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Journal of Prosthetic Dentistry

Patient-reported outcome measures and clinical assessment of implant-supported overdentures and fixed prostheses in mandibular edentulous patients: A systematic review and meta-analysis

Published:December 31, 2020DOI:https://doi.org/10.1016/j.prosdent.2020.11.005

      Abstract

      Statement of problem

      A consensus based on patients’ perceptions as to whether to use overdentures or fixed prostheses to rehabilitate mandibular edentulous arches is limited.

      Purpose

      The purpose of this systematic review and meta-analysis was to compare the patient-reported outcome measures (PROMs) and clinical outcomes associated with implant-supported overdentures and fixed prostheses in edentulous mandibles.

      Material and methods

      Nine electronic databases were searched for randomized clinical trials (RCTs) and nonrandomized clinical trials (N-RCTs). The risk of bias was assessed by the revised Cochrane risk of bias tool for RCTs (RoB 2) and N-RCT (ROBINS-I). Data sets for oral health–related quality of life (OHRQoL), satisfaction, survival rate, implant probing depth, and marginal bone loss were plotted, and the appropriate analyses were applied by using the Rev Man 5.3 software program. Certainty of evidence was also evaluated by means of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.

      Results

      Ten eligible trials were included and evaluated quantitatively. For 3 domains of OHRQoL, fixed prostheses showed significantly higher quality of life when compared with overdentures regarding functional limitation (P<.001), physical disability (P=.001), and physical pain (P=.003). Fixed prostheses also improved satisfaction, when compared with overdentures for comfort (P=.02), ease of mastication (P<.001), retention (P<.001), and stability (P<.001). The same pattern was observed for overall OHRQoL (P=.01) and satisfaction (P=.01) in which fixed prostheses improved patient satisfaction. Only ease of cleaning presented greater satisfaction for the overdenture group. Clinical parameters did not differ statistically (P>.05) between both types of prosthesis.

      Conclusions

      Fixed rehabilitations for mandibular edentulous patients seem to be a well-accepted treatment from the patients’ oral health perspective. However, mandibular overdentures are no less efficient than fixed prostheses in terms of clinical outcomes.
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      References

        • Feine J.S.
        • de Grandmont P.
        • Boudrias P.
        • Brien N.
        • LaMarche C.
        • Taché R.
        • et al.
        Within-subject comparisons of implant-supported mandibular prostheses: choice of prosthesis.
        J Dent Res. 1994; 73: 1105-1111
        • Müller F.
        • Hernandez M.
        • Grütter L.
        • Aracil-Kessler L.
        • Weingart D.
        • Schimmel M.
        Masseter muscle thickness, chewing efficiency and bite force in edentulous patients with fixed and removable implant-supported prostheses: a cross-sectional multicenter study.
        Clin Oral Implants Res. 2012; 23: 144-150
        • ELsyad M.A.
        • Elgamal M.
        • Mohammed Askar O.
        • Youssef Al-Tonbary G.
        Patient satisfaction and oral health-related quality of life (OHRQoL) of conventional denture, fixed prosthesis and milled bar overdenture for All-on-4 implant rehabilitation. A crossover study.
        Clin Oral Implants Res. 2019; 30: 1107-1117
        • Brennan M.
        • Houston F.
        • O'Sullivan M.
        • O'Connell B.
        Patient satisfaction and oral health-related quality of life outcomes of implant overdentures and fixed complete dentures.
        Int J Oral Maxillofac Implants. 2010; 25: 791-800
        • Yoda N.
        • Matsudate Y.
        • Abue M.
        • Hong G.
        • Sasaki K.
        Effect of attachment type on load distribution to implant abutments and the residual ridge in mandibular implant-supported overdentures.
        J Dent Biomech. 2015; 6 (1758736015576009)
        • Dudic A.
        • Mericske-Stern R.
        Retention mechanisms and prosthetic complications of implant-supported mandibular overdentures: long-term results.
        Clin Implant Dent Relat Res. 2002; 4: 212-219
        • Heydecke G.
        • Boudrias P.
        • Awad M.A.
        • De Albuquerque R.F.
        • Lund J.P.
        • Feine J.S.
        Within-subject comparisons of maxillary fixed and removable implant prostheses: Patient satisfaction and choice of prosthesis.
        Clin Oral Implants Res. 2003; 14: 125-130
        • Haraldson T.
        Comparisons of chewing patterns in patients with bridges supported on osseointegrated implants and subjects with natural dentitions.
        Acta Odontol Scand. 1983; 41: 203-208
        • Feine J.S.
        • Dufresne E.
        • Boudrias P.
        • Lund J.P.
        Outcome assessment of implant-supported prostheses.
        J Prosthet Dent. 1998; 79: 575-579
        • Attard N.
        • Wei X.
        • Laporte A.
        • Zarb G.A.
        • Ungar W.J.
        A cost minimization analysis of implant treatment in mandibular edentulous patients.
        Int J Prosthodont. 2003; 16: 271-276
        • Passia N.
        • Wolfart S.
        • Kern M.
        Ten-year clinical outcome of single implant-supported mandibular overdentures-A prospective pilot study.
        J Dent. 2019; 82: 63-65
        • Passia N.
        • Kern M.
        The single midline implant in the edentulous mandible: a systematic review.
        Clin Oral Investig. 2014; 18: 1719-1724
        • Thomason J.M.
        • Feine J.
        • Exley C.
        • Moynihan P.
        • Müller F.
        • Naert I.
        • et al.
        Mandibular two implant-supported overdentures as the first choice standard of care for edentulous patients--the York Consensus Statement.
        Br Dent J. 2009; 207: 185-186
        • Ayna M.
        • Gülses A.
        • Acil Y.
        A comparative study on 7-year results of "All-on-Four™" immediate-function concept for completely edentulous mandibles: metal-ceramic vs. bar-supported superstructures.
        Odontology. 2018; 106: 73-82
        • Beresford D.
        • Klineberg I.
        A within-subject comparison of patient satisfaction and quality of life between a two-implant overdenture and a three-implant-supported fixed dental prosthesis in the mandible.
        Int J Oral Maxillofac Implants. 2018; 33: 1374-1382
        • De Kok I.J.
        • Chang K.H.
        • Lu T.S.
        • Cooper L.F.
        Comparison of three-implant-supported fixed dentures and two-implant-supported overdentures in the edentulous mandible: a pilot study of treatment efficacy and patient satisfaction.
        Int J Oral Maxillofac Implants. 2011; 26: 415-426
        • Elsyad M.A.
        • Alameldeen H.E.
        • Elsaih E.A.
        Four-implant-supported fixed prosthesis and milled bar overdentures for rehabilitation of the edentulous mandible: A 1-year randomized controlled clinical and radiographic study.
        Int J Oral Maxillofac Implants. 2019; 34: 1493-1503
        • Zarb G.A.
        • Albrektsson T.
        Consensus report: towards optimized treatment outcomes for dental implants.
        J Prosthet Dent. 1998; 80: 641
        • Borges G.A.
        • Costa R.C.
        • Nagay B.E.
        • Magno M.B.
        • Maia L.C.
        • Barão V.A.R.
        • et al.
        Long-term outcomes of different loading protocols for implant-supported mandibular overdentures: A systematic review and meta-analysis.
        J Prosthet Dent. 2021; 125: 732-745
        • Elsyad M.A.
        • Khirallah A.S.
        Circumferential bone loss around splinted and nonsplinted immediately loaded implants retaining mandibular overdentures: A randomized controlled clinical trial using cone beam computed tomography.
        J Prosthet Dent. 2016; 116: 741-748
        • Alfadda S.A.
        • Chvartszaid D.
        • AlFarraj Aldosari A.
        Clinical outcomes of immediately loaded implant-supported overdentures: A long-term prospective clinical trial.
        J Prosthet Dent. 2019; 121: 911-915
        • Turkyilmaz I.
        • Tozum T.F.
        • Fuhrmann D.M.
        • Tumer C.
        Seven-year follow-up results of TiUnite implants supporting mandibular overdentures: early versus delayed loading.
        Clin Implant Dent Relat Res. 2012; 14: e83-e90
        • Niedermaier R.
        • Stelzle F.
        • Riemann M.
        • Bolz W.
        • Schuh P.
        • Wachtel H.
        Implant-supported immediately loaded fixed full-arch dentures: evaluation of implant survival rates in a case cohort of up to 7 years.
        Clin Implant Dent Relat Res. 2017; 19: 4-19
        • Balshi T.J.
        • Wolfinger G.J.
        • Slauch R.W.
        • Balshi S.F.
        A retrospective analysis of 800 Brånemark System implants following the All-on-Four protocol.
        J Prosthodont. 2014; 23: 83-88
        • Patzelt S.B.
        • Bahat O.
        • Reynolds M.A.
        • Strub J.R.
        The all-on-four treatment concept: a systematic review.
        Clin Implant Dent Relat Res. 2014; 16: 836-855
        • Albrektsson T.
        • Zarb G.
        • Worthington P.
        • Eriksson A.R.
        The long-term efficacy of currently used dental implants: a review and proposed criteria of success.
        Int J Oral Maxillofac Implants. 1986; 1: 11-25
        • Slade G.D.
        • Spencer A.J.
        Development and evaluation of the Oral Health Impact Profile.
        Community Dent Health. 1994; 11: 3-11
        • Slade G.D.
        Derivation and validation of a short-form oral health impact profile.
        Community Dent Oral Epidemiol. 1997; 25: 284-290
        • Awad M.
        • Al-Shamrany M.
        • Locker D.
        • Allen F.
        • Feine J.
        Effect of reducing the number of items of the Oral Health Impact Profile on responsiveness, validity and reliability in edentulous populations.
        Community Dent Oral Epidemiol. 2008; 36: 12-20
        • Feine J.
        • Abou-Ayash S.
        • Al Mardini M.
        • de Santana R.B.
        • Bjelke-Holtermann T.
        • Bornstein M.M.
        • et al.
        Group 3 ITI Consensus Report: Patient-reported outcome measures associated with implant dentistry.
        Clin Oral Implants Res. 2018; 29: 270-275
        • Liu D.
        • Deng Y.
        • Sha L.
        • Abul Hashem M.
        • Gai S.
        Impact of oral processing on texture attributes and taste perception.
        J Food Sci Technol. 2017; 54: 2585-2593
        • Wittneben J.G.
        • Wismeijer D.
        • Brägger U.
        • Joda T.
        • Abou-Ayash S.
        Patient-reported outcome measures focusing on aesthetics of implant- and tooth-supported fixed dental prostheses: A systematic review and meta-analysis.
        Clin Oral Implants Res. 2018; 29: 224-240
        • Gallardo Y.R.
        • Bohner L.
        • Tortamano P.
        • Pigozzo M.N.
        • Laganá D.C.
        • Sesma N.
        Patient outcomes and procedure working time for digital versus conventional impressions: A systematic review.
        J Prosthet Dent. 2018; 119: 214-219
        • Moher D.
        • Liberati A.
        • Tetzlaff J.
        • Altman D.G.
        • PRISMA Group
        Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.
        PLoS Med. 2009; 7: e1000097
        • Booth A.
        • Clarke M.
        • Dooley G.
        • Ghersi D.
        • Moher D.
        • Petticrew M.
        • et al.
        The nuts and bolts of PROSPERO: an international prospective register of systematic reviews.
        Syst Rev. 2012; 1: 2
        • Sterne J.A.C.
        • Savović J.
        • Page M.J.
        • Elbers R.G.
        • Blencowe N.S.
        • Boutron I.
        • et al.
        RoB 2: a revised tool for assessing risk of bias in randomised trials.
        BMJ. 2019; 366: l4898
        • Sterne J.A.
        • Hernán M.A.
        • Reeves B.C.
        • Savović J.
        • Berkman N.D.
        • Viswanathan M.
        • et al.
        ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions.
        BMJ. 2016; 355: i4919
        • Burda B.U.
        • O'Connor E.A.
        • Webber E.M.
        • Redmond N.
        • Perdue L.A.
        Estimating data from figures with a Web-based program: Considerations for a systematic review.
        Res Synth Methods. 2017; 8: 258-262
        • Drevon D.
        • Fursa S.R.
        • Malcolm A.L.
        Intercoder reliability and validity of WebPlotDigitizer in extracting graphed data.
        Behav Modif. 2017; 41: 323-339
        • Borenstein M.
        • Hedges L.V.
        • Higgins J.P.T.
        • Rothstein H.R.
        Introduction to meta-analysis.
        1st ed. John Wiley & Sons, Chichester2009: 59-86
        • Higgins J.P.
        • Green S.
        Cochrane handbook for systematic reviews of interventions.
        The Cochrane Collaboration, Oxford2019: 165-166
        • Borenstein M.
        Common mistakes in meta-analysis.
        Biostat Inc., New Jersey2019: 13-41
        • Ryan R.
        • Hills S.
        How to grade the quality of the evidence. Cochrane Consumers and Communication Group.
        2016 (Available at:)
        • Makkonen T.A.
        • Holmberg S.
        • Niemi L.
        • Olsson C.
        • Tammisalo T.
        • Peltola J.
        A 5-year prospective clinical study of Astra Tech dental implants supporting fixed bridges or overdentures in the edentulous mandible.
        Clin Oral Implants Res. 1997; 8: 469-475
        • Quirynen M.
        • Alsaadi G.
        • Pauwels M.
        • Haffajee A.
        • van Steenberghe D.
        • Naert I.
        Microbiological and clinical outcomes and patient satisfaction for two treatment options in the edentulous lower jaw after 10 years of function.
        Clin Oral Implants Res. 2005; 16: 277-287
        • Raghoebar G.M.
        • Friberg B.
        • Grunert I.
        • Hobkirk J.A.
        • Tepper G.
        • Wendelhag I.
        3-year prospective multicenter study on one-stage implant surgery and early loading in the edentulous mandible.
        Clin Implant Dent Relat Res. 2003; 5: 39-46
        • Tinsley D.
        • Watson C.J.
        • Russell J.L.
        A comparison of hydroxylapatite coated implant supported fixed and removable mandibular prostheses over 4 to 6 years.
        Clin Oral Implants Res. 2001; 12: 159-166