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Knowledge of the risk factors for implant osseointegration is essential for clinical decision-making and optimizing treatment success. This clinical report presents a rare case of implant failure in a patient who received intravitreal injections of a vascular endothelial growth factor (VEGF) inhibitor for the treatment of age-related macular degeneration. Following CARE guidelines, the report presents a case rehabilitated with a mandibular 2-implant overdenture using the immediate-loading protocol and standard procedures. The implants failed within six weeks of immediate loading although primary stability (≥50 Ncm) was achieved during surgery and clinical follow-ups did not show any deviance from standard implant care or patient-related complications. Further investigation suggested that the intake of a VEGF inhibitor may be the cause of failure. This clinical report highlights the importance of systemic risk factors in implant success and their consideration during planning for implant-assisted treatment.

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OBJECTIVES: To examine the impact of adding a third midline implant with stud attachment to a mandibular two-implant overdenture on patient-oriented outcomes. METHODS: In this pre-post design clinical trial, following the standard procedures, mandibular two-implant overdentures of 17 edentulous individuals (61.9 ± 6.6 years) were converted to three-implant overdentures by adding a stud attachment to an unloaded midline implant. Patient-oriented outcomes included patient expectations and satisfaction with implant overdenture as well as willingness to pay the cost of conversion. Data were collected at baseline and at the 6-week follow-up using visual analog and binary scales as well as open-ended questions. Statistical analysis included descriptive statistics, Spearman's correlation, Fisher exact test, Mann-Whitney U test, and the exact sign test. RESULTS: After connecting the third midline implant to the mandibular two-implant overdenture, there was a statistically significant decrease in the anteroposterior movement (p = 0.005) as evaluated by clinicians. Moreover, study participants reported an increase in perceived stability of the overdenture (95% CI; 0.68-1.00, p = 0.002) and in their ability to speak (95% CI; 0.63-1.00, p = 0.008). The addition of a third implant met the expectations of 94% of patients in regard to lower denture stability, 100% for retention, and 82.4% for comfort. The mandibular three-implant overdenture increased patient general satisfaction over a short period of time, but this improvement was not statistically significant. About 80% of patients would recommend this type of prosthesis to their peers but only 47% of them would agree to pay a large increase in the cost of treatment compared to a two-implant overdenture. CONCLUSIONS: The addition of a midline third implant to an existing mandibular two-implant overdenture resulted in several improved patient-reported outcomes.

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OBJECTIVE: To provide 2-year clinical- and patient-oriented data with regard to mandibular overdenture assisted by 2 immediately loaded unsplinted implants. MATERIAL AND METHODS: In this pre-post design, Phase-I clinical trial, 18 edentate individuals (62.4±7.7years) received a new set of complete denture. Then, following standard procedures, 3 threaded implants (OsseoSpeed TX™, Dentsply Implants, Mölndal, Sweden) were placed in the mandible in each patient, and locator abutments (Zest Anchors LLC, Escondido, U.S.A.) were inserted on the right and left side implants. The midline implant served as a control for within-patient comparison. The immediate loading was conducted within 24h of surgery. Data were collected at baseline (T0), 12 (T1) and 24 (T2) months after immediate loading. The clinical outcomes included implant survival rate, crestal bone level changes and implant stability. These criteria were assessed through clinical and radiographic examinations as well as resonance frequency analysis. Patient-centered outcomes included patient satisfaction and oral health-related quality of life measured using validated questionnaires. Brunner-Langer approach was used for statistical analysis. RESULTS: Implant survival rate for immediate loaded implants was 91.7% at 2-year follow-up. None of the unloaded implants failed. There was no statistically significant difference at baseline and follow-ups with regard to clinical outcomes between loaded and unloaded implants. Patient satisfaction and quality of life improved (p<0.0001) from baseline to 2-year follow-up. CONCLUSION: Immediate loading protocol did not negatively affect clinical outcomes, satisfaction and quality of life of patients wearing 2-unsplinted-implant mandibular overdenture for 2 years. This conclusion requires confirmation by randomized control trials. CLINICAL SIGNIFICANCE STATEMENT: Mandibular overdenture assisted by two immediately-loaded unsplinted implants is successful treatment based on 2-year clinical and patient-based outcomes.

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OBJECTIVES: To examine patients' expectations, the level of satisfaction, and the oral health-related quality of life (OHRQoL) with regard to the implants' immediate loading protocol (ILP) in edentate individuals. METHODS: This pilot trial used a pre-post design to assess patient-centered outcomes in 18 edentate individuals (mean age 62.4 ± 7.7 years) who have received a 2-implant (unsplinted) mandibular overdenture through an ILP. Visual analog scales, the McGill denture satisfaction questionnaire, and the oral health impact profile (OHIP-20) questionnaire were used to evaluate patients' expectations, satisfaction, and OHRQoL at baseline, 2 weeks, 1 month, and 4 months after surgery. Personality trait and socio-demographic information were obtained using the revised NEO personality inventory and a self-administered questionnaire, respectively. Non-parametric methods and Brunner-Langer approach were used to analyze the data. RESULTS: The participants had a wide range of expectations regarding the ILP. Expectations included short-term positive impact on aesthetics (83.3%) and social life (55.7%), as well as negative effects on comfort (5.6%), the ability to chew (11.1%), and the ability to clean the lower denture (11.1%). The ILP satisfied 94.4% of the participants, regardless of socio-demographic and personality profiles. There was a statistically significant improvement in overall satisfaction, comfort, perceived aesthetics, stability of the overdenture, and ability to chew from baseline to 2-week, 1-, and 4-month follow-up (P < 0.001). There was 100% agreement among patients on recommending this procedure to others. There was a statistically significant decrease in the total OHIP scores and all its domains (P < 0.001) from baseline to 2 weeks. These differences remained statistically significant at 4-month follow-up. The ILP improved patients' OHRQoL, regardless of the implant loss, the socio-demographic characteristics, and personality traits. CONCLUSIONS: The ILP of two unsplinted implants with a mandibular overdenture significantly improved satisfaction and short-term OHRQoL, and appears to meet expectations in edentulous elders. There was 100% agreement among patients on recommending this procedure to others.

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