Impact of resin bonded bridgework on quality of life of patients with hypodontia.

OBJECTIVES: To determine the impact of hypodontia on the quality of life of adolescent and young adult patients, and, to assess the impact of restoring tooth spaces with resin bonded bridgework on quality of life of patients with hypodontia. METHODS: In a prospective study, 82 patients with a confirmed diagnosis of hypodontia participated. The primary outcome was oral health related quality of life (OHRQoL) and this was measured using the OHIP-49 prior to treatment. The pre-treatment sample was then divided into two groups: the test group (n=40 patients) who had completed orthodontic treatment and had tooth spaces restored with resin bonded bridgework, and, a control group (n=42 patients) who were still in the process of orthodontic treatment. All patients completed a follow-up OHIP-49, and between and within group comparisons made. RESULTS: The pre-treatment sample included 43 females and 39 males, age ranged from 16 to 34 years (median age 19). Forty-three patients had more than 4 congenitally missing teeth and thirty-nine had ≤ 4 congenitally missing teeth. There were no differences between the groups prior to treatment. For the test group, there was a significant improvement in median OHIP summary scores (p<0.001) after treatment. OHIP scores deteriorated to a significant degree for control subjects (p=0.002). The effect sizes for the pre-post treatment change in both groups were moderate to large. CONCLUSIONS: Hypodontia has a significant impact on oral health related quality of life. Provision of resin bonded bridges has a positive impact on oral health related quality of life of patients with hypodontia.

A preliminary report of the cost-effectiveness of tooth replacement strategies for partially dentate elders.

OBJECTIVE: To compare the cost-effectiveness of conventional treatment using partial dentures with functionally orientated treatment to replace missing teeth for partially dentate elders using a randomised controlled clinical trial. BACKGROUND: In many countries, including the Republic of Ireland, the only publically funded treatment option offered to partially dentate older patients is a removable partial denture. However, evidence suggests that these removable prostheses are unpopular with patients and can potentially increase the risk of further dental disease and subsequent tooth loss. MATERIALS AND METHODS: Fourty-four partially dentate patients aged 65 years and older were recruited. Patients were randomly assigned to the two treatment arms of the study. The conventional treatment group received removable partial dentures to replace all missing natural teeth. The functionally orientated group was restored to a Shortened Dental Arch (SDA) of 10 occluding contacts using resin-bonded bridgework (RBB). The costs associated with each treatment were recorded. Effectiveness was measured in terms of the impact on oral health-related quality of life (OHRQoL) using OHIP-14. RESULTS: Both groups reported improvements in OHRQoL 1 month after completion of treatment. The conventional treatment group required 8.3 clinic visits as compared to 4.4 visits for the functionally orientated group. The mean total treatment time was 183 min 19 s for the conventional group vs. 124 min 8 s for the functionally orientated group. The average cost of treatment for the conventional group was 487.74 Euros compared to 356.20 Euros for the functional group. CONCLUSIONS: Functionally orientated treatment was more cost-effective than conventional treatment in terms of treatment effect and opportunity costs to the patients' time.

Quality of life assessment in patients with implant-supported and resin-bonded fixed prosthesis for bounded edentulous spaces.

OBJECTIVES: Dental implants have become increasingly popular in the prosthetic rehabilitation of patients with bounded edentulous spaces. Oral condition-related quality of life (QOL) levels have rarely been assessed in these patients. MATERIAL AND METHODS: Two groups of subjects with bounded edentulous spaces were studied: an implant-supported fixed prosthesis group (11 patients) and a resin-bonded fixed prosthesis group (33 patients). The two groups were well matched in terms of sex, age, missing units and location of missing units. The patients were requested to answer a self-administered QOL questionnaire with two major subscales - oral condition- and general condition-related QOL scores. The test-retest reliability of each question was pre-examined and found acceptable (mean Spearman rank correlation coefficient was 0.55 +/- 0.16). Mean QOL score differences between the two groups were analyzed by the Mann-Whitney U-test. RESULTS: Mean oral condition-related QOL scores of the implant-supported and resin-bonded fixed prosthesis groups were 87.8 +/- 9.5 and 87.1 +/- 12.3% (P = 0.85), and mean general condition-related QOL scores were 73.8 +/- 14.8 and 71.6 +/- 15.2% (P = 0.95), respectively. No significant QOL differences between the two groups were observed in the two subscales. CONCLUSION: In patients with bounded edentulous spaces, multidimensional QOL levels of patients with an implant-supported fixed prosthesis do not exceed those of patients with a resin-bonded fixed prosthesis in a short follow-up period.

Patients' satisfaction in two long-term clinical studies on resin-bonded bridges.

This study aimed to evaluate patients' satisfaction with resin-bonded bridges and the effect of failures on the degree of satisfaction. In two clinical trials, 358 patients completed guided questionnaires at regular recalls (n=1484). In this way, data regarding 'overall function', 'colour', 'shape', 'functional changes', 'complaints' and 'recommendation to other patients' were obtained. The scores of each criterion were evaluated for the variables 'trial', 'gender', 'time after placement' and 'failure', using 4-way ANOVA. Encountered failures were rated using a 'failure severity scale'. For all combinations of measurement periods, the changes in patient's opinions were calculated and the differences tested using the paired t-test. Overall satisfaction was correlated with 'colour', 'shape' and inversely correlated with 'complaints' (r>0.34; all P<0.005). No statistical differences were found between males and females. No significant changes were observed in patient satisfaction over time. Failures influenced the failure sensitive variables 'functional changes' and 'avoidance of load'. The z-scores were independent of the severity of the failures (r<0.13; all P>0. 10). The degree of patient satisfaction with resin-bonded bridges appeared to be high and did not seem to be influenced by the occurrence of failure.

Single-unit resin-bonded bridges using the natural tooth or a denture tooth.

Resin-bonded bridges were first described by Rochette in 1973. In the following year the author had occasion, for the first time, to experiment with a single-unit resin-bonded bridge (RBB) which employed the exfoliated natural tooth as a pontic. That 'temporary' measure gave good service for 17 years and was the precursor of a number of successful RBBs which utilized natural or denture teeth. The very simple method described offers the means of preserving the patient's natural appearance, thereby maintaining the psychological well-being of the patient. It is particularly applicable in patients who present with gross loss of periodontal support and where a conventional RBB or fixed bridge may be contra-indicated for personal or clinical reasons. It is not time consuming or clinically demanding. It has a high degree of patient acceptance and satisfaction. The contiguous teeth, involved as abutments, appear to be beneficially affected.