Improvement of Quality of Life with Implant-Supported Mandibular Overdentures and the Effect of Implant Type and Surgical Procedure on Bone and Soft Tissue Stability: A Three-Year Prospective Split-Mouth Trial

Evaluation of bite force, quality of life, and patients' satisfaction in elderly edentulous patients using implant overdentures

Purpose

This study aimed to compare the bite force (BF) between complete dentures and implant overdentures (IODs) retained by two mandibular implants. Additionally, we evaluated the quality of life (QoL) and patient satisfaction among individuals using IODs. In addition, the effects of demographic parameters such as age and sex, and clinical parameters such as implant length, implant diameter, attachment height, attachment color, and interimplant distance on BF, QoL, and patient satisfaction were evaluated.

Materials and methods

A total of 51 edentulous patients rehabilitated with the maxillary complete dentures and mandibular IODs retained by two implants were included in this study. BF was measured using a force meter pre- and post-implant in the same patients. Oral health-related quality of life (OHRQoL) was assessed with the Oral Health Impact Profile (OHIP-14) and patient satisfaction was assessed with the Visual Analog Scale (VAS) questionnaires.

Results

It was found that BF values were statistically higher for IODs than complete dentures (P < .001). In terms of attachment height of the OHIP scores, there was a significant difference in the psychological disability and social disability domains (P < .05). When examining the change in patient satisfaction as a function of sex, it was found that mandibular retention satisfaction differed significantly by sex (P < .05), but there was no significant difference in the other domains.

Conclusion

Within the limitations of this study, it was observed that the BF increased after the use of IODs. Several factors, including age, interimplant distance, attachment height, and attachment color, were found to impact OHRQoL. Sex and implant diameter were identified as factors affecting patient satisfaction.

A comparative evaluation of lasers and photodynamic therapy in the nonsurgical treatment of peri-implant diseases: A Bayesian network meta-analysis

PURPOSE

We conducted this Bayesian network meta-analysis (NMA) to evaluate the safety and efficacy of different lasers and PDT compared to conventional mechanical debridement (CMD) for peri-implant treatment.

METHODS

The Web of Science, Cochrane Library and PubMed databases were searched for randomized clinical trials (RCTs) assessing the clinical effectiveness of adjunctive PDT, different lasers, and CMD until January 1st, 2022. Clinical outcomes were the changes in pocket probing depth (PPD), marginal bone loss (MBL), and clinical attachment level (CAL).

RESULTS

Twenty-three studies, including 4 types of lasers, were included. Compared to that with CMD alone, PPD reduction was significantly more efficient in the diode laser (LD)+CMD groups (MD, 0.53; 95%CI, 0.13-0.93) and the PDT+CMD groups (MD, 0.83; 95%CI, 0.32-1.34) than in the CMD group in the follow-up period. Moreover, PDT+CMD treatment also showed a significantly better marginal bone level gain (MD, 0.32; 95%CI, 0.06-0.57). No significant effect on ΔCAL was observed among the different treatment strategies. Despite no differences in PPD reduction, MBL and CAL gains were found among the adjunctive laser treatment groups, PDT+CMD had the highest ranking probability of the most effective treatment in these clinical indices of periodontitis. The certainty of evidence for all outcomes was judged as very low to moderate.

CONCLUSIONS

Within the limits of this NMA, we found that adjunctive PDT achieved a small additional benefit on PPD reduction and MBL gain compared with CMD alone and had the highest probability of being ranked first on the changes in PPD, MBL and CAL. PDT+CMD may represent an alternative method for peri‑implant treatment. Further high-quality RCTs are needed to assess the influence of potential confounders on the efficacy of lasers and PDT.

Oral health-related quality of life of patients rehabilitated with fixed and removable implant-supported dental prostheses

Dental implants have become a mainstream treatment approach in daily practice, and because of their high survival rates over time, they have become the preferred treatment option for prosthetic rehabilitation in many situations. Despite the relatively high predictability of implant therapy and high costs to patients, patient perceptions of success and patient-reported outcome measures have become increasingly significant in implant dentistry. Increasing numbers of publications deal with oral health-related quality of life and/or patient-reported outcome measures. The aim of this paper was to provide an overview of the available evidence on oral health-related quality of life of fully and partially dentate patients rehabilitated with fixed and removable implant-supported dental prostheses. A comprehensive electronic search was performed on publications in English up to 2021. A selection of standardized questionnaires and scales used for the evaluation of oral health-related quality of life were analyzed and explained. The analysis encompassed three aspects: a functional evaluation of oral health-related quality of life, an esthetic assessment of oral health-related quality of life, and a cost-related evaluation of oral health-related quality of life for rehabilitation with dental implants. The data demonstrated that the preoperative expectations of patients markedly affected the outcomes perceived by the patients. As expected, reconstructions supported by implants substantially improved the stability of conventional dentures and allowed improved function and patient satisfaction. However, from a patient's perspective, oral health-related quality of life was not significantly greater for dental implants compared with conventional tooth-supported prostheses. The connection of the implants to the prostheses with locators or balls indicated high oral health-related quality of life. The data also suggest that patient expectation is not a good predictor of treatment outcome. In terms of esthetic outcomes, the data clearly indicate that patients' perceptions and clinicians' assessments differed, with those of clinicians yielding higher standards. There were no significant differences found between the esthetic oral health-related quality of life ratings for soft tissue-level implants compared with those for bone-level implants. Comparison of all-ceramic and metal-ceramic restorations showed no significant differences in patients' perceptions in terms of esthetic outcomes. Depending on the choice of outcome measure and financial marginal value, supporting a conventional removable partial denture with implants is cost-effective when the patient is willing to invest more to achieve a higher oral health-related quality of life. In conclusion, the oral health-related quality of life of patients rehabilitated with implant-supported dental prostheses did not show overall superiority over conventional prosthetics. Clinicians' and patients' evaluations, especially of esthetic outcomes, are, in the majority of cases, incongruent. Nevertheless, patient-reported outcomes are important in the evaluation of function, esthetics, and the cost-effectiveness of treatment with implant-supported dental prostheses, and should be taken into consideration in daily practice.

Semaphorin3A promotes osseointegration of titanium implants in osteoporotic rabbits

OBJECTIVE

In the present study, we intend to assess the function of Sema3A in osteointegration of titanium implants both in vivo and in vitro.

MATERIAL AND METHODS

Briefly, Sema3A was transfected in HBMSCs cells to detect its effect on osteogenesis. Subsequently, an in vivo rabbit model was established. Eighteen female rabbits were randomly assigned into three groups (n=6), and rabbits in the two treatment groups (OVX groups) were subjected to bilateral ovariectomy, while those in the control group were treated with sham operation. Twelve weeks later, we first examined expression levels of Sema3A in rabbits of the three groups. Titanium implants were implanted in rabbit proximal tibia. Specifically, rabbits in sham group were implanted with Matrigel, while the remaining in the OVX experimental group (OVX+Sema3A group) and OVX group were implanted with Matrigel containing Sema3A adeno-associated virus or empty vector, respectively.

RESULTS

Histomorphometry results uncovered that rabbits in the OVX+Sema3A group had a significantly higher BIC compared with those of the OVX group on the 12th week of post-implantation. And compared with the OVX group, the maximum push-out force increased by 89.4%, and the stiffness increased by 39.4%, the toughness increased by 63.8% in the OVX+Sema3A group at 12 weeks.

CONCLUSION

Sema3A has a positive effect on promoting early osseointegration of titanium implants in osteoporotic rabbits.

CLINICAL RELEVANCE

Our research found that Sema3A can improve the osteogenic ability of bone marrow stem cells and promotes osseointegration during osteoporosis.

Circumferential bone level and bone remodeling in the posterior mandible of edentulous mandibular overdenture wearers: influence of mandibular bone atrophy in a 3-year cohort study

OBJECTIVES

Evaluate circumferential bone level and morphological alterations in the posterior mandibular ridge of atrophic (AP) and non-atrophic (NAP) patients using implant-retained mandibular overdentures (MO) over 3 years.

MATERIALS AND METHODS

Twenty-six edentulous patients categorized according to mandibular atrophy (AP = 13/NAP = 13) received two narrow diameter implants (Facility, 2.9 × 10 mm) in the anterior region of mandible. The vertical and horizontal bone level was measured along with bone remodeling at 4 distances from the mental foramen in the posterior region of the mandible (L1-L4) via CBCT.

RESULTS

NAP showed significantly higher total height and medullary height in all posterior regions at 1 and 3 years (p ≤ 0.01). Cortical height and width were significantly higher (p ≤ 0.05) in this group at distances L1 and L4, respectively, in year 1. NAP shows a significantly higher % of medullary height at distances L1 (p ≤ 0.05), L2 (p ≤ 0.01), and L3 (p ≤ 0.05) after 1 year, and at all distances (p ≤ 0.05) after 3 years. Bone remodeling in the groups differed significantly (p ≤ 0.05) in terms of cortical width and % medullary width at L3.

CONCLUSION

AP and NAP showed similar vertical and horizontal bone level. Bone resorption in the posterior ridge was stabilized by MO over 3 years; however, AP are more susceptible to the long-term substitution of medullary bone by cortical bone.

CLINICAL RELEVANCE

This study is the first to longitudinally evaluate bone dimensions in atrophic and non-atrophic two-implant MO users by CBCT and revealed that MO is a predictable treatment based on the stabilization of the posterior bone resorption.

Clinical Versatility of the Facility-Equator Implant System as Mandibular Overdenture Retainers

The use of mandibular overdentures (MO) for the rehabilitation of totally edentulous individuals with limited bone availability is widespread and has proven clinical success. Narrow diameter implants (NDI) are available on the market as MO retainers to solve problems related to limited bone availability and bone thickness, providing a low-cost, minimally invasive treatment option. This technique evolved over the years, and changes frequently involved the number of implants used as MO retainers, as the adoption of a smaller number of implants can generate biomechanical disadvantages, contributing to the increased stress in peri-implant tissues, which may accelerate marginal bone loss (MBL), in addition to reducing masticatory capacity and satisfaction with rehabilitation. Some studies pointed out that the use of 3 or more implants as MO retainers improves the biomechanics. Thus, the objective of this study was to report 3 different clinical cases where 3 or more NDI were adopted to retain mandibular overdentures in association with diverse loading protocols: (i) 3 implants adopting conventional loading, (ii) 4 implants using progressive loading, and (iii) 4 implants with hybrid loading. The case with 4 implants and progressive loading showed a slight worsening of masticatory function at 1 year, in addition to a more pronounced MBL compared to other cases, but with improvements in satisfaction and oral health-related quality of life. Thus, NDI can be used as MO retainers with predictability and clinical success, using different numbers of implants and loading protocols.