Implantes Mandibulares

TOPICS OF INTEREST Mandibular Implant Overdenture Treatment: Consensus and Controversy
David R. Burns, DMD
A literature review of implant overdenture treatment for the edentulous mandible is presented. The report focuses on the knowledge base for this treatment modality, in an effort to distinguish between areas that are well characterized and enjoy a higher level of consensus amongpractitioners as compared with those that are more controversial and not clearly understood. J Prosthod 2000;9:37-46. Copyright 2000 by The American College of Prosthodontists. INDEX WORDS: dental implant, denture, edentulism, combination syndrome, peri-implant, patient satisfaction, treatment complications

ESEARCHERS and clinicians must address many diverse aspects of knowledge in understanding andproviding mandibular implant overdenture treatment. The areas supported by research generally embrace a higher level of consensus among practitioners. Research data, however, is not available to support all of the considerations necessary to predict successful clinical treatment outcome. There are voids in our knowledge base in which objective information does not exist. Some areas are either unable tobe tested or have not been considered using a strict research protocol. Additionally, it is not uncommon to find contradictory results and conclusions from related research efforts, even when strict research protocols are followed. In the absence of unequivocal evidence-based knowledge, these questions are often addressed using nonscientific data, clinical experience, and the opinions,assumptions, and inferences of clinicians. These contributions can be useful and clinically relevant, but should be considered controversial and subject to interpretation. To properly critique the understanding of mandibular implant overdenture treatment,
Associate Professor, Department of Prosthodontics, Virginia Commonwealth University, School of Dentistry, Richmond, VA. Accepted February 16, 2000.Supported in part by National Institutes of Health grant 1R01DE1220401A1. Presented in part at the American College of Prosthodontists Annual Session, October 22, 1999, New York, NY. Correspondence to: Dr. David R. Burns, Virginia Commonwealth University, MCV Campus, School of Dentistry, Department of Prosthodontics, P.O. Box 980566, Richmond, VA 23298-0566. E-mail: Dburns@den1. den.vcu.edu Copyright2000 by The American College of Prosthodontists 1059-941X/00/0901-0008$5.00/0 doi: 10.1053/jd.2000.6782

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clinicians must distinguish areas of consensus from areas of controversy. The purpose of this report is to review the literature, addressing some of the current issues influencing our understanding of mandibular implant overdenture treatment, and to distinguish between areas of consensusof opinion and controversy. This awareness becomes increasingly important with a growing acceptance of this treatment modality and a possible paradigm shift in therapeutic philosophy, in which implant overdenture treatment could become the future standard of care for mandibular edentulism.

Edentulism
In considering this treatment modality and to understand the extent of the clinical problem,it is necessary to first explore the treatment diagnosis: edentulism. According to National Institute of Dental and Craniofacial Research epidemiological data, approximately 10% of the US adult population is completely edentulous.1 The estimated number of edentulous individuals ages 18 to 74 using complete denture prostheses in this country is nearly 14 million.2 With people living longer, thedemographics of the United States are shifting to a progressively larger older adult subgroup. As a result, it is estimated that within the population over the next 30 years, the number of edentulous individuals over age 65 will remain constant at around 9 million, despite a decrease in the percentage who are edentulous.3

Conventional Denture Treatment
Numerous factors are involved in the...