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Title Patient Satisfaction is Achieved Whether Mandibular Implant Overdentures Contain 2 or 4 Implants
Clinical Question In edentulous patients requiring mandibular implant overdentures with four implants, is patient satisfaction higher compared to those with two implants?
Clinical Bottom Line Patient satisfaction is high regardless of the number of implants in the mandibular overdenture. (See Comments on the CAT below)
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) 23236572Lee/2012Completely edentulous participants with opposing conventional maxillary complete denture.Systematic Review
Key resultsFour studies that compared 2 and 4 implant groups showed no statistical difference in patient satisfaction. Overall patient satisfaction is greater after prosthodontic treatment compared to before treatment, regardless of the number of implants placed.
#2) 23062145Roccuzzo/2012Patients > 18 years old; fully edentulous, with information regarding opposing dentition; presenting interproximal radiographic examination.Meta-Analysis and Systematic Review of randomized controlled trials
Key resultsPatient satisfaction, number of complications and bone loss are not statistically significant to number of implants in the mandibular overdenture. Meta-analysis was performed on proportion of implants lost (ranged from 0 to 7) and mean difference in bone loss (ranged from 0.1 to 1.75mm) with a confidence interval of 95%. No meta-analysis was done on patient satisfaction.
Evidence Search (("mandible"[MeSH Terms] OR "mandible"[All Fields] OR "mandibular"[All Fields]) AND ("denture, overlay"[MeSH Terms] OR ("denture"[All Fields] AND "overlay"[All Fields]) OR "overlay denture"[All Fields] OR "overdentures"[All Fields])) AND ("patient satisfaction"[MeSH Terms] OR ("patient"[All Fields] AND "satisfaction"[All Fields]) OR "patient satisfaction"[All Fields]) AND (number[All Fields] AND implants[All Fields])
Comments on
The Evidence
Validity: In Lee’s article, no meta-analysis was done due to insufficient implant survival-rate data. Roccuzzo’s study only included randomized controlled trials that were included all relevant criteria. It did not mention whether the individual studies were assessed for validity. Perspective: It is important to consider clinical success and survival rates, but also patient satisfaction. Both two and four implants are options for a mandibular overdenture, since the data does not show a statistical difference between the two. Ultimately, it is up to the clinician to discuss the options with the patient and decide which is the best option for each individualized situation, in terms of cost and maintenance.
Applicability With no statistical difference, both two and four implant mandibular overdentures will provide patient satisfaction in completely edentulous patients. Two implant mandibular overdentures will reduce patient cost and reduce dentist chair time. Four implant mandibular overdentures with a bar might reduce maintenance visits. Treatment planning must consider patient circumstances as well as the advantages and disadvantages of both implant options.
Specialty/Discipline (General Dentistry) (Oral Surgery) (Prosthodontics) (Restorative Dentistry)
Keywords Mandibular overdentures, patient satisfaction, dental implants, edentulous
ID# 2635
Date of submission: 02/25/2014spacer
E-mail horani@livemail.uthscsa.edu
Author Suzzane Horani
Co-author(s) e-mail
Faculty mentor/Co-author Concepcion Barboza, DDS
Faculty mentor/Co-author e-mail BarbozaArgue@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?)
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Comments and Evidence-Based Updates on the CAT
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by Robert Lemke, DDS, MD (San Antonio, TX) on 02/25/2014
Nice review. I have found this to generally be true in a clinical sense, however, do recall an article that showed significantly less bone loss in the posterior when four implants were used over two. While the patients may not know differently, they preserve more of their mandible’s bone with four implants.

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