A within-subject comparison of mandibular long-bar and hybrid implant-supported prostheses: psychometric evaluation and patient preference

Although it has been shown that patients are more satisfied with prostheses supported by implants than with conventional dentures, there have been few direct comparisons of the various designs of implant-supported prostheses. This within-subject crossover clinical trial was designed to compare two forms of removable prostheses which are frequently prescribed for the edentulous mandible: a long-bar overdenture supported by 4 implants and a two-implant hybrid overdenture. Sixteen completely edentulous subjects were given a new maxillary conventional denture: Ten of them received the mandibular long-bar prosthesis first and six the hybrid. After a two-month adaptation period, psychometric measures of various aspects of the prostheses and physiological tests of masticatory efficiency were carried out over three weeks. The mandibular prostheses were then changed and the procedures repeated. At the end of the study, subjects were asked to choose the mandibular prosthesis that they wished to keep, and final psychometric measures were taken. In this paper, the results of the psychometric assessment and patient preference are presented. Subjects assessed factors such as general satisfaction, quality of life, stability, retention, comfort, esthetics, ease of cleaning, speaking, and chewing, and how well-chewed foods were before being swallowed. Most of the factors except ease of cleaning and speaking were rated significantly better with long-bar overdentures than with hybrid ones. These results are consistent with the fact that all subjects chose long-bar overdentures, reporting stability, ease of chewing, and comfort as the most important factors influencing their choice. These results suggest that, although subjects assign high ratings for most factors to hybrid overdentures, they find long-bar overdentures to be significantly more stable, comfortable, and easier for chewing.     

A randomized clinical trial comparing the efficacy of mandibular implant-supported overdentures and conventional dentures in diabetic patients. Part I: Methodology and clinical outcomes

STATEMENT OF PROBLEM: Scientific evidence is lacking to support the general application of implant-supported mandibular overdentures. PURPOSE: This randomized clinical trial was undertaken to compare the efficacy of conventional mandibular and implant-supported overdentures in diabetic edentulous patients with clinically acceptable metabolic control. METHOD: A total of 102 diabetic patients, treated with or without insulin, were randomized to receive a new maxillary denture and either a conventional or an implant-supported removable mandibular overdenture. Treatment was completed for 89 patients, 37 with the conventional and 52 with implant-supported dentures. Detailed examinations, tests, and questionnaires were given before and at 6- and 24-months after treatment completion. Comparisons between the two treatment groups were made for treatment failures based on prespecifed criteria and the type and amount of maintenance care provided. RESULTS: The insulin and noninsulin treated groups were collapsed because of the lack of significant differences at entry. The conventional denture and implant-supported overdenture groups were similar in terms of general demographics, medical status, quality of their original dentures and denture support, several functional measures, and patient satisfaction. Treatment was judged to be successful in 56.9% of patients with conventional dentures and 72.1% with overdentures. This difference in success rate was not statistically significant (p > 0.05). Patients with treatment failures in both groups required excessive maintenance care. Those with conventional dentures needed frequent denture base adjustments and relines, whereas those with overdentures required frequent clip replacements and repairs. Although significant improvements were seen with both treatment modalities, a higher percentage of patients with implant-supported overdentures than those with conventional dentures reported improvements in chewing comfort and moderate-to-complete overall satisfaction.     

Outcome assessment of implant-supported prostheses

STATEMENT OF PROBLEM: From the dental professional's standpoint, implant rehabilitation offers dramatically improved treatment alternatives to orally disabled patients. However, what a patient perceives as important to their function and satisfaction with their prostheses may be quite different from what the dentist believes are significant health-related improvements. PURPOSE: To resolve this problem, a series of investigations were designed to measure satisfaction and performance in groups of patients who wore various types of prostheses supported by endosseous titanium implants. MATERIAL AND METHODS: Methods are described for assessing treatment efficacy and population needs, including measures of perceived levels of disability, health-related quality of life, and functional capacity. RESULTS: The findings highlight patient factors that have not been considered before and appear to contribute to the success of prosthetic rehabilitation for the edentulous patient. CONCLUSION: Patient-centered approaches to the assessment of treatment efficacy are highly relevant to today's prosthodontists, whose goals are the improvement of function and quality of life for their patients.     

Biostereometric quantification of clinical denture tooth wear

In this study the wear of mandibular acrylic resin teeth opposed by porcelain maxillary teeth arranged in a lingualized occlusal scheme over a period of 3 years was measured. Six edentulous subjects received complete dentures as above and with three baseline markers of amalgam. At yearly intervals casts were made of the mandibular occlusal surfaces, including markers, and plotted by stereophotogrammetry. Volumetric loss of material was quantifiable. Ranges of 0.62-3.33 mm3/mm2 on the left side and 0.71-1.64 mm3/mm2 on the right were recorded. Friedman two-way ANOVA test indicated significant wear on teeth 35, 36, 45 and 46 but not on 34 and 44. A one-sided chewer displayed greater wear on the contralateral side, a finding difficult to explain.     

Changes in chewing patterns after implantation in the edentulous mandible

Almost all edentulous patients with implant-supported prostheses in mandibles describe an improvement in their chewing function and quality of life. This was reason to believe that an implant prosthetic treatment actually influences mandibular border movements, as well as the chewing patterns. The present study compares border movements and chewing patterns in 15 patients recorded with the Sirognathograph. The first measurements were made with existing complete dentures. After implantation and rehabilitation with a Dolder-bar and clip-to-bar overdenture, the movements were recorded again. The measurements revealed an improved guidance of the mandibular movements and larger borderline patterns following stabilization of the complete denture with the bar. This leads to more harmonic shapes in the movements and better chewing efficiency.     

Effects of cordocentesis on inferior vena cava velocity waveforms: differences between normally grown and growth-retarded fetuses

PURPOSE: The purpose of this investigation was to evaluate complete denture patients at pretreatment and postinsertion, 6 months and 18 months after denture delivery in order to develop an explanatory model of successful denture therapy to better understand patient acceptance of complete dentures. MATERIALS AND METHODS: Sixty complete-denture patients treated at a dental student clinic were followed through denture therapy and for 18 months thereafter. Subjects were examined and completed pretreatment questionnaires and posttreatment interviews. Three outcome measures of denture success were tested, and factors considered substantive in achieving a successful denture outcome were examined using multivariate analyses. RESULTS: At post-insertion, 76.7% of subjects were satisfied with their dentures, 74.6% said their expectations were met, and 66.7% said they adjusted easily to their new dentures; reports at 6 and 18 months were similarly high. Logistic regression findings suggest that psychological and interpersonal factors are more important determinants of denture satisfaction than anatomic or clinical factors. CONCLUSIONS: Subject characteristics including age, gender, race, income level, education, marital status, and maxillary and mandibular anatomy were not significantly associated with denture success as defined by the three outcome measures used in this study. Although these variables may represent important co-factors in the patient's acceptance of dental services and may affect the way a patient perceives dental care outcomes, statistically significant relationships were not found within our sample. Psychosocial variables, such as pretreatment expectations, satisfaction with the dental care received, and mental health showed a stronger relationship to a successful outcome.     

Cephalometric evaluation of the changes in patients wearing complete dentures: a 20-year study

The purpose of this continuing longitudinal investigation was to study the changes on the craniofacial complex in complete denture wearers; herein are reported the 20-year findings. At the onset of the study complete dentures were made for 64 persons. Two dentures techniques were employed: a complex method of construction and a simplified method. At the start of the project the patients' ages ranged from 30 to 60 years (average age 53 years) and all had been edentulous for at least 1 year (range 1 to 30 years). Lateral cephalometric radiographs were made immediately after initial placement of the dentures and during subsequent years (1, 2, 3, 4, 5, 7, 10, 15, and 20). The same cephalostat was used throughout and all films were exposed with the teeth in centric occlusion. Thirty-four subjects presented for the 20-year follow-up. Of this number, the radiographs of 24 subjects (14 women and 10 men; average age 65.5 years [range 50-83 years]) (12 complex denture wearers; 12 simplified technique denture wearers) were used in this report (10 had denture alterations over the 20-year period that excluded them). The 20-year observations corroborate earlier findings. There is a loss of the vertical dimension of occlusion as viewed from the right profile, and the mandible rotates in a counterclockwise fashion resulting in an increase in relative prognathism. The maxillary alveolus was stable, the mandibular alveolus resorbed, and the dentures rotated counterclockwise and shifted slightly forward. The observed changes were not significantly affected by the sex of the patient or by the denture technique employed.     

Follow up and maintenance of implant supported prostheses: a comparison of 20 complete mandibular overdentures and 20 complete mandibular fixed cantilever prostheses

Two independently selected groups of 20 patients who were edentulous in te mandible, were followed up on a regular basis over a 5-year period following restoration with a lower implant stabilised prosthesis and conventional upper denture. Significantly more treatment was required by those who received complete mandibular overdentures than those provided with complete fixed mandibular prostheses. In addition to adjustment for the relief of denture trauma to the mucosa, more mechanical problems arose with overdenture implant prostheses.     

Skeletal effects of early treatment of Class III malocclusion with maxillary expansion and face-mask therapy

The effectiveness of maxillary expansion and face-mask therapy in children with Class III malocclusion was studied in a sample of 46 subjects in mixed dentition and compared with a control sample of 32 subjects with untreated Class III malocclusion. Treated and untreated samples were divided into early and late mixed-dentition groups to aid identification of the optimum timing of the orthopedic treatment of the underlying skeletal disharmony. Cephalometric analysis was based on a stable basicranial reference system, appropriate for longitudinal studies started in the early developmental ages. The level of significance for intergroup comparisons was set at a p value of 0.01. Significant forward displacement of the maxillary complex was found in the early-treatment group. The region of the pterygomaxillary suture, in particular, showed significant changes in the subjects treated during early mixed dentition. No significant maxillary modifications were recorded in the late-treatment group. Both early and late groups exhibited smaller increments in mandibular protrusion and larger increments in the intermaxillary vertical relationship compared with their respective Class III control groups. Only children treated at an early age, however, showed a significant upward and forward direction of condylar growth, leading to smaller increments in total mandibular length. These results indicate that the combination of a bonded maxillary expander and face-mask therapy is more effective in early mixed dentition than in late mixed dentition, especially with regard to the magnitude of the protraction effects on maxillary structures.     

Effect of maxillary edentulousness on mandibular residual ridges

Bone mineral density (BMD) was measured in five different regions of the mandible of 77 postmenopausal women. These women were also classified according to the remaining, clinically determined alveolar height in the edentulous distal regions of the mandible. The duration of edentulousness in the maxilla and in the mandible was determined anamnestically. All subjects were edentulous in the maxilla, and 42 were also edentulous in the mandible. The other 35 women had teeth only in region d35-d45. This study shows that after extraction of the last teeth in the mandible, the BMD of the cortical bone is not lowered, but that the BMD of the trabecular portion is lowered more by mechanical stress caused by the remaining natural teeth than by maxillary dentures. This feature becomes apparent when duration of edentulousness in the maxilla is compared with the BMD values of different regions in the mandible.     

Clinical assessment of olfactory dysfunction in Parkinson''s disease

The possibility of placing endosseous implants in the edentulous maxilla is frequently reduced by inadequate bone volume of the residual ridge. In totally edentulous maxillae with knife-edge conformation, insufficient thickness is frequently associated with insufficient height of the residual ridge in the posterior maxilla because of pneumatization of the maxillary sinuses. This surgical method combines grafting of the maxillary sinuses, onlay grafts on the buccal side of maxillary posterior segments, and sagittal osteotomy of the anterior maxilla with interpositional bone grafts. Five to six months after maxillary reconstruction, Br?nemark implants were placed and, after osseointegration occurred, implant-supported dental prostheses were fabricated. Three patients have been treated with this method and 22 implants have been placed. The mean follow-up after final prosthetic rehabilitation has been 16 months; survival rate has been 100%. Despite the small number of patients and the short follow-up, preliminary results have shown very promising results.     

Use of the International Classification of Diseases for disability insurance in Switzerland: study of reproducibility]

Our earlier studies on edentulous elderly subjects have shown associations of severe resorption in the mandibular residual ridge with female gender and systemic diseases. The aim of this study was to examine whether other factors also were related to residual ridge resorption (RRR). Among 177 edentulous elderly subjects effects on RRR were investigated with regard to history of edentulousness and denture-wearing, the condition of the dentures and soft tissues, dental status of the opposing jaw, and oral hygiene habits. No significant association was found between degree of resorption and duration of edentulousness in either the mandible or the maxilla. RRR was related to denture quality (P < 0.05); however, severe resorption was not. In the maxilla previous use of removable partial dentures was a factor contributing to the resorption (odds ratio (OR), 2.4); flabby ridge was related to the severity of the resorption (OR, 2.4). This study showed local factors related to RRR more often in the maxilla than in the mandible, thus suggesting that severe resorption in the mandible is influenced more by systemic factors than by those investigated in this study.     

Surface charges on membranes

The mesial rest-I-bar concept is the most important contribution to clasp partial denture design in the last 30 to 40 years. When used with discernment in situations where it is not contraindicated, it constitutes an excellent design for extension-base removable partial dentures. It has become the design of choice for an increasing number of dentists. Use of the three elements that make up the clasp assembly does not necessarily insure that the clasp will function as intended. There are situations for which it should not be used. Unless adequately adjusted after framework construction as well as during the maintenance program, the beneficial effects may be more imaginary than actual. Strict adherence to the mesial position for the rest is not rational for toothsupported dentures and may be questioned for some extension-base prostheses. I-bars have several advantages as direct retainers. However, no single type of retainer is applicable for all retentive situations, and other types should be selected where conditions are unfavorable for I-bar use. A framework which permits a slight amount of movement toward the edentulous residual ridge is an important consideration in design of extension-base removable partial dentures, particularly for those of the mandibular arch. However, compromise of this principle is sometimes necessary to satisfy other design requirements. Design of the framework is only one of the factors that contribute to a successful removable partial denture. Of at least equal importance is the adequacy of support provided by the denture base and the nature of the occlusion. If meticulous attention is directed to these two factors, the forces transmitted to the teeth through the framework can be kept to a minimum and within physiologic tolerance. Conversely, neglect of these considerations may cause a framework of any design to become destructive.     

The mandibular staple bone plate: a long-term retrospective evaluation

PURPOSE: Clinical and radiographic parameters and denture satisfaction were evaluated in a long-term retrospective study of patients treated with the mandibular staple bone plate. PATIENTS AND METHODS: Fifty-six edentulous patients were treated with the mandibular staple bone plate to stabilize their lower denture. The mean evaluation period was 103 months (range, 84 to 139 months). Peri-implant mucosa and bone height were scored, together with quality of the prosthesis and prosthodontic maintenance care. Denture satisfaction was assessed by using two questionnaires. RESULTS: Four staple bone plates were removed during the evaluation period, and one appeared to be fractured. The remaining 51 staple bone plates were functional without any signs of major complications (survival rate, 91%). No further alveolar resorption in the interforaminal region of the mandible took place during the evaluation period. Patients were very satisfied with the prosthetic construction. CONCLUSIONS: The mandibular staple bone plate is a good modality to stabilize the lower denture. However, endosseous implant systems are preferred because of comparable success rates with a more simple operative procedure.     

The marital intake interview: A multimethod criterion validity assessment.

Assessed the validity of an initial intake interview with 12 couples seeking marital therapy (dissatisfied) and 16 couples seeking marital enhancement (satisfied). Ss (mean age 26.07 yrs) were interviewed with spouses together or separated. Interview items focused on marital satisfaction and perception, demographic variables, and comfort in making assertive responses. Couples were then administered several marital satisfaction and assertion questionnaires (e.g., Marital Adjustment Scale, Dyadic Adjustment Scale). Each couple also participated in a structured analog communication assessment in which they discussed a problem area in their marriage. The verbal interchanges during the communication exercises were coded by trained observers. Results suggest (a) a high degree of discriminant validity for the marital interview, (b) higher interspouse correlations for interview items during joint interviews, (c) higher indices of criterion-related validity for separate interviews, and (d) a significant relationship between the reactivity of joint interviews and the social sensitivity of the interview item. (34 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Incidence of endocrine complications and clinical disease severity related to genotype analysis and iron overload in patients with beta-thalassaemia

OBJECTIVES: This study determined demographic characteristics, satisfaction with care, and likelihood of follow-up dentist visits for patients seen in office-based, independent, dental hygienist practices. METHODS: New patients were surveyed after their initial visits to independent hygienist practices to assess their demographic characteristics and satisfaction with care at both the beginning of practice operations and 18 months after the start of these practices. Follow-up surveys were sent to patients 12 and 24 months after their initial visits to the independently practicing dental hygienists to determine if patients had visited a dentist. RESULTS: Most respondents were white, female, had attended some college, and reported high family incomes. Ninety-eight percent of respondents were satisfied with their dental hygiene care. Follow-up questionnaires revealed that over 80 percent of respondents visited the dentist within 12 months of receiving dental hygiene care in independent settings. This level of follow-up care with dentists was found both for respondents who reported having a regular dentist at their initial visits with the hygienists and for those who reported not having a regular dentist. CONCLUSIONS: Independent practice by dental hygienists provided access to dental hygiene care and encouraged visits to the dentist.     

Human herpesvirus-6 infection in liver transplant recipients: documentation of pathogenicity

In the posterior partially edentulous jaw, implants may be used to supplement existing natural dentition. Frequently, the maxillary sinuses and the mandibular nerve preclude the fabrication of freestanding implant-retained prostheses. However, if an implant and a natural abutment are combined, a fixed prosthesis can be fabricated, restoring the arch into the premolar area. The histories of three patients with attachments connecting implant-retained ceramotitanium crowns with crowns on natural abutments are described. A design for a rigid custom-made attachment for the Br?nemark system, using standard components with a machine-duplication, spark-erosion technique, is suggested.     

Control of the vertical dimension in Class II correction using a cervical headgear and lower utility arch in growing patients. Part I

A retrospective cephalometric study was performed comparing three groups of 30 growing patients with Class II, Division 1 malocclusions. Group 1 was treated with a cervical headgear/lower utility arch combination (CHG/LUA), group 2 was treated with a cervical headgear alone (CHG), and the third group was untreated. The average treatment time was 1 year, 6 months. No other appliances were used during this period. Maxillary and mandibular dental and skeletal treatment responses were compared with an analysis of variance (ANOVA) and a Scheffe's test. In addition, a multiple stepwise regression was performed to determine whether pretreatment measures of facial pattern were accurate predictors of mandibular rotational response. Both treatment groups demonstrated significant reduction in maxillary protrusion. The CHG-only group showed significantly greater anterior descent of the palatal plane as compared with the untreated group. The maxillary molars showed significant distal movement in both treatment groups without any extrusion beyond that seen with normal growth. The maxillary incisor demonstrated significant retroclination in the CHG-only group. There was no statistical difference among the groups for variables commonly used for measuring mandibular rotation or protrusion. The change in vertical position of the lower molar was not significantly different among the groups. A CHG as used in this study produced maxillary orthopedic and orthodontic changes without upper molar extrusion beyond that seen with normal eruption and in the absence of an opening rotation of the mandible, even in subjects with dolicocephalic facial patterns. The LUA did not appear to influence lower molar eruption or mandibular rotational response. None of the commonly used predictors of facial pattern, such as the Y-axis, XY-axis, or MP angle, accurately predicted mandibular rotational response. Further study would be necessary to ascertain whether this was a result of their invalidation as predictors, or a result of the treatment strategy employed.     

Shape-coordinate analysis of skeletal changes induced by rapid maxillary expansion and facial mask therapy

The aim of this study was to evaluate maxillary and mandibular shape/size changes by means of Bookstein's shape-coordinate and tensor analysis in children with Class III malocclusions treated with rapid maxillary expansion and a facial mask in order to define optimum timing of intervention for this type of therapy. The treated group (46 subjects, 26 females and 20 males) was divided into two subgroups according to the stage of dentitional development. The early-treated group consisted of 23 subjects treated in the early mixed dentition (mean age at Time 1, 6 years 9 months +/- 7 months); the late-treated group included 23 subjects treated in the late mixed dentition (mean age at Time 1, 10 years 3 months +/- 1 year). The mean treatment period was about 11 months. The control group (32 subjects with untreated Class III malocclusion, 18 females and 14 males) also was divided into two subgroups (an early control group, 17 subjects in the early mixed dentition, and a late control group, 15 subjects in the late mixed dentition). Maxillary triangles (point T, the most superior point of the anterior wall of sella turcica, point FMN, the fronto-maxillary-nasal suture, and point A) and mandibular triangles (point Condylion, point Gonion, and point Pogonion) were digitized on cephalograms in both groups at Time 1 and Time 2. Combined facial mask and rapid maxillary expansion therapy produced a significant enhancement of the forward growth of the maxilla and significantly more upward and forward direction of growth of the mandibular condyle (leading to smaller increments in mandibular total length, Co-Pg) in the early-treated group when compared with controls and to the late-treated group. Both maxillary size and mandibular size were significantly affected by treatment in the early mixed dentition. The results of this study indicate that orthopedic treatment of Class III malocclusion induces favorable size and shape changes both in the maxilla and mandible, and that this combined treatment approach is more effective in the early mixed dentition than in the late mixed dentition.     

The efficacy of local anaesthetics administered by general dental practitioners

AIM: To obtain empirical evidence for the efficacy of local anaesthesia in dentistry. DESIGN: Retrospective analysis of serial administrations of local anaesthesia. METHODS: Dentist and patient evaluations of the success of differing techniques (infiltration and block) of anaesthesia in a variety of general practice procedures. Results were analysed for correlation between dentist and patient using a 5-point scale. RESULTS: Complete data were analysed for 331 administrations. In the hands of experienced dentists over 93% of operations were assessed by both dentist and patient as comfortable or completely comfortable. Dentists were generally able to judge patient comfort (P < 0.001). Administrations requiring repeat injections were less comfortable. Dentists judged infiltration administrations more comfortable than block administrations (P < 0.001), but patient judgements of comfort failed to distinguish between differing techniques at the P < 0.05 level. CONCLUSIONS: Some variations in success rate exist between dentists the most dental procedures under local anaesthetic in general practice were assessed as being comfortable or better by both dentists and patients.