Integration of a dental hygienist into the interprofessional long-term care team.

BACKGROUND: To address poor oral health of residents in long-term care homes (LTCH), this study explored the process of integrating an educational resource and a dental hygienist on the interprofessional care team. METHODS: This convergent mixed-methods study took place at a 472-bed LTCH in Toronto, Canada from February to August 2018. Nurses employed at the LTCH participated in the study. During the study period, a dental hygienist was integrated into an interprofessional LTCH team. Nurses completed an online eLearning module about using the Oral Health Assessment Tool (OHAT) when referring residents' oral health concerns to a. Pre/post knowledge quizzes, module feedback and satisfaction surveys were administered. A retrospective chart review examined OHAT use and compared nurse and dental hygienist oral health assessments. Two cycles of semi-structured interviews with five nurses explored experiences with the eLearning module, OHAT and integration of the dental hygienist into the team. RESULTS: Nurses scored well on the knowledge quizzes and reported comfort in using the OHAT to refer oral concerns to a dental hygienist; however, actual use was minimal. oral health issues were under-reported by nurses on the Resident Assessment Instrument-Minimum Data Set (RAI-MDS); the dental hygienist reported significantly more debris, teeth lost and carious teeth (all P < 0.0001). Qualitative analysis indicated that the nurses valued dental hygienist integration into the team. Using knowledge mobilisation practices, a new oral health referral tool was developed. CONCLUSIONS: This study highlights the feasibility and desirability of an oral health eLearning module, practical assessment tools and participation of a dental hygienist on the LTCH interprofessional care team.

Patient and clinician perspectives on implant dentistry decision aid content: Results from an enhanced Delphi study.

PURPOSE: To investigate patient and clinician perspectives on what is considered important to include in a decision aid for replacement of a missing tooth with an implant. METHODS: An online modified Delphi method with pair comparisons technique was used to survey participants (66 patients, 48 prosthodontists, 46 periodontists, and 31 oral surgeons) in Ontario, Canada from November 2020 to April 2021 regarding the importance of information provided during an implant consultation. Round one included 19 items derived from the literature and informed consent protocols. The decision to retain an item was based on group consensus, defined as at least 75% of participants identifying the item as "important" or "highly important." After analysis of round one results, a second-round survey was sent to all participants to rank the relative importance of the consensus items. Statistical testing was completed using the Kruskal-Wallis one-way analysis of variance test and post hoc Mann-Whitney U tests with a significance level set at p ≤ 0.05. RESULTS: The first and second surveys had response rates of 77.0% and 45.6%, respectively. In round one, all items except purpose of steps reached group consensus. In round two, the highest group ranked items were patient responsibilities for treatment success and follow-ups after treatment. The lowest group ranked items were cost factors and restorative steps. Significant differences between the stakeholder groups were found on several items, including diagnosis (p ≤ 0.00), non-implant options (p ≤ 0.00), and cost (p ≤ 0.01). In general, patients' opinions were significantly different than clinicians' opinions on the relative importance of items. CONCLUSIONS: Clinicians and patients feel that multiple items are important to include in a decision aid for implant therapy; however, differences exist between patients and clinicians on the relative importance of items.

Dentists' Experiences and Dental Care in the COVID-19 Pandemic: Insights from Nova Scotia, Canada.

BACKGROUND: This study aimed to describe dental care provision and the perceptions of dentists in Nova Scotia, Canada, during 1 week of the COVID-19 pandemic, shortly after the closing down of non-emergency, in-person care. METHODS: A survey was distributed to all 542 registered dentists in Nova Scotia, asking about dental care provision during 19-25 April 2020. Most answers were categorical, and descriptive analyses of these were performed. Data from the 1 open-ended question were analyzed using an inductive approach to identify themes. RESULTS: The response rate was 43% (n = 235). Most dentists (181) provided care but only 13 provided in-person care. From the open-ended question, 4 concerns emerged: communication from the regulatory authority; respondents' health and that of their staff; the health of and access to care for patients; and the future of their business. CONCLUSION: Most respondents remained engaged in non-in-person dental care using various modes. They expressed concerns about their health and that of their staff and patients as well as about the future of their practice. PRACTICAL IMPLICATIONS: Dentists and dental regulatory authorities should engage in discussions to promote the health of dental staff and patients and quality of care during the chronic phase of the pandemic.

Clinical outcomes of immediately loaded implant-supported overdentures: A long-term prospective clinical trial.

STATEMENT OF PROBLEM: Long-term evidence of immediate loading of dental implants with bar overdentures is lacking. PURPOSE: The purpose of this clinical study was to assess the clinical outcomes of immediate and conventional loading protocols of mandibular overdentures supported by 2 dental implants 14 years after initial placement. MATERIAL AND METHODS: Two groups of edentulous patients who received two TiUnite implants were enrolled in this study. In the experimental group (n=35), the implants were loaded immediately. In the control group (n=16), the conventional delayed loading protocol was followed. Participants of both the groups were treated with overdentures supported by a standardized resilient bar mechanism. Clinical oral health-related quality of life and patient satisfaction outcomes were recorded for 14 years after initial placement of implants and measured at various stages of treatment. RESULTS: Significant improvements in all outcomes were observed in both the groups compared with baseline, and this improvement was sustained over the duration of the study. No differences were noted in any of the study outcomes between the 2 groups. CONCLUSIONS: Both the loading approaches provide comparable short- and long-term results. The results of this study confirm that immediate loading of implant-supported overdentures is a predictable treatment approach. Future studies should focus on assessing long-term clinical outcomes with mandibular overdentures in nonsplinted applications.

The Outcomes of Endodontically Treated Teeth Restored with Custom-Made Cast Post-and-Core Restorations: A Retrospective Cohort Study.

INTRODUCTION: Custom-made cast post-and-core (CMCPC) restorations have long been used to restore structurally deficient endodontically treated teeth (ETT). However, the evidence regarding their impact on the outcomes of ETT is largely inconclusive. This study evaluated the long-term treatment outcome of ETT restored with CMCPC. METHODS: This retrospective cohort study examined the dental records of patients that received CMCPC at a specialty private practice in Toronto, Canada between 1999 and 2021. The proportion of ETT with complete periapical healing and those that survived were estimated, and prognostic factors were investigated using multiple logistic and Cox regression analyses respectively (P < .05). RESULTS: A total of 500 and 1000 teeth met periapical healing and survival criteria, respectively. The periapical healing rate was 88.8% and was associated with the presence of baseline periapical radiolucency [odds ratio = 0.1; 95% confidence interval (CI), 0.05-0.2; P < .001]. The survival after a median follow-up time of 52.9 months (interquartile range: 26.5-99.4) was 90.1% and was associated with <75% of root length in bone [hazard ratio (HR) = 2.6; 95% CI, 1.0-6.6; P = .033], type and quality of final restoration (HR = 2.09; 95% CI, 1.1-3.9; P = .020; HR = 2.3; 95% CI, 1.2-4.5; P = .008, respectively), and the presence of periapical radiolucency at the latest recall (HR = 3.2; 95% CI, 1.7-6.3; P < .001). CONCLUSIONS: The outcome of ETT restored with CMCPC was favorable. CMCPC may be regarded as a viable restorative option for structurally deficient ETT.

Soft-Tissue Grafting Solutions.

Many soft-tissue grafting solutions are available for reconstruction and restoration of volume and esthetics of keratinized attached mucosa at compromised periodontal and peri-implant interfaces. Presence of healthy soft tissues is crucial for functional and esthetic implant success as well as longevity of natural dentition. The options available each provide unique characteristics with different indications. This article is intended to provide an efficient and comprehensive overview of this topic, covering the essentials of periodontal anatomy and physiology, indications for soft-tissue grafting, and keys in recipient and donor-site preparation, and exploring the available procedural arsenal in soft-tissue grafting.

Immediate versus conventional loading of mandibular implant-supported fixed prostheses in edentulous patients: 10-year report of a randomised controlled trial.

PURPOSE: To compare the clinical outcomes of immediate versus conventional delayed loading of four dental implants in edentulous mandibles with fixed prostheses. MATERIALS AND METHODS: A blinded, two-arm, parallel group, randomised controlled trial was conducted. A total of 42 patients were included, and each received four Brånemark System implants with a TiUnite surface. The patients were randomly assigned to two study arms: 1) immediate-loading arm (IL), in which the mandibular denture was converted into an interim implant-supported fixed prosthesis (ISFP) on the day of surgery, with a permanent ISFP being inserted at least 3 months postsurgery; 2) conventional-loading arm (CL), in which the mandibular removable prosthesis was relieved at the implant site and relined with a soft tissue conditioner. Only implants with a minimum insertion torque of ≥ 35 Ncm were included in the IL group. Implants were loaded 4 to 6 months postsurgery. Independent, blind investigators assessed the patients at 2, 6 and 12 months and at 10 years. The outcome measures were prosthesis and implant success rates, type and frequency of complications and changes in peri-implant marginal bone levels. RESULTS: A total of 20 patients were allocated to the IL group and 22 to the CL group. However, one patient from the IL arm was excluded and three patients were reallocated to the CL arm. Two implants in one patient and one in another patient could not be placed with a ≥ 35 Ncm insertion torque, and a third patient developed severe sudden gag reflex and thus it was not possible to load the implants immediately. At a later stage, one of the patients who failed the initial stability test dropped out of the study. Therefore, initially, 24 patients were conventionally loaded and 16 patients were immediately loaded. At the 10-year follow-up, six patients dropped out from the IL arm and two from the CL arm. Also, at the 10-year-follow-up, the CL and IL study arms consisted of 22 and 10 participants, respectively, using the per-protocol (PP) analysis. Six implants failed in two patients of the CL arm (two implants in one patient and four implants in another patient), and three implants failed in three patients in the IL arm (PP analysis), respectively. The patient-level implant failure rate was 10% (intention-to-treat [ITT] analysis) and 14% (PP analysis) in the CL arm, and 25% (ITT) and 20% (PP) in the IL arm. The difference was not statistically significant (95% CI from -0.18 to 0.39, P = 0.65). The failure rate at the implant level was 8% (ITT) and 8% (PP) in the CL arm, and 6% (ITT) and 5% (PP) in the IL arm. The difference was not statistically significant (95% CI from -0.06 to 0.14, P = 0.44). Ten years after loading, patients in the IL arm lost an average of 0.55 ± 0.64 mm of peri-implant bone versus 0.41 ± 0.40 mm of peri-implant bone loss observed in the CL arm. The 10-year bone loss in both arms was statistically significant compared with the baseline (P < 0.001). However, there was no statistically significant difference between the two arms for peri-implant bone level changes (the difference between the arms was 0.14 mm ± 0.50 mm; 95% CI -0.23 to 0.52; P = 0.43). One prosthesis failed due to the loss of all four implants in one patient of the CL arm. Eight patients from the IL arm were affected by 13 complications (such as pain from fractures and inflammation) versus seven patients (10 complications) from the CL arm. The complication rate was 67% in the IL arm and 35% in the CL arm. The difference in complication proportions between the two arms was not statistically significant (difference in proportions = 0.32; 95% CI = -0.08 to 0.61; P = 0.14). All complications were managed successfully. CONCLUSIONS: Long-term data of immediate loading of four dental implants with a mandibular fixed prosthesis revealed comparable clinical outcomes to conventional loading. Therefore, immediate loading should be considered in the treatment of edentulous patients.

Influence of Different Surface Characteristics on Peri-implant Tissue Behavior: A Six-Year Prospective Report.

PURPOSE: The aim of this study was to evaluate the behavior of hard and soft tissue around implants with different surface treatments. MATERIALS AND METHODS: Eight patients were identified for this study. Each patient received at least 2 implants (1 control, 1 test) into an edentulous quadrant, for a total of 10 pairs of implants. Two types of implants were used: hybrid implants (control) with a dual acid-etched surface in their apical portion and a machined coronal part, and test implants with an acid-etched surface throughout their entire length. Standardized periapical radiographs were taken at baseline, 3 months, 6 months, and 1 year post implant placement and then annually until the 6-year follow-up. Bleeding on probing (BOP) and Plaque Index (PI) were recorded annually. Probing depth (PD) was recorded at the 6-year follow-up. RESULTS: Moderate crestal bone remodeling was observed during the 1-year postimplant placement evaluation (P=.001), and test implants revealed smaller marginal bone resorption (P=.030). No significant changes in bone level were observed between the 1-year and the 6-year follow-up appointments, and a significantly smaller bone resorption was found at test implants. No statistically significant differences in bone resorption were found between maxilla and mandible. No statistically significant differences were detected between test and control implants for BOP, PI, or PD. CONCLUSIONS: The preliminary results suggest that implant surface characteristics might affect the bone remodeling phase subsequent to the surgical trauma. However, once osseointegration was established, implant surfaces did not affect bone maintenance over time. Implant surfaces did not affect soft tissue behavior. The results of this pilot study need to be confirmed in a study with a larger sample size and over a longer time frame.