Statement of problem

A consensus based on patients’ perceptions as to whether to use overdentures or fixed prostheses to rehabilitate mandibular edentulous arches is limited.

Purpose

The purpose of this systematic review and meta-analysis was to compare the patient-reported outcome measures (PROMs) and clinical outcomes associated with implant-supported overdentures and fixed prostheses in edentulous mandibles.

Material and methods

Nine electronic databases were searched for randomized clinical trials (RCTs) and nonrandomized clinical trials (N-RCTs). The risk of bias was assessed by the revised Cochrane risk of bias tool for RCTs (RoB 2) and N-RCT (ROBINS-I). Data sets for oral health–related quality of life (OHRQoL), satisfaction, survival rate, implant probing depth, and marginal bone loss were plotted, and the appropriate analyses were applied by using the Rev Man 5.3 software program. Certainty of evidence was also evaluated by means of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.

Results

Ten eligible trials were included and evaluated quantitatively. For 3 domains of OHRQoL, fixed prostheses showed significantly higher quality of life when compared with overdentures regarding functional limitation (P<.001), physical disability (P=.001), and physical pain (P=.003). Fixed prostheses also improved satisfaction, when compared with overdentures for comfort (P=.02), ease of mastication (P<.001), retention (P<.001), and stability (P<.001). The same pattern was observed for overall OHRQoL (P=.01) and satisfaction (P=.01) in which fixed prostheses improved patient satisfaction. Only ease of cleaning presented greater satisfaction for the overdenture group. Clinical parameters did not differ statistically (P>.05) between both types of prosthesis.

Conclusions

Fixed rehabilitations for mandibular edentulous patients seem to be a well-accepted treatment from the patients’ oral health perspective. However, mandibular overdentures are no less efficient than fixed prostheses in terms of clinical outcomes.

中文翻译：

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下颌无牙颌患者种植体支持的覆盖义齿和固定修复体的患者报告结果测量和临床评估：系统评价和荟萃分析

问题陈述

基于患者对是否使用覆盖义齿或固定修复体修复下颌无牙弓的看法达成的共识是有限的。

目的

本系统评价和荟萃分析的目的是比较患者报告的结果测量 (PROM) 和与下颌无牙颌种植体支持的覆盖义齿和固定修复体相关的临床结果。

材料与方法

在九个电子数据库中搜索了随机临床试验 (RCT) 和非随机临床试验 (N-RCT)。偏倚风险通过修订后的 Cochrane 偏倚风险工具评估 RCT (RoB 2) 和 N-RCT (ROBINS-I)。绘制了口腔健康相关生活质量 (OHRQoL)、满意度、存活率、种植体探诊深度和边缘骨丢失的数据集，并使用 Rev Man 5.3 软件程序进行了适当的分析。证据的确定性也通过建议分级评估、开发和评估 (GRADE) 方法进行评估。

结果

十项符合条件的试验被纳入并进行了定量评估。对于 OHRQoL 的 3 个领域，与覆盖义齿相比，固定修复体在功能限制 ( P <.001)、身体残疾 ( P =.001) 和身体疼痛 ( P =.003) 方面表现出显着更高的生活质量。与覆盖义齿相比，固定修复体在舒适度（P =.02）、咀嚼容易度（P <.001）、固位（P <.001）和稳定性（P <.001）方面也提高了满意度。总体 OHRQoL ( P =.01) 和满意度 ( P=.01)，其中固定假肢提高了患者满意度。只有易于清洁才能为覆盖义齿组带来更大的满意度。两种假体的临床参数没有统计学差异（P >.05）。

结论

从患者口腔健康的角度来看，下颌缺牙患者的固定康复似乎是一种广为接受的治疗方法。然而，就临床结果而言，下颌覆盖义齿的效率不亚于固定修复体。