Implants for elderly patients

Long-term follow-up of a patient with Parkinson's disease under nursing care after replacement of fixed implant-supported prostheses with an implant overdenture: a case report

BACKGROUND

In older patients with progressive neurodegeneration, replacing fixed implant-supported prostheses (FIP) with implant overdentures (IOD) has been proposed to prevent future mucosal injury and create an oral environment that is easier for caregivers to clean. However, there have been no reports on the progress after replacing FIP with IOD. In this report, we present the progress of an older patient with Parkinson's disease in whom FIP was replaced with IOD.

CASE PRESENTATION

An 81-year-old male patient with Parkinson's disease presented to our outpatient clinic with bruxism and crossbites. FIPs, with five Brånemark system implants, were placed in the bilateral lower molars. The FIP was replaced with an IOD with two locator attachments to create an oral environment that was easier for caregivers to clean and allow easy recovery of masticatory function if residual teeth were fractured in the care environment. As his systemic condition deteriorated, treatment was changed from outpatient to in-home visits. During dental care visits, professional oral cleaning and denture repair were continued, and good nutritional status was maintained. However, the patient developed cholecystitis and was hospitalized. During hospitalization, gastrostomy was performed because he developed aspiration pneumonia. After discharge from the hospital, the patient remained in bed all day and could not wear an IOD, resulting in buccal mucosa ulceration due to abrasion of the locator abutment. We decided to replace the abutment with cover screws; however, not all the implants could sleep submucosally. Although regular oral cleaning was resumed, new ulcers developed even when cover screws were installed. Additionally, swelling and drainage were observed at the peri-implant mucosal site where peri-implantitis had once occurred during an outpatient visit. The patient was readmitted to the hospital for a urinary tract infection, and subsequent visits were abandoned.

CONCLUSIONS

By replacing FIP with IOD in an older patient with Parkinson's disease, we addressed a barrier to caregiver-provided oral management. The removable prosthesis facilitated smooth oral care by caregivers and functional recovery in the event of trouble with residual teeth. However, it could not completely avoid the recurrence of buccal mucosal ulcers or peri-implantitis.

Dental implant considerations in patients with systemic diseases: An updated comprehensive review

BACKGROUND

Various medical conditions and the drugs used to treat them have been shown to impede or complicate dental implant surgery. It is crucial to carefully monitor the medical status and potential post-operative complications of patients with systemic diseases, particularly elderly patients, to minimize the risk of health complications that may arise.

AIM

The purpose of this study was to review the existing evidence on the viability of dental implants in patients with systemic diseases and to provide practical recommendations to achieve the best possible results in the corresponding patient population.

METHODS

The information for our study was compiled using data from PubMed, Scopus, Web of Science and Google Scholar databases and searched separately for each systemic disease included in our work until October 2023. An additional manual search was also performed to increase the search sensitivity. Only English-language publications were included and assessed according to titles, abstracts and full texts.

RESULTS

In total, 6784 studies were found. After checking for duplicates and full-text availability, screening for the inclusion criteria and manually searching reference lists, 570 articles remained to be considered in this study.

CONCLUSION

In treating patients with systemic conditions, the cost-benefit analysis should consider the patient's quality of life and expected lifespan. The success of dental implants depends heavily on ensuring appropriate maintenance therapy, ideal oral hygiene standards, no smoking and avoiding other risk factors. Indications and contraindications for dental implants in cases of systemic diseases are yet to be more understood; broader and hardcore research needs to be done for a guideline foundation.

Application of mesenchymal stromal cell sheets to prevent medication-related osteonecrosis of the jaw with titanium implants in rats

Medication-related osteonecrosis of the jaw (MRONJ) is an intractable adverse event. Dental implants are one of the triggering factors of MRONJ, and implant therapy with low MRONJ risk is required. This study aimed to investigate a rat model of MRONJ induced by extraoral placement of titanium materials and the use of mesenchymal stromal cell (MSCs) sheets to prevent MRONJ. Eight-week-old male rats were administered zoledronate and dexamethasone thrice weekly until killing. A week after drug initiation, a titanium screw and a plate were placed on the left buccal side of the mandible. Allogeneic bone marrow-derived MSC sheets were co-grafted with the titanium plates in the MSC sheet ( +) group. Six weeks after titanium placement, the rats were killed, and their excised mandibular bones were subjected to micro-computed tomography (CT) analysis. Histological analysis was performed after the titanium implants were removed. Empty lacunae visualized on hematoxylin and eosin staining were used as evidence of bone necrosis. Bone necrosis was reduced in the MSC sheet ( +) group. Tartrate-resistant acid phosphatase (TRAP) staining revealed a decreased number of TRAP-positive cells in areas with a large number of empty lacunae in the MSC sheet (-) group. Micro-CT analyses demonstrated that the bone volume fraction (BV/TV) was not significantly different between the MSC sheet (-) and ( +) groups. We conclude that MRONJ can be triggered by a titanium placement in rats, and grafting of allogeneic MSC sheets has the potential to prevent MRONJ.

Mandibular overdenture with a single implant in the canine region (c-SIMO): a feasibility study

OBJECTIVES

The aim of this multi-center pilot study was to assess the viability and feasibility of a novel treatment concept - the canine-positioned single implant mandibular overdenture (c-SIMO), with the single implant placed on the patient's preferred chewing side instead of the midline.

MATERIALS AND METHODS

Participants received a single implant in the canine region of their preferred chewing side, based on an Asymmetry Index observed during mastication. The pre-existing mandibular denture was transformed into a c-SIMO on a spherical attachment. The primary outcome was oral health-related quality of life (OHRQoL), measured with GOHAI and OHIP-EDENT. Secondary outcomes included denture satisfaction index (DSI), chewing efficiency (CE), maximum bite force (MBF), implant survival and success, and prosthetic maintenance. Data analysis included descriptive statistics and bivariate comparison tests.

RESULTS

Fifteen participants received the c-SIMO treatment (mean age: 69.9 ± 7.0). Implant success and survival rates were 100% at 1 year. Patient-reported outcome measures improved significantly compared to pre-treatment values (OHIP-EDENT: p = 0.001; DSI: p = 0.001; GOHAI: p = 0.002). Masticatory outcomes also improved significantly (CE: p = 0.001; overall MBF: p = 0.005). Post-implant, MBF was significantly higher in the ipsilateral side compared to the contralateral side at 2 weeks (p = 0.019) and 3 months (p = 0.015), but no longer at T3 (p = 0.730). Common prosthodontic events included denture base adjustments (n = 17) and matrix activation (n = 9).

CONCLUSIONS

This pilot study concludes that c-SIMO is a promising treatment option, and a potential alternative to the single midline implant overdenture.

CLINICAL RELEVANCE

The novel treatment concept of a canine-positioned single implant mandibular overdenture could be a viable treatment alternative to the midline positioning.

Evaluation of bioactivity and antibacterial properties of Ti6Al4V-based green biocomposite implant encompassing TiO2 nanotube arrays and garlic extract

This study involved the incorporation of an antibacterial garlic extract into titanium oxide nanotubes (TNTs) formed via the anodization of Ti6Al4V implants. The garlic extract, obtained through low-temperature extraction aided by ultrasound waves, was loaded into the nanotubes. The presence of the nanotubes was confirmed through X-ray diffraction (XRD), energy-dispersive X-ray spectroscopy (EDS), and scanning electron microscopy (SEM). Fourier-transform infrared spectroscopy (FT-IR) and gas chromatography-mass spectrometry (GC-MS) were used to investigate the presence of bioactive compounds, particularly sulfur compounds responsible for garlic's antibacterial effects. The impact of loading two concentrations (0.1 and 0.2 g per milliliter) of garlic extract on Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus) bacteria was examined. Results indicated a decrease in the growth range of S. aureus from 109 to 106 (CFU/ml) and E. coli from 1011 to 109 (CFU/ml) upon treatment. Additionally, cell adhesion and viability tests conducted on MG63 cells revealed an 8% increase in cell viability with the 0.1 g per milliliter concentration and a 35% decrease with the 0.2 g per milliliter concentration of garlic extract after 72 h of incubation (They have been evaluated by Microculture tetrazolium (MTT) assay). GC-MS analysis identified the presence of diethyl phthalate compounds in the garlic extract, suggesting a potential correlation with cellular toxicity observed in the sample with the higher concentration (0.2 g per milliliter) of garlic extract. Overall, the TNTs loaded with 0.1 g per milliliter of garlic extract simultaneously demonstrated antibacterial activity, cell viability, adhesion, and growth enhancement.

One-Piece Mini Dental Implant-Retained Mandibular Overdentures: 10-Year Clinical and Radiological Outcomes of a Non-Comparative Longitudinal Observational Study

This study presents the first 10-year follow-up investigation of the implant survival and peri-implant outcomes of one-piece mini dental implants (MDIs) retaining mandibular implant overdentures (IODs), including marginal bone level alterations (ΔMBLs), clinical peri-implant parameters, and complications. Twenty participants with horizontally atrophied mandibles received complete dentures and four MDIs (diameter 1.8 mm) at baseline. The dentures were converted into IODs with O-ring attachments. The 10-year follow-up comprised a radiological assessment of ΔMBLs, peri-implant parameters, as well as biological and technical complications. Results from a 10-year follow-up of 14 participants showed a 100% implant survival rate for all 56 implants. The mean ΔMBL after 10 years was -1.12 ± 0.80 mm, with 49 implants classified as successful (ΔMBL < 2 mm) and 7 implants with satisfactory survival (ΔMBL 2-4 mm). Time after implant placement significantly influenced ΔMBL, with stable MBLs after 5 years. The prosthetic survival rate after 10 years was 93%. ΔMBLs were not influenced by implant position or gender but were significantly smaller in subjects older than 65 years. Conclusively, one-piece MDIs with O-ring attachments offer a reliable treatment option for horizontally atrophied mandibles after 10 years, with high implant and prosthetic survival rates, potentially benefiting from advanced age regarding peri-implant bone stability.

One-time definitive attachment connection versus healing abutment placement for an implant-retained mandibular overdenture: Peri-implant metabolic activity

STATEMENT OF PROBLEM

Unscrewing the healing abutment can affect the soft tissue integration and apical migration of the biological width, which may compromise the integrity of peri-implant soft tissue.

PURPOSE

The purpose of this clinical study was to determine the level of glycosaminoglycan (GAG) detected in the peri-implant crevicular fluid (PICF) between the test group (1-time abutment) and control group (healing abutment) for implant-retained mandibular overdentures.

MATERIAL AND METHODS

Two dental implants were installed in the canine regions of the mandibular ridge of 18 healthy completely edentulous participants using 2-stage surgery and a delayed loading protocol. At the second stage surgery, the implant on the right side was exposed, and a healing abutment was screwed onto the implant (control group), while on the left side the definitive ball abutment was screwed onto the implant (test group). After 10 days, the healing abutment in the control group was unscrewed and replaced with the definitive ball abutment. For both groups, the ball attachment was directly picked up to incorporate the attachment house to the mandibular denture. PICF samples were collected from the participants at 7 days, 3 months, and 6 months after overdenture use. Statistical analysis was done with an independent samples t test (α=.05).

RESULTS

A significant difference was found in the volume of PICF and the level of GAG between the test and control groups at the 7-day evaluation period (P=.008, P=.002, respectively), while the volumes of PICF and the levels of GAG were not significantly different (P>.05) at the other evaluation periods.

CONCLUSIONS

The 1-time abutment protocol offers biochemical and economic advantages compared with the conventional method of using the healing abutment before placement of the definitive attachment for an implant-retained overdenture with single attachments.

Age-related knowledge deficit and attitudes towards oral implants: Survey-based examination of the correlation between patient age and implant therapy awareness

BACKGROUND

Implantology, as a recognized therapeutic approach, is gaining prominence. The decision-making process and success of implant therapy are closely linked to patient knowledge and expectations. This study aims to explore the association between age and knowledge regarding oral implants.

METHODS

Participants were categorized into three age groups (ag): ag 1 (35-44 years), ag 2 (65-74 years), and ag 3 (75 years and older). A total of 400 participants per age group were randomly selected using data from the residents' registration office of Berlin, Germany. Structured telephone interviews were conducted between 2016 and 2017, employing a 67-item questionnaire covering awareness, information level, cost estimation, attitudes, and experiences with oral implants.

RESULTS

Despite a low overall knowledge level across all age groups, there was no significant correlation between age and knowledge about oral implants. Awareness increased with age. Information sources varied, with friends, acquaintances, and dentists playing key roles. Participants expressed diverse opinions on implants, with durability and stability identified as crucial characteristics. Significant differences in knowledge were observed between age groups regarding awareness, information sources, and perceptions of dentists offering implants.

CONCLUSIONS

The study suggests a need for targeted educational programs, emphasizing age-appropriate information sources to enhance health literacy in oral implantology, particularly among older individuals. Educating physicians on oral implant basics is also crucial. Implementing these measures could empower individuals to make informed decisions about oral implant treatment, thereby contributing to improved oral health outcomes.

Effects of multisensory environment/stimulation therapy on adults with cognitive impairment and/or special needs: A systematic review and meta-analysis

AIM

This review aimed to evaluate the effects of multisensory environments/stimulation (MSE/MSS) therapy, on the behavior and psychological symptoms in adults with cognitive impairment and/or special needs.

METHODS

Online database searches were performed to identify studies reporting on the effects of MSS/MSE therapy in adults (>18 years). Data were extracted for the following investigated outcomes including anxiety, depression, mood, behavioral attributes, biomedical parameters, cognition, motor skills, quality of life (QoL), pain, and end of life quality. Two reciprocally blinded investigators extracted the data. Inter-investigator reliability (𝝹) was calculated. A meta-analysis and a qualitative analysis were performed on the information extracted.

RESULTS

Thirty-six studies were included for data extraction and analysis. Meta-analysis of the included studies revealed a significant improvement with the MSE/MSS therapy, for agitation (p = .018), anxiety (p = .023), cognition (p < .001), and depression (p < .001). MSS/MSE therapy demonstrated a tendency for the improvement of the QoL in adults (p = .05).

CONCLUSION

MSE/MSS therapies are beneficial in cognitively impaired adults and improve their anxiety, depression, cognitive and other behavioral attributes such as agitative behaviors. Promoting these therapies in geriatric care may help to improve/reduce the challenging/care-resistant behaviors in adults and facilitate effective provision of the necessary care.

Nursing home caregivers' acceptance of, and experiences with, a new digital intervention for oral healthcare: A qualitative feasibility study

OBJECTIVES

The objectives of the present study were to qualitatively investigate nursing home caregivers' acceptance of, and experiences with, a new digital intervention for oral healthcare after a period of real-life testing in three nursing homes located in Rogaland county, Norway.

BACKGROUND

Nursing home caregivers report numerous barriers when it comes to provision of adequate oral care for care-dependent older adults. Among the reported barriers are lack of knowledge and skills, care-resistant behaviours, lack of adequate routines and documentation systems for oral health, a high workload, and unclear responsibilities. To overcome these barriers, a digital tool named SmartJournal was developed to assist caregivers in preserving nursing home residents' oral health.

MATERIALS AND METHODS

Semistructured interviews were performed with selected caregivers (n = 12) taking part in SmartJournal testing. A theory-driven thematic analysis based on technology acceptance model was conducted.

RESULTS

SmartJournal was generally described as a userfriendly and useful tool. The initial reaction of the participants was mixed; some were positive, some had concerns, but many seemed to have a neutral stance to the intervention. Both barriers and facilitating factors for SmartJournal usage were revealed. Interestingly, the usage gradually changed from norm-based to routine-based behaviour during the test period. Although the tool was well-accepted, as demonstrated with study participants' willingness to use it in the future, they had several suggestions for improvements to further adapt it to a nursing home setting.

CONCLUSION

Results from the present study provide valuable information on questions about SmartJournal acceptance and intervention delivery, thereby preparing the ground for a larger scale evaluation study assessing measurable effects of SmartJournal usage in nursing homes.

Clinical evaluation of 3.0-mm narrow-diameter implants: a retrospective study with up to 5 years of observation

PURPOSE

This study aimed to evaluate the clinical outcomes of a single type of narrow-diameter implant (NDI) by investigating its survival rate and peri-implant marginal bone loss (MBL). In addition, variables possibly related to implant survival and MBL were investigated to identify potential risk factors.

METHODS

The study was conducted as a retrospective study involving 49 patients who had received 3.0-mm diameter TSIII implants (Osstem Implant Co.) at Seoul National University Dental Hospital. In total, 64 implants were included, and dental records and radiographic data were collected from 2017 to 2022. Kaplan-Meier survival curves and a Cox proportional hazard model were used to estimate the implant survival rate and to investigate the effects of age, sex, jaw, implant location, implant length, the stage of surgery, guided bone regeneration, type of implant placement, and the surgeon's proficiency (resident or professor) on implant survival. The MBL of the NDIs was measured, and the factors influencing MBL were evaluated.

RESULTS

The mean observation period was 30.5 months (interquartile range, 26.75-45 months), and 6 out of 64 implants failed. The survival rate of the NDIs was 90.6%, and the multivariate Cox regression analysis showed that age was associated with implant failure (hazard ratio, 1.17; 95% confidence interval, 1.04-1.31, P=0.01). The mean MBL was 0.44±0.75 mm, and no factors showed statistically significant associations with greater MBL.

CONCLUSIONS

NDIs can be considered a primary alternative when standard-diameter implants are unsuitable. However, further studies are required to confirm their long-term stability.

Implant-assisted removable partial dentures: Part II. a systematic review of the effects of implant position on the biomechanical behavior

PURPOSE

This systematic review aimed to evaluate the effects of implant placement sites on the biomechanical behavior of implant-assisted removable partial dentures (IARPDs) using finite element analysis (FEA).

STUDY SELECTION

Two reviewers independently conducted manual searches of the PubMed, Scopus, and ProQuest databases for articles investigating implant location in IARPDs using FEA, according to the 2020 Systematic Reviews and Meta-analyses statement. Studies published in English up to August 1, 2022, were included in the analysis based on the critical question.

RESULTS

Seven articles meeting the inclusion criteria were systematically reviewed. Six studies investigated mandibular Kennedy Class I and one study investigated mandibular Kennedy Class II. Implant placement reduced the displacement and stress distribution of the IARPD components, including dental implants and abutment teeth, regardless of the Kennedy Class type and dental implant placement site. Most of the included studies showed that, based on the biomechanical behavior, the molar region, rather than the premolar region, is the preferred implant placement site. None of the selected studies investigated the maxillary Kennedy Class I and II.

CONCLUSIONS

Based on the FEA regarding mandibular IARPDs, we concluded that implant placement in both the premolar and molar regions improves the biomechanical behaviors of IARPD components, regardless of the Kennedy Class. Implant placement in the molar region results in more suitable biomechanical behaviors compared with implant placement in the premolar region in Kennedy Class I. No conclusion was reached for Kennedy Class II due to the lack of relevant studies.

Implant-assisted removable partial dentures: Part I. a scoping review of clinical applications

PURPOSE

This scoping review aimed to systematically map research regarding implant-assisted removable partial dentures (IARPDs), and identify existing gaps in knowledge.

STUDY SELECTION

Two reviewers independently conducted a search of the MEDLINE-PubMed and Scopus databases according to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) extension for Scoping Review and included articles published in English up to August 31, 2022, including human studies, reviews, and in vitro studies. Expert opinions, animal studies, and clinical studies involving complete overdentures were excluded, and ten aspects for establishing the treatment strategy for IARPDs were examined.

RESULTS

One hundred and twelve articles were chosen. There were two treatment modalities: IARPDs retained by implant- and tooth-supported surveyed single crowns (SCs) or fixed partial dentures (FPDs). In IARPDs retained by tooth-supported surveyed SCs or FPDs, the survival rate of dental implants for IARPDs was relatively higher with a wide range of marginal bone loss and many complications, but with improved functional performance, oral health-related quality of life, and patient satisfaction. There were limited data on survival or success rates and designs of IARPDs, attachment selections, length and diameter, inclination, placement sites, and loading protocols of implants, regardless of prosthetic types. There was limited information on maxillary IARPDs except for survival rates of implants.

CONCLUSIONS

Although IARPDs could become a useful treatment strategy, there is limited scientific consensus with gaps in knowledge about their use. Additional well-designed clinical and in vitro studies are necessary to scientifically establish IARPDs as definitive prostheses in implant dentistry.

Small-diameter titanium grade IV and titanium-zirconium implants in edentulous mandibles: Ten-year results from a double-blind, randomised controlled split-mouth core-trial

The goal of this extension study was to compare the 10-year outcome of 3.3 mm diameter titanium-zirconium (TiZr) or grade IV titanium (Ti) implants in mandibular implant-overdentures.

MATERIALS AND METHODS

This study is the 10-year follow-up from a randomised, controlled, double-blind, split-mouth multicentre clinical trial. Patients with edentulous mandibles had received two implants in the interforaminal region (bone-level, diameter 3.3 mm, microrough surface), one of TiZr (test) and one of Ti (control). Implant survival and success, plaque and sulcus bleeding indices, probing pocket depth, gingival margin, clinical attachment level and radiographic crestal bone levels were evaluated.

RESULTS

Fifty of 91 patients with implants were available for the 10-year examination and 36 patients were valid for the intent-to-treat (ITT) analysis. The implant success rate was calculated as 94.6% and 91.9% for the TiZr implants and the Ti implants respectively. Four implants were lost (TiZr = 1; Ti = 3) in the entire study period. Kaplan-Meier survival analyses estimated 10- year implant survival rate for TiZr to 98.9% and Ti 95.8%.The mean of total and functional crestal bone loss was 1.49 mm (±1.37 mm) and 0.82 mm (±1.09 mm) in the TiZr group and 1.56 mm (±1.34 mm) and 0.85 mm (±1.16 mm) in the Ti group.

CONCLUSIONS

This split-mouth design RCT on mandibular implant-overdentures evidenced, bearing in mind its follow-up time-related reduced cohort size, high 10-year implant success- and survival rates. These results confirm TiZr as well-suited implant material for realising small-diameter implants. Registered on www.

CLINICALTRIALS

gov: NCT01878331.

Immediate Loading of Implants with Fixed Rehabilitations in Geriatric Edentulous Patients; Biological Complications

BACKGROUND

This study aimed to report the outcomes of the immediate loading of implants with fixed rehabilitations in edentulous geriatric patients.

METHODS

Edentulous geriatric patients were diagnosed with an oral examination, radiographic evaluation, and intermaxillary relations and treated with fixed rehabilitation over several implants. After immediate surgery, the implants were immediately loaded with a fully fixed prosthesis.

RESULTS

Twenty-four patients (20 females and 4 males) were treated using a total 210 implants. All patients (100%) had a previous history of periodontitis. Eleven patients (45.8%) were smokers. Eleven patients (45.8%) suffered from chronic medical diseases (i.e., diabetes, cardiovascular diseases). The study's clinical follow-up period extended for three years, during which thirty-three fixed prostheses were installed over the implants in 24 patients. The average marginal bone loss measured was 1.33 ± 0.17 mm. The success rate of the implants and prosthodontics being placed in this study yielded 98.5% and 97%, respectively. One patient (4.2%) showed some kind of technical complications. Eleven patients (45.8%) showed mucositis, and 25 implants (11.9%) in 10 patients (41.7%) were associated with peri-implantitis.

CONCLUSIONS

This study shows that the treatment of edentulous geriatric patients by immediate loading of implants with fixed rehabilitations is a clinically successful protocol but with a high prevalence of peri-implant diseases.

Assessment of the SmartJournal Intervention for Improved Oral Care in Nursing Homes: Protocol for a Cluster Randomized Controlled Trial

BACKGROUND

Poor oral health is common in nursing home residents, and health care professionals report numerous barriers when it comes to the provision of oral care for care-dependent older adults, such as a lack of oral health knowledge and skills, care-resistant behaviors in residents, lack of adequate oral care routines, insufficient systems for documentation of issues related to oral health, a high workload, and unclear responsibilities. An intervention, SmartJournal, has been developed to assist health personnel in preserving older patients' oral health. SmartJournal is a digital tool with three components: (1) documentation of oral hygiene routines; (2) monthly oral health assessment; and (3) education on geriatric oral care. An updated framework for research on complex interventions has been used to guide the various phases in the development of this intervention. This study focuses on the evaluation phase.

OBJECTIVE

We aim to assess (1) the effectiveness of SmartJournal use in enhancing nursing home caregivers' capability, opportunity, motivation, and routines related to oral care; and (2) whether SmartJournal use results in improved oral health for nursing home residents.

METHODS

We will use a cluster randomized controlled trial to assess impacts of SmartJournal use as specified under study objectives. Nursing homes located in Rogaland, Norway, will be recruited and randomly assigned to an intervention and a control group. The intervention group will be provided with tablets containing SmartJournal and support from research staff, while the control group will continue with existing oral care routines. Both groups will receive oral hygiene packages. The intervention will last for 12 weeks. Measurements will be performed in both groups at baseline, 3 months, and 9 months and include (1) a survey assessing caregivers' capability, opportunity, motivation, and routines related to oral care; and (2) assessment of oral health status in residents using mucosal-plaque score as a primary outcome measure. Analyses will include descriptive statistics and statistical techniques to look for changes and differences in the study variables within and between the intervention and control groups throughout the study period. Associations between study variables will also be investigated.

RESULTS

Recruitment of nursing homes for the intervention and control groups was completed in February 2023. Recruitment of individual participants (ie, nursing home residents and caregivers) is ongoing, and baseline measurements are being performed consecutively. Results are expected to be ready for analyses in fall 2024.

CONCLUSIONS

We aim to assess the effects of SmartJournal use on oral care and oral health in nursing homes. Results from this work may inform further development and implementation of SmartJournal and similar digital tools aiming to enhance health care services offered to care-dependent people. Finally, SmartJournal may have potential as a learning tool in educational programs for nurses and other health care professionals.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05724043; https://clinicaltrials.gov/study/NCT05724043.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/46926.

Evaluation of Implant Stability According to Implant Placement Site and Duration in Elderly Patients: A Prospective Multi-Center Cohort Study

The aim of this prospective study is to investigate implant stability and the reliability of different measuring devices according to implant placement site and duration in patients aged over 65 years. The study evaluated 60 implants (diameter: 3.5/4.0/4.5/5.0 mm and length: 8.5/10.0/11.5 mm) in 60 patients aged ≥ 65 years. The implant placement sites were divided into six evenly distributed sections (n = 10), i.e., maxillary right-posterior, A; maxillary anterior, B; maxillary left-posterior, C; mandibular right-posterior, D; mandibular anterior, E; mandibular left-posterior, F. Participants visited the hospital six times: implant surgery, 1V; stitch removal, 2V; 1-month follow-up, 3V; 2-month follow-up, 4V; before final restoration delivery, 5V; and after final restoration delivery, 6V. The implant stability was evaluated with the Osstell Mentor (ISQ), Periotest M (PTV), and Anycheck (IST). The mean values of ISQ, PTV, and IST were analyzed (α = 0.05). ISQ, PTV, and IST results of 4V and 5V were significantly higher than those of 1V (p < 0.05). The lowest ISQ results occurred in the E location at 4V and 5V (p < 0.05). In all mandibular locations, IST results of 6V were significantly higher than those of 1V, 2V, 3V, and 4V (p < 0.05). ISQ results were negatively correlated with PTV and positively correlated with IST, and PTV was negatively correlated with IST. By considering various factors affecting the stability of the implant, it is necessary to determine the appropriate implant load application time. This could help increase the implant success rate in elderly patients. And as a diagnostic device for implant stability and the evaluation of osseointegration in elderly patients, Anycheck was also able to prove its relative reliability compared to Osstell ISQ Mentor and Periotest M.

Evaluation of bite force, quality of life, and patients' satisfaction in elderly edentulous patients using implant overdentures

Purpose

This study aimed to compare the bite force (BF) between complete dentures and implant overdentures (IODs) retained by two mandibular implants. Additionally, we evaluated the quality of life (QoL) and patient satisfaction among individuals using IODs. In addition, the effects of demographic parameters such as age and sex, and clinical parameters such as implant length, implant diameter, attachment height, attachment color, and interimplant distance on BF, QoL, and patient satisfaction were evaluated.

Materials and methods

A total of 51 edentulous patients rehabilitated with the maxillary complete dentures and mandibular IODs retained by two implants were included in this study. BF was measured using a force meter pre- and post-implant in the same patients. Oral health-related quality of life (OHRQoL) was assessed with the Oral Health Impact Profile (OHIP-14) and patient satisfaction was assessed with the Visual Analog Scale (VAS) questionnaires.

Results

It was found that BF values were statistically higher for IODs than complete dentures (P < .001). In terms of attachment height of the OHIP scores, there was a significant difference in the psychological disability and social disability domains (P < .05). When examining the change in patient satisfaction as a function of sex, it was found that mandibular retention satisfaction differed significantly by sex (P < .05), but there was no significant difference in the other domains.

Conclusion

Within the limitations of this study, it was observed that the BF increased after the use of IODs. Several factors, including age, interimplant distance, attachment height, and attachment color, were found to impact OHRQoL. Sex and implant diameter were identified as factors affecting patient satisfaction.

The Single Midline Implant in the Edentulous Mandible-Current Status of Clinical Trials

The single midline implant in the edentulous mandible is a treatment concept that has often been controversially discussed. Nearly 30 years ago, the first available clinical results revealed high implant survival rates and remarkable improvements in oral comfort, function, patient satisfaction and oral health-related quality of life for edentulous patients compared to the situation with no implant. However, the clinical trials were predominantly conducted with a small number of patients over a short to medium follow-up period. Today, numerous clinical investigations on the single midline implant in the edentulous mandible, which increasingly include longer-term observation periods, are available. It is the aim of this overview to present the current literature and to highlight the clinical problems. This article is a 2023 update of a review published by the authors in the German language in 2021 in the German journal Implantologie. In total, 19 prospective clinical trials with a follow-up period of 0.5-10 years were analyzed. Over this observation period, single implants with modern rough implant surfaces in the edentulous mandible reveal high implant survival rates of between 90.9 and 100% when a conventional delayed loading protocol was applied.

Assessment and Improvement of Masticatory Performance in Frail Older People: A Narrative Review

According to the World Health Organization (WHO), the estimated number of older adults is around 962 million and is projected to increase to 2.1 billion by 2050. The oral frailty concept is associated with gradual oral function loss in relation to aging. There is a need to emphasize the improvement of oral function based on an evaluation of masticatory performance in patients with various oral conditions or systemic diseases and especially in the frail elderly. The present narrative review presents an overview of the current state of the assessment and improvement of masticatory performance in frail older people. To fully encompass oral frailty, oro-facial hypofunction, or oro-facial fitness, dental Patient Reported Outcomes (dPROs) should be included; nevertheless, there are limited evidence-based rehabilitation approaches. The concept of oral frailty, oro-facial hypofunction, or oro-facial fitness should involve dental Patient Reported Outcomes (dPROs), and in this sense, there are only a few evidence-based rehabilitation procedures to improve oro-facial hypofunction besides prosthodontics. It must be considered that reduced neuroplastic capacity in old individuals might preclude a positive outcome of these strategies that might need to be accompanied by functional training and nutritional counseling.

Scientific production of an oral implantology journal: a 5-year bibliometric study

Oral implantology is a science in constant evolution, with a considerable number of articles being published every year in scientific journals. Publications can be analyzed through bibliometric analysis, thus observing the evolution and trends of the articles published in the journal. To evaluate, through bibliometric analysis, the scientific production of Clinical Implant Dentistry and Related Research (CIDRR) and its evolution and trends in the last 5 years (2016-2020).All articles published in CIDRR in the last 5 years were reviewed and classified according to the year of publication, volume, number, the number of authors, demographic data of the first and last author, the geographical scope of the article, the number of affiliations of the authors, research topic, type of study, and study design. The association between these variables and citation counts was also analyzed. 599 articles were analyzed. 77.4% were authored by 4-6 authors, obtaining 78.4% from 1 to 3 different affiliations. Male researchers predominated in both the first and last authorship. China showed the highest number of publications when comparing the origin of the authors' affiliations individually; however, most researchers (40.9%) were from the European Union (EU)-Western Europe area. The most studied topic was the implant/abutment design/treatment of the surface (19.1%). Clinical research articles accounted for 92.99% of the publications, of which cross-sectional observational studies prevailed (21.7%). The presence of articles from the United States of America-Canada and EU-Western Europe was positively correlated with the impact factor. This study revealed an increasing trend in Asian research production, particularly Chinese, whereas production of European origin showed a decrease. Clinical studies increased their relative weight to the detriment of translational ones. A growing tendency in the relative weights of female authors was appreciated. Journal citations were associated with certain study variables.

Biomechanical analysis of different fixed dental restorations on short implants: a finite element study

OBJECTIVES

Although the use of short implants is becoming more common for patients with atrophic alveolar ridges, their use is still quite limited. This is due to the lack of data of long-term survival compared to standard-length implants. The aim of this study was to determine the load in the bone and implant system with different superstructures.

METHODS

Three kinds of prosthetic restorations were created on short implants based on CT-Data. Two short implants with different macro-geometries were used. The implants were inserted in idealised posterior lower mandibular segments and afterwards restored with a crown, a double splinted crown, and a bridge.

RESULTS

The analysis was performed under load of 300 N either divided between a mesial and distal point or as a point load on the pontic/mesial crown. The different design of the implant systems had a noticeable influence on the stress in the cortical bone, in the implant system, and the displacement of the superstructure as well.

CONCLUSIONS

Compared with implants of standard length, higher stresses were observed, which can lead early failure of the implant during the healing period or a late cervical bone resorption. Precise indications are essential for short implants to avoid the failure of short implants.

Tissue-Level Laser-Lok Implants Placed with a Flapless Technique: A 4-Year Clinical Study

BACKGROUND

The present study aims to analyze the use of Laser-Lok microtextured neck implants placed with a transmucosal surgical approach. The marginal bone level (MBL) and periodontal parameters were evaluated in a cohort prospective 4-year clinical study.

METHODS

A total of 41 implants were placed in 36 healthy consecutive patients (16 males, 20 females, mean age 60 ± 9 years). Tapered tissue level implants, characterized by a 2.0 mm laser-microtextured neck, were used with a flapless approach. Customized abutments and provisional resin crowns were positioned. Definitive metal-ceramic crowns were cemented approximately 4 months after insertion. Periapical radiographs were taken after 1, 3, 6, 12, 36 and 48 months from implant placement to evaluate MBL. Gingival thickness (thin/thick), plaque score (PS) and bleeding on probing (BoP) were evaluated.

RESULTS

After 48 months, all implants were safe from complications. No complications, peri-implantitis, early implant failures or mucositis occurred. The survival rate was 100%. Mean MBL during the follow-up was -0.15 ± 0.18 at T1, -0.29 ± 0.29 at T3, -0.45 ± 0.37 at T6, -0.53 ± 0.45 at T12, -1.06 ± 1.13 at T 36 and -1.10 ± 0.89 at T 48. Implants placed 2-3 months after tooth extraction revealed lower MBL variation when compared to those placed immediately (in fresh extraction sockets) or in completely healed ridges (delayed group). Narrower diameter implants (3.8 mm) showed significantly higher MBL variation when compared to 4.6 diameter implants. Multilevel analysis at T48 revealed that among all the evaluated variables, implant diameter was the factor mostly associated with MBL modifications (p = 0.027).

CONCLUSION

This 4-year clinical study supports the use of Laser-Lok implants placed at tissue level with a flapless approach. A limited bone loss during the 48-month follow-up was observed. Periodontal parameters were stable with no sign of inflammation or soft tissue alteration. The use of Laser-Lok implants with transmucosal surgery represents a suitable technique with a minimally invasive approach.

Current oral health services and the divergent needs of the baby boom cohorts

The two cohorts of Baby Boomers, the Early (born between 1945 and 1955) and the Late (born between 1956 and 1964), have some subtle yet distinct differences when it comes to their oral health and oral health related behaviors. Unlike their predecessors, the Baby Boomer cohorts are retaining more teeth, as there is a sharp fall in edentulous rates in this population. The oral health care community is now facing unparalleled challenges in providing and maintaining the oral health of this unique cohort who are keeping their teeth longer, have multiple comorbidities, and are living longer than previous generations. This paper draws from the latest studies, scientific data and research to describe a realistic picture of the oral health services available to and utilized by the Baby Boomers. The factors affecting utilization, their rising needs, demands, expectations, and areas where improvement is needed for the Baby Boomer are also reported here.

Insertion Torque, Removal Torque, and Resonance Frequency Analysis Values of Ultrashort, Short, and Standard Dental Implants: An In Vitro Study on Polyurethane Foam Sheets

Short implants were introduced to reduce morbidity, treatment duration, and complex bone regeneration interventions in atrophic jaws and to improve patient-reported outcomes. This study aimed to determine the insertion torque (IT), removal torque (RT), and resonance frequency analysis (RFA) values of ultrashort (3 mm length), short (7 mm length), and standard implants (10 mm length) inserted in 1-, 2-, 3-, and 4-mm thickness polyurethane sheets with densities of 10, 20, and 30 pounds per cubic foot (PCF). Standard-length implants were the gold standard (control). Overall, short-length implant IT values were higher or similar to the control in most experimental conditions. Those inserted into a 3 mm/30 PCF lamina showed the highest IT values, whereas 5 mm diameter ultrashort-length implants inserted into 2 and 3 mm/20 PCF laminas were higher than other implants. RT values followed the same trend and RFA values were more appreciable in short- and standard-length implants in all the scenarios. However, ultrashort-length implants reached a primary stability comparable to that of standard implants in lower thicknesses. In conclusion, although further studies are needed to corroborate this in vitro model with preclinical and clinical studies, our data shed light on short- and ultrashort-length implants geometries to a potential application in critical atrophy of the posterior jaws.

Maintenance issues of elderly patients requiring nursing care with implant treatments in dental visiting: position paper

PURPOSE

Japan, with an increasing number of elderly people needing long-term care in a super-aged society, urgent needs to develop the clinical guidelines on implant maintenance for elderly people with declining independence. The purpose is to categorize the troubles encountered in the care of patients with dental implants and to indicate actual practices and points of note.

METHODS

From the members of the Japanese Society of Oral Implantology, 12 expert panelists who were experienced with many problems of implant maintenance during dental visits and were familiar with their solutions were selected. Through repeated discussions in the many panel meetings, the problems of implant maintenance during dental visits were distilled.

RESULTS

During a dental visit, the oral cavity, general conditions, and background of elderly patients who cannot orally care for themselves must be grasped, and medical staff, care managers, and patients should understand the changes in these factors as time goes by. The solutions and responses that can be made differ greatly depending on the medical care facilities, the environment, differences in the experience of medical staff, and the patient's background. Thus, it is necessary to select safe treatments appropriate to each situation.

CONCLUSIONS

This paper features many opinions based on clinical experiences. However, clinical guidelines on implant management during dental visits should be formulated in the future based on the accumulation of evidence through the implementation of clinical research.

Maxillary overdenture on three implants retained by low-profile stud attachments - A prospective cohort study

BACKGROUND

Clinical data are needed on long-term outcomes of removable implant-supported prostheses in the fully edentulous maxilla as a function of the number of implants, effects of the attachment system and other clinical variables.

OBJECTIVE

To restore individuals with an edentate maxilla with a metal-reinforced removable prosthesis without palatal coverage retained by low-profile stud attachments on three implants.

METHODS

The regional ethics committee approved a prospective cohort study that included all consecutive patients treated in a private speciality clinic. Primary outcomes were patients reported, that is denture satisfaction scale and oral health-related quality of life - OHIP-20. Secondary outcomes were implant- (bone loss, implant complications and peri-implant conditions) and prosthesis-related (prosthesis complications, maintenance needs and mucosa condition).

RESULTS

Thirty-two study participants were recruited between March 2007 and October 2016 and followed for a minimum of five years. According to Kruskal-Wallis tests, the OHIP-20 and Denture Satisfaction Scale questionnaire pre-treatment scores differed significantly. After an average of 6.7 years, peri-implant bone loss of more than 2 mm was observed on 17% of all implants, while no or minor bone loss was seen on 38%. The estimated success of implants was 0.95 at 168 months. The estimated success of the prosthesis, that is no adverse events or need for any repairs, was 0.55 at 156 months.

CONCLUSION

The positive findings in the current clinical study strengthen the notion that for many individuals with an edentulous maxilla, a removable prosthesis retained by three implants fitted with low-profile stud-attachment is a reliable technical solution.

Periodontitis and peri-implantitis in elderly people experiencing institutional and hospital confinement

An increasing number of elderly people retain their natural teeth into old age and further, the prevalence of endosseous implants for supporting oral prosthesis is ever increasing. These teeth and implants now present a considerable challenge in terms of maintenance, especially when patients become dependent on care. Periodontal and peri-implant diseases are more prevalent in elderly than in younger age cohorts. There are distinct differences related to the inflammatory response between periodontal and peri-implant tissues, both in young and old age. The age-related reasons for the increase in periodontal infections may be related to poor oral hygiene because of a loss of dexterity or vision, but also to immunosenescence. This term describes the aging of the immune system and the decline of its effectiveness with age. Low-grade infections, like chronic periodontitis, may cause low-grade inflammation and subsequently increase the likelihood of developing chronic diseases. In return, treatment of periodontitis may improve general health, as demonstrated for diabetes. A second mechanism illustrating how poor oral health translates into systemic disease is the risk of developing aspiration pneumonia. The treatment options in old age should be evaluated with regard to the issues of general health and maintenance. Systematic periodontal maintenance therapy, as performed in younger age cohorts, may be difficult to implement in elderly people experiencing institutional or hospital confinement because of logistics, barriers related to patients and caregivers, or cost. The scale of periodontal disease in old age represents a public health issue.

Controlled mechanical early loads improve bone quality and quantity around implants: An in vivo experimental study

OBJECTIVES

This study aimed to investigate the effects of early loads on bone quality and quantity around implants and to compare the effects of early loads on bone quality and quantity with the effects of conventional loads.

MATERIALS AND METHODS

Grade IV-titanium implants with buttress threads were placed in rat maxillary bone 4 weeks after extraction of first molars. A controlled mechanical load (10 N, 3 Hz, 1,800 cycles, 2 days/week) was started via the implants 1 and 3 weeks after implant placement for 2 weeks (early and conventional loads, respectively). Bone quality, defined as distribution of bone cells, types and orientation of collagen fibers, and production of semaphorin3A, its receptor neuropilin-1, and sclerostin, were quantitatively evaluated.

RESULTS

Early loads substantially and positively affected bone quality by changing the preferential alignment of collagen fibers with increased production of type I and III collagens, semaphorin3A, and neuropilin-1, increased osteoblast numbers, decreased production of sclerostin, and decreased osteoclast numbers both inside and outside the implant threads, when compared with non-loaded conditions. Conventional loads changed bone quality around implants slightly. Interestingly, early loads had significantly stronger effects on bone quality and quantity based on the evaluation parameters than conventional loads.

CONCLUSIONS

This is the first report to provide scientific evidence for load initiation time based on both bone quality and quantity around implants. These new findings show that implants with buttress threads transmitted early loads optimally to bone tissue by improving bone quality and quantity inside and outside the implant threads.

Effects of assessing the bone remodeling process in biomechanical finite element stability evaluations of dental implants

BACKGROUND AND OBJECTIVE

While an accurate assessment of the biomechanical stability of implants is essential in dental prosthesis planning and associated treatment assurance, the bone remodeling process is often ignored in biomechanical studies using finite element (FE) analysis. In this study, we aimed to analyze the significance of assessing the bone remodeling process in FE analysis for evaluating the biomechanical stability of dental implants. We compared the FE results considering the bone remodeling process with FE results simulated using commonly used conditions, with no considerations of the bone remodeling process.

METHODS

The mathematical model proposed by Komarova et al. was used to calculate cell population dynamics and changes in bone density at a discrete site. The model was implemented in the FE software ABAQUS, using the UMAT subroutine. Three-dimensional FE models were constructed for two types of bone (III and IV) and three values of implant diameter (4.0, 4.5, and 5.0 mm). An average biting force of 50 N in the vertical direction was applied during the bone remodeling process for 150 days. Afterwards, the maximum biting force of 200 N in the 30° oblique direction was applied to evaluate the stability of the implant systems.

RESULTS

To understand the impact of bone remodeling on the resultant mechanical responses, we focused on peri-implant cancellous bone based on two parameters: apparent density change and microstrain distribution. The bone density decreased by an average of 5.3 % after implantation, and it was the lowest on the 6^th day. The average density increases of the peri-implant cancellous bone were 264.4 kgm³ (bone type III) and 220.0 kgm³ (bone type IV) over 150 days. For the bone stability analysis, the maximum principal strain in the peri-implant bone was used to evaluate the bone stability. If the bone remodeling process is ignored, then the bone volume within the fatigue failure range of the microstrain differs significantly from that if the bone remodeling process is considered, i.e., 60 % higher for bone type III and 33.4 % lower for bone type IV than when the bone remodeling process is considered.

CONCLUSIONS

The FE result without considering the bone remodeling process could be considered a conservative criterion for bone type III. However, in bone type IV, the FE result without considering the bone remodeling process tends to underestimate the risks. The bone remodeling process is more affected by the initial bone quality than the implant diameter.

Assessment of the Socioeconomic Status and Analysis of the Factors Motivating Patients to Apply for Prosthetic Treatment by Students of Dentistry at the Poznań University of Medical Sciences

This study aimed to determine the motives for undertaking prosthetic treatment at the Prosthetics Clinic of the Poznan University of Medical Sciences (PUMS), pursued by fifth- and sixth-year medicine and dentistry students. The survey consisted of 18 questions, of which 1 to 11 concerned general patient data, while questions 12 to 18 concerned prosthetic treatment. The only open question in the questionnaire was one regarding the motives for the decision to receive treatment. The study group consisted of 153 patients (102 women—66.67% and 51 men—33.33%) of the Prosthetic Clinic. After collecting a total of 200 questionnaires, rejecting 47 (23.50%) due to the lack of answers to all questions (other than question 18), a total of 153 completed (76.50%) questionnaires were obtained. The main motivating factors for patients to undertake prosthetic treatment are functional and aesthetic considerations. In addition, it turned out, that the authority of the university unit is of greater importance than financial issues. Additionally, some patients undergo treatment by students because they can see positive aspects in it, both for them and for students. Hence, the evaluation of the treatment provided by students, as well as their communication skills and their attitude, are rated very highly, although, again, the evaluation was influenced by the education level.

An Osteotomy Tool That Preserves Bone Viability: Evaluation in Preclinical and Clinical Settings

The main objectives of this work were to assess the efficiency, ease-of-use, and general performance of a novel osseoshaping tool based on first-user clinical experiences and to compare these observations with preclinical data generated in rodents using a miniaturized version of the instrument. All patients selected for the surgery presented challenging clinical conditions in terms of the quality and/or quantity of the available bone. The presented data were collected during the implant placement of 15 implants in 7 patients, and included implant recipient site (bone quality and quantity) and ridge evaluation, intra-operative handling of the novel instrument, and the evaluation of subsequent implant insertion. The instrument was easy to handle and was applied without any complications during the surgical procedure. Its use obviated the need for multiple drills and enabled adequate insertion torque in all cases. This biologically driven innovation in implant site preparation shows improvements in preserving vital anatomical and cellular structures as well as simplifying the surgical protocol with excellent ease-of-use and handling properties.

Associations among the anterior maxillary dental arch form, alveolar bone thickness, and the sagittal root position of the maxillary central incisors in relation to immediate implant placement: A cone-beam computed tomography analysis

Purpose

This study evaluated the associations of the dental arch form, age-sex groups, and sagittal root position (SRP) with alveolar bone thickness of the maxillary central incisors using cone-beam computed tomography (CBCT) images.

Materials and Methods

CBCT images of 280 patients were categorized based on the dental arch form and age-sex groups. From these patients, 560 sagittal CBCT images of the maxillary central incisors were examined to measure the labial and palatal bone thickness at the apex level and the palatal bone at the mid-root level, according to the SRP classification. The chi-square test, Kruskal-Wallis test, and multiple linear regression were used for statistical analyses.

Results

Significant differences were found in alveolar bone thickness depending on the arch form and SRP at the apex level. The square dental arch form and class I SRP showed the highest bone thickness at both levels of the palatal aspect. The taper dental arch form and class II SRP presented the highest bone thickness at the apex level of the labial aspect. No association was found between the dental arch form and SRP. Elderly women showed a significant association with thinner alveolar bone. Age-sex group, the dental arch form, and SRP had significant associations with alveolar bone thickness at the apex level.

Conclusion

The patient’s age-sex group, dental arch form, and SRP were associated with alveolar bone thickness around the maxillary central incisors with varying magnitudes. Therefore, clinicians should take these factors into account when planning immediate implant placement.

Correlations between implant success rate and personality types in the older people: A preliminary case control study

Background/ purpose

Older patients inevitably have a higher need for implant treatment, it is unknown how mental changes or psychological aspects affect the outcome of implant treatment. This study evaluated the success rate of implants and the influence of personality traits in the older people. The goal was to provide evidence for predictable implant treatment while taking into account the unique psychological changes of elders.

Materials and methods

Participants were patients who were able to independently visit our hospital between March 2004 and May 2021. Inclusion criteria were patients aged 65 years or older at the time of implant placement with regular follow-up for at least 1 year. The implant success rate was calculated by counting peri-implantitis and implant loss as failures. Multivariate analysis was used to examine the effect of patient personality characteristics on the success rate.

Results

Fifty-six implants were included in 23 patients (12 men, 11 women), with a mean age of 68.5 years (65–76) and mean maintenance duration of 9 years and 2 months. The cumulative survival rate was 87% at the patient level (94.6% at the implant level). Statistically significant differences were found for adaptive traits (odds ratio [OR] = 0.04) and non-adaptive traits (OR = 6.38); however, no significant differences were found for the other independent variables.

Conclusion

The overall implant success rate was 69.6% at the patient level (82.1% at the implant level). The personality traits in older people had a significant effect on the implant failure rate.

Comparison of Vestibular Depth Relapse and Wound Healing After Reconstructive Preprosthetic Surgery Using Cryopreserved Amniotic Membrane and Acellular Dermal Matrix - A Comparative Study

Introduction:

The significance of membranes as wound dressing in oral surgeries has been reported by previous studies. The aim of the present split-mouth randomized clinical study was to assess and compare the wound dressing properties of acellular dermal matrix (ADM) and cryopreserved human amniotic membrane (AM) after reconstructive preprosthetic oral surgery.

Materials and Methods:

Twenty-eight patients with complete mandibular edentulism and resorbed alveolar bone were included. After taking mandibular impression, a clear acrylic splint with increased labial flange height was created. In each participant, labial vestibular depth was elevated using the Clark's technique. Subsequently, half of the exposed periosteum was covered with ADM while the other half was covered with cryopreserved human AM. Vestibule depth and relapse in the two sides were measured immediately after vestibuloplasty and at the end of the 1^st week, 2^nd week, 1^st month, and 3^rd months with graduations of 0.1 mm. Furthermore, after 3 and 7 days, samples were collected from graft material, and the macrophage population was analyzed by flow cytometry.

Results:

There was no significant difference in the relapse of vestibule depth between the two grafts at different time intervals. However, the frequency of wound-infiltrating macrophages (CD68⁺ cells) was significantly higher in areas covered by ADM after 3 and 7 days.

Discussion:

ADM is as effective as cryopreserved AM in terms of maintaining the postoperative vestibular depth. On the other hand, our results suggested that the onset of healing phase in ADM-covered areas occurs faster compared to the periosteum covered with cryopreserved human AM. This clinical trial showed significantly faster postoperative healing onset when ADM was used than when cryopreserved human AM was applied on the periosteum.

Bone heating and implant removal using a high-frequency electrosurgical device: An in vivo experimental study

OBJECTIVES

Failed implant removal using a high-frequency electrosurgical device (HFED) has been reported to be less invasive than other surgical techniques. We sought to clarify the mechanism of removal torque reduction in an implant by heating with HFED.

MATERIALS AND METHODS

Sixty-eight Wistar rats received titanium implants on the maxillary bone 4 weeks after extraction of the first and second molars. The control group was sacrificed 6 weeks after implant installation. In the experimental group, the implant was heated by HFED for 10 s using three different power outputs, and samples were collected at 3, 7, and 14 days after heating. Removal torque measurement and histological analysis were performed in the control and experimental groups. Implant surfaces were observed using an electron-probe microanalyzer (EPMA). Data were analyzed using Mann-Whitney U test at a significance level of 5%.

RESULTS

The removal torque could not be measured in the control group due to fracture of the implant. After heating, the removal torque was measurable without fracture and decreased significantly at 14 days as compared with that at 3 days (p < .05). Heating with "min" power output resulted in a significantly smaller blank lacunae area and fewer osteoclasts at 14 days after heating (p < .05). EPMA revealed bone matrix adherence to outer surface of heated implant.

CONCLUSIONS

After heating, an enlarged area of blank lacunae around the implant and an increased number of osteoclasts into the bone marrow cavity were observed, which may have contributed to the reduction in removal torque.

Single-visit chairside adjustment of a metal-acrylic resin implant-supported fixed complete dental prosthesis on an unloaded implant using a novel fixed attachment system: a case report

Background

Implant-supported prosthetic treatment options are reliable for elderly edentulous patients with systemic health problems. These patients often need cost- and time-efficient solutions to avoid complications. However, it is a challenge for clinicians to treat these patients without surgical interventions, placement of additional implants, or the need to renew existing prostheses.

Case presentation

A 75-year-old medically compromised caucasian male patient using multiple medications was referred for prosthetic rehabilitation of his edentulous maxilla after several implant failures. Because the patient’s health was compromised, further surgical interventions were ruled out and the treatment was centered on the use of the remaining implants by placing a fixed attachment system and altering the existing prosthesis. The stepwise management of the patient’s situation through the use of a new attachment system and adjustment of existing prosthesis is described in the present case report.

Conclusions

Although implant therapy is not always contraindicated for medically compromised patients, it is preferable not to perform extensive surgeries to avoid complications. This clinical report describes an alternative, safe option based on a novel fixed attachment system to salvage an existing maxillary implant-supported fixed complete dental prosthesis of a patient with systemic health problems.

Fabrication of an implant-retained overdenture with ceramic crowns cemented on a polyetherketoneketone framework: A clinical report

This clinical report describes the treatment of a complex intraoral situation by fabricating a maxillary implant-retained overdenture with a high-performance polymer (polyetherketoneketone) framework and lithium disilicate crowns and mandibular tooth- and implant-supported ceramic restorations. No complications were noted in 2 years, and the patient was satisfied with function and esthetics.

Flapless Surgical Approach to Extract Impacted Inferior Third Molars: A Retrospective Clinical Study

This study aimed to compare a flapless surgical approach (FSA) with a traditional envelope flap (traditional approach (TA)). Every patient was treated with two approaches: TA and FSA. The primary outcome variables were both the discomfort during the post-operative convalescence and the correct final recovery of the impacted area. The secondary outcome variable was the average duration of the surgery. Post-operative pain and oedema were recorded. The measurements of soft tissue interface toward the distobuccal edge of the second molar were taken by periodontal probe before surgery (baseline) and 8 weeks after surgery. Statistical software was used to evaluate the data; a p-value < 0.05 was considered statistically significant. Twenty-four teeth of 12 patients (six Caucasian males and six Caucasian females, aged 23 ± 4 (17-30) years) with both lower impacted third molars (Ms3) were analysed. Considering an alpha error 0.05 that sample size allows power from 0.80 to 0.90, depending on the variable evaluated. Concerning attached gingiva, oedema and pain, the linear mixed model resulted in a statistically significant difference between the TA and FSA (p = 0.003; p < 0.01; and p = 0.018, respectively). Conversely, the model did not show a difference (p = 0.322) if pocket probing depth was considered. The FSA procedure was faster (p < 0.05) than the TA procedure (17 min and 8 s (±6 s) vs. 28 min and 6 s (±4 s), respectively). The results suggest that the FSA could be a suitable option for improving the surgical removal of lower Ms3. However, additional randomized controlled trial studies are necessary to confirm the reliability of our procedure and to verify its suitability in more complex Ms3 classifications.

Effects of overdenture attachment systems with different working principles on stress transmission: A three-dimensional finite element study

PURPOSE

The aim of the present study was to compare the stress distributions on the dental implants, abutments, and bone caused by different overdenture attachment types under functional chewing forces.

MATERIALS AND METHODS

The 3D finite element models of the mandible, dental implants, attachment types, and prostheses were prepared. In accordance with a conventional dental implant supported overdenture design, the dental implants were positioned at the bone level in the canine teeth region bilaterally. A total of eight models using eight different attachment systems were used in this study. All the models were loaded to simulate chewing forces generated during the centric relationship (450 N), lateral movement (400 N), protrusive movement (400 N), and also in the presence of a food mass unilaterally (200 N). Stress outputs were obtained as the maximum principal stress and the equivalent von-Mises stress.

RESULTS

In all attachment types, higher stress values were observed in the abutments, dental implants, and bone in the magnet attachments in different loading conditions. The highest stress values were observed among the magnet systems in the components of the Titanmagnetics model in all loading conditions (stresses were 15.4, 17.7, and 33.1 MPa on abutment, dental implant, and bone, respectively). The lowest stress value was observed in the models of Zest and O-Ring attachments.

CONCLUSION

The results of the present study implied that attachment types permitting rotation and tolerating various angles created lower stresses on the bone, dental implants, and abutments.

How old is old for implant therapy in terms of implant survival and marginal bone levels after 5-11 years?

Aim

To evaluate implant survival and marginal bone levels (MBL_evel) at least 5 years after implant installation in patients ≥65 years old.

Methods

Patient records were screened retrospectively for the following inclusion criteria: (1) ≥65 years of age at the time of implant installation, and (2) ≥5‐year radiographic follow‐up or registered implant loss. Association between patient‐ and implant‐related data with radiographically assessed data [i.e. implant survival, mean MBL_evel (i.e. average of mesial and distal level) and maximum marginal bone loss (i.e. either mesial or distal loss; maximum MBL_oss)] were statistically evaluated by mixed effects multi‐level regression models.

Results

Two‐hundred‐eighteen implants in 74 patients were included with a mean follow‐up of 6.2 years (range: 5 to 10.7 years); four early and six late implant losses have been registered (implant survival rate: 95.4%). Mean MBL_evel and maximum MBL_oss was 1.24 ± 0.9 mm and 1.48 ± 1.0 mm, respectively. Maximum MBL_oss < 2 mm, 2 to 5 mm and ≥5 mm was found in 70.7, 28.8 and 0.5% of the implants, respectively. For both, mean MBL_evel and maximum MBL_oss, age presented a slightly protective effect (mean MBL_evel: Coef. −0.041, p = .016; maximum MBL_oss: Coef. −0.045, p = .014).

Conclusion

The high implant survival rate (95.4%), low mean MBL_evel (1.24 mm) and low frequency of maximum MBL_oss ≥ 5 mm (0.5%) observed herein after 5 to 11 years follow‐up suggest that older age should not be considered as a limiting factor for implant treatment.

Considerations for the Prosthetic Dental Treatment of Geriatric Patients in Germany

Demographic changes in the industrialized countries require that dentists adapt to the growing and heterogeneous group of elderly patients and develop concepts for the dental care of fit, frail, and dependent old and very old people. In general, dental care for old and very old people should be based on their individual everyday life. As a result of demographic changes, improved oral hygiene at home, and the establishment of professional teeth and denture cleaning, tooth loss occurs increasingly in higher ages, which implies that first extensive prosthetic rehabilitation with fixed or/and removable dental prostheses is shifting to a higher average age than ever before. This phenomenon requires that the individual diseases, potential multimorbidity and polypharmacy, and associated limitations are taken into consideration. Against this background, the current survey aims to summarize epidemiological trends associated with tooth loss, using Germany as a highly representative country for demographic changes as an example. Furthermore, the current narrative summary outlines general principles that should be followed in dental care, treatment of geriatric patients, and outlines current therapeutic options in prosthetic dentistry.

Cariogenic potential of oral nutritional supplements measured by intraoral plaque pH telemetry

BACKGROUND & AIMS

Oral nutritional supplements (ONS) administered to malnourished elders and other patients contain high-levels of carbohydrates that could be a potential risk factor for dental caries. This study aimed to evaluate the cariogenic potentials of ONS using intraoral plaque telemetry.

METHODS

Ten ONS were tested on five healthy volunteers (mean age: 76.8 ± 9.15 years). Participants were requested to refrain from performing oral hygiene 3-7 days prior to testing. The pH-value below the dental plaque on the tooth was measured while the ONS was being consumed. After neutralizing the participant's saliva, a control solution (10% sucrose) was administered and telemetry measurements were repeated. Mean relative cariogenicity (RC) was calculated for each ONS. ANOVA and post hoc tests were used for statistical analyses (p < 0.05).

RESULTS

All ten ONS were potentially cariogenic on enamel with an overall RC of 0.519 ± 0.35 (Range: Min = 0.31 ± 0.16; Max = 1.00 ± 0.34). RC differed significantly between the ONS (p = 0.002). RC was lower in ONS that contained high-protein (p = 0.018). RC was not influenced by other factors such as readily consumable (p = 0.102), flavor (p = 0.869), consistency (p = 0.126), fiber containing (p = 0.134), style (p = 0.112), and age of plaque (p = 0.339).

CONCLUSIONS

The ONS administered to elders and malnourished patients are potentially cariogenic. It is imperative that the administration of ONS must be based on individual needs to potentiate a maximum benefit. Wherever possible, an attempt to limit the use of high-carbohydrate containing ONS must be practiced along with the adoption of suitable preventive measures to arrest the development and progression of caries.

Mandibular two-implant overdentures with CAD-CAM milled bars with distal extensions or retentive anchors: A randomized controlled trial

OBJECTIVE

This randomized controlled trial (RCT) aimed to demonstrate the non-inferiority of mandibular 2-implant overdentures (IODs) on a CAD-CAM milled bar with long distal extensions (MBDE) against IODs on retentive anchors (RA).

METHODS

Forty edentulous participants rehabilitated with a maxillary conventional denture and a mandibular 2-IOD participated in this trial. They were randomized into two groups [Control group (CG): RA + gold matrices; Experimental group (EG): MBDE + gold clip]. The outcomes included implant survival rate (ISR), chewing efficiency [quantitative (VoH) and subjective (SA) assessments], peri-implant marginal bone levels (PI-MBL), maximum bite force (MBF), and patient-reported outcomes [oral health impact profile (OHIP-EDENT), and denture satisfaction index (DSI)]. Outcomes were recorded at baseline (BL), two weeks (T₀ ), 6 months (T₁ ), and at 1 year (T₂ ) after the intervention. Intra- and inter-group analyses were performed using regression models with ⍺=0.05.

RESULTS

38 participants completed the T₂ visit (CG: n = 19, age = 74.7 ± 7.8 years; EG: n = 19, age = 70.3 ± 10.7 years). At T₂ , there was no implant loss in either of the groups (ISR = 100%). There were no significant differences between the groups for the PI-MBL changes (p = .754). Improvements occurred faster in the EG than in the CG, but over the observation time, there were no differences between the trial groups for VoH, MBF, OHIP-EDENT, and the DSI, except for SA being significantly better in the EG group (p = .022).

CONCLUSIONS

The results of this RCT confirm that mandibular 2-IODs with a CAD-CAM milled bar with long distal extensions are not an inferior treatment to the conventional IODs on retentive anchors in the short term (1 year).

The effect of adjuvant oral irrigation on self-administered oral care in the management of peri-implant mucositis: A randomized controlled clinical trial

OBJECTIVES

This single-blinded randomized clinical trial evaluated the effect of adjuvant oral irrigation in addition to self-administered oral care on prevalence and severity of peri-implant mucositis.

MATERIAL & METHODS

After randomization, patients suffering from peri-implant mucositis were assigned to the following: Group 1 (control) received oral hygiene instruction following a standardized protocol, including a sub- and supramucosal mechanical debridement. Group 2 and 3 additionally were instructed to use an oral irrigator with either water or 0.06% CHX solution. One implant per patient was considered for examination. Clinical examinations included Probing Depth, Bleeding on Probing (BOP-positive sites), and Modified Plaque and Gingival Index. A surrogate variable (mucositis severity score) was applied measuring severity of disease. Statistical analysis included linear regression models and sensitivity analysis.

RESULTS

Sixty periodontally healthy patients were examined for presence and severity of peri-implant mucositis. 70% of all patients reached complete resolution of disease after 12 weeks. The prevalence of peri-implant mucositis after 12 weeks was 50% in group 1, 35% in group 2, and 5% in group 3. Average BOP-positive sites were reduced in all groups after 12 weeks (mean change from baseline: group 1: -1.5; group 2: -1.8; group 3: -2.3).

CONCLUSION

Within the limits of the study, adjuvant use of an oral irrigator with 0.06% CHX in addition to mechanical biofilm removal and oral hygiene instruction can reduce the presence and severity of peri-implant mucositis after 12 weeks.

Mandibular implant-supported fixed complete dental prostheses on implants with ultrashort and standard length: A pilot treatment

Edentulous patients may be restored with complete-arch implant-supported fixed complete dental prostheses (IFCDPs) on angled distal implants or on parallel implants distributed equally across the mandible to increase the area of support. A treatment is presented to introduce the clinical concept of providing edentulous patients with an implant-supported fixed complete dental prosthesison parallel tissue-level implants in the mandible with standard length implants interforaminally and ultrashort implants distally. A structured prosthetic approach was used for the tooth arrangement with a modified workflow as per the Biofunctional Prosthetic System adapted for static computer-aided implant surgery (s-CAIS) and computer-aided design and computer-aided manufacturing (CAD-CAM) of the screw-retained implant-supported fixed complete dental prosthesis. The concept offered advantages in challenging anatomic, surgical, and prosthetic conditions; providing distal nonangled abutments and implant platforms, which were straightforward to clean. If necessary, the prosthesis could have been easily converted into a removable overdenture using the existing digital prosthetic arrangement. Should implant removal be required, the extrashort implants can be removed with minimal surgical risk or morbidity.