Predicting maximum occlusal force and tongue pressure using decision tree analysis in patients diagnosed with head and neck tumors.

STATEMENT OF PROBLEM: Preserving and restoring oral functions, especially mastication and swallowing, is important to the quality of life of patients being treated for head and neck tumors. Studies that help predict maximum occlusal force and tongue pressure during prosthetic treatment, necessary for providing comprehensive, appropriate treatment and encouraging patient adherence and confidence are lacking. PURPOSE: The purpose of this clinical study was to develop a decision tree model for predicting maximum occlusal force and tongue pressure in patients diagnosed with head and neck tumors that could help both experienced and less experienced prosthodontists and oral surgeons optimize the treatment plan and support patient compliance and their quality of life. MATERIAL AND METHODS: A total of 80 patients who had been treated for head and neck tumors were enrolled in the study. Their maximum occlusal force was measured using a pressure-sensitive film and tongue pressure using a tongue pressure measurement device. Data, including basic characteristics, were transferred to a comma separated values file, which was then imported into a statistical software package to produce a decision tree. The classification and regression tree method was used to construct a predictive model. RESULTS: The number of occlusal contacts associated with not wearing a prosthesis, flap reconstruction, radiotherapy, chemotherapy, the number of teeth present, age, tumor stage, and tumor type were found to be associated with maximum occlusal force, with a prediction accuracy of 96.3%, area under the receiver operating characteristic curve of 0.99, sensitivity of 97%, and specificity of 94%. The number of occlusal contacts associated with wearing and not wearing a prosthesis, tumor stage, age, radiotherapy, and surgery type were found to be associated with tongue pressure, with a prediction accuracy of 96.3%, area under the receiver operating characteristic curve of 0.97, sensitivity of 97%, and specificity of 93%. CONCLUSIONS: The decision tree model can be an effective tool for the prediction of maximum occlusal force and tongue pressure in patients diagnosed with head and neck tumors, helping both experienced and less experienced prosthodontists and oral surgeons to provide early, appropriate, and necessary treatment before starting prosthetic treatment and helping patients with treatment compliance and communication with medical staff.

Vertical versus angled immediately loaded implants for assisting maxillary overdentures with locator attachments: A preliminary results of one-year randomized clinical trial.

OBJECTIVES: This study aimed to evaluate the clinical outcomes and patient satisfaction of 4-implant-assisted maxillary overdentures using two different designs. MATERIALS AND METHODS: Thirty edentulous participants received four implants in the maxillary ridge. The patients were randomly divided into two equal groups: (1) the control (CG, Vertical) group (n = 15); participants received four vertical implants with straight locator attachments to retain maxillary overdentures, and (2) the study (SG, Angled) group (n = 15); participants received four angled implants with angled locator attachments to retain maxillary overdentures. Peri-implant tissue health [Plaque (PL) and gingival (GI) indices, pocket depth (PD), implant stability (ISQ) and crestal bone loss (CBL)] were evaluated after denture insertion (T0), 6 (T6), and 12 (T12) months after insertion. Patient satisfaction was evaluated using a visual analog scale (VAS) after 12 months. RESULTS: The survival rates were 96.7% and 95% for the control and study groups respectively. PL, GI, and PD increased significantly in both groups with the passage of time. No significant difference in PL, GI, PD, and ISQ was noted between groups at all observation times. CG showed higher CBL than SG at T12. For the VAS results, there was no significant difference between groups. SG recorded significantly higher satisfaction regarding comfort with maxillary and mandibular dentures, retention of mandibular dentures, oral hygiene, the ability to chew hard food, and occlusion than CG. CONCLUSION: Within the limitations of this study, angled implants with angled locator attachments may be recommended to retain maxillary overdentures opposing intact dentition or fixed restoration as it was associated with improvements of several parameters of peri-implant tissue health and patient satisfaction compared to vertical implants with straight locator attachments.

Angled ball and locator attachments for immediate loaded inclined implants used to retain maxillary overdentures: A cross over study of patient satisfaction and oral health related quality of life.

OBJECTIVES: The aim of this was to compare the influence of two different angulated abutment designs on patient satisfaction, oral health-related quality of life, and prosthetic aspects of implant-supported maxillary overdentures. MATERIALS AND METHODS: For this cross-over study, 18 patients with completely edentulous maxillary ridges opposing implant-retained mandibular overdentures received 4 implants between the maxillary sinuses using computer-guided surgery. The anterior implants were installed at canine/lateral incisor areas and inclined 15° labially. The posterior implants were inserted just anterior to the maxillary sinuses and inclined 15o distally. Eight patients received maxillary overdentures retained by angled ball attachment (ball overdenture [BOD]) and angled locator attachment in random order. After 6 months, patients indicated satisfaction with their prosthesis using a visual analog scale (VAS), and oral health impact profile (OHIP-14). Moreover, postinsertion prosthodontic maintenance and complications were recorded for both attachments. Comparisons of patient satisfaction and prosthetic complications between groups were performed using the Wilcoxon matched-pairs test and the McNemar test, respectively. RESULTS: Locator overdenture (LOD) recorded significantly higher scores than the BOD group regarding all the VAS questions except for ease of cleaning (p < 0.007). LOD recorded significantly higher patient satisfaction regarding the pronunciation of sounds (p = 0.009), painful aching (p = 0.018), feeling tense (p = 0.011), unsatisfactory diet (p = 0.013), irritability with people (p = 0.005), and life in general (p = 0.004). The most common complications were matrix activation/renewal (n = 34). BOD showed a significantly higher incidence of attachment loosening (p = 0.002), and teeth fracture (p = 0.049) than LOD. LOD showed a significantly higher incidence of attachment wear and replacement than BOD (p <0.001). There was no difference between groups regarding soft tissue complications. CONCLUSION: Within the limitations of this study, and in terms of improved patient-centered outcomes, angled locator attachments are recommended to retain maxillary implant overdentures opposed by implant retained mandibular overdentures at it was associated with increased patient satisfaction and oral health-related quality of life than angled ball attachments. However, locator attachment was associated with more postinsertion prosthodontic maintenance than ball attachment.