Protocols for the Maxillary Implant Overdenture: A Systematic Review.

PURPOSE To evaluate patient-related outcomes in restoring the edentulous maxilla with an implant overdenture. MATERIALS AND METHODS A comprehensive systematic review of the literature was conducted. Publications reporting patient-based outcomes with concomitant data on implant and/or prosthetic success were selected using predetermined inclusion criteria that were agreed upon by the two reviewers. RESULTS Twenty-three publications related to 20 study cohorts were identified to meet the inclusion criteria for maxillary implant overdentures: two randomized controlled trials (RCTs), 13 prospective case series including two crossover trials, and five retrospective studies. CONCLUSION An implant overdenture offers a stabilized removable solution for the edentulous maxilla, which provides increased patient satisfaction and quality of life improvement. A palateless design supported by four to six implants with a wide anteroposterior span has been successfully applied in some investigations. A higher failure rate was experienced with machined implants, particularly with short implants (length < 10 mm). Although both splinted and solitary anchorage systems are advocated, maintenance is higher for solitary attachments and inflammation is increased beneath the bars. Long-term maintenance care is essential for all designs. Well-designed RCTs with larger sample cohorts with longer follow-up periods are required to amplify patient- and clinician-based outcomes.