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OBJECTIVE: To investigate the occurrence of mild cognitive impairment in edentulous patients up to 3 years after they received single-implant overdentures (1-IODs). METHODS: This was a follow-up study for a crossover randomized controlled trial comparing 1-IODs and conventional complete dentures, with patient satisfaction as the primary outcome. In the present study, the cognitive function of the patients, measured with the Japanese version of the Montreal cognitive assessment (MoCA-J), was evaluated as the secondary outcome at baseline and 2 months, 1 year, 2 years, and 3 years after 1-IOD placement. The total and domain (memory, executive function, visuospatial skills, language, attention, and orientation) MoCA-J scores of the patients at each timepoint were analyzed and compared. RESULTS: Twenty-two patients with edentulous mandibles received 1-IODs. Within-group comparisons revealed that the total MoCA-J scores at 1 year and 3 years after 1-IOD placement were significantly increased compared with baseline scores. Additionally, the memory domain scores at all timepoint were significantly increased compared with the baseline scores, and the executive function domain scores at the 2-month, 2-year and 3-year timepoint were significantly increased compared with the baseline scores. CONCLUSION: Patients with edentulous mandibles who underwent 1-IOD placement showed significantly improved total scores of MoCA-J after 1 year and 3 years of wearing 1-IODs. In addition, they showed significantly improved memory domain scores at 2 months, 1 year, 2 years, and 3 years after 1-IOD placement and executive function domain scores at 2 months, 2 years, and 3 years after 1-IOD placement. CLINICAL SIGNIFICANCE: The results of this study suggest that 1-IOD treatment for older adults, especially those with edentulous mandibles, may prevent cognitive decline regardless of the condition of the maxilla.

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Background/purpose: Implant assisted removable partial dentures (IARPDs) improved biomechanical behavior of removable partial dentures (RPDs), but information of the effect of attachment type and implant position is limited. This study aimed to investigate the effect of implant position and attachment type on the stress distribution of IARPDs. Material and methods: Four implants, 10 mm in length and 4.1 mm in diameter, were bilaterally placed close to first premolar and second molar regions of a mandibular Kennedy class I model having artificial dentition from canine to canine, vertical to the occlusal plane. Five IARPDs were fabricated to accommodate locator and magnetic attachments. Strain gauges were placed on the model surface to measure the strain around implants during loading. Unilateral vertical loading was applied to the right first molar area with magnitude of 120 N and crosshead speed of 10 mm/min. Measurements were recorded under following conditions: premolar IARPDs with locator or magnetic attachments, molar IARPDs with locator or magnetic attachments. Two-way multiple analysis of variance was performed to compare the maximum principal strain (MPS) around the implants with a significance level of 0.05. Results: Implant position had significant effect on the MPS of IARPD on loading and nonloading sides while attachment type only significant on nonloading side. Molar implants showed larger MPS than premolar implants with both locator and magnetic attachments during unilateral loading. Conclusion: The stress distribution of the IARPD is significantly affected by implant position wherein anteriorly placed implants exhibit lower MPS than relatively posteriorly placed implants.

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OBJECTIVES: This prospective study aimed to compare the oral functions of removable partial dentures (RPDs) with those of implant-assisted removable partial dentures (IARPDs) with short implants and magnetic attachments in patients with mandibular Kennedy class I and II. MATERIAL AND METHODS: Thirty participants with mandibular Kennedy class I or II and at least three distal missing teeth were recruited. Oral functions, including mixing ability, comminuting ability, maximum bite force, and occlusal contact area, were assessed for RPDs (stage 0), IARPDs with healing caps (stage 1), and IARPDs with magnetic attachments (stage 2). The implants were loaded with occlusal force in stages 1 and 2. Finally, the data of the 27 participants who completed the evaluation at stage 2 were analyzed. The Wilcoxon signed-rank test with Bonferroni correction was used to assess the differences in the oral functions among the different stages. RESULTS: The implant survival rate was 93.8%. There were significant differences in the comminuting ability and occlusal contact area between stages 0 and 2 (p < .001 and p = .036, respectively) and stages 1 and 2 (p = .003 and p = .015, respectively). Regarding the maximum bite force, there was a significant difference between stages 1 and 2 (p = .018). However, there was no significant difference in the mixing ability between the three stages. CONCLUSIONS: Within the limitations of this study, it was concluded that IARPDs in the mandible with short implants and magnetic attachments may improve oral functions.

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BACKGROUND/PURPOSE: Few studies have comprehensively assessed long-term patient-reported outcomes for overdentures supported by two immediate implants. The purpose of the study was to evaluate patient-reported outcomes of immediately loaded two-implant-supported overdentures retained by ball attachments over a 5-year evaluation period. MATERIAL AND METHODS: Nineteen participants with edentulous mandibles were provided with immediately loaded two-unsplinted-implant-supported overdentures retained by ball attachments. The participants completed the Japanese version of the Oral Health Impact Profile (OHIP)-EDENT-19 and the Patient's Denture Assessment (PDA). Additionally, patient satisfaction was measured by a 100-mm visual analog scale (VAS). Measurements were performed at baseline, and at 1 and 5 years following implant surgery. RESULTS: Seventeen participants and 14 participants were evaluated at the 1-year and 5-year assessment, respectively. Considering the OHIP-EDENT-19, there was a significant decrease in the total (p = 0.046), "functional limitation" (p = 0.021), and "physical disability" (p = 0.034) scores at 1 year and the total (p = 0.045) and "physical disability" (p = 0.024) scores at 5 years following surgery, compared to the baseline scores. Considering the PDA, there was a significant increase in the "function" (p = 0.038) and "lower denture" (p = 0.003) scores at 1 year and the "function" (p = 0.032), "lower denture" (p = 0.008), and "esthetic and speech" (p = 0.043) scores at 5 years following surgery, compared to the baseline scores. Patient satisfaction at 1 year following surgery was significantly greater than that at baseline (p = 0.005). CONCLUSION: Immediately loaded two-unsplinted-implant-supported overdentures retained by ball attachments improved the oral health-related quality of life and self-assessment of dentures by the patients up to 5 years following implant surgery.

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Objective Patient satisfaction with single-implant overdentures (1-IODs) is unclear. This randomized crossover trial aimed to compare the general satisfaction, oral health-related quality of life, and patients' self-assessment between mandibular 1-IODs and experimental removable complete dentures (eRCDs). Methods New mandibular RCDs were fabricated for 22 patients with edentulous mandibles. After adapting to the RCDs, one implant was inserted in the mandibular midline. The participants were then randomly classified into groups 1 and 2. Group 1 received IODs for the first 2 months, while group 2 used eRCDs with a non-loaded implant in the midline. After 2 months, the treatment was switched. Four validated, patient-reported dental outcome measures were assessed: general satisfaction, Japanese version of the Oral Health Impact Profile for edentulous subjects (OHIP EDENT-J), General Oral Health Assessment Index (GOHAI), and Patient's Denture Assessment (PDA). The assessments were performed at the end of the IOD- and eRCD- use periods. Results General satisfaction was significantly higher during the IOD period (p = 0.002). Significant differences were observed in all domains of the OHIP, except orofacial pain (p = 0.084). Further, the total score (p<0.001) and the scores of the physical (p<0.001) and psychosocial functioning (p = 0.001) domains of the GOHAI differed significantly. The total PDA score (p = 0.001) and the scores of the function (p = 0.004), lower denture (p = 0.002), esthetics and speech (p = 0.026), and importance (p = 0.009) domains were significantly higher during the IOD period than during the eRCD period. Conclusion General satisfaction, oral health-related quality of life, and patient self-assessment scores were significantly higher for 1-IODs than for eRCDs. Clinical significance Within the limitations of this study, we found that mandibular single-implant overdentures may be an efficient alternative to mandibular experimental removable complete dentures due to higher general satisfaction, oral health-related quality of life, and patient self-assessment scores of dentures.

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Purpose Implant-assisted removable partial dentures (IARPDs) with short implants improve the oral functions of removable partial dentures (RPDs). This study aimed to compare the patient-reported outcomes of RPDs and IARPDs with short implants retained by magnetic attachments.Methods We recruited 30 participants with mandibular Kennedy Class I or II and distal extension defects of three or more teeth. RPDs, IARPDs with a healing cap, and IARPDs with a magnetic attachment were evaluated across stages using patient-reported outcomes. All participants completed questionnaires (oral health-related quality of life [OHRQoL], patient general satisfaction, and patient's denture assessment [PDA]) at each stage. The OHRQoL was evaluated using the Oral Health Impact Profile-J 54 (OHIP-J 54) score. The general patient satisfaction was evaluated using a 100 mm visual analog scale. The Wilcoxon signed-rank test and Bonferroni correction were used to evaluate differences between the groups (α=0.05).Results The OHRQoL of IARPDs was significantly higher than that of RPDs. IARPDs with a magnetic attachment had significantly better patient general satisfaction and PDA than IARPDs with a healing cap.Conclusions The OHRQoL, patient general satisfaction, and PDA were improved by IARPD with a short implant using a magnetic attachment.

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BACKGROUND: The appropriate loading protocol to improve masticatory performance (MP) is still unclear in elderly patients and two-implant overdentures (2-IODs) wearers. This study aimed to compare the long-term MP and maximum occlusal force of immediate loading (IL) and conventional loading (CL) of 2-IODs retained by magnetic attachments. Nineteen edentulous patients were randomly assigned to either an IL (n=10) or CL group (n = 9). In the IL group, the implant was loaded on the same day as insertion, whereas it was loaded 3 months after insertion in the CL group. Magnetic attachments were used to retain all overdentures to the implants. MP, measured by a piece of color-changeable chewing gum and a gummy jelly test, and maximum occlusal force, measured using an occlusal force measuring device, were assessed in both groups at baseline and at 3-, 4-, and 5-year follow-ups. RESULTS: No significant differences were observed in the MP and the maximum occlusal force between the IL and CL groups at any time point. However, a significantly higher MP was observed at the 3-year time point in the IL group (P = 0.036). The maximum occlusal force revealed a significant correlation with MP, both with the color-changeable chewing gum and gummy jelly at 5 years. CONCLUSION: After long-term observation, no significant differences in MP and maximum occlusal force were observed between the IL and CL groups. However, compared to pre-implant insertion of the complete denture, the MP in the IL group significantly improved at 3 years. Furthermore, the maximum occlusal force was significantly correlated with MP at 5 years. TRIAL REGISTRATION: UMIN, UMIN000009889 . Registered on 28 January 2013.

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Purpose The aim of this study was to evaluate patients' economic preferences for two different tooth replacement strategies for the edentulous mandible namely conventional complete dentures (CCDs) and implant overdentures supported by two implants (IODs), using a willingness-to-pay (WTP) analysis.Methods Twenty-six elderly patients who had been rehabilitated with either a mandibular CCD or IOD were invited to participate in this study. All participants were provided with the details of the two treatment protocols, including advantages, disadvantages, and treatment costs. The patients were then asked to indicate their maximum WTP values for each protocol using a payment card method for contingency evaluation.Results Fifteen patients with mandibular CCD (CCD-Group) and 12 patients with IOD (IOD-Group) participated in the study. Overall, the median and maximum WTP values recorded for IOD therapy were significantly higher than those for CCD therapy (p<0.05). Both treatment groups recorded maximum WTP values for CCD therapy, which exceeded the market cost (¥30,000 [US$280]), CCD-Group: ¥50,000 (interquartile range [IQR]: 40,000 - 65,000), and IOD-Group: ¥45,000 (IQR: 30,000-85,000)]. However, both groups registered a median and maximum WTP values for IOD therapy lower than the market cost (¥780,000 [US$7,300]), (CCD-Group: ¥500,000 [IQR: 300,000 - 750,000], IOD-Group: ¥700,000 [IQR: 500,000-800,000]).Conclusion The maximum WTP values recorded for IOD therapy were significantly higher than CCD therapy in both treatment groups. While patients were willing to pay more than the current market costs for CCDs, they were not willing to meet the market value for IODs.

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PURPOSE: To treat mandibular edentulous patients by fitting immediately loaded two-implant overdentures via guided flapless surgery and evaluate their masticatory performance. MATERIALS AND METHODS: Nineteen patients who presented with edentulous mandibles (mean age: 69.8 years; range: 60 to 85 years) at the Dental Hospital, Tokyo Medical and Dental University, were enrolled in this study. A newly fabricated complete denture was used as a radiographic guide. Computer planning followed the design procedure, and surgical guides were fabricated for each patient. Flapless surgery was performed using this guide, and two implants were placed in the canine positions. On the day of surgery, a removable overdenture supported by two ball attachments was fitted. Masticatory function was evaluated on the basis of masticatory performance with a color-changeable chewing gum, maximum occlusal force with an occlusal force meter, and occlusal contact area with an occlusal diagnostic system. RESULTS: The masticatory performance significantly improved from 48 months after surgery. The maximum occlusal force significantly increased 24 months after surgery. The occlusal contact area significantly increased from 6 months after surgery. This prospective study indicated that maximum occlusal force and occlusal contact area significantly improved at a comparatively earlier period after implant surgery and were maintained for up to 5 years with the immediate loading of two-implant overdentures with stud attachments. However, masticatory performance took more time to improve than maximum occlusal force and occlusal contact area. CONCLUSION: According to this 5-year prospective study, masticatory performance, maximum occlusal force, and occlusal contact area showed significant improvement after 4 to 5 years, 2 years, and 6 months postsurgery, espectively.

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BACKGROUND: Mandibular overdentures retained by a single implant placed in the midline of edentulous mandible have been reported to be more comfortable and function better than complete dentures. Although single-implant overdentures are still more costly than conventional complete dentures, there are a few studies which investigated whether mandibular single-implant overdentures are superior to complete dentures when patient general satisfaction is compared. The aim of this study is to assess patient general satisfaction with mandibular single-implant overdentures and complete dentures. METHODS: This study is a randomized crossover trial to compare mandibular single-implant overdentures and complete dentures in edentulous individuals. Participant recruitment is ongoing at the time of this submission. Twenty-two participants will be recruited. New mandibular complete dentures will be fabricated. A single implant will be placed in the midline of the edentulous mandible. The mucosal surface of the complete denture around the implant will be relieved for 3 months. The participants will then be randomly allocated into 2 groups according to the order of the interventions; group 1 will receive single-implant overdentures first and will wear them for 2 months, followed by complete dentures for 2 months. Group 2 will receive the same treatments in a reverse order. After experiencing the 2 interventions, the participants will choose one of the mandibular prostheses, and yearly follow-up visits are planned for 5 years. The primary outcome of this trial is patient ratings of general satisfaction on 100 mm visual analog scales. Assessments of the prostheses and oral health-related quality of life will also be recorded as patient-reported outcomes. The secondary outcomes are cost and time for treatment. Masticatory efficiency and cognitive capacity will also be recorded. Furthermore, qualitative research will be performed to investigate the factors associated with success of these mandibular denture types. Clinical outcomes, such as implant survival rate, marginal bone loss, and prosthodontic complications, will also be recorded. DISCUSSION: The results of this randomized crossover trial will clarify whether mandibular single implants and overdentures for edentulous individuals provide better patient general satisfaction when compared to conventional complete dentures. TRIAL REGISTRATION: This clinical trial was registered at the University Hospital Medical Information Network (UMIN) Center (UMIN000017883).

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OBJECTIVES: To compare the cost and to evaluate cost-effectiveness of fabricating mandibular complete dentures (CDs) using two different impression methods. METHODS: A crossover randomized controlled trial including 27 edentulous participants was performed. Mandibular CDs were fabricated using two different impression methods, as follows: (i) conventional method using a custom tray border moulded with impression compound and silicone and (ii) simplified method using a stock tray and alginate. Cost analysis was performed from a clinical practitioner's perspective. The total cost included labor cost, which was calculated using the time spent by dentists and technicians in fabricating CDs and their hourly wages, and the material costs, which were calculated using purchase prices. To evaluate cost-effectiveness, we used general patient satisfaction as an indicator of effectiveness and calculated the incremental cost effectiveness ratio (ICER). ICER represents the cost per one unit of effectiveness. RESULTS: The trial was completed by 24 participants. The total cost was 43,904 Japanese Yen (JPY) (330.91 EUR / 395.78 USD) for the conventional method and 39,792 JPY (299.93 EUR / 358.70 USD) for the simplified method, and this difference was statistically significant (p<0.001). The ICER showed a cost of 633 JPY (4.77 EUR / 5.70 USD) for every one point change in general patient satisfaction. CONCLUSIONS: The results indicated that the total cost of the conventional method was significantly higher than that of the simplified method (p<0.001). CLINICAL SIGNIFICANCE: The conventional impression method for fabricating mandibular CDs, which took additional 633 JPY (4.77 EUR / 5.70 USD) for improvement of general satisfaction, is supposed to be clinically meaningful1.

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