Comparative cost analysis of different prosthetic rehabilitations for the edentulous maxilla: early results from a randomized clinical pilot study

OBJECTIVES/AIM

To analyze and compare costs of different prosthetic rehabilitations for the edentulous maxilla.

MATERIALS AND METHODS

Patients with edentulous maxillae were rehabilitated with either of three implant-supported prosthetic protocols; removable overdenture supported by 2 implants (ISOD 2), fixed dental prostheses supported by 4 (ISFAFDP 4) or 6 (ISFAFDP 6) implants. Cost of treatment and costs during follow-up were registered and compared.

RESULTS

Twenty-four patients were included: six patients received ISOD 2 treatment, eight patients received ISFADP 4 treatment and ten patients received ISFADP 6 treatment. Initial costs for ISFAFDP 6 were higher than costs for ISFAFDP 4 and ISOD 2, but there were no differences in cost for maintenance i.e., the ISOD treatment remained the least costly treatment alternative after 1-year follow-up.

DISCUSSION

The lack of difference in cost for maintenance and repair over the first year suggests that implant-supported overdentures will remain the least costly treatment option for the edentulous maxilla, at least in a short-term perspective.

CONCLUSIONS

Removable maxillary overdentures supported by 2 implants may be a valid low cost treatment option.

Risk Factor Assessment for Survival of Removable Partial Dentures and Their Abutment Teeth: A Retrospective Analysis

PURPOSE

To investigate the risk factors related to failure of removable partial dentures (RPDs) and to compare the survival of RPDs when abutment teeth have good vs reduced bone support.

MATERIALS AND METHODS

In this longitudinal patient record-based cohort study with a mean follow-up of 44.9 months, Cox regression models were used to evaluate the associations between clinical covariates and abutment tooth failure, as well as prosthesis failure.

RESULTS

A total of 142 patients and 172 RPDs were included. Of the 172 prostheses, 64 (nearly 40%) failed after a mean time of about 4 years. Loss of abutment teeth was the main reason leading to RPD failure, followed closely by poor fit and adaptation. No factor was shown to be statistically significant at the prosthesis level. Women (Hazard Ratio [HR] = 0.542), endodontic treatment (HR = 3.460), presence of post and core (HR = 0.302), presence of a prosthetic crown (HR = 3.403), and abutment tooth type (in relation to incisor: canine HR = 0.196, premolar HR = 0.449) were the risk factors statistically significantly associated with the loss of abutment teeth. The pre-prosthesis amount of bone support of the teeth did not affect their prognosis as abutments for RPDs.

CONCLUSION

RPD treatment modality presented a high failure rate after a mean follow-up of 4 years. Vital abutment teeth had a better survival rate than the ones treated endodontically (whether restored with or without a post and core); nevertheless, the amount of bone support did not affect their survival.

Accuracy evaluation of 3D-printed guide-assisted flapless micro-osteoperforations in the anterior mandible

AIM

To evaluate the accuracy of tridimensional (3D)-printed guide-assisted flapless cortical bone micro-osteoperforations (MOPs) in the anterior mandible on a cadaver model.

MATERIALS AND METHODS

Five human cadaver heads with complete dentition in the anterior mandible were used in the present study. Preplanning CBCT and intraoral surface scans were obtained. After alignment, drilling sites in the interradicular areas were planned from canine to canine, and a surgical guide was printed. The drilling was performed and a postprocedure CBCT scan was obtained to assess the accuracy of the procedure in relation to the virtual planning.

RESULTS

The mean ± standard deviation (SD) mesiodistal interradicular space was 2.67 ± 0.84 mm. The mean ± SD error of the actual drilled hole compared with the planned position of the mesial drill site was 0.66 ± 0.33 mm, and to the distal drill site it was 0.56 ± 0.33 mm. There was a statistically significant difference between the number of times the teeth were hit mesially (10 out of 64 holes) and distally (none).

CONCLUSIONS

The proposed technique, limited to an ex vivo scenario, provides a valid and reliable method for mandibular MOPs using a 3D-generated surgical guide. However, the risk of damaging adjacent radicular surfaces, particularly in areas with limited mesiodistal interradicular bone, needs to be considered. Further studies should focus on using thinner drills and adding other methods to stabilize the guide. Additionally, by selecting individuals and perforation sites with more mesiodistal interradicular bone, less damage is likely. (Int J Comput Dent 2022;25(4):387-0; doi: 10.3290/j.ijcd.b2599841).

Blindness following soft tissue trauma in a child with haemophilia A

Traumatic retrobulbar haemorrhage, if not promptly recognised and treated, may result in acute vision loss because of compression of the optic nerve and its vascular supply. Bleeding disorders or anticoagulant therapy may contribute to the rapid onset of this phenomenon, thus making urgent diagnosis and treatment even more critical. This article reports a case of retrobulbar haemorrhage in an 8‐year‐old boy with factor VIII deficiency (haemophilia A or classic haemophilia) who delayed in seeking professional help and consequently developed permanent blindness. Minor injuries in patients with bleeding disorders or anticoagulant therapy were proven to result in severe complications, especially when these affect the eye.