Effect of implant-supported mandibular overdentures versus reline on masticatory performance and salivary flow rates in very old adults-A randomized clinical trial

Effect of dental implant therapy on the preservation of orofacial tissues: A systematic review and meta-analysis

OBJECTIVE

Fundamentally, this review addresses the following question: In partially or fully edentulous patients, do implant-supported dental prostheses preserve orofacial tissues when compared to conventional prostheses or no therapy?

MATERIALS AND METHODS

This study was conducted according to the 2020 PRISMA guidelines for systematic reviews. Electronic searches were conducted at PubMed and Embase databases followed by manual search. Clinical studies comparing the effect of implant-supported prostheses with conventional rehabilitation or no treatment on alveolar bone resorption, remaining teeth, and jaw muscle thickness were considered for inclusion. A qualitative synthesis was conducted with all included studies, and data from selected studies were pooled quantitatively to perform a meta-analysis.

RESULTS

A total of 14 studies were selected for analysis. Six studies reported on the effect of implant therapy on alveolar bone resorption (n = 453), six on the remaining teeth (n = 1014), while four studies evaluated masseter muscle thickness (n = 158). The results of the meta-analyses assessing alveolar bone resorption in the posterior mandible and in the anterior area of the maxilla, both fixed and random effects models, yielded no benefit of rehabilitation with implant-supported prostheses when compared to conventional prostheses. For masseter bone thickness, however, a significant benefit for implant-supported prosthesis was observed.

CONCLUSIONS

This systematic review and meta-analysis were unable to unequivocally answer the focus question. There are some indicators of the benefit of implant-supported prostheses over conventional prostheses or no therapy in preserving orofacial tissues, particularly for masseter muscle thickness. However, the evidence is still insufficient to confirm such perception.

Functional performance and impact on the quality of life of three treatment strategies for mandibular edentulism: Results of a parallel 3-group cross-sectional study

OBJECTIVES

This parallel cross-sectional study compared masticatory function and patient-centered outcomes among 3 removable treatment strategies for mandibular edentulism.

METHODS

Thirty-six edentulous participants rehabilitated using 3 removable treatment strategies for mandibular edentulism were allocated to one of the three groups (n=12): CCD (control), 2-IMO, and 3-IMO. Narrow diameter implants were installed using single-stage surgery and conventionally loaded with stud abutments. After 3 months of usage, the quality of life, maximum bite force, and masticatory function were evaluated. Data were analyzed with the Kruskal-Wallis test and post hoc pairwise Mann-Whitney tests with Bonferroni correction (α=0.05).

RESULTS

The 2-IMO and 3-IMO wearers did not show significant differences in any outcome, except for the 2 domains of 3-IMO wearers quality of life that obtained better Pain and General Performance scores. Both IMO groups presented significantly higher maximum bite force than CCD wearers. The 2-IMO wearers showed superior outcomes to the CCD group in all outcomes of the masticatory performance test and the X50, B and ME5.6 outcomes of the swallowing threshold test (p = 0.01), while 3-IMO participants only showed superior masticatory performance in terms of lower X50 values (19.86%, p = 0.02) and higher ME 2.8 (141.15%, p = 0.04) than CCD wearers.

CONCLUSIONS

Compared to 2-IMO wearers, 3-IMO wearers report superior impact of treatment on daily living activities in the Pain and General Performance domains. 2-IMO and 3-IMO wearers showed no significant differences between them for all evaluated bite force and masticatory function parameters.

CLINICAL SIGNIFICANCE

Although overdentures retained by 3 implants (3-IMO) provide biomechanical advantages over those retained by 2 implants (2-IMO), superior clinical and functional effectiveness is not yet proven.

Oral function in completely edentulous patients rehabilitated with implant-supported dental prostheses: A systematic review and meta-analysis

OBJECTIVES

This review evaluated the effects of rehabilitation with implant-supported prostheses on the oral function of completely edentulous adults.

MATERIALS AND METHODS

Systematic literature searches were performed to identify records reporting on oral function in completely edentulous adults rehabilitated with implant-supported prostheses. Meta-analyses were performed on various outcomes including bite force, masticatory performance, muscle activity, mandibular movement/chewing pattern, and salivary flow.

RESULTS

5507 records were identified. Thirty studies qualified for data extraction and analysis. The kappa (𝛋) for the search and identification strategy ranged between 0.50 and 1.00. Meta-analysis was performed grouping the studies by outcomes and split by time points of 6-12 months, 12-36 months, and >36 months after implant therapy. The meta-analyses revealed a significant improvement in oral function of completely edentulous adults after rehabilitation with implant-supported prostheses at 6-12 months (Z = -4.895, p < .001; 95% CI: -0.703, -0.301; τ2  = .609; Q = 114.953, df = 17, p < .001; I2  = 85.2%), at 12-36 months (Z = -4.886, p < .001; 95% CI: -0.580, -0.248; τ2  = .908; Q = 280.611, df = 35, p < .001; I2  = 87.5%) and at more than 36 months (Z = -9.108, p < .001; 95% CI: -1.472, -0.951; τ2  = .019; Q = 7.918, df = 7, p = .340; I2  = 11.6%). The included studies demonstrated a low to moderate risk of bias.

CONCLUSIONS

This systematic review concluded that the oral function of completely edentate adults significantly improved with implant-supported/retained prostheses, even when only one jaw received implant therapy. Therefore, implant therapy should be promoted for edentulous adults to alleviate the shortcomings of conventional complete removable dental prostheses.

The Effect of Patient Specific Factors on Occlusal Forces Generated: Best Evidence Consensus Statement

PURPOSE

The purpose of this Best Evidence Consensus Statement was to search the literature to determine if there is a relationship between patient specific factors and occlusal force.

MATERIALS AND METHODS

A literature review was conducted in the following databases: Evidence-Based Medicine Reviews (EBMR), Cochrane Database of Systematic Reviews, Embase, and Ovid MEDLINE(R) and Epub Ahead of Print. Articles on patient factors and occlusal force were compiled by using a combination of the key words: "bite force," "occlusal force," "partial and complete edentulism," "bruxism," and "orthognathic class." Inclusion criteria included meta-analyses, systematic reviews, randomized controlled trials, case series, and journal articles. Exclusion criteria were case reports, studies in children, animals, and bench studies.

RESULTS

Of the 1502 articles that met the initial search criteria, 97 related to patient-specific factors affecting occlusal forces. These articles were evaluated, rated, and organized into appropriate categories addressing questions of foci.

CONCLUSIONS

The range of occlusal force is highly variable among subjects correlated to patient specific factors such as age, gender, partial and complete edentulism, the presence of a maxillofacial defect, location of edentulous area, orthognathic profile, and magnitude of occlusal vertical dimension. Tooth replacement therapies targeted at increasing occlusal contact seem to have a positive effect on increasing occlusal force. Bruxism does not necessarily demonstrate higher occlusal powering but may have greater tooth contact time. Occlusal force is not clearly affected by the type of dental restoration or restorative material used. The clinical significance of the changes in occlusal forces is yet to be determined.

Application of masticatory control in dental treatment for elderly individuals

Taiwan transitioned to an aged society in 2018. Appropriate dental treatment is important for elderly individuals. Previously, reconstruction of the dentition was thought to help regain chewing function. However, concerns of the elderly population, such as decline in learning ability and saliva secretion, complicate dental reconstruction. Overlooking the special needs of elderly individuals may lead to impaired chewing function, resulting in nutritional imbalances and increased burden on the digestive tract, causing more health disorders. For the elderly population, treatment must be aimed at restoring as much chewing function as possible with minimal changes. Additionally, regular oral hygiene care, proper design of fixed partial dentures, and implant placement greatly reduce the difficulty in adapting to a new prosthesis. These measures allow us to provide better quality of life for elderly individuals.

Mandibular two-implant overdentures with CAD-CAM milled bars with distal extensions or retentive anchors: A randomized controlled trial

OBJECTIVE

This randomized controlled trial (RCT) aimed to demonstrate the non-inferiority of mandibular 2-implant overdentures (IODs) on a CAD-CAM milled bar with long distal extensions (MBDE) against IODs on retentive anchors (RA).

METHODS

Forty edentulous participants rehabilitated with a maxillary conventional denture and a mandibular 2-IOD participated in this trial. They were randomized into two groups [Control group (CG): RA + gold matrices; Experimental group (EG): MBDE + gold clip]. The outcomes included implant survival rate (ISR), chewing efficiency [quantitative (VoH) and subjective (SA) assessments], peri-implant marginal bone levels (PI-MBL), maximum bite force (MBF), and patient-reported outcomes [oral health impact profile (OHIP-EDENT), and denture satisfaction index (DSI)]. Outcomes were recorded at baseline (BL), two weeks (T₀ ), 6 months (T₁ ), and at 1 year (T₂ ) after the intervention. Intra- and inter-group analyses were performed using regression models with ⍺=0.05.

RESULTS

38 participants completed the T₂ visit (CG: n = 19, age = 74.7 ± 7.8 years; EG: n = 19, age = 70.3 ± 10.7 years). At T₂ , there was no implant loss in either of the groups (ISR = 100%). There were no significant differences between the groups for the PI-MBL changes (p = .754). Improvements occurred faster in the EG than in the CG, but over the observation time, there were no differences between the trial groups for VoH, MBF, OHIP-EDENT, and the DSI, except for SA being significantly better in the EG group (p = .022).

CONCLUSIONS

The results of this RCT confirm that mandibular 2-IODs with a CAD-CAM milled bar with long distal extensions are not an inferior treatment to the conventional IODs on retentive anchors in the short term (1 year).

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.