Reliability and validity of a questionnaire for self-assessment of complete dentures.

BACKGROUND: Demand for complete denture treatment is expected to rise over several decades. However, to date, no questionnaire on complete dentures, as evaluated by edentulous patients, has been shown to be reliable and valid. This study sought to assess the reliability and validity of Patient's Denture Assessment (PDA), which provides a multidimensional evaluation of dentures among edentulous patients. METHODS: Patients, who had new complete dentures fabricated at the University Hospital of Dentistry, Tokyo Medical and Dental University through 2009 to 2010, were enrolled. The reliability of the PDA was determined by examining internal consistency and test-retest reliability. Internal consistency for all of the question items and the six subscales was measured using Cronbach's α and average inter-item correlation coefficients among 93 participants. For 33 of these participants, test-retest reliability was determined at a 2 month-interval using the interclass correlation coefficients (ICCs) and 95% confidence interval for the summary scores and the six subscale scores. The PDA was validated in 93 participants by examining the difference in the summary score and the six subscale scores of the PDA before and after replacement with new dentures by the paired t-test. Ability to detect change was also tested in 93 patients using effect size. RESULTS: The Cronbach's α for the PDA ranged from 0.56 to 0.93. The average inter-item correlation coefficients ranged from 0.28 to 0.83. ICCs for the PDA ranged from 0.37 to 0.83. The paired t-test showed a significant difference between the summary score and the six subscale scores before and after replacement with new dentures (p < 0.05) and the effect size was 0.97. CONCLUSIONS: The PDA demonstrated good reliability by assessing internal consistency and test-retest reliability. In addition, the PDA demonstrated good validity by assessing discriminant validity. Thus, the PDA could help dentists obtain a detailed understanding of the patients' perceptions in using their dentures.

Selection patterns of dietary foods in edentulous participants rehabilitated with maxillary complete dentures opposed by mandibular implant-supported prostheses: a multicenter longitudinal assessment.

STATEMENT OF PROBLEM: Documentation of long-term changes in food intake is lacking for those treated with a maxillary complete denture opposed by a mandibular, screw-retained, implant-supported fixed prosthesis. PURPOSE: The purpose of this study was to evaluate the selection patterns of dietary foods over 5 years for edentulous participants treated in a multicenter prospective clinical trial that compared cast alloy versus laser-welded titanium frameworks of an implant-supported prostheses opposed by maxillary complete dentures to rehabilitate edentulous participants. MATERIAL AND METHODS: The study assessed data from a multicenter prospective clinical trial that followed edentulous participants from an initial baseline of wearing existing complete dentures to implant placement, restoration with a mandibular implant-supported prosthesis opposed by a maxillary complete denture, to follow-up assessment of these treatments over 5 years. The 32 participants in the cohort were treated at 5 of 9 participating centers. The data collected included 2 dietary forms, a standardized 4-day food diary form, and a dietary habits questionnaire. Each participant completed forms before entering into treatment (control) and at the 1- and 5-year follow-up assessment after being treated with a maxillary complete denture opposing a mandibular complete-arch fixed implant-supported prosthesis. Descriptive statistics were calculated for each measure at each assessment point. Regression analysis and the Sign test were used to calculate change in the participants' nutritional status (α=.05). RESULTS: Among the findings, it was noted that difficulty in masticating hard, raw, and fibrous foods decreased and intake of vegetable portions increased significantly from 2.5 to 3.3 servings. Participant comfort in eating in public places and their enjoyment of eating were significantly improved from 50% of participants being uncomfortable with their prior complete denture treatment to only 4% after 5 years. CONCLUSIONS: Within the limitations of this study, it was concluded that vegetable intake and ability to masticate raw, hard, and fibrous food for these participants improved when they received a mandibular implant-supported prosthesis opposed by a maxillary complete denture. According to the analysis and findings, the overall eating experience was more pleasurable, and eating in public was more comfortable after replacement of complete dentures with a mandibular implant-supported prosthesis.

Association between self-assessment of complete dentures and oral health-related quality of life.

The purpose of this study was to determine which factors related to patient self-assessment of dentures are associated with changes in oral health-related quality of life (OHRQoL) among edentulous patients after replacement of complete dentures, and to determine whether masticatory performance as determined using an objective method affects the changes in OHRQoL among edentulous patients. As a preliminary study, the existing questionnaire regarding self-assessment of dentures consisting of 39 question items, measured with a 100-mm visual analogue scale, was analysed by factor analysis. Then a questionnaire, composed of 22 question items, was developed containing six subscales of 'function', 'lower denture', 'upper denture', 'expectation', 'aesthetic and speech' and 'importance'. Final participants in the present study comprised 93 edentulous patients requiring new conventional complete dentures (44 men, 49 women; mean age, 75·0 years). These patients were asked to complete the Japanese version of the Oral Health Impact Profile (OHIP)-EDENT, comprising 19 question items for assessment of OHRQoL in edentulous patients, along with the developed questionnaire regarding self-assessment of dentures. Moreover, masticatory performance was measured using a colour-changeable chewing gum. The questionnaire and measurement were completed twice; before and after replacement of complete dentures. Stepwise multiple regression analysis identified 'lower denture' and 'aesthetic and speech' as significant independent variables besides OHIP-EDENT scores before replacement. These results suggest that sufficient retention of lower dentures and appropriate appearance may lead to improved OHRQoL in edentulous patients.

A prospective study on immediate loading of implants with mandibular overdentures: patient-mediated and economic outcomes.

PURPOSE: The aims of this report are to present the patient-based outcomes and associated clinical costs of an immediate loading protocol for mandibular overdentures in edentulous patients. MATERIALS AND METHODS: Two groups of patients were selected. Thirty-five consecutively treated patients received an immediate protocol, while 42 patients treated with a conventional protocol served as a historical control. Patient-based concerns for patients in the immediate group were measured at various stages of treatment with 2 questionnaires: the Denture Satisfaction Scale and the Oral Health Impact Profile. Direct clinical and time costs over a 1-year period were estimated and deflated to 2002 Canadian dollars. Salary rates by occupation, age, and gender were used to evaluate the patients' time costs. Treatment costs were compared between the 2 groups. Additionally, incremental cost-effectiveness ratios for various stages with the immediate protocol were calculated. RESULTS: Significant improvements posttreatment were observed with both the Denture Satisfaction Scale (Wilcoxon signed rank test, P < .05) and the Oral Health Impact Profile (Friedman test, P < .05). The immediate protocol was associated with higher maintenance costs, with resultant higher total costs (Mann-Whitney U test, P < .05). No difference was observed in the time costs associated with the 2 protocols. Within-group analysis of costs at various stages of the immediate protocol suggested that treatment with implant-supported overdentures was more cost-effective than treatment with conventional dentures. CONCLUSIONS: This study suggests that implants in 1 jawbone lead to a substantial improvement in perceived oral health status. Furthermore, the immediate loading protocol was not cheaper than a conventional protocol.

Cost-effectiveness of mandibular two-implant overdentures and conventional dentures in the edentulous elderly.

Implementation of new therapies is usually governed by financial considerations, so efficacy studies should also include cost comparisons. The cost and effectiveness of mandibular conventional dentures (CD, n = 30) and two-implant overdentures (IOD, n = 30) were compared in elderly subjects. Effectiveness (Oral Health Impact Profile, OHIP-20) and cost were measured up to one year post-treatment. Data for subsequent years were estimated by the Delphi method. Using an average life expectancy of 17.9 years, the equalized annual costs (in Canadian dollars) were dollar 399 for CD and dollar 625 for IOD (p < 0.001), and the equalized annual values for the outcome (OHIP-20) were 47.0 for CD and 31.3 for IOD treatment (p < 0.05). These values translate into a yearly additional cost for IOD treatment of dollar 14.41 per OHIP-20 point. These results are key to the implementation of programs to provide this form of therapy for edentulous adults.

Outcome assessment of implant-supported prostheses.

STATEMENT OF PROBLEM: From the dental professional's standpoint, implant rehabilitation offers dramatically improved treatment alternatives to orally disabled patients. However, what a patient perceives as important to their function and satisfaction with their prostheses may be quite different from what the dentist believes are significant health-related improvements. PURPOSE: To resolve this problem, a series of investigations were designed to measure satisfaction and performance in groups of patients who wore various types of prostheses supported by endosseous titanium implants. MATERIAL AND METHODS: Methods are described for assessing treatment efficacy and population needs, including measures of perceived levels of disability, health-related quality of life, and functional capacity. RESULTS: The findings highlight patient factors that have not been considered before and appear to contribute to the success of prosthetic rehabilitation for the edentulous patient. CONCLUSION: Patient-centered approaches to the assessment of treatment efficacy are highly relevant to today's prosthodontists, whose goals are the improvement of function and quality of life for their patients.