Effect of surgical and prosthodontic protocols of distal extension implant-supported removable partial dentures on clinical and patient-reported outcomes: A systematic review

See WL 1 , Khoo TL 1 , Mohan M 2 , Nimbalkar S 3 , Patil PG 4

Affiliations 

  • 1 Predoctoral student, Division of Restorative Dentistry, School of Dentistry, IMU University, Kuala Lumpur, Malaysia
  • 2 Senior Lecturer in Prosthodontics, Division of Restorative Dentistry, School of Dentistry, IMU University, Kuala Lumpur, Malaysia
  • 3 Lecturer in Orthodontics, Division of Oral Health Sciences, School of Dentistry, IMU University, Kuala Lumpur, Malaysia
  • 4 Lecturer in Prosthodontics, Division of Restorative Dentistry, School of Dentistry, IMU University, Kuala Lumpur, Malaysia. Electronic address: [email protected]
J Prosthet Dent, 2024 Apr 22.
PMID: 38653688 DOI: 10.1016/j.prosdent.2024.03.021

Abstract

STATEMENT OF PROBLEM: Standard surgical and prosthodontic protocols for managing partially dentate patients with implant-supported removable partial dentures (ISRPDs) are lacking.

PURPOSE: The purpose of this systematic review was to determine clinical and patient-reported outcome measures (PROMs) in patients provided with ISRPDs in distal edentulous arches based on different surgical and prosthodontic protocols.

MATERIAL AND METHODS: An electronic and manual literature search was conducted in 3 databases, PubMed/MEDLINE, SCOPUS, and Cochrane Library, for clinical studies on distal extension ISRPDs related to clinical and patient-reported outcomes. Kennedy Class I and II arches described in articles published from January 2000 to December 2023 were included. Clinical parameters regarding implant type, location, loading protocols, and implant survival rate and PROMs including masticatory performance, esthetics, and overall satisfaction were compared. The risk of bias was determined by using the Cochrane Risk of Bias Tool 2.0 (RoB 2.0).

RESULTS: An initial total of 103 studies were identified, but only 11 articles were selected after implementing the inclusion and exclusion criteria. Ten studies evaluated PROMs, and 6 studies evaluated clinical outcomes (5 studies evaluated both). The implant survival rate ranged from 91.7% to 100%, with no clear differentiation among the studies with immediate or delayed loading protocols. Most studies described implants positioned in the molar region. In general, patient satisfaction and oral health-related quality of life (OHRQoL) improved significantly with ISRPDs compared with conventional removable partial dentures (RPDs) or RPDs with healing abutments. Posttreatment clinical outcomes revealed stable peri-implant health with no significant bone loss or prosthetic complications. No specific implant configuration, including implant type and location or attachment system, appeared to be better than another. Ball attachments were the commonly used attachments. Two studies were of high risk and 3 studies of low risk. The remaining 6 studies were judged to have some concerns based on the RoB 2.0 analysis.

CONCLUSIONS: Providing an ISRPD improved patient satisfaction, OHRQoL, and the clinical outcomes in distal extension situations, with most studies positioning the implants in the molar region. The type of attachment did not significantly affect the outcomes, although ball attachments were the most used attachment in ISRPDs.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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