Esthetic and Patient-Centered Outcomes of Single Implants: A Retrospective Study.

PURPOSE: The aims of this clinical study were to retrospectively evaluate implant survival, patient satisfaction, and radiographic, clinical, and esthetic outcomes following single-implant treatment. MATERIALS AND METHODS: Eighty-seven patients, with a total of 126 implants (XiVE S, Dentsply Implants), who received single implant-retained crowns between 2004 and 2011 were retrospectively evaluated. Implant survival, marginal bone levels (MBL), changes in implant/mesial tooth vertical relationship, pink esthetic score (PES), white esthetic score (WES), patient assessment of the esthetics (visual analog scale), and oral health impact profile (OHIP-14) were evaluated. RESULTS: Altogether, 59 patients with a total of 85 implants attended a final clinical and radiographic follow-up examination. The mean ages of males and females at implant placement were 19.78 and 22.58 years, respectively. The mean total follow-up time from the implant surgical date was 7.51 years. The 5-year implant clinical survival rate (CSR) was 98.4% (95% CI: 96.3%-100%), and crown CSR was 91.8% (95% CI: 86.3%-97.3%). The overall mean change in MBL was -0.19 mm. No significant differences were found between the different implant diameters (3.0, 3.4, and 3.8 mm) with regard to change in MBL. Mean increase in implant infraposition was 0.13 mm. With regard to esthetics, mean initial and final total PES were 9.61 and 11.49, respectively (P < .001). The mean WES was 6.48 at follow-up. Patients' mean assessment of soft tissue esthetics and implant-supported crown appearance were 73.5 and 82.1 (maximum score 100). At the follow-up examination, the additive OHIP-14 score was 16.11. CONCLUSION: This retrospective study of XiVE S implants found excellent survival rates and showed good clinical outcomes concerning patient-centered findings, esthetics, and marginal bone preservation. In context, it is important to stress that this study consisted of mostly young patients with agenesis who were treated by experienced clinicians.

The Shortened Dental Arch concept from the perspective of Swedish General Dental Practitioners: a qualitative study.

The aim was to study the cognizance of and attitudes towards the Shortened Dental Arch (SDA) concept among Swedish General Dental Practitioners (GDPs) and the application of the SDA concept in their treatment planning using Qualitative Content Analysis. Eleven Swedish GDPs were purposively selected and all agreed to participate. In-depth semi-structured interviews were conducted and covered treatment considerations concerning two patient cases and the participants' reflections regarding pre-formulated statements about the SDA concept. Qualitative content analysis was used to analyze this data.The emerging theme was "the SDA concept is irrelevant" in the sense of the GDPs disregarding treatments providing dentitions with loss of posterior teeth. There was a strong reluctance to extract teeth, without consideration of the SDA concept, and a firmly patient-focused attitude towards the needs, age and financial situation of the patients. Within the limitations of this study, Swedish GDPs show little or no cognizance of the SDA concept and it does not seem to be applied in their treatment planning. The results show that the qualitative methodology can be beneficial for further understanding of cognizance and attitudes towards the SDA concept.

Grounded theory on factors involved in the decision-making processes of patients treated with implant therapy.

PURPOSE: The aims of this research were to describe the process leading to desire for implant treatment, describe how patients missing teeth gained information about implant treatment, identify gatekeeping factors for implant treatment, and note experiences in changes in oral health-related quality of life. MATERIALS AND METHODS: The constant comparative method for a grounded theory was used in collecting and analyzing data. Ten informants participated in the study, all of whom were treated with implant-supported fixed dentures during the past year. RESULTS: The emerging core category was that participants experienced a journey from social stigma to exhilaration. This process ended in the perspective that the participants' new lives with dental implants were very good and meant an end to their social stigma, but gatekeeping factors before treatment, such as cost and dental anxiety, were noted. The dentist's opinion and suggestions were the most decisive part of the decision-making process, and trust in the dentist and dental team was crucial in the decision to undergo treatment and in the overall treatment experience. Great improvement in oral health-related quality of life was noted. CONCLUSION: This qualitative study gives as the core category and main finding the importance of patients' trust and confidence in the dentist and his/her staff in the process of transforming desire for dental implant treatment into demand and also in making it more likely for patients to be satisfied with treatment regardless of complications.

Factors explaining desire for dental implant therapy: analysis of the results from a longitudinal study.

PURPOSE: The aim of this research was to investigate possible factors behind the desire for and changes in attitude toward implant treatment in a population of middle-aged and older individuals in Sweden. MATERIALS AND METHODS: In 1989 and 1999, questionnaires were sent to 3,000 residents in Orebro County, Sweden. Response rates were 79% and 68%, respectively. Those responding to both questionnaires yielded a longitudinal study panel. Logistic regression models were done with "desire of implant treatment" and "changes in desire of implant treatment" as dependent variables. RESULTS: Older people, non-city residents, and those with one or several missing and unreplaced teeth changed their desire for implant treatment between study years. Effects of age, residence, and better dental status disappeared during the 10-year study period. Those who were edentulous and those with removable dentures (pseudo R2: 0.17) expressed lower desire for treatment than those with all teeth remaining or only one or a few teeth missing (pseudo R2: 0.24) in 1989. High income significantly increased the probability to desire implant treatment for the study panel at both study occasions (P = .016 and P = .034 for 1989 and 1999, respectively). CONCLUSIONS: Factors influencing desire for implant treatment were primarily income and dental status. The influence of young age, urban living, and dental status regarding the subgroup with one or several teeth missing in relation to those with all their teeth disappeared during the 10-year study period.

Prosthodontics, care utilization and oral health-related quality of life.

The main aim of this thesis was to study the impact of oral health and oral prostheses on oral health-related quality of life (OHRQOL) in an adult Swedish population. Additional aims were to study social inequalities in oral health, attitudes towards the cost for dental care and dental care utilization. The study base was 1294 responses to a questionnaire from a random sample of 1974 persons aged 50-75 years, all of whom were resident in the County of Skine, Sweden. There was an association between impaired dental conditions and poor social conditions. Low dental care utilization covaried with impaired dental conditions and with stating a perceived need to obtain dental care but with no possibility to obtain it because of a cost barrier. In factor analysis, three factors captured 22 variables that aimed to measure OHRQOL. The constituent variables were summed into three index variables interpreted as oral health impact on everyday activities, on a psychological dimension and on oral function. The three variables were set as dependent variables in regression models with the independent variables social attributes, individual attributes, dentures, number of teeth and dental care attitudes. The models were run in three steps taking into account the interaction between the type of denture and the number of remaining teeth. The number of remaining teeth was more important than the type of denture when explaining OHRQOL. The type of replacement, in terms of fixed or removable denture, was less important for those with few or no remaining teeth, than for all others. OHRQOL was also explained by general health in relation to age peers as well as by varying attitudes towards dental care costs. Statistically significant interactions were observed between the number of remaining teeth and the type of denture when explaining OHRQOL. As a whole the thesis shows that social and dental conditions and cost for dental care play a great role for dental care utilization as well as for OHRQOL. Prosthodontics has an important role, where type of replacement interacts with tooth loss in its effect on QOL.

Oral prostheses and oral health-related quality of life: a survey study of an adult Swedish population.

PURPOSE: The purpose of the study was to investigate whether oral health-related quality of life (OHRQOL) in an adult Swedish population could be explained by social attributes; individual attributes; dental status, with a special focus on the role of prosthodontics; and dental care attitudes. MATERIALS AND METHODS: The study was based on responses to a questionnaire sent in 1998 to a random sample of 1,974 persons aged 50 to 75 years (66% response rate). Three factors representing various aspects of OHRQOL were set as dependent variables in multiple-regression models: oral health impact on everyday activities, oral health impact on the psychologic dimension, and oral health impact on oral function. Independent variables in the models were social attributes, individual attributes, number of teeth, denture (ie, type of denture, if present), and dental care attitudes. RESULTS: General health in relation to age peers had the strongest association with all 3 dependent variables, followed by number of teeth and need care--cost barrier. When number of teeth was excluded, removable denture was found to covary with the dependent variables in each of the 3 regression models. CONCLUSION: The number of remaining teeth is more important than the type of denture in explaining OHRQOL. It is less important that a denture is fixed for those with few remaining teeth, in contrast to all others. Explanations are also found in general health and various aspects of dental care costs.

Dimensions of oral health-related quality of life in an adult Swedish population.

The concept of oral health-related quality of life (OHRQOL) is investigated in this study. The aim was to explore the dimensionality of variables measuring OHRQOL in an adult Swedish population and to discuss the findings in relation to existing indices. The study was based on responses to a 1998 questionnaire sent to a random sample of 1974 persons aged between 50 and 75 years. There were 22 variables based on questions concerning oral situation and the impact on 7 theoretically different dimensions of QOL. The majority were satisfied with their oral health situation. During the previous 12 months, 16% of the population had experienced problems with their mouth or teeth on at least one occasion per mouth. Principal components analysis was used to analyze the dimensionality of the variables. Three factors accounted for 59% of the variance: (1) Physical and social disability, (2) psychological discomfort and disability, and (3) functional limitation and physical pain. The perception of OHRQOL is multidimensional, but the dimensions are not equally important. The dimensions of OHRQOL found in the present study are similar to those of existing instruments.

Dental care utilization: a study of 50- to 75-year-olds in southern Sweden.

This study investigates dental care utilization in an adult population in Southern Sweden in relation to dental and social conditions, attitudes to costs, and perceived need to obtain dental services. The study was based on responses to a questionnaire sent in 1998 to a random sample, 1974 persons, aged 56-75 years. The response rate was 66%. A significantly higher probability of dental care utilization less than once a year was found for men, for those with few remaining teeth, and for those with removable dentures. A higher probability of dental care utilization less than once a year was found for those who stated perceived need to obtain dental care with no possibility because of the cost and for those who stated that the cost had influenced their attendance for dental care. The results showed that there were differences for sex and dental conditions in dental care utilization and that dental care utilization was related to attitudes towards costs of dental care.