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Implant-Assisted Removable Partial Denture Prostheses: A Critical Review

of Selected Literature

Article  in  The International journal of prosthodontics · May 2018

DOI: 10.11607/ijp.5227

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 Implant-Assisted Removable Partial Denture Prostheses:
A Critical Review of Selected Literature
Renzo G. Bassetti, DMD1/Mario A. Bassetti, DMD2/Johannes Kuttenberger, MD, DMD, PhD3

Purpose: A critical review of selected relevant publications assessed clinical efficacy and
effectiveness of implant-assisted removable partial dentures (IARPDs) with implant survival and
failure rates, biologic and technical complications, and maintenance and patient satisfaction after
rehabilitation as outcomes. Materials and Methods: Screening of three databases (Medline
[PubMed], Embase [OVID], and the Cochrane Library) and a manual search of related articles
were performed. Reports on outcomes from human studies conducted between 1 January 1980
and 31 May 2016 were considered. A quality assessment of the identified full-text articles was
performed to assess risk of bias and to evaluate heterogeneity. Results: Only nine studies were
included, and all nine demonstrated high risk of bias. The mean observation period ranged from 1
to 10 years, and only four studies included at least one control group. The studies reported implant
survival rates of 91.7% to 100%, abutment tooth survival rates of 79.2% to 100%, and prosthesis
survival rates of 90% to 100%. Approximal peri-implant crestal bone level changes (∆CBL)
ranged from –0.17 to –2.2 mm. IARPDs were associated with a higher frequency of technical
complications and maintenance interventions than biologic complications. Only two question-
based studies assessed patient satisfaction before and after treatment, and both reported marked
improvement. A meta-analysis was not possible because of substantial heterogeneity in study
design. Conclusion: Limited availability of robust publications related to the selected review
topic precluded significant conclusions. Nonetheless, the preliminary assessment suggests that
IARPDs are a simple and cost-effective approach to providing symmetric prosthesis support and
stability, plus improved patient satisfaction. Int J Prosthodont 2017 (16 pages). doi: 10.11607/ijp.5227

A lthough rehabilitation with fixed implant-supported

restorations is a routine treatment, removable den-
tures may be a more appropriate treatment option in
certain circumstances.1 Various factors can influence
treatment planning, such as patient age, esthetic de-
mands, treatment costs, patient ability to maintain oral
hygiene, extent of alveolar ridge resorption, and interoc-
clusal space.1 If the distribution of potential abutment
teeth is unfavorable for rehabilitation using a conven-
tional removable partial denture (RPD), the placement
of dental implants in strategically advantageous regions
under RPDs suggests adjunctive scope for achieving
optimal symmetric support and stability in a cost-effec-
tive way.2,3 Implant-assisted removable partial dentures
(IARPDs) are also reported to provide a more positive
effect on oral health than traditional RPD treatment.4,5
1Master of Advanced Studies in Prosthodontics and Implant Dentistry,
Department of Oral and Maxillofacial Surgery, Lucerne Cantonal Hospital,
Lucerne, Switzerland.
2MAS, Department of Oral and Maxillofacial Surgery, Lucerne Cantonal
Hospital, Lucerne, Switzerland.
3Chairman, Department of Oral and Maxillofacial Surgery, Lucerne
Three published systematic review–style efforts
involved mandibular IARPDs,6–8 while one narrative
review described maxillary as well as mandibular
IARPDs. 9 There is a significant lack of robustly con-
ducted clinical research, and consequently system-
atic reviews, that analyze treatment outcome data
on IARPDs.
This critical literature review sought to assess re-
ports on efficacy and effectiveness of maxillary and/
or mandibular IARPD treatment with reported implant
survival rates, associated complications, peri-implant
crestal bone level changes (ΔCBL), and patient satis-
faction as outcomes.
Materials and Methods
Eligibility Criteria and Search Strategy
This review sought to apply the guidelines for assess-
ment of quality of execution and reporting of system-
atic reviews proposed by Layton.10

Cantonal Hospital, Lucerne, Switzerland.

Correspondence to: Dr Renzo Bassetti, Department of Oral and
Maxillofacial Surgery, Lucerne Cantonal Hospital, Spitalstrasse, 6000
Lucerne, Switzerland. Fax: +41 41 205 45 77. Email: renzo.bassetti@luks.ch
©2017 by Quintessence Publishing Co Inc.
Focused Question
Using the PICO (patient, intervention, comparison,
outcome) format, the following criteria were framed
for this specific literature search11:

doi: 10.11607/ijp.5227 1
Implant-Assisted Removable Partial Denture Prostheses
•• P: Patients with an unfavorable baseline situation
due to the lack of or strategically unfavorable al-
location of abutment teeth regarding prospective
treatment with an overdenture or RPD
•• I: Transformation of the unfavorable baseline situation
into a favorable prosthetic situation by insertion of
strategically placed dental implants to establish a fa-
vorable support zone for an implant-tooth–supported
overdenture or IARPD in the mandible and/or maxilla
•• C: IARPDs and conventional RPDs, differences be-
tween anchoring systems, long-term efficacy (ie,
survival rates, ΔCBL) of implants beneath IARPDs
and other prosthetic reconstruction types, and pa-
tient satisfaction before and after implant placement
•• O: Effectiveness of IARPD with the following out-
comes: survival rates of implants, abutment teeth,
and prostheses; complication rates; ΔCBL; and pa-
tient satisfaction
Search Strategy Method
An electronic search of three databases—MEDLINE
(via PubMed), Embase (via OVID), and the Cochrane
Library (via Cochrane Central Register of Controlled
Trials [CENTRAL])—was performed to systematically
identify the relevant literature. Articles published from
1 January 1980 to 31 May 2016 were considered. The
search string comprised a combination of keywords
(medical subjects headings [MeSH]) and free-text
terms. Linkage was achieved using Boolean operators
(OR, AND). The following search strategy was applied:
(((((removable, partial, denture*[MeSH Terms])
OR (partial denture*[MeSH Terms]) OR (dental
prosthesis*[MeSH Terms]) OR (removable denture*[Title/
Abstract]) OR (overdenture*[MeSH Terms]) AND (dental
implant*[MeSH Terms]) OR (implant support in strategic
position*[Title/Abstract])) OR (dental prosthesis*, implant
supported[MeSH Terms]) OR (implant supported pros-
thesis dental*[MeSH Terms]) OR (prosthesis dental im-
plant supported[MeSH Terms]) OR (implant supported
dental prosthesis*[MeSH Terms]) OR (implant retained
removable partial denture*[Title/Abstract]) OR (implant
supported removable partial denture*[Title/Abstract])
OR (implant-supported removable partial denture*[Title/
Abstract])) OR (implant-assisted removable partial
denture*[Title/Abstract])) AND ((implant survival[Title/
Abstract]) OR (bite force*[MeSH Terms]) OR (quality of
life[MeSH Terms]) OR (mastication[MeSH Terms]) OR
(patient satisfaction[MeSH Terms]) OR (prosthodontic
outcome*[Title/Abstract]) OR (denture satisfaction[Title/
Abstract]) OR (prosthetic maintenance[Title/Abstract])).
Additionally, a manual search of relevant ar-
ticles published between 1 January 1980 and 31
2 The International Journal of Prosthodontics
July 2016 was performed in the following journals:
Journal of Oral Rehabilitation, Journal of Prosthetic
Dentistry, Clinical Oral Implants Research, Journal of
Prosthodontics, Journal of Prosthodontic Research,
International Journal of Oral & Maxillofacial Implants,
Implant Dentistry, Clinical Implant Dentistry and
Related Research, International Journal of Periodontics
and Restorative Dentistry, International Journal of
Prosthodontics, Quintessence International, Clinical
Oral Investigations, and Journal of Oral Implantology.
Finally, the references of all selected full-text articles
were also searched for relevant studies.
Study Selection
Inclusion Criteria. The following inclusion criteria
were applied:
•• Published in a peer-reviewed journal
•• Any case series, prospective, or retrospective co-
hort studies, controlled clinical trials (CCT), or
randomized clinical trials (RCT) with five or more
patients included
•• Full text in English or German
•• Data reported regarding survival (success, if avail-
able) and failure rates of implants and/or prosthe-
ses, as well as patient satisfaction (optional)
•• Data reported regarding implant characteristics,
attachment systems, and locations
•• A minimum follow-up of 12 months after denture
delivery
Exclusion Criteria. The following exclusion crite-
ria were applied:
•• In vitro studies
•• Animal studies
•• Studies involving zygomatic or mini-implants
Validity Assessment. The publication records
and abstracts identified by the electronic and manual
searches were screened by two reviewers (R.G.B. and
M.A.B.). Only reports with available full-text articles
were evaluated and assessed for inclusion by the two
review authors. Discrepancies and disagreements
were resolved by discussion and consensus. Both
reviewers used a data extraction form to extract the
data independently.
Quality Assessment
Quality and risk of bias assessments were performed
independently by two authors (R.G.B. and M.A.B.) as
part of the data extraction process. Discrepancies and
disagreements were resolved by discussion.
 Bassetti et al

Table 1   Studies excluded at the second stage of selection and the reasons for exclusion.
Publication Reason for exclusion
Peršić et al,13 2016 No implant-assisted removable partial denture prosthesis evaluated, but pure implant-retained overdentures included
Swelem et al,14 2014 No implant-assisted removable partial denture prosthesis included
Gonçalves et al,15 2014 Follow-up < 12 mo
Gonçalves et al,16 2014 Follow-up < 12 mo
Gates et al,17 2004 Follow-up < 12 mo
Gonçalves et al,18 2013 Follow-up < 12 mo
Wolfart et al,19 2013 No data reported regarding survival/failure rates of implants
Wismeijer et al,4 2013 No data reported regarding survival/failure rates of implants
Liu et al,20 2012 Case report
Nissan et al,21 2011 Type of prosthetic rehabilitation and follow-up not clearly stated
Ohkubo et al,22 2008 Follow-up period not reported
Mijiritsky et al,23 2005 Implant characteristics/type not reported
Ormianer et al,24 2005 No implant-assisted removable partial denture prosthesis included

The quality assessment of included RCTs and CCTs

was performed using the Cochrane Collaboration’s tool 426 records
1,775 records 379 records 1 record
for assessing risk of bias.12 The quality assessment of identified identified
identified
identified
through
included studies that were not RCTs or CCTs focused on through through through
search in
the study design (prospective or retrospective); inclu- search in search in hand
Cochrane
Medline Embase search
sion of a control group; description of implant systems; Library
predefined and reported success criteria; radiographic
follow-up; measurement of peri-implant crestal bone
levels (CBL) at different time points (ie, ΔCBL); report-
1,776 records after removal of duplicates
ing of complications for implants, abutment teeth, and
prostheses; reporting of prosthetic status before and af-
ter treatment; reporting of implant and abutment teeth 1,754 records excluded after screening of
number and location; completeness of the data for each titles and abstracts
main outcome (including attrition and exclusion from
the analysis according to the quality criterion for incom-
22 full-text articles analyzed for eligibility
plete outcome data of the Cochrane Collaboration’s tool
for assessing risk of bias12); and reporting of patient sat- 13 articles excluded
isfaction before and after treatment. The studies were
then rated as having a low risk of bias (all criteria met),
an unclear risk of bias (one criterion not met), or a high 9 articles included in systematic review
risk of bias (two or more criteria not met).
Fig 1   Flow chart of the search strategy applied.
Data Synthesis

To evaluate all data and identify variations in study char-

acteristics and outcomes, data were pooled into evi-
dence tables and a descriptive summary was generated.
This enabled the detection of similarities and differences
between studies, as well as determination of the suitabil-
ity of further synthesis or comparison methods.
Results
Search Strategy Results
The electronic search of the databases and the man-
ual search resulted in identification of 2,581 potential
titles and abstracts (Medline = 1,775; Embase = 379;
Cochrane Library = 426; manual search = 1). After re-
moval of duplicates and abstract screening, 22 studies
were selected (inter-reviewer agreement κ = 0.97).
For the second phase, the 22 full-text articles were
screened and evaluated thoroughly. A total of 13 pub-
lications were excluded at this stage because they did
not fulfill the inclusion criteria (inter-reviewer agree-
ment κ = 1.0). Reasons for exclusion are presented
in Table 1.13–24 Finally, nine publications2,3,25–31 fulfilled
the inclusion criteria of this systematic review (Fig 1).

doi: 10.11607/ijp.5227 3
Implant-Assisted Removable Partial Denture Prostheses
Table 2   Risk of Bias Assessments for the Included Studies Not Conducted as Randomized Controlled Trials
Prospective (+)/
retrospective (–) Inclusion of a
design control group
Payne et al,25 2016 + +
Rinke et al,28 2015 – –
Bernhart et al,26 2012 – +
Bortolini et al,30 2011 – –
Kaufmann et al,3 2009 – ?
Grossmann et al,29 2008 – –
Krennmair et al,31 2007 – –
Hug et al,2 2006 + +
Mitrani et al,27 2003 – ?
+ = low risk of bias; ? = unclear risk of bias; – = high risk of bias.
Quality and Risk of Bias Assessments of Selected
Publications
The quality and risk of bias assessments of selected
studies are summarized in Table 2. None of the includ-
ed publications were RCTs; thus, quality assessment
using the Cochrane Collaboration’s tool for assessing
risk of bias12 could not be performed. Two studies were
of a prospective design.2,25 At least one control group
was included in three publications.2,25,26 In two stud-
ies, two groups with only minimal differences were
evaluated3,27: In one, the two groups differed in the
reason for implant insertion (planned IARPD vs im-
plant-repaired RPD),3 and in the other, implants were
used either as vertical stops or as retention elements
for the prosthesis.27 The implant system used was re-
ported in all nine studies. Predefined success criteria
were applied and success rates reported in only one
study.28 In two publications, no radiographic follow-
up was reported.26,29 Three studies did not measure
peri-implant CBL at different time points.26,29,30 Only
one publication did not examine complications.30 In
four studies, the prosthetic status before and after
treatment was stated.25,27,29,30 Three studies reported
details of the implant and abutment teeth numbers
and locations.25,28,31 Only two publications reported
complete outcome data,25,28 and three studies pro-
vided data regarding patient satisfaction before and
after treatment.2,27,30 All nine publications had a high
risk of bias (Table 2).
Characteristics of Included Publications
Author(s), year of publication, study design, obser-
vation time, number of implants/abutment teeth and
patients, prosthetic status before and after treatment,
implant location/support configuration within the jaw,
4 The International Journal of Prosthodontics
Measurement of
Predefined and peri-implant crestal
Description of reported Radiographic bone levels at
implant system success rates follow-up different time points
+ – + +
+ + + +
+ – – –
+ – + –
+ – + +
+ – – –
+ – + +
+ – + +
+ – + +
implant type used, implant length and diameter, type
of tooth abutment used, type of implant abutment
used, outcomes (implant/tooth failures/complications,
prosthetic complications, maintenance, survival rates
[implants, abutment teeth, prostheses], peri-implant
CBL or ΔCBL, and patient satisfaction) were pooled,
and a descriptive summary was generated (Table 3).
Survival Rates
Survival and Success Rates of Implants in
Combination with IARPDs. All nine studies reported
implant survival rates ranging from 91.7% to 100%. In
six studies, the baseline for the calculation of survival
rates was the time of surgery,2,3,25,27,29,31 and in three
studies, it was the time of implant loading.26,28,30 The
observation periods ranged from 1 year to 12.2 years.
In four publications, the average observation time was
> 3 years.25,28,30,31 In two studies, only the follow-up
time (1 to 8 years3 and 1 to 4 years27) was reported.
Three studies had an average observation time of <
3 years.2,26,29 In total, 436 implants inserted in 227 pa-
tients to retain or support an IARPD were included in
this review. Overall, 19 implants in 17 patients failed.
Only one study applied predefined success criteria
and reported an implant success rate of 95.6% after a
mean observation period of 5.8 years28 (Table 3).
Survival Rates of Abutment Teeth in
Combination with IARPDs. The number of abut-
ment teeth used to retain or support the IARPD was
reported in six studies. In these six studies, 13 out of
353 abutment teeth (3.7%) failed during follow-up in
11 out of 162 patients. The abutment tooth survival
rates were 79.2% to 100%,2,3,25,26,28,31 and in two of
these six studies, the survival rate was 100%.26,31 Five
of these six studies had mean observation periods of
2 to 10 years,2,25,26,28,31 and one reported a range of
 Bassetti et al

Report of Report of
complications for im- prosthetic status
plants, abutment teeth, before and after
and prostheses treatment
+ +
+ –
+ –
– +
+ –
+ +
+ ?
+ –
+ +
Report of implant and Completeness of
abutment teeth outcome data for
number and location each main outcome
+ +
+ +
? –
? –
? ?
? –
+ ?
? ?
? –
Patient satisfaction
reported before and Summary
after treatment assessment
– High
– High
– High
+ High
– High
? High
– High
+ High
+ High

1 to 8 years.3 In the other three publications, no data
regarding survival rates of abutment teeth were re-
ported25,29,30 (Table 3).
Survival Rates of IARPDs. Overall, 236 IARPDs in
227 patients, 130 in the maxilla and 106 in the man-
dible, were included and analyzed in the nine publica-
tions. All nine studies documented prosthesis survival
rates, which ranged between 90% and 100%. The
observation periods ranged between 1 year and 12.2
years.2,3,25–31 In only one study, the survival rate re-
ported (90%) did not reach 100%27 (Table 3).
Complications and Prosthodontic Maintenance
Eight of the nine studies reported data regarding com-
plications and/or prosthodontic maintenance related to
IARPDs. In these eight publications, 1,086 events (com-
plications and prosthodontic maintenance interven-
tions) were reported and had to be managed.2,3,25–28,30,31
Of these events, 29 (16 implant-related and 13 abutment
tooth–related) had a biologic cause: 5 implants in 3 pa-
tients were associated with mucositis, 9 implants in 8
patients with peri-implantitis, and 2 implants in 2 pa-
tients with mucosal hyperplasia3,27,28; and 8 abutment
teeth were associated with caries, 3 with periodontitis,
and 2 with gingival hyperplasia.3 The remaining 1,057
events were technical complications or prosthodontic
maintenance interventions (Table 3).
Types of IARPDs and Anchoring Systems
Of the 236 IARPDs, 134 were of an RPD design, in
which the implants were provided either with ball an-
chors or modified healing formers, locators, or a bar
attachment.3,25,27,29,30 The attachment teeth, for which
data were available, were provided with clasps3,25,30 or
with crowns that incorporated a milled part for frame
and support.27 Further, 46 prostheses were of an over-
denture design, and all implants were provided with
ball anchors and the abutment teeth with root copings
that included a precision attachment.2,3 The remain-
ing 56 prostheses were manufactured as RPDs with
telescopic double-crown attachments on the attach-
ment teeth as well as on the implants3,26,28,31 (Table 3).
Peri-implant ∆CBL
Measurements of the peri-implant CBL at the mesial
and distal implant aspects based on nonstandardized
two-dimensional (2D) radiographs were performed to
evaluate ∆CBL over time in only six studies.2,3,25,27,28,31
The baseline definition used in three studies2,3,31 was
the time of implant placement (T1), and in the three
other publications,25–27 it was the day of implant load-
ing/prosthesis delivery (T2). The three studies using the
T1 baseline assessed mean ∆CBL during the unloaded
healing period and the entire period after loading (T1–
T3). In the first study,3 the mean ∆CBL was reported for
the maxilla (–0.94 ± 1.3 mm) and the mandible (–0.52
± 0.9 mm) separately; in the second study,2 the mean
∆CBL for both the maxilla and mandible was reported
(–0.8 ± 1.1 mm); and in the third study, the mean ∆CBL
of only implants placed in the maxilla was assessed
(–2.2 ± 1.0 mm).31 The remaining three publications as-
sessed mean ∆CBL during the period after loading. In
two studies, the mean ∆CBL of implants placed only in
the mandible was assessed (–0.17 mm25 and –1.03 ±
1.0 mm28). The remaining study reported a mean ∆CBL
of –0.63 mm for the maxilla and mandible27 (Table 3).
Patient Satisfaction
Only four of the nine included publications reported
patient satisfaction data.2,27,29,30 Two studies measured

doi: 10.11607/ijp.5227 5
Implant-Assisted Removable Partial Denture Prostheses

Table 3   Characteristics of Included Studies

No. of implants Implant

Observation (I), abutment Prosthetic Prosthetic Implant location/ length (L)
Study time teeth (T), and status before status/no. of support configuration and diameter
Publication design (baseline) patients (P) treatment prostheses within the jaw Implant type (D) (mm)
Payne et al,25 MCPCS 10 y (T1) Control group: Maxilla: CD Control group: Control group: Straumann, L: 6, 8, 10
2016 P: 12 Mandible: Maxilla: CD Mandibular teeth: Bilateral SP/S SLA RN D: ND
T: 24 RPD with Mandible: RPD first premolar or canine, 1
bilateral distal clasp per side
Test group: extension Test group: Test group:
P: 36 Maxilla: CD Mandibular implants:
I: 72 Mandible: IARPD Bilateral first or second
T: 72 (2 implants per molar region, 1 implant
patient) per side

Mandibular abutment teeth:

Bilateral first premolar or
canine, one clasp per side
Rinke et al,28 CS (retro- 5.84 ± 3 y P: 14 ND Maxilla: Mandibular implants: Ankylos L: 8, 9.5,
2015 spective) (T2) (range: I: 24 FDP (6 patients), 2 second incisor (Dentsply 11, 14
3.0–12.2 y) T: 27 RPD (5 patients), 12 first premolar Implants) D: 3.5, 4.5,
CD (3 patients) 3 second premolar 5.5

Mandible: Mandibular abutment teeth:

IARPD in 14 1 wisdom tooth
patients 1 second molar
(1–3 abutment 1 first molar
teeth per patient, 2 second premolar
1–3 implants per 5 first premolar
patient) 13 canine
2 lateral incisor
2 central incisor
Bernhart et RS 2 y (T2) Group 1: ND Group 1: Group 1: Straumann ND
al,26 2012 P: 16 Maxilla: IARPD 5 Quad
I: 40 (14 patients) 11 Poly (5–9 abutments) Astra Tech
T: 44 (13 RT) Mandible: IARPD (Dentsply
(2 patients) Group 2: Implants)
Group 2: 1 Tri
P: 19 Group 2: 14 Quad
I: 84 Maxilla: IRO (12 3 Poly (5–6 abutments)
T: 0 patients)
Mandible: IRO (7 Group 3:
Group 3: patients) 14 Lin
P: 28 9 Tri
I: 0 Group 3: 4 Quad
T: 77 (30 RT) Maxila: RPD (16 1 Poly (6 abutments)
patients)
Mandible: RPD
(12 patients)
Bortolini et RS 8 y (T2) P: 32 RPD (Maxilla: IARPD (Maxilla: Maxilla: 42 Branemark L: 10, 11.5,
al,30 2011 I: 64 21, Mandible: 21, Mandible: 11) 1 lateral incisor MKIII (Nobel- 13, 15
11) 21 canine pharma AB) D: 3.75, 5
14 first premolar
19 KCl I 6 second premolar
10 KCl II
3 KCl III Mandible: 22
10 canine
9 first premolar
3 second premolar

MCPCS = multicentre prospective clinical study; CS = case series; CHS = cohort study; RS = retrospective study; T0 = time before treatment; T1 = time
point at surgery; T2 = implant loading/prosthesis delivery; T3 = 1–10 years after loading; RT = root canal treated; CD = complete denture; RPD = removable
partial denture (only-tooth–supported); FDP = fixed dental prosthesis; IARPD = implant-assisted removable partial denture (removable partial denture
and overdenture design); OvP = overdenture prosthesis (only-tooth–supported); IRO = implant-retained overdenture (only-implant–supported removable
prosthesis); KCI = Kennedy classification; Lin = linear support (two abutments per jaw); Tri = triangular support (three abutments per jaw); Quad =
quadrangular support (four abutments per jaw); Poly = polygonal support (five or more abutments per jaw); Bi = biologic; Te = technical; CBL = Peri-
implant crestal bone level; ∆CBL = Peri-implant crestal bone level changes; ND = no data. *Statistically significant.

6 The International Journal of Prosthodontics

 Bassetti et al

Survival rates (%)

Implant (I)/tooth (T) Prosthetic
Tooth Implant failures (Bi or Te com- complications and Abutment CBL (Tx) or Patient
abutment abutment plications) maintenance Implants teeth Prostheses ∆CBL (Tx–Ty) satisfaction
Wrought wire First 6 mo: Control group: Control group after 10 y: After 3 y: Control Control CBL (T2): ND
clasps Healing caps of T (Bi): 16 clasp adjustment 100 group after group after 2.03 ± 0.71 mm
3-mm height 2 abutment tooth loss 3 clasp fracture 10 y: 10 y:
1 reline After 10 y: 75 (6/24) 91.7 CBL (3 years
After 6 mo: Test group: 91.7 (6 after T2):
Ball anchors + I (Bi): Test group after 10 y: implants in Test group Test group 2.20 ± 0.81 mm
Dalla Bona-type Bi: 6 implant loss in 5 6 clasp adjustment 5 patients) after 10 y: after 10 y:
gold matrices patients 2 broken minor 79.2 (5/24) 100
connector
T (Bi): 17 gold matrix problem
1 abutment tooth loss 2 reline
2 all anterior teeth loss
inclusive abutment teeth
Telescopic Telescopic I (Bi): 1 matrix loosening Survival 85.2 100 ∆CBL (T2–data ND
double-crowns double-crowns 5 implants with rate: collection):
mucositis in 3 patients 100 –1.03 ± 1.0 mm
1 implant with peri-
implantitis in 1 patient Success
I (Te): rate:
5 abutment screw 95.8
loosening

T (Bi):
None
T (Te):
4 tooth loss (crown
fracture)
Telescopic Telescopic Group 1: Group 1: Group 1: Group 1: Group 1: ND ND
double-crowns double-crowns 1 abutment screw 2 loss of facing 100 100 100
(galvanoformed (galvanoformed loosening (Te)
secondary secondary Group 2: Group 2: Group 3: Group 2:
crowns) crowns) Group 2: 1 loss of cementation 97.6 97.4 100
2 abutment screw 1 loss of facing
loosening (Te) Group 3:
2 implant loss (Bi) Group 3: 100
2 peri-implantitis (Bi) 7 loss of facing

Group 3:
2 tooth loss (Bi)
1 endodontic treatment
(Bi)

Clasps Ball I (Bi): 4 implant loss in 4 Relining: 93.75 ND 100 ND Satisfaction

attachments patients 93 in 32 patients (T0):
(Sphero 1.31 ± 0.43
Block Normo I (Te): 2 abutment Tooth substitution:
System, 2.5-mm loosening (in 2 patients) 29 in 24 patients Satisfaction (1
diameter) + y after T2):
resilient cap T: 29 tooth loss Resilient cap 4.59 ± 0.47
(Rhein 83, replacement:
Bologna, Italy) 1 per year in all patients (Scale from 1
(all resilient to 5, in which
caps were 1 was the least
annually favorable)
replaced)

doi: 10.11607/ijp.5227 7
Implant-Assisted Removable Partial Denture Prostheses

Table 3   Characteristics of Included Studies

No. of implants Implant

Observation (I), abutment Prosthetic Prosthetic Implant location/ length (L)
Study time teeth (T), and status before status/no. of support configuration and diameter
Publication design (baseline) patients (P) treatment prostheses within the jaw Implant type (D) (mm)
Kaufmann et CHS (retro- 1–8 y (T1) P: 60 ND IARPD (55 1–2 implants placed per Straumann L: 8–16
al,3 2009 spective) I: 96 patients in one denture D: 3.3–5.0
T: 130 jaw, 5 patients in Nobel Replace
both jaws) Maxillary implants + Tapered
Maxilla: 45 abutment teeth: (Nobel
Mandible: 20 3 Lin Biocare)
8 Tri
34 Quad Astra Tech
(Dentsply
Maxillary implants: Implants)
4 central incisor
5 lateral incisor
18 canine
23 first premolar
18 second premolar

Mandibular implants +
teeth:
12 Lin
5 Tri
3 Quad

Mandibular implants:
1 central incisor
1 lateral incisor
13 canine
10 first premolar
2 second premolar
Grossmann et CS (retro- 31.5 mo (T1) P: 22 Maxilla: IARPD (22 Maxillary implants (1–5 per Frialit-2 or Xive L: 10,/11, 13,
al,29 2008 spective) I: 60 1–7 residual maxillary patient): (Friadent) 15/16
T: 48 teeth prostheses in 22 8 lateral incisor D: 3.8, 4.3/4.5,
patients) 19 canine Camlog root- 5.0/5.5
10 first premolar line (Alltec)
14 second premolar
9 first molar

Maxillary abutment teeth:

4 central incisor
6 lateral incisor
13 canine
5 first premolar
7 second premolar
7 first molar
1 second molar
Krennmair et CHS (retro- 38 mo (T1) P: 22 Maxilla: IARPD (22 Maxillary implants (1–5 per Frialit-2 or Xive L: 10/11, 13,
al,31 2007 spective) I: 60 1–7 residual maxillary patient): (Friadent) 15, 16
T: 48 teeth prostheses in 22 8 lateral incisor D: 3.8,
patients) 19 canine Camlog root- 4.3/4.5,
10 first premolar line (Alltec) 5.0/5.5
14 second premolar
9 first molar

Maxillary abutment teeth:

4 central incisor
6 lateral incisor
13 canine
5 first premolar
7 second premolar
7 first molar
1 second molar
MCPCS = multicentre prospective clinical study; CS = case series; CHS = cohort study; RS = retrospective study; T0 = time before treatment; T1 = time
point at surgery; T2 = implant loading/prosthesis delivery; T3 = 1–10 years after loading; RT = root canal treated; CD = complete denture; RPD = removable
partial denture (only-tooth–supported); FDP = fixed dental prosthesis; IARPD = implant-assisted removable partial denture (removable partial denture
and overdenture design); OvP = overdenture prosthesis (only-tooth–supported); IRO = implant-retained overdenture (only-implant–supported removable
prosthesis); KCI = Kennedy classification; Lin = linear support (two abutments per jaw); Tri = triangular support (three abutments per jaw); Quad =
quadrangular support (four abutments per jaw); Poly = polygonal support (five or more abutments per jaw); Bi = biologic; Te = technical; CBL = Peri-
implant crestal bone level; ∆CBL = Peri-implant crestal bone level changes; ND = no data. *Statistically significant.

8 The International Journal of Prosthodontics

 Bassetti et al

Survival rates (%)

Implant (I)/tooth (T) Prosthetic
Tooth Implant failures (Bi or Te com- complications and Abutment CBL (Tx) or Patient
abutment abutment plications) maintenance Implants teeth Prostheses ∆CBL (Tx–Ty) satisfaction
Root copings Ball anchors: 85 I (Bi): I: 93.8 97.7 100 ∆CBL (T1–T3): ND
with precision 3 implant loss (before 10 matrix loosening Maxilla: –0.94 ±
attachment: Telescopic loading) 38 matrix tightening 1.3 mm
101 double-crowns: 3 implant loss (after 22 matrix replacement Mandible: –0.52
Telescopic 8 loading) ± 0.9 mm
double-crowns: 8 peri-implantitis in 7 T:
7 patients 4 matrix loosening
Cast clasps: 1 mucosal hyperplasia in 45 matrix tightening
22 1 patient 41 matrix replacement

I (Te): Prostheses:
12 abutment loosening Repairs:
4 wear of abutment 3 fracture of resin
denture base
T (Bi):
3 tooth loss (root Adjustments:
copings) 6 redesign of existing
8 caries denture
3 periodontitis 24 sore spots
2 gingival hyperplasia 15 relining of denture
28 occlusal adjustment
T (Te): 2 excessive prosthetic
21 recementation of root tooth wear
coping;
1 war of ball anchor

Telescopic Telescopic I (Te): Prosthesis: 100 100 100 ∆CBL (T1–T3): ND

double-crowns double-crowns 3 screw loosening 4 adjustment –2.2 ± 1.0 mm

T (Te):
3 tooth loss

Telescopic Telescopic I (Te): 3 screw loosening Prosthesis: 100 100 100 ∆CBL (T1–T3): ND
double-crowns double-crowns 4 adjustment –2.2 ± 1.0 mm
T (Te): 3 tooth loss

doi: 10.11607/ijp.5227 9
Implant-Assisted Removable Partial Denture Prostheses

Table 3   Characteristics of Included Studies

No. of implants Implant

Observation (I), abutment Prosthetic Prosthetic Implant location/ length (L)
Study time teeth (T), and status before status/no. of support configuration and diameter
Publication design (baseline) patients (P) treatment prostheses within the jaw Implant type (D) (mm)
Hug et al,2 CHS 2 y (T1) Group 1: ND Group 1 (IARPD): Group 1: Straumann ND
2006 P: 14 Maxilla: 8 Maxilla: 10
I: 20 Mandible: 10 Mandible: 10
T: 32
Group 2 (OvP): Group 3:
Group 2: Maxilla: 9 Maxilla: 33
P: 17 Mandible: 12 Mandible: 24
I: 0
T: 56 Group 3 (IRO):
Maxilla: 8
Group 3: Mandible: 12
P: 15
I: 57
T: 0

Mitrani et al,27 CHS (retro- 1–4 y (T1) Group 1: Group 1: Group 1 (IARPD): Group 1: Branemark L: 8, 10,
2003 spective) P: 5 Maxilla: Maxilla: 4 Maxilla: 8 (Nobelpharma 12, 13
I: 9 (only vertical 4 KCl I Mandible: 1 Mandible: 1 AB) D: ND
stops) Mandible:
1 KCl II Group 2 (IARPD): Group 2: Straumann
Group 2: Maxilla: 3 Maxilla: 3
P: 5 Group 2: Mandible: 2 Mandible: 4
I: 7 (retention Maxilla:
elements) 1 KCl I
Mandible:
1 KCl I
1 KCl II
MCPCS = multicentre prospective clinical study; CS = case series; CHS = cohort study; RS = retrospective study; T0 = time before treatment; T1 = time
point at surgery; T2 = implant loading/prosthesis delivery; T3 = 1–10 years after loading; RT = root canal treated; CD = complete denture; RPD = removable
partial denture (only-tooth–supported); FDP = fixed dental prosthesis; IARPD = implant-assisted removable partial denture (removable partial denture
and overdenture design); OvP = overdenture prosthesis (only-tooth–supported); IRO = implant-retained overdenture (only-implant–supported removable
prosthesis); KCI = Kennedy classification; Lin = linear support (two abutments per jaw); Tri = triangular support (three abutments per jaw); Quad =
quadrangular support (four abutments per jaw); Poly = polygonal support (five or more abutments per jaw); Bi = biologic; Te = technical; CBL = Peri-
implant crestal bone level; ∆CBL = Peri-implant crestal bone level changes; ND = no data. *Statistically significant.

patient satisfaction using a questionnaire that evaluated
satisfaction levels on a scale of 1 to 5 (with 1 repre-
senting the least favorable situation).27,30 Bortolini et al
reported a mean pretreatment satisfaction level of 1.31
± 0.43, and at 1 year after IARPD delivery, the satisfac-
tion value increased to 4.59 ± 0.47.30 In Mitrani et al,
the mean satisfaction value before treatment was 1.2
and after treatment was 5.0.27 In Grossmann et al, the
patient satisfaction was assessed with a questionnaire
only after treatment, and the patients reported im-
provements in masticatory efficacy (87%) and esthet-
ics (78%). In addition, the IARPD was rated by 65% as
very comfortable, by 22% as comfortable, and by 13%
as uncomfortable.29 In the fourth study,2 at 2 years after
prosthesis delivery, patient satisfaction was assessed by
a nine-item questionnaire using a visual analog scale
(VAS). The variables were: ease of hygiene, general
satisfaction with prosthesis, ability to speak, comfort

10 The International Journal of Prosthodontics

 Bassetti et al

Survival rates (%)

Implant (I)/tooth (T) Prosthetic
Tooth Implant failures (Bi or Te com- complications and Abutment CBL (Tx) or Patient
abutment abutment plications) maintenance Implants teeth Prostheses ∆CBL (Tx–Ty) satisfaction
Root copings Group 1: Group 1: Group 1: Group 1: Group 1: Group 1, ∆CBL (T1–T3): Group 3 was
with: Ball anchors T (Te): 1 tooth loss; I: 100 96.9 2, 3: –0.8 ± 1.1 mm more satisfied
Mini Gerber 2 recementation of root 5 matrix loosening Group 2: 100 compared to
Plus (CM) Group 3: coping 6 matrix tightening Group 3: 100 group 1 in:
or Maxilla: T: 98.2 Comfort of
Ball anchors U-shaped Group 2: 2 matrix loosening wear*
(Dalla Bona, Dolder bars T (Te): 3 recementation 7 matrix tightening Stability of
CM) Mandible: Ball root coping Prosthesis: prosthesis*
anchors 2 repair
Group 3: 8 adjustment Group 3 was
I (Bi): 1 implant loss more satisfied
I (Te): 9 abutment Group 2: compared to
loosening T: group 2 in:
1 matrix loosening General
25 matrix tightening satisfaction*
Prosthesis: Speaking
6 repair ability*
21 adjustment Comfort of
wear*
Group 3: Stability of
I: prosthesis*
1 matrix loosening General
2 matrix tightening problems*
Prosthesis:
5 repair
15 adjustment

Group 2 (56) exhibited

more Te than group 1
(33) + 3 (32)*
Crowns with Group 1: Group 1: Group 1: Group 1 ND Group 1 ∆CBL (T2–T3): Satisfaction
fitted oral part Modified I (Bi): 1 framework fracture + 2: + 2: –0.63 mm (T0):
for frame and healing formers 1 implant loss 2 pitting of healing 93.8 90 1.2
support I (Te): abutment surface
Group 2: 2 screw loosening Satisfaction
OSO type Group 2: (after T2):
attachments Group 2: None 5.0
(Zaag, Preat); I (Bi): (Scale from
Extracoronal 1 mucosal hyperplasia in 1 to 5, with
attachments 1 patient 1 being least
(ERA, favorable)
Sterngold)

of wearing prosthesis, esthetic appearance, stability of
prosthesis during function, ability to chew, handling of
the prosthesis when placing or removing it, and gen-
eral problems with the prosthesis as experienced by
the patient. The responses to comfort (P < .02) and sta-
bility (P < .05) were significantly worse in the IARPD
group compared with the exclusively implant–retained
overdenture group. The remaining items were also
rated worse in the IARPD group compared with the
exclusively implant–retained overdenture group, al-
though not significantly so.
Discussion
Unlike previous systematic reviews,6–8 outcome data
of IARPDs in both jaws, not only in the mandible, were
analyzed in the present review. This was based on the
fact that the implant survival rate of implant-supported

doi: 10.11607/ijp.5227 11
Implant-Assisted Removable Partial Denture Prostheses
prostheses in the maxilla seems to be significantly
lower compared to that of those placed in the man-
dible.32 Therefore, the present systematic review was
conducted to assess clinical efficacy and effective-
ness (ie, survival rates [implants, abutment teeth],
prosthetic survival rates, complication rates, ΔCBL,
and patient satisfaction outcomes) of rehabilitation
using maxillary and/or mandibular IARPDs to facilitate
the treatment decision-making process for the private
dental practitioner.
The quality assessment enabled the evaluation
of the quality of included studies for better under-
standing, interpretation, and weighting of outcome
data, as well as the suitability for the application
of further synthesis and comparison methods.
Most studies of IARPDs were conducted inhomog-
enously, making comparisons problematic; thus,
no meta-analysis could be performed. More than
half of the included studies did not have a control
group, and there were no RCTs. Therefore, no qual-
ity assessment using the Cochrane Collaboration’s
guidelines12 could be performed. Consequently, all
included studies exhibited a high risk of bias, and
this should be taken into account when consider-
ing the outcomes of this review.
Another limitation of this systematic review is that
only full-text articles in English or German were con-
sidered and included.
Survival Rates
Survival and Success Rates of Implants in
Combination with IARPDs. The implant survival
rates (91.7% to 100%) were similar to those of implants
placed to support an exclusively implant–supported
removable prosthesis,32 implant-supported crowns,
or fixed partial dentures.33 However, only four of the
nine included studies had a mean observation time of
> 3 years.25,28,30,31 Two studies mixed short-term and
long-term follow-up results (1 to 8 years3 and 1 to 4
years27 ), while three studies had a mean observation
period of < 3 years.2,26,29
Survival and success rates differ in that complica-
tions of implant therapy are included only in success
rates. In the last 30 years, more diverse criteria for
success have been suggested.34,35 Only one study in-
cluded in this review reported a predefined success
rate,28 which amounted to 95.6% after a mean ob-
servation period of 5.8 years according to the criteria
defined by Albrektsson et al.34 This success rate is
similar to those reported previously33; however, suc-
cess rates can vary considerably depending on the
criteria applied. Accordingly, comparison with implant
success rates in other studies should be performed
with caution.
12 The International Journal of Prosthodontics
Survival Rates of Abutment Teeth in
Combination with IARPDs. The survival rates of
abutment teeth used to retain and/or support the
IARPD were reported in six of the nine studies, and
ranged from 79.2% to 100% after observation periods
of 1 to 12.2 years.2,3,25,26,28,31 A higher risk of periodon-
tal problems (eg, gingival inflammation, increased
periodontal probing depths, and gingival recession)
and caries has been reported in conventional RPD
and overdenture patients.36–40 In particular, the abut-
ment teeth are prone to detrimental effects.36,41,42 In
a retrospective study of RPD patients, an abutment
tooth survival rate of 73.6% after a 10-year follow-up
was reported;39 however, the patients in this study
were not enrolled in a regular maintenance program.
The mean survival rate of abutment teeth (96.3%) in
this review is at least partially explained by the rela-
tively short follow-up periods. In two studies exhibit-
ing survival rates of 100%, the mean follow-up periods
were 24 and 38 months.26,31 Only two studies included
in the present review presented mean observation pe-
riods of > 5 years.25,28 Furthermore, a regular main-
tenance regimen is important, particularly for RPD
patients, because abutment teeth have a higher risk
of plaque accumulation compared with nonabutment
teeth.43 However, there is evidence that appropriate
oral hygiene and a regular control and maintenance
program reduce the risk of failure of abutment teeth.44
Finally, the risk of abutment tooth loss in RPDs
is higher in patients with few remaining abutment
teeth.42,45 With the strategic positioning of dental
implants as additional retention and/or supporting
elements, a Kennedy Class I can be modified to a
Kennedy Class III, and a linear dental support can be
changed to a tri- or quadrangular dental and implant
support.25,27 Hence, swing movements along the axis
of rotation of the prosthesis can be avoided and, thus,
the risk of abutment tooth loss reduced.39
Survival Rates of IARPDs. The nine studies in-
cluded in this review reported IARPD survival rates
of 90% to 100% after observation periods of between
1 and 12.2 years.2,3,25–31 Compared with other studies
reporting a survival rate of 77% for conventional RPDs
after an 8- to 9-year period46 and a 71.3% survival rate
after a 10-year period,42 the IARPD survival rates of
the included studies were markedly higher; indeed,
the survival rate was lower than 100% in only one
study (90%).27 This suggests that the additional use of
dental implants in IARPDs might have a positive effect
on the prosthesis survival rate, possibly because RPD
patients are frequently elderly individuals who have a
higher prevalence of root caries.47,48 However, this risk
is eliminated by use of dental implants, and removable
prostheses can be modified relatively simply. A failed
abutment tooth can in many cases be replaced with a

dental implant,3 and the prosthesis must be adapted
to the new situation. A regular maintenance program
and supervision of the prosthesis are sine qua non for
a good long-term prognosis.39,42
Complications and Prosthodontic Maintenance
In eight out of the nine publications included in this
review, 1,086 events (ie, complications and prosth-
odontic maintenance interventions) were report-
ed.2,3,25–28,30,31 Only 29 of these 1,086 events were
biologic complications: 5 implants in 3 patients associ-
ated with mucositis, 9 in 8 patients with peri-implanti-
tis, and 2 in 2 patients with mucosal hyperplasia,3,27,28
and 8 abutment teeth were associated with caries,
3 with periodontitis, and 2 with gingival hyperplasia,
although these complications were not discernible to
the patients themselves.3
It is reported that the most frequently encoun-
tered biologic complications in implant treatment
are peri-implant mucositis with or without accompa-
nying marginal bone loss.49 The latter is referred to
as peri-implantitis, and its specific etiology remains
controversial. Smoking is also regarded as a risk
factor, with one review reporting a markedly higher
risk of biologic implant complications for smokers.50
Moreover, established periodontal pockets with prob-
ing depths of > 5 mm appeared to increase the risk of
peri-implantitis.51
The risk of biologic complications (caries and peri-
odontitis) is relatively high for both abutment and
nonabutment teeth, particularly the former. In a ret-
rospective study of RPD and conical crown–retained
RPD (CCRPD) patients, the incidence of caries was
12.9% for abutment teeth and 6.2% for nonabutment
teeth after 10 years.42 In the same patient cohort, the
incidence of periodontitis was 26.4% for abutment
teeth and 14.2% for nonabutment teeth.39 In two other
retrospective studies of overdenture patients, the inci-
dence of caries was 35.3% to 40.7%, and that of peri-
odontitis was 22.2% to 29.3% after 1 to 22 years.38,40
IARPD patients have an elevated risk of biologic im-
plant- and tooth-related complications. Therefore,
successful treatment of preexisting periodontitis52
and a regular recall and maintenance system are key
for successful prosthodontic therapy.39
The very low frequencies of mucositis and marginal
bone loss (5 and 9 implants, respectively, out of 436
implants), as well as periodontitis and caries (3 and 8
abutment teeth, respectively, out of 353), in this review
can be explained by the fact that only two studies28,31
reported measurements of peri-implant clinical pa-
rameters, and no study reported measurements of
periodontal clinical parameters. In a third study, no
peri-implant or periodontal clinical parameters were
Bassetti et al
reported, but seem to have been collected by a den-
tal hygienist during the regular biannual maintenance
program.3 This is the only study reporting frequencies
of caries (6.2%) and periodontitis (2.3%) at abutment
teeth. If only these three studies are considered, the
frequency of mucositis with accompanying marginal
bone loss at 1 to 12.2 years after implant insertion is
5.8% (9 out of 156) at the implant level and 9.0% (8
out of 96) at the subject level.3,28,31 The presence of
mucositis or periodontitis can be verified only by the
collection of peri-implant/periodontal clinical param-
eters, such as bleeding on probing, suppuration on
probing, and measurement of peri-implant/periodon-
tal probing depth during the observation time.49,53
Three publications26,29,30 did not examine radiograph-
ic peri-implant CBL, which is essential to diagnose
marginal bone changes.49,53 In addition, the factor of
follow-up time plays an important part in the develop-
ment of risk of biologic changes. In this context, only
three studies presented a mean observation time of
more than 5 years.25,28,30 Therefore, the frequencies
of reported biologic changes must be considered with
utmost caution.
The remaining 1,057 events were technical compli-
cations or prosthodontic maintenance interventions.
This high number may explain the high prosthesis sur-
vival rate of 100% in eight of the included nine studies,
since the IARPD patients were enrolled in a regular
prosthetic maintenance program in which necessary
adjustments or relinings could be performed before
any detrimental effect arose (in one study, irrespec-
tive of wear, the resilient attachment component was
replaced annually30) and, in the case of an abutment
tooth loss, only modifications of removable prosthe-
ses are usually necessary, and the prostheses do not
have to be replaced.
Types of IARPDs and Anchoring Systems
Of the 246 IARPDs, 134 were of an RPD design, and the
implants were provided with ball anchors, modified heal-
ing formers or locators, or bar attachments.3,25,27,29,30
The attachment teeth available were provided with
clasps3,25,30 or crowns that included a milled component
as a frame and support.27 Further, 46 prostheses were of
an overdenture design. All implants were provided with
ball anchors, and the abutment teeth with root copings
included a precision attachment.2,3 The remaining 56
prostheses were manufactured as RPDs with telescopic
double-crown attachments on the attachment teeth as
well as on the implants.3,26,28,31
In a retrospective study, clasp-retained RPDs, CCRPDs,
and combined clasp- and conical crown–retained RPDs
(CRPDs) were evaluated after a function period of 10
years.42 The rate of abutment tooth loss was significantly
doi: 10.11607/ijp.5227 13
Implant-Assisted Removable Partial Denture Prostheses
higher in the CRPD group (51.7%) compared with the
other two groups (33.3% and 41%, respectively). This
higher rate of abutment tooth loss in CRPD patients was
explained on the one hand by the decision to use a clasp
or conical crown for distal retention in molar areas (ie,
long edentulous spaces in the lateral tooth area, ques-
tionable prognosis of the molar) and on the other hand
by the higher probability of extraction for posterior teeth
compared with anterior teeth.42 However, a quadrangular
support has been reported to have a highly significant
influence on the survival rate of CCRPDs.54 Thus, the use
of dental implants to change a Kennedy Class I or II into
a Kennedy Class III, as well as to replace a molar with a
questionable prognosis, could have a positive effect on
the long-term prognosis of prosthetic treatment. It seems
that IARPDs supported by a conical crown system, as
well as a mixture of ball attachments on implants and
clasps on teeth or root coping precision attachments,
are appropriate anchoring systems for IARPDs. In those
studies in which the IARPD implants were provided with
a healing cap to serve as a supportive but not a retentive
anchor, healing cap loosening was a frequent complica-
tion.25,27 A supportive anchoring system allows relative
movement of the prosthesis on the healing cap, which
more easily facilitates screw resolution compared with a
retentive ball-anchoring system.
Peri-implant 𝚫CBL
Only six studies reported radiographic measurements
of the peri-implant CBL over time (Table 3).2,3,25,27,28,31
The baseline used in three studies2,3,31 was the time
point of implant placement (T1) (mean ∆CBL of –0.53
to –2.2 mm) and in the three other studies was the day
of implant loading/prosthesis delivery (T2) (mean ∆CBL
of –0.17 to –1.03 mm).25,27,28 In all six studies included,
radiologic CBL measurements were performed using
nonstandardized 2D x-rays. Thus, implant parameters
could be evaluated only approximately, and therefore
the comparability of different time point measurements
is questionable. However, taking into consideration all
the limitations, the mean ∆CBL values in the six in-
cluded IARPD studies might be similar to those of ex-
clusively implant–retained removable dentures (–1.44
± 0.78 mm after an observation period of 5 years in the
mandible55 and –2.1 ± 0.6 mm after a mean follow-up
period of 3.5 years in the maxilla56).
Patient Satisfaction
Four of the nine studies included in this systematic
review assessed patient satisfaction.2,27,29,30 However,
none of these four studies applied a validated and/or
widely used instrument such as the Oral Health Impact
Profile (OHIP) for measuring oral health–related quality
14 The International Journal of Prosthodontics
of life (OHRQoL). In two studies, change in satisfac-
tion was assessed by a 5-point questionnaire before
and after treatment27,30; in both, a distinct improve-
ment was reported. In the studies of Grossmann et al
and Hug et al, patient satisfaction was assessed only
after treatment.2,29 Based on the very limited clinical
assessment protocols in these four studies, no clear,
scientifically robust statement regarding improvement
of satisfaction can be made.
Nevertheless, two recent studies not included in
this review reported that IARPDs have a more posi-
tive effect on oral health compared to RPDs.4,5 In both
studies, the OHRQoL was assessed by a validated in-
strument (OHIP). However, it remains unclear to what
extent the improvement in satisfaction is related to
IARPD installation in particular or to the prosthetic
therapy in general.
Conclusions
On the basis of the currently available literature,
the posed question in this review of clinical efficacy
and effectiveness of IARPDs cannot be answered
in a scientifically compelling manner. The accrued
knowledge is based on scientifically weak evidence:
no single RCT is available, short-term and long-term
evaluations are mixed, nonstandardized 2D x-rays
for peri-implant CBL measurements are used, the
study designs are highly heterogenous, and instru-
ments for evaluating patient satisfaction and treat-
ment outcomes are nonvalidated and questionable.
Nonetheless, the preliminary evaluation of the litera-
ture suggests that IARPDs represent a simple and
cost-effective treatment approach to achieving sym-
metric prosthesis support and stability, as well as to
improving patient satisfaction. However, more scien-
tifically robust, well-designed, long-term studies are
needed to confirm this assumption.
Acknowledgments
The authors report no conflicts of interest. This review article was
supported by the authors’ own institutions (Department of Oral
& Maxillofacial Surgery of the Lucerne Cantonal Hospital). This
article does not contain any studies with human participants or
animals performed by any of the authors. For this type of study,
formal consent is not required.
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