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ABSTRACT Objective Methods Results Conclusion This study aimed to correlate the bite/occlusal force measurements obtained through two methods: a hydraulic pressure gauge with a biting transducer (GM‐10), and a computer‐assisted device that records occlusal force on a pressure‐sensitive film (Prescale II).Healthy, dentate volunteers were recruited. Participants' demographic data included age, sex, number of teeth present, presence of oral pain, history of prior orthodontic treatment and presence of parafunction. Bite/occlusal force measurements were recorded for each participant using the GM‐10 and the Prescale II devices. Linear Mixed‐effect model regression was performed with the significance set at p < 0.05.Forty‐six volunteers (women = 25, men = 21; mean‐age = 30.9 ± 9.3 years) participated. 54.3% and 34.8% presented with 28 and 29–32 teeth, respectively. 60.9% and 26.1% of the participants reported previous orthodontic treatment and oral parafunction. The overall mean GM‐10 measurements recorded were 333.0 ± 192, 276 ± 167, 208 ± 134, 142 ± 103 Newtons, for the 2nd and 1st molars, 2nd and 1st premolars, respectively. GM‐10 measurements were associated with the tooth position (p < 0.001) and the number of teeth (p < 0.001). The mean Prescale II measurements obtained with and without filter were 826 ± 594 and 1049 ± 595 Newtons, respectively, which were positively correlated with the occlusal contact area (r = 0.765; p < 0.001) and GM‐10 (r = 0.245; p = 0.019). The regression analysis for dependent repeated data confirmed the significant effect of the GM‐10 measurements (bite force) and the occlusal contact area on the Prescale II measurements.Within the limitations of this study, it can be concluded that the correlation between bite force measurements carried out by GM‐10 and Dental Prescale II was low and may not be considered interchangeable methods. The maximum bite force measured in isolated point contacts was a predictive factor of the occlusal force distributed over the entire arch. Further studies are warranted to explore this influence in the clinical implications of these findings. [ABSTRACT FROM AUTHOR]

Aims: To assess oral health, treatment burden, mortality risk, and demographics in elders with care‐resistant behaviors (CRB) in nursing homes (NH) and compare them with those without CRB. Methods and results: 503 participants from eight NH who received dental treatment through a mobile dental clinic were included. Their medical and dental records were screened regarding oral/dental health, treatment history, general health, demographics, and CRB. Statistical analysis was performed to show correlations between CRB and the measured parameters. Data were verified for normal distribution; a point‐biserial correlation model was used (95% CI: α = 0.05). No correlation was found between CRB and Decayed Missing Filled Teeth (DMF‐T) (rpb = ‐0.061, p =.177), as well as periodontal status (rpb = 0.004, p =.946). A negative correlation was observed between CRB and the required number of treatment procedures (rpb = ‐0.181, p <.0001), time (rpb = ‐0.118, p =.010), and costs (rpb = ‐0.100, p =.028). Sex predilection for men regarding CRB was evident (rpb = ‐0.155, p =.01). No correlation appeared between CRB and vital status (rpb = ‐0.41, p =.355). Conclusion: Oral health seems to be similar in institutionalized elders with or without CRB. Treatment burden was not elevated, but even reduced in elders with CRB, evincing that few/no treatment procedures were performed in those elders. CRB demonstrated a sex predilection for men. An association between CRB and increased mortality was not evident. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to evaluate the oral health of care‐dependent institutionalized older adults receiving domiciliary dental care. Methods and Results: Dental health records of institutionalized adults receiving regular domiciliary dental care were examined (observation period: 5 years). Relevant demographic and oral health information were extracted. Statistical analyses included descriptive and non‐parametric tests (α =.05). Records of 398 nursing home residents (mean‐age: 84.9 ± 6.4 years) were included. Average time spent by the residents in the institution was 2.8 ± 1.5 years. The mean number of teeth present and the overall DMF‐T score was 14.7 ± 9.1 and 27.4 ± 6.2, respectively. The DMF‐T score increased until the 3‐year recall, with a significant increase in the number of decayed teeth (2‐year: p =.013; 3‐year: p =.010). An improvement in the residents' periodontal health was seen during the observation period but was not statistically significant. Conclusion: The findings of this cross‐sectional study confirmed that regular domiciliary dental care provision to institutionalized older adults helps maintain gingival and periodontal health. However, the incidence of dental caries might still be a problem that needs to be addressed with effective measures that improve the daily oral care provision to these older adults. [ABSTRACT FROM AUTHOR]

Aims: This study evaluated the attitudes and perceptions of private dental practitioners (PPs) and students on treating patients with disabilities and sensory impairments. Methods and results: A multifaceted questionnaire was used to assess the participants' attitudes on providing care to persons with disabilities and sensory impairments [visual (VI) and hearing (HI)]. The survey evaluated different aspects of the participants' attitudes that included integrity, altruism, perceived barriers, and theory of planned behavior (TPB). One hundred twenty participants [students: n = 73, practitioners (PP): n = 47), with a mean‐age of 27.7 ± 5.3 years, completed the survey (response rate: 100%). Fourth‐year students scored better than the PP in integrity (p =.019). For altruism, the students scored better than PPs (vs. fourth‐year: p =.009, vs. fifth‐year: p =.031). There were no differences between the participant groups for the overall assessments of the TPB (p =.213), VI (p =.863), and HI (p =.261). Conclusion: Dental practitioners and students revealed a positive attitude, with few barriers, towards treating individuals with disabilities/sensory impairments and considered the training in the field of special care dentistry as a necessary part of the dental education. Furthermore, a demand for an increase in the hands‐on practical experience in treating individuals with disabilities/sensory impairments during the undergraduate study curriculum was identified. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate the reliability of two methods used to assess masticatory performance and attempt to correlate them to achieve interchangeability between the methods. Methods: Twelve healthy dentate volunteers (men = 6, women = 6; mean age = 28.3 ± 4.1) with no known dental or medical pathologies were requested to participate in this study. Each participant completed three masticatory performance assessments, including two two‐colour mixing‐ability tests using chewing‐gums (CG: gum#1 and gum#2) and the gummy‐jelly (GJ) test. For each method, participants created five samples each (total = 15 measurements per participant, gum#1 = 5, gum#2 = 5, GJ = 5). For the gum#1 and gum#2 methods, the predetermined chewing cycles were fixed at 10, 15, 20, 25 and 30 cycles, and for the GJ method, the time duration was fixed at 10, 15, 20, 25 and 30 s. The parameter measures were submitted to Z‐score transformation, and Bland–Altman plots were generated to graphically compare the differences between two techniques against their means. Additionally, mountain plot was used to assess the cumulative distribution of measurement error between the methods. Results: A total of 180 measurements were recorded. There were significant correlations between the number of chewing cycles/chewing time and masticatory performance using the gum#1 (r = −.753; p <.001), gum#2 (r = −.838; p <.001) and GJ (r =.730). When all tests were considered together for each method, significant correlations were found (p <.001). A descriptive range of mean values aiming to produce reference value ranges for predictive purposes was achieved considering the interchangeably among the methods [CG = GJ (VoH‐mg = dL): 10 cycle = 10 s: 0.329 = 110; 15 cycles = 15 s: 0.177 = 164; 20 cycles = 20 s: 0.130 = 205; 25 cycles = 25 s: 0.086 = 200; 30 cycles = 30 s: 0.077 = 267]. Conclusion: The strong correlations and high consistency between the two masticatory performance methods found in this study conclude that the two assessment methods are reliable and interchangeable. Further evaluations are warranted to arrive at a conversion formula for translation of the results between the two methods. [ABSTRACT FROM AUTHOR]

Objectives and background: To validate a novel screening test for cognitive and functional decline in older patients rehabilitated with complete removable dental prostheses (CRDPs). Materials and methods: Edentate old in‐patients rehabilitated with CRDPs were included in this study. Participants were requested to remove their prostheses before their intraoral examinations. The prostheses were then presented in an inverted orientation. Participants had to correct the orientation of the prostheses and insert them in the appropriate jaws. The test was repeated after the intraoral exam. Appropriate statistical models were used (⍺ =.05) to associate the test results with the participants' mini‐mental state examination (MMSE) score, functional independence measure (FIM), age and sex. Results: Among the 86 participants (mean‐age: 85.4 ± 6.4 years; mean MMSE: 19.8 ± 5.5; mean FIM: 77.9 ± 20.8), 21 (24.4%) failed to correctly insert the prosthesis. The prosthesis presentation test (PPT) was associated with the FIM but not the MMSE. Regression models further confirmed an association with age (P =.043), but not sex. Additional analyses revealed the PPT test is associated with the FIM's cognitive sub‐sets of memory, problem solving and social interaction. Conclusion: The PPT is a novel, simple and quick screening tool that can help detect functional difficulties in older people. It can easily be performed during an oral examination. Future studies are needed to determine whether the PPT can be used to detect deficits in executive function, as a complement to the MMSE and also as a first assessment of a patient's ability to manage dentures independently. [ABSTRACT FROM AUTHOR]

Objectives: To pilot an exploration of older adults' future preferences using discrete choice experiments to understand who should provide dental examinations and treatment, where these services should be provided, and participants' willingness to pay and willingness to travel. Background: The proportion of older adults in the general population is increasing and is recognised as a pressing public health challenge. Materials and Methods: Older people aged 65 years and over were recruited into this study from the UK, Switzerland and Greece. Drawing on earlier stakeholder engagement, a set of choice experiments are developed to explore the future preferences of older people for dental examinations and dental treatment, as they anticipated losing their independence. These were presented to the participants using a range of platforms, because of the COVID pandemic. Data were analysed in STATA using a random‐effects logit model. Results: Two hundred and forty‐six participants (median age 70 years) completed the pilot study. There was a strong preference across all countries for a dentist to undertake a dental examination (Greece: β = 0.944, Switzerland: β = 0.260, UK β = 0.791), rather than a medical doctor (Greece: β = −0.556, Switzerland: β = −0.4690, UK: β = −0.468). Participants in Switzerland and the UK preferred these examinations to be undertaken in a dental practice (Switzerland: β = 0.220, UK: β = 0.580) while participants in Greece preferred the dental examination to be undertaken in their homes (β = 1.172). Greek participants preferred dental treatment to be undertaken by a specialist (β = 0.365) in their home (β = 0.862), while participants from the UK and Switzerland preferred to avoid any dental treatment at home (Switzerland: β = −0.387; UK: β = −0.444). Willingness to pay analyses highlighted that participants in Switzerland and the UK were willing to pay more to ensure the continuity of future service provision at a family dental practice (Switzerland: β = 0.454, UK: β = 0.695). Conclusion: Discrete choice experiments are valuable for exploring older people's preferences for dental service provision in different countries. Future larger studies should be conducted to further explore the potential of this approach, given the pressing need to design services that are fit for purpose for older people. Continuity of dental service provision is considered as important by most older people, as they anticipate losing their dependence. [ABSTRACT FROM AUTHOR]

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 (흹) 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. [ABSTRACT FROM AUTHOR]

Objective: Digitally‐designed removable complete dentures are typically composed of a resin denture base without a metal framework. However, metal denture bases are preferable as resin bases are more susceptible to fracture. Therefore, this article introduces a unique technique that integrates computer‐aided design (CAD) and conventional resin processing for the fabrication of removable complete dentures with a metal framework. Clinical Consideration s : A maxillary complete denture with a metal base and a mandibular implant‐retained overdenture reinforced with a metal framework were fabricated. The dentures were designed using CAD software and a tooth library. The denture bases were milled from wax disks, and artificial teeth were placed to complete the wax dentures. The metal frameworks were also designed using CAD software and produced via casting of printed resin patterns. Finally, conventional denture processing techniques were applied to obtain dentures with metal frameworks. Conclusions: A digitally designed, removable complete denture with a metal base can be successfully fabricated using the described technique, which merges digital design and conventional methods. This article demonstrates the feasibility and potential advantages of this innovative approach in denture fabrication. Clinical Significance: The presented technique provides the following advantages: digital design features, precise space above implant overdenture attachments for a metal framework, convenience of esthetic evaluation with printed trial dentures, long‐term data storage and duplication, reliable bond between the artificial teeth and denture base, and enhanced strength of the removable complete denture due to the metal reinforcement. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objectives: This review evaluated the effects of rehabilitation with implant‐supported prostheses on the oral function of completely edentulous adults. Materials and Methods: Systematic literature searches were performed to identify records reporting on oral function in completely edentulous adults rehabilitated with implant‐supported prostheses. Meta‐analyses were performed on various outcomes including bite force, masticatory performance, muscle activity, mandibular movement/chewing pattern, and salivary flow. Results: 5507 records were identified. Thirty studies qualified for data extraction and analysis. The kappa (훋) for the search and identification strategy ranged between 0.50 and 1.00. Meta‐analysis was performed grouping the studies by outcomes and split by time points of 6–12 months, 12–36 months, and >36 months after implant therapy. The meta‐analyses revealed a significant improvement in oral function of completely edentulous adults after rehabilitation with implant‐supported prostheses at 6–12 months (Z = −4.895, p <.001; 95% CI: −0.703, −0.301; τ2 =.609; Q = 114.953, df = 17, p <.001; I2 = 85.2%), at 12–36 months (Z = −4.886, p <.001; 95% CI: −0.580, −0.248; τ2 =.908; Q = 280.611, df = 35, p <.001; I2 = 87.5%) and at more than 36 months (Z = −9.108, p <.001; 95% CI: −1.472, −0.951; τ2 =.019; Q = 7.918, df = 7, p =.340; I2 = 11.6%). The included studies demonstrated a low to moderate risk of bias. Conclusions: This systematic review concluded that the oral function of completely edentate adults significantly improved with implant‐supported/retained prostheses, even when only one jaw received implant therapy. Therefore, implant therapy should be promoted for edentulous adults to alleviate the shortcomings of conventional complete removable dental prostheses. [ABSTRACT FROM AUTHOR]

Objectives: The aim of Working Group 4 was to address patient benefits associated with implant dentistry. Focused questions on (a) dental patient‐reported outcomes (dPROs), (b) improvement in orofacial function, and (c) preservation of orofacial tissues in partially and fully edentulous patients following provision of implant‐retained/supported dental prostheses were addressed. Materials and Methods: Three systematic reviews formed the basis for discussion. Participants developed statements and recommendations determined by group consensus based on the findings of the systematic reviews. These were then presented and accepted following further discussion and modifications as required by the plenary of the 7th ITI Consensus Conference, taking place in 2023 in Lisbon, Portugal. Results: Edentulous patients wearing complete dentures (CD) experience substantial improvements in overall dPROs and orofacial function following treatment with either complete implant‐supported fixed dental prostheses (CIFDP) or implant overdentures (IODs). With respect to dPROs, mandibular IODs retained by two implants are superior to IODs retained by one implant. However, increasing the number of implants beyond two, does not further improve dPROs. In fully edentulous patients, rehabilitation with CIFDP or IOD is recommended to benefit the preservation of alveolar bone and masseter muscle thickness. Conclusions: Completely edentulous patients benefit substantially when at least the mandible is restored using an CIFDP or an IOD compared to CD. In fully edentulous patients, implant prostheses are the best option for tooth replacement. The availability of this treatment modality should be actively promoted in all edentulous communities, including those with limited access and means. [ABSTRACT FROM AUTHOR]

Objectives: Maintaining the oral health of dependent older adults is challenging, with limited access to dental care and limited focus on preventive oral health programmes. This study aimed to evaluate the attitudes of General Dental Practitioners (GDPs), working in Switzerland, to caring for dependent older adults with a focus on the use of silver diamine fluoride (SDF) as a caries preventive agent and more widely on the provision of domiciliary dental care (DDC). Methods: Seventeen GDPs working in Switzerland were interviewed. Each interview was semi‐structured by a topic guide, digitally recorded, and transcribed. The transcribed data were analysed using a thematic analysis. Results: Three major themes to the widespread use of SDF in this population were identified: lack of basic knowledge including indications for use; aesthetic concerns and product availability. Those who had knowledge about the product believed that using it in the treatment of frail older adults had advantages, especially in the preservation and/or prolongation of the life of teeth without invasive treatments. The biggest barrier was its availability. The GDPs identified three major barriers related to DDC provision: lack of infrastructure, poor financial rewards and safety concerns (patient and operator safety). Those who provided this service stated that they were doing it because of self‐motivation, kindness, or as a role in community service. Conclusions: The potential use of SDF was viewed positively by the majority of the GDPs interviewed but confusion exists over its availability in Switzerland, and other barriers were identified to more widespread use in this patient group. The GDPs interviewed in this study reported that a lack of infrastructure and a low level of remuneration continue to be barriers to more of them undertaking DDC for dependent older adults. [ABSTRACT FROM AUTHOR]

Objective: To assess the incidence of prosthodontic maintenance events and complications during 4 years of follow‐up after mandibular overdenture treatment with one or two implants. Methods: Participants received one or two implants inserted in the midline (1‐IOD group) or the lateral incisor‐canine area bilaterally (2‐IOD group). Implants were loaded with an early loading protocol after 3 weeks. Programmed recall visits were scheduled at the 6‐, 12‐, 36‐, and 48‐month follow‐ups and nonprogrammed visits in case of prosthodontic complaints. The type of maintenance was registered, and the final treatment outcome was classified as successful, surviving, unknown, dead, repair, or retreatment. Results: Forty‐seven participants, mean age 65.4 ± 8.6, 74.5% female, were included (1‐IOD = 23; 2‐IOD = 24) and 44 completed the 4‐year follow‐up. A total of 159 prosthodontic maintenance events occurred and 89 in unscheduled visits. The most common event was the need for minor modifications of the denture base due to sore spots in the oral mucosa (n = 56 in 31 patients), matrix activation (n = 54 in 34 patients), and overdenture fracture (n = 25 in 18 patients). A "successful" or "surviving" outcome could be attributed to 57.5% of cases, whereas 38.3% needed repair. No significant differences in the incidence of prosthodontic events or treatment outcomes were found between the two groups. Conclusions: Findings show that 1‐IODs perform similar to 2‐IODs when considering the incidence of fractures and the need for prosthodontic maintenance, including adjustments of the overdenture and the attachment system. [ABSTRACT FROM AUTHOR]

Background: Early diagnosis of dementia is crucial for timely intervention. However, frequently, there is a substantial delay in diagnosis. Therefore, it is essential to recognise and address the barriers to early diagnosis. These have not been systematically studied in India. We at a specialist memory clinic in India investigated the time from symptom onset to diagnosis of dementia and factors contributing to the delay.Methods: In this cross-sectional study, consecutive patients with dementia (n = 855) seen at a private hospital underwent a standard clinical assessment and investigations. The primary outcome variable was time from symptom onset to diagnosis (TTD). The association of age, education, gender, dementia subtype, and age of onset on TTD were examined using a univariate analysis of covariance.Results: The median TTD was 24 months; 43% were diagnosed after 24 months. There was a significant association between TTD and age at onset (young onset-median 36 months vs. late onset-24 months) and dementia subtype. Patients with vascular dementia were diagnosed significantly earlier as compared to patients with Alzheimer's disease (AD) and frontotemporal dementia (FTD) [median 18, 24, and 30 months, respectively]. There was no effect of gender or education on the TTD.Conclusion: About 40% of patients with dementia were diagnosed more than 2 years after symptom onset, particularly young onset dementias and FTD. Our study findings highlight the gaps in diagnosing patients with dementia in urban India and have significant implications for developing and implementing multifaceted interventions to improve the early diagnosis of dementia. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Colour‐mixing ability tests are frequently used to assess masticatory performance, but the image acquisition process may be cumbersome and technique sensitive. Objectives: To evaluate the reliability of smartphone camera images in assessing masticatory performance using a colour‐mixing ability test. Methods: Participants were recruited into three groups of dental state (n = 20 each): fully dentate, removable partial denture wearers and complete denture wearers. After performing a colour‐mixing ability test, images of the gum specimens (Hue‐Check Gum©) were captured with two smartphones and compared with the images obtained from a flatbed scanner by two examiners. The images were analysed with a subjective‐ (SA) and an opto‐electronical assessment (VoH). Inter‐ and intra‐rater reliability were tested. ANOVA models with repeated measures were used for statistical analysis (⍺ =.05). Results: All three image acquisition techniques were able to distinguish masticatory performance between different dental states. For SA, inter‐rater reliability was fair to substantial and intra‐rater reliability was substantial to almost perfect. For VoH, inter‐rater reliability with the smartphones was at times different between two examiners, but the intra‐rater assessment was reliable. The opto‐electronic analysis with smartphone images underestimated the masticatory performance significantly when compared to the flatbed scanner analysis. Seven‐day ageing of the specimens did not significantly affect the results. Conclusions: The assessment of masticatory performance with the Hue‐Check Gum© is a reliable method. The use of smartphones may occasionally underestimate masticatory performance; image acquisition with a flatbed scanner remains the gold standard. A centralised analysis of the photographed wafer may foster the reliability of the diagnosis. [ABSTRACT FROM AUTHOR]

Objective: Many older patients, housebound or living in long‐term care facilities (LTCFs) have limited access to dental care. This descriptive qualitative study aimed to understand general dental practitioners (GDPs) attitudes and perceived barriers to undertaking Domiciliary Dental Care (DDC) for those patients in Northern Ireland (NI). Methods: Semi‐structured telephone interviews were conducted with a purposive sample of 12 GDPs in Northern Ireland. Interviews were digitally recorded and transcribed verbatim. An iterative coding process using theme‐analytic methods was used. Results: The data were characterised into four major themes—risk of professional litigation, remuneration for those undertaking DDC, complexity of treatment, and the overall framework of the dental care system in NI. Two minor themes identified were practice culture and reasons for undertaking DDC. The GDPs in the study identified a number of barriers to undertaking DDC including a legal requirement to transport oxygen, lack of organisation and limited oral hygiene care provision in LTCFs, and confusion around their responsibilities for provision of DDC. Those GDPs who were providing DDC indicated that they did so out of kindness and a sense of loyalty to their long‐standing patients. Conclusion: The GDPs in this study identified a number of significant barriers to provision of DDC at organisational, structural and clinical levels. The GDPs indicated that they required clarification of their responsibilities around DDC with clear guidelines necessary given the increase in demand for this service. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effectiveness of professionally applied fluoride varnish on the incidence of dental caries amongst older adults resident in LTCFs in Northern Ireland. Background: The oral health status of older adults within Long‐Term Care Facilities (LTCFs) is significantly worse than their community living peers. Whilst evidence suggests an important role for fluoride varnish in preventing caries in this population, very few studies have evaluated this intervention. Materials and Methods: A quality improvement project was undertaken with dentate residents (n = 190) in nine LTCFs who had fluoride varnish applied by Dental Care Professionals on two separate occasions during a 12‐month period (intervention group). Nine LTCFs were chosen as matched controls (control group) with comparable numbers of residents of similar medical status (n = 217). For the intervention group, oral hygiene training was also provided for the care home staff. Results: A total of 407 patients (n = 271 female) were included in the analyses (mean age [SD]: 84.1 [6.6] years). After 12 months, the intervention group recorded a significant reduction in mean number of carious teeth (mean [95% CI]: −0.85 [−1.12, −0.58]; P <.001). Patients in the control group had significant increases in the mean number of carious teeth (mean [95% CI]: 0.21 [0.05, 0.37]; P =.012), mean plaque score (mean [95% CI]: 1.16 [0.28, 2.04]; P =.010) and mean DMFT score (mean [95% CI]: 0.13 [0.04, 0.22]; P =.004). Conclusions: This study demonstrates the potential role of fluoride varnish in combination with oral hygiene training for staff in the prevention and arrest of carious lesions among older adults in LTCFs. [ABSTRACT FROM AUTHOR]

Aim: To examine the cross‐sectional associations between single nutrient intakes and posteriori nutrient‐based dietary patterns and periodontal disease risk in a subset of the UK Biobank cohort. Materials and Methods: Dietary data were collected by 24‐h dietary recall on up to five separate occasions over 16 months. A touchscreen questionnaire was used to collect oral health information. Participants were considered at high risk of periodontal disease if they reported having painful gums and/or bleeding gums and/or loose teeth. Principal component analysis identified four nutrient‐based dietary patterns from 20 nutrients. Logistic regression was used to estimate the odds ratio of periodontal disease risk for single nutrients and nutrient‐based dietary patterns. Results: A total of 9476 participants (mean age 56.2 years [SD 8.0]) were included in the analysis. Higher intakes of vitamin B6, B12, C, and E, folate, iron, potassium, magnesium, polyunsaturated fatty acids, and total sugar were associated with a lower risk of periodontal disease. Higher intake of saturated fat was associated with an increased risk. A dietary pattern characterized by high micronutrients and fibre intake was associated with low risk of periodontal disease. Conclusion: Within this sample of middle‐aged and older adults, a "high micronutrient and fibre" dietary pattern was associated with reduced risk of periodontal disease. [ABSTRACT FROM AUTHOR]

Background and Objective: Dental care provision in long‐term care facilities (LTCFs) is often a problem despite the high demand. LTCF residents would greatly benefit from a concept that provides an onsite dental care. A rational evaluation of the costs to render this service as well as the cost benefits is worth investigating. This study aimed to calculate the costs involved in providing a mobile dental clinic (MDC) service for LTCF residents in Zurich, Switzerland. Materials and Methods: Cost models for setting up, executing and maintaining an MDC unit were generated. The costs included personnel, equipment/material, maintenance and running costs. The treatment costs were calculated for the treatment in MDC, university‐setting dental clinic (UC) and private practice (PP). Hypothetical cost estimates were generated for the return of the invested capital. Costs incurred for the institutions for accommodating the MDC visit were also calculated. Results: The set‐up capital required to start a MDC in Switzerland (for 2020) was approximately around CHF 505'007.90 (Euros 466'576.80) and was around CHF 452'666.48 (Euros 418'218.56) when a dental care professional (DCP) substituted the dentist. The estimated cost savings for an LTCF resident in the MDC were CHF 205.60 (Euros 189.95) when compared to a UC and approximately CHF 226.34 (Euros 209.12) when compared to a PP. With the dentist, the return of the invested capital can be expected by 3 years while it would take around 6 years with the DCP, assuming that the maximum number of patients possible‐to‐treat are treated every year. The daily running costs for the LTCF for accommodating the MDC visit were approximately CHF 299.04 (Euros 276.28). Conclusions: Delivery of oral health services for LTCF residents through the use of a MDC service seems to be an effective model for dependent elders with limited access to care. However, the costs of maintaining this service are high with similarly large start‐up costs. Future development of this model by utilising dental care professionals may produce cost savings but with a more limited range of services offered. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the impacts of restrictions to the provision of dental services for dependent older patients due to the COVID‐19 pandemic. Methods: Data were gathered on the number of dependent older patients treated, emergency treatment provided and the revenues generated by a specialised clinic for geriatric dentistry during the current pandemic period and compared with the recorded clinical activity from the preceding year. Hypothetical projections were generated for the remainder of the current year based on the assumption that restrictions due to COVID‐19 would remain. Results: A significant decrease in the total number of dependent older patients treated was recorded during the periods of January‐March 2020 (P =.026) and April‐May 2020 (P =.001) when compared to 2019. According to projections, by December 2020 the clinic will be providing 81.14% less clinical activity compared to 2019 (P <.0001), including a complete cessation of domiciliary services. Despite decreases in expenditure, revenues generated by the clinic have decreased significantly due to reduced clinical activity during January‐March 2020 (P =.268) and April‐May 2020 (P =.010) compared to 2019, and would decline further by 899.61% by December 2020. Conclusions: The restrictions implemented to prevent the spread of COVID‐19 have resulted in a significant reduction in oral healthcare provision for dependent older adults. Within this clinic, dedicated to dependent older adults, clinical activity is projected to reduce by 81% by the end of 2020 with associated reductions in revenue generation. Given the importance of oral healthcare delivery for this patient group, this may have significant and lasting impacts. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the color stability of CAD/CAM complete denture resins. Materials and Methods: A total of 176 resin specimens were manufactured from conventional heat‐polymerizing (pink: CONHCP: n = 16; tooth‐shade: CONHCT: n = 16), CAD/CAM subtractively manufactured (pink: WIMP: n = 16, AVMP: n = 16, MEMP: n = 16, POMP: n = 16; tooth‐shade: AVMT: n = 16, MEMT: n = 16, POMT: n = 16), and additively manufactured (pink: NDRPP: n = 16; tooth‐shade: NDRPT: n = 16) denture resins; four different aging processes (thermal cycling, distilled water, red‐wine, and coffee) were used. A spectrophotometer evaluated the color change (ΔE) using two modes of measurements (specular component included (ΔESCI) and specular component excluded (ΔESCE)) recorded at baseline (T0) and at day#30 (T30). ANOVA and post hoc tests were used for statistical analysis (alpha = 0.05). Results: Additively manufactured resins (NDRPP and NDRPT) demonstrated significant ΔE in comparison to the other groups in all aging media (p < 0.001). WIMP demonstrated higher ΔESCI in comparison to the other subtractively manufactured groups in distilled water (p < 0.001). In red‐wine, AVMT revealed significantly more ΔESCE than POMT (p = 0.039). In coffee, the ΔESCE was higher for CONHCT than MEMT (p = 0.026) and POMT (p = 0.011). Similarly, in coffee the ΔESCE for AVMT was higher than POMT (p = 0.030). Conclusion: Additively manufactured denture resins demonstrated the maximum color change compared to conventional heat‐polymerized and CAD/CAM subtractively manufactured denture resins. Furthermore, CAD/CAM subtractively manufactured denture resins were not inferior to conventional resins in terms of color stability. [ABSTRACT FROM AUTHOR]

Objective: This questionnaire‐based survey assessed the attitudes of dental hygiene students towards treating elderly patients. Methods: The 14‐item UCLA 14‐item Geriatrics Attitudes Scale (GAS‐14) questionnaire was used in this survey. A further set of nine questions evaluated the opinions of the students towards the existing geriatric curriculum in their respective institutions. Students from five dental hygiene schools from three countries (Switzerland, Belgium and Canada) participated in this survey. General demographic information from the participants was collected. Mean GAS‐14 scores were calculated; ANOVA and Bonferroni's tests were used for statistical analyses (p < 0.05). Results: Three hundred eighty‐five students (Switzerland: n = 157, mean age = 25.38 ± 4.6 years; Belgium: n = 82, mean age = 27.58 ± 12.8 years; Canada: n = 146, mean age = 25.95 ± 12.3 years) completed the survey for a response rate of 86.3%. The overall GAS‐14 scores for Switzerland, Belgium and Canada were 3.61 ± 0.42, 3.24 ± 0.37 and 3.32 ± 0.36, respectively. Switzerland scored significantly higher than Belgium and Canada (p < 0.0001). Overall scores revealed a significant effect of progressive training (p = 0.010). The GAS‐14 score was influenced by the nationality of the participants (p < 0.0001), but not influenced by sex, age, origin, religion, or marital and accommodation statuses. Majority of the students (75.8%) agreed that geriatric dentistry was an important part of their education. 77.4% agreed that they would like hands on experience in treating the elderly patient during their education. 85.1% of the participants considered mobile dental clinics as a good solution for the provision of dental care to the institutionalized elders. Conclusions: The general attitudes of DH students towards treating the elderly patients are on an acceptable level and improved as they progressed through their dental hygiene academic programmes. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to obtain a consensus on oral health policy, access to dental care, oral hygiene measures and training levels.Background: Poor oral health is widespread in care-dependent older people, but no consensus for a minimum standard of oral health care exists yet.Methods: The e-Delphi approach was applied to a selected panel of interdisciplinary experts. Data analysis was based on three measurements: (a) ≥70% of experts' opinion fall into category "agree or strongly agree," (b) median score on the 5-point Likert scale ≥4, (c) interquartile range ≤1.Results: A total of 31 experts from 17 European countries participated in this survey. Agreement was achieved for a compulsory dental examination when an elder is admitted to a long-term care (LTC) facility. Older people should brush their teeth twice/day and regularly clean interproximal spaces and oral mucosa. Dentures should be rinsed after meals and cleaned twice/day. The use of denture cleansing tablets was considered necessary. Dentures should be removed before sleeping and stored dry. A 5000 ppm fluoride toothpaste should be applied daily in elder with high caries risk. A short report on the oral health status of the elder should be included in the geriatric assessment. All experts concluded that the knowledge and the training in oral health care for caregivers and family members of care-dependent older people were imperative.Conclusions: Using the e-Delphi method, multidisciplinary healthcare professionals from different countries agreed on certain cardinal recommendations for a standard oral health care for care-dependent older people. [ABSTRACT FROM AUTHOR]

Objective: This randomized controlled trial (RCT) aimed to demonstrate the noninferiority 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 CADCAM milled bar with long distal extensions are not an inferior treatment to the conventional IODs on retentive anchors in the short term (1 year). [ABSTRACT FROM AUTHOR]

Background: The two‐colour mixing test is a quick method to assess chewing function (CF). The use of smartphone cameras for acquiring images may help in further simplifying the process. Objective: This study evaluated the reliability of smartphone‐camera images of chewing gums to assess CF. Methods: Five test samples of a bicoloured chewing gum were produced by a single fully dentate adult volunteer. The specimens were flattened to 1‐mm thick wafers. The two sides of the wafers were digitised with a conventional flatbed scanner (control) and were photographed 20 times using 8 different smartphones. The images were assessed optoelectronically to obtain the variance of hue (VoH) and subjectively by visual assessment (SA) using a categorical scale (SA1‐SA5). Spearman's correlation and regression models were used for statistical analyses. Results: The intra‐group variability for SA1‐SA3 was <1% for all smartphones, but significantly higher than controls for SA4 and SA5 (smartphone: SA4 = 5.57%; SA5 = 8.76%; control: SA4 = 2.5%; SA5 = 0.79%). VoH was progressively lower from SA1 to SA5 for all imaging devices (r > −.97; P <.001). VoH comparisons between control and smartphone images revealed significant differences for the individual SA categories, and however, the magnitude of differences was small and non‐significant when the full range of SA levels were considered. The linear mixed model regression showed significant effects for all the smartphones (P <.001) and SA levels (P <.001) in relation to the flatbed scanner values. Conclusions: Smartphone cameras may be used to evaluate colour mixture for a bolus‐kneading test, however, the precision is lower with higher degrees of colour mixing. [ABSTRACT FROM AUTHOR]

Objectives: This in vitro study aimed to compare changes in retentive force due to cyclic dislodging of three novel un‐splinted attachments. Materials and Methods: Experimental models simulating a mandibular two‐implant overdenture situation, with implants positioned with various interimplant discrepancies (0°, 20°, 40°, and 60°) were fabricated. Three attachment systems were tested, "N": a straight or 15°‐angulated stud; "L": a sole straight stud; and "C": a straight or individually angulated stud. All models underwent wet testing and were subjected to 10,000 insertion–removal cycles in a universal testing machine. The mean retentive forces were calculated for cycles 10, 100, 1,000, 5,000, and 10,000. Multiple mixed‐effects linear regression models were applied for statistical analyses (⍺ < 0.05). Results: "N" demonstrated an increasing retention until 1,000 cycles, which subsequently diminished back to its initial retention at 10,000 cycles, showing no significant loss during the entire experiment. Statistical models demonstrated no effect of implant angulation on retention, except for 60° after 10,000 cycles (p <.05). "L" showed an early peak at 100 cycles and did not significantly lose retentive force before 5,000 cycles. Angulations of 40° or higher were shown to lead to lower retentive forces (0° vs. 40° cycle 5,000: p <.05; 0° vs. 60° cycle 100: p <.05, ≥cycle 1,000: p <.001). "C" showed stable retentive forces with no significant loss only at 10,000 cycles (all angles: p <.001) or 5,000 cycles (0° vs. 60°: p <.05). Conclusions: All systems showed retentive forces promising successful clinical use in implant overdentures, even in situations with extremely angulated implants. Specific abutments compensating interimplant angulation maintain retention longer in situations with high axe divergencies. [ABSTRACT FROM AUTHOR]

Objective: This retrospective cross‐sectional study aimed to evaluate quantitatively the oral microbiome in the tri‐lobe central cavity of Locator Legacy attachment and verify whether it harbors a different, potentially more pathogenic, bacterial spectrum than the adjacent edentulous ridge. Materials and Methods: Edentulous patients rehabilitated with implant overdentures using Locator Legacy attachments were recruited for this study. The clinical examination comprised probing depths, mobility, peri‐implant, and periodontal health along with intraoral swabs for microbiological evaluation, polymerase chain reaction (PCR) testing, and candida culture. The swabs were collected from the trilobed cavity of the attachment and the adjacent edentulous ridge. PCR was performed to detect six specific bacteria, Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Tannerella forsythia, Treponema denticola, Prevotella intermedia, and Parvimonas micra. Statistical analyses were performed using McNemar's test and Wilcoxon's rank sum test with the significance set to p <.05. Results: A total of 50 participants with a mean age of 71.5 ± 9.6 years participated in the study. No significant differences in the microbiome were found between samples from the ridge and the attachment. No significantly different numbers in the candida cultures were identified, and the presence of a removable prostheses did not demonstrate a significant association with the prevalence of candida. Conclusions: Within the limits of this study and the investigated bacterial species, the trilobed cavity of the attachment does not seem to increase the bacterial load. [ABSTRACT FROM AUTHOR]

Background: The evolution of retention forces in one‐piece mini dental implants (MDIs) retaining implant overdentures (IODs) is of major importance, as the male parts cannot be exchanged, due to the implant design. Purpose: To report the evolution of retention forces of one‐piece MDIs, retaining mandibular IODs with ball/ O‐ring attachments during 5 years assessed in vivo. Materials and Methods: Four MDIs were installed in the interforaminal region and immediately loaded using the existing mandibular complete denture. Directly post‐op, at the 1‐year and the 5‐year follow‐up, the retention forces were assessed with a validated strain gauge at each implant site separately. Results: At the male part, changes could only be observed at implant site 34: During the first year, there was a statistically significant increase, whereas the retention forces were decreased at the 5‐year follow‐up. At the female part, retention forces decreased significantly over time. Baseline values could be reestablished by exchanging the O‐rings. The changes of the retention forces were more obvious in the posterior, compared to the anterior implants. Conclusions: Retention forces at the female part decrease significantly over time, when retaining mandibular IODs by MDIs with ball/ O‐ring attachments. Baseline values can be reestablished by exchanging the O‐rings. At the male part, changes of retention forces depend on the implant location. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate the prevalence of various oral hygiene tools amongst hospitalised elders and to associate their cognitive status with the prevalence of tools and oral hygiene status.Materials and Method: Elderly hospitalised participants were included in the study and underwent a brief clinical intra-oral examination. A semi-structured questionnaire evaluated the awareness and personal possession of the various oral hygiene tools. Participants' personal information and various clinical parameters including DMF (T) index, plaque index, CPITN index, denture plaque and calculus index were collected. Mini-Mental State Examination (MMSE) scores were retrieved from the medical records. Linear regression models were applied for statistical analyses (P < 0.05).Results: A total of 100 hospitalised elders (age = 84.5 ± 6.9 years; ♀ = 72, age = 84.9 ± 7.2 years; ♂ = 28, age = 83.3 ± 5.8 years) participated in this study. Awareness was high for manual toothbrush (100%), electric toothbrush (86%), dental floss (79%), interdental brush (44%), interdental stick (55%) and mouthwash (75%), but was low for tongue scraper (9%), while the prevalence of use was 93%, 17%, 27%, 21%, 29%, 39% and 4%, respectively. Linear regression models revealed plaque scores were lower when more hygiene tools were used by the participants (P = 0.0059). Participants with high MMSE scores had lower plaque scores (P = 0.0004) and possessed more oral hygiene tools (P = 0.0203).Conclusion: Poor oral hygiene is often noticed in institutionalised elders and might be related to a lack of knowledge about existing oral hygiene tools. These may help optimising oral hygiene, especially in cognitively impaired elders. Oral hygiene tools should be prescribed according to the patient's need, functional and cognitive status. [ABSTRACT FROM AUTHOR]

Purpose: To compare the masticatory efficiency (ME), maximum voluntary bite force (MBF), masseter muscle thickness (MMT), and salivary flow rates (SFR) in completely edentulous dependent elders treated either with a conversion of their existing mandibular complete removable dental prostheses (CRDPs) into a two‐implant overdenture (IOD) or a conventional reline of the CRDP. Material and Methods: Participants were randomly allocated into intervention (IG) and control (CG) groups. The IG received two implants in the mandibular canine regions, and their CRDPs were transformed into IODs. The CG received a conventional reline of their mandibular CRDPs. Outcomes were recorded at each recall visit (baseline, immediately, 3 months, 12 months after intervention, and subsequently on an annual basis). Statistical analyses used mixed linear regression models (level of significance: p < 0.05). Results: The IG comprised 16 participants (age = 85.0 ± 6.2 years), while the CG comprised 16 (age = 84.8 ± 5.4 years), with a mean follow‐up of 2.7 ± 2.2 years (range: 3 months–7 years). A significant increase of MBF in the IG was observed with an overall gain of 80 N (p < 0.001) compared with the reline group. There were no significant long‐term changes in SFR, MMT, or ME within/between groups. Conclusion: Since dependent elders with mandibular IODs present a significant gain in MBF, but no relative increase in SFR, MMT, and ME, it seems that this increased capacity of MBF is not exploited by the elders during their habitual chewing. [ABSTRACT FROM AUTHOR]

Objectives: his review evaluated implant survival in geriatric patients (≥75 years) and/or the impact of systemic medical conditions. Materials and Methods: Systematic literature searches were performed to identify studies reporting on geriatric subjects with dental implants and on implant patients who had any of the seven most common systematic conditions among geriatric patients. Meta‐analyses were performed on the postloading implant survival rates. The impact of systemic medical conditions and their respective treatment was qualitatively analyzed. Results: A total of 6,893 studies were identified; of those, 60 studies were included. The fixed‐effects model revealed an overall implant survival of 97.3% (95% CI: 94.3, 98.7; studies = 7) and 96.1% (95% CI: 87.3, 98.9; studies = 3), for 1 and 5 years, respectively. In patients with cardiovascular disease, implant survival may be similar or higher compared to healthy patients. High implant survival rates were reported for patients with Parkinson's disease or diabetes mellitus type II. In patients with cancer, implant survival is negatively affected, namely by radiotherapy. Patients with bone metastases receiving high‐dose antiresorptive therapy (ART) carry a high risk for complications after implant surgery. Implant survival was reported to be high in patients receiving low‐dose ART for treatment of osteoporosis. No evidence was found on implant survival in patients with dementia, respiratory diseases, liver cirrhosis, or osteoarthritis. Conclusions: Implant prostheses in geriatric subjects are a predictable treatment option with a very high rate of implant survival. The functional and psychosocial benefits of such intervention should outweigh the associated risks to common medical conditions. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: The aim of this split‐mouth study was to evaluate the masticatory efficiency in patients with segmentally reconstructed mandibles using free fibula flaps, with and without stabilizing osteosynthesis material in‐situ during implant placement for rehabilitation with implant‐supported removable partial dental prostheses (ISRPDPs). Methods: Ten participants (n = 10; ♀ = 2, ♂ = 8; mean age = 38.1 years) consented to participate in this study. The participants’ normal side (Side N) of the mandible served as the control side, for comparing the masticatory efficiency of the segmentally reconstructed and rehabilitated side (Side R). Masticatory efficiency was evaluated using the two‐colored chewing gum test, measured as subjective assessment (SA) and electronically evaluated variance of hue (VOH). Data were checked for normal distribution and statistically analyzed with the level of significance set to p < 0.05. Results: Thirty‐four tissue‐level implants were placed in reconstructed mandibles of 10 participants. There was no significant difference observed in the masticatory efficiencies between Side N and Side R, in both subjective and electronic assessments. No implant loss was observed after a post‐rehabilitated mean follow‐up period of 42.7 months, revealing an implant survival rate of 100%. Conclusions: In patients with surgically reconstructed mandibles, a normal masticatory function can be successfully achieved with a rehabilitation of the reconstructed side with implant‐supported removable partial dental prostheses. Implant‐supported prostheses should be actively advocated in patients with reconstructive surgeries to restore their masticatory function, extend their food choices, and improve their overall oral health‐related quality of life. [ABSTRACT FROM AUTHOR]

Abstract: The use of LOCATOR® attachments in implant‐supported removable dental prostheses (ISRDPs) has been evidenced with conflicting clinical behavior in literature. This retrospective study aimed to investigate the long‐term clinical performance of LOCATOR® attachments by evaluating the frequency of the encountered mechanical complication events (MCEs) and the factors that play a role in attachment wear (AW). The study recruited participants with ISRDPs on LOCATOR® attachments. Clinical parameters, number of MCEs (attachment replacements, attachment loosenings, denture cap‐related events, loss of retention and/or insert, and implant fractures), and AW were recorded. Nonparametric tests were applied for statistical analyses ( ໼=0.05). Baseline demographics for the recruited 47 participants (mean age: 72.0 ± 9.0 years) revealed an implant survival rate of 94.9% (mean observation period: 54.8 months), average peri‐implant probing depths, bleeding on probing scores, and plaque scores of 1.80 ± 1.50 mm, 0.70 ± 0.90, and 0.81 ± 0.90, respectively. MCEs were directly influenced by the time in use (p < 0.001). The most frequently encountered MCEs were loss of retention (p < 0.001) and denture cap‐related complications (p = 0.004). AW was found to be significantly higher in the maxilla than in the mandible (p = 0.028); in the maxilla, the vestibular (p = 0.005) and mesial (p = 0.01) aspects were the most common wear sites. Maxillary implant overdentures revealed more vestibular AW (p = 0.013). In prostheses supported by >3 implants, vestibular (p = 0.046) and mesial (p = 0.032) AW were common. Lingual AW (p = 0.021) was observed more frequently when the support was <3 implants. Loss of retention and AW are the most common complications encountered with LOCATOR® attachments. Therefore, a modification in the attachment design along with an amelioration of the attachment surface may help decrease the maintenance needs and further enhance its clinical performance. [ABSTRACT FROM AUTHOR]

Objective This systematic review was conducted to evaluate the outcome of dental implant therapy in elderly patients (≥65 years). Material and Methods Online database and hand searches were systematically performed to identify studies reporting on dental implants placed in the partially/completely edentulous jaws of elderly patients. Only prospective studies reporting on regular-diameter (≥3 mm), micro-rough surface implants were included in this review. Two investigators performed the search and data extraction. An inter-investigator reliability was verified using kappa statistics (κ). A meta-analysis was performed on implant survival rates, while the mean peri-implant marginal bone level changes ( PI- MBL), technical/mechanical complications, and biological complications were reported descriptively. Results The systematic search yielded 2221 publications, of which 11 studies were included for statistical analyses. The calculated κ for the various parameters extracted was κ = 0.818-1.000. A meta-analysis was performed on the post-loading implant survival rates at 1, 3, 5, and 10 years. The random-effects model revealed an overall 1-year implant survival of 97.7% (95% CI: 95.8, 98.8; I2 = 0.00%, P = 0.968; n = 11 studies). The model further revealed an overall implant survival of 96.3% (95% CI: 92.8, 98.1; I2 = 0.00%, P = 0.618; n = 6 studies), 96.2% (95% CI: 93.0, 97.9; I2 = 0.00%, P = 0.850; n = 7 studies), and 91.2% (95% CI: 83.4, 95.6; I2 = 0.00%, P = 0.381; n = 3 studies) for 3, 5, and 10 years, respectively. The reported 1-year average PI- MBL ranged between 0.1 and 0.3 mm, while the reported 5- and 10-year PI- MBL were 0.7 and 1.5 mm, respectively. Information obtained pertaining to the technical and biological complications in the included studies was inadequate for statistical analysis. The frequent technical/mechanical complications reported were abutment screw loosening, fracture of the overdenture prostheses, activation of retentive clips, ceramic chipping, and fractures. The common biological complication reported included peri-implant mucositis, mucosal enlargement, bone loss, pain, and implant loss. Conclusions This review provides robust evidence favoring dental implant therapy in elderly patients as a predictable long-term treatment option, in terms of implant survival, clinically acceptable PI- MBL changes, and minimal complications. Therefore, age alone should not be a limiting factor for dental implant therapy. [ABSTRACT FROM AUTHOR]

Objective The aim of this in vitro pilot study was to evaluate the influence of an artificial saliva ( AS) lubricant on the retentive force of a stud-type attachment ( LOCATOR®) for implant overdentures ( IODs). Methods Twenty custom-made models simulating a two- IOD with parallel implant situation were fabricated using LOCATOR® attachments. The in vitro testing was carried out with an Instron® universal testing machine for a total of 10,000 insertion-removal cycles, for each model, in two different aqueous test mediums (Group 1: 0.9% sodium chloride solution (NaCl), n = 10; Group 2: AS, n = 10). Changes in the mean retentive force ( F) were plotted against the cycle numbers #10, #100, #1000, #5000, and #10,000. Mixed regression models were applied for statistical analyses. Results A mixed regression (not considering interactions) predicted, compared to cycle #10, higher retentive forces at cycles #100 ( P < 0.0001), #1000 ( P = 0.017), similar forces at #5000 ( P = 0.277), and lower forces at #10,000 ( P = 0.012); there was no overall effect of the medium ( P = 0.159). A second statistical model, employing the interaction term 'cycle##medium', confirmed similarly the effect. Although the interaction term was significant at cycle #100 ( p = 0.045), there was no significant difference between the two groups ( P = 0.140). Conclusion In this in vitro pilot experiment, there was no difference in mean retentive forces of the LOCATOR® attachments when tested with either 0.9% NaCl or a Glandosane®-like artificial saliva lubricant. A larger scale study may still confirm the superiority of either lubricant for quasiclinical bench experiments. [ABSTRACT FROM AUTHOR]

Objective This in vitro study evaluated the influence of implant angulations on the retentive behavior of two overdenture attachments during cyclic dislodging. Methods Models simulating a two-implant overdenture situation were fabricated. They were divided into five groups based on their simulated implant angulations (Groups: 1 = 0°; 2 = 20°; 3 = 30°; 4 = 40°; and 5 = 60°; n = 90). Each group was further divided into two subgroups based on its attachment system (control attachment: LOCATOR®; test attachment: SFI-Anchor®) except for group 5 which had no LOCATOR® group. All models underwent 10,000 insertion-removal cycles in a wet environment. Mean retentive forces were recorded. ANOVA and linear regression models were used for statistical analyses, and the level of significance was at P < 0.05. Results The ANOVA model revealed an effect of dislodging cycles for both attachments ( P = 0.0070). The linear regression model with repeated measures revealed a significant effect of angulation within the LOCATOR® groups (0° vs. 20°: P < 0.0001; 0° vs. 30°: P < 0.0001; 0° vs. 40°: P < 0.0001), but was insignificant within the SFI-Anchor® groups (0° vs. 20°: P = 0.544; 0° vs. 30°: P = 0.134; 0° vs. 40°: P = 0.254; 0° vs. 60°: P = 0.979). It further revealed a significant increase in the retentive force between the LOCATOR® and the SFI-Anchor® (20°: P = 0.041; 30°: P < 0.0001; 40°: P < 0.0001), although there was no significant difference between the attachments at 0° ( P = 0.623). Conclusions This study confirms that the retentive behavior of SFI-Anchor® is not influenced by implant axial inclination even at angulations of up to 60°. The SFI-Anchor® may therefore be particularly indicated for clinical situations with marked implant axial discrepancies. [ABSTRACT FROM AUTHOR]

Background: Two thirds of people with dementia live in low and middle income countries (LMICs)but only about 10% of these persons are estimated to receive a dementia diagnosis. Reasons are multiple and complex. Early diagnosis is essential for initiating treatment, referral for care services, and planning for the future. There is a paucity of data on the pathways to dementia diagnosis in LMICs. We investigated the pathways and factors contributing to delay in diagnosis in a specialist memory clinic from urban India. Method: Consecutive patients and their carers attending the specialist memory clinic in Bangalore, India with cognitive complaints underwent a detailed clinical assessment, neuropsychological testing, neuroimaging, and blood tests. Details of symptom onset, visits to various medical providers, diagnoses made were captured on a proforma. Effect of education, gender, dementia subtype, and age of onset on time to diagnosis were examined using univariate analysis of covariance. Result: 879 out of 1212 patients had dementia. Only 24 (2.39%) received a dementia diagnosis elsewhere. Approximately 20% of the patients were on dementia‐specific medications but the family and the patient were unaware of the diagnosis. The median time to diagnosis was 24 (range 3 to 180) months. 43% of the patients were diagnosed 24 months after symptom onset. Patients with young onset dementia, Alzheimer's disease, and Frontotemporal dementia were diagnosed significantly later as compared to those with vascular dementia and dementia with Lewy bodies. Education and gender did not have an effect on the time to diagnosis. Conclusion: Both delay and lack of communication about the diagnosis of dementia appear to be important issues that need to be addressed to improve the early detection of dementia in India. Training of health providers appears an essential component in improving the early diagnosis of dementia. Findings from our study will be compared to literature from other LMICs and a comprehensive framework to improve early diagnosis of dementia in LMICs will be discussed. [ABSTRACT FROM AUTHOR]

Objective: This systematic review was performed to compare the survival of 1- vs. 2-implant overdentures (IODs) in the edentulous mandible. Materials and methods: Manual and electronic database (PubMed, EMBASE and CENTRAL) searches were performed to identify scientific articles, published in English, reporting on mandibular IODs utilizing unsplinted attachments. Studies were included if they were prospective human studies reporting on two-piece microrough surface implants with a diameter ≥3 mm. Data were extracted by two independent investigators, and an overall inter-investigator kappa score was calculated. A meta-analysis was performed on the included comparative studies. Results: The search shortlisted 30 prospective studies for data extraction and statistical analysis. The included studies comprised of only two randomized controlled trials (RCTs) comparing 1- vs. 2-IODs, and a further 28 prospective studies. The kappa score calculated was between 0.86 and 1 for the various parameters. One RCT favored 1-IODs (RD: 0.08, 95% CI: 0.01, 0.14) while the other favored 2-IODs (RD:-0.04, 95% CI: -0.27, 0.19). However, the overall random effects model did not reveal a significant risk difference (RD) for implant failure between the two interventions (I2 = 36.6%, P = 0.209; RD: 0.05, 95% CI: -0.07, 0.18). Conclusions: The results of this meta-analysis conclude that the postloading implant survival of 1-IODs is not significantly different from 2-IODs. However, the existing scientific evidence in the literature in terms of prospective comparative studies is scarce. Hence, before recommending the 1-IOD as a treatment modality, long-term observations are needed and a larger range of functional, prosthodontic, and patient-centered outcome measures should be considered. [ABSTRACT FROM AUTHOR]

Objective The aim of this single - blind, multicenter, parallel, randomized controlled trial was to evaluate the effectiveness of the application of a high-fluoride toothpaste on root caries in adults. Methods Adult patients ( n = 130, ♂ = 74, ♀ = 56; mean age ± SD: 56.9 ± 12.9) from three participating centers, diagnosed with root caries, were randomly allocated into two groups: Test ( n = 64, ♂ = 37, ♀ = 27; lesions = 144; mean age: 59.0 ± 12.1; intervention: high-fluoride toothpaste with 5000 ppm F), and Control ( n = 66, ♂ = 37, ♀ = 29; lesions = 160; mean age: 54.8 ± 13.5; intervention: regular-fluoride toothpaste with 1350 ppm F) groups. Clinical examinations and surface hardness scoring of the carious lesions were performed for each subject at specified time intervals ( T0 - at baseline before intervention, T1 - at 3 months and T2 - at 6 months after intervention). Mean surface hardness scores ( HS) were calculated for each patient. Statistical analyses comprised of two-way analysis of variance and post hoc comparisons using the Bonferroni- Dunn correction. Results At T0, there was no statistical difference between the two groups with regard to gender ( P = 0.0682, unpaired t-test), or age ( P = 0.9786, chi-squared test), and for the overall HS (Test group: HS = 3.4 ± 0.61; Control group: HS = 3.4 ± 0.66; P = 0.8757, unpaired t-test). The anova revealed significantly better HS for the test group than for the control groups ( T1: Test group: HS = 2.9 ± 0.67; Control group: HS = 3.1 ± 0.75; T2: Test group: HS = 2.4 ± 0.81; Control group: HS = 2.8 ± 0.79; P < 0.0001). However, the interaction term time-point*group was not significant. Conclusions The application of a high-fluoride containing dentifrice (5000 ppm F) in adults, twice daily, significantly improves the surface hardness of otherwise untreated root caries lesions when compared with the use of regular fluoride containing (1350 ppm F) toothpastes. [ABSTRACT FROM AUTHOR]

Objective The aim of this review was to test the hypothesis that 6 mm micro-rough short Straumann® implants provide predictable survival rates and verify that most failures occurring are early failures. Materials and methods A Pub Med and hand search was performed to identify studies involving micro-rough 6-mm-short implants published between January 1987 and August 2011. Studies were included that (i) involve Straumann® 6 mm implants placed in the human jaws, (ii) provide data on the survival rate, (iii) mention the time of failure, and (iv) report a minimum follow-up period of 12 months following placement. A meta-analysis was performed on the extracted data. Results From a total of 842 publications that were screened, 12 methodologically sound articles qualified to be included for the statistical evaluation based on our inclusion criteria. A total of 690 Straumann® 6-mm-short implants were evaluated in the reviewed studies (Total: placed-690, failed-25; maxilla: placed-266, failed-14; mandible: placed-364, failed-5; follow-up period: 1-8 years). A meta-analysis was performed on the calculated early cumulative survival rates ( CSR%). The pooled early CSR% calculated in this meta-analysis was 93.7%, whereas the overall survival rates in the maxilla and mandible were 94.7% and 98.6% respectively. Implant failures observed were predominantly early failures (76%). Conclusion This meta-analysis provides robust evidence that micro-rough 6-mm-short dental implants are a predictable treatment option, providing favorable survival rates. The failures encountered with 6-mm-short implants were predominantly early and their survival in the mandible was slightly superior. [ABSTRACT FROM AUTHOR]

Background Mandibular two-implant-retained overdentures were suggested as first choice of treatment for edentulous mandibles. However, wear of the attachments may reduce their retention and compromise long-term clinical success. Aim The aim of this in vitro study was to compare the change in the retentive force and removal torque of three attachment systems during simulation of insertion-removal cycles. Materials and Methods Thirty custom-manufactured polyvinyl chloride blocks mimicking an implant-retained overdenture using Locator®-, spherical Dalbo®- PLUS - and SFI®-Bar-attachments on Straumann® RN Implants were fabricated. The samples were distributed equally into three groups which were subdivided into two sets of five blocks, one set with implants parallel to one another and the other with angulated implants (12°). All attachments were tightened to 35Ncm, while the fixation screws of the SFI®-Bar were tightened to 15Ncm. Testing was carried out with an Instron® universal testing machine for a total of 14,600 insertion-removal cycles in 0.9% sodium chloride solution. Retentive forces from cycles 10, 100, 1000, 5000, 10,000 and 14,600 were used for the analysis. The removal torque of the attachments was measured before and at the end of the study. Statistical analysis comprised three-way ANOVA and multiple linear regression models. Results Initially, all three attachment systems demonstrated increasing retentive forces. From cycle 5000 on, Locator®-attachments showed lower mean retentive forces than the Dalbo®- PLUS and SFI®-Bar-groups. The Dalbo®- PLUS and SFI®-Bar-attachments showed a steady yet not significant increase during the whole observation period. Implant-angulation had no significant influence on the retention forces. The final mean removal torques were significantly reduced. No complete failure was observed. Conclusions and clinical implications Within the limits of this in vitro study, it can be concluded that the investigated overdenture attachment systems are sufficiently resistant to wear. However, the Dalbo®-Plus- and SFI®-Bar- exhibit higher retentive capacities than the Locator®-attachment over time. The fixation screw of the SFI®-Bar may loosen during long-term use, but these observations might be less important if 1-year recall intervals are respected. An angulation of up to 12° between implants does not seem to have a significant effect on attachment wear. [ABSTRACT FROM AUTHOR]