35 Maxillary implant overdentures: bars or solitary attachments implantitis incidence in the bar group was in line with comparable studies1,2, the solitary attachment group suffered from higher incidences of infection, suggesting that solitary attachments are more prone to infection. Possible cause for group differences A possible explanation for the group differences may be associated with the higher load that the solitary attachment group’s system has to bear, which was demonstrated in vitro26-28, combined with the poor bone quality that is often present in edentulous maxillae, leading to a higher incidence of implant failure29,30. Unfortunately, a correlation between occlusal (over)load and implant and/or peri implant bone loss could not be made here and should therefore be included in future research. The patient’s experience Though the complication rate with solitary attachments seems to be higher than with bars, most repairs are minor and can often be performed chair side, which was also recognized by other studies20-23. This, however, does not seem to influence the patient’s experience. Both groups scored equally high in terms of patient related outcome measures, which is in line with other studies1-3,20,21. While the bar group’s score on patient satisfaction was significantly better than the solitary attachment group’s at the one year follow-up, this did not remain significant after five years. The equalization may be attributed to a longer adaptation period in the solitary attachment group compared to the bar group. On the other hand, the bar group’s median satisfaction score decreased, which means both groups’ scores became more similar. Also the ability to chew hard and tough foods did not remain significantly different between the groups, which may have contributed to the equal satisfaction scores. Nonetheless, both groups’ PROMs scores were significantly higher compared to baseline, underlining the participants’ sustained satisfaction with their overdentures in spite of higher implant loss and more minor complications in the solitary attachment group. Future research Given the differences and similarities between the present study’s groups, it would be interesting to know how both PROMs, as well as radiographic- and clinical parameters, will develop over the coming years. Additionally, to be able to provide more predictable results, future research should focus more on the possible factors influencing peri-implant health and disease, especially in patients with poor baseline bone conditions, as in the present study. Limitations A limitation of studies with a relatively long evaluation period is the loss to follow-up, especially patients with a relatively higher age, which is often the case with fully edentulous patients. In the present study, the conclusions on MBLC change may have lost some power since three participants from the bar group had deceased and one was too ill to participate. On the other hand, the MBLC was strongly significant, which may have compensated for the loss to follow-up. It is also important to realize that, since the study was university-based, the results may deviate from those achieved by a daily dental practice. 2
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