Effect of implant-supported or retained dentures on masticatory performance: A systematic review

Removable Partial Denture Prosthodontics, Tokyo Medical and Dental University, Tokyo, Japan.
Journal of Prosthetic Dentistry (Impact Factor: 1.75). 01/2008; 98(6):470-7. DOI: 10.1016/S0022-3913(07)60147-4
Source: PubMed


While subjective patient-based measures have been increasingly recognized as critical outcomes for prosthodontic treatment, there continues to be a need to validate for patients what changes in masticatory function can be expected with the provision of new implant-supported or retained dentures.
The purpose of this review was to evaluate the critical factors impacting change in masticatory performance following the provision of new implant-supported or retained dentures.
Information retrieval followed a systematic approach using PubMed and the Cochrane Library. English articles published from 1966 to June 2007, in which the masticatory performance of subjects with implant-supported or retained dentures was assessed by objective methods and compared to performance with conventional dentures, were included. Ratings of the evidence provided in each article followed United States Agency for Healthcare Research and Quality recommendations.
From 281 articles identified, 18 peer-reviewed articles met prespecified criteria for inclusion. Specific outcomes of significance identified by these articles rated as level II are: (1) fixed implant-supported partial dentures do not provide significant improvement in masticatory performance compared to conventional removable partial dentures for Kennedy Class I and II partially edentulous mandibles; (2) the combination of a mandibular implant-supported or retained overdenture (IOD) and maxillary conventional complete denture (CD) provides significant improvement in masticatory performance compared to CDs in both the mandible and maxilla for a limited population having persistent functional problems with an existing mandibular CD due to severely resorbed mandible; and (3) the type of implant and attachment system for mandibular IODs has a limited impact. Specific outcomes of significance identified by articles rated as having a moderate level of evidence (level III) are: (1) mandibular fixed implant-supported complete dentures provide significant improvement in masticatory performance compared to mandibular CDs in subjects dissatisfied with their CDs; and (2) implant-supported mandibular resection dentures have an advantage over conventional dentures in masticatory performance on the defect side of the mouth.
Objective benefits in masticatory performance of implant-supported or retained dentures compared to conventional dentures are limited to a mandibular IOD in edentulous patients with a resorbed mandible and/or difficulty adapting to CDs.

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Available from: Kenji Fueki, Feb 09, 2016
    • "In 1998, Fontijn et al. reported that patients with mandibular implanteretained overdentures had significantly higher maximum bite forces than conventional complete-denture wearers. In 2006, Fueki et al. reported, in their literature review covering more than 50 years, objective benefits in the masticatory performance of implant-supported overdentures compared with conventional dentures in edentulous patients with resorbed mandibles (Fueki et al., 2007). These overdentures appeared to yield higher patient satisfaction scores, even with patients who had undergone preprosthetic surgery (Sadowsky, 2001). "
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    ABSTRACT: Fractures of the atrophic edentulous mandible are a rare complication that can become severe after the insertion of dental implants. This in vitro study investigated the effects of different implant settings varying in number, diameter, and length. and the influence of a fixed bar. In biomechanical experiments on artificial mandibles, an unmodified reference group, four implant settings with two different implants, and the effect of adding a fixed bar to these settings were tested. All specimens were loaded with incisal biting forces until failure due to fracture. Implants weakened all specimens significantly compared with those in the reference group. Without a fixed bar, four short and thick implants showed the best results, with high significance. With a fixed bar, four long and thin implants withstood the highest loads. The addition of fixed bars reduced the differences between the implant settings. Fixed bars did not show increased stability for all groups; however, these groups showed a higher mean strength. Four implants with a short and thick design should be the first choice when implants are placed without a fixed bar in an atrophic mandible. With a fixed bar, four long and thin implants should be used. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.
    No preview · Article · Mar 2015 · Journal of Cranio-Maxillofacial Surgery
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    • "To overcome these problems, implants have been increasingly used to retain complete dentures and have demonstrated to be a successful treatment alternative for edentulous patients with mandibular denture predicament (Fueki et al., 2007, Rashid et al., 2011, Barao et al., 2013). Despite these clear benefits, there have been reports concerning severe residual ridge resorption associated with implant-retained overdentures (Jacobs et al., 1992, Blum and McCord, 2004). "
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    ABSTRACT: Although implant-retained overdenture allows edentulous patients to take higher occlusal forces than the conventional complete dentures, the biomechanical influences have not been explored yet. Clinically, there is limited knowledge and means for predicting localized bone remodelling after denture treatment with and without implant support. By using finite element (FE) analysis, this article provides an in-silico approach to exploring the treatment effects on the oral mucosa and potential resorption of residual ridge under three different denture configurations in a patient-specific manner. Based on cone beam computerized tomography (CBCT) scans, a 3D heterogeneous FE model was created; and the supportive tissue, mucosa, was characterized as a hyperelastic material. A measured occlusal load (63N) was applied onto three virtual models, namely complete denture, two and four implant-retained overdentures. Clinically, the bone resorption was measured after one year in the two implant-retained overdenture treatment. Despite the improved stability and enhanced masticatory function, the implant-retained overdentures demonstrated higher hydrostatic stress in mucosa (43.6kPa and 39.9kPa for two and four implants) at the posterior ends of the mandible due to the cantilever effect, than the complete denture (33.4kPa). Hydrostatic pressure in the mucosa signifies a critical indicator and can be correlated with clinically measured bone resorption, pointing to severer mandibular ridge resorption posteriorly with implant-retained overdentures. This study provides a biomechanical basis for denture treatment planning to improve long-term outcomes with minimal residual ridge resorption. Copyright © 2014 Elsevier Ltd. All rights reserved.
    Full-text · Article · Dec 2014 · Journal of Biomechanics
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    • "Overdenture in mandible presents the following benefits comparing to complete denture treatment: better chewing ability, better fit and retention, improved function, and improved quality of life (Fueki et al., 2007). "
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    ABSTRACT: This study evaluated the influence of cross-section geometry of the bar framework on the distribution of static stresses in an overdenture-retaining bar system simulating horizontal misfit and bone loss. Three-dimensional FE models were created including two titanium implants and three cross-section geometries (circular, ovoid or Hader) of bar framework placed in the anterior part of a severely resorbed jaw. One model with 1.4-mm vertical loss of the peri-implant tissue was also created. The models set were exported to mechanical simulation software, where horizontal displacement (10, 50 or 100μm) was applied simulating the settling of the framework, which suffered shrinkage during the laboratory procedures. The bar material used for the bar framework was a cobalt-chromium alloy. For evaluation of bone loss effect, only the 50-μm horizontal misfit was simulated. Data were qualitatively and quantitatively evaluated using von Mises stress for the mechanical part and maximum principal stress and μ-strain for peri-implant bone tissue given by the software. Stresses were concentrated along the bar and in the join between the bar and cylinder. In the peri-implant bone tissue, the μ-strain was higher in the cervical third. Higher stress levels and μ-strain were found for the models using the Hader bar. The bone loss simulated presented considerable increase on maximum principal stresses and μ-strain in the peri-implant bone tissue. In addition, for the amplification of the horizontal misfit, the higher complexity of the bar cross-section geometry and bone loss increases the levels of static stresses in the peri-implant bone tissue.
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