The McGill Consensus Statement on Overdentures (2002): the two-implant mandibular overdenture as first-choice standard of care for the edentulous mandible

What it says#

The McGill Consensus Statement on Overdentures is short, two journal pages in each of the five places it was printed, and its subtitle carries the conclusion: mandibular two-implant overdentures as first choice standard of care for edentulous patients. It was agreed at a symposium held at McGill University in Montreal, Quebec, on May 24 and 25, 2002, and signed by an international panel listed on PubMed as Feine JS, Carlsson GE, Awad MA, Chehade A, Duncan WJ, Gizani S, Head T, Lund JP, MacEntee M, Mericske-Stern R, Mojon P, Morais J, Naert I, Payne AG, Penrod J, Stoker GT, Tawse-Smith A, Taylor TD, Thomason JM, Thomson WM and Wismeijer D, with Heydecke G added on the Gerodontology version.

The 2012 review of the literature behind the statement, by Thomason and colleagues in the Journal of Dentistry, reproduces its core wording. A panel of relevant experts in the field stated that the evidence currently available suggests that the restoration of the edentulous mandible with a conventional denture is no longer the most appropriate first choice prosthodontic treatment, and that there is now overwhelming evidence that a two-implant overdenture should become the first choice of treatment for the edentulous mandible.

That is the substance: a first choice, stated as a standard of care, for one clinical situation, the edentulous mandible, with two implants as the number. The statement was published in the International Journal of Prosthodontics (2002;15(4):413-414), the International Journal of Oral and Maxillofacial Implants (2002;17(4):601-602), Gerodontology (2002;19(1):3-4), the European Journal of Prosthodontics and Restorative Dentistry (2002;10(3):95-96, under Thomason's name) and Quintessence International (2003;34(1):78-79), which carried a comment on it in the same issue (pages 5-6).

Who it applies to#

The patient with no lower teeth who is about to have a first prosthesis made, and the dentist planning it. The statement's title names the mandible and the number of implants; it does not address the maxilla, partial edentulism, or how many implants a patient who wants more than the minimum should have.

It is a consensus of researchers and clinicians. It carries the weight of the names on it and of the trials behind it, but it is not a regulation, a licensing standard or a coverage rule. A patient who declines implant surgery, cannot have it, or cannot pay for it is still a candidate for a conventional denture; what the statement changes is which option is presented first and described as the standard.

What changed#

Before 2002 the conventional complete denture was the default first treatment for the edentulous mandible; the statement's first sentence is written against that default. In 2009 the British Society for the Study of Prosthetic Dentistry held a symposium on mandibular overdentures at its annual conference in York on April 6 and 7, circulated a draft to presenters, Council and members, and published the York Consensus Statement in the British Dental Journal on August 22, 2009 as a support and follow-up to McGill, with emphasis on qualitative and quantitative research based on patient-centred outcomes.

The 2012 review by Thomason and colleagues, written to collect the literature supporting both statements, records two things a practice owner should know. First, that since the McGill statement, uptake by dentists of implant technology for complete denture wearers had been slow. Second, the York statement's conclusion that a substantial body of evidence, much of it from randomized controlled trials, shows patients' satisfaction and quality of life with implant-supported mandibular overdentures to be significantly greater than with conventional dentures, and that while the two-implant overdenture is not the gold standard of implant therapy, it is the minimum standard that should be sufficient for most people, taking into account performance, patient satisfaction, cost and clinical time.

Where the source is#

The statement itself sits in the five journals listed above, all behind subscription or per-article access; the link under the title opens the PubMed record for the European Journal of Prosthodontics and Restorative Dentistry version, which carries the title, author and citation only. When this entry was written none of the journal pages could be opened, so the statement's wording was taken from the PubMed abstract of Thomason and colleagues' 2012 Journal of Dentistry review, which reproduces the statement's core sentences verbatim, and the account of the 2009 York statement comes from its own PubMed abstract. Details of the symposium beyond its dates and place, including the number of presentations and the trials the panel weighed, are not reported here because they could not be read from a primary source.