Interventions for replacing missing teeth: preprosthetic surgery versus dental implants

Coulthard P, Esposito M, Worthington HV, Jokstad A

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Summary

Interventions for replacing missing teeth: preprosthetic surgery versus dental implants

There is weak evidence that patients are generally less satisfied with a conventional denture made after oral surgery to improve the retention of the denture than with a denture retained by implants.
More evidence is needed to compare mouth surgery and dental implants to help retain dentures for people who cannot keep dentures in place easily.
Some people who need dentures will have trouble keeping them in place because of the shape of their gums and jaws, or muscle structure in the mouth. Surgery can be done to try and improve denture retention (preprosthetic surgery). Another option is an implant retained overdenture, where dentures are attached to dental implants that go into the jaw. The review found that there is not enough evidence from trials to show which surgical techniques, types of implant or types of denture may have better results. However, there is some evidence to suggest that people may prefer implants to conventional surgery.

This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2009 Issue 4, Copyright © 2009 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
This record should be cited as: Coulthard P, Esposito M, Worthington HV, Jokstad A. Interventions for replacing missing teeth: preprosthetic surgery versus dental implants. Cochrane Database of Systematic Reviews 2002, Issue 4. Art. No.: CD003604. DOI: 10.1002/14651858.CD003604.

This version first published online: October 21. 2002

Abstract

Background

Preprosthetic surgery refers to the surgical procedures that can modify the oral anatomy to facilitate the retention of conventional dentures. Osseointegrated implants offer an alternative treatment to improve denture retention. A denture may be connected by special attachments to implants placed into the jaw.

Objectives

To test the null hypothesis of no difference in the success (patient satisfaction and morbidity) and cost effectiveness between conventional prostheses that require preprosthetic surgery (PPS) and implant retained prostheses (IRO) that do not require preprosthetic surgery, against the alternative hypothesis of a difference.

Search strategy

The Cochrane Oral Health Group Trials Register (May 2002), CENTRAL (The Cochrane Library 2002, Issue 2), MEDLINE and EMBASE (May 2002) were searched. In addition, 55 implant companies were contacted and the bibliographies of review articles were checked for studies outside the hand searched journals and personal references were searched.

Selection criteria

Randomised controlled trials (RCTS) comparing preprosthetic surgery and implant retained dentures for improving denture retention.

Data collection and analysis

Data were independently extracted, in duplicate, by two review authors. Authors were contacted for details of randomisation and withdrawals and a quality assessment was carried out. The Cochrane Collaboration's statistical guidelines were followed.

Main results

One study, containing 60 participants, reported in four articles was identified for inclusion in this review. No studies were excluded. There was a statistically significant difference between mean patient satisfaction scores with patients in the IRO group being more satisfied in general at both year 1 (WMD = -0.66 (95% CI -1.28 to -0.04)) and 5 years (WMD = -0.90 (95% CI -1.74 to -0.06). Altered sensation of the lower lip and chin was measured at 1 year and 5 years. There was no statistically significant difference at either time point and no patients had altered sensation at 5 years.

Authors' conclusions

There is weak evidence from the results of one randomised controlled trial including 60 subjects that patients are generally less satisfied with preprosthetic surgery and a conventional denture than with an implant retained denture. There is a need for more well designed trials comparing the success and cost-effectiveness of preprosthetic surgery and implant supported dentures. Such trials should be reported according to the CONSORT guidelines (www.consort-statement.org/). However, since preprosthetic surgery is considered to be an obsolete treatment nowadays, almost completely replaced by dental implants, it may be that new RCTs on this topic will not be designed.

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