Article

Patient Reported Outcome Measures (PROMs) and maintenance events in 2‐implant supported mandibular overdenture patients: A five‐year prospective study

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Abstract

Objective To prospectively evaluate Patient Reported Outcome Measures (PROMs) and treatment outcomes of mandibular two‐implant retained overdentures (IOD) in an edentulous geriatric cohort with history of deficient Complete Dentures (CD). Materials and Methods 103 patients with deficient CD received new optimal CD. After a period of 3 months, 80 of the patients voluntarily received IOD. Outcomes collected at pre‐, post‐CD/post‐IOD treatment annually up to 5 years, included: A) Clinical outcomes: denture‐quality (Woelfel's index), complications, and maintenance events, B) PROMs: patient complaints (maxillary, mandibular functional complaint scores, generic aesthetic complaint scores, frequency, and intensity of complaints) and patient satisfaction, C) Maintenance events: technical complications and adverse events. Results 5 years data were collected from 67 patients (mean age at initiation =71.3 years, mean observation=5.9 years) with cumulative implant survival‐rate=98.72%. Multiple comparisons for 8 time‐points showed significant improvements in denture‐quality and PROMs after new CD and IOD delivery. Further significant improvements were only after IOD delivery in: mandibular denture‐quality, mandibular and generic functional complaints, frequency, intensity of complaints, and overall patient satisfaction score. Thereafter, denture‐quality and PROMs remained stable. Maintenance events clustered on 1st year and within a minority of patients. Technical complications and overall maintenance events significantly correlated with overall patient satisfaction score at 1st year. Conclusions Mandibular IOD was a beneficial treatment option for seniors with history of deficient CD, improving denture‐quality, patient satisfaction, and reducing patient complaints up to 5 years. Maintenance events clustered on 1st year, showing no significant impact on long‐term patient satisfaction and other PROMs. This article is protected by copyright. All rights reserved.

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... The study population consisted of 6724 subjects, with a mean age of 65.96 ± 8.12 (range 35-92 years, 55.9% females). Smoking status was reported in nine papers (Dierens et al., 2009;Jofre et al., 2013;Karbach et al., 2015;Ettl et al., 2016;Pozzi et al., 2016;Matthys, Vervaeke, Jacquet, & De Bruyn, 2018;Toia et al., 2019;Zhang et al., 2019;Higuchi et al., 2020), and 20% subjects were reported to be smokers (range 0%-58%). The split in relation to the extent of tooth loss was as follows: ...
... Manuscripts exclusively reporting on a population of patients affected by periodontitis were not found. Some studies reportedeither in the manuscript or after contacting the authors-the inclusion of some patients affected by periodontitis (Allen & McMillan, 2003;Dierens et al., 2009;Shigli & Hebbal, 2010;Erkapers et al., 2011;Petricevic et al., 2012;Jofre et al., 2013;Müller et al., 2013;Hoeksema et al., 2017;Ribeiro et al., 2017;McKenna et al., 2018;Reissmann et al., 2018;Zhang et al., ...
... In total, 13 studies formally included subjects with a history of periodontitis (Allen & McMillan, 2003;Dierens et al., 2009;Shigli & Hebbal, 2010;Erkapers et al., 2011;Petricevic et al., 2012;Jofre et al., 2013;Müller et al., 2013;Hoeksema et al., 2017;Ribeiro et al., 2017;McKenna et al., 2018;Reissmann et al., 2018;Zhang et al., 2019;Higuchi et al., 2020). Adequate information on the stage of the disease, the reasons for tooth loss, and the exact number of patients affected by periodontitis was not reported in these studies. ...
Article
Aim To investigate the effect of rehabilitation in fully/partially edentulous patients with stage IV periodontitis on oral-health-related quality of life (OHRQoL) and systemic health. Materials and methods A systematic electronic and manual search was conducted. Three authors independently reviewed, selected, and extracted the data. Outcomes were OHRQoL (Oral Health Impact Profile 14 [OHIP-14] and OHIP-49, General Oral Health Assessment Index [GOHAI], visual analogue scale, symptoms registration) and systemic health-related outcomes (incidence and prevalence of systemic diseases, values of systemic disease indicators). Qualitative data were synthesized for OHRQoL and systemic health-related outcomes. Meta-analysis was conducted on available quantitative data. Results The search identified 59 articles (6724 subjects in total). OHRQoL improved across all the studies, irrespective of the number of missing teeth, their location, or treatment modality. Meta-analysis showed significant improvement of OHIP-49 (36.86, p < .01) in manuscripts including subjects affected by periodontitis, consistently with the remaining literature (reduction of score points post rehabilitation: OHIP-14 = 10.52, OHIP-49 = 56.02, GOHAI = 5.40, p < .01 for all). Non-rehabilitated subjects exhibited inferior cognitive status, higher medication intake, and frailty. However, our data are limited and should be interpreted with caution. Conclusions Oral rehabilitation improves OHRQoL and, potentially, systemic health in edentulous patients. It is unclear whether these findings may be extrapolated to patients with stage IV periodontitis.
... Moreover, there are no evidencebased guidelines as to what level of maintenance care should be anticipated or what would constitute excessive aftercare. 15 Meanwhile, patients using MO who experienced prosthesis-related complications and those who were concerned about potential complications reported lower OHRQoL scores compared to those without complications. 16 However, MO significantly improved patient satisfaction, reduced patient complaints, and improved patientreported outcomes achieved when they remained stable for at least 5 years; most technical complications and maintenance events were clustered in the first year and were significantly correlated with overall patient satisfaction after 1 year. ...
... 16 However, MO significantly improved patient satisfaction, reduced patient complaints, and improved patientreported outcomes achieved when they remained stable for at least 5 years; most technical complications and maintenance events were clustered in the first year and were significantly correlated with overall patient satisfaction after 1 year. 15 However, despite all the benefits that MO bring to patients' lives, the prosthodontic maintenance involved in MO treatment has a significant impact on the clinical and laboratory expenses of this treatment and can influence patient satisfaction with the treatment over time. Therefore, it is essential to prospect the maintenance needs in order to ensure treatment success and avoid unexpected events that affect the relationship between the dental surgeon and the patient. ...
Article
Full-text available
Abstract This longitudinal study aimed to assess the performance of the Facility-Equator system as mandibular overdenture (MO) retainers from a prosthetic perspective during 2 years of loading and to investigate the oral health-related quality of life (OHRQoL) and whether prosthetic events can affect the OHRQoL. Twenty-four patients (68.1 ± 7.51 years) reported their OHRQoL through the Geriatric Oral Health Assessment Index (GOHAI) and Oral Health Impact Profile (OHIP-EDENT) questionnaires before MO loading and after 1 and 2 years of usage. Prosthetic occurrences were recorded during this period. Data were analyzed using the Wilcoxon test, Mann-Whitney test, and Spearman correlation coefficients. Of the 127 prosthetic events that occurred in the first year, the most frequent events were prosthesis adjustments (16.5%), dislodgement of the Equator attachment (14.17%), and O-ring replacement (11.8%). Eighty-seven prosthetic events were recorded in the second year, the most frequent events being prosthesis adjustments (27.6%), O-ring replacement (20.7%), and recapturing the female matrix (11.5%). All domains of the GOHAI and OHIP-EDENT questionnaires exhibited a significant difference (p < 0.05) between the baseline and 1- and 2-year evaluations, except in the Social Disability and Psychological Discomfort domains (p > 0.05) of OHIP-EDENT after 1 year. Complications related to prosthetic maintenance, such as fracturing of the prosthesis, Equator dislodgement, prosthesis rebasing, and new overdenture confection, affect the OHRQoL (p < 0.05), primarily the Physical Pain and Discomfort domains, especially in the first year of MO loading.
... More recently, Feine et al., 35 as part of Group 3 of the 6th ITI Consensus Conference concluded that in general, patients are very satisfied with the esthetics of implant-supported restorations and the surrounding mucosa. 36 The current findings suggest that certain patient opinions, perceptions, and characteristics related to oral hygiene measures are significantly associated to the diagnosis of the peri-implant condition. In general, these factors seem to discriminate between healthy conditions and PM, and thus between health and disease. ...
... In fact, it has been suggested that patient function and satisfaction are potentially influenced by complications and adverse events related to their implant-supported restorations. 36 ...
Article
Background: Dental plaque biofilm is considered to be the underlying cause of peri-implant diseases. Moreover, it has been corroborated recently the association between the presence of these diseases and deficiently designed implant-supported prostheses. In this regard, professional-administered oral hygiene measures have been suggested to play a dominant role in prevention. Material and methods: A cross-sectional study was conducted in dental implant patients according to accessibility for self-performed oral hygiene using a 0.5mm interproximal brush. Periodontal and peri-implant status were assessed based on clinical and radiographic variables to determine the prevalence of peri-implant diseases. In addition, the participants completed a questionnaire on the efficiency and accessibility for self-performed proximal hygiene. Associations of descriptive data were analyzed using the chi-squared test and Mann-Whitney U-test. Correlations of the variables with the primary outcome (accessibility) were assessed by means of generalized estimation equations and multilevel logistic regression models. Results: Based on an a priori power calculation, a total of 50 patients (171 implants) were consecutively recruited. From these, 46% of the prostheses allowed proper access for performing proximal hygiene while 54% of the prostheses precluded proper access. Poor access for proximal hygiene displayed tendency towards statistical significance with peri-implant disease (OR = 2.31; p = 0.090), in particular with peri-implant mucositis (OR = 2.43; p = 0.082) when compared to good access. In addition, an association was observed to increased levels of mucosal redness (p = 0.026) and the full-mouth bleeding score (p = 0.018). On the other hand, the presence of peri-implant disease was related to self-reported assessment of oral hygiene measures (p = 0.015) and to patient perception of gingival/mucosal bleeding when performing oral hygiene (p = 0.026). In turn, the diagnosis of peri-implant disease was significantly associated to the quantity and quality of information provided at the time of implant therapy (p = 0.004), including the influence of confounders upon disease occurrence (p = 0.038) CONCLUSIONS: To a certain extent, accessibility for self-performed proximal hygiene is associated to the peri-implant condition. On the other hand, the information received by the patient from the dental professional is essential for self-monitoring of the peri-implant conditions and for alerting to the possible presence of disorders. This article is protected by copyright. All rights reserved.
... Indeed, many clinicians advocate pre-planning a 'minimum' maintenance schedule from this early stage, both to maintain peri-implant health as well as ensure maintenance of the prosthesis and patient-reported outcomes. 46,47 Biological complications Routine monitoring of peri-implant health is recommended as per the current British Society of Periodontology guidelines. 48 This involves detailed four-or six-point pocket charting at implant sites at all recall appointments, along with assessments for bleeding and suppuration. ...
Article
The ability to provide high-quality complete dentures is a key skill for the general dental practitioner. The introduction of new implant attachments and dental technologies has opened the possibility of a wide variety of treatment options when considering implant-supported overdentures (ISODs). A thorough understanding of the advantages and disadvantages of ISODs is essential to ensuring appropriate treatment planning, consent and maintenance. Part one of this paper discussed the role of ISODs and the different attachment systems available. This second part will explore the relevant treatment planning considerations and maintenance requirements.
... Dental implants are a valuable addition to the treatment options for partially and fully edentulous patients [1,2]. However, in addition to technical complications such as ceramic chipping, screw loosening, fractures of the superstructure or the implant, dental implants may be colonized by diverse pathogenic microbial biofilms that strongly contribute to peri-implant complications. ...
Article
Full-text available
Background: The prevalence of peri-implantitis ranges between 7 and 38.4% depending on risk indicators such as smoking, diabetes mellitus, lack of periodontal maintenance program, and history or presence of periodontitis. Currently, the possible effect of the type of superstructure on peri-implant health is unclear. This cross-sectional study aims to investigate the influence of the superstructure on the prevalence of peri-implant mucositis, peri-implantitis and peri-implant dysbiosis. Methods: During a 32-month recruitment period dental implants were assessed to diagnose healthy peri-implant tissues, mucositis or peri-implantitis. The study included 1097 implants in 196 patients. Out of all peri-implantitis cases 20 randomly chosen submucosal biofilms from implants with fixed denture (FD) originating from 13 patients and 11 biofilms from implants with removable dentures (RD) originating from 3 patients were studied for microbiome analysis. Composition of transcriptionally active biofilms was revealed by RNAseq. Metatranscriptomic profiles were created for thirty-one peri-implant biofilms suffering from peri-implantitis and microbiome changes associated with superstructure types were identified. Results: 16.41% of the implants were diagnosed with peri-implantitis, 25.00% of implants with RD and 12.68% of implants with FD, respectively. Multivariate analysis showed a significant positive association on patient (p = < 0.001) and implant level (p = 0.03) between the prevalence of peri-implantitis and RD. Eight bacterial species were associated either with FD or RD by linear discriminant analysis effect size method. However, significant intergroup confounders (e.g. smoking) were present. Conclusions: Within the limitations of the present work, RDs appear to be a risk indicator for peri-implantitis and seem to facilitate expansion of specific periodontopathogens. Potential ecological and pathological consequences of shift in microbiome from RDs towards higher activity of Fusobacterium nucleatum subspecies animalis and Prevotella intermedia require further investigation.
... 17 Varios estudios clínicos controlados aleatorios han demostrado que las sobredentaduras se asocian a una mayor satisfacción de parte del paciente, mejor la calidad de vida y más capacidad masticatoria, en comparación con las PTR. [18][19][20] La cantidad de implantes recomendada para la confección de una prótesis sobredentadura inferior es una cuestión controversial. Indudablemente, lo ideal es colocar la menor cantidad necesaria para el mayor beneficio posible. ...
Article
Full-text available
Resumen Objetivo: Evaluar el porcentaje de implantes oseointe-grados colocados en pacientes edéntulos para la confección de sobredentaduras inferiores, en el marco de la formación de recursos humanos. Materiales y métodos: Se analizaron las historias clínicas de los pacientes que recibieron dos implantes den-tales inferiores para la confección de sobredentaduras en el servicio de residentes de la carrera de Especialización en Cirugía y Traumatología Bucomaxilofacial de la Facultad de Odontología de la Universidad de Buenos Aires, entre agosto de 2012 y diciembre de 2018. Se consideraron para el análisis el porcentaje de implantes oseointegrados y su relación con el tipo de operador (docente o residente), la situación del reborde óseo y el hábito de fumar. Resultados: De los 176 implantes colocados en 88 pacien-tes (edad promedio = 67 años), a los 3-4 meses el 98% se hallaba oseointegrado. No se encontró una relación estadísticamente sig-nificativa entre el tipo de operador y el fracaso (P>0,99). Conclusión: En un servicio de formación, la tasa de éxito, evaluada en la segunda cirugía, de dos implantes den-tales colocados en el maxilar inferior para sobredentaduras fue de 98%. No se hallaron diferencias entre los resultados logrados por residentes y docentes del servicio.
... Zhang et al., 2017), providing a treatment with les morbidity to the patient or, as we already addressed, with an easier maintenance (Y. Zhang et al., 2019). ...
Article
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Background The World Health Organization (WHO) recognizes edentulism as a physical impairment that results in a negative impact in the daily activities. Objective The study aimed to compare the satisfaction and the quality of life, in patients treated with implant retained overdentures with two mandibular implants (IOD) against those with mandibular conventional complete dentures (CCD). Methods Different search strategies were used to screen for articles in Pubmed/Medline, Cochrane Library and Scielo of the last 17 years (2003–2020). The keywords used were: “quality of life OR satisfaction” AND “complete denture OR conventional denture” AND “overdenture OR implant retained.” Results Six articles and two more were added by manual search. The population was 400 in the CCD and 412 for IOD. The mean age was 64.3 ± 6.41 years. The group was comprised of 283 men and 427 women. The scores obtained in the visual analog scale (VAS) before and after the treatment were statistically significant in favor of the IOD for overall satisfaction, (WMD: 12.329; 95% CI: 4.873 to 19.784, p‐value = 0.001), comfort, speech and stability. For esthetics and chewing there was non‐significant improvement while hygiene worsened for the IOD. For the comparison after the treatment between both treatment modalities a statistically significant improvement was found in overall satisfaction (WMD: 14.408; 95% CI: 8.589 to 20.226, p‐value < 0.001), comfort, speech, chewing and stability in favor of the IOD but not in esthetics or hygiene. Conclusions This systematic review and meta‐analysis show the superiority of the IOD, despite is not achieved in all aspects.
Article
Statement of problem Immediately loaded mandibular overdentures are clinically acceptable treatment options that have gained popularity because their use shortens the treatment duration. However, whether the immediate loading of dental implants can match the prosthetic events, satisfaction, and quality of life of delayed loading is still unclear. Purpose The purpose of this systematic review and meta-analysis was to compare the prosthetic events, satisfaction, and quality of life of immediate versus delayed loading implants in patients rehabilitated with mandibular overdentures. Material and methods This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and was registered at The International Prospective Register of Systematic Reviews (PROSPERO) (CRD42021258187). Electronic searches were carried out by 2 independent reviewers in the PubMed/MEDLINE, Cochrane Library, and Web of Science databases up to May 2021. Only randomized clinical trials and prospective studies with at least 10 participants that compared immediate versus delayed loading were selected. A meta-analysis was performed by using the RevMan 5 software program for complications and maintenance outcomes. Results Seven articles were included in the qualitative analysis, and 4 were included in the quantitative analysis. The meta-analysis demonstrated no significant difference between immediate and delayed loading for prosthetic complications (RR=1.71; 95% CI=0.67-4.37; I²=85%, P=.27) or maintenance (RR=1.92, 95% CI=0.44-8.28; I²=94%, P=.38). Conclusions Although the prosthetic complications and maintenance were more likely to favor the delayed loading group, available evidence showed no statistical difference for prosthetic complications and maintenance between immediate loading and delayed loading in mandibular overdentures.
Article
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Dental implants have become a mainstream treatment approach in daily practice, and because of their high survival rates over time, they have become the preferred treatment option for prosthetic rehabilitation in many situations. Despite the relatively high predictability of implant therapy and high costs to patients, patient perceptions of success and patient‐reported outcome measures have become increasingly significant in implant dentistry. Increasing numbers of publications deal with oral health‐related quality of life and/or patient‐reported outcome measures. The aim of this paper was to provide an overview of the available evidence on oral health‐related quality of life of fully and partially dentate patients rehabilitated with fixed and removable implant‐supported dental prostheses. A comprehensive electronic search was performed on publications in English up to 2021. A selection of standardized questionnaires and scales used for the evaluation of oral health‐related quality of life were analyzed and explained. The analysis encompassed three aspects: a functional evaluation of oral health‐related quality of life, an esthetic assessment of oral health‐related quality of life, and a cost‐related evaluation of oral health‐related quality of life for rehabilitation with dental implants. The data demonstrated that the preoperative expectations of patients markedly affected the outcomes perceived by the patients. As expected, reconstructions supported by implants substantially improved the stability of conventional dentures and allowed improved function and patient satisfaction. However, from a patient's perspective, oral health‐related quality of life was not significantly greater for dental implants compared with conventional tooth‐supported prostheses. The connection of the implants to the prostheses with locators or balls indicated high oral health‐related quality of life. The data also suggest that patient expectation is not a good predictor of treatment outcome. In terms of esthetic outcomes, the data clearly indicate that patients’ perceptions and clinicians' assessments differed, with those of clinicians yielding higher standards. There were no significant differences found between the esthetic oral health‐related quality of life ratings for soft tissue‐level implants compared with those for bone‐level implants. Comparison of all‐ceramic and metal‐ceramic restorations showed no significant differences in patients’ perceptions in terms of esthetic outcomes. Depending on the choice of outcome measure and financial marginal value, supporting a conventional removable partial denture with implants is cost‐effective when the patient is willing to invest more to achieve a higher oral health‐related quality of life. In conclusion, the oral health‐related quality of life of patients rehabilitated with implant‐supported dental prostheses did not show overall superiority over conventional prosthetics. Clinicians' and patients' evaluations, especially of esthetic outcomes, are, in the majority of cases, incongruent. Nevertheless, patient‐reported outcomes are important in the evaluation of function, esthetics, and the cost‐effectiveness of treatment with implant‐supported dental prostheses, and should be taken into consideration in daily practice.
Article
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Article
Statement of problem Patients and clinicians are aware of the efficacy and benefits of complete dentures, but evidence regarding their longevity is limited. Purpose The purpose of this systematic review was to examine the literature describing the longevity of complete dentures and to review variations in longevity by denture type and duration of follow-up. Material and methods Four electronic databases were searched by using key terms: MEDLINE, CINAHL (EBSCO), Dentistry and Oral Sciences Databases, and The Cochrane Library. Studies meeting the inclusion criteria were reviewed according to an established protocol and data extracted. Reference lists of identified studies were examined. Risk of bias was assessed by using the AXIS tool. Weighted means and weighted standard deviations were calculated. Pooled complete denture failure proportions were estimated by using random effects models based on the DerSimonian and Laird method. Results The search yielded 21 607 unique abstracts, of which 273 met the inclusion criteria. Assessment of the full-text articles reduced this number to 42. Of these, 24 studies were rated as having low risk of bias and 18 as very low. The weighted mean ±standard deviation longevity of maxillary complete dentures was 10.3 ±3.8 years, of mandibular dentures was 8.6 ±2.6 years, and of both maxillary and mandibular dentures was 10.8 ±4.7 years. The pooled failure proportion for complete dentures observed for 2 years or less was 0.05 (95% confidence interval [CI]: 0.00-0.10), 5 to 6 years was 0.12 (95% CI: 0.08-0.16), and 10 years or more was 0.41 (95% CI: 0.28-0.53). Conclusions Complete dentures, fabricated primarily in university settings, were found to have a weighted mean ±standard deviation longevity of 10.1 ±4.0 years. The failure rate of these prostheses increased with denture age, and the longevity of maxillary dentures was greater than that of mandibular dentures.
Article
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Objective The aim of this systematic review was to compare patient‐reported outcomes measures (PROMs) of implant‐supported fixed complete dentures (IFCDs) and overdentures (IODs). Material and methods PubMed, Cochrane Library, EMBASE, Scopus and Web of Science were searched, complemented by manual search. Studies published in English up to November 2016 comparing removable with fixed implant‐supported prosthesis on fully edentulous patients were included. The review focused on impact on patients’ oral health‐related quality of life (OHRQoL), satisfaction or other patient‐reported outcomes measures. Results Of 1,563 initially screened articles, 13 studies including 8 prospective and 5 retrospective studies fulfilled the inclusion criteria. OHRQoL and patient satisfaction were the most common PROMs. When evaluating the levels of evidence, five of thirteen studies were graded as level III and seven reached level II. The only randomized control trial was rated as Ib. The methods used to evaluate PROMs were heterogeneous among studies, and there was a lack of standardization in the measurements employed. In general, IFCD and IOD showed no significant differences when compared for PROMs, with a slight trend of IFCD being superior to IOD in most included studies. However, conflicting results were observed in many aspects such as chewing function, phonetics‐related function, overall satisfaction and aesthetics. Conclusions Inconsistent results were observed in PROMs when comparing IFCD and IOD for fully edentulous patients. A guideline for standardizing the assessment of PROMs in clinical research is needed in order to produce more meaningful evidence‐based information.
Article
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Purpose: The purpose of this within-subject crossover clinical trial was to compare and evaluate the chewing efficiency, masticatory bite force, and patient satisfaction with conventional dentures and two implant-retained mandible overdentures after 4 weeks of usage. Method: This within-subject crossover clinical trial was carried out in the Department of Prosthodontics in K.D Dental College and Hospital. A total 15 patients were selected for the study. To report the changes in chewing efficiency by chewing 6gms of peanuts with 40 chewing strokes and comparing the particle size of the chewed material between two implant retained mandibular overdenture with that of conventional denture using micro vu excel gantry type visual measurement machine. To report changes in masticatory bite force after transition of conventional complete denture patient to implant retained overdenture after using the prosthesis for four weeks each and recorded by digital transducer. To assess the patient satisfaction after transition of conventional complete denture patient to implant retained mandibular overdenture with help of OHIP edent patient satisfaction questionnaire. Results: The chewing efficiency for implant retained overdenture increased significantly than that of conventional denture. The particle size decreased to 76.34% for implant supported overdenture than that of conventional denture. The chewing strokes required by conventional denture was 69 strokes and that by implant supported overdenture which was 40 strokes to get the same mean particle size. The patients satisfaction after receiving the implant retained overdenture was significantly higher than that of complete denture. Conclusion: The provision of two mandibular implants significantly improves measures of oral function and better quality of life for edentulous patients.
Article
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Statement of problem Circumferential marginal bone around 2 splinted and nonsplinted immediately loaded implants in the edentulous mandible has not been previously investigated. Purpose The purpose of this randomized controlled clinical trial was to assess circumferential bone loss around splinted and nonsplinted immediately loaded implants retaining mandibular overdentures, using cone beam computed tomography (CBCT). Material and methods Thirty participants with complete edentulism were allocated to 2 groups and received 2 implants in the canine region of the mandible. Implants were either left nonsplinted (with ball attachment [BA]) or splinted (with bar attachment [RA]). Mandibular overdentures were connected to the implants 1 week later. CBCT was used to evaluate vertical bone loss (VBL) and horizontal bone loss (HBLo) bone loss at the distal (D), buccal (B), mesial (M), and lingual (L) sites of each implant upon overdenture insertion (baseline, T0), 1 year (T1) and 3 years (T3) after insertion. Repeated measures ANOVA was used for statistical analysis (α=.05). Results No significant difference in the survival rate (93.3% for BA and 100% for RA) was found between groups (P=.156). VBL and HBLo increased significantly at T3 compared with T1 for both groups (P<.005). After 3 years, VBL were 1.36 ±0.57 mm and 1.0 ±0.44 mm and HBLo were 0.88 ±0.48 mm for BA and 0.77 ±0.53 mm for RA. At T1 and T3, BA had more significant VBL than RA (P<.001), while HBLo did not differ significantly between groups. For both groups, a significant difference was found in VBL and HBLo between implant sites (P<.001). The B site recorded the highest VBL, and the L site recorded the lowest VBL. The M and D sites recorded the highest HBLo, and the B and L sites recorded the lowest HBLo. Conclusions Two nonsplinted immediately loaded implants retaining mandibular overdentures were associated with significantly higher vertical and horizontal circumferential bone loss than those associated with splinted implants after a follow-up of 3 years.
Article
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PurposeThis study aimed to evaluate patient satisfaction and prosthetic aspects during a 5-year prospective clinical study of mini dental implants (MDIs) retaining mandibular overdentures.Materials and methodsThis observational prospective clinical study was conducted on a group of completely edentulous patients (n = 28) with retention problems of conventional mandibular dentures. All patients received new maxillary and mandibular conventional dentures. A total of 112 MDIs (four per patient) were inserted using the flapless surgical approach and immediately loaded by the new mandibular dentures (overdentures). Patients indicated satisfaction with their prosthesis using a questionnaire and a visual analogue scale (VAS). Patient satisfaction and prosthetic complications were recorded 6 months (T6 m), 1 (T1), 3 (T3), and 5 (T5) years after overdenture insertion.ResultsThe patient satisfaction with eating (hard/soft) food (P < 0.001), talking (P < 0.001), appearance (P = 0.001), comfort (P < 0.001), healing process (P = 0.013), socialization (P < 0.001), stability/retention of mandibular dentures (P = 0.001), ease of oral hygiene (P = 0.008), and ease of handling the dentures (P < 0.001) increased significantly with time. After 5 years, the most common complication was wear/damage of O/rings (n = 235), O/ring replacement (n = 125), maxillary denture relining times (n = 13), worn teeth (n = 10), overdentures relines (n = 10), detachment of the metal housings (n = 9), and fracture of mandibular overdentures (n = 8). Mucositis, soreness, and decubitis ulcer under overdenture occurred most often at T6 m and decreased significantly with time (P = 0.002, 0.005, and 0.024, respectively).Conclusion Within the limitations of this clinical study, patient satisfaction with mini-implant retained mandibular overdentures increased significantly with time. However, this treatment required a considerable amount of prosthetic maintenance and repair after 5 years of service.
Article
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Abstract Aims: To evaluate survival rates of dental implants in patients wearing maxillary and mandibular overdentures in relation to age, sex, smoking, implant splinting or non-splinting, the maxilla rehabilitated and number of implants per dental arch. Methods: This was a prospective study of patients who were completely edentulous in either mandible or maxilla or both, rehabilitated with implant-retained overdentures, with a follow-up of at least three years. Results: 95 patients with 107 overdentures supported by 360 implants were included in the study. Rehabilitations were monitored over an average of 95±20.3 months (range 36-159). Implant survival in the maxilla was 91.9% and in the mandible 98.6%, representing a statistically significant difference (p<0.05). Age, sex and implant splinting did not influence survival rates significantly. Smokers presented a lower survival rate. Implant numbers in the maxilla had a significant influence on survival, 100% for six but 85.7% for four. Three mandibular implants achieved higher survival rates (100%) but with two (96.6%) or four (99%) survival was lower, although without significant difference. Conclusion: Long-term results suggest that three-implant mandibular overdentures have an equivalent survival rate to four-implant. In the maxilla, results showed that six implants may be the best treatment strategy. For smokers with fewer implants retaining the overdentures, there were higher numbers of implant failures.
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The demographic, health, and mental functioning characteristics of nonresponders to a community-based cross-sectional study of cognitive functioning among the elderly in Amsterdam, the Netherlands (Amsterdam Study of the Elderly (AMSTEL), October 1990 to May 1991), were examined and compared with responders. The randomly selected age-stratified (65-74, 75-84 years) sample was drawn from nonresponders listed with a subsample (n = 8) of general practitioners whose lists served as the sampling frame for the main study. The general practitioners approached and interviewed the responding nonresponders using the same standardized questions that were used in the main study. Nonresponders (n = 115) and responders (n = 999) from the same medical practices were compared by means of chi-square and odds ratios. Compared with responders, these nonresponders more often reported a history of psychiatric illness, heart attack, stroke, and diabetes, and were more likely to be unmarried, to have a lower education, and to do poorly on the cognitive test (odds ratio = 1.6, 95% confidence interval 1.0-2.6). Most significant physical and mental health differences by response status were seen among the persons aged < 75 years and not among those aged > or = 75 years. The odds for poor cognitive test performance associated with age and stroke were relatively more biased than those associated with other risk factors. These results suggest that the characteristics of young-old and old-old elderly nonresponders to cross-sectional studies of cognitive function may differ, and that there may be selective nonresponse that could bias, to a different degree, estimates of risk for poor cognitive functioning. Studies should investigate the possibilities for nonresponse in their own setting.
Article
Objective: The purpose of this prospective clinical study was to determine whether reduced bone mineral density (BMD) is correlated with a higher risk for dental implant therapy in an elderly patient population. Material and methods: Seventy-nine patients recruited at the Prince Philip Dental Hospital were provided with 2-implant-supported mandibular overdentures. Skeletal BMD was recorded before the implant therapy. The World Health Organization Osteoporosis Diagnosis Classification (femoral neck score) was utilized to define the osteoporosis status of patients. Periapical radiographs were taken with a special radiographic holder at the time of implant loading (baseline) and at follow-up examinations. The mesial and distal marginal bone levels of each implant were measured. The mean marginal bone loss (mMBL) and greatest marginal bone loss (GBL) of four implant sites at patient level were recorded for data analysis. Clinical examination including plaque score (PI) and bleeding on probing (BOP) was recorded. Results: Of the 79 patients recruited in the study, the survival rate of implant was 98.7%. Sixty-three patients (79.7%) were finally available for data collection and statistical analyses. The mean follow-up time was 62.9 (SD = 15.2) months with the mean MBL 0.65 mm (SD = 0.67) and mean GBL 1.25 mm (SD = 0.83), respectively. The average BOP and PI of patients were 49.6% (SD = 30.8) and 47.4% (SD = 37.4). Only BOP was found significantly correlated with mMBL (r = 0.321, P = 0.01). Skeletal BMD was not associated with marginal bone loss (mean MBL: r = -0.094, P = 0.466; mean GBL: r = 0.04, P = 0.761). Conclusions: Within the limits of this study, osteoporosis was not a contraindication for implant therapy, and reduced skeletal BMD was not associated with increased marginal bone loss around implants or other complications in an elderly population.
Chapter
This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effects of no treatment, treatment with conventional removable complete denture, and treatment with implant-retained removable prosthesis for the rehabilitation of edentulous mandibles.
Article
Aim: To provide an update on the use of Patient-Reported Outcome Measures (PROMs) in the field of implant dentistry (1); to compare PROMs for prostheses supported by one or more implants to alternative treatment options or a healthy dentition (2). Materials and methods: The dental literature was searched on PubMed until December 31, 2014, using a general search algorithm. An overall quantitative analysis was performed, and a qualitative appraisal was made on the output of the last 6 years. Per type of edentulism and prosthetic treatment, the general search algorithm was refined in order to select controlled studies comparing PROMs for prostheses supported by one or more implants to alternative treatment options or a healthy dentition. Results: With nearly half of the output (300 of 635) published in the last 6 years, there is a growing interest in PROMs by the scientific community. When scrutinizing the 300 most recent publications, only 84 controlled studies could be identified among which 38 RCTs and 31 cohort studies. An "ad hoc" approach is commonly employed using non-standardized questions and different scoring methods, which may compromise validity and reliability. Overall, 39 eligible papers related to fully edentulous patients treated with an implant overdenture (IOD) and 9 to fully edentulous patients treated with a fixed implant prosthesis (FIP). There is plenty of evidence from well-controlled studies showing that fully edentulous patients in the mandible experience higher satisfaction with an IOD when compared to a conventional denture (CD). This may not hold true for fully edentulous patients in the maxilla. In general, fully edentulous patients seem to opt for a fixed or removable rehabilitation on implants for specific reasons. Data pertaining to partially edentulous patients were limited (FIP: n = 6; single implants: n = 16). In these patients, the timing of implant placement does not seem to affect patient satisfaction. Patients seem to prefer straightforward implant surgery over complex surgery that includes bone grafting. Conclusion: There is an urgent need for standardized reporting of PROMs in the field of implant dentistry. Fully edentulous patients in the mandible experience higher satisfaction with an IOD when compared to a CD. All other types of prostheses have been underexposed to research.
Article
The current rates of edentulism have been estimated to be between 7 percent and 69 percent of the adult population internationally. In the United States, while the incidence of edentulism continues to decline, rapid population growth coupled with current economic conditions suggest that edentulism and conventional denture use will continue at current or higher numbers. Unfortunately, evidence-based guidelines for the care and maintenance of removable complete denture prostheses do not exist. In 2009, the American College of Prosthodontists (ACP) formed a task force to establish evidence-based guidelines for the care and maintenance of complete dentures. The task force comprised members of the ACP, the Academy of General Dentistry, the American Dental Association Council on Scientific Affairs, the American Dental Hygienists' Association, the National Association of Dental Laboratories and GlaxoSmithKline Consumer Healthcare. The review process included the assessment of over 300 abstracts and selection of over 100 articles meeting the inclusion criteria of this review. The task force reviewed synopses of the literature and formulated 15 evidence-based guidelines for denture care and maintenance. These guidelines were reviewed by clinical experts from the participating organizations and are being published in The Journal of the American Dental Association for widespread distribution to the dental community. These guidelines reflect the views of the task force.
Article
Purpose: This study evaluated overdentures retained by mini-dental implants (MDIs) as a treatment option for complete edentulism during a 3-year follow-up period. Materials and methods: This observational clinical study included completely edentulous patients who were treated with MDI-retained overdentures. The MDIs were supplied by the manufacturer. Results: Twenty-three patients received 7 maxillary and 16 mandibular MDI overdentures retained by 110 MDIs. Of the 36 MDIs placed in the maxilla, 8 failed (in two patients), 2 had compromised survival, 3 displayed satisfactory survival, and 23 were successful. Of the 74 MDIs placed in the mandible, 11 displayed satisfactory survival and 63 were successful. The marginal bone loss was more pronounced for the MDIs placed mesially (intercalated), in areas of decreased ridge width and bone density, and with lower values of insertion torque. The overdentures fractured in seven patients; in 4 of them, this corresponded to the implant housing area. Self-reported reasons for patient dissatisfaction included occasional pain under the overdenture (n = 5) and instability of the maxillary antagonist complete denture (n = 4). Conclusion: Based on this research, considering its limitations, it is possible to conclude that survival rates and health status are better for MDI overdentures applied in the mandible than for those applied in the maxilla. The most severe prosthetic complications encountered were overdenture base fracture, matrix detachment, and instability of the maxillary antagonist denture.
Article
The current review was undertaken to obtain a better understanding of the knowledge base of implant-assisted complete dental prostheses (fixed and removable) in the treatment of the completely edentulous maxilla or mandible. Indications, advantages and disadvantages, complications and maintenance issues, as well as the cost-effectiveness of both treatments, are discussed to help clinicians in their therapeutic decision-making. In summary, when indicated and depending on the patients’ needs, both removable and fixed implant-assisted prostheses are highly safe, reliable and satisfactory treatment modalities for the rehabilitation of edentulous jaws. Careful and precise treatment planning is highly recommended to assist the clinician in preventing potential prosthetic failures. The review also reveals that there is still a need for data, generated using robust research methods, on some patient-based and clinical outcomes.
Article
Objective: The aim of the present prospective clinical study was to compare patient-reported outcomes for maxillary conventional dentures and maxillary implant-supported dentures. Material and methods: Twenty-one patients (6 women and 15 men) being edentulous in the maxilla and encountering problems with their existing dentures were included. Twelve patients (4 women and 8 men) received a new set of conventional dentures, due to insufficient dentures. In nine patients (2 women and 7 men), the existing dentures were adjusted by means of relining or rebasing. All patients received implant-supported dentures on two retentive anchors. In total, 42 implants were inserted in the anterior maxilla. The participants rated their satisfaction on their existing conventional dentures, 2 months after insertion of new conventional dentures and 2 months after insertion of implant-supported dentures. Thereby, patients responded to questionnaires capturing the oral health impact profile (OHIP) using visual analog scales. Seven domains (functional limitation, physical pain, psychological discomfort, physical, psychological and social disability and handicap) were assessed. Higher scores implied poorer patient satisfaction. In addition, the questionnaire involved the evaluation of cleaning ability, general satisfaction, speech, comfort, esthetics, stability, and chewing ability. Higher scores implied higher patient satisfaction. Results: Patient satisfaction significantly increased for implant-supported dentures compared with old dentures in all seven OHIP subgroups, as well as for cleaning ability, general satisfaction, ability to speak, comfort, esthetics, and stability (P < 0.05). The comparison of new conventional dentures and implant-supported dentures revealed a statistically significantly increased satisfaction for functional limitation (difference of 33.2 mm), psychological discomfort (difference of 36.7 mm), physical disability (difference of 36.3 mm), and social disability (difference of 23.5 mm), (P < 0.05). Additionally, general satisfaction, chewing ability, speech, and stability significantly improved in implant-supported dentures (P < 0.05). Conclusions: Within the limits of this study, maxillary dentures retained by two implants provided some significant short-term improvements over conventional dentures in oral- and health-related quality of life.
Article
Objective To investigate the biological and technical success outcomes of implant-supported fixed dental prostheses with and without cantilevers, after a minimum of one year loading. Material and methodsOne hundred and seven subjects with 128 cantilever FDPs (cFDP) supported by 132 implants were compared with 99 individuals with 144 non-cantilever FPDs (ncFDPs) supported by 203 implants. Outcomes such as marginal bone loss from FDP insertion to final follow-up as well as frequency and extent of biological and technical complications were investigated and correlated with patient, site, implant and FDP design characteristics. ResultsThe cFDPs were followed for average of 51months (1551days, SD977), and ncFPDs for 49months (1483days, SD +/- 809days). Implant survival and success rates were 96.7% and 87.9% for implant supporting cFDPs, and 99.5% and 92.6% for ncFDPs. There was no significant difference in overall bone loss between cFDPs and ncFDPs (cantilever side: 0.58, SD +/- 1.16 - non-cantilever side: 0.59, SD +/- 0.99), but implants in the cantilever group lost significantly more bone in the posterior mandible (0.50 SD +/- 1.3mm for cFDPs and 0.24 SD +/- 0.80mm for ncFDPs). Within the cantilever group, cantilever arm length and implant location had an influence on bone loss. Regardless of the presence of cantilever, implants associated with technical complications had a higher rate of biological complications as well. Furthermore, the length of the cantilever arm was positively correlated with implant failure, technical complications and bone loss 1.5mm (P=0.011, <0.001, and 0.007). Conclusion Overall implants can be successfully used to support cantilever FDPs. However, there are technical and biological implications which appear inter-related.
Article
The articles discussed in working group 3 dealt with specific aspects of clinical research. In this context, the literature reporting on survival and complication rates of implant-supported or implant-tooth supported restorations in longitudinal studies of at least 5 years were discussed. The second aspect dealt with the evaluation of aesthetic outcomes in clinical studies and the related index systems available. Finally, the third aspect discussed dealt with patient-reported outcome measures (PROMs). A detailed appraisal of the available methodology was presented.
Article
Purpose: This prospective study was performed to evaluate the outcomes of XiVE® S plus implants (Dentsply Friadent, Mannheim, Germany) following conventional restoration with bar structures and overdentures in the edentulous mandible. Materials and Methods: A total of 39 patients were treated with four interforaminal implants (n = 156) splinted by a Dolder bar. Overdentures were attached to the bars after 3 months of healing. As primary outcome measures, clinical and radiological parameters were evaluated at the time of implant placement (baseline) and once a year (1, 2, 3, 4, 5 years) after functional loading. Secondary outcome measures included (i) primary stability and surgical complications, as well as (ii) Periotest® (Medizintechnik Gulden, Modautal, Germany) values, implant survival, and prosthetic complications at baseline and follow-up. Results: A total of 156 implants were placed. The vast majority (n = 149) were tightened to >30 Ncm, while torques in the range of 20–30 Ncm were obtained in the remaining cases (n = 7). Mean crestal bone levels around the implants were 0.41 mm at baseline and 1.04/1.20/1.34/1.45/1.44 mm after 1/2/3/4/5 years respectively. The mean values of the plaque, calculus, bleeding, and mucosal indices remained low throughout this period. The reported follow-up periods involved one implant loss after 3 months (survival rate: 99.4%) and one implant failure after 4 years (success rate: 98.4%). Prosthetic complications included factures of bars (n = 3) and denture teeth (n = 7). Prosthetic survival was 100%. Conclusions: Dolder bars to restore oral implants in the edentulous mandible appear to offer a high rate of implant survival, good stability of the peri-implant tissue, and a low rate of prosthetic complications.
Article
To conduct an evidence-based review of patient-reported outcome measures (PROMs) in dental implant research among dentate patients so as to gain an understanding of the use of such measures, and the potential evidence that can be gleaned from such studies. A structured literature search was carried out in the MEDLINE database. Patient-related end-points in dental implant research were categorized with respect to type of outcome and reviewed. The initial search identified 3397 publications; full texts were obtained for 133 papers, and ultimately 31 'effective papers'. PROMs were primarily concerned with assessment of patient satisfaction/preference (71%, 22). A range of prosthetic treatments associated with dental implants were identified. Few studies were prospective studies that included pre-treatment assessments. There was a lack of standardization in the assessment of patient-related outcomes. There is an increasing use of PROMs in dental implant research among dentate patients for a range of prosthetic treatments. For the most part studies have been concerned with the assessment of patient satisfaction/preference but fail to employ standardized outcome assessment methods, which hampers understanding of the benefit of dental implant therapy from patients' perspectives.
Article
Complete edentulism is the terminal outcome of a multifactorial process involving biological factors and patient-related factors. It continues to represent a tremendous global health care burden, and will for the foreseeable future. The purpose of this review is to determine what comorbid factors exist for the completely edentulous patient. This literature review evaluated articles obtained via the National Library of Medicine's PubMed website, using keywords of edentulism with various combinations of the terms comorbidity, incidence, health, nutrition, cancer, cardiovascular health, diabetes, osteoporosis, smoking, asthma, dementia, and rheumatoid arthritis. Abstracts were selected and screened, and selected full-text articles were reviewed. Articles were limited to those with adequate patient cohorts and a minimum of 2-year follow-up data. Edentulism was found to be a global issue, with estimates for an increasing demand for complete denture prostheses in the future. Completely edentulous patients were found to be at higher risk for poor nutrition, coronary artery plaque formation (odds ratio 2.32), to be smokers (odds ratio 2.42), to be asthmatic and edentulous in the maxillary arch (odds ratio 10.52), to being diabetic (odds ratio 1.82), to having rheumatoid arthritis (odds ratio 2.27), and to having certain cancers (odds ratios varying from 1.54 to 2.85, depending on the type of cancer). Chronic residual ridge resorption continues to be the primary intraoral complication of edentulation, and there appear to be few opportunities to reduce bone loss in the edentulous patient. While the completely edentulous patient seems to be at risk for multiple systemic disorders, whether development of these disorders is causal or casual has not been determined. To minimize the loss of residual alveolar ridges, exemplary complete denture therapy, along with the establishment of routine recall systems, should be the ultimate goal of treatment of this patient cohort.
Article
Based on available investigations and current trends in oral rehabilitation published in the dental literature, an attempt is made to describe the possible future role of complete dentures. For edentulous patients, complete dentures have for long been the only prosthodontic treatment option. Whereas a large number of edentulous patients report satisfaction with denture usage, a smaller number are unable to adapt; for such patients, sophistication of clinical and technical processes or quality of denture-supporting tissues, appear to have little influence on patient-perceived outcomes. Since the 1980s, osseointegrated dental implants have dramatically improved the therapeutic possibilities, especially so for maladaptive patients. Those able to access such treatment can expect significant improvements in oral functional status and quality of life. While there is a downward trend in edentulism in several countries, it is region-specific, confirming the overriding influence of socio-economic factors on health status. In most societies, despite ageing populations, the need for complete dentures is not likely to reduce in the near future. Whereas a two- or even a one-implant overdenture for the edentulous mandible is increasingly regarded as a minimum standard of care in many developed countries, its routine prescription for the majority in the world who are disadvantaged is unrealistic; for them, even 'low-tech' therapies like conventional dentures are beyond their reach. Improving the conventional management of edentulous patients is a necessity and requires a keener focus by researchers, educators and clinicians in the developed world on the needs of populations with fewer resources.
Article
The purpose of this study was to investigate the relationship between satisfaction with complete dentures and several causal factors. One hundred thirty patients who received new dentures were investigated during their treatment. The results showed that 33% of the variance in satisfaction with dentures could be clarified by (1) the attitude toward dentures, (2) the quality of the dentures, (3), the oral conditions (opposite of what was expected), and (4) the number of previous dentures worn. Thus the patient's attitude toward dentures, measured by a questionnaire administered prior to his or her receiving new dentures, and the number of previous dentures worn, are prospective indicators for satisfaction with new dentures. The oral condition and the patient's personality seem to be unimportant factors, as measured by a neurotic lability scale and by a "health locus of control scale." Only 33% of the variance in satisfaction could be clarified by means of the variables used in the study. Thus satisfaction with dentures for most patients is individually determined and, for dentist and patient, is often unpredictable.
Article
This paper compares respondents and non-respondents from the community sample of the Saskatchewan Health Status Survey of the Elderly. Response bias was assessed by comparing the demographic characteristics and use of health care services of the two groups. A stratified two-stage area probability sample was drawn from a comprehensive sampling frame. There were 1614 subjects eligible; interviews were completed with 1267 (78.5%). In the very elderly (85 + years) cohort, disproportionately more urban dwellers and more males were interviewed; the sample was otherwise demographically representative of the elderly population. Non-respondents, especially the very elderly, used significantly more medical services than respondents, and had a higher number of hospital admissions. Non-respondents over age 75 experienced significantly longer average lengths of stay. On average, non-respondents used approximately 15% more hospital days. Non-respondents over age 75 appear to be more likely to experience ill health than respondents. Hence, statistics from this survey are conservative estimates of the ill health of the elderly.
Article
A total of 249 complete denture wearers were examined from a geriatric population of 610 patients in seven institutions in four different countries. The evaluation of denture quality was made by the patients' opinions and the examiners rankings with a questionnaire on interocclusal distance, occlusal function, extension, stability, comfort, and esthetics of the dentures. At each of the surveyed institutions, the patients consistently considered their dentures better than did the examiners and the maxillary dentures were rated better that the mandibular dentures by the clinicians and by the patients.
Article
In a within-subject cross-over clinical trial, psychometric and functional measurements were taken while 15 completely edentulous subjects wore mandibular fixed prostheses and long-bar removable implant-supported prostheses. In this paper, the results of a psychometric assessment are presented. Eight subjects first received the fixed bridge and seven the removable type. After having worn a prosthesis for a minimum of two months, subjects responded to psychometric scales that measured their perceptions of various factors associated with prostheses. They also chewed test foods while masticatory activity was recorded. The prostheses were then changed and the procedures repeated. At the end of the study, patients were asked to choose the prosthesis that they wished to keep. Patients assigned significantly higher scores, on visual analogue scales, to both types of implant-supported prostheses than to their original conventional prostheses for all factors tested, including general satisfaction. However, no statistically significant differences between the two implant-supported prostheses were detected except for the difficulty of chewing carrot, apple, and sausage. For these foods, the fixed prostheses were rated higher. Subjects' responses to category scales were consistent with their responses to the visual analogue scales. These results suggest that, although patients find the fixed bridge to be significantly better for chewing harder foods, there is no difference in their general satisfaction with the two types of prostheses.
Article
Clinicians reline or replace dentures to improve occlusion, stability, retention and facial support. They believe that well-fitting dentures will maintain supporting tissues in good health and satisfy patients by improving oral function and self-esteem. In this study, satisfaction of 21 patients with poorly fitting dentures was assessed before and after the dentures were modified to improve occlusion, vertical dimension of occlusion, and retention and stability or the dentures were replaced with new ones. More than 55% of the patients were moderately to fully satisfied with their poorly fitting dentures. Most patients perceived improvements in chewing comfort, chewing ability, eating enjoyment, food choices, security, and speech after each denture modification and with new dentures. The relative importance of the four sequential modifications could not be determined because they were made sequentially and their effects became cumulative. Chewing ability, eating enjoyment, particles under dentures, and food choices were highly correlated with chewing comfort and overall patient satisfaction. The results support the belief of many clinicians that patients benefit from relining of poorly fitting dentures or replacement with new dentures. Improvements in chewing function were perceived by most patients despite the lack of improvement in masticatory performance or masseter muscle activity with modified or new dentures. It is likely that denture wearers perceive chewing ability in terms of chewing comfort rather than ability to comminute food, an objective measure of chewing performance. The latter is not altered markedly by the clinical excellence of dentures.
Article
Previous research has shown that patients' evaluations of their prostheses correlate poorly with the clinicians' assessments, as well as with intraoral anatomic factors. It has been recommended that researchers conduct more studies that use patient satisfaction as the primary outcome measure in treatment evaluation and that more attention be paid to understanding exactly what measures of patient satisfaction represent. In this study, the relationship between patients' ratings of general satisfaction and their perceptions of different aspects of mandibular prostheses is investigated. One hundred and twenty subjects applied to participate in a randomized controlled clinical trial comparing two types of mandibular prostheses: conventional dentures and implant prostheses. At baseline, they were asked to rate on 100 mm visual analog scales (VAS) factors that edentulous patients indicated were important to them. These included comfort, ability to chew, stability, esthetics, ability to speak and ease of cleaning of their conventional dentures. Subjects were also asked to rate their general satisfaction with their dentures. In addition, they selected the one quality of their denture that they considered to be most important. Multiple regression methods revealed that gender, as well as patients' ratings of comfort, stability, esthetics, ability to chew and ability to speak with their prostheses contributed significantly to general satisfaction (F<0.0001). Furthermore, 89% of the variation in ratings of general satisfaction was explained by these factors. In addition, patients who considered ability to chew as the most important factor associated with their dentures rated their general satisfaction significantly higher than the other subjects (P=0.0003). Patient satisfaction with conventional dental prostheses is highly dependent on gender, and the appearance and functionality of the appliance. The combined effect of these factors explained most of the variation in the satisfaction ratings.
Article
No generally accepted method for classification of clinical quality of complete dentures exists. While various methods have been proposed, little effort has been made to test observer agreement. The purpose of this study was to test observer agreement in the clinical assessment of complete denture quality using a systematic classification. Fifty seven (57) complete denture-wearing patients were examined on two occasions separated by two weeks. Observer agreement was measured using Cohen's? (kappa). High levels of observer agreement were found for upper and lower retention and stability and for quality of retruded jaw relationship. High levels of operator agreement were found for a method for classification of clinical quality of complete dentures suggesting that the classification may be useful as a research tool.
Article
Distinct clinical parameters determine whether fixed or removable implant-supported prostheses are indicated to restore the edentulous maxilla. However, there is a strong belief that fixed implant prostheses meet with greater patient acceptance and satisfaction, but this may differ from the patients' perceptions, their psychological responses to treatment, and their assessments of the treatment outcome. This prospective clinical study compared the treatment outcomes of fixed and removable implant-supported restorations in the edentulous maxilla with the main emphasis on the patient's point of view. Material and methods: Twenty patients who requested an implant-supported superstructure to restore the edentulous maxilla were asked to complete a questionnaire measuring their satisfaction with the present situation and the psychologic impact of their oral health status with their responses marked on a Visual Analog Scale (VAS). Ten patients were treated with a fixed, screw-retained implant prosthesis (group 1), and 10 were treated with a removable, implant-supported and bar-retained overdenture (group 2). Six months after prosthetic rehabilitation, patients were again given the questionnaire to assess their psychologic well-being and satisfaction with the implant-supported restoration. Both prosthesis designs were associated with significant improvements in comfort and retention, function, esthetics and appearance, taste, speech, and self-esteem. No difference was found between the 2 groups with respect to how the patients assessed the implant therapy. However, the results indicated that patients in group 2 experienced greater differences between pretreatment and posttreatment scores for the parameters esthetics, taste, and speech. Treatment costs per unit were significantly higher in group 1 than in group 2. Patients in groups 1 and 2 were similarly satisfied with their implant-supported prostheses in the edentulous maxilla with regard to their well-being and the cost-utility, irrespective of whether the restoration was fixed or removable.
Article
To investigate the clinical and psychological outcomes with ball attachment supported mandibular overdentures on Branemark implants placed in a single stage surgical approach. MATERIAL AND METHODS Sixteen edentulous patients aged 32-74, with atrophic (flat) mandibular residual alveolar ridges, and a history of having difficulty coping with technically adequate mandibular dentures made within the last 2 years were recruited. Mark II Branemark implants were placed using a single stage surgical technique with healing abutments placed at time of surgery. Mandibular complete dentures were modified by relieving the areas over the abutments and a resilient liner was placed. After a period of 3 months, healing abutments were replaced with ball abutments and new complete dentures were made and the patients followed for a period of 2 years. Patients completed the General Health Questionnaire (GHQ) and answered further questions relating to the functional and psychological impact of complete denture wearing before treatment and 3 months after the dentures were provided. Patients additionally completed the GHQ 2 years after overdenture insertion. Six patients suffered from loss of one of their two implants in the first 2 years after placement. Three of the implants had failed to osseointegrate, which was detected at initial loading 3 months after placement. General Health Questionnaire scores were statistically significantly reduced after treatment and the improvement was maintained over 2 years. Responses to the functional and psychological questions were similarly improved. Single stage surgery led to a higher rate of implant failure than expected. Patients showed significant psychological health benefits from the treatment provided.
Article
Dental implants provide patients with restorative options for the edentulous maxilla. Both fixed and removable prostheses can be attached to the edentulous maxilla, but the efficacy of different designs has not been determined. In this two-session within-subject crossover trial we compared maxillary implant retained fixed prostheses with removable implant overdentures opposed by mandibular implant-supported overdentures. Sixteen patients, who had previously received mandibular implants, entered the study and received four to six maxillary implants. After dropouts as a consequence of a lack of osseointegration and general health problems, 13 remained. Of these, five received the removable prosthesis first and eight the fixed prosthesis. After 2 months, the prostheses were exchanged and the second was also worn for 2 months. Psychometric measurements of general satisfaction with the prostheses as well as comfort, ability to speak, stability, esthetics, ease of cleaning and occlusion were obtained once each prosthesis had been worn for 2 months. Chewing ability was assessed for seven types of food. Removable long-bar overdentures received significantly higher ratings of general satisfaction than fixed prostheses (P = 0.003). Patients also rated their ability to speak and ease of cleaning significantly better with the removable overdentures. Nine patients chose to keep the removable prosthesis and four preferred to keep the fixed prosthesis. The results suggest that maxillary removable overdentures on multiple implants may provide patients with better function than fixed prostheses.
Article
A longitudinal clinical trial involving 103 subjects was undertaken to assess the impact of oral implant therapy on the psychosocial well-being of subjects with complete denture wearing problems. There were four experimental groups: (1) an implant group, where subjects were edentulous/edentate in one jaw and requested and received implants to retain an oral prosthesis (IG); (2) subjects edentulous/edentate in one jaw requesting implants but who received conventional dentures (CDG1); (3) edentulous subjects requesting replacement of their dentures by conventional means (CDG2); (4) dentate subjects requiring routine treatment, who were included for comparison. Data were collected in each group pre- and post-treatment using validated oral specific [the Oral Health Impact Profile (OHIP)], and generic (the SF36) health status measures. Subjects in IG, CDG1 and CDG2 also completed a denture satisfaction scale. IG and CDG1 subjects reported that tooth loss and denture wearing problems had a much greater impact on their quality of life than subjects seeking conventional dentures. Dentate subjects had a much better oral health status compared with denture-wearing subjects. Following treatment, subjects who received implant-retained prostheses (IG) reported a significant improvement in satisfaction and health-related quality of life, as did subjects who requested and received conventional dentures (CDG2). Subjects who requested implants, but received conventional dentures (CDG1), reported little improvement in denture satisfaction and only modest improvement in their quality of life. None of the denture-wearing subjects reported health-related quality of life that was as good as that of dentate subjects. The findings have significant implications in the assessment of outcomes in future clinical trials.
Article
To systematically review the incidence of biological and technical complications in implant therapy reported in prospective longitudinal studies of at least 5 years. A MEDLINE search was conducted for prospective longitudinal studies with follow-up periods of at least 5 years. Screening and data abstraction were performed independently by multiple reviewers. The types of complications assessed were as follows: implant loss, sensory disturbance, soft tissue complications, peri-implantitis, bone loss >or=2.5 mm, implant fracture and technical complications related to implant components and suprastructures. The search provided 1310 titles and abstracts, out of which 159 were selected for full-text analysis. Finally, 51 studies were included. Meta analysis of these studies indicated that implant loss prior to functional loading is to be expected to occur in about 2.5% of all implants placed in implant therapy including more than one implant and when routine procedures are used. Implant loss during function occurs in about 2-3% of implants supporting fixed reconstructions, while in overdenture therapy >5% of the implants can be expected to be lost during a 5-year period. Few studies (41% of those included) reported data on the incidence of persisting sensory disturbance >1 year following implant surgery. Most of the studies that provided such data reported on the absence or a low incidence (1-2%) of this complication beyond this interval. A higher incidence of soft tissue complications was reported for patients treated with implants supporting overdentures. There is limited information regarding the occurrence of peri-implantitis and implants exhibiting bone loss >or=2.5 mm. Implant fracture is a rare complication and occurs in <1% of all implants during a 5-year period. The incidence of technical complications related to implant components and suprastructures was higher in overdentures than in fixed reconstructions. Implant loss was most frequently described (reported in about 100% of studies), while biological complications were considered in only 40-60% and technical complications in only 60-80% of the studies. This observation indicates that data on the incidence of biological and technical complications may be underestimated and should be interpreted with caution.
Article
The purpose of this study was to compare clinicians' ratings of the state of oral tissues and their satisfaction with treatment to edentulous patients' ratings of treatment success after provision of mandibular implant overdentures or conventional dentures. Sixty subjects randomly received either mandibular overdentures retained by two implants (n = 30) or new conventional mandibular complete dentures (n = 30). All were given new conventional maxillary dentures. Baseline measures included clinical evaluation of the oral soft and hard tissues. Patients rated their general satisfaction before and after treatment, as well as their satisfaction with stability, speech, and esthetics on visual analogue scales. The treating prosthodontist rated the dentures for the same categories. Patient and clinician ratings were compared using correlations, t tests, and linear regression. None of the clinical variables were significantly correlated with patient satisfaction before or after treatment. The prosthodontist rated mandibular implant overdentures significantly better than conventional dentures regarding general satisfaction, stability, speech, and esthetics. Implant overdentures were also easier to fabricate (P < .0001). The prosthodontists' scores were not significantly correlated with patient scores for any question. Clinicians' assessments of the quality of denture-supporting tissues are poor predictors of patient satisfaction with mandibular implant or conventional prostheses. Prosthodontists and patients both rate mandibular implant overdentures as significantly superior to conventional dentures, but patients and clinicians do not usually agree when evaluating individual prostheses.
Article
The aim of this prospective randomized clinical trial was to evaluate 10 years of treatment of patients receiving a mandibular implant-retained overdenture (IRO) or a conventional complete denture (CD). One hundred twenty-one edentulous patients were treated with an IRO (2 endosseous implants, n = 61) or a conventional CD (n = 60). Clinical aspects and patient satisfaction were evaluated. One year after placement of the denture, unsatisfied patients of the CD group were given the opportunity to receive implants. In the IRO group, 4 implants were lost during the first year and 4 implants were lost during the next 4 years. Between 5 and 10 years, no implants were lost (survival rate: 93%). In the CD group, 24 patients (40%) chose an IRO between 1 and 10 years. Patients in the IRO group were significantly more satisfied than patients in the CD group after 1 year (satisfaction score 8.3 versus 6.6 on a scale of 1 to 10), after 5 years (7.4 versus 6.4), and after 10 years (7.7 versus 6.8). The mean satisfaction score of the CD group (including patients who later received implants) was still lower than that of the IRO group, in spite of the opportunity for retreatment with IROs. Endosseous implants had a high survival rate after 10 years of follow-up.
Article
Treatment of lower denture complaints of patients with an edentulous mandible with a height of at least 15 mm can consist of meticulous construction of a new set of dentures (CD), construction of a new set of dentures following preprosthetic surgery to enlarge the denture-bearing area (PPS), or construction of an implant-retained mandibular overdenture (IRO). The aim of this prospective randomized controlled clinical trial was to evaluate the satisfaction of the above mentioned treatment modalities in resolving lower denture related complaints. Ninety edentulous patients (Cawood class IV and V, mean mandibular height 20.7 +/- 2.7 mm) were randomly assigned to one of these treatment modalities. The main outcome parameters were denture satisfaction and chewing ability, which were assessed using validated self-administered questionnaires focusing on denture-related complaints and problems with chewing different types of food. These parameters were measured before treatment, and 1, 5 and 10 years after treatment. Differences among the three groups were tested by applying a one way analysis of variance and a Tukey's test for multiple comparison. At the 1 year evaluation, significantly better scores were observed in the two surgical groups (IRO, PPS) than in the CD group (P<0.05). At 5 year evaluation the 'complaints of the lower denture' showed a significantly better score in the IRO group when compared to the PPS and CD groups (P<0.05). No significant differences were observed between the PPS and CD group. At 10 year evaluation, the intention to treat analysis revealed no significant differences between the three groups, while a per protocol analysis showed that the IRO group was the most satisfied. From this study it is concluded that both on the short and long term denture satisfaction appears most favourable in the IRO group when compared to the PPS and CD groups. Implant-retained overdentures are, therefore, a favourable treatment modality for edentulous patients with lower denture problems.
Article
Few long-term studies on overdentures report both implant and prosthodontic outcomes. The aim of this prospective study was to report long-term prosthodontic- and implant-related treatment outcomes of patients treated with design-specific implant-supported overdentures. Between 1982 and 1992, 45 consecutively treated patients received a total of 47 overdentures (42 mandibular and 5 maxillary) supported by Brånemark implants. Prospective clinical and radiographic data were collected over the observation period; this study presents the most recent treatment outcomes. Thirty patients (mean age 70 years) with 32 prostheses attended the final recall visit, with 67% of patients followed for 15.53 years (range 10 to 19 years). Six implants failed, and the prosthetic plan and implant cumulative survival rates were both in excess of 90%. Mean marginal bone loss around implants after the first year of loading was small (0.05 mm/year), although the individual variation was high. Linear regression analysis of bone loss indicated that gender, bicortical stabilization, bone quality, and healing time were predictors of bone loss for the first year of loading but not for the ensuing years. Prosthetic maintenance included fractured components, denture relining, and replacement of prostheses. On average, the longevity of overdenture prostheses was 12 years, and laboratory relining was necessary every 4 years. This study confirmed the long-term outcome success of patients treated with design-specific overdenture prostheses supported by Brånemark implants. However, prosthetic maintenance was required, a fact that should be discussed with patients prior to treatment.
Article
Regular use of patient-reported outcome measures (PROMs) by health care providers in their routine practice may help to improve the quality of care, but more evidence is needed before routine use of PROMs can be recommended. A structured review was undertaken to examine whether and how regular use of PROMs might improve routine practice. A systematic search of Medline accessed through Webspirs Silverplatter was undertaken for the years 1976-2004. Controlled trials in English evaluating the impact of clinical use of PROMs on routine practice were included. Data regarding study design, characteristics of PROMs feedback, patient populations and study results were extracted by three reviewers. Feedback of PROMs results to health care providers appears to have a substantial impact on some processes of care, particularly on diagnosis of mental health conditions. However, the impact on patient health status is less consistent. Most of the published studies evaluated PROMs as a one-off screening technology and measured only provider behaviours and patient health outcomes. The pattern of results suggests a general lack of clarity in the field, especially regarding appropriate goals for PROMs and the mechanisms by which they might achieve them. To fully evaluate their role in routine practice, studies need to use PROMs that capture issues of importance to patients and to measure impacts relating to the patient-provider relationship and patient contributions to their well-being. Until studies evaluate PROMs as a means facilitate patient-centred care, their full potential in clinical practice will remain unknown.
Article
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.
Article
Implant overdenture treatment for the edentulous maxilla is challenging due to inherent anatomic and biomechanical problems. Moreover, controversy persists as to factors critical for implant and prosthetic success. Established criteria for design of the maxillary implant overdenture are lacking. This article reviews the literature on maxillary implant overdentures with an emphasis on number, length, and distribution of implants, splinted or unsplinted anchorage systems, maintenance, and patient satisfaction. A systematic review of the literature was undertaken seeking evidence to establish criteria for treatment considerations for implant overdenture treatment of the edentulous maxilla. A search of English language peer-reviewed literature was completed using Medline between the period of 1988 to 2006, focusing on evidence-based research. This was supplemented with a manual search of selected journals and textbooks. Randomized controlled clinical trials, nonrandomized controlled studies, longitudinal experimental clinical studies, longitudinal prospective studies, and longitudinal retrospective studies were favored in the review, using a general hierarchical classification. Articles that did not focus on or have an impact on implant overdenture treatment on the maxilla were excluded from the evaluation. The last search was conducted on December 31, 2006. Key terms included maxillary, dental implant, and overdenture. The literature demonstrates a limited number of randomized controlled trials and longitudinal prospective and retrospective studies to strongly support treatment consideration premises for the implant overdenture treatment of the edentulous maxilla. Within the limits of this systematic review, treatment consideration recommendations have been posited given the available evidence. Better designed, longitudinal studies with higher power are required to establish definitive evidence-based treatment planning principles for the maxillary implant overdenture patient.
Prosthetic hygiene and functional efficacy in completely edentulous patients: satisfaction and quality of life during a 5-year follow-up
  • M Martín-Ares
  • C Barona-Dorado
  • B Guisado-Moya
  • N Martínez-Rodríguez
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  • J M Martínez-González
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Thomason, J. M., Heydecke, G., Feine, J. S., & Ellis, J. S. (2007). How do patients perceive the benefit of reconstructive dentistry with regard to oral health-related quality
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