A comparison of implant-retained mandibular overdentures and conventional dentures on quality of life in edentulous patients: a randomized, prospective, within-subject controlled clinical trial

Effect of implant angulation and patrice on the retention of overdenture attachment systems: An in vitro study

PURPOSE

To test the retention of two different overdenture attachment matrices and straight abutments when implants are placed at 0-, 15-, and 30-degree diverging angulations as well as the retention of 15-degree-angled abutments to correct the overall angulation to 0-degrees.

MATERIALS AND METHODS

Matching aluminum blocks were machined to incorporate two dental implants at 0-degree, 15-degree, and 30-degree relative angulations and overdenture attachments to simulate a two-implant overdenture. At 0-degree, 15-degree, and 30-degree implant angulation, straight abutments were studied. At 30-degree implant angulation, an additional group was compared utilizing 15-degree angulated abutments that corrected the overall implant angulation to 0-degrees. A custom-designed testing apparatus that allowed automated insertion and removal of the simulated overdenture was designed, with three independent testing stations, each consisting of one simulated arch and one simulated overdenture base. The baseline and residual retention forces after 30,000 dislodging cycles of the simulated overdenture were measured. One-way ANOVA was used to compare retention differences among different color patrices within the 0-, 15-, and 30-degree implant angulation groups followed by Tukey's multiple comparison test. Two sample t-tests were used to compare 0-degree versus 15-degree implant groups with straight abutments and 30-degree implant groups with straight abutments versus 30-degree implant groups with angulated abutments.

RESULTS

Regardless of implant angulation or abutment correction, the change in retention exhibited by the Novaloc system after testing was not statistically significant for all patrice types (p > 0.05); however, the change in retention exhibited by the Locator system was statistically significant for the tested group (p = 0.0272). In both the Novaloc and Locator systems, the baseline and final retention values provided by the different patrices were significantly different except for the white and green Novaloc patrices in the 15-degree divergent implant group which did not meet the specified level of significance (p = 0.0776).

CONCLUSION

Within the limitations of this study, implant angulations upto 15 degrees do not affect differential change in retention of Novaloc patrices. There is no difference between Novaloc white inserts (light retention value) and green inserts (strong retention values) when implants diverge upto 15 degrees. When Novaloc straight abutments were placed on implants diverging by 30 degrees, blue extra-strong retention inserts outperformed yellow medium retention inserts by maintaining a higher retention value after 30,000 cycles. When utilizing Novaloc 15-degree angulated abutments that correct the overall implant angulation to zero degrees, the red light retentive patrice provides steady retention. Finally, the Locator-green patrice system provides greater retention than the comparable Novaloc-blue patrice combination; however, it also loses more retention after 30,000 cycles.

Comparison of Implant-Retained Overdenture and Conventional Complete Denture: A Survey Study to Measure Patients' Satisfaction and Quality of Life in Dental School Clinics

Patient satisfaction and quality of life are integral to assessing oral health care quality. For many Americans still using conventional complete dentures (CDs) or implant-retained mandibular overdentures (IODs), it remains essential to consider improving their oral health outcomes and quality of life. Due to inexperienced student dentists providing dental care to dental school patients, patient grievances are generally considered a problem. Patient feedback and satisfaction have proven valuable resources for monitoring and improving patient safety. While CDs and IODs are the 2 leading treatment options for edentulism, more comparative studies in the literature need to compare their outcomes in a school setting. The research question that guided this comparative analysis was, "Is patient satisfaction and quality of life affected by the type of prostheses and provider?" A validated questionnaire was mailed to 520 individuals selected from records of patients who had received treatment for edentulous mandible at a student prosthodontic clinic at the University of Kentucky College of Dentistry from 2014 to 2016 with at least 1 year of follow-up time. A validated questionnaire for edentulous patients based on the Oral Health Impact Profile (OHIP-19) was used. In addition, information on patients' oral health-related quality of life, including questions related to the edentulous patients' satisfaction with their dentures, was collected. The response rate was 33% (N = 171). The study's findings confirm previous findings, suggesting that IODs may significantly impact oral health-related quality of life. Data show that 76% of the IOD group reported improvement in experience when using the implants to retain the mandibular denture. However, there were no statistically significant differences in the OHIP scores between overall CD and IOD patient groups. Males with IODs had lower physical pain, limitations, and disability scores than males with CD. However, females with IODs reported more significant concerns associated with a social disability and handicap domains. Comparing users who had experiences with both treatment options, this study discerned essential characteristics that contribute to increased patient satisfaction with IODs and identified significance in outcomes by gender. These findings guide prosthodontic practitioners' patient care practices and identify a continuing need to discuss CD and IOD treatment protocols within dental school curricula.

Stress distribution of one-piece and two-piece mini-Implant overdentures with various attachment systems and diameters: A finite element analysis

PURPOSE

We investigated and compared the stress distribution within one- and two-piece mini-implants for overdentures with three different attachments (ball, Locator, and magnet) and two different diameters using three-dimensional finite element (3D FE) analysis and a monotonic bending test. The goal was to identify the most beneficial implant attachment system design for mini-implant overdentures with a lower risk of implant fracture.

METHODS

Twelve 3D FE models simulating a mandible segment with one- and two-piece mini-implants with different attachment systems, diameters, and overdentures were created using three-dimensional computer-aided design (CAD) software. Vertical and oblique forces (45° to the longitudinal axis of the implant) of 100 N were applied to the dentures. The stress distribution was analyzed. A bending test was performed on a mini-implant (Locator, 2.4 mm) using a testing machine to quantify the load at yield stress.

RESULTS

One-piece mini-implants showed lower maximum stress compared to two-piece mini-implants. Among the three designs, the magnet attachment systems showed the maximum stress. The maximum von Mises stress occurred at the neck of the implants, which was surrounded by cortical bone in all models, and under both loading conditions.

CONCLUSIONS

Focusing on the attachments and one- and two-piece designs of mini-implant overdentures using CAD models to reduce confounding factors affecting the stress distribution, we concluded that one-piece mini-implants tended to show lower stress compared to two-piece mini-implants. Mini-implant overdentures with Locator and ball attachments demonstrated lower stress within the implants compared to those with magnet attachments under vertical and oblique loading conditions.

The Effects of a Mandibular Overdenture on Edentulous Patients' Quality of Life: A Clinical Study

Edentulous patients' quality of life can be greatly diminished by the use of a badly fitting removable prosthesis, as many aspects of social life become notably impaired. The object of this study was to evaluate if treating these patients with a two implants mandibular overdenture could improve their quality of life as measured with the Italian version of the OHIP-14 (Oral Health Impact Profile). Edentulous patients, in good clinical condition, were selected. Two implants were placed following the recommended guidelines and three months after new mandibular dentures were manufactured, implants were uncovered and connected to the prosthesis using LOCATOR abutments. OHIP-14 was measured at baseline, one month after delivery and one year after delivery. An improvement was observed even after one month (with a mean reduction of 17 points in OHIP) and that improvement appeared to be stable at the one-year follow-up. Mandibular overdentures can improve a patient's quality of life when compared to a tissue-supported removable complete denture, as long as the patient is subjected to an appropriate follow-up as the retentive rings of the attachment can deteriorate even after two years and lose a great deal of retentive capabilities.

Treatment of stage IV periodontitis: The EFP S3 level clinical practice guideline

BACKGROUND

The recently published clinical practice guideline (CPG) for the treatment of periodontitis in stages I-III provided evidence-based recommendations for the treatment of periodontitis patients, defined according to the 2018 classification. Stage IV periodontitis shares the severity and complexity characteristics of stage III periodontitis, but includes the anatomical and functional sequelae of tooth and periodontal attachment loss (tooth flaring and drifting, bite collapse, etc.), which require additional interventions following completion of active periodontal therapy.

AIM

To develop an S3 Level CPG for the treatment of stage IV periodontitis, focusing on the implementation of inter-disciplinary treatment approaches required to treat/rehabilitate patients following associated sequelae and tooth loss.

MATERIALS AND METHODS

This S3 Level CPG was developed by the European Federation of Periodontology (EFP), following methodological guidance from the Association of Scientific Medical Societies in Germany and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) process. A rigorous and transparent process included synthesis of relevant research in 13 specifically commissioned systematic reviews, evaluation of the quality and strength of evidence, the formulation of specific recommendations and a structured consensus process with leading experts and a broad base of stakeholders.

RESULTS

The S3 Level CPG for the treatment of stage IV periodontitis culminated in recommendations for different interventions, including orthodontic tooth movement, tooth splinting, occlusal adjustment, tooth- or implant-supported fixed or removable dental prostheses and supportive periodontal care. Prior to treatment planning, it is critically important to undertake a definitive and comprehensive diagnosis and case evaluation, obtain relevant patient information, and engage in frequent re-evaluations during and after treatment. The periodontal component of therapy should follow the CPG for the treatment of periodontitis in stages I-III.

CONCLUSIONS

The present S3 Level CPG informs clinical practice, health systems, policymakers and, indirectly, the public on the available and most effective modalities to treat patients with stage IV periodontitis and to maintain a healthy dentition over lifetime, according to the available evidence at the time of publication.

Effects of conventional complete dentures and implant-supported overdentures on alveolar ridge height and mandibular bone structure: 2-year and 6-year follow-up study

OBJECTIVES

The aim of this study was to compare the changes in mandibular bone structure in edentulous patients who were rehabilitated with conventional complete dentures (CCD) and implant supported overdentures (ISO), by evaluating alveolar bone loss (ABL), panoramic mandibular index (PMI), mandibular cortical width (MCW), gonion index (GI), antegonial index (AI), and articular eminence inclination (AEI).

MATERIALS AND METHODS

Panoramic radiographs of 63 edentulous patients using CCD, 63 edentulous patients using ISO, and 126 patients without tooth loss were evaluated. Edentulous patients had a 2-year and 6-year follow-up panoramic radiograph image. ABL (anterior, premolar, and molar regions), MCW, PMI, AI, GI, and AEI were measured in each patient. Variation between measurements was analyzed using repeated measures ANOVA test and post hoc Tukey test.

RESULTS

Both edentulous groups showed significantly lower mean than without tooth lost group in all measures (p < 0.000). ISO group showed significantly lower mean ABL than CCD group in anterior (p = 0.000), right premolar (p = 0.005), left premolar (p = 0.005), right molar (p < 0.000), and left premolar (p < 0.000) regions in short term. ISO group showed significantly lower mean ABL than CCD group in anterior (p = 0.021), right molar (p < 0.000), and left premolar (p < 0.000) regions in long-term. There is no statistically significant difference between the CCD and ISO groups in right premolar (p = 0.200) and left premolar (p = 0.134) regions in long term. Both edentulous groups showed significantly lower mean MCW (p < 0.000), PMI (p < 0.000), AI (p < 0.000), GI (p < 0.012), and AEI (p < 0.002) than the without tooth loss group. There is no statistically significant difference between the CCD and ISO groups in terms of changes in the mean MCW, PMI, AI, GI, and AEI measurement in short and long term (p > 0.000).

CONCLUSIONS

In the short and long term, edentulism reduced alveolar crest height, MCW, and AEI in individuals, but had no effect on PMI, AI, or GI. The use of prosthesis did not prevent the decrease of alveolar crest height, MCW, or AEI (CCP or ISO). In the short and long term, however, ISO created less ABL in the mandibular anterior and molar regions than CCD.

CLINICAL RELEVANCE

ABL cannot be halted in edentulous people, but by using ISO instead of CCD for rehabilitation, resorption can be reduced.

Impact of rehabilitation versus edentulism on systemic health and quality of life in patients affected by periodontitis: A systematic review and meta-analysis

AIM

To investigate the effect of rehabilitation in fully/partially edentulous patients with stage IV periodontitis on oral-health-related quality of life (OHRQoL) and systemic health.

MATERIALS AND METHODS

A systematic electronic and manual search was conducted. Three authors independently reviewed, selected, and extracted the data. Outcomes were OHRQoL (Oral Health Impact Profile 14 [OHIP-14] and OHIP-49, General Oral Health Assessment Index [GOHAI], visual analogue scale, symptoms registration) and systemic health-related outcomes (incidence and prevalence of systemic diseases, values of systemic disease indicators). Qualitative data were synthesized for OHRQoL and systemic health-related outcomes. Meta-analysis was conducted on available quantitative data.

RESULTS

The search identified 59 articles (6724 subjects in total). OHRQoL improved across all the studies, irrespective of the number of missing teeth, their location, or treatment modality. Meta-analysis showed significant improvement of OHIP-49 (36.86, p < .01) in manuscripts including subjects affected by periodontitis, consistently with the remaining literature (reduction of score points post rehabilitation: OHIP-14 = 10.52, OHIP-49 = 56.02, GOHAI = 5.40, p < .01 for all). Non-rehabilitated subjects exhibited inferior cognitive status, higher medication intake, and frailty. However, our data are limited and should be interpreted with caution.

CONCLUSIONS

Oral rehabilitation improves OHRQoL and, potentially, systemic health in edentulous patients. It is unclear whether these findings may be extrapolated to patients with stage IV periodontitis.

Efficacy of rehabilitation with different approaches of implant-supported full-arch prosthetic designs: A systematic review

AIM

To evaluate the efficacy of different types of rehabilitation with fixed or removable full-arch implant-supported prosthesis designs in terms of implant loss and success in patients with at least one edentulous jaw, with tooth loss mainly due to periodontitis.

MATERIALS AND METHODS

Clinical studies with at least 12 months reporting on implant loss and implant success were searched. Meta-analysis was conducted to estimate cumulative implant loss considering different prostheses designs.

RESULTS

A total of 11 studies with unclear to low risk of bias were included in the analysis. Estimated cumulative implant loss for fixed prostheses within 1 year and 5 years was 0.64% (95% confidence interval [CI]: 0.31%-1.31%) and 1.85% (95% CI: 0.85%-3.95%), respectively. The corresponding values for removable prostheses amounted to 0.71% (95% CI: 0.22%-2.28%) and 4.45% (95% CI: 2.48%-7.85%). Peri-implantitis affected 10%-50% of the patients restored with implant-supported fixed prostheses.

CONCLUSIONS

Based on the limited low-quality data, the present analysis points to a low and similar cumulative implant loss within 1 year for patients with tooth loss mainly due to stage IV periodontitis restored with either removable or fixed implant-supported full-arch prosthesis. At 5 years of functioning, there was a tendency for better outcomes using fixed designs.

Do ball-type attachment systems for overdenture result in better patient-satisfaction? A systematic review of randomized crossover clinical trial

Objective

This review is to compare patient-satisfaction with ball-type overdenture attachment systems with others attachment systems.

Material and methods

This study was registered in PROSPERO (CRD42018097234) and adheres the PRISMA guidelines. Electronic searches on PubMed/MEDLINE, Scopus, Cochrane, and Web of Science databases for published articles were performed before October 2020. The PICO question was: “Do patients with a ball-type overdenture retention system have greater satisfaction, when compared to other attachment systems?” The evaluation of risk of bias was performed using the Cochrane risk of bias tool.

Results

After searching the databases, seven articles were selected out of a total of 2583. A total of 312 implants were placed in 139 patients, with a mean age of 65.9 years. The risk of bias in the included studies varied according to the different domains in a risk of uncertain bias or low bias risk. No difference was found between the ball attachment systems and the others systems, with respect to patient-satisfaction. The meta-analysis revealed no statistically significant difference between the ball systems and another systems (P = 0.11; MD: 10.90; 95% CI: −2.55 to 24.35).

Conclusions

Regarding patient general satisfaction, it was not possible to determine differences between the ball system and another types of attachment system for overdenture. The ball-type system was statistically superior only to the magnet system.

Functional and Patient-Centered Treatment Outcomes with Mandibular Overdentures Retained by Two Immediate or Conventionally Loaded Implants: A Randomized Clinical Trial

This study aims to assess the treatment outcomes (functional and subjective) of mandibular overdentures retained on two implants with or without an immediate loading protocol. In this randomized clinical trial, twenty fully edentulous patients were treated with a mandibular two-implant-retained overdenture and a complete new maxillary denture. In half of the sample, the implants were loaded immediately by means of VulkanLoc^® abutments after emplacement of the implant, but in the counterparts, these VulkanLoc^® abutments were connected to implants two months after the surgery (conventional protocol), and until that time the dentures were retained by healing abutments. Treatment outcomes were assessed at two, six, and twelve months after surgery. Functional outcomes were calculated according to masticatory performance, estimated by the mixed fraction of a two-coloured chewing gum after five, ten, and fifteen chewing strokes, by the occlusal force recorded by pressure-sensitive sheets, and by the bioelectrical muscular activity. The subjective outcomes of the treatment were assessed using both the oral satisfaction scale (visual analogue scale) and the Spanish version of the Oral Health Impact Profile (OHIP-20). The findings of the present study show that new complete dentures resulted in significant improvements in chewing ability, patient satisfaction, and oral health-related quality of life and that subsequent implant-retained overdentures produced further and faster significant improvements. The loading protocol may influence those positive self-reported outcomes rather than the objective functional evaluations.

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.

Immediate implant placement in edentulous oral cancer patients: a long-term retrospective analysis of 207 patients

Although the functional benefits of implants in the rehabilitation of edentulous cancer patients are well-known, most studies report on postponed implant placement. The outcome of immediate implant placement regarding successful rehabilitation, implant loading and survival is unclear. Two hundred and seven edentulous oral cancer patients that received implants during ablative surgery at the Radboud University Medical Centre between 2000 and 2011 were included. Data regarding the oncological treatment, implant placement, follow-up and prosthodontic rehabilitation were recorded retrospectively with a follow-up period of 5-17 years. Functioning implant-retained dentures were made in 73.9% of the patients. Of the surviving patients, 81.9% had functioning dentures after 2 years and 86.3% after 10 years. Patients with ASA score 1 and younger patients were rehabilitated more frequently. The median time of functioning denture placement was 336 days after surgery, with a negative influence of postoperative radiotherapy. Implant survival was 90.7%, and was lower when the implant was placed in a jaw involved in the tumour. Immediate implant placement during oral cancer surgery led to a high number of edentulous patients rehabilitated with implant-retained dentures, which are placed at an early time.

An Innovative Meta-Systematic Review into the Landscape of Literature and the Concluding Evidence on the Quality of Life of Patients Using Two Implant Supported Mandibular Complete Denture Prosthesis

Aim:

The aim of this systematic review is to analyze the existing evidence on the quality of life of patients completely edentulous in the mandible.

Materials and Methods:

A search questionnaire was formulated using population intervention comparison outcome (PICO) analysis, and a comprehensive search was initiated in PubMed Central, Medline, Cochrane, and Google Scholar databases for the related topics. Manuscripts published till December 2019 were included in this review. Out of the 63 articles obtained from searching all databases, 27 studies were excluded based on the title and abstract. Out of the remaining 36 studies, 12 were excluded based on the inclusion and exclusion criteria of our interest and 24 were included on the basis of core data.

Results:

One review author identified randomized trials meeting inclusion criteria for this review. Two review authors extracted data and assessed study quality. The oral health-related quality of life in completely edentulous mandibular patients wearing implant-supported overdentures was better when compared to conventional tissue-supported complete denture, and a minimum two implant-supported mandibular complete denture has sufficient improvement in oral health-related quality of life.

Conclusion:

There are about more than 170 reviews and clinical trials that have been published in support of the same for the past two decades. Thus, the clinicians may not be tempted in placing additional implants in well-formed mandibular edentulous ridges. To enhance the understanding of mandibular implant overdenture treatment, clinicians must scrutinize the existing evidence and formulate a protocol by striking a balance between efficient and evidence based treatment.

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.

Two Years after Loading Performance of Implant-Supported Overdenture with Metal Bar and Low-Profile Attachments: A Prospective Case Series Multicenter Clinical Study

Background. Prosthetic rehabilitation of patients with atrophic arches can be very challenging. Purpose. The aim of the present prospective multicenter study was to report the two-year preliminary data on clinical and radiographic performance of implant-supported overdentures with a metal bar and low-profile attachments. Material and Methods. A computer-aided design/computer-aided manufacturing (CAD/CAM) titanium bar or a conventional cast metal bar was fabricated according to the anatomy of the ridge, prosthetic contours (teeth setup), and implant position. Three to six threadable OT Equator attachments (Rhein 83, Bologna, Italy) were placed along the implant bar. A cobalt-chromium alloy metal framework was fabricated and fitted onto the metal bar as a counterpart. Prosthetic survival rate, biologic and technical complications, peri-implant bone loss, changes in oral health impact profile index, bleeding on probing, and plaque index were reported. Results. Overall, 177 implants were placed (range three to six) to support 43 metal bars with 170 OT Equators (Rhein 83, range three to six). Eleven metal bars were fabricated using CAD/CAM technology, while the other 32 were conventionally produced using cast technique. All the participants were followed up for at least two years (mean 42.2 months, range 24–88 months) after prosthesis delivery. Two maxillary implants failed in one nonsmoking patient (1.1%). The 2-year prosthesis survival rate was 97.7%. Only three minor technical complications were reported. Two years after loading, the mean marginal bone loss was 0.22 ± 0.09 mm (95% CI: 0.16 to 0.26). Two years after loading, OHIP was 22.3 ± 7.1 (95% CI from 17.4 to 24.6). Compared to the baseline, the difference was statistically significant ( $P\le 0.001$ ). At the two-year follow-up session, successful periodontal parameters were experienced. Conclusions. Implant overdenture supported by a CAD/CAM titanium bar may be a reliable option for the treatment of the edentulous arch over a 2-year period. Oral health-related quality of life significantly improved in all treated participants.

Computerised occlusal analysis of mini-dental implant-retained mandibular overdentures: A 1-year prospective clinical study

Occlusal analysis is a substantial tool for the functional improvement evaluation after using implant-retained overdenture comparing to complete denture without dental implant retaining. To evaluate occlusal pattern, chewing force distribution in mini-dental implant-retained mandibular overdentures by computerised occlusal analysis system and to compare patient satisfaction after 1-year function. Thirty-one patients wearing complete dentures were included in the study. Prior to mini-dental implant-retained treatment, all patients were assessed for occlusion and force distribution using computerised occlusal analysis system (T-Scan^® ), and then, all patients received two mini-dental implant-retained mandibular overdentures. Mini-dental implants were immediately loaded using low vertical profile attachments (Equator^® ). T-Scan^® was used to evaluate chewing force and force distribution at 1 day, 3 months, 6 months and 12 months. The patient satisfactions before implant placement and after 1 year were evaluated using questionnaires which included satisfaction of denture quality, psychosocial behaviour and chewing efficiency modified from the validated questionnaires. Clinical evaluation of two mini-dental implant-retained mandibular overdentures showed 100% success rate after 1 year. T-Scan^® demonstrated that maximum occlusal contact force increased continuously. The force distribution; the tooth contact number increased over the period. At 1-year follow-up, overall patient satisfaction was significantly greater than before receiving mini-dental implant treatment (P < .001). Using computerised occlusal analysis, mini-dental implants improve complete denture function significantly in terms of maximum occlusal contact force, tooth contact number without the impairment of force distribution. The oral function of the patients has been enhanced.

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.

Quality of life related to tooth loss and prosthetic replacements among persons with dependency and functional limitations

Objectives: To examine if tooth loss or treatment with different prosthetic replacements are associated with oral health-related or health-related quality of life (OHRQoL or HRQoL) among persons with dependency and functional limitations.Material and Methods: Comparisons between results of questionnaires and clinical data (number of teeth, Eichner index, presence, type, and condition of prosthetic replacements) from a population of 180 individuals with dependency and functional limitations sampled from the register of increased financial support in Norrbotten County, Sweden.Results: The associations between clinical variables and the questionnaire responses were weak overall, e.g. Spearman's rho was 0.162 (p = .033) for correlation between number of teeth and GOHAI, 0.094 (p = .249) for number of teeth and OHIP, -0.070 (p = .356) for complete dentures and GOHAI, and -0.108 (p = .185) for complete dentures and OHIP.Conclusions: The weak associations between clinical variables and questionnaire results in the present study suggest that good results on measured QoL do not necessarily indicate good oral health. As we cannot expect this specific population to report oral disorders by themselves, regular check-ups are necessary.

Implant-Supported Prosthesis for Edentulous Patient Rehabilitation. From Temporary Prosthesis to Definitive with a New Protocol: A Single Case Report

This case study concerns a patient who had lost all of his teeth, needing a rehabilitation with total prosthesis, who went to the dentist looking for help to overcome psycho-physical trauma and to overcome functional and social problems related to being a prosthesis wearer. Tooth loss occurs most in old age, even if it is not a direct consequence of aging. The rehabilitation of oral functions allows the patient to speak, chew, smile and feel confident in his own aesthetics and therefore improve, even a lot, his well-being in social relations. It is very important in oral rehabilitations to evaluate their type and therapeutic timing. This study stems from the idealization of a new protocol to simplify the supported oral rehabilitations. In this manuscript, a patient was considered and shown according to a complete photographical documentation all the phases. Rehabilitation included the use of Osstem (Osstem, Seoul, Korea) and equator type abutments (Rhein83, Bologna, Italy). This manuscript claims to represent the first of a whole series of cases demonstrating the utility of this protocol.

Patient's oral health-related quality of life and satisfaction with implant supported overdentures -a systematic review

Purpose

This systematic review was done to find the patients oral health-related quality of life (OHRQoL) and satisfaction with implant supported overdentures (IODs) when compared to conventional complete dentures (CCDs).

Materials and methods

To identify suitable literature, an electronic search was performed using Medline/PubMed and Cochrane databases. Manual search of Prosthodontics, Gerodontology and journals related to dental implants were also done. Articles published in English and articles whose abstract is available in English were included. The search was focused on patient's oral health-related quality of life and satisfaction with IODs when compared to CCDs.Titles and abstracts were screened, and literature that fulfilled the inclusion criteria was selected for a full-text reading.

Results

Initial literature search resulted in 1803 papers, 1779 were excluded after screenings of the abstracts by the reviewers which resulted in 24 studies. 5 studies were further excluded due to not fulfilling the inclusion criteria, 2 additional articles included after hand searching, resulting in total 21 articles in systematic review. The result suggests that mandibular CCDs had less retention as compared to maxillary conventional dentures CCDs, which improved drastically with IODs and provides a better oral health-related quality of life and satisfaction to the patients.

Conclusion

Retention, stability, comfort, speech and chewing efficiency improved drastically with IODs, with enhanced patient's satisfaction and a better OHRQoL. Patients reported more satisfaction and OHRQoL with mandibular IOD when compared CCDs.

Maxillary implant overdentures retained by use of bars or locator attachments: 1-year findings from a randomized controlled trial

PURPOSE

Comparison of outcomes of maxillary implant overdentures retained by use of either locator attachments or bars in a 1-year randomized controlled trial.

METHODS

Fifty edentulous participants received four maxillary implants. They were allocated to two groups (n = 25) differing in type of prosthetic attachment used to retain the maxillary prosthesis: either locator attachments or bars were applied. After one year, implant and overdenture survival was assessed. Peri-implant hygiene (Plaque-index, presence of calculus), soft tissue conditions (Gingiva-index, Sulcus Bleeding-index and pocket probing depth) and patient satisfaction (oral health impact profile (OHIP-49), denture complaints questionnaire and general satisfaction score (GSS)) were compared. The peri-implant bone level was estimated using intra-oral radiographs (student T-test).

RESULTS

Implant survival was 96.7% in the locator group and 97.9% in the bar group. No overdentures had to be remade. Patient satisfaction was significantly greater in the bar group when rated by OHIP-49 sum score and by GSS. When comparing the denture complaints questionnaire and the separate OHIP-49 item scores, no significant difference was found. There was not a significant difference in hygiene and soft tissue conditions. Marginal bone loss was estimated 0.58 ± 0.71 mm for locators and 0.31 ± 0.47 mm for bars.

CONCLUSIONS

Maxillary overdentures on four implants retained by bars or locators were compared. Bone loss was within an acceptable range for both groups after 1 year. However, less bone was lost in the bar group. Even though both treatment options improved patient satisfaction, bars seem to be particularly beneficial with regard to OHIP-49 sum score.

Social media and orthodontic treatment from the patient’s perspective: a systematic review

Background

Social media are one of the most common and easily accessible ways of gaining information about orthodontic treatment.

Objective

The main objective of this study was to systematically search the literature and determine the various aspects of the interrelationship between social media and orthodontics from the patient’s perspective.

Search methods

Electronic database searches of published and unpublished literature were performed. The reference lists of all eligible articles were hand-searched for additional studies.

Selection criteria

Randomized clinical trials (RCTs), prospective, retrospective, and cross-sectional studies were included.

Data collection and analysis

Study selection, data extraction, and risk of bias assessment were performed individually and in duplicate by the first two authors.

Results

One RCT, three retrospective, and four cross-sectional studies were deemed as eligible for inclusion in this review. The studies included patient’s statements in social media or results from questionnaires given to patients. The social media reported were with order of frequency: Twitter, YouTube, Facebook, Google+, Pinterest, and Instagram. The feelings the patients expressed seemed to be more positive than negative: enthusiasm, self-esteem and pleasure, excitement about the aesthetic result, excitement after braces removal but also antipathy, annoyances, reduced self-esteem, and impatience for removing mechanisms. In addition, one study referred to bullying through Twitter.

Limitations

The high amount of heterogeneity precluded a valid interpretation of the results through pooled estimates.

Conclusions and implications

This systematic review demonstrated that information about orthodontics, how the patient feels, and other psychosocial facets are spread through social media. It is intuitive that research relating to the effects and impact of orthodontic interventions should account not only for the physical impacts of treatment but also to encompass patient-centered outcomes.

Registration

The protocol of this study was not registered in publicly assessable database.

Conflicts of interest

None to declare.

Multicenter Retrospective Analysis of Implant Overdentures Delivered with Different Design and Attachment Systems: Results Between One and 17 Years of Follow-Up

PURPOSE

To analyze implant and prosthetic survival rates, complications, patient satisfaction, and biological parameters of patients rehabilitated with implant overdentures (IOV) on splinted and nonsplinted implants and different attachment systems, in function for one to 17 years.

METHODS

This retrospective study evaluated data collected from patients rehabilitated with implant overdentures between January 2001 and December 2016 in nine different centers. Outcome measures were implant and prosthetic success rates, mechanical complications, marginal bone loss (MBL), oral health impact profile (OHIP), bleeding on probing, and plaque index.

RESULTS

A total of 581 implants were installed in 194 patients. Patients were followed for a mean period of 60.6 months (range 6⁻206). Eighty-nine patients received 296 low profile attachment (OT Equator), 62 patients received 124 ball attachments, and 43 patients received 107 Locator attachments. In eighty-three patients the implants were splinted with computer aided design/computer aided manufacturing (CAD/CAM) or casted bar. At the last follow-up, 10 implants failed in eight patients. Statistical significance was found for failed prostheses (P = 0.0723) and complications (P = 0.0165), with better values for splinted implants. No statistically significant differences were found in proportion of implant and prosthetic failure (P > 0.05). At a five-year follow-up, proportion of complications (P = 0.0289) and failed prostheses (P = 0.0069) were statistically higher for IOV on Locator attachments. No difference was founded in MBL at one- and two-year follow-up between different attachment systems (P > 0.05). Statistically significant improvement in all the OHIP categories was reported in all the patients, after one year of function.

CONCLUSIONS

Implant overdenture showed high implant and prosthetic survival rates, low complications, high patient satisfaction, and good biological parameters in the long-term follow-up. Splinting the implants may reduce number of mechanical complications. Locator attachments showed higher number of complications. Further studies are needed to confirm these preliminary results.

Oral Health-Related Outcomes in Edentulous Patients Treated With Mandibular Implant-Retained Dentures Versus Complete Dentures: Systematic Review With Meta-Analyses

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 &lt; .001), and chewing ability (P &lt; .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.

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.

Effect of implant- and occlusal load location on stress distribution in Locator attachments of mandibular overdenture. A finite element study

PURPOSE

The aim of this study is to evaluate and compare the stress distribution in Locator attachments in mandibular two-implant overdentures according to implant locations and different loading conditions.

MATERIALS AND METHODS

Four three-dimensional finite element models were created, simulating two osseointegrated implants in the mandible to support two Locator attachments and an overdenture. The models simulated an overdenture with implants located in the position of the level of lateral incisors, canines, second premolars, and crossed implant. A 150 N vertical unilateral and bilateral load was applied at different locations and 40 N was also applied when combined with anterior load at the midline. Data for von Mises stresses in the abutment (matrix) of the attachment and the plastic insert (patrix) of the attachment were produced numerically, color-coded, and compared between the models for attachments and loading conditions.

RESULTS

Regardless of the load, the greatest stress values were recorded in the overdenture attachments with implants at lateral incisor locations. In all models and load conditions, the attachment abutment (matrix) withstood a much greater stress than the insert plastic (patrix). Regardless of the model, when a unilateral load was applied, the load side Locator attachments recorded a much higher stress compared to the contralateral side. However, with load bilateral posterior alone or combined at midline load, the stress distribution was more symmetrical. The stress is distributed primarily in the occlusal and lateral surface of the insert plastic patrix and threadless area of the abutment (matrix).

CONCLUSION

The overdenture model with lateral incisor level implants is the worst design in terms of biomechanical environment for the attachment components. The bilateral load in general favors a more uniform stress distribution in both attachments compared to a much greater stress registered with unilateral load in the load side attachments. Regardless of the implant positions and the occlusal load application site, the stress transferred to the insert plastic is much lower than that registered in the abutment.

Comparison of implant supported mandibular overdentures and conventional dentures on quality of life: a systematic review and meta-analysis of randomized controlled studies

BACKGROUND

Conventional complete dentures and implant supported overdentures are commonly used by dentists to treat completely edentulous mandibular arches. There have been problems associated with retention and stability while treating completely edentulous mandibular arches compared to maxillary arches. Many factors have been attributed to this, primarily focusing on the decreased area available for support and increased resorption. Implant supported overdentures have increased the treatment options for resorbed ridges, especially the mandible. However, no reports have proved the superiority of one treatment option over the other, especially in terms of patient-centric outcome measures such as the Oral Health Impact Profile (OHIP). Hence, this meta-analysis was conducted.

METHODS

A literature search of Medline (via PubMed), the Cochrane Central Register of Clinical Trials (CENTRAL) and the Database of Abstracts of Reviews of Effects (DARE) was performed. The reviewers screened titles, abstracts and performed full-text screening of eligible studies. The references from these studies were further screened for additional relevant studies. A random effects model was applied to measure the significance of the per cent mean difference in OHIP scale improvement between implant and conventional dentures. The Cochrane Risk of Bias Tool was applied to assess the selection, ascertainment and selective reporting biases.

RESULTS

Five studies were reviewed and identified. Results of 441 patients (228 implant and 213 conventional) were pooled for analysis of primary outcome and other secondary outcomes. A forest plot of total OHIP scores and for secondary outcomes were obtained between the interventions. Results of 441 patients (228 implant and 213 conventional) were pooled for analysis of primary outcome with a mean difference [95% confidence interval] in the score of -30.72[-48.39, -13.05]; mean difference [95% confidence interval] in the score of -26.45[-43.56, -9.35] for functional limitation; -29.16[-60.89, 2.56] for physical pain; -77.61[-154.63, -0.60] for psychological discomfort; -33.70[-47.96, -19.44] for physical disability; -41.17[-55.93, -26.40] for psychological disability; -17.27[-29.44, 5.10] for social disability; and -28.45[-33.97, -22.92] for handicap. A statistically significant difference favouring the implant group was obtained except for physical pain.

CONCLUSIONS

The implant overdenture group performed better in regard to patient satisfaction as measured using the OHIP questionnaire. Further studies are required to identify superiority between the two treatment options.

Influence of Implant Positions and Occlusal Forces on Peri-Implant Bone Stress in Mandibular Two-Implant Overdentures: A 3-Dimensional Finite Element Analysis

The aim of this study was to evaluate and compare the bone stress around implants in mandibular 2-implant overdentures depending on the implant location and different loading conditions. Four 3-dimensional finite element models simulating a mandibular 2-implant overdenture and a Locator attachment system were designed. The implants were located at the lateral incisor, canine, second premolar, and crossed-implant levels. A 150 N unilateral and bilateral vertical load of different location was applied, as was 40 N when combined with midline load. Data for von Mises stress were produced numerically, color coded, and compared between the models for peri-implant bone and loading conditions. With unilateral loading, in all 4 models much higher peri-implant bone stress values were recorded on the load side compared with the no-load side, while with bilateral occlusal loading, the stress distribution was similar on both sides. In all models, the posterior unilateral load showed the highest stress, which decreased as the load was applied more mesially. In general, the best biomechanical environment in the peri-implant bone was found in the model with implants at premolar level. In the crossed-implant model, the load side greatly altered the biomechanical environment. Overall, the overdenture with implants at second premolar level should be the chosen design, regardless of where the load is applied. The occlusal loading application site influences the bone stress around the implant. Bilateral occlusal loading distributes the peri-implant bone stress symmetrically, while unilateral loading increases it greatly on the load side, no matter where the implants are located.

Oral Health Related Quality of Life and Dental Status of Adult Patients

Background: The aim of this study was to assess the oral health-related quality of life in adult patients who visit the Dental Clinic of the Faculty of Stomatology, Pancevo, using a Serbian version of 14-items Oral Health Impact Profile (OHIP14) Questionnaire. Material and Methods: A total of 89 respondents (42 women and 47 men, mean age 52.83 ± 13.74 years) filled in the questionnaire themselves. Three calibrated dentists recorded the oral health status of the respondents (number of healthy, decayed, filled and missing teeth), the type and time of wearing prosthodontic replacements, if they existed, and assessed the need for prosthodontic treatment. The total OHIP-14 score was calculated by adding scores for all fourteen items; OHIP-14 subscale scores were calculated by adding the scores for the two items in each of the seven subscales. Results: Mean total OHIP score was 10.25 ± 8.89. Patients with less than eight extracted teeth, wearers of fixed prosthodontic appliances and patients without replacements who did not need prosthodontic treatment reported better oral health-related quality of life. The most severe oral impacts assessed by the subscale OHIP14 scores were recorded in psychological discomfort (2.44 ± 2.18), physical pain (1.87 ± 1.73) and psychological disability subscale (1.83 ± 1.88). Women more often than men were dissatisfied with their diet and had been irritable in contact with other people. Conclusion: Further studies using the OHIP14 questionnaire in a larger sample will permit identification of key factors related to poor oral health and planning of treatment protocols and preventive programs for the adult population in Serbia.

Biomechanical effects of implant number and diameter on stress distributions in maxillary implant-supported overdentures

STATEMENT OF PROBLEM

Implant-supported overdentures (ISOs) are considered a good alternative to conventional removable dentures. However, varying rates of failure have been reported in some clinical studies. Excessive stress on surrounding tissues is one of the possible causes of implant failure. As stress is transmitted to the bone through the implant, careful planning, correct number of implants, and implant positioning are keys to ensuring appropriate stress distribution. However, research of the optimal number of implants necessary to support a maxillary ISO is insufficient.

PURPOSE

The purpose of this in vitro finite element study was to determine the optimal implant location, number, and diameter to support a maxillary ISO.

MATERIAL AND METHODS

Three-dimensional models of an atrophic maxilla, dental implants, and ball attachments were modeled, and different loading conditions were applied to simulate realistic conditions. Six models with different numbers and diameters of implants, including mini-dental implants and differently located implants, were formed, and stress values were compared by implementing a finite element analysis.

RESULTS

The study showed that, as the implant number increased, decreased stress values were observed in peri-implant bone and implants in the maxillary ISO prosthesis. However, changes in implant diameter had no significant effect on stresses.

CONCLUSIONS

Increasing the implant diameter was not advantageous; the use of mini-dental implants may be a viable alternative method. However, using 4 implants for maxillary ISOs is indicated.

A comparative study on 7-year results of "All-on-Four™" immediate-function concept for completely edentulous mandibles: metal-ceramic vs. bar-retained superstructures

The study aims to document the clinical outcomes over a 7-year period of two techniques used for the rehabilitation of edentulous mandibles according to the "All-on-Four™" concept: (1) fixed complete-arch prostheses fabricated with metal-ceramic implant-supported fixed prosthesis with a titanium framework and all-ceramic crowns and (2) bar-retained implant-supported removable prosthesis with acrylic resin prosthetic teeth. The study was performed on 32 patients who received immediately loaded "All-on-Four™" fixed mandibular prostheses. (Fixed prostheses with ceramic superstructures, n:16; bar-retained removable acrylic prostheses, n:16). The patients were evaluated for up to 7 years after prosthesis completion. The endpoints included the evaluation of prosthodontic complications, bone resorption, plaque accumulation, bleeding on probing, periodontal probing depth and an oral health impact profile (OHIP). Bone loss remained under 1.2 mm in all of the implants, and no difference was observed between two groups. Plaque accumulation increased gradually in both groups, and the bar-retained acrylic-bearing implants showed significantly higher values during the first 5 years. Immediate improvement was assessed by the OHIP score in both groups. The observed bone loss and the subjective outcomes showed equivalent levels of clinical success for bar-retained and ceramic superstructures over a 7-year period. The higher level of plaque accumulation observed around implants with bar-retained superstructures requires that patients with acrylic superstructures be highly motivated to maintain their personal oral hygiene. Further studies are needed to clarify the occurrence of prosthodontic complications and assess their economic aspects.

Cost-effectiveness analysis of the single-implant mandibular overdenture versus conventional complete denture: study protocol for a randomized controlled trial

Background

Preliminary clinical studies on the single-implant mandibular overdenture (SIMO) have reported favorable results as an alternative to the conventional complete dentures for rehabilitation of the edentulous mandible. Clinical and patient-reported outcomes were assessed but no evidence is available with respect to the cost-effectiveness of this treatment, which is particularly important to test whether the incremental cost associated with the implant treatment is justified facing the benefits from the intervention. Thus, the aim of this study is to assess the cost-effectiveness of single-implant mandibular overdentures.

Methods/design

This randomized clinical trial will include edentulous individuals who meet eligibility criteria. Participants will be randomized into one of the treatment groups: a conventional complete denture group or a single-implant mandibular overdenture group. Direct costs related to therapies in both groups will be identified, measured and valuated for 1 year after treatment. Oral health-related quality of life and satisfaction with the dentures will be the primary outcome variables. Incremental cost-effectiveness ratios will be estimated and graphically presented on cost-effectiveness planes. A Markov decision tree will be constructed to set out the consequences of the competing alternatives. Sensitivity analysis on the most important assumptions will be performed in order to assess the robustness of the model.

Discussion

This is the first trial-based cost-effectiveness study on single-implant mandibular overdentures. Specific challenges in designing the protocol are considered. The expected results are of high clinical relevance and may contribute to the decision-making process when choosing between different alternatives for the rehabilitation of the edentulous mandible.

Trial registration

ClinicalTrials.gov Identifier: NCT02710357, registered on 11 March 2016.

Electronic supplementary material

The online version of this article (doi:10.1186/s13063-016-1646-0) contains supplementary material, which is available to authorized users.

Attitudes towards Prosthodontic Clinical Decision-Making for Edentulous Patients among South West Deanery Dental Foundation Year One Dentists

The aim of this study was to describe Dental Foundation year one dentists’ attitudes towards prosthodontic decision making for edentulous patients, and identify whether there are gender differences in these attitudes. All South West Deanery trainees were invited to take part in the study between May and June 2011 and a previously piloted questionnaire was administered to the trainees by their training programme directors. The questionnaire posed questions based upon a clinical scenario of discussing treatment options with patients. Seventy-two questionnaires were used in the analysis (91% overall response rate). Trainees perceived their own values to be less important than the patient’s values (p < 0.001) in decision making, but similar to the patient’s friend’s/relative’s values (p = 0.1). In addition, the trainees perceived the patient’s values to be less important than their friend’s/relatives (p < 0.001). Sixty-six per cent of trainees acknowledged an influence from their own personal values on their presentation of material to patients who are in the process of choosing among different treatment options, and 87% thought their edentulous patients were satisfied with the decision making process when choosing among different treatment options. Fifty-eight per cent of trainees supported a strategy of negotiation between patients and clinicians (shared decision making). There was no strong evidence to suggest gender had an influence on the attitudes towards decision making. The finding of a consensus towards shared decision making in the attitudes of trainees, and no gender differences is encouraging and is supportive of UK dental schools’ ability to foster ethical and professional values among dentists.

Efficacy of Mandibular 2-implant Overdenture: An Updated Meta-analysis on Patient-based Outcomes

The extent of heterogeneity regarding the efficacy of the mandibular 2-implant overdenture is still in question. The aim of this meta-analysis is to provide an update on the existing evidence from randomized controlled trials assessing the efficacy of the mandibular 2-implant overdenture in regard to patient-based outcomes. Electronic searches were carried out to September 2015 through MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and the Cochrane Systematic Reviews. Only randomized controlled trials that compared conventional dentures with mandibular 2-implant overdentures were included. Patient-based outcomes were assessed, including patient satisfaction and oral health- and general health-related quality of life. Random effects models were used to pool the effect sizes of all included studies. Further stratified analyses and heterogeneity analyses were tested, as was publication bias. In addition to the 7 randomized controlled trials that were included in the previous meta-analysis, 4 new trials were identified and included in this update. A random effects model showed that, when compared with conventional dentures, mandibular 2-implant overdentures significantly improved patient satisfaction (pooled effect size = 0.87, z = 5.31, 95% confidence interval: 0.55 to 1.19, P < 0.0001, χ² = 41.82, df = 8, P < 0.0001, I² = 81%) and oral health-related quality of life (pooled effect size = -0.66, z = 2.72, 95% confidence interval: -1.13 to -0.18, P = 0.007, χ² = 21.26, df = 4, P = 0.0003, I² = 81%). The differences in participant recruitment and their pretreatment condition were important sources of heterogeneity among the studies. Only 1 study investigated the impact of mandibular implant overdentures on perceived general health, and it revealed no between-treatment differences. The 2-implant mandibular overdenture improves patient satisfaction and quality of life for the general edentate population. Health status, poor oral condition, and patient characteristics may effect patient-based outcomes and should be considered by clinicians in treatment planning. Knowledge Transfer Statement: This meta-analysis shows that mandibular 2-implant overdentures are significantly more satisfactory to the general edentate populations than new conventional dentures. The results also show that mandibular 2-implant overdentures provide significantly better oral health-related quality of life than do new conventional dentures. These results should be shared with edentate patients in planning their treatment.

Retrospective Analysis of Implant Overdenture Treatment in the Advanced Prosthodontic Clinic at the University of Illinois at Chicago

The aim of the present retrospective study was to evaluate the clinical outcomes of implant-supported overdenture treatment provided by prosthodontic specialty residents. Twenty-three patients with 25 implant-supported overdentures (IODs) participated in the study. Seventy-four implants were placed by periodontic, prosthodontics, or oral and maxillofacial surgery students. All prostheses were fabricated in the advanced prosthodontics clinic at University of Illinois at Chicago. The condition of the peri-implant soft tissue, implants, and prostheses were evaluated. Complications and any maintenance were documented. Patients completed an oral health impact profile-14 and semantic differential scale questionnaires. Statistical analyses were performed using SPSS statistical software. Twenty mandibular and 5 maxillary IODs were evaluated. Ninety-seven percent of the attachments were locators (Zest Anchors) and 3% ball attachments. None of the implants had lost osseointegration, but 14 implants (19%) had developed marginal bone loss in one-third of the implant length or more. Fourteen (19%) implants had developed dehiscence, which ranged from 1 to 4 mm. A variation in the width of the keratinized tissue, gingival, plaque, and calculus index was observed. There was a statistically significant relationship between the presence of plaque and the bleeding on probing on the buccal aspect of implants (P = .012). The incidence of dehiscence was significantly higher on the midfacial when the keratinized tissue was less than 2 mm (P &lt; .0001). The majority of the complications were prosthetic in nature, such as broken denture teeth (74%) and worn or loose matrices (35%). Debris was observed in 19% of the locator abutments, and 36% of the overdentures were not stable in application of anterior force. Patients were compliant with oral hygiene protocols and their chewing ability was high (mean = 8.0). The overall experience was pleasant (mean = 7.5); the treatment provided good esthetics (mean = 8.3) and great satisfaction (mean = 8.5). From an educational and clinical perspective, IOD therapy has been documented to be a predictable and successful treatment option. Patients should be informed of the required maintenance and the possible complications related to IOD therapy.

Implant treatment in periodontally compromised subjects--quality of life and patient satisfaction

OBJECTIVES

The aims of this study were to determine the quality of life of periodontally compromised patients after implant treatment (primary aim) and their satisfaction with the restoration and treatment approach (secondary aim).

MATERIAL AND METHODS

In this study, 61 adult subjects were evaluated following non-surgical periodontal treatment, under regular maintenance and implant therapy with a fixed restoration. Oral health-related quality of life (OHQoL) was assessed using the German short form of the Oral Health Impact Profile (OHIP-G14). Patient satisfaction with the restoration and treatment procedure was investigated applying a self-designed questionnaire focusing on social-psychological aspects. Statistical analysis of the collected data was performed using Kruskal-Wallis and Man-Whitney U test for the relationship between OHIP score and number of implants, patient age and level of education.

RESULTS

The average OHIP-G14 score of the examined study population was 2.78 (SD ±4.2), while the item pain had the biggest influence on the number of points. No statistical significance was detected between the relationship of OHIP-G14 score and the number of placed implants (p = 0.98). Furthermore, there was no statistically significant correlation between OHIP-G14 score and patient age (p = 0.67) or for level of education (p = 0.39). The questionnaire focusing on patient satisfaction showed a high level of contentment in this study population. All patients declared that they would repeat the treatment and most (98.4%) would recommend it to their friends. Furthermore, a high level of satisfaction with aesthetics, stability, cleanability and speech comprehension was reported.

CONCLUSION

The examined study population showed a quality of life after implant therapy comparable to pre-existing reference values of a healthy non-restored population. There was no statistical significance between OHIP-G 14 score and the number of implants, patients' age and education level. Analysis of the satisfaction with the realized implant therapy provided consistently positive results.

CLINICAL RELEVANCE

When restoring periodontally compromised patients, implant treatment should be considered to achieve potentially higher oral health-related quality of life compared to for example removable dentures. This needs to be investigated in randomized controlled clinical trials.