Improving quality of life using removable and fixed implant prostheses

Removable and fixed implant-retained prostheses can greatly enhance patients' quality of life, improving their speech, appearance, and ability to eat and otherwise function normally. Yet patients may resist this type of treatment due to barriers, including cost, fear, and lengthy treatment times. It is, therefore, important that clinicians engage in discovering and understanding their patients' concerns and expectations in addition to making a thorough and complete diagnosis of their dental conditions. In the case presented, emphasis was placed on patient-clinician communication to correctly facilitate the desired clinical result. The final restoration consisted of a maxillary removable, implant-assisted denture and a mandibular screw-retained, fixed, implant-supported prosthesis.     

Within-subject comparisons of maxillary fixed and removable implant prostheses: Patient satisfaction and choice of prosthesis

Dental implants provide patients with restorative options for the edentulous maxilla. Both fixed and removable prostheses can be attached to the edentulous maxilla, but the efficacy of different designs has not been determined. In this two-session within-subject crossover trial we compared maxillary implant retained fixed prostheses with removable implant overdentures opposed by mandibular implant-supported overdentures. Sixteen patients, who had previously received mandibular implants, entered the study and received four to six maxillary implants. After dropouts as a consequence of a lack of osseointegration and general health problems, 13 remained. Of these, five received the removable prosthesis first and eight the fixed prosthesis. After 2 months, the prostheses were exchanged and the second was also worn for 2 months. Psychometric measurements of general satisfaction with the prostheses as well as comfort, ability to speak, stability, esthetics, ease of cleaning and occlusion were obtained once each prosthesis had been worn for 2 months. Chewing ability was assessed for seven types of food. Removable long-bar overdentures received significantly higher ratings of general satisfaction than fixed prostheses (P = 0.003). Patients also rated their ability to speak and ease of cleaning significantly better with the removable overdentures. Nine patients chose to keep the removable prosthesis and four preferred to keep the fixed prosthesis. The results suggest that maxillary removable overdentures on multiple implants may provide patients with better function than fixed prostheses.     

Effect of treatment with fixed and removable dental prostheses. An oral health-related quality of life study

The aim of the study was to evaluate patient-reported effects of treatment with fixed dental prostheses (FDP) and removable dental prostheses (RDP) and relate the change in Oral Health Related Quality of Life (OHRQoL) to the type of treatment and objective dental variables of aesthetics and mastication. Additionally, the purpose of the study was to identify aspects of impairment and improvement that the treatments caused. Fixed dental prostheses treatment was performed in 200 patients and RDP treatment in 107 patients. Gender, age, region of replacement, and number of teeth present and replaced were obtained. The participants completed the Oral Health Impact Profile 49 (OHIP-49) before and after treatment. A control group with no need for dental treatment also completed the OHIP-49. All participants had a significant improvement in OHRQoL. The improvement was higher for the RDP group than the FDP group. Removable dental prostheses that replaced only masticatory teeth did not improve the OHRQoL significantly. The improvement in OHRQoL for both the FDP and RDP groups was not at the level of the control group. Higher age was associated with lower improvement in OHRQoL. Higher age, being a woman and having teeth replaced in the aesthetic zone were associated with deterioration in OHRQoL. Both RDP treatment and FDP treatment were associated with a reduction in the problems most frequently reported before treatment. Treatment with RDP was associated with new problems caused by the RDP. Fixed dental prostheses and RDP treatments improved OHRQoL and reduced the number of problems. The RDP participants improved more than the FDP participants.     

A longitudinal study of quality of life outcomes in older adults requesting implant prostheses and complete removable dentures

A longitudinal clinical trial involving 103 subjects was undertaken to assess the impact of oral implant therapy on the psychosocial well-being of subjects with complete denture wearing problems. There were four experimental groups: (1) an implant group, where subjects were edentulous/edentate in one jaw and requested and received implants to retain an oral prosthesis (IG); (2) subjects edentulous/edentate in one jaw requesting implants but who received conventional dentures (CDG1); (3) edentulous subjects requesting replacement of their dentures by conventional means (CDG2); (4) dentate subjects requiring routine treatment, who were included for comparison. Data were collected in each group pre- and post-treatment using validated oral specific [the Oral Health Impact Profile (OHIP)], and generic (the SF36) health status measures. Subjects in IG, CDG1 and CDG2 also completed a denture satisfaction scale. IG and CDG1 subjects reported that tooth loss and denture wearing problems had a much greater impact on their quality of life than subjects seeking conventional dentures. Dentate subjects had a much better oral health status compared with denture-wearing subjects. Following treatment, subjects who received implant-retained prostheses (IG) reported a significant improvement in satisfaction and health-related quality of life, as did subjects who requested and received conventional dentures (CDG2). Subjects who requested implants, but received conventional dentures (CDG1), reported little improvement in denture satisfaction and only modest improvement in their quality of life. None of the denture-wearing subjects reported health-related quality of life that was as good as that of dentate subjects. The findings have significant implications in the assessment of outcomes in future clinical trials.     

Patient satisfaction and quality of single-tooth restorations

Abstract: This retrospective study focuses on patient opinion and professionally assessed quality of single‐tooth restorations of Brånemark fixtures. Patients were treated by periodontists for fixture installation and/or abutment connection and by referring general practitioners for prosthetic rehabilitation. Seventy‐eight consecutively treated patients were sent a questionnaire regarding aesthetics, phonetics and overall satisfaction. Forty‐eight patients (52 fixtures) returned the questionnaire. Forty were able to attend a clinical examination by an independent examiner. The quality of 43 single implant crowns was evaluated according to the modified guidelines for assessment of quality and professional performance used for evaluation of design, fit, occlusion/articulation and aesthetics. Bone to implant level was assessed radiographically. Patients were very positive about aesthetics, phonetics, eating comfort and overall satisfaction. Nevertheless, 6/40 patients would not undergo the same treatment again, yet all of them would recommend it to others. The professionally rated quality of the crowns was perfect in 17 and acceptable in 25 cases. One crown needed modification to prevent future complications. Two crowns had already been replaced as a result of porcelain fracture; one restoration showed abrasion and one was damaged. With a mean loading time of 33 months (range: 3–89 months), none of the patients returning the questionnaire had encountered fixture loss. All except five fixtures showed bone remodelling at or above the first implant thread. It is concluded that single Brånemark fixtures installed by periodontists and restored by general practitioners are of an acceptable clinical quality to satisfy the patient.     

Patient satisfaction with laser-sintered removable partial dentures: A crossover pilot clinical trial

Statement of problem

Clinical data regarding newly introduced laser-sintered removable partial dentures (RPDs) are needed before this technique can be recommended. Currently, only a few clinical reports have been published, with no clinical studies.

AICRG, Part IV: Patient satisfaction reported for Ankylos implant prostheses

PROBLEM: Although many maxillary dentures exhibit sufficient retention and stability for patients to adapt well to them, mandibular dentures present a major challenge. The introduction of the endosseous dental implant provided the opportunity for the patient to have esthetic replacements (implant prostheses) that were retentive and stable for all missing natural teeth. METHOD: This paper reports on the satisfaction of over 470 patients with implant prostheses fabricated using a new and innovative implant design (Ankylos, Dentsply-Friadent, Mannheim, Germany). RESULTS: A total of 1500 Ankylos implants were placed, restored, and followed for 3 to 5 years. Patients were asked to respond to a series of questions related to their satisfaction with their new replacements for missing natural teeth. A total of 95.6% of the patients rated chewing ability with Ankylos prosthesis as excellent to good; 92.2% indicated a significant improvement in their ability to chew; 92.6% reported overall clinical function much better than conventional dentures; 99.1% indicated that speech had improved or was not changed; 96.3% indicated hot and cold foods tasted better; 98.8% indicated no pain or discomfort during clinical function; 99.4% liked their new implant prosthesis; 98.0% would seek implant-prostheses treatment again, if necessary; 99.1% would recommend implant prostheses to friends and relatives; and 98.8% indicated the advantages of Ankylos prostheses far exceeded any disadvantages that may exist. CONCLUSIONS: Patients indicated that they (1) were highly satisfied with the final results of the replacements for their natural teeth that were retained or supported by this new implant design, (2) would not hesitate to recommend this form of treatment to their friends and relatives, and (3) would not hesitate to seek the same treatment again if necessary in the future.     

Patient satisfaction and preference with thermoplastic resin removable partial dentures: a randomised cross-over trial

PurposeThis randomised cross-over trial aimed to comparatively investigate patient preference and satisfaction with thermoplastic resin removable partial dentures (TR-RPDs) and conventional metal clasp-retained removable partial dentures (MC-RPDs).MethodsTwenty-eight partially dentate subjects were enrolled and randomised to receive MC-RPDs followed by TR-RPDs or vice versa (n = 14, each group). The subjects were asked to score overall satisfaction and denture-related parameters 3 months after delivery of each denture. Additionally, they were asked to choose their preferred denture type at the end of the trial.ResultsOf the 28 subjects, 24 (86%; mean age, 67.3 years) completed the trial. The overall satisfaction scores and ratings for oral appearance with TR-RPDs were significantly higher than those with MC-RPDs (P < 0.05). Moreover, 75% (18/24) and 83% (20/24) of the subjects reported greater overall satisfaction and better oral appearance with TR-RPDs than with MC-RPDs (P < 0.001, both). Scores for mucosal pain and food impaction were significantly better with TR-RPDs than with MC-RPDs (P < 0.05). Relative to MC-RPDs, TR-RPDs provided slightly better oral comfort and speech, although the differences were not statistically significant (P > 0.05). Scores for chewing ability, denture stability, and ease of denture cleaning were almost identical for both types of dentures.ConclusionsThese results suggest that TR-RPDs hold an advantage over MC-RPDs in terms of oral appearance and can offer greater satisfaction than MC-RPDs in partially dentate arches with at least an occluding pair in the posterior region.Clinical trial registrationUMIN Clinical Trials Registry (UMIN000007310).     

Provisional removable partial and complete prostheses

The incorporation of the use of provisional removable complete and partial prostheses is an extremely valuable diagnostic and therapeutic modality in the comprehensive rehabilitation of the partially and fully edentulous patient. There is no question that the use of this restoration addresses many of the chief complaints of patients in a timely fashion and, in so doing, builds a high degree of confidence in the dentist by the patient. The evaluation of the provisional restorations and their subsequent refinement results in a higher quality, more predictable definitive restoration. Experience has demonstrated that postinsertion problems are reduced with the definitive prosthesis following successful therapy with the provisional restoration. The provisional prosthesis is also valuable as a "spare" denture after insertion of the definitive prosthesis. The role of the provisional removable prosthesis is readily understood and accepted by most patients, and the appropriate use of these restorations in prosthetic dentistry is an indication of a high-quality, highly individualized, and service-oriented dental practice.     

Association between patient satisfaction with complete dentures and oral health-related quality of life: two-year longitudinal assessment

The objective was to evaluate the development of oral health-related quality of life (OHRQoL) in patients with complete dentures and the association between OHRQoL and patient satisfaction. Fifty-two patients (mean age, 66.3, 48.1% male) received dentures in at least one jaw. The analysis was conducted on participants with dentures in both jaws (CD-Both; n = 22) or in the upper jaw only (CD-Max; n = 28). Data were collected 4 weeks, 6 months, and 1 and 2 years after insertion. OHRQoL was measured by use of the OHIP-EDENT. Self-rated patient satisfaction was assessed on a scale of 0–10. To prove the hypothesis that patient satisfaction would be a meaningful predictor of OHRQoL, and not vice versa, multilevel analysis and cross-lagged correlation analysis were performed for both groups separately. OHRQoL improved from 22.9 (SD, 20.7) to 12.1 (SD, 14.5) for CD-Both and from 20.3 (SD, 17.2) to 14.7 (SD, 15.1) for CD-Max. Multilevel analysis revealed that patient satisfaction and OHRQoL were significantly associated (p < 0.0001) for both groups. Differences between the groups were found with regard to the effect of time after insertion and the interaction between time and satisfaction with OHRQoL which were significant only for the group CD-Both; however, no evidence was found for the causality of this association in the cross-lagged analysis for both groups (ZPF test, p > 0.016). Patient satisfaction and OHRQoL were associated for wearers of complete dentures. Within the limitations of the study, however, the causality that patient satisfaction predicts OHRQoL, and not vice versa, could not be proven.     

Implants for fixed and removable prostheses.

For those individuals whose oral anatomy contraindicates the use of endosteal implants, there still remains a viable alternative to conventional removable dentures. Both maxillary and mandibular implant dentures of a subperiosteal design will provide a stable implant and a retentive restorative prosthesis. The patient is free from the oral gymnastics required to manipulate such appliances and in the maxilla the dentist is able to eliminate all palatal coverage without compromising the retention of the bridge. The lower subperiosteal implant and the pterygoid extension implant discussed both obtain their stability from accurate fit of the implant substructure to the bone. The implant first becomes more retentive when the periosteum tenaciously reattaches itself to the bone and in turn secures the implant in position (Fig. 13). The restorative procedures follow sound prosthetic prinicples with particular attention on avoiding any impingement of the underlying tissue areas. Implant dentures have truly provided patients a means of exploring alternative treatment modalities other than conventional removable dentures. Literally thousands of patients today are living testimony to the accomplishments of oral implantology when pursued as an exacting science prescribed by colleagues experienced in this revolutionary dental discipline.     

Patient satisfaction with two designs of implant supported removable overdentures; ball attachment and magnets

Objective: The aim of this study was to compare ball and magnet attachments within implant-supported mandibular overdentures (ISMOD) using patient centred outcome measures. Our a priori hypothesis was that there is no difference in patient satisfaction between the two attachment types.
Material and methods: In this within-subject crossover randomised clinical trial, edentulous patients were recruited to the study and completed a denture satisfaction questionnaire before having two implants placed in the intraforaminal region of the mandible. They were randomly assigned to receive an ISMOD retained by either ball or magnetic attachment. After 3 months satisfaction questionnaires were repeated before attachments were changed to the alternative design. After a further 3 months patients completed final questionnaires. Patients were asked to choose their preferred prostheses and record the most influential factors in their final choice. The outcome variables of patient satisfaction were compared between baseline and the two attachment types using non-parametric two-related sample tests (Wilcoxon's signed rank).
Results and discussion: Sixteen patients completed the study. Patient satisfaction improved significantly between baseline and the new prosthesis with each attachment type for all domains of satisfaction ( P <0.05). Ball attachments provided greater satisfaction in the domains of general satisfaction, stability and ability to chew ( P <0.05). Patients' general satisfaction with ball attachment retained overdentures was greater than that for magnetic attachments; however, both designs provide significantly greater satisfaction than conventional dentures. In this study, the majority preferred to retain the ball attachment although one-third of patients actively chose the magnetic attachment.