Comparison of implant-retained mandibular overdentures and conventional complete dentures: a 10-year prospective study of clinical aspects and patient satisfaction

PURPOSE: The aim of this prospective randomized clinical trial was to evaluate 10 years of treatment of patients receiving a mandibular implant-retained overdenture (IRO) or a conventional complete denture (CD). MATERIALS AND METHODS: One hundred twenty-one edentulous patients were treated with an IRO (2 endosseous implants, n = 61) or a conventional CD (n = 60). Clinical aspects and patient satisfaction were evaluated. One year after placement of the denture, unsatisfied patients of the CD group were given the opportunity to receive implants. RESULTS: In the IRO group, 4 implants were lost during the first year and 4 implants were lost during the next 4 years. Between 5 and 10 years, no implants were lost (survival rate: 93%). In the CD group, 24 patients (40%) chose an IRO between 1 and 10 years. DISCUSSION: Patients in the IRO group were significantly more satisfied than patients in the CD group after 1 year (satisfaction score 8.3 versus 6.6 on a scale of 1 to 10), after 5 years (7.4 versus 6.4), and after 10 years (7.7 versus 6.8). CONCLUSION: The mean satisfaction score of the CD group (including patients who later received implants) was still lower than that of the IRO group, in spite of the opportunity for retreatment with IROs. Endosseous implants had a high survival rate after 10 years of follow-up.     

Masticatory function and patient satisfaction with implant-supported mandibular overdentures: a prospective 5-year study

PURPOSE: The aim of this study was to assess the outcome of treatment with implant-supported mandibular overdentures in terms of biting and chewing, in entirely satisfied and not fully satisfied patients. MATERIALS AND METHODS: Twelve edentulous patients who had worn dentures for at least 5 years participated. They were in good health but had retention problems with their mandibular dentures. First, all patients received new dentures. After 3 months, two Astra Tech implants were placed in the anterior part of the mandible, and 6 months later the abutments were connected. Patient assessment (questionnaire) and functional recordings (chewing ability, bite force, electromyographic activity) were performed with the new dentures, and again 3 months, 1 year, and 5 years after overdenture treatment. RESULTS: After treatment, all patients were able to comminute hard and tough food, the maximum bite force and the chewing activity increased in parallel, and the duration of the chewing cycle was reduced. Every patient felt improved function and reduction of chewing pain. However, the seven patients not fully satisfied with the function of the implant-supported mandibular overdentures were characterized by lower muscle activity, even before implant placement, than the entirely satisfied patients. CONCLUSION: Implant-supported mandibular overdenture treatment permits better biting and chewing function than conventional complete dentures.     

Patient satisfaction with implant-retained mandibular overdentures: a retrospective study

Purpose: The aim of this study was evaluation of the effect of age, gender, and past prosthetic history (duration of edentulism, number of complete dentures before implant treatment, and number of adjustment appointments) on patients' ratings of satisfaction (comfort, hygiene, retention, appearance, speech, mastication, and overall satisfaction). Materials and Methods: In this retrospective study, 55 patients who were treated with mandibular overdentures retained by splinted implants from 1998 to 2004 and met the inclusion criteria of the study were selected. Each patient was asked to fill out a questionnaire to evaluate his/her general satisfaction with the implant prostheses and other aspects of satisfaction such as comfort, aesthetic, function, and hygiene. Data were analyzed using a marginal model and the generalized estimating equations methodology to assess the relationship between the scores and the patients’ demographic and past prosthetic histories. Significance was accepted at 5% and expressed as p values and odds ratio (OR). Results: Gender had significant correlation with comfort (p < .0001). Years of being edentulous prior to implant/prosthetic treatment had direct effects on the general satisfaction and satisfaction of comfort (p < .01). One extra denture used before implant treatment resulted in less comfort (p < .01) and poorer function (p < .001). Elders were more satisfied with aesthetic (OR = 0.96) and comfort (OR = 2.96). Number of adjustment appointments had a positive correlation with comfort (p < .001) and a negative correlation with satisfaction of aesthetic (p < .001). Conclusion: The results of this study demonstrated that satisfaction was correlated with age, gender, and past prosthetic history in the patients rehabilitated with the implant‐supported overdentures.     

Implant-supported mandibular overdentures retained with ball or bar attachments: a randomized prospective 5-year study

PURPOSE: The aim of the present study was to evaluate the periimplant conditions and the maintenance requirements for implant-supported overdentures in the mandible retained with ball or bar attachments during a 5-year period. MATERIALS AND METHODS: Twenty-six completely edentulous patients had two Astra Tech dental implants placed in the anterior part of the mandible. The denture attachment system for the patients was chosen randomly by drawing lots. Eleven patients drew the bar attachment system and fifteen patients drew the ball attachment system. Plaque Index, Gingival Index, and probing pocket depth were assessed around each implant. Periotest values were recorded, and periodically identical intraoral radiographs were obtained with a specially designed film-holding device. RESULTS: No implants were lost from baseline to the 5-year registration. The periimplant conditions were very healthy after 5 years. No significant differences of the periimplant variables were recorded between the bar and the ball groups. During the first year of function, significantly more complications/repairs were registered in the bar group than in the ball group. In the following years, no significant differences were registered. The mean frequency of complications/repairs per patient per year was 1.0 in the bar group and 0.6 in the ball group during the 5-year observation period. CONCLUSION: Two implants with ball or bar attachment supported an overdenture in the mandible for 5 years with a 100% survival rate. No differences in marginal bone loss or health of the periimplant mucosa were observed between bar and ball attachment, but the frequency of technical complications/repairs per patient was higher around bar than ball attachments.     

A 5-year prospective randomized clinical trial on the influence of splinted and unsplinted oral implants retaining a mandibular overdenture: prosthetic aspects and patient satisfaction

Prosthetic outcome and patient satisfaction were evaluated in order to investigate whether there is a need or advantage to splint two implants in the mandible retaining a hinging overdenture. This study included 36 fully edentulous patients randomly divided into three groups according to the attachment system they received: magnets, ball attachments or straight bars (reference group). None of the implants failed during the whole observation period in any of the groups. After 5 years of observation, the Bar group presented the highest retention capacity and the least prosthetic complications but revealed more mucositis and gingival hyperplasia. Patient satisfaction rated similar for all groups although the Magnet group showed lower retention forces. All patients would repeat the same treatment even though the majority of the Magnet group would prefer a more retentive solution because of limited denture stability.     

A 10-year randomized clinical trial on the influence of splinted and unsplinted oral implants retaining mandibular overdentures: peri-implant outcome

PURPOSE: This randomized controlled clinical trial aimed to evaluate the efficacy of splinted implants versus unsplinted implants in overdenture therapy over a 10-year period. MATERIALS AND METHODS: The study sample comprised 36 completely edentulous patients, 17 men and 19 women (mean age 63.7 years). In each patient, 2 implants (Br?nemark System, Nobel Biocare, G?teborg, Sweden) were placed in the interforaminal area. Three to 5 months after placement, they were connected to standard abutments. The patients were then rehabilitated with ball-retained overdentures, magnet-retained overdentures, or bar-retained overdentures (the control group). Patients were followed for 4, 12, 60, and 120 months post-abutment connection. Group means as well as linear regression models were fitted with attachment type and time as classification variables and corrected for simultaneous testing (Tukey). RESULTS: After 10 years, 9 patients had died and 1 was severely ill. Over 10 years, no implants failed. Mean Plaque Index, Bleeding Index, change in attachment level, Periotest values, and marginal bone level at the end of the follow-up period were not significantly different among the groups. DISCUSSION: The annual marginal bone loss, excluding the first months of remodeling, was comparable with that found around healthy natural teeth. CONCLUSION: The fact that no implants failed and that overall marginal bone loss after the first year of bone remodeling was limited suggested that implants in a 2-implant mandibular overdenture concept have an excellent prognosis in this patient population, irrespective of the attachment system used.     

Oral health status and treatment satisfaction with mandibular implant overdentures and conventional dentures: a randomized clinical trial in a senior population

PURPOSE: The purpose of this study was to compare elderly patients' satisfaction and oral health-related quality of life with mandibular two-implant overdentures and conventional dentures. MATERIALS AND METHODS: Sixty edentulous subjects aged 65 to 75 years were randomly assigned to two groups treated with maxillary conventional dentures and either a mandibular conventional denture (n = 30) or an overdenture supported by two implants with ball retainers (n = 30). Subjects rated their general satisfaction, as well as other features of their dentures (comfort, stability, ability to chew, speech, esthetics, and cleaning ability), prior to treatment and 2 months postdelivery. Changes in ratings on the original Oral Health Impact Profile (OHIP) and its short form (OHIP-EDENT) were also used as indicators of oral health-related quality of life. RESULTS: The primary outcome of this study, ratings of general satisfaction 2 months postdelivery, was significantly better in the group treated with mandibular two-implant overdentures (P = .001). In addition, the implant group gave significantly higher ratings on comfort, stability, and ability to chew. Furthermore, using OHIP-EDENT, subjects who received mandibular two-implant overdentures had significantly fewer oral health-related quality of life problems than did the conventional group. CONCLUSION: These short-term results suggest that mandibular two-implant overdentures combined with maxillary conventional dentures provide better function and oral health-related quality of life than conventional dentures.     

An eight-year follow-up to a randomized clinical trial of participant satisfaction with three types of mandibular implant-retained overdentures

Studies have shown that mandibular implant overdentures significantly increase satisfaction and quality of life of edentulous elders. Improved chewing ability appears to have a positive impact on nutritional state. Therefore, it is important to determine the best design of this prosthesis over the long term. In this randomized controlled trial, three groups of edentulous participants with atrophic mandibles wore 3 types of implant overdentures. During an eight-year follow-up, only seven of the 110 participants had dropped out of this study. Almost all participants were still satisfied with their overdentures. Participant satisfaction concerning retention and stability of the mandibular overdenture had decreased significantly in the two-implant ball attachment group, whereas the opinion of participants in the single- and triple-bar groups was still at the same level. The long-term results suggest that a mandibular overdenture retained by 2 implants with a single bar may be the best treatment strategy for edentulous people with atrophic ridges.     

A controlled clinical trial of implant-retained mandibular overdentures: clinical aspects

summary In a controlled clinical trial, treatment effects of mandibular overdentures on two different implant-systems in edentulous patients were compared one year after insertion of the new dentures. The implant-systems used were the Brånemark system (Brå) and the IMZ-system. Treatment was randomly assigned to 60 patients according to a balanced allocation method. Evaluation included peri-implant and radiographical parameters. According to the Delphi method a clinical implant performance scale (CIP) was constructed based on all conceivable complications of the different implant systems. During the osseointegration period, five Brå- and one IMZ-implants were lost. The results of one of the peri-implant parameters and the radiographical score showed significant differences considering the (pseudo) pocket probing depth (Brå better than IMZ, P < 0.001) and the radiographic-score (IMZ better than Brå, P < 0003). The results for the CIP-scale were less favourable for the Brå-group than for the IMZ-group; however, these differences were not significant.     

Implant‐retained mandibular overdentures compared with complete dentures; a 5‐years' follow‐up study of clinical aspects and patient satisfaction

The aim of this prospective randomized controlled clinical trial was to evaluate and compare clinical aspects and satisfaction during the first year following treatment and consecutively the change in treatment during the next 4 years of follow-up. Patients were allocated to one of the following treatment modalities: an implant-retained overdenture (IRO-group, 2 endosseous implants, n = 61) or a complete denture (CD-group, n = 60). One year after placement of the denture, unsatisfied patients of the CD-group got the opportunity for a retreatment including an implant-retained overdenture. In the IRO-group 4 implants were lost during the first year and again 4 implants were lost during the next 4 years (survival rate: 93%). All patients could be re-operated successfully. In the CD-group 14 patients (23%) chose an implant-retained overdenture after 1 year. Patients of the IRO-group were significantly more satisfied than patients of the CD-group after 1 year (satisfaction score 8.3 versus 6.6, scale 1-10) and after 5 years (7.4 versus 6.4). From this study it can be concluded that endosseous implants have a high survival rate after 5-years' follow-up. Satisfaction score of the IRO-group is diminishing in time, probably because patients get used to an improved situation. After 5 years, the mean satisfaction score of the CD-group (including patients who got implants) was still lower than of the IRO-group, in spite of the opportunity to a retreatment and have implant-retained overdentures.     

Patient satisfaction and dissatisfaction with mandibular two-implant overdentures using different attachment systems: 5-year outcomes

BACKGROUND: Different attachment systems for mandibular two-implant overdentures could influence levels of patient satisfaction. Positive consensus of the majority of patients being satisfied does not preclude the possibility of dissatisfaction for some. PURPOSE: To evaluate patient satisfaction before and after 5 years of wearing mandibular two-implant overdentures using different attachment systems. MATERIALS AND METHODS: A total of 106 edentulous participants enrolled in a clinical trial completed a preliminary self-report inventory of their original complete denture complaints. New complete maxillary dentures and mandibular two-implant overdentures were provided to each participant using one of six different attachment systems. Patient satisfaction was determined at pretreatment; at baseline with mandibular two-implant overdenture insertion; and then annually for 5 years, using visual analogue and Likert-type scales. ReSULTS: Patient satisfaction with mandibular two-implant overdentures at baseline was significantly improved in all domains compared to pretreatment (old dentures) and sustained up to the 5-year recall. The level of satisfaction with Straumann gold alloy matrices at 5 years was significantly lower than that with other attachment systems. Highly significant differences were found with some social and psychological aspects by the fifth year compared to baseline. Diagnostic and prognostic indicators from a pretreatment inventory identified 12 participants (13.5%) who were dissatisfied. These indicators revealed a maladaptive predisposition to mandibular two-implant overdentures. ConclusIONS: A mandibular two-implant overdenture (opposing a conventional complete maxillary denture) will improve patient satisfaction, regardless of the attachment system. Careful evaluation of pretreatment complaints with conventional dentures can possibly identify patient dissatisfaction with mandibular two-implant overdentures.     

Prosthetic aspects of osseointegrated fixtures supporting overdentures. A 4-year report

Eighty-six consecutive patients, provided with 84 resilient and two nonresilient overdentures (six in the upper and 80 in the lower jaw), were examined. The overdentures were supported by a total of 173 osseointegrated titanium fixtures (the standard Branemark abutment), with a mean loading time of 19.1 months (range 4 to 48 months). In each jaw only two fixtures anchored the overdentures. No failures occurred during the observation period but two fixtures were lost before loading. The radiographic annual bone loss around fixtures in the lower jaw was -0.8 mm for the first year and less than -0.1 mm for the following years. The change in marginal bone height did not correlate with parameters such as the occlusion and articulation pattern, the presence or absence of a soft liner around the abutments, and the magnitude of the interabutment distance. The patients' reactions to overdenture treatment were, on the whole, positive concerning chewing function, phonetics, and comfort. The need for maintenance care of the clip-bar attachment was minimal.     

Computerised occlusal analysis of mini-dental implant-retained mandibular overdentures: A 1-year prospective clinical study

Occlusal analysis is a substantial tool for the functional improvement evaluation after using implant-retained overdenture comparing to complete denture without dental implant retaining. To evaluate occlusal pattern, chewing force distribution in mini-dental implant-retained mandibular overdentures by computerised occlusal analysis system and to compare patient satisfaction after 1-year function. Thirty-one patients wearing complete dentures were included in the study. Prior to mini-dental implant-retained treatment, all patients were assessed for occlusion and force distribution using computerised occlusal analysis system (T-Scan^®), and then, all patients received two mini-dental implant-retained mandibular overdentures. Mini-dental implants were immediately loaded using low vertical profile attachments (Equator^®). T-Scan^® was used to evaluate chewing force and force distribution at 1 day, 3 months, 6 months and 12 months. The patient satisfactions before implant placement and after 1 year were evaluated using questionnaires which included satisfaction of denture quality, psychosocial behaviour and chewing efficiency modified from the validated questionnaires. Clinical evaluation of two mini-dental implant-retained mandibular overdentures showed 100% success rate after 1 year. T-Scan^® demonstrated that maximum occlusal contact force increased continuously. The force distribution; the tooth contact number increased over the period. At 1-year follow-up, overall patient satisfaction was significantly greater than before receiving mini-dental implant treatment (P < .001). Using computerised occlusal analysis, mini-dental implants improve complete denture function significantly in terms of maximum occlusal contact force, tooth contact number without the impairment of force distribution. The oral function of the patients has been enhanced.