Maxillary implant overdenture retained by four unsplinted attachments and opposed by a natural or fixed dentition: Five-year clinical outcomes. A prospective case series

Objectives:The objective of this study was to assess, over a period of 5 years, implant prosthesis and patient-reported outcomes of complete dentures retained by four implant-supported attachments in the edentulous maxilla facing either natural teeth or fixed rehabilitation in the lower jaw. Materials and Methods:Implant, prosthodontic and patient-related outcomes were assessed in 30 patients at 1, 3 and 5 years. Prosthodontic survival, complications or maintenance events as well as implant survival were recorded. Patient-reported outcome measures (PROMs) were evaluated with the Oral Health Impact Profile (OHIP-20) questionnaire and a visual analogue scale (VAS) before implant placement (baseline) and during the follow-up period. Results:After 5 years, three patients dropped out, 21 implants failed, and four overdentures were replaced leading to a prosthesis survival rate of 85.2% (95% CI: 71.8%-98.6%) and an implant survival rate of 80.6% (95% CI: 73.1%-88.0%). Prosthodontic success rate decreased from 86.2% to 74% between the 1st and the 3rd year and reached 63% after 5 years. OHIP results improved significantly from baseline to 1 year (p < .0001) and to 3 years (p = .036), but, at 5 years, the improvement was no longer significant when compared to baseline (p = .12). The overall VAS score remained significantly higher up to 5 years (p < .001). Conclusion:A substantial number of prosthetic complications and replacements occurred over the 5-year follow-up. After 5 years, the OHIP-20 deteriorated and reached again the baseline level. Nonetheless, the VAS results suggest significantly increased patient satisfaction after implant-supported retention was provided for the removable prostheses.