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.

The McGill Denture Satisfaction Questionnaire revisited: Exploratory factor analysis of a binational sample.

OBJECTIVES: To examine the McGill Denture Satisfaction Questionnaire (MDSQ) in terms of dimensionality, item reduction and construct validity in a binational sample of complete denture wearers. MATERIALS AND METHODS: We conducted secondary analyses of baseline data from two studies on implant-retained overdentures: a quasi-experimental study in the United States (n = 145) and a randomised trial in Brazil (n = 120). All participants wore upper/lower dentures and responded at baseline to the MDSQ items concerning their original mandibular dentures. A putative model of the MDSQ items resulted in two question subsets: (a) overall satisfaction, retention/stability, aesthetics, cleaning, speech and comfort, plus general chewing ability; (b) mastication of specific foods. Analyses focused on the internal consistency of each subset and possible item reduction, using Cronbach's alpha (Cα), inter-item correlation and exploratory factor analysis (EFA). RESULTS: The 1st subset showed high inter-item correlation for most question combinations and no redundancy (r ≤ .8). An item on cleaning had low correlation, but its removal does not increase internal consistency (Cα ≥ .83). Results were similar for both studies, with EFA showing a single significant factor (namely "overall satisfaction, lower denture") able to explain nearly 54% of the variance. The 2nd subset also shows strong internal consistency (Cα ≥ .95) and inter-item correlation, with a single factor representing 65% of the variation. CONCLUSIONS: This study discloses the reliability and construct validity of the MDSQ for patient-centred evaluation of complete dental prostheses in the edentulous mandible. Findings also support the use of both "overall satisfaction" and "masticatory ability" as summary scores, for improved outcome assessment.

Group 3 ITI Consensus Report: Patient-reported outcome measures associated with implant dentistry.

OBJECTIVES: The aim of Working Group 3 was to focus on three topics that were assessed using patient-reported outcome measures (PROMs). These topics included the following: (a) the aesthetics of tooth and implant-supported fixed dental prostheses focusing on partially edentulous patients, (b) a comparison of fixed and removable implant-retained prostheses for edentulous populations, and (c) immediate versus early/conventional loading of immediately placed implants in partially edentate patients. PROMs include ratings of satisfaction and oral health-related quality of life (QHRQoL), as well as other indicators, that is, pain, general health-related quality of life (e.g., SF-36). MATERIALS AND METHODS: The Consensus Conference Group 3 participants discussed the findings of the three systematic review manuscripts. Following comprehensive discussions, participants developed consensus statements and recommendations that were then discussed in larger plenary sessions. Following this, any necessary modifications were made and approved. RESULTS: Patients were very satisfied with the aesthetics of implant-supported fixed dental prostheses and the surrounding mucosa. Implant neck design, restorative material, or use of a provisional restoration did not influence patients' ratings. Edentulous patients highly rate both removable and fixed implant-supported prostheses. However, they rate their ability to maintain their oral hygiene significantly higher with the removable prosthesis. Both immediate provisionalization and conventional loading receive positive patient-reported outcomes. CONCLUSIONS: Patient-reported outcome measures should be gathered in every clinical study in which the outcomes of oral rehabilitation with dental implants are investigated. PROMs, such as patients' satisfaction and QHRQoL, should supplement other clinical parameters in our clinical definition of success.

Patient satisfaction with laser-sintered removable partial dentures: A crossover pilot clinical trial.

STATEMENT OF PROBLEM: Clinical data regarding newly introduced laser-sintered removable partial dentures (RPDs) are needed before this technique can be recommended. Currently, only a few clinical reports have been published, with no clinical studies. PURPOSE: This clinical trial compared short-term satisfaction in patients wearing RPDs fabricated with conventional or computer-aided design and computer-aided manufacturing (CAD-CAM) laser-sintering technology. MATERIAL AND METHODS: Twelve participants with partial edentulism were enrolled in this pilot crossover double-blinded clinical trial. Participants were randomly assigned to wear cast or CAD-CAM laser-sintered RPDs for alternate periods of 30 days. The outcome of interest was patient satisfaction as measured using the McGill Denture Satisfaction Instrument. Assessments was conducted at 1, 2, and 4 weeks. The participant's preference in regard to the type of prosthesis was assessed at the final evaluation. The linear mixed effects regression models for repeated measures were used to analyze the data, using the intention-to-treat principle. To assess the robustness of potential, incomplete adherence, sensitivity analyses were conducted. RESULTS: Statistically significant differences were found in patients' satisfaction between the 2 methods of RPD fabrication. Participants were significantly more satisfied with laser-sintered prostheses than cast prostheses in regard to general satisfaction, ability to speak, ability to clean, comfort, ability to masticate, masticatory efficiency, and oral condition (P<.05). At the end of the study, 5 participants preferred the laser-sintered, 1 preferred the cast RPD, and 3 had no preference. CONCLUSIONS: The use of CAD-CAM laser-sintering technology in the fabrication of removable partial dentures may lead to better outcomes in terms of patient satisfaction in the short term. The conclusion from this pilot study requires confirmation by a larger randomized controlled trial. CLINICAL TRIAL: ClinicalTrials.gov. A study about patient satisfaction with laser-sintered removable partial dentures; NCT02769715.

Clinical guidelines and procedures for provision of mandibular overdentures on 4 mini-dental implants.

This article describes the flapless placement of mini-dental implants (MDI) to retain mandibular overdentures. Clinical inclusion/exclusion criteria and clinical protocols for the flapless placement of MDIs and for retrofitting the overdenture are presented. A minimum bone height of 13 mm and a minimal flap are recommended. After drilling, the 4 implants are placed with a self-tapping process. A minimum of 15 Ncm of resistance upon final insertion indicates that immediate loading can be performed. The metal housings with O-rings are incorporated into the prosthesis using autopolymerizing resin. The technique and protocol for immediately loaded 4-mini-implant mandibular overdentures is minimally invasive and cost effective.

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.

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.

Anti-VEGFs hinder bone healing and implant osseointegration in rat tibiae.

AIM: To assess the effect of anti-vascular endothelial growth factors (VEGF) on bone healing (defect volume) and implant osseointegration (bone-implant contact per cent) in rat tibia. MATERIALS AND METHODS: In Sprague-Dawley rats (n = 36), a unicortical defect was created in the right tibia and a titanium implant was placed in the left tibia of each rat. Rats were assigned into three groups and received either anti-vascular endothelial growth factor neutralizing antibody, Ranibizumab or saline (control). Two weeks following surgery, rats were euthanized and bone samples were retrieved. Bone healing and osseointegration were assessed using micro-CT and histomorphometry. One-way anova followed by the Tukey's test was used for data analyses. RESULTS: The volume of the bone defects in the anti-VEGF group (2.48 ± 0.33 mm(3) ) was larger (p = 0.026) than in the controls (2.11 ± 0.36 mm(3) ) as measured by µ-CT. Bone-implant contact percent in the anti-VEGF (19.9 ± 9.4%) and Ranibizumab (21.7 ± 9.2%) groups were lower (p < 0.00) than in the control group (41.8 ± 12.4%). CONCLUSIONS: The results of this study suggest that drugs that inhibit the activity of vascular endothelial growth factor (i.e. anti-VEGF) may hinder bone healing and implant osseointegration in rat tibiae.

Patient perceptions of the mandibular three-implant overdenture: a practice-based study.

OBJECTIVES: Although three-implant overdentures have often been used in clinical practice, there are few studies to support this approach. Therefore, this study aimed to determine the magnitude of change in ratings of oral health-related quality of life and to assess patients' satisfaction ratings with mandibular three-implant overdentures. MATERIALS AND METHODS: This quasi-experimental study examined oral health-related quality of life and satisfaction with prosthesis in 135 edentate participants (mean age 61.6 ± 7.9 years) who received mandibular three-implant overdentures from 2006 to 2009 in a private practice in Quebec, Canada. Data were collected from individual's dental records and a follow-up survey. The Oral Health Impact Profile (OHIP-20) was used to assess oral health-related quality of life at baseline and at follow-up. Satisfaction with the mandibular prostheses and perception of rocking movements were measured by use of a denture satisfaction questionnaire at follow-up. Descriptive statistics, bivariate and multivariate statistical analyses were used to analyse the data. RESULTS: Individuals who received mandibular three-implant overdentures had statistically significant improvements in all seven domains of the OHIP-20 from pre- to post-treatment (total OHIP change score -25.1 P < 0.001). Pre-treatment OHIP scores and rotational movement explained 58% of the variance in the OHIP's change score (P ≤ 0.05). More than three quarters of the sample population (75.6%) were completely satisfied with their three-implant overdentures, and 81.5% reported having no rocking movement. General satisfaction with the prostheses was not influenced by gender, type of fixture, or type of attachment. CONCLUSIONS: The treatment of edentulism by three-implant overdentures has favourable patient-based outcomes, with negligible perceptions of rotational movement. However, further research is needed to compare the efficacy of this alternative to other treatment modalities, such as the two-implant overdenture.

Implant-assisted complete prostheses.

The current review was undertaken to obtain a better understanding of the knowledge base of implant-assisted complete dental prostheses (fixed and removable) in the treatment of the completely edentulous maxilla or mandible. Indications, advantages and disadvantages, complications and maintenance issues, as well as the cost-effectiveness of both treatments, are discussed to help clinicians in their therapeutic decision-making. In summary, when indicated and depending on the patients' needs, both removable and fixed implant-assisted prostheses are highly safe, reliable and satisfactory treatment modalities for the rehabilitation of edentulous jaws. Careful and precise treatment planning is highly recommended to assist the clinician in preventing potential prosthetic failures. The review also reveals that there is still a need for data, generated using robust research methods, on some patient-based and clinical outcomes.

The effect of mandibular 2-implant overdentures on oral health-related quality of life: an international multicentre study.

OBJECTIVES: To determine the difference in oral health-related quality of life (OHRQoL) in patients who received mandibular 2-implant overdentures and conventional dentures in a pragmatic international study. MATERIALS AND METHODS: In this prospective study, data were gathered from 203 edentulous patients (mean age, 68.8; SD: 10.4 years) at eight centres in North America, South America and Europe. The patients were provided with new mandibular conventional dentures or implant overdentures supported by 2 implants and ball attachments and opposed by conventional dentures. At baseline and at 6 months post-treatment, patients rated their oral health-related quality of life using the OHIP-20. RESULTS: A significantly higher proportion of the participants in the implant group in North America reported improvement in both the psychological and the handicap domains, compared to those who received conventional dentures (93% vs. 52%; P < 0.05). In South America, 100% of participants who received implant overdentures reported improvement in physical pain, compared to 66% in the conventional group (P < 0.05). Differences in mean change scores among those who expressed improvement were not significantly different between sites or treatments. CONCLUSION: Mandibular 2-implant overdentures are more likely than conventional dentures to improve OHRQL for edentulous patients. Cultural differences were also observed in the impact of implant overdentures on the different domains of the OHIP-20.

3D printing vs traditional workflow for the fabrication of mandibular implant overdentures: study protocol for a mixed-methods cross-over RCT.

BACKGROUND: Complete tooth loss is a significant global oral health issue, particularly impacting older individuals with lower socioeconomic status. Computer-assisted technologies enhance oral healthcare access by the elderly. Despite promising in vitro reports on digital denture materials, evidence from randomized clinical trials (RCTs) is lacking to verify their performance. This cross-over RCT will investigate whether 3D-printed implant-retained mandibular overdentures (IMO) are more satisfactory for edentulous seniors than those made through traditional methods. METHODS/DESIGN: We will recruit 26 completely edentulous participants (any sex/gender) based on the following eligibility criteria: age ≥ 60 years, no tooth extraction in the past 12 months, two implants in the lower jaw, and need for new dentures in both jaws. Each participant will receive two denture pairs, either manufactured by 3D printing or traditionally, to be worn in a random order. A timeline of 3 months with each denture pair will be considered for outcome assessment (total: 6 months). Patient satisfaction with dentures will be measured by the McGill Denture Satisfaction Questionnaire. We will evaluate other patient-reported outcomes (including oral health-related quality of life) as well as clinician-assessed quality and cost. At the end of the trial, participants will choose which denture pair they wish to keep and interviewed about their experiences with the 3D-printed IMO. The quantitative and qualitative data will be incorporated through an explanatory mixed-methods strategy. A final quantitative assessment will happen after 12 months with the preferred IMO to assess the long-term performance and maintenance needs. DISCUSSION: This mixed-methods RCT will explore patient experiences with 3D-printed IMOs, aiming to assess the potential for altering clinical practice and dental public health policies. Our results will inform policies by showing whether 3D printing offers comparable outcomes at lower costs, facilitating greater access to oral care for the elderly. TRIAL REGISTRATION: ClinicalTrials.gov, NCT06155630, Registered on 04 December 2023. https://classic. CLINICALTRIALS: gov/ct2/show/NCT06155630.

A critical review of diabetes, glycemic control, and dental implant therapy.

OBJECTIVES: To systematically examine the evidence guiding the use of implant therapy relative to glycemic control for patients with diabetes and to consider the potential for both implant therapy to support diabetes management and hyperglycemia to compromise implant integration. MATERIAL AND METHODS: A systematic approach was used to identify and review clinical investigations directly assessing implant survival or failure for patients with diabetes. A MEDLINE (PubMED) database search identified potential articles for inclusion using the search strategy: (dental implants OR oral implants) AND (diabetes OR diabetic). Inclusion in this review required longitudinal assessments including at least 10 patients, with included articles assessed relative to documentation of glycemic status for patients. RESULTS: Although the initial search identified 129 publications, this was reduced to 16, for inclusion. Reported implant failure rates for diabetic patients ranged from 0% to 14.3%. The identification and reporting of glycemic control was insufficient or lacking in 13 of the 16 studies with 11 of these enrolling only patients deemed as having acceptable glycemic control, limiting interpretation of findings relative to glycemic control. Three of the 16 studies having interpretable information on glycemic control failed to demonstrate a significant relationship between glycemic control and implant failure, with failure rates ranging from 0% to 2.9%. CONCLUSIONS: Clinical evidence is lacking for the association of glycemic control with implant failure while support is emerging for implant therapy in diabetes patients with appropriate accommodations for delays in implant integration based on glycemic control. The role for implants to improve oral function in diabetes management and the effects of hyperglycemia on implant integration remain to be determined.

Patient-reported outcomes and clinical performance of CAD/CAM removable dentures: A scoping review.

PURPOSE: This scoping review mapped the literature on CAD/CAM (computer-aided design and manufacturing) removable complete and partial dentures regarding patient and clinician-reported outcomes. MATERIALS AND METHODS: We performed an electronic search of the Cochrane Central Register of controlled trials (CENTRAL), MEDLINE (Ovid), EMBASE, SCOPUS, and Web of Science databases (last update: March 2023). All clinical trials or observational studies investigating CAD/CAM removable dentures (conventional or implant-retained) were included. RESULTS: The search yielded 4035 records and led to 58 included studies. Results suggest that CAD/CAM complete and partial dentures, when compared to the conventional ones, can save time and resources while being rated either non-inferior or superior by patients and clinicians in most studies. However, consensus on which workflow offers fewer adjustments and postoperative sessions is still pending. CONCLUSION: The literature suggests that CAD/CAM complete and partial dentures can combine substantial time and cost savings with patient and clinician experiences at least comparable to the conventional prostheses. Given the low evidence level of existing studies, future well-designed randomized trials with large sample size are required to confirm those advantages.

Can patients detect peri­implant mucosal inflammation? Results from a multicentre randomized trial.

PURPOSE: The objective of this study was to compare patient-reported outcomes (PROs) of peri­implant soft tissue inflammation and aesthetics around single-tooth implants in the anterior maxillary region with three different implant-abutment interface designs. METHODS: Participants were randomized to one of three different types of implant-abutment interface designs [Conical (CI), flat-to-flat (FI), and Platform Switched (PS)]. Implants and provisional crowns with prefabricated titanium abutments were placed 5 months following extraction and/or ridge augmentation. Permanent ceramic crowns with zirconia abutments were placed after 12 weeks. To assess PROs, appearance and inflammation questionnaires were completed from provisional crown placement to the 3-year follow-up. RESULTS: Tooth appearance at the 3-year follow-up revealed a difference amongst CI, FI and PS implants (p=0.049; Kruskal-Wallis test). PS was rated better than FI (p=0.047) at 1 year for appearance of soft-tissue and satisfaction with colour. There were no differences for self-consciousness, smile and pain/discomfort while eating/hard food items. CONCLUSIONS: Although participants tended to rate the health of mucosa around PS implants as slighty better than the other two implant systems, the differences were minimal and inconsistent. Thus, patient satisfaction in terms self-perceived gingival health and esthetics was high for all 3 systems tested, suggesting that patients are unable to detect mucosal inflammation. CLINICAL SIGNIFICANCE: Patients find it difficult to perceive mucosal inflammation; hence, it is recommended that patients attend implant follow-up visits, even if they do not perceive inflammation. The study suggests that there is a relationship between the PROs and the clinical outcomes of tested implants.

How successful are small-diameter implants? A literature review.

BACKGROUND: Edentulism is an important issue and will remain so due to high numbers of edentate individuals worldwide. For many years, complete dentures have been the only treatment option for this population. Implant overdentures have been shown to have many advantages over conventional complete dentures. However, although dissatisfied with their mandibular dentures, some edentate elders are reluctant to undergo even simple implant treatment due to factors such as cost and fear of surgery. To address these obstacles, this paper reports on a review of small-diameter implant (SDI) studies that were performed in the last two decades. The aim of this study is to (i) determine the survival of narrow diameter implants, (ii) determine whether survival is dependent on whether these implants are placed using a flap or flapless approach, and (ii) determine whether there is a relationship between length and implant survival in SDIs. METHODS: In this review, studies were included that (i) involve implants with 3.5 mm diameter or less, (ii) have a randomized clinical trial, retrospective or prospective cohort design with human subjects, (iii) provide a follow up duration of at least 5 months following implant placement, (iv) include data on the survival rate of the implants. RESULTS: Forty one studies meeting the above criteria were published between 1993 and 2011 using SDIs from a variety of companies and surface characteristics with diameters of 1.8 mm to 3.5 mm and lengths of 8 mm to 18 mm. A total of 10,093 SDIs were inserted in approximately 2762 patients. Twenty-six studies involved flap reflection techniques for implant placement, six studies used a flapless technique and two studies used both techniques; in the remaining studies, the technique was not specified. Follow up duration varied from 5 months to over 9 years. The survival rate reported in all screened studies was over 90%, including eight studies in which a 100% survival rate was reported. In 22 studies, the reported survival rate ranged from 95% to 99.9%. Failure was reported most often in short SDIs (less than or equal 13 mm) (n = 88) compared to longer ones (more than 13 mm). CONCLUSION: Survival rates reported for SDI are similar to those reported for standard width implants. These survival rates did not appear to differ between studies that used flapless and flap reflection techniques. The failure rate appeared to be higher in shorter SDIs than in longer ones in the studies in which the length of the failed implants was reported. SDIs could be considered for use with fixed restorations and mandibular overdentures, since their success rate appears to be comparable to that of regular diameter implants. They might also be an efficient, low-cost solution for elders who wish to reduce problems with denture instability.

Wear of matrix overdenture attachments after one to eight years of clinical use.

STATEMENT OF PROBLEM: Matrices of unsplinted attachment systems are generally reported to be the weak component of implant overdentures, often requiring frequent maintenance. Clinical wear results in reduced retention of the prosthesis, requiring activation or renewal of the matrix to restore the initial level of retention. PURPOSE: The purpose of this retrospective study was to measure the wear of the matrix of a ball attachment after various periods of clinical wear. MATERIAL AND METHODS: Seventy specimens of 3 groups of matrices of ball attachments that had been in use for mean periods of 12.3 months (1Y group, n=26), 39.0 months (3Y group, n=28) and 95.6 months (8Y group, n=16) were retrieved from 35 patients (2 specimens per patient) and measured on a coordinate measuring machine equipped with a touch trigger probe. Ten unused matrices were used as controls (CTRL group). The external and internal matrix diameters and deviations from circularity were measured. For the various time periods, the decreases in matrix thickness were calculated and compared with controls. Kruskal-Wallis 1-way ANOVA by ranks, followed by the Mann-Whitney post hoc tests, were conducted to test for differences in median values among groups (α =.05). RESULTS: For the internal upper diameter of the matrices tested, the Kruskal-Wallis and Mann-Whitney tests revealed significant differences for the 3 groups compared to the controls. For group 1Y, a significant difference (P<.001) of the internal upper diameter was found compared to the CTRL group. Compared to the controls, the nonparametric analyses for groups 3Y and 8Y showed significant differences for the internal upper diameter (P<.001) and deviations from circularity (P<.001). For groups 1Y, 3Y and 8Y, matrix thickness losses were 07, 47 and 70 µm, respectively. CONCLUSIONS: Within the limitations of this study, it was observed that one year of clinical wear had limited effect on the ball attachment matrices. Three to 8 years of clinical use resulted in a significant decrease of matrix thickness, especially at the tip of the retentive lamellae.

Oral health in America 2021: Making a case for curricular change.

BACKGROUND: The NIH Oral Health in America: Advances and Challenges report is the most recent evidence-based review of the status of oral health in North America since Oral Health in America: A Report of the Surgeon General, which was published in 2000. This article aims to synthesize and discuss information from the report pertinent to improving dental education to positively impact oral health. Calls for action and suggestions for implementation are presented. METHODS: The authors reviewed each section from the report and identified key messages relevant to dental education. These were then combined into a framework based on the NIH report's three main "call to action" items. A matrix for calls to action and implementation recommendations was developed using the findings from the 2021 NIH report and a previous 2018 report on Advancing Dental Education in the 21st Century. CONCLUSION: The information discussed in the report related to dental education has the potential to improve oral health, and educators, schools, professional organizations, state, and federal agencies are called to develop and/or implement action plans focused on curriculum, competencies, workshops, guidelines, and policies based on the summary framework presented in this study.

The impact of implant-retained overdentures on type-2 diabetic and non-diabetic edentulous patients: Satisfaction and quality of life in a prospective cohort study.

OBJECTIVES: To evaluate the benefits of implant therapy for patients with diabetes, we compared (i) healthy, (ii) well controlled T2DM and (iii) poorly controlled T2DM patients, in terms of oral health-related quality of life (OHRQoL) and satisfaction with mandibular 2-implant overdentures over 12 months following restoration. MATERIALS AND METHODS: This single-center, prospective, cohort study recruited 165 edentulous adults (HbA1c<12%) to receive two endosseous implants in the anterior mandible to support mandibular overdentures. Participants were enrolled as having T2DM or not, with T2DM participants divided according to HbA1c into well-controlled (<8.1%) and poorly controlled (≥ 8.1%) groups. Participants provided responses to the OHIP-20 (OHRQoL) and the McGill Denture Satisfaction Questionnaire, before implant therapy and 6 and 12 months after overdenture insertion using Locator attachments. HbA1c was measured at the same time points. The effect of groups and time was verified using generalized estimating equations (α=0.025). RESULTS: At 12 months, 137 participants provided responses. The two diabetes groups showed improvements in OHRQoL to the same extent as the non-diabetic control group at both 6 and 12 months. Patient satisfaction showed similar improvements with no between-group differences and similar increases identified at 6 and 12 months. HbA1c was not affected by time or groups. CONCLUSIONS: Dental implant therapy provided significant improvements in patient-perceived benefits of mandibular two-implant overdentures for T2DM individuals, which are similar to those found for healthy edentulous individuals. Importantly, those benefits extend to those individuals with poorly controlled glycaemia. The addition of 2-implant supported mandibular overdentures did not affect glycaemic status over 12 months following insertion. CLINICAL SIGNIFICANCE: As risks for implant therapy relative to glycaemic status are better understood, this study documents that implant therapy may offer important benefits in QoL for T2DM patients independent of glycaemic status.

Clinical wear of overdenture ball attachments after 1, 3 and 8 years.

OBJECTIVES: Implant-supported overdentures have become the treatment of choice in restoring complete edentulism, but the types of attachment to assure durable retention are a subject of debate. Ball attachments were reported as a simple treatment, but wear of components was responsible for a decrease in retention. The aim of this retrospective study was to measure the wear of the ball abutment or patrix after three different periods of clinical wear. MATERIAL AND METHODS: Sixty-nine specimens of three groups of patrix that were in use for a mean of 12.3 months (group A), 39 months (group B) and 95.6 months (group C) were retrieved from 35 patients and measured on a coordinate measuring machine equipped with a touch trigger probe. Ten unused ball abutments were added as a control (group D). The patrix diameters and any deviation from circularity in different axes were measured. RESULTS: The diameters of groups A, B and C were significantly different from that of group D (control). No statistically significant differences were found between diameter and circularity variations between groups B and C. The maximal amount of diameter reduction was limited to approximately 30 µm, and 90% of diameter loss at the equator due to wear was reached in group B. CONCLUSION: One, 3 and 8 years of clinical wear reduced significantly the diameters of the ball abutments tested, and the maximal amount of wear was reached after 3 years of clinical use.