Influence of implant and conventional prostheses on satisfaction and quality of life: A literature review. Part 2: Qualitative analysis and evaluation of the studies.

PURPOSE: To review the influence of prosthodontic and dental implant treatment on patient satisfaction and oral health-related quality of life (OHQOL) based on a systematic search of the literature. MATERIALS AND METHODS: A systematic literature search was carried out for articles published between 1960 and February 2003. Details of the search process and results were reported in Part 1 of the study (Int J Prosthodont2004;17:83-93). The included studies were categorized and evaluated according to their level of evidence, following the guidelines of the Agency for Health Care Policy and Research. The characteristics and content of the studies were analyzed and tabulated. RESULTS: Among the 114 included studies, there were 76 publications reaching evidence level III. The results showed that the effects of compromised oral health are not limited to traditional clinical aspects, but can considerably affect patients in various activities of daily life. Twenty-four of the 38 investigations with evidence levels I and II dealt with implant stabilization of complete mandibular prostheses, comparing implant prostheses to conventional complete dentures. Fully edentulous patients experience negative impacts on OHQOL from their condition. They benefit significantly from the use of dental implants to support mandibular prostheses. However, support by more than 2 implants does not appear to further significantly increase patient satisfaction and OHQOL. CONCLUSIONS: To date, research in the field of patient-based outcomes has concentrated on dental implant treatment for the edentulous patient. Other prosthetic treatments such as single crowns, fixed and removable partial dentures, or further treatment concepts (eg, the shortened dental arch concept) are not well represented. The use of patient-centered outcome measures can help to find an individual, patient-oriented prosthetic solution.

Technology assessment in dentistry: a comparison of the longevity and cost-effectiveness of inlays.

OBJECTIVES: An example of technology assessment in dental care by evaluating the (cost-)effectiveness of types of three-surface inlays (gold, laboratory-fabricated ceramic, and chairside CAD/CAM ceramic) is provided. METHODS: MEDLINE, EMBASE, and the Cochrane Library were searched for studies published between 1966 and June 2003 that reported annual survival probabilities and annual observations. The longevity of different types of inlays was measured by the number of failure-free years. Annual survival rates from different studies were pooled by weighing the rates of each study by the inverse of the variance of the effect estimate. A cost-effectiveness analysis from the perspective of German private health insurers was performed using billing charges. RESULTS: Three, five, and two case series on laboratory-fabricated ceramic, chairside CAD/CAM ceramic, and gold inlays, respectively, were included. Over a 9-year observation period, the number of undiscounted failure-free years was 8.62 (95 percent confidence interval, 8.40-8.85), 8.65 (8.58-8.73), and 8.76 (8.72-8.80) for laboratory-fabricated ceramic, chairside CAD/CAM ceramic, and gold inlays, respectively. Laboratory-fabricated ceramic inlays were the most expensive. CONCLUSIONS: While laboratory-fabricated ceramic, chairside CAD/CAM ceramic, and gold inlays had a strikingly similar failure-free survival rate, laboratory-fabricated ceramic inlays had the highest costs and, thus, were less cost-effective than chairside CAD/CAM ceramic and gold inlays.

Influence of prosthetic and implant therapy on satisfaction and quality of life: a systematic literature review. Part 1--Characteristics of the studies.

PURPOSE: This study systematically searched the dental literature to identify and classify articles on the influence of prosthodontic and dental implant treatment on patient satisfaction and oral health-related quality of life according to their level of evidence. MATERIALS AND METHODS: A literature search was carried out for articles published between 1960 and February 2003 using an electronic key word search complemented by hand searching. The retrieved articles were subjected to inclusion and exclusion criteria. Only experimental studies were included; articles that did not focus on the effect of therapy on the patient were excluded from further processing. The levels of evidence of the articles were classified following the guidelines of the US Agency for Health Care Policy and Research. RESULTS: A total of 207 publications were identified, of which 114 reports investigating 24,863 patients met the inclusion criteria. Data from the studies were analyzed using SPSS 9.0. Two thirds of the publications showed a low evidence level of III; most were conducted in patients who were edentulous or restored with complete dentures (59% of all studies). Mostly, nonstandardized, custom-made questionnaires (80%) were used. On average, 9 (SD 4.2) outcome variables were used within each trial, but clinical criteria were more often used than psychosocial criteria. The most frequently used questions concerned "chewing function" (86%), esthetics (77%), speech (68%), and general satisfaction (67%). Validated instruments, such as the Oral Health Impact Profile, were increasingly used in recent studies, which were also methodically more sufficient. CONCLUSION: Few studies with high levels of evidence were found. Research in this field is still in a phase of development.

1.3 Development of professional competences.

Competency-based education, introduced approximately 10 years ago, has become the preferred method and generally the accepted norm for delivering and assessing the outcomes of undergraduate (European) or predoctoral (North America) dental education in many parts of the world. As a philosophical approach, the competency statements drive national agencies in external programme review and at the institutional level in the definition of curriculum development, student assessment and programme evaluation. It would be presumptuous of this group to prescribe competences for various parts of the world; the application of this approach on a global basis may define what is the absolute minimum knowledge base and behavioural standard expected of a 'dentist' in the health care setting, while respecting local limitations and values. The review of documents and distillation of recommendations is presented as a reference and consideration for dental undergraduate programmes and their administration.