Single mandibular implant study - denture satisfaction in the elderly.

To investigate whether there are differences in patients' denture satisfaction when an implant placed in the midline of the edentulous mandible is loaded either immediately or three months later, after second-stage surgery. One hundred and fifty-eight edentulous patients received a single implant in the midline of the mandible. After randomisation, it was loaded either immediately after implant placement (N = 81, group A) or three months later, after a submerged healing phase and a second-stage surgery (N = 77, group B). Patients' denture satisfaction aspects were assessed, using visual analogue scales (VAS), before treatment, one month after implant placement during the submerged healing phase (only group B) and one and four months after implant loading. The statistical analysis was performed using the Wilcoxon signed-rank and rank-sum tests. One month after loading, a significant improvement in comfort, function and stability of the mandibular denture could be observed in both groups (P ≤ 0·05). A slight but not significant improvement was found between one and four months after loading. Patients with second-stage surgery and delayed loading rated the stability and fit of the mandibular denture as significantly better than patients who had immediate loading. A single implant in the edentulous mandible significantly increased patients' denture satisfaction. After four months, stability and fit of the mandibular denture were considered better when a delayed loading protocol had been followed. A single mandibular implant in the edentulous mandible significantly increases patients' denture satisfaction, regardless of the loading protocol.

Pain and discomfort following immediate and delayed loading by overdentures in the single mandibular implant study (SMIS).

OBJECTIVES: This randomized clinical trial compares immediate and delayed loading of single implants to support mandibular overdentures. The aim of this preliminary analysis is to test the hypothesis whether patients with immediate loading will experience less pain and discomfort through the intervention than patients with delayed loading. MATERIALS AND METHODS: Edentulous patients in nine German dental schools received a midline implant with a length of 11 mm. Implants with a minimum insertion torque of 30 Ncm and an implant stability quotient of ≥60 were randomly allocated to group A for immediate loading using ball attachments or to group B for delayed loading after 3 months. Patients completed questionnaires with 100-mm visual analogue scales about the items pain, pain during chewing, swelling, bleeding, and perception of the intervention at the day of surgery and 1, 2, 3, and 7 days, thereafter. Groups were compared by Wilcoxon-Mann-Whitney tests (P ≤ 0.05). RESULTS: The questionnaires of 81 patients in group A and 74 patients in group B were completed. The medians for pain and discomfort were moderate (<30). Participants of group A felt significantly more pain from the first day and more swelling from the third day after implantation than participants of group B. The individual perception of interventions showed no significant differences between groups. CONCLUSIONS: Immediate loading evoked more postoperative pain and swelling than the two stages of delayed loading. CLINICAL RELEVANCE: Immediate loading of a single mandibular midline implant supporting overdentures should be carefully considered.

Development and validation of the Burdens in Oral Surgery Questionnaire (BiOS-Q).

Patients' perspective is increasingly re-cognised as an important outcome measure in oral surgery. However, how patients perceive the surgical treatment cannot be assessed currently. This would be an important indicator for process-related quality of care. It was the aim to develop and to validate an instrument for the assessment of patient-based measures of process-related quality of care in oral surgery. The new Burdens in Oral Surgery Questionnaire (BiOS-Q) was developed in two steps in patients undergoing oral surgery. First, an item pool was created using semi-structured interviews in 90 patients. Second, a preliminary version was applied in 297 consecutively recruited patients to assess redundancy, completion rates, face validity, difficulty and distribution. Psychometric properties of the final version of the questionnaire were evaluated. The BiOS-Q consists of 16 items and showed satisfactory internal consistency (Cronbach's alpha = 0·84) and excellent test-retest reliability (ICC = 0·90). The questionnaire's mean score was significantly correlated with dentists' burdens (r = 0·44) and patients' overall satisfaction (r = 0·39) indicating sufficient validity. The BiOS-Q is a reliable and valid instrument for the assessment of patient-based process-related quality of care in oral surgery.

Influence of tissue expanders on the growing craniofacial skeleton.

The effects of chronic pressure on the mandible during skin expansion procedures have been investigated. In 19 Göttingen miniature pigs with an average age of 3 months, tissue expanders were placed s.c. in close proximity to the growing ascending ramus of the mandible on the surface of the masseter muscle. After complete filling of the expanders (100 cc) after 6 weeks, a significant transverse discrepancy could be observed compared with the contralateral side. Additionally, severe medial dislocation of the molars were noticed. Ten weeks after the removal of the implant, the occlusal disturbance still existed, deviation of the transverse mandibular diameter still reached up to -13.6 +/- 2.1%. Because only four animals were measured based on a CT investigation, further statistical analysis was not possible. Histological examination showed osteoclastic activity of the expander with consequent bone resorption and remodelling. Strict indications should be agreed for tissue expansion in the vicinity of growing bone, as, for example, when tissue expansion is applied in children.