ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Implant Retained Mandibular Over-dentures Show Higher Patient Satisfaction Than Conventional Dentures When Meeting Pre-Treatment Expectations
Clinical Question In an edentulous patient requiring dentures, do implant supported over-dentures provide better patient satisfaction than conventional dentures?
Clinical Bottom Line Implant retained mandibular over-dentures are more likely to meet patients’ expectations when compared to conventional dentures. The significance of the difference is not clear and more research needs to be done.
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) 19515032Emami / 2009Inclusion criteria: 7 randomized controlled trials with edentulous patients 18 yrs and older wearing max CD and man CD or man implant-retained overdenture with follow-up of at least 2 months. Exclusion criteria: randomized controlled trials without man CD for use as a control.Systematic review and meta-analysis
Key resultsType of prosthesis and patient satisfaction: “The pooled effect size was 0.80 [z = 3.56, 95% confidence intervals (CI) 0.36–1.24, P = 0.0004] in favor of the implant over-denture treatment. “Type of prosthesis and oral health-related quality of life: “When analyses were restricted to studies that included participants from the general population who were recruited via advertisement, the pooled effect size declined from -0.41 to -0.71 (z=4.37, 95% CI -1.03 to -0.39, P<0.0001), revealing significant post-treatment differences in favor of the implant over-denture treatment.” Type of prothesis and perceived general health: This was not tested in the majority of the articles. Only one article tested this and found no difference between the conventional denture and implant retained over-denture group. Generally, based on patient satisfaction or oral health-related quality of life, implant overdentures are favored over conventional dentures but the true magnitude of effect is uncertain. There is a lack of evidence on perceived general health related to the type of denture.
#2) 19093056Heydecke / 2008102 middle aged (35-65) and 60 senior (65-75) edentulous for at least 5 years and experienced denture wearers.Randomized Controlled Trial
Key resultsExpectations of both groups were high for treatment but higher in the implant over-denture group (P = 0.009). Post-treatment satisfaction was significantly lower than pre-treatment expectations with the conventional denture group (P = 0.036). Post-treatment satisfaction for the middle-aged implant over-denture group was greater. Post-treatment satisfaction in the senior implant over-denture group was lower but not significant. Generally, post-treatment satisfaction is higher in the implant over-denture group than the conventional denture group (the post-treatment meets the pre-treatment expectations).
Evidence Search "Patient Satisfaction"[Mesh] AND "Denture, Complete"[Mesh] AND "Dental Prosthesis, Implant-Supported"[Mesh]
Comments on
The Evidence
Emami: Included articles were all randomized controlled trials but there were a limited amount based on inclusion criteria. Unpublished data was clarified by confirmation with the author. Trials were completed at university dental clinics or hospitals with one trial completed at a Veterans Affairs Medical Center. Dentures were fabricated by prosthodontists or senior prosthodontic residents. Implant overdentures were of two types: clip and bar attachment or two ball attachments. Follow-up ranged from 2 months to 10 years. Heterogeneity includes: patient recruitment and characteristics, duration of follow-up, extent of withdrawals and handling of losses to follow-up. Double blinding was not accomplished in any article. More research needs to be accomplished to clarify the magnitude on differences in patient satisfaction between the two types of dentures. Heydecke: 2 consecutive randomized controlled trials completed. 6 month follow up.
Applicability Subjects of these studies were experienced denture wearers. For patients dissatisfied with conventional mandibular dentures, another viable treatment option would be implant supported over-dentures. This study is relevant to edentulous patients who require mandibular dentures.
Specialty/Discipline (General Dentistry) (Prosthodontics)
Keywords Dentures, implant supported over-dentures, denture overlay
ID# 2093
Date of submission: 09/23/2011spacer
E-mail dominessy@livemail.uthscsa.edu
Author Cynthia Dominessy, DDS
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)
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by Robert Edwards, Kelsey Reyes (San Antonio) on 11/28/2017
On 25 November 2017, PubMed was searched for "denture overlay," and a more recent systemic review (SR) and meta-analysis was found: Zhonghua, 2017, PMID #28482247. This CAT looked at pre-treatment expectations and post-treatment satisfaction; the findings of Zhonghua's SR in post-treatment satisfaction support the results of the CAT. In nine studies involving 769 cases, the oral health impact profile (OHIP) score was almost double for implant related treatments over conventional complete dentures (standardized mean difference of OHIP 1.63 compared to .87). A retrospective cohort study (Fernandez/2015; PMID #26034930) also supported the findings with a OHIP-20 questionnaire resulting in a lower impact on quality of life (19 vs 33) and higher satisfaction (8.3 vs 5.3) for implant treatments.
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