Intraoral Digital Impressions for Virtual Occlusal Records: Section Quantity and Dimensions.

The purpose of this study was to locate the 3D spatial position mandibular cast and determine its occlusal contacts in a novel way by using an intraoral scanner as part of the virtual occlusal record procedure. This study also analyzes the requirements in quantity and dimensions of the intraoral virtual occlusal record. The results showed that the best section combination consists of 2 lateral and frontal sections, the width of this section being that of 2 teeth (24 mm × 15 mm). This study concluded that this procedure was accurate enough to locate the mandibular cast on a virtual articulator. However, at least 2 sections of the virtual occlusal records were necessary, and the best results were obtained when the distance between these sections was maximum.

Comparison of the accuracy of a 3-dimensional virtual method and the conventional method for transferring the maxillary cast to a virtual articulator.

STATEMENT OF PROBLEM: The currently available virtual articulators fail to locate the digitized maxillary cast at the exact position in the virtual environment. Some locate the casts on a mechanical articulator with a facebow, and this position is then digitized for the virtual environment. PURPOSE: The purpose of this study was to compare the location of the maxillary cast on an articulator by using 2 different procedures: the conventional method and a virtual method. MATERIAL AND METHODS: With the conventional procedure, the kinematic axis of the participant was determined with an axiograph. The location of the maxillary cast in reference to this axis was then physically transferred to a Panadent mechanical articulator. By a virtual procedure, the same kinematic axis and the maxillary cast were transferred directly from the participant to the Panadent virtual articulator by means of reverse engineering devices. The locations obtained with both procedures were compared in a virtual environment with an optical scanner. By calculating the deviation at every point of the occlusal surface, the results obtained with this procedure were then compared with those of the conventional method. RESULTS: The mean deviation on the occlusal surface was 0.752 mm, and the standard deviation was 0.456 mm. CONCLUSIONS: The deviation between the procedures was sufficiently small to allow the methodology for orthodontic purposes. However, the accuracy of the virtual procedure should be improved so as to extend its use to other fields, such as orthognathic surgery or dental restorations, in which the clinical technique requires an articulator.

Impaired oral health-related quality of life in Hungary.

OBJECTIVES: To describe the prevalence of impaired oral health-related quality of life (OHRQoL) in the adult Hungarian population and to determine population-based norms for three Hungarian versions of the Oral Health Impact Profile (OHIP-H). MATERIAL AND METHODS: In a survey of 1059 randomly selected subjects, OHIP responses, age, gender, and denture status [natural dentition or fixed partial dentures (FPDs), removable partial dentures (RPDs), or complete dentures (CDs)] were collected. Study outcomes were item prevalence and OHIP summary score frequency ('norms'). RESULTS: The prevalence of OHIP items ranged from 2% to 43%, with a mean item prevalence of 14%. The distribution of summary scores was characterized by decile norms. Median scores for OHIP-H49, the 49-item questionnaire, were 6 OHIP units for subjects with FPDs, 10 OHIP units for subjects with RPDs, and 6 OHIP units for subjects with CDs. The median scores were 0, 0, and 1 OHIP units for the 14-item OHIP-H, and 0, 0, and 0 OHIP units for the five-item OHIP-H. CONCLUSIONS: Our sample demonstrates substantial OHRQoL impact in the Hungarian general population. The derived norms provide a framework for interpretation of data in future studies using the Hungarian OHIP versions, as well as data on how oral conditions and cultural factors affect perceived oral health when compared with international findings.

An approach to define clinical significance in prosthodontics.

PURPOSE: The concept of the minimal important difference (MID) of an oral health-related quality of life (OHRQoL) questionnaire has been proposed to refer to the smallest OHRQoL score difference considered to be clinically important in oral health. This study determined the MID for the 49-item Oral Health Impact Profile (OHIP) in prosthodontic patients. This could serve as a patient-based approach to define clinical significance for prosthodontic interventions. MATERIALS AND METHODS: A consecutive sample of 224 adult patients completed the OHIP questionnaires twice before treatment was performed and 4 to 6 weeks after prosthodontic treatment was finished. At follow-up patients were asked about their overall impression of the treatment (global transition; answer categories "improved a lot,""improved a little,""stayed the same,""worsened a little," and "worsened a lot"). RESULTS: The median of baseline and follow-up differences in OHIP (change scores) was computed for subjects (N = 47) reporting a "little improvement." This figure was considered the MID for the OHIP, and it was found to be 6 OHIP units (95% confidence interval: 2 to 9). CONCLUSION: The MID of the OHIP is an important benchmark to assess individual and group treatment effects in prosthodontics and could be used to approach what is clinically significant in terms of patient-based outcomes.

[Impact of prosthetic care on oral health related quality of life]. / Protetikai terápiás lehetoségek eletminoségre gyakorolt hatása.

Patients' perception of oral health can be characterized by Oral Health Related Quality of Life (OHRQoL). Therefore, it should be able to be used to measure their perceived benefits of prosthodontic treatment. Oral Health Impact Profile (OHIP) is one of the technically most sophisticated and most widely used instruments measuring OHRQoL. The aim of this study was to measure the impact of prosthodontic treatment on Oral Health Related Quality of Life. The Hungarian version of OHIP (OHIP-H 53) was applied for a sample of 63 prosthodontic patients at baseline, and at 1 as well as at 6 and 12 months following treatment. OHRQoL impairment is characterized by OHIP-H 53 scores. A linear regression model was used to estimate the rate of improvement of OHRQoL in different prosthodontic treatment groups (FPD, RPD and CD) at baseline and at follow-ups. OHRQoL improved rapidly within 1 month after treatment (76% of patients) and it underwent further but moderate improvement within the following 6 to 12 months after treatment in subjects with fixed, removable and complete dentures (90%) as indicated by the reduced OHIP-H scores. The largest improvement was observed in patients treated with fixed prosthodontics. Patients receiving removable or complete dentures had poorer OHRQoL than respondents treated with fixed prosthodontics. It can be concluded that OHRQoL can be improved by prosthodontic treatment, especially by using fixed prosthodontics. Besides considering clinical factors in prosthodontics, subjective conditions should also be involved in treatment planning in order to achieve a higher rate of acceptance of prosthetic care by the patient.

Meta-analysis of treatment need for temporomandibular disorders in adult nonpatients.

AIMS: To determine the prevalence of treatment need for temporomandibular disorders in adult populations by meta-analysis of nonpatient studies and to investigate factors influencing temporomandibular disorder treatment-need estimates. METHODS: Population-based and nonpatient studies of adult subjects with temporomandibular disorders published in the English language prior to July 2006 were systematically reviewed. Electronic databases (MEDLINE, CINAHL, and Science Citation Index Expanded) were searched (n = 641). To combine data, fixed- and random-effects meta-regression models were used. Subgroup analyses were performed to assess factors influencing treatment need estimates. RESULTS: Of 676 articles identified, 17 (9,454 subjects) met the study criteria. The prevalence of treatment need for TMD in adults (95% confidence interval) was estimated to be 15.6% (10.0, 23.6) for the fixed effect model and 16.2% (11.2, 21.1) for the random-effects model. Criteria of estimating treatment need and place of study strongly influenced summary estimates of treatment need (P < .001). Need estimates derived from clinical TMD signs were higher than estimates based on subject-reported symptoms (P = .010). Estimates for younger subjects (19 to 45 years) were higher than for older subjects (46+ years; P = .013). CONCLUSION: The treatment need for TMD in the general adult population is substantial and varies according to definition, criteria, and age. Findings of this meta-analysis can be used for planning and allocating health-care resources.

Comparison of perceived oral health in patients with temporomandibular disorders and dental anxiety using oral health-related quality of life profiles.

BACKGROUND: Oral health-related quality of life (OHRQoL) instruments provide information beyond what is represented in their summary scores. Individual item information also provides useful insight into patient-related oral health problems. Our study aim was to compare patients' perceived impact from temporomandibular disorders (TMD) and from dental anxiety on oral health using item profiles contained within the Oral Health Impact Profile (OHIP). METHODS: We measured OHRQoL using the German version of the 14-item OHIP in 416 TMD patients, 173 dental anxiety patients, and 2,026 general population subjects. RESULTS: Dental anxiety patients demonstrated the highest mean OHIP summary scores, i.e., the worst OHRQoL (22.4 in anxiety patients, 14.0 in TMD patients, 4.1 in general population; P<0.001). The prevalence of frequently occurring responses of the individual items was 6-62% in dental anxiety patients, 3-40% in TMD patients, and 0.2-0.4% in the general population. The item prevalence of both patient groups was very similar for functional and pain-related OHRQoL domains. Dental anxiety patients indicated problems more frequently than TMD patients in the OHIP domains of psychological discomfort and psychological disability. CONCLUSIONS: This insight into patients' perceived oral health provided by OHIP item profiles may be important for patient diagnosis and outcome assessment in the clinical setting.

An Arabic version of the Oral Health Impact Profile: translation and psychometric properties.

OBJECTIVES: To translate the original English version of the Oral Health Impact Profile (OHIP) into an Arabic version, and to investigate the psychometric properties of the translated instrument among adults in Saudi Arabia. METHODS: The original English version of OHIP with 49 items was translated into Arabic following accepted cultural adaptation technique guidelines using a forward-backward method. After pilot testing, the instrument was administered to 426 adults in Saudi Arabia. RESULTS: A priori hypothesised associations between the OHIP summary score, self-reported oral health and five oral disorders were confirmed in a convenience sample of the general population (n = 356). These associations were interpreted as support for construct validity. The instrument's responsiveness, as indicated by a mean OHIP summary score change from 62.27 to 14.00, was established in 30 consecutive patients treated for complete and removable partial dentures. Test-retest reliability was demonstrated by intraclass correlation coefficients of 0.75 - 0.90 for dimensions and summary score (n = 40). Internal consistency was high (Cronbach's alpha > 0.74) in the general population sample. CONCLUSION: Sufficient psychometric properties of the OHIP-A make the instrument suitable for assessment of oral health-related quality of life in Saudi Arabia.

Association between factors related to the time of wearing complete dentures and oral health-related quality of life in patients who maintained a recall.

PURPOSE: To investigate the association between factors related to the time of wearing complete dentures (CDs) and oral health-related quality of life (OHRQoL) in edentulous patients who maintained a recall. MATERIALS AND METHODS: OHRQoL was measured using the German version of the Oral Health Impact Profile (OHIP-G) in a convenience sample of 50 edentulous prosthodontic patients (mean age+/- SD: 72.5 +/-9.4; age range: 52 to 91 years, 66% women) maintaining a recall 2 to 51 months after CD treatment. The outcome of the study was the sum of OHIP-G item responses (OHIP-G49; range, 0 to 196) that characterized OHRQoL. Exposure variables were (1) time since first treatment with CDs, (2) number of previous CDs, (3) age of present CDs, and (4) age at which first CDs were provided. The association between exposure variables and outcome was investigated using an ordinary least-square regression analysis, controlling for the effects of age. RESULTS: Age of current CDs, time since first CD, number of previous CDs, and the age at which CDs were first provided did not significantly influence OHRQoL. Regression coefficients for each exposure variable were, respectively, 0.0, 95% CI: -0.1 to 0.2; -0.1, 95% CI: -0.4 to 0.3; 0.8, 95% CI: -1.5 to 3.0, and 0.4, 95% CI: -0.1 to 0.8. CONCLUSION: The response to inevitable anatomic and biologic changes in the oral cavity related to edentulism, denture-wearing, age, and other factors does not necessarily translate rapidly into changes in perceived oral health in patients wearing CDs and maintaining a recall.

[Quality of life and prosthodontics]. / Eletminoség és fogpótlástan.

Orofacial pain, functional limitations, psychosocial impacts, and concern about appearance are all dimensions of oral health-related quality of life. Consequently, OHRQoL is especially important for prosthodontics. OHRQoL is assessed by multiple-item questionnaires that ask about numerous symptoms, problems and social impacts. 49 items into seven dimensions were developed in the OHIP which was then verified among several different cultural circumstances. Evaluating baseline (To) immediately after treatment (T1) and after a longer observation time (T2), a decrease of symptoms and problems could be followed in prosthodontic care. Fastest improvement in patient satisfaction was observed in case of fixed partial denture wearers. The profile of pre- and post-treatment problems differed extensively among removable partial and complete denture wearers, and only minor problems were found after a longer time of adaptation. OHIP instrument seems to be a reliable indicator of change in oral health-related quality of life, for cultural circumstances deviated largely from each others.

The Hungarian version of the Oral Health Impact Profile.

Oral health-related quality of life (OHRQoL) is increasingly of interest in dentistry. The current internationally accepted instruments used to measure OHRQoL need to be cross-culturally adapted for use in other cultural environments. It was the aim of the present study to develop a Hungarian version of the Oral Health Impact Profile (OHIP-H) following accepted guidelines. The original English-language version was translated into Hungarian, back-translated into English, and tested for its psychometric properties. Construct validity was tested on 144 prosthodontic patients and 200 randomly selected subjects. A priori hypothesized associations between OHIP summary scores and self-reported oral health and six self-reported oral conditions were investigated. The pattern of the observed associations supported the new instrument's construct validity. Responsiveness tested in 28 oral surgery patients was indicated by a statistically significant mean OHIP score change from 39.2 to 23.0. Test-retest reliability was demonstrated by intraclass correlation coefficients of 0.81-0.90 for OHIP summary scores and subscales in 31 prosthodontic patients. Cronbach's alpha values between 0.71 and 0.96 proved to have high internal consistency. Adequate psychometric properties in typical patient populations make the new instrument suitable for assessment of OHRQoL in Hungary.

Problems reported by patients before and after prosthodontic treatment.

PURPOSE: This study sought to investigate problems reported by patients before and after prosthodontic treatment. MATERIALS AND METHODS: Patient-reported problems were studied using the item list contained in the German version of the Oral Health Impact Profile in a convenience sample of 107 prosthodontic patients before (T0), 1 month after (T1), and 6 to 12 months after treatment (T2). "Frequently reported" problems were defined as impacts experienced fairly often or very often. The prevalence of frequently reported problems was compared among treatment groups and across appointments. RESULTS: At baseline, the most prevalent frequently reported problems were "difficulty chewing" (31%), "take longer to complete a meal" (28%), "food catching" (26%), "uncomfortable to eat" (24%), and "unable to eat (because of dentures)" (23%). At T2, the most prevalent frequently reported problems were "sore spots" (5%), "painful gums" (4%), "discomfort (because of dentures)" (3%), and "sore jaw" (2%). The number of reported problems decreased from 18.0 (T0) to 7.5 (T1), and further to 4.5 (T2). The decrease was the fastest in fixed partial denture wearers and the slowest in removable partial denture wearers. Some problems emerged during or after prosthodontic treatment. The kind of pre- and posttreatment problems differed substantially. CONCLUSION: The number of problems decreased substantially after prosthodontic treatment. Fixed partial dentures more effectively influenced the problems reported before treatment than did removable partial or complete dentures.

Oral health-related quality of life in patients treated with fixed, removable, and complete dentures 1 month and 6 to 12 months after treatment.

PURPOSE: This study described oral health-related quality of life (OHRQoL) before and after treatment in patients with fixed, removable, and complete dentures. MATERIALS AND METHODS: OHRQoL was measured using the German version of the Oral Health Impact Profile (OHIP-G) in a convenience sample of 107 prosthodontic patients at baseline and 1 and 6 to 12 months after treatment. The sum of OHIP-G item responses (OHIP-G49, range 0 to 196) characterized OHRQoL impairment in 42 patients treated with fixed prosthodontics, 31 patients treated with removable dentures, and 34 patients treated with complete dentures. OHIP-G49 medians were compared with the OHRQoL level in a general population sample (n = 2,026). A multivariable binomial regression analysis, controlling for the effects of baseline OHRQoL and follow-up wave, was used to compare the level of impaired OHRQoL in different prosthodontic treatment groups at follow-ups. RESULTS: OHRQoL improved in 96% of the subjects. OHIP-G49 medians reached the level of OHRQoL in the general population 1 month after treatment (fixed prosthodontics patients 6 OHIP-G units; general population subjects 5 units; removable denture patients 23 units, 15 units in general population subjects; complete denture patients 13 units, 23 units in general population subjects). OHIP-G49 medians were below population norms 6 to 12 months after treatment. In patients treated with removable/complete dentures, the expected posttreatment OHIP-G49 problem rate was 1.9 times the problem rate in patients treated with fixed prosthodontics, holding baseline OHIP-G49 and follow-up wave constant. CONCLUSION: OHRQoL changed substantially comparing pretreatment scores with 1 and 6 to 12 months of follow-up in patients treated with fixed, removable, and complete dentures.