A completely edentulous patient may have more than one implant-supported option. But once the decision has been made to move beyond a conventional complete denture, another question comes up: fixed or removable?
Fixed implant-supported prostheses offer stability and chewing efficiency. Implant overdentures are removable, easier to clean and generally less demanding from a hygiene standpoint. So, when the two are compared, does one clearly come out on top?
A recent systematic review suggests the answer is not quite that simple.
The review looked at clinical and patient-reported outcomes of fixed and removable prosthetic rehabilitation in completely edentulous patients. PubMed/MEDLINE, Scopus, Embase and Web of Science were searched for studies published up to December 2025. Ten studies met the inclusion criteria.
Because the studies differed considerably in prosthetic designs, follow-up periods, patient populations and outcome measures, the authors did not perform a meta-analysis. Instead, they carried out a narrative synthesis.
Fixed prostheses had the functional advantage
When it came to chewing function, the evidence favoured fixed prostheses.
One randomized clinical trial included in the review compared a fixed implant-retained mandibular prosthesis with a removable implant overdenture. Both improved occlusal equilibration and muscle activity, but the fixed prosthesis produced significantly greater masticatory efficiency.
The survival figures for fixed full-arch implant prostheses were also high. Across the studies reporting this outcome, implant survival ranged from 96.2% to 100%, with follow-up extending to six years in some cases.
But high implant survival did not mean an absence of prosthetic problems.
Screw loosening, prosthetic fracture and veneer chipping or fracture were among the complications reported with fixed restorations. Interestingly, one study found that these mechanical complications did not significantly affect patient satisfaction or oral health-related quality of life.
Overdentures bring a different set of advantages
The removable option should not be viewed simply as the compromise.
The review found that both fixed prostheses and implant overdentures improved oral health-related quality of life compared with conventional complete dentures.
Where the two differed was in the nature of their advantages.
Fixed prostheses were associated with better functional outcomes, while overdentures offered an easier route to hygiene maintenance. In the comparative evidence, both implant-supported options performed better than conventional complete dentures, but for different reasons.
This is perhaps the most useful part of the review for everyday treatment planning. A patient who places a high value on chewing efficiency and stability may prefer a fixed restoration. Another patient may value being able to remove the prosthesis and clean around the implants more easily.