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Journal of Oral Science Oct 2021The recent literature on maxillary implant overdenture (IOD) was reviewed in order to clarify its predictability and establish treatment guidelines. Electronic searches... (Review)
Review
The recent literature on maxillary implant overdenture (IOD) was reviewed in order to clarify its predictability and establish treatment guidelines. Electronic searches were performed using PubMed, and articles about maxillary IOD written after 1990 were reviewed, focusing on the following items: I. implant survival rate, II. maxillary IOD survival rate, III. number of implants, IV. attachment type, V. follow-up period, VI. implant system, and VII. opposing dentition. The review revealed an implant survival rate of 61-100% and an overdenture survival rate of 72.4-100%. The attachments used included bars, balls, locators, and telescope crowns. The minimum and maximum observation periods were 12 months and 120 months, respectively, and the number of implants used for supporting IOD ranged from 2 to 8. At present, there is no strong evidence to indicate that maxillary IOD is clearly superior for all the items examined. However, the existing data indicate that maxillary IOD has almost the same therapeutic effect as fixed implant superstructures, and is a treatment option that can be actively adopted for patients in whom fixed superstructures cannot be applied for various reasons.
Topics: Dental Implants; Dental Prosthesis, Implant-Supported; Denture Retention; Denture, Overlay; Humans; Maxilla
PubMed: 34408111
DOI: 10.2334/josnusd.21-0087 -
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 -
Journal of Oral Science Oct 2022The purpose of this review is to search for complications of dental implant superstructures and consider the issues involved. This narrative review was performed by... (Review)
Review
The purpose of this review is to search for complications of dental implant superstructures and consider the issues involved. This narrative review was performed by searching through PubMed databases and review articles that were published after 1990. Misfitting of the superstructure can result in loosening of screws, reduced preload, and in some cases, significant stress around the implant. External connection modalities and single implant prostheses have been reported to have more loose or broken abutment screws. In addition, when zirconia abutment was used for platform shifting, the rate of fracture of the abutment was considered to be high. Additionally, it was reported that men were significantly at an increased risk of abutment fracture. As for the retention mechanism of implant overdenture, stud attachment (Locator type) should receive more attention to wear and damage of retention parts than other attachments. The causes of the complications of implant superstructures have not been clarified in some cases, and further verification is required. Verification of complications is considered important to obtain a long-term prognosis for superstructures of implants. It will be necessary to further verify complications of implants in the future.
Topics: Dental Abutments; Dental Implants; Dental Prosthesis, Implant-Supported; Dental Stress Analysis; Denture, Overlay; Humans; Male
PubMed: 35989295
DOI: 10.2334/josnusd.21-0534 -
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 -
Clinical Implant Dentistry and Related... Aug 2021Implant-supported overdentures (IODs) have been reported to increase patients' oral health-related quality of life (OHRQoL) in comparison with conventional dentures... (Review)
Review
BACKGROUND
Implant-supported overdentures (IODs) have been reported to increase patients' oral health-related quality of life (OHRQoL) in comparison with conventional dentures (CDs); however, the conclusiveness of evidence on the clinical effectiveness and value for money of IODs versus CDs remains unclear.
PURPOSE
To review how the added value of IODs is demonstrated in the literature.
MATERIALS AND METHODS
MEDLINE, EMBASE, and the Cochrane Database were searched for randomized control trials, controlled clinical trials, and prospective cohort studies containing evaluations of the economic and health benefits and costs of IODs. Information about the clinical effectiveness, such as magnitude of bite forces or chewing efficacy, OHRQoL, costs, and cost-effectiveness of IODs, was extracted.
RESULTS
A total of 17 articles were included, reporting 15 economic evaluations: 11 cost-utility analyses (CUAs), 2 of which were combined with a cost-effectiveness analysis (CEA), and 2 cost-benefit analyses (CBAs). Seven CUAs used the Oral Health Impact Profile (OHIP) questionnaire while four used satisfaction questionnaires to assess the OHRQoL. One study applied quality-adjusted prosthesis years (QAPYs) for this purpose. The CBAs expressed both the beneficial outcome and the costs of the IOD in monetary terms. The included studies employed a large variety of economic evaluation methods, which limited cross-study comparability.
CONCLUSIONS
On the basis of existing economic evaluations, IODs have frequently been suggested to be a cost-efficient treatment alternative to CDs; however, the comparability between the various economic evaluation studies was limited due to the different outcome measures used. In addition, it remains unclear whether the additional health benefits of IODs outweigh the higher costs. This is largely dependent on the decision maker's valuation of oral health outcomes. Future research is encouraged to further elucidate patient willingness to pay for IODs and the societal return on investing in IODs more generally.
Topics: Dental Implants; Dental Prosthesis, Implant-Supported; Denture, Overlay; Humans; Patient Satisfaction; Prospective Studies; Quality of Life
PubMed: 34268866
DOI: 10.1111/cid.13027 -
Clinical Oral Implants Research Aug 2023To report the 1-year implant survival/success and peri-implant outcomes of mandibular overdentures retained by four titanium-zirconium mini implants (Straumann® Mini... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To report the 1-year implant survival/success and peri-implant outcomes of mandibular overdentures retained by four titanium-zirconium mini implants (Straumann® Mini Implant System), and to assess how surgery and loading protocols influence these outcomes.
MATERIALS AND METHODS
A 2 × 2 factorial randomized clinical trial (RCT) tested the combined effects of two loading protocols (immediate or delayed) and two surgical approaches (flapless or flapped) on the success/survival of the mini implants, and peri-implant parameters (plaque, bleeding, sulcus depth, gingival position, and marginal bone loss). Outcomes were assessed up to 1-year after loading, and generalized estimating equations (GEEs) were used to analyze longitudinal and within-patient clustered data.
RESULTS
Two hundred and ninety-six implants were placed in 74 patients. The implant survival/success rates after 1 year were 100%, and no major biological complications were observed. After 1-year, descriptive data suggest no noticeable changes in plaque scores, whilst a reduction in bleeding scores at the 6-month and 1-year follow-ups compared to baseline. Good longitudinal stability was observed for the probing depth and gingival margin height measures. Overall mean marginal bone loss was 0.68 (±0.68) mm after 3 months and 0.89 (±0.75) mm after 1-year. The flapless protocol showed better results on soft tissue stability and health but a slightly higher risk for marginal bone loss.
CONCLUSION
The results of this RCT suggest that mandibular overdentures retained by this novel mini implant system represent a safe and predictable treatment option as confirmed by implant survival/success and peri-implant outcomes, even when flapless surgery and immediate loading protocols are adopted.
Topics: Humans; Dental Implants; Titanium; Zirconium; Denture, Overlay; Dental Implantation, Endosseous; Immediate Dental Implant Loading; Mandible; Dental Prosthesis, Implant-Supported; Treatment Outcome; Follow-Up Studies; Alveolar Bone Loss
PubMed: 37254798
DOI: 10.1111/clr.14102 -
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 -
Dental and Medical Problems 2023The ball attachments and their O-rings used for the retention and stabilization of overdentures showed a decrease in retention as the number of cycles increased. This... (Review)
Review
The ball attachments and their O-rings used for the retention and stabilization of overdentures showed a decrease in retention as the number of cycles increased. This fact resulted in a decrease in the retention of the prosthesis. The purpose of this study was to evaluate the fatigue resistance of ball attachments through a systematic review. An electronic search was performed using the Cochrane Library, LILACS, PubMed, ScienceDirect, and Web of Science databases. The search was conducted based on the PICOS framework. The inclusion criteria involved in the search comprised research articles written in English and published between the years 2000 and 2020. In the final selection, 18 articles were included in the review. Most of these studies performed the fatigue retention tests using parallel implants without angles. However, some studies used different angles to analyze the fatigue retention values. With the passage of time, the wear results in deformation and, as a consequence, a decrease in the retention of most attachments, leading to treatment failure. The main factor to be considered is the loss of retention of these components and their low durability. The loss of retention is due to large extent to the materials used to manufacture the attachments and O-rings, the size and angulation of the implants, and the length of the prosthesis. Future research is needed to further elucidate the reasons for the failure of the attachments.
Topics: Humans; Dental Implants; Dental Prosthesis, Implant-Supported; Denture Retention; Denture, Overlay
PubMed: 37023344
DOI: 10.17219/dmp/146719 -
Journal of Prosthodontics : Official... Dec 2022To estimate the effects of the thermal cycling (TC) process on the metal surfaces of Locators, as well as retention loss, and the correlation between them.
PURPOSE
To estimate the effects of the thermal cycling (TC) process on the metal surfaces of Locators, as well as retention loss, and the correlation between them.
MATERIALS AND METHODS
Twenty-five new Locator R-Tx were included in the study. Four areas were marked on each Locators' patrix metal surface and scanned using a confocal scanner (μsurf explorer; NanoFocus). Three surface roughness parameters were measured in the scans: Sa (average distance of peaks from the central plain of the area), Vmp (volume of the peaks in the area), and Spc (mean curvature of the peaks describing the degree of their sharpness). Retention test was performed using Instron® 4500 compression tension tensile tester at a speed of 10 mm/min. The retention tests were done using a working model made of two acrylic blocks in which the Locator system parts were inserted. The surface parameters measurements and the retention tests were performed 2 times, once before and once after TC. The Locators were subjected to 15,000 TC cycles by investing them into 2 tubs with different water temperatures, 55°C and 5°C. During each 60-second cycle, the Locators were submerged in each tub for 20 seconds, with a 10 second transition time between the tubs. The post-TC retention and surface parameters measurements were compared with those prior to TC and the prior to TC measurements served as controls. Changes in parameters before and after TC were analyzed by a two-way ANOVA nested model with random intercept and slope by restricted maximum likelihood method. Correlation between retention and surface parameters was quantified and examined using Kendall's correlation test. The findings were considered statistically significant if p < 0.05.
RESULTS
There was a significant decrease in retention of 16.6N at the second retention test (p < 0.001). A significant statistical decrease in surface parameters were measured after TC process, Sa and Vmp (18 ×10 μm, p = 0.041 and 0.94 ×10 1/μm, p = 0.001, respectively). A significant statistical increase in Spc of 6.4 ×10 μm /μm (p = 0.023) was noticed. The correlation between retention decreases and surface changes was not statistically significant.
CONCLUSION
The TC process causes a substantial reduction in retention to the Locator system over time. In addition, TC causes significant but minor changes to the Locator surface area. Most of the changes are in the horizontal dimension.
Topics: Denture Retention; Denture, Overlay; Dental Stress Analysis; Time Factors; Water; Surface Properties; Materials Testing
PubMed: 35061925
DOI: 10.1111/jopr.13481 -
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