A Systematic Review of Marginal Bone Loss Around Implants Retaining or Supporting Overdentures

Purpose: To evaluate, through a systematic review of the literature, the effects of implant design and attachment type on marginal bone loss in implant-retained/supported overdentures. Materials and Methods: With the combined search terms "implant and overdenture," "implant-supported overdenture," "implant-retained overdenture," and "implant-anchored overdenture," along with specific inclusion and exclusion criteria, eligible articles between 1997 and 2008 (up to April 1) were retrieved from PubMed, EMBASE, OVID, the Cochrane Library databases, and seven journals by hand searching. Marginal bone loss values with regard to time, attachment type, and implant system used were compared by Kruskal- Wallis tests. Means and standard deviations of data were combined using fixed- and random-effect models and evaluated using meta-analysis. Results: Forty-six articles were included in the analyses; data extraction and meta-analysis were able to be conducted on eight studies. Data regarding maxillary overdentures could not be analyzed statistically. Bone loss around mandibular implants did not seem to be influenced by implant system or attachment design (bar, ball, magnet, and other types) in the first year, from 1 to = 5 years, and even after 5 years (P > .05). Meta-analysis could not detect differences in implant systems or attachment types (P > .05). Conclusions: Based upon a systematic review and meta-analysis of the literature that identified a total of 4,200 implants from 13 manufacturers, there was no difference in marginal bone loss around implants retaining/supporting mandibular overdentures relative to implant type or attachment designs. Keywords: attachment, dental implant, marginal bone loss, meta-analysis, overdenture, standard periapical radiograph, systematic review