03 September 2021

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Success of implant-supported mandibular overdentures

Lara Figini

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Implant-supported (MO) overdentures is now a well accepted routine treatment with predictable prognosis for the rehabilitation of completely edentulous patients. Thanks to high implant success and survival rates, MOs have a positive impact on oral healing-related quality of life, chewing function and patient satisfaction. Despite the various scientific studies on MO and on the different implant loading protocols, the results of the treatments at different follow-ups and of the peri-implant variables have not yet been systematically investigated.

Materials and methods
In a systematic review with meta-analysis, published on Journal of Prosthetic Dentistry, May 2021, the authors evaluated whether immediate or early loading protocols can offer clinical results comparable to those obtained with conventional loading protocol in rehabilitated edentulous patients with mandibular overdentures on implants. The authors performed a review of the world literature without language or follow-up restrictions, and analyzed the data obtained. The authors followed the Cochrane Collaboration and ROBINS-I criteria to assess the quality of the studies included in the above review and to assess the risk of bias. Implant success and survival rates, marginal bone loss, bleeding on probing, probing depth, plaque index and implant stability quotient were mainly investigated. Statistical analyzes were conducted in which standard mean differences were applied with a 95% confidence interval for continuous data. For dichotomous data, the risk difference was adopted.

Results
23 studies met the inclusion criteria. Meta-analysis showed statistically significant differences for plaque index at 12 months, probing depth and plaque index at 36 months in which the conventional loading protocol presented lower indices than those immediate and early loading protocol. The implant stability quotient showed a statistically significant difference only at 3 months with higher values ​​for the conventional loading protocol. For the other parameters, no statistically significant differences were found (P> .05).

Conclusions
From the data of this review, which must be confirmed in other similar reviews, the following conclusions can be drawn:

- The success and survival rates of the different loading protocols (immediate ILP or early ELP) are similar when compared with those for traditional CLP loading.
- no difference was found between groups regarding MBL marginal bone loss.
- For PD and PI, lower values ​​were found in the conventional load at 36 months of follow-up compared to ILP or ELP.
- More favorable values ​​for CLP (up to 3 months) were highlighted regarding the stability quotient of implanting ISQ, while similar values ​​for ILP were reached for longer follow-up periods, as well as for BOP.

Clinical implications
The reduction of the overall healing time with early loading protocols of dental implants for mandibular overdentures represents an important attraction for both dentists and patients and is worthy of consideration in clinical practice.

For additional information: Long-term outcomes of different loading protocols for implant-supported mandibular overdentures: A systematic review and meta-analysis.