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ABSTRACT: To evaluate the level of association between patients' denture satisfaction and oral health-related quality of life (OHRQoL) in edentate patients, and to identify the determinants of satisfaction that best predict OHRQoL. The effects of time and treatment type were also assessed.
Data from 255 edentate elders who participated in a randomised clinical trial were used. OHRQoL ratings were gathered using the Oral Health Impact Profile (OHIP-20) questionnaire. The McGill Denture Satisfaction Instrument was used to assess satisfaction with treatment (mandibular conventional denture or implant overdenture). Outcomes were measured prior to treatment, then 6 and 12 months after delivery of the new prostheses. Simple linear and multiple linear regression analyses were performed to statistically analyse the relationship.
When the combined effect of all factors was assessed, only two variables of denture satisfaction ratings were significantly associated with OHRQoL: chewing ability (P=.005) and oral condition (P=.002). These two variables explained 46.4% of the variance in the OHIP change scores. This association varied with time, but the variables of importance remained the same. Type of treatment, gender, age and other socio-demographic variables were not significantly associated with improvement in OHRQoL once their effects were combined with denture satisfaction ratings.
Within the limitations of this study, a highly positive association exists between oral health-related quality of life and denture satisfaction. Chewing ability and oral condition are the determinants of denture satisfaction best associated with OHRQoL, predicting 46.4% of its improvement following a treatment.
Journal of dentistry 04/2012; 40(8):624-31. · 2.00 Impact Factor
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ABSTRACT: The aim of this study is to determine whether mandibular bone height affects patients' ratings of satisfaction and function with mandibular 2-implant overdentures (IODs) and conventional dentures (CDs).
214 edentulous elders were randomly allocated into 2 groups and treated with maxillary CDs and either mandibular CDs or IODs. Classifications of mandibular bone height were carried out on panoramic radiographs using 4 published methods. At baseline and 6 months after delivery, all participants rated their satisfaction with their prostheses using the McGill Denture Satisfaction Instrument. Independent t-tests and a linear multivariable regression model were used for statistical analyses.
Mandibular bone height has no effect on patients' ratings of general satisfaction, nor on ratings of ability to chew, stability, comfort, aesthetics and ability to speak at 6 months (p>0.05, linear regression). There were significant between treatment differences in ratings of general satisfaction, comfort, stability and ability to chew from all mandibular bone height categories, with higher ratings assigned to IODs (p<0.01, t-tests). Linear regression analyses confirmed that, for general satisfaction, as well as ability to chew, stability, comfort, aesthetics and ability to speak, treatment with IODs contributes to higher satisfaction ratings (p<0.001), while mandibular bone height does not.
The evidence demonstrates that mandibular bone height has no effect on patients' satisfaction with the function, chewing ability and comfort of their prostheses. Furthermore, no matter how much mandibular bone, these results suggest that edentulous elders will benefit more from mandibular IODs than from CDs.
Journal of dentistry 11/2010; 38(11):899-907. · 2.00 Impact Factor
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ABSTRACT: Conventional dentures will remain the only treatment available to most edentulous people for the foreseeable future. In this study, we compared the efficiency of two methods of making complete conventional dentures-the traditional academic standard (T) and a simplified technique (S) used in private practice. We have previously shown that they produce similar levels of patient satisfaction and denture quality.
Data were gathered during a randomized controlled clinical trial of 122 subjects from initial examination until 6-month follow-up. For this report, the direct costs of providing one set of conventional complete dentures by T or S techniques were estimated. All materials used were recorded and their cost was calculated in Canadian dollars (CAN$). The costs of fabrication in an outside laboratory were added. Clinician's labor time was recorded for every procedure. Between-group comparisons for each clinical procedure were carried out with independent t-tests. The number of patients in each group who needed postdelivery treatment was compared with Chi-square tests. The effect of group assignment and of treatment difficulty on outcomes was analyzed with multiple regression analysis.
The mean total cost of the T method was significantly greater than S (CAN$166.3; p < 0.001), and clinicians spent 90 minutes longer (p < 0.001) on clinical care. The difficulty of the case had no significant influence on outcomes.
The results indicate that the S method is the more cost-efficient method and that there are no negative consequences that detract from the cost savings.
Journal of Prosthodontics 10/2010; 19(7):512-6. · 1.01 Impact Factor
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Yasuhiko Kawai DDS, MMedSci, PhD,
PhD Hiroshi Murakami DDS,
PhD Yoshiaki Takanashi DDS,
PhD James P. Lund BDS,
HDR Jocelyne S. Feine DDS,
Yasuhiko Kawai,
Hiroshi Murakami,
Yoshiaki Takanashi,
James P. Lund, Jocelyne S. Feine
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ABSTRACT: Purpose: Conventional dentures will remain the only treatment available to most edentulous people for the foreseeable future. In this study, we compared the efficiency of two methods of making complete conventional dentures—the traditional academic standard (T) and a simplified technique (S) used in private practice. We have previously shown that they produce similar levels of patient satisfaction and denture quality.Materials and Methods: Data were gathered during a randomized controlled clinical trial of 122 subjects from initial examination until 6-month follow-up. For this report, the direct costs of providing one set of conventional complete dentures by T or S techniques were estimated. All materials used were recorded and their cost was calculated in Canadian dollars (CAN$). The costs of fabrication in an outside laboratory were added. Clinician's labor time was recorded for every procedure. Between-group comparisons for each clinical procedure were carried out with independent t-tests. The number of patients in each group who needed postdelivery treatment was compared with Chi-square tests. The effect of group assignment and of treatment difficulty on outcomes was analyzed with multiple regression analysis.Results: The mean total cost of the T method was significantly greater than S (CAN$166.3; p < 0.001), and clinicians spent 90 minutes longer (p < 0.001) on clinical care. The difficulty of the case had no significant influence on outcomes.Conclusions: The results indicate that the S method is the more cost-efficient method and that there are no negative consequences that detract from the cost savings.
Journal of Prosthodontics 09/2010; 19(7):512 - 516. · 1.01 Impact Factor
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ABSTRACT: The study sample was derived from dental hospital patients awaiting the provision of a mandibular bilateral free-end removable partial denture (RPD). Inclusion criteria included the following: (1) maximum of 8 remaining mandibular teeth; (2) 1 to 2 anterior teeth spaces allowed, provided they were restorable using resin-bonded fixed partial dentures (FPDs); and (3) plaque score of 20% or less. Exclusion criteria were the following: (1) presence of maxillary molars; (2) maxillary tooth or teeth that would be unopposed by a proposed mandibular prosthesis; and (3) medical condition that precluded active treatment or prescribed diet. Before randomization, all potentially eligible participants had received a preparatory treatment including oral hygiene and restorative and periodontal treatment, if necessary. Sixty participants (25 men and 35 women;median age 67 years; range 39-81 years) were enrolled in the study and randomly allocated into 2 treatment groups (n = 30 per group) matched for age and sex. The dates of the recruitment to the study were not given, but all new prostheses were constructed and fitted between June 1995 and July 1997.
The primary treatment of interest was the distal cantilever resin-bonded FPDs. The control treatment was RPDs. Cantilever resin-bonded FPDs restored 1 occlusal unit, up to but not beyond the second premolar, using single pontic cantilevers from a single abutment whenever possible.
Patient satisfaction was assessed using self-administrated questionnaires, piloted for this study, at baseline, 3 months, and 1 year after the provision of the new prostheses. A lower median satisfaction score indicated a higher level of satisfaction. These questionnaires included items about overall satisfaction with teeth, appearance of teeth, ability to chew, and bite and level of satisfaction, as well as comfort with the prosthesis.
The mandibular shortened dental arches opposed a complete maxillary denture in 51 participants, opposed partial maxillary dentures in 7 participants, and opposed natural maxillary teeth in only 2 participants. Fifty-two patients attended the 3-month and 1-year follow-up assessments. There were no differences in the baseline satisfaction of the 2 treatment groups. The within-group changes in summary satisfaction scores indicated significantly higher satisfaction for both treatment groups from baseline (median FPD = 17.5, RPD = 16.5) to the 3-month (median FPD = 13.5, RPD = 13.0) and 1-year follow-up assessments (median FPD = 11.0, median RPD = 13.0). No between-group differences were detected (Wilcoxon signed-rank test, P < .05). Improvements in levels of general satisfaction with teeth (P = .05) and the appearance of teeth (P = .12) were significant only for the FPD group. Significant improvements in perceived masticatory ability and perceived levels of comfort were found in both groups (P < or = .05).
The authors concluded that resin-bonded cantilever FPDs are an effective means of restoring a mandibular shortened dental arch in terms of patient comfort and acceptance compared to treatments with RPDs.
The journal of evidence-based dental practice 03/2010; 10(1):64-6.
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ABSTRACT: Clinicians have reported that their patients complain that their mandibular two-implant overdentures (IOD) rotate. Therefore, we studied the frequency and severity of rotation of IODs with two-ball attachments, how rotation may influence perceived satisfaction ratings of chewing ability, and the factors that are involved in the rotation of IODs.
Seventy-nine participants were recruited and asked to rate their general satisfaction of their IODs, as well as their ability to chew foods, the existence of any mandibular denture rotation, and to what degree denture rotation bothered them. Data on participant sociodemographic, anatomical, and prosthesis characteristics were also collected. Student's t-test and logistic regression analyses were performed to analyze the differences between participants who did (R group) and did not report (NR group) denture rotation.
Thirty-seven of 79 participants were aware of rotational movement in their IODs. These patients were significantly less satisfied with their chewing ability than those who felt no rotation (69.1 mm R group vs. 82.9 mm), and discomfort caused by the rotation bothered them moderately (39/100 mm). The multivariate logistic regression analysis revealed that the arrangement of the anterior teeth and the length of the denture are significantly associated with awareness of denture rotation. Thirty-eight percent in the R group and 31% in the NR group had non-scheduled visits.
Rotational movement with a mandibular two-IOD has a negative effect on perceived chewing ability and is associated with anterior tooth arrangement and denture length.
Clinical Oral Implants Research 07/2009; 20(8):838-43. · 2.51 Impact Factor
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ABSTRACT: The aim of this study was to examine systematically the data published on the efficacy of mandibular implant-retained overdentures from the patient's perspective.
Medline, Embase, The Cochrane Central Register of Controlled Trials and The Cochrane Systematic Reviews Database were searched and complemented by hand searching. All randomized-controlled trials published in English or French up to April 2007 were included, in which conventional dentures and mandibular implant overdentures in adult edentulous individuals were compared. The outcomes of interest were patient satisfaction, oral and general health-related quality of life. Random effects models were used to pool the effect sizes (ES) of all included studies.
Ten publications of seven randomized-controlled trials were identified and eight were included in the meta-analysis. When compared with mandibular conventional dentures, implant overdentures were rated to be more satisfactory at a clinically relevant level [pooled ES 0.80, z=3.56, 95% confidence intervals (CI) 0.36-1.24, P=0.0004], but a statistical heterogeneity was found (chi(2)=31.63, df=5, P<0.00001, I(2)=84%). The pooled ES for oral health quality of life was -0.41 (z=1.31, 95% CI, -1.02 to 0.20; P=0.19, chi(2)=11.53, df=2, P<0.003, I(2)=83%). There was a lack of evidence to show the impact of mandibular implant overdenture on perceived general health.
Our findings suggest that, although mandibular implant-retained overdentures may be more satisfying for edentulous patients than new conventional dentures, the magnitude of the effect is still uncertain. There is a need for additional evidence including cost-effectiveness analyses on the impact of mandibular implant overdentures and conventional dentures.
Clinical Oral Implants Research 06/2009; 20(6):533-44. · 2.51 Impact Factor
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03/2009: pages 61 - 77; , ISBN: 9780470744116
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ABSTRACT: Many current studies of prosthodontic treatment use patient-based outcomes. Traditionally, these outcomes are measured using quantitative methods. However, qualitative research methods can provide important information that cannot be found using quantitative techniques. In this article, the authors review quantitative and qualitative research studies. Differences, advantages and disadvantages of each method are highlighted. Prosthodontic researchers are encouraged to combine these methods to benefit from the potential of each of these approaches.
The European journal of prosthodontics and restorative dentistry 01/2009; 16(4):185-9.
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ABSTRACT: With the constant introduction and marketing of new dental technologies, dentists sometimes have difficulty deciding whether a new technology will be beneficial to their patients. At the same time, these clinicians are professionally and legally obligated to inform their patients about all appropriate therapeutic alternatives. In this second article of a 2-part series, we review these obligations, as well as provide information about where dentists can find the necessary scientific evidence on which to base an informed decision.
Journal (Canadian Dental Association) 10/2008; 74(7):637-40. · 1.00 Impact Factor
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ABSTRACT: With the rapid evolution of technology and the development and marketing of new procedures in dentistry, dentists have difficulty keeping pace with all of this new technology and information. How do these clinicians know whether a new product, technique or technological advance is good and should be recommended? At what point do they have an obligation to inform their patients about new procedures supported by research? This first report of a 2-part series investigates the ethical aspects of these issues and describes some of the professional ethical dilemmas and obligations involved when new therapies are offered to the public.
Journal (Canadian Dental Association) 10/2008; 74(7):631-5. · 1.00 Impact Factor
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ABSTRACT: To measure expectations of satisfaction with implant and conventional denture treatment in 2 groups of edentulous people and compare them with their resultant ratings of satisfaction to determine if either treatment meets the pretreatment expectation.
One hundred sixty-two edentulous middle-aged (MA, n = 102) and senior (S, n = 60) patients were enrolled in 2 trials and, after randomization, received either a mandibular 2-implant overdenture (IOD) or a new conventional denture (CD). Before randomization, each subject rated their satisfaction with their current denture and expectations of satisfaction with both IOD and CD treatment on 100-mm visual analog scales (VAS). Six months posttreatment, all rated their satisfaction with their new prostheses on similar VAS. Expectations and satisfaction with treatment were compared.
Posttreatment satisfaction with CD treatment was significantly lower than pretreatment expected satisfaction in both study populations (MA, P < .0001; S, P = .036). There was no (or only borderline) significant difference between pretreatment expectation and posttreatment satisfaction for patients receiving IODs in both study populations (MA, P = .078; S, P = .057).
Posttreatment CD satisfaction failed to meet patients' pretreatment expectations of satisfaction; this was not the case for IODs, for which expectations were largely met.
Quintessence international (Berlin, Germany: 1985) 10/2008; 39(10):803-9. · 0.64 Impact Factor
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ABSTRACT: Studies show that elders wearing implant overdentures have improved nutrition and quality of life. However, upfront costs of this therapy are high, and the income of elderly edentulous populations is low.
This study was designed (i) to measure the preferences of edentulous patients for mandibular two-implant overdentures using Willingness-To-Pay (WTP) and Willingness-To-Accept (WTA), (ii) to assess the effect of long-term financing on WTP and (iii) to assess the desired role of health care plans in financing dental prostheses.
Edentulous elders (68-79 years; n = 36) wearing maxillary dentures and either a mandibular conventional denture (CD, n = 13) or a two-implant overdenture with ball attachments (IOD, n = 23) participated in this study. All had received their prostheses 2 years previously, as part of a randomised clinical trial. A three-part questionnaire was completed during a 20-min interview with a trained researcher.
Forty-six per cent (6/13) of the CD wearers and 70% (16/23) of the IOD wearers were willing to pay three times more than the current cost of conventional dentures for implant prostheses. These percentages were increased to 77% (CD) and 96% (IOD) if participants could pay for implant overdentures in monthly instalments. Eighty-six per cent (31/36) of all participants in both groups (21/23 IOD; 10/13 CD) thought that the government should cover at least some of the cost of implant overdentures.
This study shows that, the majority of elderly edentate individuals who have not experienced mandibular two-implant overdenture therapy are willing to pay the cost, particularly when payment can be made in monthly instalments.
Gerodontology 06/2008; 26(1):3-10. · 1.03 Impact Factor
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ABSTRACT: Males and females differ in their responses to many health conditions and treatments. The aim of this randomized clinical trial was to determine whether there are differences in the way that male and female edentulous elders rate their satisfaction with new mandibular implant overdentures (IODs) and conventional dentures (CDs), at 6 and 12 months following delivery.
Edentulous elders (n=256) were randomly assigned to receive maxillary conventional dentures and either mandibular overdentures supported by two implants with ball attachments or conventional dentures. Participants rated their general satisfaction, as well as other features of their dentures (comfort, stability, ability to chew, aesthetics, etc.) prior to treatment and 6 and 12 months after delivery.
Ratings of satisfaction with IODs were significantly higher than with CDs. Six months after delivery, females in the CD group rated their general satisfaction and satisfaction with ability to chew and aesthetics significantly lower than did the males. The sex differences in the CD group remained at 12 months after delivery. However, males and females in the IOD group rated their general satisfaction and all six subcategories equally.
Elderly females are less satisfied with conventional dentures than elderly males with regards to aesthetics and ability to chew, but equally satisfied with implant overdentures. At 6 and 12 months after delivery, elderly edentulous males and females wearing mandibular implant overdentures were significantly more satisfied than those wearing conventional dentures.
Journal of Dentistry 06/2008; 36(5):301-8. · 2.95 Impact Factor
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Canadian journal of rural medicine: the official journal of the Society of Rural Physicians of Canada = Journal canadien de la medecine rurale: le journal officiel de la Societe de medecine rurale du Canada 02/2008; 13(1):36-8.
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ABSTRACT: Although there may not be a direct association between oral hygiene and implant failure, oral hygiene must be maintained around implants in the edentulous mouth. Bacterial plaque on dentures can act as a reservoir for pathogens that cause respiratory disease. Unfortunately, many edentulous patients have poor oral hygiene. In this article, we describe the development of a brochure to educate patients wearing mandibular overdentures supported by 2 implants as a supplement to the dentist"s verbal instructions. Dental literature and several specialists were consulted during preparation of the brochure, which contains photographs accompanying oral hygiene instructions. It was sent to 25 participants who were subsequently called and questioned regarding its content and their oral hygiene habits. The 24 respondents found the brochure useful; most reported that they would keep the brochure for future reference and that they learned something new about how to maintain their implants properly. No one found the brochure too long or unclear. Most participants read the brochure entirely, rather than skimming it. The brochure is available to all clinicians who wish to incorporate this tool into their implant overdenture therapeutic approach.
Journal (Canadian Dental Association) 11/2007; 73(8):713. · 1.00 Impact Factor
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ABSTRACT: Reconstructive dentistry encompasses an enormous range of treatment modalities from the restoration of single teeth to the reconstruction of the whole dentoalveolar complex in edentulous patients. Some treatment modalities have been assessed in terms of quality-of-life (QoL) outcomes and satisfaction
The aim of the present investigation was to search and review studies published between 1996 and 2006 in which the impact of the treatment was measured in terms of QoL outcome, ideally, oral health-related quality of life (OHRQoL). Patient satisfaction was also accepted as an outcome.
The primary search engine used was NICB PubMed based on MeSH headings. Hand searching of the cited references in the included papers identified a number of additional studies. The primary focus of the search was to link treatment to QoL outcomes.
The majority of included studies involved the treatment of edentulous patients, particularly the mandible. The preponderance of the studies comparing conventional dentures (CDs) and implant-supported overdentures (IODs) were randomized-controlled trials (N = 18). There was compelling evidence that patients were more satisfied with IODs than CDs. There was strong evidence that OHRQoL can be significantly improved using IODs. Evidence suggesting that one retention system is superior to another needs further clarification. Although high satisfaction ratings have been reported for maxillary implant prostheses, the overall ratings given to the maxillary implant prostheses were not significantly greater than for CDs. There was only sparce information regarding QoL or satisfaction outcomes for the majority of other forms of reconstructive dentistry.
Apart from the restoration of the edentulous mandible with IODs or CD, where there is an accumulating body of evidence on the effect of treatment choice, there are many procedures for which there are little or no such data at all. As yet, the entire range of reconstructive treatment has witnessed insufficient investigations relating treatment to its effect on QoL or satisfaction. This is an area that needs to be expanded as a way of quantifying the effect of treatment choices.
Clinical Oral Implants Research 07/2007; 18 Suppl 3:168-88. · 2.51 Impact Factor
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ABSTRACT: This study was carried out to determine whether inexperienced dentists can provide two-implant overdentures that are as satisfactory and of the same cost as those provided by experienced prosthodontists.
Edentulous elders were enrolled in a randomized controlled clinical trial to compare the effects of mandibular conventional and two-implant overdentures on nutrition. They were randomly assigned to groups that were treated by either an experienced prosthodontist or by a newly-graduated dentist with minimal training in implant treatment. Data for this study were obtained during the treatment of the first 140 subjects enrolled. The change in patient ratings of satisfaction after treatment, laboratory costs and the number of unscheduled visits up to 6 months following prosthesis delivery were compared.
Satisfaction was significantly higher with implant overdentures than with conventional dentures, but there were no differences in scores for either prosthesis between the groups treated by experienced specialists or new dentists. Furthermore, six of the seven inexperienced dentists reported that they found the mandibular two-implant overdenture easier to provide than the conventional denture.
The results of this study suggest that general dentists can provide successful mandibular two-implant overdentures with minimal training.
Journal of Dentistry 12/2006; 34(10):796-801. · 2.95 Impact Factor
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ABSTRACT: Trauma to oral soft tissues in comatose patients may be more widespread than reported, as no extensive study of this problem has been conducted. Various appliances for the prevention of self-inflicted injuries to oral tissues particularly in children and the physically and mentally challenged have been documented, but there is little information on their use in adult comatose patients. Because comatose patients lack cerebral control of the masticatory cycle, they can easily injure themselves. Although it is not uncommon for patients with a decreased level of consciousness and in need of intensive care to be restrained to prevent injury due to involuntary movement of the limbs, head and neck restraint is often difficult and may be dangerous to the patient. This case report presents a simple solution to the problem of self-inflicted trauma to oral tissues.
Journal (Canadian Dental Association) 11/2005; 71(9):661-4. · 1.00 Impact Factor
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ABSTRACT: To determine the impact of mandibular two-implant overdentures or conventional complete dentures on leisure and sexual activities.
One hundred and two subjects, aged 35-65 years, received either mandibular overdentures retained by two implants (IOD; n=54) or new mandibular conventional complete dentures (CD; n=48) in a randomized controlled clinical trial. A Social Impact Questionnaire was used to assess the impact on social and sexual activity including avoiding conversation, refusing invitations, avoiding sport and feeling uneasy when kissing and in sexual relationships, and the looseness of the prostheses during such activities. Ratings were recorded on categorical scales at baseline and 2 months after treatment. Oral health related quality of life was measured with the Oral Health Impact Profile (OHIP). Between and within group comparisons were carried out using regression models. The correlation between post-treatment OHIP scores and the leisure and sexual impact items was assessed.
Two months after delivery of the prosthesis there was significant improvements in the IOD group for looseness when eating, speaking, kissing and yawning. The IOD group reported significantly less post treatment looseness than the CD group for all parameters investigated (p<0.0001). IOD subjects felt less uneasy kissing and less uneasy during sexual activity than CD subjects. Correlations between the two sexual activity items (uneasiness when kissing and during sexual relations) and the OHIP scales were weak.
Edentulism has a negative impact on social and sexual life. Mandibular overdentures provide greater improvement in of unease in intimate activities than new conventional mandibular dentures.
Journal of Dentistry 10/2005; 33(8):649-57. · 2.95 Impact Factor
