The Potential Role of Dental Patient-Reported Outcomes (dPROs) in Evidence-Based Prosthodontics and Clinical Care: A Narrative Review

Mandibular overdenture retained by four one-piece titanium-zirconium mini implants: A 2-year RCT on patient-reported outcomes

AIM

The positive impact of implant interventions on dental patient-reported outcomes is an essential parameter of treatment effectiveness. This study assessed the 2-year changes in patient satisfaction and oral health-related quality of life (OHRQoL) of edentulous patients treated with a four mini implant mandibular overdenture (IOD) METHODS: The study was planned as a 2 × 2 factorial randomized clinical trial that tested two surgical approaches (flapped or flapless) and two loading protocols (immediate and delayed) using a titanium-zirconium mini implant (Straumann Mini Implant System®) and a PEEK retentive system (Straumann® Optiloc® Retentive System). Outcome measures (OHIP-Edent scores and the McGill Denture Satisfaction questionnaire) were assessed before treatment and at the 3-, 6-, 12-, and 24-month follow-ups. The Friedman test and multiple regression using Generalized Estimating Equations (GEE) were used for data analysis, considering the per-protocol (PP) and intention-to-treat (ITT) approaches RESULTS: Seventy-four patients were randomized to the study groups. No implant failure occurred during the study period. Marked improvement in all post-treatment periods compared to baseline were observed for the two outcomes. No significant effect of patient's gender, age, and surgical protocol on the study outcomes. The effect of treatment provision was significant for the two outcomes in the PP and ITT approaches (p < 0.001). A barely significant positive effect of the immediate loading was observed for OHIP-Edent in the PP approach (p = 0.020) CONCLUSION: IOD treatment significantly improved patient-reported outcomes measures, with sustained benefits over the two years of overdenture use, and can be considered a promising treatment option in for the edentulous mandible.

Evaluating and improving the usability of a mHealth platform to assess postoperative dental pain

Objectives

The use of interactive mobile health (mHealth) applications to monitor patient-reported postoperative pain outcomes is an emerging area in dentistry that requires further exploration. This study aimed to evaluate and improve the usability of an existing mHealth application.

Materials and methods

The usability of the application was assessed iteratively using a 3-phase approach, including a rapid cognitive walkthrough (Phase I), lab-based usability testing (Phase II), and in situ pilot testing (Phase III). The study team conducted Phase I, while providers and patients participated in Phase II and III.

Results

The rapid cognitive walkthrough identified 23 potential issues that could negatively impact user experience, with the majority classified as system issues. The lab-based usability testing yielded 141 usability issues.; 43% encountered by patients and 57% by dentists. Usability problems encountered during pilot testing included undelivered messages due to mobile phone carrier and service-related issues, errors in patients' phone number data entry, and problems in provider training.

Discussion

Through collaborative and iterative work with the vendor, usability issues were addressed before launching a trial to assess its efficacy.

Conclusion

The usability of the mHealth application for postoperative dental pain was remarkably improved by the iterative analysis and interdisciplinary collaboration.

Impact of dental prosthetic treatment and patients' expectations on the seven domains and four-dimensional scale of the Oral Health Impact Profile

BACKGROUND

Recently, recommendations were given for a new scoring of the Oral Health Impact Profile (OHIP). The original seven domain structure should be replaced by a four-dimensional scale.

OBJECTIVES

To investigate the effect of dental prosthetic treatment on the seven domains and the four-dimensional scale of the OHIP-G49/53 questionnaire.

METHODS

Seventy four patients were grouped according their pre- and post-treatment situation and the type of treatment they received. Patients completed the OHIP-G49/53 questionnaire before prosthetic treatment (T0), and at 1 week (T1), 3 months (T2) and 6 months (T3) after treatment. Treatment effects on the seven domains and the four dimensions of the OHIP scale were analysed, and the oral health-related quality of life (OHRQoL) was measured. Patients' expectations of their prosthetic treatment were also evaluated. Data were analysed using two-way Mixed ANOVA, regression analysis, and Cronbach's alpha test with a level of significance of α ≤ .017.

RESULTS

OHRQoL significantly improved following prosthetic treatment compared with baseline. The largest improvement was found between T0 and T1 evaluations (all p ≤ .001). Unlike the seven-domain scale, the four OHIP dimensions demonstrated further significant improvements across the T1/T2/T3 evaluations (all p ≤ .017). Different pre-treatment findings had different treatment effects on the four OHIP dimensions and seven OHIP domains. Patients' expectations were mainly fulfilled.

CONCLUSION

Compared with the seven-domain scale, the four dimensions showed significant follow-up changes, suggesting the four dimensions are suitable for evaluating treatment effects up to 6 months. Clinically meaningful effects of dental prosthetic treatment can be sensitively measured using the four-dimensional OHIP scale.

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

The Scientific Investigation Committee of the American Academy of Restorative Dentistry offers this review of the 2022 dental literature to briefly touch on several topics of interest to modern restorative dentistry. Each committee member brings discipline-specific expertise in their subject areas that include (in order of the appearance in this report): prosthodontics; periodontics, alveolar bone, and peri-implant tissues; dental materials and therapeutics; occlusion and temporomandibular disorders; sleep-related breathing disorders; oral medicine and oral and maxillofacial surgery; and dental caries and cariology. The authors focused their efforts on reporting information likely to influence the daily dental treatment decisions of the reader with an emphasis on innovations, new materials and processes, and future trends in dentistry. With the tremendous volume of literature published daily in dentistry and related disciplines, this review cannot be comprehensive. Instead, its purpose is to update interested readers and provide valuable resource material for those willing to subsequently pursue greater detail on their own. Our intent remains to assist colleagues in navigating the tremendous volume of newly minted information produced annually. Finally, we hope that readers find this work helpful in managing patients.

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.

How do implant patients experience complications? A cross-sectional multicentre pilot study

BACKGROUND

This cross-sectional study aimed to quantify the impact of implant-related complications on perceived pain, functional impairment, concern, quality of life (QoL) and confidence which were the study's primary outcomes.

MATERIALS AND METHODS

Patients were recruited in five centres over 19 months. They completed a structured ad hoc questionnaire scoring pain, chewing ability, concern, QoL and confidence in future implant treatment. Some potential independent variables were also recorded. The data were analysed descriptively and with a multiple-stepwise regression model for correlations of the five primary variables with the other data.

RESULTS

The sample consisted of 408 patients, with prosthesis mobility being the most common complication (40.7%). Most patients (79.2%) consulted because of a complication, while 20.8% were asymptomatic and consulted regularly. Pain was correlated with symptoms at consultation and in biological/mixed complications (p < .001; R2  = 44.8%). Chewing impairment with implant loss, prosthesis fracture and removable implant-supported or total prostheses (p < .001; R2  = 42.8%); patient concern was correlated with the clinical symptoms and removable implant-supported prostheses (p < .001; R2  = 36.1%); impact on QoL was correlated with implant loss, prosthesis fracture and removable implant-supported prostheses (p < .001; R2  = 41.1%). Patient confidence was relatively independent and only impact on quality of life significantly influenced it (r = 0.73).

CONCLUSIONS

Implant-related complications moderately impaired patients' perceptions of pain, chewing ability, concern and QoL. Nevertheless, complications only slightly reduced their confidence in future implant treatment.

Treatment effect of implant-supported fixed complete dentures and implant overdentures on patient-reported outcomes: A systematic review and meta-analysis

OBJECTIVES

To analyze the effect of implant treatment in edentulous patients rehabilitated with implant-supported fixed complete dentures (IFCDs) or implant overdentures (IODs) on dental patient-reported outcomes (dPROs).

MATERIALS AND METHODS

In January 2022, Medline, Embase, CINAHL, Cochrane Library, PubMed Central, Web of Science, and ClinicalTrials.gov were screened for prospective clinical studies on completely edentulous patients treated with IFCDs and/or IODs, reporting pre-treatment and follow-up dPROs. Hedges' g effect sizes (ES) with corresponding 95% confidence intervals (CI) were calculated. Afterward, meta-analyses were conducted using random effect models.

RESULTS

A total number of 1608 records was initially identified. Of those, 28 studies reporting dPROs from 1457 patients were finally included. The applied dental patient-reported outcome measures (dPROMs) included several versions of the Oral Health Impact Profile (OHIP) or specific items assessing satisfaction with Visual Analogue Scales (VAS). The overall ES was large for rehabilitation with IFCDs (1.68 [CI: 1.15, 2.20]) and IODs (1.26 [CI: 0.99, 1.52]) with no significant difference (p = .165) between the two. Denture stability was the only factor rated significantly higher for IFCDs (ES difference: 2.37 [CI: 0.21, 4.54]; p = .032). Subgroup analyses revealed moderately higher ES for IODs on two implants relative to one implant (ES difference: 0.73 [CI: 0.34, 1.12]; p < .001).

CONCLUSIONS

There is a strong positive effect of implant treatment in edentulous patients, independent of the type of prosthetic rehabilitation. In patients seeking high stability, IFCDs may be preferable. In mandibular IODs on a single implant, there was a significantly positive effect of an additional implant on dPROs.

DENTAL PATIENT-REPORTED OUTCOMES UPDATE 2022

Much progress has been made this year in patient-reported outcomes related research. A number of important articles were published, shedding light on relevant methodological issues as well as future directions. In order to further promote the wide use of dental patient-reported outcomes (dPROs) and dental patient-reported outcome measures (dPROMs) in dental research and dental practice, and to provide novel insights into relevant measurement and analytical methods, the Journal of Evidence-Based Dental Practice has put together this special issue, the second of a series entitled Dental Patient-Reported Outcomes Update. To put Special Issue articles into a broader perspective, this review will provide a concise summary of key, relevant PRO and dPRO articles published during the year of 2022. A brief introduction of those manuscripts collected in this Special Issue follows. Six main domains are covered in this Special Issue: (i) the availability and applicability of dPROs and dPROMs, (ii) the current usage of dPROs and dPROMs in published research, (iii) methodological considerations in dPRO-related research, (iv) the landscape and trends of dPRO-related research, (v) the significance and relevance of dPRO usage, and (vi) dPROs and value-based oral health care.

A NARRATIVE REVIEW ON THE OVERLOOKED ASPECTS OF dPROs IN CONNECTION WITH DENTAL MATERIALS

OBJECTIVE

Dentists use a large number of dental materials to treat patients, mainly for pain relief, improved oral function, and orofacial appearance purposes. These materials supposably have been clinically tested and registered before launching onto the market. In terms of clinical testing, despite various objective and subjective assessments that could be done, the dentist-centred outcomes and regulatory body requirements might not fully reflect the perspective of the patient. Thus, dental-patient reported outcomes (dPROs) might be useful in providing valuable self-perceived feedback to stakeholders across a long period of time about the materials... performances.

METHODS AND RESULTS

This narrative review evaluated various assessment dPROs tools and their applications to contemporary dental materials, trying to link up basic materials science and biomechanics with the patients... reported outcomes.

CONCLUSIONS

dPROs can eventually form a basis of value-based dentistry for dental materials that would be of importance in terms of research, regulatory and safety.

LESSONS LEARNED FROM the FIRST STEPS of IMPLEMENTING VALUE-BASED ORAL HEALTH CARE: A CASE STUDY FROM the MEDICAL UNIVERSITY of VIENNA

BACKGROUND

Value-based oral healthcare (VBOHC) has two fundamental components, the assessment of patients' dental outcomes and the measurement of the costs to achieve those outcomes. The aim of this article is to describe challenges and opportunities of implementing dental patient-reported outcomes (dPROs) in clinical care at the University Clinic of Dentistry, Medical University of Vienna, in Austria, to determine lessons learned and describe next steps forward to VBOHC implementation.

METHODS

A case study determining lessons learned based on an implementation process to incorporate a dental patient-reported outcome measure (dPROM) in routine clinical care was conducted. The German version of the five items Oral Health Impact Profile (OHIP-5), a dPROM was selected and integrated into the general anamnesis including dental and medical history for patients aged ≥16 years. The anamnesis is paper based and is to be completed by each new patient during the registration process. Thereafter, it is uploaded to the patients' dental record via scan by the main central admission. However, it is then the treating dentist's task to transfer the data into the digital system. Data accuracy between digital and paper forms was investigated, and lessons learned regarding the first steps of implementing VBOHC were summarized based on the implementation process findings.

RESULTS

To date, 8,147 patients were approached to fill in OHIP-5. However, only 266 patients´ OHIP- 5 files were transferred into the digital system by the dentist. To explore the accuracy between the manual transfer of data from paper forms to digital format, the data of 89 randomly selected patients was compared. Of this sample, 74 (83.1%) patient's data sets were found to be identical. Lessons learned included the importance of institutional dedication, stakeholders' engagement, dPROMs integration in follow up visits, the significance of digital solutions, and the continuous monitoring and evaluation.

CONCLUSION

Integrating dPROMs in clinical settings is achievable and is the first important step to move forward with VBOHC implementation.