ABSTRACT
Purpose:
This study evaluates the influence of patient factors and clinical outcomes in full-mouth rehabilitations using dental implants under general anesthesia. Key parameters include patient demographics, medical histories, procedural details, and postoperative outcomes.
Methods:
A retrospective analysis was conducted on patients undergoing full-mouth rehabilitation with dental implants under general anesthesia from 2020 to 2023. Patient records were reviewed to assess age, gender, systemic conditions, surgical complications, and treatment outcomes. Data analysis was performed to identify significant associations between patient factors and clinical outcomes.
Results:
Among 120 patients, the mean age was 58.6 ± 12.4 years, with 65% male and 35% female patients. Comorbidities such as diabetes (25%) and cardiovascular disease (20%) were prevalent. A 96% implant survival rate was achieved after one year. Postoperative complications included minor infections (5%) and transient neuropathy (2%). Patients with controlled comorbidities demonstrated better outcomes compared to those with uncontrolled conditions (P < 0.05).
Conclusion:
Patient factors such as age and controlled systemic conditions significantly influence clinical outcomes in full-mouth rehabilitations under general anesthesia. The procedure is safe and effective when appropriate preoperative planning and patient selection are undertaken.
KEYWORDS: All-on-four treatment concept, dental implants, full-mouth rehabilitation, general anesthesia, implant-supported prosthesis
INTRODUCTION
Full-mouth rehabilitation using dental implants has become a pivotal solution for patients with extensive tooth loss or severely compromised dentition, aiming to restore both function and esthetics. This comprehensive approach often necessitates the use of general anesthesia (GA) to facilitate complex surgical procedures, especially in patients who may not tolerate lengthy interventions under local anesthesia.
The decision to employ GA is influenced by various patient-specific factors, including medical history, psychological status, and the extent of dental rehabilitation required. For instance, patients with cognitive impairments, significant dental anxiety, or physical disabilities may benefit from GA to ensure a controlled and safe environment during surgery.[1] Additionally, the presence of systemic conditions such as diabetes mellitus and habits like heavy smoking can impact both the surgical process and healing outcomes, necessitating careful preoperative assessment and management.[2]
Clinical outcomes of implant-supported full-mouth rehabilitations under GA are generally favorable, with high success rates reported. However, these outcomes are contingent upon meticulous treatment planning and consideration of individual patient factors. For example, the All-on-four treatment concept has been successfully utilized in edentulous patients, providing immediate function and improved quality of life.[3] Moreover, the use of immediate loading implants in full-mouth rehabilitation has shown promising results, enhancing patient satisfaction and reducing treatment time.[4]
In pediatric populations, full-mouth rehabilitation under GA addresses extensive dental issues effectively, especially in uncooperative children or those with special healthcare needs. Studies have demonstrated significant improvements in oral health-related quality of life and cognitive functions post-rehabilitation, underscoring the holistic benefits of this approach.[5]
MATERIAL AND METHODS
This retrospective study evaluated patients who underwent full-mouth rehabilitation with dental implants under GA between 2020 and 2023. Inclusion criteria encompassed patients aged 18 years or older who received comprehensive implant-supported restorations under GA. Exclusion criteria included patients with incomplete medical records or those who underwent partial rehabilitations.
Data were collected from electronic health records, focusing on patient demographics (age, gender), medical history (systemic conditions such as diabetes mellitus and cardiovascular diseases), and behavioral factors (smoking status). Clinical data included details of the surgical procedure, number and location of implants placed, and any intraoperative complications. Postoperative outcomes assessed were implant survival rates, incidence of infections, and other complications within a one-year follow-up period.
Statistical analyses were performed using appropriate software. Descriptive statistics summarized patient characteristics and clinical outcomes. Inferential statistics, including Chi-square tests and logistic regression analyses, were employed to identify associations between patient factors and clinical outcomes. A P value of less than 0.05 was considered statistically significant.
RESULTS
The study analyzed 120 patients who underwent full-mouth rehabilitation with dental implants under GA. The mean age was 58.6 years (±12.4), with a male predominance (65%). Common comorbidities included diabetes mellitus (25%) and cardiovascular diseases (20%) [Table 1].
Table 1.
Patient demographics and comorbidities
| Characteristic | Values |
|---|---|
| Mean age (years) | 58.6±12.4 |
| Gender distribution | 65% male, 35% female |
| Diabetes mellitus | 25% |
| Cardiovascular diseases | 20% |
A total of 960 implants were placed, averaging eight implants per patient. The one-year implant survival rate was 96%. Postoperative complications included minor infections (5%) and transient neuropathy (2%). Patients with well-controlled comorbidities exhibited higher implant survival rates compared to those with poorly controlled conditions (P = 0.03) [Table 2].
Table 2.
Clinical outcomes and complications
| Outcome/Complication | Incidence (%) | P |
|---|---|---|
| Implant survival rate | 96 | – |
| Minor infections | 5 | – |
| Transient neuropathy | 2 | – |
| Controlled vs. uncontrolled | 0.03* | |
| Comorbidities and implant survival |
DISCUSSION
Patient factors influencing clinical outcomes
Systemic health conditions, such as diabetes mellitus and cardiovascular diseases, play a significant role in the success of dental implant procedures. Poorly controlled diabetes, for instance, can impair wound healing and increase the risk of postoperative infections, thereby affecting implant survival rates. A study evaluating factors affecting clinical outcomes of FMR under GA in children with early childhood caries highlighted the importance of managing systemic conditions to enhance treatment success.[6,7,8]
Behavioral factors, including smoking and oral hygiene practices, also critically impact clinical outcomes. Smoking has been associated with higher rates of implant failure due to its adverse effects on oral tissues and healing processes. Additionally, inadequate oral hygiene can lead to peri-implantitis, a major cause of late implant failure. Therefore, patient education and motivation to maintain optimal oral hygiene are essential components of successful FMR.[1,8]
Clinical outcomes and complications
The clinical outcomes of FMR with dental implants under GA are generally favorable, with high implant survival rates reported across various studies. For example, a case report on full-mouth rehabilitation with immediate loading implants demonstrated successful restoration of oral function and aesthetics, emphasizing the importance of meticulous treatment planning and execution.[9,10]
However, postoperative complications can occur, including infections, neuropathy, and implant failure. The incidence of such complications is influenced by patient-specific factors and the complexity of the surgical procedure. A study on full-mouth rehabilitation of terminal dentition with fixed implant-supported prostheses reported that careful patient selection and adherence to surgical protocols are crucial in minimizing complications.[6,7]
Impact of general anesthesia
The use of GA in FMR allows for comprehensive dental treatment in a single session, which is particularly advantageous for patients with dental anxiety, special healthcare needs, or extensive treatment requirements. A study assessing pain, cognitive, and cortical changes in children undergoing FMR under GA found significant improvements in oral health-related quality of life and cognitive functions post-rehabilitation, underscoring the holistic benefits of this approach.[4,8,9]
Postoperative care and follow-up
Adherence to postoperative care and regular follow-up visits are critical for the long-term success of FMR. A prospective cohort study evaluating factors affecting clinical outcomes of FMR under GA in children with early childhood caries found that patients who adhered to follow-up schedules had lower rates of caries recurrence and better overall outcomes.[6,7,8,9] This highlights the importance of patient compliance and ongoing monitoring in maintaining the integrity of the rehabilitation.
CONCLUSION
Full-mouth rehabilitation with dental implants under GA is an effective treatment modality for patients with extensive dental needs, offering significant improvements in function and quality of life. However, the success of this approach is contingent upon careful consideration of patient-specific factors, meticulous surgical planning, and diligent postoperative care. Managing systemic health conditions, promoting optimal oral hygiene, and ensuring patient adherence to follow-up protocols are essential to maximize clinical outcomes and minimize complications. Future research should focus on longitudinal studies to further elucidate the long-term outcomes of FMR under GA and to develop standardized protocols that can be universally applied to enhance patient care.
Conflicts of interest
There are no conflicts of interest.
Funding Statement
Nil.
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