The first-choice standard of care for an edentulous mandible: A Delphi method survey of academic prosthodontists in the United States

Background. In 2002 and 2009, two consensus statements-one from a symposium in Canada and one from England-were issued that recommended that the first-choice standard of care for an edentulous mandible should be the two implants-retained mandibular overdenture (IRMOD). The authors conducted a survey to determine if, in 2011, U.S. academic prosthodontic experts'opinions were aligned with those in the two consensus statements. Methods. The authors administered a Delphi method survey to an expert panel of 16 nationally representative academic prosthodontists to determine if there is consensus on the first-choice standard of care for an edentulous mandible between the IRMOD and a conventional mandibular complete denture (CD). Consensus agreement was defined as a 70 percent agreement level among the panelists. Results. The panel attained consensus favoring the IRMOD for nine of the 10 parameters assessed-retention, stability, speech, masticatory efficiency, comfort while eating soft foods and hard foods, confidence in intimate situations, satisfaction and self-esteem. The exception was esthetics for which only a majority (51-69 percent) favored the IRMOD. Conclusions. The panelists reached consensus that they would recommend an IRMOD instead of a CD as the first-choice standard of care for patients who are healthy or have mild systemic disease, but not for patients with severe systemic disease. Clinical Implications. Surveyed academic prosthodontists recommend an IRMOD as the first choice standard of care when restoring an edentulous mandible of a healthy patient or a patient with mild systemic disease.