Indicadores de qualidade de vida relacionada a saúde bucal (QVRSB) e sua relação com fatores clínicos e funcionais em usuários de overdentures mandibulares reabilitados com o sistema Facility-Equator

Abstract

The assessment of Oral health-related quality of life (OHRQoL) is an important patientcentered outcome to measure and predict the treatment with implant-retained mandibular overdentures (MO). However, the OHRQoL aspects of fully edentulous patients with mandibular bone atrophy rehabilitated with MO are still not well understood, as there are currently no paired or randomized clinical trials available. Thus, the objective of this thesis was to investigate the influence of MO rehabilitation in the patients OHRQoL. As well as verifying the possible influences of the independent variables: age, time since edentulism, different types of occlusal loading (conventional loading - CL and immediate - IML); and prosthetic intercurrences resulting from rehabilitation with MO retained by 2 narrow diameter implants (NDI) in the OHRQoL. or this, four studies were planned: i) A prospective short-term clinical study that evaluated the impact of treatment with MO retained by 2 NDI on OHRQoL using three questionnaires (OHIPEDENT, DIDL, and GOHAI) completed by 25 fully edentulous patients before and after 3 months of MO loading; ii) A 1-year prospective paired longitudinal clinical study that investigated the influence of age (≤ 65 and > 65 years) and time since edentulism (< 25 years and ≥ 25 years) of 33 patients on masticatory function (MF) and OHRQoL in edentulous individuals, before and during the first year of MO usage. The MF was evaluated through the masticatory performance (MP) and swallowing threshold (ST) tests before and after 1, 3, 6, and 12 months of MO loading. The OHRQoL was evaluated through the OHIP-EDENT and GOHAI questionnaires, before and after 3, 6, and 12 months. iii) A 1-year randomized clinical trial that randomized the occlusal load protocol of IML (10 patients) or CL (10 patients) and investigated the influence of the occlusal loading type on NDI as MO retainers through clinical, biological, functional, and OHRQoL, along with the incidence of the prosthetic intercurrences in each group. The outcomes were: peri-implant health indices (plaque index - PI, calculus presence - CP, gingival index - GI, probing depth - PD and bleeding on probing - BOP), primary and secondary stability of implants (ISQ), survival and success rates, marginal bone loss (MBL), marginal bone change (MBC), concentration of IL-1β and TNF-α cytokines in the peri-implant crevicular fluid, MF was evaluated using the MP test and OHRQoL was analyzed via the OHIP-EDENT questionnaire and via description of intercurrences during treatment. iv) A 2-year longitudinal clinical study that evaluated the performance of the10 Equator abutment as MO retainer in 24 patients from the prosthetic perspective during 2 years of prosthesis loading and investigated whether maintenance events and prosthetic complications can affect OHRQoL. OHRQoL was assessed through the OHIP-EDENT and GOHAI questionnaires. The results of study I showed that the OHRQoL of conventional denture (CD) wearers was significantly improved after 3 months of treatment with MO, especially in the domains of questionnaires that include functional and pain-related aspects. The second clinical study showed that the age and time since edentulism did not influence the MF of MO wearers after 1 year. However, MO significantly improved the MF of all patients, and this improvement was more evident in younger patients (≤ 65 years) with a shorter time of mandibular edentulism (< 25 years). The OHRQoL was influenced only by age and time since edentulism in CD wearers, and treatment with MO eliminated these differences. The randomized clinical trial (study III) showed that IML generates a better adaptation of the peri-implant tissues around the prosthetic components, as indicated by a lower probing depth and fewer prosthetic intercurrences. Significant differences in TNF-α and IL-1β levels between the CL and IML groups at 6 months of healing likely relate different time under function in both protocols. The improvement in MF and OHRQoL was observed regardless of the type of occlusal loading used. However, the IML group perceived OHRQoL improvements faster, yet this group needed more time to attain comparable MF improvements. The results of the fourth study show that certain complications and prosthetic maintenance events, such as fracturing of the prosthesis, Equator dislodgment, prosthesis rebase, and confection of new overdentures, affect patients’ OHRQoL. The physical pain and discomfort domains were most affected and the effects were largest during the first year of MO usage. In addition, all domains of the GOHAI and OHIP-EDENT questionnaires showed a significant improvement when comparing the baseline and the final evaluations after 1 and 2 years of MO loading, except for the social disability and psychological disability domains of OHIP-EDENT after 1 year. In conclusion, the four studies demonstrate that OHRQoL is significantly improved as early as 3 months after treatment with MO retained by 2 NDI. Considerable improvement can thus be achieved even in a population with low bone availability in the anterior region of the mandible, independent of patient’s age, time since edentulism, and occlusal loading protocol. However, prosthetic complications and maintenance events can affect the patients’ OHRQoL up to 2 years after loading.