Refusal of implant supported mandibular overdentures by elderly patients

Should our older, edentulous patients live with their teeth sitting in a glass of water?

Over 20 years ago, the McGill consensus statement stated that a mandibular two-implant overdenture should be the first choice of care for our edentulous patients. We have around three million edentulous patients in England and Wales currently, many over the age of 60, and many of whom are not able to wear a satisfactory set of complete dentures, let alone able to eat a normal diet. In 2009, the York consensus statement produced by the British Society of Prosthodontics concluded that "a substantial body of evidence is now available demonstrating that patients' satisfaction and quality of life with implant-supported overdentures in the mandible is significantly greater than conventional dentures". So, why has the NHS ignored these important scientific papers and left our older population in a state of dental neglect? This discussion paper will consider some of the facts and suggest that there may, potentially, be some solutions.

The Optimal Position of the Implant Supporting Distal Extension Removable Denture: Case Reports and Literature Review

The management of distal extension edentulism by removable partial denture (RPD), in cases where fixed solutions cannot be considered, poses various challenges inherent in the mixed support of the prosthesis, especially when the edentulism is of a large extent. When an implant is placed to assist a removable denture, it allows ensuring a bio-functional, aesthetic, and comfortable rehabilitation. Additionally, it renders possible resolutions to problems related to conventional RPD. The implant can be placed in proximity or at a distance from abutment teeth, with each position presenting its own advantages and benefits. The choice of the optimal position is made following a clinical examination and cone beam computed tomography. Through two clinical cases, we will illustrate the management of distal edentulism with implant-assisted RPD, then review the key elements to consider during the prosthetic realization in the management of extended edentulism and discuss the parameters involved in the choice of preferred implant sites.

Exploring experiences of living with removable dentures-A scoping review of qualitative literature

OBJECTIVE

Examine the literature on the experiences of living with removable dentures (complete or partial) to identify any gaps and provide a map for future research.

BACKGROUND

Increasing proportions of society are living partially dentate with some form of restoration, including removable dentures. Previous studies have reported on the location, materials and usage of these prostheses, along with effects on oral-health-related quality of life (OHRQoL). However, less is known about experiences with removable dentures from a patient-centred perspective.

METHODS

A scoping review of the qualitative literature was undertaken using the framework of Arksey and O'Malley, updated by Levac et al. Literature searches were carried out using Medline and Web of Science. Papers were screened by title and abstract using inclusion and exclusion criteria. Remaining papers were read in full and excluded if they did not meet the required criteria. Nine papers were included in the final review.

FINDINGS

Key themes from these papers were: impact of tooth loss and living without teeth, and its impacts in relation to social position, appearance, confidence and function (chewing and speaking); social norms and tooth loss, including attitudes to tooth retention and treatment costs, and changes in intergenerational norms towards dentures; expectations of treatment, including patients being more involved in decision making, viewing the denture as a "gift" and dentures helping to achieve "an ideal"; living with a removable denture (complete or partial), including patient preparedness for a denture, adaptation and impacts on activities and participation; and the dentist-patient relationship, including issues with information and communication, and differing priorities between patients and dentists.

CONCLUSION

Little qualitative research exists on experiences of living with a removable denture. Existing literature demonstrates the importance of dispersed activities in differing social, spatial and temporal contexts when wearing removable dentures. Focusing on processes of positive adaptation to dentures and OHRQoL, rather than deficits, is also required to fully understand patients' experiences. Additionally, more complex technological advances may not always be in the best interest of every patient.

The edentulous patient: the impact of implants on quality of life

Edentulism (total tooth loss) can be managed with four possible options: no prosthetic replacement, conventional complete dentures, implant-retained overdentures (removable), or implant-supported bridgework (fixed). Selection of these choices is influenced by social, medical, anatomical, technical, and economic factors. The care team involved in the decision-making process (be it patients, clinicians and occasionally commissioners of services) should be aware of the different treatment options and their potential impact on the patient's quality of life (QoL). The cost effectiveness of this impact can also be evaluated. Knowledge of the life-long sequelae of edentulism will also help practitioners guide patients in their treatment planning decisions when they may be approaching an edentulous state, preparing them for the challenges that may lie ahead. This paper aims to address the impact that edentulism has on QoL and the treatment options, focusing on the patient perspective.

Mini-implant mandibular overdentures under a two-step immediate loading protocol: A 4-6-year retrospective study

OBJECTIVES

This retrospective study to evaluate the treatment outcomes of mandibular mini-implant overdentures (MIODs) placed under a two-step immediate loading protocol.

BACKGROUND

The mini-implant overdenture emphasises the advantages of simplicity using flapless surgery and immediate loading. However, some mini-implant have lowe initial stability.

MATERIALS AND METHODS

A total of 30 participants who used mandibular MIODs and maxillary removable complete dentures (RCDs) over 4 years were included. Four one-piece mini-implants (<3 mm in diameter) were placed by a flapless surgical approach after fabrication of new RCDs, and the O-ring attachment was attached at least 8 weeks after implant placement.

RESULTS

The average observation period was 58.9 ± 9.2 months after mini-implant loading. The survival rate of the implants was 100.0%, and the overall change in mean marginal bone level (ΔMBL) was -0.9 ± 1.1 mm. The implant success rate was 83.3% at the implant level, and 66.7% at the patient level. The mean initial Periotest value was 0.9 ± 3.1, and it was positively associated with ΔMBL and implant success (P < .05). Patient satisfaction improved after conversion from RCDs to MIODs (P < .05), and mastication and pain showed greater satisfaction with longer loading time (P < .05).

CONCLUSIONS

The mandibular MIODs could be chosen as an alternative treatment under a two-step immediate-loading protocol in edentulous patients with limited alveolar bone volume. To ensure superior treatment outcomes of MIODs, initial stability of implant must be obtained using as wide a diameter as possible within the anatomically allowable limits.

Five years clinical outcome of maxillary mini dental implant overdenture treatment: A prospective multicenter clinical cohort study

BACKGROUND

The long-term clinical outcome of mini dental implants (MDIs) to support an overdenture is underreported especially in severely atrophic maxillae and when installed flaplessly.

PURPOSE

The current report is a 5-years follow-up of the previously published 2- and 3-years clinical outcome of MDIs supporting a maxillary overdenture in narrow alveolar ridges. MDI survival, marginal bone level, peri-implant health, technical complications, and oral health related quality of life (OHIP) and respective changes over time are reported.

MATERIALS AND METHODS

Subjects aged 50 years or older, in need of improvement of maxillary denture retention, were included. The MDIs were 2.4 mm diameter one-piece tapered implants, Class 4 pure Titanium, and lengths 10 or 11.5 mm. Under local anesthesia, 5-6 MDIs were placed in atrophic maxillae with a free-handed flapless approach. One week postoperative the denture was adapted with a retentive soft reliner. The final prosthetic connection was established after 6 months with a metal-reinforced horse-shoe denture. Clinical outcome after 5 years was assessed with probing pocket depts (PPD), bleeding on probing (BoP), and additional cone beam computed tomography (CBCT) MDI bone level measurements were performed. Oral Health-Related Quality of Life (OHRQoL) investigated with OHIP-14 was assessed preoperative, during provisional loading, and after final prosthetic connection up to 5 years.

RESULTS

Initially, 31 patients (14 females and 17 males) with mean age 62.30 underwent treatment. In the provisional loading interval, 16 patients encountered 32/185 MDIs failures, resulting in a failure of 17.3%; 170 MDIs were functionally loaded in 29 patients. Additionally, 14 implants were lost in three patients, all of whom had had already previous failures. Reimplantation of 17 MDIs were performed during the provisional loading and 2 MDI after functional loading. After 5 years, the absolute implant failure rate was 46/204 (22.5%), corresponding to a cumulative failure rate of 23.2%. Prosthetic failure was observed in four patients due to implant loss and in two patients related to excessive one-piece implant ball attachment wear, making the 5-years prosthetic success 80.0%. The mean PPD and absence/presence of BoP for 149 implants at 5 years was 4.3 and 0.2 mm, respectively. Average mesial-distal-vestibular-palatal bone loss in the interval 2-5 years was 0.08 mm. No statistically significant difference in marginal MDI bone loss between male or female (p = 0.835), smoking and nonsmoking (p = 0.666) was observed. The five-years total measured CBCT interdental bone level (mesial and distal) correlates with the 5-years PPD (Pearson 0.434; p = 0.01). After 5 years, OHRQoL with the treatment procedure was assessed in 27/31 participants. Decreasing mean total OHIP-14 scores with improved OHRQoL, was observed in 27/31 participants, with values of 21.3 at baseline to 15.6 at the time of provisional loading which significantly (p = 0.006) decrease to 7.3 at the final prosthetic connection. The next 3-5 years further decrease was observed with 6.5 and 4.96, respectively.

CONCLUSIONS

Maxillary MDIs for overdentures are an accessible and acceptable treatment option. Although after 5 years between one fifth and one fourth of the MDIs were lost, prosthetic success remains 80.0% and high OHRQoL could be achieved.

Willingness to accept or refuse mandibular implant overdenture treatment: A prospective study on edentulous enrolled in a clinical trial

BACKGROUND

Several complete denture wearers have major complaints and may be benefitted from implant treatment. However, the factors that shape the demand for and utilization of implants need further investigation.

OBJECTIVE

The aim was to evaluate edentulous patient's willingness to accept or refuse the offer and provision of implant-retained treatment.

METHODS

As part of a clinical trial, edentulous subjects were offered a mandibular overdenture retained by four mini-implants opposing a conventional maxillary denture. Treatment was offered without any financial costs for the patients. Patients' level of interest in receiving treatment was assessed using a 5-point Likert scale, and they were asked to respond to a list of reasons that led to their decision to accept or refuse implants. Those who refused implants received conventional prosthodontic interventions as required, and those who accepted implant treatment underwent surgical planning and implant placement.

RESULTS

Of 175 eligible subjects, 147 accepted the offer of treatment and were invited to take part in the study (69.4% women, mean age 67.4 ± 10.0 years). Overall, 111 patients (75.5%) expressed a positive intention to undergo implant treatment at the initial contact. Implant treatment was performed for 56.3% (9/16) of those who answered 'probably yes' about their level of interest in implant treatment on the Likert scale, and 69.6% (64/92) of 'certainly yes' (p < .001). Older subjects were less likely to receive implants (OR = 0.93; p = .036), whilst those with a positive intention towards implants (OR = 3.15; p = .001), those previously treated by the dental team (OR = 7.89; p < .001), and who actively demanded implants (OR = 18.1; p < .001) were more likely to accept treatment. Improved chewing was the most common reason for accepting implants, whilst fear of surgery was the most reported reason for refusal.

CONCLUSION

Refusal of implants was high among edentate patients even when financial costs were removed. Patients' initial attitude towards acceptance is a key factor in the demand for and uptake of implant therapy.

Influence of diameter on mechanical behavior of morse taper narrow implants

Dental implants could give back function, esthetics and quality of life to patients. The correct choice of the implant, especially in borderline cases, is essential for a satisfactory result. Aim: Thus, the objective of this study was to evaluate the mechanical behavior of Morse taper implants with two different prosthetic interfaces. Methods: Twenty self-locking Morse taper implants, 2.9 mm in diameter (FAC), and 20 Morse taper implants, 3.5 mm in diameter (CM) were divided into two groups (n=10), and submitted to strength to failure test, optical microscopic evaluation of fracture, metallographic analysis of the alloy, finite element analysis (FEA) and strain gauge test. A Student’s t test (α = 0.05) was made for a statistical analysis. Results: For the strength to failure test, a statistically difference was observed (p <0.001) between FAC (225.0 ± 19.8 N) and CM (397.3 ± 12.5 N). The optical microscopic evaluation demonstrated a fracture pattern that corroborated with FEA´s results. The metallographic analysis determined that the implants of the FAC group have titanium-aluminum-vanadium alloy in their composition. In the strain gauge test, there was no statistical difference (p = 0.833) between CM (1064.8 ± 575.04 μS) and FAC (1002.2 ± 657.6 μS) groups. Conclusion: Based on the results obtained in this study, ultra-narrow implants (FAC) should ideally be restricted to areas with low masticatory effort.

Effect of Sinus Perforation with Flaplessly Placed Mini Dental Implants for Oral Rehabilitation: A 5-Year Clinical and Radiological Follow-Up

Background: Flaplessly placed one-piece mini dental implants (MDI) are an option to support maxillary overdentures. Evenly distribution of the implants over the atrophic alveolar process implies a risk of accidental sinus perforation in the posterior area which could induce sinus-related pathology. Methods: Thirty-one patients received 5–6 maxillary MDIs. Schneiderian membrane swelling was assessed with CBCT at the deepest point of the sinus in the mid-sagittal plane prior to surgery (baseline), after 2 and 5 years. Additionally, subjective patient-reported rhinosinusitis complaints, the effect of smoking, and gender differences were investigated. Results: Mean thickness of the Schneiderian membrane was 2.87 mm at baseline, 3.15 mm at 2 years, and 4.30 mm at 5 years in 27 of 31 initially treated patients. MDI perforation was detected in 21/54 sinuses. At 2 years, perforation length does not affect membrane thickness whereas baseline swelling does. In smokers, each perforated mm induced 0.87 mm additional swelling. After 5 years, the effect of baseline swelling becomes smaller whereas perforation length became statistically significant, with 0.53 mm increase for every perforated mm. The effect of smoking lost its significance. No relations between gender, membrane thickness changes, or subjective clinical sinus complaints and MDI perforation were found. Conclusion: Accidental MDI sinus perforation induces Schneiderian membrane swelling but does not interfere with clinical sinusal outcome after 5 years.

Sociodemographic Factors and Implant Consideration by Patients Attending Removable Prosthodontics Clinics

Objective. This study is aimed at investigating the treatment options offered to and chosen by patients attending a student prosthodontics clinic and to investigate the effect of the sociodemographic background of participants on implant consideration. Material and Methods. A cross-sectional descriptive study was conducted on 200 participants including their socioeconomic background, treatment options presented, treatment preferences, and implant consideration. Bivariate tests (unpaired $t$ -test, chi-square, and Mann–Whitney test) and Spearman correlation were used for comparison of different socioeconomic groups according to treatment preferences (implant consideration versus conventional removable prosthesis). Results. Treatment options presented by dental students include 63.5% complete denture, 32% implants/removable dentures, and partial denture 4.5%. Conventional removable prostheses were mostly chosen due to low income. Implants were only considered by 26% of participants. Age and implant consideration had a significant negative correlation. No significant difference in gender and residency area on implant consideration was found. The chi-square test showed a significant difference between implant consideration and conventional removable prostheses in the various occupation groups. Conclusions. Low income is the main factor prohibiting patients from considering dental implants. Age and educational level may play a considerable role in considering dental implants. There should be more emphasis on dental students’ treatment planning education to include and explain dental implants as a treatment option for their patients in the prosthodontics clinic.

Effect of Various Retentive Element Materials on Retention of Mandibular Implant-Retained Overdentures

This study aimed to examine the retentive characteristics of each retentive element material and the effects from thermocycling using the two implant-retained mandibular overdenture model. Two stud abutments and three retentive element materials; nylon, polyetheretherketone (PEEK) and polyvinylsiloxane (PVS) were used in this study. Four tested groups, with a total of 40 overdentures, were fabricated, including a Locator® abutment with nylon retention insert (NY), Novaloc® abutment with PEEK retention insert (PK), Locator® abutment with PVS retention insert (RL), and Novaloc® abutment with PVS retention insert (RN). The retentive force (N) was measured before thermocycling, and at 2500, 5000, and 10,000 cycles after thermocycling. Significant changes in the percentage of retention loss were found in the NY and PK groups (p < 0.05) at 6 and 12 months for the RL group (p < 0.05) after artificial aging. The RN group exhibited a constant retentive force (p > 0.05). The tendency of the percentage of retention loss significantly increased for PEEK, nylon, and PVS silicone over time. The results of the present study implied that retentive element materials tend to lose their retentive capability as a result of thermal undulation and water dispersion. Nylon and PEEK, comprising strong polar groups in polymer chains, showed a higher rate of retention loss than polyvinylsiloxane.

One-year prospective study on single short (7-mm) implant overdentures in patients with severely resorbed mandibles

OBJECTIVE

This prospective study aimed to assess the effectiveness of using a single short implant to retain a single-implant mandibular overdenture (SIMO) in participants with severely atrophic edentulous mandibles.

MATERIAL AND METHODS

The study sample included 18 edentulous participants with severely resorbed mandibular ridges and limited bone height in the symphyseal region sufficient for the insertion of a 7.0-mm-height implant. First, patients received new conventional dentures or had their dentures relined, followed by the insertion of a 3.75 x 7 mm morse-taper implant, and the incorporation of a stud-type attachment and a nylon retentive insert after a 3-month healing period. Implant stability quotient (ISQ) was measured at baseline and after 3 and 12 months. Patient-reported outcomes (satisfaction with the dentures and oral health-related quality of life) were assessed before implant placement and at the 3-, 6-, and 12-month follow-ups. Clinical-radiographic outcomes and the incidence of prosthodontic events were assessed throughout the follow-up period.

RESULTS

The implant survival rate was 100%. ISQ increased from baseline (72.7 ± 6.6) to the 3-month (82.0 ± 3.3) and 1-year (85.4 ± 2.9) follow-ups (p < .001). After 1 year, satisfaction with the mandibular prosthesis increased significantly, and the overall OHIP-Edent score decreased by 79.2%. No effects were found for the maxillary denture (p = .420). Due to dissatisfaction with treatment, two participants (11.1%) required additional implants after the 1-year follow-up and were considered as prosthodontic failures.

CONCLUSION

Single-implant mandibular overdenture retained by a short implant showed favorable outcomes after 1 year. Further studies with larger samples and longer follow-up periods are needed to confirm the findings of this single-group prospective study. The present study was registered at the Brazilian Clinical Trials Registry (REBEC), identifier RBR-7p2xmg. The trial registry occurred during the study execution, and its final approval was delayed because of several formatting adequacies required by the platform REBEC.

Prosthetic aftercare, mastication, and quality of life in mandibular overdenture wearers with narrow implants: A 3-year cohort study

OBJECTIVES

This cohort study investigated clinical, functional, and quality of life outcomes, along with prosthetic maintenance events in mandibular overdenture (MO) wearers for 3 years.

METHODS

Thirty MO wearers with narrow diameter implants (NDIs) and locking taper stud abutments (Facility-Equator system) were annually monitored by registering the visible plaque index (VPI), peri‑implant inflammation (PI), calculus presence (CP), probing depth (PD), bleeding on probing (BOP), secondary implant stability (ISQ), marginal bone loss (MBL), masticatory performance and dental impact in daily life (DIDL) questionnaire domains. Multilevel mixed-effects linear regression was performed to analyse changes over time. Chi-square tests were performed to analyse the relationship between the appearance of prosthetic complications and maintenance occurrences. The survival rate of patients with NDIs was calculated using the Kaplan-Meier test.

RESULTS

Twenty-six individuals attended all follow-ups, the survival rate of 83.3% in the first year was maintained, and no one implant was lost over the 3-year period. There were significant differences for PD between 1 and 3 years (p ≤ 0.01) and between 2 and 3 years for PI (p ≤ 0.01), GI (p ≤ 0.01), ISQ (p = 0.02), and MBL (p ≤ 0.01). All masticatory performance outcomes showed significant differences (p ≤.01). Prosthetic maintenance events decreased significantly over time. Appearance, general performance, and eating and chewing domains presented high effect sizes.

CONCLUSION

Continued changes were observed in the clinical parameters of MO users over the 3-year period. In addition, most functional parameters, except for particle homogenization, improved significantly over time. The positive impact on quality of life is likely related to the significant reduction in prosthetic maintenance events.

CLINICAL SIGNIFICANCE

Periodic returns to assess peri‑implant tissues and MO maintenance should be performed to ensure the success of rehabilitation to assure improvements in masticatory function and oral health-related quality of life.

Comparing Masticatory Performance of Maxillary Mini Dental Implant Overdentures, Complete Removable Dentures and Dentate Subjects

Background: Mini dental implant (MDI) overdenture rehabilitation for the edentulous maxilla is a valuable, less invasive and affordable treatment alternative for complete removable dentures (CRD). However, comparative quantification of masticatory performance in different oral conditions are scarce. Purpose: This study compares objective masticatory performance of dentate groups, maxillary CRD and MDI overdentures and subjective masticatory performance in maxillary CRD and MDI overdentures. Materials and Methods: Four groups were defined, age 20+ dentate dental students (DS), age 50+ complete dentate subjects (DP), age 50+ maxillary CRD or MDI overdentures/dentate mandible. Objective masticatory performance was evaluated by measuring circular Variance of Hue (VOH) or the mixture degree of two-color chewing gum (Hue-check View Gum^® Test). Additionally, subjective masticatory comparison was investigated in the CRD and MDI groups, with a visual analogue scale (VAS) for different food consistencies and the Oral Health Related Quality of Life (OHRQL) OHIP-14 questionnaire. Results: The mean VOH was 0.11 (SD 0.50, range 0.05–0.27) for the dentate dental 20+ students, 0.13 (SD 0.08, range 0.03–0.31) for the 50+ dentate group (p = 0.774), 0.41 (SD 0.41, range 0.14–0.76) for the CRD group and 0.39 (SD 0.18, range 0.07–0.76) for the MDI group (p = 0.725). Based on the VAS scores, no improvement was found between the CRD and the MDI overdenture group (p > 0.050). The mean OHIP-14 total score was 12.10 (SD 15.87, range 0–56) for CRD, while the MDI group (p = 0.039) saw a significant improvement to 2.85 (SD 2.85, range 0–15). Conclusion: Comparable results in objective masticatory performance were registered in dentate 20+ and 50+ subjects with a remarkable inferior outcome for the CRD and MDI group. Compared to CRD, MDI overdentures revealed no substantial improvement in subjective and objective masticatory performance. However, for MDI a significant increase in OHRQL was apparent.

Prospective clinical implementation of optional implant treatment into pregraduate dental education-mini implants for retention and support of mandibular overdentures

Background

The primary aim of the study was to evaluate mini implant (MDI) survival, prosthodontic maintenance, and patient-reported outcome measures after conducting an optional pregraduate academic course on patients with mandibular edentulism including fabrication of overdentures and MDI planning and placement as well as chair-side incorporation of the respective restauration. In a prospective clinical study, 20 patients received 80 MDIs that were restored with mandibular overdentures. All treatment steps including placement of 40 MDIs were conducted by undergraduate students under strict guidance of a consultant. Next to students’ perceptions after participation, survival of MDIs, and prosthodontic maintenance, patients’ perceptions as well as peri-implant parameters were assessed after 4 weeks and 3 and 12 months.

Results

Three MDIs fractured (two during insertion and one after 3 months; total survival 96.25%). Two overdentures fractured and a total of 23 cases of minor prosthodontic maintenance were required. Over time, patients’ satisfaction significantly increased. Besides, questionnaires showed a high rate of students’ positive perception and high self-confidence to include MDI therapy into own practice.

Conclusions

The results are in accordance to those reported by postgraduate dentists. In accordance, therapy with MDI-retained mandibular overdentures seems to be feasible and successful at pregraduate level if the students receive guidance.

Patient preferences for different tooth replacement strategies for the edentulous mandible: A willingness-to-pay analysis

PURPOSE

The aim of this study was to evaluate patients' economic preferences for two different tooth replacement strategies for the edentulous mandible namely conventional complete dentures (CCDs) and implant overdentures supported by two implants (IODs), using a willingness-to-pay (WTP) analysis.

METHODS

Twenty-six elderly patients who had been rehabilitated with either a mandibular CCD or IOD were invited to participate in this study. All participants were provided with the details of the two treatment protocols, including advantages, disadvantages, and treatment costs. The patients were then asked to indicate their maximum WTP values for each protocol using a payment card method for contingency evaluation.

RESULTS

Fifteen patients with mandibular CCD (CCD-Group) and 12 patients with IOD (IOD-Group) participated in the study. Overall, the median and maximum WTP values recorded for IOD therapy were significantly higher than those for CCD therapy (p<0.05). Both treatment groups recorded maximum WTP values for CCD therapy, which exceeded the market cost (¥30,000 [US$280]), CCD-Group: ¥50,000 (interquartile range [IQR]: 40,000 - 65,000), and IOD-Group: ¥45,000 (IQR: 30,000-85,000)]. However, both groups registered a median and maximum WTP values for IOD therapy lower than the market cost (¥780,000 [US$7,300]), (CCD-Group: ¥500,000 [IQR: 300,000 - 750,000], IOD-Group: ¥700,000 [IQR: 500,000-800,000]).

CONCLUSION

The maximum WTP values recorded for IOD therapy were significantly higher than CCD therapy in both treatment groups. While patients were willing to pay more than the current market costs for CCDs, they were not willing to meet the market value for IODs.

A critical review of qualitative research publications in dental implants from 2006 to 2020

OBJECTIVES

This critical review is aimed to investigate the current status of qualitative research in dental implant research and to explore the quality of available information.

MATERIAL AND METHODS

A systematic search was done on the journal databases to identify dental implant research articles that used qualitative methodology during 2006 and 2020. The resulting articles were appraised against the checklist offered by the Critical Appraisal Skills programme (CASP) tool. Also, the theories evolved from the research were reviewed to understand the value of this methodology in dental implant research.

RESULTS

Twenty-five (25) articles out of the 8,421 original results were identified as using qualitative methodology. The researchers have sought to identify the views of patients about tooth loss, dental implants, and the information they receive from dental professionals, and views of the dentists about dental implant practice. The review found that there were few inconsistencies in the quality of such research especially the qualitative data analysis.

CONCLUSIONS

The quantity of qualitative research in dental implants remains low; however, the quality has improved in the past two decades. Despite these improvements, there is still a lack of research in understanding both patients' and dentists' views on dental implant procedures and management.

Influence of marginal bone resorption on two mini implant-retained mandibular overdenture: An in vitro study

PURPOSE

To investigate the biomechanical effect of marginal bone resorption (MBR) on the mandibular mini implant (MI)-retained overdenture (MI-OD) on the edentulous model.

MATERIALS AND METHODS

The experimental mandibular edentulous model was modified from a commercial model with 2 mm thick artificial soft tissue under denture base. Two MIs (Φ2.6 mm × 10 mm) were bilaterally placed between the lateral incisor and the canine area and attached with magnetic attachments. Three groups were set up as follows: 1) alveolar bone around the MI without MBR (normal group), 2) with MBR to 1/2 the length of the implant (resorption group), and 3) complete denture (CD) without MI (CD group). Strain around the MI, pressure near the first molar area, and displacement of denture were simultaneously measured, loading up to 50 N under bilateral/unilateral loading. Statistical analysis was performed using independent-samples t test and one-way ANOVA (α=.05).

RESULTS

The strain around the MI with MBR was approximately 1.5 times higher than that without MBR. The pressure in CD was higher than in MI-ODs (P <.05), while there was no statistical difference between the normal and resorption group (P >.05). Similarly, the CD demonstrated a greater displacement of the denture base than did the MI-ODs during bilateral and unilateral loadings (P <.05).

CONCLUSION

The strain around the MI with MBR was approximately 1.5 times higher than that without MBR. The pressure on posterior alveolar ridge and denture displacement of MI-ODs significantly decreased compared to CDs, even when MBR occurs. Bilateral balanced occlusion was recommended for MI-ODs, especially when MBR occurred.

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

OBJECTIVES

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

MATERIAL AND METHODS

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

RESULTS

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

CONCLUSION

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

Cost-effectiveness of three different concepts for the rehabilitation of edentulous mandibles: Overdentures with 1 or 2 implant attachments and hybrid prosthesis on four implants

BACKGROUND

There are scarce data regarding the combined assessment of the costs and effects of implant treatments for edentulous patients when multiple options are available.

AIM

This randomised clinical trial aimed to assess the cost-effectiveness of three different concepts for treatment: mandibular overdenture retained by a single (Group I; n = 11) or two implants (Group II; n = 13) and fixed hybrid prosthesis on four implants (Group III; n = 13).

METHODS

Treatment effectiveness was measured as the 1-year before-after changes in patient satisfaction with the mandibular prosthesis. Costs were prospectively quantified from the perspective of the health provider, including all direct cost items attributed to the delivery of treatments and up to the 1-year follow-up, using a "bottom-up" costing estimation method.

RESULTS

Patient satisfaction after treatment improved significantly for the three groups. The overall costs were R$ 2370.66, R$ 3185.21 and R$ 5739.52 for Groups I, II and III, respectively (P < .001). Analysis of incremental cost-effectiveness ratios suggested that the overdentures retained by one or two implants were more cost-effective than the fixed implant treatment, considering the mean cost and effectiveness values and the ±20% one-way sensitivity analysis.

CONCLUSION

This study suggests that the incremental costs for the fixed hybrid prosthesis, compared to the overdenture treatments, is not proportional to the respective gain in effectiveness. Therefore, although all treatment options had satisfactory outcomes, the use of implants to retain a mandibular overdenture, irrespective of the use of one or two implants, is more cost-effective than the fixed implant treatment for the edentulous mandible.

Functionally Orientated Tooth Replacement for Older Patients

Across the globe the population is ageing. In addition, older patients are retaining increasing numbers of natural teeth into old age. Therefore, clinicians are faced with the challenges of managing chronic dental diseases, including caries and periodontal disease, alongside replacing missing units. A number of treatment options are available to replace missing teeth for such patients with large numbers currently receiving removable partial dentures. Alternative approaches to treatment should be considered for this population group, including functionally orientated tooth replacement according to the principles of the shortened dental arch concept. In correctly chosen cases, this approach can provide patients with an acceptable, functional and aesthetic reduced dentition. Additionally, evidence suggests that such an approach can significantly reduce the maintenance burden for patients and clinicians which can ultimately deliver a more cost effective solution compared to removable alternatives.

The patient experience of dental implant surgery: a literature review of pertinent qualitative studies

This review aims to identify and summarise the findings of published qualitative studies relating to patients' experiences of dental implant surgery, by means of textual narrative synthesis. A comprehensive two-stage electronic and manual search of the literature identified relevant qualitative studies up to January 2020. Included primary studies (n = 15) used qualitative research methods including interviews and focus groups to investigate patients' experiences of dental implant treatment. They looked at the experience of tooth loss, the decision making process, the pre-implant experience, motivating factors and barriers for treatment and the post-implant experience with the prosthesis. There is a deficiency in the exploration of the patients' intraoperative dental surgical experience and the adjunctive effects of conscious sedation. The included studies give considerable insight into patients' experiences of the dental implant journey, which in the main, had overall positive consensus. The limited information available regarding patients' experience of the intra operative dental implant surgery with or without conscious sedation warrants further investigation. This information is a fundamental step to understanding the patients' preferences, needs and values and ultimately enhancing the quality of patient care.

Three-Dimensional Radiographic Outcome of Free-Handed Flaplessly Placed Mini Dental Implants in Edentulous Maxillae after 2-Years Function

Background: Free-handed, flaplessly placed mini dental implants (MDIs) are a valuable, more affordable and minimally invasive treatment to support overdentures in fully edentulous jaws, especially for medically compromised patients. However, critical 3D radiographic evaluation is lacking. This multicenter prospective case series assessed clinical outcome and carried out 3D- cone-beam computerized tomography (CBCT) analysis of free-handed flaplessly placed one-piece maxillary MDIs by an experienced maxillofacial surgeon. Methods: Thirty-one patients suffering from an ill-fitting maxillary denture relating to compromised bone volume (as confirmed on CBCT), with a dentate mandible, were selected. They received 5–6 MDIs free-hand flaplessly placed and mentally guided with preoperative CBCT. Final connection and attachment activation took place six months later. After two years each implant was individually assessed with CBCT for perforations on eight sites. Implant survival, prosthetic failure, clinical stability and sinus/nasal complaints were registered after three years. Results: 32/185 (17.3%) MDIs failed during the provisional loading with non-activated attachments; 17 replacements in 10 patients were performed. Of the 170 actively loaded 170 MDIs, 82.3% survived and 27/31 prostheses (87%) were fully functional. In total 98/170 MDIs showed no perforation. Based on 1360 CBCT observations, 231 perforations (16.9%) were registered. Of most perforations 37 (25%) were observed at the apical tip and 37 were positioned (21%) into the sinus/nasal cavity, although without clinical complaints. Conclusions: Given the compromised population, the minimally invasive procedure and the low treatment cost involved, a failure rate of 17% is substantial, however clinically acceptable given the critical bone condition. However, even in experienced surgical hands, freehanded and flapless placement yield a high risk for implant perforation, although this did not necessarily lead to complications.

Is a two-step impression mandatory for complete denture fabrication on the severely resorbed mandible? A randomized trial on patient perception and denture quality

OBJECTIVES

To evaluate the effectiveness of CCDs produced by two impression procedures for the mandibular ridge, in patients with severe mandibular atrophy.

METHODS

Fifty-two completely edentulous patients with severely resorbed mandibles were randomly allocated into two groups according to the impression procedure of the mandibular ridge: SI - single impression (stock tray and irreversible hydrocolloid); TI - two-step impression (custom tray, border molding with compound, and polyether). Assessments of oral health related quality of life (OHRQoL, primary outcome) and denture satisfaction were performed by using validated questionnaires. Denture quality was evaluated by means of functional tests.

RESULTS

Regardless of the technique, participants reported better OHRQoL (P < 0.001) in both follow-up periods (3 and 6 months after denture delivery), and groups resulted in similar OHIP-EDENT scores in its different domains (P > 0.05). Between-group differences were insignificant for general satisfaction (3 months, P = 0.699, 6 months, P = 0.392), as well as for aspects such as esthetics, comfort, mastication, speech, and prosthesis retention (P > 0.05). Overall clinical quality of the CCDs (P = 0.383) was similar between-group, as well as in specific aspects - interocclusal distance, occlusion, articulation, retention of the maxillary denture, and stability of both maxillary and mandibular dentures (P > 0.05).

CONCLUSIONS

Mandibular CCDs based on a single impression technique showed quality levels comparable to those generated by a two-step impression, both from the patient and clinician perspective.

CLINICAL SIGNIFICANCE

A simplified impression technique which eliminates the secondary impression can provide CCDs of good clinical quality, which influences the OHRQoL, and satisfaction in the same extent they would by a two-step procedure, even for patients with severely reabsorbed mandibular ridges. (ClinicalTrials.gov: NCT02339194).

How old is old for implant therapy in terms of early implant losses?

OBJECTIVES

To assess, retrospectively, whether older age has an impact on implant osseointegration when compared with younger age.

METHODS

All patients ≥65 years old at implant installation, in an university setting over a time-period of 11.5 years, with complete anamnestic data and follow-up until prosthetic restoration were included, and any early implant loss (EIL; i.e. lack of osseointegration prior to or at the time-point of prosthetic restoration) was recorded. Further, one implant, from each of the elderly patients, was attempted matched to one implant in a younger patient (35 to <55 years old at implant installation) from the same clinic based on (a) gender, (b) implant region, (c) smoking status and (d) bone grafting prior to/simultaneously with implant installation. The potential impact of various local and systemic factors on EIL in the entire elderly population, and in the matched elderly and younger patient group was statistically assessed.

RESULTS

Four hundred forty-four patients ≥65 years old (range 65.1-91.3; 56.8% female) receiving 1,517 implants were identified; 10 patients had one EIL each (implant/patient level: 0.66/2.25%). Splitting this patient cohort additionally into four age groups [65-69.9 (n = 213), 70-74.9 (n = 111), 75-79.9 (n = 80) and ≥80 (n = 40)], EIL was on the implant level 0.41, 0.83, 0.34 and 2.26%, respectively, (p = .102) and on the patient level 1.41, 2.70, 1.25 and 7.50%, respectively, (p = .104); multilevel analysis showed weak evidence of association of increasing age with higher EIL rate (p = .090). Matching was possible in 347 cases, and 5 (1.44%) and 9 (2.59%) EIL in the elderly and younger patients, respectively, were observed (p = .280). EIL could not be associated with any systemic condition or medication intake.

CONCLUSIONS

Elderly patients ≥65 years old presented a similarly low EIL rate as younger patients 35 to <55 years old, while patients ≥80 years old may have a slight tendency for a higher EIL rate. Hence, ageing does not seem to compromise osseointegration, and if at all, then only slightly and at a later stage of life.

The course from tooth loss to successful rehabilitation with denture: Feelings influenced by socioeconomic status

Objective:

This study evaluated the perception of users of complete dentures (successful cases) provided by the public health service throughout the course from tooth loss to rehabilitation.

Methods:

A total of 11 individuals who received their complete dentures through the public health service were interviewed according to a qualitative approach based on three pre-established topics: (1) tooth loss, (2) living without teeth, and (3) living with dentures. The obtained material was submitted to content analysis.

Results:

Individuals associated the socioeconomic status with lifelong oral health experiences and difficulty to access oral treatment. Tooth loss was the solution to pain and sometimes perceived as a natural event of life. Living without teeth was a negative surprise that resulted in physical and psychological impairments. The period of adaptation to dentures represented suffering and required psychological efforts to be successful.

Conclusion:

The dentures represented a reward for the suffering and recovered normal function, appearance, and socialization.

Pragmatic care for an aging compromised dentition

As our population ages, dentists face challenges in maintaining compromised teeth in aging patients. For the most part, elderly patients (i.e., over 65 years of age) prefer to keep their natural teeth and in some cases, avoid removable dentures altogether. Ideally, patients should not be rendered edentate late in life, as they are unlikely to successfully adapt to the limitations of complete replacement dentures. However, this is not always possible and care should ideally be planned to avoid edentulism, or at least, to carefully manage the transition to the edentate state. In the course of planning care, the dentist needs to recognise the need for age appropriate care, factoring in the impact of the elderly patient's health status and social circumstances. For elderly patients with a compromised dentition, the dentist should try to provide care which is minimally invasive and with as low a burden of maintenance as possible. In this paper, principles of pragmatic care for elderly patients with a compromised dentition will be outlined using clinical cases. Three pathways will be outlined: (i) maintenance of a functional natural dentition using adhesive restorative techniques; (ii) use of overlay prostheses and complete replacement overdentures to manage toothwear and toothloss, complete replacement overdentures, and; (iii) staging a transition to the edentate state using transitional removable partial dentures.

Impact of patient characteristics on edentulous subjects' preferences for prosthodontic rehabilitation with implants

OBJECTIVE

The aim of this study was to assess the influence of patient characteristics on edentulous subjects' preferences for different prosthodontic treatments with implants.

MATERIALS AND METHODS

A cross-sectional study was carried out with 131 edentulous subjects referred for treatment at a university clinic. Participants received detailed information about available treatment options and were asked to rank their preferences among three alternatives for rehabilitation of the maxilla and mandible: conventional dentures (CD), 2-implant-retained overdentures (IOD), or 4-implant fixed dentures (IFD). Individual data and prosthodontic-related variables were assessed through interviews. Oral health-related quality of life impacts was measured using the Brazilian version of the Oral Health Impact Profile for edentulous subjects (OHIP-Edent). Descriptive statistics, bivariate tests, and binary and multinomial logistic regressions were used for data analysis.

RESULTS

The majority of participants chose CD as their most preferred treatment for the maxilla (45.8%), while IFD was the most prevalent choice for the mandible (38.9%). Regression analysis showed that the OHIP-Edent "oral pain and dysfunction" (OPD) domain scores were positively associated with IOD preference for the maxilla (OR = 1.31; p = 0.010) and mandible (OR = 1.46; p = 0.002) and with IFD preference for the mandible (OR = 1.20; p = 0.031). Subjects with lower levels of formal education and those with lower income levels were less likely to choose IFD.

CONCLUSION

Level of education, income, and perceived quality of life impacts are potentially predictive variables of edentulous patients' preference for rehabilitation with implants. These factors may constitute important aspects to be considered by clinicians when treatment planning for edentulous patients.

Interviews and focus groups in qualitative research: an update for the digital age

Qualitative research is used increasingly in dentistry, due to its potential to provide meaningful, in-depth insights into participants' experiences, perspectives, beliefs and behaviours. These insights can subsequently help to inform developments in dental practice and further related research. The most common methods of data collection used in qualitative research are interviews and focus groups. While these are primarily conducted face-to-face, the ongoing evolution of digital technologies, such as video chat and online forums, has further transformed these methods of data collection. This paper therefore discusses interviews and focus groups in detail, outlines how they can be used in practice, how digital technologies can further inform the data collection process, and what these methods can offer dentistry.

Are UK graduates equipped with the skill set required to meet the demands of the UK's edentulous population?

As the UK witnesses a decline in the number of edentulous adults, there is a simultaneous reduction in the number of cases available to undergraduate dental students for the teaching of complete dentures. When edentulous adults are unable to function with conventional complete dentures, particularly pertaining to the mandibular denture, an implant-supported mandibular overdenture has been evidenced as the gold standard for edentulous patients. The evidence in favour of mandibular implant-supported overdentures is one of the most robust evidence bases for any clinical treatment and similarly it has been shown that undergraduate students are equally as capable in the provision of implant-supported overdentures as experienced prosthodontists. Yet there appears to be a disparity in the General Dental Council's undergraduate learning outcomes pertaining to care for edentulous adults. Furthermore, the UK seems to be falling behind in this respect in comparison to our European, American and Australian colleagues. This review looks at the evidence for the provision of implant-supported overdentures in the setting of the undergraduate dental curriculum, the potential barriers within this teaching forum and how well prepared UK undergraduates are for the clinical management of edentulous patients in the future.

Single-implant overdentures retained by the Novaloc attachment system: study protocol for a mixed-methods randomized cross-over trial

BACKGROUND

Overdentures retained by a single implant in the midline have arisen as a minimal implant treatment for edentulous mandibles. The success of this treatment depends on the performance of a single stud attachment that is susceptible to wear-related retention loss. Recently developed biomaterials used in attachments may result in better performance of the overdentures, offering minimal retention loss and greater patient satisfaction. These biomaterials include resistant polymeric matrixes and amorphous diamond-like carbon applied on metallic components. The objective of this explanatory mixed-methods study is to compare Novaloc, a novel attachment system with such characteristics, to a traditional alternative for single implants in the mandible of edentate elderly patients.

METHODS/DESIGN

We will carry out a randomized cross-over clinical trial comparing Novaloc attachments to Locators for single-implant mandibular overdentures in edentate elderly individuals. Participants will be followed for three months with each attachment type; patient-based, clinical, and economic outcomes will be gathered. A sample of 26 participants is estimated to be required to detect clinically relevant differences in terms of the primary outcome (patient ratings of general satisfaction). Participants will choose which attachment they wish to keep, then be interviewed about their experiences and preferences with a single implant prosthesis and with the two attachments. Data from the quantitative and qualitative assessments will be integrated through a mixed-methods explanatory strategy. A last quantitative assessment will take place after 12 months with the preferred attachment; this latter assessment will enable measurement of the attachments' long-term wear and maintenance requirements.

DISCUSSION

Our results will lead to evidence-based recommendations regarding these systems, guiding providers and patients when making decisions on which attachment systems and implant numbers will be most appropriate for individual cases. The recommendation of a specific attachment for elderly edentulous patients may combine positive outcomes from patient perspectives with low cost, good maintenance, and minimal invasiveness.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT03126942 . Registered on 13 April 2017.

Mini-Implants for Mandibular Overdentures: Cost-Effectiveness Analysis alongside a Randomized Trial

Mandibular overdentures retained by 2 conventional implants have been considered the standard of care for complete edentulism, according to the McGill and York consensuses. However, many patients refuse this treatment modality due to the associated costs and postsurgical discomfort. Mini-implants have the chance to overcome these limitations due to their potentially lower costs and a relatively uncomplicated surgical technique. This study compared treatment costs and incremental cost-effectiveness following the insertion of mini-implants (2 or 4) or 2 standard-size implants for the retention of mandibular overdentures, by means of a randomized clinical trial. In total, 120 edentulous participants (mean age 59.5 ± 8.5 y) were randomly allocated into 3 groups according to treatment received: 4 mini-implants (group 1), 2 mini-implants (group 2), or 2 standard implants (group 3). Treatment costs and outcomes (Oral Health Impact Profile for Edentulous [OHIP-EDENT] and satisfaction with the dentures) were evaluated after 6 mo. Incremental cost-effectiveness ratios (ICERs) were calculated for each intervention in terms of cost per 1-point change in patient outcomes. A 1-way sensitivity analysis was performed considering a 95% confidence interval variation in cost and outcome parameters, represented in tornado diagrams. Overall treatment cost was the lowest for group 2 (average cost: US$318.08), followed by group 1 (US$510.75) and group 3 (US$566.13). Groups did not differ in terms of the length of unscheduled appointments and time spent by participants. In summary, our findings indicate that mandibular overdentures retained by 2 or 4 mini-implants are less costly compared to 2-implant overdentures. Despite the lower costs of overdentures retained by 2 mini-implants, those retained by 4 mini-implants showed further improvement in patient-reported outcomes and reduced costs compared to standard implants ( ClinicalTrials.gov NCT01411683).

Knowledge Transfer Statement: This report shows that mini-implant retained overdentures are less costly than overdenture treatment on 2 standard-sized implants. Treatment with 2 mini-implants is an effective procedure to substantially save resources, whereas treatment with 4 mini-implants provides better results from a patient perspective combined with slightly reduced costs compared to the treatment with 2 standard implants. Therefore, mini-implant overdentures may be effective and more accessible than overdentures on 2 standard-size implants for those with limited incomes.

A Qualitative Study on Patients' Perceptions of Two Types of Attachments for Implant Overdentures

The aim of this qualitative study was to gain a deeper understanding of patient perceptions of wearing implant-retained overdentures with ball-shaped or cylindrical attachment systems. Twenty-two wearers of implant-supported overdentures participated in this qualitative study based on a randomized crossover clinical trial that aimed to compare a cylindrical attachment and a ball attachment. In phase I of the study, group A experienced ball attachments (n = 11) and group B Locator attachments (n = 11) for 1 year. Afterward, in phase II, the attachments were changed; group A received Locator attachments and group B received ball attachments. One week after the attachment's replacement, semistructured individual interviews were conducted. All interviews were audiotaped and transcribed. The analysis was guided by thematic content analysis. Most of the patients from both groups preferred the attachment they received in phase II, regardless the type. A major theme raised by the participants to justify their preference between the attachment types was prosthesis retention/stability, sometimes considered as a positive and other times as a negative factor. Other themes were also explored: oral function, pain, hygiene, previous experiences, confidence on the dentist's work, and esthetic. Aspects related to the retention/stability of the overdentures are the main concerns associated with the perceptions of most patients treated with implant overdentures regardless of the type of attachment. Adequate retention level should be identified and adjusted on an individual basis and maintained overtime as possible. Therefore, follow-up appointments should be planned for readjustment of the attachment's retention. Overretention should be avoided.

Cost-effectiveness analysis of two impression methods for the fabrication of mandibular complete dentures

OBJECTIVES

To compare the cost and to evaluate cost-effectiveness of fabricating mandibular complete dentures (CDs) using two different impression methods.

METHODS

A crossover randomized controlled trial including 27 edentulous participants was performed. Mandibular CDs were fabricated using two different impression methods, as follows: (i) conventional method using a custom tray border moulded with impression compound and silicone and (ii) simplified method using a stock tray and alginate. Cost analysis was performed from a clinical practitioner's perspective. The total cost included labor cost, which was calculated using the time spent by dentists and technicians in fabricating CDs and their hourly wages, and the material costs, which were calculated using purchase prices. To evaluate cost-effectiveness, we used general patient satisfaction as an indicator of effectiveness and calculated the incremental cost effectiveness ratio (ICER). ICER represents the cost per one unit of effectiveness.

RESULTS

The trial was completed by 24 participants. The total cost was 43,904 Japanese Yen (JPY) (330.91 EUR / 395.78 USD) for the conventional method and 39,792 JPY (299.93 EUR / 358.70 USD) for the simplified method, and this difference was statistically significant (p<0.001). The ICER showed a cost of 633 JPY (4.77 EUR / 5.70 USD) for every one point change in general patient satisfaction.

CONCLUSIONS

The results indicated that the total cost of the conventional method was significantly higher than that of the simplified method (p<0.001).

CLINICAL SIGNIFICANCE

The conventional impression method for fabricating mandibular CDs, which took additional 633 JPY (4.77 EUR / 5.70 USD) for improvement of general satisfaction, is supposed to be clinically meaningful¹.

Facilitators and barriers influencing the readiness to receive dental implants in a geriatric institutionalised population-A randomized non-invasive interventional study

OBJECTIVE

Although elderly people have many serious dental issues and are in need of prosthesis, few opt for dental implants. The aim of this study was to investigate barriers that prevent elderly people from receiving dental implants. Specifically, we examined (i) whether the message was delivered before or after the interview had an impact, and (ii) whether it did matter who delivered the message.

MATERIALS AND METHODS

Sixty-six residents from seven residential homes in the Canton of Grisons, Switzerland were included. The sample was randomized to a treatment group that received comprehensive education about dental implants before the interview and a control group that received education after completing the questionnaire.

RESULTS

The sample consisted of 54 women (81.8%) and 12 males (18.2%) with an average age of 86.2 years. Education before the interview did not show any impact on the attitude towards dental implants. Main reasons for a negative attitude towards implants were old age and high costs. Participants who received information about implants from their relatives and their own dentist and not from the study dentist were significantly more willing to receive implants.

CONCLUSION

Providing an adequate education about benefits and risks of receiving dental implants does not change the attitude towards dental implants. The source of information/messenger does influence attitudes towards implants. If the person delivering the education and information is a relative or a known medical person, the person's attitude is more likely to change as compared to people receiving the information from an unrelated person.

Reasons for not using Implants to retain Complete Denture: Patients' Survey

OBJECTIVE

This study aimed to gain more information from complete denture (CD) wearers who did not receive dental implants, of the reasons preventing them from using implants to retain their CD in a selected sample of dental patients in Riyadh, Saudi Arabia.

MATERIALS AND METHODS

A paper-and-pencil questionnaire containing 20 direct questions of the possible reasons preventing CD wearers from receiving implants to retain their dentures was distributed in three different places in Riyadh, Saudi Arabia.

RESULTS

A total of 270 subjects were included in this survey. The results showed that 180 (66.7%) patients indicated that the fear of pain associated with implant placement was the main reason preventing them from receiving an implant treatment, followed by fear of the surgical procedure (175, 64.8%), fear of postoperative complications (166, 61.5%), information from other people about the various problems associated with implant treatment (154, 57%), and finally cost of the implant (141, 52.2%).

CONCLUSION

Fear is the main reason preventing CD wearers from receiving implant treatment. Therefore, it is essential for dentists to be familiar with the reasons for implant refusal to overcome a common, yet an influential obstacle.

Clinical guidelines and procedures for provision of mandibular overdentures on 4 mini-dental implants

This article describes the flapless placement of mini-dental implants (MDI) to retain mandibular overdentures. Clinical inclusion/exclusion criteria and clinical protocols for the flapless placement of MDIs and for retrofitting the overdenture are presented. A minimum bone height of 13 mm and a minimal flap are recommended. After drilling, the 4 implants are placed with a self-tapping process. A minimum of 15 Ncm of resistance upon final insertion indicates that immediate loading can be performed. The metal housings with O-rings are incorporated into the prosthesis using autopolymerizing resin. The technique and protocol for immediately loaded 4-mini-implant mandibular overdentures is minimally invasive and cost effective.

Tooth replacement for partially dentate elders: A willingness-to-pay analysis

OBJECTIVES

The primary aim of this study was to investigate partially dentate elders' willingness-to-pay (WTP) for two different tooth replacement strategies: Removable Partial Dentures (RPDs) and, functionally orientated treatment according to the principles of the Shortened Dental Arch (SDA). The secondary aim was to measure the same patient groups' WTP for dental implant treatment.

METHODS

55 patients who had completed a previous RCT comparing two tooth replacement strategies (RPDs (n=27) and SDA (n=28)) were recruited (Trial Registration no. ISRCTN26302774). Patients were asked to indicate their WTP for treatment to replace missing teeth in a number of hypothetical scenarios using the payment card method of contingency evaluation coupled to different costs. Data were collected on patients' social class, income levels and other social circumstances. A Mann-Whitney U Test was used to compare differences in WTP between the two treatment groups. To investigate predictive factors for WTP, multiple linear regression analyses were conducted.

RESULTS

The median age for the patient sample was 72.0 years (IQR: 71-75 years). Patients who had been provided with RPDs indicated that their WTP for this treatment strategy was significantly higher (€550; IQR: 500-650) than those patients who had received SDA treatment (€500; IQR: 450-550) (p=0.003). However patients provided with RPDs indicated that their WTP for SDA treatment (€650; IQR: 600-650) was also significantly higher than those patients who had actually received functionally orientated treatment (€550; IQR: 500-600) (p<0.001). The results indicated that both current income levels and previous treatment allocation were significantly correlated to WTP for both the RPD and the SDA groups. Patients in both treatment groups exhibited little WTP for dental implant treatment with a median value recorded which was half the market value for this treatment (€1000; IQR: 500-1000).

CONCLUSIONS

Amongst this patient cohort previous treatment experience had a strong influence on WTP as did current income levels. Both treatment groups indicated a very strong WTP for simpler, functionally orientated care using adhesive fixed prostheses (SDA) over conventional RPDs.

CLINICAL SIGNIFICANCE

Partially dentate older patients expressed a strong preference for functionally orientated tooth replacement as an alternative to conventional RPDs.

Patients' perceptions of implant placement surgery, the post-surgical healing and the transitional implant prostheses: a qualitative study

OBJECTIVES

This study aimed to explore patients' thoughts, feelings about, and experiences of, implant placement surgery (IPS), the post-surgical healing stage and the immediate post-surgical transitional implant prosthesis (TIP) (fixed and removable).

METHODS

A qualitative study design was chosen and 38 semi-structured telephone and face-to-face interviews were conducted with 34 patients at different stages of implant treatment. The interviews were transcribed verbatim; the data collection and coding process followed the principles of thematic analysis, which was facilitated through the use of NVivo10.

RESULTS

Patients anticipated that surgery would be painful and unpleasant but were prepared to accept this temporary discomfort for the expected benefits of implant treatment. However, a key finding was that patients felt they had overestimated the trauma of surgery but underestimated the discomfort and difficulties of the healing phase. A number of difficulties were also identified with the TIP phase following implant surgery.

CONCLUSION

Existing research has tended to focus on the longer term benefits of dental implant treatment. This qualitative study has investigated in-depth patients' perceptions of dental implant surgery, including their experiences related to sedation, and of transitional implant restoration. While patients felt their concerns were overestimated in relation to the implant surgery, they experienced greater morbidity than they expected in the healing phase. Recommendations are made for relatively small changes in care provision which might improve the overall patient experience. Partial dentate patients treated with a fixed transitional prosthesis experienced advantages more quickly than patients with an overdenture.

A qualitative investigation into patients' perspectives on edentulousness

OBJECTIVES

This study explored the experiences of edentulous patients for their perceptions of tooth loss and patient attitudes to treatment options for rehabilitation of the edentate state.

METHODS

Purposive sampling was used to recruit edentate patients with varying denture-wearing experience from two dental hospitals in the Republic of Ireland. Sixteen edentate patients, aged 59 to 83 years, of whom 12 were women and four men were interviewed. Interviews were transcribed, and thematic analysis was undertaken.

RESULTS

Findings from this study reflect previous studies, whereby some patients indicated dissatisfaction with the functionality of their dentures. The majority of participants had no regret regarding the loss of their teeth, and despite dissatisfaction with dentures, they would not consider other forms of treatment. Finance was not considered an issue in determining whether to seek out treatment by these participants. These participants expressed a reluctance to get new dentures in case they were more problematic.

CONCLUSION

This study illustrates that some elder edentate patients were dissatisfied with the functionality of their dentures and raised concerns that about the quality of dentures which may be provided to them by dentists. These participants identified clinical dental technicians as a preferred point of contact for their care. Consideration should be given to new oral healthcare delivery models which are accessible and acceptable to future elders.

Impact of a "TED-Style" presentation on potential patients' willingness to accept dental implant therapy: a one-group, pre-test post-test study

PURPOSE

A survey was conducted to assess the impact of a TED-like educational session on participants' willingness to accept dental implant therapy.

MATERIALS AND METHODS

Volunteers interested in having information about dental implant therapies were recruited and asked to complete a two-part survey before and after an educational session. The initial survey elicited demographic information, self-perceived knowledge on dental implants and willingness to this kind of treatment. A "TED-style" presentation that provided information about dental implant treatments was conducted before asking the participants to complete a second set of questions assessing the impact of the session.

RESULTS

The survey was completed by 104 individuals, 78.8% were women and the mean age was 66.5±10.8. Before the educational session, 76.0% of the participants refused dental implants mainly due to lack of knowledge. After the educational session, the rejection of dental implants decreased by almost four folds to 20.2%.

CONCLUSION

This study proved that an educational intervention can significantly increase willingness to accept treatment with dental implants in a segment of the population who is interested in having information about dental implant therapy. Furthermore, educational interventions, such as TED-like talks, might be useful to increase popular awareness on dental implant therapy.

A fixed movable resin-bonded fixed dental prosthesis--A 16 years clinical report

PATIENTS

This report describes the case of a 48-year-old female patient who initially received a 4-unit fixed-fixed (FF) resin-bonded fixed dental prosthesis (RBFDP) for replacement of mandibular left second premolar and first molar. Twenty-one months later, debond of the RBFDP was found at one of retainers. A new fixed-movable RBFDPs with a modified non-rigid connector as well as increased resistance form features was placed and successfully retained at the 16-year clinical review.

DISCUSSION

RBFDPs are a conservative tooth replacement option that requires minimum tooth preparation and retention by a resin cement to etched enamel. However debonding is the most frequently seen complication and has been attributed to the relative movement between abutment teeth during function that stress the bonding interface. This case report highlights the use of modified non-rigid connector which allows relative movement between abutment teeth and therefore a reduced stress on the bonding interface.

CONCLUSION

It is proposed that the use of modified non-rigid connectors that allow independent movement between the abutment teeth during function was responsible for the long term clinical success of fixed-movable RBFDPs.

A randomized controlled trial of the different impression methods for the complete denture fabrication: Patient reported outcomes

OBJECTIVES

To compare the effect of conventional complete dentures (CD) fabricated using two different impression methods on patient-reported outcomes in a randomized controlled trial (RCT).

METHODS

A cross-over RCT was performed with edentulous patients, required maxillomandibular CDs. Mandibular CDs were fabricated using two different methods. The conventional method used a custom tray border moulded with impression compound and a silicone. The simplified used a stock tray and an alginate. Participants were randomly divided into two groups. The C-S group had the conventional method used first, followed by the simplified. The S-C group was in the reverse order. Adjustment was performed four times. A wash out period was set for 1 month. The primary outcome was general patient satisfaction, measured using visual analogue scales, and the secondary outcome was oral health-related quality of life, measured using the Japanese version of the Oral Health Impact Profile for edentulous (OHIP-EDENT-J) questionnaire scores.

RESULTS

Twenty-four participants completed the trial. With regard to general patient satisfaction, the conventional method was significantly more acceptable than the simplified. No significant differences were observed between the two methods in the OHIP-EDENT-J scores.

CONCLUSIONS

This study showed CDs fabricated with a conventional method were significantly more highly rated for general patient satisfaction than a simplified.

CLINICAL SIGNIFICANCE

CDs, fabricated with the conventional method that included a preliminary impression made using alginate in a stock tray and subsequently a final impression made using silicone in a border moulded custom tray resulted in higher general patient satisfaction.

TRIAL REGISTRATION

UMIN000009875.

Minimal intervention dentistry and older patients part 2: minimally invasive operative interventions

As described in the first paper of this two part series, the expansion of our older population and the concomitant reduction in levels of edentulism will result in an increase in the number of patients presenting in general practice with complex restorative challenges. The application of the concepts of minimal intervention dentistry and minimally invasive operative techniques may offer a powerful armamentarium to the general dentist to provide ethical and conservative treatment to older patients.

CLINICAL RELEVANCE

When it is unavoidable, operative intervention should be as minimally invasive as practicable in older patients to preserve the longevity of their natural dentition.

A randomised controlled trial of complete denture impression materials

Objectives

There is continuing demand for non-implant prosthodontic treatment and yet there is a paucity of high quality Randomised Controlled Trial (RCT) evidence for best practice. The aim of this research was to provide evidence for best practice in prosthodontic impressions by comparing two impression materials in a double-blind, randomised, crossover, controlled, clinical trial.

Methods

Eighty-five patients were recruited, using published eligibility criteria, to the trial at Leeds Dental Institute, UK. Each patient received two sets of dentures; made using either alginate or silicone impressions. Randomisations determined the order of assessment and order of impressions. The primary outcome was patient blinded preference for unadjusted dentures. Secondary outcomes were patient preference for the adjusted dentures, rating of comfort, stability and chewing efficiency, experience of each impression, and an OHIP-EDENT questionnaire.

Results

Seventy-eight (91.8%) patients completed the primary assessment. 53(67.9%) patients preferred dentures made from silicone impressions while 14(17.9%) preferred alginate impressions. 4(5.1%) patients found both dentures equally satisfactory and 7 (9.0%) found both equally unsatisfactory. There was a 50% difference in preference rates (in favour of silicone) (95%CI 32.7–67.3%, p < 0.0001).

Conclusion

There is significant evidence that dentures made from silicone impressions were preferred by patients.

Clinical significance

Given the strength of the clinical findings within this paper, dentists should consider choosing silicone rather than alginate as their material of choice for secondary impressions for complete dentures.

Trial Registration: ISRCTN 01528038.



This article forms part of a project for which the author (TPH) won the Senior Clinical Unilever Hatton Award of the International Assocation for Dental Research, Capetown, South Africa, June 2014.