EdenteV2, Istex, Corpus, bibRecord, 006385

Mandibular implant-retained overdentures: A literature review

Identifieur interne : 006385 ( Istex/Corpus ); précédent : 006384; suivant : 006386

Mandibular implant-retained overdentures: A literature review

Auteurs : Steven J. Sadowsky

Source :

The Journal of Prosthetic Dentistry [ 0022-3913 ] ; 2001.

RBID : ISTEX:C8AEBF77212D2C37EA973F014FD4C8C032D8A697

English descriptors

KwdEn :
- Anchorage, Anchorage design, Anchorage systems, Anterior mandible, Ball attachments, Bone preservation, Clin, Clinical report, Complete dentures, Dent, Dentistry, Denture, Edentulous, Edentulous mandible, Endosseous implants, First year, Geertman, Implant, Implant overdenture, Interforaminal region, Kalk, Light activation, Light exposure, Literature review, Mandible, Mandibular, Mandibular implant overdentures, Mandibular overdenture, Mandibular overdenture therapy, Mandibular overdentures, Mandibular prostheses, Maxilla, Maxillary, Maxillofac, Meijer, Multicenter study, Naert, Occlusal, Occlusal forces, Oral maxillofac implants, Osseointegrated, Osseointegrated implants, Overdenture, Overdentures, Patient satisfaction, Porcelain, Porcelain disk, Porcelain inlays, Prospective study, Prosthesis, Prosthet, Prosthet dent, Prosthetic, Prosthetic dentistry, Prosthodont, Randomized, Resin cements, Resorption, Retrospective, Retrospective study, Sadowsky, Significant differences, Splinted, Steenberghe, Thermal analysis, Unsplinted, Vivo study, Waas.
Teeft :
- Anchorage, Anchorage design, Anchorage systems, Anterior mandible, Ball attachments, Bone preservation, Clin, Clinical report, Complete dentures, Dent, Dentistry, Denture, Edentulous, Edentulous mandible, Endosseous implants, First year, Geertman, Implant, Implant overdenture, Interforaminal region, Kalk, Light activation, Light exposure, Literature review, Mandible, Mandibular, Mandibular implant overdentures, Mandibular overdenture, Mandibular overdenture therapy, Mandibular overdentures, Mandibular prostheses, Maxilla, Maxillary, Maxillofac, Meijer, Multicenter study, Naert, Occlusal, Occlusal forces, Oral maxillofac implants, Osseointegrated, Osseointegrated implants, Overdenture, Overdentures, Patient satisfaction, Porcelain, Porcelain disk, Porcelain inlays, Prospective study, Prosthesis, Prosthet, Prosthet dent, Prosthetic, Prosthetic dentistry, Prosthodont, Randomized, Resin cements, Resorption, Retrospective, Retrospective study, Sadowsky, Significant differences, Splinted, Steenberghe, Thermal analysis, Unsplinted, Vivo study, Waas.

Abstract

Abstract: The implant-retained overdenture for the mandible has been shown to be a highly successful prosthetic treatment similar to the fixed implant denture. However, controversy persists as to its design and indications. Few literature reviews have been published on the topic. This article critically analyzes the existing mandibular implant overdenture literature relative to bone preservation, effect on antagonist jaw, number of implants required, anchorage systems, maintenance, and patient satisfaction. A MEDLINE search was completed (from 1987 to 2001), along with a manual search, to locate relevant English-language articles on mandibular implant overdentures. Twelve treatment concepts are elucidated from a distillation of the literature review. (J Prosthet Dent 2001;86:468-73.)

Url:

https://api.istex.fr/document/C8AEBF77212D2C37EA973F014FD4C8C032D8A697/fulltext/pdf

DOI: 10.1067/mpr.2001.119921

Links to Exploration step

ISTEX:C8AEBF77212D2C37EA973F014FD4C8C032D8A697

Le document en format XML

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<head><ce:article-footnote><ce:label>☆</ce:label>
<ce:note-para><ce:sup>a</ce:sup>
Associate Clinical Professor, Department of Continuing Education; Private Practice, Poulsbo, Wash.</ce:note-para>
</ce:article-footnote>
<ce:article-footnote><ce:label>☆☆</ce:label>
<ce:note-para>Reprint requests to: Dr Steven J. Sadowsky, 19365 7th Ave, #114, Poulsbo, WA 98370, Fax: (360)779-7732 E-mail: Sadow333@aol.com</ce:note-para>
</ce:article-footnote>
<ce:title>Mandibular implant-retained overdentures: A literature review</ce:title>
<ce:presented>Presented before The Academy of Prosthodontics annual meeting, Santa Fe, N.M., May 2001.</ce:presented>
<ce:author-group><ce:author><ce:given-name>Steven J.</ce:given-name>
<ce:surname>Sadowsky</ce:surname>
<ce:degrees>DDS<ce:sup>a</ce:sup>
</ce:degrees>
</ce:author>
<ce:affiliation><ce:textfn>University of Southern California, Los Angeles, Calif</ce:textfn>
</ce:affiliation>
</ce:author-group>
<ce:abstract><ce:section-title id="st0010">Abstract</ce:section-title>
<ce:abstract-sec><ce:simple-para id="sp0030">The implant-retained overdenture for the mandible has been shown to be a highly successful prosthetic treatment similar to the fixed implant denture. However, controversy persists as to its design and indications. Few literature reviews have been published on the topic. This article critically analyzes the existing mandibular implant overdenture literature relative to bone preservation, effect on antagonist jaw, number of implants required, anchorage systems, maintenance, and patient satisfaction. A MEDLINE search was completed (from 1987 to 2001), along with a manual search, to locate relevant English-language articles on mandibular implant overdentures. Twelve treatment concepts are elucidated from a distillation of the literature review. <ce:bold>(J Prosthet Dent 2001;86:468-73.)</ce:bold>
</ce:simple-para>
</ce:abstract-sec>
</ce:abstract>
</head>
<body><ce:sections><ce:para id="p0010">Despite its broad acceptance, the mandibular implant-retained overdenture has been investigated only with longitudinal studies since 1987. van Steenberghe et al<ce:cross-ref refid="bib1"><ce:sup>1</ce:sup>
</ce:cross-ref>
 were among the first authors to propose placement of only 2 implants in the edentulous mandible. Their 98% success rate, with up to 52 months of observation, was encouraging. However, 5-year prospective studies on implant overdentures supported by endosseous implants are limited.</ce:para>
<ce:para id="p0015">Mericske-Stern et al<ce:cross-ref refid="bib2"><ce:sup>2</ce:sup>
</ce:cross-ref>
 reported 97% implant survival with 2 implants (splinted or solitary), irrespective of keratinized tissue or duration of edentulism. Jemt et al<ce:cross-ref refid="bib3"><ce:sup>3</ce:sup>
</ce:cross-ref>
 reported 100% cumulative success rate for overdentures supported by 2 implants; the mean marginal bone loss was 0.5 mm during a 5-year period. Naert et al<ce:cross-ref refid="bib4"><ce:sup>4</ce:sup>
</ce:cross-ref>
 compared the clinical outcome of different overdenture anchorage systems and found 100% implant success after 5 years for all groups. In spite of these reports, controversy persists regarding the treatment concept and indications.<ce:cross-refs refid="bib5 bib6"><ce:sup>5,6</ce:sup>
</ce:cross-refs>
</ce:para>
<ce:para id="p0020">This article reviews the literature on mandibular implant overdentures to clarify factors critical in treatment planning. Emphasis is placed on bone preservation, effect on antagonist jaw, number of implants required, anchorage design, immediate loading, maintenance, and patient satisfaction. A MEDLINE search was completed (from 1987 to 2001), along with a manual search, to locate relevant English-language articles on mandibular implant overdentures.</ce:para>
<ce:para id="p0025">Treatment considerations for implant overdentures on the maxilla appear to be different than for those on the mandible.<ce:cross-ref refid="bib7"><ce:sup>7</ce:sup>
</ce:cross-ref>
 Atrophy of edentulous jaws may limit implant placement on the maxilla, whereas in the mandible, the reduction of residual ridge often leaves a significant depth and width of basal bone anteriorly to accommodate implants.<ce:cross-ref refid="bib8"><ce:sup>8</ce:sup>
</ce:cross-ref>
 The maxilla consists of a looser arrangement of trabecular bone that is less capable of stabilizing and supporting implants.<ce:cross-ref refid="bib9"><ce:sup>9</ce:sup>
</ce:cross-ref>
 Anatomic limitations and bony morphology may compromise implant number, length, and inclination. A greater burden of maintenance care<ce:cross-ref refid="bib10"><ce:sup>10</ce:sup>
</ce:cross-ref>
 and higher failure rates<ce:cross-ref refid="bib11"><ce:sup>11</ce:sup>
</ce:cross-ref>
 have been reported for the implant overdenture on the maxilla in contrast to the mandible.</ce:para>
<ce:section id="s0010"><ce:section-title id="st0015">Bone preservation</ce:section-title>
<ce:para id="p0030">In longitudinal studies, Atwood et al<ce:cross-ref refid="bib12"><ce:sup>12</ce:sup>
</ce:cross-ref>
 and Tallgren<ce:cross-ref refid="bib13"><ce:sup>13</ce:sup>
</ce:cross-ref>
 showed an average annual alveolar ridge height reduction of approximately 0.4 mm in the edentulous anterior mandible resulting from physiologic changes. The anterior mandibular bone under an implant overdenture may resorb as little as 0.5 mm over a 5-year period, and long-term resorption may remain at 0.1 mm annually.<ce:cross-refs refid="bib3 bib14 bib15"><ce:sup>3,14,15</ce:sup>
</ce:cross-refs>
 Similar findings for a fixed implant complete denture have been documented.<ce:cross-ref refid="bib16"><ce:sup>16</ce:sup>
</ce:cross-ref>
 Recently, von Wowern and Gotfredsen<ce:cross-ref refid="bib17"><ce:sup>17</ce:sup>
</ce:cross-ref>
 observed load-related positive bone remodeling in the anterior mandible caused by increased function with implants. This effect appeared to be independent of the attachment system.</ce:para>
<ce:para id="p0035">However, the resilient overdenture design may in fact cause posterior mandibular resorption. Jacobs et al<ce:cross-ref refid="bib18"><ce:sup>18</ce:sup>
</ce:cross-ref>
 found a 2- to 3-fold annual posterior mandibular resorption in overdenture wearers as opposed to complete denture wearers if patients were edentulous for less than 10 years. Conversely, in their retrospective study, Davis et al<ce:cross-ref refid="bib19"><ce:sup>19</ce:sup>
</ce:cross-ref>
 found that the fixed implant complete denture may not only preserve bone but also regenerate posterior bone. Therefore, for younger patients or those with an extremely narrow posterior mandibular height, an overdenture design on 2 implants may be contraindicated.</ce:para>
</ce:section>
<ce:section id="s0015"><ce:section-title id="st0020">Effect on antagonist jaw</ce:section-title>
<ce:para id="p0040">Several authors have reported a combination syndrome effect with various designs of mandibular implant overdentures opposing maxillary complete dentures.<ce:cross-refs refid="bib20 bib21 bib22 bib23"><ce:sup>20-23</ce:sup>
</ce:cross-refs>
 This condition can lead to a transfer of significant occlusal forces onto the anterior maxilla with maxillary alveolar bone resorption and soft tissue inflammation. Haraldson et al<ce:cross-ref refid="bib24"><ce:sup>24</ce:sup>
</ce:cross-ref>
 also noted that increased occlusal forces could generate more midline fractures of the opposing denture. Furthermore, investigators have found subjective loss of fit and need for a maxillary denture reline in 25% to 33% of treatment groups over 5 years.<ce:cross-refs refid="bib25 bib26"><ce:sup>25,26</ce:sup>
</ce:cross-refs>
 However, this phenomenon remains controversial. In a randomized, 6-year prospective study evaluating a transmandibular prosthesis, single-bar overdenture, and complete denture, Narhi et al<ce:cross-ref refid="bib27"><ce:sup>27</ce:sup>
</ce:cross-ref>
 found continuous maxillary ridge width reduction independent of prosthesis type. The occlusal concept was considered important to preserve maxillary bone. Thiel et al<ce:cross-ref refid="bib28"><ce:sup>28</ce:sup>
</ce:cross-ref>
 and other authors<ce:cross-refs refid="bib29 bib30 bib31"><ce:sup>29-31</ce:sup>
</ce:cross-refs>
 have recommended no anterior contact in the centric relation position and minimal anterior contact during excursive mandibular movements. Regular recalls to evaluate the overdenture for extension base fit, maximal extension, and appropriate plane of occlusion have also been emphasized to decrease the need for relines of the maxillary denture.<ce:cross-ref refid="bib28"><ce:sup>28</ce:sup>
</ce:cross-ref>
</ce:para>
</ce:section>
<ce:section id="s0020"><ce:section-title id="st0025">Number of implants</ce:section-title>
<ce:para id="p0045">Meijer et al<ce:cross-ref refid="bib32"><ce:sup>32</ce:sup>
</ce:cross-ref>
 conducted a finite element analysis of 2 versus 4 implants placed in the interforaminal region of the mandible. In neither of the models was a reduction of the principle stresses clearly demonstrated if the load was uniformly distributed. Furthermore, in a prospective 12-month study, Batenburg et al<ce:cross-ref refid="bib33"><ce:sup>33</ce:sup>
</ce:cross-ref>
 evaluated 60 mandibular overdenture patients divided into 2 groups: 1 treated with 2 implants and the other with 4 implants. They found no significant differences in the peri-implant health. These studies were consistent with Mericske-Stern's<ce:cross-ref refid="bib34"><ce:sup>34</ce:sup>
</ce:cross-ref>
 retrospective work on 67 patients divided into 3 groups: 29 with 2 implants connected with a bar, 27 with 2 solitary ball anchors, and 11 with 3 or 4 implants splinted with a bar. She concluded that retention, stability, and occlusal equilibration of the dentures improved only slightly with an increasing number of implants.</ce:para>
<ce:para id="p0050">In an in vivo study, Fontijn-Tekamp et al<ce:cross-ref refid="bib35"><ce:sup>35</ce:sup>
</ce:cross-ref>
 compared a transmandibular design of 4 implants and 2 anteriorly placed endosseous implants. They found that masticatory forces did not differ between the mainly implant-borne and mucosa-implant-borne treatments; these results were similar to the findings of Geertman et al.<ce:cross-ref refid="bib36"><ce:sup>36</ce:sup>
</ce:cross-ref>
 However, these patients all wore opposing complete dentures, which may have been a limiting factor.<ce:cross-ref refid="bib37"><ce:sup>37</ce:sup>
</ce:cross-ref>
</ce:para>
<ce:para id="p0055">In the light of these studies, the use of more than 2 implants to support a mandibular overdenture has been recommended only in the following scenarios<ce:cross-refs refid="bib5 bib38"><ce:sup>5,38</ce:sup>
</ce:cross-refs>
: a dentate maxilla, implants <8 mm in length and <3.5 mm in width, sensitive mucosa, high muscle attachments, sharp mylohyoid projections, large V-shaped ridges, or patients with high retention needs.</ce:para>
</ce:section>
<ce:section id="s0025"><ce:section-title id="st0030">Anchorage design</ce:section-title>
<ce:para id="p0060">Published reports on the stress on mandibular overdentures retained by 2 implants, either interconnected or independent, are contradictory. In vitro and in vivo studies by Menicucci et al<ce:cross-refs refid="bib39 bib40"><ce:sup>39,40</ce:sup>
</ce:cross-refs>
 compared the stresses on the bone surrounding 2 implants with either a bar-clip or ball attachments for overdentures. They found greater stresses on the peri-implant bone with a bar-clip attachment. This was consistent with a photoelastic analysis by Kenney et al.<ce:cross-ref refid="bib41"><ce:sup>41</ce:sup>
</ce:cross-ref>
 However, other authors, in an in vivo study on force transmission onto implants supporting overdentures, found that rigid bars contributed to load sharing.<ce:cross-ref refid="bib42"><ce:sup>42</ce:sup>
</ce:cross-ref>
</ce:para>
<ce:para id="p0065">In longitudinal prospective studies, Gotfredsen and Holm,<ce:cross-ref refid="bib43"><ce:sup>43</ce:sup>
</ce:cross-ref>
 Naert et al,<ce:cross-ref refid="bib15"><ce:sup>15</ce:sup>
</ce:cross-ref>
 and Bergendal and Engquist<ce:cross-ref refid="bib44"><ce:sup>44</ce:sup>
</ce:cross-ref>
 found no differences in implant survival rate, health of peri-implant tissue, or marginal bone loss in the 2 different anchorage systems on 2 implants retaining an overdenture. In another study, Chao et al<ce:cross-ref refid="bib45"><ce:sup>45</ce:sup>
</ce:cross-ref>
 concluded that the direction of occlusal forces has more influence than the connection of implants and that the difference in stress concentration between models with and without a bar is small. Furthermore, in an in vivo study on 2 implants, Mericske-Stern<ce:cross-ref refid="bib46"><ce:sup>46</ce:sup>
</ce:cross-ref>
 observed that the anchorage system may have a more minor influence and that other parameters, such as superstructure fit and occlusion, may also determine loading of implants.</ce:para>
<ce:para id="p0070">A number of authors<ce:cross-refs refid="bib47 bib48 bib49 bib50"><ce:sup>47-50</ce:sup>
</ce:cross-refs>
 have hypothesized that it is appropriate to use 2 implants with an interconnector parallel to the hinge axis and a resilient overdenture on an ovoid or round bar. Their aim was to enhance free rotation during dorsal loading with twist-free load transmission to the implants. However, a review of mandibular overdenture treatment concepts proposes that these concepts were based on empirical data, and the use of a rigid versus moveable retention mechanism remains controversial.<ce:cross-refs refid="bib6 bib51"><ce:sup>6,51</ce:sup>
</ce:cross-refs>
</ce:para>
<ce:para id="p0075">It has been shown that solitary ball attachments are less costly, less technique sensitive,<ce:cross-ref refid="bib52"><ce:sup>52</ce:sup>
</ce:cross-ref>
 and easier to clean<ce:cross-ref refid="bib53"><ce:sup>53</ce:sup>
</ce:cross-ref>
 than bars. Moreover, the potential for mucosal hyperplasia reportedly is more easily reduced with solitary ball attachments.<ce:cross-ref refid="bib54"><ce:sup>54</ce:sup>
</ce:cross-ref>
 Bars, however, have been shown to be more retentive.<ce:cross-ref refid="bib55"><ce:sup>55</ce:sup>
</ce:cross-ref>
</ce:para>
<ce:para id="p0080">In a photoelastic analysis, Sadowsky and Caputo<ce:cross-ref refid="bib56"><ce:sup>56</ce:sup>
</ce:cross-ref>
 investigated the stress transfer of different anchorage designs on 4 implants in the parasymphyseal region supporting an overdenture. They tested a cantilever bar, a noncantilevered bar, and solitary attachments. The results showed that, with intimate extension base contact, there was little difference in stress transfer. Retention, jaw morphology and anatomy, and patient compliance for recall were recommended parameters for choice of anchorage design.</ce:para>
</ce:section>
<ce:section id="s0030"><ce:section-title id="st0035">Immediate loading</ce:section-title>
<ce:para id="p0085">Gatti et al<ce:cross-ref refid="bib57"><ce:sup>57</ce:sup>
</ce:cross-ref>
 completed a prospective study in which 21 patients were restored immediately after implant placement in the anterior mandible, and a U-shaped bar connecting 4 implants was loaded with an implant-retained overdenture. The authors recorded a 96% implant success rate over a mean observation period of 37 months. Cooper et al<ce:cross-ref refid="bib58"><ce:sup>58</ce:sup>
</ce:cross-ref>
 used a single-stage surgical placement of 2 microthreaded screw implants to immediately support a relieved mandibular overdenture, followed by ball attachments 3 months later; a 95.6% success rate was reported. Recently, Roynesdal et al<ce:cross-ref refid="bib59"><ce:sup>59</ce:sup>
</ce:cross-ref>
 used 2 titanium-sprayed solid screw implants in the interforaminal region in a prospective, 24-month study. After 3 weeks, the overdenture prosthesis was connected to the ball attachments. The implant survival rate was 100%. Despite the small sample size and short observation period, the high satisfaction rate indicates that this is a promising treatment concept.</ce:para>
</ce:section>
<ce:section id="s0035"><ce:section-title id="st0040">Maintenance</ce:section-title>
<ce:para id="p0090">Prospective and retrospective reports of postinsertion complications with 2 implants (splinted or unsplinted) retaining a mandibular overdenture are numerous.<ce:cross-refs refid="bib4 bib10 bib25 bib26 bib43 bib44 bib60 bib61 bib62 bib63 bib64"><ce:sup>4,10,25,26,43,44,60-64</ce:sup>
</ce:cross-refs>
 The consensus of many studies is that maintenance requirements were greatest during the first year of service<ce:cross-refs refid="bib4 bib10 bib61 bib62 bib63 bib64 bib65 bib66 bib67 bib68 bib69 bib70 bib71"><ce:sup>4,10,61-71</ce:sup>
</ce:cross-refs>
 and related to alteration of contour and repair of the matrix or patrix.<ce:cross-ref refid="bib65"><ce:sup>65</ce:sup>
</ce:cross-ref>
 Controversy persists as to whether the bar or ball design requires more maintenance.<ce:cross-refs refid="bib4 bib43 bib44"><ce:sup>4,43,44</ce:sup>
</ce:cross-refs>
 Wear or fracture of the ball attachment head seems less frequent than that of gold alloy bars.<ce:cross-refs refid="bib66 bib67"><ce:sup>66,67</ce:sup>
</ce:cross-refs>
 In a 5-year multicenter study, replacement of O-rings was reported in 50% of patients, usually within the first year. Clip adjustments and fractures occurred in as many as 62% and 33% of patients, respectively.<ce:cross-ref refid="bib10"><ce:sup>10</ce:sup>
</ce:cross-ref>
 The shorter the bar segment, the greater the chance of clip loosening in the acrylic resin.<ce:cross-ref refid="bib38"><ce:sup>38</ce:sup>
</ce:cross-ref>
</ce:para>
<ce:para id="p0095">The importance of using a metal reinforcement in the mandibular overdenture prosthesis is still debatable. Questions have arisen because of low fracture rates with high-impact resin,<ce:cross-ref refid="bib25"><ce:sup>25</ce:sup>
</ce:cross-ref>
 additional expenditures, and increased implant loading with metal frameworks.<ce:cross-ref refid="bib71"><ce:sup>71</ce:sup>
</ce:cross-ref>
 In one study, bar groups revealed more mucositis and gingival hyperplasia, whereas unsplinted groups displayed more decubitus ulcers.<ce:cross-ref refid="bib4"><ce:sup>4</ce:sup>
</ce:cross-ref>
 In another investigation, when the burden of prosthodontic maintenance was compared with that of implant-supported mandibular overdentures with more than 2 implants, no statistical difference was found, and all designs appeared to function as hinging overdentures after 5 years.<ce:cross-ref refid="bib25"><ce:sup>25</ce:sup>
</ce:cross-ref>
 Few studies have reported any difference in the frequency of relines (8% to 40%) between splinted and unsplinted attachments or among 2, 3, or 4 implants.<ce:cross-ref refid="bib65"><ce:sup>65</ce:sup>
</ce:cross-ref>
</ce:para>
</ce:section>
<ce:section id="s0040"><ce:section-title id="st0045">Patient satisfaction</ce:section-title>
<ce:para id="p0100">Numerous authors have addressed patient satisfaction with the mandibular implant overdenture.<ce:cross-refs refid="bib4 bib54 bib72 bib73 bib74 bib75 bib76 bib77 bib78 bib79 bib80 bib81"><ce:sup>4,54,72-81</ce:sup>
</ce:cross-refs>
 Meijer et al<ce:cross-ref refid="bib79"><ce:sup>79</ce:sup>
</ce:cross-ref>
 found that, after 5 years, patients with mandibular overdentures retained by 2 implants interforaminally had higher satisfaction scores than complete denture patients. Raghoebar et al<ce:cross-ref refid="bib72"><ce:sup>72</ce:sup>
</ce:cross-ref>
 confirmed this finding in another randomized study, even with complete denture patients who had undergone preprosthetic surgery.</ce:para>
<ce:para id="p0105">In a crossover study, Feine et al<ce:cross-ref refid="bib74"><ce:sup>74</ce:sup>
</ce:cross-ref>
 compared a group with fixed implant prostheses with another group with a long-bar, removable, implant-supported prosthesis on the mandible. The authors found that 50% of the patients chose the removable design for ease of cleaning and esthetics. There was a tendency for the removable prosthesis to be chosen by older (>50 years) subjects. Those that chose the fixed alternative rated stability and ability to chew most important.</ce:para>
<ce:para id="p0110">In another crossover study, de Grandmont et al<ce:cross-ref refid="bib75"><ce:sup>75</ce:sup>
</ce:cross-ref>
 compared psychometric and functional measurements on 15 edentulous patients who wore both a fixed implant prosthesis and a long-bar overdenture. Although the patients found the fixed implant complete denture to be significantly better for chewing harder foods, there was no difference in general satisfaction.</ce:para>
<ce:para id="p0115">Wismeijer et al<ce:cross-ref refid="bib81"><ce:sup>81</ce:sup>
</ce:cross-ref>
 investigated 110 edentulous patients who had received mandibular implant overdenture treatment with 1 of the following: 2 implants with ball attachments, 2 implants with an interconnecting bar, or 4 interconnected implants. Most of the implants were at least 10 mm long. No significant differences were found, and almost all subjects expressed satisfaction.</ce:para>
</ce:section>
<ce:section id="s0045"><ce:section-title id="st0050">Treatment considerations</ce:section-title>
<ce:para id="p0120">On the basis of the available literature, the following clinical treatment concepts should be considered:<ce:list id="l0010"><ce:list-item id="o0010"><ce:para id="p0125">The mandibular overdenture retained by implants in the interforaminal region appears to maintain bone in the anterior mandible.</ce:para>
</ce:list-item>
<ce:list-item id="o0015"><ce:para id="p0130">In younger patients or those edentulous for less than 10 years, a fixed implant denture may preserve posterior bone better than an implant overdenture in the mandible.</ce:para>
</ce:list-item>
<ce:list-item id="o0020"><ce:para id="p0135">Although reports are conflicting, patients with mandibular implant overdentures may experience a loss of fit of their antagonist denture. Occlusal schemes with no anterior contact in the centric relation position and minimal anterior contact in excursions may reduce the combination syndrome effect. Frequent recalls to assess stability and retention should be scheduled, and relines of prostheses should be made when necessary.</ce:para>
</ce:list-item>
<ce:list-item id="o0025"><ce:para id="p0140">It appears that retention, stability, and chewing ability improve only slightly with an implant-supported mandibular overdenture as compared with an implant-mucosa-supported overdenture.</ce:para>
</ce:list-item>
<ce:list-item id="o0030"><ce:para id="p0145">Multiple implants can be recommended for the mandibular overdenture when sensitive jaw anatomy, increased occlusal forces, or high retention needs are present or when implant length is <8 mm or implant width is <3.5 mm.</ce:para>
</ce:list-item>
<ce:list-item id="o0035"><ce:para id="p0150">When 2 implants are used in the anterior mandible to retain an overdenture, solitary ball attachments appear to be less costly, less technique sensitive, and more accommodating of tapered arches. However, ball attachments seem to be less retentive than the bar design.</ce:para>
</ce:list-item>
<ce:list-item id="o0040"><ce:para id="p0155">The use of immediately loaded implants in the anterior mandible for the overdenture design is a promising treatment concept.</ce:para>
</ce:list-item>
<ce:list-item id="o0045"><ce:para id="p0160">Overdentures retained by 2 implants in the anterior mandible appear to demonstrate a higher burden of maintenance during the first year than in subsequent years. Controversy persists as to whether the ball or bar design requires more maintenance.</ce:para>
</ce:list-item>
<ce:list-item id="o0050"><ce:para id="p0165">There appears to be no statistical difference when long-term maintenance is compared among mandibular implant overdentures retained by 2 implants in contrast to those retained by 3 or moe implants.</ce:para>
</ce:list-item>
<ce:list-item id="o0055"><ce:para id="p0170">Mandibular implant overdentures appear to show higher patient satisfaction scores than complete dentures, even with patients who have undergone preprosthetic surgery.</ce:para>
</ce:list-item>
<ce:list-item id="o0060"><ce:para id="p0175">Patients appear to be similarly satisfied with a fixed implant complete denture or a removable implant overdenture on the mandible. Patients who rate stability more important than hygiene tend to choose a fixed prosthesis.</ce:para>
</ce:list-item>
<ce:list-item id="o0065"><ce:para id="p0180">When the anchorage system or number of implants is varied, there may be no significant differences in satisfaction with moderately resorbed edentulous patients restored with mandibular implant overdentures.</ce:para>
</ce:list-item>
</ce:list>
</ce:para>
</ce:section>
<ce:section id="s0050"><ce:section-title id="st0055">Supplementary Files</ce:section-title>
<ce:para id="p0185"><ce:float-anchor refid="mmc1"></ce:float-anchor>
<ce:float-anchor refid="mmc2"></ce:float-anchor>
</ce:para>
</ce:section>
</ce:sections>
<ce:acknowledgment><ce:section-title id="st0060">Acknowledgements</ce:section-title>
<ce:para id="p0190">I gratefully acknowledge Cari Burnham and Elena Siegel for their word processing assistance.</ce:para>
</ce:acknowledgment>
</body>
<tail><ce:bibliography id="bi0010"><ce:section-title id="st0065">References</ce:section-title>
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</sb:title>
<sb:volume-nr>6</sb:volume-nr>
</sb:series>
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<name type="personal"><namePart type="given">Steven J.</namePart>
<namePart type="family">Sadowsky</namePart>
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<affiliation>University of Southern California, Los Angeles, Calif</affiliation>
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<abstract lang="en">Abstract: The implant-retained overdenture for the mandible has been shown to be a highly successful prosthetic treatment similar to the fixed implant denture. However, controversy persists as to its design and indications. Few literature reviews have been published on the topic. This article critically analyzes the existing mandibular implant overdenture literature relative to bone preservation, effect on antagonist jaw, number of implants required, anchorage systems, maintenance, and patient satisfaction. A MEDLINE search was completed (from 1987 to 2001), along with a manual search, to locate relevant English-language articles on mandibular implant overdentures. Twelve treatment concepts are elucidated from a distillation of the literature review. (J Prosthet Dent 2001;86:468-73.)</abstract>
<note>aAssociate Clinical Professor, Department of Continuing Education; Private Practice, Poulsbo, Wash.</note>
<note>Reprint requests to: Dr Steven J. Sadowsky, 19365 7th Ave, #114, Poulsbo, WA 98370, Fax: (360)779-7732 E-mail: Sadow333@aol.com</note>
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<identifier type="ISSN">0022-3913</identifier>
<identifier type="PII">S0022-3913(00)X0016-9</identifier>
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Mandibular implant-retained overdentures: A literature review

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