Short and sticky options in the treatment of the partially dentate patient

Tooth replacement options for partially dentate older adults: a survival analysis

OBJECTIVES

To compare the success of two different tooth replacement strategies for partially dentate older adults; namely resin bonded bridgework (RBB) provided to restore patients according to the principles of the shortened dental arch concept (SDA) and conventional full-arch rehabilitation with removable dental prostheses (RDPs).

METHODS

A randomised controlled clinical trial (RCT) was conducted with partially dentate adults aged 65 years or older. Each patient from the RDP group had all missing natural teeth replaced with cobalt-chromium framework RDPs. Each patient from the SDA group was restored to 10 occluding pairs of natural and replacement teeth using RBB. Patients were followed-up at 6, 12, 24, 36 months. Success rates were generated according to defined success criteria. Log-rank tests and Cox's proportional hazard models were used to compare the success of the two treatment strategies.

RESULTS

After 36 months, 89 patients completed the RCT; n = 45 in the RDP group and n = 44 in the SDA group. The overall success rate of the SDA treatment was 90.4% compared to 73.0% for RDPs (p = 0.005). In the upper arch SDA treatment was 100% successful compared to 86.4% for RDPs (p = 0.019). In the lower arch, lower success rates were reported for both the SDA treatment (80.0%) and RDPs (60.0%) (p = 0.054). Further analyses with cox's proportional hazard models demonstrated that SDA treatment was significantly more successful than RDPs (Hazard Ratio: 2.47, p = 0.04).

CONCLUSIONS

After 36 months SDA treatment using RBB was significantly more successful than RDPs used for conventional full-arch rehabilitation in partially dentate older adults.

CLINICAL SIGNIFICANCE

Functionally orientated treatment according to the principles of the SDA is a feasible alternative to RDPs for partially dentate older patients. SDA treatment using RBB can achieve higher success rates compared to RDPs in this patient group.

Unconscious Racial Bias May Affect Dentists' Clinical Decisions on Tooth Restorability: A Randomized Clinical Trial

METHODS

In this single-center cross-sectional survey, 57 dentists were given a clinical scenario in combination with a patient's relevant clinical photographs and radiographs depicting either a Black or White patient presenting with a decayed tooth and associated symptoms of irreversible pulpitis. Explicit bias was measured through a questionnaire, which evaluated participants' course of treatment, strength of recommendation, and their perception of patients' dental cooperativeness. Implicit bias was evaluated through brief implicit associate tests.

RESULTS

Recommendation for root canal treatment (RCT) in the White patient condition was significantly higher than in the Black patient condition (χ² = 4.77, P < 0.05). Overall, participants were significantly more likely to recommend root canal treatment to White patients (t = 2.46, P = 0.0172) and significantly more likely to recommend extraction for Black patients (t = 3.03, P = 0.0034). In total, 91.23% and 78.95% of all participants displayed high Brief Implicit Association Test race and cooperation scores, respectively, showing a pro-White bias in both categories. This trend was shown to be irrespective of the patient condition.

CONCLUSIONS

Dentists' decision making was affected by the race of the patient, resulting in a greater likelihood of extractions (less RCT) for Black patients presenting with a broken-down tooth and symptoms of irreversible pulpitis.

KNOWLEDGE TRANSFER STATEMENT

The results of this study can be used by clinicians to understand the impact that unconscious racial bias may have on their treatment planning decisions. This information can create awareness, thereby reducing the impact that potential biases can have on the treatment patients receive.

Knowledge, perceptions and clinical application of the shortened dental arch concept among Malaysian government dentists

AIM

To assess the knowledge and perceptions of Malaysian government dentists regarding the shortened dental arch (SDA) concept and its application in clinical practice.

BACKGROUND

The SDA concept refers to a specific type of dentition with intact anterior teeth and a reduction in posterior occlusal pairs. Dentists' knowledge and perceptions of the SDA concept can influence its application in clinical practice.

METHODS

A self-administered questionnaire on the SDA concept was distributed to 326 government dentists in the states of Selangor and Kuala Lumpur, Malaysia. The data were analysed using SPSS version 22 software.

RESULTS

The response rate was 84.0%. The majority of respondents had good knowledge on five of six knowledge items and good attitudes towards 10 of 17 perception items. However, only one-fifth (20.4%) reported having applied the SDA concept in the clinic. A larger number of participants who graduated locally than who graduated abroad perceived that patients <60 years of age, without molar support, can attain acceptable chewing function and that SDA treatment does not lead to loss of occlusal vertical dimension (P < 0.05). A larger number of participants with ≤5 years of work experience than with >5 years of work experience perceived that the SDA concept enables simpler treatment planning (P < 0.05). Finally, a larger number of participants who graduated abroad than who graduated locally observed that patients without molar support had temporomandibular joint problems (P < 0.05).

CONCLUSION

Although Malaysian government dentists have good knowledge and perceptions of the SDA concept, it is not widely applied in the clinic. Concerted efforts in SDA training of dentists are needed to help to shorten denture waiting lists and reduce costs.

Restoration of Endodontically-Treated Posterior Teeth

A case study provides opportunity to discuss treatment planning and the selection of materials and techniques to provide a replacement restoration of an endodontically-treated molar tooth. The discussion highlights treatment options along with the strengths and weaknesses of the alternative approaches to achieving a successful clinical outcome.

Prevalence and Clinical Effects of Certain Therapy Concepts among Partially Edentulous Serbian Elderly

PURPOSE

This study was conducted to identify the prevalence of partially edentulous individuals in Serbia and to identify prosthodontic treatment used for their rehabilitation as well as to compare prosthodontic treatment concepts among Serbian elderly participants who answered closed-format questionnaires.

MATERIALS AND METHODS

The study was conducted at the Clinic for Dental Prosthetics, University of Belgrade, Military Medical Academy and the Department of Prosthodontics of Home Centre Belgrade; the study consisted of 120 participants. A questionnaire with closed-format questions regarding the influence of applied therapy concepts for participants with Kennedy Class I partial edentulism was created. Statistical software SPSS 11.5 was used for data analysis. Chi-square tests were performed, and p-values were calculated for each parameter.

RESULTS

A total of 1081 people were examined; 730 participants were partially edentulous in at least one jaw. Five hundred forty-one participants wore Kennedy Class I maxillary or mandibular removable partial dentures (RPDs). Ninety percent of the patients were restored with RPDs; 60% of participants were unrestored, had shortened dental arches, and requested alternative therapeutic solutions. Significantly lower needs for new treatments were identified in participants with fixed dental prostheses (7.5%).

CONCLUSIONS

Kennedy Class I was the most common type of partial edentulism among Serbian elderly, usually treated with RPDs. Elderly participants with the applied shortened dental arch and RPD therapy concepts requested alternative therapeutic solutions more often than those rehabilitated with fixed partial dentures.

Prosthodontic care for elderly patients

For older patients, clinicians should consider maintaining teeth and using functionally-orientated treatment strategies as an alternative to removable prostheses. When the remaining dentition has a poor prognosis, key teeth should be preserved as overdenture abutments and a gradual transition to edentulousness planned. Where complete dentures are provided, these can be retained using dental implants to overcome many of the problems associated with conventional replacement dentures.

CLINICAL RELEVANCE

The elderly population of today is better informed and more demanding of oral healthcare providers than previous generations. Clinicians should be aware of all the prosthodontic treatment options available for older patients.

Finite element analysis of fixed partial denture replacement

The purpose of this study was to investigate, by means of the finite element method the mechanical behaviour of three designs of fixed partial denture (FPD) for the replacement of the maxillary first premolar in shortened dental arch therapy. Two-dimensional, linear, static finite element analyses were carried out to investigate the biomechanics of the FPDs and their supporting structures under different scenarios of occlusal loading. Displacement and stress distribution for each design of FPD were examined, with particular attention being paid to the stress variations along the retainer-abutment--and the periodontal ligament-bone interfaces. The results indicated that displacement and maximum principal stresses in the fixed-fixed, three-unit FPD were substantially less than those in the two-unit cantilever FPDs. Of the two cantilever FPDs investigated, the distal cantilever design was found to suffer less displacement and stresses than the mesial cantilever design under similar conditions of loading. The highest values for maximum principal stress in the cantilever FPDs were found within the connector between the pontic and the retainer, and within the periodontal ligament and adjacent bone on the aspect of the retainer away from the pontic.

Eruptive tooth movement — the current state of knowledge

How the dentition erupts, and what controls it, is fundamental to almost all aspects of clinical dentistry, yet the mechanisms behind this have not yet been fully elucidated. When the process continues into space that has been created through toothwear or tooth loss, problems in placing restorations can be encountered. This review examines the possible mechanisms of tooth eruption. Differences between processes in animals and humans are highlighted. The limitations of conclusions drawn from animal studies are then discussed with reference to human dental conditions. The differing forms of overeruption in humans are described and the treatment options for overerupted teeth, including prevention of the situation arising, are provided with a discussion of the quality of the evidence base behind these.

A study of the incidence of overeruption and occlusal interferences in unopposed posterior teeth

OBJECTIVES

To determine the incidence and extent of overeruption in unopposed posterior teeth; to determine the incidence of occlusal interferences associated with unopposed posterior teeth; and to detect an association between the extent of overeruption and the presence of occlusal interference.

DESIGN

The study was a single centre clinical retrospective analysis. Setting The setting was in the Combined Care Clinic of Leeds Dental Institute. The patients were undergoing routine restorative care by final year undergraduate dental students during 2000.

SUBJECTS AND METHODS

All patients over18 years of age with one or more unopposed posterior tooth, were invited to participate. A sample group of 120 subjects were recruited. A clinical occlusal examination was carried out and the presence of initial retruded contact position (RCP) contacts and excursive interferences were recorded. Study models were made and digitally scanned.

OUTCOME MEASURES

Measurements of overeruption from the curve of Spee were made from the images obtained, by a single observer. Reliability of the measurements was assessed by means of a Bland Altman Plot. The presence and site of RCP contacts and excursive interferences were recorded by a single observer. Reliability of the measurements was assessed by means of Kappa scores. The association between overeruption and the presence of occlusal interference was examined using Spearmans Correlation Coefficient.

RESULTS

A total of 120 subjects were recruited, with a total of 155 unopposed sites. Eighty-one of the sites belonged to male subjects, 74 to female subjects. The mean age of the group was 50.9 years, Standard deviation 13.9 Eighty-three per cent of sites displayed overeruption (95% CI 78-90), ranging from under 0.5 mm to 5.4 mm. The reliability of the observations was found to be good. A total of 51.6% (95% CI 44-60) of unopposed teeth were involved in RCP contacts or excursive interferences. Thirty-two sites were involved in more than one contact or interference. The intra-examiner agreement was found to be good, using Kappa. The findings of the Spearman's correlation, show that if an association exists between overeruption and occlusal interference, it is weak, and of no statistical significance.

CONCLUSIONS

Eighty-three per cent of unopposed teeth are likely to overerupt, and the extent of the overeruption may be marked. The incidence and extent of overeruption is of clinical significance, not only in terms of treatment planning to prevent undesirable vertical movement, but also in the restoration of the edentulous space. The reliability of observations made in the study was found to be good, justifying the methodology. Fifty-one point six per cent of unopposed teeth are likely to be involved in RCP contacts or excursive interferences. The incidence is of clinical significance when planning the restoration of unopposed teeth, or the associated edentulous space. Only a weak statistical association was demonstrated between the degree of overeruption and the presence of occlusal interferences.