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©Archives of Dental Sciences Review Article

2010, Vol.1, Issue 1, 12-16 Rohit H Saran

Review
Comparative Analysis of Implant Supported dentures with Complete Mandibular
Denture.
Rohit H Saran1

1. Rohit H Saran (M.D.S.)


Associate Professor, Department. of Prosthodontia, Vinayaka Missions Dental College, Mau, Attaria,
Dist: Sitapur (U.P.)

Corresponding Author
Rohit H. Saran, Department of Prosthodontia, Vinayaka Missions Dental College, Mau, Attaria,
Dist: Sitapur (U.P.)
E-mail: drrohitbansee@rediffmail.com
Contact no.: 05864-277247
Abstract:
Objective: Last decade has witnessed revolutionary improvements not only in the execution of dental
practice but in the aspirations of patients as well. There were times when conventional denture was the only
option available to meet the needs of edentulous patients. However, with the advent of dental implants more
retentive, stable, functional and esthetically pleasing dentures can be promised to the patient, especially in
the mandible. The implant-supported prosthesis if possible seems to be a better alternative to the
conventional removable denture. This article describes the strengths of the implant-supported mandibular
overdenture along with the risks of this approach. Recent literature has been reviewed to summarize the
reported success rate of implants used to support a mandibular overdenture.
Conclusion: The literature review indicates that implants placed in the anterior mandible (anterior to the
foramen) have a very high success rate (more than 95%). Patients have reported a high degree of acceptance
and satisfaction with the implant-supported overdenture.
Key words: Implant Supported Denture, Complete Denture.

Introduction:
An overdenture is defined as a prosthesis that impact of disease and for assessing the efficacy
covers and is partially supported by natural of treatments. Quality of life in denture wearers
teeth, tooth roots, and/or dental implants1. Tooth is measured by socio-dental indicators. Locker
loss is a serious life event2. According to the defined these indicators as; measures of the
WHO criteria edentulism is a form of physical extent to which dental and oral disorders disrupt
impairment, the loss of all teeth causes a normal social role functioning and bring about
disability for most people who wear major changes in behavior such as an inability to
conventional dentures as they may have work or attend school, or undertake parental or
difficulty in performing two essential tasks; household duties. Therefore quality of life
eating and speaking. Quality of life is defined as affects denture wearers with regard to patient
an individual's perception of their position in satisfaction, nutrition and psycho-social aspects
life, in the context of the culture and value of life. Quality of life however is, adversely
systems in which they live, and in relation to affected by tooth loss.
their goals, expectations, standards and
concerns3. Another dimension of quality of life Success Rates of Implant Clinical Trials and
is Oral health-related quality of life. This is Results.
defined as an individual's assessment of how the Implants are no longer considered experimental.
following affect his or her well-being: functional The table shows representative clinical trials
factors, psychological factors, social factors, and over the past six years4, 6, 8, 20. The table shows
experience of pain or discomfort in relation to the primary author, size of study, study design
orofacial concerns. Quality of life is established and representative results of each study.
as an important outcome for evaluating the

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©Archives of Dental Sciences Comparative Analysis of Implant Supported Dentures
2010, Vol.1, Issue 1, 12-16 Rohit H Saran

REPRESENTATIVE IMPLANT CLINICAL outcome. Uncontrolled diabetes and use of drugs


TRIALS AND RESULT such as steroids need to be carefully considered
TYPE OF
STUDY
RESULT AUTHOR in the treatment plan, and the clinician may need
Higher patient to adjust time to loading accordingly.
Awad and
Randomized satisfaction than
colleagues4
Clinical Trial with conventional
denture
Anatomy and bone quality also affect the
Buser and outcome and ease of surgical placement of
Survival rate: > 95
Prospective colleagues20 implants. Implants need adequate bone height
percent for screws
and width for placement. If the native bone at
Tawse-Smith and the recipient site is inadequate to accept the
Success rate: 95.8
Prospective colleagues9
percent implant, bone grafts—with or without guided
Prospective, Success rate: 97 Meijer and bone regeneration— must be considered. Bone
Multicenter percent colleagues11 quality, which is related to density of the
Success rate: trabecular bone, usually is not a problem in the
submerged
implants, 97.9 Moberg and anterior mandible. Other segments of the
Prospective percent; colleagues13 alveolar bone, such as the posterior maxilla, are
nonsubmerged
implants, 96.8
more likely to have lower bone density, which
percent can limit implant stability and osseointegration.
Prospective, Success rate: 92.6
Rodriguez and With proper diagnosis and treatment planning,
Colleagues16
Multicenter percent the limitations and risks of implant placement
Success rate: are manageable. Good communication between
hydroxyapatite, or the surgical and restorative members of the team
Prospective, HA, cylinder, 97.5 Morris and Ochi15
Multicenter percent; titanium, or is a necessity. High-quality training and
Ti, screw, 99.4 experience in implant surgery and restorative
percent care are fundamental to delivering quality care.
Success rate: HA, Jeffcoat and
Prospective,
99 percent; Ti colleagues6
Multicenter
screw, 96 percent Discussion
Bergendal and Implant-supported overdentures offer many
Prospective, Success rate: 100 Engquist8
Multicenter percent practical advantages over conventional complete
dentures and removable partial dentures. These
include decreased bone resorption; reduced or
Risks Associated with Implant Placement eliminated prosthesis movement; better
No surgical procedure, including the placement esthetics; improved tooth position; better
of implants, is without risk. The risks associated occlusion, including improved occlusal load
with implant placement include postoperative direction, increased occlusal function and
bleeding, numbness if the mandibular nerve is maintenance of the occlusal vertical dimension.
disturbed, infection and lack of osseointegration. In addition, implant- supported overdentures
The risks can be minimized with proper training improve phonetics, the patient’s psychological
and experience. Case selection and diagnosis is outlook and quality of life. Conventional
the key to success with implant procedures, as dentures rely upon the residual alveolar ridge
with all dental procedures. Other risk factors and mucosa for support and retention. Many
also may affect the outcome of the implant- patients have problems adapting to their
supported prosthesis. Smoking is a risk factor complete dentures, especially to the mandibular
for long term implant success. Patients who prosthesis. The widespread use of denture
smoke are more likely to experience infection adhesives is one indication that these prostheses
and/or progressive alveolar bone loss, which generally provide inadequate comfort and
ultimately may lead to implant loss. Untreated function.
periodontitis also is a risk factor for the failure
of dental implants. Obviously, fully edentulous The most prevalent treatment plan for the
patients do not have periodontitis, but even after edentulous patient is the complete removable
the extraction of a single tooth with periodontal maxillary and mandibular denture. This
disease, the site may harbor pathogenic bacteria treatment is relatively inexpensive in
that may lead to periimplantitis. Factors that comparison with fixed implant-supported
may influence the healing or potential infection prostheses, but it has several drawbacks as well.
of the implant recipient site also may affect the Like all dental restorative procedures, a

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©Archives of Dental Sciences Comparative Analysis of Implant Supported Dentures
2010, Vol.1, Issue 1, 12-16 Rohit H Saran

complete removable denture requires extensive Within 1 year, the PPS and Implant supported
attention to detail if an excellent clinical result is mandibular overdenture group experienced
to be achieved. Depending on the shape of the better chewing ability than the CD group. The
residual ridge, the denture may fail to fulfill PPS group was satisfied in the short term. The
patient expectations in various parameters. Implant supported mandibular overdenture
group experienced long-term satisfaction (10
Preservation and Maintenance of Ridge years.) From the above evidence it can be
Morphology: concluded that patient satisfaction is improved
The rate of residual ridge resorption in with the provision of an Implant supported
edentulous patients who do not have tooth mandibular overdenture compared to a CD, with
replacements is highly variable and may be as or without PPS. Patients were not only satisfied
much as several millimeters per year. This in the short-term but also at a 10 year recall as
resorption can render the current prosthesis well.
inadequate in terms of both function and
esthetics and can lead to the necessity of Quality of life - Nutrition
fabricating a new denture. Overdenture on the As tooth number decreases, mastication
other hand has good stability and retention, and becomes more difficult; patients are also more
patients who have received them have reported likely to practice forms of food avoidance and
improved function and satisfaction4. Another dietary restriction. Morais et al. revealed that
benefit of implant supported prostheses is patients provided with an Implant supported
suggested by data indicating that after receiving mandibular overdenture reported an increased
implants, patients may eat a diet with more fiber. ability to bite, eat and chew, without losing their
Other studies have measured the rate of residual dentures, 6 months posttreatment. This group
ridge resorption in the five years after implant also showed improvements in anthropometric
placement. The rate of resorption is decreased data and blood nutrient data. Serum albumin
significantly from the rates seen with concentration increased by 1.4g/l (a recognized
conventional dentures, and recent research has indicator of good general health) 15. Serum B12
shown that the height of the posterior ridge concentrations also increased. The process of
increases with continued use of implant- dietary restriction amongst edentulous patients
supported prostheses5. Although patients in has also been studied. Allen and McMillan
studies are not directly comparable to the found that subjects who received Implant
population as whole, patients with implant supported mandibular overdentures altered their
supported prostheses return for visits with the food choices, including, "hard to chew foods"14.
same practitioner at a very high rate6. From the literature it can be concluded that the
Implant supported mandibular overdenture
Quality of life - Patient Satisfaction: offers the patient significant improvements in
It is accepted in the literature that satisfaction in nutritional status. The Implant supported
denture wearers depends upon the ability of the mandibular overdenture will not necessarily
patient to chew and speak, and also on the result in the patient eating a more balanced diet
appearance of the prosthesis7. Berg et al. found of their own initiative. Thus, in order to allow
that 66% of patients were dissatisfied with their patients benefit most from their improved
CDs due to discomfort, suboptimal retention and masticatory function, dietary advice should be
fit, and/or pain associated with the lower CD10. given14.
Results showed that the Implant supported
mandibular overdenture group was more Quality of life - Psychosocial effects of Implant
satisfied 1 year post-treatment. Dissatisfaction in supported mandibular overdentures
the CD group was due to the poor retention of Blomberg stated that teeth do not function just
the lower CD; only 27% were satisfied post- as a part of the masticatory system; the oral
treatment. The design of this study shows a high region is also a speech and a psycho-sexual
degree of validity, however, a longer follow-up centre. The success of denture treatment is not
is required. The first prospective study with a 10 solely based upon functional parameters. The
year follow-up was carried out by Raghoeber et effects of denture wearing on social activities
al.12. Patients were randomized as follows: a) have been studied by Heydecke et al. who
CD (control group); b) PPS with a CD; and, c) carried out a 2 month follow-up comparing CDs
Implant supported mandibular overdenture. and Implant supported mandibular

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©Archives of Dental Sciences Comparative Analysis of Implant Supported Dentures
2010, Vol.1, Issue 1, 12-16 Rohit H Saran

overdentures17. Many studies use scales such as considered in planning treatment for the fully
the Oral Health Impact Profile to measure edentulous patient. However, prospective
quality of life. Unlike the Social Impact randomized studies with longer follow-up
Questionnaire, the Oral Health Impact Profile periods are required. It can also be concluded
does not take into account social or sexual that patients restored with Implant supported
activities. This study concluded that the Implant mandibular dentures will experience
supported mandibular overdenture had a positive improvements in quality of life with regard to
effect on social activities 2 months post- oral health-related quality of life.
treatment. Conversely, the instability of the CD
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2010, Vol.1, Issue 1, 12-16 Rohit H Saran

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