Title Implant-Supported Mandibular Overdentures Provide a Better Oral Health-Related Quality of Life than Complete Mandibular Dentures in Very Old Patients
Clinical Question In frail geriatric patients, do complete dentures or implant-supported mandibular overdentures provide better quality of life?
Clinical Bottom Line Implant-supported mandibular overdentures provide a better oral health-related quality of life and oral functional status than complete mandibular dentures in elderly patients. However, the benefits to general health and quality of life are inconclusive.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
24158342Müller/2013 34 patients 75 years or older institutionalized or receiving help for daily living activities who have a mandibular denture problem.Randomized Controlled Trial
Key resultsPatients who received the implant overdenture (IOD) intervention had an improved oral health–related quality of life (OHRQoL) based on the Oral Health Impact Profile (OHIP)–EDENT (p < .035) compared to patients with mandibular complete dentures who received a conventional reline. Patients with IODs developed higher maximum voluntary bite forces (p < .0001), but the chewing efficiency did not improve (p > .059). Masseter muscle thickness on the preferred chewing side increased for patients with IODs but remained unchanged in the control group (p = .028). “The intervention had no influence on stimulated saliva flow rate.” There was a significant decrease in body mass index (BMI) for both groups (p = .049), but the decline was smaller in the intervention group. However, the blood markers and nutritional assessment did not follow this tendency.
Evidence Search ("Denture, Overlay"[Mesh] AND "Denture, Complete"[Mesh] AND "Aged, 80 and over"[Mesh]) AND "Quality of Life"[Mesh]
Comments on
The Evidence
Validity: This is a randomized controlled clinical trial to compare conventional denture and implant-supported mandibular overdenture interventions in an older frail cohort. Patients with IODs showed a better OHRQoL, higher maximal bite forces, thicker masseter muscle mass, and less BMI decline as compared to their denture reline counterparts. The interventions used existing complete dentures rather than remaking new dentures. The effect of the IOD intervention on QoL for new dentures in this study cohort is unclear. The lack of significance in chewing efficiency between the two interventions could be due to large individual variations or wear on the old denture teeth from abrasion. The study sample size is small and may not have enough statistical power to detect differences for all outcome measures, e.g., salivary flow rates, nutritional status, and blood markers. It is also worth noting that, in the 1-year follow-up period, 5 of 18 in the control group withdrew from the study (not satisfied) but none of IOD group (n=16) withdrew. This study demonstrated that the IOD intervention for older frail or ADL (activity of daily living)-dependent patients is feasible and may be beneficial for improving OHRQoL. Larger sample sizes with prospective and randomized controlled studies are required to determine whether IODs can improve overall health and quality of life.
Applicability IOD intervention for very old patients (>75 years old), even those who are frail and ADL-dependent, can be the treatment of choice. At the clinical level, selection of the size of the implant and the type of attachment is critical for the success of IOD intervention. Denture care for patients 75 and older is more difficult due to age-related decline in physical and mental health and muscle degeneration. As the geriatric population grows, it is important to understand which treatment options would benefit the elderly patient’s quality of life.
Specialty (General Dentistry) (Prosthodontics)
Keywords Dentures, implant-supported overdentures
ID# 3067
Date of submission 04/04/2016
E-mail back@livemail.uthscsa.edu
Author Mina Back
Co-author(s) e-mail
Faculty mentor Chih-Ko Yeh, BDS, PhD
Faculty mentor e-mail YEH@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?)
None available
Comments and Evidence-Based Updates on the CAT
None available