Patient satisfaction with laser-sintered removable partial dentures: A crossover pilot clinical trial.

STATEMENT OF PROBLEM: Clinical data regarding newly introduced laser-sintered removable partial dentures (RPDs) are needed before this technique can be recommended. Currently, only a few clinical reports have been published, with no clinical studies. PURPOSE: This clinical trial compared short-term satisfaction in patients wearing RPDs fabricated with conventional or computer-aided design and computer-aided manufacturing (CAD-CAM) laser-sintering technology. MATERIAL AND METHODS: Twelve participants with partial edentulism were enrolled in this pilot crossover double-blinded clinical trial. Participants were randomly assigned to wear cast or CAD-CAM laser-sintered RPDs for alternate periods of 30 days. The outcome of interest was patient satisfaction as measured using the McGill Denture Satisfaction Instrument. Assessments was conducted at 1, 2, and 4 weeks. The participant's preference in regard to the type of prosthesis was assessed at the final evaluation. The linear mixed effects regression models for repeated measures were used to analyze the data, using the intention-to-treat principle. To assess the robustness of potential, incomplete adherence, sensitivity analyses were conducted. RESULTS: Statistically significant differences were found in patients' satisfaction between the 2 methods of RPD fabrication. Participants were significantly more satisfied with laser-sintered prostheses than cast prostheses in regard to general satisfaction, ability to speak, ability to clean, comfort, ability to masticate, masticatory efficiency, and oral condition (P<.05). At the end of the study, 5 participants preferred the laser-sintered, 1 preferred the cast RPD, and 3 had no preference. CONCLUSIONS: The use of CAD-CAM laser-sintering technology in the fabrication of removable partial dentures may lead to better outcomes in terms of patient satisfaction in the short term. The conclusion from this pilot study requires confirmation by a larger randomized controlled trial. CLINICAL TRIAL: ClinicalTrials.gov. A study about patient satisfaction with laser-sintered removable partial dentures; NCT02769715.

Decontamination of titanium implants using physical methods.

OBJECTIVES: Current decontamination methods of titanium (Ti) implant present limited success in achieving predictable re-osseointegration. We hypothesized that even though these techniques could be useful in elimination of bacteria, they might be unsuccessful in removing organic contaminants and restoring the original surface composition. The aim of this study was to assess the effect of four decontamination methods on the surface chemistry and bacterial load of biofilm-contaminated implant surfaces in order to improve implant surface decontamination. MATERIAL AND METHODS: The ability of clinically available methods such as metal and plastic curettes, Ti brushes and Er: YAG laser to decontaminate Ti implant surfaces was assessed. Surface morphology, chemical composition and properties of machined Ti discs (Ø 5.0 and 1.0 mm thick) were analysed before and after oral biofilm contamination using scanning electron microscope and X-ray photoelectron spectroscopy. The presence and viability of bacteria were evaluated with live-dead assays. RESULTS: Biofilm contamination created an organic layer rich in hydrocarbons and bacteria that covered entirely the Ti surfaces. This organic layer has tightly adhered to Ti surfaces and could not be completely removed with any of the methods assessed. Ti brushes achieved greater elimination of organic contaminants and bacteria than curettes and Er: YAG laser; however, none of them was able to restore the original surface chemistry. Alternatively, Er: YAG laser-treated surfaces showed the lowest live-to-dead bacterial ratio. CONCLUSIONS: Ti brushes were more effective than curettes (metal or plastic) and Er: YAG laser in decontaminating Ti implant surfaces, although none of these techniques was able to completely eliminate surface contamination. Er: YAG laser was more effective than curettes and Ti brushes in killing the biofilm bacteria.

Impact of mandibular implant prostheses on the oral health-related quality of life in partially and completely edentulous patients.

OBJECTIVE: To assess the oral health-related quality of life (OHRQoL) of patients provided with mandibular implant fixed partial prostheses (IFPP) for rehabilitation of two adjacent missing posterior teeth and complete denture patients provided with mandibular implant-supported overdenture (ISOD). The response to change in OHRQoL with implant prostheses was additionally compared. MATERIAL AND METHODS: In this prospective study, 20 IFPP (mean age 47.0; SD 12.9 years) and 28 ISOD (mean age 61.5; SD 9.1 years) patients received 2 mandibular implants. Metal ceramic nonsplinted fixed prostheses were provided in IFPP group, while in ISOD group, the mandibular overdentures were retained by nonsplinted attachments. Patients rated their oral health-related quality of life using OHIP-14 Malaysian version at baseline (T0), 2-3 months (T1) and 1 year (T2) postimplant treatment. Mean OHIP-14 for total and domain scores between groups and intervals was analysed using repeated-measures ANOVA and t-test. Mann-Whitney and Wilcoxon signed-rank tests were used for the comparison of mean score change and effect size, while the association between pre- and post-treatment scores was determined using multivariate linear regression modelling. RESULTS: The total OHIP and domain scores before implant treatment were significantly higher (lower OHRQoL) in IFPP than in ISOD groups, except for physical pain where this domain showed similar impact in both groups. Postimplant scores between groups at T1 and T2 showed no significant difference. The mean score changes at T0-T1 and T0-T2 for total OHIP-14 and domains were significantly greater in IFPP except in the domains of physical pain and disability which showed no difference. Large effect size (ES) was observed for total OHIP-14 in IFPP while moderate in ISOD. Improved OHRQoL was dependent on the treatment group and pretreatment score. CONCLUSION: Improvement in OHRQoL occurred following both mandibular implant-supported overdentures and implant fixed partial prostheses.

Aragonite toothpaste for management of dental calculus: A double-blinded randomized controlled clinical trial.

OBJECTIVES: Aragonite from animal origin such as cuttlefish bone powder is an abrasive with hardness properties ideal for calculus removal. The purpose of this randomized controlled trial was to test the efficacy of a cuttlebone-derived aragonite toothpaste in removing dental calculus. MATERIALS AND METHODS: Eighty-one patients who fulfilled the inclusion criteria were blindly and randomly assigned into two study groups. The intervention treatment group (n = 40) received cuttlebone toothpaste (Dr. D-Tart) and the control group (n = 41) received an off-the-shelf commercial toothpaste (Crest). Evaluations were performed before and after scaling and polishing procedures done at 3 months in order to evaluate the toothpaste's ability to remove calculus and to prevent calculus formation. Calculus, stains, plaque, and gingival indices scores, and patient satisfaction surveys were compared at baseline (first visit), 3, and 9 months, using generalized linear models and Wald's χ2 test. RESULTS: At the end of the 3-month period, the intervention group showed a 30% reduction in total calculus compared to the baseline score (p = .0006) and 45% less total calculus compared to the control group (p = .0001). Six months after scaling, the mean calculus score for Crest users was 42% higher than that for Dr. D-Tart users (p = .0692). There was a significant improvement in the gingival health of cuttlebone toothpaste users at the observed intervals, and both kinds of toothpaste achieved comparable results in terms of plaque and stains removal. CONCLUSIONS: Aragonite toothpaste can remove calculus, prevent calculus formation, and improve gingival health. Patients are generally satisfied with the performance of the aragonite toothpaste. CLINICAL SIGNIFICANCE: Animal-derived aragonite toothpaste (Dr. D-Tart) shows promising efficacy in removing calculus, preventing calculus formation, and for the improvement of gingival health. CLINICAL TRIAL ID: A08-M35-16B.

Advanced inorganic nanocomposite for decontaminating titanium dental implants.

Oral hygiene and regular maintenance are crucial for preserving good peri-implant health. However, available prophylaxis products and toothpastes, which are optimized for cleaning teeth, tend to contaminate and abrade implant surfaces due to their organic components and silica microparticles, respectively. This study aims to develop an organic-free implant-paste based on two-dimensional nanocrystalline magnesium phosphate gel and hydrated silica nanoparticles (20-30% w/w) for cleaning oral biofilm on titanium dental implants. The surface chemistry, morphology, and bacterial load of contaminated Ti disks before and after decontamination using prophylaxis brushing with toothpaste and implant-paste were characterized by X-ray photoelectron spectroscopy (XPS), scanning electron microscopy, and fluorescence spectroscopy. Both commercial toothpastes and implant-paste remove bacteria, however, only implant-paste protects Ti metal from abrasion and removes organic contaminants. XPS showed a significant decrease of carbon contamination from 73% ± 2 to 20% ± 2 after mechanical brushing with implant-paste compared to 41% ± 11 when brushing with commercial toothpastes (p < 0.05). Fluorescence microscopy revealed that bacteria load on biofilm contaminated Ti (44 × 103 ± 27 × 103 /µm2 ) was significantly reduced with the implant-paste to 2 × 103 ± 1 × 102 /µm2 and with a commercial toothpaste to 2.9 × 103 ± 7·102 /µm2 . This decay is relatively higher than the removal achieved using rotary prophylaxis brush alone (5 × 103 ± 1 × 103 /µm2 , p < 0.05). Accordingly, this novel implant-paste shows a great promise as an efficient decontamination approach. © 2018 Wiley Periodicals, Inc. J. Biomed. Mater. Res. Part B, 2018. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 761-772, 2019.

Electrochemical Treatment of Contaminated Titanium Surfaces in Vitro: An Approach for Implant Surface Decontamination.

Bacterial contamination on titanium implants can cause inflammation and eventually implant failure. Currently used methods for decontamination of implants have demonstrated limited success. Metal surfaces can be disinfected electrochemically. However, the effect of electrochemical treatments on biofilm-contaminated titanium is largely unknown. We hypothesized that electrochemical treatments are able to safely remove organic contamination and bacteria from titanium implants without altering their surfaces. This study was designed to assess the electrochemical properties of bacteria-contaminated surfaces in order to develop new treatments to clean titanium. Surface morphology, composition, bacterial load, and electrochemical properties of polished titanium discs were analyzed before and after biofilm contamination and subsequent decontamination with various electrochemical methods. The effect of the combination of the electrochemical with titanium brush cleaning was also evaluated. Results were then analyzed and compared to baseline readings (prior to contamination) using repeated measures ANOVA. Biofilm contamination increased the levels of carbon, nitrogen, and live bacteria on titanium surfaces while reducing their open circuit potential and corrosion resistance. Optimized electrochemical treatments with alternating current (-2.3 mA, + 22.5 µA) and voltages (1.8 V), were bactericidal and able to completely decontaminate saliva-contaminated titanium surfaces within 5 min while preserving surface integrity and histological quality of mammalian tissues. Furthermore, with the aid of mechanical brushing, the optimized electrochemical treatment was able to achieve complete decontamination of biofilm-contaminated Ti surfaces. The electrochemical treatment seems to be promising and well worth investigating for the clinical management of peri-implant infections.

Short dental implants: an emerging concept in implant treatment.

OBJECTIVE: Short implants have been advocated as a treatment option in many clinical situations where the use of conventional implants is limited. This review outlines the effectiveness and clinical outcomes of using short implants as a valid treatment option in the rehabilitation of edentulous atrophic alveolar ridges. DATA SOURCES: Initially, an electronic search was performed on the following databases: Medline, PubMed, Embase, Cochrane Database of Systematic Reviews, and DARE using key words from January 1990 until May 2012. An additional hand search was included for the relevant articles in the following journals: International Journal of Oral and Maxillofacial Implants, Clinical Oral Implants Research, Journal of Clinical Periodontology, International Journal of Periodontics, Journal of Periodontology, and Clinical Implant Dentistry and Related Research. Any relevant papers from the journals' references were hand searched. Articles were included if they provided detailed data on implant length, reported survival rates, mentioned measures for implant failure, were in the English language, involved human subjects, and researched implants inserted in healed atrophic ridges with a follow-up period of at least 1 year after implant-prosthesis loading. CONCLUSION: Short implants demonstrated a high rate of success in the replacement of missing teeth in especially atrophic alveolar ridges. The advanced technology and improvement of the implant surfaces have encouraged the success of short implants to a comparable level to that of standard implants. However, further randomized controlled clinical trials and prospective studies with longer follow-up periods are needed.