Oral Health-related Quality of Life: Conventional Complete Dentures vs Implant Overdentures

Prosthodontic replacement of missing teeth in edentulous patients can ultimately enhance patients' quality of life. In addition to various treatment options to address edentulism, modern dentists must consider anatomical and surgical limitations as well as the cost and duration of treatment. Achieving predictable improvements in patients' quality of life with affordable treatment require an evidence-based understanding of available choices. This issue of Prosthodontics Newsletter reviews published research comparing conventional complete dentures to implant overdentures for enhancing patients' oral health-related quality of life.

One vs Two Implants to Support Overdentures

N umerous studies have shown the superiority of implant-supported overdentures over conventional dentures for treating mandibular edentulism. The gold standard calls for the use of mandibular overdentures retained by 2 implants; however, the cost may put this treatment out of reach for some patients. The use of 1 implant rather than 2 has been suggested to reduce the cost, but evidence as to whether this has an impact on patient quality of life is lacking. Jayasinghe et al from the University of Peradeniya, Sri Lanka, designed a study to compare the effectiveness of conventional dentures, 1-implant–supported overdentures and 2-implant–supported overdentures for prosthetic rehabilitation of the edentulous mandible.

The researchers enrolled 30 edentulous patients, all screened to establish both medical fitness and sufficiency of bone to undergo implant placement. All patients received conventional complete dentures, which they wore for ≥3 months, after which time they completed self-assessment questionnaires and were then randomly assigned to 1 of 2 groups:

• SIMOD: 1 implant in the midline of the mandible
• TIMOD: 2 implants in either the canine or first premolar region

After confirmation of osseointegration, mandibular overdentures were placed. At 3 months, 6 months and 1 year after receiving the overdentures, patients assessed their oral health-related quality of life (OHRQoL) and their satisfaction with the prosthesis, while clinicians evaluated outcomes based on retention, stability, support of the overdentures and overall success of treatment.

Esthetic and functional outcomes in the TIMOD group were superior to conventional dentures at all time points, with significant improvements in all outcome measures, including comfort, esthetics, chewing, speech, retention, stability, support and general patient satisfaction. The SIMOD group showed similar results at 3 and 6 months; an insufficient number of patients in this group attended the 1-year follow-up to reach any conclusions. The TIMOD group had better outcomes than the SIMOD group for patient comfort; however, all other evaluations showed no statistically significant differences. Replacement of conventional dentures with either type of implant-supported overdentures resulted in significantly improved OHRQoL.

Jayasinghe RM, Attygalla M, Fonseka MCN, et al. Single versus two dental implants retained mandibular over dentures: comparison of function, patient satisfaction, oral health-related quality of life and success of treatment. BMC Res Notes 2024;17:374.

OHRQoL and Nutrition by Restoration Type

A s the world population's life expectancy increases, so does edentulism. Inadequate retention and stability of conventional dentures may compromise chewing efficiency, which can increase malnutrition and overall poor health. To examine how the relationships among the form of prosthetic rehabilitation, the patient's nutritional status and oral health-related quality of life (OHRQoL) may be interrelated, Demirekin and Erten from Süleyman Demirel University, Türkiye, created a cross-sectional clinical study to compare the nutritional status and OHRQoL in completely edentulous patients who received conventional complete dentures, implant-supported overdentures or implant-supported fixed prostheses.

The 140 fully edentulous patients aged ≥40 years were divided into 3 groups:

• 40 received conventional complete dentures (CDs)
• 50 received implant-supported overdentures (IODs)
• 50 received implant-supported fixed prostheses (IFPs)

All had completed their prosthetic treatment ≥6 months prior to enrollment. The participants completed the OHIP-14 and OHQoL-UK questionnaires, which evaluate OHRQoL, and the Mini Nutritional Assessment-Short Form (MNA-SF), a questionnaire assessing nutritional status. Potential confounding demographic factors, including age, sex, education and income, were recorded.

The highest OHIP-14 scores, signifying poorer OHRQoL, were in the CD group; the lowest were in the IFP group. Similarly, the CD group recorded the poorest OHQoL-UK scores; the IFP group scored highest in OHRQoL (Table 1). The CD group showed the greatest proportion of patients at risk of malnutrition. Controlling for potential confounders, multivariate analysis demonstrated a significant association between OHRQoL and prosthetic type; patients receiving implant-supported prostheses scored better on the OHIP-14 and OHQoL-UK. The association of prosthetic type with nutritional status lessened after adjustment for demographic and socioeconomic variables, suggesting that the causes of possible malnutrition are multifactorial.

Demirekin ZB, Erten E. Association between prosthetic rehabilitation type, nutritional status, and oral health-related quality of life in completely edentulous adults: a cross-sectional study. BMC Oral Health 2026;doi:10.1186/s12903-026-08805-6.

Patient Satisfaction: 10-year Follow-up

S tudies show that implant-supported mandibular overdentures improve the oral health-related quality of life (OHRQoL) in edentulous patients who previously wore conventional mandibular dentures, but nearly all have been short-term, typically between 2 and 5 years. One study (Gjengedal H et al, Int J Prosthodont 2013;26:68-73) reported that edentulous patients had a strong increase in OHRQoL 3 months and 2 years after replacing their conventional mandibular dentures with implant-supported overdentures; all patients randomized to having their conventional dentures relined rather than replaced chose to receive implant-supported overdentures.

Mukilvannan et al from the University of Bergen, Norway, followed the original patient group to measure changes in patient satisfaction and OHRQoL 10 years after the end of the earlier study. Of the original 54 patients, 16 had died, 4 did not participate due to severe health problems, and 5 could not be reached. The 29 remaining patients included 17 from the original group and 12 who received implant-supported overdentures at the end of the previous study. Each respondent completed the same questionnaire from the previous study that measured patient satisfaction with their dentures, along with the OHIP-20 questionnaire to assess their OHRQoL.

At the 10-year follow-up, patients who replaced their conventional dentures with implant-supported overdentures reported significantly higher levels of satisfaction, comfort, retention and fit with their mandibular dentures, along with better ability to chew and less soreness or pain. Their OHRQoL significantly increased in the domains of functional disability, physical pain, psychological discomfort, physical disability, social disability and overall OHRQoL. In the group that received mandibular implant-supported overdentures at the beginning, only overall satisfaction changed. All other measures, including all domains of the OHIP-20, remained unchanged.

Mukilvannan G, Gjerde CG, Schriwer C, et al. An 8- to 10-year follow-up of denture satisfaction and oral health-related quality of life with implant-retained mandibular overdentures. Int J Prosthodont 2021;34:317-323.

OHRQoL with Mandibular Overdentures

M ore than 20 years ago, the McGill Consensus Statement that "two-implant mandibular overdentures should replace mandibular conventional dentures as the minimum standard of care for completely edentulous patients" was echoed several years later by the York Consensus Statement. Bajunaid et al from King Saud University, Saudi Arabia, compared patients' satisfaction and oral health-related quality of life (OHRQoL) using conventional dentures compared with implant-supported overdentures.

The 58 edentulous participants in the study had used mandibular implant-supported overdentures for >3 months after previously using conventional complete dentures. They completed a 3-part questionnaire about their demographic data and the length of time they had worn the mandibular implant-retained overdentures, including 17 questions comparing their experiences wearing conventional dentures and implant-retained overdentures in

• general satisfaction
• ease of cleaning
• ability to speak
• comfort
• aesthetics
• stability
• ability to chew different types of food
• function
• general oral condition

A single, open-ended question asked for their opinion on implant-retained overdentures.

As to whether their general oral health had negatively impacted their overall health, 65.5% responded yes. More were "very satisfied" or "satisfied" with their implant-retained overdentures (50.0%) than with their conventional dentures (8.6%). Similar results involved ability to speak (74.1% vs 36.2%), comfort (72.4% vs 31.1%), aesthetics (46.5% vs 20.7%), stability (46.5% vs 5.1%) and overall ability to chew food (67.2% vs 20.7%), including improvement in each of the various food categories listed. These category results were statistically significant; the only area without a significant difference was ease of cleaning. Open-ended responses reinforced the patients' preference for implant-supported dentures.

Bajunaid SO, Alshahrani AS, Aldosari AA, et al. Patients' satisfaction and oral health-related quality of life of edentulous patients using conventional complete dentures and implant-retained overdentures in Saudi Arabia. Int J Environ Res Public Health 2022;19:557.

OHRQoL with Implant-Supported Dentures

O ften clinical outcome measures to determine treatment success do not align with patients' subjective evaluations. The OHIP-49, a 49-item oral health-related quality of life (OHRQoL) questionnaire, is widely used to evaluate patients' perceptions of treatment outcomes. The OHIP-5 condenses the questionnaire to 5 items while capturing 86% of the variability in OHRQoL as measured by the OHIP-49. Sabău et al from the University of Oradea, Romania, used the OHIP-5 to analyze changes in OHRQoL in elderly edentulous patients whose conventional dentures were replaced with fixed implant-supported dentures.

Fifty-two edentulous patients with conventional dentures <1 year old completed the OHIP-5, consisting of the following 5 questions:

• Have you had difficulty chewing any foods because of problems with your mouth, dentures or jaws?
• Have you experienced painful aching in your mouth?
• Have you felt uncomfortable about the appearance of your mouth, dentures or jaws?
• Have you noticed a reduced sense of taste from problems with your mouth, dentures or jaws?
• Have you had difficulty performing your usual activities from problems with your mouth, dentures or jaws?

Responses ranged from never (1 point) to very often (5 points). Patients subsequently received 4 to 8 dental implants and fixed implant-supported dentures with multiunit abutments. Three months later the patients again completed the OHIP-5.

Patients showed significant improvement in all 5 areas after receiving fixed implant-supported dentures. Patients responding "never" to experiencing difficulty chewing foods increased from 1.9% to 57.7%, while those responding "never" to painful aching in the mouth increased from 3.8% to 76.9%. Results were consistent regardless of sex or age.

Sabău DT, Moca AE, Juncar RI, et al. Analysis of oral health-related quality of life in elderly Romanian edentulous patients: implant-supported versus conventional complete dentures. J Clin Med 2024;13:6865.