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The Journal of Prosthetic Dentistry Feb 2024Evidence regarding the retention system for a mandibular overdenture is important for treatment planning. However, the clinical performance of stud and ball attachments... (Meta-Analysis)
Meta-Analysis Review
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.
Topics: Humans; Denture, Overlay; Quality of Life; Dental Prosthesis, Implant-Supported; Denture Retention; Dental Implants; Mandible; Patient Reported Outcome Measures
PubMed: 35931572
DOI: 10.1016/j.prosdent.2022.02.006 -
Journal of Prosthodontics : Official... Apr 2020This systematic review was undertaken to establish the most favourable protocol to treat an edentulous mandible with a single implant-retained overdenture. The... (Meta-Analysis)
Meta-Analysis
PURPOSE
This systematic review was undertaken to establish the most favourable protocol to treat an edentulous mandible with a single implant-retained overdenture. The formulated PICO question was: "Which surgical and prosthetic protocols result in the highest survival and complication rates of implants and prostheses employed in a single implant retained overdenture for the rehabilitation of a completely edentulous mandibular ridge?"
MATERIALS AND METHODS
A structured literature search was conducted using the following databases; PubMed, ScienceDirect, COCHRANE, LILACS, IndeMED, OVID, EMBASE, NIH Clinical Trials for reports related to the single implant-retained overdenture treatment. Only English articles were included. Publications with a minimum follow up time of 1 year and above were included for meta-analysis. A Poisson regression model was applied to estimate the survival rates of the implant and prosthesis employed.
RESULTS
The electronic database search yielded 2083 titles and abstracts; and a total of 17 were selected for the systematic review, of which 11 studies were subjected to meta-analysis. The implants showed high estimated five and 10-year survival rates of 91.93% and 84.62%, respectively. Implants that were delayed loaded showed the greatest survival rates, while immediately loaded implants presented with higher survival rates at five (p = 0.849) and 10 years (p = 0.464) when compared to early loaded implants. The greatest number of fractures were associated with ball abutments with an event rate of 10.8 (95% CI: 10.5-11.09) per 100 prosthesis years, while locator abutments showed a greater number of maintenance events with an event rate of 16.84(95% CI:16.01-17.66) per 100 prosthesis years.
CONCLUSION
Single implant-retained overdenture treatment is a cost-effective, minimally invasive and simple treatment that can be used to restore function and aesthetics to edentulous patients, with relatively high implant and prosthesis success rates and minimal complications.
Topics: Dental Implants; Dental Prosthesis, Implant-Supported; Denture, Overlay; Esthetics, Dental; Humans; Jaw, Edentulous; Mandible
PubMed: 31849146
DOI: 10.1111/jopr.13133 -
The Journal of Prosthetic Dentistry May 2021Evidence provided by implant-supported mandibular overdenture research on different loading protocols is important. However, methodological inconsistency, as well as... (Meta-Analysis)
Meta-Analysis
STATEMENT OF PROBLEM
Evidence provided by implant-supported mandibular overdenture research on different loading protocols is important. However, methodological inconsistency, as well as inadequate reporting of results, hampers a consistent decision in terms of clinical applicability.
PURPOSE
The purpose of this systematic review and meta-analysis was to evaluate whether immediate or early loading protocols can achieve comparable clinical outcomes when compared with a conventional loading protocol in edentulous patients rehabilitated with mandibular overdentures.
MATERIAL AND METHODS
In accordance with the Participant, Intervention, Comparison, Outcome strategy, prospective clinical studies without restrictions as to language or follow-up period were included. The Cochrane collaboration and ROBINS-I tools were used for quality assessment and risk-of-bias evaluation. The follow-up for the different outcomes ranged from 3 to 168 months, with the focus on implant success and survival rates, marginal bone loss, bleeding on probing, probing depth, plaque index, and the implant stability quotient. Statistical analyses in which standard mean differences were applied with a 95% confidence interval when continuous data were included were performed. For dichotomous data, risk difference was adopted.
RESULTS
The search strategy resulted in 14 234 references. Twenty-three studies fulfilled the inclusion criteria. Meta-analysis showed statistically significant differences for plaque index at 12 months (standard mean difference=0.284 [0.022, 0.545], P=.033, I=35%), probing depth at 36 months (standard mean difference=0.460 [0.098, 0.823], P=.013, I=0%), and on pooled results for plaque index (standard mean difference=0.157 [0.031, 0.284], P=.015, I=18%) in which the conventional loading protocol presented lower indices than those of immediate loading protocol or early loading protocol. Implant stability quotient presented a statistically significant difference only at 3 months (standard mean difference=0.602 [0.309, 0.895], P<.001, I=0%) with higher values for the conventional loading protocol. For the other parameters, statistically significant differences (P>.05) were not found.
CONCLUSIONS
Immediate loading protocol or early loading protocolfor mandibular overdentures has been determined to be a well-established treatment and worthy of consideration in clinical practice.
Topics: Dental Implantation, Endosseous; Dental Implants; Dental Prosthesis, Implant-Supported; Denture, Overlay; Humans; Immediate Dental Implant Loading; Jaw, Edentulous; Mandible; Prospective Studies; Treatment Outcome
PubMed: 32684353
DOI: 10.1016/j.prosdent.2020.04.017 -
Quintessence International (Berlin,... 2020To evaluate the influence of implant splinting on peri-implant marginal bone level and implant failures in completely edentulous patients who have been rehabilitated... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
To evaluate the influence of implant splinting on peri-implant marginal bone level and implant failures in completely edentulous patients who have been rehabilitated with mandibular implant overdentures.
METHOD AND MATERIALS
A literature search of electronic databases (PubMed and Cochrane Central Register of Controlled Trials [CENTRAL]) was performed, with the last search conducted in July 2019. Randomized controlled trials with at least a 12-month follow-up period were selected. The review and meta-analysis were performed in accordance with PRISMA guidelines. Two comparisons were included in the meta-analysis: (1) Two-implant supported ball versus two-implant supported bar mandibular overdenture; (2): Two- versus four-implant supported bar mandibular overdenture.
RESULTS
Six randomized controlled trials fulfilled the inclusion criteria and were included in a quality assessment and meta-analysis. Pooled data revealed a nonsignificant difference in marginal bone level (I2 = 0%; P = 1; mean difference = 0.00; 95% CI -0.37 to 0.37) and implant failures (P = .24; risk ratio = 6.07; 95% CI 0.30 to 121.33) when two-implant ball overdentures were compared to two-implant bar overdentures. Similarly, there was no significant difference in marginal bone level (I2 = 59%; P = .59; mean difference = -0.16; 95% CI -0.73 to 0.41) or implant failures (I2 = 0%; P = .36; risk ratio = 2.03; 95% CI 0.45 to 9.16) when two- versus four-implant bar overdentures were compared.
CONCLUSION
Based on the findings of the meta-analysis, there is no influence of implant splinting on peri-implant marginal bone level and implant failures for completely edentulous patients rehabilitated with mandibular implant overdentures. However, this result should be interpreted with caution due to the limited number of analyzed studies, most of them considered at unclear risk of bias. Well-designed randomized controlled trials with follow-up periods of at least 5 years are highly recommended to establish evidence with regard to the influence of implant splinting on mandibular overdentures.
Topics: Dental Implants; Dental Prosthesis, Implant-Supported; Denture, Overlay; Humans; Jaw, Edentulous; Mandible; Mouth, Edentulous; Randomized Controlled Trials as Topic
PubMed: 32080685
DOI: 10.3290/j.qi.a44144 -
The International Journal of Oral &... 2022To evaluate the performance of fixed complete dental prostheses supported by axial and tilted implants after at least 3 years of follow-up. (Meta-Analysis)
Meta-Analysis
PURPOSE
To evaluate the performance of fixed complete dental prostheses supported by axial and tilted implants after at least 3 years of follow-up.
MATERIALS AND METHODS
An electronic search plus a hand search up to April 2021 was undertaken. Clinical studies were selected using specific inclusion criteria, independent of the study design. The main outcomes were cumulative implant survival rate, marginal bone level changes, and complications, after ≥ 3 years of follow-up. The difference in outcomes between axial and tilted implants and between the maxilla and mandible was evaluated using meta-analysis and the Mantel-Cox test.
RESULTS
Out of 824 articles retrieved, 24 were included. In total, 2,637 patients were rehabilitated with 2,735 full prostheses (1,464 maxillary, 1,271 mandibular), supported by 5,594 and 5,611 tilted and axial implants, respectively. In a range between 3 and 18 years of follow-up, 274 implants failed. The cumulative implant survival rate was 93.91% and 99.31% for implants and prostheses, respectively. The mean marginal bone level change was moderate, exceeding 2 mm in only two studies. Marginal bone loss was significantly lower around axial compared with tilted implants (P < .0001), whereas it was not affected by arch (maxilla vs mandible; P = .17).
CONCLUSION
Fixed complete dental prostheses supported by tilted and axially placed implants represent a predictable option for the rehabilitation of edentulous arches. Further randomized trials are needed to determine the efficacy of this surgical approach and the remodeling pattern of marginal bone in the long term.
Topics: Dental Implantation, Endosseous; Dental Implants; Dental Prosthesis Design; Dental Prosthesis, Implant-Supported; Follow-Up Studies; Humans; Jaw, Edentulous; Maxilla; Treatment Outcome
PubMed: 36170316
DOI: 10.11607/jomi.9710 -
International Journal of Oral and... Jul 2022The aim of this systematic review was to investigate whether the presence of third molars (3Ms) during sagittal split osteotomy of the mandible increases the risk of... (Meta-Analysis)
Meta-Analysis Review
The aim of this systematic review was to investigate whether the presence of third molars (3Ms) during sagittal split osteotomy of the mandible increases the risk of complications. Searches were conducted using MEDLINE via PubMed, LILACS, Cochrane Central, Scopus, DOSS, and SIGLE via OpenGrey up to December 2020. Fifteen articles were included for evaluation and 14 in the meta-analysis, with a total of 3909 patients and 7651 sagittal split osteotomies (670 complications). Inferior alveolar nerve (IAN) exposure in the proximal segment was the most frequent complication (n = 409), followed by bad splits (n = 151). Meta-analysis revealed no significant increase in the incidence of 3M-related IAN exposure (P = 0.45), post-surgical infections (P = 0.15), osteosynthesis material removal (P = 0.37), or bad splits (P = 0.23). The presence of 3Ms was associated with a reduced risk of nerve disorder (P = 0.05) and favoured bad splits in the lingual plate (P = 0.005). The quality of evidence was very low, mainly due to non-randomized study designs, high risk of bias, inconsistency, and imprecision. This systematic review suggests that the removal of 3Ms before sagittal mandibular osteotomy does not reduce the incidence of complications. Thus, we recommend future better-designed studies with rigorous methodologies and adjustments for confounding factors.
Topics: Humans; Mandible; Mandibular Nerve; Mandibular Osteotomy; Molar, Third; Osteotomy, Sagittal Split Ramus; Risk Factors
PubMed: 34953646
DOI: 10.1016/j.ijom.2021.12.004 -
Clinical Oral Implants Research Apr 2020This review evaluated the change in treatment outcomes after conversion from conventional removable partial denture (RPD) to implant-assisted removable partial denture... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
This review evaluated the change in treatment outcomes after conversion from conventional removable partial denture (RPD) to implant-assisted removable partial denture (IARPD). The patient-reported outcome measures (PROMs), objective parameters for evaluation of functional performance, and biological and mechanical complication were evaluated.
MATERIALS AND METHODS
This systematic review was based on the Cochrane review methodology and followed the criteria of the preferred reporting items for systematic reviews and meta-analyses (PRISMA). We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, Web of Science, and Scopus up to April 3, 2019. After the initial search, additional electronic and hand searches were performed to identify further studies, ongoing studies, and gray literature, without restrictions on language, year of publication, or publication type.
RESULTS
In total, 6,544 non-duplicate articles were identified, and 31 were eligible for full-text search. Finally, 19 publications based on 13 independent studies were selected. In the meta-analysis, general patient satisfaction was significantly increased (p < .05), and the improved mastication was remarkable oral function. In oral health-related quality of life, the oral health impact profile score was significantly improved, and improvements of physical pain and psychological disability were prominent (p < .05). Masticatory performance was improved in terms of maximum bite force, active occlusal contact area, and mandibular jaw movement (p < .05). The weighted mean survival rate of implants was 96.60%.
CONCLUSIONS
After conversion from conventional RPD to IARPD, the PROMs and masticatory performance significantly improved in partially edentulous patients under mandibular Kennedy classification I.
Topics: Dental Implants; Dental Prosthesis, Implant-Supported; Denture, Partial, Removable; Humans; Mandible; Mastication; Patient Satisfaction; Quality of Life
PubMed: 31945212
DOI: 10.1111/clr.13574 -
Journal of Stomatology, Oral and... Jun 2022We aimed to evaluate whether there is a consensus among bi- (2D) and three-dimensional (3D) evaluations of mandible condyle position and its rotation center. Also, if...
We aimed to evaluate whether there is a consensus among bi- (2D) and three-dimensional (3D) evaluations of mandible condyle position and its rotation center. Also, if this data can be replicated in orthognathic surgery planning. The survey was carried out on the major databases (PubMed, SCOPUS, Embase, Cochrane). Human or human bio models evaluations in 2D or 3D of mandibular condylar position concerning its fossa and rotational axis for orthognathic surgery planning were eligible. The heterogeneity of the studies and uncertainties in methodological biases did not allow us to identify the superiority of 2D or 3D methodology in determination of the condylar rotational axis. There is a lot of divergences in the definition of occlusal relationships among dental specialties. Although there was no consensus regarding condylar position in relation to the fossa, the most reported axis of rotation was positioned posterior-inferior. Weak scientific evidence and divergences in dental vocabulary shows the need for clinical studies with more accurate and transparent methodological design to standardize concepts. Despite we cannot affirm, we can suggest that the centric relation (CR) is not the condylar position when clinically manipulated in the posterior superior direction. This condylar position is the retruded contact position (RCt) while CR is the functional position of the condyle. In this way, the orthognathic surgery has two occlusal relationships during planning and execution. The ideal axis of rotation for orthognathic surgery planning must be fixed, permit individualization for each condyle and be reproducible. The 2D planning is obsolete as cannot provide all the necessary tools for an accurate planning.
Topics: Humans; Mandibular Condyle; Orthognathic Surgery; Orthognathic Surgical Procedures; Rotation
PubMed: 34237437
DOI: 10.1016/j.jormas.2021.06.004 -
The Journal of Prosthetic Dentistry Dec 2022Healing abutments and attachments have been used for implant-supported removable partial dentures (ISRPDs). However, the effects of these abutments and attachments on... (Review)
Review
STATEMENT OF PROBLEM
Healing abutments and attachments have been used for implant-supported removable partial dentures (ISRPDs). However, the effects of these abutments and attachments on the clinical outcomes of the implants and prostheses are elusive because of the lack of standardized research protocols.
PURPOSE
The purpose of this systematic review was to determine the clinical outcomes of mandibular distal extension ISRPDs with healing abutments and attachments by analyzing qualified studies.
MATERIAL AND METHODS
An electronic and manual literature search was conducted on PubMed, Web of Science, Scopus, Embase, and Cochrane Library databases including articles published in English from 1980 to 2020. Publications of clinical outcome studies on the mandibular distal extension ISRPDs with healing abutments or attachments were screened by inclusion and exclusion criteria. Clinical outcomes of removable partial dentures (RPDs) and ISRPDs with different types of abutments or attachments were compared by using patient-reported outcome measures, implant survival rate, masticatory performance, and implant- or prosthesis-related complications. Study designs and clinical outcome data were extracted and analyzed. The evidence of the selected studies and degree of recommendation were made according to the Oxford Centre for Evidence-based Medicine, and the risk of bias of the studies was assessed based on Newcastle-Ottawa criteria.
RESULTS
Of 541 articles initially identified after removing duplicate records, 11 articles were selected by applying the inclusion and exclusion criteria, by inter-viewer agreement, and by hand searching. Nine prospective cohort studies, 1 retrospective cohort study, and 1 randomized controlled trial were included with evidence levels assessed at 1b, 2b, and 2c. The risk of bias varied from 5 to 8 out of 9. Patient overall satisfaction, oral health-related quality of life (OHRQoL) scores, and masticatory ability were significantly improved for ISRPDs with either healing abutments, ball, or LOCATOR attachments when compared with RPDs. The implant survival rate varied from 92% to 97% at 2 to 10 years for ball attachment and was 100% at 1 year for LOCATOR attachment-supported ISRPDs. Marginal bone loss (MBL) varied from 0 to 1 mm in all studies, although LOCATOR attachments had significantly less MBL compared with ball attachments. The maximal pocket depth and bleeding on probing index around implants at 1 year were 1.7 to 1.8 mm and 0.1 to 0.3. Loose healing caps were the main mechanical complication of implants. There were more prosthetic complications in ISRPDs with ball attachments than RPDs at 10-year follow-up, including gold matrix loosening, loss of retention, and denture base fractures. No direct comparisons were made of patient-reported outcomes or prosthetic complications between ball and LOCATOR attachment-supported ISRPDs.
CONCLUSIONS
Healing abutments and attachments (ball or LOCATOR) improved patient-reported outcomes and the masticatory function of mandibular distal extension ISRPDs. However, insufficient evidence was found to determine the relative effectiveness of different attachment systems on the clinical outcomes of mandibular distal extension ISRPDs. Abutment loosening was the most frequent mechanical complication for healing abutments. More prosthetic complications were associated with ball attachment-supported ISRPDs than RPDs. The major weaknesses of this systematic review were the relatively moderate level of evidence and the publication language, since implant attachments are used in many non-English speaking countries.
Topics: Humans; Denture, Partial, Removable; Denture Retention; Dental Prosthesis, Implant-Supported; Dental Implants; Quality of Life; Prospective Studies; Retrospective Studies; Mandible; Denture, Overlay
PubMed: 34301416
DOI: 10.1016/j.prosdent.2021.04.008 -
Journal of Prosthodontic Research Jul 2022To evaluate the effect of overdenture (OD) attachment type and the number of implants supporting mandibular ODs on peri-implant health. (Meta-Analysis)
Meta-Analysis
PURPOSE
To evaluate the effect of overdenture (OD) attachment type and the number of implants supporting mandibular ODs on peri-implant health.
STUDY SELECTION
From inception to October 2020, electronic databases (Medline/PubMed, Embase, Cochrane Library, and Scopus) were systematically searched. The outcomes of interest were marginal bone loss (MBL), pocket probing depth (PPD), plaque index, bleeding index, and implant survival rate. Bayesian network meta-analysis was performed using the GeMTC package supported by R. The weighted mean difference and 95% credible interval were estimated.
RESULTS
Twenty-eight studies with a total of 1166 participants who received 2666 dental implants were included. Except for 4 bar and 4 telescopic, which showed a statistically lower MBL than the 2 locator, all other interventions showed insignificant differences in MBL (P > 0.05). The difference in periodontal probing depth was not statistically significant when comparing the different groups. The pooled implant survival rates of the different interventions ranged from 88.9% to 100%. The rank probability test showed that 4 bar and 4 telescopic had the lowest MBL, 2 magnet and 2 bar had the highest PI, whereas 4 locator showed the least PPD.
CONCLUSION
Except for 4 implants+bar, or telescopic, and 4 locator that, respectively, showed less MBL and PPD compared to some interventions, it seemed that different attachment types and number of implants supporting mandibular ODs have no clear superiority over the other in terms of peri-implant health outcomes.
Topics: Bayes Theorem; Dental Implants; Dental Prosthesis, Implant-Supported; Denture, Overlay; Humans; Jaw, Edentulous; Mandible; Network Meta-Analysis
PubMed: 34588403
DOI: 10.2186/jpr.JPR_D_21_00073