Clinical outcomes of three Parkinson's disease patients treated with mandibular implant overdentures.

Parkinson's disease (PD) often affects the oro-pharyngeal musculature, leading to problems with speaking, chewing and swallowing. The inevitable reduction in food and fluid intake contributes to the further deterioration of neurological symptoms. Parkinson's disease patients have great difficulties in adjusting to the use of complete dentures. It is the purpose of this report to evaluate the benefit of using dental implants combined with overdentures to improve chewing and predigestion capacity in severely handicapped PD patients. Three edentulous PD patients (2 male, 1 female; mean age 75.7 years; mean PD duration 4.3 years; PD severity grade III according to Hoehn and Yahr; mean edentulousness 19.3 years) complaining of poor chewing ability were included in this evaluation. One-stage dental implants were placed in the interforaminal region of the mandible. After completion of healing, new overdentures were fabricated. Custom-made non-rigid (resilient) telescopic attachments were used for retention of the overdentures on the implants. Follow-up examinations of the 3 patients were made between 28 and 42 months after the completion of treatment, and peri-implant tissue conditions as well as the patients' self-assessed satisfaction level were recorded. A modified gastrointestinal symptoms questionnaire, Hoehn and Yahr Scale and body weight measurements were used to monitor gastrointestinal impairment and PD severity. The peri-implant parameters indicated healthy soft tissue conditions and all Periotest values were in the negative range. The patients judged their chewing abilities to be greatly improved. Since placing the implants, PD severity had deteriorated to grade IV (Hoehn and Yahr scale) in 2 patients and was stable in 1 patient. The body weight had improved slightly in all patients (mean 2.2 kg). On the gastrointestinal scale, all patients had improved from a mean score of 8.7 to 5.7. Non-rigid telescopic attachments for overdenture stabilization are particularly suitable for PD patients as they are easy to handle and to clean. The patients reported remarkable improvement in their chewing ability, an assessment which would seem to be supported by the improved gastro-intestinal index. The regimen described appears to be a useful adjunctive treatment in edentulous Parkinson's disease patients and may be considered for patients with diseases similarly affecting motor skills.