Success and complication rates of non-precious alloy telescopic crowns in a general dental practice.

OBJECTIVES This retrospective, single-center, practice-based cohort study aimed to analyze factors associated with the success of removable partial dentures retained by telescopic crowns (TRPD). MATERIALS AND METHODS TRPD which were placed in a single practice of a practice-based research network were analyzed. Data from 139 patients (age (SD): 66 (11) years; 66 female) with 174 TRPD including 488 non-precious alloy telescopic crowns (TC) between 2004 and 2016 were included. TC without any technical complication were considered as successful, and as survived, if they were still in function at the last check-up. Multilevel Cox proportional hazard models were used to evaluate the association between clinical factors and time until failure. RESULTS Within a mean follow-up period (SD) of 4.2 (3.3) years (min-max: 1 day-12 years), 372 (76%) TC (AFR5years,TC-level: 5.0%) as well as 136 (87%) TRPD (AFR5years,TRPD-level: 5.1%) ("worst-case scenario") and 150 (86%) TRPD (AFR5years,TRPD-level: 3.4%) ("best-case scenario") were considered as successful. The main failure types were recementation (n = 39), endodontic treatment (n = 36), and extraction (n = 35). TC in male patients showed 1.6 times higher risk for failure than in female patients (95%CI: 1.1-2.4; p = 0.023). TC on premolars showed 2.2 times higher risk for failure than on incisors (95%CI: 1.1-5.0; p = 0.023) and TC in dentures with ≤ 3TC showed 2.1 times higher risk for failure than TC in dentures with > 3TC (1.3-3.4; p = 0.042). Furthermore, TC on the most distal tooth in an arch showed 2.4 times higher risk for failure than TC on a more mesial tooth (1.5-3.8; p < 0.001). CONCLUSION For removable partial dentures retained by telescopic crowns, high success rates could be found after up to 12 years. Patient-level and tooth-level factors were significantly associated with failure. CLINICAL RELEVANCE For removable partial dentures retained by telescopic crowns, high success rates could be found after up to 12 years. Patient-level and tooth-level factors were significantly associated with failure

Clinical outcomes of different implant types in mandibular bar-retained overdentures: a retrospective analysis with up to 20 years follow-up.

PURPOSE To determine the clinical and radiological outcomes of hybrid-design- (HD) and bone-level (BL) implants for bar-retained mandibular implant-overdentures (IODs). METHODS For this retrospective study, edentulous patients who had received maxillary complete dentures and mandibular bar-retained IODs were invited for a follow-up assessment. Implant survival, implant success and health of peri-implant tissues were assessed on an implant level-based analysis. Patient-based parameters served to identify risk factors for peri-implant bone loss, presence of peri-implantitis and success. RESULTS Eighty patients (median age 72.72 [67.03; 78.81] years, 46 females) with 180 implants (median follow-up 12.01 [10.82; 21.04] years) were assessed. There was no difference concerning the rate of implant failure (p = 0.26), or peri-implantitis (p = 0.97) between HD and BL implants. Solely in one study group, there was the presence of peri-implant pus. Implant success was higher in BL implants with one group being notably higher than the comparing groups (p = 0.045). For bone loss, a width of keratinized mucosa (KM) ≤ 1 mm (p = 0.0006) and the presence of xerostomia (p = 0.09) were identified as risk factors. Smoking (p = 0.013) and a higher body mass index (BMI) (p = 0.03) were a risk factor for peri-implantitis. As risk factors for reduced implant success, a small width of KM (p = 0.003) and the presence of xerostomia (p = 0.007) were identified. CONCLUSIONS For mandibular bar-retained IODs, both BL and HD implants are mostly successful. A minimum of 1 mm KM around implants and normal salivary flow are relevant factors for implant success and stable peri-implant bone levels. Smoking and a high BMI are potential risk factors for peri-implantitis

Accuracy of keyless vs drill-key implant systems for static computer-assisted implant surgery using two guide-hole designs compared to freehand implant placement: an in vitro study.

PURPOSE This in vitro study aimed at comparing the accuracy of freehand implant placement with static computer-assisted implant surgery (sCAIS), utilizing a keyless and a drill-key implant system and two guide-hole designs. METHODS A total of 108 implants were placed in 18 partially edentulous maxillary models simulating two different alveolar ridge morphologies. 3D digital deviations between pre-planned and post-operative implant positions were obtained. Guide material reduction was assessed in the keyless implant system for the manufacturer's sleeve and sleeveless guide-hole designs. RESULTS sCAIS using a sleeveless guide-hole design demonstrated smaller mean angular, crestal and apical deviations compared to sCAIS utilizing a manufacturer's sleeve and the freehand group (2.6 ± 1.6°, vs 3.3 ± 1.9°, vs 4.0 ± 1.9°; 0.5 ± 0.3 mm, vs 0.6 ± 0.3 mm, vs 0.8 ± 0.3 mm; and 1.0 ± 0.5 mm, vs 1.2 ± 0.7 mm, vs 1.5 ± 0.6 mm). Smaller angular and apical mean deviations were observed in the keyless implant system as compared with the drill-key implant system (3.1 ± 1.7°, vs 3.5 ± 1.9°, p = 0.03; and 1.2 ± 0.6 mm, vs 1.4 ± 0.7 mm, p = 0.045). Overall, smaller angular, crestal, and apical deviations (p < 0.0001) were observed in healed alveolar ridges (2.4 ± 1.7°, 0.5 ± 0.3 mm, and 0.9 ± 0.5 mm) than in extraction sockets (4.2 ± 1.6°, 0.8 ± 0.3 mm, and 1.6 ± 0.5 mm). Higher mean volumetric material reduction was observed in sleeveless than in manufacturer's sleeve guide-holes (- 0.10 ± 0.15 mm3, vs - 0.03 ± 0.03 mm3, p = 0.006). CONCLUSIONS Higher final implant positional accuracy was observed in sCAIS for the keyless implant system, with a sleeveless guide-hole design, and in healed ridges. Sleeveless guide holes resulted in higher volumetric material reduction compared with the manufacturer's sleeve

Group 3 ITI Consensus Report: Patient-reported outcome measures associated with implant dentistry

Objectives: The aim of Working Group 3 was to focus on three topics that were assessed using patient-reported outcome measures (PROMs). These topics included the following: (a) the aesthetics of tooth and implant-supported fixed dental prostheses focusing on partially edentulous patients, (b) a comparison of fixed and removable implant-retained prostheses for edentulous populations, and (c) immediate versus early/conventional loading of immediately placed implants in partially edentate patients. PROMs include ratings of satisfaction and oral health-related quality of life (QHRQoL), as well as other indicators, that is, pain, general health-related quality of life (e.g., SF-36). Materials and methods: The Consensus Conference Group 3 participants discussed the findings of the three systematic review manuscripts. Following comprehensive discussions, participants developed consensus statements and recommendations that were then discussed in larger plenary sessions. Following this, any necessary modifications were made and approved. Results: Patients were very satisfied with the aesthetics of implant-supported fixed dental prostheses and the surrounding mucosa. Implant neck design, restorative material, or use of a provisional restoration did not influence patients’ ratings. Edentulous patients highly rate both removable and fixed implant-supported prostheses. However, they rate their ability to maintain their oral hygiene significantly higher with the removable prosthesis. Both immediate provisionalization and conventional loading receive positive patient-reported outcomes. Conclusions: Patient-reported outcome measures should be gathered in every clinical study in which the outcomes of oral rehabilitation with dental implants are investigated. PROMs, such as patients’ satisfaction and QHRQoL, should supplement other clinical parameters in our clinical definition of success

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p&lt;0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p&lt;0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Retrospective clinical evaluation of 2- to 6-unit implant-supported fixed partial dentures : Mean follow-up of 9 years.

BACKGROUND: Implant-supported fixed partial dentures (ISFPDs) are one of the most common options to rehabilitate partially edentulous patients. PURPOSE: To assess the clinical outcomes of ISFPDs. METHODS: This retrospective study included all patients treated with ISFPDs with 2 to 6 prosthetic units at one specialist clinic. Implant/prosthesis failure and technical complications were the outcomes analyzed. RESULTS: Six hundred and forty-two patients with 876 ISFPDs (2241 implants) were included, followed up for 108.0 ± 76.2 months. Eighty-eight prostheses and 112 implants (26 before, 86 after prosthesis installation) failed. The estimated CSR of ISFPDs at 30 years was 72.7%. Smokers presented lower implant survival than nonsmokers. Two hundred and ninety-nine ISFPDs (33.2%) presented technical complications. Bruxism was a factor to exert a higher risk of screw and implant fracture, and ceramic chipping. ISFPDs with cantilever presented higher risk of failure, and screw loosening/fracture. Prostheses supported by implants with internal abutment connection or with two pontics had higher risk of presenting ceramic chipping. Extension of the prosthesis did not seem to exert influence on prosthesis failure/complications. CONCLUSIONS: ISFPDs presented good long-term prognosis. Implant failure was the main reason for ISFPD failure. The results suggest that bruxism and the presence of cantilever may contribute to the increased rate of mechanical complications and prosthesis failure

Exploring older Swiss people's preferred dental services for when they become dependent

The objective of this study was to explore the preferred dental services of older people for when they become dependent. It aimed to assess their preferred type of health care professional and location of dental service, and relate their preferences to their willingness to pay (WTP) and willingness to travel (WTT). Older people aged 65 years or older were invited to participate in a questionnaire-based discrete choice experiment (DCE), to measure preferences for dental examinations and treatment, defined by two attributes: type of professional and location of the activity. Hypothetical scenarios based attributes were displayed in a projected visual presentation and participants noted their personal preference using a response sheet. Data was analyzed using a random-effects logit model. Eighty-nine participants (mean age 73.7 ± 6.6 years) attended focus group sessions. Respondents preferred that the family dentist (β: 0.2596) or an auxiliary (β: 0.2098) undertake the examination and wanted to avoid a medical doctor (β: –0.469). The preferred location for dental examination was at a dental practice (β: 0.2204). Respondents preferred to avoid treatments at home (β: –0.3875); they had a significant preference for treatment at the dental office (β: 0.2255) or in a specialist setting (β: 0.1620, ns). However, the type of professional did not have a significant influence on overall preference. Participants with a low WTP preferred examination at home (β: 0.2151) and wanted to avoid the dental practice (β: –0.0235), whereas those with a high WTP preferred the dental office (β: 0.4535) rather than home (β: –0.3029). WTT did not have a significant influence on preference. The study showed that older people generally preferred receiving dental services in a dental practice or specialist setting, and would prefer not to be treated at home. Continuity of dental services provided by the family dentist should therefore be prioritized where possible and further studies should examine the role of domiciliary care at home