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Title The Use of Splinted or Unsplinted Attachment Systems Do Not Affect the Biological or Prosthetic Success of Implant Overdentures
Clinical Question In patients receiving implant-retained/supported overdentures (P), does the choice of attachment type between splinted (I) and unsplinted attachment systems (C) affect biological and prosthetic complications (O)?
Clinical Bottom Line The choice of attachment systems in patients receiving implant overdentures does not exert a discernible impact on clinical outcomes. This conclusion is supported by a systematic review and meta-analysis of multiple randomized controlled trials and a retrospective study. This finding can be applied to inform treatment decisions for patients receiving implant overdentures. Understanding that attachment systems have no substantial impact on clinical outcomes can simplify treatment choices and reduce potential complications in these cases.
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) 29761853Leao / 2018380 patients rehabilitated with implant overdentures; Completely edentulousMeta-Analysis
Key resultsThe meta-analysis found that there were no statistically significant distinctions between splinted and unsplinted attachment systems concerning three key parameters: marginal bone loss (P = .39; MD: -0.11; 95% CI: -0.37 to 0.14), complications (P = .31; RR: 1.26; CI: 0.80-1.99), and implant survival rate (P = .14; RR: 0.37% CI: 0.10-1.36).
#2) 30934037Lian / 201933 patients with maxillary edentulism rehabilitated with implant overdenturesRetrospective Study
Key resultsOver a 77-month follow-up, 5 out of 72 implants failed in the stud-retained group, resulting in a cumulative implant survival rate of 81.4%, and 2 out of 60 implants failed in the bar-retained group, resulting in a cumulative implant survival rate of 86.2%. Apart from a slightly higher modified Plaque Index (P = .035) in the bar-attached group, there were no significant differences between the two attachment groups in terms of implant survival rate, marginal bone loss, peri-implant clinical parameters, or prosthetic maintenance.
#3) 36115712Prasad / 2022477 studies, of which 25 RCT rehabilitated with mandibular implant overdenturesMeta-Analysis
Key resultsImplants and implant-supported mandibular overdentures demonstrated a high survival rate regardless of the attachment system employed, and splinting implants did not notably impact the rate of biological complications. The failure rate for bar-type retention was 7.7% (95% CI, 3.0 to 18.1), for magnetic retention systems was 7.6% (95% CI, 2.2 to 22.7), and for ball-type retention was 6.8% (95% CI, 3.0 to 14.3). (P=.902).
Evidence Search ((((implant overdentures) AND (attachment systems)) AND (biological complications)) AND (prosthesis complications)) AND (patient's satisfaction)
Comments on
The Evidence
Both studies exhibit strengths in their systematic review methodologies. Prasad et al. structured their inquiry using the PICO framework, ensuring a clearly focused question, and included a substantial number of randomized controlled trials (RCTs) for quantitative analysis, aligning with best practices for evaluating interventions. Their comprehensive search strategy across multiple databases and manual searches in relevant journals suggests a diligent effort to incorporate relevant studies. While they assessed the risk of bias, more detailed reporting of the quality assessment would enhance the assessment's robustness. In the case of Leao et al., the study rigorously addressed a focused question concerning attachment systems for overdentures. The inclusion of appropriate study designs such as RCTs, diligent database searches, and the use of quality assessment tools demonstrates their commitment to a methodologically sound review. The meta-analyses conducted in both reviews appear reasonable, with Leao et al. showcasing an understanding of the potential factors influencing their outcomes. However, the limited number of studies in both cases highlights the need for further research to substantiate the findings. Regardless, all studies arrived at the same conclusion that the choice of attachment type between splinted and unsplinted attachment systems did not affect biological and prosthetic complications.
Applicability For completely edentulous patients seeking rehabilitation with implant-supported or retained removable prostheses, the selection of the attachment system for the overdenture plays a pivotal role in treatment decisions. The choice between splinted and unsplinted attachments has significant implications for both the cost of treatment and restorative space requirements. Generally, splinted attachments tend to be more expensive and demand greater vertical restorative space. It is a common belief that the splinted attachment design provides superior clinical outcomes compared to unsplinted designs. However, based on the findings from the referenced studies, clinicians can confidently convey to patients that opting for overdentures with an unsplinted attachment design would not compromise the quality of their prosthesis. This information aids in ensuring that patients make informed decisions about their treatment options.
Specialty/Discipline (General Dentistry) (Prosthodontics)
Keywords Complete Edentulism, Implant overdentures, Overdenture attachment systems, biological complications, prosthetic complications
ID# 3531
Date of submission: 10/16/2023spacer
E-mail kimj24@uthscsa.edu
Author Jaehyun Kim
Co-author(s) Destin Nguon
Co-author(s) e-mail nguond@uthscsa.edu
Faculty mentor/Co-author Kyumin Whang, PhD
Faculty mentor/Co-author e-mail whang@uthscsa.edu
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