Comparison of retention of monolithic zirconia crowns with alumina airborne-particle abraded and nonabraded intaglio using three different cements: A clinical simulation.

STATEMENT OF PROBLEM: The necessity of roughening the intaglio surface of zirconia crowns to achieve adequate retention is unclear. PURPOSE: The purpose of this clinical simulation study was to evaluate the retention of airborne-particle-abraded and nonabraded monolithic zirconia crowns using 3 different cement types. MATERIAL AND METHODS: Extracted human molars were used and prepared with a 10-degree taper. Impressions were made of the prepared teeth with a polyvinyl siloxane (PVS) material, and dies were made with Type 4 gypsum. Each die was scanned with a NobelProcera 1G Scanner, and the standard tessellation language (STL) files were transferred electronically to the Nobel Biocare production site, where a bar was added virtually on top of each crown and parameters were set for milling. Seventy-two Procera zirconia crowns were generated, of which half were airborne-particle abraded on the intaglio surface with 50-µm alumina particles at 400 to 500 kPa for 15 seconds. The other 36 received no intaglio treatment other than cleaning. Both groups of 36 crowns were divided into 3 subgroups of 12 specimens. The area of each preparation was calculated using a computer-aided design software program. The specimens were distributed to attain similar mean surface areas among the cementation groups. The crowns were cemented onto the specimen with a controlled force of 196 N. The 3 cements used were self-adhesive, modified resin RelyX Unicem Aplicap, resin-modified glass ionomer RelyX Luting, and a composite resin, Panavia F2.0 with ED Primer A & B. All specimens were thermocycled (5 °C to 55 °C) for 5000 cycles and then removed axially with a universal testing machine (Instron Model 5585H) at a crosshead speed of 0.5 mm/min. The removal force was recorded, and stress of dislodgement was calculated for each crown. A 2-way analysis of variance was used for statistical analyses. The type of failure was analyzed with the chi-squared test of association for independent samples (α=.05 for all tests). RESULTS: The mean dislodging force for crowns with airborne-particle abraded intaglio was 5.4 MPa, which was statistically greater than the mean of 3.2 MPa for nonabraded specimens (P<.001). No significant differences related to the dislodging stresses were detected among the 3 cements (P=.109). The mode of failure was similar whether abraded or not, with 50% of specimens retaining cement in the crown after separation. CONCLUSIONS: Alumina airborne-particle abrasion of the intaglio of zirconia to create surface roughness is beneficial in retaining the crowns, regardless of the cement type. The nonabraded crowns demonstrated significantly lower retentive stress with crown removal. The principal mode of failure was similar whether the zirconia intaglio was airborne-particle abraded or not. The most common mode of failure (>50% of specimens) was at least three-fourths of the cement remaining within the crown.

An International Survey among Prosthodontists of the Use of Mandibular Implant-Supported Dental Prostheses.

PURPOSE: To evaluate the use of implant-supported overdentures (IOD) and implant-supported fixed dental prostheses (IFDP) in patients with edentulous mandibles among international prosthodontists. MATERIALS AND METHODS: A questionnaire was sent by e-mail to all clinically active prosthodontists in the International College of Prosthodontists with questions related to implant treatment of the edentulous mandible performed in 2015. RESULTS: One hundred and sixteen prosthodontists from 33 countries responded to the questionnaire. The vast majority of the responding prosthodontists was faculty or worked in private practice, and the great majority had performed treatment with mandibular implant-supported dental prostheses; however, two thirds of the respondents reported that <20% of the implant patients in their clinic had received treatment related to edentulous mandibles. The majority reported using 2 implants (84%), while 13% used 4 for overdenture retention. There were great variations regarding retention systems used for mandibular IODs; the most common was individual Locator attachments. Cost was considered the most common reason to choose mandibular IOD, There was a wide variation of materials used for mandibular IFDPs. The most common combination included milled titanium frameworks and acrylic resin teeth. CONCLUSIONS: This survey, completed by 116 prosthodontists from 33 countries, showed that implant treatment for edentulous mandibles is common, but there was great variation among the respondents regarding amount of treatments performed, design, and materials used for the implant prostheses.

Use of implant-supported prostheses in edentulous mandibles among prosthodontists in Sweden.

The aim of this study was to investigate the production of mandibular implant-supported fixed and removable prostheses among prosthodontic specialists in Sweden and to compare the results with findings in a similar study made in 2001 (17). Questionnaires regarding treatment with mandibular implant prostheses during 20011 were mailed to all specialists in prosthodontics in Sweden (n = 156, according to available data). Of the 156 questionnaires, 129 (83%) were returned and of those 114 were completed. The reported number of treatments with mandibular implant-supported prostheses varied much among the specialists. Fixed implant prostheses were more common than overdentures (means 11 and 3, median values 8 and 2, respectively). However, the range was large for both alternatives. Ten (9%) of the specialists reported no treatment with fixed implant prostheses while 29 (25%) had not made any implant overdenture during 2011. The most common anchorage system for overdentures in 2011 (as well as in 2001) was two un-splinted implants with ball attachments or Locator abutments. The most common reasons for choosing overdenture treatment instead of a fixed implant prosthesis in 2011 were the reduced cost and the patient's main wish to improve denture retention. A majority of the prosthodontists (58%) reported that patients with implant overdentures were as satisfied as those with fixed implant-supported prostheses, whereas 40% claimed they were less satisfied. Two respondents (2%) considered that overdenture patients were more satisfied than those with a fixed prosthesis. It can be concluded that the general attitude among Swedish prosthodontists towards implant overdentures has not changed much during the 10-year period between the present and the previous investigation.An overdenture is still a seldom-used option in implant treatment of patients with edentulous mandibles in Sweden. Instead, a fixed implant-supported prosthesis continues to be the preferred option,

A prospective randomized study on the immediate loading of mandibular overdentures supported by one or two implants: a 12-month follow-up report.

PURPOSE: The purpose of the present study was to evaluate and compare treatment with mandibular overdentures supported by one or two implants placed and loaded immediately. MATERIALS AND METHODS: Edentulous subjects with maxillary and mandibular complete dentures were recruited to participate in the study. All subjects received new maxillary and mandibular complete dentures, after which they were scheduled for implant surgery. Using a randomized sampling system, one or two implants were placed in the interforaminal area, and separate ball attachments were connected to the implants. The existing mandibular denture was relined, provided with retentive o-rings, and delivered the day of surgery. Subjects were seen for follow-up examinations after 3, 6, and 12 months, during which marginal bone levels and implant stability were measured. Survival rates were calculated and the data were analyzed statistically. RESULTS: Thirty-six subjects (16 men and 20 women with a mean age of 53.2 years [range, 38 to 69 years]) received 55 implants. Seventeen subjects received one implant in the symphyseal area, and the other 19 received two implants in the canine positions. Ten implants in nine subjects failed during the observation period, and three subjects with two implants each withdrew from the study, resulting in a 12-month implant survival rate of 81.8%. Three subjects lost their only implant and one patient lost both implants. The remaining five subjects lost one of their two implants. Six of the failures occurred during the first month after placement. CONCLUSION: Immediate loading of one or two separate implants by means of ball attachment-supported mandibular overdentures should be performed with caution, as a higher than expected implant failure rate was observed. No statistically significant differences in failure rates between the two groups were observed.

Accuracy of a new ring-opening metathesis elastomeric dental impression material with spray and immersion disinfection.

STATEMENT OF PROBLEM: A new elastomeric impression material has been formulated with a ring-opening metathesis chemistry. In addition to other properties of clinical significance, the impression accuracy must be confirmed. PURPOSE: The purpose of this study was to compare the accuracy of the new elastomeric impression material with vinyl polysiloxane and polyether following both spray and immersion disinfection. MATERIAL AND METHODS: Impressions of a modified dentoform with a stainless steel crown preparation in the lower right quadrant were made, and type IV gypsum working casts and dies were formed. Anteroposterior (AP), cross-arch (CA), buccolingual (BL), mesiodistal (MD), occlusogingivobuccal (OGB), and occlusogingivolingual (OGL) dimensions were measured using a microscope. Working cast and die dimensions were compared to those of the master model. The impression materials were a newly formulated, ring-opening metathesis-polymerization impression material (ROMP Cartridge Tray and ROMP Volume Wash), vinyl polysiloxane (VPS, Aquasil Ultra Monophase/LV), and a polyether (PE, Impregum Penta Soft/Permadyne Garant L). Fifteen impressions with each material were made, of which 5 were disinfected by spray for 10 minutes (CaviCide), 5 were disinfected by immersion for 90 minutes (ProCide D), and 5 were not disinfected. There were significant cross-product interactions with a 2-way ANOVA, so a 1-way ANOVA and Dunnett's T3 multiple comparison test were used to compare the dimensional changes of the 3 impression materials, by disinfection status and for each location (alpha=.05). RESULTS: For ROMP, there were no significant differences from the master, for any dimension, when comparing the control and 2 disinfectant conditions. No significant differences were detected among the 3 impression materials for CA, BL, and MD. The working die dimensions of OGB and OGL for VPS with immersion disinfection were significantly shorter than with PE and ROMP (P<.05). Overall, the AP dimension was more accurate than CA, and the BL of working dies was 0.040 mm greater in diameter than MD. CONCLUSIONS: The accuracy of gypsum working casts and working dies from the new and 2 existing types of impression material were similar, for both spray and immersion disinfection. Judicious application of a die spacer can compensate for the small differences observed. VPS may require additional laboratory accommodation to compensate for a shorter working die.

Decision making among Swedish general dental practitioners concerning prosthodontic treatment planning in a shortened dental arch.

The purposes of this study were to describe how dentists evaluated the importance of various patient-related items when planning for a treatment in a shortened dental arch, to analyse common dimensions of the decision-making in comparison to other decision situations, and to identify explanatory factors behind these dimensions. A questionnaire containing different statements regarding the shortened dental arch concept was sent to a random sample of Swedish general dentists (n=189), with a response rate of 54%. The dentists were asked to evaluate items to be considered when planning for a prosthetic treatment in a shortened dental arch. Differences between individuals were great as well as between groups of dentists. Especially delivery system but also place of dental education and attitudinal factors were related to the shortened dental arch decision making process.

Satisfaction and Clinical Outcomes Among Patients with Immediately Loaded Mandibular Overdentures Supported by One or Two Dental Implants: Results of a 5-Year Prospective Randomized Clinical Trial.

PURPOSE: The purpose of this study was to evaluate patient satisfaction and clinical outcomes among subjects with mandibular overdentures supported by one or two immediately placed dental implants 5 years after loading. MATERIALS AND METHODS: Thirty-six subjects (16 men and 20 women) received one or two dental implants in the anterior mandible, and all implants were loaded the day of surgery. Subjects were scheduled for follow-up 3-, 6-, and 12 months after implant placement and thereafter annually for 4 more years. Patient satisfaction scores were measured with the Oral Health Impact Profile-EDENT (OHIPEDENT) questionnaire. RESULTS: Seventeen subjects (7 male and 10 female) with a mean age of 59.4 years (range, 44 to 74 years) were available for the 5-year follow-up examination. Nine subjects with 10 failing implants were excluded during the first year and nine subjects were lost to follow-up. No implants failed between the 12- and 60-month follow-up examinations, and the need for denture maintenance was low. Mean peri-implant bone change was 0.92 mm, and the Spearman test failed to show correlation between the insertion torque value and implant stability quotient. Patient satisfaction scores increased significantly when compared with baseline values and continued to be high for both groups, with no significant differences. CONCLUSION: Ten implants in nine subjects failed early, but no failures were observed after the 12-month examination. No significant differences were found between subjects in the two groups with respect to implant survival rates and peri-implant bone loss, and patient satisfaction scores continued to be high. Although patient satisfaction and implant success were high during the 12- to 60-month period, the results should be interpreted with caution because of the high number of failing implants and patients lost to follow-up. More research is needed to study outcomes of treatment with immediately loaded mandibular implant overdentures.

Patient evaluation after treatment with maxillary implant-supported overdentures.

PURPOSE: To evaluate and compare outcome among patients after implant overdenture treatment in the maxilla. MATERIALS AND METHODS: The study sample comprised two groups of patients: group 1, in which the patients were planned for overdenture treatment, and group 2, in which the patients originally were planned for a fixed prosthesis in the maxilla but had overdenture treatment owing to implant failures, resulting in an insufficient number of implants to support a fixed prosthesis. All patients treated with maxillary implant-supported overdentures in the Department of Prosthetic Dentistry, Central Hospital, Skövde, Sweden, between 1993 and 2002 received a questionnaire at their yearly follow-up visit with nine questions related to their treatment. All questions had visual analogue scale response alternatives ranging from a negative to a positive opinion. RESULTS: Nineteen patients, 10 in group 1 and 9 in group 2, completed the questionnaire, yielding a response rate of 86%. Both groups expressed a high satisfaction rate, and few regretted their choice of treatment. Patients planned for overdenture treatment (group 1) reported significantly fewer speech problems after treatment compared with those originally planned for a fixed prosthesis (group 2, p < .05). No other significant differences between the two groups were seen. CONCLUSION: Within the limitations of the present study, it can be concluded that maxillary implant overdenture treatment may be considered a viable option among patients with an insufficient number of implants for a fixed prosthesis.

Oral health and treatment need among older individuals living in nursing homes in Skaraborg, Västra Götaland, Sweden.

The aim of this study was to describe the oral health among residents living in seven nursing homes in Skaraborg,Västra Götaland, Sweden. The study was cross-sectional and included two parts; a clinical examination and a patient questionnaire. To be included in the study, each subject should be able to understand and answer simple questions about their general and oral health, and also be able to participate in a clinical examination. In all, 172 individuals were included in the study sample. Edentulousness was prevalent, and more than 50% of the subjects were edentulous in the maxilla. Poor denture stability and retention were observed among the majority of the edentulous subjects, while fractured/decayed teeth and remaining roots were common among the dentate subjects. 47% had oral mucosal lesions. Mucosa friction index was high, and good oral hygie ne was registered for 12% of the dentate subjects. The majority of the patients with remaining teeth brushed their teeth twice a day, while those wearing dentures brushed more seldom. The majority of the respondents claimed, they had not received help from the program included in the Swedish National Dental Insurance System, introduced in 1999. The intention with the program was to promote good oral health among individuals, who due to medical--or social conditions, were not able to attend the regular oral health care system.

Specialisation and specialist education in prosthetic dentistry in Europe.

This presentation reports on the results of a meeting of prosthodontists from selected European countries. The aim of the meeting was to analyse and promote specialisation and specialist education in Prosthetic Dentistry in Europe. Representatives for Europe were selected from the European Prosthodontic Association (EPA) board, the Education and Research Committee of International College of Prosthodontists (ICP), countries with a legally recognised speciality, countries without a recognised speciality but organised training programmes and countries with neither of these situations. Data about specialisation and specialist training in Prosthodontics in Europe was scrutinised and discussed. The programmes for countries with specialist training had relatively similar content, mostly of three years duration. There was strong agreement that a recognised speciality raises the level of care within the discipline for both specialists and non-specialists. In several of the countries where a speciality had been introduced it had been initiated by pressure from public health planning authorities. The conclusions are that from a professional viewpoint an advancement of the speciality over Europe would develop the discipline, improve oral health planning and quality of patient care. A working group for harmonisation was recommended.

A retrospective evaluation of treatments with implant-supported maxillary overdentures.

BACKGROUND: Considerably lower success rates have been presented for implant-supported overdentures in the maxilla compared with the mandible. PURPOSE: The aim of the study was to report the outcome of implant-supported maxillary overdentures from one clinic. METHODS: All patients treated with implant-supported maxillary overdentures in the Department of Prosthetic Dentistry, Central Hospital, Skövde, Sweden, between 1993 and 2002 were identified from patient charts and included in the study. All patients had a rigid cast gold alloy bar designed with ball attachments retaining an overdenture. RESULTS: Twenty-seven subjects were included, of whom 13 were originally planned for overdenture treatment (group 1) and the other 14 for a fixed prosthesis (group 2). The mean observation period was 5.7 years for subjects in group 1 and 5.5 years for those in group 2. One hundred forty-five implants were placed, and the majority of the failures were diagnosed as early ones and were found in group 2. The cumulative implant survival rate after 5 years was 77% in group 1 and 46% in group 2. The probability of having implant failure was almost three times higher among subjects in group 2 compared with subjects in group 1. Most technical and biologic complications were related to the retention system. CONCLUSION: Maxillary implant-supported overdentures show a high implant failure rate, but fewer implant failures occurred for patients originally planned for overdenture treatment.

Subjective need for implant treatment among middle-aged people in Sweden and Denmark.

BACKGROUND: The use of oral implants in prosthodontics has become widespread and regarded as a predictable treatment modality. However, there is a lack of knowledge among the general population about the prevalence and need for implant treatments. PURPOSE: This study was undertaken to register and compare the prevalence of dental implants and the subjective need for implant treatment among people in Sweden and Denmark. MATERIALS AND METHODS: Random samples taken from the national population registers in Sweden and Denmark comprised 1001 Swedish subjects aged 55 to 79 years and 1175 Danish subjects aged 45 to 69 years. Subjects were requested to fill out questionnaires regarding dental conditions, subjective need for implant treatment, whether they had received treatment with dental implants during the previous 10 years, and so on. RESULTS: Of the Swedes, 4.8% reported that they had dental implants, compared with 2.5% of the Danes. In the Swedish sample, age was significantly associated with subjective need for implant treatment. In the Danish sample, women showed a significantly higher subjective need for implant treatment than did men. CONCLUSIONS: Compared with the Swedish sample, the subjective need for treatment with dental implants was higher in the Danish sample, although the patient fees were substantially higher in Denmark.

Use of mandibular implant overdentures: treatment policy in prosthodontic specialist clinics in Sweden.

The aim was to examine the use of mandibular implant overdentures in Swedish prosthodontic specialist clinics. Questionnaires related to treatment with mandibular implant overdentures during 2001 were sent to the heads of the 30 prosthodontic specialist clinics of the Public Dental Health Service in Sweden. Completed questionnaires were received from 28 (93%). The number of treatments with mandibular implant overdentures varied much among the clinics (0 to 22). Seven clinics had not performed any such treatment, and the median number was 2. The number of fixed implant-supported prostheses was much higher (median value 17, range 4 to 100). The correlation between the number of implant overdentures and fixed implant-supported prostheses in edentulous mandibles was weak (r = 0.33; P = 0.10). The most common anchorage system was ball attachments on two unsplinted implants. The most common reason for the choice of the overdenture treatment was the reduced cost, whereas the patient's main wish to improve denture retention came next. The question whether the demand for implant overdentures had increased during the last few years, was answered with "no" by 19, with "yes" by 5 and with "don't know" by 4 clinics. All but one responded that their attitude to implant overdentures had not changed after the introduction of free pricing in Swedish dentistry. It can be concluded that compared to the rapidly increasing international use of mandibular implant overdentures, this treatment of edentulous patients is rare in Sweden, where fixed implant-supported prostheses still are predominant.

A prospective randomized study on the immediate loading of mandibular overdentures supported by one or two implants; a 3 year follow-up report.

AIM: The objective of the study was to evaluate and compare treatments with mandibular overdentures supported by one or two immediately placed implants 3 years after loading. MATERIALS AND METHODS: Thirty-six edentulous subjects were eligible for inclusion. Using a random sampling system, one or two implants were placed in the mandible. Separate ball attachments were connected to the implants, and the denture was relined and delivered the day of surgery with the retentive components incorporated in the denture base. At the follow-up examinations peri-implant bone levels, implant and denture stability/retention, and need for maintenance and adjustments were evaluated. Moreover, the OHIP-EDENT questionnaire was used to measure patient satisfaction. RESULTS: Nineteen subjects (10 men and 9 women) with a mean age of 56 years were available for the 3-year follow-up examination. The group with 1 implant (Group 1) consisted of 11 subjects (5 women and 6 men) while the remaining 8 (5 women and 3 men) belonged to Group2. Nine subjects had been excluded during the first year due to failing implants, 6 had moved, 1 had died, and 1 reported severe illness. No implant failures between the 12-and 36 month follow-up were observed. The mean peri-implant bone change was.86 mm and the Implant Stability Quotient showed only minor changes with no significant difference between the groups when compared with the 12-month follow-up. Patient satisfaction scores increased significantly when compared with the baseline values and continued to be high for both groups and need for denture maintenance was low. CONCLUSION: No significant differences were found between subjects in the two groups with respect to implant survival and peri implant bone loss, and patient satisfaction scores continued to be high for both groups. Need for denture maintenance was low in both groups.

Retentive characteristics of overdenture attachments during repeated dislodging and cyclic loading.

The retentive and morphologic changes of overdenture attachments were evaluated independently after repeated insertion and sinusoidal loading on implant abutments. Stud and magnetic attachments were embedded in overdenture housing (n = 5). The overdentures were subjected to either repeated insertion and removal for 5,400 cycles or sinusoidal cyclic loading for 100,000 cycles. A 67.8% decrease in retentive force was observed after 100,000 loading cycles (P < .05), and a 73.9% decrease of retentive force occurred after 5,400 insertion-removal cycles (P < .05). Stud attachments showed more loss of retention and physical deterioration than magnetic attachments tested under identical conditions.

Effect of tilted and short distal implants on axial forces and bending moments in implants supporting fixed dental prostheses: an in vitro study.

PURPOSE: The aim of this study was to evaluate the axial forces (AFs) and bending moments (BMs) on implants supporting a fixed dental prosthesis (FDP) with a distal cantilever (10 mm) compared to an FDP supported by a tilted or short (7 mm instead of 13 mm) posterior implant by means of in vitro strain gauge measurements. MATERIALS AND METHODS: Nine titanium Branemark implants were placed in an edentulous composite mandible. The mechanical loading conditions were evaluated for the following three situations: (1) short distal implants supporting a cantilever, (2) long tilted distal implants, and (3) no distal implants supporting a cantilever. A vertical load of 50 N was applied at the first molar position, and the resultant AFs and BMs were measured for the three different situations, three different numbers of supporting implants (three, four, or five), and three different prosthesis materials (titanium, acrylic, and fiber-reinforced acrylic). RESULTS: The mean BMs, as well as the maximum AFs and BMs, were significantly higher in the model with a cantilever compared to that having the tilted or short distal implants (P < .001). There was no significant difference between the models with a distally tilted implant versus a short distal implant. CONCLUSION: The use of posterior implants reduced the AFs and BMs on implants supporting an FDP compared to that with a distal cantilever. No difference in mechanical loading was observed between short tilted distal implants.

Changes in attitudes toward desire for implant treatment: a longitudinal study of a middle-aged and older Swedish population.

PURPOSE: To assess, at a 10-year interval, changes in attitudes toward desire for implant treatment among middle-aged and older Swedish subjects with respect to dental status. MATERIALS AND METHODS: Three thousand subjects, residents of Orebro County, Sweden, were surveyed via the same questionnaire in 1989 and again in 1999 regarding their possible need for and interest in implant-based prosthodontic treatment. RESULTS: One thousand six hundred sixty-five subjects responded to both surveys. In 1989 few respondents indicated an interest in implant treatment, whereas in 1999, 92% of those who had not indicated an interest in the earlier survey now indicated that they desired implant treatment. The cohort reporting having no teeth had a considerable lower increase in desire. Among those who reported a possible treatment need (ie, missing 1 or more teeth and had not had them replaced or those who wore complete dentures), cost was the most commonly cited reason for declining implant treatment. CONCLUSIONS: There was a dramatic increase in the interest for implant treatment over the period from 1989 to 1999. Changes in awareness of implant treatment, along with an expansion in the number of qualified providers, may have contributed to this increase.

Implant dentistry in the undergraduate dental education program at Dalhousie University. Part 1: clinical outcomes.

PURPOSE: This study evaluated the outcome of treatments performed by students in the undergraduate implant elective program at Dalhousie University. MATERIALS AND METHODS: All patients treated with dental implants in the undergraduate elective program at the Faculty of Dentistry, Dalhousie University, Halifax, Nova Scotia, Canada, between 1994 and 2004 were identified from patient records. Brånemark implants (Nobel Biocare) were placed by experienced oral and maxillofacial surgeons or periodontists using the traditional 2-stage protocol and an intermediate healing period of 3 to 6 months. Undergraduate students in the elective implant program were responsible for the restorative part of the treatment. RESULTS: A total of 166 implants were placed in 95 patients (38 men, 57 women; mean age: 52 years, range: 18 to 84 years). Of the 166 implants, 142 had been restored at the time of the study. Ten of the implants failed: 4 were lost during healing and the remaining 6 were lost after loading, leading to an implant survival rate of 93%. A total of 64 single-implant restorations, 7 multiple-unit fixed restorations, and 33 implant overdentures were fabricated. CONCLUSION: The results indicate that the clinical outcome of implant treatments performed by undergraduate students in the implant elective program at Dalhousie University is similar to that reported by experienced clinicians/research teams. Although the implant surgery was performed by an experienced oral and maxillofacial surgeon or periodontist, the student had the main responsibility for treatment planning and performing the prosthodontic procedures. The results also suggest that implant dentistry could be implemented as part of the curriculum in the undergraduate programs of dental schools.

Prosthodontics and the patient. Part 2: Need becoming demand, demand becoming utilization.

PURPOSE: Patients' oral health needs are estimated through dialogue and professional assessment. The concepts of need and demand are vital to studies of dental care and oral health. Need does not always lead to demand for treatment or to utilization, depending on the gatekeeping processes between need and demand and between demand and utilization. Demand must be accepted with the understanding that there is no objective need and that demand depends on the patient's opinion. In accordance with this, the need for prosthodontic treatment is highly individual and is not automatically related to oral health status, making need and demand difficult to measure in that respect. Therefore, sociodental factors should be included and evaluated in studies of need and demand for utilization of prosthodontic care. MATERIALS AND METHODS: This theoretical and analytic paper focuses on the gatekeeping processes between need and demand and between demand and utilization of prosthodontic care. RESULTS: The concept of gatekeeping refers to the social and psychologic processes that transform need into demand and demand into utilization. It implies that they are complex processes that can render great differences between demand and actual utilization. CONCLUSION: It is not possible to estimate a patient's needs for prosthodontic care, since there is no objective need. Demand and utilization are factors that play an important role in the gatekeeping process. These factors are dependent on the patient's opinion, which is influenced by numerous factors.

Attitudes toward the shortened dental arch concept among Swedish general dental practitioners.

PURPOSE: The purpose of this investigation was to obtain the opinions and assess the attitudes of Swedish general dental practitioners in private practice versus a public health care setting regarding management of patients with a shortened dental arch (SDA). MATERIALS AND METHODS: A questionnaire containing different statements regarding the SDA concept was sent to a random sample of 189 clinicians. Differences between male and female practitioners and between private practitioners (PPs) and those employed by the Public Dental Health Service (PDHS) were tested for statistical significance by the Student t test. RESULTS: The response rate was 54% (102 clinicians). Among the respondents, 62% were men and 38% were women. Fifty-six percent were PPs and 44% were employed by the PDHS. The results showed small differences in attitudes between various groups of practitioners but large individual variations. In general, Swedish general practitioners had a positive attitude toward the SDA concept with respect to oral function and oral comfort. They recognized few risks with a dentition lacking molar support, although female clinicians were more risk conscious. PPs expressed fewer advantages in using the SDA concept than PDHS practitioners with respect to the reduced risk for overtreatment, better patient economy, and the ability for older patients to keep their teeth. CONCLUSION: The results from this questionnaire study indicate that, overall, Swedish general practitioners have an affirmative opinion toward the SDA concept.