51
|
Yoo SY, Kim SK, Heo SJ, Koak JY, Jeon HR. New Rehabilitation Concept for Maxillary Edentulism: A Clinical Retrospective Study of Implant Crown Retained Removable Partial Dentures. J Clin Med 2021; 10:jcm10081773. [PMID: 33921768 PMCID: PMC8073221 DOI: 10.3390/jcm10081773] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/05/2021] [Accepted: 04/15/2021] [Indexed: 11/16/2022] Open
Abstract
There have been no studies of implant-crown-retained removable partial dentures (IC-RPD) for the treatment of maxillary edentulism. The purpose of this study was to perform clinical and radiographic evaluations of implants in IC-RPD compared to implant overdentures (IOD) in maxillary edentulous patients. Twenty IC-RPDs with 74 splinted implant crowns and 18 IODs with 71 implants retained with magnet attachments were observed in 38 patients. We statistically analyzed survival rates and marginal bone loss (MBL) of implants based on multiple variables including first year pathologic condition, location of placed implant, age, and sex in both treatments. Patient reported oral measurements (PROMs) regarding functional/esthetic improvement after IC-RPD or IOD treatments and prosthetic complications were also statistically analyzed. After a median observation period of 47.1 months (up to 147 months), we observed 97.3% implant survival rates for IC-RPD and 70.4% for IOD (p < 0.001). Among variables, first year pathologic condition (p < 0.001) and sex (p = 0.027) influenced implant survival rates. The MBL of implants for IC-RPD and IOD groups at the final check-up were 1.12 ± 1.19 mm and 3.31 ± 1.71 mm, respectively (p < 0.001). In both groups, patients with peri-implantitis (p < 0.001) and patients older than 65 years (p = 0.029) showed significantly higher implant MBL regardless of treatment modality. Functional and esthetic satisfaction were significantly improved (p < 0.001) after both treatments. The IOD group showed more frequent prosthetic complications compared to the IC-RPD group. Within the limitations of a retrospective study, we concluded that RPD with few splinted implant crowns is a feasible alternative treatment modality for maxillary edentulous patients with anatomical limitations.
Collapse
Affiliation(s)
- Soo-Yeon Yoo
- Department of Prosthodontics and Dental Research Institute, Seoul National University Dental Hospital, School of Dentistry, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; (S.-Y.Y.); (S.-J.H.); (J.-Y.K.)
| | - Seong-Kyun Kim
- Department of Prosthodontics and Dental Research Institute, Seoul National University Dental Hospital, School of Dentistry, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; (S.-Y.Y.); (S.-J.H.); (J.-Y.K.)
- Correspondence: ; Tel.: +82-2-2072-3860
| | - Seong-Joo Heo
- Department of Prosthodontics and Dental Research Institute, Seoul National University Dental Hospital, School of Dentistry, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; (S.-Y.Y.); (S.-J.H.); (J.-Y.K.)
| | - Jai-Young Koak
- Department of Prosthodontics and Dental Research Institute, Seoul National University Dental Hospital, School of Dentistry, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; (S.-Y.Y.); (S.-J.H.); (J.-Y.K.)
| | - Hye-Rin Jeon
- Department of Mathematics, Ewha Womans University, Seoul 03760, Korea;
| |
Collapse
|
52
|
Starch-Jensen T, Bruun NH. Patient's perception of recovery after osteotome-mediated sinus floor elevation with Bio-Oss collagen compared with no grafting material: a randomized single-blinded controlled trial. Int J Implant Dent 2021; 7:20. [PMID: 33748923 PMCID: PMC7982363 DOI: 10.1186/s40729-021-00302-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 02/11/2021] [Indexed: 01/23/2023] Open
Abstract
Background Osteotome-mediated sinus floor elevation with or without a grafting material is associated with high implant survival, intrasinus bone gain, and low frequency of complications. However, patient’s perception of recovery and satisfaction with the surgical intervention are rarely reported. The objective of the present randomized controlled trial was to assess patient’s perception of recovery after osteotome-mediated sinus floor elevation with Bio-Oss collagen compared with no grafting material. Forty healthy patients were randomly allocated to Bio-Oss collagen or no grafting material. Oral health-related quality of life was assessed by Oral Health Impact Profile-14 at enrollment. Patient’s perception of recovery was assessed by self-administrated questionnaires and visual analog scale evaluating pain, social and working isolation, physical appearance, duration and quality of life alterations, eating and speaking ability, diet variations, and sleep impairment after 1 week and 1 month, respectively. Descriptive statistics was expressed as mean percentage with standard deviation. Correlation between impaired oral health-related quality of life, age, gender, and recovery were assessed by T test. Level of significance was 0.05. Results Osteotome-mediated sinus floor elevation is associated with high patient satisfaction, limited postoperative discomfort, and willingness to undergo similar surgery. Influence on patient’s daily life activities seems to be minimal and limited to the first postoperative days. Most patients managed to return to work and their routine daily activities after 0-2 days. Impaired preoperative oral health-related quality of life, gender, or younger age seems not to predispose for delayed recovery. However, number of days with pain, eating difficulties, and sleep disturbances were significantly increased with Bio-Oss collagen compared with no grafting material (P<0.05). Conclusion Patient’s discomfort seems to be minimal and limited to the first postoperative days following osteotome-mediated sinus floor elevation with or without a grafting material. Impaired preoperative oral health-related quality of life, gender, or younger age seems not to predispose for delayed recovery.
Collapse
Affiliation(s)
- Thomas Starch-Jensen
- Department of Oral and Maxillofacial Surgery, Aalborg University Hospital, 18-22 Hobrovej, DK-9000, Aalborg, Denmark. .,Department of Clinical Medicine, The Faculty of Medicine, Aalborg University, Aalborg, Denmark.
| | - Niels Henrik Bruun
- Unit of Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| |
Collapse
|
53
|
Single-implant mandibular overdentures: Clinical, radiographic, and patient-reported outcomes after a 5-year follow-up. J Prosthet Dent 2021; 128:949-955. [PMID: 33640091 DOI: 10.1016/j.prosdent.2021.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 01/14/2021] [Accepted: 01/14/2021] [Indexed: 11/21/2022]
Abstract
STATEMENT OF PROBLEM Previous studies on single-implant mandibular overdentures have reported favorable results for clinical and patient-reported outcomes. However, information from longer term clinical studies is lacking. PURPOSE The purpose of this clinical study was to assess clinical, radiographic, and patient-reported outcomes of edentulous individuals rehabilitated with single-implant mandibular overdentures after a 5-year follow-up. MATERIAL AND METHODS A prospective clinical study was performed including completely edentulous individuals who received new conventional complete dentures and then an external hexagon implant in the mandibular midline region, followed by the incorporation of a retention system (O-ring/ball attachment; Neodent). Data collection occurred at baseline and 3, 6, 12, 24, and 60 months after implant loading. Assessed outcomes included implant stability, peri-implant soft tissue condition, peri-implant marginal bone level, satisfaction with the prostheses, and oral health-related quality of life (OHRQoL). Clinical maintenance events were also recorded. Descriptive statistics, incidence rates, Wilcoxon Signed Ranks test, and Generalized Estimating Equation regression were used for data analysis (α=.05). RESULTS Thirty of 34 eligible participants attended the 5-year follow-up visit, mean ±standard deviation age was 68.1 ±7.8 years, and 70% were women. The overall implant survival rate was 88.9%. After 5 years, the OHRQoL showed statistically significant improvement for all evaluation periods compared with baseline (P<.001). Regarding satisfaction with the mandibular denture, a significant increase was found between all evaluation periods compared with baseline in terms of comfort, stability, and ability to masticate (P<.001). Implant stability significantly increased (P=.003), and a mean bone loss of 1.46 mm was observed compared with baseline measures. The most frequent maintenance event was replacement of the O-ring matrix (n=80). Twenty-one midline fractures of the overdenture occurred in 14 study participants. No significant changes in peri-implant soft tissue conditions were observed. CONCLUSIONS A single-implant mandibular overdenture effectively maintained the positive effect of the intervention on oral health-related quality of life and patient satisfaction, stable peri-implant condition, and acceptable rates of prosthetic events.
Collapse
|
54
|
Fonteyne E, Matthys C, Bruneel L, Becue L, De Bruyn H, Van Lierde K. Articulation, oral function, and quality of life in patients treated with implant overdentures in the mandible: A prospective study. Clin Implant Dent Relat Res 2021; 23:388-399. [PMID: 33615684 DOI: 10.1111/cid.12989] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 01/13/2021] [Accepted: 01/15/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Modifications of facial and oral structures affect aesthetic appearance, orofacial functions, and have impact on quality of life. PURPOSE This study determined alterations of articulation, oromyofunctional behavior, and Oral Health Related Quality of Life (OHRQoL) in patients replacing complete removable dentures by implant retained overdentures in the mandible. MATERIALS AND METHODS Twenty-one fully edentulous patients received mandibular overdenture retained on a bar connecting two titanium dental implants. Patients were evaluated after receiving a new set of fully removable dentures (stage 1), after surgery during provisionalization on healing abutments (stage 2), and after final connection to the bar (stage 3). Assessments were taken by speech therapists and included evaluation of: articulation (picture naming and reading); oromyofunctional behavior; OHRQoL (OHIP-14 questionnaire), and overall satisfaction and speech (VAS). To measure changes over time, Wilcoxon matched-pairs signed-rank-test and McNemar test was used. RESULTS There was no significant impact of the treatment on speech nor on the results of oromyofunction. In stage 1, patients had different kinds of articulation errors (mean:1.21) which evolved to 0.71 and 0.67. In stage 3, especially problems with the /s/ sound are seen in 37% (7/19) of the participants. Results of OHRQoL and satisfaction reveal that the average of satisfaction with oral health evolved from 67% to 63% and finally 78%. OHIP-14 total score was 17.4/56 in stage 1, remained unchanged in stage 2 and evolved in stage 3 to 9.8/56 (P: .010). This indicates improvement. Satisfaction with speech evolved significantly from 68% pretreatment to 82% in stage 3 (P: .013). CONCLUSION Despite existing articulation and oromyofunctional disorders after treatment, people are very satisfied with their OHRQoL and their speech. Impact of mandibular denture wearing on OHRQoL declines once connected. It's important to inform patients that speech and oromyofunctional disorders may occur during treatment where especially the /s/ sound is vulnerable.
Collapse
Affiliation(s)
- Ester Fonteyne
- Faculty of Medicine and Health Sciences, Department of Oral Health Sciences, Section Periodontology and Oral Implantology, Ghent University, Ghent, Belgium.,Department of Dentistry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Carine Matthys
- Faculty of Medicine and Health Sciences, Department of Oral Health Sciences, Clinic for Removable Prosthodontics, Ghent University, Ghent, Belgium
| | - Laura Bruneel
- Faculty of Medicine and Health Sciences, Department of Speech, Language, and Hearing Sciences, Ghent University, Ghent, Belgium
| | - Laurence Becue
- Faculty of Medicine and Health Sciences, Department of Oral Health Sciences, Section Periodontology and Oral Implantology, Ghent University, Ghent, Belgium
| | - Hugo De Bruyn
- Faculty of Medicine and Health Sciences, Department of Oral Health Sciences, Section Periodontology and Oral Implantology, Ghent University, Ghent, Belgium.,Department of Dentistry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Kristiane Van Lierde
- Faculty of Medicine and Health Sciences, Department of Speech, Language, and Hearing Sciences, Ghent University, Ghent, Belgium.,Department of Communication, University of Pretoria, Pretoria, South Africa
| |
Collapse
|
55
|
Aesthetic Parameters and Patient-Perspective Assessment Tools for Maxillary Anterior Single Implants. Int J Dent 2021; 2021:6684028. [PMID: 33708255 PMCID: PMC7932805 DOI: 10.1155/2021/6684028] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/04/2020] [Accepted: 12/17/2020] [Indexed: 12/17/2022] Open
Abstract
Background This review aimed to concisely describe the current aesthetic objective indices for a single-implant maxillary anterior crown. The secondary aim was to propose introducing a unified, standardized questionnaire for adequately collecting patient-reported outcome measures (PROMs) in implant dentistry. Materials and Methods A literature review was conducted using both EMBASE/Ovid and MEDLINE/PubMed databases by combining keywords and Emtree/Mesh terms related to “Esthetics,” “Self-Assessment or Surveys and Questionnaires,” and “Single-Tooth Dental Implants.” Results The most meaningful aesthetic objective indices for single implants in the literature are the Pink Esthetic Score (PES), the Papilla Presence Index (PPI), Peri‐Implant and Crown Index (PICI), PES/White Esthetic Score (PES/WES), the Implant Crown Aesthetic Index (ICAI), and a modified version of the ICAI (mod-ICAI) index. Clearly, PES/WES is still the most widely accepted tool. It is encouraging to observe that there is an increasing tendency in recent years to report PROMs more frequently in the implant dentistry literature. We proposed the implementation of a unified, standardized questionnaire using a self-administered visual analogue scale (VAS) scoring system, which evaluates overall satisfaction, comfort, tooth appearance, gingival appearance, function, and hygiene complexity. This tool should be validated in the oral implantology research context for its regular implementation or further development. Conclusions Conducting qualitative studies among dental implant patients who received few implants or single-tooth implant reconstructions in the aesthetic zone may help dental researchers understand better how to efficiently develop and validate a quantitative instrument. This standard tool would reduce heterogeneity bias by providing comparable data between studies.
Collapse
|
56
|
Xia Y, Ma C, Chen J, Witter DJ, Zhang Q, Creugers NHJ. Mandibular residual ridge morphology in relation to complete dentures and implant overdentures-Part II: Predictors for effectiveness of implant overdenture therapy. Clin Implant Dent Relat Res 2021; 23:140-148. [PMID: 33592681 DOI: 10.1111/cid.12975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 11/20/2020] [Accepted: 12/17/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The significance of mandibular residual ridge height and satisfaction with conventional complete dentures (CCD) as predictors for the added value of implant-overdenture (IOD) therapy is unknown. PURPOSE To investigate the predictive value of thresholds for (1) residual ridge height at premolar location (PRH), and (2) satisfaction with CCD-stability for the added value of two intraforaminal implants supporting the mandibular CCD. METHODS Thirty CCD wearing patients (67.9 ± 7.0 years) for whom a new CCD was advised, received a new CCD. Mandibular gypsum models were digitally measured. After 3 months free of complaints (T1), perceived CCD-stability was evaluated, and participants received two intraforaminal implants. At T1 and T2 (3 months free of complaints after IOD therapy) participants completed OHIP14-CN, and denture satisfaction (VAS) questionnaires, and performed mixing ability tests. Participants were grouped according to PRH of ≥6.15 mm versus < 6.15 mm, and perceived CCD-stability satisfied vs. dissatisfied. Scores at T2 were compared to T1 (paired t-tests). Predictive values of PRH and CCD-stability were analyzed with logistic multivariate regression models. RESULTS At T2, only participants with PRH of <6.15 mm or dissatisfied with CCD-stability had significant lower OHIP-total and domain scores for 'physical pain' and 'physical disability' and significantly higher VAS scores for perceived chewing function, denture retention and oral comfort. Regression analyses showed that participants with PRH of <6.15 mm, or dissatisfied with CCD-stability had significantly higher chance for lower OHIP-total and domain scores 'physical pain' and 'physical disability', and for higher VAS scores for perceived chewing function, denture retention and oral comfort at T2. Masticatory performance improved significantly after IOD therapy, but independent of PRH and CCD-stability. CONCLUSION PRH and satisfaction with CCD-stability were adequate prognostic indicators for improvement of oral health-related quality of life and denture satisfaction by mandibular IOD therapy.
Collapse
Affiliation(s)
- Yuning Xia
- State Key Laboratory of Military Stomatology and National Clinical Research Center for Oral Diseases and Shaanxi Key Laboratory of Oral Diseases, Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Chufan Ma
- State Key Laboratory of Military Stomatology and National Clinical Research Center for Oral Diseases and Shaanxi Key Laboratory of Oral Diseases, Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, China.,Air Force Medical Center, Fourth Military Medical University, Beijing, China
| | - Jihua Chen
- State Key Laboratory of Military Stomatology and National Clinical Research Center for Oral Diseases and Shaanxi Key Laboratory of Oral Diseases, Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Dick J Witter
- Department of Oral Function and Prosthetic Dentistry, College of Dental Science, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Qian Zhang
- Department of Oral Function and Prosthetic Dentistry, College of Dental Science, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Nico H J Creugers
- Department of Oral Function and Prosthetic Dentistry, College of Dental Science, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
57
|
Patient Satisfaction in Medicine and Dentistry. Int J Dent 2020; 2020:6621848. [PMID: 33456467 PMCID: PMC7787801 DOI: 10.1155/2020/6621848] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/04/2020] [Accepted: 12/16/2020] [Indexed: 01/09/2023] Open
Abstract
Health professionals, such as medical and dental clinicians, have scant understanding of patients' experiences and perceptions of satisfaction. Nevertheless, implementing a patient-reported outcome measures (PROMs) research practice in surgical sciences is necessary. Hence, the objective of this article was to better understand patients' satisfaction with their medical and dental care. The methods of the current article are based on a narrative review of the literature strategy. A literature review was conducted using both EMBASE and Medline databases up to July 12, 2020, by combining keywords and terms related to “satisfaction theories” and “patient satisfaction,” and “medicine” or “dentistry/stomatology/odontology.” Patient satisfaction's multidimensional nature has been established since the perceived reasons for satisfaction varied widely among patients. Many aspects of treatment influence participant satisfaction at different stages of the intervention process. An improved understanding of the basis for managing patients' expectations with information reiteratively and efficiently may ultimately reduce patients' potential for negative feelings toward the medical and dental treatment experience. Lastly, the consumerist method may misrepresent the still undertheorized concept of satisfaction in health service.
Collapse
|
58
|
Chiou SJ, Lee LH, Lee PC, Lin KC. Better Self-report Health Status and Provider-Patient Communication in Dental Service Can Improve the Patient Experience: A Cross-year Comparison from the NHI Survey. HEALTH COMMUNICATION 2020; 35:1569-1575. [PMID: 31423836 DOI: 10.1080/10410236.2019.1652390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Several factors, including healthcare outcomes and quality, influence patients' expectations of healthcare services. Currently, as patients have more understanding about dental care services, patient satisfaction is essential for continually improving the services being provided. The purpose of this study is to analyze the multiyear annual National Health Insurance (NHI) patient experience survey in Taiwan to explore the factors associated with the satisfaction rate from 2012-2016. This study used the annual NHI survey to explore patients' experiences of receiving medical service in dental care from 2012 to 2016. There were over 40 major items in the survey each year; however, we only selected suitable items that followed the Andersen model. We ran a logistics regression testing the relationship between the covariates and the items related to satisfaction in outcomes in different years. Patients who received health education from a provider in most time, self-reported better health status, felt that cost of care was not expensive, did not wait too long for counseling time and found it easy to make an appointment, had two to ten times greater satisfaction in outcomes compared with those who did not (OR: 1.83-10.06). Individuals working in the healthcare industry should implement communication strategies to improve patients' experience in the care process by including easy-to-understand explanations or sharing decision-making with patients. Furthermore, in patient experience surveys in dental care, less attention should be paid to whether patients can provide meaningful quality measures and more attention to ways in which patient experiences can be improved. This can be achieved by providing easy-to-understand explanations, giving patients an opportunity to express their concerns, and by sharing decision-making with patients.
Collapse
Affiliation(s)
- Shang-Jyh Chiou
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences
| | - Li-Hui Lee
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences
| | - Pei-Chen Lee
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences
| | - Kuan-Chia Lin
- Institute of Hospital and Health Care Administration, National Yang-Ming University
| |
Collapse
|
59
|
Van Doorne L, Fonteyne E, Matthys C, Bronkhorst E, Meijer G, De Bruyn H. "Longitudinal Oral Health-Related Quality of Life in maxillary mini dental implant overdentures after 3 years in function". Clin Oral Implants Res 2020; 32:23-36. [PMID: 33043547 DOI: 10.1111/clr.13677] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 08/17/2020] [Accepted: 09/28/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Longitudinal evaluation of Oral Health-Related Quality of Life (OHRQoL) during treatment of flaplessly placed, one-piece mini-dental-implants (MDIs) for maxillary overdentures is rarely investigated, nor is the impact of MDI failures. MATERIAL AND METHODS This multicenter prospective cohort study evaluated the 3-year outcome of 5-6 MDIs in the edentulous maxilla in patients above 50 years with dentate mandible. Provisional dentures were provided before final prosthetic connection was established at 6 months. Postoperative discomfort was assessed using a visual analogue score (VAS). OHRQoL was investigated using the Oral Health Impact Profile (OHIP)-14 at baseline (preoperatively), postoperatively, post-prosthetic connection and after 3 years in function. RESULTS 164 (78.4%) of the 204 placed MDIs were still in situ after 3 years, in 29/31 patients. Two patients lost 5/6 MDIs resulting in two prosthetic failures (6.45%). With regard to pain, a score of 4.1/10 (SD 2.8) was recorded on day 1, and 1.1/10 (SD 1.7) on day 7. A decrease in total OHIP-14 scores was observed postoperatively (15.6; SD 12.8) as compared to baseline (21.3; SD 13.1), with improvement of OHRQoL. Furthermore, this was statistically significant at connection of the final prosthesis (7.3; SD 6.7) (p = .006). The OHIP-14 improved less (p = .011) when experiencing one or more implant losses (9.5; SD: 9.85), in comparison with no implant loss (20.7; SD: 13.97). A failure of one MDI did not affect OHIP-14 score (p = .658); however, multiple failures did (p = .007). CONCLUSION Maxillary MDI overdenture treatment yields significant OHRQoL improvement when at least 5 MDIs survive, preserving functional comfort.
Collapse
Affiliation(s)
- Luc Van Doorne
- Cosmipolis Clinic, Brugge, Belgium.,Ghent University Hospital, Gent, Belgium
| | | | | | - Ewald Bronkhorst
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Gert Meijer
- Department of Dentistry-Implantology and Periodontology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, Netherlands
| | - Hugo De Bruyn
- Department of Dentistry-Implantology and Periodontology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, Netherlands
| |
Collapse
|
60
|
Fu L, Liu G, Wu X, Zhu Z, Sun H, Xia H. Patient-reported outcome measures of edentulous patients restored with single-implant mandibular overdentures: A systematic review. J Oral Rehabil 2020; 48:81-94. [PMID: 32989781 DOI: 10.1111/joor.13103] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 09/15/2020] [Accepted: 09/17/2020] [Indexed: 11/29/2022]
Abstract
AIM To review the literatures concerning the effect of the single-implant mandibular overdenture (SIMO) on patient-reported outcome measures (PROMs) and masticatory function in the fully edentulous patients. MATERIALS AND METHODS Electronic databases (PubMed, Cochrane Library, EMBASE and Web of Science) were searched, complemented with manual resources. Prospective studies published in English up to February 2020 reporting the effect of SIMO on PROMs and masticatory function in the edentulous patients were included. This review focused on oral health-related quality of life (OHRQoL), satisfaction and masticatory function outcomes. RESULTS Of 1157 initially screened articles, 9 randomised controlled trials (RCTs) and 8 prospective studies involving 551 subjects fulfilled the inclusion criteria. Two RCTs were graded as high risk of bias or some concern, while others were low risk. All prospective studies had adequate representativeness and assessment, but only one study had a controlled cohort. In general, the edentulous patients restored with SIMOs had improved OHRQoL and general satisfaction compared to those with conventional complete dentures (CCDs), but the outcome of masticatory function was controversial. Compared with two-implant mandibular overdenture (TIMO), SIMO showed no significant differences regarding general satisfaction and satisfaction with speech, comfort, chewing ability, aesthetics and social life. Conflicting results were observed in OHRQoL and satisfaction with retention and stability. Better masticatory performance was observed in TIMO group than SIMO group. CONCLUSION Within the limitation of this review, SIMO is featured with better OHRQoL and satisfaction than CCD. SIMO and TIMO rendered similar patient satisfaction, but TIMO had better masticatory performance.
Collapse
Affiliation(s)
- Liangliang Fu
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China.,Department of Oral Implantology, Hospital and School of Stomatology, Wuhan University, Wuhan, China
| | - Gufeng Liu
- School of Stomatology, Wuhan University, Wuhan, China
| | - Xiaoyi Wu
- School of Stomatology, Wuhan University, Wuhan, China
| | - Zhenzhen Zhu
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China.,Department of Oral Implantology, Hospital and School of Stomatology, Wuhan University, Wuhan, China
| | - Huifang Sun
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Haibin Xia
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China.,Department of Oral Implantology, Hospital and School of Stomatology, Wuhan University, Wuhan, China
| |
Collapse
|
61
|
Pignaton TB, Spin-Neto R, Ferreira CEDA, Martinelli CB, de Oliveira GJPL, Marcantonio E. Remodelling of sinus bone grafts according to the distance from the native bone: A histomorphometric analysis. Clin Oral Implants Res 2020; 31:959-967. [PMID: 32716570 DOI: 10.1111/clr.13639] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 07/16/2020] [Accepted: 07/19/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To evaluate graft remodelling according to the distance from the native bone in maxillary sinuses grafted with anorganic bovine bone (ABB). MATERIAL AND METHODS Bilateral sinus grafting was performed in twenty patients with residual bone height <5 mm before implant placement. After 8 months, biopsy samples were harvested, and histomorphometric analysis was performed to examine bone formation according to the distance (in mm) from the native bone (sinus floor). In the grafted area, the percentages of new bone (NB), residual graft material (rABB), and soft tissue (ST) were evaluated. RESULTS A total of 103 biopsy samples were evaluated, and the percentages of NB, rABB, and ST were 31.62 ± 9.85%, 18.94 ± 7.88%, and 49.41 ± 9.52%, respectively, in the 1st mm; 27.15 ± 9.83%, 23.33 ± 9.45%, and 49.53 ± 11.73%, respectively, in the 2nd mm; 23.61 ± 13.02%, 21.35 ± 11.08%, and 55.03 ± 16.14%, respectively, in the 3rd mm; and 21.67 ± 12.29%, 19.67 ± 10.28%, and 58.66 ± 12.46%, respectively, in the 4th mm. The 1st millimetre of the grafted area (closer to the native bone) presented a larger amount of NB than the other portions of the grafted areas and a smaller amount of rABB than the 2nd mm of the grafted area (p < .05). The amount of ST was larger in the 3rd and 4th mm of the grafted area than in the first 2 millimetres (p < .05). CONCLUSION The distance from the native bone influences bone formation following maxillary sinus augmentation.
Collapse
Affiliation(s)
- Tulio Bonna Pignaton
- Department of Diagnosis and Surgery, Araraquara Dental School, UNESP, Araraquara, Brazil
| | - Rubens Spin-Neto
- Section of Oral Radiology, School of Dentistry,, Aarhus University, Aarhus, Denmark
| | | | | | | | - Elcio Marcantonio
- Department of Diagnosis and Surgery, Araraquara Dental School, UNESP, Araraquara, Brazil
| |
Collapse
|
62
|
Hartmann R, Bandeira ACFDM, Araújo SCD, Brägger U, Schimmel M, Leles CR. A parallel 3‐group randomised clinical trial comparing different implant treatment options for the edentulous mandible: 1‐year effects on dental patient‐reported outcomes and chewing function. J Oral Rehabil 2020; 47:1264-1277. [DOI: 10.1111/joor.13070] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 07/10/2020] [Accepted: 07/31/2020] [Indexed: 12/20/2022]
Affiliation(s)
| | | | | | - Urs Brägger
- Department of Reconstructive Dentistry School of Dental Medicine of the University of Bern Bern Switzerland
| | - Martin Schimmel
- Department of Reconstructive Dentistry School of Dental Medicine of the University of Bern Bern Switzerland
| | | |
Collapse
|
63
|
Ramani RS, Bennani V, Aarts JM, Choi JJE, Brunton PA. Patient satisfaction with esthetics, phonetics, and function following implant-supported fixed restorative treatment in the esthetic zone: A systematic review. J ESTHET RESTOR DENT 2020; 32:662-672. [PMID: 32715619 DOI: 10.1111/jerd.12625] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/21/2020] [Accepted: 06/24/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To determine patient satisfaction with esthetics, phonetics, and function following implant-supported fixed restorative treatment in the esthetic zone by measuring the Oral Health Related Quality of Life (OHRQoL). MATERIALS AND METHODS This systematic review follows the "Preferred reporting items for systematic review and meta-analysis protocols" (PRISMA-P) 2015 statement. Studies were searched in the databases Ovid, PubMed, Web of Science, Scopus, and the Cochrane Library. The quality of the studies included in the review was scored using the GRADE system. The impact of the findings was analyzed by calculating effect size and standardization of results across different OHRQoL measurements was achieved by calculating the percentage equivalent. RESULTS A total of 13 studies were selected to be included in his systematic review after application of the inclusion criteria. A total of six studies recorded pre- and post-treatment OHRQoL results, while the remaining seven studies provided only post-treatment results. CONCLUSIONS This review concluded that implant-supported fixed restorations in the esthetic zone have an overall positive impact on OHRQoL. However, patient satisfaction from this treatment reduced as the number of missing teeth replaced by implants was increased. CLINICAL SIGNIFICANCE When implant-supported fixed restorations are being planned in the esthetic zone, dentists need to consider the patient's perception and the subsequent impact of these restorations on the patient's quality of life. Clinicians can be assured that patient OHRQoL will increase; however, clinicians should also keep in mind the importance of the gingival frame. Furthermore, they should be aware of the challenges when planning cases with larger numbers of implants in the esthetic zone as this could lead to a lowering of a patient QoL.
Collapse
Affiliation(s)
- Rishi S Ramani
- Department of Oral Rehabilitation, University of Otago School Dentistry, Dunedin, New Zealand
| | - Vincent Bennani
- Department of Oral Rehabilitation, University of Otago, Dunedin, New Zealand
| | - John M Aarts
- Department of Oral Rehabilitation, University of Otago, Dunedin, New Zealand
| | | | - Paul A Brunton
- Division of Health Sciences, University of Otago, Dunedin, New Zealand
| |
Collapse
|
64
|
De Bruyckere T, Cabeza RG, Eghbali A, Younes F, Cleymaet R, Cosyn J. A randomized controlled study comparing guided bone regeneration with connective tissue graft to reestablish buccal convexity at implant sites: A 1‐year volumetric analysis. Clin Implant Dent Relat Res 2020; 22:468-476. [DOI: 10.1111/cid.12934] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/23/2020] [Accepted: 06/19/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Thomas De Bruyckere
- Faculty of Medicine and Pharmacy, Oral Health Research Group (ORHE)Vrije Universiteit Brussel (VUB) Brussels Belgium
- Department of Periodontology and Oral ImplantologyFaculty of Medicine and Health Sciences, Dental School, Ghent University Ghent Belgium
| | - Ricardo Garcia Cabeza
- Department of Periodontology and Oral ImplantologyFaculty of Medicine and Health Sciences, Dental School, Ghent University Ghent Belgium
| | - Aryan Eghbali
- Faculty of Medicine and Pharmacy, Oral Health Research Group (ORHE)Vrije Universiteit Brussel (VUB) Brussels Belgium
- Department of Periodontology and Oral ImplantologyFaculty of Medicine and Health Sciences, Dental School, Ghent University Ghent Belgium
| | - Faris Younes
- Department of Periodontology and Oral ImplantologyFaculty of Medicine and Health Sciences, Dental School, Ghent University Ghent Belgium
| | - Roberto Cleymaet
- Faculty of Medicine and Pharmacy, Oral Health Research Group (ORHE)Vrije Universiteit Brussel (VUB) Brussels Belgium
| | - Jan Cosyn
- Faculty of Medicine and Pharmacy, Oral Health Research Group (ORHE)Vrije Universiteit Brussel (VUB) Brussels Belgium
- Department of Periodontology and Oral ImplantologyFaculty of Medicine and Health Sciences, Dental School, Ghent University Ghent Belgium
| |
Collapse
|
65
|
Li Manni L, Lecloux G, Rompen E, Aouini W, Shapira L, Lambert F. Clinical and radiographic assessment of circular versus triangular cross‐section neck Implants in the posterior maxilla: A 1‐year randomized controlled trial. Clin Oral Implants Res 2020; 31:814-824. [DOI: 10.1111/clr.13624] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 04/30/2020] [Accepted: 05/04/2020] [Indexed: 01/11/2023]
Affiliation(s)
- Lou Li Manni
- Department of Periodontology and Oral Surgery University Hospital of Liège Liège Belgium
| | - Geoffrey Lecloux
- Department of Periodontology and Oral Surgery University Hospital of Liège Liège Belgium
| | - Eric Rompen
- Department of Periodontology and Oral Surgery University Hospital of Liège Liège Belgium
| | - Walid Aouini
- Department of Periodontology and Oral Surgery University Hospital of Liège Liège Belgium
- Department of Periodontology Faculty of Dental Medicine Monastir Tunisia
| | - Lior Shapira
- Department of Periodontology Hebrew University‐Hadassah Faculty of Dental Medicine Jerusalem Israel
| | - France Lambert
- Department of Periodontology and Oral Surgery University Hospital of Liège Liège Belgium
- Dental Biomaterials Research Unit University of Liège Liège Belgium
| |
Collapse
|
66
|
De Angelis P, Manicone PF, De Angelis S, Grippaudo C, Gasparini G, Liguori MG, Camodeca F, Piccirillo GB, Desantis V, D’Amato G, D’Addona A. Patient and Operator Centered Outcomes in Implant Dentistry: Comparison between Fully Digital and Conventional Workflow for Single Crown and Three-Unit Fixed-Bridge. MATERIALS 2020; 13:ma13122781. [PMID: 32575559 PMCID: PMC7344688 DOI: 10.3390/ma13122781] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 06/02/2020] [Accepted: 06/12/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Scientific information about the effects of implant therapy following a precise workflow and patient and operators' preferences should be considered to choose which implant treatment protocol to use, and to achieve patient's satisfaction and functional results. The aim of this study was to analyze implant rehabilitations with a fully digital workflow and compare this approach with a conventional one. METHODS This study comprises 64 patients treated with a fully digital approach and 58 patients treated using a conventional protocol. Patient and operator centered outcomes were assessed through two visual analogue scale (VAS) questionnaires. RESULTS The VAS questionnaire demonstrated better results for the digital workflow concerning anxiety, convenience, taste, nausea sensation, pain and breathing difficulties (p < 0.0001). The VAS questionnaire administered to the operators showed better scores for the digital approach in relation to anxiety, convenience, difficulties of the impression procedure and the workflow (p < 0.0001). A significant reduced mean time for the digital workflow as well as a reduced number of required visits were recorded. CONCLUSION The analysis of a fully digital and a conventional protocol showed better results according to patient and operators' preferences when a fully digital approach was used.
Collapse
Affiliation(s)
- Paolo De Angelis
- Division of Oral Surgery and Implantology, Department of Head, Neck, and Sensory Organs, Fondazione Policlinico Universitario A. Gemelli IRCCS—Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (P.F.M.); (C.G.); (M.G.L.); (F.C.); (G.B.P.); (V.D.); (A.D.)
- Correspondence: ; Tel.: +39-34-5477-1308
| | - Paolo Francesco Manicone
- Division of Oral Surgery and Implantology, Department of Head, Neck, and Sensory Organs, Fondazione Policlinico Universitario A. Gemelli IRCCS—Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (P.F.M.); (C.G.); (M.G.L.); (F.C.); (G.B.P.); (V.D.); (A.D.)
| | | | - Cristina Grippaudo
- Division of Oral Surgery and Implantology, Department of Head, Neck, and Sensory Organs, Fondazione Policlinico Universitario A. Gemelli IRCCS—Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (P.F.M.); (C.G.); (M.G.L.); (F.C.); (G.B.P.); (V.D.); (A.D.)
| | - Giulio Gasparini
- Oral and Maxillofacial Surgery Unit, Department of Head, Neck, and Sensory Organs, Fondazione Policlinico Universitario A. Gemelli IRCSS—Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Margherita Giorgia Liguori
- Division of Oral Surgery and Implantology, Department of Head, Neck, and Sensory Organs, Fondazione Policlinico Universitario A. Gemelli IRCCS—Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (P.F.M.); (C.G.); (M.G.L.); (F.C.); (G.B.P.); (V.D.); (A.D.)
| | - Francesca Camodeca
- Division of Oral Surgery and Implantology, Department of Head, Neck, and Sensory Organs, Fondazione Policlinico Universitario A. Gemelli IRCCS—Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (P.F.M.); (C.G.); (M.G.L.); (F.C.); (G.B.P.); (V.D.); (A.D.)
| | - Giovan Battista Piccirillo
- Division of Oral Surgery and Implantology, Department of Head, Neck, and Sensory Organs, Fondazione Policlinico Universitario A. Gemelli IRCCS—Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (P.F.M.); (C.G.); (M.G.L.); (F.C.); (G.B.P.); (V.D.); (A.D.)
| | - Viviana Desantis
- Division of Oral Surgery and Implantology, Department of Head, Neck, and Sensory Organs, Fondazione Policlinico Universitario A. Gemelli IRCCS—Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (P.F.M.); (C.G.); (M.G.L.); (F.C.); (G.B.P.); (V.D.); (A.D.)
| | | | - Antonio D’Addona
- Division of Oral Surgery and Implantology, Department of Head, Neck, and Sensory Organs, Fondazione Policlinico Universitario A. Gemelli IRCCS—Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (P.F.M.); (C.G.); (M.G.L.); (F.C.); (G.B.P.); (V.D.); (A.D.)
| |
Collapse
|
67
|
Bouhy A, Rompen E, Lamy M, Legros C, Lecloux G, Lambert F. Maxillary implant overdenture retained by four unsplinted attachments and opposed by a natural or fixed dentition: One-year clinical outcomes. Clin Oral Implants Res 2020; 31:747-767. [PMID: 32497274 DOI: 10.1111/clr.13623] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 02/14/2020] [Accepted: 02/23/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim of this prospective study was to evaluate the implant, prosthesis, and patient-reported outcomes of maxillary removable prostheses retained by 4 implant-supported study abutments after a follow-up period of 1 year in patients with natural teeth or a fixed rehabilitation in the mandible. MATERIALS AND METHODS A total of 30 patients were included, and all received 4 implants in the upper maxilla. After 12 weeks, the prostheses were connected to the implant with unsplinted attachments. The implant and prosthodontics outcomes were assessed over a follow-up period of 1 year. Patient-reported outcome measures (PROMs) were evaluated with the Oral Health Impact Profile (OHIP-20) questionnaire and an adaptation of the McGill Denture Satisfaction Instrument using a visual analogue scale (VAS). RESULTS A single patient dropped out. At the post-operative 12-week follow-up, 79.3% (95% CI: 64.6%-94.1%) of the patients displayed peri-implant mucosa hyperplasia and 69.0% (95% CI: 52.1%-85.8%) showed pain. After 1 year, 16 implants failed in 10 patients, leading to an implant survival rate of 86.2% (95% CI: 79.0%-92.5%), and the mean peri-implant bone loss was 1.01 ± 0.77 mm (95% CI: 0.85-1.16 mm). The prosthesis survival rate was 96.6% (95% CI: 82.2%-99.9%). The OHIP-20 and VAS scores both improved significantly from baseline to 1 year (p < .001). CONCLUSION The implant survival rate was lower compared to the literature for the upper maxilla. Despite the encountered problems, PROMs showed significant improvement with the implant overdenture retained by 4 unsplinted implants compared to conventional dentures.
Collapse
Affiliation(s)
- Alice Bouhy
- Department of Removable Prosthodontics, University of Liège, Liège, Belgium
| | - Eric Rompen
- Department of Periodontology and Oral Surgery, Faculty of Medicine, University of Liege, Liège, Belgium
| | - Marc Lamy
- Department of Removable Prosthodontics, University of Liège, Liège, Belgium
| | - Caroline Legros
- Department of Removable Prosthodontics, Faculty of Medicine, University of Liege, Liège, Belgium
| | - Geoffrey Lecloux
- Department of Periodontology and Oral Surgery, Faculty of Medicine, University of Liege, Liège, Belgium
| | - France Lambert
- Department of Periodontology and Oral Surgery, Faculty of Medicine, University of Liege, Liège, Belgium
| |
Collapse
|
68
|
Fonteyne E, De Bruyn H, De Fruyt F. Quality of life and social participation in dental rehabilitation: A personality and multi-informant perspective. J Dent 2020; 103S:100021. [PMID: 34059306 DOI: 10.1016/j.jjodo.2020.100021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 04/16/2020] [Accepted: 06/02/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Contemporary research on the impact of dental rehabilitation scarcely focuses on the role of personality and social relationships in QoL related to dental implant treatment. To overcome biases related to evaluation with self-reports, descriptions provided by informed external observers are recommended. AIMS To investigate the impact of implant-supported rehabilitation on quality of life and social participation taking into account patient's personality. MATERIALS AND METHODS Fifty-four patients were included in this study and assigned to either a single unit group (n = 15) or a complete jaw restoration group (n = 39). Of the 54 participants, 49 nominated an external observer who can evaluate the daily behavior of the patient. Before and after treatment patients and their external observer completed the OHIP-14, the NEO-FFI and the MSPP questionnaires respectively focusing on Oral Health related Quality of Life, Personality and Social participation. RESULTS AND CONCLUSION The correlations between self- and observer ratings on pre and post treatment outcomes on were insignificant (QoL pre: p = 0.086, post: p = 0.115, freq. soc. part pre: p = 0.944, post: p = 0.876, div. soc. part pre: p = 0.798, post: p = 0.167), suggesting considerable differences in observer perspectives. The traits Neuroticism, Extraversion and Agreeableness were associated with QoL. Openness, Conscientiousness and Agreeableness were associated with social participation. Patients in the complete jaw restoration group reported more impact of the implant treatment on quality of life as compared to the single unit group (p = 0.007). The complete jaw restoration group reported an improved quality of life after treatment and significant increases of both frequency (p = 0.001) and diversity of social participation (p = 0.036). In conclusion there was a minor impact of treatment with single crowns on quality of life and social participation compared to the full denture group. The role of personality and the use of multi-informants in evaluating dental treatment was found important.
Collapse
Affiliation(s)
- Ester Fonteyne
- Department of Oral Health Sciences Section Periodontology and Oral Implantology, Ghent University, Ghent, Belgium.
| | - Hugo De Bruyn
- Professor Periodontology Dental School Ghent, Chairman Department of Dentistry, Radboud University Medical Center, Research Institute Health Sciences, Department of Dentistry - Implantology and Periodontology, Nijmegen, the Netherlands.
| | - Filip De Fruyt
- Department of Developmental, Personality and Social Psychology, Ghent University, Belgium.
| |
Collapse
|
69
|
Ackermann KL, Barth T, Cacaci C, Kistler S, Schlee M, Stiller M. Clinical and patient-reported outcome of implant restorations with internal conical connection in daily dental practices: prospective observational multicenter trial with up to 7-year follow-up. Int J Implant Dent 2020; 6:14. [PMID: 32266497 PMCID: PMC7138872 DOI: 10.1186/s40729-020-00211-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 03/12/2020] [Indexed: 11/12/2022] Open
Abstract
Background The interpretation of the results of randomized clinical trials is often questioned in relation with daily circumstances in practices. This prospective observational multicenter study was instigated to reflect the need for information in real-life situations with dental implants with internal conical implant-abutment connection (Conelog implant system). The implants were followed up at least 5-year post-loading; survival analysis (Kaplan-Meier), changes of soft tissue, and bone level over time, as well as patient satisfaction were evaluated. Results In total, 130 dental implants were placed in 94 patients (64 female, 30 male). Mean age of patients was 50.4 ± 13.7. At 5-year post-loading, 104 implants in 76 patients were available for evaluation. The cumulative implant survival rate was 96.6%. After an initial bone remodeling process post-surgery (bone loss of − 0.52 ± 0.55 mm), the bone level change remained clinically stable from loading to 5-year post-loading (− 0.09 ± 0.43 mm). Patient satisfaction surveyed by questionnaire (comfort, ability to chew and taste, esthetics, general satisfaction) steadily increased towards the end. At the last study follow-up, all the patients rated their general satisfaction as either very satisfied (87.5%) or satisfied (12.5%). Conclusion The study implants have shown to be highly effective with reliable peri-implant tissue stability over the 5 to 7 years of observation for both single tooth restorations and fixed partial dentures while used in standard conditions in daily dental practice. The results obtained are comparable with those obtained in controlled clinical trials.
Collapse
Affiliation(s)
| | | | | | | | - Markus Schlee
- , Forchheim, Germany.,Department of Maxillofacial Surgery, Goethe University Frankfurt, Frankfurt, Germany
| | | |
Collapse
|
70
|
Sánchez-Torres A, Cercadillo-Ibarguren I, Figueiredo R, Gay-Escoda C, Valmaseda-Castellón E. Mechanical complications of implant-supported complete-arch restorations and impact on patient quality of life: A retrospective cohort study. J Prosthet Dent 2020; 125:279-286. [PMID: 32165011 DOI: 10.1016/j.prosdent.2020.01.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 01/08/2020] [Accepted: 01/08/2020] [Indexed: 01/10/2023]
Abstract
STATEMENT OF PROBLEM Mechanical complications (for example, fractures) in implant-supported complete-arch restorations may affect the social and professional activities of the patient. However, most studies seem to overlook patient perceptions and generally do not assess the changes in the quality of life (QoL) of patients who experience these complications. PURPOSE The purpose of this retrospective cohort study was to assess the influence of technical or mechanical complications of complete-arch implant-supported prostheses on patient perception and QoL by using the Oral Health Impact Profile (OHIP)-14. MATERIAL AND METHODS A retrospective cohort study was formed of patients treated consecutively at a private clinic with immediately loaded complete-arch prostheses supported by a minimum of 4 implants (Replace Tapered; Nobel Biocare AB) and Multi-Unit conical abutments (Multi-Unit abutments; Nobel Biocare AB). OHIP-14 and questions regarding self-reported satisfaction were used to evaluate the influence of mechanical complications on QoL. RESULTS Fifty-six participants (26 men and 30 women) with a mean age of 64 ±11.1 years, and 72 restored arches were included. The mean ±standard deviation follow-up time was 52 ±26 months. The prosthetic success rate was 38.8%, and the survival rate was 100% (no failure was registered). The most common complications were abutment screw loosening (43%), chipping or fracture of the veneering material (25%), and screw loosening (21%). The OHIP-14 scores were close to zero, without differences between participants with or without mechanical complications. Overall, the participants reported that the prostheses allowed good oral hygiene (94.6%) and met their expectations (89%) and that they would repeat the treatment (87.5%) and would recommend it to others (93%). CONCLUSIONS Minor mechanical complications such as screw loosening and chipping or fracture of the veneering material were frequent events but had no impact on the satisfaction and QoL of patients with immediately loaded complete-arch implant-supported prostheses.
Collapse
Affiliation(s)
- Alba Sánchez-Torres
- Associate Professor of Oral Surgery, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain; Researcher, IDIBELL Institute, Barcelona, Spain
| | - Iñaki Cercadillo-Ibarguren
- Associate Professor of Oral Surgery, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain; Researcher, IDIBELL Institute, Barcelona, Spain
| | - Rui Figueiredo
- Associate Professor of Oral Surgery, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain; Researcher, IDIBELL Institute, Barcelona, Spain.
| | - Cosme Gay-Escoda
- Chairman and Professor of Oral and Maxillofacial Surgery, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain; Director of the Master's Degree Program in Oral Surgery and Implantology (EFHRE International University/FUCSO), Belize City, Belize; Coordinator/Researcher, IDIBELL Institute, Barcelona, Spain; Head of the Department of Oral Surgery, Implantology and Maxillofacial Surgery, Teknon Medical Center, Barcelona, Spain
| | - Eduard Valmaseda-Castellón
- Professor of Oral Surgery, Professor of the Master's Degree Program in Oral Surgery and Implantology, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain; Researcher, IDIBELL Institute, Barcelona, Spain
| |
Collapse
|
71
|
De Bruyckere T, Cosyn J, Younes F, Hellyn J, Bekx J, Cleymaet R, Eghbali A. A randomized controlled study comparing guided bone regeneration with connective tissue graft to re-establish buccal convexity: One-year aesthetic and patient-reported outcomes. Clin Oral Implants Res 2020; 31:507-516. [PMID: 32011032 DOI: 10.1111/clr.13587] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 10/15/2019] [Accepted: 01/08/2020] [Indexed: 01/04/2023]
Abstract
OBJECTIVES To compare guided bone regeneration (GBR) with connective tissue graft (CTG) in terms of aesthetic and patient-reported outcomes (PROMs). MATERIALS AND METHODS Patients with a single tooth gap in the anterior maxilla and horizontal alveolar defect were enrolled in a single-blind RCT. All sites had a buccopalatal bone dimension of at least 6 mm, received a single implant and were randomly allocated to the control (GBR) or test group (CTG) to re-establish buccal soft tissue convexity. Primary outcomes were Pink Esthetic Score (PES) and Mucosal Scarring Index (MSI) assessed after 1 year. Secondary outcomes included PROMs registered during the early stages of healing and after 1 year. RESULTS Twenty-one patients were included per group (control: 11 females, mean age 51; test: nine females, mean age 48). Although there was no significant difference in the PES between the groups (control: 10.11; test: 10.48; p = .577), the MSI was significantly lower in the test (1.10) than in the control group (2.53) (p = .017). Based on descriptive statistics, the latter demonstrated wider scars, more colour mismatch and slightly more suture marks. However, these were not considered disturbing by the patients given similar VAS on soft tissue aesthetics (control: 84; test: 87). Oedema and haematoma were rated twice as high in the control group on at least two postoperative time points, and patients took more painkillers (7.10 vs. 4.86). OHIP-14 decreased in both groups between baseline and 1-year follow-up, indicative of less discomfort in daily life. Differences in MSI and PROMs between the groups may be explained by the need of a vertical releasing incision in order to achieve sufficient access for GBR, periosteal incisions and the use of biomaterials that may induce inflammation. CONCLUSION GBR and CTG resulted in favourable aesthetic outcomes as assessed by professionals and patients. However, given additional vertical and periosteal incisions, GBR resulted in more scarring, postoperative discomfort and a higher need for painkillers.
Collapse
Affiliation(s)
- Thomas De Bruyckere
- Vrije Universiteit Brussel (VUB), Faculty of Medicine and Pharmacy, Oral Health Research Group (ORHE), Brussels, Belgium.,Department of Periodontology and Oral Implantology, Faculty of Medicine and Health Sciences, Dental School, Ghent University, Ghent, Belgium
| | - Jan Cosyn
- Vrije Universiteit Brussel (VUB), Faculty of Medicine and Pharmacy, Oral Health Research Group (ORHE), Brussels, Belgium.,Department of Periodontology and Oral Implantology, Faculty of Medicine and Health Sciences, Dental School, Ghent University, Ghent, Belgium
| | - Faris Younes
- Vrije Universiteit Brussel (VUB), Faculty of Medicine and Pharmacy, Oral Health Research Group (ORHE), Brussels, Belgium.,Department of Periodontology and Oral Implantology, Faculty of Medicine and Health Sciences, Dental School, Ghent University, Ghent, Belgium
| | - Jade Hellyn
- Department of Periodontology and Oral Implantology, Faculty of Medicine and Health Sciences, Dental School, Ghent University, Ghent, Belgium
| | - Jonas Bekx
- Department of Periodontology and Oral Implantology, Faculty of Medicine and Health Sciences, Dental School, Ghent University, Ghent, Belgium
| | - Roberto Cleymaet
- Vrije Universiteit Brussel (VUB), Faculty of Medicine and Pharmacy, Oral Health Research Group (ORHE), Brussels, Belgium
| | - Aryan Eghbali
- Vrije Universiteit Brussel (VUB), Faculty of Medicine and Pharmacy, Oral Health Research Group (ORHE), Brussels, Belgium.,Department of Periodontology and Oral Implantology, Faculty of Medicine and Health Sciences, Dental School, Ghent University, Ghent, Belgium
| |
Collapse
|
72
|
Botelho J, Machado V, Proença L, Bellini DH, Chambrone L, Alcoforado G, Mendes JJ. The impact of nonsurgical periodontal treatment on oral health-related quality of life: a systematic review and meta-analysis. Clin Oral Investig 2020; 24:585-596. [PMID: 31901977 DOI: 10.1007/s00784-019-03188-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 12/23/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To estimate the impact of nonsurgical periodontal treatment (NSPT) on patients' oral health-related quality of life (OHRQoL). The focused question for this systematic review was: in adults patients with periodontitis, does NSPT improve oral health-related quality of life? MATERIAL AND METHODS Five databases (PubMed, CIHNL, EMBASE, LILACS and CENTRAL) were searched up to April 2019 (PROSPERO CRD42018103393). Intervention trials and cohort studies assessing the OHRQoL data of adults with periodontitis, enduring non-surgical periodontal treatment (NSPT) were eligible for inclusion. Subgroup random-effects meta-analysis was conducted methodically. RESULTS Overall, 491 studies were retrieved, out of which 19 met the inclusion criteria. Two randomized clinical trials (RCTs) and ten cohort studies were further analysed. Seven cohort studies were included in the statistical analysis. Subgroup meta-analyses of cohort studies revealed that NSPT improves in average 2.49 (95% CI 0.95-4.02), 8.94 (95% CI 6.89-10.99) and 6.49 (95% CI 5.11-7.88) OHRQoL levels at 1-2 weeks, 3-4 weeks and 6-12 weeks of post-treatment, respectively. CONCLUSIONS NSPT procedures greatly improve the oral health-related quality of life within a short time, remaining stable after 3 months of treatment. CLINICAL RELEVANCE This systematic review brings forward summary evidence that NSPT improves the OHRQoL in adults with periodontitis from a patient-centred perception and remain stable in the short term.
Collapse
Affiliation(s)
- João Botelho
- Periodontology Department, Egas Moniz Dental Clinic, Egas Moniz, CRL, Monte de Caparica, Portugal.,Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz, CRL, Monte de Caparica, Portugal
| | - Vanessa Machado
- Periodontology Department, Egas Moniz Dental Clinic, Egas Moniz, CRL, Monte de Caparica, Portugal.,Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz, CRL, Monte de Caparica, Portugal
| | - Luís Proença
- Quantitative Methods for Health Research Unit (MQIS), CiiEM, Egas Moniz, CRL, Monte de Caparica, Portugal
| | | | - Leandro Chambrone
- School of Dentistry, Ibirapuera University, São Paulo, SP, Brazil. .,Unit of Basic Oral Investigation (UIBO), El Bosque University, Bogota, Colombia.
| | - Gil Alcoforado
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz, CRL, Monte de Caparica, Portugal
| | - José João Mendes
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz, CRL, Monte de Caparica, Portugal
| |
Collapse
|
73
|
Uribarri A, Bilbao‐Uriarte E, Segurola A, Ugarte D, Verdugo F. Marginal and internal fit of CAD/CAM frameworks in multiple implant‐supported restorations: Scanning and milling error analysis. Clin Implant Dent Relat Res 2019; 21:1062-1072. [DOI: 10.1111/cid.12839] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 06/24/2019] [Accepted: 08/05/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Agurne Uribarri
- Department of Stomatology II, School of Medicine and DentistryUniversity of Basque Country Leioa Spain
| | - Eneritz Bilbao‐Uriarte
- Department of Stomatology II, School of Medicine and DentistryUniversity of Basque Country Leioa Spain
| | - Aiora Segurola
- Department of Stomatology II, School of Medicine and DentistryUniversity of Basque Country Leioa Spain
| | - Done Ugarte
- Department of Mechanics and Industrial Production, Higher Polytechnic SchoolMondragon University Arrasate Mondragon Spain
| | - Fernando Verdugo
- Department of Periodontics, VA HospitalGreater Los Angeles Healthcare Los Angeles California
| |
Collapse
|
74
|
Matthys C, Vervaeke S, Besseler J, Doornewaard R, Dierens M, De Bruyn H. Five years follow‐up of mandibular 2‐implant overdentures on locator or ball abutments: Implant results, patient‐related outcome, and prosthetic aftercare. Clin Implant Dent Relat Res 2019; 21:835-844. [DOI: 10.1111/cid.12840] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 07/08/2019] [Accepted: 08/09/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Carine Matthys
- Clinic for Removable Prosthodontics, Faculty of Medicine and Health SciencesDental School, Ghent University Ghent Belgium
| | - Stijn Vervaeke
- Periodontics and Implantology, Department of Periodontology and Oral Implantology, Faculty of Medicine and Health SciencesDental School, Ghent University Ghent Belgium
| | - Jos Besseler
- Private practitionerBesseler Dental Clinic Enschede The Netherlands
| | - Ron Doornewaard
- Periodontics and Implantology, Department of Periodontology and Oral Implantology, Faculty of Medicine and Health SciencesDental School, Ghent University Ghent Belgium
| | - Melissa Dierens
- Periodontics and Implantology, Private practice Ghent Belgium
| | - Hugo De Bruyn
- Periodontics and Implantology, Department of Periodontology and Oral Implantology, Faculty of Medicine and Health SciencesDental School, Ghent University Ghent Belgium
- Department of Dentistry‐ Implantology & Periodontology, Research Institute Health SciencesRadboud University Medical Center Nijmegen The Netherlands
| |
Collapse
|
75
|
Matthys C, Vervaeke S, Besseler J, De Bruyn H. Five‐year study of mandibular overdentures on stud abutments: Clinical outcome, patient satisfaction and prosthetic maintenance—Influence of bone resorption and implant position. Clin Oral Implants Res 2019; 30:940-951. [DOI: 10.1111/clr.13501] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 06/18/2019] [Accepted: 06/18/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Carine Matthys
- Clinic for Removable Prosthodontics, Faculty of Medicine and Health Sciences, Dental School Ghent University Ghent Belgium
| | - Stijn Vervaeke
- Department of Periodontology and Oral Implantology, Faculty of Medicine and Health Sciences, Dental School Ghent University Ghent Belgium
| | | | - Hugo De Bruyn
- Department of Periodontology, Oral Implantology, Removable and Implant Prosthodontics, Faculty of Medicine and Health Sciences, Dental School Ghent University Ghent Belgium
- Department of Dentistry – Implantology & Periodontology Radboud University Medical Center, Research Institute Health Sciences Nijmegen The Netherlands
| |
Collapse
|
76
|
Fonteyne E, Van Doorne L, Becue L, Matthys C, Bronckhorst E, De Bruyn H. Speech evaluation during maxillary mini-dental implant overdenture treatment: A prospective study. J Oral Rehabil 2019; 46:1151-1160. [PMID: 31271663 PMCID: PMC6899632 DOI: 10.1111/joor.12852] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 06/11/2019] [Accepted: 07/01/2019] [Indexed: 12/27/2022]
Abstract
Large proportions of patients are edentulous and wear removable dentures leading to reduced functional comfort and less oral health‐related quality of life. Satisfaction with the oral situation after implantation depends on the outcome in eating comfort, speech comfort and aesthetics. Modification in form and location of the teeth may affect speech. The aim of this study is to determine speech, oromyofunctional behaviour, satisfaction with the treatment and the impact on quality of life of the horse‐shoe overdenture retained by mini‐dental implants (MDIs) in the maxilla. This prospective multicentre cohort study included 32 patients for treatment. 5 to 6 implants were placed, traumatically piercing the mucosa. Patients were evaluated three times during treatment (pre‐operatively with conventional prosthesis including full palatal coverage (CD), post‐operatively with provisionally relined CD and with horse‐shoe overdenture on MDI). The assessment included a phonetic evaluation, examination of oromyofunctional behaviour, evaluation of the impact on quality of life (OHIP‐14) and a rating of satisfaction with the treatment and speech on a visual analogue scale. Several speech sounds are found to be disturbed before treatment. In the next two stages of the treatment, the number of speech issues decreases. In the final stage, ten people show minor speech problems, especially with the /s/ sound. In this stage, seven people still present with oromyofunctional problems, especially whistling problems. In this last stage, people are very satisfied with the treatment (83%) and with speech (84%). The impact on quality of life is low (8.23/56).
Collapse
Affiliation(s)
- Ester Fonteyne
- Department of Oral Health Sciences, Section Periodontology and Oral Implantology, Ghent University, Ghent, Belgium
| | - Luc Van Doorne
- Department of Oral Health Sciences, Section Maxillo-Facial Surgery, Periodontology and Oral Implantology, Ghent University, Ghent, Belgium
| | | | - Carine Matthys
- Clinic for Removable Prosthodontics, Faculty of Medicine and Health Sciences, Dental School, Ghent University, Ghent, Belgium
| | - Ewald Bronckhorst
- Department of Dentistry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hugo De Bruyn
- Department of Dentistry, Periodontology Dental School Ghent, Radboud University Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
77
|
Stabilizing mandibular complete dentures by a single midline implant—influence on quality of life: 2-year results from a randomized clinical trial comparing different loading protocols. Clin Oral Investig 2019; 24:927-935. [DOI: 10.1007/s00784-019-02969-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 05/16/2019] [Indexed: 10/26/2022]
|
78
|
Zucchelli G, Tavelli L, Stefanini M, Barootchi S, Mazzotti C, Gori G, Wang HL. Classification of facial peri-implant soft tissue dehiscence/deficiencies at single implant sites in the esthetic zone. J Periodontol 2019; 90:1116-1124. [PMID: 31087334 DOI: 10.1002/jper.18-0616] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 12/06/2018] [Accepted: 01/14/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND The incidence of a peri-implant soft tissue dehiscence/deficiency (PSTD) is not a rare finding. Despite multiple previous attempts aimed at correcting the PSTDs, a classification of these conditions has not yet been proposed. This lack in the literature may also lead to discrepancies in the reported treatment outcomes and thus misinform the clinician or the readers. The aim of the present article was therefore to present a classification of peri-implant PSTD at a single implant site. METHODS Four classes of PSTDs were discussed based on the position of the gingival margin of the implant-supported crown in relation to the homologous natural tooth. In addition, the bucco-lingual position of the implant head was also taken into consideration. Each class was further subdivided based on the height of the anatomical papillae. RESULTS Subsequently, for each respective category a surgical approach (including bilaminar techniques, the combined prosthetic-surgical approach or soft tissue augmentation with a submerged healing) was also suggested. CONCLUSION This paper provides a new classification system for describing PSTDs at single implant sites, with the appropriate recommended treatment protocol.
Collapse
Affiliation(s)
- Giovanni Zucchelli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Lorenzo Tavelli
- Department of Periodontics & Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - Martina Stefanini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Shayan Barootchi
- Department of Periodontics & Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - Claudio Mazzotti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | | | - Hom-Lay Wang
- Department of Periodontics & Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
79
|
Doornewaard R, Glibert M, Matthys C, Vervaeke S, Bronkhorst E, de Bruyn H. Improvement of Quality of Life with Implant-Supported Mandibular Overdentures and the Effect of Implant Type and Surgical Procedure on Bone and Soft Tissue Stability: A Three-Year Prospective Split-Mouth Trial. J Clin Med 2019; 8:E773. [PMID: 31159202 PMCID: PMC6617188 DOI: 10.3390/jcm8060773] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 05/27/2019] [Accepted: 05/28/2019] [Indexed: 12/01/2022] Open
Abstract
In fully edentulous patients, the support of a lower dental prosthesis by two implants could improve the chewing ability, retention, and stability of the prosthesis. Despite high success rates of dental implants, complications, such as peri-implantitis, do occur. The latter is a consequence of crestal bone loss and might be related to the implant surface and peri-implant soft tissue thickness. The aim of this paper is to describe the effect of implant surface roughness and soft tissue thickness on crestal bone remodeling, peri-implant health, and patient-centered outcomes. The mandibular overdenture supported by two implants is used as a split-mouth model to scrutinize these aims. The first study compared implants placed equicrestal to implants placed biologically (i.e., dependent on site-specific soft tissue thickness). The second clinical trial compared implants with a minimally to a moderately rough implant neck. Both studies reported an improvement in oral health-related quality of life and a stable peri-implant health after three years follow-up. Only equicrestal implant placement yielded significantly higher implant surface exposure, due to the establishment of the biologic width. Within the limitations of this study, it can be concluded that an implant supported mandibular overdenture significantly improves the quality of life, with limited biologic complications and high survival rates of the implants.
Collapse
Affiliation(s)
- Ron Doornewaard
- Department Periodontology & Oral Implantology, Dental School, Faculty Medicine and Health Sciences, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium.
| | - Maarten Glibert
- Department Periodontology & Oral Implantology, Dental School, Faculty Medicine and Health Sciences, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium.
| | - Carine Matthys
- Department Periodontology & Oral Implantology, Dental School, Faculty Medicine and Health Sciences, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium.
| | - Stijn Vervaeke
- Department Periodontology & Oral Implantology, Dental School, Faculty Medicine and Health Sciences, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium.
| | - Ewald Bronkhorst
- Section Implantology & Periodontology, Department of Dentistry, Radboudumc, Philips van Leydenlaan 25, 6525 EX Nijmegen, The Netherlands.
| | - Hugo de Bruyn
- Department Periodontology & Oral Implantology, Dental School, Faculty Medicine and Health Sciences, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium.
- Section Implantology & Periodontology, Department of Dentistry, Radboudumc, Philips van Leydenlaan 25, 6525 EX Nijmegen, The Netherlands.
| |
Collapse
|
80
|
Anadioti E, Gates WD, Elpers J, De Kok IJ, Cooper LF. Retrospective cohort analysis of maxillary overdentures retained by unsplinted implants. J Prosthet Dent 2019; 122:301-308.e1. [PMID: 30948296 DOI: 10.1016/j.prosdent.2018.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 10/06/2018] [Accepted: 10/08/2018] [Indexed: 10/27/2022]
Abstract
STATEMENT OF PROBLEM Implant therapy involving an unsplinted 2-implant-retained overdenture is well defined as a successful treatment for a patient with an edentulous mandible. However, a similar unsplinted implant therapy supporting a maxillary overdenture is not well characterized. PURPOSE The purpose of this retrospective study was to evaluate maxillary overdentures retained by 4 unsplinted implants measuring implant survival, overdenture survival, and patient-reported outcomes. MATERIAL AND METHODS Participants who had received an unsplinted implant-retained maxillary overdenture were included in the study. Participants presented for one denture recall appointment, during which comprehensive examination, including radiographs, was performed and clinical findings were recorded. Participants also completed the Oral Health Impact Profile-49 (OHIP-49) and a 20-item visual analog scale (VAS) satisfaction questionnaire. Nonparametric statistical tests were used to compare OHIP-49 and VAS scores across age, sex, time since overdenture insertion, mandibular dental status, smoking status, maxillary mucosal health, and overdenture hygiene. RESULTS For the 44 participants, 3 of 4 implants failed in 1 individual. The cumulative implant survival rate was 98% (97.7% patient level). No prosthetic failures (that is, overdenture replacement) occurred, indicating a 100% prosthesis survival rate. The mean ±standard deviation OHIP-49 severity score was 23.6 ±26.0, and the mean ±standard deviation total VAS score was 179.2 ±29.4. Increased age was associated with lower OHIP-49 severity score (P=.036), and participants with unhealthy oral mucosa or denture stomatitis demonstrated significantly higher OHIP-49 severity scores (P=.003). CONCLUSIONS In this retrospective evaluation, unsplinted implant-retained maxillary overdenture therapy was associated with high implant and prosthetic survival, as well as high patient satisfaction and quality of life. Age, sex, maxillary mucosal health, and mandibular dental status resulted in significant differences with respect to oral health-related quality of life and patient satisfaction, indicating that this treatment option may be ideal for certain patients.
Collapse
Affiliation(s)
- Evanthia Anadioti
- Assistant Professor, Clinical Restorative Dentistry, Department of Preventive and Restorative Sciences, University of Pennsylvania School of Dental Medicine, Philadelphia, Penn.
| | - W Day Gates
- Private practice, Mobile, Ala; and Adjunct Assistant Professor, Department of Prosthodontics, University of North Carolina School of Dentistry, Chapel Hill, NC
| | - Julie Elpers
- Private practice, Boston, Mass; and Adjunct Assistant Professor, Department of Prosthodontics, University of North Carolina School of Dentistry, Chapel Hill, NC
| | - Ingeborg J De Kok
- Associate Professor, Department of Prosthodontics, University of North Carolina School of Dentistry, Chapel Hill, NC
| | - Lyndon F Cooper
- Associate Dean for Research; Head, Department of Oral Biology, University of Illinois at Chicago, College of Dentistry, Chicago, Ill
| |
Collapse
|
81
|
Huynh-Ba G, Oates TW, Williams MAH. Immediate loading vs. early/conventional loading of immediately placed implants in partially edentulous patients from the patients' perspective: A systematic review. Clin Oral Implants Res 2019; 29 Suppl 16:255-269. [PMID: 30328205 DOI: 10.1111/clr.13278] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 03/16/2018] [Accepted: 03/17/2018] [Indexed: 01/30/2023]
Abstract
OBJECTIVES This systematic review aimed at answering the following PICO question: In patients receiving immediate (Type 1) implant placement, how does immediate compare to early or conventional loading in terms of Patient-Reported Outcome Measures (PROMs)? MATERIAL AND METHODS Following search strategy development, the OVID, PubMed, EMBASE, and Cochrane Database of Systematic Reviews databases were search for the relevant literature. All levels of evidence including randomized controlled trials, prospective and retrospective cohort studies, and case series of at least five patients were considered for possible inclusion. An additional manual search was performed by screening the reference lists of relevant studies and systematic reviews published up to May 2017. The intervention considered was the placement of immediate implant. Study selection and data extraction were performed independently by two reviewers. RESULTS The search yielded a list of 1,102 references, of which nine were included in this systematic review. The limited number of studies included and the heterogeneity of the data identified prevented the performance of a meta-analysis. Three studies, one of which was a randomized controlled trial, allowed the extraction of comparative data specific to the aim of the present systematic review. The remaining studies allowed only data extraction for one single treatment modality and were viewed as single cohort studies. Overall, irrespective of the PROMs chosen, patients' satisfaction was overall high with little difference between the two loading protocols. Moreover, studies indicated a positive impact on oral health-related quality of life following immediate implant placement and loading. CONCLUSIONS Within the limitations of the present systematic review, immediate implant placement and loading in single tooth edentulous space seems to be a well-accepted treatment modality from the patients' perspective and is worthy of consideration in clinical practice. However, the paucity of comparative data limits any definitive conclusions as to which loading protocol; immediate or early/conventional, should be given preference based on PROMs.
Collapse
Affiliation(s)
- Guy Huynh-Ba
- Department of Periodontics, School of Dentistry, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Thomas W Oates
- Department of Advanced Oral Sciences & Therapeutics, School of Dentistry, University of Maryland, Baltimore, Maryland
| | - Mary Ann H Williams
- Health Sciences & Human Services Library, University of Maryland, Baltimore, Maryland
| |
Collapse
|
82
|
Wittneben JG, Wismeijer D, Brägger U, Joda T, Abou-Ayash S. Patient-reported outcome measures focusing on aesthetics of implant- and tooth-supported fixed dental prostheses: A systematic review and meta-analysis. Clin Oral Implants Res 2019; 29 Suppl 16:224-240. [PMID: 30328183 DOI: 10.1111/clr.13295] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 03/24/2018] [Accepted: 05/15/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim of this systematic review and meta-analysis was to summarize the existing evidence on patient-reported aesthetic outcome measures (PROMs) of implant-supported, relative to tooth-supported fixed dental prostheses. MATERIAL AND METHODS In April 2017, two reviewers independently searched the Medline (PubMed), EMBASE, and Cochrane electronic databases, focusing on studies including patient-reported aesthetic outcomes of implant- and tooth-supported fixed dental prostheses (FDPs). Human studies with a mean follow-up period of at least 1 year, a minimum of ten patients, and English, German, or French publication were included. For the comparison of subgroups, random-effects meta-regression for aggregate-level data was used. RESULTS The systematic search for implant-supported prostheses focusing on patient-reported outcomes identified 2,675 titles, which were screened by two independent authors. Fifty full-text articles were analyzed, and finally, 16 publications (including 19 relevant study cohorts) were included. For tooth-supported prostheses, no studies could be included. A total of 816 implant-supported reconstructions were analyzed by patients. Overall aesthetic evaluation by the patients' visual analogue scale (VAS) rating was high in implant-supported FDPs (median: 90.3; min-max: 80.0-94.0) and the surrounding mucosa (median: 84.7; min-max: 73.0-92.0). Individual restorative materials, implant neck design (i.e., tissue or bone level type implants), and the use of a fixed provisional had no effect on patients' ratings of the definitive implant-supported FDPs. CONCLUSIONS Aesthetics is an important patient-reported measure, which lacks in standardized methods; however, patients' satisfaction was high for implant- supported FDPs and the surrounding mucosa.
Collapse
Affiliation(s)
- Julia-Gabriela Wittneben
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.,Department of Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, Boston, MA
| | - Daniel Wismeijer
- Department of Oral Implantology and Prosthetic Dentistry, ACTA, University of Amsterdam and VU University, Amsterdam, The Netherlands
| | - Urs Brägger
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Tim Joda
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Samir Abou-Ayash
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| |
Collapse
|
83
|
Doornewaard R, Jacquet W, Cosyn J, De Bruyn H. How do peri-implant biologic parameters correspond with implant survival and peri-implantitis? A critical review. Clin Oral Implants Res 2019; 29 Suppl 18:100-123. [PMID: 30306697 PMCID: PMC6220966 DOI: 10.1111/clr.13264] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 04/02/2018] [Accepted: 04/11/2018] [Indexed: 02/06/2023]
Abstract
Objectives The aim of this critical review was to evaluate whether commonly used biologic diagnostic parameters correspond to implant survival and peri‐implantitis prevalence. Materials and methods Publications from 2011 to 2017 were selected by an electronic search using the Pubmed database of the US National Library of Medicine. Prospective and retrospective studies with a mean follow‐up time of at least 5 years and reporting prevalence of peri‐implantitis as well as mean bone loss and standard deviation were selected. The correlation between reported prevalence of peri‐implantitis and reported implant survival, mean follow‐up time, mean bone loss, mean probing depth, and mean bleeding on probing was calculated. Mean bone loss and standard deviation were used for estimation of proportion of implants with bone loss exceeding 1, 2, and 3 mm. Results Full‐text analysis was performed for 255 papers from 4,173 available ones, and 41 met all the inclusion criteria. The overall mean weighted survival rate was 96.9% (89.9%–100%) and the reported prevalence of peri‐implantitis ranged between 0% and 39.7%, based on 15 different case definitions. The overall weighted bone loss was 1.1 mm based on 8,182 implants and an average mean loading time ranging from 5 to 20 years. No correlation was found between mean bone loss and the reported prevalence of peri‐implantitis. The estimated prevalence of implants with bone loss above 2 mm was 23%. The overall weighted mean probing depth was 3.3 mm, and mean weighted bleeding was 52.2%. Only a weak correlation was found between survival and function time (r = −0.49). There was no relation between the probing depth or bleeding and the mean bone loss, mean follow‐up time, and reported prevalence of peri‐implantitis. Conclusion Biologic parameters mean probing depth and mean bleeding on probing do not correlate with mean bone loss and this irrespective of follow‐up. Case definition for peri‐implantitis varied significantly between studies indicating that an unambiguous definition based on a specified threshold for bone loss is not agreed upon in the literature.
Collapse
Affiliation(s)
- Ron Doornewaard
- Department Periodontology & Oral Implantology, Dental School, Faculty Medicine and Health Sciences, Ghent University Belgium, Ghent, Belgium
| | - Wolfgang Jacquet
- Department Periodontology & Oral Implantology, Dental School, Faculty Medicine and Health Sciences, Ghent University Belgium, Ghent, Belgium.,Oral Health Research Group ORHE, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Educational Sciences EDWE-LOCI, Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Brussels, Belgium
| | - Jan Cosyn
- Department Periodontology & Oral Implantology, Dental School, Faculty Medicine and Health Sciences, Ghent University Belgium, Ghent, Belgium.,Oral Health Research Group ORHE, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Hugo De Bruyn
- Department Periodontology & Oral Implantology, Dental School, Faculty Medicine and Health Sciences, Ghent University Belgium, Ghent, Belgium.,Section Implantology & Periodontology, Department of Dentistry, Radboudumc, Nijmegen, The Netherlands
| |
Collapse
|
84
|
Zhang Y, Chow L, Siu A, Fokas G, Chow TW, Mattheos N. Patient‐reported outcome measures (PROMs) and maintenance events in 2‐implant‐supported mandibular overdenture patients: A 5‐year prospective study. Clin Oral Implants Res 2019; 30:261-276. [DOI: 10.1111/clr.13412] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 01/10/2019] [Accepted: 01/14/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Yuxuan Zhang
- Implant Dentistry, Prosthodontics, Faculty of Dentistry The University of Hong Kong Hong Kong Hong Kong
| | - Luke Chow
- Implant Dentistry, Prosthodontics, Faculty of Dentistry The University of Hong Kong Hong Kong Hong Kong
| | - Adam Siu
- Implant Dentistry, Prosthodontics, Faculty of Dentistry The University of Hong Kong Hong Kong Hong Kong
| | - George Fokas
- Implant Dentistry, Prosthodontics, Faculty of Dentistry The University of Hong Kong Hong Kong Hong Kong
| | - Tak W. Chow
- Implant Dentistry, Prosthodontics, Faculty of Dentistry The University of Hong Kong Hong Kong Hong Kong
- Department of Preventive and Restorative Dentistry, College of Dental Medicine University of Sharjah Sharjah United Arab Emirates
| | - Nikos Mattheos
- Implant Dentistry, Prosthodontics, Faculty of Dentistry The University of Hong Kong Hong Kong Hong Kong
| |
Collapse
|
85
|
Yao CJ, Cao C, Bornstein MM, Mattheos N. Patient‐reported outcome measures of edentulous patients restored with implant‐supported removable and fixed prostheses: A systematic review. Clin Oral Implants Res 2018; 29 Suppl 16:241-254. [DOI: 10.1111/clr.13286] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 03/01/2018] [Accepted: 03/01/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Coral J Yao
- Implant Dentistry, ProsthodonticsFaculty of DentistryUniversity of Hong Kong Hong Kong China
| | - Cong Cao
- Center of StomatologyChina Japan Friendship Hospital Beijing China
- ITI Scholar 2016‐2017Implant DentistryProsthodonticsFaculty of DentistryUniversity of Hong Kong China
| | - Michael M. Bornstein
- Oral and Maxillofacial RadiologyFaculty of DentistryUniversity of Hong Kong Hong Kong China
| | - Nikos Mattheos
- Implant Dentistry, ProsthodonticsFaculty of DentistryUniversity of Hong Kong Hong Kong China
| |
Collapse
|
86
|
Cacaci C, Ackermann KL, Barth T, Kistler S, Stiller M, Schlee M. A non-interventional multicenter study to document the implants success and survival rates in daily dental practices of the CONELOG screw-line implant. Clin Oral Investig 2018; 23:2609-2616. [DOI: 10.1007/s00784-018-2646-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 09/20/2018] [Indexed: 11/28/2022]
|
87
|
Kroll P, Hou L, Radaideh H, Sharifi N, Han PP, Mulligan R, Enciso R. Oral Health-Related Outcomes in Edentulous Patients Treated With Mandibular Implant-Retained Dentures Versus Complete Dentures: Systematic Review With Meta-Analyses. J ORAL IMPLANTOL 2018; 44:313-324. [DOI: 10.1563/aaid-joi-d-17-00210] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The objective of this systematic review was to determine the effect on oral health-related outcomes from mandibular implant-retained dentures opposing maxillary complete dentures in edentulous middle-age and older adults, compared with complete removable dentures in both arches. Randomized controlled trials included participants with an average age of 65 years or older. The Cochrane Library, MEDLINE, and Web of Science were searched. A total of 228 abstracts were reviewed for inclusion criteria, with 14 trials included and analyzed for risk of bias. Eleven of these studies were assessed as being at an unclear risk of bias, and 3 were at high risk. Mandibular implant-retained overdenture therapy showed statistically significant improvements in the patients' general satisfaction (P = .003), oral health-related quality of life (P < .001), and chewing ability (P < .001), over the patients with complete dentures. There were no significant differences in the percentage of patients who were satisfied with their overdentures vs complete dentures for comfort, retention, esthetics, or chewing ability; however, only 2 studies reported these outcomes. In terms of nutritional status 1 year after treatment, vitamin B12 blood levels increased significantly in the implant-retained group (P = .003), but not the other nutritional values. Implant-retained mandibular overdentures are an option for middle-aged and elderly edentulous patients as they significantly improve some of the outcomes; however, the quality of the evidence was moderate/low, due to the small number of studies included and the risk of bias. Future research should include objective outcomes such as masticatory performance, chewing efficacy, and muscular coordination.
Collapse
Affiliation(s)
- Philip Kroll
- Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, Calif
| | - Lisa Hou
- Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, Calif
- Division of Dental Public Health and Pediatric Dentistry, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, Calif
| | - Hani Radaideh
- Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, Calif
| | - Nazanin Sharifi
- Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, Calif
| | - Phuu P. Han
- Division of Dental Public Health and Pediatric Dentistry, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, Calif
| | - Roseann Mulligan
- Division of Dental Public Health and Pediatric Dentistry, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, Calif
| | - Reyes Enciso
- Division of Dental Public Health and Pediatric Dentistry, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, Calif
| |
Collapse
|
88
|
Marotti J, Gatzweiler B, Wolfart M, Sasse M, Kern M, Wolfart S. Implant Placement under Existing Removable Dental Prostheses and the Effect on Follow-Up and Prosthetic Maintenance. J Prosthodont 2018; 28:e752-e763. [PMID: 30028055 DOI: 10.1111/jopr.12943] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2018] [Indexed: 12/25/2022] Open
Abstract
PURPOSE The aim of this prospective clinical study was to compare the maintenance interventions required for solely implant-retained overdentures (I-OD) with that of overdentures retained by a combination of telescopic crowns and implants (T/I-OD). MATERIALS AND METHODS The participants in this study were 22 patients who initially presented either with a removable complete denture (n = 11) or with an overdenture retained by 1 to 2 telescopic crowns on natural teeth (n = 11). Subsequently, the total number of abutments was increased to 5 to 6 (maxilla) or 4 to 5 (mandible) by placing implants in strategically advantageous regions, generating two distinct groups: I-OD and T/I-OD. Ball attachments were connected to the implants and integrated into the existing denture. The maintenance aspects were analyzed according to the type of treatment (preventive, biological, and technical) and to the severity of treatment (minimal, moderate, and extensive). RESULTS During a mean observation time of 6.5 years, the tooth survival rate was 89% (T/I-OD) and the implant survival rate 100% (both groups). The survival rates of the overdentures ranged from 90.9% (I-OD) to 100% (T/I-OD). A mean number of 0.6 (I-ODs) and 2.0 (T/I-OD) treatments were performed for biological reasons; and 8.2 (I-ODs) and 9.6 (T/I-OD) for technical reasons, per patient, during the observation time. From biological aspects, significantly more extensive maintenance was found to be necessary in the T/I-OD group than in the I-OD group. CONCLUSIONS The therapeutic concept of implant placement under existing prostheses was promising when performed in indicated cases.
Collapse
Affiliation(s)
- Juliana Marotti
- Department of Prosthodontics and Biomaterials, Centre for Implantology, Medical School RWTH Aachen University, Aachen, Germany
| | - Bodo Gatzweiler
- Department of Prosthodontics and Biomaterials, Centre for Implantology, Medical School RWTH Aachen University, Aachen, Germany
| | - Mona Wolfart
- Department of Prosthodontics, Propaedeutics and Dental Materials, Christian-Albrechts University, Kiel, Germany
| | - Martin Sasse
- Department of Prosthodontics, Propaedeutics and Dental Materials, Christian-Albrechts University, Kiel, Germany
| | - Matthias Kern
- Department of Prosthodontics, Propaedeutics and Dental Materials, Christian-Albrechts University, Kiel, Germany
| | - Stefan Wolfart
- Department of Prosthodontics and Biomaterials, Centre for Implantology, Medical School RWTH Aachen University, Aachen, Germany
| |
Collapse
|
89
|
Starch-Jensen T, Nielsen HB. Prosthetic Rehabilitation of the Partially Edentulous Atrophic Posterior Mandible with Short Implants (≤ 8 mm) Compared with the Sandwich Osteotomy and Delayed Placement of Standard Length Implants (> 8 mm): a Systematic Review. EJOURNAL OF ORAL MAXILLOFACIAL RESEARCH 2018; 9:e2. [PMID: 30116514 PMCID: PMC6090250 DOI: 10.5037/jomr.2018.9202] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 06/28/2018] [Indexed: 01/26/2023]
Abstract
Objectives Test the hypothesis of no difference in prosthetic rehabilitation of the partially edentulous atrophic posterior mandible with short implants (≤ 8 mm) compared with the sandwich osteotomy and delayed placement of standard lengths implants (> 8 mm). Material and Methods A MEDLINE (PubMed), Embase and Cochrane library search in combination with a hand-search was conducted by including studies published in English. No year of publication restriction was applied. Results Six randomized controlled trials characterized by low or moderate risk of bias fulfilled the inclusion criteria. There were no statistically significant differences (P > 0.05) in the survival rate of suprastructures and implants between the two treatment modalities after one year. Sandwich osteotomy and delayed implant placement demonstrated statistically significant higher long-term peri-implant marginal bone loss as well as biological and technical complications compared with short implants (P < 0.0001). Moreover, patients significantly favoured prosthetic rehabilitation with short implants (P < 0.0001). Conclusions Short implants and the sandwich osteotomy with delayed placement of standard length implants appear to result in predictable outcomes in terms of high survival rate of suprastructures and implants after prosthetic rehabilitation of the partially edentulous atrophic posterior mandible. However, further long-term randomized controlled trials assessing donor site morbidity, an economic perspective, professional and patient-related outcome measures with the two treatment modalities are needed before definite conclusions can be provided about the beneficial use of short implants for prosthetic rehabilitation of the partially edentulous atrophic posterior mandible compared with the sandwich osteotomy and delayed placement of standard length implants.
Collapse
Affiliation(s)
- Thomas Starch-Jensen
- Department of Oral and Maxillofacial Surgery, Aalborg University Hospital, AalborgDenmark
| | | |
Collapse
|
90
|
Matthys C, Vervaeke S, Jacquet W, De Bruyn H. Impact of crestal bone resorption on quality of life and professional maintenance with conventional dentures or Locator-retained mandibular implant overdentures. J Prosthet Dent 2018; 120:886-894. [PMID: 29724562 DOI: 10.1016/j.prosdent.2017.11.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 11/21/2017] [Accepted: 11/21/2017] [Indexed: 12/11/2022]
Abstract
STATEMENT OF PROBLEM The influence of the mandibular resorption profile on clinical outcome after converting a conventional complete denture into a Locator-retained implant overdenture is unknown. PURPOSE The purpose of this prospective study was to assess the oral health-related quality of life (OHRQoL) and prosthetic maintenance of mandibular overdentures on 2 Locator abutments in relation to the resorption degree of the edentulous mandible. MATERIAL AND METHODS Twenty-five participants were treated and classified according to the Cawood and Howell (CAW-H) resorption classification for the resorption profile of the mandible, CAW-H group III-IV (n=14) and CAW-H group V (n=11). Participants received conventional complete dentures (CDs) before implant placement and immediate nonfunctional loading on Locators with a resilient liner. After 3 months, the attachments were functionally activated. Assessments were made using the Oral Health Impact Profile 14 (OHIP-14) questionnaires with existing CDs and new CDs at 1, 3, and 15 months after loading. Prosthetic maintenance (repairs, rebasings, replacement of retention parts) and biological prosthetic aftercare were assessed. For comparison between groups, the Kruskal-Wallis and Mann-Whitney U tests were applied for continuous and ordinal variables and the chi-square test for cross-tabulations. To analyze repeated OHIP-14 scores, the Friedman test was used for ordered alternatives to test whether the measurements differed (overall significance level α=.05). Then the Wilcoxon signed rank test was conducted to detect specific differences (α=.05). RESULTS OHIP-14 scores decreased significantly after implant placement and functional connection for the whole population (P<.001) and for both sub groups, the CAW-H group III-IV (P<.001) and the CAW-H group V (P=.013). CAW-H group V participants needed more retention inserts than CAW-H group III-IV participants (26 versus 3, respectively; P=.006). The incidence of repair and rebasing was limited for both groups, and biological aftercare and pain relief were comparable. CONCLUSIONS Changing a CD to an overdenture significantly improved ORLQoL regardless of the resorption degree, but heavily resorbed mandibles require more replacements of retention inserts.
Collapse
Affiliation(s)
- Carine Matthys
- Deputy Head, Clinic for Removable Prosthodontics, Dental School, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
| | - Stijn Vervaeke
- Specialist, Periodontics and Implantology, Department of Periodontology and Oral Implantology, Dental School, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Wolfgang Jacquet
- Professor, Applied Mathematics-Statistics, Department of Oral Health Sciences, and Department of Educational Sciences Localities Ontologies Commons Integrated, University of Amsterdam Brussel, Brussels, Belgium; and Lecturer, Anton de Kom University of Suriname, Paramaribo, Suriname; and Research consultant, Dental School, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Hugo De Bruyn
- Specialist, Periodontics and Implantology, Professor and Chairman, Department of Periodontology and Oral Implantology, Dental School, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; and visiting professor, Department of Prosthodontics, Malmö University, Malmö, Sweden; Department Head, Department of Dentistry, Radboud University Nijmegen, Nijmegen, The Netherlands
| |
Collapse
|
91
|
Raes S, Eghbali A, Chappuis V, Raes F, De Bruyn H, Cosyn J. A long-term prospective cohort study on immediately restored single tooth implants inserted in extraction sockets and healed ridges: CBCT analyses, soft tissue alterations, aesthetic ratings, and patient-reported outcomes. Clin Implant Dent Relat Res 2018; 20:522-530. [DOI: 10.1111/cid.12613] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 03/14/2018] [Accepted: 03/21/2018] [Indexed: 01/18/2023]
Affiliation(s)
- Stefanie Raes
- Department of Periodontology and Oral Implantology, Dental School, Faculty of Medicine and Health Sciences; Ghent University; Ghent Belgium
| | - Aryan Eghbali
- Oral Health Research Group (ORHE), Faculty of Medicine and Pharmacy; Vrije Universiteit Brussel; Brussels Belgium
| | - Vivianne Chappuis
- Department of Oral Surgery and Stomatology, School of Dental Medicine; University of Bern; Bern Switzerland
| | - Filiep Raes
- Department of Periodontology and Oral Implantology, Dental School, Faculty of Medicine and Health Sciences; Ghent University; Ghent Belgium
| | - Hugo De Bruyn
- Department of Periodontology and Oral Implantology, Dental School, Faculty of Medicine and Health Sciences; Ghent University; Ghent Belgium
- Department of Prosthodontics, Faculty of Odontology; Malmö University; Malmö Sweden
- Department Periodontology and Implantology; College of Dental Science, Radboud University Medical Center; Nijmegen The Netherlands
| | - Jan Cosyn
- Department of Periodontology and Oral Implantology, Dental School, Faculty of Medicine and Health Sciences; Ghent University; Ghent Belgium
- Oral Health Research Group (ORHE), Faculty of Medicine and Pharmacy; Vrije Universiteit Brussel; Brussels Belgium
| |
Collapse
|
92
|
Cosyn J, Thoma DS, Hämmerle CHF, De Bruyn H. Esthetic assessments in implant dentistry: objective and subjective criteria for clinicians and patients. Periodontol 2000 2018; 73:193-202. [PMID: 28000279 DOI: 10.1111/prd.12163] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In recent years the scientific community has shown a clear interest in the esthetic outcome of implant treatment. The present paper provides an overview of the esthetic ratings that have been used in implant dentistry. A distinction can be made between objective evaluations by clinicians and subjective evaluations by patients. The former mainly include: midfacial and interproximal soft-tissue levels; two-dimensional/three-dimensional soft-tissue alterations; assessment of the color match between the natural dentition, on the one hand, and the peri-implant tissues and the reconstruction, on the other hand; and ordinal indices, such as the pink and white esthetic score. Patient's needs and judgment may differ from objective indicators of implant success and esthetics. As a result, assessing treatment on the basis of patient-reported outcomes measures should be considered important. Validated questionnaires have been used that mainly assess the impact of oral health on the overall well-being of individuals. The esthetic judgment of patients is usually based on nonstandardized questions with varying scoring methods, including visual analog scales, Likert and other category scales and open questions. The heterogeneity in scoring systems between studies may compromise proper comparison of objective and subjective esthetic outcomes between studies and therapeutic concepts.
Collapse
|
93
|
Offord D, Mathieson G, Kingsford N, Matthys C, Glibert M, De Bruyn H. Peri-implant health, clinical outcome and patient-centred outcomes of implant-supported overdentures in the mandible and the maxilla. BDJ Open 2018; 3:17017. [PMID: 29607087 PMCID: PMC5842836 DOI: 10.1038/bdjopen.2017.17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 07/03/2017] [Accepted: 07/10/2017] [Indexed: 11/09/2022] Open
Abstract
Objectives/Aims: The primary aim of this retrospective pilot study was to evaluate the clinical outcome of overdentures on four non-splinted maxillary implants compared to the mandible using locator attachments and secondly to assess patient's opinion of the treatment. Materials and Methods: The treatment protocol used here is summarised as a single-stage surgical approach followed by immediate loading (same day in 12 of 17 patients) of a removable prosthesis in the maxilla and mandible. Most of the implants were installed into fresh extraction sockets. Clinical outcomes were evaluated in 68 southern implants, straight (non co-axis) or angulated (co-axis) in 17 patients. Patients were examined by independent examiners at an average follow-up of 14.5 months after implant placement. Results: Outcomes measured were implant survival, bone loss, bleeding on probing, probing pocket depths and plaque score in addition to quality of life measured with OHIP-14 questionnaires. An overall implant survival of 100% was achieved. The mean marginal bone level (mm) over the entire cohort of 66 measured implants was (1.4 mm; range, 0–5.5). A significant difference (P=0.01) was found between bone level, from implant head to bone contact in the maxilla (M, 0.9 mm; s.d., 1.1; range, 0–4) and the mandible (M, 1.7; s.d., 1.0; range, 0–5.5). The marginal bone-to-implant head distance with the angulated co-axis implants was 1.9 mm (s.d., 1.5; range, 0–5.5) compared to non co-axis, mean 1.2 mm (s.d., 1.1; range, 0–4) (P=0.01). The OHIP-14 overall mean was 3.3 (out of a maximum of 56). Conclusion: The implant survival was 100% and the patients benefited from the overdenture treatment on four non-connected implants. The extremely low OHIP-14 indicated a very high level of patient satisfaction following treatment. The results of this study merit further long-term investigation to fully investigate the success of immediately loading implants in the maxilla as well as cost-benefit.
Collapse
Affiliation(s)
| | | | | | - Carine Matthys
- Department of Periodontology and Oral Implantology, University of Ghent, University Hospital Ghent, Ghent, Belgium
| | - Maarten Glibert
- Department of Periodontology and Oral Implantology, University of Ghent, University Hospital Ghent, Ghent, Belgium
| | - Hugo De Bruyn
- Department of Periodontology and Oral Implantology, University of Ghent, University Hospital Ghent, Ghent, Belgium
| |
Collapse
|
94
|
Patient-Reported Outcomes After Lateral Wall Sinus Floor Elevation: A Systematic Review. IMPLANT DENT 2018; 27:236-245. [PMID: 29319545 DOI: 10.1097/id.0000000000000717] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this systematic review is to assess patient-reported outcome measures (PROMs) after a sinus lift elevation by means of a lateral approach. MATERIAL AND METHODS An electronic search was performed to search for eligible publications reporting PROMs after a lateral wall sinus lift procedure. Selected articles were further scrutinized and underwent a quality check before inclusion in a final study pool. RESULTS The electronic search provided us with 2444 articles of which 98 were further examined through a full-text analysis. Of these 98 studies, 11 were selected based on our inclusion and exclusion criteria. Results on a different number of PROMs were examined and compared: pain, edema, ability to eat, ability to work, phonetics, daily activities, bleeding, bruising, ability to sleep, bad breath, patient preference, and Oral Health Impact Profile-14 (OHIP-14). Methods of evaluation were 3- to 5-point scales, visual analog scale scores, and OHIP-14 questionnaires. Evaluation time points differed between 1 single evaluation time to a daily registration during 1 week. CONCLUSIONS A general peak in discomfort could be noticed on day 1 postoperatively with a general decline thereafter. Severe morbidity or discomfort occurred but not in most patients.
Collapse
|
95
|
Zucchelli G, Sharma P, Mounssif I. Esthetics in periodontics and implantology. Periodontol 2000 2018; 77:7-18. [DOI: 10.1111/prd.12207] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
96
|
Stefanini M, Felice P, Mazzotti C, Mounssif I, Marzadori M, Zucchelli G. Esthetic evaluation and patient-centered outcomes in single-tooth implant rehabilitation in the esthetic area. Periodontol 2000 2018; 77:150-164. [DOI: 10.1111/prd.12215] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
|
97
|
Testori T, Weinstein T, Scutellà F, Wang HL, Zucchelli G. Implant placement in the esthetic area: criteria for positioning single and multiple implants. Periodontol 2000 2018; 77:176-196. [PMID: 29484714 DOI: 10.1111/prd.12211] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Patient expectations from implant treatment have changed over the years and esthetics plays an important role in defining what is now called success of rehabilitation. Of the many factors that influence the outcome of the rehabilitation, the two main ones are the bone and soft-tissue deficiencies at the intended implant site. Many surgical approaches are described in terms of timing of implant placement and management of regenerative procedures. The aim of this article is to discuss the different implant placement alternatives in the esthetic area, in particular: (i) the timing of implant placement/regenerative procedures/skeletal growth/altered passive eruption; (ii) the correct three-dimensional position of the fixture between the cuspids and in the premolar area; (iii) multiple missing teeth in the esthetic area with single tooth/pontic or cantilevered options/prosthetic compensation; (iv) placement of implants into infected sites; and (v) the influence of abutment and crown morphology on implant position. Combining our long-standing clinical experience and the pertinent literature, the following conclusions can be drawn: Immediate implant placement can be a successful procedure in terms of esthetics but it is technique sensitive and requires an experienced team. Immediate placement is less traumatic to the patient as fewer surgical procedures are involved and patients tend to prefer this clinical approach with regards to quality of life. The diagnostic phase is of utmost importance, with not only bone and soft tissue deficiencies being addressed but also: skeletal growth, dental/implant soft tissue parameters such as altered passive eruption and the morphology of the roots adjacent to the edentulous area. Post-extraction immediate loading is feasible in infected sites. The correct position of the fixture should follow widely accepted guidelines but the abutment morphologies play a role in the vestibular/palatal position of the implant. The long axis of the implant, aiming at the incisal edge of the future restorations, is the most appropriate implant position when a shoulder-less abutment is used and allows a restorative crown morphology with a cervical contour resembling a natural tooth. The use of a shoulder-less abutment gives more space for the tissue to grow compared with the traditional abutment with shoulder finish line.
Collapse
|
98
|
Kan JYK, Rungcharassaeng K, Deflorian M, Weinstein T, Wang HL, Testori T. Immediate implant placement and provisionalization of maxillary anterior single implants. Periodontol 2000 2018; 77:197-212. [PMID: 29478284 DOI: 10.1111/prd.12212] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
An inevitable loss of soft and hard tissue after tooth extraction often results in a compromised site for anterior implant esthetics in both vertical and horizontal dimensions. Immediate implant placement and provisionalization has been a viable option for replacing failing maxillary anterior teeth as it preserves the vertical existing osseous and gingival architecture. With the simultaneous addition of soft- and hard-tissue grafts, the peri-implant horizontal tissue topography can also be maintained. The esthetic success of immediate implant placement and provisionalization procedures is influenced by a number of factors that can be identified as patient-dependent or clinician-dependent. This article describes in detail the process of patient selection, indications, contraindications, diagnosis, treatment planning and treatment execution required to achieve functional and esthetic success with immediate implant placement and provisionalization.
Collapse
|
99
|
Box VH, Sukotjo C, Knoernschild KL, Campbell SD, Afshari FS. Patient-Reported and Clinical Outcomes of Implant-Supported Fixed Complete Dental Prostheses: A Comparison of Metal-Acrylic, Milled Zirconia, and Retrievable Crown Prostheses. J ORAL IMPLANTOL 2018; 44:51-61. [DOI: 10.1563/aaid-joi-d-17-00184] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The purpose of this retrospective study was to assess the incidence of biologic and technical complications for implant-supported fixed complete dental prostheses (IFCDPs) and their relationship to oral health-related quality of life (OHQoL) and patient-reported outcomes. Metal-acrylic (MA), retrievable crown (RC), monolithic zirconia (MZ), and porcelain veneered zirconia (PVZ) prostheses were included. Patients who received an IFCDP at least 1 year prior to recall were identified. Exclusion criteria were: (1) an opposing complete denture and (2) time in service >70 months. A total of 37 patients with 49 prostheses, including 22 MA, 14 RC, 7 MZ, and 6 PVZ prostheses were recalled. Patient-reported outcomes were assessed via OHIP-49 (Oral Health Impact Profile) and a scripted interview with open-ended questions. All designs had high complication rates (12 of 22 MA, 10 of 14 RC, 2 of 7 MZ, and 5 of 6 PVZ). The most common complications were: (1) MA: posterior tooth wear, (2) RC: chipping and fracturing of the restorations, (3) MZ: wear of opposing restorations, and (4) PVZ: chipping of opposing restorations. Average OHIP-49 scores ranged from 7 to 29, indicating high OHQoL, patient satisfaction, regardless of prosthetic design (P = .16). The standardized interview highlighted that although most patients were extremely satisfied (73%), some continued to be bothered by material bulk (14%) and felt that maintenance of oral hygiene was excessively time-consuming (16%). In the context of this study, despite high complication rates and maintenance needs, all IFCDP designs resulted in high OHQoL and patient satisfaction.
Collapse
Affiliation(s)
- Virginia Hogsett Box
- Department of Restorative Dentistry, College of Dentistry, University of Illinois at Chicago, Chicago, Ill
- Private practice, Dallas, Tex
| | - Cortino Sukotjo
- Department of Restorative Dentistry, College of Dentistry, University of Illinois at Chicago, Chicago, Ill
| | - Kent L. Knoernschild
- Department of Restorative Dentistry, College of Dentistry, University of Illinois at Chicago, Chicago, Ill
| | - Stephen D. Campbell
- Department of Restorative Dentistry, College of Dentistry, University of Illinois at Chicago, Chicago, Ill
| | - Fatemeh S. Afshari
- Department of Restorative Dentistry, College of Dentistry, University of Illinois at Chicago, Chicago, Ill
| |
Collapse
|
100
|
Insua A, Monje A, Wang HL, Inglehart M. Patient-Centered Perspectives and Understanding of Peri-Implantitis. J Periodontol 2017; 88:1153-1162. [DOI: 10.1902/jop.2017.160796] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Angel Insua
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI
| | - Alberto Monje
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI
- Department of Oral Surgery and Stomatology, ZMK Bern, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI
| | - Marita Inglehart
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI
| |
Collapse
|