literature being published daily, this review cannot possibly be comprehensive. Rather, its purpose is to update interested readers and provide important resource material for those interested in pursuing greater details on their own. It remains our intent to assist colleagues in negotiating the extensive volume of important information being published annually. It is our hope that readers find this work useful in successfully managing the patients and dental problems they encounter.