Shahrokh Esfandiari

How successful are small-diameter implants? A literature review.

BACKGROUND Edentulism is an important issue and will remain so due to high numbers of edentate individuals worldwide. For many years, complete dentures have been the only treatment option for this population. Implant overdentures have been shown to have many advantages over conventional complete dentures. However, although dissatisfied with their mandibular dentures, some edentate elders are reluctant to undergo even simple implant treatment due to factors such as cost and fear of surgery. To address these obstacles, this paper reports on a review of small-diameter implant (SDI) studies that were performed in the last two decades. The aim of this study is to (i) determine the survival of narrow diameter implants, (ii) determine whether survival is dependent on whether these implants are placed using a flap or flapless approach, and (ii) determine whether there is a relationship between length and implant survival in SDIs. METHODS In this review, studies were included that (i) involve implants with 3.5 mm diameter or less, (ii) have a randomized clinical trial, retrospective or prospective cohort design with human subjects, (iii) provide a follow up duration of at least 5 months following implant placement, (iv) include data on the survival rate of the implants. RESULTS Forty one studies meeting the above criteria were published between 1993 and 2011 using SDIs from a variety of companies and surface characteristics with diameters of 1.8 mm to 3.5 mm and lengths of 8 mm to 18 mm. A total of 10,093 SDIs were inserted in approximately 2762 patients. Twenty-six studies involved flap reflection techniques for implant placement, six studies used a flapless technique and two studies used both techniques; in the remaining studies, the technique was not specified. Follow up duration varied from 5 months to over 9 years. The survival rate reported in all screened studies was over 90%, including eight studies in which a 100% survival rate was reported. In 22 studies, the reported survival rate ranged from 95% to 99.9%. Failure was reported most often in short SDIs (less than or equal 13 mm) (n = 88) compared to longer ones (more than 13 mm). CONCLUSION Survival rates reported for SDI are similar to those reported for standard width implants. These survival rates did not appear to differ between studies that used flapless and flap reflection techniques. The failure rate appeared to be higher in shorter SDIs than in longer ones in the studies in which the length of the failed implants was reported. SDIs could be considered for use with fixed restorations and mandibular overdentures, since their success rate appears to be comparable to that of regular diameter implants. They might also be an efficient, low-cost solution for elders who wish to reduce problems with denture instability.

Implant overdentures for edentulous elders: study of patient preference.

BACKGROUND Studies show that elders wearing implant overdentures have improved nutrition and quality of life. However, upfront costs of this therapy are high, and the income of elderly edentulous populations is low. OBJECTIVES This study was designed (i) to measure the preferences of edentulous patients for mandibular two-implant overdentures using Willingness-To-Pay (WTP) and Willingness-To-Accept (WTA), (ii) to assess the effect of long-term financing on WTP and (iii) to assess the desired role of health care plans in financing dental prostheses. METHODS Edentulous elders (68-79 years; n = 36) wearing maxillary dentures and either a mandibular conventional denture (CD, n = 13) or a two-implant overdenture with ball attachments (IOD, n = 23) participated in this study. All had received their prostheses 2 years previously, as part of a randomised clinical trial. A three-part questionnaire was completed during a 20-min interview with a trained researcher. RESULTS Forty-six per cent (6/13) of the CD wearers and 70% (16/23) of the IOD wearers were willing to pay three times more than the current cost of conventional dentures for implant prostheses. These percentages were increased to 77% (CD) and 96% (IOD) if participants could pay for implant overdentures in monthly instalments. Eighty-six per cent (31/36) of all participants in both groups (21/23 IOD; 10/13 CD) thought that the government should cover at least some of the cost of implant overdentures. CONCLUSIONS This study shows that, the majority of elderly edentate individuals who have not experienced mandibular two-implant overdenture therapy are willing to pay the cost, particularly when payment can be made in monthly instalments.

From theoretical concepts to policies and applied programmes: the landscape of integration of oral health in primary care

BackgroundDespite its importance, the integration of oral health into primary care is still an emerging practice in the field of health care services. This scoping review aims to map the literature and provide a summary on the conceptual frameworks, policies and programs related to this concept.MethodsUsing the Levac et al. six-stage framework, we performed a systematic search of electronic databases, organizational websites and grey literature from 1978 to April 2016. All relevant original publications with a focus on the integration of oral health into primary care were retrieved. Content analyses were performed to synthesize the results.ResultsFrom a total of 1619 citations, 67 publications were included in the review. Two conceptual frameworks were identified. Policies regarding oral heath integration into primary care were mostly oriented toward common risk factors approach and care coordination processes. In general, oral health integrated care programs were designed in the public health sector and based on partnerships with various private and public health organizations, governmental bodies and academic institutions. These programmes used various strategies to empower oral health integrated care, including building interdisciplinary networks, training non-dental care providers, oral health champion modelling, enabling care linkages and care coordinated process, as well as the use of e-health technologies. The majority of studies on the programs outcomes were descriptive in nature without reporting long-term outcomes.ConclusionsThis scoping review provided a comprehensive overview on the concept of integration of oral health in primary care. The findings identified major gaps in reported programs outcomes mainly because of the lack of related research. However, the results could be considered as a first step in the development of health care policies that support collaborative practices and patient-centred care in the field of primary care sector.

Caries Prevalence and Experience in Individuals with Osteogenesis Imperfecta

Objective Dentinogenesis Imperfecta (DI) forms a group of dental abnormalities frequently found associated with Osteogenesis Imperfecta (OI), a hereditary disease characterized by bone fragility. The objectives of this study was to quantify the caries experience among different OI-types and quantify how these values change due to DI. Methods To determine which clinical characteristics were associated with increased CPE in patients with OI, the adjusted DFT scores were used to account for frequent hypodontia, impacted teeth and retained teeth in OI population. Results The stepwise regression analysis while controlling for all other variables demonstrated the presence of DI (OR 2.43; CI 1.37 to 4.32; p=0.002) as the significant independent predictor of CPE in the final model. Conclusion This study found no evidence that CPE of OI subjects differs between the types of OI. The presence of DI when controlled for other factors was found to be the significant predictor of CPE.

The Development and Validation of a Questionnaire Measuring Barriers to Career Progression Faced by Women Dentists in Saudi Arabia

To develop and validate a questionnaire assessing barriers faced by Saudi Arabian female dentists in the progression of their career. We developed a three-part questionnaire based on a literature review, semi-structured interviews, and consultation with 3 panels of experts. The instrument was sent to a convenience sample of 150 female dentists who were faculty members at different university hospitals in Saudi Arabia. Cronbach’s alpha was used to test reliability. Exploratory factor analysis was used to evaluate construct validity. A total of 62 dentists returned the questionnaire (response rate 41.3%), 55 of which were useable for the pilot testing of the measure. The final instrument included 20 items divided into four subscales: Family Challenges, Environment Challenges, Interpersonal Challenges, and Sociocultural Challenges. Cronbach’s α for the total questionnaire was 0.899. Exploratory factor analysis on the questionnaire led to a set of subscales differing from those defined beforehand (KMO = 0.784 very good). A new valid and reliable questionnaire has been developed that measures barriers to female dentists’ career progression in Saudi Arabia.

Effectiveness of immediately loaded single-implant mandibular overdentures versus mandibular complete dentures: A 1-year follow-up of a randomized clinical trial

OBJECTIVE This randomized clinical trial (RCT) aimed to assess the 1-year effectiveness of single-implant mandibular overdentures (SIMO) compared to conventional complete dentures (CCD). METHODS In the first phase of the study, participants received new maxillary and mandibular CCDs. Then, they were randomly allocated to one of the study groups (CCD or SIMO). Participants in SIMO group received an external hexagon implant in the mandibular midline, with the immediate connection of an O-Ring/ball attachment. Oral health-related quality of life (OHIP-EDENT) and patient satisfaction in both groups were assessed before allocation and at 6- and 12-month follow-up visits. Both intention-to-treat (ITT) and per-protocol approaches were used for analyses. Statistical analyses were performed using the Wilcoxon Signed Ranks test and the Generalized Estimating Equations. RESULTS Eighty-four participants (CCD n = 42; SIMO n = 42) were included, out of which 70 completed the 12-month follow-up (CCD n = 34; SIMO n = 36). ITT analysis showed no changes for the CCD group in the longitudinal assessment compared to baseline. Participants in SIMO group had a significant improvement in OHIP-EDENT scores and satisfaction with the mandibular denture. No changes for the maxillary denture were observed in either groups. Similar results were found when per-protocol analysis was performed. CONCLUSIONS SIMO treatment resulted in a significant improvement in patient perceived outcomes compared to the CCD. SIMO may be considered as an alternative treatment modality for patients with poorly adapted and/or unstable mandibular dentures (ClinicalTrials.gov NCT03463174). CLINICAL RELEVANCE The immediately loaded single-implant mandibular overdenture markedly improved patient satisfaction and oral health-related quality of life of conventional denture wearers after a 12-month follow-up.

Clinical guidelines and procedures for provision of mandibular overdentures on 4 mini-dental implants

This article describes the flapless placement of mini-dental implants (MDI) to retain mandibular overdentures. Clinical inclusion/exclusion criteria and clinical protocols for the flapless placement of MDIs and for retrofitting the overdenture are presented. A minimum bone height of 13 mm and a minimal flap are recommended. After drilling, the 4 implants are placed with a self-tapping process. A minimum of 15 Ncm of resistance upon final insertion indicates that immediate loading can be performed. The metal housings with O-rings are incorporated into the prosthesis using autopolymerizing resin. The technique and protocol for immediately loaded 4-mini-implant mandibular overdentures is minimally invasive and cost effective.

A meta-analysis of retention systems for implant-supported prostheses in partially edentulous jaws

Statement of problem Choosing an appropriate retention system for patients with partial edentulism and dental implants is impeded by a paucity of evidence. The available evidence is extrapolated from either completely edentulous or mixed study populations. Purpose The purpose of this systematic review was to assess the effects of different retention systems used for implant‐supported prostheses in patients with partially edentulous jaws by measuring the rates of failure, survival, and event‐free situations. Material and methods An electronic database search supplemented by a manual search was conducted to identify the best, good, and fair quality studies reporting at least 10 participants with a 1‐year follow‐up (PROSPERO‐CRD 42015024649). Summary estimates of the survival, failure, and event‐free proportions were obtained using a random effects model with a 95% confidence interval. Results Among the 896 citations from 3875 titles identified by the search, 104 studies reporting over 5317 participants with 9568 reconstructions and a total exposure time of 46 553.18 years were included in the analysis. Screw‐retained single crowns showed twofold minor complication even rates (8.5%; 95% confidence interval [CI]: 5.5‐12.9) compared with cement‐retained single crowns (4.2%. 95% CI; 3.2‐5.4). None of the retention systems were more advantageous than the others in relation to failure and event‐free outcomes. However, the summary of the findings suggests that cement‐retained single crowns, splinted crowns, and cantilever‐fixed partial dentures performed better (with fewer events) than screw‐retained restorations in the long term. Conclusions Results suggest that cement retention may be an appropriate system for implant‐supported restorations in partial edentulism. However, high‐quality prospective studies and cost evaluation are recommended to confirm the evidence.

The Effect of Phentolamine on Reversing Soft Tissue Anesthesia An Oral Health Technology Assessment Report

Long-lasting numbness of soft tissues such as lips, tongue, and cheeks after dental anesthesia is not only unpleasant but has the potential to cause self-inflicted damage to the numb tissue. Phentolamine mesylate, when injected in vicinity to the site of local anesthesia, accelerates the absorption of local anesthesia. Dental use of this drug was approved in the United States and Canada in 2008 and 2014, respectively. The rapidly increasing popularity of this novel technology (intraoral phentolamine injections) warrants a health technology assessment for clinicians. A medical librarian conducted a systematic literature search (up to March 1, 2016) for any clinical study involving intraoral phentolamine injection. Meta-analysis of the efficacy data from 4 clinical studies supports the role of intraoral phentolamine injections in shortening the duration of numbness after local anesthesia. No publication bias was found in the selected studies. The selected studies identified no serious adverse events other than pain at the site of injection and some postprocedural pain. Our cost-effectiveness analysis shows phentolamine mesylate to be an effective treatment modality when compared with no treatment, sham, or placebo injection. Phentolamine mesylate incurs an additional cost (in US dollars) of

Community-specific, preventive oral health policies: preventive measures on dental caries

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