Comparison of masticatory performance and oral health-related quality of life between immediate and conventional loading protocols for an implant-supported mandibular overdenture: A systematic review and meta-analysis of randomized clinical trials

Abstract

Statement of problem. Immediate loading protocols involve placing prostheses on implants shortly after their insertion. Although these protocols are gaining popularity because of their potential benefits, uncertainty remains regarding their comparative effectiveness in terms of masticatory performance and oral health-related quality of life (OHRQoL). A comprehensive synthesis of available evidence to guide clinical decision-making is lacking. Purpose. This systematic review aimed to compare the differences in masticatory performance and OHRQoL between immediate and conventional loading protocols for an implant-supported mandibular overdenture in edentulous patients. Material and methods. After determining participants, intervention, comparison, outcome, study design (PICOS) and eligibility criteria, an extensive search was executed in the PubMed, Scopus, ISI, Cochrane Library, and Embase databases without restrictions. Additional searches were undertaken in Google Scholar, ProQuest, and the reference lists of the selected articles. The selection of papers, data extraction, and quality assessment were performed by 2 independent reviewers. A meta-analysis was conducted using a random effects model, with the standardized mean difference (SMD) for masticatory performance and OHRQoL reported alongside a 95 confidence interval (CI) to estimate the pooled effect size. Results. After screening 1605 identified records, 9 randomized clinical trials (RCTs) met the eligibility criteria. One study had an unclear risk and the others were low risk. Immediate loading was associated with better masticatory performance (SMD: 0.69; 95 CI: 0.06 to 1.31; P=.033) and improved oral health-related quality of life (SMD: -1.56; 95 CI: -2.40 to-0.73; P<.001) compared with conventional loading. Conclusions. The immediate loading protocol demonstrates a statistically significant advantage over the conventional loading protocol regarding masticatory performance and OHRQoL. These findings suggest that immediate loading may be considered a suitable treatment option for patients requiring implant-supported mandibular overdentures.