Validation of a new, specific, complete, and short OHRQoL scale (QoLFAST-10) for wearers of implant overdentures and fixed-detachable hybrid prostheses

Modulators of oral health-related quality of life of maxillary implant overdenture users, analysed with the QoLIP-10, QoLDAS-9, and QoLFAST-10 specific questionnaires

OBJECTIVES

To identify potential modulators of OHRQoL in patients with maxillary implant-retained overdentures using specific implant-prosthesis questionnaires.

METHODS

In this cross-sectional observational study, 70 volunteers with maxillary implant overdentures were divided into two balanced groups (n=35 each) concerning gender and partnership status. The participants completed the QoLIP-10, QoLDAS-9, and QoLFAST-10 scales. Sociodemographic, clinical, and prosthesis-related variables were gathered. Descriptive statistics and non-parametric probes (Chi-square, Kruskal-Wallis, Mann-Whitney U tests, and Spearman rho correlation) were used to assess potential modulators of patient satisfaction (α=0.05).

RESULTS

Concerning the influence of gender, women reported the greatest satisfaction, as evidenced by the QoLIP-10 Performance domain (item 9), and the QoLDAS-9 total score and both its Psycho-facial and Interactive domains. Regarding the partnership status, unpartnered patients showed the significantly highest satisfaction, as indicated by the QoLDAS-9 Sociodental domain (item 7) and the both the QoLFAST-10 total and Social dimensional scores. Significant improvements in OHRQoL associated with higher retention, stability, and aesthetics of the implant overdenture were indicated by both the QoLFAST-10 and QoLDAS-9 questionnaires. No correlation was observed between the study groups in terms of the OHRQoL revealed by the total scores for each scale.

CONCLUSIONS

The QoLIP-10, QoLDAS-9, and QoLFAST-10 specific questionnaires consistently pointed to a better satisfaction of women and unpartnered patients wearing maxillary implant overdentures. Aesthetic, functional, and social factors also influenced the assessment of the patients' wellbeing.

CLINICAL SIGNIFICANCE

Specific questionnaires are effective tools for identifying sociodemographic and clinical OHRQoL modulators, to accurately assess the success chances of implant overdenture rehabilitations.

Outcome measurements and quality of randomized controlled clinical trials of tooth-supported fixed dental prostheses: A systematic review and qualitative analysis

STATEMENT OF PROBLEM

The lack of consensus regarding a standardized set of outcome measurements and noncompliance with current reporting guidelines in clinical trials of tooth-supported fixed dental prostheses (FDPs) hamper interstudy comparability, compromise scientific evidence, and waste research effort and resources in prosthetic dentistry.

PURPOSE

The primary objective of this systematic review was to identify all primary and secondary outcome measurements assessed in randomized controlled trials (RCTs) of tooth-supported FDPs. Secondary objectives were to assess their methodological quality by using the Cochrane Collaboration's risk of bias tool (RoB, v2.0) and their reporting quality by means of a standardized 16-item CONSORT assessment tool through published reports.

MATERIAL AND METHODS

An electronic search was conducted in MEDLINE, EMBASE, and Cochrane library to identify all RCT-related articles published in the past 10 years. Differences in RoB were tested with the Pearson chi-squared test, and those in CONSORT score with the Student t test.

RESULTS

A total of 64 RCTs from 79 publications were deemed eligible. The diversity of outcome measures used in the field is apparent. Twenty percent of the included studies had a low RoB, 79% showed some concerns, and 1% had a high RoB. The mean ±standard deviation CONSORT compliance score was 22.56 ±3.17. Trials adhered to the CONSORT statement reported lower RoB than those that did not adhere (P<.001). RCTs with a low RoB reported more comprehensive adherence to CONSORT guidelines than those with some concerns (MD 4 [95% CI 1.52-6.48]; P=.004).

CONCLUSIONS

A standardized core outcome reporting set in clinical research on tooth-supported FDPs remains evident. Adherence to the CONSORT statement continues to be low, with some RoB concerns that can be improved.

Evaluation of the quality of life and the satisfaction level after reconstruction with anterior iliac crest graft and implant-supported fixed prosthesis treatment

PURPOSE

To evaluate oral health-related quality of life (OHRQoL) and satisfaction levels related to treatment in patients who have complete implant treatment and prosthetic rehabilitation after anterior iliac crest grafting.

MATERIALS AND METHODS

Fifty-four patients (37 F, 17 M) with a total of 487 implants placed and implant-supported fixed prosthesis treatment completed were included in the study. OHIP-14OHIP-14 scale and satisfaction Likert scale questions were used to evaluate the OHRQoL and the satisfaction levels related to the treatment applied, respectively. To compare the outcomes, the significance test and the Mann-Whitney U-test were used. One-way analyses of variance and Kruskal-Wallis were used to assess the significance of differences among or between the groups.

RESULTS

The quality of life (QoL) was higher, and the mean OHIP-14 scores were lower in women, older patients, and cases with a longer follow-up period, recorded as 13.6 ± 10.3 (p: 0.263), 12.9 ± 11.3 (p: 0.079), and 11.8 ± 9.6 (p: 0.015*), respectively. Moreover, satisfaction levels of the patients related to the treatment were 83.3%.

CONCLUSIONS

The treatment of severely atrophic jaws with anterior iliac crest for the implant and prosthetic rehabilitation has a positive effect on the QoL. This effect has increased with time, and the satisfaction levels of the patients related to this procedure were high, and their expectations regarding this treatment were met at a high level.

Fracture resistance of cantilevered full-arch implant-supported hybrid prostheses with carbon fiber frameworks after thermal cycling

OBJECTIVES

This in vitro study aimed to find the best combination of mesostructure and veneering materials for full-arch implant-supported hybrid prostheses (HPs) in terms of the fracture resistance (FR) of their cantilevers.

METHODS

Three groups (n = 5 each) of maxillary HPs were fabricated: Group-1 (CC-A, control): Co-Cr frameworks coated with acrylic resin; Group-2 (CF-A): carbon fiber veneered with acrylic resin; and Group-3 (CF-R): carbon fiber coated with composite resin. All specimens were submitted to 5,000 thermal cycles (5 °C - 55 °C, dwell time: 30 s), and subjected to a single cantilever bending test in a universal testing machine (crosshead speed: 0.5 mm/min) until failure. The fracture pattern was assessed using stereo microscope and SEM. The one-way ANOVA and Bonferroni tests were run (α= 0.05).

RESULTS

The FR yielded significant differences among the three groups (p< 0.001). CC-A samples reached the highest FR values (p ≤ 0.001), whereas both CF-A and CF-R HPs exhibited the comparably (p = 0.107) lowest FR. CC-A specimens failed cohesively (100%): mostly without chipping (80%). CF-A mesostructures were always broken at the connections of the distal implants. CF-R prostheses often failed adhesively (80%).

CONCLUSIONS

The HPs made of Co-Cr veneered with acrylic demonstrated the best mechanical behavior, being the only group whose 13-mm long cantilevers exceeded the clinically acceptable FR of 900 N. The HPs constructed with carbon fiber frameworks showed, additionally, more unfavorable fracture patterns.

CLINICAL SIGNIFICANCE

For HPs with cantilevers up to 13 mm, Co-Cr mesostructures coated with acrylic may represent the optimum combination of materials.

'Differences in self-perceived OHRQoL between fully dentate subjects and edentulous patients depending on their prosthesis type, socio-demographic profile, and clinical features'

OBJECTIVES

This observational cross-sectional study aimed to evaluate and compare the oral health-related quality of life (OHRQoL) and clinical performance between dentate subjects and edentulous patients restored with conventional dentures or implant overdentures.

METHODS

85 edentulous patients were grouped as follows: Group-1 (CD): conventional denture wearers (n= 42), and Group-2 (IO): implant-retained overdenture wearers (n= 43). For the OHRQoL comparisons, a control group of subjects with a healthy natural dentition (Group-3, ND; n= 50) was included. Participants completed three validated questionnaires (OHIP-14sp, OHIP-20sp, and QoLIP-10). Socio-demographic data, prosthesis-related factors, clinical condition of the mouth, and patient subjective evaluations, were gathered. Descriptive and non-parametric probes were run (α= 0.05).

RESULTS

The ND group was the most unsatisfied (OHIP-14sp; p≤ 0.001). The OHIP-20sp attributed significantly worse Psychological disability (p= 0.029) and Handicap (p= 0.027) to CD wearers when compared to IO wearers. The CD group showed the significantly highest need for relining (p= 0.041), and the lowest retention (p= 0.011). The OHIP-14sp disclosed a significantly worse OHRQoL for those volunteers who had a job (p= 0.003), a basic education instead of a secondary one (p= 0.022), and no partner (p= 0.006).

CONCLUSIONS

The overall OHRQoL was comparable for both prosthodontic groups, being modulated by socio-demographic and prosthesis-related features. Nonetheless, CD wearers presented prosthetic complications more frequently.

Single versus two-implant mandibular overdentures using early-loaded titanium-zirconium implants with hydrophilic surface and ball attachments: 1-year randomized clinical trial

OBJECTIVE

This randomized clinical trial aimed to compare the outcomes of the mandibular overdenture retained by one (1-IOD) or two (2-IOD) implants.

MATERIALS AND METHODS

Participants received new complete dentures, were assessed at baseline and randomly assigned to groups. Early loaded single midline implant (1-IOD) or two implants in the canine regions bilaterally (2-IOD). Ball attachments were used for overdenture retention. Post-treatment outcomes (6- and 12-month follow-ups) included patient satisfaction, oral health-related quality of life measures, and chewing function. Data analysis included within- and between-group comparisons, and Generalized Estimating Equations. Both superiority and non-inferiority hypotheses were tested.

RESULTS

Forty-seven participants were included (1-IOD = 23; 2-IOD = 24). Significant improvements in OHIP-Edent were observed after insertion of new dentures and at the 1-year follow-up compared with baseline. No differences were found between the 1- and 2-IOD groups for the OHIP-Edent and QoLFAST scores. Patient satisfaction with the mandibular denture improved significantly from baseline to the 6-month follow-up and remained unaltered until 1 year, with no differences between groups. The magnitudes of treatment effect sizes were moderate to large for patient-reported outcomes. Progressive improvement in chewing function occurred in both groups. Non-inferiority testing based on a 15% non-inferiority margin showed inconclusive results for patient-reported outcomes, whilst chewing function in the 1-IOD group was concluded to be not inferior to the 2-IOD group.

CONCLUSIONS

Results support the use of both 1- and 2-IOD. The 1-IOD was also an acceptable alternative to the 2-IOD as a secondary option for the treatment of the edentulous mandible.

Functional oral health-related quality of life impact: A systematic review in populations with tooth loss

Patients perceive the impact of oral disorder in four major areas, the dimensions of oral health-related quality life (OHRQoL) Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact. The functional aspect is essential given the need of chewing, biting, speech and swallowing. The objective of this study was to identify OHRQoL information for dental subjects with functional oral health problems. In a systematic review, distinct and clinically relevant groups of dental subject samples, in this study called "population groups," with such functional OHRQoL information based on the Oral Health Impact Profile (OHIP) were identified (PROSPERO registration: CRD42017064033). The search strategy was "Oral Health Impact Profile" or OHIP. Searches were conducted in the PubMed interface of the Medline database, EMBASE, Cochrane, CINAHL and PsyINFO on 8 June 2017 and updated on 14 January 2019. Published OHIP domain data of different versions were recalculated into OHIP-14`s Physical Disability domain score, characterising the subject's Oral Function impact. 3,653 potentially abstracts were screened. We identified 78 publications reporting dimensional information on 154 subject samples with 52 populations. A typical mean functional impact for partially dentate subjects was 1.6 units on a 0 to 8 unit metric, while for edentate subjects, the mean functional impact was 2.6 units. The functional impact score ranged from 0 to 7.9 units with 50% of the patient samples located between 0.8 and 2.6 units. For the first time, we provide normalised and therefore comparable metric information about the functional OHRQoL impact for a substantial number of functional oral conditions.

Eleven-year follow-up of reconstruction with autogenous iliac bone graft and implant-supported fixed complete denture for severe maxillary atrophy: A case report

RATIONALE

The iliac bone graft procedure is one of the treatment options for individuals with extremely resorbed alveolar bones. An autogenous block bone graft can allow the use of an implant-supported fixed dental prosthesis, rather than conventional removable dentures, by completely edentulous patients. However, the iliac bone graft technique is an invasive procedure and should be carefully selected based on its long-term clinical results. This case report describes 11-year long-term outcomes for implant-supported complete denture on the grafted iliac bone.

PATIENT CONCERNS

A 68-year-old Asian man was referred for oral rehabilitation with fixed dental prostheses. The patient had been unsatisfied with his removable dental prostheses in masticatory performance.

DIAGNOSIS

Radiographical examination revealed severely atrophied maxilla.

INTERVENTIONS

The atrophied maxilla was reconstructed with an iliac block bone graft, after which an implant-supported fixed complete denture was placed.

OUTCOMES

During 11 years of follow-up, several prosthetic and mechanical complications were encountered. Nevertheless, no biological complications were observed. Marginal bone levels around the implants were well-maintained on the radiographs after 11 years of prosthetic use.

LESSONS

Iliac bone graft can be chosen as a predictable treatment option that allows patients with extremely atrophic maxilla to use a fixed dental prosthesis instead of a removable denture.

Fracture load of metal-ceramic, monolithic, and bi-layered zirconia-based posterior fixed dental prostheses after thermo-mechanical cycling

OBJECTIVES

This study aims to evaluate the fracture load of differently fabricated 3-unit posterior fixed dental prostheses (FDPs) with an intermediate pontic.

METHODS

Fifty sets of two stainless-steel abutments were randomly assigned to five groups (n = 10 each) depending on the material and technique used for manufacturing the FDPs: (1) Metal-ceramic (MC, control); (2) Lava Zirconia (LZ, bi-layered); (3) Lava Plus (LM, monolithic); (4) VITA In-Ceram YZ (YZ, bi-layered); and (5) IPS e-max ZirCAD (ZZ, bi-layered). After being luted to the dies, all FDPs were submitted to thermo-mechanical cycling (120,000 masticatory cycles, 50 N; plus 774 thermal cycles of 5 °C/55 °C, dwell time: 30 s). Samples were then subjected to a three-point bending test until fracture in a universal testing machine (cross-head speed: 1 mm/min). Fracture load of the veneering ceramic (VF) and total fracture load (TF) were recorded. Microstructure and failure patterns were assessed. Data was analysed using one-way ANOVA and Tukey HSD post-hoc tests (α = 0.05).

RESULTS

MC restorations recorded higher VF and TF values than did zirconia FDPs (p = 0.0001), which showed no between-group differences. Within the bi-layered groups, TF was significantly higher than VF. LM pieces registered lower average grain size than did LZ specimens (p = 0.001). Overall, the connector was the weakest part.

CONCLUSIONS

All of the groups tested could withstand clinical chewing forces in terms of average fracture load. Zirconia-based samples performed similarly to each other, but showed lower mean fracture load values than did metal-ceramic ones.

CLINICAL SIGNIFICANCE

Monolithic zirconia may be recommendable for solving the chipping problem.

Combination of straight and tilted implants for supporting screw-retained dental prostheses in atrophic posterior maxillae: A 2-year prospective study

OBJECTIVES

To evaluate the two-year survival rate (SR) and marginal bone loss (MBL) of fixed dental prostheses (FDPs) supported by straight (S) and tilted (T) implants under the influence of diverse study variables.

METHODS

A prospective investigation comprising 21 patients provided with a total of 27 maxillary screw-retained restorations fixed to 70 dental implants was developed. Two groups of implants were considered depending on their inclination with respect to the occlusal plane: Group 1 (S, n=37): straight/axial implants and Group 2 (T, n=33): tilted/angled fixations. Each FDP was supported by a combination of S and T implants. SR and MBL were assessed at the time of loading and two years after surgery. Patient-, surgical- and/or rehabilitation-related information was gathered. Data were statistically analysed at the α=0.05 significance level.

RESULTS

After 24 months, a 100% SR was achieved and the MBL of S and T implants were statistically similar. T implants located in the molar region showed lower MBL than did those replacing premolars (p=0.031).

CONCLUSIONS

Upright and angled fixations inserted at posterior maxillary areas resulted in comparable survival rates and peri-implant MBL after two years. The marginal bone resorption around tilted implants depended on their location.

CLINICAL SIGNIFICANCE

Screw-retained restorations fixed to straight and tilted implants seem to be a safe treatment option in posterior atrophic maxillae.

Implant Supported Fixed Restorations versus Implant Supported Removable Overdentures: A Systematic Review

AIM:

The aim of this study is to systematically evaluate and compare implant retained fixed restoration versus implant retained over denture.

MATERIAL AND METHODS:

Search was made in 2 databases including PubMed and PubMed Central. Title and abstract were screened to select studies comparing implant retained fixed restorations versus implant retained removable overdentures. Articles which did not follow the inclusion criteria were excluded. Included papers were then read carefully for a second stage filter, this was followed by manual searching of bibliography of selected articles.

RESULTS:

The search resulted in 5 included papers. One study evaluated the masticatory function, while the other 4 evaluated the patient satisfaction. Two of them used Visual Analogue Scale (VAS) as a measurement tool, while the other two used VAS and Categorical Scales (CAT). Stability, ability to chew, ability to clean, ability to speak and esthetics were the main outcomes of the 4 included papers.

CONCLUSION:

Conflicting results was observed between the fixed and removable restorations.