Student ePortfolios to develop reflective skills and demonstrate competency development: Evaluation of a curriculum pilot project.

INTRODUCTION: The University of British Columbia Faculty of Dentistry developed a longitudinal curriculum pilot project to assess the usefulness of portfolios for dental students to develop reflective skills and demonstrate competency development, and to examine relationships between portfolio grades and clinical success. MATERIALS AND METHODS: Students in one dental class created portfolios with reflections on examples relevant to eight selected competency statements each year of the program. As part of our program evaluation, we set out to look at trends in portfolio grades, meta-reflection skills, student and faculty views of the project, and relationships among portfolio grades, 4th year clinical grades and faculty rankings. RESULTS: Portfolio grades improved from years 1 to 3, dropping off slightly in year 4. The highest level of internal consistency for grades within and between years occurred with Competency 42, while the lowest level occurred with Competency 4. Most students were able to demonstrate meta-reflection by 4th year. Students generally agreed with portfolios and reflection in concept, but suggested a looser structure, and they shared concerns with faculty about the workload involved. Portfolio grades did not correlate with clinical course grades (P = 0.092), but they did correlate significantly with faculty rankings except for year 1. CONCLUSION: While portfolio grades for reflections were not consistent, and they did not quite correlate with clinical course grades, they correlated strongly with faculty rankings. Future use of portfolios at UBC Dentistry will be enhanced by increasing curricular support regarding both competency development and the importance of reflection for professionals, decreasing workload by focusing on five Key Competencies, incorporating more formative and face-to-face feedback, and providing greater opportunities for peer sharing.

A 5-year randomized trial to compare 1 or 2 implants for implant overdentures.

The hypothesis of this 5-y randomized clinical trial was that there would be no significant difference in the satisfaction of edentulous participants with removable complete overdentures attached to 1 or 2 mandibular implants. Secondary aims were to test changes in satisfaction between and within the groups from baseline to 5 y and differences between the groups in implant survival and prosthodontic maintenance over 5 y. Each of the 86 participants (mean age, 67 y) was randomly allocated to receive either 1 implant in the midline (group 1) or 2 implants in the canine areas (group 2) attached to a mandibular overdenture opposing a maxillary complete denture. Satisfaction was self-assessed by participants on a visual analog scale at baseline prior to implants, as well as at 2 mo and 1, 3, and 5 y with implant overdentures, whereas implant survival and prosthodontic maintenance were assessed by clinical examination. After 5 y, 29 participants in group 1 and 33 in group 2 were available, with most dropouts due to death. Satisfaction with the implant denture after 5 y was significantly (P < 0.001) higher than at baseline in both groups and remained with no significant difference (P = 0.32) between the groups. No implants failed in group 1 but 5 failed before loading in 4 participants in group 2. Most participants required maintenance or occasionally denture replacement, and although differences between the groups were not statistically significant, group 1 experienced almost twice as many fractured dentures usually adjacent to the implant attachment. We conclude that there were no significant differences after 5 y in satisfaction or survival of implants with mandibular overdentures retained by 1 implant or 2 implants. Additional research is required to confirm long-term treatment effectiveness of single-implant dentures and the implications of prosthetic maintenance with implant overdentures (ClinicalTrials.gov: NCT02117856).

Implant angulation: a measurement technique, implant overdenture maintenance, and the influence of surgical experience.

PURPOSE: The purposes of this study were to develop a technique to measure the angulation between two implants and between each implant and reference planes, to analyze the relationship between the maintenance (adjustments and repairs) of ball-attachment mandibular implant overdentures and implant angulation, and to see if there is any correlation between surgeon experience and implant orientation. MATERIALS AND METHODS: Final casts of 41 patients who had received two-implant ball-attachment mandibular overdentures were used to measure implant angulations using digital photographs and plane geometry. The measured angles were compared with the number of adjustments and repairs of the prostheses and analyzed by surgeon experience for any trends. RESULTS: No significant relationships were found between number of adjustments and repairs and the interimplant angles. However, there was a significantly higher number of repairs when the lingual inclination of an implant was > or = 6.0 degrees (P = .033) or if the facial inclination was < 6.5 degrees (P = .036). Less experienced surgeons had a significantly greater tendency to place implants that diverged from each other in the frontal plane (P = .045) and with a facial or lingual inclination in the sagittal plane (P = .035). CONCLUSION: While interimplant angulation did not appear to affect prosthesis maintenance, individual implants with a lingual inclination > or = 6 degrees and a facial inclination < 6.5 degrees were associated with significantly more prosthesis repairs. There was a tendency for implants placed by less experienced surgeons to demonstrate greater inclination.

The outcome of implant overdentures from a prosthodontic perspective: proposal for a classification protocol.

PURPOSE: This article proposes a classification protocol for reporting the outcome of implant overdentures. MATERIALS AND METHODS: Review of the literature pertaining to postinsertion prosthodontic procedures for maxillary and mandibular implant overdentures revealed a wide range in the terminology used and methods of reporting outcome, usually as a result of the use of varying designs among different implant systems. A need for comparative evaluation of the prosthodontic success of implant overdentures was identified. RESULTS: An existing classification protocol for implant-fixed prostheses containing six objectively defined fields was modified for implant overdentures. This new protocol, which also uses the descriptive fields of success, survival, unknown, dead, and retreatment (repair or failure), provides a method whereby postinsertion prosthodontic procedures and subsequent time to retreatment can be quantified regardless of design, method of attachment, or implant system. A ratio method for identifying prosthodontic treatment cost effectiveness of implant overdentures is included. CONCLUSION: This protocol could assist clinicians in their choices of implant overdenture therapy by providing accurate comparisons of varying implant overdenture systems and designs, and by identifying prosthodontic treatment cost effectiveness.

Altered sensation associated with implants in the anterior mandible: a prospective study.

STATEMENT OF PROBLEM: Reported incidences of altered sensation after placement of mandibular implants range from a low of 0% to almost 44%, making it difficult to advise subjects regarding risk. PURPOSE: This study involved presurgical and postsurgical assessment of sensation in the lips and chins of 75 subjects, all of whom objectively demonstrated normal sensation before surgery. MATERIAL AND METHODS: Objective and subjective tests were administered before, and at planned intervals for 12 months after, the placement of 2 implants in the anterior mandible. RESULTS: Objective changes were observed in only 1 subject and then only at the 2-week postsurgery interval. There were significant differences for all subjects in subjective sensation changes from baseline to 2 weeks after surgery (P =.007) and from 2 weeks to 6 months (P =.003) or 12 months (P =. 003). There was a higher percentage of subjects with normal sensation before surgery who reported sensory changes 2 weeks after implant placement (34% vs 24% for all subjects), but only 1% of subjects still reported altered sensation 1 year later. Although there were no significant differences between men and women in reports of altered sensation, more women than men noted sensation changes 2 weeks after implants were placed (25% vs 13%). There appeared to be no relationships among gender, the degree of ridge resorption, and reports of altered sensation. CONCLUSION: Thus, although approximately 24% of subjects may report altered sensation in the short-term after implant surgery in the anterior mandible, the problem appears to be a transient one, with only about 1% experiencing sensation changes 1 year after implant surgery.

Complications associated with excess cement around crowns on osseointegrated implants: a clinical report.

The potential advantages and disadvantages of cement-retained implant crowns are reviewed, with a focus on complications related to residual excess cement. A series of 4 case reports illustrates the symptoms and treatment modalities associated with excess cement around implant crowns, and suggestions are offered for the prevention of such problems.

Positioning implants for overdentures: a prototype implant-paralleling device. Technical note.

As implant-assisted dentistry continues to grow, increasing emphasis is being placed on the surgical positioning of implants so that they can be optimally restored. While this is essential for esthetics with fixed implant restorations, it is equally important with implant overdentures, where the type of retentive mechanism artificial tooth position, and denture flange contour may be affected by implant position Unfortunately, surgical guides or templates may be used less often with overdenture cases because of the associated time, costs, and difficulty in positioning during surgery, leading to compromised implant location or orientation. This paper describes a prototype paralleling device that can aid in the surgical positioning of implants for overdentures.

The economics of complete dentures and implant-related services: a framework for analysis and preliminary outcomes.

It is not always clear that the implant-prosthesis offers distinct advantages over the conventional complete denture for managing the edentulous jaw. This article discusses the measurement, distribution, impact, and management of the edentulous jaw, and describes a framework for analyzing the economic costs and benefits associated with the conventional denture and the implant prosthesis. There are physiologic and psychosocial costs and benefits to both the conventional denture and the implant prosthesis, which indicates that neither method is distinctly superior. The physiologic costs are low and the psychosocial costs are similar for both treatments, whereas the direct financial costs associated with the implant prosthesis are substantially higher.

An outcomes assessment of a hybrid-PBL course in treatment planning.

As part of an ongoing process of curriculum development, a new course was developed at the University of British Columbia (UBC) to address problems such as lack of student enjoyment of the learning process, poor student preparedness for clinical treatment planning, and underdeveloped critical thinking skills in students beginning their clinical experience. The new course utilized a hybrid problem-based learning (PBL) format that provided students with an overview in lecture format while encouraging active learning in small group tutorials and seminars. Half the second-year class was randomly selected to participate in the new course, while the other half received the standard lectures on the subject. An outcomes assessment examined whether the aforementioned problems had been addressed in the new course. Course participants completed a post-course evaluation, and all students completed a self-assessment of their preparedness and progress in treatment planning and diagnostic. Clinical instructors, who were blind to the identity of the new course participants, were asked to independently assess each student using the same criteria. Results indicate that students who participated in the hybrid-PBL course enjoyed the learning process and later rated themselves as being better prepared and improving more in the areas of treatment planning and diagnostic records than their counterparts, although the latter results were not routinely statistically significant (p < 0.1). Instructor evaluations supported these differences between the two groups.

A prospective study on the maintenance of implant prostheses in private practice.

This study examined the adjustments, repairs, time, and costs required to maintain 69 implant prostheses in private prosthodontic practice for an average of 22 months after placement. For the removable prosthesis design, the most common adjustment was contouring the prosthesis and the most common repair was retentive component replacement. Screw tightening or fracture repair were the most frequently needed modifications for fixed implant prostheses. Each removable implant prosthesis averaged four times as many postplacement adjustments and almost twice as many repairs as did each fixed implant prosthesis, and the mean length of each maintenance appointment was also longer for removable prostheses. Mean repair costs were approximately 60% higher for the removable design.

Cost analysis of fabricating implant prostheses.

This prospective study analyzed the time and costs involved in fabricating implant prostheses in private practice and the factors affecting prosthesis design. Esthetic was the most commonly reported factor influencing the decision to use a fixed or removable prosthesis, while cost was infrequently cited. The single-tooth fixed implant required the least time to fabricate and had the lowest clinical fees, while the removable bar/clip prosthesis had the highest fees and demanded the greatest amount of time to fabricate. Single-tooth fixed and individual attachment removable prostheses generated approximately half the hourly income produced by multiple-unit fixed and bar/clip removable implant prostheses, and the individual attachment design had the highest ratio of expenses to income.

Apical root strain as a function of post extension into a composite resin core.

This study tested the hypothesis that there is no difference in the amount of strain measured in the root of an extracted tooth at the apical end of a prefabricated post, whether a composite resin core completely covers the head of the post or the post is exposed at the occlusal surface of the core. Twenty extracted teeth were measured (1) after endodontic treatment (baseline), (2) after a composite resin core was fabricated over a prefabricated post, and (3) after a cast crown was cemented. The teeth were randomly divided into two groups after baseline testing. In group 1, the post was buried within the core, and in group 2, the head of the post was exposed on the occlusal surface of the core. Analysis of results indicated a statistically significant decrease in strain from the baseline to the crown when 1 mm of composite resin covered the head of the post. However, based on the small strain values measured, the difference may not be clinically significant.

In vitro changes in clips and bars used to retain implant overdentures.

Although implant-retained overdentures are a less expensive alternative to fixed implant-supported prostheses in certain situations, problems with retentive clips fracturing and needing frequent replacement have been reported. This study compared baseline and posttest retention of metal and plastic clip-retained overdenture analogs and monitored surface changes in bars and clips throughout the testing process. A laboratory model was made with two implant analogs processed into an acrylic resin platform to which three bars were fitted. Two overdenture analogs were made and retained on the model with metal or plastic clips. Each bar-clip assembly was subjected to 5500 insertion and removal cycles to simulate 3 years of in vivo insertion and removal. Although the differences in retention between metal and plastic clips and between clips before and after testing were statistically significant, it is questionable whether they are clinically significant. Neither clip fracture nor loss occurred during this study, which suggests that it may be functional or parafunctional loading and not repeated insertion and removal of an implant overdenture that may cause the stated problems.

Fabrication of an implant surgical guide using a denture replica technique.

The outcome of the prosthodontic phase of implant treatment is affected by the position of implant fixtures within the dental supporting tissues; therefore, surgical guides are often used to facilitate ideal fixture placement. This article describes the fabrication and modification of a wax replica of the patient's existing prosthesis, which is converted into a surgical guide. This approach permits accurate fixture placement relative to planned tooth positions in the implant-supported prosthesis, without the need to fabricate a new conventional denture prior to surgery.

Problems with prostheses on implants: a retrospective study.

Prosthetic parameters for implant success have not been well defined but should include patient satisfaction and prosthesis maintenance, including adjustments and repairs. In addition, differences between fixed and removable implant-supported prostheses (ISPs) should be quantified. This study retrospectively evaluated both patient satisfaction and maintenance for 156 patients. Removable ISPs averaged almost three times as many adjustments per prosthesis (2.1 versus 0.8 per fixed ISP) and more than twice as many repairs (1.9 per removable ISP versus 0.9 per fixed ISP). The most common adjustments were to the contour of both types of prosthesis, and the most frequent repairs involved the retentive clips with removable ISPs and the gold screws with fixed ISPs. The incidence of repeat repairs was more than twice as high with removable prostheses compared with fixed prostheses. However, the repairs to opposing dentures most often needed were for conventional dentures opposing fixed ISPs. The vast majority of repairs were needed within the first year of service. Despite the high maintenance needed, patients were satisfied with both types of ISP, with the exception of limited satisfaction with cleansability, particularly with fixed restorations. The high incidence of early repairs, and the greater potential for a removable ISP requiring adjustment and repair, should be considered both when discussing options with the patient and when estimating treatment and maintenance costs before the commencement of implant therapy.

A retrospective study on the maintenance and repair of implant-supported prostheses.

This study reviewed the prosthodontic treatment and aftercare required by 29 patients with 32 implant-supported prostheses (12 fixed and 20 removable) placed on 107 implants. Patients were followed for 4 to 39 months. The majority of implant-supported prostheses (53%) were placed in the mandible. Visual analogue scales were used by the patients to rate their satisfaction with their prostheses and their chewing ability. Approximately one third of the patients studied required three or more relines of their existing dentures between first- and second-stage surgeries, while over half of the definitive implant-supported prostheses required a major adjustment or repair. Removable prostheses required 78% of the total repairs and accounted for 80% of those prostheses that needed repeated repairs. In general, patients were very satisfied with their implant-supported prostheses, but 17% complained of mild speech difficulties and 7% noted slight difficulty in cleaning their fixed prostheses. Overall, the short-term prosthetic management required for the implant-supported prostheses in this study was substantial, particularly with the removable prostheses, and this should be taken into account when evaluating prosthetic options.

The corrected cast impression: an alternative technique.

Although the corrected or altered cast impression technique is widely taught, it seems to be used very little, in part because it requires separate appointments for framework try-in, corrected cast impression, and occlusal registration. This article describes a technique whereby each of these procedures may be accomplished accurately in one appointment. Visible light-cured resin impression trays with integral occlusion rims are fabricated after the framework has been fitted. Standard procedures are used for the corrected cast impression, and interocclusal records are made with the framework with the impression attached. A stable occlusal registration material allows the interocclusal records to be set aside and used to articulate the corrected cast before the impression tray is separated from the cast. Benefits of this technique include significant time savings, improved accuracy, and simplified procedures.