What is the evidence on the added value of implant‐supported overdentures? A review

Abstract

Background Implant‐supported overdentures (IODs) have been reported to increase patients' oral health‐related quality of life (OHRQoL) in comparison with conventional dentures (CDs); however, the conclusiveness of evidence on the clinical effectiveness and value for money of IODs versus CDs remains unclear. Purpose To review how the added value of IODs is demonstrated in the literature. Materials and methods MEDLINE, EMBASE, and the Cochrane Database were searched for randomized control trials, controlled clinical trials, and prospective cohort studies containing evaluations of the economic and health benefits and costs of IODs. Information about the clinical effectiveness, such as magnitude of bite forces or chewing efficacy, OHRQoL, costs, and cost‐effectiveness of IODs, was extracted. Results A total of 17 articles were included, reporting 15 economic evaluations: 11 cost‐utility analyses (CUAs), 2 of which were combined with a cost‐effectiveness analysis (CEA), and 2 cost–benefit analyses (CBAs). Seven CUAs used the Oral Health Impact Profile (OHIP) questionnaire while four used satisfaction questionnaires to assess the OHRQoL. One study applied quality‐adjusted prosthesis years (QAPYs) for this purpose. The CBAs expressed both the beneficial outcome and the costs of the IOD in monetary terms. The included studies employed a large variety of economic evaluation methods, which limited cross‐study comparability. Conclusions On the basis of existing economic evaluations, IODs have frequently been suggested to be a cost‐efficient treatment alternative to CDs; however, the comparability between the various economic evaluation studies was limited due to the different outcome measures used. In addition, it remains unclear whether the additional health benefits of IODs outweigh the higher costs. This is largely dependent on the decision maker's valuation of oral health outcomes. Future research is encouraged to further elucidate patient willingness to pay for IODs and the societal return on investing in IODs more generally.

Maxillary overdenture on three implants retained by low‐profile stud attachments – A prospective cohort study

“… 54 One element is that patients' valuation of oral health outcomes differs, which is reflected in their decision of whether the perceived additional health benefits of a particular prosthetic solution outweigh the higher costs. 16 Another critical consideration in the treatment decision process is fear of pain or complications related to invasive surgery. 55 Patients' preferences are that any intraoral surgery should be minimally invasive.…”

“…10,11 More robust clinical data are needed on long-term outcomes of removable implant-supported prostheses in the fully edentulous maxilla as a function of a minimum number of implants, 12,13 attachment system 14 and other clinical variables, 15 to estimate the value for money and contingent valuation of alternative prosthesis modalities. 16,17 The current investigators have previously described the clinical experiences of patients receiving a palate-free metal-reinforced maxillary overdenture retained by three implants fitted with lowprofile stud attachments. 18 It was recognised that more long-term prospective data were required to determine this technical solution's potential merits and disadvantages.…”

“…More robust clinical data are needed on long‐term outcomes of removable implant‐supported prostheses in the fully edentulous maxilla as a function of a minimum number of implants, 12 , 13 attachment system 14 and other clinical variables, 15 to estimate the value for money and contingent valuation of alternative prosthesis modalities. 16 , 17 …”

Cost/effectiveness analysis of treatment options for the rehabilitation of the total edentulous mandible

“…These variables change according to the patient's socio-economic status and geographic location and several attempts have been made to compare the different treatments, with the aim to identify the most performant one. 10 Cost-effectiveness evaluations allow to compare the different therapeutic strategies, considering their economic cost and health benefits. The impact of the intervention on patient's quality of life is usually captured by questionnaires that are specifically designed to evaluate patients' satisfaction related to a general o specific health condition.…”

“…So obtained implant overdenture represents a middle way between fixed denture and CD, being more retentive than conventional denture and, at the same time, less expensive than Fixed prosthesis. 10 Several attempts have been made to detect patients' satisfaction with different types of prosthesis, confirming the best performance of fixed denture, compared to the other options. 6,11 Nevertheless, in addition to the purely clinical aspect, economic considerations are important for the choice of rehabilitation.…”