A pilot randomised controlled trial evaluating mini and conventional implant retained dentures on the function and quality of life of patients with an edentulous mandible.

BACKGROUND: Total tooth loss (edentulism) can be a debilitating condition, impacting on ability to chew, speak and interact with others. The most common treatment is with complete removable dentures, which may be successful, but in the lower jaw, bone resorption that worsens over time makes denture-wearing difficult. Two dental implants in the mandible to retain the lower denture has been advocated as the gold standard of treatment, but has not been universally provided due largely to financial constraints and also patient fear. Mini implants (MI) are cheaper and less invasive than conventional implants (CI), but may not have equivalent longevity. Therefore, it is unknown whether they represent a cost-effective treatment modality over time. The aim of this pilot randomised controlled trial was to assess the feasibility of carrying out a trial on this cohort of patients, and to inform the study design of a large multicentre trial. METHODS: Forty-six patients were randomly allocated to receive either two mini implants or two conventional implants in the mandible to retain their lower dentures. Quality of life (QoL) questionnaires, pain and anxiety scores, and an objective "gummy jelly" chewing test were carried out at multiple timepoints, along with detailed health economics information. Implants were placed one-stage, and an early loading protocol was utilised. Patients were reviewed 8 weeks post-placement, and finally at 6 months. Implant failure, recruitment and retention rates were recorded and analysed. RESULTS: The pilot study demonstrated that it is possible to recruit, randomise and retain edentulous (mainly elderly) patients for an implant trial. We recruited to target and retention rates were acceptable. The large number of questionnaires was onerous for participants to complete, but the distribution of scores and feedback from participants helped inform the choice of primary and secondary outcomes in a full trial. The chewing test was time-consuming and inconsistent. Implant failure rate was low (1/46). The data on indirect costs gathered at every visit was viewed as repetitive and unnecessary, as there was little or no change between visits. CONCLUSIONS: The pilot study has shown that acceptable recruitment and retention rates are achievable in this population of patients for this intervention. The results provide valuable information for selection of outcome variables and sample size calculations for future trials. TRIAL REGISTRATION: (ISRCTN): 87342238 Trial registration date: 05/07/2013.

Dental dilemmas: Endodontics or dental implants?

UNLABELLED: This narrative review explores treatment planning options in restorative dentistry. The growth of dental implants, as an accessible and predictable treatment option, gives practitioners a useful tool for managing the missing tooth or teeth with a hopeless prognosis. Traditionally, endodontics and fixed prosthodontics have been used to restore teeth and spaces where the outlook for such treatment appears reasonable. Practitioners may, however, question the predictability and cost effectiveness of such an approach where, at times, it might appear that replacement of a compromised tooth with a dental implant could be a more predictable option. The evidence base for these treatment options is explored and discussed, and suggestions are made for future management strategies. CLINICAL RELEVANCE: A clear knowledge and understanding of the scientific literature for implants and endodontic treatment is necessary if practitioners are to make an evidence-based approach when treatment planning these modalities for their patients. This is particularly true in cases where there may appear to be a reasonable choice between the two of these.

Mandibular two implant-supported overdentures as the first choice standard of care for edentulous patients--the York Consensus Statement.

The Annual Conference of the BSSPD (British Society for the Study of Prosthetic Dentistry) was held in York on 6 and 7 April 2009. At the symposium on mandibular overdentures, presenters offered a synopsis of the research available on the efficacy of implant-supported mandibular overdentures in the edentulous mandible. Emphasis was given to both qualitative and quantitative research based on patient-centred outcomes of treatment. A draft consensus was circulated to all presenters and to the Council members of the BSSPD and to BSSPD members on the Society's website. The statement was modified in the light of their comments, audience feedback following the presentations and members' feedback. We hope that this consensus statement will be a useful guide for patients and clinicians and that it will act to stimulate wider debate. We also hope that it will prove useful to other patient and professional organisations and will inform discussions with providers of national healthcare and with independent funders.

Peer assessment of professional competence.

BACKGROUND: Current assessment formats for medical students reliably test core knowledge and basic skills. Methods for assessing other important domains of competence, such as interpersonal skills, humanism and teamwork skills, are less well developed. This study describes the development, implementation and results of peer assessment as a measure of professional competence of medical students to be used for formative purposes. METHODS: Year 2 medical students assessed the professional competence of their peers using an online assessment instrument. Fifteen randomly selected classmates were assigned to assess each student. The responses were analysed to determine the reliability and validity of the scores and to explore relationships between peer assessments and other assessment measures. RESULTS: Factor analyses suggest a 2-dimensional conceptualisation of professional competence: 1 factor represents Work Habits, such as preparedness and initiative, and the other factor represents Interpersonal Habits, including respect and trustworthiness. The Work Habits factor had moderate, yet statistically significant correlations ranging from 0.21 to 0.53 with all other performance measures that were part of a comprehensive assessment of professional competence. Approximately 6 peer raters were needed to achieve a generalisability coefficient of 0.70. CONCLUSIONS: Our findings suggest that it is possible to introduce peer assessment for formative purposes in an undergraduate medical school programme that provides multiple opportunities to interact with and observe peers.