Student ePortfolios to develop reflective skills and demonstrate competency development: Evaluation of a curriculum pilot project.

INTRODUCTION: The University of British Columbia Faculty of Dentistry developed a longitudinal curriculum pilot project to assess the usefulness of portfolios for dental students to develop reflective skills and demonstrate competency development, and to examine relationships between portfolio grades and clinical success. MATERIALS AND METHODS: Students in one dental class created portfolios with reflections on examples relevant to eight selected competency statements each year of the program. As part of our program evaluation, we set out to look at trends in portfolio grades, meta-reflection skills, student and faculty views of the project, and relationships among portfolio grades, 4th year clinical grades and faculty rankings. RESULTS: Portfolio grades improved from years 1 to 3, dropping off slightly in year 4. The highest level of internal consistency for grades within and between years occurred with Competency 42, while the lowest level occurred with Competency 4. Most students were able to demonstrate meta-reflection by 4th year. Students generally agreed with portfolios and reflection in concept, but suggested a looser structure, and they shared concerns with faculty about the workload involved. Portfolio grades did not correlate with clinical course grades (P = 0.092), but they did correlate significantly with faculty rankings except for year 1. CONCLUSION: While portfolio grades for reflections were not consistent, and they did not quite correlate with clinical course grades, they correlated strongly with faculty rankings. Future use of portfolios at UBC Dentistry will be enhanced by increasing curricular support regarding both competency development and the importance of reflection for professionals, decreasing workload by focusing on five Key Competencies, incorporating more formative and face-to-face feedback, and providing greater opportunities for peer sharing.

A 5-year randomized trial to compare 1 or 2 implants for implant overdentures.

The hypothesis of this 5-y randomized clinical trial was that there would be no significant difference in the satisfaction of edentulous participants with removable complete overdentures attached to 1 or 2 mandibular implants. Secondary aims were to test changes in satisfaction between and within the groups from baseline to 5 y and differences between the groups in implant survival and prosthodontic maintenance over 5 y. Each of the 86 participants (mean age, 67 y) was randomly allocated to receive either 1 implant in the midline (group 1) or 2 implants in the canine areas (group 2) attached to a mandibular overdenture opposing a maxillary complete denture. Satisfaction was self-assessed by participants on a visual analog scale at baseline prior to implants, as well as at 2 mo and 1, 3, and 5 y with implant overdentures, whereas implant survival and prosthodontic maintenance were assessed by clinical examination. After 5 y, 29 participants in group 1 and 33 in group 2 were available, with most dropouts due to death. Satisfaction with the implant denture after 5 y was significantly (P < 0.001) higher than at baseline in both groups and remained with no significant difference (P = 0.32) between the groups. No implants failed in group 1 but 5 failed before loading in 4 participants in group 2. Most participants required maintenance or occasionally denture replacement, and although differences between the groups were not statistically significant, group 1 experienced almost twice as many fractured dentures usually adjacent to the implant attachment. We conclude that there were no significant differences after 5 y in satisfaction or survival of implants with mandibular overdentures retained by 1 implant or 2 implants. Additional research is required to confirm long-term treatment effectiveness of single-implant dentures and the implications of prosthetic maintenance with implant overdentures (ClinicalTrials.gov: NCT02117856).

The outcome of implant overdentures from a prosthodontic perspective: proposal for a classification protocol.

PURPOSE: This article proposes a classification protocol for reporting the outcome of implant overdentures. MATERIALS AND METHODS: Review of the literature pertaining to postinsertion prosthodontic procedures for maxillary and mandibular implant overdentures revealed a wide range in the terminology used and methods of reporting outcome, usually as a result of the use of varying designs among different implant systems. A need for comparative evaluation of the prosthodontic success of implant overdentures was identified. RESULTS: An existing classification protocol for implant-fixed prostheses containing six objectively defined fields was modified for implant overdentures. This new protocol, which also uses the descriptive fields of success, survival, unknown, dead, and retreatment (repair or failure), provides a method whereby postinsertion prosthodontic procedures and subsequent time to retreatment can be quantified regardless of design, method of attachment, or implant system. A ratio method for identifying prosthodontic treatment cost effectiveness of implant overdentures is included. CONCLUSION: This protocol could assist clinicians in their choices of implant overdenture therapy by providing accurate comparisons of varying implant overdenture systems and designs, and by identifying prosthodontic treatment cost effectiveness.

Implant angulation: a measurement technique, implant overdenture maintenance, and the influence of surgical experience.

PURPOSE: The purposes of this study were to develop a technique to measure the angulation between two implants and between each implant and reference planes, to analyze the relationship between the maintenance (adjustments and repairs) of ball-attachment mandibular implant overdentures and implant angulation, and to see if there is any correlation between surgeon experience and implant orientation. MATERIALS AND METHODS: Final casts of 41 patients who had received two-implant ball-attachment mandibular overdentures were used to measure implant angulations using digital photographs and plane geometry. The measured angles were compared with the number of adjustments and repairs of the prostheses and analyzed by surgeon experience for any trends. RESULTS: No significant relationships were found between number of adjustments and repairs and the interimplant angles. However, there was a significantly higher number of repairs when the lingual inclination of an implant was > or = 6.0 degrees (P = .033) or if the facial inclination was < 6.5 degrees (P = .036). Less experienced surgeons had a significantly greater tendency to place implants that diverged from each other in the frontal plane (P = .045) and with a facial or lingual inclination in the sagittal plane (P = .035). CONCLUSION: While interimplant angulation did not appear to affect prosthesis maintenance, individual implants with a lingual inclination > or = 6 degrees and a facial inclination < 6.5 degrees were associated with significantly more prosthesis repairs. There was a tendency for implants placed by less experienced surgeons to demonstrate greater inclination.

Altered sensation associated with implants in the anterior mandible: a prospective study.

STATEMENT OF PROBLEM: Reported incidences of altered sensation after placement of mandibular implants range from a low of 0% to almost 44%, making it difficult to advise subjects regarding risk. PURPOSE: This study involved presurgical and postsurgical assessment of sensation in the lips and chins of 75 subjects, all of whom objectively demonstrated normal sensation before surgery. MATERIAL AND METHODS: Objective and subjective tests were administered before, and at planned intervals for 12 months after, the placement of 2 implants in the anterior mandible. RESULTS: Objective changes were observed in only 1 subject and then only at the 2-week postsurgery interval. There were significant differences for all subjects in subjective sensation changes from baseline to 2 weeks after surgery (P =.007) and from 2 weeks to 6 months (P =.003) or 12 months (P =. 003). There was a higher percentage of subjects with normal sensation before surgery who reported sensory changes 2 weeks after implant placement (34% vs 24% for all subjects), but only 1% of subjects still reported altered sensation 1 year later. Although there were no significant differences between men and women in reports of altered sensation, more women than men noted sensation changes 2 weeks after implants were placed (25% vs 13%). There appeared to be no relationships among gender, the degree of ridge resorption, and reports of altered sensation. CONCLUSION: Thus, although approximately 24% of subjects may report altered sensation in the short-term after implant surgery in the anterior mandible, the problem appears to be a transient one, with only about 1% experiencing sensation changes 1 year after implant surgery.

Complications associated with excess cement around crowns on osseointegrated implants: a clinical report.

The potential advantages and disadvantages of cement-retained implant crowns are reviewed, with a focus on complications related to residual excess cement. A series of 4 case reports illustrates the symptoms and treatment modalities associated with excess cement around implant crowns, and suggestions are offered for the prevention of such problems.

Positioning implants for overdentures: a prototype implant-paralleling device. Technical note.

As implant-assisted dentistry continues to grow, increasing emphasis is being placed on the surgical positioning of implants so that they can be optimally restored. While this is essential for esthetics with fixed implant restorations, it is equally important with implant overdentures, where the type of retentive mechanism artificial tooth position, and denture flange contour may be affected by implant position Unfortunately, surgical guides or templates may be used less often with overdenture cases because of the associated time, costs, and difficulty in positioning during surgery, leading to compromised implant location or orientation. This paper describes a prototype paralleling device that can aid in the surgical positioning of implants for overdentures.