Comparison of the Quality of Life Among the Immediate Loading Implant Overdentures Using the Single and the Double Implants: An Original Study

ABSTRACT

Introduction:

In edentulous individuals, single implant-retained mandibular overdentures are an effective substitute for double implant-retained overdentures. In this current research, the oral health-related quality of life (OHRQoL) was assessed for the immediate loading overdenture using the implants. The comparisons are drawn between the single and double implants.

Materials and Methods:

Forty subjects received single and double implants for the placement of the mandibular overdentures. Within a week days of implant insertion, they were loaded with overdentures. Using the Oral Health Impact Profile-14 (OHIP-14) questionnaire, the OHRQoL was measured before treatment, one month following treatment, and 12 months thereafter.

Results:

In both the single implant and double implant groups, participants’ mean OHIP-14 scores decreased statistically significantly for the different timelines. For the single implant group, the baseline total mean OHIP-14 score was 14.33, and for double implants, it was 19.15. Following therapy, it decreased to 8.55 in the single implant group and 9.48 for the double implant group at one month, and at 12 months, it further decreased to 3.25 in the single implant group while it was 5.15 in the double implant group.

Conclusions:

Single and double implants increase the QoL for older subjects who are edentulous at the 1-month and 1-year recall points. When two implants are used by older individuals, the single implant might offer an equivalent quality of life.

INTRODUCTION

One of the most often utilized treatment techniques for edentulism is the use of conventional complete dentures. Edentulism is a physical handicap caused by a compromised capacity to carry out basic living functions, such as speaking and eating. The most crucial factor in determining patient satisfaction is the clinically stable mandibular denture.[1-5] Implants have been recently employed for a variety of conditions. They can be used to rehabilitate both the partial and complete edentulous arches. They can be used for removable as well as fixed dental prostheses.[6-8] Lack of retention and stability, however, causes denture users to have decreased chewing ability.[9]

The overdentures can provide more retention and stability in complete dentures. These are also preferred for various reasons in favor of the patient. The overdentures can take support from the implants. These implants can be single or multiple that are placed in two or three areas of the ridges. These are studies supporting the role of single implants for overdentures.[10-15] The logic suggests that the two implants give better retention than the single implant for the overdenture. Many clinical trials have been performed in the same line.

In comparison to the double implant, the single implant lowers the patient’s initial treatment costs, lessens postoperative pain, and offers lower maintenance costs. A clinically viable alternative to double implant, single implant was first proposed by Cordioli.[11] They also concluded that all their subjects have shown success even at the end of five years. de Souza Batista et al.[13] and Mahoorkar et al.[14] conducted studies more recently suggesting that single implant support has been more practically feasible.

The loading of the overdentures over the implants has been a point of debate. The denture can be loaded delayed or immediately or after a few weeks, with different effects on the longevity of the overdenture as well as the implants.[14-18] For all the various times of the loading, the output parameters were similar. However, the immediate loading procedures became popular because they allow patients to experience immediate esthetics and function while also assisting in the reduction of postoperative pain and suffering by reducing the masticatory load on the healing tissues.[18] Immediate loading single implants have been successfully used by many clinicians.[19,20]

The study designs for the previous studies ranged from clinical randomized trials and prospective to retrospective studies. In all these studies, the QoL using various measurement techniques was considered as the final outcome.[18-24] There is very less literature regarding the overdenture using a single implant and immediate loading. There are seldom studies that have considered the QOL in these circumstances using the immediate load and single implant overdenture. The “Oral Health Impact Profile (OHIP)” is one of the best reliable and valid methods used to evaluate the quality of life.[25] In this current research, the oral health-related QOL (OHRQoL) was assessed for the immediate loading overdenture using the implants. The comparisons are drawn between the single and double implants.

MATERIAL AND METHODS

Research plan

This prospective, randomized, clinical trial aims to assess OHRQoL among subjects receiving double and single implants. The “CONSORT” reporting guideline as well as the “Declaration of Helsinki” was used to prepare the manuscript.[13] The joint committee on research and ethics granted institutional ethical approval for the study.

Participants

Forty participants received treatment with immediately loaded implant overdentures using the implants “Touareg-OS, ADIN Dental Implant System, Afula, Israel” and they were then monitored for one month and one year. All participants provided their written, informed permission. The study period was for 18 months which included the selection as well as the follow-up of the participants.

Inclusion principles

Both sexes must be entirely edentulous in the mandible, be between the ages of 40 and 80, have worn full dentures for three months, have sufficient alveolar ridge for standard implants, consent for the implantation, and approve to appear at scheduled follow-up sessions.

Exclusion principles

The following patients were not considered for the study:

• Systemic illnesses or metabolic conditions that may affect research; pregnant women or nursing mothers

• Smokes now or last gave up less than a year ago

• Non-functional habits

• Current radiation, chemotherapy, or medications interfering with the recovery

After being evaluated by a professional for functionality and acceptability, patients’ current complete dentures were taken into consideration for attachment pick up. All clinical and technical elements of dentures, such as denture border extension, occlusion, retention, and stability, were assessed.[20] Only patients who required a new set of dentures were given permission to use them for at least 3 months before receiving implant treatment. According to established guidelines, either a cone beam computed tomography or an intraoral periapical radiograph was used to assess the mandibular bone’s compatibility for implant insertion.[20]

Intervention

The initial screening and participant selection were carried out considering the selection criteria. Using sealed opaque white envelopes and a 1:1 allocation ratio, the participants were then randomly assigned to the two groups. Each subject received a unique secret code number that served to safeguard their identity. To reduce the likelihood of inter-operator skill bias, all surgical and prosthetic procedures were carried out by a single implantologist. The implants were placed based on the manufacturer’s instructions. The single implant group received the implant at the midline of the alveolar ridge while at the canines, the double implant group received the implants. According to the patient’s needs, either pink or blue female attachments were used. Each participant received a prescription for 3–5 days of postsurgical analgesics. The statistician and data processor were both blind. Blinding of both study participants and implant doctors was not possible.

Measurements of OHRQOL

Following the designated timeline, the subjects’ opinions were noted baseline, after one month, and after 12 months of the implantation. The OHIP-14 was administered in either depending on the language preference and comprehension of the patient. The OHIP-14’s had seven parameters which contained two questions: “functional limitation, physical discomfort, psychological discomfort, physical disability, psychological disability, social disability, and handicap.” Never, infrequently, occasionally, frequently, and always were the five response options for each question. The achievable OHIP14 scores range from 0 to 56 for the 14 questions. The items were scored on five-point scales with “0” denoting “never” and “4” denoting “always.”[26-28]

Statistic evaluation

Descriptive statistics were used to assess the findings and make comparisons between the groups. Kruskal–Wallis test and Shapiro–Wilk test were used to examine the OHIP-14 scores over time with baseline and after. IBM Corporation’s Statistical Package for Social Sciences was used to conduct the statistical analysis; version 25.0 of “IBM SPSS Statistics for Windows (IBM Corp., Armonk, New York).” The chosen level of significance was < 0.05.

RESULTS

The average age of the 40 participants, who were included, was 64.5 ± 2.3 years old; the participants’ ages ranged from 42 to 80 years. There were 15 men and 25 women. One implant failed in the double implant group due to peri implantitis. Finally, 19 subjects in the double implant group and 20 subjects in the single implant group were analyzed for the parameters intended in the study.

For the single implant group, the baseline total mean OHIP 14 score was 14.33, and for double implants, it was 19.15. Following therapy, it decreased to 8.55 in the single implant group and 9.48 for the double implant group at one month, and at 12 months, it further decreased to 3.25 in the single implant group and 5.15 in the double implant group. The subscale “physical discomfort” had the greatest baseline values in both the single implant group (3.9) and double implant group (4.1), while the subscale “social disability” had the lowest baseline levels in both the single implant group (0.5) and double implant group (1.48). When compared to the double implant group, only the “psychological discomfort” category revealed a greater change in scores for the single implant group (1.05 at 1 month and 0.35 at 1 year) (1.14 at 1 month, 0.73 at 1 year) [Table 1].

Table 1.

Comparison of different OHIP-14 scores at various timelines

	Baseline		1 Month		12 Months
	Single	Double	Single	Double	Single	Double
Functional limitation	2.1	3.4	1.25	2.07	0.55	1.18
Physical pain	3.9	4.11	2.5	2.23	1.41	1.18
Psychological discomfort	2.4	2.11	1.05	1.14	0.35	0.73
Physical disability	3.4	3.61	1.8	1.78	0.75	0.57
Psychological disability	1.3	2.23	0.7	0.73	0.05	0.765
Social disability	0.5	1.48	0.3	0.68	0	0.32
Handicap	0.6	1.61	0.35	0.65	0.04	0.32
Total score	14.33	19.15	8.55	9.48	3.25	5.15

When the total scores were analyzed, it was found that significant dissimilarities were seen for the mean OHIP-14 scores P < 0.001 as well as at the baseline P = 0.021. The double implant group had a greater score at all three follow-up timelines in the study [Table 2].

Table 2.

Pairwise Mann–Whitney comparisons at various time intervals

Time (OHIP14)	Group	Mean rank	P
Baseline	Single	140.56	0.021
	Double	166.13
1 month	Single	150.16	0.369
	Double	158.10
12 months	Single	145.40	0.058
	Double	162.10
Mean OHIP-14 score (between the timelines also P<0.001 was obtained)	Single	435.01	<0.001
	Double	485.23

DISCUSSION

The results showed higher OHRQoL with the double implant group compared with the single implant group subjects, rejecting the null hypothesis. The OHIP 14 questionnaire was used in this clinical investigation that was randomized and controlled to assess OHRQoL. Because it is not always feasible in a clinical environment to administer the entire 49-item OHIP, a condensed version created by Slade[24] was employed. The double implant provides the edentulous mandible with the minimum quality of care, making the use of the single implant inferior. However, the single implant has some benefits, such as “lower cost, minimal surgical stress, and minimal repair or maintenance.” The OHIP 14 results show that the double implant had higher baseline overall scores and the single implant had lower total scores. The reason for this observation can be attributed to the selection bias and hence the significant disparities that are seen between the two groups may not be of great value. All participants in the current study were chosen at random; no special factors, such as age, sex, or ethnicity were taken into consideration. From the baseline to one month and one year later, all subscale scores displayed a declination. A greater drop in scores suggested an improvement in OHRQoL. Compared to the single implant group, the double implant group experienced a higher decline in scores at 1 month and 12 months. Except for “psychological discomfort,” which showed a higher reduction in scores with the single implant compared with the double implant, all the subscales showed a similar trend. This could not be the reason that the single implant merely significantly reduced “psychological discomfort.” Most likely, this is just an overwhelmingly positive response from the single implant group’s participants to their treatment response, and psychologically, they may be feeling more at ease thanks to increased retention compared to their prior experiences.

In a systematic evaluation of nine randomized controlled trials (RCTs) and eight prospective studies with 500 participants, Fu et al.[25] found that there were no significant alterations between the single implant and double implant for the various parameters of the OHP. Retention and stability and OHRQoL, however, showed mixed findings. The majority of these investigations used standard loading techniques. The results of the current study were consistent with those of the earlier studies and showed that groups with instantaneous loading in single implant and the double implant had comparable OHRQoL.

The measurement of the OHIP scores and subsequent QoL results in the previous literature is inconsistent. Brennan et al.[29] compared OHRQoL using OHIP 14 between patients treated with implant overdentures and those treated with full implant fixed prosthesis. The scores are shown as a percentage. Using OHIP 14, Felix et al.[30] investigated the effects of implant-supported fixed oral rehabilitation on QoL, and the findings were given as median values. The rating standards were not applied consistently. The few studies employed a “never” to “always” 5-point grading system, whereas the few studies used a 0–4 and a 1–5. The literature explains a variety of approaches to present the patient’s QoL.

Due to the small sample size, this study did not take into account each individual’s demographics and personal information, which is a study limitation. This study was carried out at a tertiary dental hospital; however, it can be cautiously applied to the care of patients in various parts of the world. Type of food, frequency of eating, and changes in how difficulties are perceived can all have an impact on OHRQoL, and the study can be broadened to assess these factors. Future studies can compare the impact of various demographic and personal characteristics on a variety of subjective parameters.

CONCLUSION

The following findings were reached within the bounds of this randomized controlled clinical investigation. At 1 month of the initial loading and 12 months of recall, single and double implant-retained mandibular overdentures increase the QOL for older edentulous patients. Comparable QoL may be offered with a single implant for patients with double implants.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.