ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Mandibular Implant-Supported Overdentures Do Not Significantly Improve Masticatory Performance Over Conventional Complete Dentures In Diabetic Patients with Average Residual Ridge Heights
Clinical Question In patients with Type II diabetes mellitus, do implant supported mandibular overdentures improve masticatory efficiency when compared to complete dentures?
Clinical Bottom Line Although improvements in masticatory performance compared to entry dentures was greater in patients fitted with new implant-supported overdentures than conventional dentures, the difference in masticatory performance at 24 months post-treatment between the two treatments was not significant. The evidence is valid but most applicable to edentulous patients receiving Hader bar-clip implant supported overdentures.
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) 9627891Garrett/199889 edentulous patients with diabetes mellitus.Randomized Controlled Trial
Key resultsNo statistically significant difference was found between the masticatory performance scores (preferred side and swallowing threshold of peanuts and carrots) of conventional dentures and implant-supported overdentures at 24 months post treatment (p = 0.12; F = 1.92).
#2) 18061741Fueki/2007500 endentulous subjects across 7 studies fitted with a new mandibular IOD or CD and maxillary CD.Systematic Review of RCTs, prospective, and retrospective studies
Key resultsSubgroup analysis of data from Garrett found masticatory performance in subjects with average mandibular ridge heights (27 mm) is not significantly different for IOD (n=43, Effect Size=0.5, 95% CI [0.3-0.7]) or CD (n=25, ES=0.2, 95% CI [-0.1-0.4]) therapies; however, significant improvements in masticatory performance with IOD (n=11, ES=0.8, 95% CI [0.4-1.2]) compared to CD (n=6, ES=-0.3, 95% CI [-0.9-0.2]) are seen in patients with mandibular residual ridge heights less than 21 mm. Other RCTs and prospective and retrospective studies support the relationship between reduced residual ridge height and improved masticatory performance with implant overdentures compared to conventional complete dentures.
Evidence Search "Mastication"[Mesh] AND "Dental Prosthesis, Implant-Supported"[Mesh] AND "diabetes"[All Fields]
Comments on
The Evidence
Validity: The randomized study groups were similar at the start of the study and the study completion rate was good. All study patients received thorough clinical evaluations and received new maxillary and mandibular dentures. Study follow-up and patient compliance were adequate. Perspective: Diabetic patients with poorly fitting dentures would benefit significantly from either new conventional dentures or implant-supported overdentures. This report does not consider other aspects of a patient’s oral health quality.
Applicability The study was inclusive of all edentulous, well-controlled diabetic patients, including those patients satisfied with their original dentures. Both treatments provided, mandibular conventional dentures and implant-supported overdentures, are feasible in a general practice. A more recent systematic review of implant overdenture therapy in both diabetic and non-diabetic patients demonstrates significant improvement in masticatory performance in patients with resorbed mandibles and/or difficulty adapting to conventional mandibular complete dentures. More well-designed studies are necessary to provide stronger evidence and generalize these findings across both diabetic and non-diabetic populations.
Specialty/Discipline (General Dentistry) (Oral Surgery) (Periodontics) (Prosthodontics)
Keywords Implant supported overdenture, Diabetes mellitus, Mastication
ID# 2377
Date of submission: 04/04/2013spacer
E-mail eaddy@livemail.uthscsa.edu
Author Daniel B. Eaddy
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Thomas W. Oates, DMD, PhD
Faculty mentor/Co-author e-mail oates@uthscsa.edu
Basic Science Rationale
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