Cost-effectiveness analysis of the single-implant mandibular overdenture versus conventional complete denture: study protocol for a randomized controlled trial

Evaluation of patient satisfaction and masticatory performance in mandible single implant-assisted overdenture

OBJECTIVES

Many authors' have advocated a minimum of two implants to support a mandibular overdenture, but financial restraints specifically among the geriatric population in developing countries made this treatment plan economically difficult. Hence, this study was planned to assess the symphyseal (midline) single implant-assisted complete overdenture for patient satisfaction and masticatory performance.

MATERIALS AND METHODS

In this clinical study, 12 edentulous first-time denture wearers underwent placement of a single implant in the mandibular symphyseal region. After 1 week, new complete dentures were fabricated and delivered to the patients. Post 3 months, the denture was fixed with a nylon cap-ball attachment to the anchor implant. Patients were questioned about comparison in the level of satisfaction and complaint before loading the implant (control group) and after 1 week, 1 month, and 3 months. The implant-assisted overdenture was fabricated with the help of a questionnaire. Masticatory performance was calculated with the help of a bite force measuring device at the same time intervals. SPSS 17.0 statistical software was used to analyze the data.

RESULTS

It was found that single implant anchorage of the mandibular complete denture resulted in a significant increase (P < 0.05) in patient's subjective satisfaction and a decrease (P < 0.05) in complaints at the end of 3 months. There was a significant (P < 0.01) increase in bite force in implant overdenture after 3 months (5.459 kgf) as compared to that of the complete denture (3.406 kgf).

CONCLUSION

Single implant-assisted overdenture can be an appropriate treatment modality to treat edentulousness in the geriatric population. It insinuates the remarkable improvement of prosthesis function and oral comfort with minor surgical procedures.

A Novel Guided Zygomatic and Pterygoid Implant Surgery System: A Human Cadaver Study on Accuracy

The aim of this human cadaver study was to assess the accuracy of zygomatic/pterygoid implant placement using custom-made bone-supported laser sintered titanium templates. For this purpose, pre-surgical planning was done on computed tomography scans of each cadaver. Surgical guides were printed using direct metal laser sintering technology. Four zygomatic and two pterygoid implants were inserted in each case using the guided protocol and related tools. Post-operative computed tomography (CT) scans were obtained to evaluate deviations between the planned and inserted implants. Accuracy was measured by overlaying the real position in the post-operative CT on the virtual presurgical placement of the implant in a CT image. Descriptive and bivariate analyses of the data were performed. As a result, a total of 40 zygomatic and 20 pterygoid implants were inserted in 10 cadavers. The mean deviations between the planned and the placed zygomatic and pterygoid implants were respectively (mean ± SD): 1.69° ± 1.12° and 4.15° ± 3.53° for angular deviation. Linear distance deviations: 0.93 mm ± 1.23 mm and 1.35 mm ± 1.45 mm at platform depth, 1.35 mm ± 0.78 mm and 1.81 mm ± 1.47 mm at apical plane, 1.07 mm ± 1.47 mm and 1.22 mm ± 1.44 mm for apical depth. In conclusion, the surgical guide system showed accuracy for all the variables studied and allowed acceptable and accurate implant placement regardless of the case complexity.

One-year prospective clinical study comparing patient satisfaction and masticatory performance of mandibular overdentures supported by one versus two implants

There is a lack of clinical evidence on mandibular overdentures (MOD) supported by a single implant.

Relevance of Tongue Force on Mandibular Denture Stabilization during Mastication

PURPOSE

Tongue activity, involving stereognosis of denture position, food bolus distribution, and direct denture pressing, can affect the stability of removable mandibular dentures. Knowledge of details of tongue activity in patients with removable dentures could contribute to the development of training methods to improve bilateral mastication. The hypothesis of this study was that tongue force improves mandibular complete denture stabilization on the atrophied foundation during mastication load transfer with a typical balanced occlusion.

MATERIALS AND METHODS

Finite element analysis was used to assess the effect of tongue activity on denture stability, which was evaluated with objective biomechanical criteria. Denture movement (displacement), sliding distance on the mucosal surface, and pressure on the foundation during occlusal load transfer were considered with and without additional tongue forces.

RESULTS

Tongue force in the canine zone of the balancing flange contributed to a slight reduction in the sliding distance. An adverse effect of tongue force on the working side and in the posterior zone of the balancing side was found.

CONCLUSIONS

Despite the lack of substantial improvement in stability with the addition of tongue forces, tongue action that contributes to a slight reduction in sliding may help reduce common frictional trauma resulting from cyclic movement during chewing. The beneficial impact of tongue force shown in earlier work under conditions of complete adherence of dentures to the foundation indicates a benefit of using adhesives.

Mandibular complete denture versus single-implant overdenture: a systematic review of patient-reported outcomes

The single-implant mandibular overdenture (SIMO) has been proposed as an alternative for edentulous patients who are poorly adapted to their dentures due to low retention and stability of the conventional mandibular complete denture (CD). However, there is a lack of evidence regarding the effectiveness of SIMO, which can be measured by examining patient perception of treatment effects. The aim of this systematic review was to assess the comparative results of CD and SIMO treatments using patient-reported outcome measures. A literature search was carried out in PubMed, Scopus and Cochrane Central databases. The search included studies published up to July 2017. The focus question was: 'Do single-implant mandibular overdentures improve patient-reported outcomes compared to conventional complete dentures in edentulous patients?' Eligible studies were randomised clinical trials (RCT) and prospective studies. After initial screening for eligibility and full-text analysis, 11 studies were included for data extraction and quality assessment (five parallel-group RCTs, two crossover RCTs and four prospective studies). All studies reported marked improvement in satisfaction with the dentures and quality of life measures after SIMO treatment, irrespective of variations in implant treatment protocols and retention systems. Methodological considerations revealed a lack of evidence from RCTs on the comparative effectiveness of the two treatment strategies. Hence, although available evidence suggests considerable improvement in patient-reported outcomes following the insertion of a single implant to retain a mandibular denture, further well-designed comparative studies between SIMO and CD are required to improve the level of evidence and to support the indication of SIMO treatment in routine practice.