A randomized controlled trial of implant-retained mandibular overdentures

Evidence from randomized clinical trials of implant-retained overdentures is very limited at the present time. The aim of this study was to compare implant-retained mandibular overdentures and conventional complete dentures in a randomized controlled trial (RCT). Our a priori hypothesis was that implant-retained mandibular overdentures would be significantly better than conventional complete dentures. Edentulous patients (n = 118) were randomly allocated to either an Implant Group (n = 62) or a Denture Group (n = 56). Patients completed the Oral Health Impact Profile (OHIP) and a denture satisfaction scale pre-treatment and three months post-treatment. Upon completion of treatment, both groups reported improvement (p < 0.001, Wilcoxon Ranks Sum test) in oral-health-related quality of life and denture satisfaction. There were no significant post-treatment differences between the groups, but a treatment effect may be masked by application of "intention to treat" analysis. The OHIP change scores were significantly greater for patients receiving implants than for those who refused them.     

Implant-retained mandibular overdentures versus conventional dentures: 10 years of care and aftercare

PURPOSE: This 10-year prospective, randomized, clinical trial investigated the treatment outcome of edentulous patients treated with mandibular overdentures retained by 2 endosseous implants compared with conventional dentures in patients with or without vestibuloplasty. MATERIALS AND METHODS: One hundred fifty-one edentulous patients (5 groups) with a symphyseal mandibular bone height between 8 and 25 mm participated. Sixty-two patients were treated with an overdenture retained by 2 implants (groups 1 and 3), 59 patients were treated with a conventional denture (groups 2 and 5), and 30 patients were treated with a conventional denture after preprosthetic vestibuloplasty (group 4). Patients who received conventional dentures but preferred implants later on could undergo implant surgery after 1 year of their initial treatment, but were analyzed in their original group. The prosthetic and surgical care and aftercare were scored during a 10-year evaluation period. RESULTS: One hundred thirty-three patients completed the 10-year follow-up evaluations. Forty-four percent of patients treated with conventional dentures switched within 10 years to implant-retained overdentures, versus 16% of the patients who were treated with conventional dentures after vestibuloplasty. On average, a greater time investment and more treatment sessions were needed in patients treated with implant-retained overdentures compared to patients treated with conventional dentures. CONCLUSION: Patients treated with an implant-retained overdenture need more treatment interventions and treatment time than patients treated with conventional dentures.     

A longitudinal study of quality of life outcomes in older adults requesting implant prostheses and complete removable dentures

A longitudinal clinical trial involving 103 subjects was undertaken to assess the impact of oral implant therapy on the psychosocial well-being of subjects with complete denture wearing problems. There were four experimental groups: (1) an implant group, where subjects were edentulous/edentate in one jaw and requested and received implants to retain an oral prosthesis (IG); (2) subjects edentulous/edentate in one jaw requesting implants but who received conventional dentures (CDG1); (3) edentulous subjects requesting replacement of their dentures by conventional means (CDG2); (4) dentate subjects requiring routine treatment, who were included for comparison. Data were collected in each group pre- and post-treatment using validated oral specific [the Oral Health Impact Profile (OHIP)], and generic (the SF36) health status measures. Subjects in IG, CDG1 and CDG2 also completed a denture satisfaction scale. IG and CDG1 subjects reported that tooth loss and denture wearing problems had a much greater impact on their quality of life than subjects seeking conventional dentures. Dentate subjects had a much better oral health status compared with denture-wearing subjects. Following treatment, subjects who received implant-retained prostheses (IG) reported a significant improvement in satisfaction and health-related quality of life, as did subjects who requested and received conventional dentures (CDG2). Subjects who requested implants, but received conventional dentures (CDG1), reported little improvement in denture satisfaction and only modest improvement in their quality of life. None of the denture-wearing subjects reported health-related quality of life that was as good as that of dentate subjects. The findings have significant implications in the assessment of outcomes in future clinical trials.     

Patient satisfaction with mandibular implant overdentures and conventional dentures 6 months after delivery

PURPOSE: This study examined patient satisfaction with conventional complete dentures and mandibular implant overdentures opposing conventional maxillary dentures 6 months after delivery. MATERIALS AND METHODS: Sixty edentulous subjects (aged 65 to 75 years) were randomly assigned to either a mandibular conventional denture or an overdenture supported by two implants with ball-shaped retentive anchors. Patients rated their general satisfaction and other features of their prostheses, together with their ability to eat certain food items, on 100-mm visual analogue scales before assignment, and after 2 and 6 months. RESULTS: Both treatment groups reported greater satisfaction with their new prostheses at 6 months. General satisfaction ratings were higher in the implant group than in the conventional denture group by approximately 36% (mean difference 22.3 mm). The implant group also rated comfort (mean difference 22.4 mm), stability (mean difference 28.5 mm), and ability to chew (mean difference 17.3 mm) significantly higher. Significantly higher scores were also given by the implant group for their ability to chew certain hard foods. A trend for an increase in the differences between the groups, in favor of the implant group, was observed between the 2- and 6-month recalls, although the increase was only significant for ease of cleaning. The primary influence on general satisfaction 6 months after the delivery of the prostheses was the provision of the two-implant overdenture. CONCLUSION: Edentulous seniors who received mandibular implant overdentures opposing a conventional denture rated their general satisfaction approximately 36% higher than did a comparable group provided with new conventional dentures.     

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.     

A retrospective study to assess patient satisfaction with implant-stabilized prostheses

This study measured the levels of patient satisfaction in those who received treatment with implant-retained overdentures, and compared their status before and after therapy. Satisfaction questionnaires were mailed to patients who had previously worn a removable prosthesis. Questions addressed eating, aesthetics and comfort before and after the treatment. Eighty-six (79.8%) subjects had problems regarding looseness of their denture prior to treatment. Patients were generally satisfied with their implant-retained overdentures in terms of function, comfort, appearance and speech. The results suggest that unstable, problematic complete dentures can be managed by providing patients with implant-retained overdentures. Clinical Relevance: From the patients' perspective, implant-supported overdentures offer overall satisfaction and improvement.     

Comparing the efficacy of mandibular implant-retained overdentures and conventional dentures among middle-aged edentulous patients: satisfaction and functional assessment

PURPOSE: The aim of this randomized clinical trial was to compare the relative efficacy of mandibular overdentures retained by only two implants and a bar attachment with conventional dentures. MATERIALS AND METHODS: Edentulous adults, aged 35 to 65 years, were randomly assigned to two groups that received either a mandibular conventional denture (n = 48) or an overdenture supported by two endosseous implants with a connecting bar (n = 54). All subjects rated their general satisfaction and other features of their original dentures and their new prostheses (comfort, stability, ability to chew, speech, esthetics, and cleaning ability) on 100-mm visual analogue scales prior to treatment and 2 months postdelivery. Oral health-related quality of life was also evaluated pre- and posttreatment. RESULTS: Multiple regression analysis revealed that the mean general satisfaction was significantly higher in the overdenture group than in the conventional denture group (P = .0001). Age, gender, marital status, and income were not significantly associated with ratings of general satisfaction. Furthermore, the implant group gave significantly higher ratings on three additional measures of the prostheses (comfort, stability, and ease of chewing; P < .05). CONCLUSION: A mandibular two-implant overdenture opposed by a maxillary conventional denture is a more satisfactory treatment than conventional dentures for edentulous middle-aged adults.     

Effectiveness of three treatment modalities for the edentulous mandible. A five-year randomized clinical trial

Currently, 3 treatment options are available for patients with denture complaints and an edentulous mandible with a height of at least 15 mm: meticulous construction of a new set of dentures (CD), construction of a new set of dentures following preprosthetic surgery to enlarge the denture-bearing area (PPS), and construction of an implant-retained mandibular overdenture (IRO). The aim of this study was to evaluate patient satisfaction and subjective chewing ability of edentulous patients treated with one of these treatment modalities. Ninety edentulous patients (Cawood class IV and V, mean mandibular height 20.7 mm) were randomly assigned to receive 1 of these 3 groups. Denture satisfaction and chewing ability were assessed using questionnaires focusing on denture-related complaints and problems chewing different types of food were assessed before treatment, and 1- and 5-years after treatment. At the 1-year evaluation, significantly better scores were observed in the 2 surgical groups (IRO, PPS) than in the CD group. At 5-year evaluation the "complaints of the lower denture" showed a significantly better score in the IRO group when compared to the PPS and CD groups. No significant differences were observed between the PPS and CD group. From this study it is concluded that both in the short and long term denture satisfaction appears most favourable in the IRO group when compared to the PPS and CD groups. Implant-retained overdentures are therefore a satisfactory treatment modality for edentulous patients with problems with their lower denture, even in cases of not severely resorbed mandibles.     

Immediate implant placement in edentulous oral cancer patients: a long-term retrospective analysis of 207 patients

Although the functional benefits of implants in the rehabilitation of edentulous cancer patients are well-known, most studies report on postponed implant placement. The outcome of immediate implant placement regarding successful rehabilitation, implant loading and survival is unclear. Two hundred and seven edentulous oral cancer patients that received implants during ablative surgery at the Radboud University Medical Centre between 2000 and 2011 were included. Data regarding the oncological treatment, implant placement, follow-up and prosthodontic rehabilitation were recorded retrospectively with a follow-up period of 5–17 years. Functioning implant-retained dentures were made in 73.9% of the patients. Of the surviving patients, 81.9% had functioning dentures after 2 years and 86.3% after 10 years. Patients with ASA score 1 and younger patients were rehabilitated more frequently. The median time of functioning denture placement was 336 days after surgery, with a negative influence of postoperative radiotherapy. Implant survival was 90.7%, and was lower when the implant was placed in a jaw involved in the tumour. Immediate implant placement during oral cancer surgery led to a high number of edentulous patients rehabilitated with implant-retained dentures, which are placed at an early time.     

Patient expectations of oral implant-retained prostheses in a UK dental hospital

STATEMENT OF PROBLEM: The loss of the natural dentition leads to severe functional impairment in many edentulous adults. A prosthesis retained and supported by osseointegrated dental implants may provide a satisfactory solution for people who have lost all their natural teeth. However, little information is available as to what patients requesting implants expect of implant-retained prostheses. AIM: The aim of this study was to assess the expectations of a group of edentulous patients requesting implant therapy. METHOD: The study included two groups: (1) a group of edentulous adults who requested implant therapy ('implant group'); and (2) an edentulous control group, of similar age and gender distribution as the implant group, receiving conventional complete dentures. Following a clinical and radiographic examination of the patients, data were collected using validated questionnaires. Both groups made a subjective assessment of current dentures. The implant group also completed a questionnaire which assessed expectations of implant-retained prostheses. RESULTS: Baseline satisfaction with current dentures was low in both groups, with the implant group being significantly less satisfied with comfort and stability of their mandibular dentures. Perceived ability of the implant group to chew hard foods was less than the control group. The implant group's expectations of an implant-retained prosthesis were significantly greater than for a conventional denture. CONCLUSION: Careful assessment of patient expectation of implant therapy is essential to determine appropriate treatment need, and to highlight unrealistic expectations.     

Two-center clinical trial of implant–retained mandibular overdentures versus complete dentures – chewing ability

Abstract This study is a two-center clinical trial with the aim to assess the treatment effects of implant-retained mandibular overdentures versus conventional complete dentures. Treatment had been assigned according to a balanced allocation method. The following criteria were used to enhance the comparability of the treatment groups: age, gender, the edentulous period of the mandible, the number of previously made mandibular dentures, the number of years having worn the present mandibular denture and the symphyseal bone height. 151 patients with severely resorbed mandibles participated in the study, they were treated at two centers. Ninety-one patients received an implant-retained mandibular overdenture (IRO) and 60 patients a conventional complete denture (CD). Since some patients refused the allocated treatment the “Intention To Treat” principle was applied. This implies that patients are evaluated in the originally allocated treatment group regardless of the actual treatment they received. Patient's experiences were evaluated before treatment and I yr after insertion of the new dentures. Results before treatment showed that both treatment groups were comparable: they were dissatisfied with their mandibular denture and they could hardly chew tough or hard foods. One year after insertion of the new dentures the IRO-group was satisfied with their mandibular denture, whereas only one third of the CD-group was satisfied. With respect to the chewing ability the IRO-group scored significantly better than the CD-group (P0.0001).     

Impact of implant support for mandibular dentures on satisfaction, oral and general health-related quality of life: a meta-analysis of randomized-controlled trials

Objectives: The aim of this study was to examine systematically the data published on the efficacy of mandibular implant-retained overdentures from the patient's perspective.
Material and methods: Medline, Embase, The Cochrane Central Register of Controlled Trials and The Cochrane Systematic Reviews Database were searched and complemented by hand searching. All randomized-controlled trials published in English or French up to April 2007 were included, in which conventional dentures and mandibular implant overdentures in adult edentulous individuals were compared. The outcomes of interest were patient satisfaction, oral and general health-related quality of life. Random effects models were used to pool the effect sizes (ES) of all included studies.
Results: Ten publications of seven randomized-controlled trials were identified and eight were included in the meta-analysis. When compared with mandibular conventional dentures, implant overdentures were rated to be more satisfactory at a clinically relevant level [pooled ES 0.80, z =3.56, 95% confidence intervals (CI) 0.36–1.24, P =0.0004], but a statistical heterogeneity was found (χ²=31.63, df=5, P <0.00001, I ²=84%). The pooled ES for oral health quality of life was −0.41 ( z =1.31, 95% CI, −1.02 to 0.20; P =0.19, χ²=11.53, df=2, P <0.003, I ²=83%). There was a lack of evidence to show the impact of mandibular implant overdenture on perceived general health.
Conclusions: Our findings suggest that, although mandibular implant-retained overdentures may be more satisfying for edentulous patients than new conventional dentures, the magnitude of the effect is still uncertain. There is a need for additional evidence including cost-effectiveness analyses on the impact of mandibular implant overdentures and conventional dentures.     

全颌固定式种植义齿

目的：牙列缺失的种植义齿修复多采用覆盖义齿方式，但某些患者仍希望得到固定修复。Branemark的可拆卸固定全颌种植义齿技术复杂，美观清洁卫生等也不理想。本研究要建立一种牙列缺失的固定种植我齿修复模式。方法：11例有条件的无牙颌患者，在CDIC种植体支持基础上，用常规烤瓷溶附冠桥技术完全成颌固定式种植义齿修复。结果：1至5年的观察表明，该修复模式在咀嚼功能，美观性，舒适感及清洁卫生维护均获得满意结果。     

Favoring trauma as an etiological factor in denture stomatitis

The etiology of denture stomatitis remains controversial. Trauma due to unstable dentures has been suggested as an etiological factor. Therefore, we tested the hypothesis that the prevalence of denture stomatitis is reduced when mandibular dentures are stabilized by implants. Data were collected at a one-year follow-up from 173 edentulous elders who had randomly received mandibular implant overdentures or conventional dentures. The diagnosis of denture stomatitis was determined according to the Newton classification. Elders wearing conventional dentures were almost 5 times more likely to have denture stomatitis than those wearing mandibular two-implant overdentures (P < 0.0001, Fisher's exact test). Adjusted odds ratios showed that only the type of the prosthesis (AOR = 4.54, 95% CI 2.20 to 9.40) and nocturnal wear (AOR = 3.03, 95% CI 1.24 to 7.40) predict the frequency of denture stomatitis. Thus, implant overdentures may reduce oral mucosal trauma and control denture stomatitis.     

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.     

Oral status and nutrition in the institutionalized elderly.

OBJECTIVES: To evaluate, in an elderly population, whether poor oral status might be a contributing factor to the development of undernutrition and might be associated with less eating pleasure, more subjective eating difficulty and increased mashed food consumption. METHODS: An oral examination and an evaluation of masticatory capacity were performed on 120 institutionalized elderly subjects. The nutritional assessment included serum albumin concentration, the Mini Nutritional Assessment and a questionnaire on eating habits. RESULTS: Edentulous subjects without dentures or with only one complete denture had significantly lower MNA scores than edentulous subjects with two complete dentures (p < 0.05). Edentulous subjects with two complete dentures more frequently reported taking pleasure from eating (p = 0.05), and had less frequent difficulties with hard foods (p = 0.01) than edentulous subjects without dentures or with only one complete denture. Mashed food consumption (p < 0.01) was also reported more frequently in edentulous subjects without dentures or with only one complete denture. Subjects with two complete dentures had similar or better MNA scores as dentate subjects with relatively few remaining teeth (10.4 +/- 7.8 teeth). About half of the subjects (53%) could not perform the masticatory test. These subjects had lower MNA scores (p = 0.001) and a larger proportion ate mashed food (p < 0.001) compared to those who were able to perform the test. CONCLUSIONS: Poor oral status (edentulous without dentures or with only one complete denture) increased difficulty in eating hard foods, increased mashed food consumption and decreased eating pleasure. It seemed also to put institutionalized subjects at higher risk of undernutrition.     

Sex differences in denture satisfaction

OBJECTIVES: Males and females differ in their responses to many health conditions and treatments. The aim of this randomized clinical trial was to determine whether there are differences in the way that male and female edentulous elders rate their satisfaction with new mandibular implant overdentures (IODs) and conventional dentures (CDs), at 6 and 12 months following delivery. METHODS: Edentulous elders (n=256) were randomly assigned to receive maxillary conventional dentures and either mandibular overdentures supported by two implants with ball attachments or conventional dentures. Participants rated their general satisfaction, as well as other features of their dentures (comfort, stability, ability to chew, aesthetics, etc.) prior to treatment and 6 and 12 months after delivery. RESULTS: Ratings of satisfaction with IODs were significantly higher than with CDs. Six months after delivery, females in the CD group rated their general satisfaction and satisfaction with ability to chew and aesthetics significantly lower than did the males. The sex differences in the CD group remained at 12 months after delivery. However, males and females in the IOD group rated their general satisfaction and all six subcategories equally. CONCLUSIONS: Elderly females are less satisfied with conventional dentures than elderly males with regards to aesthetics and ability to chew, but equally satisfied with implant overdentures. At 6 and 12 months after delivery, elderly edentulous males and females wearing mandibular implant overdentures were significantly more satisfied than those wearing conventional dentures.     

Relationship between prosthodontic evaluation and patient ratings of mandibular conventional and implant prostheses

PURPOSE: The purpose of this study was to compare clinicians' ratings of the state of oral tissues and their satisfaction with treatment to edentulous patients' ratings of treatment success after provision of mandibular implant overdentures or conventional dentures. MATERIALS AND METHODS: Sixty subjects randomly received either mandibular overdentures retained by two implants (n = 30) or new conventional mandibular complete dentures (n = 30). All were given new conventional maxillary dentures. Baseline measures included clinical evaluation of the oral soft and hard tissues. Patients rated their general satisfaction before and after treatment, as well as their satisfaction with stability, speech, and esthetics on visual analogue scales. The treating prosthodontist rated the dentures for the same categories. Patient and clinician ratings were compared using correlations, t tests, and linear regression. RESULTS: None of the clinical variables were significantly correlated with patient satisfaction before or after treatment. The prosthodontist rated mandibular implant overdentures significantly better than conventional dentures regarding general satisfaction, stability, speech, and esthetics. Implant overdentures were also easier to fabricate (P < .0001). The prosthodontists' scores were not significantly correlated with patient scores for any question. CONCLUSION: Clinicians' assessments of the quality of denture-supporting tissues are poor predictors of patient satisfaction with mandibular implant or conventional prostheses. Prosthodontists and patients both rate mandibular implant overdentures as significantly superior to conventional dentures, but patients and clinicians do not usually agree when evaluating individual prostheses.     

Implant retained overdentures for two patients with severe lichen planus: a clinical report

Lichen planus is a common inflammatory mucocutaneous disease that often manifests itself intraorally. Oral lichen planus can appear in many forms; the most significant form for the edentulous patient is the erosive variety. For the patient, wearing a complete denture is quite dramatic because of the friability of the tissue. Implant-supported overdentures are a predictable treatment for edentulous patients, but this has been discouraged for the patient with erosive lichen planus. This article describes 2 patients with oral erosive lichen planus who were successfully treated with implant-retained mandibular overdentures.     

Patient satisfaction with mandibular implant overdentures and conventional dentures 6 months after delivery

Purpose

This study examined patient satisfaction with conventional complete dentures and mandibular implant overdentures opposing conventional maxillary dentures 6 months after delivery.

Materials and Methods

Sixty edentulous subjects (aged 65 to 75 years) were randomly assigned to either a mandibular conventional denture or an overdenture supported by two implants with ball-shaped retentive anchors. Patients rated their general satisfaction and other features of their prostheses, together with their ability to eat certain food items, on 100-mm visual analogue scales before assignment, and after 2 and 6 months.

Results

Both treatment groups reported greater satisfaction with their new prostheses at 6 months. General satisfaction ratings were higher in the implant group than in the conventional denture group by approximately 36% (mean difference 22.3 mm). The implant group also rated comfort (mean difference 22.4 mm), stability (mean difference 28.5 mm), and ability to chew (mean difference 17.3 mm) significantly higher. Significantly higher scores were also given by the implant group for their ability to chew certain hard foods. A trend for an increase in the differences between the groups, in favor of the implant group, was observed between the 2- and 6-month recalls, although the increase was only significant for ease of cleaning. The primary influence on general satisfaction 6 months after the delivery of the prostheses was the provision of the two-implant overdenture.

Conclusion

Edentulous seniors who received mandibular implant overdentures opposing a conventional denture rated their general satisfaction approximately 36% higher than did a comparable group provided with new conventional dentures.