M_Quirynen Overdenture in lower jaw
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Transcript of M_Quirynen Overdenture in lower jaw
Catholic University Leuven,
Department of Periodontology,
U.Z. St Raphael, Capucijnenvoer 7,
B-3000 Leuven, Belgium.
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