Two-ImplantSupported Mandibular Overdentures:

Do Clinical Denture Quality and Inter-Implant Distance

Affect Patient Satisfaction?
Sara A. Alfadda, BDS, MSc (Prosthodontics), PhD, FRCD (C)1,2/
Mohammad D. Al Amri, BDS, MS (Prosthodontics), FRCD (C)1/Amal Al-Ohali, BDS3/
Arwa Al-Hakami, BDS4/Noura Al-Madhi, BDS5

Purpose: To investigate the following three null hypotheses in patients rehabilitated with a
mandibular overdenture supported by two unsplinted implants: (1) patient satisfaction is not
related to the clinical quality of the dentures; (2) inter-implant distance (IID) has no effect on the
clinical quality of the dentures; and (3) IID does not influence patient satisfaction. Materials
and Methods: Forty edentulous patients who were rehabilitated with a two-implantsupported
mandibular overdenture participated in the study. Independent investigators evaluated the dentures
on the basis of five clinical criteria using the validated Denture Quality Evaluation Form, and the
patients completed the validated Denture Satisfaction Scale. Irreversible hydrocolloid impressions
of the mandible were made and poured immediately in die stone. The IID was measured by
adapting an orthodontic wire to the mandibular alveolar ridge crest, extending from the center
of one implant to the center of the other. Spearman correlation analyses were used to identify
possible correlations, with a significance level set at P < .05. Results: The clinicians overall mean
rating of the clinical quality of the dentures was 91.5% (standard deviation 6.27%). The stability of
the mandibular overdenture and of the maxillary conventional complete denture was significantly
related to satisfaction (r = 0.389 and r = 0.44, respectively). Significant associations were found
between the mandibular stability items and satisfaction with both maxillary and mandibular
dentures. The stability of the maxillary denture was significantly associated with patient satisfaction
with mandibular denture retention, stability, and comfort. None of the 12 denture satisfaction
items were significantly associated with IID. Similarly, IID did not have an effect on the quality of
either denture in terms of retention, stability, or occlusion. Conclusion: Denture stability was the
feature that had the most influence on patient satisfaction with the mandibular overdenture and
with the maxillary conventional denture. IID had no effect on the clinical quality of either denture
and did not influence patient satisfaction. Int J Prosthodont 2017;30:519525. doi: 10.11607/ijp.5295

E dentulism is a debilitating and irreversible pre-

dicament that can lead to functional and social
limitations.1 In the pre-endosseous implant era, con-
associated with insufficient stability and retention of
the prosthesis.2 Moreover, even if the dentures were
fabricated to meet optimum clinical standards, many
ventional complete dentures were the treatment of patients reported dissatisfaction with their prosthetic
choice by edentulous patients for more than a cen- treatment.3,4 Fortunately, the introduction of implant-
tury. However, this treatment modality has often been supported overdentures has effectively addressed
most of these patient concerns.510
1Associate Professor, Department of Prosthetic Dental Sciences, In vitro studies evaluating the effects of dental im-
College of Dentistry, King Saud University, Riyadh, Saudi Arabia. plant distribution on vertical and oblique dislodging
2Visiting Professor, Department of Prosthodontics, Faculty of Dentistry,
forces on overdentures have reported inconsistent
University of Toronto, Toronto, Ontario, Canada.
3Professor, Department of Prosthetic Dental Sciences, College of Dentistry,
conclusions.1113 Clinicians can acknowledge that in
King Saud University, Riyadh, Saudi Arabia.
a clinical setting, forces exerted on the denture are
4Teaching Assistant, Department of Maxillofacial Surgery, not perpetually purely vertical or horizontal. Muscle
College of Dentistry, King Saud University, Riyadh, Saudi Arabia. tonus, neuromuscular coordination, and the tongue,
5Resident, Department of Operative Dentistry, University of Iowa,
cheeks, lips, saliva, and arch relations are biomechan-
Iowa City, Iowa, USA.
ical factors that have a dualistic impact on the stability
Correspondence to: Dr Sara A. Alfadda, Department of Prosthetic and retention of the denture.14 In fact, these factors
Dental Sciences, College of Dentistry, King Saud University, are usually identified during initial clinical examina-
P.O. Box 1914, Riyadh, 11441 Saudi Arabia.
tions, and technical procedures are refined accord-
Email: [email protected], [email protected]
ingly to minimize the adverse effects of an unfavorable
2017 by Quintessence Publishing Co Inc. situation. Accordingly, it seems prudent to account

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Do Clinical Denture Quality and IID Affect Patient Satisfaction?

The dentures were fabricated by faculty mem-

bers and supervised dental students at the College
of Dentistry. The well-established complete denture
fabrication protocol was followed.16 Then, the Locator
attachments were incorporated in the mandibular
denture following the manufacturers instructions
(Locator male, 3 Ib). To achieve external validity, the
clinicians who fabricated the dentures were not in-
volved in the denture quality evaluation process and
were not aware of the current study objectives.
The study protocol was discussed in detail with
Fig 1 Measuring IID by adapting orthodontic wire to the crest of the
mandibular residual ridge between the centers of the two implants. each patient, and informed, witnessed, and signed
consent was obtained.

for such possible confounding factors when stability Denture Quality Evaluation
and retention of dentures are being scientifically in-
vestigated. Moreover, evidence on patient-mediated Two independent calibrated investigators ( for intra-
concerns, namely quality of life and satisfaction, as examiner reliability > 86%) examined the patients
related to inter-implant distance (IID) is scarce.15 using a Denture Quality Evaluation Form, which was
Therefore, the aim of the current study was to address developed and validated by the authors team and has
the following null hypotheses in individuals rehabili- been described previously.2 The form was designed
tated with mandibular overdentures supported by two to assess the dentures objectively on the basis of the
unsplinted implants: following seven criteria: esthetics (lip support, lower
lip line),17 retention and stability of both maxillary and
Patient satisfaction is not related to the clinical mandibular dentures,18 and balanced articulation.16,19
quality of the dentures. Clinical parameters were described precisely on the
IID has no effect on the clinical quality of the form and were scored on a dichotomous scale (sat-
dentures as evaluated by the clinicians. isfactory = 1, unsatisfactory = 0). Based on the ob-
IID does not influence patient satisfaction with jectives of the current study, however, the esthetics
their dentures. items (lip support, lower lip line) were eliminated.

Materials and Methods Evaluation of Patient Satisfaction

A priori sample size calculations revealed that 30 Patient-mediated outcomes data were collected using
participants were required to achieve a power of an Arabic version of the validated self-report Denture
more than 80% to detect a correlation as large as Satisfaction Scale.20 This scale uses a Likert-type re-
r > 0.50 at a significance level of = .05. The human sponse format that ranges from 1 (not at all satisfied)
ethics board at the College of Dentistry, King Saud to 5 (totally satisfied). The following 12 variables were
University, Riyadh, Saudi Arabia approved the study assessed on this scale: overall satisfaction, retention,
protocol (reference number: IR 0102). stability, comfort, and esthetics of maxillary and man-
The population of interest was completely eden- dibular dentures, as well as chewing efficiency and
tulous patients who were rehabilitated by means of ability to speak. The scores ranged from 12 to 60.
implant-retained overdentures with two Locator at- Higher total scores indicate greater satisfaction.
tachments (Locator, Zest Dental Solutions) from
September 2011 to May 2016. A sample of 40 patients Measurement of IID
was randomly selected by independent investigators
who were not involved in the patients treatment to Irreversible hydrocolloid impressions (Jeltrate
eliminate any possibilities of selection bias. To be in- Dustless Alginate Impression, Dentsply) of the man-
cluded, the patients were required to be wearing their dible were made and poured in die stone (Microstar
dentures currently and to be able to communicate Thixo Die Stone, Jensen Dental). An orthodontic wire
clearly with the clinician. Exclusion criteria included was then adapted to the mandibular alveolar ridge
the presence of general physical or psychologic dis- crest extending from the center of one implant to the
orders that precluded normal oral function (eg, severe center of the other (Fig 1). The IID was measured in
facial paralysis), comprehensive clinical examination, millimeters using a flexible ruler.
or the completion of the questionnaires.

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 Alfadda et al

Statistical Analysis Table 1 D

 emographic Characteristics of the
Participants (N = 40)
The data were analyzed using SPSS version 16.5 Characteristics No. of participants
(SPSS Inc). Categorical variables, such as demo- Sex, n (%)
graphic characteristics and satisfaction scores, were Males 28 (70.0)
Females 12 (30.0)
presented either as frequencies or as frequencies and
Age (y), mean SD 57.9 14.6
percentages. Continuous variables, which included
Education, n (%)
the average satisfaction scores, were presented as Not completed high school 21 (52.5)
mean standard deviation (SD). Spearman correla- Completed high school 18 (45.0)
tion analyses were performed to determine the asso- Completed university 1 (2.5)
ciations between the measured variables of interest. Annual income (US$), n (%)
P value was considered significant at < .05. < $5,500 9 (22.5)
$5,500$9,999 26 (65.0)
$10,000 5 (12.5)
Results Health status, n (%)
Healthy 21 (52.5)
A total of 40 implant-supported mandibular overden- Diabetes mellitus 11 (27.5)
ture patients were enrolled in this study (28 males, 12 Hypertension 4 (10.0)
females). The mean SD age of the patients was ap- Heart conditions 1 (2.5)
Others 3 (7.5)
proximately 58 14.6 years. Other characteristics of
Smoking status, n (%)
the study sample are presented in Table 1. The mean Current smoker 11 (27.5)
SD overall denture satisfaction score was 3.98 Former smoker 5 (12.5)
1.43. This result indicated that most patients were Nonsmoker 24 (60)
very satisfied with their dentures for all 12 satisfaction Age of current mandibular overdenture 1.89 1.56
(y), mean SD
domains, although approximately 78% of the patients
Patients with previous dentures, n (%)
had never had a denture before or had only had one 01 31 (77.5)
set (Table 2). Patients were more satisfied with the >1 9 (22.5)
mandibular overdenture (mean SD = 3.98 1.46) Bone quality (mandible), n (%)
than with the maxillary complete denture (mean SD Type 1 3 (9.1)
= 3.92 1.63); however, this difference was not sta- Type 2 8 (24.2)
Type 3 13 (39.4)
tistically significant (P = .19).
Type 4 9 (27.3)
The clinicians mean SD overall rating of the clini- Bone quantity (mandible), n (%)
cal quality of the dentures was 91.5% 6.27% across A 4 (10)
the five items scored. Retention of the maxillary den- B 26 (65)
ture was more likely to be rated as unacceptable by C 9 (22.5)
the clinicians compared to the mandibular overden- D 1 (2.5)
Opposing dentition, n (%)
ture, but the difference was not statistically significant
Natural teeth 2 (5.0)
(Table 3). RPD 6 (15.0)
Table 4 shows the association between the vari- CD 27 (67.5)
ous parameters of denture quality and overall patient Implant OVD 5 (12.5)
satisfaction. Mandibular and maxillary denture sta- Oral hygiene, n (%)
bility were both significantly related to satisfaction Good 13 (33.3)
Fair 16 (41.0)
(r = 0.389 and r = 0.44, respectively). Poor 10 (25.6)
Patterns of associations (strength and direction) be- Note: Data presented as n (%) for frequencies and mean SD for
tween the denture quality parameters and the denture continuous variables.
RPD = removable partial denture; CD = complete denture;
satisfaction items are shown in Table 5. None of the OVD = overdenture.
inverse relationships were statistically significant. This
result is likely due to clinicians rarely rating retention
or stability as unacceptable. The results showed sev- were significantly associated with maxillary denture
eral significant associations between the mandibu- satisfaction only. Similarly, the retention of the man-
lar stability items and both maxillary and mandibular dibular denture was associated only with mandibular
denture satisfaction items. Moreover, the stability of denture satisfaction.
the maxillary denture was significantly associated The mean SD of IID was 25.4 7.1 mm (minimum
with most items pertaining to mandibular denture sat- 11 mm, maximum 43 mm). None of the 12 denture sat-
isfaction (ie, retention, stability, comfort, and overall isfaction items were statistically significantly related
satisfaction). However, retentive maxillary dentures to the IID (Table 6). Similarly, IID did not have an effect

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Do Clinical Denture Quality and IID Affect Patient Satisfaction?

Table 2 Denture Satisfaction Scale20 Scores

No. of patientsa
Not at all Not very Reasonably Very Totally Mean Standard
How Satisfied Are You With satisfied satisfied satisfied satisfied satisfied scoreb deviationb Missing
Your maxillary denture overall? 3 2 1 6 15 4.0 1.4 0
Your mandibular denture overall? 6 5 5 4 20 3.68 1.56 0
Retention of the maxillary denture? 4 2 2 4 14 3.85 1.54 1
Retention of the mandibular denture? 5 4 4 5 22 3.87 1.49 0
Stability of the maxillary denture? 4 2 2 6 12 3.77 1.5 1
Stability of the mandibular denture? 5 4 4 5 22 3.87 1.49 0
Comfort of the maxillary denture? 5 1 2 5 14 3.81 1.57 0
Comfort of the mandibular denture? 7 2 4 5 22 3.82 1.57 0
Chewing efficiency? 2 2 1 4 18 4.26 1.29 0
Appearance/esthetics of the maxillary 1 2 4 4 15 4.15 1.19 1
denture?
Appearance/esthetics of the mandibular 1 0 5 9 23 4.39 0.92 2
denture?
Ability to speak with your dentures? 2 3 4 1 16 4.0 1.41 1
Maxillary items only N/A N/A N/A N/A N/A 3.92 1.63 N/A
Mandibular items only N/A N/A N/A N/A N/A 3.98 1.46 N/A
Total score (all items) N/A N/A N/A N/A N/A 3.98 1.43 N/A
Total satisfaction score by sex
Males N/A N/A N/A N/A N/A 4.19 1.02 N/A
Females N/A N/A N/A N/A N/A 3.95 1.22 N/A
aNumbers do not always total 40 because not all participants responded to every item.
b Scale ranges from 1 (not at all satisfied) to 5 (totally satisfied).

Table 3 Denture Quality Evaluation Scores, as Assessed by Clinicians

Participants (N = 40), n (%)a
Denture quality parameter Acceptable Unacceptable Missing data
Stability of maxillary denture 36 (90.0) 2 (5.0) 2 (5.0)
Stability of mandibular denture 36 (90.0) 4 (10.0) 0
Retention of maxillary denture 33 (82.5) 5 (12.5) 2 (5.0)
Retention of mandibular denture 39 (97.5) 1 (2.5) 0
Balanced articulation 39 (97.5) 1 (2.5) 0
Mean across all five quality items 36.6 (91.5) 2.6 (6.5) 0.25 (2.0)
Data presented as frequencies (%). aPercentages are based on the number of participants for whom the clinicians provided a rating.

Discussion
Table 4 C
 orrelations Between Denture Quality,
Inter-Implant Distance (IID), and Patient
Satisfaction Null Hypothesis 1
Denture quality parameter IID Satisfaction
Due to some morphologic, psychologic, or socio-
Stability of maxillary denture 0.159 0.44*
economic factors, maxillary conventional complete
Stability of mandibular denture 0.194 0.389*
dentures may be the treatment modality of choice.
Retention of maxillary denture 0.353 0.38
The present results indicate that the majority of the
Retention of mandibular denture 0.121 0.242
completely edentulous patients were very satisfied
Occlusion 0.129 0.33
with their maxillary conventional complete dentures,
*P < .05.
despite the fact that almost 75% of them had no previ-
ous experience or had only had one previous denture.
This finding confirms that well-fabricated convention-
al complete dentures in the maxilla can indeed meet
on the quality of either of the dentures in terms of patient expectations. However, it should be reiterated
retention, stability, or occlusion (Table 4). that these dentures must be fabricated to the optimum

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 Alfadda et al

Table 5 Correlations Between Denture Quality Parameters and Denture Satisfaction Items
Denture quality parameter
Stability of Stability of Retention of Retention of
Denture satisfaction scale scores maxillary denture mandibular denture maxillary denture mandibular denture Occlusion
Your maxillary denture overall? 0.153 0.231 0.397* 0.278 0.285
Your mandibular denture overall? 0.454** 0.484** 0.211 0.363* 0.253
Retention of maxillary denture? 0.360* 0.402* 0.555** 0.319 0.292
Retention of mandibular denture? 0.485** 0.520** 0.219 0.382* 0.267
Stability of maxillary denture? 0.316 0.356* 0.518** 0.238 0.274
Stability of mandibular denture? 0.492** 0.520** 0.266 0.382* 0.267
Comfort of maxillary denture? 0.238 0.293 0.333* 0.232 0.262
Comfort of mandibular denture? 0.450** 0.524** 0.220 0.361* 0.252
Chewing efficiency? 0.057 0.088 0.173 0.120 0.120
Appearance/esthetics of maxillary denture? 0.039 0.241 0.177 0.172 0.128
Appearance/esthetics of mandibular denture? 0.212 0.362* 0.029 0.135 0.129
Ability to speak? 0.223 0.276 0.029 0.358* 0.181
*P < .05. **P < .01.

clinical standards in terms of stability, retention, es- Table 6 C

 orrelation Between Denture Satisfaction and
thetics, phonetics, and occlusion. Stable conventional Inter-Implant Distance
complete dentures that allowed patients to achieve a Coefficient P
Denture Satisfaction Scale scores (R) value
satisfactory chewing capacity had a positive effect on
Your maxillary denture overall 0.001 .997
denture acceptance and quality of life.21 Even in cases
Your mandibular denture overall 0.022 .905
with severely resorbed alveolar ridges, clinicians may
Retention of maxillary denture 0.247 .189
successfully achieve satisfactory denture stability and
Retention of mandibular denture 0.060 .738
retention in the maxilla by identifying and account-
Stability of maxillary denture 0.253 .178
ing for the compromising biomechanical factors at an
Stability of mandibular denture 0.083 .648
early stage to ensure the most favorable outcomes.
Comfort of maxillary denture 0.095 .604
The patient satisfaction rate for the implant-
Comfort of mandibular denture 0.005 .977
supported mandibular overdenture was higher than
Chewing efficiency 0.049 .789
that for the maxillary denture. These results built on
Appearance/esthetics of maxillary denture 0.081 .666
the authors previous findings among conventional
Appearance/esthetics of mandibular denture 0.198 .277
complete denture wearers, in which the mandibular
Ability to speak 0.022 .907
conventional complete denture received a significant-
* Statistically significant at P < .05.
ly lower satisfaction score compared to the maxillary
denture.2 In the current study, implant attachments
greatly contributed, positively, to the retention of the to the forces of dislodgment along the path of place-
mandibular dentures and consequently led to higher ment,19 is considered the least important objective of
rates of patient satisfaction. This finding is clearly a removable denture, since dislodging forces are not
demonstrated by the statistically significant correla- functional forces. Boucher has even described a den-
tion between the stability of both dentures and satis- ture that would withstand a dislodgment test as a failure
faction and further supports what has been described under functional conditions.26 Accordingly, when the
by other researchers.9,2224 patients in the present study were able to function ef-
The stability of the dentures had a stronger influence ficiently with their stable dentures, it reflected positively
on patient satisfaction than retention. While denture on their overall satisfaction level, despite their relatively
retention resulted in higher satisfaction with the pros- low rating of the maxillary denture retention.
thesis in the corresponding arch, stability impacted Occlusion did not appear to play a role in patient
patients denture satisfaction in both arches. These satisfaction. Although this finding is in agreement
findings could be explained from a functional viewpoint. with what other researchers have reported,2,27,28 it
Stability is defined as the quality of a removable denture should be interpreted with caution. Balanced articula-
to resist displacement by functional horizontal or rota- tion is an indispensable element of denture stability,
tional stresses,19 making it the most desirable feature the parameter that had the most influence on patient
during usein fact, it has long been described as the satisfaction in the present study.
distinguishing factor between the success and failure of Based on the findings of this study, this null hypoth-
a removable denture.25 Retention, defined as resistance esis was rejected.

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Do Clinical Denture Quality and IID Affect Patient Satisfaction?

Null Hypothesis 2 observer bias all enhanced the external validity of this
research. However, long-term, prospective, controlled
None of the denture quality parameters were statisti- clinical trials incorporating other possible confound-
cally significantly related to IID. In vitro reports have ing factors in the IID/denture stability equation (eg,
suggested that implants inserted in the canine area un- height and type of implant attachment) are required
dergo greater exposure to frontal traumatic impact force to confirm these findings.
when compared to implants inserted more anteriorly (ie,
lateral incisor area).11 Other researchers demonstrated Conclusions
that various force directions would have different ef-
fects on two-implantsupported overdentures.12 While In patients rehabilitated with mandibular overden-
the vertical and anteroposterior dislodging forces of the tures supported by two unsplinted implants, the fol-
simulated overdenture prosthesis increased with widely lowing conclusions can be made:
spaced implants, the oblique dislodging forces effect
remained constant regardless of the implant locations. Stability of the dentures has a stronger influence
However, these findings were not observed in the cur- on patient satisfaction than retention.
rent clinical study. A reasonable explanation could be Stability of both maxillary and mandibular dentures
the recognized differences between in vitro and in vivo is significantly associated with patient satisfaction
studies with respect to their designs and limitations. In with both dentures.
vitro experiments permit a simpler and more controlled Patient satisfaction with mandibular overdenture
approach to the research question. The masticatory retention, stability, and comfort is influenced by
system, however, is an extremely complex functional the stability of the maxillary complete denture.
system. This complexity makes it challenging to iden- The impact of retention on patient satisfaction is
tify the interactions between its individual elements site specific (ie, the retentive mandibular overden-
and their absolute effect on a functioning overdenture ture was associated with patient satisfaction only
through benchtop testing. Clinical trials are generally with their mandibular overdenture, and vice versa).
better suited for observing the overall effects of the in- IID has no effect on the clinical quality of maxillary
dependent variable (ie, the IID) when local confounding or mandibular dentures and does not influence
factors are expected to influence the results. Hence, it is patient satisfaction.
assumed that any potential loss of retention elicited by
the various implant locations might have been offset by Acknowledgments
the salivary and orofacial muscular action.
Based on the findings of the current study, this null This research project was supported by a grant from the Research
hypothesis was accepted. Center of the Female Scientific and Medical Colleges, Deanship of
Scientific Research, King Saud University. The authors declare that
they have no conflicts of interest and that there was no external
Null Hypothesis 3 source of funding for the present study.

No statistically significant correlations were found

between the 12 denture satisfaction items and IID. References
These findings were similar to previous findings re-
ported in the literature, with comparable IID means 1. Alfadda SA, Al-Fallaj HA, Al-Banyan HA, Al-Kadhi RM. A clini-
cal investigation of the relationship between the quality of con-
and SDs.15 Patient satisfaction is mostly a reflection
ventional complete dentures and the patients quality of life.
of a comfortable and functioning denture. Since IID Saudi Dent J 2015;27:9398.
did not have an effect on the denture quality param- 2. Alfadda SA. The relationship between various parameters of
eters (ie, stability, retention, and occlusion), and the complete denture quality and patients satisfaction. J Am Dent
clinicians were able to fabricate a denture that met Assoc 2014;145:941948.
3. Fenlon MR, Sherriff M. Investigation of new complete denture
these requirements regardless of the amount of im-
quality and patients satisfaction with and use of dentures after
plant separation, it was therefore anticipated that a two years. J Dent 2004;32:327333.
lack of correlation between IID and patient satisfac- 4. Heydecke G, Klemetti E, Awad MA, Lund JP, Feine JS.
tion would be observed. Accordingly, this null hypoth- Relationship between prosthodontic evaluation and patient rat-
esis was accepted. ings of mandibular conventional and implant prostheses. Int J
Prosthodont 2003;16:307312.
The calculation of the a priori sample size to en-
5. Attard NJ, Zarb GA, Laporte A. Long-term treatment costs
sure high power at a significance level of = .05, the associated with implant-supported mandibular prostheses in
use of a validated Denture Quality Evaluation Form edentulous patients. Int J Prosthodont 2005;18:117123.
and a Denture Satisfaction Scale, and the indepen-
dent evaluation of the outcomes to eliminate possible

524 The International Journal of Prosthodontics

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 Alfadda et al

6. Emami E, de Souza RF, Bernier J, Rompr P, Feine JS. Patient 16. Alan GT, Payne AG, Zarb GA. Implant overdentures. In: Zarb
perceptions of the mandibular three-implant overdenture: A GA, Bolender CL, Eckert SE (eds). Prosthodontic Treatment for
practice-based study. Clin Oral Implants Res 2015;26:639643. Edentulous Patients: Complete Dentures and Implant-Supported
7. Kuoppala R, Npnkangas R, Raustia A. Quality of life of pa- Prostheses, ed 12. St. Louis, MO: Mosby, 2004:195197.
tients treated with implant-supported mandibular overdentures 17. Brunton PA, McCord JF. An analysis of nasolabial angles and
evaluated with the Oral Health Impact Profile (OHIP-14): A sur- their relevance to tooth position in the edentulous patient. Eur J
vey of 58 patients. J Oral Maxillofac Res 2013;4:e4. Prosthodont Restor Dent 1993;2:5356.
8. Alfadda SA, Attard NJ, David LA. Five-year clinical results of 18. Bergman B, Carlsson GE. Review of 54 complete denture wear-
immediately loaded dental implants using mandibular overden- ers. Patients opinions 1 year after treatment. Acta Odontol
tures. Int J Prosthodont 2009;22:368373. Scand 1972;30:399414.
9. de Souza FI, de Souza Costa A, Dos Santos Pereira R, Dos 19. The glossary of prosthodontic terms [editorial]. J Prosthet Dent
Santos PH, de Brito RB Jr, Rocha EP. Assessment of satisfaction 2005;94:1092.
level of edentulous patients rehabilitated with implant-support- 20. Allen PF, McMillan AS, Walshaw D. A patient-based assess-
ed prostheses. Int J Oral Maxillofac Implants 2016;31:884890. ment of implant-stabilized and conventional complete dentures.
10. Zarb GA, Schmitt A. The edentulous predicament. II: The longi- J Prosthet Dent 2001;85:141147.
tudinal effectiveness of implant-supported overdentures. J Am 21. de Souza e Silva ME, de Magalhes CS, Ferreira e Ferreira E.
Dent Assoc 1996;127:6672. Complete removable prostheses: From expectation to (dis)sat-
11. Kan B, Coskunses FM, Mutlu I, Ugur L, Meral DG. Effects of isfaction. Gerodontology 2009;26:143149.
inter-implant distance and implant length on the response to 22. Emami E, Cerutti-Kopplin D, Menassa M, et al. Does immediate
frontal traumatic force of two anterior implants in an atrophic loading affect clinical and patient-centered outcomes of man-
mandible: Three-dimensional finite element analysis. Int J Oral dibular 2-unsplinted-implant overdenture? A 2-year within-
Maxillofac Surg 2015;44:908913. case analysis. J Dent 2016;50:3036.
12. Scherer MD, McGlumphy EA, Seghi RR, Campagni WV. 23. Sadowsky SJ, Zitzmann NU. Protocols for the maxillary implant
Comparison of retention and stability of implant-retained over- overdenture: A systematic review. Int J Oral Maxillofac Implants
dentures based upon implant number and distribution. Int J 2016;31(suppl):s182s191.
Oral Maxillofac Implants 2013;28:16191628. 24. Cataln A, Martnez A, Marchesani F, Gonzlez U. Mandibular
13. Hong HR, Pae A, Kim Y, Paek J, Kim HS, Kwon KR. Effect of implant overdentures retained by two mini-implants: A seven-year re-
position, angulation, and attachment height on peri-implant bone tention and satisfaction study. J Prosthodont 2016;25:364370.
stress associated with mandibular two-implant overdentures: 25. Wright CR. Evaluation of the factors necessary to develop sta-
A finite element analysis. Int J Oral Maxillofac Implants 2012; bility in mandibular dentures. J Prosthet Dent 1966;16:414430.
27:e69e76. 26. Boucher CO. Complete denture impressions based upon the
14. Zarb GA, Hobkirk J, Eckert S, Jacob R (eds). Prosthodontic anatomy of the mouth. J Am Dent Assoc 1944;31:11741181.
Treatment for Edentulous Patients: Complete Dentures and 27. Wolff A, Gadre A, Begleiter A, Moskona D, Cardash H. Correlation
Implant-Supported Prostheses, ed 13. St. Louis, MO: Elsevier between patient satisfaction with complete dentures and den-
Mosby, 2013. ture quality, oral condition, and flow rate of submandibular/sub-
15. Geckili O, Cilingir A, Erdogan O, et al. The influence of in- lingual salivary glands. Int J Prosthodont 2003;16:4548.
terimplant distance in mandibular overdentures supported by 28. Anastassiadou V, Robin Heath M. The effect of denture quality
two implants on patient satisfaction and quality of life. Int J attributes on satisfaction and eating difficulties. Gerodontology
Prosthodont 2015;28:1921. 2006;23:2332.

Literature Abstract

How Does Mandibular Bone Atrophy Influence the Masticatory Function, OHRQoL and Satisfaction in
Overdenture Wearers? Clinical Results Until 1-Year Post-Loading.

This longitudinal clinical study investigated differences in the masticatory function (MF), satisfaction, and oral healthrelated quality of life
(OHRQoL) between atrophic patients (AP) and nonatrophic patients (NAP) before and after rehabilitation with mandibular overdentures
(MO). A total of 26 complete denture (CD) wearers were categorized into two groups according to the mandibular bone atrophy
(MBA) degree. MF was evaluated before and after 1, 3, 6, and 12 months of the MO loading via two standardized tests: (1) masticatory
performance (MP) (MP_X50, MPB, ME 56, ME 28) and (2) swallowing threshold (ST) (time, number of cycles, ST_X50, STB, ME 56, ME
28). The Dental Impact on Daily Living (DIDL) Questionnaire measured changes in the satisfaction level and OHRQoL. MP comparisons
showed significant differences only for ME 56 12 months after MO loading (AP = 3379 236; NAP = 1758 201). ST presented
significant differences before MO loading for: ST_X50 (AP = 548 083; NAP = 431 144), ME 56 (AP = 5317 2471; NAP = 2983
3145), and ME 28 (AP = 876 691; NAP = 1861 1071). One month after MO loading, NAP performed the ST test 21% faster than
AP. After 3 months, significant improvements in STB (AP = 493 482; NAP = 273 127) and ME 28 (AP = 1715 1000; NAP = 2469
782) were also observed. DIDL evaluation showed significant differences in the oral comfort domain after 3 months (AP = 066 029;
NAP = 087 016) and after 6 months (AP = 079 022; NAP = 098 008), with lower satisfaction levels in the AP. It was concluded
that MBA negatively affects the MF, mainly the ST. After 6 months, differences between AP and NAP disappeared, and ST results were
equalized. AP initially has lower satisfaction levels, reaching similar levels of satisfaction as NAP after 1 year.
Marcello-Machado RM, Faot F, Schuster AJ, Bielemann AM, Chagas Jnior OL, Del Bel Cury AA. J Oral Rehabil 2017;44(11):850859.
References: 29. Reprints: Raissa Micaella Marcello Machado, Graduate Program in Clinical Dentistry, Department of Prosthodontics and Periodontology,
Piracicaba Dental School, State University of Campinas, Piracicaba, SP, Brazil. Email (corresponding author): Fernanda Faot, [email protected]
Carlo Marinello, Switzerland

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