Role of psychotherapy in managing a case of generalised aggressive periodontitis.

Generalised aggressive periodontitis is characterised by "generalized interproximal attachment loss affecting at least three permanent teeth other than first molars and incisors." The management of generalised aggressive periodontitis is challenging as it involves an interdisciplinary approach. When the patient presents himself late to the clinician, the tooth and bone loss can be up to 60%. Natural teeth and alveolar bone contribute to the contour and aesthetics of the face. Loss of teeth in younger age may lead to attitude, behaviour changes and may cause psychological depression and withdrawal from society. The main distinguishing feature of this case report is the psychological counselling provided along with periodontal and prosthetic treatment.

Posttreatment quantification of patient experiences with full-arch implant treatment using a modification of the OHIP-14 questionnaire.

Patient well-being is always the goal of rehabilitation of edentulism; however, evaluations of treatment success often overlook the patient's subjective feelings about comfort, function, speech, social image, social inhibitions, psychological discomfort, and/or disabilities. The purpose of this study was to assess these patient responses using an oral health questionnaire. To assess such feelings, a self-administered 20-question multiple-choice patient-reported Edentulous Patient Impact Questionnaire was developed, based upon the previously validated Oral Health Impact Profile patient-assessment tool. Responses were solicited from randomly selected patients treated with an implant-supported, fixed, immediately loaded full arch prosthesis. The questionnaires were completed by 250 patients. Of the respondents, 95% described themselves as being either extremely satisfied (74%) or satisfied (21%) with their new teeth, and 98% said they would definitely recommend similar treatment (88%) or consider recommending it (10%) to a friend or colleague. Based upon an oral health impact survey completed by 250 patients treated with full-arch implant-supported, immediately loaded fixed dental prostheses, it appears that patient satisfaction is high and that treated patients would generally be willing to recommend this treatment to others.

Patient-centered outcome of immediately loaded implants in the rehabilitation of fully edentulous jaws.

INTRODUCTION: Edentulism often involves functional, esthetic, phonetic and psychological problems. OBJECTIVES: To evaluate patient-centered outcomes of full-arch screw-retained rehabilitation on immediately loaded implants. MATERIAL AND METHODS: Fifty patients treated with Astra Tech(TM) implants answered self-administered questionnaires on a visual analogue scale (VAS) 100 mm scale or with multiple-choice or open questions: at baseline, 1 week, 3 or 6 months and 1 year. Changes of VAS in time were analyzed using mixed models for repeated measures, adjusting for gender, age and jaw; comparison of cross-sectional parameters between jaws was performed with the Mann-Whitney U- or chi(2)-test, all at the 0.05 significance level. RESULTS: The median calculated general satisfaction score increased from 40.25 (mean=40.9; SD=23.82; range=0-95) at baseline to 98.25 (mean=95.3; SD=6.68; range=74-100) after 1 year. Overall comfort, eating comfort, speaking comfort and perceived esthetics improved significantly within 1 week after surgery and immediate provisionalization. This did not change significantly until the final bridge was installed after 3 months (mandible) or 6 months (maxilla), when a further significant improvement was demonstrated. The most common postoperative complication was swelling, especially in the maxilla. The importance of one-stage surgery and immediate loading was rated very high by patients before treatment, especially in the mandible. The main reason for choosing fixed prosthetics was eating comfort. Phonetics and esthetics were more important in the maxilla than in the mandible. CONCLUSION: Immediate full-arch rehabilitation yeilds an instant significant improvement in general patient satisfaction and self-perceived factors related to comfort, function and esthetics. Eating comfort is the main concern for the patient and shows the highest improvement. Postoperative complications are limited and patients considered immediate loading important.

A longitudinal study of quality of life of elderly with mandibular implant-supported fixed prostheses.

OBJECTIVES: To verify the consequences of implant-supported fixed oral rehabilitation on the quality of life (QL) of elderly individuals. MATERIAL AND METHODS: Fifteen patients were studied, being 10 females and five males; all were aged >60 years, were completely edentulous, wore removable dentures on both arches, and were treated with implant-supported fixed dentures. Three QL questionnaires were applied, two related to the oral conditions (Oral Impact on Daily Performance - OIDP - and Oral Health Impact Profile, short version - OHIP-14) and one dealing with global aspects (World Health Organization Quality of Life - WHOQOL-BREF), before 3, 6, and 18 months after surgical placement of implants. RESULTS: Scores in the OIDP and OHIP-14 questionnaires were better after dental treatment. The WHOQOL-BREF was less sensitive, confirming the higher reliability of specific questionnaires (focal) compared with general questions in such situations. CONCLUSION: Treatment with implant-supported fixed prostheses improved QL in the elderly; these effects are better detected by specific instruments focused on the subject.

An analysis of satisfaction with complete immediate (over)dentures.

OBJECTIVES: The purpose of the study was to investigate denture satisfaction related to treatment modality, age, gender, denture quality, chewing ability, denture experience and patients' attitude towards denture wearing. METHODS: In a randomized controlled clinical trial 74 patients who required immediate denture therapy were treated either with complete immediate dentures, or with complete immediate overdentures on the lower canines with and without Dyna Direct magnetic attachments. All patients were evaluated clinically and by questionnaires over a one year period after denture insertion. RESULTS: Regression analysis showed that the quality of the denture, chewing ability, attitude towards dentures in general and the expectation of the new dentures can explain the variance in denture satisfaction for 23-27%. CONCLUSIONS: It can be concluded that with respect to satisfaction the technical quality of the dentures, as well as patients' previous attitude towards wearing dentures are the most important factors in immediate denture treatment. The treatment modality, having received an overdenture or not, appeared to be unimportant in this respect in the first year after denture insertion.

Immediate complete dentures.

When dentists treat patients for immediate complete dentures, they assume responsibility not only for the clinical and laboratory techniques unique to immediate complete denture fabrication, but also the responsibility for informing their patients about their treatment options, instructing their patients in the care of their oral tissues and dentures, and for continuing maintenance of the immediate dentures. Immediate dentures can be a traumatic introduction to complete dentures if patients are not informed fully about the complexity of the clinical and laboratory procedures, the need for immediate denture maintenance, and the costs associated with immediate denture treatment. The importance of 8 to 12 months of continuing care for immediate denture patients must be explained to patients and the dangers of neglecting continuing care must be emphasized.

Satisfaction with complete immediate dentures and complete immediate overdentures. A 1 year survey.

The aim of this study was to evaluate denture satisfaction over a 1 year period after extraction of the last teeth. Seventy-four patients who required immediate denture therapy in the mandible were randomly treated, (1) with complete immediate dentures (22); (2) with immediate overdentures on two lower canines without attachments (26); or (3) with immediate overdentures on two lower canines provided with Dyna direct magnetic attachments, inserted on the abutments 9 months after treatment (26). Denture satisfaction was estimated by means of questionnaires, filled out by each patient at certain periods, starting before treatment and ending 1 year after denture insertion. After 1 year approximately 85% of the patients in the three groups were satisfied with their dentures, had got used to them and could eat well. This phenomenon was constant over the whole first year period. No differences in denture satisfaction were found between the three groups. It can be concluded that although patients who receive immediate complete dentures might experience a lot of discomfort during the first year of edentulousness, they are satisfied, in general, with their dentures independent of the treatment procedure.