Angled ball and locator attachments for immediate loaded inclined implants used to retain maxillary overdentures: A cross over study of patient satisfaction and oral health related quality of life.

Abstract

The aim of this was to compare the influence of two different angulated abutment designs on patient satisfaction, oral health-related quality of life, and prosthetic aspects of implant-supported maxillary overdentures. For this cross-over study, 18 patients with completely edentulous maxillary ridges opposing implant-retained mandibular overdentures received 4 implants between the maxillary sinuses using computer-guided surgery. The anterior implants were installed at canine/lateral incisor areas and inclined 15° labially. The posterior implants were inserted just anterior to the maxillary sinuses and inclined 15o distally. Eight patients received maxillary overdentures retained by angled ball attachment (ball overdenture [BOD]) and angled locator attachment in random order. After 6months, patients indicated satisfaction with their prosthesis using a visual analog scale (VAS), and oral health impact profile (OHIP-14). Moreover, postinsertion prosthodontic maintenance and complications were recorded for both attachments. Comparisons of patient satisfaction and prosthetic complications between groups were performed using the Wilcoxon matched-pairs test and the McNemar test, respectively. Locator overdenture (LOD) recorded significantly higher scores than the BOD group regarding all the VAS questions except for ease of cleaning (p < 0.007). LOD recorded significantly higher patient satisfaction regarding the pronunciation of sounds (p=0.009), painful aching (p=0.018), feeling tense (p=0.011), unsatisfactory diet (p=0.013), irritability with people (p=0.005), and life in general (p=0.004). The most common complications were matrix activation/renewal (n=34). BOD showed a significantly higher incidence of attachment loosening (p=0.002), and teeth fracture (p=0.049) than LOD. LOD showed a significantly higher incidence of attachment wear and replacement than BOD (p <0.001). There was no difference between groups regarding soft tissue complications. Within the limitations of this study, and in terms of improved patient-centered outcomes, angled locator attachments are recommended to retain maxillary implant overdentures opposed by implant retained mandibular overdentures at it was associated with increased patient satisfaction and oral health-related quality of life than angled ball attachments. However, locator attachment was associated with more postinsertion prosthodontic maintenance than ball attachment.