| Objectives:There is a need to evaluate and compare the outcomes of implant-retained overdentures using different attachment systems comprehensively.The retrospective study evaluated the clinical outcomes,patients’ satisfaction and related factors of implant-retained overdentures,with the purpose to improve clinical outcomes of implant-retained overdentures,as well as providing guidance for clinical choice.Materials and methods:Part 1: A total of 57 consecutive patients according to the inclusion of present study treated with implant-retained overdentures between January 2010 and December 2014 were included.And there were 69 edentulous cases,including 12 patients were both maxillary and mandibular edentulous treated with implant-retained overdentures(IOD),the rest of 45 were single edentulous.Among them,the upper attachment of 36 cases were bar,22 cases were magnet and 11 were ball.Date collection was performed through registration of the records of all patients.Before the clinical examination,information of medical history was reviewed by the questionnaires with an emphasis on systematic history and oral hygiene habits for both the implants and prosthesis.Parameters for peri-implant tissue conditions(e.g.peri-implant marginal bone loss,peri-implant probing depth,plaque index,bleeding on probing and mucosal hyperplasia)were examined and recorded.And the complications including prostheses fracture,wear/damage of attachment part,abutment fracture,screw loosening,poor retention,detachment of artificial teeth,relines of overdentures and occlusal adjustments were recorded.The related factors were analyzed by the SPSS 17.0 software package.Part 2: All patients enrolled in the part 1 were asked to complete Visual Analog Scales(VAS)questionnaires for the assessment of patients,satisfaction.The questionnaire records different aspects regarding general satisfaction,comfort,retention,speech,esthetics,pain,chewing and ease of hygiene maintenance.The outcomes and related factors including attachment types,age,gender and jaw were recorded and analyzed by SPSS 17.0 software package.Results:Part 1: After an average follow-up of 48 ± 11.3 months,four implants failed to integrate during the healing phase before loading,resulting in a survival rate of 98.1%(208/212).The overall implant marginal bone loss was 1.38 mm ± 0.74 mm and there was no statistically significant difference between types of attachments(P > 0.05).However,the peri-implant probing depth in patients with magnet and ball attachments were significantly lower than those in patients with bar attachments(P < 0.05).And there was no statistically significant difference between types of attachments regarding to the plaque index(P > 0.05).In the present study,6.13%(13)implants were bleeding on probe,including nine in the bar groups,three in magnet group and one in the ball groups.And mucous hyperplasia in patients with bar attachments(nine with slight and three with abundant hyperplasia)appeared to be severer than those with magnet attachments and ball attachments,but according the analysis,there was no statistically significant difference(P > 0.05).Besides,the daily cleaning habits,denture using habits(sleeping with overdenture at night)and the using habits of dental floss all had a significant effect on the plaque index(P < 0.05).The major complications of bar groups were bar fracture,prostheses fracture,screw loosening,detachment of artificial teeth,relines of overdentures and occlusal adjustments;magnet groups were poor retention,prostheses fracture,relines of overdentures,occlusal adjustments;ball groups were wear/damage of the spring coil,occlusal adjustments,prostheses fracture,abutment fracture.Part 2: Most patients were satisfied with their prostheses with the overall satisfaction were 87.72±7.57,and there was no statistically significant difference between the attachment types(P > 0.05),except that magnet and ball attachments were much easier to clean compared with bar attachments(P < 0.05).And there was a correlation between the age and “overall satisfaction” with the outcome that the older patients groups(≥ 65)were more satisfied than the younger(< 65)(P < 0.05).Besides,there was no statistically significant difference between the gender and jaw regarding to patients,satisfaction(P > 0.05).Conclusion:After a mean follow-up of 48 ± 11.3 months,the implant survival rate was high,with the outcome of 98.1%(208/212).Although hygienic maintenance are more complicated around bar attachments compared with magnet and bar attachments,implant-retained overdentures is a satisfactory treatment option for edentulous patients irrespective of the attachment designs.The complications were adjustment of upper attachment,relines of overdentures and occlusal adjustments,and the incidence rate of maintenance efforts for all the groups are homogeneous and low.Besides,most of the patients were satisfied with the treatment regardless of the attachment type.While,it is reminded that dentists should give all patients professional hygiene instructions and a regular recall maintaining as well as necessary treatment program. |
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