Within-patient evaluation of chewing efficiency and maximum bite force of conventional dentures, fixed prostheses, and milled bar overdentures used for All-on-4 implant rehabilitation of atrophied mandibular ridges: A short-term randomized trial

Budget Impact Analysis: Digital Workflow Significantly Reduces Costs of Implant Supported Overdentures (IODs)

BACKGROUND

For edentulism, an implant supported removable complete overdenture (IOD) is an attractive solution to restore patients' chewing capacity, aesthetics, and self‐esteem, however, treatment is expensive and time consuming.

PURPOSE/AIM

To estimate the decline in costs for digitally designed and CAD/CAM fabricated IODs (3D‐IODs) compared to conventionally fabricated IODs (C‐IODs) at comparable general health related quality of life (GHRQoL).

MATERIALS AND METHOD

A randomized crossover study enrolled 36 fully edentulous patients, in whom six maxillary implants were placed together with two mandibular implants, if not already present. At the start of the study, a set of C‐IODs and 3D‐IODs was fabricated for each patient. All patients wore each IOD‐type for 1 year: first the 3D‐IOD and the second year a C‐IOD, or vice versa. At all three‐time points patients general QoL was assessed using the EQ‐5D‐5L questionnaire as well as the SF‐36 from which the SF‐6D was obtained, to research the anticipation of no significant difference. To enable cost consequence analysis (CCA), both costs made within healthcare and patient costs were assessed. Subsequently, a budget impact analysis (BIA) was performed to demonstrate the potential savings.

RESULTS

No differences in general GHRQoL were seen between C‐IOD (M = 0.840, SD = 0.177) and 3D‐IOD (M = 0.837, SD = 0.156) (paired t‐test (N = 31): p = 0.880). With respect to the total costs for a complete IOD, however, the digital approach showed a reduction in initial total costs of 14.2% (€4700.33 vs. €4030.61: p < 0,001), in treatment time of 41.1% (309 vs. 182 min: p < 0.001), and in number of treatment sessions of 47.1% (5.68 vs. 3.0: p < 0.001). For repairs for an IOD in both the upper and lower jaw, the C‐IOD and 3D‐IOD scored similar for treatment time as well as additional costs.

CONCLUSION

Implementing a 3D workflow in the production of IOD's supplies patients with a high‐quality 3D‐IOD at lower costs.

TRIAL REGISTRATION

NL‐OMON44248 https://onderzoekmetmensen.nl/en/trial/44248.

Surface hardness and wear resistance of prefabricated and CAD-CAM milled artificial teeth: A cross-over clinical study

PURPOSE

To clinically evaluate the surface roughness and wear resistance of prefabricated and CAD-CAM milled acrylic resin teeth for complete dentures.

MATERIALS AND METHODS

In a cross-over study design, 10 completely edentulous patients were randomly included in this study and given two complete dentures. The first complete denture was made using prefabricated teeth, while the second was constructed using CAD-CAM milled teeth. Following insertion (T0), 3 months (T3), and 6 months (T6), the complete dentures were scanned. Utilizing 3D surface super-imposition techniques, the vertical (2D wear), and volumetric (3D wear) material loss were measured. The hardness of the teeth was evaluated at the time of denture insertion (T0) and then after 6 months (T6) of denture insertion by digital Vickers hardness tester. Statistical analysis was done using SPSS software. Paired groups were compared by paired t-test. Also, a repeated measure test was used. The significant difference was considered if p ≤ 0.05.

RESULTS

The time of denture function was linearly correlated with the wear of the prefabricated and CAD-CAM milled denture tooth. Prefabricated acrylic teeth had significantly more vertical and volumetric wear after 3 and 6 months, compared to CAD-CAM milled denture teeth where p-values were 0.01, 0.009, 0.003, and 0.024, respectively. Additionally, CAD-CAM milled teeth displayed significantly higher hardness values than prefabricated teeth both before and after 6 months of use where p-values were 0.001. After 6 months, all studied teeth showed a decrease in their hardness.

CONCLUSIONS

In terms of wear resistance and surface hardness, CAD-CAM milled acrylic resin teeth were superior to prefabricated acrylic resin artificial teeth once the complete denture functions.

Evaluation of patient satisfaction and maximum biting force of three differently constructed bars on two implants retaining mandibular overdenture - one year follow-up (a randomized controlled clinical trial)

BACKGROUND

Different bar construction techniques will affect the bar passive fitness, which may induce stresses or strain on the implant and/or tightening screw and sequentially may affect the biting force and patient satisfaction.

AIM OF THE STUDY

This clinical investigation assessed patient satisfaction and maximum biting force (MBF) using three differently constructed (conventional casting, milling, and 3D printing CAD/CAM techniques) cobalt-chromium (Co-Cr) bar-retained implants mandibular overdentures over a one-year period of follow-up.

MATERIALS AND METHODS

Thirty edentulous patients seeking for two implants bar-retained mandibular overdentures were randomly assigned into three groups as the following: Group I: 10 patients received a Co-Cr conventional casting bar, Group II: 10 patients received a Co-Cr CAD/CAM milled bar, and Group III: 10 patients received a Co-Cr CAD/CAM 3D-printed bar. All the bar groups were connected to two implants in the canine area bilaterally. Within the first two weeks following implant placement, patients received the definitive prosthesis. Patient satisfaction was evaluated by using the (OHIP-EDENT-19) questionnaire form after 6, and 12 months. Additionally, the maximum biting force was tested at after delivery, 3, 6, and 12 months for each group. The results were collected, tabulated, and statistically analyzed.

TRIAL REGISTRATION

This study was recorded on ClinicalTrials.gov retrospectively registered (ID: NCT06401187) on 30/04/2024.

RESULTS

After one year follow up, regrading patient satisfaction the three groups showed no statistically significant difference. Although, the functional limitation domain was in favor of the milled bar. Regarding the maximum biting force, no statistically significant difference was found among three groups. However, at 12 mouths follow-up the milled bar showed statistically value.

CONCLUSION

Within the limitations of this study, the conventional, milled and 3D printed bar overdentures groups can be used as a satisfactory treatment modality for edentulous mandible in terms of patient satisfaction and maximum biting force.

Changes in masticatory performance and bite force after treatment with mandibular overdentures retained by four titanium-zirconium mini implants: One-year randomised clinical trial

OBJECTIVE

This prospective study is part of a randomised clinical trial and reports the changes in masticatory performance (MP) and bite force, and explores their influential factors, 1 year after the provision of mandibular overdentures retained by four titanium-zirconium mini implants.

METHODS

Edentulous patients received conventional complete dentures, followed by placement of four mini implants (Straumann® Mini Implant System) in the anterior mandible and converting the conventional prosthesis into a mandibular overdenture. Treatment protocols were randomised using a 2×2 factorial design combining different surgical (flapped vs. flapless) and loading (immediate vs. delayed) protocols. MP was assessed using a two-colour mixing ability test and a colorimetric analysis to measure the level of colour mixing (Variance of Hue-VoH). Maximum voluntary bite force (MBF) was measured by a digital gnathodynamometer in the posterior and anterior regions. Sex, age, surgical and loading protocols and ridge morphology were tested as independent variables. MP and MBF tests were performed at baseline (pre-treatment) and the 3-, 6- and 12-month after implant loading. Descriptive statistics, independent t-test, and linear mixed-effect model (LMM) regression were used for data analysis.

RESULTS

Seventy-four participants were assessed and 73 completed the 1-year follow-up. Statistically significant improvements in functional parameters were observed in all follow-up periods compared to baseline (p < .001). The flapless protocol was associated with higher improvement in MP at the 3-month follow-up (p = .004), while less resorbed ridges were associated with better MP (p = .038) and higher MBF (p < .001).

CONCLUSION

The mandibular overdenture protocol using four titanium-zirconium mini implants was effective in improving MP and MBF of edentulous patients, compared to pre-treatment values. The findings also suggest that improvements in chewing function and bite force are impacted by clinical factors since better outcomes were observed for flapless surgeries and less resorbed edentulous ridges.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.Gov ID NCT04760457.

Evaluation of masticatory performance and patient satisfaction for conventional and 3D-printed implant overdentures: a randomized crossover study

BACKGROUND

This crossover clinical study aimed to evaluate and compare masticatory performance and patient satisfaction for patients rehabilitated with conventional heat-cured acrylic resin and 3D-printed mandibular implant overdentures retained with bar attachment.

MATERIALS AND METHODS

Sixteen completely edentulous healthy participants received new conventional dentures. In the mandible, four interforaminal implants were inserted. Following the stage of osseointegration, the bar was constructed in a trapezoidal configuration. Each patient randomly received the following overdentures using a crossover design: (1) conventional heat-cured acrylic resin overdenture and (2) 3D-printed overdenture (developed by scanning of mandibular conventional overdenture). The masticatory performance was assessed by conducting a two-colour mixing ability test at 5, 10, 20, 30, and 50 masticatory cycles. Moreover, the McGill Denture Satisfaction Questionnaire (MDSQ) was employed to assess patient satisfaction. Evaluation was performed after 3 months of using each overdenture. Paired sample t tests were used to compare the masticatory performance and MDSQ scores of patients for both prostheses.

RESULTS

No significant difference in masticatory performance was reported between the two types of overdentures. Regarding patient satisfaction, only the esthetic aspect was significantly better for conventionally processed overdentures than for printed overdentures. Insignificant differences were observed regarding other MDSQ items between the two overdentures.

CONCLUSION

Within this clinical study, 3D-printed implant overdentures showed promising results in terms of chewing efficiency and patient satisfaction compared to conventionally fabricated implant overdentures.

TRIAL REGISTRATION

Retrospectively registered at www.

CLINICALTRIALS

gov : NCT06148727.(28/11/2023).

Comparison of Direct Intraoral Scan and Traditional Impression for CAD/CAM Mandibular Overdenture Base: RCT on Peri-implant Marginal Bone Changes

AIM

This study aimed to evaluate the impact of digital vs traditional impression techniques on peri-implant vertical bone resorption in the creation of mandibular overdenture bases supported by four implants using CAD/CAM technology.

MATERIALS AND METHODS

Twenty edentulous patients were placed in four mandibular implants and randomly divided into groups: (A) the control group (CIG) (n = 10); patients obtained CAD/CAM denture base using conventional impression technique and group (B) the study (DIG) group (n = 10); patients obtained CAD/CAM denture base using digital impression technique. Peri-implant vertical bone height was measured immediately (T0), 6 (T6), and 12 (T12) months after insertion. Peri-implant vertical bone loss (VBL) was calculated first 6 months (T1), the second 6 months (T2), and 1 year (T3) after insertion.

RESULTS

For both groups, the survival rates of inserted implants were 100%. The amount of VBL in the first year in both groups was within normal ranges. In both groups, VBL significantly decreased over time. The control group recorded significantly higher VBL than (DIG) group at T2 (p = 0.006) and at T3 (p = 0.005).

CONCLUSION

Digital intraoral scanning technique may be considered a more beneficial registration method than traditional impression technique for the construction of CAD/CAM 4-implant-assisted overdenture base regarding the preservation of vertical bone levels.

CLINICAL SIGNIFICANCE

Both digital intraoral scanners and conventional impression techniques can be used for the construction of CAD/CAM-implant-assisted overdenture bases regarding the preservation of peri-implant vertical bone resorption. How to cite this article: Seifeldeen AR, Aboelez MA, Gebreel AA, et al. Comparison of Direct Intraoral Scan and Traditional Impression for CAD/CAM Mandibular Overdenture Base: RCT on Peri-implant Marginal Bone Changes. J Contemp Dent Pract 2024;25(6):527-534.

Evaluation of masticatory efficiency and OHRQoL in implant-retained overdenture with different numbers of implant in the edentulous mandible: a one-year follow-up prospective study

PURPOSE

The aim of this article is to evaluate to the masticatory function performance and Oral Health-related Quality of Life (OHRQoL) in implant-retained overdenture compared with different implant number placements in the edentulous mandible.

METHODS

From 2013 to 2015, each patients received 3 implants (iSy-Implant, Camlog, Wimsheim, Germany) in intraforaminal mandible (34, 41/31, 44). After operation, inserted implants were gradually loaded and incorporated into an overdenture with a self-aligning attachment system (Locator abutments) in 3 + 3 + 3 months. Five checked points were performed chewing cycle test with multicolored chewing gum and OHIP-G14 questionnaire and a sum score questionnaire as following: pre-operation, one implant load (41/31), two implants loaded (33,43), three implants loaded and 1-year follow up.

RESULT

A total of 10 patients with 30 implants were placed, the survival rate of the implants was 100% within 1-year follow-up. Regarding the masticatory function analysis, for the higher number of chewing cycles, the higher mixing rate was observed. After 1 year, the inter-mixing rate without significant changes was found compared to the time after three implants were loaded with attachment system. The mean value of OHIP-G14 was 30.4 preoperatively, 21.1 after loading the first locator, 10.7 after loading two locator abutments, and 3.2 after loading all three locator abutments. After 1 year, OHIP-G14 was 2.6 without significantly changed. The mean of the sum score was 15.5 preoperatively, 27.8 after activation of the first locator, 39.4 after activation of two locators, 46.2 after activation of all three locators, and 47.3 after 1 year. An increase of 0.7 sum score units per time point was observed. No significance was detectable, analogous to OHIP-G14, compared to the time of activation of all three locator setups (p-value = 0.22).

CONCLUSIONS

A significant improvement in masticatory function performance and OHRQoL was evaluated with the increasing number of implants with locator attachment in edentulous mandible. With the investigation of the OHIP-G14 and sum score, the results of patient report outcome might be associated with the increase in the number of implants.

Treatment effect of implant-supported fixed complete dentures and implant overdentures on patient-reported outcomes: A systematic review and meta-analysis

OBJECTIVES

To analyze the effect of implant treatment in edentulous patients rehabilitated with implant-supported fixed complete dentures (IFCDs) or implant overdentures (IODs) on dental patient-reported outcomes (dPROs).

MATERIALS AND METHODS

In January 2022, Medline, Embase, CINAHL, Cochrane Library, PubMed Central, Web of Science, and ClinicalTrials.gov were screened for prospective clinical studies on completely edentulous patients treated with IFCDs and/or IODs, reporting pre-treatment and follow-up dPROs. Hedges' g effect sizes (ES) with corresponding 95% confidence intervals (CI) were calculated. Afterward, meta-analyses were conducted using random effect models.

RESULTS

A total number of 1608 records was initially identified. Of those, 28 studies reporting dPROs from 1457 patients were finally included. The applied dental patient-reported outcome measures (dPROMs) included several versions of the Oral Health Impact Profile (OHIP) or specific items assessing satisfaction with Visual Analogue Scales (VAS). The overall ES was large for rehabilitation with IFCDs (1.68 [CI: 1.15, 2.20]) and IODs (1.26 [CI: 0.99, 1.52]) with no significant difference (p = .165) between the two. Denture stability was the only factor rated significantly higher for IFCDs (ES difference: 2.37 [CI: 0.21, 4.54]; p = .032). Subgroup analyses revealed moderately higher ES for IODs on two implants relative to one implant (ES difference: 0.73 [CI: 0.34, 1.12]; p < .001).

CONCLUSIONS

There is a strong positive effect of implant treatment in edentulous patients, independent of the type of prosthetic rehabilitation. In patients seeking high stability, IFCDs may be preferable. In mandibular IODs on a single implant, there was a significantly positive effect of an additional implant on dPROs.