Four or six implants in the maxillary posterior region to support an overdenture: 5‐year results from a randomized controlled trial

Abstract

Objective To compare clinical and patient‐reported outcomes when providing maxillary overdentures on four bar‐ and six bar‐connected implants placed in the posterior region during a 5‐year follow‐up period. Materials and methods Sixty‐six fully edentulous patients with functional maxillary denture complaints and insufficient bone volume to allow implant placement were scheduled for a maxillary sinus floor elevation procedure with bone from the anterior iliac crest and randomized to receive either four or six implants in the posterior maxilla and four implants in the mandible. After 3 months of osseointegration, a bar‐supported overdenture was constructed. Maxillary implant survival, overdenture survival, clinical scores, peri‐implant bone height changes and patient satisfaction were assessed. Results Sixty patients completed the 5‐year follow‐up. Implant survival was 100% in the four‐implant group and 99.5% in the six‐implant group. No new overdentures had to be made in the four‐implant group, and three new overdentures were made in the six‐implant group due to excessive wear of the denture base and teeth (90.9% overdenture survival). Clinical parameters did not differ significantly between groups. Mean marginal bone loss compared to baseline was 0.58 ± 0.51 mm in the four‐implant group and 0.60 ± 0.58 mm in the six‐implant group, respectively. Overall, patient satisfaction improved significantly, but did not differ between groups. Conclusion Following a bilateral maxillary sinus floor elevation procedure, a bar‐supported overdenture on four implants in the posterior maxillary region is not inferior to an overdenture supported by six implants after a 5‐year evaluation period in patients with functional maxillary denture complaints and marked posterior resorption (Clinical trial registration number: NTR2969).

Long‐term effectiveness of maxillary sinus floor augmentation: A systematic review and meta‐analysis

“…The approach to the lateral antral wall was performed by a trapdoor technique and/or by preparing an access hole by removal of the buccal bone plate (Table ). AB was harvested from the maxillary sinus region (Bornstein, Chappuis, Von Arx, & Buser, ; Khoury, Keller, & Keeve, ), chin (Bornstein et al., ; Mordenfeld et al., ), tuberosity (Cannizzaro et al., ; Khoury et al., ), ascending mandibular ramus (Bornstein et al., ; Khoury et al., ), anterior iliac crest (Boven, Slot, Raghoebar, Vissink, & Meijer, ; Dasmah, Thor, Ekestubbe, Sennerby, & Rasmusson, ; Slot, Raghoebar, Cune, Vissink, & Meijer, ) or posterior iliac crest (Bornstein et al., ). Deproteinized bovine bone mineral (DBBM; Bio‐Oss, Geistlich Pharma AG, Wolhusen, Switzerland) was used in six studies (Bornstein et al., ; Cannizzaro et al., ; Mordenfeld, Lindgren, & Hallman, ; Mordenfeld et al., ; Oliveira, El Hage, Carrel, Lombardi, & Bernard, ; Özkan, Akoǧlu, & Kulak‐Özkan, ) and synthetic BS (Ceros TCP, Mathys AG, Bettlach, Switzerland and Bone Ceramic, Straumann AG, Basel, Switzerland) in two studies (Bornstein et al., ; Mordenfeld et al., ).…”

Patient satisfaction and clinical outcomes in implant‐supported overdentures retained by milled bars: Two‐year follow‐up

“…Several studies and systematic reviews have recently evaluated how the patients may objectively perceive the effects of reconstructive dentistry on significant improvement of the quality of life . The main benefits have been reported for fully edentulous patients, which represent the most investigated population . These patients report that they are able to eat tougher foods thanks to their increased bite force and ability to chew …”

Bar versus ball attachments for maxillary four‐implant retained overdentures: A randomized controlled trial

“…Based on the paradigm shift to “patient‐centred care, ” PROMs are accepted as an essential patient‐subjective assessment parameter for clinical trials to evaluate the success of dental implant treatment (Feine et al, ), which reflects patient's needs and desires for evaluating the treatment outcomes (Derks, Hakansson, Wennstrom, Klinge, & Berglundh, ; McGrath, Lam, & Lang, ). Slot et al () reported a 5‐year RCT study that showed improved overall patient satisfaction after MIO treatment, regardless of whether the number of implants was 4 or 6. In a 2‐year clinical study, MIOs yielded higher patient satisfaction on the VAS in 4 out of seven items, including pain, comfort, function and stability variables, and OHIP‐14 and OHIP‐20 also showed significant improvement with MIO compared to CCDs (Al‐Zubeidi et al, ).…”

“…However, dental implant therapy, including fixed or removable prostheses, may be considered if the patient is unsatisfied with the new conventional complete denture (CCD) because of the anatomic morphological limitations of the patient, which may impair denture stability and retention or impair patient intolerance, including gag reflexes (Sadowsky, Fitzpatrick, & Curtis, ). Based on the development of dental implantology, MIOs provide high implant success rates, stable clinical parameters and increased patient satisfaction and are accepted as one of the predictive treatment options for completely edentulous maxillary patients (Slot, Raghoebar, Cune, Vissink, & Meijer, , ).…”

“…To ensure higher predictability, the appropriate protocol for an MIO is presented in terms of the number of implants, type of attachment and denture design. Regarding the number of implants for MIOs, Slot et al reported no significant differences in any of the clinical and radiographic parameters or patient satisfaction between 4 and 6 implant groups in 5‐year randomized controlled trials (Slot, Raghoebar, Cune, Vissink, & Meijer, , ). Zembic, Tahmaseb, Jung, and Wismeijer () reported that maxillary overdentures retained by two implants should be used with caution based on the results of a 1‐year prospective clinical study.…”