Attitudes of general dental practitioners to the maintenance of Locator retained implant overdentures

Challenges in dental implant provision and its management in general dental practice

OBJECTIVES

Dental implants have become a well-publicised treatment modality in dentistry. Implants are generally placed in the private sector by dentists who have undertaken further learning. The continued maintenance of implants falls within the duty of care for the general dental practitioner. The objective of this qualitative study is to investigate the current status of dental implants in general dental practice, and to explore the dentists view on dental implant education at both undergraduate and postgraduate level.

METHODS

In-depth interviews as a qualitative methodology was used in the study. The participants were recruited through theoretical sampling guided by saturation of information. Based on this, 22 general dental practitioners practicing in the UK were interviewed. Transcribed interview data were coded with NVIVO software and then analysed using a thematic framework analysis method.

RESULTS

General dentists from different educational backgrounds, experience levels participated in the study. They highlighted that the guidelines and protocols when dealing with implants were unclear and expressed their unwillingness to treat patients who had their specialised dental treatment performed elsewhere.

CONCLUSION

Expensive dental implant treatment is not being followed up by the general dental practitioner due to a wide range of barriers. Unclear care paths will lead to a likely increase in problems following implant placement.

CLINICAL SIGNIFICANCE

General Dentists' views of dental implants in general practice and their expectations from education providers are explored and show the need for improved education.

Are UK graduates equipped with the skill set required to meet the demands of the UK's edentulous population?

As the UK witnesses a decline in the number of edentulous adults, there is a simultaneous reduction in the number of cases available to undergraduate dental students for the teaching of complete dentures. When edentulous adults are unable to function with conventional complete dentures, particularly pertaining to the mandibular denture, an implant-supported mandibular overdenture has been evidenced as the gold standard for edentulous patients. The evidence in favour of mandibular implant-supported overdentures is one of the most robust evidence bases for any clinical treatment and similarly it has been shown that undergraduate students are equally as capable in the provision of implant-supported overdentures as experienced prosthodontists. Yet there appears to be a disparity in the General Dental Council's undergraduate learning outcomes pertaining to care for edentulous adults. Furthermore, the UK seems to be falling behind in this respect in comparison to our European, American and Australian colleagues. This review looks at the evidence for the provision of implant-supported overdentures in the setting of the undergraduate dental curriculum, the potential barriers within this teaching forum and how well prepared UK undergraduates are for the clinical management of edentulous patients in the future.

The use of dental implants, cast bars and sleeve overdentures in oral cancer patients

Surgical resection of an oral tumour (and the associated free flap reconstruction) can significantly alter the oral anatomy. The lack of sulcus depth, alveolar ridge, presence of a mobile flap and limited tongue movement can make it impossible for patients to control a removable prosthesis. To help this cohort of patients, dental implants can be invaluable. The Oral Rehabilitation Team at Central Manchester University Dental Hospital have used dental implants to rehabilitate oral cancer patients for over thirty years. After their resective surgery, a number of patients were dentally rehabilitated with a laboratory-made, precious metal-alloy bar supported by at least four dental implants. A metal-alloy under-sleeve retained overdenture was then provided to fit over the milled bar. The majority of the 50 patients in this case series had tumours in the anterior floor of the mouth. It was noted that 76% of the patients received a rim resection and were reconstructed with a fasciocutaneous, soft tissue free flap. Six percent of patients received a segmental resection and were reconstructed with either a fibular or deep circumflex iliac artery free flap. The dental implants and sleeve overdentures had a survival rate of 100%. None of the dentures lost retention, implying that the frictional grip between the overcasting and the milled bar was sufficient to appease the retention demands of this cohort. However, 10% of patients encountered complications. This would suggest a success (or complication free) rate of 90% for this cohort of 50 oncology patients. This would still imply that milled bars/sleeve overdentures carry a relatively low maintenance burden and may be a useful treatment option for oral cancer patients.

Mandibular Implant Overdentures: Treatment and Medico-Legal Considerations

The concept of a two-implant overdenture as the minimum standard of care or first choice treatment for the edentulous mandible was first proposed in 2002 and has since been backed by an overwhelming body of evidence supporting greater patient satisfaction and improved quality of life. This article examines the implant overdenture concept and its various options and discusses best practice from both the patient's and a medico-legal standpoint.

Biomaterial aspects: A key factor in the longevity of implant overdenture attachment systems

Background:

New attachment systems are released for mandibular two-implant overdentures often without evidence-based support. Biomaterial aspects are now the parameters considered when choosing the appropriate attachment. Studies regarding their properties remain scarce.

Purpose:

The purpose of this review was to help the clinician in selrcting the most adapted stud attachments according evidence-based dentistry.

Materials and Methods:

An electronic search was conducted using specific databases (PubMed, Medline, and Elsevier libraries). Peer-reviewed articles published in English up to July 2014 were identified. Emphasis was given on the biomaterial aspects and technical complications. No hand search was added.

Results:

The electronic search generated 115 full-text papers, of which 84 papers were included in the review. The majority were clinical and in vitro studies. Some review articles were also considered. Papers reported survival and failures of overdenture connection systems. Emphasis was laid on attachment deformation.

Conclusion:

Implant overdentures long-term follow-up studies may provide useful guidelines for the clinician in selecting the type of attachment system and overdenture design. Locator attachments are more and more used, with lesser complications reported.

Summary of: attitudes of general dental practitioners to the maintenance of Locator retained implant overdentures

INTRODUCTION

Locator retained implant overdentures are associated with a high incidence of prosthodontic complications. This study investigated whether general dental practitioners (GDPs) were willing to maintain these prostheses in primary dental care.

METHOD

A questionnaire was distributed to all GDPs referring patients for an implant assessment to the Charles Clifford Dental Hospital, Sheffield between 1 January 2012 and 30 June 2012.

RESULTS

Ninety-four out of one hundred and forty-six questionnaires were returned (response rate: 64%). Thirteen GDPs (14%) were able to identify the Locator attachment system from clinical photographs. Eighty-two GDPs (87%) would adjust the fit surface of a Locator retained implant overdenture. Twenty-three GDPs (25%) would replace a retentive insert, 18 GDPs (19%) would tighten a loose abutment, 68 GDPs (72%) would debride abutments and 25 GDPs (27%) would remake a Locator-retained implant overdenture. Forty-seven GDPs (50%) felt that the maintenance of these prostheses was not their responsibility. The main barriers identified to maintenance by GDPs were a lack of training, knowledge and equipment. Seventy GDPs (74%) would like further training in this area.

CONCLUSIONS

GDPs are not familiar with the Locator attachment system and are reluctant to maintain implant retained overdentures. GDPs would like further training in this area.