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The Journal of Prosthetic Dentistry Jun 2015A number of authors have reported the placement of a distal implant associated with a partial removable dental prosthesis (PRDP) to make this rehabilitation more stable.... (Review)
Review
Placement of a distal implant to convert a mandibular removable Kennedy class I to an implant-supported partial removable Class III dental prosthesis: A systematic review.
STATEMENT OF PROBLEM
A number of authors have reported the placement of a distal implant associated with a partial removable dental prosthesis (PRDP) to make this rehabilitation more stable. This strategy may represent an option for resolving the problem of the intrusive movements of the PRDP and for reducing treatment costs.
PURPOSE
The purpose of this systematic review was to evaluate the current evidence about the placement of a distal implant associated with a mandibular PRDP to improve patient satisfaction and the clinical performance of the abutment tooth and distal implant.
MATERIAL AND METHODS
Two independent prosthetic specialist reviewers conducted this systematic review. The search was performed using selected clinical studies with PRDP associated with distal implants published in English up to May 2014 from the PubMed and Cochrane Library databases. A data extraction form was developed to collect general information: authors, title, year of publication, aim of study, level of evidence, number of participants, number of implants used, implant system, implant length and diameter, abutment type, masticatory performance, patient satisfaction, implant mean bone loss, abutment tooth mean bone loss, prosthetic complications, follow-up period, and implant survival rate. The quality of the selected studies and the risk of bias were also reported.
RESULTS
The initial electronic search identified 231 studies, and the manual process identified 15 studies (total of 246 studies). After the title and abstract reading and the removal of duplicates, the full texts of 43 studies were obtained. The articles that did not meet the inclusion criteria were excluded (28 studies), and the data from 15 studies were extracted. Seven were retrospective studies, 1 a crossover pilot study, 2 case series, 2 paired clinical studies, and 3 case reports, demonstrating that a high number of the selected studies were of low methodological quality. Nevertheless, the high survival rates for PRDP associated with dental implants have been described.
CONCLUSIONS
The use of a PRDP associated with dental implants to convert a Kennedy class I to class III dental prosthesis benefits patients by improving their satisfaction and masticatory abilities without decreasing implant survival rates. Considering the abutment tooth survival rate, clinical studies with comparable methodology are still lacking to define protocols regarding the use of distal implants associated with PRDP. Long-term, prospective clinical trials are still needed to understand which implant abutments increase abutment tooth survival rate.
Topics: Dental Implants; Dental Prosthesis, Implant-Supported; Denture Design; Denture, Partial, Removable; Humans; Jaw, Edentulous, Partially; Mandible; Mastication; Patient Satisfaction; Survival Analysis
PubMed: 25818673
DOI: 10.1016/j.prosdent.2014.12.011 -
Journal of Dentistry (Shiraz, Iran) Mar 2023Obstructive sleep apnea (OSA) is an underdiagnosed and potentially serious disorder that is accentuated by edentulism. The overclosure of the mandible and a potential...
Impact of Complete Denture and Mandibular Advancement Device in the Management of Completely Edentulous Obstructive Sleep Apneic Individuals: A Systematic Review with Meta-Analysis.
STATEMENT OF THE PROBLEM
Obstructive sleep apnea (OSA) is an underdiagnosed and potentially serious disorder that is accentuated by edentulism. The overclosure of the mandible and a potential upper airway collapse during sleep creates challenges in treating edentulous sleep apneic patients.
PURPOSE
To evaluate complete dentures and mandibular advancement devices as potential oral appliances in the management of sleep apnea in completely edentulous patients.
MATERIALS AND METHOD
The study design was a systematic review with meta-analysis. The search criteria complied with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines and the keywords in population, intervention, control, and outcomes (PICO) format was systematically searched for relevant research articles published till August 2021 in an electronic database (PubMed, Cochrane, Science Direct, Ovid). Randomized controlled trials and cohort studies were included that compared the effectiveness of oral appliances on apnea-hypopnea index (AHI), airway space, and quality of sleep in edentulous sleep apneic patients.
RESULTS
1785 articles were derived from the initial search and based on inclusion criteria, 10 articles were systematically filtered for qualitative analysis and assessed for risk of bias using the Cochrane risk of bias tool and ROBINS-I tool. Out of the 10 articles, 5 articles were taken for quantitative analysis. The use of a mandibular advancement device (MAD) showed a decrease in AHI score, but the available data was heterogeneous to conduct a meta-analysis. The mean difference of AHI for the random effect model between the non-complete denture and complete denture wearers at sleep was -0.49[95% CI (-1.47,0.48)] events per hour, but the change was non-significant (>.05).
CONCLUSION
The complete dentures as an oral appliance had reduced apneic episodes in completely edentulous sleep apneic patients, but the effectiveness cannot be solely attributed to the prosthesis in the treatment of OSA. MAD showed greater improvement in reducing AHI, however, the level of evidence was inadequate to provide a conclusive statement.
PubMed: 37051494
DOI: 10.30476/dentjods.2022.93891.1743 -
Journal of Advanced Periodontology &... 2022This systematic review and meta-analysis investigated the prevalence of proximal contact loss and its associated factors. A bibliographic search was conducted in June...
This systematic review and meta-analysis investigated the prevalence of proximal contact loss and its associated factors. A bibliographic search was conducted in June 2021 with no limitation in the article date or language and updated in January 2022 by hand searching. There was no time limit on the search to retrieve all studies. The search included randomized controlled trials or quasi-experiments, and cross-sectional or cohort studies were included in the absence of these studies. Two authors screened the title and abstract. After evaluating the full texts of selected articles, irrelevant studies and or non-English papers that were impossible to translate were excluded. Disagreements between the re-viewers' selection process were resolved by debate on the eligibility of studies. Standardized critical appraisal instruments from the Joanna Briggs Institute for different types of studies were used to assess the studies' quality. Comprehensive Meta-Analysis (CMA) software (Version 2.2; Biostat, Englewood, NJ) was used for data analysis. The proximal contact loss (PCL) frequency was %29. According to the results, the frequencies of PCL for the distal and mesial aspects were %7 and %21, respectively. The meta-analysis results showed that the contact loss events on the mesial aspect were statistically higher than on the distal aspect (P<0.0001). There were no significant differences between other associated factors such as the mandibular or maxillary arch, retention type, opposing dentition, implant type, molar or non-molar, parafunction behaviors, and vitality of adjacent teeth. There was a significant association between bone loss and PCL, and in individuals with bone loss >%50, the proximal contact loss was higher (OR: %95[ 2.43 CI: 4.03‒1.47], P=0.0006). The PCL in the anterior area was lower than in the posterior area (P=0.004). Although the frequency of contact loss in females was higher than in males, this rate was not statistically significant. The PCL on the mesial aspect and the posterior area was high. In individuals with bone loss >%50, the proximal contact loss was higher than in others.
PubMed: 36714081
DOI: 10.34172/japid.2022.023 -
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 -
The Journal of Prosthetic Dentistry Aug 2017Different factors can affect prosthetic maintenance requirements for mandibular implant overdentures (IODs). However, the literature shows a high level of disagreement... (Review)
Review
STATEMENT OF PROBLEM
Different factors can affect prosthetic maintenance requirements for mandibular implant overdentures (IODs). However, the literature shows a high level of disagreement concerning the effect of each factor on maintenance needs.
PURPOSE
The purpose of this systematic review was to address the focus question: "In the clinical studies published since 2004 of adult patients with totally edentulous mandibles treated by IODs with a variable number of implants and different designs, what were the maintenance types, frequencies, and complications?"
MATERIAL AND METHODS
A search of MEDLINE and PubMed databases was performed targeting papers in English on prosthetic maintenance of mandibular IODs published between 2004 and June 2015, aiming at recognizing the needs for adjustment, repair, and renewal. The recorded data were divided into 6 categories, and a percentage value was attributed to each.
RESULTS
From a total of 130 articles, 33 studies met the specified inclusion criteria for the review (14 randomized controlled trials, 8 prospective clinical trials, 3 retrospective studies, and 4 systematic reviews). These articles provided evidence that a mean complication rate was impossible to determine because of the multiplicity of contributing factors. No clear identification of the causes of mechanical complications was found, nor was there any clear evidence of superiority of one implant and/or attachment design over another.
CONCLUSIONS
Prosthetic complications with IODs are unavoidable. However, they can be reduced to an expected level if a close follow-up protocol is implemented aiming at anticipating risks of unexpected complications. Further clinical studies are needed to achieve a constructive meta-analysis that accounts for different parameters such as opposite arch, attachment functional variety, connection method, and prosthesis quality.
Topics: Aftercare; Dental Care; Dental Prosthesis, Implant-Supported; Denture, Overlay; Humans; Mandible
PubMed: 28385441
DOI: 10.1016/j.prosdent.2016.10.037 -
Journal of Oral Rehabilitation Feb 2018This study reviews the clinical and radiographic outcomes of Mini-implants (MI) and Narrow Diameter Implants (NDI) as mandibular overdenture (MO) retainers. Six... (Meta-Analysis)
Meta-Analysis Review
This study reviews the clinical and radiographic outcomes of Mini-implants (MI) and Narrow Diameter Implants (NDI) as mandibular overdenture (MO) retainers. Six databases were consulted for clinical studies that evaluated implants with diameter ≤3.5 mm. Data on the MI and NDI for survival and success rate and peri-implant bone loss and were collected and submitted to meta-analysis. Thirty-six studies were included, 24 reporting MI performance and 12 describing NDI results. The MI group comprised data from 1 cross-sectional clinical study, 3 retrospective longitudinal (RL) clinical studies, 13 prospective longitudinal (PL) clinical studies and 7 randomised clinical trials (RCT) with follow-up periods ranging from 1 day to 7 years. Eight studies used conventional loading, thirteen used immediate loading, two studies used both loading types, and one study did not report. The NDI group comprised data from 3 RL clinical studies, 6 PL clinical studies and 3 RCT with follow-up ranging from 6 months to 10 years. Ten studies used conventional loading, 1 study used immediate loading, and 1 study did not report. The average survival rates of MI and NDI studies were 98% and 98%, respectively, while the average success rates were 93% and 96%, respectively. The average peri-implant bone loss after 12, 24 and 36 months was 0.89, 1.18 and 1.02 mm for MI and 0.18, 0.12 and -0.32 mm for NDI. Both MI and NDI showed adequate clinical behaviour as overdenture retainers. The NDI showed a better long-term predictability to retain OM with most studies adopting conventional loading.
Topics: Alveolar Bone Loss; Cross-Sectional Studies; Dental Prosthesis Design; Dental Prosthesis, Implant-Supported; Dental Restoration Failure; Denture, Overlay; Humans; Jaw, Edentulous; Mandible; Radiography; Treatment Outcome
PubMed: 29125652
DOI: 10.1111/joor.12585 -
Inflammopharmacology Aug 2023This study aimed to evaluate the scientific evidence on the effect of preemptive drug coadministration (PDC) for relieving inflammatory events (pain, swelling, and... (Review)
Review
Is coadministration of preemptive medications an effective strategy for reducing inflammatory clinical events and the need for rescue medication after mandibular third molar surgery? A systematic review of randomized clinical trials.
This study aimed to evaluate the scientific evidence on the effect of preemptive drug coadministration (PDC) for relieving inflammatory events (pain, swelling, and trismus) in mandibular third molar surgery. A PROSPERO-registered systematic review (CRD42022314546) was conducted according to the PRISMA guide. The searches were carried out in six primary databases and the gray literature. Studies not written in languages with the Latin alphabet (Roman) were excluded. Potential randomized controlled trials (RCTs) were screened for eligibility. Cochrane's Risk of Bias-2.0 (RoB) tool was assessed. A synthesis without meta-analysis (SWiM) based on a vote counting and an effect direction plot. Nine studies (low RoB) fulfilled the eligibility criteria and were included for data analysis, with a total of 484 patients. PDC mostly involved corticosteroids (Cort) and non-steroidal anti-inflammatory drugs (NSAIDs). PDC of Cort and other drugs mainly reduced pain scores (6 and 12 h postoperatively) and swelling (48 h postoperatively). PDC of NSAIDs and other drugs mainly reduced pain scores at 6, 8, and 24 h follow-up; swelling and trismus intensity ameliorated at 48 h postoperatively. The most frequently prescribed rescue medication was paracetamol, dipyrone, and paracetamol plus codeine. Results from individual studies have shown reduced consumption of ingested rescue analgesics. In summary, the available evidence from clinical trials included in this SWiM suggests that PDC may provide benefits in reducing the severity of inflammatory outcomes related to mandibular third molar surgery, especially the pain scores in the first hours after surgery, and the rescue analgesic consumption during the postoperative period.
Topics: Humans; Acetaminophen; Analgesics; Anti-Inflammatory Agents, Non-Steroidal; Molar, Third; Pain; Randomized Controlled Trials as Topic; Trismus
PubMed: 37306939
DOI: 10.1007/s10787-023-01258-1 -
The Journal of Prosthetic Dentistry Dec 2021The immediate loading protocol for 2-implant mandibular overdentures has been widely reported. Nevertheless, the clinical effects reported in different articles are... (Meta-Analysis)
Meta-Analysis
STATEMENT OF PROBLEM
The immediate loading protocol for 2-implant mandibular overdentures has been widely reported. Nevertheless, the clinical effects reported in different articles are quite different.
PURPOSE
The purpose of this systematic review and meta-analysis of randomized controlled trials (RCTs) was to compare the clinical effects of immediate and delayed loading of 2-implant mandibular overdentures.
MATERIAL AND METHODS
The review followed the guidelines of Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). PubMed, Cochrane Library, Web of Science, Embase, Scopus, ScienceDirect, CBM, CNKI, and Wan Fang databases were searched electronically for RCTs published before March 25, 2020. Two authors independently conducted literature screening, quality assessment, and data extraction. The outcomes of interest were implant failure rate, marginal bone loss (MBL), implant stability quotient (ISQ), periotest value (PTV), and patient satisfaction.
RESULTS
A total of 2498 unduplicated records were identified. After full-text analysis, 7 eligible RCTs were included. All studies were followed for at least 12 months, and the meta-analysis was based on this. The meta-analysis showed that the implant failure rate in the immediate group was higher than that in the delayed group, but there was no statistically significant difference (I=0%; n=7; risk difference [RD]=0.03; 95% confidence interval [CI]=-0.01 to 0.08). The difference of MBL between immediate and delayed loading was not significant (I=88%; n=6; mean difference [MD]=-0.04; 95% CI=-0.16 to 0.24). Because of the limited articles reporting on ISQ, PTV, and patient satisfaction, no quantitative analysis was conducted for these outcomes.
CONCLUSIONS
Although the implant failure rate was more likely to favor the delayed group, available evidence indicates no statistical difference in implant failure and marginal bone loss between immediate and delayed loading protocols.
Topics: Humans; Dental Implantation, Endosseous; Dental Implants; Dental Prosthesis, Implant-Supported; Denture, Overlay; Randomized Controlled Trials as Topic
PubMed: 33139056
DOI: 10.1016/j.prosdent.2020.09.011 -
Cureus Sep 2023Restoration of hemimandibulectomy defects following tumour extirpation to restore oral function is a herculean task for practitioners. Prosthetic treatment alternatives... (Review)
Review
Restoration of hemimandibulectomy defects following tumour extirpation to restore oral function is a herculean task for practitioners. Prosthetic treatment alternatives available for rehabilitation of acquired hemimandibulectomy defects according to mandibular reconstruction type and extent (Cantor-Curtis classification) are unclear. This systematic review aims to assess the spectrum of prosthodontic rehabilitation approaches with regard to reconstruction type and extent of mandibular surgical defects. The databases incorporated for literature search were Google Scholar and Medline (PubMed). Relevant search terms for hemimandibulectomy and reconstruction with prosthetic rehabilitation were used. Two reviewers independently assessed the articles using eligibility criteria; published case reports and case series in the English language and depicting prosthodontic treatment modality of patients greater than 15 years were included. A total of 202 records were identified from the database search of which 19 duplicates were removed. The remaining articles were assessed for eligibility, and 55 articles (comprising 58 cases) were finally included in the study. This review revealed various prosthetic alternatives ranging from guide flange, twin occlusion, palatal ramp, conventional to hybrid partial and complete dentures to implant-supported prosthesis including a few innovative prosthetic approaches. This systematic review provides a plethora of prosthodontic rehabilitation approaches according to the extent of hemimandibular surgical defect and type of reconstruction. This will facilitate practitioners and prosthodontists in sequential treatment planning and management of hemimandibulectomy cases in their routine practice.
PubMed: 37799255
DOI: 10.7759/cureus.44647 -
BMC Oral Health Mar 2021Immediate loading has recently been introduced into unsplinted mandibular implant-retained overdentures for the management of edentulous patients due to their increasing... (Meta-Analysis)
Meta-Analysis
Effects of immediate and delayed loading protocols on marginal bone loss around implants in unsplinted mandibular implant-retained overdentures: a systematic review and meta-analysis.
BACKGROUND
Immediate loading has recently been introduced into unsplinted mandibular implant-retained overdentures for the management of edentulous patients due to their increasing demand on immediate aesthetics and function. However, there is still a scarcity of meta-analytical evidence on the efficacy of immediate loading compared to delayed loading in unsplinted mandibular implant-retained overdentures. The purpose of this study was to compare the marginal bone loss (MBL) around implants between immediate and delayed loading of unsplinted mandibular implant-retained overdentures.
METHODS
Randomized controlled trials (RCTs), controlled clinical trials (CCTs), and cohort studies quantitatively comparing the MBL around implants between immediate loading protocol (ILP) and delayed loading protocol (DLP) of unsplinted mandibular overdentures were included. A systematic search was carried out in PubMed, EMBASE, and CENTRAL databases on December 02, 2020. "Grey" literature was also searched. A meta-analysis was conducted to compare the pooled MBL of two different loading protocols of unsplinted mandibular overdentures through weighted mean differences (WMDs) with 95% confidence intervals (95% CIs). The subgroup analysis was performed between different attachment types (i.e. Locator attachment vs. ball anchor). The risk of bias within and across studies were assessed using the Cochrane Collaboration's tool, the Newcastle-Ottawa scale, and Egger's test.
RESULTS
Of 328 records, five RCTs and two cohort studies were included and evaluated, which totally contained 191 participants with 400 implants. The MBL of ILP group showed no significant difference with that of DLP group (WMD 0.04, CI - 0.13 to 0.21, P > .05). The subgroup analysis revealed similar results with Locator attachments or ball anchors (P > .05). Apart from one RCT (20%) with a high risk of bias, four RCTs (80%) showed a moderate risk of bias. Two prospective cohort studies were proved with acceptable quality. Seven included studies have reported 5.03% implant failure rate (10 of 199 implants) in ILP group and 1.00% failure rate (2 of 201 implants) in DLP group in total.
CONCLUSIONS
For unsplinted mandibular implant-retained overdentures, the MBL around implants after ILP seems comparable to that of implants after DLP. Immediate loading may be a promising alternative to delayed loading for the management of unsplinted mandibular implant-retained overdentures. PROSPERO registration number: CRD42020159124.
Topics: Alveolar Bone Loss; Dental Implants; Dental Prosthesis, Implant-Supported; Denture, Overlay; Esthetics, Dental; Humans; Immediate Dental Implant Loading; Jaw, Edentulous; Mandible
PubMed: 33731092
DOI: 10.1186/s12903-021-01486-3