J Adv Prosthodont.  2014 Aug;6(4):245-252. 10.4047/jap.2014.6.4.245.

Implant and root supported overdentures - a literature review and some data on bone loss in edentulous jaws

• Carlsson G

• KMID: 1974842
• DOI: http://doi.org/10.4047/jap.2014.6.4.245

Abstract

PURPOSE
To present a literature review on implant overdentures after a brief survey of bone loss after extraction of all teeth.
MATERIALS AND METHODS
Papers on alveolar bone loss and implant overdentures have been studied for a narrative review.
RESULTS
Bone loss of the alveolar process after tooth extraction occurs with great individual variation, impossible to predict at the time of extraction. The simplest way to prevent bone loss is to avoid extraction of all teeth. To keep a few teeth and use them or their roots for a tooth or root-supported overdenture substantially reduces bone loss. Jaws with implant-supported prostheses show less bone loss than jaws with conventional dentures. Mandibular 2-implant overdentures provide patients with better outcomes than do conventional dentures, regarding satisfaction, chewing ability and oral-health-related quality of life. There is no strong evidence for the superiority of one overdenture retention-system over the others regarding patient satisfaction, survival, peri-implant bone loss and relevant clinical factors. Mandibular single midline implant overdentures have shown promising results but long-term results are not yet available. For a maxillary overdenture 4 to 6 implants splinted with a bar provide high survival both for implants and overdenture.
CONCLUSION
In edentulous mandibles, 2-implant overdentures provide excellent long-term success and survival, including patient satisfaction and improved oral functions. To further reduce the costs a single midline implant overdenture can be a promising option. In the maxilla, overdentures supported on 4 to 6 implants splinted with a bar have demonstrated good functional results.

Keyword

Ball attachment; Early loading; Mandibular 2-implant overdenture; Maxillary implant overdenture; Single midline implant

MeSH Terms

Alveolar Bone Loss
Alveolar Process
Denture, Overlay*
Dentures
Humans
Jaw
Jaw, Edentulous*
Mandible
Mastication
Maxilla
Patient Satisfaction
Prostheses and Implants
Quality of Life
Splints
Tooth
Tooth Extraction

Figure

• 

  Fig. 1 Tracings from profile radiographs of mandibular symphyseal region of 12 subjects 2 days, 5 years and 21 years after extraction of all teeth in the mandible (with permission from J Prosthet Dent15).

• 

  Fig. 2 Comparison of bone loss in a patient with a root-supported overdenture (A) and a conventional complete denture (B) 5 years after extraction of teeth and insertion of dentures (with permission from J Prosthet Dent21).

• 

  Fig. 3 (A) Single implant with a ball attachment in an edentulous mandible to retain an overdenture. (B) The inner surface of the mandibular overdenture with retainer for the ball attachment (with permission from Int J Oral Maxillofac Implants41).

• 

  Fig. 4 (A) Four implants in an edentulous maxilla splinted with a bar for an overdenture. (B) The inner surface of the maxillary overdenture showing the bar retainers fixed in the denture base material (with permission from Quintessence13).

• 

  Fig. 5 Distribution of the use of implant overdentures (IODs) and fixed implant-supported prostheses (FISPs) for implant treatment of edentulous mandibles in 10 countries (with permission from Int J Prosthodont12).

Reference

1. Mojon P. The world without teeth: demographic trends. Feine JS, Carlsson GE, editors. Implant overdentures. The standard of care for edentulous patients. Chicago: Quintessence;2003. p. 3–14.

2. Müller F, Naharro M, Carlsson GE. What are the prevalence and incidence of tooth loss in the adult and elderly population in Europe? Clin Oral Implants Res. 2007; 18:2–14.

3. Österberg T, Dey DK, Sundh V, Carlsson GE, Jansson JO, Mellström D. Edentulism associated with obesity: a study of four national surveys of 16 416 Swedes aged 55-84 years. Acta Odontol Scand. 2010; 68:360–367.

4. Carlsson GE, Ekbäck G, Johansson A, Ordell S, Unell L. Is there a trend of decreasing prevalence of TMD-related symptoms with ageing among the elderly? Acta Odontol Scand. 2014; 03. 25.

5. Bouma J. On becoming edentulous. An investigation into dental and behavioural reasons for full mouth extractions. University of Groningen;1987. Thesis.

6. Carlsson GE, Omar R. The future of complete dentures in oral rehabilitation. A critical review. J Oral Rehabil. 2010; 37:143–156.

7. Brånemark PI, Hansson BO, Adell R, Breine U, Lindström J, Hallén O, Ohman A. Osseointegrated implants in the treatment of the edentulous jaw. Experience from a 10-year period. Scand J Plast Reconstr Surg Suppl. 1977; 16:1–132.

8. Adell R, Lekholm U, Rockler B, Brånemark PI. A 15-year study of osseointegrated implants in the treatment of the edentulous jaw. Int J Oral Surg. 1981; 10:387–416.

9. Ekelund JA, Lindquist LW, Carlsson GE, Jemt T. Implant treatment in the edentulous mandible: a prospective study on Brånemark system implants over more than 20 years. Int J Prosthodont. 2003; 16:602–608.

10. Zarb G, Jansson T, Jemt T. Other prosthodontic applications. Brånemark PI, Zarb GA, Albrektsson T, editors. Tissue-integrated prostheses: Osseointegration in clinical dentistry. Chicago: Quintessence;1985. p. 283–292.

11. Feine JS, Carlsson GE, editors. Implant overdentures. The standard of care for edentulous patients. Chicago: Quintessence;2003.

12. Carlsson GE, Kronström M, de Baat C, Cune M, Davis D, Garefis P, Heo SJ, Jokstad A, Matsuura M, Närhi T, Ow R, Pissiotis A, Sato H, Zarb GA. A survey of the use of mandibular implant overdentures in 10 countries. Int J Prosthodont. 2004; 17:211–217.

13. Mericske-Stern R. Prosthodontic management of maxillary and mandibular overdentures. Feine JS, Carlsson GE, editors. Implant overdentures. The standard of care for edentulous patients. Chicago: Quintessence;2003. p. 83–98.

14. Slot W, Raghoebar GM, Vissink A, Huddleston Slater JJ, Meijer HJ. A systematic review of implant-supported maxillary overdentures after a mean observation period of at least 1 year. J Clin Periodontol. 2010; 37:98–110.

15. Bergman B, Carlsson GE. Clinical long-term study of complete denture wearers. J Prosthet Dent. 1985; 53:56–61.

16. Atwood DA. Reduction of residual ridges: a major oral disease entity. J Prosthet Dent. 1971; 26:266–279.

17. Lerner UH. The biology of bone remodeling in jaw bones with and without teeth. Molin Thorén M, Gunne J, editors. Textbook of removable prosthodontics. The Scandinavian approach. Copenhagen: Munksgaard;2012. p. 51–60.

18. Douglass CW, Shih A, Ostry L. Will there be a need for complete dentures in the United States in 2020? J Prosthet Dent. 2002; 87:5–8.

19. Owen PC. Appropriatech: prosthodontics for the many, not just for the few. Int J Prosthodont. 2004; 17:261–262.

20. Carlsson GE. Responses of jawbone to pressure. Gerodontology. 2004; 21:65–70.

21. Crum RJ, Rooney GE Jr. Alveolar bone loss in overdentures: a 5-year study. J Prosthet Dent. 1978; 40:610–613.

22. Preiskel HW. Overdentures made easy. A guide to implant and root supported prostheses. London: Quintessence;1996.

23. Verma R, Joda T, Brägger U, Wittneben JG. A systematic review of the clinical performance of tooth-retained and implant-retained double crown prostheses with a follow-up of ≥ 3 years. J Prosthodont. 2013; 22:2–12.

24. Sennerby L, Carlsson GE, Bergman B, Warfvinge J. Mandibular bone resorption in patients treated with tissue-integrated prostheses and in complete-denture wearers. Acta Odontol Scand. 1988; 46:135–140.

25. Davis WH, Lam PS, Marshall MW, Dorchester W, Hochwald DA, Kaminishi RM. Using restorations borne totally by anterior implants to preserve the edentulous mandible. J Am Dent Assoc. 1999; 130:1183–1189.

26. von Wowern N, Gotfredsen K. Implant-supported overdentures, a prevention of bone loss in edentulous mandibles? A 5-year follow-up study. Clin Oral Implants Res. 2001; 12:19–25.

27. Wright PS, Glantz PO, Randow K, Watson RM. The effects of fixed and removable implant-stabilised prostheses on posterior mandibular residual ridge resorption. Clin Oral Implants Res. 2002; 13:169–174.

28. Vercruyssen M, Marcelis K, Coucke W, Naert I, Quirynen M. Long-term, retrospective evaluation (implant and patient-centred outcome) of the two-implants-supported overdenture in the mandible. Part 1: survival rate. Clin Oral Implants Res. 2010; 21:357–365.

29. Feine JS, Carlsson GE, Awad MA, Chehade A, Duncan WJ, Gizani S, Head T, Lund JP, MacEntee M, Mericske-Stern R, Mojon P, Morais J, Naert I, Payne AG, Penrod J, Stoker GT Jr, Tawse-Smith A, Taylor TD, Thomason JM, Thomson WM, Wismeijer D. The McGill Consensus Statement on Overdentures. Montreal, Quebec, Canada. May 24-25, 2002. Int J Prosthodont. 2002; 15:413–414.

30. Thomason JM, Kelly SA, Bendkowski A, Ellis JS. Two implant retained overdentures-a review of the literature supporting the McGill and York consensus statements. J Dent. 2012; 40:22–34.

31. Berg E, Nesse H. Missing teeth. Molin Thorén M, Gunne J, editors. Textbook of removable prosthodontics. The Scandinavian approach. Copenhagen: Munksgaard;2012. p. 19–31.

32. Walton JN, MacEntee MI. Choosing or refusing oral implants: a prospective study of edentulous volunteers for a clinical trial. Int J Prosthodont. 2005; 18:483–488.

33. Naert I. The influence of attachment systems on implant-retained mandibular overdentures. Feine JS, Carlsson GE, editors. Implant overdentures. The standard of care for edentulous patients. Chicago: Quintessence;2003. p. 99–109.

34. Ma S, Tawse-Smith A, Thomson WM, Payne AG. Marginal bone loss with mandibular two-implant overdentures using different loading protocols and attachment systems: 10-year outcomes. Int J Prosthodont. 2010; 23:321–332.

35. Rutkunas V, Mizutani H, Puriene A. Conventional and early loading of two-implant supported mandibular overdentures. A systematic review. Stomatologija. 2008; 10:51–61.

36. Schimmel M, Srinivasan M, Herrmann FR, Müller F. Loading protocols for implant-supported overdentures in the edentulous jaw: a systematic review and meta-analysis. Int J Oral Maxillofac Implants. 2014; 29:271–286.

37. Attard NJ, Zarb GA, Laporte A. Long-term treatment costs associated with implant-supported mandibular prostheses in edentulous patients. Int J Prosthodont. 2005; 18:117–123.

38. Wismeijer D, Stoker GT. Caomparison of treatment strategies for implant overdentures. Feine JS, Carlsson GE, editors. Implant overdentures. The standard of care for edentulous patients. Chicago: Quintessence;2003. p. 61–70.

39. Meijer HJ, Raghoebar GM, Batenburg RH, Visser A, Vissink A. Mandibular overdentures supported by two or four endosseous implants: a 10-year clinical trial. Clin Oral Implants Res. 2009; 20:722–728.

40. Cordioli G, Majzoub Z, Castagna S. Mandibular overdentures anchored to single implants: a five-year prospective study. J Prosthet Dent. 1997; 78:159–165.

41. Krennmair G, Ulm C. The symphyseal single-tooth implant for anchorage of a mandibular complete denture in geriatric patients: a clinical report. Int J Oral Maxillofac Implants. 2001; 16:98–104.

42. Walton JN, Glick N, Macentee MI. A randomized clinical trial comparing patient satisfaction and prosthetic outcomes with mandibular overdentures retained by one or two implants. Int J Prosthodont. 2009; 22:331–339.

43. Alsabeeha NH, Payne AG, De Silva RK, Thomson WM. Mandibular single-implant overdentures: preliminary results of a randomised-control trial on early loading with different implant diameters and attachment systems. Clin Oral Implants Res. 2011; 22:330–337.

44. Cheng T, Sun G, Huo J, He X, Wang Y, Ren YF. Patient satisfaction and masticatory efficiency of single implant-retained mandibular overdentures using the stud and magnetic attachments. J Dent. 2012; 40:1018–1023.

45. Kronstrom M, Davis B, Loney R, Gerrow J, Hollender L. A prospective randomized study on the immediate loading of mandibular overdentures supported by one or two implants; a 3 year follow-up report. Clin Implant Dent Relat Res. 2014; 16:323–329.

46. Roccuzzo M, Bonino F, Gaudioso L, Zwahlen M, Meijer HJ. What is the optimal number of implants for removable reconstructions? A systematic review on implant-supported overdentures. Clin Oral Implants Res. 2012; 23:229–237.

47. Osman RB, Payne AG, Ma S. Prosthodontic maintenance of maxillary implant overdentures: a systematic literature review. Int J Prosthodont. 2012; 25:381–391.

48. Raghoebar GM, Meijer HJ, Slot W, Slater JJ, Vissink A. A systematic review of implant-supported overdentures in the edentulous maxilla, compared to the mandible: How many implants? Eur J Oral Implantol. 2014; 7:191–201.

49. Dudley J. Maxillary implant overdentures: current controversies. Aust Dent J. 2013; 58:420–423.

50. Kronström M, Carlsson GE. Use of mandibular implant overdentures: treatment policy in prosthodontic specialist clinics in Sweden. Swed Dent J. 2003; 27:59–66.

51. Ascher A, Carlsson GE, Kronström M. Use of implant-supported prostheses in edentulous mandibles among prosthodontists in Sweden. Swed Dent J. 2014; in press.

52. Zarb GA. Introduction to osseointegration in clinical dentistry. J Prosthet Dent. 1983; 49:824.

53. Lindquist LW, Carlsson GE. Long-term effects on chewing with mandibular fixed prostheses on osseointegrated implants. Acta Odontol Scand. 1985; 43:39–45.