A Randomized Clinical Trial of Oral Health‐Related Quality of Life, Peri‐Implant and Kinesiograph Parameters in Wearers of One‐or Two‐Implant Mandibular Overdentures

Influence of the extension of the anchorage surface of mandibular overdentures on patient's quality of life and satisfaction: 5-year follow-up of a randomized clinical trial

AIM

To evaluate the impact of extending the anchorage surface of mandibular overdentures on oral health-related quality of life (OHRQoL) and degree of satisfaction (SD) of edentulous patients.

MATERIALS AND METHODS

Edentulous patients were randomly assigned to receive a mandibular overdenture with 2 interforaminal implants (Control) or, in addition, 2 extra-short (4-mm) implants distal to the mental foramen (Experimental), all splinted with a non-cantilevered bar. The Oral Health Impact Profile for Edentulous (OHIP-EDENT) questionnaire and a Visual Analogue Scale (VAS) were used to measure OHRQoL and SD with treatment at 3- and 60-month follow-ups. Intraindividual comparisons at 3- and 60-months were analyzed using the Wilcoxon test. The Mann-Whitney U test was applied to compare different groups (Control vs. Experimental) at a significance level of 5 %.

RESULTS

The results for mandibular overdenture remained consistent during the 5-year follow-up period. However, the addition of implants in the posterior region to increase the anchorage surface (Experimental) had a smaller positive impact on the "Functional limitation" (p = 0.009), "Psychological disability" (p = 0.032) and "Overall score" (p = 0.036) dimensions of the OHIP-EDENT, as well as on the "Cleaning ability" domain (p = 0.018) of the VAS compared to the Control group.

CONCLUSION

The addition of implants distally to the mental foramen to increase the anchorage surface did not significantly influence patient-centered outcomes when compared to the use of only 2 implants in an approach with anchorage limited to the interforaminal region.

CLINICAL TRIAL REGISTRATION

The current study was not registered in a public database as required. It is important to note that the recommendation for registration was introduced by the Committee of Medical Journal Editors in 2017, while patient inclusion in the research began in 2016. Since the data in this manuscript covers a follow-up period of up to 5 years after surgical intervention, late registration was not possible.

CLINICAL RELEVANCE

The addition of implants in the regions distal to the mental foramen, increasing the anchorage surface without cantilever, did not bring additional and significant patient-centered benefits compared to the installation of implants only in the interforaminal region.

Single mandibular implant study - impact on dietary habits after 5 years of observation in patients with immediate and delayed loading protocols

OBJECTIVES

Single midline implants in the edentulous mandible can be used to support existing complete dentures to improve patients' satisfaction and masticatory efficiency. The impact on patients' dietary habits and the influence of the loading protocol of the implants was the subject of this study.

MATERIALS AND METHODS

In this prospective randomized clinical trial, edentulous patients with existing complete dentures in both jaws were treated with a single midline implant in the mandible. In group A, the implants were loaded immediately, in group B the loading was delayed after three months. Patients were asked to report on their nutritional intake before implant placement and 12, 24 and 60 months after loading using a standardized two-part questionnaire.

RESULTS

Nutritional intake regarding the frequency of consumption of the requested food items did not change significantly during the 60-months study period, regardless of the loading protocol. In contrast, the second part of the questionnaire revealed that after 60 months, there was a significant decrease in avoidance of food, that had a coarse and hard texture in both groups. This significant decrease was observable in the group A in the first 12 and 24 months and in the group B after 60 months.

CONCLUSION

A change in the patients' dietary habits due to the insertion of a single midline implant in the mandible to support the existing complete denture cannot be observed, independently to the loading protocol.

CLINICAL RELEVANCE

Improving the chewing efficiency by single midline implants in the edentulous mandible does not lead to a change in dietary habits.

Impact of loading protocol of a mandibular single implant-supported complete denture on oral health-related quality of life over a period of 5 years: A randomized controlled trial

OBJECTIVES

The aim of the present study was to assess the long-term course of OHRQoL and the impact of the loading protocol in patients receiving a single mandibular implant supporting a complete denture over a period of five years.

METHODS

In this multicenter RCT, a total of 158 edentulous patients were initially included and were randomly allocated immediately after placement of a mandibular midline implant to either immediate loading (IL) or to conventional loading (CL) with submerged healing. The assessment of OHRQoL was performed with the 49-item Oral Health Impact Profile (OHIP) at baseline and 1, 4, 12, 24, and 60 months after loading. At 5-year follow-up, 100 patients (mean age: 69.2 years; 45.0% female) with completed OHIP were available for analyses. A mixed-effects model with patients as random effect and an unstructured covariance matrix was developed to address repeated outcome measurement.

RESULTS

The OHRQoL improved substantially after loading, indicated by a decrease of mean OHIP summary scores from 51.0 points at baseline, by 14.2 (95%-CI: 9.4 - 19.1; p<0.001) points to 37.2 points at 1-month follow-up, and by continuous improvement to 20.4 OHIP points at final follow-up. Considering constant treatment effects, the loading protocol had no significant effect on OHIP scores (-3.7, 95%-CI: -9.4 - 2.2; p = 0.204). Time effect was statistically significant with -0.21 (95%-CI: -0.28 - -0.15; p<0.001) points per month.

CONCLUSION

Both the immediate and conventional loading of a single mandibular midline implant supporting a complete denture offer long-lasting high levels of OHRQoL, with no significant or clinically relevant long-term differences.

CLINICAL SIGNIFICANCE

The study firstly presents long-term data for OHRQoL by investigating the loading protocol of single mandibular implant-supported complete dentures. Since immediate loading has been associated with a reduced implant survival rate for this concept, information on patient benefits is essential for evidence-based decision making.

Treatment effect of implant-supported fixed complete dentures and implant overdentures on patient-reported outcomes: A systematic review and meta-analysis

OBJECTIVES

To analyze the effect of implant treatment in edentulous patients rehabilitated with implant-supported fixed complete dentures (IFCDs) or implant overdentures (IODs) on dental patient-reported outcomes (dPROs).

MATERIALS AND METHODS

In January 2022, Medline, Embase, CINAHL, Cochrane Library, PubMed Central, Web of Science, and ClinicalTrials.gov were screened for prospective clinical studies on completely edentulous patients treated with IFCDs and/or IODs, reporting pre-treatment and follow-up dPROs. Hedges' g effect sizes (ES) with corresponding 95% confidence intervals (CI) were calculated. Afterward, meta-analyses were conducted using random effect models.

RESULTS

A total number of 1608 records was initially identified. Of those, 28 studies reporting dPROs from 1457 patients were finally included. The applied dental patient-reported outcome measures (dPROMs) included several versions of the Oral Health Impact Profile (OHIP) or specific items assessing satisfaction with Visual Analogue Scales (VAS). The overall ES was large for rehabilitation with IFCDs (1.68 [CI: 1.15, 2.20]) and IODs (1.26 [CI: 0.99, 1.52]) with no significant difference (p = .165) between the two. Denture stability was the only factor rated significantly higher for IFCDs (ES difference: 2.37 [CI: 0.21, 4.54]; p = .032). Subgroup analyses revealed moderately higher ES for IODs on two implants relative to one implant (ES difference: 0.73 [CI: 0.34, 1.12]; p < .001).

CONCLUSIONS

There is a strong positive effect of implant treatment in edentulous patients, independent of the type of prosthetic rehabilitation. In patients seeking high stability, IFCDs may be preferable. In mandibular IODs on a single implant, there was a significantly positive effect of an additional implant on dPROs.

Impact of the extension of the anterior-posterior spread on quality of life and satisfaction of patients treated with implant-retained mandibular overdentures - a randomized clinical trial

OBJECTIVES

To compare the degree of satisfaction (SD) and the impact on oral health-related quality of life (OHRQoL) of edentulous patients treated with conventional complete dentures (CCDs) and mandibular overdentures (IODs) with a short anteroposterior spread (S-APS) or a large antero-posterior spread (L-APS).

MATERIALS AND METHODS

Edentulous patients were treated with CCDs and subsequently randomly allocated to receive a bar clip mandibular overdenture retained by 2 interforaminal implants (Control) or 4 (Test: 2 additional implants distal to the mental foramen). The Oral Health Impact Profile Edent questionnaire (OHIP-20E) and the Visual Analogue Scale (VAS) were applied at a mean follow-up of 38.5 months to assess the impact on OHRQoL and DS, respectively. Comparisons between the type of prosthesis and the extension of the AP spread were made with Student's t test for paired samples and for independent samples, respectively, at a significance level of 5%.

RESULTS

The IODs had significantly lower OHRQoL values ​​in the dimensions "functional limitation" (p=0.03), "physical pain" (p=0.02), "psychological discomfort" (p<0.01), "disability physical" (p<0.01) and "general score" (p<0.01) (n=20 patients). The IODs presented DS values ​​significantly for "aesthetics" (p=0.04), "stability" (p=0.03), "masticatory capacity" (p<0.01), "function" (p<0.01) and "oral condition" (p=0.03). The S-APS group (control) resulted in significantly lower values ​​in the dimensions "physical pain" (p<0.01) and "general score" (p<0.01) and no domain with statistical difference in the VAS scale.

CONCLUSIONS

IODs significantly improved OHRQoL and DS. The increase in AP spread did not result in benefits for the patient's OHRQOL and DS in this clinical study. (Study Protocol Number: 1.452.492) CLINICAL SIGNIFICANCE: Implantology has experienced in the last 20 years a permanent evolution that aim at increasing predictability and improving long-term clinical performance. Placement of short implants distally to the mental foramen, for instance, and the resulting increase of the anterior-posterior spread, is a promising approach and is worthy of investigation.

Incidence and risk factors for non-adaptation of new mandibular complete dentures: a clinical trial

OBJECTIVE

To investigate the incidence and risk factors for non-adaptation of the conventional mandibular complete denture (CMCD).

MATERIALS AND METHODS

A total of 108 edentulous patients were rehabilitated with complete dentures (CDs) and followed up at 3- and 6-month intervals. Adaptation was confirmed based on chewing, phonetics, and comfortable swallowing with the CDs. The risk factors among sociodemographic and patient-centered factors were analyzed. Statistical analyses included the chi-square test and then a multivariate analysis.

RESULTS

After 3 months, 38.0% of patients showed non-adaptation to CMCDs. Non-adaptation was significantly associated with the absence of previous mandibular denture experience (p = 0.042), ulcerations after 15 days of rehabilitation (p < 0.001), and a reduced posterior mandibular ridge (p = 0.035). After 6 months, this incidence decreased to 14.1%. The factors associated with non-adaptation were ulcerative lesions after 15 (p < 0.001) and 30 (p < 0.001) days of the delivery of CDs and the non-regular use of mandibular CDs (p < 0.001).

CONCLUSION

The incidence of non-adaptation was higher after 3 months, with reduction after 6 months. Sociodemographic variables did not influence the adaptation. After 3 months, the absence of previous experience, traumatic ulcers, and reduced mandibular ridges hindered the adaptation of patients to mandibular CDs. After 6 months, only the occurrence of ulcerative lesions and non-regular wear of dentures were risk factors for non-adaptation.

CLINICAL RELEVANCE

A considerable number of patients have difficulties in adapting to the mandibular dentures. Identifying the factors of non-adaptation of the dentures will contribute to increasing the predictability of this critical adaptation period.

Speech and the swallowing threshold in single implant overdenture wearers: A paired control study

BACKGROUND

Single implant mandibular overdentures (SIMOs) can improve mastication in edentulous elderly people. However, little attention has been paid to their effects on articulation disorders and the swallowing threshold relative to those of conventional complete dentures (CDs).

OBJECTIVE

To compare the effects of new conventional CD set and SIMOs on articulation disorders, mandibular movements during speech and swallowing threshold using a paired study design.

METHODS

Twenty-two edentulous Brazilian Portuguese-speaking elderly people (mean age 66.7 ± 4.6 years) were first evaluated whilst wearing their old conventional CDs. Articulation disorders were analysed by audio and video recordings, mandibular movements during speech were measured by kinesiography, and the swallowing threshold was assessed by masticatory cycle counting and medium particle size (X₅₀ ) calculation. Participants then received new conventional CDs, and evaluations were repeated 2 months later. Subsequently, single implants were installed in the midlines of subjects' mandibles, and the conventional CDs were converted to SIMOs. After 2 months of SIMOs use, the evaluations were repeated. Data were submitted to the Cochran-Mantel-Haenszel and ANOVA.

RESULTS

No difference in articulation disorders was found between new conventional CD and SIMO use. The frequency of anterior lisp during /s/ and /z/ phoneme pronunciation was reduced with new conventional CD use relative to old conventional CD use (p < .05). The X₅₀ decreased progressively with new conventional CD and SIMO use (both p < .05).

CONCLUSION

SIMOs do not alter speech relative to new well-fitted conventional CDs, but improved the swallowing threshold, in edentulous elderly people.

Clinical and satisfaction outcomes of using one or two dental implants for mandibular overdentures: preliminary short-term follow-up of a randomized clinical trial

Objective

This randomized clinical trial aimed to evaluate the marginal bone loss and peri-implant aspects in patients with mandibular overdentures retained by one or two implants and assess patient satisfaction, prosthesis-related clinical outcomes, and masticatory efficiency.

Methods

Patients from the School of Dentistry of the University of Passo Fundo (UPF) with lower conventional complete dentures dissatisfied with prosthetic retention were selected. Eighteen patients were analyzed and divided into randomized treatment groups: GA, installation of one implant in the midline of the mandibular symphysis (8 patients), and GB, installation of two implants in the lower canine region (10 patients). Implant survival and prosthetic maintenance were assessed by clinical and radiographic examinations performed 6 months after implant placement and 3 months after loading. Finally, the masticatory efficiency of the prostheses was evaluated with the QoLIP-10 (Quality of Life with Implant-Prostheses) questionnaire, and the degree of patient satisfaction used the visual analog scale (VAS).

Results

Regarding the esthetic satisfaction of the patients, there was no statistical difference between the two groups studied (p = 0.680). Patients who received two implants presented easier chewing (p = 0.049) and a lower average number of prosthesis maintenance. There was no difference between the groups regarding peri-implant bone resorption 3 months after the use of prostheses.

Conclusions

The use of two dental implants showed higher masticatory ability and lower need for maintenance appointments when compared with one implant in mandibular overdentures but did not affect peri-implant aspects and patient satisfaction. The treatment using one implant was effective for the aspects evaluated, but further clinical studies are required on the subject.

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.

Patient-reported outcome measures of edentulous patients restored with single-implant mandibular overdentures: A systematic review

AIM

To review the literatures concerning the effect of the single-implant mandibular overdenture (SIMO) on patient-reported outcome measures (PROMs) and masticatory function in the fully edentulous patients.

MATERIALS AND METHODS

Electronic databases (PubMed, Cochrane Library, EMBASE and Web of Science) were searched, complemented with manual resources. Prospective studies published in English up to February 2020 reporting the effect of SIMO on PROMs and masticatory function in the edentulous patients were included. This review focused on oral health-related quality of life (OHRQoL), satisfaction and masticatory function outcomes.

RESULTS

Of 1157 initially screened articles, 9 randomised controlled trials (RCTs) and 8 prospective studies involving 551 subjects fulfilled the inclusion criteria. Two RCTs were graded as high risk of bias or some concern, while others were low risk. All prospective studies had adequate representativeness and assessment, but only one study had a controlled cohort. In general, the edentulous patients restored with SIMOs had improved OHRQoL and general satisfaction compared to those with conventional complete dentures (CCDs), but the outcome of masticatory function was controversial. Compared with two-implant mandibular overdenture (TIMO), SIMO showed no significant differences regarding general satisfaction and satisfaction with speech, comfort, chewing ability, aesthetics and social life. Conflicting results were observed in OHRQoL and satisfaction with retention and stability. Better masticatory performance was observed in TIMO group than SIMO group.

CONCLUSION

Within the limitation of this review, SIMO is featured with better OHRQoL and satisfaction than CCD. SIMO and TIMO rendered similar patient satisfaction, but TIMO had better masticatory performance.

Masticatory function improvement with the use of mandibular single-implant overdentures in edentulous subjects: a systematic literature review

INTRODUCTION

In this systematic review, several masticatory function parameters assessed during mandibular single-implant overdenture (SIO) use were compared to pre- SIO placement values in edentulous patients with aim of contributing to a consensus regarding denture treatment options.

EVIDENCE ACQUISITION

This study was registered a priori in the PROSPERO database (CRD42018106567). Two independent reviewers carried out electronic searches in eight databases, without language or time frame limitations, to collate clinical studies comparing masticatory function of edentulous patients before versus after SIO installation with the implant placed on the mandibular midline. Risk of bias was assessed with a before-and-after tool and evidence certainty level was evaluated with the Grading of Recommendations Assessment, Development and Evaluation program.

EVIDENCE SYNTHESIS

Eleven studies were included in this review (1 prospective, 3 crossover trials, 4 randomized clinical trials, 2 paired clinical trials, and 1 pilot). Enrolled patients were mostly over 60 years old; all patients were using conventional complete dentures (CD) prior to SIO installation. Masticatory performance, masticatory efficiency, bite force, and muscle activity were improved after the SIO placement compared to during mandibular CD use. Mandibular movement and masticatory ability data were inconclusive. Most of the studies had low risk of bias, but all had very low certainly level ratings due to methodological heterogeneity.

CONCLUSIONS

Placement of SIO improves masticatory function, as reflected mostly by masticatory performance and efficiency data, relative to CD use. Further studies comparing dental rehabilitation options, including SIOs, are needed to improve the quality of evidence in the literature.

Oral Health-Related Quality of Life among Elderly People with Edentulous Jaws in Hafar Al-Batin Region, Saudi Arabia

Aims and Objectives:

The aims of this study were to determine oral health-related quality of life (OHRQoL) among elderly people aged 65 and above years from Hafar Al-Batin area, Saudi Arabia, by utilizing Arabic version of Geriatric Oral Health Assessment Index (GOHAI-Ar).

Materials and Methods:

This was a cross-sectional study undertaken from October 2017 to December 2017. A convenience sampling methodology was employed to select the elderly patients aged ≥65 years attending dental clinics of primary health-care centers in five different regions of the Hafar Al-Batin, Saudi Arabia. OHRQoL of the participants was measured using the Saudi Arabian version of GOHAI-Ar. The oral examinations performed to record a total number of remaining natural teeth, complete and removable partial dentures, and fixed partial dentures. Descriptive and inferential statistics were performed.

Results:

A total of 200 elderly participants (M = 157 and F = 43) having mean age (± standard error [SE]) was 69.26 (±0.34) years, participated in the study. Mean ± SE of GOHAI-Ar was 27.68 ± 0.54, physical function 9.12 ± 0.26, pain and discomfort (6.87 ± 0.18), and psychological discomfort (11.69 ± 0.25). Remaining natural teeth and prosthodontic status significantly correlated with pain and discomfort. The presence of prosthesis was found to influence the psychological function. Gender and prosthodontic statuses were found to have significant correlation with OHRQoL.

Conclusion:

Poor OHRQoL among elderly from Hafar Al-Batin city was found, and presence dental prosthesis showed a positive impact on OHRQoL.