Should edentulous patients be constrained to removable complete dentures? The use of dental implants to improve the quality of life for edentulous patients

doi:10.1111/j.1741‐2358.2009.00294.x
Should edentulous patients be constrained to removable complete dentures? The use of dental implants to improve the quality of life for edentulous patients Background: Nowadays, there is some speculation among dental educators that the need for complete dentures will significantly decrease in the future and that training in their provision should be removed from the dental curriculum. Objective: To sensitise the reader to the functional shortcomings of complete denture therapy in the edentulous patient and present restorative options including implants to improve edentulous quality of life in these patients. Methods: Information retrieval followed a systematic approach using PubMed. English articles published from 1964 to 2008, in which the masticatory performance of patients with implant‐supported dentures was assessed by objective methods and compared with performance with conventional dentures, were included. Results: National epidemiological survey data suggested that the adult population in need of one or two complete dentures will increase from 35.4 million adults in 2000 to 37.9 million adults in 2020. Clinical studies have showed that the ratings of general satisfaction were significantly better in the patients treated with implant overdentures post‐delivery compared with the complete denture users. In addition, the implant group gave significantly higher ratings on comfort, stability and ability to chew. Furthermore, patients who received mandibular implant overdentures had significantly fewer oral health‐related quality of life problems than did the conventional group. Conclusion: Implant‐supported dentures including either complete overdentures or a hybrid prosthesis significantly improve the quality of life for edentulous patients compared with conventional removable complete dentures. Therefore, the contemporary dental practitioner should consider other options as well as conventional removable complete dentures to restore edentulous patients.     

Implant supported dentures: an estimation of chewing efficiency

doi: 10.1111/j.1741‐2358.2009.00303.x
Implant supported dentures: an estimation of chewing efficiency Background: Treatment of edentulous patients is one of the most demanding tasks the dentist can meet in his everyday practice. Implant based methods help to improve functioning of dentures and life quality of so treated patients. Objectives: The aim of the study was to evaluate the chewing efficiency of patients treated with lower complete implant‐supported overdentures and the simultaneous evaluation of treatment results by patients. Materials and methods: For the investigation were chosen edentulous patients, treated with upper conventional complete dentures and lower complete overdentures supported on two implants. In this group of patients, were conducted investigations of chewing efficiency changes, based on the Optocal test and overdentures functioning evaluation made by patients in the survey. Results: The objective evaluation of the chewing efficiency indicated the decrease of this value in the five years of observations. Lower complete overdentures supported on implants significantly increased the comfort of chewing of edentulous patients. Conclusions: The results of the study let us to assess positively the result of the therapy using titanium implants and lower complete overdentures. The therapy described significantly increases the life comfort of the edentulous patients. Decreasing chewing efficiency indicated by the research result should be compensated with the dentures maintaining or the prostheses exchange after about five years of use.     

The influence of age and denture wear on the size of edentulous structures

Objectives : This study was designed to evaluate the influence of age and denture use on the size of arches and residual ridges in edentulous patients. Design : At two nursing homes, maxillary and mandibular stone casts of 302 fully edentulous patients were utilized to measure the size of the arches and residual ridges, according to age and use of complete dentures. Age cohorts were divided into three groups; 60–69, 70–79, and 80–89 years old. Two hundred and forty‐nine denture wearers used complete dentures for at least 2 years before examinations. Fifty‐three non‐denture users had never worn removable prostheses. Chi‐square analysis (p<0.05) was used to establish the possible relations between the linear values and the size indexes of the ridges and arches and the two examined parameters: age and denture wear. Results : Young old patients possessed edentulous structures that were not significantly larger than elderly old patients in both the maxilla and the mandible. Non‐denture users had significantly bigger arches and ridges in both edentulous jaws than denture users. Conclusions : Young old, non‐denture users tended to have bigger residual edentulous tissues compared to elderly old patients who used complete dentures.     

The effect of different attachment systems with implant‐retained overdentures on maximum bite force and EMG

doi: 10.1111/j.1741‐2358.2010.00389.x The effect of different attachment systems with implant‐retained overdentures on maximum bite force and EMG Objective: To compare the effect of different attachment systems with implant‐retained overdentures on maximum bite force and muscle activity using electromyography (EMG). Background: Denture retention and stability is of considerable interest in prosthetic dentistry. Materials and methods: Thirty‐five patients were examined: 15 edentulous patients treated with mandibular implant‐retained overdentures (MIRO) and maxillary dentures (MCD) (two implant‐ball attachment) (BC); 10 edentulous patients treated with MIRO and MCD (four implants‐bar attachments) (BRC); 10 patients with edentulous mandibular treated with MIRO and maxillary fixed partial dentures (MFPD) (two implant‐ball attachments) (BF). Before implant placement all patients received new dentures. After using these dentures for 3 months the maximum bite force and electrical activity of masseter muscle were measured. Two or four implants were then inserted into the intraforaminal region. After osseointegration periods, patients were treated with MIRO which duplicated their dentures and after three months the measurements were repeated. The data were collected and statistically analysed. Results: Muscle activity and chewing ability increased in the second period of measurements. Also chewing time was significantly decreased at the first measurements. The highest muscle activity was observed in the group of patients treated with group BF. Conclusion: The EMG values of the masseter muscle significantly increased when an implant attachments was used in the overdenture.     

Elders with implant overdentures: a 22-year clinical report

doi: 10.1111/j.1741‐2358.2012.00628.x Elders with implant overdentures: a 22‐year clinical report Objective: To report on the long‐term survival and prosthodontic maintenance of two edentulous adults with mandibular overdentures supported by hydroxyapatite (HA)‐coated implants. Background: Mandibular implant overdentures are a successful treatment option with positive impact on the quality of life of elderly edentulous adults. Long‐term survival of the implants requires continued rigorous prosthodontic maintenance. Clinical report: Two elderly edentulous adults with mandibular overdentures supported by 2 HA‐coated implants were presented for prosthodontic rehabilitation after 22 years of placement. The implants were osseo‐integrated and surviving at presentation based on accepted criteria. The mandibular implant overdentures suffered recurrent loss of retention and stability. Prosthodontic treatment involving the replacement of defective attachment systems and construction of new sets of mandibular implant overdentures opposing complete maxillary dentures is presented. Conclusion: The long‐term survival of mandibular 2‐implant overdentures requires continued prosthodontic maintenance. A conservative approach in the rehabilitation of two older edentulous adults with mandibular 2‐implant overdentures was described including proper selection of attachment systems.     

下颌LOCATOR种植覆盖义齿咀嚼效率的比较

目的：种植支持的覆盖义齿是针对下颌骨后牙区没有足够骨量的病人的一种适当的治疗方案。LOCATOR是近年来一种新型改良的种植体附着系统。本研究在病人佩戴LOCATOR附着系统支持的下颌种植覆盖义齿后,通过比较不同种植体数量对咀嚼效率的影响,以期用最小的成本达到较好的临床效果。方法：19名下颌无牙颌患者中,10名植入2枚种植体,9名植入3枚种植体。三月后行LOCATOR附着系统支持的种植覆盖义齿修复,并计算咀嚼效率增加量。结果：通过SPSS20．0软件进行统计分析,采用95％可信区间,α=0．05,对两组覆盖义齿咀嚼效率的增加量进行t检验：P〉0．05,两组之间咀嚼效率的增加量无显著性差异。针对下颌LOCATOR种植覆盖义齿,植入两枚种植体和三枚种植体提升的咀嚼效率并无统计学差异。结论：针对LOCATOR系统支持的下颌种植覆盖义齿,两枚种植体既能有效地提高咀嚼效率。     

Resonance frequency analysis of overdenture retainer implants with immediate loading

doi: 10.1111/j.1741‐2358.2011.00488.x
Resonance frequency analysis of overdenture retainer implants with immediate loading Objective: To evaluate 16 patients of both sexes with lower overdenture and upper complete dentures, by analysing the resonance frequency of the initial and late stability of implants used to retain the overdenture under immediate loading. Background: Oral rehabilitation treatment with complete dentures using implants has been increasingly more common among the specialists in the oral rehabilitation area. This is an alternative for obtaining retention and stability in treatments involving conventional complete dentures, where two implants are enough to retain the overdenture satisfactorily. Materials and methods: The Osstell? Mentor device was used for the analysis in the initial period (primary stability), 3 and 15 months after the installation of the lower overdenture (secondary stability). The statistical analysis was performed with the repeated measures model (p < 0.01). Results: The implant stability quotients were observed to increase after 15 months of the rehabilitating treatment. Conclusion: The use of overdentures over two lower implants should become the treatment of choice for individuals who have a fully edentulous mandible.     

Radiographic changes in alveolar bone height on overdenture abutments: a longitudinal study

Objective: Stabilisation of partial dentures is an important part of prosthodontic treatment, particularly in patients with an excessive reduction in alveolar bone supporting their abutment teeth. In these cases, overdenture prostheses are one possible treatment choice. Background: The aim of this study was to evaluate the effects of overdentures on the condition of alveolar bone of the remaining teeth, and to evaluate the overdenture concept in the prosthetic treatment of partially edentulous patients. Materials and methods: The investigation was conducted on 22 patients during observation periods of 6 and 10 years. After preparation, all abutment teeth were provided with either amalgam restorations or gold copings. An overdenture in the lower jaw was fabricated for every patient. A special film holder was used to repeat the X‐ray procedure in every patient in the same manner. The radiographs were evaluated using the grid scale. The alveolar bone level of all remaining teeth was evaluated on dental films by measuring the distance between the root apex and coronal border of the alveolar bone. Results: A statistically significant difference (p < 0.01) was calculated 6 years after delivery stage between distal alveolar bone levels of experimental abutments under overdentures and the remaining teeth of the control group. Alveolar bone of abutment teeth was considerably preserved, particularly in seven patients observed 10 years after provision of their dentures. Conclusion: Within the limitation of this study, the validity of the overdenture treatment in partially edentulous patients is concluded. Good oral hygiene was crucial for the success of treatment with overdentures.     

下颌种植覆盖义齿的生物力学研究进展

口腔生物力学是用生物力学的概念和方法,研究口腔医学中的有关基础性科学问题、解决口腔医学中的临床实际问题、发展口腔临床技术的一门学科。在口腔正畸学、修复学、种植学及口腔颌面外科学等领域存在着大量的生物力学问题,生物力学已成为口腔医学的基础科学之一。传统全口义齿修复常常会出现固位稳定差、咀嚼效率低、患者有疼痛感、适应时间长等情况,很大程度上不能满足患者的修复要求。种植覆盖义齿对于下颌牙槽嵴严重吸收的患者,效果尤为明显。种植覆盖义齿是义齿与种植体之间以不同的附着体作为连接,形成患者可以自行摘戴的种植体支持的覆盖义齿修复。下颌种植覆盖义齿因其能有效地提高下半口义齿的固位性和稳定性、显著提高了患者的咀嚼效率,目前已成为修复下颌牙槽骨严重吸收的无牙颌患者的有效修复方法。本文针对下颌种植覆盖义齿的生物力学研究进展作一综述。     

Implant overdentures for edentulous elders: study of patient preference

Background: Studies show that elders wearing implant overdentures have improved nutrition and quality of life. However, upfront costs of this therapy are high, and the income of elderly edentulous populations is low. Objectives: This study was designed (i) to measure the preferences of edentulous patients for mandibular two‐implant overdentures using Willingness‐To‐Pay (WTP) and Willingness‐To‐Accept (WTA), (ii) to assess the effect of long‐term financing on WTP and (iii) to assess the desired role of health care plans in financing dental prostheses. Methods: Edentulous elders (68–79 years; n = 36) wearing maxillary dentures and either a mandibular conventional denture (CD, n = 13) or a two‐implant overdenture with ball attachments (IOD, n = 23) participated in this study. All had received their prostheses 2 years previously, as part of a randomised clinical trial. A three‐part questionnaire was completed during a 20‐min interview with a trained researcher. Results: Forty‐six per cent (6/13) of the CD wearers and 70% (16/23) of the IOD wearers were willing to pay three times more than the current cost of conventional dentures for implant prostheses. These percentages were increased to 77% (CD) and 96% (IOD) if participants could pay for implant overdentures in monthly instalments. Eighty‐six per cent (31/36) of all participants in both groups (21/23 IOD; 10/13 CD) thought that the government should cover at least some of the cost of implant overdentures. Conclusions: This study shows that, the majority of elderly edentate individuals who have not experienced mandibular two‐implant overdenture therapy are willing to pay the cost, particularly when payment can be made in monthly instalments.     

Electromyographic evaluation of masseter and anterior temporalis muscles in rest position of edentulous patients with temporomandibular disorders, before and after using complete dentures with sliding plates

Objectives: This study was performed with the purpose of investigating electromyographic (EMG) activity of the anterior temporalis and masseter muscles in edentulous individuals with temporomandibular disorder (TMD), before and after using sliding plates on complete dentures in the mandibular rest position. Background: Edentulous patients may present TMD, which is characterised by pain in temporomandibular joints, masticatory and neck muscles, uncoordinated and limited mandible movements, joint sounds and an altered occlusal relationship. It is imperative to offer treatment in order to re‐establish stomatognathic system structures before submitting the individual to any definitive restorative treatment. Materials and methods: The patients were edentulous for at least 10 years. EMG recordings were made before the insertion of the dentures (0 months) and also after using the sliding plates at the fourth month, 9th month and 12th month, using computerised electromyography K6‐I/ EMG Light Channel Surface. EMG evaluations of the muscles were performed under the following clinical conditions: rest position with dentures (R1), rest position without dentures (R2), rest position with dentures post‐activity (chewing) (R3), rest position without dentures post‐activity (chewing) (R4). Results: All patients obtained remission of muscular fatigue and reduced pain in stomatognathic system structures. Temporalis muscle showed significant increase in EMG activity compared with initial values (p < 0.01). Masseter muscles showed significantly lower mean values (p < 0.01) compared with initial values. Conclusion: The sliding plates allowed the process of neuromuscular deprogramming, contributing to muscular balance of the masticatory system, and are therefore indicated to be used before the fabrication of definitive complete dentures in patients with TMD.     

Complete denture wearing and fractures among edentulous patients treated in university clinics

doi: 10.1111/j.1741‐2358.2011.00551.x
Complete denture wearing and fractures among edentulous patients treated in university clinics Objective: The prevalence of wearing and fracture of complete dentures was evaluated among edentulous patients treated in two dental schools in Brazil. Background: Acceptance and wearing of complete dentures are related to adaptive behaviour of edentulous patients. However, one reason that could interfere with the wearing dentures is their potential to fracture, which is still a common complication in denture rehabilitation practice. Material and methods: Two hundred and twenty‐four edentulous patients rehabilitated with complete dentures from 2000 to 2005 in Araçatuba and Araraquara Dental School, University of State of São Paulo, were assessed in 2006 and 2007 to answer a questionnaire about wearing and fracture of their dentures. Statistical analysis were performed using Epi Info software and chi‐squared test to compare maxillary and mandibular data (α = 0.05). Results: Almost 26% of the patients did not wear their dentures, and among the remainder, the majority wore the maxillary denture. About 30% of the dentures were fractured, with higher prevalence in the maxillary arch (p = 0.003). Conclusions: Discontinuation of wearing dentures was quite high, especially considering the treatment which was carried out in university clinics. Prevalence of fractures was also high, greater for the maxillary denture, and was one of the main reasons for non‐wearing of complete dentures.     

A comparison of patient satisfaction between treatment with conventional complete dentures and overdentures in the elderly: a literature review

doi:10.1111/j.1741‐2358.2009.00299.x
A comparison of patient satisfaction between treatment with conventional complete dentures and overdentures in the elderly: a literature review Background: It has been stated that mandibular overdentures are more satisfactory than conventional dentures, but problems relating to the use of retrospective ratings, lack of control group and sequential provision of treatment may compromise the findings. Objective: To establish a comparison between treatment with conventional complete dentures and implant‐retained overdentures in elderly patients by conducting a literature review. Materials and methods: A search of English language peer‐review literature was completed using Medline up to 2008 focusing on evidence‐based research. Randomised clinical trials (RCTs) and longitudinal prospective studies were favoured in the review, using a general hierarchical classification. Articles that did not focus exclusively on the comparison of patient satisfaction between complete dentures and overdentures were excluded from further evaluation. The last search was conducted in February 2008. Key terms included quality of life, patient satisfaction, edentulism, complete denture and overdenture. Results: Among the 90 articles found in the initial search, 27 met the inclusion criteria. This included 18 RCTs and eight prospective and one cohort study. Most of the articles stated superiority of the mandibular implant‐retained overdenture therapy over the conventional complete denture regarding patient satisfaction and quality of life. Conclusion: Even with implant treatment presenting higher patient satisfaction and improvement of quality of life, it was not possible to establish a direct comparison between the studies due to differences in adopted methodologies.     

A study to compare the oral health impact profile and satisfaction before and after having replacement complete dentures constructed by either the copy or the conventional technique

Aims: To assess the oral health impact profile (OHIP) on edentulous subjects who needed to have their dentures replaced either by a copy technique or a conventional technique, and to determine whether any change in the subjects’ assessment of their original and replacement dentures impacted on oral health related quality of life parameters. Background: The OHIP is an instrument used to measure subjects’ perceptions of the social impact of oral disorders on their well being. Changes in the OHIP may occur when subjects need to have their complete dentures replaced. Furthermore, it is possible that the method by which the dentures are constructed may impact on this. Methods: A total of 65 edentulous subjects were studied. Thirty‐three subjects had their dentures constructed by a copy technique and 32 by a conventional technique. Subjects completed the OHIP‐14 questionnaires before and after being provided with a set of replacement complete dentures. They also assessed specific features of the upper and lower dentures. Responses were recorded on a Likert scale. Results: For many subjects, the responses in the before treatment questionnaires were at the lower end of the Likert scale, indicating that there were no major impacts on oral health related quality of life parameters. There were no major differences between the copy denture subjects and the conventional denture subjects in relation to the change in OHIP scores before and after treatment. Generally subjects expressed improved satisfaction with the new lower denture. However, for the copy denture group there were significant improvements for all seven assessments compared with only five out of seven assessments for subjects in the conventional group. Conclusion: For these groups of edentulous subjects, although they may need dentures to be replaced after a period of wear, this does not necessarily have significant impacts on oral health related quality of life parameters. It seems likely that this is the main reason why the provision of new dentures by either a copying or conventional technique did not result in major changes to the OHIP.     

Influence of connection type on the biomechanical behavior of distal extension mandibular removable partial dentures supported by implants and natural teeth

Few studies are performed to evaluate the influence of connection type on the stress distribution of distal extension mandibular removable partial dentures (RPDs) supported by both implants and natural teeth. In this study, five three-dimensional finite element models were prepared to simulate mandibular bilateral partially edentulous arches. Four were RPDs supported by both implants and natural teeth, and the other one was RPDs supported only by natural teeth. The maximum equivalent (EQV) stress values of bone around implants, the abutments, and the mucosa displacements of the related supporting structures were measured. It was found that a non-rigid telescopic coping was more favorable to protect the implant than a rigid telescopic coping. Compared with other connection types, the easy resilient attachment (ERA) system seemed to be effective to associate implant without complications. However, the results obtained in the present study should be cautiously interpreted in the clinic.     

Comparing the efficacy of mandibular implant-retained overdentures and conventional dentures among elderly edentulous patients: satisfaction and quality of life

Objectives: The aim of this study was to compare the satisfaction and the quality of life in an elderly population using either mandibular conventional dentures or implant‐retained overdentures. Materials and methods: A total of 34 patients were divided into two groups: group I – complete dentures users; group II – users of upper complete dentures opposed by implant‐retained overdentures. The subjects were submitted to a questionnaire based on Oral Health Impact Profile and oral health related quality of life to evaluate their satisfaction levels and quality of life with their prostheses. Data were evaluated using a non‐parametric statistical analysis (Fischer test) with significant difference at α = 0.05. Results: There were no significant differences between the groups in relation to comfort, aesthetics, chewing ability, overall satisfaction, pain, functional, phonetic, social, and psychological limitations (p > 0.05). Comparing the stability of mandibular dentures, group II presented the better results (p < 0.05). Conclusion: Although the stability of the mandibular implant‐retained overdenture was enhanced compared to a conventional denture, the quality of life and satisfaction levels were similar for both the groups.     

Biomechanical evaluation of the natural abutment teeth in combined tooth-implant-supported telescopic prostheses: a three-dimensional finite element analysis

Telescopic overdentures supported by the combination of natural teeth and implants have been thought a valuable treatment for the severely compromised partially edentulous patients. But the combination of teeth and implants involves highly complex biomechanical problems. This study is to evaluate biomechanical behaviors of the natural abutment teeth with the treatment of combined tooth-implant supported telescopic crown prostheses in mandible through 3D FEA. According to this study, the prosthetic option supported by a combination of teeth and implants and retained by double crowns could protect teeth and their periodontal support tissues acting as a rigid splint, and may be a valuable treatment option for partially edentulous patients with severely reduced remaining teeth in mandible.     

下颌起排法全口排牙临床效果研究

目的:研究通过比较不同的排牙方式制作的全口义齿对咀嚼次数、咀嚼效率以及患者的主观感受的影响。方法:78例无牙颌患者按照牙槽嵴高度分为正常组和低平组,正常组有患者32例,低平组有患者46例,每组分别戴用上颌起排法和下颌起排法制作的全口义齿,比较咀嚼次数、咀嚼效率和满意度的差别。结果:在戴用上颌起排法制作的全口义齿时,正常组的咀嚼次数高于低平组,差异具有统计学意义(t=3.60,P0.05);戴用下颌起排法制作的全口义齿后,低平组的咀嚼次数高于采用上颌起排法的全口义齿,差异具有统计学意义(t=4.41,P0.05);在戴用上颌起排法制作的全口义齿中,正常组的咀嚼效率高于低平组,差异具有统计学意义(t=5.72,P0.05);而在戴用下颌起排法制作的全口义齿后,低平组的咀嚼效率高于采用上颌起排法的全口义齿,差异具有统计学意义(t=7.16,P0.05)。正常组认为使用下颌起排法制作全口义齿咀嚼能力、稳固感好于上颌起排法,差异均具有统计学意义(P0.05);低平组认为使用下颌起排法制作全口义齿咀嚼能力、稳固感和舒适感好于上颌起排法,差异均具有统计学意义(P0.05)。结论:对于牙槽嵴低平无牙颌患者使用下颌起排法制作的全口义齿,能够有效地增强咀嚼效率,提高义齿的稳定性。     

Evaluation of satisfaction with masticatory efficiency of new conventional complete dentures in edentulous patients--a survey

doi: 10.1111/j.1741‐2358.2012.00634.x Evaluation of satisfaction with Masticatory efficiency of new conventional complete dentures in edentulous patients. A survey Background: Knowing how patients really feel after treatment is, very often, as relevant as the success rate of the conventional dentures and it can even be the measurement of masticatory function. Aim and objectives: This questionnaire survey aimed to analyse the satisfaction level and masticatory efficiency of patients treated with conventional complete dentures. Design and setting: Thirty edentulous patients were considered in the study. Satisfaction level and masticatory efficiency were analysed based on specific questionnaires for edentulous patients and by a likert rating scale from 0 to 5, at three moments: Prior to treatment (edentulous period), after the insertion of the new dentures and at 30–45 days follow‐up. Materials and methods: Thirty patients including 12 male and 18 female patients (mean age 65 years), who voluntarily came for the services. T‐test was applied at three different levels. Results: The rehabilitation with conventional complete dentures produced an improvement (p < 0.05) in satisfaction level and masticatory efficiency. Conclusion: Thus, those patients who were edentulous previously and dissatisfied with their masticatory ability showed improvement after receiving a new set of conventional complete dentures.