Publications by authors named "Jocelyne Feine"

87 Publications

A 5-Year Esthetic RCT Assessment of Anterior Maxillary Single-Tooth Implants with Different Abutment Interfaces.

Int J Oral Maxillofac Implants 2021 Jan-Feb;36(1):165-176

Purpose: This study sought to define the tissue responses at different implant-abutment interfaces by studying bone and peri-implant mucosal changes using a 5-year prospective randomized clinical trial design study. The conus interface was compared with the flat-to-flat interface and platform-switched implant-abutment systems.

Materials And Methods: One hundred forty-one subjects were recruited and randomized to the three treatment groups according to defined inclusion and exclusion criteria. Following implant placement and immediate provisionalization in healed alveolar ridges, clinical, photographic, and radiographic parameters were measured at 6 months and annually for 5 years. The calculated changes in marginal bone levels, peri-implant mucosal zenith location, papillae lengths, and peri-implant Plaque Index and bleeding on probing were statistically compared.

Results: Forty-eight conus interface implants, 49 flat-to-flat interface implants, and 44 platform-switched implants were placed in 141 subjects. Six platform-switched interface and eight flatto- flat interface implants failed, most of them within 3 months. After 5 years, 33 conical interface, 28 flat-to-flat interface, and 27 platform-switched interface implants remained for evaluation. Calculation of marginal bone level change showed a mean marginal bone loss of -0.16 ± 0.45 (-1.55 to 0.65), -0.92 ± 0.70 (-2.90 to 0.20), and -0.81 ± 1.06 (-3.35 to 1.35) mm for conical interface, flat-to-flat interface, and platform-switched interface implants, respectively (P < .0005). The peri-implant mucosal zenith changes were minimal for all three interface designs (0.10 mm and +0.08 mm, P > .60). Only 16% to 19% of the surfaces had presence of bleeding on probing, with no significant differences (P > .81) between groups. Interproximal tissue changes were positive and similar among the implant interface designs.

Conclusion: Over 5 years, the immediate provisionalization protocol resulted in stable peri-implant mucosal responses for all three interfaces. Compared with the flat-to-flat and platform-switched interfaces, the conical interface implants demonstrated significantly less early marginal bone loss. The relationship of marginal bone responses and mucosal responses requires further experimental consideration.
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http://dx.doi.org/10.11607/jomi.8333DOI Listing
February 2021

The McGill Denture Satisfaction Questionnaire revisited: Exploratory factor analysis of a binational sample.

Gerodontology 2020 Sep 3;37(3):233-243. Epub 2020 Jun 3.

Oral Health and Society, Faculty of Dentistry, McGill University, Montreal, QC, Canada.

Objectives: To examine the McGill Denture Satisfaction Questionnaire (MDSQ) in terms of dimensionality, item reduction and construct validity in a binational sample of complete denture wearers.

Materials And Methods: We conducted secondary analyses of baseline data from two studies on implant-retained overdentures: a quasi-experimental study in the United States (n = 145) and a randomised trial in Brazil (n = 120). All participants wore upper/lower dentures and responded at baseline to the MDSQ items concerning their original mandibular dentures. A putative model of the MDSQ items resulted in two question subsets: (a) overall satisfaction, retention/stability, aesthetics, cleaning, speech and comfort, plus general chewing ability; (b) mastication of specific foods. Analyses focused on the internal consistency of each subset and possible item reduction, using Cronbach's alpha (Cα), inter-item correlation and exploratory factor analysis (EFA).

Results: The 1st subset showed high inter-item correlation for most question combinations and no redundancy (r ≤ .8). An item on cleaning had low correlation, but its removal does not increase internal consistency (Cα ≥ .83). Results were similar for both studies, with EFA showing a single significant factor (namely "overall satisfaction, lower denture") able to explain nearly 54% of the variance. The 2nd subset also shows strong internal consistency (Cα ≥ .95) and inter-item correlation, with a single factor representing 65% of the variation.

Conclusions: This study discloses the reliability and construct validity of the MDSQ for patient-centred evaluation of complete dental prostheses in the edentulous mandible. Findings also support the use of both "overall satisfaction" and "masticatory ability" as summary scores, for improved outcome assessment.
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http://dx.doi.org/10.1111/ger.12477DOI Listing
September 2020

University-based initiatives towards better access to oral health care for rural and remote populations: A scoping review.

PLoS One 2019 31;14(5):e0217658. Epub 2019 May 31.

Faculty of Dentistry, McGill University, Montreal, Quebec, Canada.

This scoping review maps a wide array of literature to identify academic programs that have been developed to enhance oral health care for rural and remote populations and to provide an overview of their outcomes. Arksey and O'Malley's 5-stage scoping review framework has steered this review. We conducted a literature search with defined eligibility criteria through electronic databases, websites of academic records, professional and rural oral health care organizations as well as grey literature spanning the time interval from the late 1960s to May 2017. The charted data was classified, analyzed and reported using a thematic approach. A total of 72 citations (67 publications and seven websites) were selected for the final review. The review identified 62 universities with program initiatives towards improving access to oral health care in rural and remote communities. These initiatives were classified into three categories: training and education of dental and allied health students and professionals, education and training of rural and remote community members and oral health care services. The programs were successful in terms of dental students' positive perception about rural practice and their enhanced competencies, students' increased adoption of rural practices, non-dental health care providers' improved oral health knowledge and self-efficacy, rural oral health and oral health services' improvement, as well as cost-effectiveness compared to other strategies. The results of our review suggest that these innovative programs were effective in improving access to oral health care in rural and remote regions and may serve as models for other academic institutions that have not yet implemented such programs.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0217658PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6544292PMC
January 2020

Three-Year Prospective Randomized Comparative Assessment of Anterior Maxillary Single Implants with Different Abutment Interfaces.

Int J Oral Maxillofac Implants 2019 Jan/Feb;34(1):150-158

Purpose: The goal of this investigation was to define time-dependent peri-implant tissue changes at implants with different abutment interface designs.

Materials And Methods: Participants requiring replacement of single maxillary anterior and first premolar teeth were recruited and treated under an institutional review board (IRB)-approved protocol. Implants, titanium abutments, and provisional crowns were placed in healed ridges 5 months following preservation after tooth extraction with recombinant human bone morphogenetic protein-2 (rhBMP-2). Twelve weeks later, permanent crowns were placed on patient-specific abutments and evaluated at 6, 12, and 36 months following implant placement. Clinical and radiographic assessments of abutments and crowns, peri-implant mucosa, and marginal bone levels were recorded.

Results: The 3-year assessment included 45 conical interface (CI), 34 flat-to-flat interface (FI), and 32 platform-switched interface (PS) implants in 111 participants. At 3 years, the mean marginal bone level (MBL) change at CI, FI, and PS implants was -0.12, -1.02, and -1.04 mm, respectively (P = .014). "Zero" MBL loss or gain was measured over the 3-year period at 72.1% CI, 3.0% FI, and 16.6% PS implants. There was a minor change (0.0 to 0.3 mm) in peri-implant mucosal zenith positions over time and between groups. Eighty percent of CI implants, 61% of FI implants, and 84% of PS implants were observed to have a clinically stable peri-implant mucosal zenith position with less than 0.5 mm of measured recession. Over the 36-month period, there were no significant changes in the location of mesial or distal papilla in any group.

Conclusion: Significant differences in MBLs were observed at different implant interfaces. Conical implant interfaces, but not flat-to-flat or platform-switched implant interfaces, were associated with no MBL changes over 3 years. Peri-implant mucosal stability was generally observed. The relationship of marginal bone responses and peri-implant mucosal stability requires further evaluation.
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http://dx.doi.org/10.11607/jomi.6810DOI Listing
March 2019

Group 3 ITI Consensus Report: Patient-reported outcome measures associated with implant dentistry.

Clin Oral Implants Res 2018 Oct;29 Suppl 16:270-275

Universidad Inter Continental, Mexico City, Mexico.

Objectives: The aim of Working Group 3 was to focus on three topics that were assessed using patient-reported outcome measures (PROMs). These topics included the following: (a) the aesthetics of tooth and implant-supported fixed dental prostheses focusing on partially edentulous patients, (b) a comparison of fixed and removable implant-retained prostheses for edentulous populations, and (c) immediate versus early/conventional loading of immediately placed implants in partially edentate patients. PROMs include ratings of satisfaction and oral health-related quality of life (QHRQoL), as well as other indicators, that is, pain, general health-related quality of life (e.g., SF-36).

Materials And Methods: The Consensus Conference Group 3 participants discussed the findings of the three systematic review manuscripts. Following comprehensive discussions, participants developed consensus statements and recommendations that were then discussed in larger plenary sessions. Following this, any necessary modifications were made and approved.

Results: Patients were very satisfied with the aesthetics of implant-supported fixed dental prostheses and the surrounding mucosa. Implant neck design, restorative material, or use of a provisional restoration did not influence patients' ratings. Edentulous patients highly rate both removable and fixed implant-supported prostheses. However, they rate their ability to maintain their oral hygiene significantly higher with the removable prosthesis. Both immediate provisionalization and conventional loading receive positive patient-reported outcomes.

Conclusions: Patient-reported outcome measures should be gathered in every clinical study in which the outcomes of oral rehabilitation with dental implants are investigated. PROMs, such as patients' satisfaction and QHRQoL, should supplement other clinical parameters in our clinical definition of success.
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http://dx.doi.org/10.1111/clr.13299DOI Listing
October 2018

Pink Esthetic Score Outcomes Around Three Implant-Abutment Configurations: 3-Year Results.

Int J Oral Maxillofac Implants 2018 Sep/Oct;33(5):1126-1135

Purpose: To evaluate the influence that three different implant-abutment interface designs had on peri-implant mucosal outcomes as assessed by the pink esthetic score (PES) 3 years after delayed implant placement and immediate provisionalization.

Materials And Methods: Adult subjects (n = 141) requiring replacement of a bounded single tooth in the anterior maxilla as well as first premolar sites were randomized to receive one of three unique implant-abutment interface designs (conical interface [CI]; flat-to-flat interface [FI]; or platform-switch interface [PS]). Treatment included immediate provisionalization with prefabricated titanium abutments, followed by custom computer-aided design/computer-aided manufacturing (CAD/CAM) zirconia abutments and cement-retained, all-ceramic crowns delivered after 12 weeks. Bilateral (anterior sites) or unilateral (premolar sites) digital clinical photographs were made at 1, 3, 6, 12, 24, and 36 months post-implant placement. Five calibrated faculty evaluators who previously scored the 1-year PES image dataset scored the 24- and 36-month photographs using a digital, cloud-based tablet interface.

Results: Six hundred ten clinical photographs were evaluated, resulting in a total of 3,050 sum PES values and 21,350 individual PES values. Faculty evaluator intrarater and interrater reliability were found to be "substantial," with intraclass correlation coefficient (ICC) values of 0.76 and 0.77, respectively. All three implant-abutment interface groups demonstrated acceptable esthetics at 3 years (mean sum PES = 10.1 ± 1.9, 4.0 to 13.2), with no single group demonstrating significantly greater mean sum PES values than another at the 3-year follow-up or at any recall interval in between.

Conclusion: No significant differences were observed in mean sum PES scores for subjects randomized to one of three different implant-abutment interface geometries. Within the limitations of this study thus far, the first 6 months following definitive prosthesis delivery appear to still be the most significant with regard to improvement in PES outcomes for all three treatment groups.
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http://dx.doi.org/10.11607/jomi.6659DOI Listing
November 2018

The patient general satisfaction of mandibular single-implant overdentures and conventional complete dentures: Study protocol for a randomized crossover trial.

Medicine (Baltimore) 2018 May;97(20):e10721

Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University Implant Center, Showa University Dental Hospital, Tokyo, Japan Oral Health and Society Division, Faculty of Dentistry, McGill University, Quebec, Canada.

Background: Mandibular overdentures retained by a single implant placed in the midline of edentulous mandible have been reported to be more comfortable and function better than complete dentures. Although single-implant overdentures are still more costly than conventional complete dentures, there are a few studies which investigated whether mandibular single-implant overdentures are superior to complete dentures when patient general satisfaction is compared. The aim of this study is to assess patient general satisfaction with mandibular single-implant overdentures and complete dentures.

Methods: This study is a randomized crossover trial to compare mandibular single-implant overdentures and complete dentures in edentulous individuals. Participant recruitment is ongoing at the time of this submission. Twenty-two participants will be recruited. New mandibular complete dentures will be fabricated. A single implant will be placed in the midline of the edentulous mandible. The mucosal surface of the complete denture around the implant will be relieved for 3 months. The participants will then be randomly allocated into 2 groups according to the order of the interventions; group 1 will receive single-implant overdentures first and will wear them for 2 months, followed by complete dentures for 2 months. Group 2 will receive the same treatments in a reverse order. After experiencing the 2 interventions, the participants will choose one of the mandibular prostheses, and yearly follow-up visits are planned for 5 years. The primary outcome of this trial is patient ratings of general satisfaction on 100 mm visual analog scales. Assessments of the prostheses and oral health-related quality of life will also be recorded as patient-reported outcomes. The secondary outcomes are cost and time for treatment. Masticatory efficiency and cognitive capacity will also be recorded. Furthermore, qualitative research will be performed to investigate the factors associated with success of these mandibular denture types. Clinical outcomes, such as implant survival rate, marginal bone loss, and prosthodontic complications, will also be recorded.

Discussion: The results of this randomized crossover trial will clarify whether mandibular single implants and overdentures for edentulous individuals provide better patient general satisfaction when compared to conventional complete dentures.

Trial Registration: This clinical trial was registered at the University Hospital Medical Information Network (UMIN) Center (UMIN000017883).
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http://dx.doi.org/10.1097/MD.0000000000010721DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5976348PMC
May 2018

Do traditional techniques produce better conventional complete dentures than simplified techniques? A 10-year follow-up of a randomized clinical trial.

J Dent 2018 07 22;74:30-36. Epub 2018 May 22.

McGill University Faculty of Dentistry, 2001 3640 rue University, Montreal, QC, H3A 0C7, Canada. Electronic address:

Objectives: The use of a simplified method (S) of fabricating complete dentures has been shown to be more cost-efficient than the traditional method (T), and there are no negative consequences that detract from the cost savings in the short term. However, it is not clear whether this remains constant over a decade. The objective of this study was to clarify patients' perspectives and determine any differences between the dentures fabricated with these two different techniques after a decade of use.

Material And Methods: Edentate individuals participated in a randomized controlled clinical trial and completed a 6-month follow-up from 2001 to 2003 (T group n = 50; S group n = 54). For this 10-year follow-up, they were interviewed by telephone. The assessment included whether the denture was still in use or replaced, the condition of the dentures, patient satisfaction and oral health-related quality of life (OHRQoL). Between and within-group differences and the factors that cause deterioration of oral health-related quality of life (OHRQoL) were determined.

Results: Among 54 responders (25 T and 29 S), 14T and 21S kept the original dentures. Both groups were similar in ratings of satisfaction and OHRQoL (maxilla T: 80.0 S: 86.0, p = 0.36; mandibular; T: 66.1 S: 72.3, p = 0.48; OHRQoL T: 111.1 S: 108.5, p = 0.46). Irrespective of fabrication method, discomfort, chewing difficulty and esthetics were the factors that deteriorate OHRQoL (adjusted r = 0.76, p < 0.001).

Conclusion: The results indicate that the simplified method remains more cost-efficient than the traditional method over a 10-year period. (IRB approval: A09-E71-12 B McGill University, trial registry: ClinicalTrial.org; NCT02289443).
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http://dx.doi.org/10.1016/j.jdent.2018.04.027DOI Listing
July 2018

Assessing Dental Students' Readiness to Treat Populations That Are Underserved: A Scoping Review.

J Dent Educ 2018 May;82(5):483-491

Linda Furlini, PhD, is Research Associate, Division of Oral Health and Society, Faculty of Dentistry, McGill University; Nioushah Noushi, MSc, is a PhD student, Division of Oral Health and Society, Faculty of Dentistry, McGill University; Geneviève Castonguay, PhD, is Research Associate, Division of Oral Health and Society, Faculty of Dentistry, McGill University; Paul Allison, PhD, is Dean, Faculty of Dentistry, McGill University; Christophe Bedos, PhD, is Associate Professor, Division of Oral Health and Society, Faculty of Dentistry, McGill University; Raphael De Souza, PhD, is Associate Professor, Division of Oral Health and Society, Faculty of Dentistry, McGill University; Shahrokh Esfandiari, PhD, is Associate Dean, Faculty of Dentistry, McGill University; Richard Hovey, PhD, is Associate Professor, Division of Oral Health and Society, Faculty of Dentistry, McGill University; Mary Ellen Macdonald, PhD, is Associate Professor, Division of Oral Health and Society, Faculty of Dentistry, McGill University; Martin Morris, MSc, is Librarian, Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University; Belinda Nicolau, PhD, is Associate Professor, Division of Oral Health and Society, Faculty of Dentistry, McGill University; Frances Power, DDS, is Assistant Professor, Division of Oral Health and Society, Faculty of Dentistry, McGill University; and Jocelyne Feine, PhD, is Professor, Division of Oral Health and Society, Faculty of Dentistry, McGill University.

In North America, all dental schools have adopted some form of community-based dental education (CBDE) or service-learning, but little is known about the areas being researched and reported in published studies. The aim of this study was to conduct a scoping review to determine what areas of research had been conducted to determine the effects of CBDE on dental students' readiness to treat populations that are underserved. A systematic search of articles published in English or French since 2000 was performed on July 29, 2015, and combined quantitative and qualitative synthesis of data was conducted. Of the 32 studies evaluated, 23 (72%) were quantitative, seven (22%) were qualitative, and two were multi-method. The majority (66%) used self-report methods, most frequently surveys. Participants in 50% of the studies were fourth-year dental students; the others assessed third- and fourth-year (13%), first- and second-year (6%), and first-year (13%) students. Dentists were the participants in three studies (9%), with dentists and students in one study (3%). Either the types of populations receiving care were unspecified or four or more groups were pooled together in 25 studies (78%), while two focused on children, one on rural populations, one on elderly populations, two on persons with special health care needs, and one on low-income populations. The study areas were wide-ranging, but generally fell into three categories: student performance (37.5%), teaching approaches and evaluation methods (37.5%), and perceptions of CBDE (25%). This review identified many research gaps for determining whether students are prepared to treat populations that are underserved. The disparate nature of CBDE research demonstrates a compelling argument for determining elements that define student readiness to care for patients who are underserved and for research that includes the voices of patients, curriculum development, and more comprehensive and rigorous evaluation methodologies.
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http://dx.doi.org/10.21815/JDE.018.053DOI Listing
May 2018

Single-implant overdentures retained by the Novaloc attachment system: study protocol for a mixed-methods randomized cross-over trial.

Trials 2018 Apr 23;19(1):243. Epub 2018 Apr 23.

Division of Oral Health and Society, Faculty of Dentistry, McGill University, 2001 McGill College Avenue, Suite 500, Montréal, QC, H3A 1G1, Canada.

Background: Overdentures retained by a single implant in the midline have arisen as a minimal implant treatment for edentulous mandibles. The success of this treatment depends on the performance of a single stud attachment that is susceptible to wear-related retention loss. Recently developed biomaterials used in attachments may result in better performance of the overdentures, offering minimal retention loss and greater patient satisfaction. These biomaterials include resistant polymeric matrixes and amorphous diamond-like carbon applied on metallic components. The objective of this explanatory mixed-methods study is to compare Novaloc, a novel attachment system with such characteristics, to a traditional alternative for single implants in the mandible of edentate elderly patients.

Methods/design: We will carry out a randomized cross-over clinical trial comparing Novaloc attachments to Locators for single-implant mandibular overdentures in edentate elderly individuals. Participants will be followed for three months with each attachment type; patient-based, clinical, and economic outcomes will be gathered. A sample of 26 participants is estimated to be required to detect clinically relevant differences in terms of the primary outcome (patient ratings of general satisfaction). Participants will choose which attachment they wish to keep, then be interviewed about their experiences and preferences with a single implant prosthesis and with the two attachments. Data from the quantitative and qualitative assessments will be integrated through a mixed-methods explanatory strategy. A last quantitative assessment will take place after 12 months with the preferred attachment; this latter assessment will enable measurement of the attachments' long-term wear and maintenance requirements.

Discussion: Our results will lead to evidence-based recommendations regarding these systems, guiding providers and patients when making decisions on which attachment systems and implant numbers will be most appropriate for individual cases. The recommendation of a specific attachment for elderly edentulous patients may combine positive outcomes from patient perspectives with low cost, good maintenance, and minimal invasiveness.

Trial Registration: ClinicalTrials.gov, NCT03126942 . Registered on 13 April 2017.
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http://dx.doi.org/10.1186/s13063-018-2606-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5913792PMC
April 2018

Rural-urban disparity in oral health-related quality of life.

Community Dent Oral Epidemiol 2018 04 21;46(2):132-142. Epub 2017 Sep 21.

Faculty of Dentistry, McGill University, Montréal, QC, Canada.

Objectives: The objective of this population-based cross-sectional study was to estimate rural-urban disparity in the oral health-related quality of life (OHRQoL) of the Quebec adult population.

Methods: A 2-stage sampling design was used to collect data from the 1788 parents/caregivers of schoolchildren living in the 8 regions of the province of Quebec in Canada. Andersen's behavioural model for health services utilization was used as a conceptual framework. Place of residency was defined according to the Statistics Canada Census Metropolitan Area and Census Agglomeration Influenced Zone classification. The outcome of interest was OHRQoL measured using the Oral Health Impact Profile (OHIP)-14 validated questionnaire. Data weighting was applied, and the prevalence, extent and severity of negative oral health impacts were calculated. Statistical analyses included descriptive statistics, bivariate analyses and binary logistic regression.

Results: The prevalence of poor oral health-related quality life (OHRQoL) was statistically higher in rural areas than in urban zones (P = .02). Rural residents reported a significantly higher prevalence of negative daily-life impacts in pain, psychological discomfort and social disability OHIP domains (P < .05). Additionally, the rural population showed a greater number of negative oral health impacts (P = .03). There was no significant rural-urban difference in the severity of poor oral health. Logistic regression indicated that the prevalence of poor OHRQoL was significantly related to place of residency (OR = 1.6; 95% CI = 1.1-2.5; P = .022), perceived oral health (OR = 9.4; 95% CI = 5.7-15.5; P < .001), dental treatment needs factors (perceived need for dental treatment, pain, dental care seeking) (OR = 8.7; 95% CI = 4.8-15.6; P < .001) and education (OR = 2.7; 95% CI = 1.8-3.9; P < .001).

Conclusion: The results of this study suggest a potential difference in OHRQoL of Quebec rural and urban populations, and a need to develop strategies to promote oral health outcomes, specifically for rural residents. Further studies are needed to confirm these results.
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http://dx.doi.org/10.1111/cdoe.12344DOI Listing
April 2018

Patient satisfaction with laser-sintered removable partial dentures: A crossover pilot clinical trial.

J Prosthet Dent 2018 Apr 11;119(4):560-567.e1. Epub 2017 Jul 11.

Faculty of Dentistry, Division of Restorative Dentistry, McGill University, Montreal, Quebec, Canada. Electronic address:

Statement Of Problem: Clinical data regarding newly introduced laser-sintered removable partial dentures (RPDs) are needed before this technique can be recommended. Currently, only a few clinical reports have been published, with no clinical studies.

Purpose: This clinical trial compared short-term satisfaction in patients wearing RPDs fabricated with conventional or computer-aided design and computer-aided manufacturing (CAD-CAM) laser-sintering technology.

Material And Methods: Twelve participants with partial edentulism were enrolled in this pilot crossover double-blinded clinical trial. Participants were randomly assigned to wear cast or CAD-CAM laser-sintered RPDs for alternate periods of 30 days. The outcome of interest was patient satisfaction as measured using the McGill Denture Satisfaction Instrument. Assessments was conducted at 1, 2, and 4 weeks. The participant's preference in regard to the type of prosthesis was assessed at the final evaluation. The linear mixed effects regression models for repeated measures were used to analyze the data, using the intention-to-treat principle. To assess the robustness of potential, incomplete adherence, sensitivity analyses were conducted.

Results: Statistically significant differences were found in patients' satisfaction between the 2 methods of RPD fabrication. Participants were significantly more satisfied with laser-sintered prostheses than cast prostheses in regard to general satisfaction, ability to speak, ability to clean, comfort, ability to masticate, masticatory efficiency, and oral condition (P<.05). At the end of the study, 5 participants preferred the laser-sintered, 1 preferred the cast RPD, and 3 had no preference.

Conclusions: The use of CAD-CAM laser-sintering technology in the fabrication of removable partial dentures may lead to better outcomes in terms of patient satisfaction in the short term. The conclusion from this pilot study requires confirmation by a larger randomized controlled trial.

Clinical Trial: ClinicalTrials.gov. A study about patient satisfaction with laser-sintered removable partial dentures; NCT02769715.
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http://dx.doi.org/10.1016/j.prosdent.2017.04.021DOI Listing
April 2018

Erratum to: Osseointegration of standard and mini dental implants: a histomorphometric comparison.

Int J Implant Dent 2017 Dec 28;3(1):28. Epub 2017 Jun 28.

Faculty of Dentistry, McGill University, 2001 McGill College Avenue, Suite 500, Montreal, Quebec, H3A 1G1, Canada.

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http://dx.doi.org/10.1186/s40729-017-0088-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5489440PMC
December 2017

In vitro comparison of two titanium dental implant surface treatments: 3M™ESPE™ MDIs versus Ankylos®.

Int J Implant Dent 2017 Dec 27;3(1):27. Epub 2017 Jun 27.

Faculty of Dentistry, McGill University, Montreal, Quebec, Canada.

Background: An ideal implant should have a surface that is conducive to osseointegration. In vitro cell culture studies using disks made of same materials and surface as of implants may provide useful information on the events occurring at the implant-tissue interface. In the current study, we tested the hypothesis that there is no difference in the proliferation and differentiation capacities of osteoblastic cells when cultured on titanium disks mimicking the surface of 3M™ESPE™ MDIs or standard (Ankylos®) implants.

Methods: Cells were grown on disks made of the same materials and with same surface texture as those of the original implants. Disks were sterilized and coated with 2% gelatin solution prior to the cell culture experiments. C2C12 pluripotent cells treated with 300 ng/ml bone morphogenetic protein 2 BMP-2 and a stably transfected C2C12 cell line expressing BMP2 were used as models for osteogenic cells. The Hoechst 33258-stained nuclei were counted to assay cell proliferation, while alkaline phosphatase (ALPL) immunostaining was performed to investigate osteogenic differentiation. MC3T3-E1 cells were cultured as model osteoblasts. The cells were differentiated and assayed for proliferation and metabolic activities by Hoechst 33258 staining and Alamar blue reduction assays, respectively. Additionally, cultures were stained by calcein to investigate their mineral deposition properties.

Results: Electron microscopy showed greater degree of roughness on the MDI surfaces. Nuclear counting showed significantly higher number of C2C12 cells on the MDI surface. Although immunostaining detected higher number of ALPL-positive cells, it was not significant when normalized by cell numbers. The number of MC3T3-E1 cells was also higher on the MDI surface, and accordingly, these cultures showed higher Alamar blue reduction. Finally, calcein staining revealed that the MC3T3-E1 cells grown on MDI surfaces deposited more minerals.

Conclusions: Although both implant surfaces are conducive for osteoblastic cell attachment, proliferation, and extracellular matrix mineralization, cell proliferation is higher on MDI surfaces, which may in turn facilitate osseointegration via increased ECM mineralization.
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http://dx.doi.org/10.1186/s40729-017-0083-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5487315PMC
December 2017

Improving practice guidelines for the treatment of denture-related erythematous stomatitis: a study protocol for a randomized controlled trial.

Trials 2017 05 5;18(1):211. Epub 2017 May 5.

Faculty of Dental Medicine, Université de Montréal, Montreal, QC, Canada.

Background: Denture-related erythematous stomatitis (DES) is a chronic biofilm-mediated disease, affecting one in every three complete denture wearers. Antifungals are the treatment most commonly prescribed by oral health professionals, based on the belief that colonization by Candida spp. is the main cause of DES. However, high recurrence rates and adverse effects are commonly observed, prompting the need for practice guidelines regarding treatment. Results from our pilot study demonstrate that palatal brushing can reduce the palatal inflammation and potentially associated Candida carriage without any need for antifungal therapy. The objective of this study is to validate these pilot results by means of a randomized controlled trial (RCT) and provide a practice guideline for clinicians.

Methods/design: A pragmatic, two-parallel-arm, multicenter RCT will be conducted in Canada, Brazil, and Chile. Fifty-two adult complete denture wearers presenting with moderate to severe DES will be allocated randomly to two groups: the Intervention arm will consist of palatal brushing and standard oral and denture hygiene measures, while the Control arm will include only standard oral and denture hygiene measures. The study outcome will be the oral Candida carriage. Participants will be assessed at baseline, and at 3 and 6 months post intervention. Descriptive, bivariate, and mixed models with repeated measures will be performed following the intention-to-treat principle.

Discussion: This pragmatic RCT will serve to provide a clinical practice guideline regarding the use of preventive measures in the treatment of biofilm-mediated oral diseases. Moreover, it will have a great impact on reducing the harm of antifungal overtreatment on patients suffering from DES.

Trial Registration: ClinicalTrials.gov, NCT02686632 . Registered on 15 February 2016.
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http://dx.doi.org/10.1186/s13063-017-1947-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5420092PMC
May 2017

Osseointegration of standard and mini dental implants: a histomorphometric comparison.

Int J Implant Dent 2017 Dec 1;3(1):15. Epub 2017 May 1.

Faculty of Dentistry, McGill University, 2001 McGill College Avenue, Suite 500, Montreal, Quebec, H3A 1G1, Canada.

Background: Mini dental implants (MDIs) are becoming increasingly popular for rehabilitation of edentulous patients because of their several advantages. However, there is a lack of evidence on the osseointegration potential of the MDIs. The objective of the study was to histomorphometrically evaluate and compare bone apposition on the surface of MDIs and standard implants in a rabbit model.

Methods: Nine New Zealand white rabbits were used for the study to meet statistical criteria for adequate power. Total 18 3MESPE MDIs and 18 standard implants (Ankylos Friadent, Dentsply) were inserted randomly into the tibia of rabbits (four implants per rabbit); animals were sacrificed after a 6-week healing period. The specimens were retrieved en bloc and preserved in 10% formaldehyde solution. Specimens were prepared for embedding in a light cure acrylic resin (Technovit 9100). The most central sagittal histological sections (30-40 μm thick) were obtained using a Leica SP 1600 saw microtome. After staining, the Leica DM2000 microscope was used, the images were captured using Olympus DP72 camera and associated software. Bone implant contact (BIC) was measured using Infinity Analyze software.

Results: All implants were osseointegrated. Histologic measures show mineralized bone matrix in intimate contact with the implant surface in both groups. The median BIC was 57.5% (IQR 9.0) in the MDI group and 55.0% (IQR 4.5) in the control group (P > 0.05, Mann-Whitney test). There were no statistical differences in osseointegration at 6 weeks between MDIs and standard implants in rabbit tibias.

Conclusions: Based on these results, it is concluded that osseointegration of MDIs is similar to that of standard implants.
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http://dx.doi.org/10.1186/s40729-017-0079-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5411366PMC
December 2017

Customized SmartPeg for measurement of resonance frequency of mini dental implants.

Int J Implant Dent 2017 Dec 1;3(1). Epub 2017 Feb 1.

Faculty of Dentistry, McGill University, 2001 McGill College Avenue, Suite 500, Montreal, Quebec, H3A 1G1, Canada.

Background: One-piece narrow diameter implants (NDIs) have been recommended as "Single-tooth replacements in the anterior zones, single posterior, multiple-unit fixed dental prosthesis (FDP), edentulous jaws to be rehabilitated with FDP, and edentulous jaws rehabilitation with overdentures in situations with reduced mesiodistal space or reduced ridge width." (ITI consensus 2013). Since NDIs can be immediately loaded, it is important to be able to carry out stability testing. We developed and validated a customized SmartPeg for this type of implant to measure the Implant Stability Quotient (ISQ). The ISQ of mini dental implants (MDIs) was measured and compared with the stability of standard and in a rabbit model.

Objective: The aim of the study is to test the feasibility of a customized SmartPeg for resonance frequency measurement of single-piece mini dental implants and to compare primary stability of a standard and the mini dental implant (3M™ESPE™ MDI) in a rabbit model after 6 weeks of healing.

Methods: Eight New Zealand white rabbits were used for the study. The protocol was approved by the McGill University Animal Ethics Review Board. Sixteen 3M™ESPE™ MDI and equal number of standard implants (Ankylos® Friadent, Dentsply) were inserted into the tibia/femur of the rabbits and compared. Each rabbit randomly received two 3M™ESPE™ MDI and two Ankylos® implants in each leg. ISQ values were measured with the help of an Osstell ISQ device using custom-made SmartPegs for the MDIs and implant-specific SmartPegs™ (Osstell) for the Ankylos®. Measurements were obtained both immediately following implant placement surgery and after a 6-week healing period. Each reading was taken thrice and their average compared using Wilcoxon matched pairs signed-rank tests.

Results: The median ISQ and interquartile range (IQR) values were 53.3 (8.3) at insertion and 60.5 (5.5) at 6 weeks for the 3M™ESPE™MDI and, respectively, 58.5 (4.75) and 65.5 (9.3) for the Ankylos® implant. These values also indicate that both types of implants achieved primary and secondary stability, and this is supported by histological data. ISQ values of both 3M™ESPE™ MDI and Ankylos® increased significantly from the time of insertion to 6 weeks post-insertion (p < 0.05).

Conclusions: The new custom-made SmartPeg is suitable for measuring the Implant Stability Quotient of 3M™ESPE™MDIs. The primary stability of 3M™ESPE™MDIs is similar to the primary stability attained by standard implants in the rabbit tibia.
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http://dx.doi.org/10.1186/s40729-017-0066-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5289123PMC
December 2017

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

J Prosthet Dent 2017 Jan 1;117(1):22-27. Epub 2016 Aug 1.

Associate Professor, Faculty of Dentistry, McGill University, Montreal, Quebec, Canada. Electronic address:

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.
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http://dx.doi.org/10.1016/j.prosdent.2016.04.020DOI Listing
January 2017

A double blind randomized clinical trial comparing lingualized and fully bilateral balanced posterior occlusion for conventional complete dentures.

J Prosthodont Res 2017 Apr 26;61(2):113-122. Epub 2016 Jul 26.

Oral Health and Society Research Unit, McGill University Faculty of Dentistry, Montreal, Canada.

Purpose: A lingualized occlusion (LO) for complete dentures reduces lateral inferences and occlusal force contacts and direction; thus, LO is theorized to be more suitable for patients with compromised ridges than fully bilateral balanced articulation (FBBA). However, no studies have yet provided evidence to support LO in edentate patients with compromised alveolar ridges. The purpose of this study was to compare LO and FBBA in edentulous individuals with compromised ridges.

Methods: Sixty edentulous individuals were randomly allocated into groups and received dentures with either LO or FBBA. Following delivery, several denture-related satisfaction variables were measured using 100mm visual analogue scales; oral health-related quality of life (OHRQoL) was also assessed using the Oral Health Impact Profile (OHIP). Sub-group analyses of the effect of moderate and severe mandibular bone loss were also carried out.

Results: No significant differences were detected between LO and FBBA with the primary outcome. At 6 months, participants with severely atrophied mandibles and FBBA rated their satisfaction with retention of mandibular dentures significantly lower than those with LO (median LO: 86, FBBA: 58.5, p=0.03). They also had significantly lower OHRQoL for the domain of Pain (median LO: 4, FBBA: 5, p=0.02). General satisfaction and total OHIP scores significantly improved between baseline and 6 months only for the LO subjects with severely atrophied mandibles (satisfaction: p=0.003, OHIP total score: p=0.0007).

Conclusions: The results indicate that the LO occlusal scheme with hard resin artificial teeth is more efficient for patients with severely resorbed mandibular ridges.
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http://dx.doi.org/10.1016/j.jpor.2016.07.003DOI Listing
April 2017

Prospective assessment of CAD/CAM zirconia abutment and lithium disilicate crown restorations: 2.4 year results.

J Prosthet Dent 2016 Jul 28;116(1):33-9. Epub 2016 Jan 28.

Private practice, Houston, Texas.

Statement Of Problem: Single-tooth implant restorations are commonly used to replace anterior maxillary teeth. The esthetic, functional, and biologic outcomes are, in part, a function of the abutment and crown.

Purpose: The purpose of this clinical study was to describe the implant, abutment, and crown survival and complication rates for CAD/CAM zirconia abutment and lithium disilicate crown restorations for single-tooth implants.

Material And Methods: As part of a broader prospective investigation that enrolled and treated 141 participants comparing tissue responses at the conical interface (CI; AstraTech OsseoSpeed), flat-to-flat interface (FI; NobelSpeedy), and platform-switch interface (PS; NanoTite Certain Prevail) of single-tooth implants, computer-aided design and computer-aided manufacturing (CAD/CAM) zirconia abutments (ATLANTIS Abutment) and cemented lithium disilicate (e.max) crowns were used in the restoration of all implants. After 2.4 years in function (3 years after implant placement), the implant, abutment, and crown of 110 participants were evaluated. Technical and biologic complications were recorded. Demographic results were tabulated as percentages with mean values and standard deviations. Abutment survival was calculated with the Kaplan-Meier method.

Results: After 2.4 years, no abutments or crowns had been lost. Abutment complications (screw loosening, screw fracture, fracture) were absent for all 3 implant groups. Crown complications were limited to 2 crowns debonding and 1 with excess cement (2.5%). Five biological complications (4.0%) were recorded. The overall complication rate was 6.5%.

Conclusions: CAD/CAM zirconia abutments restored with cemented lithium disilicate crowns demonstrated high survival on 3 different implant-abutment interface designs. No abutment or abutment screw fracture occurred. The technical complications observed after 2.4 years were minor and reversible. The use of CAD/CAM zirconia abutments with cemented lithium disilicate crowns is associated with high technical and biologic success at 2.4 years.
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http://dx.doi.org/10.1016/j.prosdent.2015.08.023DOI Listing
July 2016

Electronic assessment of peri-implant mucosal esthetics around three implant-abutment configurations: a randomized clinical trial.

Clin Oral Implants Res 2016 Jun 21;27(6):707-15. Epub 2015 Jun 21.

PerioHealth Professionals, Houston, TX, USA.

Objectives: To objectively assess the influence that three different implant-abutment interface designs had on peri-implant mucosal esthetics at 1 year post-implant placement via the pink esthetic score (PES). Additionally, to demonstrate the novel employment of a tablet-based digital imaging format to reliably assess and score clinical images as part of a multicenter clinical trial according to PES criteria.

Materials And Methods: Adult subjects (n = 141) with healed tooth-bound edentulous sites in the anterior maxilla as well as first premolar region were randomized to receive one of three different implant-abutment interface designs (conical interface = CI; flat-to-flat interface = FI; or platform switch interface = PS). Immediate provisionalization was performed with prefabricated titanium abutments, with definitive custom CAD/CAM zirconia abutments and all-ceramic cement-based crowns being delivered 12-week post-implant placement. Bilateral (anterior sites) or unilateral (premolar sites) digital clinical photographs were made at 1, 3, 6, and 12 months post-implant placement. Five calibrated faculty evaluators of different clinical backgrounds scored images during a 4-week timeframe on a standardized, tablet-based, digital imaging format.

Results: Six hundred and forty-nine clinical photographs were evaluated resulting in a total of 3245 sum PES values and 22,715 individual PES values. Faculty evaluator intra- and inter-rater reliability was found to be "strong" (ICC = 0.84) and "substantial" (ICC = 0.64), respectively, demonstrating repeatability of both the PES, evaluator calibration, and standardization of tablet-based scoring. All implant-abutment interface groups demonstrated significant improvements in mean sum PESs up to 1 year, with the largest improvement between restoration delivery and 6 months. No significant differences were found between groups in mean sum PESs both for individual study visits as well as for changes between study visits.

Conclusions: No significant differences in mean sum PESs were found between subjects randomized to three different implant-abutment interfaces. However, significant differences were found as a function of time for all three groups, with the largest improvement in mean sum PESs occurring between definitive abutment and restoration delivery and 6 months. Use of electronic, tablet-based digital imaging scoring formats represents a novel and repeatable methodology for scoring PES images in large, multicenter clinical trials.
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http://dx.doi.org/10.1111/clr.12640DOI Listing
June 2016

Anti-VEGFs hinder bone healing and implant osseointegration in rat tibiae.

J Clin Periodontol 2015 Jul 14;42(7):688-96. Epub 2015 Jul 14.

Faculty of Dentistry, McGill University, Montreal, QC, Canada.

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 Tukey's 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.
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http://dx.doi.org/10.1111/jcpe.12424DOI Listing
July 2015

A multicenter randomized comparative trial of implants with different abutment interfaces to replace anterior maxillary single teeth.

Int J Oral Maxillofac Implants 2015 May-Jun;30(3):622-32

Purpose: The implant-abutment interface may affect peri-implant mucosal architecture, and influence health and esthetics. The goal of this 1-year follow-up report of a 5-year clinical investigation was to examine the peri-implant mucosal tissue responses to different implant-abutment interface designs.

Materials And Methods: Subjects requiring an anterior maxillary implant were recruited. Tooth extractions, with or without preservation or ridge augmentation procedures, were performed as required. After 5 months of healing, one of three different implant-abutment combinations (conical interface [CI] n = 48); flat-to-flat interface [FI] n = 49); or platform switch interface [PS] n = 44) was placed and provisionalized. Twelve weeks later, permanent crowns were placed and data gathered throughout the first year. Peri-implant mucosal architecture and bone levels were evaluated clinically, photographically, and radiographically.

Results: At 1 year, seven FI and six PS implants failed and two FI and two PS implant participants were lost to follow-up, resulting in survival rates of 100% (CI), 85.7% (FI), and 86.4% (PS) (90.8% overall). Marginal bone level changes were -0.22 mm (CI, P < .05), -1.2 mm (FI, P < .05), and -1.32 mm (PS, P < .05) after 1 year. Marginal bone level stability (≤ 0.5-mm bone loss or gain) was recorded for 87% (CI), 8% (FI), and 27% (PS) of implants. Measurement of midbuccal mucosal zenith and papilla positions revealed no change in the mucosal positions and 0.2 to 0.3 mm of gain in papilla dimensions in all groups.

Conclusion: Significant differences in marginal bone loss were observed among the three implant-abutment interfaces. At 1 year follow-up, changes in the buccal mucosal zenith position or papilla dimensions were not discernable. A continued longitudinal evaluation of peri-implant bone and mucosal changes around these different interfaces is ongoing.
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http://dx.doi.org/10.11607/jomi.3772DOI Listing
February 2016

Esthetic outcomes in relation to implant-abutment interface design following a standardized treatment protocol in a multicenter randomized controlled trial--a cohort of 12 cases at 1-year follow-up.

Int J Periodontics Restorative Dent 2015 Mar-Apr;35(2):149-59

The design of an implant-abutment interface may have an impact on the peri-implant soft tissue esthetics. In an ongoing randomized controlled trial (RCT) with 141 participants, the authors evaluated the peri-implant tissue responses around three different implant-abutment interface designs used to replace single teeth in the esthetic zone. The aim of this report is to describe the treatment protocol utilized in this ongoing RCT by (1) demonstrating in detail a clinical case treated under this protocol and (2) reporting peri-implant soft tissue responses in a cohort of 12 representative cases from the RCT at 1-year follow-up. Male and female adults requiring single implants in the anterior maxilla were enrolled in the RCT according to the study protocol. Five months following any required extraction and/or socket bone grafting/ridge augmentation, one of the following three implant-abutment interfaces was placed and immediately provisionalized: (1) conical interface (CI; OsseoSpeed, Dentsply Implants), n = 4; (2) flat-to-flat interface (FI; NobelSpeedy Replace, Nobel Biocare), n = 4; or (3) platform-switch interface (PS; NanoTite Certain Prevail, Biomet 3i), n = 4. Twelve weeks later, definitive crowns were delivered. Throughout the treatment, peri-implant buccal gingival zenith height and mesial/distal papilla height were measured on stereotactic device photographs, and pink esthetic scores (PES) were determined. The demographics of the participants in each of the three implant-abutment interface groups were very similar. All 12 study sites had ideal ridge form with a minimum width of 5.5 mm following implant site development performed according to the described treatment protocol. Using this treatment protocol for single-tooth replacement in the anterior maxilla, the clinicians were able to obtain esthetic peri-implant soft tissue outcomes with all three types of implant-abutment interface designs at 1-year follow-up as shown by the Canfield data and PES. The proposed treatment protocol for single-tooth replacement in the esthetic zone provides a reliable method to obtain and assess the esthetic outcome as a function of implant-abutment interface design and is now in its fifth year of follow-up.
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http://dx.doi.org/10.11607/prd.2341DOI Listing
December 2016

The effect of nocturnal wear of complete dentures on sleep and oral health related quality of life: study protocol for a randomized controlled trial.

Trials 2014 Sep 13;15:358. Epub 2014 Sep 13.

Faculty of Dentistry, Université de Montréal, 2900 Edouard-Montpetit, Montreal, QC H3T 1J4, Canada.

Background: Edentulism and sleep disturbance are chronic conditions that are common in older people and have serious adverse consequences for their functioning and quality of life. Edentulism can disturb sleep through the alteration of the craniofacial structure and surrounding soft tissue. However, the effect of prosthetic rehabilitation of edentulism on sleep quality is still not well understood. The objectives of this study are to test whether nocturnal denture wear affects sleep quality, daytime sleepiness, and the oral health related quality of life of edentate older people with moderate to severe sleep apnea, and to identify modifiers of effect of nocturnal denture wear.

Methods/design: We will carry out a single-blind randomized cross-over trial. Seventy edentate older people with moderate to severe obstructive sleep apnea will be enrolled. The study participants will be assigned to wear and not wear their dentures on alternate periods of 30 days. The outcome measures will be sleep quality (assessed by portable polysomnography), daytime sleepiness (assessed by the Epworth Sleepiness Scale), and oral health related quality of life (assessed by validated questionnaire). A number of characteristics (sociodemographic, oropharyngeal morphology, oral and prosthesis characteristics, and perceived general health quality of life) will be assessed by means of clinical examination, 3D imaging of the craniofacial structure, and validated questionnaires at baseline. Linear mixed effects regression models for repeated measures will be fitted to test the study hypotheses. The main analyses will be based on the intention-to-treat principle. To assess the robustness of the findings to potential incomplete adherence, sensitivity analyses will be conducted while applying the per-protocol principle.

Discussion: This practice-relevant evidence could represent a preventive approach to improve sleep characteristics of the older population and improve their well-being and quality of life.

Trial Registration: ClinicalTrials.gov NCT01868295.
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http://dx.doi.org/10.1186/1745-6215-15-358DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4177759PMC
September 2014

Implant-assisted complete prostheses.

Periodontol 2000 2014 Oct;66(1):119-31

The current review was undertaken to obtain a better understanding of the knowledge base of implant-assisted complete dental prostheses (fixed and removable) in the treatment of the completely edentulous maxilla or mandible. Indications, advantages and disadvantages, complications and maintenance issues, as well as the cost-effectiveness of both treatments, are discussed to help clinicians in their therapeutic decision-making. In summary, when indicated and depending on the patients' needs, both removable and fixed implant-assisted prostheses are highly safe, reliable and satisfactory treatment modalities for the rehabilitation of edentulous jaws. Careful and precise treatment planning is highly recommended to assist the clinician in preventing potential prosthetic failures. The review also reveals that there is still a need for data, generated using robust research methods, on some patient-based and clinical outcomes.
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http://dx.doi.org/10.1111/prd.12041DOI Listing
October 2014

Patient perceptions of the mandibular three-implant overdenture: a practice-based study.

Clin Oral Implants Res 2015 Jun 19;26(6):639-43. Epub 2014 Feb 19.

Department of Restorative Dentistry, Faculty of Dentistry, Université de Montréal, Montreal, QC, Canada; Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal, QC, Canada.

Objectives: Although three-implant overdentures have often been used in clinical practice, there are few studies to support this approach. Therefore, this study aimed to determine the magnitude of change in ratings of oral health-related quality of life and to assess patients' satisfaction ratings with mandibular three-implant overdentures.

Materials And Methods: This quasi-experimental study examined oral health-related quality of life and satisfaction with prosthesis in 135 edentate participants (mean age 61.6 ± 7.9 years) who received mandibular three-implant overdentures from 2006 to 2009 in a private practice in Quebec, Canada. Data were collected from individual's dental records and a follow-up survey. The Oral Health Impact Profile (OHIP-20) was used to assess oral health-related quality of life at baseline and at follow-up. Satisfaction with the mandibular prostheses and perception of rocking movements were measured by use of a denture satisfaction questionnaire at follow-up. Descriptive statistics, bivariate and multivariate statistical analyses were used to analyse the data.

Results: Individuals who received mandibular three-implant overdentures had statistically significant improvements in all seven domains of the OHIP-20 from pre- to post-treatment (total OHIP change score -25.1 P < 0.001). Pre-treatment OHIP scores and rotational movement explained 58% of the variance in the OHIP's change score (P ≤ 0.05). More than three quarters of the sample population (75.6%) were completely satisfied with their three-implant overdentures, and 81.5% reported having no rocking movement. General satisfaction with the prostheses was not influenced by gender, type of fixture, or type of attachment.

Conclusions: The treatment of edentulism by three-implant overdentures has favourable patient-based outcomes, with negligible perceptions of rotational movement. However, further research is needed to compare the efficacy of this alternative to other treatment modalities, such as the two-implant overdenture.
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http://dx.doi.org/10.1111/clr.12351DOI Listing
June 2015

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

J Dent 2014 Feb 4;42(2):99-106. Epub 2013 Dec 4.

Oral Health and Society Research Unit, Faculty of Dentistry; Department of Epidemiology and Biostatistics and Department of Oncology, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.

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.
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http://dx.doi.org/10.1016/j.jdent.2013.11.021DOI Listing
February 2014

Are people who still have their natural teeth willing to pay for mandibular two-implant overdentures?

J Investig Clin Dent 2014 May 16;5(2):117-24. Epub 2013 Jul 16.

Division of Oral Health and Society, Faculty of Dentistry, McGill University, Montreal, QC, Canada.

Aim: Oral health in Canada and most developed and developing countries is funded by private payers, whose acceptance of treatment depends on their valuation of it. This study aims to determine how dentate individuals in Quebec, Canada, would value the benefits of mandibular two-implant overdentures based on their willingness to pay (WTP) for the treatment, either directly or with insurance/government coverage.

Methods: A total of 39 individuals (23-54 years) completed a Web-based WTP survey that consisted of three cost scenarios: (a) out-of-pocket payment; (b) private dental insurance coverage; and (c) public funding through additional taxes. Variations in WTP amounts were measured using regression models.

Results: Among respondents who were dentate or missing some teeth, average WTP out of pocket for implant overdentures was CAD$5419 for a 90% success rate. They were willing to pay an average CAD$169 as one-time payment for private dental insurance, with a one in five chance of becoming edentate. WTP amounts increased substantially with the probability of success of implant overdenture therapy. The results of regression analyses were consistent with theoretical predictions for education level and income (P < 0.05).

Conclusions: The results of this study, within its limitations, suggest that dentate individuals would be willing to pay a significant amount to receive mandibular two-implant overdentures if and when they become edentate.
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http://dx.doi.org/10.1111/jicd.12057DOI Listing
May 2014

The nocturnal use of complete dentures and sleep stability in edentulous elders.

J Dent 2013 Aug 8;41(8):703-9. Epub 2013 Jun 8.

Faculté de Médecine Dentaire, Université de Montréal, Montreal, QC, Canada.

Objective: To evaluate the stability of sleep quality and the impact of nocturnal use of complete dentures on sleep quality in an elderly edentulous population over a one-year period.

Materials And Methods: Written informed consent was obtained from 172 edentulous elders who agreed to enrol in a longitudinal cohort study. A total of 153 participants completed the follow-up after one year. Perceived quality of sleep and daytime sleepiness were measured using the Pittsburgh Sleep Quality Index (PSQI, score 0-21) and the Epworth Sleepiness Scale (ESS, score 0-24) at baseline (T0) and at follow-up (T1). Data on oral health related quality of life, type of mandibular dentures (conventional versus implant-retained mandibular overdenture), nocturnal wear of the dentures and socio-demographic status were obtained by means of the OHIP-20 questionnaire, a clinical examination form and a socio-demographic questionnaire.

Results: No statistically significant differences were detected in the global PSQI mean scores and EES mean scores from baseline (PSQI 4.77 ± 3.32; EES 5.35 ± 3.72) to the follow-up assessment (PSQ1 5.04 ± 3.50; EES 5.53 ± 4.34). Edentate elders wearing prostheses at night had poorer daytime sleepiness scores than those who removed their prostheses at night (p=0.003 unadjusted model; p=0.058 adjusted for age, gender, type of prosthesis and the OHIP-20 total score).

Conclusion: Results of this study suggest that wearing complete dentures while sleeping has little effect on sleep quality or daytime sleepiness.
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http://dx.doi.org/10.1016/j.jdent.2013.05.017DOI Listing
August 2013