Quality of life in patients in South Korea requiring special care after fixed implants: a retrospective analysis.

BACKGROUND: The study on oral health-related quality of life (OHRQoL) of disabled patients is rare but critical for welfare of patients. The aim of this study was to examine the effect of fixed implants in edentulous areas on OHRQoL in Korean disabled patients. METHODS: The OHRQoL of 63 disabled individuals was evaluated using the Oral Health Impact Profile (OHIP)-14 questionnaires and studied by potential affecting variables such as age, sex, disability severity, and time of disability acquisition. Wilcoxon-signed rank tests were used to examine the OHIP-14 scores for those who had pre/post-fixed implants. Multiple linear regression analysis was used to examine the relationships between factors and OHIP-14 scores before and after implants. A partial correlation analysis was also performed to determine which variables influenced OHIP-14 scores before and after treatment. The Mann-Whitney test was employed for sex and time of disability acquisition analysis (α = 0.05). RESULTS: Significant improvement was found in OHIP-14 post-implant treatment scores (P < .001). After implant treatment, the severity of disability produced significantly different results (P = .009). Pearson's correlation coefficient between severity of disability and pre/post-implant OHIP-14 scores was 0.265 (P = .030). After controlling for severity of disability, the results showed older patients had lower OHIP-14 scores (P = .032). No differences were found for sex or time of disability acquisition (congenital vs. acquired). CONCLUSIONS: Fixed implant treatment improved OHRQoL for disabled patients, and the severity of disability was positively correlated with improvement of OHRQoL. For patients with a similar level of disability, the OHRQoL decreased with age.

Comparison of Fit and Stability Between 3D-Printed and Milled Implant Abutments with Titanium-6Al-4V and Co-Cr Metal Alloys.

PURPOSE: To compare the fit of 3D-printed titanium (Ti) and cobalt-chromium (Co-Cr) abutments with implants to computer numerical control (CNC)-milled, ready-made abutment-implant assemblies. Their clinical applicability was also evaluated by measuring removal torque values (RTVs) and percentage torque loss of abutment screws. MATERIALS AND METHODS: A total of 138 abutments were included in the study: 92 abutments were fabricated with Ti and Co-Cr alloys using computer-assisted design (CAD) through selective laser melting, and 46 ready-made abutments were prepared. The fit of interfaces between 90 abutments from the three groups (30 ready-made, 30 3D-printed Ti, and 30 3D-printed Co-Cr abutments) and implant assemblies was demonstrated by scanning electron microscopy (SEM) and confocal scanning laser microscopy (CSLM). After 30-Ncm torque tightening of Ti abutment screws twice within 10 minutes, the RTVs and percentage torque loss of screws of 48 abutments (16 ready-made, 16 3D-printed Ti, and 16 3D-printed Co-Cr) were evaluated after 10 minutes of thermocycling and cyclic loading. RESULTS: The fits of 3D-printed Co-Cr abutments were not statistically different from those of ready-made abutments (P = .383), while the fit of 3D-printed Ti abutments was inadequate (P < .001). The RTVs of 3D-printed abutments after cyclic loading were significantly decreased compared with those of CNC-milled abutments (P < .001). CONCLUSION: The fit of interfaces between 3D-printed Co-Cr abutments and implants was adequate. The RTVs of 3D-printed Co-Cr abutments were not significantly different from those of CNC-milled abutments after 10 minutes of 30-Ncm torque tightening and thermocycling.

Effect of a multichannel oral irrigator on periodontal health and the oral microbiome.

Oral biofilms or dental plaques are one of the major etiological factors for diverse oral diseases. We aimed to evaluate the effect of a multichannel oral irrigator (MCOI) on periodontal health in 29 participants randomly divided into two groups: the MCOI group and the control group. To evaluate the effect of the MCOI on periodontal health, the modified Quigley Hein Plaque Index (PI), Mühlemann-Son Sulcus Bleeding Index (SBI), bleeding on probing (BOP), and swelling were evaluated and compared before and after MCOI use for 3 days. Although PI and SBI showed statistically significant increases in the control group, the MCOI group showed no significant changes in either parameter. Moreover, the percentage of BOP was significantly lower in the MCOI group. Saliva samples were analyzed by 16s rRNA amplicon sequencing to investigate changes in the oral microbiome. Sequencing results showed that Porphyromonas spp. were significantly increased in the control group, whereas no significant change was detected in the MCOI group. Using the MCOI, enriched populations and functional pathways were detected in pioneer species comprising non-mutans streptococci. These findings provide evidence of the effectiveness of the MCOI in maintaining periodontal health and a healthy microbial ecology in the oral cavity.

Could Fixed Implants Be a Viable Treatment Option in Disabled Patients? A Clinical Retrospective Study.

PURPOSE: To verify the survival rates and marginal bone loss (MBL) of implants in patients with different disability types. MATERIALS AND METHODS: Clinical and radiographic assessments were performed in a total of 189 implants for fixed implant prostheses in 72 patients. Data were collected on loaded implants at least 1 year in function, and the mean observation time was 37.3 months. Implant survival was examined, and MBL was observed around the implants of two groups (mental disability vs physical disability) based on age, sex, implant location (anterior vs posterior), and prosthetic connection (internal vs external). RESULTS: Of the 189 implants, 4 failed; the total implant survival rate was 97.8% across a mean of 37.3 months. The cumulative survival rate at 85 months in a Kaplan-Meier survival curve analysis was 94.3% ± 3% in patients with mental disability and 50% ± 35.4% in patients with physical disability, which was a statistically significant difference between the disability groups (P = .006). Fisher exact test showed significant differences in MBL only with age (P < .001). The implant MBL by disability type-adjusted for age and observation period-showed significant differences in multiple linear regression analyses (P = .003). CONCLUSION: The implant survival rates in patients with disability were in line with those reported for nondisabled patients. The MBL of the implants was within the physiologic bone loss after implant loading. Implants in patients with mental disability showed higher cumulative survival rates than in patients with physical disability, but also a higher amount of MBL. Within the limitations of this study, dental implants for patients with disability are viable. These results can establish future implant treatment plans for this population. Int J Oral Maxillofac Implants 2023;38:562-568. doi: 10.11607/jomi.9880.

Clinical and radiographic evaluations of implants as surveyed crowns for Class I removable partial dentures: A retrospective study.

PURPOSE: The purpose of this study was to evaluate survival rates and marginal bone loss (MBL) of implants in IC-RPDs. MATERIALS AND METHODS: Seventy implants were placed and used as surveyed crowns in 30 RPDs. The survival rates and MBL around implants based on multiple variables, e.g., position, sex, age, opposing dentitions, splinting, type of used retainer, and first year bone loss, were analyzed. Patient reported outcome measures (PROMs) regarding functional/esthetic improvement after IC-RPD treatment, and complications were also inspected. RESULTS: The 100% implant survival rates were observed, and 60 of those implants showed MBL levels less than 1.5 mm. No significant differences in MBL of implants were observed between implant positions (maxilla vs. mandible; P = .341) and type of used retainers (P = .630). The implant MBL of greater than 0.5 mm at 1 year showed significantly higher MBL after that (P < .001). Splinted implant surveyed crowns showed lower MBL in the maxilla (splinted vs. non-splinted; P = .037). There were significant esthetic/functional improvements observed after treatment, but there were no significant differences in esthetic results based on implant position (maxilla vs. mandible). Implants in mandible showed significantly greater improvement in function than implants in the maxilla (P = .002). Prosthetic complication of IC-RPD was not observed frequently. However, 2 abutment teeth among 60 were failed. The bone loss of abutment teeth was lower than MBL of implants in IC-RPDs (P = .001). CONCLUSION: Class I RPD connected to residual teeth and strategically positioned implants as surveyed crowns can be a viable treatment modality.

Clinical Performance of Implant Crown Retained Removable Partial Dentures for Mandibular Edentulism-A Retrospective Study.

The studies on implant-crown-retained removable partial dentures (IC-RPDs) for edentulism are scarce. The purpose of this study was to evaluate survival rates and marginal bone loss (MBL) of IC-RPDs compared to implant overdentures (IODs) in mandibular edentulism. Variables that influenced survival and marginal bone loss (MBL) of implants in both treatment modalities were analyzed and the functional/esthetic satisfaction of patients as well as prosthetic complications were also observed. Eighteen IC-RPDs with a total of 60 implant-supported survey crowns and 24 IODs with a total 94 implants retained with magnet attachments were observed. After a median observation period of 46.6 months (up to 149 months), we observed 98.3% implant survival rates for IC-RPDs and 92.5% for IODs. Kaplan-Meier survival curves based on the treatment modality showed that, at 96 months, cumulative survival rates were 98.3% in IC-RPD and 83.1% in IOD. For implant survival rates, no statistical differences were observed according to age, sex, opposing dentition, or implant positions (p = 0.515, 0.666, 0.201, 0.749, respectively). The implant MBL measurements for IC-RPD and IOD groups at the final recall check were 0.93 ± 1.22 mm and 2.12 ± 2.09 mm, respectively. Additionally, there were no significant differences between groups (p = 0.554). The implants with peri-implantitis at year 1 showed significantly higher MBL at final check-up (p < 0.001). The MBL of implants showed significant differences based on age (p = 0.008) and opposing dentition (p = 0.003). No significant differences of implant MBL were observed for the position of placed implants (p = 0.621) or sex (p = 0.666). Patient-reported outcome measures (PROMs) on functional and esthetic satisfaction were significantly improved after IC-RPD or IOD treatment (p < 0.001). The most frequent prosthetic complication of IC-RPD was clasp loosening, while for IOD group, it was attachment dislodgement. Within the limitations of this retrospective study, we concluded that IC-RPDs could be considered as a viable treatment option for edentulous patients who need few fixed abutments for satisfaction.

Dimensional Accuracy of Dental Models for Three-Unit Prostheses Fabricated by Various 3D Printing Technologies.

Previous studies on accuracy of three-dimensional (3D) printed model focused on full arch measurements at few points. The aim of this study was to examine the dimensional accuracy of 3D-printed models which were teeth-prepped for three-unit fixed prostheses, especially at margin and proximal contact areas. The prepped dental model was scanned with a desktop scanner. Using this reference file, test models were fabricated by digital light processing (DLP), Multi-Jet printing (MJP), and stereo-lithography apparatus (SLA) techniques. We calculated the accuracy (trueness and precision) of 3D-printed models on 3D planes, and deviations of each measured points at buccolingual and mesiodistal planes. We also analyzed the surface roughness of resin printed models. For overall 3D analysis, MJP showed significantly higher accuracy (trueness) than DLP and SLA techniques; however, there was not any statistically significant difference on precision. For deviations on margins of molar tooth and distance to proximal contact, MJP showed significantly accurate results; however, for a premolar tooth, there was no significant difference between the groups. 3D color maps of printed models showed contraction buccolingually, and surface roughness of the models fabricated by MJP technique was observed as the lowest. The accuracy of the 3D-printed resin models by DLP, MJP, and SLA techniques showed a clinically acceptable range to use as a working model for manufacturing dental prostheses.

New Rehabilitation Concept for Maxillary Edentulism: A Clinical Retrospective Study of Implant Crown Retained Removable Partial Dentures.

There have been no studies of implant-crown-retained removable partial dentures (IC-RPD) for the treatment of maxillary edentulism. The purpose of this study was to perform clinical and radiographic evaluations of implants in IC-RPD compared to implant overdentures (IOD) in maxillary edentulous patients. Twenty IC-RPDs with 74 splinted implant crowns and 18 IODs with 71 implants retained with magnet attachments were observed in 38 patients. We statistically analyzed survival rates and marginal bone loss (MBL) of implants based on multiple variables including first year pathologic condition, location of placed implant, age, and sex in both treatments. Patient reported oral measurements (PROMs) regarding functional/esthetic improvement after IC-RPD or IOD treatments and prosthetic complications were also statistically analyzed. After a median observation period of 47.1 months (up to 147 months), we observed 97.3% implant survival rates for IC-RPD and 70.4% for IOD (p < 0.001). Among variables, first year pathologic condition (p < 0.001) and sex (p = 0.027) influenced implant survival rates. The MBL of implants for IC-RPD and IOD groups at the final check-up were 1.12 ± 1.19 mm and 3.31 ± 1.71 mm, respectively (p < 0.001). In both groups, patients with peri-implantitis (p < 0.001) and patients older than 65 years (p = 0.029) showed significantly higher implant MBL regardless of treatment modality. Functional and esthetic satisfaction were significantly improved (p < 0.001) after both treatments. The IOD group showed more frequent prosthetic complications compared to the IC-RPD group. Within the limitations of a retrospective study, we concluded that RPD with few splinted implant crowns is a feasible alternative treatment modality for maxillary edentulous patients with anatomical limitations.

Between government policy, clinical autonomy, and market demands: a qualitative study of the impact of the Prescribing Analysis System on behavior of physicians in South Korea.

BACKGROUND: In South Korea, the Health Insurance Review and Assessment Service manages the Prescribing Analysis System (PAS) to evaluate the appropriate use of medication. To achieve the system's goal of changing prescribing behavior, it is critical to understand how physicians respond to the PAS. This study analyzes the opinions of South Korean physicians about the PAS, the way it is used, and factors affecting prescribing behavior. METHODS: A qualitative, exploratory approach was used, with four focus groups of physicians from different specialties. A semi-structured guide was used to explore their opinions. Transcripts of the discussions were analyzed by the authors, who independently considered content using uniform categories. Common themes were extracted and used to gather results and draw conclusions. RESULTS: Physicians acknowledged some positive aspects of the PAS but, overall, had mainly negative impressions of the system, and particularly, the evaluation reports that it generates. They reported that their prescribing behavior was affected by predisposing factors, including experiential, environmental and psychological factors. Physicians reported that their negative perceptions regarding the regulations were primarily influenced by concerns about maintaining their autonomy and expertise. However, their strong resistance to these perceived infringements on their independence may be considered inconsistent in relation to their professional autonomy as there was an equally strong concern about market competition. Physicians' objections to the PAS are more likely to have been caused by deeply rooted distrust of the government agency in charge of the system. DISCUSSION: Interestingly, we found that physicians' strong resistance to perceived violations of their autonomy seems somewhat inconsistent and contradictory. While they are very positive about new information or printed materials provided by pharmaceutical representatives, they are less enthusiastic when it comes to governmental guidelines or standards. Similarly, they appear to willingly accept situations in which they believe they should comply with patients' demands as a means of surviving in a competitive market. It is notable that physicians' negative perceptions of PAS seemed to be aggravated by suspicion and distrust regarding the purpose of this program. CONCLUSIONS: Because of widespread beliefs in professional autonomy, market competition, and a deep-seated distrust of the system, it would be difficult for the government to persuade physicians to change their prescribing behaviors using only the PAS. Successful implementation of the PAS will not only require its improvement as a policy tool, but also the creation of a social consensus regarding the PAS.

Biochemical Responses of Anodized Titanium Implants with a Poly(lactide-co-glycolide)/Bone Morphogenetic Protein-2 Submicron Particle Coating. Part 2: An In Vivo Study.

PURPOSE: A biochemical approach to implant surfaces can improve bone growth, resulting in desirable bone-implant interfaces. This study was conducted to identify the effect on osseointegration of direct coating of titanium (Ti) implants with poly(D,L-lactide-co-glycolide)(PLGA)/recombinant human bone morphogenetic 2 (rhBMP-2) submicron particles by electrospray. MATERIALS AND METHODS: Anodized Ti implants were used as a control group, and implants coated with 80 µL of PLGA/rhBMP-2 (50 µg/mL rhBMP-2 per implant) submicron particles by electrospray were used as the experimental group in an in vivo rabbit tibia model. After 3 or 7 weeks of healing, specimens were obtained and prepared for histologic and histomorphometric analyses. RESULTS: The implant surface coated with submicron PLGA/rhBMP-2 showed new bone growth in the apical direction earlier than control implants. In the experimental group at 3 weeks, the bone-to-implant contact ratio and bone area of the three best consecutive threads were significantly higher than those in the control group. However, there was no significant difference between groups at 7 weeks. CONCLUSION: Within the limitations of this study, the PLGA/rhBMP-2-coated implants facilitated osseointegration between bone and the Ti surface during the early healing phase.

Biochemical Responses of Anodized Titanium Implants with a Poly(lactide-co-glycolide)/Bone Morphogenic Protein-2 Submicron Particle Coating. Part 1: An In Vitro Study.

PURPOSE: This study was conducted to examine the effects of coating poly(D,L-lactide-co-glycolide) (PLGA)/recombinant human bone morphogenetic protein-2 (rhBMP-2) submicron particles by electrospray onto titanium (Ti) implants on the proliferation and differentiation capacity of mesenchymal stem cells. In addition, the duration of rhBMP-2 release was investigated. MATERIALS AND METHODS: Ti disks were fabricated and divided into four groups as follows. Group C (control) was anodized at 300 V, group P was anodized and then coated with 0.2% PLGA, group B1 was anodized and then coated with PLGA/rhBMP-2 submicron particles at 200 ng per disk, and group B2 was anodized and then coated with PLGA/rhBMP-2 submicron particles at 600 ng per disk. The topography of the PLGA/rhBMP-2-coated Ti surfaces was examined, and proliferation assays, alkaline phosphatase activity tests, and rhBMP-2 releasing tests were conducted in vitro. RESULTS: There was no difference in the roughness of control Ti disks and Ti disks coated with PLGA/rhBMP-2 submicron particles by electrospray. The proliferation of mesenchymal stem cells increased over time; at 7 days, cell proliferation on the Ti disks coated with rhBMP-2 was significantly higher than the other groups. Anodized Ti disks coated with PLGA/rhBMP-2 (groups B1 and B2) released rhBMP-2 for approximately 21 days. In accordance with the amount of rhBMP-2 released from the PLGA/rhBMP-2 construct, the differentiation capacity of mesenchymal stem cells on the PLGA/rhBMP-2-coated disks was increased significantly. CONCLUSION: Submicron PLGA/rhBMP-2 coating on Ti implants by electrospray facilitated cell proliferation and differentiation, which is important for early healing and integration of implants.

Economic evaluation of single-tooth replacement: dental implant versus fixed partial denture.

PURPOSE: This study assessed the cost-effectiveness from a societal perspective of a dental implant compared with a three-unit tooth-supported fixed partial denture (FPD) for the replacement of a single tooth in 2010. MATERIALS AND METHODS: A decision tree was developed to estimate cost-effectiveness over a 10-year period. The survival rates of single-tooth implants and FPDs were extracted from a meta-analysis of single-arm studies. Medical costs included initial treatment costs, maintenance costs, and costs to treat complications. Patient surveys were used to obtain the costs of the initial single-tooth implant or FPD. Maintenance costs and costs to treat complications were based on surveys of seven clinical experts at dental clinics or hospitals. Transportation costs were calculated based on the number of visits for implant or FPD treatment. Patient time costs were estimated using the number of visits and time required, hourly wage, and employment rate. Future costs were discounted by 5% to convert to present values. RESULTS: The results of a 10-year period model showed that a single dental implant cost US $261 (clinic) to $342 (hospital) more than an FPD and had an average survival rate that was 10.4% higher. The incremental cost-effectiveness ratio was $2,514 in a clinic and $3,290 in a hospital for a prosthesis in situ for 10 years. The sensitivity analysis showed that initial treatment costs and survival rate influenced the cost-effectiveness. If the cost of an implant were reduced to 80% of the current cost, the implant would become the dominant intervention. CONCLUSION: Although the level of evidence for effectiveness is low, and some aspects of single-tooth implants or FPDs, such as satisfaction, were not considered, this study will help patients requiring single-tooth replacement to choose the best treatment option.