Long-term evaluation of quality of life and satisfaction between implant bar overdentures and conventional complete dentures: A 23 years retrospective study

Full-Arch Rehabilitation With Mucosa-Supported Prostheses Utilizing a Digital Workflow: A Case Report

The advent of digital workflows has revolutionized oral rehabilitation, offering excellent prosthesis and restoration adaptation while reducing work time. This case report aims to describe a full-arch rehabilitation protocol using mucosa-supported prostheses through a digital workflow. The technique begins with scanning the upper jaw and taking an impression of the lower jaw, followed by scanning to create a digital cast. Next, border molding and the final impression of both arches are performed using a closed-mouth technique, during which the patient is guided to perform lateral and protrusive movements. Subsequently, intraoral scanning of the occlusion and both impressions is conducted, leading to the design of the final dentures with the established occlusion. Finally, the dentures are printed in Formlabs resin specifically designed for dentures. The digital workflow facilitates the manufacturing of mucosa-supported full-arch prostheses effectively. This method allows for the adjustment of the vertical dimension of occlusion, ensures excellent adaptation of the prosthesis to the soft tissues, and provides aesthetic satisfaction for the patient. Additionally, it reduces the number of sessions required to install the definitive prosthesis.

Evaluation of safety and efficacy of locally developed dental implants: A noninferiority randomized controlled trial

STATEMENT OF PROBLEM

Various dental implants are available in India, but imported devices are expensive; an affordable locally produced dental implant system would be beneficial.

PURPOSE

The purpose of this noninferiority randomized controlled trial was to compare the safety and efficacy of a locally developed dental implant system to those of an established imported dental implant system with similar microsurface characteristics.

MATERIAL AND METHODS

A total of 136 participants with 201 partially edentulous sites, aged 18 to 65 years, were enrolled in the trial, with 134 sites receiving test implants and 67 sites control implants (n ratio, 2:1). The implants received a delayed submerged healing protocol and were loaded 3 to 6 months after surgery. Maximum insertion torque (IT) was recorded during the implant surgery, and the implant stability quotient (ISQ) was evaluated on the day of surgery and at the second-stage procedure. The mean crestal bone loss (MCBL) was measured on periapical radiographs at prosthetic placement (baseline) and at 6 months and 12 months after loading. The primary measure of outcome was the implant survival rate, and the secondary measure of evaluation was the intergroup difference in MCBL at baseline, 6 months, and 12 months.

RESULTS

A total of 127 test and 61 control implant sites were available for follow-up 1 year after prosthesis placement. At the end of 12 months, the test and control implant groups demonstrated a survival rate of 97% and 100%, respectively. The MCBL difference was significant between the 2 groups at baseline (P<.05). However, at 6 and 12 months, the difference between the test and control groups was not significantly different (P>.05).

CONCLUSIONS

The survival rate of the test group fell within the previously assumed 10% noninferiority margin. Therefore, the null hypothesis was accepted for the trial, and the locally developed implants were noninferior to the imported implants at a sample allocation ratio of 2:1.

Assessment of Quality of Life and Supporting Structures in Implant Retained Mandibular Overdenture: A 5-Year Cohort Study

Aim

To assess oral health-related quality of life (OHRQoL), marginal bone loss (MBL), and changes in soft tissue including probing pocket depth and implant stability in 2 implants retained mandibular overdentures during 5 years follow-up periods.

Methods

Forty completely edentulous patients with age 51-64 years were recruited for that longitudinal cohort study. Complete dentures were performed for all participants. Two implants (3.6 × 11.5 mm) were installed in the canine areas of the mandible. OHRQoL and MBL measures were performed every 1 year for 5 years, while clinical measures were made every 6 months for 60 months. Data were examined using repeated ANOVA and Friedman test.

Results

Thirty-seven patients had 74 implants; with mean age 56 ± 3.6 years; 43% females (n = 16) and 57% males (n = 21) accomplished the study. There were statistically significant differences in OHRQoL, MBL, and changes in soft tissue, including probing pocket depth and implant stability in 2 implants retained mandibular overdentures during 5 years follow-up periods, p ≤ 0.05.

Conclusion

Mandibular overdentures retained by 2 implants provide a positive long-term effect on OHRQoL, MBL, probing pocket depth, and implant stability.

'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.

Patient factors related to early implant failures in the edentulous jaw: A large retrospective case-control study

BACKGROUND

Dental implants provide anchorage for dental prostheses to restore functions for individuals with edentulous jaws. During the healing phase, proper osseointegration is required to prevent early implant failure. More knowledge is needed regarding factors related to early failure of dental implants.

PURPOSE

The aim of the present study was to identify possible risk factors for early implant failure, with respect to anamnestic and clinical parameters.

MATERIALS AND METHODS

All patients with edentulous jaws with early implant failure (n = 408) from one referral clinic were compared with a matched control group (n = 408) with no implant failure. Early implant failure was identified during the first year of prosthetic function. Matching was performed on age, gender, year of surgery, type of jaw, and type of implant surface. In addition, data on anamnestic and clinical parameters were collected. The data were analyzed with a multivariable logistic regression model using early implant failure as the binary outcome.

RESULTS

Five anamnestic factors were statistically significant with respect to higher probability for early implant failure: systemic disease, allergies in general, food allergies, smoking, and intake of analgesic medication. Four clinical conditions (i.e., implants in the opposing jaw, low primary stability, reduced bone volume, and healing complications) were also related to higher probability for early implant failure.

CONCLUSIONS

This study identified nine factors associated with early implant failure, several related to patient's general health. Further investigations are needed to fully understand the causality between the obtained variables and early implant failure.

A Seven-year Follow-up Study of Patient Satisfaction with Three-implant-retained Mandibular Overdentures

PURPOSE: This study aimed to compare patients’ satisfaction with mandibular overdentures retained by three-splinted implants versus conventional complete denture wearers during a 7-year follow-up study period. MATERIALS AND METHODS: Thirty edentulous male patients (mean age: 60 years) were carefully selected and divided into two equal groups. All patients received a new set of complete dentures. Group I patients received three implants in the anterior mandible and were connected after 3 months with bars, clips, and loaded. Group II patients received conventional complete dentures. Patients’ satisfaction was recorded for both groups at 3 weeks (baseline) and after 1, 3, 5, and 7 years. Patients were then asked to grade their overdentures/dentures on a visual analog scale and written questionnaire to evaluate their overall satisfaction. RESULTS: Satisfaction scores of Group I patients were found to be statistically significantly higher than that of Group II patients (p < 0.05) at 3, 5, and 7 years follow-up, meanwhile, no statistically significant difference was found at baseline or after 12 months. CONCLUSION: The long-term results suggest that three-implant-retained mandibular overdenture with a clip-bar attachment appears to be a successful rehabilitation strategy which is superior to conventional dentures for patients with advanced ridge resorption.

Evaluation of Quality of Life and Satisfaction in Patients with Fixed Prostheses on Zygomatic Implants Compared with the All-on-Four Concept: A Prospective Randomized Clinical Study

Purpose: No published research has compared patients’ quality of life and satisfaction with fixed prostheses supported by zygomatic implants with those supported by all-on-four prostheses. The aim of this study was to evaluate patients’ quality of life and satisfaction with fixed prostheses on zygomatic implants compared with the all-on-four concept. Materials and Methods: A total of 80 patients with atrophic edentulous maxillae were randomized into two groups: Group 1 (rehabilitated with fixed prostheses supported by 2–4 zygomatic and 2–4 conventional implants in the anterior region) and Group 2 (fixed prostheses on four implants in the anterior region following an all-on-four concept). One year after placement of the definitive prostheses, patients completed OHIP-14 and satisfaction questionnaires. Results: In all seven domains of the OHIP-14 and in the overall scores, a worse quality of life was found in Group 2 patients, with statistically significant differences between the two groups (p ≤ 0.05). Patients with zygomatic implants were more satisfied with their prostheses, with a statistically significant difference (p < 0.001). Conclusions: According to the results of this study, rehabilitation of patients with edentulous atrophic maxillae with prostheses supported by zygomatic implants combined with anterior implants provided better patient quality of life and satisfaction than prostheses supported by four implants.

Long transmaxillary implants improve oral health-related quality of life of patients with atrophic jaws-a case series

Background

The advancement of contemporary dentistry is related to the improvement of existing techniques, materials, and technology, consistently for improving people’s oral health, which can ultimately reflect better quality of life. This study aimed to evaluate the oral-health-related quality of life (OHRQoL) of patients with atrophic jaws, who reported for the placement of long transmaxillary implants and posterior prosthetic rehabilitation. Twelve patients (n = 12), of both sexes, with a mean age of 55.83 ± 2.78 years, who were unable to receive conventional implants immediately because of lack of bone, received two long transmaxillary implants in a horizontal position, anteroposteriorly, one on each side, from the canine pillar to the maxillary tuberosity. After 6 months, the conventional clinical sequence for fabricating a fixed prosthesis type protocol or removable prosthesis type overdenture (MK1® system) was performed, when required to recover the lip volume. The Oral Health Impact Profile questionnaire (OHIP-14) was applied preoperatively and 6 months after rehabilitation using a prosthesis on the implants. The results were statistically analyzed using a significance level of 0.05.

Results

An improvement in the perception of OHRQoL was observed between the pre- and postoperative periods in the OHIP-14 total score and the domains related to functional limitation, physical pain, psychological discomfort, psychological disability, social disability, and handicap (p < 0.05).

Conclusion

It may be concluded that transmaxillary implant rehabilitation improves the OHRQoL.

Oral Health Related Quality of Life of Patients Using Conventional Dentures versus Implant-Supported Overdentures

Objectives:

This study aimed to compare the oral health related quality of life (OHRQoL) of patients using conventional dentures versus implant-supported overdentures.

Materials and Methods:

This study evaluated the OHRQoL of 90 patients between 35 to 75 years who were selected from several public and private dental clinics in Tehran in 2018. Of all, 45 had conventional dentures of both jaws, and 45 had a mandibular overdenture supported by two implants at the site of mandibular canine teeth and a conventional maxillary denture. The OHRQoL of patients was determined using the Oral Health Impact Prfile-20 (OHIP-20). The questionnaire was translated to Persian, and its content validity and internal consistency were confirmed. Data were analyzed by one-way ANOVA, Mann-Whitney test, and independent t-test.

Results:

In the conventional denture group, 46.7% had good, 46.7% had moderate, and 6.6% had poor OHRQoL. These values were 55.6%, 37.8% and 6.6% in the overdenture group, respectively. Level of education had a significant correlation with the total score of OHIP-20 in both groups (P<0.05). But no significant association was noted between the residential status and gender of patients with different domains of OHRQoL (P>0.05) except for the psychological disability domain, which had a higher mean value in males with conventional dentures (P<0.05).

Conclusion:

Patients with a mandibular overdenture supported by two implants at the site of canine teeth and a conventional maxillary denture had higher OHRQoL than patients with conventional dentures of both jaws.

Four narrow dental implants and conventionally cast bar-supported removable hybrid acrylic complete denture as a therapeutic modality for terminal dentition

The report portrays four narrow implants and cast bar-supported removable hybrid acrylic complete dentures and other terminal dentition treatment options in the maxilla. The therapeutic module could be efficient and satisfactory to patients.

Comparison of psychometric properties of GOHAI, OHIP-14, and OHIP-EDENT as measures of oral health in complete edentulous patients aged 60 years and more

OBJECTIVES

To compare the psychometric properties of three OHRQoL indicators (GOHAI, OHIP-14, and OHIP-EDENT) in a group of complete edentulous subjects and to explore the ability of these instruments to distinguish between individuals with different prosthetic and oral health status.

METHODS

This was a cross-sectional study. Edentulous individuals aged 60 years and more were recruited between January 2019 and February 2020 in a medical and dental care centers. The Lebanese versions of GOHAI, OHIP-14, and OHIP-EDENT were used. External and internal consistencies were assessed using intraclass correlation coefficient (ICC) and Cronbach alpha, respectively. The concurrent validity was evaluated by testing the indicators against a proxy measure of a similar concept. To test their discriminative abilities, the ADD (GOHAI and OHIP) and SC (GOHAI and OHIP) scores were dichotomized according to the 25th and 75th percentile, respectively, and multivariate analyses were performed using sociodemographic, clinical, and subjective health parameters as explanatory variables.

RESULTS

Two hundred and two edentulous subjects (age: 72.94 ± 7.378 years) were included. The proportion of subjects with no impact was lower for OHIP-EDENT (7.9%) compared to GOHAI (28.2%) and OHIP-14 (38.6%). Reproducibility was satisfactory for all OHRQoL tools since they were able to reproduce the results consistently in time (ICC > 0.80). The Cronbach alpha values were greater than 0.8 indicating acceptable internal consistency. The concurrent validity of the three tools was acceptable since subjects with lower OHRQoL score were less satisfied with their dentures and reported a higher need for self-rated therapy. Concerning the discriminant validity, OHIP-EDENT was more discriminant than OHIP-14 and GOHAI, since it was more able to identify patients with poor prosthetic issues or using instable denture.

CONCLUSION

The OHIP-EDENT was more effective in identifying edentulous individuals with oral and prosthetic problems. Our results can help decide which dental instrument to use to assess the perception of oral health in edentulous individuals. More prospective studies are required to compare their evaluative properties.

Evaluation of the quality of life and satisfaction in patients using complete dentures versus mandibular overdentures. Systematic review and meta-analysis

Background

The World Health Organization (WHO) recognizes edentulism as a physical impairment that results in a negative impact in the daily activities.

Objective

The study aimed to compare the satisfaction and the quality of life, in patients treated with implant retained overdentures with two mandibular implants (IOD) against those with mandibular conventional complete dentures (CCD).

Methods

Different search strategies were used to screen for articles in Pubmed/Medline, Cochrane Library and Scielo of the last 17 years (2003–2020). The keywords used were: “quality of life OR satisfaction” AND “complete denture OR conventional denture” AND “overdenture OR implant retained.”

Results

Six articles and two more were added by manual search. The population was 400 in the CCD and 412 for IOD. The mean age was 64.3 ± 6.41 years. The group was comprised of 283 men and 427 women. The scores obtained in the visual analog scale (VAS) before and after the treatment were statistically significant in favor of the IOD for overall satisfaction, (WMD: 12.329; 95% CI: 4.873 to 19.784, p‐value = 0.001), comfort, speech and stability. For esthetics and chewing there was non‐significant improvement while hygiene worsened for the IOD. For the comparison after the treatment between both treatment modalities a statistically significant improvement was found in overall satisfaction (WMD: 14.408; 95% CI: 8.589 to 20.226, p‐value < 0.001), comfort, speech, chewing and stability in favor of the IOD but not in esthetics or hygiene.

Conclusions

This systematic review and meta‐analysis show the superiority of the IOD, despite is not achieved in all aspects.

Retention of removable complete dentures made with different posterior palatal seal techniques and oral health quality of life: A clinical study

STATEMENT OF PROBLEM

How different methods of recording posterior palatal seal affect removable complete-denture retention and oral health quality of life is unclear.

PURPOSE

The purpose of this clinical study was to compare the retention and oral health quality of life (OHIP-14) between conventional and arbitrary posterior palatal seal techniques in participants with removable complete dentures.

MATERIAL AND METHODS

Edentulous patients were recruited according to definitive criteria. The participants were randomly divided into conventional and arbitrary seal. After the delivery of the denture, the retention was evaluated with a force gauge dynamometer and at 3, 6, 9, and 12 months. Denture satisfaction was evaluated with the OHIP-14 questionnaire. Data were statistically analyzed by using the t test and repeated measure ANOVA (α=.05).

RESULTS

The mean ±standard deviation values (N) for conventional seal at 0, 3, 6, 9, and 12 months by dynamometer in the anterior region ranged from 4.73 ±0.78 to 4.90 ±0.81 and in the posterior region between 5.07 ±0.84 and 5.31 ±0.99. Dynamometer values for arbitrary seal in the anterior region were from 4.56 ±0.77 to 4.88 ±0.81, and in the posterior, it varied between 4.74 ±0.74 and 5.15 ±0.81. Force gauge values (N) for conventional and arbitrary seal were in the range of 18.35 ±2.84 to 20.69 ±3.89. The general mean ±SD OHIP-14 was higher for the conventional seal at 3.12 ±0.25 than for the arbitrary seal at 2.73 ±0.23 The difference between the conventional and arbitrary seal techniques was not statistically significant (P>.05) CONCLUSIONS: No significant difference in complete denture retention was detected between the 2 posterior palatal seal techniques. Oral health quality of life was higher with the conventional seal technique.

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.

Multidisciplinary Oral Rehabilitation of a Severely Compromised Dentition

The decision-making process of complex clinical cases should involve multiple specialists to obtain a predictable result on a long-term basis. In view of the above, the present report is aimed at describing the multidisciplinary management of a partially edentulous female patient presenting with a severely compromised residual dentition. To improve function and aesthetics, the treatment combined multiple extractions, temporary rehabilitation with a complete removable denture, guided bone regeneration and implant insertion, soft tissue management, tooth alignment, and restorative dentistry. Thus, several dental branches were embraced during the treatment phases, including oral surgery and implantology, periodontology, orthodontics, and prosthodontics. The involvement of different specialists ensured the achievement of a good result from biological, functional, and aesthetic aspects. The patient was satisfied with the final outcome. In conclusion, to meet the patient's expectations particularly in complex clinical situations, the interdisciplinary approach becomes essential from the early phases in order to identify the ideal treatment plan with the correct time sequence.

Oral Rehabilitation with Zygomatic Implants in a Patient with Cleft Palate

Edentulous patients with an atrophic maxilla associated with lip-palate fissures have unpredictable results after undergoing grafting procedures. In situations where the atrophic maxilla does not adequately allow reconstruction, the use of zygomatic implants has been indicated, and probably these implants can be indicated for the rehabilitation of patients with lip-palate fissures. This case report describes the oral rehabilitation treatment of a patient with a lip-palate cleft treated with zygomatic implants and implant-supported fixed prosthesis with two years of follow-up. A 65-year-old female patient had a lip-palate cleft and previously underwent surgery to close the cleft. The patient had a severely atrophic maxilla and had difficulty adapting to a removable total prosthesis. Due to the small amount of bone remaining and extensive fibrous tissue in the palate region, a rehabilitation with conventional implants associated with zygomatic implants was chosen. Two zygomatic implants and a conventional implant were placed on the right side, and a zygomatic implant and conventional implant were placed on the left side; these implants were later activated by a protocol-type prosthesis. The zygomatic implants provided an adequate aesthetic and functional outcome of the prosthesis in a patient with cleft palate.

Clinical evaluation of inter-implant distance influence on the wear characteristics of low-profile stud attachments used in mandibular implant‑retained overdentures

Background

This study was aimed to evaluate the influence of inter-implant distance on the wear characteristics of low-profile stud attachments used in mandibular implant retained overdentures.

Material and Methods

Forty Completely edentulous participants aged between 50 - 70 years were enrolled in this study. Each patient received 2-implants by 2-stage submerged surgical protocol. Participants categorized into 4-groups. Group I: 19 mm inter-implant distance with Locator retained overdentures; Group II: 19 mm inter-implant distance with OT Equator retained overdentures; Group III: 25 mm inter-implant distance with Locator retained overdentures; Group IV: 25 mm inter-implant distance with OT Equator retained overdentures. The female housings of each attachment were picked up to the mandibular overdenture. 12 month later the male inserts were replaced by new one. The used retentive male inserts were examined by Stereomicroscopic.

Results

Stereomicroscopic examination revealed wear were detected on both inner surface and, the core of male inserts. Comparison between the unused and the used Locator and OT equator retentive male inserts at various inter-implant distance revealed highly significant wear changes between them at either 19 mm, or 25 mm inter-implant distance P1= .000, P2=.000 respectively.

Conclusions

After one year of implant overdenture clinical use; both locator and OT equator retentive male inserts revealed significant surface deformities and wear. Wear were more notable on both locator and OT equator retentive male inserts with 25 mm interimplant distance than with 19 mm interimplant distance. Key words:Inter-implant distance, attachments wear, locator retentive male inserts, OT equator retentive male inserts.

Dental Mesenchymal Stem Cell-Based Translational Regenerative Dentistry: From Artificial to Biological Replacement

Dentistry is a continuously changing field that has witnessed much advancement in the past century. Prosthodontics is that branch of dentistry that deals with replacing missing teeth using either fixed or removable appliances in an attempt to simulate natural tooth function. Although such "replacement therapies" appear to be easy and economic they fall short of ever coming close to their natural counterparts. Complications that arise often lead to failures and frequent repairs of such devices which seldom allow true physiological function of dental and oral-maxillofacial tissues. Such factors can critically affect the quality of life of an individual. The market for dental implants is continuously growing with huge economic revenues. Unfortunately, such treatments are again associated with frequent problems such as peri-implantitis resulting in an eventual loss or replacement of implants. This is particularly influential for patients having co-morbid diseases such as diabetes or osteoporosis and in association with smoking and other conditions that undoubtedly affect the final treatment outcome. The advent of tissue engineering and regenerative medicine therapies along with the enormous strides taken in their associated interdisciplinary fields such as stem cell therapy, biomaterial development, and others may open arenas to enhancing tissue regeneration via designing and construction of patient-specific biological and/or biomimetic substitutes. This review will overview current strategies in regenerative dentistry while overviewing key roles of dental mesenchymal stem cells particularly those of the dental pulp, until paving the way to precision/translational regenerative medicine therapies for future clinical use.