A randomized controlled trial on the efficiency of free-handed, pilot-drill guided and fully guided implant surgery in partially edentulous patients.

OBJECTIVES: To compare the effectiveness of free-handed (FH), pilot-drill guided (PG) and fully guided (FG) implant surgery by means of the apical global deviation (AGD) in relation to the additional financial cost and time spent. MATERIALS AND METHODS: Thirty-three partially edentulous patients in need of ≥2 implants in the posterior maxilla were randomly allocated to one of the following treatment groups: FH, PG and FG. Eleven patients (mean age 57; eight females; altogether 26 implants) were treated by FH surgery, 11 (mean age 53; seven females; altogether 24 implants) by PG surgery and 10 (mean age 60; six females; altogether 21 implants) by FG surgery. The accuracy in implant positioning was assessed by comparing the actual implant position to its planned position with the AGD as the main measure of effectiveness. Cost analysis included data on time investment (pre- and per-operative) and operational cost. The efficiency of PG and FG surgery was assessed by means of the incremental cost-effectiveness ratio (ICER), defined as the extra investment that is needed per unit reduction in AGD when compared to FH surgery. RESULTS: FG surgery was most effective (mean AGD: 0.97 mm) and FH surgery was least effective (mean AGD: 2.11 mm) in terms of surgical accuracy. As a result, 5/26 implants had to be restored with a cement-retained restoration following FH surgery, although screw-retention was planned for all implants in every group. The total time investment did not differ significantly between the 3 groups (p = 0.811). A significant additional cost per implant was found for PG and FG as compared to FH surgery pointing to 8.29% (€176.54) and 10.45% (€222.52), respectively (p < 0.001). The ICER revealed an additional cost of €5.48 and €4.12 per per cent reduction in AGD for PG and FG surgery, respectively. CONCLUSION: The extra operational cost for guided implant surgery is acceptable and clinically justified since cementation can be avoided. FG surgery is the most efficient surgical approach, even though the absolute operational cost is higher when compared to PG and FH surgery.

Patient-related and financial outcomes analysis of conventional full-arch rehabilitation versus the All-on-4 concept: a cohort study.

BACKGROUND: Patient-related variables such as cost of treatment, length of the treatment period, and comfort provided by the interim prosthesis when treatment planning for full-arch rehabilitation are often neglected in dental publications. METHODS: Two patient cohorts were followed up longitudinally in this study: the "All-on-4 treatment concept group" and the "historical group." The number of implants, total treatment time, number of surgical procedures, number of sinus grafts, necessity for immediate provisional implants, adjusted cost associated for treatment in each group, and the quality of interim prosthesis were compared. RESULTS: The total adjusted cost for patients receiving All-on-4 treatment concept averaged at $42,422 ± 3860 (&OV0556;31,392 ± 2856), whereas the mean total adjusted cost for the historical group was $57,944 ± 20,198 (&OV0556;42,879 ± 2113) (P = 0.01). The difference in cost had a mean value of $7307 (&OV0556;5407) per jaw. Factors associated with complexity of treatment and patient comfort, such as the quality of interim prosthesis, number of surgeries, and duration of treatment time, all significantly favored the All-on-4 treatment concept group in comparison with conventional treatment modalities. CONCLUSIONS: When implant rehabilitation of the total jaw is sought, the All-on-4 treatment concept should be considered the least costly and least time consuming treatment option.

Paying for treatments? Influences on negotiating clinical need and decision-making for dental implant treatment.

BACKGROUND: The aim of this study is to examine how clinicians and patients negotiate clinical need and treatment decisions within a context of finite resources. Dental implant treatment is an effective treatment for missing teeth, but is only available via the NHS in some specific clinical circumstances. The majority of people who receive this treatment therefore pay privately, often at substantial cost to themselves. People are used to paying towards dental treatment costs. However, dental implant treatment is much more expensive than existing treatments--such as removable dentures. We know very little about how dentists make decisions about whether to offer such treatments, or what patients consider when deciding whether or not to pay for them. METHODS/DESIGN: Mixed methods will be employed to provide insight and understanding into how clinical need is determined, and what influences people's decision making processes when deciding whether or not to pursue a dental implant treatment. Phase 1 will use a structured scoping questionnaire with all the General dental practitioners (GDPs) in three Primary Care Trust areas (n = 300) to provide base-line data about existing practice in relation to dental implant treatment, and to provide data to develop a systematic sampling procedure for Phase 2. Phases 2 (GDPs) and 3 (patients) use qualitative focused one to one interviews with a sample of these practitioners (up to 30) and their patients (up to 60) to examine their views and experiences of decision making in relation to dental implant treatment. Purposive sampling for phases 2 and 3 will be carried out to ensure participants represent a range of socio-economic circumstances, and choices made. DISCUSSION: Most dental implant treatment is conducted in primary care. Very little information was available prior to this study about the quantity and type of treatment carried out privately. It became apparent during phase 2 that ISOD treatment was an unusual treatment in primary care. We thus extended our sample criteria for Phase 3 to include people who had had other implant supported restorations, although not single tooth replacements.

Can general dentists produce successful implant overdentures with minimal training?

OBJECTIVES: This study was carried out to determine whether inexperienced dentists can provide two-implant overdentures that are as satisfactory and of the same cost as those provided by experienced prosthodontists. METHODS: Edentulous elders were enrolled in a randomized controlled clinical trial to compare the effects of mandibular conventional and two-implant overdentures on nutrition. They were randomly assigned to groups that were treated by either an experienced prosthodontist or by a newly-graduated dentist with minimal training in implant treatment. Data for this study were obtained during the treatment of the first 140 subjects enrolled. The change in patient ratings of satisfaction after treatment, laboratory costs and the number of unscheduled visits up to 6 months following prosthesis delivery were compared. RESULTS: Satisfaction was significantly higher with implant overdentures than with conventional dentures, but there were no differences in scores for either prosthesis between the groups treated by experienced specialists or new dentists. Furthermore, six of the seven inexperienced dentists reported that they found the mandibular two-implant overdenture easier to provide than the conventional denture. CONCLUSIONS: The results of this study suggest that general dentists can provide successful mandibular two-implant overdentures with minimal training.

[Secondary adentia and dental implantation (epidemiological and sociological study by a telephone interview method)]. / Vtorichnaia adentia i dental'naia implantatsiia (épidemiologicheskoe i sotsiologicheskoe issledovanie metodom telefonnogo oprosa).

Epidemiological research of partial secondary adentia was done by means of telephone interviewing the population of city of Samara (1104 persons are interrogated). Prevalence and intensity of the disease in various age groups, and also average indices for all adult population are established. The share of the persons requiring for dental prosthetics among patients with defects of dental lines is determined. The same method investigates awareness of the population about dental implantation, and also the estimation is given to public opinion on treatment with the use of implants.

Determinants of dentists' decisions to initiate dental implant treatment: a judgment analysis.

STATEMENT OF PROBLEM: Do psychosocial patient characteristics influence the decision of a dentist in recommending implant treatment? PURPOSE: This study assessed the importance that dental general practitioners attach to psychosocial patient characteristics when judging the suitability of these patients for dental implant treatment. METHOD AND MATERIAL: The judgment strategy of 30 Dutch dental practitioners was studied by using 2 tasks. Dentists first judged a series of written scenarios representing fictitious patients, each patient being characterized by 4 psychosocial aspects to determine the patients' suitability for implant treatment. The second task involved rank ordering 14 patient characteristics according to their importance in implant treatment decisions. RESULTS: Dentists judged the personal appearance of the patient and, to a lesser degree, the patient's socioeconomic status to influence decisions to treat. However, these characteristics are ranked as quite unimportant in decision making, whereas motivation, oral hygiene, and level of neuroticism were the most important patient characteristics. CONCLUSIONS: The results on the 2 tasks were clearly not in agreement. There was a substantial disagreement between what dentists say to be important characteristics (rank order task) and the characteristics they actually use to judge the suitability for implant treatment (scenario task). Moreover, it appeared that agreement among the dentists is quite low, especially for the scenario task.

A survey on dental care and oral implantology in Beijing, China.

In this article, we present a survey on dental care and oral implantology in Beijing, China. The Chinese population comprises 1.2 billion or about 20% of the world's population. This survey shows: (i) there is a well-developed dental system in China, mostly operated by the Chinese government; (ii) in Beijing, there are 1328 dentists and oral surgeons and 515 special dental nurses working in dental departments of hospitals; (iii) about 2 million new patients visit the dentist every year; (iv) oral implantology is a new technology for the Chinese dentist and oral surgeon, as shown by the finding that in 1992, only 384 persons were treated with oral implants in a few hospitals in Beijing; however, most hospitals are interested in performing oral implantology in the near future; (v) imported implants are too expensive for Chinese patients, and therefore good qualified domestic implants and cheaper imported implants have a great market potential.

Practicing implant dentistry profitably.

The success of dental implants has opened up countless treatment possibilities for restorative dentists to offer to their patients. Just as our clinical paradigms have had to change because of this new technology, so too must our paradigms concerning the way we communicate with our patients change if we are to get them to say "yes" to treatment that we know that they need. Success in clinical treatment using implants requires a systematic approach. A systematic approach to communicating with your patients will allow you to have the same high degree of success with treatment acceptance that is possible with dental implants. The key to the systems we have discussed is Relationship Centered Care. A relationship is fostered and enhanced through a Comprehensive Examination Process, a structured Consultation Process utilizing the influencing process and Financial Arrangements that allow the patient to receive what they want while the office maintains the profitability that it needs. A system for calculating rational fees can be utilized that allows the practice to have control over an area that traditionally was controlled by anecdotal factors. The Pride Institute has developed this material and is presenting it to the profession so that restorative dentists can truly practice implant dentistry profitably.