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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Quality of Life of Patients Treated With Implant-Supported
Mandibular Overdentures Evaluated With the Oral Health Impact Profile (OHIP-14):
a Survey of 58 Patients</title><author><name sortKey="Kuoppala, Ritva" sort="Kuoppala, Ritva" uniqKey="Kuoppala R" first="Ritva" last="Kuoppala">Ritva Kuoppala</name><affiliation><nlm:aff id="aff1"><institution>Department of Prosthetic Dentistry and Stomatognathic Physiology, Institute of Dentistry, Oral and Maxillofacial Department, Oulu University Hospital, Oulu</institution><country>Finland.</country></nlm:aff></affiliation></author><author><name sortKey="N P Nkangas, Ritva" sort="N P Nkangas, Ritva" uniqKey="N P Nkangas R" first="Ritva" last="N P Nkangas">Ritva N P Nkangas</name><affiliation><nlm:aff id="aff1"><institution>Department of Prosthetic Dentistry and Stomatognathic Physiology, Institute of Dentistry, Oral and Maxillofacial Department, Oulu University Hospital, Oulu</institution><country>Finland.</country></nlm:aff></affiliation></author><author><name sortKey="Raustia, Aune" sort="Raustia, Aune" uniqKey="Raustia A" first="Aune" last="Raustia">Aune Raustia</name><affiliation><nlm:aff id="aff1"><institution>Department of Prosthetic Dentistry and Stomatognathic Physiology, Institute of Dentistry, Oral and Maxillofacial Department, Oulu University Hospital, Oulu</institution><country>Finland.</country></nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">24422032</idno><idno type="pmc">3886109</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3886109</idno><idno type="RBID">PMC:3886109</idno><idno type="doi">10.5037/jomr.2013.4204</idno><date when="2013">2013</date><idno type="wicri:Area/Pmc/Corpus">000838</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000838</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Quality of Life of Patients Treated With Implant-Supported
Mandibular Overdentures Evaluated With the Oral Health Impact Profile (OHIP-14):
a Survey of 58 Patients</title><author><name sortKey="Kuoppala, Ritva" sort="Kuoppala, Ritva" uniqKey="Kuoppala R" first="Ritva" last="Kuoppala">Ritva Kuoppala</name><affiliation><nlm:aff id="aff1"><institution>Department of Prosthetic Dentistry and Stomatognathic Physiology, Institute of Dentistry, Oral and Maxillofacial Department, Oulu University Hospital, Oulu</institution><country>Finland.</country></nlm:aff></affiliation></author><author><name sortKey="N P Nkangas, Ritva" sort="N P Nkangas, Ritva" uniqKey="N P Nkangas R" first="Ritva" last="N P Nkangas">Ritva N P Nkangas</name><affiliation><nlm:aff id="aff1"><institution>Department of Prosthetic Dentistry and Stomatognathic Physiology, Institute of Dentistry, Oral and Maxillofacial Department, Oulu University Hospital, Oulu</institution><country>Finland.</country></nlm:aff></affiliation></author><author><name sortKey="Raustia, Aune" sort="Raustia, Aune" uniqKey="Raustia A" first="Aune" last="Raustia">Aune Raustia</name><affiliation><nlm:aff id="aff1"><institution>Department of Prosthetic Dentistry and Stomatognathic Physiology, Institute of Dentistry, Oral and Maxillofacial Department, Oulu University Hospital, Oulu</institution><country>Finland.</country></nlm:aff></affiliation></author></analytic><series><title level="j">Journal of Oral & Maxillofacial Research</title><idno type="eISSN">2029-283X</idno><imprint><date when="2013">2013</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><title>ABSTRACT</title><sec sec-type="objectives"><title>Objectives</title><p>The purpose of this study was to evaluate the oral health-related quality of
life of patients treated with implant-supported mandibular overdentures and to compare
the attachment systems used.</p></sec><sec sec-type="material and methods"><title>Material and Methods</title><p>Altogether 112 patients treated with implant-supported mandibular overdentures
in 1985 - 2004 were invited to the follow-up; 58 of them attended and replied to
the Oral Health Impact Profile (OHIP-14) -questionnaire. There were 48 overdentures
with a bar connection and 10 with a ball connection, the total number of implants
installed and still in use was 197. The mean follow-up time was 13.7 years. The
associations between the OHIP-14 variables and the patient's age, gender as well
as the number of implants supporting the overdenture and the type of attachment
used were assessed.</p></sec><sec sec-type="results"><title>Results</title><p>The results showed that patients with implant-supported mandibular overdentures
were satisfied with their oral health-related quality of life (OHRQoL). Older patients
were more satisfied than younger ones in both genders. Neither the implant connection
type nor the number of supporting implants seemed to have a significant influence
on the OHRQoL.</p></sec><sec sec-type="conclusions"><title>Conclusions</title><p>Especially older patients with mandibular implant-supported overdentures were
satisfied with their oral health-related quality of life. Attachment type or the
number of supporting implants did not have a significant influence on the oral health-related
quality of life.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Heckmann, Sm" uniqKey="Heckmann S">SM Heckmann</name></author><author><name sortKey="Heussinger, S" uniqKey="Heussinger S">S Heussinger</name></author><author><name sortKey="Linke, Jj" uniqKey="Linke J">JJ Linke</name></author><author><name sortKey="Graef, F" uniqKey="Graef F">F Graef</name></author><author><name sortKey="Proschel, P" uniqKey="Proschel P">P Pröschel</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kuoppala, R" uniqKey="Kuoppala R">R Kuoppala</name></author><author><name sortKey="N P Nkangas, R" uniqKey="N P Nkangas R">R Näpänkangas</name></author><author><name sortKey="Raustia, A" uniqKey="Raustia A">A Raustia</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Emami, E" uniqKey="Emami E">E Emami</name></author><author><name sortKey="Heydecke, G" uniqKey="Heydecke G">G Heydecke</name></author><author><name sortKey="Rompre, P" uniqKey="Rompre P">P Rompre</name></author><author><name sortKey="De Grandmont, P" uniqKey="De Grandmont P">P de Grandmont</name></author><author><name sortKey="Feine, Js" uniqKey="Feine J">JS Feine</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Thomason, Jm" uniqKey="Thomason J">JM Thomason</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Van Der Bildt, A" uniqKey="Van Der Bildt A">A van der Bildt</name></author><author><name sortKey="Van Kampen, Fm" uniqKey="Van Kampen F">FM van Kampen</name></author><author><name sortKey="Cune, Ms" uniqKey="Cune M">MS Cune</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Turkyilmaz, I" uniqKey="Turkyilmaz I">I Turkyilmaz</name></author><author><name sortKey="Company, Am" uniqKey="Company A">AM Company</name></author><author><name sortKey="Mcglumphy, Ea" uniqKey="Mcglumphy E">EA 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Allen</name></author><author><name sortKey="Mcmillan, As" uniqKey="Mcmillan A">AS McMillan</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Carlsson, Ge" uniqKey="Carlsson G">GE Carlsson</name></author><author><name sortKey="Omar, R" uniqKey="Omar R">R Omar</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Heydecke, G" uniqKey="Heydecke G">G Heydecke</name></author><author><name sortKey="Locker, D" uniqKey="Locker D">D Locker</name></author><author><name sortKey="Awad, M" uniqKey="Awad M">M Awad</name></author><author><name sortKey="Lund, Jp" uniqKey="Lund J">JP Lund</name></author><author><name sortKey="Feine, Js" uniqKey="Feine J">JS Feine</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Geckili, O" uniqKey="Geckili O">O Geckili</name></author><author><name sortKey="Bilhan, H" uniqKey="Bilhan H">H Bilhan</name></author><author><name sortKey="Mumcu, E" uniqKey="Mumcu E">E Mumcu</name></author><author><name sortKey="Dayan, C" uniqKey="Dayan C">C Dayan</name></author><author><name sortKey="Yabul, A" uniqKey="Yabul A">A Yabul</name></author><author><name sortKey="Tuncer, N" uniqKey="Tuncer N">N Tuncer</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Van Kampen, Fm" uniqKey="Van Kampen F">FM van Kampen</name></author><author><name sortKey="Vander Bildt, A" uniqKey="Vander Bildt A">A vander Bildt</name></author><author><name sortKey="Cune, Ms" uniqKey="Cune M">MS Cune</name></author><author><name sortKey="Bosman, F" uniqKey="Bosman F">F Bosman</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Steele, Jg" uniqKey="Steele J">JG Steele</name></author><author><name sortKey="Sanders, Ae" uniqKey="Sanders A">AE Sanders</name></author><author><name sortKey="Slade, Gd" uniqKey="Slade G">GD Slade</name></author><author><name sortKey="Allen, Pf" uniqKey="Allen P">PF Allen</name></author><author><name sortKey="Lahti, S" uniqKey="Lahti S">S Lahti</name></author><author><name sortKey="Nuttall, N" uniqKey="Nuttall N">N Nuttall</name></author><author><name sortKey="Spencer, Aj" uniqKey="Spencer A">AJ Spencer</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mcgrath, C" uniqKey="Mcgrath C">C McGrath</name></author><author><name sortKey="Bedi, R" uniqKey="Bedi R">R Bedi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Siadat, H" uniqKey="Siadat H">H Siadat</name></author><author><name sortKey="Alikhasi, M" uniqKey="Alikhasi M">M Alikhasi</name></author><author><name sortKey="Mirfazaelian, A" uniqKey="Mirfazaelian A">A Mirfazaelian</name></author><author><name sortKey="Geramipanah, F" uniqKey="Geramipanah F">F Geramipanah</name></author><author><name sortKey="Zaery, F" uniqKey="Zaery F">F Zaery</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Slade, Gd" uniqKey="Slade G">GD Slade</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Strassburger, C" uniqKey="Strassburger C">C Strassburger</name></author><author><name sortKey="Heydecke, G" uniqKey="Heydecke G">G Heydecke</name></author><author><name sortKey="Kerschbaum, T" uniqKey="Kerschbaum T">T Kerschbaum</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mumcu, E" uniqKey="Mumcu E">E Mumcu</name></author><author><name sortKey="Bilhan, H" uniqKey="Bilhan H">H Bilhan</name></author><author><name sortKey="Geckili, O" uniqKey="Geckili O">O Geckili</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="review-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">J Oral Maxillofac Res</journal-id><journal-id journal-id-type="iso-abbrev">J Oral Maxillofac Res</journal-id><journal-id journal-id-type="publisher-id">JORM</journal-id><journal-title-group><journal-title>Journal of Oral & Maxillofacial Research</journal-title></journal-title-group><issn pub-type="epub">2029-283X</issn><publisher><publisher-name>Stilus Optimus</publisher-name><publisher-loc>Kaunas, Lithuania</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">24422032</article-id><article-id pub-id-type="pmc">3886109</article-id><article-id pub-id-type="publisher-id">v4n2e4ht</article-id><article-id pub-id-type="doi">10.5037/jomr.2013.4204</article-id><article-categories><subj-group subj-group-type="heading"><subject>Original Paper</subject></subj-group></article-categories><title-group><article-title>Quality of Life of Patients Treated With Implant-Supported
Mandibular Overdentures Evaluated With the Oral Health Impact Profile (OHIP-14):
a Survey of 58 Patients</article-title></title-group><contrib-group><contrib id="contrib1" contrib-type="author" corresp="yes"><name><surname>Kuoppala</surname><given-names>Ritva</given-names></name><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib id="contrib2" contrib-type="author"><name><surname>Näpänkangas</surname><given-names>Ritva</given-names></name><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib id="contrib3" contrib-type="author"><name><surname>Raustia</surname><given-names>Aune</given-names></name><xref ref-type="aff" rid="aff1">1</xref></contrib></contrib-group><aff id="aff1" rid="aff1"><sup>1</sup><institution>Department of Prosthetic Dentistry and Stomatognathic Physiology, Institute of Dentistry, Oral and Maxillofacial Department, Oulu University Hospital, Oulu</institution><country>Finland.</country></aff><author-notes><corresp>Ritva Kuoppala,
<addr-line>P. O. Box 5281, FI-90014 University of Oulu</addr-line><country>Finland</country><phone>+358 40 713 7072</phone>Fax: +358 8 537 5560<email>ritva.kuoppala@oulu.fi</email></corresp></author-notes><pub-date pub-type="collection"><season>Apr-Jun</season><year>2013</year></pub-date><pub-date pub-type="epub"><day>1</day><month>7</month><year>2013</year></pub-date><volume>4</volume><issue>2</issue><elocation-id>e4</elocation-id><history><date date-type="received"><day>13</day><month>2</month><year>2013</year></date><date date-type="accepted"><day>19</day><month>6</month><year>2013</year></date></history><permissions><copyright-statement> Copyright © Kuoppala R, Näpänkangas R, Raustia
A. Published in the JOURNAL OF ORAL & MAXILLOFACIAL RESEARCH (http://www.ejomr.org),
1 July 2013.</copyright-statement><copyright-year>2013</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc-nd/3.0/"><license-p><pmc-comment>CREATIVE COMMONS</pmc-comment>This is an open-access article, first published in
the JOURNAL OF ORAL & MAXILLOFACIAL RESEARCH, distributed under the terms of the
Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 Unported License
(<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by-nc-nd/3.0/">http://creativecommons.org/licenses/by-nc-nd/3.0/</ext-link>), which permits unrestricted
non-commercial use, distribution, and reproduction in any medium, provided the original
work and is properly cited. The copyright, license information and link to the original
publication on <ext-link ext-link-type="uri" xlink:href="http://www.ejomr.org">http://www.ejomr.org</ext-link> must be included.</license-p></license></permissions><self-uri xlink:type="simple" xlink:href="http://www.ejomr.org/JOMR/archives/2013/2/e4/v4n2e4ht.htm"></self-uri><abstract><title>ABSTRACT</title><sec sec-type="objectives"><title>Objectives</title><p>The purpose of this study was to evaluate the oral health-related quality of
life of patients treated with implant-supported mandibular overdentures and to compare
the attachment systems used.</p></sec><sec sec-type="material and methods"><title>Material and Methods</title><p>Altogether 112 patients treated with implant-supported mandibular overdentures
in 1985 - 2004 were invited to the follow-up; 58 of them attended and replied to
the Oral Health Impact Profile (OHIP-14) -questionnaire. There were 48 overdentures
with a bar connection and 10 with a ball connection, the total number of implants
installed and still in use was 197. The mean follow-up time was 13.7 years. The
associations between the OHIP-14 variables and the patient's age, gender as well
as the number of implants supporting the overdenture and the type of attachment
used were assessed.</p></sec><sec sec-type="results"><title>Results</title><p>The results showed that patients with implant-supported mandibular overdentures
were satisfied with their oral health-related quality of life (OHRQoL). Older patients
were more satisfied than younger ones in both genders. Neither the implant connection
type nor the number of supporting implants seemed to have a significant influence
on the OHRQoL.</p></sec><sec sec-type="conclusions"><title>Conclusions</title><p>Especially older patients with mandibular implant-supported overdentures were
satisfied with their oral health-related quality of life. Attachment type or the
number of supporting implants did not have a significant influence on the oral health-related
quality of life.</p></sec></abstract><kwd-group><kwd>implant-supported denture</kwd><kwd>dental implant</kwd><kwd>oral health</kwd><kwd>quality of life</kwd><kwd>outcome studies</kwd><kwd>mandible.</kwd></kwd-group></article-meta></front><body><sec><title>INTRODUCTION</title><p>Dental implants have been used in edentulous jaws to improve the retention and
stability of complete dentures. Attachment to the implants improves the stability
and function of the prostheses and increases patient satisfaction [<xref ref-type="bibr" rid="B1">1-4</xref>].
The implant connection also improves neuromuscular activity and adaptation and thereby
substantially improves masticatory function in edentulous patients [<xref ref-type="bibr" rid="B5">5-12</xref>].
Implant treatment nearly doubles maximum bite forces compared with those achieved
with conventional complete dentures, and jaw muscles are used in a more efficient
way [<xref ref-type="bibr" rid="B1">1</xref>,<xref ref-type="bibr" rid="B13">13</xref>].</p><p>Quality of life is affected in some way by oral health in the majority of people
[<xref ref-type="bibr" rid="B14">14-16</xref>]. The
type and quality of prosthetic constructions, and nowadays more often implant-supported
prostheses, can be considered one aspect of oral health in elderly patients. The
oral health impact profile index (OHIP-14) [<xref ref-type="bibr" rid="B17">17</xref>]
has been used as a shortened 14-item questionnaire to evaluate the impact of oral
health on the quality of life. The index measures people's perception of the social
impact of oral disorders on their well-being. The OHIP-14 captures only negative
impacts, whereas some other oral health-dependent quality of life instruments capture
both positive and negative impacts. However, the OHIP is the most frequently used
and best-documented instrument nowadays [<xref ref-type="bibr" rid="B18">18</xref>].
</p><p>The aim of our retrospective study was to gather information about the outcome
of treatment with implant-supported mandibular overdentures from the patients' perceptions
by using the oral health impact profile index (OHIP-14) and to compare the attachment
systems used. The research hypothesis was that implant connection in complete dentures
results in a favourable assessment of patients' oral health-related quality of life.</p></sec><sec sec-type="materials|methods"><title>MATERIAL AND METHODS</title><p>Altogether 112 patients treated with implant-supported mandibular overdentures
between 1985 and 2004 were invited to the follow-up [<xref ref-type="bibr" rid="B2">2</xref>].
Patients were referred to specialist care to the Department of Oral and Maxillofacial
Surgery in Oulu University Hospital being very demanding cases. Main indications
for implant treatment of these patients were severe retention problems of conventional
prostheses, recurrent mucosal pain and sore spots and problems with chewing related
to advanced alveolar bone resorption.</p><p>The number of patients who took no contact and did not attend was 22. Fourteen
patients had no possibility to come or said they didn't want to come and 18 patients
had died. In all, 58 (51.8%) of the invited patients 46 female and 12 male) attended
the examination; 33/58 of the patients were treated during 1985 - 1994 and 25/58
during 1995 - 2004. Fifty participants out of 58 gave answers to all the OHIP-14
items [<xref ref-type="bibr" rid="B18">18</xref>].
There were 6 persons with 1 missing answer and 2 persons with more than 2 missing
answers.</p><p>The mean age of the patients examined was 55.2 years (range 37 to 78) at the
time of the implantation procedure and 69 years (range 56 to 90) at the time of
the follow-up, the mean follow-up time was 13.7 years (range 3.3 to 21.9).</p><p>The total number of implants installed and still in use was 197 (average number
3 implants/ overdenture, range 2 to 4), mean length 12 mm (range 8 to 21 mm). There
were altogether 48 overdentures with a bar connection and 10 with a ball connection.
Fifty-three patients had a conventional complete denture in the opposite jaw, 2
patients had an implant-retained overdenture, 1 patient had an implant-supported
fixed partial denture, 1 patient had a removable partial denture and 1 patient had
his own teeth. The questionnaire (OHIP-14) was filled in by the patients before
the clinical examination [<xref ref-type="bibr" rid="B17">17</xref>].</p><p>Every 7 dimension includes two items, yielding altogether 14 (OHIP 1-14). The
seven dimensions are functional limitation, physical pain, psychological discomfort,
physical disability, psychological disability, social disability and handicap. The
five categories of response for each item are never (= 0), hardly ever (= 1), occasionally
(= 2), fairly often (= 3) and very often (= 4). Higher OHIP scores indicate worse,
and lower OHIP scores indicate better oral health-related quality of life. </p><p>This study of 58 patients was approved by the Ethical Committee of the Northern
Ostrobothnia Hospital District.</p><p><bold>Statistical analysis</bold></p><p>The average values for the OHIP-14 were calculated using non-missing score values
and the results were analyzed using ANOVA and Student's T-test. SPSS software (SPSS,
Version 16.0, SPSS, Chicago, IL, USA) was used to perform the statistical analyses
of the data. A significant level of P < 0.05 was used.</p></sec><sec sec-type="results"><title>RESULTS</title><p>The frequencies of the seven different OHIP dimensions are presented in
<xref ref-type="fig" rid="fig1">Figure 1A - G</xref>. The distribution of the patient's
responses was uniform in all seven OHIP-14 dimensions except in the dimension of
'physical pain', where fewer 'never' answers i.e. more complaints were reported
by the patients (<xref ref-type="fig" rid="fig1">Figure 1B</xref>).</p><p>According to the questionnaire, it was seen that most of the patients were satisfied
with their oral health and prostheses and there were no statistically significant
differences between women and men (P > 0.05).</p><fig id="fig1" orientation="portrait" position="float"><label>Figure 1</label><caption><p>Patients' perceptions of the social impact of oral disorders on their well-being
according to the questionnaire (OHIP-14). The five categories of response for each
item are never (= 0), hardly ever (= 1), occasionally (= 2), fairly often (= 3)
and very often (= 4).</p><p>A = Functional limitation ('trouble pronouncing words because
of problems with teeth, mouth or dentures' (OHIP 1) and 'sense of taste has worsened
because of problems with teeth, mouth or dentures' (OHIP 2)).</p><p>B = Physical pain
('painful aching in the mouth' (OHIP 3) and 'uncomfortable to eat any foods because
of problems with teeth, mouth or dentures' (OHIP 4)).</p><p>C = Psychological discomfort
('have been self-conscious because of teeth, mouth or dentures' (OHIP 5) and 'have
felt tense because of problems with teeth, mouth or dentures' (OHIP 6)).</p><p>D = Physical
disability ('diet has been unsatisfactory because of problems with teeth, mouth
or dentures' (OHIP 7) and 'have had to interrupt meals because of problems with
teeth, mouth or dentures' (OHIP 8)).</p><p>E = Psychological disability ('difficult to
relax because of problems with teeth, mouth or dentures' (OHIP 9) and 'have been
a bit embarrassed because of problems with teeth, mouth or dentures' (OHIP 10)).</p><p>F = Social disability ('have been a bit irritable with other people because of problems
with teeth, mouth or dentures' (OHIP 11) and 'have had difficulty doing usual jobs
because of problems with teeth, mouth or dentures' (OHIP 12)).</p><p>G = Handicap ('have
felt that life in general is less satisfying because of problems with teeth, mouth
or dentures' (OHIP 13) and 'have been totally unable to function because of problems
with teeth, mouth or dentures' (OHIP 14)).</p></caption><graphic xlink:href="jomr-04-e4-g001"></graphic></fig><p>The youngest age group (patients under 65 years of age) seemed to differ
from the older ones, who usually had fewer complaints in the dimensions of the
OHIP-14 (<xref ref-type="fig" rid="fig2">Figure 2</xref>). The older patients
reported 'never' answers more often than the patients under 65 years of age,
whereas the patients under 65 years of age more often reported 'very often'
or 'fairly often' answers in the OHIP-14 questionnaire. The subjects under 65
years of age seemed to be more dissatisfied with their quality of life, especially
in terms of psychological discomfort and disability. They had been self-conscious
and had felt tense because of their dentures and more often had had difficulty
relaxing and more often had been embarrassed because of problems with their
teeth, mouth or dentures. For example, 87% of the subjects in the older age
groups, reported never having difficulty relaxing.</p><fig id="fig2" orientation="portrait" position="float"><label>Figure 2</label><caption><p>Mean OHIP-14 sum scores in three different age groups (P < 0.05).</p></caption><graphic xlink:href="jomr-04-e4-g002"></graphic></fig><p>The number of implants supporting the overdenture as well as the connection
type (bar or ball connection) did not have a statistically significant influence
on the OHIP-14 values (P > 0.05) (<xref ref-type="fig" rid="fig3">Figure 3</xref>).
It can be seen, however, that patients with two implants and an overdenture
reported higher OHIP-14 values, but not significantly, which means more dissatisfaction
with OHRQoL compared with patients with four implants and an overdenture. Slightly
higher OHIP-14 values, but not significantly, i.e. more dissatisfaction, were
also noted with a ball connection than with bars (<xref ref-type="fig" rid="fig4">Figure
4</xref>). When comparing the patient groups according to the time elapsed since
completion of the prosthetic treatment (follow-up time 3 to 12 years and 13
to 22 years), no statistical differences were found in the OHIP-14 values.</p><fig id="fig3" orientation="portrait" position="float"><label>Figure 3</label><caption><p>Mean OHIP-14 scores and number of implants per overdenture. No statistically
significant difference was found between the groups (P > 0.05).</p></caption><graphic xlink:href="jomr-04-e4-g003"></graphic></fig><fig id="fig4" orientation="portrait" position="float"><label>Figure 4</label><caption><p>Mean OHIP-14 scores and attachment type in overdentures. No statistically significant
difference was found between the groups (P > 0.05).</p></caption><graphic xlink:href="jomr-04-e4-g004"></graphic></fig></sec><sec sec-type="discussion"><title>DISCUSSION</title><p>According to the results of the present study, it can be seen that patients treated
with implant-supported mandibular overdentures were satisfied with the outcome of
the treatment when evaluated using the OHIP-14 questionnaire. The clinical situation
recorded to be good, the prostheses functioned well and only few breakages were
recorded in the prosthetic constructions as reported earlier [<xref ref-type="bibr" rid="B2">2</xref>].
It must be noted that in some cases the follow-up time was over 20 years, and 67%
of the patients examined still had their original overdenture in use [<xref ref-type="bibr" rid="B2">2</xref>].
In five cases long implants had been used in mandible, one patient having even 21
mm long implants, which was common in the 80' to achieve bicortical anchorage to
implants.</p><p>No statistically significant difference was foundbetween the number of implants
supporting an overdenture or the attachment system used when evaluated with the
OHIP-14 [<xref ref-type="bibr" rid="B19">19</xref>]. Contrary to the study
by Siadat et al. [<xref ref-type="bibr" rid="B16">16</xref>], gender did
not correlate here with patient satisfaction.</p><p>Older patients were even more satisfied in the aspects of psychological discomfort
and disability when compared with patients under 65 years of age. The people in
the youngest age group were usually still involved in working life and had to cope
with different social situations, and the demands of oral status might have been
higher than in the older age groups. It has been confirmed that older people often
lack the facility to adapt to changes in edentulousness.</p><p>The degree of adaptive capacity can be expected to influence the quality of life
[<xref ref-type="bibr" rid="B1">1</xref>,<xref ref-type="bibr" rid="B2">2</xref>]. On the other hand, it has
been noted that older people are even satisfied with less than ideal oral health
and they have less unrealistic expectations of the treatment than younger patients.
Less complaints about oral conditions among the elderly have been noted in several
studies, for instance in the UK and the USA, with lower impact rankings in QoL reports,
that is to say the impact of oral health problems on the quality of life decreases
with increasing age [<xref ref-type="bibr" rid="B14">14</xref>,<xref ref-type="bibr" rid="B16">16</xref>].</p><p>This study was retrospective and information given by the patients concerning
their oral health-related quality of life with the aid of OHIP-14 questionnaire
was not available before implant treatment. Every patient, however, had a history
of severe problems related to use of conventional mandibular dentures. According
to the present study, treatment outcome with implant-supported mandibular overdentures
was found to be good and successful when evaluated with the oral health impact profile
(OHIP-14).</p></sec><sec sec-type="conclusions"><title>CONCLUSIONS</title><p>The results of this retrospective study show that patients treated with implant-supported
mandibular overdentures were satisfied with their oral health-related quality of
life. Differences in age groups show that older patients were even more satisfied
than younger ones. Gender as well as attachment type or the amount of connecting
implants did not seem to be especially significant in this study.</p></sec></body><back><ack><sec sec-type="acknowledgments and disclosure statements"><title>ACKNOWLEDGMENTS AND DISCLOSURE STATEMENTS</title><p>The authors report no conflicts of interest related to this study.</p></sec></ack><ref-list><title>REFERENCES</title><ref id="B1"><label>1</label><element-citation publication-type="other"><person-group person-group-type="author"><name><surname>Heckmann</surname><given-names>SM</given-names></name><name><surname>Heussinger</surname><given-names>S</given-names></name><name><surname>Linke</surname><given-names>JJ</given-names></name><name><surname>Graef</surname><given-names>F</given-names></name><name><surname>Pröschel</surname><given-names>P</given-names></name></person-group><source>Improvement and long-term stability of neuromuscular adaptation
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