PROCESO BÚSQUEDA DE INFORMACIÓN SISTEMATIZADA

UNIDAD DE INVESTIGACIÓN FACULTAD DE ODONTOLOGÍA

TEMATICA SOBREDENTADURAS IMPLANTOMUCOSOPORTADAS

1.FORMULE LA PREGUNTA CORRESPONDIENTE A SU PREGUNTA

En pacientes edéntulos maxilares que requiren sobredentaduras

implantomucosoportadas, ¿ Cual es el número de implantes ideal que soporte la prótesis?

PREGUNTA DESGLOSADA EN ELEMENTOS PICO- VARIABLES

P PACIENTE EDÉ NTULO TOTAL

I SOBREDENTADURAS IMPLANTOMUCOSOPORTADAS

C IMPLANTES DENTALES
O LONGEVIDAD, SUPERVIVENCIA

2. SELECCIÓN DE PALABRAS
PICO Variable Palabras claves
Palabra clave Edentulous mouths
Edentulous, jaw
Edentulous, jaws
Edentulous, mouth
Términos [MeSH] Edentulous, mouths
PACIENTE
P Jaws, edentulous
EDÉNTULO
Mouth, edentulous
TOTAL
Jaw, edentulous, partially
Jaw, edentulous
Términos [DeSC]
Jaw, edentulous, partially
Mouth, edentulous
Sinó nimos
Jaw, edentulous
Palabra clave Overdentures, dental implant
Dentures, overlay, implant supported
SOBREDENTAD Overlay, denture, implant supported
URAS Términos [MeSH] Overlay, dentures, implant supported
I IMPLANTOMU Overdenture, implant supported
COSOPORTADA Overdenture, implant supported
S
Términos [DeSC] Dentures, overlay
Sinó nimos Overdentures, implant supported
SOBREDENTAD Palabra clave Number of impplants
C URAS Términos [MeSH] Number of implants
DENTOMUCOS Términos [DeSC] Implant required
OPORTADAS Sinó nimos Implant required
O LONGEVIDAD, Palabra clave Number of implants
SUPERVIVENCI Términos [MeSH]
A
 Rate, Survival
Rates, Survival
Survival Rates
Longevity
Time, Mean Survival
Times, Mean Survival
Cumulative Survival Rate
Cumulative Survival Rates
Mean Survival Time
Mean Survival Times
Analysis, Survival
Analyses, Survival
Survival Analyses
Survival
Términos [DeSC]
Longevity
Survival
Sinó nimos
Longevity
 ESTRATEGIA DE BÚSQUEDA AVANZADA 1 – SOBREDENTADURAS SOBRE IMPLANTES
# BÚSQUEDA PUBMED
Edentulous jaw OR Edentulous jaws OR Edentulous mouth
#1 OR Edentulous mouths OR Jaws edentulous OR Mouth
P
edentulous
OR edentulous partially
Dentures overlay, implant supported OR Overlay denture,
implant supported OR Overlay dentures, implant supported OR
I #2
Overdentures, implant supported OR Overdenture, implant
supported
C #3 Number of implants
Rate Survival OR Rates, Survival OR Survival Rates OR Longevity
OR Time, Mean Survival OR Times, Mean Survival OR Cumulative
O #4 OR Survival Rate OR Cumulative Survival Rates OR Mean Survival
OR Mean Survival Times OR Analysis, Survival OR Analyses,
Survival OR Survival Analyses
(Number of implants) OR (Dentures overlay, implant supported
#5 OR Overlay denture, implant supported OR Overlay dentures,
#3 OR #2 implant supported OR Overdentures, implant supported OR
Overdenture, implant supported)
((Number of implants) OR Dentures overlay, implant supported
#6 OR Overlay denture, implant supported OR Overlay dentures,
#5 OR #1 implant supported OR Overdentures, implant supported OR
(#3 OR #2) OR #1 Overdenture, implant supported)) OR (Edentulous jaw OR
Edentulous jaws OR Edentulous mouth OR Edentulous mouths OR
Jaws edentulous OR Mouth edentulous OR edentulous partially))
(((Number of implants) OR Dentures overlay, implant supported
OR Overlay denture, implant supported OR Overlay dentures,
FINAL implant supported OR Overdentures, implant supported OR
#7 Overdenture, implant supported)) OR (Edentulous jaw OR
#6 AND #4 Edentulous jaws OR Edentulous mouth OR Edentulous mouths OR
(((#3) OR (#2) OR (#1)) Jaws edentulous OR Mouth edentulous OR edentulous partially))
AND (#4)h AND Rate Survival OR Rates, Survival OR Survival Rates OR
Longevity OR Time, Mean Survival OR Times, Mean Survival OR
Cumulative OR Survival Rate OR Cumulative Survival Rates OR
Mean Survival OR Mean Survival Times OR Analysis, Survival OR
Analyses, Survival OR Survival Analyses
 RESULTADOS 1
ESTRATEGIA DE BÚSQUEDA AVANZADA – SOBREDENTADURAS IMPLANTOMUCOSOPORTADAS
#
ENCONTRADO
BÚSQUED ESTRATEGIA SELECCIONADOS
S
A
Edentulous jaw OR Edentulous jaws OR
Edentulous mouth OR Edentulous mouths OR
P #1 220 results
Jaws edentulous OR Mouth edentulous OR
edentulous partially
Dentures overlay, implant supported OR Overlay
denture, implant supported OR Overlay dentures,
I #2 68 results
implant supported OR Overdentures, implant
supported OR Overdenture, implant supported
C #3 Number of implants 888 results
Rate Survival OR Rates, Survival OR Survival Rates
OR Longevity OR Time, Mean Survival OR Times,
Mean Survival OR Cumulative OR Survival Rate OR
O #4 20.133 results
Cumulative Survival Rates OR Mean Survival OR
Mean Survival Times OR Analysis, Survival OR
Analyses, Survival OR Survival Analyses
(Number of implants) OR (Dentures overlay,
implant supported OR Overlay denture, implant
#5
supported OR Overlay dentures, implant 934 results
#3 OR #2
supported OR Overdentures, implant supported
OR Overdenture, implant supported)
((Number of implants) OR Dentures overlay,
#6
implant supported OR Overlay denture, implant
supported OR Overlay dentures, implant supported
#5 OR #1
OR Overdentures, implant supported OR
1.090 results
Overdenture, implant supported)) OR (Edentulous
(#3 OR
jaw OR Edentulous jaws OR Edentulous mouth OR
#2) OR #1
Edentulous mouths OR Jaws edentulous OR Mouth
edentulous OR edentulous partially))
(((Number of implants) OR Dentures overlay,
implant supported OR Overlay denture, implant
FINAL supported OR Overlay dentures, implant supported
#7 OR Overdentures, implant supported OR
#6 AND #4 Overdenture, implant supported)) OR (Edentulous
jaw OR Edentulous jaws OR Edentulous mouth OR
(((#3) OR Edentulous mouths OR Jaws edentulous OR Mouth
16.284 results
(#2) OR edentulous OR edentulous partially)) AND Rate
(#1)) AND Survival OR Rates, Survival OR Survival Rates OR
(#4) Longevity OR Time, Mean Survival OR Times, Mean
Survival OR Survival Rate OR Cumulative Survival
Rates OR Mean Survival OR Mean Survival Times
OR Analysis, Survival OR Analyses, Survival OR
Survival Analyses
ESTRATEGIA DE BÚSQUEDA AVANZADA – SOBREDENTADURAS IMPLANTOMUCOSOPORTADAS
PUBMED/EMBASE – BEST MATCH
OPCIÓN 1
(((Number of implants) OR Dentures overlay, implant supported OR Overlay denture,
implant supported OR Overlay dentures, implant supported OR Overdentures,
implant supported OR Overdenture, implant supported)) OR (Edentulous jaw OR
Edentulous jaws OR Edentulous mouth OR Edentulous mouths OR Jaws edentulous
OR Mouth edentulous OR edentulous partially)) AND Rate Survival OR Rates,
Survival OR Survival Rates OR Longevity OR Time, Mean Survival OR Times, Mean
ESTRATEGIA Survival OR Survival Rate OR Cumulative Survival Rates OR Mean Survival OR Mean
FINAL Survival Times OR Analysis, Survival OR Analyses, Survival OR Survival Analyses

OPCIÓN 2
Number of implants OR overdenture, implant supported OR overlay dentures, implant
supported OR mouth edentulous OR maxillary edentulous AND rates survival OR
longevity OR mean survival (98 ARTÍCULOS)

Artículos en inglés
Estudios in vivo
Criterios de
Estudios de revisió n sistemá tica
inclusión
Aná lisis estadístico con meta-aná lisis

Reportes de caso
Criterios de
Artículos de revisió n
exclusión
ARTICULOS PRESELECCCIONADOS
REFERENCIA VANCOUVER – ABSTRACT

Slot, W., Raghoebar, G. M., Vissink, A., & Meijer, H. J. A. (2013). Maxillary overdentures supported by
four or six implants in the anterior region; 1-year results from a randomized controlled trial. Journal of
Clinical Periodontology, 40(3), 303–310.

Objective: Comparing treatment outcome of four and six bar-connected implants in the anterior maxillary region to
support an overdenture during a 1-year fol- low-up period.

Material and methods: Fifty edentulous patients with lack of retention and stabil- ity of the upper denture, but with
sufficient bone volume to place implants in the anterior maxillary region, were selected. Randomization assigned patients
to either four or six implants. Implant survival, overdenture survival, clinical scores, radiographic bone height changes,
and patients’ satisfaction were assessed. Results: Forty-nine patients (one drop out) completed the 1-year follow-up. After
1 year, implant survival was 100% in the four implants group and 99.3% in the six implants group (one implant lost).
Overdenture survival was 100% in both groups. Mean clinical scores were low and did not differ between groups (inde-
pendent Student’s t-test). Mean marginal bone resorption was 0.24 0.32 mm in the four implants group and 0.25 0.29
mm in the six implants group. Patients’ satisfaction had improved in both groups (paired Student’s t-test).

Conclusion: Bar-supported overdentures on four implants in the anterior maxil- lary region are not inferior to
overdentures supported by six bar-connected implants. Implant survival was high, peri-implant conditions were healthy
and patients’ satisfaction had increased significantly in both groups.

Slot, W., Raghoebar, G. M., Vissink, A., Huddleston Slater, J. J., & Meijer, H. J. A. (2010). A
systematicreview of implant-supported maxillary overdentures after a mean observation period of at least 1
year: Review Article. Journal of Clinical Periodontology, 37(1), 98–110.

Aim: The aim of the present systematic review of implant-supported maxillary overdentures was to assess the survival of
implants, survival of maxillary overdentures and the condition of surrounding hard and soft tissues after a mean
observation period of at least 1 year.

Material and methods: MEDLINE (1950–August 2009), EMBASE (1966–August 2009) and CENTRAL (1800–August 2009)
were searched to identify eligible studies. Two reviewers independently assessed the articles.

Results: Out of 147 primarily selected articles, 31 studies fulfilled the inclusion criteria. A meta-analysis showed an
implant survival rate (SR) of 98.2% per year in case of six implants and a bar anchorage. In case of four implants and a bar
anchorage, the implant SR was 96.3% per person. In case of four implants and a ball anchorage, the implant SR was 95.2%
per year.

Conclusion: In all three treatment options, the SR of the implants is more than 95%. The studies included reveal that a
maxillary overdenture supported by six dental implants, which are connected with a bar, is the most successful treatment
regarding survival of both the implants and overdenture. Second in line is the treatment option with four implants and a
bar. The treatment option with four or less implants and a ball attachment system is the least successful.

Slot, W., Raghoebar, G. M., Cune, M. S., Vissink, A., & Meijer, H. J. A. (2016). Maxillary overdentures supported by
four or six implants in the anterior region: 5-year results from a randomized controlled trial. Journal of Clinical
Periodontology, 43(12), 1180–1187.

Objective: To compare four and six-implant maxillary overdenture after an observation period of 5 years.

Material and methods: Fifty subjects with functional problems concerning their maxillary denture, who had ample bone
volume in the anterior region to place four or six implants, were included and randomly assigned to either group. Implant
and overdenture survival, clinical performance, marginal bone loss and patient satisfaction were assessed.

Results: Forty-six patients completed the 5-year follow-up. One implant failed in the six- implant group (99.2 % survival)
and none in the four-implant group (100% survival). No overdentures had to be replaced during the observation period
and the number of complications was limited. Clinical function was good, with no difference in clinical parameters
between the groups. Mean marginal bone resorption was 0.50 ± 0.37 and 0.52 ±
0.43 mm in the four- and six implant group respectively. This article is protected by copyright. All rights reserved.

Conclusion: In patients with functional complaints of their maxillary denture, bar-supported overdentures on four
implants in the anterior maxillary region were not inferior to overdentures supported by six implants after 5-years of
function. Implant survival and patient satisfaction were high, clinical parameters favorable, bone loss and complications
to the denture were minor in both groups.

Raghoebar, G. M., Meijer, H. J. A., Slot, W., James, J. R., Slater, H., & Vissink, A. (2014). A systematic
review of implant-supported overdentures in the edentulous maxilla, compared to the mandible: How many
implants? European Journal of Oral Implantology, 7, S191–S201.

Background and aim: There is now overwhelming evidence from systematic reviews that a two- implant overdenture is
the first choice of treatment for the edentulous mandible. Conversely, consen- sus is lacking for implant-supported
maxillary overdentures. Therefore, we systematically reviewed the treatment outcome of concepts used for implant-
supported maxillary overdentures, focusing on the survival of implants, survival of maxillary overdentures and condition
of the implant surrounding hard and soft tissues after a mean observation period of at least 1 year.

Material and methods: MEDLINE (1950 to December 2013), EMBASE (1966 to December 2013) and CENTRAL (1800 to
December 2013) were searched to identify eligible studies. Two reviewers independently assessed the articles using
specific study design-related quality assessment forms.

Results: Out of 195 primarily selected articles, 24 studies fulfilled the inclusion criteria. A meta- analysis showed an
implant survival rate of 98.1% and overdenture survival of 99.5% per year in the case of ≥ 6 implants and a splinted (bar)
anchorage. In the case of ≤ 4 implants and a splinted (bar) anchorage, implant survival rate and overdenture survival
were 97.0% and 96.9% per year, res- pectively. In the case of ≤ 4 implants and a non-splinted anchorage (ball, locator,
telescopic crown), implant survival rate and overdenture survival were 88.9% and 98.8% per year, respectively. The
condition of the peri-implant tissues was not reported in most studies.

Conclusions: An implant-supported maxillary overdenture (all studies ≥ 4 implants) provided with a splinted anchorage
is accompanied with a high implant and overdenture survival rate (both >95% per year), while there is an increased risk
of implant loss when ≤ 4 implants with a non-splinted anchorage are used.

Di Francesco, F., De Marco, G., Sommella, A., & Lanza, A. (2019). Splinting vs Not Splinting Four Implants
Supporting a Maxillary Overdenture: A Systematic Review. The International Journal of Prosthodontics, 32(6), 509
518.

Purpose: To investigate the influence of splinted vs unsplinted designs for a maxillary overdenture supported by four
implants in terms of the outcome measures implant survival, overdenture longevity, and patient satisfaction. Materials
and Methods: A systematic search, complemented by a handsearch, was carried out in the Embase, MEDLINE (PubMed),
and Web of Science databases from 2000 to 2018. The PRISMA statement and a PICO approach were adopted. Free-text
words were used in the strategy search, including “4-implant- retained overdenture,” “4-implant-supported overdenture,”
“implant-supported overdenture,” “implant- retained overdenture,” “maxillary overdenture,” “splinted design,” “un-
splinted design,” and their combinations. All selected articles provided at least a 1-year follow-up, 10 fully edentulous
patients, and at least one of the following clinical outcomes: survival rate of implants, survival rate of overdentures,
and/or patient satisfaction scores. Nonparametric Fisher test for unpaired data was adopted in order to analyze data
deriving from the survival rates of implants and overdentures. Results: The initial electronic search produced a total of
2,922 articles. After applying the inclusion criteria, 14 articles were included. The mean follow-up time after implant
placement ranged from 1 to 10 years. No statistical difference was detected in the survival rate of implants between the
splinted implant group and the unsplinted implant group (P = .1). Only 4 included studies reported an overdenture
survival rate of lower than 95%. It is interesting to note that among these 4 studies, 3 employed four splinted implants
with a bar anchorage; however, no statistical difference was detected in the survival rate of overdentures between the
splinted and unsplinted groups (P = .47). High scores were reported by all studies investigating patient satisfaction.
Conclusion: Within the limits of this systematic review, it can be concluded that the survival rates of implants and
overdentures and patient satisfaction with a maxillary overdenture supported by four implants were not influenced by
the overdenture design, and no statistical difference was detected between the splinted and unsplinted groups. Int J
Prosthodont 2019;32:509–518. doi: 10.11607/ijp.6333

Di Francesco, F., De Marco, G., Gironi Carnevale, U. A., Lanza, M., & Lanza, A. (2019). The number of
implants required to support a maxillary overdenture: a systematic review and meta-analysis. Journal of
Prosthodontic Research, 63(1), 15–24.

Purpose: The number of implants needed to support a maxillary overdenture is still a controversial issue. The aim of this
systematic review was to investigate the number of implants required to support a maxillary overdenture in order to
obtain optimal treatment outcomes in terms of implant survival, overdenture longevity and patient satisfaction.

Study selection: Pubmed and EMBASE databes were systematically searched and complemented by hand searching from
2000 to 2017. The Prisma statement and a PICOS approach were adopted. All selected articles provided at least two-year
follow-up and 10 totally edentulous patients. Survival rate of implants and overdentures were statistically analyzed
according to number of implants and according to splitting technique, employing non-parametric Fisher Test for unpaired
data. For the pooled analysis of implant failures, the odds ratio between group of 4 splinted implants and group of more
than 4 splinted was calculated.

Results: A total of 28 articles were included. Data analysis of the included studies showed that the survival rate of
implants appeared higher in ! 4 implants group, whereas the high survival rate of overdentures and patient satisfaction
were not significantly influenced by the number of implants.
Conclusions: The findings of our analysis indicate that overall the most frequent tendency is to place at least four
implants, splinted or unsplinted, in order to ensure a higher survival rate of implants. However, the relationship between
overdenture survival, the patient’s quality of life, and the number of implants required to support a maxillary overdenture
has yet to be clarified.

G.C. Boven; J.W.A. Slot; G.M. Raghoebar; A. Vissink; H.J.A. Meijer (2017). Maxillary implant-supported
Overdentures Opposed by (Partial) Natural Dentitions: A 5-Year Prospective Case Series Study. Journal of
oral rehabilitation. Volume44, Issue12, Pages 988-995

PURPOSE:
To assess the 5-year treatment outcome of maxillary implant-retained overdentures opposed by natural antagonistic
teeth.
METHODS:
50 consecutive patients received maxillary overdentures supported by six dental implants. Implants were placed in the
anterior region, if enough bone was present (n=25 patients) Implant were placed in the posterior region if implant
placement in in the anterior region was not possible (n=25 patients). Variables assessed included survival of implants,
condition of hard and soft peri-implant tissues, and patients' satisfaction.
RESULTS:
Five-year implant survival rate was 97.0% and 99.3% and mean radiographic bone loss was 0.23 mm and 0.69 mm in the
anterior and posterior group, respectively. Median scores for plaque, calculus, gingiva, bleeding, and mean scores for
pocket probing depth were low and stayed low. Patients' satisfaction after treatment was high in both groups.
CONCLUSIONS:
Within the limits of this 5-year study, it is concluded that six dental implants (placed in the anterior or posterior region)
connected with a bar and opposed to natural antagonistic teeth result in acceptable results for clinical parameters; and
good outcomes for marginal bone level changes and patient satisfaction.

Slot, W., Raghoebar, G. M., Vissink, A. y Meijer, H. J. A. (2013).

Sobredentaduras maxilares soportadas por
cuatro o seis implantes en la región anterior; Resultados de 1 año de un ensayo
controlado aleatorio. Diario de
Periodontología clínica, 40 (3), 303–310.

Objetivo: comparar el resultado del tratamiento de cuatro y seis implantes

conectados a barras en la región anterior del maxilar para soportar una
sobredentadura durante un período de seguimiento de 1 año.

Material y métodos: Se seleccionaron 50 pacientes desdentados con falta de

retención y estabilidad de la prótesis superior, pero con suficiente volumen
óseo para colocar implantes en la región anterior del maxilar. La aleatorización
asignó a los pacientes a cuatro o seis implantes. Se evaluaron la supervivencia
del implante, la supervivencia de la sobredentadura, las puntuaciones clínicas,
los cambios radiográficos en la altura del hueso y la satisfacción de los
pacientes. Resultados: Cuarenta y nueve pacientes (un abandono) completaron el
seguimiento de 1 año. Después de 1 año, la supervivencia del implante fue del
100% en el grupo de cuatro implantes y del 99,3% en el grupo de seis implantes
(un implante perdido). La supervivencia de las sobredentaduras fue del 100% en
ambos grupos. Las puntuaciones clínicas medias fueron bajas y no difirieron
entre los grupos (prueba t de Student independiente). La resorción ósea marginal
media fue de 0,24 0,32 mm en el grupo de cuatro implantes y de 0,25 0,29 mm en
el grupo de seis implantes. La satisfacción de los pacientes había mejorado en
ambos grupos (prueba t de Student pareada).

Conclusión: Las sobredentaduras soportadas por barras en cuatro implantes en la

región anterior del maxilar no son inferiores a las sobredentaduras soportadas
por seis implantes conectados por barras. La supervivencia de los implantes fue
alta, las condiciones periimplantarias eran saludables y la satisfacción de los
pacientes había aumentado significativamente en ambos grupos.