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Studies on maxillary overdentures: implant- and prosthesis survival, cost analysis and patient-reported outcomes
Malmö University, Faculty of Odontology (OD).ORCID iD: 0000-0001-6625-4482
2022 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Edentulism is a debilitating condition which may negatively affect quality of life, particularly in relation to nutritional and social health, speech, and poor facial appearance. Prosthetic options available range from conventional complete dentures to implant-supported overdentures (ISODs) and implant-supported full arch fixed partial dentures (ISFAFDPs). The choice of treatment is connected to the patient's general health, oral status, preferences and financial means. From the point of view of the treatment provider, there is a lack of evidence to support choice of treatment, as information from randomised clinical trials is sparse. This is particularly true when it comes to cost analysis and patient-reported outcome measures (PROMs). There is consensus today that an implant-supported overdenture is a valid treatment option for the edentulous mandible, but the same recommendation cannot be made for maxillary overdentures due to a lack of evidence.

The present study investigates implant-supported maxillary overdentures regarding implant and prosthesis survival, costs and PROMs in comparison to fixed implant-supported prostheses.

The thesis comprises four studies.Study I analysed implant and prosthesis failure rates with implant-supported maxillary overdentures in a systematic review. The cumulative survival rate (CSR) for the implants and the prostheses was 70.4% and 79.8%, respectively. The main finding was that patients with few implants presented higher prosthesis failure rates than patients with more implants per prosthesis.Of the most commonly used attachment systems, the ball/O-ring and the Ceka were the ones with the highest rates of patients with at least one implant failure. Most of the failures happened within the first year after installation for both implants (52.1%) and prostheses (41.8%).Study II, a retrospective analysis, compared the clinical outcomes of implantsupported overdentures (ISODs) with either bar-clip or ball attachments. The results showed that all ISOD failures resulted from loss of implants. The bar-clip system resulted in more complications than the ball attachment system, suggesting that ISODs with the bar-clip system may necessitate a greater number of appointments and chair time for adjustments, thus increasing the maintenance costs for the patient.Studies III and IV were based on a prospective clinical trial comparing different implant-supported prosthetic rehabilitations for the edentulous maxilla: implantsupported full-arch fixed partial dentures on 4 or 6 implants (ISFAFDP 4 orISFAFDP 6) versus maxillary overdentures on 2 implants.Study III is a comparative cost analysis, the results of which showed that all implants and restorations were in function at follow-up after the first year, i.e., the survival rate was 100%. Initial costs, i.e., cost of prostheses at delivery, were higher for ISFAFDP 6 and ISFAFDP 4 due to the higher number of implants and higher cost of materials and fees. There were no statistically significant differences in post-treatment costs between the groups.In study IV, patient-reported outcomes regarding aesthetics and function were compared. The results showed that all patients, irrespective of group, showed improved patient-reported outcomes from before treatment to the one-year follow-up. There were no significant differences between groups regarding functional status of the masticatory system (Jaw Functional Limitation Scale -JFLS parameters) or how patients perceive their dental and Orofacial Aesthetic Scale (OAS), and only minor differences between the two groups with fixed restorations regarding patients’ perception of the social impact of oral disorders on their well-being (Oral Health Impact Profile - OHIP).

Place, publisher, year, edition, pages
Malmö: Malmö University Press, 2022. , p. 64
Series
Doctoral Dissertation in Odontology
Keywords [en]
Prosthodontic, Dental Implants, Dental Prosthesis, Implant-Supported overdenture, cost analysis, Maxilla, Prosthesis Failure
National Category
Dentistry
Identifiers
URN: urn:nbn:se:mau:diva-56192DOI: 10.24834/isbn.9789178773213ISBN: 9789178773220 (print)ISBN: 9789178773213 (electronic)OAI: oai:DiVA.org:mau-56192DiVA, id: diva2:1712868
Public defence
2022-12-16, Aulafoajén på Odontologiska fakulteten, Carl Gustafs väg 34, 09:15
Opponent
Supervisors
Note

Note: The papers are not included in the fulltext online

Available from: 2022-11-23 Created: 2022-11-23 Last updated: 2024-03-01Bibliographically approved
List of papers
1. Implant and Prosthesis Failure Rates with Implant-Supported Maxillary Overdentures: A Systematic Review
Open this publication in new window or tab >>Implant and Prosthesis Failure Rates with Implant-Supported Maxillary Overdentures: A Systematic Review
2021 (English)In: International Journal of Prosthodontics, ISSN 0893-2174, E-ISSN 1139-9791, Vol. 34, no 4, p. 482-491kArticle in journal (Refereed) Published
Abstract [en]

Purpose: To assess the clinical outcomes of maxillary overdentures supported by dental implants by conducting a literature review. Materials and Methods: An electronic search was undertaken in March 2019. Eligibility criteria included publications reporting cases of implant-supported maxillary overdentures with follow-up information. Results: A total of 131 publications were included (1,478 overdentures supported by 6,681 implants). The mean number of attachments per overdenture was 3.8 ± 1.2 (range: 1 to 9), and a bar-clip system was used in about half of the cases. The prostheses were followed up for a mean of 47.9 ± 32.8 (range: 1 to 240) months. A total of 401 implants (6.0%) failed in 219 patients (14.8%), and 55 prostheses (3.7%) failed at a mean of 40.2 ± 53.2 (range: 6 to 240) months after placement. Most of the failures happened within the first year after placement for both implants (52.1%) and prostheses (41.8%). Patients with fewer implants per prosthesis presented higher prosthesis failure rates than patients with more implants per prosthesis. The cumulative survival rate for dental implants after 19 years was 70.4%, and for implant-supported maxillary overdentures was 79.8%. Presence of palatal coverage and/or metallic structure/reinforcement does not seem to have an influence on failure rate. Of the most commonly used attachment systems, the ball/O-ring and the Ceka were the ones with the highest rates of patients having at least one implant failure. Conclusion: Most of the prosthesis failures were due to loss of implants, and the first year was the most critical period for failures. The number of dental implants placed per patient seemed to have an impact on the occurrence of overdenture failure.

Place, publisher, year, edition, pages
Quintessence, 2021
Keywords
denture, human, implant-supported denture, maxilla, overlay denture, prosthesis complication, surgery, tooth implant, Dental Implants, Dental Prosthesis, Implant-Supported, Denture Retention, Denture, Overlay, Humans, Prosthesis Failure
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-48631 (URN)10.11607/ijp.6905 (DOI)000731320200011 ()33625390 (PubMedID)2-s2.0-85115445638 (Scopus ID)
Available from: 2021-12-28 Created: 2021-12-28 Last updated: 2023-01-02Bibliographically approved
2. Retrospective study comparing the clinical outcomes of bar-clip and ball attachment implant-supported overdentures
Open this publication in new window or tab >>Retrospective study comparing the clinical outcomes of bar-clip and ball attachment implant-supported overdentures
Show others...
2020 (English)In: Journal of Oral Science, ISSN 1343-4934, E-ISSN 1880-4926, Vol. 62, no 4, p. 397-401, article id 19-0412Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to compare the clinical outcomes of implant-supported overdentures (ODs) with either bar-clip or ball attachments. The implant, prosthesis failure, and technical complications were the outcomes analyzed in this retrospective clinical study conducted in a specialty clinic. Seventy-five patients with 242 implants supported by 76 ODs (36 maxillary, 40 mandibular) were included in the study and followed up for 88.8 ± 82.9 months (mean ± standard deviation). Bar-clip and ball attachments were used in 78.9% and 21.1% of the cases, respectively. Forty-three implant failures (17.8%) in 17 prostheses (17/76; 22.4%) were observed in this study. The average period of implant failure was 43.3 ± 41.0 months, and most of them were maxillary turned implants. The bar-clip system demonstrated more complications in the attachment parts compared to the ball attachment system. Poor retention of the prosthesis was similar between the two systems. Loss of implants resulted in the failure of 10 ODs in this study. ODs opposed by natural dentition or fixed prostheses presented with more complications. The Cox proportional hazards model did not show a significant effect on prosthesis failure for any of the factors. These findings indicated that patients with ODs need constant maintenance follow-ups to address the technical complications and perform prosthodontic maintenance regardless of the attachment system used.

Place, publisher, year, edition, pages
Tokyo Nihon University School of Dentistry, 2020
Keywords
Overdenture, dental implant, attachment, prosthodontic maintenance, failure
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-18133 (URN)10.2334/josnusd.19-0412 (DOI)000573430900010 ()32848099 (PubMedID)2-s2.0-85091647505 (Scopus ID)
Available from: 2020-08-27 Created: 2020-08-27 Last updated: 2024-02-05Bibliographically approved
3. Comparative cost analysis of different prosthetic rehabilitations for the edentulous maxilla: early results from a randomized clinical pilot study
Open this publication in new window or tab >>Comparative cost analysis of different prosthetic rehabilitations for the edentulous maxilla: early results from a randomized clinical pilot study
2022 (English)In: BDJ Open, E-ISSN 2056-807X, Vol. 8, no 1, article id 8Article in journal (Refereed) Published
Abstract [en]

Objectives/aim To analyze and compare costs of different prosthetic rehabilitations for the edentulous maxilla. Materials and methods Patients with edentulous maxillae were rehabilitated with either of three implant-supported prosthetic protocols; removable overdenture supported by 2 implants (ISOD 2), fixed dental prostheses supported by 4 (ISFAFDP 4) or 6 (ISFAFDP 6) implants. Cost of treatment and costs during follow-up were registered and compared. Results Twenty-four patients were included: six patients received ISOD 2 treatment, eight patients received ISFADP 4 treatment and ten patients received ISFADP 6 treatment. Initial costs for ISFAFDP 6 were higher than costs for ISFAFDP 4 and ISOD 2, but there were no differences in cost for maintenance i.e., the ISOD treatment remained the least costly treatment alternative after 1-year follow-up. Discussion The lack of difference in cost for maintenance and repair over the first year suggests that implant-supported overdentures will remain the least costly treatment option for the edentulous maxilla, at least in a short-term perspective. Conclusions Removable maxillary overdentures supported by 2 implants may be a valid low cost treatment option.

Place, publisher, year, edition, pages
Springer Nature, 2022
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-50902 (URN)10.1038/s41405-022-00100-0 (DOI)000772056500001 ()35318307 (PubMedID)2-s2.0-85126884159 (Scopus ID)
Available from: 2022-04-04 Created: 2022-04-04 Last updated: 2024-02-05Bibliographically approved
4. Comparison of patient-reported outcomes between immediately and conventionally loaded mandibular two-implant overdentures: early results from a randomized clinical pilot study
Open this publication in new window or tab >>Comparison of patient-reported outcomes between immediately and conventionally loaded mandibular two-implant overdentures: early results from a randomized clinical pilot study
2022 (English)Manuscript (preprint) (Other academic)
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-56190 (URN)
Available from: 2022-11-23 Created: 2022-11-23 Last updated: 2024-01-16Bibliographically approved

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