Evidenzbasiertes behandlungskonzept für die versorgung des atrophierten zahnlosen unterkiefers mit implantatgestützten deckprothesen

Edentulous patients, patients with a severely resorbed mandible in particular, often experience problems with their dentures. Treatment concepts involving placement of at least two implants to support a mandibular overdenture have been proposed. This paper reviews the various treatment concepts with the aim to propose an evidence-based treatment concept for mandibular overdentures supported by endosseous implants. Based on a critical review of the literature, it is proposed that two implants, placed in a single-stage procedure, supporting a mandibular overdenture (bar construction) are sufficient for most applications. Four implants are indicated in situations involving an opposing dentulous maxilla, a narrow mandibular arch, extreme resorption of the mandible (bone height less than 12 mm), and mandibular soreness and pain. Two implants (ball attachment) are indicated in patients who have difficulties maintaining proper oral hygiene and also can be considered in those with a narrow mandibular arch. Future research should be focused on long-term, detailed follow-up clinical trials to further refine this treatment approach. In particular it is anticipated that in the near future two implants will be proven to be a proper treatment approach in some of the current indications of inserting four implants to support a mandibular overdenture. This will contribute to a higher level of care in this field by minimizing the surgical morbidity and reducing economic costs.