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OBJECTIVE The aim was to evaluate edentulous patient's willingness to accept or refuse the offer and provision of implant-retained treatment. METHODS As part of a clinical trial, edentulous subjects were offered a mandibular overdenture retained by four mini-implants opposing a conventional maxillary denture. Treatment was offered without any financial costs for the patients. Patients' level of interest in receiving treatment was assessed using a 5-point Likert scale and they were asked to respond to a list of reasons that led to their decision to accept or refuse implants. Those who refused implants received conventional prosthodontic interventions as required, and those who accepted implant treatment underwent surgical planning and implant placement. RESULTS Of 175 eligible subjects, 147 accepted the offer of treatment and were invited to take part in the study (69.4% women, mean age 67.4±10.0 years). Overall, 111 patients (75.5%) expressed a positive intention to undergo implant treatment at the initial contact. Implant treatment was performed for 56.3% (9/16) of those who answered "probably yes" about their level of interest in implant treatment on the Likert scale, and 69.6% (64/92) of "certainly yes" (p

OBJECTIVE To report the 1-year implant survival/success and peri-implant outcomes of mandibular overdentures retained by four titanium-zirconium mini implants (Straumann® Mini Implant System), and to assess how surgery and loading protocols influence these outcomes. MATERIALS AND METHODS A 2 × 2 factorial randomized clinical trial (RCT) tested the combined effects of two loading protocols (immediate or delayed) and two surgical approaches (flapless or flapped) on the success/survival of the mini implants, and peri-implant parameters (plaque, bleeding, sulcus depth, gingival position, and marginal bone loss). Outcomes were assessed up to 1-year after loading, and generalized estimating equations (GEEs) were used to analyze longitudinal and within-patient clustered data. RESULTS Two hundred and ninety-six implants were placed in 74 patients. The implant survival/success rates after 1 year were 100%, and no major biological complications were observed. After 1-year, descriptive data suggest no noticeable changes in plaque scores, whilst a reduction in bleeding scores at the 6-month and 1-year follow-ups compared to baseline. Good longitudinal stability was observed for the probing depth and gingival margin height measures. Overall mean marginal bone loss was 0.68 (±0.68) mm after 3 months and 0.89 (±0.75) mm after 1-year. The flapless protocol showed better results on soft tissue stability and health but a slightly higher risk for marginal bone loss. CONCLUSION The results of this RCT suggest that mandibular overdentures retained by this novel mini implant system represent a safe and predictable treatment option as confirmed by implant survival/success and peri-implant outcomes, even when flapless surgery and immediate loading protocols are adopted.

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

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

Purpose: To assess the effectiveness of converting a conventional mandibular denture (CMD) into a single-implant mandibular overdenture (SIMO). Materials and Methods: Edentulous subjects received a new set of CMDs and were randomly assigned to CMD or SIMO groups. For SIMO patients, a midline, early loaded implant was placed and incorporated into the CMD after 3 weeks. Patient satisfaction and oral health–related quality of life were assessed at baseline and up to 1 year. Regression models were constructed using generalized estimating equations. Results: After 12 months, 32 patients were assessed (CMD: n = 17; SIMO: n = 15). Significant improvement was observed for the SIMO group when compared to baseline measures. Conclusion: SIMO may be considered an effective alternative for patients unsatisfied with their CMDs.

Objectives: 1) Explore the challenges of providing daily oral care in care homes; 2) Understand oral care practices provided by care home staff; 3) Co-design practical resources supporting care home staff in these activities.\ud Methods: Three Sheffield care homes were identified via the ‘ENRICH Research Ready Care Home Network’ and three to six staff per site were recruited as co-design partners. Design researchers led three co-design\ud workshops exploring care home staff’s experiences of providing daily oral care, including challenges, coping strategies and the role of current guidelines. New resources were prototyped to support the use of guidelines\ud in practice. The design researchers developed final resources to enable the use of these guidelines in-practice-in-context.\ud Findings: Care home staff operate under time and resource constraints. The proportion of residents with dementia and other neurodegenerative conditions is rapidly increasing. Care home staff face challenges when\ud residents adopt ‘refusal behaviours’ and balancing daily oral care needs with resident and carer safety becomes complex. Care home staff have developed many coping strategies to navigate ‘refusal behaviours’.\ud Supporting resources need to ‘fit’ within the complexities of practice-in-context.\ud Conclusions: The provision of daily oral care practices in care homes is complex and challenging. The co-design process revealed care home staff have a ‘library’ of context-specific practical knowledge and coping strategies.\ud This study offers insights into the process of making guidelines usable for professionals in their contexts of practice, exploring the agenda of implementing evidence-based guidelines.

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

Background Evidence for interventions promoting oral health amongst care home residents is weak. The National Institute for Health and Care Excellence (NICE) guideline NG48 aims to maintain and improve the oral health of care home residents. A co-design process that worked with residents and care home staff to understand how the NG48 guideline could be best implemented in practice has been undertaken to refine a complex intervention. The aim of this study is to assess the feasibility of the intervention to inform a future larger scale definitive trial. Methods This is a protocol for a pragmatic cluster randomised controlled trial with a 12-month follow-up that will be undertaken in 12 care homes across two sites (six in London, six in Northern Ireland). Care homes randomised to the intervention arm (n = 6) will receive the complex intervention based on the NG48 guideline, whilst care homes randomised to the control arm (n = 6) will continue with routine practice. The intervention will include a training package for care home staff to promote knowledge and skills in oral health promotion, the use of the Oral Health Assessment Tool on residents by trained care home staff, and a ‘support worker assisted’ daily tooth-brushing regime with toothpaste containing 1500 ppm fluoride. An average of ten residents, aged 65 years or over who have at least one natural tooth, will be recruited in each care home resulting in a recruited sample of 120 participants. Assessments will be undertaken at baseline, 6 months and 12 months, and will include a dental examination and questionnaires on general health and oral health administered by a research assistant. A parallel process evaluation involving semi-structured interviews will be undertaken to explore how the intervention could be embedded in standard practice. Rates of recruitment and retention, and intervention fidelity will also be recorded. A cost-consequence model will determine the relevance of different outcome measures in the decision-making context. Discussion The study will provide valuable information for trialists, policymakers, clinicians and care home staff on the feasibility and associated costs of oral health promotion in UK care homes. Trial registration ISRCTN10276613. Registered on 17th April 2020. http://www.isrctn.com/ISRCTN10276613.

Purpose The aim of this study was to evaluate patients' economic preferences for two different tooth replacement strategies for the edentulous mandible namely conventional complete dentures (CCDs) and implant overdentures supported by two implants (IODs), using a willingness-to-pay (WTP) analysis.Methods Twenty-six elderly patients who had been rehabilitated with either a mandibular CCD or IOD were invited to participate in this study. All participants were provided with the details of the two treatment protocols, including advantages, disadvantages, and treatment costs. The patients were then asked to indicate their maximum WTP values for each protocol using a payment card method for contingency evaluation.Results Fifteen patients with mandibular CCD (CCD-Group) and 12 patients with IOD (IOD-Group) participated in the study. Overall, the median and maximum WTP values recorded for IOD therapy were significantly higher than those for CCD therapy (p

Objective: The aim of this study was to assess the influence of patient characteristics on edentulous subjects’ preferences for different prosthodontic treatments with implants. Materials and Methods: A cross-sectional study was carried out with 131 edentulous subjects referred for treatment at a university clinic. Participants received detailed information about available treatment options, and were asked to rank their preferences among three alternatives for rehabilitation of the maxilla and mandible: conventional dentures (CD), 2-implant retained overdentures (IOD) or 4-implant fixed dentures (IFD). Individual data and prosthodontic-related variables were assessed through interviews. Oral health-related quality of life impacts were measured using the Brazilian version of the Oral Health Impact Profile for edentulous subjects (OHIP-Edent). Descriptive statistics, bivariate tests, and binary and multinomial logistic regressions were used for data analysis. Results: The majority of participants chose CD as their most preferred treatment for the maxilla (45.8%), while IFD was the most prevalent choice for the mandible (38.9%). Regression analysis showed that the OHIP-Edent “oral pain and dysfunction” (OPD) domain scores were positively associated with IOD preference for the maxilla (OR=1.31; p=0.010) and mandible (OR=1.46; p=0.002), and with IFD preference for the mandible (OR=1.20; p=0.031). Subjects with lower levels of formal education and those with lower income levels were less likely to choose IFD. Conclusion: Level of education, income and perceived quality of life impacts are potentially predictive variables of edentulous patients’ preference for rehabilitation with implants. These factors may constitute important aspects to be considered by clinicians when treatment planning for edentulous patients.

Objective: This study compared the clinical time spent and the costs incurred whilst constructing complete dentures (CDs) using a two-visit digital-denture protocol with the conventional complete denture protocol, in a university setting. Methods: Twelve undergraduate final-year dental students utilized both the digital denture protocol and the conventional complete denture protocol to construct two sets of CDs for patients requiring either an upper CD opposing a partial natural dentition restored using a partial removable prosthesis [Group#1: students: n = 6, upper CD: n = 12 (6-digital complete dentures +6-conventional complete dentures)] or both upper and lower CDs [Group#2: students: n = 6, upper and lower CDs: n = 24 (12-digital complete dentures+ 12-conventional complete dentures)]. Overall time spent and costs (clinical, materials, and laboratory) were calculated. A cost minimization analysis was performed to compare the economic costs of the two protocols. Paired t-tests were applied for the statistical analyses (p

A técnica de cópia de próteses totais (PT), reconhecida como “copy denture”, tem como principal benefício potencializar uma rápida adaptação ao novo par de próteses, uma vez que este irá possuir um formato já conhecido pelo paciente, mantendo tanto a posição dos dentes quanto sua dimensão vertical de oclusão. Apesar de haver relatos na literatura, esta técnica é pouco difundida e, muitas vezes, não é considerada como opção de tratamento em casos de pacientes idosos com maiores dificuldades potenciais de se adaptarem a novas próteses totais. Desta forma, o objetivo deste relato de caso é descrever o tratamento com próteses totais maxilar e mandibular utilizando-se a técnica de cópia. A primeira etapa consistiu na inclusão das próteses existentes em silicone extra duro laboratorial, seguido da confecção da base de prova com resina acrílica auto-polimerizável invertida no molde de silicone e, por último, o preenchimento da porção dentada do molde com cera 7 aquecida em fase líquida. A cópia em cera da prótese foi utilizada para averiguação em boca da relação maxilomandibular, do padrão oclusal, da dimensão vertical de oclusão (DVO) e também para realização da moldagem funcional com silicone de adição fluido. Os modelos de trabalho foram confeccionados e o conjunto foi montado em articulador semi ajustável para montagem dos dentes em cera. Em seguida, foi realizada a prova dos dentes em cera e verificação da oclusão, suporte de lábio e corredor bucal. Com a aprovação da paciente, as PTs seguiram para etapa de acrilização. Após instalação das próteses e finalização do tratamento reabilitador a paciente relatou uma mudança significativa na retenção e estabilidade de suas novas próteses, além de conforto e facilidade em se adaptar com o novo par de próteses. O caso foi acompanhado por 6 meses sem o surgimento de novas lesões em mucosa ou queixas da paciente. A técnica de cópia de próteses totais (“copy denture”) demonstrou ser um método de confecção de PTs simplificado, com reduzidas etapas clínicas e laboratoriais, sendo uma possível alternativa à técnica convencional, especialmente para pacientes idosos que apresentam próteses totais sem alterações significativas.

BackgroundIn recent years, the single-implant mandibular overdenture (SIMO) has been proposed as an alternative to more complex overdenture designs as a simplified implant intervention for edentulous patients.ObjectiveThe aim of this study was to run a cost-effectiveness analysis alongside a randomized clinical trial comparing the SIMO and the conventional complete denture (CCD) treatment. Imediately loaded external hexagon implant and ball attachment were used for the overdenture goup. Direct costs related to therapies were identified and valuated throughout a 1-year period after delivery, in Brazilian currency (R$) and converted into international dollars (I$) using purchase power parity exchange rates. Treatment effectiveness was measured using the OHIP-Edent and satisfaction scores for calculation of incremental cost-effectiveness ratios (ICER).ResultsOutcomes were assessed at the 1-year follow-up for 65 patients (CCD=34; SIMO=31). Overall OHIP-Edent and satisfaction scores improved significantly in the SIMO group, while remained unchanged in the CCD group. The mean overall costs were R$1,179.04 (I$590.99) for the CCD group and R$2,127.91 (I$1,068.20) for the SIMO group – 80.7% incremental cost for SIMO. The ICER calculation for SIMO treatment showed a mean cost of I$48.20 for 1-point reduction in OHIP-Edent scores, and I$12.56 for 1-point increase in satisfaction score.ConclusionsFindings support the effectiveness of this simplified and low-cost implant intervention for edentulous patients. SIMO also seems a cost-effective alternative to the CCD and the relatively low incremental cost may potentially increase the utilization of dental implants among older subjects, especially those with limited financial resources.Clinical significanceThe immediately loaded single-implant mandibular overdenture was superior to the conventional complete denture in terms of patient-reported outcome measures at a low incremental cost.

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

Objectives To compare the success of two different tooth replacement strategies for partially dentate older adults; namely resin bonded bridgework (RBB) provided to restore patients according to the principles of the shortened dental arch concept (SDA) and conventional full-arch rehabilitation with removable dental prostheses (RDPs). Methods A randomised controlled clinical trial (RCT) was conducted with partially dentate adults aged 65 years or older. Each patient from the RDP group had all missing natural teeth replaced with cobalt–chromium framework RDPs. Each patient from the SDA group was restored to 10 occluding pairs of natural and replacement teeth using RBB. Patients were followed-up at 6, 12, 24, 36 months. Success rates were generated according to defined success criteria. Log-rank tests and Cox’s proportional hazard models were used to compare the success of the two treatment strategies. Results After 36 months, 89 patients completed the RCT; n = 45 in the RDP group and n = 44 in the SDA group. The overall success rate of the SDA treatment was 90.4% compared to 73.0% for RDPs (p = 0.005). In the upper arch SDA treatment was 100% successful compared to 86.4% for RDPs (p = 0.019). In the lower arch, lower success rates were reported for both the SDA treatment (80.0%) and RDPs (60.0%) (p = 0.054). Further analyses with cox’s proportional hazard models demonstrated that SDA treatment was significantly more successful than RDPs (Hazard Ratio: 2.47, p = 0.04). Conclusions After 36 months SDA treatment using RBB was significantly more successful than RDPs used for conventional full-arch rehabilitation in partially dentate older adults. Clinical significance Functionally orientated treatment according to the principles of the SDA is a feasible alternative to RDPs for partially dentate older patients. SDA treatment using RBB can achieve higher success rates compared to RDPs in this patient group.

Background: There is scarce data regarding the combined assessment of the costs and effects of implant treatments for edentulous patients when multiple options are available. Aim: This randomized clinical trial aimed to assess the cost-effectiveness of three different concepts for treatment: mandibular overdenture retained by a single (Group I; n=11) or two implants (Group II; n=13), and fixed hybrid prosthesis on four implants (Group III; n=13). Methods: Treatment effectiveness was measured as the 1-year before-after changes in patient satisfaction with the mandibular prosthesis. Costs were prospectively quantified from the perspective of the health provider, including all direct cost items attributed to the delivery of treatments and up to the 1-year follow-up, using a “bottom-up” costing estimation method. Results: Patient satisfaction after treatment improved significantly for the three groups. The overall costs were R$ 2,370.66, R$ 3,185.21, and R$ 5,739.52 for Groups I, II and III, respectively (p

Background Oral healthcare service provision for dependent older adults is often poor. For dental services to provide more responsive and equitable care, evidence-based approaches are needed. To facilitate future research, the development and application of a core outcome set would be beneficial. The aim of this study is to develop a core outcome set for oral health services research involving dependent older adults. Methods A multi-step process involving consensus methods and including key stakeholders will be undertaken. This will involve identifying potentially relevant outcomes through a systematic review of previous studies examining the effectiveness of strategies to prevent oral disease in dependent older adults, combined with semi-structured interviews with key stakeholders. Stakeholders will include dependent older adults, family members, carers, care-home managers, health professionals, researchers, dental commissioners and policymakers. To condense and prioritise the long list of outcomes generated by the systematic review and semi-structured interviews, a Delphi survey consisting of several rounds with key stakeholders, as mentioned above, will be undertaken. The 9-point Likert scale proposed by the GRADE Working Group will facilitate this consensus process. Following the Delphi survey, a face-to-face consensus meeting with key stakeholders will be conducted where the stakeholders will anonymously vote and decide on what outcomes should be included in the finalised core outcome set. Discussion Developing a core set of outcomes that are clinically and patient-centred will help improve the design, conduct and reporting of oral health services research involving dependent older adults, and ultimately strengthen the evidence base for high-quality oral health care for dependent older adults. Trial registration The study was registered with the COMET initiative on 9 January 2018 http://www.cometinitiative.org/studies/details/1081?result=true.

Objectives To gain a consensus from consultants in restorative dentistry about the types of teeth that should be extracted from head and neck cancer patients (HNC) pre-radiotherapy. Materials Literature- and clinician-informed questionnaires were emailed to an ‘expert panel’ of consultants (n = 24/28; 86%) in the United Kingdom (UK) and Ireland on three consecutive occasions (Delphi rounds). The results of Round 1 were used to revise the questionnaire that was distributed in Round 2, and this procedure was repeated for Round 3. During Rounds 2 and 3, participants were asked to indicate, on a 5-point Likert scale, their level of agreement with a series of statements on the types of teeth that should be extracted pre-radiotherapy. The target level of consensus for each statement was 70%. Results In Round 2, there was consensus-agreement for 69 of 102 statements (i.e. ≥ 70% of participants rated ‘agree’ or ‘strongly agree’ to the relevant statement). Consensus agreement was also achieved for 20 of 28 statements in Round 3. Therefore, a total of 89 consensus statements are presented that illuminate the decision-making process for the pre-radiotherapy extraction of molar, premolar, and anterior teeth with periodontal pocketing, furcation disease, mobility, caries, tooth-wear, apical disease, or other pathology. Conclusion The statements represent the consensus professional views of participated consultants in restorative dentistry in the UK and Ireland regarding the types of teeth that should be extracted from HNC patients pre-radiotherapy. The results provide a platform for the development of future guidelines. Clinical Significance Pre-radiotherapy dental assessments for head and neck cancer patients are considered mandatory. This study presents different criteria that should be considered for the treatment planning of these patients in relation to pre-radiotherapy extractions, according to the collective consensus opinion of participated consultants in restorative dentistry in the UK and Ireland.

Introduction:Full nutritional assessments are currently complex and invasive. There is a need for a non-invasive, timely and cost-effective method to assess nutritional status. Evidence indicates the usefulness of saliva in diagnosing oral or systemic disorders. Saliva is suggested to be a reliable and non-invasive matrix in which to measure nutritional biomarkers. The aim of this work was to systematically review the evidence for salivary biomarkers as indicators of nutritional status.Materials and Methods:Studies identifying salivary biomarkers in relation to nutritional status or dietary intake outcomes were included. A search strategy combined terms “saliva” AND “biomarkers” AND “nutrition”. Four databases were searched, MEDLINE, EMBASE, Web of Science and Scopus. All study designs conducted in humans of all ages, from all countries and settings were included. Non-English and animal studies were excluded. Risk of bias was assessed using the Newcastle-Ottawa Scale and Cochrane Risk of Bias tool where applicable. (PROSPERO Registration Number:CRD42018107667)Results:6585 papers were identified, 4836 papers remained after removing duplicates, 4715 were irrelevant, 134 full-texts were assessed for eligibility and 64 papers included in the final analysis. A number of potential salivary biomarkers related to nutritional status were identified including: total protein, albumin, prealbumin, transferrin, ferritin and iron. Total protein levels in saliva in malnourished individuals were significantly different to controls in 7/10 studies (70%). In one study conducted in individuals with iron deficiency anaemia (IDA), total protein was significantly different to controls. Albumin levels in malnourished individuals were significantly different to controls in 5/8 studies (62.5%). Prealbumin and transferrin levels in malnourished individuals were significantly different to controls in 3/3 studies (100%). In one study conducted in malnourished individuals, salivary ferritin levels was significantly different to controls. Ferritin levels in individuals with IDA were significantly different to controls in 3/3 studies (100%). Iron levels in individuals with IDA were significantly different in 2/2 studies (100%). However, even within the studies above where significant differences existed, the direction of salivary biomarker differences was sometimes inconsistent. For example, total protein in malnourished individuals was significantly lower than controls in three studies, higher in three studies and one showed mixed findings. In addition, overall the quality of evidence available was very poor.Discussion:Despite conflicting evidence in salivary nutritional biomarkers in individuals with malnutrition or IDA, saliva may be a useful non-invasive matrix to assess nutritional status. Further high quality research exploring the utility of these biomarkers is required.

OBJECTIVES: This study investigated whether oral health status, defined as number of natural teeth and subsequent prosthodontic rehabilitation, was associated with future dietary intake and diet quality in older adults in The Prospective Epidemiological Study of Myocardial Infarction (PRIME).METHODS: PRIME was originally established to explore cardiovascular risk factors in 50-59 year old men in Northern Ireland (1991-1994). A rescreening phase assessed oral health (2001-2004), while diet was assessed in 2015. Diet quality was characterised by the Dietary Diversity Score and Mediterranean Diet Score. In the current analysis, associations between oral health status, dietary intake and quality were assessed using regression models in 1096 participants.RESULTS: Amongst study participants, the overall mean number of teeth was 18.5, 51.5 % had ≥21 natural teeth and 49.6 % wore dentures. Oral health status was categorised into five groups: 21-28 teeth with (n = 111) and without (n = 453) dentures, 1-20 teeth with (n = 354) and without (n = 99) dentures and edentate with dentures (n = 79). After full adjustment, men with ≥21 teeth and dentures had a higher future intake of fruit, vegetables, and nuts, and diet quality scores, compared to those with CONCLUSIONS: Having ≥21 natural remaining teeth positively affected the future intake of fruit, vegetables, and nuts, as well as diet quality. Dentures may be beneficial in men with ≥21 natural remaining teeth, as they were associated with an increased future intake of fruit, vegetables, and nuts and better diet quality.CLINICAL SIGNIFICANCE: Oral health status is associated with dietary intake, after an average time period of 13 years, with those with a larger number of natural teeth having a better diet quality. Further research is required to investigate this relationship in larger, diverse populations with more detailed dietary assessment.

Post-radiotherapy head and neck cancer patients are at increased risk of dental caries due to radiotherapy-induced salivary gland hypofunction and radiation-damage to tooth structure. Dental caries may cause pain and discomfort, and is likely to have a detrimental impact on patients’ quality of life. This systematic review appraised and synthesised best available evidence regarding the incidence and severity of post-radiotherapy dental caries in head and neck cancer patients. Six databases and two trial registries were searched from their inception to May 2019. A total of 22 papers met the inclusion criteria. The pooled percentage of patients that developed dental caries post-radiotherapy was 29% (n = 15 studies; 95% CI 21%, 39%; I2 = 88.0%). Excluding studies with longer than two years follow-up, the pooled percentage was 37% (n = 9 studies; 95% CI 25%, 51%; I2 = 88.6%). Meta-regression analysis revealed that studies with a higher mean/median radiotherapy dose exposure, had an increased incidence of dental caries (p = 0.02). Furthermore, studies with a higher proportion of patients treated with chemotherapy in addition to radiotherapy, had an increased incidence of dental caries (p = 0.02) after the exclusion of an outlier. It is important to be mindful of the high degree of observed heterogeneity and the inclusion of a large number of non-randomised studies. Data regarding the number of carious teeth, the number of carious tooth surfaces, and the number of carious lesions developed post-radiotherapy was unsuitable for meta-analysis. There is a need for well-designed research studies to improve understanding of dental caries-risk in post-radiotherapy head and neck cancer patients.

OBJECTIVES: To explore the long-term impact for patients living with an obturator prosthesis, following a maxillectomy for a head and neck neoplasm.METHODS: A qualitative approach was employed, using semi-structured interviews. A purposive sample of eight men and four women, living with an obturator prosthesis for at least five years, were recruited. Interviews were digitally recorded and transcribed. Using thematic analysis, two researchers analysed the data.RESULTS: The data were categorised into four themes: 1. Preparedness for living with an obturator, 2. Impact of living with an obturator - what changes to expect, 3. Stability and retention of the obturator, and 4. Coping strategies to aid adjustment. Long-term effects of living with an obturator spanned many aspects of life to include: chewing and eating, speaking, dealing with nasal leakage and altered body image, employment and intimacy issues, along with embarrassment during social encounters. Optimal retention and stability of the obturator, as perceived by the patient, lead to improved social confidence and engagement. The emotional impact varied greatly on peoples' lives.CONCLUSIONS: Patients experiencing the greatest long-term challenges had larger defects, were of employment age and had not returned to work. Gaining an improved understanding of the psychology of coping overtime is clearly important, as this can inform interventions to facilitate adjustment for those who are emotionally struggling. Furthermore, the findings of this study could inform the design of a communication tool to facilitate shared-decision making and aid preparedness for living with an obturator following a maxillectomy.CLINICAL SIGNIFICANCE: The multidisciplinary head and neck team should provide patients with detailed pre-operative information, including potential effects on social, work and personal relationships. The restorative dentistry team has a pivotal role in the long-term management of these patients, as obturators have a finite lifespan with ongoing maintenance necessary to promote optimal retention and stability.

Key Clinical Message This case report outlines a conservative treatment approach utilised in the management of a patient with a transverse left sided mandibular asymmetry, in an attempt to obtain functional and aesthetic occlusion, using removable intraoral prostheses. AbstractA small degree of facial and dental asymmetry is a common finding and is normal in the facial dynamics of the population. In some cases, facial asymmetries can be more obvious and can lead to functional and aesthetic concerns. Management of these patients can be very challenging.

OBJECTIVES This review compared Computer-aided designand Computer-aided manufactured (CAD-CAM) and conventionally constructed removable complete dentures (CDs). DATA Seventy-three studies reporting on CAD-CAM (milled/3D-printed) CDs were included in this review. The most recent literature search was performed on 15/03/2021. SOURCES Two investigators searched electronic databases [PubMed (MEDLINE), Embase, CENTRAL], online search engines (Google) and research portals. Hand searches were performed to identify literature not available online. STUDY SELECTION Studies on CAD-CAM CDs were included if they reported on trueness of fit, biocompatibility, mechanical, surface, chemical, color , microbiological properties, time-cost analysis, and clinical outcomes. Inter-investigator reliability was assessed using kappa scores. Meta-analyses were performed on the extracted data . RESULTS The kappa score ranged between 0.897-1.000. Meta-analyses revealed that 3D-printed CDs were more true than conventional CDs (p��=��0.039). Milled CDs had a higher flexural-strength than conventional and 3D-printed CDs (p��

Successful root canal treatment requires management of the bacterial infection within the root canal space and protection of residual tooth structure with direct/indirect restorations. Long-term success depends upon prevention of re-infection of the root canal space as well as ensuring favourable distribution of the occlusal forces throughout the residual tooth structure. Appropriate planning and design of the final restoration prior to initiating root canal treatment is paramount in achieving this objective. This article describes simultaneous restorability assessment and access cavity preparation to optimize outcome of both endodontic and prosthodontic treatment of the endodontically involved tooth. CPD/Clinical Relevance: This paper proposes a method to improve visibility and reduce iatrogenic errors whilst simultaneously facilitating effective design of the definitive restoration based on the quantity and distribution of residual tooth structure.

Special care dentistry (SCD) provides holistic oral service provision for people with complex health and care needs. These can include physical, sensory, intellectual, mental, medical, emotional or social impairment or disability or, more often, a combination of these factors. The level of disability within these population groups can vary, and a proportion of people will have multiple and overlapping impairments and/or medical conditions. This paper explores a number of possible research methods that may better reflect the diversity and challenges of this population group, where the emphasis is placed on co-production and co-design.

As natural teeth are lost, many older adults choose softer foods lacking in essential micronutrients and fiber, yet replacing missing teeth alone does not positively influence diet. Dietary intervention in combination with treatment to replace missing teeth is increasing, though understanding of effective intervention components is limited. This systematic review synthesized literature relating to oral rehabilitation coupled with dietary intervention in adults. The primary outcome was dietary intake; secondary outcomes pertained to oral health and dietary intervention characteristics including: theoretical basis and behavior change techniques (BCTs). MEDLINE, Web of Science, PubMed and CENTRAL were searched. Nine studies were included. Study designs were heterogeneous involving 526 participants. Narrative synthesis identified improvements in at least one aspect of participants’ oral health (i.e. biting/chewing) alongside at least one positive diet/nutrition outcome post-intervention for all studies. F/V results were pooled for three studies using meta-analysis techniques resulting in a standardized mean difference (SMD) of 0.29 [CI −0.54, 1.12], p = 0.49, but with marked heterogeneity (p = 0.0007). Few interventions were theory-based and intervention components were poorly described. Overall, narrative synthesis indicated support for dietary intervention coupled with oral rehabilitation on diet. Meta-analysis was only possible with three studies highlighting limitations. Large-scale, appropriately described trial methodologies are needed.

OBJECTIVES: This study developed and tested a habit-based tailored dietary intervention, in conjunction with oral rehabilitation amongst partially dentate older adults. METHODS: A randomised controlled trial was conducted on 56 patients recruited from the Centre for Dentistry, Queens University Belfast (mean age = 71.8 years). Participants were randomised to an intervention group (habits-based dietary intervention) or a control group and followed up for 8 months. The intervention group attended four meetings with a trained researcher to discuss individual areas of their dietary intake (fruit/vegetables, wholegrains, healthy proteins). Habit formation was assessed using the Self-Report Behavioural Automaticity Index (SRBAI) and the primary outcome measure was self-reported automaticity for healthy food choices. RESULTS: Preliminary results showed that change in automaticity and habit adherence in the intervention group for all tailored dietary habits was significant between baseline and follow up visits (P 0.05). BMI decreased in the intervention group (29.5 to 28.6 kg/m2) compared to a slight increase in the control group (27.9 to 28.0 kg/m2). There were improvements in Mini Nutritional Assessment (0.75 intervention: 0.53 control) mean change scores for both groups, however between-group differences were not statistically significant (P = 0.7). CONCLUSIONS: Based on preliminary results, this study demonstrated the success of a habit-based dietary intervention coupled with oral rehabilitation in positively influencing dietary behaviours and other nutritional outcomes in partially dentate older adults. FUNDING SOURCES: Northern Ireland HSC Research and Development Office and the Health Service Executive Awards on Ageing.

OBJECTIVES: Evidence linking oral health status with dietary intake and quality in older adults is inconsistent and limited by few prospective studies conducted to date. This study investigated whether oral health status, defined as number of natural teeth and prosthodontic rehabilitation, had an impact on future dietary intake and dietary quality in older Northern Irish (NI) men. METHODS: This study involved older men [n = 1096, mean = 63.5(2.9) years] from the Prospective Epidemiological Study of Myocardial Infarction (PRIME). A dental examination was undertaken at baseline (2001–2006) and oral health status was defined as: 21–28 teeth without dentures (n = 453), 21–28 teeth with dentures (n = 111), 1–20 teeth without dentures (n = 99), 1–20 teeth with dentures (n = 354), and edentate with dentures (n = 79). A food frequency questionnaire administered in 2015 derived intakes of major food groups and diet quality scores were characterised by the Dietary Diversity Score (DDS) and Mediterranean Diet Score (MDS). Associations between oral health status, food intake and diet quality scores were assessed using regression models adjusted for potential confounders including, age, socio-economic status, smoking and alcohol. RESULTS: In fully adjusted models, the mean dietary intake of fruit, vegetables and nuts significantly differed between oral health status groups. In comparison to edentate men with dentures, the mean fruit intake was significantly higher in each dentate group: 21–28 teeth without dentures (P = 0.001), 21–28 teeth with dentures (P = 0.001), 1–20 teeth without dentures (P = 0.04), and 1–20 teeth with dentures (P = 0.03). The mean DDS was significantly higher amongst men with 21–28 teeth without dentures, compared to those with 1–20 teeth without dentures (P = 0.001), 1–20 teeth with dentures (P

Objectives:We aimed to appraise the comparative clinical efficacy of atraumatic restorative treatment (ART) versus conventional restorative treatment (CT) using a meta‐analysis, and assessed the robustness of evidence by trial sequential analysis (TSA).Background:Due to its simplified clinical approach, ART may be advantageous over CT for restoration of root caries lesions in institutionalised older patients.Methods:Three electronic databases (PubMed, Embase and Cochrane CENTRAL) were screened, and hand searches and cross‐referencing performed to identify randomised controlled trials reporting on survival of ART vs CT for restoration of root caries in older patients. Trial selection, data extraction and risk of bias assessment were performed by two independent reviewers. ART and CT were compared using fixed‐ or random‐effects pairwise meta‐analysis for per‐protocol (PP), intention‐to‐treat (ITT) and best‐case scenarios. TSA was used to control for risk of random errors.Results:A total of 235 studies were identified, and three trials involving 130 patients (463 restorations) were included. Risk of bias was high or moderate in all but one trial. ART was associated with a significantly increased risk of failure (OR [95% CI] 2.06 [1.06/4.00]) in PP‐ but not in ITT analysis (1.36 [0.92/2.02]). Analyses for best‐case scenarios found great uncertainty introduced by attrition. No firm evidence was reached according to TSA.Conclusions:For restoration of root caries, there is insufficient data to clearly rule out whether differences between ART and CT exist. Limited available data indicate there might be an increased risk of failure for ART.

Objective: To assess the oral‐health‐related quality of life (OHRQoL) in a cohort of Irish older patients and explore associations with overall health status.Background: The impact of oral health conditions on older individuals’ quality of life may be influenced by patients’ general health status. Background: The impact of oral health conditions on older individuals’ quality of life may be influenced by patients’ general health status.Materials and Methods: This paper reports a cross‐sectional study, which analysed baseline data from patients aged over 60 years. Patients were recruited from two different environments, namely Cork University Dental Hospital and St. Finbarr’s Hospital, to take part in two research studies. All patients completed the Oral Health Impact Profile (OHIP‐14) and EuroQol‐5D (EQ‐5D) questionnaires. All patients pro‐vided a comprehensive overview of their general medical status. Data from the Quality of Life questionnaires were analysed to check for differences between healthy and frail elders and explore associations between OHRQoL and general health. Results: The patient sample comprised 146 (44.6%) male and 181 (55.4%) female participants, with a mean (SD) age of 73.96 (6.9). Frail patients reported a higher mean OHIP‐14 score compared to non‐frail patients (P < 0.001). Pearson’s correla‐tion analysis showed a negative association between OHIP‐14 and EQ‐5D scores. Regression analysis showed that among frail individuals, better general health cor‐responded to poorer OHRQoL. In the non‐frail cohort, better general health was re‐lated to better OHRQoL, although these results were not statistically significant.Conclusions: General health was not significantly associated with the way that pa‐tients perceive their oral health within this patient cohort. However, factors such as objective oral health, denture wear and patient’s expectations may play a role in this association.

Background Many factors determine dietary intake in older adults, including physical health, psychological well-being and socio-economic status. Dental status may also be important. The aim was to examine how dental status impacts perceived ability to eat to certain foods, nutrient intake and nutritional status in UK older adults. Methods Data collected by the National Diet and Nutrition Survey Rolling Programme was analysed. A 4-day food diary assessed dietary intake, while a Computer Assisted Personal Interview collected socio-demographic, health behaviour and oral health information. Participants aged 65 years and over (n = 1053) were categorised into three groups according to their dental status: edentate with dentures (E-DEN, n = 292), dentate with dentures (D-DEN, n = 305) or dentate with no dentures (DEN, n = 456). A total of 515 participants provided a blood sample that was used to assess nutrient concentrations including vitamin B12, vitamin C, ferritin, vitamin B6 (pyridoxal-5-phosphate, PLP), retinol, β-carotene and 25-hydroxyvitamin D (25-OH-D). Multiple regression methods were performed to examine cross-sectional associations between dental status, food selection, nutrient intake and nutritional status. Results Both E-DEN and D-DEN groups, compared with the DEN group, were more likely to report difficulty eating apples, raw carrots, lettuce, nuts, well-cooked steak and crusty bread (P

OBJECTIVES:to compare the survival of ART and a conventional restorative technique (CT) for restoring carious lesions in older adults after 5 years.METHODS:In this parallel randomised controlled clinical trial, 219 independently-living adults were recruited from a dental hospital/community and a geriatric day hospital. Ninety-nine patients who met the inclusion criteria and presented with carious lesions were randomly allocated to receive either ART or conventional restorations (anaesthesia, rotary instruments and resin-modified glass ionomer). The status of restorations was assessed 6 months, 1, 2 and 5 years after restoration placement. Estimates of cumulative survival were calculated for each interval between assessments and a Cox Proportional Hazards (PH) model was fitted to the interval-censored survival time.RESULTS:Three hundred restorations (ART n=142; CT n=158) were placed on 99 patients, 46 males and 53 females, with a mean age of 73.2, SD: 6.8(65-90 yrs). After 5 years, ART and CT presented cumulative probability of survival of 85% and 79% (p=0.8095), respectively.CONCLUSIONS:ART presents survival rates comparable to a conventional technique, when treating older adults after 5 years. The ART approach could be a useful tool to provide dental care for older adults particularly in the nonclinical setting. (Trial Registration number: ISRCTN 76299321).CLINICAL RELEVANCE:This study shows that ART presents survival rates comparable to conventional techniques to treat carious lesions in older patients after 5 years. It is well accepted by this age cohort, and therefore could be an alternative to treat the elderly, especially those who are homebound or cannot attend the dentist.

OBJECTIVE: Denture fracture is one of the most common complications in prosthodontics and implant overdentures are reported to be at higher risk of fractures. Therefore, the aim of this study was to assess the incidence and factors associated with the occurrence of fractures in patients treated with a single implant mandibular overdenture (SIMO) opposed by a conventional maxillary complete denture.METHODS: A cohort of 152 patients, 65.1% female and 34.9% male, mean age 65.4 ± 8.5 years, were prospectively followed-up for a minimum of 1 year and up to 6.7 years. Patients received a single midline mandibular implant with a retention system incorporated in the overdenture: Straumann ball abutment and gold elliptical matrix (n = 37), Neodent ball/nylon matrix (n = 83), or Neodent Equator/nylon matrix (n = 32). Fracture was defined as a complete separation of denture parts and classified as midline fracture (over the implant region), or elsewhere. No metal reinforcement was incorporated into the overdenture. Incidence rates, life table analysis, Kaplan-Meier, and Cox regression were used for data analysis.RESULTS: Overdenture fractures occurred in 49 patients (32.2% incidence), with repeated fractures in 16 patients. The majority of fractures were associated with function (42.6%) or due to the overdenture being dropped (36.8%). Overall incidence density was 0.14 fracture/patient/year. The risk of fracture was associated with the duration of the overdenture use (HR = 0.84; 95%CI = 0.71-0.99).CONCLUSION: Midline denture fracture was a common complication in patients receiving SIMO treatment regardless of the implant / retention system. The use of metal reinforcement may be considered to reduce the risk of recurrent fractures.CLINICAL SIGNIFICANCE: This clinical prospective study showed that single-implant mandibular overdentures are at high risk of midline fractures. Proper post-insertion monitoring and the identification and management of patient's individual risk factors are essential for the successful treatment in the long-term.

Aims/Objectives: To evaluate studies of the effectiveness of different tooth replacement strategies in adult patients with shortened dental arches (SDA). Specifically, the objectives of the proposed review are to determine the survival rates of different prosthodontic interventions; the risk of tooth loss with and without different prosthodontic interventions; and the impact of different tooth replacement strategies on oral-health related quality of life (OHRQoL). Materials and methods: The protocol has been registered with the International Prospective Register of Systematic Reviews (PROSPERO), and was developed in accordance with the guidelines of the Preferred Reporting Items for Systematic Review and Meta-analyses Protocols (PRISMA-P). Studies will be selected according to outlined eligibility criteria including types of studies, participants, interventions, comparators and outcomes. Specific search strategies will be created and data collection and analysis will be undertaken by two independent reviewers. Discussion: The review will assess the body of evidence for clinical decision making in patients with SDA and reduced dentitions, by comparing the effectiveness of different tooth replacement strategies. In addition, it will assess the influence of patients in this decision making, help to inform subsequent cost-effectiveness analyses, identify areas of further research and hopefully inform future healthcare policy.

Objectives: This review evaluated implant survival in geriatric patients (≥75 years), and/or the impact of systemic medical conditions.Materials and Methods: Systematic literature searches were performed to identify studies reporting on geriatric subjects with dental implants, and on implant‐patients who had any of the seven most common systematic conditions amongst geriatric patients. Meta‐analyses were performed on the post‐loading implant survival rates . The impact of systemic medical conditions and their respective treatment were qualitatively analyzed. Results: A total of 6893 studies were identified; of those 60 studies were included. The fixed effects model revealed an overall implant survival of 97.3% (95% CI: 94.3, 98.7; studies=7), and 96.1% (95% CI: 87.3, 98.9; studies=3), for 1 and 5 years, respectively. In patients with cardiovascular disease, implant survival may be similar or higher compared to healthy patients. High implant survival rates were reported for patients with Parkinson's disease or diabetes mellitus type II. In cancer patients, implant survival is negatively affected, namely by radiotherapy. Patients with bone metastases receiving high‐dose anti‐ resorptive therapy (ART) carry a high risk for complications after implant surgery. Implant survival was reported to be high in patients receiving low‐dose ART for treatment of osteoporosis.. No evidence was found on implant survival in patients with dementia, respiratory diseases, liver cirrhosis or osteoarthritis. Conclusions: Implant‐prostheses in geriatric subjects is a predictable treatment option with a very high rate of implant survival. The functional and psychosocial benefits of such intervention should outweigh the associated risks to common medical conditions.

Background: Across the European Union costs for the treatment of oral disease is expected to rise to €93 Billion by 2020 and be higher than those for stroke and dementia combined. A significant proportion of these costs will relate to the provision of care for older people. Dental caries severity and experience is now a major public health issue in older people and periodontal disease disproportionately affects older adults. Poor oral health impacts on older people’s quality of life, their self-esteem, general health and diet. Oral health care service provision for older people is often unavailable or poor, as is the standard of knowledge amongst formal and informal carers. The aim of this discussion paper is to explore some of the approaches that could be taken to improve the level of co-production in the design of healthcare services for older people.Main text: People’s emotional and practical response to challenges in health and well-being and the responsiveness of systems to their needs is crucial to improve the quality of service provision. This is a particularly important aspect of care for older people as felt, expressed and normative needs may be fundamentally different and vary as they become increasingly dependent. Co-production shifts the design process away from the traditional ‘top-down’ medical model, where needs assessments are undertaken by someone external to a community and strategies are devised that encourage these communities to become passive recipients of services. Instead, an inductive paradigm of partnership working and shared leadership is actively encouraged to set priorities and ultimately helps improve the translational gap between research, health policy and health-service provision. Discussion: The four methodological approaches discussed in this paper (Priority Setting Partnerships, Discrete Choice Experiments, Core Outcome Sets and Experience Based Co-Design) represent an approach that seeks to better engage with older people and ensure an inductive, co-produced process to the research and design of healthcare services of the future. These methods facilitate partnerships between researchers, healthcare professionals and patients to produce more responsive and appropriate public services for older people.KEYWORDS: older people, healthcare service design, oral health, co-production and co-creation

Objectives: With a decreased number of teeth, a reduction in chewing function can contribute to changes in food choices and ultimately impact on overall nutritional status. This study compared the impact of two tooth replacement strategies for partially dentate older patients on masticatory performance and nutritional status.Methods: Patients aged 65 years and older were randomly allocated to two different treatment groups. For the RPDP-group (removable partial dental prostheses) each participant was restored to complete dental arches with cobalt-chromium removable prostheses. For the SDA-group (shortened dental arch), participants were restored to 10 occluding pairs of natural and replacement teeth using adhesive bridgework. Masticatory performance was assessed with a colour-mixing ability test. Each patient provided haematological samples that were screened for biochemical markers of nutritional status. Patients were also assessed using the Mini Nutritional Assessment (MNA).Results: Eighty-nine patients completed the test for masticatory performance and provided blood samples and MNA scores at baseline (BL) and after 12 months (12 m). Masticatory performance (p < 0.001) and MNA (p < 0.05) increased significantly in both groups, but no significant between group differences were noted. A mixed picture was observed for nutrition biomarkers. Mixed-effect linear regression models did not demonstrate that nutritional status could be predicted from masticatory performance.Conclusions: These results indicate that prosthodontic rehabilitation according to the principles of the SDA is equivalent to RPDPs in terms of restoration of chewing capacity for partially dentate older patients. However, masticatory performance may only have minor associations with nutritional status for this patient group.Clinical significance: Replacing teeth with either RPDPs or SDA provides a prerequisite for efficient chewing. Further research is required to determine the impact of oral rehabilitation coupled with nutritional counselling for this patient population.

Objectives: The aim of Working Group 4 was to address topics related to biologicrisks and complications associated with implant dentistry. Focused questions on (a) diagnosis of peri‐implantitis, (b) complications associated with implants in augmented sites, (c) outcomes following treatment of peri‐implantitis, and (d) implant therapy in geriatric patients and/or patients with systemic diseases were addressed.Materials and methods: Four systematic reviews formed the basis for discussion in Group 4. Participants developed statements and recommendations determined by group consensus based on the findings of the systematic reviews. These were then presented and accepted following further discussion and modifications as required by the plenary.Results: Bleeding on probing (BOP) alone is insufficient for the diagnosis of peri‐implantitis. The positive predictive value of BOP alone for the diagnosis of peri‐implantitis varies and is dependent on the prevalence of peri‐implantitis within the population. For patients with implants in augmented sites, the prevalence of peri‐implantitis and implant loss is low over the medium to long term. Peri‐implantitis treatment protocols which include individualized supportive care result in high survival of implants after 5 years with about three‐quarters of implants still present. Advanced age alone is not a contraindication for implant therapy. Implant placement in patients with cancer receiving high‐dose antiresorptive therapy is contraindicated due to the associated high risk for complications.Conclusions: Diagnosis of peri‐implantitis requires the presence of BOP as well as progressive bone loss. Prevalence of peri‐implantitis for implants in augmented sites is low. Peri‐implantitis treatment should be followed by individualized supportive care. Implant therapy for geriatric patients is not contraindicated; however, comorbidities and autonomy should be considered.

Purpose To analyze the available evidence in the English, German and Japanese literature on the survival and complications of natural teeth with cast copings used to retain overdentures (ROD). Study selection A systematic search strategy was conducted using MeSH terms and pre-defined criteria. Two groups of researchers searched Pubmed, CENTRAL, Embase (English, German), Ichushi-web (Japanese) as well as hand searching. Data were extracted independently by the two groups. The estimated frequency of abutment tooth loss was calculated from data on the number of lost teeth and exposure time. A meta-analysis was conducted to estimate the annual frequency of abutment tooth loss across all included studies. Results A total of 4791 eligible studies from PubMed, Embase, and CENTRAL. An additional 316 articles were identified from the Ichushi-Web plus another 131 articles from additional sources. From those manuscripts, 19 reported relevant outcome data that was then extracted. The pooled data included a total of 1954 abutment teeth with a combined total exposure time of 9098 years. The estimated linear rate of loss was 1.76 %/year (95 %CI 1.13; 2.72). Caries and periodontal infections were identified as the most common reasons for abutment tooth loss. Conclusions Natural tooth retained overdentures often constitute the last resort before edentulism and might aid in this transition, especially in very old patients with reduced adaptive capacities. Given correct design, preparation and aftercare, RODs with cast copings, still are a valid treatment option in partially edentulous patients.