Treatment outcomes of implant-assisted removable partial denture with distal extension based on the Kennedy classification and attachment type: a systematic review

Orofacial esthetics, chewing function, and oral health-related quality of life in Kennedy class I patients with mini-implant-retained removable partial dentures: A 3-year clinical prospective study

This prospective clinical study aimed to assess self-reported orofacial esthetics, chewing function, and oral health-related quality of life (OHRQoL) over three years in the Kennedy Class I patients without posterior dentition who received free-end saddle removable partial dentures (RPDs) retained by two mini dental implants (MDIs) inserted in the canine/first premolar region. The study's robust findings reaffirm the viability of MDI-retained RPDs as a treatment modality in contemporary prosthodontics, instilling confidence in the dental community.

MATERIALS AND METHODS

92 participants with posterior edentulism in the maxilla or mandible received 184 MDIs and 92 RPDs. After one year, three participants were excluded, and another seven were excluded after three years. The final sample was 82 participants. Self-perceived orofacial esthetics was assessed by the Orofacial Esthetic Scale (OES), chewing function by the Chewing Function Questionnaire (CFQ), and the OHRQoL by the OHIP-14. Statistical analysis utilized multivariate regression analysis, standardized effect size calculation, Wilcoxon Signed Rank test, and Friedman's test.

RESULTS

OHRQoL and chewing function significantly improved (p < 0.001) one month after MDI loading by the new RPDs and continued to improve over the observation period (p < 0.05). The OES also significantly improved (p < 0.001) and remained almost unchanged over the next three years (p = 0.440).

CONCLUSION

Despite the limitations of this study, the MDI-retained RPD appears to be a viable treatment modality in contemporary prosthodontics from the patients' perspective.

Effect of surgical and prosthodontic protocols of distal extension implant-supported removable partial dentures on clinical and patient-reported outcomes: A systematic review

STATEMENT OF PROBLEM

Standard surgical and prosthodontic protocols for managing partially dentate patients with implant-supported removable partial dentures (ISRPDs) are lacking.

PURPOSE

The purpose of this systematic review was to determine clinical and patient-reported outcome measures (PROMs) in patients provided with ISRPDs in distal edentulous arches based on different surgical and prosthodontic protocols.

MATERIAL AND METHODS

An electronic and manual literature search was conducted in 3 databases, PubMed/MEDLINE, SCOPUS, and Cochrane Library, for clinical studies on distal extension ISRPDs related to clinical and patient-reported outcomes. Kennedy Class I and II arches described in articles published from January 2000 to December 2023 were included. Clinical parameters regarding implant type, location, loading protocols, and implant survival rate and PROMs including masticatory performance, esthetics, and overall satisfaction were compared. The risk of bias was determined by using the Cochrane Risk of Bias Tool 2.0 (RoB 2.0).

RESULTS

An initial total of 103 studies were identified, but only 11 articles were selected after implementing the inclusion and exclusion criteria. Ten studies evaluated PROMs, and 6 studies evaluated clinical outcomes (5 studies evaluated both). The implant survival rate ranged from 91.7% to 100%, with no clear differentiation among the studies with immediate or delayed loading protocols. Most studies described implants positioned in the molar region. In general, patient satisfaction and oral health-related quality of life (OHRQoL) improved significantly with ISRPDs compared with conventional removable partial dentures (RPDs) or RPDs with healing abutments. Posttreatment clinical outcomes revealed stable peri-implant health with no significant bone loss or prosthetic complications. No specific implant configuration, including implant type and location or attachment system, appeared to be better than another. Ball attachments were the commonly used attachments. Two studies were of high risk and 3 studies of low risk. The remaining 6 studies were judged to have some concerns based on the RoB 2.0 analysis.

CONCLUSIONS

Providing an ISRPD improved patient satisfaction, OHRQoL, and the clinical outcomes in distal extension situations, with most studies positioning the implants in the molar region. The type of attachment did not significantly affect the outcomes, although ball attachments were the most used attachment in ISRPDs.

Implant-assisted removable partial dentures: Part I. a scoping review of clinical applications

PURPOSE

This scoping review aimed to systematically map research regarding implant-assisted removable partial dentures (IARPDs), and identify existing gaps in knowledge.

STUDY SELECTION

Two reviewers independently conducted a search of the MEDLINE-PubMed and Scopus databases according to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) extension for Scoping Review and included articles published in English up to August 31, 2022, including human studies, reviews, and in vitro studies. Expert opinions, animal studies, and clinical studies involving complete overdentures were excluded, and ten aspects for establishing the treatment strategy for IARPDs were examined.

RESULTS

One hundred and twelve articles were chosen. There were two treatment modalities: IARPDs retained by implant- and tooth-supported surveyed single crowns (SCs) or fixed partial dentures (FPDs). In IARPDs retained by tooth-supported surveyed SCs or FPDs, the survival rate of dental implants for IARPDs was relatively higher with a wide range of marginal bone loss and many complications, but with improved functional performance, oral health-related quality of life, and patient satisfaction. There were limited data on survival or success rates and designs of IARPDs, attachment selections, length and diameter, inclination, placement sites, and loading protocols of implants, regardless of prosthetic types. There was limited information on maxillary IARPDs except for survival rates of implants.

CONCLUSIONS

Although IARPDs could become a useful treatment strategy, there is limited scientific consensus with gaps in knowledge about their use. Additional well-designed clinical and in vitro studies are necessary to scientifically establish IARPDs as definitive prostheses in implant dentistry.

A technique to guide implant placement with the long axis parallel to the path of insertion of removable partial dentures

This article describes a novel technique that allows the planning and placing of dental implants with their long axis parallel to a path of insertion chosen for a prospective removable partial denture. The technique is straightforward, uses digital technologies efficiently, and enables prosthetically driven implant placement. It also optimizes the outcome when dental implants are used in association with removable partial dentures.

Rehabilitation of distal extension maxillary ridges with fixed and removable implant-supported prostheses: Preliminary 12-month randomized clinical trial

PURPOSE

This trial evaluated clinical outcomes of fixed and removable implant-supported prostheses for rehabilitation of atrophied distal extension maxillary ridges.

MATERIALS AND METHODS

A total of 54 participants with atrophied distal extension maxillary ridges were randomly assigned into three groups (n = 18/group). Group I (SLF); participants treated with fixed restoration supported by three long implants after sinus augmentation, Group II (SF); participants treated with fixed restoration supported by one long and two short implants, and Group III (OD): participants treated with removable partial denture assisted by one long implant that was placed mesial to maxillary sinus (IARPD). Modified plaque index (MPI), modified gingival index (MGI), pocket depth (PD), implant stability (IS), and crestal bone loss (CBL) were measured after prosthesis insertion (T0), 6 (T6), and 12 months (T12) after insertion. Patient satisfaction was measured at T12 using a visual analog scale (VAS).

RESULTS

The implant survival rates were 96.8%, 92.4%, and 84.6% for SLF, SF, and OD groups respectively. The SLF recorded the highest MPI, MGI, PD, and IS values, followed by the SF, and the OD showed the lowest values. The OD recorded the highest CBL followed by the SF and the SLF showed the lowest CBL. With exception of satisfaction with surgery and cleaning, SLF and SF groups recorded significantly higher patient satisfaction than the OD for all VAS questions.

CONCLUSION

Fixed restorations supported with either long or short implants were associated with improved implant stability, reduced bone loss, and increased patient satisfaction compared to implant-assisted RPDs. However, implant-assisted RPDs were associated with more favorable peri-implant soft tissue health and increased satisfaction with surgery, healing, and cleaning.

Incorporation of the Altered Cast Technique in the Fabrication Workflow of an Implant-Assisted Removable Partial Denture (IARPD) for an Elderly Patient

Implants are currently used to serve as abutments for implant-assisted removable partial dentures (IARPDs) to facilitate retention and support of the prosthesis. Implants are proposed in cases of posterior edentulous areas to convert Kennedy Class I or II to Class III or when the preparation of existing teeth to serve as abutments is contraindicated. The purpose of this report is to describe the protocol applied to fabricate an IARPD to restore a Kennedy Class II mandible of an elderly patient by incorporating traditional methods, such as the altered cast technique. Each step of the clinical procedure is thoroughly illustrated to document the selected appointment sequence. The patient was satisfied with the delivered prosthesis that demanded no additional implants to be placed but exploitation of an existing one. IARPDs are a viable and cost-effective solution substantiated by numerous reports with positive effects on patient satisfaction.

Mini-Implants Retaining Removable Partial Dentures in Subjects without Posterior Teeth: A 5-Year Prospective Study Comparing the Maxilla and the Mandible

Background and objectives: Long-term studies of clinical outcomes of mini-implants (MDIs) in the first premolar/canine sites retaining a bilateral free-ending removable partial dentures (RPD) in Kennedy class I subjects have not been well documented. The aim was to assess clinical outcomes in a prospective 5-year cohort study comparing the mandible and maxilla. Material and Methods: Participants (n = 92) who received two MDIs each and a new RPD were reviewed after one, three and five years. A total of 71 participants (82 mini-implants in the mandible; 58 in the maxilla) completed the study. Marginal bone level change, success, survival rates, Modified Plaque (MPI) and Bleeding Indices (MBI) were assessed. Results: The five-year success rate was 93.3% and 93.4% (p > 0.05), in the mandible and the maxilla, respectively. Mean peri-implant bone loss (MBL) increased significantly over five years (p < 0.01) to 0.50 mm in the mandible and 0.52 mm in the maxilla. Age had a significant effect on the MBL (higher rates in younger participants), while jaw of insertion, gender, and antagonistic jaw status did not. MPI and MBI were not significantly correlated with MBL. Conclusions: The insertion of two MDIs in previous first premolar/canine sites for retention of a free-end saddle RPD can be a successful treatment modality in subjects with narrow alveolar ridges.

Full Mouth Rehabilitation Using Telescopic Removable Prosthesis

A female, aged 55 years, was presented to the clinic concerned with her inability to function properly due to missing teeth and collapse of her vertical dimension. On examination, remaining tooth position of the upper arch was favorable for telescopic denture and remaining tooth position of the lower arch was favorable for removable prosthesis. The patient requested an aesthetic maxillary and mandibular denture with no visible metal clasps on smiling. Therefore, upper telescopic removable complete denture and lower chrome cobalt removable prostheses were suggested to the patient as conservative treatment to reestablish her occlusal vertical dimension and restore her aesthetics and function.

Finite Element Comparative Analysis of Von Mises Stress Levels in Unilateral Removable Partial Denture with and without Distal Implant

The aim of this paper is to compare von Mises stress levels and displacements between two possible designs of a class II Kennedy unilateral removable partial denture. Finite element analysis was used to compare two unilateral class II Kennedy removable partial dentures replacing a mandibular second premolar, and first and second molars and with the same design, except a distal implant. The 3D model was created for a mandibular RPD with three artificial teeth and double ball attachment on the abutment teeth and a horizontal ball attachment for the implant, using Autodesk Inventor 2022 software. On the saddle, significant differences appear only when force is applied on the second molar. Association with implant increases von Mises stresses on the acrylic saddle, where displacements values are similar, and decreases von Mises stresses on the muco-osseous support, where displacements values are also similar. Regarding metal reinforcement of the denture, von Mises stress values are greater for forces applied on the second premolar in the implant situation, and smaller for forces applied on the first and second molars. Association with implant decreases von Mises stresses on the metal reinforcement of the denture only if the force is applied distally, on the two molars; in this case, the metal reinforcement is more stressed above the mesial double ball attachment, where displacements values are similar. Regarding the artificial teeth, adding a distal implant does not significantly influence the stress and displacements values, except on the second premolar where the von Mises stresses values are greater, where displacements values are similar. Although an association with an implant increases the risk of fracture for the denture, the results demonstrate that in the posterior area of the edentulous space, the denture exerts less pressure on the mucosa and subjacent bone, protecting the area against resorption.

The Quantification of Salivary Flow and pH and Stomatognathic System Rehabilitation Interference in Patients with Oral Diseases, Post-Radiotherapy

Xerostomia is a common complication post-radiotherapy in patients with oral cancer. The acute and long-term side effects can considerably reduce the patient’s quality of life. The aim of our study was to perform analysis of salivary flow and pH in patients after radiotherapy. Methodology: Clinical and laboratory evaluations were conducted in the 2014–2019 period; out of a total 58 subjects aged between 45 and 84, 28 individuals with oral cancer were selected from St. Spiridon Hospital, Clinic of Maxillo-facial Surgery and Oncology Hospital, Iasi post-radiotherapy. Results: Significant downsized mean values of the hydrogen ion concentration (pH) in saliva (p < 0.001) were recorded in patients after radiotherapy, pH value = 4.580 (±1.051). The mean value of resting salivary flow (MRSF) was significantly lower for the group of patients with radiotherapy (MRSF) = 0.145 mL/min. In 89.29% of cases (25 post-radiotherapy cases), in order to perform oral complex rehabilitation treatment, several endodontic and periodontal treatments were performed. A total of 78.57% of the cases received complex oral rehabilitation as mobile or hybrid prostheses or fixed solutions. Conclusion: Understanding post-radiotherapy salivary biochemic modifications in patients with oral cancer could be of critical importance, in view of related oral disorder prevention.

Clinical performance of tooth implant-supported removable partial dentures: a systematic review and meta-analysis

OBJECTIVE

To assess the clinical performance of tooth implant-supported removable partial dentures in terms of abutment survival in relation to the attachment system used.

METHODS

An electronic search in MEDLINE/PubMed Web of Science and Cochrane Central Register of Controlled Trials databases was performed. The methodological quality of the studies was assessed using the Newcastle-Ottawa Scale. Survival rates after 3 years and 5 years, loss, and complication rates per 100 years were estimated by Poisson regression.

RESULTS

A total of twelve studies were included; eleven studies were used for the meta-analysis. Survival analysis for mixed attachments showed an estimated survival rate of 100% after 3 years and 5 years. For uniform attachments, the estimated survival rate was 99.3% after 3 years and 98.8% after 5 years. Tooth abutment survival analysis for mixed attachments estimated a survival rate of 95% after 3 years and 91.7% after 5 years: Uniform attachments reached a survival rate of 97.2% after 3 years and 95.4% after 5 years. The prosthetic survival rate was 100% for mixed and uniform abutments after 3 years and 5 years of function.

CONCLUSIONS

Tooth implant-supported removable partial dentures can be considered as a reliable option with excellent prosthetic and implant survival rates and favorable rates for the abutments after 3-year and 5-year follow-ups. Complications may be reduced when 5 or more abutments are used.

CLINICAL RELEVANCE

Tooth implant-supported removable partial dentures are a favorable and potential alternative to restore a partially edentulous arch by optimizing the number and distribution of abutments.