Satisfaction and psychosocial aspects of patients with an extremely resorbed mandible treated with implantretained overdentures

The objective of the present report was to study the effect of implant treatment on subjective parameters in edentulous patients with an extremely resorbed mandible. Three different treatment modalities to support an overdenture were compared: transmandibular implant according to Bosker, augmentation of the mandible followed by four endosseous implants, and the insertion of four short endosseous implants. Sixty patients [50 women and 10 men, mean (∫ SD) age 59 (∫ 11) years] met the inclusion criteria and were assigned in one of the three treatment groups. Before treatment and 12 months after placement of the new overdentures, denture satisfaction, psychosocial aspects and experiences during the surgical phase were assessed with a battery of questionnaires. After 1 year, 58 patients were available for evaluation: one patient had died, and one patient had moved out of the region. There was a significant improvement of patient satisfaction and psychosocial functioning in all three treatment groups. At the 1-year evaluation, differences amongst the three groups were not significant. However, in terms of discomfort and pain during the surgical phase as well as the length of this phase (at least 6 months), the augmentation using an autologous bone graft from the iliac crest followed by inserting four endosseous implants 3 months later appeared the least favorite option of the three modalities studied. With the availability of dental implants to stabilize (mandibular) overdentures in edentulous patients, treatment possibilities have changed dramatically. Dental implants can be applied in a predictable way (Batenburg et al. 1998a) to provide retention and stability for a mandibular overdenture in patients for whom only marginal and temporary improvement could be achieved in the past (De Koomen et al. 1979). The primary aims of treating edentulous patients with implant-retained overdentures are to reduce pain and discomfort, to improve function, and to stimulate psychosocial well-being. In addition to objective improvement of retention, stability, and chewing efficiency, it is imperative to know the effect of such a treatment on the well-being of the patients. For patients, a treatment is only successful when oral comfort, chewing, self confidence, and appearance are restored to a satisfactory level. Numerous treatment outcome studies have been published, most of which have focused on clinical and radiological aspects (Boerrigter et al. 1997; Batenburg et al. 1998b). Although there are several studies describing the effect of dental implants on subjective parameters, including patient satisfaction and psychosocial aspects (Kent 1992; Kent & Johns 1991), few studies have been designed according to the principles of a randomized clinical trial (Boerrigter Stellingsma et al . Satisfaction of patients treated with implant-retained overdentures et al. 1995; Bouma et al. 1997; Locker 1998; Raghoebar et al. 2000). As long as the bone volume in the edentulous mandible is sufficient, the use of two endosseous implants installed in the interforaminal area has proved to be very successful in stabilizing and retaining an overdenture (Chao et al. 1995; Batenburg et al. 1998b). The clinical results are very reliable (Boerrigter et al. 1997), and patients judge this kind of treatment to be very beneficial (Raghoebar et al. 2000). For cases with an extremely resorbed mandible, i.e. those ‘exceeding’ class VI in the classification of Cawood & Howell (1988), and diminished bone volume the following treatment options have been proposed. O Transmandibular implant according to Bosker et al. (1991). O Augmentation of the extremely resorbed mandible with an autogenous bone graft (iliac crest), followed after 3months by the installation of four endosseous implants in the interforaminal region (Stellingsma et al. 1998). O The installation of four short implants in the interforaminal region (Triplett et al. 1991; Keller 1995; Stellingsma et al. 2000). Evaluation of clinical aspects and subjective parameters following these strategies in a randomized, clinical trial has not yet been reported. The objective of this study was to quantify and analyse the effect of the abovementioned treatment strategies on subjective parameters in patients with an extremely resorbed mandible. The clinical aspects will be reported separately. Material and methods