Changes in the edentulous maxilla in persons wearing implant-retained mandibular overdentures
Identifieur interne : 007645 ( Istex/Corpus ); précédent : 007644; suivant : 007646Changes in the edentulous maxilla in persons wearing implant-retained mandibular overdentures
Auteurs : Timo O. N Rhi ; Mariëlle E. Geertman ; Miluska Hevinga ; Hanan Abdo ; Warner KalkSource :
- The Journal of Prosthetic Dentistry [ 0022-3913 ] ; 2000.
English descriptors
- KwdEn :
- Bone resorption, Canine, Cast evaluations, Centric occlusion, Clinical findings, Complete denture, Complete dentures, Dent, Dentistry, Denture, Denture causes pain, Edentulous, Edentulous maxilla, Frontal contact, Implant, Imso overdenture, Incisive papilla, Incisor, Lateral forces, Loose maxillary denture, Mandibular, Mandibular implant treatment, Mandibular overdentures, Mandibular restoration, Maxilla, Maxillary, Maxillary denture, Maxillary dentures, Measurement error, Measurement sites, Molar, Molar regions, Nijmegen, Occlusion, Oral function, Oral maxillofac implants, Overdenture, Overdentures, Prominent points, Prosthesis, Prosthet, Prosthet dent, Prosthetic, Prosthetic dentistry, Residual, Residual ridge, Residual ridge width, Resorption, Sample size, Soft tissues.
- Teeft :
- Bone resorption, Canine, Cast evaluations, Centric occlusion, Clinical findings, Complete denture, Complete dentures, Dent, Dentistry, Denture, Denture causes pain, Edentulous, Edentulous maxilla, Frontal contact, Implant, Imso overdenture, Incisive papilla, Incisor, Lateral forces, Loose maxillary denture, Mandibular, Mandibular implant treatment, Mandibular overdentures, Mandibular restoration, Maxilla, Maxillary, Maxillary denture, Maxillary dentures, Measurement error, Measurement sites, Molar, Molar regions, Nijmegen, Occlusion, Oral function, Oral maxillofac implants, Overdenture, Overdentures, Prominent points, Prosthesis, Prosthet, Prosthet dent, Prosthetic, Prosthetic dentistry, Residual, Residual ridge, Residual ridge width, Resorption, Sample size, Soft tissues.
Abstract
Abstract: Statement of Problem: It has been suggested that risk for severe resorption in the anterior maxilla is increased in persons wearing mandibular implant-retained overdentures. However, little information is available about the changes in the edentulous maxilla after mandibular implant treatment. Purpose: This study determined the possible changes in the width of the maxillary residual ridge 6 years after receiving mandibular implant-supported or implant-mucosa–supported overdentures and evaluated the association between the anatomic changes and subjective complaints with maxillary complete dentures. Methods and Material: The subjects for this study (n = 55), enrolled among the participants of a prospective clinical trial, were randomly assigned into 3 groups treated with: (a) implant-supported overdentures on a transmandibular implant system (n = 21); (b) implant-mucosa–supported overdentures on 2 IMZ implants (n = 20); or (c) conventional complete dentures (n = 14). A lingual contact occlusion concept with anterior open bite was used for tooth arrangement in all subjects. Diagnostic casts were made at baseline, and again at the 6-year follow-up. Most prominent points perpendicular to the crest of residual ridge were located in the incisor, canine, and premolar regions, after which the width of the ridge was recorded at these points with a Boley gage. Subjects’ opinions on their dentures were evaluated with a questionnaire. Results: Significant reduction in the width of the ridge was found in all measurement areas (mean difference = 0.4 to 0.6 mm; P <.0001). However, changes were small and not associated with the type of prosthetic restoration in the mandible. In subjects with implant-mucosa–supported overdentures, complaint of loose maxillary denture correlated with the decrement of residual ridge width. Conclusion: The width of residual ridge decreases with time, despite the type of mandibular prosthetic restoration. (J Prosthet Dent 2000;84:43-9.)
Url:
DOI: 10.1067/mpr.2000.107113
Links to Exploration step
ISTEX:EEDBF3D7C619997E70426F14853929E95F9E2092Le document en format XML
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Geertman</name><affiliation><mods:affiliation>Assistant Professor, Oral Function and Prosthetic Dentistry, University of Nijmegen</mods:affiliation></affiliation></author><author><name sortKey="Hevinga, Miluska" sort="Hevinga, Miluska" uniqKey="Hevinga M" first="Miluska" last="Hevinga">Miluska Hevinga</name><affiliation><mods:affiliation>Assistant Professor, Oral Function and Prosthetic Dentistry, University of Nijmegen</mods:affiliation></affiliation></author><author><name sortKey="Abdo, Hanan" sort="Abdo, Hanan" uniqKey="Abdo H" first="Hanan" last="Abdo">Hanan Abdo</name><affiliation><mods:affiliation>Student, Oral Function and Prosthetic Dentistry, University of Nijmegen</mods:affiliation></affiliation></author><author><name sortKey="Kalk, Warner" sort="Kalk, Warner" uniqKey="Kalk W" first="Warner" last="Kalk">Warner Kalk</name><affiliation><mods:affiliation>Professor and Head, Department of Prosthodontics, University of Groningen</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:EEDBF3D7C619997E70426F14853929E95F9E2092</idno><date when="2000" year="2000">2000</date><idno type="doi">10.1067/mpr.2000.107113</idno><idno type="url">https://api.istex.fr/document/EEDBF3D7C619997E70426F14853929E95F9E2092/fulltext/pdf</idno><idno type="wicri:Area/Istex/Corpus">007645</idno><idno type="wicri:explorRef" wicri:stream="Istex" wicri:step="Corpus" wicri:corpus="ISTEX">007645</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a" type="main" xml:lang="en">Changes in the edentulous maxilla in persons wearing implant-retained mandibular overdentures</title><author><name sortKey="N Rhi, Timo O" sort="N Rhi, Timo O" uniqKey="N Rhi T" first="Timo O." last="N Rhi">Timo O. 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However, little information is available about the changes in the edentulous maxilla after mandibular implant treatment. Purpose: This study determined the possible changes in the width of the maxillary residual ridge 6 years after receiving mandibular implant-supported or implant-mucosa–supported overdentures and evaluated the association between the anatomic changes and subjective complaints with maxillary complete dentures. Methods and Material: The subjects for this study (n = 55), enrolled among the participants of a prospective clinical trial, were randomly assigned into 3 groups treated with: (a) implant-supported overdentures on a transmandibular implant system (n = 21); (b) implant-mucosa–supported overdentures on 2 IMZ implants (n = 20); or (c) conventional complete dentures (n = 14). A lingual contact occlusion concept with anterior open bite was used for tooth arrangement in all subjects. Diagnostic casts were made at baseline, and again at the 6-year follow-up. Most prominent points perpendicular to the crest of residual ridge were located in the incisor, canine, and premolar regions, after which the width of the ridge was recorded at these points with a Boley gage. Subjects’ opinions on their dentures were evaluated with a questionnaire. Results: Significant reduction in the width of the ridge was found in all measurement areas (mean difference = 0.4 to 0.6 mm; P <.0001). However, changes were small and not associated with the type of prosthetic restoration in the mandible. In subjects with implant-mucosa–supported overdentures, complaint of loose maxillary denture correlated with the decrement of residual ridge width. Conclusion: The width of residual ridge decreases with time, despite the type of mandibular prosthetic restoration. 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Närhi DDS, PhD</name><affiliations><json:string>Assistant Professor, Department of Prosthodontics, Institute of Dentistry, University of Turku</json:string></affiliations></json:item><json:item><name>Mariëlle E. Geertman DDS, PhD</name><affiliations><json:string>Assistant Professor, Oral Function and Prosthetic Dentistry, University of Nijmegen</json:string></affiliations></json:item><json:item><name>Miluska Hevinga DDS</name><affiliations><json:string>Assistant Professor, Oral Function and Prosthetic Dentistry, University of Nijmegen</json:string></affiliations></json:item><json:item><name>Hanan Abdo BDS</name><affiliations><json:string>Student, Oral Function and Prosthetic Dentistry, University of Nijmegen</json:string></affiliations></json:item><json:item><name>Warner Kalk DDS, PhD</name><affiliations><json:string>Professor and Head, Department of Prosthodontics, University of Groningen</json:string></affiliations></json:item></author><arkIstex>ark:/67375/6H6-Z0710MCC-X</arkIstex><language><json:string>eng</json:string></language><originalGenre><json:string>Full-length article</json:string></originalGenre><abstract>Abstract: Statement of Problem: It has been suggested that risk for severe resorption in the anterior maxilla is increased in persons wearing mandibular implant-retained overdentures. However, little information is available about the changes in the edentulous maxilla after mandibular implant treatment. Purpose: This study determined the possible changes in the width of the maxillary residual ridge 6 years after receiving mandibular implant-supported or implant-mucosa–supported overdentures and evaluated the association between the anatomic changes and subjective complaints with maxillary complete dentures. Methods and Material: The subjects for this study (n = 55), enrolled among the participants of a prospective clinical trial, were randomly assigned into 3 groups treated with: (a) implant-supported overdentures on a transmandibular implant system (n = 21); (b) implant-mucosa–supported overdentures on 2 IMZ implants (n = 20); or (c) conventional complete dentures (n = 14). A lingual contact occlusion concept with anterior open bite was used for tooth arrangement in all subjects. Diagnostic casts were made at baseline, and again at the 6-year follow-up. Most prominent points perpendicular to the crest of residual ridge were located in the incisor, canine, and premolar regions, after which the width of the ridge was recorded at these points with a Boley gage. Subjects’ opinions on their dentures were evaluated with a questionnaire. Results: Significant reduction in the width of the ridge was found in all measurement areas (mean difference = 0.4 to 0.6 mm; P >.0001). However, changes were small and not associated with the type of prosthetic restoration in the mandible. In subjects with implant-mucosa–supported overdentures, complaint of loose maxillary denture correlated with the decrement of residual ridge width. Conclusion: The width of residual ridge decreases with time, despite the type of mandibular prosthetic restoration. (J Prosthet Dent 2000;84:43-9.)</abstract><qualityIndicators><score>8.9</score><pdfWordCount>3900</pdfWordCount><pdfCharCount>26549</pdfCharCount><pdfVersion>1.4</pdfVersion><pdfPageCount>7</pdfPageCount><pdfPageSize>612 x 792 pts (letter)</pdfPageSize><refBibsNative>true</refBibsNative><abstractWordCount>289</abstractWordCount><abstractCharCount>1992</abstractCharCount><keywordCount>0</keywordCount></qualityIndicators><title>Changes in the edentulous maxilla in persons wearing implant-retained mandibular overdentures</title><pmid><json:string>10898841</json:string></pmid><pii><json:string>S0022-3913(00)39744-X</json:string></pii><corporate><json:item><name>Institute of Dentistry, University of Turku, Turku, Finland, University of Nijmegen, Nijmegen, The Netherlands, and University of Groningen, Groningen, The Netherlands</name></json:item></corporate><genre><json:string>research-article</json:string></genre><host><title>The Journal of Prosthetic Dentistry</title><language><json:string>unknown</json:string></language><publicationDate>2000</publicationDate><issn><json:string>0022-3913</json:string></issn><pii><json:string>S0022-3913(00)X0001-7</json:string></pii><volume>84</volume><issue>1</issue><pages><first>43</first><last>49</last></pages><genre><json:string>journal</json:string></genre></host><namedEntities><unitex><date><json:string>2000</json:string></date><geogName></geogName><orgName><json:string>University of Nijmegen</json:string><json:string>Department of Prosthodontics, Institute of Dentistry, University of Turku</json:string><json:string>Department of Prosthodontics, University of Groningen</json:string><json:string>Institute of Dentistry, University of Turku, Turku, Finland, University of Nijmegen, Nijmegen, The Netherlands, and University of Groningen, Groningen, The Netherlands Statement</json:string><json:string>World Health Organization</json:string></orgName><orgName_funder></orgName_funder><orgName_provider></orgName_provider><persName><json:string>E. Geertman</json:string><json:string>Hanan Abdo</json:string><json:string>AL Table</json:string></persName><placeName><json:string>Berkeley</json:string><json:string>Calif.</json:string></placeName><ref_url></ref_url><ref_bibl><json:string>Jacobs et al</json:string></ref_bibl><bibl></bibl></unitex></namedEntities><ark><json:string>ark:/67375/6H6-Z0710MCC-X</json:string></ark><categories><wos><json:string>1 - science</json:string><json:string>2 - dentistry, oral surgery & medicine</json:string></wos><scienceMetrix><json:string>1 - health sciences</json:string><json:string>2 - clinical medicine</json:string><json:string>3 - dentistry</json:string></scienceMetrix><scopus><json:string>1 - Health Sciences</json:string><json:string>2 - Dentistry</json:string><json:string>3 - Oral Surgery</json:string></scopus><inist><json:string>1 - sciences appliquees, technologies et medecines</json:string><json:string>2 - sciences biologiques et medicales</json:string><json:string>3 - sciences medicales</json:string><json:string>4 - otorhinolaryngologie. stomatologie</json:string></inist></categories><publicationDate>2000</publicationDate><copyrightDate>2000</copyrightDate><doi><json:string>10.1067/mpr.2000.107113</json:string></doi><id>EEDBF3D7C619997E70426F14853929E95F9E2092</id><score>1</score><fulltext><json:item><extension>pdf</extension><original>true</original><mimetype>application/pdf</mimetype><uri>https://api.istex.fr/document/EEDBF3D7C619997E70426F14853929E95F9E2092/fulltext/pdf</uri></json:item><json:item><extension>zip</extension><original>false</original><mimetype>application/zip</mimetype><uri>https://api.istex.fr/document/EEDBF3D7C619997E70426F14853929E95F9E2092/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/EEDBF3D7C619997E70426F14853929E95F9E2092/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a" type="main" xml:lang="en">Changes in the edentulous maxilla in persons wearing implant-retained mandibular overdentures</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>ELSEVIER</publisher><availability><p>©2000 Editorial Council of The Journal of Prosthetic Dentistry.</p></availability><date>2000</date></publicationStmt><notesStmt><note>Reprint requests to: Dr Timo O. Närhi, Department of Prosthodontics, Institute of Dentistry, University of Turku, Lemminkäisenkatu 2, SF-20520 Turku, FINLAND, Fax: (358)2-333-8356, E-mail: timo.narhi@utu.fi</note><note type="content">Section title: Original Articles</note></notesStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a" type="main" xml:lang="en">Changes in the edentulous maxilla in persons wearing implant-retained mandibular overdentures</title><author role="org"><orgName>Institute of Dentistry, University of Turku, Turku, Finland, University of Nijmegen, Nijmegen, The Netherlands, and University of Groningen, Groningen, The Netherlands</orgName></author><author xml:id="author-0000"><persName><forename type="first">Timo O.</forename><surname>Närhi</surname></persName><roleName type="degree">DDS, PhD</roleName><affiliation>Assistant Professor, Department of Prosthodontics, Institute of Dentistry, University of Turku</affiliation></author><author xml:id="author-0001"><persName><forename type="first">Mariëlle E.</forename><surname>Geertman</surname></persName><roleName type="degree">DDS, PhD</roleName><affiliation>Assistant Professor, Oral Function and Prosthetic Dentistry, University of Nijmegen</affiliation></author><author xml:id="author-0002"><persName><forename type="first">Miluska</forename><surname>Hevinga</surname></persName><roleName type="degree">DDS</roleName><affiliation>Assistant Professor, Oral Function and Prosthetic Dentistry, University of Nijmegen</affiliation></author><author xml:id="author-0003"><persName><forename type="first">Hanan</forename><surname>Abdo</surname></persName><roleName type="degree">BDS</roleName><affiliation>Student, Oral Function and Prosthetic Dentistry, University of Nijmegen</affiliation></author><author xml:id="author-0004"><persName><forename type="first">Warner</forename><surname>Kalk</surname></persName><roleName type="degree">DDS, PhD</roleName><affiliation>Professor and Head, Department of Prosthodontics, University of Groningen</affiliation></author><idno type="istex">EEDBF3D7C619997E70426F14853929E95F9E2092</idno><idno type="DOI">10.1067/mpr.2000.107113</idno><idno type="PII">S0022-3913(00)39744-X</idno></analytic><monogr><title level="j">The Journal of Prosthetic Dentistry</title><title level="j" type="abbrev">YMPR</title><idno type="pISSN">0022-3913</idno><idno type="PII">S0022-3913(00)X0001-7</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="2000"></date><biblScope unit="volume">84</biblScope><biblScope unit="issue">1</biblScope><biblScope unit="page" from="43">43</biblScope><biblScope unit="page" to="49">49</biblScope></imprint></monogr></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2000</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>Statement of Problem: It has been suggested that risk for severe resorption in the anterior maxilla is increased in persons wearing mandibular implant-retained overdentures. However, little information is available about the changes in the edentulous maxilla after mandibular implant treatment. Purpose: This study determined the possible changes in the width of the maxillary residual ridge 6 years after receiving mandibular implant-supported or implant-mucosa–supported overdentures and evaluated the association between the anatomic changes and subjective complaints with maxillary complete dentures. Methods and Material: The subjects for this study (n = 55), enrolled among the participants of a prospective clinical trial, were randomly assigned into 3 groups treated with: (a) implant-supported overdentures on a transmandibular implant system (n = 21); (b) implant-mucosa–supported overdentures on 2 IMZ implants (n = 20); or (c) conventional complete dentures (n = 14). A lingual contact occlusion concept with anterior open bite was used for tooth arrangement in all subjects. Diagnostic casts were made at baseline, and again at the 6-year follow-up. Most prominent points perpendicular to the crest of residual ridge were located in the incisor, canine, and premolar regions, after which the width of the ridge was recorded at these points with a Boley gage. Subjects’ opinions on their dentures were evaluated with a questionnaire. Results: Significant reduction in the width of the ridge was found in all measurement areas (mean difference = 0.4 to 0.6 mm; P <.0001). However, changes were small and not associated with the type of prosthetic restoration in the mandible. In subjects with implant-mucosa–supported overdentures, complaint of loose maxillary denture correlated with the decrement of residual ridge width. Conclusion: The width of residual ridge decreases with time, despite the type of mandibular prosthetic restoration. (J Prosthet Dent 2000;84:43-9.)</p></abstract></profileDesc><revisionDesc><change when="2000">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/document/EEDBF3D7C619997E70426F14853929E95F9E2092/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Elsevier doc found" wicri:toSee="Elsevier, no converted or simple article"><istex:xmlDeclaration>version="1.0" encoding="utf-8"</istex:xmlDeclaration><istex:docType PUBLIC="-//ES//DTD journal article DTD version 5.0.1//EN//XML" URI="art501.dtd" name="istex:docType"><istex:entity SYSTEM="gr1" NDATA="IMAGE" name="gr1"></istex:entity><istex:entity SYSTEM="gr2" NDATA="IMAGE" name="gr2"></istex:entity><istex:entity SYSTEM="gr3" NDATA="IMAGE" name="gr3"></istex:entity><istex:entity SYSTEM="mmc1" NDATA="APPLICATION" name="mmc1"></istex:entity></istex:docType><istex:document><article docsubtype="fla" xml:lang="en"><item-info><jid>YMPR</jid><aid>39744</aid><ce:pii>S0022-3913(00)39744-X</ce:pii><ce:doi>10.1067/mpr.2000.107113</ce:doi><ce:copyright type="other" year="2000">Editorial Council of The Journal of Prosthetic Dentistry.</ce:copyright></item-info><ce:floats><ce:e-component id="mmc1"><ce:caption><ce:simple-para id="sp0010">Portuguese PDF</ce:simple-para></ce:caption><ce:link locator="mmc1"></ce:link><ce:alt-e-component><ce:caption><ce:simple-para id="sp0015">Portuguese PDF</ce:simple-para></ce:caption></ce:alt-e-component></ce:e-component></ce:floats><head><ce:article-footnote><ce:label>☆</ce:label><ce:note-para>Reprint requests to: Dr Timo O. Närhi, Department of Prosthodontics, Institute of Dentistry, University of Turku, Lemminkäisenkatu 2, SF-20520 Turku, FINLAND, Fax: (358)2-333-8356, E-mail: timo.narhi@utu.fi</ce:note-para></ce:article-footnote><ce:dochead><ce:textfn>Original Articles</ce:textfn></ce:dochead><ce:title>Changes in the edentulous maxilla in persons wearing implant-retained mandibular overdentures</ce:title><ce:author-group><ce:author><ce:given-name>Timo O.</ce:given-name><ce:surname>Närhi</ce:surname><ce:degrees>DDS, PhD</ce:degrees><ce:cross-ref refid="aff2"><ce:sup>a</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>Mariëlle E.</ce:given-name><ce:surname>Geertman</ce:surname><ce:degrees>DDS, PhD</ce:degrees><ce:cross-ref refid="aff3"><ce:sup>b</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>Miluska</ce:given-name><ce:surname>Hevinga</ce:surname><ce:degrees>DDS</ce:degrees><ce:cross-ref refid="aff4"><ce:sup>c</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>Hanan</ce:given-name><ce:surname>Abdo</ce:surname><ce:degrees>BDS</ce:degrees><ce:cross-ref refid="aff5"><ce:sup>d</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>Warner</ce:given-name><ce:surname>Kalk</ce:surname><ce:degrees>DDS, PhD</ce:degrees><ce:cross-ref refid="aff6"><ce:sup>e</ce:sup></ce:cross-ref></ce:author><ce:collaboration><ce:text>Institute of Dentistry, University of Turku, Turku, Finland, University of Nijmegen, Nijmegen, The Netherlands, and University of Groningen, Groningen, The Netherlands</ce:text></ce:collaboration><ce:affiliation id="aff2"><ce:label>a</ce:label><ce:textfn>Assistant Professor, Department of Prosthodontics, Institute of Dentistry, University of Turku</ce:textfn></ce:affiliation><ce:affiliation id="aff3"><ce:label>b</ce:label><ce:textfn>Assistant Professor, Oral Function and Prosthetic Dentistry, University of Nijmegen</ce:textfn></ce:affiliation><ce:affiliation id="aff4"><ce:label>c</ce:label><ce:textfn>Assistant Professor, Oral Function and Prosthetic Dentistry, University of Nijmegen</ce:textfn></ce:affiliation><ce:affiliation id="aff5"><ce:label>d</ce:label><ce:textfn>Student, Oral Function and Prosthetic Dentistry, University of Nijmegen</ce:textfn></ce:affiliation><ce:affiliation id="aff6"><ce:label>e</ce:label><ce:textfn>Professor and Head, Department of Prosthodontics, University of Groningen</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="sp0020"><ce:bold>Statement of Problem:</ce:bold> It has been suggested that risk for severe resorption in the anterior maxilla is increased in persons wearing mandibular implant-retained overdentures. However, little information is available about the changes in the edentulous maxilla after mandibular implant treatment. <ce:bold>Purpose:</ce:bold> This study determined the possible changes in the width of the maxillary residual ridge 6 years after receiving mandibular implant-supported or implant-mucosa–supported overdentures and evaluated the association between the anatomic changes and subjective complaints with maxillary complete dentures. <ce:bold>Methods and Material:</ce:bold> The subjects for this study (n = 55), enrolled among the participants of a prospective clinical trial, were randomly assigned into 3 groups treated with: (a) implant-supported overdentures on a transmandibular implant system (n = 21); (b) implant-mucosa–supported overdentures on 2 IMZ implants (n = 20); or (c) conventional complete dentures (n = 14). A lingual contact occlusion concept with anterior open bite was used for tooth arrangement in all subjects. Diagnostic casts were made at baseline, and again at the 6-year follow-up. Most prominent points perpendicular to the crest of residual ridge were located in the incisor, canine, and premolar regions, after which the width of the ridge was recorded at these points with a Boley gage. Subjects’ opinions on their dentures were evaluated with a questionnaire. <ce:bold>Results:</ce:bold> Significant reduction in the width of the ridge was found in all measurement areas (mean difference = 0.4 to 0.6 mm; <ce:italic>P</ce:italic> <.0001). However, changes were small and not associated with the type of prosthetic restoration in the mandible. In subjects with implant-mucosa–supported overdentures, complaint of loose maxillary denture correlated with the decrement of residual ridge width. <ce:bold>Conclusion:</ce:bold> The width of residual ridge decreases with time, despite the type of mandibular prosthetic restoration. (J Prosthet Dent 2000;84:43-9.)</ce:simple-para></ce:abstract-sec></ce:abstract></head><body><ce:sections><ce:para id="p0010"><ce:display><ce:textbox id="b0010"><ce:textbox-body><ce:sections><ce:para id="p0015"><ce:italic>Treatment with implant-supported or implant-mucosa–supported mandibular overdentures does not increase residual ridge width reduction in the edentulous maxilla.</ce:italic></ce:para></ce:sections></ce:textbox-body></ce:textbox></ce:display></ce:para><ce:para id="p0020">Implant-retained overdentures may be considered either implant-supported or implant-mucosa–supported, depending on the number of implants and type of superstructures used to retain the prostheses. In this article, the term <ce:italic>implant-retained overdenture</ce:italic> is used to describe both of the overdenture constructions. Distinction between the 2 overdenture type is made when needed.</ce:para><ce:para id="p0025">Most persons wearing implant-retained overdentures are satisfied with the treatment results.<ce:cross-refs refid="bib1 bib2"><ce:sup>1,2</ce:sup></ce:cross-refs> Improved chewing function and increased bite forces have also been recorded after the implant treatment.<ce:cross-refs refid="bib3 bib4"><ce:sup>3,4</ce:sup></ce:cross-refs> Furthermore, improved retention and function of a denture may have favorable psychological effects. A person’s social life has been reported to become more active after conventional complete dentures have been replaced with implant-retained overdentures.<ce:cross-refs refid="bib1 bib2 bib5"><ce:sup>1,2,5</ce:sup></ce:cross-refs></ce:para><ce:para id="p0030">Severe resorption is frequently seen in edentulous anterior maxilla in those with shortened dental arch in the mandible. This so-called combination syndrome is a result of occlusal load caused by excessive anterior function.<ce:cross-ref refid="bib6"><ce:sup>6</ce:sup></ce:cross-ref> According to previous studies, persons wearing implant-retained prostheses may create bite forces comparable to those performed by natural dentition,<ce:cross-ref refid="bib7"><ce:sup>7</ce:sup></ce:cross-ref> and it has been suggested that the risk for combination syndrome increases in persons wearing mandibular implant-retained prostheses opposed to maxillary complete dentures.<ce:cross-refs refid="bib8 bib9"><ce:sup>8,9</ce:sup></ce:cross-refs></ce:para><ce:para id="p0035">Patients’ satisfaction with prostheses decreases over time.<ce:cross-ref refid="bib10"><ce:sup>10</ce:sup></ce:cross-ref> However, it has been speculated that satisfaction with maxillary dentures may also decrease because of the increased resorption caused by mandibular implant treatment.<ce:cross-ref refid="bib11"><ce:sup>11</ce:sup></ce:cross-ref> Anatomic changes in the edentulous maxilla have been evaluated in several studies that used diagnostic casts,<ce:cross-refs refid="bib12 bib13 bib14 bib15"><ce:sup>12-15</ce:sup></ce:cross-refs> panoramic radiographs,<ce:cross-refs refid="bib16 bib17 bib18"><ce:sup>16-18</ce:sup></ce:cross-refs> or computerized methods.<ce:cross-refs refid="bib19 bib20 bib21"><ce:sup>19-21</ce:sup></ce:cross-refs> However, no published randomized clinical trials have evaluated the changes in the edentulous maxilla after mandibular implant treatment; the information available is based on retrospective evaluations of successfully treated patients.</ce:para><ce:para id="p0040">The aim of this longitudinal study was to evaluate the changes in the edentulous maxilla and patients’ satisfaction with maxillary dentures, after wearing mandibular implant-supported or implant-mucosa–supported overdentures or a new set of conventional complete dentures for 6 years.</ce:para><ce:section id="s0010"><ce:section-title id="st0015">Material and methods</ce:section-title><ce:para id="p0045">The subjects for this study were enrolled among the participants of prospective clinical trial on implant-retained mandibular overdentures carried out at the University of Nijmegen since 1989.<ce:cross-ref refid="bib2"><ce:sup>2</ce:sup></ce:cross-ref> The original study group consisted of persons who had persistent problems in wearing conventional complete dentures (n = 89). Subjects were randomly assigned for an overdenture group and a control group treated with conventional complete dentures. In the overdenture group subjects received an implant-supported overdenture on 5 bars retained by a transmandibular implant (Krijnen Medical BV, Beesd, The Netherlands) or they were treated with implant-mucosa–supported overdenture on a single bar retained by 2 IMZ implants (Friedrichdfeld AG, Mannheim, Germany). Treatments were carried out according to a specific protocol and all subjects received new maxillary dentures. Porcelain teeth (Optiform, ENTA-Lactona, Bergen op Zoom, The Netherlands) were used for all treatment groups and tooth setup was performed according to the lingual contact occlusion concept.<ce:cross-refs refid="bib11 bib22 bib23"><ce:sup>11,22,23</ce:sup></ce:cross-refs> The study protocol was approved by the hospital ethical committee of the University of Nijmegen and the subjects were enrolled in the study after signing the informed consent.</ce:para><ce:para id="p0050">The group consisted of 55 subjects who were successfully treated according to the original treatment allocation and agreed to participate in the 6-year follow-up (Table I).<ce:display><ce:table id="t0010" colsep="0" rowsep="0" frame="topbot"><ce:label>Table I</ce:label><ce:caption><ce:simple-para id="sp0025">Study population</ce:simple-para></ce:caption><tgroup cols="7"><colspec colname="col1" colsep="0"></colspec><colspec colname="col2" colsep="0"></colspec><colspec colname="col3" colsep="0"></colspec><colspec colname="col4" colsep="0"></colspec><colspec colname="col5" colsep="0"></colspec><colspec colname="col6" colsep="0"></colspec><colspec colname="col7" colsep="0"></colspec><thead><row><entry>Mandibular dentition</entry><entry align="center">n</entry><entry align="center">Men</entry><entry align="center">Women</entry><entry align="center">Mean age</entry><entry align="center">Maxilla edentulous</entry><entry align="center">Number of dentures in the maxilla</entry></row></thead><tbody><row><entry>Implant-mucosa–supported overdenture (IMZ)</entry><entry align="center">20</entry><entry align="center">4</entry><entry align="center">16</entry><entry align="center">59.8 ± 7.2</entry><entry align="center">28.8 ± 9.7</entry><entry align="center">3.0 ± 1.4</entry></row><row><entry>Implant-supported overdenture (TMI)</entry><entry align="center">21</entry><entry align="center">4</entry><entry align="center">14</entry><entry align="center">61.4 ± 9.2</entry><entry align="center">31.6 ± 8.6</entry><entry align="center">3.7 ± 2.2</entry></row><row><entry>Complete denture</entry><entry align="center">14</entry><entry align="center">4</entry><entry align="center">10</entry><entry align="center">65.7 ± 10.3</entry><entry align="center">25.1 ± 9.8</entry><entry align="center">3.9 ± 1.4</entry></row></tbody></tgroup></ce:table></ce:display>Of the original study group, 34 subjects could not be included: 4 subjects died, 3 dropped out before the 1-year follow-up, 10 refused to participate in the 6-year follow-up, and 4 subjects could not be contacted as they had moved without leaving any information on their current place of residence. Poor quality of either the baseline or the follow-up diagnostic casts prevented the cast evaluations in 13 subjects. In addition to routine annual examination, the following items focusing on the edentulous maxilla were evaluated.</ce:para><ce:section id="s0015"><ce:section-title id="st0020">Occlusion and articulation</ce:section-title><ce:para id="p0055">Occlusion was evaluated using guided closure and was considered as: good, if centric relation (CR) coincided with centric occlusion (CO); moderate, if minor (<0.5 mm) deviation was observed between CR and CO; poor, if clear (>0.5 mm) deviation was observed between CR and CO. Articulation was considered as good when it was fully balanced during lateral movements performed from CO, otherwise it was considered poor.<ce:cross-ref refid="bib24"><ce:sup>24</ce:sup></ce:cross-ref> Presence or absence of frontal contact in CO was also noted.</ce:para></ce:section><ce:section id="s0020"><ce:section-title id="st0025">Retention and stability</ce:section-title><ce:para id="p0060">Retention of the maxillary complete denture was examined using the following scores: (1) good = good resistance to vertical pull, and sufficient resistance to lateral forces; (2) satisfactory = slight to moderate resistance to vertical pull, and little or no resistance to lateral forces; and (3) poor = no resistance to vertical pull and lateral forces; the denture falls out of place. Stability was determined with the following criteria: (1) good = slight or no rocking on denture-supporting structures when under pressure; (2) moderate = moderate rocking on supporting structures under pressure; and (3) poor = extreme rocking on supporting structures under pressure.<ce:cross-ref refid="bib24"><ce:sup>24</ce:sup></ce:cross-ref></ce:para></ce:section><ce:section id="s0025"><ce:section-title id="st0030">Oral mucosa</ce:section-title><ce:para id="p0065">The presence of the following mucosal changes was recorded and their location was illustrated in the World Health Organization evaluation form for oral mucosal changes<ce:cross-ref refid="bib25"><ce:sup>25</ce:sup></ce:cross-ref>: (1) decubitus ulcers; (2) localized hyperemia; (3) hyperplasia; (4) denture stomatitis; (5) flabby ridge; and (6) lichenoid changes.</ce:para></ce:section><ce:section id="s0030"><ce:section-title id="st0035">Model examination</ce:section-title><ce:para id="p0070">Irreversible hydrocolloid impressions (CA37 fast set Dustfree, Cavex, Haarlem, Holland) were made for the diagnostic cast models. The scar line<ce:cross-ref refid="bib26"><ce:sup>26</ce:sup></ce:cross-ref> was used to aid in locating the top of the residual ridge that was marked on the baseline and follow-up models. The palatal edge of the incisive papilla was located after which a line was drawn along the midline of the palate. The canine-papilla line (CPC line<ce:cross-ref refid="bib27"><ce:sup>27</ce:sup></ce:cross-ref>) was drawn and the canine regions were marked on the models. The distance between canines was measured, and one third the distance mesial from the canines represented the location of lateral incisors. Total length of maxilla was then determined by measuring the distance between the palatal edge of the incisive papilla and the fovea. The midpoint of the line was marked on the models and used to locate the molar regions.</ce:para><ce:para id="p0075">Most prominent points on the buccal wall of the residual ridge were located from incisor, canine, and molar regions and marked on the models. A palatal reference point was selected from recognized landmarks on the same level (Fig. 1), after which the thickness of the ridge was measured by placing the Boley cage perpendicular to the scar line (Fig. 2).<ce:display><ce:figure id="f0010"><ce:label>Fig. 1</ce:label><ce:caption><ce:simple-para id="sp0030">Most prominent points of buccal wall with their reference points on palatal side marked on model (see text).</ce:simple-para></ce:caption> <ce:link locator="gr1"></ce:link></ce:figure></ce:display><ce:display><ce:figure id="f0015"><ce:label>Fig. 2</ce:label><ce:caption><ce:simple-para id="sp0035">Measurement of width of residual ridge with Boley cage.</ce:simple-para></ce:caption> <ce:link locator="gr2"></ce:link></ce:figure></ce:display>Measurements were made simultaneously from the baseline and follow-up models. To evaluate repeatability of cast measurements 10 models (9% of all models evaluated) were randomly selected for reevaluation 2 weeks after the original recordings were made. Mean measurement error was calculated for each of the 3 measurement sites.</ce:para></ce:section><ce:section id="s0035"><ce:section-title id="st0040">Subjective opinion about the dentures</ce:section-title><ce:para id="p0080">Subjective opinion about the dentures was obtained using the set of questions in which the denture complaints were expressed on a 4-point scale.<ce:cross-refs refid="bib2 bib28"><ce:sup>2,28</ce:sup></ce:cross-refs> The overall functional complaint score was calculated by summing up the scores of 3 items describing the looseness of maxillary denture. The scores for pain sensation while eating food with various consistencies formed the overall pain complaint score. Satisfaction with maxillary and mandibular dentures was expressed on a 10-point rating scale (1-10).</ce:para></ce:section><ce:section id="s0040"><ce:section-title id="st0045">Statistical analysis</ce:section-title><ce:para id="p0085">Statistical analysis was performed by the means of StatView SE+ Graphics program (Abacus, Berkeley, Calif.). The existence of systematic error in cast evaluations was detected with paired <ce:italic>t</ce:italic> test. Magnitude of change in the ridge width that could have been detected with the sample size for the 3 groups was calculated with the following scale:<ce:inline-figure><ce:link locator="gr3"></ce:link></ce:inline-figure> where δ = minimal detectable difference (critical difference); SD = standard deviation of the mean residual ridge width at baseline; 1–α = 90% probability for the critical δ value (1–β = 0.90; β =.1); and α = level of significance 5% (α=.05). Z values were obtained from the normal distribution table.</ce:para><ce:para id="p0090">Comparisons of the 3 groups at each measurement site were made in a repeated measures multivariate analysis of variance (MANOVA) model. Clinical examinations were successfully completed for 53 subjects. Two subjects whose data was incomplete were excluded from statistical analysis concerning the clinical findings. Subjective opinion on the dentures was obtained from 50 subjects; 5 subjects did not return the questionnaire and they were excluded from the statistical analyses. Association of clinical findings and the type of mandibular restoration was analyzed with Chi-square test.</ce:para><ce:para id="p0095">Differences in complaint scores among the groups were analyzed with Kruskal-Wallis test. Associations between subjective complaints and changes in the width of the residual ridge were demonstrated by use of Spearman correlation. Pairwise comparisons in satisfaction scores among the 3 groups were made by Fisher’s least significant difference method, after the F test for equal means from an ANOVA was found to be significant at the 5% level.</ce:para></ce:section></ce:section><ce:section id="s0045"><ce:section-title id="st0050">Results</ce:section-title><ce:para id="p0100">Magnitude of change in the ridge width that could have been detected with the sample size in the incisor area was 1.0 mm for implant-mucosa–supported overdentures, 1.1 mm for implant-supported overdentures and 1.3 mm for complete dentures. In canine area, the figures were 0.9, 0.9, and 1.0 mm, and in molar area they were 1.6, 1.6, and 1.9 mm, respectively. No systematic measurement error was found (paired <ce:italic>t</ce:italic> test). Depending on the site, mean measurement error varied between 0.4 and 0.6 mm (Table II).<ce:display><ce:table id="t0015" colsep="0" rowsep="0" frame="topbot"><ce:label>Table II</ce:label><ce:caption><ce:simple-para id="sp0040">Mean magnitude of error (mm) in the 3 measurement sites</ce:simple-para></ce:caption><tgroup cols="6"><colspec colname="col1" colsep="0"></colspec><colspec colname="col2" colsep="0"></colspec><colspec colname="col3" colsep="0"></colspec><colspec colname="col4" colsep="0"></colspec><colspec colname="col5" colsep="0"></colspec><colspec colname="col6" colsep="0"></colspec><thead><row><entry></entry><entry align="center">Measurement area*</entry><entry align="center">n</entry><entry align="center">Mean</entry><entry align="center">SD</entry><entry align="center">SE</entry></row></thead><tbody><row><entry>Incisor</entry><entry align="center">Left + right</entry><entry align="center">20</entry><entry align="center">0.4</entry><entry align="center">0.7</entry><entry align="center">0.1</entry></row><row><entry>Canine</entry><entry align="center">Left + right</entry><entry align="center">20</entry><entry align="center">0.5</entry><entry align="center">0.5</entry><entry align="center">0.1</entry></row><row><entry>Molar</entry><entry align="center">Left + right</entry><entry align="center">20</entry><entry align="center">0.6</entry><entry align="center">0.6</entry><entry align="center">0.1</entry></row><row><entry namest="col1" nameend="col6">*Absolute values of left and right sides were used to calculate the mean value for each measurement site.</entry></row></tbody></tgroup></ce:table></ce:display></ce:para><ce:para id="p0105">The evaluation of denture function showed that the occlusion was good in all the subjects and the articulation was considered moderate for only 6 subjects. None of the subjects had frontal contact in centric occlusion. Retention and stability of maxillary complete denture was good or moderate for almost all the subjects, with no significant association with the type of mandibular restoration (Chi-square). Oral mucosal changes related to maxillary denture were relatively rare, except for localized hyperemia that was found in 16 participants (Table III).<ce:display><ce:table id="t0020" colsep="0" rowsep="0" frame="topbot"><ce:label>Table III</ce:label><ce:caption><ce:simple-para id="sp0045">Clinical findings related to the function of maxillary complete dentures in the 6-year follow-up</ce:simple-para></ce:caption><tgroup cols="6"><colspec colname="col1" colsep="0"></colspec><colspec colname="col2" colsep="0"></colspec><colspec colname="col3" colsep="0"></colspec><colspec colname="col4" colsep="0"></colspec><colspec colname="col5" colsep="0"></colspec><colspec colname="col6" colsep="0"></colspec><thead><row><entry>Maxillary denture: clinical findings</entry><entry align="center">ISO (n = 21)</entry><entry align="center">IMSO (n = 19)</entry><entry align="center">CD (n = 13)</entry><entry align="center">Total (n = 53)</entry><entry align="center"><ce:italic>P</ce:italic> value</entry></row></thead><tbody><row><entry><ce:italic>Retention</ce:italic></entry><entry align="center"></entry><entry align="center"></entry><entry align="center"></entry><entry align="center"></entry><entry align="center"><ce:italic>NS</ce:italic></entry></row><row><entry>Good</entry><entry align="center">72%</entry><entry align="center">47%</entry><entry align="center">62%</entry><entry align="center">60%</entry><entry align="center"></entry></row><row><entry>Moderate</entry><entry align="center">28%</entry><entry align="center">47%</entry><entry align="center">38%</entry><entry align="center">38%</entry><entry align="center"></entry></row><row><entry>Poor</entry><entry align="center">0%</entry><entry align="center">6%</entry><entry align="center">0%</entry><entry align="center">2%</entry><entry align="center"></entry></row><row><entry><ce:italic>Stability</ce:italic></entry><entry align="center"></entry><entry align="center"></entry><entry align="center"></entry><entry align="center"></entry><entry align="center"><ce:italic>NS</ce:italic></entry></row><row><entry>Good</entry><entry align="center">81%</entry><entry align="center">63%</entry><entry align="center">92%</entry><entry align="center">77%</entry><entry align="center"></entry></row><row><entry>Moderate</entry><entry align="center">19%</entry><entry align="center">31%</entry><entry align="center">8%</entry><entry align="center">21%</entry><entry align="center"></entry></row><row><entry>Poor</entry><entry align="center">0%</entry><entry align="center">5%</entry><entry align="center">0%</entry><entry align="center">2%</entry><entry align="center"></entry></row><row><entry>Frontal contact in CO</entry><entry align="center">19%</entry><entry align="center">22%</entry><entry align="center">54%</entry><entry align="center">29%</entry><entry align="center">NS</entry></row><row><entry><ce:italic>Mucosa</ce:italic></entry><entry align="center"></entry><entry align="center"></entry><entry align="center"></entry><entry align="center"></entry><entry align="center"></entry></row><row><entry>Ulcers</entry><entry align="center">5%</entry><entry align="center">5%</entry><entry align="center">0%</entry><entry align="center">4%</entry><entry align="center">NS</entry></row><row><entry>Localized hyperemia</entry><entry align="center">38%</entry><entry align="center">26%</entry><entry align="center">23%</entry><entry align="center">30%</entry><entry align="center">NS</entry></row><row><entry>Stomatitis</entry><entry align="center">0%</entry><entry align="center">0%</entry><entry align="center">8%</entry><entry align="center">2%</entry><entry align="center">NS</entry></row><row><entry>Hyperkeratosis</entry><entry align="center">10%</entry><entry align="center">5%</entry><entry align="center">0%</entry><entry align="center">6%</entry><entry align="center">NS</entry></row><row><entry>Hyperpasia</entry><entry align="center">10%</entry><entry align="center">5%</entry><entry align="center">0%</entry><entry align="center">6%</entry><entry align="center">NS</entry></row><row><entry namest="col1" nameend="col6"></entry></row></tbody></tgroup><ce:legend><ce:simple-para id="sp0050">Statistical valuation with Chi square. <ce:italic>ISO</ce:italic> = Implant-supported overdenture; <ce:italic>IMSO</ce:italic> = implant-mucosa–supported overdenture; <ce:italic>CD</ce:italic> = complete denture; <ce:italic>NS</ce:italic> = not significant; <ce:italic>CO</ce:italic> = centric occlusion.</ce:simple-para></ce:legend></ce:table></ce:display></ce:para><ce:para id="p0110">The width of residual alveolar ridge decreased significantly during the 6-year follow-up in all measurement sites. However, no significant differences between the genders or among the 3 treatment groups were found (Table IV).<ce:display><ce:table id="t0025" colsep="0" rowsep="0" frame="topbot"><ce:label>Table IV</ce:label><ce:caption><ce:simple-para id="sp0055">Changes in the width of maxillary residual ridge during 6-year follow-up</ce:simple-para></ce:caption><tgroup cols="11"><colspec colname="col1" colsep="0"></colspec><colspec colname="col2" colsep="0"></colspec><colspec colname="col3" colsep="0"></colspec><colspec colname="col4" colsep="0"></colspec><colspec colname="col5" colsep="0"></colspec><colspec colname="col6" colsep="0"></colspec><colspec colname="col7" colsep="0"></colspec><colspec colname="col8" colsep="0"></colspec><colspec colname="col9" colsep="0"></colspec><colspec colname="col10" colsep="0"></colspec><colspec colname="col11" colsep="0"></colspec><thead><row><entry morerows="1">Mandibular dentition</entry><entry morerows="1" align="center">Measurement sites (n)</entry><entry namest="col3" nameend="col5" align="center">Incisor*</entry><entry namest="col6" nameend="col8" align="center">Canine</entry><entry namest="col9" nameend="col11" align="center">Molar</entry></row><row><entry colname="col3" align="center">BL</entry><entry align="center">F-U</entry><entry align="center">Change</entry><entry align="center">BL</entry><entry align="center">F-U</entry><entry align="center">Change</entry><entry align="center">BL</entry><entry align="center">F-U</entry><entry align="center">Change</entry></row></thead><tbody><row><entry>ISO</entry><entry align="center">42</entry><entry align="center">8.4 ± 1.8</entry><entry align="center">7.8 ± 1.7</entry><entry align="center">–0.6 ± 1.0</entry><entry align="center">8.0 ± 1.5</entry><entry align="center">7.5 ± 1.3</entry><entry align="center">–0.5 ± 0.8</entry><entry align="center">12.1 ± 3.5</entry><entry align="center">12.2 ± 3.2</entry><entry align="center">–0.1 ± 1.6</entry></row><row><entry>IMSO</entry><entry align="center">40</entry><entry align="center">8.1 ± 1.3</entry><entry align="center">7.8 ± 1.4</entry><entry align="center">–0.3 ± 0.9</entry><entry align="center">8.0 ± 1.1</entry><entry align="center">7.4 ± 1.3</entry><entry align="center">–0.7 ± 0.8</entry><entry align="center">12.4 ± 2.8</entry><entry align="center">11.9 ± 2.5</entry><entry align="center">–0.5 ± 1.7</entry></row><row><entry>CD</entry><entry align="center">28</entry><entry align="center">7.4 ± 1.4</entry><entry align="center">7.0 ± 1.3</entry><entry align="center">–0.3 ± 0.8</entry><entry align="center">7.8 ± 1.3</entry><entry align="center">7.2 ± 1.4</entry><entry align="center">–0.6 ± 0.8</entry><entry align="center">12.0 ± 2.9</entry><entry align="center">11.6 ± 2.5</entry><entry align="center">–0.4 ± 1.6</entry></row><row><entry>Total</entry><entry align="center">110</entry><entry align="center">8.0 ± 1.6</entry><entry align="center">7.6 ± 1.5</entry><entry align="center">–0.4 ± 0.9<ce:sup>†</ce:sup></entry><entry align="center">8.0 ± 1.3</entry><entry align="center">7.4 ± 1.3</entry><entry align="center">–0.6 ± 0.8<ce:sup>†</ce:sup></entry><entry align="center">12.2 ± 3.1</entry><entry align="center">11.9 ± 2.8</entry><entry align="center">–0.3 ± 1.6</entry></row><row><entry namest="col1" nameend="col11">*Significant association between the residual ridge width and type of mandibular restoration (P<.03; MANOVA). <ce:sup>†</ce:sup>Significant decrement in the residual ridge width (P<.0001; MANOVA).</entry></row></tbody></tgroup><ce:legend><ce:simple-para id="sp0060"><ce:italic>BL</ce:italic> = Baseline; <ce:italic>F-U</ce:italic> = follow-up; <ce:italic>ISO</ce:italic> = implant-supported overdenture; <ce:italic>IMSO</ce:italic> = implant-mucosa–supported overdenture; <ce:italic>CD</ce:italic> = complete denture.</ce:simple-para></ce:legend></ce:table></ce:display>In the incisor area in 77% of the subjects decrement of the residual ridge width exceeded the critical value for the sample size. In canine and in molar regions, the percentages were 50% and 30%, respectively. Position of incisive papilla in relation to the top of the residual ridge remained relatively stable. The position was the same in 74% of the subjects as 6 years earlier, whereas in 22%, it moved anteriorly.</ce:para><ce:para id="p0115">Functional complaints with maxillary complete dentures were rare. One third of the subjects had occasionally noticed looseness of the maxillary denture when eating or opening the mouth wide, whereas 20% had occasionally noticed pain when eating hard or rough food (Table V).<ce:display><ce:table id="t0030" colsep="0" rowsep="0" frame="topbot"><ce:label>Table V</ce:label><ce:caption><ce:simple-para id="sp0065">Maxillary denture complaints in mandibular overdenture wearers and controls 6 years after the treatment</ce:simple-para></ce:caption><tgroup cols="6"><colspec colname="col1" colsep="0"></colspec><colspec colname="col2" colsep="0"></colspec><colspec colname="col3" colsep="0"></colspec><colspec colname="col4" colsep="0"></colspec><colspec colname="col5" colsep="0"></colspec><colspec colname="col6" colsep="0"></colspec><thead><row><entry>Complaint</entry><entry align="center">Score*</entry><entry align="center">ISO (n = 19)</entry><entry align="center">IMSO (n = 18)</entry><entry align="center">CD (n = 13)</entry><entry align="center">Total (n = 50)</entry></row></thead><tbody><row><entry>1. Denture comes loose while eating</entry><entry align="center">1</entry><entry align="center">15</entry><entry align="center">10</entry><entry align="center">10</entry><entry align="center">35</entry></row><row><entry></entry><entry align="center">2</entry><entry align="center">4</entry><entry align="center">6</entry><entry align="center">3</entry><entry align="center">13</entry></row><row><entry></entry><entry align="center">3</entry><entry align="center">0</entry><entry align="center">2</entry><entry align="center">0</entry><entry align="center">2</entry></row><row><entry></entry><entry align="center">4</entry><entry align="center">0</entry><entry align="center">0</entry><entry align="center">0</entry><entry align="center">0</entry></row><row><entry>2. Denture comes loose while speaking</entry><entry align="center">1</entry><entry align="center">17</entry><entry align="center">15</entry><entry align="center">12</entry><entry align="center">44</entry></row><row><entry></entry><entry align="center">2</entry><entry align="center">1</entry><entry align="center">3</entry><entry align="center">1</entry><entry align="center">5</entry></row><row><entry></entry><entry align="center">3</entry><entry align="center">0</entry><entry align="center">0</entry><entry align="center">0</entry><entry align="center">0</entry></row><row><entry></entry><entry align="center">4</entry><entry align="center">1</entry><entry align="center">0</entry><entry align="center">0</entry><entry align="center">1</entry></row><row><entry>3. Denture comes loose while opening wide</entry><entry align="center">1</entry><entry align="center">13</entry><entry align="center">7</entry><entry align="center">10</entry><entry align="center">30</entry></row><row><entry></entry><entry align="center">2</entry><entry align="center">4</entry><entry align="center">10</entry><entry align="center">1</entry><entry align="center">15</entry></row><row><entry></entry><entry align="center">3</entry><entry align="center">1</entry><entry align="center">1</entry><entry align="center">2</entry><entry align="center">4</entry></row><row><entry></entry><entry align="center">4</entry><entry align="center">1</entry><entry align="center">0</entry><entry align="center">0</entry><entry align="center">1</entry></row><row><entry>4. Denture causes pain while eating hard food</entry><entry align="center">1</entry><entry align="center">17</entry><entry align="center">14</entry><entry align="center">12</entry><entry align="center">43</entry></row><row><entry></entry><entry align="center">2</entry><entry align="center">1</entry><entry align="center">3</entry><entry align="center">1</entry><entry align="center">5</entry></row><row><entry></entry><entry align="center">3</entry><entry align="center">0</entry><entry align="center">0</entry><entry align="center">0</entry><entry align="center">0</entry></row><row><entry></entry><entry align="center">4</entry><entry align="center">1</entry><entry align="center">0</entry><entry align="center">0</entry><entry align="center">1</entry></row><row><entry>5. Denture causes pain while eating soft food</entry><entry align="center">1</entry><entry align="center">18</entry><entry align="center">16</entry><entry align="center">12</entry><entry align="center">46</entry></row><row><entry></entry><entry align="center">2</entry><entry align="center">1</entry><entry align="center">2</entry><entry align="center">1</entry><entry align="center">4</entry></row><row><entry></entry><entry align="center">3</entry><entry align="center">0</entry><entry align="center">0</entry><entry align="center">0</entry><entry align="center">0</entry></row><row><entry></entry><entry align="center">4</entry><entry align="center">0</entry><entry align="center">0</entry><entry align="center">0</entry><entry align="center">0</entry></row><row><entry>6. Denture causes pain while eating craggy food</entry><entry align="center">1</entry><entry align="center">15</entry><entry align="center">14</entry><entry align="center">11</entry><entry align="center">40</entry></row><row><entry></entry><entry align="center">2</entry><entry align="center">4</entry><entry align="center">1</entry><entry align="center">2</entry><entry align="center">7</entry></row><row><entry></entry><entry align="center">3</entry><entry align="center">0</entry><entry align="center">2</entry><entry align="center">0</entry><entry align="center">2</entry></row><row><entry></entry><entry align="center">4</entry><entry align="center">0</entry><entry align="center">1</entry><entry align="center">0</entry><entry align="center">1</entry></row><row><entry namest="col1" nameend="col6">*1 = Never; 2 = occasionally; 3 = often; 4 = constantly.</entry></row></tbody></tgroup><ce:legend><ce:simple-para id="sp0070"><ce:italic>ISO</ce:italic> = Implant-supported overdenture; <ce:italic>IMSO</ce:italic> = implant-mucosa–supported overdenture, <ce:italic>CD</ce:italic> = complete denture.</ce:simple-para><ce:simple-para id="sp0075">Mean scores among groups not significant (Kruskal-Wallis).</ce:simple-para></ce:legend></ce:table></ce:display>No significant differences in the complaint scores were found amount the 3 groups (Kruskal-Wallis test).</ce:para><ce:para id="p0120">For those with implant-mucosa–supported overdentures subjective looseness of maxillary denture correlated with residual ridge width reduction in the incisor (<ce:italic>r</ce:italic> =0.44, <ce:italic>P</ce:italic> <.01) and canine areas (<ce:italic>r</ce:italic> =0.36, <ce:italic>P</ce:italic> <.03; Spearman correlation). No correlations with functional complaints and residual ridge width reduction were found in those with implant-supported overdentures or complete dentures.</ce:para><ce:para id="p0125">Subjects with implant-supported overdentures were more satisfied (satisfaction score 8.7 ± 0.8) with their mandibular and maxillary prostheses than were those with implant-mucosa–supported overdentures (7.8 ± 1.0; <ce:italic>P</ce:italic> <.05) or complete dentures (7.5 ± 1.3; <ce:italic>P</ce:italic> <.01).</ce:para></ce:section><ce:section id="s0050"><ce:section-title id="st0055">Discussion</ce:section-title><ce:para id="p0130">The patterns of resorption in the maxilla differ from those in the mandible, and are most pronounced the first years after the loss of teeth. In contrast to the edentulous mandible, maxillary resorption is frequently seen as gradually decreasing the width of the residual ridge.<ce:cross-refs refid="bib12 bib15"><ce:sup>12,15</ce:sup></ce:cross-refs></ce:para><ce:para id="p0135">Jacobs et al<ce:cross-ref refid="bib17"><ce:sup>17</ce:sup></ce:cross-ref> used panoramic radiographs for retrospective evaluation of maxillary bone resorption after the treatment with conventional complete dentures, implant-mucosa–retained mandibular overdentures or fixed implant-supported mandibular prostheses. They concluded that the resorption was most pronounced in complete denture wearers and slightly higher annual resorption was observed in the subjects with implant-supported fixed prostheses than in the overdenture wearers. However, continuing bone resorption was found in all groups of subjects. Although the reproducibility of the method Jacobs et al<ce:cross-ref refid="bib16"><ce:sup>16</ce:sup></ce:cross-ref> used for radiographic evaluation was very high, it may have underestimated the amount of vertical bone loss as the reference area used for calculating anterior and posterior maxillary ratios obviously decreases with bone loss. In our study, panoramic radiographs were made as a part of routine annual examinations, but standardized radiographs were not possible to obtain. The head positioning for panoramic radiography affects vertical measurements<ce:cross-ref refid="bib18"><ce:sup>18</ce:sup></ce:cross-ref>; thus, direct measurements from nonstandardized radiographs are not reliable. Although model analysis does not give information on bone resorption directly, it demonstrates morphologic changes in denture-bearing area more accurately than the analysis based on nonstandardized panoramic radiographs. Ridge mapping has been used to evaluate the thickness of the soft tissues. However, because of the porous construction of maxillary bone, ridge mapping may not always give reliable information on the actual width of the residual ridge.<ce:cross-ref refid="bib19"><ce:sup>19</ce:sup></ce:cross-ref> The use of ultrasound overcomes the problem and sonographic imaging seems to be the most accurate evaluation method currently available.<ce:cross-ref refid="bib19"><ce:sup>19</ce:sup></ce:cross-ref> Unfortunately, it was not possible to evaluate the thickness of the soft tissues from our subjects.</ce:para><ce:para id="p0140">Diagnostic casts have frequently been used to evaluate the changes in the edentulous maxilla, because several anatomic landmarks can be located from the casts to aid the evaluation.<ce:cross-refs refid="bib12 bib13 bib14 bib15"><ce:sup>12-15</ce:sup></ce:cross-refs> Three-dimensional computerized analysis has recently been developed for the evaluation of the maxillary casts.<ce:cross-ref refid="bib20"><ce:sup>20</ce:sup></ce:cross-ref> In our study, changes in the width of the residual ridge were measured in the areas in which the most pronounced reduction of residual ridge width was expected to occur. Variability from sources such as pressure applied during the impression may lead to variability in soft tissue points.<ce:cross-ref refid="bib21"><ce:sup>21</ce:sup></ce:cross-ref> Therefore, assessment of the reliability of measures should have included a series of multiple impressions and casts from the same persons at one time. On the other hand, longitudinal studies with extensive evaluations can be stressful for the subjects. In our study, to keep the number of dropouts as few as possible, all efforts were made to decrease the chairside time. This caused some limitations to the study design and reliability assessment, for example, could not be performed.</ce:para><ce:para id="p0145">Subjects who were not included in the cast evaluations were those who refused to participate in the 6-year follow-up or those whose diagnostic casts could not be used for the measurements. It is unlikely that the characteristics of these subjects could have had significant impact on the results. Because of a large variability in residual ridge width, especially in the molar area, the power of the method we used was relatively poor. Increasing the size of the study population would have improved the power, but because of the nature of the study, it was not possible.</ce:para><ce:para id="p0150">It must be also noted that the differences we found were only slightly higher than the mean magnitude of measurement error. Cast evaluations involved both soft and hard tissues, and it is not known how much of the ridge reduction is due to bone resorption and what role does the changes in soft tissue anatomy play. Furthermore, additional error is likely to occur in cast evaluation, but it is unknown, because there was no evaluation of error introduced by impression and cast-related procedures.</ce:para><ce:para id="p0155">This study appears to be the first prospective randomized clinical trial on objective and subjective changes in the edentulous maxilla after the treatment with mandibular implant-retained overdentures. A retrospective case report has previously shown increased anterior maxillary bone loss in persons wearing implant-retained mandibular overdentures.<ce:cross-ref refid="bib9"><ce:sup>9</ce:sup></ce:cross-ref> However, no control group was included in that study and the follow-up period was relatively short. The findings of continuous residual ridge reduction is in agreement with a previous study,<ce:cross-ref refid="bib16"><ce:sup>16</ce:sup></ce:cross-ref> although in our study the reduction was not associated with mandibular prosthetic status.</ce:para><ce:para id="p0160">To preserve anterior maxillary bone, an occlusal concept with anterior open bite has been recommended for implant-retained mandibular prostheses.<ce:cross-ref refid="bib23"><ce:sup>23</ce:sup></ce:cross-ref> In our study, all subjects were treated with lingualized occlusion concept without anterior tooth contact in maximal occlusion. If anterior contact was noticed during the annual recall examination, the occlusion was adjusted to relieve the pressure from the anterior maxilla. Lehner and Mammen<ce:cross-ref refid="bib9"><ce:sup>9</ce:sup></ce:cross-ref> reported that patients might loosen contacts between the posterior teeth, which subsequently increases the anterior guidance. Their study and our findings demonstrate the importance of occlusal design in implant-retained prostheses.</ce:para><ce:para id="p0165">Sensation of a loose maxillary denture, as was found in those with implant-mucosa–supported overdentures, is a logical consequence of the residual ridge width reduction. The previous assumption that patients’ complaints of a loose maxillary denture is associated with an increased residual ridge reduction in the maxilla caused by mandibular implant treatment was not confirmed by our study.</ce:para><ce:para id="p0170">The reason for higher satisfaction score in persons wearing implant-supported overdentures than in those with implant-mucosa–supported overdentures or complete dentures is not known. Implant-supported overdentures may retain the occlusal plane better than do the implant-mucosa–supported overdentures or complete dentures, and morphologic changes in the maxilla are not readily noticed. Changes in the plane of occlusion with different types of overdentures would be an interesting topic for future studies. It must be remembered, however, that the satisfaction score evaluated not only the maxillary denture but also the subjects’ opinions on their prostheses in general. Therefore, differences in the subjects’ experiences with their mandibular dentures had obviously a significant impact on their scorings.</ce:para></ce:section><ce:section id="s0055"><ce:section-title id="st0060">Conclusions</ce:section-title><ce:para id="p0175">Within the limitations of this study, the following conclusions were made:<ce:list id="l0010"><ce:list-item id="o0010"><ce:para id="p0180">Residual ridge width of an edentulous maxilla decreases gradually in incisor and canine areas.</ce:para></ce:list-item><ce:list-item id="o0015"><ce:para id="p0185">The decrease in residual ridge width is small and not associated with the type of mandibular restoration.</ce:para></ce:list-item></ce:list></ce:para></ce:section><ce:section id="s0065"><ce:section-title id="st0065">Supplementary Files</ce:section-title><ce:para id="p0190"><ce:float-anchor refid="mmc1"></ce:float-anchor></ce:para></ce:section></ce:sections></body><tail><ce:bibliography id="bi0010"><ce:section-title 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lang="en"><title>Changes in the edentulous maxilla in persons wearing implant-retained mandibular overdentures</title></titleInfo><titleInfo type="alternative" lang="en" contentType="CDATA"><title>Changes in the edentulous maxilla in persons wearing implant-retained mandibular overdentures</title></titleInfo><name type="corporate"><namePart>Institute of Dentistry, University of Turku, Turku, Finland, University of Nijmegen, Nijmegen, The Netherlands, and University of Groningen, Groningen, The Netherlands</namePart></name><name type="personal"><namePart type="given">Timo O.</namePart><namePart type="family">Närhi</namePart><namePart type="termsOfAddress">DDS, PhD</namePart><affiliation>Assistant Professor, Department of Prosthodontics, Institute of Dentistry, University of Turku</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Mariëlle E.</namePart><namePart type="family">Geertman</namePart><namePart type="termsOfAddress">DDS, PhD</namePart><affiliation>Assistant Professor, Oral Function and Prosthetic Dentistry, University of Nijmegen</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Miluska</namePart><namePart type="family">Hevinga</namePart><namePart type="termsOfAddress">DDS</namePart><affiliation>Assistant Professor, Oral Function and Prosthetic Dentistry, University of Nijmegen</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Hanan</namePart><namePart type="family">Abdo</namePart><namePart type="termsOfAddress">BDS</namePart><affiliation>Student, Oral Function and Prosthetic Dentistry, University of Nijmegen</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Warner</namePart><namePart type="family">Kalk</namePart><namePart type="termsOfAddress">DDS, PhD</namePart><affiliation>Professor and Head, Department of Prosthodontics, University of Groningen</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="Full-length article" authority="ISTEX" authorityURI="https://content-type.data.istex.fr" valueURI="https://content-type.data.istex.fr/ark:/67375/XTP-1JC4F85T-7">research-article</genre><originInfo><publisher>ELSEVIER</publisher><dateIssued encoding="w3cdtf">2000</dateIssued><copyrightDate encoding="w3cdtf">2000</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><abstract lang="en">Abstract: Statement of Problem: It has been suggested that risk for severe resorption in the anterior maxilla is increased in persons wearing mandibular implant-retained overdentures. However, little information is available about the changes in the edentulous maxilla after mandibular implant treatment. Purpose: This study determined the possible changes in the width of the maxillary residual ridge 6 years after receiving mandibular implant-supported or implant-mucosa–supported overdentures and evaluated the association between the anatomic changes and subjective complaints with maxillary complete dentures. Methods and Material: The subjects for this study (n = 55), enrolled among the participants of a prospective clinical trial, were randomly assigned into 3 groups treated with: (a) implant-supported overdentures on a transmandibular implant system (n = 21); (b) implant-mucosa–supported overdentures on 2 IMZ implants (n = 20); or (c) conventional complete dentures (n = 14). A lingual contact occlusion concept with anterior open bite was used for tooth arrangement in all subjects. Diagnostic casts were made at baseline, and again at the 6-year follow-up. Most prominent points perpendicular to the crest of residual ridge were located in the incisor, canine, and premolar regions, after which the width of the ridge was recorded at these points with a Boley gage. Subjects’ opinions on their dentures were evaluated with a questionnaire. Results: Significant reduction in the width of the ridge was found in all measurement areas (mean difference = 0.4 to 0.6 mm; P <.0001). However, changes were small and not associated with the type of prosthetic restoration in the mandible. In subjects with implant-mucosa–supported overdentures, complaint of loose maxillary denture correlated with the decrement of residual ridge width. Conclusion: The width of residual ridge decreases with time, despite the type of mandibular prosthetic restoration. (J Prosthet Dent 2000;84:43-9.)</abstract><note>Reprint requests to: Dr Timo O. Närhi, Department of Prosthodontics, Institute of Dentistry, University of Turku, Lemminkäisenkatu 2, SF-20520 Turku, FINLAND, Fax: (358)2-333-8356, E-mail: timo.narhi@utu.fi</note><note type="content">Section title: Original Articles</note><relatedItem type="host"><titleInfo><title>The Journal of Prosthetic Dentistry</title></titleInfo><titleInfo type="abbreviated"><title>YMPR</title></titleInfo><genre type="journal" authority="ISTEX" authorityURI="https://publication-type.data.istex.fr" valueURI="https://publication-type.data.istex.fr/ark:/67375/JMC-0GLKJH51-B">journal</genre><originInfo><publisher>ELSEVIER</publisher><dateIssued encoding="w3cdtf">200007</dateIssued></originInfo><identifier type="ISSN">0022-3913</identifier><identifier type="PII">S0022-3913(00)X0001-7</identifier><part><date>200007</date><detail type="volume"><number>84</number><caption>vol.</caption></detail><detail type="issue"><number>1</number><caption>no.</caption></detail><extent unit="issue-pages"><start>1</start><end>115</end></extent><extent unit="pages"><start>43</start><end>49</end></extent></part></relatedItem><identifier type="istex">EEDBF3D7C619997E70426F14853929E95F9E2092</identifier><identifier type="ark">ark:/67375/6H6-Z0710MCC-X</identifier><identifier type="DOI">10.1067/mpr.2000.107113</identifier><identifier type="PII">S0022-3913(00)39744-X</identifier><accessCondition type="use and reproduction" contentType="copyright">©2000 Editorial Council of The Journal of Prosthetic Dentistry.</accessCondition><recordInfo><recordContentSource authority="ISTEX" authorityURI="https://loaded-corpus.data.istex.fr" valueURI="https://loaded-corpus.data.istex.fr/ark:/67375/XBH-HKKZVM7B-M">elsevier</recordContentSource><recordOrigin>Editorial Council of The Journal of Prosthetic Dentistry., ©2000</recordOrigin></recordInfo></mods><json:item><extension>json</extension><original>false</original><mimetype>application/json</mimetype><uri>https://api.istex.fr/document/EEDBF3D7C619997E70426F14853929E95F9E2092/metadata/json</uri></json:item></metadata><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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