Minimally invasive approaches for implant-supported overdentures in the atrophied mandible

Objectives: The study compares three minimally invasive approaches for the retention of implant supported mandibular complete dentures, particularly focusing on patient satisfaction. Background: The McGill Consensus Statement recommends restoration of the edentulous mandible with an overdenture retained on two implants. Alternatively, less invasive treatment concepts with shorter treatment times have been developed for critical cases. Material and Methods: Thirty-nine patients (with a total of 78 implants) with advanced mandibular bone atrophy were randomly assigned to three groups: “single standard implant-retained overdentures” (SSO) and “mini-implant-retained overdentures” (MO), which was further subdivided into “two mini-implant-retained overdentures” (TMO) and “four mini-implant-retained overdentures” (FMO). The technical and biological parameters and oral health-related quality of life were evaluated over a 10-year period. Data were analysed for group comparisons and longitudinal trend analysis. Results: Sixteen patients (42%) dropped out during the study period. At the time of follow-up, 98.4% of the implants were in situ. The first need for technical intervention occurred after 3.8 ± 1.1, 4.2 ± 0.9, and 4.6 ± 1.3 years in the TMO, SSO, and FMO groups, respectively. Attachment exchange (39%) was the most frequently performed intervention in all groups. Healthy peri-implant and mucosal conditions were observed in 74% and 40% of patients after 1 and 10 years, respectively. The OHIP-G14 score was 22.6 before implantation, 7.6 at 1 year (effect size [ES]: 1.1), and 5.4 at 10 years (ES: 2.3). Conclusion: Irrespective of the minimal concept selected, complete mandibular dentures retained on implants improved the subjective perception of the quality of life. Application of these alternative minimal concepts may be practical in clinical practice.