Should our older, edentulous patients live with their teeth sitting in a glass of water?

Over 20 years ago, the McGill consensus statement stated that a mandibular two-implant overdenture should be the first choice of care for our edentulous patients. We have around three million edentulous patients in England and Wales currently, many over the age of 60, and many of whom are not able to wear a satisfactory set of complete dentures, let alone able to eat a normal diet. In 2009, the York consensus statement produced by the British Society of Prosthodontics concluded that "a substantial body of evidence is now available demonstrating that patients' satisfaction and quality of life with implant-supported overdentures in the mandible is significantly greater than conventional dentures". So, why has the NHS ignored these important scientific papers and left our older population in a state of dental neglect? This discussion paper will consider some of the facts and suggest that there may, potentially, be some solutions.

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.

Micromechanical versus chemical bonding between CoCr alloys and methacrylate resins.

INTRODUCTION: As adhesive systems for bonding to metals have developed in dentistry, considerable importance is attached to the preparation of the metal alloy for both mechanical and chemical bonding. Different grit sizes when sandblasting Cobalt Chromium (CoCr) will provide a different three-dimensional surface for bonding. Previous reports have shown that 4-Methacryloyloxyethyl trimellitic anhydride (4-Meta) resins offer high bond strengths to CoCr alloy, with various surface preparations providing varying bond strengths. The relevance of this to bond strength was assessed. OBJECTIVES: The aim of the study was to evaluate the importance of grit size of alumina in the preparation of CoCr alloy and to determine the effect on the tensile bond strength of four different acrylic resins to the CoCr alloy. METHODS: Ten specimens were prepared within each group of four resins. Four grit sizes were assessed, 50, 110, 250 microm, and a range from 180 to 330 microm. The specimens were tested both within one day of production after storing at 37 degrees C in phosphate-buffered saline for seven days and after thermocycling. RESULTS: Grit size resulted in a change in average contact surface area available for bonding. A significant difference (p < 0.01) existed in bond strengths between each of the materials, but no significant difference (p = 0.0673) was determined when different grit sizes were included. SIGNIFICANCE: It was concluded that grit size determined the available contact surface area of CoCr alloy for bonding but did not determine the bond strength that could be achieved between acrylic resins and CoCr alloy as a result of the poor adaptation of the resin to the complex surface topography.

The influence of interimplant distance and attachment type on the retention characteristics of mandibular overdentures on 2 implants: 6-month fatigue retention values.

This in vitro study evaluated the 6-month fatigue retention provided by 5 paired overdenture attachments placed at 3 different interimplant distances (19, 23, and 29 mm). Mean fatigue retention was calculated for each attachment type and compared with the retention produced by the other attachments tested and the initial retention values published earlier. Interimplant distance was found to play a significant role only in the retention of the Hader bar with red and yellow clips. A significant reduction in retention values was observed for 4 of 5 attachment types.

The influence of interimplant distance and attachment type on the retention characteristics of mandibular overdentures on 2 implants: initial retention values.

PURPOSE: This in vitro study aimed to investigate the influence of (1) the interimplant distance and (2) the type of attachment on the retention of mandibular overdentures on 2 implants. MATERIALS AND METHODS: Three stone casts were fabricated, each with 2 implant analogues embedded at distances of 19, 23, and 29 mm apart. Three different interchangeable mandibular overdenture attachments were secured onto the analogues: Hader bars, ball abutments, and stainless steel keepers for new generation neodymium-iron-boron magnets. In total, 45 groups of paired attachments were tested for initial vertical peak tensile load at the 3 interimplant distances. RESULTS: Interimplant (interclip) distance played a significant role only in the retention produced by the Hader bar/red clip configuration. At 19 and 23 mm, the ball/socket attachments were statistically more retentive than the yellow clips, white clips, and magnets, but not compared to the red clips. At 29 mm, the ball abutments showed statistical superiority compared with all other attachments. Mean clinical intercanine distance for conventional full dentures was 22.88 mm. CONCLUSION: Interimplant distance can affect the initial retention of mandibular overdentures on 2 implants depending on the type of attachment used. For a predetermined interimplant distance, attachment performance varies greatly.