A Within-Subject Comparison of Patient Satisfaction and Quality of Life Between a Two-Implant Overdenture and a Three-Implant-Supported Fixed Dental Prosthesis in the Mandible

Purpose: This within-subject comparison tested the null hypothesis that there is no difference in patient satisfaction and oral health-related quality of life when an individual with an edentulous mandible is rehabilitated with a two-implant overdenture or a three-implant-supported fixed dental prosthesis. Materials and Methods: Twelve subjects with an edentulous mandible or failing dentition were rehabilitated with the use of endosseous dental implants. Three implants were placed, and were immediately loaded with a provisional fixed prosthesis with minimal cantilever. After healing for 4 months, two Locator attachments were inserted and an overdenture was trialed; then, after a further 4 months, a fixed prosthesis was placed on the three implants. The fixed prosthesis was fabricated using computer-assisted design, and a titanium framework was manufactured with a resin base and teeth. Patient satisfaction and oral health-related quality of life was assessed before treatment, after wearing the provisional, and after each treatment option using a seven-item visual analog scale and a modified version of the 49-item oral health impact profile. Results: Of the 12 subjects, 11 chose the fixed over the removable prosthesis. A statistically significant (P .05) and positive effect on the overall score of both assessment tools was reported for both treatment modalities (when compared with pretreatment scores). Although no significant difference (P > .05) was found between the two options in overall scores of both surveys or in any of the seven domains of the modified oral health impact profile, the fixed prosthesis had a statistically higher score for stability, retention, and ease of chewing on a visual analog scale. Conclusion: Both treatment modalities provided a significant and similar improvement in patient satisfaction and oral health-related quality of life compared with a conventional complete mandibular removable dental prosthesis; however, a statistically significant higher score was reported for stability, retention, and ease of chewing for the fixed dental prostheses. Based on the 12 participants in this study, greater stability and ease of chewing with the fixed prosthesis likely influenced patient preference in most but not all subjects. Keywords: fixed, implants, mandible, overdenture, patient satisfaction, quality of life, removable