The effect of attachment type and implant number on satisfaction and quality of life of mandibular implant-retained overdenture wearers

Four locator attachments of mandibular implant-retained overdentures with two different distributions: A 10-year retrospective preliminary study of residual alveolar ridge changes

OBJECTIVES

There is little information on the long-term function of the four Locator attachment of the mandibular implant retained overdenture (OD), particularly with different distributions.

PURPOSE

To compare the effect of different four inter-foraminal implant distributions retaining a mandibular OD after 10 years of function on posterior mandibular ridge resorption (PMandRR), anterior maxillary ridge resorption (AMaxRR), and the amount of marginal bone loss (MBL) around all four implants.

MATERIALS AND METHODS

Twenty-two participants with total edentulism who had worn mandibular OVDs retained by four inter-foraminal implants for 10 years of functional life were selected for this study. They were divided into two groups based on implant distribution: Group I with a quadrilateral distribution (QD) of implants and Group II with a linear distribution (LD) of implants. PMandRR, AMaxRR, and MBL around implants were measured.

RESULTS

After 10 years of function, PMandRR was significantly higher in the LD group than in the QD group (p < 0.001*). There was no significant difference in AMaxRR between the QD and LD groups (p = 0.431). The QD group showed a significantly greater amount of MBL around dental implants when compared with the LD group (p = 0.002*).

CONCLUSIONS

The LD of implants demonstrates more PMandRR compared with the QD. The QD of implants demonstrates a greater amount of MBL around dental implants compared with the LD. Both implant distributions demonstrate the same effect on the AMaxRR. MBL around implants remained within normal accepted values after 10 years of function.

The past forty-three years of dental implantology literature. A global mapping and scientometric analysis

PURPOSE

The aim of this research is to make a scientometric analysis of the dental implantology literature and to present the results in a more understandable way to the reader by visualizing them with maps.

METHODS

The dental implantology literature was accessed through the Web of Science database. Scientometric data was obtained with Citespace 6.1 software, co-citation, clustering analysis, citation burst, and mapping analyzes were performed. Scimago Graphica software was used for additional visualizations.

RESULTS

A total of 35,704 articles were included in the analysis. There were 88,616 authors, 72,333 institutes, 142 countries/regions, and 3,265 journals contributing to the dental implantology literature. The United States was first with 7,334 publications and 225,868 citations. The literature between 1980 and 2023 was divided into 19 different clusters, and the literature between 2000 and 2023 was divided into 16 different clusters.

CONCLUSIONS

Key themes in the field include the use of autogenous bone, advancements in implant surface technology, and the use of platform switching and intraoral scanners. Emerging topics of interest include esthetic considerations in the treatment of the anterior region, stress distribution, the use of zirconia, and the impact of implant treatment on oral health-related quality of life. With similar scientometric analysis studies to be done in the future, the progress of the literature can be followed on the basis of evidence.

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

STATEMENT OF PROBLEM

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

PURPOSE

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

MATERIAL AND METHODS

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

RESULTS

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

CONCLUSIONS

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

A comparative evaluation of masticatory load distribution in different types of prosthesis with varying number of implants: A FEM analysis

Aim

To identify the optimal number and position of implants to reduce stress concentration on the implant, denture, and attachment system for sustaining an overdenture prosthesis.

Materials and methods

By incorporating one to eight indigenous implants with bar-type attachments, eight 3D finite element models of mandibular overdentures were created. All models received a 200 N vertical load, and the biomechanical characteristics of peri-implant bone were assessed.

Result

The study observed that with a vertical load of 200 N, the maximum equivalent stress around peri-implant tissue in all models was within the physiological tolerance threshold of bone. The von Mises stress values ranged from 116.18 MPa to 536.7 MPa.

Conclusion

The three-implant-supported overdenture model revealed superior peri-implant stress, stability, cost-effectiveness, and hygiene maintenance outcomes. Placing a third implant in the mid-symphysis region may offer a practical solution to reduce rotations in two-implant-supported overdentures.

The effect of frontal trauma on the edentulous mandible with four different interforaminal implant-prosthodontic anchoring configurations. A 3D finite element analysis

PURPOSE

The present three-dimensional (3D) finite element analysis (FEA) was aimed to assess the biomechanical effects and fracture risks of four different interforaminal implant-prosthodontic anchoring configurations exposed to frontal trauma.

MATERIAL AND METHODS

A symphyseal frontal trauma of 1 MPa was applied to four dental implant models with different configurations (two unsplinted interforaminal implants [2IF-U], two splinted interforaminal implants [2IF-S], four unsplinted interforaminal implants[ 4IF-U], four splinted interforaminal implants [4IF-S]. By using a 3D-FEA analysis the effective cortical bone stress values were evaluated in four defined regions of interest (ROI) (ROI 1: symphyseal area; ROI 2: preforaminal area; ROI 3: mental foraminal area; and ROI 4: condylar neck) followed by a subsequent intermodel comparison.

RESULTS

In all models the frontal traumatic force application revealed the highest stress values in the condylar neck region. In both models with a four-implant configuration (4IF-U, 4IF-S), the stress values in the median mandibular body (ROI 1) and in the condylar neck region (ROI 4) were significantly reduced (P <0.01) compared with the two-implant models (2IF-U, 2IF-S). However, in ROI 1, the model with four splinted implants (4IF-S) showed significantly (P < 0.01) reduced stress values compared to the unsplinted model (4IF-U). In addition, all models showed increased stress patterns in the area adjacent to the posterior implants, which is represented by increased stress values for both 2IF-U and 2IF-S in the preforaminal area (ROI 3) and for the four implant-based models (4IF-U, 4IF-S) in the mental foraminal area.

CONCLUSION

The configuration of four splinted interforaminal implants showed the most beneficial distribution of stress pattern representing reduced stress distribution and associated reduced fracture risk in anterior symphysis, condylar neck and preforaminal region.

Evaluation of bite force, quality of life, and patients' satisfaction in elderly edentulous patients using implant overdentures

Purpose

This study aimed to compare the bite force (BF) between complete dentures and implant overdentures (IODs) retained by two mandibular implants. Additionally, we evaluated the quality of life (QoL) and patient satisfaction among individuals using IODs. In addition, the effects of demographic parameters such as age and sex, and clinical parameters such as implant length, implant diameter, attachment height, attachment color, and interimplant distance on BF, QoL, and patient satisfaction were evaluated.

Materials and methods

A total of 51 edentulous patients rehabilitated with the maxillary complete dentures and mandibular IODs retained by two implants were included in this study. BF was measured using a force meter pre- and post-implant in the same patients. Oral health-related quality of life (OHRQoL) was assessed with the Oral Health Impact Profile (OHIP-14) and patient satisfaction was assessed with the Visual Analog Scale (VAS) questionnaires.

Results

It was found that BF values were statistically higher for IODs than complete dentures (P < .001). In terms of attachment height of the OHIP scores, there was a significant difference in the psychological disability and social disability domains (P < .05). When examining the change in patient satisfaction as a function of sex, it was found that mandibular retention satisfaction differed significantly by sex (P < .05), but there was no significant difference in the other domains.

Conclusion

Within the limitations of this study, it was observed that the BF increased after the use of IODs. Several factors, including age, interimplant distance, attachment height, and attachment color, were found to impact OHRQoL. Sex and implant diameter were identified as factors affecting patient satisfaction.

Dentists' Preference toward Fixed Versus Removable Implant Prosthesis on Edentulous Jaws to Improve Quality of Life

Implants that can be used in the prosthetic rehabilitation of full and partial edentulous patients are now frequently used due to advances in dentistry. The aim of the study is to find the prevalence of implant supported fixed vs. removable prosthesis and associated quality of life evaluation. A cross-sectional, descriptive study was conducted in an institution, on randomly selected individuals. The study group consisted of adult patients who attended the outpatient Department of Prosthodontics from June 2019-March 2020. Eighty-six thousand (86,000) case sheets were evaluated and Chi-square test, independent t-test and frequency analysis were used to explore the relationship between two variables. Out of the patients, 76.5% preferred fixed prosthesis while 23.5% chose removable prosthesis. Females preferred fixed prosthesis over removable. The young-old age group had more removable prosthesis compared to the middle- and elderly age group. Patients with implant supported fixed dental prosthesis had a better quality of life compared with patients with implant supported overdentures. Esthetic and functional rehabilitation is a preferred option females generally care more about their teeth and looks so wanted more fixed options. The young-old age group preferred removable prosthesis over fixed prosthesis. Patients with implant supported fixed dental prosthesis have a better quality of life compared with patients with implant supported overdentures.

The Effect of Number and Distribution of Mini Dental Implants on Overdenture Stability: An In Vitro Study

The rotational movement of mini dental implants (MDIs) overdenture disturbs the function of the prosthesis. Many dentists place more MDIs to improve the overdenture stability; however, the influence of the MDIs number and distribution on the overdenture resistance to para-axial dislodgment has not been investigated. Seven resin models simulating atrophic mandibles housed twenty MDIs placed according to seven arrangements. Acrylic overdentures were fabricated for each cast and were dislodged five times in lateral, anterior and posterior directions, and the peak load dislodgment was measured. Each overdenture underwent 540 axial removal/placement cycles. The para-axial dislodgments were measured again, and data were compared. Dislodgment force values were measured in all directions, and the data were analysed using analysis of variance ANOVA and post hoc (p < 0.05). After six months of simulated placement/removal, increasing the MDI number showed a difference in resistance to para-axial dislodgment. The distribution affected the resistance to dislodgment in some directions. The inter-implant distance of 27 mm provided better resistance to posterior dislodgment than placing two MDIs close together at 19 mm. The placement of three MDIs at any distribution showed no significant difference except for resistance to posterior dislodgment. FourMDIs placed at any distribution showed a significant difference in all groups in all tested directions. The resistance to the para-axial dislodgment of MDI overdenture could improve with the increasing MDIs number and careful planning of MDI distribution.

Comparison of two resilient attachment systems for implant-/mucosa-supported overdentures with a PEKK framework: a clinical pilot study

OBJECTIVES

The aim of the study was to determine differences between Locator and CM LOC attachment systems regarding patient satisfaction and wear of the abutments and their inserts. Plaque accumulation onto the polyetherketoneketone (PEKK) framework and polymethylmethacrylate (PMMA) was investigated for the implant-supported overdentures.

METHODS

Seventeen edentulous patients were randomised to receive either Locator or CM LOC system for the first year. The total number of implants was 53. After the randomisation, 25 implants received Locator system, and 28 implants received CM LOC system in the first year. After a period of 12 months, the attachment system was exchanged from either Locator to CM LOC or vice versa. Oral Health Impact Profile (OHIP-14) questionnaires were used to evaluate patient satisfaction, chewing comfort, and pressure lesions. Prosthesis hygiene on the PMMA and PEKK surfaces was evaluated by using Stark plaque index. After the exchange of the abutments, they were stored until the end of the 24 months, and the surface wear of the abutments was analysed using a scanning electron microscope.

RESULTS

Three patients (10 implants) died shortly before the end of the first year. Two patients (7 implants) received only Locator system since CM LOC was not indictable for their implant system. Patient's satisfaction was increased when the attachment system was changed from Locator to CM LOC after 12 months of wearing time. Chewing ability and comfort were increased when the attachment system was changed from CM LOC to Locator after 12-month wearing time. There was no influence of the change of the attachment system on pressure lesions. The observed plaque accumulation was higher on the PMMA than on the PEKK surface. For the 8 investigated Locator abutments, the wear was within low and middle level. For the 28 investigated CM LOC abutments, the wear was within middle and high level for the terminal implants and between low and middle for the central implants (for patients who received 4 implants).

CONCLUSIONS

Patient's satisfaction and wearing comfort can be improved with implant-supported overdentures with CM LOC abutments in comparison to Locator. There was no clear difference between both attachment systems concerning the chewing ability of the patients. Plaque accumulation was observed on both attachment systems in different areas. Plaque accumulation on PEKK surface was less than on PMMA surface.

CLINICAL RELEVANCE

The CM LOC attachment system offers stable and comfortable wearing conditions for implant-supported overdentures. The use of PEKK as a framework material could reduce the incidence of pressure lesions.

Traditional Removable Partial Dentures versus Implant-Supported Removable Partial Dentures: A Retrospective, Observational Oral Health-Related Quality-of-Life Study

Removable partial dentures (RPD) are still a valid alternative for the restoration of missing teeth. Additionally, implant-supported removable partial dentures (ISRPD) represent a valid alternative as it allows to avoid the use of clasps and increase stability. The objective of this study was to evaluate through an OHIP-14 questionnaire the level of satisfaction and quality of life (QoL) of patients treated before RPD and then with ISRPD. Twenty patients were rehabilitated with traditional RPDs, and after one year the prosthesis was modified into ISRPD, by inserting an implant and a ball or locator attachment. At the end of both phases, patients completed the Oral Health Impact Profile (OHIP-14) questionnaire. The collected data were statistically analyzed through the Wilcoxon U test, as overall OHIP score and difference between treatments. The mean of the OHIP summary (range from 0 to 56) in the RPD Group was 20.95 (±5.27). In the ISRPD Group it was 13.95 (±3.91), with a statistically significant difference (p < 0.05) between the two Groups. The same findings were highlighted for the differences between groups in every domain question. Patients showed significant improvements after rehabilitation in all areas of investigation, stating how the transformation of a removable prosthesis into an implant-supported one can improve patients’ QoL with benefits in chewing ability, aesthetics and self-satisfaction.

Masticatory efficiency in complete denture and single implant-retained mandibular overdenture wearers with different occlusion schemes: A randomized clinical trial

STATEMENT OF PROBLEM

How the masticatory function of complete denture wearers is influenced by the positioning and occlusion of posterior teeth or by the presence of a single mandibular implant is unclear.

PURPOSE

The purpose of this randomized crossover clinical trial was to evaluate the masticatory efficiency of wearers of bimaxillary complete dentures and of wearers of maxillary complete denture and single implant-retained mandibular overdentures, both with bilateral balanced occlusion and lingualized occlusion.

MATERIAL AND METHODS

Participants received 2 sets of complete dentures with interchangeable teeth in the mandibular prosthesis to allow a change in the occlusion scheme. Subsequently, 1 implant was placed in the mandibular symphysis region, and the mandibular complete dentures were converted to overdentures. The masticatory efficiency was measured by the sieve method for both occlusal schemes.

RESULTS

Repeated measures ANOVA showed no statistically significant difference in the masticatory efficiency with the 2 occlusal schemes for conventional complete dentures (P=.707) or overdentures (P=.407). When comparing the type of prosthesis, statistical differences were found for masticatory efficiency (P=.012), with improved mastication for the overdentures.

CONCLUSIONS

A mandibular single implant improved the masticatory efficiency of patients with complete dentures, but the occlusal scheme did not influence this factor.

A 5-Year Retrospective Study Evaluating Periodontal Health and Oral Health-Related Quality of Life of Implant-Supported Overdentures With Locator and Magnetic Attachments

This study compared peri-implant vertical bone loss, the periodontal index, prosthodontic maintenance requirements and oral health-related quality of life (OHQoL) of patients using mandibular implant-supported overdentures with 2 different attachment systems after an average of 5 years of use. Sixteen mandibular overdenture patients with magnet attachments (group 3), 24 with implant-supported mandibular overdentures with Locator attachments (group 2), and 25 conventional complete denture patients (group 1) were included in the study. The existing at least 5 years old dentures of all patients were evaluated for prosthodontic maintenance by the same prosthodontist and the patients were administered the oral health impact profile-14-Turkish version (OHIP-TR-14) questionnaire. Peri-implant tissue health was evaluated clinically in terms of plaque scores, bleeding scores, probing depth, and gingival index. Radiographic evaluation was performed in terms of peri-implant vertical bone loss. Radiographic evaluations were performed 5 years after overdenture insertion. There were no statistically significant differences between the groups in terms of total OHIP-TR-14 scores (P > .05). Although the average vertical bone resorption measured in group 2 at the end of 5 years was 1.38 mm, there was an average vertical bone loss of 1.45 mm in group 3, but this difference was not statistically significant (P > .05). Among the periodontal health indicators, there were no statistically significant differences in the mean values for periodontal indexes. According to results of the study, there were no differences in peri-implant vertical bone loss in groups 2 and 3, in periodontal health in mandibular overdentures with groups 2 and 3, or between total OHIP-TR-14 scores of patients in all groups.

Reliability and validity of the Turkish version of oral health impact profile for edentulous subjects

Purpose

The validated translations of the OHIP-EDENT exist in different languages; however, there is no reliable and validated Turkish translation. The present study was conducted to evaluate the reliability and to validate the Oral Health Impact Profile in edentulous subjects translated to Turkish (OHIP-EDENT-T).

Materials and methods

The study sample included 104 conventional complete denture wearers (58 women and 46 men, mean age: 61.13 ± 9.43 years). The original English version of OHIPEDENT was translated into Turkish using a forward-backward method and applied to the subjects. The reliability of the OHIP-EDENT-T was evaluated using internal consistency and the test-retest method. Validity was determined as construct and convergent validity. The construct validity of OHIP-EDENT-T was assessed using exploratory and confirmatory factor analysis.

Results

The Cronbach's alpha value for OHIP-EDENT-T was 0.890. The intraclass correlation coefficient (ICC) was 0.749 for the OHIP-EDENT-T total score, and ICCs for the subscales ranged from 0.630 (95% CI = 0.501-0.823) to 0.859 (95% CI = 0.531-0.897), indicating good to excellent agreement. The Kaiser-Meyer-Olkin value for sampling adequacy was 0.820 and results of Bartlett's sphericity test indicated statistical significance (χ2=1139.767; df=171, p=0.001). This showed that factorial analysis could be applied to the data set. The three-factor structure of the scale explained 81.1% of the observed variance. The agreement of the three-factor solution was further tested with confirmatory factor analysis, and the fit index was found to be acceptable (chi-square fit test=1.449, RMSEA=0.040, GFI=0.94, CFI=0.93).

Conclusion

Within the limitations of this study, it can be concluded that OHIP-EDENT-T is a valid and reliable instrument for evaluating the quality of life of edentulous patients.

Clinical outcomes of implant-retained mandibular overdentures using the bar and magnetic attachment systems: an up to 5-year retrospective study

Background

Implant-retained mandibular overdentures (IODs) represent an effective and reliable treatment modality for edentulous patients. The present retrospective study compared the clinical outcomes of IODs using bar attachment (BA) system with those using magnetic attachment (MA) system after functioning for up to 5 years.

Methods

Human subjects treated with IODs between 01-01-2010 and 12-31-2014 were identified from patient records. Of the 54 subjects who met the inclusion criteria, 48 subjects including 26 treated with BA-IODs and 22 with MA-IODs (96 mandibular implants) were recruited for the study. The implant units and prostheses were evaluated individually for peri-implant health. Prosthetic complications and maintenance during follow-up were recorded. The subjects responded to the visual analog scale (VAS) and the Oral Health Impact Profile questionnaires for evaluation of patient satisfaction and oral health-related quality of life (OHRQoL).

Results

The survival rates of the implants and prostheses were 96.9% and 95.8%, respectively, over a mean observation period of 48±11.3 (range, 13-64) months. Peri-implant probing depth (PPD) and plaque index (PI) were significantly better for the MA group compared with the BA group (P<0.05), while marginal bone loss (MBL) and sulcus bleeding index (SBI) showed no significant differences (P>0.05). Prosthetic complications and maintenance were attachment-dependent. Most recruited subjects were satisfied with their prostheses. There was no statistically significant difference regarding general patient satisfaction or OHRQoL between the two groups (P>0.05). Nevertheless, patients complained that the BA-IODs were significantly more difficult to clean than the MA-IODs (P<0.05).

Conclusions

IODs have an ideal medium-term outcome irrespective of the attachment design. It is recommended that oral hygiene instructions and regular clinical examination be given to subjects wearing IODs.

Peri-implant mucosal response to implant-supported overdentures: A systematic review and meta-analysis

OBJECTIVES

To systematically review and evaluate the effects of different types of attachments, implant numbers and loading protocols on the peri-implant mucosa of implant-supported overdentures (ISODs).

BACKGROUND

The impact of peri-implant tissue health on the ISOD treatment outcome is unclear, and current evidence is inadequate on this aspect.

MATERIALS AND METHODS

A systematic literature search for randomised controlled trials or prospective studies was conducted in indexed databases from 1995 to April 2020. The focused question was as follows: How does the peri-implant mucosa respond to implant-supported or implant-tissue-supported complete overdentures based on different types of attachments, implant numbers, and loading protocols, in terms of clinical outcomes achieved [plaque index (PI), gingival index (GI), probing pocket depth (PD) and bleeding index (BI)]? A random- or fixed-effects model was applied to measure the significance of standardised mean differences (SMD) of PD between the groups.

RESULTS

Seventeen studies met the eligibility criteria. The SMD for PD between splinted/bar and unsplinted/stud attachments was 0.10 mm (95% CI: -0.27 to 0.47; P = .60) and between 2- and 4-implant groups was 0.15 mm (95% CI: -0.16 to 0.45; P = .34), which were not statistically significant. Significant difference (P = .003) was observed between immediate/early loading and delayed loading (SMD = 0.46 mm [95% CI: 0.16 to 0.75]).

CONCLUSIONS

Probing depth for the immediate loaded implants was significantly higher than for the delayed loading group. No attachment type, implant number or loading protocol seemed to have a clear advantage over the other, in terms of other peri-implant mucosal outcome measures.

Attachment-retained removable prostheses: Patient satisfaction and quality of life assessment

STATEMENT OF PROBLEM

Studies on the impact of incorporating attachments in removable prostheses on patient-based outcomes are scarce.

PURPOSE

The purpose of this clinical study was to investigate oral health-related quality of life (OHRQoL) and patient satisfaction in partially edentulous participants before and after rehabilitation with mandibular attachment-retained removable prostheses as compared with conventional removable prostheses.

MATERIAL AND METHODS

This crossover study included 74 participants (aged 36 to 57). Initially, 56 received conventional clasp-retained removable dental prostheses (RDPs), and 18 received conventional overdentures (ODs) based on their mandibular partially edentulous state. Two months later, of the 56 RDP participants, 24 had received extracoronal attachment-retained RDPs, 17 received telescope-retained RDPs, and 15 received bar-attachment retained RDPs. The 18 OD participants received ball attachment-retained ODs. Assessments included Oral Health Impact Profile-short version-14 for OHRQoL and a visual analog scale (VAS) for patient satisfaction. Assessments were done before treatment and 2 months after wearing each prosthesis with a 1-month washout period. Statistical analysis included the Friedman then the Wilcoxon signed rank test for Oral Health Impact Profile-short version-14 scores and repeated measures ANOVA then the Bonferroni or paired t test for VAS scores (α=.05).

RESULTS

There were no dropouts. Rehabilitation, irrespective of prosthesis type, significantly improved OHRQoL in all domains and significantly increased overall patient satisfaction (P<.05). When compared with the conventional prostheses, attachment-retained prostheses significantly improved functional limitation, psychological discomfort, and physical limitation domains in all groups (P<.05), as well as the physical pain domain in the OD group (P=.041). General satisfaction, stability, comfort, ability to speak, and ability to masticate significantly increased (P<.05) with attachment-retained prostheses. Conventional prostheses were significantly easier to clean (P<.05) in all groups, except for the telescope-attachment group.

CONCLUSIONS

Both conventional and attachment-retained prostheses significantly increased patient satisfaction and improved OHRQoL in all domains as compared with before treatment. However, incorporation of attachments further improved functional limitation, psychological discomfort, and physical limitation domains in all groups, as well as the physical pain domain in the OD group. Participants were more satisfied with their attachment-retained prostheses in most aspects.

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.

Oral Health-Related Quality of Life in Single Implant Mandibular Overdenture Retained by CM LOC versus Ball Attachment: A Randomized Controlled Trial

AIM:

This randomised clinical study aimed to detect whether CMLOC attachment could improve Oral Health-Related Quality of Life (OHRQOL) when compared to ball attachment.

METHODS:

Eighty edentulous patients were recruited to receive a single symphyseal implant for mandibular overdenture, after three months, randomisation was done to divide them into two groups; Dalbo ball (control group) and Cendres and Metaux locator (CM-LOC) (intervention) attachments respectively, oral health impact profile for edentulous patients (OHIP-EDENT)questionnaire was recorded before implant placement, two weeks after pick up, at 3, 6, 9, and 12 months.

RESULTS:

Results revealed a lack of statistical significance between the two groups except for psychological discomfort at 2 weeks after pick-up (p-value = 0.029)

CONCLUSION:

Single implant overdenture is a simple, reliable treatment modality for treating edentulous mandible and both CM LOC and Ball attachments are good alternatives for such treatment modality.

Evaluation of two interforaminal implants and implant-assisted removable dentures on stress distribution: an in vitro study

Objectives

In mandibular edentulism, the treatment option with a two-interforaminal implant-retained bridge and a removable partial denture is rarely evaluated in literature. The aim of this in vitro study was to evaluate the stress distribution of this treatment option by comparing it with traditional treatment options with interforaminal implants in the edentulous mandible.

Materials and Methods

Two interforaminal implants were placed in a formalin-fixed cadaver mandible, and overdentures with three different types of attachments were fabricated: (1) two ball attachments and an overdenture, (2) a Dolder bar and an overdenture, and (3) screw-retained two-implant inter-canine porcelain fused to a metal bridge and an implant-assisted removable denture (IARD) with precision attachments. Three biting conditions were generated for each denture type, and the strains were documented under vertical loading of 100 N.

Results

The calculated strain values from measured strains in all measurement sites and loading conditions for the screw-retained two-implant inter-canine porcelain fused to a metal bridge and a cast framework partial denture with precision attachments situation were lower than in the other scenarios (P<0.05).

Conclusion

Within the limitations of the present study, it can be concluded that an IARD may be a reasonable and valuable alternative to ball attachments or a bar in two interforaminal implants, especially when the patients prefer to be able to show their teeth even when they take out their removable dentures.

Use of osseointegrated implants in the intermaxillary suture in a patient with microstomia: Case report with a 2-year follow-up

AIM

To report the rehabilitation of a female patient, 40 years old, with a microstomia.

CASE REPORT

The Z-plasty surgery was performed in the region of the labial commissure to increase the mouth opening. In the mandible, two implants were installed in the interforaminal region and an overdenture with bar/clip attachment system was made. The maxilla was atrophic, with the presence of two bone sites in the intermaxillary suture region: the first one anterior to the incisive foramen and the second one in the middle of the hard palate. Two implants were placed without a graft in those sites. The conventional maxillary denture was converted into an overdenture with ball attachments system.

CONCLUSION

Based on the presented case, with a 2-year follow-up, it can be concluded the validity of the use of the techniques of surgeries to increase the mouth opening, implants in intermaxillary suture and overdentures as rehabilitation therapy for patients with microstomia.

A Novel Extended Range Attachment System to Retain Implant Overdentures: A Clinical Report

Various attachment systems have been used to facilitate the retention, stability, and support of overdentures. The low profile design, pivoting technology, and durability of the Locator attachment made it one of the commonly used tissue-supported implant-retained overdentures. It has been successfully used to retain overdentures as well as partial dentures. This article describes the uses of the new Locator R-Tx abutment and illustrates both the direct and indirect techniques used to process the denture attachment housing into the prosthesis to retain overdentures and partial dentures.

Mandibular Implant-supported Overdentures: Prosthetic Overview

Implant-supported overdentures are becoming the treatment of choice for the completely edentulous mandible. They significantly improve the quality of life in edentulous patients. For this review article, the literature was searched to identify pertinent studies. No meta-analysis was conducted because of high heterogeneity within the literature. Accordingly, in this review article, the author provides an update on implant-supported mandible overdentures with regard to the number of implants, type of loading, stress-strain distribution, mode of implant-to-denture attachment, occlusal considerations and complications.

[Clinical application of mandibular overdenture supported by a two-implant and interforaminal bar in an edentulous atrophic mandible]

Implant-overdenture supported by an interforaminal bar provides stability and is effective in an edentulous atrophic mandible. However, using this attachment requires precise planning from the restorative and surgical aspects to ensure a satisfying outcome. Consdering the feature and space requirements for bar attachment, this article establishes a clinical protocol for a two-implant-retained overdenture on the mandible. In this study, a case of mandibular edentulism was considered to illustrate this protocol and provide a reference for clinical practice.

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.

Quality of Life of Patients Treated With Implant-Supported Mandibular Overdentures Evaluated With the Oral Health Impact Profile (OHIP-14): a Survey of 58 Patients

Objectives

The purpose of this study was to evaluate the oral health-related quality of life of patients treated with implant-supported mandibular overdentures and to compare the attachment systems used.

Material and Methods

Altogether 112 patients treated with implant-supported mandibular overdentures in 1985 - 2004 were invited to the follow-up; 58 of them attended and replied to the Oral Health Impact Profile (OHIP-14) -questionnaire. There were 48 overdentures with a bar connection and 10 with a ball connection, the total number of implants installed and still in use was 197. The mean follow-up time was 13.7 years. The associations between the OHIP-14 variables and the patient's age, gender as well as the number of implants supporting the overdenture and the type of attachment used were assessed.

Results

The results showed that patients with implant-supported mandibular overdentures were satisfied with their oral health-related quality of life (OHRQoL). Older patients were more satisfied than younger ones in both genders. Neither the implant connection type nor the number of supporting implants seemed to have a significant influence on the OHRQoL.

Conclusions

Especially older patients with mandibular implant-supported overdentures were satisfied with their oral health-related quality of life. Attachment type or the number of supporting implants did not have a significant influence on the oral health-related quality of life.