MBRU Theses & Dissertations

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Clinical Outcomes of Single Implant Supported Versus Implant Supported-Fixed Prostheses in Dubai Health Authority Clinic
(2019-08)
Background: Whether implant-supported fixed prostheses have worse clinical outcomes than single implant-supported prosthesesis controversial. Aim: This study aimed to assess the clinical outcomes of single implant-supported prostheses and implant-supported fixed prostheses placed in Al Badaa Dental Center in Dubai Health Authority (DHA). Materials and methods: This retrospective study compared biological and technical complications among single implant-supported prostheses and implant-supported fixed prostheses in a time framed sample of all patients who received dental implants between January 2009 and December 2016. Cantilevered implants, implants supporting complete dentures or removal partial dentures and any case involving a sinus lift procedure or bone grafting were excluded. The records of all eligible cases were assessed for prosthetic complications including screw loosening or fracture and ceramic de-lamination. Mesial and distal bone height around the implants were measured on digital radiographs by one examiner. Results: A total of 455 patients (151 males; 304 females) had 1673 implants. The mean age of males (53.7 years, SD 14.6) was significantly greater than that of females (49.3 years, SD 12.9, p< 0.001). The lower left and right posterior sextants were the most frequent sites for implants while the lower anterior sextant was the least common. Mean mesial crestal bone loss in implant supported-fixed prostheses was significantly greater (1.14mm, SD 0.63) compared to single implant-supported prostheses(0.30mm, SD 0.43,p<0.001).Mean distal crestal bone loss was also significantly greater (1.29mm, SD 0.71) in implant supported-fixed prostheses than in single implant-supported prostheses (0.36mm, SD 0.54,p<0.001). Mean crestal bone loss mesially and distally in patients with a medical condition (N=165) was significantly greater compared to medically fit patients (N=290, p<0.001). Mean mesial and distal bone loss was significantly greater around implants placed in the lower anterior sextant compared to all the other sites (p<0.001). A total of 66 cement retained implants had significantly more complications than expected compared to the 1607 screw retained implants (Fisher’s Exact test, p<0.001). Conclusion: Implant supported-fixed prostheses have greater bone loss than single implant-supported prostheses. Age, position in the mouth and having a medical condition are factors that influence bone loss.
Comparative in vitro study between digital and conventional impression techniques for artificial maxillectomy defect
(2022) Alanezi, Ahmad
Background: The trend in using 3D digital dental technology has increased in the past two decades, however, its application in prosthetic rehabilitation of maxillofacial defects is still developing. The aim of this in vitro study was to assess the accuracy of utilizing digital technology to record an artificial central maxillofacial defect in comparison to conventional impression methods. Methods: Five casts were fabricated using conventional impression and casting method and five using digital technology from a master model. The casts were assessed in terms of time taken to fabricate each model and the accuracy when compared to the master cast. A digital calibre was used to record the distance using the reference point. Two measurements were recorded: anterior posterior measurement and lateral measurement. Shapiro-Wilk-Smirnov statistical test was used to test the normality of continuous variables. One independent sample t-test was used to compare means between standard and conventional and digital method. Pair t-test was used to compare pairwise between conventional and digital methods. Results: The data revealed that there was a significant less antero-posterior measure among digital technique comparing with a conventional technique, the difference -0.80 (0.22) with pvalue was 0.001. For the lateral measurement, there was less lateral measure within digital technique comparing with the measure among conventional techniques, the difference was - 0.73(0.09) and p-value < 0.001. Regarding the total time of the process, no statistical significance different was detected between digital techniques and conventional techniques, with difference -18.60 (127.54) and p-value 0.76. Conclusion: In this study, digital impression technique produced different results in terms of accuracy especially in the lateral measure when compared with master models. The time taken to record the arch and the defect using an intraoral scanner was significantly less when comparing with traditional impression method. There was no statistically significant difference between the two techniques in terms of the total time taken to fabricate a maxillary central defect. Additional research should be conducted to reach more conclusive results.
A Comparison of Artificial Crown Dimensions To Natural Teeth
(2019-08) Bamedhaf, Omar
Background: Crown dimensions can have a significant effect on the health of adjacent gingivae and on occlusal harmony. This study aimed to determine crown dimensions on artificial crowns and their contralateral natural teeth. Materials and methods: Patients attending Dubai dental hospital with an artificial crown on a first or second molar and a sound contralateral tooth were invited to take part in this cross-sectional study. Clinical measures included the Basic Periodontal Examination and a check of inter-occlusal contacts with shimstock. Models were cast from polyvinylsiloxane impressions and scanned using Ortho Insight 3D (Motion View, MicronDental, USA). Mesio-distal (MD) and bucco-lingual (BL) measurements were made using the software and also by use of a Boley gauge (Premium Instruments, USA). Results: A total of 16 participants (11 males; 5 females) with a mean age of 44 years were recruited to form a convenience sample. There was no difference in mean age by gender. A total of 20 pairs of crowns were included and most were in service for less than 5 years. There were 14 (70%) all-ceramic crowns, 5 (25%) metal-ceramic and 1 metal crown, with the upper left first molar being the most crowned tooth.The mean BL width of artificial crowns was significantly greater than the mean BL width of sound teeth using both methods of measurement (p<0.01). The mean BL widths were 11.57mm/11.17mm using the software and 11.49mm/11.07mm using the Boley gauge. The mean MD dimensions were not significantly different at 10.32mm on artificial crowns and 10.26mm on sound teeth using the software and 10.24mm and 10.16mm with the Boley gauge. Periodontal status was not significantly different between artificial crowns and sound teeth. A cusp tip to fossa relationship was the most prevalent occlusal scheme with a modest correlation between artificial crowns and contralateral sound teeth (Spearman rho=+0.6, p<0.05). Conclusion: Artificial crowns are wider bucco-lingually than their contralateral sound teeth. The bucco-lingual dimension of sound teeth should be measured, recorded and written in the laboratory prescription so that technicians can replicate this dimension more accurately.
Dental Implant and Restoration Selection by Prosthodontists in Dubai
(2017-08) Al Saleh, Fatma
Introduction: Dental implant prostheses are dental prostheses that are retained and/or supported by implants placed in the partially or completely edentulous jaw. With various implant systems and prosthetic component designs being introduced, decisions have to be made when choosing an implant system and a certain prosthodontic protocol. A comprehensive survey of implant prosthodontic specialists has not been previously performed in the Middle East. This study aimed to determine selection criteria and choice of dental implants and restorations by prosthodontic specialists in the Emirate of Dubai, UAE. Materials and Methods: A validated 16 item survey was used as the basis for the study questionnaire. The topics included demographic information, implant training and experience, implant treatment planning, implant restorations, implant system preference and selection in addition to implant loading. The lists of licensed prosthodontists in Dubai were accessed through the official websites of DHA and DHCC. An email requesting the recipient’s participation in the study with an attached questionnaire was sent to all registered prosthodontists. Results: Out of the 91 prosthodontists practicing in Dubai, a total of 77 (84.6%) respondents completed the questionnaires and only51 (66.2%) prosthodontists reported practicing implant dentistry. Out of which,28 (54.9%)reported surgically placing dental implants and 23 (45.1%)reported restoring them only prosthetically. Prefabricated metal abutments are the most commonly selected abutments for single crowns:38 (76.0%) and for fixed dental prostheses: 34 (66.7%). Screw-retention is preferred mostly for single crowns: 34(68.0%) and fixed dental prostheses: 37 (74.0%).Locators were the most commonly selected type of attachment for implant-retained/supported dentures: 24 (49.0%).There was no major preference for a certain implant system as selections were various. The most important criteria when selecting an implant system were the general implant features, literature support and simplicity of restorative kit while the least important criteria were educational training background, educational support from provider (company) and cost. Conclusion: Within the limitations of this study, it can be concluded that most licensed prosthodontists in Dubai (66.2%) practice implant dentistry. Out of which, more than half (54.9%) surgically place dental implants. Implant company/system selections are various and there is no major preference for a certain system. Differences in preferences are present between government (DHA)and non-government employed prosthodontists (DHCC and private clinics).The majority of prosthodontists select implant systems based on implant features, literature review and simplicity of restorative kit.
Direct Composite Resin for the Management of Tooth Wear: A Systematic Review and Meta-Analysis
(2019-08) Vajani, Jay
Background: The survival of direct composite resin restorations for the treatment of worn teeth hasbeen reported in several studies. This systematic review aims to integrate studies with outcomes that are comparable and to critically evaluate the literature. Methods: A comprehensive electronic search of 4 databases (Medline-PubMed, Cochrane Central, Scopus, Google scholar) was performed on literature published between January 1990 and December 2017. Inclusion criteria were based on the PICO format. Exclusions included studies on children, adults with non-carious cervical lesions, cast and all-ceramic restorations, case reports with ≤4 participants, narrative and systematic reviews, other meta-analyses.The risk of bias was assessed by a funnel plot. Selected data extraction included participant sample size, number of composite restorations, number of operators, type of composite, whether the Occlusal Vertical Dimension (OVD) was increased or not, location (anterior or posterior), mean or total follow-up time and success rate expressed as either percent of successful restorations or Median Survival Time (MST) in years. Results: A total of 1461 studies were identified and 1316 were screened. 61 full text papers were assessed for eligibility resulting in 11 studies that met inclusion criteria for quantitative analysis. These 11 publications assessed 2,733 direct composite restorations placed in 375subjects with survival ranging from 50% to 96.4%. The funnel plot showed a low risk of publication bias. A meta-analysis of proportions using survival percentage of direct composite restorations gave a pooled effect size estimate of 81.3 % survival, but considerable heterogeneity was evident (I2=96.7). Between study variance was high. Studies were mainly of a case series type performed in hospital settings. Conclusions: Clinical heterogeneity was a significant factor with different operators, different interventions (composite manufacturer, micro-filled or hybrid) and outcomes expressed in different ways (percentage survival, Median Survival Time, Annual Failure Rate). Furthermore, sample sizes varied from 6 to 164 patients with concomitant wide age range and the number of restorations followed-up varied widely also from 16 to 1,010 composites. Follow-up times were generally short which could have a significant influence on survival outcome. It is reasonable to assume more advanced wear would be seen and treated in a hospital setting but few studies described the severity of the wear which would also affect survival outcome. Inconsistent results between studies implies statistical heterogeneity may also be present. Overall, the estimated survival of direct composite restorations in tooth wear cases was 81.3% although the substantial heterogeneity seriously limits the precision of this estimate.
Effectiveness of Spray Disinfectants on Three dental Impression Materials
(2019-08) AlShikh, Ayesha
Background: The disinfection of dental impressions is fundamental to prevent cross-infection from the dental surgery to the laboratory. Spray rather than immersion disinfectants have recently been introduced to dental practice. This study aimed to compare the effectiveness of two spray disinfectants used at Hamdan Bin Mohammed College of Dental Medicine (HBMCDM) in Dubai, United Arab Emirates. Materials and methods: Two disinfectants were compared, a new non-aldehyde alcohol based disinfectant, Bossklein (Silsden, W Yorks, BD20 0EF, UK) and an aldehyde based disinfectant, MD520 (Dürr Dental, 74321 Bietigheim-Bissingen, Germany). Impressions taken on the prosthodontic and orthodontic clinics were swabbed immediately after rinsing under running tap water (pre-disinfection) and after spraying (post-disinfection). Maxillary or mandibular impressions taken in alginate (irreversible hydrocolloid), polyether and polyvinyl siloxane (PVS) were swabbed from the same gingivalareas before and after spraying. Manufacturer’s instructions were followed regarding the spray protocol for Bossklein which was to soak thoroughly and leave to dry naturally. To standardize the method of delivery, hand spraying only, MD520 was also used from a spray bottle as the gold standard but subsequently the Hygojet box system was not used as per manufacturer’s direction. Swabs were transported to the microbiology laboratory, MedLab, in Amies medium. All swabs were plated onto blood agar within 2 hours. Plates were incubated for 3 days at 37⁰C then at room temperature for 3 days. After incubation, the number of contaminated impressions before and after disinfection for each impression material was compared using the chi square test with the level of significance set at p<0.05. Results: A total of 87 impressions were assessed (alginate=41; PVS=31; polyether=15). The counts were categorized into 2 groups: no growth or growth present. Post-disinfection contamination was present on 6 alginate and 6 PVS impressions but only 1 polyether impression (x2=1.27, NSS). Analysis of post-disinfection growth according to impression and disinfectant found significantly more contaminated PVS impressions sprayed with Bossklein than with MD520 (x2= 5.37, p<0.05). Disinfection with MD520 resulted in only 2 contaminated impressions, both in alginate. Conclusions: Spray disinfection of dental impressions may not be as effective as immersion methods. Effective spray disinfection relies on correct operator technique such as thoroughness of soaking. A low number of trigger squeezes of spray bottles may be related to cost saving which is an issue immersion disinfectants do not have. Dental staff must be trained appropriately and understand that disinfection protocols differ.
Erosive potential of Drinks Consumed in Dubai
(2019-08) Fusain, Khalil S
Background: Acid erosion has become a common dental problem. Dietary acid, mainly in the form of drinks, is the main source of extrinsic acid. Although studies have tested drinks for chemical parameters in Europe, no studies have been done on drinks in Dubai. The aim of this study was to determine pH, titratable acidity and concentrations of calcium, phosphate and fluoride in a range of drinks available in Dubai. Materials and methods: A variety of drinks were analyzed (n=17) including teas, fruit juices, still and carbonated water. All drinks were tested at room temperature but teas were also tested as hot drinks. Titratable acidity was measured by volume of 0.1M NaOH needed to bring acid drinks to pH5.5 and 7.0 and Ca, F and PO4 meters were used to measure the respective concentrations in the drinks. A positive control was orange juice and the negative control was Volvic water. Results: The pH of the drinks ranged from 7.56 for Ramzy Licorice drink to 2.56 for Hibiscus hot tea. Mean pH for groups of drinks in ascending order are as follows: Fruit juices 3.36; Carbonated drinks 3.97; Hot teas 4.70; Powdered reconstituted drinks 5.13; Cold teas 5.28. Fruit juices had a significantly lower pH than the negative control (one-way ANOVAF=3.514, p<0.05). Titratable acidity ranged widely from 54ml for Barakat orange juice to 0.5mlof NaOH for Rooh Afza fruit juice. Fluoride concentration ranged from 15.95ppm for Pran Litchi to 0.04ppm for Perrier water. Calcium ranged widely from 605ppm for Barakat orange juice to 0ppm for Pran Litchi and the highest phosphate concentration was for cold chamomile tea (22ppm) with zero detectable phosphate in Red Bull, Sunquick, Rooh Afza, Pran Litchi and Barakat orange juice. Conclusion: All drinks had erosive potential with fruit juices having the lowest mean pH. Certain local drinks such as Pran Litchi have low pH and high titratable acidity with zero calcium and phosphate and thus have significant erosive potential.
Erosive potential of drinks consumed in Dubai.
(2021) ALDeekan, Ebraheem S E
Background: Most of the consumed soft drinks are acidic in nature, regular consumption of these drinks which contain the main source of extrinsic acid in diet may result in dental erosion. Although studies have tested drinks for chemical parameters internationally, limited studies have been conducted on drinks in Dubai. The aim of this in vitro study was to evaluate the erosive potential of different soft drinks in Dubai by determining the pH, titratable acidity and concentrations of phosphate, calcium, and fluoride in a variety of commercially available drinks in Dubai. Materials and methods: Twenty-four commercially available soft drinks in Dubai were selected for this in- vitro study. The drinks were divided based on their carbon dioxide (CO2) contents into carbonated and non-carbonated drinks. All drinks were stored according to the manufacturers’ recommendations prior of conducting the study.The properties of each product were analyzed to measure their Acidity (pH), Titratable Acidity (TA), Fluoride (F), Calcium (Ca) and Phosphate (PO4). Inductively Coupled Plasma-Atomic Emission Spectrometers (SGIMADZU ICPE-9820) was used to calculate the mineral contents of tested juices at room temperature. Results: The highest and lowest pH values were 4.38 & 2.79 which recorded for Orange juice (Rauch) and Sun cola (sun top) respectively. On the other hand, 3.6 and 0.11 were the highest and lowest titratable acidity values, which recorded for Mixed fruit lemon (Almarai) and Barbican- strawberry, respectively. Among both carbonated and non-carbonated drinks, the highest and lowest Ca values were 55.6 and 1.98 which were measured for orange juice (Rauch) and blue raspberry (Vimto) respectively. Both highest and lowest reading were ii among the non-carbonated drinks. In carbonated drinks, 7.83 was the highest Ca level measured for Power horse energy while 2.18 was the lowest value measured for Lemon IceTea (Lipton). Among all carbonated drinks, phosphate was not detected apart from Barbican-apple juice which contains 39.55ppm phosphate. On the other hand, the values of phosphate among non-carbonated were ranged from 447.63 to 19.04 for orange juice (Rauch) and Berry mix (sun top) respectively. the mean and standard deviation of calcium levels for both carbonated and noncarbonated were 3.31(2.21) and 9.96(12.16) respectively. Mean (SD) for phosphate were 39.55(0) and 140.67(134.33) for carbonated and noncarbonated drinks correspondingly. pH means were 3.23(0.12) and 3.4(0.44), while means titratable acidity were 0.24 (0.19) and 0.52 (0.78) for carbonated and noncarbonated, respectively. Kruskal-Wallis test was used to compare the means of all variables between carbonated and noncarbonated drinks. only difference in calcium level was statistically significant (p˂0.05). The means of pH and Calcium were compared with data of mineral waters and treated waters which revealed significant difference with all tested drinks at (p˂0.05). Conclusion: All drinks had erosive potential with fruit juices having the lowest mean pH and lowest mineral contents. The association between minerals and pH are high.
Evaluating the Spread of Aerosols During Crown Preparation: An In-Vitro Study
(2022) El Meski, Farah
Background: The severe acute respiratory syndrome (SARS-CoV-2 or COVID-19) brought in an unanticipated dire situation and affected dental practice significantly. Due to the nature of profession, suspension of treatment was imperative as transmission was obscure. Patients did not display evident symptoms and therefore the threat between the dental team and patients was collective. There was a lack of apparent adherence to public health protocols which led to an astronomical number of cases, prolonged period of isolation, oral care neglect and finally decrease in quality of life. However, the current challenging situation ensured better approach and management of patients to optimize standards of care through understanding transmission, reducing spread and enhancing all modalities of treatment. The aim of this study was to explore and evaluate aerosol generation and spread by developing an established laboratory dependent approach strictly simulating prosthodontic aerosol generating procedures. Materials and method: Restorative crown preparation on the upper right central incisor (#11) and upper right first molar (#16) was performed on a dental manikin in a simulated laboratory. Citric acid (10%) was injected into the waterline and litmus paper was used to demarcate the contaminated regions in the surrounding (30cm distance), the dentist’s faceshield and chest and the simulated assistant’s chest. The chromatic color change (blue to red) was analyzed through Fiji-ImageJ software to evaluate the color intensity (pixels) of aerosol generation. Results: Contamination was detected at each allocated site. The maximum contaminated mean(SD) surface area was seen at 30cm behind the manikin’s head for both tooth #11 and #16, 157.64(±0.68) pixels and 122.49(±2.89) respectively. Very low contamination levels were detected at the operator’s face-shield for both tooth #11 and #16, 73.35(±0.78) and 65.14(±1.25) respectively. Reduced aerosol splatter was detected as contamination decreased with use of extra oral suction, demonstrating positive results. EOS resulted an average percentage decrease of 20.6% and 19.2% respectively with highest percentage decrease at the operator’s chest. Conclusions: Aerosol generating procedures such as restorative crown preparation impose high risk of exposure, and with the basis of our findings, mitigation options such as the extraoral suction and personal protective equipment support in reducing spread and chance of transmission.
The Evaluation of Smile Design by Lay People and Dentists in the UAE.
(2017-08) Al Shamsi, Asma
Aim: This study aimed to evaluate what features of a smile are regarded attractive as viewed by lay people and dental professionals in the UAE. Material and Methods: A questionnaire survey of standardized images of smiles was distributed to 190 dental professionals including 135 under-graduate students at Sharjah University and 190 lay people. A sample size calculation determined the sample as 384.The participants were not randomly selected and were not a representative sample of the UAE population but a convenience sample. The participants were all adults above the age of 17years. The questionnaire had 7 separate aesthetic features with between 3 to 6 different standardized computer generated images for each feature. The different features included amount of tooth exposed, lip line height, buccal corridor and midline position. Results: There were a total of 380 participants with a mean age of 28.6 years (SD 7.9) of which 228 (60%) were female. Significantly more females compared to males preferred a convex smile irrespective of whether or not the upper teeth contacted the lower lip (p<0.01). Females tended to prefer a low lip line compared to males but this was at the borderline of significance (p=0.067). Interestingly, more married respondents preferred the low lip line whereas unmarried respondents were evenly distributed between those liking an average and low lip line (p<0.05). The coincidence of dental and facial midlines would be expected as the preferred choice for both dental professionals and lay people but significantly more lay people preferred the smile that deviated to the right whereas dentists preferred midlines to be coincident (p<0.001). Furthermore, residents of Abu Dhabi, Dubai and Sharjah preferred the coincidence of midlines whereas the lay people from Fujairah preferred the right deviation of the dental midline. Over half the unmarried respondents had a significantly greater preference for midline coincidence but married respondents were more evenly split regarding this aspect of smile design (p<0.05). There were no preference differences for most of the smile design features as judged by dentists and lay people. Conclusion: There is general agreement between dentists and lay people regarding the most pleasing features of smile design. Females prefer a convex incisal curve that follows lip curvature and tend to prefer a low lip line. Coincidence of facial and dental midlines was expected to be preferred by both dentists and lay people but surprisingly this was not the case as lay people, married respondents and residents from Fujairah prefer a right deviation. Why should this preference for a smile with a deviated dental midline be regarded as attractive requires further research but may be influenced by tribal or other cultural factors.
Evaluation of the submandibular fossa and its correlation to implant placement using Cone-Beam Computed Tomography
(2022) Alqaood, Faisal
Background: The alveolar ridge morphology in the posterior mandibular region has many variations that may pose fatal complications if not assessed and addressed properly. Aim: The aim of this study is to assess the different morphological variations in the posterior mandible and attempt to propose a new classification for the submandibular concavity. Materials and Methods: Cone Beam Computed Tomography (CBCT) from 195 patients taken from the Dubai Dental Hospital (DDH) database after going through the inclusion/exclusion criteria and analyzed. The data collected included width of the alveolar bone at the crest (Wc), width of the alveolar bone at the base (Wb), alveolar ridge height (Vcb), alveolar bone height below the P point (Vb) and alveolar bone height above the P point (Vc). Furthermore, age, gender, presence or absence of the first molar and if the submandibular undercut is present or absent. Results: The selected 195 CBCT scans included 46.2% males and 53.8% females with an age ranging from 20 years to over 70 years old. In those, U type ridge (ridge with undercut) was found to be the most prevalent type (54.4% left, 52.1% right) followed by P type (parallel ridge) (27.2% left, 33.5% right) and the least type was the C type (convergent type) (18.5% left, 14.4% right). Alveolar ridge height had correlation with age, gender, ridge type, presence or absence of the first molar and presence or absence of an undercut. Alveolar ridge width had a correlation with the width of the alveolar bone at the crest and ridge type. The concavity depth has a correlation with the presence of the first molar, presence of an undercut and the ridge type. Conclusion: Proper understanding of the ridge morphology lead to a safe and predictable dental implant planning and treatment. The proposed new classification can help the dental practitioner to provide accurate assessment of the submandibular concavity when planning for dental implant insertion in the posterior mandible, this will lead to safe and predictable treatment outcome.
The Impact of Cantilever Direction on the Clinical Outcome of Implant-Supported Fixed Dental Prostheses
(2017-08) Alaleeli, Hayat
It has been shown that dental implants tend to lose bone over time, which ultimately results in soft tissue loss. Recent studies, however, suggest that the design of implant-supported prostheses may contribute to peri-implant tissue stability. Aim: To evaluate retrospectively radiographic bone loss around implants supporting cantilevered pontics with either mesial or distal direction, and to identify the technical complications that may occur with mesial/distal cantilever fixed dental prosthesis. Material and Methods: Records of 14 partially dentate patients, aged between 45-83 years (mean age 69.4), who were treated from March 2003 to March 2015, with mesial/distal cantilever implant-supported fixed dental prostheses were reviewed. For each implant, the radiographs from the time of implant loading were compared to radiographs from the last follow-up visit. There were evaluated regarding: 1- The distance from widest diameter of the abutment to the crest of the peri-implant bone. 2- The radiographic changes of marginal hard tissue height from the time of implant loading compared to the time of the last follow-up appointment. Technical complications were noted as (screw-loosening, prosthesis de-cementation and prosthesis loosening). Results: A total of 28 cantilever implant-supported fixed dental prostheses supporting 32 cantilever units were evaluated. Of these 10 (35.7%) had mesial cantilevers, while 18 (64.7%) had a distal cantilever. There was no significant difference in the distribution of the cases between males and females (7 males and 7 females). The non-smokers were 43%. And the non-recorded were 29%. All technical complications associated with implants adjacent to distal cantilever pontics (prosthesis loosening P= 0.114, prosthesis de-cementation P= 0.114 and implant abutment screw-loosening: P= 0.37). Furthermore, all technical complications occurred with cantilever arm length < 10 mm. Mesial and distal bone loss on implants adjacent to the cantilevered units was not state different if cantilever direction was mesial or distal (mesial cantilever P= 0.533, distal cantilever: P= 0.82) Conclusion: Within the limitation of this study, marginal bone loss does not seem to be influenced by the presence of mesial or distal cantilever extensions. Minor technical complications were found with a distal cantilever (prosthesis loosening, prosthesis de-cementation and implant abutment screw-loosening).
Loss of pulp vitality following preparation of vital teeth for crowns/FDPs restorations for at least 5 years of follow up period: A Systematic Review and Meta-Analysis
(2022) EyalSalman, Jumana
Background: Loss of pulp vitality is a common biological complication after full coverage indirect restorations, and dental practitioners should be aware of the contributing factors to achieve best treatment outcome. Aim: The aim of current review was to investigate the incidence of loss of pulp vitality in the vital teeth restored with full coverage crown or FPDs (fixed dental prostheses) and the factors that might lead to loss of pulp vitality following crown preparation procedure. Material and Methods: An electronic PubMed search accompanied with manual searching was conducted for the clinical studies on full coverage single crown or full coverage FPDs of vital teeth were performed from 1960 to November 2021 for at least 5 years of follow up period. Risk of bias was assessed with the Newcastle-Ottawa Scale. Statistical analyses were used to identify instantaneous incidence of loss of pulp vitality for the single crowns and bridge abutments groups, and subgroup of restorations according to the type of restoration material. Results: The search provided 1964 records, after duplicates removal and screening of titles and abstracts, 27 records were eligible for full text reading resulting in 12 studies being included on full coverage crowns/bridges restorations in initially vital teeth. The instantaneous incidence of loss of pulp vitality in full coverage crowns/bridges group was 5.4% (95% CI,2.3- 12.3) and 7.4% (95% CI,4.4-12) respectively and the mean incidence of both groups was 6.5% (95% CI,4-10.4). The value of z is 3.1486, and the value of p is 0.00164, the result is significant at (p < 0.05) when comparing the loss of pulp vitality incidence of crowns and abutments. A Sub Mata-analysis conducted to identify the incidence in the type of material groups (MetalCeramic, All Ceramic and Zirconia) and yield incidence of pulp vitality loss among all ceramic material with an incidence of 5.3% (95%CI, 1.7-15.1), out of one study, and 6.5% (95%CI, 2.6-15.6) among metal ceramic restorations in three studies, while the incidence was 6.3% (95%CI,0.4-53.9) of zirconia crowns in one study. Conclusion: Preserving the pulp vitality after cementation of crown or bridge is important for the best treatment outcome. The incidence of loss of pulp vitality in full coverage FDPs abutments is more compared to full coverage single crown in the vital teeth.
The Oral Health Status of Attendees and Residents in UAE Care Homes
(2019-08) Al Mazrooei, Banan
Background: The oral health status of day stay attendees and residents in care homes in the UAE has not been previously investigated. This cross-sectional study aimed to determine the oral health status of care home attendees and residents in the UAE. Materials and Methods: All care homes identified from the UAE Ministry of Health website were selected and all subjects attending or residing in care homes were included, forming a convenience sample. The WHO classification was used for medical conditions. Oral and dental status was recorded on the WHO Oral Health Assessment form for adults (2013) and other demographic details were recorded separately. The three examiners had training and calibration exercises prior to conducting the dental examinations. A mean inter-examiner Kappa of 0.6 was achieved. Results: A total of 107participants with a mean age of 67.5 years (sd 15.65years) were examined in 4 Emirates. Nineteen subjects had significant cognitive impairment and could not co-operate and only partial examination was possible. Males (n=57) had a mean age of 69.2yrs (sd 16.3) which was not significantly different to the mean age of females (65.5yrs, sd 14.8). Most of the participants (n=70) had an ASA classification of mild systemic disease whilst 25 were classified with severe systemic disease. Multiple medical problems were most common (n=28), followed by endocrine disease (n=26) and mental health problems (n=20). Circulatory disease was present in 9 subjects and stroke/nervous system problems in 6 participants. Periodontal problems were present in 58 (72%) of 81 dentate participants since 26 participants were edentate. Overall mean DMFT was 23.2 (sd 9.0) but mean DMFT in males was significantly greater (26.5) compared to females at 19.8 (p<0.001). Age had a weak positive correlation with DMFT, Spearman’s rho = +0.43 (p<0.001). Eighteen participants out of 88 (20.5%) complained of pain or soreness at the time of examination. The frequency of tooth brushing/cleaning the mouth was not correlated to participants’ mobility (being bed-bound). Linear regression analysis of DMFT (dependent variable) and age, education, and ASA as predictor variables resulted in significant predictive value for the variance of DMFT accounted for by age and education but not ASA. Conclusion: Oral health was generally poor with high caries experience. Pain and discomfort were present in a high number of participants. Dental care is a priority for this group.
Patient Satisfaction with Complete Dentures in Fujairah Dental Center
(2017-08) Abdulrahman, Fatima
Introduction: Complete dentures are the most common treatment modality for edentate patients. Patient satisfaction with their dentures has not been previously investigated in the UAE. Aim: This study aimed to assess patient satisfaction with complete dentures provided at Fujairah Dental Centre. Methods: All patients seen and treated with complete dentures at Fujairah Dental Centre between 2014and 2016 were invited to take part and thus formed a convenience sample. A 21-item questionnaire was developed. Demographic details included age and level of education. Satisfaction with several variables such as comfort, appearance, speech and masticatory efficiency were assessed on a 4-point scale. Other questions asked about soreness, taste and the reasons for not having dental implants. Results: A total of 60 patients from Fujairah Dental Centre took part in this questionnaire survey of complete denture satisfaction. The overall mean age of respondents was 63.08 years with no statistical difference by gender. Responses to several aspects of denture satisfaction were analysed. Masticatory efficiency of the lower denture was rated as excellent by the lowest number of respondents (36%) whereas ease of insertion/removal of the upper denture was rated excellent by most respondents (74%). A significantly greater proportion of females felt older with wearing dentures compared to males (p<0.001). A strong positive correlation existed between denture comfort and masticatory efficiency, rho=+0.75 for upper, +0.72 for lower (p<0.001). The mean length of time the participants were edentulous was 3.05 years for males and 2.45 years for females. There was no association between length of time participants were edentulous and denture satisfaction with either comfort or masticatory efficiency. Only half of the participants felt that the quality of speech was excellent, while 7 (11%) had occasional sore mouth and 11(18%)had experienced alteration in taste. Conclusion: The overall level of satisfaction with complete dentures was good to excellent. Respondents were less satisfied with the lower denture and in particular masticatory efficiency.
The perception of dental esthetics assessed by Prosthodontic Residents and UAE recognized Specialists in Prosthodontics
(2017-08) Alhassani, Noura
Smiles can be improved by veneering teeth using a relatively conservative technique. The appearance of veneers and smile design has not been previously investigated in the UAE. This study aimed to assess the aesthetic preferences of different smile designs rated by a group of prosthodontic residents and specialists. Materials and Methods: A questionnaire was devised asking about demographic details such as age and gender as well as clinical experience before and after graduation. Images of ten cases who had ceramic veneers fitted on their anterior teeth were included in the questionnaire. There were two images for each case: smiling with lips shown and close-up with retracted lips and cheeks. A total of seven questions regarding the appearance for each case were posed to each rater. Each question had a 5 point Likert rating scale from poor to excellent. All residents in prosthodontics at HBMCDM and UAE recognized specialists in prosthodontics were invited to participate. The specialists were recruited from the DHA/CPQ database. Results: A total of 25 dentists rated the 10 cases. There were 12 residents and 13 specialists, 40% were from the UAE and 60% from other countries. The residents were significantly younger than the specialists with mean ages of 29.4 years and 43.0 years respectively (p<0.001). Ten raters were male and 15 female. An overall amalgamated mean score was calculated for each case by summing all 7 individual scores for the 7 questions by rater. Males rated case 8, visible papillae following lip contour, significantly more highly than females (p<0.004). The overall ranking of the 10 cases was determined by gaining a mean % score for each case by summing the Likert scores for all seven questions and dividing by the maximum score of 35 per case. Both the residents and specialists agreed that case 9 (long teeth contacting the lower lip) was the most pleasant (68%) and that case 5 (midline discrepancy) was the most unattractive (39%). Overall, cases 9 and 6 were the most pleasing and cases 5 and 10 were the most displeasing. Conclusion: The residents and prosthodontic specialists were mostly in agreement when rating the esthetics of several different smile designs. Symmetry and the upper lip just covering the upper gingival margins were the most pleasing whilst a non-coincident midline and gingival inflammation were deemed the most unattractive.
Prosthodontic Outcomes of Implant-Supported Single Crowns on Short Dental Implants
(2017-08) Al Soori, Shuaa
Background: Short dental implants were introduced to avoid advanced surgical procedures. The survival and failure rates of super structures on short implants has not been previously investigated in the UAE. This study assessed the prosthodontic outcomes of implant-supported single crowns on short implants within Dubai Health Authority (DHA) Materials and methods: The case records of all patients treated with implants at Al-Badaa Health Center were reviewed for the 3-year period from January 2014 to December 2016. All cases that received a short implant, defined as ≤8mm were included in the study. A data collection form was devised to capture patient demographic data including age and gender as well as several implant variables regarding type, length, position and connection. Results: A total of 211 patients with 211 short dental implants were included in this retrospective study. Most subjects were female (n=127) with a mean age of 48.34 years (12.23) and the 84 males had a mean age of 54.65 years (15.49). The males were significantly older than females (p<0.001). The complications of implant supported crowns were categorized as screw/abutment loosening, chipped ceramic or cement dissolution. The survival rate by gender of implant crowns without complications was not statistically different with 73 in males and 104 in females. The most commonly placed short implant was Ankylos (134) followed by Astra (60) and Xive (17). The overall failure rate was2.4% (n=5) with no statistical difference by implant type. Analysis of implant length and diameter on clinical outcome of failure/survival found no differences even if diameter was dichotomized on<4.0mm or ≥4.0mm. Most implants were placed in the upper arch. The frequency distribution of failure was not different according to mode of crown retention nor to crown material. Kaplan-Meier estimates of survival indicated that the first failures occurred 8-10 months after implant loading. Conclusion: The majority of short dental implant supported crowns reviewed in this study were successful over the 3-year period of assessment. Failures were not associated with type or size of implant.
A retrospective analysis of biological complications of implant-supported fixed dental prostheses
(2021) Almutairi, Zainab
Background: In the past few decades implant supported fixed dental protheses has become widely accepted treatment option for replacing missing teeth. Despite their high survival rate, complications such as peri-implant diseases are common. Aim: To evaluate patient-, implant- surgical- and prosthetic-related risk factors that are associated with peri-implant diseases, identify prevalence and predictors of peri-implant diseases. Materials and Methods: A retrospective study of 162 patients who received 301 dental implants was conducted to evaluate the prevalences and risk indicators for peri-implant mucositis and peri-implantitis. The data were analyzed using the binary logistic regression to evaluate different risk indicators peri-implantitis. Results: The prevalence of peri-implant mucositis at the patients and implant levels were 44.4% and 38.2%, respectively. For peri-implantitis, the prevalence at the patient level was 5.6%, while the prevalence at the implant level was 4.0%. Patients diagnosed with peri-implant mucositis were more likely to be irregular attenders of peri-implant maintenance while those diagnosed with peri-implantitis were likely to be smokers, had history of treated periodontitis or did not attend of regular peri-implant maintenance visits. Conclusion: Within the limitations of this retrospective study, the analysis identified plausible risk indicators, namely smoking, history of treated periodontitis and irregular peri-implant ii maintenance visits, that would allow clinicians to identify those at risk and ensure continuous peri-implant supportive care.
Risk factors for dental implant failure: A 10-year retrospective study
(2021) AlZarooni, Fatima
Background: Owing to the high long-term survival rates of osseointegrated dental implants it has become increasingly used as the treatment of choice to replace missing teeth in the past few decades. Nevertheless, implant failures and loss may occur as a result of biological and technical complications. Aim: To identify the risk factors associated with early and late implant failures in patients treated at Dubai Health Authority (DHA) and establish risk assessment model. Materials and Methods: A total of 645 patients aged ≥18 years had 830 failed implants at DHA between 2010 and 2019. The data was manually collected from records available at DHA and then analyzed using logistic regression analysis. The collected data was divided into two sub-categories; systemic-/patient-related factors, and implant-/site-related factors. The strength of association between the frequency of early and late implant failure and each variable was measured by chi-square analysis. Differences were considered statistically significant at P < 0.05. For systemic and patient-related factors, the patient was considered the unit of analysis. For implant-related factors, the implant was considered as the statistical unit. Results: Out of 14191 implants inserted during the observation period, 721 implants failed before loading (5.1%) and 109 implants failed after loading (0.8%). More than half of late failed implants (59.3%) were single implant and (57.0%) were screw-retained prostheses. A significant association was observed between implant failure and histories of treated ii periodontitis (P < 0.0001), previous implant failure (P < 0.0001), and irregular dental attendance (P = 0.006). Implants inserted in the posterior region in both arches had a significant impact on implant failure with more early and late implant failures (P < 0.0001). The other variables did not influence early or late implant failures. Conclusion: Within the limitations of this retrospective study, the analysis identified plausible risk factors for early implant failure, namely history of treated periodontitis, previous implant failure and irregular dental attendance that would allow clinicians to identify those at risk and ensure continuous peri-implant supportive care. Further studies are necessary to achieve more robust understanding on potential risk factors for implant failures and to provide effective preventive and therapeutic protocols.
A Survey of the Application of the Shortened Dental Arch by Dentists in the UAE
(2021) AlHmoudi, Haleimah Saeed Ali
Background: The Shortened Dental Arch (SDA) is a dentition of no more than twenty teeth with an intact anterior region but a reduced number of occluding pairs of posterior teeth. The SDA concept is a valid treatment option in cases in which anteriors and premolars can provide adequate aesthetics, function, and occlusalstability. It focuses on providing the partially dentate patient with the advantages of oral functionality, improved oral hygiene, comfort, while avoiding overtreatment and its unnecessary cost. Aim: To evaluate the general attitude of dentists in the UAE towards the SDA concept and its application in their practice. Materials and Methods: This is a cross-sectional study utilizing an online voluntary and anonymous questionnaire. The questionnaire was sent to all dentists registered with Emirates Medical Association (EMA). The questionnaire consists of 17 questions which comprise demographics, awareness, application in dental practice, preferred treatment modality, and risks and benefits associated with SDA. This survey was carried out during the period ranging from June till October 2020. The data was analyzed using SPSS Statistics. Results: The response rate reported was 40.3%. There is a general awareness of the SDA concept among UAE dentists (n=237, 65.8%); however, it is not usually applied in clinical practice (n=196, 54.7%). Specialists were more aware about the concept and applied it more frequently in their clinical practice than the General Dental Practitioners (GDPs) (P-value = 0.000, 0.041 respectively). Female dentists (n=71, 60.7%) preferred to provide molar support iii to their SDA patients more frequently than male dentists (n=109, 45.8%) (P-value 0.006). Respondents agreed that SDA was associated with the risks of teeth migration (n=211, 59.9%), tooth wear (n=196, 55.8%), and/or Temporomandibular Disorder (TMD) (n=163, 45.3%). Implant was found to be the treatment of choice for many of the participants (n=169, 46.6%) to replace missing molars followed by acrylic Removal Partial Denture (RPD) (n=129, 35.5%). Conclusion: Within the limitations of this study, most of the dentists who responded to this survey are aware of the SDA concept and have a positive attitude about it. However, they do not frequently apply it in clinical practice. The preferred treatment modality for SDA by many dentists in UAE is implants followed by acrylic RPD. Dentists in this study prefer to propose SDA to patients with limited financial resources and medically compromised patients.

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