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Journal of Indian Prosthodontic Society 2021This systematic review aimed to compare different attachment systems used in mandibular implant supported overdentures by assessing outcomes such as prosthodontic... (Meta-Analysis)
Meta-Analysis Review
AIM
This systematic review aimed to compare different attachment systems used in mandibular implant supported overdentures by assessing outcomes such as prosthodontic maintenance and complication, peri implant tissue changes, retention, and patient satisfaction for optimum selection of attachment system.
SETTINGS AND DESIGN
This systematic review conducted following Preferred Reporting Items for the Systematic Review and Meta Analysis (PRISMA) guidelines.
MATERIALS AND METHODS
A systematic electronic literature search was conducted through PubMed, The Cochrane Central Register of Controlled Trials (Central), and Science direct. A hand search was also performed for individual journals and reference lists of selected studies. Randomized controlled clinical trials and crossover clinical trials from 2010 to 2020 with follow up of more than 1 year were included. The Cochrane Collaboration's tool was used for assessing the risk of bias of included studies.
STATISTICAL ANALYSIS USED
The statistical meta analysis was performed using Review Manager (RevMan) [computer program]. Version 5.4. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboation, 2020.
RESULTS
Six studies that met the inclusion criteria possess the low risk of bias with follow up of more than 1 year were included in this systematic review. Out of four outcomes, meta analysis was performed for prosthodontic maintenance and peri implant tissue changes. Due to the limited availability of data, retention and patient satisfaction were reviewed systematically without meta analysis. The result of meta analysis for ball versus magnet attachment showed statistically significant differences in prosthodontic complications and maintenance, and ball attachment reported fewer complications than the locator attachment (risk ratio [RR] =0.55, confidence interval [CI] =95%, P = 0.03). Peri implant tissue changes were analyzed in the included studies as probing depth and marginal bone loss. The result of meta analysis for probing depth showed no statistically significant difference between bar versus telescopic type of attachment (RR = 0.20, CI = 95%, P = 0.74). The meta analysis results for marginal bone loss showed no statistically significant difference between bar versus telescopic type of attachment (mean difference = 0.35, CI = 95%, P = 0.10).
CONCLUSION
It can be concluded from the current review that bar attachment provided the most superior retention. The telescopic attachment system not only showed the most favorable patient's satisfaction but also reported the least peri implant mucosal changes. The ball attachment system is a favorable choice for limited inter arch space and parallel implant placement.
Topics: Cross-Over Studies; Denture, Overlay; Humans; Jaw, Edentulous; Mandible; Patient Satisfaction
PubMed: 34810359
DOI: 10.4103/jips.jips_158_21 -
The Journal of Prosthetic Dentistry Dec 2022Prosthetic rehabilitation, especially with removable complete dentures (CDs), can contribute to speech problems, although the prevalence of the problem is unclear. (Review)
Review
STATEMENT OF PROBLEM
Prosthetic rehabilitation, especially with removable complete dentures (CDs), can contribute to speech problems, although the prevalence of the problem is unclear.
PURPOSE
The purpose of this systematic review was to examine the influence of implant-supported fixed complete dentures (FCDs), implant-supported overdentures, and removable CDs on speech articulation disorders in patients with at least 1 completely edentulous jaw.
MATERIAL AND METHODS
This study was prepared according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered in the International Prospective Register of Systematic Reviews (CRD42020182705). The PubMed/Medline, Embase, Web of Science, Scopus, Latin American and Caribbean Health Sciences, Brazilian Clinical Trials Registry, and Cochrane Library databases were searched through April 2020 to identify clinical trials comparing maxillary and/or mandibular implant-supported dentures with removable CD use in terms of speech articulation in participants with at least 1 completely edentulous jaw. The risk of bias of selected studies was assessed with the Joanna Briggs Institute critical appraisal tools, and the quality of evidence was tested by using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.
RESULTS
Initially, 2586 articles were identified, and their titles and abstracts were read. Sixteen articles were read in full, and 8 studies (4 paired clinical trials and 4 cross-sectional studies) were included in this review. In total, 290 prosthesis users aged 29 to 90 years, approximately 44 of whom had hearing difficulties, were included. Four studies had a low risk of bias, and 4 studies had a high risk of bias. Distortions of the /s/ phoneme were observed more often in the first 6 months of maxillary FCD use than with removable CD use. Speech articulation did not differ between mandibular FCD and removable CD users. The quality of evidence for speech articulation disorders was low.
CONCLUSIONS
Given the low quality of evidence on speech articulation disorders, further research on speech articulation disorders in prosthesis wearers is needed.
Topics: Humans; Dental Prosthesis, Implant-Supported; Speech; Cross-Sectional Studies; Dental Implants; Denture, Complete; Denture, Overlay; Jaw, Edentulous; Articulation Disorders; Patient Satisfaction
PubMed: 33865562
DOI: 10.1016/j.prosdent.2021.03.006 -
The Journal of Prosthetic Dentistry Nov 2023Standard-diameter dental implants are not always applicable because of anatomic limitations of the residual ridge. Thus, mini-implants have been increasingly used and... (Meta-Analysis)
Meta-Analysis Review
STATEMENT OF PROBLEM
Standard-diameter dental implants are not always applicable because of anatomic limitations of the residual ridge. Thus, mini-implants have been increasingly used and offer an alternative. However, data regarding prosthetic complications, maintenance factors, and clinical outcomes are limited.
PURPOSE
The purpose of this systematic review and meta-analysis was to compare prosthetic complications and maintenance events and clinical outcomes in residual ridges rehabilitated with mandibular implant overdentures (IODs) by using standard implants or mini-implants.
MATERIAL AND METHODS
Nine electronic databases were searched. Quantitative analyses to measure the risk ratio (RR) and standardized mean difference (SMD) were applied. Those methods were used to assess prosthetic complications and maintenance events (abutment adjustments, replacement of retentive element, occlusal adjustment, and overdenture fracture) and clinical outcomes related to postoperative pain, probing depth (PD), plaque index (PI), marginal bone loss (MBL), and implant survival rate.
RESULTS
Altogether, 7 publications were selected. Mini-implants presented reduced abutment adjustments (RR 0.23 [0.07, 0.73], P=.01), replacement of retentive element (RR 0.41 [0.31, 0.54], P<.001), occlusal adjustment (RR 0.53 [0.31, 0.91], P=.02), and overdenture fracture (RR 0.46 [0.23, 0.94], P=.03) compared with standard implants. Additionally, mini-implants presented lower values for PI at 6 months (SMD -0.27 [-0.47, -0.08], P=.006) and 12 months (SMD -0.25 [-0.46, -0.05], P=.01). No additional tangible differences were noted.
CONCLUSIONS
Mini-implants might be an alternative choice based on the number of prosthetic complications and maintenance events. This was also confirmed by the comparable clinical data between standard implants and mini-implants.
Topics: Humans; Dental Implants; Denture, Overlay; Dental Prosthesis, Implant-Supported; Alveolar Bone Loss; Mandible
PubMed: 35120735
DOI: 10.1016/j.prosdent.2021.11.010 -
The Journal of Prosthetic Dentistry Apr 2022A consensus based on patients' perceptions as to whether to use overdentures or fixed prostheses to rehabilitate mandibular edentulous arches is limited. (Meta-Analysis)
Meta-Analysis Review
Patient-reported outcome measures and clinical assessment of implant-supported overdentures and fixed prostheses in mandibular edentulous patients: A systematic review and meta-analysis.
STATEMENT OF PROBLEM
A consensus based on patients' perceptions as to whether to use overdentures or fixed prostheses to rehabilitate mandibular edentulous arches is limited.
PURPOSE
The purpose of this systematic review and meta-analysis was to compare the patient-reported outcome measures (PROMs) and clinical outcomes associated with implant-supported overdentures and fixed prostheses in edentulous mandibles.
MATERIAL AND METHODS
Nine electronic databases were searched for randomized clinical trials (RCTs) and nonrandomized clinical trials (N-RCTs). The risk of bias was assessed by the revised Cochrane risk of bias tool for RCTs (RoB 2) and N-RCT (ROBINS-I). Data sets for oral health-related quality of life (OHRQoL), satisfaction, survival rate, implant probing depth, and marginal bone loss were plotted, and the appropriate analyses were applied by using the Rev Man 5.3 software program. Certainty of evidence was also evaluated by means of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.
RESULTS
Ten eligible trials were included and evaluated quantitatively. For 3 domains of OHRQoL, fixed prostheses showed significantly higher quality of life when compared with overdentures regarding functional limitation (P<.001), physical disability (P=.001), and physical pain (P=.003). Fixed prostheses also improved satisfaction, when compared with overdentures for comfort (P=.02), ease of mastication (P<.001), retention (P<.001), and stability (P<.001). The same pattern was observed for overall OHRQoL (P=.01) and satisfaction (P=.01) in which fixed prostheses improved patient satisfaction. Only ease of cleaning presented greater satisfaction for the overdenture group. Clinical parameters did not differ statistically (P>.05) between both types of prosthesis.
CONCLUSIONS
Fixed rehabilitations for mandibular edentulous patients seem to be a well-accepted treatment from the patients' oral health perspective. However, mandibular overdentures are no less efficient than fixed prostheses in terms of clinical outcomes.
Topics: Dental Implants; Dental Prosthesis, Implant-Supported; Denture, Overlay; Humans; Jaw, Edentulous; Mandible; Mouth, Edentulous; Patient Reported Outcome Measures; Patient Satisfaction; Quality of Life
PubMed: 33390270
DOI: 10.1016/j.prosdent.2020.11.005 -
Clinical and Experimental Dental... Apr 2021The World Health Organization (WHO) recognizes edentulism as a physical impairment that results in a negative impact in the daily activities. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The World Health Organization (WHO) recognizes edentulism as a physical impairment that results in a negative impact in the daily activities.
OBJECTIVE
The study aimed to compare the satisfaction and the quality of life, in patients treated with implant retained overdentures with two mandibular implants (IOD) against those with mandibular conventional complete dentures (CCD).
METHODS
Different search strategies were used to screen for articles in Pubmed/Medline, Cochrane Library and Scielo of the last 17 years (2003-2020). The keywords used were: "quality of life OR satisfaction" AND "complete denture OR conventional denture" AND "overdenture OR implant retained."
RESULTS
Six articles and two more were added by manual search. The population was 400 in the CCD and 412 for IOD. The mean age was 64.3 ± 6.41 years. The group was comprised of 283 men and 427 women. The scores obtained in the visual analog scale (VAS) before and after the treatment were statistically significant in favor of the IOD for overall satisfaction, (WMD: 12.329; 95% CI: 4.873 to 19.784, p-value = 0.001), comfort, speech and stability. For esthetics and chewing there was non-significant improvement while hygiene worsened for the IOD. For the comparison after the treatment between both treatment modalities a statistically significant improvement was found in overall satisfaction (WMD: 14.408; 95% CI: 8.589 to 20.226, p-value < 0.001), comfort, speech, chewing and stability in favor of the IOD but not in esthetics or hygiene.
CONCLUSIONS
This systematic review and meta-analysis show the superiority of the IOD, despite is not achieved in all aspects.
Topics: Aged; Dental Implants; Dental Prosthesis, Implant-Supported; Denture, Complete; Denture, Complete, Lower; Denture, Overlay; Female; Humans; Male; Middle Aged; Patient Satisfaction; Personal Satisfaction; Quality of Life
PubMed: 33205918
DOI: 10.1002/cre2.347 -
Clinical Oral Implants Research Sep 2023To analyze the effect of implant treatment in edentulous patients rehabilitated with implant-supported fixed complete dentures (IFCDs) or implant overdentures (IODs) on... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To analyze the effect of implant treatment in edentulous patients rehabilitated with implant-supported fixed complete dentures (IFCDs) or implant overdentures (IODs) on dental patient-reported outcomes (dPROs).
MATERIALS AND METHODS
In January 2022, Medline, Embase, CINAHL, Cochrane Library, PubMed Central, Web of Science, and ClinicalTrials.gov were screened for prospective clinical studies on completely edentulous patients treated with IFCDs and/or IODs, reporting pre-treatment and follow-up dPROs. Hedges' g effect sizes (ES) with corresponding 95% confidence intervals (CI) were calculated. Afterward, meta-analyses were conducted using random effect models.
RESULTS
A total number of 1608 records was initially identified. Of those, 28 studies reporting dPROs from 1457 patients were finally included. The applied dental patient-reported outcome measures (dPROMs) included several versions of the Oral Health Impact Profile (OHIP) or specific items assessing satisfaction with Visual Analogue Scales (VAS). The overall ES was large for rehabilitation with IFCDs (1.68 [CI: 1.15, 2.20]) and IODs (1.26 [CI: 0.99, 1.52]) with no significant difference (p = .165) between the two. Denture stability was the only factor rated significantly higher for IFCDs (ES difference: 2.37 [CI: 0.21, 4.54]; p = .032). Subgroup analyses revealed moderately higher ES for IODs on two implants relative to one implant (ES difference: 0.73 [CI: 0.34, 1.12]; p < .001).
CONCLUSIONS
There is a strong positive effect of implant treatment in edentulous patients, independent of the type of prosthetic rehabilitation. In patients seeking high stability, IFCDs may be preferable. In mandibular IODs on a single implant, there was a significantly positive effect of an additional implant on dPROs.
Topics: Humans; Denture, Overlay; Prospective Studies; Dental Implants; Denture, Complete; Mouth, Edentulous; Patient Reported Outcome Measures
PubMed: 37750530
DOI: 10.1111/clr.14065 -
Gerodontology Sep 2019Loss of teeth has a negative influence on essential oral functions. It is important to understand edentulous patients' perceptions about the impacts of treatment options... (Review)
Review
Oral health-related quality of life and satisfaction of edentulous patients using conventional complete dentures and implant-retained overdentures: An umbrella systematic review.
BACKGROUND
Loss of teeth has a negative influence on essential oral functions. It is important to understand edentulous patients' perceptions about the impacts of treatment options on their oral health-related quality of life (OHRQoL) and satisfaction.
AIMS
To appraise the systematic reviews (with/without meta-analysis) that investigate the impacts of complete conventional dentures (CCDs) and/or implant-retained overdentures (IRODs) on the oral health-related quality of life (OHRQoL) and satisfaction among edentulous patients.
METHODS
The Joanna Briggs Institute (JBI) methodology for conduct of an umbrella systematic review was followed. Three database systems were used: Medline, Google Scholar and Cochrane Library. PROSPERO was searched for ongoing or recently completed systematic reviews. The reviews must report OHRQoL and patients' satisfaction as outcomes.
RESULTS
A total of eight reviews were included in data synthesis (six were systematic reviews without meta-analysis, one was systematic review with meta-analysis, and one was meta-analysis). The level of evidence of all included reviews based on the Scottish Intercollegiate Guidelines Network ranged between 1+ and 1-.
CONCLUSION
The results of this umbrella systematic review demonstrate the superiority of using IRODs compared with CCDs on the OHRQoL and patients' satisfaction outcomes. However, this positive impact is more accentuated when patients demand implant treatment or cannot adapt to CCDs treatment. Financial factors and adaptive capability indeed affect patient tolerance to both treatment modalities.
Topics: Humans; Dental Prosthesis, Implant-Supported; Denture, Complete; Denture, Overlay; Jaw, Edentulous; Meta-Analysis as Topic; Oral Health; Patient Satisfaction; Personal Satisfaction; Quality of Life; Systematic Reviews as Topic
PubMed: 30875108
DOI: 10.1111/ger.12399 -
Journal of Prosthodontic Research Oct 2021Purpose To clarify the rate of posterior residual ridge resorption (PRRR) in different denture treatments and the factors that can affect PRRR.Study selection A...
Purpose To clarify the rate of posterior residual ridge resorption (PRRR) in different denture treatments and the factors that can affect PRRR.Study selection A bibliographical electronic search was conducted on MeSH, Web of Science, and Ovid databases. Hand searching was also conducted. Longitudinal studies recording the average rate of PRRR in the mandible were included. The effect size was calculated based on the mean rate of PRRR with standard deviation and group size. The random-effects analysis was used to perform meta-analyses across qualified studies.Results A total of 2245 eligible studies were collected from the MeSH, Web of Science, and Ovid databases and hand searching. In the end, 19 studies met the inclusion criteria and were extracted. The average rate of PRRR in different mandibular denture treatments was assessed in this systematic review. The mean combined effect size was -1.05 ± 0.5 (95% confidence interval [CI]: -3.18-1.08) between four-implant overdentures and two-implant overdentures. The combined effect size was -0.01 ± 0.22 (95% CI: -0.93-0.82) between complete dentures and two-implant overdentures. Body mass index, number of dentures used, denture wearing habit, impression technique, artificial tooth material, and peri-implant bone resorption showed no significant effect on the rate of PRRR. Gender, denture material, and relining frequency showed a significant effect on the rate of PRRR.Conclusions This review summarized different average rates of PRRR in mandibular denture treatments. Meta-analyses have reported that four-implant overdenture treatments can lower the rate of PRRR compared to two-implant overdenture treatments. However, there was no significant difference in the treatment effect between the complete denture and two-implant overdenture treatments.
Topics: Bone Resorption; Dental Prosthesis, Implant-Supported; Denture, Complete; Denture, Overlay; Humans; Mandible
PubMed: 33281173
DOI: 10.2186/jpr.JPR_D_20_00075 -
Gerodontology Mar 2021To systematically review and evaluate the effects of different types of attachments, implant numbers and loading protocols on the peri-implant mucosa of... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To systematically review and evaluate the effects of different types of attachments, implant numbers and loading protocols on the peri-implant mucosa of implant-supported overdentures (ISODs).
BACKGROUND
The impact of peri-implant tissue health on the ISOD treatment outcome is unclear, and current evidence is inadequate on this aspect.
MATERIALS AND METHODS
A systematic literature search for randomised controlled trials or prospective studies was conducted in indexed databases from 1995 to April 2020. The focused question was as follows: How does the peri-implant mucosa respond to implant-supported or implant-tissue-supported complete overdentures based on different types of attachments, implant numbers, and loading protocols, in terms of clinical outcomes achieved [plaque index (PI), gingival index (GI), probing pocket depth (PD) and bleeding index (BI)]? A random- or fixed-effects model was applied to measure the significance of standardised mean differences (SMD) of PD between the groups.
RESULTS
Seventeen studies met the eligibility criteria. The SMD for PD between splinted/bar and unsplinted/stud attachments was 0.10 mm (95% CI: -0.27 to 0.47; P = .60) and between 2- and 4-implant groups was 0.15 mm (95% CI: -0.16 to 0.45; P = .34), which were not statistically significant. Significant difference (P = .003) was observed between immediate/early loading and delayed loading (SMD = 0.46 mm [95% CI: 0.16 to 0.75]).
CONCLUSIONS
Probing depth for the immediate loaded implants was significantly higher than for the delayed loading group. No attachment type, implant number or loading protocol seemed to have a clear advantage over the other, in terms of other peri-implant mucosal outcome measures.
Topics: Dental Implants; Dental Prosthesis, Implant-Supported; Denture, Overlay; Humans; Mandible; Mucous Membrane; Prospective Studies; Treatment Outcome
PubMed: 33164257
DOI: 10.1111/ger.12505 -
The Journal of Contemporary Dental... Nov 2021The purpose of this review is to compare randomized clinical trials evaluating the peri-implant tissue outcomes using different unsplinted attachment systems in two... (Review)
Review
AIM
The purpose of this review is to compare randomized clinical trials evaluating the peri-implant tissue outcomes using different unsplinted attachment systems in two implant-retained mandibular overdentures.
BACKGROUND
Literature lacks information on various unsplinted attachment systems and their effect on peri-implant tissue health. A focus question (as per PICOS) was set as follows: Does one particular unsplinted attachment system (I) compared with another (C) results in better peri-implant outcomes (O) in two implant-retained mandibular overdentures (P) using randomized controlled trials (RCTs) (S)? The literature search was conducted in the PubMed, MEDLINE and Cochrane Central Register of Controlled Trials (CENTRAL) databases between January 2011 and December 2021. The keywords used were "denture, overlay," "denture," "overlay" AND "dental prosthesis, implant supported," "dental implants," "dental implant abutment design" AND "jaw, edentulous," "mouth, edentulous" AND "mandible." Only RCTs on two implant-retained mandibular overdentures using unsplinted attachment systems measuring peri-implant tissue outcomes with minimum 1-year follow-up were selected. In total, 224 studies were identified in initial search, and 25 were shortlisted for full-text evaluation. Four studies were included for systematic review upon considering inclusion and exclusion criteria. The risk of bias was evaluated using Cochrane Risk of Bias Tool 2.0 (RoB 2.0).
REVIEW RESULTS
A total of 41 patients received ball attachments (in 3 studies), 36 patients received low-profile attachments (in 3 studies), 16 patients received magnet attachments (in 1 study), and 13 patients received telescopic attachments (in 1 study). All four studies used standard sized implants, however, differed in implant manufacturers. Two studies which compared ball attachments low-profile attachments revealed-similar peri-implant tissue health parameters but differed in crestal bone-level changes. One study compared ball with telescopic attachments and revealed similar results in crestal bone-level changes and all four peri-implant tissue health parameters. Single study compared magnets with low-profile attachments and shown lesser bone loss with magnet attachments. Single study was judged to have low risk of bias, single with some concerns, and remaining two to have high risk of bias.
CONCLUSION
Gingival index and bleeding index of the patients were not influenced by any of the unsplinted overdenture attachment (stud, magnet, telescopic) system. Inconclusive results found among the studies evaluated comparing crestal bone loss and plaque index.
CLINICAL SIGNIFICANCE
This review manuscript has simplified comparative analysis of different unsplinted attachment systems used in two implant mandibular overdentures to help clinicians choose correct system in such situation.
Topics: Dental Prosthesis, Implant-Supported; Denture Retention; Denture, Overlay; Humans; Jaw, Edentulous; Mandible; Randomized Controlled Trials as Topic
PubMed: 35343463
DOI: No ID Found