Immediately loaded single-implant mandibular overdentures compared to conventional complete dentures: A cost-effectiveness analysis.

BACKGROUND: In recent years, the single-implant mandibular overdenture (SIMO) has been proposed as an alternative to more complex overdenture designs as a simplified implant intervention for edentulous patients. OBJECTIVE: The aim of this study was to run a cost-effectiveness analysis alongside a randomized clinical trial comparing the SIMO and the conventional complete denture (CCD) treatment. Imediately loaded external hexagon implant and ball attachment were used for the overdenture goup. Direct costs related to therapies were identified and valuated throughout a 1-year period after delivery, in Brazilian currency (R$) and converted into international dollars (I$) using purchase power parity exchange rates. Treatment effectiveness was measured using the OHIP-Edent and satisfaction scores for calculation of incremental cost-effectiveness ratios (ICER). RESULTS: Outcomes were assessed at the 1-year follow-up for 65 patients (CCD=34; SIMO=31). Overall OHIP-Edent and satisfaction scores improved significantly in the SIMO group, while remained unchanged in the CCD group. The mean overall costs were R$1,179.04 (I$590.99) for the CCD group and R$2,127.91 (I$1,068.20) for the SIMO group - 80.7% incremental cost for SIMO. The ICER calculation for SIMO treatment showed a mean cost of I$48.20 for 1-point reduction in OHIP-Edent scores, and I$12.56 for 1-point increase in satisfaction score. CONCLUSIONS: Findings support the effectiveness of this simplified and low-cost implant intervention for edentulous patients. SIMO also seems a cost-effective alternative to the CCD and the relatively low incremental cost may potentially increase the utilization of dental implants among older subjects, especially those with limited financial resources. CLINICAL SIGNIFICANCE: The immediately loaded single-implant mandibular overdenture was superior to the conventional complete denture in terms of patient-reported outcome measures at a low incremental cost.

Single versus two-implant mandibular overdentures using early-loaded titanium-zirconium implants with hydrophilic surface and ball attachments: 1-year randomized clinical trial.

OBJECTIVE: This randomized clinical trial aimed to compare the outcomes of the mandibular overdenture retained by one (1-IOD) or two (2-IOD) implants. MATERIALS AND METHODS: Participants received new complete dentures, were assessed at baseline and randomly assigned to groups. Early loaded single midline implant (1-IOD) or two implants in the canine regions bilaterally (2-IOD). Ball attachments were used for overdenture retention. Post-treatment outcomes (6- and 12-month follow-ups) included patient satisfaction, oral health-related quality of life measures, and chewing function. Data analysis included within- and between-group comparisons, and Generalized Estimating Equations. Both superiority and non-inferiority hypotheses were tested. RESULTS: Forty-seven participants were included (1-IOD = 23; 2-IOD = 24). Significant improvements in OHIP-Edent were observed after insertion of new dentures and at the 1-year follow-up compared with baseline. No differences were found between the 1- and 2-IOD groups for the OHIP-Edent and QoLFAST scores. Patient satisfaction with the mandibular denture improved significantly from baseline to the 6-month follow-up and remained unaltered until 1 year, with no differences between groups. The magnitudes of treatment effect sizes were moderate to large for patient-reported outcomes. Progressive improvement in chewing function occurred in both groups. Non-inferiority testing based on a 15% non-inferiority margin showed inconclusive results for patient-reported outcomes, whilst chewing function in the 1-IOD group was concluded to be not inferior to the 2-IOD group. CONCLUSIONS: Results support the use of both 1- and 2-IOD. The 1-IOD was also an acceptable alternative to the 2-IOD as a secondary option for the treatment of the edentulous mandible.

Effectiveness of immediately loaded single-implant mandibular overdentures versus mandibular complete dentures: A 1-year follow-up of a randomized clinical trial.

OBJECTIVE: This randomized clinical trial (RCT) aimed to assess the 1-year effectiveness of single-implant mandibular overdentures (SIMO) compared to conventional complete dentures (CCD). METHODS: In the first phase of the study, participants received new maxillary and mandibular CCDs. Then, they were randomly allocated to one of the study groups (CCD or SIMO). Participants in SIMO group received an external hexagon implant in the mandibular midline, with the immediate connection of an O-Ring/ball attachment. Oral health-related quality of life (OHIP-EDENT) and patient satisfaction in both groups were assessed before allocation and at 6- and 12-month follow-up visits. Both intention-to-treat (ITT) and per-protocol approaches were used for analyses. Statistical analyses were performed using the Wilcoxon Signed Ranks test and the Generalized Estimating Equations. RESULTS: Eighty-four participants (CCD n = 42; SIMO n = 42) were included, out of which 70 completed the 12-month follow-up (CCD n = 34; SIMO n = 36). ITT analysis showed no changes for the CCD group in the longitudinal assessment compared to baseline. Participants in SIMO group had a significant improvement in OHIP-EDENT scores and satisfaction with the mandibular denture. No changes for the maxillary denture were observed in either groups. Similar results were found when per-protocol analysis was performed. CONCLUSIONS: SIMO treatment resulted in a significant improvement in patient perceived outcomes compared to the CCD. SIMO may be considered as an alternative treatment modality for patients with poorly adapted and/or unstable mandibular dentures (ClinicalTrials.gov NCT03463174). CLINICAL RELEVANCE: The immediately loaded single-implant mandibular overdenture markedly improved patient satisfaction and oral health-related quality of life of conventional denture wearers after a 12-month follow-up.

Mandibular complete denture versus single-implant overdenture: a systematic review of patient-reported outcomes.

The single-implant mandibular overdenture (SIMO) has been proposed as an alternative for edentulous patients who are poorly adapted to their dentures due to low retention and stability of the conventional mandibular complete denture (CD). However, there is a lack of evidence regarding the effectiveness of SIMO, which can be measured by examining patient perception of treatment effects. The aim of this systematic review was to assess the comparative results of CD and SIMO treatments using patient-reported outcome measures. A literature search was carried out in PubMed, Scopus and Cochrane Central databases. The search included studies published up to July 2017. The focus question was: 'Do single-implant mandibular overdentures improve patient-reported outcomes compared to conventional complete dentures in edentulous patients?' Eligible studies were randomised clinical trials (RCT) and prospective studies. After initial screening for eligibility and full-text analysis, 11 studies were included for data extraction and quality assessment (five parallel-group RCTs, two crossover RCTs and four prospective studies). All studies reported marked improvement in satisfaction with the dentures and quality of life measures after SIMO treatment, irrespective of variations in implant treatment protocols and retention systems. Methodological considerations revealed a lack of evidence from RCTs on the comparative effectiveness of the two treatment strategies. Hence, although available evidence suggests considerable improvement in patient-reported outcomes following the insertion of a single implant to retain a mandibular denture, further well-designed comparative studies between SIMO and CD are required to improve the level of evidence and to support the indication of SIMO treatment in routine practice.

Overdentures on Implants for Better Quality of Life Among the Fully Edentulous Patients - Case Reports.

Global aging population has brought several challenges for their medical systems and total edentulism is one of them. The fabrication of removable acrylic dentures seems to be a simple and cheap treatment solution, but a majority of patients is not satisfied with their functional instability, causing limited diets, mouth soreness, speech and psycho-social problems etc. The results in many studies indicate an impact of oral conditions associated with the full denture wearing on oral-health related quality of life, especially in lower jaw. The reason for improper denture retention could be alveolar ridge bone resorption and numerous studies about this problem are plausible. Bone resorption in lower jaw may turn the alveolar ridge into a flabby soft tissue which is unable to sustain proper denture retention. The implant-retained prosthesis is an alternative treatment option in these situations. Implants will provide retention, stability, function and aesthetics and they are not so expensive solution. The aim of this article is to show solving of retention problems of a lower denture in two different clinical cases using implants and without any special technology.

Patient perceptions of the mandibular three-implant overdenture: a practice-based study.

OBJECTIVES: Although three-implant overdentures have often been used in clinical practice, there are few studies to support this approach. Therefore, this study aimed to determine the magnitude of change in ratings of oral health-related quality of life and to assess patients' satisfaction ratings with mandibular three-implant overdentures. MATERIALS AND METHODS: This quasi-experimental study examined oral health-related quality of life and satisfaction with prosthesis in 135 edentate participants (mean age 61.6 ± 7.9 years) who received mandibular three-implant overdentures from 2006 to 2009 in a private practice in Quebec, Canada. Data were collected from individual's dental records and a follow-up survey. The Oral Health Impact Profile (OHIP-20) was used to assess oral health-related quality of life at baseline and at follow-up. Satisfaction with the mandibular prostheses and perception of rocking movements were measured by use of a denture satisfaction questionnaire at follow-up. Descriptive statistics, bivariate and multivariate statistical analyses were used to analyse the data. RESULTS: Individuals who received mandibular three-implant overdentures had statistically significant improvements in all seven domains of the OHIP-20 from pre- to post-treatment (total OHIP change score -25.1 P < 0.001). Pre-treatment OHIP scores and rotational movement explained 58% of the variance in the OHIP's change score (P ≤ 0.05). More than three quarters of the sample population (75.6%) were completely satisfied with their three-implant overdentures, and 81.5% reported having no rocking movement. General satisfaction with the prostheses was not influenced by gender, type of fixture, or type of attachment. CONCLUSIONS: The treatment of edentulism by three-implant overdentures has favourable patient-based outcomes, with negligible perceptions of rotational movement. However, further research is needed to compare the efficacy of this alternative to other treatment modalities, such as the two-implant overdenture.

Clinical trial of an experimental cleaning solution: antibiofilm effect and integrity of a silicone-based denture liner.

AIM: This study evaluated the antibiofilm effect of an experimental solution of 2% Ricinus communis (R. communis) on a silicone-based denture liner by means of a randomized clinical trial, as well as the integrity of such liner following a cleansing regimen with such solution. MATERIALS AND METHODS: About 30 complete denture wearers had their lower dentures relined with a silicone-based denture liner and randomly allocated to cleanse their dentures by means of: (A) a specific toothbrush for complete dentures and dentifrice; (B) soaking in an experimental 2% R. communis solution; and (C) association of A and B. Considered outcomes were biofilm coverage area (%), microbial counts by means of the deoxy-ribonucleic acid (DNA) checkerboard hybridization technique and physical integrity of the soft liner, assessed during a time interval of 60 days. Mean group values were compared by analysis of variance (ANOVA) and Tukey tests or generalized linear method (α = 0.05). RESULTS: The mechanical method presented the lowest biofilm percentage (1.45 ± 1.03) if compared to the chemical method (2.96 ± 1.98) and the associated one (2.71 ± 1.76). After 60 days (3.37 ± 2.04), biofilm accumulation was higher than at 15 days (1.28 ± 0.77) and 30 days (2.46 ± 1.54). The denture liner was less deteriorated and kept its physical integrity when the mechanical method was applied. The chemical method presented higher effectiveness against microorganisms, including some Candida species. CONCLUSION: The 2% R. communis solution presented stronger antimicrobial capacity than brushing on a silicone-based denture liner after immersion. However, it was not superior to the mechanical method in preserving the physical integrity of the material and in biofilm removal. CLINICAL SIGNIFICANCE: Soft denture liners hygiene is a very important issue and not conclusive in the literature. The experimental solution of 2% R. communis evaluated presented promising antimicrobial potential and should be more explored to be recommended as cleanser.

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.

Interforaminal implant placement in oral cancer patients: during ablative surgery or delayed? A 5-year retrospective study.

In a retrospective study, two mandibular prosthetic rehabilitation strategies supported by implants in oral cancer patients were evaluated: implants placed in the non-resected edentulous symphyseal area during ablative surgery (DAS implants); or at a later stage (postponed (P) implants). Medical files of patients from two head-neck oncology groups from 2000 to 2005 were screened for study inclusion. DAS protocol was used in one group and P protocol in the other. After a 5 year follow-up of 261 edentulous patients with oral cancer in the second group, P implants were placed in 27 patients to support an overdenture. Of the 249 edentulous patients in the first group, 82 patients were given an implant supported overdenture using the DAS implant protocol. Regarding implant loss, no statistically significant differences were seen between the DAS and P implants. In the DAS group, more patients benefited from an implant-supported lower overdenture (39 versus 11%, respectively), and they received their overdenture on average 20.0 months sooner (sd=11.01, p<0.001) after ablative surgery. 17.1% of DAS implants and 4.6% of P implants were never loaded due to tumour and patient related factors including unfavourable implant soft tissue, tumour recurrence near the implant, or radiotherapy induced trismus.

Myofunctional therapy as an aid to prosthodontic treatment after hemiglossectomy: a clinical report.

Although several reports describe the prosthetic management of patients after hemiglossectomy, the techniques are related to the fabrication of the prostheses, no reports on maximizing the functional potential of the remaining tongue musculature and surrounding tissues were identified by the authors. This clinical report describes the use of myofunctional therapy as an aid to the maxillofacial prosthodontic rehabilitation of an edentulous patient who was diagnosed with invasive squamous cell carcinoma of the tongue and underwent hemiglossectomy. Myofunctional therapy was introduced before, during, and after the fabrication of conventional maxillary and mandibular complete dentures. Muscle exercises were devised to improve the posture and muscular tonus of the remaining tongue, and thus help with mastication and adaptation to the mandibular denture. Myofunctional therapy improved the posture and function of the remaining tongue, providing acceptable mastication and increased stability of the mandibular denture.

Evaluation of the occlusion vertical dimension of complete dentures after microwave disinfection.

OBJECTIVES: An increase in occlusal vertical dimension (OVD) after microwave disinfection may result in the need for adjustments in the complete dentures. This in vitro study evaluated the increase in OVD of maxillary complete dentures submitted to microwave disinfection protocols. MATERIAL AND METHODS: Thirty sets of complete dentures were evaluated as follows: Group 1-15 sets had the maxillary complete dentures submitted to microwave disinfection (650 W/3 min), once a week, for 4 weeks. Group 2-15 sets had the maxillary complete dentures submitted to microwave disinfection (650 W/3 min), three times a week, for 4 weeks. The vertical dimension was measured with a micrometre (in mm) before disinfection protocols (baseline readings) and after each week of disinfection. Data were analysed using Wilcoxon and Friedman tests (α = 0.05). RESULTS: For Group 1, no significant difference was found between the increases in OVD and zero, and no significant difference was found between the weeks. For Group 2, the increases in OVD were significantly greater than zero, and the Friedman test showed that weeks 3 and 4 had significantly greater changes than week 1 and that week 4 had significantly greater change than week 2. CONCLUSION: Microwave disinfection only promoted significant increase in OVD in Group 2, in which the values increased progressively.

The influence of mandibular implant-retained overdentures in masticatory efficiency.

OBJECTIVE: To evaluate the masticatory efficiency of patients rehabilitated with conventional dentures (CDs) or implant-retained mandibular overdentures. BACKGROUND: Despite the evident benefits of implants on mastication as assessed by subjective patient-based outcomes, the extent of implant overdenture treatment effect on food comminution is not well established. MATERIALS AND METHODS: A randomised clinical trial was carried out with 29 completely edentulous patients divided into two groups. The first group was rehabilitated with a mandibular overdenture retained by two splinted implants with bar-clip system, while the second group was rehabilitated with a mandibular CD. Both groups also were rehabilitated with maxillary CDs. Masticatory efficiency and patient satisfaction were assessed 3 months after denture insertion. Masticatory efficiency was evaluated through the colorimetric method with the beads as the artificial test-food. Comparisons for masticatory efficiency and patient satisfaction were performed using Student's t-test (α = 0.05). RESULTS: No significant statistical difference was found for masticatory efficiency (p = 0.198). Patient overall satisfaction was significantly higher for the mandibular overdenture (p < 0.001). In addition, mandibular overdenture patients were significantly more satisfied with chewing experience (p < 0.05) and retention of the lower denture (p < 0.005). CONCLUSION: The results of this study suggest that mandibular overdenture significantly improves chewing experience, although limited effect on masticatory efficiency has been observed.

Use of training dentures in management of gagging.

Gagging is a frequent impediment to the performance of dental procedures. This stimulation of the gagging reflex, or more accurately, the vomiting reflex, is a special problem in prosthodontic service. A hypersensitive gagging reflex often prevents the dentist from carrying out critical procedures or causes them to perform at a less than satisfactory level. In addition, once having suffered an unpleasant gagging experience in a dentist's office, the patients develop a fear of further visits to dentists. The purpose of this paper is to describe methods of managing the gagging patient that has a sound rationale based on modified treatment approaches starting from impression making to design of the prosthesis aided by training dentures to help the patient to tolerate prosthesis in mouth before fabrication of definite prosthesis.

Improved denture retention in patients with retracted tongues.

BACKGROUND: Patients who wear mandibular dentures and hold their tongues in retracted positions alter the dimensions of the sublingual space and disrupt the peripheral seal that is needed for optimal denture retention. The authors studied whether retention could be improved if patients moved their tongues from a retracted resting position to an ideal resting position. METHODS: The authors observed and classified the mandibular residual ridge morphologies of 85 participants who wore complete dentures. The authors recorded and compared the retention of the mandibular denture before and after repositioning the tongue to the ideal resting position. RESULTS: When the participants' tongues were in a retracted resting position, the average retention of the mandibular denture was 75.38 gram weight (+/- 81.83 standard deviation [SD]). After participants repositioned their tongues to the ideal resting position, the average retention of the mandibular denture was 118.89 gw (+/- 93.00 SD), an increase of 57.73 percent. CONCLUSIONS: In all morphological classes, when participants held their tongues in the ideal resting position, the average mandibular denture retention increased by 57.73 percent, a statistically significant improvement compared with when participants held their tongues in a retracted resting position. CLINICAL IMPLICATIONS: Clinicians are encouraged to evaluate carefully the tongue resting position in all patients who wear dentures, help create reasonable therapeutic expectations by informing patients about the significant effect that tongue position will have on future denture retention and provide helpful neuromuscular training for patients with retracted-tongue habits.

The use of laser technology (Er;Cr:YSGG) and stereolithography to aid in the placement of a subperiosteal implant: case study.

The use of laser technology has helped this clinician to provide treatment with less postoperative pain and increased healing. The subperiosteal implant is a modality that has been used for several decades, although its popularity has declined in favor of endosseous dental implants. In some instances, however, it remains the treatment of choice, specifically in the atrophic mandible (where placement of endosseous implants is not possible) or when placement would increase the chances of jaw fracture. This article reports the case of a patient rehabilitated using a simplified surgical protocol involving laser surgery and stereolithography.

Treatment of painful post-traumatic peripheral neuropathy with capsaicin in an edentulous patient with extreme resorption in the mental region: a case report.

AIM: The aim of this report is to present a clinical case of extensive alveolar resorption in the mental region of the mandible of a complete denture wearer for which capsaicin was used for alleviation and remission of post-traumatic painful peripheral neuropathy. BACKGROUND: Resorption of the residual ridge occurs in a chronic and progressive manner, altering the configuration of the ridge and the mucosa covering it and subsequently compromising the stability of the complete denture prosthesis. Individual variability associated with such factors as gender, age, edentulous period, nutrition, excessive load and compression on the ridge, parafunctional habits, occlusal instability, and maladaptation of the prosthesis may have a role in the rate and manner of bone loss. REPORT: A 62-year-old woman, edentulous at the age of 30, presented with complaints of pain and spontaneous "electrical shocks" in the mucosa under her mandibular complete denture. The pain increased while chewing approximately two years ago due to the pressure of this denture on her supporting tissues. The patient indicated the level of pain corresponded to a score of ten out of ten on the Visual Analogical Scale (VAS). Treatment included denture replacement and topical application of capsaicin gel using a custom tray technique. SUMMARY: The review of the literature and the results obtained from the management of this case have served to emphasize how much neuropathic pain research has demonstrated the complexity of its neurophysiologic mechanism due to the lack of association with any somatic manifestation. During the fabrication of a new lower denture the topical application of capsaicin was shown to be effective in the relief and remission of the painful symptoms of the neuropathy as of this writing.

[First clinical experiences with ceramic ball attachments for overdentures]. / Erste klinische Erfahrungen mit Retentionselementen aus Keramik.

In this prospective clinical study on 40 patients with similar clinical conditions (edentulous jaw with 2 interforaminal implants) commercially available ceramic ball attachments (ruby) were compared to commercial titanium ball attachments. The primary aim of the study was to measure the wear of the ball attachments after being 1 year in function. However, in the course of the study already after 7 to 12 months multiple failures with ceramic ball attachments occurred. Twelve (28%) of 43 ceramic ball attachments had to be replaced, mostly because of fractures (8) of the ceramic ball. It seems that ceramic ball attachments of the investigated design are not able to withstand normal intraoral stresses. The short-term susceptibility to fractures didn't allow to examine the ceramic-inherent features such as compressive strength and wear resistance. Furthermore, a secure connection between a titan base and a ceramic ball seems to be challenging. Based on these results, in implant-retained removable prosthesis the use of metal-based retainers is still recommended, although during maintenance a higher wear has to be expected. This wear can be compensated by either activating or changing the matrix or the patrix.

A clinical pathway for complete immediate denture therapy: successful prosthetic management for hopeless dentitions.

This article presents a rationale for utilizing complete immediate denture therapy, highlighting various advantages, disadvantages, and contraindications for this treatment. Jerbi's technique for presurgical cast carving is reviewed and a unique case report is detailed, involving a 22-year-old patient whose hopelessly debilitated dentition was treated by full-mouth extraction and placement of a maxillary and mandibular complete immediate denture. In addition, a brief review of changing dietary patterns and social habits is presented in relation to the recent escalation of rampant dental caries in youth and young adult patient populations.

Immediate placement of implants and appliance in an irradiated patient: a case study.

PURPOSE: The purpose of this study was to evaluate the immediate placement of implants and appliance using hyperbaric oxygenation on a 45-year-old male with a history of squamous cell carcinoma of the floor of the mouth. MATERIALS: Five Nobel Biocare implants between the mental foamina were used along with a course of pre- and postsurgical hyperbaric oxygenation. RESULTS: After 39 months, the patient is symptom free and shows no signs of rejection. Conclusion Using an accepted hyperbaric oxygenation protocol when placing and restoring immediate implants in this patient resulted in a successful treatment outcome.