Implementing an oral health policy in long-term care facilities for older adults in Flanders, Belgium: The Oral Health Care Track.

BACKGROUND: The oral health of care-dependent older people living in residential care facilities is generally suboptimal. To facilitate adequate daily oral care and timely referral to a dental professional, studies emphasise the need for sustainable, structured oral healthcare policies in aged care organisations. The effect of such interventions is often limited or uncertain owing to a lack of understanding of how effective the integration and implementation of the policy has been within the facilities. This study reports on the development of a method to adequately implement an oral healthcare policy in long-term care organisations for older adults. MATERIALS AND METHODS: An intervention mapping protocol was used to develop a theory- and practise-based methodology. This step-by-step approach combined findings from a literature review, experiences from earlier projects and behaviour change theories in a multilevel programme. RESULTS: Intervention mapping yielded a systematic programme for implementing an oral healthcare policy in aged care organisations. The Oral Health Care Track or "De Mondzorglijn" comprises seven phases, each subdivided into several tasks. The programme's implementation is guided by oral healthcare coaches. CONCLUSION: By using intervention mapping, it was possible to combine behaviour change theories, information derived from needs assessment and earlier experiences into a comprehensive programme to improve the oral health and quality of life of older residents in residential care facilities. Further research is needed to evaluate the use of coaches in the implementation of the Oral Health Care Track.

Evaluation of the extent of plaque removal and users' experience of alternative toothbrushes: A randomized single-blind crossover study.

INTRODUCTION: In residential care, tooth brushing with a manual toothbrush can be challenging because of technical difficulties, time consumption and poor patient cooperation, resulting in a sub-optimal cleaning. The study aimed at comparing the efficiency in plaque removal, brushing time and users' experience between three toothbrushes: a single-headed conventional manual toothbrush, a triple-headed manual toothbrush and a U-shaped electric toothbrush. METHODS: This was a single-blind crossover study with three pre-post-test conditions. Participants were 26 dental students divided into fixed pairs to play the role of caregivers and care receivers. Pre/post plaque scores were determined by two independent investigators according to the Quigley-Hein Plaque Index (QHI). Questionnaires evaluated participants' experiences. Statistical tests of significances of differences and ANOVA were performed. RESULTS: Results showed that plaque removal was more effective for the manual toothbrush and the triple-headed toothbrush compared to the U-shaped electric toothbrush (p < 0.001). Brushing time was the longest for the single manual toothbrush (149 s). The U-shaped electric toothbrush showed significantly better results for aspects related to comfort and salivation. The manual and triple-headed toothbrush showed better results for aspects related to cleanliness and motivation to use. CONCLUSION: Notwithstanding its favourable comfort, tooth plaque removal is not enhanced by a U-shaped electric toothbrush. The triple-headed and single-headed toothbrushes reduced plaque more substantially than the U-shaped toothbrush. In addition, the triple-headed manual toothbrush was not only effective in plaque removal, but also had a shorter brushing time and was easy to use, being an adequate alternative for care-dependent patient groups.

Effectiveness of a 3D simulation tool to teach the designing of metal removable partial dentures: A mixed-method study.

INTRODUCTION: Acquiring insights into the framework design of metal-based removable partial dentures (mRPD) is a current challenge in dental education. The aim of the present study was to explore the effectiveness of a novel 3D simulation tool to teach designing mRPD by investigating the learning gain and the acceptance and motivation towards the tool of dental students. MATERIALS AND METHODS: A 3D tool based on 74 clinical scenarios was developed for teaching the design of mRPD. Fifty-three third year dental students were randomly divided into two groups, with the experimental group (n = 26) having access to the tool during 1 week while the control group (n = 27) had no access. Quantitative analysis was based on a pre- and post-test in order to evaluate the learning gain, technology acceptance and motivation towards using the tool. Moreover, qualitative data was collected by means of an interview and focus group to get additional insights into the quantitative results. RESULTS: Although the results showed a higher learning gain for students in the experimental condition, the study did not find a significant difference between both conditions based on quantitative results. However, during the focus groups, all students of the experimental group revealed that the 3D tool improved their understanding of mRPD biomechanics. Moreover, survey results revealed that students positively evaluated the perceived usefulness and ease of use of the tool and indicated to have the intention to use the tool in the future. Suggestions were made for a redesign (e.g. creating scenarios themselves) and further implementation of the tool (e.g. analysing the scenarios in pairs or small groups). CONCLUSION: First results of the evaluation of the new 3D tool for teaching the design framework of mRPD are promising. Further research based on the design-based research methodology is needed to investigate the effects of the redesign on motivation and learning gain.

Modeling local dependence in latent vector autoregressive models.

We propose a Bayesian latent vector autoregressive (LVAR) model to analyze multivariate longitudinal data of binary and ordinal variables (items) as a function of a small number of continuous latent variables. We focus on the evolution of the latent variables while taking into account the correlation structure of the responses. Often local independence is assumed in this context. Local independence implies that, given the latent variables, the responses are assumed mutually independent cross-sectionally and longitudinally. However, in practice conditioning on the latent variables may not remove the dependence of the responses. We address local dependence by further conditioning on item-specific random effects. A simulation study shows that wrongly assuming local independence may give biased estimates for the regression coefficients of the LVAR process as well as the item-specific parameters. Novel features of our proposal include (i) correcting biased estimates of the model parameters, especially the regression coefficients of the LVAR process, obtained when local dependence is ignored and (ii) measuring the magnitude of local dependence. We applied our model on data obtained from a registry on the elderly population in Belgium. The purpose was to examine the values of oral health information on top of general health information.

Oral healthcare delivery in institutionalised older people: A health-economic evaluation.

OBJECTIVES: This health-economic evaluation aimed to assess the cost-effectiveness of a number of alternatives for preventive and curative oral health care in institutionalised older people in Flanders. METHODS: A six-state Markov model was used to compare expected costs and healthy oral years (HOYs) of four alternatives: (1) usual care; (2) on-site preventive care; (3) on-site preventive care + curative care in the community; and (4) on-site preventive care + on-site curative care. A healthcare payer perspective was adopted, and the time horizon was 10 years. Deterministic and probabilistic sensitivity analyses were performed. RESULTS: Incremental cost-effectiveness ratios (ICERs) of alternatives 2, 3 and 4 (all compared to alternative 1) were as follows: (2) 7944 €/HOY gained; (3) 1576 €/HOY gained; and (4) 1132 €/HOY gained. Hence, alternatives 2 and 3 were not cost-effective compared to alternative 4. The probability that oral care interventions are more effective and cost-saving than usual care was <3% for all three interventions. CONCLUSIONS: For institutionalised older people, on-site solutions for preventive and curative oral health care might be the most cost-effective alternative. It should be kept in mind that on-site solutions require large initial investment and that the advanced age of the population and the high costs of oral health care make it unlikely that these interventions would become cost-saving, even in the long term.

Latent Ornstein-Uhlenbeck models for Bayesian analysis of multivariate longitudinal categorical responses.

We propose a Bayesian latent Ornstein-Uhlenbeck (OU) model to analyze unbalanced longitudinal data of binary and ordinal variables, which are manifestations of fewer continuous latent variables. We focus on the evolution of such latent variables when they continuously change over time. Existing approaches are limited to data collected at regular time intervals. Our proposal makes use of an OU process for the latent variables to overcome this limitation. We show that assuming real eigenvalues for the drift matrix of the OU process, as is frequently done in practice, can lead to biased estimates and/or misleading inference when the true process is oscillating. In contrast, our proposal allows for both real and complex eigenvalues. We illustrate our proposed model with a motivating dataset, containing patients with amyotrophic lateral sclerosis disease. We were interested in how bulbar, cervical, and lumbar functions evolve over time.

Assessment of oral health in older adults by non-dental professional caregivers-development and validation of a photograph-supported oral health-related section for the interRAI suite of instruments.

OBJECTIVES: An optimized oral health-related section and a video training were developed and validated for the interRAI suite of instruments. The latter is completed by professional non-dental caregivers and used in more than 40 countries to assess care needs of older adults. METHODS: The optimized oral health-related section (ohr-interRAI) consists of nine items and a video training that were developed in consecutive phases. To evaluate psychometric properties, a study was conducted in 260 long-term care residents. Each resident was assessed by a dentist and by four caregivers (two who received the video training, two who did not). RESULTS: Mean kappa values and percent agreement between caregivers and dentist ranged between κ = 0.60 (80.2%) for dry mouth and κ = 0.13 (54.0%) for oral hygiene. The highest inter-caregiver agreement was found for dry mouth with κ = 0.63 [95% CI: 0.56-0.70] (81.6%), while for the item palate/lips/cheeks only κ = 0.27 [95% CI: 0.18-0.36] (76.7%) was achieved. Intra-caregiver agreement ranged between κ = 0.93 [95% CI: 0.79-1.00] (96.4%) for dry mouth and κ = 0.45 [95% CI: 0.06-0.84] (82.8%) for gums. Logistic regression analysis showed only small differences between caregivers who watched the video training and those who did not. CONCLUSIONS: Psychometric properties of the optimized ohr-interRAI section were improved compared to previous versions. Nevertheless, particularly the items based on inspection of the mouth require further refinement and caregiver training needs to be improved. CLINICAL RELEVANCE: Valid assessment of oral health by professional caregivers is essential due to the impaired accessibility of regular dental care for care-dependent older adults.

Clinical Oral Disorders in Adults Screening Protocol (CODA-SP) from the 2019 Vancouver IADR Consensus Symposium.

BACKGROUND: The Clinical Oral Disorder in Elders (CODE) index was proposed in 1999 to assess the oral health status and treatment needs of older people who typically were edentate or had few natural teeth. Since then, more people are retaining natural teeth into old age and have oral disorders similar to younger adults. In addition, there has been further guidance on screening for disease that includes changes to the clinical indicators of several oral disorders and greater sensitivity to people's concerns about their oral health and care needs. METHODS: Experts in dental geriatrics assembled at a satellite symposium of the International Association of Dental Research in June 2019 to revise the objectives and content of the CODE index. Before the symposium, 139 registrants were asked for comments on the CODE index, and 11 content experts summarised current evidence and assembled reference lists of relevant information on each indicator. The reference lists provided the base for a narrative review of relevant evidence supplemented by reference tracking and direct searches of selected literature for additional evidence. RESULTS: Analysis of the evidence by consensus of the experts produced the Clinical Oral Disorders in Adults Screening Protocol (CODA-SP). CONCLUSIONS: The CODA-SP encompasses multiple domains of physical and subjective indicators with weighted severity scores. Field tests are required now to validate its effectiveness and utility in oral healthcare services, outcomes and infrastructure.

Assessment of oral health conditions presented in photographs - is there a difference between dentists and non-dental professional caregivers?

BACKGROUND: Photographs can help non-dental professional caregivers to identify problems when inspecting the mouth of care-dependent older individuals. This study evaluated whether the assessment of oral health-related conditions presented in photographs differed between dentists and non-dental professional caregivers. MATERIALS AND METHODS: One-hundred-and-seventy-nine photographs were taken from long-term care facility residents and from patients at the Department of Dentistry of a University Hospital. The following oral health aspects were depicted: denture hygiene, oral hygiene, teeth, gums, tongue and palate/lips/cheeks. Collection continued until for each oral health aspect a pool of photographs was available that showed conditions from perfect health and hygiene to severe problems. A segmented Visual Analogue Scale was applied to assess the conditions presented in the photographs. Each photograph was assessed by each participant of this study. The benchmark was established by three dentists with academic-clinical expertise in gerodontology, special needs dentistry and periodontology. For each photograph, they provided a collective score after reaching consensus. Photographs were assessed individually by 32 general dentists and by 164 non-dental professional caregivers. Linear mixed effects models and generalized linear mixed effects models were fitted and mean squared errors were computed to quantify differences between both groups. RESULTS: For the different oral health aspects, absolute distances from the benchmark scores were 1.13 (95%CI:1.03-1.23) to 1.51 (95%CI:1.39-1.65) times higher for the caregivers than for the dentists. The odds to overestimate the condition were higher for the caregivers than the dentists for oral hygiene (OR = 0.72, 95%CI = 0.62-0.84) and teeth (OR = 0.74; 95%CI = 0.61-0.88). The odds to underestimate the condition were higher for the caregivers than the dentists for gums (OR = 1.39; 95%CI:1.22-1.59) and palate/lips/cheeks (OR = 1.22; 95%CI = 1.07-1.40). Over all assessments, the variance in caregiver scores was 1.9 (95%CI:1.62-2.23) times higher than that for the dentists. CONCLUSION: Small but significant differences were found between dentists and non-dental professional caregivers assessing oral health-related conditions presented in photographs. When photographs are used to aid non-dental professional caregivers with the oral health assessment, these visualizations should be complemented with comments to facilitate accurate interpretation.

A randomized controlled clinical trial comparing guided with nonguided implant placement: A 3-year follow-up of implant-centered outcomes.

STATEMENT OF PROBLEM: Implant-based prosthetic solutions can be time consuming. If implants can be placed successfully with a guide, surgery time can be reduced. PURPOSE: The purpose of this randomized controlled clinical trial was to assess implant outcomes, both clinical and radiological, comparing guided with nonguided implant placement after 3 years of follow-up. MATERIAL AND METHODS: A total of 314 implants were placed in 72 jaws (60 participants). The jaws were randomly assigned to 1 of the 6 treatment groups: Materialise Universal/mucosa (Mat Mu), Materialise Universal/bone (Mat Bo), Facilitate/mucosa (Fac Mu), Facilitate/bone (Fac Bo), freehand navigation (Freehand), and a pilot-drill template (Templ). Radiographic and clinical parameters (bone loss, pocket probing depth, bleeding on probing, and plaque scores) were recorded at the time of implant placement, prosthesis installment (baseline), and 1-year, 2-year, and 3-year follow-up. Analysis was performed using a linear mixed model, and correction for simultaneous hypothesis was made according to Sidak (α=.05). RESULTS: Three participants left the study before the 3-year follow-up; hence, 302 implants in 69 jaws were included in this study. None of the implants failed. The mean marginal bone loss after the third year of loading was 0.7 ±1.3 mm for the guided surgery group and 0.5 ±0.6 mm for the control group. No significant intergroup or follow-up period differences were observed (P>.05). In the guided surgery groups, the mean number of surfaces with bleeding on probing and plaque at 3-year follow-up was 1.7 ±1.5 and 1.7 ±1.7, respectively; for the control groups, this was 1.6 ±1.4 and 1.6 ±1.6, respectively. The mean pocket probing depth was 3.0 ±1.3 mm for the guided group and 2.6 ±1.0 mm for the control group. No significant differences were found (P>.1). CONCLUSIONS: Within the limitation of this study, no statistically significant differences could be found between the guided group and the control group at the 3-year follow-up.

The oral health-related section of the interRAI: Evaluation of test content validity by expert rating and assessment of potential reasons for inaccurate assessments based on focus group discussions with caregivers.

OBJECTIVES: To explore the failure of the oral health-related section of the interRAI (ohr-interRAI), this study investigated test content validity (A.) and reasons for inaccurate assessments (B.). BACKGROUND: Poor oral health negatively affects quality of life and is associated with a number of systemic diseases. The interRAI instruments, internationally used for geriatric assessment, should accurately detect oral conditions that require care. Previous research showed that the ohr-interRAI and related precursor versions do not achieve this goal. MATERIALS AND METHODS: (A.) A group of 12 experts rated completeness, relevance, clarity of wording and feasibility of the ohr-interRAI. Content validity indices were calculated per item (threshold 0.78). (B.) Focus group discussions with 23 caregivers were organized. A semi-structured question guide made sure that all topics of interest were covered. Qualitative content structuring analysis was applied after transcription. RESULTS: (A.) Experts agreed on the relevance of the items on chewing, pain, gingival inflammation and damaged teeth. They regarded none of the items as worded clearly and only prosthesis use and pain were considered to be assessable by untrained caregivers. All experts agreed that the ohr-interRAI was incomplete. (B.) Focus group discussions revealed that in the care environment oral health had low priority. Aspects related to the ohr-interRAI itself and aspects related to the assessment situation impeded the oral health assessment. The approach of the caregivers to complete the ohr-interRAI was inappropriate to accurately detect oral care needs. CONCLUSIONS: Findings challenge test content validity of the ohr-interRAI and reveal reasons for inaccurate assessments.

Predictors of Patient Satisfaction with Removable Denture Renewal: A Pilot Study.

PURPOSE: Conventional removable dentures still play an important role in the treatment of lost teeth. A thorough understanding of the parameters that influence patient satisfaction is useful for deciding whether denture replacement is meaningful. From a clinical perspective, factors that can be measured before starting treatment are relevant. This pilot study investigated whether patient satisfaction after denture renewal was affected by aspects related to the old prostheses, type of jaw, and patient motivation for denture renewal. MATERIALS AND METHODS: Fifty subjects (mean age 68.2 ± 8.4) were provided with 74 removable dentures (partial n = 20, complete n = 54). Satisfaction was assessed before treatment and 3 months after new prosthesis insertion. Total satisfaction 3-month post-insertion (TSP3) merged 6 individual satisfaction items measured after treatment. Change of total satisfaction 3-month post-insertion (CTS3) represented the difference of total satisfaction when old and new prostheses were compared. The effect of the following independent variables was investigated: reason patients requested new dentures (fit, esthetics, broken denture, wear, advice of dentist, extractions), satisfaction with the old prosthesis (general, retention, stability, comfort, pronunciation, chewing, esthetics), and technical quality of the old prostheses as assessed by a dentist (stability, retention, fit, border, wear, esthetics). Gender, age, and a cognitive screening test were included as confounding variables. Mann-Whitney-U tests and linear mixed model analysis were performed. RESULTS: All individual satisfaction items significantly improved with new prostheses for maxillary and mandibular jaws. TSP3 was higher for maxillary prostheses, if retention satisfaction with the old prosthesis was good, and if the dentist assessed the esthetics of the old prosthesis as deficient. CTS3 was associated with male gender, dissatisfaction with chewing before treatment, and dissatisfaction with esthetics before treatment. CONCLUSIONS: This pilot study showed that satisfaction 3 months after new denture insertion was associated with aspects of satisfaction and quality related to the old prosthesis, type of jaw, and gender. These factors may help dentists predict therapeutic benefits when deciding on the need for denture replacement. Further research should be done with a greater number of subjects and should include balanced quantities of the different types of dentures.

Titanium implant functionalization with phosphate-containing polymers may favour in vivo osseointegration.

AIM: Osseointegration of titanium implants is predictable, but can be improved via surface functionalization. MATERIALS AND METHODS: One hundred and twenty implants were installed in parietal bone of 12 domestic pigs and left to heal for 1 or 3 months. Five groups were defined according surface treatments: immersion in water (H2 O), 10% polyphosphoric acid (PPA10), 1% phosphorylated pullulan (PPL1), 10% phosphorylated pullulan (PPL10) or 10% phosphorylated pullulan + 1 µg bone morphogenetic protein-2 (PPL10 BMP). As primary outcome, implant osseointegration was evaluated by quantitative histology, namely peri-implant bone formation (B/T in %) and bone-to-implant contact (BIC in %) for each healing period. The Wilcoxon signed-rank test and Mann-Whitney U-test with α = 0.05 were performed. RESULTS: PPL10 and PPA10 groups showed significantly higher B/T and BIC results than the control (H2 O) group at 1-month (p < .05). No significant difference was found between PPL1 and H2 O or between PPL10 BMP and H2 O, irrespective of healing time (1 or 3 months) or investigated parameter (B/T and BIC; p > .05). After 3 months, no experimental group showed a significant difference compared to the control group (H2 O) for both investigated parameters (B/T and BIC; p > .05). CONCLUSION: Functionalizing titanium implants with inorganic or organic phosphate-containing polymers at 10 wt% concentration may stimulate peri-implant bone formation and implant osseointegration at early healing times.

An oral health survey of vulnerable older people in Belgium.

OBJECTIVES: The aim of this study was to gain insight in the oral health of persons aged 65 years or more. MATERIALS AND METHODS: Data were obtained from 652 vulnerable older persons (≥65) by means of a clinical oral examination. Additional demographic data were gathered including age, gender, residence, and care dependency. RESULTS: The mean age of the total study sample was 83 (7.7) years and 71 % was female. Nearly 33 % of the sample was living at home with support, and 67 % was residing in nursing homes. The number of occluding pairs was low and the proportion of edentulous people was highest among persons with the highest care dependency. The mean Decay-missing-filled teeth index (DMFT) was 20.3 (9.0). A prosthetic treatment need and inadequate oral hygiene levels were observed in 40 % and more than 60 % of the subjects, respectively. The highest treatment need was observed in the oldest age group and the highest mean dental plaque in older persons with the highest care dependency. CONCLUSIONS: The oral health in frail older people in Belgium is poor. The restorative and prosthetic treatment need is high and oral hygiene levels are problematic. Age, residence, and care dependency seemed to have some influence on oral health parameters. CLINICAL SIGNIFICANCE: In the long term, the most important future challenge of oral health care policies is to identify older adults before they begin to manifest such oral health deterioration. Regular dental visits should be strongly promoted by all (oral) health care workers during the lifespan of all persons including older adults.

The proportion of cancellous bone as predictive factor for early marginal bone loss around implants in the posterior part of the mandible.

AIM: This study envisaged to explain early marginal bone loss (first years of function) around implants in the posterior area of the mandible by the local bone quality (ratio cortical vs. cancellous bone). MATERIAL AND METHODS: Four hundred and twenty-three Brånemark MKIII implants inserted in the posterior region of the mandible were examined, retrospectively, on intra-oral radiographs taken at abutment connection, and 1 and 3-4 years after loading. The quality of the bone was assessed on cone beam or multi-slice CTs. The bone quality was determined by the relative proportions of cortical and trabecular bone at the insertion site. Cortical bone was defined as a clearly white structure without a trabecular pattern. Trabecular bone was defined as the structure between the two cortical plates. The width of both structures was measured at 1, 3, 5, and 7 mm away from the crest of the alveolar bone and converted in to relative proportions. Other parameters (smoking, history of periodontitis, dehiscence, pre-tapping, submerged healing, etc.) were retrieved from the patients record. RESULTS: At abutment connection, the mesial and distal marginal bone level was located 0.7 (±0.7) and 0.8 (±0.7) mm apically to the implant-abutment junction. At 1 year and 3-4 years of loading implants placed in a mandible consisting of <30% of cancellous bone had lost 1.49 and 1.83 mm, respectively. Implants placed in jawbone consisting of more than 60% of cancellous bone lost 0.74 and 0.91 mm after 1 year and 3-4 years of loading. The bone-level changes (both first year as well as after 3-4 years) were significantly less when the implant was placed in sites with a higher proportion of cancellous bone. Other parameters were significantly less important. CONCLUSIONS: Very cortical bone could jeopardize the long-term stability of the marginal bone surrounding implants placed in the posterior region of the mandible. A correlation between marginal bone loss and the proportion of cortical bone was demonstrated around Brånemark implants. At present, no comparable studies are available, and therefore, it cannot be excluded that similar events take place around other implant systems.

Effect of insertion torque on titanium implant osseointegration: an animal experimental study.

OBJECTIVE: To evaluate the effect of implant insertion torque on the peri-implant bone healing and implant osseointegration. MATERIAL AND METHODS: Bilaterally in the tibia of five adult New Zealand white rabbits, 20 implants were installed, subdivided into four groups, corresponding to two insertion torque conditions (low, < 10 Ncm vs. high > 50 Ncm) and 2 experimental periods (2 weeks vs. 4 weeks of healing). The implant insertion torque was determined by the surgical drill diameter relative to the implant diameter. Implant osseointegration was evaluated by quantitative histology (bone-to-implant contact with host bone [BIC-host], with neoformed bone [BIC-de novo], with both bone types [BIC-total], and peri-implant bone [BA/TA]). Every response was modelled over time using GEE (general estimation equation) with an unstructured variance-covariance matrix to correct for dependency between the measurements from one animal. The statistical significance level of α = 0.05 was applied. RESULTS: Significantly, more BIC-host and BIC-total were recorded for H implants compared with L implants after 2 week of healing (P = 0.010 and P = 0.0001, respectively). However, this result was no longer found for the extended healing period. Furthermore, BIC-total significantly increased over time for L implants (P < 0.00001). In contrast, the significant increase in BA/TA over time was found for H implants (P < 0.01). Finally, H insertion torque led to an increased BA/TA after 4 week of healing (P < 0.02) compared with the L insertion protocol. CONCLUSION: L insertion torque implants installed in the rabbit tibial bone osseointegrate with considerable de novo bone formation. This bone neoformation enables L implants to catch up, already during the early osseointegration stage, the initial inferior amount BIC contact compared with that of H implants. A negative impact of the created strain environment accompanying H insertion torque implant installation on the biological process of osseointegration could not be observed, at least not at tissue level.

Stimulation of titanium implant osseointegration through high-frequency vibration loading is enhanced when applied at high acceleration.

Low-magnitude high-frequency loading, applied by means of whole body vibration (WBV), affects the bone. Deconstructing a WBV loading stimulus into its constituent elements and investigating the effects of frequency and acceleration individually on bone tissue kinetics around titanium implants were aimed for in this study. A titanium implant was inserted in the tibia of 120 rats. The rats were divided into 1 control group (no loading) and 5 test groups with low (L), medium (M) or high (H) frequency ranges and accelerations [12-30 Hz at 0.3×g (F(L)A(H)); 70-90 Hz at 0.075×g (F(M)A(M)); 70-90 Hz at 0.3×g (F(M)A(H)); 130-150 Hz at 0.043×g (F(H)A(L)); 130-150 Hz at 0.3×g (F H A H)]. WBV was applied for 1 or 4 weeks. Implant osseointegration was evaluated by quantitative histology (bone-to-implant contact (BIC) and peri-implant bone formation (BV/TV)). A 2-way ANOVA (duration of experimental period; loading mode) with α = 0.05 was performed. BIC significantly increased over time and under load (p < 0.0001). The highest BICs were found for loading regimes at high acceleration with medium or high frequency (F(M)A(H) and F(H)A(H)), and significantly differing from F(L)A(H) and F(M)A(M) (p < 0.02 and p < 0.005 respectively). BV/TV significantly decreased over time (p < 0.0001). Loading led to a site-specific BV/TV increase (p < 0.001). The highest BV/TV responses were found for F(M)A(H) and F(H)A(H), significantly differing from F(M)A(M) (p < 0.005). The findings reveal the potential of high-frequency vibration loading to accelerate and enhance implant osseointegration, in particular when applied at high acceleration. Such mechanical signals hold great, though untapped, potential to be used as non-pharmacologic treatment for improving implant osseointegration in compromised bone.

Bone tissue response to implant surfaces functionalized with phosphate-containing polymers.

OBJECTIVES: Inorganic polyphosphates are said to stimulate the activity of osteoblast-like cells in vitro. The purpose of this study was to evaluate in vivo bone regeneration around implants treated with polyphosphoric acid (PPA) and phosphorylated pullulan (PPL). MATERIAL AND METHODS: Two types of implants with different surface roughness (R1: Sa ≈ 0.23 µm; R2: Sa ≈ 1.35 µm) were treated with three solutions (distilled water, 10%wt PPA, or 10%wt PPL) prior to implantation in both tibia of twelve female white rabbits. Each animal received six implants randomly positioned according to their surface roughness and treatment: R1 + water; R1 + PPA; R1 + PPL; R2 + water; R2 + PPA; R2 + PPL. Animals were sacrificed after 1 or 4 weeks, and samples were prepared for histological and histomorphometrical analysis. Bone regeneration areas were evaluated for bone-to-implant contact (BIC) and bone fraction (BF) in areas 100 and 500 µm remote from the implant surface. Data were statistically analyzed by means of Friedman and Wilcoxon matched-pair tests (P < 0.05). RESULTS: After 1 week, bone tissue was rarely formed in the regeneration areas. After 4 weeks, implants treated with PPA presented higher ratios of BIC (R1 = 52.3 ± 13.1; R2 = 54.6 ± 11.0) than the ones treated with water (R1 = 24.1 ± 15.1; R2 = 32.4 ± 13.0). On the other hand, around the implant surface (100 µm), PPL-treated implants induced higher BF (R1 = 78.3 ± 34.1; R2 = 71.2 ± 21.8) as compared with the water-treated ones (R1 = 46.1 ± 22.0; R2 = 49.6 ± 21.0). At 500 µm, however, no statistically significant differences in BF were found among the groups evaluated (P > 0.05). Surface roughness influenced neither BIC nor BF. CONCLUSIONS: Implant surface treatment with phosphate-containing polymers may positively influence osseointegration.

Evaluation of plaque removal by a single-headed versus a triple-headed manual toothbrush using different plaque assessment tools.

Background: Dental plaque is a common issue that can be effectively managed with proper oral hygiene practices and regular oral health care. The aim of this crossover study was to assess dental plaque using different methods (digital and clinical plaque scores) and evaluate the effectiveness of toothbrushing with a triple-headed manual toothbrush compared to a single-headed manual toothbrush in removing dental plaque. Methods: Plaque staining was performed to assess dental plaque amounts before and after brushing with the triple-headed (test) and single-headed (control) manual toothbrush in 21 study participants after plaque was allowed to accumulate for 48 hours. Dental plaque was scored both clinically as well as digitally. Results: Toothbrushing with a manual single-headed toothbrush and a triple-headed toothbrush was found to be equally effective when comparing plaque removal ability. Brushing time was shorter when using a triple-headed toothbrush, compared to a single-headed toothbrush. Conclusion: The triple-headed manual toothbrush may be a good alternative to the single-headed manual toothbrush for certain patient groups.

Contexte: La plaque dentaire est un problème courant qui peut être géré efficacement en adoptant de bonnes pratiques d'hygiène buccale et en obtenant régulièrement des soins buccodentaires. L'objectif de cette étude croisée était d'évaluer l'état de la plaque dentaire à l'aide de différentes méthodes (cotes de plaque numériques et cliniques) et d'évaluer l'efficacité du brossage à l'aide d'une brosse à dents manuelle à 3 côtés comparativement au brossage avec une brosse à dents manuelle à 1 côté pour éliminer la plaque dentaire. Méthodes: On a coloré la plaque dentaire pour en évaluer la quantité avant et après le brossage avec une brosse à dents manuelle à 3 côtés (essai) et à 1 côté (contrôle) parmi les 21 participants à l'étude après avoir laissé la plaque s'accumuler pendant 48 heures. On a attribué une cote clinique et numérique à la plaque dentaire. Résultats: Le brossage avec une brosse à dents manuelle à 3 côtés s'est révélé tout aussi efficace que le brossage avec une brosse manuelle à 1 côté sur le plan de l'élimination de la plaque. Le temps de brossage était plus court avec une brosse à dents à 3 côtés qu'avec une brosse à dents à 1 côté. Conclusion: Pour certains groupes de patients, la brosse à dents à 3 côtés peut être une bonne alternative à la brosse à dents ordinaire.