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Background This student-centred prospective cohort study evaluated the impact of multimodal teaching methods on student performance in the theoretical domain of dental studies. Methods Dental students answered anonymous questionnaires indicating their preferences and opinions three times over three consecutive academic years. Data collected included gender, course, year of study and most frequent and preferred learning modality. Survey responses from Google Forms were analysed with SPSS 20.0 software (IBM Company, Chicago, IL, USA). Scale responses were tested with the Mann-Whitney U test against gender, program and year of study. Grades obtained from structured examinations held in the third academic year were analysed using the Wilcoxon Signed Rank Test according to the teaching method employed. The level of statistical significance was set at p 80%) throughout the study. Acceptance of online modalities increased over time (Kruskal-Wallis test, p =

Aim and objective: To assess the self-reported impact of coronavirus disease-2019 (COVID-19) pandemic on the different members of the dental team in public, private, and academic sectors in Malta. Materials and methods: An anonymous online questionnaire on self-reported work and lifestyle changes was designed and administered. Since data were classified as categorical ranks, nonparametric tests were used to compare variables among the different dental team members. Statistical analysis: Multiple-choice question and checklist responses were treated as qualitative variables and were compared among groups using the Chi-square test. Questionnaire data obtained from the Likert scale, in turn, were treated as categorical ranks and therefore assessed using the Kruskal–Wallis test. Results from all variables obtained from the questionnaire were compared among the different dental team members. A p, peer-reviewed

Background: Despite increasing prevalence, age-specifc risk predictive models for erosive tooth wear in preschoolage children have not been developed. Identifcation of at-risk groups and the timely introduction of behavioural change or treatment will stop the progression of erosive wear in the permanent dentition. This study aimed to identify age-specifc risk factors for erosive wear. Distinct risk prediction models for 3-year-old and 5-year-old children were developed. Methods: A prospective cohort study included school-based clinical examinations and parent administered questionnaires for consented 3 and 5-year-old healthy children. Calibrated examiners measured the following health parameters under standardised conditions: erosion, using the Basic Erosive Wear Examination Index (BEWE), caries using the International Caries Detection and Assessment System (ICDAS), plaque and calculus according to the British Association for the Study of Community Dentistry (BASCD) scores, dental traumatic injuries and soft tissue lesions, salivary testing and BMI. Other health conditions were collected via a parent-administered questionnaire that explored oral- and general-health. Non parametric tests were utilised to explore the temporal relation of erosion with, demographic factors, oral hygiene habits, general health and dietary habits. Variables showing signifcance with a diference in BEWE cumulative score over time were utilised to develop two risk prediction models. The models were evaluated by Receiver Operating Characteristics analysis. Results: Risk factors for the 3-year-old cohort (N=336) included erosive wear (χ2 (1, 92)=12.829, p, peer-reviewed

BACKGROUND Little is known on the effect of varying implant diameters, especially with mini implants (ie, less than 3 mm in diameter), on oral health-related quality of life (OHrQoL). PURPOSE To compare OHrQoL and satisfaction in patients with mandibular overdentures immediately retained by either two conventional or two mini-implants. MATERIALS AND METHODS Edentulous patients receiving immediately loaded overdentures retained by Locators on either two conventional diameter (4.1 mm) or two mini (2.9 mm or less) implants were selected based on available buccal-lingual ridge width in the intraforaminal area. Two questionnaires were used (Oral Health Impact Profile-14 [OHIP-14]; and Denture Satisfaction Questionnaire [DSQ]) to determine OHrQoL and overall denture satisfaction. Questionnaires were filled out at six different time points up to a 1-year follow-up. Mann-Whitney U test was used for group comparisons. Friedman and Wilcoxon tests were used to identify changes within group along the time points. Correlation between OHIP-14 and DSQ was assessed with Spearman test. RESULTS A total of 48 patients were analyzed and equally distributed to each group. The conventional group presented a significantly smaller change of OHIP functional score from the baseline to the first week of follow-up after surgery (P = .017). In addition, total DSQ scores were significantly higher for the conventional group at 12 weeks (P = .022) and there was a significant difference between groups in satisfaction with mandibular prosthesis at 24 weeks (P = .034). Correlation between OHIP-14 and DSQ was not significant (P > .05). Individual results of each group (ie, within group analysis) over all assessed time points revealed a significant OHrQoL (P = .001 for conventional, P = .006 for mini-implants) and satisfaction (P < .001 for both groups) improvement in both groups. CONCLUSION Mandibular overdentures retained by two conventional or mini-implants lead to a significant and comparable improvements in OHrQoL and satisfaction over a 1-year follow-up.

Background Little is known about differences between mini-implants and conventional immediately loaded implants for overdentures. Objectives To compare clinical outcomes using two immediately loaded conventional or mini-implants for mandibular overdentures. Materials and methods Edentulous patients receiving either conventional (4.1 mm) or mini-implants (2.9 mm or less), based on available bone width were analyzed. All implants were immediately loaded with mandibular overdentures installed using locator attachments. Digital periapical radiographs for measuring marginal bone loss and clinical outcomes (ie, periodontal probing, plaque, and bleeding indices) were assessed at 1, 3, 6, and 12-month follow-up periods. Results Fifty patients (25 receiving conventional implants-12 females, mean age of 65.3 ± 7.3 years; and 25 receiving mini-implants-11 females, mean age of 66.8 ± 8.1 years) was analyzed. Peak insertion torque (P = .001) and bone loss (P = .02), as well as change in plaque (P = .02) and bleeding (P = .04) indices at 12 months differed significantly between groups. Furthermore, linear regression revealed the height of the locator as a risk factor for bone loss (P = .038). Conclusions The present findings suggest that two mini-implants are significantly more susceptible to bone loss after immediate loading, for which the height of locator might be considered a risk factor.

To compare patient-reported outcomes among balanced, lingualized, and monoplane occlusal schemes in relation to edentulous jaw classifications.This randomized controlled trial was conducted in edentulous patients receiving new complete dentures using balanced, lingualized, or monoplane occlusal schemes. Demographic variables, bone ridge quantity, number of adjustments required after denture insertion, and satisfaction and quality of life (QoL) indices (ie, the Denture Satisfaction Questionnaire [DSQ] and General Oral Health Assessment Index [GOHAI], respectively) were assessed at 1, 2, 4, 8, 12, and 52 weeks. Within-group comparisons at different time points were carried out with Brunner-Langer nonparametric analysis. Furthermore, Kruskal-Wallis test was used to compare distributions of ordinal or continuous variables among the three occlusal scheme groups.A total of 60 subjects (mean age: 68.1 ± 11.1 years; 56.7% men and 43.3% women) were analyzed. All three groups presented significant improvements in DSQ and GOHAI scores between denture insertion and the 1-year follow-up appointment (P.001). There were no statistical differences in the distribution of demographic variables (eg, age, gender, years edentulous, and age of existing dentures) or of bone ridge classifications among the three groups. Similarly, there were no statistical differences in ridge classifications or in the DSQ and GOHAI values among the three groups for both the maxilla and mandible (P.05) over the 52-week follow-up. On the other hand, the number of cases requiring denture adjustments was significantly lower in the lingualized scheme group, as compared to the two other groups (P = .034).Within the limitations of this study, the present findings suggest that the occlusal scheme for posterior teeth did not influence patient-reported subjective outcomes. However, the lingualized occlusal scheme required significantly fewer adjustments.

Purpose To compare the marginal fit and internal surface roughness of CAD/CAM zirconia copings milled with 3- and 5-axis milling devices. Materials and methods Forty titanium implant stock abutments (4.8 mm in diameter, 4 mm in height) screwed to dental implants (4.1 mm in diameter) embedded in resin were considered phantoms and included in this in vitro study. All 40 phantoms were scanned with the same intraoral scanner, from which images of the virtual wax-up of zirconia copings were obtained and exported as standard tessellation language (STL) files. From each resulting STL file, two copings were milled: one using a 3-axis milling device, and the other using a 5-axis milling device. After milling, zirconia copings underwent high-speed sintering before being analyzed for marginal fit (ie, marginal gap measurement), and internal surface roughness was assessed with a scanning electron microscope (SEM). Statistical comparisons between groups were assessed with Mann-Whitney test. Results Median marginal gap values were 34.80 μm (95% CI: 0.00 to 173.98) for the 5-axis milling device group and 141.97 μm (95% CI: 82.13 to 163.46) for the 3-axis milling device group. A statistically significant difference in marginal gap was found between both milling device groups (P = .039). In addition, qualitative SEM analysis indicated higher internal surface roughness for the 3-axis milling device group. Conclusion Within the limitations of this study, the present findings suggest that 5-axis milling devices outperform 3-axis milling devices for milling CAD/CAM zirconia copings from intraoral scans of implant stock abutments.

OBJECTIVE: To compare the influence of coronavirus disease 2019 (COVID-19) pandemic on the student reported outcomes among dental students reading/studying different courses offered in the only dental school in Malta. MATERIALS AND METHODS: An anonymous questionnaire consisting of 13 closed-ended and open-ended questions was sent to all students (n = 97) at the Faculty of Dental Surgery at the University of Malta. Emergent themes from open-ended questions were identified and tallied. Since data were classified as categorical ranks, nonparametric tests were used to compare variables among the different courses, years of study, preclinical/clinical students, and gender categories. RESULTS: Dental technology students were significantly less stressed about contracting COVID-19 (P = 0.005) and regarding lack of preparation due to inability to physically go to the library (P = 0.019). Female students reported significantly more anxiety for the following factors: "feeling anxious all the time" (P = 0.033), "worried about contracting COVID-19'" (P = 0.012), "worried that a family member may contract COVID-19'" (P = 0.048), "more anxious about exams this year because of the challenges we are facing" (P = 0.029), and "concern about losing manual dexterity skills" (P = 0.038). Qualitative data gathered show considerable stress reported by students regarding changes in examination processes and formats and lack of timely communication. CONCLUSION: Students were greatly affected by the COVID-19 pandemic and this caused fear of losing their manual dexterity skills, anxiety related to its consequences on their long-term plans, and anxiety related to the examinations. Dental schools in turn should adapt rapidly and customize changes that are specific to the individual student cohort and their stage of training.

Background Fractures in mandibular implant-retained overdentures are a common complication. However, little is known on the related risk factors and outcome differences when using two conventional diameter or two mini implants. Purpose The purpose of this study was first, to evaluate the required maintenance and complications with the overdentures and second, to analyze risk factors for overdenture fractures. Materials and methods This cohort study was conducted in edentulous patients with complete dentures. Patients received either two conventional (4.1 mm in diameter) and two mini (2.9 mm or less in diameter) implants, based on available buccal-lingual ridge width. All implants were immediately loaded with mandibular overdentures retained by Locator abutments. The number of prosthodontic after care visits (scheduled and unscheduled) were recorded and compared between the two implant diameter groups. Fracture occurrence was the primary outcome variable. Risk estimates were presented as odds ratios (ORs) with 95% confidence intervals (CIs). The ORs were adjusted for potential clinical confounders (ie, necessity of relining, matrix recapture, abutment loosening, implant diameter, height of the Locator, and retention force). Results A total of 50 edentulous patients were analyzed. One conventional diameter and three mini implants failed within a 1-year follow-up period. Prosthetic maintenance requirements for overdentures on both implant diameter groups were comparable. A total of 12 overdenture fractures (four in the mini implant group and eight in the conventional diameter group) occurred. Adjusted OR (AOR) analysis showed a significant association between abutment loosening and overdenture fracture (AOR = 12.00, 95% CI = 1.11-129.45; P = .041). Conclusion Within the limitations of this study, the present findings suggest that implant diameter does not affect number of prosthetic maintenance and complications, and that abutment loosening is a risk factor for overdenture fractures, regardless of the implant diameter used.

To describe a method of digitally customizing 3D-printed face mask designs using 3D face scans and free software.The procedure of creating customized face masks initially involved importing and aligning STL files of face scans and mask components in free CAD software. The imported mask described in this article is composed of three different STL files (body, filter structure, and grid). The body of the mask was then edited to fit precisely into the face scan STL by using the software's offset tool, followed by adjustments and smoothening of the surfaces of the edges. The resulting customized body of the mask plus the filter and grid STL files were exported and 3D printed with polylactic acid (PLA) filament using a fused deposition modeling (FDM) 3D printer. For the purposes of comparison, a conventional 3D-printed mask (from the original STL files, without being customized for the face scan) was also 3D printed from the original STL files. Both face masks were tested on the same two volunteers.The customized 3D-printed face mask presented a higher adaptation compared with the conventional face mask. The area of facial contact matched the one digitally designed in the software. The 3D-printed grid could clip exactly into the filter, which in turn could be precisely screwed into the body of the face mask.Within the limitations of this technical report, the present findings suggest that customized 3D-printed face masks with enhanced adaptation can be digitally designed using face scans and free CAD software.

Statement of problem The digital waxing of single crowns can be affected by the quality of intraoral scans and use of computer-aided design (CAD) software programs. However, clinical outcomes of the resulting crowns are also affected by computer-aided manufacturing (CAM) methodologies. Studies on the effect of different levels of expertise on digital waxing are lacking. Purpose The purpose of this in vitro study was to assess the impact of different levels of expertise on the reliability and reproducibility of margin outlining during digital waxing. Material and methods Thirty analogs of implant stock abutments (O4.8×4 mm) were embedded into resin blocks. To simulate different clinical situations, abutments were divided into 3 groups: 10 abutments (group GOS) received artificial gingiva and were scanned with an open system intraoral scanner, while 10 abutments with (group GIS) and 10 abutments without artificial gingiva (group IS) were scanned with an intraoral scanner within an integrated CAD-CAM system. All resulting standard tessellation language (STL) files were used by 2 different observers (an experienced CAD professional and a clinician with basic CAD knowledge) to digitally design a left mandibular central incisor in the same software program. All resulting digital crown designs were exported to STL files to assess crown margin accuracy at the coupling interface by superimposition with the control STL file of the scan body designed for the same abutment by the manufacturer. For this purpose, a CAD software program was used to automatically calculate median, minimum, and maximum deviations of margins in millimeters. Statistically significant pairwise differences among groups and between observers were assessed with the Wilcoxon signed-rank test (α=.05). Results For the CAD professional, median deviations between designed crown STL files and the control STL of the scan body were 0.08 mm (range: 0.04 to 0.15) for group GOS; 0.10 mm (range: 0.06 to 0.18) for group GIS; and 0.05 mm (range: 0.03 to 0.08) for group IS. For the clinician, median deviations were 0.08 mm (range: 0.04 to 0.12) for group GOS; 0.11 mm (range: 0.07 to 0.17) for group GIS; and 0.05 mm (range: 0.04 to 0.11) for group IS. There were no significant differences between observers (P>.05). However, statistically significant differences were found between group IS and the other 2 groups (P=.001) but not between groups GOS and GIS (P>.05). Conclusions The present findings suggest that a digital wax pattern made with a dental CAD software program is not affected by varying levels of expertise but might be affected by subgingival margins.

Background The economic burden for patients seeking treatment with implant-supported prostheses has not been given adequate attention. Purpose To document long-term costs from a prospective trial on edentulous patients treated with mandibular implant-supported overdentures and 2 loading protocols. Materials and methods The direct clinical and time costs for 35 patients receiving an immediate-loading protocol (ILP) and 40 patients with a conventional-loading protocol, over 14 years of observation, were analyzed in 2016 Canadian dollars as a base year. Quality of life (QoL) for the ILP was measured using the OHIP-20 questionnaire. Results The ILP was associated with higher complication costs ($870.77 ± 692.24 vs $85.73 ± 133.14) with resultant higher maintenance costs ($1746.37 ± 892.68 vs $853.04 ± 276.21) (P

Purpose To investigate the surface microstructural changes and the release of ions from metal alloys used in removable dental prostheses and the potential effects of acidic reflux found in patients suffering from gastroesophageal reflux disease (GERD). Materials and Methods Thirty-seven (37) patients were recruited. Data were gathered through a questionnaire and clinical examination. Samples of metal alloy from the dentures and patient's saliva were collected. GERD was confirmed using the GerdQ questionnaire. Denture samples were characterized using scanning electron microscopy (SEM) and energy dispersive spectroscopy (EDS), while salivary samples were tested for trace metal ions using inductively coupled plasma (ICP). Results Characterization of denture samples revealed the presence of nickel, cobalt, and chromium. Nickel-chromium exhibited an etched surface appearance, while cobalt-chromium exhibited no noticeable surface microstructural changes. Higher mean salivary levels of chromium and cobalt in patients wearing any metal alloy-based denture and of chromium and nickel in patients wearing Ni-Cr prostheses were found to be significant. No differences were found in salivary metal ion levels of patients suffering from GERD. Conclusions Nickel-chromium alloy is prone to acid etching in the oral cavity, while cobalt-chromium alloy appears to be more resistant. Cobalt, chromium, and nickel are leached in saliva of patients using cast removable prostheses. The impact of gastric acid on metal ion release from dental metal alloys deserves further investigations. Clinical Significance This preliminary study suggests that metal-based removable prostheses leach trace metal ions in saliva. Nickel-chromium-based dentures exhibit an etched appearance unrelated to GERD.

Introduction Many societies have observed a steady increase of many older adults living longer due to advancements in health and standard of living. The dental team requires specialised training in gerodontology to better prepare for the future needs of the elderly patients. It is the aim of this study to report the undergraduate students' activities and perspectives on their work experience in a geriatric residence. Materials and methods An anonymous online questionnaire on the theoretical and practical aspects of training was sent to students in dentistry and dental hygiene (DH) undergraduate courses. Students were also invited to discuss their experiences. Data of clinical treatment performed by the students were collected. The number of clinical hours of student exposure to patients was measured. Results Completion of the questionnaire was high (90%). Both DH and dentistry students have in excess of 100 hours/y of clinical practice. Overall students rate their experience as a positive one that enriches patients' well-being. However they identify barriers to oral health and experience challenges related to their clinical work and level of competence (Kruskal-Wallis Test P Conclusions study participants were strongly motivated towards the management of frail older adults and cognisant of the barriers and constraints of achieving a reasonable level of oral health. Gerodontology programmes should be adaptable in order to create the appropriate environment and address socio-emotional challenges experienced by students.

Purpose: The objective of this study was to determine the oral health–related quality of life in state institutionalized older adults and correlate it to their oral health status. Materials and Methods: A group of 278 older adults (average age: 83.5 ± 6.5 years) from 9 state institutions in Malta was randomly selected. Participants were clinically examined and answered three questionnaires (Oral Health Impact Profile [OHIP-14], Geriatric Oral Health Assessment Index [GOHAI], and Denture Satisfaction). Results: Oral health–related quality of life measurements were significantly associated with pocket depth (OHIP-14 and GOHAI, P < .05); decayed, missing, or filled teeth (OHIP-14 and GOHAI, P < .05); carious teeth (OHIP-14 and GOHAI, P < .05); number of missing teeth (OHIP-14 and GOHAI, P < .05); and maxillary and mandibular dentures (OHIP-14 and GOHAI, P < .0001). Denture satisfaction was associated with denture age (P = .010) and types of prostheses (P < .05). Conclusion: Institutionalized older adults have high levels of oral disease. Although oral health–related quality of life is generally good, those participants with a poorer oral health–related quality of life had significant associations with poor oral health. However, the extent varies with the individual’s perception of good health.

A research study cannot commence without a proposal. This paper highlights the preparatory steps and details the individual sections of a research proposal. The importance of the proposal toward the research project and the eventual writing of a thesis or dissertation is also emphasised. The implications of using human subjects are also discussed., peer-reviewed

Purpose: Titanium dental implants have a high success rate; however, there are instances when a modified surface may be desirable. The aim of this article was to systematically review the different types of implant coatings that have been studied clinically, in vivo and in vitro, and the coating techniques being implemented. Materials and Methods: The literature was searched electronically and manually through The Cochrane Library, Medline, and PubMed databases to identify articles studying dental implant surfaces and coating techniques. The database search strategy revealed 320 articles, of which 52 articles were considered eligible—40 in relation to implant coatings and 12 to the coating technique. An additional 30 articles were retrieved by hand search. Results: Several materials were identified as possible candidates for dental implant coatings; these include carbon, bisphosphonates, bone stimulating factors, bioactive glass and bioactive ceramics, fluoride, hydroxyapatite (HA) and calcium phosphate, and titanium/titanium nitride. HA coatings still remain the most biocompatible coatings even though the more innovative bioglass suggests promising results. The most common coating techniques are plasma spraying and hydrocoating. More recent techniques such as the nanoscale technology are also discussed. Conclusions: Several implant coatings have been proposed, and some appear to give better clinical results and improved properties than others. Clinical trials are still required to provide compelling evidence-based results for their long-term successful outcomes.

In spite of its recent emergence over the past 30 years, oral health-related quality of life (OHRQoL) has important impact on the clinical practice of dentistry and dental research. OHRQoL is a multidimensional paradigm that involves a subjective evaluation of the individual’s oral health, functional well-being, emotional well-being, expectations and satisfaction with care, and sense of self. It has been beneficial in relation to clinical research and health policies regulation. OHRQoL is an integral part of general health and well-being, World Health Organization (WHO) had considered Oral health related quality of life as an important section of the Global Oral Health Program (2003)., peer-reviewed

To determine the influence of erosive tooth wear in the primary dentition on parental perceptions of oral health. This cross-sectional study involved a standardised clinical examination of 775 preschool aged children and a parent-administered questionnaire. Erosive tooth wear was measured using the Basic Erosive Wear Examination Index. 71% and 81% of 3 (n = 256) and 5 year-old children (n = 337) respectively exhibited signs of erosive tooth wear. Prevalence was influenced by region (p = 0.049) (p = 0.007) in both age cohorts (χ2, p

1. Abstract 1.1.Objective:The study evaluated the impact of orthodontic treatment on the quality of life in two patient groups with Class II Division 1 malocclusion. 1.2.Materials and methods:98 patients were assigned to Fixed or Twin-block appliance treatment groups. Patients’ treatment needs were categorized with IOTN. The OHRQoL was assessed by OHIP-14 during different periods of treatment. 1.3.Results:Both groups showed comparable improvements in OHRQoL as the treatment progressed (Anova test p=0.05). Similar results were observed when OHRQoL was analyzed at IOTN subgroup level (Bonferroni Test p

A person’s quality of life (QoL) can be affected with poor oral health.1 Measurement of oral health related quality of life (OHRQoL) helps professionals clarify the role of oral health status on the overall quality of life.2 It also assists in clinical decisions taking into account patients’ needs and serves as an effective communication mechanism with policy makers.3,4 Consequently modern healthcare systems should address patient’s health complaints, taking into consideration the impact of patients’ illness on quality of life.5 Modern dental procedures endeavour to improve patients’ quality of life. Orthodontic treatment based on purely clinical and functional perceptions may not fully address patients’ concerns. Patients and their parents have been shown to share similar treatment expectations, although parents reported more realistic prospects. Ethnicity significantly influences expectations for orthodontic treatment, and this may relate to differences in the patients’ and parents’ assessment of the clinical outcome. In the previous paper (part 1), the impact of fixed and Twin block appliances on. OHRQoL was assessed, both groups demonstrated significant improvement toward the end of the treatment. However, in the current paper the economic analysis for Twin block and fixed appliances was performed. Economic evaluation is widely used and well accepted in the appraisal of health care. However in the field of orthodontics, there have been relatively few economic analyses performed., peer-reviewed

Introduction: Evaluation of the effectiveness of a well-targeted educational campaign specially designed toward the improvement of oral health and maintenance of removable orthodontic appliances should be considered during an orthodontic treatment. Objectives: The objective of this study was to assess the impact of the oral hygiene protocol on oral health through assessing plaque accumulation on the removable orthodontic appliance, to establish the impact of oral hygiene protocol on oral health through assessing the patients’ plaque accumulation on the tooth surface and gingival bleeding, and to evaluate the degree of halitosis between the intervention and control groups. Materials and Methods: The study involved 80 patients who were equally assigned to the intervention and control removable orthodontic treatment groups. Data were collected by means of questionnaires, soft-tissue examination, breath checker, and staining the appliance with methylene blue disclosing solution. Results: The plaque score of both groups at Review 2 emphasized a significant difference (P = 0.021), yet neither differences at baseline (P = 0.989) nor Review 1 (P = 0.786) were found. The odor score of both groups at Review 2 showed a significant difference (P = 0.012). All interventional patients and only 10% of the control group patients were aware of appliance removal during sport. There was no significant difference (P = 0.211) between the responses of patients concerning the cleaning method of the appliance. The patients showed a higher user rate of mouthwash, and they were more successful with respect to when it should be used. Conclusion: The effectiveness of an educational session has been demonstrated in some aspects of the research., peer-reviewed

The purpose of this literature review is to present the outcomes of clinical studies on immediate and early loading protocols, identify shortcomings, and suggest a number of questions that still require exploration. English language clinical studies, limited to peer-reviewed journals between 1975 and 2004, were reviewed to identify treatment outcomes with these loading protocols. The data were tabulated from studies reporting on patients treated with fixed and overdenture prostheses. The former included partially edentulous patients treated with single or multi-unit prostheses. Within the limitations of this review, it can be concluded that these treatment protocols are predictable in the anterior mandible, irrespective of implant type, surface topography, and prosthesis design (success rates 90%-100%). Limited evidence for the edentulous maxilla (success rates 90%-100%) and the partially edentulous patient (success rates 93%-100%) are available, underscoring the need for further research. Studies suggest that to achieve predictable results in extraction sites, implant placement should be restricted to sites without a history of periodontal involvement (success rates 61%-100%). A number of questions require further exploration. There is a need to thoroughly investigate clinical outcomes to measure the economic benefit of these protocols and the impact of treatment on a patient's quality of life. Furthermore, more accurate long-term studies reporting on treatment protocols for separate clinical situations are required to allow meaningful comparisons.

Purpose: Studies on the oral health status of institutionalized older adults are less prevalent than those of community-dwelling older adults, as institutionalized older adults tend to be frailer. Poor oral health in older adults has a negative impact on the quality of life and self-confidence of older people and potentially poses a financial burden on both the older adult and society in general. The objective of this study was to assess and compare the oral health status of state institutionalized older adults in Malta with that of their European counterparts. Materials and Methods: A total of 278 older adults with an average age of 83.6 ± 6.5 years from nine state institutions in Malta were randomly selected. Participants were clinically examined for caries, periodontal disease, oral mucosal lesions, and prosthetic status. Results: The oral health status of state institutionalized older adults was poor, with a very low routine dental attendance (29.3%) and, consequently, a high level of treatment need (44.4% of dentate individuals required extractions and 42.1% of dentate individuals required restorations). Only 2% of dentate individuals had healthy periodontal tissues with no clinical attachment loss over 4 mm. Edentulism among state institutionalized older adults stood at 41%. Conclusions: Institutionalized older adults from Malta have a poor oral health status comparable to institutionalized older adults from Europe in general, which poses fiscal and cultural challenges that need to be addressed by the dental community.

Purpose: The purpose of this study was to investigate the success outcomes of implants and prosthodontic treatment placed in patients with a previous history of hypothyroidism that was being controlled with medications. Materials and Methods: Twenty-seven female patients with a medically confirmed history of primary hypothyroid disease who were on replacement medications at the time of implant surgery were selected as the study group. They were matched with 29 control patients by age, gender, location (jaw and zone) of implants, type of prosthesis, and dental status of the opposing arch. Additional factors studied were medical history, medications, smoking habits, and bone quality and quantity. Results: There was no statistical difference in the number of implant failures between the two groups (p =.781). The hypothyroid patients had more soft tissue complications (p =.018) following stage 1 surgery. More bone loss around implants in the hypothyroid patients was recorded after year 1 of loading when compared with loss in their matched controls (p =.017). Conclusions: This study suggests that medically controlled hypothyroid female patients treated with dental implants are not at higher risk of implant failure when compared with matched controls, and that a history of controlled hypothyroidism does not appear to be a contraindication for implant therapy with endosseous implants.

Purpose: To show the reliability of the Maltese translations of OHIP-14, GOHAI, and the Denture Satisfaction Questionnaire, define the reliability of the responses, and determine the correlation between OHIP-14 and GOHAI. Materials and Methods: The items of the three questionnaires (OHIP-14, GOHAI, and Denture Satisfaction) were translated into Maltese and back into English to compare with the original version. Specific sampling of a population well versed in Maltese and English was carried out to obtain a sample of respondents for each questionnaire. Data were gathered through self-administered questionnaires: first administering the Maltese version and following with the English version 1 week later. Results: Participation rates were high (98%). Cronbach’s alpha for all three questionnaires was high (> 0.7), indicating satisfactory test-retest reliability of the instruments. Similarly, the Spearman correlation coefficients for both the English and Maltese versions of OHIP-14 and GOHAI were good (> 0.6). Conclusion: The Maltese versions of OHIP-14, GOHAI, and the Denture Satisfaction Questionnaire can be safely used as a valid alternative to the English versions in studies of patients who are limited in linguistic proficiency

The aim of this study was to report the short-term clinical- and patient-based results of an early loading protocol using two Fixture Original implants with a mandibular overdenture.Fifteen consecutively treated patients were enrolled in this study. Each patient received 2 implants; one patient received an additional implant during the observation period, yielding a total of 31 implants used in this study. All patients were treated with overdentures supported by a resilient ovoid bar mechanism. Clinically based outcomes were documented throughout the study, while patient-based outcomes were recorded at baseline and at the 1-year follow-up using the Denture Satisfaction and the Oral Health Impact Profile.Patients were followed for an average of 28.87 ± 5.04 months. The overall success rate was 100% for the implants and 93% for the original prosthetic treatment plan, since an overdenture was converted to a fixed prosthesis for one patient throughout follow-up. The mean bone loss measured during the first year of loading was 0.11 mm (standard deviation: 0.14 mm). Prosthetic maintenance events were mainly related to the acrylic superstructure. Patient-based treatment outcomes showed a statistically significant improvement with the prosthetic treatment and in their quality of life (Wilcoxon signed rank rest, P.05).This short-term longitudinal study suggests that Fixture Original implants can be loaded early using mandibular overdentures. Additionally, modified prosthetic and surgical protocols led to minimal postinsertion prosthodontic maintenance. The results underscore the effectiveness of the overdenture technique in rectifying patients' complaints with conventional mandibular prostheses.

The aims of this report are to present the patient-based outcomes and associated clinical costs of an immediate loading protocol for mandibular overdentures in edentulous patients.Two groups of patients were selected. Thirty-five consecutively treated patients received an immediate protocol, while 42 patients treated with a conventional protocol served as a historical control. Patient-based concerns for patients in the immediate group were measured at various stages of treatment with 2 questionnaires: the Denture Satisfaction Scale and the Oral Health Impact Profile. Direct clinical and time costs over a 1-year period were estimated and deflated to 2002 Canadian dollars. Salary rates by occupation, age, and gender were used to evaluate the patients' time costs. Treatment costs were compared between the 2 groups. Additionally, incremental cost-effectiveness ratios for various stages with the immediate protocol were calculated.Significant improvements posttreatment were observed with both the Denture Satisfaction Scale (Wilcoxon signed rank test, P.05) and the Oral Health Impact Profile (Friedman test, P.05). The immediate protocol was associated with higher maintenance costs, with resultant higher total costs (Mann-Whitney U test, P.05). No difference was observed in the time costs associated with the 2 protocols. Within-group analysis of costs at various stages of the immediate protocol suggested that treatment with implant-supported overdentures was more cost-effective than treatment with conventional dentures.This study suggests that implants in 1 jawbone lead to a substantial improvement in perceived oral health status. Furthermore, the immediate loading protocol was not cheaper than a conventional protocol.

The aim of this report is to present the implant and clinical outcomes of an immediate-loading protocol of TiUnite implants with mandibular overdentures in edentulous patients.Two groups of edentulous patients were selected. Thirty-five consecutively treated patients received 70 immediately loaded TiUnite implants and 69 Brånemark implants as backup (1 patient received 1 Brånemark implant). The control group was a historical cohort that comprised 42 patients who received 111 Brånemark implants. All overdentures were supported by a resilient bar mechanism. Implant and clinical outcomes, including maintenance events for the first year, were recorded.Implant success rates were in excess of 95% with both protocols. Immediately loaded implants had less bone loss than did implants loaded with the conventional protocol (Mann-Whitney U test; P = .001). Patients in the immediate-loading group required more prosthodontic maintenance, consisting of overdenture remakes and laboratory relining of prostheses (Chi-square test; P.05). Of note, 74% of patients in the immediate-loading group needed a reline to improve the denture seal around the bar housing (Chi-square test; P.05).The favorable implant and bone level outcomes with immediate loading attest to its biologic success. The prosthetic maintenance encountered in the immediate-loading group does not negate the clinical potential of the treatment but rather suggests that the protocol may benefit from modifications.

The study's aim was to report long-term costs in edentulous patients treated with mandibular implant-supported prostheses.Ninety patients were divided into four groups based on the type of implant prosthesis (fixed or overdenture) and treatment year. Records were obtained from dental charts, and an economic analysis from the patient's perspective was conducted. Clinical time associated with various procedures was measured and applied to the four groups. Salary rates by age, occupation, and gender were used to value patients' time. Direct clinical and time costs over 10 years were converted to 2002 Canadian dollars using the Consumer Price Index and discounted at a 3% rate. A sensitivity analysis at an equal salary rate was carried out to test the robustness of the time costs.Initial treatment and maintenance costs over the observation period were significantly higher for fixed compared to overdenture prostheses. A significant improvement in maintenance costs for the first patient group treated with fixed prostheses was observed over the follow-up period. Longer term (15 years) treatment costs for the initial two groups were significantly higher for the fixed group. The sensitivity analysis at an equal salary rate demonstrated the same trend: Time costs were significantly higher for the fixed groups.Long-term treatment costs indicated that the mandibular overdenture was a less expensive treatment compared to the fixed implant prosthesis.

The aim of this prospective study was to report long-term treatment outcomes (prosthetic and implant related) of edentulous patients treated with implant-supported fixed prostheses who participated in the first clinical implant study in North America.Forty-five patients were treated with Brånemark implants supporting a total of 47 fixed prostheses (42 mandibular and 5 maxillary) between 1979 and 1984. All patients were recalled regularly for comprehensive prospective clinical and radiographic assessments.Thirty-one patients (33 prostheses) attended a final recall visit in 2002; 71% of patients had been followed for 20 years (range 18 to 23 years), with overall prosthetic plan and implant outcome success rates of 84% and 87%, respectively. Mean marginal bone loss around the implants after the first year of loading was small (0.05 mm/year), with high individual variations. Poor oral hygiene, smoking history, and implant position appeared to be predictors of marginal bone loss. Prosthetic maintenance was ongoing and included fractured components and replacement of prostheses; the longevity of a fixed prosthesis for this group of patients was 8.39+/-5.30 years.This study confirmed the overall long-term treatment outcome success of patients treated with fixed prostheses supported by Brånemark implants. Successful osseointegration with a small mean bone loss was maintained as study patients aged, although prosthetic maintenance was required. The latter consideration should be discussed with all patients seeking such treatment.

Few long-term studies on overdentures report both implant and prosthodontic outcomes. The aim of this prospective study was to report long-term prosthodontic- and implant-related treatment outcomes of patients treated with design-specific implant-supported overdentures.Between 1982 and 1992, 45 consecutively treated patients received a total of 47 overdentures (42 mandibular and 5 maxillary) supported by Brånemark implants. Prospective clinical and radiographic data were collected over the observation period; this study presents the most recent treatment outcomes.Thirty patients (mean age 70 years) with 32 prostheses attended the final recall visit, with 67% of patients followed for 15.53 years (range 10 to 19 years). Six implants failed, and the prosthetic plan and implant cumulative survival rates were both in excess of 90%. Mean marginal bone loss around implants after the first year of loading was small (0.05 mm/year), although the individual variation was high. Linear regression analysis of bone loss indicated that gender, bicortical stabilization, bone quality, and healing time were predictors of bone loss for the first year of loading but not for the ensuing years. Prosthetic maintenance included fractured components, denture relining, and replacement of prostheses. On average, the longevity of overdenture prostheses was 12 years, and laboratory relining was necessary every 4 years.This study confirmed the long-term outcome success of patients treated with design-specific overdenture prostheses supported by Brånemark implants. However, prosthetic maintenance was required, a fact that should be discussed with patients prior to treatment.

Statement of the Problem. The clinical success of implant-supported fixed partial dentures has been documented. However, few studies have reported long-term results or any association between implant outcomes and host determinants. Purpose. This study reports on implant and prosthesis outcomes in a group of partially edentulous patients treated with Branemark implants in the posterior zones. It also examines factors described in the medical history that may influence implant survival. Material and Methods. The charts of patients treated with implants from 1983 and followed prospectively through December 2001 at the University of Toronto were reviewed. One hundred thirty partially edentulous patients treated with implant-supported restorations in the posterior zones (area distal to mental foramen) were selected. Implant and prosthesis treatment outcomes were recorded and analyzed through the Kaplan-Meier and Cox regression methods ( P Results. A total of 130 patients received 432 Branemark dental implants in 174 posterior edentulous spans. The mean age of the patients at the time of insertion of the implants was 50.97 ± 13.27 years. At 15 years, the overall implant and prosthesis survival rates were 91.6% and 89%, respectively. At 5 years, the survival rate of the wide-platform 5-mm-diameter implants was 76.3%. Implant diameter ( P =.0001) and a history of a chronic medical condition ( P =.01) were correlated with implant survival outcomes. Conclusions. High success of implant-supported prostheses in the posterior zones of both the maxilla and mandible. It corroborated other studies that have shown higher failure rates for wide-platform implants, emphasizing the need for proper establishment of clinical trials prior to marketing of new implant designs. (J Prosthet Dent 2003;89:352-9.)

Purpose The aims of this report are to present the patient-based outcomes and associated clinical costs of an immediate loading protocol for mandibular overdentures in edentulous patients. Materials and Methods Two groups of patients were selected. Thirty-five consecutively treated patients received an immediate protocol, while 42 patients treated with a conventional protocol served as a historical control. Patient-based concerns for patients in the immediate group were measured at various stages of treatment with 2 questionnaires: the Denture Satisfaction Scale and the Oral Health Impact Profile. Direct clinical and time costs over a 1-year period were estimated and deflated to 2002 Canadian dollars. Salary rates by occupation, age, and gender were used to evaluate the patients' time costs. Treatment costs were compared between the 2 groups. Additionally, incremental cost-effectiveness ratios for various stages with the immediate protocol were calculated. Results Significant improvements posttreatment were observed with both the Denture Satisfaction Scale (Wilcoxon signed rank test, P P P Conclusions This study suggests that implants in 1 jawbone lead to a substantial improvement in perceived oral health status. Furthermore, the immediate loading protocol was not cheaper than a conventional protocol.— Reprinted with permission of Quintessence Publishing.

Purpose The aim of this report is to present the implant and clinical outcomes of an immediate-loading protocol of TiUnite implants with mandibular overdentures in edentulous patients. Materials and Methods Two groups of edentulous patients were selected. Thirty-five consecutively treated patients received 70 immediately loaded TiUnite implants and 69 Branemark implants as backup (1 patient received 1 Branemark implant). The control group was a historical cohort that comprised 42 patients who received 111 Branemark implants. All overdentures were supported by a resilient bar mechanism. Implant and clinical outcomes, including maintenance events for the first year, were recorded. Results Implant success rates were in excess of 95% with both protocols. Immediately loaded implants had less bone loss than did implants loaded with the conventional protocol (Mann-Whitney U test; P =.001). Patients in the immediate-loading group required more prosthodontic maintenance, consisting of overdenture remakes and laboratory relining of prostheses (Chi-square test; P P Conclusion The favorable implant and bone level outcomes with immediate loading attest to its biologic success. The prosthetic maintenance encountered in the immediate-loading group does not negate the clinical potential of the treatment but rather suggests that the protocol may benefit from modifications.— Reprinted with permission of Quintessence Publishing.

Purpose The study's aim was to report long-term costs in edentulous patients treated with mandibular implant-supported prostheses. Materials and Methods Ninety patients were divided into four groups based on the type of implant prosthesis (fixed or overdenture) and treatment year. Records were obtained from dental charts, and an economic analysis from the patient's perspective was conducted. Clinical time associated with various procedures was measured and applied to the four groups. Salary rates by age, occupation, and gender were used to value patients' time. Direct clinical and time costs over 10 years were converted to 2002 Canadian dollars using the Consumer Price Index and discounted at a 3% rate. A sensitivity analysis at an equal salary rate was carried out to test the robustness of the time costs. Results Initial treatment and maintenance costs over the observation period were significantly higher for fixed compared to overdenture prostheses. A significant improvement in maintenance costs for the first patient group treated with fixed prostheses was observed over the follow-up period. Longer term (15 years) treatment costs for the initial two groups were significantly higher for the fixed group. The sensitivity analysis at an equal salary rate demonstrated the same trend: Time costs were significantly higher for the fixed groups. Conclusion Long-term treatment costs indicated that the mandibular overdenture was a less expensive treatment compared to the fixed implant prosthesis.— Reprinted with permission of Quintessence Publishing.

Purpose Few long-term studies on overdentures report both implant and prosthodontic outcomes. The aim of this prospective study was to report long-term prosthodontic- and implant-related treatment outcomes of patients treated with design-specific implant-supported overdentures. Materials and methods Between 1982 and 1992, 45 consecutively treated patients received a total of 47 overdentures (42 mandibular and maxillary) supported by Branemark implants. Prospective clinical and radiographic data were collected over the observation period; this study presents the most recent treatment outcomes. Results Thirty patients (mean age 70 years) with 32 prostheses attended the final recall visit, with 67% of patients followed for 15.53 years (range 10 to 19 years). Six implants failed, and the prosthetic plan and implant cumulative survival rates were both in excess of 90%. Mean marginal bone loss around implants after the first year of loading was small (0.05 mm/year), although the individual variation was high. Linear regression analysis of bone loss indicated that gender, bicortical stabilization, bone quality, and healing time were predictors of bone loss for the first year of loading but not for the ensuing years. Prosthetic maintenance included fractured components, denture relining, and replacement of prostheses. On average, the longevity of overdenture prostheses was 12 years, and laboratory relining was necessary every 4 years. Conclusion This study confirmed the long-term outcome success of patients treated with design-specific overdenture prostheses supported by Branemark implants. However, prosthetic maintenance was required, a fact that should be discussed with patients prior to treatment.—Reprinted with permission of Quintessence Publishing.

Purpose The aim of this prospective study was to report long-term treatment outcomes (prosthetic and implant related) of edentulous patients treated with implant-supported fixed prostheses who participated in the first clinical implant study in North America. Materials and methods Forty-five patients were treated with Branemark implants supporting a total of 47 fixed prostheses (42 mandibular and 5 maxillary) between 1979 and 1984. All patients were recalled regularly for comprehensive prospective clinical and radiographic assessments. Results Thirty-one patients (33 prostheses) attended a final recall visit in 2002; 71% of patients had been followed for 20 years (range 18 to 23 years), with overall prosthetic plan and implant outcome success rates of 84% and 87%, respectively. Mean marginal bone loss around the implants after the first year of loading was small (0.05 mm/year), with high individual variations. Poor oral hygiene, smoking history, and implant position appeared to be predictors of marginal bone loss. Prosthetic maintenance was ongoing and included fractured components and replacement of prostheses; the longevity of a fixed prosthesis for this group of patients was 8.39 ± 5.30 years. Conclusion This study confirmed the overall long-term treatment outcome success of patients treated with fixed prostheses supported by Branemark implants. Successful osseointegration with small mean bone loss was maintained as study patients aged, although prosthetic maintenance was required. The latter consideration should be discussed with all patients seeking such treatment.— Reprinted with permission of Quintessence Publishing.