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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 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 -
Journal of Oral Rehabilitation Jan 2021To review the literatures concerning the effect of the single-implant mandibular overdenture (SIMO) on patient-reported outcome measures (PROMs) and masticatory function...
AIM
To review the literatures concerning the effect of the single-implant mandibular overdenture (SIMO) on patient-reported outcome measures (PROMs) and masticatory function in the fully edentulous patients.
MATERIALS AND METHODS
Electronic databases (PubMed, Cochrane Library, EMBASE and Web of Science) were searched, complemented with manual resources. Prospective studies published in English up to February 2020 reporting the effect of SIMO on PROMs and masticatory function in the edentulous patients were included. This review focused on oral health-related quality of life (OHRQoL), satisfaction and masticatory function outcomes.
RESULTS
Of 1157 initially screened articles, 9 randomised controlled trials (RCTs) and 8 prospective studies involving 551 subjects fulfilled the inclusion criteria. Two RCTs were graded as high risk of bias or some concern, while others were low risk. All prospective studies had adequate representativeness and assessment, but only one study had a controlled cohort. In general, the edentulous patients restored with SIMOs had improved OHRQoL and general satisfaction compared to those with conventional complete dentures (CCDs), but the outcome of masticatory function was controversial. Compared with two-implant mandibular overdenture (TIMO), SIMO showed no significant differences regarding general satisfaction and satisfaction with speech, comfort, chewing ability, aesthetics and social life. Conflicting results were observed in OHRQoL and satisfaction with retention and stability. Better masticatory performance was observed in TIMO group than SIMO group.
CONCLUSION
Within the limitation of this review, SIMO is featured with better OHRQoL and satisfaction than CCD. SIMO and TIMO rendered similar patient satisfaction, but TIMO had better masticatory performance.
Topics: Dental Prosthesis, Implant-Supported; Denture, Overlay; Esthetics, Dental; Humans; Mandible; Mastication; Mouth, Edentulous; Patient Reported Outcome Measures; Patient Satisfaction; Quality of Life
PubMed: 32989781
DOI: 10.1111/joor.13103 -
Minerva Stomatologica Aug 2020In this systematic review, several masticatory function parameters assessed during mandibular single-implant overdenture (SIO) use were compared to pre- SIO placement...
INTRODUCTION
In this systematic review, several masticatory function parameters assessed during mandibular single-implant overdenture (SIO) use were compared to pre- SIO placement values in edentulous patients with aim of contributing to a consensus regarding denture treatment options.
EVIDENCE ACQUISITION
This study was registered a priori in the PROSPERO database (CRD42018106567). Two independent reviewers carried out electronic searches in eight databases, without language or time frame limitations, to collate clinical studies comparing masticatory function of edentulous patients before versus after SIO installation with the implant placed on the mandibular midline. Risk of bias was assessed with a before-and-after tool and evidence certainty level was evaluated with the Grading of Recommendations Assessment, Development and Evaluation program.
EVIDENCE SYNTHESIS
Eleven studies were included in this review (1 prospective, 3 crossover trials, 4 randomized clinical trials, 2 paired clinical trials, and 1 pilot). Enrolled patients were mostly over 60 years old; all patients were using conventional complete dentures (CD) prior to SIO installation. Masticatory performance, masticatory efficiency, bite force, and muscle activity were improved after the SIO placement compared to during mandibular CD use. Mandibular movement and masticatory ability data were inconclusive. Most of the studies had low risk of bias, but all had very low certainly level ratings due to methodological heterogeneity.
CONCLUSIONS
Placement of SIO improves masticatory function, as reflected mostly by masticatory performance and efficiency data, relative to CD use. Further studies comparing dental rehabilitation options, including SIOs, are needed to improve the quality of evidence in the literature.
Topics: Dental Implants; Dental Prosthesis, Implant-Supported; Denture, Overlay; Humans; Mandible; Mastication; Middle Aged; Patient Satisfaction; Prospective Studies
PubMed: 32945635
DOI: 10.23736/S0026-4970.20.04327-7 -
Quintessence International (Berlin,... 2020To investigate bone loss in the anterior edentulous maxilla restored with maxillary complete dentures and opposed by mandibular two-implant-supported overdentures... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To investigate bone loss in the anterior edentulous maxilla restored with maxillary complete dentures and opposed by mandibular two-implant-supported overdentures (2-IODs) or complete dentures.
METHOD AND MATERIALS
A systematic search was conducted using the Ovid MEDLINE, Embase, Web of Science, CINAHL, and Cochrane databases for studies investigating bone loss in the anterior edentulous maxilla with mandibular 2-IODs or complete dentures. Two reviewers assessed the eligibility of studies and risk of bias assessment was conducted according to the Newcastle-Ottawa Scale. A meta-analysis was performed using statistical software to estimate weighted mean difference in bone loss with 95% confidence interval (CI). The level of significance was defined as P value (< .05).
RESULTS
A total of 2,510 studies were identified through electronic and manual searching. Six studies were selected and compounded for quantitative synthesis of 163 patients. Bone loss in the anterior edentulous maxilla was greater with 2-IODs than with complete dentures. The total estimate of weighted mean difference between 2-IODs and complete dentures was -1.40 (95% CI -3.12 to 0.31). However, the difference was not statistically significant (P = .11). The data were heterogenous across the studies based on chi-square statistics (χ2 [df = 7] = 52.75, P < .0001; τ2 = 5.53, I2 = 95.21%). In addition, the impact of implant splinting on bone loss was not significant (P > .29). None of the included studies were considered to be at high risk of bias.
CONCLUSION
Within the limitations of the current systematic review and meta-analysis, the estimate of bone loss in the anterior edentulous maxilla was greater with 2-IODs than with complete dentures. However, the difference was not statistically significant. A well-designed randomized clinical study needs to be conducted to validate the results of this systematic review.
Topics: Dental Prosthesis, Implant-Supported; Denture, Complete; Denture, Overlay; Humans; Jaw, Edentulous; Mandible; Maxilla
PubMed: 32696032
DOI: 10.3290/j.qi.a44928 -
The Journal of Prosthetic Dentistry May 2021Evidence provided by implant-supported mandibular overdenture research on different loading protocols is important. However, methodological inconsistency, as well as... (Meta-Analysis)
Meta-Analysis
STATEMENT OF PROBLEM
Evidence provided by implant-supported mandibular overdenture research on different loading protocols is important. However, methodological inconsistency, as well as inadequate reporting of results, hampers a consistent decision in terms of clinical applicability.
PURPOSE
The purpose of this systematic review and meta-analysis was to evaluate whether immediate or early loading protocols can achieve comparable clinical outcomes when compared with a conventional loading protocol in edentulous patients rehabilitated with mandibular overdentures.
MATERIAL AND METHODS
In accordance with the Participant, Intervention, Comparison, Outcome strategy, prospective clinical studies without restrictions as to language or follow-up period were included. The Cochrane collaboration and ROBINS-I tools were used for quality assessment and risk-of-bias evaluation. The follow-up for the different outcomes ranged from 3 to 168 months, with the focus on implant success and survival rates, marginal bone loss, bleeding on probing, probing depth, plaque index, and the implant stability quotient. Statistical analyses in which standard mean differences were applied with a 95% confidence interval when continuous data were included were performed. For dichotomous data, risk difference was adopted.
RESULTS
The search strategy resulted in 14 234 references. Twenty-three studies fulfilled the inclusion criteria. Meta-analysis showed statistically significant differences for plaque index at 12 months (standard mean difference=0.284 [0.022, 0.545], P=.033, I=35%), probing depth at 36 months (standard mean difference=0.460 [0.098, 0.823], P=.013, I=0%), and on pooled results for plaque index (standard mean difference=0.157 [0.031, 0.284], P=.015, I=18%) in which the conventional loading protocol presented lower indices than those of immediate loading protocol or early loading protocol. Implant stability quotient presented a statistically significant difference only at 3 months (standard mean difference=0.602 [0.309, 0.895], P<.001, I=0%) with higher values for the conventional loading protocol. For the other parameters, statistically significant differences (P>.05) were not found.
CONCLUSIONS
Immediate loading protocol or early loading protocolfor mandibular overdentures has been determined to be a well-established treatment and worthy of consideration in clinical practice.
Topics: Dental Implantation, Endosseous; Dental Implants; Dental Prosthesis, Implant-Supported; Denture, Overlay; Humans; Immediate Dental Implant Loading; Jaw, Edentulous; Mandible; Prospective Studies; Treatment Outcome
PubMed: 32684353
DOI: 10.1016/j.prosdent.2020.04.017 -
Journal of the American Dental... May 2020
Large uncertainty regarding how splinted and unsplinted maxillary implant-retained overdentures compare owing to limitations in systematic review addressing this question.
Topics: Dental Implants; Dental Prosthesis, Implant-Supported; Denture, Overlay; Jaw, Edentulous; Mandible; Maxilla; Uncertainty
PubMed: 32220346
DOI: 10.1016/j.adaj.2019.12.008 -
Quintessence International (Berlin,... 2020To evaluate the influence of implant splinting on peri-implant marginal bone level and implant failures in completely edentulous patients who have been rehabilitated... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
To evaluate the influence of implant splinting on peri-implant marginal bone level and implant failures in completely edentulous patients who have been rehabilitated with mandibular implant overdentures.
METHOD AND MATERIALS
A literature search of electronic databases (PubMed and Cochrane Central Register of Controlled Trials [CENTRAL]) was performed, with the last search conducted in July 2019. Randomized controlled trials with at least a 12-month follow-up period were selected. The review and meta-analysis were performed in accordance with PRISMA guidelines. Two comparisons were included in the meta-analysis: (1) Two-implant supported ball versus two-implant supported bar mandibular overdenture; (2): Two- versus four-implant supported bar mandibular overdenture.
RESULTS
Six randomized controlled trials fulfilled the inclusion criteria and were included in a quality assessment and meta-analysis. Pooled data revealed a nonsignificant difference in marginal bone level (I2 = 0%; P = 1; mean difference = 0.00; 95% CI -0.37 to 0.37) and implant failures (P = .24; risk ratio = 6.07; 95% CI 0.30 to 121.33) when two-implant ball overdentures were compared to two-implant bar overdentures. Similarly, there was no significant difference in marginal bone level (I2 = 59%; P = .59; mean difference = -0.16; 95% CI -0.73 to 0.41) or implant failures (I2 = 0%; P = .36; risk ratio = 2.03; 95% CI 0.45 to 9.16) when two- versus four-implant bar overdentures were compared.
CONCLUSION
Based on the findings of the meta-analysis, there is no influence of implant splinting on peri-implant marginal bone level and implant failures for completely edentulous patients rehabilitated with mandibular implant overdentures. However, this result should be interpreted with caution due to the limited number of analyzed studies, most of them considered at unclear risk of bias. Well-designed randomized controlled trials with follow-up periods of at least 5 years are highly recommended to establish evidence with regard to the influence of implant splinting on mandibular overdentures.
Topics: Dental Implants; Dental Prosthesis, Implant-Supported; Denture, Overlay; Humans; Jaw, Edentulous; Mandible; Mouth, Edentulous; Randomized Controlled Trials as Topic
PubMed: 32080685
DOI: 10.3290/j.qi.a44144 -
The International Journal of... 2020To analyze the current evidence on bone loss in the posterior edentulous mandible restored with complete dentures (CDs), two-implant-supported overdentures (2-IODs), or... (Meta-Analysis)
Meta-Analysis
PURPOSE
To analyze the current evidence on bone loss in the posterior edentulous mandible restored with complete dentures (CDs), two-implant-supported overdentures (2-IODs), or four-implant-supported overdentures (4-IODs).
MATERIALS AND METHODS
A search was conducted in the Ovid MEDLINE, Embase, Web of Science, CINAHL, and Cochrane databases for clinical studies comparing bone loss in posterior edentulous mandibles restored with CDs, 2-IODs, or 4-IODs. A meta-analysis was performed using statistical software to estimate the mean differences in bone loss with 95% CI. The level of significance was set at P < .05.
RESULTS
The search strategy identified 2,806 articles, of which 14 met the inclusion criteria. The meta-analysis included 7 two-arm studies comparing CDs vs 2-IODs or 2-IODs vs 4-IODs. No statistically significant difference was found in bone loss between 2-IODs and CDs (mean difference -0.25 [95% CI -0.85 to 0.36]; P = .43), whereas bone loss was significantly lower with 4-IODs than with 2-IODs (mean difference -0.96 [95% CI -1.86 to -0.06]; P = .04). Overall, the data were highly heterogenous (I > 74%).
CONCLUSION
4-IODs can benefit the patient by decreasing bone loss in the posterior edentulous mandible. However, 2-IODs may not be superior to CDs in reducing bone loss in the posterior mandible. A validation of these results is needed through well-designed RCTs.
Topics: Dental Implants; Dental Prosthesis, Implant-Supported; Denture, Complete; Denture, Overlay; Humans; Mandible
PubMed: 32069343
DOI: 10.11607/ijp.6636 -
Journal of Prosthodontics : Official... Apr 2020This systematic review was undertaken to establish the most favourable protocol to treat an edentulous mandible with a single implant-retained overdenture. The... (Meta-Analysis)
Meta-Analysis
PURPOSE
This systematic review was undertaken to establish the most favourable protocol to treat an edentulous mandible with a single implant-retained overdenture. The formulated PICO question was: "Which surgical and prosthetic protocols result in the highest survival and complication rates of implants and prostheses employed in a single implant retained overdenture for the rehabilitation of a completely edentulous mandibular ridge?"
MATERIALS AND METHODS
A structured literature search was conducted using the following databases; PubMed, ScienceDirect, COCHRANE, LILACS, IndeMED, OVID, EMBASE, NIH Clinical Trials for reports related to the single implant-retained overdenture treatment. Only English articles were included. Publications with a minimum follow up time of 1 year and above were included for meta-analysis. A Poisson regression model was applied to estimate the survival rates of the implant and prosthesis employed.
RESULTS
The electronic database search yielded 2083 titles and abstracts; and a total of 17 were selected for the systematic review, of which 11 studies were subjected to meta-analysis. The implants showed high estimated five and 10-year survival rates of 91.93% and 84.62%, respectively. Implants that were delayed loaded showed the greatest survival rates, while immediately loaded implants presented with higher survival rates at five (p = 0.849) and 10 years (p = 0.464) when compared to early loaded implants. The greatest number of fractures were associated with ball abutments with an event rate of 10.8 (95% CI: 10.5-11.09) per 100 prosthesis years, while locator abutments showed a greater number of maintenance events with an event rate of 16.84(95% CI:16.01-17.66) per 100 prosthesis years.
CONCLUSION
Single implant-retained overdenture treatment is a cost-effective, minimally invasive and simple treatment that can be used to restore function and aesthetics to edentulous patients, with relatively high implant and prosthesis success rates and minimal complications.
Topics: Dental Implants; Dental Prosthesis, Implant-Supported; Denture, Overlay; Esthetics, Dental; Humans; Jaw, Edentulous; Mandible
PubMed: 31849146
DOI: 10.1111/jopr.13133