Maxillary overdentures supported by four or six implants in the anterior region: 10-year randomized controlled trial results.

AIM: To evaluate bar-supported maxillary implant overdenture treatment when supported by either four or six implants after 10 years. MATERIALS AND METHODS: Edentulous subjects with maxillary denture complaints and ample bone volume to facilitate implants in the anterior region of the maxilla were planned for implant overdenture treatment, randomized to receive either four implants (n = 25) or six implants (n = 25) and subsequently evaluated after 10 years of function. Outcome variables included peri-implant bone-level changes, implant and overdenture survival, complications, presence of plaque, calculus and bleeding, degree of peri-implant inflammation, probing depth and patient satisfaction. Differences between the groups and between evaluation periods were tested with a Student's t-test. RESULTS: Fourteen patients with totally 72 implants were lost to follow-up. Two patients from the six-implant group experienced implant loss (four implants), resulting in 96.1% implant survival in this group versus 100% survival in the four-implant group. Clinical, radiographical and patient-reported outcome measures did not differ statistically significant between the two groups. Patients from both groups were generally quite satisfied with the result after 10 years. CONCLUSIONS: Similar and favourable outcomes are seen in bar-supported maxillary overdentures on either four or six anteriorly placed implants after a 10-year evaluation period.

Maxillary bar overdentures on four or six posterior implants: 10-year results from a randomized clinical trial.

OBJECTIVE: To compare clinical and patient-reported outcomes when providing maxillary overdentures on four and six splinted implants placed in the posterior region during a 10-year follow-up period. MATERIALS AND METHODS: Sixty-six edentulous participants with functional maxillary denture complaints and insufficient bone volume to allow implant placement were scheduled for a bone augmentation procedure. After healing, participants were randomized to receive either four or six implants in the posterior maxilla. After 3 months of osseointegration, a bar overdenture was constructed. Implant survival, overdenture survival, clinical scores, peri-implant bone height changes, and patient satisfaction were assessed. RESULTS: Forty-six participants completed the 10-year follow-up. Implant survival was 100% in the 4-implant group and 96.7% in the 6-implant group. Seven new overdentures were made in the 4-implant group and 12 new overdentures were made in the 6-implant group due to excessive wear of the denture base and teeth. Clinical parameters did not differ significantly between groups. Mean marginal bone loss compared to baseline was 0.41 ± 0.37 mm in the 4-implant group and 0.70 ± 1.07 mm in the 6-implant group. Overall, patient satisfaction improved significantly, but did not differ between groups. CONCLUSION: From this 10-year follow-up trial, it was concluded that bar maxillary overdentures on four or six implants in the posterior region of an augmented maxilla resulted in a comparable treatment outcome with high implant survival, limited loss of peri-implant marginal bone, and high patients' satisfaction. (Clinical trial registration number: NTR9729).

Development of 'learn to dare!': An online assessment and intervention platform for anxious children.

BACKGROUND: Many children and adolescents suffer from problematic levels of anxiety, but the multitude of these children do not receive an intervention. It is of importance to increase the accessibility and availability of child anxiety interventions, as to identify and treat anxious children early and successfully. Online platforms that include information, assessments and intervention can contribute to this goal. Interventions for child anxiety are frequently based on Cognitive Behavioral Therapy, because of its strong theoretical and empirical basis. However, the working mechanisms of Cognitive Behavioral Therapy in children are poorly studied. To our knowledge, mediation studies on child anxiety are non-existent regarding online Cognitive Behavioral Therapy. METHODS: We will aim at children aged 8-13 years with problematic anxiety. We recruit these children via the community setting, and refer them to our online platform 'Learn to Dare!' (in Dutch: 'Leer te Durven!'), https://leertedurven.ou.nl, where information about child anxiety and our research is freely accessible. After an active informed consent procedure, the participants can access the screening procedure, which will select the children with problematic anxiety levels. Thereafter, these children will be randomized to an online intervention based on Cognitive Behavioral Therapy (n = 120) or to a waitlist control (WL, n = 120). The intervention consists of 8 sessions with minimal therapist support and contains psycho-education, exposure (based on inhibitory learning), cognitive restructuring and relapse prevention. Child anxiety symptoms and diagnoses, cognitions, avoidance behavior and level of abstract reasoning are measured. Assessments are the same for both groups and are performed before and after the proposed working mechanisms are offered during the intervention. A follow-up assessment takes place 3 months after the final session, after which children in the waitlist control group are offered to take part in the intervention. DISCUSSION: This protocol paper describes the development of the online platform 'Learn to Dare!', which includes information about child anxiety, the screening procedure, anxiety assessments, and the online intervention. We describe the development of the online intervention. Offering easy accessible interventions and providing insight into the working mechanisms of Cognitive Behavioral Therapy contributes to optimizing Cognitive Behavioral Therapy for anxious youth.

Four or six implants in the maxillary posterior region to support an overdenture: 5-year results from a randomized controlled trial.

OBJECTIVE: To compare clinical and patient-reported outcomes when providing maxillary overdentures on four bar- and six bar-connected implants placed in the posterior region during a 5-year follow-up period. MATERIALS AND METHODS: Sixty-six fully edentulous patients with functional maxillary denture complaints and insufficient bone volume to allow implant placement were scheduled for a maxillary sinus floor elevation procedure with bone from the anterior iliac crest and randomized to receive either four or six implants in the posterior maxilla and four implants in the mandible. After 3 months of osseointegration, a bar-supported overdenture was constructed. Maxillary implant survival, overdenture survival, clinical scores, peri-implant bone height changes and patient satisfaction were assessed. RESULTS: Sixty patients completed the 5-year follow-up. Implant survival was 100% in the four-implant group and 99.5% in the six-implant group. No new overdentures had to be made in the four-implant group, and three new overdentures were made in the six-implant group due to excessive wear of the denture base and teeth (90.9% overdenture survival). Clinical parameters did not differ significantly between groups. Mean marginal bone loss compared to baseline was 0.58 ± 0.51 mm in the four-implant group and 0.60 ± 0.58 mm in the six-implant group, respectively. Overall, patient satisfaction improved significantly, but did not differ between groups. CONCLUSION: Following a bilateral maxillary sinus floor elevation procedure, a bar-supported overdenture on four implants in the posterior maxillary region is not inferior to an overdenture supported by six implants after a 5-year evaluation period in patients with functional maxillary denture complaints and marked posterior resorption (Clinical trial registration number: NTR2969).

Maxillary overdentures supported by four or six implants in the anterior region: 5-year results from a randomized controlled trial.

OBJECTIVE: To compare a four- and six-implant maxillary overdenture after an observation period of 5 years. MATERIAL AND METHODS: Fifty subjects with functional problems concerning their maxillary denture, who had ample bone volume in the anterior region to place four or six implants, were included and randomly assigned to either group. Implant and overdenture survival, clinical performance, marginal bone loss and patient satisfaction were assessed. RESULTS: Forty-six patients completed the 5-year follow-up. One implant failed in the six implants group (99.2% survival) and none in the four implants group (100% survival). No overdentures had to be replaced during the observation period and the number of complications was limited. Clinical function was good, with no difference in clinical parameters between the groups. Mean marginal bone resorption was 0.50 ± 0.37 and 0.52 ± 0.43 mm in the four and six implant group respectively. CONCLUSION: In patients with functional complaints of their maxillary denture, bar-supported overdentures on four implants in the anterior maxillary region were not inferior to overdentures supported by six implants after 5 years of function. Implant survival and patient satisfaction were high, clinical parameters favourable, bone loss and complications to the denture were minor in both groups (Clinical trial registration number: NTR2969).

A comparison between 4 and 6 implants in the maxillary posterior region to support an overdenture; 1-year results from a randomized controlled trial.

OBJECTIVE: To compare the treatment outcome of 4 vs. 6 bar-connected implants in the posterior region of the maxilla to support an overdenture during a 1-year follow-up period. MATERIALS AND METHODS: Sixty-six edentulous patients with an insufficient amount of bone volume in the maxilla to place implants were asked to participate in this study. Randomization assigned patients to either 4 or 6 implants. In all patients, a maxillary sinus floor elevation procedure with bone from the iliac crest was performed, and after a 3-month healing period, 4 or 6 dental implants were inserted in the maxillary posterior region in a one-stage procedure. After 3 months of osseointegration, a bar-supported overdenture was constructed. Implant survival, overdenture survival, clinical scores, peri-implant bone height changes and patients' satisfaction were assessed. Study analysis was performed according a non-inferiority design. RESULTS: All patients completed the one-year follow-up. After a functional period of 1-year, implant survival was 100% in the 4 implants group and 99.5% in the 6 implants group. Overdenture survival was 100% in both groups. Mean clinical scores were very low and did not significantly differ between groups. Mean marginal bone resorption was 0.35 ± 0.31 mm and 0.46 ± 0.34 mm in the 4 and 6 implants group, respectively. Patients' satisfaction improved significantly in both groups, but did not differ between groups. CONCLUSION: A bar-supported overdenture on 4 implants in the posterior maxillary region is not inferior to an overdenture supported by 6 bar-connected dental implants.

Maxillary overdentures supported by four or six implants in the anterior region; 1-year results from a randomized controlled trial.

OBJECTIVE: Comparing treatment outcome of four and six bar-connected implants in the anterior maxillary region to support an overdenture during a 1-year follow-up period. MATERIAL AND METHODS: Fifty edentulous patients with lack of retention and stability of the upper denture, but with sufficient bone volume to place implants in the anterior maxillary region, were selected. Randomization assigned patients to either four or six implants. Implant survival, overdenture survival, clinical scores, radiographic bone height changes, and patients' satisfaction were assessed. RESULTS: Forty-nine patients (one drop out) completed the 1-year follow-up. After 1 year, implant survival was 100% in the four implants group and 99.3% in the six implants group (one implant lost). Overdenture survival was 100% in both groups. Mean clinical scores were low and did not differ between groups (independent Student's t-test). Mean marginal bone resorption was 0.24 ± 0.32 mm in the four implants group and 0.25 ± 0.29 mm in the six implants group. Patients' satisfaction had improved in both groups (paired Student's t-test). CONCLUSION: Bar-supported overdentures on four implants in the anterior maxillary region are not inferior to overdentures supported by six bar-connected implants. Implant survival was high, peri-implant conditions were healthy and patients' satisfaction had increased significantly in both groups.

Attachment of clips in a bar-retained maxillary implant overdenture: a clinical report.

Implant-supported overdentures are a good alternative for patients with conventional dentures that lack retention and stability. The most common prosthetic complications in mandibular and maxillary implant-supported overdentures are fracture and loosening of the attachment system. This clinical report describes the treatment of a completely edentulous patient with sinus floor elevation by using bone from the iliac crest and the insertion of 4 implants in the maxilla and mandible followed by implant-supported overdentures. The technical procedure for the attachment of clips to an acrylic resin overdenture base with the use of metal reinforcement is described. The advantage of this attachment procedure is an improved attachment system with less fracture and less loosening of the clips.

Incidence of peri-implant mucositis and peri-implantitis in patients with a maxillary overdenture: A sub-analysis of two prospective studies with a 10-year follow-up period.

BACKGROUND: Though studies on maxillary overdentures show satisfying results on implant survival, patient-related outcomes and prosthetic complications, the epidemiology of peri-implant diseases in this specific group of patients has hardly been reported. While the general patient-level prevalence of peri-implant mucositis and peri-implantitis are estimated at ~45% and ~20%, respectively, the risk of developing these diseases within a specific period is less clear. To fully appreciate the epidemiology of peri-implant diseases, more long-term data on incidence of peri-implant diseases are needed. PURPOSE: The purpose of this sub-analysis of two prospective studies was to assess the incidence of peri-implant mucositis and peri-implantitis in fully edentulous patients with implant-retained maxillary overdentures during a 10-year follow-up period. MATERIALS AND METHODS: One hundred and sixteen patients treated with implant-supported maxillary overdentures were available from two clinical trials. Data on biological complications, clinical and radiographical parameters were collected for 106 patients at 5-year, for 82 patients at 10-year follow-up. The incidence was calculated following the consensus of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. Extent and severity then were calculated to enable an appropriate epidemiological description of peri-implantitis. RESULTS: The patient-level incidence of peri-implant mucositis was 37.7% after 5 years and 64.6% after 10 years whereas the patient-level incidence of peri-implantitis was 10.4% after 5 years and 19.5% after 10 years. After 10 years, the extent of peri-implant mucositis and peri-implantitis is 52.8% and 43.8%, respectively. In terms of severity, 26.5% of all affected implants suffered from >3 mm bone loss and 17.6% of all affected implants was lost. CONCLUSION: Three of five fully edentulous patients with implant-supported maxillary overdentures experience peri-implant mucositis after 10 years. Peri-implantitis occurs in one of five patients after 10 years. In spite of these incidence rates, implant survival remains high.

A systematic review of implant-supported maxillary overdentures after a mean observation period of at least 1 year.

AIM: The aim of the present systematic review of implant-supported maxillary overdentures was to assess the survival of implants, survival of maxillary overdentures and the condition of surrounding hard and soft tissues after a mean observation period of at least 1 year. MATERIAL AND METHODS: MEDLINE (1950-August 2009), EMBASE (1966-August 2009) and CENTRAL (1800-August 2009) were searched to identify eligible studies. Two reviewers independently assessed the articles. RESULTS: Out of 147 primarily selected articles, 31 studies fulfilled the inclusion criteria. A meta-analysis showed an implant survival rate (SR) of 98.2% per year in case of six implants and a bar anchorage. In case of four implants and a bar anchorage, the implant SR was 96.3% per person. In case of four implants and a ball anchorage, the implant SR was 95.2% per year. CONCLUSION: In all three treatment options, the SR of the implants is more than 95%. The studies included reveal that a maxillary overdenture supported by six dental implants, which are connected with a bar, is the most successful treatment regarding survival of both the implants and overdenture. Second in line is the treatment option with four implants and a bar. The treatment option with four or less implants and a ball attachment system is the least successful.

The implementation and the cultural adjustment of functional family therapy in a Dutch psychiatric day-treatment center.

Because of the increasing severity of adolescent problem behavior, evidence-based practices are becoming of interest as an alternative to traditional treatment with the behavior problems of adolescents in juvenile justice settings. Despite interest in evidence-based practices, questions exist regarding whether or not evidence-based intervention models can be successfully transported to cultures other than those in which they were developed. This article describes the transportation process of an American evidence-based family therapy (Functional Family Therapy [FFT]) into the service delivery system of a psychiatric day treatment center for juvenile delinquents in Amsterdam. The characteristics of FFT that make it cross-culturally sensitive are discussed. Results from the changes in service delivery suggest FFT can be successfully implemented in international settings with adjustments to make the model fit the culture(s) of The Netherlands without changing the model of FFT itself.

Maxillary overdentures supported by anteriorly or posteriorly placed implants opposed by a natural dentition in the mandible: a 1-year prospective case series study.

BACKGROUND: For maxillary overdenture therapy, treatment guidelines are missing. There is a need for longitudinal studies. PURPOSE: The purpose of this 1-year prospective case series study was to assess the treatment outcome of maxillary overdentures supported by six dental implants opposed by natural antagonistic teeth in the mandible. MATERIALS AND METHODS: Fifty patients were treated with a maxillary overdenture supported by six dental implants, either placed in the anterior region (n = 25 patients) or in the posterior region (n = 25 patients). Items of evaluation were the following: survival of implants, condition of hard and soft peri-implant tissues, and patients' satisfaction. RESULTS: One-year implant survival rate was 98% in the anterior group and 99.3% in the posterior group. Mean radiographic bone loss in the anterior and posterior groups after 1 year of loading was 0.22 and 0.50 mm, respectively. Mean scores for plaque, calculus, gingiva, bleeding, and pocket probing depth were low, and patients' satisfaction was high, with no differences between the groups. CONCLUSION: Six dental implants placed in either the anterior region or the posterior region of the edentulous maxilla, connected with a bar, and opposed by antagonistic teeth in the mandible supply a proper base for the support of an overdenture.

A systematic review of implant-supported overdentures in the edentulous maxilla, compared to the mandible: how many implants?

BACKGROUND AND AIM: There is now overwhelming evidence from systematic reviews that a two implant overdenture is the first choice of treatment for the edentulous mandible. Conversely, consensus is lacking for implant-supported maxillary overdentures. Therefore, we systematically reviewed the treatment outcome of concepts used for implant-supported maxillary overdentures, focusing on the survival of implants, survival of maxillary overdentures and condition of the implant surrounding hard and soft tissues after a mean observation period of at least 1 year. MATERIAL AND METHODS: MEDLINE (1950 to December 2013), EMBASE (1966 to December 2013) and CENTRAL (1800 to December 2013) were searched to identify eligible studies. Two reviewers independently assessed the articles using specific study design-related quality assessment forms. RESULTS: Out of 195 primarily selected articles, 24 studies fulfilled the inclusion criteria. A metaanalysis showed an implant survival rate of 98.1% and overdenture survival of 99.5% per year in the case of ≥ 6 implants and a splinted (bar) anchorage. In the case of ≤ 4 implants and a splinted (bar) anchorage, implant survival rate and overdenture survival were 97.0% and 96.9% per year, respectively. In the case of ≤ 4 implants and a non-splinted anchorage (ball, locator, telescopic crown), implant survival rate and overdenture survival were 88.9% and 98.8% per year, respectively. The condition of the peri-implant tissues was not reported in most studies. CONCLUSIONS: An implant-supported maxillary overdenture (all studies ≥ 4 implants) provided with a splinted anchorage is accompanied with a high implant and overdenture survival rate (both >95% per year), while there is an increased risk of implant loss when ≤ 4 implants with a non-splinted anchorage are used.