Patient-reported effect in patients receiving implant or tooth-supported fixed prosthesis

Prognosis of Single Implant-Supported Prosthesis in Patients With Primary Sjögren's Syndrome: A Five-Year Prospective Clinical Study

BACKGROUND

Primary Sjögren's syndrome (pSS) is a chronic systemic autoimmune disease characterized by hyposalivation. Currently, there is limited evidence for the prognosis of dental implant treatment in Sjögren's syndrome.

AIM/HYPOTHESIS

We hypothesized comparable clinical outcomes of implant-supported restorations in pSS-patients and control subjects, and improvement in oral health-related quality of life 5 years after restoration.

MATERIAL AND METHODS

Patients with pSS and matched (age, gender, and tooth region) control group were recruited between June 2016 and March 2020. The clinical and radiological examination were performed, and patient-reported oral health impact profile (OHIP-49) questionnaire was used 2 months (baseline), 1, 3, and 5 years after prosthetic treatment.

RESULTS

We included 23 patients with pSS and 24 matched control subjects (all women, mean age: 57.1 years). The overall DMFT (decayed-missed-filled-tooth) was significantly higher (p = 0.008), symptoms of dry mouth were more severe (p = 0.001), and unstimulated and chewing-stimulated saliva flow rates were significantly lower (p < 0.001) in pSS than in control group. All implants survived with no implant mobility. At implant sites, the plaque index and probing depths did not differ (p = 0.301 and 0.446, respectively), but the gingival index was significantly higher (p = 0.003) in pSS than control group. The mean marginal bone loss, prosthetic complications, and clinician-reported aesthetic outcomes were similar in both groups after 5 years. The OHIP scores were significantly higher in the pSS than control group (p < 0.001) but reduced significantly in both groups (p = 0.026).

CONCLUSION

Replacement of missing single teeth with dental implants was successful in patients with pSS 5 years after restoration.

Digital versus conventional prosthetic workflow for dental students providing implant-supported single crowns: A randomized crossover study

STATEMENT OF PROBLEM

Digital scanning has become popular and has been reported to be more comfortable for patients and equally or more accurate than conventional impression techniques. However, clinical evidence to support the advantages of digital scanning is sparse.

PURPOSE

The purpose of this randomized crossover study was to examine and compare the patient and provider perceptions of digital scanning and conventional impression making for implant-supported single crowns (ISSCs) provided by dental students under supervision. Furthermore, the quality and patient-reported outcome of the definitive restorations were compared.

MATERIAL AND METHODS

Forty participants in need of a single tooth replacement were enrolled. Three months after initial implant placement, recordings were made for implant-supported crowns. The participants were randomized into a conventional or a digital group but underwent both procedures. Only the designated impression or scan was sent to the dental laboratory technician to be processed. All participants and students were asked questions concerning which technique they preferred. Furthermore, the participants filled out an oral health impact profile (OHIP-14) questionnaire before and after treatment. The restorations' esthetic and technical quality was evaluated using the Copenhagen Index Score (CIS).

RESULTS

The participants preferred the digital technique (80%) over the conventional technique (2%), while 18% of the participants had no preference. The participants were bothered significantly more (P<.001), experienced significantly more shortness of breath (P<.001), and were significantly more anxious during the conventional impression than during the digital scan (P<.001). Most students also preferred the digital technique (65%) over the conventional technique (22%), and 13% had no preference. The students found that the conventional impression procedure was less time-consuming but more uncertain in comparison with the digital technique. The digital technique was perceived as significantly more impractical than the conventional technique (P<.05). The results from CIS showed no significant difference in the quality of the restorations. Following treatment, the OHIP-14 scores showed a significant drop, suggesting an increase in oral health-related quality of life (P<.001).

CONCLUSIONS

The perceptions of the participants and students of the digital intraoral scanning were significantly better than those of the conventional technique. No significant differences in the quality of the restorations or OHIP scores were observed using the two recording techniques.

Dental implant treatment in patients with cancer on high-dose antiresorptive medication: A prospective feasibility study with 2 years follow-up

OBJECTIVES

Dental implant treatment is considered contraindicated in patients with cancer on high-dose antiresorptive medication (HDAR). The aim of this prospective, feasibility study was to evaluate implant treatment in patients with cancer on HDAR, in terms of implant survival, implant success, and oral health-related quality of life (OHLQoL) after 2 years of loading.

MATERIALS AND METHODS

Implants were inserted in three groups of HDAR patients: (1) Previous tooth extraction, no medication-related osteonecrosis of the jaw (MRONJ), (2) Previous MRONJ, now healed, (3) Existing MRONJ, planned surgical resection. Implants were placed without adjunctive bone or soft tissue argumentation. Abutment operation was performed after ≥12 weeks. Prosthetic treatment was initiated ≥14 weeks. Survival and success rate were determined, and OHLQoL was analyzed with OHIP-49 and QLQ-H&N35 questionnaires. Patients were seen for 6 months, 1- and 2 years follow-up.

RESULTS

Twenty-two patients, 39 implants, completed the implant-based prosthetic treatment. Implant-supported crowns and overdentures were fabricated. Thirteen patients (59%) with 23 implants (59%) completed 2 years follow-up. Overall implant survival and success rate after 2 years of loading were 100% and 97.4%, respectively. OHLQoL for the patients increased in all groups after the treatment, a substantial increase was seen in group 3. Two patients developed MRONJ, but not related to the implant treatment.

CONCLUSION

Dental implant treatment, with high survival and success rate and increased post-treatment OHLQoL, is feasible in HDAR patients after 2 years of loading. Caution with general recommendations should be exercised.

Resin-bonded fixed dental prosthesis versus implant-supported single crowns in the anterior region

BACKGROUND

Different treatment options exist for replacement of an anterior tooth, and as implant-supported single crowns (ISSC) and resin-bonded fixed dental prosthesis (RBFDPs) both are widespread treatment options, it is of clinical relevance to know which treatment modality can be considered superior.

PURPOSE

The purpose of this comparative study was to evaluate the 3- and 5-year survival and failure rate of tooth-supported resin-bonded fixed dental prosthesis compared to implant-supported single crowns. The null hypothesis was that there was no significant difference in survival rate, occurrence of complications or patient-reported outcome between RBFDPs and ISSCs.

MATERIALS AND METHODS

A total of 45 resin-bonded FDPs were inserted in 27 young patients (test group) with tooth agenesis in the anterior part of the maxilla or mandible and a control group of 28 patients also with tooth agenesis in the anterior region but treated with 40 implant-supported single crowns were included in this study. All patients and treatments were followed with a baseline and a 3- or 5-year examination. All patients had to fill out an Oral Health Impact Profile (OHIP-49) questionnaire at baseline and at the 3- or 5-year examination. The restorations were evaluated according to the Copenhagen Index Score (CIS).

RESULTS

For the RBFDP (test) group there was an 82% survival rate and 18% failure rate, that is, four RBFDPs were not in situ after 3 years and four RBFDPs were not in situ after 5 years. Correspondingly, the ISSC showed a survival rate of 98% and a failure rate of 2%, that is, only one failure (ceramic fracture) after 3 and none after 5 years. Of the 82% RBFDPs in situ, there were no complications in 78% of the cases, whereas 22% had complications after 3 (4 complications) and 5 years (4 complications). There were 92% of the ISSCs without any complications and 8% (ie, 3 ISSCs) with complications after 3 or 5 years. In general, there was a significant reduction in the OHIP-49 scores, for example, an improved oral health quality of life for both treatment options.

CONCLUSION

The results of this study indicate that ISSCs have lower complication and failure rates than RBFDPs. In general, the OHIP-scores were significantly reduced regardless of whether RBFDPs or ISSC were used.

Patient-reported outcomes for bone regenerative procedures

Evidence-based dentistry used for decision-making and assessment of treatment includes three components: evidence from the literature, clinical expertise, and patient expectations. Patient satisfaction embraces affability, availability, and ability and can be examined using questionnaires or structured questions to the patient to evaluate patient perception of the treatment. The questions can be quantified using dichotomous, point, or visual analog scales. This would be a straightforward patient-reported outcome measure (PROM). Validated and specific oral health-related quality of life (OHRQoL) questionnaires such as the oral health impact profile (OHIP), oral impact on daily performance (OIDP), or the dental impact on daily living (DIDL) can be used as PROMs, and these measures are appropriate for population studies, where you can measure changes over time and differences between treatment groups. PROMs have shown to enhance patient engagement when integrated into clinical care. PROMs for bone regenerative procedures are mainly used as secondary outcome and are concentrating on the prosthetic outcome more than the pain, discomfort, anxiety, and cost of the surgical procedures. Surprisingly, most patients are satisfied and willing to have the procedures performed again. Whether this is recall bias or not and how the information's from the dentist and the team influence the patients answers to PROMs questionnaires are discussed. The importance of patient perspectives in bone regeneration procedures is obvious and combined with clinical outcome measures, it increases our ability to provide better care. Studies using PROMs as a primary outcome variable are required.

Can patients detect peri‑implant mucosal inflammation? Results from a multicentre randomized trial

PURPOSE

The objective of this study was to compare patient-reported outcomes (PROs) of peri‑implant soft tissue inflammation and aesthetics around single-tooth implants in the anterior maxillary region with three different implant-abutment interface designs.

METHODS

Participants were randomized to one of three different types of implant-abutment interface designs [Conical (CI), flat-to-flat (FI), and Platform Switched (PS)]. Implants and provisional crowns with prefabricated titanium abutments were placed 5 months following extraction and/or ridge augmentation. Permanent ceramic crowns with zirconia abutments were placed after 12 weeks. To assess PROs, appearance and inflammation questionnaires were completed from provisional crown placement to the 3-year follow-up.

RESULTS

Tooth appearance at the 3-year follow-up revealed a difference amongst CI, FI and PS implants (p=0.049; Kruskal-Wallis test). PS was rated better than FI (p=0.047) at 1 year for appearance of soft-tissue and satisfaction with colour. There were no differences for self-consciousness, smile and pain/discomfort while eating/hard food items.

CONCLUSIONS

Although participants tended to rate the health of mucosa around PS implants as slighty better than the other two implant systems, the differences were minimal and inconsistent. Thus, patient satisfaction in terms self-perceived gingival health and esthetics was high for all 3 systems tested, suggesting that patients are unable to detect mucosal inflammation.

CLINICAL SIGNIFICANCE

Patients find it difficult to perceive mucosal inflammation; hence, it is recommended that patients attend implant follow-up visits, even if they do not perceive inflammation. The study suggests that there is a relationship between the PROs and the clinical outcomes of tested implants.

Medication-related osteonecrosis of the jaw and successful implant treatment in a patient on high-dose antiresorptive medication: A case report

OBJECTIVES

Oral rehabilitation can be a challenge in patients on high-dose antiresorptive medication (HDAR), especially if the alveolar anatomy has changed due to previous medication-related osteonecrosis of the jaw (MRONJ) resection. In healthy patients, dental implant treatment has found wide acceptance in prosthetic rehabilitation as it increases the patient's oral health-related quality of life. However, it is considered contraindicated in patients on HDAR due to the risk of MRONJ, although a recent feasibility study indicates that implant treatment may indeed be an option in these patients. The aim of the present case report is to illustrate the risk of MRONJ in a patient with cancer on HDAR and to discuss the reasons behind the outcomes of the implant treatment.

MATERIALS AND METHODS

A patient with prostate cancer with bone metastases on high-dose denosumab therapy with previous MRONJ had four implants inserted bilaterally in the maxilla (14, 13, 23, 24). Two identical implant-supported screw-retained cantilever bridges were fabricated. The patient was followed for more than 1 year.

RESULTS AND CONCLUSION

Peri-implantitis, and/or MRONJ, was diagnosed around two of the implants (23, 24), probably induced by crestal bone trauma from a healing abutment and/or a misfitting prosthetic reconstruction. A peri-implantitis operation was performed, but without the desired response, and the two implants (23, 24) were later removed in an MRONJ resection. The implants on the other side of the maxilla (14, 13) remained without complications. Dental implant treatment is feasible in patients on HDAR, but comorbidities (e.g., diabetes mellitus) and polypharmacy (e.g., chemotherapy and steroids) may add to the risk of implant failure. Minimal trauma surgery and prosthodontics are crucial to increase the chance of successful healing in an HDAR patient.

Patient's perception of timing concepts in implant dentistry: A systematic review

Protocols for implant dentistry, most frequently include periods until healing of the extraction sockets and osseointegration of the implant. Deductional thinking imply that patients would prefer if treatment time in implant dentistry were reduced.

AIM

What is the patient perception of immediate or early implant placement or loading in comparison with traditional, delayed placement, and/or loading assessed by patient-reported outcome measures, as evidenced in randomized controlled clinical trials or prospective controlled studies?

MATERIAL AND METHODS

A systematic review was performed following the PRISMA guidelines with a literature search up to June 30. All hits were imported into Rayyan online software and analyzed by two authors for eligibility. Cochrane RoB2.0 and Newcastle-Ottawa Scale were used to evaluate risk of bias in the individual studies.

RESULTS

Of the initially 1439 articles, 76 underwent full-text analysis and finally 40 articles, representing 35 cohort studies, were included. The quality evaluation demonstrated some concerns among most of the studies.

CONCLUSION

a) There is no strong evidence to support that the time for implant placement or loading of implant-supported single or short-span reconstructions or overdentures influence patients´ discomfort, satisfaction with function or esthetics or overall satisfaction with the implant treatment. b) There is some evidence that studies including edentulous patients rehabilitated with implant-supported full-arch FDPs demonstrate more satisfied patients with immediate than for the early or delayed loaded implant reconstructions after short time, but the difference is not clear one year after treatment.

Material preferences for tooth-supported 3-unit fixed dental prostheses: A survey of German dentists

STATEMENT OF PROBLEM

Different material options are available for fixed dental prostheses (FDPs), but valid data on the favored materials of German dentists for 3-unit FDPs are lacking. It is unclear whether preferences depend on the individual characteristics of the dentists or their dental practices.

PURPOSE

The purpose of this survey was to identify the preferred material selection of German dentists for the fabrication of tooth-supported 3-unit FDPs depending on the location of the abutment teeth and the individual characteristics of the dentist or the dental practice.

MATERIAL AND METHODS

A survey was developed that included questions on the demographic characteristics (sex, area of expertise, age group, time since graduation, number of inhabitants, and the postal code of the dental practice or dental school) of the participating dentist and their preferred materials for the fabrication of tooth-supported 3-unit FDPs. Three clinical scenarios (anterior maxillary FDP, posterior maxillary FDP, posterior mandibular FDP) were presented. The dentists were allowed to select from predefined options or to give a free answer. For comparisons of characteristic associations, the number of inhabitants was chosen to represent the characteristics of the dental practice, and sex and time since graduation were selected to represent the characteristics of the dentist. Group comparisons were conducted with Chi-square tests (α=.05).

RESULTS

A response of 721 dentists from all parts of Germany was received, and data from 688 dentists were included in the analyses. Ceramic was the most preferred material for the fabrication of 3-unit FDPs independent of the location of the abutment teeth with veneered zirconia as the favored option. Metal-ceramic was ranked second. The time since graduation ≤15 years was associated with a preference of ceramic over metal-ceramic for the anterior restoration (P<.001).

CONCLUSIONS

Most participating dentists selected appropriate restorative materials depending on the individual clinical setting presented in the survey. For the anterior 3-unit FDP, time since graduation was associated with the preference for a restorative material. Some dentists selected lithium-X-silicate ceramics for situations beyond their recommended indication range.

The Effect of Patient Specific Factors on Occlusal Forces Generated: Best Evidence Consensus Statement

PURPOSE

The purpose of this Best Evidence Consensus Statement was to search the literature to determine if there is a relationship between patient specific factors and occlusal force.

MATERIALS AND METHODS

A literature review was conducted in the following databases: Evidence-Based Medicine Reviews (EBMR), Cochrane Database of Systematic Reviews, Embase, and Ovid MEDLINE(R) and Epub Ahead of Print. Articles on patient factors and occlusal force were compiled by using a combination of the key words: "bite force," "occlusal force," "partial and complete edentulism," "bruxism," and "orthognathic class." Inclusion criteria included meta-analyses, systematic reviews, randomized controlled trials, case series, and journal articles. Exclusion criteria were case reports, studies in children, animals, and bench studies.

RESULTS

Of the 1502 articles that met the initial search criteria, 97 related to patient-specific factors affecting occlusal forces. These articles were evaluated, rated, and organized into appropriate categories addressing questions of foci.

CONCLUSIONS

The range of occlusal force is highly variable among subjects correlated to patient specific factors such as age, gender, partial and complete edentulism, the presence of a maxillofacial defect, location of edentulous area, orthognathic profile, and magnitude of occlusal vertical dimension. Tooth replacement therapies targeted at increasing occlusal contact seem to have a positive effect on increasing occlusal force. Bruxism does not necessarily demonstrate higher occlusal powering but may have greater tooth contact time. Occlusal force is not clearly affected by the type of dental restoration or restorative material used. The clinical significance of the changes in occlusal forces is yet to be determined.

A Danish version of the oral health impact profile-14 (OHIP-14): translation and cross-cultural adaptation

Background

The Oral Health Impact Profile-14 (OHIP-14) questionnaire assesses quality of life related to people’s perception of oral disorders on their well-being. However, a translated and validated Danish version of OHIP-14 is not yet available.

The purpose of this pilot study was to translate and cross-culturally adapt the English version of the OHIP-14 into Danish (OHIP-14-DK). In addition, to assess its content and face validity, internal consistency and test-retest reliability.

Methods

The English version of OHIP-14 was translated into Danish following a standard protocol of cross-cultural adaptation. Stages I-IV: translation phase to generate a pre-final version “OHIP-14-DK”. Stage V: pre-testing phase. A random sample of 22 orthodontic patients (mean age 24.7 years, SD ±14.8; 14 females, 8 males) were selected at the Section of Orthodontics, Aarhus University, Denmark. All patients self-completed the OHIP-14-DK and were then interviewed to assess its content and face validity. Internal consistency was assessed with Cronbach’s alpha coefficients. All patients completed the same questionnaire again at a one-week interval. Test-retest reliability was assessed using Spearman’s correlation coefficient and intra-class correlation coefficient (ICC).

Results

The initial and back translations were very similar: the OHIP-14-DK proved to have a good level of equivalence with no translation errors or deviations. Furthermore, the OHIP-14-DK seemed well-adapted to Danish culture and was understood by individuals down to 12 years of age. Pre-testing demonstrated good face and content validity; interviews had a response rate of 100% and confirmed that each item was understandable without inducing reluctance or hesitation. Thus, responses were related to their corresponding item. Therefore, no final adjustments were required for the pre-tested version. Cronbach’s alpha for the OHIP-14-DK subscales fell in the 0.75–0.84 range, indicating an adequate-to-good internal consistency. Spearman’s correlation coefficient for the OHIP-14-DK total score was 0.77. The ICC for the OHIP-14-DK total score was 0.91.

Conclusions

The OHIP-14-DK seems well adapted to Danish culture, proved to be face and content valid and also showed good internal consistency and excellent reliability. However, its psychometric properties still need to be tested.

Study registration

Not applicable

Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

This comprehensive review of the 2019 restorative dental literature is offered to inform busy dentists regarding remarkable publications and noteworthy progress made in the profession. Developed by the Scientific Investigation Committee of the American Academy of Restorative Dentistry, each author brings discipline-specific expertise to 1 of 8 sections of the report: (1) prosthodontics; (2) periodontics, alveolar bone, and peri-implant tissues; (3) implant dentistry; (4) dental materials and therapeutics; (5) occlusion and temporomandibular disorders; (6) sleep-related breathing disorders; (7) oral medicine and oral and maxillofacial surgery; and (8) dental caries and cariology. The report targets important information likely to influence day-to-day dental treatment decisions. Each review is not intended to stand alone but to update interested readers so that they may visit source material when greater detail is desired. As the profession moves toward evidence-based clinical decision-making, an incredible volume of potentially valuable dental literature continues to increase. It is the intention of this review and its authors to provide assistance in negotiating the extensive dental literature published in 2019. It is our hope that readers find this work useful in the clinical management of dental patients.

Tooth loss, denture wearing and implants: Findings from the National Study of Adult Oral Health 2017-18

BACKGROUND

We aimed to describe the prevalence of different tooth loss outcomes along with the use of dentures and implants among Australians aged 15+ years across socioeconomic and demographic groups. In addition, we performed time trend analyses of tooth loss.

METHODS

Data from the National Study of Adult Oral Health 2017-18 included gender, age, residential location, household income, Socio-Economic Indexes for Areas, possession of dental insurance and pattern of dental visiting. Outcomes were complete tooth loss, inadequate dentition, average number of missing teeth, denture wearing and implants. We compared our findings with data from previous surveys carried out in 1987-88 and 2004-06.

RESULTS

Tooth loss decreased from 14.4% in 1987-88 to 6.4% in 2004-06, and to 4.0% in 2017-18. The proportion of people with lack of functional dentition halved from 20.6% 1987-88 to 10.2% in 2017-18; the average number of teeth lost due for any reason slightly reduced from 2004-06 (6.1) to 2017-18 (5.7). Tooth loss increased with age and was higher among socioeconomically disadvantaged, uninsured and those with unfavourable pattern of dental visiting groups than in their counterparts.

CONCLUSIONS

An overall improvement in tooth retention was identified over the last decades. However, socioeconomic inequalities persist.