Peri‐implant mucosal response to implant‐supported overdentures: A systematic review and meta‐analysis

Abstract

Objectives To systematically review and evaluate the effects of different types of attachments, implant numbers and loading protocols on the peri‐implant mucosa of implant‐supported overdentures (ISODs). Background The impact of peri‐implant tissue health on the ISOD treatment outcome is unclear, and current evidence is inadequate on this aspect. Materials and Methods A systematic literature search for randomised controlled trials or prospective studies was conducted in indexed databases from 1995 to April 2020. The focused question was as follows: How does the peri‐implant mucosa respond to implant‐supported or implant‐tissue‐supported complete overdentures based on different types of attachments, implant numbers, and loading protocols, in terms of clinical outcomes achieved [plaque index (PI), gingival index (GI), probing pocket depth (PD) and bleeding index (BI)]? A random‐ or fixed‐effects model was applied to measure the significance of standardised mean differences (SMD) of PD between the groups. Results Seventeen studies met the eligibility criteria. The SMD for PD between splinted/bar and unsplinted/stud attachments was 0.10 mm (95% CI: −0.27 to 0.47; P = .60) and between 2‐ and 4‐implant groups was 0.15 mm (95% CI: −0.16 to 0.45; P = .34), which were not statistically significant. Significant difference (P = .003) was observed between immediate/early loading and delayed loading (SMD = 0.46 mm [95% CI: 0.16 to 0.75]). Conclusions Probing depth for the immediate loaded implants was significantly higher than for the delayed loading group. No attachment type, implant number or loading protocol seemed to have a clear advantage over the other, in terms of other peri‐implant mucosal outcome measures.

Influence of the loading protocol and platform switching in two‐implant bar‐retained overdentures: 3‐year results from a randomized controlled equivalence clinical trial

“…The clinical peri-implant parameters were very similar in both test groups. The PDs, presence of plaque, and BOP-positive implant sites are described in the literature to a similar extent (Baskaradoss et al, 2021). Interestingly, there were only two prosthesis fractures (one per group), although the space requirements for converting a complete denture to an IOD are relatively high for a bar compared with single anchors (Albrecht et al, 2015).…”

Patient satisfaction and soft tissue changes around BioHPP® bar compared to cobalt chromium bar retaining mandibular implant-over dentures: A randomized clinical trial

“…In addition to other peri-implant soft-tissue parameters, probing depth was reported as a factor affecting implant survival in cases of implant supported overdentures (26) . While other studies have reported that the peri-implant PD may not be significantly correlated with bone loss, the changes in probing depth and other soft tissue peri-implant parameters aid as a valuable sign in peri-implantitis diagnosis, which affects the implant survival in implant supported over dentures (16) .…”

“…Despite that some studies mentioned that implant number has no influence on the soft tissue in implant supported overdenture cases, the All-on-Four treatment concept was established to intensify the use of existing remnant bone in atrophic jaws, which permits instant function and evades regenerative procedures (15) (16) . Adding to that an efficient prosthetic basis can be established from the well-spread implants (17) .…”

Current trends for maxillary implant overdentures

“…Therefore, they recommended both of ball and locator attachments in terms of survival rate, tissue response, and patient satisfaction. Another systematic review for the peri-implant mucosa response was showed that the at-tachment types, such as telescopic, bar or locator system, were not affected the deep peri-implant pocket 26) .…”