Cochrane · intervention · CD008001
Interventions for replacing missing teeth: attachment systems for implant overdentures in edentulous jaws
Payne, AGT, Alsabeeha, NHM, Atieh, MA, et al. · Cochrane Database of Systematic Reviews · 2018 · Cochrane Library
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
20
current version
GRADE rated
10
No studies
4
Included studies
6
as reported
No studies 4 · 20%Ungraded 6 · 30%Very low 10 · 50%Low 0 · 0%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Edentulous adults receiving implant overdentures in one or both jaws to overcome problems with conventional complete dentures | Six trials, all on mandibular overdentures (edentulous adults); participants per trial ranged 18 to 100 (294 mandibular overdentures total); no eligible maxillary trials (n=6) |
| Intervention | The same number of implants of the same implant system comparing different attachment systems; Ball/stud, magnetic, telescopic or bar attachment systems with mandibular 1-, 2-, 3-, or 4-implant overdentures (splinted or unsplinted); Ball/stud, magnetic, telescopic or bar attachment systems with maxillary 1- to 6-implant overdentures (splinted or unsplinted) | Ball/stud attachments (n=6); Bar attachments (n=4); Magnetic attachments (n=3); Telescopic attachments (n=1) |
| Comparison | Different attachment systems on the same number of implants; the same attachment system supported by a different number of implants | Bar attachments (n=4); Magnetic attachments (n=3); Telescopic attachments (n=1) - each compared with ball as the common reference |
| Outcomes | Prosthodontic success by specific categorization and six-field protocol; Prosthodontic maintenance by general categorization; Patient preference in cross-over trials; Patient satisfaction or quality of life assessed by a validated measure; Cost (treatment time and/or material costs) | Prosthodontic success by specific categorization (usable data in 3 trials); Prosthodontic maintenance by general categorization (recorded in 6, mostly unusable); Patient satisfaction by validated measure (recorded in 3, unusable); Cost (recorded in 2, 1 usable); Patient preference in cross-over trials (0 assessed) |
| Study designs | Randomised controlled trials (RCTs) including cross-over trials with at least 1 year follow-up | Six RCTs: five parallel-group and one cross-over trial (n=6) |
| Timing | Minimum 1 year follow-up (short term 1 to 3 years; medium term 3 to 5 years; long term 5 to 10 years) | Study duration ranged 2 to 10 years; only short- and medium-term data usable (no usable long-term data) |
Search date: 2018-01. Databases: Cochrane Oral Health's Trials Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE Ovid; Embase Ovid; US National Institutes of Health Trials Registry (ClinicalTrials.gov); WHO International Clinical Trials Registry Platform
Questions and results
Show all 2 versionsBall (stud) attachment system vs Bar attachment system
Population: Edentulous adults receiving mandibular implant overdentures (opposing conventional complete maxillary dentures)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Re-treatment: replacement of attachment system (short term) Short term (1 to 3 years) | RR 1.18 [0.38, 3.71] 78 vs 92 | 2 studies · 130 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Prosthodontic success (short term) Short term (1 to 3 years) | Considerable heterogeneity (I2 = 97%). Pooling of data was not done. See comment / See comment | 2 studies · 130 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Patient satisfaction / quality of life (validated measure) | Only Walton 2002 assessed patient satisfaction but reported narrative results and failed to provide any usable numbers. Quality of life as assessed by a validated measure was not recorded in any of the trials. | 1 study | Ungraded |
Cost (treatment time and/or material costs) | Walton 2002 reported costs but the data could not be used due to failure to report means and standard deviations and only providing the median of the costs. | 1 study | Ungraded |
Prosthodontic maintenance (general categorization) Short term (1 to 3 years) | Recorded by Kappel 2016 and Walton 2002; they did not provide usable data for inclusion in the review. | 2 studies | Ungraded |
Re-treatment: repair of attachment system (short term) Short term (1 to 3 years) | RR 3.11 [1.68, 5.75] 141 vs 437 | 2 studies · 130 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Ball (stud) attachment system vs Telescopic attachment system
Population: Edentulous adults receiving mandibular implant overdentures (opposing conventional complete maxillary dentures)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Prosthodontic maintenance: patrix replaced (short term) Short term (1 to 3 years) | RR 6.00 [0.86, 41.96] 91 vs 545 | 1 study · 22 participants | Very low Downgraded: risk of bias, imprecision |
Patient satisfaction / quality of life (validated measure) | Cepa 2017 assessed patient satisfaction but did not use validated measures and we could not use the data. Quality of life as assessed by a validated measure was not recorded. | 1 study | Ungraded |
Prosthodontic success (specific categorization) Short term (1 to 3 years) | no estimate extracted | NR | No studies |
Prosthodontic maintenance: matrix activated (short term) Short term (1 to 3 years) | RR 11.00 [0.68, 177.72] 0 vs 0 | 1 study · 22 participants | Very low Downgraded: risk of bias, imprecision |
Cost (treatment time and/or material costs) | no estimate extracted | NR | No studies |
Prosthodontic maintenance: reline of implant overdenture (short term) Short term (1 to 3 years) | RR 2.33 [0.81, 6.76] 273 vs 635 | 1 study · 22 participants | Very low Downgraded: risk of bias, imprecision |
Prosthodontic maintenance: matrix replaced (short term) Short term (1 to 3 years) | RR 1.75 [0.71, 4.31] 364 vs 636 | 1 study · 22 participants | Very low Downgraded: risk of bias, imprecision |
Ball (stud) attachment system vs Magnetic attachment system
Population: Edentulous adults receiving mandibular implant overdentures (opposing conventional complete maxillary dentures)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Cost of prosthodontic maintenance (medium term) Medium term (3 to 5 years) | MD -247.37 [-346.32, -148.42] | 1 study · 69 participants | Very low Downgraded: risk of bias, imprecision |
Prosthodontic success (medium term) Medium term (3 to 5 years) | RR 0.84 [0.64, 1.10] 826 vs 694 | 1 study · 69 participants | Very low Downgraded: risk of bias, imprecision |
Patient satisfaction / quality of life (validated measure) | Two trials (Cune 2010; Naert 1999) reported patient satisfaction. However, we could not use any data from these studies. Quality of life as assessed by a validated measure was not recorded in any of the trials. | 2 studies | Ungraded |
Prosthodontic maintenance (general categorization) | Recorded by Cristache 2014, Cune 2010 and Naert 1999; they did not provide usable data for inclusion in the review. | 3 studies | Ungraded |
Re-treatment: repair of attachment system (medium term) Medium term (3 to 5 years) | RR 1.75 [0.65, 4.72] 174 vs 304 | 1 study · 69 participants | Very low Downgraded: risk of bias, imprecision |
Patient preference (cross-over trials) | no estimate extracted | NR | No studies |
Any attachment system for maxillary implant overdentures vs A different attachment system for maxillary implant overdentures
Population: Edentulous adults receiving maxillary implant overdentures
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR | no estimate extracted | NR | No studies |