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The International Journal of... 2019To investigate the influence of splinted vs unsplinted designs for a maxillary overdenture supported by four implants in terms of the outcome measures implant survival,...
PURPOSE
To investigate the influence of splinted vs unsplinted designs for a maxillary overdenture supported by four implants in terms of the outcome measures implant survival, overdenture longevity, and patient satisfaction.
MATERIALS AND METHODS
A systematic search, complemented by a handsearch, was carried out in the Embase, MEDLINE (PubMed), and Web of Science databases from 2000 to 2018. The PRISMA statement and a PICO approach were adopted. Free-text words were used in the strategy search, including "4-implant-retained overdenture," "4-implant-supported overdenture," "implant-supported overdenture," "implant-retained overdenture," "maxillary overdenture," "splinted design," "un-splinted design," and their combinations. All selected articles provided at least a 1-year follow-up, 10 fully edentulous patients, and at least one of the following clinical outcomes: survival rate of implants, survival rate of overdentures, and/or patient satisfaction scores. Nonparametric Fisher test for unpaired data was adopted in order to analyze data deriving from the survival rates of implants and overdentures.
RESULTS
The initial electronic search produced a total of 2,922 articles. After applying the inclusion criteria, 14 articles were included. The mean follow-up time after implant placement ranged from 1 to 10 years. No statistical difference was detected in the survival rate of implants between the splinted implant group and the unsplinted implant group (P = .1). Only 4 included studies reported an overdenture survival rate of lower than 95%. It is interesting to note that among these 4 studies, 3 employed four splinted implants with a bar anchorage; however, no statistical difference was detected in the survival rate of overdentures between the splinted and unsplinted groups (P = .47). High scores were reported by all studies investigating patient satisfaction.
CONCLUSION
Within the limits of this systematic review, it can be concluded that the survival rates of implants and overdentures and patient satisfaction with a maxillary overdenture supported by four implants were not influenced by the overdenture design, and no statistical difference was detected between the splinted and unsplinted groups.
Topics: Dental Implants; Dental Prosthesis, Implant-Supported; Denture Retention; Denture, Overlay; Humans; Jaw, Edentulous; Maxilla
PubMed: 31664267
DOI: 10.11607/ijp.6333 -
The Journal of Prosthetic Dentistry Apr 2020Overdentures can improve the quality of life of elderly patients compared with conventional complete dentures. Different attachment systems can be used to retain these...
STATEMENT OF PROBLEM
Overdentures can improve the quality of life of elderly patients compared with conventional complete dentures. Different attachment systems can be used to retain these prostheses, but which system results in better function, mechanical performance, and patient comfort is unclear.
PURPOSE
The purpose of this systematic review was to evaluate randomized clinical trials to compare overdentures supported by either bar and clip or ball and O-ring attachments for retention, masticatory efficiency, bone loss, and patient satisfaction.
MATERIAL AND METHODS
A literature search was conducted in the PubMed and Web of Science databases. From 163 studies, 16 randomized clinical trials were included in this systematic review based on the inclusion and exclusion criteria. The risk of bias was evaluated according to the RevMan software Risk of Bias Table (RoB Table), and only the studies with a low or intermediate risk of bias were included in the review.
RESULTS
From the limited number of studies, the attachment type did not affect the masticatory quality of the patients, bone loss marginal to the implants, or the degree of patient satisfaction. However, overdentures with the bar and clip attachment tended to have higher initial retention than the ball and O-ring system.
CONCLUSIONS
Both the bar and clip and ball and O-ring attachment systems presented similar clinical performance regarding mechanical and functional properties and patient satisfaction.
Topics: Aged; Dental Implants; Dental Prosthesis, Implant-Supported; Denture Retention; Denture, Complete; Denture, Overlay; Humans; Mandible; Quality of Life
PubMed: 31542217
DOI: 10.1016/j.prosdent.2019.03.024 -
Survival of Mini Dental Implants Used to Retain Mandibular Complete Overdentures: Systematic Review.The International Journal of Oral &... 2019To evaluate the survival rate of mini implants used to retain mandibular overdentures.
PURPOSE
To evaluate the survival rate of mini implants used to retain mandibular overdentures.
MATERIALS AND METHODS
An electronic search, supplemented by hand searching of the references, was conducted with no time or language restriction in October 2016 and updated in October 2017. The results were reviewed independently by the two authors. All randomized controlled trials, clinical trials, observational studies, and case series were included. The primary outcome measure was implant survival (months).
RESULTS
The search retrieved a combined total of 391 articles. Following screening, 17 articles were included. A total of 1,715 mini implants were assessed in 475 patients. Follow-up periods ranged from 6 to 84 months (mean: 28.24 months). There were 75 failures in total. The overall survival rate was 95.63%. The majority of patients received four implants to retain their prostheses. Most studies used a flapless surgical technique, but there were vast differences in loading protocols and retention methods. Formal meta-analysis was not conducted due to the heterogeneity between studies.
CONCLUSION
Based on the findings of this systematic review, mini dental implants exhibit excellent survival rates in the short to medium term. They appear to be a reasonable alternative treatment modality to retain mandibular complete overdentures from the available evidence.
Topics: Dental Implantation, Endosseous; Dental Implants; Dental Prosthesis, Implant-Supported; Dental Restoration Failure; Denture, Overlay; Humans; Mandible; Mouth, Edentulous; Prosthesis Fitting
PubMed: 30883617
DOI: 10.11607/jomi.6991 -
Gerodontology Sep 2019Loss of teeth has a negative influence on essential oral functions. It is important to understand edentulous patients' perceptions about the impacts of treatment options... (Review)
Review
Oral health-related quality of life and satisfaction of edentulous patients using conventional complete dentures and implant-retained overdentures: An umbrella systematic review.
BACKGROUND
Loss of teeth has a negative influence on essential oral functions. It is important to understand edentulous patients' perceptions about the impacts of treatment options on their oral health-related quality of life (OHRQoL) and satisfaction.
AIMS
To appraise the systematic reviews (with/without meta-analysis) that investigate the impacts of complete conventional dentures (CCDs) and/or implant-retained overdentures (IRODs) on the oral health-related quality of life (OHRQoL) and satisfaction among edentulous patients.
METHODS
The Joanna Briggs Institute (JBI) methodology for conduct of an umbrella systematic review was followed. Three database systems were used: Medline, Google Scholar and Cochrane Library. PROSPERO was searched for ongoing or recently completed systematic reviews. The reviews must report OHRQoL and patients' satisfaction as outcomes.
RESULTS
A total of eight reviews were included in data synthesis (six were systematic reviews without meta-analysis, one was systematic review with meta-analysis, and one was meta-analysis). The level of evidence of all included reviews based on the Scottish Intercollegiate Guidelines Network ranged between 1+ and 1-.
CONCLUSION
The results of this umbrella systematic review demonstrate the superiority of using IRODs compared with CCDs on the OHRQoL and patients' satisfaction outcomes. However, this positive impact is more accentuated when patients demand implant treatment or cannot adapt to CCDs treatment. Financial factors and adaptive capability indeed affect patient tolerance to both treatment modalities.
Topics: Humans; Dental Prosthesis, Implant-Supported; Denture, Complete; Denture, Overlay; Jaw, Edentulous; Meta-Analysis as Topic; Oral Health; Patient Satisfaction; Personal Satisfaction; Quality of Life; Systematic Reviews as Topic
PubMed: 30875108
DOI: 10.1111/ger.12399 -
The International Journal of Oral &... 2019This systematic review evaluated the mean survival rate and marginal bone loss (MBL) of dental implants with ≤ 6 mm in length, across a time frame of 5 years. The...
PURPOSE
This systematic review evaluated the mean survival rate and marginal bone loss (MBL) of dental implants with ≤ 6 mm in length, across a time frame of 5 years. The overall prosthetic and biologic complications were evaluated, and their survival rates obtained. In addition, the complication rates of the splinted vs nonsplinted implants were assessed.
MATERIALS AND METHODS
An electronic literature search in PubMed (MEDLINE) and EMBASE (OVID) and Cochrane were performed, in addition to a manual search through all periodontics and implantology-related journals, up to October 2017, to identify relevant articles.
RESULTS
Out of 515 potentially eligible articles, 19 investigations assessing a total of 910 extra-short (≤ 6 mm) implants were included and further evaluated. After 5 years of follow-up, a mean survival rate of 94.1% (90% in the maxilla and 96% in the mandible) and a maximum bone loss of 0.53 mm were demonstrated. Additionally, a statistically significant difference in terms of bone loss was observed between tissue-level (0.12 mm) and bone-level implants (0.36 mm) at 12 months (P < .01), but not between internal and external abutment connections (P = .17). The most commonly reported prosthetic complication was screw loosening. Finally, splinted implants showed less overall prosthetic complications (RR = 3.32; 95% CI: 1.9 to 5.7), screw loosening (RR = 15.2; 95% CI: 5.92 to 39.31), and implant failure (RR = 1.96; 95% CI: 0.8 to 4.8) than nonsplinted implants.
CONCLUSION
Extra-short implants are a viable treatment alternative in ridges exhibiting atrophy, demonstrating a satisfactory survival rate, as well as a low rate of prosthetic and biologic complications across a 5-year follow-up. Additionally, splinting extra-short implants is associated with fewer prosthetic complications and lower implant failure rate compared with nonsplinted implants.
Topics: Adult; Alveolar Bone Loss; Cohort Studies; Dental Implants; Dental Prosthesis Design; Dental Prosthesis, Implant-Supported; Dental Restoration Failure; Denture, Overlay; Female; Humans; Jaw, Edentulous; Male; Mandible; Maxilla; Middle Aged
PubMed: 30695086
DOI: 10.11607/jomi.6893 -
Journal of the Mechanical Behavior of... Mar 2019The purpose of this systematic review was to investigate the effect of reinforcement on the mechanical behaviour of implant overdenture (IOD) bases and its cumulative...
PURPOSE
The purpose of this systematic review was to investigate the effect of reinforcement on the mechanical behaviour of implant overdenture (IOD) bases and its cumulative biological effect on the underlying supporting structures (implants and the residual ridge).
MATERIAL AND METHODS
The required documents were collected electronically from PubMed and Web of Science databases targeting papers published in English that focused on denture base reinforcement for IOD prostheses in order to recognize the principal outcomes of reinforcement on the mechanical and biological properties of overdentures. Such biological outcomes as: strains on implants, peri-implant bone loss, residual ridge resorption, and strain on the residual alveolar ridge.
RESULTS
A total of 269 citations were identified. After excluding any repeated articles between databases and the application of exclusion and inclusion criteria, only 13 publications fulfilled the inclusion criteria. Three publications investigated the mechanical properties of fibre and/or metal-reinforced implant overdentures while another 3 articles investigated the effect of metal reinforcement on stress distribution and strains transmitted to the underlying implants. In addition, 3 in vitro studies investigated the effect of metal reinforcement on overdenture base strain and stresses. Stress distribution to the residual ridge and strain characteristics of the underlying tissues were investigated by 2 in vitro studies. Five clinical studies performed to assist the clinical and prosthetic maintenance of metal-reinforced IOD were included. Data concerning denture base fracture, relining, peri-implant bone loss, probing depth, and implant survival rates during the functional period were extracted and considered in order to evaluate the mechanical properties of the denture base, residual ridge resorption and implant preservation rates, respectively.
CONCLUSION
The use of a denture base reinforcement can reduce the fracture incidence in IOD bases by enhancing their flexural properties and reducing the overdenture base deformation. Strains on the underlying supporting structures of overdenture prostheses including dental implants and the residual ridge can be decreased and evenly distributed using a metal reinforcement.
Topics: Biomechanical Phenomena; Dental Implants; Denture, Overlay; Humans; Mechanical Phenomena
PubMed: 30594062
DOI: 10.1016/j.jmbbm.2018.12.006 -
Clinical Oral Implants Research Oct 2018The aim of this systematic review was to compare patient-reported outcomes measures (PROMs) of implant-supported fixed complete dentures (IFCDs) and overdentures (IODs).
OBJECTIVE
The aim of this systematic review was to compare patient-reported outcomes measures (PROMs) of implant-supported fixed complete dentures (IFCDs) and overdentures (IODs).
MATERIAL AND METHODS
PubMed, Cochrane Library, EMBASE, Scopus and Web of Science were searched, complemented by manual search. Studies published in English up to November 2016 comparing removable with fixed implant-supported prosthesis on fully edentulous patients were included. The review focused on impact on patients' oral health-related quality of life (OHRQoL), satisfaction or other patient-reported outcomes measures.
RESULTS
Of 1,563 initially screened articles, 13 studies including 8 prospective and 5 retrospective studies fulfilled the inclusion criteria. OHRQoL and patient satisfaction were the most common PROMs. When evaluating the levels of evidence, five of thirteen studies were graded as level III and seven reached level II. The only randomized control trial was rated as Ib. The methods used to evaluate PROMs were heterogeneous among studies, and there was a lack of standardization in the measurements employed. In general, IFCD and IOD showed no significant differences when compared for PROMs, with a slight trend of IFCD being superior to IOD in most included studies. However, conflicting results were observed in many aspects such as chewing function, phonetics-related function, overall satisfaction and aesthetics.
CONCLUSIONS
Inconsistent results were observed in PROMs when comparing IFCD and IOD for fully edentulous patients. A guideline for standardizing the assessment of PROMs in clinical research is needed in order to produce more meaningful evidence-based information.
Topics: Databases, Factual; Dental Implantation, Endosseous; Dental Implants; Dental Prosthesis, Implant-Supported; Denture, Complete; Denture, Overlay; Esthetics, Dental; Humans; Mastication; Mouth, Edentulous; Patient Outcome Assessment; Patient Reported Outcome Measures; Patient Satisfaction; Quality of Life; Treatment Outcome
PubMed: 30328202
DOI: 10.1111/clr.13286 -
The Cochrane Database of Systematic... Oct 2018Implant overdentures are one of the most common treatment options used to rehabilitate edentulous patients. Attachment systems are used to anchor the overdentures to... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Implant overdentures are one of the most common treatment options used to rehabilitate edentulous patients. Attachment systems are used to anchor the overdentures to implants. The plethora of attachment systems available dictates a need for clinicians to understand their prosthodontic and patient-related outcomes.
OBJECTIVES
To compare different attachment systems for maxillary and mandibular implant overdentures by assessing prosthodontic success, prosthodontic maintenance, patient preference, patient satisfaction/quality of life and costs.
SEARCH METHODS
Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 24 January 2018); Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 12) in the Cochrane Library (searched 24 January 2018); MEDLINE Ovid (1946 to 24 January 2018); and Embase Ovid (1980 to 24 January 2018). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials on 24 January 2018. No restrictions were placed on the language or date of publication when searching the electronic databases.
SELECTION CRITERIA
All randomised controlled trials (RCTs), including cross-over trials on maxillary or mandibular implant overdentures with different attachment systems with at least 1 year follow-up.
DATA COLLECTION AND ANALYSIS
Four review authors extracted data independently and assessed risk of bias for each included trial. Several corresponding authors were subsequently contacted to obtain missing information. Fixed-effect meta-analysis was used to combine the outcomes with risk ratios (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, with 95% confidence intervals (95% CI). We used the GRADE approach to assess the quality of evidence and create 'Summary of findings' tables.
MAIN RESULTS
We identified six RCTs with a total of 294 mandibular overdentures (including one cross-over trial). No trials on maxillary overdentures were eligible. Due to the poor reporting of the outcomes across the included trials, only limited analyses between mandibular overdenture attachment systems were possible.Comparing ball and bar attachments, upon pooling the data regarding short-term prosthodontic success, we identified substantial heterogeneity (I = 97%) with inconsistency in the direction of effect, which was unexplained by clinical or methodological differences between the studies, and accordingly we did not perform meta-analyses for this outcome. Short-term re-treatment (repair of attachment system) was higher with ball attachments (RR 3.11, 95% CI 1.68 to 5.75; 130 participants; 2 studies; very low-quality evidence), and there was no difference between both attachment systems in short-term re-treatment (replacement of attachment system) (RR 1.18, 95% CI 0.38 to 3.71; 130 participants; 2 studies; very low-quality evidence). It is uncertain whether there is a difference in short-term prosthodontic success when ball attachments are compared with bar attachments.Comparing ball and magnet attachments, there was no difference between them in medium-term prosthodontic success (RR 0.84, 95% CI 0.64 to 1.10; 69 participants; 1 study; very low-quality evidence), or in medium-term re-treatment (repair of attachment system) (RR 1.75, 95% CI 0.65 to 4.72; 69 participants; 1 study; very low-quality evidence). However, after 5 years, prosthodontic maintenance costs were higher when magnet attachments were used (MD -247.37 EUR, 95% CI -346.32 to -148.42; 69 participants; 1 study; very low-quality evidence). It is uncertain whether there is a difference in medium-term prosthodontic success when ball attachments are compared with magnet attachments.One trial provided data for ball versus telescopic attachments and reported no difference in prosthodontic maintenance between the two systems in short-term patrix replacement (RR 6.00, 95% CI 0.86 to 41.96; 22 participants; 1 study; very low-quality evidence), matrix activation (RR 11.00, 95% CI 0.68 to 177.72; 22 participants; 1 study; very low-quality evidence), matrix replacement (RR 1.75, 95% CI 0.71 to 4.31; 22 participants; 1 study; very low-quality evidence), or in relining of the implant overdenture (RR 2.33, 95% CI 0.81 to 6.76; 22 participants; 1 study; very low-quality evidence). It is uncertain whether there is a difference in short-term prosthodontic maintenance when ball attachments are compared with telescopic attachments.In the only cross-over trial included, patient preference between different attachment systems was assessed after only 3 months and not for the entire trial period of 10 years.
AUTHORS' CONCLUSIONS
For mandibular overdentures, there is insufficient evidence to determine the relative effectiveness of different attachment systems on prosthodontic success, prosthodontic maintenance, patient satisfaction, patient preference or costs. In the short term, there is some evidence that is insufficient to show a difference and where there was no evidence was reported. It was not possible to determine any preferred attachment system for mandibular overdentures.For maxillary overdentures, there is no evidence (with no trials identified) to determine the relative effectiveness of different attachment systems on prosthodontic success, prosthodontic maintenance, patient satisfaction, patient preference or costs.Further RCTs on edentulous cohorts must pay attention to trial design specifically using the same number of implants of the same implant system, but with different attachment systems clearly identified in control and test groups. Trials should also determine the longevity of different attachment systems and patient preferences. Trials on the current array of computer-aided designed/computer-assisted manufactured (CAD/CAM) bar attachment systems are encouraged.
Topics: Dental Implantation; Denture, Overlay; Humans; Jaw, Edentulous; Randomized Controlled Trials as Topic; Tooth Preparation, Prosthodontic; Treatment Outcome
PubMed: 30308116
DOI: 10.1002/14651858.CD008001.pub2 -
Journal of Prosthodontic Research Jan 2019The number of implants needed to support a maxillary overdenture is still a controversial issue. The aim of this systematic review was to investigate the number of... (Meta-Analysis)
Meta-Analysis
PURPOSE
The number of implants needed to support a maxillary overdenture is still a controversial issue. The aim of this systematic review was to investigate the number of implants required to support a maxillary overdenture in order to obtain optimal treatment outcomes in terms of implant survival, overdenture longevity and patient satisfaction.
STUDY SELECTION
Pubmed and EMBASE databes were systematically searched and complemented by hand searching from 2000 to 2017. The Prisma statement and a PICOS approach were adopted. All selected articles provided at least two-year follow-up and 10 totally edentulous patients. Survival rate of implants and overdentures were statistically analyzed according to number of implants and according to splitting technique, employing non-parametric Fisher Test for unpaired data. For the pooled analysis of implant failures, the odds ratio between group of 4 splinted implants and group of more than 4 splinted was calculated.
RESULTS
A total of 28 articles were included. Data analysis of the included studies showed that the survival rate of implants appeared higher in ≥ 4 implants group, whereas the high survival rate of overdentures and patient satisfaction were not significantly influenced by the number of implants.
CONCLUSIONS
The findings of our analysis indicate that overall the most frequent tendency is to place at least four implants, splinted or unsplinted, in order to ensure a higher survival rate of implants. However, the relationship between overdenture survival, the patient's quality of life, and the number of implants required to support a maxillary overdenture has yet to be clarified.
Topics: Dental Implants; Dental Prosthesis, Implant-Supported; Denture Retention; Denture, Overlay; Humans; Jaw, Edentulous; Maxilla; Patient Satisfaction; PubMed; Quality of Life; Treatment Outcome
PubMed: 30269880
DOI: 10.1016/j.jpor.2018.08.006 -
Journal of Oral and Maxillofacial... Jan 2019The purpose of this study was to describe a new case using implant-retained overdentures in a patient with severe oral lichen planus (OLP) and to perform a literature...
PURPOSE
The purpose of this study was to describe a new case using implant-retained overdentures in a patient with severe oral lichen planus (OLP) and to perform a literature review to evaluate the effectiveness and safety of implant rehabilitation in OLP patients.
MATERIAL AND METHODS
In our patient with erosive OLP, restoration was performed with implant-retained overdentures using the Locator attachment system (Zest Anchors, Escondido, CA). Our case showed favorable restorative results and excellent implant osseointegration with acceptable marginal bone resorption during the follow-up period of 3 years. We performed a literature search of the PubMed (Medline), Embase, and Cochrane databases for articles published between 1990 and 2018 using the key terms "oral lichen planus" and "implant."
RESULTS
This search identified 13 publications, including 9 single case reports or case series and 4 small-scale controlled studies. A total of 86 OLP patients and 259 dental implants were analyzed. The survival rate of implants was 95.8% during a follow-up period ranging from 1 to 13 years.
CONCLUSION
Dental implants seem to be an acceptable and reliable treatment option in patients with OLP. Nevertheless, clinical information on this topic is still scarce, and more well-designed randomized studies are needed to define the benefits and risks of implant rehabilitation in OLP patients.
Topics: Dental Implants; Dental Prosthesis, Implant-Supported; Denture, Overlay; Follow-Up Studies; Humans; Lichen Planus, Oral
PubMed: 30176217
DOI: 10.1016/j.joms.2018.07.031