Oral health-related quality of life after prosthodontic treatment for patients with partial edentulism: A systematic review and meta-analysis

Methods of Topical Administration of Drugs and Biological Active Substances for Dental Implants-A Narrative Review

Dental implants are, nowadays, established surgical devices for the restoration of lost teeth. Considered as an alternative for traditional prosthetic appliances, dental implants surpass them in reliability and patient feedback. Local drug delivery around the implants promotes osseointegration and reduces peri-implantitis. However, there are currently no methods of a multiple, precise topical administration of drugs to the implant area. Engineering coatings on the implants, drug application on carriers during implantation, or gingival pockets do not meet all requirements of dental surgeons. Therefore, there is a need to create porous implants and other medical devices that will allow a multiple drug delivery at a controlled dose and release profile without traumatic treatment. Due to the growing demand for the use of biologically active agents to support dental implant treatment at its various stages (implant placement, long-term use of dental superstructures, treatment of the peri-implant conditions) and due to the proven effectiveness of the topical application of pharmacological biologically active agents to the implant area, the authors would like to present a review and show the methods and devices that can be used by clinicians for local drug administration to facilitate dental implant treatment. Our review concludes that there is a need for research in the field of inventions such as new medical devices or implants with gradient solid-porous structures. These devices, in the future, will enable to perform repeatable, controllable, atraumatic, and repeatable injections of active factors that may affect the improvement of osteointegration and the longer survival of implants, as well as the treatment of peri-implantitis.

Modern partial dentures - part 2: a review of novel metal-free materials and innovations in polymers

New materials are continuously being developed and advanced for the provision of partial dentures. However, the rate at which they are developing makes it hard for the clinician to discern which would be worth adopting into their practice.This paper looks at some of those materials, including the earlier alternatives to conventional acrylic resins, polyamides and acetal resin, followed by a review of the newer novel polymers that are currently in use, including aryl-ketone-polymers and the polymer group polyaryletherketones.The newer polymers have many similarities, in both properties and aesthetics, such as increased elasticity that allows the dentures to engage deeper undercuts, while maintaining high strength. A significant benefit of the novel polymers is in their ability to fit into a digital workflow. Computer-aided design and manufacture confer a high degree of consistency, efficiency and accuracy in the prosthesis. The ability to use precise digital tools to create frameworks and clasps of accurate parameters limits the introduction of technical error that has the potential to be introduced in the construction of a conventional cobalt-chrome framework.The novel high-performance polymers show great promise. Research is needed on these materials investigating the effects on oral health, longevity and survival of the appliances, as well as studies looking at patient satisfaction and the impact on quality of life.

Dental prosthetic treatment reduced the risk of weight loss among older adults with tooth loss

OBJECTIVES

Weight loss is a critical health issue in older adults. Oral function is essential for nutrient intake and can be restored using dental prosthetic treatments in patients with tooth loss. This study aimed to investigate the relationship between tooth loss and weight loss among the older adults and to evaluate the magnitude of its risk reduction by dental prosthetic treatment.

DESIGN

Three-year follow-up longitudinal study based on a self-reported questionnaire.

SETTING

Community-dwelling older adults in Japan.

PARTICIPANTS

Adults aged 65 and older (n = 53,690).

MEASUREMENTS

We used >10% weight loss during follow-up, the number of remaining teeth, and the use of dental prostheses as the outcome variable, exposure variable, and mediator, respectively. We fitted the logistic regression model including possible confounders and calculated the odds ratios (ORs) and 95% confidence intervals (95% CIs) of the controlled direct effect (CDE) at the level of use or nonuse of the dental prosthesis based on a causal mediation analysis framework. Additionally, we calculated the proportion eliminated by the dental prosthesis.

RESULTS

The mean age of participants was 72.6 years (1 SD = 5.5), and 47.4% were males. About 5.8% (n = 3132) of them experienced >10% weight loss during the follow-up. Weight loss was observed in 6.8% of the participants with 0-19 remaining teeth and in 4.3% of them with ≥20 remaining teeth. The CDE of 0-19 remaining teeth was greater when no one used dental prosthesis (OR = 1.41; 95% CI = 1.26-1.59) compared with that when all participants used dental prosthesis (OR = 1.26; 95% CI = 1.08-1.46). This indicated that dental prosthesis decreased the risk of weight loss by 37.3%.

CONCLUSION

Our study revealed that tooth loss increased the risk of clinically critical levels of weight loss among community-dwelling older adults. However, this risk was reduced by dental prosthetic treatment.

Retentive Forces of Removable Partial Denture Clasp Assemblies Made from Polyaryletherketone and Cobalt-Chromium: A Comparative Study

PURPOSE

To compare retentive forces of removable partial denture clasps traditionally fabricated with cobalt-chromium (CoCr) material and two computer-aided design and computer-aided manufactured (CAD/CAM) thermoplastic polymers.

MATERIALS AND METHODS

Forty-eight clasp assemblies (16 CoCr, 16 polyetheretherketone (PEEK) and 16 polyetherketoneketone (PEKK) thermoplastic polymer) were fabricated for 48 mandibular tooth analogs. Individual clasps were inserted and removed on the tooth analogs utilizing a chewing simulator for 15,000 cycles to simulate 10 years of use. Retentive forces were measured utilizing a mechanical load tester at baseline and intervals of 1500 cycles. Data were analyzed with one-way Analysis of Variance, Tukey post-hoc, and paired T tests.

RESULTS

Mean retentive forces between all groups were significantly different (p < 0.001). Retentive forces of CoCr clasps were significantly higher than both polymers (p < 0.001). The mean retentive forces for PEEK were not significantly different from PEKK (p = 0.23). A significant increase in retentive forces was observed for all three clasps after the first period of cycling, followed by continual decrease for the remaining cycles. At the endpoint of 15,000 cycles, no clasp assemblies showed lower retentive forces than at initial baseline.

CONCLUSION

Thermoplastic polymer clasps demonstrated lower retentive forces compared to CoCr clasps. All three groups displayed a similar pattern of initial increase, followed by a gradual decrease, of retentive force. Despite this observation, the clasps maintained similar or higher retentive forces than measured at baseline. This resistance to fatigue and ability to fabricate with CAD/CAM technologies provides support for clinical use of these high-performance polymer (HPP) materials.

Evaluation of quality of life and oral hygiene attitudes of individuals using dental prostheses during the COVID-19 pandemic

STATEMENT OF PROBLEM

The COVID-19 pandemic impacted every area of our lives, including delaying urgent dental care. However, studies evaluating how patients using dental prostheses have been affected by the pandemic are lacking.

PURPOSE

The purpose of this study was to investigate how patients using different types of dental prostheses were being affected by the COVID-19 pandemic.

MATERIAL AND METHODS

A total of 129 randomly selected individuals from among those who had been examined in the same clinic before the COVID-19 outbreak were included in the study. The study participants were divided into 4 groups according to their type of prosthesis: complete dentures, implant-retained removable dentures, tooth-supported fixed partial dentures, and implant-supported fixed partial dentures. The Oral Health Impact Profile (OHIP-14) questionnaire was implemented by telephone interviews with the study participants, who were also asked about their concerns and steps made regarding prosthetic hygiene during the COVID-19 pandemic. Data were evaluated by the Kruskal-Wallis and post hoc Dunn tests, and multivariate logistic regression analysis with forward selection was carried out to identify predictors of the oral health-related quality of life (OHRQoL) status (α=.05).

RESULTS

OHIP-14 total scores did not vary significantly among the groups (P>.05). When the domain scores of OHIP-14 were considered separately, the analysis revealed that the implant-retained removable denture group had significantly poorer functional limitations when compared with the tooth-supported fixed partial denture (P=.005) and implant-supported fixed partial denture (P=.031) groups. The results of the multivariate logistic regression analysis indicated a statistically significant association between OHRQoL during the COVID-19 pandemic and the frequency of tooth or denture cleaning (1 time a day versus less than 1 time a day: P=.011; 2-3 times a day versus less than 1 time a day: P=.032).

CONCLUSIONS

All prosthesis users exhibited increased interest in dental hygiene and an increase in the frequency of prosthesis cleaning during the pandemic. Furthermore, the study determined that the frequency of tooth or denture cleaning was associated with significantly improved OHRQoL during the time of the COVID-19 pandemic. Among the denture groups, those treated with implant-retained removable dentures had the poorest functional limitation in terms of OHRQoL, which can be linked to postponement of routine maintenance appointments. Therefore, providing all patients with scientifically sound information on prosthetic care during a pandemic would be highly beneficial.

Oral health-related quality of life is associated with the prevalence and development of depressive symptoms in older Japanese individuals: The Ohasama Study

OBJECTIVE

This prospective study investigated the cross-sectional association between impaired oral health-related quality of life (OHRQoL) and the prevalence of depressive symptoms, and the longitudinal association between impaired OHRQoL and development of depressive symptoms among older adults.

BACKGROUND

Previous studies have shown a relationship between poor oral health and depression among older adults; however, findings are inconsistent.

MATERIALS AND METHODS

Participants were 669 community-dwelling older Japanese individuals aged≥55 years (mean: 67.8 ± 7.2 years). Data of 296 participants were used for longitudinal analyses. OHRQoL was evaluated using the Oral Impacts on Daily Performances scale. Impaired OHRQoL was defined as the presence of at least one impact on the scale. Depressive symptoms were assessed using the Japanese version of the Zung self-rating depression scale with a cut-off score of 40.

RESULTS

The cross-sectional logistic regression model demonstrated that impaired OHRQoL was significantly associated with depressive symptoms (odds ratio [OR], 5.17; 95% confidence interval [CI], 2.99-8.95) independent of age, sex, body mass index, hypertension, cerebrovascular/cardiovascular disease, smoking, drinking alcohol, education, cognitive function, objective oral health (dentition status) and oral health behaviour (dental visit within 1 year). Similarly, impaired OHRQoL predicted the development of depressive symptoms within 4 years in a fully adjusted longitudinal model (OR, 6.00; 95% CI, 1.38-26.09).

CONCLUSION

Impaired OHRQoL was identified as a potential comorbidity of depressive symptoms and a predictor for depressive disorder later in life. OHRQoL may be a useful clinical outcome for elder patients with regard to their mental and oral health.

MicroRNA in Implant Dentistry: From Basic Science to Clinical Application

Specific microRNA (miRNA) expression profiles have been reported to be predictive of specific clinical outcomes of dental implants and might be used as biomarkers in implant dentistry with diagnostic and prognostic purposes. The aim of the present narrative review was to summarize current knowledge regarding the use of miRNAs in implant dentistry. The authors attempted to identify all available evidence on the topic and critically appraise it in order to lay the foundation for the development of further research oriented towards the clinical application of miRNAs in implant dentistry.

Material preferences for tooth-supported 3-unit fixed dental prostheses: A survey of German dentists

STATEMENT OF PROBLEM

Different material options are available for fixed dental prostheses (FDPs), but valid data on the favored materials of German dentists for 3-unit FDPs are lacking. It is unclear whether preferences depend on the individual characteristics of the dentists or their dental practices.

PURPOSE

The purpose of this survey was to identify the preferred material selection of German dentists for the fabrication of tooth-supported 3-unit FDPs depending on the location of the abutment teeth and the individual characteristics of the dentist or the dental practice.

MATERIAL AND METHODS

A survey was developed that included questions on the demographic characteristics (sex, area of expertise, age group, time since graduation, number of inhabitants, and the postal code of the dental practice or dental school) of the participating dentist and their preferred materials for the fabrication of tooth-supported 3-unit FDPs. Three clinical scenarios (anterior maxillary FDP, posterior maxillary FDP, posterior mandibular FDP) were presented. The dentists were allowed to select from predefined options or to give a free answer. For comparisons of characteristic associations, the number of inhabitants was chosen to represent the characteristics of the dental practice, and sex and time since graduation were selected to represent the characteristics of the dentist. Group comparisons were conducted with Chi-square tests (α=.05).

RESULTS

A response of 721 dentists from all parts of Germany was received, and data from 688 dentists were included in the analyses. Ceramic was the most preferred material for the fabrication of 3-unit FDPs independent of the location of the abutment teeth with veneered zirconia as the favored option. Metal-ceramic was ranked second. The time since graduation ≤15 years was associated with a preference of ceramic over metal-ceramic for the anterior restoration (P<.001).

CONCLUSIONS

Most participating dentists selected appropriate restorative materials depending on the individual clinical setting presented in the survey. For the anterior 3-unit FDP, time since graduation was associated with the preference for a restorative material. Some dentists selected lithium-X-silicate ceramics for situations beyond their recommended indication range.

Oral Health-Related Quality of Life in Anticoagulated Patients with Warfarin Treatment: A Cross-Sectional Study

To evaluate factors associated with oral health-related quality of life (OHRQoL) in patients under oral anticoagulant therapy with warfarin, a cross-sectional study was conducted. Validated questionnaires assessed self-reported periodontal disease, demographic variables, and OHRQoL using the short version of the Oral Health Impact Profile (OHIP-14) instrument. After calibration (Kappa > 0.60), an examiner evaluated patients' experience with dental caries and the need for dental prostheses. Statistical analysis involved proportions and measures of central tendency. Negative binomial regression models were used to estimate the rate ratios (RR) and the corresponding 95% confidence interval (CI). The sample consisted of 158 individuals, with a mean age of 58.8 years (SD = 12.1), of which 62.7% of the participants were women. The OHIP-14 mean was 10.62 (SD = 10.92). A higher OHIP-14 total score (worse OHRQoL) was associated with ethnic group, age, periodontal disease self-report, dental caries, and oral health self-report. Demographic and clinical factors can negatively influence the perception of anticoagulated patients on OHRQoL.

Mid-Term outcomes and periodontal prognostic factors Of autotransplanted third molars: A Retrospective Cohort Study

BACKGROUND

Tooth autotransplantation is a valid method for replacing non-restorable teeth. This study aimed to assess mid-term survival and success of autotransplanted third molars and the clinical periodontal parameters and factors predicting successful periodontal attachment apparatus regeneration.

METHODS

In total, 36 patients who had undergone extraction and subsequent autotransplantation of 36 third molars using virtual planning and computer-aided rapid prototyping models by an oral surgeon and endodontist were eligible. Probing pocket depth (PPD), gingival recession (REC), clinical attachment level (CAL), pulpal and periapical healing, root resorption, and radiographic bone loss (RBL) were evaluated. Additionally, a questionnaire evaluated patient-reported outcomes.

RESULTS

The mean age of the participants was 30.2 years with a mean follow-up duration of 29.42 ± 14.56 months. The overall survival and success rates were 97.2% and 91.7%, respectively. No statistically significant differences were found in success and survival rates between open and closed apex groups or between compromised and intact buccal bone groups. No signs of pulp necrosis were found in the open apex group. Progressive replacement resorption was detected in one closed apex case. The mean PPD was 2.7 ± 0.45 mm for all transplanted teeth. REC was 0.13 mm higher in transplanted teeth than in previous hopeless teeth. CAL changes were neither clinically relevant (-0.17 ± 0.66 mm) nor statistically significant. The reported patient satisfaction was high.

CONCLUSIONS

Autotransplantation of third molars is a predictable treatment method, with a 2.5-year cumulative tooth survival and success of 97.2% and 91.7%, respectively, which were not influenced by recipient site integrity or root development.

Effect of fluid contamination on reverse torque values in implant-abutment connections under oral conditions

PURPOSE

Implant mechanical complications, including screw loosening, can influence dental implant success. It has been shown that torque values are affected by contamination occurred in implant-abutment (I/A) interface. This study aimed to examine the effects of blood, saliva, fluoride and chlorhexidine contamination on reverse torque values (RTVs) of abutment screws in oral conditions.

MATERIALS AND METHODS

50 fixtures were mounted into the stainless-steel holders and divided into five groups (n = 10). Except control group (NC), fixture screw holes in other groups were contaminated with chlorhexidine (CG), saliva (SG), blood (BG), or fluoride (FG). Abutment screws were tightened with a digital torque meter. I/A assemblies were subjected to thermocycling and cyclic loading. The mean RTVs were recorded and data were analyzed with one-way ANOVA and Tukey test.

RESULTS

Except for specimens in SG (20.56 ± 1.33), other specimens in BG (21.11 ± 1.54), CG (22.89 ± 1.1) and FG (24.00 ± 1.12) displayed significantly higher RTVs compared to NC (19.00 ± 1.87). The highest RTVs were detected in CG and FG.

CONCLUSION

The obtained data robustly suggest that RTVs were significantly affected by fluid contaminations. Specimens in FG and CG displayed the highest RTVs. Therefore, clinicians should have enough knowledge about probable contaminations in I/A interface in order to manage them during clinical procedure and to inform patients about using oral care products.

Outcomes of osseointegrated implants in patients with benign and malignant pathologies of the head and neck: a 10-year single-centre study

The surgical management of head and neck pathologies involving the maxilla and mandible results in significant functional and aesthetic deficits, and ultimately reduced quality of life. Composite free flaps used for reconstruction address many of these deficits and create a foundation for the use of osseointegrated implants to support prosthetic replacement of the dentition. There are few comparative studies examining outcomes of implants in native and reconstructed bone in head and neck cancer patients. The aim of this retrospective cohort study was to compare survival rates and the effects of risk factors between implants placed in native and reconstructed bone. The Kaplan-Meier method estimated cumulative 1- and 5-year implant survival rates of 99.5% and 95% for native bone and 96% and 88% for reconstructed bone. Multivariate Cox regression found an increased risk of implant failure in reconstructed bone (hazard ratio (HR) 9.9, 95% confidence interval (CI) 3.4-29.7, P<0.001). Subgroup analysis of the cohorts found an increased risk of failure in the reconstructed group associated with radiotherapy (HR 6.4, 95% CI 1.8-22.3, P=0.004), current smoking (HR 23.2, 95% CI 2.7-198.6, P=0.004), and previous smoking (HR 9.0, 95% CI 1.1-71.9, P=0.038). There was no effect in the native bone group. Implants placed into reconstructed bone had higher rates of failure, and smoking status and radiotherapy increased the risk of implant failure.

Influence of implant location on titanium-zirconium alloy narrow-diameter implants: A 1-year prospective study in smoking and nonsmoking populations

STATEMENT OF PROBLEM

Titanium-zirconium (Ti-Zr) alloy (Roxolid) narrow-diameter implants (NDIs) have been widely used for implant-supported prostheses in anterior and posterior regions in the jaws. However, the relationship between implant location and clinical outcome remains unclear.

PURPOSE

The purpose of this clinical study was to evaluate and compare the clinical and radiographic outcomes of NDIs placed in different regions of the jaws in both smokers and nonsmokers.

MATERIAL AND METHODS

Eighty-four participants scheduled to receive NDIs for tooth rehabilitation were included, and the inserted NDIs were divided into 3 groups depending on their locations: implants used to restore anterior teeth, implants used to restore premolars, and implants used to restore molars. Crestal bone loss (CBL), implant survival and success rates, bleeding on probing (BOP), and pocket probing depth (PPD) were evaluated 6 and 12 months after implant loading (α=.017 for implant survival and success rates after Bonferroni correction, α=.05 for other parameters).

RESULTS

Statistical analysis of 6- and 12-month CBL of all participants presented no statistically significant difference among the 3 groups. For smokers, the molar group presented significantly more CBL than the premolar group (0.90 ±0.94 versus 0.16 ±0.27 mm, P=.027) at the 6-month examination. The implant survival rates were 95.65%, 100%, and 100% for anterior, premolar, and molar regions, respectively (P=.283). No statistically significant difference was observed regarding periodontal parameters (P>.05).

CONCLUSIONS

Implant location has no influence on the clinical and radiographic parameters of Ti-Zr NDIs placed in a nonsmoking population. However, the combination of posterior location and smoking may induce higher risk of crestal bone loss. Caution should be taken when restoring molars for smokers with NDIs.

Relationship between Fixed Dental Crowns and Volatile Sulphur Compounds

Objectives: The aim of this study was to investigate and compare the level of halitosis in patients with/without fixed crowns and in addition the influence of various crown parameters on halitosis was also explored. Methods: In total, 96 subjects (fixed crowns = 52; no crowns = 44) participated in the study. The levels volatile sulphur compounds (VSCs) of hydrogen sulphide (H2S), methyl mercaptan (CH3SH), and dimethyl sulphide (CH3SCH3) were evaluated with breath samples using gas chromatography and used for classification as presence or absence of halitosis. The periodontal clinical parameters for all the participants as well as the crown parameters for participants with fixed crowns were also evaluated. Cross tabulation, Chi-square test, and one-way analysis of variance tests were used for the statistical analysis and comparisons. Results: Breath samples revealed, 50 (52.1%) participants were suffering from halitosis. Out of VSCs, the level of CH3SCH3 (62.5%) was found to be the most prevalent. Significant correlations were observed between the presence of fixed crowns and oral halitosis (p < 0.001). Statistically significant difference in the concentration of H2S and CH3SH (p < 0.001) and no significance for CH3SCH3 (p = 0.075) between patients with/without fixed crowns was found. The presence of halitosis was more prevalent in the subjects with crown parameters (subgingival margin, over-contoured margin, open-crown margin, over-contoured and under-contoured crowns) considered clinically defective/unacceptable (p < 0.05). Conclusions: Presence of fixed dental crowns significantly contributes to the oral halitosis. Dental crowns with defects significantly impair the hygienic conditions and oral microflora resulting in high prevalence of halitosis.

Association between dental factors and mortality

AIM

To study whether oral parameters such as endodontic infections, root canal fillings, number of teeth or wearing removable dentures at baseline are associated with cardiovascular- and all-cause mortality in a follow-up of approximately 8 years.

METHODOLOGY

The Finnish Parogene cohort consists of 508 Finnish adults (mean age 63.3 years, SD 9.1) with cardiac symptoms, all of whom had undergone coronary angiography for accurate baseline coronary status. Extensive clinical and radiographic oral examinations were performed, and additional data were acquired from medical records and questionnaires. Root canal fillings and endodontic lesions, as well as their co-occurrence, were determined from panoramic radiographs. The mortality data were assessed via record linkage with the Finnish Causes of Death register (mean follow-up time 7.81 years, SD 1.45 years). A total of n = 471 dentate patients were included in the statistical analyses.

RESULTS

A total of n = 69 deaths were recorded, of which n = 41 were due to cardiovascular diseases (CVDs, ICD-10 I00-I99). The deceased had fewer root canal fillings (mean 1.57; SD 1.64 vs. mean 2.30; SD 2.34, P = 0.03) than the survivors. The number of missing teeth was associated with smoking, occluded coronary arteries and diabetes. Cox regression with Firth's penalized maximum-likelihood method using age as timescale revealed an inverse association (HR; 95%CI) between mortality and number of teeth (all-cause 0.91; 0.86-0.96, CVD mortality 0.89; 0.83-0.96), use of removable dentures (all-cause 0.24; 0.09-0.62, CVD mortality 0.20; 0.06-0.72), root canal fillings (all-cause 0.82; 0.70-0.94, CVD mortality 0.79; 0.63-0.96) and having root canal fillings in all teeth with apical rarefactions (all-cause 0.27; 0.06-0.79, CVD mortality 0.09; 0.01-0.63), when gender, smoking, occluded coronary arteries, periodontal inflammatory burden index and the number of teeth were adjusted for.

CONCLUSIONS

The number of missing teeth appeared to be the strongest predictor of mortality in this study, whereas endodontic infections per se had no independent association. Nevertheless, signs of professional intervention in these problems, such as root canal fillings and removable dentures, appeared to be associated with improved survival, which might partly be explained by the utilization of healthcare services.

A study of fluid dynamics and human physiology factors driving droplet dispersion from a human sneeze

Recent studies have indicated that COVID-19 is an airborne disease, which has driven conservative social distancing and widescale usage of face coverings. Airborne virus transmission occurs through droplets formed during respiratory events (breathing, speaking, coughing, and sneezing) associated with the airflow through a network of nasal and buccal passages. The airflow interacts with saliva/mucus films where droplets are formed and dispersed, creating a route to transmit SARS-CoV-2. Here, we present a series of numerical simulations to investigate droplet dispersion from a sneeze while varying a series of human physiological factors that can be associated with illness, anatomy, stress condition, and sex of an individual. The model measures the transmission risk utilizing an approximated upper respiratory tract geometry for the following variations: (1) the effect of saliva properties and (2) the effect of geometric features within the buccal/nasal passages. These effects relate to natural human physiological responses to illness, stress, and sex of the host as well as features relating to poor dental health. The results find that the resulting exposure levels are highly dependent on the fluid dynamics that can vary depending on several human factors. For example, a sneeze without flow in the nasal passage (consistent with congestion) yields a 300% rise in the droplet content at 1.83 m (≈6 ft) and an increase over 60% on the spray distance 5 s after the sneeze. Alternatively, when the viscosity of the saliva is increased (consistent with the human response to illness), the number of droplets is both fewer and larger, which leads to an estimated 47% reduction in the transmission risk. These findings yield novel insight into variability in the exposure distance and indicate how physiological factors affect transmissibility rates. Such factors may partly relate to how the immune system of a human has evolved to prevent transmission or be an underlying factor driving superspreading events in the COVID-19 pandemic.

Retentive Characteristics of a Polyetheretherketone Post-Core Restoration with Polyvinylsiloxane Attachments

A new application of a polyetheretherketone (PEEK) post-core restoration combined with polyvinylsiloxane (PVS) attachments was proposed and substantiated. This study aimed to evaluate retentive characteristics of the PEEK post-core restoration with PVS attachment systems. Specimens with PVS attachments were fabricated to evaluate retention force during 10,000 cyclic dislodgements. Additionally, the retention forces of PVS attachments with three different values of Shore hardness were further measured before and after aging treatments. The results of cyclic dislodgement test indicated a strong negative linear relationship between the cyclic times and retention force (p < 0.0001, r = −0.957). Furthermore, the retention forces of the PVS were significantly improved with Shore hardness increased, which was also affected by the aging treatment (F (2, 138) = 10.95, p < 0.0001). Therefore, the PEEK post-core restoration with PVS attachments exhibited the favorable retention force, which could be a promising alternative for dental prostheses.

Development and feasibility of a tailored habit-based dietary intervention coupled with natural tooth replacement on the nutritional status of older patients

BACKGROUND

Older adults suffering partial tooth loss may need additional intervention strategies other than natural tooth replacement alone to improve their nutritional status. This study aimed to design and develop a habit-based tailored dietary intervention and to assess the feasibility and acceptability of the intervention, in conjunction with natural tooth replacement, amongst partially dentate older adults.

METHODS

The design and development of the dietary intervention (phase 1) consisted of analysis of the target population's dietary intake and qualitative research through focus groups with community-dwelling older adults (aged 65 years and over). The dietary intervention consisted of forming three healthy dietary habits around fruits and vegetables, wholegrains and healthy proteins. Feasibility of the intervention was then tested amongst older adults who had recently completed dental treatment for natural tooth replacement in a small non-randomised single arm study (phase 2). The principal feasibility outcome was the usability and acceptability of the intervention which was measured using evaluation questionnaires and by conducting post-intervention semi-structured interviews. Supporting outcomes consisted of feasibility of screening procedures, recruitment strategies and retention/attrition rates as well as the participant's compliance to the intervention assessed through self-monitoring tracking sheets.

RESULTS

Twenty-one older adults (mean [SD] age 72.1 [10.4].) took part in one of four focus group discussions (phase 1). Twelve themes related to barriers (e.g. oral health, appetite) and facilitators (e.g. nutritional knowledge, retirement) of healthy eating guided intervention development, as did a further five themes when asked for direct intervention feedback. Nine older adult participants (mean [SD] age 72.5[9.7]) were recruited into the feasibility study (phase 2) where eight themes were identified from feedback interview discussions. The principal outcome measures identified intervention feasibility as participants considered the intervention acceptable and useable as both the evaluation questionnaire and qualitative interview results were overwhelmingly positive. As a supporting outcome measure, strong intervention compliance was also achieved. Screening procedures were accepted but additional recruitment strategies (e.g. incorporation of home study visits or recruitment via posters advertisement) may benefit future study enrolment and retention.

CONCLUSION

Phase 1 and phase 2 findings have allowed for an iterative, user-driven intervention to be developed and refined for a randomised control study to evaluate the intervention's effectiveness.

TRIAL REGISTRATION

ISRCTN66118345.

Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

This comprehensive review of the 2019 restorative dental literature is offered to inform busy dentists regarding remarkable publications and noteworthy progress made in the profession. Developed by the Scientific Investigation Committee of the American Academy of Restorative Dentistry, each author brings discipline-specific expertise to 1 of 8 sections of the report: (1) prosthodontics; (2) periodontics, alveolar bone, and peri-implant tissues; (3) implant dentistry; (4) dental materials and therapeutics; (5) occlusion and temporomandibular disorders; (6) sleep-related breathing disorders; (7) oral medicine and oral and maxillofacial surgery; and (8) dental caries and cariology. The report targets important information likely to influence day-to-day dental treatment decisions. Each review is not intended to stand alone but to update interested readers so that they may visit source material when greater detail is desired. As the profession moves toward evidence-based clinical decision-making, an incredible volume of potentially valuable dental literature continues to increase. It is the intention of this review and its authors to provide assistance in negotiating the extensive dental literature published in 2019. It is our hope that readers find this work useful in the clinical management of dental patients.

Tooth loss, denture wearing and implants: Findings from the National Study of Adult Oral Health 2017-18

BACKGROUND

We aimed to describe the prevalence of different tooth loss outcomes along with the use of dentures and implants among Australians aged 15+ years across socioeconomic and demographic groups. In addition, we performed time trend analyses of tooth loss.

METHODS

Data from the National Study of Adult Oral Health 2017-18 included gender, age, residential location, household income, Socio-Economic Indexes for Areas, possession of dental insurance and pattern of dental visiting. Outcomes were complete tooth loss, inadequate dentition, average number of missing teeth, denture wearing and implants. We compared our findings with data from previous surveys carried out in 1987-88 and 2004-06.

RESULTS

Tooth loss decreased from 14.4% in 1987-88 to 6.4% in 2004-06, and to 4.0% in 2017-18. The proportion of people with lack of functional dentition halved from 20.6% 1987-88 to 10.2% in 2017-18; the average number of teeth lost due for any reason slightly reduced from 2004-06 (6.1) to 2017-18 (5.7). Tooth loss increased with age and was higher among socioeconomically disadvantaged, uninsured and those with unfavourable pattern of dental visiting groups than in their counterparts.

CONCLUSIONS

An overall improvement in tooth retention was identified over the last decades. However, socioeconomic inequalities persist.

Assessment of factors influencing oral health-related quality of life (OHRQoL) of patients with removable dental prosthesis

OBJECTIVE

The aim of this study was to evaluate factors affecting oral health related quality of life (OHRQoL) of patients using removable dental prosthesis.

METHODS

The present study employed a cross sectional analytical design. A total of 200 patients participated and interviewed using a cross sectional analytical design. In the first section of the questionnaire patients were asked about demographic data whereas the second part of the questionnaire assessed medical history, oral habits, smoking status, oral hygiene habits and frequency of dental visit. The questionnaire also collected information regarding patient's removable prosthesis. Questionnaire of OHIP-DENT (Oral Health Impact Profile) was also employed to measure oral health quality of life (OHRQoL) on the domains of functional limitation (FL), physical pain (P1), psychological discomfort (P2), physical disability (D1), psychological disability (D2), social disability (D3) and handicap (H). Relationships between the demographic, socio-economic and education variables and others OHIP-EDENT scores were explored by comparing mean scores by applying ANOVA.

RESULTS

The study participants comprised of 107 males (53.5%) and 93 females (46.5%). Regarding oral care, participants reporting to visit their dentist within one year were 40.0%. The highest score was recorded for the functional limitation (FL) domain (15.62±6.6), followed by social disability (D3) (15.23±5.06) and physical pain (P1) (14.28±4.8). The respective scores for physical (D1) and psychological disability (D2) and handicap (H) were 10.47±4.84, 11.32±5.38 and 12.45±4.50 respectively.

CONCLUSIONS

Removable partial denture patients showed minimum problems with mastication, social compromise and functional discomfort. The oral health quality of life of removable denture patients is significantly influenced by patient education level, socio-economic status, medical conditions, smoking and tobacco use habits.

Evaluation of oral health-related quality of life in patient with removable prosthesis: A cross-sectional study

Aim:

This study aimed to evaluate the relationship between oral health and quality of life in removable prosthesis users.

Materials and Methods:

An investigative cross-sectional study was designed, and 200 participants were considered based on calculations from the studies in the past. The Oral Health Impact Profile (OHIP)-14 survey comprises two parts in the study. Questions related to sociodemographic factors that documented age, gender, and type of removable prosthesis were included in the initial part of survey. Questions related to impact of oral health on quality of life make up the latter part of the survey. The answers ranged from “Definitely no” to “Definitely yes” for every item on a scale having 5 points. The likely range of scores is from 14 to 70. Data were analyzed by using the Statistical Package for the Social Sciences (SPSS) software program, version 20.0 for Windows. A value of P < 0.05 was considered statistically significant.

Results:

A survey evaluating the relationship between oral health and quality of life was adequately completed by 200 participants. Of these, 18 (22%) were women and 154 (78%) were men. The parameters such as gender, age, and the relationship between oral health and quality of life did not show significant difference either within groups or between the groups. The enrolled participants were wearing different dental prostheses such as complete dentures (CDs) in both upper (U) jaw and lower (L) jaw (19%), U jaw (3%), L jaw (4%) and removable prostheses in both jaws (30%), U jaw (24%) and L jaw (20%). No statistically significant differences were seen between them. The scores for oral health-related quality of life (OHRQoL) were associated positively with removable prosthesis score (r = 0.122) and were statistically significant.

Conclusion:

This study concluded that the use of removable prosthesis may positively impact OHRQoL. The period of usage of removable dentures was the highly significant parameter affecting patient gratification, whereas the practice of using removable prostheses was the highly significant parameter affecting the relationship between oral health and quality of life.

Effect of alveolar ridge preservation interventions following tooth extraction: A systematic review and meta-analysis

AIM

The aim of this systematic review was to critically analyse the available evidence on the effect of different modalities of alveolar ridge preservation (ARP) as compared to tooth extraction alone in function of relevant clinical, radiographic and patient-centred outcomes.

MATERIAL AND METHODS

A comprehensive search aimed at identifying pertinent literature for the purpose of this review was conducted by two independent examiners. Only randomized clinical trials (RCTs) that met the eligibility criteria were selected. Relevant data from these RCTs were collated into evidence tables. Endpoints of interest included clinical, radiographic and patient-reported outcome measures (PROMs). Interventions reported in the selected studies were clustered into ARP treatment modalities. All these different ARP modalities were compared to the control therapy (i.e. spontaneous socket healing) in each individual study after a 3- to 6-month healing period. Random-effects meta-analyses were conducted if at least two studies within the same ARP treatment modality reported on the same outcome of interest.

RESULTS

A combined database, grey literature and hand search identified 3,003 records, of which 1,789 were screened after removal of duplicates. Following the application of the eligibility criteria, 25 articles for a total of 22 RCTs were included in the final selection, from which nine different ARP treatment modalities were identified: (a) bovine bone particles (BBP) + socket sealing (SS), (b) construct made of 90% bovine bone granules and 10% porcine collagen (BBG/PC) + SS, (c) cortico-cancellous porcine bone particles (CPBP) + SS, (d) allograft particles (AG) + SS, (e) alloplastic material (AP) with or without SS, (f) autologous blood-derived products (ABDP), (g) cell therapy (CTh), (h) recombinant morphogenic protein-2 (rhBMP-2) and (i) SS alone. Quantitative analyses for different ARP modalities, all of which involved socket grafting with a bone substitute, were feasible for a subset of clinical and radiographic outcomes. The results of a pooled quantitative analysis revealed that ARP via socket grafting (ARP-SG), as compared to tooth extraction alone, prevents horizontal (M = 1.99 mm; 95% CI 1.54-2.44; p < 0.00001), vertical mid-buccal (M = 1.72 mm; 95% CI 0.96-2.48; p < 0.00001) and vertical mid-lingual (M = 1.16 mm; 95% CI 0.81-1.52; p < 0.00001) bone resorption. Whether there is a superior ARP or SS approach could not be determined on the basis of the selected evidence. However, the application of particulate xenogenic or allogenic materials covered with an absorbable collagen membrane or a rapidly absorbable collagen sponge was associated with the most favourable outcomes in terms of horizontal ridge preservation. A specific quantitative analysis showed that sites presenting a buccal bone thickness >1.0 mm exhibited more favourable ridge preservation outcomes (difference between ARP [AG + SS] and control = 3.2 mm), as compared to sites with a thinner buccal wall (difference between ARP [AG + SS] and control = 1.29 mm). The effect of other local and systemic factors could not be assessed as part of the quantitative analyses. PROMs were comparable between the experimental and the control group in two studies involving the use of ABDP. The effect of other ARP modalities on PROMs could not be investigated, as these outcomes were not reported in any other clinical trial included in this study.

CONCLUSION

Alveolar ridge preservation is an effective therapy to attenuate the dimensional reduction of the alveolar ridge that normally takes place after tooth extraction.

On the Future Design of Bio-Inspired Polyetheretherketone Dental Implants

Polyetheretherketone (PEEK) is a promising implant material because of its excellent mechanical characteristics. Although this polymer is a standard material in spinal applications, PEEK is not in use in the manufacturing of dental implants, where titanium is still the most-used material. This may be caused by its relative bio-inertness. By the use of various surface modification techniques, efforts have been made to enhance its osseointegrative characteristics to enable the polymer to be used in dentistry. In this feature paper, the state-of-the-art for dental implants is given and different surface modification techniques of PEEK are discussed. The focus will lie on a covalently attached surface layer mimicking natural bone. The usage of such covalently anchored biomimetic composite materials combines many advantageous properties: A biocompatible organic matrix and a mineral component provide the cells with a surrounding close to natural bone. Bone-related cells may not recognize the implant as a foreign body and therefore, may heal and integrate faster and more firmly. Because neither metal-based nor ceramics are ideal material candidates for a dental implant, the combination of PEEK and a covalently anchored mineralized biopolymer layer may be the start of the desired evolution in dental surgery.

Patient-reported effect in patients receiving implant or tooth-supported fixed prosthesis

OBJECTIVES

To compare the patient-reported effect of treatment with implant-supported fixed prosthesis (ISFP) and fixed dental prosthesis (FDP) in patients with a small number of tooth losses to replace.

METHODS

From a population of 155 patients receiving either ISFP or FDP, 68 patients were matched in pairs based on gender, number of teeth replaced, zone of replacement, age and number of remaining teeth. The patient-reported effect was prospectively obtained by measuring change in the short-form oral health impact (OHIP-14) from before to one month after treatment. Effect size (ES), standardised response mean (SRM) and a minimal important difference of two units were applied to estimate the magnitude of the change.

RESULTS

Both the ISFP and FDP groups decreased significantly in OHIP-14 after treatment (P < .01). The change was not significantly different between the ISFP and FDP groups. The magnitude of the change was for both treatments moderate and slightly higher in the ISFP group (ES = 0.52 and SRM = 0.58) than in the FDP group (ES = 0.48 and SRM = 0.47). Applying the minimal important difference showed that 23 participants in the ISFP group and 21 in the FDP group had good effect.

CONCLUSIONS

The patient-reported effect of treatment with ISFP or FDP was similar, clinically meaningful and of moderate magnitude in patients with a small number tooth losses to replace.

Extraction Socket Preservation with or without Membranes, Soft Tissue Influence on Post Extraction Alveolar Ridge Preservation: a Systematic Review

Objectives

The purpose of this systematic review was to assess quantitatively and qualitatively the influence of two different factors: membranes and soft tissue graft influence for the extraction socket preservation.

Material and Methods

A wide-ranging electronic search was performed in six databases up to 30 of November 2018 in order to identify all the clinical and randomized clinical trials performed in humans published with no data restriction. The inclusion criteria were extraction socket preservation with and without membranes or a soft tissue graft in a intact socket with at least six months of follow-up, have more than 12 patients or treat more than 12 sites per group and evaluated at least one of the primary outcomes measures (radiographic measures histological assessment, clinical measures).

Results

From an initial search of 1524 studies only 6 papers fulfil the inclusion and exclusion criterions. All the six selected papers, presented a wide heterogeneity of treatments used, evaluated variables and observation period that made impossible to recommend any specific techniques and/or material to achieve better results. The limited data found suggest that the used of membrane reveals to achieve better results. It wasn’t possible to observe in any clinical trial that compares the used of soft tissue graft.

Conclusions

New trials need to be performed in order to identify what specific techniques and/or materials are better to decrease the reabsorption of the socket after tooth extraction. Clinical trials designed to understand when/how the soft tissues grafts influence at the socket preservation is needed.

Cost-effectiveness of implant-supported dental prosthesis compared to conventional dental prosthesis

OBJECTIVE

To conduct a cost-effectiveness analysis of alternatives for rehabilitation treatment of mandibular edentulism in the context of the Brazilian Unified Health System (implant-supported total dental prosthesis versus conventional total dental prosthesis).

METHODS

A Markov model was developed to capture long-term clinical and economic outcomes. The model’s population was comprised of a hypothetical cohort of 1,000,000 patients, aged 55 years, with total mandibular edentulism and without medical contraindications for performing surgical procedures. The adopted analysis perspective was that of the Brazilian Unified Health System. Based on the proposed model, we calculated cost – in BRL, and effectiveness – measured by quality-adjusted prosthesis year (QAPY). The time horizon of the analysis was 20 years.

RESULTS

Considering a 5% discount in costs and effects, the incremental cost-effectiveness ratio of implant-supported total dental prostheses compared to conventional total dental prosthesis (BRL 464.22/QAPY) was lower than the willingness to pay threshold adopted in the model (BRL 3,050.00/QAPY).

CONCLUSIONS

The results of this economic analysis showed that the rehabilitation of mandibular edentulous patients by implant-supported total prosthesis is very cost-effective when compared to conventional complete prosthesis, considering the cost-effectiveness limits employed.

Is reduced dentition with and without dental prosthesis associate with oral health-related quality of life? A cross-sectional study

BACKGROUND

Oral health-related quality of life (OHRQoL) has important implications for the clinical practice of dentistry and dental research and should contribute to professional judgment about restorative treatments and prosthetic replacement in patients who had reduced dentitions. The aim was to compare the OHRQoL among adults (35-44 years) categorized according to different definitions of reduced dentition and considering the use (or non-use) of dental prosthesis.

METHODS

This study used data from a probabilistic sample of adults in Sao Paulo, Brazil, 2015. OHRQoL was based on none items of Oral Impacts on Daily Performance (OIDP) index, as prevalence (at least one impact) and extent (the number of items with non-zero score). We used different criteria to assess dentition status: (1) Shortened Dental Arch (SDA): having 3-5 natural occlusal units (OUs) in posterior teeth and intact anterior region; (2) hierarchical functional classification system: a five-level stepwise classification of dentition; and (3) presence of ≥21 teeth. The use or nonuse of dental prosthesis was recorded. Negative binomial regression models involved the adjustment for social determinants of health.

RESULTS

Nearly half (53.1%) of the 5753 participating adults had at least one oral health issue impacting OHRQoL. OIDP prevalence in adults with SDA did not differ from those with more OUs (PR = 1.02; 95%CI 0.91-1.13). Individuals with non-functional dentition had worse OHRQoL regardless of their use of a dental prosthesis. Adults with fewer than 21 remaining teeth, ranked significantly higher in OIDP extent, regardless of dental prosthesis use (PR = 1.38; 95%CI 1.16-1.63 with prosthesis; PR = 1.62; 95%CI 1.19-2.20 without dental prosthesis).

CONCLUSIONS

Individuals with more missing teeth reported worse OHRQoL regardless of using a dental prosthesis. Preserving a functional dentition, even with missing teeth, is compatible with OHRQoL.

Dentists and Dental Intern’s Preferences of Root Canal Treatment with Restoration Versus Extraction then Implant-Supported Crown Treatment Plan

Objectives:

The intent of this study was to evaluate and compare the preferences and treatment choices between dentists and dental interns with regard to the following different treatment modalities: Root Canal Treatment (RCT) with restoration versus extraction with Implant-Supported Crown (ISC) or surgical treatment in relation to the given case scenarios.

Methods:

The questionnaire was presented as an online survey with a case scenario. The total number of the respondents were 165. The four clinical case scenarios included an anterior and posterior tooth having apical periodontitis, with and without previous RCT. The treatment options were as follows: RCT with restoration, extraction then implant, and surgical treatment.

Results:

A total of 165 dentists and dental interns were included in this study. A hundred and three 62.4% respondents were dentists, 60; 36.3% were males and 105; 63.7% were females. Most of the respondents graduated from the College of Dentistry, Jazan University (93.9%). The highest percentages and numbers for Anterior Teeth (AT) were selected in related to the RCT and restorations in the four scenarios among gender, dentists, and interns, with no considerable differences. A high percentage of RCT and restoration option was recorded for Posterior Teeth (PT) with no previous restoration and around 50% for the same treatment modality to posterior teeth with previous restorations. For Future Planning Postgraduate Studies (FPPS), it was obvious that most of the selected specialties agreed with the RCT and restorations choice.

Conclusion:

All dentists and interns in both genders preferred RCT with restorations over extraction, and then ISC in the AT with and without previous RCTs. In the PT with no previous RCT, the participants agreed that RCT with restorations is superior to other choices. Among the FPPS, the respondents demonstrated an absolute agreement to RCT and restorations as a treatment of choice for different scenarios.

Clinical Significance:

Dentists should preserve the natural teeth by RCT with restoration as the first treatment choice followed by other choices. The nonsurgical approach should always be adopted as a routine measure in PA lesions of endodontic origin. Conservative orthograde endodontic therapy demonstrates favorable outcomes with a regular periodic review and assessment of the healing process of PA lesions.