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Int Poster J Dent Oral Med 14 (2012), No. 3     15. Sep. 2012

Int Poster J Dent Oral Med 2012, Vol 14 No 3, Poster 616

FOUR-YEARS EVALUATION OF DIFFERENT RETENTION SYSTEMS FOR IMPLANT-SUPPORTED OVERDENTURES

Language: English
 

Authors:
Dr. PhD Corina Marilena Cristache, Dr. Gheorghe Cristache, E.N.T. Specialist, Dr. Cosmin Marian Circu,
Concordia Dent Clinic, Bucharest, Romania
Dr. PhD Alexandru Andrei Iliescu, Lecturer, Assoc. Prof. Dr. PhD Mihai Burlibasa,
University of Medicine and Pharmacy "Carol Davila", Faculty of Dental Medicine, Bucharest, Romania

Date/Event/Venue:
13-15 October 2011
The 20th Annual Scientific Meeting of the European Association of Osseointegration (EAO)
Athens, Greece

Poster Award
EAO Travel Grant

Introduction

The multitude of benefits to the edentulous population from mandibular two implant over-dentures is well known, overwhelming in improved function, emotional stability, physical health, and esthetics (1).
There is no strong evidence supporting a single standard of care concerning type of retention system in the edentulous mandible due to the fact that functional demands of edentulous patients are highly variable and the choice of treatment is strongly influenced by adaptive capacity, socio-cultural background and also by financial means (2).
 

Objectives

The aim of our study is to compare, in a prospective controlled clinical trial, the Locator System with two other types of retention (Retentive Anchors and Magnets) for implant supported over-denture in atrophic edentulous mandible, with the use of Straumann Dental Implant System.
 

Material and Methods

The study was divided in two parts – in the first part of the study 46 fully mandibular edentulous patients were enrolled (age 42-84 years, mean-60,6). Each patient received 2 screw-type Straumann standard implants Ø4.1mm, SLA surface in the canine region of the mandible, placed in a 1-stage non-submerged procedure according to a strict protocol (3). After 6-weeks healing period implants were early loaded (4) and the patients were randomly assigned to one of two main groups: Group B-23 patients received Retentive Anchors Fig. 1) (and Group M-23 patients received Magnets (Fig. 2). The two groups of patients were compared in the second part of the study with 23-patients (age 49-80 years, mean-65) receiving Locator system abutments (Group-L) (Fig. 3) following same research protocol (ClinicalTrials.gov Identifier: NCT01034930). A new mandibular over-denture with metal reinforcement was made (Fig. 4, 5, 6).
Total costs (5) of the surgical, prosthetic and maintenance procedure were calculated for the three attachment systems used after 48 months. Patient satisfaction was assessed with the aid of questionnaires validated and cross-cultural adapted for Romanian language (ClinicalTrials.gov Identifier: NCT01392456) from the Allen and Locker's index OHIP-EDENT (6), initial (before surgery-with the original denture) and at 1 and 4-years follow-up. OHIP-EDENT (Oral Health Impact Profile in Edentulous Adults), the short form (19 items) derived from OHIP using an item impact method had good measurement properties, making it appropriate for use in the clinical settings and detects the impact of oral health in the quality of life (OHRQoL) of patients who wear total prosthesis. It includes questions addressing masticatory capacity, pleasure of eating, level of comfort and relationship problems.

Fig. 1a: Retentive Anchors abutments on implants Fig. 1b: Retentive Anchor abutment
Fig. 2a: Magnets abutments on implants Fig. 2b: Magnet abutment
Fig. 3a: Locator abutments on implants Fig. 3b: Locator abutment
Fig. 4: Patient before treatment Fig. 5: Patient treated with implant over-denture retained by Locator system
 
Fig. 6: Mandibular over-denture with Locator male
 
 

Results

Four implants failed before loading were replaced and healed uneventfully (97,1% success rate after four years).
Surgical and prosthetic costs were similar, but components costs were highest at M group and lowest at B group (Fig. 7).
Patient satisfaction improved significantly in the three groups across all variables (Fig. 8, 9) including esthetics, except ease of cleaning – the B and L-group had higher maintenance necessities (Fig. 10). M-group scored lower stability but also lower maintenance requirements (Fig. 9, 10).

Fig. 7: Graphically expression of total costs after 48 months Fig. 8: Graphically expression for ease of chewing with the lower denture
Fig. 9: Graphically expression of mandibular denture stability
 
Fig. 10: Graphically expression for ease of denture cleaning

Conclusions

Implant-supported overdenture improves retention and stability, provides better esthetics, phonetics, bone preservation, increased comfort, better psychosocial state, and enhanced nutrition, all resulting in an improved quality of life.The choice of the retention system used is determined by the special requirements of each patient.
Implant-supported mandibular overdenture is a simple, predictable, and cost-effective treatment for edentulous patients.
Acknowledgment: Study supported by Grant 316/2003 and 507/207 from International Team for Implantology (ITI) Foundation for the Promotion of Oral Implantology, Switzerland.
 

Literature

  1. Naert, I., Alsaadi, G., van Steenberghe, D., & Quirynen, M. A 10-year randomized controlled trial on the of splinted and unsplinted oral implants retaining mandibular overdentures: Peri-implant outcomes. International Journal of Oral and Maxillofacial Implants, 19, 2004,695-702.
  2. Fitzpatrick B. Standard of care for the edentulous mandible: a systematic review.J Prosthet Dent. 2006 Jan;95(1):71-8.
  3. Weingart D, ten Bruggenkate CM. Treatment of fully edentulous patients with ITI implants. Clin Oral Impl Res 2000: 11 (Suppl.): 69-82. C Munksgaard 2000.
  4. Morton D. Consensus Statements and Recommended Clinical Pocedures Regarding Loading Protocols for Endosseous Dental Implants in ITI Treatment Guide vol 2 Loading Protocols in Implant Dentistry - Partially Dentate Patients - Morton D., Ganeles J, - Quintessence Publishing Co, Ltd. pg. 5-10.
  5. Cristache C.M, Sfeatcu I.R, Burlibasa M., Cristache G. Implant supported mandibular overdenture - a literature review of costs, maintenance and patient satisfaction OHDMBSC - Vol. V - No. 3 -September, 2006.
  6. Allen F, Locker D. A modified short version of the oral health impact profile for assessing health-related quality of life in edentulous adults. Int J Prosthodont. 2002; 15: 446-50.
     

This Poster was submitted by Dr. PhD Corina Marilena Cristache.
 

Correspondence address:
Dr. PhD Corina Marilena Cristache
Concordia Dent Clinic
257N, Soseaua Oltenitei
041335, Bucharest
Romania