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Objectives: To measure expectations of satisfaction with implant and conventional denture treatment in 2 groups of edentulous people and compare them with their resultant ratings of satisfaction to determine if either treatment meets the pretreatment expectation. Method and Materials: One hundred sixty-two edentulous middle-aged (MA, n = 102) and senior (S, n = 60) patients were enrolled in 2 trials and, after randomization, received either a mandibular 2-implant overdenture (IOD) or a new conventional denture (CD). Before randomization, each subject rated their satisfaction with their current denture and expectations of satisfaction with both IOD and CD treatment on 100-mm visual analog scales (VAS). Six months posttreatment, all rated their satisfaction with their new prostheses on similar VAS. Expectations and satisfaction with treatment were compared. Results: Posttreatment satisfaction with CD treatment was significantly lower than pretreatment expected satisfaction in both study populations (MA, P < .0001; S, P = .036). There was no (or only borderline) significant difference between pretreatment expectation and posttreatment satisfaction for patients receiving IODs in both study populations (MA, P = .078; S, P = .057). Conclusion: Posttreatment CD satisfaction failed to meet patients' pretreatment expectations of satisfaction; this was not the case for IODs, for which expectations were largely met. [ABSTRACT FROM AUTHOR]

Purpose: To assess the value of removable partial dentures (RPDs) in subjects with shortened dental arches (SDAs) with regard to quality of life. Materials and Methods: Subjects from 2 university dental centers (82 men, 78 women; mean age: 54 ± 18 years) were categorized into the following groups: (1) SDA with intact anterior regions (SDA-1, n = 44); (2) SDA and interrupted anterior region (SDA-2, n = 21); (3) SDA (intact anterior region) extended with distal-extension RPD (RPD-1, n = 25); (4) subjects with interrupted SDA and interrupted anterior region treated with RPD (RPD-2, n = 32); or (5) complete dental arches (CDA, n = 38) as a control. All subjects underwent a short clinical examination and completed 2 structured questionnaires: the Oral Health Impact Profile (OHIP-49) and the Short-Form Health Survey (SF-36). Recorded clinical variables included: teeth present (yes/no), replacement by RPD (yes/no), and number of occlusal units. Age-dependent outcomes were adjusted to outcomes for the age of 60 years. Linear regression models were used to assess differences between the groups. Results: Reliability and validity were good for all subscales. For OHIP, the investigation groups had significantly higher scores (more complaints) than CDA for the subscales 'functional limitation,' 'psychologic discomfort,' and 'physical disability.' Of the 4 investigation groups, SDA-1 subjects had the lowest mean scores. SF-36 scores showed less prominent and less conclusive differences between investigation groups and CDA subjects. SDA-2 subjects showed worse health, with significantly lower scores than RPD-2 subjects for 'vitality,' 'social function,' and 'mental health.' For pure SDA subjects (SDA-1) there was a significant positive effect for 'number of occlusal units' in 5 of the OHIP subscales and 2 of the SF-36 subscales. Conclusion: From a quality-of-life perspective, patients with SDAs perceive benefits from RPDs only if anterior teeth replacements are included. In contrast, in subjects with uninterrupted SDAs, where only posterior teeth were replaced by distal-extension RPDs, such benefits could not be demonstrated. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To determine if patient ratings of their ability to chew are dependent on the method of complete denture fabrication. METHOD AND MATERIALS: Twenty edentulous patients participated in a randomized within-subject crossover trial. Each participant received 2 sets of new complete dentures. One pair (Gerber prosthesis) was manufactured based on tracings (to determine centric relation) and facebow transfer; semianatomic teeth with a lingualized and balanced occlusal pattern were used. The other set of complete dentures was made using a simplified procedure without facebow transfer; jaw relations were recorded with wax occlusion rims, and anatomic teeth were set with a canine and premolar guidance (Gysi prosthesis). The 2 dentures were delivered in randomized order, and each was worn for 3 months. Three months after insertion, patients' ratings of each new prosthesis were obtained on visual analog scales for general satisfaction, comfort, ability to speak, stability, esthetics, ease of cleaning, and ability to chew. RESULTS: Patients rated their general satisfaction, stability, and esthetic appearance significantly better for the Gysi prostheses ( P < .05). No significant differences between the 2 denture treatment methods were detected for ability to speak, comfort, chewing ability, and the ease of cleaning the dentures. CONCLUSION: A comprehensive method for the fabrication of complete dentures using lingualized teeth does not appear to positively influence patient ratings of denture satisfaction when compared to a simple procedure with anatomic teeth. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To demonstrate the existing difficulties and variability in the application of evidence-based dentistry by comparing the recommendations made by 4 dental experts for the treatment of a fractured tooth. METHOD AND MATERIALS: A case presentation was given to 4 specialists, who were asked to independently develop and explain their personal favorite treatment strategy, based on the best available external evidence and their clinical expertise. The entire case was then reviewed by an expert in evidence-based medicine and discussed with the first author. RESULTS: Each of the 4 experts relied on different articles in justifying their clinical decisions. The minimal overlap in the literature they cited largely explains the different treatment suggestions: While the endodontist preferred a metal post-and-core and a porcelain-fused-to-metal (PFM) crown, both the operative dentist and the prosthodontist opted for a glass-fiber post/fiber-reinforced resin composite post. The perio-prosthodontist recommended a PFM crown with either a direct or indirect post and core. The citation analysis revealed that little high-quality information is available about what would be the best therapy for horizontal fractures of root-canal-treated anterior teeth. CONCLUSIONS: This article illustrates that, although it is now common practice in dentistry to base clinical decision making on external evidence from the literature, search strategies and the resulting clinical recommendations still vary greatly. [ABSTRACT FROM AUTHOR]

PURPOSE: The aim of this clinical 2-year follow-up study was to compare the postoperative sensitivity of abutment teeth restored with full coverage restorations retained with either conventional glass-ionomer cement or a new adhesive resin cement containing 4-methacrylolyloxyethyl trimellitate anhydride (4-META). MATERIALS AND METHODS: Sixty patients received 120 full-coverage restorations on vital abutment teeth, cemented with either a glass-ionomer cement (Ketac-Cem) or a new adhesive resin cement (Chemiace II). A randomized split-mouth design and a patient double-blind data acquisition protocol were used. The teeth were examined before cementation, after 1 week, and after 6, 12, and 24 months. RESULTS: With regard to postcementation sensitivity, a low incidence was observed for both groups. With the adhesive resin cement, little postoperative hypersensitivity was observed after 1 week (13.3%), 6 months (5.9%), 12 months (2.1%), and 24 months (none); results were similar with the conventional glass-ionomer cement Ketac-Cem after 1 week (5.9%), 6 months (5.9%), 12 months (6.4%), and 24 months (none). After 6 months, 2 teeth of the Chemiace II group showed no sensitivity. Endodontic treatment was carried out for these 2 abutment teeth. After 24 months, no cases of postoperative hypersensitivity were recorded for either group. CONCLUSION: In this study, the incidence of postoperative hypersensitivity after cementation of full-crown restorations with a conventional glass-ionomer cement and a new adhesive resin cement was similar. [ABSTRACT FROM AUTHOR]

PURPOSE: To review the influence of prosthodontic and dental implant treatment on patient satisfaction and oral health-related quality of life (OHQOL) based on a systematic search of the literature. MATERIALS AND METHODS: A systematic literature search was carried out for articles published between 1960 and February 2003. Details of the search process and results were reported in Part 1 of the study (Int J Prosthodont2004;17:83-93). The included studies were categorized and evaluated according to their level of evidence, following the guidelines of the Agency for Health Care Policy and Research. The characteristics and content of the studies were analyzed and tabulated. RESULTS: Among the 114 included studies, there were 76 publications reaching evidence level III. The results showed that the effects of compromised oral health are not limited to traditional clinical aspects, but can considerably affect patients in various activities of daily life. Twenty-four of the 38 investigations with evidence levels I and II dealt with implant stabilization of complete mandibular prostheses, comparing implant prostheses to conventional complete dentures. Fully edentulous patients experience negative impacts on OHQOL from their condition. They benefit significantly from the use of dental implants to support mandibular prostheses. However, support by more than 2 implants does not appear to further significantly increase patient satisfaction and OHQOL. CONCLUSIONS: To date, research in the field of patient-based outcomes has concentrated on dental implant treatment for the edentulous patient. Other prosthetic treatments such as single crowns, fixed and removable partial dentures, or further treatment concepts (eg, the shortened dental arch concept) are not well represented. The use of patient-centered outcome measures can help to find an individual, patient-oriented prosthetic solution. [ABSTRACT FROM AUTHOR]

PURPOSE: This study systematically searched the dental literature to identify and classify articles on the influence of prosthodontic and dental implant treatment on patient satisfaction and oral health-related quality of life according to their level of evidence. MATERIALS AND METHODS: A literature search was carried out for articles published between 1960 and February 2003 using an electronic key word search complemented by hand searching. The retrieved articles were subjected to inclusion and exclusion criteria. Only experimental studies were included; articles that did not focus on the effect of therapy on the patient were excluded from further processing. The levels of evidence of the articles were classified following the guidelines of the US Agency for Health Care Policy and Research. RESULTS: A total of 207 publications were identified, of which 114 reports investigating 24,863 patients met the inclusion criteria. Data from the studies were analyzed using SPSS 9.0. Two thirds of the publications showed a low evidence level of III; most were conducted in patients who were edentulous or restored with complete dentures (59% of all studies). Mostly, nonstandardized, custom-made questionnaires (80%) were used. On average, 9 (SD 4.2) outcome variables were used within each trial, but clinical criteria were more often used than psychosocial criteria. The most frequently used questions concerned 'chewing function' (86%), esthetics (77%), speech (68%), and general satisfaction (67%). Validated instruments, such as the Oral Health Impact Profile, were increasingly used in recent studies, which were also methodically more sufficient. CONCLUSION: Few studies with high levels of evidence were found. Research in this field is still in a phase of development. [ABSTRACT FROM AUTHOR]

PURPOSE: The purpose of this study was to compare clinicians' ratings of the state of oral tissues and their satisfaction with treatment to edentulous patients' ratings of treatment success after provision of mandibular implant overdentures or conventional dentures. MATERIALS AND METHODS: Sixty subjects randomly received either mandibular overdentures retained by two implants (n = 30) or new conventional mandibular complete dentures (n = 30). All were given new conventional maxillary dentures. Baseline measures included clinical evaluation of the oral soft and hard tissues. Patients rated their general satisfaction before and after treatment, as well as their satisfaction with stability, speech, and esthetics on visual analogue scales. The treating prosthodontist rated the dentures for the same categories. Patient and clinician ratings were compared using correlations, t tests, and linear regression. RESULTS: None of the clinical variables were significantly correlated with patient satisfaction before or after treatment. The prosthodontist rated mandibular implant overdentures significantly better than conventional dentures regarding general satisfaction, stability, speech, and esthetics. Implant overdentures were also easier to fabricate (P < .0001). The prosthodontists' scores were not significantly correlated with patient scores for any question. CONCLUSION: Clinicians' assessments of the quality of denture-supporting tissues are poor predictors of patient satisfaction with mandibular implant or conventional prostheses. Prosthodontists and patients both rate mandibular implant overdentures as significantly superior to conventional dentures, but patients and clinicians do not usually agree when evaluating individual prostheses. [ABSTRACT FROM AUTHOR]

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 (Bi OS-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 Bi OS-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 Bi OS-Q is a reliable and valid instrument for the assessment of patient-based process-related quality of care in oral surgery. [ABSTRACT FROM AUTHOR]

The aim of this randomized controlled clinical trial was to evaluate over a 5-year period, the clinical outcome of shrinkage-free ZrSiO4-ceramic (KaVo Everest HPC®) full coverage crowns on posterior teeth in comparison with conventional gold crowns that served as the control. This study reports results of a 5-year study protocol up to 24 months. Patients totalling 224 were randomly divided into two treatment groups. Of these, 123 patients were restored with 123 Everest HPC® crowns, fabricated by the Kavo Everest computer-aided manufacturing (CAM) procedure and 101 patients received 101 gold crowns, but two were excluded from analysis. All crowns were conventionally cemented with glass–ionomer cement. After an observation period of 6, 12 and 24 months, the prospective survival rates (Kaplan–Meier) for the KaVo Everest HPC® crowns were 97·9%, 95·1% and 89·8% and for the gold crowns 100%, 94·8% and 92·7%, respectively. There were no significant differences between the two groups ( P = 0·2). The 1-year failure rates were 4·9% for the KaVo Everest HPC® crowns and 5·2% for the gold crowns. The 1-year cumulative risks for loss of vitality, secondary caries, fractures, loss of crown and extraction of abutment of the analyzed abutments (88) were 8·9%, 0%, 0%, 1·1% and 1·1%, respectively, for the gold crowns and 2·8%, 0%, 4·7%, 0% and 0·9%, respectively, for the ceramic crowns (107 analyzed abutments). No perfect marginal fit was shown by 49·5% of the evaluated ceramic crowns and 26·1% of the gold crowns. Only 1·9% of the KaVo Everest HPC® crowns had a marginal crevice. In conclusion, Everest HPC® crowns with an adequate occlusal tooth reduction of >1·5 mm are suitable for posterior restorations, but the marginal fit shows a potential for improvement. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To confirm the clinical applicability of a novel ZrSiO4 (zircon) based shrinkage-free ceramic material, the flexural strength, fracture toughness and chemical solubility were tested. In addition, the fracture load of full crowns made from this material was tested after cyclic thermomechanical loading. Methods: Flexural strength of 12 specimens was measured using a biaxial bending test. Fracture toughness was measured using 10 slotted box shaped specimens. The specimens were fractured using a universal testing machine; fracture loads were recorded. A chemical solubility test was performed in accordance with ISO norm 6872. Additionally, 32 ZrSiO4 all-ceramic crowns were fabricated on extracted caries-free human molars. Sixteen Empress 2 and 16 PFM crowns served as a reference control. After artificial aging of 1.2 million cycles in the chewing simulator, the survival rate of the crowns was determined. The fracture load of all surviving specimens was obtained by loading the crowns until fracture in a universal testing machine. Results: A flexural strength of 328MPa was found. The fracture toughness of the ZrSiO4 ceramic was 5.16MPam0.5. The chemical solubility amounted to 7.2μg/cm2. All specimens survived the chewing simulation (survival rate: 100%); no crowns had to be re-cemented. A mean fracture strength of 1790N was found for Everest HPC for Empress 2 crowns, 1715N for Empress 2 crowns and 2416N for PFM crowns. Fracture loads of PFM crowns were significantly higher than for Empress 2 crowns (P =0.032) as well as ZrSiO4-crowns (P =0.007). There was no significant difference between ZrSiO4-crowns and Empress 2 crowns (P =0.743). Significance: At the present stage, Everest HPC can be recommended for the fabrication of single crowns as an alternative to conventional PFM and other all-ceramic crowns, because its fracture strength exceeds average masticatory forces in the posterior region. [Copyright &y& Elsevier]

The aim of this in vitro study was to evaluate the fracture load and marginal accuracy of crowns made from a shrinkage-free ZrSiO4 ceramic cemented with glass–ionomer or composite cement after chewing simulation. Thirty-two human mandibular molars were randomly divided into two groups. All teeth were prepared for and restored with shrinkage-free ZrSiO4 ceramic crowns (Everest HPC®, KaVo). The crowns of group A ( N = 16) were luted to the teeth using KetacCem® and group B ( N = 16) were adhesively cemented using Panavia®21EX. Measurements of the marginal accuracy before and after cementation were made using replicas and an image analysis system. All specimens were exposed to 1·2 million cycles of thermo-mechanical fatigue in a chewing simulator. Surviving specimens were subsequently loaded until fracture in a static testing device. Fracture loads (N) were recorded. All specimens survived chewing simulation. The mean fracture loads (±s.d.) were Group A, 1622 N (±433); group B, 1957 N (±806). There was no significant difference between the two groups ( P > 0·05). The marginal gap values before cementation were (mean ± s.d.): Group A, 32·7 μm (±6·8); group B, 33·0 μm (±6·7).The mean marginal gap values after cementation were (±s.d.): Group A, 44·6 μm (±6·7); group B, 46·6 μm (±7·7). The marginal openings were significantly higher after cementation for both groups ( P < 0·05). All test groups demonstrated fracture load and marginal accuracy values within the range of clinical acceptability. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

It is unclear whether mandibular implant overdentures improve the nutritional state of edentulous patients better than conventional dentures. In a randomized clinical trial, we tested for post-treatment differences in nutritional status between patients with mandibular two-implant retained overdentures and those with conventional complete dentures. Edentulous subjects (ages 65- 75 yrs) received two-implant mandibular overdentures (IOD, n = 30) or conventional dentures (CD, n = 30). Measures of nutritional state were gathered before and 6 mos after treatment. Significant improvements in anthropometric parameters were detected in the IOD but not in the CD group, for percent body fat (p = 0.011) and skin-fold thickness at the biceps, subscapularis, and abdomen (p < 0.05), with significant decreases in waist circumference (p < 0.0001) and waist-hip ratio (p = 0.001). Significant increases were seen in concentrations of serum albumin (p = 0.015), hemoglobin (p = 0.01), and B12 (p = 0.01). No significant betweengroup differences were found. These results suggest that low-cost IOD treatment may improve the nutritional state of edentulous people. [ABSTRACT FROM AUTHOR]