Clinical performance and prosthetic outcomes in reinforced implant-supported overdentures: A systematic review.
TL;DR
Reinforced implant overdentures show high survival but require ongoing maintenance, and attachment design and reinforcement type primarily influence complication profiles rather than survival.
Abstract
STATEMENT OF PROBLEM Prosthetic reinforcement and attachment selection are intended to improve the mechanical stability and serviceability of implant-supported overdentures; however, their influence on survival and maintenance outcomes has not been consistently quantified.
Purpose
The purpose of this systematic review was to evaluate the effect of reinforcement strategies and attachment systems on survival, mechanical complications, and maintenance outcomes of reinforced implant-supported overdentures. MATERIAL AND
Methods
The MEDLINE (PubMed), Scopus, and Ovid databases were searched for English-language clinical studies published from 2010 through 2025. Randomized controlled trials and nonrandomized clinical studies reporting reinforced implant overdentures were included. Study selection and data extraction were performed independently by 2 reviewers. Risk of bias was assessed using RoB 2.0 for randomized trials and ROBINS-I for nonrandomized studies. Because of heterogeneity in design and outcome reporting, meta-analysis was not performed, and results were synthesized descriptively.
Results
Twenty-nine studies were included (3 randomized trials and 26 observational investigations). The sample sizes ranged from single-patient reports to cohorts exceeding 200 participants, with follow-up periods between 6 and 168 months. Stud attachments (LOCATOR or ball), bar-retained frameworks, and telescopic systems were the most frequently evaluated. Implant survival exceeded 95% in most studies. Prosthesis survival was high; however, maintenance events were common, including attachment wear, insert replacement, clip activation, relining, and denture base or framework repair. Bar-reinforced overdentures demonstrated fewer base fractures but greater hygiene-related maintenance, whereas stud attachments showed higher component replacement rates. Substantial clinical and methodological heterogeneity and predominantly observational designs limited comparative analysis.
Conclusions
Reinforced implant overdentures show high survival but require ongoing maintenance. Attachment design and reinforcement type primarily influence complication profiles rather than survival. Current evidence is mainly observational, and high-quality randomized trials with standardized outcomes are needed.