Patients' E-Readiness to use E-Health technologies for oral health.

INTRODUCTION: Scientific evidence highlights the importance of E-Readiness in the adoption and implementation of E-Oral Health technologies. However, to our knowledge, there is no study investigating the perspective of patients in this regard. Therefore, the objective of this study was to explore patients' E-Readiness in the field of dentistry. MATERIALS AND METHODS: A qualitative study was conducted using interpretive descriptive methodology. Purposeful sampling with maximum variation and snowball techniques were used to recruit the study participants via McGill University dental clinics and affiliated hospitals, as well as private or public dental care organizations. A total of 15 face-to-face, semi-structured and 60 to 90-minute audio recorded interviews were conducted. Data collection and analyses were performed concurrently, and interviews were continued until saturation was reached. Activity theory was used as the conceptual framework, and thematic analysis was used to analyze data. Data analysis was conducted both manually and with the use of "ATLAS-ti" software. RESULTS: Four major themes emerged from the study; unlocking barriers, E-Oral Health awareness, inquisitiveness for E-Oral Health technology and enduring oral health benefits. These themes correspond with all three types of readiness (core, engagement and structural). CONCLUSION: The study results suggest that dental patients consider E-Oral Health as a facilitator to access to care, and they are ready to learn and use E-Oral Health technology. There is a need to implement and support E-Oral Health technologies to improve patient care.

Rural-urban disparities in patient satisfaction with oral health care: a provincial survey.

BACKGROUND: Identifying spatial variation in patient satisfaction is essential to improve the quality of care. Thus, the objective of this study was to investigate rural-urban disparities in patient satisfaction and to determine the factors that could influence satisfaction with oral health care. METHODS: Data from 1788 parents/caregivers of children who participated in the Quebec Ministry of Health clinical study were subject to secondary analysis. The Perneger model of patient satisfaction was used as the conceptual framework for the study. Satisfaction with oral health care was measured using the WHO-sponsored International Collaborative Study of Oral Health Outcomes (ICS-II). Explanatory variables included predisposing factors and enabling resources. Statistical analyses included descriptive statistics, as well as bivariate and linear regression models. RESULTS: Individuals with higher income, dental insurance coverage, having a family dentist, reporting ease in finding a dentist, and having access to a private dental clinic were more satisfied with oral health care (p < 0.001). There were statistically significant differences between rural and urban Quebec residents in their ratings of patient satisfaction on four items, including dental office location (p = 0.013), dental equipment (p = 0.016), cost of dental treatment (p < 0.001), and cleanliness of dental office (p = 0.004), with greater satisfaction for urban dwellers. The multiple linear regression model showed that major determinants of patient satisfaction were being born in Canada, income ≥ 40,000$ CAD, having a family dentist, and having visited the dentist in the last year for regular checkups. However, ethnicity, having difficulty finding a dentist, and being in need of dental treatment negatively influenced patient satisfaction with oral health care. CONCLUSIONS: These findings suggest that Quebec rural-urban disparity exists in patient satisfaction with care and that determinants of health influence this outcome. Intensive and powerful knowledge dissemination activities are needed to mobilize policymakers in implementing public health strategies to reduce this disparity.

A 5-Year Esthetic RCT Assessment of Anterior Maxillary Single-Tooth Implants with Different Abutment Interfaces.

PURPOSE: This study sought to define the tissue responses at different implant-abutment interfaces by studying bone and peri-implant mucosal changes using a 5-year prospective randomized clinical trial design study. The conus interface was compared with the flat-to-flat interface and platform-switched implant-abutment systems. MATERIALS AND METHODS: One hundred forty-one subjects were recruited and randomized to the three treatment groups according to defined inclusion and exclusion criteria. Following implant placement and immediate provisionalization in healed alveolar ridges, clinical, photographic, and radiographic parameters were measured at 6 months and annually for 5 years. The calculated changes in marginal bone levels, peri-implant mucosal zenith location, papillae lengths, and peri-implant Plaque Index and bleeding on probing were statistically compared. RESULTS: Forty-eight conus interface implants, 49 flat-to-flat interface implants, and 44 platform-switched implants were placed in 141 subjects. Six platform-switched interface and eight flatto- flat interface implants failed, most of them within 3 months. After 5 years, 33 conical interface, 28 flat-to-flat interface, and 27 platform-switched interface implants remained for evaluation. Calculation of marginal bone level change showed a mean marginal bone loss of -0.16 ± 0.45 (-1.55 to 0.65), -0.92 ± 0.70 (-2.90 to 0.20), and -0.81 ± 1.06 (-3.35 to 1.35) mm for conical interface, flat-to-flat interface, and platform-switched interface implants, respectively (P < .0005). The peri-implant mucosal zenith changes were minimal for all three interface designs (0.10 mm and +0.08 mm, P > .60). Only 16% to 19% of the surfaces had presence of bleeding on probing, with no significant differences (P > .81) between groups. Interproximal tissue changes were positive and similar among the implant interface designs. CONCLUSION: Over 5 years, the immediate provisionalization protocol resulted in stable peri-implant mucosal responses for all three interfaces. Compared with the flat-to-flat and platform-switched interfaces, the conical interface implants demonstrated significantly less early marginal bone loss. The relationship of marginal bone responses and mucosal responses requires further experimental consideration.

Three-Year Prospective Randomized Comparative Assessment of Anterior Maxillary Single Implants with Different Abutment Interfaces.

PURPOSE: The goal of this investigation was to define time-dependent peri-implant tissue changes at implants with different abutment interface designs. MATERIALS AND METHODS: Participants requiring replacement of single maxillary anterior and first premolar teeth were recruited and treated under an institutional review board (IRB)-approved protocol. Implants, titanium abutments, and provisional crowns were placed in healed ridges 5 months following preservation after tooth extraction with recombinant human bone morphogenetic protein-2 (rhBMP-2). Twelve weeks later, permanent crowns were placed on patient-specific abutments and evaluated at 6, 12, and 36 months following implant placement. Clinical and radiographic assessments of abutments and crowns, peri-implant mucosa, and marginal bone levels were recorded. RESULTS: The 3-year assessment included 45 conical interface (CI), 34 flat-to-flat interface (FI), and 32 platform-switched interface (PS) implants in 111 participants. At 3 years, the mean marginal bone level (MBL) change at CI, FI, and PS implants was -0.12, -1.02, and -1.04 mm, respectively (P = .014). "Zero" MBL loss or gain was measured over the 3-year period at 72.1% CI, 3.0% FI, and 16.6% PS implants. There was a minor change (0.0 to 0.3 mm) in peri-implant mucosal zenith positions over time and between groups. Eighty percent of CI implants, 61% of FI implants, and 84% of PS implants were observed to have a clinically stable peri-implant mucosal zenith position with less than 0.5 mm of measured recession. Over the 36-month period, there were no significant changes in the location of mesial or distal papilla in any group. CONCLUSION: Significant differences in MBLs were observed at different implant interfaces. Conical implant interfaces, but not flat-to-flat or platform-switched implant interfaces, were associated with no MBL changes over 3 years. Peri-implant mucosal stability was generally observed. The relationship of marginal bone responses and peri-implant mucosal stability requires further evaluation.

Do traditional techniques produce better conventional complete dentures than simplified techniques? A 10-year follow-up of a randomized clinical trial.

OBJECTIVES: The use of a simplified method (S) of fabricating complete dentures has been shown to be more cost-efficient than the traditional method (T), and there are no negative consequences that detract from the cost savings in the short term. However, it is not clear whether this remains constant over a decade. The objective of this study was to clarify patients' perspectives and determine any differences between the dentures fabricated with these two different techniques after a decade of use. MATERIAL AND METHODS: Edentate individuals participated in a randomized controlled clinical trial and completed a 6-month follow-up from 2001 to 2003 (T group n = 50; S group n = 54). For this 10-year follow-up, they were interviewed by telephone. The assessment included whether the denture was still in use or replaced, the condition of the dentures, patient satisfaction and oral health-related quality of life (OHRQoL). Between and within-group differences and the factors that cause deterioration of oral health-related quality of life (OHRQoL) were determined. RESULTS: Among 54 responders (25 T and 29 S), 14T and 21S kept the original dentures. Both groups were similar in ratings of satisfaction and OHRQoL (maxilla T: 80.0 S: 86.0, p = 0.36; mandibular; T: 66.1 S: 72.3, p = 0.48; OHRQoL T: 111.1 S: 108.5, p = 0.46). Irrespective of fabrication method, discomfort, chewing difficulty and esthetics were the factors that deteriorate OHRQoL (adjusted r = 0.76, p < 0.001). CONCLUSION: The results indicate that the simplified method remains more cost-efficient than the traditional method over a 10-year period. (IRB approval: A09-E71-12 B McGill University, trial registry: ClinicalTrial.org; NCT02289443).

Rural-urban disparity in oral health-related quality of life.

OBJECTIVES: The objective of this population-based cross-sectional study was to estimate rural-urban disparity in the oral health-related quality of life (OHRQoL) of the Quebec adult population. METHODS: A 2-stage sampling design was used to collect data from the 1788 parents/caregivers of schoolchildren living in the 8 regions of the province of Quebec in Canada. Andersen's behavioural model for health services utilization was used as a conceptual framework. Place of residency was defined according to the Statistics Canada Census Metropolitan Area and Census Agglomeration Influenced Zone classification. The outcome of interest was OHRQoL measured using the Oral Health Impact Profile (OHIP)-14 validated questionnaire. Data weighting was applied, and the prevalence, extent and severity of negative oral health impacts were calculated. Statistical analyses included descriptive statistics, bivariate analyses and binary logistic regression. RESULTS: The prevalence of poor oral health-related quality life (OHRQoL) was statistically higher in rural areas than in urban zones (P = .02). Rural residents reported a significantly higher prevalence of negative daily-life impacts in pain, psychological discomfort and social disability OHIP domains (P < .05). Additionally, the rural population showed a greater number of negative oral health impacts (P = .03). There was no significant rural-urban difference in the severity of poor oral health. Logistic regression indicated that the prevalence of poor OHRQoL was significantly related to place of residency (OR = 1.6; 95% CI = 1.1-2.5; P = .022), perceived oral health (OR = 9.4; 95% CI = 5.7-15.5; P < .001), dental treatment needs factors (perceived need for dental treatment, pain, dental care seeking) (OR = 8.7; 95% CI = 4.8-15.6; P < .001) and education (OR = 2.7; 95% CI = 1.8-3.9; P < .001). CONCLUSION: The results of this study suggest a potential difference in OHRQoL of Quebec rural and urban populations, and a need to develop strategies to promote oral health outcomes, specifically for rural residents. Further studies are needed to confirm these results.

Prospective assessment of CAD/CAM zirconia abutment and lithium disilicate crown restorations: 2.4 year results.

STATEMENT OF PROBLEM: Single-tooth implant restorations are commonly used to replace anterior maxillary teeth. The esthetic, functional, and biologic outcomes are, in part, a function of the abutment and crown. PURPOSE: The purpose of this clinical study was to describe the implant, abutment, and crown survival and complication rates for CAD/CAM zirconia abutment and lithium disilicate crown restorations for single-tooth implants. MATERIAL AND METHODS: As part of a broader prospective investigation that enrolled and treated 141 participants comparing tissue responses at the conical interface (CI; AstraTech OsseoSpeed), flat-to-flat interface (FI; NobelSpeedy), and platform-switch interface (PS; NanoTite Certain Prevail) of single-tooth implants, computer-aided design and computer-aided manufacturing (CAD/CAM) zirconia abutments (ATLANTIS Abutment) and cemented lithium disilicate (e.max) crowns were used in the restoration of all implants. After 2.4 years in function (3 years after implant placement), the implant, abutment, and crown of 110 participants were evaluated. Technical and biologic complications were recorded. Demographic results were tabulated as percentages with mean values and standard deviations. Abutment survival was calculated with the Kaplan-Meier method. RESULTS: After 2.4 years, no abutments or crowns had been lost. Abutment complications (screw loosening, screw fracture, fracture) were absent for all 3 implant groups. Crown complications were limited to 2 crowns debonding and 1 with excess cement (2.5%). Five biological complications (4.0%) were recorded. The overall complication rate was 6.5%. CONCLUSIONS: CAD/CAM zirconia abutments restored with cemented lithium disilicate crowns demonstrated high survival on 3 different implant-abutment interface designs. No abutment or abutment screw fracture occurred. The technical complications observed after 2.4 years were minor and reversible. The use of CAD/CAM zirconia abutments with cemented lithium disilicate crowns is associated with high technical and biologic success at 2.4 years.

Electronic assessment of peri-implant mucosal esthetics around three implant-abutment configurations: a randomized clinical trial.

OBJECTIVES: To objectively assess the influence that three different implant-abutment interface designs had on peri-implant mucosal esthetics at 1 year post-implant placement via the pink esthetic score (PES). Additionally, to demonstrate the novel employment of a tablet-based digital imaging format to reliably assess and score clinical images as part of a multicenter clinical trial according to PES criteria. MATERIALS AND METHODS: Adult subjects (n = 141) with healed tooth-bound edentulous sites in the anterior maxilla as well as first premolar region were randomized to receive one of three different implant-abutment interface designs (conical interface = CI; flat-to-flat interface = FI; or platform switch interface = PS). Immediate provisionalization was performed with prefabricated titanium abutments, with definitive custom CAD/CAM zirconia abutments and all-ceramic cement-based crowns being delivered 12-week post-implant placement. Bilateral (anterior sites) or unilateral (premolar sites) digital clinical photographs were made at 1, 3, 6, and 12 months post-implant placement. Five calibrated faculty evaluators of different clinical backgrounds scored images during a 4-week timeframe on a standardized, tablet-based, digital imaging format. RESULTS: Six hundred and forty-nine clinical photographs were evaluated resulting in a total of 3245 sum PES values and 22,715 individual PES values. Faculty evaluator intra- and inter-rater reliability was found to be "strong" (ICC = 0.84) and "substantial" (ICC = 0.64), respectively, demonstrating repeatability of both the PES, evaluator calibration, and standardization of tablet-based scoring. All implant-abutment interface groups demonstrated significant improvements in mean sum PESs up to 1 year, with the largest improvement between restoration delivery and 6 months. No significant differences were found between groups in mean sum PESs both for individual study visits as well as for changes between study visits. CONCLUSIONS: No significant differences in mean sum PESs were found between subjects randomized to three different implant-abutment interfaces. However, significant differences were found as a function of time for all three groups, with the largest improvement in mean sum PESs occurring between definitive abutment and restoration delivery and 6 months. Use of electronic, tablet-based digital imaging scoring formats represents a novel and repeatable methodology for scoring PES images in large, multicenter clinical trials.

Are people who still have their natural teeth willing to pay for mandibular two-implant overdentures?

AIM: Oral health in Canada and most developed and developing countries is funded by private payers, whose acceptance of treatment depends on their valuation of it. This study aims to determine how dentate individuals in Quebec, Canada, would value the benefits of mandibular two-implant overdentures based on their willingness to pay (WTP) for the treatment, either directly or with insurance/government coverage. METHODS: A total of 39 individuals (23-54 years) completed a Web-based WTP survey that consisted of three cost scenarios: (a) out-of-pocket payment; (b) private dental insurance coverage; and (c) public funding through additional taxes. Variations in WTP amounts were measured using regression models. RESULTS: Among respondents who were dentate or missing some teeth, average WTP out of pocket for implant overdentures was CAD$5419 for a 90% success rate. They were willing to pay an average CAD$169 as one-time payment for private dental insurance, with a one in five chance of becoming edentate. WTP amounts increased substantially with the probability of success of implant overdenture therapy. The results of regression analyses were consistent with theoretical predictions for education level and income (P < 0.05). CONCLUSIONS: The results of this study, within its limitations, suggest that dentate individuals would be willing to pay a significant amount to receive mandibular two-implant overdentures if and when they become edentate.

Health technology assessment in oral health.

Health-care costs are rising at an alarmingly fast rate worldwide, particularly in developed countries such as the United States. This is predominantly a result of the development of new, high-cost health technologies intended for improved diagnosis and treatment. The purpose of health technology assessment is to systematically determine the true benefits of new technologies, taking into account clinical efficacy/effectiveness and cost as well as societal preference and ethical issues. In this report, the purpose of health technology assessment is explained in light of new developments in oral health technology, particularly intraoral implants. This information is intended to educate and to challenge oral health opinion leaders to consider all of the issues involved in the development and diffusion of new oral health technologies.

Efficient resource use in simplified complete denture fabrication.

PURPOSE: Conventional dentures will remain the only treatment available to most edentulous people for the foreseeable future. In this study, we compared the efficiency of two methods of making complete conventional dentures-the traditional academic standard (T) and a simplified technique (S) used in private practice. We have previously shown that they produce similar levels of patient satisfaction and denture quality. MATERIALS AND METHODS: Data were gathered during a randomized controlled clinical trial of 122 subjects from initial examination until 6-month follow-up. For this report, the direct costs of providing one set of conventional complete dentures by T or S techniques were estimated. All materials used were recorded and their cost was calculated in Canadian dollars (CAN$). The costs of fabrication in an outside laboratory were added. Clinician's labor time was recorded for every procedure. Between-group comparisons for each clinical procedure were carried out with independent t-tests. The number of patients in each group who needed postdelivery treatment was compared with Chi-square tests. The effect of group assignment and of treatment difficulty on outcomes was analyzed with multiple regression analysis. RESULTS: The mean total cost of the T method was significantly greater than S (CAN$166.3; p < 0.001), and clinicians spent 90 minutes longer (p < 0.001) on clinical care. The difficulty of the case had no significant influence on outcomes. CONCLUSIONS: The results indicate that the S method is the more cost-efficient method and that there are no negative consequences that detract from the cost savings.

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.

Implant overdentures for edentulous elders: study of patient preference.

BACKGROUND: Studies show that elders wearing implant overdentures have improved nutrition and quality of life. However, upfront costs of this therapy are high, and the income of elderly edentulous populations is low. OBJECTIVES: This study was designed (i) to measure the preferences of edentulous patients for mandibular two-implant overdentures using Willingness-To-Pay (WTP) and Willingness-To-Accept (WTA), (ii) to assess the effect of long-term financing on WTP and (iii) to assess the desired role of health care plans in financing dental prostheses. METHODS: Edentulous elders (68-79 years; n = 36) wearing maxillary dentures and either a mandibular conventional denture (CD, n = 13) or a two-implant overdenture with ball attachments (IOD, n = 23) participated in this study. All had received their prostheses 2 years previously, as part of a randomised clinical trial. A three-part questionnaire was completed during a 20-min interview with a trained researcher. RESULTS: Forty-six per cent (6/13) of the CD wearers and 70% (16/23) of the IOD wearers were willing to pay three times more than the current cost of conventional dentures for implant prostheses. These percentages were increased to 77% (CD) and 96% (IOD) if participants could pay for implant overdentures in monthly instalments. Eighty-six per cent (31/36) of all participants in both groups (21/23 IOD; 10/13 CD) thought that the government should cover at least some of the cost of implant overdentures. CONCLUSIONS: This study shows that, the majority of elderly edentate individuals who have not experienced mandibular two-implant overdenture therapy are willing to pay the cost, particularly when payment can be made in monthly instalments.

New technologies in health care. Part 1: A moral and ethical predicament.

With the rapid evolution of technology and the development and marketing of new procedures in dentistry, dentists have difficulty keeping pace with all of this new technology and information. How do these clinicians know whether a new product, technique or technological advance is good and should be recommended? At what point do they have an obligation to inform their patients about new procedures supported by research? This first report of a 2-part series investigates the ethical aspects of these issues and describes some of the professional ethical dilemmas and obligations involved when new therapies are offered to the public.

Monitoring recruitment success and cost in a randomized clinical trial.

Recruitment of older adults into research studies is challenging and, as a consequence, the recruitment period is often extended and more expensive than planned. This study monitored the effectiveness (number of subjects attracted) and cost of different recruitment strategies when recruiting edentulous elderly adults. Socio-demographic data were gathered and compared to 2001 Canadian census data. Advertisements in major Montreal newspapers attracted the most people (24.3%). However, the most economical recruitment method proved to be placement of ads in senior newspapers (dollar 73.74 per subject). The information gathered in this study will assist others in planning recruitment strategies for edentulous elderly populations.

Can general dentists produce successful implant overdentures with minimal training?

OBJECTIVES: This study was carried out to determine whether inexperienced dentists can provide two-implant overdentures that are as satisfactory and of the same cost as those provided by experienced prosthodontists. METHODS: Edentulous elders were enrolled in a randomized controlled clinical trial to compare the effects of mandibular conventional and two-implant overdentures on nutrition. They were randomly assigned to groups that were treated by either an experienced prosthodontist or by a newly-graduated dentist with minimal training in implant treatment. Data for this study were obtained during the treatment of the first 140 subjects enrolled. The change in patient ratings of satisfaction after treatment, laboratory costs and the number of unscheduled visits up to 6 months following prosthesis delivery were compared. RESULTS: Satisfaction was significantly higher with implant overdentures than with conventional dentures, but there were no differences in scores for either prosthesis between the groups treated by experienced specialists or new dentists. Furthermore, six of the seven inexperienced dentists reported that they found the mandibular two-implant overdenture easier to provide than the conventional denture. CONCLUSIONS: The results of this study suggest that general dentists can provide successful mandibular two-implant overdentures with minimal training.

A cost comparison of mandibular two-implant overdenture and conventional denture treatment.

PURPOSE: This article compares the cost of mandibular two-implant overdenture treatment to that of conventional denture treatment in an academic teaching hospital. MATERIALS AND METHODS: Sixty edentulous patients (aged 65 to 75 years) participated in a randomized clinical trial. All patients received a new maxillary complete denture and either a mandibular conventional denture (n = 30) or an implant overdenture on two unsplinted implants (n = 30). Resource-based microcosting of direct and indirect costs (eg, expenses and time cost to patients) of all scheduled and unscheduled visits was conducted through 1 year following delivery of the prostheses. RESULTS: Mean direct costs (1999 CD dollars) for scheduled visits in the implant and conventional groups were 2,332 dollars and 814 dollars, respectively, and mean indirect costs were 1,150 dollars and 810 dollars, respectively. Differences between the two groups were significant. Twenty-six patients in each group had unscheduled visits during the study at a median direct cost for the overdentures of 85 dollars and 64 dollars for the conventional dentures. Median indirect costs for unscheduled visits were 163 dollars and 202 dollars, respectively. These differences were not significant. Mean total costs of the overdentures were 4,245 dollars and 2,316 dollars for the conventional dentures, and the between-group difference was significant. CONCLUSION: The direct cost of mandibular two-implant overdenture treatment was 2.4 times higher than that of conventional denture treatment. When indirect costs were added, the implant-to-conventional total cost ratio estimate was 1.8. These cost data can now be combined with estimates of the efficacy of the two types of prosthesis so practitioners and patients can make informed decisions about these prosthodontic treatment concepts.

Comparing the efficacy of mandibular implant-retained overdentures and conventional dentures among middle-aged edentulous patients: satisfaction and functional assessment.

PURPOSE: The aim of this randomized clinical trial was to compare the relative efficacy of mandibular overdentures retained by only two implants and a bar attachment with conventional dentures. MATERIALS AND METHODS: Edentulous adults, aged 35 to 65 years, were randomly assigned to two groups that received either a mandibular conventional denture (n = 48) or an overdenture supported by two endosseous implants with a connecting bar (n = 54). All subjects rated their general satisfaction and other features of their original dentures and their new prostheses (comfort, stability, ability to chew, speech, esthetics, and cleaning ability) on 100-mm visual analogue scales prior to treatment and 2 months postdelivery. Oral health-related quality of life was also evaluated pre- and posttreatment. RESULTS: Multiple regression analysis revealed that the mean general satisfaction was significantly higher in the overdenture group than in the conventional denture group (P = .0001). Age, gender, marital status, and income were not significantly associated with ratings of general satisfaction. Furthermore, the implant group gave significantly higher ratings on three additional measures of the prostheses (comfort, stability, and ease of chewing; P < .05). CONCLUSION: A mandibular two-implant overdenture opposed by a maxillary conventional denture is a more satisfactory treatment than conventional dentures for edentulous middle-aged adults.

Does a prosthodontist spend more time providing mandibular two-implant overdentures than conventional dentures?

PURPOSE: In this article, the time taken by a prosthodontist to fabricate and maintain mandibular overdentures retained by two implants and conventional dentures is compared. MATERIALS AND METHODS: Sixty edentulous patients between the ages of 65 and 75 completed a randomized clinical trial. All received new maxillary conventional dentures and either a mandibular conventional denture (n = 30) or a two-implant overdenture on ball attachments (n = 30). The time spent by the prosthodontist and the number of visits required for treatment, including both scheduled and unscheduled visits, were recorded for each patient from preliminary impressions to 6 months following delivery. Data from the two groups were compared using Mann-Whitney U tests. RESULTS: The prosthodontist spent a mean total time of 296 minutes in treating an implant overdenture patient and 282 minutes on a conventional denture patient during the period from preliminary impressions to the 6-month follow-up. The mean numbers of appointments were 10.1 (implant group) and 10.8 (conventional group). These differences were not significant. CONCLUSION: Although additional knowledge is required to treat patients with implant prostheses, the time required by the prosthodontist to provide two-implant mandibular overdentures with ball attachments was not significantly different than the time needed for conventional denture treatment.