Development of patient-centric eating advice for complete denture wearers.

BACKGROUND: Edentulous people eat less healthily, and wearing dentures impairs eating function and enjoyment. OBJECTIVE: To apply a sequential approach to integrate scientific evidence, and patient and professional experience to co-develop intervention to support better eating with dentures. METHODS: Focus groups, two with purposive samples of patients and two with dental professionals, explored experiences and opinions about advice on eating with complete dentures. Findings were distilled with evidence from the literature to underpinned concepts for eating interventions. User engagement informed prioritisation of ideas and led to the development of a leaflet on eating with dentures. RESULTS: Patients receive no advice on what they can realistically expect when eating with dentures, and professionals lacked confidence to provide eating advice. Patients did not think dentists a credible provider of eating advice, feeling peer support more appropriate and offering numerous strategies for eating with dentures. Concepts for eating intervention included a patient leaflet, Web-based eating interventions, patient support blogs, waiting room videos and improved nutrition training for dental professionals. User feedback informed prioritisation of ideas, leading to the development of a leaflet on eating with dentures. Justified by the data, the leaflet focused on patient-generated tips for overcoming the functional limitations of eating with dentures, and unobtrusive healthier eating advice. Face validity with users confirmed acceptability. CONCLUSION: A systematic and rigorous integration of scientific evidence, expert experience and patient input has developed a patient-centric, evidence-based approach to a patent leaflet on eating with dentures that, based on initial face validity, is likely to be well received.

Provision of information to patients on dental implant treatment: Clinicians' perspectives on the current approaches and future strategies.

OBJECTIVES: To explore 1) the approaches that are adopted by clinicians to give patients information in relation to dental implant treatment during clinical consultations; 2) clinicians' reflections on their current practices of implant information provision; and 3) clinicians' suggestions to improve future implant information provision. METHODS: A qualitative study employing face-to-face semi-structured interviews with eight clinicians working in UK secondary dental care. The data gathering and analysis followed the principles of qualitative thematic analysis. RESULTS: Clinicians reported that patients often hold misconceptions about dental implants, which are commonly acquired from generic information sources such as the media. This might be linked to high expectations regarding treatment outcomes and difficulties in communicating during clinical consultations. Clinicians were sometimes reluctant to voluntarily offer information about the longevity/ lifespan of implant supported restoration (ISR) and they had different opinions regarding the timing of information related to their long-term maintenance needs. Several strategies for improving the current practice of information giving in relation to dental implant treatment were suggested by clinicians. CONCLUSION: Providing accurate and timely information to patients could be challenging, although clinicians recognised the importance of doing so. As clinicians explained and debated their current approaches and reflected on their practices, they identified areas of potential improvement and ways to improve information provision related to dental implants. These were mainly focused on transforming patient care so that there is efficient co-operative alliance between patients and dental care providers. Considering upgrading information provision throughout the implant treatment pathway would transform this aspect of healthcare to make it more "patient-centred" than it is currently.

Patients' perceptions of implant placement surgery, the post-surgical healing and the transitional implant prostheses: a qualitative study.

OBJECTIVES: This study aimed to explore patients' thoughts, feelings about, and experiences of, implant placement surgery (IPS), the post-surgical healing stage and the immediate post-surgical transitional implant prosthesis (TIP) (fixed and removable). METHODS: A qualitative study design was chosen and 38 semi-structured telephone and face-to-face interviews were conducted with 34 patients at different stages of implant treatment. The interviews were transcribed verbatim; the data collection and coding process followed the principles of thematic analysis, which was facilitated through the use of NVivo10. RESULTS: Patients anticipated that surgery would be painful and unpleasant but were prepared to accept this temporary discomfort for the expected benefits of implant treatment. However, a key finding was that patients felt they had overestimated the trauma of surgery but underestimated the discomfort and difficulties of the healing phase. A number of difficulties were also identified with the TIP phase following implant surgery. CONCLUSION: Existing research has tended to focus on the longer term benefits of dental implant treatment. This qualitative study has investigated in-depth patients' perceptions of dental implant surgery, including their experiences related to sedation, and of transitional implant restoration. While patients felt their concerns were overestimated in relation to the implant surgery, they experienced greater morbidity than they expected in the healing phase. Recommendations are made for relatively small changes in care provision which might improve the overall patient experience. Partial dentate patients treated with a fixed transitional prosthesis experienced advantages more quickly than patients with an overdenture.

Patient non-attendance: utilising clinical time.

BACKGROUND: In undergraduate dental or medical programmes clinical time with exposure to patients is limited. A priority for all those involved in the delivery of a clinical programme is to ensure that this time is used effectively and to maximum potential. Patient non-attendance is a reality, and developing organised activities to provide alternative learning opportunities is important. METHODS: We have developed a range of close-contact teaching and learning activities (CCTLs) for dental students to productively use patient non-attendance time. CCTLs are short, skills-based tasks that are directly observed and have structured assessment criteria. Used formatively, they are performed in the clinical environment utilising the materials, equipment and clinical staff usually available during the clinical session. FINDINGS: The CCTLs have proved particularly useful for early-stage clinical students, by developing understanding and skills, reinforcing protocols and promoting the role of the wider dental team in teaching. Students have welcomed these activities and engagement has been high. In addition to improving skills, they have proved helpful in familiarising students with direct observation, and have inspired peer collaboration and feedback. DISCUSSION: The CCTLs have promoted opportunities for students to receive direct feedback, which may be difficult to deliver if a patient were present. Empowering students to lead on their own learning requirements also promotes the ethos of lifelong learning that will be fundamental to future professional development. Investment of resources to develop these activities has proved worthwhile, as we have found that CCTLs can complement and maximise the potential of clinical attachments. Patient non-attendance is a reality, and developing organised activities to provide alternative learning opportunities is important.

In individuals with complete tooth loss, the mandibular implant-retained overdenture increases patient satisfaction and oral health related quality of life compared to conventional dentures.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: A comparison of implant-retained mandibular overdentures and conventional dentures on quality of life in edentulous patients: a randomized, prospective, within-subject controlled clinical trial. Harris D, Höfer S, O'Boyle CA, Sheridan S, Marley J, Benington IC, Clifford T, Houston F, O'Connell B. Clin Oral Implants Res 2013; 24(1): 96-103. REVIEWERS: Elham Emami, DDS, MSc, PhD, J. Mark Thomason, BDS, PhD, FDS, RCS (Ed) PURPOSE/QUESTION: Is there any difference between mandibular implant-retained overdentures and conventional dentures in terms of oral health-related quality of life and patient satisfaction when restoring edentulous mandibular dental arches? SOURCE OF FUNDING: Industry, Straumann Ltd TYPE OF STUDY/DESIGN: Randomized controlled trial LEVEL OF EVIDENCE: Level 2: Limited-quality, patient-oriented evidence STRENGTH OF RECOMMENDATION GRADE: Not applicable.

The use of mandibular implant-retained overdentures improve patient satisfaction and quality of life.

SELECTION CRITERIA: This study comprises meta-analyses of studies examining the effect of treatment of edentulism with implant-retained mandibular overdentures. Initially 2262 nonduplicated articles were identified from the database searches, of which 37 were eligible for full-text searching. Twenty-seven were excluded because they failed to meet the inclusion criteria, their populations and outcomes overlapped, or their outcomes were outside the remit of the review. A total of 10 manuscripts on 7 randomized controlled trials were included in the meta-analysis. The sample sizes in these trials varied from 60 to 157 participants. The total number of different subjects included in the studies considered was 750. Some of the published papers included the same study populations but with different outcome measures, for example Awad et al(1) and Thomason et al(2) (oral health-related quality of life at 2 months and general satisfaction at 6 months, respectively). Study populations that appeared in more than 1 publication were included only once in the meta-analysis using the more informative publication for that outcome. The age range of those involved in the studies ranged from 35 to 80 years, and all patients wore conventional maxillary complete dentures and either mandibular implant-retained or conventional complete dentures. Outcomes were included with a follow-up period of at least 2 months. KEY STUDY FACTOR: Key study factors were the treatment with an implant-retained mandibular overdenture of edentulous patients who had previously been treated with conventional complete dentures. MAIN OUTCOME MEASURE: The primary outcomes were general satisfaction, oral health quality of life (QOL), and general health QOL measures. These patient-centred measures were used to assess the efficacy of the treatment provided. Outcomes of the meta-analysis are expressed in terms of effect size (ES). MAIN RESULTS: Ten publications of 7 randomized controlled trials were identified, and 8 of these publications were used in the meta-analysis. For the effect of treatment on general patient satisfaction, from the 10 publications 6 studies with a population of 588 participants (n = 322 implant overdentures; n = 266 conventional dentures) were used. General satisfaction was expressed by the participants using a 100-mm visual analog scale or Likert-type response scale. The pooled ES was 0.80 (z = 3.56, 95% confidence interval [CI] 0.36-1.24, P = .0004) in favor of the implant overdenture. The standardized mean differences were positive in all of the studies. The P value for heterogeneity (

The prevalence of dysplasia and malignant lip lesions in transplant patients.

BACKGROUND: Solid organ transplant patients are at an increased risk of developing lip malignancies. The role of HLA mismatch as a risk factor for such changes has only been described in skin. METHODS: Lip lesions were evaluated in 403 solid organ transplant patients (immunosuppressed for at least 3 months) and findings compared to age and sex matched, otherwise healthy patients who acted as controls. HLA typing was provided for the transplant patients. All patients provided details of smoking history, alcohol consumption, skin type, as assessed by ease of burning to sunlight, and exposure to sunlight or other forms of ultraviolet radiation. RESULTS: Lip lesions were identified in 36 transplant patients and 29 were biopsied. Fourteen of the biopsies confirmed dysplastic or malignant changes. For the control patients, one lesion was identified as dysplastic. The prevalence of dysplastic and malignant lip lesions was significantly higher (P = 0.006) in the transplant patients when compared to controls. Risk factors for dysplastic/malignant changes in the transplant group included age (P = 0.01), smoking (P = 0.033) and HLA-B mismatch (P = 0.001). Lip covering provided a significant reduction (P = 0.045) in the development of lip changes. CONCLUSION: All transplant patients should be regularly screened for lip malignancies and consulted on smoking and sunlight exposure. HLA-B mismatch does appear to make these patients more susceptible to dysplastic/malignant changes.

Refusal of implant supported mandibular overdentures by elderly patients.

OBJECTIVE: The aim of this study was to gain greater in-depth understanding of why elderly patients who are currently dissatisfied with conventional dentures decline implant treatment. BACKGROUND: There is strong evidence from high-quality randomised controlled trials to support the use of implant-supported overdentures for the restoration of the edentulous mandible. However, whilst recruiting for randomised clinical trials, researchers have found that a high proportion of potential subjects decline participation, despite the removal of financial constraints. MATERIALS AND METHODS: The study adopted a qualitative approach to provide a rich and deep understanding of people's reasons for refusal. Data were collected through focus group interviews in a two-centre study based in Montreal, Canada and Newcastle, UK. A semi-structured interview schedule was used and iteratively developed as analysis identified themes from previous focus groups. Transcripts of focus groups were coded and emergent themes determined. RESULTS: Two main themes emerged; patients' fear and anxiety (relating to the pain of surgery, complications of the procedure and immediate post-surgical denture use), and the appropriateness of the procedure in an elderly person. CONCLUSIONS: Fears of pain, complications and social embarrassment, exacerbated by age, are important factors that help explain refusal of implants by elderly patients.

A pilot study examining the effects of enhanced aesthetics on oral health related quality of life and patient's satisfaction with complete dentures.

A randomised cross-over study with a validated assessment tool was used to assess patient satisfaction and oral health related quality of life after the delivery of two sets of dentures: one set had an enhanced aesthetics. There was a significant increase in patient satisfaction and oral health related quality of life when baseline data was compared with both types of replacement dentures. Some patients preferred the prostheses with enhanced aesthetics, although all patients reported significantly increased satisfaction with their new dentures; these findings are explored. No difference was seen in the outcome variables between the control and aesthetic dentures and sequence of delivery showed no difference.

Does mandibular edentulous bone height affect prosthetic treatment success?

OBJECTIVES: The aim of this study is to determine whether mandibular bone height affects patients' ratings of satisfaction and function with mandibular 2-implant overdentures (IODs) and conventional dentures (CDs). METHODS: 214 edentulous elders were randomly allocated into 2 groups and treated with maxillary CDs and either mandibular CDs or IODs. Classifications of mandibular bone height were carried out on panoramic radiographs using 4 published methods. At baseline and 6 months after delivery, all participants rated their satisfaction with their prostheses using the McGill Denture Satisfaction Instrument. Independent t-tests and a linear multivariable regression model were used for statistical analyses. RESULTS: Mandibular bone height has no effect on patients' ratings of general satisfaction, nor on ratings of ability to chew, stability, comfort, aesthetics and ability to speak at 6 months (p>0.05, linear regression). There were significant between treatment differences in ratings of general satisfaction, comfort, stability and ability to chew from all mandibular bone height categories, with higher ratings assigned to IODs (p<0.01, t-tests). Linear regression analyses confirmed that, for general satisfaction, as well as ability to chew, stability, comfort, aesthetics and ability to speak, treatment with IODs contributes to higher satisfaction ratings (p<0.001), while mandibular bone height does not. CONCLUSIONS: The evidence demonstrates that mandibular bone height has no effect on patients' satisfaction with the function, chewing ability and comfort of their prostheses. Furthermore, no matter how much mandibular bone, these results suggest that edentulous elders will benefit more from mandibular IODs than from CDs.

The use of mandibular implant-retained overdentures improve patient satisfaction and quality of life.

SELECTION CRITERIA: This study comprises meta-analyses of studies examining the effect of treatment of edentulism with implant-retained mandibular overdentures. Initially 2262 non-duplicated articles were identified from the database searches, of which 37 were eligible for full-text searching. Twenty-seven were excluded because they failed to meet the inclusion criteria, their populations and outcomes overlapped, or their outcomes were outside the remit of the review. A total of 10 manuscripts on 7 randomized controlled trials were included in the meta-analysis. The sample sizes in these trials varied from 60 to 157 participants. The total number of different subjects included in the studies considered was 750. Some of the published papers included the same study populations but with different outcome measures, for example Awad et al and Thomason et al (oral health-related quality of life at 2 months and general satisfaction at 6 months, respectively). Study populations that appeared in more than 1 publication were included only once in the meta-analysis using the more informative publication for that outcome. The age range of those involved in the studies ranged from 35 to 80 years, and all patients wore conventional maxillary complete dentures and either mandibular implant-retained or conventional complete dentures. Outcomes were included with a follow-up period of at least 2 months. KEY STUDY FACTOR: Key study factors were the treatment with an implant-retained mandibular over denture of edentulous patients who had previously been treated with conventional complete dentures. MAIN OUTCOME MEASURE: The primary outcomes were general satisfaction, oral health quality of life(QOL), and general health QOL measures. These patient-centred measures were used to assess the efficacy of the treatment provided. Outcomes of the meta-analysis are expressed in terms of effect size (ES). MAIN RESULTS: Ten publications of 7 randomized controlled trials were identified, and 8 of these publications were used in the meta-analysis. For the effect of treatment on general patient satisfaction, from the 10 publications 6 studies with a population of 588 participants (n = 322 implant overdentures; n = 266 conventional dentures) were used. General satisfaction was expressed by the participants using a 100-mm visual analog scale or Likert-type response scale. The pooled ES was 0.80 (z = 3.56, 95% confidence interval [CI] 0.36-1.24, P = .0004) in favor of the implant overdenture. The standardized mean differences were positive in all of the studies. The P value for heterogeneity (chi2= 31.63, df = 5) was P less than .00001 and l(2)= 84%.For the effect of mandibular prosthesis on oral health-related QOL, the meta-analysis included only studies using the Oral Health Impact Factor (OHIP) as the measurement instrument. A total of 280 participants were therefore included in the analysis (n = 146 implant over-dentures; n = 134 conventional dentures). For the 3 pooled trials the ES was -0.41(z = 131, 95% CI -1.02 to 0.20, P = .19). Significant heterogeneity was again observed. The P value for heterogeneity (chi2 = 11.53, df = 2) was P equals .003 and l(2) equals 83%. In 2 of the 3 trials the 95% CI did not include an ES of zero. When the analysis was restricted to studies including populations that were recruited from the general population recruited via advertisement, the pooled ES values declined from -0.41 to -0.71 (z = 4.37, 95% CI -1.03 to -0.39, P < .0001), the -ve value for their ES were consistent with a significantly positive effect in favor of the implant overdenture treatment. For the effect of treatment on perceived general health, only 1 article was found that used a general instrument to measure this--the authors had used the SF-36 and found no difference between groups on any of the subscales--as no other study used a similar scoring method no further processing of the data was undertaken. CONCLUSIONS: The analyses illustrate that patient general satisfaction and oral health-related QOL are greater with mandibular implant-retained overdentures than conventional dentures, but the magnitude of these effects remain uncertain, and heterogeneity of outcomes was observed. The review sheds no new light on the effect of the treatment on general health related QOL.

Mandibular two implant-supported overdentures as the first choice standard of care for edentulous patients--the York Consensus Statement.

The Annual Conference of the BSSPD (British Society for the Study of Prosthetic Dentistry) was held in York on 6 and 7 April 2009. At the symposium on mandibular overdentures, presenters offered a synopsis of the research available on the efficacy of implant-supported mandibular overdentures in the edentulous mandible. Emphasis was given to both qualitative and quantitative research based on patient-centred outcomes of treatment. A draft consensus was circulated to all presenters and to the Council members of the BSSPD and to BSSPD members on the Society's website. The statement was modified in the light of their comments, audience feedback following the presentations and members' feedback. We hope that this consensus statement will be a useful guide for patients and clinicians and that it will act to stimulate wider debate. We also hope that it will prove useful to other patient and professional organisations and will inform discussions with providers of national healthcare and with independent funders.

Paying for treatments? Influences on negotiating clinical need and decision-making for dental implant treatment.

BACKGROUND: The aim of this study is to examine how clinicians and patients negotiate clinical need and treatment decisions within a context of finite resources. Dental implant treatment is an effective treatment for missing teeth, but is only available via the NHS in some specific clinical circumstances. The majority of people who receive this treatment therefore pay privately, often at substantial cost to themselves. People are used to paying towards dental treatment costs. However, dental implant treatment is much more expensive than existing treatments--such as removable dentures. We know very little about how dentists make decisions about whether to offer such treatments, or what patients consider when deciding whether or not to pay for them. METHODS/DESIGN: Mixed methods will be employed to provide insight and understanding into how clinical need is determined, and what influences people's decision making processes when deciding whether or not to pursue a dental implant treatment. Phase 1 will use a structured scoping questionnaire with all the General dental practitioners (GDPs) in three Primary Care Trust areas (n = 300) to provide base-line data about existing practice in relation to dental implant treatment, and to provide data to develop a systematic sampling procedure for Phase 2. Phases 2 (GDPs) and 3 (patients) use qualitative focused one to one interviews with a sample of these practitioners (up to 30) and their patients (up to 60) to examine their views and experiences of decision making in relation to dental implant treatment. Purposive sampling for phases 2 and 3 will be carried out to ensure participants represent a range of socio-economic circumstances, and choices made. DISCUSSION: Most dental implant treatment is conducted in primary care. Very little information was available prior to this study about the quantity and type of treatment carried out privately. It became apparent during phase 2 that ISOD treatment was an unusual treatment in primary care. We thus extended our sample criteria for Phase 3 to include people who had had other implant supported restorations, although not single tooth replacements.

Implant overdentures for edentulous elders: study of patient preference.

BACKGROUND: Studies show that elders wearing implant overdentures have improved nutrition and quality of life. However, upfront costs of this therapy are high, and the income of elderly edentulous populations is low. OBJECTIVES: This study was designed (i) to measure the preferences of edentulous patients for mandibular two-implant overdentures using Willingness-To-Pay (WTP) and Willingness-To-Accept (WTA), (ii) to assess the effect of long-term financing on WTP and (iii) to assess the desired role of health care plans in financing dental prostheses. METHODS: Edentulous elders (68-79 years; n = 36) wearing maxillary dentures and either a mandibular conventional denture (CD, n = 13) or a two-implant overdenture with ball attachments (IOD, n = 23) participated in this study. All had received their prostheses 2 years previously, as part of a randomised clinical trial. A three-part questionnaire was completed during a 20-min interview with a trained researcher. RESULTS: Forty-six per cent (6/13) of the CD wearers and 70% (16/23) of the IOD wearers were willing to pay three times more than the current cost of conventional dentures for implant prostheses. These percentages were increased to 77% (CD) and 96% (IOD) if participants could pay for implant overdentures in monthly instalments. Eighty-six per cent (31/36) of all participants in both groups (21/23 IOD; 10/13 CD) thought that the government should cover at least some of the cost of implant overdentures. CONCLUSIONS: This study shows that, the majority of elderly edentate individuals who have not experienced mandibular two-implant overdenture therapy are willing to pay the cost, particularly when payment can be made in monthly instalments.

Do mandibular implant overdentures and conventional complete dentures meet the expectations of edentulous patients?

OBJECTIVES: To measure expectations of satisfaction with implant and conventional denture treatment in 2 groups of edentulous people and compare them with their resultant ratings of satisfaction to determine if either treatment meets the pretreatment expectation. METHOD AND MATERIALS: One hundred sixty-two edentulous middle-aged (MA, n = 102) and senior (S, n = 60) patients were enrolled in 2 trials and, after randomization, received either a mandibular 2-implant overdenture (IOD) or a new conventional denture (CD). Before randomization, each subject rated their satisfaction with their current denture and expectations of satisfaction with both IOD and CD treatment on 100-mm visual analog scales (VAS). Six months posttreatment, all rated their satisfaction with their new prostheses on similar VAS. Expectations and satisfaction with treatment were compared. RESULTS: Posttreatment satisfaction with CD treatment was significantly lower than pretreatment expected satisfaction in both study populations (MA, P < .0001; S, P = .036). There was no (or only borderline) significant difference between pretreatment expectation and posttreatment satisfaction for patients receiving IODs in both study populations (MA, P = .078; S, P = .057). CONCLUSION: Posttreatment CD satisfaction failed to meet patients' pretreatment expectations of satisfaction; this was not the case for IODs, for which expectations were largely met.

Sex differences in denture satisfaction.

OBJECTIVES: Males and females differ in their responses to many health conditions and treatments. The aim of this randomized clinical trial was to determine whether there are differences in the way that male and female edentulous elders rate their satisfaction with new mandibular implant overdentures (IODs) and conventional dentures (CDs), at 6 and 12 months following delivery. METHODS: Edentulous elders (n=256) were randomly assigned to receive maxillary conventional dentures and either mandibular overdentures supported by two implants with ball attachments or conventional dentures. Participants rated their general satisfaction, as well as other features of their dentures (comfort, stability, ability to chew, aesthetics, etc.) prior to treatment and 6 and 12 months after delivery. RESULTS: Ratings of satisfaction with IODs were significantly higher than with CDs. Six months after delivery, females in the CD group rated their general satisfaction and satisfaction with ability to chew and aesthetics significantly lower than did the males. The sex differences in the CD group remained at 12 months after delivery. However, males and females in the IOD group rated their general satisfaction and all six subcategories equally. CONCLUSIONS: Elderly females are less satisfied with conventional dentures than elderly males with regards to aesthetics and ability to chew, but equally satisfied with implant overdentures. At 6 and 12 months after delivery, elderly edentulous males and females wearing mandibular implant overdentures were significantly more satisfied than those wearing conventional dentures.

How do patients perceive the benefit of reconstructive dentistry with regard to oral health-related quality of life and patient satisfaction? A systematic review.

BACKGROUND: Reconstructive dentistry encompasses an enormous range of treatment modalities from the restoration of single teeth to the reconstruction of the whole dentoalveolar complex in edentulous patients. Some treatment modalities have been assessed in terms of quality-of-life (QoL) outcomes and satisfaction OBJECTIVES: The aim of the present investigation was to search and review studies published between 1996 and 2006 in which the impact of the treatment was measured in terms of QoL outcome, ideally, oral health-related quality of life (OHRQoL). Patient satisfaction was also accepted as an outcome. MATERIALS AND METHODS: The primary search engine used was NICB PubMed based on MeSH headings. Hand searching of the cited references in the included papers identified a number of additional studies. The primary focus of the search was to link treatment to QoL outcomes. RESULTS: The majority of included studies involved the treatment of edentulous patients, particularly the mandible. The preponderance of the studies comparing conventional dentures (CDs) and implant-supported overdentures (IODs) were randomized-controlled trials (N = 18). There was compelling evidence that patients were more satisfied with IODs than CDs. There was strong evidence that OHRQoL can be significantly improved using IODs. Evidence suggesting that one retention system is superior to another needs further clarification. Although high satisfaction ratings have been reported for maxillary implant prostheses, the overall ratings given to the maxillary implant prostheses were not significantly greater than for CDs. There was only sparce information regarding QoL or satisfaction outcomes for the majority of other forms of reconstructive dentistry. CONCLUSION: Apart from the restoration of the edentulous mandible with IODs or CD, where there is an accumulating body of evidence on the effect of treatment choice, there are many procedures for which there are little or no such data at all. As yet, the entire range of reconstructive treatment has witnessed insufficient investigations relating treatment to its effect on QoL or satisfaction. This is an area that needs to be expanded as a way of quantifying the effect of treatment choices.

Conventional rehabilitation of edentulous patients: the impact on oral health-related quality of life and patient satisfaction.

PURPOSE: This study examined patient satisfaction and oral health-related impacts on the quality of life of patients restored with complete conventional or duplicate dentures. MATERIALS AND METHODS: Forty patients (aged 55 to 85 years) were assigned to receive new complete maxillary and mandibular dentures using either a conventional or duplication technique according to clinical need. Patients rated their satisfaction with their dentures on 100-mm visual analogue scales before treatment and 1 month after delivery of their new dentures. Their oral health-related quality of life was determined by completion of an Oral Health-Related Impacts on Quality of Life questionnaire (OHIP-20) at the same time points. RESULTS: Both groups of patients had similar satisfaction and OHIP ratings at the beginning of the study and 1 month after delivery of their new dentures. The two groups were comparable with regard to age and gender. Statistically significant improvement in the OHIP domains of functional limitation and physical and psychological disability was seen in both groups. The conventional group also showed significant improvement with regard to handicap, whereas the duplicate denture group showed significant improvement in the patients' rating of pain and psychological discomfort. Patient satisfaction improved significantly in both groups across all variables except ease of cleaning and ability to speak. The duplication technique resulted in patients being less satisfied with the esthetics of their new dentures. CONCLUSION: In this study, the provision of new dentures either with a conventional technique or with a duplication technique resulted in an overall improvement in oral health-related quality of life and satisfaction. These improvements were statistically significant for some domains, which varied depending on the technique used for construction of the new dentures. Neither technique was seen to be superior, which may be a reflection of the patients' treatment expectations at the outset. Patients' reported satisfaction with their dentures and the impact that dentures have on their quality of life may not be useful measures for determining the most appropriate technique for providing new dentures.