M_Quirynen Overdenture in lower jaw

Catholic University Leuven,

Department of Periodontology,

U.Z. St Raphael, Capucijnenvoer 7,

B-3000 Leuven, Belgium.

marc.quirynen@med.kuleuven.ac.be

M. Quirynen

LeuvenBrussels

Overdenture in lower law.

Outcome, surgery, maintenance?

long-term outcome implants supporting OD lower jaw,

comparison (patient centred outcome): conventional denture vs. OD,

comparison (patient centred outcome): OD vs. fixed full prosthesis,

surgical aspects and how to avoid risks,

Overdentures

insufficient retention lower denture

Retrospective study: KULeuven: all overdentures lower jaw:

- inclusion criteria: impl at least 4y in function,

- n = 495 patients (mean age at insertion 61y), 1051 impl

- 2-stage, turned impl (Brånemark),

- 86% bar, 12% ball, 2% magnets,

- 248 patients seen during last 3 years, 121 contacted by phone

- 126 patients (latest info)

- loading time (range: > 4 up to > 25 years)

Kaplan Meier analysis

Overdenture in lower jaw: implant survival

M. Vercruysen, K. Mercelis, W. Coucke, I. Naert, & M. Quirynen (submitted)

CSR 23 y: 95.7%

0 50 100 150 200 250 300

0.9

00

.92

0.9

40

.96

0.9

81

.00

Time (months)

Pro

ba

bil

ity im

pla

nt

pre

se

nt

SURVIVAL

Overdenture in lower jaw: implant survival

M. Vercruysen, K. Mercelis, W. Coucke, I. Naert, & M. Quirynen (submitted)

25 y

FAQ: what is impact smoking, implant length,

bone quality, 1-stage vs. 2-stage

CSR 23 y: 96.6%

0 50 100 150 200 250

0.8

50

.90

0.9

51

.00

Time (months)

Pro

ba

bil

ity im

pla

nt

pre

se

nt

SURVIVAL vs. smoking

non

≤ 10

> 10

+

Overdenture in lower jaw: implant survival

M. Vercruysen, K. Mercelis, W. Coucke, I. Naert, & M. Quirynen (submitted)

CSR 20 y: 90.5%

non

≤ 10

> 10

p = 0,008

No significant

difference

CSR 12 y: 100%

Overdenture in lower jaw: implant survival

M. Vercruysen, K. Mercelis, W. Coucke, I. Naert, & M. Quirynen (submitted)

0 50 100 150 200 250

0.9

00

.92

0.9

40

.96

0.9

81.0

0

Time (months)

Pro

ba

bil

ity im

pla

nt

pre

se

nt

SURVIVAL vs. implant length

≤ 8

> 8

impl ins ‟97, rx „05

p = 0,27

0 50 100 150 200 250

0.9

00

.92

0.9

40

.96

0.9

81

.00

1

2

3

4

Time (months)

Pro

ba

bil

ity i

mp

lan

t p

res

en

t (p

erc

en

tag

es

)

p = 0,85

Overdenture in lower jaw: implant survival

M. Vercruysen, K. Mercelis, W. Coucke, I. Naert, & M. Quirynen (submitted)

Overdenture in lower jaw: implant survival

0 50 100 150 200 250

0.8

00

.85

0.9

00

.95

1.0

0

2-stage

1-stage

Time (months)

Pro

ba

bil

ity im

pla

nt

pre

se

nt

(pe

rce

nta

ge

s)

p < 0,001

CSR 10 y: 83%

Early failures

M. Vercruysen, K. Mercelis, W. Coucke, I. Naert, & M. Quirynen (submitted)

machined implant surfaceA: what is impact

smoking: ,

implant length: =,

bone quality =,

1-stage vs. 2-stage: but

Overdenture in lower jaw: implant success

“Susceptible” host Pathogenic species < Beneficial species

Immune reactioninefficient/genetics

Smoking

Diabetes

Medication

Stress

Viral infections?

Maintenance

“Susceptible” host Pathogenic species < Beneficial species

Immune reactioninefficient/genetics

Smoking

Diabetes

Medication

Stress

A. actinomycetem-

comitans

P. gingivalis

T. forsythensis

Spirochetes

etc...

Actinomyces sp.

S. mitis

S. sanguis

Viral infections?

environment: OH, diet, .....

Maintenance

macrophages ingesting

Candida albicans

neutrophil function juvenile / aggressive periodontitis

= high risk factor for

periodontitis / peri-implantitis

Maintenance

before / after full-mouth tooth extraction

Danser et al. 1994,

“teeth” = primary reservoir periopathogens!

full edentulous patient: less at risk

# + P “Detection frequency” : # intra-oral niches

Full extraction Pocket Mucosa Tongue Saliva Tonsils

A.a. 2/8 2 / - 2 / 0 2 / 0 2 / 0 2 / 0

P.g. 6/8 6 / - 2 / 0 4 / 0 4 / 0 3 / 0

P.i. 8/8 8 / - 4 / 1 6 / 3 6 / 4 5 / 3

Maintenance

-1.0 -0.5 0.0

Fre

qu

en

cy

(perc

en

tage

)

Mean value:

0.07 mm

(SD:0.14)N=892

ANNUAL CHANGE BONE LEVEL: Y 1- 5

Change in marginal bone level (mm)

7.3%

-1.0 -0.8 -0.6 -0.4 -0.2 0.0 0.2

Fre

qu

en

cy (

perc

enta

ge)

Mean value:

0.06 mm

(SD:0.12)N=598

ANNUAL CHANGE BONE LEVEL: Y 1- 8

Change in marginal bone level (mm)

3%

Probing depth %

1 mm 7.5

2 mm 35.6

3 mm 43.2

4 mm 8.4

5 mm 4.1

6 mm 0.8

>6 mm 0.4

≥ 6 mm: < 1.2 %.

5 mm: 4.1 %.

Maintenance

after 6 years of loading

Overdenture in lower jaw: retention

bar

ballmagnets

Bar (n = 7)

Magnet (n = 6)

Ball (n = 8)

How do you find your LP in general? 8.2 7.5 8.0

How well does your LP remain in place? 8.1 7.3 8.6

How well can you eat with your LP? 8.3 7.2 8.4

How well can you talk with your LP? 8.2 8.1 8.4

How do you find appearance of your LP? 8.1 8.2 8.0

patient satisfaction over 10 y of function: RCT

questions on scale 0 (very bad) – 10 (very good)

Overdenture in lower jaw: retention

I. Naert, G. Alsaadi, D. van Steenberghe & M. Quirynen (2004) Int. J. Oral & Maxillofac. Implants: 695-702

I. Naert, G. Alsaadi & M. Quirynen (2004) Int. J. Prosthodont.: 401-410

conventional denture (CD) vs. implant retained overdent. (IOD):

systematic review including 18 RCTs:

CD significantly inferior to IOD:

- functional ability (chewing, speaking)

- aesthetics,

- self-confidence,

- general satisfaction

- quality of life (psychological functioning)

- diet, general health ?

Overdenture in lower jaw: benefits

J. Thomason, G. Heydecke, J. Feine, J. Ellis (2007) Clin. Oral Impl. Res.: 168-188

= superior

vs.OD = golden standard

for edentulous lower jaw

implant retained overdenture: short-bar 2 impl vs. “long-bar” 4 impl

RCTs:

short bar same outcome as long bar

implant as well as patient related

indications for long bar:

- short implants ??

- soreness of gingiva

- need for total relief (mental foramen)

- V shaped mandible

Overdenture in lower jaw: benefits

G. Stoker, D. Wismeijer & M. van Waas (2007) J. Dent. Res.: 276-280.

A. Visser, G. Raghoebar, H. Meijer, R. Batenburg, A. Vissink (2004) Clin. Oral Impl. Res.: 19-25.

vs.are =

?

V

long-bar impl. supp. OD (lbOD) vs. fixed full dental prosth. (FFP)

within subject (n=15), cross-over comparison:

- no major difference in general satisfaction

- same chewing efficiency,

- FFdP: significantly superior in chewing hard food,

- lbOD: easier to clean,

- end trial: 7 choose lbOD (ease of cleaning)

8 choose FFdP (< 5 y edentulous)

Overdenture in lower jaw: benefits

P. de Grandmont, J. Feine, R. taché, P. Boudruas, W. Donohue, R. Tanguay, J. Lund (1994) J. Dent. Res.: 1096-1104

J. Feine, P. de Grandmont, P. Boudrias, N. Brien, C. LaMarche, R. Tache & J. Lund (1994) J. Dent. Res.: 1105-1111

vs.=

-Evaluation available bone (height & width)

palpation = reliability ?

- Location mandibular canal, mental foramen

from canine to 1st molar

- Presence of bone pathologies

Overdenture in lower jaw

the sublingual fossa

distinct osseous depression (I2 - P1),

superior to mylohyoid muscle, sublingual gland

lingual concavity: > 6 ± 2 mm, 3% jaws

Quirynen et al. (2003), Clin Oral Impl Res 280-285

the lingual foramina (accessory)

cervical fascia:

- superficial layer,

- of infrahyoid muscles

- pretracheal layer

Thanks

H e l p p p p

Overdenture in lower jaw: risks

C. Kalpidis & R. Setayesh (2004) J. Periodontol.: 631-645

precautions:

- dissect / explore bone lingually,

- pre-operative cone beam / CT

- never blind surgery without proper RX