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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

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

Andreas Zenthöfer, Peter Rammelsberg, Tomas Cabrera, Alexander Jochen Hassel Department of Prosthodontics, Dental School, University of Heidelberg, 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

Objective: To evaluate intraexaminer reliability in measurement of basic tooth color by use of a clinically applicable spectrophotometer. Method and Materials: Three examiners determined the L* (lightness), C* (chroma), and h* (hue) values and tooth color according to the Vita 3D-Master shade guide system (Vident), twice for 161 anterior teeth of 19 subjects by use of a spectrophotometer (Vita Easyshade 1, Vita Zahnfabrik). Between the 2 measurements on each tooth, the investigators had to completely remove the probe tip from the mouth. The reliability of the measurements was observed, and deviations between the 2 L*C*h* measurements, as well as DEab for the measurements, were calculated. Results: Exact agreement of chosen shade tab according to the 3D-Master shade guide was achieved in 48% of cases. Mean DL*, DC*, and Dh* for all examiners were 1.9 (SD 1.7), 1.3 (SD 1.3), and 0.5 degrees (SD 0.7 degrees), respectively. The maximum deviation was 9 for DL*, 7 for DC*, and 3 degrees for Dh*. Mean DEab for the measurements was 2.7 (SD 1.8, range 0 to 9.5). Conclusion: Intraexaminer reliability was usually acceptable, although a clinically relevant difference between the 2 measurements of an examiner was occasionally observed. This uncertainty should be borne in mind in clinical routine and in studies reporting changes in color, eg, studies of tooth bleaching. [ABSTRACT FROM AUTHOR]

This clinical report describes the rehabilitation of an edentulous mandible with an implant-supported fixed prosthesis using an all-ceramic framework fabricated from zirconium oxide. Four interforaminal implants were inserted and allowed to heal submerged. The implant-supported fixed prosthesis was then fabricated using CAD/CAM and electroforming technology. No clinical complications were observed at the 6-month follow-up examination, and the patient was highly satisfied with function and esthetics. All-ceramic frameworks provide a high standard of esthetics; reduce the number of metals used in the oral cavity; and have a lower density compared to metals, which reduces weight in the case of large frameworks. [ABSTRACT FROM AUTHOR]

PURPOSE: The objective of this study was to investigate interexaminer reliability in the clinical measurement of the L*C*h* (lightness/value, chroma, hue) values of anterior teeth using a spectrophotometer (Vita Easyshade). MATERIALS AND METHODS: The basic color of the maxillary right central incisors and canines of 23 subjects was spectrophotometrically determined by 4 clinicians and an experienced user (development manager) of the spectrophotometer. Also, to analyze the effect of different training with the instrument on interexaminer reliability, 2 of the clinicians were instructed in the use of the spectrophotometer by the experienced examiner, whereas the others instructed themselves by studying the operating manual. RESULTS: Agreement between all examiners was acceptable to excellent (intraclass coefficient > 0.4). The mean value of the measured differences for the central incisors of all subjects for L* values was 5 (for C* = 3.8, h* = 2.7 degrees) and for canines, the mean L* was 4.5 (C* = 3, h* = 1.6 degrees). Results from comparison of the 2 different training methods were inconsistent. Agreement with the experienced examiner ranged from not acceptable (C* values for incisors of self-instructed examiners) to excellent. CONCLUSION: The distribution of the measurements of 1 subject could lead to deviations in color, probably with clinical impact. For canines, the measurements were at least equally reproducible (in some cases significantly more reproducible) compared to central incisors. Because of the small number of examiners and the inconsistent results, it was not possible to reach a definite conclusion about the effect of different training methods on interexaminer reliability. [ABSTRACT FROM AUTHOR]

PURPOSE: The aim of this pilot study was to investigate a universal and easy method for improving the speech function of complete maxillary dentures. Specifically, it was analyzed whether sandblasting could improve speech performance, since this process increases the tactile surface area in the region of tongue-to-denture contact. MATERIALS AND METHODS: Fourteen volunteers with complete maxillary dentures in a geriatric rehabilitation center (7 men, 7 women, mean age 81.2) were recruited. Speech samples (normal conversation, logopedic standard text, and a word list) were recorded for all subjects. In 11 cases, a specific area of the denture was sandblasted, while the remaining 3 cases served as controls. After 1 week of service, the same speech samples were recorded again. The rating of the speech samples was performed by 2 experienced speech therapists. The rater did not know whether the sample was a control case or whether it was before or after intervention. RESULTS: The speech therapists found no difference between the 2 speech samples in all 3 cases in the control group. For 8 of 11 subjects, the speech sample after sandblasting was rated better by both therapists (P = .002). In 2 subjects, no difference was observed, and deterioration was found in only 1 subject by 1 speech therapist. CONCLUSION: Taking into account the limited number of subjects, the results show that sandblasting may lead to moderate improvements in speech performance in most cases. Deterioration is not expected, but in such cases, it is easy to restore the denture with simple polishing. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate color matching under natural daylight and daylight lamp conditions. Twenty-nine preclinical students underwent a training course and then matched randomly chosen shade tabs of Vita 3D-Master Shade Guide under both natural daylight and daylight lamp conditions. Color difference (LlEni,) between presented and selected shade tabs was calculated. Statistical differences were explored by use of multivariate analyses. Mean LlEab was 2.5 (1.0 to 4.3) with daylight lamp and 3.4 (0.9 to 7.4) with natural daylight. The difference was statistically significant (P < .001 ). The use of a daylight lamp helps to standardize light conditions and significantly improve the ability to match colors. [ABSTRACT FROM AUTHOR]

It was investigated whether L*a*b* values for teeth as well as shade tabs for one 30Master shade were similar to one another. Teeth were measured using Vita Easyshade and L*a*b* values and the closest 3D shade was then recorded. The shade-guide tabs were also measured using the same device. 3D-Master shades yielded different L*a*b* values for the teeth than for the tabs. L* and a* values, especially, were systematically different. Therefore, Easyshade L*a*b* values for teeth and tabs could not be directly compared. [ABSTRACT FROM AUTHOR]

This in vivo study investigated interexaminer reliability in the clinical measurement of L*C*h* values using a spectrophotometer (Shadepilot, DeguDent), which provides laminar measurement. Thirty incisors were measured by 3 trained clinicians. Intraclass correlation coefficient was used to assess reliability. Additionally, the range of differences between the measurements by all examiners for each subject was calculated to assess the clinical impact of the differences. Agreement was acceptable to excellent for all measurements. Additionally, the reliability of the measurement of L* and C* was excellent (all measurements < 5). Laminar spectrophotometric measurement seems to be superior to punctiform measurement. [ABSTRACT FROM AUTHOR]

The objective of this study was to assess the change in oral health-related quality of life following treatment with double crown-retained removable partial dentures (RPDs). Sixty RPDs in 54 patients (mean age: 65 years) were fabricated and retained with either galvanoformed telescopic secondary crowns (n = 30) or conical secondary crowns (n = 30). The Oral Health Impact Profile (OHIP) was assessed pretreatment and during 6- and 12-month follow-up appointments. Patient assessment of denture-satisfaction was also recorded on a Lickert-type scale. A decrease in the OHIP-sum score was significant after treatment for both groups, but not between the experimental groups. The denture assessment showed good values for both groups. Treatment with different double crown-retained RPDs improved oral health-related quality of life. [ABSTRACT FROM AUTHOR]

This study aimed to assess the correlation between self-rated denture function and oral health-related quality of life (OHRQoL) in different age groups. Subjects' OHRQoL was measured using the Oral Health Impact Profile, and self-ratings of denture function were assessed on a Likert-type scale for patients with fixed and removable partial dentures in 3 age groups (N = 253). For subjects with fixed partial dentures, all correlations were significant for the younger patients but not for higher age groups, whereas the opposite was true for subjects with removable partial dentures. The importance of self-perception of denture function in OHRQoL is different in various groups of patients, depending on age and dental status. [ABSTRACT FROM AUTHOR]

It is often difficult to satisfactorily restore the esthetics of patients' teeth if commercially available artificial acrylic or composite resin anterior teeth are used. A technique for fabrication of an individual set of composite resin teeth for an edentulous patient is described in this clinical report. A diagnostic cast, made before extraction of the original anterior teeth and kept by the patient for over 10 years, was duplicated with a silicone matrix. This technique results in an esthetic match of shape, size, and positioning of the teeth. It also enables the teeth of the prosthesis to be closer to the appearance of the patient's natural teeth than is achievable with premanufactured artificial teeth. [ABSTRACT FROM AUTHOR]

Objectives: Translation, reliability analysis and validation of a German version of the Geriatric/General Oral Health Assessment Index (GOHAI) was the aim of this study. Methods: Translation was performed by a forward-backward process. Validity was assessed as convergent validity in comparison with another self-perceived assessment of oral health (OHIP-14) and as group validity ( n = 218; mean age 73 years). Reliability was proved in terms of internal consistency, inter-item and item-scale correlations, and stability (test-retest procedure; n = 36; mean age 77 years). The responsiveness to change in oral health status was assessed by pre- and post-treatment comparison ( n = 21; mean age 63 years). Results: A German version of the GOHAI is presented. Convergent validity was sufficient ( r = -0.76 compared with OHIP-14); group validity could be demonstrated for self-perceived need for treatment, chewing problems, number of own teeth, caries lesions present and dental status. The internal consistency was high (Cronbach's alpha = 0.92) as were inter-item and item-scale correlations, for which good homogeneity of the index was apparent. The test-retest correlation for the summary score was r = 0.84, single item correlations ranged from r = 0.36 to r = 0.89. The GOHAI sum score increased significantly after patients received new dentures, indicating responsiveness of the GOHAI to clinical change in the expected direction. Conclusions: The German version of the GOHAI had sufficient reliability, validity and responsiveness to be used as measure of oral health-related quality of life in cross-sectional and longitudinal studies of the elderly. [ABSTRACT FROM AUTHOR]

STATEMENT OF PROBLEM.: Clinicians providing edentulous patients with complete dentures are often confronted with the problem of not knowing the patient's natural tooth color. It would be valuable to be able to determine this from other facial features. PURPOSE.: The purpose of this study was to assess the possibility of predicting tooth color in the elderly from hair and eye color, facial skin complexion, and gender. MATERIAL AND METHODS.: The lightness (L*), chroma (C*), and hue (h*) of the color of 541 natural teeth were measured for a white study population (94 subjects, 75 to 77 years old, 55.3% male) by means of a single measurement with a clinically applicable spectrophotometer. Hair and eye color and facial skin complexion were recorded in categories. Mixed-effects regression models were calculated for each L*, C*, and h* value with hair and eye color, facial skin complexion, and gender as independent variables (alpha=.05). RESULTS.: Only gender and hair color in univariate analysis and, additionally, eye color in multivariate analysis, were significant predictors of tooth color. Higher L* values (lighter color) were associated with lighter eye color and with female gender. The C* value was lower (less saturated) for women. More yellow/green than yellow/red h* values were associated with hair colors other than black and with female gender. However, the parameter estimates of the variables were rather low. CONCLUSIONS.: Determination of tooth color from hair and eye color and from gender in the white elderly was only partially possible. (J Prosthet Dent 2008;99:101-106). [ABSTRACT FROM AUTHOR]

Objective: The Oral Impact of Daily Performances (OIDP) is a dental patient-reported outcome measure (dPROM) for the estimation of oral health-related quality of life (OHRQoL) and takes the frequency as well as the severity of problems into account; however, it is not available in German language. The aim of this study was, therefore, to evaluate the reliability and validity of the German version of the OIDP in patients of a private practice., Material and Methods: Translation of the original OIDP version was performed by a forward-backward process. Reliability was evaluated in terms of construct stability (test-retest) for the single items and the sum scores. The responsiveness to change in oral health status was assessed by pre- and post-treatment comparison, in addition. Validity was assessed as convergent validity in comparison with other dPROMs (OHIP-14; GOHAI) and objective dental findings., Results: A total of 330 patients participated in this study (mean age: 42.0 (18.0)). The OHRQoL of the participants was relatively high (OIDP score 4.3 (SD 14.3), OHIP score 4.8 (SD 5.3), GOHAI score 54.2 (SD 5.4)). A moderate construct stability for the total OIDP-score (ICC 0.686) was found whilst reliability for the single items varied between 0.179 (social contact) to 0.559 (showing teeth). Significant correlations were found for OIDP and OHIP (p < 0.001; r = 0.361) and OIDP and GOHAI (p < 0.001; r =  - 0.391) indicating moderate validity with a tendency to even stronger correlations for OIDP-s and OIDP-f (r ≥ 0.500)., Conclusions: The German version of the OIDP demonstrated sufficient reliability and validity. OIDP's general performance should be interpreted cautiously as the outcome was detected in a specifically healthy population., Clinical Relevance: The OIDP is yet the only dPROM that evaluates both severity as well as frequency which makes validation interesting regarding specific target populations., (© 2024. The Author(s).)

To investigate the predictability and the outcome of surface modification techniques, including anodization. Four surface modification techniques were evaluated in this in-vitro study: sandblasting (S), polishing+anodizing (PA), sandblasting+anodizing (SA), polishing+etching+ anodizing (PEA). Color coordinates L*, a* and b* were collected using a spectroradiometer. Color differences between all groups were quantified by use of ΔE 00 . A possible influence of group membership was evaluated using 1-way ANOVA. Pair-wise inter-group comparisons were performed using post-hoc Tukey tests. PA specimens were the brightest and showed a pronounced yellowish and reddish hue. S and SA groups were significantly darker and predictability of outcome was higher compared to another groups. The most predictable surface treatment method is sandblasting. Anodizing techniques come along with the brightest and most chromatic color impression of the titanium.

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 (ΔE 00 ) 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) of both white and precolored monolithic zirconia. For each grinding step and each target color, the precolored groups had a significantly lower ΔE 00 mean than the white groups (P<.05), except at the 20-μm step for groups W-A4 and P-A4 (P>.05). For target color A2, the difference was significant with P<.001 at all 9 grinding steps. For target color A3.5, the difference was significant with P=.003 at grinding level 20 μm, and P<.001 for all other grinding steps. For target color A4, the difference was not significant with P=.603 at grinding level 20 μm, whereas the difference was significant with P=.007 at grinding level 50 μm, and with P<.001 for all other grinding steps., 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., (Copyright © 2021 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

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 Säckingen, 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., (© 2018 Wiley Periodicals Inc.)

Purpose: To assess the extent of differences between the oral health of people aged 50 and 70 years in a community-based setting., Materials and Methods: This research is part of the Interdisciplinary Study on Adult Development (ILSE). All participants lived in the city of Heidelberg, Germany. For the dental study, 194 participants born 1930-1932 (n = 88) or 1950-1952 (n = 106) underwent a comprehensive dental examination. For each participant the number of teeth present, the number of decayed, missing, and filled tooth surfaces (DMF-S), the Plaque Index (PI), the Gingiva Index (GI) and the Community Index of Periodontal Treatment Needs (CPITN) were determined. Depending on the structure of the data, differences between the birth cohorts were calculated by use of t tests or chi-squared tests. Multivariate analysis was also performed to assess possible effects of gender and birth cohort., Results: Oral health conditions were significantly worse among septuagenarians than among quinquagenarians. Besides poorer oral hygiene, as measured by use of PI and GI (p <0.001), periodontal conditions were worse for septuagenarians (p <0.001), who also had fewer natural teeth (p <0.002); the number of carious lesions was similar in the cohorts (p >0.05). These results were confirmed by multivariate analysis and seem to be mostly gender independent., Conclusions: Oral hygiene and health is poor for quinquagenarians and septuagenarians, with more problems associated with greater age but not with gender. Longitudinal studies are necessary to evaluate the intraindividual development of changes of oral health during ageing.

Objectives: To evaluate the reliability and accuracy of spectrophotometric shade determination of premolars and to compare the results with those for incisors., Material and Methods: 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., Results: 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 < 0.001). No significant difference in accuracy was detected between premolars and incisors (p = 0.182). The linear regression model confirmed the bivariate testing., Conclusions: The reliability and accuracy of spectrophotometric shade determination seem comparable for incisors and premolars. The recently introduced ES-V seems more accurate than its predecessor model. Further studies are needed to validate the results of this study.

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 < .05., Results: Complete target variables of 146 participants were analysed. The mean (SD) chewing efficiency of the study sample, as expressed by the variance of hue, was .590 (.250). The type of prosthesis used (P < .001), the number of occluding tooth pairs (P < .001) and the presence of dementia (P = .002) were the main variables significantly affecting chewing efficiency. The condition of removable dentures also had an effect (P = .016). Multivariate testing predominantly confirmed these associations., Conclusion: The chewing efficiency of seniors in nursing homes is somewhat compromised. Beyond dental aspects, suffering from dementia seems to reduce the chewing efficiency. Further interventional/longitudinal studies are, however, encouraged to verify this outcome., (© 2019 John Wiley & Sons Ltd.)

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 ΔE 00 compared to baseline values., Results: All factors (material, staining solution, aging stage) were significantly associated with the extent of discolorations (P < .001). Maximum color changes occurred after 28 days staining (EN: ΔE 00 = 4.5 ± 4.0; GB: ΔE 00 = 5.0 ± 4.5; LS: ΔE 00 = 3.0 ± 2.3) clearly exceeding the 50:50 threshold for acceptable color deviations. Due to repolishing, discoloration of LS samples was almost completely eliminated (ΔE 00 = 0.4 ± 0.3) and significantly reduced for the other two materials (EN: ΔE 00 = 1.0 ± 0.9; GB: ΔE 00 = 0.9 ± 0.4; P = .428)., Conclusion: Discoloration of hybrid ceramics ranged in-between lithium disilicate and composites, however more comparable to composites. Repolishing could reduce discolorations substantially., Clinical Relevance: This study should help dental practitioners to estimate the color stability of common dental materials and the effect of polishing in removal of discolorations., (© 2019 The Authors. Journal of Esthetic and Restorative Dentistry published by Wiley Periodicals, Inc.)

Background: Limited assessment tools for estimating the oral health of nursing home residents are available in the German language., Aims: 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., Methods: 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., Results: 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 < 0.001), as well as satisfying inter-examiner agreement for the single items., Conclusions: The German version of the OHAT is a reliable and valid tool for the assessment of oral health conditions of nursing home residents. When used by caregivers, instruction on the tool and practical training are mandatory to ensure reliable estimations. However, further studies with a larger sample size are encouraged to verify the outcomes of this study.

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., (© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

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., (© 2018 Wiley Periodicals, Inc.)

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 Säckingen, 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 < .001). The effect of group membership was reproduced in multivariate analysis whereas age and gender did not reach statistical significance., Conclusions: With more intensive education and practical training the ability to perform clinical shade determinations improved for students without previous clinical experience. The results obtained support the idea of implementing thematic small-group education in the dental curriculum., (© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Aim: 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., Methods: 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., Results: 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., Conclusion: 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.

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., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

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<0.001). However, primarily TM >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<0.05)., 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., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

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. ΔE ab and E 2000 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 < .001) whereas in OC chroma increased (ΔC = -3.3; P < .001). For both groups, a significant shift to more reddish tooth colors was observed. In almost all cases, color differences between baseline and follow-up exceeded the 50:50 acceptability thresholds for color differences (ΔE = 2.7) in both YC (≈90%) and OC (≈80%)., Conclusions: For both quinquagenarians and septuagenarians, clinically relevant changes in tooth color were observed after a decade; these could affect the long-term success of prosthetic restorations in terms of a satisfactory color match between natural teeth and dental prostheses. In contrast with the findings of cross-sectional studies, the changes were partially age-group-specific., Clinical Significance: Tooth color can change over a decade. When fixed dental prostheses are planned, one should consider that changes of tooth color could lead to mismatch between a restoration and adjacent teeth during the period in clinical service., (© 2017 Wiley Periodicals, Inc.)

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.

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'Éclairage (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.

Objective: 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)., Materials and Methods: 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., Results: Improvement of OHRQoL was observed in both groups after treatment (t = 7.27, p < 0.001). 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., Conclusions: 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.

Objective: 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., Method: 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., Results: In bivariate testing, participants with dementia had a significantly lower DHI (p < 0.001), a lower GBI (p < 0.05), and a lower CPITN (p < 0.01) at follow-up. In participants without dementia, only for DHI (p < 0.001) a significant improvement was observed. In multivariate analyses, the significant association could not be reproduced (p > 0.05)., Conclusions: 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.

Objective: 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., Materials and Methods: 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-off < 45) 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., Results: 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 (p < 0.05). 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)., Conclusions: 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.

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., (© 2014 The Authors. Psychogeriatrics © 2014 Japanese Psychogeriatric Society.)

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., (© 2013 Wiley Periodicals, Inc.)

Purpose: To compare survival and incidence of complications for solely implant-supported double-crown-retained dentures (DCRDs) and combined tooth-implant-supported DCRDs for restoration of a complete jaw., Materials and Methods: Patients were consecutively admitted to treatment at the Department of Prosthodontics, University of Heidelberg, during a time period from 2003 to 2011. Schedule and unscheduled visits were recorded on standardized documentation forms. Age, gender, location of implants, number of abutment teeth, jaw, and antagonist were assessed as possible factors affecting the number of complications per patient., Results: Fifty-five patients with 66 DCRDs on 209 implants and 102 teeth were included. Of these, 30 dentures on 129 implants were solely implant-supported whereas the other 36 were combined tooth-implant-supported. During an observation period of up to 8.3 years (mean 3.4 years; SD 1.9) superstructure survival was 93.3% for the solely implant-supported DCRDs and 100% for the combined tooth-implant-supported DCRDs. Survival without major complications was 86.7% and 83.3%, respectively. Gender and location of both superstructure and implants were statistically associated with a greater number of complications., Conclusion: Within the limitations of this exploratory retrospective study, not only solely implant-supported DCRDs but also superstructures combining remaining teeth and implants within DCRDs might be a reliable treatment option for elderly patients. Prospective randomized clinical trials are needed to confirm this, however., (© 2012 Wiley Periodicals, Inc.)

Purpose: Although the VITA 3D-Master (3D) shade guide offers improved shade-matching 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 ΔE values for VC matches and for the indirect methods were evaluated using t tests., Results: A mean ΔE (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 ΔE 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.

Unlabelled: Older people with dementia are very dependent on nursing, and caregivers are frequently confronted with oral-care-resistant behaviour which may lead to shortcomings in oral health., Objective: To compare oral hygiene and health status of institutionalised older people suffering, or not, from dementia., Basic Research Design: Prospective cohort study (single-blind)., Clinical Setting: Institutionalised older population in south-west Germany., Participants: Ninety-three, allocated to two groups: dementia (n = 57) and non-dementia (n = 36) based on a mini mental state examination., Main Outcome Measures: Target variables were plaque control record (PCR), gingival bleeding index (GBI), community periodontal index of treatment needs (CPITN), and denture hygiene index (DHI). Differences between the dementia and non-dementia groups were evaluated by univariate testing of all target variables., Results: Univariate analysis revealed the amount of plaque in the dementia group was significantly higher than in the non-dementia group (p = 0.004). Mean CPITN of participants in the dementia group was significantly worse than those of participants in the non-dementia group (p < 0.001). All participants in the dementia group had periodontitis in at least one of the sextants, compared with 74% in the non-dementia group (p < 0.001). For DHI (p = 0.198) and GBI (p = 0.275) no differences were found between the groups., Conclusions: Some aspects of oral hygiene and health seem to be worse for the institutionalised older people with dementia. Permanent specially adapted intervention for residents suffering from dementia in long-term care homes, and training for caregivers, is desirable to maintain life-long oral hygiene and health.

Objective: 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)., Methods: 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., Results: 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)., Conclusion: 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., Clinical Relevance: 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.

Objectives: 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)., Materials and Methods: 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., Results: 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., Conclusions: 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., Clinical Relevance: VLCR might be a viable alternative to PMMA for patients with allergic reactions to residual monomer or benzoyl peroxide.

Background: Oral hygiene and health of the institutionalized elderly are frequently described as inadequate., Objectives: 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., Methods: 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., Results: 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; P < 0.023). 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 (P < 0.001)., Conclusions: 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., (© 2012 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objectives: 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., Methods: 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., Results: Median ΔE was 2.38 for direct matching with the VC and 2.86 for indirect matching by use of a simple conversion table (p < 0.01). Optimized tables performed slightly better (median ΔE = 2.81)., Conclusions: 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.

This report focuses on the association between oral health-related quality of life (OHRQoL) and depression/anxiety of a homogeneous group of cancer patients who were recurrence-free for 8 years after treatment for advanced oral squamous cell. Participants were 24 patients (mean age 55 years, 75% men) treated with neoadjuvant concurrent radiochemotherapy followed by surgery with a mean recurrence-free period of 95 months (from 39 to 164 months). The OHRQoL (OHIP) and the anxiety/depression (HADS) were assessed twice (1 year between t1 and t2). OHRQoL was impaired in this group (mean OHIP score 65 units). In cross-lagged correlation analysis, the correlation between OHRQoL to t1 and depression to t2 was significant and greater than the non-significant correlation for depression to t1 and OHRQoL to t2 indicating that OHRQoL predicts depression better than vice versa. However, the difference in the correlation coefficients was not significant (ZPF-test). The same was true for OHRQoL and anxiety. The OHRQoL measured with the OHIP was impaired in comparison to the normal population. In the limitations of the study design and bearing the small sample size in mind, the results give evidence that OHRQoL predicts psychological outcomes, namely depression and anxiety, better than vice versa., (Copyright © 2011 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

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., (© 2011 Wiley Periodicals, Inc.)

The objective was to evaluate the development of oral health-related quality of life (OHRQoL) in patients with complete dentures and the association between OHRQoL and patient satisfaction. Fifty-two patients (mean age, 66.3, 48.1% male) received dentures in at least one jaw. The analysis was conducted on participants with dentures in both jaws (CD-Both; n = 22) or in the upper jaw only (CD-Max; n = 28). Data were collected 4 weeks, 6 months, and 1 and 2 years after insertion. OHRQoL was measured by use of the OHIP-EDENT. Self-rated patient satisfaction was assessed on a scale of 0-10. To prove the hypothesis that patient satisfaction would be a meaningful predictor of OHRQoL, and not vice versa, multilevel analysis and cross-lagged correlation analysis were performed for both groups separately. OHRQoL improved from 22.9 (SD, 20.7) to 12.1 (SD, 14.5) for CD-Both and from 20.3 (SD, 17.2) to 14.7 (SD, 15.1) for CD-Max. Multilevel analysis revealed that patient satisfaction and OHRQoL were significantly associated (p < 0.0001) for both groups. Differences between the groups were found with regard to the effect of time after insertion and the interaction between time and satisfaction with OHRQoL which were significant only for the group CD-Both; however, no evidence was found for the causality of this association in the cross-lagged analysis for both groups (ZPF test, p > 0.016). Patient satisfaction and OHRQoL were associated for wearers of complete dentures. Within the limitations of the study, however, the causality that patient satisfaction predicts OHRQoL, and not vice versa, could not be proven.