Health State Utilities in Edentulous Patients: A Time Trade-off Approach.

BACKGROUND: Health is generally regarded as a very high good, and oral health may substantially affect the quality of life of patients. Oral health-related quality of life has usually been investigated by means of disease-specific descriptive instruments, such as the Oral Health Impact Profile and the General Oral Health Assessment Index. These instruments, however, do not enable a comparison of oral health-related quality of life with other medical diseases. Economic methods, such as the time trade-off technique, enable a comparison of the impact of oral health with other medical diseases and thus provide a means to build a bridge in quality-of-life assessments between medicine and dentistry. METHODS: We included in our study a total of 58 patients who received a complete denture in our clinic in the last 10 y (between January 2001 and May 2012) and who were ≥65 y old. Patient preferences for the edentulous and poorest imaginable oral health state were assessed via the time trade-off method. RESULTS: Edentulous patients rated their current oral health state as 0.73 (SD, 0.25) and the poorest oral health state as 0.43 (SD, 0.33) on a scale between 0 (death) and 1 (best possible health state). These results are comparable to patient preferences for other serious diseases, such as breast cancer (0.75), asymptomatic HIV infection (0.69), depression (0.44), and osteoarthritis of the hip (0.44). CONCLUSION: In conclusion, our results suggest that oral health may substantially affect quality of life no less than other medical diseases. KNOWLEDGE TRANSFER STATEMENT: Health is generally considered the highest good of humankind. In the present article, we show that oral health substantially affects quality of life. In particular, we show that loss of teeth (i.e., being edentulous) reduces quality of life no less than other systemic diseases. Treatment modalities for the edentulous patient may therefore substantially improve the patient's well-being and should be a research priority.

A cost-effectiveness analysis of implant overdentures.

Placement of dental implants may improve the retention and stability of complete dentures in edentulous patients. Treatment costs, however, substantially increase with implant treatment. We therefore performed a stochastic cost-effectiveness analysis, comparing implant-supported over-denture prostheses (4 implants), implant-retained overdentures (2 implants), and complete dentures, from the patient's perspective in Switzerland, to assess whether implant treatment in the mandible represents value for money spent. Twenty patients were included in each treatment group and were followed up for three years. Health outcomes were expressed in Quality-adjusted Prosthesis Years, and dental health care costs and time costs were recorded in year 2000 Swiss Francs (CHF 100 = US dollars 61). The cost per Quality-adjusted Prosthesis Year gained for implant treatment was CHF 9100 (2 implants) and CHF 19,800 (4 implants) over 3 years. Over a ten-year period, these threshold ratios were reduced to CHF 3800 (2 implants) and CHF 7100 (4 implants) per Quality-adjusted Prosthesis Year gained.

Long-term results of implants treated with guided bone regeneration: a 5-year prospective study.

The aim of this prospective 5-year longitudinal study was to follow endosteal implants in which guided bone regeneration (GBR) was applied during implant placement. In 75 patients, defects around implants (Branemark System) were treated with Bio-Oss and Bio-Gide (112 implants). In split-mouth patients in this group, Bio-Oss and Gore-Tex were used in the second defect site (41 implants). All 75 patients had at least 1 implant that was entirely surrounded by bone and served as the control (112 implants). After placement of the definitive prostheses (single-tooth, fixed, or removable implant prostheses), patients were recalled after 6 months and then every 12 months during a 5-year observation period. The following variables were investigated: implant survival, marginal bone level (MBL), presence of plaque, peri-implant mucosal conditions, height of keratinized mucosa (KM), and marginal soft tissue level (MSTL). The cumulative implant survival rate after 5 years varied between 93% and 97% for implants treated with or without GBR. The mean MBL after 60 months was 1.83 mm for sites treated with Bio-Oss and Bio-Gide, 2.21 mm for sites treated with Bio-Oss and Gore-Tex, and 1.73 mm for the control sites. The MBL values were found to increase significantly with time and differed significantly among the treatment groups. During the observation period, KM varied between 3.16 and 3.02 mm. A slight recession of 0.1 mm was observed, and plaque was found in 15% of all sites and was associated with inflammatory symptoms of the peri-implant mucosa. It was observed that such symptoms and recession correlated more strongly with the type of restoration than with the type of treatment. This study demonstrated that implants placed with or without GBR techniques had similar survival rates after 5 years, but that bone resorption was more pronounced in sites with GBR treatment. It was assumed that the use of GBR is indeed indicated when the initial defect size is larger than 2 mm in the vertical dimension.

Factors influencing metal-resin tensile bond strength to filled composites.

This study evaluated the effect of metal surface conditioning, application of a silicon layer, water storage, and resin filling on tensile bond strength of a metal-resin system using three experimental composites (un-, micro-, and macrofilled) having the same self-curing resin composed of Bis-GMA and TEGDMA (2:1 wt%). Test specimens were prepared by bonding the resin between pairs of Ni-Cr-Be alloy cast disks (diameter, 8 mm) previously subjected to heat treatments simulating porcelain firing procedures. A specially constructed apparatus facilitated the absolutely parallel alignment and orientation of the disk faces to each other, maintaining a constant resin thickness of 100 microns. Before being bonded, the sand-blasted metal surfaces were either electrolytically etched and/or silicoated. Prior to being tested, assemblies were stored in water at 37 degrees C for one and 30 days. Thereafter, the specimens were processed in a universal testing machine at a cross-head speed of 2 mm/min until failure. Bond strengths ranged from 4.2 to 20.5 MPa. Data were analyzed by ANOVA with a factorial design (conf. level = 99%). The results showed that: (i) bond strength was increased when the metal was silicoated, (ii) the combination of sandblasting/silicoating produced the best values, and (iii) the 30-day water storage combined with silicoating enhanced the strength of the bond. The resin filling had no significant effect, indicating that neither its presence nor type affects bonding strengths to metal.

Alveolar ridge augmentation with Bio-Oss: a histologic study in humans.

The aim of the present study was to investigate the healing of alveolar ridge defects augmented with cancellous bovine bone mineral. In six partially edentulous patients, bone augmentation was necessary prior to implant placement because of severe alveolar ridge resorption. The defect sites, all located in the maxilla, were filled with Bio-Oss and covered with the resorbable collagen membrane Bio-Gide. Biopsies were obtained from the defect sites 6 to 7 months following grafting and were processed for ground sectioning. The histologic analysis revealed that the Bio-Oss particles occupied 31% of the total biopsy area. An intimate contact between woven bone and Bio-Oss was detected along 37% of the particle surfaces. A mixed type of bone was found; it contained woven bone and parallel-fibered bone, which demonstrates features of remodeling activity. Signs of resorption of the grafting material were observed in the histologic sections, which indicates that the material takes part in the remodeling process. It is suggested that Bio-Oss may be a very suitable material for staged localized ridge augmentation in humans.

Overdenture supported by osseointegrated fixtures: a case report.

The increasing use of oral endoprostheses has offered new alternatives for fixed and removable prosthesis design. However, the use of implants also requires the complex understanding and use of sound prosthodontic principles. The establishment of proper maxillomandibular relationships (vertical dimension, occlusal plane, curve of Spee, tooth arrangement), esthetics, and function are essential precursors to success. Although the usefulness of rehabilitation with overdentures supported by osseointegrated fixtures is sometimes underestimated, overdentures provide an adequate treatment alternative in indicated cases. A case is presented in which previous preprosthetic surgery had failed and subsequently an overdenture supported by osseointegrated fixtures was constructed.

[The Procera Allceram all-ceramic system. The clinical and technical laboratory aspects in the use of a new all-ceramic system]. / Das Vollkeramiksystem Procera AllCeram. Klinische und labortechnische Aspekte bei der Anwendung eines neuen vollkeramischen Systems.

The aim of this article was to present the CAD/CAM-assisted Procera system as a new all-ceramic full-coverage crown system. New technologies need to be evaluated technically and clinically to be able to fulfill the requests for aesthetics, physical strength and biocompatibility when restoring the anterior and posterior region. The Procera AllCeram system offers the opportunity to fabricate densely sintered, high-purity, tooth-colored copings. Mechanical properties of the Procera alumina coping, indications and contraindications and additional applications are discussed. The clinical and technical procedures and any specific limitations and peculiarities are summarized and documented with clinical cases in a step-by-step illustration.

[Tensile loading behavior of different conditioned and bonded metal test samples]. / Zugbelastungsverhalten verschieden konditionierter und geklebter Metallprobekörper.

The purpose of this research was to analyze simultaneously the effect of 4 factors (metal conditioning, bonding agent, metal silicoating and water storage) on the tensile behavior of a Bis-GMA resin (microfilled) bonded Ni-Cr-Be alloy by analysis of variance with a multifactorial design. The results showed that metal surface conditioning and the presence of bonding agent had no effect. In contrast, water storage of 33 days or silicoating influenced significantly and positively the tensile bond strength. In addition, 2 significant factor-interactions were detected: a) between silicoating and water storage and b) between metal surface conditioning (sandblasting/etching) and silicoating. Metal sandblasting followed by silicoating reacted more favorably than the combination etching/silicoating. In all cases the mechanochemical adhesion (silicoating technique) resulted in a composite bond strength that was far superior to that of conventional, pure mechanical bonding.

[The aspiration and swallowing of foreign bodies. The management of the aspiration or swallowing of foreign bodies during dental treatment]. / Aspiration und Verschlucken von Fremdkörpern. Verhalten bei Aspiration oder Verschlucken von Fremdkörpern während der zahnärztlichen Behandlung.

The purpose of this article is to draw attention to the possible complications of foreign body ingestion or aspiration associated with dental treatment, especially oral implant treatment. A guide for the management of swallowed or inhaled objects is given. When the object cannot be coughed out, then it is mandatory to take frontal and lateral chest roentgenograms to identify the object's position in the intestinal system or in the tracheobronchial tree. In case of ingestion, attempts should be made to recover the foreign object by esophagoscopy. Aspirated foreign bodies should be removed within 24 hours. Acute obstruction can be life threatening and delaying the removal of foreign objects may make a bronchoscopy technically more difficult. The clinician must be aware of the complications involved in accidentally inhaling or ingesting foreign bodies during dental treatment. Patients at greater risk of swallowing or aspirating foreign objects need to be identified and extra preventive steps must be taken to avoid such complications.

[Surface and circumference determination in resin-bonded retainer elements: a possibility for long-term prognosis?]. / Die Flächen- und Umfangbestimmung bei Adhäsivhalte-Elementen: eine Möglichkeit der Langzeitprognose?

An evaluation of about 300 abutment teeth of resin-bonded bridges (Rochette, electrochemically etched) and resin-bonded extracoronal attachments was performed to determine the surface area and the length of the circumference of the retainers. By using a combined indirect (preparation of the specimen) and direct (automatic image analysis) method for the determination of both parameters a mean value of 50 mm2 for the surface area and 30 mm for the circumference, respectively, was evaluated. In addition, two indices (loading-index (BI): sigma surface area/width of pontic tooth; moisture penetration-index (FPI): sigma surface area/sigma circumferences) as predictors for the longevity of resin-bonded reconstructions were calculated. The loading-index was a good predictor for successful reconstructions: the clinical success was the better, the bigger the retention area, and the smaller the circumference of the retainer and the smaller the pontic tooth.

[Tooth loss, dental restorations and dental attendance in Switzerland]. / Zahnverlust, prothetische Versorgung und zahnärztliche Inanspruchnahme in der Schweiz.

The aim of this study is to report about the dental health situation in Switzerland and to evaluate frequencies of dental visits. Data were obtained from the first and second national Health Survey of the Federal Office for Statistics in 1992/3 and 1997. Based on a random sample of the population aged from 15 to 74 years, 71% participated in an oral interviews and of this group of individuals, 75% later filled in a written questionnaire in 1992/3. Data analysis showed that the proportion of the fully dentate population (28 remaining teeth) is 41%, while almost 50% had some prosthetic treatment. 31% were treated with fixed prostheses, i.e.crowns and/or bridges, and 19% with removable prostheses, i.e. partial and/or full dentures. With increasing age the number of missing teeth and the frequency of prosthetic treatment went up. The population with prosthodontic reconstruction increased mainly in the third and forth decades. In the elderly population (age 65-74 years), a shift was observed from fixed to removable prostheses; two thirds in this groups was restored with removable prostheses. The proportion of subjects visiting the dentist was by 70% in 1992/3 and declined to 65% in 1997. Subjects wearing removable prostheses had apparently lower frequencies (43%) in dental visits than subjects with fixed prostheses (80%). A potential concern exists for the edentulous population who presented a limited need for dental visits of only 22% during the year preceding the study.

Fixed or removable implant-supported restorations in the edentulous maxilla: literature review.

Among the prosthesis designs used to treat the edentulous maxilla are fixed or removable implant-supported restorations. Since the aesthetic requirements and preoperative situation of each patient varies, controversy exists regarding prostheses' success rates and complications. The purpose of this article is to compare the treatment options and prosthesis designs with their indications and to compare implant and prosthesis success and treatment expense. This objective was accomplished through the review of reports with regard to varying design considerations and factors that influence the decision-making process and treatment outcomes.

Anterior single-tooth replacement: clinical examination and treatment planning.

The replacement of a single anterior tooth is a complex, challenging procedure that can be accomplished with implant-supported restorations as well as conventional porcelain-fused-to-metal and resin-bonded fixed partial dentures. A comprehensive diagnostic form may be beneficial in determining the most effective means of rendering treatment for each patient. This article demonstrates the use of this form, diagnostic models, and radiographs to diagnose and restore three patients who presented for the replacement of a single tooth in the anterior maxilla.