The effectiveness of 2‐implant overdentures – a pragmatic international multicentre study

Summary The purpose of this multicentre observational study was to determine patient satisfaction with either conventional dentures or mandibular 2‐implant overdentures in a ‘real world’ setting. Two hundred and three edentulous patients (mean age 68·8 ± 10·4 years) were recruited at eight centres located in North America, South America and Europe. The patients were provided with new mandibular conventional dentures or implant overdentures supported by two implants and ball attachments. At baseline and at 6 months post‐treatment, they rated their satisfaction with their mandibular prostheses on 100‐mm visual analogue scale questionnaires. One hundred and two (50·2%) participants had valid baseline and 6‐month satisfaction data. Although both groups reported improvements, the implant overdenture group reported significantly higher ratings of overall satisfaction, comfort, stability, ability to speak and ability to chew. These results suggest that edentulous patients who choose mandibular implant overdentures have significantly greater improvements in satisfaction, despite their relatively higher cost, than those who choose new conventional dentures.     

Attachment‐Retained Gingival Prosthesis for Implant‐Supported Fixed Dental Prosthesis in the Maxilla: A Clinical Report

The rehabilitation of edentulous maxillae is a complex procedure due to the involvement of esthetic and functional requirements. A trial maxillary denture can be used to identify the need for adequate upper lip support when replacing removable complete dentures by implant‐fixed dental prostheses. This clinical report describes the outcome of the rehabilitation of an edentulous atrophic maxilla with unfavorable maxillomandibular relationship and deficient upper lip support. A trial denture was fabricated and used to diagnose the need for a prosthesis capable of restoring the upper lip support. The reduced upper lip support was also confirmed by a lateral cephalogram. The patient was rehabilitated by an implant‐fixed dental prosthesis associated with an attachment‐retained gingival prosthesis. The case presented shows that when loss of upper lip support is detected and the patient does not wish to undergo further surgical reconstruction procedure, the retention of a gingival prosthesis using a ball attachment is a satisfactory treatment option.     

The impact of dietary advice on edentulous adults' denture satisfaction and oral health‐related quality of life 6 months after intervention

Objective: The aim of this study was to compare the impact of customised dietary advice on patients' satisfaction with their dentures and oral health‐related quality of life (OHRQoL) in patients wearing implant‐supported mandibular overdentures (IOD) or conventional dentures (CD). Materials and methods: In this prospective cohort study, 28 IOD (two implant‐retained mandibular overdenture) and 26 CD patients completed a denture satisfaction scale and the 20‐item oral health impact profile (OHIP‐20) before and 6 months following provision of customised dietary advice. Results: At 6 months following provision of individualised dietary advice, the IOD group showed significantly greater satisfaction than the conventional group for denture comfort (80.6, ± 15.6, vs. 68.7 ± 15.6 P=0.001), stability (75.8 ± 15.9 vs. 59.5 ± 30.4, P=0.002), and perceived chewing ability (79 ± 30.4 vs. 59.5 ± 30.4, P=0.027) ± when adjusted for baseline scores. Before delivery of the dietary advice there were no significant differences between groups for Satisfaction or OHIP scores. No difference in OHRQoL was seen between groups. Conclusions: The delivery of customised dietary advice to edentulous patients impacts differently on their satisfaction with denture comfort, stability and chewing ability depending on the nature of their prosthesis. This re‐evaluation of satisfaction occurs when edentulous patients challenge themselves to consume more fruits, vegetables and fibre‐rich foods. The IOD group reported an increased level of satisfaction and perceived chewing ability whereas it appeared that CD wearers may have had their awareness of the shortcomings of this sort of prosthesis reawakened. To cite this article:
Ellis JS, Elfeky AF, Moynihan PJ, Seal C, Hyland RM, Thomason M. The impact of dietary advice on edentulous adults' denture satisfaction and oral health‐related quality of life 6 months after intervention.
Clin. Oral Impl. Res. 21 , 2010; 386–391.
doi: 10.1111/j.1600‐0501.2009.01859.x     

A Novel Approach for Converting a Mandibular Complete Denture to a Fixed Interim,Screw‐Retained Implant Prostheses: A Case Report

For most of the last century, conventional complete dentures have been the standard of care and the most common treatment for edentulous patients. Technological advancements in fabrication techniques may significantly reduce the number of office visits required to fabricate complete dentures. Immediate occlusal loading with mandibular full arch prostheses has been extensively researched and is now one of the standards of care for edentulous patients. A clinical technique for converting a mandibular immediate complete denture to an interim full arch, screw‐retained fixed prosthesis with novel implant restorative components for immediate loading on four implants is described.     

Three-year clinical outcome of single implant-retained mandibular overdentures--results of preliminary prospective study

Objectives

The aim of this preliminary prospective study was to evaluate the clinical outcome, the oral health-related quality of life (OHRQoL), and the subjective chewing ability of patients with mandibular complete dentures retained by a single implant placed in the mandible midline.

Methods

Patients wearing complete dentures were treated with a single implant in the mandible, followed by relining of the dentures and incorporation of ball attachments for implant retention. Implant outcome, prosthodontic maintenance, subjective chewing ability, and the oral health impact profile of the patients were assessed at baseline and at four weeks after connecting the denture and implant.

Results

Eleven patients were enrolled in this investigation, and the mean observation period was 43.4 months (minimum period: 35, maximum period: 52 months). No implants were lost during observation period, but four dentures needed repair because of the fracture of the denture base in the midline area. A significant improvement was observed in the OHRQoL of the patients after the attachment of the mandibular dentures with a single midline implant. Furthermore, the subjective chewing ability of the patients was significantly improved after implant connection.

Conclusions

Within the limitations of this preliminary prospective clinical study, single implant-supported mandibular overdentures were a successful treatment option for older edentulous patients who showed improvements in their OHRQoL and chewing ability.     

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.     

Clinical evaluation of complete denture therapy: examiner consistency

Criteria were developed to clinically evaluate denture base stability and retention. Six completely edentulous subjects participated in the study. Each patient was treated with two sets of complete dentures. Six prosthodontists who were not involved in the patients' treatment evaluated the stability and retention of each denture at the delivery appointment and weekly for the following 2 weeks by means of criteria in a standardized form. Evaluation of stability and retention for maxillary and mandibular complete dentures worn during weeks 1 and 2 were compared with the evaluations made at the delivery appointment for each denture. In tabulation of the data, the criteria considered reliable were mandibular denture retention, maxillary denture retention evaluated unilaterally, and maxillary denture stability. In each category most examiners rated the judgments the same or better when compared with the delivery appointment data for each patient.     

Single mandibular implant study – denture satisfaction in the elderly

To investigate whether there are differences in patients’ denture satisfaction when an implant placed in the midline of the edentulous mandible is loaded either immediately or three months later, after second‐stage surgery. One hundred and fifty‐eight edentulous patients received a single implant in the midline of the mandible. After randomisation, it was loaded either immediately after implant placement (N = 81, group A) or three months later, after a submerged healing phase and a second‐stage surgery (N = 77, group B). Patients’ denture satisfaction aspects were assessed, using visual analogue scales (VAS), before treatment, one month after implant placement during the submerged healing phase (only group B) and one and four months after implant loading. The statistical analysis was performed using the Wilcoxon signed‐rank and rank‐sum tests. One month after loading, a significant improvement in comfort, function and stability of the mandibular denture could be observed in both groups (P ≤ 0·05). A slight but not significant improvement was found between one and four months after loading. Patients with second‐stage surgery and delayed loading rated the stability and fit of the mandibular denture as significantly better than patients who had immediate loading. A single implant in the edentulous mandible significantly increased patients’ denture satisfaction. After four months, stability and fit of the mandibular denture were considered better when a delayed loading protocol had been followed. A single mandibular implant in the edentulous mandible significantly increases patients’ denture satisfaction, regardless of the loading protocol.     

Association between self‐assessment of complete dentures and oral health‐related quality of life

The purpose of this study was to determine which factors related to patient self‐assessment of dentures are associated with changes in oral health‐related quality of life (OHRQoL) among edentulous patients after replacement of complete dentures, and to determine whether masticatory performance as determined using an objective method affects the changes in OHRQoL among edentulous patients. As a preliminary study, the existing questionnaire regarding self‐assessment of dentures consisting of 39 question items, measured with a 100‐mm visual analogue scale, was analysed by factor analysis. Then a questionnaire, composed of 22 question items, was developed containing six subscales of ‘function’, ‘lower denture’, ‘upper denture’, ‘expectation’, ‘aesthetic and speech’ and ‘importance’. Final participants in the present study comprised 93 edentulous patients requiring new conventional complete dentures (44 men, 49 women; mean age, 75·0 years). These patients were asked to complete the Japanese version of the Oral Health Impact Profile (OHIP)‐EDENT, comprising 19 question items for assessment of OHRQoL in edentulous patients, along with the developed questionnaire regarding self‐assessment of dentures. Moreover, masticatory performance was measured using a colour‐changeable chewing gum. The questionnaire and measurement were completed twice; before and after replacement of complete dentures. Stepwise multiple regression analysis identified ‘lower denture’ and ‘aesthetic and speech’ as significant independent variables besides OHIP‐EDENT scores before replacement. These results suggest that sufficient retention of lower dentures and appropriate appearance may lead to improved OHRQoL in edentulous patients.     

Replacement of a mandibular implant-fixed prosthesis with an implant-supported overdenture to improve maintenance and care

PatientsA 69-year-old woman presented to the Osaka University Dental Hospital. She had two chief complaints, (a) food accumulation under the lower teeth and (b) poor maxillary denture retention while eating. On clinical examination the patient presented with a maxillary complete denture and fixed mandibular implant prosthesis. For preventing food accumulation under the fixed implant prosthesis and to keep the maxillary denture stable by providing posterior occlusal contact for bilaterally balanced occlusion, the use of a mandibular implant-supported overdenture with self-adjusting magnetic attachments provided a prosthetic solution for this patient. After provided the new dentures, the patient was pleased and was comfortable with the aesthetic, stability and retention of the dentures. There were no discernable clinical or radiographic changes after 1 year of use.DiscussionTo prevent food accumulation beneath the fixed implant prosthesis and maintain the stability of the maxillary denture by providing posterior occlusal contact for bilaterally balanced occlusion, a mandibular implant-retained overdenture with magnetic attachments was used to provide a prosthetic solution for this patient.ConclusionIn this clinical case, an implant-fixed prosthesis in the edentulous mandibular region was replaced into an implant-supported overdenture with considerations for (a) preventing the food accumulation beneath the lower prosthesis, (b) achieving the proper occlusion in the posterior part for maxillary denture stability and (c) ease of maintenance and care for the prostheses.     

Neutral zone or conventional mandibular complete dentures: a randomised crossover trial comparing oral health‐related quality of life

There is widespread consensus that the neutral zone (NZ) concept contributes to improved stability for mandibular complete dentures (CDs). However, little is known about its impact on oral health‐related quality of life (OHRQoL) of edentulous patients compared to conventionally (CV) manufactured dentures. In this prospective crossover trial, performed at the Oral Health Centre of the University of the Western Cape, CV and NZ mandibular dentures were made for each patient. Scores from the 20‐item oral health impact profile (OHIP‐20) for both types of dentures were compared with pre‐treatment scores using paired t‐tests. Treatment effect size (ES) was established. Associations of OHIP‐20 scores and several patient variables (age, gender, period of edentulousness, quality of the denture‐bearing tissue, denture dimensions, preference) were performed using the generalised linear model. Significance was set at P = 0·05. Records of thirty‐five participants were included in the study (mean age of 62·3 years, range 47–85 years). There were highly significant differences between pre‐treatment and both post‐treatment OHIP‐20 scores with t = 6·470 for CV and t = 6·713 for NZ. Treatment ES was large for both types of dentures (>0·8). Difference of ES between NZ and CV dentures was small (ES < 0·2). None of the patient variables showed significant associations with OHIP‐20 scores of the two types of dentures, except for preference and NZ OHIP‐20 scores. For this group of patients, both treatment methods improved OHRQoL significantly and patient‐related factors did not influence impact on OHRQoL differently for both interventions.     

Occlusal contacts of edentulous patients with mandibular hybrid dentures opposing maxillary complete dentures.

The purpose of this study was to evaluate differences between the occlusal contacts of edentulous patients with mandibular implant-supported hybrid dentures opposing maxillary complete dentures and those of patients with conventional maxillary and mandibular complete dentures. Six parameters related to occlusion were measured in the 2 groups (n = 40 for each group) using pressure-sensitive film. The mean values generated by each test group for each parameter were compared using a t test. Pearson's correlation coefficients between occlusal force, age, and time in function were examined. Occlusal force and area in the implant denture wearers were larger than those in the conventional denture wearers. No significant difference was seen in occlusal force balance between the left and right sides. The center of occlusal load in the implant denture wearers was more anterior. The maxillary denture may become more unstable in implant denture wearers. It is suggested that the stability and retention of a maxillary denture be checked and the occlusion be adjusted more frequently in the hybrid denture wearer than in the conventional denture wearer.     

An investigation of factors influencing patients' use of new complete dentures using structural equation modelling techniques

A review of the literature demonstrated that research had not identified a set of prognostic indicators for prospective complete denture patients, with different authors publishing contradictory results. OBJECTIVE: To investigate possible relationships between patient and clinical factors and denture wear and use of dentures for eating. METHODS: Patients attending Guy's Dental Hospital, London, for provision of complete dentures were recruited. For each patient relevant history was recorded and an examination of the edentulous mouth and existing dentures, where present, was undertaken at the beginning of treatment. At the first post-insertion appointment the edentulous mouth, previous and new dentures were examined. Three months after the review appointment patients were sent a postal questionnaire to assess patient use of dentures and patient satisfaction. Data were analysed using structural equation modelling techniques. RESULTS: 723 patients were recruited. Significant relationships were found between quality of complete dentures and patients' use of complete dentures and between quality of residual edentulous ridges and patients' use of complete dentures. These results contrast with most previous research into prognostic indicators for success in complete denture treatments. CONCLUSIONS: Quality of residual edentulous ridges and quality of new complete dentures predict patients' use of new complete dentures.     

Mandibular Kennedy Class I implant‐tooth‐borne removable partial denture: a systematic review

Summary The purpose of this systematic review is to evaluate the use of implant‐tooth‐borne removable partial dentures in prosthetic rehabilitation of Kennedy Class I partially edentulous arches. A comprehensive search was performed in MEDLINE, EMBASE, Cochrane Oral Health Group’s Trials Register, Cochrane Central Register of Controlled Trials, UK National Research Register, Australian New Zealand Clinical Trials Registry (ANZCTR), conference proceedings and abstracts up to 25 August 2009. Searching the reference list of the selected articles and hand searching of several journals were also performed. A total of nine studies were included. Of these, two were randomized, three were retrospective and four were case reports. All but two had a low reporting quality (level IV on a four‐level hierarchy of evidence). Nevertheless, the improvement in function, aesthetics and stability has been demonstrated in all studies with minimal prosthetic care. Within the limitations of this study, implant‐assisted/supported removable partial denture may provide a simple, economical and less invasive treatment modality. The predictability of such approach in the management of bilateral distal‐extension situation is, however, still questionable. A higher quality of published studies namely with a focus on long‐term randomized clinical trials are needed.     

Mandibular implant-supported removable partial denture with distal extension: a systematic review

Summary The aim of this article is to investigate patient satisfaction, survival rate of implants, and prosthetic complications or maintenance for rehabilitation with removable partial dentures associated with implants in mandibular Kennedy class I and II cases. A systematic literature review was conducted by three independent reviewers including articles published from January 1981 through September 2011. Medline and Cochrane Library electronic databases were used in addition to hand searching to assess clinical outcomes for mandibular implant-supported removable partial denture with distal extension. This review yielded 1751 records that were narrowed down to 5. The studies revealed implant survival rates ranging from 95% to 100% with one failure reported of 98 implants. The removable partial dentures associated with implant in mandibular free-end arches showed some complications and need of repair for relining, pitting of the healing abutment, replacement of resilient component of the attachment, damage in framework, screw loosening and damage in acrylic denture base. Patient satisfaction was evaluated through a five-point questionnaire, and results ranged between 4·12 and 5·0, considering 1 as the least favourable situation. The literature review showed increase in patient satisfaction and high survival rates of implants associated with mandibular removable partial dentures with distal extensions. However, some complications and need of prosthetic repair were reported. Although this treatment approach could represent a low-cost and beneficial rehabilitation for free-end mandibular ridges, the lack of controlled and randomised well-designed clinical trials suggests further studies with more representative samples to validate the outcomes of this treatment modality.     

下颌种植覆盖义齿修复后满意度的调查分析

目的 比较牙列缺失患者行下颌半口义齿和下颌种植覆盖义齿修复的主观感受。方法 对16例戴用下颌半口义齿后又行下颌种植义齿修复的患者，采用自拟修复前初诊问卷和种植修复后问卷调查，由患者本人就诊时填写。结果 种植固定义齿与下颌半口义齿在舒适、功能、固位等方面存在明显差异。结论 牙列缺失患者行下颌杆卡式种植覆盖义齿，较下颌半口活动义齿修复能更好地满足患者需求，获得高质量的义齿。     

The Social Solution—Denture Esthetics, Phonetics, and Function

Tooth loss and rehabilitation with dentures can have tremendous patient impact and social implications. In an image-conscious society, dentures restore a sense of normalcy and allow the patient the ability to interact with others. The most frequent denture complaints include chewing discomfort and objectionable esthetics and phonetics. Determining patient expectations and their influence on patient satisfaction with treatment is critical. Current evidence on functional outcomes, patient satisfaction, and cost-effectiveness of treatment with conventional dentures versus implants are important factors to consider during treatment planning for the edentulous patient. The purpose of this article is to review some exemplar literature for the successful treatment of the edentulous patient.     

Does a prosthodontist spend more time providing mandibular two-implant overdentures than conventional dentures?

PURPOSE: In this article, the time taken by a prosthodontist to fabricate and maintain mandibular overdentures retained by two implants and conventional dentures is compared. MATERIALS AND METHODS: Sixty edentulous patients between the ages of 65 and 75 completed a randomized clinical trial. All received new maxillary conventional dentures and either a mandibular conventional denture (n = 30) or a two-implant overdenture on ball attachments (n = 30). The time spent by the prosthodontist and the number of visits required for treatment, including both scheduled and unscheduled visits, were recorded for each patient from preliminary impressions to 6 months following delivery. Data from the two groups were compared using Mann-Whitney U tests. RESULTS: The prosthodontist spent a mean total time of 296 minutes in treating an implant overdenture patient and 282 minutes on a conventional denture patient during the period from preliminary impressions to the 6-month follow-up. The mean numbers of appointments were 10.1 (implant group) and 10.8 (conventional group). These differences were not significant. CONCLUSION: Although additional knowledge is required to treat patients with implant prostheses, the time required by the prosthodontist to provide two-implant mandibular overdentures with ball attachments was not significantly different than the time needed for conventional denture treatment.     

Immediate Loading of Two Implants with a Mandibular Implant‐Retained Overdenture: A New Treatment Protocol

Purpose: The aim of this study was to present the clinical outcomes of the immediate loading of two bar‐splinted implants retaining a mandibular overdenture. Materials and Methods: In a clinical trial, 124 edentulous patients were treated according to a new treatment concept, which involves the immediate loading of two bar‐splinted SLActive implants with an implant‐retained mandibular overdenture. The new conventional mandibular denture is used as a template for implant positioning and as an impression tray, and for mounting the retention clip by the dental laboratory. At the same day the implants are placed, the conventional denture is converted into an implant‐retained overdenture. During the healing and evaluation period, resonance frequency analysis (RFA) was undertaken to assess the effect of loading on implant stability and survival. Results: The survival rate of the implants was 98.8% during the evaluation period (12–40 months). Only 3 of the 248 implants were lost. During the healing (osseointegration) phase, the implant‐stability quotient increased significantly (p = .0001). During the evaluation period, four patients (3%) needed a relining of their mandibular overdenture, whereas 13 patients (11%) needed relining of the maxillary denture. Conclusions: Two interconnected implants can be successfully loaded by a mandibular overdenture at the same day of implant placement with a high survival rate of the implants. Only a few patients needed additional relining of the overdenture. Repeated RFA measurements can be useful in gauging implant stability and survival.