Patient satisfaction and survival of maxillary overdentures supported by four or six splinted implants: a systematic review with meta-analysis

Fabrizio Di Francesco, Gennaro De Marco, Estefani B Capcha, Alessandro Lanza, Corina M Cristache, Rolando Vernal, Emilio A Cafferata, Fabrizio Di Francesco, Gennaro De Marco, Estefani B Capcha, Alessandro Lanza, Corina M Cristache, Rolando Vernal, Emilio A Cafferata

Abstract

Background: Implant-supported overdentures offer enhanced mechanical properties, which lead to better patient satisfaction and survival rates than conventional dentures. However, it is unclear whether these satisfaction levels and survival rates depend on the number of implants supporting the overdenture. Therefore, this systematic review aimed to compare maxillary overdentures supported by four or six splinted implants in terms of patient satisfaction, implant survival, overdenture survival, and prosthodontic complications.

Methods: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (PubMed), and EMBASE databases were systematically searched and complemented by hand searching from 2000 to 2019, employing a combination of specific keywords. Studies comparing the use of four versus six implants for supporting overdentures with at least one-year of follow-up after prosthesis installation and including ten fully edentulous patients were included. The risk of bias (RoB) was analyzed with Cochrane's RoB 2 and Newcastle-Ottawa tools. Implants and prosthesis survival rates were analyzed by random-effects meta-analysis and expressed as risk ratios or risk differences, respectively, and by the non-parametric unpaired Fisher's test.

Results: A total of 15 from 1865 articles were included, and reported follow-up times after implant placement ranged from 1 to 10 years. Irrespective of the number of implants used, high scores were reported by all studies investigating patient satisfaction. Meta-analysis and non-parametric Fisher's test showed no statistical differences regarding the survival rate of implants (P = 0.34, P = 0.3) or overdentures (P = 0.74, P = 0.9) when using 4 versus 6 splinted implants to support overdentures, and no significant differences regarding prosthodontic complications were found between groups. Randomized studies presented high RoB and non-randomized studies presented acceptable quality.

Conclusions: Within the limits of this systematic review, we can conclude that the bar-supported overdenture on four implants is not inferior to the overdenture supported by six implants for rehabilitating the edentulous maxilla, in terms of patient satisfaction, survival rates of implants and overdentures, and prosthodontic complications.

Keywords: Dental implant; Overdenture; Patient satisfaction; Splinted design; Systematic review.

Conflict of interest statement

The authors declare that there is no conflict of interest, any suggestion of plagiarism or copyright infringement regarding the publication of this paper.

Figures

Fig. 1
Fig. 1
Data selection flowchart
Fig. 2
Fig. 2
Forest plot of the dental implants survival risk ratios when using 4 versus 6 splinted implants for supporting overdentures
Fig. 3
Fig. 3
Forest plot of the overdentures survival risk diferences when using 4 versus 6 splinted implants for supporting them
Fig. 4
Fig. 4
Dental implants and overdentures survival rates when using 4 or 6 splinted implants

References

    1. Hsu YJ, Lin JR, Hsu JF. Patient satisfaction, clinical outcomes and oral health-related quality of life after treatment with traditional and modified protocols for complete dentures. J Dent Sci. 2021;16:236–240. doi: 10.1016/j.jds.2020.05.024.
    1. Borges GA, Barbin T, Dini C, et al. Patient-reported outcome measures and clinical assessment of implant-supported overdentures and fixed prostheses in mandibular edentulous patients: a systematic review and meta-analysis. J Prosthet Dent. 2020;S0022–391:30694–30696.
    1. Leão RS, Moraes SLD, Vasconcelos BCE, Lemos CAA, Pellizzer EP. Splinted and unsplinted overdenture attachment systems: a systematic review and meta-analysis. J Oral Rehabil. 2018;45:647–656. doi: 10.1111/joor.12651.
    1. Roccuzzo M, Bonino F, Gaudioso L, Zwahlen M, Meijer HJ. What is the optimal number of implants for removable reconstructions? A systematic review on implant-supported overdentures. Clin Oral Implants Res. 2012;23:229–237. doi: 10.1111/j.1600-0501.2012.02544.x.
    1. Di Francesco F, De Marco G, Gironi Carnevale UA, Lanza M, Lanza A. The number of implants required to support a maxillary overdenture: a systematic review and meta-analysis. J Prosthodont Res. 2019;63:15–24. doi: 10.1016/j.jpor.2018.08.006.
    1. Sadowsky SJ, Zitzmann NU. Protocols for the maxillary implant overdenture: a systematic review. Int J Oral Maxillofac Implants. 2016;31:S182–S191. doi: 10.11607/jomi.16suppl.g5.2.
    1. Raghoebar GM, Meijer HJ, Slot W, Slater JJ, Vissink A. A systematic review of implant-supported overdentures in the edentulous maxilla, compared to the mandible: how many implants? Eur J Oral Implantol. 2014;7:S191–201.
    1. Sadowsky SJ. Treatment considerations for maxillary implant overdentures: a systematic review. J Prosthet Dent. 2007;97:340–348. doi: 10.1016/S0022-3913(07)60022-5.
    1. Stoumpis C, Kohal RJ. To splint or not to splint oral implants in the implant-supported overdenture therapy? A systematic literature review. J Oral Rehabil. 2011;38:857–869. doi: 10.1111/j.1365-2842.2011.02220.x.
    1. Ferrigno N, Laureti M, Fanali S, Grippaudo G. A long-term follow-up study of non-submerged ITI implants in the treatment of totally edentulous jaws. Part I: ten-year life table analysis of a prospective multicenter study with 1286 implants. Clin Oral Implants Res. 2002;13:260–273. doi: 10.1034/j.1600-0501.2002.130305.x.
    1. Slot W, Raghoebar GM, Cune MS, Vissink A, Meijer HJA. Four or six implants in the maxillary posterior region to support an overdenture: 5-year results from a randomized controlled trial. Clin Oral Implants Res. 2019;30(2):169–177. doi: 10.1111/clr.13403.
    1. Al-Ansari A. No difference between splinted and unsplinted implants to support overdentures. Evid Based Dent. 2012;13:54–55. doi: 10.1038/sj.ebd.6400863.
    1. Di Francesco F, De Marco G, Sommella A, Lanza A. Splinting vs not splinting four implants supporting a maxillary overdenture: a systematic review. Int J Prosthodont. 2019;32:509–518. doi: 10.11607/ijp.6333.
    1. Slot W, Raghoebar GM, Vissink A, Huddleston Slater JJ, Meijer HJ. A systematic review of implant-supported maxillary overdentures after a mean observation period of at least 1 year. J Clin Periodontol. 2010;37:98–110. doi: 10.1111/j.1600-051X.2009.01493.x.
    1. Shamseer L, Moher D, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-Analysis protocols (PRISMA-P)2015: elaboration and explanation. BMJ. 2015;349:g7647. doi: 10.1136/bmj.g7647.
    1. Sterne JAC, Savović J, Page MJ, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366:l4898. doi: 10.1136/bmj.l4898.
    1. Wells GA, Shea BJ, O’Connell D, Peterson J, Welch V, Losos M, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. 2014. . Accessed 1 July 2016.
    1. Den Hartog L, Slater JJ, Vissink A, Meijer HJ, Raghoebar GM. Treatment outcome of immediate, early and conventional single-tooth implants in the aesthetic zone: a systematic review to survival, bone level, soft-tissue, aesthetics and patient satisfaction. J Clin Periodontol. 2008;35:1073–1086. doi: 10.1111/j.1600-051X.2008.01330.x.
    1. Slot W, Raghoebar GM, Cune MS, Vissink A, Meijer HJA. Four or six implants in the maxillary posterior region to support an overdenture: 5-year results from a randomized controlled trial. Clin Oral Implants Res. 2019;30:169–177. doi: 10.1111/clr.13403.
    1. Slot W, Raghoebar GM, Cune MS, Vissink A, Meijer HJ. Maxillary overdentures supported by four or six implants in the anterior region: 5-year results from a randomized controlled trial. J Clin Periodontol. 2016;43:1180–1187. doi: 10.1111/jcpe.12625.
    1. Slot W, Raghoebar GM, Vissink A, Meijer HJ. Maxillary overdentures supported by four or six implants in the anterior region; 1-year results from a randomized controlled trial. J Clin Periodontol. 2013;40:303–310. doi: 10.1111/jcpe.12051.
    1. Slot W, Raghoebar GM, Vissink A, Meijer HJ. A comparison between 4 and 6 implants in the maxillary posterior region to support an overdenture: 1-year results from a randomized controlled trial. Clin Oral Implants Res. 2014;25:560–566. doi: 10.1111/clr.12118.
    1. Boven GC, Meijer HJA, Vissink A, Raghoebar GM. Maxillary implant overdentures retained by use of bars or locator attachments: 1-year findings from a randomized controlled trial. J Prosthodont Res. 2020;64:26–33. doi: 10.1016/j.jpor.2019.04.013.
    1. Boven GC, Slot JWA, Raghoebar GM, Vissink A, Meijer HJA. Maxillary implant-supported overdentures opposed by (partial) natural dentitions: a 5-year prospective case series study. J Oral Rehabil. 2017;44:988–995. doi: 10.1111/joor.12557.
    1. Krennmair G, Krainhöfner M, Piehslinger E. Implant-supported maxillary overdentures retained with milled bars: maxillary anterior versus maxillary posterior concept–a retrospective study. Int J Oral Maxillofac Implants. 2008;23:343–352.
    1. Zou D, Wu Y, Huang W, Wang F, Wang S, Zhang Z, et al. A 3-year prospective clinical study of telescopic crown, bar, and locator attachments for removable four implant-supported maxillary overdentures. Int J Prosthodont. 2013;26:566–573. doi: 10.11607/ijp.3485.
    1. Mangano F, Luongo F, Shibli JA, Anil S, Mangano C. Maxillary overdentures supported by four splinted direct metal laser sintering implants: a 3-year prospective clinical study. Int J Dent. 2014;2014:252343. doi: 10.1155/2014/252343.
    1. Katsoulis J, Brunner A, Mericske-Stern R. Maintenance of implant-supported maxillary prostheses: a 2-year controlled clinical trial. Int J Oral Maxillofac Implants. 2011;26:648–656.
    1. Mangano C, Mangano F, Shibli JA, Ricci M, Sammons RL, Figliuzzi M. Morse taper connection implants supporting “planned” maxillary and mandibular bar-retained overdentures: a 5-year prospective multicenter study. Clin Oral Implants Res. 2011;22:1117–1124. doi: 10.1111/j.1600-0501.2010.02079.x.
    1. Akca K, Cehreli MC, Uysal S. Marginal bone loss and prosthetic maintenance of bar-retained implant-supported overdentures: a prospective study. Int J Oral Maxillofac Implants. 2010;25:137–145.
    1. Park JH, Shin SW, Lee JY. Bar versus ball attachments for maxillary four-implant retained overdentures: a randomized controlled trial. Clin Oral Implants Res. 2019;30:1076–1084. doi: 10.1111/clr.13521.
    1. Van Assche N, Michels S, Quirynen M, Naert I. Extra short dental implants supporting an overdenture in the edentulous maxilla: a proof of concept. Clin Oral Implants Res. 2012;23:567–576. doi: 10.1111/j.1600-0501.2011.02235.x.
    1. Simões IÍN, Spyrides SMM, Schanuel FRS, De Mello EB. Comparative study of splinted and unsplinted implant-retained maxillary overdentures without palatal coverage: a literature review. Braz Dent Sci. 2017;20:32–41. doi: 10.14295/bds.2017.v20i4.1482.
    1. Zou D, Wu Y, Huang W, Zhang Z, Zhang Z. A 5- to 8-year retrospective study comparing the clinical results of implant-supported telescopic crown versus bar overdentures in patients with edentulous maxillae. Int J Oral Maxillofac Implants. 2013;28:1322–1330. doi: 10.11607/jomi.3100.
    1. Elsyad MA, Dayekh MA, Khalifa AK. Locator versus bar attachment effect on the retention and stability of implant-retained maxillary overdenture: an in vitro study. J Prosthodont. 2017;2:e627–e636.
    1. De Albuquerque Júnior RF, Lund JP, Tang L, Larivée J, de Grandmont P, Gauthier G, et al. Within subject comparison of maxillary long-bar implant-retained prostheses with and without palatal coverage: patient-based outcomes. Clin Oral Implants Res. 2000;11:555–565. doi: 10.1034/j.1600-0501.2000.011006555.x.
    1. Dudley J. Maxillary implant overdentures: current controversies. Aust Dent J. 2013;58:420–423. doi: 10.1111/adj.12116.
    1. Osman RB, Payne AG, Ma S. Prosthodontic maintenance of maxillary implant overdentures: a systematic literature review. Int J Prosthodont. 2012;25:381–391.
    1. Cakarer S, Can T, Yaltirik M, Keskin C. Complications associated with the ball, bar and Locator attachments for implant-supported overdentures. Med Oral Patol Oral Cir Bucal. 2011;16:e953–e959. doi: 10.4317/medoral.17312.
    1. Trakas T, Michalakis K, Kang K, Hirayama H. Attachment systems for implant retained overdentures: a literature review. Implant Dent. 2006;15:24–34. doi: 10.1097/01.id.0000202419.21665.36.
    1. Andreiotelli M, Strub JR. Prosthodontic complications with implant overdentures: a systematic literature review. Int J Prosthodont. 2010;23:195–203.
    1. Çehreli MC, Karasoy D, Kokat AM, Akça K, Eckert SE. Systematic review of prosthetic maintenance requirements for implant-supported overdentures. Int J Oral Maxillofac Implants. 2010;25:163–180.
    1. Kiener P, Oetterli M, Mericske E, Mericske-Stern R. Effectiveness of maxillary overdentures supported by implants: maintenance and prosthetic complications. Int J Prosthodont. 2001;14:133–140.
    1. Visser A, Raghoebar GM, Meijer HJA, Vissink A. Implant retained maxillary overdentures on milled bar suprastructures: a 10-year follow-up of surgical and prosthetic care and aftercare. Int J Prosthodont. 2009;22:181–192.
    1. Widbom C, Söderfeldt B, Kronström M. A retrospective evaluation of treatments with implant-supported maxillary overdentures. Clin Implant Dent Relat Res. 2005;7:166–172. doi: 10.1111/j.1708-8208.2005.tb00061.x.

Source: PubMed

スポンサーと協力者

医学的状態

薬物療法

3
購読する