A within-subject clinical trial on the conversion of mandibular two-implant to three-implant overdenture: Patient-centered outcomes and willingness to pay.

OBJECTIVES: To examine the impact of adding a third midline implant with stud attachment to a mandibular two-implant overdenture on patient-oriented outcomes. METHODS: In this pre-post design clinical trial, following the standard procedures, mandibular two-implant overdentures of 17 edentulous individuals (61.9 ± 6.6 years) were converted to three-implant overdentures by adding a stud attachment to an unloaded midline implant. Patient-oriented outcomes included patient expectations and satisfaction with implant overdenture as well as willingness to pay the cost of conversion. Data were collected at baseline and at the 6-week follow-up using visual analog and binary scales as well as open-ended questions. Statistical analysis included descriptive statistics, Spearman's correlation, Fisher exact test, Mann-Whitney U test, and the exact sign test. RESULTS: After connecting the third midline implant to the mandibular two-implant overdenture, there was a statistically significant decrease in the anteroposterior movement (p = 0.005) as evaluated by clinicians. Moreover, study participants reported an increase in perceived stability of the overdenture (95% CI; 0.68-1.00, p = 0.002) and in their ability to speak (95% CI; 0.63-1.00, p = 0.008). The addition of a third implant met the expectations of 94% of patients in regard to lower denture stability, 100% for retention, and 82.4% for comfort. The mandibular three-implant overdenture increased patient general satisfaction over a short period of time, but this improvement was not statistically significant. About 80% of patients would recommend this type of prosthesis to their peers but only 47% of them would agree to pay a large increase in the cost of treatment compared to a two-implant overdenture. CONCLUSIONS: The addition of a midline third implant to an existing mandibular two-implant overdenture resulted in several improved patient-reported outcomes.

Predictors of Satisfaction with Dentures in a Cohort of Individuals Wearing Old Dentures: Functional Quality or Patient-Reported Measures?

PURPOSE: To examine the extent to which denture satisfaction can be determined by a measure of the denture's functional quality and by patient-reported measures. MATERIALS AND METHODS: This study used data obtained from 117 edentulous individuals with a mean age of 73.7 (SD = 5.6) years in southern Brazil. The edentulous individuals rated their levels of general satisfaction with their actual dentures, using a visual analog scale. Explanatory variables included the individual's information about ability to chew, ability to speak, esthetics, and sociodemographic factors. The dentures were evaluated using the validated 9-item Functional Assessment of Dentures instrument. Bivariate statistical analyses and Poisson regression models (prevalence ratio [PR]; 95% CI; p < 0.05) were used to test the association of explanatory variables with patients' general satisfaction with their complete dentures. RESULTS: There was a statistically significant association between patients' general satisfaction and stability of maxillary (rocking movement) (adjusted PR = 1.28; 95% CI: 1.07-1.52) and mandibular dentures (occlusal displacement) (adjusted PR = 1.68; 95% CI: 1.16-2.43), masticatory ability (adjusted PR = 1.54; 95% CI: 1.08-2.19), and the age of the mandibular denture (adjusted PR = 1.47; 95% CI: 1.10-1.97). CONCLUSIONS: The results of this study indicated that measures of denture stability, masticatory ability, and age of dentures appeared to be determinants of patients' satisfaction with dentures.

Does immediate loading affect clinical and patient-centered outcomes of mandibular 2-unsplinted-implant overdenture? A 2-year within-case analysis.

OBJECTIVE: To provide 2-year clinical- and patient-oriented data with regard to mandibular overdenture assisted by 2 immediately loaded unsplinted implants. MATERIAL AND METHODS: In this pre-post design, Phase-I clinical trial, 18 edentate individuals (62.4±7.7years) received a new set of complete denture. Then, following standard procedures, 3 threaded implants (OsseoSpeed TX™, Dentsply Implants, Mölndal, Sweden) were placed in the mandible in each patient, and locator abutments (Zest Anchors LLC, Escondido, U.S.A.) were inserted on the right and left side implants. The midline implant served as a control for within-patient comparison. The immediate loading was conducted within 24h of surgery. Data were collected at baseline (T0), 12 (T1) and 24 (T2) months after immediate loading. The clinical outcomes included implant survival rate, crestal bone level changes and implant stability. These criteria were assessed through clinical and radiographic examinations as well as resonance frequency analysis. Patient-centered outcomes included patient satisfaction and oral health-related quality of life measured using validated questionnaires. Brunner-Langer approach was used for statistical analysis. RESULTS: Implant survival rate for immediate loaded implants was 91.7% at 2-year follow-up. None of the unloaded implants failed. There was no statistically significant difference at baseline and follow-ups with regard to clinical outcomes between loaded and unloaded implants. Patient satisfaction and quality of life improved (p<0.0001) from baseline to 2-year follow-up. CONCLUSION: Immediate loading protocol did not negatively affect clinical outcomes, satisfaction and quality of life of patients wearing 2-unsplinted-implant mandibular overdenture for 2 years. This conclusion requires confirmation by randomized control trials. CLINICAL SIGNIFICANCE STATEMENT: Mandibular overdenture assisted by two immediately-loaded unsplinted implants is successful treatment based on 2-year clinical and patient-based outcomes.

Odontologia e qualidade de vida: uma abordagem baseada em evidências / Dentistry and quality of life: an evidence-based approach

A qualidade de vida é um dos temas bastante ressaltados na contemporaneidade. O aumento da expectativa de vida e o incremento do cuidado em saúde geraram exigências para que a vida seja cada vez mais repleta de qualidade. Nesse sentido, houve popularização excessiva de terminologia “qualidade de vida”. Não há dúvida de que é importante que haja o entendimento da população sobre a importância de viver com qualidade. Entretanto, as abordagens em saúde que procuram avaliar impactos na qualidade de vida necessitam ser trabalhadas de forma mais profunda, e não simplesmente no nível da hipótese e do senso comum. Não se pode achar que é óbvio que todo cuidado bucal impacte positivamente na qualidade de vida. Essa informação necessita estar embasada em estudos de qualidade. Assim, muitos instrumentos e formas sistemáticas de avaliação de qualidade de vida relacionada à saúde bucal foram desenvolvidos, o que permite que essa temática seja trabalhada à luz da literatura. O objetivo desta coluna é fazer uma análise do impacto da saúde bucal na qualidade de vida, demonstrando a importância da profissão para melhorá-la...

Quality of life is one of the contemporary hot topics. The increased life expectancy, along with the improved health care have generated demands for a life full of quality. As a consequence, the expression “quality of life” has been excessively used. There is no doubt that it is important for the populations to understand the importance of living with quality. However, health care approaches towards the evaluation of impact in quality of life need to be studied deeper, not only in the hypothetical but in the common sense level. It is not fair to consider obvious that every oral care measure impacts positively in quality of life. This information needs to be based in high quality studies. Thus, several instruments and systematic approaches for evaluating oral health related to quality of life have been developed, allowing for this theme to be addressed in the light of the current literature. The aim of this paper is to analyze the impact of oral health on quality of life, demonstrating the importance of the profession for its improvement...

Effect of raloxifene on alveolar bone resorption after mucoperiosteal fl ap surgery in mice / Efeito do raloxifeno sobre reabsorção óssea alveolar após cirurgia de retalho mucoperiosteal em camundongos

Background: Mucoperiosteal fl ap surgeries (MFS) are carried out to provide access to the alveolar bone and root surfaces in several clinical situations. Nevertheless, they lead to a variable degree of alveolar bone resorption. Raloxifene is an agonist in bone, and acts inhibiting bone loss. Objective: To evaluate the effect of raloxifene in preventing alveolar bone resorption after MFS using an experimental model of mouse mandibles. Methods: MFS was performed on the buccal aspect of the left side of the mandible (BL) in 20 male CF1 Musdomesticus mice divided into two groups with the same number of animals: the experimental group was treated once daily with raloxifene injections (3 mg/kg), and the placebo group was treated with daily injections of the vehicle. The buccal aspects of right hemimandibles were used as controls (BR). Mandibles were removed, defl eshed and stained with toluidine blue in a stereomicroscope. Digital images were obtained and the alveolar bone loss was measured (mm²) using an image analysis software. Results: The BL area exhibited signifi cantly more bone loss (Student t test; p < 0.01) when compared to the BR area, in both groups. No statistically signifi cant difference was observed between the experimental and the placebo groups. Conclusion: In this study, raloxifene did not inhibit alveolar bone resorption following MFS in male mice.

Introdução: Cirurgias de retalho mucoperiosteal (CRM) são realizadas para permitir acesso ao osso alveolar e à superfície radicular em várias situações clínicas. No entanto, elas levam a um grau variável de reabsorção óssea alveolar. O raloxifeno tem ação agonista em tecido ósseo e atua inibindo perda óssea. Objetivo: Avaliar o efeito do raloxifeno na prevenção de reabsorção óssea alveolar após CRM usando o modelo experimental de mandíbulas de camundongos. Métodos: Foram realizadas CRMs na face vestibular, lado esquerdo, das mandíbulas (VE) de 20 camundongos CF1 Musdomesticus machos, divididos em dois grupos com mesmo número de animais: o grupo experimental foi tratado uma vez ao dia com injeções de raloxifeno (3 mg/kg), e o grupo placebo foi tratado uma vez ao dia com injeções do veículo. A face vestibular do lado direito da hemimandíbula foi usada como controle (BD). As mandíbulas foram removidas, dissecadas e coradas com azul de toluidina sob um estereomicroscópio. Imagens digitais foram obtidas e a perda óssea alveolar foi medida (mm²) usando um software de análise de imagens. Resultados: A área VE exibiu perda óssea signifi cativamente maior (teste t de Student; p < 0,01) quando comparada com a área BD, em ambos os grupos. Não foi observada diferença estatisticamente signifi cativa entre os grupos experimental e placebo. Conclusão: Neste estudo, o raloxifeno não inibiu a reabsorção óssea alveolar após CRM em camundongos machos.

Cognitive status of edentate elders wearing complete denture: Does quality of denture matter?

BACKGROUND: Emerging evidence suggests that an individual's level of mastication may play a role in their cognitive status. This suggests that in edentate individuals wearing complete denture, non-optimal mastication via inadequate denture could be related to cognitive status. OBJECTIVES: To examine the impact of quality of denture on cognitive status of a sample of elderly edentate Brazilian individuals wearing complete denture. METHODS: This study is a cross-sectional analysis of data collected from 117 edentate elders (mean age 73.7 ± 5.6 years) wearing complete denture, in southern Brazil. Cognitive impairment was assessed using the Brazilian version of the mini-mental state examination (MMSE). Clinical examination was conducted to evaluate the quality of dentures by use of the FAD (functional assessment of dentures) instrument. Masticatory ability was assessed by self-reported questions. RESULTS: The mean MMSE score for the total sample was 23.1 (SD=4.4) and was associated with age (p=0.001), education (p<0.0001), depressive symptoms (p=0.003), as well as the masticatory ability (p=0.001) and functional quality of dentures (p<0.0001). Unsatisfactory masticatory ability was more frequent in edentate individuals with lower FAD score (p<0.0001) and led to a lower MMSE total score. Unsatisfactory masticatory ability was associated with MMSE scores (p=0.002) after adjustment. CONCLUSION: The study results support the potential role of optimal functional quality of dentures in maintaining cognitive activity in elders. This association may be explained via mastication pathway. CLINICAL SIGNIFICANCE: The potential beneficial effect of functional dentures on cognitive status via mastication could encourage preventive strategies to decrease substantial risk of morbidity in elders.

Measurement of loosening torque of prosthetic components in Morse taper connection implants

AIM: The aim of this study was to verify two different types of interfaces in Morse taper connection implants, relating the mechanical resistance to a loosening torque that is required to separate or move the prosthetic abutment. MATERIAL AND METHODS: Ten Morse taper connection implants and their respective abutments were divided into two groups (n = 5), DH (double hexagon) interface and OI (octagonal implant) interface. A standard insertion of implants was performed in a stainless steel base, where each abutment received a sequence of two consecutive tightening torques at a 10-minute interval, followed by a loosening torque, which was measured using a digital torque gauge. The Student's t-test with a 5% significance level was used for data analysis. RESULTS: The results showed a statistically significant difference in the loosening torque values compared with DH torque values (p < 0.05). However, the difference between tightening and loosening torque values was not statistically significant in the OI group (p = 0.465). CONCLUSION: The study concluded that there was a difference in the torque required to loosen the abutment screws between the DH group and the OI group, with the latter showing better results.

Food intake selection influenced by opposing functional natural teeth or removable denture: observational study

AIM: The purpose of this study was to investigate the relationship between types of dentition in occlusion and the perceived ability to eat a range of common foods in elderly. MATERIAL AND METHODS: We included 363 individuals (117 men, 246 women; mean age = 73.4 ± 5.8 years) Self-reported information on questionnaires were linked to oral examination to establish types of dentition in occlusion assessing their influence on the needs to alter the food selection and on the difficulty to chew key foods. RESULTS: The individuals were classified as having their occlusion performed by completed removable prostheses (D/D) (51.2%), mixed dentition (D/N-N/D) (32.8%) or with natural teeth (N/N) (16%). Individuals with natural teeth N/N or mixed dentition (N/D-D/N) had less necessity to change their food intake, relative to individuals with their occlusion performed by complete removal denture (D/D) (p<0.05). Most of the individuals that had to modify their food intake avoided hard-to-chew food (p<0.05). CONCLUSION: The reduced masticatory ability may lead to changes in dietary selection with risk of an impaired nutritional status especially in elderly complete denture wearers.

Influence of reverse torque values in abutments with or without internal hexagon indexes.

STATEMENT OF PROBLEM: The mechanical stability of the implant-abutment connection is of fundamental importance for successful implant-supported restorations. Therefore, understanding removal torque values is essential. PURPOSE: The purpose of this study was to evaluate the reverse torque values of indexed and nonindexed abutments of the Morse Taper system. MATERIAL AND METHODS: Twelve Morse taper implants with their respective abutments were divided into 2 groups (n=6): group NI, nonindexed abutments; and group IN, indexed abutments. Each abutment received a sequence of 2 consecutive torques for insertion (15 Ncm) at an interval of 10 minutes, and 1 reverse torque, all measured with a digital torque wrench. The Student t test with a 5% significance level was used to evaluate the data. RESULTS: Statistical analysis showed no significant difference in reverse torque values between nonindexed and indexed abutments (P=.57). When comparing insertion torque and reverse torque values between the groups, group NI presented a mean torque loosening percentage of 8% (P=.013), whereas group IN presented a loosening of 15.33% (P<.001). CONCLUSION: The use of indexed abutments for the Morse taper system presented similar biomechanical stability when compared with nonindexed abutments, both with a significant reduction in reverse torque values.

A method of assessing the effectiveness of the friction fit interface by measuring reverse torque.

STATEMENT OF THE PROBLEM: The connection between abutments and implants is fundamental to successful prosthetic rehabilitation, and the loosening or fracture of the parts are undesirable outcomes. PURPOSE: The purpose of this study was to measure the reverse torque values of 2 different types of Morse taper implants. MATERIAL AND METHODS: Ten Morse taper implants were used, with their respective abutments. They were divided into 2 groups (n = 5): Group DH, implant interface with a double hexagon and Group OI, octagonal implant interface. Each abutment received 2 consecutive insertion torques (32 Ncm) at a 10-minute interval and 1 reverse torque after 5 minutes. The data were analyzed with the Student t test (α= .05). RESULTS: The Student t test demonstrated no significant differences between the values of the insertion and removal torques of the 2 groups (Group DH, P= .22 and Group OI, P= .42) or the removal torque values of the groups (P= .12). CONCLUSION: The results suggest that the strength required to loosen the abutment screws as measured by reverse torque is similar for both a double hexagon interface (DH) and an octagonal interface (OI).