University of Groningen

Maxillary overdentures on dental implantsBoven, Geessien Catharina

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Publication date:2018

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Citation for published version (APA):Boven, G. C. (2018). Maxillary overdentures on dental implants. [Groningen]: Rijksuniversiteit Groningen.

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Improving masticatory performance, bite force,

nutritional state and patient satisfaction with implant

overdentures: a systematic review.

This chapter is an edited version of the manuscript:Boven GC, Raghoebar GM, Vissink A, Meijer HJAImproving masticatory performance, bite force, nutritional state and patient’s satisfaction with implant overdentures: a systematic review of the literature. J Oral Rehabil. 2015 Mar;42(3):220-33. doi: 10.1111/joor.12241. Epub 2014 Oct 13.

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AbstractBackground Oral function with removable dentures is improved when dental implants are used for support. A variety of methods is used to measure change in masticatory performance, bite force, patient satisfaction and nutritional state. A systematic review describing the outcome of the various methods to assess patients’ appreciation has not been reported.Objectives The objective is to systematically review the literature on the possible methods to measure change in masticatory performance, bite force, patient satisfaction and nutritional state of patients with removable dentures and to describe the outcome of these.Data sources Medline, Embase and The Cochrane Central Register of Controlled Trials were searched (last search July 1, 2014). The search was completed by hand to identify eligible studies. Two reviewers independently assessed the articles.Study eligibility criteria Articles should be written in English. The study design should be prospective. The outcome should be any assessment of function/satisfaction before and at least one year after treatment. Eligible participants Fully edentulous subjects.Interventions Any kind of root-form implant(s) to support a mandibular and/or maxillary overdenture.Results 53 out of 920 found articles fulfilled the inclusion criteria. A variety of methods was used to measure oral function; mostly follow-up was one year. Most studies included mandibular overdentures, three studies included maxillary overdentures. Implant-supported dentures were accompanied by high patient satisfaction with regard to denture comfort, but this high satisfaction was not always accompanied by improvement in general quality of life and/or health related quality of life. Bite force improved, masseter thickness increased and muscle activity in rest decreased. Patients could chew better and eat more tough foods. No changes were seen in dietary intake, BMI and blood markers. Improvements reported after one year apparently decreased slightly with time, at least on the long run. Conclusions Treating complete denture wearers with implants to support their denture improves their chewing efficiency, increases maximum bite force and clearly improves satisfaction. The effect on quality of life is uncertain and there is no effect on nutritional state.

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IntroductionMissing teeth, which are not replaced with prosthesis, result in a poor quality of life comparable with the effects of cancer and renal disease on physical well-being scales (1). When patients are provided with conventional dentures (CDs), improvements are reported with regard to overall satisfaction, aesthetics, comfort and speech, while the improvement in functional outcomes is often unsatisfactory (2). Usually, the functional outcome and patient satisfaction is increased when implants are placed to retain the mandibular (3) and/or maxillary (4) denture. Many studies on patients’ appreciation of implant overdentures (IODs) use questionnaires to rate whether patients are satisfied with the current situation or not (5-7). For this purpose, a wide variety of questionnaires is available, either validated (8-12) or non-validated (13, 14). In addition, treatment effect of IODs is measured with testing chewing efficacy, bite force, muscle activity and muscle anatomy. The assumption is made that improvement in these items also reflects greater patient satisfaction (13, 15, 16).

Reviews on certain aspects of patients’ appreciation of treatment with implant-supported overdentures are available. For patient satisfaction reviews were done to assess dentist- and patient-mediated preferences (17), the efficacy of mandibular IODs from the patient’s perspective (18), a comparison between treatment with CDs and IODs in elderly patients (19), the outcome in terms of (oral health related) quality of life (QoL) (20), and to assess the association between the oral health status and health related QoL (21). For the restoration of the edentulous mandible with IODs or CDs there is an accumulating body of evidence on the effect of treatment choice. Providing edentulous patients with implant-supported complete dentures contributed to improved health related QoL. Some articles show a significant association between oral health status and health related QoL. Although mandibular IODs may be more satisfying for edentulous patients than new CDs, the magnitude of the effect is still uncertain. Even with implant treatment presenting higher patient satisfaction and improvement of quality of life, it was not possible to establish a direct comparison between studies due to differences in adopted methodologies. Better designed, long-term studies are required to further explore differences in patient acceptance to each treatment intervention (CD, IOD, fixed prosthesis) for the edentulous mandible.

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Evidence suggests that edentulous individuals lack specific nutrients and, as a result, may be at risk for various health disorders. Some reviews about the effect of treating edentulous subjects with IODs or CDs on nutritional and physical state (22, 23) are done. The effect on the nutritional state in edentulous subjects treated with implant therapy is similar to the one obtained with conventional removable dentures. This is not an optimum nutritional state, which also depends on other factors not related to prosthodontics treatment. The authors (24, 25) suggest that mandibular prostheses supported by two implants might offer a solution to the lack of intake of healthy, hard-to-chew foods by people wearing CDs.

A lot of different questionnaires and different ways of measuring function as a parameter of satisfaction are reported. A systematic review describing the outcome of the various methods to assess patients’ appreciation has not been reported. Therefore, the aim of the present systematic review on edentulous patients treated with IODs is to assess patients’ appreciation of the situation before and after treatment after an observational period of at least one year with respect to satisfaction, chewing (patterns), bite force and nutritional state measured by various methods.

MethodsInformation sources and search strategyA thorough search of the literature was conducted and was completed on July 1, 2014. The primary database used was Medline (via PubMed). Additional databases used were Embase and The Cochrane Central Register of Controlled Trials. The search was supplemented by hand-searching (checking references of the relevant review articles and eligible studies for additional useful publications). The search strategy was a combination of MesH terms and free text words. The strategy has been depicted in table 1.

Eligibility criteriaThe studies had to meet the following requirements:

• Type of participants Patients who received an implant-retained mandibular and/or maxillary IOD replacing a CD.• Types of intervention Placement of root-form implants to support a removable complete overdenture in de mandible and/or maxilla replacing a conventional complete denture. There were no

restrictions with respect to type of implant, number of implants,

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Table 1. Search strategy developed for Medline (via PubMed) and revised appropriately for each search databaseParameter Search StrategyOverdenture #1 "Dental Prosthesis, Implant-Supported"[Mesh] OR "Den-

ture, Overlay"[Mesh] #2 implant overdenture* OR implant-supported* OR implant-stabilized* OR implant-retain* OR overdentur* OR removable denture* OR removable prosthesis*

Conventional Denture #3 "Denture, Complete"[Mesh]#4 complete dentur* OR full dentur* OR conventional* OR edentulous*

Quality of life #5 "Quality of Life"[Mesh] #6 "quality of life"

Patient satisfaction

#7"Patient satisfaction"[Mesh]

#8 satisfact* OR “ satisfied” OR comfort*#9 "Treatment Outcome"[Mesh]

Ability to chew #10 "Mastication"[Mesh]#11 "chewing" OR "mastication" OR "masticatory"

Bite force #12 "Bite Force"[Mesh]#13 "biting" OR "bite force"

Identifying correct type of studies

#14 "Epidemiologic Studies"[Mesh] OR "Randomized Con-trolled Trial" [Publication Type] OR "Questionnaires"[Mesh]#15 random* OR "prospective" OR "longitudinal" OR "follow-up" OR questionnaire* OR measur* OR assess* OR survey* OR scale*

Excluding partial dentures, including partial palatal coverage

#16 partial*[tiab] NOT palatal*[tiab]

Search strategy (#1 OR #2) AND (#3 OR #4) AND (#5 OR #6 OR #7 OR #8 OR #9 OR #10 OR #11 OR #12 OR #13) AND (#14 OR #15) NOT #16

Last run data search 1 July 2014

attachment system, and immediate or conventional loading.• Comparison Outcomes should be a comparison between before and at least one year after treatment for the same patient.• Principle outcomes Principle outcome is from methods assessing changes of at least one of the following parameters: patient

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satisfaction (with a range of parameters); quality of life; oral health related quality of life; function (with a range of parameters); bite force; ability to chew; nutritional state; and any other parameters to measure whether the amount of initial complaints has changed.• Study design All types of prospective studies were considered for evaluation.

Inclusion criteria• Publications must be reporting in English.• Treatment of the patients has to be initially planned for an overdenture replacing a conventional complete denture.• Detailed information on IODs; in case of combined data for IODs and implant-supported fixed complete dentures, extraction of data for the overdentures must be eligible.• Measurements for the same patient must be done pre-treatment and after 1 year or longer.

Exclusion criteria• Less than 10 patients treated with overdentures.• Articles describing other studies.

Validity assessment and data extractionInitial screening of the abstracts was performed by one reviewer (GCB), based on the criteria above. Full-text documents were obtained for all articles meeting the inclusion criteria. Full text analysis was performed by two reviewers (GCB, HJAM) independently.

Methodological quality and risk of bias were assessed independently by the reviewers using specific study-design related checklists designed by the Dutch Cochrane Collaboration as described by Offringa et al. (26) for each of the obtained full text papers. Agreement was reached by a consensus discussion and if necessary, a third reviewer (GMR) was consulted.

ResultsStudy selectionThe results of the primary search for the period until 1 July 2014 was 917 hits for the Medline search, 194 hits for the Embase search and 109 hits for the Cochrane search (Fig. 1). Using this strategy, 1220 papers were initially

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identified, of which 276 articles appeared to be double and of which 31 were review articles and as such contained no new data. These papers were excluded.

Figure 1. Flow diagram study selection

After scanning of titles and abstracts a further 837 papers were excluded because they didn’t meet the inclusion- and exclusion criteria. This approach resulted in 76 papers to be evaluated by full-text analysis. The amount of excluded articles with reasons for exclusion is found in figure 1. Reference checking of relevant reviews and included studies revealed

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5 additional articles that met the criteria. The remaining 53 studies were filed electronically. The data were recorded and reported in annotated form (Table 2 (which can be found at the end of this chapter)).

Results of individual studiesOf all the studies found, most studies used patient satisfaction as a parameter (Table 2). A few were (also) evaluating chewing, bite force or other types of parameters. Most studies reported on mandibular overdentures, only three studies included maxillary overdentures. Generally an improvement in satisfaction was seen after treating patients with CDs with IODs.

Five of the seven studies on chewing reported improvement. All four studies that reported on bite force reported an increase in bite force. Chewing patterns seemed to improve, and no change in BMI and blood plasma levels was seen.

A summary of the studies and outcomes is given in table 2.

Chewing evaluationAll studies reporting on masticatory performance showed a higher increase after IOD treatment than after CD treatment. Patients were able to chew better (27, 28) needed less chewing cycles to reach the same result (15) and were able to eat more tough foods (29) after IOD treatment. One author (13) found no differences in mixing ability between patients treated with CDs or IODs.

Bite force evaluationTwo authors (13, 29) described an improvement of the average maximum bite force after IOD treatment and this improvement remained established after 10 years (15). However, the average maximum bite force obtained with IODs was still significantly lower than that of dentate subjects (16).

One-year patient satisfaction evaluationTreating CD wearers with IODs led to obvious improvements of patient satisfaction with their oral status as seen from custom made questionnaires (3, 4, 16, 30-48), the general satisfaction scores (4, 27, 33, 40, 44, 48-50), the Vervoorn questionnaires (also known as denture complaints

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questionnaire) (4, 48, 50, 51), the OHIP-20 (46, 52-54), the OHIP-EDENT (13, 55, 56), the McGills denture satisfaction questionnaire (57, 58), the self-reported denture satisfaction scale (13, 53, 59) and the patient denture complaint questionnaire (60). The improvement in satisfaction did not necessarily lead to improvement in general quality of life (32) or health related quality of life (46).

Two authors (32, 51) described improvement of psychological factors and less activity restriction for patients treated with implants to support their dentures. One author (57) described that patients are less satisfied with overdentures than with fixed bridges. However overdentures score better on ease of cleaning. The Short Form Health Survey with 36 questions (SF-36) (46), World health organization Well-being Index (WHO-Five) (46) and Brief Approach/Avoidance Coping Questionnaire (BACQ) (46) showed no difference between treatment with a CD or IOD.

Five-year patient satisfaction evaluationAs seen from the custom made questionnaires (37, 61-66), general satisfaction scores (63), verbal questions (29), the self-reported denture satisfaction score (59), OHIP-20 (59) and OHIP-14 (66) treating CD wearers with implants to support their dentures led to obvious improvements of patient satisfaction with their oral status. All authors described that improvements reached after one year are stable for the first five years.

One author (66) described that the amount of satisfaction of edentulous patients differs depending on prosthetic type. Patients rehabilitated with fixed prostheses obtained a generally higher level of satisfaction than patients wearing overdentures, except for the parameter for oral hygiene (halitosis and ease of cleaning).

Ten-year patient satisfaction evaluationThe improvement reached after one year was stable for the next ten years (67-70). If the mean satisfaction score of a treatment group was low at baseline, it stayed lower after treatment than the scores of groups receiving the same treatment with a higher satisfaction score at baseline (68).

Other evaluationsTwo authors (27, 71) described changes in mandibular movements after

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treatment. One author (27) reported an increase in the area covered and more harmonic and efficient chewing movement were seen by another author (71). Chewing muscle thickness increased after IOD treatment (13) and muscle activity during rest decreased (16). No (positive) changes in salivary flow (13), BMI (13, 60) blood markers (13, 60, 72) were seen.

No changes in dietary intake (13, 72) and energy distribution (14) were seen. However, those wearing IODs were significantly more likely to take in their nutrients through fresh, whole fruits and vegetables (72).

Synthesis of resultsNo outcome measures could be meaningfully combined, so no meta-analysis was carried out. DiscussionMajor findingsThis review attempted to identify published articles describing the effect of IOD therapy on elements of chewing efficacy, bite force, quality of life, patient satisfaction and other found functional outcomes. The focus of this article was to describe and summarize the outcome of the studies published so far.

Treating CD wearers with implants to support their dentures led to obvious improvements of patient satisfaction with their oral status as measured by questionnaires and interviews. One author found no improvement as measured by the SF-36, BACQ and the WHO-five. A part of the explanation for this might be that the SF-36 has limited construct validity for measuring oral health conditions, as stated by Allen et al. (73). This might also be true for the other questionnaires. The improvement in satisfaction did not necessarily lead to improvement in general quality of life or health related quality of life. The questionnaire used to measure quality of life, did not really focus on oral health, so it might be that the questionnaire can’t measure the impact on the general quality of health when the quality of oral health is improved.

For the parameter of chewing it was found that patients treated with IOD’s could chew better and eat more tough foods. Although patients could eat more tough foods (such as raw fruit, vegetables, nuts, etc.), an IOD didn’t

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seem to improve dietary intake as measured by interviews, questionnaires and blood samples. A diet is a habit and it seems that by just improving the dental situation, the dietary habit does not change. In one article (13) no improvement in chewing efficiency was found, the explanation given was that they reused the existing dentures with abraded denture teeth. Because their treatment group existed of very old adults, also age-related decline of motor coordination could have contributed to this fact. Remarkably is the loss to follow up of 56% after 12 months in the CD group, this contributes to the questionability of the results of this study.

As expected, bite force improved after IOD treatment. Because of more usage and training of the m. masseter the thickness increased. Muscle activity in rest decreased, because there was no longer a need to stabilize the loose denture.

Improvements reached after one year seemed to decrease slightly but were stable over time, at least for 10 years.

LimitationsEven though there is a large amount of articles available about patients with CDs treated with IODs, almost all of these articles are about mandibular overdentures. In this review we included only three studies on maxillary overdentures. Thus, conclusions are based mostly on data about mandibular overdentures and might not be applicable for maxillary overdentures. Next to this only a few articles have a follow-up of longer than one year. So, long-term results are based on a small amount of data. Also the methods used in the reviewed studies are various, therefore it is only partly possible to compare the results of the different studies.

Comparison with existing reviewsIn literature various authors (23-25) suggested that mandibular prostheses supported by only 2 implants offer a solution to the lack of intake of healthy, hard-to-chew foods by people wearing CDs. In the articles described in this systematic review no changes in energy distribution and dietary intake were seen. This was also described in the reviews done by Thomason et al. (20) and Sánchez-Ayala et al. (22). Thomason et al. (20) described that without tailored dietary advice, prosthetic rehabilitation didn’t necessarily result in a satisfactory diet. They suggested a relationship

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between QoL and dietary selection, which might be justifiable, because in this systematic review it is found that QoL does not always improve after rehabilitation. Naito et al. (21) did a review on the relationship between satisfaction and quality of life and found 3 articles that confirmed an improvement in QoL after improving the oral health status and 4 that didn’t confirm it. This seemed to show that the magnitude of the improvement in QoL is uncertain. Maybe there is some improvement, but no valid data is available due to measuring methods which are not appropriate for measuring the improvement in QoL. Even though an improvement in QoL is not certain, the improvement in satisfaction is obvious. This is in line with the conclusion of Thomason et al. (20) and Assunção et al. (19). Emami et al. (18) described that an improvement in satisfaction was seen, but the magnitude was uncertain. This might be due to poor possibilities to compare the results of individual studies because of all the different measuring methods used.

Conclusions and implicationsTreating complete denture wearers with implants to support their denture improves their chewing efficiency, increases maximum bite force and it clearly improves satisfaction. The effect on quality of life is uncertain.

There is little research about maxillary overdentures, so the results of this systematic review are mainly related to mandibular IODs. Because the overwhelming amount of research done on mandibular overdentures with a follow-up of one year, future research should focus on long term results and more on maxillary overdentures.

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Tabl

e 2.

Cha

ract

eristi

cs o

f inc

lude

d st

udie

s.Fi

rst a

utho

rYe

arGr

oups

Sam

ple

size

Follo

w-u

p in

mon

ths

Chew

ing

Bite

fo

rce

Patie

nt

satis

facti

onO

ther

Out

com

es

Benz

ing

(71)

1994

150,

6-4

1Ch

ewin

g pa

ttern

s,

man

dibu

-la

r bor

der

mov

emen

ts

+

Cune

(30)

1994

A (S

elec

ted

for i

mpl

ant

trea

tmen

t):

132

132

Grou

p A:

0,

12

Cust

om m

ade

ques

-tio

nnai

re

+

Boer

rigte

r (3

1)19

95IO

D, n

=32

320,

12

Cust

om m

ade

ques

-tio

nnai

re++

PPS,

n=2

9

0, 1

2

“+

CD, n

=29

0,

12

“

No

chan

geBo

uma

(32)

1997

IOD,

n=3

232

0, 1

2GA

RS-D

, PW

SoDP

, HS

CL, L

ASAM

, cus

tom

m

ade

ques

tionn

aire

+, n

o eff

ect o

n Q

oLPP

S, n

=29

0,

12

“

+, n

o eff

ect o

n Q

oLCD

, n=2

9Ra

ghoe

bar

(61)

20

00IO

D, n

=32

320,

12,

60

Cust

om m

ade

ques

-tio

nnai

re++

PPS,

n=2

90,

12,

60

“+

30

2

Tabl

e 2.

(con

tinue

d)Fi

rst a

utho

rYe

arGr

oups

Sam

ple

size

Follo

w-u

p in

mon

ths

Chew

ing

Bite

fo

rce

Patie

nt

satis

facti

onO

ther

Out

com

es

CD, n

=29

0, 1

2, 6

0

“

+

Ragh

oeba

r (6

7)20

03IO

D, n

=32

320,

12,

60,

12

0

Cu

stom

mad

e qu

es-

tionn

aire

++

PPS,

n=2

8

0, 1

2, 6

0,

120

“

+

CD, n

=30

0,

12,

60,

12

0

“

+

Boer

rigte

r (3

3)19

95IO

D, n

=91

910,

12

Cust

om m

ade

ques

-tio

nnai

re, g

ener

al

satis

facti

on sc

ore

(0-1

0)

+*

CD, n

=60

0,

12

“

Geer

tman

(3

4)IO

D, n

=91

910,

12

Cust

om m

ade

ques

-tio

nnai

re in

cl. c

hew

-in

g ab

ility

que

stion

s

+*

CD, n

=60

0,

12

“

Bu

rns (

35)

1995

17

0, 1

wee

k,

6, 1

2

Cu

stom

mad

e qu

es-

tionn

aire

+

Cord

ioli

(62)

1997

21

0, 1

, 6, 1

8,

36, 4

8, 6

0

Cu

stom

mad

e qu

es-

tionn

aire

+

31

2

Tabl

e 2.

(con

tinue

d)Fi

rst a

utho

rYe

arGr

oups

Sam

ple

size

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w-u

p in

mon

ths

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ing

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fo

rce

Patie

nt

satis

facti

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ther

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com

es

Wism

eije

r (3

6)19

972

impl

/bal

l, n=

3611

00,

16

Cust

om m

ade

ques

-tio

nnai

re

+

2 im

pl/b

ar,

n=37

0,

16

“

+

4 im

pl/b

ar,

n=37

0,

16

“

+

Tim

mer

man

(3

7)20

042

impl

/bal

l, n=

3611

00,

19,

100

Cust

om m

ade

ques

-tio

nnai

re

+

2 im

pl/b

ar,

n=37

0,

19,

100

“

++

4 im

pl/b

ar,

n=37

0,

19,

100

“

++

Garr

et (2

8)19

98IO

D, n

=62

620,

6, 2

4Sw

allo

win

g th

resh

old

++

CD, n

=40

0,

6, 2

4“

+

Kapu

r (3)

1999

IOD,

n=6

262

0, 6

, 24

Cust

om m

ade

ques

-tio

nnai

re

++

CD, n

=40

0,

6, 2

4

“

+

Pera

(27)

1998

12

0, 1

2Te

st fo

od

+

32

2

Tabl

e 2.

(con

tinue

d)Fi

rst a

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arGr

oups

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ple

size

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ths

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nt

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es

Gene

ral s

atisf

actio

n sc

ore

(0-1

0)

+**

Size

and

sh

ape

of

chew

ing

cycl

es

+

Mei

jer (

63)

1999

IOD,

n=6

161

0, 1

2, 6

0

Cu

stom

mad

e qu

es-

tionn

aire

, gen

eral

sa

tisfa

ction

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e (1

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+*

CD, n

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0,

12,

16

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eije

r (68

)20

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61

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0,

120

Cust

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ques

-tio

nnai

re, g

ener

al

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facti

on sc

ore

(0-1

0)

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CD, n

=60

(afte

r 60

mon

ths

24

patie

nts

elec

t-ed

to

rece

ive

impl

ants

)

0, 1

2, 6

0,

120

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33

2

Tabl

e 2.

(con

tinue

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rst a

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oups

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es

Land

a (3

8)20

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2

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stom

mad

e qu

es-

tionn

aire

+

Bakk

e (2

9)20

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0, 3

, 12,

60

Chew

ing

abili

ty

+

max

i-m

um

bite

fo

rce

+

Verb

al q

uesti

ons

+

Elec

tro-

myo

grap

hic

activ

ity

+

Wal

ton

(39)

2002

670,

1, 1

2

Cu

stom

mad

e qu

es-

tionn

aire

, gen

eral

sa

tisfa

ction

scor

e (0

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+

Mac

Ente

e (4

0)20

05BA

R, n

=34

680,

1, 1

2,

24

Cu

stom

mad

e qu

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tionn

aire

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eral

sa

tisfa

ction

scor

e (0

-100

)

+

BALL

, n=3

4

0, 1

, 12,

24

“

+

34

2

Tabl

e 2.

(con

tinue

d)Fi

rst a

utho

rYe

arGr

oups

Sam

ple

size

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ths

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ing

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fo

rce

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nt

satis

facti

onO

ther

Out

com

es

Stel

lings

ma

(51)

2003

TMI,

n=20

600,

12

Verv

oorn

que

stion

-na

ire, g

ener

al sa

tis-

facti

on sc

ore

(0-1

0),

GARS

-D, P

WSo

DP

++

AUG,

n=2

0

0, 1

2

“

+

SHO

RT,

n=20

0,

12

“

++

Attar

d (5

2)20

06

350,

12

The

self-

repo

rted

de

ntur

e sa

tisfa

ction

sc

ale,

OHI

P-20

+

Van

der B

ilt

(74)

2006

18

0, 3

, 6, 1

2

Jaw

mus

cle

activ

ityN

o ch

ange

, ne

w u

n-su

ppor

ted

dent

ure

low

er

activ

ityVa

n de

r Bilt

(1

5)20

1018

0, 3

, 6, 1

2,

120

Mas

ticat

ory

perf

orm

ance

+

Max

i-m

um

bite

fo

rce

+

35

2

Tabl

e 2.

(con

tinue

d)Fi

rst a

utho

rYe

arGr

oups

Sam

ple

size

Follo

w-u

p in

mon

ths

Chew

ing

Bite

fo

rce

Patie

nt

satis

facti

onO

ther

Out

com

es

Zitz

man

n (4

1)20

062

impl

/bal

l, n=

2060

0, 6

, 36

Cust

om m

ade

ques

-tio

nnai

re

+

4 im

pl/b

ar,

n=20

0,

6, 3

6

“

+

CD, n

=20

0,

6, 3

6

“

+

Lidd

elow

(4

2)20

07

280,

3, 1

2

Cu

stom

mad

e qu

es-

tionn

aire

+

Lidd

elow

(4

3)20

10

350,

3, 1

2,

36

Cu

stom

mad

e qu

es-

tionn

aire

+

Coop

er (6

4)20

0859

0, 1

2, 6

0

Cu

stom

mad

e qu

es-

tionn

aire

+

Pan

(57)

2008

IOD,

n=1

2812

80,

6, 1

2

M

cGill

Den

ture

satis

-fa

ction

inst

rum

ent

+*

CD, n

=128

0,

6, 1

2

“

Alfa

dda

(59)

IM, n

= 35

350,

12,

60

The

self-

repo

rted

de

ntur

e sa

tisfa

ction

sc

ale,

OHI

P-20

+

CON

, n=4

2 (h

istor

ical

co

hort

)

6

0

“

+

Mei

jer (

69)

2009

2 im

pl,

n=30

600,

1, 5

, 12,

60

, 120

Cu

stom

mad

e qu

es-

tionn

aire

+

36

2

Tabl

e 2.

(con

tinue

d)Fi

rst a

utho

rYe

arGr

oups

Sam

ple

size

Follo

w-u

p in

mon

ths

Chew

ing

Bite

fo

rce

Patie

nt

satis

facti

onO

ther

Out

com

es

4 im

pl,

n=30

0,

1, 5

, 12,

60

, 120

“

+

Mei

jer (

70)

2009

IMZ,

n=3

090

0, 1

2, 6

0,

120

Cust

om m

ade

ques

-tio

nnai

re

+

BRA,

n=3

0

0, 1

2, 6

0,

120

“

+

ITI,

n=30

0,

12,

60,

12

0

“

+

Wal

ton

(44)

2009

1 im

pl,

n=42

860,

2, 1

2

Cu

stom

mad

e qu

es-

tionn

aire

, gen

eral

sa

tisfa

ction

scor

e (0

-100

)

+

2 im

pl,

n=44

0,

2, 1

2

“

+

Attar

d (5

3)20

10

150,

12

The

self-

repo

rted

de

ntur

e sa

tisfa

ction

sc

ale,

OHI

P-20

+

Burn

s (45

)20

11

300,

6, 1

2,

18, 2

4, 3

0,

36

Cust

om m

ade

ques

-tio

nnai

re in

cl. c

hew

-in

g ab

ility

que

stion

s

+

Da S

ilva

(16)

2011

16

0, 3

, 15

m

axi-

mum

bi

te

forc

e

+

37

2

Tabl

e 2.

(con

tinue

d)Fi

rst a

utho

rYe

arGr

oups

Sam

ple

size

Follo

w-u

p in

mon

ths

Chew

ing

Bite

fo

rce

Patie

nt

satis

facti

onO

ther

Out

com

es

Cu

stom

mad

e qu

es-

tionn

aire

+

Elec

tro-

myo

grap

hic

activ

ity

+

Al-Z

ubei

di

(65)

2012

10

60,

1, 1

2,

36, 6

0

Cu

stom

mad

e qu

es-

tionn

aire

+

Awad

(72)

2012

CD, n

=127

128

0, 6

, 12

Chew

ing

abili

ty a

nd

habi

ts q

ues-

tionn

aire

fo

od

prep

a-ra

tion,

ab

ility

to

chew

; no

chan

geIO

D, n

=128

0,

6, 1

2“

+

Bloo

d pl

as-

ma

leve

ls-

for

bot

h gr

oups

Butte

l (49

)20

12

200,

6, 2

4

Ge

nera

l sati

sfac

tion

scor

e (0

-10)

+

Gjen

geda

l (1

4)20

13IO

D, n

=30

300,

3, 2

4

Cu

stom

mad

e qu

es-

tionn

aire

, SF-

36,

WHO

-five

wel

l-bei

ng

inde

x, B

ACQ

, OHI

P-20

++

, HRQ

oL

no c

hang

e

RCD,

n=3

0

0, 3

, 24

“

+, H

RQoL

no

cha

nge

38

2

Tabl

e 2.

(con

tinue

d)Fi

rst a

utho

rYe

arGr

oups

Sam

ple

size

Follo

w-u

p in

mon

ths

Chew

ing

Bite

fo

rce

Patie

nt

satis

facti

onO

ther

Out

com

es

Gjen

geda

l (4

6)

Cu

stom

m

ade

ques

-tio

nnai

re

abou

t foo

d av

oida

nce,

di

etar

y in

take

as-

sess

men

t by

tele

phon

e in

terv

iew

s

+*

Guljé

(50)

2012

12

0, 1

2

Ve

rvoo

rn q

uesti

on-

naire

, ove

rall

satis

fac-

tion

rate

(0-1

0)

+

Jabo

ur (5

4)20

12CD

, n=6

885

0, 1

2, 2

4

O

HIP-

20

+

IOD,

n=8

5

0, 1

2, 2

4

“

++

Kren

nmai

r (5

8)20

12

200,

3, 6

, 12

McG

ill D

entu

re sa

tis-

facti

on in

stru

men

t

+

Kron

stro

m

(55)

2012

1 im

pl,

n=17

360,

12,

36

OHI

P-ED

ENT

+

2

impl

, n=9

0,

12,

36

“

+

Mar

tinez

- G

onzá

lez

(66)

2013

IOD,

n=2

020

0, 1

2, 2

4,

60

O

HIP-

14, c

usto

m

mad

e qu

estio

nnai

re

++

39

2

Tabl

e 2.

(con

tinue

d)Fi

rst a

utho

rYe

arGr

oups

Sam

ple

size

Follo

w-u

p in

mon

ths

Chew

ing

Bite

fo

rce

Patie

nt

satis

facti

onO

ther

Out

com

es

FIX,

n=2

0

0, 1

2, 2

4,

60

“

+

Jofr

e (5

6)20

13CD

, n=1

515

0, 1

2

O

HIP-

EDEN

T

+

SDI,

n=15

0,

12

“

++Kh

oo (6

0)20

13

430,

3, 6

, 12

Patie

nt d

entu

re c

om-

plai

nt q

uesti

onna

ire

After

new

CD

+, a

fter

IOD

++

BMI,

Seru

m

albu

min

le

vels

No

chan

ge

Mal

mst

rom

(4

7)20

13

500,

2 w

k.,

3, 1

2, 2

4

Cu

stom

mad

e qu

es-

tionn

aire

+

Mül

ler (

13)

2013

IOD,

n=1

616

0, 3

, 12

Mix

ing

abili

-ty

test

N

o ch

ange

CD

, n=1

8

0, 3

, 12

“

No

chan

ge

M

axi-

mum

vo

lun-

tary

bi

te

forc

e

+ fo

r IO

D gr

oup

The

self-

repo

rted

de

ntur

e sa

tisfa

ction

sc

ale,

OHI

P-ED

ENT

+*

40

2

Tabl

e 2.

(con

tinue

d)Fi

rst a

utho

rYe

arGr

oups

Sam

ple

size

Follo

w-u

p in

mon

ths

Chew

ing

Bite

fo

rce

Patie

nt

satis

facti

onO

ther

Out

com

es

BM

I, M

ini

Nut

rition

al

Asse

ss-

men

t, Bl

ood

mar

kers

, M

asse

ter

thic

knes

s,

saliv

a flo

w.

BMI –

bl

ood

mar

ker,

nutr

ition

al

asse

ss-

men

t, sa

liva

flow

no

cha

nge

in b

oth

grou

ps,

mas

sete

r th

ickn

ess

+ fo

r IO

D gr

oup

Slot

(48)

2013

4 im

pl,

n=33

660,

12

Chew

ing

abili

ty q

ues-

tionn

aire

, Ver

voor

n qu

estio

nnai

re, O

vera

ll sa

tisfa

ction

scor

e (0

-10)

+

6

impl

, n=

33

0, 1

2

“

+

41

2

Tabl

e 2.

(con

tinue

d)Fi

rst a

utho

rYe

arGr

oups

Sam

ple

size

Follo

w-u

p in

mon

ths

Chew

ing

Bite

fo

rce

Patie

nt

satis

facti

onO

ther

Out

com

es

Slot

(4)

2013

4 im

pl,

n=25

500,

12

Chew

ing

abili

ty q

ues-

tionn

aire

, Ver

voor

n qu

estio

nnai

re, O

vera

ll sa

tisfa

ction

scor

e (0

-10)

+

6

impl

, n=

25

0, 1

2

“

+

* In

com

paris

on w

ith th

e ot

her t

reat

men

t gro

up;

** T

he d

egre

e of

satis

facti

on w

as co

rrel

ated

nei

ther

to in

crea

sed

mas

ticat

ory

effici

ency

nor

to im

prov

ed o

ral f

uncti

on;

+: so

me

impr

ovem

ent a

fter t

reat

men

t; ++

: muc

h im

prov

emen

t afte

r tre

atm

ent;

-: Th

e sit

uatio

n aft

er tr

eatm

ent i

s wor

se th

an b

efor

e;Ab

brev

iatio

ns G

ARS-

D: G

roni

ngen

Acti

vity

Res

tric

tion

Scal

e–De

ntist

ry; P

WSo

DP: P

sych

olog

ical

Wel

l-bei

ng S

cale

for D

entu

re P

atien

ts; H

SCL:

Hop

kins

Sym

ptom

Che

ck L

ist;

LASA

M: L

inea

r Ana

logu

e Se

lf-As

sess

men

t Met

hod,

One

-Item

Ver

sion;

OHI

P-20

: ora

l hea

lth im

pact

pro

file

– 20

que

stion

s; S

F-36

: sho

rt fo

rm 3

6-ite

m h

ealth

surv

ey; B

ACQ

: br

ief a

ppro

ach/

avoi

danc

e co

ping

que

stion

naire

; OHI

P-ED

ENT:

ora

l hea

lth im

pact

pro

file

– fo

r ede

ntul

ous p

atien

ts; O

HIP-

14: o

ral h

ealth

impa

ct p

rofil

e –

14 q

uesti

ons;

BM

I: bo

dy m

ass i

ndex

; CD:

conv

entio

nal d

entu

re; I

OD:

impl

ant o

verd

entu

re;

PPS:

Pre

-pro

sthe

tic su

rger

y; im

pl: i

mpl

ants

; BAR

: bar

supe

rstr

uctu

re; B

ALL:

bal

l sup

erst

ruct

ure;

TM

I: tr

ansm

andi

bula

r im

plan

ts; A

UG: a

ugm

enta

tion

befo

re p

laci

ng

impl

ants

; SHO

RT: t

reat

men

t with

four

shor

t im

plan

ts; C

ON

: con

venti

onal

load

ing

prot

ocol

; IM

: Im

med

iate

load

ing

prot

ocol

; IM

Z: IM

Z im

plan

t sys

tem

; BRA

: Brå

nem

ark

impl

ant s

yste

m; I

TI: I

TI im

plan

t sys

tem

; HRQ

oL: H

ealth

rela

ted

qual

ity o

f life

; RCD

: rel

inin

g of

conv

entio

nal d

entu

re; F

IX: fi

xed

supe

rstr

uctu

re; S

DI: S

mal

l dia

met

er im

plan

ts.

42

2

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43

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44

2

29. Bakke M, Holm B, Gotfredsen K. Masticatory function and patient satisfaction with implant-supported mandibular overdentures: a prospective 5-year study. Int J Prosthodont. 2002; 15: 575-581.

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32. Bouma J, Boerrigter LM, Van Oort RP, Sonderen E, Boering G. Psychosocial effects of implant-retained overdentures. Int J Oral Maxillofac Implants. 1997; 12: 515-522.

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34. Geertman ME, Boerrigter EM, Van’t Hof MA, Van Waas MA, Van Oort RP, Boering G et al. Two-centre clinical trial of implant-retained mandibular overdentures versus complete dentures-chewing ability. Community Dent Oral Epidemiol. 1996; 24: 79-84.

35. Burns DR, Unger JW, Elswick RK,Jr, Giglio JA. Prospective clinical evaluation

of mandibular implant overdentures: Part II-Patient satisfaction and preference. J Prosthet Dent. 1995; 73: 364-369. 36. Wismeijer D, Van Waas MA, Vermeeren JI, Mulder J, Kalk W. Patient satisfaction with implant-supported mandibular overdentures. A comparison of three treatment strategies with ITI-dental implants. Int J Oral Maxillofac Surg. 1997; 26: 263-267.

37. Timmerman R, Stoker GT, Wismeijer D, Oosterveld P, Vermeeren JI, Van Waas MA. An eight-year follow-up to a randomized clinical trial of participant satisfaction with three types of mandibular implant-retained overdentures. J Dent Res. 2004; 83: 630-633.

38. Landa LS, Cho SC, Froum SJ, Elian N, Tarnow DP. A prospective 2-year clinical evaluation of overdentures attached to nonsplinted implants utilizing ERA attachments. Pract Proced Aesthet Dent. 2001; 13: 151-6; quiz 158.

39. Walton JN, MacEntee MI, Glick N. One-year prosthetic outcomes with implant overdentures: a randomized clinical trial. Int J Oral Maxillofac Implants. 2002; 17: 391-398.

40. MacEntee MI, Walton JN, Glick N. A clinical trial of patient satisfaction and prosthodontic needs with ball and bar attachments for implant-retained complete overdentures: three-year results. J Prosthet Dent. 2005; 93: 28-37.

41. Zitzmann NU, Marinello CP. Patient satisfaction with removable implant-supported prostheses in the edentulous mandible. Schweiz Monatsschr Zahnmed. 2006; 116: 237-244.

42.Liddelow GJ, Henry PJ. A prospective

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