Restorative dentistry clinical decision-making for hypodontia: complex cases.

Hypodontia is a relatively common condition and patients will be seen by both general dental practitioners and specialist dental colleagues. Although hypodontia can be described as mild, moderate and severe, this does not directly correlate with the complexity of treatment required to provide an acceptable outcome. In addition, the complexity of treatment provided by one colleague in the multidisciplinary team may not be the same as for other colleagues.When treatment planning and delivering dental care for these patients, especially those with severe hypodontia, it is useful to recognise the factors that make their care complex and also to follow principles for multidisciplinary treatment planning.

Debonding of cast metal-based cantilever and fixed-fixed resin-retained bridgework: A review of the literature.

AIM: Cast metal-based resin-retained bridgework (RRB) offers a practical, conservative approach when restoring edentulous spaces. This review examines the debonding of cast metal-based RRB, comparing cantilever resin-retained bridgework (CRRB) and fixed-fixed resin-retained bridgework (FRRB) designs taking into context developments in RRB design, construction, and cementation over time. METHODS: An electronic search was conducted through Medline and Embase with the aid of Boolean operators to combine the following key words: "adhesive bridges", "resin-bonded bridges", "resin-retained bridges", "resin-bonded fixed partial dentures", "cantilever", "debond", "fixed-fixed", "decementation", "failure", "success", "outcome", "longevity" and "survival". The search was limited to peer-reviewed articles written in English and published from 1995 through to 2019. MAIN FINDINGS: Thirty-one studies were included. Five studies compared the longevity of CRRB versus FRRB, five assessed the clinical performance of CRRBs alone, and 21 studies assessed the clinical performance of FRRBs. There was great variability in study design and the reporting of clinical outcomes, and an analysis and critique of the included papers is provided. Overall, CRRB tend to debond less and hence provide longer-term and more reliable clinical service when compared to FRRB. PRINCIPAL CONCLUSIONS: More high-level, long-term, prospective and clinical controlled trials are required to further analyse and evaluate the long-term outcomes of cast metal-based RRB.

Dental rehabilitation after surgery for oral cancer.

PURPOSE OF REVIEW: This article reviews the recent literature relating to dental rehabilitation of the oral cancer patient. The impact of loss of teeth on the well being of the oral cancer patient, the process of dental rehabilitation and the latest outcome studies are discussed. RECENT FINDINGS: For patients treated for oral cancer major concerns may include their ability to masticate, speak and swallow and if these issues are not addressed this may lead to psychological difficulties. The loss of teeth is a determinant of patient health-related quality of life, with a reduced self-perceived oral health status in association with greater numbers of missing teeth. There is, therefore, a patient need and demand for dental rehabilitation which aims to restore orofacial form and function and general well being. Dental rehabilitation begins at time of diagnosis and a multidisciplinary approach is critical for best treatment outcomes. Implant-based dental rehabilitation is an effective treatment modality but should be used judiciously. The beneficial effects of dental rehabilitation may be veiled by the side effects of cancer and concurrent comorbidities. SUMMARY: The introduction of three-dimensional planning, guided implant surgery and manufacturing tools has facilitated the treatment of head and neck cancer patients and challenges long-held dogma of treatment.

The responsiveness of the Liverpool Oral Rehabilitation Questionnaire (LORQ): a pilot study.

This study aimed to evaluate the responsiveness of denture patients to the Liverpool Oral Rehabilitation Questionnaire (LORQ). Changes in scores for 20 core items completed from 2000 to 2005 by 16 patients both before and after oral rehabilitation were assessed. The median age of respondents was 68 years and the median time between questionnaires was 2.6 years. Results indicated that masticatory efficiency impacted both food choice (P = .03) and social life (P = .06). After rehabilitation there was less worry about maxillary prostheses falling out (P = .07), less embarrassment while conversing (P = .02), and less worry about losing self-confidence from embarrassment caused by dentures (P = .06). Also, drooling problems deteriorated (P = .03). This exploratory study reports encouraging findings, but a larger prospective multicenter study is required to determine the responsiveness of the current version of the LORQ (version 3).

The further development and validation of the Liverpool Oral Rehabilitation Questionnaire (LORQ) version 3: a cross-sectional survey of patients referred to a dental hospital for removable prostheses replacement.

STATEMENT OF PROBLEM: The Liverpool Oral Rehabilitation Questionnaire (LORQ) is a health-related quality of life instrument assessing the impact of oral rehabilitation on patients' health-related quality of life (HRQOL) following treatment for oral cancer. The small number of patients wearing prostheses in previous studies limited the validation of the denture/denture satisfaction part of the questionnaire. PURPOSE: The purpose of this study was to further validate the LORQ by obtaining HRQOL data from patients requiring replacement dentures. MATERIAL AND METHODS: The LORQv3, together with items assessing mood and anxiety, was administered with the Oral Health Impact Profile 14-item (OHIP-14) questionnaire to 104 consecutive patients, between the ages of 40 and 79, referred by their general dentists to the department of prosthodontics at the Liverpool University Dental Hospital for replacement of removable prostheses between November 2004 and June 2005. The Mann-Whitney and Kruskal-Wallis tests compared scores between patient groups. Internal consistency was measured by Cronbach's alpha. Spearman's correlation investigated associations between items on the LORQv3 and items from the OHIP-14. Test-retest was measured by the kappa coefficient, weighted by applying standard weights according to the number of categories in error. RESULTS: Patients wearing complete dentures in 1 or both arches generally scored worse for oral function and mandibular denture problems/satisfaction than patients wearing removable partial dentures. Thirty-three percent of patients were somewhat or extremely depressed, 25% were anxious or very anxious, and 15% were both depressed and anxious. CONCLUSIONS: The denture section of the LORQv3 identified expected differences among various patient subgroups in this cohort confirmed by similar findings for the OHIP-14 and the literature. Thus, this part of the LORQv3 referring to dentures and patient satisfaction demonstrated good construct and criterion validity.

A survey of consultants and specialists in restorative dentistry on their use of health-related quality of life questionnaires.

A national survey of 178 consultants and specialists in restorative dentistry was undertaken to assess their use of health-related quality of life questionnaires in patients having oral rehabilitation following treatment for oral cancer. The response rate was 74% (132). 42% treated patients following oral cancer, 25% forming part of the head and neck multidisciplinary team. Only 19% had ever used questionnaires. Main barriers to their use were lack of experience with evaluation (27%), lack of staff to administer questionnaires (21%) and insufficient time (18%). Few clinicians thought that questionnaires were not clinically relevant or that no suitable instrument existed. In order to facilitate the use of an oral rehabilitation-specific questionnaire in clinical practice there needs to be greater awareness of the potential benefits, training in the process and the means of reducing the administrative burden.