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Objectives: The reconstruction of extended and complex defects of the alveolar bone is a frequent requirement prior to implant placement. The aim of this study was to assess and compare location, intensity, and experience of pain after bone graft harvesting for dental implants with respect to the donor site., Methods: In this prospective non-randomized intervention study, a consecutive sample of 23 patients who received autologous bone grafts from intra-oral (IO; N = 8) or extra-oral (EO; N = 15) donor sites prior to insertion of dental implants for fixed dental prostheses were recruited. All patients completed a self-administered questionnaire regarding pain location, intensity, and experience at baseline (B; before surgery), at the first follow-up (F1; 3 days after surgery), and at the second follow-up (F2; 4 weeks after surgery). Relative Risk Ratios (RRR) were determined for pain locations. For pain intensity and pain experience, 95% confidence intervals were evaluated using percentiles of a bootstrap with 1000 replications to assess statistical significance., Results: Both patient groups did perceive pain in the mouth/face after the intervention, but patients in the EO donor site group had additional pain at the hip, felt their pain longer and of higher intensity, and had more negative pain experiences than patients with IO donor sites (all p < 0.05)., Conclusions: While both IO and EO bone graft harvesting are procedures that are associated with pain in a large proportion of patients, an EO donor site is expected to lead to more pain-related burdens than an IO donor site., Clinical Significance: Prior to bone graft harvesting, surgeons can now provide patients with tailored information regarding pain perceptions to be expected. This will help the patients with making an informed decision, and on whether or not to agree with surgery., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Objectives: To compare oral health-related quality of life (OHRQoL) in children and adolescents with and without migration background, and to assess whether potential differences in OHRQoL can be sufficiently explained by oral health characteristics., Materials Und Methods: A consecutive sample of 112 children and adolescents was recruited in a German university-based orthodontic clinic, and a convenience sample of 313 children and adolescents of German public schools was enrolled in the study (total N = 425, age range 7-17 years). However, 29 participants were excluded due to insufficient information regarding migration background. Accordingly, the non-migrant group consisted of 262 participants (61.6%). For children with migration background, two groups were classified: (i) one parent born in a foreign country (N = 41, 9.6%, single-sided migration background), and (ii) both parents and/or child born in a foreign country ( N= 93, 21.9%, double-sided migration background). OHRQoL was assessed using the German 19-item version of the Child Oral Health Impact Profile (COHIP-G19). Additionally, physical oral health of 269 children with classified migration background was determined in a dental examination., Results: Overall, OHRQoL was significantly lower in the group with double-sided migration background indicated by lower COHIP-G19 summary scores (mean: 58.6 points) than in the group with single-sided migration background (mean: 63.3 points) or the non-migrant group (mean: 63.2 points). Likewise, the summary scores of the subscale "oral health well-being" and the subscale "social/emotional, school, and self-image" were also lower in the double-sided migrant group than in the other two groups. Linear regression analysis showed an association between double-sided migration background and impaired OHRQoL, even after statistically controlling for demographic, socioeconomic, and oral health characteristics., Conclusion: Children and adolescents with double-sided migration background have poorer OHRQoL than comparably aged migrants with single-sided migration background or non-migrations. Between-group differences in OHRQoL could not be sufficiently explained by effects of socioeconomic status or physical oral health characteristics. Thus, other methodological, cultural, or immigration-related factors might also play an important role for the observed effects.

Objectives: To compare oral health, access barriers to dental care, oral health behavior and oral hygiene behavior of elderly German residents with and without immigration background., Design: In this cross-sectional explorative study, a convenience sample (N = 112, age ≥ 60 years, 54% immigrants) was recruited in four dental practices in Hamburg, Germany. Oral health was assessed with Decayed/Missing/Filled Teeth (DMFT), Papillary Bleeding Index (PBI), and Approximal Plaque Index (API). Dental health was operationalized as number of decayed teeth, and poor oral hygiene based on a PBI ≥ 40%. Access barriers and oral health behavior were assessed with a standardized questionnaire., Results: While caries experience was similar in migrants and non-migrants (DMFT mean: 24.8 vs. 23.4, n.s.), significantly more teeth were decayed (5.3 vs. 2.1, p < 0.001), and API (55.3% vs. 33.0%, p = 0.002) and PBI (46.3% vs. 30.5%, p = 0.016) were significantly higher in migrants. After adjusting for age, sex, income, education, and number of teeth, migrants still had on average 3 decayed teeth more than non-migrants. However, impact of migration background on poor oral health changed from OR = 3.61 (p = 0.007) to OR = 1.05 (n.s.) after adjusting for confounders, mainly due to lower income in migrants. Fewer migrants had visited a dentist within the past 12 months, and migrants were less likely to have a regular dentist that they visit and more often indicated language or cost barriers than non-migrants., Conclusion: Elderly German migrants have higher treatment needs than non-migrants. Likely causes are poorer oral hygiene and lower utilization of dental care services. Specific prevention programs targeting migrants are warranted to improve oral health in this disadvantaged group.

Inflammation may be a risk factor for atrial fibrillation (AF). Oral infections frequently lead to chronic inflammation, such as gingivitis, periodontitis, and endodontic lesions. In this narrative review, we consider five basic pathogenic mechanisms that involve oral infections and inflammations in the pathogenesis of AF: (1) low level bacteremia by which oral bacteria enter the blood stream at inflamed sites of the oral cavity and invade the heart; (2) Systemic inflammation induced by inflammatory mediators, which are released from the sites of oral inflammation into the blood stream, affecting cardiac remodeling; (3) autoimmunity against molecular structures expressed in the heart caused by the host immune response to specific components of oral pathogens; (4) potentially arrhythmic effects mediated by activation of the autonomous nervous system triggered by oral inflammations; and (5) arrhythmic effects resulting from specific bacterial toxins that are produced by oral pathogenic bacteria. A number of studies support the involvement of all five mechanisms, suggesting a potentially complex contribution of oral inflammations to the pathogenesis of AF.

Oral infections occur frequently in humans and often lead to chronic inflammations affecting the teeth (i.e., caries), the gingival tissues surrounding the teeth (i.e., gingivitis and endodontic lesions), and the tooth-supporting structures (i.e., periodontitis). At least four basic pathogenic mechanisms have been proposed that involve oral inflammations in the pathogenesis of atherosclerosis: (1) low level bacteremia by which oral bacteria enter the blood stream and invade the arterial wall; (2) systemic inflammation induced by inflammatory mediators released from the sites of the oral inflammation into the blood stream; (3) autoimmunity to host proteins caused by the host immune response to specific components of oral pathogens; (4) pro-atherogenic effects resulting from specific bacterial toxins that are produced by oral pathogenic bacteria. In this narrative review, we summarize published experimental evidence related to these four mechanisms and discuss their impact on the pathogenesis of atherosclerosis.

Aims: To investigate whether a shortened dental arch (SDA), as identified by reduced posterior occlusal contacts, is a risk factor for the progression of temporomandibular joint (TMJ) intra-articular disorders (ID), as identified using imaging techniques., Methods: This multisite, prospective observational study with a mean follow-up period of 7.9 years had a sample of 345 participants with at least 1 temporomandibular disorder (TMD) diagnosis at baseline. SDA was defined as reduced occlusal posterior support due to lack of occlusal intercuspal contacts in the molar region on the left and/or right side. SDA was assessed at baseline and at follow-up with metalized Mylar Tape. The presence or absence of a TMJ ID and the specific TMJ ID diagnoses for baseline and follow-up images were established by a calibrated, blinded radiologist at each of three sites by using bilateral magnetic resonance imaging for soft tissue imaging for disc displacement and by bilateral multidetector computed tomography or cone beam computed tomography for hard tissue imaging for degenerative joint diseases. Wilcoxon rank sum test and linear regression analyses were used to test for an impact of SDA on TMJ ID status., Results: At baseline, TMJ ID status of either side was not significantly affected by the presence of SDA on the ipsilateral or contralateral side of the jaw (all P > .05). Furthermore, the presence or absence of SDA at baseline was also not a significant predictor for progression of the TMJ ID status between baseline and follow-up (all P > .05)., Conclusion: The findings of this study suggest that there is no significant effect of SDA on progression of TMJ ID.

Periodontitis (PD) is a common gingival infectious disease caused by an over-aggressive inflammatory reaction to dysbiosis of the oral microbiome. The disease induces a profound systemic inflammatory host response, that triggers endothelial dysfunction and pro-thrombosis and thus may aggravate atherosclerotic vascular disease and its clinical complications. Recently, a risk haplotype at the ANRIL / CDKN2B-AS1 locus on chromosome 9p21.3, that is not only associated with coronary artery disease / myocardial infarction (CAD/MI) but also with PD, could be identified by genome-wide association studies. The locus encodes ANRIL - a long non-coding RNA (lncRNA) which, like other lncRNAs, regulates genome methylation via interacting with specific DNA sequences and proteins, such as DNA methyltranferases and polycomb proteins, thereby affecting expression of multiple genes by cis and trans mechanisms. Here, we describe ANRIL regulated genes and metabolic pathways and discuss implications of the findings for target identification of drugs with potentially anti-inflammatory activity in general.

Purpose: This study aimed to compare the long-term outcomes of two different nonimplant treatments in the bilateral shortened dental arch (SDA)., Materials and Methods: In a multicenter randomized controlled clinical trial, patients with complete molar loss in one arch were assigned to one of two different nonimplant treatments. In the partial removable dental prosthesis (PRDP) group, patients were provided with a distal-extension prosthesis retained with precision attachments. In the SDA group, patients were treated according to the SDA concept by preserving or restoring a premolar occlusion., Results: Of the 152 treated patients, 82 reached the 10-year examination independent of their dental or prosthetic status. In the intention-to-treat analysis, the survival rates for tooth loss at 10 years were 0.44 (95% confidence interval [CI]: 0.30 to 0.56) in the PRDP group and 0.52 (95% CI: 0.37 to 0.65) in the SDA group. For tooth loss in the study arch, the survival rates were 0.67 (95% CI: 0.52 to 0.78) in the PRDP group and 0.60 (95% CI: 0.45 to 0.73) in the SDA group. The number of teeth lost was higher than expected. In a multivariate analysis using a multiple Cox regression model, the covariates age (unit: 1 year, Hazard Ratio [HR]: 1.033, P = .03) and DMFT value (unit: 1 tooth, HR: 1.121, P = .03) were significant for time to first tooth loss in the study arch., Conclusion: The results suggest an overestimation of the influence of the prosthetic management of the bilateral SDA. In treatment decisions, patient preferences should be considered with appropriate weight.

Objectives: The aim of the present study was to review the current literature relating to the impact of dental implants on oral health-related quality of life (OHRQoL) in edentulous or partially dentate patients., Data/sources: Systematic literature searches were performed in the PubMed, EMBASE, and Cochrane Library databases, using high level MeSH terms. The searches were limited to studies published in English from 1960 to June 11, 2017, reporting OHRQoL outcomes using validated instruments, and having enrolled at least 50 patients., Study Selection: After removal of duplicates, a total of 2827 unique hits were identified. After title, abstract, and full text screening, 63 articles were included in the review presenting findings of 55 individual studies. The provision of implant-supported dentures was associated with a significant increase in OHRQoL in partially dentate and in edentulous patients, with the magnitude of achieved improvement typically being greater for implant-supported dentures than with conventional ones. Furthermore, OHRQoL impairment prior to treatment was strongly associated with OHRQoL improvement., Conclusion: For partially dentate patients, there is not enough evidence that implant-supported FDP are superior in terms of OHRQoL than conventional FDP, but moderate evidence suggests that implant-supported FDP perform better than conventional RDP. In edentulous patients, evidence suggests that only if OHRQoL at baseline is highly impaired and patients request implant treatment, IOD are superior than CD in terms of treatment-induced OHRQoL improvement., Clinical Significance: Patients can be informed that implant treatment is usually related to a significant improvement in OHRQoL. However, improvement is not necessarily higher than for conventional prosthodontic treatments but depends on patient's clinical and psychosocial characteristics., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Objectives: The aim of this multicenter prospective clinical study was to evaluate anodized tapered implants with a conical connection and integrated platform shifting placed in the anterior and premolar maxilla., Materials and Methods: The study enrolled patients requiring single-tooth restorations in healed sites of maxillary anterior and premolar teeth. All implants were immediately temporized. Clinical and radiographic evaluations were conducted at implant insertion, 6 months, and 1 year. Outcome measures included bone remodeling, cumulative survival rate (CSR), success rate, soft-tissue health and esthetics, and patient satisfaction. Bone remodeling and pink esthetic score were analyzed using Wilcoxon signed-rank tests. CSR was calculated using life table analysis. Other soft-tissue outcomes were analyzed using sign tests., Results: Out of 97 enrolled patients (102 implants), 87 patients (91 implants) completed the 1-year visit. Marginal bone remodeling was -0.85 ± 1.36 mm. After the expected initial bone loss, a mean bone gain of 0.11 ± 1.05 mm was observed between 6 months and 1 year. The CSR was 99.0%, and the cumulative success rate was 97.0%. Partial or full papilla was observed at 30.8% of sites at baseline, 87.2% at 6 months, and 90.5% at 1 year. Soft-tissue response, esthetics, and patient satisfaction all improved during the study period., Conclusions: Bone gain was observed following the expected initial bone loss, and soft-tissue outcomes improved suggesting favorable tissue response using anodized tapered conical connection implants., Clinical Relevance: Rapid stabilization of bone remodeling and robust papilla regeneration indicate favorable tissue healing promoted by the conical connection, platform-shift design., Trial Registration: clinicaltrials.gov NCT02175550.

Objectives: Being a secondary outcome in a multicenter randomized controlled trial, the present analysis focused on interdental spacing in the shortened dental arch (SDA). The aim was to evaluate changes in interdental spacing in dependence of two different treatments after an observation period of up to 5 years., Material and Methods: Patients were either treated with a partial removable dental prosthesis (PRDP) for molar replacement (PRDP group) or according to the SDA concept aiming at a premolar occlusion (SDA group) in a randomized manner. Interdental spacing in the anterior region was measured with gauges and categorized as "0" (<0.1 mm), "1" (<0.5 mm), "2" (0.5-1 mm), and "3" (>1 mm). The statistical analysis was performed with analysis of variance models followed by linear contrast., Results: Ninety-one patients (SDA n = 41, PRDP n = 50) were included. Changes of interdental spacing were detected in 70.7 % of all cases. A significant difference between the mean score changes was found in the mandible comparing the PRDP group and the SDA group. The respective mean score changes from baseline to 5 years were 0.23 (SD 0.49) for the PRDP group and 0.02 (SD 0.30) for the SDA group (p = 0.023)., Conclusions: Major interdental spacing could be observed in neither of the groups. The SDA concept resulted in a slightly better outcome., Clinical Relevance: When deciding whether to replace missing molars, the present results give further support to the SDA concept.

Purpose: To develop a reliable and valid instrument for the comprehensive assessment of patients' burdens during dental impression making, the Burdens in Dental Impression Making Questionnaire, BiDIM-Q., Materials: The item pool was generated in a convenience sample of 20 prosthodontic patients using semi-structured face-to-face interviews. The final instrument was tested in 145 consecutively recruited patients, and psychometric properties of the BiDIM-Q were determined. Four different impression materials were used according to the manufacturers' instructions and indications: alginate, c-silicone, polyvinylsiloxane, and polyether., Results: The final BiDIM-Q consisting of 12 items showed sufficient reliability, indicated by Cronbach's alpha of .82 and an average inter-item correlation of .29. Validity was supported by Pearson correlation coefficients for the correlation between the instrument's total score with the patients' overall satisfaction rating (r=.63), and by the correlation matrix for the correlations of the patients' perceptions with the practitioners' satisfaction ratings. Overall, patient perceived burdens were low with highest burdens observed when using polyether in partially dentate patients for pick-up impressions, while lowest burdens were reported when using c-silicone for impressions of edentulous jaws., Conclusion: The BiDIM-Q is a reliable and valid tool for assessing patient-based process-related quality of care in dentistry allowing a deeper insight into patients' perspective during dental impression making., (Copyright © 2016 Japan Prosthodontic Society. Published by Elsevier Ltd. All rights reserved.)

Statement of Problem: In existing published reports, some studies indicate the superiority of digital impression systems in terms of the marginal accuracy of ceramic restorations, whereas others show that the conventional method provides restorations with better marginal fit than fully digital fabrication. Which impression method provides the lowest mean values for marginal adaptation is inconclusive. The findings from those studies cannot be easily generalized, and in vivo studies that could provide valid and meaningful information are limited in the existing publications., Purpose: The purpose of this study was to systematically review existing reports and evaluate the marginal fit of ceramic single-tooth restorations after either digital or conventional impression methods by combining the available evidence in a meta-analysis., Material and Methods: The search strategy for this systematic review of the publications was based on a Population, Intervention, Comparison, and Outcome (PICO) framework. For the statistical analysis, the mean marginal fit values of each study were extracted and categorized according to the impression method to calculate the mean value, together with the 95% confidence intervals (CI) of each category, and to evaluate the impact of each impression method on the marginal adaptation by comparing digital and conventional techniques separately for in vitro and in vivo studies., Results: Twelve studies were included in the meta-analysis from the 63 identified records after database searching. For the in vitro studies, where ceramic restorations were fabricated after conventional impressions, the mean value of the marginal fit was 58.9 μm (95% CI: 41.1-76.7 μm), whereas after digital impressions, it was 63.3 μm (95% CI: 50.5-76.0 μm). In the in vivo studies, the mean marginal discrepancy of the restorations after digital impressions was 56.1 μm (95% CI: 46.3-65.8 μm), whereas after conventional impressions, it was 79.2 μm (95% CI: 59.6-98.9 μm), Conclusion: No significant difference was observed regarding the marginal discrepancy of single-unit ceramic restorations fabricated after digital or conventional impressions., (Copyright © 2016 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Purpose: This study compared polyvinylsiloxane with polyether in handling dental impressions., Materials and Methods: Each participant (N = 39) made four impressions, each a combination of pickup and reseating techniques with polyether or polyvinylsiloxane, of one implant cast representing a specific clinical situation (tooth gaps, limited residual dentition, or edentulous jaw). Handling of impressions was subsequently rated by using a 12-item questionnaire with 100-mm visual analog scales., Results: While mean satisfaction scores were higher for polyvinylsiloxane than for polyether (69.5/63.0, P < .001), differences among subgroups were statistically significant only for pickup technique, limited residual dentition, and edentulous jaw., Conclusion: Implant impressions made with polyvinylsiloxane using a pickup technique seem to be the best option for most clinical situations.

Objectives: The aims were to assess the impact of the number of years since dentists' graduation on appraisement of diagnostic needs and utilization of treatment options for temporomandibular disorders (TMD) and to investigate whether increased knowledge in TMD is sufficiently considered in today's dentist's undergraduate curricula and, therefore, represented in more evidence-based TMD management in dentists with less years since graduation., Material and Methods: A questionnaire regarding knowledge and management of TMD was developed and was subsequently applied in a random sample of 400 dentists in a region in Northern Germany., Results: Of the 222 dentists (response rate 55.6 %), participating in the study, the frequency of TMD treatment need in the general population was estimated at 21.5 %, with lower values in dentists with more years passed since graduation. Measures regarding utilization of standardized examination forms, perceptions of insufficient specialization, and referrals of patients to TMD specialists indicated a lower quality and certainty in TMD management in participants with less time since graduation. While the provision of splints was a well-established treatment option in initial TMD management of all participants, additional TMD treatment options were mentioned less often, with lower proportions of participants making use of these options within the first decade since graduation., Conclusions: Evidence-based TMD management is not fully represented in dental practitioners in Germany. This might be due to an insufficient consideration of TMD management in the dentist's undergraduate curricula., Clinical Relevance: Effective interventions to increase dentists' knowledge and to change dentists' practices in TMD management are required.

C-reactive protein (CRP) level is associated with the 10-year risk of an atherosclerotic vascular disease (ASVD), suggesting presence of systemic inflammation probably long before ASVD is present. Where, however, does this systemic inflammation come from? One active area of research has been the study of dental infection and various forms of periodontal disease (PD), both of which are highly prevalent in populations at risk for ASVD. Recent data show that ASVD and PD interact with each other via systemic release of specific pro- and anti-inflammatory cytokines, small signal molecules and enzymes which modulate initiation and progression of the chronic inflammatory reaction involved in both diseases. In addition, periodontal pathogens were identified within atherosclerotic lesions and thrombi isolated from myocardial infarction patients. LDL cholesterol, a strong risk factor for ASVD, is also associated with PD; and statins, used to treat ASVD, are also active to prevent or reduce PD. Finally, there is growing evidence for common genetic susceptibility factors involved in both diseases. These findings support commonalities with respect to the pathogenic mechanisms involved in both inflammatory diseases. Conversely, a causative relationship cannot yet be concluded in the absence of data from large longitudinal cohort and randomized controlled intervention trials., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Objectives: Treatment effects should be large and long-lasting. The aim of this study was to describe for patients treated with fixed dental prostheses (FDP), removable dental prostheses (RDP), and complete dentures (CD) how they perceived their oral health over a period of two years using the concept oral health-related quality of life (OHRQoL)., Methods: In this prospective clinical study, a consecutive sample of 272 adult patients receiving prosthodontic treatment was recruited. The Oral Health Impact Profile (OHIP-G) was used at baseline before prosthodontic treatment, 4-6 weeks, and 6, 12, 18, and 24 months after therapy. The OHRQoL of the prosthodontic patients were compared with findings from a general population-based study (N=811), and OHRQoL changes were compared to the minimal important difference of the OHIP., Results: At baseline, mean OHIP sum score was 31.1 points, indicating substantially lower OHRQoL than for general population subjects. After a substantial treatment-induced drop of OHRQoL impairment in all treatment groups, OHIP scores increased slowly, but did not reach pretreatment levels after 24 months. While full treatment effect was already present 4-6 weeks after treatment in the FDP and RDP groups, OHRQoL improvement continued until the 12-month assessment in the CD group. When follow-up OHIP scores of the entire sample were compared to baseline scores, all changes were statistically significant, but the magnitude exceeded the OHIP's MID (6 points) only in the assessments at 4-6 weeks, 6 months, and 12 months., Conclusion: Effects of prosthodontic interventions on patients' perception seem to last for at least 2 years., Clinical Significance: Taking into consideration that prosthodontic treatment is only one factor for the oral health of a patient, prosthodontic rehabilitation seems to have a substantial influence on a patient's oral health trajectory., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

The aim of this study was to evaluate the use of blending learning that added online tools to traditional learning methods in a preclinical course in prosthetic dentistry at one dental school in Germany. The e-learning modules were comprised of three main components: fundamental principles, additional information, and learning objective tests. Video recordings of practical demonstrations were prepared and cut into sequences meant to achieve single learning goals. The films were accompanied by background information and, after digital processing, were made available online. Additionally, learning objective tests and learning contents were integrated. Evaluations of 71 of 89 students (response rate: 80%) in the course with the integrated e-learning content were available for the study. Compared with evaluation results of the previous years, a substantial and statistically significant increase in satisfaction with learning content (from 30% and 34% to 86%, p<0.001) and learning effect (from 65% and 63% to 83%, p<0.05) was observed. Satisfaction ratings stayed on a high level in three subsequent courses with the modules. Qualitative evaluation revealed mostly positive responses, with not a single negative comment regarding the blended learning concept. The results showed that the e-learning tool was appreciated by the students and suggest that learning objective tests can be successfully implemented in blended learning.

Objective: The aim of this cross-sectional study was to estimate bone loss of implants with platform-switching design and analyze possible risk indicators after 5 years of loading in a multi-centered private practice network., Method and Materials: Peri-implant bone loss was measured radiographically as the distance from the implant shoulder to the mesial and distal alveolar crest, respectively. Risk factor analysis for marginal bone loss included type of implant prosthetic treatment concept and dental status of the opposite arch., Results: A total of 316 implants in 98 study patients after 5 years of loading were examined. The overall mean value for radiographic bone loss was 1.02 mm (SD ± 1.25 mm, 95% CI 0.90- 1.14). Correlation analyses indicated a strong association of peri-implant bone loss > 2 mm for removable implant-retained prostheses with an odds ratio of 53.8., Conclusion: The 5-year-results of the study show clinically acceptable values of mean bone loss after 5 years of loading. Implant-supported removable prostheses seem to be a strong co-factor for extensive bone level changes compared to fixed reconstructions. However, these results have to be considered for evaluation of the included special cohort under private dental office conditions.

Objectives: To assess patient-perceived process-related quality of care in patients undergoing different prosthodontic treatments, and to investigate whether perceived burdens are related to specific procedures during prosthodontic treatments, i.e., to specific treatment components., Methods: In this non-randomised prospective intervention study, 104 dental patients (mean age: 52.2±13.9 years, 50% female) were included. Burdens during treatments with fixed dental prostheses (FDP, n=90), removable dental prostheses (RDP, n=10), and complete dentures (CD; n=4) were assessed with the Burdens in Prosthetic Dentistry Questionnaire (BiPD-Q). The BiPD-Q total score was calculated as mean of all 25 items, and subscale scores were derived from items corresponding to six specific treatment components (anesthesia, preparation, impression, provisional care/try-in, fixation, global perception), with values ranging from 0 (best) to 100 (worst). Subscale scores were compared by using repeated-measures ANOVA, paired t-tests, and effect sizes, to identify treatment components with highest burdens., Results: Mean BiPD-Q total score was 22.1, ranging from 8.6 for patients with CD to 24.0 for FDP patients. Perceived burdens differed significantly between treatment components, with highest burdens for anesthesia (score: 34.0), followed by preparation (score: 26.8) and impression (score: 24.7). When subscale score for anesthesia was compared to scores for other treatment components, effect sizes were medium to large., Conclusion: While prosthodontic treatment is overall perceived as only moderately burdening, specific treatment components differ significantly in perceived burdens., Clinical Significance: Anesthesia, preparation, and impression are treatment components with most unpleasant perceptions, offering the highest potential for improvements for patient-perceived process-related quality of care in prosthetic dentistry., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Objectives: The aim of this multi-center, randomized controlled trial was to assess the impact of missing posterior support on the risk for temporomandibular disorder (TMD) pain by comparing patients with either shortened dental arches (SDA) or molar replacement by removable dental prostheses (RDP)., Methods: A sample of 215 patients with bilateral molar loss in at least one jaw was consecutively recruited in 14 prosthodontic departments of dental schools in Germany. Of the initial sample, 152 patients (mean age: 59.7 years; 53.9 % female) received randomly allocated interventions (SDA: n = 71; RDP: n = 81). Presence of TMD pain was assessed using patients' self-reports and was verified by physical examination and by pain intensity, as the mean of current pain, worst pain, and average pain in the last 6 months, with 10-point ordinal rating scales. Assessments were performed before treatment and at follow-ups until 60 months after treatment. Impact of interventions on TMD risk and pain intensity was computed by applying logistic and linear random-intercept models., Results: Tooth replacement (RDP) did not significantly change the risk for self-reported (odds ratio [OR]: 1.1; confidence interval [CI]: 0.4 to 3.4) or clinically verified (OR: 0.7; CI: 0.1 to 4.3) TMD pain compared to no tooth replacement (SDA). Mean characteristic pain intensity was virtually identical in both groups (Coeff: 0.01; CI: -0.30 to 0.32)., Conclusion: Retaining or preservation of an SDA is not a major risk factor for TMD pain over the course of 5 years when compared to molar replacement with RPDs., Clinical Relevance: Seemingly, missing molars do not have to be replaced in order to prevent TMD pain.

Objectives: To assess and compare changes in health-related quality of life (HRQoL) and oral health-related quality of life (OHRQoL) after bone graft harvesting for dental implants with respect to the donor site., Material and Methods: Autologous bone grafts were harvested in a consecutive sample of 23 patients (mean age: 46.1 years; 52% female) either from an intra-oral (IO; N = 8; chin, ascending ramus, buttress region) or an extra-oral (EO; N = 15; anterior iliac crest) donor site, followed by implant placements. HRQoL was self-administered by the patients using the Short-Form 36 (SF-36) and OHRQoL was assessed using the Oral Health Impact Profile (OHIP-49) preoperatively, 3 days and 4 weeks after surgery. Impact of donor site on changes in both concepts of QoL was determined in multiple linear regression analyses., Results: Patients with extra-oral donor sites reported a substantial deterioration in the physical component (PC) of HRQoL indicated by an increase in the PC score of the SF-36 (P < 0.001), whereas this score did not significantly change in patients with intra-oral donor sites. The mental health component (MC) of HRQoL (MC score of the SF-36) remained virtually identical in both groups. OHRQoL deteriorated from baseline (67.7 OHIP points) to first follow-up (76.6 OHIP points) in both groups, however, changes were not statistically significant., Conclusion: In clinical decision-making regarding donor site for bone graft harvesting, patients and clinicians should be aware of the expected decrease in HRQoL if deciding to use extra-oral donor sites. Whenever possible, intra-oral donor sites should be preferred., (© 2012 John Wiley & Sons A/S.)

Purpose: To develop and validate an instrument for the assessment of patient-based measures of process-related quality of care in prosthodontic patients., Materials and Methods: In this nonrandomized study, the new Burdens in Prosthetic Dentistry Questionnaire (BiPD-Q) was developed in two steps using a total of 128 prosthodontic patients in a mixed-method approach, combining quantitative-qualitative methodologies. First, the item pool for the instrument was created using semistructured interviews and a group of experts in prosthodontics. This resulted in a preliminary version of the questionnaire. Second, an assessment of redundancy, completion rates, face validity, difficulty, and distribution of the core set of the items was performed. The final version of the BiPD-Q had psychometric core properties (reliability and validity) evaluated., Results: The BiPD-Q consisted of 25 items. Reliability was satisfactory (Cronbach's alpha = .87). The mean score of all items of the BiPD-Q was significantly correlated with mean perceived burdens during treatment as rated by the clinician (r = 0.26; P < .01) and with overall satisfaction with the treatment procedures as rated by patients (r = .31; P < .01), indicating sufficient convergent validity., Conclusion: A reliable and valid instrument for the assessment of patient-based process-related quality of care in prosthodontics has been developed. The BiPD-Q allows comparisons of different dental procedures within a treatment course and of different treatment providers. The use of this type of questionnaire appears to be a valuable tool for dental health care research. The outcomes of research using the BiPD-Q may result in a more pleasant treatment experience for future patients.

Background: Interpretation of scores from oral health-related quality of life (OHRQoL) instruments, such as the Oral Health Impact Profile (OHIP) is challenging. It was the aim of this study to determine how many oral impacts correspond to one point of the 49-item OHIP using a new approach which translates numeric problem counts into the traditionally used ordinal OHIP response categories., Methods: A sample of 145 consecutively recruited prosthodontic patients seeking treatment or having a routine examination completed the German version of the 49-item OHIP with the original ordinal response format as a self-administered questionnaire. In addition, the numerical frequencies of impairment during the previous month were requested in personal interviews. Based on a multilevel mixed-effects linear regression, we estimated the mean difference with 95% confidence interval (CI) in numerical frequency between two adjacent ordinal responses., Results: A numerical frequency of 15.2 (CI: 14.8 - 15.7) impacts per month corresponded to one OHIP point. This translates to approximately one impact every other day in the past month., Conclusions: The oral problem count per day that corresponds to one OHIP-49 point can be used to interpret this instrument's scores in cross-sectional and longitudinal studies. This number can help to better understand OHRQoL burden for patients, clinicians, and researchers alike.

Objectives: To assess the 5-year and 10-year survival and complication rates of implant-supported fixed reconstructions in partially and totally edentulous patients with regard to the optimal number and distribution of dental implants., Material and Methods: This review was designed as a systematic review of the literature. A search strategy was developed and executed using an electronic and selective hand search for English-language articles in Dental Journals limited to human clinical trials. Search terms were grouped into categories for "problem" - "intervention" - "outcome". For articles retrieved by this search, abstracts were screened by two reviewers based on the inclusion criteria. Selected articles were then obtained in full texts. Finally, the selection based on inclusion/exclusion criteria was repeated for the full-text articles., Results: Of the 210 titles retrieved by the search, 51 were selected for full-text review based on the information given in the abstract. From the full-text articles, a total of nine studies were included for this systematic review. In meta-analysis, prosthetic survival rates over 5 and 10 years for partial Fixed Dental Prostheses (FDPs) on two to four implants were estimated as 98.9% (95% CI: 98.5-99.2%) and as 97.8% (95% CI: 96.9-98.4%) respectively. A survival rate for maxillary Full-Arch Fixed Dental Prostheses (FAFDPs) on four to six implants after 5 years was assessed as 97.5% (95% CI: 94.1-98.9%) and a survival rate after 10 years as 95.0% (95% CI: 88.5-97.9%). The result for the survival rates in case of mandibular FAFDPs on four to six implants after 5 years was 97.9% (95% CI: 96.3-98.8%) and after 10 years 95.9% (95% CI: 92.8-97.7%). Specific implant-to-replaced-unit-ratios were not available in any of the studies., Conclusion: For implant-supported FAFDPs, using 4-6 implants is a well-documented treatment option with high estimated 5-year survival of the construction. It is unclear whether three implants for supporting a FAFDP will achieve similar survival rates. The RCTs needed that report implant-to-replaced-units-ratios for partial FDPs and include 3 vs. 4-6 implants for supporting a FAFDP in the mandible., (© 2012 John Wiley & Sons A/S.)

This study evaluated the fracture resistance and the survival rate of different all-ceramic crowns in-vitro after thermomechanical fatigue loading in comparison to porcelain-fused-to-metal posterior crowns. Sixteen crowns for human mandibular first molars were made of each of the following: Cercon, IPS-Empress 2 In-Ceram Zirconia, Procera AllZircon and porcelain-fused-to-metal. Half of the specimens of each group was thermocycled and dynamically loaded using a chewing simulator All samples were thereafter tested for the maximum fracture resistance. The survival rates after 1-2 million cycles in the artificial mouth were 100% in all the tested crown systems. The chewing simulation and thermocycling did not significantly decrease the fracture strength of the ceramic crowns (P>0.005). The median fracture load of Cercon, Procera AllZircon, In-Ceram Zirconia and PFM was significantly higher than IPS-Empress 2 both for loaded and non loaded groups (P<0.005) while the difference between Cercon, Procera AllZircon, In-Ceram Zirconia and PFM was not significant (P>0.005). All-ceramic systems showed fracture load values similar to those of porcelain-fused-to-metal molar crowns and therefore may be considered for use in clinical studies.

Background: Various treatment options for the prosthetic treatment of jaws where all molars are lost are under discussion. Besides the placement of implants, two main treatment types can be distinguished: replacement of the missing molars with removable dental prostheses and non-replacement of the molars, i.e. preservation of the shortened dental arch. Evidence is lacking regarding the long-term outcome and the clinical performance of these approaches. High treatment costs and the long time required for the treatment impede respective clinical trials., Methods/design: This 14-center randomized controlled investigator-initiated trial is ongoing. Last patient out will be in 2010. Patients over 35 years of age with all molars missing in one jaw and with at least both canines and one premolar left on each side were eligible. One group received a treatment with removable dental prostheses for molar replacement (treatment A). The other group received a treatment limited to the replacement of all missing anterior and premolar teeth using fixed bridges (treatment B). A pilot trial with 32 patients was carried out. Two hundred and fifteen patients were enrolled in the main trial where 109 patients were randomized for treatment A and 106 for treatment B. The primary outcome measure is further tooth loss during the 5-year follow-up. The secondary outcome measures encompassed clinical, technical and subjective variables. The study is funded by the Deutsche Forschungsgemeinschaft (German Research Foundation, DFG WA 831/2-1, 2-2, 2-3, 2-4, 2-5)., Discussion: The particular value of this trial is the adaptation of common design components to the very specific features of complex dental prosthetic treatments. The pilot trial proved to be indispensable because it led to a number of adjustments in the study protocol that considerably improved the practicability. The expected results are of high clinical relevance and will show the efficacy of two common treatment approaches in terms of oral health. An array of secondary outcome measures will deliver valuable supplementary information. If the results can be implemented in the clinical practice, the daily dental care should strongly profit thereof., Trial Registration: The trial is registered at ClinicalTrials.gov under ISRCTN68590603 (pilot trial) and ISRCTN97265367 (main trial).

In order to assess the enhanced value of removable partial dentures on the quality of life, patients at 2 university clinics were screened for the presence of complete or shortened dental arches. Those selected were assigned to 1 of 5 subgroups: 1) a shortened dental arch with all frontal teeth, 2) a shortened dental arch with one or more frontal diastemas, 3) a shortened dental arch with all frontal teeth, restored by a removable partial denture, 4) a shortened dental arch and several diastemas, restored by a removable partial denture, 5) a complete dental arch. The participants completed the Oral Health Impact Profile (OHIP-49) and the Short Form Health Survey (SF-36). Clinical data recorded were: whether any teeth were missing and if so which, whether or not these had been replaced by a removable partial denture, and the number of occluding pairs of (pre)molars. The results revealed that a shortenend dental arch has a certain impact on the quality of life. However, the participants only experienced benefits from a removable partial denture if the denture also replaced frontal teeth.

Objectives: The aim of this study was to examine systematically the data published on the efficacy of mandibular implant-retained overdentures from the patient's perspective., Material and Methods: Medline, Embase, The Cochrane Central Register of Controlled Trials and The Cochrane Systematic Reviews Database were searched and complemented by hand searching. All randomized-controlled trials published in English or French up to April 2007 were included, in which conventional dentures and mandibular implant overdentures in adult edentulous individuals were compared. The outcomes of interest were patient satisfaction, oral and general health-related quality of life. Random effects models were used to pool the effect sizes (ES) of all included studies., Results: Ten publications of seven randomized-controlled trials were identified and eight were included in the meta-analysis. When compared with mandibular conventional dentures, implant overdentures were rated to be more satisfactory at a clinically relevant level [pooled ES 0.80, z=3.56, 95% confidence intervals (CI) 0.36-1.24, P=0.0004], but a statistical heterogeneity was found (chi(2)=31.63, df=5, P<0.00001, I(2)=84%). The pooled ES for oral health quality of life was -0.41 (z=1.31, 95% CI, -1.02 to 0.20; P=0.19, chi(2)=11.53, df=2, P<0.003, I(2)=83%). There was a lack of evidence to show the impact of mandibular implant overdenture on perceived general health., Conclusions: Our findings suggest that, although mandibular implant-retained overdentures may be more satisfying for edentulous patients than new conventional dentures, the magnitude of the effect is still uncertain. There is a need for additional evidence including cost-effectiveness analyses on the impact of mandibular implant overdentures and conventional dentures.

The fabrication of a prosthesis for a child requires an extensive diagnostic process together with a detailed medical and dental history. The treatment modalities for children and adults are different. By young patients attention must be paid in order to establish a feeling of trust and close cooperation between the dentist and the patient. The aim of the treatment with removable denture prosthesis is the re-establishment of aesthetic, phonetic and function while assuring at the same time a high standard of oral hygiene and periodontal maintenance. The continuous jaw growth and the dentition changes of a child must be closely monitored. Therefore, frequent (3-6 months recall intervals) follow-up examinations and denture adjustments are needed.

The rehabilitation of a child's dentition with a removable prosthesis is more complex and time consuming, when comparing it to the one of adults. Prerequisite for a successful treatment is a careful consideration of age-related, technical, functional and psychological aspects. The aesthetic and functional replacement of the missing teeth using a removable prosthesis results in an increased self-esteem for the young patients. This case report describes the management of a young child as well as the treatment planning and the prosthetic rehabilitation process.

Objectives: The purpose of this prospective long-term study was to evaluate the incidence of the most common technical problems, namely screw loosening, screw fracture, fracturing of veneering porcelain and framework fracture in implant-supported fixed partial dentures (FPDs), and assess the survival and success rate (event-free survival) after 5 years of function., Materials and Methods: In 76 partially edentulous patients, a total of 205 3i-implants (machined surface) were placed and restored with 112 implant-supported FPDs (46 single crowns, 81 splinted crowns, seven FPD bridges and 23 FPDs with cantilevers). The survival rate of FPDs supported by implants was 94.5% (CI-95: 90.1-98.8) after an average observation period of 5 years. The success rate (event-free survival) of the FPDs was 80% (CI-95: 87.3-72.7). After an observation period of 5 years the cumulative incidence of screw loosening was 6.7% (CI-95: 1.8-11.5), the cumulative incidence for screw fracture was 3.9% (CI-95: 0.1-7.7). Fracture of the veneering porcelain occurred in 5.7% (CI-95: 1.2-10.2) of all FPDs. Fracturing of the suprastructure framework was rare (1%; CI-95: 0-2.9). The overall complication incidence after 5 years was highest in the group of FPDs with cantilever, which showed the lowest success rate 68.6% (CI-95: 50-87.3), followed by single crowns (77.6%; CI-95: 53.3-100) and splinted crowns (86.1%; CI-95: 59.5-100). No complication occurred in FPD bridges., Conclusion: Fixed partial dentures supported by 3i-implants showed low technical complications rates, the most common being loosening of the abutment screw. Managing these complications can cause extra amount of chair-side time and patient dissatisfaction.

Objectives: The use of patient-based outcomes to measure therapeutic effectiveness is increasing, because a growing number of clinical scientists are attempting to evaluate the impact of therapy on the recipient. There are indications that patients suffering from temporomandibular disorders (TMDs) may also show a reduced oral health-related quality of life (OHQoL). It was the purpose of this paper to answer the question as to whether therapeutic interventions in TMD patients have a positive effect on their OHQoL., Material and Methods: A systematic electronic search (Ovid Medline 1966-2006; Science Citation Index 1945-2006) of the literature was carried out to identify pertinent articles of randomized and non-randomized clinical trials. Reports on retrospective and prospective studies that specifically focused on OHQoL changes in TMD patients as a consequence of therapeutic interventions were included. The reference lists of the identified articles were screened to find additional pertinent publications., Results: The investigation yielded seven relevant contributions from Medline. A quantitative analysis of the seven identified articles was not possible. There was considerable heterogeneity among the investigations with regard to study design, patient characteristics, and provided therapy. Three of the identified articles reported about prospective controlled studies, of which one was an RCT. Four additional investigations were retrospective. According to the results of the only RCT, a 6-week course of the non-selective cyclooxygenase (COX) inhibitor naproxen may lead to slightly better OHQoL in patients with temporomandibular joint (TMJ) arthralgia than the selective COX-2 inhibitor celecoxib. The two other articles reporting of a controlled study showed that selective serotonine uptake inhibitors accompanied by psychological therapy improved OHQoL in individuals with TMJ arthralgia. In contrast, TMJ surgery did not improve OHQoL., Conclusion: It appears that all therapeutic interventions reported in the identified publications led to at least some improvement of OHQoL. The only exception were patients with multiple TMJ surgeries.

Background: Reconstructive dentistry encompasses an enormous range of treatment modalities from the restoration of single teeth to the reconstruction of the whole dentoalveolar complex in edentulous patients. Some treatment modalities have been assessed in terms of quality-of-life (QoL) outcomes and satisfaction, Objectives: The aim of the present investigation was to search and review studies published between 1996 and 2006 in which the impact of the treatment was measured in terms of QoL outcome, ideally, oral health-related quality of life (OHRQoL). Patient satisfaction was also accepted as an outcome., Materials and Methods: The primary search engine used was NICB PubMed based on MeSH headings. Hand searching of the cited references in the included papers identified a number of additional studies. The primary focus of the search was to link treatment to QoL outcomes., Results: The majority of included studies involved the treatment of edentulous patients, particularly the mandible. The preponderance of the studies comparing conventional dentures (CDs) and implant-supported overdentures (IODs) were randomized-controlled trials (N = 18). There was compelling evidence that patients were more satisfied with IODs than CDs. There was strong evidence that OHRQoL can be significantly improved using IODs. Evidence suggesting that one retention system is superior to another needs further clarification. Although high satisfaction ratings have been reported for maxillary implant prostheses, the overall ratings given to the maxillary implant prostheses were not significantly greater than for CDs. There was only sparce information regarding QoL or satisfaction outcomes for the majority of other forms of reconstructive dentistry., Conclusion: Apart from the restoration of the edentulous mandible with IODs or CD, where there is an accumulating body of evidence on the effect of treatment choice, there are many procedures for which there are little or no such data at all. As yet, the entire range of reconstructive treatment has witnessed insufficient investigations relating treatment to its effect on QoL or satisfaction. This is an area that needs to be expanded as a way of quantifying the effect of treatment choices.

Background: Complex procedures involving a facebow transfer and the use of lingualised teeth are deemed to have a positive influence on the chewing ability with complete dentures., Objectives: To determine if patients' ratings of their ability to chew depend on the method of complete denture fabrication., Methods: Edentulous patients (n = 20) participated in a within-subject crossover trial. Each patient received two sets of new complete dentures. One pair was manufactured based on intraoral tracing of centric relation and facebow transfer; semi-anatomical teeth with lingualised occlusion denture (LOD) were chosen. The second pair was made using a simplified procedure without facebow transfer; jaw relations were recorded with wax occlusion rims, and anatomical teeth with a first premolar/canine-guidance (CGD) were selected. The dentures were delivered in randomised order, and each was worn for 3 months. Three months after delivery, patients' ratings of each new prosthesis were recorded on visual analogue scales for their ability to chew seven index foods. Repeated measurements analysis of variance was performed to investigate possible carry-over effects accounting for confounding by treatment period., Results: When comparing the two treatments, participants rated their ability to chew in general, to masticate carrots, hard sausage, steak and raw apple in particular, was significantly better with the CGD (anatomical teeth) than with the LOD (p < 0.05)., Conclusion: Comprehensive methods for the fabrication of complete dentures including semi-anatomical lingualised teeth and a full registration do not seem to influence the perceived chewing ability, when compared with more simple procedures. Chewing ability for tough foods appears to benefit from the use of anatomical teeth.

The rehabilitation of patients with acquired defects of the maxilla is a challenge in terms of reestablishing oronasal separation. In most patients these goals are met by means of prosthetic rehabilitation with an obturator prosthesis. If the remaining dentition does not offer sufficient retention and support, the placement of zygoma implants can enhance the stability of the prosthesis. Due to the anatomic intricacies of the zygomatic bone and the implant length, computer-supported navigated implant placement can be advantageous. In the following clinical report, a diabetic patient with a status of posthemimaxillectomy secondary to aspergillusis infection is presented, in whom a zygoma implant was placed using a CT scan-based navigation system. A special retentive anchoring abutment was used to integrate the zygoma implant into a telescopic crown-retained denture on the residual dentition. This tooth-implant-supported obturator prosthesis restored function and phonetics, as well as esthetics, for this young patient.

Purpose: The aim of this clinical 2-year follow-up study was to compare the postoperative sensitivity of abutment teeth restored with full coverage restorations retained with either conventional glass-ionomer cement or a new adhesive resin cement containing 4-methacrylolyloxyethyl trimellitate anhydride (4-META)., Materials and Methods: Sixty patients received 120 full-coverage restorations on vital abutment teeth, cemented with either a glass-ionomer cement (Ketac-Cem) or a new adhesive resin cement (Chemiace II). A randomized split-mouth design and a patient double-blind data acquisition protocol were used. The teeth were examined before cementation, after 1 week, and after 6, 12, and 24 months., Results: With regard to postcementation sensitivity, a low incidence was observed for both groups. With the adhesive resin cement, little postoperative hypersensitivity was observed after 1 week (13.3%), 6 months (5.9%), 12 months (2.1%), and 24 months (none); results were similar with the conventional glass-ionomer cement Ketac-Cem after 1 week (5.9%), 6 months (5.9%), 12 months (6.4%), and 24 months (none). After 6 months, 2 teeth of the Chemiace II group showed no sensitivity. Endodontic treatment was carried out for these 2 abutment teeth. After 24 months, no cases of postoperative hypersensitivity were recorded for either group., Conclusion: In this study, the incidence of postoperative hypersensitivity after cementation of full-crown restorations with a conventional glass-ionomer cement and a new adhesive resin cement was similar.

No soft tissue shade guide is available for matching the color of denture resins to human intraoral soft tissues. To determine the color of both the gingiva and the alveolar mucosa, intraoral soft tissue colors of 150 men and women were assessed under standardized lighting conditions. Colors of the papilla, attached gingiva, and alveolar mucosa in the central incisor region of the maxilla and mandible were examined using Munsell color tabs and their corresponding notations (value, hue, chroma). Statistical evaluation was performed by using frequency tables and multiple regression (level of significance p=0.05). Color ratings for the maxillary interincisal papilla lay in the yellow hue spectrum. A high incidence of ratings was found between 7/6 2.5R and 7/4 5R (Munsell color notations). Two further peaks were identified for the colors 3/6 2.5 R and 8/4 10R. Five peaks with the highest frequency of ratings were present with regard to the color of the mucosa in the maxillary incisal region: 6/6 2.5R, 7/6 2.5R, 6/8 5R, 5/8 7.5RP, and 5/6 10RP. In the mandible, a similar pattern was found. Using the results from visual matching tests, five color frequency peaks were identified. They could be used to construct an intraoral soft tissue shade guide.

A multi-centre randomized clinical trial is under way at 14 university dental schools in Germany to compare prosthodontic treatments for the shortened dental arch (SDA). One of the aims of this pilot-study was to measure the effect of two treatment options of the SDA on oral health-related quality of life and on the Research Diagnostic Criteria (RDC) for temporomandibular disorders (TMD). Thirty-four patients participated in the pilot-study. Inclusion criteria were: all molars were missing and the presence of at least both canines and one premolar in each quadrant. Participants were randomly assigned to receive either removable partial dentures including molar replacement (RPD&#95;group) or retain a premolar occlusion (PROC&#95;group). The Oral Health Impact Profile (OHIP-49) and the RDC for TMD were completed by participants before treatment (pre-treatment), 6 weeks (6 wks), 6 months (6m) and 12 months (12 m) after treatment. At the 12-month follow up, data of 10 women and 11 men (mean age: 62 +/- 10 years) were available. Medians of the OHIP total-scores were as follows: RPD (n = 10), 43.5 (pre-treatment), 18.2 (6 wks), 13.3 (6m), 14.7 (12 m). PROC (n = 11): 31.8 (pre-treatment), 27.1 (6 wks), 8.8 (6m), 8.3 (12 m). Significant differences were shown for RPD&#95;group between pre-treatment and 6m/12 m and for PROC&#95;group between pre-treatment and 6m. There were no significant differences between treatment groups at any time. Within each group, an improvement of life-quality was observed. No significant difference could be reported between the two therapy concepts. This may be due to the low sample size within the pilot study.

The aim of this study was to compare titanium-reinforced ZrO(2) and pure Al(2)O(3) abutments regarding their outcome after chewing simulation and static loading. Forty-eight standard diameter implants with an external hexagon were divided into three groups of 16 implants each and restored with three different types of abutments (group A: ZrO(2) abutments with titanium inserts; group B: Al(2)O(3) abutments; group C: titanium abutments). All abutments were fixated on the implants with gold-alloy screws at 32 Ncm torque, and metal crowns were adhesively cemented onto the abutments. The specimens were exposed to 1.2 million cycles in a chewing simulator. Surviving specimens were subsequently loaded until fracture in a static testing device. Fracture loads (N) and fracture modes were recorded. A Wilcoxon Rank test to compare fracture loads among the three groups and a Fisher exact test to detect group differences in fracture modes were used for statistical evaluation (P < 0.05). All specimens but one of group B survived chewing simulation. No screw loosening occurred. The median fracture loads (+/-s.d.) were as follows: group A, 294 N (+/-53); group B, 239 N (+/-83), and group C, 324 N (+/-85). The smaller fracture loads in group B were statistically significant. The use of pure Al(2)O(3) abutments resulted in significantly more abutment fractures. It is proposed that titanium-reinforced ZrO(2) abutments perform similar to metal abutments, and can therefore be recommended as an aesthetic alternative for the restoration of single implants in the anterior region. All-ceramic abutments made of Al(2)O(3) possess less favourable properties.

Implementation of new therapies is usually governed by financial considerations, so efficacy studies should also include cost comparisons. The cost and effectiveness of mandibular conventional dentures (CD, n = 30) and two-implant overdentures (IOD, n = 30) were compared in elderly subjects. Effectiveness (Oral Health Impact Profile, OHIP-20) and cost were measured up to one year post-treatment. Data for subsequent years were estimated by the Delphi method. Using an average life expectancy of 17.9 years, the equalized annual costs (in Canadian dollars) were dollar 399 for CD and dollar 625 for IOD (p < 0.001), and the equalized annual values for the outcome (OHIP-20) were 47.0 for CD and 31.3 for IOD treatment (p < 0.05). These values translate into a yearly additional cost for IOD treatment of dollar 14.41 per OHIP-20 point. These results are key to the implementation of programs to provide this form of therapy for edentulous adults.

Objectives: To determine the impact of mandibular two-implant overdentures or conventional complete dentures on leisure and sexual activities., Methods: One hundred and two subjects, aged 35-65 years, received either mandibular overdentures retained by two implants (IOD; n=54) or new mandibular conventional complete dentures (CD; n=48) in a randomized controlled clinical trial. A Social Impact Questionnaire was used to assess the impact on social and sexual activity including avoiding conversation, refusing invitations, avoiding sport and feeling uneasy when kissing and in sexual relationships, and the looseness of the prostheses during such activities. Ratings were recorded on categorical scales at baseline and 2 months after treatment. Oral health related quality of life was measured with the Oral Health Impact Profile (OHIP). Between and within group comparisons were carried out using regression models. The correlation between post-treatment OHIP scores and the leisure and sexual impact items was assessed., Results: Two months after delivery of the prosthesis there was significant improvements in the IOD group for looseness when eating, speaking, kissing and yawning. The IOD group reported significantly less post treatment looseness than the CD group for all parameters investigated (p<0.0001). IOD subjects felt less uneasy kissing and less uneasy during sexual activity than CD subjects. Correlations between the two sexual activity items (uneasiness when kissing and during sexual relations) and the OHIP scales were weak., Conclusions: Edentulism has a negative impact on social and sexual life. Mandibular overdentures provide greater improvement in of unease in intimate activities than new conventional mandibular dentures.

Purpose: This study undertook a systematic overview of the literature on the description and visual measurement of gingival color., Materials and Methods: Two research questions were formulated. The first addressed the description of gingival color, while the second aimed at visual color measurement techniques. An electronic search was performed in 22 literature databases. The electronic search was complemented by hand searching. The retrieved articles were independently reviewed by two members of the research team. The levels of evidence of the articles were classified following the guidelines of the Oxford Centre for Evidence-Based Medicine., Results: Of the nine articles retrieved by the two searches, six applied to the first question, two applied to the second question, and one applied to both questions. Three articles were published in Japanese and dealt with the color of gingival and alveolar mucosa. The clinical studies showed that the intraoral tissues of younger persons are of a lighter color. Evidence levels were no higher than 4., Conclusion: Studies on the description of gingival color used a narrative approach. Studies on visual gingival color measurement had diverse aims, methods, and parameters. It is impossible to compare or even combine their outcomes in a scientifically meaningful manner. Since none of the investigations used a controlled or randomized design, they represent low levels of evidence.

Speech is often perturbed after placement of maxillary implant-retained prostheses. We tested the hypothesis that the rate of speech errors varies with prosthetic design. Thirty edentulous subjects with mandibular implant prostheses entered two within-subject crossover trials. Subjects wore maxillary fixed prostheses and removable long-bar overdentures (Trial 1), or overdentures with and without palates (Trial 2). Test words from a French language speech battery were recorded after each prosthesis had been worn for two months. The percentages of stops, fricatives, and vowels correctly perceived by lay judges were calculated. Subjects produced a significantly higher percentage of sounds correctly with overdentures than with fixed prostheses. Between-treatment differences were significant for stops and fricatives (p < 0.01), but not for vowels. There were no significant differences in error rates between the two overdentures. In conclusion, maxillary implant overdentures with and without palates enable patients to produce more intelligible speech than fixed prostheses.

Purpose: This study systematically searched the dental literature to identify and classify articles on the influence of prosthodontic and dental implant treatment on patient satisfaction and oral health-related quality of life according to their level of evidence., Materials and Methods: A literature search was carried out for articles published between 1960 and February 2003 using an electronic key word search complemented by hand searching. The retrieved articles were subjected to inclusion and exclusion criteria. Only experimental studies were included; articles that did not focus on the effect of therapy on the patient were excluded from further processing. The levels of evidence of the articles were classified following the guidelines of the US Agency for Health Care Policy and Research., Results: A total of 207 publications were identified, of which 114 reports investigating 24,863 patients met the inclusion criteria. Data from the studies were analyzed using SPSS 9.0. Two thirds of the publications showed a low evidence level of III; most were conducted in patients who were edentulous or restored with complete dentures (59% of all studies). Mostly, nonstandardized, custom-made questionnaires (80%) were used. On average, 9 (SD 4.2) outcome variables were used within each trial, but clinical criteria were more often used than psychosocial criteria. The most frequently used questions concerned "chewing function" (86%), esthetics (77%), speech (68%), and general satisfaction (67%). Validated instruments, such as the Oral Health Impact Profile, were increasingly used in recent studies, which were also methodically more sufficient., Conclusion: Few studies with high levels of evidence were found. Research in this field is still in a phase of development.

Unlabelled: Implant overdentures and conventional prostheses have been compared in several trials using a variety of functional and oral health-related quality of life (OHQOL) outcomes. In this paper, we describe the impact of implant overdentures on general and OHQOL in seniors., Objectives: To compare the oral health-related and general quality of life of seniors (aged 65-75 years) who received either mandibular implant overdentures or conventional dentures., Methods: Sixty edentulous patients were recruited. Thirty received mandibular overdentures retained by two implants (IOD) and a conventional maxillary denture, the other 30 subjects received new maxillary and mandibular conventional complete dentures (CD). All completed the 20-item version of the Oral Health Impact Profile (OHIP-20) before treatment, then at two and 6 months after delivery of the dentures. The SF-36 general health questionnaire was completed at baseline and 6 months only., Results: Pretreatment and 6-month data from 55 subjects were analyzed. Those who received the IODs had significantly better OHIP-20 total scores at 6 months. Results for IOD subjects were also superior in the functional limitation, physical pain, physical disability and psychological disability subscales. While no significant between group difference was found on the SF-36 health survey, significant pre-post-treatment differences within the IOD group were detected for the role emotional, vitality and the social function scales., Conclusions: Mandibular overdentures retained by two implants provide elderly patients with better OHQOL. General health-related quality of life improved in the implant group.

Purpose: The purpose of this study was to compare clinicians' ratings of the state of oral tissues and their satisfaction with treatment to edentulous patients' ratings of treatment success after provision of mandibular implant overdentures or conventional dentures., Materials and Methods: Sixty subjects randomly received either mandibular overdentures retained by two implants (n = 30) or new conventional mandibular complete dentures (n = 30). All were given new conventional maxillary dentures. Baseline measures included clinical evaluation of the oral soft and hard tissues. Patients rated their general satisfaction before and after treatment, as well as their satisfaction with stability, speech, and esthetics on visual analogue scales. The treating prosthodontist rated the dentures for the same categories. Patient and clinician ratings were compared using correlations, t tests, and linear regression., Results: None of the clinical variables were significantly correlated with patient satisfaction before or after treatment. The prosthodontist rated mandibular implant overdentures significantly better than conventional dentures regarding general satisfaction, stability, speech, and esthetics. Implant overdentures were also easier to fabricate (P < .0001). The prosthodontists' scores were not significantly correlated with patient scores for any question., Conclusion: Clinicians' assessments of the quality of denture-supporting tissues are poor predictors of patient satisfaction with mandibular implant or conventional prostheses. Prosthodontists and patients both rate mandibular implant overdentures as significantly superior to conventional dentures, but patients and clinicians do not usually agree when evaluating individual prostheses.

Dental implants provide patients with restorative options for the edentulous maxilla. Both fixed and removable prostheses can be attached to the edentulous maxilla, but the efficacy of different designs has not been determined. In this two-session within-subject crossover trial we compared maxillary implant retained fixed prostheses with removable implant overdentures opposed by mandibular implant-supported overdentures. Sixteen patients, who had previously received mandibular implants, entered the study and received four to six maxillary implants. After dropouts as a consequence of a lack of osseointegration and general health problems, 13 remained. Of these, five received the removable prosthesis first and eight the fixed prosthesis. After 2 months, the prostheses were exchanged and the second was also worn for 2 months. Psychometric measurements of general satisfaction with the prostheses as well as comfort, ability to speak, stability, esthetics, ease of cleaning and occlusion were obtained once each prosthesis had been worn for 2 months. Chewing ability was assessed for seven types of food. Removable long-bar overdentures received significantly higher ratings of general satisfaction than fixed prostheses (P = 0.003). Patients also rated their ability to speak and ease of cleaning significantly better with the removable overdentures. Nine patients chose to keep the removable prosthesis and four preferred to keep the fixed prosthesis. The results suggest that maxillary removable overdentures on multiple implants may provide patients with better function than fixed prostheses.

Purpose: This article reviews the development of esthetic implant abutments and illustrates the use of aluminum oxide implant abutments in two cases., Materials and Methods: Two patients were restored with single-tooth implants for the replacement of anterior teeth. One patient received a prefabricated aluminum oxide abutment, which was customized by the dental technician. A second patient received a custom aluminum oxide abutment, which was designed and fabricated using CAD/CAM technology. Both cases were restored with all-ceramic crowns., Results: Satisfactory functional and esthetic results were achieved in both cases. The CAD/CAM abutment required no further customization in the dental laboratory., Conclusion: The use of aluminum oxide ceramic abutments improves dental and mucogingival esthetics in single-implant restorations. The use of CAD/CAM technology simplifies the design and customization process. Clinical studies are required to confirm the long-term performance of this type of restoration.