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LETTERS TO THE EDITORDepartment of Oral and Maxillofacial Surgery and Special Dental Care, University of Groningen and University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, the Netherlands To the Editor: Stoker et al.(2007) performed an aftercare and cost-effectiveness assessment of 3 types of implant-retained mandibular overdentures in a cohort of 110 patients with a follow-up of 8 years. They claimed that their observations were unique, but there are other studies on aftercare and costs of mandibular overdentures in large groups of patients, with a comparable to longer follow-up. Unfortunately, Stoker et al.(2007) omitted comparing their outcomes with those studies. In considerations of overall treatment time needed for aftercare, and thus costs, there might be a pitfall. From about the eighth year after implant loading, there will be an increased need for lower denture remakes, either implant-retained or conventional. Thus, Stoker et al.(2007) might have underreported the need for lower denture remakes and thus underestimated the time needed for prosthetic aftercare. The time needed for aftercare might increase shortly after the end of their follow-up, making the cost-effectiveness of an implant treatment less favorable. Moreover, Stoker et al.(2007) scored the aftercare in rather general terms, as has been done in many other studies (Wismeijer et al., 1995; Naert et al., 1997; Meijer et al., 2004; Telleman et al., 2006). However, to predict problems patients may encounter and to develop approaches to prevent or reduce these problems, one should score aftercare in greater detail. Detailed information is essential, since part of the aftercare may be technique-driven. We studied aftercare in greater detail over a 10-year period and, e.g., already mentioned that certain types of bars or clips had to be replaced by other types because of a high occurrence of failure during follow-up (Visser et al., 2006). Stoker et al.(2007) confirmed that abutment design and the choice of material used for the retentive part of the matrix influenced the friction grip and thus the need for aftercare. Such information becomes available to the readership only when aftercare is reported in greater detail. REFERENCES
The authors reply
1 Free University, Department of Oral Function, Academic Centre for Dentistry Amsterdam, Dental School, Amsterdam, The Netherlands; and Correspondence: 3 corresponding author, Hogeweg 5, NL-3212 LG Simonshaven, The Netherlands, geertstoker{at}wxs.nl The comments made by Visser et al. show the expertise of their group in the same field of research as ours. Nevertheless, we feel the need to reply to their letter to the Editor. The study mentioned by Visser et al.(2006) was published after our paper was submitted. In our study (Stoker et al., 2007) and many others, only direct costs are taken into account. We examined other studies on aftercare and costs and concluded that there are different approaches when measuring costs. Our study is based on chair-time in minutes, where others (e.g., Walton et al., 1996; MacEntee and Walton, 1998) estimate direct costs on fees charged by clinicians, and still others (e.g., Watson et al., 2002) estimate professional time by multiplying the numbers of aftercare events by the (estimated) respective time allocations. The study of Visser et al.(2006) belongs to the latter group. An evaluation period is almost always too short to reveal every possible aftercare event during the lifecycle of a chosen treatment modality. Long-term evaluations in a randomized clinical trial of mandibular implant-retained overdentures are still scarce. There is no specific proof that there is an increased demand for lower denture remakes 8 years after loading, or even after 10 years. However, one may assume that this demand will increase in time and eventually present itself for every patient who lives through the lifecycle of the provided treatment modality. In our analysis, all aftercare events that occurred were collected and taken into account. Infrequently occurring aftercare events are not mentioned in our Table 2 (Frequencies of Specific Aftercare and Treatment during the Evaluation Period of 8.3 Years), due to the limited space allowed per the guidelines of the JDR. Detailed information of any importance is discussed in the paper. In this study, an egg-shaped Dolder bar with the original clip was used and did not show specific problems. In contrast, however, the ball attachment group showed specific problems caused by the loss of retention. Sincerely, REFERENCES
Journal of Dental Research, Vol. 86, No. 10,
919-920 (2007)
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