A retrospective multicenter study comparing metal-ceramic and composite single crowns performed in public general dentistry: 5-year results.

Objective The aim of this study was to evaluate and compare the 5-year survival and complication rate of metal-ceramic (MC) and composite single crowns performed within Public Dental Service, general dentistry, in three Swedish counties and with patients' gender, tooth position, root canal treatment and the presence of a post-and-core taken into account. Methods Data were collected from dental records of 600 patients who had received either an MC (n = 300) or a composite (n = 300) crown on a premolar or molar tooth in the year 2005 and where 5 years of follow-up data were available. Status at treatment completion and at follow-up was recorded, together with any history of intervention during the follow-up period. Results The 5-year survival rate for MC crowns was higher than for composite crowns (93% versus 70%; p < 0.001). This difference was stable, irrespective of the county, patients' gender or tooth position. No gender difference in survival rate was seen for MC crowns, while the survival of composite crowns was significantly higher among women than among men (75% versus 65%; p < 0.05). For MC crowns, there was a tendency toward a lower survival rate for endodontically treated teeth without a post-and-core (83%) as compared to those provided with a post-and-core (93%) and to vital teeth (94%). Surviving composite crowns had recordings of significantly more complications than MC crowns (p < 0.001). Conclusion On premolars and molars, MC crowns have a better medium-term prognosis and fewer complications than composite crowns.

Grounded theory on factors involved in the decision-making processes of patients treated with implant therapy.

PURPOSE: The aims of this research were to describe the process leading to desire for implant treatment, describe how patients missing teeth gained information about implant treatment, identify gatekeeping factors for implant treatment, and note experiences in changes in oral health-related quality of life. MATERIALS AND METHODS: The constant comparative method for a grounded theory was used in collecting and analyzing data. Ten informants participated in the study, all of whom were treated with implant-supported fixed dentures during the past year. RESULTS: The emerging core category was that participants experienced a journey from social stigma to exhilaration. This process ended in the perspective that the participants' new lives with dental implants were very good and meant an end to their social stigma, but gatekeeping factors before treatment, such as cost and dental anxiety, were noted. The dentist's opinion and suggestions were the most decisive part of the decision-making process, and trust in the dentist and dental team was crucial in the decision to undergo treatment and in the overall treatment experience. Great improvement in oral health-related quality of life was noted. CONCLUSION: This qualitative study gives as the core category and main finding the importance of patients' trust and confidence in the dentist and his/her staff in the process of transforming desire for dental implant treatment into demand and also in making it more likely for patients to be satisfied with treatment regardless of complications.

Factors explaining desire for dental implant therapy: analysis of the results from a longitudinal study.

PURPOSE: The aim of this research was to investigate possible factors behind the desire for and changes in attitude toward implant treatment in a population of middle-aged and older individuals in Sweden. MATERIALS AND METHODS: In 1989 and 1999, questionnaires were sent to 3,000 residents in Orebro County, Sweden. Response rates were 79% and 68%, respectively. Those responding to both questionnaires yielded a longitudinal study panel. Logistic regression models were done with "desire of implant treatment" and "changes in desire of implant treatment" as dependent variables. RESULTS: Older people, non-city residents, and those with one or several missing and unreplaced teeth changed their desire for implant treatment between study years. Effects of age, residence, and better dental status disappeared during the 10-year study period. Those who were edentulous and those with removable dentures (pseudo R2: 0.17) expressed lower desire for treatment than those with all teeth remaining or only one or a few teeth missing (pseudo R2: 0.24) in 1989. High income significantly increased the probability to desire implant treatment for the study panel at both study occasions (P = .016 and P = .034 for 1989 and 1999, respectively). CONCLUSIONS: Factors influencing desire for implant treatment were primarily income and dental status. The influence of young age, urban living, and dental status regarding the subgroup with one or several teeth missing in relation to those with all their teeth disappeared during the 10-year study period.

Factors shaping demand for prostethic dentistry treatment with special focus on implant dentistry.

AIM: The main aim of this thesis was to investigate how attitudes influence the latent and manifest need, desire, demand, and utilization for dental implant treatment, considering the gatekeeping process between need and demand, and between demand and utilization of dental treatment. MATERIAL AND METHODS: A conceptual analysis of the need and demand concept from the literature was a first step in the study. A second step was to examine changes in attitudes toward desire for implant treatment over time, also in relation to dental status, in a population of middle aged and older individuals in Sweden based on two questionnaire studies, one in 1989 and the other in 1999 among the same 3000 participants. The individuals who responded both in 1989 and 1999 constituted a panel of 56% of the 1989 survey sample. Logistic regression models were done with desire of implant treatment as dependent variable. In paper V, a qualitative study using grounded theory was done on the treated patients' subjective perspective on receiving a fixed implant-supported denture. RESULTS: An emancipatory perspective with the patient-dentist dialogue was regarded as central for an optimal treatment result in the prosthetic treatment decision-making process. A main finding was that need is established only in a communicative dialogue with mutual respect between the profession and the patient. The study implied that the gatekeeping concept relates to a complex process rendering great differences between demand and actual utilization. The main result from the questionnaires was the huge increase in interest for implant-treatment from 1989 to 1999. In 1999 almost all (94%) of the study population expressed desire for implant treatment; as many as 92 % percent of those who did not express a desire for implants in 1989 had changed their mind 10 years later. The regression analysis showed that older people, non-city residents, and those with one or several missing and unreplaced teeth, changed desire for implant treatment between the study years. Effects of age, residence, and better dental status disappeared during the ten year study period. Those edentulous and those with removable dentures expressed less desire than those with all teeth remaining, or only one or a few teeth missing, in 1989. High income significantly increased the probability to desire implant treatment for the study panel at both study occasions. The qualitative study, using the method for grounded theory, gave as core category and main finding the importance of the patients' trust and confidence in the dentist and his/her staff, in the process of transforming desire for dental implant treatment into manifest demand, and also making it more likely for the patients' to become satisfied with the treatment result regardless of complications. CONCLUSION: There is no objective need in prosthodontic treatment. Manifest need and demand change over time, and are influenced by the patients' attitude and situation, and by the dentist's practice profile. True need can only be identified in a dialogue between the professional and the patient. Income and dental status, but not age, place of residence, nor concern for dental appearance, influence desire for implant treatment at the end of the studied 10-year period. Individuals with removable dentures, or those being edentulous in one or both jaws have a lower probability to desire implant treatment than those with all teeth remaining, or with missing teeth replaced by fixed partial dentures. The qualitative study underlined the importance of the relationship between the professional and the patient. The patients' trust and confidence in the dentist and his/her staff were decisive in the process of making a demand for implant treatment manifest and turning it into actual utilization. The informants from this study described their confidence and trust as dependent on a communicative dialogue with mutual respect between the patient and the professional.

A 5-year prospective clinical study of submerged and nonsubmerged Paragon system implants in the edentulous mandible.

PURPOSE: The aim of this investigation was to evaluate the clinical outcome of two different surgical protocols in the edentulous mandible: submerged and nonsubmerged. Further, the Paragon dental implant with a titanium plasma-sprayed surface was evaluated. MATERIALS AND METHODS: Twenty-nine consecutively treated patients with 168 implants supporting fixed prostheses were included. All but 3 patients were provided 6 implants, placed via nonsubmerged healing on one side and submerged healing on the other. Data were collected from patient records and radiographs. Twenty-four patients participated in the 5-year clinical follow-up examination. RESULTS: After 5 years, all patients still had their mandibular fixed prostheses in function. Cumulative survival rates were 100% for prostheses and 99.4% for implants. However, 3 implants fractured in 1 patient. One submerged implant was lost before loading but no further implants were lost during follow-up. The radiographic bone loss was small for all implants with a mean of 0.14 mm (standard deviation [SD]: 0.37) at 1 year and 0.42 mm (SD: 0.48) at 5 years for nonsubmerged implants and 0.17 mm (SD: 0.32) at 1 year and 0.51 mm (SD: 0.33) at 5 years for submerged implants. Nineteen implants (including the 3 that fractured) presented annual bone loss exceeding 0.2 mm after the first year, yielding a cumulative success rate of 86.2% after 5 years. CONCLUSION: Single-stage surgery was shown to have the same predictability as two-stage surgery in the anterior edentulous mandible. Paragon implants with a titanium plasma-sprayed surface showed a fracture rate of 2.2% and a success rate of 86.2% after 5 years.

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.

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.

20-year follow-up of patients receiving high-cost dental care within the Swedish Dental Insurance System: 1977-1978 to 1998-2000.

The objective was to perform a long-term follow-up study of patients that had received high cost dental care within the Swedish National Dental Insurance System in 1977-1978 with special focus on remaining teeth, periodontal disease progression, change in the prevalence of root-filled teeth and teeth with apical periodontitis as well as the survival of fixed prosthetic reconstructions. All 262 patients who had had their treatment plans sent for approval for high-cost dental care in 4 local health insurance districts and who were sampled for base-line studies in 1977-1978, were offered a free clinical examination including radiographs in 1998. 177 patients (68 % of the original sample) could be reached for telephone interview and 104 of them (40 % of the original sample) were examined clinically and radiographically. Comparisons were made with records and radiographs from 1977-1978. The analyses were performed with the individual patient as the studied unit. The low progression of severe periodontal disease during the 20-23 year follow-up period and the decrease in number of teeth with apical periodontitis among a majority of the patients examined, indicated that the dental care received resulted in a limitation of dental disease on the individual level. Furthermore 63 % of the patients had the fixed prosthetic reconstructions, received after approval 1977-1978, in full extention after 20-23 years. However, more tooth losses were observed among the patients in this study than in similar studies in Swedish general populations over the same decades. Furthermore multiple tooth extractions were significantly more frequent in patients with severe periodontitis at baseline and in patients with less apical periodontitis at follow-up in this study. Thus it seems that tooth extraction not seldom was a treatment choice for teeth with severe periodontitis and apical periodontitis among the patients examined clinically in this study.

Prosthodontics and the patient: what is oral rehabilitation need? Conceptual analysis of need and demand for prosthodontic treatment. Part 1: a conceptual analysis.

PURPOSE: The concepts of need and demand are central in studies on dental care. In the literature, a normative definition is often used, but it pays little attention to the individual's personal comfort and quality of life. Need and demand for prosthodontic services are difficult to measure, as prosthodontic treatment is highly individual and not closely related to edentulousness. Need, however defined, does not always lead to demand for treatment, depending on a variety of factors. MATERIALS AND METHODS: The present article is part of a larger study in which the intention is to evaluate need and demand for prosthodontic treatment among the participants in a 1989 and 1999 longitudinal study of a population sample. As the first step, this article reports a conceptual analysis of the need concept from the literature. RESULTS: Need is stated as socially established in the interaction between patient and clinician. It makes demand dependent on available treatment options from the care provider and society. In the prosthetic treatment decision-making process, the emancipatory perspective with the patient-clinician dialogue is of utmost importance to achieve an optimal treatment result. CONCLUSION: The professional attitude toward need must be that there is no true objective or subjective need. Need is established only in a communicative dialogue with mutual respect between the professional and the patient.