Michael I. MacEntee

Fit of three porcelain-fused-to-metal marginal designs in vivo: A scanning electron microscope study

This study examined the comparative fit in vivo of three types of PFM crown margins. Marginal openings were measured with an SEM on replicas derived from elastomeric impressions. There was no significant difference among beveled metal margins, metal butt margins, or porcelain butt margins either before or after cementation at the 95% confidence level. This study has shown that it is possible under clinical conditions to consistently produce porcelain butt margins with less than 50 micron marginal opening in PFM restorations.

Problems with prostheses on implants: a retrospective study.

Prosthetic parameters for implant success have not been well defined but should include patient satisfaction and prosthesis maintenance, including adjustments and repairs. In addition, differences between fixed and removable implant-supported prostheses (ISPs) should be quantified. This study retrospectively evaluated both patient satisfaction and maintenance for 156 patients. Removable ISPs averaged almost three times as many adjustments per prosthesis (2.1 versus 0.8 per fixed ISP) and more than twice as many repairs (1.9 per removable ISP versus 0.9 per fixed ISP). The most common adjustments were to the contour of both types of prosthesis, and the most frequent repairs involved the retentive clips with removable ISPs and the gold screws with fixed ISPs. The incidence of repeat repairs was more than twice as high with removable prostheses compared with fixed prostheses. However, the repairs to opposing dentures most often needed were for conventional dentures opposing fixed ISPs. The vast majority of repairs were needed within the first year of service. Despite the high maintenance needed, patients were satisfied with both types of ISP, with the exception of limited satisfaction with cleansability, particularly with fixed restorations. The high incidence of early repairs, and the greater potential for a removable ISP requiring adjustment and repair, should be considered both when discussing options with the patient and when estimating treatment and maintenance costs before the commencement of implant therapy.

Oral mucosal disorders in denture wearers

Patients who wear dentures present with a variety of symptoms and abnormal intraoral findings. The advanced age of the average denture wearer and the nature of the denture-bearing mucosa appear to influence the nature of the problems. Superimposed infection with candidal organisms and traumatic lesions are the most commonly encountered abnormalities. Patients with symptoms but no intraoral changes frequently had a psychologic component to their complaint and did not improve after alteration of their dentures.

The economics of complete dentures and implant-related services: A framework for analysis and preliminary outcomes☆☆☆★★★♢

It is not always clear that the implant-prosthesis offers distinct advantages over the conventional complete denture for managing the edentulous jaw. This article discusses the measurement, distribution, impact, and management of the edentulous jaw, and describes a framework for analyzing the economic costs and benefits associated with the conventional denture and the implant prosthesis. There are physiologic and psychosocial costs and benefits to both the conventional denture and the implant prosthesis, which indicates that neither method is distinctly superior. The physiologic costs are low and the psychosocial costs are similar for both treatments, whereas the direct financial costs associated with the implant prosthesis are substantially higher.

Oral health in long-term care - The implications of organizational culture

Abstract When an investigation designed to compare extant models of delivering oral health and dental services to the institutionalized elderly revealed that structural variables explained very little of the difference between effective and ineffective programs, secondary analytic techniques were employed to consider alternative explanations. The original study was a program evaluation based on a comparative case study of 12 long-term care (LTC) facilities. Data for each case included interviews with administrators, care providers, family members, and residents, administrative documentation, and clinical measures of oral health from the residents. The secondary analysis revealed the mechanisms through which the organizational context of each facility influenced the effectiveness of the oral health services. In addition, it revealed how administrative and leadership issues influenced the quality of care.

Dentistry and distributive justice

There is a growing concern in most countries to address the problem of inequities in health-care within the context of financial restraints on the public purse and the realities of health professions that are influenced strongly by the economic priorities of free-market economies. Dental professionals, like other health professionals, are well aware that the public expects oral health-related services that are effective, accessible, available and affordable. Yet, there is remarkably little reference in the literature to the theories of distributive justice that might offer guidance on how an equitable oral health service could be achieved. This paper considers three prominent theories of distributive justice--libertarianism, egalitarianism and contractarianism--within the controversial context of basic care and quality of life. The discussion leads towards a socially responsible, egalitarian perspective on prevention augmented by a social contract for curative care with the aim of providing maximum benefit to the least advantaged in society.

Using Written Vignettes in Focus Groups Among Older Adults to Discuss Oral Health as a Sensitive Topic

When the mouth yields pain and distress, it can impact psychosocially the lives of older adults and might constitute a sensitive topic for open disclosure. In this article, we describe our use of a written vignette in focus groups for discussion of oral health and disablement. Six focus groups were conducted with 42 older men and women with an average age of 75 years who were purposefully selected through advertisements posted in community centers and retirement homes. In discussions lasting for an average of 90 min, groups of up to 9 participants commented positively and negatively on the vignettes story and voluntarily discussed their personal experiences, family histories, and testimonies about the mouth and coping and adapting strategies to disabilities. The discussion about oral health can be sensitive, but the vignette shifted the focus away from the participants and allowed them to share personal experiences with oral health and disablement.

Short-term contamination of luting cements by water and saliva

OBJECTIVES The aim of this study was to determine the effect of water, artificial saliva and natural saliva on the hardening process of three dental luting cements. METHODS Cement samples, 1 mm thick and 5 mm in diameter, were subjected to various storage conditions in an oven maintained at 37 degrees C. Some samples were aged in 100% humidity or water for up to 1 wk. The other samples were covered with water, artificial saliva or natural saliva at various times after mixing. The Knoop hardness values of the cement surfaces were measured. Differences between groups were evaluated with an ANOVA followed by a Tukey multiple comparison at the 5% level of significance. The hardness ratio of the contaminated samples was calculated using the 30 min mean KHN of the samples aged in 100% humidity as the divisor. RESULTS The glass ionomer samples were significantly harder (48.3 +/- 3.8) than the zinc phosphate (38.9 +/- 7.5) or composite cements (35.4 +/- 10.2) after 1 wk in 100% humidity storage condition. When immersed in water, the hardness of both the glass ionomer and the zinc phosphate decreased to almost half that of the specimens stored in 100% humidity (26.2 +/- 2.7 and 16.9 +/- 2.5, respectively). Contamination decreased the hardness of zinc phosphate and glass ionomer (hardness ratio, water contamination at 5 min: 0.39 +/- 0.10 and 0.52 +/- 0.12, respectively) but had very little effect on the composite. Overall, water had a greater softening effect than artificial or natural saliva on the cements. SIGNIFICANCE In light of these results, glass ionomer cement should be protected from water and saliva for the first 15 min after mixing.

A 5-Year Randomized Trial to Compare 1 or 2 Implants for Implant Overdentures

The hypothesis of this 5-y randomized clinical trial was that there would be no significant difference in the satisfaction of edentulous participants with removable complete overdentures attached to 1 or 2 mandibular implants. Secondary aims were to test changes in satisfaction between and within the groups from baseline to 5 y and differences between the groups in implant survival and prosthodontic maintenance over 5 y. Each of the 86 participants (mean age, 67 y) was randomly allocated to receive either 1 implant in the midline (group 1) or 2 implants in the canine areas (group 2) attached to a mandibular overdenture opposing a maxillary complete denture. Satisfaction was self-assessed by participants on a visual analog scale at baseline prior to implants, as well as at 2 mo and 1, 3, and 5 y with implant overdentures, whereas implant survival and prosthodontic maintenance were assessed by clinical examination. After 5 y, 29 participants in group 1 and 33 in group 2 were available, with most dropouts due to death. Satisfaction with the implant denture after 5 y was significantly (P < 0.001) higher than at baseline in both groups and remained with no significant difference (P = 0.32) between the groups. No implants failed in group 1 but 5 failed before loading in 4 participants in group 2. Most participants required maintenance or occasionally denture replacement, and although differences between the groups were not statistically significant, group 1 experienced almost twice as many fractured dentures usually adjacent to the implant attachment. We conclude that there were no significant differences after 5 y in satisfaction or survival of implants with mandibular overdentures retained by 1 implant or 2 implants. Additional research is required to confirm long-term treatment effectiveness of single-implant dentures and the implications of prosthetic maintenance with implant overdentures (ClinicalTrials.gov: NCT02117856).

Seniors' Assessment of their Health and Life Satisfaction: The Case for Contextual Evaluation.

Health care professionals have been puzzled by the highly positive statements on health and life satisfaction made by seniors, particularly when compared to professionally collected data. In 1987–1988, a stratified, random sample of 520 seniors living independently in the community (70–99 years) were interviewed in their own homes. The above response pattern again held. However, it was apparent that opinions on life satisfaction vary with type of health problem. Content analysis of the spontaneous remarks made by the participants indicates that the overall, current, and anticipated levels of satisfaction expressed were associated significantly with the historical perspective or lifeview of the participants, and with their state of health. Utilizing the theoretical concept “sense of coherence” gives direction to understanding these phenomena.