The effect of mandibular 2-implant overdentures on oral health-related quality of life: an international multicentre study

Effect of different implant positions for two implant-retained mandibular overdenture: a retrospective 5-years radiographic evaluation of the circumferential peri-implant bone loss and posterior ridge resorptive changes

BACKGROUND

Studies did not recommend which position for implant overdenture poses the lowest biomechanical risk and the least chance of peri-implant bone loss and ridge resorption for those who might need a mandibular two-implant overdenture. The study objectives were to investigate the impact of implant position, in lateral incisors or canine positions, on peri-implant bone loss and posterior ridge resorption.

METHODS

Fifty patients with mandibular two-implants were recalled and divided according to the implant position into two groups (group L: implants in lateral incisor positions and group C: implants in canine positions). The circumferential peri-implant bone level and posterior ridge resorption were assessed at implant insertion (T0), one year later (T1), and five years later (T5) using the follow-up CBCT. Data were analyzed using the Statistical Package of Social Science (SPSS) program. A Mann-Whitney test was used to compare two different groups. Paired groups were compared using the Wilcoxon signed-rank test. The threshold of significance is fixed at a 5% level (p-value).

RESULTS

Significant differences in the vertical bone loss between groups appeared at (T5 - T1) (Mann Whitney test, (P = 0.01)) and at (T5 - T0) (Mann Whitney test, (P = 0.005)), and a significant difference in horizontal bone loss between groups was found at (T1 - T0) (Mann Whitney test, (P = 0.041)) and (T5 - T1) (Mann Whitney test, (P = 0.041)). Also, there were significant differences over the evaluation period between groups at certain points along the ridge at M1 (Mann Whitney test, (P = 0.021)), M3 (Mann Whitney test, (P = 0.008)), and M4 (Mann Whitney test, (P = 0.015)).

CONCLUSIONS

According to the findings of this clinical study, the placement of implants in the lateral incisor position for two implant-retained overdentures is a viable choice. In comparison to the canine position, the lateral incisor position demonstrated superior peri-implant responses, which could potentially enhance the longevity of the implants. Furthermore, the placement of implants in the lateral incisor position can promote a more even distribution of stress and help mitigate posterior ridge resorption. Conversely, implants in the canine position may cause a seesaw effect and result in greater posterior ridge resorption.

CLINICAL TRIAL REGISTRY NUMBER

(NCT06055842) (13/03/2024).

Accuracy of template-based guided dental implant placement-An in vitro comparison of different manufacturing methods

OBJECTIVES

This study investigates effects of surgical guide manufacturing process on 3D transfer accuracy of planned dental implant position, using three production methods: additive 3D-printed (3DF), subtractive milled (MF), and analog laboratory fabricated templates (LF).

MATERIAL AND METHODS

Implant position for a single-tooth gap (#26) planned digitally. 3DF and MF templates were designed digitally, while LF templates were analogously created. For each manufacturing type, 10 surgical guides were fabricated. Each guide was used for template-guided implant placement in model replicas. For evaluation of implant placement, cone beam computed tomography scans of all implanted models were superimposed, and implant positions were determined. Deviations at implant shoulder/apex were measured, and median and inter-quartile range (IQR) were determined for mesio-distal, oro-facial, coronal apico, 3D spaces, and angles.

RESULTS

At implant shoulder, vertical components dominated position deviations (up to 1.04 mm, IQR 0.28 mm for 3DF). Horizontal deviations were much lower (mesio-distally up to 0.38 mm, IQR 0.36 mm (LF)). Implant apex shows similar vertical deviations, while horizontal deviations clearly increased compared to shoulder, especially in mesio-distal direction. Median angular deviations were between 2.1° (IQR 2.0 mm, max. 4.2°) for 3DF and 3.3° (IQR 1.9 mm, max. 5.3°) for MF. No statistical differences were found between manufacturing types (Kruskal-Wallis test, p = .05).

CONCLUSIONS

The study showed the method of implant guide fabrication did not affect the accuracy of implant placement within the limits of an in vitro environment. All methods resulted in implant placement which did not exceed the accepted safety deviation envelope (1.5-2.0 mm).

Comparison of Implant-Retained Overdenture and Conventional Complete Denture: A Survey Study to Measure Patients' Satisfaction and Quality of Life in Dental School Clinics

Patient satisfaction and quality of life are integral to assessing oral health care quality. For many Americans still using conventional complete dentures (CDs) or implant-retained mandibular overdentures (IODs), it remains essential to consider improving their oral health outcomes and quality of life. Due to inexperienced student dentists providing dental care to dental school patients, patient grievances are generally considered a problem. Patient feedback and satisfaction have proven valuable resources for monitoring and improving patient safety. While CDs and IODs are the 2 leading treatment options for edentulism, more comparative studies in the literature need to compare their outcomes in a school setting. The research question that guided this comparative analysis was, "Is patient satisfaction and quality of life affected by the type of prostheses and provider?" A validated questionnaire was mailed to 520 individuals selected from records of patients who had received treatment for edentulous mandible at a student prosthodontic clinic at the University of Kentucky College of Dentistry from 2014 to 2016 with at least 1 year of follow-up time. A validated questionnaire for edentulous patients based on the Oral Health Impact Profile (OHIP-19) was used. In addition, information on patients' oral health-related quality of life, including questions related to the edentulous patients' satisfaction with their dentures, was collected. The response rate was 33% (N = 171). The study's findings confirm previous findings, suggesting that IODs may significantly impact oral health-related quality of life. Data show that 76% of the IOD group reported improvement in experience when using the implants to retain the mandibular denture. However, there were no statistically significant differences in the OHIP scores between overall CD and IOD patient groups. Males with IODs had lower physical pain, limitations, and disability scores than males with CD. However, females with IODs reported more significant concerns associated with a social disability and handicap domains. Comparing users who had experiences with both treatment options, this study discerned essential characteristics that contribute to increased patient satisfaction with IODs and identified significance in outcomes by gender. These findings guide prosthodontic practitioners' patient care practices and identify a continuing need to discuss CD and IOD treatment protocols within dental school curricula.

Small-diameter titanium grade IV and titanium-zirconium implants in edentulous mandibles: Ten-year results from a double-blind, randomised controlled split-mouth core-trial

The goal of this extension study was to compare the 10-year outcome of 3.3 mm diameter titanium-zirconium (TiZr) or grade IV titanium (Ti) implants in mandibular implant-overdentures.

MATERIALS AND METHODS

This study is the 10-year follow-up from a randomised, controlled, double-blind, split-mouth multicentre clinical trial. Patients with edentulous mandibles had received two implants in the interforaminal region (bone-level, diameter 3.3 mm, microrough surface), one of TiZr (test) and one of Ti (control). Implant survival and success, plaque and sulcus bleeding indices, probing pocket depth, gingival margin, clinical attachment level and radiographic crestal bone levels were evaluated.

RESULTS

Fifty of 91 patients with implants were available for the 10-year examination and 36 patients were valid for the intent-to-treat (ITT) analysis. The implant success rate was calculated as 94.6% and 91.9% for the TiZr implants and the Ti implants respectively. Four implants were lost (TiZr = 1; Ti = 3) in the entire study period. Kaplan-Meier survival analyses estimated 10- year implant survival rate for TiZr to 98.9% and Ti 95.8%.The mean of total and functional crestal bone loss was 1.49 mm (±1.37 mm) and 0.82 mm (±1.09 mm) in the TiZr group and 1.56 mm (±1.34 mm) and 0.85 mm (±1.16 mm) in the Ti group.

CONCLUSIONS

This split-mouth design RCT on mandibular implant-overdentures evidenced, bearing in mind its follow-up time-related reduced cohort size, high 10-year implant success- and survival rates. These results confirm TiZr as well-suited implant material for realising small-diameter implants. Registered on www.

CLINICALTRIALS

gov: NCT01878331.

Quantitative and qualitative assessment of the wear pattern of two attachment systems of dissimilar materials for mandibular implant-retained overdentures: an in-vitro study

BACKGROUND

Attachment material is one of the contributing factors to the degree of wear of the attachment components in mandibular implant-retained overdentures. The purpose of this in vitro study was to compare the wear behavior of 2 different attachment systems of dissimilar materials in mandibular implant-retained overdentures by qualitative and quantitative methods.

METHODS

Two attachment systems of different materials were utilized (n = 16); Titach (Dental Evolutions Inc, Beverly Hills, CA, USA) with a titanium-to-titanium interface and Locator R-Tx (Zest Anchors Inc, Escondido, CA, USA) with a titanium-to-nylon interface. One thousand cycles of overdenture insertion and removal simulating 1-year clinical use were performed. All matrices were removed from the overdentures and all patrices were unscrewed from the implants for wear assessment quantitively using a stereomicroscope and qualitatively using a scanning electron microscope. Data were analyzed by using an independent sample t test.

RESULTS

After cyclic loading, stereomicroscopic findings showed that the Titach group had statistically significant higher wear value than the Locator R-Tx group (p < 0.001). Moreover, scanning electron microscopy images showed noticeable abrasion in Titach patrix at the area of highest convexity. However, the Locator R-Tx matrix displayed an apparent tear of rubber inserts.

CONCLUSIONS

Titach attachment with the titanium-to-titanium interface revealed more wear than Locator R-Tx attachment with the titanium-to-nylon interface. Thus, the type of attachment material influences the degree of wear of the attachment components.

Fabrication of CAD-CAM custom-made bar clip for implant-supported overdentures using an intraoral scanner: A dental technique

This article describes a digital technique for fabricating individually designed overdenture bar clips. The patient was scanned intraorally using a Medit i700 scanner; the custom clip was designed using the Blender software program and milled from polyoxymethylene blocks. This low-cost technique offers more available options compared with traditional clips, improving the management of retention loss.

Do Systemic Diseases and Medications Influence Dental Implant Osseointegration and Dental Implant Health? An Umbrella Review

The aim of this umbrella review is to evaluate what are the most common medications and systemic diseases that can affect bone-implant integration, the success rate and survival rate of dental implants, peri-implant tissue health, and implant loss. Systematic reviews, with meta-analysis or not, about how systemic diseases and medications influence dental implant osseointegration, survival rate, success rate, and peri-implant diseases, published only in the English language, are electronically searched across the most important scientific databases. The present umbrella review includes eight systematic reviews, and osteoporosis and diabetes are the most investigated pathologies. Systemic diseases, such as neurologic disorders, HIV, hypothyroidism, cardiovascular diseases, and drugs, such as beta blockers, anti-hypertensives, or diuretics do not show a decreased rate of implant osseointegration. It seems that drugs, such as proton-pump inhibitors (PPIs) or serotonin reuptake inhibitors (SSRIs), negatively affect implant osseointegration. Few studies compare the effects of drugs and systemic diseases on the parameters considered in this overview. It is important to underline how the results of this review need to be validated with subsequent and more reviews.

The Effects of a Mandibular Overdenture on Edentulous Patients' Quality of Life: A Clinical Study

Edentulous patients' quality of life can be greatly diminished by the use of a badly fitting removable prosthesis, as many aspects of social life become notably impaired. The object of this study was to evaluate if treating these patients with a two implants mandibular overdenture could improve their quality of life as measured with the Italian version of the OHIP-14 (Oral Health Impact Profile). Edentulous patients, in good clinical condition, were selected. Two implants were placed following the recommended guidelines and three months after new mandibular dentures were manufactured, implants were uncovered and connected to the prosthesis using LOCATOR abutments. OHIP-14 was measured at baseline, one month after delivery and one year after delivery. An improvement was observed even after one month (with a mean reduction of 17 points in OHIP) and that improvement appeared to be stable at the one-year follow-up. Mandibular overdentures can improve a patient's quality of life when compared to a tissue-supported removable complete denture, as long as the patient is subjected to an appropriate follow-up as the retentive rings of the attachment can deteriorate even after two years and lose a great deal of retentive capabilities.

The effect of ball versus locator attachment system on the performance of implant supported overdenture: A systematic review

Objective

This systematic review was aimed to compare ball and locator attachment system on the basis of clinical and biomechanical performance of implant supported overdenture as well as biological and patient related outcomes.

Material and methods

Open and free electronic and manual searches were performed in digital databases including MEDLINE via PubMed, the Cochrane Database of Clinical Trials, and Scopus along with some other reliable sources. From the 667 retrieved records, 11 full-text controlled trials were included in this study. Risk of bias was assessed according to RoB 2.0 except for one RCT (economic evaluation), only assessed by CASP checklist.

Results

From the 11 retrieved studies, total 183 locator and 219 ball attachments were identified in 452 subjects of 30 yrs-95 yrs of age. Studies provided data about prosthodontic complications or maintenance (replacement or the activation of matrix and patrix part, loss of retention, fracture and relining of the prosthesis, fracture of the attachment and the survival probability), oral health impact profile, soft tissue parameters and periodontal complications, marginal bone loss, patient related outcome and cost of the attachment systems. Only 5 studies were assessed at low risk bias, while other 6 at moderate to high risk of bias.

Conclusion

Locator attachment system show lesser complications including loss of retention and lower maintenance appointments, lesser soft tissue, and periodontal complications than the ball attachment. Ball is better in terms of cost effectiveness. In other related outcomes, no significant differences were noted between ball and locator attachment.

Patients' Satisfaction and Oral Health-Related Quality of Life of Edentulous Patients Using Conventional Complete Dentures and Implant-Retained Overdentures in Saudi Arabia

The aim of this study was to compare patients’ satisfaction and quality of life (QoL) when using implant overdentures vs. conventional dentures. The QoL of Saudi patients who were provided mandibular implant-supported overdentures was assessed using a structured questionnaire. Overall satisfaction; ability to speak, eat, and chew food; comfort; esthetics; stability; and satisfaction of general oral health were measured. A total of 48.3% vs. 6.9% were, overall, very satisfied with their implant overdentures and conventional dentures, respectively. A total of 37.9% of the patients were very satisfied regarding speaking with their implant overdentures vs. 17.2% with conventional dentures. Furthermore, 41.4% were very comfortable with their implant overdentures vs. 5.2% were very comfortable using conventional dentures. However, only 15.5% were very satisfied with the esthetics of the conventional dentures compared to 43.1% being satisfied with implant overdentures. Only 1.7% were very satisfied with the stability of conventional dentures vs. 44.8% being satisfied using implant overdentures. About 8.6% of the candidates were very satisfied regarding chewing food with conventional dentures vs. 36.2% being very satisfied using implant overdentures. Approximately 10.3% were very satisfied with their general oral health using conventional dentures compared to 29.3% being very satisfied using implant overdentures. Mandibular implant overdentures had a strong impact on patients’ quality of life over conventional complete dentures and should be considered the minimum standard of care provided to completely edentulous patients.

Impact of rehabilitation versus edentulism on systemic health and quality of life in patients affected by periodontitis: A systematic review and meta-analysis

AIM

To investigate the effect of rehabilitation in fully/partially edentulous patients with stage IV periodontitis on oral-health-related quality of life (OHRQoL) and systemic health.

MATERIALS AND METHODS

A systematic electronic and manual search was conducted. Three authors independently reviewed, selected, and extracted the data. Outcomes were OHRQoL (Oral Health Impact Profile 14 [OHIP-14] and OHIP-49, General Oral Health Assessment Index [GOHAI], visual analogue scale, symptoms registration) and systemic health-related outcomes (incidence and prevalence of systemic diseases, values of systemic disease indicators). Qualitative data were synthesized for OHRQoL and systemic health-related outcomes. Meta-analysis was conducted on available quantitative data.

RESULTS

The search identified 59 articles (6724 subjects in total). OHRQoL improved across all the studies, irrespective of the number of missing teeth, their location, or treatment modality. Meta-analysis showed significant improvement of OHIP-49 (36.86, p < .01) in manuscripts including subjects affected by periodontitis, consistently with the remaining literature (reduction of score points post rehabilitation: OHIP-14 = 10.52, OHIP-49 = 56.02, GOHAI = 5.40, p < .01 for all). Non-rehabilitated subjects exhibited inferior cognitive status, higher medication intake, and frailty. However, our data are limited and should be interpreted with caution.

CONCLUSIONS

Oral rehabilitation improves OHRQoL and, potentially, systemic health in edentulous patients. It is unclear whether these findings may be extrapolated to patients with stage IV periodontitis.

CAD-CAM complete removable dental prostheses: A double-blind, randomized, crossover clinical trial evaluating milled and 3D-printed dentures

OBJECTIVE

This double-blind, randomized, crossover, clinical trial aimed to evaluate and compare the differences between milled and 3D-printed complete removable dental prostheses (CRDPs).

METHODS

Fifteen edentulous patients (men: n = 10, women: n = 5; age: 66.7 ± 8.0 years) rehabilitated with conventional CRDPs were recruited for this trial. Participants were randomized to first receiving either the milled or 3D-printed CAD-CAM manufactured CRDPs and then after 6-weeks cross over to the other set. Both, clinicians and participants were blinded to the group allocation. Outcomes included patient's denture satisfaction (PDS), oral-health related quality of life (OHIP-EDENT), willingness-to-pay analysis, final choice (FC) of CRDPs, clinician's denture quality evaluation (CDQE), chewing efficiency (CE), maximum-voluntary-bite-force (MBF), and prosthodontic maintenance needs. The outcomes were measured at baseline (with old CRDPs), at 1 and 6 weeks after new CRDP insertion; following crossover with the second set of CRDPs, an identical protocol was followed. Generalized linear regression for repeated measures was used for statistical analysis with α=0.05.

RESULTS

All participants completed the trial. 3D-printed CRDPs required more maintenance visits, adjustment time (p = 0.0003), and adjustment costs (p = 0.021). Patients were willing-to-pay an average of 606.67 Swiss Francs more than the actual cost for the milled CRDPs. There were no differences in the PDS, OHIP, FC, CDQE, CE, and MBF between the two CRDPs groups.

CONCLUSIONS

The findings of this double-blind randomized crossover clinical trial confirm that both milled and 3D-printed CRDPs are valid treatment modalities for edentulous patients, with the latter performing inferiorly with regard to the time and costs involved with the prosthodontic aftercare, as well as the patients' willingness-to-pay.

CLINICAL RELEVANCE

The findings of this trial provide evidence to help the clinician in choosing the appropriate CAD-CAM manufacturing process for fabricating the CRDPs.

Evidence is limited about the equivalence of bar/clip and ball/O-ring attachments in edentulous patients restored by implant overdentures

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION

Gonçalves F, Campestrini VLL, Rigo-Rodrigues MA, Zanardi PR. Effect of the attachment system on the biomechanical and clinical performance of overdentures: A systematic review. J Prosthet Dent. 2020 Apr;123(4):589-594. doi: 10.1016/j.prosdent.2019.03.024. Epub 2019 Sep 18. PMID: 31,542,217.

SOURCE OF FUNDING

Nothing was mentioned about funding sources for the review TYPE OF STUDY/DESIGN: Systematic review with meta-analysis.

Do ball-type attachment systems for overdenture result in better patient-satisfaction? A systematic review of randomized crossover clinical trial

Objective

This review is to compare patient-satisfaction with ball-type overdenture attachment systems with others attachment systems.

Material and methods

This study was registered in PROSPERO (CRD42018097234) and adheres the PRISMA guidelines. Electronic searches on PubMed/MEDLINE, Scopus, Cochrane, and Web of Science databases for published articles were performed before October 2020. The PICO question was: “Do patients with a ball-type overdenture retention system have greater satisfaction, when compared to other attachment systems?” The evaluation of risk of bias was performed using the Cochrane risk of bias tool.

Results

After searching the databases, seven articles were selected out of a total of 2583. A total of 312 implants were placed in 139 patients, with a mean age of 65.9 years. The risk of bias in the included studies varied according to the different domains in a risk of uncertain bias or low bias risk. No difference was found between the ball attachment systems and the others systems, with respect to patient-satisfaction. The meta-analysis revealed no statistically significant difference between the ball systems and another systems (P = 0.11; MD: 10.90; 95% CI: −2.55 to 24.35).

Conclusions

Regarding patient general satisfaction, it was not possible to determine differences between the ball system and another types of attachment system for overdenture. The ball-type system was statistically superior only to the magnet system.

'Differences in self-perceived OHRQoL between fully dentate subjects and edentulous patients depending on their prosthesis type, socio-demographic profile, and clinical features'

OBJECTIVES

This observational cross-sectional study aimed to evaluate and compare the oral health-related quality of life (OHRQoL) and clinical performance between dentate subjects and edentulous patients restored with conventional dentures or implant overdentures.

METHODS

85 edentulous patients were grouped as follows: Group-1 (CD): conventional denture wearers (n= 42), and Group-2 (IO): implant-retained overdenture wearers (n= 43). For the OHRQoL comparisons, a control group of subjects with a healthy natural dentition (Group-3, ND; n= 50) was included. Participants completed three validated questionnaires (OHIP-14sp, OHIP-20sp, and QoLIP-10). Socio-demographic data, prosthesis-related factors, clinical condition of the mouth, and patient subjective evaluations, were gathered. Descriptive and non-parametric probes were run (α= 0.05).

RESULTS

The ND group was the most unsatisfied (OHIP-14sp; p≤ 0.001). The OHIP-20sp attributed significantly worse Psychological disability (p= 0.029) and Handicap (p= 0.027) to CD wearers when compared to IO wearers. The CD group showed the significantly highest need for relining (p= 0.041), and the lowest retention (p= 0.011). The OHIP-14sp disclosed a significantly worse OHRQoL for those volunteers who had a job (p= 0.003), a basic education instead of a secondary one (p= 0.022), and no partner (p= 0.006).

CONCLUSIONS

The overall OHRQoL was comparable for both prosthodontic groups, being modulated by socio-demographic and prosthesis-related features. Nonetheless, CD wearers presented prosthetic complications more frequently.

A Seven-year Follow-up Study of Patient Satisfaction with Three-implant-retained Mandibular Overdentures

PURPOSE: This study aimed to compare patients’ satisfaction with mandibular overdentures retained by three-splinted implants versus conventional complete denture wearers during a 7-year follow-up study period. MATERIALS AND METHODS: Thirty edentulous male patients (mean age: 60 years) were carefully selected and divided into two equal groups. All patients received a new set of complete dentures. Group I patients received three implants in the anterior mandible and were connected after 3 months with bars, clips, and loaded. Group II patients received conventional complete dentures. Patients’ satisfaction was recorded for both groups at 3 weeks (baseline) and after 1, 3, 5, and 7 years. Patients were then asked to grade their overdentures/dentures on a visual analog scale and written questionnaire to evaluate their overall satisfaction. RESULTS: Satisfaction scores of Group I patients were found to be statistically significantly higher than that of Group II patients (p < 0.05) at 3, 5, and 7 years follow-up, meanwhile, no statistically significant difference was found at baseline or after 12 months. CONCLUSION: The long-term results suggest that three-implant-retained mandibular overdenture with a clip-bar attachment appears to be a successful rehabilitation strategy which is superior to conventional dentures for patients with advanced ridge resorption.

Success Rate and Safety of Dental Implantology in Patients Treated With Antiresorptive Medication: A Systematic Review

There is no agreement of data on the subject of implant failure and the development of osteonecrosis in patients receiving antiresorptive agents. The purpose of this systematic review is to evaluate whether dental implants placed in patients on antiresorptive medication have an increased failure rate and whether the implant placement or the implant existence are risk factors for developing medication-related osteonecrosis of the jaw (MRONJ). An electronic search was conducted in PubMed/Medline, and all publications fulfilling the inclusion criteria were included. The search was completed by a hand research of the references cited in all electronic identified publications, resulting in 411 articles. Based on the inclusion criteria, 32 studies were included, with a total of 5221 patients, 12 751 implants, 618 cases of implants loss, and 136 cases of MRONJ analyzed. Because of the small number of studies, most of which were characterized by a low level of quality, it cannot be established that the use of antiresorptive medication affects dental implant survival rates. The risk of MRONJ as an early or late complication is also not well established. Therefore, successful dental implant procedures in patients receiving antiresorptive medication might be possible, but more studies need to be carried out in the future to verify this topic. Apart from intravenous antiresorptive drugs, which remain an absolute contraindication, the use of antiresorptive medication is not a contraindication to dental implantology, but it must be accompanied by careful treatment planning, informing patients about possible complications, and essential long follow-up periods.

Outcome of peri-implant maintenance care in patients with an implant-supported lower denture-A 3.5-year retrospective analysis

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.

An Innovative Meta-Systematic Review into the Landscape of Literature and the Concluding Evidence on the Quality of Life of Patients Using Two Implant Supported Mandibular Complete Denture Prosthesis

Aim:

The aim of this systematic review is to analyze the existing evidence on the quality of life of patients completely edentulous in the mandible.

Materials and Methods:

A search questionnaire was formulated using population intervention comparison outcome (PICO) analysis, and a comprehensive search was initiated in PubMed Central, Medline, Cochrane, and Google Scholar databases for the related topics. Manuscripts published till December 2019 were included in this review. Out of the 63 articles obtained from searching all databases, 27 studies were excluded based on the title and abstract. Out of the remaining 36 studies, 12 were excluded based on the inclusion and exclusion criteria of our interest and 24 were included on the basis of core data.

Results:

One review author identified randomized trials meeting inclusion criteria for this review. Two review authors extracted data and assessed study quality. The oral health-related quality of life in completely edentulous mandibular patients wearing implant-supported overdentures was better when compared to conventional tissue-supported complete denture, and a minimum two implant-supported mandibular complete denture has sufficient improvement in oral health-related quality of life.

Conclusion:

There are about more than 170 reviews and clinical trials that have been published in support of the same for the past two decades. Thus, the clinicians may not be tempted in placing additional implants in well-formed mandibular edentulous ridges. To enhance the understanding of mandibular implant overdenture treatment, clinicians must scrutinize the existing evidence and formulate a protocol by striking a balance between efficient and evidence based treatment.

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.

Immediate versus delayed loading of mandibular implant-retained overdentures: A 60-month follow-up of a randomized clinical trial

AIM

The purpose of this observational, post-trial follow-up study was to evaluate 60-month outcomes of a randomized controlled clinical trial that compared immediately and delayed loaded two unsplinted implants, supporting a locator-retained mandibular overdenture.

MATERIALS AND METHODS

Patients from a randomized controlled clinical trial, treated with either immediate or delayed loading of two implants, supporting a locator-retained mandibular overdenture, were recalled for 60-month evaluation. Patients underwent a clinical and radiographic examination to evaluate the peri-implant soft tissue parameters and bone. Prosthetic maintenance needs and complications were also recorded.

RESULTS

Twenty three of the 30 patients were available for the 60-month follow-up. The mean radiographic bone level change measured using standardized periapical radiographs from baseline to 60 months was 0.89 mm (±0.74) and 0.18 (±0.41) for delayed loading and immediate loading groups, respectively. A statistically significant difference was observed at 60 months with a smaller radiographic bone level change in the immediate loading group. No implants were lost between 12 and 60 months. At 60 months, per-protocol implant survival rate was 100% for both the groups. No difference was found in the peri-implant soft tissue parameters and prosthetic needs between the groups.

CONCLUSION

Both immediately and delayed loaded implants supporting a locator-retained mandibular overdenture showed similar clinical outcomes.

Comparison of Two Low-Profile Prosthetic Retention System Interfaces: Preliminary Data of an In Vitro Study

In recent years, a major research goal of companies has been to create mechanical components suitable for rehabilitation that are safer and more reliable. Evaluating their biomechanical features could be a way to improve them. The purpose of this study was to evaluate the different biomechanical features of low-profile retentive systems (Rhein®). Two different attachment systems were tested: OT Equator® Smart Box and Locator® R-TX. Once a machine was created for the simulation of the connection and disconnection of the attacks in a combined manner, it was possible to evaluate these parameters over time. Attachments were mounted in two different configurations of the divergence angle: 10° and 50°. The drop retention force proved to be stable over time. The Locator® R-TX attachment experienced a more rapid decrement of the retention force than the OT Equator® Smart Box. Both tested systems experienced a high drop in retention; this drop tended to stabilize after 1.5 years of use, and it was correlated with the divergence angle. The OT Equator® Smart Box system underwent this loss of retention more gradually than the Locator® R-TX. This study demonstrates preliminary results from a bioengineering and biomechanical point of view, providing useful information for the continuous improvement of these devices and, therefore, for the quality of patients' oral health.

Microbiological evaluation of LOCATOR® Legacy attachments: A cross-sectional clinical study

Objective

This retrospective cross‐sectional study aimed to evaluate quantitatively the oral microbiome in the tri‐lobe central cavity of Locator Legacy attachment and verify whether it harbors a different, potentially more pathogenic, bacterial spectrum than the adjacent edentulous ridge.

Materials and Methods

Edentulous patients rehabilitated with implant overdentures using Locator Legacy attachments were recruited for this study. The clinical examination comprised probing depths, mobility, peri‐implant, and periodontal health along with intraoral swabs for microbiological evaluation, polymerase chain reaction (PCR) testing, and candida culture. The swabs were collected from the trilobed cavity of the attachment and the adjacent edentulous ridge. PCR was performed to detect six specific bacteria, Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Tannerella forsythia, Treponema denticola, Prevotella intermedia, and Parvimonas micra. Statistical analyses were performed using McNemar's test and Wilcoxon's rank sum test with the significance set to p < .05.

Results

A total of 50 participants with a mean age of 71.5 ± 9.6 years participated in the study. No significant differences in the microbiome were found between samples from the ridge and the attachment. No significantly different numbers in the candida cultures were identified, and the presence of a removable prostheses did not demonstrate a significant association with the prevalence of candida.

Conclusions

Within the limits of this study and the investigated bacterial species, the trilobed cavity of the attachment does not seem to increase the bacterial load.

Patient's oral health-related quality of life and satisfaction with implant supported overdentures -a systematic review

Purpose

This systematic review was done to find the patients oral health-related quality of life (OHRQoL) and satisfaction with implant supported overdentures (IODs) when compared to conventional complete dentures (CCDs).

Materials and methods

To identify suitable literature, an electronic search was performed using Medline/PubMed and Cochrane databases. Manual search of Prosthodontics, Gerodontology and journals related to dental implants were also done. Articles published in English and articles whose abstract is available in English were included. The search was focused on patient's oral health-related quality of life and satisfaction with IODs when compared to CCDs.Titles and abstracts were screened, and literature that fulfilled the inclusion criteria was selected for a full-text reading.

Results

Initial literature search resulted in 1803 papers, 1779 were excluded after screenings of the abstracts by the reviewers which resulted in 24 studies. 5 studies were further excluded due to not fulfilling the inclusion criteria, 2 additional articles included after hand searching, resulting in total 21 articles in systematic review. The result suggests that mandibular CCDs had less retention as compared to maxillary conventional dentures CCDs, which improved drastically with IODs and provides a better oral health-related quality of life and satisfaction to the patients.

Conclusion

Retention, stability, comfort, speech and chewing efficiency improved drastically with IODs, with enhanced patient's satisfaction and a better OHRQoL. Patients reported more satisfaction and OHRQoL with mandibular IOD when compared CCDs.

Implant overdentures retained by self-aligning stud-type attachments: A clinical report

The functionality of a new overdenture attachment (LOCATOR R-Tx) was described for different clinical situations: a conventional mandibular implant overdenture (IOD) retained by 2 implants, a straightforward chairside maintenance procedure for replacing a worn LOCATOR (Legacy) attachment with the new LOCATOR R-Tx, and a complex clinical situation with nonideal implant positions with compromised parallelism. The LOCATOR R-Tx is an advance on the existing LOCATOR Legacy attachment and has an improved abutment head design with a more durable surface coating to prevent attachment wear and thereby reduce frequency of maintenance.

Influence of facial patterns on the masticatory function and quality of life of completely edentulous patients during the transition to implant-retained mandibular overdentures

STATEMENT OF PROBLEM

Although implant-retained mandibular overdentures (IMOs) provide functional benefits, the influence of the vertical facial pattern (FP) and the anteroposterior skeletal discrepancy (ASD) on the masticatory function and patient-centered outcomes during the transition to IMOs is still uncertain.

PURPOSE

The purpose of this interventional clinical study was to evaluate the influence of the FP and ASD on the masticatory function, oral health-related quality of life (OHRQoL), and satisfaction of completely edentulous patients before and after transition to IMOs.

MATERIAL AND METHODS

Cephalometric analysis was performed on 42 participants before treatment. Ricketts analysis was used to classify the FP, and the maxillomandibular relationship to the base of the skull determined the ASD. Masticatory performance (MP) and swallowing threshold (ST) test results were evaluated by the multiple sieve method by using artificial test food (Optocal cubes) to determine the median particle size (×50), homogenization index (B), and masticatory efficiency based on sieves 5.6 (ME: 5.6) and 2.8 (ME: 2.8). OHRQoL and satisfaction were evaluated by using the Dental Impact on Daily Living questionnaire. The data were analyzed using mixed-effects linear regression models to estimate the effect of time, FP, ASD, age, and sex on MP, ST, and OHRQoL.

RESULTS

The MP, ST, OHRQoL, and satisfaction improved significantly after IMO loading, irrespective of FP and ASD. However, MP outcomes were most negatively affected mainly among dolichofacial (B and ME: 2.8), class II, and class III (×50, B, and ME: 2.8) participants. The ST test showed that class II participants still showed inferior ×50 values and performed a lower number of cycles than class I and class III participants. Women presented reduced masticatory function for all MP and ST outcomes and reported lower coefficients for appearance and general performance domains than men.

CONCLUSIONS

The MP test detected more subtle improvements than the ST test, especially in class III participants. The class II participants benefited the least from the IMO installation according to the ST test. The IMO treatment improved the OHRQoL and satisfaction of edentulous patients, irrespective of the FP or ASD.

How fast can treatment with overdentures improve the masticatory function and OHRQoL of atrophic edentulous patients? A 1-year longitudinal clinical study

OBJECTIVES

The aim of this prospective clinical study was to evaluate the masticatory function (MF) and subjective perception of patients with poor denture-bearing tissue in relation to change and the time required to identify an improvement in these parameters after rehabilitation with mandibular overdentures (MO) by two narrow-diameter two-piece implants.

MATERIAL AND METHODS

Twenty-three edentulous patients were selected for MO installation. The masticatory function (MF) was evaluated with the masticatory performance (MP) and swallowing threshold (ST) tests. In the MP test, each volunteer was instructed to masticate a portion of Optocal (standardized artificial test food) for 40 masticatory cycles. During the swallowing threshold test, the patients were instructed to chew a new portion of Optocal cubes until they felt the desire to swallow. The MF tests were performed while complete denture (CD) wearers (baseline) and 1, 3, 6, and 12 months after MO loading. In addition, the subjective perception was assessed through the questionnaires Dental Impact on Daily Living (DIDL), Geriatric Oral Health Assessment Index (GOHAI), and Oral Health Impact Profile in Edentulous (OHIP- EDENT) at the baseline and 3, 6, and 12 months after MO loading.

RESULTS

A significant improvement in masticatory function (p < .05) was observed already in the first month of loading. Three months after MO loading, a significant improvement (p < .05) was found in the subjective perception of patients. The effect size indicates that the MO had the greatest impact on the domains related to function and comfort of all questionnaires and in relation to psychosocial domain of the GOHAI. The level of patient satisfaction increased significantly after the MO loading and reached >90% satisfied patients at 12 months.

CONCLUSION

The MO improved both the MF of the patient and their oral health-related quality of life and satisfaction regarding the prosthesis in a short time period.

Predictive Parameters of Oral Health Quality of Life in Complete Mandibular Denture Wearers Stabilized by Mini-Implants: A Two-Year Follow-Up Study

The frequent instability of mandibular removable complete dentures affects patient Oral Health Related Quality of Life (OHRQoL). An innovative therapeutic strategy used to improve stability involves placing four symphyseal mini-implants. This study was aimed at assessing OHRQoL over time in subjects in which mini-implants were placed and exploring if certain parameters could predict the evolution of their OHRQoL. The Quality of life of subjects with dentures was assessed using the Geriatric Oral Health Assessment Index (GOHAI) before (T0), 2–6 months (T1), twelve months (T2) and twenty-four or more months (T3) after mini-implant setting. Age, gender and chewing ability were tested as explanatory variables for the change in OHRQoL with time. Thirteen women and six men were included (mean age: 69 ± 10 years). After mini-implant placement, mean GOHAI scores at T1, T2 and T3 increased significantly (p < 0.001). The GOHAI-Add mean score was not affected by age or gender. Baseline chewing ability impacted the “functional” and “pain and discomfort” fields of the mean GOHAI scores (p < 0.05). The OHRQoL was quickly improved after mini-implant placement in complete denture wearers and then stabilized over time. Baseline chewing ability can be used as a predictive parameter of OHRQoL.

Effect of implant- and occlusal load location on stress distribution in Locator attachments of mandibular overdenture. A finite element study

PURPOSE

The aim of this study is to evaluate and compare the stress distribution in Locator attachments in mandibular two-implant overdentures according to implant locations and different loading conditions.

MATERIALS AND METHODS

Four three-dimensional finite element models were created, simulating two osseointegrated implants in the mandible to support two Locator attachments and an overdenture. The models simulated an overdenture with implants located in the position of the level of lateral incisors, canines, second premolars, and crossed implant. A 150 N vertical unilateral and bilateral load was applied at different locations and 40 N was also applied when combined with anterior load at the midline. Data for von Mises stresses in the abutment (matrix) of the attachment and the plastic insert (patrix) of the attachment were produced numerically, color-coded, and compared between the models for attachments and loading conditions.

RESULTS

Regardless of the load, the greatest stress values were recorded in the overdenture attachments with implants at lateral incisor locations. In all models and load conditions, the attachment abutment (matrix) withstood a much greater stress than the insert plastic (patrix). Regardless of the model, when a unilateral load was applied, the load side Locator attachments recorded a much higher stress compared to the contralateral side. However, with load bilateral posterior alone or combined at midline load, the stress distribution was more symmetrical. The stress is distributed primarily in the occlusal and lateral surface of the insert plastic patrix and threadless area of the abutment (matrix).

CONCLUSION

The overdenture model with lateral incisor level implants is the worst design in terms of biomechanical environment for the attachment components. The bilateral load in general favors a more uniform stress distribution in both attachments compared to a much greater stress registered with unilateral load in the load side attachments. Regardless of the implant positions and the occlusal load application site, the stress transferred to the insert plastic is much lower than that registered in the abutment.

Influence of Implant Positions and Occlusal Forces on Peri-Implant Bone Stress in Mandibular Two-Implant Overdentures: A 3-Dimensional Finite Element Analysis

The aim of this study was to evaluate and compare the bone stress around implants in mandibular 2-implant overdentures depending on the implant location and different loading conditions. Four 3-dimensional finite element models simulating a mandibular 2-implant overdenture and a Locator attachment system were designed. The implants were located at the lateral incisor, canine, second premolar, and crossed-implant levels. A 150 N unilateral and bilateral vertical load of different location was applied, as was 40 N when combined with midline load. Data for von Mises stress were produced numerically, color coded, and compared between the models for peri-implant bone and loading conditions. With unilateral loading, in all 4 models much higher peri-implant bone stress values were recorded on the load side compared with the no-load side, while with bilateral occlusal loading, the stress distribution was similar on both sides. In all models, the posterior unilateral load showed the highest stress, which decreased as the load was applied more mesially. In general, the best biomechanical environment in the peri-implant bone was found in the model with implants at premolar level. In the crossed-implant model, the load side greatly altered the biomechanical environment. Overall, the overdenture with implants at second premolar level should be the chosen design, regardless of where the load is applied. The occlusal loading application site influences the bone stress around the implant. Bilateral occlusal loading distributes the peri-implant bone stress symmetrically, while unilateral loading increases it greatly on the load side, no matter where the implants are located.

An International Survey among Prosthodontists of the Use of Mandibular Implant-Supported Dental Prostheses

PURPOSE

To evaluate the use of implant-supported overdentures (IOD) and implant-supported fixed dental prostheses (IFDP) in patients with edentulous mandibles among international prosthodontists.

MATERIALS AND METHODS

A questionnaire was sent by e-mail to all clinically active prosthodontists in the International College of Prosthodontists with questions related to implant treatment of the edentulous mandible performed in 2015.

RESULTS

One hundred and sixteen prosthodontists from 33 countries responded to the questionnaire. The vast majority of the responding prosthodontists was faculty or worked in private practice, and the great majority had performed treatment with mandibular implant-supported dental prostheses; however, two thirds of the respondents reported that <20% of the implant patients in their clinic had received treatment related to edentulous mandibles. The majority reported using 2 implants (84%), while 13% used 4 for overdenture retention. There were great variations regarding retention systems used for mandibular IODs; the most common was individual Locator attachments. Cost was considered the most common reason to choose mandibular IOD, There was a wide variation of materials used for mandibular IFDPs. The most common combination included milled titanium frameworks and acrylic resin teeth.

CONCLUSIONS

This survey, completed by 116 prosthodontists from 33 countries, showed that implant treatment for edentulous mandibles is common, but there was great variation among the respondents regarding amount of treatments performed, design, and materials used for the implant prostheses.

Electromyography evaluation of masseter and temporalis, bite force, and quality of life in elderly patients during the adaptation of mandibular implant-supported overdentures

OBJECTIVES

The aim of this study was to investigate the outcomes of the installation of two implant-supported overdentures until such treatment is complete. Although this treatment is well established in the literature, there are no studies comparing what happens to muscles and the quality of life (QoL) of patients during the treatment.

METHODS

We selected 13 completely edentulous patients, according to inclusion and exclusion criteria, to rehabilitate with mandibular overdentures retained by two dental implants and a complete denture as antagonists. We evaluated the efficacy of the treatment and its evolution in five steps: (i) initially, with the old complete dentures, (ii) after the implants' placement with the mandibular prosthesis relined, (iii) after the placement of the healing abutments, (iv) after the installation and adaptation of new prostheses, and (v) after a 3-month follow-up period. At each stage, we evaluated patients via temporal and masseter electromyography (EMG), molar and incisive bite force, and QoL.

RESULTS

The results for EMG found a decrease in muscle activity during rest, the mastication of raisins, and lateral movements when the overdentures were installed. For the bite force and QoL, there was a gradual improvement from the placement of the healing abutments period (P ˂ 0.05), which was sustained until the follow-up.

CONCLUSIONS

Comfort and stability improved during the treatment, demonstrated by the QoL and bite force results. These results are positive for elderly patients who might refuse an implant-supported overdenture due to treatment length.

Dental implants in patients treated with antiresorptive medication - a systematic literature review

Objective

Bisphosphonate-associated osteonecrosis of the jaws (BP-ONJ) is triggered by inflammatory processes. Typical trigger factors are periodontal disease, denture pressure sores, and surgical interventions such as tooth extractions. Unfortunately there is only little data on how to proceed with implant therapy in patients with bisphosphonate treatment. This topic is not addressed in the German guidelines on medication-associated osteonecrosis. Therefore a systematic literature review was performed.

Methods

The PICO design was used: (Patients) For which subclientel of patients with antiresorptive therapy (intervention) do dental implants have a benefit (control) compared to forgoing dental implants (outcome) in regards to oral rehabilitation and quality of life without having a substantial risk of BP-ONJ development? A PubMed search was performed including all studies dealing with this topic. Case reports and studies with less than 5 cases were excluded.

Results

There is only very little data available, mostly retrospective case series. 50 articles were analyzed in detail. BP-ONJ can be triggered by dental implants and by dentures in patients with benign and malignant primary diseases. In most studies, analyzing osteoporosis patients only, no cases of BP-ONJ were observed in patients with implant therapy in the time span observed. There are no studies about implant therapy in patients with malignant diseases. Many case series analyzing the trigger factors for BP-ONJ describe dentures as one of the main causes. Perioperative antimicrobial prophylaxis has a benefit in the prevention of BP-ONJ development.

Conclusion

Successful implant therapy is possible in patients receiving antiresorptive therapy. The possibility of osteonecrosis development needs to be explained to the patient. An individual risk assessment is essential, taking the primary disease with the medication and further wound-healing-compromising diseases and medications into account. If possible, bone augmentations should be avoided, and a perioperative antimicrobiological prophylaxis is strongly recommended in these patients.

Efficacy of Mandibular 2-implant Overdenture: An Updated Meta-analysis on Patient-based Outcomes

The extent of heterogeneity regarding the efficacy of the mandibular 2-implant overdenture is still in question. The aim of this meta-analysis is to provide an update on the existing evidence from randomized controlled trials assessing the efficacy of the mandibular 2-implant overdenture in regard to patient-based outcomes. Electronic searches were carried out to September 2015 through MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and the Cochrane Systematic Reviews. Only randomized controlled trials that compared conventional dentures with mandibular 2-implant overdentures were included. Patient-based outcomes were assessed, including patient satisfaction and oral health- and general health-related quality of life. Random effects models were used to pool the effect sizes of all included studies. Further stratified analyses and heterogeneity analyses were tested, as was publication bias. In addition to the 7 randomized controlled trials that were included in the previous meta-analysis, 4 new trials were identified and included in this update. A random effects model showed that, when compared with conventional dentures, mandibular 2-implant overdentures significantly improved patient satisfaction (pooled effect size = 0.87, z = 5.31, 95% confidence interval: 0.55 to 1.19, P < 0.0001, χ² = 41.82, df = 8, P < 0.0001, I² = 81%) and oral health-related quality of life (pooled effect size = -0.66, z = 2.72, 95% confidence interval: -1.13 to -0.18, P = 0.007, χ² = 21.26, df = 4, P = 0.0003, I² = 81%). The differences in participant recruitment and their pretreatment condition were important sources of heterogeneity among the studies. Only 1 study investigated the impact of mandibular implant overdentures on perceived general health, and it revealed no between-treatment differences. The 2-implant mandibular overdenture improves patient satisfaction and quality of life for the general edentate population. Health status, poor oral condition, and patient characteristics may effect patient-based outcomes and should be considered by clinicians in treatment planning. Knowledge Transfer Statement: This meta-analysis shows that mandibular 2-implant overdentures are significantly more satisfactory to the general edentate populations than new conventional dentures. The results also show that mandibular 2-implant overdentures provide significantly better oral health-related quality of life than do new conventional dentures. These results should be shared with edentate patients in planning their treatment.