Comparison of patient satisfaction, quality of life, and bite force between elderly edentulous patients wearing mandibular two implant-supported overdentures and conventional complete dentures after 4 years

Changes in masticatory performance and bite force after treatment with mandibular overdentures retained by four titanium-zirconium mini implants: One-year randomised clinical trial

OBJECTIVE

This prospective study is part of a randomised clinical trial and reports the changes in masticatory performance (MP) and bite force, and explores their influential factors, 1 year after the provision of mandibular overdentures retained by four titanium-zirconium mini implants.

METHODS

Edentulous patients received conventional complete dentures, followed by placement of four mini implants (Straumann® Mini Implant System) in the anterior mandible and converting the conventional prosthesis into a mandibular overdenture. Treatment protocols were randomised using a 2×2 factorial design combining different surgical (flapped vs. flapless) and loading (immediate vs. delayed) protocols. MP was assessed using a two-colour mixing ability test and a colorimetric analysis to measure the level of colour mixing (Variance of Hue-VoH). Maximum voluntary bite force (MBF) was measured by a digital gnathodynamometer in the posterior and anterior regions. Sex, age, surgical and loading protocols and ridge morphology were tested as independent variables. MP and MBF tests were performed at baseline (pre-treatment) and the 3-, 6- and 12-month after implant loading. Descriptive statistics, independent t-test, and linear mixed-effect model (LMM) regression were used for data analysis.

RESULTS

Seventy-four participants were assessed and 73 completed the 1-year follow-up. Statistically significant improvements in functional parameters were observed in all follow-up periods compared to baseline (p < .001). The flapless protocol was associated with higher improvement in MP at the 3-month follow-up (p = .004), while less resorbed ridges were associated with better MP (p = .038) and higher MBF (p < .001).

CONCLUSION

The mandibular overdenture protocol using four titanium-zirconium mini implants was effective in improving MP and MBF of edentulous patients, compared to pre-treatment values. The findings also suggest that improvements in chewing function and bite force are impacted by clinical factors since better outcomes were observed for flapless surgeries and less resorbed edentulous ridges.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.Gov ID NCT04760457.

Prosthodontic Rehabilitation of a Completely Edentulous Patient by Salvaging Ailing Implants Using a Bar Retained Over Denture: A Case Report

Patients who are edentulous experience challenges with their dentures, especially the mandibular ones. The primary concerns of these patients include reduced chewing efficiency, instability, and loss of retention. With the advancement of implants and prosthetic options, these concerns can be addressed by resorting to implant-supported fixed and removable prostheses. The impetuous use of dental implants to solve these issues leads to inadvertent failures in the treatment undertaken. Improper planning of cases leads to prosthesis breakage and implant failures leaving the patient dissatisfied. One such case of rehabilitation of a completely edentulous over-denture patient with ailing implants is described in this clinical report.

Evaluation of bite force, quality of life, and patients' satisfaction in elderly edentulous patients using implant overdentures

Purpose

This study aimed to compare the bite force (BF) between complete dentures and implant overdentures (IODs) retained by two mandibular implants. Additionally, we evaluated the quality of life (QoL) and patient satisfaction among individuals using IODs. In addition, the effects of demographic parameters such as age and sex, and clinical parameters such as implant length, implant diameter, attachment height, attachment color, and interimplant distance on BF, QoL, and patient satisfaction were evaluated.

Materials and methods

A total of 51 edentulous patients rehabilitated with the maxillary complete dentures and mandibular IODs retained by two implants were included in this study. BF was measured using a force meter pre- and post-implant in the same patients. Oral health-related quality of life (OHRQoL) was assessed with the Oral Health Impact Profile (OHIP-14) and patient satisfaction was assessed with the Visual Analog Scale (VAS) questionnaires.

Results

It was found that BF values were statistically higher for IODs than complete dentures (P < .001). In terms of attachment height of the OHIP scores, there was a significant difference in the psychological disability and social disability domains (P < .05). When examining the change in patient satisfaction as a function of sex, it was found that mandibular retention satisfaction differed significantly by sex (P < .05), but there was no significant difference in the other domains.

Conclusion

Within the limitations of this study, it was observed that the BF increased after the use of IODs. Several factors, including age, interimplant distance, attachment height, and attachment color, were found to impact OHRQoL. Sex and implant diameter were identified as factors affecting patient satisfaction.

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.

In situ quantitative assessment of food oral processing parameters: A review of feasible techniques and devices

Oral processing is a combination of various actions, the detailed description of which has always been the subject of relevant research. By means of imaging technology and sensory evaluation, more knowledge of oral processing have been accumulated. Presently, the advances in sensory technology have added quantitative parameters to the qualitative description of oral processing, which also enriched the specifics of each action. Previous studies have shown that oral processing includes lip closure, dental occlusion, masticatory muscles activity, tongue movement, and swallowing, whose processing contains rich information such as the movement of organ and the intensity of organ contacts. "Quantification" was taken in this review as the basic feature of in situ detection information, the relevant parameters and feasible methods for the quantitative description of each activity was recorded in detail. In addition, basic problems and feasible optimization schemes of the existing in situ detection device are also proposed in the hope of promoting the development of in situ detection device thus providing available information for the description of oral processing.

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.

A research of service quality perceptions and patient satisfaction: Case study of public hospitals in Romania

The quality of medical services provided by public hospitals has become a crucial principle in health. Awareness and satisfaction of patients are increasing in pace with technological processes and therapeutic procedures. Therefore, Romania's public hospitals must provide quality to patients and assure medical staff's efficiency and professionalism, a high level of satisfaction, and patient safety. This paper aimed to evaluate patient satisfaction measures used in Romania's Healthcare System. Between January and February 2019, an exploratory study was conducted. Data were collected through face-to-face interviews based on a questionnaire only with patients who used the health system last year. The results showed that only 39.71% of Romanians are satisfied with the quality of medical services, which means that 61.29% of respondents are disappointed by the health system. Because it is free of charge, the public sector is the only option available for a wide range of patients. The study's results may be an essential basis in developing and successfully improving marketing research on the quality of medical services provided through public hospitals especially considering that Romania must improve the health care system perception. Findings suggest that traditional patient satisfaction measures fail, and new ways must be taken into consideration.

Factors associated with edentulous patients' willingness about implant-supported complete denture: a multivariate analysis

OBJECTIVE

The aim of this study was to evaluate the factors influencing edentulous patients' willingness about mandibular implant-supported complete denture.

MATERIALS AND METHODS

A cross-sectional study was carried out with 117 bimaxillary edentulous patients wearing removable complete dentures (CDs). Patients were assessed concerning denture-related items (number of previous mandibular CDs, previous denture wearing period, dentures maker professional, and regular wearing of previous mandibular dentures) and individual-related aspects, such as mandibular edentulousness period, mandibular bone height, and willingness to the use of mandibular implant-supported complete denture. Masticatory performance was evaluated by the median particle diameter. Mandibular bone height and satisfaction were assessed using a validated method. The Chi-square test was used for data analysis and prevalence ratios were adjusted by using multivariate Poisson regression, both with 95% confidence interval.

RESULTS

A total of 78 participants (66.7%) were interested in mandibular implant-supported overdenture (mean age 65.33 ± 9.49). Masticatory performance was not influenced by choosing mandibular implant-supported complete denture. The preference about mandibular implant-supported complete denture was correlated with longer mandibular complete denture experience (p = 0.021) and it was significantly associated with dissatisfaction about retention (p = 0.005).

CONCLUSION

Previous experience with mandibular complete dentures and dissatisfaction about retention influence the willingness about mandibular implant-supported overdenture.

CLINICAL RELEVANCE

Many factors are associated with rehabilitation preferences for edentulous patients and mandibular implant-supported complete denture is one of the available alternatives. Therefore, this study has demonstrated the factors influencing the decision to replace a mandibular conventional complete denture by dental implant treatment based on patient's outcomes. Such finding may be considered as a relevant aspect towards shared decision-making for prosthodontic rehabilitation of edentulous patients.

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.

Reliability and validity of the Turkish version of oral health impact profile for edentulous subjects

Purpose

The validated translations of the OHIP-EDENT exist in different languages; however, there is no reliable and validated Turkish translation. The present study was conducted to evaluate the reliability and to validate the Oral Health Impact Profile in edentulous subjects translated to Turkish (OHIP-EDENT-T).

Materials and methods

The study sample included 104 conventional complete denture wearers (58 women and 46 men, mean age: 61.13 ± 9.43 years). The original English version of OHIPEDENT was translated into Turkish using a forward-backward method and applied to the subjects. The reliability of the OHIP-EDENT-T was evaluated using internal consistency and the test-retest method. Validity was determined as construct and convergent validity. The construct validity of OHIP-EDENT-T was assessed using exploratory and confirmatory factor analysis.

Results

The Cronbach's alpha value for OHIP-EDENT-T was 0.890. The intraclass correlation coefficient (ICC) was 0.749 for the OHIP-EDENT-T total score, and ICCs for the subscales ranged from 0.630 (95% CI = 0.501-0.823) to 0.859 (95% CI = 0.531-0.897), indicating good to excellent agreement. The Kaiser-Meyer-Olkin value for sampling adequacy was 0.820 and results of Bartlett's sphericity test indicated statistical significance (χ2=1139.767; df=171, p=0.001). This showed that factorial analysis could be applied to the data set. The three-factor structure of the scale explained 81.1% of the observed variance. The agreement of the three-factor solution was further tested with confirmatory factor analysis, and the fit index was found to be acceptable (chi-square fit test=1.449, RMSEA=0.040, GFI=0.94, CFI=0.93).

Conclusion

Within the limitations of this study, it can be concluded that OHIP-EDENT-T is a valid and reliable instrument for evaluating the quality of life of edentulous patients.

Bonding between implant attachment pickup materials and CAD-CAM denture base material

STATEMENT OF PROBLEM

Adequate bonding between pickup material and the newer generation of prepolymerized polymethyl methacrylate (PMMA) for computer-aided-design and computer-aided manufacturing (CAD-CAM) dentures is essential to the success of treatment. However, studies on the bond between these 2 materials are lacking.

PURPOSE

The purpose of this in vitro study was to evaluate the bond strength of 3 different chairside implant LOCATOR attachment pickup material groups and prepolymerized PMMA by investigating their pushout force.

MATERIAL AND METHODS

Prepolymerized PMMA, (Lucitone 199) was used as the denture base material. The material was cut into 25×25×5-mm disks, and a Ø6.5-mm hole was drilled into the center of the disks. Six pickup materials from 3 groups were tested: composite resin with bonding agent (N=3, EZ PickUp, Quick Up, and Triad gel), composite resin without bonding agent (N=1, Chairside), and acrylic resin (N=2, Jet denture repair acrylic, and Duralay). All materials were prepared as per the manufacturers' recommendations and were used to fill the center hole. The specimens were left for 48 hours to completely polymerize before testing. Half of the specimens from each material then received thermocycling treatment. All specimens were subjected to axial pushout testing with a universal testing machine.

RESULTS

In the nonthermocycled specimens, Duralay and Jet denture repair acrylic resin showed significantly higher pushout force than that of the other groups (P<.001). Triad gel showed higher pushout force than EZ PickUp and Quick Up (P<.001). Chairside showed the lowest push-out force. The same trend was also observed in the thermocycled specimens. The peak pushout force of nonthermocycled Chairside composite resin was significantly lower than that of thermocycled Chairside composite resin (P=.03). Conversely, the peak pushout force of nonthermocycled EZ PickUp specimens was significantly higher than that of thermocycled EZ PickUp specimens (P=.01). Variation in fracture patterns among groups was observed, and the correlation between pushout force and fracture patterns was recorded.

CONCLUSIONS

Two materials from the acrylic resin group, Jet denture repair acrylic and Duralay, showed higher pushout forces, indicating a better bond with Lucitone 199 CAD-CAM denture base material compared with other tested materials, including composite resin with bonding agent (EZ PickUp, Quick Up, and Triad gel) and composite resin without bonding agent (Chairside).

Evaluation of quality of life and oral hygiene attitudes of individuals using dental prostheses during the COVID-19 pandemic

STATEMENT OF PROBLEM

The COVID-19 pandemic impacted every area of our lives, including delaying urgent dental care. However, studies evaluating how patients using dental prostheses have been affected by the pandemic are lacking.

PURPOSE

The purpose of this study was to investigate how patients using different types of dental prostheses were being affected by the COVID-19 pandemic.

MATERIAL AND METHODS

A total of 129 randomly selected individuals from among those who had been examined in the same clinic before the COVID-19 outbreak were included in the study. The study participants were divided into 4 groups according to their type of prosthesis: complete dentures, implant-retained removable dentures, tooth-supported fixed partial dentures, and implant-supported fixed partial dentures. The Oral Health Impact Profile (OHIP-14) questionnaire was implemented by telephone interviews with the study participants, who were also asked about their concerns and steps made regarding prosthetic hygiene during the COVID-19 pandemic. Data were evaluated by the Kruskal-Wallis and post hoc Dunn tests, and multivariate logistic regression analysis with forward selection was carried out to identify predictors of the oral health-related quality of life (OHRQoL) status (α=.05).

RESULTS

OHIP-14 total scores did not vary significantly among the groups (P>.05). When the domain scores of OHIP-14 were considered separately, the analysis revealed that the implant-retained removable denture group had significantly poorer functional limitations when compared with the tooth-supported fixed partial denture (P=.005) and implant-supported fixed partial denture (P=.031) groups. The results of the multivariate logistic regression analysis indicated a statistically significant association between OHRQoL during the COVID-19 pandemic and the frequency of tooth or denture cleaning (1 time a day versus less than 1 time a day: P=.011; 2-3 times a day versus less than 1 time a day: P=.032).

CONCLUSIONS

All prosthesis users exhibited increased interest in dental hygiene and an increase in the frequency of prosthesis cleaning during the pandemic. Furthermore, the study determined that the frequency of tooth or denture cleaning was associated with significantly improved OHRQoL during the time of the COVID-19 pandemic. Among the denture groups, those treated with implant-retained removable dentures had the poorest functional limitation in terms of OHRQoL, which can be linked to postponement of routine maintenance appointments. Therefore, providing all patients with scientifically sound information on prosthetic care during a pandemic would be highly beneficial.

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.

Effects of immediate and delayed loading protocols on marginal bone loss around implants in unsplinted mandibular implant-retained overdentures: a systematic review and meta-analysis

BACKGROUND

Immediate loading has recently been introduced into unsplinted mandibular implant-retained overdentures for the management of edentulous patients due to their increasing demand on immediate aesthetics and function. However, there is still a scarcity of meta-analytical evidence on the efficacy of immediate loading compared to delayed loading in unsplinted mandibular implant-retained overdentures. The purpose of this study was to compare the marginal bone loss (MBL) around implants between immediate and delayed loading of unsplinted mandibular implant-retained overdentures.

METHODS

Randomized controlled trials (RCTs), controlled clinical trials (CCTs), and cohort studies quantitatively comparing the MBL around implants between immediate loading protocol (ILP) and delayed loading protocol (DLP) of unsplinted mandibular overdentures were included. A systematic search was carried out in PubMed, EMBASE, and CENTRAL databases on December 02, 2020. "Grey" literature was also searched. A meta-analysis was conducted to compare the pooled MBL of two different loading protocols of unsplinted mandibular overdentures through weighted mean differences (WMDs) with 95% confidence intervals (95% CIs). The subgroup analysis was performed between different attachment types (i.e. Locator attachment vs. ball anchor). The risk of bias within and across studies were assessed using the Cochrane Collaboration's tool, the Newcastle-Ottawa scale, and Egger's test.

RESULTS

Of 328 records, five RCTs and two cohort studies were included and evaluated, which totally contained 191 participants with 400 implants. The MBL of ILP group showed no significant difference with that of DLP group (WMD 0.04, CI - 0.13 to 0.21, P > .05). The subgroup analysis revealed similar results with Locator attachments or ball anchors (P > .05). Apart from one RCT (20%) with a high risk of bias, four RCTs (80%) showed a moderate risk of bias. Two prospective cohort studies were proved with acceptable quality. Seven included studies have reported 5.03% implant failure rate (10 of 199 implants) in ILP group and 1.00% failure rate (2 of 201 implants) in DLP group in total.

CONCLUSIONS

For unsplinted mandibular implant-retained overdentures, the MBL around implants after ILP seems comparable to that of implants after DLP. Immediate loading may be a promising alternative to delayed loading for the management of unsplinted mandibular implant-retained overdentures. PROSPERO registration number: CRD42020159124.

Technique for Converting A Fractured Implant Locator Abutment to A Custom Implant Cast Post and Core

This technique article describes an efficient, cost effective and time saving procedure using the fractured abutment as a custom cast post and core when an overdenture abutment is fractured and attempts to retrieve the fractured segment fail.

Effect of Cleanser Solutions on the Retention Force of O'ring Attachment: An in Vitro Study

The aim of this study was to evaluate the effect of cleaning solutions on the retention force of o-ring-type overdenture attachments. The effect of four solutions on nitrile rings were evaluated: Cepacol (C), Cepacol with fluoride (CF), Listerine (L) and 0.05% sodium hypochlorite (SH); deionized water (DW) was used as a control. Matrices containing two implants and abutments and acrylic specimens with the metal capsules were obtained and divided into the groups. A simulation of 90 overnight immersions (8 h) was performed, and the tensile strength value was obtained at the beginning (T0) and in every 30 days (T1, T2 and T3) (n=6). In order to analyze o-ring surface damage after the immersions, a scanning electron microscopy (SEM) was used (n=1). For statistical analysis of the results, analysis of variance (ANOVA) and multiple comparisons with Bonferroni adjustment (test power=1.000; a=0.05) were used. There was a significant difference for the factors time (p<0.001), solution (p<0.001) and for the interaction time × solution (p<0.001). Considering the times of each solution, only for DW there was no significant loss of retention over time. Comparing the solutions in each moment, there was no difference among the solutions in T0. From T1, CF and SH provided less retention than DW (p<0.005). Through SEM it was possible to observe changes in the surface of the CF and SH nitrile o-rings. CF and SH should be avoided due to deleterious action in o-rings.

Evaluation of Bite Force and Masticatory Performance: Complete Denture vs Mandibular Overdenture Users

This cross-sectional observational study with 24 patients evaluated differences in bite force (BF) and masticatory performance (MP) between conventional complete denture (CCD) and implant mandibular overdenture (IMO) users and the correlation between these variables. The BF test was performed bilaterally with an occlusal force device. During the MP test, patients were asked to chew Optocal particles for 40 cycles. The Shapiro Wilk test was employed to verify the normality of the data, the student t test to identify differences between groups, and Pearson's correlation to investigate interrelationships between variables. A multiple linear regression was subsequently performed via the stepwise method. P values ≤0.05 were considered statistically significant. Unlike IMO users, CCD users presented a significant difference (25.6%) in BF between the dominant and non-dominant chewing side (p=0.04). IMO users presented significantly higher BF (p=0.01) without presenting a dominant side (p=0.38), and also performed significantly better for the following MP parameters: MPX50 values decreased by 27.25% in IMO users (p=0.01), MPB decreased by 48.38% (p=0.01), and ME 5.6 decreased by 53.25% (p=0.02), while ME2.8 increased by 151.57% (p=0.01). The BF and MPX50 in the IMO wearers group were negatively correlated (-0.57; p=0.05); this correlation coefficient was the only parameter included in the multivariate regression model. IMO users have higher BF and better masticatory performance than CCD users, especially in terms of chewed particles size reduction. MP is correlated with a higher BF in IMO users through better particle trituration.

Do implant-retained mandibular overdentures maintain radiographic, functional, and patient-centered outcomes after 3 years of loading?

OBJECTIVES

Analyzing whether radiographic, functional, and oral health-related quality of life (OHRQoL) outcomes are maintained over 3 years of implant-retained mandibular overdenture (IMO) function and investigating the bite force associations in the 3rd year of function.

MATERIAL AND METHODS

A longitudinal clinical study in which 24 IMO users were evaluated during a 3-year follow-up period. Patients' posterior area index, masticatory function, OHRQoL and bite force were assessed. The masticatory function parameter ST_X50 reflects the opening through which 50% of the crushed particles would pass, ST_B describes the homogeneity of the bolus, and the masticatory efficiency parameters ME_5.6 and ME_2.8 represent the % of material retained in the 5.6 and 2.8 mm sieves, respectively.

RESULTS

A significant increase in posterior area index (p ≤ .01) was found in all evaluated periods. Minor deteriorations in ST_X50 (p ≤ .01) and ME_5.6 (p ≤ .01) between the 2nd and the 3rd year coincided with improvements in ST_B (p ≤ .01), number of cycles (p ≤ .01), and cycle time (p = .02). The global OHIP-Edent score (p = .02) and the scores in the functional limitation (p = .02), psychological discomfort (p ≤ .01), and handicap domains (p ≤ .01) increased significantly between the 2nd and the 3rd year. Correlations between bite force and cycle time (p = .03) and between posterior area index and ST_X50 (p ≤ .01) and ME_2.8 (p = .02) were also found.

CONCLUSION

Changes in posterior area index, masticatory function, and OHRQoL are still ongoing during the 3rd year of IMO function. Bite force and posterior area index influence the masticatory function outcomes in the 3rd year of IMO function.

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.

Effect of LOCATOR attachments with different retentive forces on the stability of 2-implant-retained mandibular overdenture

STATEMENT OF PROBLEM

The LOCATOR system has been widely used for 2-implant-retained mandibular overdentures (2-MOs), but the influence of different LOCATOR attachments on the stability of 2-MOs has not been assessed.

PURPOSE

The purpose of this in vitro study was to investigate the stability of 2-MOs anchored by LOCATOR attachments with different retentive forces.

MATERIAL AND METHODS

An edentulous mandibular test cast with 2 bone-level implants inserted in the left and right mandibular canine regions was used. Twelve overdentures were then fabricated and anchored on the cast, following the instructions of the LOCATOR system. By replacing inserts of the 12 overdentures, the stability of 3 groups of LOCATOR inserts with different retentive forces was evaluated: blue group, pink group, and transparent group. With artificial saliva used on the cast and overdentures, vertical forces of 40 N, 55 N, and 100 N were loaded on the occlusal surface of the left incisor, left canine, and left molar, respectively. Under each loading condition, the vertical displacements at the loading point and the vertical and horizontal displacements of overdentures at the right distal edge were measured at the same time. One-way ANOVA and the post hoc Tukey honestly significant difference (HSD) test were used to compare the stability of 2-MOs with different LOCATOR attachments (α=.05 for all tests).

RESULTS

When a force of 40 N was applied to the incisor, the largest vertical movement of the incisor loading point appeared in the blue group (P<.05), and the displacements of the pink group showed significant difference from those of the transparent group (P>.05). When 55 N was loaded on the canine, the blue group showed the largest vertical displacements of both the loading point and the right distal edge of the overdentures (P<.05). No significant difference was found in the vertical displacements between the pink group and the transparent group (P>.05). When a force of 100 N was loaded on the molar point, the transparent group indicated a smaller movement in the vertical direction at the edge of the overdentures than the blue group (P<.05) or the pink group (P<.05).

CONCLUSIONS

LOCATOR attachments with different retentive forces had a significant effect on the denture stability of 2-MOs. Compared with the blue inserts, the pink and transparent inserts can offer greater stability for 2-MOs and could therefore be suggested for clinical situations.

Evaluation of two interforaminal implants and implant-assisted removable dentures on stress distribution: an in vitro study

Objectives

In mandibular edentulism, the treatment option with a two-interforaminal implant-retained bridge and a removable partial denture is rarely evaluated in literature. The aim of this in vitro study was to evaluate the stress distribution of this treatment option by comparing it with traditional treatment options with interforaminal implants in the edentulous mandible.

Materials and Methods

Two interforaminal implants were placed in a formalin-fixed cadaver mandible, and overdentures with three different types of attachments were fabricated: (1) two ball attachments and an overdenture, (2) a Dolder bar and an overdenture, and (3) screw-retained two-implant inter-canine porcelain fused to a metal bridge and an implant-assisted removable denture (IARD) with precision attachments. Three biting conditions were generated for each denture type, and the strains were documented under vertical loading of 100 N.

Results

The calculated strain values from measured strains in all measurement sites and loading conditions for the screw-retained two-implant inter-canine porcelain fused to a metal bridge and a cast framework partial denture with precision attachments situation were lower than in the other scenarios (P<0.05).

Conclusion

Within the limitations of the present study, it can be concluded that an IARD may be a reasonable and valuable alternative to ball attachments or a bar in two interforaminal implants, especially when the patients prefer to be able to show their teeth even when they take out their removable dentures.

Cost-effectiveness of implant-supported dental prosthesis compared to conventional dental prosthesis

OBJECTIVE

To conduct a cost-effectiveness analysis of alternatives for rehabilitation treatment of mandibular edentulism in the context of the Brazilian Unified Health System (implant-supported total dental prosthesis versus conventional total dental prosthesis).

METHODS

A Markov model was developed to capture long-term clinical and economic outcomes. The model’s population was comprised of a hypothetical cohort of 1,000,000 patients, aged 55 years, with total mandibular edentulism and without medical contraindications for performing surgical procedures. The adopted analysis perspective was that of the Brazilian Unified Health System. Based on the proposed model, we calculated cost – in BRL, and effectiveness – measured by quality-adjusted prosthesis year (QAPY). The time horizon of the analysis was 20 years.

RESULTS

Considering a 5% discount in costs and effects, the incremental cost-effectiveness ratio of implant-supported total dental prostheses compared to conventional total dental prosthesis (BRL 464.22/QAPY) was lower than the willingness to pay threshold adopted in the model (BRL 3,050.00/QAPY).

CONCLUSIONS

The results of this economic analysis showed that the rehabilitation of mandibular edentulous patients by implant-supported total prosthesis is very cost-effective when compared to conventional complete prosthesis, considering the cost-effectiveness limits employed.

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.

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.

Effect on patient satisfaction of mandibular denture tooth arrangement in the neutral zone

STATEMENT OF PROBLEM

The effect of the neutral zone (NZ) technique on different functional aspects (masticatory performance, speech, and muscle activity) has been studied objectively. Subjectively, some studies reported that their participants felt that NZ dentures were more stable, retentive, and comfortable than conventionally fabricated dentures. These studies, however, lacked a measurable assessment scale or a specifically designed questionnaire.

PURPOSE

The purpose of this within-subject, crossover clinical trial was to investigate patient satisfaction levels in edentulous patients after rehabilitation with dentures fabricated using the NZ concept as compared with conventional dentures using a specific, question-oriented patient satisfaction questionnaire.

MATERIAL AND METHODS

The clinical trial included 52 participants. Each received one set of conventional dentures and another fabricated based on the NZ concept with a 1-month wash-out period. Participants randomly chose 1 of 2 closed opaque envelopes with 2 denture sequences, either conventional then NZ or NZ then conventional. Hence, participants were blinded to the dentures they wore. Patient satisfaction with each denture type was assessed 6 weeks after insertion by a blinded staff member using a 5-scale questionnaire developed for the most important functional aspects (esthetics, masticatory ability, retention, stability, speech, and comfort). The Wilcoxon Signed Rank test was used to compare the satisfaction scores of the 2 denture types (α=.05).

RESULTS

Patient satisfaction scores were significantly higher with the NZ dentures than with the conventional dentures in all aspects; P=.001 for question 2 (opinion of denture appearance) and P<.001 for all other questions.

CONCLUSIONS

NZ dentures offer significantly higher levels of patient satisfaction than conventional dentures in all functional aspects (retention, stability, masticatory ability, and speech) as well as in comfort and appearance.

The Impact of Replacement Conventional Dentures on Eating Experience

Introduction:

Despite much research on the impact of edentulism and prosthetic rehabilitation on food and nutrient intake, there is little information on how replacing complete dentures affects social and emotional issues around eating.

Objectives:

To investigate, in a cohort study, how replacing conventional complete dentures affects eating-related quality of life (ERQoL). A secondary aim was to test the responsiveness of an Emotional and Social Issues Related to Eating (ESIRE) questionnaire to change in ERQoL.

Methods:

Participants, recruited from the Dental Hospital, Newcastle-upon-Tyne, UK, completed the self-administrated ESIRE questionnaire before and after provision of new conventional complete dentures. Paired t test was used to determine any change between pre- and posttreatment ESIRE scores, which can range from 0 (poor) to 100 (excellent). Cohen’s d effect size was used to measure the magnitude of change in ERQoL. Standardized response mean (SRM) was used to measure the responsiveness of the ESIRE questionnaire to changes in ERQoL.

Results:

Fifty-five participants aged 52 to 85 y (mean, 72 y), including 21 males (42%) and 29 females (58%), completed the study. A statistically significant improvement in the total ESIRE scores was found, mean (SE) +20.3 (3.30), P < 0.001. Equally, all domains of the ESIRE questionnaire showed significant improvements: enjoyment of food/eating, +27.3 (3.63), P < 0.001; self-consciousness/embarrassment, +18.1 (3.88), P < 0.001; interruption to meals, +13.3 (5.27), P < 0.05; confidence when eating, +18.7 (4.84), P < 0.001; time for eating/preparation of meals, +18.5 (4.85), P < 0.001); and functional ability to eat, +18.2 (3.67), P < 0.001). Cohen’s d was large (0.95) for the total score and ranged from medium (0.37) to large (1.30) for all domains. Value of SRM was large (0.87) for the total score and ranged from medium (0.36) to large (1.1) for all domains.

Conclusion:

Denture replacement can directly improve ERQoL. The ESIRE questionnaire was responsive to clinically important changes in ERQoL.

Knowledge Transfer Statement:

The results of this study improve the understanding of the impact of denture replacement on eating-related quality of life (ERQoL). Clinicians are encouraged to pay more attention to the impact of wearing conventional complete dentures on social and emotional issues around eating. The findings should motivate clinicians and inspire specialists in prosthodontics and oral rehabilitation to continue providing conventional complete dentures as a suitable treatment option for edentulous patients.

A Novel Extended Range Attachment System to Retain Implant Overdentures: A Clinical Report

Various attachment systems have been used to facilitate the retention, stability, and support of overdentures. The low profile design, pivoting technology, and durability of the Locator attachment made it one of the commonly used tissue-supported implant-retained overdentures. It has been successfully used to retain overdentures as well as partial dentures. This article describes the uses of the new Locator R-Tx abutment and illustrates both the direct and indirect techniques used to process the denture attachment housing into the prosthesis to retain overdentures and partial dentures.

Impact of crestal bone resorption on quality of life and professional maintenance with conventional dentures or Locator-retained mandibular implant overdentures

STATEMENT OF PROBLEM

The influence of the mandibular resorption profile on clinical outcome after converting a conventional complete denture into a Locator-retained implant overdenture is unknown.

PURPOSE

The purpose of this prospective study was to assess the oral health-related quality of life (OHRQoL) and prosthetic maintenance of mandibular overdentures on 2 Locator abutments in relation to the resorption degree of the edentulous mandible.

MATERIAL AND METHODS

Twenty-five participants were treated and classified according to the Cawood and Howell (CAW-H) resorption classification for the resorption profile of the mandible, CAW-H group III-IV (n=14) and CAW-H group V (n=11). Participants received conventional complete dentures (CDs) before implant placement and immediate nonfunctional loading on Locators with a resilient liner. After 3 months, the attachments were functionally activated. Assessments were made using the Oral Health Impact Profile 14 (OHIP-14) questionnaires with existing CDs and new CDs at 1, 3, and 15 months after loading. Prosthetic maintenance (repairs, rebasings, replacement of retention parts) and biological prosthetic aftercare were assessed. For comparison between groups, the Kruskal-Wallis and Mann-Whitney U tests were applied for continuous and ordinal variables and the chi-square test for cross-tabulations. To analyze repeated OHIP-14 scores, the Friedman test was used for ordered alternatives to test whether the measurements differed (overall significance level α=.05). Then the Wilcoxon signed rank test was conducted to detect specific differences (α=.05).

RESULTS

OHIP-14 scores decreased significantly after implant placement and functional connection for the whole population (P<.001) and for both sub groups, the CAW-H group III-IV (P<.001) and the CAW-H group V (P=.013). CAW-H group V participants needed more retention inserts than CAW-H group III-IV participants (26 versus 3, respectively; P=.006). The incidence of repair and rebasing was limited for both groups, and biological aftercare and pain relief were comparable.

CONCLUSIONS

Changing a CD to an overdenture significantly improved ORLQoL regardless of the resorption degree, but heavily resorbed mandibles require more replacements of retention inserts.

Mandibular Implant-supported Overdentures: Prosthetic Overview

Implant-supported overdentures are becoming the treatment of choice for the completely edentulous mandible. They significantly improve the quality of life in edentulous patients. For this review article, the literature was searched to identify pertinent studies. No meta-analysis was conducted because of high heterogeneity within the literature. Accordingly, in this review article, the author provides an update on implant-supported mandible overdentures with regard to the number of implants, type of loading, stress-strain distribution, mode of implant-to-denture attachment, occlusal considerations and complications.

Electromyography evaluation of masseter and temporalis, bite force, and quality of life in elderly patients during the adaptation of mandibular implant-supported overdentures

OBJECTIVES

The aim of this study was to investigate the outcomes of the installation of two implant-supported overdentures until such treatment is complete. Although this treatment is well established in the literature, there are no studies comparing what happens to muscles and the quality of life (QoL) of patients during the treatment.

METHODS

We selected 13 completely edentulous patients, according to inclusion and exclusion criteria, to rehabilitate with mandibular overdentures retained by two dental implants and a complete denture as antagonists. We evaluated the efficacy of the treatment and its evolution in five steps: (i) initially, with the old complete dentures, (ii) after the implants' placement with the mandibular prosthesis relined, (iii) after the placement of the healing abutments, (iv) after the installation and adaptation of new prostheses, and (v) after a 3-month follow-up period. At each stage, we evaluated patients via temporal and masseter electromyography (EMG), molar and incisive bite force, and QoL.

RESULTS

The results for EMG found a decrease in muscle activity during rest, the mastication of raisins, and lateral movements when the overdentures were installed. For the bite force and QoL, there was a gradual improvement from the placement of the healing abutments period (P ˂ 0.05), which was sustained until the follow-up.

CONCLUSIONS

Comfort and stability improved during the treatment, demonstrated by the QoL and bite force results. These results are positive for elderly patients who might refuse an implant-supported overdenture due to treatment length.

Biomechanics of oral mucosa

The prevalence of prosthodontic treatment has been well recognized, and the need is continuously increasing with the ageing population. While the oral mucosa plays a critical role in the treatment outcome, the associated biomechanics is not yet fully understood. Using the literature available, this paper provides a critical review on four aspects of mucosal biomechanics, including static, dynamic, volumetric and interactive responses, which are interpreted by its elasticity, viscosity/permeability, apparent Poisson's ratio and friction coefficient, respectively. Both empirical studies and numerical models are analysed and compared to gain anatomical and physiological insights. Furthermore, the clinical applications of such biomechanical knowledge on the mucosa are explored to address some critical concerns, including stimuli for tissue remodelling (interstitial hydrostatic pressure), pressure–pain thresholds, tissue displaceability and residual bone resorption. Through this review, the state of the art in mucosal biomechanics and their clinical implications are discussed for future research interests, including clinical applications, computational modelling, design optimization and prosthetic fabrication.

Small-diameter titanium Grade IV and titanium-zirconium implants in edentulous mandibles: three-year results from a double-blind, randomized controlled trial

OBJECTIVE

The aim of this study was to compare crestal bone-level changes, soft tissue parameters and implant success and survival between small-diameter implants made of titanium/zirconium (TiZr) alloy or of Grade IV titanium (Ti) in edentulous mandibles restored with removable overdentures.

MATERIALS AND METHODS

This was a randomized, controlled, double-blind, split-mouth multicenter clinical trial. Patients with edentulous mandibles received two Straumann bone-level implants (diameter 3.3 mm), one of Ti Grade IV (control) and one of TiZr (test), in the interforaminal region. Implants were loaded after 6-8 weeks and removable Locator-retained overdentures were placed within 2 weeks of loading. Modified plaque and sulcus bleeding indices, radiographic bone level, and implant survival and success were evaluated up to 36 months.

RESULTS

Of 91 treated patients, 75 completed the three-year follow-up. Three implants were lost (two control and one test implant). The survival rates were 98.7% and 97.3%, and the mean marginal bone level change was -0.78 ± 0.75 and -0.60 ± 0.71 mm for TiZr and Ti Grade IV implants. Most patients had a plaque score of 0 or 1 (54% for test and 51.7% for control), and a sulcus bleeding score of 0 (46.1% for test and 44.9% for control). No significant differences were found between the two implant types for bone-level change, soft tissue parameters, survival and success.

CONCLUSIONS

After 36 months, similar outcomes were found between Ti Grade IV and TiZr implants. The results confirm that the results seen at 12 months continue over time.

Geriatric prosthodontic care

The geriatric population (age 65 and older) is the fastest growing segment nationally and globally. The large population will continue to increase because of baby boomers that have recently turned 65 years old. Within this cohort, there is much diversity in health, socioeconomic levels, education, and health beliefs. There is a decline in edentulism yet still there are oral health conditions that persist with age, such as caries, tooth loss, and increased needs for prosthodontic dental treatment. Several factors should be taken into account in geriatric prosthodontic care, including quality of life and psychosocial needs.

Quality of Life of Patients Treated With Implant-Supported Mandibular Overdentures Evaluated With the Oral Health Impact Profile (OHIP-14): a Survey of 58 Patients

Objectives

The purpose of this study was to evaluate the oral health-related quality of life of patients treated with implant-supported mandibular overdentures and to compare the attachment systems used.

Material and Methods

Altogether 112 patients treated with implant-supported mandibular overdentures in 1985 - 2004 were invited to the follow-up; 58 of them attended and replied to the Oral Health Impact Profile (OHIP-14) -questionnaire. There were 48 overdentures with a bar connection and 10 with a ball connection, the total number of implants installed and still in use was 197. The mean follow-up time was 13.7 years. The associations between the OHIP-14 variables and the patient's age, gender as well as the number of implants supporting the overdenture and the type of attachment used were assessed.

Results

The results showed that patients with implant-supported mandibular overdentures were satisfied with their oral health-related quality of life (OHRQoL). Older patients were more satisfied than younger ones in both genders. Neither the implant connection type nor the number of supporting implants seemed to have a significant influence on the OHRQoL.

Conclusions

Especially older patients with mandibular implant-supported overdentures were satisfied with their oral health-related quality of life. Attachment type or the number of supporting implants did not have a significant influence on the oral health-related quality of life.