COMPARISON OF IMPLANT-RETAINED OVERDENTURE AND CONVENTIONAL COMPLETE DENTURE IN THE EDENTULOUS MANDIBLE: A SURVEY STUDY TO MEASURE PATIENTS\u27 SATISFACTION AND QUALITY OF LIFE IN DENTAL SCHOOL CLINICAL ENVIRONMENT

Patient satisfaction and quality of life are integral parts of assessing the quality of oral health care. Current aging population trends suggest a growing need to understand the effects of edentulism on oral health and quality of life. As the proportion of aged Americans expands, there will be an increased need to understand treatment options and patient communication strategies. In addition, as new treatment options and innovative technologies emerge, it will be essential to understand patients\u27 concerns and identify best practices associated with denture treatments\u27 individual fit and function. Advanced denture treatments can now be fabricated using CAD/CAM digital denture techniques. However, for many Americans still using conventional complete dentures (CD) or Implant Retained-Overdentures (IOD), it remains essential to consider improving their oral health outcomes and quality of life metrics. Dental schools often feel pressured to adopt and teach the most advanced practices. However, they must continue to focus on the needs of edentulous patients and develop communication training and treatment options for an expanding population of CD and IOD patients. New technological innovations will not displace the need for dental school clinics to prepare student clinicians to identify patient concerns and carefully communicate treatment options. Due to inexperienced student dentists who provide dental care to patients in dental school settings, patient grievances are generally considered a problem. Patients become unhappy and dissatisfied due to several factors such as less caregiving efficiency, discontinuity of care due to the school\u27s curriculum and summer break, and various institutional policies, i.e., competencies. Patient feedback and satisfaction have proven to be valuable resources for monitoring and improving patient safety. Effective management of patient concerns can assist individual patients and provide insight for dental schools and professional prosthodontic practices that aspire to deliver the highest quality of care possible. Until the new CAD/CAM methods are made more available in public practice and reduced in cost, many edentulous patients will choose between CD and IOD based on the recommendations of their dental provider. In some instances, a CD may be required because of anatomic, functional, or economic reasons. However, implant-retained overdentures are increasingly understood as a preferential alternative treatment option for those with remaining natural teeth and financial ability. While these are the two leading treatment options for edentulism, there is a lack of comparative studies in the literature comparing CD and IOD outcomes. Therefore, there is a need for studies that examine patient satisfaction and quality of life outcomes, particularly as they are associated with student dentists and considered in association with demographic factors. This study assesses patient satisfaction and quality of life among CD wearers and those with IODs. The data collected enable the examination of many essential factors related to oral health and quality of life. Together, these variable considerations allow a deeper understanding of the interpersonal skills and fabrication techniques that should be emphasized in a clinical dental school environment. The research question that guided the comparative analysis was, Is patient satisfaction and quality of life affected by the type of prostheses and provider? A validated questionnaire was mailed to 520 individuals randomly selected from records of patients who had received treatment for edentulous mandible at a student prosthodontic clinic at the University of Kentucky College of Dentistry from 2014 to 2016 with at least one year of follow-up time. A validated questionnaire for edentulous patients based on the Oral Health Impact Profile (OHIP-19) was used. In addition, information on patients\u27 oral health-related quality of life, including questions related to the edentulous patients\u27 satisfaction with their dentures, was collected. The response rate was 33% (N = 171). Survey results were analyzed using two-sample t-tests and chi-square tests to evaluate differences between and within groups. The study\u27s findings confirm previous findings which suggest that IODs may have a greater impact on oral health-related quality of life. Data show that 76% of the IOD group reported improvement in experience when using the implants to retain the mandibular denture. However, there were no statistically significant differences in the OHIP scores between overall CD and IOD patient groups. Males with IOD had lower physical pain, limitations, and disability scores than males with CD. However, females with IOD reported more significant concerns associated with a social disability and handicap domains. Comparing users who had experiences with both treatment options, this study discerned important characteristics that contribute to increased patient satisfaction with IOD and identified significance in outcomes by gender. These findings serve to guide prosthodontic practitioners\u27 patient care practices and identify a continuing need to discuss CD and IOD treatment protocols within dental school curricula

A Simplified Technique for Implant-Abutment Level Impression After Soft Tissue Adaptation Around Provisional Restoration

Impression techniques for implant restorations can be implant level or abutment level impressions with open tray or closed tray techniques. Conventional implant-abutment level impression techniques are predictable for maximizing esthetic outcomes. Restoration of the implant traditionally requires the use of the metal or plastic impression copings, analogs, and laboratory components. Simplifying the dental implant restoration by reducing armamentarium through incorporating conventional techniques used daily for crowns and bridges will allow more general dentists to restore implants in their practices. The demonstrated technique is useful when modifications to implant abutments are required to correct the angulation of malpositioned implants. This technique utilizes conventional crown and bridge impression techniques. As an added benefit, it reduces costs by utilizing techniques used daily for crowns and bridges. The aim of this report is to describe a simplified conventional impression technique for custom abutments and modified prefabricated solid abutments for definitive restorations

Efficacy of Stem Cell Allograft in Maxillary Sinus Bone Regeneration: A Randomized Controlled Clinical and Blinded Histomorphometric Study

Purpose: This study aimed to evaluate the quality and quantity of newly generated bone in the maxillary sinus grafted with stem cell-based allograft material. Methods: This study was a single site, prospective, blinded, randomized, and controlled clinical trial. Eleven subjects with 18 edentulous posterior maxillary sites requiring sinus augmentation for delayed implant placement using a lateral window approach were enrolled. At the time of sinus augmentation, test sinus was grafted with stem cell-based allograft (Osteocel Plus; NuVasive Therapeutics), while the control sinus was grafted with conventional cortico-cancellous allograft (alloOss; ACE Surgical). Cone beam computer tomography (CBCT) scan was taken before and 14 weeks post-sinus augmentation procedure, i.e., 2 weeks before implant placement. Thirty-six trephined core bone biopsies were harvested from the anterior and posterior grafted lateral-window osteotomy sites at the time of implant placement. Results: The results showed a statistically significant difference in the vital bone percentage between the test and the control groups at the posterior grafted sites (p = 0.03). There was no significant difference in the percentage of vital bone between the anterior and posterior grafted sites within the test and control groups (p \u3e .05). The CBCT analysis showed that the maxillary sinuses at the posterior grafted sites were statistically wider than those at the anterior grafted sites in both groups (p \u3c .05). Conclusions: Different allograft bone materials can be used in the maxillary sinus augmentation procedures. Stem cell allograft has more osteogenic potential with a better outcome in the wide posterior sinus

A Simplified Technique for Implant-Abutment Level Impression after Soft Tissue Adaptation around Provisional Restoration

Impression techniques for implant restorations can be implant level or abutment level impressions with open tray or closed tray techniques. Conventional implant-abutment level impression techniques are predictable for maximizing esthetic outcomes. Restoration of the implant traditionally requires the use of the metal or plastic impression copings, analogs, and laboratory components. Simplifying the dental implant restoration by reducing armamentarium through incorporating conventional techniques used daily for crowns and bridges will allow more general dentists to restore implants in their practices. The demonstrated technique is useful when modifications to implant abutments are required to correct the angulation of malpositioned implants. This technique utilizes conventional crown and bridge impression techniques. As an added benefit, it reduces costs by utilizing techniques used daily for crowns and bridges. The aim of this report is to describe a simplified conventional impression technique for custom abutments and modified prefabricated solid abutments for definitive restorations

Three-port micro-inverter with power decoupling capability for Photovoltaic (PV) system applications

This paper proposes a new single-phase inverter topology for Photovoltaic (PV) applications. The capability of decoupling the double-line-frequency ripple, using a small capacitance, is the main feature of the proposed topology. This allows for using a film capacitor instead of an electrolytic capacitor, resulting in higher inverter reliability. Additionally, no extra circuitry is needed to manage the transformer leakage energy. © 2014 IEEE

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)