W.

Day Gates III The effect of implant-supported

Lyndon F. Cooper
Anne E. Sanders
removable partial dentures on oral
Glenn J. Reside health quality of life
Ingeborg J. De Kok

Authors’ affiliations:
W. Day Gates III Private Practice, Mobile, AL, USA
Lyndon F. Cooper, Ingeborg J. De Kok, Department
of Prosthodontics, University of North Carolina
School of Dentistry, Chapel Hill, NC, USA
Anne E. Sanders, Department of Dental Ecology,
University of North Carolina School of Dentistry,
Chapel Hill, NC, USA
Glenn J. Reside, Department of Oral &
Maxillofacial Surgery, University of North Carolina
School of Dentistry, Chapel Hill, NC, USA
Corresponding author:
Ingeborg J. De Kok, DDS, MS
Assistant Professor
Department of Prosthodontics
University of North Carolina School of Dentistry
330 Brauer Hall, CB 7450
Chapel Hill
NC 27599-7450, USA
Tel.: +1 919 966 2719
Fax: +1 919 966 3821
e-mail: ingeborg_dekok@dentistry.unc.edu
Key words: implant-supported removable partial denture, oral health quality of life,
removable partial denture, short implants
Abstract
Purpose: Removable partial dentures (RPDs) represent standard treatment for partial edentulism
despite major shortcomings. To alleviate these shortcomings, endosseous implants provide support
and stability as well as contribute to maintenance of alveolar bone. This prospective, within
subject, time series study evaluated patient-based outcomes of RPDs compared to implant-
supported removable partial dentures (ISRPDs). The study hypothesis was that the ISRPD would
substantially improve oral health quality of life for patients.
Materials and methods: Seventeen patients requesting new mandibular Kennedy I or II RPDs
received one 6-mm dental implant in one or both of the posterior edentulous areas. After healing,
conventional RPDs were fabricated and delivered. Twelve weeks later, second-stage surgery was
performed, and ball abutments with Clix attachments were inserted, thereby converting the
prostheses to ISRPDs. Oral health quality of life was evaluated using the 49-item Oral Health
Impact Profile (OHIP-49) questionnaire. The OHIP-49 was administered prior to treatment
(baseline), at 6 and 12 weeks following RPD delivery and at 6 and 12 weeks following ISRPD
conversion. Radiographic evaluation was performed at 6 and 12 weeks following ISRPD conversion.
In statistical analysis, a fixed-slope random intercept variance components model took account of
the multiple observations per person over time.
Results: In 17 subjects, 29 of 30 implants survived. The failed implant was replaced without
complications. Abutment complications were limited to one abutment loosening and one
attachment replacement. Minor prosthodontic complications were recorded. The OHIP-49 score
reduced by 11.8 points, on average, at 12 weeks following ISRPD conversion (P = 0.011).
Conclusions: Patients reported improved oral health following conversion to an ISRPD from RPD.
The ISRPD involving short implants is one treatment option that should be considered when
treatment planning Kennedy Class I and II patients.

By the year 2030, the population of the
United States older than 65 years is expected
to double (Krasne 2007). Accompanying this
will be an increase in the number of partially
edentate individuals with the number
complete or partial dentures exceeding 60
million by 2020 (Meskin & Brown 1988;
Douglass & Watson 2002). For the partially
edentulous patients, dental rehabilitation
may involve removable partial dentures
(RPDs), fixed partial dentures (FPDs),
Date: implant-supported crowns, and/or FPDs. For
Accepted 29 October 2012
many of these individuals, an RPD represents
To cite this article: a removable, economical, and conservative
Gates WD, Cooper LF, Sanders AE, Reside GJ, De Kok IJ. The
effect of implant-supported removable partial dentures on oral treatment. When RPDs are rejected, the
health quality of life.
reasons frequently include a desire for a fixed
Clin. Oral Impl. Res. 25, 2014, 207–213
doi: 10.1111/clr.12085 prosthesis, esthetics, unsatisfactory retention,
and increased risk of biologic complications
(Leles et al. 2009).
The benefits of RPD therapy are modest.
Negative therapeutic outcomes have been
illustrated by the National Health and Nutri-
tion Survey (NHANES III), which evaluated
1303 RPDs by calibrated dentists. Of these
RPDs, two-thirds were determined to have at
least one defect, with lack of stability being
the most prevalent. Specifically, mandibular
RPDs lack reported retention (Hummel et al.
2002). In relation to these limitations, within
5 years, approximately 25% of all RPDs
required replacement or were not being worn.
This number increased to 50% in 10 years
(Vermeulen et al. 1996) and is dramatically
different than outcomes reported for fixed

© 2012 John Wiley & Sons A/S. 207

Gates et al
ISRPDs and oral health quality of life
prostheses (Pjetursson & Lang 2008). The
basis for dissatisfaction with RPDs includes
problems with fit, mastication, and denture
comfort. While dissatisfaction is also related
to esthetics, number of missing teeth, and
oral hygiene, satisfaction was not influenced
by RPD classification, number of missing
posterior teeth, or number of modification
spaces (Frank et al. 1998; Zlataric et al.
2000). Nonetheless, the least frequently worn
prosthesis following the treatment of partial
edentulism is the distal extension RPD
(Wetherell & Smales 1980).
It has been hypothesized that these short-
comings may be alleviated using implants
placed under RPDs to provide support,
increase stability, and maintain bone in the
posterior edentulous areas. Incorporation of
dental implants into RPD treatment through
the use of an overdenture approach may
address the more common complaints associ-
ated with RPD (i.e., stability, retention,
comfort) and do this in a cost-effective man-
ner (Mitrani et al. 2003; Mijiritsky et al.
2005; Grossmann et al. 2008; Ohkubo
et al. 2008; Kaufmann et al. 2009; Minoretti
et al. 2009). Several authors have considered
the feasibility and outcomes of implant-sup-
ported removable partial dentures (ISRPDs)
yet, there is little scientific evidence docu-
menting the effect of the ISRPDs on the oral
health of patients receiving removable
denture treatment beyond case reports (Miji-
ritsky 2007; Grossmann et al. 2009; Shahmiri
& Atieh 2010). Aside from technical limita-
tions and prosthetic complications, further
studies may be extended to include measures
of patient satisfaction and oral health quality
of life (OHQoL) of the patient receiving care.
The purpose of this research was to con-
duct a prospective, consecutive, controlled,
time series clinical study to evaluate (i) the
change in OHQoL by incorporating short
implants with RPD therapy, (ii) prosthetic
outcome of ISRPD, and (iii) 1-year survival of
4.0 9 6 mm implants (Astra Tech, Waltham,
MA, USA) in the posterior mandible.
Materials and methods
This study was an open, prospective, time
series clinical trial to document the implant
survival rates and evaluate the change in
OHQoL of patients following the placement
of 4.0 9 6 mm implants in the posterior
mandible of the partially edentulous patients
who desire implants to aid in RPD function
(Fig. 1). The study population consisted of 17
patients, each receiving conventional RPD
208 | Clin. Oral Impl. Res. 25, 2014 / 207–213
Time Series within Subject Study Design
Implant Conversion
Conventional
Enrollment placement from RPD to
RPD Delivery
N = 17 (2 stage) ISRPD
T = 0–12 week
T = –4 week T = 12–24 week
OHIP #1 OHIP #2 – 6 week OHIP #4 – 18 week
Baseline OHIP #3 – 12 week OHIP #5 – 24 week
Fig. 1. Study design.
intentionally followed by ISRPD treatments.
The research protocol was approved by the
University of North Carolina Institutional
Review Board.
The required inclusion criteria for patient
enrollment were (i) 18–85 years old, (ii) ASA
Class I or II, (iii) no history of radiation in
head or neck region, (iv) non-smoker, (v) post-
control phase of periodontal and restorative
treatment, (vi) at least four remaining teeth in
the mandibular arch including two contra
lateral cuspids and/or 1st bicuspids, (vii) stable Fig. 2. Implant with cover screw placed for submucosal
healing in the residual posterior mandibular alveolar
opposing dentition, (viii) willing to have
ridge.
proper tooth preparations and/or recom-
mended survey crowns fabricated to receive
RPD, (ix) minimum of 4 mm interarch
implants submerged, second-stage surgical
distance available for mandibular dentition,
procedure exposed the implants and ball
and (x) radiographic evaluation with pano-
abutments were inserted (Fig. 3). The con-
ramic x-ray (P-11) with >8 mm of bone occlu-
ventional RPD was converted to a tissue-/
sal to inferior alveolar canal and >5 mm wide
implant-supported ISRPD by intra-oral pick
crest of mandible without undercuts.
up of Clix attachments using acrylic resin
Patients seeking a mandibular Kennedy
(Fig. 4). Questionnaires (OHIP-49) were com-
class I or II RPD were recruited, and a new
pleted at 6 and 12 weeks after delivery of
RPD was fabricated. The Oral Health Impact
conventional RPD. Subsequent follow-up at
Profile (OHIP)-49 questionnaire was initially
18 and 24 weeks (Fig. 5) included investiga-
administered upon enrollment. The OHIP-49
tion of implant bone levels (peri-apical radio-
(Slade & Spencer 1994) evaluates the impact
graphs, illustrated in Fig. 6) and patient’s
of dental conditions on OHQoL. The items
OHQoL.
were derived from the 1980 World Health
The 17 patients (12 female) treated in this
Organization International Classification of
study ranged from 51 to 81 years of age
Impairments, Disabilities and Handicaps
(mean 61.5 years). They had retained 8.1
(World Health Organization 1980) adapted for
oral health (Locker 1988). OHIP-49 assesses
multiple dimensions of functional limitation,
physical pain, psychological discomfort,
physical disability, psychological disability,
social disability, and ultimately handicap
(Appendix 1).
Prior to fabrication of a conventional RPD
by traditional methods, a 4.0 9 6 mm Astra-
Tech OsseoSpeed Dental Implant (AstraTech,
AB) was placed by a two-stage procedure in
each mandibular unbound posterior edentu-
lous space (Fig. 2). A cast RPD was fabricated
Fig. 3. Abutment placement 12 weeks after implant
after implant placement, following conven- placement. Clix metal housing in position and abut-
tional protocols. After the patient had been ment prior to attachment pick up and conversion to
wearing the RPD for 12 weeks with the ISRPD.
© 2012 John Wiley & Sons A/S.

(a)
Fig. 4. Intaglio surface of removable partial denture (a) prior to and (b) following conversion to an implant-supported
removable partial denture at 12 weeks following implant placement.
Fig. 5. Intraoral occlusal images at 24-week follow-up.
Fig. 6. Periapical radiographs at 24-week follow-up.
natural mandibular teeth on average (range
4–11) and had an average of 4.8 teeth on their
RPD (range 2–10). Thirteen patients had
experience with a removable prosthesis prior
to enrollment into the study.
Statistical methods
The dependent variable was the OHIP-49
severity score computed as the sum of ordi-
nal responses across all 49 items. Responses
were made on a five-point ordinal scale rang-
ing from “never” (coded 0) to “very often”
(coded 4). This continuous variable has a
possible range from zero to 196 with higher
scores denoting worse oral health quality of
life. Any missing value was replaced with
the sample mean computed from non-miss-
ing responses to the relevant OHIP item. As
© 2012 John Wiley & Sons A/S.
(b)
a secondary outcome, the effect of treatment
delivery was examined separately for each of
the seven OHIP-49 dimensions. Bonferroni
correction adjusted for multiple tests across
the seven OHIP-49 dimensions, with a more
conservative threshold for statistical signifi-
cance (P-value = 0.007).
Finally, the seven OHIP items that com-
prise the NHANES-OHIP questionnaire (see
Appendix 1) were summed to permit a com-
parison of severity scores in this study with
those obtained for a representative sample of
the United States’ adult population.
The OHIP-49 was administered at baseline
(week 0) and at four subsequent visits timed
to assess patient outcomes at critical treat-
ment phases at weeks 6, 12, 18, and 24. This
serial administration permitted testing the
Gates et al
ISRPDs and oral health quality of life
study hypothesis that treatment delivery
would improve patient OHQoL. Follow-up at
6 and 12 weeks assessed the impact of the
conventional RPD on oral health quality of
life. The week 18 evaluation assessed the
impact of conversion to an ISRPD. Final
assessment of the stable environment was
conducted at week 24, about 6 months after
initiation of treatment. Group differences in
mean OHIP-49 severity scores at baseline
were tested using the Student’s t-test or
ANOVA. To compare patient scores against
OHIP norms for the United States’ popula-
tion, a summary score was computed limited
to the seven OHIP items contained in the
NHANES-OHIP.
To account for multiple measures being
made on each patient over time, models esti-
mated covariance parameters. A series of
two-level fixed-slope, random intercept vari-
ance components models was fitted using
maximum-likelihood estimation with the
xtmixed command in STATA software
(StataCorp. 2011). The mixed-effects linear
regression models estimated the effect of
treatment on patients’ OHQoL at five end
points over the treatment period. First, the
null model was fitted to estimate the intra-
class correlation coefficient, which indicated
the extent of variance within patients. The
second model additionally estimated the
effect of a visit; the final model adjusted for
covariates. Beta coefficients are directly inter-
pretable as mean the OHIP-49 severity score.
Coefficients prefixed with a minus symbol
indicate a reduction in OHIP-49 scores rela-
tive to the referent category.
Results
Oral health related quality of life
Initial OHIP-49 severity scores ranged from 19
(infrequent impact) to 102 (frequent impact)
with a mean value of 61.9 (95% confidence
interval [CI]: 49.2, 74.5). At baseline, 10
patients responded “very often” to at least
one OHIP-14 item. Patients aged  60 years
and patients with only natural teeth in the
maxilla reported lower OHIP-49 scores than
younger patients and those with a maxillary
denture; however, no between-group differ-
ences reached statistical significance of
P < 0.05 (Table 1).
In the null mixed model, the intraclass cor-
relation coefficient of 0.312 indicated that
31% of the variance in OHIP-49 severity
scores was attributed to correlation within
patients (not tabulated). This is interpreted as
69% of the reduction in OHIP-49 severity
scores over time is due to the effect of the
209 | Clin. Oral Impl. Res. 25, 2014 / 207–213
Gates et al
ISRPDs and oral health quality of life

Table 1. Selected characteristics of study participants and mean (SE) OHIP-49 Severity Score at experienced a prosthesis reported much
baseline (n = 17)
greater reductions in OHIP-49 scores than
Patient characteristics N Median Mean (SE) OHIP-49 score at baseline patients without prior experience (results not
All patients 17 61.0 61.9 (6.0) tabulated).
Gender Examination of OHIP-49 scores at Visit 5
Male 5 47.0 58.4 (15.1)
Female 12 64.5 63.3 (6.2) revealed significant improvement in patients’
Age oral health quality of life from Visit 3 levels
<60 years 8 80.0 74.1 (7.6) on six of seven dimensions (Fig. 8). However,
 60 years 9 47.0 51.0 (7.6)
when applying the lower threshold of signifi-
Race
White 12 55.5 59.8 (7.0) cance following Bonferroni correction
Non-white 5 81.0 66.8 (12.3) (P = 0.0007), only physical disability
Experience with prostheses remained significant.
Prior experience 13 61.0 64.9 (6.6)
No prior experience 4 54.0 52.0 (13.9)
Opposing arch Prosthetic complications
Natural teeth 4 59.0 58.3 (12.3) Prosthetic complications involved clasp
Removable partial denture 6 49.0 57.0 (12.1) adjustment (n = 5), fracture of denture tooth
Overdenture 2 71.0 71.0 (11.0)
Denture 5 68.0 67.0 (11.6)
(n = 2), reline of denture base (n = 2), and
Removable partial denture design reprocess of RPD (n = 1) were primarily
Kennedy Class I 11 60.0 59.7 (6.9) minor and could be managed within a single
Kennedy Class II, Mod 1 4 79.5 73.5 (11.8)
clinical visit. Abutment loosening was rare,
Kennedy Class I, Mod 1 1 82.0 82.0 (…)*
Kennedy Class II 1 19.0 19.0 (…)* and the need for relines of the intaglio
N retained mandibular teeth surface of dentures base was limited.
4–8 teeth 10 55.5 61.9 (8.5)
9–11 teeth 7 68.0 61.9 (8.7)
Implant survival
N teeth on partial denture
2–4 teeth 8 73.0 61.6 (10.9) Twenty-nine 6-mm implants survived with
5–10 teeth 9 60.0 62.1 (6.5) one early failure in one of 17 patients. The
*
No standard error computed as only one patient in this category.
implant was replaced with no complications.
The 29 surviving implants placed in all 17
patients remained functional without pain,
dental treatment. The categorical variable 70 infection, or mobility through 2 year of
“Visit” was additionally fitted in the model
follow-up. The implant survival was 97%.
Mean (SE) OHIP-49 severity score

with Visit 1 nominated as the referent cate- 60

gory. Substantial and statistically significant

50 Discussion
reductions in mean OHIP-49 severity scores
were observed at each of Visits 2–5 relative 40
This open, prospective, time series clinical
to Visit 1 scores (P = <0.001) (Table 2).
30 trial used the OHIP-49 to evaluate the pros-
A threefold reduction in mean OHIP-49
thodontic therapy of seventeen partially den-
severity scores was observed over the 20
tate patients missing terminal teeth of one or
26-week treatment period where scores
10 both mandibular quadrants. The results sup-
reduced 41.0 units per patient on average
port the conclusions of previous studies and
(Fig. 7). The greatest effect was recorded at
0 case reports regarding ISRPDs and extend
Visit 2 (6 weeks following conventional RPD Baseline Week 6 Week 12 Week 18 Week 24
information to include patient-based out-
delivery) where OHIP-49 scores reduced sig- Visit
come measures. In this report, implant sur-
nificantly by 23.7 units per patient on aver-
Fig. 7. A “visit” refers to each administration of the vival was high, despite using 6-mm implants,
age (P = <0.001). A second notable treatment OHIP-49 questionnaire timed to assess patient outcomes and prosthetic complications were within the
effect was at Visit 4; mean OHIP-49 scores at critical treatment phases at baseline (Visit 1), Visit 2
anticipated spectrum of possible events.
were reduced significantly by 11.8 OHIP-49 (week 6), Visit 3 (week 12), Visit 4 (week 18), and Visit 5
(week 24). Follow-up at 6 and 12 weeks assessed the Importantly, measurement of patients’ oral
units on average from Visit 3 levels
impact of the conventional removable partial denture on health–related quality of life increased with
(P = 0.011). Further slight gains observed at
oral health quality of life. The week 20 evaluation prosthetic treatment involving ISRPDs.
assessed the impact of conversion to a tissue-/implant-
Earlier studies have focused on technical
supported removable partial overdenture. Final assess-
Table 2. Difference in mean OHIP-49 severity and clinical aspects of delivery of care, partic-
ment of the stable environment was conducted at week
scores at visits 2–5 relative to visit 1 baseline ularly implant survival and prosthetic com-
26, 6 months after initiation of treatment. Higher scores
levels (n = 17)
denote worse oral health quality of life. Mean scores at plications. The focus of this investigation,
Beta Visits 2, 3, 4, and 5 were significantly lower at Visit 1. although limited by the 2-year follow-up
coefficient 95% CI P-value The Visit 4 score was significantly lower than the Visit 3
period, indicates that incorporation of dental
Visit 1 Ref score (P = 0.011). The mean Visit 5 score was not signifi-
cantly lower than Visit 4 (P = 0.351).
implants makes a positive and significant
Visit 2 23.7 32.8, 14.6 <0.001
Visit 3 24.8 33.9, 15.7 <0.001 improvement on the patient’s oral health–
Visit 4 36.6 45.7, 27.6 <0.001 Visit 5 relative to Visit 4 were non-signifi- related quality of life. Six of the seven theo-
Visit 5 40.9 50.0, 31.9 <0.001 cant (P = 0.351). In analysis stratified by prior retical subscale dimensions demonstrated
Constant 61.9 52.0, 71.7 <0.001
RPD experience, patients who previously statistical improvements from RPD to ISRPD

210 | Clin. Oral Impl. Res. 25, 2014 / 207–213 © 2012 John Wiley & Sons A/S.

20
OHIP-49 dimension
18 Functional limitation
Physical pain
16 Psychological discomfort
Physical disability
Mean OHIP-49 dimension score
Psychological disability
14
Social disability
Handicap
12
10
8 tions included loss of retention that involved
6
4
2 bility and to create a proper relationship
0 ing dentition. These findings are congruent
Baseline Week 6 Week 12 Week 18 Week 24
Visit
Fig. 8. Mean OHIP-49 scores at each visit plotted for the seven OHIP-49 dimensions. Reductions in mean OHIP-49
scores at Visit 5 from Visit 3 scores were statistically significant functional limitation (P = 0.022), pain (P = 0.048),
physical disability (P < 0.001), psychological disability (P = 0.041), social restriction (P = 0.009), and handicap
(P = 0.009), and approached significance for psychological discomfort scores was of borderline significance
(P = 0.054). However, when applying the lower threshold of significance following Bonferroni correction
(P = 0.0007), only physical disability remained significant.
with an overall mean reduction of 14 points 61.9 to 39.7) (Inukai et al. 2008). Here, the
at 18-week and 19.2 points at 24-week incorporation of short dental implants and
follow-ups. These patients indicated that Clix attachments to support the ISRPD that
they are better able to function and are more resulted in additional significant improve-
comfortable with their treatment. Other mea- ments in the OHIP-49 score were recorded.
sures of the impact of prosthesis on quality Importantly, these better self-reported out-
of life measures include the recent report of comes occurred without extensive surgical
Johns et al. (2009) who found that a reduc- procedures, such as grafting to place multiple
tion of six OHIP units in the total score implants or the expense associated with fixed
denoted “little improvement,” and an implant-supported restorations.
improvement of 10 OHIP units was related Previous efforts to improve the treatment
to “a lot better” global transition response. for Kennedy class I and II patients include
Based on these findings, the present 40 OHIP the work of Kapur et al. who utilized blade
unit improvement in self-reported oral health implants to support posterior FPDs vs. RPDs.
quality of life demonstrates this treatment is Recognizing the significant limitations of
both clinically and statistically significant. RPD therapy, 25 of the 115 RPD patients
At the initiation of treatment, patients had were excluded from comparison with the
significantly lower oral health quality of life implant-supported FPD due their treatment
that the United States general population. being judged a “failure” (Kapur 1991). Regard-
The baseline mean NHANES-OHIP score ing patient satisfaction, RPD patients had
(11.1 (SE = 0.960) was elevated fourfold over better oral hygiene, but were limited by dis-
the NHANES study estimate for 2003–2004 comfort, phonetics, restricted food choices,
(mean = 2.8) (Sanders et al. 2009). Treatment and inadequate prosthesis retention. This
resulted in a mean reduction beyond the pioneering work reliant on blade implants for
values reported for individuals without teeth comparison suggested the limitations of RPD
(3.6 [SE = 0.87] vs. 4.51). The patient’s therapy but failed to provide a biologically
reported outcomes mirror a Japanese cohort’s predictable alternative offered by endosseous
experience for which the delivery of a implants that emerged shortly after the publi-
high-quality RPD reduced the mean OHIP-49J cation of this important study.
score from 51.6 to 42.5. The present cohort Short endosseous implant support for RPDs
also denoted improvements based upon the offers a simplified approach with broad appli-
first stage of treatment involving a high-qual- cation; however, meticulous treatment plan-
ity RPD (reduction in mean OHIP-49 from ning should be executed to avoid future
© 2012 John Wiley & Sons A/S.
Gates et al
ISRPDs and oral health quality of life
treatment issues. Short implant survival is
supported by recent systematic reviews
(Atieh et al. 2012). Here, when 6-mm
implants were placed in the first or second
molar positions, high initial survival was
revealed.
Despite the improved OHQoL reported here,
complications did occur. Several patients
reported some post-delivery discomfort, which
required denture base adjustments. Complica-
adjustment of the retentive RPD clasps. Abut-
ment tightening and resilient attachment
changes occurred. Two patients required a
reline of the denture base to ensure RPD sta-
between the denture base, tissue, and remain-
with other reports for ISRPDs and overden-
tures (MacEntee et al. 2005; Cakarer et al.
2011). The remaining complication was inci-
dental and related to accidental damage to the
prosthesis by the patient.
One of the limitations of this clinical
study is the use of the time series design. A
cross-over study design would have permitted
a more definitive assessment of the treat-
ment modality by compensating for patient
expectations of the treatment. Related to
this, the cohort design lacked the presence of
a control group. Consequently, we attribute
the reduction in adverse impacts solely to
implant placement. Another aspect was that
the RPD had to permit use of the framework
for both and RPD and ISRPD, at times com-
promising optimal ISRPD design.
Conclusion
This study demonstrated that ISRPDs
substantially improved the OHQoL in patients
with mandibular Kennedy Class I and Kennedy
Class II partial edentulism. The ISRPD may be
considered a treatment option when treatment
planning Kennedy Class I and II patients. The
use of short implants (e.g., 4.0 9 6 mm
implants) may be considered to support ISRPD,
but with caution due to inadequate long-term
follow-up. With proper treatment planning,
construction, and follow-up care, prosthodontic
complications of ISRPD are minimal and simi-
lar to complications of RPDs.
Acknowledgements: This study was
supported in part by an Astra Tech
investigator-initiated study (IIS-D-2008-32)
and by the Southeastern Academy of
Prosthodontics.
211 | Clin. Oral Impl. Res. 25, 2014 / 207–213
Gates et al
ISRPDs and oral health quality of life
Appendix 1: Oral Health Impact
Profile questions and dimensionsa
Functional limitation questions
1. Have you had difficulty chewing any
foods because of problems with your
teeth, mouth, or dentures?
2. Have you had trouble pronouncing any
words because of problems with your
teeth, mouth, or dentures?
3. Have you noticed a tooth which doesn’t
look right?
4. Have you felt that your appearance has
been affected because of problems with
your teeth, mouth, or dentures?
5. Have you felt that your breath has been
stale because of problems with your
teeth, mouth, or dentures?
6. Have you felt that your sense of taste has
worsened because of problems with your
teeth, mouth, or dentures?
7. Have you had food catching in your teeth
or dentures?
8. Have you felt that your digestion has
worsened because of problems with your
teeth, mouth, or dentures?
9. Have you felt that your dentures have
not been fitting properly?
Physical pain questions
10. Have you had painful aching in your
mouth?
11. Have you had a sore jaw?
12. Have you had headaches because of prob-
lems with your teeth, mouth, or dentures?
13. Have you had sensitive teeth, for example,
due to hot or cold foods or drinks?
14. Have you had tooth ache?
15. Have you had painful gums?
16. Have you found it uncomfortable to eat
any foods because of problems with your
teeth, mouth, or dentures?
17. Have you had sore spots in your mouth?
18. Have you had uncomfortable dentures?
Psychological discomfort questions
19. Have you been worried by dental prob-
lems?
20. Have you been self conscious because of
your teeth, mouth, or dentures?
21. Have dental problems made you misera-
ble?
References
Atieh, M., Zadeh, H., Stanford, C. & Cooper, L.F.
(2012) Survival of short dental implants for treat-
ment of posterior partial edentulism: a systematic
review. The International Journal of Oral &
Maxillofacial Implants 27: 1323–1331.
212 | Clin. Oral Impl. Res. 25, 2014 / 207–213
22. Have you felt uncomfortable about the
appearance of your teeth, mouth, or
dentures?
23. Have you felt tense because of prob-
lems with your teeth, mouth, or den-
tures?
Physical disability questions
24. Has your speech been unclear because of
problems with your teeth, mouth, or
dentures?
25. Have people misunderstood some of your
words because of problems with your
teeth, mouth, or dentures?
26. Have you felt that there has been less
flavor in your food because of
problems with your teeth, mouth, or den-
tures?
27. Have you been unable to brush your
teeth properly because of problems with
your teeth, mouth, or dentures?
28. Have you had to avoid eating some foods
because of problems with your teeth,
mouth, or dentures?
29. Has your diet been unsatisfactory because
of problems with your teeth, mouth, or
dentures?
30. Have you been unable to eat with
your dentures because of problems with
them?
31. Have you avoided smiling because of
problems with your teeth, mouth, or
dentures?
32. Have you had to interrupt meals because
of problems with your teeth, mouth, or
dentures?
Psychological disability questions
33. Has your sleep been interrupted because
of problems with your teeth, mouth, or
dentures?
34. Have you been upset because of problems
with your teeth, mouth, or dentures?
35. Have you found it difficult to relax
because of problems with your teeth,
mouth, or dentures?
36. Have you felt depressed because of prob-
lems with your teeth, mouth, or dentures?
37. Has your concentration been affected
because of problems with your teeth,
mouth, or dentures?
Cakarer, S., Can, T., Yaltirik, M. & Keskin, C.
(2011) Complications associated with the ball,
bar and Locator attachments for implant-sup-
ported overdentures. Medicina Oral Patologia
Oral y Cirugia Bucal 16: e953–e959.
38. Have you been a bit embarrassed because
of problems with your teeth, mouth, or
dentures?
Social disability questions
39. Have you avoided going out because of
problems with your teeth, mouth, or
dentures?
40. Have you been less tolerant of your
spouse or family because of problems
with your teeth, mouth, or dentures?
41. Have you had trouble getting on with
other people because of problems with
your teeth, mouth, or dentures?
42. Have you been a bit irritable with other
people because of problems with your
teeth, mouth, or dentures?
43. Have you had difficulty doing your usual
jobs because of problems with your teeth,
mouth, or dentures?
Handicap questions
44. Have you felt that your general health
has worsened because of problems with
your teeth, mouth, or dentures?
45. Have you suffered any financial loss
because of problems with your teeth,
mouth, or dentures?
46. Have you been unable to enjoy other
people’s company as much because of
problems with your teeth, mouth, or
dentures?
47. Have you felt that life in general was less
satisfying because of problems with your
teeth, mouth, or dentures?
48. Have you been totally unable to function
because of problems with your teeth,
mouth, or dentures?
49. Have you been unable to work to your
full capacity because of problems with
your teeth, mouth, or dentures?
Underlined items are those used in the
National Health and Nutrition Examination
Survey (NHANES) with a representative sam-
ple of adults in the United States. Referred to
as NHANES-OHIP items.
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