Maxillary 3-implant removable prostheses without palatal coverage on Locator abutments - a case series

Two or four implants for maxillary overdentures in edentulous patients: 1-year results of a randomized controlled trial

INTRODUCTION

Maxillary implant overdenture therapy is a good treatment option for treating patients experiencing problems with their conventional maxillary denture. Retaining the overdenture with four implants and a bar attachment system serves as the current gold standard. However, there is a demand for less costly and less invasive treatment options. The aim of this randomized controlled trial was to compare marginal bone level change (MBLC), implant and overdenture survival, clinical, masticatory, and patient-related outcomes (PROMs) of maxillary implant overdentures with either two or four implants and a bar attachment system.

MATERIALS AND METHODS

Forty edentulous participants were randomly allocated to two groups (n = 20), to receive either two or four implants in the maxilla. After healing, all the participants received an implant overdenture retained by a bar attachment system. All the participants were evaluated 1 and 12 months after overdenture placement. The primary outcome was MBLC. Secondary outcomes were implant and overdenture survival, clinical, masticatory, and PROMs. The outcomes were analyzed using parametric and non-parametric tests.

RESULTS

MBLC was -0.03 mm in the 2-implant group and -0.16 mm in the 4-implant group (p = 0.21). Implant survival was 83.3% in the 2-implant group and 94.4% in the 4-implant group (p = 0.03). The median pocket depth change and clinical outcomes were low, and masticatory performance along with PROMs improved in both groups and did not differ significantly between them.

CONCLUSION

Maxillary 4-implant overdentures perform better than maxillary 2-implant overdentures with a bar attachment system in terms of implant and overdenture survival and therefore remains the gold standard. However, both overdentures perform similarly in terms of MBLC, clinical, masticatory, and PROMs.

Maxillary implant overdentures retained with bars or solitary attachments: A 5-year randomised controlled trial

Purpose To compare the 5-year follow-up outcomes of maxillary overdentures retained by bars or solitary attachments.Methods Fifty consecutively selected fully edentulous patients experiencing problems with their conventional denture received four implants and were randomly allocated to receive a maxillary overdenture with either bar- or solitary attachment retention. Marginal bone level change (primary outcome), implant- and overdenture survival rate, clinical- and patient related outcome measures were recorded at baseline, and after 1 and 5 years. Biological and technical complications were recorded throughout the entire follow-up period.Results After 5 years, the mean marginal bone level change was higher in the solitary attachment group (-1.41±1.38mm, P=0.024) than in the bar group (-0.99±0.96mm). Also, fewer implants survived in the solitary attachment group (89.5%, P=0.027) than in the bar group (96.3%). The overdenture survival rate was 95.0% and 91.3% in the bar and solitary attachment group, respectively. Although the clinical and patient related outcomes were favourable and did not differ significantly between the groups, the peri-implantitis incidence was 25.8% in the solitary attachment group and 5.1% in the bar group. Any technical complications were minor.Conclusions In maxillary 4-implant overdenture therapy, the marginal bone level, implant survival rate and the number of complications are better with bar attachments than with solitary attachments. Both groups' clinical and patient related outcome measure scores were equal throughout the entire follow-up period.

Maxillary implant overdenture retained by four unsplinted attachments and opposed by a natural or fixed dentition: Five-year clinical outcomes. A prospective case series

OBJECTIVES

The objective of this study was to assess, over a period of 5 years, implant prosthesis and patient-reported outcomes of complete dentures retained by four implant-supported attachments in the edentulous maxilla facing either natural teeth or fixed rehabilitation in the lower jaw.

MATERIALS AND METHODS

Implant, prosthodontic and patient-related outcomes were assessed in 30 patients at 1, 3 and 5 years. Prosthodontic survival, complications or maintenance events as well as implant survival were recorded. Patient-reported outcome measures (PROMs) were evaluated with the Oral Health Impact Profile (OHIP-20) questionnaire and a visual analogue scale (VAS) before implant placement (baseline) and during the follow-up period.

RESULTS

After 5 years, three patients dropped out, 21 implants failed, and four overdentures were replaced leading to a prosthesis survival rate of 85.2% (95% CI: 71.8%-98.6%) and an implant survival rate of 80.6% (95% CI: 73.1%-88.0%). Prosthodontic success rate decreased from 86.2% to 74% between the 1st and the 3rd year and reached 63% after 5 years. OHIP results improved significantly from baseline to 1 year (p < .0001) and to 3 years (p = .036), but, at 5 years, the improvement was no longer significant when compared to baseline (p = .12). The overall VAS score remained significantly higher up to 5 years (p < .001).

CONCLUSION

A substantial number of prosthetic complications and replacements occurred over the 5-year follow-up. After 5 years, the OHIP-20 deteriorated and reached again the baseline level. Nonetheless, the VAS results suggest significantly increased patient satisfaction after implant-supported retention was provided for the removable prostheses.

The performance of two-implant overdentures in the atrophic maxilla: a case series with 1-year follow-up

PURPOSE

To assess the implant and prosthesis survival rates, the clinical, radiographical and patient-related outcome measures, and the masticatory performance of maxillary overdentures supported by two implants in patients with an atrophic maxilla.

METHODS

In this case series, 15 consecutive patients who were eligible for maxillary implant overdenture therapy, but who had insufficient bone volume to place at least four implants and were unwilling to be treated with reconstructive surgery were asked to participate. After giving consent, participants received two implants in the maxilla under local anaesthesia. After 3 months of osseointegration, a maxillary overdenture with palatal coverage and solitary attachments was fabricated. Implant and overdenture survival, marginal bone level change, clinical outcome measures, masticatory performance and patient-related outcomes were evaluated at baseline and 1 year after overdenture placement.

RESULTS

Fourteen out of 15 participants completed the follow-up period of 12 months. Implant and overdenture survival rate were 89.3% and 85.7%, respectively. Change in marginal bone level (- 0.5 ± 0.7 mm), change in probing depth (0.0 ± 1.0 mm), and clinical outcomes were favourable. Masticatory performance and patient-related outcomes improved significantly compared to baseline. Complications were minimal.

CONCLUSIONS

Within the limitations of this study, it can be concluded that patients with extreme resorption of the maxilla that are unwilling to be treated with reconstructive surgery, benefit from two-implant maxillary overdentures retained by solitary attachments in terms of improved masticatory functioning and denture satisfaction. However, they have relatively high risk of implant loss.

TRIAL REGISTRATION

UMCG Trial Register (RR201900060), registered 22 January 2019.

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.

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.

Functional oral health-related quality of life impact: A systematic review in populations with tooth loss

Patients perceive the impact of oral disorder in four major areas, the dimensions of oral health-related quality life (OHRQoL) Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact. The functional aspect is essential given the need of chewing, biting, speech and swallowing. The objective of this study was to identify OHRQoL information for dental subjects with functional oral health problems. In a systematic review, distinct and clinically relevant groups of dental subject samples, in this study called "population groups," with such functional OHRQoL information based on the Oral Health Impact Profile (OHIP) were identified (PROSPERO registration: CRD42017064033). The search strategy was "Oral Health Impact Profile" or OHIP. Searches were conducted in the PubMed interface of the Medline database, EMBASE, Cochrane, CINAHL and PsyINFO on 8 June 2017 and updated on 14 January 2019. Published OHIP domain data of different versions were recalculated into OHIP-14`s Physical Disability domain score, characterising the subject's Oral Function impact. 3,653 potentially abstracts were screened. We identified 78 publications reporting dimensional information on 154 subject samples with 52 populations. A typical mean functional impact for partially dentate subjects was 1.6 units on a 0 to 8 unit metric, while for edentate subjects, the mean functional impact was 2.6 units. The functional impact score ranged from 0 to 7.9 units with 50% of the patient samples located between 0.8 and 2.6 units. For the first time, we provide normalised and therefore comparable metric information about the functional OHRQoL impact for a substantial number of functional oral conditions.

Maxillary implant overdentures retained by use of bars or locator attachments: 1-year findings from a randomized controlled trial

PURPOSE

Comparison of outcomes of maxillary implant overdentures retained by use of either locator attachments or bars in a 1-year randomized controlled trial.

METHODS

Fifty edentulous participants received four maxillary implants. They were allocated to two groups (n = 25) differing in type of prosthetic attachment used to retain the maxillary prosthesis: either locator attachments or bars were applied. After one year, implant and overdenture survival was assessed. Peri-implant hygiene (Plaque-index, presence of calculus), soft tissue conditions (Gingiva-index, Sulcus Bleeding-index and pocket probing depth) and patient satisfaction (oral health impact profile (OHIP-49), denture complaints questionnaire and general satisfaction score (GSS)) were compared. The peri-implant bone level was estimated using intra-oral radiographs (student T-test).

RESULTS

Implant survival was 96.7% in the locator group and 97.9% in the bar group. No overdentures had to be remade. Patient satisfaction was significantly greater in the bar group when rated by OHIP-49 sum score and by GSS. When comparing the denture complaints questionnaire and the separate OHIP-49 item scores, no significant difference was found. There was not a significant difference in hygiene and soft tissue conditions. Marginal bone loss was estimated 0.58 ± 0.71 mm for locators and 0.31 ± 0.47 mm for bars.

CONCLUSIONS

Maxillary overdentures on four implants retained by bars or locators were compared. Bone loss was within an acceptable range for both groups after 1 year. However, less bone was lost in the bar group. Even though both treatment options improved patient satisfaction, bars seem to be particularly beneficial with regard to OHIP-49 sum score.

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.