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.

Paying for treatments? Influences on negotiating clinical need and decision-making for dental implant treatment.

BACKGROUND: The aim of this study is to examine how clinicians and patients negotiate clinical need and treatment decisions within a context of finite resources. Dental implant treatment is an effective treatment for missing teeth, but is only available via the NHS in some specific clinical circumstances. The majority of people who receive this treatment therefore pay privately, often at substantial cost to themselves. People are used to paying towards dental treatment costs. However, dental implant treatment is much more expensive than existing treatments--such as removable dentures. We know very little about how dentists make decisions about whether to offer such treatments, or what patients consider when deciding whether or not to pay for them. METHODS/DESIGN: Mixed methods will be employed to provide insight and understanding into how clinical need is determined, and what influences people's decision making processes when deciding whether or not to pursue a dental implant treatment. Phase 1 will use a structured scoping questionnaire with all the General dental practitioners (GDPs) in three Primary Care Trust areas (n = 300) to provide base-line data about existing practice in relation to dental implant treatment, and to provide data to develop a systematic sampling procedure for Phase 2. Phases 2 (GDPs) and 3 (patients) use qualitative focused one to one interviews with a sample of these practitioners (up to 30) and their patients (up to 60) to examine their views and experiences of decision making in relation to dental implant treatment. Purposive sampling for phases 2 and 3 will be carried out to ensure participants represent a range of socio-economic circumstances, and choices made. DISCUSSION: Most dental implant treatment is conducted in primary care. Very little information was available prior to this study about the quantity and type of treatment carried out privately. It became apparent during phase 2 that ISOD treatment was an unusual treatment in primary care. We thus extended our sample criteria for Phase 3 to include people who had had other implant supported restorations, although not single tooth replacements.

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.

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.

The impact of falling rates of edentulism.

PURPOSE: The aim of this study was to investigate the impact of both population age changes and falling edentulism rate on the denture market in three European countries. MATERIALS AND METHODS: Detailed information on the rate of edentulism for only three European countries (Finland, Sweden, and the UK) was available. For the UK and Sweden, published predicted rates of edentulism for the future decades were used, whereas predictions for Finland were computed using published edentulism rates. Edentulousness in one jaw was also predicted and included in the computation. Demographic projections were taken from government agency websites. RESULTS: The denture market will decrease in the three countries. Sweden, where edentulism is already low, will experience the largest percentage decrease (60%) over 20 years, but, in absolute number, the change will be of smaller magnitude than that in the UK and Finland. The range of projections for Finland was large, reflecting the difficulty of predicting trends with incomplete information. Within the limitations of this study's design, the impact of population age changes will not increase the denture market in Europe, even with the most pessimistic projections for edentulism rate. CONCLUSION: The complete denture market in Europe will fall despite changing age demographics. The falling rates are large enough to markedly affect future patterns of treatment provision and training.