Patient-Centered Risk Assessment in Implant Treatment Planning.

PURPOSE: To evaluate the current scientific evidence on estimating cumulative risk for biologic complications relating to dental implants and to develop a patient-centered risk assessment tool for establishing aggregate risk. MATERIALS AND METHODS: A review of the scientific literature on risk indicators relating to dental implants was completed with the goal of identifying and weighting individual risk indicators so aggregate biologic risk could be estimated. Three authors completed independent reviews of the literature, identifying 31 systematic reviews on risk indicators for biologic complications with dental implants, from which 24 potential risk indicators were considered. Due to inconclusive scientific data on risk indicators, a Delphi process was used to gather structured expert opinion to supplement findings from the literature. Eleven Delphi participants with expertise in prosthodontics or periodontics participated in two email exchanges and one face-to-face meeting to comment and debate on the initial identification and weighting of risk indicators, propose the addition or removal of risk indicators, and provide recommended clinical management for each risk indicator. RESULTS: After three rounds of debate, literature review, and additions and removals of various risk indicators, consensus (defined as 95% or more in agreement) was achieved on 20 risk indicators. The Delphi group concluded that the risk indicators of smoking, diabetes, antiresorptive agents, and cemented restorations should include subcategories to more accurately identify and represent patient-specific risk. Clinical recommendations based on individual and aggregate risk were established by consensus. CONCLUSION: The literature on risk indicators for biologic complications was conflicting and inconclusive. The Delphi method was used to identify and establish the weighting of individual risk indicators, resulting in a risk assessment tool for estimating aggregate risk.

Crown Taper Angles Achieved by Dental Students: A Systematic Review.

The aim of this systematic review was to examine the literature on clinical taper angles achieved by dental students during crown preparation to determine the theoretical and clinically acceptable values identified in research studies. Medline, Embase, Web of Knowledge, the Cochrane Library, the British Dental Journal, and the Journal of the American Dental Association were searched to identify relevant studies. Studies were included if they were in vivo research on full crown preparations by dental students and published in English. Data extracted were country, year of publication, model selection and measurement methods, tests for reproducibility, tooth type, number of teeth assessed, and tapers achieved. The search resulted in 12 included articles from 11 countries published between 1978 and 2014 featuring a total of 2,306 preparations. In those studies, students failed to achieve ideal convergence angles (between 4° and 14°) but produced clinically acceptable results (between 10° and 20°). These findings should be taken into account when assessing dental students during their training programs.

Agreement between two raters' evaluation for integrated Traditional Prosthodontic Practical Exam with Directly Observed Procedural Skills in Egypt.

PURPOSE: It aimed to determine the agreement between two raters evaluating students at prosthodontic clinical practical exam integrated with directly observed procedural skills (DOPS). METHODS: A sample of 76 students was monitored by two raters to evaluate the process and the final registered maxillomandibular relation for completely edentulous patient in Mansoura Dental School, Egypt at practical exam of the Bachelor students on May 15, till June 28, 2017. Each registered relation was evaluated from total 60 marks subdivided to three score-categories: occlusal plane orientation (OPO), vertical dimension registration (VDR), and centric relation registration (CRR). The marks of each category included mark of DOPS. The marks of OPO and VDR for both raters were compared by graph method to measure reliability using the Bland and Altman analysis. The reliability of CRR marks was evaluated by Krippendorff's alpha ratio. RESULTS: The results revealed similarity between raters for OPO (mean = 18.1) and closes of limits of agreement (0.73 and -0.78). For VDR, there were closeness of means (mean= 17.4 and 17.1 for examiner 1 and 2 respectively); with limits of agreement (2.7and-2.2). There was a strong correlation (Krippendorff's alpha ratio= 0.92; 95% CI [0.79-0.99]) among raters at evaluating CRR. CONCLUSION: The two raters' evaluation of clinical traditional practical exam integrated with directly observed procedural skills revealed not to be different to evaluate candidate at the end of the clinical prosthodontic course. The limits of agreement between raters would be optimum at exclusion subjective evaluation parameters and complicated cases from examination procedures.

Awareness, knowledge, and attitude of dental students toward infection control in prosthodontic clinic of a dental school in India.

BACKGROUND: Infection control practices are crucial and important elements in clinical dentistry as there is an increase in the prevalence of infectious diseases among dental patients. This necessitates the application of recommended procedures for infection control in dental schools and clinics. OBJECTIVES: The aim is to evaluate the awareness, knowledge, and attitude of the undergraduate dental students toward infection control measures in the prosthodontic clinic and to assess their satisfaction toward applying these measures during prosthodontic treatment. MATERIALS AND METHODS: A questionnaire-based study was conducted among 180 third, fourth and fifth year dental students (119 females and 61 males) in November 2015 in a private dental school of Rani Durgawati University, Jabalpur (Madhya Pradesh), India. It included 25 close-ended questions related to vaccination status and previous sharp injuries, awareness, knowledge, and attitude toward infection control in the prosthodontic clinic, previous education about infection control, and subjects' satisfaction with their knowledge and attitude. The questionnaire was distributed among 3rd, 4th, and 5th year students and informed consent were obtained before commencing the questionnaire. RESULTS: A total of 180 participants responded to the questionnaire. Their perception toward infection control practices in the prosthodontic clinic varied from 14.4% to 100%, where former were regularly disinfecting dental cast before sending it to the laboratory and later ones were regularly using gloves while attending the patient. Most of the subjects responded "good" or "fair" to the questions related to the evaluation of their knowledge and policy implementation of infection control in prosthodontic clinic (P < 0.0001). Around 47.8% were almost satisfied, and 28.9% were fairly satisfied with their knowledge and performance. CONCLUSIONS: The study findings showed inadequate attitude and awareness of subjects toward infection control in prosthodontic practice. Their self-assessment and satisfaction reflect their performance toward infection control policy.

Effectiveness of prosthodontic interventions and survival of remaining teeth in adult patients with shortened dental arches-A systematic review.

OBJECTIVES: A systematic review of randomised and non-randomised controlled trials was conducted to evaluate studies of the effectiveness of different tooth replacement strategies in adult patients with shortened dental arches. The objectives of the review were to determine the survival rates of different prosthodontic interventions, the risk of tooth loss with and without prosthodontic interventions, and the impact of different tooth replacement strategies on oral-health related quality of life (OHRQoL). METHODS: The protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO CRD42017064851), and the review was conducted in accordance with the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). RESULTS: The search strategy identified 112 potentially relevant publications; 22 from Medline (OVID), 54 from EMBASE (OVID), 35 from CENTRAL, one from the authors' knowledge of the subject area, and none from OpenSIGLE. Ten articles were included in this systematic review. Of these, four were analyses of different outcomes from a multicentre randomized controlled trial in Germany, whilst one study was the pilot phase for this trial. Two further randomized controlled trials were included from the United Kingdom and Republic of Ireland. The remaining articles were reports of prospective cohort studies from Denmark and the Netherlands. CONCLUSIONS: there is currently insufficient evidence to recommend one tooth replacement strategy over another in adult patients with reduced dentitions. CLINICAL SIGNIFICANCE: There is a need for further research as there are insufficient numbers of good quality randomised controlled trials currently available. Authors should be encouraged to adhere to CONSORT guidelines for randomized controlled trials, and report findings in such a way that facilitates future meta-analysis.

[Understanding new progress in prosthodontics from the perspective of updates in the glossary of prosthodontic terms].

Glossary of Prosthodontic Terms is a standardized vocabulary with international influence. Its ninth edition was published in J Prosthet Dent in 2017, 12 years after the last edition. During this period, great development has taken place in the dental prosthetics due to dental implant and digital dentistry as well as application of new materials and technologies. The research results of dental adhesion, aesthetic dentistry, orofacial function, and tissue regeneration has been fully applied in dental clinic. This paper attempts to capture and accurately understand the changes of some important, especially controversial academic concepts through the comparison of the seventh, eighth and ninth edition of vocabulary. Four parts including new terms, obsolete terms, terms with updated concept, and terms with the continuity of concept are used to show the important progress of prosthodontics.

Aspects of Malpractice in Prosthodontics.

Crowns, fixed partial dentures, and removable dentures are the popular prosthetic dental restorations in current dental practice. Prosthodontic rehabilitation of the mouth, particularly in advanced and complex cases, requires careful planning, adequate clinical skills, and exacting technical standards. While a successful outcome is the ultimate goal for any prosthodontic treatment, complications, injuries, dissatisfaction, and/or failure may occur. When such events develop as a result of negligence or violation of standards of care, they are considered under the term of malpractice and may incur ethical and medico-legal implications. This paper reviews and highlights some aspects of malpractice in prosthodontics. The current state of prosthodontic malpractice on a global level will also be evaluated. Standards of prosthodontic care, current literature of prosthodontic malpractice, where and how prosthodontic malpractice occurs, and recommendations for the future are presented. A thorough understanding of what is quality prosthodontic care and what disrupts this care can be a useful guard against professional litigation and may protect patients from poor quality of dental prosthetic care.

Impact of the CONSORT Statement endorsement in the completeness of reporting of randomized clinical trials in restorative dentistry.

OBJECTIVES: The aim of this study was to assess if journal endorsement of the CONSORT Statement is associated with improved completeness of reporting of randomized controlled trials (RCTs) in restorative dentistry. MATERIALS AND METHODS: RCTs in restorative dentistry published in two journals that have (Journal of Dentistry and Clinical Oral Investigations) and have not (Operative Dentistry and Journal of Prosthetic Dentistry) endorsed the CONSORT Statement were selected. We compared the completeness of reporting between comparison groups (endorsers versus non-endorsers, before versus after endorsement) using a risk ratio (RR) with a 99% confidence interval for each outcome of CONSORT 2010. Also, the risk of bias of each study was evaluated. RESULTS: The electronic search retrieved a total of 3701 records. After the title and abstract evaluation, 169 full texts were screened and 79 RCTs identified. Considering CONSORT-endorsing journals before and after CONSORT endorsement, six items had effect estimates indicating a relatively higher proportion of completely reported RCTs published after CONSORT endorsement. Considering CONSORT-endorsing journals compared to non-endorsing journals, twelve items indicated a relatively higher proportion of completely reported RCTs published in CONSORT-endorsing journals. In both analyses the overall evidence did not present statistical significance. CONCLUSION: Although CONSORT endorsement has been linked with some improvement in the completeness of RCTs reports in the biomedical literature, this was not reflected in the present analysis confined to restorative dentistry. More innovative and involved approaches to enhancing reported may therefore be required. CLINICAL SIGNIFICANCE: Inadequate reporting of randomized controlled trials can produce important consequences for all stakeholders including waste of resources and implication on healthcare decisions. A broad understandment of the use of reporting guidelines is necessary to lead to better results.

Clinical Practice Guidelines for Recall and Maintenance of Patients with Tooth-Borne and Implant-Borne Dental Restorations.

PURPOSE: To provide guidelines for patient recall regimen, professional maintenance regimen, and at-home maintenance regimen for patients with tooth- and implant-borne removable and fixed restorations. METHODS: The American College of Prosthodontists (ACP) convened a scientific panel of experts appointed by the ACP, American Dental Association (ADA), Academy of General Dentistry (AGD), and American Dental Hygienists Association (ADHA) who critically evaluated and debated recently published findings from 2 systematic reviews on this topic. The major outcomes and consequences considered during formulation of the clinical practice guidelines (CPGs) were risk for failure of tooth- and implant-borne restorations. The panel conducted a round table discussion of the proposed guidelines, which were debated in detail. Feedback was used to supplement and refine the proposed guidelines, and consensus was attained. RESULTS: A set of CPGs was developed for tooth-borne restorations and implant-borne restorations. Each CPG comprised of 1) patient recall; 2) professional maintenance, and 3) at-home maintenance. For tooth-borne restorations, the professional maintenance and at-home maintenance CPGs were subdivided for removable and fixed restorations. For implant-borne restorations, the professional maintenance CPGs were subdivided for removable and fixed restorations and further divided into biological maintenance and mechanical maintenance for each type of restoration. The at-home maintenance CPGs were subdivided for removable and fixed restorations. CONCLUSION: The clinical practice guidelines presented in this document were initially developed using the 2 systematic reviews. Additional guidelines were developed using expert opinion and consensus, which included discussion of the best clinical practices, clinical feasibility and risk-benefit ratio to the patient. To the authors' knowledge, these are the first CPGs addressing patient recall regimen, professional maintenance regimen, and at-home maintenance regimen for patients with tooth-borne and implant-borne restorations. This document serves as a baseline with the expectation of future modifications when additional evidence becomes available.

Clinical practice guidelines for recall and maintenance of patients with tooth-borne and implant-borne dental restorations.

PURPOSE: To provide guidelines for patient recall regimen, professional maintenance regimen, and at-home maintenance regimen for patients with tooth-borne and implant-borne removable and fixed restorations. MATERIALS AND METHODS: The American College of Prosthodontists (ACP) convened a scientific panel of experts appointed by the ACP, American Dental Association (ADA), Academy of General Dentistry (AGD), and American Dental Hygienists Association (ADHA) who critically evaluated and debated recently published findings from two systematic reviews on this topic. The major outcomes and consequences considered during formulation of the clinical practice guidelines (CPGs) were risk for failure of tooth- and implant-borne restorations. The panel conducted a round table discussion of the proposed guidelines, which were debated in detail. Feedback was used to supplement and refine the proposed guidelines, and consensus was attained. RESULTS: A set of CPGs was developed for tooth-borne restorations and implant-borne restorations. Each CPG comprised (1) patient recall, (2) professional maintenance, and (3) at-home maintenance. For tooth-borne restorations, the professional maintenance and at-home maintenance CPGs were subdivided for removable and fixed restorations. For implant-borne restorations, the professional maintenance CPGs were subdivided for removable and fixed restorations and further divided into biological maintenance and mechanical maintenance for each type of restoration. The at-home maintenance CPGs were subdivided for removable and fixed restorations. CONCLUSIONS: The clinical practice guidelines presented in this document were initially developed using the two systematic reviews. Additional guidelines were developed using expert opinion and consensus, which included discussion of the best clinical practices, clinical feasibility, and risk-benefit ratio to the patient. To the authors' knowledge, these are the first CPGs addressing patient recall regimen, professional maintenance regimen, and at-home maintenance regimen for patients with tooth-borne and implant-borne restorations. This document serves as a baseline with the expectation of future modifications when additional evidence becomes available.

An Assessment of the Risk of Bias in Randomized Controlled Trial Reports Published in Prosthodontic and Implant Dentistry Journals.

PURPOSE: The objective of this study was to assess the risk of bias of randomized controlled trials (RCTs) published in prosthodontic and implant dentistry journals. MATERIALS AND METHODS: The last 30 issues of 9 journals in the field of prosthodontic and implant dentistry (Clinical Implant Dentistry and Related Research, Clinical Oral Implants Research, Implant Dentistry, International Journal of Oral & Maxillofacial Implants, International Journal of Periodontics and Restorative Dentistry, International Journal of Prosthodontics, Journal of Dentistry, Journal of Oral Rehabilitation, and Journal of Prosthetic Dentistry) were hand-searched for RCTs. Risk of bias was assessed using the Cochrane Collaboration's risk of bias tool and analyzed descriptively. RESULTS: From the 3,667 articles screened, a total of 147 RCTs were identified and included. The number of published RCTs increased with time. The overall distribution of a high risk of bias assessment varied across the domains of the Cochrane risk of bias tool: 8% for random sequence generation, 18% for allocation concealment, 41% for masking, 47% for blinding of outcome assessment, 7% for incomplete outcome data, 12% for selective reporting, and 41% for other biases. CONCLUSION: The distribution of high risk of bias for RCTs published in the selected prosthodontic and implant dentistry journals varied among journals and ranged from 8% to 47%, which can be considered as substantial.

A multidisciplinary treatment of patients with craniofacial disorders. Own experience.

Oral rehabilitation of patients with craniofacial disorders is a great challenge and needs a multidisciplinary approach. This is due to the diverse etiology of the disease and severity of changes in tissues and organs. Congenital absence of tooth germs manifested in the form of oligodontia or anodontia, the presence of persistent deciduous teeth in ectodermal dysplasia (ED), cleft lip and hard palate or cancer-induced changes in the tissues of the stomatognathic system are the most common causes of these disorders. The observed abnormalities are responsible for functional disorders of musculo-articular system, speech and chewing. In addition, noticeable adverse changes in the appearance have a huge psychological impact on patients and their well-being. Therefore, the treatment of these medical conditions should begin in childhood and comprise interdisciplinary rehabilitation, involving prosthetics and orthodontics supported by surgery, as well as speech or laryngological therapy. In this paper the interdisciplinary treatment of patients with oral hard and soft tissues disorders during ectodermal dysplasia is discussed. Early oral rehabilitation can restore lost or abnormally shaped tissues and proper functions of the masticatory system. It can also have a positive impact on further physical and psychological development of patients.

[Technical aspects of treatments with single- and multi-unit fixed dental prostheses]. / Tandtechnische aspecten van de vervaardiging van kronen en bruggen.

For the manufacture of single- and multi-unit fixed dental prostheses, effective communication between dentist and dental technician is required. Mutual insight concerning the (im)possibilities of available treatments and technical options is prerequisitefor this communication. The manufacture of single- and multi-unit fixed dental prostheses involves 4 phases: recording the required detailed information on the relevant teeth and the occlusal system, the technical adjustments, the technical design and the technical fabrication. These phases can be accomplished through an analogue or (semi)digital procedure. Pioneering developments are computer aided design and computer aided manufacturing (CAD/CAM), and computerised milling machines. Associated with this are 3 manufacturing methods which can be distinguished: the dental practice method, the dental laboratory method and the milling centre method. Materials applied are metal alloys and ceramics, while resins are used for provisional and transitional constructions. Due to the fact that the choice of material in the analogue procedure is limited, CAD/CAM offers more options, the digital procedure is expected to gain ground gradually. It is expected that this development will provide an impulse to higher quality.

Repeatability and reliability of human eye in visual shade selection.

Deficiencies in the human visual percep-tion system have challenged the efficiency of the visual shade-matching protocol. The aim of this study was to evaluate the repeatability and reliability of human eye in visual shade selection. Fifty-four volunteering dentists were asked to match the shade of an upper right central incisor tooth of a single subject. The Vita 3D-Master shade guide was used for the protocol. Before each shade-matching procedure, the definitive codes of the shade tabs were hidden by an opaque strip and the shade tabs were placed into the guide randomly. The procedure was repeated 1 month later to ensure that visual memory did not affect the results. The L*, a* and b* values of the shade tabs were measured with a dental spectrophotometer (Vita Easyshade) to produce quantitative values to evaluate the protocol. The paired samples t-test and Pearson correlation test were used to compare the 1st and 2nd selections. The Yates-corrected chi-square test was use to compare qualitative values. Statistical significance was accepted at P < 0·05. Comparing baseline and 1st month records, statistical significance (P < 0·001) was found among qualitative data regarding repeatability on a yes/no (1/0) basis, revealing a very low percentage of repeatability (11·1%). Comparing baseline and 1st month records, statistical significance was not found (P = 0·000) among the L*, a*, b* and ΔE variables. These results indicate that dentists perform insufficiently regarding repeatability in visual shade matching, but they are able to select clinically acceptable shades.

[The conventional and the digital impression method for single-unit and multi-unit fixed dental prostheses]. / De conventionele en de digitale afdrukmethode voor kronen en bruggen.

To manufacture single-unit and multi-unit fixed dental prostheses, an accurate cast is required. Casts can be obtained either by the conventional or the digital impression method. For both methods, dry tooth surfaces and a well exposed finish line of the tooth preparation are required. The conventional impression method requires an elastic impression material. Elastomers have a high detail accuracy, which can produce, in combination with a good fitting and rigid impression tray, an impression with reliable dimensional stability. Based on the number of different impression material consistencies used and the number ofphases of the impression procedure, several options of the conventional impression method can be distinguished. For the digital impression method, teeth or implants are scanned to produce a digital cast which can be used directly with the help of computer technology to produce single-unit or multi-unit fixed dental prostheses. The digital impression method has a number of advantages when compared to the conventional impression method, but is not applicable for all prosthetic cases.

Oral Rehabilitation Outcomes Network-ORONet.

The published literature describing clinical evidence used in treatment decisionmaking for the management of tooth loss continues to be characterized by a lack of consistent outcome measures reflecting not only clinical performance but also a range of patient concerns. Recognizing this problem, an international group of clinicians, educators, and scientists with a focus on prosthodontics formed the Oral Rehabilitation Outcomes Network (ORONet) to promote strategies for improving health based on comprehensive, patient-centered evaluations of comparative effectiveness of therapies for oral rehabilitation. An initial goal of ORONet is to identify outcome measures for prosthodontic therapies that represent multiple domains with patient relevance, are amenable to utilization in both institutional and practice-based environments, and have established validity. Following a model used in rheumatology, the group assessed the prosthodontic literature, with an emphasis on implantbased therapies, for outcomes related to longevity and functional, psychologic, and economic domains. These systematic reviews highlight a need for further development of standardized outcomes that can be integrated across clinical and research environments.

The Burdens in Prosthetic Dentistry Questionnaire (BiPD-Q): development and validation of a patient-based measure for process-related quality of care in prosthetic dentistry.

PURPOSE: To develop and validate an instrument for the assessment of patient-based measures of process-related quality of care in prosthodontic patients. MATERIALS AND METHODS: In this nonrandomized study, the new Burdens in Prosthetic Dentistry Questionnaire (BiPD-Q) was developed in two steps using a total of 128 prosthodontic patients in a mixed-method approach, combining quantitative-qualitative methodologies. First, the item pool for the instrument was created using semistructured interviews and a group of experts in prosthodontics. This resulted in a preliminary version of the questionnaire. Second, an assessment of redundancy, completion rates, face validity, difficulty, and distribution of the core set of the items was performed. The final version of the BiPD-Q had psychometric core properties (reliability and validity) evaluated. RESULTS: The BiPD-Q consisted of 25 items. Reliability was satisfactory (Cronbach's alpha = .87). The mean score of all items of the BiPD-Q was significantly correlated with mean perceived burdens during treatment as rated by the clinician (r = 0.26; P < .01) and with overall satisfaction with the treatment procedures as rated by patients (r = .31; P < .01), indicating sufficient convergent validity. CONCLUSION: A reliable and valid instrument for the assessment of patient-based process-related quality of care in prosthodontics has been developed. The BiPD-Q allows comparisons of different dental procedures within a treatment course and of different treatment providers. The use of this type of questionnaire appears to be a valuable tool for dental health care research. The outcomes of research using the BiPD-Q may result in a more pleasant treatment experience for future patients.

Interpreting one oral health impact profile point.

BACKGROUND: Interpretation of scores from oral health-related quality of life (OHRQoL) instruments, such as the Oral Health Impact Profile (OHIP) is challenging. It was the aim of this study to determine how many oral impacts correspond to one point of the 49-item OHIP using a new approach which translates numeric problem counts into the traditionally used ordinal OHIP response categories. METHODS: A sample of 145 consecutively recruited prosthodontic patients seeking treatment or having a routine examination completed the German version of the 49-item OHIP with the original ordinal response format as a self-administered questionnaire. In addition, the numerical frequencies of impairment during the previous month were requested in personal interviews. Based on a multilevel mixed-effects linear regression, we estimated the mean difference with 95% confidence interval (CI) in numerical frequency between two adjacent ordinal responses. RESULTS: A numerical frequency of 15.2 (CI: 14.8 - 15.7) impacts per month corresponded to one OHIP point. This translates to approximately one impact every other day in the past month. CONCLUSIONS: The oral problem count per day that corresponds to one OHIP-49 point can be used to interpret this instrument's scores in cross-sectional and longitudinal studies. This number can help to better understand OHRQoL burden for patients, clinicians, and researchers alike.