Four-implant-supported overdenture treatment in the maxilla. Part II: Speech- and oral health-related quality of life in patients with implant-supported overdentures in the maxilla-A prospective 3-year follow-up

BACKGROUND

Implant-supported overdentures (IOD) are becoming a more commonly used treatment in the dental practice and it risks causing speech problems.

PURPOSE

The aim of this study was investigating the changes in speech, satisfaction with speech, and overall oral health-related quality of life (OHRQoL) in edentulous patients during and after treatment with maxillary IODs.

MATERIALS AND METHODS

Twenty-one patients receiving an IOD participated in speech assessment. They were examined preoperatively with their conventional denture (CD) with full palatal coverage, after connection of the implant-bar connected denture, without palatal coverage, and 3 years thereafter. The examination included assessment of articulation in speech, OHRQoL based on total OHIP-14, and satisfaction with overall oral health and speech (visual analogue scale).

RESULTS

There was a reduction in mean number of articulation disorders from 1.00 at baseline to 0.55 at connection, although statistically insignificant (p = 0.059). Especially the /s/ sound is vulnerable. At 3 years follow-up, still 6/16 (37.5%) of the patients suffered from this speech problem. Overall satisfaction improved from 64.05/100 at baseline to 82.95/100 at connection (p = 0.008) and remained unchanged with 81.69/100 after 3 years follow-up. Patients' satisfaction with speech increased from 70.62/100 with CD to 82.63/100, 3 years follow-up (p = 0.009). Total OHIP-14 decreased from 21.45/56 with CD to 8.00/56 (p < 0.001) with IOD and 6.13/56 3 years after connection (p = 0.001). Significant improvement of all seven domains in OHRQoL was observed with IOD compared to CD.

CONCLUSIONS

Patients treated with maxillary IODs show improved OHRQoL 3 years after connection of the IOD compared to the CD. Even though patients reported improvement of satisfaction and OHRQoL, articulation disorders were still present, suggesting that patients should be informed about possible speech issues.

Articulation, oral function, and quality of life in patients treated with implant overdentures in the mandible: A prospective study

BACKGROUND

Modifications of facial and oral structures affect aesthetic appearance, orofacial functions, and have impact on quality of life.

PURPOSE

This study determined alterations of articulation, oromyofunctional behavior, and Oral Health Related Quality of Life (OHRQoL) in patients replacing complete removable dentures by implant retained overdentures in the mandible.

MATERIALS AND METHODS

Twenty-one fully edentulous patients received mandibular overdenture retained on a bar connecting two titanium dental implants. Patients were evaluated after receiving a new set of fully removable dentures (stage 1), after surgery during provisionalization on healing abutments (stage 2), and after final connection to the bar (stage 3). Assessments were taken by speech therapists and included evaluation of: articulation (picture naming and reading); oromyofunctional behavior; OHRQoL (OHIP-14 questionnaire), and overall satisfaction and speech (VAS). To measure changes over time, Wilcoxon matched-pairs signed-rank-test and McNemar test was used.

RESULTS

There was no significant impact of the treatment on speech nor on the results of oromyofunction. In stage 1, patients had different kinds of articulation errors (mean:1.21) which evolved to 0.71 and 0.67. In stage 3, especially problems with the /s/ sound are seen in 37% (7/19) of the participants. Results of OHRQoL and satisfaction reveal that the average of satisfaction with oral health evolved from 67% to 63% and finally 78%. OHIP-14 total score was 17.4/56 in stage 1, remained unchanged in stage 2 and evolved in stage 3 to 9.8/56 (P: .010). This indicates improvement. Satisfaction with speech evolved significantly from 68% pretreatment to 82% in stage 3 (P: .013).

CONCLUSION

Despite existing articulation and oromyofunctional disorders after treatment, people are very satisfied with their OHRQoL and their speech. Impact of mandibular denture wearing on OHRQoL declines once connected. It's important to inform patients that speech and oromyofunctional disorders may occur during treatment where especially the /s/ sound is vulnerable.

"Longitudinal Oral Health-Related Quality of Life in maxillary mini dental implant overdentures after 3 years in function"

OBJECTIVES

Longitudinal evaluation of Oral Health-Related Quality of Life (OHRQoL) during treatment of flaplessly placed, one-piece mini-dental-implants (MDIs) for maxillary overdentures is rarely investigated, nor is the impact of MDI failures.

MATERIAL AND METHODS

This multicenter prospective cohort study evaluated the 3-year outcome of 5-6 MDIs in the edentulous maxilla in patients above 50 years with dentate mandible. Provisional dentures were provided before final prosthetic connection was established at 6 months. Postoperative discomfort was assessed using a visual analogue score (VAS). OHRQoL was investigated using the Oral Health Impact Profile (OHIP)-14 at baseline (preoperatively), postoperatively, post-prosthetic connection and after 3 years in function.

RESULTS

164 (78.4%) of the 204 placed MDIs were still in situ after 3 years, in 29/31 patients. Two patients lost 5/6 MDIs resulting in two prosthetic failures (6.45%). With regard to pain, a score of 4.1/10 (SD 2.8) was recorded on day 1, and 1.1/10 (SD 1.7) on day 7. A decrease in total OHIP-14 scores was observed postoperatively (15.6; SD 12.8) as compared to baseline (21.3; SD 13.1), with improvement of OHRQoL. Furthermore, this was statistically significant at connection of the final prosthesis (7.3; SD 6.7) (p = .006). The OHIP-14 improved less (p = .011) when experiencing one or more implant losses (9.5; SD: 9.85), in comparison with no implant loss (20.7; SD: 13.97). A failure of one MDI did not affect OHIP-14 score (p = .658); however, multiple failures did (p = .007).

CONCLUSION

Maxillary MDI overdenture treatment yields significant OHRQoL improvement when at least 5 MDIs survive, preserving functional comfort.

Quality of life and social participation in dental rehabilitation: A personality and multi-informant perspective

OBJECTIVES

Contemporary research on the impact of dental rehabilitation scarcely focuses on the role of personality and social relationships in QoL related to dental implant treatment. To overcome biases related to evaluation with self-reports, descriptions provided by informed external observers are recommended.

AIMS

To investigate the impact of implant-supported rehabilitation on quality of life and social participation taking into account patient's personality.

MATERIALS AND METHODS

Fifty-four patients were included in this study and assigned to either a single unit group (n = 15) or a complete jaw restoration group (n = 39). Of the 54 participants, 49 nominated an external observer who can evaluate the daily behavior of the patient. Before and after treatment patients and their external observer completed the OHIP-14, the NEO-FFI and the MSPP questionnaires respectively focusing on Oral Health related Quality of Life, Personality and Social participation.

RESULTS AND CONCLUSION

The correlations between self- and observer ratings on pre and post treatment outcomes on were insignificant (QoL pre: p = 0.086, post: p = 0.115, freq. soc. part pre: p = 0.944, post: p = 0.876, div. soc. part pre: p = 0.798, post: p = 0.167), suggesting considerable differences in observer perspectives. The traits Neuroticism, Extraversion and Agreeableness were associated with QoL. Openness, Conscientiousness and Agreeableness were associated with social participation. Patients in the complete jaw restoration group reported more impact of the implant treatment on quality of life as compared to the single unit group (p = 0.007). The complete jaw restoration group reported an improved quality of life after treatment and significant increases of both frequency (p = 0.001) and diversity of social participation (p = 0.036). In conclusion there was a minor impact of treatment with single crowns on quality of life and social participation compared to the full denture group. The role of personality and the use of multi-informants in evaluating dental treatment was found important.

Speech evaluation during maxillary mini-dental implant overdenture treatment: A prospective study

Large proportions of patients are edentulous and wear removable dentures leading to reduced functional comfort and less oral health‐related quality of life. Satisfaction with the oral situation after implantation depends on the outcome in eating comfort, speech comfort and aesthetics. Modification in form and location of the teeth may affect speech. The aim of this study is to determine speech, oromyofunctional behaviour, satisfaction with the treatment and the impact on quality of life of the horse‐shoe overdenture retained by mini‐dental implants (MDIs) in the maxilla. This prospective multicentre cohort study included 32 patients for treatment. 5 to 6 implants were placed, traumatically piercing the mucosa. Patients were evaluated three times during treatment (pre‐operatively with conventional prosthesis including full palatal coverage (CD), post‐operatively with provisionally relined CD and with horse‐shoe overdenture on MDI). The assessment included a phonetic evaluation, examination of oromyofunctional behaviour, evaluation of the impact on quality of life (OHIP‐14) and a rating of satisfaction with the treatment and speech on a visual analogue scale. Several speech sounds are found to be disturbed before treatment. In the next two stages of the treatment, the number of speech issues decreases. In the final stage, ten people show minor speech problems, especially with the /s/ sound. In this stage, seven people still present with oromyofunctional problems, especially whistling problems. In this last stage, people are very satisfied with the treatment (83%) and with speech (84%). The impact on quality of life is low (8.23/56).

Robot-assisted laparoscopic radical cystectomy: initial experience on 27 consecutive patients

Recent reports have demonstrated that robot-assisted laparoscopic cystectomy is technically feasible. We report technical and functional results of a large series of patients undergoing laparoscopic cystectomy with the da Vinci surgical system (DVSS). A total of 27 patients (24 males) underwent laparoscopic radical cystectomy with the DVSS (intuitive surgical) between January 2004 and December 2005. Indications for cystectomy were muscle-invasive transitional cell carcinoma (TCC) or leiomyosarcoma of the urinary bladder (n = 24) and bladder shrinking following prior radiotherapy for TCC. A pelvic lymphadenectomy was a routine part of the procedure. Urinary diversions were ilieal conduits (n = 19) and ileal neobladders (n = 8). Mean operating time was 340 min (range 150-450) with a mean blood loss of 301 ml (range 50-550). The mean number of lymph nodes retrieved during lymphadenectomy was 23. Surgical margins were negative except in one case. After a mean follow-up of 10.2 months, two perioperative (anastomotic leakage, adhesions) and three postoperative complications (ileus, intestinal fistula, urinary tract obstruction) occurred. Six out of seven patients reported satisfying erectile function following nerve-sparing surgery. Day-time continence was completely restored after a mean 3.5 months in seven of eight patients. Robot-assisted laparoscopic cystectomy is a safe procedure. Satisfying functional and oncological short-term results can be achieved within acceptable operating time limits.

Torsion of the spermatic cord after orchiopexy

The cases of spermatic cord torsion reported here show that this condition may occur even some time after fixation. Three men, aged 22, 30 and 35 years, visited the urologist with complaints of an acute scrotum following earlier orchiopexy for spermatic cord torsion. Different techniques are employed to fixate the testicles after spermatic cord torsion. These cases confirm that Jaboulay's bottleneck procedure is the method of choice for bilateral fixation in patients presenting with this condition.

Major intra-abdominal complications following extracorporeal shockwave lithotripsy (ESWL) in a patient with Ehlers-Danlos syndrome

A retroperitoneal bleeding is an unusual complication of extracorporeal shockwave lithotripsy (ESWL), which can be treated in a conservative way most of the time. However, an intra-abdominal bleeding after ESWL is extremely rare, which can cause life-threatening situations and requires an immediate intervention. Probably, only patients with a certain tissue fragility or connective tissue disorder are at risk to develop such an intra-abdominal bleeding. We present a case of a serious intra-abdominal bleeding due to a rupture of the vena mesenterica superior in an Ehlers-Danlos patient, evoked by an ESWL.

Comparison of tamsulosin with alfuzosin in the treatment of patients with lower urinary tract symptoms suggestive of bladder outlet obstruction (symptomatic benign prostatic hyperplasia). The European Tamsulosin Study Group

OBJECTIVE

To compare the efficacy and tolerability of the alpha 1 A-subtype selective drug tamsulosin with the nonsubtype-selective agent alfuzosin in the treatment of patients with lower urinary tract symptoms (LUTS) suggestive of bladder outlet obstruction (BOO), often termed symptomatic benign prostatic hyperplasia (BPH).

PATIENTS AND METHODS

The study comprised 256 patients with benign prostatic enlargement and LUTS suggestive of BOO (symptomatic BPH) who received tamsulosin 0.4 mg once daily or alfuzosin 2.5 mg three times daily during 12 weeks of treatment. The response was assessed by measurements of maximum urinary flow rate (Qmax), a symptom score (Boyarsky) and blood pressure at regular intervals.

RESULTS

Tamsulosin and alfuzosin produced comparable improvements in Qmax and total Boyarsky symptom score. Both treatments were well tolerated with respect to adverse events. Tamsulosin had no statistically significant effect on blood pressure compared with baseline but alfuzosin induced a significant reduction in both standing and supine blood pressure, compared with baseline (P < 0.05).

CONCLUSION

Tamsulosin is the first adrenoceptor antagonist that is selective for the alpha 1 A-subtype; this specificity may explain its lack of effect on blood pressure compared with alfuzosin, an agent that is not receptor subtype specific. Moreover, this finding may partly explain why tamsulosin, in contrast to other currently available alpha 1-adrenoceptor antagonists, can be administered without dose titration. Another advantage compared with alfuzosin (and prazosin) is the once-daily dosing regimen of tamsulosin.

[Antegrade scrotal sclerotherapy in the treatment of varicocele]

The antegrade scrotal sclerotherapy is a minimally invasive surgical technique in the treatment of the varicocele. Through a small scrotal incision a straight vein merging in the spermatic vein is isolated and cannulated. An antegrade phlebography is performed and ethoxysclerol is injected in the vein. We have performed this technique in 35 patients with a follow-up of at least 3 months. All patients except one (97%) show no more varicocele. This technique has a low morbidity, is cheap and as effective as the other treatment modalities. The antegrade sclerotherapy is competitive to the retrograde embolisation and has the advantage that the treatment can be performed in all cases, even in cases of recidive.

Down-staging prostate cancer. Is it possible by androgen depletion and Mitomycin C therapy?

The study was carried out in order to investigate the possibility of tumor reduction in prostate cancer patients. As a reduction of the primary tumor was observed with hormonal treatment and complete response of soft tissue tumor markers with Mitomycin C, this combined treatment was given in seven patients to evaluate if it was able to down-stage those cases which were thought to be incurable (T3N1-2M0/T4N0-2M0). Although the clinical evaluation suggested a significant down-staging, the explorative lymphadenectomy was unable to confirm this. The proposed treatment is able to reduce the tumor bulk significantly of the primary cancer as well as of its metastases; progression during the treatment was not seen.

Multiple ureteral diverticula: report of 2 cases and review of the literature

Multiple ureteral diverticula, probably acquired, are rare; they are most frequently diagnosed in elderly males and associated with infections of the urinary tract and prostatic hypertrophy. There is no definite treatment. On the other hand, one should be well aware of the possibly higher risk of transitional cell carcinoma. At least yearly urinalysis and cytology seem mandatory.

Basket extraction--its place in the current treatment of the lower ureteric stone: clinical experience

120 basket extractions have been tried in 115 patients suffering from lower ureteric stones. We used Dormia baskets as well as Johnson baskets. In 83% of the cases the stone has been removed. The present study was conducted in order to trace a possible connection between the success rate of extraction and the duration of symptoms or the size of the stone. Whereas the chances of success in case of a basket extraction performed within 3 months amount to 90%, the success rate drops to 66% once this period of 3 months has expired. Stones smaller than 10 mm (greatest diameter) are removed in 86% of extractions. Stones measuring 10 mm or more, only in 50%. The role of the cross diameter is mentioned. The place of basket extraction in the treatment of lower ureteric stone is discussed.

Loop cutaneous ureterostomy as a method of urinary diversion in the adult

A loop cutaneous ureterostomy was performed as an emergency treatment in 6 patients with bladder or prostatic cancer. Out of 9 operated ureters, only one stenosis was observed. Infection is a possible complication which can sometimes alter the renal function.

Blunt ureteral trauma with perineal urine fistulization: review of the literature

The first case of blunt ureteral disruption with external urine fistulization is presented. Reanastomosis with temporary urine diversion by a nephrostomy tube was successful. A review of the literature since 1950 revealed only 49 cases that proved this pathology should be considered in the differential diagnosis of post-traumatic hematuria or the development of mass in the flank. Nephrectomy is no longer used since a thorough attempt at reconstructive surgery will provide good functional results.