Implant Mandibular Overdentures Retained by Immediately Loaded Implants: A 1-Year Randomized Trial Comparing Patient-Based Outcomes Between Mini Dental Implants and Standard-Sized Implants.

PURPOSE: The aim of this 1-year randomized trial was to determine the stability and the magnitude of the effect of converting patients' conventional mandibular dentures to implant overdentures (IODs) on their satisfaction and oral health-related quality of life (OHRQoL). The IODs were retained either with two immediately loaded interconnected standard-diameter implants or with four immediately loaded mini dental implants (MDIs). MATERIALS AND METHODS: Fifty completely edentulous subjects complaining about insufficient retention of their mandibular dentures were randomly assigned to two groups; 25 patients received IODs retained with four MDIs and 25 patients received IODs retained with two standard-sized tissue level (STL) interconnected implants. All IODs were opposed by conventional maxillary dentures. Patients rated their satisfaction on a 100-mm visual analog scale (VAS) and their quality of life on a denture-specific short version of the oral health impact profile (OHIP-20) before assignment, and after 3 and 12 months. A two-way mixed analysis of variance (ANOVA) was conducted to assess the change in time and its interaction with treatment mode on patients' overall satisfaction ratings, the total OHIP-20, and their specific domain scores. RESULTS: Immediate loading was possible for all the patients who received the MDIs. By contrast, the immediate loading protocol could be followed for only 15 of the patients allocated to the STL implant group. For the remaining patients, a delayed loading protocol was applied. There was a significant improvement in patients' general satisfaction between baseline and 3 months and between baseline and 12 months postoperatively (F2,44 = 81.006, P < .001). This increase did not differ between the treatment groups (F4,90 = 1.838, P = .128). The results also showed a decrease in mean overall OHIP score (F2,43 = 46.863, P < .001) between baseline and 3 months and between baseline and 12 months postoperatively, indicating a higher level of OHRQoL. In addition, patients scored lower 3 and 12 months after treatment than at baseline for all seven domains. This decrease did not differ between the treatment groups (F4,88 = 0.608, P = .658). CONCLUSION: The results suggested that in terms of patient-based outcomes, mandibular overdentures retained by immediately loaded MDIs can offer an improvement of equal magnitude with that achieved by overdentures retained by standard-sized implants.

Implant Mandibular Overdentures Retained by Immediately Loaded Implants: A 1-Year Randomized Trial Comparing the Clinical and Radiographic Outcomes Between Mini Dental Implants and Standard-Sized Implants.

PURPOSE: The aim of this 1-year randomized trial was to evaluate and compare the clinical and radiographic performance of four immediately loaded mini dental implants (MDIs) and two immediately loaded standard-sized tissue-level (STL) implants, placed in the interforaminal region of the mandible and used to retain mandibular overdentures (IODs) in completely edentulous patients. MATERIALS AND METHODS: A total of 50 completely edentulous patients wearing conventional maxillary dentures and complaining about insufficient retention of their mandibular dentures were divided into two groups; 25 patients received four MDIs and 25 patients received two STL implants. The marginal bone loss (MBL) at the mesial and distal sides of each implant was assessed by means of standardized intraoral radiographs after a period of 1 year. Implant success and survival rates were also calculated. RESULTS: Immediate loading was possible for all patients in the first group. In the second group, an immediate loading protocol could not be applied for 10 patients. These patients were treated with a delayed loading protocol. A mean MBL of 0.42 ± 0.56 mm for the MDIs and 0.54 ± 0.49 mm for the immediately loaded STL implants was recorded at the end of the evaluation period. There was no statistically significant difference between the MDIs and the immediately loaded STL implants. Two MDIs failed, resulting in a survival rate of 98%. The success rate was 91%. For the immediately loaded conventional implants, the survival rate was 100% and the success rate 96.7% after 1 year of function. However, in 10 patients, the immediate loading protocol could not be followed. CONCLUSION: Considering the limitations of this short-term clinical study, immediate loading of four unsplinted MDIs or two splinted STL implants to retain mandibular overdentures seems to be a feasible treatment option. The marginal bone level changes around the MDIs were well within the clinically acceptable range.

A Systematic Review on Immediate Loading of Implants Used to Support Overdentures Opposed by Conventional Prostheses: Factors That Might Influence Clinical Outcomes.

PURPOSE: Different treatment protocols in terms of number, diameter, and suprastructure design have been proposed for immediately loaded implants that are used to support mandibular overdentures opposed by maxillary conventional dentures. The aim of this study was to investigate the influence of these protocols on survival rates as well as clinical and prosthodontic outcomes. MATERIALS AND METHODS: Several electronic databases were searched for all relevant articles published from 1966 to June 2014. Only randomized controlled trials and prospective studies with a minimum follow-up of 12 months were selected. The primary outcomes of interest were the success and survival rates of the implants. Prosthodontic complications were also evaluated. RESULTS: Fourteen studies fulfilled the inclusion criteria. Of the studies identified, nine were randomized controlled trials and five were prospective studies. The mean follow-up period was 3 years or less for the vast majority of the studies. The reported survival and success rates were comparable to that of conventional loading for most of the included studies. No specific immediate loading protocol seemed to perform better in terms of clinical and prosthodontic outcomes. CONCLUSION: Immediate loading protocols of mandibular overdentures seem to be a viable alternative to conventional loading. It was not possible to recommend a specific treatment protocol related to the number, diameter of the implants, and attachment system used. Long-term, well-designed studies comparing different immediate loading modalities could help to establish a protocol that delivers the most clinically predictable, efficient, and cost-effective outcome for edentulous patients in need of implant overdentures.

Histopathology of ameloblastoma of the jaws; some critical observations based on a 40 years single institution experience

The aim of the present study is to examine all cases of intraosseous benign ameloblastomas treated between 1970and 2010 in a single institution and to look for a possible correlation between the histopathological aspects and the demographical and clinical parameters, as well as the treatment outcome. The data of a total number of 44patients were retrieved from the records. Nine patients were excluded because of doubt about the correct diagnosis(8 patients) or because of an extra-osseous presentation (1 patient).No statistically significant differences were found between the histopathological (sub)types of ameloblastomas and the demographical and clinical parameters, nor between the histopathological (sub)types and treatment outcome. Of the 28 patients treated by enucleation, in 17 patients one or more recurrences occurred, with no significant predilection for any histopathological (sub)type, including the unicystic type. There were no significant differences in the recurrence rate after enucleation in patients below and above the age of 20 years either. In six out of 17patients with a recurrence, the recurrent lesion showed a different histopathological subtype than was encountered in the primary. In two cases a change from solid/multicystic to desmoplastic ameloblastomas was noticed. In conclusion, the current histopathological classification of benign intraosseous ameloblastoma does not seem to have clinical relevance with the possible exception of the luminal unicystic ameloblastoma that has been removed into to, unfragmented. Since no primary desmoplastic ameloblastomas were encountered in the present study nofurther comments can be made on this apparently rare entity (AU)