Patient-Reported Outcomes of Maxillary Edentulous Patients Wearing Overdentures Retained by Two Implants from Insertion to 4 Years.

PURPOSE: This cohort study evaluated patient satisfaction for maxillary implant-retained overdentures (IODs) on two implants up to 4 years and assessed the treatment effect over time. MATERIALS AND METHODS: Patients encountering problems with their conventional dentures were included and received maxillary IODs on two titanium-zirconium implants and ball anchors in the canine area. Patient satisfaction was assessed using the oral health impact profile (OHIP-20E) questionnaires both for dentures and IODs. Two months after insertion of IODs (baseline), the patients chose the preferred overdenture design with full or reduced palatal coverage. OHIP-20E questionnaires were followed according to the individual choice at 1 and 4 years, and outcomes were compared with baseline. RESULTS: Sixteen out of 21 patients were evaluated at a mean follow-up of 4 years (range: 2.4 to 4.8 years). There was no significant difference in the OHIP domains for IODs at 1 year (OHIP_total_1y: 9.5, SD: 13.0) and 4 years (OHIP_total_4y: 14.2, SD: 19.1) compared with baseline (OHIP_total_BL: 12.4, SD: 14.7). Patients were most satisfied with social disability both for IODs (OHIP_BL: 6.0, SD: 7.6; OHIP_1y: 3.4, SD: 5.4; OHIP_4y: 5.7, SD: 9.5) and dentures (OHIP_CD_old: 28, SD: 29.7; OHIP_CD_new: 25.4, SD: 28.67). Patients were least satisfied with functional limitation both for IODs (OHIP_BL: 6.0, SD: 7.6; OHIP_1y: 3.4, SD: 5.4; OHIP_4y: 5.7, SD: 9.5) and dentures (OHIP_CD_old: 28, SD: 29.7; OHIP_CD_new: 25.4, SD: 28.67). CONCLUSION: Patient satisfaction with maxillary IODs on two implants did not change from baseline to 4 years and was high at 4 years of function.

Ten-year clinical outcome of single implant-retained mandibular overdentures-A prospective pilot study.

OBJECTIVES: The aim of this prospective pilot study was to evaluate the concept of one single implant placed in the edentulous mandible to retain a complete denture with regard to implant survival and prosthodontic maintenance over an observation period of 10 years. MATERIALS AND METHODS: Eleven edentulous patients were included and received one implant in the midline of the mandible. Five implants healed submerge and were uncovered 2 months later. The other six healed un-submerged and were provided with a healing abutment 4 mm in height thus moderately loaded. All denture bases were temporarily relined during the healing period and two months later provided with a ball attachment for implant retention. Implant related parameters and prosthodontic maintenance interventions were assessed four weeks after implant loading and then annually. RESULTS: Over a mean observation period of 108.9 months (35-136 months), no implant was lost. The most frequent prosthetic maintenance intervention was activation of the matrix due to loss of retention, followed by exchange of the female part. Fracture of the denture base in the attachment area was a frequent complication and occurred in 8 cases. Two denture bases fractured twice. CONCLUSION: Within the limitations of this prospective pilot study, the concept of a single midline implant to retain a mandibular complete denture is promising over ten years for edentulous patients. Regular recall visits should be scheduled due to frequent maintenance interventions. Further research on this topic with a larger study cohort is needed.

Sobredentadura: solución eficaz en la rehabilitación del adulto mayor. Presentación de un caso / Overdenture: effective solution in the rehabilitation of the elderly. Case presentation

Introducción: El envejecimiento es un fenómeno universal e irreversible, que involucra cambios morfológicos y funcionales en la cavidad bucal. Los ancianos con edentulismo total presentan reabsorción progresiva de sus rebordes residuales, lo cual conlleva a la pérdida de retención y estabilidad de sus prótesis. Objetivo: Presentar un caso clínico donde se colocan implantes de bola rehabilitados con una sobredentadura removible. Presentación del caso: Paciente femenina de 61años de edad atendida en la consulta multidisciplinaria de Implantología de la Clínica Docente de Prótesis de Marianao, portadora de una prótesis total inferior con falta de retención y estabilidad, la cual había cambiado en varias ocasiones sin poder resolver su problema. Además presenta reabsorción marcada del reborde residual alveolar. Después de una evaluación integral y el consentimiento de la paciente, se procede a la colocación de dos implantes de bola OVD en zonas del 33 y 43 mediante cirugía con colgajo, siendo rehabilitada con una sobredentadura removible en la misma sesión de trabajo. Conclusiones:Esta rehabilitación protésica permitió satisfacer la función masticatoria, una correcta fonación y estética facial adecuadas, necesarias todas para la calidad de vida del adulto mayor(AU)

Introduction: Aging is a universal and irreversible phenomenon, involving morphological and functional changes in the oral cavity with age. The fully edentulous elderly have progressive reabsorption of their residual ridges, leading to loss of retention and stability of their prostheses. Objective: To present a case where rehabilitated ball implants, with a removable overdenture placed. Case presentation: A female patient of 61 years old attended in the Prosthetics Implantology multidisciplinary consult of the Educational Clinic of Marianao municipality, with lower full denture prosthesis with lack of retention and stability, which had changed repeatedly unable to solve her need. Also it has marked residual alveolar ridge reabsorption. After a comprehensive evaluation and with the consent of the patient, we proceed to the placement of two OVD ball implants in 33 and 43 zone by flap surgery, being restored with a removable overdenture in the same work session. Conclusions: This prosthetic rehabilitation allowed satisfying the chewing function, correct phonation and an appropriate facial aesthetic, all necessary for the quality of life of the elderly(AU)

Retention and Stability of Implant-Retained Mandibular Overdentures Using Different Types of Resilient Attachments: An In Vitro Study.

PURPOSE: The aim of this study was to evaluate and compare the retention and stability of mandibular implant overdentures using different types of resilient attachments. MATERIALS AND METHODS: Two implant analogs were inserted in the canine areas of an acrylic edentulous mandibular model. A metal-reinforced experimental overdenture was constructed and connected to the implant analogs (on two occasions) using either resilient telescopic or Locator attachments. Locators were divided into three subgroups according to the degree of retention of the male nylon insert: Locator extra-light retention (blue insert), Locator light retention (pink insert), and Locator medium retention (transparent insert). Vertical and oblique (anterior, posterior, and lateral) dislodging forces were measured at the beginning of the study (initial retention) and after 540 cycles of denture insertion and removal (final retention). RESULTS: For all dislodging forces, Locator medium recorded the highest initial and final retention. Telescopic attachments recorded the lowest retention during vertical and anterior dislodging, and Locator extra-light recorded the lowest retention during lateral and posterior dislodging. For all types of Locator attachments, anterior dislodging recorded the highest initial and final retention, and lateral dislodging recorded the lowest retention. For the telescopic attachment, posterior dislodgment recorded the highest initial and final retention, and anterior dislodging recorded the lowest retention. CONCLUSION: After repeated denture insertions and removals, the highest retention and stability were recorded with Locator medium followed by Locator light. The lowest retention was recorded with resilient telescopic attachment, and the lowest stability was recorded with Locator extra-light.

Survival Rate of Resin and Ceramic Inlays, Onlays, and Overlays: A Systematic Review and Meta-analysis.

This systematic review and meta-analysis aimed to evaluate the survival rate of ceramic and resin inlays, onlays, and overlays and to identify the complication types associated with the main clinical outcomes. Two reviewers searched PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials for articles published between 1983 through April 2015, conforming to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews. Clinical studies meeting the following criteria were included: 1) studies related to resin and ceramic inlays, onlays, and overlays; 2) prospective, retrospective, or randomized controlled trials conducted in humans; 3) studies with a dropout rate of less than 30%; and 4) studies with a follow-up longer than 5 y. Of 1,389 articles, 14 met the inclusion criteria. The meta-regression indicated that the type of ceramic material (feldspathic porcelain vs. glass-ceramic), study design (retrospective vs. prospective), follow-up time (5 vs. 10 y), and study setting (university vs. private clinic) did not affect the survival rate. Estimated survival rates for glass-ceramics and feldspathic porcelain were between 92% and 95% at 5 y (n = 5,811 restorations) and were 91% at 10 y (n = 2,154 restorations). Failures were related to fractures/chipping (4%), followed by endodontic complications (3%), secondary caries (1%), debonding (1%), and severe marginal staining (0%). Odds ratios (95% confidence intervals) were 0.19 (0.04 to 0.96) and 0.54 (0.17 to 1.69) for pulp vitality and type of tooth involved (premolars vs. molars), respectively. Ceramic inlays, onlays, and overlays showed high survival rates at 5 y and 10 y, and fractures were the most frequent cause of failure.

Maxillary Complete Denture Outcomes: A Systematic Review of Patient-Based Outcomes.

PURPOSE: The aim of this systematic review is to report on the current knowledge regarding patient satisfaction as a primary outcome for maxillary complete denture therapy. We asked, "For the maxillary edentulous patient treated using maxillary dentures, what are the patient-based outcomes regarding quality of life and treatment satisfaction." MATERIALS AND METHODS: An electronic search of publications up to March 2014 was established using four databases: PubMed, Web of Science, Scopus, and Embase. To meet the ultimate goal of establishing clinical guidelines based on available information, prospective comparative studies, cohort prospective studies, and retrospective studies on more than 10 subjects were included. The electronic search identified 4,530 articles that were evaluated at the title, abstract, and article level to include 31 articles of interest. The patient-based outcomes and satisfaction data included were examined and reported. RESULTS: The studies included 5,485 participants. Of these, 2,685 were identified as wearing maxillary complete dentures. Reported mean ages ranged from 59.7 to 73.6 years. A systematic review indicated that the provision of new maxillary complete dentures for edentulous patients results in improved self-reported satisfaction and oral health-related quality of life. The included reports, while providing evidence that complete denture satisfaction of participants and new dentures improve self-reported outcomes, did not include variables that influence these positive outcomes. CONCLUSION: A broad range of evidence supports the use of complete dentures for rehabilitation of the edentulous maxilla. When considering treatment of the edentulous maxilla, the expectations of patients for esthetic and phonetic (social) rehabilitation are high and can be met using maxillary complete dentures as the mode of prosthetic rehabilitation. Patients dissatisfied with new complete dentures may be referred for dental implant therapies involving fixed or removable prostheses.

Implant overdentures: dental students' performance in fabrication, denture quality, and patient satisfaction.

The purpose of this study was to evaluate dental students' performance when fabricating a mandibular two-implant overdenture (OD) as compared to conventional dentures (CD) and to determine if these prostheses were successful. Twenty students and twenty patients were divided into two groups: complete denture group (CDG) and maxillary denture and two-implant OD group (ODG). Students' progress was evaluated at each appointment as they were given a clinical assessment score (CAS), which varied from 1 (unacceptable, needs to repeat procedure) to 4 (acceptable, no errors). The success of the prosthesis was evaluated by the patients using a visual analog scale (VAS) and an expert (a prosthodontist) using a denture quality assessment (DQA) form. Performance for both groups was not statistically different across all eight appointments (CDG 3.16 versus ODG 3.25; p=0.46). Patients with ODs reported greater stability with their dentures (p=0.048) and greater ability to chew than patients with CDs (p=0.03). There were no differences between the groups in terms of expert appraisal (ODG 71.1 versus CDG 67.5; p=0.59). The performance of dental students when fabricating a two-implant OD is thus not different from that of a CD. Students can successfully fabricate a two-implant OD as perceived by both patients and prosthodontists.

Is there a certain number of implants needed to retain an overdenture?

The aim of this systematic review was to determine if there are reasons to recommend a certain number of implants for retaining or supporting maxillary or mandibular overdentures. Literature search for this review covered clinical trials, randomized controlled-clinical trials, meta-analyses and review articles in English dental journals from 1990 to 2007. The search produced 1779 articles, of which the abstracts of 182 studies were reviewed and those with any exclusion criterion were removed. The remaining 39 full articles were reviewed against the inclusion criteria for finalizing the selection. Eleven research reports meeting the inclusion criteria were selected for this review; three for the maxilla and eight for the mandible. According to this data, in the maxilla and in the mandible, patient satisfaction or function of the prosthesis are not dependent on the number of implants or type of attachment. In the mandible, an overdenture with two implants and with bar attachment has the least number of complications.

Immediate Occlusal Loading (IOL) of dental implants: predictable results through DIEM guidelines.

For years, dental implants have been loaded immediately upon implant placement with varying degrees of success. As clinicians' understanding of the biological and mechanical factors involved in immediate occlusal loading (IOL) has evolved, the success of these procedures has increased--particularly as a treatment option for the restoration of the edentulous mandible or the mandible that will be rendered edentulous during treatment. Due to increasing interest in this treatment alternative, the authors have provided a clear definition of the terminology associated with IOL and have demonstrated the DIEM Guidelines used to increase the success and predictability of such treatment. This presentation also introduces new implant components that simplify the clinical application of the immediate loading concept, enhancing its benefits and acceptance among dental patients and practices alike.

In vitro retention force changes of prefabricated attachments for overdentures.

Changes in the retention force of six prefabricated spherical and cylindrical attachments were examined in vitro under continuous loading. The testing machine permitted insertion-separation cycles to be tested under reproducible conditions while a calibrated measuring device determined the insertion and retention forces. At the beginning, during the so-called run-in period, all anchoring elements showed a very unstable behaviour characterized by a varying marked increase and subsequent decrease in the retention force. During the ensuing functional period, the retention force followed a more stable course. In this phase, the frictional attachments having lamellae for activation proved more stable than did the spring-loaded retention attachments. Furthermore, in two of five cylindrical anchors by Gerber, the spring broke. This provides support to the concept that prefabricated attachments should be constructed as robust elements composed of as few individual parts as possible. This would help to ensure that service and repairs remain at a minimum. Frictional attachments with lamellae for activation are to be preferred for use in matrices and patrices over attachments having spring-loaded retention.

Elementos retentivos en sobredentaduras: reporte de un caso clínico / Retentive elements in overdentures. Report of a clinical case

Los tratamientos de sobredentaduras están tomando cada vez más auge debido a que la población tiene una mayor educación respecto a su salud oral, además de que los odontólogos están mejor capacitados para realizar este tipo de tratamiento. En este artículo se pretende ilustrar las diferentes opciones de aditamentos que se tienen para aumentar la retención y estabilidad de la dentadura y se presentan las características de los aditamentos Preci-ball son fáciles de conseguir, sus procedimientos clínicos y de laboratorio son sencillos y rápidos, son maquinados en aleación oro o paladio y limpiados fácilmente

Consideraciones estéticas en el diseño de retenedores directos de prótesis parciales removibles / Esthetic considerations in the design of direct retainers for removable partial dentures

La P.R.P. retenida con ganchos constituye un problema estético que puede ser minimizado a través de un adecuado análisis y diseño del caso. La utilización del aditamento ofrece la ventaja de obtener excelentes restultados estéticos al eliminar el brazo retentivo vestibular de los ganchos; sin embargo, la utilización de éstos representa trabajo adicional para el odontólogo y mayor costo para el paciente; además, el uso de estos aditamentos es un tema controversial y confuso en la especialidad debido a la multitud de alternativas, como son aditamentos intracoronales, extracoronales, intrarradiculares, extrarradiculares, de precisión, de smiprecisión, rígido y elásticos. En esta revisión se presentan algunas consideraciones estéticas en el diseño de retenedores directos, así como la nomenclatura, clasificación e indicaciones de los diferentes tipos de aditamentos utilizados como retenedores de P.P.R. y los criterios para su selección

Sobredentaduras: Evaluación de los sistemas de retención, parte II / Overdentures: evaluation of the retention systems, part 2

Sin éxito a lo largo del tiempo, la prostodoncia trató de superar los inconveninentes presentados por los pacientes portadores de prótesis completa; frente a las exigencias de los edéntulos y en la búsqueda de mejorar esta situación incómoda y tediosa para el paciente y el profesional, aparecen las prótesis removibles y sobredentaduras sobre raíces e implantes solos o combinándose entre sí. Señalando sus ventajas y desventajas; razones diagnósticas para su aplicación, obteniendo una clasificación de acuerdo a su función. Se hace incapié en la planificación preprotética, clave para el éxito de nuestra prótesis; no improvisando, y compartiendo con el laboratorista, desde la concepción hasta la instalación, desde el análisis del terreno donde se trabaja, la búsqueda de retención y estabilidad, con la inclusión de la biomecánica de los materiales; harán en su conjunto el objetivo de nuestro trabajo. Realizando una selección de las conexiones retentivas existentes; describiendo los magnetos, broches, barras, analizando sus indicaciones y contraindicaciones; dadas las exigencias de todos los pasos clínicos, se estará en la observación del efecto sobre el periodonto, la neuro-musculatura, evitando la parafunción y de los elementos retentivos entre sí; recalcando la colaboración de nuestros pacientes con su higiene oral, para ver satisfechos los esfuerzos puestos en la clínica y en el laboratorio (AU)

Sobredentaduras: Evaluación de los sistemas de retención, parte II / Overdentures: evaluation of the retention systems, part 2

Sin éxito a lo largo del tiempo, la prostodoncia trató de superar los inconveninentes presentados por los pacientes portadores de prótesis completa; frente a las exigencias de los edéntulos y en la búsqueda de mejorar esta situación incómoda y tediosa para el paciente y el profesional, aparecen las prótesis removibles y sobredentaduras sobre raíces e implantes solos o combinándose entre sí. Señalando sus ventajas y desventajas; razones diagnósticas para su aplicación, obteniendo una clasificación de acuerdo a su función. Se hace incapié en la planificación preprotética, clave para el éxito de nuestra prótesis; no improvisando, y compartiendo con el laboratorista, desde la concepción hasta la instalación, desde el análisis del terreno donde se trabaja, la búsqueda de retención y estabilidad, con la inclusión de la biomecánica de los materiales; harán en su conjunto el objetivo de nuestro trabajo. Realizando una selección de las conexiones retentivas existentes; describiendo los magnetos, broches, barras, analizando sus indicaciones y contraindicaciones; dadas las exigencias de todos los pasos clínicos, se estará en la observación del efecto sobre el periodonto, la neuro-musculatura, evitando la parafunción y de los elementos retentivos entre sí; recalcando la colaboración de nuestros pacientes con su higiene oral, para ver satisfechos los esfuerzos puestos en la clínica y en el laboratorio

[Comparison of dental implant systems for mandibular overdentures]. / Implantaatsystemen voor overkappings-protheses in de onderkaak vergeleken.

OBJECTIVE: To compare three implant systems in patients with severely resorbed mandibles 1 year after insertion of the mandibular denture. DESIGN: A prospective multicenter randomized clinical trial. SETTING: Centers at University of Nijmegen and Groningen. METHODS: Three different implant systems were used: the transmandibular implant, the IMZ and the Brånemark system. Treatment was assigned to 88 patients according to a balanced allocation method. Evaluation included clinical and radiographic parameters. A Clinical Implant Performance scale (CIP) was constructed based on all conceivable complications of the different implant systems. RESULTS: During the healing period 1 IMZ- and 1 BRA-implant were lost. One TMI was removed after functional loading. The results of the clinical and radiographic parameters and the CIP-scale showed no significant differences between the three implant systems. CONCLUSION: Taking the one year evaluation into account the three systems used did not differ in clinical and radiographic performance.

[Long term results of overdentures supported by one-stage ITI-implants]. / Langetermijnresultaten van overkappingsprothesen op één-fase ITI-implantaten.

OBJECTIVE: To evaluate the long-term outcome of overdenture treatment in edentulous patients who received dental implants and an overdenture in the mandible. DESIGN: The patients, endentulous in upper and lower jaw, were treated with 218 one face ITI implants, inserted in the interforaminal part of the mandible and evaluated during the first 80 months after insertion of the implants. SETTING: The patients were asked to fill out a questionnaire concerning denture satisfaction and social comfort. The medical files were used for evaluating the aftercare. RESULTS: 7 implants were lost during the period of 80 months. A minimum of surgical and prosthetic aftercare was necessary to maintain the implants and overdentures. The patient satisfaction of the dentures was high, as well as the social comfort, and there was no significant difference between the results after 19 and 80 months. Complaints about the upper dentures were hardly present. CONCLUSION: Implants inserted in the interforaminal part of the mandible are successful. Oral and social comfort is high and less aftercare is necessary, when a strict recall protocol is taken into account.