In a retrospective study, 150 patients with edentulous maxillae were selected for treatment with Brånemark implants. The patients were arranged into four different groups, based on jaw shape prior to implant placement. After second-stage surgery, they were provided with either fixed prostheses, removable overdentures followed by fixed prostheses after at least 1 year, or overdentures for the whole period. Patients were followed up for 5 years, with implant and prosthesis survival, annual visits, marginal bone loss, and complications recorded. Results of the study indicated that treatment outcome in edentulous maxillae might be predicted by careful presurgical evaluation of jaw shape. Five-year cumulative implant failure rates varied from 7.9% for patients considered to have enough bone to be provided with fixed prostheses immediately after second-stage surgery to 28.8% for those with severely resorbed jaws receiving an overdenture. The corresponding cumulative prosthesis failure rates were 3.0% and 18.9%, respectively. Patients provided with autogenous bone grafts compared favorably to the group presenting severely resorbed jaws and provided with overdentures, but showed a compromised result compared to the group with the least resorption. Failure of implant treatment correlated significantly with bone quality and ratio of 7-mm implants. All groups, except those treated with bone grafts, showed an average marginal bone level of 1.2 mm after 5 years, irrespective of type of prosthesis. The bone-grafted group showed a corresponding mean level of 2.3 mm after 5 years of function. Regarding clinical complications, a different pattern, mainly related to the type of prosthetic construction used, was observed between the groups. The number of visits clearly indicated that severely resorbed jaws provided with overdentures were the most demanding.
Keywords: osseointegration, implants, maxilla, jaw shape, grafting, follow-up, overdenture, maintenance