Patterns in Oral Hygiene and Dietary Habits in School Children during the COVID-19 Pandemic.

Aim: To assess oral hygiene and dietary patterns in school children participating in a school-based preventive oral health program during the COVID-19 pandemic. Materials and methods: In this cross-sectional study, an anonymous questionnaire exploring oral hygiene and dietary patterns during the COVID-19 pandemic was completed by parents of school children. Data were compared among different schools, school years, and between genders using nonparametric tests. Associations among further nominal and categorical variables related to oral hygiene and dietary habits were also assessed using the chi-square test. Results: Only 26% (n = 32) of parents reported that their children brushed their teeth the recommended amount of twice or more per day during the pandemic. In addition, 17.2% of the parents reported less brushing than before the pandemic. A total of 40 parents (32.8%) reported that their child consumed unhealthy beverages once a day or more. Comparison between genders revealed that male participants were drinking significantly unhealthier than female (p = 0.038). Sugary foods were consumed once a day or more by 63.1% of children. No significant differences were found between public and church schools. Significant direct associations were found between changes in dietary habits and brushing frequency (p = 0.017), between parental concern regarding the interruption of the school program and decreased brushing frequency (p = 0.005), and negative changes in dietary habits (p = 0.013). Clinical significance: Within the limitations of this study, the present significant findings observed during the pandemic support the importance of school programs in promoting oral hygiene and healthy dietary habits of children. How to cite this article: Agius A-M, Gatt G, Cortes ARG, et al. Patterns in Oral Hygiene and Dietary Habits in School Children during the COVID-19 Pandemic. Int J Clin Pediatr Dent 2023;16(2):205-210.

Multimodal teaching methods for students in dentistry: a replacement for traditional teaching or a valuable addition? A three-year prospective cohort study.

BACKGROUND: This student-centred prospective cohort study evaluated the impact of multimodal teaching methods on student performance in the theoretical domain of dental studies. METHODS: Dental students answered anonymous questionnaires indicating their preferences and opinions three times over three consecutive academic years. Data collected included gender, course, year of study and most frequent and preferred learning modality. Survey responses from Google Forms were analysed with SPSS 20.0 software (IBM Company, Chicago, IL, USA). Scale responses were tested with the Mann-Whitney U test against gender, program and year of study. Grades obtained from structured examinations held in the third academic year were analysed using the Wilcoxon Signed Rank Test according to the teaching method employed. The level of statistical significance was set at p < 0.05. RESULTS: The response rate was high (> 80%) throughout the study. Acceptance of online modalities increased over time (Kruskal-Wallis test, p < 0.001) and 75% of students requested that online teaching modalities be maintained. Significant differences in gender, program of study, year of study and discipline taught were observed (Mann-Whitney test, p < 0.05). Females differed from males by favouring online modalities and face-to-face lectures, respectively, and clinical year students opted to retain pre-recorded online lectures. Recorded lectures resulted better for teaching core knowledge (Wilcoxon Signed Rank Test, p = 0.034), while face-to-face lectures were better for teaching applied knowledge (Wilcoxon Signed Rank Test, p = 0.043). Student responses to open-ended questions identified the need for a blended approach with in-person lecturing as an opportunity to socialise and avoid mental health issues. Although preferences varied, students showed a willingness to influence their learning and changes in curriculum, a predilection for self-directed learning and the need for freedom in engaging with resources and content. CONCLUSIONS: In the context of this study, online teaching modalities resulted in comparable examination performance and improved student satisfaction. This highlights the need for a blended approach to teaching.

Effect Of Different Milling Devices On Marginal Fit Of CAD-CAM Zirconia Copings On Implant Stock Abutments.

PURPOSE: To compare the marginal fit and internal surface roughness of CAD/CAM zirconia copings milled with 3- and 5-axis milling devices. MATERIALS AND METHODS: Forty titanium implant stock abutments (4.8 mm in diameter, 4 mm in height) screwed to dental implants (4.1 mm in diameter) embedded in resin were considered phantoms and included in this in vitro study. All 40 phantoms were scanned with the same intraoral scanner, from which images of the virtual wax-up of zirconia copings were obtained and exported as standard tessellation language (STL) files. From each resulting STL file, two copings were milled: one using a 3-axis milling device, and the other using a 5-axis milling device. After milling, zirconia copings underwent high-speed sintering before being analyzed for marginal fit (ie, marginal gap measurement), and internal surface roughness was assessed with a scanning electron microscope (SEM). Statistical comparisons between groups were assessed with Mann-Whitney test. RESULTS: Median marginal gap values were 34.80 µm (95% CI: 0.00 to 173.98) for the 5-axis milling device group and 141.97 µm (95% CI: 82.13 to 163.46) for the 3-axis milling device group. A statistically significant difference in marginal gap was found between both milling device groups (P = .039). In addition, qualitative SEM analysis indicated higher internal surface roughness for the 3-axis milling device group. CONCLUSION: Within the limitations of this study, the present findings suggest that 5-axis milling devices outperform 3-axis milling devices for milling CAD/CAM zirconia copings from intraoral scans of implant stock abutments.

Patient Reported Outcomes on Different Occlusal Schemes in Complete Denture Wearers.

PURPOSE: To compare patient-reported outcomes among balanced, lingualized, and monoplane occlusal schemes in relation to edentulous jaw classifications. MATERIALS AND METHODS: This randomized controlled trial was conducted in edentulous patients receiving new complete dentures using balanced, lingualized, or monoplane occlusal schemes. Demographic variables, bone ridge quantity, number of adjustments required after denture insertion, and satisfaction and quality of life (QoL) indices (ie, the Denture Satisfaction Questionnaire [DSQ] and General Oral Health Assessment Index [GOHAI], respectively) were assessed at 1, 2, 4, 8, 12, and 52 weeks. Within-group comparisons at different time points were carried out with Brunner-Langer nonparametric analysis. Furthermore, Kruskal-Wallis test was used to compare distributions of ordinal or continuous variables among the three occlusal scheme groups. RESULTS: A total of 60 subjects (mean age: 68.1 ± 11.1 years; 56.7% men and 43.3% women) were analyzed. All three groups presented significant improvements in DSQ and GOHAI scores between denture insertion and the 1-year follow-up appointment (P < .001). There were no statistical differences in the distribution of demographic variables (eg, age, gender, years edentulous, and age of existing dentures) or of bone ridge classifications among the three groups. Similarly, there were no statistical differences in ridge classifications or in the DSQ and GOHAI values among the three groups for both the maxilla and mandible (P > .05) over the 52-week follow-up. On the other hand, the number of cases requiring denture adjustments was significantly lower in the lingualized scheme group, as compared to the two other groups (P = .034). CONCLUSION: Within the limitations of this study, the present findings suggest that the occlusal scheme for posterior teeth did not influence patient-reported subjective outcomes. However, the lingualized occlusal scheme required significantly fewer adjustments.

Effect of varying levels of expertise on the reliability and reproducibility of the digital waxing of single crowns: A preliminary in vitro study.

STATEMENT OF PROBLEM: The digital waxing of single crowns can be affected by the quality of intraoral scans and use of computer-aided design (CAD) software programs. However, clinical outcomes of the resulting crowns are also affected by computer-aided manufacturing (CAM) methodologies. Studies on the effect of different levels of expertise on digital waxing are lacking. PURPOSE: The purpose of this in vitro study was to assess the impact of different levels of expertise on the reliability and reproducibility of margin outlining during digital waxing. MATERIAL AND METHODS: Thirty analogs of implant stock abutments (Ø4.8×4 mm) were embedded into resin blocks. To simulate different clinical situations, abutments were divided into 3 groups: 10 abutments (group GOS) received artificial gingiva and were scanned with an open system intraoral scanner, while 10 abutments with (group GIS) and 10 abutments without artificial gingiva (group IS) were scanned with an intraoral scanner within an integrated CAD-CAM system. All resulting standard tessellation language (STL) files were used by 2 different observers (an experienced CAD professional and a clinician with basic CAD knowledge) to digitally design a left mandibular central incisor in the same software program. All resulting digital crown designs were exported to STL files to assess crown margin accuracy at the coupling interface by superimposition with the control STL file of the scan body designed for the same abutment by the manufacturer. For this purpose, a CAD software program was used to automatically calculate median, minimum, and maximum deviations of margins in millimeters. Statistically significant pairwise differences among groups and between observers were assessed with the Wilcoxon signed-rank test (α=.05). RESULTS: For the CAD professional, median deviations between designed crown STL files and the control STL of the scan body were 0.08 mm (range: 0.04 to 0.15) for group GOS; 0.10 mm (range: 0.06 to 0.18) for group GIS; and 0.05 mm (range: 0.03 to 0.08) for group IS. For the clinician, median deviations were 0.08 mm (range: 0.04 to 0.12) for group GOS; 0.11 mm (range: 0.07 to 0.17) for group GIS; and 0.05 mm (range: 0.04 to 0.11) for group IS. There were no significant differences between observers (P>.05). However, statistically significant differences were found between group IS and the other 2 groups (P=.001) but not between groups GOS and GIS (P>.05). CONCLUSIONS: The present findings suggest that a digital wax pattern made with a dental CAD software program is not affected by varying levels of expertise but might be affected by subgingival margins.

Self-reported dental student stressors and experiences during the COVID-19 pandemic.

OBJECTIVE: To compare the influence of coronavirus disease 2019 (COVID-19) pandemic on the student reported outcomes among dental students reading/studying different courses offered in the only dental school in Malta. MATERIALS AND METHODS: An anonymous questionnaire consisting of 13 closed-ended and open-ended questions was sent to all students (n = 97) at the Faculty of Dental Surgery at the University of Malta. Emergent themes from open-ended questions were identified and tallied. Since data were classified as categorical ranks, nonparametric tests were used to compare variables among the different courses, years of study, preclinical/clinical students, and gender categories. RESULTS: Dental technology students were significantly less stressed about contracting COVID-19 (P = 0.005) and regarding lack of preparation due to inability to physically go to the library (P = 0.019). Female students reported significantly more anxiety for the following factors: "feeling anxious all the time" (P = 0.033), "worried about contracting COVID-19'" (P = 0.012), "worried that a family member may contract COVID-19'" (P = 0.048), "more anxious about exams this year because of the challenges we are facing" (P = 0.029), and "concern about losing manual dexterity skills" (P = 0.038). Qualitative data gathered show considerable stress reported by students regarding changes in examination processes and formats and lack of timely communication. CONCLUSION: Students were greatly affected by the COVID-19 pandemic and this caused fear of losing their manual dexterity skills, anxiety related to its consequences on their long-term plans, and anxiety related to the examinations. Dental schools in turn should adapt rapidly and customize changes that are specific to the individual student cohort and their stage of training.

Patient-based outcomes with conventional or mini-implants immediately loaded with locator-retained mandibular overdentures: A cohort study.

BACKGROUND: Little is known on the effect of varying implant diameters, especially with mini implants (ie, less than 3 mm in diameter), on oral health-related quality of life (OHrQoL). PURPOSE: To compare OHrQoL and satisfaction in patients with mandibular overdentures immediately retained by either two conventional or two mini-implants. MATERIALS AND METHODS: Edentulous patients receiving immediately loaded overdentures retained by Locators on either two conventional diameter (4.1 mm) or two mini (2.9 mm or less) implants were selected based on available buccal-lingual ridge width in the intraforaminal area. Two questionnaires were used (Oral Health Impact Profile-14 [OHIP-14]; and Denture Satisfaction Questionnaire [DSQ]) to determine OHrQoL and overall denture satisfaction. Questionnaires were filled out at six different time points up to a 1-year follow-up. Mann-Whitney U test was used for group comparisons. Friedman and Wilcoxon tests were used to identify changes within group along the time points. Correlation between OHIP-14 and DSQ was assessed with Spearman test. RESULTS: A total of 48 patients were analyzed and equally distributed to each group. The conventional group presented a significantly smaller change of OHIP functional score from the baseline to the first week of follow-up after surgery (P = .017). In addition, total DSQ scores were significantly higher for the conventional group at 12 weeks (P = .022) and there was a significant difference between groups in satisfaction with mandibular prosthesis at 24 weeks (P = .034). Correlation between OHIP-14 and DSQ was not significant (P > .05). Individual results of each group (ie, within group analysis) over all assessed time points revealed a significant OHrQoL (P = .001 for conventional, P = .006 for mini-implants) and satisfaction (P < .001 for both groups) improvement in both groups. CONCLUSION: Mandibular overdentures retained by two conventional or mini-implants lead to a significant and comparable improvements in OHrQoL and satisfaction over a 1-year follow-up.

Maintenance and risk factors for fractures of overdentures using immediately loaded conventional diameter or mini implants with Locator abutments: A cohort study.

BACKGROUND: Fractures in mandibular implant-retained overdentures are a common complication. However, little is known on the related risk factors and outcome differences when using two conventional diameter or two mini implants. PURPOSE: The purpose of this study was first, to evaluate the required maintenance and complications with the overdentures and second, to analyze risk factors for overdenture fractures. MATERIALS AND METHODS: This cohort study was conducted in edentulous patients with complete dentures. Patients received either two conventional (4.1 mm in diameter) and two mini (2.9 mm or less in diameter) implants, based on available buccal-lingual ridge width. All implants were immediately loaded with mandibular overdentures retained by Locator abutments. The number of prosthodontic after care visits (scheduled and unscheduled) were recorded and compared between the two implant diameter groups. Fracture occurrence was the primary outcome variable. Risk estimates were presented as odds ratios (ORs) with 95% confidence intervals (CIs). The ORs were adjusted for potential clinical confounders (ie, necessity of relining, matrix recapture, abutment loosening, implant diameter, height of the Locator, and retention force). RESULTS: A total of 50 edentulous patients were analyzed. One conventional diameter and three mini implants failed within a 1-year follow-up period. Prosthetic maintenance requirements for overdentures on both implant diameter groups were comparable. A total of 12 overdenture fractures (four in the mini implant group and eight in the conventional diameter group) occurred. Adjusted OR (AOR) analysis showed a significant association between abutment loosening and overdenture fracture (AOR = 12.00, 95% CI = 1.11-129.45; P = .041). CONCLUSION: Within the limitations of this study, the present findings suggest that implant diameter does not affect number of prosthetic maintenance and complications, and that abutment loosening is a risk factor for overdenture fractures, regardless of the implant diameter used.

Immediately loaded mini-implants supporting mandibular overdentures: A one-year comparative prospective cohort study.

BACKGROUND: Little is known about differences between mini-implants and conventional immediately loaded implants for overdentures. OBJECTIVES: To compare clinical outcomes using two immediately loaded conventional or mini-implants for mandibular overdentures. MATERIALS AND METHODS: Edentulous patients receiving either conventional (4.1 mm) or mini-implants (2.9 mm or less), based on available bone width were analyzed. All implants were immediately loaded with mandibular overdentures installed using locator attachments. Digital periapical radiographs for measuring marginal bone loss and clinical outcomes (ie, periodontal probing, plaque, and bleeding indices) were assessed at 1, 3, 6, and 12-month follow-up periods. RESULTS: Fifty patients (25 receiving conventional implants-12 females, mean age of 65.3 ± 7.3 years; and 25 receiving mini-implants-11 females, mean age of 66.8 ± 8.1 years) was analyzed. Peak insertion torque (P = .001) and bone loss (P = .02), as well as change in plaque (P = .02) and bleeding (P = .04) indices at 12 months differed significantly between groups. Furthermore, linear regression revealed the height of the locator as a risk factor for bone loss (P = .038). CONCLUSIONS: The present findings suggest that two mini-implants are significantly more susceptible to bone loss after immediate loading, for which the height of locator might be considered a risk factor.

Use of free CAD software for 3D printing individualized face masks based on face scans.

AIM: To describe a method of digitally customizing 3D-printed face mask designs using 3D face scans and free software. MATERIALS AND METHODS: The procedure of creating customized face masks initially involved importing and aligning STL files of face scans and mask components in free CAD software. The imported mask described in this article is composed of three different STL files (body, filter structure, and grid). The body of the mask was then edited to fit precisely into the face scan STL by using the software's offset tool, followed by adjustments and smoothening of the surfaces of the edges. The resulting customized body of the mask plus the filter and grid STL files were exported and 3D printed with polylactic acid (PLA) filament using a fused deposition modeling (FDM) 3D printer. For the purposes of comparison, a conventional 3D-printed mask (from the original STL files, without being customized for the face scan) was also 3D printed from the original STL files. Both face masks were tested on the same two volunteers. RESULTS: The customized 3D-printed face mask presented a higher adaptation compared with the conventional face mask. The area of facial contact matched the one digitally designed in the software. The 3D-printed grid could clip exactly into the filter, which in turn could be precisely screwed into the body of the face mask. CONCLUSION: Within the limitations of this technical report, the present findings suggest that customized 3D-printed face masks with enhanced adaptation can be digitally designed using face scans and free CAD software.

A cost analysis of a long-term prospective study of patients treated with immediately loaded implant-supported mandibular overdentures.

BACKGROUND: The economic burden for patients seeking treatment with implant-supported prostheses has not been given adequate attention. PURPOSE: To document long-term costs from a prospective trial on edentulous patients treated with mandibular implant-supported overdentures and 2 loading protocols. MATERIALS AND METHODS: The direct clinical and time costs for 35 patients receiving an immediate-loading protocol (ILP) and 40 patients with a conventional-loading protocol, over 14 years of observation, were analyzed in 2016 Canadian dollars as a base year. Quality of life (QoL) for the ILP was measured using the OHIP-20 questionnaire. RESULTS: The ILP was associated with higher complication costs ($870.77 ± 692.24 vs $85.73 ± 133.14) with resultant higher maintenance costs ($1746.37 ± 892.68 vs $853.04 ± 276.21) (P < .05). OHIP results showed a sustained improvement in QoL through the first 5 year of follow-up. A worsening of QoL, specifically the functional-related OHIP scores, was noted at 14 years. Incremental cost-effectiveness ratios indicated that the accrued maintenance costs for the ILP made the treatment less cost-effective over time. CONCLUSIONS: This long-term study confirmed that ILP is associated with higher maintenance costs and varying subjective QoL measurements. Clinical treatment protocols should be evaluated over a long period and address different perspectives.

Systematic review of current dental implant coating materials and novel coating techniques.

PURPOSE: Titanium dental implants have a high success rate; however, there are instances when a modified surface may be desirable. The aim of this article was to systematically review the different types of implant coatings that have been studied clinically, in vivo and in vitro, and the coating techniques being implemented. MATERIALS AND METHODS: The literature was searched electronically and manually through The Cochrane Library, Medline, and PubMed databases to identify articles studying dental implant surfaces and coating techniques. The database search strategy revealed 320 articles, of which 52 articles were considered eligible--40 in relation to implant coatings and 12 to the coating technique. An additional 30 articles were retrieved by hand search. RESULTS: Several materials were identified as possible candidates for dental implant coatings; these include carbon, bisphosphonates, bone stimulating factors, bioactive glass and bioactive ceramics, fluoride, hydroxyapatite (HA) and calcium phosphate, and titanium/titanium nitride. HA coatings still remain the most biocompatible coatings even though the more innovative bioglass suggests promising results. The most common coating techniques are plasma spraying and hydrocoating. More recent techniques such as the nanoscale technology are also discussed. CONCLUSIONS: Several implant coatings have been proposed, and some appear to give better clinical results and improved properties than others. Clinical trials are still required to provide compelling evidence-based results for their long-term successful outcomes.

Early loading of fixture original implants with mandibular overdentures--a preliminary report on a prospective study.

PURPOSE: The aim of this study was to report the short-term clinical- and patient-based results of an early loading protocol using two Fixture Original implants with a mandibular overdenture. MATERIALS AND METHODS: Fifteen consecutively treated patients were enrolled in this study. Each patient received 2 implants; one patient received an additional implant during the observation period, yielding a total of 31 implants used in this study. All patients were treated with overdentures supported by a resilient ovoid bar mechanism. Clinically based outcomes were documented throughout the study, while patient-based outcomes were recorded at baseline and at the 1-year follow-up using the Denture Satisfaction and the Oral Health Impact Profile. RESULTS: Patients were followed for an average of 28.87 ± 5.04 months. The overall success rate was 100% for the implants and 93% for the original prosthetic treatment plan, since an overdenture was converted to a fixed prosthesis for one patient throughout follow-up. The mean bone loss measured during the first year of loading was 0.11 mm (standard deviation: 0.14 mm). Prosthetic maintenance events were mainly related to the acrylic superstructure. Patient-based treatment outcomes showed a statistically significant improvement with the prosthetic treatment and in their quality of life (Wilcoxon signed rank rest, P < .05). CONCLUSIONS: This short-term longitudinal study suggests that Fixture Original implants can be loaded early using mandibular overdentures. Additionally, modified prosthetic and surgical protocols led to minimal postinsertion prosthodontic maintenance. The results underscore the effectiveness of the overdenture technique in rectifying patients' complaints with conventional mandibular prostheses.

Five-year clinical results of immediately loaded dental implants using mandibular overdentures.

PURPOSE: The aim of this report is to present the clinical and patient-based outcomes of an immediate-loading protocol of TiUnite implants with mandibular overdentures in edentulous patients 5 years following initial placement. MATERIALS AND METHODS: The study comprised two groups of edentulous patients. In the experimental group, 35 consecutively treated patients received 70 TiUnite implants that were loaded immediately, as well as 69 Branemark machined implants as a backup treatment. One patient received one Branemark implant. The control group comprised patients who were treated previously with conventional two-stage implant procedures, but were all case matched to the intervention group and served as a historical cohort. This group included 42 patients who received 111 Branemark implants. Both groups of patients were treated with overdentures that were supported with a standardized resilient bar mechanism. Clinical and patient-based outcomes in the immediate group were recorded for the first 5 years following the initial placement of implants and were measured at various stages of treatment using two questionnaires: the Denture Satisfaction Scale and the Oral Health Impact Profile (OHIP-20). RESULTS: Just over 98% of implants were found to be successful in both groups (Fisher exact test: P = 1.000). A statistically significant improvement in patients' total, mandibular, and functional satisfaction scores was found when comparing baseline data to the data obtained 5 years following loading in the experimental group (P < .001). There were no significant differences between the 1- and 5-year total, mandibular, and functional satisfaction scores, or between baseline and 5-year maxillary denture satisfaction scores. A statistically significant and positive correlation was found between baseline and 1-year maxillary satisfaction scores (P = .002). Any improvement in the patients' quality of life (QoL) was maintained during the first 5 years of loading. CONCLUSION: The results of this longitudinal study suggest that immediate loading of two dental implants by means of bar-retained mandibular overdentures is a predictable treatment option and leads to substantial improvement in patients' satisfaction and QoL. Importantly, this mirrors the outcomes found for patients subjected to the more commonly accepted two-stage implant procedure.

A prospective study on immediate loading of implants with mandibular overdentures: patient-mediated and economic outcomes.

PURPOSE: The aims of this report are to present the patient-based outcomes and associated clinical costs of an immediate loading protocol for mandibular overdentures in edentulous patients. MATERIALS AND METHODS: Two groups of patients were selected. Thirty-five consecutively treated patients received an immediate protocol, while 42 patients treated with a conventional protocol served as a historical control. Patient-based concerns for patients in the immediate group were measured at various stages of treatment with 2 questionnaires: the Denture Satisfaction Scale and the Oral Health Impact Profile. Direct clinical and time costs over a 1-year period were estimated and deflated to 2002 Canadian dollars. Salary rates by occupation, age, and gender were used to evaluate the patients' time costs. Treatment costs were compared between the 2 groups. Additionally, incremental cost-effectiveness ratios for various stages with the immediate protocol were calculated. RESULTS: Significant improvements posttreatment were observed with both the Denture Satisfaction Scale (Wilcoxon signed rank test, P < .05) and the Oral Health Impact Profile (Friedman test, P < .05). The immediate protocol was associated with higher maintenance costs, with resultant higher total costs (Mann-Whitney U test, P < .05). No difference was observed in the time costs associated with the 2 protocols. Within-group analysis of costs at various stages of the immediate protocol suggested that treatment with implant-supported overdentures was more cost-effective than treatment with conventional dentures. CONCLUSIONS: This study suggests that implants in 1 jawbone lead to a substantial improvement in perceived oral health status. Furthermore, the immediate loading protocol was not cheaper than a conventional protocol.

Immediate loading of implants with mandibular overdentures: one-year clinical results of a prospective study.

PURPOSE: The aim of this report is to present the implant and clinical outcomes of an immediate-loading protocol of TiUnite implants with mandibular overdentures in edentulous patients. MATERIALS AND METHODS: Two groups of edentulous patients were selected. Thirty-five consecutively treated patients received 70 immediately loaded TiUnite implants and 69 Brånemark implants as backup (1 patient received 1 Brånemark implant). The control group was a historical cohort that comprised 42 patients who received 111 Brånemark implants. All overdentures were supported by a resilient bar mechanism. Implant and clinical outcomes, including maintenance events for the first year, were recorded. RESULTS: Implant success rates were in excess of 95% with both protocols. Immediately loaded implants had less bone loss than did implants loaded with the conventional protocol (Mann-Whitney U test; P = .001). Patients in the immediate-loading group required more prosthodontic maintenance, consisting of overdenture remakes and laboratory relining of prostheses (Chi-square test; P < .05). Of note, 74% of patients in the immediate-loading group needed a reline to improve the denture seal around the bar housing (Chi-square test; P < .05). CONCLUSION: The favorable implant and bone level outcomes with immediate loading attest to its biologic success. The prosthetic maintenance encountered in the immediate-loading group does not negate the clinical potential of the treatment but rather suggests that the protocol may benefit from modifications.

Immediate and early implant loading protocols: a literature review of clinical studies.

The purpose of this literature review is to present the outcomes of clinical studies on immediate and early loading protocols, identify shortcomings, and suggest a number of questions that still require exploration. English language clinical studies, limited to peer-reviewed journals between 1975 and 2004, were reviewed to identify treatment outcomes with these loading protocols. The data were tabulated from studies reporting on patients treated with fixed and overdenture prostheses. The former included partially edentulous patients treated with single or multi-unit prostheses. Within the limitations of this review, it can be concluded that these treatment protocols are predictable in the anterior mandible, irrespective of implant type, surface topography, and prosthesis design (success rates 90%-100%). Limited evidence for the edentulous maxilla (success rates 90%-100%) and the partially edentulous patient (success rates 93%-100%) are available, underscoring the need for further research. Studies suggest that to achieve predictable results in extraction sites, implant placement should be restricted to sites without a history of periodontal involvement (success rates 61%-100%). A number of questions require further exploration. There is a need to thoroughly investigate clinical outcomes to measure the economic benefit of these protocols and the impact of treatment on a patient's quality of life. Furthermore, more accurate long-term studies reporting on treatment protocols for separate clinical situations are required to allow meaningful comparisons.

Long-term treatment costs associated with implant-supported mandibular prostheses in edentulous patients.

PURPOSE: The study's aim was to report long-term costs in edentulous patients treated with mandibular implant-supported prostheses. MATERIALS AND METHODS: Ninety patients were divided into four groups based on the type of implant prosthesis (fixed or overdenture) and treatment year. Records were obtained from dental charts, and an economic analysis from the patient's perspective was conducted. Clinical time associated with various procedures was measured and applied to the four groups. Salary rates by age, occupation, and gender were used to value patients' time. Direct clinical and time costs over 10 years were converted to 2002 Canadian dollars using the Consumer Price Index and discounted at a 3% rate. A sensitivity analysis at an equal salary rate was carried out to test the robustness of the time costs. RESULTS: Initial treatment and maintenance costs over the observation period were significantly higher for fixed compared to overdenture prostheses. A significant improvement in maintenance costs for the first patient group treated with fixed prostheses was observed over the follow-up period. Longer term (15 years) treatment costs for the initial two groups were significantly higher for the fixed group. The sensitivity analysis at an equal salary rate demonstrated the same trend: Time costs were significantly higher for the fixed groups. CONCLUSION: Long-term treatment costs indicated that the mandibular overdenture was a less expensive treatment compared to the fixed implant prosthesis.

Long-term treatment outcomes in edentulous patients with implant-fixed prostheses: the Toronto study.

PURPOSE: The aim of this prospective study was to report long-term treatment outcomes (prosthetic and implant related) of edentulous patients treated with implant-supported fixed prostheses who participated in the first clinical implant study in North America. MATERIALS AND METHODS: Forty-five patients were treated with Brånemark implants supporting a total of 47 fixed prostheses (42 mandibular and 5 maxillary) between 1979 and 1984. All patients were recalled regularly for comprehensive prospective clinical and radiographic assessments. RESULTS: Thirty-one patients (33 prostheses) attended a final recall visit in 2002; 71% of patients had been followed for 20 years (range 18 to 23 years), with overall prosthetic plan and implant outcome success rates of 84% and 87%, respectively. Mean marginal bone loss around the implants after the first year of loading was small (0.05 mm/year), with high individual variations. Poor oral hygiene, smoking history, and implant position appeared to be predictors of marginal bone loss. Prosthetic maintenance was ongoing and included fractured components and replacement of prostheses; the longevity of a fixed prosthesis for this group of patients was 8.39+/-5.30 years. CONCLUSION: This study confirmed the overall long-term treatment outcome success of patients treated with fixed prostheses supported by Brånemark implants. Successful osseointegration with a small mean bone loss was maintained as study patients aged, although prosthetic maintenance was required. The latter consideration should be discussed with all patients seeking such treatment.

Long-term treatment outcomes in edentulous patients with implant overdentures: the Toronto study.

PURPOSE: Few long-term studies on overdentures report both implant and prosthodontic outcomes. The aim of this prospective study was to report long-term prosthodontic- and implant-related treatment outcomes of patients treated with design-specific implant-supported overdentures. MATERIALS AND METHODS: Between 1982 and 1992, 45 consecutively treated patients received a total of 47 overdentures (42 mandibular and 5 maxillary) supported by Brånemark implants. Prospective clinical and radiographic data were collected over the observation period; this study presents the most recent treatment outcomes. RESULTS: Thirty patients (mean age 70 years) with 32 prostheses attended the final recall visit, with 67% of patients followed for 15.53 years (range 10 to 19 years). Six implants failed, and the prosthetic plan and implant cumulative survival rates were both in excess of 90%. Mean marginal bone loss around implants after the first year of loading was small (0.05 mm/year), although the individual variation was high. Linear regression analysis of bone loss indicated that gender, bicortical stabilization, bone quality, and healing time were predictors of bone loss for the first year of loading but not for the ensuing years. Prosthetic maintenance included fractured components, denture relining, and replacement of prostheses. On average, the longevity of overdenture prostheses was 12 years, and laboratory relining was necessary every 4 years. CONCLUSION: This study confirmed the long-term outcome success of patients treated with design-specific overdenture prostheses supported by Brånemark implants. However, prosthetic maintenance was required, a fact that should be discussed with patients prior to treatment.