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Clinical Implant Dentistry and Related... Dec 2023Maxillary implant overdenture therapy is a good treatment option for treating patients experiencing problems with their conventional maxillary denture. Retaining the... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
Maxillary implant overdenture therapy is a good treatment option for treating patients experiencing problems with their conventional maxillary denture. Retaining the overdenture with four implants and a bar attachment system serves as the current gold standard. However, there is a demand for less costly and less invasive treatment options. The aim of this randomized controlled trial was to compare marginal bone level change (MBLC), implant and overdenture survival, clinical, masticatory, and patient-related outcomes (PROMs) of maxillary implant overdentures with either two or four implants and a bar attachment system.
MATERIALS AND METHODS
Forty edentulous participants were randomly allocated to two groups (n = 20), to receive either two or four implants in the maxilla. After healing, all the participants received an implant overdenture retained by a bar attachment system. All the participants were evaluated 1 and 12 months after overdenture placement. The primary outcome was MBLC. Secondary outcomes were implant and overdenture survival, clinical, masticatory, and PROMs. The outcomes were analyzed using parametric and non-parametric tests.
RESULTS
MBLC was -0.03 mm in the 2-implant group and -0.16 mm in the 4-implant group (p = 0.21). Implant survival was 83.3% in the 2-implant group and 94.4% in the 4-implant group (p = 0.03). The median pocket depth change and clinical outcomes were low, and masticatory performance along with PROMs improved in both groups and did not differ significantly between them.
CONCLUSION
Maxillary 4-implant overdentures perform better than maxillary 2-implant overdentures with a bar attachment system in terms of implant and overdenture survival and therefore remains the gold standard. However, both overdentures perform similarly in terms of MBLC, clinical, masticatory, and PROMs.
Topics: Humans; Denture, Overlay; Dental Implants; Jaw, Edentulous; Maxilla; Dental Prosthesis, Implant-Supported; Mouth, Edentulous; Denture Retention
PubMed: 37563860
DOI: 10.1111/cid.13262 -
The European Journal of Prosthodontics... Feb 2024The aim of this study was to evaluate the surface wear and retention force of telescopic attachments made of zirconia primary crowns and poly-ether- ketone -ketone...
PURPOSE
The aim of this study was to evaluate the surface wear and retention force of telescopic attachments made of zirconia primary crowns and poly-ether- ketone -ketone (PEKK) secondary crowns for 2-implant retained mandibular complete overdentures.
MATERIALS AND METHODS
Ten healthy completely edentulous patients aged 55-60 years were selected for this study. Each patient received two implants in the mandibular canine regions. Maxillary conventional complete dentures were constructed against implant-retained mandibular overdentures for all patients. Zirconia- PEKK telescopic attachments were fabricated to retain the overdentures where primary copings were constructed of zirconia and secondary ones were constructed of PEKK. Retention force and surface wear were evaluated at the time of overdenture insertion (T0), and after 6 months of overdenture use (T6).
RESULTS
The results revealed less wear of zirconia copings compared to PEKK ones at T0 and T6. However, both materials showed insignificant wear after 6 months of overdenture use. A significant increase in retention force was observed after 6 months of overdenture use.
CONCLUSION
Within limitations of this study, PEKK may be considered a promising alternative material for telescopic secondary crowns construction combined to zirconia primary ones, regarding the wear resistance and the satisfactory retention forces.
Topics: Humans; Dental Implants; Ether; Ketones; Denture Retention; Ethyl Ethers; Ethers; Crowns; Denture, Overlay; Dental Prosthesis, Implant-Supported; Zirconium
PubMed: 37549130
DOI: 10.1922/EJPRD_2524Emera08 -
Journal of Dentistry Oct 2023To explore the perspectives and experiences of edentate individuals in regard to the immediate-loading protocol of an implant-supported overdenture.
OBJECTIVES
To explore the perspectives and experiences of edentate individuals in regard to the immediate-loading protocol of an implant-supported overdenture.
METHODS
A qualitative approach and interpretive description methodology was used. Seventeen edentate individuals (mean age: 61.9 ± 6.6 years) who received implant-supported overdentures through an immediate-loading protocol participated. Audio-recorded, semi-structured, in-depth interviews, each with a 60-90-minute duration, were conducted by two trained interviewers. The interview guide was developed based on Perneger's Detailed Model. Qualitative data were analyzed using a thematic approach including interview debriefing, transcript coding, data display, inductive thematic analysis, and interpretation.
RESULTS
Three main themes emerged from the interviews: patient awareness and engagement with treatment, experience-shaped expectations, and immediate gratification. All patients expressed satisfaction with the treatment. Providing detailed information, good communication, and accessibility of the dental care provider had a significant impact on patient satisfaction with prosthetic care. Patients highlighted that the high cost of implant therapy was the major barrier to receiving this treatment in the private sector and perceived dental insurance coverage as a facilitator of this process.
CONCLUSIONS
Study findings conclude that patient awareness about immediate-loading protocol improved their treatment engagement, and patient satisfaction with the treatment outcomes was higher than anticipated. The satisfaction was primarily related to prosthesis stability, receiving the prosthesis the same day, and low cost of treatment. Patients' positive experience and satisfaction with the immediate-loading protocol indicate that this treatment modality should be considered in treatment planning for edentate individuals.
CLINICAL SIGNIFICANCE
The perceptions and experiences of edentulous patients gathered in this study highlight their satisfaction with immediate loading for implant-supported overdentures. This therapeutic modality can be considered a viable option in treatment planning for edentulous individuals.
Topics: Humans; Middle Aged; Aged; Dental Implants; Patient Satisfaction; Denture, Overlay; Mandible; Dental Prosthesis, Implant-Supported; Treatment Outcome; Immediate Dental Implant Loading; Jaw, Edentulous; Mouth, Edentulous; Personal Satisfaction
PubMed: 37527728
DOI: 10.1016/j.jdent.2023.104644 -
Journal of Dentistry Sep 2023To investigate the occurrence of mild cognitive impairment in edentulous patients up to 3 years after they received single-implant overdentures (1-IODs). (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To investigate the occurrence of mild cognitive impairment in edentulous patients up to 3 years after they received single-implant overdentures (1-IODs).
METHODS
This was a follow-up study for a crossover randomized controlled trial comparing 1-IODs and conventional complete dentures, with patient satisfaction as the primary outcome. In the present study, the cognitive function of the patients, measured with the Japanese version of the Montreal cognitive assessment (MoCA-J), was evaluated as the secondary outcome at baseline and 2 months, 1 year, 2 years, and 3 years after 1-IOD placement. The total and domain (memory, executive function, visuospatial skills, language, attention, and orientation) MoCA-J scores of the patients at each timepoint were analyzed and compared.
RESULTS
Twenty-two patients with edentulous mandibles received 1-IODs. Within-group comparisons revealed that the total MoCA-J scores at 1 year and 3 years after 1-IOD placement were significantly increased compared with baseline scores. Additionally, the memory domain scores at all timepoint were significantly increased compared with the baseline scores, and the executive function domain scores at the 2-month, 2-year and 3-year timepoint were significantly increased compared with the baseline scores.
CONCLUSION
Patients with edentulous mandibles who underwent 1-IOD placement showed significantly improved total scores of MoCA-J after 1 year and 3 years of wearing 1-IODs. In addition, they showed significantly improved memory domain scores at 2 months, 1 year, 2 years, and 3 years after 1-IOD placement and executive function domain scores at 2 months, 2 years, and 3 years after 1-IOD placement.
CLINICAL SIGNIFICANCE
The results of this study suggest that 1-IOD treatment for older adults, especially those with edentulous mandibles, may prevent cognitive decline regardless of the condition of the maxilla.
Topics: Humans; Aged; Follow-Up Studies; Denture, Overlay; Quality of Life; Denture, Complete; Patient Satisfaction; Cognition; Dental Prosthesis, Implant-Supported; Mandible; Dental Implants; Denture Retention
PubMed: 37506810
DOI: 10.1016/j.jdent.2023.104632 -
Journal of Dentistry Sep 2023This parallel cross-sectional study compared masticatory function and patient-centered outcomes among 3 removable treatment strategies for mandibular edentulism.
OBJECTIVES
This parallel cross-sectional study compared masticatory function and patient-centered outcomes among 3 removable treatment strategies for mandibular edentulism.
METHODS
Thirty-six edentulous participants rehabilitated using 3 removable treatment strategies for mandibular edentulism were allocated to one of the three groups (n=12): CCD (control), 2-IMO, and 3-IMO. Narrow diameter implants were installed using single-stage surgery and conventionally loaded with stud abutments. After 3 months of usage, the quality of life, maximum bite force, and masticatory function were evaluated. Data were analyzed with the Kruskal-Wallis test and post hoc pairwise Mann-Whitney tests with Bonferroni correction (α=0.05).
RESULTS
The 2-IMO and 3-IMO wearers did not show significant differences in any outcome, except for the 2 domains of 3-IMO wearers quality of life that obtained better Pain and General Performance scores. Both IMO groups presented significantly higher maximum bite force than CCD wearers. The 2-IMO wearers showed superior outcomes to the CCD group in all outcomes of the masticatory performance test and the X50, B and ME5.6 outcomes of the swallowing threshold test (p = 0.01), while 3-IMO participants only showed superior masticatory performance in terms of lower X50 values (19.86%, p = 0.02) and higher ME 2.8 (141.15%, p = 0.04) than CCD wearers.
CONCLUSIONS
Compared to 2-IMO wearers, 3-IMO wearers report superior impact of treatment on daily living activities in the Pain and General Performance domains. 2-IMO and 3-IMO wearers showed no significant differences between them for all evaluated bite force and masticatory function parameters.
CLINICAL SIGNIFICANCE
Although overdentures retained by 3 implants (3-IMO) provide biomechanical advantages over those retained by 2 implants (2-IMO), superior clinical and functional effectiveness is not yet proven.
Topics: Humans; Cross-Sectional Studies; Quality of Life; Mastication; Mandible; Denture, Overlay; Pain; Physical Functional Performance; Dental Prosthesis, Implant-Supported; Patient Satisfaction; Dental Implants
PubMed: 37473828
DOI: 10.1016/j.jdent.2023.104625 -
The Journal of Contemporary Dental... Apr 2023The aim of this present study was to compare two placement designs of four implants used to support a telescopic mandibular overdenture regarding the marginal bone... (Randomized Controlled Trial)
Randomized Controlled Trial
Comparison between Two Design Concepts of Four Implants Placement Used to Support Telescopic Mandibular Overdenture: A Prospective Study of Implant Marginal Bone Height Changes.
AIM
The aim of this present study was to compare two placement designs of four implants used to support a telescopic mandibular overdenture regarding the marginal bone height changes.
MATERIALS AND METHODS
Each patient received four implants. Two anterior implants were installed vertically in the canine area. Patients were randomized into two groups according to the direction of posterior implants installed in the premolar area. Group I: where the implants were installed vertically parallel to the anterior implants and group II: where the implants were installed 30 distally. The implants were delayed loaded with a telescopic mandibular overdenture. The implant's marginal bone changes were evaluated after 6 and 12 months of overdenture insertion.
RESULTS
Mean marginal bone loss of anterior implants showed a statistically significant difference between both groups. The vertically parallel posterior implants in group I showed statistically significant higher marginal bone loss than posterior implants in group II after follow-up periods. The 30 distally tilted posterior implants maintained the implant marginal bone after 12 months of overdenture insertion.
CONCLUSION
Rehabilitation of the edentulous mandible with telescopic overdenture supported by four parallel implants is a promising successful treatment option.
CLINICAL SIGNIFICANCE
Tilting the posterior implants will improve the anteroposterior spread that in turn increases the support and the survival rate of the implants. Also, using this technique gives us an opportunity to use fewer implants.
Topics: Humans; Treatment Outcome; Prospective Studies; Denture, Overlay; Dental Prosthesis, Implant-Supported; Mandible; Dental Implants; Jaw, Edentulous; Follow-Up Studies; Alveolar Bone Loss
PubMed: 37469262
DOI: 10.5005/jp-journals-10024-3495 -
Journal of Prosthodontics : Official... Jun 2024To evaluate and compare the initial retention force of three resilient unsplinted attachment systems for implant-retained mandibular overdentures: two cylindrical... (Comparative Study)
Comparative Study
PURPOSE
To evaluate and compare the initial retention force of three resilient unsplinted attachment systems for implant-retained mandibular overdentures: two cylindrical attachment systems (Locator R-Tx® and Novaloc®), and one ball attachment system (Ball System).
MATERIALS AND METHODS
For each attachment system, initial retention is measured as the average of the maximal dislodging forces during 10 insertion-removal cycles. For the Ball System, three activation degrees of the matrix are included versus four and six color-coded retention devices for the Locator R-Tx® and the Novaloc®, respectively, to represent the complete regular retention devices panel. For each retention device or activation degree, eight samples are tested.
RESULTS
The initial retention range is similar between the Ball System (7.7 ± 3.4 N - 19.9 ± 4.6 N) and the Novaloc® (2.0 ± 0.5 N - 18.9 ± 1.4 N) and broader for the Locator R-Tx® (3.3 ± 5.0 N - 60.2 ± 6.0 N). In each attachment system, the initial retention of each retention device is significantly different from the others, except for the two most retentive Novaloc® ones. Retention devices were also classified according to their initial retention (low, medium, and maximum). In each retention group, the Novaloc® and the Ball System provided similar retention values lower than the Locator R-Tx®.
CONCLUSION
Most of the retention devices tested provided an initial retention force of over 5 N for all three attachment systems. The Locator R-Tx® had the most comprehensive range, and the Novaloc® seemed to provide the most reproducible values, unlike the Ball System due to the activation required by the operator.
Topics: Denture, Overlay; Denture Retention; Dental Prosthesis, Implant-Supported; Humans; In Vitro Techniques; Dental Stress Analysis; Mandible; Materials Testing; Denture Design
PubMed: 37439403
DOI: 10.1111/jopr.13729 -
BMC Oral Health Jul 2023The aim of this study is to evaluate the stresses on the supporting bone, implants, and framework materials under masticatory forces in mandibular overdenture prostheses...
BACKGROUND
The aim of this study is to evaluate the stresses on the supporting bone, implants, and framework materials under masticatory forces in mandibular overdenture prostheses modeled with different framework materials and different implant types, using the Finite Element Analysis (FEA).
METHODS
For the finite element modeling, two identical mandibular jaw models were created; one with two standard (diameter:4.1 mm/12 mm length) and the other with two mini-implants (diameter:2.4 mm/12 mm length) were placed in the canine teeth area. The polymethylmethacrylate (PMMA) denture was modeled upon them, supported by Cobalt Chromium alloy (CoCr), Poly-ether ether ketone (PEEK), and Zantex materials with framework. No framework was added as a control model; only PMMA overdenture prosthesis was modeled.
RESULTS
Regardless of the framework materials of the overdenture prostheses, the stress values on mini-implants in all models yielded approximately two times higher results comparing to standard implants. More stress transmission was observed in the supporting bone and implants in the control prostheses and overdenture prostheses supported with respectively PEEK, Zantex, CoCr alloy frameworks, respectively. In the framework materials, more stress occurred on CoCr, Zantex and PEEK in that order.
CONCLUSION
In the light of this study, the use of mini-implants as an alternative to standard implants is not promising in terms of distribution and transmission of chewing stresses. As a framework material, standard rigid metal alloys were found to be more advantageous than polymer materials in terms of stress distribution.
Topics: Dental Implants; Finite Element Analysis; Denture, Overlay; Polymethyl Methacrylate; Mandible; Ethers; Dental Prosthesis, Implant-Supported; Stress, Mechanical; Dental Stress Analysis
PubMed: 37408011
DOI: 10.1186/s12903-023-03080-1 -
Journal of Prosthodontics : Official... Oct 2023The aim of this systematic review was to compare treatment outcomes in terms of implant survival rate, marginal bone loss, and patient-reported outcome measures (PROMs)... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
The aim of this systematic review was to compare treatment outcomes in terms of implant survival rate, marginal bone loss, and patient-reported outcome measures (PROMs) between narrow-diameter implants and regular-diameter implants (RDIs) for mandibular implant overdentures (MIOs).
METHODS
This study was based on the methodology adapted as per Cochrane. Medline, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, and Scopus were searched for pertinent studies published by July 22, 2022. Outcome parameters included in this meta-analysis were implant survival rate, marginal bone loss, visual analogue scale score for patient satisfaction, and value of oral health impact profile.
RESULTS
A total of 782 non-duplicate articles and 83 clinical study registrations were identified from database and hand searches, of which 26 were eligible for full-text searches. Finally, 12 publications reporting on 8 independent studies were included in this review. In the meta-analysis, implant survival rate and marginal bone loss did not significantly differ between narrow-diameter implants and RDIs. Regarding RDIs, narrow-diameter implants were associated with significantly better outcomes in general patient satisfaction and oral health-related quality of life than RDIs for mandibular overdentures.
CONCLUSIONS
Narrow-diameter implants have competitive treatment outcomes compared to RDIs in terms of implant survival rate, marginal bone loss, and PROMs. [Correction added on July 21, 2023, after first online publication: The abbreviation RDIs was changed to PROMs in the preceding sentence.] Thus, narrow-diameter implants might be an alternative treatment option for MIOs in situations with limited alveolar bone volume.
Topics: Humans; Dental Implants; Quality of Life; Denture, Overlay; Dental Prosthesis, Implant-Supported; Treatment Outcome; Mandible; Alveolar Bone Loss
PubMed: 37365991
DOI: 10.1111/jopr.13726 -
Clinical Implant Dentistry and Related... Oct 2023The long-term clinical outcome of mini dental implants (MDIs) to support an overdenture is underreported especially in severely atrophic maxillae and when installed...
BACKGROUND
The long-term clinical outcome of mini dental implants (MDIs) to support an overdenture is underreported especially in severely atrophic maxillae and when installed flaplessly.
PURPOSE
The current report is a 5-years follow-up of the previously published 2- and 3-years clinical outcome of MDIs supporting a maxillary overdenture in narrow alveolar ridges. MDI survival, marginal bone level, peri-implant health, technical complications, and oral health related quality of life (OHIP) and respective changes over time are reported.
MATERIALS AND METHODS
Subjects aged 50 years or older, in need of improvement of maxillary denture retention, were included. The MDIs were 2.4 mm diameter one-piece tapered implants, Class 4 pure Titanium, and lengths 10 or 11.5 mm. Under local anesthesia, 5-6 MDIs were placed in atrophic maxillae with a free-handed flapless approach. One week postoperative the denture was adapted with a retentive soft reliner. The final prosthetic connection was established after 6 months with a metal-reinforced horse-shoe denture. Clinical outcome after 5 years was assessed with probing pocket depts (PPD), bleeding on probing (BoP), and additional cone beam computed tomography (CBCT) MDI bone level measurements were performed. Oral Health-Related Quality of Life (OHRQoL) investigated with OHIP-14 was assessed preoperative, during provisional loading, and after final prosthetic connection up to 5 years.
RESULTS
Initially, 31 patients (14 females and 17 males) with mean age 62.30 underwent treatment. In the provisional loading interval, 16 patients encountered 32/185 MDIs failures, resulting in a failure of 17.3%; 170 MDIs were functionally loaded in 29 patients. Additionally, 14 implants were lost in three patients, all of whom had had already previous failures. Reimplantation of 17 MDIs were performed during the provisional loading and 2 MDI after functional loading. After 5 years, the absolute implant failure rate was 46/204 (22.5%), corresponding to a cumulative failure rate of 23.2%. Prosthetic failure was observed in four patients due to implant loss and in two patients related to excessive one-piece implant ball attachment wear, making the 5-years prosthetic success 80.0%. The mean PPD and absence/presence of BoP for 149 implants at 5 years was 4.3 and 0.2 mm, respectively. Average mesial-distal-vestibular-palatal bone loss in the interval 2-5 years was 0.08 mm. No statistically significant difference in marginal MDI bone loss between male or female (p = 0.835), smoking and nonsmoking (p = 0.666) was observed. The five-years total measured CBCT interdental bone level (mesial and distal) correlates with the 5-years PPD (Pearson 0.434; p = 0.01). After 5 years, OHRQoL with the treatment procedure was assessed in 27/31 participants. Decreasing mean total OHIP-14 scores with improved OHRQoL, was observed in 27/31 participants, with values of 21.3 at baseline to 15.6 at the time of provisional loading which significantly (p = 0.006) decrease to 7.3 at the final prosthetic connection. The next 3-5 years further decrease was observed with 6.5 and 4.96, respectively.
CONCLUSIONS
Maxillary MDIs for overdentures are an accessible and acceptable treatment option. Although after 5 years between one fifth and one fourth of the MDIs were lost, prosthetic success remains 80.0% and high OHRQoL could be achieved.
Topics: Humans; Male; Female; Middle Aged; Dental Implants; Denture, Overlay; Maxilla; Cohort Studies; Prospective Studies; Quality of Life; Alveolar Bone Loss; Dental Prosthesis, Implant-Supported; Treatment Outcome; Dental Restoration Failure
PubMed: 37309711
DOI: 10.1111/cid.13233