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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 -
The International Journal of Oral &...To examine and compare stress values of implants, highest tensile and compressive values, and their distribution in cortical and trabecular bone near and around the...
PURPOSE
To examine and compare stress values of implants, highest tensile and compressive values, and their distribution in cortical and trabecular bone near and around the implant region using different materials (aramid fiber, glass fiber, polyethylene fiber, carbon fiber, and cobalt-chromium [Co-Cr] alloy). Four dental implants were placed in the maxillary crest with two different location scenarios, and the 3D finite element analysis method was used to evaluate stress characteristics.
MATERIALS AND METHODS
Two maxillary models were created in which the implants were placed in different locations (lateral and first premolar, canine and second premolar). Four implant-supported overdenture prostheses were reinforced, applying Co-Cr alloy, glass fiber, aramid fiber, and carbon fiber. Static loads of 200 N were applied on the first molar region using the food stuff method. Stresses around the implants and denture-bearing areas and compression and tensile stresses on the cortical and trabecular bone were evaluated.
RESULTS
In all tested models, the highest von Mises stresses on implants and prostheses were observed in aramid fiber-reinforced overdentures. This was followed by glass fiber, Co-Cr alloy, and carbon fiber groups, respectively. It was observed that the lowest tensile and highest compression stress values in cortical and trabecular bone occurred in prostheses supported with carbon fiber. In all infrastructure materials, the design in which the implants were placed bilaterally in the lateral teeth and the first premolar region was found to be advantageous in terms of stress levels and distribution.
CONCLUSION
High elastic modulus fiber-reinforced overdenture prostheses transmitted less stress to implants and surrounding tissues than Co-Cr alloy. Anteriorly placed implant design illustrated lower stress values in the prosthesis, implant, and cortical and trabecular bone, and this placement design may increase the survival rates of both dental implants and overdentures. In light of this study, fibers can be recommended for clinical use and securely applied as an alternative material to metal support. Int J Oral Maxillofac Implants 2023;38:523-532. doi: 10.11607/jomi.9946.
Topics: Dental Implants; Denture, Overlay; Finite Element Analysis; Carbon Fiber; Dental Prosthesis, Implant-Supported; Chromium Alloys; Dental Stress Analysis; Stress, Mechanical
PubMed: 37279217
DOI: 10.11607/jomi.9946 -
Clinical Implant Dentistry and Related... Aug 2022The study aimed to evaluate the effect of implant-supported prosthesis in completely edentulous participants in terms of osseoperception ability, neural activity, and...
A comparative evaluation of neurophysiological activity, active tactile sensibility and stereognostic ability of complete denture prosthesis, and implant-supported prosthesis wearer-A pilot study.
AIM
The study aimed to evaluate the effect of implant-supported prosthesis in completely edentulous participants in terms of osseoperception ability, neural activity, and stereognostic ability in comparison to removable prosthetic options.
MATERIALS AND METHODS
A total sample of 18 patients, irrespective of gender and age were allocated into three groups according to the three-treatment protocol (upper and lower complete denture, upper complete denture opposing lower implant-retained overdenture, implant-supported fixed prosthesis in both arches). Four weeks after completion of the treatment procedure active tactile sensibility (ATS) was checked by using varying thicknesses (12, 40, 80, 100, 200 μ) of articulating foils and papers. Functional magnetic resonance imaging (fMRI) was performed to record neurophysiological activity in cerebral cortex in all the participants. Various forms of test pieces (heat cure acrylic resin) were used to evaluate stereognostic ability. Data regarding the neurophysiological activity were analyzed by using Krushkal-Wallis test and p ≤ 0.05 was considered to be statistically significant. Data from stereognostic ability test procedure and ATS were compared by using chi-squared test and p ≤ 0.05 was considered to be statistically significant.
RESULTS
Statistically significant difference was found in between the articulating foils in terms of true negative responses as the foil thickness increased in participants wearing complete denture in both the arches (p = 0.004) and implant-supported fixed prosthesis in both the arches (p = 0.010). Participants in implant-supported fixed prosthesis group showed significantly more activation in primary motor cortex (right side), somatosensory cortex (left side), angular gyrus (both sides), temporal lobe (left) compared to other groups. No significant difference found in thalamus and premotor cortex region in between the participants of different groups. No statistically significant difference found in between the groups in terms of true responses identifying correct shapes. Mean number of correct responses in stereognostic ability test were 4.16 (83.33%), 3.5 (70%), 3.83 (76.66%) for participants of complete denture group, upper complete denture opposing lower implant retained overdenture group, and implant-supported fixed prosthesis group, respectively.
CONCLUSION
Primary motor cortex, somatosensory cortex, and other regions of brain were diffusely activated in participants wearing implant-supported fixed prosthesis in both the arches. Less number of false responses were recorded in participants of implant-supported fixed prosthesis group and upper complete denture opposing lower implant-retained overdenture group in ATS test compared to participants wearing complete denture in both the arches.
Topics: Dental Implants; Dental Prosthesis, Implant-Supported; Denture, Complete; Denture, Overlay; Humans; Jaw, Edentulous; Pilot Projects
PubMed: 35500283
DOI: 10.1111/cid.13094 -
The International Journal of... 2022To compare the speaking space, perceived rotational movement during chewing, and oral health-related quality of life (OHRQoL) of elderly people rehabilitated with new...
PURPOSE
To compare the speaking space, perceived rotational movement during chewing, and oral health-related quality of life (OHRQoL) of elderly people rehabilitated with new conventional complete dentures (CDs) and single-implant mandibular overdentures (SIMOs) using a paired design. Patient expectations for SIMO use were also evaluated.
MATERIALS AND METHODS
The participants were 22 elderly users of unsatisfactory CDs. They received new sets of conventional CDs, and assessment was performed after 2 months of use. Speaking space was recorded with a kinesiograph while participants read a list of words. Participants were asked two questions about perceived posterior rotational denture movement during chewing. The Dental Impact on Daily Living (DIDL) questionnaire was used to examine OHRQoL, and a visual analog scale was used to quantify participants' SIMO expectations. Subsequently, the mandibular CDs were converted to SIMOs, and the assessment was repeated after 2 months of use. Speaking space and OHRQoL data were submitted to ANOVA and Student t test, and perceived mandibular movement and expectation data were examined using likelihood-ratio chi-square test.
RESULTS
The speaking space and perceived rotational movement did not differ between CD and SIMO use. General performance and eating restriction DIDL scores increased after SIMO insertion. Participants' SIMO expectations regarding speaking, cleaning, esthetics, and general aspects were met.
CONCLUSION
Relative to CD use, SIMO use did not change the speaking space or perceived rotational movement when chewing among elderly patients. It improved OHRQoL via enhancement of two DIDL dimensions and met most elderly patients' expectations.
Topics: Humans; Aged; Mastication; Motivation; Denture, Overlay; Quality of Life; Patient Satisfaction; Dental Prosthesis, Implant-Supported; Esthetics, Dental; Denture, Complete; Mandible; Denture Retention
PubMed: 36645860
DOI: 10.11607/ijp.7901 -
BMC Oral Health Jun 2022The aim of the present study was to evaluate the retention and loss of retention after fatigue testing at different time intervals between two types of bar clip...
OBJECTIVES
The aim of the present study was to evaluate the retention and loss of retention after fatigue testing at different time intervals between two types of bar clip materials (digitally designed PEEK bar clip and regular Nylon bar clip).
MATERIALS AND METHODS
An epoxy model was constructed for a completely edentulous mandible. Two implants were placed according to prosthetically driven implant placement by a computer-guided surgical stent. Bar clips were digitally designed, 3D printed, and pressed into Poly Ether Ether Ketone (PEEK). Pick up of PEEK and nylon clips was performed on the dentures fitting surface using self-cured acrylic resin. Each study group was subjected to an insertion and removal fatigue test simulating 3 years of patient usage. Retention values were recorded using the universal testing machine at initial retention and after 1, 2, and 3 years of simulated usage. For proper sample sizing, 24 models and dentures (12 for each group) were used. An independent sample t-test and repeated measures analysis of variance were used to compare the data.
RESULTS
There were statistically significant differences in retention between the PEEK and nylon bar clips at the beginning of the experiment (p = 0.000*). But after 3 years of simulated use, there was no significant difference in retention between the test groups (p = 0.055, NS). After 3 years of simulated use, the retention of PEEK clips decreased by - 58.66% recording 17.37 ± 1.07 N, while the retention of nylon clip increased by + 2.99% recording 16.56 ± 0.88 N.
CONCLUSION
The digitally designed PEEK clip showed comparable retention results to the nylon clip after 3 years of simulated use.
CLINICAL RELEVANCE
Maintenance of bar attachment with PEEK clip offers a clinical solution after the wear of normal plastic clips, which is a cheap solution that is easily fabricated and picked up into the denture. Digital fabricated PEEK bar retentive inserts can be used in cases of bar attachment wear.
Topics: Dental Implants; Dental Prosthesis, Implant-Supported; Dental Stress Analysis; Denture Retention; Denture, Overlay; Ethers; Humans; Mandible; Nylons; Surgical Instruments
PubMed: 35681163
DOI: 10.1186/s12903-022-02262-7 -
The Journal of Contemporary Dental... May 2022To compare and evaluate the mean bite force and masticatory performance of conventional complete dentures (CD) in comparison with the lower implant-supported overdenture...
AIM
To compare and evaluate the mean bite force and masticatory performance of conventional complete dentures (CD) in comparison with the lower implant-supported overdenture opposing an upper CD by using a strain gauge transducer and a test material respectively, in the same patient over a different period of time.
MATERIALS AND METHODS
The study included 20 edentulous patients in the age range 45-65 years with a good general and oral health. In the first phase of the study, conventional CD were fabricated and delivered to each patient who participated in the study. A strain gauge transducer was used to analyze the maximum bite force and an agar test material was used to assess the masticatory performance using the sieve method. The existing lower denture was used to deliver a two-implant overdenture system and two implants were placed in the intermental-foraminal region of the mandible. One month after the delivery of implant-supported overdenture, the maximum bite force and masticatory performance were assessed as before.
RESULTS
To test two independent variables, the data were analyzed statistically using an unpaired -test. In comparison to the conventional upper and lower CD rehabilitations, the implant-supported lower denture and conventional upper CD rehabilitations resulted in statistically significant improvements in biting force and masticatory performance.
CONCLUSION
Study findings demonstrate that the completely edentulous patients can be rehabilitated with the upper CD and lower two-implant supported overdenture system that offers improved biting force and masticatory performance than conventional upper and lower dentures.
CLINICAL SIGNIFICANCE
Masticatory efficiency is one of the important indicators of functional state of stomatognathic system. Determination of individual masticatory performance has been used to ascertain the therapeutic effect of prosthetic device.
Topics: Aged; Bite Force; Dental Implants; Dental Prosthesis, Implant-Supported; Denture Retention; Denture, Complete; Denture, Complete, Lower; Denture, Overlay; Humans; Mandible; Mastication; Middle Aged; Mouth, Edentulous; Patient Satisfaction
PubMed: 35986459
DOI: No ID Found -
Clinical Oral Investigations Jul 2022To evaluate the maintenance requirements and the presence of prosthetic complications associated with marginal bone loss in the implant-retained bar and locator...
OBJECTIVES
To evaluate the maintenance requirements and the presence of prosthetic complications associated with marginal bone loss in the implant-retained bar and locator prostheses.
MATERIALS AND METHODS
The study was executed between the years 2013 and 2018 on 114 patients who had undergone 283 dental implants. Patients were examined at follow-up recall sessions at 12 and 24 months after the placement of the dentures. The clinical examination also included intraoral and extraoral examinations of the patients; compatibility of the prostheses placed to about occlusion; an adaptation of the prosthesis to the tissues, health, and continuity of the soft tissues; complaints of the patients; implant success rates; and marginal bone loss, and prosthetic complications were evaluated at follow-up sessions, and statistical analysis was performed.
RESULTS
Locator attachment was placed in 94 patients with separated mandibles and maxillae, and a removable prosthesis with a bar attachment was placed in 20 patients. When evaluating the level of marginal bone loss regardless of the presence of complications, the area where the implant was set, the number of days after loading, and the type of retainer, it was found to be significant at the end of the 12th the 24th months. The results showed a significant relationship between the prosthesis type and the presence of complications at month 24 (p < 0.05). There was no significant relationship between the position of the denture and the presence of complications at month 12 (p > 0.05). There was no significant relationship between the location of the denture and the presence of complications at month 24 (p > 0.05).
CONCLUSION
Complications do not affect marginal bone loss, but the resulting marginal bone loss is the result of the patient not paying enough attention to oral hygiene. Routine inspections of the prosthesis after the completion of treatment seem to be important. If the requirements resulting from these checks are met, complications that may occur in the future will be prevented.
CLINICAL RELEVANCE
The maintenance requirements and the presence of prosthetic complications associated with marginal bone loss in the implant-retained bar and locator prostheses were evaluated. Complications occurred more frequently with the bar-supported removable implant prostheses.
Topics: Alveolar Bone Loss; Dental Implants; Dental Prosthesis, Implant-Supported; Denture Retention; Denture, Overlay; Follow-Up Studies; Humans; Jaw, Edentulous; Mandible; Retrospective Studies
PubMed: 35513583
DOI: 10.1007/s00784-022-04437-6 -
Journal of Esthetic and Restorative... Jan 2021Overdenture therapy is an important option for implant rehabilitation. However, numerous reports suggest that mechanical/technical complications and failures can limit...
OBJECTIVE
Overdenture therapy is an important option for implant rehabilitation. However, numerous reports suggest that mechanical/technical complications and failures can limit therapeutic success. The goal of this report is to illustrate a digital approach to design and construction of a robust overdenture with high-esthetic value.
MATERIALS AND METHODS
Beginning with new denture design to establish esthetic parameters, 3D modeling of a metal framework and the denture teeth are completed in a connected manner. This enables connection of rapidly printed, prototype dentition that is attached directly to the framework without intervening wax or acrylic components. Following evaluation of the dentition and required adjustments, the final dentition is milled from resin and processed to the selective laser sintered framework.
RESULTS
The advantages of the digital workflow include the control of dimensions and strength of the framework, the esthetic relationship of the framework to the dentition and the facilitation of esthetic try-in of the dentition.
CONCLUSION
Enhancing a robust overdenture can be readily achieved using a digital workflow.
CLINICAL SIGNIFICANCE
The use of digital technology enables the clinical team to plan and produce prostheses with dimensions and contours that support long-term function and esthetics. The clinical chair time can be potentially reduced by use of digital design that facilitates try-in and reduces major errors by improved communication between the patient, dentist, and technician.
Topics: Computer-Aided Design; Dental Implants; Dental Prosthesis, Implant-Supported; Denture, Overlay; Esthetics, Dental; Humans; Workflow
PubMed: 33484047
DOI: 10.1111/jerd.12711 -
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 Dentistry Sep 2023To investigate the occurrence of mild cognitive impairment in edentulous patients up to 3 years after they received single-implant overdentures (1-IODs). (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To investigate the occurrence of mild cognitive impairment in edentulous patients up to 3 years after they received single-implant overdentures (1-IODs).
METHODS
This was a follow-up study for a crossover randomized controlled trial comparing 1-IODs and conventional complete dentures, with patient satisfaction as the primary outcome. In the present study, the cognitive function of the patients, measured with the Japanese version of the Montreal cognitive assessment (MoCA-J), was evaluated as the secondary outcome at baseline and 2 months, 1 year, 2 years, and 3 years after 1-IOD placement. The total and domain (memory, executive function, visuospatial skills, language, attention, and orientation) MoCA-J scores of the patients at each timepoint were analyzed and compared.
RESULTS
Twenty-two patients with edentulous mandibles received 1-IODs. Within-group comparisons revealed that the total MoCA-J scores at 1 year and 3 years after 1-IOD placement were significantly increased compared with baseline scores. Additionally, the memory domain scores at all timepoint were significantly increased compared with the baseline scores, and the executive function domain scores at the 2-month, 2-year and 3-year timepoint were significantly increased compared with the baseline scores.
CONCLUSION
Patients with edentulous mandibles who underwent 1-IOD placement showed significantly improved total scores of MoCA-J after 1 year and 3 years of wearing 1-IODs. In addition, they showed significantly improved memory domain scores at 2 months, 1 year, 2 years, and 3 years after 1-IOD placement and executive function domain scores at 2 months, 2 years, and 3 years after 1-IOD placement.
CLINICAL SIGNIFICANCE
The results of this study suggest that 1-IOD treatment for older adults, especially those with edentulous mandibles, may prevent cognitive decline regardless of the condition of the maxilla.
Topics: Humans; Aged; Follow-Up Studies; Denture, Overlay; Quality of Life; Denture, Complete; Patient Satisfaction; Cognition; Dental Prosthesis, Implant-Supported; Mandible; Dental Implants; Denture Retention
PubMed: 37506810
DOI: 10.1016/j.jdent.2023.104632