Treatment Effect of Implant-Supported Fixed Complete Dentures and Implant Overdentures on Patient-Reported Outcomes

Consensus Statement 1: In fully edentulous patients wearing removable complete dentures (CD), the use of dental implants to retain/support dental prostheses in the maxilla and/or the mandible leads to an improvement in overall dental patient-reported outcomes (dPROs). This statement is based on a descriptive analysis of 2 RCTs and 26 prospective case series (1457 patients).

Consensus Statement 2: Edentulous patients wearing complete dentures (CD) gain substantial improvements in overall dPROs following treatment which are comparable with either complete implant-supported fixed dental prostheses (CIFDPs) or implant overdentures (IODs). This statement is based on a meta-analysis of 2 RCTs and 13 prospective case series (519 patients). Effect size (ES) CIFDPs: 1.68 [1.15, 2.20]; ES IODs: 1.26 [0.99, 1.52].

Consensus Statement 3: When restoring the edentulous mandible with an IOD, both bar and non-splinted attachments lead to a similar improvement in dPROs. This statement is based on a meta-analysis of 2 RCTs and 18 prospective case series (639 patients). ES bars: 1.33 [0.37, 2.29]; ES non-splinted attachments: 1.38 [1.17, 1.58].

Consensus Statement 4: With respect to dPROs, mandibular IODs retained by two implants are superior to IODs retained by one implant. This statement is based on a meta-analysis of 3 RCTs and 17 prospective case series (639 patients). ES difference: 0.72 [0.38, 1.06].

Consensus Statement 5: Increasing the number of implants to more than two implants to retain a mandibular IOD does not further improve dPROs. Effect size in respect to the increase in dPROs in relation to the number of implants to support/retain a mandibular IOD. This statement is based on a meta-analysis of 2 RCTs and 18 prospective case series (598 patients).

1) In fully edentulous patients can a CIFDP or an IOD be recommended to provide optimal stability and comfort?

In fully edentulous patients, based on dPROs, both CIFDPs and IODs result in an improvement in stability and comfort compared to CDs. For the highest levels of stability, retention, and comfort, CIFDPs may be recommended over IODs, whenever clinically indicated. Clinical decisions should also consider other relevant factors including speech, esthetic concerns, prosthetic space requirements, costs, stability, retention, maintenance requirements, and manual dexterity. Continuous assessment of the patient's ability to manage the prosthesis and maintain plaque control should be performed.

2) What is the ideal attachment for a mandibular IOD?

What is the ideal attachment for a mandibular IOD? In fully edentulous patients, both splinted and unsplinted attachments are equally effective from a patient's perspective and can be recommended.

3) Based on dPROs, what is the ideal number of implants to retain/support a mandibular IOD?

Based on dPROs, what is the ideal number of implants to retain/support a mandibular IOD? In fully edentulous patients, mandibular IODs retained by one or two implants show positive effects on dPROs compared to a mandibular CD, with two implants being the optimal number. Additional implants do not offer further improvements in dPROs. Based on expert opinion, if the opposing maxilla is dentate or restored with a fully implant-supported prosthesis, more than two standard-diameter implants in strategic positions are recommended to support the mandibular IOD to avoid complications and fractures of the implants and prosthetic components. More than two implants are also recommended to enable implant support over mucosal support in compromised anatomical situations (e.g., highly resorbed posterior mandible) and/or compromised mucosal conditions (e.g., hyposalivation).