Survival of tooth-implant connections: A systematic review and meta-analysis.

Implant-supported prostheses have considerable biomechanical advantages in partially edentulous patients when compared to other prosthetic options. Given the steady drop in the frequency of patients reporting with complete edentulism, it is not unusual to see situations where teeth and implants can be splinted to provide support for fixed prostheses. A tooth implant prosthesis differs majorly from an implant-supported prosthesis in terms of force dissipation and design. The aim of this systematic review was to compare the survival rates of tooth-implant-supported prostheses with fully implant-supported and fully tooth-supported prostheses. Using the appropriate search terms, PubMed, Google Scholar, and other indexed journals were used to search the English-language literature. According to the review protocols and the PICOS inclusion criteria, the pertinent studies were chosen. The screening of appropriate studies, evaluation of study quality, and data extraction were carried out independently by two reviewers. The pooling of survival data by prostheses failure, implant failure, and marginal bone loss was used in the meta-analysis. The cumulative data of all included studies indicated that tooth-implant-supported prostheses showed a 5-year survival rate of 77%-84% and a 10-year survival rate of 72%. The pooled risk ratio for prostheses failure and implant failure was 0.99 and 1.76, respectively. These results were not statistically significant (P > 0.05). The pooled standard mean difference for marginal bone loss was 0.59, and the results were statistically significant (P < 0.05). A tooth-implant-supported fixed partial denture (FPD) has a similar survival rate when compared to implant-supported FPD or T-FPD.

Comparing the functional efficiency of tooth-supported overdentures and implant-supported overdentures in patients requiring oral rehabilitation: A systematic review.

The aim of this article is to compare the functional efficiency of tooth-supported overdentures and implant-supported overdentures in patients requiring oral rehabilitation. The comparative quantification of the improvement in functional efficiency is very difficult to assess because of the variations in the study designs like the age of the population studied, the male-to-female ratio, the outcome measures used, the clinical setting in which the implant therapy was provided, oral status of the subjects included and the type of implant therapy provided. In this systematic review, the articles included compared the functional efficiency by assessing the bite force, chewing efficiency, electromyographic (EMG) changes measured by EMG analysis, and patient satisfaction for subjects who have been rehabilitated with either a tooth-supported overdenture or an implant-supported overdenture. This will help the clinicians to better plan the treatment, keeping in mind the long-term prognosis for that particular patient.

Assessment of postoperative discomfort and nerve injuries after surgical removal of mandibular third molar: A prospective study.

INTRODUCTION: The surgical removal of mandibular third molar (M3) teeth may result in a number of complications including pain, swelling, bleeding, alveolar osteitis or nerve dysfunction. Most of these problems are temporary, but in some cases, nerve paresthesia may become permanent and lead to functional problems. AIMS AND OBJECTIVES: This study aims at measuring the clinical severity of pain, swelling, muscle trismus, infection, dry socket and any nerve injury-related paresthesia after surgical removal of M3. It also assesses the validity of the postoperative symptom severity and identifies the most frequent occurrences and postoperative complications. MATERIAL AND METHODS: The prospective study data was collected from 163 patients visiting the Department of Oral and Maxillofacial Surgery, for surgical extraction of impacted M3. Postoperative assessment was done after 1 week at the time of suture removal for pain, swelling, wound closure, postoperative bleeding, dry socket, infection, paresthesia and trismus. Pain intensity in the form of visual analogue scale, clinical swelling determination using thread measure, trismus assessment by differences in mouth opening, paresthesia/anesthesia by questioning about tongue, chin and lip sensibility and performing neurosensory tests like 2-point discrimination, pin prick and light touch. Patients with neurosensory disturbance were followed for 6 months. RESULTS: This study confirmed the previously reported prevalence rates of neurological deficit and demonstrated 2% incidence of lingual nerve injury where no symptom lasted for more than 12 weeks. Inferior alveolar nerve paresthesia not reported in case series. Most of the patients reported with mild pain, mild swelling and trismus at seventh postoperative day at the time of suture removal. CONCLUSION: Although third molar surgery is a secure and low morbidity procedure, the risk of complications will always exist and it increases with increased surgical difficulty, hence the patient should always be educated about the risks and benefits of surgery in order to ensure adequate surgical management of impacted M3.

Effect of Chemical Disinfection on Surface Detail Reproduction and Dimensional Stability of a New Vinyl Polyether Silicone Elastomeric Impression Material.

BACKGROUND: Surface detail reproduction (SDR) and dimensional stability of elastomeric impression material play a crucial role in fixed prosthodontics. AIM AND OBJECTIVES: The aim of this study was to compare the effect of chemical disinfection on SDR and dimensional stability of polyvinyl siloxane (PVS) and polyether (PE) with a new vinyl polyether silicone (VPES) elastomeric impression material. MATERIALS AND METHODS: A stainless steel mold was made to fabricate the study specimens for nonaqueous PVS, PE, and VPES elastic dental impression materials. Single mix impression techniques with light- and heavy-body consistency of all three materials were used to prepare the test specimens. The specimens were immersed in glutaraldehyde (Cidex) 2.45% and sodium hypochlorite (Hypo) 3.0% disinfection for 15 min (T1) and 12 h (T2) immersion after which dimensional stability and SDR were recorded using stereomicroscope and digital Vernier caliper. STATISTICAL ANALYSIS: The data were analyzed using the one-way ANOVA, paired t-test, Kruskal-Wallis test, and Wilcoxon signed-rank test. RESULTS: Dimensional stability at the T2 time interval showed a highly significant difference for control and glutaraldehyde groups (P < 0.001), whereas a statistically significant difference for Hypo group (P < 0.05). SDR of the three materials when compared at T1 time interval showed a statistically significant difference (P = 0.015). A comparison between two disinfectants at T1 time interval revealed a highly significant difference (P < 0.001), while at T2 interval significant difference was obtained (P = 0.009). CONCLUSION: VPES impressions display acceptable dimensional stability and SDR for clinical use with immersion disinfection. Although some statistically significant differences in linear dimensional stability and semidefinite programming were observed among VPES, PE, and PVS, but the clinical impact of these differences is minor considering the overall accuracy of casts which was high.

Accuracy of an intraoral digital impression: A review.

Intraoral scanners (IOSs) are used for capturing the direct optical impressions in dentistry. The development of three-dimensional technology and the trend of increasing the use of IOSs in dental office routine lead to the need to assess the accuracy of intraoral digital impressions. The aim of this review was to assess the accuracy of the different IOS and the effect of different variables on the accuracy outcome. An electronic search using PubMed with specific keywords to obtain potential references for review. A search of MEDLINE (PubMed) identified 507 articles. After title and abstract screening, 412 articles were excluded for not meeting the inclusion criteria and discarding duplicate references. Ninety-five articles were followed for full screening; only 24 articles were included in the final analysis. The studies indicated a variable outcome of the different IOS systems. While the accuracy of IOS systems appears to be promising and comparable to conventional methods, they are still vulnerable to inaccuracies.

Mechanical Properties of a New Vinyl Polyether Silicone in Comparison to Vinyl Polysiloxane and Polyether Elastomeric Impression Materials.

BACKGROUND: A new elastomeric impression material which is a combination of vinyl polysiloxane (VPS) and polyether (PE) elastomers called "polyvinyl ether silicone" (PVES) has been introduced with predictable accuracy and high-quality impressions. There is insufficient data on mechanical properties of this material. MATERIALS AND METHODS: A comparative study of mechanical properties of VPS, PE, and PVES was carried out using light- and heavy-body consistencies of the three materials. Three standardized stainless steel molds were made to fabricate study specimens (n = 96). The specimens were tested for elastic recovery, strain under compression, tear energy, and tensile strength (TS) using the universal testing machine. Statistical analysis was done using two-way analysis of variance test. RESULTS: Elastic recovery was higher in VPS as compared to other two materials. Strain under compression was higher for PE followed by PVES. Tensile energy was significantly higher in PVS while TS was higher in VPS, followed by PVES and PE. CONCLUSION: PVES tested was found to be more flexible with high tensile energy. This material can be preferred in cases with undercut areas favoring the removal of impressions without tear and distortion.

Effect of Monopoly-coating Agent on the Surface Roughness of a Tissue Conditioner Subjected to Cleansing and Disinfection: A Contact Profilometric In vitro Study.

INTRODUCTION: Tissue conditioners are used to improve the health of the soft tissues of denture-bearing areas. However, leaching of plasticizers from tissue conditioners results in deterioration, which necessitates frequent replacement. The life of these liners varies, but it can be extended by the use of a coating material. AIM: To evaluate the surface roughness of a tissue conditioner with monopoly coating, subjected to denture cleanser and disinfectant. MATERIALS AND METHODS: Sixty disk-shaped specimens of Visco-gel were made and divided into six groups of 10 each (control 1 [C1], control 2 [C2], control 3 [C3], group 1 [M1], group 2 [M2], and group 3 [M3]). Specimens of the control group were not coated with monopoly, while the specimens of the groups 1, 2, and 3 were coated with monopoly. Specimens of C1 and M1 were immersed in distilled water. Specimens of C2, C3, M2, and M3 were immersed into solution of denture cleanser for 8 h at room temperature and immersed in distilled water for the remainder of the 24-h period. C3 and M3 specimens were treated with disinfectant for 10 min before testing the surface roughness. The surface roughness was measured on 1st, 3rd, 5th, 7th, and 14th day, using a contact profilometer. Student's paired t-test was used to compare the mean Ra values within each group. In the present study, P < 0.05 was considered as the level of significance. RESULTS: The mean surface roughness values of M1, M2, and M3 groups were less than C1, C2, and C3, respectively. Among all the groups, M1 showed the least surface roughness values. CONCLUSION: Monopoly-coating agent prevents the deterioration and reduces the surface roughness of the tissue conditioner.

Effect of Water Storage on the Flexural Strength of Heat-cured Denture Base Resin Reinforced with Stick (s) Glass Fibers.

BACKGROUND: Flexural strength (FS) of denture base resins (DBRs) had been improved by reinforcing it with different glass fibers. However, a limited data are available on the effect of glass fiber reinforcement with conventional heat-cured resin after prolonged water storage. AIMS AND OBJECTIVES: This study aimed to evaluate the reinforcing effect of novel S-glass and nylon fibers on the FS of acrylic DBRs. It also aimed to evaluate the effect of glass fiber reinforcement on the FS of acrylic DBRs after a prolonged storage in water. MATERIALS AND METHODS: One hundred and sixty identical specimens were fabricated in specially designed molds according to the manufacturer's instructions. The three experimental groups were prepared consisting of conventional (unreinforced) acrylic resin, novel S-glass fiber-reinforced and nylon fiber-reinforced acrylic resin. The specimens were fabricated in a standardized fashion for each experimental group. Each group was further subdivided into two groups on the basis of storage conditions (dry and wet). FS was tested using a three-point universal testing machine at a crosshead speed of 5 mm/min. Glass fiber-reinforced group was further tested after prolonged storage in distilled water. Entered data were statistically analyzed with one-way ANOVA and least significant difference post hoc test. RESULTS: In this study, statistically significant differences were noted in the FS of all the groups. S-glass fiber-reinforced group had highest FS compared to the other two groups (P < 0.001). Nylon fiber-reinforced group had lowest FS. All the groups stored in distilled water revealed a decrease in strength compared to those stored in dry atmosphere. Among wet specimens, those stored for 3 weeks had a significantly higher FS than those stored at one and 2 weeks (P < 0.01). CONCLUSION: Within the limitations of this investigation, the FS of heat-cured acrylic DBR was improved after reinforcement with glass fibers. It can be recommended to strengthen distal extension partial and complete denture bases. Nylon fibers may not be desirable for strengthening acrylic denture bases.

Adverse health effects and unhealthy behaviors among dental undergraduates surfing social networking sites.

INTRODUCTION: Little is known about the relationships between adverse health effects and unhealthy behaviors among dental undergraduate students surfing social networking sites (SNSs). OBJECTIVES: The aim of this study was to determine the associations between adverse health effects and unhealthy behaviors with social networking usage among dental students. MATERIALS AND METHODS: A cross-sectional study was conducted in a private university in Madhya Pradesh (India) among 300 dental undergraduate students. A self-administered questionnaire was used. It included questions on sociodemographical data, pattern of social networking use, social relationship, unhealthy behaviors, and health effects. RESULTS: The mean age was 21.5 (±2.3) years. The average daily SNSs surfing hours were 3.5 (±1.8). Significant associations were found between average hours of social networking and the following factors: isolation from family members and society, refusing to answer calls, musculoskeletal pain, headache, and eye irritation (P < 0.001). The average hours spent on social networking were significantly associated with holding urination and defecation while online, surfing SNSs until midnight, and postponing, forgetting, or skipping meals (P < 0.001). Cohen's effect size value between adverse health effect and social networking hours were 0.78, 0.86, 0.82, 0.86, and 0.81 for back pain, shoulder pain, wrist pain, headache, and eye irritation, respectively. The effect size value between health-related behaviors and social networking hours were 0.72, 0.62, 0.72, 0.71, and 0.84 for holding urine, holding defecation, postponing meal, skipping meal, and social networking until midnight, respectively. Gender-wise comparison for social networking hours showed a low practical significance (d = 0.09). CONCLUSIONS: The average hours spent on social networking were associated with adverse health effects and unhealthy behaviors among dental undergraduate students, as well as social isolation from the family and society.

An alternative technique for hollowing maxillary complete denture.

Extreme resorption of edentulous maxilla may cause difficulty during fabrication of a maxillary complete denture. Increased inter-ridge distance often creates a clinical problem due to heavy-weighted maxillary prosthesis. This article elaborates an alternative approach for hollowing a maxillary complete denture. It utilizes a clear template of the trial denture facilitating the creation of a gelatin cavity form. This hollowing ensures the even thickness of both denture base resins for structural integrity and reduces the heaviness of the denture.

Reflective learning in community-based dental education.

BACKGROUND: Community-based dental education (CBDE) is the implementation of dental education in a specific social context, which shifts a substantial part of dental clinical education from dental teaching institutional clinics to mainly public health settings. Dental students gain additional value from CBDE when they are guided through a reflective process of learning. We propose some key elements to the existing CBDE program that support meaningful personal learning experiences. METHODS: Dental rotations of 'externships' in community-based clinical settings (CBCS) are year-long community-based placements and have proven to be strong learning environments where students develop good communication skills and better clinical reasoning and management skills. We look at the characteristics of CBDE and how the social and personal context provided in communities enhances dental education. RESULTS: Meaningfulness is created by the authentic context, which develops over a period of time. Structured reflection assignments and methods are suggested as key elements in the existing CBDE program. Strategies to enrich community-based learning experiences for dental students include: Photographic documentation; written narratives; critical incident reports; and mentored post-experiential small group discussions. A directed process of reflection is suggested as a way to increase the impact of the community learning experiences. DISCUSSION: We suggest key elements to the existing CBDE module so that the context-rich environment of CBDE allows for meaningful relations and experiences for dental students and enhanced learning.

Fabrication of a Cranial Prosthesis Combined with an Ocular Prosthesis Using Rapid Prototyping: A Case Report.

Rapid prototyping (RP) is a technique of manufacturing parts by the additive layer manufacturing technology; where, a three-dimensional (3D) model created in a computer aided design (CAD) system is sectioned into 2D profiles, which are further constructed by RP layer by layer. Its use is not limited to industrial or engineering fields and has extended to the medical field for the manufacturing of custom implants and prostheses, the study of anatomy and surgical planning. Nowadays, dentists are more frequently encountered with the individuals affected with craniofacial defects due to trauma. In such cases, the craniomaxillofacial rehabilitation is a real challenge to bring the patients back to society and promote their well-being. The conventional impression technique for facial prosthesis fabrication has the disadvantage of deforming the soft tissue and causing discomfort for the patient. Herein, we describe the fabrication of a cranial prosthesis combined with an ocular prosthesis with RP and stereolithography.

Denture hygiene knowledge, attitudes, and practices toward patient education in denture care among dental practitioners of Jabalpur city, Madhya Pradesh, India.

CONTEXT: Researchers have concentrated their focus on denture wearer's attitude and practice toward denture cleansing despite the fact that they should be more focused on the attitudes of the dentists' themselves towards patient education at the time of denture delivery. It is an obligation of every dentist to motivate, instruct and provide the means and methods of plaque control for their patients. AIMS: The aim was to assess the denture hygiene knowledge, attitudes and practice towards patient education in denture care among dental practitioners (DPs) of Jabalpur city, Madhya Pradesh, India. MATERIAL AND METHODS: A total of 168 dental practitioners completed a comprehensive questionnaire. All participants signed an informed consent before answering the questionnaire. The institutional review committee approved the study. STATISTICAL ANALYSIS: Chi-square test for non-parametric study was employed to determine the statistical difference between the two groups. A P-value of 0.05 was considered to be statistically significant. RESULTS: Most of the subjects were qualified with a bachelor degree 142 (85%). 25 (18%) subjects did not associate oral biofilms on complete denture with conditions like denture stomatitis and other serious systemic diseases. Approximately half of the DPs 69 (48%) and specialists 8 (31%) agreed that explaining denture hygiene instructions to old patients can be very time consuming. A recall program for their patients is of importance according to 39 (27%) of DPs and 3 (12%) specialists. CONCLUSIONS: It may be concluded that the study subjects had limited knowledge of denture cleansing materials and denture hygiene importance. Attitudes varied among the subjects when it came to sharing information with their patients.

Psychometric assessment of anxiety with the Modified Dental Anxiety Scale among central Indian adults seeking oral health care to a dental school.

BACKGROUND: Anxiety toward dental treatment can cause people to delay or avoid seeking oral health care despite being in need of treatment. Therefore, recognizing such anxious patients and their appropriate management plays important aspects in clinical practice. AIM: The aim of this study was to investigate the level of dental anxiety (DA), factors affecting it, and anxiety toward dental extraction among adults seeking dental care to a dental school in Central India. MATERIALS AND METHODS: The study sample consisted of 1360 consecutive patients aged 18-70 years. Participants completed a questionnaire while in the waiting room, which included the Modified Dental Anxiety Scale (MDAS) to assess the level of DA. An additional item was included which asked participants to rate the anxiety felt on having a tooth extracted. RESULTS: Among the study group, 65.1% were men and 34.9% were women. Based on the MDAS score, 41.8% of the participants were identified to be less anxious, 53.2% were moderately or extremely anxious, and 5% were suffering from dental phobia. Female participants and younger patients were more anxious (P = 0.0008). Patients who were anxious had postponed their dental visit (P = 0.0008). Participants who had negative dental experience were more anxious (P = 0.03). Nearly, 83% reported anxiety toward extraction procedure. A significant association was observed between anxiety toward dental extraction and the patients' gender (P = 0.03), age (P = 0.0007), education level (P = 0.03), employment status (P = 0.0006), income (P = 0.0007), self-perceived oral health status (P = 0.03), and their history of visit to dentist (P = 0.02). CONCLUSION: Majority of patients in this population revealed high levels of DA. Factors such as age, gender, education level, occupation, financial stability, and previous bad dental experience influence DA to various levels. Extraction followed by injection of local anesthetics and drilling of tooth provoked more anxiety.

The relationship between innercanthal dimension and interalar width to the intercanine width of maxillary anterior teeth in central Indian population.

STATEMENT OF PROBLEM: Selection of proper sized maxillary anterior teeth is one of the difficult clinical steps in complete denture esthetics. Several studies have been reported to establish methods of estimating the combined width of maxillary anterior teeth. PURPOSE: The aim of this study was to determine whether a relationship exists between the innercanthal distance (ICD) and interalar width (IAW) with the combined width of maxillary anterior teeth. MATERIAL AND METHODS: The maxillary anterior teeth of 600 adult subjects were examined. ICD was measured between the median angles of the palpebral fissure. IAW was measured between the ala of the nose at their widest point. The mean combined width of the maxillary anterior teeth was determined intraorally at their widest dimension. Pearson's correlation coefficients were calculated to determine the relationship between ICD, IAW and the combined width of maxillary anterior teeth (α =0.05). RESULTS: Although the Pearson correlation coefficients were relatively small, a significant relationship existed between innercanthal dimension and IAW (P < 0001). CONCLUSION: Within the limitations of this study, the results suggest that ICD and IAW cannot be used as a preliminary method for determining the width of the maxillary anterior teeth for edentulous patients.

Knowledge, attitude and practices of denture adhesives use among private dental practitioners' of jabalpur city, madhya pradesh: a cross sectional survey.

The use of denture adhesives (DA) and their role in prosthodontics has been a conflicted topic both in clinical practice and dental education. The use of adhesives, are viewed as poor reflection of their clinical skills and prosthetic expertise or to provide retention to an ill-fitting prosthesis by many dentists. These conflicting views have raised many doubts among practicising dentists on the use of DAs in their clinical practice. The aim of this study was to assess the knowledge, attitudes and practices of DA use among private dental practitioners' of Jabalpur city, Madhya Pradesh. This descriptive, cross-sectional survey was conducted using a self-administered questionnaire involving private dental practitioners of Jabalpur city. A total of 172 private dental practitioners of Jabalpur made up the sample of the study. A comprehensive, closed-ended, self-administered questionnaire was employed which was designed to collect the sociodemographic details and to assess the knowledge, attitudes and practices of DA use among private dental practitioners'. The institutional review committee approved the study. Data were imported to the SPSS 13.01 program to draw the means and percentages. Majority of the dentists were males (55 %), preponderance (68 %) of the dentists were in the 21-30 years age-group. Greater part of the study population comprised of general dental practitioners (GDPs) (81 %). When the subjects were questioned if DA were soluble in saliva, 32 % of the GDPs replied wrongly. Similarly 25 % of the GDPs didn't know that using DA with incompletely removed old DA affected tissue health. Zinc containing DA are recently held responsible for causing neurological diseases on their prolonged usage, 71 % of the GDPs and 74 % of other specialists were unaware in this context. A total of 115 (83 %) GDPs, 6 (100 %) prosthodontists and 22 (81 %) other specialist's used DA as a beneficial adjunct in their clinical practice. DA being used frequently by the dentists, unfortunately they did not have sufficient knowledge regarding the material. The attitude is a reflection of an individual's knowledge, which was also not homogeneous. By pursuing continuing education courses, the practitioners can update themselves regarding new technology and materials, thus improving the standard of care for prosthodontic patients.

A New Trend in Recording Subgingival Tissue around an Implant While Making a Direct Abutment Impression.

A successful implant-supported restoration must provide adequate function and esthetics. Osseointegrated implants have given an alternative choice for patients who have lost their teeth. Most commonly encountered problems while doing a transfer from patient to the master cast in restoring implant-supported crowns are an uneven distribution of occlusal loads and undue torquing forces on the various elements of implant. This is caused due to poor fit of frameworks connected to implant, which further leads to marginal bone loss, loosening of screws, fatigue fracture of implant components, and ultimately implant failure. This paper presents a simplified and easy solution to overcome such problems by introducing an innovative gingival retraction system for restoring implant-supported crowns to achieve superior and predictable long-term outcomes.

Magnet retained cheek plumper in complete denture esthetics: a case report.

This clinical report describes a technique to improve support for sunken cheeks using magnet retained detachable acrylic cheek plumpers. The new generation of magnets with improved technology provides sufficient denture retention for clinical application. However, further follow-up may be necessary to ascertain the long-term usefulness of the magnet-retained prosthesis, because of corrosion and further loss of magnetism.

A sectional-splinting technique for impressing multiple implant units by eliminating the use of an open tray.

Since the inception of root form implant dentistry by P-I Branemark in the early 1980's, so many technical advances have been put forward by several authors. However, the open tray impression technique is still performed for impressing multiple implant fixtures as it was first described in the original Branemark procedure manual. The most critical aspect for a successful implant-supported restoration is the passive and an accurate fit of superstructures to avoid preload and loading stresses. Splinting impression technique in multiple implants has gained popularity. Auto-polymerizing acrylic resin is among the most routinely practiced splinting material for multiple implant units. However, unfortunately, it exhibits shrinkage, which makes an impression quite inaccurate. This case report presents the solution to minimize the shrinkage of resin by utilizing sectional-splinting technique as advocated in the previous implant literature.