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Andreas Zenthöfer,1 Judith Ehret,1 Melania Zajac,1 Samuel Kilian,2 Jana Kostunov,1 Peter Rammelsberg,1 Anna-Luisa Klotz1 1University of Heidelberg, Dental School, Department of Prosthodontics, Heidelberg, 69120, Germany; 2University of Heidelberg, Institute of Medical Biometry and Informatics, Heidelberg, 69120, GermanyCorrespondence: Anna-Luisa KlotzUniversity of Heidelberg, Dental School, Department of Prosthodontics, INF 400, Heidelberg, 69120, GermanyTel +49 6221 56-8799Fax +49 6221 56-5371Email anna-luisa.klotz@med.uni-heidelberg.deObjective: To evaluate how changes in oral health and chewing efficiency affect the changes in oral-health-related quality of life (OHRQoL) of nursing-home residents over six months.Methods: The study was conducted in nine nursing homes. Sociodemographic and general data were collected for all eligible individuals (n = 150). Of these, 114 participants (mean age 82.0 [± 9.5] years, 77.2% women) were available for the following tests at baseline and six months later: a comprehensive examination of dental and general health, a two-colour mixing-ability test (to assess chewing efficiency), the Geriatric Oral Health Assessment Index (GOHAI; to evaluate the OHRQoL), and the Mini Mental State Examination (MMSE; to diagnose the presence and severity of dementia). Univariate and multivariate linear regression models were compiled to analyse possible factors affecting OHRQoL.Results: For the final analysis, 108 participants were available. For the study cohort as a whole, a decrease in the number of functional occluding pairs (C: 0.195; p = 0.034) and an increase in dental-treatment needs (C: − 1.968; p = 0.056) had the greatest negative effects on OHRQoL as expressed by the GOHAI score. For denture wearers, a deterioration of denture condition (C: − 2.946; p = 0.003) was the most important predictor for a decline in OHRQoL.Conclusion: A short-term decline in oral health and function affects the OHRQoL of nursing-home residents. The most important dental variables in this regard are the number of functional occluding pairs and dental and denture-related treatment needs.Keywords: chewing-efficiency test, nursing home, OHRQoL, oral health

Andreas Zenthöfer,1 Judith Ehret,1 Melania Zajac,1 Samuel Kilian,2 Peter Rammelsberg,1 Anna-Luisa Klotz1 1University of Heidelberg, Dental School, Department of Prosthodontics, Heidelberg 69120, Germany; 2University of Heidelberg, Institute of Medical Biometry and Informatics, Heidelberg 69120, GermanyCorrespondence: Priv.-Doz. Dr. Anna-Luisa KlotzUniversity of Heidelberg, Dental School, Department of Prosthodontics, INF 400, Heidelberg 69120, GermanyTel + 49 6221 56 8799Fax +49 6221 56-5371Email anna-luisa.klotz@med.uni-heidelberg.deObjective: The aim of this study was to evaluate the effects of dental status and chewing efficiency on the oral-health-related quality of life (OHRQoL) of nursing-home residents.Materials and Methods: The study was conducted in nine nursing homes. All eligible participants were included, and general and medical data, information about nutritional status and their dental and prosthetic status were collected. Chewing efficiency was assessed by means of a two-colour mixing-ability test. The simple count version of the Geriatric Oral Health Assessment Index (SC-GOHAI) was used to evaluate participants’ OHRQoL, and the Mini-Mental State Examination to classify the presence of cognitive impairment. Univariate and multivariate regression models were used to analyse data.Results: The mean age of the participants was 82.1 (± 9.8) years and most participants suffered from at least very mild cognitive impairment. OHRQoL for all participants (n = 143) and denture wearers only (n = 105) was substantially associated with the type of prosthesis, the presence of natural teeth, the number of functional occluding pairs and dental and denture-related (if applicable) treatment needs. Furthermore, in both model’s univariate analysis showed that chewing efficiency also affected OHRQoL. In contrast, multivariate analysis of all participants revealed that only a higher number of functional occluding pairs (C: 0.250; p < 0.001), fewer dental treatment needs (C: − 1.733; p = 0.019) and a better nutritional status (C: − 1.298; p = 0.048) were relevant for better OHRQoL. For denture wearers, a higher number of functional occluding pairs (C: 0.192; p = 0.011), a better denture condition (C: − 2.194; p= 0.003) and a higher body mass index (BMI) (C: 0.145; p = 0.006) were the main variables associated with better OHRQoL among participants.Conclusion: Good oral health and oral function, including chewing efficiency, are associated with a high OHRQoL of nursing-home residents. However, few dental treatment needs, well-fitting dentures without treatment needs and a high number of functional occluding pairs seem to be the principal variables for an acceptable OHRQoL of nursing-home residents.Keywords: chewing efficiency, two-colour chewing-gum test, dental prostheses, OHRQoL, SC-GOHAI, BMI

Anna-Luisa Klotz,1 Melania Zajac,1 Judith Ehret,1 Samuel Kilian,2 Peter Rammelsberg,1 Andreas Zenthöfer1 1University of Heidelberg, Dental School, Department of Prosthetic Dentistry, Heidelberg 69120, Germany; 2University of Heidelberg, Institute of Medical Biometry and Informatics, Heidelberg 69120, GermanyCorrespondence: Anna-Luisa KlotzUniversity of Heidelberg, Im Neuenheimer Feld 400, Heidelberg 69120, GermanyTel +49 6221 566082Fax +49 6221 565371Email anna-luisa.klotz@med.uni-heidelberg.dePurpose: The purpose of this study was to identify how changes to general health might affect the oral health of nursing-home residents over a six-month period.Materials and Methods: The study was conducted in nine nursing homes in Germany. Sociodemographic and general data were collected at baseline and after six months. Complete baseline and follow-up data were available for 114 participants. The Clinical Dementia Rating (CDR) and the Global Deterioration Scale (GDS) were used to identify the presence and, if applicable, severity of dementia among participants. The Apraxia Screen of TULIA (AST) was used to identify motor impairment. A comprehensive dental examination of each participant was also performed. The examination included the documentation of dental and denture status and the number of decayed, missing and filled teeth (DMF-T). In addition, dental and denture hygiene were quantitatively assessed using the Plaque Index (PI) and the Denture Hygiene Index (DHI), respectively. Global dental treatment needs were evaluated by use of the Oral Health Assessment Tool (OHAT). Univariate and multivariate linear regression models were compiled to analyse possible factors affecting the dependent target variables.Results: During the study period, denture hygiene among the study population worsened by an average of 15%. The regression models detected that a more advanced age (in years) was associated with a less pronounced deterioration of denture hygiene as measured by use of the DHI (−0.806 per additional year of age; p = 0.030). Furthermore, an increase in the level of care needed (coefficient (C): −1.948; p = 0.002) and a more poorly graded assessment of general health compared with the value at baseline (C: 1.054; p = 0.026) were both associated with a deterioration of oral health as evaluated by use of the OHAT. In addition to these results, an increase in care needs was also associated with a deterioration of dental health as evaluated by use of the DMF-T (C: 0.966; p = 0.013).Conclusion: In the short term, a deterioration of general health, including an increase in care needs, seems to be the predominant factor associated with a more pronounced deterioration of oral health among nursing-home residents.Keywords: oral health, oral hygiene, caries, older people, nursing home

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

Conclusions: Within the limitations of this laboratory study, 5Y-PSZ based anterior crowns can be a viable treatment option. Framework design, choice of the veneering ceramics and artificial aging show relevant effects on the fracture resistances. Concerted veneering ceramics should be used and partially veneering of the zirconia frameworks should be favored over full veneers.

Significance: Color changes of zirconia luted to titanium are primarily affected by the color of the substrate if a translucent cement was used. Vice versa, the application of an opaque cement effectively masked the dark substrate color. Substrate color and choice of cement have to be taken into consideration when performing shade selection.

The aim of this paper was to evaluate the fracture resistance of 3D-printed zirconia occlusal veneers (OVs) of different thicknesses and supported by different abutment materials. Materials and Methods: The standard OV of a natural molar was prepared and digitized using a laboratory 3D scanner. The resulting digital tooth abutment was milled either using cobalt–chromium (CoCr) or a fiber-reinforced composite (FRC). All the abutments were digitized and standardized OVs (30° tilt of all the cusps) designed with 0.4 mm, 0.6 mm, or 0.8 mm wall thicknesses. The OVs were fabricated using either the Programill PM7 milling device (Ivoclar Vivadent, PM) or one of two 3D zirconia printers, Cerafab 7500 (Lithoz, LC) or Zipro-D (AON, ZD). The ZD samples were only tested on CoCr abutments. The completed OVs were luted to their abutments and subjected to artificial aging, consisting of thermocycling and chewing simulation before fracture testing with a steel sphere (d = 8 mm) as an antagonist with three contact points on the occlusal OV surface. Besides the total fracture resistance Fu,tot, the lowest contact force Fu,cont leading to the local fracture of a cusp was of interest. The possible effects of the factors fabrication approach, wall thickness, and abutment material were evaluated using ANOVA (α = 0.05; SPSS Ver.28). Results: The total fracture resistance/contact forces leading to failure ranged from Fu,tot = 416 ± 83 N/Fu,cont = 140 ± 22 N for the 0.4 mm OVs fabricated using LC placed on the FRC abutments to Fu,tot = 3309 ± 394 N (ZD)/Fu,cont = 1206 ± 184 N (PM) for the 0.8 mm thick OVs on the CoCr abutments. All the factors (the fabrication approach, abutment material, and OV wall thickness) had an independent effect on Fu,tot as well as Fu,cont (p < 0.032). In pairwise comparisons for Fu,tot of the OVs luted to the CoCr abutments, the ZD samples statistically outperformed the LC- and PM-fabricated teeth irrespective of the thickness (p < 0.001). Conclusions: Within the limitations of this study, the printed occlusal veneers exhibited comparable fracture resistances to those of the milled variants. However, more resilient abutments (FRC as a simulation of dentine) as well as a thinner wall thickness led to reduced OV fracture resistance, suggesting that 0.4 mm thick zirconia OVs should not be unreservedly used in every clinical situation.

The efficacy of retainers is a pivotal concern in orthodontic care. This study examined the biomechanical behaviour of retainers, particularly the influence of retainer stiffness and tooth resilience on force transmission and stress distribution. To do this, a finite element model was created of the lower jaw from the left to the right canine with a retainer attached on the oral side. Three levels of tooth resilience and variable retainer bending stiffness (influenced by retainer type, retainer diameter, and retainer material) were simulated. Applying axial or oblique (45° tilt) loads on a central incisor, the force transmission increased from 2% to 65% with increasing tooth resilience and retainer stiffness. Additionally, a smaller retainer diameter reduced the uniformity of the stress distribution in the bonding interfaces, causing concentrated stress peaks within a small field of the bonding area. An increase in retainer stiffness and in tooth resilience as well as a more oblique load direction all lead to higher overall stress in the adhesive bonding area associated with a higher risk of retainer bonding failure. Therefore, it might be recommended to avoid the use of retainers that are excessively stiff, especially in cases with high tooth resilience.

The rehabilitation of free-end situations is a frequent indication in prosthetic dentistry. Cantilever fixed dental prostheses (cFDPs) made of 1st and 2nd generation zirconia are one treatment option. Due to a unique gradient technology, combinations of different zirconium dioxide generations are thus feasible in one restoration. However, data about these materials are rare. The purpose of this study was therefore to investigate the fracture resistance and fracture modes of tooth-supported cFDPs fabricated from different zirconia materials (gradient technology) and different framework thicknesses. A total of 40 cFDPs were fabricated using the CAD/CAM approach and belonged to five test groups. The different groups differed in the yttria content, the proportion of the tetragonal/cubic phases, or in wall thickness (0.7 mm or 1 mm). After completion, the cFDPs were subjected to thermal cycling and chewing simulation (1.2 × 106 load cycles, 108 N load). Afterwards, cFDPs were statically loaded until fracture in a universal testing machine. A non-parametric ANOVA was compiled to determine the possible effects of group membership on fracture resistance. In addition, post-hoc Tukey tests were used for bivariate comparisons. The mean fracture loads under axial load application ranged from 288 to 577 N. ANOVA detected a significant impact of the used material on the fracture resistances (p < 0.001). Therefore, the use of cFDPs fabricated by gradient technology zirconia may not be unreservedly recommended for clinical use, whereas cFPDs made from 3Y-TZP exhibit fracture resistance above possible masticatory loads in the posterior region.

Objectives: To evaluate the impact of surface conditioning of titanium, zirconia thickness, and cement type on the final color of zirconia luted to the titanium. Methods: A total of 192 grade 5 titanium specimens with the final dimensions 10 mm × 10 mm × 2 mm were fabricated and subjected to four different surface conditioning including, that is, sandblasting, etching, and anodization. In addition, 192 zirconia specimens with the same dimensions as the titanium specimens but altered thicknesses of 0.7 (n = 96) and 1.0 (n = 96) mm were fabricated using 5Y‐TZP zirconia. Color as expressed by L∗ (lightness), a∗ (red–green axis), and b∗ (blue–yellow axis) of titanium and zirconia specimens as well as the joined titanium–zirconia complex, total assembly (Panavia V5 clear, PC; opaque, PO, each n = 96) were determined under standardized conditions using a spectroradiometer (SpectraScan P‐650). Color differences were calculated using the ΔE00 formula. ANOVA supplemented with post hoc Tukey test for group comparisons was compiled to estimate possible effects of titanium conditioning, zirconia thickness, and type of cement used on the final zirconia color (SPSS Ver. 28; α = 0.05). Results: All investigated factors affected the zirconia color of the total assembly (p < 0.001). Using PO mean values of all groups were still close to baseline colors (ΔE00 between 5.5 and 6.2). When using PC, the final color was significantly altered, irrespective of the other parameters. Specimens luted with PO appeared lighter, less reddish (a∗ was affected predominately by sample thickness), and more bluish, while luting with PC resulted in reduced lightness combined with large shifts along the red and yellow axes. Significance: Color changes of zirconia luted to titanium are primarily affected by the color of the substrate if a translucent cement was used. Vice versa, the application of an opaque cement effectively masked the dark substrate color. Substrate color and choice of cement have to be taken into consideration when performing shade selection. [ABSTRACT FROM AUTHOR]