Aesthetic Parameters and Patient-Perspective Assessment Tools for Maxillary Anterior Single Implants.

BACKGROUND: This review aimed to concisely describe the current aesthetic objective indices for a single-implant maxillary anterior crown. The secondary aim was to propose introducing a unified, standardized questionnaire for adequately collecting patient-reported outcome measures (PROMs) in implant dentistry. MATERIALS AND METHODS: A literature review was conducted using both EMBASE/Ovid and MEDLINE/PubMed databases by combining keywords and Emtree/Mesh terms related to "Esthetics," "Self-Assessment or Surveys and Questionnaires," and "Single-Tooth Dental Implants." RESULTS: The most meaningful aesthetic objective indices for single implants in the literature are the Pink Esthetic Score (PES), the Papilla Presence Index (PPI), Peri-Implant and Crown Index (PICI), PES/White Esthetic Score (PES/WES), the Implant Crown Aesthetic Index (ICAI), and a modified version of the ICAI (mod-ICAI) index. Clearly, PES/WES is still the most widely accepted tool. It is encouraging to observe that there is an increasing tendency in recent years to report PROMs more frequently in the implant dentistry literature. We proposed the implementation of a unified, standardized questionnaire using a self-administered visual analogue scale (VAS) scoring system, which evaluates overall satisfaction, comfort, tooth appearance, gingival appearance, function, and hygiene complexity. This tool should be validated in the oral implantology research context for its regular implementation or further development. CONCLUSIONS: Conducting qualitative studies among dental implant patients who received few implants or single-tooth implant reconstructions in the aesthetic zone may help dental researchers understand better how to efficiently develop and validate a quantitative instrument. This standard tool would reduce heterogeneity bias by providing comparable data between studies.

A metatheory explaining how patients manage tooth loss.

OBJECTIVES: To explore how a metatheory composed of five dominant psychosocial theories of communication, developmental regulation, emotions, resources and social cognition, explains the beliefs, concerns and experiences, of people experiencing tooth loss. BACKGROUND: Complete tooth loss is the leading cause of disability associated with oral conditions in 19 of 21 global regions, and it is among the most difficult treatment challenges in dentistry. METHODS: Interviews with 18 participants were analysed inductively using interpretive description and qualitative synthesis to explain their beliefs and experiences relating to tooth loss. RESULTS: Theoretical constructs from the five dominant theories constituting the metatheory explained the beliefs, concerns and experiences of the participants. For example, both before and after tooth loss they engaged in adaptive behaviours according to developmental regulation theory; implemented management strategies according to emotion theory, social cognitive theory, and resource theory; sought help from friends and dental professionals according to communication theory; and modified their physical and social activities according to social cognitive theory. CONCLUSION: A metatheory synthesised from five dominant theories addressing communication, personal background, emotions, resources and social awareness, offers a comprehensive and plausible explanation of how people respond psychologically and socially to the loss of their teeth, and expands the scope of information needed to help manage their loss and subsequent treatment.

A qualitative synthesis of theories on psychosocial response to loss of breasts, limbs or teeth.

OBJECTIVES: The aim of this systematic review is to generate a qualitative synthesis of psychosocial theories being used to explain the beliefs and behaviors of people responding to loss of anatomical parts, such as breasts, limbs, or teeth. DATA & SOURCES: A search in four databases and subsequent manual search of pertinent reference lists identified theories on how people respond to loss of anatomical parts. Findings were analyzed by consensus through a three-stage interpretive process to: deconstruct and interpret each theory, categorize similar theoretical constructs, and distill the dominant theoretical perspectives identified as most relevant to explaining responses to the loss. STUDY SELECTION: 2540 citations produced 288 articles referring to 89 primary theories containing 586 constructs. Through synthesis of seven construct categories a metatheory with essential contributions from theories on communications, developmental regulation, emotions, resources, and social cognition can explain responses to loss. CONCLUSIONS: This qualitative synthesis provides a conceptual foundation for further investigations to explain how people manage loss of anatomical parts. CLINICAL SIGNIFICANCE: The combination of five dominant theories serves as a prelude to the development of a metatheory, which will further help determine how people psychosocially respond to the loss of anatomical parts.

Patient Satisfaction in Medicine and Dentistry.

Health professionals, such as medical and dental clinicians, have scant understanding of patients' experiences and perceptions of satisfaction. Nevertheless, implementing a patient-reported outcome measures (PROMs) research practice in surgical sciences is necessary. Hence, the objective of this article was to better understand patients' satisfaction with their medical and dental care. The methods of the current article are based on a narrative review of the literature strategy. A literature review was conducted using both EMBASE and Medline databases up to July 12, 2020, by combining keywords and terms related to "satisfaction theories" and "patient satisfaction," and "medicine" or "dentistry/stomatology/odontology." Patient satisfaction's multidimensional nature has been established since the perceived reasons for satisfaction varied widely among patients. Many aspects of treatment influence participant satisfaction at different stages of the intervention process. An improved understanding of the basis for managing patients' expectations with information reiteratively and efficiently may ultimately reduce patients' potential for negative feelings toward the medical and dental treatment experience. Lastly, the consumerist method may misrepresent the still undertheorized concept of satisfaction in health service.

Oral healthcare challenges for older Punjabi-speaking immigrants.

This study explored how older Punjabi-speaking South-Asian immigrants (four focus groups; 33 participants) in Surrey, British Columbia, perceive oral health and related problems. Content analysis revealed two umbrella themes: (a) interpretations of mouth conditions and (b) challenges to oral health. The umbrella themes had four sub-themes: damage caused by heat (wai), disturbances caused by caries, coping with dentures, and quality of life. Three challenges were considered: home remedies, Western dentistry, and difficulties accessing dentists. Participants explained oral diseases in terms of a systemic infection (resha), and preferred to decrease imbalances of wai in the mouth with home remedies from India. We conclude that older Punjabi-speaking immigrants interpret oral health and disease in the context of both Western and Ayurvedic traditions, and that they manage dental problems with a mix of traditional remedies supplemented, if possible, by elective oral health care in India, and by emergency dental care in Canada.

Attachment systems for mandibular implant overdentures: a systematic review.

PURPOSE: The aim of this systematic review was to address treatment outcome according to attachment systems for mandibular implant overdentures in terms of implant survival rate, prosthetic maintenance and complications, and patient satisfaction. MATERIALS AND METHODS: A systematic literature search was conducted using PubMed and hand searching of relevant journals considering inclusion and exclusion criteria. Clinical trial studies on mandibular implant overdentures until August, 2010 were selected if more than one type of overdenture attachment was reported. Twenty four studies from 1098 studies were finally included and the data on implant survival rate, prosthetic maintenance and complications, patient satisfaction were analyzed relative to attachment systems. RESULTS: Four studies presented implant survival rates (95.8 - 97.5% for bar, 96.2 - 100% for ball, 91.7% for magnet) according to attachment system. Ten other studies presented an implant survival rate ranging from 93.3% to 100% without respect to the attachment groups. Common prosthetic maintenance and complications were replacement of an assay for magnet attachments, and activation of a matrix or clip for ball or bar attachments. Prosthetic maintenance and complications most commonly occurred in the magnet groups. Conflicting findings were found on the rate of prosthetic maintenance and complications comparing ball and bar attachments. Most studies showed no significant differences in patient satisfaction depending upon attachment systems. CONCLUSION: The implant survival rate of mandibular overdentures seemed to be high regardless attachment systems. The prosthetic maintenance and complications may be influenced by attachment systems. However patient satisfaction may be independent of the attachment system.

Number of implants for mandibular implant overdentures: a systematic review.

PURPOSE: The aim of this systematic review is to address treatment outcomes of Mandibular implant overdentures relative to implant survival rate, maintenance and complications, and patient satisfaction. MATERIALS AND METHODS: A systematic literature search was conducted by a PubMed search strategy and hand-searching of relevant journals from included studies. Randomized Clinical Trials (RCT) and comparative clinical trial studies on mandibular implant overdentures until August, 2010 were selected. Eleven studies from 1098 studies were finally selected and data were analyzed relative to number of implants. RESULTS: Six studies presented the data of the implant survival rate which ranged from 95% to 100% for 2 and 4 implant group and from 81.8% to 96.1% for 1 and 2 implant group. One study, which statistically compared implant survival rate showed no significant differences relative to the number of implants. The most common type of prosthetic maintenance and complications were replacement or reattaching of loose clips for 2 and 4 implant group, and denture repair due to the fracture around an implant for 1 and 2 implant groups. Most studies showed no significant differences in the rate of prosthetic maintenance and complication, and patient satisfaction regardless the number of implants. CONCLUSION: The implant survival rate of mandibular overdentures is high regardless of the number of implants. Denture maintenance is likely not inflenced substantially by the number of implants and patient satisfaction is typically high again regardless os the number of implants.

Magnet-retained implant-supported overdentures: review and 1-year clinical report.

Open-field aluminum-nickle-cobalt magnets have been used in prosthodontics for many years, but success has been limited because these magnets are susceptible to corrosion by the saliva and because their retentive force is weak relative to the initial retention offered by mechanical attachments. More recently, magnets have been made from alloys of the rare earth elements samarium and neodymium, which provide stronger magnetic force per unit size. In addition, a new generation of laser-welded containers has improved protection from salivary corrosion. The current resurgence of interest in this type of attachment appears justified because, unlike mechanical attachments, magnets have potential for unlimited durability and might therefore be superior to mechanical ball or bar attachments for the retention of removable prostheses on implants. To date, no long-term prospective trials have been conducted to confirm the clinical durability of this new generation of magnets for retaining dentures on either teeth or implants. The aim of this study was to document initial clinical experiences and levels of satisfaction among edentulous patients treated with mandibular implant-supported overdentures retained using a new generation of rare-earth magnetic attachments. At the outset, all but one of the 17 patients had had several years of experience with implant-supported overdentures. During the first year, the mean overall satisfaction among these 17 patients increased from less than 70 to over 90 out of 100 (standardized visual analogue scale). No unusual difficulties were encountered in rendering the treatment or maintaining the attachments. This report offers preliminary evidence of the excellent potential of these magnets for retaining mandibular implant-supported overdentures.

Using written vignettes in focus groups among older adults to discuss oral health as a sensitive topic.

When the mouth yields pain and distress, it can impact psychosocially the lives of older adults and might constitute a sensitive topic for open disclosure. In this article, we describe our use of a written vignette in focus groups for discussion of oral health and disablement. Six focus groups were conducted with 42 older men and women with an average age of 75 years who were purposefully selected through advertisements posted in community centers and retirement homes. In discussions lasting for an average of 90 min, groups of up to 9 participants commented positively and negatively on the vignette's story and voluntarily discussed their personal experiences, family histories, and testimonies about the mouth and coping and adapting strategies to disabilities. The discussion about oral health can be sensitive, but the vignette shifted the focus away from the participants and allowed them to share personal experiences with oral health and disablement.

Elders assessment of an evolving model of oral health.

OBJECTIVES: To evaluate qualitatively a model of oral health through focus groups among elders. METHODS: The participants (30 women and 12 men; mean age: 75 years) attended one of six focus groups to discuss the relevance of the model to their oral health-related beliefs and experiences, and transcripts of the narratives were analysed systematically for the components, associations and recommendations emerging from the discussions. RESULTS: The groups confirmed the relevance of the original components of the model with minor modifications, but felt that for completeness it required four additional components: diet; economic priorities; personal expectations; and health values and beliefs. They recommended that the negative connotations of limited activity, impairment and restricted participation were modified with the positive terms activity and participation, and they suggested that ellipses rather than concentric circles more aptly illustrate the dynamic and overlapping importance of the various components in the model. CONCLUSION: The original model required additional components and graphic representation to accommodate all of the experiences and beliefs relating to the oral health of the elders who participated in this qualitative study.

Does the type of implant prosthesis affect outcomes for the completely edentulous arch?

PURPOSE: A systematic review, including meta-analysis, was conducted to answer the question "Does the type of implant prosthesis affect outcomes for the completely edentulous arch?" The current paper was to assess the impact of fixed or removable prosthesis type on implant survival and success outcomes. MATERIALS AND METHODS: Pertinent literature was identified through December 31, 2005 using a PubMed search strategy and hand-searching of relevant journals, a personal library, and reference lists from included studies. Inclusion and exclusion criteria were applied to the titles and abstracts and subsequently to the full text of included references. The 72 included studies reported oral implant survival or success, crestal bone levels or loss, and/or prosthesis success or maintenance differentiated by arch and by prosthesis type (fixed or removable, splinted or nonsplinted) established either in 1-year randomized clinical trials or 5-year observational studies. RESULTS: Statistical analysis revealed only a site-specific rather than a design-specific finding that implant survival for mandibular fixed prosthesis groups had a 6.6% greater implant survival than maxillary fixed prostheses groups (P < .001). The observation of greater implant failure for removable over fixed protheses groups in the maxilla appeared likely due to deficient preoperative bone volume in the removable prosthesis groups. DISCUSSION: There is little evidence that implant survival or success is affected directly by prosthesis type based on current designs studied for at least 5 years. Prosthesis maintenance does appear to vary with different prosthesis designs. CONCLUSION: While this study suggests implant survival and success may not be affected by variation across the established types of implant prostheses, maintenance demands can vary with implant prosthesis type, especially with overdenture attachments. Clinicians should remain diligent in basing implant prosthodontic technique on established protocols.

A retrospective study on the treatment outcome of wide-bodied implants.

PURPOSE: This retrospective study documented the 5-year cumulative survival rate (CSR) of 5-mm-diameter wide-bodied implants in posterior jaws as related to identified risk factors and relative host bone site dimensions. MATERIALS AND METHODS: Sixty-four wide-bodied implants placed consecutively in the posterior jaws of 43 patients were matched using several identified risk factors with 64 regular-diameter implants (3.75-mm or 4-mm diameter) placed in the posterior jaws of 25 of the same patients and 14 others. Life table analyses were undertaken to examine the difference in CSR between the groups. Multivariate Cox regression was conducted to assess the relationship between potential risk factors and overall CSR. RESULTS: Ten of the wide-bodied implants failed (CSR 80.9%), while two of the regular-diameter implants failed (CSR 96.8%). The difference between the groups was statistically significant. Multivariate analysis demonstrated a significant predictive relationship between overall CSR and the ratio of implant volume to remaining bone volume. This suggests that relative determinants of critical bone volume to implant dimensions may need to be considered when planning implant surgery. CONCLUSION: Wide-bodied implants placed in the posterior jaw can suffer a significantly elevated risk of implant failure compared to regular-diameter implants. This susceptibility may relate to either implant design or the relative relationship of implant to host bone dimensions.

Crestal bone loss proximal to oral implants in older and younger adults.

STATEMENT OF PROBLEM: Older adults often have bone loss and may be at risk of bone resorption around oral implants. PURPOSE: This study tested the hypothesis that there is no difference in crestal bone loss proximal to oral implants in the complete implant prosthesis sites of older and younger adults. MATERIAL AND METHODS: Two groups of 35 complete dental implant prosthesis sites (23 screw-retained fixed prostheses and 12 bar-retained overdentures) were selected by matching sites in 32 older adults (60 to 74 years old with 166 Bränemark implants) to sites in 34 younger adults (29 to 49 years old with 162 Bränemark implants) on the basis of possible confounding factors including gender, prosthetic design, implant number, arch, year of surgery, and opposing dentition. Statistical comparisons (Mann-Whitney test at P<.05) were made of mean crestal bone level at loading and mean annual crestal bone loss during the first year, first to fourth year, after first year, and after fourth year of loading with periapical radiographic measurements of the vertical distance in millimeters from the apical edge of the implant collar to the most apical initial point of contact between the implant and bone. RESULTS: No significant differences were found between the groups. Mean bone levels at loading were 1.4 mm below the collar in both groups and mean annual crestal bone loss after the first year of loading was 0.04 mm/y in both groups. However, significant differences were found between some old and young subgroups stratified by arch and prosthetic design. CONCLUSION: Within the limitations of this study, elders should expect no more rapid bone resorption around oral implants in edentulous jaws than that seen in young adults.

Outcomes of implant prosthodontic treatment in older adults.

Older adults are expected to account for an increasingly disproportionate number of individuals needing oral implant prostheses. However, this biotechnology was initially studied for predominantly middle-aged edentulous patients, not elderly people. High rates of success and minimal crestal bone loss have been reported for oral implants mainly in this group. The results of studies at the University of Toronto now clearly support earlier reports that older adults respond to oral implants in the same manner as younger adults, despite their tendency for systemic illness, including osteoporosis. However, unfavourable jawbone quantity and quality, particularly atrophy of the maxilla, impaired implant success. Furthermore, placement of implants in sites that had been edentulous for shorter periods was associated with greater crestal bone loss, a finding that may have implications for younger adults undergoing such treatment. The major decision-making challenge in managing depleted dentitions and complete edentulism in an aging society now lies in differentiating the treatment outcomes, especially patient-mediated assessments (including economic analyses), of the various prosthodontic options available for older adults.