Oral Function in Completely Edentulous Patients Rehabilitated with Implant-Supported Dental Prostheses

Consensus Statement 1: Overall oral function improves significantly in edentulous patients rehabilitated with mandibular IODs/CIFDPs opposing a conventional maxillary CD when compared to those rehabilitated with CDs in both jaws. This statement is based on the overall results of the meta-analyses performed for the investigated time points at 6–12 months (Z= −4.895, p< .001; 10 studies: 2 RCTs, 8 prospective studies; 443 patients), at 12–36 months (Z= −4.886, p< .001; 14 studies: 3 RCTs, 11 prospective studies; 586 patients) and at more than 36 months (Z= −9.108, p< .001; 5 prospective studies; 179 patients) in function.

Consensus Statement 2: Bite force increases in edentulous patients rehabilitated with mandibular IODs/CIFDPs opposing a maxillary CD when compared to those rehabilitated with CDs in both jaws. This statement is based on the meta-analysis performed for the investigated time points at 6–12 months (Z= −3.788, p< .001, 2 prospective studies, 52 patients), at 12–36 months (Z= −4.041, p< .001, 4 studies: 1 RCT and 3 prospective studies, 152 patients), and at more than 36 months (Z= −8.061, p< .001, 5 prospective studies, 179 patients).

Consensus Statement 3: Chewing (masticatory performance and efficiency) improves in edentulous patients rehabilitated with mandibular IODs/CIFDPs opposing a maxillary CD when compared to those rehabilitated with CDs in both jaws. This statement is based on the meta-analysis of data provided by 7 studies (2 RCTs and 5 prospective studies; 327 patients) for the assessment of masticatory performance by mixing ability tests (variance of hue: Z= −2.283, p< .022, 5 studies: 2 RCTs and 3 prospective studies, 235 patients; mixing ability test: Z= −4.711, p< .001, 2 prospective studies, 92 patients) with a follow-up period of 12–36 months. Assessment of chewing function using the sieving method (comminution tests) showed the largest effect size.

1) With respect to oral function, should implant-retained/supported prostheses be considered the best treatment option in completely edentulous patients?

Oral function significantly improves in completely edentulous patients when the mandible is restored using an CIFDP or an IOD compared to CDs, therefore this should be recommended as the best treatment. The availability of this treatment modality should be actively promoted in all edentulous communities, including those with limited access and means.

1) My upper denture fits well but I have problems with my lower denture, particularly when eating. Is there a better alternative than my current lower denture?

Yes, there are removable dentures and fixed bridges attached to implants to replace your loose lower denture. There are many studies that show that these improve satisfaction and the ability to chew and bite. Implants will help to stabilize your dentures/bridges, making them more comfortable and less likely to move around.

2) As my upper denture fits well, should an implant denture/bridge be my first choice of treatment instead of a new lower full denture?

Since you are not satisfied with your current lower denture, yes, a dental implant denture/bridge should be considered as your first option to help replace all of your missing lower teeth. Studies show that these are very beneficial to patients like you. However, a full assessment will be required to examine the amount of bone you have available to place implants and to consider your medical history.

3) If I keep my full denture as it is but want an implant denture in my lower jaw, how many implants will I need?

If we are considering a removable implant denture, it is possible to use 1 implant, but we recommend 2, as the studies show us that this will provide you with greater satisfaction. Interestingly, the evidence also shows that putting in more than 2 implants will not lead to any improvements in your satisfaction.

4) Will I be happy with the removable implant denture in the long term?

Yes, the majority of patients in your situation remain satisfied with their removable implant dentures for at least 10 years.

5) What if I would like to have a fixed solution, something that I do not have to remove?

If you prefer to have a fixed denture, then you will require a minimum of 4 implants to provide you with a fixed implant bridge. Many patients have reported that this option provides the highest degree of stability and comfort. However, you must understand that the fixed option makes daily cleaning more challenging and will be more expensive.