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Some issues related to evidence-based implantology

View Article: PubMed Central - PubMed

ABSTRACT

This article reviews relevant dental literature to answer some frequent questions related to evidence-based implantology. There are hundreds of implant systems on the market, but the majority lack clinical documentation. Recommended number of implants for full-arch fixed prostheses is four or five in the mandible but at least six in the maxilla. Less expensive implant-retained overdentures make implant treatment available to a greater portion of edentulous subjects. Mandibular overdentures on two implants, and even one implant, have shown excellent long-term outcomes. In the maxilla, less than four implants are not recommended for good results. Single implant restorations have good prognosis, but placement of the implant should be postponed until adulthood. Osseointegrated implants have revolutionized clinical dentistry. However, in a global perspective, implants make up only a small part of all prosthodontic treatment. Knowledge and skill in conventional prosthodontics must be maintained as it will remain the most common part of the specialty.

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(a and b) Single midline implant with a ball attachment to retain a mandibular overdenture
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Figure 2: (a and b) Single midline implant with a ball attachment to retain a mandibular overdenture

Mentions: Economic factors are common obstacles for implants treatment, especially in socioeconomically weak edentulous groups. To reduce the cost is therefore important to increase the use. A way to reduce the cost is to minimize the number of implants. The surprisingly good 5-year results of mandibular overdentures retained by a single midline implant presented already in the 1990s[28] have promoted a number of studies to evaluate this treatment option, one-IOD [Figure 2; Reprinted from Feine and Carlsson[18] with permission]. Several studies have corroborated the good results with such IODs and recommend them particularly for geriatric patients with low functional demands and economic limitations. A recent 5-year randomized trial compared one or two implants for IODs. No implant failed in the one-IOD group whereas five failed before loading in the two-IOD group. It was concluded that there were no significant differences after 5 years in satisfaction or survival of implants with mandibular overdentures retained by one implant or two implants.[29] Even more recently, a systematic review and meta-analysis have been published of studies on one- and two-IODs.[30] “The results of this meta-analysis conclude that the postloading implant survival of one-IODs is not significantly different from two-IODs. However, the existing scientific evidence in the literature in terms of prospective comparative studies is scarce. Hence, before recommending the one-IOD as a treatment modality, long-term observations are needed, and a larger range of functional, prosthodontic, and patient-centered outcome measures should be considered.” These conclusions are certainly correct regarding the meta-analysis, but for the clinic, they seem too guarded. It would seem acceptable to recommend more general use of one-IODs as there are several studies already with excellent outcomes over 5 years. It is well-known that a majority of edentulous people belong to the poorest segment of the population, and the single midline mandibular IOD might be a possibility to overcome economic limitations for some of them.


Some issues related to evidence-based implantology
(a and b) Single midline implant with a ball attachment to retain a mandibular overdenture
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4837771&req=5

Figure 2: (a and b) Single midline implant with a ball attachment to retain a mandibular overdenture
Mentions: Economic factors are common obstacles for implants treatment, especially in socioeconomically weak edentulous groups. To reduce the cost is therefore important to increase the use. A way to reduce the cost is to minimize the number of implants. The surprisingly good 5-year results of mandibular overdentures retained by a single midline implant presented already in the 1990s[28] have promoted a number of studies to evaluate this treatment option, one-IOD [Figure 2; Reprinted from Feine and Carlsson[18] with permission]. Several studies have corroborated the good results with such IODs and recommend them particularly for geriatric patients with low functional demands and economic limitations. A recent 5-year randomized trial compared one or two implants for IODs. No implant failed in the one-IOD group whereas five failed before loading in the two-IOD group. It was concluded that there were no significant differences after 5 years in satisfaction or survival of implants with mandibular overdentures retained by one implant or two implants.[29] Even more recently, a systematic review and meta-analysis have been published of studies on one- and two-IODs.[30] “The results of this meta-analysis conclude that the postloading implant survival of one-IODs is not significantly different from two-IODs. However, the existing scientific evidence in the literature in terms of prospective comparative studies is scarce. Hence, before recommending the one-IOD as a treatment modality, long-term observations are needed, and a larger range of functional, prosthodontic, and patient-centered outcome measures should be considered.” These conclusions are certainly correct regarding the meta-analysis, but for the clinic, they seem too guarded. It would seem acceptable to recommend more general use of one-IODs as there are several studies already with excellent outcomes over 5 years. It is well-known that a majority of edentulous people belong to the poorest segment of the population, and the single midline mandibular IOD might be a possibility to overcome economic limitations for some of them.

View Article: PubMed Central - PubMed

ABSTRACT

This article reviews relevant dental literature to answer some frequent questions related to evidence-based implantology. There are hundreds of implant systems on the market, but the majority lack clinical documentation. Recommended number of implants for full-arch fixed prostheses is four or five in the mandible but at least six in the maxilla. Less expensive implant-retained overdentures make implant treatment available to a greater portion of edentulous subjects. Mandibular overdentures on two implants, and even one implant, have shown excellent long-term outcomes. In the maxilla, less than four implants are not recommended for good results. Single implant restorations have good prognosis, but placement of the implant should be postponed until adulthood. Osseointegrated implants have revolutionized clinical dentistry. However, in a global perspective, implants make up only a small part of all prosthodontic treatment. Knowledge and skill in conventional prosthodontics must be maintained as it will remain the most common part of the specialty.

No MeSH data available.