title: A randomized clinical trial comparing the efficacy of mandibular implant-supported overdentures and conventional dentures in diabetic patients. Part II. Comparisons of masticatory performance.
abstract: BACKGROUND
  Convincing evidence is lacking to demonstrate the functional superiority of mandibular implant-supported overdentures over conventional dentures.
  
  
  OBJECTIVE
  This randomized clinical trial was conducted to compare masticatory functional effectiveness of mandibular implant-supported overdentures and conventional dentures in diabetic denture wearers with clinically acceptable metabolic control.
  
  
  METHODS
  A total of 102 edentulous diabetic patients, treated with or without insulin, were randomized to receive a new maxillary and either a mandibular conventional denture or an implant-supported overdenture. Treatment was completed in 89 patients, 37 with conventional dentures and 52 with Hader bar-clip attachment overdentures supported by two IMZ implants. Besides data from medical and dental histories, oromaxillofacial examinations, and questionnaires, masticatory tests were performed by patients before and at 6 and 24 months after treatment completion. Although 78 patients (28 in the conventional, 50 in the overdenture group) performed tests at 6 months after treatment, 68 (25 in the conventional, 43 in the overdenture) had performance data for both entry and 6-month posttreatment intervals.
  
  
  RESULTS
  The two treatment groups were highly comparable in terms of general characteristics, quality of original dentures, tissue support, and past denture experience. No significant differences were found between patients treated for diabetes with or without insulin. All four masticatory performance scores with original dentures were higher in the conventional denture group than the overdenture group. The posttreatment performance scores for the two treatment groups became similar because of the higher gains in the overdenture group. Patients with low initial performance scores showed greater posttreatment gains with both conventional dentures and overdentures.
  
  
  CONCLUSIONS
  The implant-supported overdenture showed no significant advantage over the conventional denture for improving the ability to comminute food in this group of diabetic patients with higher than average initial functional levels observed for other groups of denture wearers in previous studies.
authors.affiliation: Department of Veterans Affairs Medical Center, West Los Angeles, Calif., USA.
authors.forename: N R
authors.initials: NR
authors.lastname: Garrett
authors.forename: K K
authors.initials: KK
authors.lastname: Kapur
authors.forename: M O
authors.initials: MO
authors.lastname: Hamada
authors.forename: E D
authors.initials: ED
authors.lastname: Roumanas
authors.forename: E
authors.initials: E
authors.lastname: Freymiller
authors.forename: T
authors.initials: T
authors.lastname: Han
authors.forename: R M
authors.initials: RM
authors.lastname: Diener
authors.forename: S
authors.initials: S
authors.lastname: Levin
authors.forename: T
authors.initials: T
authors.lastname: Chen
mesh_terms: D000704:Analysis of Variance; D010367:Arachis; D018552:Daucus carota; D003679:Deglutition; D017742:Dental Care for Chronically Ill / Q000379:methods*; D019094:Dental Prosthesis, Implant-Supported; D003826:Denture, Complete, Lower; D003828:Denture, Overlay; D003920:Diabetes Mellitus; D006801:Humans; D008409:Mastication; D008875:Middle Aged; D015999:Multivariate Analysis