Patient-reported outcome measures and clinical performance of implant-retained mandibular overdentures with stud and ball attachments: A systematic review and meta-analysis

Statement of problem. Evidence regarding the retention system for a mandibular overdenture is important for treatment planning. However, the clinical performance of stud and ball attachments for mandibular overdenture retainers is unclear. Purpose. The purpose of this systematic review and meta -analysis was to compare the clinical performance and self -reported patient outcomes of ball and stud attachments as mandibular overdenture retainers. Material and methods. Randomized (RCTs) and nonrandomized (N-RCTs) controlled clinical trials were selected based on the eligibility criteria. The risk of bias was assessed by using the Cochrane Collaboration Tools, and the certainty of the evidence (COE) by using the grades of recommendation, assessment, development, and evaluation (GRADE) workshop approach. Meta -analyses according to the follow-up period were performed for implant survival, prosthetic maintenance and complications, bleeding on probing (BoP), marginal bone loss (MBL), satisfaction, and oral health -related quality of life (OHRQoL). Results. Thirteen RCTs and 4 N-RCTs were included. Twelve studies presented a high risk of bias. The stud demonstrated a lower risk ratio (RR) (P<.001) for maintenance and complications concerning the need for matrix activation (RR 7.12 [2.65, 19.15]) (very low COE) and new overdentures (RR 2.47 [1.02, 5.96]) (moderate COE), ranging from 1 to 5 years of follow-up. Mean difference (MD) for MBL after 1 (MD 0.40 [0.28, 0.52]; P<.001) and 5 years (MD 0.18 [0.16, 0.20]; P<.001) was higher for ball attachments than that for stud (very low COE) attachments. Stud attachments also improved satisfaction (P<.001) when compared with ball attachments (very low COE). Implant survival rate (high COE), BoP (very low COE), and OHRQoL (low COE) were similar for the attachments. Conclusions. Stud and ball attachments are clinically appropriate options as mandibular overdenture retainers and are capable of restoring OHRQoL. Nevertheless, the stud showed greater improvement in satisfaction and less prosthetic aftercare and MBL. (J Prosthet Dent 2024;131:197-211)