Comparison of Implant-Retained Overdenture and Conventional Complete Denture: A Survey Study to Measure Patients' Satisfaction and Quality of Life in Dental School Clinics.

Patient satisfaction and quality of life are integral to assessing oral health care quality. For many Americans still using conventional complete dentures (CDs) or implant-retained mandibular overdentures (IODs), it remains essential to consider improving their oral health outcomes and quality of life. Due to inexperienced student dentists providing dental care to dental school patients, patient grievances are generally considered a problem. Patient feedback and satisfaction have proven valuable resources for monitoring and improving patient safety. While CDs and IODs are the 2 leading treatment options for edentulism, more comparative studies in the literature need to compare their outcomes in a school setting. The research question that guided this comparative analysis was, "Is patient satisfaction and quality of life affected by the type of prostheses and provider?" A validated questionnaire was mailed to 520 individuals selected from records of patients who had received treatment for edentulous mandible at a student prosthodontic clinic at the University of Kentucky College of Dentistry from 2014 to 2016 with at least 1 year of follow-up time. A validated questionnaire for edentulous patients based on the Oral Health Impact Profile (OHIP-19) was used. In addition, information on patients' oral health-related quality of life, including questions related to the edentulous patients' satisfaction with their dentures, was collected. The response rate was 33% (N = 171). The study's findings confirm previous findings, suggesting that IODs may significantly impact oral health-related quality of life. Data show that 76% of the IOD group reported improvement in experience when using the implants to retain the mandibular denture. However, there were no statistically significant differences in the OHIP scores between overall CD and IOD patient groups. Males with IODs had lower physical pain, limitations, and disability scores than males with CD. However, females with IODs reported more significant concerns associated with a social disability and handicap domains. Comparing users who had experiences with both treatment options, this study discerned essential characteristics that contribute to increased patient satisfaction with IODs and identified significance in outcomes by gender. These findings guide prosthodontic practitioners' patient care practices and identify a continuing need to discuss CD and IOD treatment protocols within dental school curricula.

Comparison of Implant-Retained Overdenture and Conventional Complete Denture: A Survey Study to Measure Patients' Satisfaction and Quality of Life in Dental School Clinics.

Patient satisfaction and quality of life are integral to assessing oral health care quality. For many Americans still using conventional complete dentures (CD) or Implant Retained-Overdentures (IOD), it remains essential to consider improving their oral health outcomes and quality of life. Due to inexperienced student dentists providing dental care to dental school patients, patient grievances are generally considered a problem. Patient feedback and satisfaction have proven valuable resources for monitoring and improving patient safety. While CD and IOD are the two leading treatment options for edentulism, more comparative studies in the literature need to compare their outcomes in a school setting. The research question that guided this comparative analysis was, "Is patient satisfaction and quality of life affected by the type of prostheses and provider?" A validated questionnaire was mailed to 520 individuals selected from records of patients who had received treatment for edentulous mandible at a student prosthodontic clinic at the [redacted for peer review] from 2014 to 2016 with at least one year of follow-up time. A validated questionnaire for edentulous patients based on the Oral Health Impact Profile (OHIP-19) was used. In addition, information on patients' oral health-related quality of life, including questions related to the edentulous patients' satisfaction with their dentures, was collected. The response rate was 33% (N = 171). The study's findings confirm previous findings, suggesting that IODs may significantly impact oral health-related quality of life. Data show that 76% of the IOD group reported improvement in experience when using the implants to retain the mandibular denture. However, there were no statistically significant differences in the OHIP scores between overall CD and IOD patient groups. Males with IOD had lower physical pain, limitations, and concerns associated with a social disability and handicap domains. Comparing users who had experiences with both treatment options, this study discerned essential characteristics that contribute to increased patient satisfaction with IOD and identified significance in outcomes by gender. These findings guide prosthodontic practitioners' patient care practices and identify a continuing need to discuss CD and IOD treatment protocols within dental school curricula.

Dental Implant Treatment in Bruxers: A Case Report and Literature Review.

This case report presents a literature review and a case report of a full-mouth implant rehabilitation for a 65-year-old woman with a history of Bruxism. The patient's oral condition showed dentition with severe occlusal wear, extensive dental work, and missing teeth replaced with bridges and implants. The existing dental work was failing due to recurrent caries and the mechanical failure of long-span bridges. The unique aspect of the treatment presented in this report is the management of existing osseointegrated implants of different systems with different platform designs, which adds to the treatment's complexity. The existing implants were incorporated into the planned treatment, and other implants were added to support maxillary zirconia and mandibular hybrid full-arch prostheses. After 2 years of function, extensive wear was evident on the milled acrylic, even though an occlusal guard was used. New acrylic teeth were processed using the same milled titanium bar of the mandibular hybrid prosthesis, and the occlusal surfaces of the acrylic teeth were protected with gold onlays. The patient is seen regularly for maintenance every 6 months with no further complications. Careful evaluation, planning, and treatment execution are paramount in managing patients with a history of bruxism. Patients should be prepared and informed about possible mechanical failure and seen regularly for maintenance.

A Cephalometric Analysis Assessing the Validity of Camper's Plane to Establishing the Occlusal Plane in Edentulous Patients.

Complete denture fabrication requires multiple clinical and laboratory steps. One of the most critical clinical steps is establishing an anatomical occlusal plane based on hard and soft tissue references. The aim of this study was to determine whether age or gender affects the level of the Ala-Tragus plane to establish which reference point on the Tragus should be used when fabricating the occlusal plane in edentulous patients. Clinical photographs and lateral cephalometric radiographs with complete dentitions were taken from 58 volunteers at the DMD clinic at the University of Kentucky. Each photograph was superimposed over its corresponding cephalometric image. An analysis was conducted to establish the angle of the occlusal plane relative to the Ala-Tragus landmarks; this data was then grouped according to age and gender. The analysis shows that age and gender did not significantly affect where the Camper's plane should be approximated for complete denture treatment. However, it was found that the most parallel line to the occlusal plane was Ala's inferior border to the 'Tragus's inferior border. It should be noted that the volunteers' skeletal classification was significantly related to a Cl III malocclusion tendency. Still, with this new information, functionality and esthetics can be more adequately addressed for patients undergoing complete denture treatment. Given our results, we suggest redefining the 'Camper's plane with a line extending from 'Ala's inferior border to the 'Tragus's inferior border instead of the superior border. Further consideration should be taken if the patient is a skeletal CL III malocclusion.

Interdisciplinary management of an adult orthodontic patient: a case report and literature review.

The purposes of this case report are to describe the course of treatment for a 29-year-old woman with a chief complaint of spaces in her dentition and to review relevant clinical topics in the literature. The primary etiology of the spacing in this case was a congenitally missing maxillary right lateral incisor and a peg-shaped maxillary left lateral incisor. The clinical diagnosis included skeletal and dental discrepancies in all 3 planes of space; a skeletal and dental open bite; a high and asymmetric smile line with a skeletal occlusal cant; a Class II dental occlusion; a Class III skeletal tendency; and insufficient space for standard-size restoration of the maxillary lateral incisors. A history of poor oral hygiene, multiple restorations, and tooth wear were added challenges. The patient initially requested minimal esthetic procedures. However, during the course of treatment, she changed her treatment goals to achieve optimal esthetics. The case required a multidisciplinary planning approach. This report highlights treatment options, outcomes, and avoidable mistakes for this type of complex case involving high esthetic demands. Additionally, key factors are identified to achieve successful treatment and patient satisfaction.

Digital Implant Dentistry Predoctoral Program at University of Kentucky.

This report describes the predoctoral comprehensive digital implant dentistry program at the University of Kentucky, College of Dentistry (UKCD). UKCD has implemented a digital dentistry workflow in the dental curriculum for predoctoral and graduate programs since 2018. Digital implant dentistry education involves using cone beam computed tomography (CBCT) for diagnosis and treatment planning, intraoral scanner for digital impression, and treatment planning software to plan for single implant-supported restorations and implant-retained mandibular overdenture cases. The laboratory components include virtual designing of a surgical guide and using three-dimensional printing to fabricate a fully guided surgical template for implant placement procedures for the patient. In the last 3 years, including the COVID year, a total of 294 implants have been placed by dental students. Unfortunately, 6 implants failed in the early healing time due to infection, with an overall success rate of 98%. These treatment outcomes are very favorable compared with published literature.

Comparison of Dehydrated Human Amnion-Chorion and Type 1 Bovine Collagen Membranes in Alveolar Ridge Preservation: A Clinical and Histological Study.

Alveolar ridge preservation maintains ridge dimensions and bone quality for implant placement. The aim of this randomized controlled clinical study is to compare the use of a human amnion-chorion membrane to a collagen membrane in an exposed-barrier ridge preservation technique. Furthermore, this study will determine if intentional membrane exposure compromises ridge dimensions and bone vitality. Forty-three patients requiring extraction and delayed implant placement were randomly assigned into either the experimental or control group. Twenty-one participants received human amnion-chorion membrane (test) during ridge preservation while 22 participants received the collagen membrane (control). In both groups, demineralized freeze-dried bone allografts were used to graft the socket and primary closure was not achieved. The patients underwent implant placement after an average healing period of 19.5 weeks, and 2.7 × 8-mm core bone specimens were obtained for histomorphometric analyses. The clinical ridge dimensions were measured after extraction and at the time of delayed implant placement. No significant difference was observed in the mean vital bone formation between the experimental (51.72 ± 8.46%) and control (49.96 ± 8.31%; P > .05) groups. The bone height and width did not differ, as determined by clinical measurements (P > .05). Using either a human amnion-chorion membrane or type 1 bovine collagen as the open barrier did not change healing, compromise ridge dimensions, or affect bone vitality between the 2 groups.

Efficacy of stem cell allograft in maxillary sinus bone regeneration: a randomized controlled clinical and blinded histomorphometric study.

PURPOSE: This study aimed to evaluate the quality and quantity of newly generated bone in the maxillary sinus grafted with stem cell-based allograft material. METHODS: This study was a single site, prospective, blinded, randomized, and controlled clinical trial. Eleven subjects with 18 edentulous posterior maxillary sites requiring sinus augmentation for delayed implant placement using a lateral window approach were enrolled. At the time of sinus augmentation, test sinus was grafted with stem cell-based allograft (Osteocel Plus; NuVasive Therapeutics), while the control sinus was grafted with conventional cortico-cancellous allograft (alloOss; ACE Surgical). Cone beam computer tomography (CBCT) scan was taken before and 14 weeks post-sinus augmentation procedure, i.e., 2 weeks before implant placement. Thirty-six trephined core bone biopsies were harvested from the anterior and posterior grafted lateral-window osteotomy sites at the time of implant placement. RESULTS: The results showed a statistically significant difference in the vital bone percentage between the test and the control groups at the posterior grafted sites (p = 0.03). There was no significant difference in the percentage of vital bone between the anterior and posterior grafted sites within the test and control groups (p > .05). The CBCT analysis showed that the maxillary sinuses at the posterior grafted sites were statistically wider than those at the anterior grafted sites in both groups (p < .05). CONCLUSIONS: Different allograft bone materials can be used in the maxillary sinus augmentation procedures. Stem cell allograft has more osteogenic potential with a better outcome in the wide posterior sinus.

Full-Mouth Rehabilitation With Implant-Prosthesis in Marfan Syndrome Patient: Clinical Report and Literature Review.

The purpose of this case report is to present implant-retained maxillary and mandibular complete overdentures in a patient with Marfan syndrome. The patient initially presented with generalized periodontitis (stage IV, grade C). Due to the progressive nature of periodontal disease, the patient elected to have implant-retained maxillary and mandibular complete dentures. Bilateral maxillary sinus augmentation was performed 6 months before full-mouth extraction, alveoloplasty, and immediate implant placement. Maxillary and mandibular immediate overdentures were delivered. After 4 months of healing, the final overdenture was fabricated. The patient was seen regularly throughout the healing process for peri-implant maintenance. Soft-tissue grafts were completed to increase the thickness of the mucosa around the implants. The patient has been followed for 2 years and is functioning well without major complications. For patients with Marfan syndrome, implant-retained prostheses are a viable treatment option in the presence of a failing dentition.

Immediate Loading of Unsplinted Implant Retained Mandibular Overdenture: A Randomized Controlled Clinical Study.

This clinical study aimed to clinically and radiographically compare the implant survival rate and peri-implant tissue response between immediate and delayed loading protocols for unsplinted implant retained mandibular overdentures. Twenty patients were enrolled to participate in this study. Each subject was randomly assigned to 1 of 2 treatment groups: test group patients' implants (n = 10), which were immediately loaded, and control group patients' implants (n = 10), which were conventionally loaded. Locator abutments were torqued to 15 Ncm at delivery. Attachments were picked up intraorally immediately after implant placement for the test group and at 3 months for the control group, and 3-lb retention inserts were placed. Marginal bone levels based on cone beam computed tomography fixed reference points were recorded at baseline and 12 months. Modified plaque index, gingival index, and implant stability quotients were recorded at baseline, 3 months, and 12 months. After 12 months, implant survival rate was 100% in both groups. Marginal bone levels, keratinized mucosa, modified plaque index, and gingival index were significantly different among the groups at 3- and 12-month intervals, whereas no significant differences were found in implant stability quotients between the groups. The fact that implant survival rate was 100% in both treatment groups suggests that, within the limitations of this study, immediate loading protocol for unsplinted implant retained mandibular complete overdenture is as predictable, safe, and successful as the delayed loading protocol. Implementing the immediate loading protocol for mandibular implant retained overdentures could shorten treatment time, which could lead to better patient's satisfaction.

What is the Best Micro and Macro Dental Implant Topography?

Implant surface micro and macro topography plays a key role in early osseointegration. The physicochemical features of the implant surface (ie, chemical composition, hydrophobicity/hydrophilicity and roughness) influence the deposition of extracellular matrix proteins, the precipitation of bone mineral, and the stimulation of cells. Modification of the implant topography provides better primary stability and faster osseointegration, allowing for immediate placement or immediate loading. Randomized clinical trials are warranted to compare the response of osseointegration with various implant micro and macro surface topographies in people with various local or systemic risk factors.

What is the Best Available Luting Agent for Implant Prosthesis?

Cement-retention is a viable option in restoring dental implants. A wide range of dental cements with different properties are commercially available for use in the cementation of implant prostheses. The selection of a dental cement for proper clinical application can be challenging. This article overviews the commercially available dental cements used in cement-retained implant-supported prostheses. Guidelines for cement selection are presented according to abutment and prosthetic material. Cementation techniques to reduce excess cement in peri-implant tissues are also mentioned.

Comparison of Xenogeneic Collagen Matrix vs. Free Gingival Grafts to Increase the Zone of Keratinized Mucosa Around Functioning Implants.

PURPOSE: To evaluate the effectiveness of collagen matrix (CM) grafts as an alternative to free gingival grafts (FGGs) in increasing the zone of keratinized tissue (KT) around dental implants. METHODS: Thirty subjects with 2 contralateral implants were recruited. The test group (n = 30) received CM grafts. The control group (n = 30) received FGGs. Clinical variables were plaque index, gingival index, probing depths, bleeding on probing (BOP), and mucosal recession (MR). Subjects were followed at 1 and 2 weeks and 1, 3, and 6 months. RESULTS: FGGs resulted in mean gains (3.73 ± 1.93 mm) in KT for 28 of 30 implants (93% success rate). CM grafts resulted in mean gains (3.23 ± 1.52 mm) in KT for 29 of the 30 implants (97% success rate). Mean change in pocket depth around implants grafted with FGG was -0.24 ± 1.02 mm and with CM was -0.25 ± 0.80 mm. Mean change in BOP around implants grafted with FGG was 0.03 ± 0.49 and with CM was 0.13 ± 0.57. CONCLUSION: CM grafts achieved results comparable to those of FGGs in augmented tissue. They do not negatively affect probing depths, MR, or bleeding on probing.

A systematic review of studies comparing conventional complete denture and implant retained overdenture.

PURPOSE: Several studies reported better outcomes when restoring edentulous mandible with unsplinted IODs compared to CCDs; however, it is not clear if these outcomes remain when the full literature is considered. The aim of this systematic review is to compare conventional complete dentures (CCDs) to unsplinted implant-retained overdentures (IODs) with regard to efficacy, satisfaction and quality of life. STUDY SELECTION: The main question addressed was: How do CCDs compare to unsplinted IODs with regard to efficacy, satisfaction and quality of life? Three databases were electronically searched to identify articles comparing CCD to unsplinted IOD. Twenty-six articles were selected and reviewed in full. Of these selected articles, twenty-five compared CCDs restoring function in both arches to a maxillary CCD opposing a mandibular IOD retained by two unsplinted implants. Only one articles compared a maxillary CCDs to a maxillary IOD. RESULTS: Outcome measures varied among the studies, including the Oral Health Impact Profile (OHIP), visual analogue scales (VAS), and masticatory performance tests. Overall, IODs were associated with significantly better patient's masticatory performance and quality of life as indicated by Oral Health as Related to Quality of Life (OHRQoL). Mandibular unsplinted IODs were more likely than CCDs to be associated with improved OHRQoL for edentulous patients and were associated with significantly higher ratings of overall satisfaction, comfort, stability, ability to speak and ability to chew. CONCLUSIONS: Results of this systematic review indicate the superiority of IODs retained by two unsplinted mandibular implants when compared to CCDs with regards to efficacy, satisfaction and quality of life.

Volatile sulphur compounds in exhaled air of dental students smoking the waterpipe: a nested case control study.

BACKGROUND: This study aims at investigating a potential adverse effect that waterpipe tobacco smoking may cause by comparing levels of volatile sulphur compounds in exhaled air of male dental students who smoke the waterpipe with those who do not smoke. METHODS: Dental students were categorized into waterpipe smokers and non-smokers. Volatile sulphur compounds were measured using a halimeter following the completion of questionnaire on smoking and oral hygiene habits and self-perceived halitosis. Statistics were carried out using ANOVA and relevant post hoc tests, associations were investigated using cross tabulation with the χ2 test. RESULTS: Results showed significantly higher levels of volatile sulphur compounds in: waterpipe smokers who smoke at least once a month when compared with non-smokers regardless their oral hygiene habits; subjects who do not brush their teeth; and subjects who self-perceive halitosis. There were no significant differences in these levels for similar groups on the basis of: use of floss, or use of mouth wash. CONCLUSIONS: It seems that waterpipe tobacco smoking results in increased volatile sulphur compounds levels in exhaled air. Oral hygiene practices like the use of tooth brush, dental floss, and mouth wash also seem to result in lower levels.

Microthreaded Implants and Crestal Bone Loss: A Systematic Review.

This systematic literature review investigated the effect of microthreaded-neck dental implants on crestal bone loss. Using the participants, interventions, comparison groups, outcomes, and study design (PICO) system, we addressed the following focused question: Do microthreaded-neck dental implants positively affect the crestal bone level around dental implants? We searched 3 electronic databases to find articles published between January 1995 and June 2016 that contained any combination of the following keywords: dental implant, microthread, microthreaded, crestal bone level, crestal bone loss, and alveolar bone level. We excluded case reports, review articles, letters to the editor, commentaries, and articles published in a language other than English. We found a total of 70 articles. After eliminating duplicates and applying PICO eligibility criteria, we selected only articles that reported the results of randomized controlled trials, prospective or retrospective cohort studies, case control studies, cross-sectional studies, or other types of clinical trials that compared the microthreaded implant design with other implant designs. We were left with 23 articles for review. The 23 articles reported crestal bone loss ranging from .05 mm to .9 mm, with a range of 12 to 96 months of follow-up. Less crestal bone was lost with dental implants that had a microthreaded neck design than with machined-surface or conventional rough-surface dental implants. Thus, microthreaded dental implants are a better choice than are implants with other designs. Future studies should use standardized imaging techniques to evaluate the placement of these implants in bone-augmented sites.

A Simplified Technique for Implant-Abutment Level Impression after Soft Tissue Adaptation around Provisional Restoration.

Impression techniques for implant restorations can be implant level or abutment level impressions with open tray or closed tray techniques. Conventional implant-abutment level impression techniques are predictable for maximizing esthetic outcomes. Restoration of the implant traditionally requires the use of the metal or plastic impression copings, analogs, and laboratory components. Simplifying the dental implant restoration by reducing armamentarium through incorporating conventional techniques used daily for crowns and bridges will allow more general dentists to restore implants in their practices. The demonstrated technique is useful when modifications to implant abutments are required to correct the angulation of malpositioned implants. This technique utilizes conventional crown and bridge impression techniques. As an added benefit, it reduces costs by utilizing techniques used daily for crowns and bridges. The aim of this report is to describe a simplified conventional impression technique for custom abutments and modified prefabricated solid abutments for definitive restorations.

Full Mouth Implant-supported Rehabilitation of a Patient with Ectodermal Dysplasia: Clinical Report and Literature Review.

OBJECTIVE: The purpose of this case report is to present the clinical course of full mouth rehabilitation in an 1 8-year-old female patient with ectodermal dysplasia who was treated with implant-supported fixed partial dentures for the mandible and the maxilla. CASE REPORT: Fourteen dental implants (8 in the maxilla and 6 in the mandible) were placed simultaneously after full mouth extraction and alveoloplasty surgery. After 6 months of healing, prosthetic rehabilitation was started for screw-retained fixed partial dentures. The patient was followed for one year and a peri-implant maintenance regime established for six-month recalls. The patient was satisfied with the prosthesis both esthetically and functionally. Furthermore, the patient reported significant improvements in oral function and psychosocial activities. CONCLUSION: The use of dental implants to support full mouth prosthetic rehabilitation for adolescents with ectodermal dysplasia may provide a considerable improvement in function and esthetic compared to conventional removable prosthetic options. This has the potential to enhance the quality of life for these patients.

A Simplified Technique to Measure Plaque on the Intaglio Surfaces of Complete Dentures.

OBJECTIVE: The main aim of this study was to develop a simplified quantitative denture plaque index that could help dentists to motivate denture patients to maintain optimal oral hygiene. The secondary aim was to assess specific areas of dentures more prone to accumulate plaque and subjects' oral hygiene habits related to their dentures. METHODS: One hundred subjects who wore maxillary and/or mandibular complete dentures for at least one year were included in the study as a powered sample. Fifteen females and 85 males, age range 45-75 years, were recruited. The study was carried out at King Saud University (KSU), College of Dentistry. A plaque disclosing solution was used to assess the plaque covered areas of denture. A quantitative percentage (10 x 10%) score index was developed by assessing plaque scores from digital images of intaglio surfaces of the dentures. The weighted kappa method was used to assess inter-examiner agreement in the main study. RESULTS: The new denture plaque index was identified as ASKD-DPI (Almas, Salameh, Kutkut, and Doubali-Denture Plaque Index). It ranged from 0 - 100%, and reflected the percentage of the intaglio surfaces of maxillary and mandibular complete dentures that contained plaque. It also classified quantitative percentages: 30 subjects ranged from 0 - 30% (low DPI), 50 subjects ranged from 31 - 70% (moderate DPI), and 20 subjects ranged from 71 - 100% (high DPI) denture plaque score. CONCLUSIONS: A simplified denture plaque index (ASKD-DPI) technique was developed and tested in this study. ASKD-DPI may be used for evaluating denture plaque scores, monitoring denture hygiene, and measuring compliance of patients regarding plaque control for complete dentures.

Immediate implant placement: surgical techniques for prevention and management of complications.

Loss of soft and hard tissue is common after tooth extraction. Substantial resorption of alveolar bone compromises esthetics and may result in prosthetic and surgical limitations. Immediate implant placement at the time of tooth extraction is used to maintain alveolar ridge dimensions. Clinical studies support the successful outcome of immediate placement of dental implants in fresh extraction sockets; comparative clinical studies have found that implant survival rates after immediate placement are similar to those after delayed placement. This article addresses surgical techniques for immediate implant placement and the prevention and the management of complications associated with this procedure.