Oral function in completely edentulous patients rehabilitated with implant-supported dental prostheses: A systematic review and meta-analysis

Analysis of Clinical and Patient-Reported Outcomes Between Single- and Two-Implant Mandibular Overdenture-An Umbrella Review

BACKGROUND

A two-implant mandibular overdenture (TIMO) is considered a viable approach for the rehabilitation of the edentulous mandible, enhancing retention, stability, overall function and patient-reported outcome. Recently, the minimalist strategy of single-implant mandibular overdenture (SIMO) was proposed as an alternative treatment for mandibular edentulism.

OBJECTIVES

To analyse systematic reviews (SRs) and provide a comprehensive overview of clinical and patient-reported outcomes, including implant failure, peri-implant marginal bone loss, overall prosthetic complications and maintenance, patient satisfaction and oral health-related quality of life, in SIMO compared with TIMO.

METHODS

The umbrella review was designed and reported following the PRISMA guidelines, and the protocol was registered in the PROSPERO database (CRD42024599304). Included SRs evaluated the clinical and/or patient-reported outcomes in edentulous patients rehabilitated with SIMO and TIMO. A literature search was conducted without restrictions on the language in Web of Science, ProQuest, SCIELO, KCI, Grants Index, Scopus, PubMed/MEDLINE and the Cochrane Library databases. Critical evaluation of the included SRs was conducted using AMSTAR 2.

RESULTS

Out of 243 papers suitable for title/abstract screening, 7 SRs were selected. One SR favoured SIMO over TIMO for both implant failure and peri-implant marginal bone loss, whereas in another SR it was shown that TIMO revealed significantly more implant failures after 1 and 5 years, significantly more prosthetic failures after 1 year, and significantly more O-ring replacements after 5 years, compared to SIMO. Regarding the quality assessment of included SRs, two were categorised as 'critically low', two as 'low' and three as 'moderate'.

CONCLUSIONS

SIMO corresponds with the conventional TIMO as a potentially effective treatment for the rehabilitation of the edentulous mandible. Additional studies are warranted to obtain more robust patient evidence and refine clinical guidelines.

The Effect of Dental Implant Restoration on the Biomechanics of the Temporomandibular Joint in Patients with Posterior Tooth Loss: A Pilot Study

Currently, controversy persists over whether dental implant restoration exacerbates or alleviates temporomandibular disorders (TMDs). This study aimed to analyze the impact of dental implant restoration on the biomechanics of the temporomandibular joint (TMJ) in patients with posterior tooth loss. Ten healthy volunteers (Control group) and twenty patients with posterior tooth loss (preoperative in the Pre group and postoperative in the Post group) were recruited. Three-dimensional maxillofacial models of the maxilla, mandible, dentition, and articular discs were reconstructed. The von Mises, contact, and tensile stresses of the TMJ were analyzed. Before implant restoration, the stresses of the TMJ in the Pre group were considerably higher than those in the Control group, especially on the missing tooth side. After restoration, the stresses in the Post group decreased significantly, with a near-symmetrical distribution. Additionally, before restoration, the patients with TMD had the highest stresses of the TMJ, followed by those without TMD, and the Control group had the lowest. After restoration, the stress magnitudes in the patients with or without TMD returned to the normal range. In summary, dental implant restoration can significantly improve the asymmetric stress distribution of the TMJs, substantially reduce excessive stress caused by tooth loss, and alleviate or eliminate the symptoms related to TMDs.

Patient-Reported Outcomes With Immediate-Loaded Zygomatic Implant Fixed Rehabilitation in Patients With Edentulous Atrophic Maxilla: A Retrospective Practice-Based Clinical Study

OBJECTIVE

To assess if immediate-loaded zygomatic implant-supported fixed rehabilitation meets the expectations of and satisfies patients with atrophic edentulous maxilla.

METHODS

This study included an analysis of data obtained from the dental records of 22 consecutive patients with atrophic edentulous maxillae who received immediate-loaded zygomatic implant-supported fixed rehabilitation between 2017 and 2020. Patients' expectations and satisfaction scores were recorded on a validated 100-mm visual analog scale (VAS). Data was analysed using descriptive statistics and generalized estimating equations.

RESULTS

The results showed a majority of patients had high expectations (VAS > 90) of the rehabilitation with regard to their general satisfaction (71%), aesthetics (71%), chewing (66%), speech (66%), and influence on social life (81%). At 6 months, a majority of the patients showed high general satisfaction (72%), and high satisfaction with aesthetics (77%), chewing (72%), speech (66%), and social life (72%) (VAS > 90). There was a statistically significant increase in the level of satisfaction with chewing from 2 weeks to 6 months after immediate loading (B = 0.309, SE = 0.138, 95% CI: 0.038, 0.580, p = 0.025). A statistically significant association was found between pre-treatment expectations and satisfaction with the rehabilitation's impact on speech, aesthetics, and social life. The satisfaction levels were not influenced by age and sex. All participants agreed that they would recommend this procedure to their peers.

CONCLUSIONS

The results of this study suggest that immediate-loaded zygomatic implant-supported fixed rehabilitation could meet the expectations and satisfy edentulous patients with atrophic maxilla.

A randomized clinical trial comparing retention of complete dentures and oral health quality of life of patients with conventional and bioelectric impressions

Aim

The aim of the present study was to comparatively evaluate the retention of complete dentures and oral health-related quality of life (OHRQoL) of patients with conventional and bioelectric impressions or transcutaneous electric nerve stimulation (TENS).

Materials and methods

A total of thirty (n = 30) completely edentulous patients were randomly distributed into two groups: Group-C (n = 15) (Conventional) and Group-T (n = 15) (bioelectric). In Group C, border molding was performed using the manual manipulation of borders, and the final impression was made using zinc-oxide eugenol. In Group T, border molding and final impression were performed with the TENS application. Dentures were fabricated, and retention was evaluated with a digital gauge. OHRQoL was assessed at insertion and after three months of follow-up using the Oral Health Impact Profile Edentulous in Hindi (OHIP-Edent-H) questionnaire. A two-way ANOVA test was used for the significance level (P < 0.05). Student t-test was used for intergroup comparison, and paired t-test was used for intragroup comparison of OHRQoL.

Results

There was no significant difference in the retention of maxillary and mandibular dentures fabricated with both techniques (P = 0.283, P = 0.682). Although, OHRQoL increased significantly in both groups at follow-up (P = 0.001). However, at follow-up, the Functional Limitation (FL) domain was significantly better in the conventional group.

Conclusions

Although, there was no significant difference in retention and OHRQoL between both groups. However, more clinical trials with large samples and longer follow-ups are required to reach a conclusive result.

Nutrition, Chewing Ability and Quality of Life in Older Adults With Implant Overdentures: A Prospective Clinical Study

OBJECTIVES

To evaluate the changes in nutritional status, chewing ability and oral health-related quality of life in edentulous individuals who have initially been rehabilitated with immediate complete dentures (CD) which are then transformed to implant-supported overdentures (IOD) after a period of osseointegration.

BACKGROUND

Compared to those with conventional dentures, individuals with IODs exhibit improved patient-reported outcomes, chewing capacity and biting force. While prior research highlights differences in nutritional markers between these groups, there is limited investigation into intra-individual changes in nutritional status, chewing ability and oral health-related quality of life during the transition from CDs to IODs.

MATERIALS AND METHODS

Edentulous individuals aged 50 years or older and needing oral rehabilitation with IODs were eligible for this prospective study. The primary outcome measure was the nutritional status as measured by the Mini Nutritional Assessment (MNA). The Oral Health Impact Profile (OHIP-14) questionnaire and chewing ability questionnaire represented secondary outcome measures. These measures were assessed at baseline (T0), 3-month follow-up after application of the CD (T1), and 3- and 6-month follow-up after the CD had been transformed to IOD (T2 and T3). Statistical analyses used repeated measures ANOVA or the Friedman test for OHIP-14 and MNA scores, with logistic regression used for malnutrition risk.

RESULTS

Thirty-five participants were included in the final analysis. MNA scores significantly worsened from the baseline to the 3-month follow-up after the application of the CD. There was no significant change in nutritional status between baseline and the IOD 3- and 6-month follow-up appointment. IODs led to significant improvements in the OHIP total score at both the 3- and 6-month follow-ups (p < 0.001, W = 0.60) with a strong effect size. Difficulty in chewing decreased significantly, affecting 91.4% of participants at baseline, which reduced to 51.4% (18/35) by the 6th month.

CONCLUSION

Implant-supported overdentures do not influence nutritional status, but they improve chewing ability and oral-health related quality of life in older adults.

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.

Small-diameter titanium grade IV and titanium-zirconium implants in edentulous mandibles: Ten-year results from a double-blind, randomised controlled split-mouth core-trial

The goal of this extension study was to compare the 10-year outcome of 3.3 mm diameter titanium-zirconium (TiZr) or grade IV titanium (Ti) implants in mandibular implant-overdentures.

MATERIALS AND METHODS

This study is the 10-year follow-up from a randomised, controlled, double-blind, split-mouth multicentre clinical trial. Patients with edentulous mandibles had received two implants in the interforaminal region (bone-level, diameter 3.3 mm, microrough surface), one of TiZr (test) and one of Ti (control). Implant survival and success, plaque and sulcus bleeding indices, probing pocket depth, gingival margin, clinical attachment level and radiographic crestal bone levels were evaluated.

RESULTS

Fifty of 91 patients with implants were available for the 10-year examination and 36 patients were valid for the intent-to-treat (ITT) analysis. The implant success rate was calculated as 94.6% and 91.9% for the TiZr implants and the Ti implants respectively. Four implants were lost (TiZr = 1; Ti = 3) in the entire study period. Kaplan-Meier survival analyses estimated 10- year implant survival rate for TiZr to 98.9% and Ti 95.8%.The mean of total and functional crestal bone loss was 1.49 mm (±1.37 mm) and 0.82 mm (±1.09 mm) in the TiZr group and 1.56 mm (±1.34 mm) and 0.85 mm (±1.16 mm) in the Ti group.

CONCLUSIONS

This split-mouth design RCT on mandibular implant-overdentures evidenced, bearing in mind its follow-up time-related reduced cohort size, high 10-year implant success- and survival rates. These results confirm TiZr as well-suited implant material for realising small-diameter implants. Registered on www.

CLINICALTRIALS

gov: NCT01878331.