Abstract
Statement of problem
Healing abutments and attachments have been used for implant-supported removable partial
dentures (ISRPDs). However, the effects of these abutments and attachments on the
clinical outcomes of the implants and prostheses are elusive because of the lack of
standardized research protocols.
Purpose
The purpose of this systematic review was to determine the clinical outcomes of mandibular
distal extension ISRPDs with healing abutments and attachments by analyzing qualified
studies.
Material and methods
An electronic and manual literature search was conducted on PubMed, Web of Science,
Scopus, Embase, and Cochrane Library databases including articles published in English
from 1980 to 2020. Publications of clinical outcome studies on the mandibular distal
extension ISRPDs with healing abutments or attachments were screened by inclusion
and exclusion criteria. Clinical outcomes of removable partial dentures (RPDs) and
ISRPDs with different types of abutments or attachments were compared by using patient-reported
outcome measures, implant survival rate, masticatory performance, and implant- or
prosthesis-related complications. Study designs and clinical outcome data were extracted
and analyzed. The evidence of the selected studies and degree of recommendation were
made according to the Oxford Centre for Evidence-based Medicine, and the risk of bias
of the studies was assessed based on Newcastle-Ottawa criteria.
Results
Of 541 articles initially identified after removing duplicate records, 11 articles
were selected by applying the inclusion and exclusion criteria, by inter-viewer agreement,
and by hand searching. Nine prospective cohort studies, 1 retrospective cohort study,
and 1 randomized controlled trial were included with evidence levels assessed at 1b,
2b, and 2c. The risk of bias varied from 5 to 8 out of 9. Patient overall satisfaction,
oral health–related quality of life (OHRQoL) scores, and masticatory ability were
significantly improved for ISRPDs with either healing abutments, ball, or LOCATOR
attachments when compared with RPDs. The implant survival rate varied from 92% to
97% at 2 to 10 years for ball attachment and was 100% at 1 year for LOCATOR attachment-supported
ISRPDs. Marginal bone loss (MBL) varied from 0 to 1 mm in all studies, although LOCATOR
attachments had significantly less MBL compared with ball attachments. The maximal
pocket depth and bleeding on probing index around implants at 1 year were 1.7 to 1.8
mm and 0.1 to 0.3. Loose healing caps were the main mechanical complication of implants.
There were more prosthetic complications in ISRPDs with ball attachments than RPDs
at 10-year follow-up, including gold matrix loosening, loss of retention, and denture
base fractures. No direct comparisons were made of patient-reported outcomes or prosthetic
complications between ball and LOCATOR attachment-supported ISRPDs.
Conclusions
Healing abutments and attachments (ball or LOCATOR) improved patient-reported outcomes
and the masticatory function of mandibular distal extension ISRPDs. However, insufficient
evidence was found to determine the relative effectiveness of different attachment
systems on the clinical outcomes of mandibular distal extension ISRPDs. Abutment loosening
was the most frequent mechanical complication for healing abutments. More prosthetic
complications were associated with ball attachment-supported ISRPDs than RPDs. The
major weaknesses of this systematic review were the relatively moderate level of evidence
and the publication language, since implant attachments are used in many non-English
speaking countries.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Prosthetic DentistryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The effects of removable partial dentures on abutment tooth mobility: a clinical study.J Prosthet Dent. 1973; 30: 139-146
- Stewart’s clinical removable partial prosthodontics.4th ed. Quintessence, Chicago2008: 19-205
- McCracken’s removable partial prosthodontics.12th ed. Mosby, St. Louis2010: 115-129
- Treatment outcomes with mandibular removable partial dentures: a population-based study of patient satisfaction.J Prosthet Dent. 1998; 80: 36-45
- Advanced removable partial dentures.1st ed. Quintessence, Chicago1999: 153-160
- Stewart’s clinical removable partial prosthodontics.4th ed. Quintessence, Chicago2008: 259-278
- Mandibular Kennedy class I implant-tooth-borne removable partial denture: a systematic review.J Oral Rehabil. 2010; 37: 225-234
- Mandibular implant-supported removable partial denture with distal extension: a systematic review.J Oral Rehabil. 2012; 39: 791-798
- Placement of a distal implant to convert a mandibular removable Kennedy class I to an implant-supported partial removable Class III dental prosthesis: A systematic review.J Prosthet Dent. 2015; 113: 528-533
- Effect of conversion to implant-assisted removable partial denture in patients with mandibular Kennedy classification: a systematic review and meta-analysis.Clin Oral Implants Res. 2020; 31: 360-373
- Implant-supported removable partial dentures in the mandible: a 3-16 year retrospective study.J Prosthodont Res. 2017; 61: 98-105
- Implant-retained removable partial dentures: an 8-year retrospective study.J Prosthodont. 2011; 20: 168-172
- Multicentre prospective evaluation of implant-assisted mandibular removable partial dentures: surgical and prosthodontic outcomes.Clin Oral Implants Res. 2017; 28: 116-125
- Removable dentures with implant support in strategic positions followed for up to 8 years.Int J Prosthodont. 2009; 22: 233-241
- Prospective clinical study of prosthetic treatment outcome of implant-retained-removable-partial-denture during 5 year-follow-ups.Australas Med J. 2017; 10: 927-933
- A retrospective case series of implants used to restore partially edentulous patients with implant-supported removable partial dentures: 31-month mean follow-up results.Quintessence Int. 2008; 39: 665-671
- Implant tooth-supported removable partial denture with at least 15-year long-term follow-up.Clin Implant Dent Relat Res. 2015; 17: 917-922
- Commentary: Removable dentures with implant support in strategic positions followed for up to 8 years.Int J Prosthodont. 2009; 22: 242
- Interventions for replacing missing teeth: attachment systems for implant overdentures in edentulous jaws.Cochrane Database Syst Rev. 2018; 10: Cd008001
- Effect of the attachment system on the biomechanical and clinical performance of overdentures: a systematic review.J Prosthet Dent. 2020; 123: 589-594
- The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration.J Clin Epidemiol. 2009; 62: e1-e34
- Utilization of the PICO framework to improve searching PubMed for clinical questions.BMC Med Inform Decis. 2007; 7: 16
- Explanation of the 2011 Oxford Centre for Evidence-Based Medicine (OCEBM) levels of evidence (background document) [Internet].Oxford Centre for Evidence-Based Medicine, Oxford2016
- The Newcastle–Ottawa Scale (NOS) for assessing the quality of non-randomized studies in meta-analysis [Internet].Ottawa Hospital Research Institute, Ottawa2011
- Implant-supported removable partial denture improves the quality of life of patients with extreme tooth loss.Braz Dent J. 2015; 26: 463-467
- The effect of implant-supported removable partial dentures on oral health quality of life.Clin Oral Implants Res. 2014; 25: 207-213
- Implant retention and support for distal extension partial removable dental prostheses: satisfaction outcomes.J Prosthet Dent. 2014; 112: 334-339
- Mastication and jaw motion of partially edentulous patients are affected by different implant-based prostheses.J Oral Rehabil. 2014; 41: 507-514
- Implant-supported mandibular removable partial dentures: functional, clinical and radiographical parameters in relation to implant position.Clin Implant Dent Relat Res. 2017; 19: 432-439
- Implant-supported mandibular removable partial dentures; patient-based outcome measures in relation to implant position.J Dent. 2016; 55: 92-98
- Effect of two implant-supported partial overdenture attachment design on the periodontal health.J Contemp Dent Pract. 2020; 21: 68-72
- Implant supported distal extension over denture retained by two types of attachments. A comparative radiographic study by cone beam computed tomography.J Int Oral Health. 2015; 7: 5-10
- Multicentre prospective evaluation of implant-assisted mandibular bilateral distal extension removable partial dentures: patient satisfaction.Clin Oral Implants Res. 2013; 24: 20-27
- Implant-supported versus implant-retained distal extension mandibular partial overdentures and residual ridge resorption: a 5-year retrospective radiographic study in men.Int J Prosthodont. 2011; 24: 306-313
- Design, operation, and interpretation of clinical trials.J Dent Res. 2010; 89: 759-772
- Posterior implants for distal extension removable prostheses: a retrospective study.Int J Periodontics Restorative Dent. 2003; 23: 353-359
- Effect of implant support on distal-extension removable partial dentures: in vivo assessment.Int J Oral Maxillofac Implants. 2008; 23: 1095-1101
- Clinical evaluation of implant-supported removable partial dentures with a stress-breaking attachment.Implant Dent. 2017; 26: 516-523
- Clinical performance of LOCATOR® attachments: a retrospective study with 1-8 years of follow-up.Clin Exp Dent Res. 2018; 4: 132-145
- The use of extraoral implants for distal-extension removable dentures: a clinical evaluation up to 8 years.Int J Oral Maxillofac Implants. 2009; 24: 1129-1137
- Clinical practice guidelines for recall and maintenance of patients with tooth-borne and implant-borne dental restorations.J Am Dent Assoc. 2016; 147: 67-74
Article info
Publication history
Published online: July 21, 2021
Identification
Copyright
© 2021 by the Editorial Council for the Journal of Prosthetic Dentistry.
