Edentulism among diabetic patients compared to non-diabetic controls: A systematic review and meta-analysis.

OBJECTIVE: The purpose of this paper is to systematically and critically appraise the available scientific evidence concerning the prevalence of edentulism among diabetic patients compared to non-diabetic people. METHODS: MEDLINE-PubMed and Cochrane-CENTRAL databases were comprehensively searched up to April 2023 to identify appropriate studies. The inclusion criteria were observational studies conducted in human subjects ≥18 years of age with the primary aim of investigating the prevalence of edentulism among diabetic patients. Based on the extracted data, a meta-analysis was performed. Recommendations based on the body of evidence were formulated using the GRADE approach. RESULTS: Independent screening of 2085 unique titles and abstracts revealed seven publications that met the eligibility criteria. Study size ranged from 293 to 15,943 participants. Data from all seven studies were suitable for meta-analysis. Overall, 8.3% of the studied population was edentulous. The weighted mean prevalence of edentulism among diabetic and non-diabetics was 14.0% and 7.1%, respectively. The overall odds ratio for diabetic patients to be edentulous as compared to non-diabetics was 2.39 (95% CI [1.73, 3.28], p < 0.00001). CONCLUSION: There appears to be moderate certainty that the risk of being edentulous for diabetic patients compared to non-diabetic people is significant, but the odds ratio is estimated to be small.

Management of Bilateral Edentulous Mandible Fractures Through an Intraoral Approach Using CAD/CAM Technology: A Case Report.

The surgical management of edentulous mandible fractures presents unique challenges secondary to poor bone stock and the absence of dentition to assist with fracture reduction. In complex injury patterns, such as bilateral edentulous mandible fractures, an external approach is often necessary to achieve adequate reduction and adaptation of a load-bearing reconstruction plate. We report a case in which computer-assisted design/computer-assisted manufacturing (CAD/CAM) was applied as an adjunct for the acute management of bilateral edentulous mandible fractures in a 58-year-old man. CAD/CAM technology was used to fabricate a patient-specific reconstruction plate and a maxillomandibular splint, which facilitated the successful treatment of this complex injury through an intraoral approach. This case highlights the potential of CAD/CAM technology to improve operative efficiency and clinical outcomes in the acute management of complex edentulous mandible fractures.

Diagnosis and treatment of orofacial pain in a patient with unserviceable complete dentures: A clinical report.

An ill-fitting complete denture has the potential to create pain and discomfort as well as conceal or confound the diagnosis of other primary sources of orofacial pain such as trigeminal neuralgia. Guidelines of the American Academy of Orofacial Pain offer an evidence-based approach for the assessment, diagnosis, and management of orofacial pain. A complete and accurate differential diagnosis is paramount to the success of treatment as well as to the circumvention of unnecessary therapy. The purpose of this clinical report was to emphasize an evidence-based approach to the diagnosis and treatment of orofacial pain in a patient with edentulism and a history of prolonged denture wear.

Assessing the effects of tooth loss in adult crania using geometric morphometrics.

With high numbers of unidentified skeletonised remains recovered annually in South Africa and an increased number of edentate individuals being reported, the question arises as to whether tooth loss would result in craniofacial changes which might alter the accuracy of osteological analyses. Forty-five fixed landmarks together with sliding semilandmarks were collected from 229 white South African crania and were used to capture curve data pertaining to the basicranium, alveoli, zygomatic arches, nasal aperture and orbits. Geometric morphometric methods were employed to assess the effects of tooth loss on these structures. Although a number of effects were seen when the skull was analysed in its entirety, only the alveoli proved to be significantly affected when regions were analysed individually. Both upper facial height and palate shape were affected by tooth loss, which may influence various osteometric measurements and qualitative traits that are used during the assessment of ancestry and sex.

Rehabilitation of an Edentulous Maxilla in a Patient with Isolated Cleft Palate.

This article aims to discuss the use of short dental implants in cleft patients, the construction of an implant-retained obturator and the use of a Createch milled titanium bar with three Locator overdenture attachments incorporated within the bar. CPD/Clinical Relevance: Implant-retained obturators offer a possible solution for treating patients with isolated cleft palate who are struggling with dentures due to the unfavourable soft and hard tissue profile. This paper demonstrates how to manage such patients and shows all the clinical and laboratory stages involved.

Interrami intraoral fixation technique utilized as a conservative approach to edentulous/atrophic mandibular fractures.

Interrami intraoral Kirschner wire fixation (IRIF) technique is presented as new conservative successful indirect rigid fixation utilized for the reduction and fixation of edentulous/atrophic mandible fractures. This technique is carried out under local anesthesia without the need for open reduction internal fixation, which can lead to a compromise in the blood supply of fracture region. It is also quicker, easier, requires fewer postoperative visits, and cheaper than small or large bone plate fixations.Five edentulous mandibular fractures, 2 of them atrophic, 2 non-atrophic, and 1 partial edentulous, were successfully treated. In all cases, the IRIF technique was utilized to establish an indirect rigid fixation using horseshoe-shaped Kirschner wire with a 2-mm diameter. No complication was reported during these cases. This technique prevails over the Gunning splint and external edentulous fracture fixation techniques as it provides adequate fracture site stability, is more comfortable, and is better tolerated for a longer period of time by the patient. In addition, there are fewer complications caused by malunions from direct intraoral or extraoral small and large plate fixation techniques. Other advantages of the IRIF technique are that it enables the mandible to function as a single unit and preserves its function and anatomical position immediately after surgery. In contrast, the Gunning splint acts only to preserve the balance of a single segment's position.

Effects of edentulism in obstructive sleep apnea syndrome.

OBJECTIVES: The purpose of this study was to investigate the effects of edentulism in obstructive sleep apnea syndrome (OSAS) patients. MATERIALS AND METHODS: The study patients' were selected from the Gaziantep University Sleep Clinic and Orthodontic Department archives between the years of 2009 and 2011. Study groups were determined according to age and edentulism, and the overall study population consisted of 42 (21 male, 21 female) OSAS patients. Data from 14 edentulous (Group I), 14 older dentate (Group II), and 14 middle-aged dentate OSAS patients (Group III) were compared in this study. Polysomnographic parameters, which were measured and analyzed included: Sleep time, sleep efficiency, sleep stage 1, sleep stage 2, sleep stage 3, percentage of rapid eye movement sleep, apnea-hypopnea index, oxygen saturation and arousal index. The Kruskal-Wallis and Mann-Whitney U statistical tests were used for comparing the differences between the three groups and subgroups. RESULTS: Sleep time parameters showed significant differences between the groups (P<0.05). Differences occurred between Group I and Group III in the sleep time parameter (P<0.05), while the edentulous subjects showed lower mean sleep time values when compared to the older and middle-aged dentate groups. CONCLUSION: According to our results, edentulism may not impact polysomnography parameters, with the exception of the sleep time parameter. Important attention should be given to edentulous individuals during sleep with their dentures to prevent OSAS complications. The use of dentures may prevent or protect patients from the predisposing factors of OSAS.

Fracture of the genial tubercles of the mandible: case report and review of the literature.

Fracture of the genial tubercles is a rare occurrence and can occur as a solitary fracture or an associated fracture of the mandible. A solitary fracture seems to be associated with severe atrophy of the mandible. A report of a case of fractured genial tubercles in an 80-year-old edentulous female patient is described and a review of the literature is presented.

An algorithm for the treatment of noncondylar mandibular fractures.

An algorithm for the treatment of noncondylar mandibular fractures is presented based on outcomes from studies that have been performed during the past 30 years. It is designed to assist clinicians in formulating a treatment plan that can be expected to provide the patient with a predictable outcome.

The 'anatomically difficult' denture case.

UNLABELLED: Complete loss of teeth from one or both arches is a disabling condition which is usually managed by a conventional removable denture. Rehabilitation may be poorly tolerated by patients, particularly in the lower jaw, and is more difficult in situations when the anatomy of the denture-bearing area is less favourable. These situations may require specific prosthodontic or surgical techniques, or a combination of both. Prosthodontic solutions involve special impression techniques and the use of soft linings and it is vitally important to manage patient expectations in such cases. This article describes prosthodontic management options for dealing with the fibrous (flabby) anterior ridge and bony exostoses. CLINICAL RELEVANCE: Although tooth loss in the UK is diminishing, it is nevertheless important that dental practitioners are able to demonstrate good prosthodontic skills for managing an ageing population. Surgical correction of anatomical defects may occasionally be employed.

Fracture treatment in atrophic mandible.

BACKGROUND: Fractures of the atrophic mandible have been historically treated in various ways, from intermaxillary fixation to internal fixation, some cases require bone grafts. Besides, the Luhr classification serves as a guide to select the type of treatment. OBJECTIVE: To show the treatment of fractures in atrophic mandible with plates and screws, and the potential indications of bone graft in this type of fractures. METHOD: We presented a serie of 17 patients with atrophic mandible treated with plates and screws, some of them no blocked system and other with locked screws. For patients in luhr classes II and III cancellous bone grafts were used, looking for best osteogenic response, harvesting for the proximal third of the tibia. RESULTS: Postoperative progress was generally uneventful. Oral intake with purees was resumed 24 hours after surgery, as well as ambulation. Fracture healing at 6 months was seen in 17 patients. One patient died before the 6-month time point as the result of a stroke. Delayed union was diagnosed 3 months after surgery in another patient, who refused secondary treatment. CONCLUSIONS: Treatment of fractures in atrophic mandibles with plates and screws is a reliable procedure. Luhr classification provide useful guidance regarding the use of bone grafts for best osteogenic response in the fracture. This treatment allows a quick restart of the feeding by mouth and movilization of the patients.

ANTECEDENTES: Las fracturas en mandíbula atrófica han sido tratadas desde con fijación intermaxilar hasta con osteosíntesis. Pueden requerir injertos óseos. La clasificación de Luhr es una guía para orientar el tratamiento. OBJETIVO: Mostrar el tratamiento de fracturas en mandíbula atrófica con placas y tornillos y las posibles indicaciones de uso de injerto óseo en este tipo de fracturas. MÉTODO: Se presenta una serie de 17 pacientes con mandíbula atrófica fracturada tratada con placas y tornillos, algunas con sistemas no bloqueados y otros bloqueados. En las de clase II and III se aplicó injerto óseo esponjoso para mejorar la capacidad osteogénica. El injerto se tomó del tercio proximal de la tibia, previa evaluación radiológica. RESULTADOS: La evolución en general fue satisfactoria. Se inició la vía oral con papillas y los pacientes deambularon a las 24 h de posoperatorio. Se observó consolidación en 17 pacientes. Hubo una defunción por enfermedad vascular cerebral antes de 6 meses. Una paciente tuvo retardo de consolidación diagnosticado al tercer mes, pero no aceptó tratamiento secundario. CONCLUSIONES: El tratamiento de las fracturas mandibulares atróficas con placa y tornillos bajo concepto de carga absorbida es un procedimiento confiable. La clasificación de Luhr es útil para orientar la utilización de injerto óseo, buscando mejorar la capacidad osteogénica en la fractura. Este tratamiento permite un pronto reinicio de la vía oral, así como la movilización de los pacientes.

Spontaneous fracture of the genial tubercles: a case report.

UNLABELLED: Spontaneous fracture of the genial tubercles is rare and, of the 13 reported cases in the literature, all involve the older edentulous patient. A case of genial tubercle fracture in a 62-year-old edentulous female is presented. The symptoms are pain and swelling of the floor of the mouth and restricted tongue movement. Surgical intervention was not required and a complete recovery without loss of function was made. CLINICAL RELEVANCE: This case aims to make practitioners aware of genial tubercle fracture as a possible diagnosis when the older edentulous patient presents with pain and swelling in the floor of the mouth.

[Zygomatic anchorage concept in full edentulism]. / Le concept de l'ancrage zygomatique dans l'édentation totale.

The zygoma anchorage concept for severe atrophy of the maxilla was developed by Brånemark in the 1980s. It concerned patients having undergone maxillectomy as well as patients with edentulous upper jaws and mild to severe maxillary atrophy. The concept was created and clinically developed in 1997, by placing two zygomatic implants and four standard ones to compensate sub-sinus bone resorption. It was applied later to patients presenting extremely severe maxillary atrophy, using the "zygoma quad" concept with the placement of four zygomatic implants. Zygoma anchorage is reliable in terms of osseo-integration and biomechanical support of screwed prostheses, according to frequently published data (overall survival rate ranging between 91 and 100%). The increasing practice of immediate loading makes it the treatment of choice for oral rehabilitation. It decreases surgical invasiveness and the delay between surgery and oral rehabilitation. It allows a quick social and professional reinsertion and increases the comfort and quality of life for patients with fully edentulous maxilla with mild, moderate, or severe atrophy.

Macroplate fixation of fractures of the edentulous atrophic mandible: immediate function and masticatory rehabilitation.

The present study aimed at evaluating the treatment outcome of fractures of the edentulous atrophic mandible by means of an extraoral approach using open reduction and internal fixation with macroplates. Eighteen patients with 21 fractures of the atrophic mandible, who had been treated between 1997 and 2006, were retrospectively analysed. Mandible height was categorised according to the Luhr classification and the patients' general health (The American Society of Anesthesiologists (ASA) classification). Three types of titanium macroplates were used. Demographic data, treatment outcomes and the pre- and postoperative ability to wear mandible dentures were evaluated. The study population consisted of five men and 13 women with a median age of 78 years. The mean follow-up duration was 28 months. The most common cause of fractures was accidental falls (50%); the mandible was affected in 77.8%. Three fractures occurred in class I (bone height 15-20 mm), seven in class II (10-15 mm), and 11 in class III atrophy (<10 mm). According to the ASA classification, the collective showed a mean value of 3. An overall complication rate of 16.7% was noted, consisting of two minor and one major complication that required a second intervention. Five patients needed removal of the osteosynthesis material for prosthetic reasons. Only 50% of the patients were able to wear their dentures before surgery, and all but one were able to wear their prosthesis postoperatively. Treatment of atrophic mandible fractures with macroplates by means of an extraoral approach showed good results and a low complication rate. This procedure allows elderly patients to instantly load the mandible in the means of prosthetic and masticatory rehabilitation, preventing the necessity for second interventions.

Consequences of insufficient treatment planning for flapless implant surgery for a mandibular overdenture: a clinical report.

Flapless implant surgery is an emerging modality of treatment in implant dentistry that is known to offer several advantages. However, this procedure is inadvisable for situations where there is an absence of labial/buccal bone, reduced width of alveolar ridge, or a need for alveoloplasty to create prosthetic space. This clinical report describes the biologic and prosthodontic consequences of placing implants through flapless surgery and without preoperative treatment planning. Importance of proper treatment planning and a detailed discussion of prosthetic/restorative space analysis are discussed.

Combination syndrome symptomatology and treatment.

Combination syndrome (CS) is one of the most fascinating oral conditions yet is poorly understood and underappreciated in the literature and clinical practice. This article reviews the most important literature on this subject and analyzes the etiology, symptomatology, diagnosis, and current therapeutic modalities for treatment in an attempt to better understand CS. The syndrome represents an example ofa complex pathologic condition of the entire stomatognathic system with a multitude of hard-tissue, soft-tissue, and occlusal changes. These changes, initiated by a certain sequence of events, beginning with a prolonged period of tooth loss, can lead to severe bone atrophy in different regions of the jaws, loss of masticatory function, and the need for complex treatment. Implant rehabilitation of these patients in a preventative approach with cooperation of the entire dental team is emphasized.

Correlation of prosthetic status with the GOHAI and TMD indices.

This study sought to find a correlation between the prosthetic status and TMD and between the prosthetic status and self-perception of oral health in a Brazilian elderly population (n = 400). Prosthetic status was recorded in clinical examinations, and TMD was determined by applying the Helkimo index. Self-perception of oral health was evaluated based on the Geriatric Oral Health Assessment Index (GOHAI). The most prevalent prosthetic status was edentulous using complete dentures (47.5%). Absence of subjective TMD symptoms was found in 69.5%, and of clinical TMD signs in 38.3% of the population. The average GOHAI score was 33.02 +/- 2.85. A correlation was found between prosthetic status and TMD subjective symptoms (P = 0.017), but prosthetic status and TMD objective signs were uncorrelated (P = 0.061). Prosthetic status and self-perception of oral health were positively correlated (P = 0.001).

Periodontal disease and oral hygiene habits in a type 2 diabetic population.

OBJECTIVES: Periodontal disease is a serious oral health problem that is observed in patients with diabetes mellitus. The aim of the present study is to observe the oral health condition in a diabetic type 2 population in connection with glycaemic control and lifestyle. MATERIALS AND METHODS: A questionnaire was distributed to 118 patients in a centre for diabetics to collect information, such as date of birth, year of onset of diabetes, diabetic parameters, pharmacological therapy and oral hygiene habits. An oral examination was conducted to evaluate the presence of plaque, calculus, tooth mobility, caries and gingivitis. In a sub-group scaling and root planning (SRP) was completed. RESULTS: Thirty-one of 118 patients were edentulous and were excluded from the main analysis. Nearly 60% of patients presented dental plaque and gingivitis. A statistically significant difference in patients with or without a glycaemic control was only observed in women. Patients treated with SRP had significant better oral health and a slight reduction of HbA1c. CONCLUSION: Poor oral health care was observed in the diabetic population. The high risk of periodontal disease needs the attention of dental hygienist.

A new method to eliminate the risk of maxillary sinusitis with zygomatic implants.

PURPOSE: A new approach for zygomatic implant placement was proposed to eliminate the risk of maxillary sinusitis related to the procedure. MATERIALS AND METHODS: A prospective study of this new approach was conducted, and consecutive patients treated between June 2007 and December 2008 were included. An extended sinus lift with retained bone window was performed, such that zygomatic implants were placed completely outside the displaced maxillary sinuses. All patients were followed up radiologically at regular intervals using cone beam computed tomography to evaluate the status of the zygomatic implants and the condition of the maxillary sinuses. RESULTS: Sixteen patients (9 women and 7 men with a mean age of 60) were treated with 37 zygomatic implants. Within the period of investigation from 6 months to 24 months, there were no failed zygomatic implants, and no instances of maxillary sinusitis were reported. CONCLUSIONS: The new approach that combined the zygomatic implant placement with the extended sinus lift procedure was predictable and fulfilled the purpose of lowering the risk of maxillary sinusitis.

Mandibular subluxation for distal internal carotid artery exposure in edentulous patients.

Four patients with high internal carotid artery (ICA) occlusive disease were indicated for surgical endarterectomy and needed additional exposure besides regular head rotation and extension. When indicated, in our clinic this is usually achieved by mandibular subluxation with interdental wiring. Due to dental wear and periodontal disease, all 4 patients were edentulous. As a consequence, the technique of interdental wiring could not be used. In this technical note we will explain a method for interarch fixation with the use of two ipsilateral monocortical miniscrews and wiring, and the use of patients' pre-existing mandibular implants and provisional overdenture. This method gives rise to an additional exposure of 15 to 20 mm of the ICA.