Changes in oral health-related quality of life after three different strategies of implant therapy: a clinical trial

Odontology - This research aims to evaluate changes in Oral Health-related Quality of Life (OHQoL) by means of the Oral Impacts on Daily Performances (OIDP) of patients treated with three...     

Immediate post-operative effects of different periodontal treatment modalities on oral health-related quality of life: a randomized clinical trial

AIM: Oral health-related quality of life (OHQoL) characterizes a person's perception of how oral health influences an individual's life quality. The aim of this study is to investigate how the treatment modalities may affect the immediate post-operative quality of life of patients with periodontitis. MATERIALS AND METHODS: Sixty psychologically and socio-demographically matched periodontitis patients were randomly divided into three groups [20 non-surgical (NS), 20 surgical (SG), 20 surgical plus enamel matrix protein derivative (S+EMD)]. The OHQoL was assessed with two patient-centred outcome measures [Oral Health Impact Profile-14 (OHIP-14) and General Oral Health Assessment Index (GOHAI)] in the post-operative period of 1 week. RESULTS: Whereas there were no differences of OHQoL at the baseline, the patients treated by surgery had reported that they had experienced a worse OHQoL compared with the NS and S+EMD groups both in the OHIP-14 and GOHA indexes (p=0.001). CONCLUSIONS: The results of this study clearly indicated that patient perceptions on the immediate post-operative period were significantly better in the NS and S+EMD groups when compared with the SG group. These findings need to be confirmed in further studies with larger populations.     

Effect of submental flap reconstruction versus obturator rehabilitation after maxillectomy on quality of life: a randomized clinical trial

The surgical removal of a maxillary tumour will result in an oronasal communication, which can negatively affect the patient’s life and daily functions. Following maxillectomy, the defect can be treated with a prosthetic obturator or microvascular flap. However, the gold standard technique remains controversial. The aim of this study was to evaluate and compare quality of life (QoL) outcomes of submental island flap versus maxillary obturator reconstruction after partial maxillectomy. Sixty patients indicated for maxillectomy were allocated randomly to two equal-sized groups. Control group patients underwent reconstruction with a surgical obturator, while intervention group patients underwent submental island flap reconstruction. Patient QoL was evaluated at the 6-month follow-up using the University of Washington Quality of Life Questionnaire. Statistically significant differences in QoL were found between the two groups. Chewing (P = 0.034), swallowing (P < 0.001), speech (P = 0.009), taste (P = 0.04), mood (P = 0.01), and anxiety (P = 0.003) domains showed a statistically significant improvement in the submental group compared to the obturator group. However, the obturator group showed a greater improvement in appearance (P < 0.001). The masticatory function scores in the obturator group were significantly higher after obturator rehabilitation (P < 0.001). In conclusion, this study found that submental flap reconstruction provided better function and QoL than the obturator. This reconstruction was associated with less pain and better pronouncing of words, chewing, swallowing food, and psychosocial adjustment.     

Effect of flapless implant surgery on soft tissue profile: a randomized controlled clinical trial

BACKGROUND: Flapless implant surgery has been suggested as one possible treatment option for enhancement of implant esthetics. METHODS: Twenty-four patients with a missing tooth in the premaxillary region were randomly assigned to one of two groups (12 each): immediate loading (IL) or delayed loading (DL) (loading after 4 months). An endosseous implant was placed in each patient via a flapless surgery. Clinical measurements including the papillary index (PPI) (0, no papilla; 1, less than half; 2, more than half but not complete fill; 3, complete fill; and 4, overfill), marginal levels of the soft tissue (ML), probing depths (PDs), modified bleeding index (mBI), modified plaque index (mPI), and the width of the keratinized mucosa (WKM) were performed at baseline (at the time of loading) and at 2, 4, and 6 months. RESULTS: The soft tissue profile remained stable up to 6 months, without significant differences between the two groups (mean PPI and ML at 6 months, 2.16 and 0.30 mm, respectively). Mean PPI in the IL group significantly increased from 1.50 at baseline to 2.09 at 2 months, and the significance remained up to 6 months (2.30 at 6 months) (P <0.05), whereas in the DL group, no significant changes were found from baseline to 6 months in mean PPI (2.06 at both time points). Mean PPI increased over time when two treatment groups were combined; however, no statistical significance was found. In ML, the difference at baseline between the two groups (-0.28 mm for DL versus 0.17 mm for IL; P <0.05) was no longer significant at 2 months (0 versus 0.08 mm for DL and IL, respectively) and thereafter (P >0.05). No significant differences were detected between groups at each time and over time in the other clinical parameters, PD, mBI, mPI, and WKM (P >0.05). CONCLUSIONS: The results of this study indicate that creeping attachment (i.e., soft tissue recovery) might occur within 2 months after IL. The study suggests that flapless implant surgery provides esthetic soft tissue results in single-tooth implants either immediately or delayed loaded. Other long-term randomized controlled clinical trials with a large sample size and comparison group (i.e., implant surgery with flap) are recommended to verify the conclusions drawn in this preliminary study.     

Non-participation in a randomized controlled trial: the effect on clinical and non-clinical variables

Studies reporting clinical and non-clinical parameters of participants and non-participants of clinical trials are scarce. In the available studies non-participants were likely to show less favourable outcomes than participants on both socioeconomic parameters as well as on caries experience. However, the impact of non-participation on the total sample of the research population is not established. In the present study, as part of baseline data collection for a randomized controlled trial on caries-preventive strategies, 346 parents of children 6.0 years (± 3 months) of age were approached to let their child participate. Sixty parents refused, but 56 of them were willing to fill out the same set of questionnaires and to allow their child to be clinically examined once. Parents from participating children had higher socioeconomic status, were more often of autochthonous origin and scored better on knowledge questions than parents of non-participating children. Furthermore, parents of participating children reported a higher willingness to invest, were more likely to hold on to regular meals and their child had lower levels of plaque compared to non-participating children. Surprisingly, the participating children had higher dmfs scores than the non-participating children. Their care index (fs/ds + fs) was higher than that of non-participating children. Based on the findings of this study, the presumption that non-participating children will show less favourable clinical outcomes cannot be supported. Although participants differed from non-participants, they did not differ from the total population. It is suggested that the external validity of a randomized controlled trial on caries-preventive strategies is not necessarily affected by non-participation bias.     

Psychological impact on implant patients' oral health-related quality of life

OBJECTIVES: The literature has shown that patients' satisfaction with dental prostheses is associated with the existence of certain personality profiles. It is important to study such relationships in dental implant patients. MATERIAL AND METHODS: Fifty patients (28 men and 22 women), aged between 22 and 71 years (mean age 43.22 years, SD 12.24 years), who were partially edentulous and were seeking dental implant therapy were entered into this study. The patients were requested to answer two reliable and valid questionnaires--the Dental Impact on Daily Living (DIDL) and the Neuroticism Extraversion Openness Five-Factor Inventory (NEO-FFI)--before implant treatment and 2-3 months after prosthodontic rehabilitation therapy. RESULTS: Certain personality traits were found to have a significant relationship with patients' satisfaction with dental implants both before and after implant therapy (P < 0.05). Neuroticism score had valuable features in predicting patients' total satisfaction ratings (P = 0), satisfaction with appearance dimension (P = 0), satisfaction with oral comfort dimension (P = 0.005) as well as satisfaction with general performance dimension (P = 0). CONCLUSION: Personality traits have an impact on patients' satisfaction with dental implant therapy. In addition, personality traits provide valuable information for the prediction of patients' satisfaction with their implant-supported prostheses. Neuroticism, openness, agreeableness and consciousness are very helpful in this regard. Neuroticism was found the main predictor of the patients' oral health-related quality of life following implant treatment.     

A randomized controlled clinical trial comparing the effects of three loading protocols on dental implant stability

Purpose: The primary goal of this stratified randomized controlled trial (SRCT) was to compare the stability of dental implants placed under three different loading regimens during the first 16 weeks of healing following implant placement. Implants were loaded immediately, early (6 weeks), or with conventional/delayed timing (12 weeks). Secondary outcomes were to compare marginal bone adaptation for 3 years after placement. Materials and Methods: Single posterior implant sites in the maxilla or mandible were examined. The insertion torque value was the primary determinant of load assignment. Resonance frequency analysis was performed at follow-up appointments for the first 16 weeks (with results provided as implant stability quotients [ISQs]). Marginal bone levels were assessed via radiographs. Results: Forty patients each received a single 4.0-mm diameter dental implant between 2004 and 2007. One implant failure occurred in Lekholm and Zarb type 4 bone with insertion torque value (ITV) of < 8.1 Ncm; the cumulative success rate was 97.5%. All implants, when classified by bone and loading type, increased in stability over time, with a minor reduction of 1.3 ISQ units seen at 4 weeks in the immediate loading group. The mean marginal bone loss over 3 years was 0.22 mm. The mean ITVs at implant placement for bone types 1 and 2 (grouped together), 3, and 4 were 32, 17, and 10, respectively, and were significantly different (P < .05). Conclusions: ITV was a good objective measure of bone type. Using an ITV of 20 Ncm as the determinant for immediate loading and an ITV of 10 Ncm or greater as the determinant for early loading provided long-term success for this implant and led to no negative changes in tissue response. All bone type groups and loading groups showed no reduction in stability during the first 4 months of healing.     

Measuring parental perceptions of child oral health-related quality of life

OBJECTIVES: The aim of this study was to develop and evaluate the P-CPQ, a measure of parental/caregiver perceptions of the oral health-related quality of life of children. This forms one component of the Child Oral Health Quality of Life Questionnaire (COHQOL). METHODS: An item pool was developed through a review of existing child health questionnaires and interviews with parents/caregivers of children with pedodontic, orthodontic, and orofacial conditions. The resulting 47 items were used in a study in which 208 parents/caregivers provided data on their frequency and importance. The 31 items rated the most frequent and important were selected for the final questionnaire (P-CPQ). The P-CPQ validity and reliability were assessed by a new sample of 231 parents, 79 of whom completed two copies for the assessment of test-retest reliability. RESULTS: The P-CPQ discriminated among the three clinical groups included in the expected direction. Within-group analyses using clinical data provided some evidence that scores were associated with the severity of the condition. The P-CPQ also showed good construct validity. It had excellent internal consistency reliability with a Cronbach's alpha of 0.94 and demonstrated perfect test-retest reliability (ICC=0.85). CONCLUSION: The study provides data to indicate that the P-CPQ is valid and reliable.     

A randomized controlled trial of outreach placement's effect on dental students' clinical confidence

This randomized controlled trial compared the effects of outreach placement with traditional, exclusively dental school-based clinical experience on students' confidence in providing treatment for patients presenting with common dental problems. Senior dental students (n=49) were allocated at random to existing dental school-based clinics or placement in primary care clinics to work supervised by local dentists. At baseline, students self-rated their global confidence on a five-point scale. These measures were repeated at follow-up, augmented by a transition judgment and a then-test of confidence (asking students to look back and re-rate their pre-placement confidence). Groups were comparable at baseline. Follow-up scores for global confidence were similar between groups. The outreach group scored higher in the transition judgment (mean 3.7, SD 0.9) than the control group (mean 3.1, SD 1.1, P=0.05). In the then-test, on reflection, the outreach group considered their baseline ratings of confidence were overoptimistic (mean then-test scores 3.2, SD 0.9 and baseline 3.7, SD 0.5) while the control group thought theirs were accurate (mean then-test scores 3.8, SD 0.7 and baseline 3.6, SD 0.8, P=0.01). The findings suggest dental outreach training in primary care settings is more effective than dental school training alone in improving students' confidence in tackling clinical situations. The measurement of change in confidence is complicated by shifts in students' internal scales arising from insights gained on outreach.     

Effect of implant macrogeometry on peri-implant healing outcomes: a randomized clinical trial

Objectives

This randomized split-mouth clinical trial investigated the influence of implant macrogeometry on bone properties and peri-implant health parameters during the healing process.

Material and methods

Ninety-nine implants were placed bilaterally in posterior mandibles of 23 patients that received at least four dental implant macrogeometries: standard geometry, Integra (IN) and three geometries inducing “healing chamber”: Duo (D), Compact (C), and Infra (IF). Insertion torque (IT) and implant stability quotient (ISQ) were measured. Peri-implant health were monitored by visible plaque index (VPI), peri-implant inflammation (PI), and presence of calculus (CC). Data were collected during 90 days. Data were assessed for normality using the asymmetry and kurtosis coefficients followed by the Shapiro-Wilk test. A one-way ANOVA was used to investigate differences in IT and linear bone dimensions between the macrogeometry groups. The repeated measurements ANOVA test or ANOVA-R was used for analysis of ISQ, VPI, and PI. Tukey-Kramer test or Student’s t test was used for comparisons between the groups or within each macrogeometry.

Results

Macrogeometry did not significantly influence IT and ISQ values. The minimum ISQ was recorded after 7 days (71.95 ± 12.04, p = 0.0001). Intermediate ISQ was found after 14 days, when the ISQ reached values that are statistically identical to primary stability. The VPI showed significantly higher scores for the D (0.88 ± 1.03) and IN (0.72 ± 0.94) implants after 7 days. The PI was only influenced by the healing time significantly decreasing from 7 (1.07 ± 0.89) to 21 days (0.18 ± 0.18).

Conclusion

Implant macrogeometry did not influence IT nor ISQ values. The relationship between IT and SS was more evident for the Duo implant, but only in the final stage of healing process.

Clinical relevance

Show to the clinician that the macrogeometry and drilling protocols did not interfere in the clinical behavior of the implants during the healing process. However, the IT, primary and secondary stability, is quite dependent of the surgeon experience.

     

The effect of fluoride gel use on bleaching sensitivity: a double-blind randomized controlled clinical trial

BACKGROUND: Fluoride has been recognized as a desensitizer; however, no study has addressed its effects to decrease tooth sensitivity when compared with a placebo in a double-blind randomized clinical study. METHODS: The authors divided 30 participants into two groups: one that received a placebo and another that was treated with fluoride. All patients used 16 percent carbamide peroxide (CP) in a custom-fitted tray until their teeth achieved shade A1 or lighter. After daily removal of CP, the patients wore a tray containing either sodium fluoride or placebo for four minutes. The authors statistically analyzed the perception of the intensity of tooth sensitivity and the weekly shade changes for both groups, as well as the intensity of tooth sensitivity (alpha = .05). RESULTS AND CONCLUSIONS: The use of fluoride gel did not affect the whitening efficacy of the CP. The authors observed no difference between the groups receiving the placebo and the fluoride treatment in terms of tooth sensitivity experience (P > .05); however, patients who received the placebo had a higher-intensity tooth sensitivity than that of patients who received the fluoride (P < .001). CLINICAL IMPLICATIONS. The use of 1.23 percent sodium fluoride after each bleaching regimen does not affect the bleaching efficacy of CP. Also, the use of sodium fluoride gel reduces the intensity of tooth sensitivity.     

Screening and enrolling subjects in a randomized clinical trial involving implant dentures

PURPOSE: When planning and budgeting for a clinical trial, researchers have few references to help them estimate how many volunteers will need to be screened, how long the screening process may take, and how much it may cost to enroll sufficient qualified subjects. The purpose of this study was to analyze the time and costs involved in recruiting, screening, and enrolling subjects for a randomized clinical trial examining patient satisfaction with mandibular dentures retained by 1 or 2 implants. MATERIALS AND METHODS: Data collected included age and sex of volunteers, recruiting sources, length of time and costs of recruiting and screening volunteers, and reasons for inclusion or exclusion. Results were analyzed using Pearson chi-square tests. RESULTS: We estimated that we would need to screen 180 volunteers over a period of 4 years at an estimated total cost of CAN$47,664.00 to enroll 86 subjects. Instead, we had to screen 220 volunteers at a direct cost of $63,324.81. We excluded 28% of volunteers, while 32% declined participation and 40% agreed to participate in the study. Volunteers were most commonly excluded because of technical problems with their existing dentures, while they were most likely to decline participation because of perceived surgical risks with implants. Those who agreed to participate most commonly cited anticipation of a more secure mandibular denture as their reason for enrolling. CONCLUSION: We had to screen more volunteers at a higher cost than anticipated, with only 40% of those screened meeting inclusion criteria and agreeing to participate in the trial.