A Qualitative Study on Patients' Perceptions of Two Types of Attachments for Implant Overdentures

Patient-reported outcome measures and clinical performance of implant-retained mandibular overdentures with stud and ball attachments: A systematic review and meta-analysis

STATEMENT OF PROBLEM

Evidence regarding the retention system for a mandibular overdenture is important for treatment planning. However, the clinical performance of stud and ball attachments for mandibular overdenture retainers is unclear.

PURPOSE

The purpose of this systematic review and meta-analysis was to compare the clinical performance and self-reported patient outcomes of ball and stud attachments as mandibular overdenture retainers.

MATERIAL AND METHODS

Randomized (RCTs) and nonrandomized (N-RCTs) controlled clinical trials were selected based on the eligibility criteria. The risk of bias was assessed by using the Cochrane Collaboration Tools, and the certainty of the evidence (COE) by using the grades of recommendation, assessment, development, and evaluation (GRADE) workshop approach. Meta-analyses according to the follow-up period were performed for implant survival, prosthetic maintenance and complications, bleeding on probing (BoP), marginal bone loss (MBL), satisfaction, and oral health-related quality of life (OHRQoL).

RESULTS

Thirteen RCTs and 4 N-RCTs were included. Twelve studies presented a high risk of bias. The stud demonstrated a lower risk ratio (RR) (P<.001) for maintenance and complications concerning the need for matrix activation (RR 7.12 [2.65, 19.15]) (very low COE) and new overdentures (RR 2.47 [1.02, 5.96]) (moderate COE), ranging from 1 to 5 years of follow-up. Mean difference (MD) for MBL after 1 (MD 0.40 [0.28, 0.52]; P<.001) and 5 years (MD 0.18 [0.16, 0.20]; P<.001) was higher for ball attachments than that for stud (very low COE) attachments. Stud attachments also improved satisfaction (P<.001) when compared with ball attachments (very low COE). Implant survival rate (high COE), BoP (very low COE), and OHRQoL (low COE) were similar for the attachments.

CONCLUSIONS

Stud and ball attachments are clinically appropriate options as mandibular overdenture retainers and are capable of restoring OHRQoL. Nevertheless, the stud showed greater improvement in satisfaction and less prosthetic aftercare and MBL.

Vertical versus angled immediately loaded implants for assisting maxillary overdentures with locator attachments: A preliminary results of one-year randomized clinical trial

OBJECTIVES

This study aimed to evaluate the clinical outcomes and patient satisfaction of 4-implant-assisted maxillary overdentures using two different designs.

MATERIALS AND METHODS

Thirty edentulous participants received four implants in the maxillary ridge. The patients were randomly divided into two equal groups: (1) the control (CG, Vertical) group (n = 15); participants received four vertical implants with straight locator attachments to retain maxillary overdentures, and (2) the study (SG, Angled) group (n = 15); participants received four angled implants with angled locator attachments to retain maxillary overdentures. Peri-implant tissue health [Plaque (PL) and gingival (GI) indices, pocket depth (PD), implant stability (ISQ) and crestal bone loss (CBL)] were evaluated after denture insertion (T0), 6 (T6), and 12 (T12) months after insertion. Patient satisfaction was evaluated using a visual analog scale (VAS) after 12 months.

RESULTS

The survival rates were 96.7% and 95% for the control and study groups respectively. PL, GI, and PD increased significantly in both groups with the passage of time. No significant difference in PL, GI, PD, and ISQ was noted between groups at all observation times. CG showed higher CBL than SG at T12. For the VAS results, there was no significant difference between groups. SG recorded significantly higher satisfaction regarding comfort with maxillary and mandibular dentures, retention of mandibular dentures, oral hygiene, the ability to chew hard food, and occlusion than CG.

CONCLUSION

Within the limitations of this study, angled implants with angled locator attachments may be recommended to retain maxillary overdentures opposing intact dentition or fixed restoration as it was associated with improvements of several parameters of peri-implant tissue health and patient satisfaction compared to vertical implants with straight locator attachments.

Single-Implant Overdentures Retained by a Novel Attachment: A Mixed Methods Crossover Randomized Clinical Trial

INTRODUCTION

Single-implant mandibular overdentures (SIMOs) are one of the least invasive implant treatments for edentulism. The new Novaloc attachment system can improve the clinical performance of implant-retained overdentures but has not been tested for SIMOs.

OBJECTIVES

To compare Novaloc and a gold standard system (Locator) for SIMOs in an edentate elderly population in terms of patient-reported outcomes and device- and treatment-related complications.

METHODS

In this single-center crossover randomized clinical trial (RCT), 10 edentulous participants received an implant in the lower midline and had their lower complete dentures converted to SIMOs. The participants received each attachment system for 3 mo in a randomized order, followed by measurement of patient satisfaction and oral health-related quality of life via the McGill Denture Satisfaction Questionnaire and the Oral Health Impact Profile for Edentulous People questionnaire, respectively. Complications were registered throughout the RCT. Patients were interviewed for their experiences with SIMOs and preference for one of the attachment systems. Quantitative analysis employed mixed linear models and chi-square tests (α = 0.05), whereas interview data underwent thematic analysis and, in turn, integration into quantitative data (mixed methods explanatory design).

RESULTS

All 10 randomized participants completed the trial. Mean ± SD general satisfaction was 92% ± 8% with Novaloc versus 85% ± 13% with Locator (mean difference, 9%; 95% CI, 1% to 17%). For specific McGill Denture Satisfaction Questionnaire items, only denture stability was significantly increased for Novaloc. Seven participants preferred Novaloc over Locator at the end of the RCT (chi-square, P = 0.045). No difference was found between the attachments in terms of oral health-related quality of life based on the Oral Health Impact Profile for Edentulous People and complications. Thematic analysis revealed high patient satisfaction with SIMOs, with denture stability the main criterion for their satisfaction and attachment preference.

CONCLUSION

Among elderly edentulous patients wearing SIMOs, Novaloc led to increased patient satisfaction and preference. Better patient-perceived denture stability may explain this result. The attachment systems exhibited similar short-term maintenance needs.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT03126942 (first registered on April 13, 2017). Secondary identifiers: A03-M07-17A (McGill University, Institutional Review Board) and 2018-3873 (McGill University Health Centre, Research Ethics Board).

KNOWLEDGE TRANSFER STATEMENT

The results of this mixed methods study can be used by clinicians when choosing which attachment system to use for SIMOs. Results suggest that edentulous patients prefer attachments with a better-defined seating position, such as that of the Novaloc system, as opposed to the nylon matrix on metallic abutment of the Locator system.

Using an Attachment System with PEEK Matrices for Single-Implant Overdentures: In Vitro Retention Force

Single-implant overdentures (SIOs) represent a major biomechanical challenge in terms of prosthetic retention. The Novaloc attachment system has the potential to overcome those challenges when used for SIOs, due to the use of PEEK matrices. This study compared the retentive force of the Novaloc attachment to the traditional Locator system, before and after cyclic insertion–removal cycles. Three Novaloc matrices (white, yellow, and green, corresponding to low, medium, and high retention, respectively) and Locator (medium retention) were tested, totalling four groups. Retentive force was measured using an Imada force gauge before and after 1095 insertion–removal cycles, corresponding to a year of SIO wearing. Retention was tested with the implants angulated at 0, 10, and 20°. Data for the different groups, angles, and cycling periods were tested via linear regression analysis and two-way ANOVA (α = 0.05). Although the Locator system yielded higher retention forces in general, it lost a much higher percentage of retention with cycling. This trend was similar with the three angles, with forces being inversely proportional to the implant angulation. The authors conclude that Novaloc may provide more reliable retention for SIOs due to their higher resistance to insertion–removal cycling.

The effect of ball versus locator attachment system on the performance of implant supported overdenture: A systematic review

Objective

This systematic review was aimed to compare ball and locator attachment system on the basis of clinical and biomechanical performance of implant supported overdenture as well as biological and patient related outcomes.

Material and methods

Open and free electronic and manual searches were performed in digital databases including MEDLINE via PubMed, the Cochrane Database of Clinical Trials, and Scopus along with some other reliable sources. From the 667 retrieved records, 11 full-text controlled trials were included in this study. Risk of bias was assessed according to RoB 2.0 except for one RCT (economic evaluation), only assessed by CASP checklist.

Results

From the 11 retrieved studies, total 183 locator and 219 ball attachments were identified in 452 subjects of 30 yrs-95 yrs of age. Studies provided data about prosthodontic complications or maintenance (replacement or the activation of matrix and patrix part, loss of retention, fracture and relining of the prosthesis, fracture of the attachment and the survival probability), oral health impact profile, soft tissue parameters and periodontal complications, marginal bone loss, patient related outcome and cost of the attachment systems. Only 5 studies were assessed at low risk bias, while other 6 at moderate to high risk of bias.

Conclusion

Locator attachment system show lesser complications including loss of retention and lower maintenance appointments, lesser soft tissue, and periodontal complications than the ball attachment. Ball is better in terms of cost effectiveness. In other related outcomes, no significant differences were noted between ball and locator attachment.

Angled ball and locator attachments for immediate loaded inclined implants used to retain maxillary overdentures: A cross over study of patient satisfaction and oral health related quality of life

OBJECTIVES

The aim of this was to compare the influence of two different angulated abutment designs on patient satisfaction, oral health-related quality of life, and prosthetic aspects of implant-supported maxillary overdentures.

MATERIALS AND METHODS

For this cross-over study, 18 patients with completely edentulous maxillary ridges opposing implant-retained mandibular overdentures received 4 implants between the maxillary sinuses using computer-guided surgery. The anterior implants were installed at canine/lateral incisor areas and inclined 15° labially. The posterior implants were inserted just anterior to the maxillary sinuses and inclined 15o distally. Eight patients received maxillary overdentures retained by angled ball attachment (ball overdenture [BOD]) and angled locator attachment in random order. After 6 months, patients indicated satisfaction with their prosthesis using a visual analog scale (VAS), and oral health impact profile (OHIP-14). Moreover, postinsertion prosthodontic maintenance and complications were recorded for both attachments. Comparisons of patient satisfaction and prosthetic complications between groups were performed using the Wilcoxon matched-pairs test and the McNemar test, respectively.

RESULTS

Locator overdenture (LOD) recorded significantly higher scores than the BOD group regarding all the VAS questions except for ease of cleaning (p < 0.007). LOD recorded significantly higher patient satisfaction regarding the pronunciation of sounds (p = 0.009), painful aching (p = 0.018), feeling tense (p = 0.011), unsatisfactory diet (p = 0.013), irritability with people (p = 0.005), and life in general (p = 0.004). The most common complications were matrix activation/renewal (n = 34). BOD showed a significantly higher incidence of attachment loosening (p = 0.002), and teeth fracture (p = 0.049) than LOD. LOD showed a significantly higher incidence of attachment wear and replacement than BOD (p <0.001). There was no difference between groups regarding soft tissue complications.

CONCLUSION

Within the limitations of this study, and in terms of improved patient-centered outcomes, angled locator attachments are recommended to retain maxillary implant overdentures opposed by implant retained mandibular overdentures at it was associated with increased patient satisfaction and oral health-related quality of life than angled ball attachments. However, locator attachment was associated with more postinsertion prosthodontic maintenance than ball attachment.

Do ball-type attachment systems for overdenture result in better patient-satisfaction? A systematic review of randomized crossover clinical trial

Objective

This review is to compare patient-satisfaction with ball-type overdenture attachment systems with others attachment systems.

Material and methods

This study was registered in PROSPERO (CRD42018097234) and adheres the PRISMA guidelines. Electronic searches on PubMed/MEDLINE, Scopus, Cochrane, and Web of Science databases for published articles were performed before October 2020. The PICO question was: “Do patients with a ball-type overdenture retention system have greater satisfaction, when compared to other attachment systems?” The evaluation of risk of bias was performed using the Cochrane risk of bias tool.

Results

After searching the databases, seven articles were selected out of a total of 2583. A total of 312 implants were placed in 139 patients, with a mean age of 65.9 years. The risk of bias in the included studies varied according to the different domains in a risk of uncertain bias or low bias risk. No difference was found between the ball attachment systems and the others systems, with respect to patient-satisfaction. The meta-analysis revealed no statistically significant difference between the ball systems and another systems (P = 0.11; MD: 10.90; 95% CI: −2.55 to 24.35).

Conclusions

Regarding patient general satisfaction, it was not possible to determine differences between the ball system and another types of attachment system for overdenture. The ball-type system was statistically superior only to the magnet system.