©Archives of Dental Sciences Review Article

2010, Vol.1, Issue 1, 12-16 Rohit H Saran

Review
Comparative Analysis of Implant Supported dentures with Complete Mandibular
Denture.
Rohit H Saran1

1. Rohit H Saran (M.D.S.)

Associate Professor, Department. of Prosthodontia, Vinayaka Missions Dental College, Mau, Attaria,
Dist: Sitapur (U.P.)

Corresponding Author
Rohit H. Saran, Department of Prosthodontia, Vinayaka Missions Dental College, Mau, Attaria,
Dist: Sitapur (U.P.)
E-mail: drrohitbansee@rediffmail.com
Contact no.: 05864-277247
Abstract:
Objective: Last decade has witnessed revolutionary improvements not only in the execution of dental
practice but in the aspirations of patients as well. There were times when conventional denture was the only
option available to meet the needs of edentulous patients. However, with the advent of dental implants more
retentive, stable, functional and esthetically pleasing dentures can be promised to the patient, especially in
the mandible. The implant-supported prosthesis if possible seems to be a better alternative to the
conventional removable denture. This article describes the strengths of the implant-supported mandibular
overdenture along with the risks of this approach. Recent literature has been reviewed to summarize the
reported success rate of implants used to support a mandibular overdenture.
Conclusion: The literature review indicates that implants placed in the anterior mandible (anterior to the
foramen) have a very high success rate (more than 95%). Patients have reported a high degree of acceptance
and satisfaction with the implant-supported overdenture.
Key words: Implant Supported Denture, Complete Denture.

Introduction:
An overdenture is defined as a prosthesis that
covers and is partially supported by natural
teeth, tooth roots, and/or dental implants1. Tooth
loss is a serious life event2. According to the
WHO criteria edentulism is a form of physical
impairment, the loss of all teeth causes a
disability for most people who wear
conventional dentures as they may have
difficulty in performing two essential tasks;
eating and speaking. Quality of life is defined as
an individual's perception of their position in
life, in the context of the culture and value
systems in which they live, and in relation to
their goals, expectations, standards and
concerns3. Another dimension of quality of life
is Oral health-related quality of life. This is
defined as an individual's assessment of how the
following affect his or her well-being: functional
factors, psychological factors, social factors, and
experience of pain or discomfort in relation to
orofacial concerns. Quality of life is established
as an important outcome for evaluating the
impact of disease and for assessing the efficacy
of treatments. Quality of life in denture wearers
is measured by socio-dental indicators. Locker
defined these indicators as; measures of the
extent to which dental and oral disorders disrupt
normal social role functioning and bring about
major changes in behavior such as an inability to
work or attend school, or undertake parental or
household duties. Therefore quality of life
affects denture wearers with regard to patient
satisfaction, nutrition and psycho-social aspects
of life. Quality of life however is, adversely
affected by tooth loss.
Success Rates of Implant Clinical Trials and
Results.
Implants are no longer considered experimental.
The table shows representative clinical trials
over the past six years4, 6, 8, 20. The table shows
the primary author, size of study, study design
and representative results of each study.

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©Archives of Dental Sciences Comparative Analysis of Implant Supported Dentures
2010, Vol.1, Issue 1, 12-16 Rohit H Saran

REPRESENTATIVE IMPLANT CLINICAL outcome. Uncontrolled diabetes and use of drugs

TRIALS AND RESULT such as steroids need to be carefully considered
TYPE OF
STUDY
RESULT AUTHOR in the treatment plan, and the clinician may need
Higher patient to adjust time to loading accordingly.
Awad and
Randomized satisfaction than
colleagues4
Clinical Trial with conventional
denture
Anatomy and bone quality also affect the
Buser and outcome and ease of surgical placement of
Survival rate: > 95
Prospective colleagues20 implants. Implants need adequate bone height
percent for screws
and width for placement. If the native bone at
Tawse-Smith and the recipient site is inadequate to accept the
Success rate: 95.8
Prospective colleagues9
percent implant, bone grafts—with or without guided
Prospective, Success rate: 97 Meijer and bone regeneration— must be considered. Bone
Multicenter percent colleagues11 quality, which is related to density of the
Success rate: trabecular bone, usually is not a problem in the
submerged
implants, 97.9 Moberg and anterior mandible. Other segments of the
Prospective percent; colleagues13 alveolar bone, such as the posterior maxilla, are
nonsubmerged
implants, 96.8
more likely to have lower bone density, which
percent can limit implant stability and osseointegration.
Prospective, Success rate: 92.6
Rodriguez and With proper diagnosis and treatment planning,
Colleagues16
Multicenter percent the limitations and risks of implant placement
Success rate: are manageable. Good communication between
hydroxyapatite, or the surgical and restorative members of the team
Prospective, HA, cylinder, 97.5 Morris and Ochi15
Multicenter percent; titanium, or is a necessity. High-quality training and
Ti, screw, 99.4 experience in implant surgery and restorative
percent care are fundamental to delivering quality care.
Success rate: HA, Jeffcoat and
Prospective,
99 percent; Ti colleagues6
Multicenter
screw, 96 percent Discussion
Bergendal and Implant-supported overdentures offer many
Prospective, Success rate: 100 Engquist8
Multicenter percent practical advantages over conventional complete
dentures and removable partial dentures. These
include decreased bone resorption; reduced or
Risks Associated with Implant Placement eliminated prosthesis movement; better
No surgical procedure, including the placement esthetics; improved tooth position; better
of implants, is without risk. The risks associated occlusion, including improved occlusal load
with implant placement include postoperative direction, increased occlusal function and
bleeding, numbness if the mandibular nerve is maintenance of the occlusal vertical dimension.
disturbed, infection and lack of osseointegration. In addition, implant- supported overdentures
The risks can be minimized with proper training improve phonetics, the patient’s psychological
and experience. Case selection and diagnosis is outlook and quality of life. Conventional
the key to success with implant procedures, as dentures rely upon the residual alveolar ridge
with all dental procedures. Other risk factors and mucosa for support and retention. Many
also may affect the outcome of the implant- patients have problems adapting to their
supported prosthesis. Smoking is a risk factor complete dentures, especially to the mandibular
for long term implant success. Patients who prosthesis. The widespread use of denture
smoke are more likely to experience infection adhesives is one indication that these prostheses
and/or progressive alveolar bone loss, which generally provide inadequate comfort and
ultimately may lead to implant loss. Untreated function.
periodontitis also is a risk factor for the failure
of dental implants. Obviously, fully edentulous The most prevalent treatment plan for the
patients do not have periodontitis, but even after edentulous patient is the complete removable
the extraction of a single tooth with periodontal maxillary and mandibular denture. This
disease, the site may harbor pathogenic bacteria treatment is relatively inexpensive in
that may lead to periimplantitis. Factors that comparison with fixed implant-supported
may influence the healing or potential infection prostheses, but it has several drawbacks as well.
of the implant recipient site also may affect the Like all dental restorative procedures, a

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©Archives of Dental Sciences
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complete removable denture requires extensive
attention to detail if an excellent clinical result is
to be achieved. Depending on the shape of the
residual ridge, the denture may fail to fulfill
patient expectations in various parameters.
Preservation and Maintenance of Ridge
Morphology:
The rate of residual ridge resorption in
edentulous patients who do not have tooth
replacements is highly variable and may be as
much as several millimeters per year. This
resorption can render the current prosthesis
inadequate in terms of both function and
esthetics and can lead to the necessity of
fabricating a new denture. Overdenture on the
other hand has good stability and retention, and
patients who have received them have reported
improved function and satisfaction4. Another
benefit of implant supported prostheses is
suggested by data indicating that after receiving
implants, patients may eat a diet with more fiber.
Other studies have measured the rate of residual
ridge resorption in the five years after implant
placement. The rate of resorption is decreased
significantly from the rates seen with
conventional dentures, and recent research has
shown that the height of the posterior ridge
increases with continued use of implant-
supported prostheses5. Although patients in
studies are not directly comparable to the
population as whole, patients with implant
supported prostheses return for visits with the
same practitioner at a very high rate6.
Quality of life - Patient Satisfaction:
It is accepted in the literature that satisfaction in
denture wearers depends upon the ability of the
patient to chew and speak, and also on the
appearance of the prosthesis7. Berg et al. found
that 66% of patients were dissatisfied with their
CDs due to discomfort, suboptimal retention and
fit, and/or pain associated with the lower CD10.
Results showed that the Implant supported
mandibular overdenture group was more
satisfied 1 year post-treatment. Dissatisfaction in
the CD group was due to the poor retention of
the lower CD; only 27% were satisfied post-
treatment. The design of this study shows a high
degree of validity, however, a longer follow-up
is required. The first prospective study with a 10
year follow-up was carried out by Raghoeber et
al.12. Patients were randomized as follows: a)
CD (control group); b) PPS with a CD; and, c)
Implant supported mandibular overdenture.
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Comparative Analysis of Implant Supported Dentures
Rohit H Saran
Within 1 year, the PPS and Implant supported
mandibular overdenture group experienced
better chewing ability than the CD group. The
PPS group was satisfied in the short term. The
Implant supported mandibular overdenture
group experienced long-term satisfaction (10
years.) From the above evidence it can be
concluded that patient satisfaction is improved
with the provision of an Implant supported
mandibular overdenture compared to a CD, with
or without PPS. Patients were not only satisfied
in the short-term but also at a 10 year recall as
well.
Quality of life - Nutrition
As tooth number decreases, mastication
becomes more difficult; patients are also more
likely to practice forms of food avoidance and
dietary restriction. Morais et al. revealed that
patients provided with an Implant supported
mandibular overdenture reported an increased
ability to bite, eat and chew, without losing their
dentures, 6 months posttreatment. This group
also showed improvements in anthropometric
data and blood nutrient data. Serum albumin
concentration increased by 1.4g/l (a recognized
indicator of good general health) 15. Serum B12
concentrations also increased. The process of
dietary restriction amongst edentulous patients
has also been studied. Allen and McMillan
found that subjects who received Implant
supported mandibular overdentures altered their
food choices, including, "hard to chew foods"14.
From the literature it can be concluded that the
Implant supported mandibular overdenture
offers the patient significant improvements in
nutritional status. The Implant supported
mandibular overdenture will not necessarily
result in the patient eating a more balanced diet
of their own initiative. Thus, in order to allow
patients benefit most from their improved
masticatory function, dietary advice should be
given14.
Quality of life - Psychosocial effects of Implant
supported mandibular overdentures
Blomberg stated that teeth do not function just
as a part of the masticatory system; the oral
region is also a speech and a psycho-sexual
centre. The success of denture treatment is not
solely based upon functional parameters. The
effects of denture wearing on social activities
have been studied by Heydecke et al. who
carried out a 2 month follow-up comparing CDs
and Implant supported mandibular
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©Archives of Dental Sciences
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overdentures17. Many studies use scales such as
the Oral Health Impact Profile to measure
quality of life. Unlike the Social Impact
Questionnaire, the Oral Health Impact Profile
does not take into account social or sexual
activities. This study concluded that the Implant
supported mandibular overdenture had a positive
effect on social activities 2 months post-
treatment. Conversely, the instability of the CD
was shown to adversely affect social activities
and interpersonal relationships. Unease in
interpersonal relationships was reduced by 32%
2 months post treatment with the Implant
supported mandibular overdenture17. The Social
Impact Questionnaire scale showed a high level
of reliability. However a longer follow-up
period is still required. The effect of the Implant
supported mandibular overdenture on social
activities was also studied by Melas et al. who
carried out a retrospective cohort study based
upon the Oral Impacts on Daily Performances
social and dental indicator18. The Oral Impacts
on Daily Performances measured psycho-social
variables such as: smiling, clear speech,
emotional status, social contact and, "going out."
Results showed that patients with Implant
supported mandibular overdentures were more
satisfied with the comfort of their dentures.
Sizable percentages (66%) of CD wearers were
dissatisfied with the comfort of their
prostheses18. The main limitation of this study
was its design. The groups were also not
comparable on the basis of age; however, from
previous literature it seems that there is no
relationship between age and patient
satisfaction19. Thus, age is unlikely to have
confounded the above results. From the
literature, patients restored with Implant
supported mandibular overdentures experience
less discomfort and improved psychosocial
function. Studies with longer follow-up periods
are required.
Conclusion
The literature and clinical experience indicate
that the implant-supported prosthesis provides
predictable results with improved stability and
function and a high degree of satisfaction as
compared with conventional removable
dentures. Clinical studies in the literature in
which implants were used in the mandible
anterior to the foramen indicate that the success
rate for implants in the lower mandible is 95
percent or greater. These data indicate that
implant- supported prostheses should be
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Comparative Analysis of Implant Supported Dentures
Rohit H Saran
considered in planning treatment for the fully
edentulous patient. However, prospective
randomized studies with longer follow-up
periods are required. It can also be concluded
that patients restored with Implant supported
mandibular dentures will experience
improvements in quality of life with regard to
oral health-related quality of life.
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Comparative Analysis of Implant Supported Dentures
Rohit H Saran
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