Based on available investigations and current trends in oral rehabilitation published in the dental literature, an attempt is made to describe the possible future role of complete dentures. For edentulous patients, complete dentures have for long been the only prosthodontic treatment option. Whereas a large number of edentulous patients report satisfaction with denture usage, a smaller number are unable to adapt; for such patients, sophistication of clinical and technical processes or quality of denture-supporting tissues, appear to have little influence on patient-perceived outcomes. Since the 1980s, osseointegrated dental implants have dramatically improved the therapeutic possibilities, especially so for maladaptive patients. Those able to access such treatment can expect significant improvements in oral functional status and quality of life. While there is a downward trend in edentulism in several countries, it is region-specific, confirming the overriding influence of socio-economic factors on health status. In most societies, despite ageing populations, the need for complete dentures is not likely to reduce in the near future. Whereas a two- or even a one-implant overdenture for the edentulous mandible is increasingly regarded as a minimum standard of care in many developed countries, its routine prescription for the majority in the world who are disadvantaged is unrealistic; for them, even 'low-tech' therapies like conventional dentures are beyond their reach. Improving the conventional management of edentulous patients is a necessity and requires a keener focus by researchers, educators and clinicians in the developed world on the needs of populations with fewer resources.

The future of complete dentures in oral rehabilitation. A critical review

http://www.ykdent.com.tw/pdf/Overdenture/tio2.pdf

Two implant retained overdentures--a review of the literature supporting the McGill and York consensus statements

Statement of problem Dentists and patients are regularly confronted by a difficult treatment question: should a tooth be saved through root canal treatment and restoration (RCT), be extracted without any tooth replacement, be replaced with a fixed partial denture (FPD) or an implant-supported single crown (ISC)? Purpose The purpose of this systematic review was to compare the outcomes, benefits, and harms of endodontic care and restoration compared to extraction and placement of ISCs, FPDs, or extraction without tooth replacement. Material and methods Searches performed in MEDLINE, Cochrane, and EMBASE databases were enriched by hand searches, citation mining, and expert recommendation. Evidence tables were developed following quality and inclusion criteria assessment. Pooled and weighted mean success and survival rates, with associated confidence intervals, were calculated for single implant crowns, fixed partial dentures, and initial nonsurgical root canal treatments. Data related to extraction without tooth replacement and psychosocial outcomes were evaluated by a narrative review due to literature limitations. Results The 143 selected studies varied considerably in design, success definition, assessment methods, operator type, and sample size. Direct comparison of treatment types was extremely rare. Limited psychosocial data revealed the traumatic effect of loss of visible teeth. Economic data were largely absent. Success rates for ISCs were higher than for RCTs and FPDs, respectively; however, success criteria differed greatly among treatment types, rendering direct comparison of success rates futile. Long-term survival rates for ISCs and RCTs were similar and superior to those for FPDs. Conclusions Lack of comparative studies with similar outcomes criteria with comparable time intervals limited comparison of these treatments. ISC and RCT treatments resulted in superior long-term survival, compared to FPDs. Limited data suggested that extraction without replacement resulted in inferior psychosocial outcomes compared to alternatives. Long-term, prospective clinical trials with large sample sizes and clearly defined outcomes criteria are needed.

/pdf/outcomes-of-root-canal-treatment-and-restoration-implant-5bgq2igpwa.pdf

Outcomes of root canal treatment and restoration, implant-supported single crowns, fixed partial dentures, and extraction without replacement: A systematic review

Aim To establish how widespread the emotional effects of tooth loss are. Method A questionnaire, distributed to 100 edentulous people undergoing routine prosthetic care in the Department of Prosthetic Dentistry at Guy's, King's and St Thomas' Dental Institute (GKT), was used to explore the emotional effects of tooth loss. Results Ninety four people completed the questionnaire of whom 42 stated that they had experienced difficulties in accepting the loss of their teeth. In comparison with people who had no difficulties in accepting the situation, these people were: more likely to feel less confident about themselves; more likely to feel inhibited in carrying out everyday activities; and less able to accept the inevitable change in facial shape which occurs following the loss of teeth. Additionally, they took longer to come to terms with their tooth loss (All these differences were statistically significant). Just over three-quarters of the people who were unprepared for the loss of their teeth, felt that an explanation from the dentist prior to dental extractions would have helped. Conclusion The impact that tooth loss can have on people and their lives should not be underestimated. In this study it affected 45% of the participants.

/pdf/the-emotional-effects-of-tooth-loss-a-preliminary-4juiz7ftuo.pdf

The emotional effects of tooth loss: a preliminary quantitative study.

Age- and sex-related changes in the normal human ear

The Annual Conference of the BSSPD (British Society for the Study of Prosthetic Dentistry) was held in York on 6 and 7 April 2009 At the symposium on mandibular overdentures, presenters offered a synopsis of the research available on the efficacy of implant-supported mandibular overdentures in the edentulous mandible Emphasis was given to both qualitative and quantitative research based on patient-centred outcomes of treatment A draft consensus was circulated to all presenters and to the Council members of the BSSPD and to BSSPD members on the Society's website The statement was modified in the light of their comments, audience feedback following the presentations and members' feedback We hope that this consensus statement will be a useful guide for patients and clinicians and that it will act to stimulate wider debate We also hope that it will prove useful to other patient and professional organisations and will inform discussions with providers of national healthcare and with independent funders

/pdf/mandibular-two-implant-supported-overdentures-as-the-first-1pom6k59d9.pdf

Mandibular two implant-supported overdentures as the first choice standard of care for edentulous patients - The york consensus statement

Objective: To assess the oral health impact profile (OHIP) on edentulous subjects in Scotland and England who needed to have their dentures replaced, and to determine whether any change in the subjects’ assessment of their original and replacement dentures impacted on oral health related quality of life parameters.



Background:  The loss of all teeth may impact on functional activities. The OHIP is an instrument used to measure subjects’ perception of the social impact of oral disorders on their well being.



Methods:  A total of 58 edentulous subjects were studied. Subjects completed the OHIP-14 questionnaires before and after being provided with a set of replacement complete dentures. They also assessed specific features of the upper and lower dentures. Responses were recorded on a Likert scale.



Results:  For many subjects, the responses in the before treatment questionnaires were at the lower end of the Likert scale, indicating that there were no major impacts on oral health related quality of life parameters. There were significant improvements in four of the 14 OHIP parameters assessed after treatment. With the new dentures, subjects expressed improved satisfaction, particularly for the lower prosthesis. There were no major differences between the responses of the subjects in Scotland and England.



Conclusion:  For this group of edentulous subjects, although they may need dentures to be replaced after a period of wear, this does not necessarily have significant social impacts. For this reason the provision of new dentures did not result in major changes to the OHIP.

A study to compare the oral health impact profile and satisfaction before and after having replacement complete dentures in England and Scotland

Purpose The purpose of this study was to compare the emotional effects of tooth loss in three edentulous populations. Materials and methods A questionnaire study involved 142 edentulous subjects undergoing routine prosthodontic care at Guy's, King's and St Thomas's Dental Institute, London; the Dental School, Dundee, Scotland; and the Faculty of Dentistry, University of Hong Kong. Data were analyzed using the chi-squared test. Results Difficulty in accepting tooth loss was a relatively common experience (44%) in all groups, with almost half feeling that their confidence had been affected. The majority (66%) felt that their choice of food was restricted and that the overall eating experience was less enjoyable, particularly the Hong Kong group. A significant proportion of the participants were concerned about their appearance without dentures, although the trend was less marked in Hong Kong. Forty-three percent felt that they were not adequately prepared for tooth loss, although the Hong Kong group was least concerned. Conclusion In general, the emotional effect of tooth loss was significant in all groups. The restrictions on daily activities were generally greater in the Hong Kong group. However, this group was much less inhibited by denture wearing. The differences observed in the Hong Kong Chinese are most likely due to different cultural values and expectations associated with these aspects of daily living.

A transcultural perspective on the emotional effect of tooth loss in complete denture wearers.

The emotional effects of tooth loss in partially dentate people attending prosthodontic clinics in dental schools in England, Scotland and Hong Kong: a preliminary investigation.

Brendan J. J. Scott

Papers

Mandibular two implant-supported overdentures as the first choice standard of care for edentulous patients - The york consensus statement

The emotional effects of tooth loss: a preliminary quantitative study.

A study to compare the oral health impact profile and satisfaction before and after having replacement complete dentures in England and Scotland

A transcultural perspective on the emotional effect of tooth loss in complete denture wearers.

The emotional effects of tooth loss in partially dentate people attending prosthodontic clinics in dental schools in England, Scotland and Hong Kong: a preliminary investigation.