Implant-supported Complete Dentures Research Articles

Impact of loading protocol of a mandibular single implant-supported complete denture on oral health-related quality of life over a period of 5 years: A randomized controlled trial

ObjectivesThe aim of the present study was to assess the long-term course of OHRQoL and the impact of the loading protocol in patients receiving a single mandibular implant supporting a complete denture over a period of five years. MethodsIn this multicenter RCT, a total of 158 edentulous patients were initially included and were randomly allocated immediately after placement of a mandibular midline implant to either immediate loading (IL) or to conventional loading (CL) with submerged healing. The assessment of OHRQoL was performed with the 49-item Oral Health Impact Profile (OHIP) at baseline and 1, 4, 12, 24, and 60 months after loading. At 5-year follow-up, 100 patients (mean age: 69.2 years; 45.0% female) with completed OHIP were available for analyses. A mixed-effects model with patients as random effect and an unstructured covariance matrix was developed to address repeated outcome measurement. ResultsThe OHRQoL improved substantially after loading, indicated by a decrease of mean OHIP summary scores from 51.0 points at baseline, by 14.2 (95%-CI: 9.4 – 19.1; p<0.001) points to 37.2 points at 1-month follow-up, and by continuous improvement to 20.4 OHIP points at final follow-up. Considering constant treatment effects, the loading protocol had no significant effect on OHIP scores (-3.7, 95%-CI: -9.4 – 2.2; p = 0.204). Time effect was statistically significant with -0.21 (95%-CI: -0.28 – -0.15; p<0.001) points per month. ConclusionBoth the immediate and conventional loading of a single mandibular midline implant supporting a complete denture offer long-lasting high levels of OHRQoL, with no significant or clinically relevant long-term differences. Clinical significanceThe study firstly presents long-term data for OHRQoL by investigating the loading protocol of single mandibular implant-supported complete dentures. Since immediate loading has been associated with a reduced implant survival rate for this concept, information on patient benefits is essential for evidence-based decision making.

Efficacy of adjunct photodynamic therapy on Candida growth and oral health quality of life in denture stomatitis patients with type 2 diabetes mellitus wearing implant-retained overdentures: A randomized clinical study

AimThe aim of the present clinical trial was to study the efficacy of combined miconazole and PDT in the improvement of quality of life and levels of Candida species in chronic hyperglycemic patients with denture stomatitis (DS). MethodsOne hundred patients were randomly divided into five groups; 20 each in the miconazole, PDT, miconazole+ PDT, CHX and distilled water groups. Methylene blue mediated irradiation was conducted using 600 nm diode laser with power, energy density and radiance as 100 mW, 3527 mW/cm2 and 9 J, respectively. Patients were advised to apply 2.5 ml of 2% topical miconazole four times a day. The existence of Candida spp. was detected by means of microbiological culture technique. Candida colony counts from the palates and dentures surfaces, quantified as colony forming unit (CFU)/mL were evaluated at baseline, end of 14 days, 28 days and 60 days. Oral health related quality of life was assessed with the help of a questionnaire. ResultsThe quality of life showed significant improvement in the group where combination treatment was executed. The overall CFU/mL values were greater in the dentures in comparison to those from the palates of the patients of all the five groups. During all time periods of the study, the CFU/mL values obtained from combination treatment group showed significant differences. Candida albicans was the most predominant yeast. ConclusionThis study showed the effectiveness of methylene blue- PDT in combination with miconazole in improving oral health related quality of life and significantly reducing Candida CFU counts to resolve palatal inflammation in diabetic individuals with implant-supported complete dentures.

Factors associated with edentulous patients' willingness about implant-supported complete denture: a multivariate analysis.

The aim of this study was to evaluate the factors influencing edentulous patients' willingness about mandibular implant-supported complete denture. A cross-sectional study was carried out with 117 bimaxillary edentulous patients wearing removable complete dentures (CDs). Patients were assessed concerning denture-related items (number of previous mandibular CDs, previous denture wearing period, dentures maker professional, and regular wearing of previous mandibular dentures) and individual-related aspects, such as mandibular edentulousness period, mandibular bone height, and willingness to the use of mandibular implant-supported complete denture. Masticatory performance was evaluated by the median particle diameter. Mandibular bone height and satisfaction were assessed using a validated method. The Chi-square test was used for data analysis and prevalence ratios were adjusted by using multivariate Poisson regression, both with 95% confidence interval. A total of 78 participants (66.7%) were interested in mandibular implant-supported overdenture (mean age 65.33 ± 9.49). Masticatory performance was not influenced by choosing mandibular implant-supported complete denture. The preference about mandibular implant-supported complete denture was correlated with longer mandibular complete denture experience (p = 0.021) and it was significantly associated with dissatisfaction about retention (p = 0.005). Previous experience with mandibular complete dentures and dissatisfaction about retention influence the willingness about mandibular implant-supported overdenture. Many factors are associated with rehabilitation preferences for edentulous patients and mandibular implant-supported complete denture is one of the available alternatives. Therefore, this study has demonstrated the factors influencing the decision to replace a mandibular conventional complete denture by dental implant treatment based on patient's outcomes. Such finding may be considered as a relevant aspect towards shared decision-making for prosthodontic rehabilitation of edentulous patients.

Clinical study of the biofilm of implant-supported complete dentures in healthy patients.

The purpose of this study was to quantify the area covered by biofilm and identify bacteria and yeasts present in mandibular acrylic resin full-arch implant-supported fixed prostheses. Biofilm control of implant-supported fixed prosthesis is hampered by their design, and it can cause oral and systemic problems, mainly in immunocompromised patients like the elder. Knowledge about microbiota reinforces the awareness about the need for periodic professional cleaning maintenance. Twenty prostheses were unscrewed, washed in 0.89% sodium chloride, stained with eosin 1% and photographed. The area covered by biofilm was digitally delimited and quantified. Biofilm samples were collected, diluted up to 1:107 , seeded in chromogenic agar media and incubated for 48hours, at 37°C, for counting of colony-forming units (CFU/mL). DNA hybridization was performed to complement the identification and quantification of microorganisms. Data were analyzed using Mann-Whitney test, Spearman correlation and Fisher's exact test (α=.05). An average of 62% of the gingival surface of the prostheses was covered by biofilm. Enterococcus spp. (5.82±1.38log10 CFU/mL) and Staphylococcus aureus (5.75±2.02log10 CFU/mL) showed higher prevalence in cultures. Patients with five implants had less biofilm compared to those with four implants (P=.031) but had higher Escherichia coli counts (P=.039). In DNA hybridization, Streptococcus pneumoniae, Veillonella parvula and Fusobacterium nucleatum presented higher quantification and were present in all the samples; patients over 65years old contained more Candida tropicalis (P=.049); prostheses on five implants presented lower quantification for several species. Biofilm was present on all prostheses, containing potentially pathogenic microorganisms. The number of implants may play a role in quantification of biofilm and in microorganism counts.

An Innovative Meta-Systematic Review into the Landscape of Literature and the Concluding Evidence on the Quality of Life of Patients Using Two Implant Supported Mandibular Complete Denture Prosthesis

Aim: The aim of this systematic review is to analyze the existing evidence on the quality of life of patients completely edentulous in the mandible. Materials and Methods: A search questionnaire was formulated using population intervention comparison outcome (PICO) analysis, and a comprehensive search was initiated in PubMed Central, Medline, Cochrane, and Google Scholar databases for the related topics. Manuscripts published till December 2019 were included in this review. Out of the 63 articles obtained from searching all databases, 27 studies were excluded based on the title and abstract. Out of the remaining 36 studies, 12 were excluded based on the inclusion and exclusion criteria of our interest and 24 were included on the basis of core data. Results: One review author identified randomized trials meeting inclusion criteria for this review. Two review authors extracted data and assessed study quality. The oral health-related quality of life in completely edentulous mandibular patients wearing implant-supported overdentures was better when compared to conventional tissue-supported complete denture, and a minimum two implant-supported mandibular complete denture has sufficient improvement in oral health-related quality of life. Conclusion: There are about more than 170 reviews and clinical trials that have been published in support of the same for the past two decades. Thus, the clinicians may not be tempted in placing additional implants in well-formed mandibular edentulous ridges. To enhance the understanding of mandibular implant overdenture treatment, clinicians must scrutinize the existing evidence and formulate a protocol by striking a balance between efficient and evidence based treatment.

An open-source multifunctional registration device for implant-supported complete dentures

A 3D printed registration device is described for implant-supported complete dentures that simultaneously register implant position, soft-tissue contour, anterior tooth position, occlusal vertical dimension, and centric relation. This information is captured clinically in 10 to 20 minutes and can then be transferred to the dental laboratory technician to continue the prosthetic workflow. The standard tessellation language (STL) file for the registration device is available for free download and use.

Early Effect of Implant-Supported Rehabilitation and Nocturnal Bruxism on Maximum Occlusal Force: A Cross-Sectional Study.

This clinical study evaluated the early effect of oral rehabilitation with dental implants and nocturnal bruxism on maximum occlusal force (MOF), before sensorimotor adaptation. A consecutive sample consisted of 127 patients divided into three groups according to their dental state: G1- implant-supported fixed complete denture (IFCD) opposing to a small fixed prosthesis or natural dentition; G2- IFCD opposing to a complete denture; and G3- small fixed prosthesis or natural dentition in both arches. Clinical data were collected after prosthesis installation: systemic and oral health conditions, MOF, self-reported bruxism, and bruxism severity (low, moderate, severe). Data were analysed by ANOVA and Tukey-Krammer tests. Dental state and the interaction sex-bruxism had significant effect on MOF. G1 had higher MOF than G3, but G2 was not significantly different from G1 and G3. Men with bruxism had the highest MOF. The levels of bruxism severity did not have a significant effect on MOF. The results suggest that MOF varies as a function of dental state and the interaction sex-bruxism. However, presence and severity of bruxism alone does not affect MOF.

Impact of immediately loaded implant-supported maxillary full-arch dental prostheses: a systematic review.

The immediate loading of implant-assisted fixed prostheses in edentulous maxillae may achieve favorable success rates with reduced treatment time. An evidence summary of clinical trials is key to recommend loading protocols in these cases. To compare immediately loaded, fully implant-supported complete dentures to early and conventional/delayed loading in the edentulous maxillae of adult patients by a systematic review of controlled clinical trials (CCT). CCTs reports were identified up to January 17, 2019 from Cochrane Oral Health Group's Trial register, Cochrane Central Register of controlled trials (CENTRAL), MEDLINE (Ovid), BIOSIS, EMBASE, CINAHL, Web of Science, and DARE. Two independent reviewers screened titles/abstracts and confirmed inclusion using full texts. Data were extracted and quality assessed (Cochrane Risk of Bias tool) independently and in duplicate. Study heterogeneity prevented pooling by meta-analysis. Out of 1,052 candidate studies, four CCTs were included. Two trials had patient satisfaction as an outcome: (1) A randomized trial compared immediately and early loaded fixed dentures and found more satisfaction with the first after 12 months; (2) A non-randomized study found better satisfaction with immediate fixed dentures compared to conventional loading after 3 months (no more at 12 months). Regarding implant success and prosthetic complications, three trials did not report significant differences comparing immediate loading to other protocols. This review found weak evidence of differences between immediate load and other loading regimens, regarding patient satisfaction and maintenance events/adversities. The potential of immediate loading for favorable results in edentulous maxillae reinforces the need for well-designed RCTs, for solid clinical guidelines. Registration number CRD42018071316 (PROSPERO database).

Effects of attachment type and palatal coverage on oral perception and patient satisfaction in maxillary implant-supported complete denture patients.

The effect of oral rehabilitation on the oral perception of implant-supported overdenture patients is a concern. This study evaluated the effects of the attachment type and palatal coverage on oral perception and patient satisfaction in maxillary implant-supported complete denture patients. The correlation between oral perceptual ability (OPA) and patient satisfaction in three groups was investigated. Group I consisted of dentate individuals (n = 40), Group II consisted of maxillary implant-supported complete denture patients with bar attachments and palatal coverage (n = 12), and Group III of maxillary implant-supported complete denture patients with magnetic attachments and palatal coverage (n = 14). In addition, implant-supported maxillary overdentures with bar attachments, with (Group II; n = 12) and without (Group IV; n = 18) palatal coverage, were examined in terms of patient satisfaction and OPA. The relationship between OPA and patient satisfaction was assessed with the Turkish version of the Oral Health Impact Profile-14 (OHIP-TR-14) satisfaction survey. To compare oral sensory function among the groups, tactile awareness and pressure awareness were assessed. There was no significant difference in OHIP-TR-14 scores between Groups II and III. In addition, there was no correlation between oral tactile function and patient satisfaction in Groups II and III. For patients with maxillary bar-retained implant-supported overdentures, palatal coverage did not affect the correlation between OPA and patient satisfaction, lateral pressure threshold, or tactile thickness threshold. According to the results of the study, whether maxillary implant-supported overdentures were made with a bar- or magnetic-type retainer, and whether bar-retained implant-supported overdentures had an open or closed palate did not affect the correlation between patient satisfaction and oral perception.

Fixed Conometric Retention with CAD/CAM Conic Coupling Abutments and Prefabricated Syncone Caps: A Case Series

The conometric retention system was proposed and described as a predictable alternative to retain fixed implant-supported complete dentures and, more recently, to retain fixed partial restorations. Currently available studies describe a technique based on the Ankylos (Dentsply) implant system and stock conic coupling abutments. The purpose of this case series study is therefore to demonstrate the possibility of using Atlantis computer-aided design/computer-assisted manufacture technology to produce Conus abutments (Dentsply) and using the fixed conometric retention with other implant brands for which appropriate stock conic coupling abutments are not available.

Impact of Prosthetic Rehabilitation on Quality of Life in Patients with Significant Dental and Orofacial Tissue Loss: A Mixed-Methods Study.

To assess the impact of prosthetic rehabilitation on quality of life (QoL) in patients with cleft lip and palate (CLP) and in edentulous patients with implant-supported complete dentures (ICD). CLP (n = 20) and ICD (n = 26) patients completed the Oral Health Impact Profile (OHIP-14). Nine patients with an OHIP-14 score above the 75th percentile were interviewed. Data were interpreted using inductive content analysis and triangulation. ICD patients scored higher than CLP patients in overall OHIP-14 score and in most domains (P < .05). After rehabilitation, CLP patients reported improvement in psychosocial functions but worsening in physical functions. ICD patients had improvement in all domains, but were less satisfied. The mixed-methods study design can detect the origins and interactions of factors in treated patients with complex problems.

Evaluation of Oral Stereognosis in Relation to Tactile Ability and Patient Satisfaction.

We investigated the oral stereognostic ability (OSA) of dentate individuals, conventional complete denture patients, and maxillary implant-supported denture patients with bar attachments. Stereognosis tests were carried out, and the relationship between OSA and patient satisfaction was assessed with a satisfaction survey: the Turkish version of the oral health impact profile-14 (OHIP-TR-14). To compare differences in oral sensory function among individuals with natural dentition, complete denture wearers, and maxillary implant-supported denture wearers, tactile awareness (thickness perception threshold) and pressure awareness (threshold of lateral loading) were assessed. According to the results, the oral perception level of natural dentate patients was higher than that of the complete denture group and maxillary implant-supported complete denture group at the end of the study. There was no statistically significant difference in OHIP-TR-14 scores between the maxillary implant-supported complete denture group and the complete denture group ( P < .05). The control group perceived the applied lateral and vertical forces statistically earlier than the other groups ( P < .001). There was no statistically significant difference between the complete denture and maxillary implant-supported denture groups in terms of the lateral pressure threshold or thickness tactile threshold ( P > .05). At the end of the study it was concluded that there was no correlation between oral perception levels and satisfaction in patients with complete dentures and patients with maxillary implant-supported complete dentures. The control group, compared with the complete denture and maxillary implant-supported complete denture groups, perceived the lateral and vertical forces statistically earlier than the other groups.

Impact of implant-supported prostheses on nutritional status and oral health perception in edentulous patients

Improvement of nutritional status and perception of oral health are supposed to be different with complete conventional denture or implant-supported fixed or removable prostheses. Since no study has been conducted in Lebanon, the aim of our study was to assess the nutritional status and oral heath related quality of life (OHRQoL) in totally edentulous patients after treatment with complete denture or implant supported-prostheses. This was an observational clinical prospective study. A convenient sample of Lebanese people aged 60 years or more was selected between September 2013 and July 2015 from the Departments of removable and fixed prosthesis at Saint-Joseph University of Beirut. The treatment options included complete denture, implant-supported complete denture and implant-supported fixed prostheses. Nutritional status and OHRQoL were assessed with the Mini-Nutritional Assessment Index (MNA) and the Geriatric Oral Health Assessment Index (GOHAI) respectively at Baseline (first visit before treatment), 2-3 weeks after treatment (t1), 3 months (t2) and 6 months (t3) after treatment. Fifty-one participants (mean age: 69.39±7.164 years) were included. The results have shown an improvement over time in nutritional status and OHRQoL for all treatment groups. However, 2-3 weeks after treatment the number of participants at risk of malnutrition was higher with complete removable denture, intermediate with implant-supported complete denture and lower with implant-supported fixed prostheses (p-value=0.049). Moreover, the mean GOHAI score was significantly lower over time with complete removable denture compared to implant-supported prostheses (p-value <0.05). Our study has shown an enhancement in the quality of life and the nutritional status for implant supported-prostheses compared to conventional removable dentures. Therefore, it is fundamental that dentists communicate with their patients about implant treatment to understand their expectations, to explain the outcomes and achieve the desired clinical result.

Neutral zone concept applied in implant-supported mandibular complete denture treatment of a retrognathic patient

This case report demonstrates the neutral zone technique for oral rehabilitation of patient with severe retrognathism, who had a previous implant-supported complete denture with improper relationship between artificial teeth and oral structures. A new mandibular screw-retained implant-supported complete denture was made base-on neutral zone principles to give to the patient a comfortable and functional prosthesis. The nonfunctional position of artificial teeth in complete denture may impair in oral functions such as speaking, swallowing, smiling, as well as loss of denture retention and stability, discomfort, and injuries to oral soft tissues. Neutral zone concept aids to produce complete denture more suitable, once it harmonizes the prosthesis to anatomic structures. In implant-supported complete dentures, retention and stability problems are not a concern. However, in some situations, nonfunctional artificial teeth position causes oral lesions, discomfort, and phonetics problems. Although neutral zone is a technique developed for conventional complete denture, it can be useful in implantology.

Model of oral rehabilitation with immediate or delayed implant-supported complete dentures: Radiographic evaluation

Objective: The study aims were to compare the radiographic bone loss of implant-supported complete dentures submitted to immediate or delayed loading and to correlate this loss with different features of the patients involved. Material and Methods: Sixty protocol model implants, in 49 patients, were selected. Thirty-two protocol model implants were submitted to immediate loading, i.e., within 48 h. The remainder were submitted to delayed loading, three to six months later. Questionnaires that collected data on gender, age, location and number of implants, maintenance time and socioeconomic status were analysed. The measurements were obtained from digital panoramic radiographs (ANOVA, MANOVA; Student’s t test, p &lt; 0.05). Results: The radiographic bone loss in the models that underwent immediate and delayed loading was 2.4 mm and 2.5 mm (p &gt; 0.05), respectively; regarding gender and the location and number of implants, the results did not differ (p &gt; 0.05). The average ages of the immediate (62.8 ± 10.1 years old) and the delayed (54.5 ± 5.46 years old) protocol groups were significantly different (p &lt; 0.05). In tests examining multivariate associations with the dependent variable of bone loss &gt;4 mm, there was association with a greater number of sites in the maxilla, older age and female gender. The odds ratio indicated that a loss of more than 4 mm was 17 times more likely in the maxilla. Conclusion: 1 - Well-maintained implant-supported complete denture sunder went little bone loss; 2 - there were no differences in radiographic outcomes between different techniques of rehabilitation; and 3 - there was greater bone loss in the maxilla, compared to the mandible; 4 - there were no correlations between bone loss and social class, age or gender of the patients.Key Words: Bone Loss, Dental, Dental Implants, Radiography.

Multifunctional Guide for Implant Placement, Impressions, and an Occlusal Index for Fixed Complete Dentures.

This article proposes an approach to simplify the steps and reduce fabrication time for fixed implant-supported complete dentures. A multifunctional guide can function as a surgical template during implant placement and provides a framework for the definitive impression and occlusal registration. It therefore enables immediate or early loading of dental implants in full-arch rehabilitations.

Reestablishment of the condyle-fossa and maxillomandibular relationships using a flat occlusal plane splint and implant-supported denture: case report with a 2-year follow-up

When the shape, structure, and/or function of one of the parts of the components of the stomatognathic system change, structural and physiological changes also occur to absorb or compensate the consequent loads. Hence, an insightful rehabilitation of this type of patient involves essential procedures, such as: correct orientation of the occlusal plane, determination of the vertical dimension of occlusion, and a stable and healthy maxillomandibular relationship, since the nonobservance of these aspects may result in prosthodontic rehabilitation failure. The objective of the present case study is to report the preoperative planning and prosthodontic rehabilitation of an edentulous patient with severe maxillary atrophy and signs and symptoms of temporomandibular disorders. The patient underwent flat occlusal plane splint therapy to reestablish the condyle-fossa and maxillomandibular relationships and muscle activity, followed by prosthodontic rehabilitation with implant-supported complete dentures. The maxillomandibular relationship was determined by the intraoral tracing technique, with a 24-month follow-up.

A Technique to Obtain and Transfer Jaw Relation Records from Conventional Complete Denture to Implant-Supported Complete Denture

Priortothefabricationofimplant-supportedfixedcompletedentures,�theexistingor� transitional removable complete dentures can be used to establish the optimal jaw relation. This article introduces a simple technique to accurately transfer the established jaw relation from removablecompletedenturetofinalfixedprosthesis.

Finite element analysis of provisional structures of implant-supported complete prostheses.

The use of provisional resin implant-supported complete dentures is a fast and safe procedure to restore mastication and esthetics of patients soon after surgery and during the adaptation phase to the new denture. This study assessed stress distribution of provisional implant-supported fixed dentures and the all-on-4 concept using self-curing acrylic resin (Tempron) and bis-acrylic resin (Luxatemp) to simulate functional loads through the three-dimensional finite element method. Solidworks software was used to build three-dimensional models using acrylic resin (Tempron, model A) and bis-acrylic resin (Luxatemp, model B) for denture captions. Two loading patterns were applied on each model: (1) right unilateral axial loading of 150 N on the occlusal surfaces of posterior teeth and (2) oblique loading vector of 150 N at 45°. The results showed that higher stress was found on the bone crest below oblique load application with a maximum value of 187.57 MPa on model A and 167.45 MPa on model B. It was concluded that model B improved stress distribution on the denture compared with model A.

Assessing the degree of experience and satisfaction of patients treated with implant-supported complete dentures

Assessing the degree of experience and satisfaction of patients treated with implant-supported complete dentures