Mandibular two‐implant overdentures with CAD‐CAM milled bars with distal extensions or retentive anchors: A randomized controlled trial

Abstract

Objective: This randomized controlled trial (RCT) aimed to demonstrate the noninferiority of mandibular 2-implant overdentures (IODs) on a CAD-CAM milled bar with long distal extensions (MBDE) against IODs on retentive anchors (RA). Methods: Forty edentulous participants rehabilitated with a maxillary conventional denture and a mandibular 2-IOD participated in this trial. They were randomized into two groups [Control group (CG): RA + gold matrices; Experimental group (EG): MBDE + gold clip]. The outcomes included implant survival rate (ISR), chewing efficiency [quantitative (VoH) and subjective (SA) assessments], peri-implant marginal bone levels (PI-MBL), maximum bite force (MBF), and patient-reported outcomes [oral health impact profile (OHIP-EDENT), and denture satisfaction index (DSI)]. Outcomes were recorded at baseline (BL), two weeks (T 0), 6 months (T 1), and at 1 year (T 2) after the intervention. Intra-and inter-group analyses were performed using regression models with ⍺=0.05. Results: 38 participants completed the T 2 visit (CG: n = 19, age = 74.7 ± 7.8 years; EG: n = 19, age = 70.3 ± 10.7 years). At T 2 , there was no implant loss in either of the groups (ISR = 100%). There were no significant differences between the groups for the PI-MBL changes (p = .754). Improvements occurred faster in the EG than in the CG, but over the observation time, there were no differences between the trial groups for VoH, MBF, OHIP-EDENT, and the DSI, except for SA being significantly better in the EG group (p = .022). Conclusions: The results of this RCT confirm that mandibular 2-IODs with a CAD-CAM milled bar with long distal extensions are not an inferior treatment to the conventional IODs on retentive anchors in the short term (1 year).

The Effect of Patient Specific Factors on Occlusal Forces Generated: Best Evidence Consensus Statement

“…88 Some evidence of those (n = 40) treated and randomly assigned with a 2 implant splinted bar clip design compared with 2 retentive attachments did not indicate a significant difference in occlusal force generation. 89…”

Effects of attachment type and number of dental implants supporting mandibular overdenture on peri-implant health: A systematic review and network meta-analysis

“…Eighteen studies were excluded for the following reasons (Supplementary Table 2). The other 28 studies were included in this NMA, including 19 randomized controlled trials [6][7][8][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38], six retrospective studies [11,[39][40][41][42][43], and three prospective studies [44][45][46].…”

“…Only one study has used three implants to support Other general characteristics of the included studies are summarized in Tables 1 and 2. For assessment of marginal bone level, 13 studies [6,11,24,26,31,34,36,37,39,40,[44][45][46] used periapical radiographs, and four studies utilized panoramic radiographs [29,30,32,42]. The plaque and bleeding indices were evaluated using the Mombelli index [47].…”

“…Nineteen studies [6][7][8][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] were considered to have a low risk of bias, and nine studies [11,[39][40][41][42][43][44][45][46] had a moderate risk of bias (Supplementary Table 3).…”

“…MBL was reported in 17 studies [6,11,24,26,[29][30][31][32]34,36,37,39,40,42,[44][45][46] and 650 patients with 1613 implants placed in the edentulous mandible. Five attachments (bar, ball, resilient telescopic, locator, and magnet) along with different numbers of dental implants were evaluated.…”