Attachment systems for mandibular implant-supported overdentures: A systematic review and meta-analysis of randomized controlled trials.

STATEMENT OF PROBLEM: Although mandibular implant-supported overdentures have been highly recommended as a treatment option, a consensus on the type of attachment systems that can be used to increase implant and prostheses survivability is lacking. PURPOSE: The purpose of this systematic review and meta-analysis was to compare different types of attachments for retention by investigating outcome measures such as implant and prosthesis survival rates and biological and prosthesis complications in participants with a mandibular implant-supported overdenture. MATERIAL AND METHODS: The search was performed in the PubMed, Cochrane, Embase, and Scopus databases by following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria and registered with the International Prospective Register of Systematic Reviews (CRD42021253566). An analysis of association was conducted between different attachment systems and implant and overdenture survival rates in randomized controlled clinical trials. RESULTS: The initial search indicated 477 studies, of which 25 randomized controlled trials (RCTs) were included for analysis. A total of 2154 implants and 737 overdentures were analyzed in the meta-analysis. The main results indicated the failure rate for dental implants to be 2.0% (95% confidence interval [CI], 1.3 to 3.2) and overdentures 4.2% (95% CI, 1.6 to 10.5), respectively. With regard to different attachment systems, a similar failure rate was identified with bar-type retention (7.7% to 95% CI, 3.0 to 18.1), magnetic retention systems (7.6% to 95% CI, 2.2 to 22.7), and ball-type retention (6.8% to 95% CI, 3.0 to 14.3). No significant difference was found in biological complications for splinted and unsplinted implant overdentures (P=.902). Regarding prosthetic complications, the most favorable groups were LOCATOR attachments followed by telescopic and Conus, bar, and ball attachments. Magnet attachments had higher prosthetic complications (7.4 times) than the other attachments. CONCLUSIONS: Implants and implant-supported mandibular overdentures showed a high survival rate irrespective of the attachment system used. Splinting implants did not significantly affect the rate of biological complications. Prosthetic complications were most common for magnet and least common for LOCATOR attachments.

A qualitative examination of the benefits and challenges of a psychosocial screening intervention in pediatric oncology: "Support comes to us".

BACKGROUND: Pediatric cancer diagnosis and treatment can have detrimental mental health effects on parents (caregivers) and their children/adolescents (youth). Psychosocial screening and intervention have been recognized as standards of care in pediatric oncology. The most effective psychosocial interventions to support those in need post screening have not been determined. AIMS: This qualitative study aimed to investigate the perceived benefits and challenges for caregiver and youth participants in the screening-intervention arm of an Enhanced Psychosocial Screening Intervention (EPSI) pilot study. METHODS: EPSI consists of a psychosocial navigator (PSN) who shares screening results conducted near diagnosis (T1) and monthly for 1 year (T2) with treating teams and families. All 17 caregiver-youth dyads who had completed EPSI were invited to participate in a semi-structured interview. RESULTS: Ten caregivers and nine youth participated. Identified themes were grouped into benefits and challenges of EPSI: feeling supported and cared for (support comes to us regularly, having someone to talk to); and feeling empowered through knowledge of resources and services were perceived as benefits. Caregivers were challenged by feeling overwhelmed, and youth by screening questions perceived as too repetitive. CONCLUSIONS: Regular monthly contacts for a year by the PSN with screening results and recommendations were perceived as beneficial by youth newly diagnosed with cancer and their caregivers who participated in EPSI. Feeling that support came to them and they had someone to talk to was a critical component. While information about psychosocial resources was not always used right away, it did evoke feelings of being empowered.

Pilot randomized psychosocial trial of a screening intervention in pediatric oncology.

OBJECTIVE: Psychosocial screening is a standard of care in pediatric oncology, but there is limited information about how to intervene after screening. This pilot trial aimed to determine feasibility of the novel Enhanced Psychosocial Screening Intervention (EPSI) and explore its preliminary efficacy outcomes. We examined rates of recruitment, retention, intervention acceptability, and monthly distress screening completion, as well as exploratory efficacy outcomes (Patient-Reported Outcomes Measurement Information System: depression, anxiety and fatigue; distress thermometer, pain and sleep). METHODS: Parallel-group randomized pilot trial: Caregiver-youth (10-17 years at enrollment, newly diagnosed with cancer) dyads were randomly allocated to either EPSI or standard care with 1:1 ratio allocation. EPSI consists of having a Psychosocial Navigator who shares screening results conducted near diagnosis and monthly for one year with treating teams and families, and provides recommendations tailored to screening results. RESULTS: Enrollment rate was 54% (38 dyads); retention was 90% and acceptability 86% (caregivers) and 76% (youth). Exploratory symptoms of depression, anxiety, distress and fatigue outcomes consistently improved mainly for caregivers. CONCLUSIONS: Results suggest EPSI is feasible and acceptable and exploratory mental and physical efficacy outcomes are promising for use in a future confirmatory multisite efficacy trial.

Failure rates associated with guided versus non-guided dental implant placement: a systematic review and meta-analysis.

OBJECTIVE: The purpose of the systematic review and meta-analysis was to evaluate implant failure rates and their association with guided and free-hand implant placement techniques. MATERIALS AND METHODS: A literature search was conducted across PubMed, Medline via Ovid, Cochrane database, and Google Scholar. The search was completed in September 2020. Series of meta-analyses were conducted to compare implant failure rates with guided and free-hand techniques. RESULTS: A total of 3387 articles were identified from the electronic search. After applying the inclusion criteria, eight articles were selected for qualitative assessment and four for quantitative synthesis (meta-analysis). The included studies had a risk ratio of 0.29 (95% CI: 0.15, 0.58), P < 0.001 for the use of guided implant placement. Implant failure rates were affected by the different placement techniques indicated by the test for overall effect (Z = 3.53, P = 0.0004). The incidence of implant failure in guided surgery versus free-hand surgery was found to be 2.25% and 6.42%, respectively. CONCLUSION: Both guided and free-hand implant placement techniques resulted in a high implant survival rate. However, implant failure rates were almost three times higher in the free-hand implant placement category. A guided implant placement approach is recommended for a successful outcome.

Adverse Events from Emergency Physician Pediatric Extremity Radiograph Interpretations: A Prospective Cohort Study.

OBJECTIVES: We determined how often emergency physician pediatric musculoskeletal (MSK) radiograph interpretations were discordant to that of a radiologist and led to an adverse event (AE). We also established the variables independently associated with this outcome. METHODS: This prospective cohort study was conducted in an urban, tertiary care children's emergency department (ED). We enrolled children who presented to an ED with an extremity injury and received radiographs. ED physicians documented their radiograph interpretation, which was compared to a radiology reference standard. Patients received telephone follow-up and had institutional medical records reviewed in 3 weeks. An AE occurred if there were clinical sequelae and/or repeat health care visits due to a delay in correct radiograph interpretation. RESULTS: We enrolled 2,302 children (mean [±SD] age = 9.0 [4.4] years; 1,288 (56.0%) male]. Of these, 180 (7.8%; 95% confidence interval = 6.8 to 9.0) ED physician discordant interpretations resulted in an AE. Specifically, there were no negative clinical outcomes; however, relative to cases diagnosed correctly at the index ED, patients whose fracture was not initially identified encountered 77.2% more subsequent ED visits, while those falsely diagnosed with a fracture experienced 41.5% additional orthopedic clinic visits. Odds of an ED discrepant interpretation was significantly higher if a physician's pretest probability of a fracture was ≤ 20% versus> 20% (adjusted odds ratio [aOR] = 1.6), patient's pain score was ≤ 2 versus> 2 (aOR = 1.6), and injury was located in a joint versus other location (aOR = 1.7). CONCLUSIONS: Emergency physician discordant pediatric MSK radiograph interpretations that resulted in an AE occurred with regular frequency in a pediatric ED setting. AEs were primarily an increase in subsequent health care visits. Importantly, a low clinical suspicion for a fracture or injury located in the joint were risk factors for ED physician discordant interpretations.

Predoctoral Dental Students' Perceptions of Dental Implant Training: Effect of Preclinical Simulation and Clinical Experience.

The aims of this study were to assess 1) differences in perceptions of dental implant training between dental students who received didactic training alone (control group) and those who received didactic plus simulation training (test group); 2) differences in response between students with and without clinical experience in implant dentistry; and 3) the interaction effect of simulation training and clinical experience on students' satisfaction. A survey was distributed to the control group in 2014 and to the test group in 2015; both groups were at the same U.S. dental school. Data were collected on confidence levels with various implant restorative procedures along with overall satisfaction and number of implant restorations performed by each student. The response rate was 78.7% in the control group and 81.3% in the test group. In the control group, 85.7% of students reported being satisfied with implant training compared to 90.8% of students in the test group. The interaction effect of simulation training and clinical experience on overall student satisfaction was OR=1.5 at 95% CI: 0.8, 3.0. The students who had clinical experience with implant restorative procedures had significantly greater satisfaction than those who did not (OR=4.8, 95% CI: 2.1, 11.1, p<0.01). This study found that both the simulation and clinical experience affected these students' confidence and satisfaction levels with implant education: they were almost five times more satisfied with implant training when clinical experience in implant restorative procedures was a part of their implant education.

Implant Treatment in the Predoctoral Clinic: A Retrospective Database Study of 1091 Patients.

PURPOSE: This retrospective study was conducted at the Marquette University School of Dentistry to (1) characterize the implant patient population in a predoctoral clinic, (2) describe the implants inserted, and (3) provide information on implant failures. MATERIALS AND METHODS: The study cohort included 1091 patients who received 1918 dental implants between 2004 and 2012, and had their implants restored by a crown or a fixed dental prosthesis. Data were collected from patient records, entered in a database, and summarized in tables and figures. Contingency tables were prepared and analyzed by a chi-squared test. The cumulative survival probability of implants was described using a Kaplan-Meier survival curve. Univariate and multivariate frailty Cox regression models for clustered observations were computed to identify factors associated with implant failure. RESULTS: Mean patient age (±1 SD) at implantation was 59.7 ± 15.3 years; 53.9% of patients were females, 73.5% were Caucasians. Noble Biocare was the most frequently used implant brand (65.0%). Most implants had a regular-size diameter (59.3%). More implants were inserted in posterior (79.0%) than in anterior jaw regions. Mandibular posterior was the most frequently restored site (43%); 87.8% of implants were restored using single implant crowns. The overall implant-based cumulative survival rate was 96.4%. The patient-based implant survival rate was 94.6%. Implant failure risk was greater among patients than within patients (p < 0.05). Age (>65 years; hazard ratio [HR] = 3.2, p = 0.02), implant staging (two-stage; HR = 4.0, p < 0.001), and implant diameter (wide; HR = 0.4, p = 0.04) were statistically associated with implant failure. CONCLUSIONS: Treatment with dental implants in a supervised predoctoral clinic environment resulted in survival rates similar to published results obtained in private practice or research clinics. Older age and implant staging increased failure risk, while the selection of a wide implant diameter was associated with a lower failure risk.

Effect of Different Thicknesses of Pressable Ceramic Veneers on Polymerization of Light-cured and Dual-cured Resin Cements.

AIM: This study evaluated the effects of ceramic veneer thicknesses on the polymerization of two different resin cements. MATERIALS AND METHODS: A total of 80 ceramic veneer disks were fabricated by using a pressable ceramic material (e.max Press; Ivoclar Vivadent) from a Low Translucency (LT) ingot (A1 shade). These disks were divided into light-cured (LC; NX3 Nexus LC; Kerr) and dual-cured (DC; NX3 Nexus DC; Kerr) and each group was further divided into four subgroups, based on ceramic disk thickness (0.3, 0.6, 0.9, and 1.2 mm). The values of Vickers microhardness (MH) and degree of conversion (DOC) were obtained for each specimen after a 24-hour storage period. Association between ceramic thickness, resin cement type, and light intensity readings (mW/cm(2)) with respect to microhardness and degree of conversion was statistically evaluated by using analysis of variance (ANOVA). RESULTS: For the DOC values, there was no significant difference observed among the LC resin cement subgroups, except in the 1.2 mm subgroup; only the DOC value (14.0 ± 7.4%) of 1.2 mm DC resin cement had significantly difference from that value (28.9 ± 7.5%) of 1.2 mm LC resin cement (p < 0.05). For the MH values between LC and DC resin cement groups, there was statistically significant difference (p < 0.05); overall, the MH values of LC resin cement groups demonstrated higher values than DC resin cement groups. On the other hands, among the DC resin cement subgroups, the MH values of 1.2 mm DC subgroup was significantly lower than the 0.3 mm and 0.6 mm subgroups (p < 0.05). However, among the LC subgroups, there was no statistically significant difference among them (p > 0.05). CONCLUSION: The degree of conversion and hardness of the resin cement was unaffected with veneering thicknesses between 0.3 and 0.9 mm. However, the DC resin cement group resulted in a significantly lower DOC and MH values for the 1.2 mm subgroup. CLINICAL SIGNIFICANCE: While clinically adequate polymerization of LC resin cement can be achieved with a maximum 1.2 mm of porcelain veneer restoration, the increase of curing time or light intensity is clinically needed for DC resin cements at the thickness of more than 0.9 mm.

Strength properties of preceramic brazed joints of a gold-palladium alloy with a microwave-assisted oven and gas/oxygen torch technique.

STATEMENT OF PROBLEM: The effect of microwave brazing on the strength properties of dental casting alloys is not yet known. PURPOSE: The purpose of this study was to compare the strength properties of preceramic brazed joints obtained by using a microwave oven and a conventional torch flame for a high noble alloy (Au-Pd). MATERIAL AND METHODS: A total of 18 tensile bars made of an Au-Pd ceramic alloy were fabricated. Six specimens were cut and joined with a high-fusing preceramic solder in a specially designed microwave oven, and 6 specimens were joined with a conventional natural gas/oxygen torch. The remaining 6 uncut specimens were tested as a control. All the specimens were subjected to testing with a universal testing machine. A 1-way ANOVA was performed for each strength property tested. RESULTS: The tensile strength of the uncut group was the highest (745 ±19 MPa), followed by the microwave group (420 ±68 MPa) and the conventional torch group (348 ±103 MPa) (P<.001); however, no significant difference in tensile strength was found between the microwave group and gas torch group. The tensile strength of the microwave group exceeded ANSI/ADA Standard No. 88, Dental Brazing Alloys (a joint standard of the American National Standards Institute and the American Dental Association). CONCLUSIONS: The microwave heating preceramic solder method demonstrated the excellent tensile strength of an Au-Pd alloy and may be an alternative way of joining alloys when a torch flame is contraindicated.

Discrepancies between Abstracts Presented at International Association for Dental Research Annual Sessions from 2004 to 2005 and Full-Text Publication.

Purpose. The purpose of this study was to evaluate the discrepancies between abstracts presented at the IADR meeting (2004-2005) and their full-text publication. Material and Methods. Abstracts from the Prosthodontic Section of IADR meeting were obtained. The following information was collected: abstract title, number of authors, study design, statistical analysis, outcome, and funding source. PubMed was used to identify the full-text publication of the abstracts. The discrepancies between the abstract and the full-text publication were examined, categorized as major and minor discrepancies, and quantified. The data were collected and analyzed using descriptive analysis. Frequency and percentage of major and minor discrepancies were calculated. Results. A total of 109 (95.6%) articles showed changes from their abstracts. Seventy-four (65.0%) and 105 (92.0%) publications had at least one major and one minor discrepancies, respectively. Minor discrepancies were more prevalent (92.0%) than major discrepancies (65.0%). The most common minor discrepancy was observed in the title (80.7%), and most common major discrepancies were seen in results (48.2%). Conclusion. Minor discrepancies were more prevalent than major discrepancies. The data presented in this study may be useful to establish a more comprehensive structured abstract requirement for future meetings.

Analysis of abstracts presented at the prosthodontic research section of IADR General Sessions 2004-2005: demographics, publication rates, and factors contributing to publication.

PURPOSE: The purposes of this study were to describe the demographics of abstracts presented at the prosthodontics section of IADR General Sessions from 2004 to 2005, evaluate the publication rate of abstracts, and analyze the relationship between variables in abstracts and publication. MATERIALS AND METHODS: Prosthodontics research section abstracts from the IADR General Session in 2004 and 2005 were evaluated for: number of authors, presentation type, origin, affiliation, topic, study design, statistics, study outcome, and funding. The publication rate was calculated following a PubMed search. The journal of publication, year of publication, and the length of time before publication were analyzed. Descriptive statistics were used for the data analysis; the relationships between presentation type, study design, study outcome, statistics, funding, and publication were analyzed using logistic regression (α= 0.05). RESULTS: From 346 abstracts, 37.0% were published. For oral presentations, 40.7% were published; 35.8% of poster presentations were published. The mean duration before publication was 26.4 months. North America had the most abstracts, and Europe had the most publications. Fixed prosthodontic research had the highest number and proportion for publication. A significant association with publication was noted for neutral study outcomes (p= 0.018), studies with funding (p= 0.035), and abstracts from Europe (p= 0.001). CONCLUSIONS: The majority of abstracts from the prosthodontics research section of IADR General Sessions from 2004 and 2005 remain unpublished. A significant association for publication was noted with neutral outcomes, funding, and abstracts from Europe.

Gingival abscess removal using a soft-tissue laser.

A case of acute inflammatory enlargement of gingival tissue in the form of a gingival abscess is presented in this paper. Its clinical features and histopathologic presentation are described. The etiology of this condition could be a variety of sources such as microbial plaque infection, trauma, and foreign body impaction. In this case, treatment included complete excision by the means of a 810-nm soft-tissue diode laser, which resulted in resolution of the abscess and clinical wound healing within approximately 2 to 3 weeks. Prognosis was excellent due to early diagnosis and immediate treatment.

Gender trends in dental leadership and academics: a twenty-two-year observation.

The purpose of this study was to examine gender disparities in dental leadership and academics in the United States. Nine journals that represent the dental specialties and high published impact factors were selected to analyze the percentage of female dentists' first and senior authorship for the years 1986, 1990, 1995, 2000, 2005, and 2008. Data on appointment status and female deanship were collected from the American Dental Association (ADA) survey, and the trends were studied. The proportion of female presidents in ADA-recognized specialty organizations was also calculated. Overall, the increase in first female authorship was not statistically significant, but the increase of last female authorship was statistically significant in a linear trend over the years. The percentage of tenured female faculty members and female deans in U.S. dental schools increased by factors of 1.7 and 9, respectively, during the study period. However, female involvement in professional organizations was limited. Findings from this study indicate that female participation in authorship and leadership has increased over time. Nevertheless, females are still a minority in dental academics and leadership.

A modified treatment approach for fabricating a mandibular distal-extension partial denture: a clinical report.

An altered cast impression technique is routinely used for fabricating distal-extension partial dentures. The advantages of an altered cast impression technique are that it evenly distributes stresses between hard and soft tissues and reduces stresses to the abutment teeth. However, there is some controversy among clinicians as to the technique and requirements of both tooth and tissue management of the distal-extension partial denture. A modified approach of fabricating a distal-extension partial denture is presented using a laboratory-processed functional reline method. The functional reline is performed after the removable partial denture is processed to perfect the fit of the denture base to the residual ridge. This enables the partial denture to be constructed from a cast made from a single impression and results in a prosthesis that is stable and has well-extended borders. Not only is it easy and less technique-sensitive for the operator, but it also results in increased comfort and reduced need for multiple adjustment visits for the patient.

Repairing an implant titanium milled framework using laser welding technology: a clinical report.

The application of laser welding technology allows titanium to be welded predictably and precisely to achieve accurate fit of a milled framework. Laser energy results in localized heat production, thereby reducing thermal expansion. Unlike soldering, laser energy can be directed to a small area, making it possible to laser weld close to acrylic resin or ceramic. This article describes the use of laser welding to repair an implant titanium milled fixed denture. A quick, cost-effective, accurate repair was accomplished, and the repaired framework possessed adequate strength and the same precise fit as the original framework.

Comparison of porcelain surface and flexural strength obtained by microwave and conventional oven glazing.

STATEMENT OF PROBLEM: Although the superior qualities of microwave technology are common knowledge in the industry, effects of microwave glazing of dental ceramics have not been investigated. PURPOSE: The purpose of this study was to investigate the surface roughness and flexural strength achieved by glazing porcelain specimens in a conventional and microwave oven. MATERIAL AND METHODS: Thirty specimens of each type of porcelain (Omega 900 and IPS d.Sign) were fabricated and sintered in a conventional oven. The specimens were further divided into 3 groups (n=10): hand polished (using diamond rotary ceramic polishers), microwave glazed, and conventional oven glazed. Each specimen was evaluated for surface roughness using a profilometer. The flexural strength of each specimen was measured using a universal testing machine. A 2-way ANOVA and Tukey HSD post hoc analysis were used to determine significant intergroup differences in surface roughness (alpha=.05). Flexural strength results were also analyzed using 2-way ANOVA, and the Weibull modulus was determined for each of the 6 groups. The surfaces of the specimens were subjectively evaluated for cracks and porosities using a scanning electron microscope (SEM). RESULTS: A significant difference in surface roughness was found among the surface treatments (P=.02). Follow-up tests showed a significant difference in surface roughness between oven-glazed and microwave-glazed treatments (P=.02). There was a significant difference in flexural strength between the 2 porcelains (P<.005), but no significant difference in flexural strength by surface treatment (P=.48). The Weibull modulus value for the Omega 900 microwave-glazed group was the highest (1.9) as compared to the other groups. CONCLUSIONS: The surface character of microwave-glazed porcelain was superior to oven-glazed porcelain. Omega 900 had an overall higher flexural strength than IPS d.Sign. Weibull distributions of flexural strengths for Omega 900 oven-glazed and microwave-glazed specimens were similar. SEM analysis demonstrated a greater number of surface voids and imperfections in IPS d. Sign as compared to Omega 900.

Altering occlusal vertical dimension provisionally with base metal onlays: a clinical report.

This article presents a method for altering occlusal vertical dimension (OVD) to restore dentitions with limited restorative space due to loss of tooth structure. A provisional increase in OVD is achieved using predominately base metal onlays, which offer advantages over conventional techniques. The onlays are resistant to wear, may be bonded well to nonrestored and restored tooth surfaces with resin cements, and provide a fairly reversible method of increasing OVD. A patient situation is presented which demonstrates the use of provisional base metal onlays in complete mouth rehabilitation.

A technique for duplicating a fixed complete denture.

The fixed implant prosthesis often requires repair due to fracture and/or wear of acrylic resin teeth. Repair of such a prosthesis, although simple, requires retaining the prosthesis to be revised in the laboratory. In order to reveneer the implant prosthesis, a provisional restoration should be fabricated for the patient that provides similar function and esthetics. This article presents a technique for duplicating the existing fixed implant-supported prosthesis prior to repair/reveneer, thus providing a smooth transition from the provisional to the definitive prosthesis.