Received: 3 September 2021 | Revised: 24 November 2021 | Accepted: 1 December 2021

DOI: 10.1002/cre2.521

REVIEW ARTICLE

Implant‐supported removable partial dentures compared

to conventional dentures: A systematic review and
meta‐analysis of quality of life, patient satisfaction, and
biomechanical complications

Octave N. Bandiaky1 | Dohoue L. Lokossou2 | Assem Soueidan3 |

Pierre Le Bars4 | Moctar Gueye5 | Elhadj B. Mbodj5 | Laurent Le Guéhennec6

1
Division of Fixed Prosthodontics, University
of Nantes, Nantes, France Abstract
2
School of Dentistry, University of El Hadji Objectives: The purpose of this systematic review and meta‐analysis was to com-
Ibrahima Niasse, Dakar, Sénégal
pare implant‐supported removable partial dentures (ISRPDs) with distal extension
3
Department of Periodontology, Rmes U1229,
University of Nantes, Nantes, France removable partial dentures (DERPDs) in terms of patient‐reported outcome mea-
4
Division of Fixed Prosthodontics, sures (PROMs: patients' quality of life and satisfaction) and to determine mechanical
CHU Nantes, Nantes, France and biological complications associated with ISRPDs.
5
Department of Odontology, Clinic of Fixed
Material and Methods: An electronic search was performed on four databases to
and Removable Prosthodontics, University of
Dakar, Dakar, Senegal identify studies treating Kennedy class I or II edentulous patients and which com-
6
Department of Prosthetic Dentistry, Faculty pared ISRPDs with DERPDs in terms of PROMS and studies, which evaluated me-
of Dentistry, University of Nantes, Nantes,
chanical and biological complications associated ISRPDs. Two authors independently
France
extracted data on quality of life, patient satisfaction, and biomechanical complica-
Correspondence tions from these studies. The risk of bias was assessed for each study, and for
Laurent Le Guéhennec, Department of
Prosthetic Dentistry, Faculty of Dentistry, PROMs, the authors performed a meta‐analysis by using a random‐effects model.
University of Nantes, 1 Pl Alexis Ricordeau, Results: Thirteen articles were included based on the selection criteria. The difference
44042 Nantes, France.
Email: [email protected] in mean scores for quality of life (30.5 ± 1.8; 95% confidence interval [CI], 24.9–36.1)
and patient satisfaction (−20.8 ± 0.2; 95% CI, −23.7 to −17.8) between treatments with
Funding information
conventional and implant‐supported removable dentures was statistically significant
None
(p < .05). Implant‐supported removable dentures improved patients' overall quality of
life and satisfaction. Some mechanical and biological complications, such as clasp ad-
justment, abutment or implant loosening, marginal bone resorption, and peri‐implant
mucositis, were noted in ISRPDs during patient follow‐up. Studies assessing PROMs
were very heterogeneous (I2 = 65%, p = .85; I2 = 75%, p = .88).
Conclusions: ISRPDs significantly improved quality of life and patient satisfaction.
Some mechanical and biological complications have been associated with ISRPDs
treatment, requiring regular monitoring of patients to avoid the occurrence of these
complications.

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium,
provided the original work is properly cited.
© 2021 The Authors. Clinical and Experimental Dental Research published by John Wiley & Sons Ltd.

294 | wileyonlinelibrary.com/journal/cre2 Clin Exp Dent Res. 2022;8:294–312.

BANDIAKY ET AL. | 295

KEYWORDS
implant‐supported removable partial dentures, patient's satisfaction, quality of life, removable
partial denture

1 | INTRODUCTION quality of life and satisfaction of patients when compared with

DERPDs (De Carvalho et al., 2001; Ganz, 1991; Giffin & Dent,
Distal extension removable partial dentures (DERPDs) are a suitable 1996; Kuzmanovic et al., 2004; Mijiritsky & Karas, 2004; Ohkubo
treatment option that improves stomatognathic functions, which et al., 2008; Uludag & Celik, 2006; Park et al., 2020). The IRSPDs
are still widely used in the rehabilitation of Kennedy‐Applegate class provide cost‐effective treatment. This treatment option not only
I or II partially edentulous patients (Gonçalves et al., 2014a; increases the retention of the prosthesis and hence limits lateral
Vanzeveren et al., 2003). However, this type of prosthesis is asso- and vertical displacement of the removable partial denture, but it
ciated with increased alveolar bone resorption, caries lesions on also distributes masticatory forces more effectively along the
teeth, and psychologically less acceptable treatment (Knezović prosthesis and the adjacent teeth (Cho, 2002). It also increases
Zlatarić et al., 2002). Moreover, DERPDs present many biomecha- patient satisfaction and improves chewing ability, phonetics, and
nical problems (unsatisfactory retention and stability), which may esthetics, since sometimes the unesthetic vestibular bracing arms
compromise masticatory efficiency (Cunha et al., 2008). Ad- can be removed (Ohkubo et al., 2007; Shahmiri & Atieh, 2010).
ditionally, its limited functional and aesthetic properties (Shala et al., Previous studies have reported that ISRPDs are of both func-
2016) and its relatively high complication or failure rate (Knezović tional and aesthetic interest. It is a preferable treatment option
Zlatarić et al., 2002; Vermeulen et al., 1996; Wagner & Kern, 2000) for patients with complaints about their DERPDs (Mijiritsky &
explain why DERPDs can be a source of discomfort and dis- Karas, 2004; Uludag & Celik, 2006; Wismeijer et al., 2013). The
satisfaction for patients (Armellini et al., 2008; Bilhan et al., 2012). relevant literature demonstrates that the additional retention
For these reasons, some patients rehabilitated with DERPD do not provided by implants increases stability (Ohkubo et al., 2008) and
wear their prostheses regularly (Vanzeveren et al., 2003), hence the thus improves masticatory efficacy and patient satisfaction (Cho,
need for clinicians to consider other treatment alternatives as dental 2002; De Freitas et al., 2012; Goiato et al., 2018; Grossmann
implants. According to the literature, dental implants are a highly et al., 2009; Suzuki et al., 2017; Wismeijer et al., 2013; Zancopé
successful treatment option for the replacement of missing teeth et al., 2015). In addition to functional comfort, there is also an
(Albrektsson et al., 1986; Howe et al., 2019; Pjetursson et al., 2012; aesthetic gain through the removal of unsightly clasps in the
Weber & Sukotjo, 2007). Their long‐term survival rate was assessed anterior areas (Grossmann et al., 2008). ISRPDs also improve the
in many systematic reviews (Hjalmarsson et al., 2016; Howe et al., quality of life of patients wearing appliances without the need for
2019; Moraschini et al., 2015) which reported various results. The invasive surgery (bone grafts, sinus lift, etc.) (Cho, 2002; Goiato
authors of these reviews concluded that this survival rate at et al., 2018; Wismeijer et al., 2013). However, there is a lack of
10‐years follow‐up was over 92.8% (95% confidence interval [CI]: systematic reviews and meta‐analyses providing clear scientific
90–94.8) (Hjalmarsson et al., 2016; Howe et al., 2019; Moraschini evidence of the long‐term therapeutic efficacy of this prosthesis
et al., 2015). However, the presence of bone defects at the im- compared to conventional dentures (DERPDs). For these reasons,
plantation site limits at times the availability of bone tissue for the purpose of this systematic review and meta‐analysis was to
placing an adequate number of implants. Fortunately, there are compare ISRPDs and DERPDs in terms of the patient‐reported
other therapeutic solutions that make it possible to overcome this outcome measures (PROMs: quality of life and patient satisfac-
obstacle. It is notably about the use of dental implants with reduced tion) and to determine the mechanical and biological complica-
dimensions (Threeburuth et al., 2018) or preliminary bone re- tions associated with ISRPDs. The null hypothesis was that no
construction of the edentulous jaw, a process that can uses the difference would be found in the quality of life and satisfaction of
combination of bone substitutes with autologous mesenchymal patients rehabilitated with ISRPDs compared to those fitted with
stem cells or autologous bone grafting (Arinzeh et al., 2005; DERPDs.
Finkemeier, 2002; Gjerde et al., 2017, 2018). Likewise, bone sub-
stitutes of animal, human or synthetic origin may be used alone to
reconstruct small defects (Malard et al., 2007). However, these al- 2 | M A T E R I A L S AN D M E T H O D S
ternative treatments are often associated with increased cost,
treatment time, and postoperative morbidity. 2.1 | Protocol and study questions
Implant‐supported removable partial dentures (ISRPDs) have
been suggested as a minimally invasive approach for partially This systematic review and meta‐analysis were conducted in ac-
edentulous patients and are a suitable alternative to DERPDs cordance with the PRISMA (Preferred Reporting Items for Systematic
without compromising implant success while improving the reviews and Meta‐Analyses) recommendations (Moher et al., 2009)
296 | BANDIAKY ET AL.

and the Cochrane Guidelines (Cumpston et al., 2019). The review was search by utilizing a comprehensive search strategy that included
not registered in PROSPERO before data collection. controlled vocabulary and free terms. The following keywords
This study deals only with data from clinical studies published in combined with Boolean operators and Medical Subject Headings
bibliographic databases or specialized journals, its aspect does not (MeSH), Health Sciences Descriptors (DeCS), and Embase Subject
require the approval of the ethics committee nor the “protection of Headings (Emtree) were used in all databases ([removable partial
human subjects and animals in research” or informed consent. denture OR Kennedy Class I partial edentulous OR distal‐
extension removable partial denture OR jaws OR edentulous OR
denture displacement OR conventional RPDs OR partial denture
2.2 | Type of intervention, primary and secondary OR removable] AND [dental implants OR implant mechanical
outcomes complications OR implant‐supported removable partial dentures
OR patients satisfaction OR patients quality of life OR PROMs OR
The participants comprised patients with Kennedy Class I or II randomized controlled trials OR comparatives studies OR pro-
edentulism; the intervention was patients rehabilitated with ISRPDs spective studies OR implant survival rate OR periodontal pocket
in comparison with those rehabilitated with DERPDs. The primary OR tooth loss OR bone loss OR implant loss]). A manual search
outcome of studies was the patient‐reported outcome measures was also performed in the following journals: Clinical Implant
(quality of life and patient's satisfaction) evaluated after DERPD and Dentistry and Related Research, Clinical Oral Implants Research,
ISRPD treatment. A population, intervention, control, and outcome Journal of Dentistry, Journal of Oral Implantology, The Journal of
(PICO) were used to formulate a primary outcome question: Does the Prosthetic Dentistry, and the Journal of Clinical and Experimental
use of ISRPD improve quality of life and patient satisfaction than Dental Research.
DERPD. Quality of life is a patient's judgment of various aspects of
their physical, health, social and psychological well‐being. Patient
satisfaction refers to the sense of well‐being that patients feel fol- 2.5 | Selection procedure and data extraction
lowing prosthetic treatment. The secondary outcomes were the
mechanical and biological complications (marginal bone loss, tooth A calibration of two reviewers (L. L and O.N.B.) was performed
mobility, periodontal pocket, implant survival rate) associated with before the selection of studies, to determine inter‐examiner
ISRPDs. agreement in the study‐selection process for publication in the
PubMed/MEDLINE, SciELO, Cochrane Library, and ScienceDirect
databases and in specialized journals. This calibration was per-
2.3 | Inclusion and exclusion criteria formed according to the method described by Landis and Koch
(1977). After achieving an appropriate level of agreement
The review included human clinical controlled studies evaluating (κ ≥ 0.81), the reviewers (L.L and O.N.B.) performed a methodical
patient‐reported outcome measures and biomechanical complica- analysis of all studies titles, abstracts and full text, independently.
tions associated with ISRPDs, and in which patients were re- Any disagreements were resolved by discussion to find a con-
habilitated first with a DERPD and then with an ISRPD. Articles from sensus during study selection and data extraction. The selection of
studies with no available data, prosthetic rehabilitations other than studies at the database level was performed in four steps. First, the
ISRPDs and DERPDs, clinical report cases, and literature reviews retrieved articles were imported into a bibliographic reference
were excluded from this analysis. Similarly, studies that did not management software program (Zotero; Corporation for Digital
compare ISRPD to DERPD in terms of patients' quality of life or Scholarship), where duplicates were removed. In the second step,
satisfaction, that did not evaluate the clinical complications of the titles of the different references were independently reviewed
ISRPDs, or with fewer than 10 participants were excluded from this by L. L and O. N. B., and articles not related to the topic were
analysis. eliminated. Then, the abstracts and the full text of the study were
read to apply the inclusion and exclusion criteria in the third step.
At this stage, any studies not meeting the inclusion criteria were
2.4 | Search strategy and databases excluded, and the reasons for exclusion were recorded for each
study. Data extraction and synthesis were performed by L. L. using
Four databases (MEDLINE/PubMed, Scientific Electronic Library Microsoft Excel 2010 (Excel 2010; Microsoft Corp). The informa-
Online [SciELO], Cochrane Library, and ScienceDirect) were tion was verified and confirmed by O. N. B. The following data
electronically searched to identify all the relevant studies for were collected: author and year of publication, study design,
articles published up to 2021 with no date or language limita- number and age of participants, implant system/diameter/length,
tions. The search strategy at the database level remains identical attachment systems, Kennedy class and edentulous arch, study
for all these databases. A supplemental manual search was per- group, follow‐up period, marginal bone loss; and implant survival
formed by reviewing the reference lists of the related papers. rate, variables that were assessed and the method of assessment
Publication and selection bias was minimized in the bibliographic of these variables, as well as the main results.
BANDIAKY ET AL. | 297

2.6 | Risk of individual bias of the studies Pellizzer et al., 2010; Threeburuth et al., 2018) studies were excluded
and the reasons of their exclusion are presented in Figure 1. Thirteen
The risks of bias were evaluated for the totality of the studies in- studies (Bellia et al., 2020; Bortolini et al., 2011; Campos et al., 2015;
cluded according to a modified MINORS scale (Methodological Index Gates et al., 2014; Gonçalves et al., 2014b; Grossmann et al., 2008;
for Non‐Randomized Studies) of Tsirogiannis et al. (2016). This scale Jensen et al., 2016, 2017; Mijiritsky et al., 2013; Oh et al., 2021;
consisted of 10 items, with 2 additional items proposed for in vivo Ortiz‐Puigpelat et al., 2014; Payne et al., 2017; Wismeijer et al.,
studies. Each item is scored from 0 to 2; for most items, 0 indicates 2013) were included in the systematic review.
that the content of the item is not reported, 1 indicates that the
content is reported but inadequately, and 2 indicates that it is suffi-
ciently reported. The risk of bias could be weak, moderate, or high 3.1 | Study characteristics
(Table 1).
One study was RCT (Bellia et al., 2020; Campos et al., 2015; Gates
et al., 2014; Gonçalves et al., 2014b; Jensen et al., 2016; Mijiritsky
2.7 | Synthesis of results et al., 2013; Payne et al., 2017; Wagner & Kern, 2000; Wismeijer et al.,
2013) and five (Bortolini et al., 2011; Grossmann et al., 2008; Jensen
Data from the various studies were extracted, and the results were et al., 2017; Oh et al., 2021; Ortiz‐Puigpelat et al., 2014) had a pro-
synthesized. For studies in which the authors reported results as spective and retrospective design respectively. Some of these studies
medians and interquartile ranges, the values were converted to were conducted by the same authors on the same participants but
means and SDs using the formula (q1 + median + q3)/3, where q1 with different outcomes (Campos et al., 2015; Gonçalves et al., 2014b;
indicates the 25th percentile and q3 the 75th percentile, as proposed Jensen et al., 2016; Jensen et al., 2017; Payne et al., 2017; Wismeijer
in the study by Nagarkar et al. (2018). An approximation of the SD et al., 2013). The characteristics of these studies are described in
was obtained by applying this formula: (q3 − q1)/1.35. When several Table 2 and the details of the search strategy are presented in a flow
data points were reported by the authors, the most negative ones chart (Figure 1). A total of 238 participants with a mean age of
were used for the quantitative synthesis. The same was true for 60.8 ± 8.01 years (range: 44.2–75.4 years) were evaluated and 535
patient follow‐up, where the data from the longest follow‐up were implants were used as abutments for ISRPDs (500 conventional dental
retained. Meta‐analysis was performed by using R Commander™ implants and 35 mini‐dental implants). The follow‐up duration of the
software, and a random‐effects model (Gonçalves et al., 2014a; study varied from 2 to 180 months. The implant diameters ranged
Higgins & Thompson, 2002). The choice of this model was justified by from 3.3 to 6 mm and the length ranged from 6 to 15 mm. The most
the fact that most of the studies were small (number of patients <30) used implant system was Straumann, followed by Neodent, Zimmer
and that the effect of the intervention measured (quality of life and Dental Implant, and Biomet 3i. The most of participants were partially
patient satisfaction) was different for each of these studies, given dentate mandibles characterized by many missing teeth. Kennedy
their heterogeneity. Thus, a random‐effects model will give more Class I was the most dominant and the ball attachment system was
weight to these small studies. When studies used the same type of used in most studies (Bortolini et al., 2011; Campos et al., 2015; Gates
intervention and comparison groups with the same outcome mea- et al., 2014; Gonçalves et al., 2014b; Grossmann et al., 2008; Jensen
sure, the results were pooled with mean differences for continuous et al., 2017; Mijiritsky et al., 2013; Payne et al., 2017; Wismeijer et al.,
outcomes and risk ratios for dichotomous outcomes and calculated 2013). Some studies compared ISRPDs to DERPDs in terms of the
95% CIs and p values for each outcome (DerSimonian and Laird PROMs (quality of life and patient satisfaction) (Bortolini et al., 2011;
method) (DerSimonian & Laird, 1986). Heterogeneity between the Campos et al., 2015; Gates et al., 2014; Gonçalves et al., 2014b;
2
studies was assessed by using the Higgins I statistic (Higgins & Grossmann et al., 2008; Jensen et al., 2016; Jensen et al., 2017;
Thompson, 2002). We considered an I2 value of 50% or more to Mijiritsky et al., 2013; Ortiz‐Puigpelat et al., 2014; Wismeijer et al.,
indicate substantial heterogeneity. A sensitivity analysis based on the 2013) while others evaluated both these patients reported outcome
risk of bias of the included studies (low risk of bias vs. high or unclear measures and the mechanical and biological complications associated
risk of bias) was conducted. with ISRPDs (Table 2).

3 | RESULTS 3.2 | Primary outcome of the studies (PROMs:

quality of life and patient's satisfaction)
A bibliographic search of the four electronic databases and specia-
lized journals identified 2752 relevant articles. After removing du- Concerning the primary outcome measures, some studies evaluated
plicates and title and abstract screening, 2731 articles were excluded, only or both the quality of life of patients and their degree of sa-
and 21 studies were eligible for full‐text analysis, of which eight tisfaction after they received rehabilitation treatment with DERPDs
(Bural et al., 2016; Kaufmann et al., 2009; Maeda et al., 2005; and ISRPDs (Table 2). The quality of life and satisfaction of these
Minoretti et al., 2009; Ohkubo et al., 2008; Ohyama et al., 2020; patients were evaluated by using the oral health‐related quality of life
 298

TABLE 1 Modified methodological index assessing level risk bias in nonrandomized studies (MINORS)
|

Clinical studies
Campos and Gates Wismeijer and Ortiz
Jensen Gonçalves III Bellia Jensen Bortolini Payne Mijiritsky Grossmann Puigpelat
Evalaution scale Score attributed (2016) (2014, 2015) (2014) (2020) (2016) (2011) (2013, 2017) (2013) (2008) (2014) Oh (2020)
Clearly stated purpose 0: not reported, 1: 2 2 2 2 2 2 2 2 2 2 2
reported but
inadequate, 2:
reported and
adequate.

Study design 0: not reported, 1: 2 2 2 2 2 1 2 2 2 2 2

reported but
inadequate, 2:
reported and
adequate.

Randomization 0: not reported, 1: 1 0 0 0 1 0 0 0 0 0 0

reported but
inadequate, 2:
reported and
adequate.

Formation and 0: not reported, 1: 2 2 2 2 2 0 2 0 0 0 0

comparability of reported but
groups inadequate, 2:
reported and
adequate.

Characteristics of the 0: not reported, 1: 2 2 2 2 2 2 2 0 2 2 2

study reported but
inadequate, 2:
reported and
adequate.

Factor(s) studied, or 0: not reported, 1: 2 2 2 2 2 2 2 2 2 2 2

parameters reported but
measured, are they inadequate, 2:
well described? reported and
adequate.

Primary endpoint 0: not reported, 1: 2 2 2 2 2 2 2 2 2 2 2

reported but
inadequate, 2:
reported and
adequate.
BANDIAKY
ET AL.
TABLE 1 (Continued)

Clinical studies
BANDIAKY

Campos and Gates Wismeijer and Ortiz

Jensen Gonçalves III Bellia Jensen Bortolini Payne Mijiritsky Grossmann Puigpelat
ET AL.

Evalaution scale Score attributed (2016) (2014, 2015) (2014) (2020) (2016) (2011) (2013, 2017) (2013) (2008) (2014) Oh (2020)
Appropriate sample size 0: not reported, 1: 2 1 2 1 2 2 1 2 2 1 2
reported but
inadequate, 2:
reported and
adequate.

Statistical power and 0: not reported, 1: 2 2 2 2 2 0 0 0 0 0 1

justification of the reported but
number of inadequate, 2:
participants reported and
adequate.

Statistical analysis 0: not reported, 1: 2 2 2 2 2 0 2 0 2 2 2

reported but
inadequate, 2:
reported and
adequate.

Prospective data 0: not reported, 1: 2 2 2 1 2 2 2 2 1 1 1

collection reported but
inadequate, 2:
reported and
adequate.

Follow‐up period 0: not reported, 1: 2 2 2 1 2 2 2 2 2 2 2

adapted to the reported but
objective of the study inadequate, 2:
reported and
adequate.

Total score 23 21 22 19 23 15 19 14 17 16 18

Abbreviation: MINORS, methodological index for nonrandomized studies.

|
299
300 | BANDIAKY ET AL.

FIGURE 1 Flowchart of included studies

questionnaire (OHRQoL), the oral health impact profile (OHIP‐49), was (30.5 ± 1.8; 95% CI, 24.9–36.1). Due to the missing data on
the short‐form health survey (SF‐36), a visual analog scale (VAS), and patients' quality of life before implant placement, the study by Jensen
a patient satisfaction questionnaire. All selected studies reported a et al. (2017) was excluded from the quantitative synthesis of results.
significant improvement in PROMs with the use of ISRPDs as com- The studies, which assessed this parameter, showed substantial
pared with DERPDs and in the investigation of Jensen et al. (2016) heterogeneity (I2 = 65%, τ2 = 0.70, p = .85). Patients satisfaction was
the patients preferred implants positioned in the molar region (50%) evaluated in five clinical comparative studies using a VAS (Gonçalves
compared with the premolar region (30%). The instrument measures et al., 2014b; Jensen et al., 2017; Wismeijer et al., 2013) with a
of quality of life are widely described in the literature (Gates et al., numerical slider scaled from “0 = not at all satisfied” to “100 = total
2014; Jensen et al., 2017), and its highest score corresponds to a low satisfaction” and a questionnaire (Bortolini et al., 2011; Ortiz‐
level of quality of life associated with prosthetic rehabilitation. To Puigpelat et al., 2014) with a score between 1 and 5. Data synthesis
draw relevant conclusions between the two prosthetic therapy on four studies (Bortolini et al., 2011; Gonçalves et al., 2014b; Ortiz‐
modalities, the data from only four studies (Campos et al., 2015; Puigpelat et al., 2014; Wismeijer et al., 2013) showed that the mean
Gates et al., 2014; Jensen et al., 2016; Wismeijer et al., 2013) are values of the satisfaction scores obtained were higher in patients
summarized in Figure 2, and their pooling shows a statistically sig- rehabilitated with ISRPDs (41.3 ± 8.9) than with DERPDs (20.5 ± 8.7),
nificant difference in the mean quality of life score between DERPDs and the means difference (−20.79; 95% CI, −23.75 to −17.82) be-
(65.5 ± 16.3) and ISRPDs (30.9 ± 18.1) (p < .05). The mean difference tween the two treatment modalities was statistically significant
TABLE 2 Extracted data of included articles

Restored
BANDIAKY

Patients, Arch (KA

Study n (mean class; Study group Implant system/ Attachment
ET AL.

reference Study aim age years) Study design No. RNT Implant, n (implant location) diameter/length system Variables Mains results

Campos et al. Evaluate 12 (62.6) Prospective Mn (I; 6) 24 Group 1 (n = 12): Titamax‐Neodent/ Ball (O'ring; OHRQOL The strategic
(2015) OHRQOL in compara- DERPD Group 2 3.75–6 mm/ Neodent) placement of
Brazil partially tive study (n = 12): 7–13 mm osteointegrated
dentate DERDP + 2 implants in the
subjects, implants (36–46) posterior region of
comparing the patients
use of DERPD presenting
and ISRPD mandibular
Kennedy Class I
edentulism
improved
significantly their
OHRQOL

Gates III et al. Evaluate 17 (61.5) Prospective Mn (I, II; 30 Group 1 (n = 17): AstraTech AB/ Ball OHRQOL Mechanical ISRPDs substantially
(2014) OHRQOL for study 4–11) DERPD + 1 or 2 4 mm/6 mm and biological improved the
USA patients implant(s) complications OHQoL in
treated with submerged (36 patients with
DERPDs or 36–46) Group mandibular
compared to 2 (n = 17): Kennedy Class I
ISRPDs DERPD + 1 or 2 and Kennedy
implant(s) (36 Class II partial
or 36–46) edentulism. The
use of short
implants (e.g., 4.0
9 6 mm implants)
may be considered
to support ISRPD,
but with caution
due to inadequate
long‐term
follow‐up

Ortiz‐ Report on the 12 (75.4) Retrospective Mx, Mn (I, 24 Partially edentulous Screwplant (Implant Locator Patient satisfaction Treatment with ISRPD
Puigpelat clinical case series II; 4–7) patients Direct)/ Mechanical and can improve the
et al. performance 3.7–4.7 mm/ biological patient's function,
(2014) of ISRPD with 8–13 mm complications phonetics, and
Spain Locator esthetics without
abutments in the need for
different extensive bone
|

(Continues)
301
 302

TABLE 2 (Continued)
|

Restored
Patients, Arch (KA
Study n (mean class; Study group Implant system/ Attachment
reference Study aim age years) Study design No. RNT Implant, n (implant location) diameter/length system Variables Mains results

partial regeneration
edentulism surgeries and
situations, prosthodontic
with a mean rehabilitations
follow‐up
period of 28.6
months

Gonçalves Evaluate patient 12 (62.6) Prospective Mn (I; 6) 24 Group 1 (n = 12): Titamax‐Neodent/ Ball (O'ring; Patient satisfaction Implant‐retained and‐
et al. satisfaction compara- DERPD Group 2 3.75–6 mm/ Neodent) Mechanical and supported
(2014b) after use of tive study (n = 12): 7–13 mm biological removable
Brazil DERPD and DERPD + 2 complications prostheses
ISRPD implants (36–46) improve retention
and stability,
minimize
rotational
movements, and
significantly
increase
participant
satisfaction

Jensen et al. Assess the 30 (60.9) Cross‐ Mn (I; 6) 120 Group 1 (n = 30): Straumann RN/ Locator (Zest OHRQOL Mandibular implant
(2016) benefits of over RTC DERPD Group 2 3.30–4.1 mm/ Anchors, Inc., support favorably
The implant (n = 30): 6–8 mm Escondido, influences oral
Nether- support to DERPD + 2 California, health related
lands DERPD in implants USA) patient‐based
partially (PM) + 2 outcome
dentate implants (M) measures in
patients to patients with a
determine the bilateral free‐
most ending situation.
favorable The majority of
implant patients prefer the
position implant support to
be in the molar
region
BANDIAKY
ET AL.
TABLE 2 (Continued)

Restored
BANDIAKY

Patients, Arch (KA

Study class; Study group Implant system/ Attachment
ET AL.

n (mean
reference Study aim age years) Study design No. RNT Implant, n (implant location) diameter/length system Variables Mains results

Wismeijer Compare the 48 (61.7) Multicentre Mn 72 Control group Straumann/ Ball OHRQOL Patient Mandibular implant‐
et al. levels of prospective (I; 6–8) (n = 12): DERPD 4.1 mm/6–8 mm satisfaction assisted
(2013) patient study Test groups: removable partial
New satisfaction Groups 1, 2, 3 dentures are a
zeland, with either (n = 36): preferable
Colombia DERPD and DERPD + 2 treatment option
and the ISRPD implants (37–47) for patients with
Nether- complaints about
lands their conventional
distal extension
partial dentures.
ISRPDs showed
significant
improvement on
the OHIP and
OHIQ scores
compared to
DERPDs

Jensen et al. Assess 23 (59) Retrospective Mn 46 Group 1: DERPD + 2 Straumann RN/ Ball/Locator/ Mechanical and ISRPD is a viable
(2017) performance, study (I; 6–8) implants (PM) 3.30–4.1 mm/ healinga- biological treatment option
The together with Group 2: 6–8 mm butment complications with a high
Nether- biological and DERPD + 2 Patient satisfaction implant survival
lands technical implants (M) OHRQOL rate and satisfied
complications, patients after a
of ISRPD in maximum of 16
mandibular years. Technical
Kennedy class and biological
I situations complications
with implants should be
placed in the anticipated.
anterior or Anteriorly placed
posterior implants
position performed slightly
better

Bortolini Evaluate the long‐ 32 (56.8) Retrospective Mn (I, 64 Group 1 (n = 19): Branemark MKIII‐ Ball Patient satisfaction Implant‐retained
et al. term Study II, III) Class I + ISRPDs Nobelpharma/ Mechanical and RPDs are a reliable
(2011) outcomes of Group 2 (n = 10): 3.75–5 mm/ biological intermediate
Italy removable Class II + ISRPDs 10–15 mm complications solution that can
|

partial Group 3 (n = 3): reduce biological

303

(Continues)
 304

TABLE 2 (Continued)
|

Restored
Patients, Arch (KA
Study n (mean class; Study group Implant system/ Attachment
reference Study aim age years) Study design No. RNT Implant, n (implant location) diameter/length system Variables Mains results

dentures Class and economic

(RPDs) III + ISRPDs costs while
retained (but maintaining
not implant treatment
supported) by benefits and the
dental ease of RPD
implants procedures.
Periimplant soft
tissues and
residual
edentulous ridges
remain stable
over time

Mijiritsky Describe the 20 (56) Prospective Mx and 42 Partially edentulous Zimmer Dental; Ball Patient satisfaction No implant failure was
et al. long‐term study Mn (I, patients Friadent; MIS Mechanical and noted during
(2013) follow‐up of II; 6–8) Implants/3.7–5 biological follow‐up,
Russia cases treated mm/10–13 mm complications resulting in a rate
with ISRPD for implant
after at least survival of 100%
15 years. for the study.
Marginal bone loss
around implants
and prosthetic
complications
were minor and
included one rest
rupture. All
patients were
satisfied and
reported good
chewing ability
and stability of the
prosthetic devices
BANDIAKY
ET AL.
TABLE 2 (Continued)

Restored
BANDIAKY

Patients, Arch (KA

Study class; Study group Implant system/ Attachment
ET AL.

n (mean
reference Study aim age years) Study design No. RNT Implant, n (implant location) diameter/length system Variables Mains results

Grossmann Evaluate the 23 (44.2) Retrospective Mx, 44 Partially edentulous Straumann/4.1 mm/ Ball Patient satisfaction ISRPD could serve as
et al. survival of case series Mn patients 6–10 mm Biological a longterm
(2008) endosseous (NR) complications predictable
Israel dental treatment
implants used modality. Careful
in restoring patient selection,
partially with an
edentulous appropriate
patients with maintenance and
ISRPD recall system, is
recommended to
obtain satisfactory
results

Oh et al. Evaluate the 24 (67.4) Retrospective MnMx 80 Partially edentulous NR NR Mechanical and IARPDs combined
(2021) clinical status clinical (I, II, patients treated biological with implant
Republic and study IV; with an IARPD surveyed
of Korea complications 2–5) prostheses could
of IARPDs be a treatment
combined option when
with implant additional
surveyed retention, support,
prostheses and stability are
required for partial
edentulism

Payne et al. To determine 48 (61.7) Multicentre Mn 72 Control group SLA active; RN, Ball Biological complications Late implant failures
(2017) implant prospective (I; 6–8) (n= 12): DERPD Straumann/ and increased
New survival and study Test groups: 4.1 mm/ prosthodontic
zeland, prosthodontic Groups 1, 2, 3 6–10 mm maintenance
Colombia maintenance (n = 36): when an
and the of implant‐ DERPD + 2 attachment
Nether- assisted implants (37–47) system is used
lands mandibular identify the need
removable for further
partial research, including
dentures more robust
statistical analyses

(Continues)
|
305
306 | BANDIAKY ET AL.

Abbreviations: DERPD, distal extension removable partial denture; IARPD, implant‐assisted removable partial dentures; ISRPD, implant‐supported removable partial denture; KA, Kennedy‐Applegate; M, molar;
Mn, mandible; Mx, maxilla; No, number; NR, not reported; OHRQOL, oral health‐related quality of life; PM, premolar; RCT; randomized controlled trial; RNT, remaining natural teeth; RPDs, removable partial
(p < .05) (Figure 3). The study by Jensen et al. (2017) was also ex-

option for patients

may be considered
a viable treatment

for more complex

contraindications
cluded from quantitative synthesis due to the missing data on pa-

edentulism and
retaining RPDs

rehabilitation
The use of short
implants for
tients' satisfaction at baseline. The study in which the investigators

with distal
Mains results
assessed the patient satisfaction were heterogeneous (I2 = 75%,

implant
τ2 = 0.65, p = .88).
Biological complications

3.3 | Secondary outcomes of the studies

Ten studies included in the systematic review evaluated the me-

chanical and biological complications associated with ISRPDs and
Variables

reported various results regarding implant survival rates, marginal

bone loss around implants, abutment loosening or mobility, implant
mobility, bleeding on probing or deep probing depth. They also re-
ported the prosthetic complications such as fracture of the denture
Attachment

base, rest, clasps or resin. Some authors (Gonçalves et al., 2014b;

Locator

Mijiritsky et al., 2013; Oh et al., 2021) reported an implant survival

system

rate of 100% after the follow‐up period ranging from 2 to 180

months, while for others (Bellia et al., 2020; Bortolini et al., 2011;
face)‐Biomet 3i/

Gates et al., 2014; Grossmann et al., 2008; Jensen et al., 2017; Ortiz‐
(NanoTiteSur-
Implant system/
diameter/length

Super Short 3i

Puigpelat et al., 2014; Payne et al., 2017) this survival rate was
Implantes

5–6 mm/
5–6mm

91.6%–97% (Table 3). The number of implants that failed was ranging
from 1 to 6. The mean marginal bone loss around implants ranged
between 0.64 and 2.11 mm and the mean deep pockets varied from 2
to 4 mm. Some authors (Bortolini et al., 2011; Gates et al., 2014;
Partially edentulous
Implant, n (implant location)

Grossmann et al., 2008) reported implant bleeding on probing, mo-

bility or deep probing depth, abutment loosening, loose healing cap
Study group

patients

(Payne et al., 2017) or ball attachments replacement. Bortolini et al.

(2011) reported that the peri‐implant soft tissues and marginal gin-
giva of most patients were slightly inflamed. In the study of Gates III
et al. (2014), prosthetic complications involved clasp, fracture of
denture tooth, reline of the denture base, and reprocess of DERPDs
Mx, Mn (I, 35

were primarily minor and could be managed within a single clinical

visit. Gonçalves et al. (2014b) found stable periodontal conditions
II; NR)
Arch (KA
Restored

No. RNT

around the implants, no intrusions or mobility of teeth, and no

class;

radiographic changes in bone level after 2 months follow‐up. For

their part, Jensen et al. (2017) reported that posterior implants de-
age years) Study design

Prospective

monstrated significantly more complications than anterior implants

study

(peri‐implant mucositis). In their study, Bellia et al. (2020) concluded

that the use of short implants for retaining DERPDs may be con-
sidered a viable treatment option for patients with distal edentulism
20 (61.5)
Patients,
n (mean

and contraindications for more complex implant rehabilitation.

As shown in Table 1, the level of risk of bias was moderate overall
for all studies. The studies were of low methodological quality be-
Kennedy Class
and 4 years of
short implants

cause half of the studies were retrospective case series.

survival at 1

edentulism
removable

(RPDs) in
Evaluate the

dentures
retaining

I and II
Study aim
(Continued)

partial

4 | D IS CU SS IO N

ISRPDs can be considered as an alternative to DERPDs and implant‐

TABLE 2

(2020)
reference

et al.

supported fixed partial prostheses when placement of an adequate

dentures.
Study

Bellia

number of implants is limited by bone height and thickness or by

financial reasons. In this situation, a small number of conventional or
BANDIAKY ET AL. | 307

F I G U R E 2 Mean score OHIP questionnaires between 2 treatment modalities (DERPD vs. ISRPD). Wilcoxon signed‐rank test. Significant at
p < .05. CI, confidence intervals; DERPD, distal removable partial denture; ISRPD, implant‐supported removable partial dentures; OHIP, oral
health impact profile; OHRQOL, oral health‐related quality of life; SD, standard deviation

F I G U R E 3 Mean VAS score assessing participant's satisfaction. Significant at p < .05. DERPD, distal removable partial denture; ISRPD,
implant‐supported removable partial dentures; SD, standard deviation; VAS, visual analog scale

mini‐implants can be placed to retain and stabilize the DERPDs, pro- and satisfaction scores observed after the placement of osseointe-
vide comfort, and increase patient masticator efficacy (De Freitas et al., grated implants in a mandibular posterior region (Campos et al., 2015).
2012). The objective of this systematic review and meta‐analysis was In this review, patients included in the studies that evaluated the
to compare ISRPDs and DERPDs in terms of PROMs (quality of life and PROMs were first rehabilitated with DERPDs which were converted to
patient satisfaction) and to determine the mechanical and biological ISRPDs following placement of implants in the premolar or molar re-
complications associated with ISRPDs. The null hypothesis—that no gion. The loading of these implants as well as the insertion of the
difference would be found in the quality of life and satisfaction of attachment systems were carried out at least 3 months later, which
patients rehabilitated with ISRPDs compared to those treated with was sufficient time to achieve osteointegration. In their study, Ortiz‐
DERPDs—was rejected. Meta‐analyses performed at studies that Puigpelat et al. (2014) reported that the treatment of partially eden-
evaluated these parameters demonstrated a significant improvement tulous patients with ISRPDs improves the PROMs without the need
in quality of life and patient satisfaction for ISRPDs compared with for extensive bone regeneration surgeries and prosthodontic re-
DERPDs. Therefore, ISRPDs can be considered a favorable treatment habilitation. ISRPDs improve also prosthesis performance, overall pa-
option improving the biomechanical behavior of the prosthesis, and tient satisfaction with respect to retention, comfort, and masticatory
the stomatognathic functions of the patients, and their quality of life or capacity (Gonçalves et al., 2014b). Chikunov et al. (2008) reported
satisfaction. Our results corroborate those of Lemos et al. (2021) that other advantages related to the ISRPDs: a smaller number of implants,
reported a systematic increase in PROMs following the implant's as- lower cost, fewer time‐consuming clinical and laboratory procedures,
sociation to DERPDs. These results may be explained by the fact that simplified hygiene when compared with fixed dental prostheses, better
the strategic placement of implants in the posterior region under an distribution of the masticatory loads to the abutment teeth and im-
existing removable partial prosthesis transforms Kennedy class I or II plants, preservation of residual bone around the implants and re-
edentulism into class III edentulism improving thus the retention and maining teeth, better comfort because of minimal rotational
stability of this prosthesis. All these advantages may be felt by the movement, treatment compliance, and possible later conversion into a
patient, explaining the substantial improvements in the quality of life complete overdenture. Most of the implants placed in the patients
308 | BANDIAKY ET AL.

TABLE 3 Biomechanical complications associated with ISRPD

Number of Number of Implant

Study Follow‐up implants implants survival
reference mean time placed Prosthetic complications and maintenance loss rate (%)

Gates III et al. 2 years 30 Clasp adjustment 1 97

(2014) Fracture of denture tooth
Reline of denture base
Reprocess of DERPD
Loss of abutment tooth
Attachment replacement

Gonçalves 2 months 48 None 0 100

et al.
(2014b)

Bortolini et al. 8 years 64 Abutment loosening or mobility 4 93.7

(2011) Tooth substitution
Relining

Mijiritsky 15 years 42 Marginal bone loss around implants ranged between 0 100
et al. 0 and 2 mm (mean 0.64 ± 0.6 mm)
(2013) Rest rupture

Grossmann 31.5 months 44 Loss of abutment tooth 2 95.5

et al.
(2008)

Ortiz 28.6 months. 24 Mobility of the metal retentive cap 2 91.6

Puigpelat Fracture of framework
et al. Denture teeth wear
(2014) Addition denture teeth
Plastic retentive male change

Oh et al. 27.6 months 80 Mean marginal bone resorption of implants at 1 year after 0 100
(2021) loading (0.77 ± 0.63 mm)
Mean probing depth (3.4 ± 0.1 mm)
Two clasp fractures, 1 rest fracture, decementation, and 1
fracture of porcelain on an implant surveyed
prosthesis

Jensen et al. 8 years 46 Mean peri‐implant bone loss was 1.06 ± 0.59 in PM and 3 91.7
(2017) 1.10 ± 0.53
Posterior implants demonstrated significantly more
complications than anterior implants (peri‐implant
mucositis)
Loss of 3 implants in the posterior groupProbing
depth (3.3 ± 1.4)

Bellia et al. 4 years Bleeding on probing 2 94.3

(2020) Deep probing depth (2‐4 mm)
Implant mobility
Mean bone loss was 1.04 ± 1.88 mm

Payne et al. 10 years Marginal bone loss (2.11 ± 0.76) 6 92

(2017) Clasp adjustments
Loose healing cap
Fractured wrought wire clasps on distal abutment tooth,
puncture fractures of resin

Abbreviation: ISRPD, implant‐supported removable partial dentures.

included in these studies were conventional types. However, Bellia by limiting the prosthesis' dislocation from its supporting surfaces,
et al. (2020) reported that the use of short implants for retaining particularly during mastication. Indeed, these DERPDs are known to be
DERPDs may be considered a viable treatment option for patients with more vulnerable to lifting forces (Wismeijer et al., 2013). This is
distal edentulism and contraindications for more complex implant re- probably one of the main reasons why patients resort to implants to
habilitation. The conversion of the already well‐accepted and patient‐ obtain a more stable and retentive prosthesis limiting food accumu-
integrated DERPDs into an ISRPDs brings more comfort during wear lation underneath the distal extension bases of the removable partial
BANDIAKY ET AL. | 309

denture and decreasing the pressure on the resilient mucosa. In ad- ensure success and prevent or minimize future problems, such as
dition, less relining of the intaglio surface is required with implant periodontal and peri‐implant bone changes. The studies included for
support but hygiene maintenance of the natural teeth and implant the evaluation of these parameters were very heterogeneous due to
attachment systems will be required. Therefore, our results should be differences in patient characteristics (age, gender, number of residual
interpreted with caution, our review included both prospective and teeth, occlusal pattern, duration of follow‐up, the position of, and size
retrospective studies for the evaluation of PROMs. This mix of design of implants.
studies constitutes a bias in the interpretation of the results. In addi- Our work has limitations, and its results should be interpreted
tion, the instruments (OHRQoL, OHIP‐49, SF‐36, VAS, and ques- with caution because of the low methodological quality of the in-
tionnaires) used to evaluate these PROMS differ from one study to cluded studies, the small number of participants, and the short
another. This shows that these studies are highly heterogeneous even follow‐up period for some studies. These are mainly retrospective
if the participants are their own control. In addition, the characteristics studies with a low level of scientific evidence. There is a lack of
of the participants were different, some of whom were already unable randomized controlled studies dividing patients into parallel groups
to wear their DERPDs, which constitutes a selection bias. and evaluating their quality of life and level of satisfaction and the
For implant survival rate, our results were consistent with those biomechanical complications associated with each type of prosthetic
of previous systematic reviews (De Freitas et al., 2012; Lemos et al., rehabilitation. However, some positive points emerge from this study,
2021; Park et al., 2020; Zancopé et al., 2015) which reported a low and the patients served as their own controls, which limits the in-
proportion of implant failure rates over a follow‐up period ranging terindividual variability of the results.
from 6 to 180 months. Our results can be explained by the fact that
most of the implants used in the selected studies were of conven-
tional length and diameter. Indeed, it has been described in the lit- 5 | CONCLUSIONS
erature that these types of implants had a better survival rate than
mini‐implants (Lemos et al., 2016; Papaspyridakos et al., 2018). A qualitative and quantitative synthesis of the data reported in the
However, Threeburuth et al. (2018) found no difference in terms of included studies indicates that:
implant survival rate between conventional‐size and mini dental im-
plants 12 months after surgery. Some authors concluded that the 1. ISRPDs significantly improved patients' quality of life and sa-
mini dental implants can be applied for retaining mandibular Kennedy tisfaction compared to DERPDs.
class I removable partial dentures in patients with little bone avail- 2. Some mechanical and biological complications were observed
ability with ovedentures (Jawad & Clarke, 2019; Lemos et al., 2017; following the completion of the ISRPDs.
Threeburuth et al., 2018). On the other hand, some authors reported 3. Longitudinal prospective clinical studies in a large population are
that the placement of implants at the mandibular arch may contribute needed to confirm the stability of the results related to the quality
to higher survival of the implants because the bone density and the of life and patient satisfaction and to evaluate the biomechanical
thickness of the compact bone are higher in the mandible, which complications associated with ISRPDs.
leads to a higher probability of survival than the maxillary arch (Lemos
et al., 2017). Biological complications such as marginal bone loss ACKNOWLEDGME NT S
around implants and pocket depth have been reported in studies that The authors thank Amany Laham for her help in translating the paper
evaluated these parameters. The average marginal bone loss varies into English.
from 0.64 to 2 mm. These results corroborate those of Lemos et al.
(2021) who reported in their systematic review a mean bone loss of CONFLIC T OF INTERE ST
1.10 mm for ISRPDs, which was an acceptable mean value. Mijiritsky The author declares that there is no conflict of interest.
et al. (2013) reported a marginal bone loss around implants ranging
between 0 and 2 mm (mean, 0.64 ± 0.6 mm) after 15 years of follow‐ A UT H O R C O N T R I B U TI O NS
up. This marginal bone loss was >2 mm in Payne et al study after 10 Conducting the literature review, selecting articles, supervision,
years follow‐up period. In the study by Jensen et al. (2017), the mean conception and design of the literature review, collecting and syn-
peri‐implant bone loss was 1.06 ± 0.59 and 1.10 ± 0.53 in the pre- thesizing data, evaluation of the level of risk of bias, drafting the
molar and molar regions respectively. Posterior implants demon- article and writing of the statistical analysis part, writing the
strated significantly more complications than anterior implants (peri‐ manuscript and final approval of the version to be submitted: Octave
implant mucositis). These results on bone loss were similar to those of N. Bandiaky. Conducting the literature review and the level of risk of
Bellia et al. (2020). The average pocket depth varies from one study bias, selecting articles, collecting and synthesizing data, and final ap-
to another. Other biological (abutment loosening, bleeding on prob- proval of the version to be submitted: Dohoue L. Lokossou. Analysis and
ing), and mechanical complications described in Table 3 have been interpretation of data, proofreading and correction of the manuscript
reported by the authors of the different studies. All of these results before submission for publication and final approval of the version to be
demonstrated that the ISRPDs did not compromise the longevity of submitted: Assem Soueidan, Pierre Le Bars, Moctar Gueye, Elhadj B.
dental implants (Lemos et al., 2021), but careful planning is crucial to Mbodj, and Laurent Le Guéhennec.
310 | BANDIAKY ET AL.

D A TA A V A I L A B I L I T Y S T A T E M E N T De Freitas, R., de Carvalho Dias, K., da Fonte Porto Carreiro, A.,

The datasets collected and/or analyzed during the current systematic Barbosa, G., & Ferreira, M. (2012). Mandibular implant‐supported
removable partial denture with distal extension: A systematic
review and meta‐analysis are available from the corresponding au-
review. Journal of Oral Rehabilitation, 39(10), 791–798.
thor on reasonable request. Ganz, S. D. (1991). Combination natural tooth and implant‐borne
removable partial denture: A clinical report. The Journal of
ORCID Prosthetic Dentistry, 66(1), 1–5.
Gates, III, W. D., Cooper, L. F., Sanders, A. E., Reside, G. J., & De Kok, I. J.
Octave N. Bandiaky https://orcid.org/0000-0002-6556-1947
(2014). The effect of implant‐supported removable partial dentures
on oral health quality of life. Clinical Oral Implants Research, 25(2),
REFERENCES 207–213.
Albrektsson, T., Zarb, G., Worthington, P., & Eriksson, A. (1986). The long‐ Giffin, K. M., & Dent, J. P. (1996). Solving the distal extension removable
term efficacy of currently used dental implants: A review and partial denture base movement dilemma: A clinical report. The
proposed criteria of success. The International Journal of Oral & Journal of Prosthetic Dentistry, 76, 347–349.
Maxillofacial Implants, 1(1), 11–25. Gjerde, C., Mustafa, K., Hellem, S., Rojewski, M., Gjengedal, H.,
Arinzeh, T. L., Tran, T., Mcalary, J., & Daculsi, G. (2005). A comparative Yassin, M. A., Feng, X., Skaale, S., Berge, T., & Rosen, A. (2018). Cell
study of biphasic calcium phosphate ceramics for human therapy induced regeneration of severely atrophied mandibular
mesenchymal stem‐cell‐induced bone formation. Biomaterials, bone in a clinical trial. Stem Cell Research & Therapy, 9(1), 1–15.
26(17), 3631–3638. Gjerde, C. G., De Santis, D., Dominici, M., Guglielmo, Z., Sølve, H.,
Armellini, D. B., Heydecke, G., Witter, D. J., & Creugers, N. H. (2008). Piccinno, M. S., Burns, J. P. J. S., Murgia, A., Candini, O., & Mauro, K.
Effect of removable partial dentures on oral health‐related quality of (2017). Autologous porcine bone marrow mesenchymal cells for
life in subjects with shortened dental arches: A 2‐center cross‐ reconstruction of a resorbed alveolar bone: A preclinical model in
sectional study. International Journal of Prosthodontics, 21(6), mini‐pigs.
524–530. Goiato, M. C., Sônego, M. V., Pellizzer, E. P., Gomes, J. M., de, L.,
Bellia, E., Audenino, G., Ceruti, P., & Bassi, F. (2020). Clinical assessment of da Silva, E. V. F., & Dos Santos, D. M. (2018). Clinical outcome of
short implants retaining removable partial dentures: 4‐year follow‐ removable prostheses supported by mini dental implants. A
up. The International Journal of Oral & Maxillofacial Implants, 35(1), systematic review. Acta Odontologica Scandinavica, 76(8), 628–637.
207–213. Gonçalves, T. M. S. V., Campos, C. H., & Rodrigues Garcia, R. C. M.
Bilhan, H., Erdogan, O., Ergin, S., Celik, M., Ates, G., & Geckili, O. (2014a). Mastication and jaw motion of partially edentulous patients
(2012). Complication rates and patient satisfaction with are affected by different implant‐based prostheses. Journal of Oral
removable dentures. The Journal of Advanced Prosthodontics, Rehabilitation, 41(7), 507–514.
4(2), 109–115. Gonçalves, T. M. S. V., Campos, C. H., & Rodrigues Garcia, R. C. M.
Bortolini, S., Natali, A., Franchi, M., Coggiola, A., & Consolo, U. (2011). (2014b). Implant retention and support for distal extension partial
Implant‐retained removable partial dentures: An 8‐year removable dental prostheses: Satisfaction outcomes. The Journal of
retrospective study. Journal of Prosthodontics: Implant, Esthetic and Prosthetic Dentistry, 112(2), 334–339.
Reconstructive Dentistry, 20(3), 168–172. Grossmann, Y., Levin, L., & Sadan, A. (2008). A retrospective case series of
Bural, C., Buzbas, B., Ozatik, S., Bayraktar, G., & Emes, Y. (2016). Distal implants used to restore partially edentulous patients with implant‐
extension mandibular removable partial denture with implant supported removable partial dentures: 31‐month mean follow‐up
support. European Journal of Dentistry, 10(4), 566–570. results. Quintessence International, 39(8), 665–671.
Campos, C. H., Gonçalves, T. M. S. V., & Garcia, R. C. M. R. (2015). Grossmann, Y., Nissan, J., & Levin, L. (2009). Clinical effectiveness of
Implant‐supported removable partial denture improves the quality implant‐supported removable partial dentures—A review of the
of life of patients with extreme tooth loss. Brazilian Dental Journal, literature and retrospective case evaluation. Journal of Oral and
26, 463–467. Maxillofacial Surgery, 67(9), 1941–1946.
De Carvalho, W. R., Barboza, E. P., & Caúla, A. L. (2001). Implant‐retained Higgins, J. P., & Thompson, S. G. (2002). Quantifying heterogeneity in a
removable prosthesis with ball attachments in partially edentulous meta‐analysis. Statistics in Medicine, 21(11), 1539–1558.
maxilla. Implant Dentistry, 10(4), 280–284. Hjalmarsson, L., Gheisarifar, M., & Jemt, T. (2016). A systematic review of
Chikunov, I., Doan, P., & Vahidi, F. (2008). Implant‐retained partial survival of single implants as presented in longitudinal studies with a
overdenture with resilient attachments. Journal of Prosthodontics, follow‐up of at least 10 years. European Journal of Oral Implantology,
17(2), 141–148. 9(Suppl 1), S155–S162.
Cho, H. (2002). Load transfer by distal extension RPD with implant assisted Howe, M.‐S., Keys, W., & Richards, D. (2019). Long‐term (10‐year) dental
support. Presented at 2002 IADR, San Diego. implant survival: A systematic review and sensitivity meta‐analysis.
Cumpston, M., Li, T., Page, M. J., Chandler, J., Welch, V. A., Higgins, J. P., & Journal of Dentistry, 84, 9–21.
Thomas, J. (2019). Updated guidance for trusted systematic reviews: Jawad, S., & Clarke, P. T. (2019). Survival of mini dental implants used
A new edition of the Cochrane Handbook for Systematic Reviews of to retain mandibular complete overdentures: Systematic review.
Interventions. Cochrane Database of Systematic Reviews, 10, International Journal of Oral & Maxillofacial Implants, 34(2),
ED000142. 343–356.
Cunha, L. D. P., Pellizzer, E. P., Verri, F. R., & Pereira, J. A. (2008). Jensen, C., Meijer, H. J., Raghoebar, G. M., Kerdijk, W., & Cune, M. S. (2017).
Evaluation of the influence of location of osseointegrated implants Implant‐supported removable partial dentures in the mandible: A
associated with mandibular removable partial dentures. Implant 3–16 year retrospective study. Journal of Prosthodontic Research,
Dentistry, 17(3), 278–287. 61(2), 98–105.
DerSimonian, R., & Laird, N. (1986). Meta‐analysis in clinical trials. Jensen, C., Raghoebar, G. M., Kerdijk, W., Meijer, H. J., & Cune, M. S.
Controlled Clinical Trials, 7, 177–188. (2016). Implant‐supported mandibular removable partial dentures;
Finkemeier, C. G. (2002). Bone‐grafting and bone‐graft substitutes. The patient‐based outcome measures in relation to implant position.
Journal of Bone & Joint Surgery, 84(3), 454–464. Journal of Dentistry, 55, 92–98.
BANDIAKY ET AL. | 311

Kaufmann, R., Friedli, M., Hug, S., & Mericske‐Stern, R. (2009). Removable partial dentures: In vitro assessment. Journal of Oral Rehabilitation,
dentures with implant support in strategic positions followed for up 34(1), 52–56.
to 8 years. International Journal of Prosthodontics, 22(3), 233–241. Ohyama, T., Nakabayashi, S., Yasuda, H., Kase, T., & Namaki, S. (2020).
Knezović Zlatarić, D., Čelebić, A., & Valentić‐Peruzović, M. (2002). The Mechanical analysis of the effects of implant position and abutment
effect of removable partial dentures on periodontal health of height on implant‐assisted removable partial dentures. Journal of
abutment and non‐abutment teeth. Journal of Periodontology, 73(2), Prosthodontic Research, 64(3), 340–345.
137–144. Ortiz‐Puigpelat, O., Gargallo‐Albiol, J., Hernández‐Alfaro, F., & Cabratosa‐
Kuzmanovic, D. V., Payne, A. G., & Purton, D. G. (2004). Distal implants to Termes, J. (2014). Short‐term retrospective case series of implant‐
modify the Kennedy classification of a removable partial denture: A assisted removable partial dentures with locator abutments. International
clinical report. The Journal of Prosthetic Dentistry, 92(1), 8–11. Journal of Periodontics & Restorative Dentistry, 34(6), 121–128.
Landis, J. R., & Koch, G. G. (1977). The measurement of observer Papaspyridakos, P., De Souza, A., Vazouras, K., Gholami, H., Pagni, S., &
agreement for categorical data. Biometrics, 33(1), 159–174. Weber, H. (2018). Survival rates of short dental implants (≤6mm)
Lemos, C. A. A., Ferro‐Alves, M. L., Okamoto, R., Mendonça, M. R., & compared with implants longer than 6 mm in posterior jaw areas: A
Pellizzer, E. P. (2016). Short dental implants versus standard dental meta‐analysis. Clinical Oral Implants Research, 29, 8–20.
implants placed in the posterior jaws: A systematic review and meta‐ Park, J., Lee, J., Shin, S., & Kim, H. (2020). Effect of conversion to implant‐
analysis. Journal of Dentistry, 47, 8–17. assisted removable partial denture in patients with mandibular
Lemos, C. A. A., Nunes, R. G., Santiago‐Júnior, J. F., de Luna Gomes, J. M., Kennedy classification Ⅰ: A systematic review and meta‐analysis.
Limirio, J. P. J. O., Rosa, C. D. D. R. D., Verri, F. R., & Pellizzer, E. P. (2021). Clinical Oral Implants Research, 31(4), 360–373.
Are implant‐supported removable partial dentures a suitable treatment Payne, A. G., Tawse‐Smith, A., Wismeijer, D., De Silva, R. K., & Ma, S.
for partially edentulous patients? A systematic review and meta‐analysis. (2017). Multicentre prospective evaluation of implant‐assisted
The Journal of Prosthetic Dentistry, S0022‐3913(21):00334‐6. mandibular removable partial dentures: Surgical and prosthodontic
Lemos, C. A. A., Verri, F. R., de Souza Batista, V. E., Júnior, J. F. S., outcomes. Clinical Oral Implants Research, 28(1), 116–125.
Mello, C. C., & Pellizzer, E. P. (2017). Complete overdentures Pellizzer, E. P., Verri, F. R., Falcón‐Antenucci, R. M., Goiato, M. C., &
retained by mini implants: A systematic review. Journal of Dentistry, Gennari Filho, H. (2010). Evaluation of different retention
57, 4–13. systems on a distal extension removable partial denture
Maeda, Y., Sogo, M., & Tsutsumi, S. (2005). Efficacy of a posterior implant associated with an osseointegrated implant. Journal of
support for extra shortened dental arches: A biomechanical model Craniofacial Surgery, 21(3), 727–734.
analysis. Journal of Oral Rehabilitation, 32(9), 656–660. Pjetursson, B. E., Thoma, D., Jung, R., Zwahlen, M., & Zembic, A. (2012).
Malard, O., Espitalier, F., Bordure, P., Daculsi, G., Weiss, P., & Corre, P. A systematic review of the survival and complication rates of
(2007). Biomaterials for tissue reconstruction and bone substitution implant‐supported fixed dental prostheses (FDP s) after a mean
of the ear, nose and throat, face and neck. Expert Review of Medical observation period of at least 5 years. Clinical Oral Implants
Devices, 4(5), 729–739. Research, 23, 22–38.
Mijiritsky, E., & Karas, S. (2004). Removable partial denture design Shahmiri, R., & Atieh, M. (2010). Mandibular Kennedy Class I implant‐
involving teeth and implants as an alternative to unsuccessful fixed tooth‐borne removable partial denture: A systematic review. Journal
implant therapy: A case report. Implant Dentistry, 13(3), 218–222. of Oral Rehabilitation, 37(3), 225–234.
Mijiritsky, E., Mazor, Z., Lorean, A., & Levin, L. (2013). Implant diameter Shala, K. S., Dula, L. J., Pustina‐Krasniqi, T., Bicaj, T., Ahmedi, E. F., Lila‐
and length influence on survival: Interim results during the first 2 Krasniqi, Z., & Tmava‐Dragusha, A. (2016). Patient's satisfaction with
years of function of implants by a single manufacturer. Implant removable partial dentures: A retrospective case series. The Open
Dentistry, 22(4), 394–398. Dentistry Journal, 10, 656–663.
Minoretti, R., Triaca, A., & Saulacic, N. (2009). The use of extraoral Suzuki, Y., Kono, K., Shimpo, H., Sato, Y., & Ohkubo, C. (2017). Clinical
implants for distal‐extension removable dentures: A clinical evaluation of implant‐supported removable partial dentures with a
evaluation up to 8 years. International Journal of Oral & stress‐breaking attachment. Implant Dentistry, 26(4), 516–523.
Maxillofacial Implants, 24(6), 1129–1137. Threeburuth, W., Aunmeungtong, W., & Khongkhunthian, P. (2018).
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & Prisma Group. (2009). Comparison of immediate‐load mini dental implants and
Preferred reporting items for systematic reviews and meta‐analyses: conventional‐size dental implants to retain mandibular Kennedy
The PRISMA statement. PLOS Medecine, 6, 1000097. class I removable partial dentures: A randomized clinical trial. Clinical
Moraschini, V., Poubel, L., da, C., Ferreira, V., & dos Sp Barboza, E. (2015). Implant Dentistry and Related Research, 20(5), 785–792.
Evaluation of survival and success rates of dental implants reported Tsirogiannis, P., Reissmann, D. R., & Heydecke, G. (2016). Evaluation of
in longitudinal studies with a follow‐up period of at least 10 years: A the marginal fit of single‐unit, complete‐coverage ceramic
systematic review. International Journal of Oral and Maxillofacial restorations fabricated after digital and conventional impressions:
Surgery, 44(3), 377–388. A systematic review and meta‐analysis. The Journal of Prosthetic
Nagarkar, S. R., Perdigao, J., Seong, W.‐J., & Theis‐Mahon, N. (2018). Dentistry, 116(3), 328–335.
Digital versus conventional impressions for full‐coverage Uludag, B., & Celik, G. (2006). Fabrication of a maxillary implant‐supported
restorations: A systematic review and meta‐analysis. The Journal of removable partial denture: A clinical report. The Journal of Prosthetic
the American Dental Association, 149(2), 139–147. Dentistry, 95(1), 19–21.
Oh, Y.‐K., Bae, E.‐B., & Huh, J.‐B. (2021). Retrospective clinical evaluation Vanzeveren, C., D'Hoore, W., Bercy, P., & Leloup, G. (2003). Treatment
of implant‐assisted removable partial dentures combined with with removable partial dentures: A longitudinal study. Part I. Journal
implant surveyed prostheses. The Journal of Prosthetic Dentistry, of Oral Rehabilitation, 30(5), 447–458.
126(1), 76–82. Vermeulen, A., Keltjens, H., Van't Hof, M., & Kayser, A. (1996). Ten‐year
Ohkubo, C., Kobayashi, M., Suzuki, Y., & Hosoi, T. (2008). Effect of implant evaluation of removable partial dentures: Survival rates based on
support on distal‐extension removable partial dentures: In vivo retreatment, not wearing and replacement. The Journal of Prosthetic
assessment. International Journal of Oral & Maxillofacial Implants, Dentistry, 76(3), 267–272.
23(6), 1095–1101. Wagner, B., & Kern, M. (2000). Clinical evaluation of removable partial
Ohkubo, C., Kurihara, D., Shimpo, H., Suzuki, Y., Kokubo, Y., & Hosoi, T. dentures 10 years after insertion: Success rates, hygienic problems,
(2007). Effect of implant support on distal extension removable and technical failures. Clinical Oral Investigations, 4(2), 74–80.
312 | BANDIAKY ET AL.

Weber, H.‐P., & Sukotjo, C. (2007). Does the type of implant prosthesis
affect outcomes in the partially edentulous patient? International How to cite this article: Bandiaky, O. N., Lokossou, D. L.,
Journal of Oral & Maxillofacial Implants, 22(7), 140–172.
Soueidan, A., Le Bars, P., Gueye, M., Mbodj, E. B., & Le
Wismeijer, D., Tawse‐Smith, A., & Payne, A. G. (2013). Multicentre
Guéhennec, L. (2022). Implant‐supported removable partial
prospective evaluation of implant–assisted mandibular bilateral
distal extension removable partial dentures: Patient satisfaction. dentures compared to conventional dentures: A systematic
Clinical Oral Implants Research, 24(1), 20–27. review and meta‐analysis of quality of life, patient
Zancopé, K., Abrão, G. M., Karam, F. K., & Neves, F. D. (2015). Placement satisfaction, and biomechanical complications. Clinical and
of a distal implant to convert a mandibular removable Kennedy class
Experimental Dental Research, 8, 294–312.
I to an implant‐supported partial removable Class III dental
prosthesis: A systematic review. The Journal of Prosthetic Dentistry, https://doi.org/10.1002/cre2.521
113(6), 528–533.