Barriers to postgraduate education in primary dental care: a qualitative study.

OBJECTIVES: Postgraduate education for primary care dentists offers numerous benefits in terms of advancing clinical skills and career opportunities, culminating in improved treatment and patient outcomes. There is a strong desire amongst primary care dentists to enhance skills and provide contemporaneous evidence-based dentistry, accredited by higher educational qualifications. However, significant barriers hinder their pursuit of further training and career advancement. The aim of this study is to explore the barriers to undertaking formal postgraduate education for dental practitioners working in primary dental care. Exploration of these perceptions should help to identify further areas of study to help alleviate some of these obstacles, enabling more primary care dentists to access postgraduate education and improve patient care. METHOD: A qualitative study was undertaken through individual narrative interviews with primary care dental practitioners (n = 20) with varying levels of experience and located across the UK. All interviews were conducted using a study guide, transcribed and analysed thematically. RESULTS: The participants indicated that there is a strong desire to undertake postgraduate study amongst primary care dental practitioners. Significant barriers were identified, with three major themes emerging: 1.Personal Cost: Time constraints and accessibility, Financial Burden, Family Commitments. 2.Business Viability: Business time constraints, Inability to use Enhanced Skills, Remuneration systems. 3.Business Culture and Team Dynamics: Stage of Career, Current Practice Business Model, Leadership and Vision. These barriers appear to be multifaceted and interconnected, however participants also identified significant opportunities to address them. CONCLUSION: Study participants identified a range of personal and professional barriers to undertaking postgraduate dental education whilst working in primary dental care. Practitioners working within predominately NHS orientated practices perceived more professional barriers than those in private practice. The majority of participants indicated their preference for hybrid models of education which would work around clinical commitments. Further research and engagement with stakeholders should be undertaken to help reduce these barriers.

Prolonged use of old dentures: A qualitative study with Brazilian older adults.

OBJECTIVE: To explore older adults' perceptions, motivations and reasons for using and not replacing old and worn complete dentures over prolonged periods. MATERIALS AND METHODS: In-depth, semi-structured interviews were conducted with Brazilian edentulous older adults who were wearing complete dentures which were at least 20 years old. A purposive sampling method was used to recruit participants from an existing waiting list of those referred to a hospital clinic for new dentures. The interviews were video-recorded, transcribed verbatim and analysed using thematic analysis. RESULTS: Sixty-two individuals were assessed and nine were included in the study, aged from 61 to 77 years (mean = 65.4), with seven (77.8%) of them women. The reported time using their current dentures ranged from 22 to 45 years (mean = 28). Content analysis revealed three main themes: the perception of the current dentures' condition after prolonged use; reasons for the prolonged use and non-replacement; and unsuccessful attempts to replace the dentures. Overall, participants acknowledged the poor condition of their dentures and did recognise the need for replacement. Several factors had prompted them to delay or temporarily forego replacement, with financial constraints being the main barrier. Some reported failed attempts to replace the dentures in the past years or months; however, challenging adaptation to the new prostheses led to them reverting back to their old dentures as a fallback solution. CONCLUSION: Factors influencing prolonged denture use in older adults include a complex interplay of financial aspects, treatment awareness, access and personal factors. Dental professionals can play a pivotal role in promoting timely denture adjustment or replacement by addressing these factors through patient education and personalised care.

A cross-sectional CBCT assessment of the relative position of one-piece titanium-zirconium mini-implants placed for mandibular overdentures using non-guided surgery.

OBJECTIVE: To assess the relative position of mini-implants to retain a mandibular overdenture, according to the surgical protocol, technical and anatomical factors. METHODS: Mandibular cone-beam computed tomography (CBCT) scans were analyzed for 73 patients who received four one-piece titanium-zirconium mini-implants. Drilling was performed using a 1.6 mm needle drill and a 2.2 mm Pilot Drill, according to the bone density with a surgical stent. Post-insertion CBCT images in DICOM format were analyzed using the E-Vol-DX software with BAR filters. Divergence angle between implants and between implants and the overdenture path of insertion was measured using CliniView 10.2.6 software. RESULTS: Divergence between implants ranged from 0° to 22.3° (mean = 4.2; SD = 3.7) in the lateral and from 0° to 26.2° (mean = 5.3; SD = 4.1) in the frontal projections (p < .001). Only 1 (0.2%) and 3 (0.7%) of the measurements were higher than 20° in the lateral and frontal views, respectively. The mean angulations between the implant and the path of insertion for the overdenture were 9.3° (SD = 7.5) and 4.0° (SD = 2.9) for the lateral and frontal views, respectively (p < .001). Regression analyses showed a significant association between the divergence of implants and the frontal view projection (p < .001), greater distance between the paired implants (p = .017), the flapped surgical protocol (p = .002), higher final insertion torque (p = .011), and deeper preparation with the needle drill (p < .001). CONCLUSIONS: The mini-implants were placed with low divergence angles and satisfactory parallelism. Factors including shorter distances between the implants, higher density bone, and a flapless surgical approach all contributed positively to improved parallelism of the mini-implants.

Mandibular overdenture retained by four one-piece titanium-zirconium mini implants: A 2-year RCT on patient-reported outcomes.

AIM: The positive impact of implant interventions on dental patient-reported outcomes is an essential parameter of treatment effectiveness. This study assessed the 2-year changes in patient satisfaction and oral health-related quality of life (OHRQoL) of edentulous patients treated with a four mini implant mandibular overdenture (IOD) METHODS: The study was planned as a 2 × 2 factorial randomized clinical trial that tested two surgical approaches (flapped or flapless) and two loading protocols (immediate and delayed) using a titanium-zirconium mini implant (Straumann Mini Implant System®) and a PEEK retentive system (Straumann® Optiloc® Retentive System). Outcome measures (OHIP-Edent scores and the McGill Denture Satisfaction questionnaire) were assessed before treatment and at the 3-, 6-, 12-, and 24-month follow-ups. The Friedman test and multiple regression using Generalized Estimating Equations (GEE) were used for data analysis, considering the per-protocol (PP) and intention-to-treat (ITT) approaches RESULTS: Seventy-four patients were randomized to the study groups. No implant failure occurred during the study period. Marked improvement in all post-treatment periods compared to baseline were observed for the two outcomes. No significant effect of patient's gender, age, and surgical protocol on the study outcomes. The effect of treatment provision was significant for the two outcomes in the PP and ITT approaches (p < 0.001). A barely significant positive effect of the immediate loading was observed for OHIP-Edent in the PP approach (p = 0.020) CONCLUSION: IOD treatment significantly improved patient-reported outcomes measures, with sustained benefits over the two years of overdenture use, and can be considered a promising treatment option in for the edentulous mandible.

Mandibular overdenture retained by four one-piece titanium-zirconium mini implants: A 2-year follow-up on prosthodontic outcomes.

OBJECTIVE: This 2-year prospective study reports the incidence of prosthetic complications and maintenance events after treatment with mandibular overdenture retained by four mini implants opposed to a maxillary denture. METHODS: Implant intervention included flapless or flapped surgery combined with immediate or delayed loading, as part of a randomized clinical trial. Four one-piece titanium-zirconium mini-implants (Straumann Mini Implant System) were inserted, and the retentive PEEK elements (Optiloc) were incorporated into the overdenture using chairside procedures. Prosthodontic complications and maintenance events were recorded over a 2-year follow-up, and the final outcome was defined according to standardized criteria. Data analysis included descriptive statistics, incidence and incidence density rates, and Kaplan-Meier survival. RESULTS: 73 out of 74 patients (64.9 % female), mean age of 64 (SD=8.2) years, completed the study follow-up (one withdrew after 9 months). Implant survival was 100 %. A total of 163 prosthodontic events occurred in 53 patients (72.6 %), and 20 patients had no clinical complaints or maintenance needs. The most common procedures were adjustment/repair of the overdenture base (47.0 %), replacement of retentive inserts (19.8 %), and laboratory relining (12.9 %). A high prosthodontic success rate was achieved (93.2 %), and all patients presented serviceable overdentures and continuous use after the resolution of prosthodontic complications. The incidences of matrix replacement and laboratory relines were low in the first year, while denture base adjustments were common within the first year, especially in the first 6 months. CONCLUSION: The mini implant system showed high prosthodontic success rates. Minor adjustments/repairs during the initial follow-up were common. Relines and matrix replacements tend to occur after one year of overdenture use, and matrix replacements may occur as a consequence of the need for relining.

A 1-Year Parallel-Group Randomized Clinical Trial Comparing the Effectiveness of a Mandibular Complete Denture vs an Early Loaded Single-Implant Overdenture.

PURPOSE: To assess the effectiveness of converting a conventional mandibular denture (CMD) into a single-implant mandibular overdenture (SIMO). MATERIALS AND METHODS: Edentulous patients received a new CMD and were randomly assigned to the CMD or SIMO group. For SIMO patients, a midline early-loaded implant was inserted and incorporated into the CMD after 3 weeks. Patient satisfaction and oral health-related quality of life were assessed at baseline and up to 1 year. Regression models were constructed using Generalized Estimating Equation (GEE). RESULTS: After 12 months, 32 patients were assessed (CMD: n = 17; SIMO: n = 15). Significant improvement was observed for the SIMO group compared to baseline measures. CONCLUSIONS: SIMO may be considered an effective alternative for patients unsatisfied with their CMDs.

Changes in masticatory performance and bite force after treatment with mandibular overdentures retained by four titanium-zirconium mini implants: One-year randomised clinical trial.

OBJECTIVE: This prospective study is part of a randomised clinical trial and reports the changes in masticatory performance (MP) and bite force, and explores their influential factors, 1 year after the provision of mandibular overdentures retained by four titanium-zirconium mini implants. METHODS: Edentulous patients received conventional complete dentures, followed by placement of four mini implants (Straumann® Mini Implant System) in the anterior mandible and converting the conventional prosthesis into a mandibular overdenture. Treatment protocols were randomised using a 2×2 factorial design combining different surgical (flapped vs. flapless) and loading (immediate vs. delayed) protocols. MP was assessed using a two-colour mixing ability test and a colorimetric analysis to measure the level of colour mixing (Variance of Hue-VoH). Maximum voluntary bite force (MBF) was measured by a digital gnathodynamometer in the posterior and anterior regions. Sex, age, surgical and loading protocols and ridge morphology were tested as independent variables. MP and MBF tests were performed at baseline (pre-treatment) and the 3-, 6- and 12-month after implant loading. Descriptive statistics, independent t-test, and linear mixed-effect model (LMM) regression were used for data analysis. RESULTS: Seventy-four participants were assessed and 73 completed the 1-year follow-up. Statistically significant improvements in functional parameters were observed in all follow-up periods compared to baseline (p < .001). The flapless protocol was associated with higher improvement in MP at the 3-month follow-up (p = .004), while less resorbed ridges were associated with better MP (p = .038) and higher MBF (p < .001). CONCLUSION: The mandibular overdenture protocol using four titanium-zirconium mini implants was effective in improving MP and MBF of edentulous patients, compared to pre-treatment values. The findings also suggest that improvements in chewing function and bite force are impacted by clinical factors since better outcomes were observed for flapless surgeries and less resorbed edentulous ridges. CLINICAL TRIAL REGISTRATION: ClinicalTrials.Gov ID NCT04760457.

Single lateral implant for mandibular overdentures as a fallback solution or a viable treatment alternative: Four case reports.

This report of four clinical cases aims to illustrate the use of a lateral implant as a solution for implant overdentures in the mandible in different clinical situations. The first two cases describe the clinical situations of patients wearing two-implant mandibular overdentures until the failure of one of the implants, one due to implant loss and the other due to a fracture of an abutment screw, and how the conditions were managed. The third case illustrates the placement of a single implant to retain an overdenture, where a midline implant, as originally planned, was not feasible due to anatomic reasons. The final case describes the use of a lateral implant to support and retain a single-implant mandibular overdenture. The four cases demonstrate that a single lateral implant can be utilized as sole retention in cases of a failing contra-lateral implant and as an alternative to a single implant in the midline.

Using a theoretically informed process evaluation alongside a trial to improve oral health for care home residents.

BACKGROUND: Poor oral health is common among older adults residing in care homes impacting their diet, quality of life, self-esteem, general health and well-being. The care home setting is complex and many factors may affect the successful implementation of oral care interventions. Exploring these factors and their embedded context is key to understanding how and why interventions may or may not be successfully implemented within their intended setting. OBJECTIVES: This methodology paper describes the approach to a theoretically informed process evaluation alongside a pragmatic randomised controlled trial, so as to understand contextual factors, how the intervention was implemented and important elements that may influence the pathways to impact. MATERIALS AND METHODS: SENIOR is a pragmatic randomised controlled trial designed to improve the oral health of care home residents in the United Kingdom. The trial uses a complex intervention to promote and provide oral care for residents, including education and training for staff. RESULTS: An embedded, theoretically informed process evaluation, drawing on the PAHRIS framework and utilising a qualitative approach, will help to understand the important contextual factors within the care home that influence both the trial processes and the implementation of the intervention. CONCLUSION: Utilising an implementation framework as the basis for a theoretically informed process evaluation provides an approach that specifically focuses on the contextual factors that may influence and shape the pathways to impact a given complex intervention a priori, while also providing an understanding of how and why an intervention may be effective. This contrasts with the more common post hoc approach that only focuses on implementation after the empirical results have emerged.

Exploring the attitudes of general dental practitioners to providing dietary advice alongside oral rehabilitation for older adults.

OBJECTIVE: We aimed to capture General Dental Practitioners' (GDPs) views on delivering dietary advice to older adults in combination with treatment to replace missing teeth and identify solutions to help inform the development and implementation of future dietary interventions within primary dental care. BACKGROUND: As natural teeth are lost, older adults may need to choose softer, more manageable foods which might be of lower nutrient density. Previous research has indicated that prosthodontic rehabilitation can improve masticatory function but not the intake of nutrients, highlighting a potential need for a combined approach of oral rehabilitation and dietary counselling. MATERIALS AND METHODS: Semi-structured telephone interviews were conducted with a purposive sampling strategy of 12 GDPs. Interviews were digitally recorded and transcribed verbatim. An iterative coding process using theme-analytic methods was used. RESULTS: Twelve interviews were conducted with GDPs in the United Kingdom. The themes that emerged from the interviews included: the awareness of the importance of dietary advice among GDPs; the concerns GDPs had on patients' adherence to dietary advice; uncertainty over roles and responsibilities in the provision of dietary advice; and the limited time and remuneration for dietary advice in dental practice. A minor theme identified was the motivation of GDPs to implement dietary advice alongside oral rehabilitation. All reported that they were already providing dietary advice to their patients but that this was limited to caries prevention. CONCLUSION: The GDPs interviewed expressed positive attitudes towards providing dietary advice alongside oral rehabilitation for older adults. However, a lack of confidence, awareness, time and remuneration are barriers to its provision in primary dental care. To facilitate the implementation of dietary advice alongside oral rehabilitation, clear guidance on and training in delivering dietary advice and multidisciplinary cooperation are required.

Towards an operational definition of oral frailty: A e-Delphi study.

OBJECTIVES: Building upon our recently developed conceptual definition of oral frailty (the age-related functional decline of orofacial structures), this e-Delphi study aims to develop an operational definition of oral frailty by identifying its components. METHODS: We used a modified e-Delphi study to reach a consensus among international experts on the components of oral frailty. Twelve out of fifteen invited experts in the field of gerodontology participated. Experts responded to three rounds of an online 5-point scale questionnaire of components to be included or excluded from the operational definition of oral frailty. After each round, scores and rationales were shared with all experts, after which they could revise their position. A consensus was reached when at least 70% of the experts agreed on whether or not a component should be included in the operational definition of oral frailty. RESULTS: The experts achieved a high level of agreement (80 - 100%) on including eight components of oral frailty and excluding nineteen. The operational definition of oral frailty should include the following components: 1) difficulty eating hard or tough foods, 2) inability to chew all types of foods, 3) decreased ability to swallow solid foods, 4) decreased ability to swallow liquids, 5) overall poor swallowing function, 6) impaired tongue movement, 7) speech or phonatory disorders, and 8) hyposalivation or xerostomia. CONCLUSION: This e-Delphi study provided eight components that make up the operational definition of oral frailty. These components are the foundation for the next stage, which involves developing an oral frailty assessment tool.

Compliance with oral hygiene and dietary advice for the prevention of post-radiotherapy dental disease among head and neck cancer patients - a qualitative study.

OBJECTIVES: To elicit head and neck cancer (HANC) patients' views about their oral health and to identify potential issues regarding compliance with clinical oral hygiene and dietary advice for the prevention of post-radiotherapy dental disease. METHODS: A purposive sample of twelve HANC patients between 6- and 12-months post-radiotherapy were recruited to undergo a semi-structured interview with a qualitative researcher. A pre-piloted topic guide was used to frame each interview. Qualitative data were analysed via thematic analysis. RESULTS: Data were categorised into four main themes - 'How HANC patients perceive oral health', 'Cancer diagnosis and cancer care pathway', 'Impact of oncology treatment (radiotherapy, surgery, and chemotherapy)', and 'Post-oncology treatment recovery', with 14 subthemes. Oral health was viewed as an important component of HANC patients' overall physical and mental health post-treatment. Patients' non-compliance with adequate oral hygiene practice was related to oral mucositis, a "burning" sensation associated with high fluoride toothpaste, forgotten or inconsistent clinical advice, and an inadequate supply of preventive oral hygiene products. The potentially highly cariogenic nature of prescribed nutritional supplements for patients at risk of malnutrition did not tend to be communicated to patients in advance of their prescription. CONCLUSIONS: Adequate oral health is essential for the overall physical and mental well-being of post-treatment HANC patients. Non-compliance with preventive clinical advice increases the risk of post-treatment oral health deterioration and was related to miscommunication, inadequate supplies of oral hygiene products, and treatment-related oral discomfort. CLINICAL SIGNIFICANCE: Post-treatment HANC patients are at increased risk of dental disease. Educational and behavioural techniques should be employed to enhance patients' compliance with clinical oral hygiene and dietary advice for the prevention of post-radiotherapy dental disease. Patients should be informed about the potentially highly cariogenic nature of nutritional supplements, and these patients should undergo frequent dental recall. Clinical advice regarding oral hygiene and dietary practices needs to be given consistently to HANC patients by different specialists of the HANC multidisciplinary team.

Exploring facilitators and barriers associated with oral care for inpatients with dysphagia post-stroke.

OBJECTIVE: To explore the attitudes, facilitators and barriers in providing oral care for inpatients with dysphagia post-stroke as perceived by healthcare professionals. BACKGROUND: Dysphagia is a common complication of stroke and is associated with a higher incidence of aspiration pneumonia, malnutrition and dehydration. In the acute phase of stroke recovery, a dental professional is not usually part of the multidisciplinary team caring for the patient and oral care is the responsibility of the healthcare professionals in the stroke unit. There is a lack of high-quality evidence to demonstrate the most effective method of providing oral care for patients with dysphagia post-stroke. MATERIALS AND METHODS: This was a single-site study conducted with healthcare professionals working in the Stroke Unit of Cork University Hospital in Ireland, using focus groups and a qualitative thematic analysis approach. RESULTS: A total of three focus groups were conducted in the Stroke Unit with 17 healthcare professionals. The focus groups included representation from all healthcare professional groups providing direct clinical care to patients on the Stroke Unit including geriatric medicine, dietetics, speech and language therapy, healthcare assistance, nursing, occupational therapy and physiotherapy. A qualitative thematic analysis was carried out and seven overarching themes emerged from the data. Three themes related to facilitators to providing oral care for this patient group: (i) a focus on oral care in both policy and practice, (ii) expanding professional roles in the provision of oral care, (iii) perceived importance of oral care in recovery and rehabilitation. Four themes related to barriers to the provision of oral care for this patient group: (i) lack of confidence and concerns related to the perceived risk for patients with dysphagia, (ii) unique challenges of patient and stroke-related factors, (iii) lack of resources and time and (iv) perceived importance of oral care in recovery and its relative importance with competing demands. CONCLUSION: Members of the stroke multidisciplinary team believe that they all have a part to play in the delivery of oral care for patients with dysphagia post-stroke. Opportunities exist for the development of multidisciplinary interventions to improve the oral cavity assessment and oral care provided in the Stroke Unit.

Exploring preferences of older adults for dental services: A pilot multi-national discrete choice experiment.

OBJECTIVES: To pilot an exploration of older adults' future preferences using discrete choice experiments to understand who should provide dental examinations and treatment, where these services should be provided, and participants' willingness to pay and willingness to travel. BACKGROUND: The proportion of older adults in the general population is increasing and is recognised as a pressing public health challenge. MATERIALS AND METHODS: Older people aged 65 years and over were recruited into this study from the UK, Switzerland and Greece. Drawing on earlier stakeholder engagement, a set of choice experiments are developed to explore the future preferences of older people for dental examinations and dental treatment, as they anticipated losing their independence. These were presented to the participants using a range of platforms, because of the COVID pandemic. Data were analysed in STATA using a random-effects logit model. RESULTS: Two hundred and forty-six participants (median age 70 years) completed the pilot study. There was a strong preference across all countries for a dentist to undertake a dental examination (Greece: ß = 0.944, Switzerland: ß = 0.260, UK ß = 0.791), rather than a medical doctor (Greece: ß = -0.556, Switzerland: ß = -0.4690, UK: ß = -0.468). Participants in Switzerland and the UK preferred these examinations to be undertaken in a dental practice (Switzerland: ß = 0.220, UK: ß = 0.580) while participants in Greece preferred the dental examination to be undertaken in their homes (ß = 1.172). Greek participants preferred dental treatment to be undertaken by a specialist (ß = 0.365) in their home (ß = 0.862), while participants from the UK and Switzerland preferred to avoid any dental treatment at home (Switzerland: ß = -0.387; UK: ß = -0.444). Willingness to pay analyses highlighted that participants in Switzerland and the UK were willing to pay more to ensure the continuity of future service provision at a family dental practice (Switzerland: ß = 0.454, UK: ß = 0.695). CONCLUSION: Discrete choice experiments are valuable for exploring older people's preferences for dental service provision in different countries. Future larger studies should be conducted to further explore the potential of this approach, given the pressing need to design services that are fit for purpose for older people. Continuity of dental service provision is considered as important by most older people, as they anticipate losing their dependence.

Implant survival/success and peri-implant outcomes of titanium-zirconium mini implants for mandibular overdentures: Results from a 1-year randomized clinical trial.

OBJECTIVE: To report the 1-year implant survival/success and peri-implant outcomes of mandibular overdentures retained by four titanium-zirconium mini implants (Straumann® Mini Implant System), and to assess how surgery and loading protocols influence these outcomes. MATERIALS AND METHODS: A 2 × 2 factorial randomized clinical trial (RCT) tested the combined effects of two loading protocols (immediate or delayed) and two surgical approaches (flapless or flapped) on the success/survival of the mini implants, and peri-implant parameters (plaque, bleeding, sulcus depth, gingival position, and marginal bone loss). Outcomes were assessed up to 1-year after loading, and generalized estimating equations (GEEs) were used to analyze longitudinal and within-patient clustered data. RESULTS: Two hundred and ninety-six implants were placed in 74 patients. The implant survival/success rates after 1 year were 100%, and no major biological complications were observed. After 1-year, descriptive data suggest no noticeable changes in plaque scores, whilst a reduction in bleeding scores at the 6-month and 1-year follow-ups compared to baseline. Good longitudinal stability was observed for the probing depth and gingival margin height measures. Overall mean marginal bone loss was 0.68 (±0.68) mm after 3 months and 0.89 (±0.75) mm after 1-year. The flapless protocol showed better results on soft tissue stability and health but a slightly higher risk for marginal bone loss. CONCLUSION: The results of this RCT suggest that mandibular overdentures retained by this novel mini implant system represent a safe and predictable treatment option as confirmed by implant survival/success and peri-implant outcomes, even when flapless surgery and immediate loading protocols are adopted.

Impact of shortened dental arch therapy on nutritional status and treatment costs in older adults: A systematic review.

OBJECTIVE: This review was undertaken to evaluate, whether a shortened dental arch (SDA) was a good alternative to a conventional prosthodontic rehabilitation (RPD) in older adults when nutritional and economic factors are compared. DATA: A total of 92 studies were included for the full-text analysis, and finally 4 reports from two RCTs qualified for data extraction and analysis. The final search update was performed on 06.11.2022 and no further searches and updates were performed after this date. SOURCES: Electronic databases [PubMed (MEDLINE), Embase, CENTRAL] were systematically searched to identify studies comparing nutritional and economic outcomes in partially edentate adults rehabilitated with conventional RPD and SDA therapy. STUDY SELECTION: Studies were excluded if there were less than 10 participants per group, and if the subjects were not clinically followed up in recall visits. Two investigators performed the data extraction and were reciprocally blinded. Inter-investigator reliability was assessed using Cohen's unweighted kappa (κ). A meta-analysis could not be performed and the results were reported qualitatively. RESULTS: The calculated κ ranged between 0.80 and 1.00. Three reports from two studies reported on nutritional outcomes and one report provided information on economic benefits, when comparing between the SDA therapy and conventional prosthodontic rehabilitation. No significant difference was recorded in the nutritional status of patients rehabilitated using the SDA concept compared with RPDs. Higher costs for treatment provision and maintenance for patients in the RPD group was found when compared to SDA treatment. CONCLUSIONS: This systematic review identified the shortened dental arch concept as a reasonable alternative to the conventional prosthodontic rehabilitation where cost-effectiveness and nutrition are concerned based on the limited evidence obtained from current literature. CLINICAL SIGNIFICANCE: SDA therapy may be considered as a feasible treatment concept in older adults especially in those with complex medical statuses and limited finances.

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.

Mandibular bone characteristics, drilling protocols, and final insertion torque for titanium-zirconium mini-implants for overdentures: A cross-sectional analysis.

OBJECTIVE: The aim of this study was to assess the final insertion torque values achieved using site-specific drilling protocols for a novel mini implant system for removable complete overdentures. Anatomical and technical factors influencing final insertion torque were recorded and analyzed. MATERIAL AND METHODS: Participants were randomized to two surgical protocol groups (flapped or flapless) and all received four mini implants (Straumann® mini implant system; Straumann AG) in the anterior mandible, using a 1.6 mm needle drill and a 2.2 mm pilot drill for the implant bed site preparation. The final insertion torque was recorded as the main outcome variable during surgery. Bone type, radiographical bone density, ridge form, implant length, and the drilling protocol were considered as independent variables. Descriptive statistics, generalized estimating equations (GEE) regression, and heatmap charts were used for data analyses. RESULTS: A total of 296 mini implants were placed in 74 patients (mean age = 64.1 ± 8.0; 64.9% female) using flapless (n = 37) or flapped (n = 37) surgeries. Mean final insertion torque was 55.8 ± 18.4 Ncm (10.5% > 35 Ncm, 48.9% between 35 and 65 Ncm, and 40.6% > 65 Ncm). The needle drill was used in only 43.9% of the implant bed sites. Higher final torque values were observed for higher bone densities (bone type I > II > III, and D1-D2 > D3-D4), highly resorbed ridge forms (5-6 > 3-4), flapped surgeries, and male patients. However, regression models showed that the likelihood of achieving optimal insertion torque (≥35 and ≤65 Ncm) was higher for females (OR = 2.14; 95%CI = 1.14-4.01; p = 0.018), ridge forms 3-4 (OR = 2.87; 95%CI = 1.05-7.85; p = 0.040), and flapless surgeries (OR = 1.96; 95%CI = 1.09-3.51; p = 0.024). CONCLUSIONS: Sufficient primary stability for immediate loading was achieved for the majority of the mini implants placed. Surgical implant bed preparation should be site-specific to achieve optimal primary stability for immediate loading while avoiding excessive insertion torque.

Expected and perceived burdens in patients receiving mandibular overdentures retained by one or two implants.

PURPOSE: This study aimed to assess patients' expected burdens before treatment and their perceived burdens after the surgical and prosthodontic procedures of mandibular overdenture treatment and to evaluate factors influencing patients' perceptions. METHODS: Data were collected from 47 participants enrolled in a randomized clinical trial comparing mandibular overdentures retained by one or two implants. A 20-item questionnaire measured on a four-point Likert scale covering the surgical and prosthetic treatment procedures was used to assess the patients' perception of the procedural burdens before (expected burdens) and immediately after (experienced burdens) each procedure. Operators' perceptions of intercurrences associated with the procedures were also assessed as an independent variable. RESULTS: Low levels of perceived burdens were observed both before and after treatment. The mean overall scores of 1.65 ± 0.46 and 1.53 ± 0.33 for expected and experienced burdens, respectively, indicated that most items ranged between "not burdensome at all" and "somewhat burdensome." Significant differences between expected and experienced burdens were found for eight items (P < 0.001). Considering the treatment stages, expected burdens scored higher in the pre-surgical, surgical, and prosthetic stages and lower in the post-surgical phase than experienced burdens. Overall, the experienced burdens were significantly affected by the expected burdens (P < 0.001) and operator's perceived burdens(P = 0.045). CONCLUSIONS: Treatments were associated with low levels of perceived burdens related to surgical and prosthodontic procedures and were highly correlated with the expected burdens before treatment. However, patients tend to overestimate the expected burdens before treatment, especially for surgical procedures.

Putting guidelines into practice: Using co-design to develop a complex intervention based on NG48 to enable care staff to provide daily oral care to older people living in care homes.

OBJECTIVES: (1) Explore the challenges of providing daily oral care in care homes; (2) understand oral care practices provided by care home staff; (3) co-design practical resources supporting care home staff in these activities. METHODS: Three Sheffield care homes were identified via the "ENRICH Research Ready Care Home Network," and three to six staff per site were recruited as co-design partners. Design researchers led three co-design workshops exploring care home staff's experiences of providing daily oral care, including challenges, coping strategies and the role of current guidelines. New resources were prototyped to support the use of guidelines in practice. The design researchers developed final resources to enable the use of these guidelines in-practice-in-context. FINDINGS: Care home staff operate under time and resource constraints. The proportion of residents with dementia and other neurodegenerative conditions is rapidly increasing. Care home staff face challenges when residents adopt "refusal behaviours" and balancing daily oral care needs with resident and carer safety becomes complex. Care home staff have developed many coping strategies to navigate "refusal behaviours." Supporting resources need to "fit" within the complexities of practice-in-context. CONCLUSIONS: The provision of daily oral care practices in care homes is complex and challenging. The co-design process revealed care home staff have a "library" of context-specific practical knowledge and coping strategies. This study offers insights into the process of making guidelines usable for professionals in their contexts of practice, exploring the agenda of implementing evidence-based guidelines.