SupplementPages 5, Language: English
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SupplementPages 8-20, Language: English
The tasks of Working Groups 1 to 6 at the 4th Consensus Meeting of the Oral Reconstruction Foundation were to elucidate clinical recommendations for implant-supported full-arch rehabilitations in edentulous patients. Six systematic/ narrative reviews were prepared to address the following subtopics: (1) the influence of medical and geriatric factors on implant survival; (2) the prevalence of peri-implant diseases; (3) the influence of material selection, attachment type, interarch space, and opposing dentition; (4) different interventions for rehabilitation of the edentulous maxilla; (5) different interventions for rehabilitation of the edentulous mandible; and (6) treatment choice and decision-making in elderly patients. Consensus statements, clinical recommendations, and implications for future research were determined based on structured group discussions and plenary session approval.
SupplementPages 21-26, Language: English
Purpose: To provide an overview of the influence of medical and geriatric factors on implant survival in order to form clinical recommendations for the practitioner.
Materials and Methods: This narrative literature review was performed to address the following questions: (1) Is age (> 75 years) a risk factor for implant survival?; (2) Is diabetes mellitus a risk factor for implant survival?; and (3) Is antiresorptive therapy a risk factor for implant survival? The PubMed, Web of Knowledge (Thomson Reuters), and Google Scholar databases were searched for systematic reviews and research papers of evidence level II and above that were published up to February 2019 for each topic.
Results: (1) Age > 75 years does not affect implant survival according to short-term follow up (1 to 5 years). However, polypharmacy should be considered in this patient group. (2) Diabetes mellitus is not a risk factor for implant survival in the short term, but there is no information on appropriate perioperative treatment and wound closure. There is little evidence in the literature on the success of bone grafting and progressive loading protocols in diabetic patients. (3) Implant therapy cannot be recommended in patients under high-dose bisphosphonate and antibody therapy. Bone grafting should be avoided under antiresorptive therapy. There are no treatment regimens available for patients with periimplantitis receiving antiresorptive medication.
Conclusion: This review suggests that the risk assessment for an implant patient should not be based on age, but rather on the patient’s specific risk factors, such as former and current diseases and medication.
SupplementPages 27-45, Language: English
Purpose: To assess the prevalence of peri-implant diseases (ie, peri-implant mucositis and peri-implantitis) in patients rehabilitated with full-arch, implant-supported restorations.
Materials and Methods: A search protocol was developed to answer the following focus question: What is the prevalence of peri-implant diseases in edentulous patients rehabilitated with implant-supported fixed or removable restorations? RCTs, controlled clinical trials, and prospective studies with at least 12 months of follow-up and a minimum of 10 patients having at least one edentulous arch were searched.
Results: A total of 18 studies (3 RCTs, 1 nonrandomized controlled trial, and 14 prospective studies) were included. According to a single study, the prevalence of peri-implant mucositis in fully edentulous patients was 57%, corresponding to 47% at the implant level. The prevalence of peri-implant mucositis among patients having at least one edentulous arch ranged between 0% and 13.7% of patients, and from 0% to 20% of implants. In fully edentulous patients, the prevalence of peri-implantitis was found to range between 1.5% and 29.7% of patients and between 2.1% and 20.3% of the implants, while the corresponding values among the patients with at least one edentulous arch were 0% to 25% and 0% to 7.2%, respectively.
Conclusion: Edentulous patients (fully edentulous or at least one edentulous arch) restored with either fixed or removable restorations were frequently affected by peri-implant disease.
SupplementPages 46-62, Language: English
Purpose: To analyze the influence of material selection, attachment type, interarch space, and opposing dentition on the prosthetic outcomes of fixed and removable implant complete prostheses (FCIPs and RCIPs, respectively).
Materials and Methods: This review was designed as an overview of systematic reviews. An electronic database search was performed to identify scientific literature that reported on FCIPs and RCIPs. The last search was performed in January 2020. The final inclusion of systematic reviews for data extraction was decided by consensus of the authors. The included studies were analyzed qualitatively.
Results: A total of 21 systematic reviews (FCIP: n = 11, RCIP: n = 10) out of 5,733 articles initially identified were included for data extraction and interpretation. High overall 5-year and 10-year prosthesis survival rates were shown for FCIPs and RCIPs (93.3% to 100% and 96.9% to 100%, respectively). Chipping/fracture of the veneering material was the most frequent technical complication for FCIPs, and attachment-related complications were the main technical problems for RCIPs. For FCIPs, the effect of prosthetic material was not significant on the technical complications nor the survival rates. No studies were identified that provided direct information on the effect of interarch space in FCIPs and RCIPs.
Conclusions: Both FCIPs and RCIPs obtained high overall survival rates, but technical complications cannot be avoided with either prosthesis type. No prosthetic material can be considered as the material of choice over another. Attachment type has no influence on the overall clinical outcomes of RCIPs. The influence of opposing dentition and the required prosthetic space were not investigated sufficiently.
SupplementPages 63-84, Language: English
Purpose: To synthesize evidence derived from systematic reviews (SRs) on different interventions for rehabilitation of the edentulous maxilla with implant-supported restorations.
Materials and Methods: A protocol-oriented search was established to address the PICO question: What is the current evidence regarding rehabilitation of the edentulous maxilla with different implant-supported prostheses in terms of implant and prosthesis survival? The primary outcomes were implant and prosthesis survival rates evaluated from SRs of clinical studies including adult patients with complete edentulism of the maxilla and comparing different implant-supported rehabilitation strategies. Methodologic quality of the SRs was assessed with the AMSTAR-2 tool.
Results: The final selection process led to the inclusion of 36 SRs that were grouped as: (1) addressing maxillae with sufficient bone to place implants; (2) addressing maxillae with insufficient bone to place implants; and (3) comparing different types of prosthesis, number of implants, patient-reported outcomes, and economic evaluations. The literature describes four or more implants as suitable for full-arch fixed prostheses and implant-supported overdentures; in both cases, the overall survival rate is > 95%. Miniimplants present very high short-term failure rates (> 30%). Poor description of technical complications, adjustments, and maintenance and corresponding costs precluded a cost-effectiveness analysis.
Conclusion: No implant-supported rehabilitation of the edentulous maxilla (fixed or removable) should be supported on fewer than four implants. A one-piece full-arch fixed dental prosthesis can be supported by a minimum of two anterior axial plus two posterior distally tilted implants or by six to eight axial implants symmetrically distributed through the posterior and anterior regions of the arch. Four to six implants is the advised number to support an overdenture. The use of mini-implants in the maxilla is inadvisable.
SupplementPages 85-92, Language: English
Purpose: To evaluate the current literature and provide clinical recommendations related to the number of implants, implant characteristics, loading protocols, survival rates, biologic and mechanical complications, patient satisfaction, and financial considerations for mandibular implant-supported full-arch prostheses.
Materials and Methods: A PubMed/MEDLINE search for literature published between January 1, 1980 and February 8, 2019, was performed for systematic reviews on this topic. The PICO question was: In mandibular fully edentulous patients treated with implant full-arch prostheses, is there any difference between fixed and removable implant prostheses in terms of implant and prosthesis survival rates? Only systematic reviews with or without meta-analyses were included. The findings varied based on the type of implant full-arch prosthesis.
Results: High survival rates for implants and prostheses have been reported for fixed and removable implant full-arch prostheses in the mandible. Immediate loading procedures present with high survival rates for both fixed and removable prostheses. There are differences in the number of implants, implant characteristics, complications, and financial implications between these two types of prostheses, which clinicians need to account for as part of the treatment planning process.
Conclusion: Implant-supported overdentures and implant-supported fixed complete dentures represent clinically successful treatment approaches. In cases where both treatment options are indicated, patient expectations and cost should be the determining factors for selecting a treatment modality.
SupplementPages 93-101, Language: English
Purpose: To review and analyze the literature regarding removable vs fixed implant prosthetic treatment for complete edentulism in elderly people.
Materials and Methods: A narrative review of published articles was conducted. Electronic and manual searches were performed to identify studies comparing removable vs fixed implant modalities for edentulous patients and/or reporting on specific outcomes for fixed vs removable implant restorations in elderly patients.
Results: It is evident that there are differences in mechanical and biologic maintenance needs due to differences in prosthetic materials and designs for fixed vs removable implant restorations. Anatomical restrictions, age-related problems, lifestyle, cost, maintenance needs, access to dental services, and past experience (both of the provider and the patient) all play a role in prosthesis selection for these patients. Patient expectations and their financial means will define their choices. Patientreported outcome measures are not standardized, and any assumptions made based on different studies need to be carefully evaluated.
Conclusion: The decision-making pathway for determining what type of implant-supported prosthesis is preferable for edentulous patients is complicated by many variables that must be considered when treatment planning for maximum benefit for the patient. Detailed explanations of potential outcomes, complications, difficulties, and benefits of therapeutic options is mandatory. Proper assessment of patients’ expectations and desires before treatment is critical for a successful outcome.