Implant overdentures: The standard of care for edentulous patients

  • J.S. Feine &
  • G.E. Carlsson
UK: Quintessence price £40, pp 172 ISBN 0867154306 | ISBN: 0-867-15430-6

This book is a compilation of the 15 papers presented at an important international Symposium in Canada in 2002 on the topic of two-implant mandibular overdentures. There are 14 chapters by 23 contributors from a number of countries. The book is edited by two of these contributors, Jocelyne Feine and Gunnar Carlsson.

The early chapters cover demographic trends, the effect of tooth loss and subsequent treatment on nutrition, the impact of edentulism on general health, and patient preferences and expectations. Later chapters cover aspects of two-implant mandibular overdenture treatment including comparisons with conventional dentures, cost of treatment, choice of implant systems, treatment strategies, indications and treatment planning, attachment systems, and loading strategies. Chapter 10 deserves special mention as it is the only one with a discussion of the evidence relating to maxillary implant dentures as well as to mandibular implant dentures. Much of the material has already been published but has been cleverly brought together by each contributor.

There are occasional departures from the Symposium's philosophy of evidence-based decisions and practice. An example of this occurs in Chapter 13 which contains a com-prehensive description of the clinical stages involved in placing two mandibular implants as a single stage procedure followed by the construction of the overdenture. The caption for Figures 13-5 and 13-6 states that it is important for a line joining the two mandibular implants to be parallel to a line joining the retromolar pads. There was no evidence for this statement and I was surprised to note that the authors did not follow their own advice — the implant analogues illustrated in Figure 13-35 are clearly asymmetrical. In fact, this very question is addressed in Chapter 10: there really is no evidence to support the concept.

There also seems to be some uncertainty as to where the two mandibular implants should be placed. In Chapter 13, the authors opt for the canine region whereas in Chapter 9, the author presents a good case for the lateral incisor region. Fortunately, the definitive answer is again in Chapter 10 where we are advised that the choice of implant site should be governed by the size and curvature of the anterior arch.

Contrary to what you might think, these inconsistencies actually heighten interest and will encourage the reader to look for answers based on evidence.

The book ends with the McGill Consensus Statement that the treatment of choice for a patient with an edentulous mandible should be a two-implant overdenture rather than a conventional denture. The evidence presented in the rest of the book is overwhelming, although the Statement should perhaps be qualified in that most of the evidence pertains to situations where the opposing maxilla is also edentulous and restored with a complete denture without implants.

I enjoyed reading this book and can recommend it to anyone who has an interest in implant overdentures. At £40, it is an inexpensive way of obtaining the material presented at the Symposium. Every postgraduate student in prosthodontics should have access to the book but it probably covers the subject in a greater depth than an undergraduate dental student would need. I was delighted to have the opportunity of adding it to my bookshelf.