Elham Emami

Impact of implant support for mandibular dentures on satisfaction, oral and general health‐related quality of life: a meta‐analysis of randomized‐controlled trials

OBJECTIVES The aim of this study was to examine systematically the data published on the efficacy of mandibular implant-retained overdentures from the patients perspective. MATERIAL AND METHODS Medline, Embase, The Cochrane Central Register of Controlled Trials and The Cochrane Systematic Reviews Database were searched and complemented by hand searching. All randomized-controlled trials published in English or French up to April 2007 were included, in which conventional dentures and mandibular implant overdentures in adult edentulous individuals were compared. The outcomes of interest were patient satisfaction, oral and general health-related quality of life. Random effects models were used to pool the effect sizes (ES) of all included studies. RESULTS Ten publications of seven randomized-controlled trials were identified and eight were included in the meta-analysis. When compared with mandibular conventional dentures, implant overdentures were rated to be more satisfactory at a clinically relevant level [pooled ES 0.80, z=3.56, 95% confidence intervals (CI) 0.36-1.24, P=0.0004], but a statistical heterogeneity was found (chi(2)=31.63, df=5, P<0.00001, I(2)=84%). The pooled ES for oral health quality of life was -0.41 (z=1.31, 95% CI, -1.02 to 0.20; P=0.19, chi(2)=11.53, df=2, P<0.003, I(2)=83%). There was a lack of evidence to show the impact of mandibular implant overdenture on perceived general health. CONCLUSIONS Our findings suggest that, although mandibular implant-retained overdentures may be more satisfying for edentulous patients than new conventional dentures, the magnitude of the effect is still uncertain. There is a need for additional evidence including cost-effectiveness analyses on the impact of mandibular implant overdentures and conventional dentures.

Favoring Trauma as an Etiological Factor in Denture Stomatitis

The etiology of denture stomatitis remains controversial. Trauma due to unstable dentures has been suggested as an etiological factor. Therefore, we tested the hypothesis that the prevalence of denture stomatitis is reduced when mandibular dentures are stabilized by implants. Data were collected at a one-year follow-up from 173 edentulous elders who had randomly received mandibular implant overdentures or conventional dentures. The diagnosis of denture stomatitis was determined according to the Newton classification. Elders wearing conventional dentures were almost 5 times more likely to have denture stomatitis than those wearing mandibular two-implant overdentures (P < 0.0001, Fisher’s exact test). Adjusted odds ratios showed that only the type of the prosthesis (AOR = 4.54, 95% CI 2.20 to 9.40) and nocturnal wear (AOR = 3.03, 95% CI 1.24 to 7.40) predict the frequency of denture stomatitis. Thus, implant overdentures may reduce oral mucosal trauma and control denture stomatitis.

The Impact of Edentulism on Oral and General Health

An adequate dentition is of importance for well-being and life quality. Despite advances in preventive dentistry, edentulism is still a major public health problem worldwide. In this narrative review, we provide a perspective on the pathways that link oral to general health. A better understanding of disease indicators is necessary for establishing a solid strategy through an organized oral health care system to prevent and treat this morbid chronic condition.

Better oral health related quality of life: type of prosthesis or psychological robustness?

UNLABELLED Sense of coherence (SOC) is an individual-based coping characteristic and believed to influence a persons ability to adapt to life stressors, such as edentulism and using complete denture. Thus, SOC may mediate the effect of prosthetic treatment on quality of life. OBJECTIVES 1. To simultaneously test the effect of type of treatment and sense of coherence on oral health related quality of life (OHRQoL) in edentate elders and to identify any interaction. 2. To report the level of sense of coherence among a sample of edentate elders. METHODS Data were collected and analysed cross-sectionally at a 1-year follow-up from 173 edentulous elders who had randomly received mandibular-implant overdentures or conventional dentures, both opposed by new conventional maxillary dentures. The dependent outcome variable, oral health related quality of life, was measured using the Oral Health Impact Profile (OHIP-20). Independent variables included SOC and prosthesis type, as well as socio-demographic variables. SOC was evaluated using the 13-item likert scale of The Orientation to Life questionnaire. RESULTS The group mean SOC score was 70.28 (SD=9.6). Married or coupled people had significantly higher SOC scores than those who were separated, single or divorced (p=0.04). General linear model analyses demonstrated that there was a statistically significant main effect for type of prosthesis, F(1.169)=0.71, p=0.008, with no interaction with SOC. CONCLUSION The results of this study suggest that, in edentulous elders, SOC does not mediate the effect of the type of prosthetic treatment on oral health related quality of life.

Interactions between sleep disorders and oral diseases

Dental sleep medicine is a rapidly growing field that is in close and direct interaction with sleep medicine and comprises many aspects of human health. As a result, dentists who encounter sleep health and sleep disorders may work with clinicians from many other disciplines and specialties. The main sleep and oral health issues that are covered in this review are obstructive sleep apnea, chronic mouth breathing, sleep-related gastroesophageal reflux, and sleep bruxism. In addition, edentulism and its impact on sleep disorders are discussed. Improving sleep quality and sleep characteristics, oral health, and oral function involves both pathophysiology and disease management. The multiple interactions between oral health and sleep underscore the need for an interdisciplinary clinical team to manage oral health-related sleep disorders that are commonly seen in dental practice.

Linking evidence to treatment for denture stomatitis: a meta-analysis of randomized controlled trials.

OBJECTIVES The aim of this meta-analysis was to compare the efficacy of antifungal therapy with any other alternative methods used for the treatment of denture stomatitis. DATA SOURCES MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Reviews were searched, complemented by hand searching, until the first week of January 2013. STUDY SELECTION Included studies consisted of randomized clinical trials published in English or French, which compared antifungals with any other alternative or placebo, used for the treatment of denture stomatitis. The remission of clinical signs of denture stomatitis, and the reduction in Candida colony counts were considered as the clinical and microbiological outcomes, respectively. Random effects models were used to conduct the statistical analyses. RESULTS From 233 identified articles, a total of 15 manuscripts on 14 randomized controlled trials were included in systematic review and 8 in the meta-analysis. No statistically significant difference between antifungal treatment and disinfection methods was found for both clinical (OR=0.7; 95% CI: 0.32-1.36; Z=-1.14; p=0.256) and microbiological (OR=0.8; 95% CI: 0.26-2.5; Z=-0.35; p=0.724) outcomes. The meta-analysis showed a statistically significant difference between an antifungal and a placebo for the microbiological outcome (OR=0.32; 95% CI: 0.12-0.89; Z=-2.2; p=0.028), favouring the antifungals. However, there was no statistically significant difference between antifungal and placebo for the clinical outcome (OR=0.2; 95% CI: 0.04-1.04; Z=-1.9; p=0.056). CONCLUSIONS Disinfection agents, antiseptic mouthwashes, natural substances with antimicrobial properties, microwave disinfection and photodynamic therapy could be suggested as an adjunct or alternative to antifungal medications in the treatment of denture stomatitis.

Tooth Loss Increases the Risk of Diminished Cognitive Function A Systematic Review and Meta-analysis

Emerging evidence suggests that oral health is associated with cognitive function. This review aims to systematically assess this association in adult populations via prospective cohort study designs. Eligible study reports were identified by searching the MEDLINE (via Ovoid), EMBASE, PsycoINFO, and Cochrane Library databases. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated with a random effects model. From 1,251 identified articles, 10 were included in the systematic review and 8 in the meta-analysis. Random effects analysis showed, with statistically low heterogeneity, that individuals with suboptimal dentition (<20 teeth) were at a 20% higher risk for developing cognitive decline (HR = 1.26, 95% CI = 1.14 to 1.40) and dementia (HR = 1.22, 95% CI = 1.04 to 1.43) than those with optimal dentition (≥20 teeth). Studies on the association between periodontal disease and cognitive status showed conflicting results. Within the limits of the quality of published evidence, this meta-analysis lends further support to the hypothesis that tooth loss is associated with an increased risk of cognitive impairment and dementia. Knowledge Transfer Statement: Based on the published literature, the results of this study show that the risk for cognitive impairment and dementia increases with loss of teeth. This information adds to the evidence showing links between oral and general health and suggests that oral health strategies aimed to preserve teeth may be important in reducing risk of systemic disease.

Anti‐VEGFs hinder bone healing and implant osseointegration in rat tibiae

AIM To assess the effect of anti-vascular endothelial growth factors (VEGF) on bone healing (defect volume) and implant osseointegration (bone-implant contact per cent) in rat tibia. MATERIALS AND METHODS In Sprague-Dawley rats (n = 36), a unicortical defect was created in the right tibia and a titanium implant was placed in the left tibia of each rat. Rats were assigned into three groups and received either anti-vascular endothelial growth factor neutralizing antibody, Ranibizumab or saline (control). Two weeks following surgery, rats were euthanized and bone samples were retrieved. Bone healing and osseointegration were assessed using micro-CT and histomorphometry. One-way anova followed by the Tukeys test was used for data analyses. RESULTS The volume of the bone defects in the anti-VEGF group (2.48 ± 0.33 mm(3) ) was larger (p = 0.026) than in the controls (2.11 ± 0.36 mm(3) ) as measured by μ-CT. Bone-implant contact percent in the anti-VEGF (19.9 ± 9.4%) and Ranibizumab (21.7 ± 9.2%) groups were lower (p < 0.00) than in the control group (41.8 ± 12.4%). CONCLUSIONS The results of this study suggest that drugs that inhibit the activity of vascular endothelial growth factor (i.e. anti-VEGF) may hinder bone healing and implant osseointegration in rat tibiae.

Focusing on outcomes and methods in removable prosthodontics trials: a systematic review

OBJECTIVES The aim of this study was to systematically examine the outcomes of interest of trials in removable prosthodontics and to assess their overall quality. MATERIAL AND METHODS Electronic databases were searched up to August 2011 and complemented by hand searching for published randomized controlled trials (RCTs) in the field of removable prosthodontics in the six major prosthodontic and implant journals. The primary outcome of RCTs was considered as the outcome of interest of this review, and only manuscripts in which the studys primary outcome was reported in the abstract were included. Outcomes were classified according to the Strength of Recommendation Taxonomy (SORT) classification. The quality of individual reports of RCTs was assessed following the Cochrane Handbook for Systematic Reviews of Interventions (Higgins & Green, www.cochrane-handbook.org). RESULTS The search retrieved 86 reports of RCTs. Among these publications, 43% reported a patient-oriented primary outcome. Most of the publications did not present a clear description of sequence generation (54%) or allocation concealment (65%). Blinding of participants, clinicians, and outcomes assessors was not applicable or reported in most trials. Handling of withdrawals and losses was adequate in 52% of trials. CONCLUSIONS Although published RCTs in removable prosthodontics have increased over time, efforts should be made to increase patient-reported outcomes and the methodological quality of these reports. Such improvement will lead to a better body of evidence in the field, thus providing increased support for clinical decision-making.

Failure rate of single-unit restorations on posterior vital teeth: A systematic review

Statement of problem No knowledge synthesis exists concerning when to use a direct restoration versus a complete‐coverage indirect restoration in posterior vital teeth. Purpose The purpose of this systematic review was to identify the failure rate of conventional single‐unit tooth‐supported restorations in posterior permanent vital teeth as a function of remaining tooth structure. Material and methods Four databases were searched electronically, and 8 selected journals were searched manually up to February 2015. Clinical studies of tooth‐supported single‐unit restorative treatments with a mean follow‐up period of at least 3 years were selected. The outcome measured was the restorations’ clinical or radiological failure. Following the Preferred Reporting Items for Systematic reviews and Meta‐Analyses guidelines, the Cochrane Collaboration procedures for randomized control trials, the Strengthening the Reporting of Observational Studies in Epidemiology criteria for observational studies, 2 reviewers independently applied eligibility criteria, extracted data, and assessed the quality of the evidence of the included studies using the American Association of Critical Care Nurses’ system. The weighted‐mean group 5‐year failure rates of the restorations were reported according to the type of treatment and remaining tooth structure. A metaregression model was used to assess the correlation between the number of remaining tooth walls and the weighted‐mean 5‐year failure rates. Results Five randomized controlled trials and 9 observational studies were included and their quality ranged from low to moderate. These studies included a total of 358 crowns, 4804 composite resins, and 303 582 amalgams. Data obtained from the randomized controlled trials showed that, regardless of the amount of remaining tooth structure, amalgams presented better outcomes than composite resins. Furthermore, in teeth with fewer than 2 remaining walls, high‐quality observational studies demonstrated that crowns were better than amalgams. A clear inverse correlation was found between the amount of remaining tooth structure and restoration failure. Conclusions Insufficient high‐quality data are available to support one restorative treatment or material over another for the restoration of vital posterior teeth. However, the current evidence suggests that the failure rates of treatments may depend on the amount of remaining tooth structure and types of treatment.