ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Best Attachment For An Implant-Supported Over-Denture Is One Retained By Two Implants With A Single Bar
Clinical Question Is there a specific attachment that provides improved patient satisfaction with implant-supported over-dentures?
Clinical Bottom Line Based on patient satisfaction, the best treatment option for an implant-supported mandibular over-denture is one retained with two implants and a single bar.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 15271972Timmerman / 2004110 edentulous patientsRandomized Controlled Trial
Key resultsThree treatment groups were tested: tissue-retained over-denture on two implants with ball attachments, a combined tissue-implant-retained over-denture on two implants with a single bar, and an implant-retained over-denture on four implants with a triple bar. Patient satisfaction was based on retention and stability not the degree of retention. Highest satisfaction was found in patients treated with an implant-retained over-denture with two implants and a single bar. Patients that received treatment with two implants and ball attachments were less satisfied over time when compared to the other treatment groups (p = 0.008). Patients were evaluated 3 times: baseline, 19 months, and 8.3 years after delivery of denture.
Evidence Search (“Dental Prosthesis, Implant-Supported” [Mesh] AND “Denture Precision Attachment” [Mesh] AND “Dentures” [Mesh] AND Randomized Controlled Trial [ptyp]
Comments on
The Evidence
The length of the follow up in this study (8.3 years) seems sufficient to take into account wear and tear of precision attachments as well as adjustment to a new prosthetic device. The subjects were referred patients that were having issues with their conventional dentures. This is representative of patients that would be referred for implant supported dentures. Patient satisfaction was based on retention and stability, not degree of retention.
Applicability From a cost-perspective, this would be relevant in treatment planning a patient for treatment that would provide highest patient satisfaction while taking into account what would be cost-effective to the patient (i.e. 2 implants vs. 4).
Specialty/Discipline (General Dentistry) (Prosthodontics)
Keywords Precision attachments, dentures, implant-supported dentures, patient satisfaction
ID# 2080
Date of submission: 08/03/2011spacer
E-mail dominessy@livemail.uthscsa.edu
Author Cynthia Dominessy
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author S. Thomas Deahl, II, DMD, PhD
Faculty mentor/Co-author e-mail DEAHL@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
post a comment
by Kaylee Denton and Kristina Orquiz (San Antonio, TX) on 11/28/2017
A PubMed search conducted in November, 2017 yielded two systematic reviews: Kim et al. 2012 (PMID 23236571) and Lee et al. 2012 (PMID 2323657. These reviews concluded that neither the number of implants nor the type of attachment system, statistically affected patient satisfaction. Additionally, Mahoorkar 2016 (PMID: 27134432) performed a literature review regarding single implant retained mandibular over dentures that demonstrated equally acceptable patient satisfaction between single and two implant retained over dentures via 7 clinical studies. This new research changes the previously published answer to the clinical question since there is not a single attachment system nor a certain number of implants that shows higher patient satisfaction.
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