Patient-centered and clinical outcomes of mandibular overdentures retained with the locator system: A prospective observational study.

STATEMENT OF PROBLEM: Whether clinical or demographic variables affect the perception of treatment in terms of quality of life and satisfaction is unknown. PURPOSE: The purpose of this prospective study was to make an evidence-based assessment of the treatment outcomes (patient- and clinically based) of locator-retained mandibular overdentures. MATERIAL AND METHODS: This prospective observational study assessed patients with edentulism who had worn mandibular overdentures supported by 2 implants and retained by the locator system for at least 1 year of functional life (N=80). Medical histories were reviewed, and patients underwent oral examinations. Prosthetic clinical outcomes and patient well-being were registered using the Oral Health Impact Profile 20 (OHIP-20) and Oral Satisfaction Scale (OSS). RESULTS: Patient well-being scored an overall OHIP-20 score of 19.0 ±14.0 of 80 (the higher the score, the greater the impact and the worse the oral health-related quality of life); overall oral satisfaction was 8.3 ±1.7 of 10. Women suffered greater social impact (0.8 ±1.0) and disability (0.4 ±0.8) than men (0.4 ±0.7 versus 0.2 ±0.4, respectively). Impact on well-being was inversely proportional to both patient age and the age of the prosthesis (r=-0.25; P<.01). Implants had been placed on average 73.6 ±39.2 months previously, showing a survival rate of 82.5%. Most of the overdentures had been functioning for over 60 months. Relining (46.3%), readjustments (82.5%), and changes of nylon retention (1.5 ±1.8 per patient over 60 months of use) devices negatively influenced well-being. CONCLUSIONS: Mandibular overdentures produced good results with regard to quality of life and oral satisfaction, but attention should be paid to factors affecting clinical outcomes and patient well-being.

Oral Health-Related Quality of Life in Edentulous Patients with Two- vs Four-Locator-Retained Mandibular Overdentures: A Prospective, Randomized, Crossover Study.

PURPOSE: To compare the oral health-related quality of life (OHRQoL) in a prospective, randomized crossover trial in patients with mandibular overdentures retained with two or four locators. MATERIALS AND METHODS: In 30 patients with edentulous mandibles, four implants (ICX-plus implants [Medentis Medical]) were placed in the intraforaminal area. Eight weeks after transgingival healing, patients were randomly assigned to have two or four implants incorporated in the prosthesis. After 3 months, the retention concepts were switched. The patients with a two-implant-supported overdenture had four implants incorporated, whereas patients with a four-implant-supported overdenture had two retention locators taken out. After 3 more months, all four implants were retained in the implant-supported overdenture in every patient. To measure OHRQoL of the patients, the Oral Health Impact Profile 14, German version (OHIP-14 G), was used. RESULTS: A considerable increase in OHRQoL could be seen in all patients after the prosthesis was placed on the implants. Also, a statistically significant difference of OHRQoL could be seen in the OHIP-14 G scores between two-implant and four-implant overdentures. Patients had a higher OHRQoL after incorporation of four implants in the overdenture compared with only two implants. CONCLUSION: Patients with implant-retained overdentures had better OHRQoL compared with those with conventional dentures. The number of incorporated implants in the locator-retained overdenture also influenced the increase in OHRQoL, with four implants having a statistically significant advantage over two implants.

Different types of antagonists modify the outcome of complete denture renewal.

PURPOSE: The effect of renewing removable dentures on masticatory function was evaluated according to the occlusion offered by different types of mandibular arches. MATERIALS AND METHODS: Twenty-eight patients with complete maxillary dentures were subdivided into three groups in terms of mandibular dentition type: dentate, partial denture, and complete denture. The participants were observed before and 8 weeks after maxillary denture renewal. The mandibular denture was also renewed in the partial and complete denture groups. The participants masticated carrots, peanuts, and three model foods of different hardnesses. The particle size distribution of the boluses obtained from natural foods was characterized by the median particle size (d50) in relation to the masticatory normative indicator (MNI). Chewing time (CT), number of chewing cycles (CC), and chewing frequency (CF) were video recorded. A self-assessment questionnaire for oral health-related quality of life (Geriatric Oral Health Assessment Index [GOHAI]) was used. Statistical analyses were carried out with a mixed model. RESULTS: Renewal of the dentures decreased d50 (P < .001). The number of participants with d50 values above the MNI cutoff decreased from 12 to 2 after renewal. Renewal induced an increase in mean CF while chewing model foods (P < .001). With all foods, renewal tended to affect CT, CC, and CF differently among the three groups (statistically significant renewal Å~ group interactions). The GOHAI score increased significantly for all groups. CONCLUSIONS: Denture renewal improves masticatory function. The complete denture group benefited least from renewal; the dentate group benefited most. This study confirmed the usefulness of denture renewal for improving functions and oral health- related quality of life.

Effect of an acrylic resin-based resilient liner applied to mandibular complete dentures on satisfaction ratings among edentulous patients.

PURPOSE: The aim of this study was to investigate whether an acrylic resin-based resilient liner (ARL) could improve the satisfaction ratings of complete denture wearers. The null hypothesis was that no difference exists between the satisfaction ratings of conventional acrylic resin denture (CARD) wearers and those of ARL denture (ARLD) wearers. MATERIALS AND METHODS: From April 2004 to July 2006, a randomized controlled trial was conducted at two centers, including 74 edentulous patients. Of these, 37 patients were each randomly allocated to the ARLD and CARD groups. All of the patients rated their satisfaction with dentures, including general satisfaction and satisfaction with chewing ability, speaking, cleaning, stability, retention, comfort, and esthetics. These satisfaction ratings were measured by a 100-mm visual analog scale. Perceived chewing ability of different foods, divided into five grades, was measured using a questionnaire. The mastication index (MI) was calculated for each grade. RESULTS: General satisfaction, satisfaction with chewing, and satisfaction with speaking were significantly higher in the ARLD than in the CARD group (P = .049, .025, and .049, respectively). The chewing satisfaction with maxillary dentures in the ARLD group was significantly higher than that of the CARD group (P = .02). No significant difference existed between the MI of the ARLD (69.2 ± 17.0) and CARD groups (66.7 ± 18.7). CONCLUSIONS: Within its limitations, this study showed that the ARL improves a complete denture wearer's satisfaction ratings.

Reliability and validity of a questionnaire for self-assessment of complete dentures.

BACKGROUND: Demand for complete denture treatment is expected to rise over several decades. However, to date, no questionnaire on complete dentures, as evaluated by edentulous patients, has been shown to be reliable and valid. This study sought to assess the reliability and validity of Patient's Denture Assessment (PDA), which provides a multidimensional evaluation of dentures among edentulous patients. METHODS: Patients, who had new complete dentures fabricated at the University Hospital of Dentistry, Tokyo Medical and Dental University through 2009 to 2010, were enrolled. The reliability of the PDA was determined by examining internal consistency and test-retest reliability. Internal consistency for all of the question items and the six subscales was measured using Cronbach's α and average inter-item correlation coefficients among 93 participants. For 33 of these participants, test-retest reliability was determined at a 2 month-interval using the interclass correlation coefficients (ICCs) and 95% confidence interval for the summary scores and the six subscale scores. The PDA was validated in 93 participants by examining the difference in the summary score and the six subscale scores of the PDA before and after replacement with new dentures by the paired t-test. Ability to detect change was also tested in 93 patients using effect size. RESULTS: The Cronbach's α for the PDA ranged from 0.56 to 0.93. The average inter-item correlation coefficients ranged from 0.28 to 0.83. ICCs for the PDA ranged from 0.37 to 0.83. The paired t-test showed a significant difference between the summary score and the six subscale scores before and after replacement with new dentures (p < 0.05) and the effect size was 0.97. CONCLUSIONS: The PDA demonstrated good reliability by assessing internal consistency and test-retest reliability. In addition, the PDA demonstrated good validity by assessing discriminant validity. Thus, the PDA could help dentists obtain a detailed understanding of the patients' perceptions in using their dentures.

Evaluation of the efficacy of mandibular conventional and implant prostheses in a group of Turkish patients: a quality of life study.

PURPOSE: The aim of this study was to compare the satisfaction and quality of life (QoL) in a group of patients using mandibular complete dentures, implant-retained overdentures, removable partial dentures (RPDs), or implant-supported fixed partial dentures (FPDs). MATERIALS AND METHODS: A total of 116 patients (aged 36 to 81, mean age 58 ± 10.03 years) were assigned to four groups (n = 29) and treated with mandibular implant-retained overdentures, implant-supported FPDs (two implants/three unit FPDs), conventional complete dentures, or RPDs. The groups were well matched in terms of gender, age, and the edentulous period. All patients had edentulous maxillary arches and completely or partially edentulous mandibles. All prostheses were mandibular prostheses. The OHIP-14, OHQoL-UK, and SF-36 surveys were used to determine QoL before implant surgery and 1 year after prosthetic treatment. RESULTS: The baseline and 1-year data from 116 patients were analyzed. A significant improvement was found among the QoL scales for all groups (p < 0.05). The most significant improvement was found in the implant-retained overdenture group (15.67 ± 2.47), while the least improvement was found among the implant-supported FPD group (5.14 ± 2.08). The SF-36 test revealed no differences between the before and after treatment scores for general health, pain, vitality, social function, and physical function difficulties (p > 0.05). The only significant difference was found for mental health (p = 0.011). CONCLUSION: A positive influence on oral health-related QoL was observed in all groups. The QoL values were the most improved in the implant-retained overdenture group.

Prosthetic rehabilitation of head and neck cancer patients focusing on mandibular dentures in irradiated patients.

PURPOSE: This retrospective study assessed treatment outcomes and patient satisfaction of irradiated head and neck cancer patients treated with mandibular implant overdentures (IODs) or conventional dentures (CDs). MATERIALS AND METHODS: Fifty-one irradiated head and neck cancer patients, out of a total of 158 patients included, completed the standardized questionnaire and underwent a clinical assessment. Nineteen patients were treated with removable CDs and 32 patients received IODs between January 2006 and January 2011. The mean follow-up of patients was 5.75 years (range: 1 to 23 years). RESULTS: A total of 45 (88.3%) mandibular dentures were in function at the time of assessment. The overall denture satisfaction was 7.3 (range: 1 to 10, SD: 2.14). Patients being treated with adjuvant concepts, including surgical tumor ablation, scored worse than patients after radiation therapy alone. Edentulous patients seem to benefit from implants, especially with respect to prosthesis retention. Men take more benefit from IODs compared with women. CONCLUSIONS: The results are comparable to other studies of head and neck cancer patients and also of healthy individuals. Surgical interventions in adjuvant therapy concepts lead to reduced denture satisfaction. The concept of prosthetic rehabilitation as part of oncologic treatment can be judged as successful.

Selection patterns of dietary foods in edentulous participants rehabilitated with maxillary complete dentures opposed by mandibular implant-supported prostheses: a multicenter longitudinal assessment.

STATEMENT OF PROBLEM: Documentation of long-term changes in food intake is lacking for those treated with a maxillary complete denture opposed by a mandibular, screw-retained, implant-supported fixed prosthesis. PURPOSE: The purpose of this study was to evaluate the selection patterns of dietary foods over 5 years for edentulous participants treated in a multicenter prospective clinical trial that compared cast alloy versus laser-welded titanium frameworks of an implant-supported prostheses opposed by maxillary complete dentures to rehabilitate edentulous participants. MATERIAL AND METHODS: The study assessed data from a multicenter prospective clinical trial that followed edentulous participants from an initial baseline of wearing existing complete dentures to implant placement, restoration with a mandibular implant-supported prosthesis opposed by a maxillary complete denture, to follow-up assessment of these treatments over 5 years. The 32 participants in the cohort were treated at 5 of 9 participating centers. The data collected included 2 dietary forms, a standardized 4-day food diary form, and a dietary habits questionnaire. Each participant completed forms before entering into treatment (control) and at the 1- and 5-year follow-up assessment after being treated with a maxillary complete denture opposing a mandibular complete-arch fixed implant-supported prosthesis. Descriptive statistics were calculated for each measure at each assessment point. Regression analysis and the Sign test were used to calculate change in the participants' nutritional status (α=.05). RESULTS: Among the findings, it was noted that difficulty in masticating hard, raw, and fibrous foods decreased and intake of vegetable portions increased significantly from 2.5 to 3.3 servings. Participant comfort in eating in public places and their enjoyment of eating were significantly improved from 50% of participants being uncomfortable with their prior complete denture treatment to only 4% after 5 years. CONCLUSIONS: Within the limitations of this study, it was concluded that vegetable intake and ability to masticate raw, hard, and fibrous food for these participants improved when they received a mandibular implant-supported prosthesis opposed by a maxillary complete denture. According to the analysis and findings, the overall eating experience was more pleasurable, and eating in public was more comfortable after replacement of complete dentures with a mandibular implant-supported prosthesis.

Prosthetic outcome, patient complaints, and nutritional effects on elderly patients with magnet-retained, implant-supported overdentures--a 1-year report.

PURPOSE: To study the changes in treatment outcomes of complete dentures and magnet-retained, implant-supported overdentures in a group of elderly patients. MATERIALS AND METHODS: In this nonrandomized trial, 43 edentulous patients (14 men and 29 women) were fitted with complete dentures followed by implant-supported mandibular overdenture in a sequential model. Treatment outcomes used for analysis included objective assessment of denture quality (Woelfel's index), patient satisfaction, nutritional status, body mass index (BMI), and serum albumin level. The McNemar test was used to determine if significant differences in the Woelfel's index and nutritional status existed at different treatment phases. Repeated measures ANOVA and multiple pairwise comparison tests were used to analyze patient satisfaction. BMI status and serum albumin level at different treatment phases were analyzed with one-way ANOVA and Tukey post hoc test. RESULTS: At the 1-year follow-up, significant improvements were recorded for the objective assessment of denture quality and patient complaints (P < .05). No subject was found to be malnourished at pretreatment and in subsequent treatment phases. BMI and serum albumin level were not significantly different at different treatment phases (P > .05) CONCLUSIONS: The present study demonstrated that in elderly patients with stable health and nutritional status, complete dentures made in a university clinic brought about overall improvement in denture quality and reduction in denture complaint score. Insertion of mandibular implant-supported overdentures further improved the mandibular denture quality and reduced the mandibular denture complaint score. In this group of patients, no improvement in BMI, serum albumin value, and nutritional status were documented.

The influence of relining or implant retaining existing mandibular dentures on health-related quality of life: a 2-year randomized study of dissatisfied edentulous patients.

PURPOSE: The purpose was to assess and compare self-reported oral health and oral and general health related quality of life (OHRQoL and HRQoL) in two groups of edentulous adults who reported dissatisfaction with their mandibular dentures, and who were treated with a conventional relining of this denture or by having it converted into an implant-retained one. MATERIALS AND METHODS: Sixty subjects were randomly allocated into two equal groups, a relined conventional denture (RCD) group and an implant-retained overdenture (IOD) group. Data on demographics, oral health, OHRQoL, and HRQoL were recorded by means of a self-administered questionnaire at baseline, 3 months, and 2 years. RESULTS: Fifty-four subjects completed the protocol, 28 in the IOD-group and 26 in the RCD-group. The IOD group reported significant improvement in oral health and Oral Health Impact Profile (OHIP-20) sum score and all its domains after 3 months. The improvements remained stable at the 2-year control. The RCD group reported almost no significant improvements. Neither group reported improved HRQoL. CONCLUSION: The results of this study support the findings from other RCT studies that to implant-retain the mandibular denture significantly improves self-reported oral health and OHRQoL. This treatment modality should be a minimum standard of care in complete denture wearers dissatisfied with their mandibular denture.

The oral health-related quality of life in edentulous patients treated with conventional complete dentures.

OBJECTIVE: To compare the oral health-related quality of life (OHRQoL) between patients with both maxillary and mandibular complete denture and those with either the maxillary or the mandibular complete denture. BACKGROUND: Satisfaction of denture wearers can be estimated using the OHRQoL questionnaires like the OHIP-EDENT and the Geriatric Oral Health Assessment Index (GOHAI). METHODS: Two questionnaires were used to compare the OHRQoL between edentulous patients who had conventional removable complete denture on both jaws and those who had on either one of the jaws. RESULT: The age of the participants ranged from 42 to 75 years, with the mean age of 58 ± 8.12 years. The mean OHIP-EDENT scores were significantly high among those who wore conventional dentures in both jaws (54.12 ± 5.21), compared with the participants who only had denture either on upper or lower jaw (46.52 ± 7.35). It was noticed that the mean GOHAI score was significantly lower (p < 0.05) among participants who had conventional denture on both upper and lower jaw (28.25 ± 3.67), as compared to those who had conventional denture only on one arch (35.12 ± 2.11). CONCLUSION: Patients with complete dentures in both jaw (Group I) were less satisfied than patients with single complete denture (Group II). The result obtained in this study shows dissatisfaction with conventional dentures among edentulous patients.

Association between self-assessment of complete dentures and oral health-related quality of life.

The purpose of this study was to determine which factors related to patient self-assessment of dentures are associated with changes in oral health-related quality of life (OHRQoL) among edentulous patients after replacement of complete dentures, and to determine whether masticatory performance as determined using an objective method affects the changes in OHRQoL among edentulous patients. As a preliminary study, the existing questionnaire regarding self-assessment of dentures consisting of 39 question items, measured with a 100-mm visual analogue scale, was analysed by factor analysis. Then a questionnaire, composed of 22 question items, was developed containing six subscales of 'function', 'lower denture', 'upper denture', 'expectation', 'aesthetic and speech' and 'importance'. Final participants in the present study comprised 93 edentulous patients requiring new conventional complete dentures (44 men, 49 women; mean age, 75·0 years). These patients were asked to complete the Japanese version of the Oral Health Impact Profile (OHIP)-EDENT, comprising 19 question items for assessment of OHRQoL in edentulous patients, along with the developed questionnaire regarding self-assessment of dentures. Moreover, masticatory performance was measured using a colour-changeable chewing gum. The questionnaire and measurement were completed twice; before and after replacement of complete dentures. Stepwise multiple regression analysis identified 'lower denture' and 'aesthetic and speech' as significant independent variables besides OHIP-EDENT scores before replacement. These results suggest that sufficient retention of lower dentures and appropriate appearance may lead to improved OHRQoL in edentulous patients.

Clinical evaluation of satisfaction in patients rehabilitated with an immediately loaded implant-supported prosthesis: a controlled prospective study.

PURPOSE: The purpose of this controlled prospective study was to compare the satisfaction of patients rehabilitated with an immediately loaded implant-supported prosthesis and patients rehabilitated with a conventional denture in the mandible. MATERIALS AND METHODS: Selected mandibular partially or totally edentulous patients were included in this prospective study. Patients' mandibles were completely rehabilitated with immediately loaded implants supporting a screw-retained full-arch prosthesis (test group) or with a conventional denture (control group). The Satisfaction Profile (SAT-P), which investigates a number of psychologic aspects related to the function and esthetics of the stomatognathic apparatus, was administered to each patient 1 month before and 3 months after provisional prosthetic rehabilitation. The questionnaire comprised four different SAT-P items: quality of eating, eating behavior, mood, and self-confidence. A visual analog scale was used to elicit patient responses. SAT-P item scores were analyzed statistically by means of the Student t test and the chi-square test (or the Mann-Whitney nonparametric test), with P < .05 considered significant. RESULTS: Forty-one patients were consecutively treated with 205 immediately loaded implants supporting a screw-retained full-arch prosthesis (test group); 38 patients were consecutively treated with a conventional denture (control group). Statistically significant differences were observed between the test and control groups for all four SAT-P items. The test group reported greater satisfaction for all items versus the control group. In both groups, the differences between pre- and postrehabilitation values were statistically significant. CONCLUSIONS: Each patient was satisfied with their treatment outcomes, but patients who received an implant-supported prosthesis were more satisfied than the patients who received a conventional denture. The results suggest that a screw-retained full-arch prosthesis on immediately loaded implants is a predictable means of enhancing patient satisfaction.

Comparison of patient satisfaction, quality of life, and bite force between elderly edentulous patients wearing mandibular two implant-supported overdentures and conventional complete dentures after 4 years.

This study compared two groups of patients who were elderly and edentulous, one group included subjects who had mandibular overdentures supported by two implants (Group I); the other groups wore conventional complete dentures (Group II). This retrospective study included 100 edentulous patients (50 from each group) with an average age of 67.86 years, who had been followed for 4 years. The groups were compared in terms of patient satisfaction, quality of life (QOL), and bite force. The bite force and patient satisfaction scores of Group I were found to be statistically significantly higher than Group II (p < .05). However, no statistically significant difference was found between the two groups' QOL scores (p > .05) except on the physical pain subscale (p = .013). Based on these results, it can be concluded that after 4 years of function, subjects wearing mandibular overdentures supported by two implants had higher values for bite force and patient satisfaction scores, but similar QOL scores when compared to conventional complete denture-wearers.

Development of a patient-based questionnaire about emotional and social issues related to eating with dentures.

OBJECTIVES: In order to fully assess the impact of prosthetic rehabilitation and to formulate appropriate dietary advice, in-depth information about patients' experiences of eating with dentures is needed. The objective of this study was to develop and validate a questionnaire that accurately reflected the real concerns of patients with dental prostheses about the aspects of their life related to eating, using detailed information derived from qualitative interviews with patients. METHODS: Themes around factors related to eating with dentures were derived from interviews with patients (n=66) with either implant-supported mandibular over-dentures or conventional dentures. The themes were used to design a self-completed questionnaire with questions scored on a visual analogue scale and additionally questions answered using free text. The content and face validity of the questionnaire was tested on a different group of patients (n=10) with implant-supported mandibular over-dentures ('implant-supported') or conventional dentures. Test-retest reliability analysis was conducted on a further group of 30 patients (n=15 implant-supported; n=15 conventional dentures). RESULTS: A questionnaire has been developed with 33 questions scored on a visual analogue scale and 31 open questions designed to collect further information as free text. Themes identified were around social, emotional and practical issues about eating. The instrument has good internal reliability with a Cronbach alpha values of 0.86-0.95 and good test-retest reliability with intra-class correlation coefficients 0.87-0.92 across the domains. CONCLUSIONS: A patient-based instrument has been developed to measure emotional and social issues related to eating with dentures (ESIRE questionnaire). The questionnaire will be a useful tool in future trials of prosthetic rehabilitation.

Measuring patient-based outcomes: is treatment satisfaction associated with oral health-related quality of life?

OBJECTIVES: To evaluate the level of association between patients' denture satisfaction and oral health-related quality of life (OHRQoL) in edentate patients, and to identify the determinants of satisfaction that best predict OHRQoL. The effects of time and treatment type were also assessed. METHODS: Data from 255 edentate elders who participated in a randomised clinical trial were used. OHRQoL ratings were gathered using the Oral Health Impact Profile (OHIP-20) questionnaire. The McGill Denture Satisfaction Instrument was used to assess satisfaction with treatment (mandibular conventional denture or implant overdenture). Outcomes were measured prior to treatment, then 6 and 12 months after delivery of the new prostheses. Simple linear and multiple linear regression analyses were performed to statistically analyse the relationship. RESULTS: When the combined effect of all factors was assessed, only two variables of denture satisfaction ratings were significantly associated with OHRQoL: chewing ability (P=.005) and oral condition (P=.002). These two variables explained 46.4% of the variance in the OHIP change scores. This association varied with time, but the variables of importance remained the same. Type of treatment, gender, age and other socio-demographic variables were not significantly associated with improvement in OHRQoL once their effects were combined with denture satisfaction ratings. CONCLUSIONS: Within the limitations of this study, a highly positive association exists between oral health-related quality of life and denture satisfaction. Chewing ability and oral condition are the determinants of denture satisfaction best associated with OHRQoL, predicting 46.4% of its improvement following a treatment.

Residual ridge resorption, lower denture stability and subjective complaints among edentulous individuals.

Residual ridge resorption in the mandible after tooth loss may lead to worsening of complete denture stability and to various subjective complaints. The aim was to evaluate the association between radiologically assessed residual ridge resorption in the mandible, clinically assessed stability of lower complete denture and subjective complaints among elderly denture wearers. The study population consisted of 326 (115 men and 211 women) edentulous subjects aged 60-78years, all of whom were wearing complete dentures in the mandible. Data on subjective complaints were obtained from questionnaires and interviews. Denture stability was assessed clinically. Residual ridge resorption was analysed from panoramic radiographs. The results showed that women were significantly more often satisfied with their lower dentures and reported fewer problems with eating than men. They also had significantly more often residual ridge resorption than men. Among women, residual ridge resorption was significantly associated with poor chewing ability, low satisfaction with dentures and poor denture stability. Among men, residual ridge resorption did not associate with subjective complaints or denture stability. Poor satisfaction with dentures associated significantly with poor denture stability in both genders. In conclusion, these results highlight the importance of denture maintenance treatment. As the extent of residual ridge resorption in the mandible was the most important factor that increased dissatisfaction with lower complete dentures, it is also important to inhibit the progression of resorption by preventing tooth loss or by using implant-retained dentures.

Prosthetic aspects and patient satisfaction with resilient liner and clip attachments for bar- and implant-retained mandibular overdentures: a 3-year randomized clinical study.

PURPOSE: This report aimed to compare prosthetic aspects and patient satisfaction during a 3-year randomized clinical trial of bar- and implant-retained mandibular overdentures attached with either resilient liners or clips. MATERIALS AND METHODS: Thirty edentulous male patients (mean age: 62.5 years) received two implants in the anterior mandible after being allocated into two equal groups (according to attachment type received) using balanced randomization. After 3 months, implants were connected with resilient bars. New maxillary complete dentures were then constructed, and mandibular overdentures were retained to the bars with either clips (group I) or silicone resilient liners (group II). Subjects indicated satisfaction with their prostheses using a questionnaire and visual analog scale. Patient satisfaction and prosthetic complications were recorded for both attachments at 6 months and 1 and 3 years after overdenture insertion. RESULTS: Comfort and stability with the maxillary denture and ease of hygiene procedures were rated higher in group II, while ease of handling the dentures was rated higher in group I. No significant differences in other parameters of patient satisfaction between groups were noted after 3 years. The mean number of prosthetic adjustments and repairs in group I (11.9) was significantly higher (P = .00) compared to that in group II (4.8). The most common complication in group I was clip wear, while separation of the resilient liner from the denture base was the most common problem in group II. Hyperplasia under the bar and flabby ridge in the maxilla occurred significantly more often in group I compared to group II. CONCLUSIONS: Resilient liner-retained mandibular overdentures had comparable patient satisfaction, less prosthetic maintenance and costs, and less soft tissue complications when compared to clip-retained ones after 3 years.

The effect of attachment type and implant number on satisfaction and quality of life of mandibular implant-retained overdenture wearers.

OBJECTIVE: The aim of this study was to compare the quality of life and patient satisfaction outcomes of two attachment systems in mandibular overdentures with different numbers of supporting implants. MATERIALS AND METHODS: Sixty-two edentulous patients with either splinted or single attachments in mandibular implant overdentures with different numbers of supporting interforaminal implants were investigated for patient satisfaction and quality of life in this retrospective study. Comparisons between groups were perceived by the Mann-Whitney U test. Relations among the parameters were investigated by Spearman's rho correlation analysis. The results were evaluated statistically at a significance level of p < 0.05. RESULTS: No statistically significant association is found between visual analogue scales scores and attachment type as well as implant number (p > 0.05), whereas Oral Health Impact Profile (OHIP)-14 total scores for patients with 4-implant-supported bars were significantly lower than all the other attachment types (p < 0.05). Additionally, a negative (rate = 32.2%), statistically significant association between period of edentulism and total OHIP-14 scores was detected (p < 0.05). CONCLUSIONS: A mandibular implant-retained overdenture supported with four implants and bar attachments shows the highest 'quality of life' score and patient satisfaction is not influenced by the number of implants or attachment type.