IMPACT OF SHORTENED DENTAL ARCH ON ORAL HEALTH-RELATED QUALITY OF LIFE.

BACKGROUND: A shortened dental arch (SDA) is an established treatment concept for patients with missing molars. However, little is known regarding long-term course of oral health-related quality of life (OHRQoL) in patients with SDA and the benefits from replacement of missing molars. OBJECTIVE: Purpose of this multi-center randomized clinical trial was to assess OHRQoL over a period of 15 years in patients with molar replacement by a removable partial denture (RPD) compared to patients with a restored SDA without molar replacement. METHODS: Patients at least 35 years of age with all molars missing in 1 jaw and at least the canine and one premolar present on each side were included. Patients received either a precision attachment-retained, RPD for replacement of missing molars (n = 79), or the dental arch ended with the second premolar (SDA) that had to be present or replaced by a cantilever fixed dental prosthesis (n = 71). Follow-up examinations continued for 15 years. OHRQoL was assessed with the 49-item Oral Health Impact Profile (OHIP). OHIP summary and dimension scores were longitudinally modeled in the statistical analyses to assess course of OHRQoL over time applying an intention-to-treat approach. In addition, scores for the OHRQoL dimensions Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact were analyzed. RESULTS: After an initial improvement in OHRQoL indicated by a mean decrease of 20.0 OHIP points with an effect size of 0.61 in the entire study population, OHRQoL stayed relatively constant over the entire follow-up period. Assuming a constant time and treatment effects over the study period, OHRQoL did not differ statistically significant between the 2 treatments (0.4 OHIP points; 95%-CI: 7.1 - 6.2). OHRQoL after treatment did not change notably over 15 years and was statistically nonsignificant as well (P = .872). Similar findings were observed in all 4 OHRQoL dimensions. CONCLUSIONS: In patients, missing all molars in one jaw OHRQoL improved providing RPD or restoring SDA to a clinically relevant degree. Treatment-related improvement remained mostly stable over a period of at least 15 years. Therefore, patients can be informed that both treatment concepts are equivalent concerning long-term OHRQoL. Accordingly, patients' preferences regarding treatment options should be granted priority in treatment decision making with the SDA treatment option being the default.

Rehabilitation of shortened dental arches: A fifteen-year randomised trial.

BACKGROUND: Few long-term studies on treatments in the shortened dental arch (SDA) are available. OBJECTIVE: The objective of this trial was to analyse the long-term success of two different treatment concepts. METHODS: Patients over 35 years of age with missing molars in one jaw and at least the canine and one premolar present on both sides were eligible. In the partial removable dental prosthesis (PRDP) group (N = 81), molars and missing second premolars were replaced by a precision attachment retained prosthesis. In the SDA group (N = 71), the dental arch ended with the second premolar that had to be present or replaced by a cantilever fixed dental prosthesis. Follow-up examinations were carried out over 15 years. RESULTS: A comprehensive outcome variable comprised four failure categories for which Kaplan-Meier survival (success) analyses were conducted. Half of the patients exhibited a continuous preservation of the per protocol prosthetic status that remained totally unaffected by complications for more than 10 years. The event-free success rates for moderate or worse failure implied a loss of the per protocol prosthetic status. The respective survival rates fell below 50% at 14.2 years in the PRDP group and 14.3 years in the SDA group. In none of the analyses, a significant group difference was found. CONCLUSIONS: In patients with an SDA condition, changes in the prosthetic status have to be expected. The affected proportion increases almost linearly from shortly after treatment and comprises the majority after 15 years. The influence of the examined treatments on success appears to be low.

Investigation of the Association Between Cement Retention and Prevalent Peri-Implant Diseases: A Cross-Sectional Study.

BACKGROUND: The aim of this study is to examine the association between retention type (cement-retained versus screw-retained restorations) and prevalence of peri-implant diseases in a German university-treated population. METHODS: Data were analyzed from individuals that underwent clinical and radiographic peri-implant examinations as part of a university-based cross-sectional study from September 2011 to October 2012. RESULTS: Data from 139 individuals (mean age: 57.59 years) having 394 implants were analyzed: 192 implants supporting single crowns and 202 fixed partial dentures. Overall, 11.9% of the participants had peri-implantitis, whereas 68.9% had peri-implant mucositis. Crude odds ratios (95% confidence intervals) for peri-implantitis and peri-implant mucositis for cement- versus screw-retained restorations were 1.43 (0.45, 4.60) and 0.89 (0.53, 1.48), respectively. Results remained non-significant in multivariable models adjusting for type of restoration and smoking (all P values >0.50). There was also no effect of splinting restorations on disease prevalence in adjusted analyses (P values >0.32). CONCLUSIONS: In this university-treated sample, there is no association between the type of prosthesis retention and peri-implant diseases. Current findings show that, when appropriate selection and removal of cement is performed, cement retention is not a risk indicator for peri-implant diseases.

Cross-sectional study on the prevalence and risk indicators of peri-implant diseases.

PURPOSE: To evaluate the prevalence of peri-implant diseases in a university patient sample and to analyse possible risk variables associated with their occurrence. MATERIALS AND METHODS: One hundred and eighty-six patients with 597 implants were examined clinically and radiographically. The mean period of function was 5.5 years (range 1 to 16.5 years). A subgroup analysis was performed for implants with a minimum function time of 5 years. Outcome measures were implant failures, prevalence and risk indicators of peri-implant diseases. In order to identify statistically significant risk indicators of peri-implant mucositis and peri-implantitis multi-level logistic regression models were constructed. RESULTS: The prevalence of peri-implantitis and peri-implant mucositis on patient levels were 12.9% (13.3% for ≥ 5 years) and 64.5% (64.4% for ≥ 5 years), respectively. Multi-level analysis showed that a high plaque score (OR = 1.365; 95% CI: 1.18 to 1.57, P < 0.001) was a risk indicator for periimplant mucositis, while augmentation of the hard or soft tissue at implant sites had a protective effect (OR = 0.878 95% CI: 0.79 to 0.97, P = 0.01). It was also shown that the odds ratio for having peri-implant mucositis increased with the increase of plaque score in a dose-dependent manner. With respect to peri-implantitis, loss of the last tooth due to periodontitis (OR = 1.063; 95% CI: 1.00 to 1.12, P = 0.03) and location of the implants in the maxilla (OR = 1.052, 95% CI: 1.00 to 1.09, P = 0.02) were identified as statistically significant risk indicators. CONCLUSIONS: Within the limitations of this study, the history of periodontal disease was the most significant risk indicator for peri-implantitis and the level of oral hygiene was significantly associated with peri-implant mucositis.

A novel technique for the direct fabrication of fixed interim restorations.

This article describes an alternative technique for the fabrication of interim restorations. A thermoplastic, vacuum-formed template and translucent vinyl polysiloxane material are combined in the waxed diagnostic cast to fabricate a matrix in which the interim material can be placed. With this matrix, a variety of materials, such as dual-polymerized or light-polymerized resins, can be used in a predictable way. The major advantage of this technique is that it allows for the fabrication of accurate restorations with excellent reproduction of surface anatomy and for alterations of the tooth shape with light-polymerized materials.