Oral health-related quality of life in subjects with implant-supported prostheses: A systematic review

Abstract

Objectives

The aim of the present study was to review the current literature relating to the impact of dental implants on oral health-related quality of life (OHRQoL) in edentulous or partially dentate patients.

Data/sources

Systematic literature searches were performed in the PubMed, EMBASE, and Cochrane Library databases, using high level MeSH terms. The searches were limited to studies published in English from 1960 to June 11, 2017, reporting OHRQoL outcomes using validated instruments, and having enrolled at least 50 patients.

Study selection

After removal of duplicates, a total of 2827 unique hits were identified. After title, abstract, and full text screening, 63 articles were included in the review presenting findings of 55 individual studies. The provision of implant-supported dentures was associated with a significant increase in OHRQoL in partially dentate and in edentulous patients, with the magnitude of achieved improvement typically being greater for implant-supported dentures than with conventional ones. Furthermore, OHRQoL impairment prior to treatment was strongly associated with OHRQoL improvement.

Conclusion

For partially dentate patients, there is not enough evidence that implant-supported FDP are superior in terms of OHRQoL than conventional FDP, but moderate evidence suggests that implant-supported FDP perform better than conventional RDP. In edentulous patients, evidence suggests that only if OHRQoL at baseline is highly impaired and patients request implant treatment, IOD are superior than CD in terms of treatment-induced OHRQoL improvement.

Clinical significance

Patients can be informed that implant treatment is usually related to a significant improvement in OHRQoL. However, improvement is not necessarily higher than for conventional prosthodontic treatments but depends on patient’s clinical and psychosocial characteristics.

Introduction

Missing teeth are a common problem among adults of all ages, with the annual incidence of subjects losing ≥1 teeth ranging from 1 to 14% in European countries . The prevalence of edentulism typically increases with age; it is therefore a common problem especially in the elderly . In the US alone, it is estimated that approximately one-third of adults aged ≥65 years are edentulous . Additionally, on a global level, by 2020 an estimated 38 million adults will require one or two complete dentures . Tooth loss, and in particular visible tooth loss (i.e., in the aesthetic zone), is associated with aesthetic problems and reductions in oral health-related quality of life (OHRQoL) . Masticatory ability is also influenced by tooth loss . The magnitude of impairment in OHRQoL is related to the number of missing teeth, with studies showing an association between number of missing teeth and reduction in OHRQoL . Additionally, subjects may be emotionally affected by tooth loss; a Hong Kong-based study reported that tooth loss had a negative effect in terms of food choices, eating in public and forming close relationships .

A number of treatment options exist for subjects with missing teeth and also for those completely edentulous, including the replacement of a single missing tooth using conventional and implant-supported fixed dental prostheses (FDP) and for partially dentate (also referred to as partially edentulous) or edentulous patients using conventional removable dental prostheses (RDP) or implant-supported overdentures. However, some patients with conventional dentures, particularly wearers of mandibular dentures, may experience looseness or mobility of the denture, differences in salivary flow, oral sensory function and bite force, and an accelerated rate of residual bone resorption . Some patients also experience aesthetic as well as functional problems including difficulties in pronouncing certain sounds and chewing problems. Similarly, implants are associated with caveats including higher initial costs and their placement is a more protracted process and involves surgery, both of which may represent barriers for many patients . However, when it comes to the question what treatment should be chosen, a conventional or an implant-supported prosthesis, the patient perspective is a significant factor in decision-making, with OHRQoL improvement to be expected following implant treatment being a highly relevant information.

While findings from single studies might vary or be even contradictory, systematic reviews offer the best way to bring available information together. They allow to rate the methodological quality and potential bias of the single studies and offer a critically condensed summary. Regarding the impact of implant-supported prostheses on OHRQoL, systematic reviews are available for partially dentate and edentulous populations . A systematic review by Thomason et al. included studies on OHRQoL and patient satisfaction published 1996–2006 in a broad range of subjects including those undergoing single tooth replacement as well as subjects who required reconstruction of the whole jaw . The consensus findings were that subjects were more satisfied with implants than conventional dentures and that OHRQoL is significantly improved following the placement of implants. Another systematic review by Strassburger et al. on studies in partially dentate or edentulous subjects published 1960–2003, concluded that the placement of implant-supported mandibular prostheses is associated with an improvement in OHRQoL, but that the placement of more than two implants does not result in further incremental improvements on OHRQoL or patient satisfaction . Additionally, a 2009 systematic review by Emami et al. analyzed findings from randomized controlled trials of mandibular implant-retained overdentures versus conventional mandibular dentures in edentulous patients . While the meta-analysis of patient satisfaction showed a large effect size in favor of implants, the effect in the meta-analysis of OHRQoL did not achieve statistical significance and significant heterogeneity was reported between the studies. Even though these reviews provide some evidence for the impact of implant support of prostheses on patient perceptions, the reviews are somewhat outdated and do not consider more recent research findings.

The aim of the present study was to review the current literature relating to the impact of dental implants on OHRQoL in edentulous or partially dentate patients, and in particular to compare the relative impact of implant-based prostheses with that of conventional prostheses in terms of OHRQoL.

Materials and methods

The study was designed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement .

Criteria for considering studies for this review

Type of studies

No exclusion criteria in terms of study design were applied; as such cross-sectional, retrospective, and prospective studies were included. Studies could be either observational or randomized controlled trials (RCT).

Types of participants

We considered adult male and female subjects for inclusion. Studies that were performed exclusively in pediatric populations were excluded. At least 50 patients had to be enrolled in the studies for inclusion.

Types of interventions

We included any study where at least a subgroup of participants had or received dental implants.

Types of outcome measures

For inclusion, studies were required to report OHRQoL outcomes using validated instruments such as (but not limited to) the Oral Health Impact Profile (OHIP) , the Geriatric Oral Health Assessment Index (GOHAI) , the UK oral health related quality of life measure (OHQoL-UK) , or Dental Impact on Daily Living (DIDL) questionnaires.

Search strategy

Literature searches were performed using the PubMed, EMBASE, and Cochrane Library databases, together covering most of the scientific literature in the field. The initial search strategy was designed for use in the PubMed database using high level MeSH terms as follows and adapted for use in the EMBASE and Cochrane Library databases: ((((“Dental Prosthesis”[Mesh] OR “Dental Restoration, Temporary”[Mesh] OR “Dental Restoration, Permanent”[Mesh] OR “Dental Implantation”[Mesh] OR “Dental Implants”[Mesh] OR “Mandibular Prosthesis Implantation”[Mesh] OR “Periodontium”[Mesh] OR “Prosthodontics”[Mesh]))) AND (“Quality of life”[Mesh] OR “patient satisfaction” [Mesh])) NOT (Editorial[Publication Type] OR Letter[Publication Type] OR Case Reports[Publication Type] OR Comment[Publication Type] OR Review[Publication Type]). The searches were limited to studies published in English from 1960 to June 11, 2017.

Data collection and analysis

Selection of studies

Title and abstracts were screened by one review author (RL), while full texts of articles were assessed for inclusion independently by two review author (RL, JS). Disagreement was solved by discussion.

Data extraction and management

A pair of review authors independently extracted data using a standardised data collection sheet. The review authors were not blinded to authors of included studies. The two review authors resolved disagreements by discussion or, if necessary, by consulting a third review author (DRR) in order to reach consensus. The following information was recorded where available:

  • 1.

    Year of publication, authors, and country of origin

  • 2.

    Primary aim

  • 3.

    Study design

  • 4.

    Participants: sample size, age, gender, subgroups

  • 5.

    Intervention: materials and techniques used, time to follow-up

  • 6.

    Control: materials and techniques used, time to follow-up

  • 7.

    Outcomes: primary and secondary outcomes

Assessment of risk of bias in included studies

Risk of bias assessment was performed for included studies with highest level of evidence, i.e., RTCs. It followed the guidance in the Cochrane Handbook for Systematic Reviews of Interventions . Two review authors (RL, JS) independently assessed and scored studies in order to identify any potential sources of systematic. Judgements concerning the related risk of bias for each domain were assigned as either ‘low risk’, ‘high risk’, or where insufficient information was available to make a judgement, ‘unclear risk’. Additional a ‘Risk of bias’ table for included studies is presented.

Data synthesis

Due to methodological differences, e.g. different OHRQoL questionnaires or versions, and different characteristics in included studies resulting in substantial heterogeneity a meta-analysis was deemed not indicated. Instead, for better comparison of study findings, standardizes effects sizes (ES) were computed for differences and change scores. These ES allow not only to compare findings of studies with different outcome measures, but also to assess the clinical relevance of the findings. According to guidelines, an ES of 0.2 is considered small, 0.5 is medium, and 0.8 is large . Furthermore, an ES of 0.5 represents the minimal important difference for many patients reported outcome measures .

Materials and methods

The study was designed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement .

Criteria for considering studies for this review

Type of studies

No exclusion criteria in terms of study design were applied; as such cross-sectional, retrospective, and prospective studies were included. Studies could be either observational or randomized controlled trials (RCT).

Types of participants

We considered adult male and female subjects for inclusion. Studies that were performed exclusively in pediatric populations were excluded. At least 50 patients had to be enrolled in the studies for inclusion.

Types of interventions

We included any study where at least a subgroup of participants had or received dental implants.

Types of outcome measures

For inclusion, studies were required to report OHRQoL outcomes using validated instruments such as (but not limited to) the Oral Health Impact Profile (OHIP) , the Geriatric Oral Health Assessment Index (GOHAI) , the UK oral health related quality of life measure (OHQoL-UK) , or Dental Impact on Daily Living (DIDL) questionnaires.

Search strategy

Literature searches were performed using the PubMed, EMBASE, and Cochrane Library databases, together covering most of the scientific literature in the field. The initial search strategy was designed for use in the PubMed database using high level MeSH terms as follows and adapted for use in the EMBASE and Cochrane Library databases: ((((“Dental Prosthesis”[Mesh] OR “Dental Restoration, Temporary”[Mesh] OR “Dental Restoration, Permanent”[Mesh] OR “Dental Implantation”[Mesh] OR “Dental Implants”[Mesh] OR “Mandibular Prosthesis Implantation”[Mesh] OR “Periodontium”[Mesh] OR “Prosthodontics”[Mesh]))) AND (“Quality of life”[Mesh] OR “patient satisfaction” [Mesh])) NOT (Editorial[Publication Type] OR Letter[Publication Type] OR Case Reports[Publication Type] OR Comment[Publication Type] OR Review[Publication Type]). The searches were limited to studies published in English from 1960 to June 11, 2017.

Data collection and analysis

Selection of studies

Title and abstracts were screened by one review author (RL), while full texts of articles were assessed for inclusion independently by two review author (RL, JS). Disagreement was solved by discussion.

Data extraction and management

A pair of review authors independently extracted data using a standardised data collection sheet. The review authors were not blinded to authors of included studies. The two review authors resolved disagreements by discussion or, if necessary, by consulting a third review author (DRR) in order to reach consensus. The following information was recorded where available:

  • 1.

    Year of publication, authors, and country of origin

  • 2.

    Primary aim

  • 3.

    Study design

  • 4.

    Participants: sample size, age, gender, subgroups

  • 5.

    Intervention: materials and techniques used, time to follow-up

  • 6.

    Control: materials and techniques used, time to follow-up

  • 7.

    Outcomes: primary and secondary outcomes

Assessment of risk of bias in included studies

Risk of bias assessment was performed for included studies with highest level of evidence, i.e., RTCs. It followed the guidance in the Cochrane Handbook for Systematic Reviews of Interventions . Two review authors (RL, JS) independently assessed and scored studies in order to identify any potential sources of systematic. Judgements concerning the related risk of bias for each domain were assigned as either ‘low risk’, ‘high risk’, or where insufficient information was available to make a judgement, ‘unclear risk’. Additional a ‘Risk of bias’ table for included studies is presented.

Data synthesis

Due to methodological differences, e.g. different OHRQoL questionnaires or versions, and different characteristics in included studies resulting in substantial heterogeneity a meta-analysis was deemed not indicated. Instead, for better comparison of study findings, standardizes effects sizes (ES) were computed for differences and change scores. These ES allow not only to compare findings of studies with different outcome measures, but also to assess the clinical relevance of the findings. According to guidelines, an ES of 0.2 is considered small, 0.5 is medium, and 0.8 is large . Furthermore, an ES of 0.5 represents the minimal important difference for many patients reported outcome measures .

Results

Description of studies

After removal of duplicates a total of 2827 unique hits were identified. A first-round screen of all titles and abstracts resulted in a short-list of 166 articles for full text review. Following this, a total of 63 articles presenting findings of 55 individual studies were selected for inclusion in the final review ( Fig. 1 ).

Fig. 1
Schematic diagram of literature search and screening process.

A total of 21 studies were conducted in partially dentate subjects and two further studies included a mix of edentulous and partially dentate subjects ( Table 1 ). Furthermore, 32 studies identified in the literature review were conducted in edentulous patients ( Table 2 ).

Table 1
Summary of OHRQoL studies on implant-supported prostheses in partially dentate subjects.
Study Aim Methods and design Subjects Summary findings
Abu Hantash et al. To investigate the impact of psychological characteristics on OHRQoL in patients receiving implant-supported single crowns or fixed partial dentures Prospective, clinical study N = 50 patients Personality traits influenced patients’ responses to implants; neuroticism was significantly linked to overall satisfaction (lower levels of neuroticism associated with higher levels of satisfaction).
Assessments: before treatment and 2–3 months after treatment Mean age: 43.2 yrs (range: 22–71 yrs)
Measures: OHRQoL and personality traits 44.0% female
Instruments: DIDL, NEO-FFI
Al-Omiri et. al. Comparison between satisfaction with the dentition and dental prostheses and personal profiles in patients with implant-supported prostheses Prospective, clinical study N = 80 patients Patients’ satisfaction with their dentition was higher after implant treatment. Patients’ daily living and satisfaction with implant-supported prostheses were affected by personality traits.
Assessment: before treatment and 3 months after rehabilitation Mean age: 41.0 yrs (range: 18–77 yrs)
Measures: patient satisfaction, personality traits 47.5% female
Instruments: DIDL, NEO-FFI
Al-Omiri et. al. Assessment of the relationship between satisfaction with implant-supported fixed rehabilitations, their impacts on daily living, and personality profiles Cross-sectional study N = 100 patients (implant patients: n = 50; partially dentate controls: n = 50) Satisfaction was higher in patients with implants than in the control group. Daily living and satisfaction of patients with implant-supported fixed prostheses were influenced by personality traits.
Assessment: >3 month after treatment Mean age = 44.3 yrs (range = 23–60 yrs)
Measures: dental satisfaction 70% female
Instruments: DIDL, NEO-FFI
Alzarea et. al. To investigate OHRQoL of patients with dental implants and periodontal parameters of implants and healthy teeth Cross-sectional study N = 92 patients Patients with dental implants were satisfied with their OHRQoL.
Assessment: 1 year after treatment Mean age: 43 yrs (range 25–68 yrs)
Measures: OHRQoL 47.8% female
Instruments: OHIP-14
Bramanti et al. To determine the impact of implant-supported fixed partial dentures rehabilitation on OHRQoL among partially edentulous patients. Prospective, clinical study N = 50 patients OHRQoL improved after treatment with implant-supported fixed partial dentures, especially in patients with Kennedy class I and IV.
Assessments: before treatment and 2 years after treatment Mean age: 51.2 yrs (range: 40–70 yrs)
Measures: OHRQoL 56% female
Instruments: OHIP-14
Dolz et al. To compare the effect of implant rehabilitation on HRQoL and OHRQoL when implants are loaded either conventionally or immediately Prospective, non-randomized clinical trial N = 104 patients (immediate loading group: n = 29; conventional loading group: n = 75) A significant improvement was observed in OHRQoL and global oral satisfaction but not in HRQoL for both loading groups from baseline to the final evaluation. The improvement in OHRQoL was markedly greater in the patients who received immediately loaded implants. There were no significant differences in the ratings of general oral satisfaction or HRQoL.
Assessments: before treatment, 3 months after implant placement, and 3–5 months after final restoration Mean age: 55.5 yrs (range: not provided )
Measures: OHRQoL, HRQoL, global oral satisfaction 55.5% female
Instruments: OHIP-49, EuroQoL, VAS
Fillion et al. Assessment of OHRQoL improvement in patients who underwent dental implant treatment Prospective, clinical study N = 176 patients (single tooth group: n = 77; fixed partial denture group: n = 75; full prostheses group: n = 24) Implant treatment improved OHRQoL of participants. Before treatment, the mean GOHAI scores were lower for participants with fewer teeth. Highest improvement was observed in patients who needed complete dentures.
Assessments: before and 3–15 months after implant placement Mean age: 52.0 yrs (range: 18–84 yrs)
Measures: OHRQoL 59.1% female
Instruments: GOHAI
Furuyama et al. Comparison of OHRQoL in subjects with at least one dental implant and with removable partial dentures Cross-sectional study N = 188 patients (implant-supported fixed dentures [ID] group: n = 79; removable partial dentures [RPD] group: n = 109) Mean OHIP summary domain scores were significantly higher in subjects with removable partial dentures than in subjects with implant-supported fixed dentures, corresponding to better OHRQoL in the latter group.
Assessments: once at least 1 month’s usage of either treatment Mean age: 51.7 yrs [ID] and 66.5 yrs [RPD] (range: not provided )
Measures: OHRQoL 55.7% [ID] and 69.7% [RPD] female
Instruments: OHIP-49
Goiato et al. Evaluation of OHRQoL of patients with implant-supported fixed partial dentures. Cross-sectional study N = 106 patients The OHRQoL of patients wearing implant-supported fixed partial dentures was high.
Assessments: once Mean age: 54.2 yrs (range: not provided )
Measures: OHRQoL 58.5% female
Instruments: OHIP-14
Herrmann et al. Comparison of implant survival and OHRQoL of reduced-diameter implants and regular-diameter implants Retrospective study N = 311 patients (reduced-diameter implants [test] group: n = 107; regular-diameter implants [control] group: n = 204) There was no significant difference in patients’ OHRQoL between those with reduced-diameter implants or regular-diameter implants.
Assessments: posttreatment (mean follow-up period: 22.4 ± 8.2 months) Mean age: 53.3 yrs [test group] and 60.2 yrs [control group] (range : not reported )
Measures: OHRQoL 57.9% [test group] and 54.8% [control group] female
Instruments: OHIP-14
Kimura et al. Assessment of response shift in OHRQoL measures in subjects receiving implant-supported fixed or removable partial dentures Prospective, clinical study N = 138 patients (implant-supported fixed dentures [ID] group: n = 78; conventional fixed partial dentures [FPD] group: n = 37; removable partial dentures [RPD] group: n = 23) A significant response shift was reported in subjects with implant-supported fixed partial dentures and fixed partial dentures but not for those with removable partial dentures. Only subjects with implant-supported fixed partial dentures had a significant improvement in OHRQoL, irrespective whether response shift was taken into account.
Assessment: before treatment and after treatment completion Mean age: 61.4 yrs (range: 24–87 yrs)
Measures: OHRQoL 73.2% female
Instruments: OHRQoL questionnaire by Sonoyama et al.
Kriz et al. and Pavel et al. Assessment of OHRQoL improvement in patients receiving implant-supported fixed, removable, or complete dentures Prospective, clinical study N = 97 patients Implant treatment was associated with improvements in OHRQoL, which was influenced by the number of front teeth replaced with higher improvements when more front teeth were replaced.
Assessment: before implantation and at least 1 month after prosthodontic rehabilitation Mean age: 46.9 yrs (range: not provided )
Measures: OHRQoL 58.8% female
Instruments: OHRQoL questionnaire based on GOHAI and OHIP-14
Nickenig et al. Assessment of OHRQoL in partially edentulous subjects before and after implant treatment Prospective, clinical study N = 343 patients (partially edentulous implant patients [IP]: n = 219, fully dentate controls [DC]: n = 124) In the implant group, a significant improvement in OHIP score was reported post-treatment, but OHRQoL after implant treatment was still slightly more impaired than in fully dentate controls.
Assessments: before implantation and 1–2 months after prosthodontic rehabilitation Mean age: [IP] 44.7 yrs (range 19.2–67.6 yrs) and [DC] 45.2 yrs (range 21.3–56.7 yrs)
Measures: OHRQoL Gender: not provided
Instruments: OHIP-21
Nickenig et al. Assessment of the impact of dental implants on OHRQoL. Prospective, multicenter clinical study N = 8689 patients OHRQoL improved after treatment with dental implants and prosthodontic rehabilitation. The most significant improvement was observed in patients with edentulous jaws or anterior single-tooth gaps.
Assessments: preoperative, intermediate and posttreatment Mean age: 48.8 yrs (range: 19–89 years).
Measures: OHRQoL 46,7% female
Instruments: OHIP-21
Park et al. Comparison of OHRQoL after treatment with single-tooth implants versus three-unit fixed partial dentures for single missing tooth restoration. Cross-sectional study N = 71 patients (single-tooth implant group: n = 35; three-unit FPD: n = 36) After treatment, OHRQoL was rated better than before treatment without significant differences between groups.
Assessments: retrospective pretreatment (then test) and posttreatment Mean age: 52.2 yrs (range: 40–69 yrs)
Measures: OHRQoL 69% female
Instruments: OHIP-14
Perea et al. Assessment of OHRQoL of cemented implant prostheses for validation of the QoLIP-10 questionnaire Cross-sectional study N = 84 patients (screwed FDPs supported by 2 implants: n = 35); screwed FDPs supported by 3–5 implant: n = 7; cemented FDPs supported by 2 implants: n = 36; cemented FDPs supported by 3–5 implants: n = 6) The highest improvement in QoL was assessed for short cemented implant restorations. Patient satisfaction depended on extension and type of retention of the restoration.
Assessments: once after 1 year of treatment Mean age: not provided
Measures: OHRQoL 57.1% female
Instruments: OHIP-14, QoLIP-10
Persic et al. Assessment of improvement in orofacial esthetics, chewing function and OHRQoL on different prosthodontic rehabilitation options Prospective, clinical study N = 263 patients (conventional dentures group: n = 151; implant-supported dentures group: n = 112) After-treatment, OES, OHIP14, and CFQ scores were significantly better than baseline scores for all types of treatments. Implant support resulted in significantly higher improvements in OHRQoL, orofacial esthetics, and chewing function than for conventional dentures.
Assessments: before treatment and 3 months after prosthodontic rehabilitation Mean age: 62.3 yrs (range 27–93 yrs)
Measures: OHRQoL, orofacial esthetics, chewing function 61.6% female
Instruments: OHIP-14, OES, CFQ
Petricevic et al. Assessment of OHRQoL in subjects with implant- and tooth-supported fixed partial dentures Prospective, clinical study N = 164 patients (implant-supported fixed partial dentures [ID] group: n = 64; tooth-supported fixed partial dentures [FPD] group: n = 38; control group [CG]: n = 62) Baseline OHIP score were significantly higher (worse) in the implant group versus the fixed partial denture and the control group. OHRQoL was significantly improved 3 weeks after prosthodontic treatment in both treatment groups, and further improved to 3 years post treatment. Even though decrease in OHIP scores was higher in patients with implant support, OHRQoL was still more impaired after treatment than in patients with tooth-supported dentures.
Assessment: before treatment and at 3 weeks and 3 years after prosthodontic rehabilitation Mean age: 46.5 yrs [ID], 57.6 yrs [FDP], and 42,3 yrs [CG] (range 28–74 yrs)
Measures: OHRQoL 43.8% [ID], 63.2% [FPD], and 69.4% [CG] female
Instruments: OHIP-49
Ponsi et al. Comparison of changes in OHRQoL due to placement of a single implant in different areas (anterior, premolar, and molar areas) Prospective, clinical study N = 80 patients In the total population, mean OHIP score improved significantly following treatment. However, OHRQoL improvement was only significant for replaced anterior teeth or premolars but not for molars.
Assessment: after implant placement before uncovering and 3 months after prosthodontic rehabilitation Mean age: 52 yrs (range: 24–75 yrs)
Measures: OHRQoL 64% female
Instruments: OHIP-14
Raes et al. Comparison of OHRQoL of patients with single implants after placement in extraction sockets with placement in healed alveolar ridges Case-control study N = 96 patients (extraction group: n = 46; healed ridge group: n = 50) OHRQoL improved in both treatment groups. There was no significant difference in OHIP-scores between groups.
Assessment: at baseline and 1, 6, and 12 months after treatment Mean age: 43 yrs (range: 18–72 yrs)
Measures: OHRQoL 57.3% female
Instruments: OHIP-14
Swelem et al. Investigation of changes in OHRQoL in partially edentulous patients after different types of treatment with tooth-supported and implant-supported dentures Prospective, clinical study N = 200 patients (tooth-supported fixed dental prostheses group: n = 32; removable dental prostheses group: n = 111; implant-supported fixed dental prostheses group: n = 57) All treatments produced significant improvements in OHRQoL. Changes in OHIP summary scores were comparable in patients treated with either tooth-supported or implant-supported fixed dental prostheses.
Assessment: before treatment and 6 weeks and 6 months after prosthodontic rehabilitation Mean age: 41.8 yrs (range: 30–50 yrs)
Measures: OHRQoL 50.0% female
Instruments: OHIP-14
Thoma et al. Comparison of OHRQoL and implant survival rate of short (6 mm) versus long (11–15 mm) dental implants in combination with sinus grafting Prospective, RCT N = 101 patients The implant survival rate was 100%. OHIP summary scores decreased in both groups between baseline and follow-up.
Assessment: at baseline, at suture removal, at prosthesis insertion, and at 1-year follow-up Mean age: 50.5 yrs (range: 20–75 yrs)
Measures: OHRQoL, implant survival 51.5% female
Instruments: OHIP-49
Yu et al. Investigation of the relationship between anterior teeth implantation and OHRQoL improvement Prospective, clinical study N = 238 patients In patients with partial removable dentures for anterior teeth loss who seek replacement of these dentures, treatment with implant-supported fixed dental prostheses significantly improved OHRQoL. Most patients were satisfied with treatment result.
Assessment: before implantation and at 6 months after prosthodontic rehabilitation Mean age: 41.5 yrs (range: 29–56 yrs)
Measures: OHRQoL, implant restoration-related satisfaction 55.9% female
Instruments: OHIP-14, satisfaction items
CFQ, Chewing Function Questionnaire; DIDL, Dental Impact on Daily Living; EuroQoL, European Quality of Life indicator; GOHAI, Geriatric Oral Health Assessment Index; NEO-FFI, Neuroticism Extraversion Openness Five-Factor Inventory; OES, Orofacial Esthetic Scale; OHIP, Oral Health Impact Profile; OHRQoL, oral health-related quality of life; QoLIP, Quality of Life with Implant-Prostheses; VAS, Visual Analogue Scale.

Table 2
Summary of OHRQoL studies on implant-supported prostheses in edentulous subjects.
Study Aim Methods and design Subjects Summary findings
Attard et al. and Alfadda et al. Assessment of clinical and patient-reported outcomes 5 years after placement of mandibular implant-supported overdentures with immediate loading Prospective, clinical study N = 77 patients (n = 35 patients with data on PROs) One year after treatment, there was a statistically significant improvement in total and functional dental satisfaction scores and in OHRQoL. Initial improvements were maintained over five years.
Assessment: before treatment and at 1 and 5 years after prosthodontic rehabilitation Mean age: 64.1 yrs (range: not reported )
Measures: OHRQoL, dental satisfaction 39.1% female
Instruments: OHIP-20, DSQ
Allen et al. Assessment of the impact of preoperative expectations and implant-stabilized prostheses versus conventional prostheses on oral health status Prospective, clinical study N = 75 patients (implant denture [ID] group: n = 20; conventional denture group 1 [CD1]: n = 20; conventional denture group 2 [CD2]: n = 35) Preoperative, satisfaction in the three groups was very low. At 3 months after treatment, the three groups had a higher denture satisfaction and decreased OHIP summary scores. The expectation levels preoperative did not influence the satisfaction.
Assessment: before treatment and 3 months after prosthodontic rehabilitation Mean age: 55.8 yrs [ID], 60.2 yrs [CD1], and 65.1 yrs [CD2] (range: not reported )
Measures: OHIP, denture satisfaction, expectations of implant therapy 85.0% [ID], 55.0% [CD1], and 74,3% [CD2] female
Instruments: OHIP-49, DSQ
Allen et al. Assessment of implant-retained overdentures (2 implants) versus conventional complete dentures reporting clinical and OHRQoL outcomes Prospective, RCT N = 118 patients (implant denture [ID] group: n = 62; conventional denture [CD] group: n = 56) At 3 months after treatment, there were significant improvements in OHRQoL and denture satisfaction in both groups versus baseline. However, no significant differences between treatment groups were observed.
Assessment: before treatment and at 3 months after treatment Mean age: 64.5 yrs [ID] and 68.5 yrs [CD] (range: not reported )
Measures: OHRQoL, denture satisfaction 71.1% [ID] and 71.7% [CD] female
Instruments: OHIP-49, DSQ
Allen and McMillan Clinical trial of the impact of oral implants on OHRQoL Prospective, clinical trial N = 103 patients (implant denture [ID] group: n = 26; conventional denture implant request [CD1] group: n = 22; conventional denture [CD2] group: n = 35; dentate control [DG] group: n = 20) Subjects requesting implants had lower baseline OHRQoL versus patients requesting conventional dentures. Effect size for change in OHIP score was large for the group receiving implants and small for both groups receiving conventional dentures.
Assessment: pre- and posttreatment Mean age: 58.7 yrs [ID and DG], 60.2 yrs [CD1], and 65.1 yrs [CD2] (range: not provided )
Measures: HRQoL, OHRQoL, denture satisfaction 88.5% [ID], 54.5% [CD1], 74.3% [CD2], and 30.0% [DG] female
Instruments: OHIP-49, DSQ, SF-36
Awad et. al. Comparison of OHRQoL in patients with mandibular implant-supported overdentures and patients with conventional prostheses Prospective, RCT N = 102 patients (conventional denture [CD] group: n = 48; implant overdenture [IOD] group: n = 54) The assessment indicates that patients with implants have a more positive OHRQoL compared to conventional therapy.
Assessment: pre- and 2 month posttreatment Mean age: not provided (range: 35–65 yrs)
Measures: OHRQoL 49% female
Instruments: OHIP, VAL
Awad et al. , Heydecke et al. and Heydecke et al. Comparison of patient satisfaction, OHRQoL, and HRQoL in elderly subjects receiving mandibular 2-implant supported overdentures or conventional dentures Prospective, RCT N = 60 patients (conventional denture [CD] group: n = 30; implant overdenture [IOD] group: n = 30) At 2 months post treatment, subjects who received implants had higher satisfaction than subjects who received conventional dentures. Post-treatment OHIP score was significantly better in subjects receiving implants in comparison with those receiving conventional dentures. However, effects of implant treatment on HRQoL were only significant for subscales Role Emotional, Vitality, and Social Function.
Assessment: before treatment and 2, 6, and 12 months after treatment Mean age: 69.4 yrs [CD] and 68.9 yrs [IOD] (range 65–75 yrs)
Measures: OHRQoL, dental satisfaction, HRQoL 60.0% [CD] and 53.3% [IOD] female
Instruments: OHIP-49, VAS, SF-36
Awad et al. Comparison of OHRQoL in subjects receiving 2-implant supported mandibular overdentures and conventional dentures Prospective, multicenter, non-randomized controlled trial N = 203 patients (implant denture [ID] group: n = 104; conventional denture [CD] group: n = 99) The proportion of patients who showed improved OHIP-20 scores at 6 months was higher in the groups receiving implants in comparison with those receiving conventional dentures.
Assessment: at baseline and 6 months after treatment Mean age: 68.8 yrs (range: not provided )
Measures: OHRQoL 61.4% [ID] and 57.4% [CD| female
Instruments: OHIP-20
Brennan et al. Comparison of OHRQoL and patient satisfaction in subjects receiving implant-supported overdentures and implant-supported fixed dentures Cross-sectional study N = 62 patients (implant-supported overdenture [IOD] group: n = 25; implant-supported fixed denture [IFD] group: n = 37) Overdenture group reported lower overall satisfaction and satisfaction with chewing ability and esthetics versus subjects with fixed prostheses. Overall OHRQoL was high in both groups; subjects in the fixed prostheses group had significantly lower levels of psychological discomfort and psychological disability versus overdenture subjects.
Assessment: after treatment (no exact follow-up time reported) Mean age: 57.5 yrs [IOD] and 56.0 yrs [IFD] (range: not provided )
Measures: OHRQoL, satisfaction 56.0% [IOD] and 67.6% [IFD] female
Instruments: OHIP-14, VAS
Candel-Marti et al. Comparison of OHRQoL and satisfaction in patients with palatal positioned implants and with well-centered implants supporting fixed full-arch prostheses Cross-sectional study N = 57 patients (palatal positioned implants [PI] group: n = 32; well-centered implants [CI] group: n = 25) Satisfaction and quality of life were high and similar in both groups.
Assessment: 5–11 years after implant treatment Mean age: 55.0 yrs [PI] and 55.9 yrs [CI] (range: not provided )
Measures: OHRQoL, satisfaction 75% [PI] and 48% [CI] female
Instruments: OHIP-14, VAS
Cakir et. al. Comparison of satisfaction and QoL in subjects receiving mandibular complete dentures, implant-retained overdentures, removable partial dentures, or implant-supported fixed partial dentures Prospective, RCT N = 116 patients (implant-retained overdentures n = 29, implant-supported FPDs n = 29, conventional complete dentures n = 29, or RPD n = 29) OHRQoL improved in all groups at post-treatment. Highest improvement was observed in the implant-retained overdenture group.
Assessment: before treatment and 1 yr after treatment Mean age: 58.0 yrs (range: 36–81 yrs)
Measures: QoL 54.3% female
Instruments: OHIP-14, OHQoL-UK, SF-36
De Souza et al. Comparison of mandibular overdentures retained by 2 or 4 mini-implants with standard implants Prospective, RCT N = 120 patients (4 mini-implants [4MI] group: n = 38; 2 mini-implants [2MI] group: n = 42; 2 standard implants [2SI] group: n = 40) OHRQoL and satisfaction improved in all groups post-treatment, with most favorable results in patients with mini-implant-retained mandibular overdentures. However, the provision of mini-implants was associated with considerably higher implant failure rate than observed for standard implants.
Assessment: before intervention and 3, 6 and 12 months after treatment Mean age: 59.3 yrs [4MI], 59.1 yrs [2MI], and 60.2 yrs [2SI] (range: not provided )
Measures: OHRQoL, satisfaction 68,4% [4MI], 71,4% [2MI] and 62,5% [2SI] female
Instruments: OHIP-EDENT, VAS
Ellis et al. To investigate the impact of dietary advice in subjects with 2-implant-supported mandibular overdentures and conventional dentures Prospective, clinical study N = 54 patients (implant-supported overdenture [IOD] group: n = 28; conventional denture [CD] group: n = 26) At 6 months, the implant group had significantly better satisfaction scores in terms of denture comfort, stability and chewing ability. However, there was no significant between-group difference in OHRQoL.
Assessment: before intervention and 6 months after dietary advice was provided Mean age: 65.4 yrs [IOD] and 70.6 yrs [CD] (range : not provided )
Measures: OHRQoL, satisfaction 71.4% [IOD] and 69.2% [CD] female
Instruments: OHIP-20, denture satisfaction scale
Emami et al. and Jabbour et al. To assess influence of sense of coherence on OHRQoL for implant-supported overdentures versus conventional dentures and to determine the stability and magnitude of the effect on OHRQoL Prospective, RCT N = 173 patients (implant-supported overdenture [IOD] group: n = 97; conventional denture [CD] group: n = 76) Subjects with implants had a significantly higher improvement in OHRQoL versus conventional dentures. There was no significant relationship between OHRQoL and SOC. At both follow-ups, participants wearing implant-supported overdenture reported significantly better total OHIP scores than those wearing conventional dentures.
Assessment: before treatment, and 1 and 2 years after treatment Mean age: 72.1 yrs (range: 66–88 yrs)
Measures: OHRQoL, SOC 53,6% [IOD] and 53,9% [CD] female
Instruments: OHIP-20, SOC-13
Emami et al. Assessment of OHRQoL in subjects receiving mandibular three-implant overdentures Prospective, clinical study N = 135 patients The study observed an improvement in all seven domains of the OHIP-20 after receiving a mandibular three-implant overdenture.
Assessment: before treatment and after treatment Mean age: 61.6 yrs (range: not reported)
Measures: OHRQoL, Denture satisfaction 68.1% female
Instruments: OHIP-20, DSQ
Erkapers et al. To assess satisfaction after implant treatment in atrophic maxilla Prospective, multicenter, clinical study N = 51 patients Post-treatment there were significant improvements in total OHIP score and all OHIP subdomain scores on all occasions.
Assessment: prior to treatment and 12 weeks, and 6 and 12 months after treatment Mean age: 65.8 yrs (range: 47–83 yrs)
Measures: OHRQoL 52.9% female
Instruments: OHIP-49
Fernandez-Estevan et al. Assessment of OHRQoL in patients with implant-supported overdentures and conventional complete dentures Cross-sectional study N = 193 (dentate patient group [DP]: n = 57; conventional complete denture [CD] group: n = 56; implant-supported overdentures [IOD] group: n = 80 Patients with implant-supported overdentures has significantly lower OHIP summary scores than patients with conventional complete dentures. Level of impairment in patients with implants was comparable to dentate controls.
Assessment: after treatment Mean age: 69.5 yrs [DP and CD] and 69.6 yrs [IOD]
Measures: OHRQoL 57.2% [DP and CD] and 60.0% [IOD] female
Instruments: OHIP-20, OSS.
Geckili et al. To assess the impact of two-implant retained overdentures on OHRQoL Prospective, clinical study N = 78 patients Following implant treatment there was a significant improvement in OHIP-14 total score and all subscale scores. OHQoL-UK total and all subscales were also significantly improved following implant treatment.
Assessment: prior to treatment and 6 months after treatment Mean age: not provided (range: 65–82 yrs)
Measures: OHRQoL Gender: not provided
Instruments: OHIP-14, OHQoL-UK
Geckili et al. To compare patient satisfaction, quality of life, and bite force with respect to implant support for complete dentures Cross-sectional study N = 100 patients (implant-supported overdenture [IOD] group: n = 50; conventional denture [CD] group: n = 50) While patients in the implant treatment group were significantly more satisfied than patients with conventional dentures, differences in OHRQoL were only small and not significant.
Assessment: 4 years after treatment Mean age: 67.9 yrs (range: 65–74 yrs)
Measures: OHRQoL, satisfaction, bite force 62.0% [IOD] and 68.0% [CD] female
Instruments: OHIP-14, VAS
Geckili et al. and Mumcu et. al. To assess the influence of masticatory function and type/number of implants on patient satisfaction and quality of life of patients wearing mandibular implant-supported overdentures Cross-sectional study N = 62 patients (2 implants with ball: n = 14; 2 implants with Locator: n = 14; 3 implants with ball: n = 12; 3 implants with bar: n = 11; 4 implants with bar: n = 11 The number of implants or attachment type were not associated with patient satisfaction but with OHRQoL. Lowest OHIP summary scores were observed in patients with 4-implant-supported bars.
Assessment: 3 years after treatment Mean age: 64.0 yrs (range: 42–90 yrs)
Measures: OHRQoL, Satisfaction and Maximum Bite Force 51.6% female
Instruments: OHIP −14, VAS
Geckili et al. and Geckili et al. To assess the influence of interimplant distance and momentary retention forces on patient satisfaction and QoL in subjects receiving mandibular overdentures supported by two implants Prospective, clinical study N = 55 patients (ball attachments: n = 22, Locator attachments: n = 33 Longer interimplant distance was associated with better OHRQoL. Furthermore, OHIP scores in the social disability and handicap domains were lower in subjects with higher retention forces.
Assessment: after treatment Mean age: 64.4 yrs (range: not provided)
Measures: OHRQoL 56.4% female
Instruments: OHIP-14, VAS
Gjengedal et al. To compare OHRQoL and HRQoL in edentulous patients who were treated either with a conventional relining of the existing complete denture or by converting it into an implant-retained overdenture Prospective, RCT N = 54 patients (relined conventional denture [RCD] group: n = 26; implant-retained overdenture [IOD] group: n = 28) In edentulous patients dissatisfied with their existing conventional complete dentures, implant support resulted in substantial short-term and middle-term improvements in OHRQoL whereas conventional relining had no effect on OHRQoL. However, HRQoL, general well-being, and coping strategies were not affected by either treatment option.
Assessment: before treatment, and 3 months and 2 years after treatment Mean age: 67 yrs (range: 53–78 yrs) [RCD] and 68 yrs (range: 48–78 yrs) [IOD]
Measures: OHRQoL, HRQoL, general well-being, coping strategies 65.4% [RCD] and 64.3% [IOD] female
Instruments: OHIP-20, SF-36, WHO-Five Well-Being Index, BACQ
Harris et al. Determination of differences in patient satisfaction with implant overdentures compared to conventional complete dentures Prospective, multicenter RCT N = 122 patients (conventional denture [CD] group: n = 62; implant-retained overdenture [IOD] group: n = 60) While in patients dissatisfied with their existing conventional complete dentures the provision with new ones already substantially improved patient satisfaction and OHRQoL, implant treatment led to further improvements in patient perceptions. However, no impact on HRQoL was detected.
Assessment: baseline, 3 months after receiving conventional complete dentures, and additional 3 months with conventional or implant-supported complete dentures Mean age: 64,4 yrs (range: not provided )
Measures: OHRQoL, denture satisfaction, HRQoL 68.0% female
Instruments: OHIP-49, DSQ, SEIQoL
Heydecke et al. Assessment of the impact of implants on social and sexual activities in subjects with new mandibular conventional complete dentures or 2-implant retained mandibular overdentures Prospective, RCT N = 102 patients (conventional denture [CD] group: n = 48; implant-supported overdenture [IOD] group: n = 54) Following treatment, improvements in OHRQoL were reported for each group, but improvement was significantly better for subjects receiving implants versus those receiving conventional dentures. Conventional complete dentures are associated with more negative impacts on leisure and sexual activities than implant overdentures.
Assessment: before treatment and two months after treatment Mean age: 51.2 yrs [CD] and 50.8 yrs [IOD] (range 35–65 yrs)
Measures: OHRQoL, social and sexual activities 45.8% [CD] and 51.9% [IOD] female
Instruments: OHIP-49, SIQ
Melas et al. Comparison of OHRQoL between patients treated with implant-stabilized overdentures and conventional dentures Prospective, clinical study N = 83 patients (implant overdenture [IOD] group: n = 43; conventional denture [CD] group: n = 40) Compared to conventional dentures patients with implant-stabilized overdentures were statistically significantly higher satisfied and experienced less impact on daily life.
Assessment: posttreatment Mean age: 69.6 yrs [CD] and 63.7 yrs [IOD] (range: not provided )
Measures: OHRQoL 52.9% female
Instruments: OIDP
Mundt et al. Assessment of OHRQoL, implant survival and prosthetic aftercare of edentulous people treated with mini dental implants for stabilization of their complete dentures Retrospective study N = 133 patients OHIP summary scores after treatment were low, indicating high OHRQoL.
Assessment: retrospective pretreatment (then test) and post treatment Mean age: 71.2 yrs (range: 48–100 yrs)
Measures: OHRQoL 59.4% female
Instruments: OHIP-14
Persic et al. Comparison of OHRQoL in patients rehabilitated with three different types of mandibular implant overdentures after at least 3 years in function Cross-sectional study N = 122 patients (4 mini-implants [4MI] group: n = 50; 2 implants with locator [2IL] group: n = 56; 2 implants with bar [2IB] group: n = 16) Patients with IODs supported by 4 mini-implants had better OHRQoL than those with 2 standard implants and bar- and locator-retained IODs.
Assessment: 3–5 years after treatment Mean age: 66.7 yrs [4MI], 61.9 yrs [2IL], and 60.8 yrs [2IB]
Measures: OHRQoL 62.3% female
Instruments: OHIP-14
Preciado et al. To validate QoLIP-10 and to compare OHRQoL in patients with conventional complete dentures, implant-retained overdentures and hybrid implant-prostheses Cross-sectional study N = 150 patients (conventional complete denture group: n = 50; implant-retained overdenture group: n = 50; hybrid implant-prosthesis group: n = 50) Overall OHRQoL did not differ significantly between patients with conventional complete dentures, implant-retained overdentures and hybrid implant-prostheses for both instruments OHIP-20 and QoLIP-10.
Assessment: approximately 1–16 yrs after treatment Mean age: not provided (range: 40–90 yrs)
Measures: OHRQoL 64.0% female
Instruments: OHIP-20, QoLIP-10
Preciado et al. To validate QoLIP-10 and to assess OHRQoL in patients with various types of screwed implant-prostheses Cross-sectional study N = 131 patients (implant-retained overdenture group: n = 38, hybrid implant-prosthesis group: n = 50, implant-supported fixed partial denture group: 43) While OHRQoL measured with the summary scores of OHIP-14 and QoLIP-10 did not differ substantially between patient groups, hybrid prosthesis wearers had lower OHRQoL in some of the subscales, in particular Dental-Facial Aesthetics and Performance of the QoLIP-10 and Functional Limitation of the OHIP-14.
Assessment: at least 10 months after treatment Mean age: not provided (range: not provided )
Measures: OHRQoL, dental satisfaction 57.3% female
Instruments: OHIP-14, QoLIP-10, VAS
Schoen et al. and Korfage et al. To assess impact of mandibular implants on OHRQoL and HRQoL in patients with tooth loss due to head and neck cancer receiving mandibular implant-retained overdentures, and to compare effects with respect to radiation Prospective, clinical study N = 50 patients Implant-retained overdentures were associated with improvements in OHIP scores, which were more pronounced in non-irradiated versus irradiated patients. Post-treatment QoL and OHRQoL were worse in patients who had undergone radiation therapy versus those who had not. In surviving patients, there was no significant change in OHIP scores from 1-year to 5-year follow-up.
Assessment: before treatment, 6 weeks, and 1 and 5 years after treatment Mean age: 61.5 yrs (range 41–81 yrs)
Measures: OHRQoL, denture satisfaction, HRQoL 30% female
Instruments: OHIP-49, EORTC QLQ-C30 and H&N35
Sun et al. Evaluation of masticatory efficiency and OHRQoL in patients with implant-retained mandibular overdentures Prospective, clinical study N = 50 patients Implant-retained mandibular overdentures significantly improved patients’ OHRQoL. The improvement in OHRQoL was mainly due to a decrease in OHIP scores in the subscale Functional Limitation, which was correlated to improvements in masticatory efficiency.
Assessment: 1 month before treatment, and 6 months after treatment Mean age: 62 yrs (range: 55–74 yrs)
Measures: OHRQoL, masticatory efficiency 44.0% female
Instruments: OHIP-49
Torres et al. To assess the impact of personality traits on OHRQoL in patients with conventional mandibular overdentures versus implant-supported mandibular overdentures Cross-sectional study N = 100 subjects (conventional denture [CD] group: n = 50, implant-supported overdenture [IOD] group: n = 50) Subjects in the implant group had significantly better OHIP scores in comparison with those with conventional dentures. Personality traits, in particular neuroticism and conscientiousness, were related to OHRQoL in both treatment groups.
Assessment: between 12 and 48 months after treatment Mean age: 64.2 yrs [CD] and 61.8 yrs [IOD] (range: not provided )
Measures: OHRQoL, personality traits 52.0% [CD] and 48.0% [IOD] female
Instruments. OHIP-14, NEO-FFI
Vercruyssen et al. Comparison of implant and patient outcome of guided and conventional implant placement Prospective, RCT N = 59 patients For both treatment groups a significant improvement in OHRQoL was observed with no differences between guided or conventional implant placement.
Assessment: after implant placement, prosthesis instalment and 1-year follow-up Mean age: 58 yrs (range: 31–78 yrs)
Measures: OHRQoL 52.0% female
Instruments. OHIP-49
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Jun 17, 2018 | Posted by in General Dentistry | Comments Off on Oral health-related quality of life in subjects with implant-supported prostheses: A systematic review
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