The use of patient-related outcomes (PRO) and experience (PRE) in assessing the periodontal and implant patient.

The purpose of this review was to summarize the evidence with regard to behavioral and psychosocial assessment of the periodontitis patient, the candidate for implant therapy, and the peri-implantitis patient. Periodontitis has an adverse effect on quality of life and its treatment can lead to significant improvements experienced by the patient. The latter is true for rehabilitation with dental implants, although patients harbor diverse expectations and perceptions of implant therapy, which can often interfere with satisfaction and/or influence long-term success. A thorough behavioral assessment of the candidate for implant therapy is essential, which should include, perceptions, expectations, as well as risk for behavioral disorders. Remedial action is essential to correct misperceptions and any identified risks. Finally, patients have limited awareness of limited ability to identify signs of peri-implantitis. The diagnosis of peri-implantitis can be a cause of significant distress, resentment, and loss of trust to the treatment and the caregivers. Despite documented value in clinical research, currently available instruments assessing patient-reported outcomes have little application in day-to-day clinical practice. Face-to-face patient to doctor open-ended communication remains the most effective way to comprehensively establish the long-term "therapeutic alliance" essential for the long journey for the periodontitis patient.

Patient satisfaction following dental implant treatment: A survey.

PURPOSES: This aim of this cross-sectional study was to investigate the factors associated with patient satisfaction in patients with a dental implant-supported single crown or fixed prosthesis. MATERIALS AND METHODS: One hundred and ninety-six patients with dental implants functioning more than 1 year were provided with a 13-question questionnaire to report their satisfaction regarding the functional aspects, aesthetic outcome, cleansing ability, general satisfaction, treatment cost, and overall satisfaction. Patient satisfaction was reported using a visual analogue scale (VAS). The association of these variables and each aspect of satisfaction were investigated by multivariate linear regression analysis. RESULTS: One hundred forty-four of 196 patients reported high overall satisfaction (VAS > 80%). All aspects of patient satisfaction levels were very high (mean VAS > 80%), except for satisfaction in cleansing ability and treatment cost (mean VAS < 75%). The patients with a history of implant failure had significantly lower satisfaction in the functional aspects, aesthetic outcome, and general satisfaction than patients without implant failure (p ≤ 0.001). The subjects who experienced mechanical complication were less satisfied with treatment cost (p = 0.002). Sinus augmentation negatively affected functional satisfaction compared with individuals without sinus augmentation (p = 0.041). The subjects with a higher income or a posterior implant had significantly higher overall satisfaction (p = 0.003 and p < 0.001, respectively). Moreover, restoration by specialists positively affected general satisfaction compared with being restored by post-graduate students (p = 0.01). CONCLUSION: Patients restored with a dental implant-supported single crown or fixed prosthesis had very high patient satisfaction. Implant failure, mechanical complication, and sinus augmentation negatively affected patient satisfaction in multiple aspects. In contrast, the factors positively affecting patient satisfaction were a posterior implant, patient's monthly income, and restoration by specialists. These results have to be interpreted with care due to the cross-sectional study design.

Clinical Evaluation of Toothbrushes for Elderly Patients: A Crossover Study.

OBJECTIVES: The aim of this study was to evaluate the efficacy of 2 newly designed toothbrushes used by elderly individuals based on plaque removal and gingival inflammation reduction compared with 2 commercially available toothbrushes. MATERIALS AND METHODS: This was a randomised, controlled, single-blind, 4-period crossover clinical trial. Thirty elderly participants meeting the inclusion criteria were randomly allocated into 4 groups, which determined the sequence of the 4 toothbrushes: CUdent/extra soft, CUdent/soft, GoodAge, and Colgate. The participants' baseline bleeding on probing (BOP) and plaque index (PI) were assessed by one blinded calibrated examiner, then their teeth were professionally cleaned. The participants were assigned to use the tested toothbrush and were recalled for postbrushing examination 2 weeks later to evaluate their BOP and PI. At the end of each test period, the participants used their own toothbrush during the 2-week washout period before using the next tested toothbrush. RESULTS: The mean age of the 30 participants was 63.2 years. The mean baseline BOP score was 44.4%, and mean baseline PI was 2.7. Three participants dropped out; thus, 27 participants (15 females and 12 males) provided data throughout the study period. The participant characteristics and baseline data between the groups were similar. CUdent/extra soft and CUdent/soft demonstrated significantly better PI scores at the buccal surfaces than GoodAge (P < .05). CUdent/soft had the lowest PI scores and Colgate presented the lowest BOP score in every comparison for other areas; however, the differences were not significant. No signs of tissue trauma or abrasion were observed. CONCLUSIONS: The newly designed toothbrushes were comparable to the commercially available toothbrushes in plaque removal efficacy and reducing gingival inflammation. CUdent/extra soft and soft were significantly more effective in plaque removal in the buccal regions than GoodAge.

Association between keratinized mucosa width and peri-implant diagnostic parameters in Asian maintenance compliers: A Cross-sectional study.

Aims: To investigate the association between the keratinized mucosa (KM) width and peri-implant diagnostic parameters in implant maintenance. Materials and methods: A total of 331 posterior implant-supported fixed prostheses in 165 patients were evaluated. Demographic data were collected from history taking and treatment records. Plaque index, bleeding index, probing depth, mucosal recession, and bone level in relation to buccal keratinized mucosa were examined. The Kruskal-Wallis, Mann-Whitney U, and multivariable models were used as the statistical tests. Results: The majority of subjects attended implant maintenance at least once a year and demonstrated optimal oral hygiene. keratinized mucosa width ranged from 0-7 mm. Considering the keratinized mucosa widths, a marked recession was determined at < 2 mm keratinized mucosa and less recession was determined at > 2 mm keratinized mucosa. The multivariate model indicated that < 2 mm keratinized mucosa was significantly associated with increased mucosal recession (B = 0.12; CI: 0.01, 0.23). Plaque accumulation, mucosal inflammation, and interproximal bone level were not related to keratinized mucosa width after adjusting for oral hygiene, smoking status, history of chronic periodontitis, and implant prosthesis type. Conclusions: The presence of more than 2 mm of KM width was associated with mucosal recession. However, other peri-implant diagnostic parameters were not associated with the width of keratinized mucosa.

Effect of mixed chlorhexidine and hydrogen peroxide mouthrinses on developing plaque and stain in gingivitis patients: a randomized clinical trial.

AIMS: To evaluate the effects of mixed chlorhexidine (CHX)/hydrogen peroxide (H2O2) mouthrinses compared with CHX mouthrinse alone on plaque, tooth stain, and gingivitis. MATERIALS AND METHODS: This study was a double-blind, randomized two group parallel experiment, using a 14-day non-brushing half-mouth model. The test group was randomly assigned to the mixed 0.12% CHX and 1.5% H2O2 mouthrinse, whereas the control group used 0.12% CHX. Sixty healthy volunteers were enrolled in the study and received scaling and polishing 2 weeks prior to the experiment and then rinsed with the allocated mouthrinses twice daily for 2 weeks. The plaque, stain, and gingivitis scores were evaluated and recorded by a calibrated investigator. RESULTS: Fifty-two subjects completed the study (CHX + H2O2n = 25/CHX n = 27). There were significant differences between the control and test groups for plaque index (CHX 0.64 ± 0.41 vs. CHX + H2O2 0.46 ± 0.36, p = 0.035) and stain intensity at proximal areas (CHX 0.26 ± 0.36 vs. CHX + H2O2 0.09 ± 0.14, p = 0.019) at the end of the experimental non-brushing side. However, the gingival indices did not differ significantly (CHX 0.61 ± 0.34 vs. CHX + H2O2 0.62 ± 0.31, p = 0.938) between groups. CONCLUSIONS: In the absence of oral hygiene practice, the mixed CHX + H2O2 mouthrinse was slightly superior in reducing plaque scores and stain compared with CHX alone. CLINICAL RELEVANCE: The clinical effectiveness of CHX + H2O2 is comparable with CHX mouthwash alone. Therefore, the use of the mixed mouthrinse is beneficial compared with CHX for minimizing biofilm and tooth staining.

The lack of keratinized mucosa is associated with poor peri-implant tissue health: a cross-sectional study.

OBJECTIVES: The aim of this cross-sectional study is to determine the association between the absence of keratinized mucosa and peri-implant tissue health. METHODS AND MATERIALS: This cross-sectional study comprised 412 implants from 200 patients from faculty-based clinics. Demographic, medical, and clinical information were collected. The modified sulcus bleeding index, modified plaque index, mucosal recession, probing depth, bone level, the width of keratinized mucosa, and implant status were evaluated by three calibrated examiners. Each implant was categorized into either of two peri-implant mucosa groups: keratinized mucosa (KM) or non-keratinized mucosa (NKM). The chi-square test was performed to the association between the keratinized mucosa groups and peri-implant clinical parameters and peri-implant status. Multiple logistic regression models were analyzed to test potential associations between peri-implant clinical parameters and the presence or absence of keratinized mucosa. RESULTS: Thirty-two implants (7.8%) were categorized into the NKM group. The prevalence of peri-implantitis was 12.5% and 8.3% at the subject level and implant level, respectively. The NKM group was associated with more plaque accumulation, mucosal recession, interproximal bone level ≥ 3 mm, and peri-implantitis (p < 0.05). After controlling for confounding factors, the NKM group demonstrated higher plaque accumulation, mucosal recession, and interproximal bone level ≥ 3 mm with adjusted odds ratios of 2.98 (1.33-6.66), 3.20 (95% CI, 1.03-9.90), and 4.62 (1.70-12.58), respectively. CONCLUSION: Within the limitation of this study, the lack of keratinized mucosa around the dental implants was significantly associated with more plaque accumulation, mucosal recession, interproximal bone level ≥ 3 mm, and peri-implantitis.

Evaluation of esthetic parameters related to a single implant restoration by laypeople and dentists.

STATEMENT OF PROBLEM: Currently available assessment tools for evaluating the esthetic outcome of implant restorations consist of objective indices created for dentists. The investigation of esthetic parameters according to the patient's perspective is lacking. PURPOSE: The purpose of this observational study was to evaluate and compare the importance of different soft-tissue and restoration-related esthetic parameters for patients and clinicians. MATERIAL AND METHODS: A photoediting software program (Photoshop CC; Adobe Corp) was used to produce 10 photographs with modified smiles from the original photograph by altering 1 parameter of the pink esthetic score and white esthetic score (PES/WES) at a time. A total of 120 participants were recruited in the study, including 40 laypeople, 40 prosthodontists, and 40 periodontists. A total of 440 visual analog scale (VAS) values were obtained for each group to record participants' subjective esthetic assessments of all photographs (10 modified and 1 original photograph). Repeated-measures ANOVA and post hoc mean comparison (t grouping) were used to identify whether the individual alteration on the PES and WES indices was significant for each group. RESULTS: For the laypeople, color (hue and value) appeared to be the most important parameter. After color, the order of importance was as follows: root convexity along with soft-tissue color and texture, level of facial mucosa, distal papilla, mesial papilla, translucency or characterization, surface texture, and tooth form. For the periodontists, color (hue and value) was also the most important parameter, but it was not separable from a cluster of other parameters: level of facial mucosa, root convexity along with soft-tissue color and texture, mesial papilla, and distal papilla. For the prosthodontists, color (hue and value) and level of facial mucosa were the most important parameters affecting esthetic assessment, followed by root convexity along with soft-tissue color and texture, mesial papilla, and distal papilla. CONCLUSIONS: All groups graded color (hue and value) as the most important parameter affecting the esthetic outcome and the original unaltered photograph as the most esthetically pleasing image. All participants (laypeople and dental specialists) appeared to be able to perceive the same 5 parameters including color (hue and value), level of facial mucosa, mesial papilla, distal papilla, and root convexity along with soft-tissue color and texture that are negatively affecting esthetic outcomes. Except for color (hue and value), restoration-related esthetic parameters had a lesser effect on the overall esthetic assessments for all groups.

The effect of factors related to periodontal status toward peri-implantitis.

OBJECTIVE: To investigate the association between periodontal status and peri-implant diseases in patients with osseointegrated dental implants of different implant systems. MATERIALS AND METHODS: This cross-sectional study evaluated 200 consecutive implant patients using clinical and radiographic examinations during periodontal maintenance visits. The demographic data and treatment history were obtained from history taking and chart record review. The association between periodontal status and peri-implant diseases was analyzed using chi-square and logistic regression analysis. RESULTS: Patients with a history of chronic periodontitis had a significantly higher prevalence of peri-implantitis compared with those without a history of periodontal disease (25% vs. 10.9%). The highest prevalence of peri-implantitis was observed in patients with a history of severe chronic periodontitis. Data analysis revealed that peri-implant health status was significantly associated with past periodontal status, maintenance status, and present periodontal status. However, multivariate analysis indicated that only a history of chronic periodontitis was significantly associated with peri-implantitis (adjusted OR = 2.55, 95% CI 1.14-5.70, p = 0.02). CONCLUSIONS: Patients with a history of chronic periodontitis, especially those with severe periodontal disease had a 2.5-fold increased risk of peri-implantitis.

Clinician assessments and patient perspectives of single-tooth implant restorations in the esthetic zone of the maxilla: A systematic review.

STATEMENT OF PROBLEM: Esthetic outcomes associated with implant dentistry are important to both clinicians and patients. However, esthetic satisfaction may vary between the 2 groups. In order to evaluate the current publications relating to this topic, the following focused question was developed, "what are the quantitative and qualitative differences between clinician evaluations and patient perspectives in the assessment of single-tooth implant outcomes in the esthetic zone?" PURPOSE: The purpose of this systematic review was to identify differences in esthetic satisfaction between clinicians and patients when evaluating single-tooth implant-supported restorations. MATERIAL AND METHODS: An electronic search of the Medline database and Cochrane Central Register of Controlled Trials (2000 to 2014) was performed. The search was supplemented by a manual search of specific journals. A quality assessment of full-text articles was performed according to Cochrane Collaboration's tool and Newcastle-Ottawa scale for risk of bias assessment. Information regarding outcomes was collected and compared. RESULTS: The search term combinations identified 555 titles. Subsequent to further review, 11 publications, including 2 randomized controlled trials, were selected for inclusion. Because of the heterogeneity of the study designs, study interventions, and esthetic assessment methods, no meta-analysis was performed. The clinicians identified a satisfactory outcome in 51% to 100% for peri-implant soft tissue and 62% to 90% for implant restorations. Patients showed a mean range score of 43% to 93% for peri-implant soft tissue and 81% to 96% for implant restorations. The visual analog scale score of the dentists was always lower than that of the patients. The review identified correlations between subjective and objective assessments for the Pink Esthetic Score (PES), the Papilla Index (PI), the Implant Crown Aesthetic Index (ICAI), and the modified (mod-ICAI) indices. CONCLUSIONS: Clinicians are more critical of esthetic outcomes than patients. The PES and the PI correlated with the patients' responses concerning the peri-implant soft tissue. The ICAI and the mod-ICAI showed a correlation of both the peri-implant mucosa and implant-supported crown satisfaction. Thus, a comprehensive and practical index should be developed to assess the esthetic outcomes for single-tooth implant restorations in the esthetic zone.

Digital approach to planning computer-guided surgery and immediate provisionalization in a partially edentulous patient.

This report describes a digital approach for computer-guided surgery and immediate provisionalization in a partially edentulous patient. With diagnostic data obtained from cone-beam computed tomography and intraoral digital diagnostic scans, a digital pathway of virtual diagnostic waxing, a virtual prosthetically driven surgical plan, a computer-aided design and computer-aided manufacturing (CAD/CAM) surgical template, and implant-supported screw-retained interim restorations were realized with various open-architecture CAD/CAM systems. The optional CAD/CAM diagnostic casts with planned implant placement were also additively manufactured to facilitate preoperative inspection of the surgical template and customization of the CAD/CAM-fabricated interim restorations.