The second edition of Implant Dentistry at a Glance, in the highly popular at a Glance series, provides an accessible, thoroughly revised and updated comprehensive introduction that covers all the essential sub-topics that comprise implant dentistry.

Features an easy-to-use double-page spread, with text and corresponding images
Expanded and updated throughout, with 13 new chapters and coverage of many advances
Includes access to a companion website with self-assessment questions and illustrative case studies

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Information

Publisher

Wiley-Blackwell

Year

2018

ISBN

9781119292630

Edition

Topic

Medicine

Subtopic

Dentistry

Chapter 1
Quality of life associated withimplant‐supported prostheses: An introduction to implant dentistry

According to the World Health Organization, ‘Health is a state of complete physical, mental, and social well‐being and not merely the absence of disease, or infirmity’ (WHO, 1946). Based on this definition, the WHO defines quality of life (QoL) ‘as individuals’ perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns’ (WHO, 1997). In other words, ‘QoL is a popular term that conveys an overall sense of well‐being, including aspects of happiness and satisfaction with life as a whole’ (CDC, 2000).

The concept of health‐related quality of life (HRQoL) on an individual level ‘includes physical and mental health perceptions (e.g., energy level, mood) and their correlates including health risks and conditions, functional status, social support, and socio‐economic status’ (CDC, 2000). In short, the Centers for Disease Control and Prevention have defined HRQoL as ‘an individual’s or group’s perceived physical and mental health over time’.

Oral health quality of life

Questionnaires have been developed to assess the impact of oral conditions on HRQoL. Oral health‐related quality of life (OHRQoL) encompasses a collection of metrics such as Dental Impact on Daily Living (DIDL), Geriatric/General Oral Health Assessment Index (GOHAI), Oral Health Impact Profile (OHIP) and Oral Impacts on Daily Performances (OIDP). Among these metrics, the 14‐item OHIP‐14 is the most popular. The diversity of measures makes it difficult to adopt a global approach to assess the impact of missing teeth on OHRQoL.

Dental implants and oral health

Implant dentistry aims to replace missing teeth. This is a very challenging aspect of dentistry: Should dentists replace the teeth that have been lost? However, from the patient’s perspective, it makes sense to ask the question: What are the benefits of dental implant placement? In other words, the following issues should be addressed:

• Should missing teeth be replaced?
• Does implant dentistry improve a patient’s quality of life?
• Is implant dentistry a cost‐effective option?

We hope that this chapter will help the practitioner, not to convince patients to have dental implants, but to provide them with sufficient information to assist in the decision‐making process.

Should missing teeth be replaced?

It is beyond the scope of this book to explore the scientific rationale supporting the replacement of missing teeth. However, logic dictates that we need a minimum number of teeth and functional masticatory units (FMUs, defined as pairs of opposing teeth or dental restoration allowing mastication, excluding incisors) to ensure an acceptable OHRQoL.

Number of teeth

A significant link has been established between the number of teeth and OHRQoL (Tan et al., 2016). Fewer than 17 teeth is associated with poor OHRQoL in the elderly (Jensen et al., 2008).

The concept of shortened dental arches (SDAs) has been proposed (Witter et al., 1999). This concept refers to dentition with intact anterior teeth and loss of posterior teeth; that is, molar teeth. It has been suggested that at least 20 teeth are required in order to maintain functional, aesthetic and natural dentition, and to meet oral health targets (Petersen and Yamamoto, 2005). Dentists advocate the practical applicability of SDAs. A recent multicentre survey showed that about 80% of participating professionals agreed with the SDA concept (Abuzar et al., 2015).

Moreover, there is no significant difference in terms of OHRQoL between subjects with SDAs and those with removable dentures (Antunes et al., 2016; Tan et al., 2015). This means that a worse OHRQoL is not SDA related and that the concept of directing treatment and resources to anterior and premolar teeth, without molar teeth replacement, is an acceptable option. In other words, there is a need to replace some but not all missing teeth.

Functional masticatory units

FMUs are needed to facilitate the chewing process. Masticatory function differs somewhat from masticatory capacity. Evaluation of masticatory function is based on complex laboratory methods. Qualitative assessment is based on video or electromyographic examination (Hennequin et al., 2005). Quantitative assessment focuses on measuring particle size values for masticated raw carrots collected just before swallowing (Woda et al., 2010). However, in clinical and epidemiological studies, the number of FMUs is a validated parameter for discriminating between functional and dysfunctional masticatory capacities (Godlewski et al., 2011). A threshold of five FMUs generally serves as the cut‐off in epidemiological studies (Adolph et al., 2017; Darnaud et al., 2015).

A limited biting/chewing capacity is not conducive to a healthy diet and can lead to a high glycaemic index, increased fat consumption and reduced fibre consumption. In other words, ‘good nutrition is a cornerstone of good health’ (WHO, 2017) and masticatory capacity is one of the most important factors for ensuring a healthy diet. A systematic review of longitudinal studies reported that signs of impaired swallowing efficacy were deemed a risk factor for malnutrition in elderly people (odds ratio [OR] = 2.73; p = 0.015; Moreira et al., 2016). The number of FMUs has been positively linked (OR = 2.79, 95% confidence interval [CI]: 1.49–5.22) with poor nutritional status in individuals over 65 years of age, according to the Mini‐Nutritional Assessment (MNA; El Osta et al., 2014). Malnutrition is associated with an increase in inflammatory biomarkers in post‐menopausal women (Wood et al., 2014). A higher morbidity/mortality risk was observed among haemodialysis patients with a high malnutrition‐inflammation score (Pisetkul et al., 2010). To conclude, a minimum of five FMUs is needed not only to ensure an adequate masticatory capacity, but also to guarantee a healthy diet.

Finally, it must be emphasised that the number of teeth and FMUs is not sufficient to portray the overall picture of edentulism. Teeth also contribute to an individual’s appearance; that is, they have an aesthetic connotation. Dental aesthetics are known to be associated with OHRQoL (Broder and Wilson‐Genderson, 2007; Klages et al., 2004). Teeth are also important for phonation. Last but not least, missing teeth are associated with poor self‐esteem and can thus have a psychological impact.

Does implant dentistry improve the patient’s quality of life?

Most studies evaluate the advantages of implant‐supported overdenture in the mandible. Limited research has focused on maxillary overdentures. Many different studies from various centres using a range of protocols suggest that patients positively rate their QoL after dental implant therapy. OHRQoL is generally better in patients with fixed prostheses than in those with a removable prosthesis (OHIP‐14; Brennan et al., 2010). Based on OHIP‐21 metrics, assessment of post‐implant therapy confirmed a significant improvement in terms of OHRQoL (Nickenig et al., 2008). However, a recent systematic review indicates that the use of implant‐supported overdentures to treat individuals with 100% dentures improves chewing efficiency, bite force and patient satisfaction. Nevertheless, no effect on nutritional status is apparent and QoL results remain inconclusive (Boven et al., 2015).

Studies dealing with fixed implant‐supported prostheses in the maxilla region are few and far between, and are mostly based on single‐implant placement. A significant implant‐related improvement in OHRQoL is evident from aesthetic and functional perspectives in patients with at least one implant in the anterior dental region (Pavel et al., 2012). In addition, an extremely positive response in OIDP has been reported in all patients treated for single‐tooth replacement with an anterior maxillary implant (Angkaew et al., 2017). Finally, based on a seven‐question customised, mailed questionnaire, elderly patients receiving dental...

Cover
Title page
Copyright
Dedication
Table of Contents
Preface
Acknowledgments
About the companion website
Chapter 1: Quality of life associated withimplant‐supported prostheses: An introduction to implant dentistry
Chapter 2: The basics: Osseointegration
Chapter 3: The basics: The peri‐implant mucosa
Chapter 4: The basics: Surgical anatomy of the mandible
Chapter 5: The basics: Surgical anatomy of the maxilla
Chapter 6: The basics: Bone shape and quality
Chapter 7: Implant macrostructure: Shapes and dimensions
Chapter 8: Implant macrostructure: Short implants
Chapter 9: Implant macrostructure: Special implants
Chapter 10: Implant macrostructure: Implant/abutment connection
Chapter 11: Implant microstructure: Implant surfaces
Chapter 12: Choice of implant system: General considerations
Chapter 13: Choice of implant system: Clinical considerations
Chapter 14: Success, failure, complications and survival
Chapter 15: The implant team
Chapter 16: Patient evaluation: Medical evaluation form and laboratory tests
Chapter c17: Patient evaluation: Surgery and the patient at risk
Chapter 18: Patient evaluation: The patient at risk for dental implant failure
Chapter 19: Patient evaluation: Local risk factors
Chapter 20: Patient evaluation: Dental history
Chapter 21: Patient evaluation: Dental implants in periodontally compromised patients
Chapter 22: Patient evaluation: Aesthetic parameters
Chapter 23: Patient evaluation: Surgical parameters
Chapter 24: Patient evaluation: Surgical template
Chapter 25: Patient evaluation: Imaging techniques
Chapter 26: Patient records
Chapter 27: The pretreatment phase
Chapter 28: Treatment planning: Peri‐implant environment analysis
Chapter 29: Treatment planning: The provisional phase
Chapter 30: Treatment planning: Immediate, early and delayed loading
Chapter 31: Treatment planning: Single‐tooth replacement
Chapter 32: Treatment planning: Implant‐supported fixed partial denture
Chapter 33: Treatment planning: Fully edentulous patients
Chapter 34: Treatment planning: Edentulous mandible
Chapter 35: Treatment planning: Edentulous maxilla
Chapter 36: Treatment planning: Aesthetic zone
Chapter 37: Dental implants in orthodontic patients
Chapter 38: Surgical environment and instrumentation
Chapter 39: Surgical techniques: Socket preservation
Chapter 40: Surgical techniques: The standard protocol
Chapter 41: Surgical techniques: Implants placed in postextraction sites
Chapter 42: Surgical techniques: Computer‐guided surgery
Chapter 43: CAD/CAM and implant prosthodontics: Background
Chapter 44: CAD/CAM and implant prosthodontics: Technical procedure
Chapter 45: Bone augmentation: One‐stage/simultaneous approach versus two‐stage/staged approach
Chapter 46: Bone augmentation: Guided bone regeneration – product and devices
Chapter 47: Bone augmentation: Guided bone regeneration – technical procedures
Chapter 48: Bone augmentation: Graft materials
Chapter 49: Bone augmentation: Block bone grafts
Chapter 50: Bone augmentation: Split osteotomy (split ridge technique)
Chapter 51: Bone augmentation: Sinus floor elevation – lateral approach
Chapter 52: Bone augmentation: Sinus floor elevation – transalveolar approach
Chapter 53: Bone augmentation: Alveolar distraction osteogenesis
Chapter 54: Soft tissue integration
Chapter 55: Soft tissue augmentation
Chapter 56: Prescriptions in standard procedure
Chapter 57: Postoperative management
Chapter 58: Surgical complications: Local complications
Chapter 59: Surgical complications: Rare and regional complications
Chapter 60: Life‐threatening surgical complications
Chapter 61: Peri‐implant diseases: Diagnosis
Chapter 62: Peri‐implant diseases: Treatment
Chapter 63: Dental implant maintenance
Appendix A: Glossary
Appendix B: Basic surgical table and instrumentation
Appendix C: Preparation of the Members of the Sterile Team
Appendix D: Medical history form
Appendix E: Consent form for dental implant surgery
Appendix F: Postoperative patient records: stage 1
Appendix G: Postoperative patient records: stage 2
Appendix H: Postoperative instructions
Appendix I: Treatment planning: fully edentulous patient
Appendix J: Overdenture supported by two implants: surgical procedure
Appendix K: Overdenture supported by two implants: prosthetic procedure
Appendix L: Fixed prosthesis (mandible) supported by four implants
Appendix M: Fixed prosthesis (maxilla) supported by four implants
Appendix N: Overview of the digitalimplant dentistry
Appendix O: The double scanning method
Appendix P: The double scanning method
Appendix Q: Guided bone regeneration
References and further reading
Index
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