Development and validation of the Burdens in Oral Surgery Questionnaire (BiOS‐Q)

Patients’ perspective is increasingly re‐cognised as an important outcome measure in oral surgery. However, how patients perceive the surgical treatment cannot be assessed currently. This would be an important indicator for process‐related quality of care. It was the aim to develop and to validate an instrument for the assessment of patient‐based measures of process‐related quality of care in oral surgery. The new Burdens in Oral Surgery Questionnaire (BiOS‐Q) was developed in two steps in patients undergoing oral surgery. First, an item pool was created using semi‐structured interviews in 90 patients. Second, a preliminary version was applied in 297 consecutively recruited patients to assess redundancy, completion rates, face validity, difficulty and distribution. Psychometric properties of the final version of the questionnaire were evaluated. The BiOS‐Q consists of 16 items and showed satisfactory internal consistency (Cronbach's alpha = 0·84) and excellent test–retest reliability (ICC = 0·90). The questionnaire's mean score was significantly correlated with dentists’ burdens (r = 0·44) and patients’ overall satisfaction (r = 0·39) indicating sufficient validity. The BiOS‐Q is a reliable and valid instrument for the assessment of patient‐based process‐related quality of care in oral surgery.     

Single mandibular implant study – denture satisfaction in the elderly

To investigate whether there are differences in patients’ denture satisfaction when an implant placed in the midline of the edentulous mandible is loaded either immediately or three months later, after second‐stage surgery. One hundred and fifty‐eight edentulous patients received a single implant in the midline of the mandible. After randomisation, it was loaded either immediately after implant placement (N = 81, group A) or three months later, after a submerged healing phase and a second‐stage surgery (N = 77, group B). Patients’ denture satisfaction aspects were assessed, using visual analogue scales (VAS), before treatment, one month after implant placement during the submerged healing phase (only group B) and one and four months after implant loading. The statistical analysis was performed using the Wilcoxon signed‐rank and rank‐sum tests. One month after loading, a significant improvement in comfort, function and stability of the mandibular denture could be observed in both groups (P ≤ 0·05). A slight but not significant improvement was found between one and four months after loading. Patients with second‐stage surgery and delayed loading rated the stability and fit of the mandibular denture as significantly better than patients who had immediate loading. A single implant in the edentulous mandible significantly increased patients’ denture satisfaction. After four months, stability and fit of the mandibular denture were considered better when a delayed loading protocol had been followed. A single mandibular implant in the edentulous mandible significantly increases patients’ denture satisfaction, regardless of the loading protocol.     

Critical Appraisal

A number of studies have introduced patient-based outcome measures into the dental literature. Patient-based outcomes most often are collected using a questionnaire approach. The assessment of oral health status or oral health-related quality of life may be a promising concept supplementing clinical data. This review presents articles on the development of a measure of oral health status and the application of this concept in clinical studies.     

Speech with maxillary implant prostheses: ratings of articulation

Speech is often perturbed after placement of maxillary implant-retained prostheses. We tested the hypothesis that the rate of speech errors varies with prosthetic design. Thirty edentulous subjects with mandibular implant prostheses entered two within-subject crossover trials. Subjects wore maxillary fixed prostheses and removable long-bar overdentures (Trial 1), or overdentures with and without palates (Trial 2). Test words from a French language speech battery were recorded after each prosthesis had been worn for two months. The percentages of stops, fricatives, and vowels correctly perceived by lay judges were calculated. Subjects produced a significantly higher percentage of sounds correctly with overdentures than with fixed prostheses. Between-treatment differences were significant for stops and fricatives (p < 0.01), but not for vowels. There were no significant differences in error rates between the two overdentures. In conclusion, maxillary implant overdentures with and without palates enable patients to produce more intelligible speech than fixed prostheses.     

Complete dentures and oral health‐related quality of life – do coping styles matter?

Oral health-related quality of life (OHRQOL) in edentulous patients with complete dentures is often impaired. This paper investigates the effect of different coping styles on OHRQOL. PURPOSE: (a) To assess OHRQOL of edentulous patients with conventional complete dentures, and (b) to investigate if individual differences in these patients' styles of coping with stress affect their OHRQOL. MATERIALS AND METHODS: Data were collected from 249 fully edentulous patients with complete dentures (mean age: 66.0 years) who responded to a mailed survey (adjusted response rate: 48.8%). OHRQOL was measured with the 14-item short form of the oral health impact profile (OHIP). Ratings of coping strategies were obtained using the 28-item Brief COPE, an instrument measuring various styles of coping with stress. Linear regression analyses were used to explore the relationships between coping styles, background variables such as age, gender, income, and age of prosthesis, and the patients' OHRQOL. RESULTS: About 35% of the respondents reported impacts from their oral conditions on their overall OHRQOL (OHIP-14 total score) occasionally, fairly often, or often. Physical pain was even more prevalent, with 53.3% of the respondents reporting pain impacts. The linear regression model (P < 0.0001) explained 31.1% of the variation in the OHIP-14 total score. The coping variables instrumental support, behavioral disengagement, substance abuse, denial, and religion were significant negative predictors of OHRQOL. Only emotional support was a significant positive predictor of OHRQOL. CONCLUSION: Wearing conventional complete dentures has a significant impact on OHRQOL. This impact is moderated by the styles a patient uses to cope with stress. Using emotional support has a positive effect on OHRQOL, while other coping styles, namely instrumental support, behavioral disengagement, substance abuse, denial, and religion are significant negative predictors of OHRQOL.     

The multi PDZ domain protein MUPP1 as a putative scaffolding protein for organizing signaling complexes in the acrosome of mammalian spermatozoa

Spermatozoa undergo complex sequences of precisely timed events during the process of fertilization. These priming events, which comprise capacitation, egg recognition, acrosome reaction, and sperm-oocyte fusion, are regulated by the activation of different intracellular signaling pathways. The efficacy and accuracy of signal transduction pathways often depend on the assembly of multiprotein signaling complexes, thereby coordinating and guiding the flow of regulatory information. To address the question whether PDZ-domain proteins, the most abundant protein interaction modules involved in the assembly of supramolecular signaling complexes, are present in rodent sperm, homologue of the RT-PCR approaches were performed with specific primer pairs for the vertebrate INAD-like PDZ domain protein MUPP1. The results revealed that this scaffolding protein, which comprises 13 different PDZ domains, is expressed in mouse testis. To obtain further support for the expression of the multi-PDZ domain protein MUPP1 in testicular tissue, immunohistochemical as well as immunocytochemical experiments were performed using a MUPP1-specific antibody. Detailed analyses of the spatial MUPP1-expression profile revealed that immunoreactivity is concentrated within the acrosomal region of round as well as elongated mouse spermatozoa. These results were confirmed in experimental approaches demonstrating that MUPP1 immunofluorescence was shed off from the acrosome region after acrosome reaction. To examine whether MUPP1 is also present in other mammalian sperm, immunocytochemical approaches were performed with isolated bovine as well as human sperm. The results revealed prominent MUPP1 expression which was restricted to the apical acrosomal region and, most notably, to the equatorial segment of the acrosome. The predominant expression profile of MUPP1 in sperm of different mammalian species suggests that this PDZ-domain protein may be involved in organizing signaling molecules mediating primary reactions of fertilization.     

The restoration of endodontically treated,single-rooted teeth with cast or direct posts and cores: a systematic review

Direct post-and-core restorations with prefabricated posts are becoming increasingly popular. A literature review was conducted to compare the clinical and in vitro performance of cast posts and cores to that of direct cores with prefabricated posts in single-rooted teeth. Research on the restoration of endodontically treated teeth was identified through a search of electronic databases. The search yielded a total of 1773 references. After these references were subjected to strict inclusion criteria, 10 in vitro and 6 in vivo studies remained and critically reviewed. A comparison of fracture loads in the in vitro studies revealed no significant difference between cast and direct posts and cores. Meta-analysis of the data suggested that there is no difference in fracture behavior associated with the 2 treatment modalities. An overall survival analysis was not possible for the in vivo studies. The survival for cast posts and cores in 2 studies ranged from 87.2% to 88.1% and in a third study reached 86.4% for direct cores after 72 months. Randomized clinical trials on this topic were not available but should be conducted to verify published findings.     

Survival rate and fracture strength of endodontically treated maxillary incisors with moderate defects restored with different post-and-core systems: an in vitro study

PURPOSE: This study compares the survival rate and fracture strength of endodontically treated maxillary incisors with moderate coronal defects restored with different post-and-core systems after exposure to an artificial mouth. MATERIALS AND METHODS: Sixty-four caries-free human maxillary central incisors were selected for standardized size and quality, endodontically treated, and decoronated 2 mm coronal to the cementoenamel junction. Group 1 was restored with titanium posts and composite cores, group 2 received zirconia posts and a composite core, and in group 3 zirconia posts with a heat-pressed ceramic core were used. Teeth restored with cast posts and cores served as controls. All teeth were prepared and restored with complete cast crowns. All samples were exposed to 1.2 million cycles in a computer-controlled chewing simulator with simultaneous thermocycling. In addition, the samples were loaded until fracture in a static testing device. RESULTS: The survival rates of the different groups were: 94% for titanium/composite, 63% for zirconia/composite, 100% for the all-ceramic post and core, and 94% for the cast post and core. The following mean fracture strengths were obtained: titanium/composite = 425 +/- 155 N, zirconia/composite = 202 +/- 212 N, zirconia/ceramic = 378 +/- 64 N, cast post and core = 426 +/- 178 N. The lower fracture load in the group with zirconia posts and composite cores was statistically significant. The use of zirconia posts resulted in fewer oblique root fractures. CONCLUSION: Prefabricated titanium posts with composite cores, zirconia posts with heat-pressed ceramic cores, and cast posts and cores yield comparable survival rates and fracture strengths for the restoration of crowned maxillary incisors with moderate coronal defects. Survival rates and fracture strengths for zirconia posts with composite cores are significantly lower, so this combination cannot be recommended for clinical use.