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Oral rehabilitation of children with extensive aplasia includes a number of dental considerations as well as attention to psychological and physical development. The well-documented results of the use of implants in adults have raised the question of the use of implants and the timing of this procedure in children and adolescents with multiple aplasia. Eight-years' experience of a multidisciplinary approach to oral rehabilitation of children with extensive aplasia is described. Special emphasis is placed on early diagnosis, careful therapy planning, and co-ordination and timing of different parts of the therapy. The specific considerations from the point of view of paediatric dentists, orthodontists, oral surgeons, and prosthodontists are presented. A system for integrating all these aspects and knowledge will be a guarantee for high professional standards and a successful outcome. To exemplify the multidisciplinary approach, three treated cases are presented.

Nineteen prosthodontic clinics participated in a prospective study of fixed prostheses supported by osseointegrated implants (FPOIs) with laser-welded titanium frameworks. Ninety-three patients with 100 FPOIs were included and followed for 2 years. The results from this group were compared to another group that was examined retrospectively. In the retrospective group (control group), 91 patients received 96 FPOIs with cast frameworks, and these patients were treated shortly before the patients in the titanium-framework group (test group). The two groups were treated at the same centers. The results for both groups were good, with only 1.2% of loaded implants lost during the follow-up period (1.6% in the titanium-framework group; 0.7% in the control group). One framework in each group fractured. However, in complete maxillary cases, there were significantly more subjects in the titanium-framework group who were affected by implant losses compared to the control group. There was also a tendency towards more fractures of artificial teeth and acrylic resin in the titanium-framework group, compared to the control group. A possible explanation might be that dental technicians at the different centers were not used to the design of the titanium frameworks when the study began. Thus, the results from the first 2 years are promising, but further studies are needed to establish the long-term serviceability of laser-welded titanium frameworks.

A follow-up study of composite retained onlay bridges inserted to replace permanent anterior teeth in adolescents was performed. The material comprised 100 bridges and the dominating reasons for replacement of teeth were aplasia and trauma. Clinical controls were performed every six months and the mean observation time was 34 months. (Range 11-59 months). Seventyone bridges were functioning without complications during the observation period. Dislodgement occurred in 29 bridges on 54 different occasions. Dislodgement was seen more frequently in boys. The dominating reason for dislodgement was new trauma during sports activities or fights, which occurred more frequently in patients with trauma as the original reason for replacement of teeth. Owing to the tooth-preserving potential and reversibility, it is considered a valuable method of replacing missing anterior teeth in young individuals. Further investigations should concentrate on technical development aimed at achieving optimum retention and on clinical evaluation over longer periods.

A study of the knowledge about dental health and diseases of youths in their late teens has been conducted. A 10-class questionnaire relating to dental caries and gingivitis/periodontitis was answered by three test groups (A, B, C) totalling seventy-eight 19-year-olds who, during a 3-year period, had undergone professional prophylaxis at different intervals. Nineteen young people of the same age without organized preventive measures since their last attendance at the public dental service constituted a control group (D). The test groups were found to have a significantly better knowledge of factors relating to gingivitis/periodontitis than the control group. In questions relating to caries there were no differences among the groups. Higher points were scored in knowledge of therapy and prevention than of the causes and symptoms of the dental diseases. Several regularly repeated sessions for professional prophylaxis did not lead to better knowledge than only a few. No consistent correlation was found for any of the groups between knowledge and both quantitative tooth cleaning, i.e. type and frequency of use of oral hygiene aids, and qualitative tooth cleaning, expressed as the occurrence of plaque and gingivitis. Nor were significant differences found in these respects between individuals with and without a caries increment during the observation period regardless of grouping.

Dietary habits and dental caries were analysed in 95 19-year-old Swedish adolescents who had been subjected to different preventive measures during their late teens. A 24-hour recall was used and showed that the intakes of milk and milk products, meat, fish and eggs accorded with recommended norms but not those of vegetables, fruits and berries, and potatoes and root vegetables. Only 6% of the subjects had eaten the recommended three principal meals during the day tested. At the end of the trial, only weak or moderate correlations were found between snacks, including sucrose snacks, and selected clinical variables. Subjects who did not develop new carious lesions during the experimental 2 years had fewer risk factors, defined as the most negative values (quartile limit) for sucrose snack consumption, tooth cleaning score, lactobacillus count, saliva secretion rate and saliva buffer capacity, than those who developed one or more new lesions. During the experimental period, with an overall low caries incidence, no single factor tested for presumed risk was found to be the discriminating factor for occurrence of dental caries.

Having natural teeth is a matter of varying importance according to the priorities given to dental health status, compliance with recommendations and demand for dental care. The aim of this study was to assess the relative adjustment needed when one or more teeth are lost and when dentures are provided compared with other life events. The study was conducted as a mailed questionnaire to a sample of 311 20-70 year old subjects in the community of Jönköping. Seventy-five per cent of the sample, with a mean age of 43.2 years, responded. The Social Readjustment Rating Questionnaire, comprising 46 life events, was supplemented with two events concerning tooth loss and denture-wearing. The answers were given on a graphic rating scale with end points 'not difficult at all' and 'more difficult than anything' and coded by values 0 to 20. After calculation of mean values, the questions were rank ordered; the item with the highest mean was given the highest rank. 'Losing one or more teeth' was ranked 28.5 (means = 10.7) and 'getting dentures' 33 (means = 12.0) of the 48 life events investigated. This suggests that a majority of respondents perceived losing teeth and being provided with dentures as more important in terms of adjustment than events such as 'marriage', 'retirement' and 'changing work'. No significant differences in relation to age and sex were found.