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Purpose: To evaluate the efficacy of manual and machine-aided cleaning to remove matured plaque from removable partial dentures (RPDs). Materials and Methods: A total of 32 patients with bilateral free-end saddle RPDs were included. The plaque was stained, and the RPD was photographed on all sides. One saddle was randomly allocated to manual cleaning, while the other was allocated to no cleaning. The patient manually cleaned the saddle by applying a denture brush and gel. The whole RPD was then cleaned with the aid of a machine using a rotating needle device. After each step, plaque dyeing and photography were repeated. The plaque proportions (% pixel) were measured using special software. For statistical analysis, mixed models were used to adjust for baseline covariates, including plaque and surfaces, and to cover all time points. Results: The mean plaque area without cleaning at the fitting surface was higher than at the buccal/lingual surfaces (32.8% [95% CI: 28.1% to 36.4%] vs 15.3% [13.1% to 17.4%], respectively). Manual cleaning was not substantially better than no cleaning (4.6% [-0.1% to 9.2%] for the difference at the fitting surface [showing a substantial difference of < 10%]), and the difference found was even smaller at the buccal/lingual surfaces. Machine-aided cleaning was substantially better than manual cleaning (16.1% [12.0% to 20.2%] for the difference at the fitting surface and 7.3% [4.6% to 10.0%] at buccal/lingual surfaces). The combination of manual and machine-aided cleaning was not better than machine-aided cleaning alone (-0.2% [-2.6% to 2.1%] difference at the fitting surface). Conclusion: Manual cleaning is insufficient in removing matured denture plaque. Machine-aided cleaning is superior to manual cleaning, especially at fitting surfaces. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this investigation was to compare the chewing efficiency after immediate and delayed loading of mini-implants that served as supplementary support for removable partial dentures (RPDs). Materials and Methods: In this four-center randomized trial, patients who had RPDs in arches with unfavorable tooth distributions, ie, no canine and at most two posterior teeth in one or both quadrants, received strategic mini-implants with ball abutments. The mini-implants in group A were loaded immediately either by housings with O-rings (insertion torque ≥ 35 Ncm) or by soft relining material (insertion torque < 35 Ncm). In group B, the RPDs were only hollowed over the balls. After 4 months, the soft relined RPDs and all RPDs of group B received the housings. Masticatory efficiency was evaluated with a validated mixing ability test of two-colored chewing gum before surgery and 14 days, 4 months (before housing pickup), 4.5 months, and 12 months after surgery. The circular variance of hue was the measure of mixing. Results: From 76 participants with 79 RPDs, 38 each were randomly allocated to group A or B. In group A, the housings in six participants were picked up immediately, and the remaining RPDs were primarily soft relined. There was a significant group difference only after 4 months. The mixing ability was better after immediate loading than after delayed loading (P < .0001). In group B, the chewing efficiency was notably deteriorated after the RPDs were hollowed over the ball abutments. However, immediately after all housings were picked up, the chewing efficiency in both groups was substantially improved, and the variance of hue values after 1 year were very similar in the groups. Conclusion: The chewing performance can be improved by inserting supplementary mini-implants under existing RPDs with unfavorable tooth support. This improvement occurred faster by immediate loading than by delayed loading. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate changes in distribution of teeth and in prosthodontic tooth replacement during an 11-year period in an adult population.Materials and Methods: Information on prosthetic status was collected from 4,288 participants aged 20 to 81 years at baseline in the Study of Health in Pomerania (SHIP-0) and from 2,244 participants aged 30 to 92 years who reappeared in the 11-year follow-up (SHIP-2). The tooth distribution per arch was classified into one of the six following classes: class 0 (edentulous), class 1 (one to three remaining teeth), class 2 (extended tooth-bounded space or extreme shortened dental arch), class 3 (small anterior space), class 4 (small posterior space with one or more missing premolars), or class 5 (functional dentition).Results: Longitudinally, the most pronounced change in class was the transition from class 1 to class 0 (maxilla: 54.5%, mandible: 58.3%). The percent change from other higher classes to lower classes ranged between 10% and 40%. In the same age groups of 40 to 79 years, the number of edentate arches was cut in half, with a corresponding increase in functional dentitions. The proportion of unrestored arches decreased in all classes. Double crown-retained partial removable dental prostheses (PRDPs) showed the highest increase (a 15% to 20% increase) at the expense of acrylic PRDPs in classes 1 and 2. In small spaces, the proportion of fixed dental prostheses (FDPs) also increased by 15% to 20%. Seven participants of SHIP-0 (0.16%) and 56 participants of SHIP-2 (2.5%) had dental implants.Conclusion: Similar age groups showed improvement in oral conditions. The proportion of higher-end restorations (FDPs and double crown-retained PRDPs), including the frequency of dental implants, increased. [ABSTRACT FROM AUTHOR]

Purpose: To demonstrate how data collected using the computerized planimetric method (CPM) can be analyzed by providing an example in which the amount of plaque accumulation and the efficacy of the rotating needles device (RND) in cleaning specific parts of partial removable dental prostheses (PRDPs) were estimated.Materials and Methods: Thirty-four participants wearing a total of 41 double-crown-retained PRDPs with veneered secondary crowns were included in this study. The PRDPs underwent the following steps: preparing the PRDP for photography, photography of the PRDP, cleaning the PRDP with the RND, and re-photography. One trained examiner used a tested CPM to analyze 98 images (49 before/49 after). Each participant was considered as a statistical unit; thus, if the participant had two PRDPs, one was randomly selected for analysis. Reliability was tested using intraclass correlation coefficients (ICCs[1, 2]), and nonparametric Wilcoxon signed rank test was used for all comparisons.Results: The intraclass correlation coefficients (images before/after) for both the base and veneer were > 0.9. Wilcoxon signed rank test P value was < .001 for the comparison of plaque accumulation on the base and veneer, estimating the RND's efficacy on both PRDP parts (before/after) and comparing the RND's efficacy on the base and the RND's efficacy on the veneer.Conclusions: There are different ways to analyze data collected via CPM; thus, it is advisable to provide an explanation for the choice of modeling. Plaque accumulation was significantly greater on the double-crown veneer than on the base. The RND efficacy in cleaning the veneer and the base is significant, but more substantial in cleaning the base. [ABSTRACT FROM AUTHOR]

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

Purpose: The aim of this study was to evaluate the reliability and agreement of a new computerized planimetric method (CPM) for the measurement and assessment of plaque on all types of removable dental prostheses (RDPs).Materials and Methods: From a database containing 780 images taken following a standardized method for 65 RDPs, 55 images were randomly selected for image analysis. Adobe Photoshop software was used according to standard operating procedure (SOP) by one main examiner two times in different sessions, and one time by three additional examiners. To estimate the intra- and interexaminer reliability, intraclass correlation coefficient ICC(2,1) were used. Three parameters were used to estimate agreement: standard error of measurement (SEM), smallest detectable change at the 95% confidence level (SDC95%), and limits of agreement (LoA) according to the Bland-Altman method.Results: In all steps of the image analysis, both intra- and interexaminer reliability were excellent, with ICC(2,1) values > 0.85 at the 95% confidence level. The intra- and interexaminer values for both the SEMagreement and SDC95% were ≤ 6% and ≤ 17%, respectively. The Bland-Altman analysis revealed a satisfactory level of agreement.Conclusion: This study shows excellent inter- and intraexaminer reproducibility, a satisfactory level of examiner agreement, and acceptable measurement error. Furthermore, the method can be used with all types of RDPs. The CPM is more suitable for clinical research because of its objectivity, reliability, high level of standardization, and ability to detect and quantify small changes in plaque. [ABSTRACT FROM AUTHOR]

Objective: To develop and test self-administered satisfaction questionnaires for patients with removable dental prostheses (RDPs) in the German language. Method and Materials: A three-phase methodology was used. A pilot questionnaire was developed in phase one. At the end of phase two, the final version of the questionnaires were reached. In phase three, 192 questionnaires were distributed to evaluate the psychometric properties of the final version of the questionnaires. Construct validity, content validity from the patients' perspective, and questionnaire reliability were estimated. Results: At the end of phase two, the final versions of the questionnaires were defined as instruments with good face validity. At the end of phase three, content validity from the patients' perspective was assessed and found to be good. Exploratory factor analysis identified a one-factor model for each questionnaire. Consequently, each questionnaire was summed to create a single index. Internal consistency of the indexes was assessed using Cronbach's α and found to be excellent (α > 0.9). A high repeatability of all the items was identified through a test-retest. Intra-class correlation coefficient (ICC) values ranged from 0.80 to 0.99. Conclusion: The questionnaires and indexes are valid and highly reliable instruments, and can be used to measure patient satisfaction with RDPs. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this multicenter single mandibular implant study was to compare the clinical outcome of an immediately loaded implant placed in the midline of an edentulous mandible with the clinical outcome when closed healing and delayed loading is chosen. Here, the patient recruitment period and the main reasons for exclusion were analyzed.Materials and Methods: Patient recruitment was performed at nine German universities. Rather conservative inclusion and exclusion criteria, including denture satisfaction, denture status, a psychologic symptom checklist, and a defined bone height in the posterior mandible, had to be fulfilled. It was initially calculated that 230 persons would have to be screened within 13 months to include 180 persons in the trial.Results: Within 13 months (December 2012 to December 2013), 201 patients were screened for possible inclusion in the trial and 148 met the inclusion criteria. Finally, after the recruitment period was extended by 2.5 months, 224 patients were screened and 169 were included. Of those screened, 55 (24.6%) did not meet the inclusion criteria and were excluded. Another 4 patients (1.8%) were excluded based on their psychologic symptom checklist score, while 5 others (2.8%) showed signs of noncompliance. A further 8 patients (4.4%) decided not to participate and withdrew their informed consent, and another 3 (1.3%) were no longer available after screening. Another 2 patients were excluded due to medical contraindications and 1 due to an insufficient mandibular denture. In 34 cases (15.2%), the residual bone height did not comply with McGarry type II or III.Conclusion: Within the limitations of this patient recruitment period, it can be concluded that residual bone height is the most important factor when considering elderly edentulous patients for implant therapy. The psychologic symptom checklist score was less important. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate changes in marginal bone levels around maxillary and mandibular mini-implants stabilizing complete dentures and to explore possible risk factors associated with bone loss. Materials and Methods: All eligible patients from nine private dental practices were invited to participate. Panoramic radiographs were obtained postoperatively and at the follow-up examination. The changes in bone level were estimated with linear mixed models that included the factors sex, age, jaw, region (anterior versus posterior), smoking habits, and loading concept. Results: Of the 180 invited patients, 133 participated in the follow-up (response rate: 73.9%). Of 336 mini-implants in 54 maxillas and 402 mini-implants in 95 mandibles, 15 maxillary Implants and 11 mandibular implants were lost after insertion, and 4 mandibular implants fractured. Radiographic evaluations in 11 participants were not possible. The mean marginal bone loss at the remaining 634 mini-implants in 122 patients was 0.8 mm in the maxilla and 0.5 mm in the mandible over a mean observation time of 2.2 ± 1.0 years. This difference in univariate estimation lost significance after adjusting for the other variables. Implants in former smokers showed more bone loss than implants in participants who had never smoked. Implants that were loaded 3 to 4 months after placement (delayed loading) showed more marginal bone loss than immediately loaded implants. No statistically significant differences were found between men and women, different age groups, or anterior and posterior implants. Conclusion: Mean marginal bone loss around mini-implants used to stabilize complete dentures was insignificantly higher in the maxilla than in the mandible after a mean observation period of 2.3 years. These values are comparable with marginal bone loss around standard-diameter implants. A previous smoking habit and delayed loading after implant placement with a low insertion torque were shown to be possible risk factors for bone loss. [ABSTRACT FROM AUTHOR]

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

This study sought to evaluate platform-switched implants for immediate placement. A total of 136 implants were placed in 58 patients using either an immediate or delayed implant protocol. Bone level changes of the implants were measured mesially and distally and statistically analyzed with linear mixed models. No implant was lost. There was no significant difference between immediate and delayed implants in approximal bone level changes during the first year (95% confidence interval: -0.10 to -0.01 for immediate versus -0.14 to -0.07 for delayed implants). Subsequent bone resorption was negligible in both groups. [ABSTRACT FROM AUTHOR]

Purpose: To examine whether there is a gender-dependent risk profile for signs of temporomandibular disorders (TMD) in a population-based sample. Materials and Methods: Sociodemographic, behavioral, and medical factors were checked for associations with TMD in a cross-sectional study of 3,567 subjects aged 25 to 74 years in Germany. Data were collected from clinical examinations, interviews, and questionnaires. Logistic regression analyses were used to estimate factors associated with signs of TMD across gender. TMD signs included tenderness or pain on palpation of 3 or more masticatory muscles and tenderness or pain on palpation in 1 or both temporomandibular joints (TMJs). Results: In women, muscle tenderness or pain was found to be significantly associated with general arthrosis/arthritis and lower back pain. In men, muscle tenderness or pain was significantly associated with school education > 11 years, various categories of loss of occlusal support, lip/tongue/cheek biting, and general arthrosis/arthritis. In women, TMJ tenderness or pain was associated with widowed status, bruxism, general arthrosis/arthritis, lower back pain, and sex-hormone replacement. In men, TMJ tenderness or pain was associated with multiple losses of posterior supporting zones, gout, and lower back pain. In women, there were inverse associations between loss of occlusal support in 3 posterior zones and muscle and TMJ tendernes. Conclusion: Except for some general health conditions and bruxism, the hypothesis of a gender-dependent risk profile for signs of TMD is partly supported. The results of this study indicate that TMD is a complex disorder associated with mixed etiologic factors between genders. [ABSTRACT FROM AUTHOR]