A multicentric study to evaluate the treatment outcome and complications after oral rehabilitation with implant-supported hybrid prostheses

Background

As a newer modality of rehabilitation of completely edentulous patients, there is no conclusive evidence on which of the variants of hybrid prosthesis, namely acrylic teeth on a metal substructure or porcelain fused to metal teeth over on a metal substructure, is better in terms of treatment outcome, reduced mechanical complications, and better patient compliance.

Methods

Sixteen completely edentulous patients, both male and female, were selected from the OPD of the study centers during the study period. Group A: Eight patients rehabilitated by maxillary and mandibular hybrid prosthesis using a substructure of metal covered by acrylic teeth, which was screwed on the implants. Group B: Eight patients rehabilitated by maxillary and mandibular hybrid prosthesis using a substructure of metal covered by porcelain fused to metal teeth, which was screwed on implants. The patients were recalled at 3 months, 6 months, and 1 year following rehabilitation, and necessary clinical and radiological observations were made to evaluate the overall health and complications. Oral health-related quality of life was measured using the Oral Health Impact Profile (OHIP)-EDENT questionnaire before treatment and after rehabilitation. The same methodology, clinical procedures, and evaluation criteria were followed in all the study centers. The data obtained were then compiled and analyzed.

Results

None of the patients in group A or B showed any signs of need to remake. There was no statistically significant difference in proportions of cases showing signs of loosening of components, soft tissue overgrowth, breakage of acrylic, chipping of porcelain, and wear of teeth in both the groups. The amount of screw loosening, wear of prosthetic superstructure, and bone loss around implants were less (even though not statistically significant) in group A. Both the groups showed satisfactory esthetics. OHIP- EDENT evaluation gave completely satisfactory report after rehabilitation in both groups.

Conclusion

Both the types of complete rehabilitation, hybrid prosthesis of acrylic teeth on a metal substructure and hybrid prosthesis of porcelain fused to metal teeth on a metal substructure were successful and comparably reliable.

Profile of breast diseases at a self-referral clinic in Ghana

BACKGROUND

Breast cancer is a common malignancy in Ghana, and many patients are referred with advanced disease and long duration of symptoms.

OBJECTIVE

To determine the spectrum of breast disease diagnosed through patient self-referral in Ghana.

METHODS

A breast clinic, where patients could walk in without referral, was started in the Korle Bu Teaching Hospital in 2001. A team of surgeons, radiation oncologists, oncology nurses, a clinical psychologist and a clinical pharmacist sat in conference once a week to see and discuss self-referred patients.

RESULTS

Seven hundred and forty eight patients, mean age 38.6 (range 8-85) years, were seen during a four-year period. There were 741 females and seven males. The main complaints were pain 450 (50.2%), lump 257 (28.7%) and nipple discharge 62 (8.3%). Fifty (5.6%) came for check-up; 139 (18.6%) had more than one complaint. The mean (S.D.) duration of symptoms was; for nipple discharge 14.1 (10.5) months, lump 11.9 (7.7) months, and pain 11.3 (8.9) months. The main diagnoses were: Normal breasts 192 (27.7%), mastalgia 135 (18.1%), fibroadenosis 114 (15.2%), fibroadenomas 84 (11.2%), breast cancer 58 (7.8%), suspected breast cancer 25 (3.3%), galactorrhea 9 (1.2%), mastitis 8 (1.1%), musculoskeletal pain 8 (1.1%), duct ectasia 8 (1.1%), mondor's disease 7 (0.94%) and recurrent breast cancer 6 (0.8%). In patients with breast cancer, 42 (66%) had advanced disease, 6 (9.4%) had recurrent disease and 4 (63%) had metastatic disease.

CONCLUSION

The number of self-referrals, detected breast cancers and duration of symptoms justify the need for self-referral clinics in Ghana.