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To evaluate the reliability and accuracy of spectrophotometric shade determination of premolars and to compare the results with those for incisors. Fifty-seven participants with natural maxillary incisors and premolars were recruited to investigate the research question. The colour of test teeth (incisors, n = 210; premolars, n = 192) was measured by use of the Vita Easyshade Advance (ES-A) and Vita Easyshade V (ES-V). Accuracy was evaluated by rating the shade tab matches recommended by the devices (scale, 1 = excellent match to 3 = mismatch). Inter-device reliability between the ES-A and ES-V for measurement of incisors and premolars was evaluated using intra-class correlation coefficients (ICC). The ratings for the accuracy of the devices were analysed using descriptive and bivariate statistics. A linear regression model was used to evaluate possible independent influencing confounders on the shade match. Inter-device agreement of the ES-A and ES-V for measurement of incisors and premolars was excellent for all colour components (ICC > 0.9). The accuracy of both devices was acceptable to excellent for incisors and premolars, although the ES-V was more accurate than the ES-A (p

BACKGROUND The oral health of seniors in nursing homes is compromised. Furthermore, reduced chewing efficiency is described to be associated with reduced cognition. However, studies investigating how prosthetic status affects the chewing efficiency of nursing home residents are not available. OBJECTIVE To evaluate associations between prosthetic status, dementia and chewing efficiency of seniors in nursing homes. METHODS This study was performed in nine nursing homes. In addition to assessing the general and medical data of the participants, a dental examination was assessed and the severity of dementia was evaluated by use of the Clinical Dementia Rating (CDR). Furthermore, chewing efficiency was assessed by use of a two-colour mixing ability test. Descriptive and bivariate statistics, as well as linear regression models with the dependent variable chewing efficiency and possible confounders, were used to analyse data at P

Statement of problem Monolithic zirconia restorations have become popular because of their excellent mechanical properties and acceptable esthetics. While the biomechanical properties of zirconia have been investigated, research into their esthetic properties is sparse. Zirconia can be colored by infiltration before sintering, although how occlusal adjustment can affect restoration color is unclear. Purpose The purpose of this in vitro study was to analyze the color of differently characterized monolithic white and precolored zirconia specimens after standardized grinding. Material and methods White and precolored monolithic zirconia plates (Cercon ht) (n=36) were stained by infiltration with target colors Vita A2, A3.5, and A4. In a standardized experimental arrangement, all plates were ground in 9 steps, and the color was measured with a spectroradiometer at each step. Color differences (ΔE00) were analyzed by using regression analysis, the Kruskal-Wallis test, and the inverse prediction with confidence intervals (α=.05). Results Mechanical material removal had a significant effect on the color stability (P .05). For target color A2, the difference was significant with P Conclusions Precolored zirconia had less color change after grinding than white zirconia. This study established grinding depths for white and precolored zirconia corresponding to color perceptibility and acceptability thresholds.

Objective To evaluate the repeatability, interexaminer, and interdevice reliability of two clinically applicable spectrophotometers under laboratory and clinical conditions. Material and methods For the in vitro part of the study, measurements were performed by the use of Vita Easyshade Advance 4.0 (ES-A) and the Easyshade V (ES-V) at identical positions on different shade tabs (3D-Master; Vita Zahnfabrik, Bad Sackingen, Germany). To test repeatability, one shade tab was measured 50 times by one operator. To determine interrater and interdevice agreement, two operators used both devices to perform 10 measurements on five different shade tabs. Clinical interdevice and interexaminer reliability was checked with a positioning jig used (15 participants). Measurement accuracy of both devices was evaluated for the recommended color of shade tabs. Results Repeatability of results from both Easyshades was excellent for all color components (maximum deviation between measurements was ≤0.1 units). Interrater agreement was also perfect (intraclass correlation, ICC = 1.000). Interdevice agreement was lower, but still good (ICC ≥ 0.834). In the clinical environment, interrater and interdevice agreements were similar (ICC > 0.964 and ICC > 0.873). Accuracy was satisfactory for both devices, with both observers in full agreement for nearly 80% of ratings. Conclusions Both Easyshades produced reliable and accurate measurements and can therefore be recommended for clinical determination of tooth color. Clinical significance The outcome of this study might help clinicians estimate the performance of a new digital shade determination device.

Objective To assess surface discoloration of four enamel sealants based on different chemical compositions after exposure to artificial aging and staining solutions. Furthermore, their cleanability after polishing will be evaluated. Materials and methods Selected sealants were a composite resin-based sealant with fillers (Pro Seal), a composite resin-based sealant without fillers (Light BondSealant), a resin-modified glass ionomer-based sealant (ClinproXT Varnish) and a silicon-based sealant (Protecto). Natural teeth served as medium. Immersion solutions were water, juice, tea, and turmeric. In a standardized setting, all samples were measured seven times with a spectroradiometer (Photoresearch PR670) at baseline, after thermocycling; 7 days; 2 and 4 weeks of immersion; and after finally polishing. Results Thermocycling had no significant effect on color stability. After exposure to staining solutions, all sealed surfaces showed significant color changes. Color change predominately occurred for all sealants in the first week of staining (P ≤ .01). Best resistance to staining decreased as follows: Protecto > Light Bond Sealant > ProSeal > Clinpro XT Varnish. Surface cleaning by polishing significantly reduced the color change. Conclusion Sealed enamel surfaces are prone to discoloration, which is most prominent in filled composite and glass-ionomer-based sealants. Staining can be reduced by polishing; however, in this in vitro setting the original color could not be restored. Clinical significance Enamel sealants might exert adverse effects in terms of discoloration. This should be taken into consideration by clinicians and patients, particularly when sealants are applied in esthetically critical areas.

OBJECTIVES To evaluate the effect of small-group education including practical training on dental students' shade determination performance compared with a control group. METHODS Sixty-three non-colour-blind preclinical students were asked to participate and belonged to an intervention (n = 31) and a control (n = 32) group, respectively. All students received a lecture on dental shade determination. The members of the intervention group were educated and practically trained in small groups in addition. Ten volunteers, each with unrestored upper right middle and lateral incisors, were recruited. The students of both the intervention and control groups were then asked to determine the colour of the volunteers' test teeth using the 3D-Master shade guide (Vita Zahnfabrik, Bad Sackingen, Germany) under artificial daylight illumination. For analytical purposes, the CIE L*a*b* coordinates were obtained using a spectrophotometer. Colour differences, ΔE, between all shade tabs selected by the students and the natural teeth were calculated. ΔE observed in the intervention and control groups were compared using t tests. In addition, a multi-level regression model was adjusted for age and gender. RESULTS Mean (SD) ΔE between the shade tabs selected by the students and the natural teeth in the intervention and control groups were 3.8 (2.1) and 4.3 (2.3), respectively (P

OBJECTIVE To investigate the color stability of hybrid ceramics and to compare it to composite and lithium disilicate ceramics. MATERIALS AND METHODS One hundred eighty samples were fabricated and processed with a semiautomatic grinding and polishing device (final step: 1200 grit). After thermocycling, samples were immersed in a staining solution (five subgroups: water, red wine, curry, black tea, cola) for 4 weeks. A spectroradiometer was used to determine the color of the samples in CIE L*a*b*. Color measurements were performed before staining (baseline, initial color), after thermocycling, after 2 and 4 week storage in staining solution and each after a two stage repolishing approach. Discoloration of specimens was calculated by means of ΔE00 compared to baseline values. RESULTS All factors (material, staining solution, aging stage) were significantly associated with the extent of discolorations (P

Andreas Zenthöfer,1 Inga Meyer-Kühling,2,3 Anna-Luisa Hufeland,1 Johannes Schröder,2,3 Tomas Cabrera,1 Dominik Baumgart,1 Peter Rammelsberg,1 Alexander J Hassel1 1Department of Prosthetic Dentistry, University of Heidelberg, 2Institute of Gerontology, University of Heidelberg, 3Section of Geriatric Psychiatry, Center of Psychiatry, University of Heidelberg, Heidelberg, Germany Aim: The aim of this study was to evaluate the effectiveness of carers’ education on improvements in oral health and denture hygiene of care-dependent and cognitively impaired older people in nursing homes compared to those without intervention. Methods: A total of 219 seniors living in 14 nursing homes in southwest Germany (intervention: n=144; control: n=75) were enrolled in this study. For each participant, Plaque Control Record (PCR), Gingival Bleeding Index (GBI), Denture Hygiene Index (DHI) and Community Periodontal Index of Treatment Needs (CPITN) were assessed at baseline and six months following the interventions. In addition, demographic parameters such as age, sex, chronic diseases, permanent medications, level of dependency and cognitive state were recorded. In the intervention homes, education for caregivers was provided and ultrasound baths for denture cleaning were implemented. Changes in the dental target variables PCR, GBI, CPITN and DHI during the six-month study period were compared between subjects in the intervention and the control groups as well as between subjects with and without dementia. Additionally, multivariate models were compiled for each dental index to evaluate possible confounders. Results: In the intervention group, PCR and DHI significantly improved during the study period (P0.05). Conclusion: Carers’ education improves oral health of people in nursing homes over a clinically relevant period of time. Implementation of ultrasound baths is a simple and effective measure to improve denture hygiene of both institutionalized elderly people and seniors with dementia and in severe need of care. From a clinical standpoint, it is noteworthy that the respective interventions can be easily implemented in everyday care routine. Keywords: oral health, intervention, older people, nursing home, longitudinal

Allgemeinerkrankungen und korperliche Einschrankungen nehmen im Alter zu, die Mundgesundheit alterer Menschen reduziert sich im Vergleich zu jungeren. Parodontalerkrankungen und (Wurzel-)Karies sowie Neoplasien der Mundhohle treten vermehrt auf. Oftmals verlaufen Zahn-, Mund- und Kieferkrankheiten schwerer. Die Frequenz regelmasiger Zahnarztbesuche sinkt, andere arztliche Konsultationen nehmen zu. Durch zahnarztliche Pravention sind jedoch immer weniger Patienten vollstandig zahnlos. Zahnverluste und Versorgungen mit (herausnehmbarem) Zahnersatz konnen Kaufunktion und Ernahrung negativ beeinflussen. Funktionelle und asthetische Einbusen im Vergleich zu naturlichen Zahnen konnen zudem die Lebensqualitat reduzieren. Bei kognitiven und manuellen Einschrankungen kann sich der Mundgesundheitszustand noch deutlicher verschlechtern. Der vorliegende Artikel gibt einen Uberblick uber die Datenlage zur Mundgesundheit und mundgesundheitsbezogenen Lebensqualitat des alternden Patienten.

The purpose of this in vitro study was to evaluate the effect of enamel sealants on bleaching of natural teeth by use of 40 % hydrogen peroxide in a dental surgery. The color stability of the results from bleaching was, furthermore, determined 10 months after the bleaching procedure. In a standardized setting, four sealants (Pro Seal®, Light Bond™ Sealant, Protecto®, and Clinpro™ XT Varnish) were applied to and removed from human teeth in accordance with the manufacturer’s instructions. Natural teeth served as medium; half of the teeth were sealed and the others served as controls. Hydrogen peroxide gel (40 %; Opalescence Boost; Ultradent Products, South Jordan, UT, USA) was used as bleaching agent. Color measurement was performed with a spectroradiometer (Photoresearch PR670) before the bleaching process (T1) and 24 h (T2) and 10 months (T3) after bleaching. The spectroradiometer results were expressed by use of the Commission Internationale de l’Eclairage (CIE) L*a*b* color notation. The L*, a*, and b* values of the sealed and the unsealed surfaces were not significantly different at any time during the study (p > 0.05), irrespective of the sealant used. Ten months after the bleaching process, mean L*, a*, and b* values were lower than at 1-day post-bleaching; the mean value of ΔE between 1-day post-bleaching and 10 months post-bleaching was 2.46 (±3.1). The results of the study suggest that the effectiveness of professional tooth whitening is not appreciably affected by the application of the four sealants tested.

Limited assessment tools for estimating the oral health of nursing home residents are available in the German language. To develop a German version of the Oral Health Assessment Tool (OHAT) and to evaluate test–retest and inter-examiner reliability in use for the assessment of nursing home residents’ oral health by caregivers before and after dental training. The original English version of the OHAT was translated into German by a forward–backward translation process. Reliability assessments were conducted in a nursing home (n = 18) by independent application of the OHAT by two trained dentists and four professional caregivers. After receiving dental training, the caregivers repeated the OHAT with the same participants. Reliability analyses of single items were performed using Cohen’s kappa statistics. Intra-class correlations were compiled to assess reliability of the total scores. T tests were used to compare percentage agreement, and under- and overestimation of findings between a reference dentist and the caregivers before and after the training unit. Specificity and sensitivity of the German OHAT were 87% and 86%. Test–retest reliability of the total OHAT score as estimated by the dentists was excellent (ICC 0.910; 95% CI 0.776–0.965). Before training, mean κ values between the reference dentist and caregivers ranged between 0.155 and 0.912, whereas the inter-examiner reliability of most items was only fair. After training, overall agreement between the dentist and the caregivers improved significantly from 62.1 to 83.1% (p

OBJECTIVE The objective of this study was to evaluate possible longitudinal associations between oral health-related quality of life (OHRQoL) and subjective well-being among quinquagenarians and septuagenarians over up to 10 years of clinical observation. METHODS This research is part of the "Interdisciplinary Study on Adult Development and Aging (ILSE)." All participants lived in an urban region of southwest Germany. One hundred and fifty-two participants born in 1930-1932 (older cohort, OC; n = 54) and 1950-1952 (younger cohort, YC; n = 98) underwent comprehensive psychological, medical and dental examinations at baseline and up to 10 years thereafter. The Geriatric Oral Health Assessment Index (GOHAI) was used to assess OHRQoL. The Philadelphia Geriatric Center Morale Scale (PGCMS), general life satisfaction (GLS) and individuals' general satisfaction with their health (SWH) were used to evaluate subjective well-being. Regression models and structural equation modelling (SEM) were used to analyse the longitudinal associations between OHRQoL and subjective well-being. RESULTS A cross-lagged prediction model revealed a positive association between baseline OHRQoL and subjective well-being across 10 years for both birth cohorts, OC [0.49 (0.21; 0.69)] and YC [0.36 (0.24; 0.52)]. However, higher subjective well-being at baseline was not a predictor of better OHRQoL 10 years later for either cohort. CONCLUSIONS OHRQoL seems to be a substantial predictor of subjective well-being in quinquagenarians and septuagenarians across the rather long observational period. Further studies with larger sample sizes are required to confirm this finding.

Objective To evaluate changes in tooth color for 2 age cohorts (younger cohort, YC: 1950-1952; older cohort, OC: 1930-1932) over a mean observation period of 8 years. Material and Methods Sixty-one participants with 106 upper central incisors were subjected to baseline and follow-up examinations (YC: n = 46/OC: n = 15). International Commission on Illumination color coordinates of 1 or 2 unrestored test teeth for each participant were recorded by use of a spectrophotometer (VITA Easyshade 1) during both measurement times. Changes of color coordinates during the study period were evaluated by use of generalized linear mixed models with the variable “participant” as random effect. ΔEab and E2000 color differences were calculated between baseline and follow-up. Results Significant changes in color coordinates were observed, with the exception of lightness in OC. The direction of the changes depended on the cohort. A decrease of lightness (value) was observed in YC (ΔL = 4.0; P

Objective The objective of this research was to identify risk factors for tooth loss in two birth cohorts, quinquagenarians and septuagenarians, after up to 10 years of clinical observation. Design One hundred and twenty-three participants were recruited from the Interdisciplinary Study of Adult Development (ILSE) and examined at baseline and up to 10 years after. Thirty-nine and 84 participants belonged to the older (OC; born in 1930/32) cohort and younger (YC; born in 1950/52) cohort, respectively. Each participant underwent a dental examination comprising evaluation of the dental status (number of teeth, prosthetic restorations), Plaque Index (PI), Gingival Index (GI), DMF-S, periodontal probing depths (PD) and tooth mobility (TM). Incidence of tooth loss over the study period was calculated for both cohorts as well as for the grouped dental target variables. A logistic regression model for tooth loss (0 = tooth present/1 = tooth lost) was compiled with possible binary confounders. Results During the study period (eight years in mean), 1.2 (1.9) and 2.6 (2.6) teeth were lost in YC and OC, respectively, reflecting correspondent loss rates of 5% and 14% (p 1 merged into substantial tooth loss (60% lost). The regression analysis confirmed the bivariate findings. Older age and worse oral health issues were identified as risk factors for tooth loss(p Conclusions Both quinquagenarians and septuagenarians show relevant tooth loss over a period of up to 10 years but more in septuagenarians. The predominant predictor for tooth loss seems to be greater tooth mobility. With the rising challenges due to aging in several societies, knowing the risks might help clinicians when weighing treatment strategies and should encourage refining preventive measures for older patients.

Objectives The purpose of this work was to investigate the long-term effectiveness of oral health education of caregivers in nursing homes with care-dependent and cognitively impaired residents. Methods Fourteen nursing homes with a total of 269 residents were allocated to a control group, with continued normal care, or to an intervention group. Allocation was performed at nursing home level. In the intervention group, caregivers were given oral health education, and ultrasonic cleaning devices were provided to clean removable prostheses. Oral health was assessed at baseline and after 6 and 12 months by use of the Plaque Control Record (PCR), Gingival Bleeding Index (GBI), Community Periodontal Index of Treatment Needs (CPITN) and Denture Hygiene Index (DHI). Mixed models for repeated measures were performed for each target variable, with possible confounding factors (intervention/control group, age, sex, residence location and care-dependence). Results In the control group, no changes of target variables were observed between baseline and the 6- and 12-month follow-ups. After 6 and 12 months, PCR and DHI were significantly improved in the intervention group. For PCR, the intergroup difference of improvements was −14.4 (95% CI: −21.8; −6.9) after 6 months. After 12 months, the difference was −16.2 (95% CI: −27.7; −4.7). For DHI, the intergroup difference compared to baseline was −15 (95% CI: −23.6; −6.5) after 6 months and −13.3 (95% CI: −24.9; −1.8) after 12 months. There was neither a statistically significant effect on GBI nor on CPITN. Care-dependency showed a substantial trend to smaller improvements in PCR (P = .074), while an inverse effect was apparent for DHI (P < .001). Conclusions Education of caregivers improves and maintains the oral health of care-dependent nursing home residents over longer periods. Use of ultrasonic devices is a promising means of improving denture hygiene among the severely care-dependent. Such interventions can be easily and cheaply implemented in routine daily care.

The objective of this controlled clinical study was to evaluate the association between oral health and 1-year mortality among nursing home residents with or without oral health intervention. This research was part of a multidisciplinary intervention study (EVI-P) performed in 14 nursing homes in Germany. Two-hundred and nineteen nursing home residents were included in the study and assigned to an intervention group, for which dental health education was offered and ultrasonic baths were used for denture cleaning (n = 144), or to a control group (n = 75). Before the intervention, each participant was examined, and dental status, plaque control record (PCR), Denture Hygiene Index, and results from the Revised Oral Assessment Guide were recorded. Amount of care needed and dementia were also assessed, by use of the Barthel Index and the Mini Mental State Examination, respectively. Participant mortality was determined after 12 months, and bivariate analysis and logistic regression models were used to evaluate possible factors affecting mortality. Bivariate analysis detected a direct association between greater mortality and being in the control group (p = .038). Participants with higher PCR were also more likely to die during the study period (p = .049). For dentate participants, the protective effect of being in the intervention group was confirmed by multivariate analysis in which covariates such as age and gender were considered. Oral hygiene and oral health seem to affect the risk of mortality of nursing home residents. Dental intervention programs seem to reduce the risk of 1-year mortality among nursing home residents having remaining natural teeth. Further studies, with larger sample sizes and evaluation of the causes of death, are necessary to investigate the reasons for these associations.

Anna-Luisa Klotz,1 Alexander Jochen Hassel,1 Johannes Schröder,2,3 Peter Rammelsberg,1 Andreas Zenthöfer1 1Department of Prosthodontics, Dental School, 2Institute of Gerontology, 3Section of Geriatric Psychiatry, University of Heidelberg, Heidelberg, Germany Purpose: The objective of this cross-sectional study was to evaluate the effect of prosthetic status on the oral health-related quality of life (OHRQoL) of nursing home residents with or without dementia.Methods: The study was performed in 14 nursing homes across the federal state of Baden-Württemberg, Germany. All eligible participants were included, and general and medical information and information about their dental and prosthetic statuses were collected. The Geriatric Oral Health Assessment Index (GOHAI) was administered to evaluate OHRQoL. The Mini-Mental State Examination (MMSE) served to classify participants into living or not living with dementia according to the established cutoff value for dementia (MMSE 0.05). The number of teeth (odds ratio [OR]: 2.0), the type of prosthetic status (OR: 6.5), and denture-related treatment needs (OR: 2.4) were the major factors significantly affecting OHRQoL (P

Background Diminished oral health of the institutionalized elderly has frequently been reported. This is not only of significance with regard to nutrition and general health, but it can also affect oral health-related quality of life. This paper evaluates the effects of oral and general conditions on oral health-related quality of life for the institutionalized elderly, as measured by the Geriatric Oral Health Assessment Index (GOHAI). Materials and Methods Ninety-four residents of four long-term care homes in southern Germany agreed to participate in this study, and interviews were conducted using the GOHAI questionnaire. The Revised Oral Health Assessment Guide was applied to allocate participants into two groups: satisfactory oral health and poor oral health. To evaluate the effects of age, gender, number of chronic diseases, frequently taken drugs, care level, Mini-Mental State Examination score, periodontitis (for participants with their own teeth), pressures caused by prostheses, and type of denture worn, a linear regression model with the total GOHAI score was calculated with these determinants. Results The mean ± SD GOHAI score was 53.3 ± 6.2 in the satisfactory oral health group and 48.7 ± 7.3 in the poor oral health group. Statistical analysis showed that the GOHAI scores were significantly different in satisfactory oral health and poor oral health groups (P = 0.030) and were affected by care level (P = 0.008) and type of dentures worn (P = 0.006). Conclusions Within the limitations of this study, it can be concluded that oral health-related quality of life of the institutionalized elderly is low and is positively associated with better oral health.

Poor oral hygiene and dental health are very common among the institutionalized elderly. The purpose of this study was to evaluate the association of apraxia with oral hygiene and/or health.Ninety-two residents of 13 long-term care homes in southwest Germany participated in the study. For each participant, ideomotor apraxia scoring (AS) was conducted and demographic variables were collected. Participants underwent a comprehensive dental examination to assess the oral health indices gingival bleeding index (GBI), community periodontal index of treatment needs (CPITN) and denture hygiene index (DHI). Statistical comparison of dental indices among apraxic and non-apraxic individuals (cut-off45) was performed by use of t-tests. In addition, linear regression models were constructed with the dental indices as dependent variables. Each model was fitted with the dichotomized variable AS (pathologic or healthy) and adjusted for age and sex.Mean (SD) GBI of 48.5 (25.9), CPITN of 2.9 (0.7) and DHI of 82.6 (14.6) were observed among the participants. Statistical analysis revealed AS was significantly associated with all oral health indicators (p0.05). Linear regression models showed apraxia is a predictor of GBI (p = 0.002) and CPITN (p = 0.027), but not of denture hygiene (p = 0.916).Although this pilot investigation has limitations, the results suggest the presence of apraxia should be considered when planning oral healthcare strategies. Further research with larger samples is encouraged to confirm these relationships.

To investigate the association between prosthetic rehabilitation and malnutrition in institutionalized elders, 255 nursing home residents were recruited for this study and underwent a comprehensive dental examination. The body mass index (BMI) was administered to estimate the nutritional condition. Participants with BMI < 20 kg/mc were categorized as malnourished (n = 33), whereas all others were categorized as adequately nourished (n = 222). The number of teeth present and the prevalence of prosthetic rehabilitation were significantly lower in malnourished participants (P < .05). Malnutrition risk was 4.6 times higher for participants who were edentulous and did not wear dentures. Adequate replacement of teeth is important to prevent malnutrition in institutionalized older people.

Purpose The purpose of this prospective follow-up study was to evaluate survival and success of early-loaded implants placed in the edentulous mandible and the survival of the fixed dental prostheses (FDPs) after in mean 7.2 years. Materials and Methods Thirty-seven patients (mean age 64.5 years, 18.9% male) received 185 implants in the intraforaminal area of the edentulous mandible (five implants per patient). Within 2 weeks, all implants were early loaded with fixed dental prostheses. The patients were recalled once a year for clinical and radiographic examinations. The 17 patients (79 implants) attending the recall in 2012 were additionally asked for their satisfaction of functional and aesthetic aspects. Results During a mean observation time of 7.2 years, 20 implants were lost in 11 patients, resulting in implant survival of 89.2%. Eight of all implants (4.3%) had too much marginal bone loss to satisfy the criteria of success. A total of 19 prosthetic complications and aftercare measurements had to be performed between in mean 4.5 to 7.2 years of observation. The survival of the original FDPs decreased to 83.8%. Of the 17 patients attending the recall in 2012, a total 59.5% had a satisfactory oral hygiene. According to the criteria of Albrektsson, the success rate for the remaining 79 implants was 89.9% after in mean 11.7 years. Patient satisfaction for assessment of functional and aesthetic aspects was in median 9 and 8 on the numeric rating scales. Conclusion Long-term observation of in mean 7.2 years showed satisfactory results for both implant and superstructure survival. Prosthetic complications were easy to repair in most cases, but patients' ability for oral hygiene was reduced after the longer observation period. Especially in elderly patients, their attitudes and manual skills should be considered when planning the design of a new superstructure.

Purpose: To retrospectively compare the fixation modalities semipermanent and permanent for all cemented single crowns and Fixed Dental Prostheses (FDPs) placed at the Department of Prosthodontics in the years 2002 to 2010 with regard to the incidence of survival and complications. Materials and Methods: Two hundred forty-one patients (48.5% male, mean age 57.3 years) received 166 FDPs and 232 single crowns. A total of 50.6% of the FDPs and 54.7% of the single crowns were fixed using semipermanent cements. Aside from fixation, age, gender, type, location, and material of the suprastructures were assessed as possible factors affecting complications, namely de-cementation, chipping, framework, or abutment fracture. Results: During an observation period of up to 6.6 years (mean 2.24 years; standard deviation 1.38), the survival rates were 96.4% and 100% for FDPs (semipermanent/permanent cementation), and 98.4% and 92.4% for single crowns (semipermanent/permanent). The success rates achieved, counting every complication, for the FDPs were 61.9% and 70.7% (semipermanent/permanent) and for single crowns were 75.6% and 77.1% (semipermanent/permanent). The cement used had a significant effect on loss of retention of the FDPs (p = .006), but no significant effect on the retention of the single crowns. Cementation procedure exhibited no significant impact on chipping for both FDPs and single crowns. The frequency of framework or abutment fractures was too low for further statistical analyses. Conclusion: Both semipermanent and permanent cementation of FDPs and single crowns resulted in high survival rates. Within the limitations of the study design, because of the amount of chairside aftercare required, implant-borne FDPs could be recommended for permanent cementation.

Purpose: The objective of this retrospective study was to compare the incidence of chipping of implant-supported, all-ceramic, and metal–ceramic single crowns. Material and Methods: One hundred fifty-three patients (51.7% male, mean age 55.0 years) received 232 cemented implant-supported single crowns. One hundred and seventy-nine crowns had a metal framework (gold alloy) and 53 crowns were all-ceramic (zirconia framework and glass–ceramic veneer material). Age, gender, kind of cementation, and location of the restorations were assessed as possible factors affecting chipping. Results: During the observation period of up to 5.8 years (mean 2.1 years; standard deviation 1.4), a total of 13 (24.5%) all-ceramic and 17 (9.5%) metal–ceramic crowns suffered from chipping, a difference that was statistically significant. A total of ten single crowns had to be remade resulting in survival of 86.8% (all-ceramic) and 98.3% (metal–ceramic). The other possible factors did not have a significant effect on the chipping. Conclusion: Chipping was found to be more frequent for all-ceramic implant-supported single crowns. If the reasons for the vulnerability of all-ceramic crowns remain unknown, implants with all-ceramic single crowns should generally be recommended with care.

An important aspect of dental education is teaching and learning shade matching.To assess the success of two different strategies for learning shade matching.Seventy-one pre-clinical students (mean age 23; 33.3% men) were divided into two groups. One group (TTB) formed teams of two and they matched three pre-determined teeth on each other using the 3D-Master shade guide. After this exercise, they learned shade matching using a standardized device (Tooth Guide Training Box, TTB) by matching shade tabs in an artificial environment. The other group (GL) matched tooth color in a pre-defined clinical setting in groups of four students. After this, they matched the same teeth as before training, again in groups of two, similarly to group TTB. The reference tooth color was determined by two experienced prosthodontic clinicians. The L*a*b* values for the tabs were provided by the manufacturer and the color difference (ΔE(ab)) between the chosen tab and the reference was calculated. Linear general estimation equation models were used for statistical evaluation (p = 0.05).In the TTB group, the difference between ΔE(ab) values before and after training was 0.03, which was not significant (p = 0.927; 95% CI: -0.70/0.77). In the GL group, ΔE(ab) was 0.98 smaller after training, which was significant (p0.001; 95% CI: 0.50/1.50).The ability to match tooth color could be improved by using a group-learning approach in a clinical setting and implementation of such a training session should be considered in undergraduate and postgraduate dental education.

Patients with dermatological diseases often have associated psychological problems. For patients with allergic diseases, only a few publications have focused on psychological aspects. The objective of this study was to assess the psychometric profile, including somatization, depression, anxiety and health-related quality of life (HRQoL), of patients suffering from drug intolerance or hymenoptera venom allergies. In a prospective cohort study design, patients who were admitted to hospital for a challenge test for an alternative drug (n = 49, 24.5% men) or for induction of desensitization therapy with hymenoptera venom (n = 58, 37.9% men) were included. Psychometric screening questionnaires focusing on somatization (Symptom Check List), depression and anxiety (Hospital Anxiety Depression Scale), and also on HRQoL (Short Form questionnaire) were assessed. The scores were compared with population scores and between the two groups. Both groups had significantly higher somatization scores (P ≤ 0.003) than the normal population, and the challenge-test group had lower HRQoL than the normal population. Between-group analysis revealed significantly higher somatization scores in the challenge-test group (P = 0.011) and more impaired HRQoL (physical health domain P < 0.001). Anxiety/depression scores were not significantly different from those of the normal population, or between groups, although abnormally high scores for anxiety were frequent (18% and 12% for the challenge-test and allergy groups, respectively). Somatization, reduced HRQoL and anxiety seem to be part of the symptoms of patients with allergic diseases, especially for patients with drug intolerance. Standardized questionnaires could help to discover patients who may need psychological support. This may help to improve the patients' symptoms and quality of life.

Introduction: An objective structured clinical examination (OSCE) has been implemented in preclinical dentistry. It was taken at an early stage (propaedeutics course). The objectives of this study were to evaluate the reliability, validity, and feasibility of the examination, and the effect of circuit number on OSCE score. Methods: The OSCE was designed by an expert committee on the basis of pre-reviewed blueprints and checklists. Eleven stations formed an interdisciplinary circuit. Six groups of students (n = 62) passed sequentially round the same circuit. Statistical analysis was performed by using SPSS. Reliability was determined by measurement of internal consistency (Cronbach’s α, Guttman’s λ2), standard error of measurement (SEM) (comprising generalisability index α, dependability index ϕ and pass 150;fail reliability pc), consistency coefficient κ, item 150;scale correlation (Pearson correlation), and, because the unidimensionality of the stations could not be assumed, factor analysis including varimax rotation. Convergent validity (Pearson correlation, t-test), and predictive validity for future preclinical courses and the final preclinical examination were assessed by analysis of variance (ANOVA). The effect of the circuit number on score improvement was calculated, including a correction for the general competence of the students (ANOVA). Cost was calculated on the basis of the time invested. Results: Fifty-three out of sixty-two students passed the OSCE (mean score: 67%, SD 7.7, range, 47–81). Scores for each station correlated significantly with total scores (r = 0.35–0.54, P < 0.01). For internal consistency, α = 0.75 (relative SEM 3.8) and λ2 = 0.766. The dependability index was ϕ = 0.694 (absolute SEM 4.4), pc = 0.89 and κ = 0.61. Factor analysis yielded two components: dental-materials-oriented stations and all other stations (explained variance 43%). Scores correlated significantly with success in passing practical tests (i.e. performing dental procedures under examination conditions) (known group validity, P < 0.01) and with scores for subsequent courses and the final preclinical examination (Physikum) (predictive validity, P < 0.001). Later groups performed 4% better on average (CI 95%: 1.2–6.8%; P < 0.01). The cost was 181 Euro per student. Conclusions: The OSCE is reliable and valid in the context of preclinical dentistry. The cost is substantial. The problem of improvement of students' results with ascending circuit number has to be addressed.

Visual tooth colour assessment by use of the Vita 3D-Master(®) (3D; Vita Zahnfabrik, Bad Sackingen, Germany) is well documented. To improve handling, a new linear arrangement of the shade tabs has been introduced (LG; Linearguide 3D-Master(®) ). The purpose of this study was to investigate whether the linear design has an effect on shade matching. Fifty-six students underwent identical, theoretical and practical training, by use of an Internet learning module [Toothguide Training Software(®) (TT)] and a standardised training programme [Toothguide Training Box(®) (TTB)]. Each student then matched 30 randomly chosen shade tabs presented in an intra-oral setting by a standardised device [Toothguide Check Box(®) (TCB)]; 15 matches were made using the 3D and 15 using the LG shade guide system, under a daylight lamp (840 matches for each guide). It was recorded to what extent the presented and selected shade tabs, or the lightness group of the tabs, matched, also the needed time for colour matching. The results showed that 35% of perfect matches were observed for the 3D and 32% for the LG. The lightness group was correct in 59% of cases for 3D and 56% for LG. Mean time needed for matching of tabs and lightness group was no different between groups (no significant difference for any assessment). Within the limitations of the study design, the colour assessment with regard to performance and time needed in shade matching was not different with the LG or the 3D. Therefore, the user should choose which shade tab arrangement is more applicable.

Although a body of research has targeted predictors of well-being and depression in old age, the consideration of oral health-related quality of life (OHRQoL) as a predictor of these major psychosocial endpoints has been rare in the previous literature. The objective of this study was to test whether OHRQoL is associated with well-being and depression, after controlling for relevant confounders; also, the mediating role of subjective health, a major predictor of both well-being and depression, has been explored. OHRQoL was measured by two commonly used assessment instruments, the geriatric oral health assessment index (GOHAI) and oral health impact profile (OHIP); well-being was assessed by the Philadelphia Geriatric Center Morale Scale (PGCMS) and depression by the self-rating depression scale (SDS). We used a subsample of 197 participants from the older cohort (1930-1932) of the Interdisciplinary Longitudinal Study of Adult Development. Regression models and structural equations modeling (SEM) were used for the test for study variable relationships. Both GOHAI and OHIP revealed significant associations to both PGCMS and SDS at the bivariate level. In regression analyses considering gender, household situation, subjective health, and both OHRQoL indicators, only OHIP remained a significant predictor of well-being and depression. In addition, supportive evidence for a mediating role of subjective health regarding the linkage between OHRQoL and an overall latent construct of well-being was found in the SEM analysis. In conclusion, OHRQoL is significantly linked with well-being and depression in old age, while subjective health is able to mediate the relationship. The generally underrated role of OHRQoL with respect to well-being and depression in late adulthood deserves more attention.

A key criterion in the design of dental shade guides used for matching tooth color is that the shade tabs cover the natural tooth color space as completely as possible with a manageable number of tabs. Earlier studies have designed hypothetical shade guides from a given population of tooth colors described in the CIELAB system using the goal of minimizing the mean coverage error. In this study, we investigate this topic using the goal of maximizing coverage, meaning that as many measured colors as possible were within a given color difference from the nearest shade tab of the guide. We use techniques of linear discrete optimization to determine the positions of the shade tabs and consider both color difference formulas, CIELAB and CIEDE2000, in an exemplary tooth color population. We obtain coverage error and coverage figures for hypothetical shade guides of various numbers of tabs designed with the goal of either minimizing coverage error or maximizing coverage. Results show that discrete optimization and the goal of maximizing coverage could be used to improve shade guide development. The described technique could be used not only for dental shade guides development, but also for any purpose requiring coverage of as many colors as possible while keeping the number of reference colors manageable. © 2009 Wiley Periodicals, Inc. Col Res Appl, 2010

The objective of this study was to evaluate metameric effects, that is, the dependence of the colours of teeth and shade tabs on the illuminant used. The colours of 49 teeth of 37 participants and of the corresponding shade tabs of the 3D-Master (VITA Zahnfabrik; colour match DeltaE(ab)< 2) were measured using an intra-oral spectrophotometer (VITA Easyshade). Spectral reflectance data (from 400 to 700 nm) were recorded. Commission Internationale de l'Eclairage (CIE) L*a*b* values were calculated for D65 (reference daylight), A (incandescent light), and TL84 (store/office light) as reference illuminants. A modified metamerism index (Mod-M) and hue-angle ratios were calculated to express differences between tooth and tab colour relative to the difference observed under D65 illumination. The Mod-M for teeth and tabs was greater than unity (indicating a greater colour difference relative to D65) by 57.1% for A and by 49.3% for TL84. Hue-angle ratios of teeth and tabs using the test illuminants were different from those obtained using the standard illuminant D65. If teeth and shade tab matching is conducted using daylight illumination, the colour difference may not be the same under other lighting conditions, leading to perceptible, or even unacceptable, colour differences under these conditions.

Objectives To assess disk position and the prevalence of disk displacement (DD) in a sample of the elderly by use of contrast agent–enhanced magnetic resonance imaging (MRI). Study design Thirty subjects (73-75 years old) were drawn from a representative sample and examined clinically. The position and contours of the temporomandibular disk was assessed by using gadolinium-enhanced MR images which were evaluated by 2 independent raters. Statistical assessment was performed by using descriptive statistics and nonparametric tests. Results Agreement between raters with respect to disk position was excellent. The MRI showed that 8 subjects (27%; 2 men, 6 women) had DD. Conclusion Gadolinum-enhanced MRI showed that DD is common in the elderly (27%) and that DD occurs more frequently in women than in men. In women without DD the disk is positioned more anteriorly than in men.

Hintergrund Der Mundgesundheitszustand geriatrischer Patienten wird seit Jahrzehnten als vollig unzureichend beschrieben. Durch den im Vergleich zu Zahnarzten engeren Kontakt zum Patient stehen geriatrisch tatige Arzte haufig vor der Aufgabe, die Mundgesundheit beurteilen zu mussen. Ziel dieser Pilotuntersuchung war es, die Ubereinstimmung in der Erhebung von Mundgesundheitsparametern zwischen einem geriatrisch tatigen Arzt und einem Zahnarzt zu bestimmen. Es sollte zusatzlich untersucht werden, inwieweit sich die Ubereinstimmung durch eine praktische Ubungseinheit fur den Arzt verbessern lasst.

To verify the hypotheses that treatment with double-crown-retained removable partial dentures (RPDs) improves oral health-related quality-of life (OHRQoL) over a 36-month period and that the performance of RPDs retained by use of electroplated double crowns (EP-RPDs) was different to that of RPDs retained by use of cast double crowns (C-RPDs).Fifty-four patients (mean age = 64 years, 63% men) were recruited and randomly assigned to C-RPD or EP-RPD. OHRQoL was assessed pre-treatment, post-treatment and 6, 12, 24 and 36 months after insertion, by use of the oral health impact profile (OHIP). An unweighted total score was calculated (OHIP-SUM). A two-level hierarchical model was used for statistical analysis. First-level units were the measurements on the six occasions; second-level units were the patients.Improvement of OHRQoL was observed in both groups after treatment (t = 7.27, p0.001). Whereas a treatment-material interaction indicated that treatment with EP-RPDs resulted in greater immediate improvement of OHRQoL, a time-material interaction indicated that long-term improvement was greater for C-RPDs.Treatment with EP-RPDs and C-RPDs improved OHRQoL initially. Over a period of 36 months the effect was significant. The treatment is, therefore, a promising therapeutic option. The cast conical design seems to have advantages with regard to long-term OHRQoL.

Previous research has revealed poor oral hygiene and health among older people suffering from dementia. To evaluate the oral health and denture hygiene of older people with and without dementia, six months after carer have followed a dental education programme.Ninety-three older people living in four long-term care homes in south-western Germany were included in this longitudinal cohort study. All participants were allocated into two groups on basis of the medical dementia diagnosis extracted from the medical records in the care documentation: suffering from dementia (n = 33) or not (n = 60). For each participant plaque control record, gingival bleeding index (GBI), community periodontal index of treatment needs (CPITN), and denture hygiene index (DHI) were assessed at baseline and six months after carer have followed a dental education programme, and after use of ultrasonic devices for denture cleaning. Differences between all target variables from baseline to follow-up, and between participants with and without dementia, were evaluated by bivariate and multivariate testing.In bivariate testing, participants with dementia had a significantly lower DHI (p0.001), a lower GBI (p0.05), and a lower CPITN (p0.01) at follow-up. In participants without dementia, only for DHI (p0.001) a significant improvement was observed. In multivariate analyses, the significant association could not be reproduced (p0.05).Use of ultrasonic baths can be a successful means for improving denture hygiene among older people in long-term care with and without dementia. Education for carer in order to improve oral hygiene, however, seems to be of minor significance and to be more effective for people with dementia.

Poor oral health conditions are well documented in the institutionalized elderly, but the literature is lacking research on relationships between dementia and periodontal health in nursing home residents. The purpose of this cohort study, therefore, was to assess whether dementia is associated with poor oral health/denture hygiene and an increased risk of periodontal disease in the institutionalized elderly. A total of 219 participants were assessed using the Mini Mental State Examination (MMSE) to determine cognitive state. According to the MMSE outcome, participants scoring ≤20 were assigned to dementia group (D) and those scoring >20 to the non-dementia group (ND), respectively. For each of the groups D and ND, Gingival Bleeding Index (GBI) and Denture Hygiene Index (DHI) linear regression models were used with the confounders age, gender, dementia, number of comorbidities and number of permanent medications. To assess the risk factors for severe periodontitis as measured by the Community Index of Periodontal Treatment Needs, a logistic regression analysis was performed. Statistical analysis revealed no significant differences of GBI as well of DHI for demented and healthy subjects (p > 0.05). Severe periodontitis was detected in 66 % of participants with dementia. The logistic regression showed a 2.9 times increased risk among demented participants (p = 0.006). Oral hygiene, denture hygiene and periodontal health are poor in nursing home residents. The severity of oral problems, primarily periodontitis, seems to be enhanced in subjects suffering from dementia. Longitudinal observations are needed to clarify the cause–reaction relationship.

Objectives The aim of this study was to evaluate the clinical performance of posterior, metal-free polymer crowns with and without a glass-fiber framework, in comparison to metal–ceramic crowns. Methods After randomisation, 80 single crowns, manufactured from a newly designed polymer composite, were set in posterior teeth. Half of these received a glass-fiber framework, while half were prepared without any framework stabilisation. All polymer crowns were adhesively luted with resin cement. As the control group, 40 conventional metal–ceramic crowns were inserted with hybrid cement. Documentation included failures and other complications, as well as gingival/plaque status and aesthetic performance. Results During the 12-month observation period, eight polymer crowns and three metal–ceramic crowns showed clinically relevant complications. The most frequent complications were root canal treatments ( n = 4) and decementation ( n = 4) of the crowns. A total of two crowns (one polymer crown with fiber network and one crown of the control group) had to be replaced. After 12 months, polymer crowns with glass-fiber framework exhibited significantly higher plaque accumulation ( p = 0.005) and gingival index ( p = 0.04) than metal–ceramic crowns, while no significant differences could be demonstrated for polymer crowns without fiber reinforcement. Postoperative sensibility and aesthetic performance did not differ significantly between the groups. Conclusions Within a 12-month observation period, posterior polymer crowns with and without glass-fiber framework demonstrated acceptable stability and aesthetic performance. Polymer crowns with fiber framework showed significant higher plaque accumulation and gingival index than metal–ceramic crowns.

– Objective: The aim of this study was to investigate the influence of the age of the subject on inter-examiner reliability of the clinical signs of temporomandibular disorder (TMD). Methods: Forty-three elderly (ES) and 44 younger adults (YS) were selected. The female/male distribution was almost the same in the two groups. All participants underwent clinical examination according to the Research Diagnostic Criteria for TMD, performed successively by two clinicians. Results: For metric measurements – with the exception of unassisted opening – the ES gave a significantly lower range of motion with both examiners and significantly worse percentage agreement between the examiners. A remarkable inter-examiner disagreement in the elderly was found with laterotrusion and protrusion movements. The prevalence of joint sounds was rated inconsistently by the examiners. The reliability of detection was not different in the two groups. The prevalence of tender muscle sites was also inconsistent. The overall percentage agreement for subjects with at least one tender muscle point was not age dependent. Because of the very low prevalence in ES, further statistical assessment of reliability is not possible. Conclusions: The age-dependent lower range of motion and the inferior reliability of metric measurements in the elderly could lead to wrong diagnoses. The reliability of detecting joint sounds and tender muscles was not age dependent within the limitations of the study.

Andreas Zenthöfer, Peter Rammelsberg, Tomas Cabrera, Alexander Jochen Hassel Department of Prosthodontics, DentalSchool, University ofHeidelberg, Heidelberg, Germany Abstract: To determine relationships between the need for dental treatments of institutionalized elderly people and cognitive impairment and the general level of care needed. Two hundred and sixty-eight residents of long-term care facilities in Germany were included in this study. Age, sex, diseases, number of frequently taken drugs, and location of the long-term care facility of the participants were recorded. For each participant, the need for care was assessed by use of the Barthel index (BI). Cognitive impairment was evaluated by use of the mini-mental state examination (MMSE). To assess dental treatment needs, the revised oral assessment guide (ROAG) was applied for different oral health conditions, which were rated “healthy” or “treatment needed”. Spearman correlations were performed to evaluate associations between BI and MMSE and dental treatment needs. Statistical analysis revealed significant associations of BI (P

Purpose: Although the VITA 3D-Master (3D) shade guide offers improved shadematching performance, many dental materials are only available in VITA Classical (VC) shades. This study aimed to clarify whether it is possible to convert 3D shades determined by observers into VC shades (indirect method) without adding a clinically significant error in comparison with direct shade determination using the VC shade guide. Materials and Methods: Forty ceramic specimens were fabricated. L*a*b* values were recorded using a spectroradiometer. Sixty participants (35 dentists, 15 technicians, and 10 students) were recruited and asked to determine the shades of specimens using the VC and 3D shade guides under standardized conditions. Conversion tables were constructed by allocating the closest VC shade tab to every matched 3D shade and by use of an optimization algorithm (indirect methods). Differences between ?E values for VC matches and for the indirect methods were evaluated using t tests. Results: A mean ?E (SD) of 4.34 (2.00) for VC and 4.22 (2.21) for 3D was observed (P = .040). Compared with direct shade matching using VC, the indirect method with the optimized tables resulted in a mean ?E of 4.32 (1.96), which was not significantly different (P = .586). Conclusions: Within the limitations of this study, the conversion tables were suitable for the determination of tooth color using the 3D shade guide followed by conversion into VC shades without adding a clinically significant error.

The objective of this study was to evaluate the repeatability, inter-examiner and inter-device reliability, and accuracy of the new VITA Easyshade Advance (ES-A) spectrophotometer in comparison with the Easyshade Compact (ES-C). For the in vitro study, six porcelain disks of random shade mixtures were fabricated from VITA ceramic powders. To analyze the repeatability of the ES-C and ES-A, readings were obtained by one examiner for one porcelain disk and one shade tab (VITA 3D-Master). Measurements were repeated by two examiners to evaluate inter-examiner reliability. To assess accuracy, porcelain disks and shade tabs were measured with the ES-C and ES-A and by means of a spectroradiometer (SR). ∆E values between the shade tabs and disks were calculated. Differences between devices were evaluated by use of univariate analysis. Reliability and accuracy of both devices were also tested in a clinical setting. The intra-class correlation coefficient (ICC) was calculated for all assessments of reliability. Good agreement was observed for replicate measurements (ICC > 0.9), for inter-examiner reliability of the ES-A and ES-C (ICC > 0.9), and for inter-device agreement (ICC > 0.9). Univariate analysis revealed that ∆E values for the spectrophotometers were consistent (p = 0.783); spectroradiometrically measured ∆E was comparable, but the mean value was smaller than that for the spectrophotometers (p = 0.004). Clinical inter-device agreement was acceptable to high (ICC > 0.777). The accuracy of the ES-A was higher than that of the ES-C (p = 0.001). Within the limitations of the experiment, the spectrophotometers tested enabled reliable and accurate measurement. In the clinical setting, however, the ES-A seems more accurate. ES-C and ES-A can be valuable tools for the determination of tooth colors. Because of their good reliability, they should especially be used for the assessment of tooth color changes over time.

The purpose of this study was to compare plaque adhesion, tissue reaction, and technical complications for complete dentures based on visible light-cured resin (VLCR) or on conventional poly(methyl methacrylate) (PMMA). A stratified randomized cohort study was designed with 52 patients treated with a complete denture in the maxilla (n = 28), the mandible (n = 2), or both (n = 22). Seventy-four dentures were manufactured, 38 of PMMA and 36 of VLCR. Investigators and patients were unaware of the nature of the denture base material. Plaque adhesion, tissue reaction, and technical complications were investigated 4 weeks after denture insertion (baseline). Recall investigations were performed after 6, 12, and 24 months. After 6, 12, and 24 months, plaque adhesion was significantly higher for VLCR dentures than for PMMA dentures. Tissue reaction was comparable for both groups, however. After 6, 12, and 24 months, need for repair was significantly greater for VLCR prostheses. The mean number of additional aftercare sessions per patient after 24 months was 50 % higher for VLCR than for PMMA. Good oral hygiene must be established by patients treated with VLCR dentures, to remove biofilm from these dentures. Increased aftercare must also be taken into account when this material is used. VLCR might be a viable alternative to PMMA for patients with allergic reactions to residual monomer or benzoyl peroxide.

Keloids are benign fibrous proliferations, histologically characterized by excessive deposition of dermal collagen in a frequently mucinous matrix, due to increased collagen synthesis in fibroblasts and decreased collagen degradation. Although keloids are benign, they mean a substantial cosmetic disfigurement to the patients, especially if they occur on the ears, leading to a reduction of patients’ quality of life. In addition, they can be itchy and painful.

Because of its good matching performance the VITA 3D-Master shade guide (3D) is frequently used for determination of tooth color. Numerous composites/ceramics are, however, available in VITA Classical (VC) shades only. The objective of this study was to investigate the possibility of performing a shade match with 3D Master and converting this result via a table in a VC shade (indirect method) without this resulting in an apparent inferior shade matching in comparison with direct shade matching with the VC.Experiments were performed with an artificial, computer-generated tooth color space. Conversion tables were generated by calculating the color difference (ΔE) between a 3D shade and the closest VC shade (simple conversion table) and with the aid of optimization procedures. Statistical differences between the direct and indirect methods and between the indirect methods were assessed by use of a U-test.Median ΔE was 2.38 for direct matching with the VC and 2.86 for indirect matching by use of a simple conversion table (p0.01). Optimized tables performed slightly better (median ΔE = 2.81).Within the limitations of the study, it is usually possible to determine tooth color with the 3D and convert it, via a table, into a VC shade without adding a clinically apparent error to the direct shade match with the VC.

Oral hygiene and health of the institutionalized elderly are frequently described as inadequate.This randomized and single-blinded (outcome evaluation) study compared three types of intervention for improving oral hygiene with a control. The purpose was to investigate whether there were any significant differences between the intervention and control groups.One hundred and six participants living in long-term care homes in South-West Germany were recruited and randomly divided into four groups-three therapy groups and one control group. For all three therapy groups, teeth and dentures were cleaned professionally and individual instruction was given. One of these groups was also re-instructed and remotivated by a dentist (n = 27). One also received help from, and was remotivation by, staff educated in dental hygiene (n = 26). The third therapy group was not remotivated after professional cleaning of teeth and dentures (n = 26). For the control group, there was no intervention (n = 23). The main target clinical data were mean plaque (plaque-control record, O'Leary), gingival bleeding (Ainamo/Bay), and denture hygiene indices. For assessment of the difference between being in an intervention group and in a control group, mixed-model analysis for repeated measurements was performed for each main target variable. In addition, target clinical data were evaluated in long-term follow-up after 3 years.Compared with controls, denture hygiene, plaque, and gingival bleeding indices were significantly lower in the intervention groups over a twelve-week period (mixed model for repeated measurements; P0.023). Estimates of effects between control and each treatment group were comparable among the three therapy groups; however, even though two of the groups received further help and instruction. Long-term follow-up showed that all indices were significantly worse than at the last study recall (P0.001).Professional cleaning of teeth and dentures, with individual instruction, can be recommended to improve oral hygiene. However, the effect decreases over time and renewal of the intervention is necessary.

Patients with dermatological diseases often have associated psychological problems. For patients with allergic diseases, only a few publications have focused on psychological aspects. The objective of this study was to assess the psychometric profile, including somatization, depression, anxiety and health-related quality of life (HRQoL), of patients suffering from drug intolerance or hymenoptera venom allergies. In a prospective cohort study design, patients who were admitted to hospital for a challenge test for an alternative drug (n = 49, 24.5% men) or for induction of desensitization therapy with hymenoptera venom (n = 58, 37.9% men) were included. Psychometric screening questionnaires focusing on somatization (Symptom Check List), depression and anxiety (Hospital Anxiety Depression Scale), and also on HRQoL (Short Form questionnaire) were assessed. The scores were compared with population scores and between the two groups. Both groups had significantly higher somatization scores (P ≤ 0.003) than the normal population, and the challenge-test group had lower HRQoL than the normal population. Between-group analysis revealed significantly higher somatization scores in the challenge-test group (P = 0.011) and more impaired HRQoL (physical health domain P0.001). Anxiety/depression scores were not significantly different from those of the normal population, or between groups, although abnormally high scores for anxiety were frequent (18% and 12% for the challenge-test and allergy groups, respectively). Somatization, reduced HRQoL and anxiety seem to be part of the symptoms of patients with allergic diseases, especially for patients with drug intolerance. Standardized questionnaires could help to discover patients who may need psychological support. This may help to improve the patients' symptoms and quality of life.

Background: Ear keloids continue to be a therapeutic challenge. Objective: To evaluate the clinical success of a modified “oyster splint technique.” Methods: Ten patients with an ear keloid agreed to receive the compression therapy. After surgical removal, a compressive device made of acrylic resin was applied on top of a silicone gel sheet and patients were asked to wear the splint 23 hours a day for at least 8 months. If the scar showed a tendency to grow, corticosteroids were injected intralesionally. In addition to recurrence rate, other parameters and wearing times were obtained by an interview. Results: Two of 10 patients experienced a recurrence in a mean follow-up period of 18.2 months (range 4–44 months). The daily wearing time of the compression splint was critical for the success of the treatment ( p = .022). The splint had to be worn at least 10 hours a day for a minimum of 8 months to prevent recurrence. However, the need for additional intralesional steroid injections was significantly lower in patients wearing the splint for more than 20 hours per day ( p = .048). The splint treatment was painless for 80% of patients. The therapeutic result was given a median mark of 1.75 (1 = best, 6 = worst). Conclusion: Although it requires considerable time and effort, the technique seems to be a promising therapy.