Influence of gender and bruxism on the masseter muscle: A population-based magnetic resonance imaging study.

INTRODUCTION: This study aimed to (1) examine the cross-sectional area (CSA) of the masseter muscle in relation to bruxism and (2) investigate if there are gender-related differences in the masseter muscle in a population-based magnetic resonance imaging (MRI) study. METHODS: The study included 720 subjects aged 30-89 years (391 women and 329 men) from the Study of Health in Pomerania, a cross-sectional population-based study assessing the prevalence and incidence of common population-relevant diseases and their risk factors in Northeastern Germany. The participants underwent both a whole-body MRI and a full oral examination. The CSAs of the masseter muscles on both sides were measured from MRI images. The presence or absence of awake and/or sleep grinding and clenching, unilateral chewing, and other parafunctional activities were obtained from the dental interview. Linear and ordinal logistic regression models were used to examine the associations between the CSAs of the masseter, bruxism, and gender. RESULTS: The frequency of bruxism and reports of muscle or joint pain were significantly higher in women. The analysis revealed that a larger masseter CSA was significantly associated with bruxism only in men. The larger CSA was manifested only in the higher frequency bruxers. CONCLUSIONS: Bruxism had heterogeneous effects on the masseter muscle between genders. Although a higher prevalence of bruxism was reported by women, the larger CSA of the masseter muscle was significantly higher in bruxing men but not in women. This study emphasizes the need for a gender-specific approach when evaluating the clinical implications of bruxism on the masseter muscle.

Survival and stability of strategic mini-implants with immediate or delayed loading under removable partial dentures: a 3-year randomized controlled clinical trial.

OBJECTIVES: Stability values of mini-implants (MIs) are ambiguous. Survival data for MIs as supplementary abutments in reduced dentitions are not available. The aim of this explorative research was to estimate the 3-year stability and survival of strategic MIs after immediate and delayed loading by existing removable partial dentures (RPDs). MATERIAL AND METHODS: In a university and three dental practices, patients with unfavorable tooth distributions received supplementary MIs with diameters of 1.8, 2.1, and 2.4 mm. The participants were randomly allocated to group A (if the insertion torque ≥ 35 Ncm: immediate loading by housings; otherwise, immediate loading by RPD soft relining was performed) or delayed loading group B. Periotest values (PTVs) and resonance frequency analysis (RFA) values were longitudinally compared using mixed models. RESULTS: A total of 112 maxillary and 120 mandibular MIs were placed under 79 RPDs (31 maxillae). The 1st and 3rd quartile of the PTVs ranged between 1.7 and 7.8, and the RFA values ranged between 30 and 46 with nonrelevant group differences. The 3-year survival rates were 92% in group A versus 95% in group B and 99% in the mandible (one failure) versus 87% in the maxilla (eleven failures among four participants). CONCLUSIONS: Within the limitations of explorative analyses, there were no relevant differences between immediate and delayed loading regarding survival or stability of strategic MIs. CLINICAL RELEVANCE: The stability values for MIs are lower than for conventional implants. The MI failure rate in the maxilla is higher than in the mandible with cluster failure participants. CLINICAL TRIAL REGISTRATION: German Clinical Trials Register (Deutsches Register Klinischer Studien, DRKS-ID: DRKS00007589, www.germanctr.de ), January 15, 2015.

HOW TO IDENTIFY SUBGROUPS IN LONGITUDINAL CLINICAL DATA: TREATMENT RESPONSE PATTERNS IN PATIENTS WITH A SHORTENED DENTAL ARCH.

BACKGROUND: When dental patients seek care, treatments are not always successful,that is patients' oral health problems are not always eliminated or substantially reduced. Identifying these patients (treatment non-responders) is essential for clinical decision-making. Group-based trajectory modeling (GBTM) is rarely used in dentistry, but a promising statistical technique to identify non-responders in particular and clinical distinct patient groups in general in longitudinal data sets. AIM: Using group-based trajectory modeling, this study aimed to demonstrate how to identify oral health-related quality of life (OHRQoL) treatment response patterns by the example of patients with a shortened dental arch (SDA). METHODS: This paper is a secondary data analysis of a randomized controlled clinical trial. In this trial SDA patients received partial removable dental prostheses replacing missing teeth up to the first molars (N = 79) either or the dental arch ended with the second premolar that was present or replaced by a cantilever fixed dental prosthesis (N = 71). Up to ten follow-up examinations (1-2, 6, 12, 24, 36, 48, 60, 96, 120, and 180 months post-treatment) continued for 15 years. The outcome OHRQoL was assessed with the 49-item Oral Health Impact Profile (OHIP). Exploratory GBTM was performed to identify treatment response patterns. RESULTS: Two response patterns could be identified - "responders" and "non-responders." Responders' OHRQoL improved substantially and stayed primarily stable over the 15 years. Non-responders' OHRQoL did not improve considerably over time or worsened. While the SDA treatments were not related to the 2 response patterns, higher levels of functional, pain-related, psychological impairment in particular, and severely impaired OHRQoL in general predicted a non-responding OHRQoL pattern after treatment. Supplementary, a 3 pattern approach has been evaluated. CONCLUSIONS: Clustering patients according to certain longitudinal characteristics after treatment is generally important, but specifically identifying treatment in non-responders is central. With the increasing availability of OHRQoL data in clinical research and regular patient care, GBTM has become a powerful tool to investigate which dental treatment works for which patients.

Immediate versus delayed loading of strategic mini-implants under existing removable partial dentures: patient satisfaction in a multi-center randomized clinical trial.

OBJECTIVE: The purpose of this study was to evaluate and compare the effects of the immediate and delayed loading of strategic mini-implants (MIs) on the satisfaction of patients with removable partial dentures (RPDs). MATERIALS AND METHODS: In this multi-center randomized clinical trial, strategic MIs were inserted under 79 RPDs in 76 participants. Two questionnaires, one for the upper jaw and one for the lower jaw, were given before surgical intervention and 2 weeks, 4 months, 4.5 months, 1 year, 2 years, and 3 years after implant insertion. To estimate the loading effect (immediate vs. delayed) in terms of the odds ratio, an ordinal logistic regression model was used. The Wilcoxon matched-pairs signed-rank test, which was corrected for clusters in the patient population, was used to evaluate changes in patient satisfaction. RESULTS: After 4 months, a statistically significant difference in favor of the immediate loading group was recognized in terms of the overall satisfaction score. The patient satisfaction scores recorded after 4.5 months and 1, 2, and 3 years showed substantial improvements compared with the scores recorded before implant insertion in both groups. At the item level, substantial improvements were noted in the following domains: general satisfaction, RPD retention, stability, support, eating, speaking, and aesthetics. CONCLUSIONS: Strategic MIs improved the satisfaction of patients with RPDs during the medium-term follow-up period. An earlier improvement in the satisfaction of patients with RPDs was seen after immediate loading of the MIs as compared with delayed loading. CLINICAL RELEVANCE: Inserting MIs under existing RPDs can improve patients' satisfaction with their RPDs in several domains.

Rehabilitation of shortened dental arches: A fifteen-year randomised trial.

BACKGROUND: Few long-term studies on treatments in the shortened dental arch (SDA) are available. OBJECTIVE: The objective of this trial was to analyse the long-term success of two different treatment concepts. METHODS: Patients over 35 years of age with missing molars in one jaw and at least the canine and one premolar present on both sides were eligible. In the partial removable dental prosthesis (PRDP) group (N = 81), molars and missing second premolars were replaced by a precision attachment retained prosthesis. In the SDA group (N = 71), the dental arch ended with the second premolar that had to be present or replaced by a cantilever fixed dental prosthesis. Follow-up examinations were carried out over 15 years. RESULTS: A comprehensive outcome variable comprised four failure categories for which Kaplan-Meier survival (success) analyses were conducted. Half of the patients exhibited a continuous preservation of the per protocol prosthetic status that remained totally unaffected by complications for more than 10 years. The event-free success rates for moderate or worse failure implied a loss of the per protocol prosthetic status. The respective survival rates fell below 50% at 14.2 years in the PRDP group and 14.3 years in the SDA group. In none of the analyses, a significant group difference was found. CONCLUSIONS: In patients with an SDA condition, changes in the prosthetic status have to be expected. The affected proportion increases almost linearly from shortly after treatment and comprises the majority after 15 years. The influence of the examined treatments on success appears to be low.

Validity and reliability of new instruments for measuring patient satisfaction with removable dentures, Arabic Version.

BACKGROUND: The psychometric properties of self-administered instruments for measuring patient satisfaction with removable dentures should be tested before inviting patients to express their opinions. This study aimed to evaluate the validity and reliability of new instruments in the Arabic language that measure patient satisfaction with all types of removable dentures. METHODS: A three-step methodology was used to translate and test the instruments. In step one, the instruments were translated from tested German instruments to develop the pilot questionnaires. In step two, the face validity of the pilot questionnaires was tested through three rounds of interviews. There were 15, 13, and 15 participants per round, respectively. At the end of every round, the results of the interviews were discussed with an expert panel. The expert panel confirmed the form and the type of questionnaires' adjustments before a new round of interviews began. At the end of step two, the final form of the questionnaires was reached. In step three, 235 questionnaires were distributed to 133 participants to estimate the construct validity of the upper jaw and the lower jaw questionnaires. After one week, the participants were asked to complete the questionnaires again. A total of 102 questionnaires were returned and used to assess the instruments' reliability. Factor analysis was used to assess the construct validity. The intraclass correlation coefficient and Cronbach's alpha were used to estimate the reliability and suitability of the items in the indexes. RESULTS: The result of step one was two pilot questionnaires. The pilot questionnaires were adjusted in step two. At the end of step two, the questionnaires proved to have good face validity. Factor analyses in step three revealed that only one factor could be retained. The one-factor model explained 60.95% and 63.06 of the total variance of the upper jaw and lower jaw questionnaires, respectively. The items in every questionnaire shared the same cluster and could be summed to form an upper jaw index and lower jaw index that reflected patient satisfaction with removable dentures. Cronbach's alpha values indicated excellent internal consistency and reliability for the upper jaw questionnaire (α = 0.91) and the lower jaw questionnaire (α = 0.92). Intraclass correlation coefficient values ranged from 0.72 to 0.95, which can be considered "moderate" to "excellent". CONCLUSIONS: The Arabic version of questionnaires and indexes assessing patient satisfaction with upper and lower removable dentures are reliable and valid self-administered instruments.

IMPACT OF SHORTENED DENTAL ARCH ON ORAL HEALTH-RELATED QUALITY OF LIFE.

BACKGROUND: A shortened dental arch (SDA) is an established treatment concept for patients with missing molars. However, little is known regarding long-term course of oral health-related quality of life (OHRQoL) in patients with SDA and the benefits from replacement of missing molars. OBJECTIVE: Purpose of this multi-center randomized clinical trial was to assess OHRQoL over a period of 15 years in patients with molar replacement by a removable partial denture (RPD) compared to patients with a restored SDA without molar replacement. METHODS: Patients at least 35 years of age with all molars missing in 1 jaw and at least the canine and one premolar present on each side were included. Patients received either a precision attachment-retained, RPD for replacement of missing molars (n = 79), or the dental arch ended with the second premolar (SDA) that had to be present or replaced by a cantilever fixed dental prosthesis (n = 71). Follow-up examinations continued for 15 years. OHRQoL was assessed with the 49-item Oral Health Impact Profile (OHIP). OHIP summary and dimension scores were longitudinally modeled in the statistical analyses to assess course of OHRQoL over time applying an intention-to-treat approach. In addition, scores for the OHRQoL dimensions Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact were analyzed. RESULTS: After an initial improvement in OHRQoL indicated by a mean decrease of 20.0 OHIP points with an effect size of 0.61 in the entire study population, OHRQoL stayed relatively constant over the entire follow-up period. Assuming a constant time and treatment effects over the study period, OHRQoL did not differ statistically significant between the 2 treatments (0.4 OHIP points; 95%-CI: 7.1 - 6.2). OHRQoL after treatment did not change notably over 15 years and was statistically nonsignificant as well (P = .872). Similar findings were observed in all 4 OHRQoL dimensions. CONCLUSIONS: In patients, missing all molars in one jaw OHRQoL improved providing RPD or restoring SDA to a clinically relevant degree. Treatment-related improvement remained mostly stable over a period of at least 15 years. Therefore, patients can be informed that both treatment concepts are equivalent concerning long-term OHRQoL. Accordingly, patients' preferences regarding treatment options should be granted priority in treatment decision making with the SDA treatment option being the default.

Stabilizing mandibular complete dentures by a single midline implant-influence on quality of life: 2-year results from a randomized clinical trial comparing different loading protocols.

OBJECTIVES: The knowledge about the influence of dental treatment on health-related quality of life (HRQoL) is still limited. The aim of this multicenter randomized controlled clinical trial was to assess the effect of stabilizing an existing complete denture, by means of a single mandibular implant, on HRQoL. Furthermore, the impact of the loading protocol, i.e., immediate or delayed loading, in edentulous patients was evaluated. METHODS: One hundred fifty-eight participants aged 60-89 years were randomly assigned to study group A (immediate loading; n = 81) and to group B (delayed loading; n = 78). All participants received a single midline implant in the mandible. The implants were either immediately loaded (group A) or after a closed healing period of 3 months (group B) by connecting the existing mandibular complete dentures to ball attachments. HRQoL was assessed with the Short Form-36 questionnaire of health (SF-36) at baseline, 4 months, and 24 months after implant loading. RESULTS: Improvement of HRQoL by means of a single implant-retained mandibular overdenture could not be demonstrated after 4 and 24 months of implant loading. Furthermore, the application of two different loading protocols did not influence HRQoL ratings of study participants. CONCLUSION: The loading protocol is not a factor, influencing HRQoL in patients treated by a single midline implant in the edentulous mandible. CLINICAL RELEVANCE: A single midline implant in the edentulous mandible, stabilizing a mandibular complete denture, cannot be recommended for improving HRQoL.

Reducing uncertainty in estimating associations of oral exposures with Helicobacter pylori serology in the general population.

AIM: Evidence for reducing Helicobacter (H.) pylori by periodontal therapy comes from small studies in China, limiting generalizability. To estimate the association between periodontal disease and anti-H. pylori IgG titer levels in a European country, we used population-based data from the Study of Health in Pomerania. MATERIALS AND METHODS: For pocket depth as the primary exposure, we restricted the age range to participants younger than 60 years (n = 2,481) to avoid selection bias due to edentulism in this cross-sectional study. For the full age range up to 81 years, we chose the number of missing teeth (n = 3,705). RESULTS: The association between pocket depth and the outcome was weak. Given the ceiling effect for the number of missing teeth (ordinal logistic regression; odds ratio of the interquartile range effect = 1.6; 95% CI: 1.3-1.9; p-value for linearity = 0.005), we checked whether wearing removable dental prosthesis was associated with higher anti-H. pylori IgG titer levels (odds ratio = 1.3; 95% CI: 1.1-1.5). CONCLUSIONS: Tooth loss and wearing removable dental prosthesis were weakly to moderately associated with higher anti-H. pylori IgG titer levels in the general population of a European country.

The randomized shortened dental arch study: influence of two different treatments on interdental spacing over 5 years.

OBJECTIVES: Being a secondary outcome in a multicenter randomized controlled trial, the present analysis focused on interdental spacing in the shortened dental arch (SDA). The aim was to evaluate changes in interdental spacing in dependence of two different treatments after an observation period of up to 5 years. MATERIAL AND METHODS: Patients were either treated with a partial removable dental prosthesis (PRDP) for molar replacement (PRDP group) or according to the SDA concept aiming at a premolar occlusion (SDA group) in a randomized manner. Interdental spacing in the anterior region was measured with gauges and categorized as "0" (<0.1 mm), "1" (<0.5 mm), "2" (0.5-1 mm), and "3" (>1 mm). The statistical analysis was performed with analysis of variance models followed by linear contrast. RESULTS: Ninety-one patients (SDA n = 41, PRDP n = 50) were included. Changes of interdental spacing were detected in 70.7 % of all cases. A significant difference between the mean score changes was found in the mandible comparing the PRDP group and the SDA group. The respective mean score changes from baseline to 5 years were 0.23 (SD 0.49) for the PRDP group and 0.02 (SD 0.30) for the SDA group (p = 0.023). CONCLUSIONS: Major interdental spacing could be observed in neither of the groups. The SDA concept resulted in a slightly better outcome. CLINICAL RELEVANCE: When deciding whether to replace missing molars, the present results give further support to the SDA concept.

Prospective association of sex steroid concentrations with periodontal progression and incident tooth loss.

AIM: The aim of this study was to determine the prospective association between sex steroid concentrations with periodontal progression and incident tooth loss in men and women. METHODS: We used data from 1465 women and 1838 men (age 20-81 years) with completed five-year-follow-up from the Study-of-Health-in-Pomerania, a population-based longitudinal cohort. Serum levels of total testosterone (TT) and other sex steroids were measured. Mean clinical attachment loss (CAL) and the number of teeth were assessed. Generalized regression models were implemented for cross-sectional and longitudinal analyses, adjusting for age, education, smoking, waist circumference, diabetes, physical activity, blood sampling time and time between baseline and follow-up. RESULTS: Fully adjusted models revealed no consistent associations between TT and mean CAL, neither in cross-sectional [men: ß = -0.0004 (-0.023;0.022), p = 0.97; women: ß = -0.033 (-0.057; -0.009), p = 0.006] nor in longitudinal analyses [men: ß = -0.033 (-0.100;0.034), p = 0.33; women: ß = -0.023 (-0.086;0.040), p = 0.47]. For tooth loss, neither cross-sectional nor longitudinal associations with any of the sex steroid concentrations were found. CONCLUSIONS: No consistent associations of sexual steroids with periodontal progression or tooth loss were found. Further cohort studies are necessary to evaluate possible associations between endocrinological parameters, like supra- or subphysiologic testosterone concentrations, and periodontal progression or tooth loss.

Immediate versus delayed loading of strategic mini dental implants for the stabilization of partial removable dental prostheses: a patient cluster randomized, parallel-group 3-year trial.

BACKGROUND: Acceptable short-term survival rates (>90 %) of mini-implants (diameter < 3.0 mm) are only documented for mandibular overdentures. Sound data for mini-implants as strategic abutments for a better retention of partial removable dental prosthesis (PRDP) are not available. METHODS/DESIGN: The purpose of this study is to test the hypothesis that immediately loaded mini-implants show more bone loss and less success than strategic mini-implants with delayed loading. In this four-center (one university hospital, three dental practices in Germany), parallel-group, controlled clinical trial, which is cluster randomized on patient level, a total of 80 partially edentulous patients with unfavourable number and distribution of remaining abutment teeth in at least one jaw will receive supplementary min-implants to stabilize their PRDP. The mini-implant are either immediately loaded after implant placement (test group) or delayed after four months (control group). Follow-up of the patients will be performed for 36 months. The primary outcome is the radiographic bone level changes at implants. The secondary outcome is the implant success as a composite variable. Tertiary outcomes include clinical, subjective (quality of life, satisfaction, chewing ability) and dental or technical complications. DISCUSSION: Strategic implants under an existing PRDP are only documented for standard-diameter implants. Mini-implants could be a minimal invasive and low cost solution for this treatment modality. TRIAL REGISTRATION: The trial is registered at Deutsches Register Klinischer Studien (German register of clinical trials) under DRKS-ID: DRKS00007589 ( www.germanctr.de ) on January 13(th), 2015.

Pre-diabetes and well-controlled diabetes are not associated with periodontal disease: the SHIP Trend Study.

AIM: To examine associations of pre-diabetes and well-controlled diabetes with periodontitis. MATERIALS AND METHODS: The Study of Health in Pomerania (SHIP)-Trend is a cross-sectional survey in North-Eastern Germany including 3086 participants (49.4% men; age 20-82 years). Clinical attachment loss (CAL) and periodontal probing depth (PPD) were assessed applying a random half-mouth protocol. The number of teeth was determined. Pre-diabetes comprised impaired fasting glucose and impaired glucose tolerance. Previously known diabetes was defined as well controlled if glycated haemoglobin (HbA1c) was <7.0%. Participants were categorized as follows: normal glucose tolerance (NGT), pre-diabetes, newly detected type 2 diabetes (T2DM), known T2DM with HbA1c<7.0% and known T2DM with HbA1c≥7.0%. RESULTS: Pre-diabetes was neither associated with mean CAL and PPD in multivariable adjusted linear regression models nor with edentulism (OR = 1.09 (95%-CI: 0.69-1.71)) and number of teeth (OR = 0.96 (95%-CI: 0.75-1.22), lowest quartile versus higher quartiles) in logistic regression models. Associations with mean CAL and edentulism were stronger in poorly controlled previously known diabetes than in well-controlled previously known diabetes (for edentulism: OR = 2.19 (95%-CI: 1.18-4.05), and OR = 1.40 (95%-CI: 0.82-2.38), respectively, for comparison with NGT). CONCLUSIONS: Periodontitis and edentulism were associated with poorly controlled T2DM, but not with pre-diabetes and well-controlled diabetes.

Clinical response of edentulous people treated with mini dental implants in nine dental practices.

OBJECTIVES: To analyse implant survival, prosthetic aftercare and quality of life (QoL) after stabilisation of complete dentures with mini-implants. BACKGROUND: Many edentulous patients refuse implant therapy due to the expenses and fear of surgery. Studies on minimally invasive and low-cost mini-implants remain rare. MATERIALS AND METHODS: A total of 133 participating patients from nine private practices were evaluated via patient records, questionnaires and clinical examinations. Complications, maintenance, QoL questions and the German short version of the oral health impact profile (OHIP-G14) were analysed. RESULTS: After 7 to 61 months, 15 of 336 maxillary implants and 11 of 402 mandibular implants had to be removed. In addition, four mandibular implants experienced fracture. The difference between the 4-year survival rates of 94.3% for the maxilla and 95.7% for the mandible was not statistically significant (p = 0.581). All original 144 overdentures remained functional. The prosthetic interventions were typically limited to repairs of acrylic base fractures (about one in five patients), changes of plastic O-rings and relining procedures. The participants showed OHIP-G14 scores (median = 2) that were comparable with those of patients with overdentures retained by conventional implants. CONCLUSIONS: Mini-implant survival was similar to that of regular-diameter implants. Although some prosthetic aftercare was necessary, none of the overdentures had to be replaced. Prospective studies comparing conventional and mini-implants are warranted.

The randomized shortened dental arch study: temporomandibular disorder pain.

OBJECTIVES: The aim of this multi-center, randomized controlled trial was to assess the impact of missing posterior support on the risk for temporomandibular disorder (TMD) pain by comparing patients with either shortened dental arches (SDA) or molar replacement by removable dental prostheses (RDP). METHODS: A sample of 215 patients with bilateral molar loss in at least one jaw was consecutively recruited in 14 prosthodontic departments of dental schools in Germany. Of the initial sample, 152 patients (mean age: 59.7 years; 53.9 % female) received randomly allocated interventions (SDA: n = 71; RDP: n = 81). Presence of TMD pain was assessed using patients' self-reports and was verified by physical examination and by pain intensity, as the mean of current pain, worst pain, and average pain in the last 6 months, with 10-point ordinal rating scales. Assessments were performed before treatment and at follow-ups until 60 months after treatment. Impact of interventions on TMD risk and pain intensity was computed by applying logistic and linear random-intercept models. RESULTS: Tooth replacement (RDP) did not significantly change the risk for self-reported (odds ratio [OR]: 1.1; confidence interval [CI]: 0.4 to 3.4) or clinically verified (OR: 0.7; CI: 0.1 to 4.3) TMD pain compared to no tooth replacement (SDA). Mean characteristic pain intensity was virtually identical in both groups (Coeff: 0.01; CI: -0.30 to 0.32). CONCLUSION: Retaining or preservation of an SDA is not a major risk factor for TMD pain over the course of 5 years when compared to molar replacement with RPDs. CLINICAL RELEVANCE: Seemingly, missing molars do not have to be replaced in order to prevent TMD pain.

The intra- and inter-rater reproducibility of bone level measurements at strategic mini-implants using dental panoramic radiography.

OBJECTIVES: This experimental study focused on the intra- and inter-rater reproducibility of vertical bone level (VBL) measurements at strategic mini-implants (MI) using digital panoramic radiographs (PR). STUDY DESIGN: VBLs of 152 MIs for removable partial denture stabilization at 50 randomly chosen PRs from a clinical trial were digitally evaluated by three ratters. Rater deviations exceeding 0.5 mm were re-examined. The intra-class correlation coefficient (ICC) was applied to estimate reliability. The smallest detectable change (SDC) was interrelated to the minimal clinically important change of 0.2 mm. RESULTS: The first measurement round revealed intra- and inter-rater ICCs of > 0.8. However, 28 sites (9 %) were unreadable, and 97 sites (32 %) revealed differences between observers of ≥ 0.5 mm. Following a consensus session and re-training, an additional 8 sites were excluded and all remaining VBL differences were ≤ 0.5 mm. Thus, the SDCs with 95 % credibility were improved from 0.73 to 0.31 mm in the intra-rater and from 1.52 to 0.34 mm in the inter-rater statistics. Given a 50 % credibility for this special setting, both the intra- and inter-rater SDCs were 0.11 mm. CONCLUSIONS: Digital PR can be reliably utilized to determine VBLs around MIs under conditions of at least two trained observers, mutual calibration sessions, and exclusion of unquantifiable radiographs. GERMAN CLINICAL TRIALS REGISTER ID: DRKS00007589, www.germanctr.de.

Impact of depressive symptoms on prosthetic status--results of the study of health in Pomerania (SHIP).

OBJECTIVES: Previous investigations have confirmed that every fifth dental patient suffers from clinically significant depressive symptoms. However, the putative impact of depressive symptoms on the prosthetic status has not been addressed in these studies. The objective of this study was to investigate the association between depressive symptoms and prosthetic status based on data from the Study of Health in Pomerania (SHIP-0). METHODS: Data from 2,135 participants aged 30 to 59 years were analyzed. A classification (six classes regarding the number and position of missing teeth per jaw) was used to identify the degree of prosthetic status (no/suboptimal/optimal tooth replacement). The presence of depressive symptoms was assessed with a modified version of von Zerssen's complaints scale. Screening for lifetime diagnoses of mental disorders was performed with the Composite International Diagnostic-Screener (CID-S). Multivariable logistic regressions including several confounders were calculated. RESULTS: A significant protective dose-response effect of depressive symptoms on prosthetic status was found only in men for the lower jaw [0-1 depressive symptoms: odds ratio (OR) = 3.84, 95 % confidence interval (CI, 1.65-8.92), p < 0.01; 2-3: OR = 2.87 (CI, 1.22-6.74), p < 0.05; reference, ≥8; adjusted for age, school education, smoking status, household income, marital status, living without a partner, risky alcohol consumption, obesity, diabetes, and physical activity]. There was no such association in women or for the upper jaw. The analyses using the CID-S confirmed these results. CONCLUSIONS: In the lower jaw, men with depressive symptoms had a better prosthetic status than men without depressive symptoms suggesting a higher level of concern regarding their personal health. CLINICAL RELEVANCE: If dentists might have an opportunity to identify men with depressive symptoms they can provide a wide range of treatment options that may enhance patients' self-esteem and contribute to the patient' well-being. Furthermore, depressive symptoms could indicate a discrepancy between self-perception of the dental health and the actual status which influence the dentists' treatment decision making.

Retrospective and clinical evaluation of retrievable, tooth-implant supported zirconia-ceramic restorations.

OBJECTIVE: Permanent cementations of zirconia-ceramic restorations may conflict with the rationale for retrievability of implant-supported restorations. The aim of this study was to test the hypothesis that retrievable, tooth-implant supported FDPs made of veneered zirconia ceramic cores are a viable treatment alternative. MATERIAL AND METHODS: Restorations of patients in private practice and dental clinic were evaluated by reviewing patient records retrospectively and performing a final clinical examination. Permanently cemented copings protected the tooth abutments. The zirconia-ceramic restorations were semi-permanently cemented to the copings and the implant abutments using acrylic-urethane cement. In addition to Kaplan-Meier analyses for complications, the effect of age, gender, signs of bruxism, jaw and number of units on complications was estimated using Cox regression analyses (significance p < 0.05). RESULTS: The follow-up period for 23 patients (nine with signs of bruxism) with four anterior and 27 posterior zirconia-ceramic restorations (3-12 units) ranged from 12.7-47.9 months. Core fractures of two posterior prostheses in patients with signs of bruxism yielded a 40-month survival rate of 93.5%. There were 10 cohesive chippings within the veneering porcelain for seven patients (six patients with signs of bruxism), which resulted in 40-month chipping rates of 5.6% among non-bruxers and 100% among patients with signs of bruxism. The hazard ratio for signs of bruxism was 20 (95% confidence interval: 2.1-188.3, p = 0.009). CONCLUSIONS: Retrievable, tooth-implant supported restorations made of zirconia-ceramics should be used with caution because of some core fractures and a considerable number of minor veneer fractures. The fracture risk was very high among patients with signs of bruxism. Due to the low number of occasions for intentional retrievals, a recommendation to use semi-permanently cemented, all-ceramic FDPs would still be premature.

Upgrading removable denture design by using strategic implants: A case report.

Inserting a dental implant in a strategic position under a removable partial denture (RPD) can upgrade the RPD design by changing a mainly tissue-supported RPD to an implant-tissue-supported RPD or an implant-tooth-tissue-supported RPD with better retention, support, and stability. CASE PRESENTATION: The patient (female, 77-year-old) was unsatisfied with her maxillary and mandibular clasp-retained removable dentures (RDs). Medical, social, and systemic health evaluations revealed that the patient was healthy. Dental history, intraoral and extraoral examinations, functional screening, and esthetic analyses revealed that the patient had a reduced vertical dimension, resulting in pseudo-class III malocclusion and angular cheilitis. Strategic implants were used to improve the retention, support, and stability of the new RDs. The maxillary canine 23 (World Dental Federation notation) and maxillary premolar 24 were used to retain the maxillary conical crown attachments. Three strategic mini-implants were inserted in the positions of teeth 12, 13, and 14 to support and retain the maxillary RPD. Two locators above the standard implants (33 and 43) were used to support and retain the mandibular overdenture. An improvement in the oral health-related quality of life and patient satisfaction with respect to the maxillary and mandibular RDs was observed immediately after using the new RDs. This improvement did not diminish after a year. CONCLUSION: Herein, using strategic implants to support the maxillary RPD and two standard implants under the mandibular overdenture improved the oral health-related quality of life and patient satisfaction with respect to the maxillary and mandibular prostheses in terms of the retention, stability, support, eating ability, speaking ability, appearance, and cleanability.

The association of tooth loss with all-cause and circulatory mortality. Is there a benefit of replaced teeth? A systematic review and meta-analysis.

We systematically reviewed whether the number of teeth is related to all-cause or circulatory mortality and whether replaced teeth are protective against all-cause or circulatory mortality. The search was based on the PubMed database. All cohort studies published in peer-reviewed journals were selected. Studies on periodontal disease and mortality were excluded if they did not provide information on the number of teeth. Risk estimates from studies with appropriate exposure definition, confounder adjustment and sample size were included in a meta-analysis. Three high-quality studies found a relationship between the number of teeth and circulatory mortality, whereas a moderate study did not. Two out of four moderate- to high-quality studies reported a relationship between the number of teeth and all-cause mortality. No study has investigated whether replaced teeth are protective against mortality. Therefore, denture use was taken as proxy. The methodological quality of studies on denture use and mortality was generally low to moderate. The findings of two moderate studies indicated an effect of prosthodontic replacements on all-cause mortality, which was supported in bias analysis. It is open whether competing risks of cause-specific death other than circulatory mortality reduce an effect of the number of teeth on all-cause mortality. An effect of denture use on circulatory mortality remains to be established, as well as whether the number of replaced teeth affects mortality. Specifying the role of potential pathways by which tooth loss-related mortality is mediated will possibly increase the value of dental treatment for general health.