The extremely resorbed mandible, 10-year results of a randomized controlled trial on 3 treatment strategies

Authors

  • Kees Stellingsma,

    Corresponding author
    1. Department of Oral and Maxillofacial Surgery and Maxillofacial Prosthetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
    • Corresponding author:

      Dr. Kees Stellingsma, DDS, PhD

      Department of Oral and Maxillofacial Surgery and Maxillofacial Prosthetics

      University Medical Center Groningen

      University of Groningen

      P.O. Box 30.001

      9700 RB Groningen

      The Netherlands

      Tel.: +31 50 3613840

      Fax: +31 50 3611136

      e-mail: c.stellingsma@umcg.nl

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  • Gerry M. Raghoebar,

    1. Department of Oral and Maxillofacial Surgery and Maxillofacial Prosthetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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  • Anita Visser,

    1. Department of Oral and Maxillofacial Surgery and Maxillofacial Prosthetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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  • Arjan Vissink,

    1. Department of Oral and Maxillofacial Surgery and Maxillofacial Prosthetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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  • Henny J. A. Meijer

    1. Department of Oral and Maxillofacial Surgery and Maxillofacial Prosthetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
    2. Department of Oral Function and Prosthetic Dentistry, Dental School, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Abstract

Objectives

To prospectively compare the clinical and radiographic results of three modes of implant treatment for implant-retained mandibular overdentures in patients with extremely resorbed mandibles. The three treatment strategies used were (1) a transmandibular implant, (2) augmentation of the mandible with an autologous bone graft followed by placement of four endosseous implants, and (3) placement of four short endosseous implants.

Materials and methods

Sixty edentulous patients met the inclusion criteria and were assigned according to a balanced allocation method to 1 of the 3 treatment strategies. Implant survival, surgical retreatment rates, and peri-implant bone loss were assessed according to a standardized protocol during a 10-year evaluation period.

Results

During the evaluation period, significantly more implants were lost in the transmandibular implant (cumulative 10-year implant survival rate, 76.3%) and the augmentation groups (88%) compared to the group provided with short endosseous implants (98.8%). The 10-year retreatment rate was significantly more favorable in the endosseous implants only (0%) and augmentation groups (5%) compared to the transmandibular group (30%). In all three groups, there was minor peri-implant bone loss.

Discussion

Although implant loss is a frequently used outcome measure for success, the necessity of surgical retreatment seems to be of more relevance for both the patient and the clinician.

Conclusion

Considering the favorable clinical and radiographic parameters and the fact that patients can be treated in outdoor clinic setting, the use of short endosseous implants in combination with an overdenture is the first choice of treatment in patients with extremely resorbed mandibles.

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