A cross-sectional CBCT assessment of the relative position of one-piece titanium-zirconium mini-implants placed for mandibular overdentures using non-guided surgery.

OBJECTIVE: To assess the relative position of mini-implants to retain a mandibular overdenture, according to the surgical protocol, technical and anatomical factors. METHODS: Mandibular cone-beam computed tomography (CBCT) scans were analyzed for 73 patients who received four one-piece titanium-zirconium mini-implants. Drilling was performed using a 1.6 mm needle drill and a 2.2 mm Pilot Drill, according to the bone density with a surgical stent. Post-insertion CBCT images in DICOM format were analyzed using the E-Vol-DX software with BAR filters. Divergence angle between implants and between implants and the overdenture path of insertion was measured using CliniView 10.2.6 software. RESULTS: Divergence between implants ranged from 0° to 22.3° (mean = 4.2; SD = 3.7) in the lateral and from 0° to 26.2° (mean = 5.3; SD = 4.1) in the frontal projections (p < .001). Only 1 (0.2%) and 3 (0.7%) of the measurements were higher than 20° in the lateral and frontal views, respectively. The mean angulations between the implant and the path of insertion for the overdenture were 9.3° (SD = 7.5) and 4.0° (SD = 2.9) for the lateral and frontal views, respectively (p < .001). Regression analyses showed a significant association between the divergence of implants and the frontal view projection (p < .001), greater distance between the paired implants (p = .017), the flapped surgical protocol (p = .002), higher final insertion torque (p = .011), and deeper preparation with the needle drill (p < .001). CONCLUSIONS: The mini-implants were placed with low divergence angles and satisfactory parallelism. Factors including shorter distances between the implants, higher density bone, and a flapless surgical approach all contributed positively to improved parallelism of the mini-implants.

Changes in masticatory performance and bite force after treatment with mandibular overdentures retained by four titanium-zirconium mini implants: One-year randomised clinical trial.

OBJECTIVE: This prospective study is part of a randomised clinical trial and reports the changes in masticatory performance (MP) and bite force, and explores their influential factors, 1 year after the provision of mandibular overdentures retained by four titanium-zirconium mini implants. METHODS: Edentulous patients received conventional complete dentures, followed by placement of four mini implants (Straumann® Mini Implant System) in the anterior mandible and converting the conventional prosthesis into a mandibular overdenture. Treatment protocols were randomised using a 2×2 factorial design combining different surgical (flapped vs. flapless) and loading (immediate vs. delayed) protocols. MP was assessed using a two-colour mixing ability test and a colorimetric analysis to measure the level of colour mixing (Variance of Hue-VoH). Maximum voluntary bite force (MBF) was measured by a digital gnathodynamometer in the posterior and anterior regions. Sex, age, surgical and loading protocols and ridge morphology were tested as independent variables. MP and MBF tests were performed at baseline (pre-treatment) and the 3-, 6- and 12-month after implant loading. Descriptive statistics, independent t-test, and linear mixed-effect model (LMM) regression were used for data analysis. RESULTS: Seventy-four participants were assessed and 73 completed the 1-year follow-up. Statistically significant improvements in functional parameters were observed in all follow-up periods compared to baseline (p < .001). The flapless protocol was associated with higher improvement in MP at the 3-month follow-up (p = .004), while less resorbed ridges were associated with better MP (p = .038) and higher MBF (p < .001). CONCLUSION: The mandibular overdenture protocol using four titanium-zirconium mini implants was effective in improving MP and MBF of edentulous patients, compared to pre-treatment values. The findings also suggest that improvements in chewing function and bite force are impacted by clinical factors since better outcomes were observed for flapless surgeries and less resorbed edentulous ridges. CLINICAL TRIAL REGISTRATION: ClinicalTrials.Gov ID NCT04760457.

Exploring the attitudes of general dental practitioners to providing dietary advice alongside oral rehabilitation for older adults.

OBJECTIVE: We aimed to capture General Dental Practitioners' (GDPs) views on delivering dietary advice to older adults in combination with treatment to replace missing teeth and identify solutions to help inform the development and implementation of future dietary interventions within primary dental care. BACKGROUND: As natural teeth are lost, older adults may need to choose softer, more manageable foods which might be of lower nutrient density. Previous research has indicated that prosthodontic rehabilitation can improve masticatory function but not the intake of nutrients, highlighting a potential need for a combined approach of oral rehabilitation and dietary counselling. MATERIALS AND METHODS: Semi-structured telephone interviews were conducted with a purposive sampling strategy of 12 GDPs. Interviews were digitally recorded and transcribed verbatim. An iterative coding process using theme-analytic methods was used. RESULTS: Twelve interviews were conducted with GDPs in the United Kingdom. The themes that emerged from the interviews included: the awareness of the importance of dietary advice among GDPs; the concerns GDPs had on patients' adherence to dietary advice; uncertainty over roles and responsibilities in the provision of dietary advice; and the limited time and remuneration for dietary advice in dental practice. A minor theme identified was the motivation of GDPs to implement dietary advice alongside oral rehabilitation. All reported that they were already providing dietary advice to their patients but that this was limited to caries prevention. CONCLUSION: The GDPs interviewed expressed positive attitudes towards providing dietary advice alongside oral rehabilitation for older adults. However, a lack of confidence, awareness, time and remuneration are barriers to its provision in primary dental care. To facilitate the implementation of dietary advice alongside oral rehabilitation, clear guidance on and training in delivering dietary advice and multidisciplinary cooperation are required.

Using a theoretically informed process evaluation alongside a trial to improve oral health for care home residents.

BACKGROUND: Poor oral health is common among older adults residing in care homes impacting their diet, quality of life, self-esteem, general health and well-being. The care home setting is complex and many factors may affect the successful implementation of oral care interventions. Exploring these factors and their embedded context is key to understanding how and why interventions may or may not be successfully implemented within their intended setting. OBJECTIVES: This methodology paper describes the approach to a theoretically informed process evaluation alongside a pragmatic randomised controlled trial, so as to understand contextual factors, how the intervention was implemented and important elements that may influence the pathways to impact. MATERIALS AND METHODS: SENIOR is a pragmatic randomised controlled trial designed to improve the oral health of care home residents in the United Kingdom. The trial uses a complex intervention to promote and provide oral care for residents, including education and training for staff. RESULTS: An embedded, theoretically informed process evaluation, drawing on the PAHRIS framework and utilising a qualitative approach, will help to understand the important contextual factors within the care home that influence both the trial processes and the implementation of the intervention. CONCLUSION: Utilising an implementation framework as the basis for a theoretically informed process evaluation provides an approach that specifically focuses on the contextual factors that may influence and shape the pathways to impact a given complex intervention a priori, while also providing an understanding of how and why an intervention may be effective. This contrasts with the more common post hoc approach that only focuses on implementation after the empirical results have emerged.

Single lateral implant for mandibular overdentures as a fallback solution or a viable treatment alternative: Four case reports.

This report of four clinical cases aims to illustrate the use of a lateral implant as a solution for implant overdentures in the mandible in different clinical situations. The first two cases describe the clinical situations of patients wearing two-implant mandibular overdentures until the failure of one of the implants, one due to implant loss and the other due to a fracture of an abutment screw, and how the conditions were managed. The third case illustrates the placement of a single implant to retain an overdenture, where a midline implant, as originally planned, was not feasible due to anatomic reasons. The final case describes the use of a lateral implant to support and retain a single-implant mandibular overdenture. The four cases demonstrate that a single lateral implant can be utilized as sole retention in cases of a failing contra-lateral implant and as an alternative to a single implant in the midline.

Implant survival/success and peri-implant outcomes of titanium-zirconium mini implants for mandibular overdentures: Results from a 1-year randomized clinical trial.

OBJECTIVE: To report the 1-year implant survival/success and peri-implant outcomes of mandibular overdentures retained by four titanium-zirconium mini implants (Straumann® Mini Implant System), and to assess how surgery and loading protocols influence these outcomes. MATERIALS AND METHODS: A 2 × 2 factorial randomized clinical trial (RCT) tested the combined effects of two loading protocols (immediate or delayed) and two surgical approaches (flapless or flapped) on the success/survival of the mini implants, and peri-implant parameters (plaque, bleeding, sulcus depth, gingival position, and marginal bone loss). Outcomes were assessed up to 1-year after loading, and generalized estimating equations (GEEs) were used to analyze longitudinal and within-patient clustered data. RESULTS: Two hundred and ninety-six implants were placed in 74 patients. The implant survival/success rates after 1 year were 100%, and no major biological complications were observed. After 1-year, descriptive data suggest no noticeable changes in plaque scores, whilst a reduction in bleeding scores at the 6-month and 1-year follow-ups compared to baseline. Good longitudinal stability was observed for the probing depth and gingival margin height measures. Overall mean marginal bone loss was 0.68 (±0.68) mm after 3 months and 0.89 (±0.75) mm after 1-year. The flapless protocol showed better results on soft tissue stability and health but a slightly higher risk for marginal bone loss. CONCLUSION: The results of this RCT suggest that mandibular overdentures retained by this novel mini implant system represent a safe and predictable treatment option as confirmed by implant survival/success and peri-implant outcomes, even when flapless surgery and immediate loading protocols are adopted.

Willingness to accept or refuse mandibular implant overdenture treatment: A prospective study on edentulous enrolled in a clinical trial.

BACKGROUND: Several complete denture wearers have major complaints and may be benefitted from implant treatment. However, the factors that shape the demand for and utilization of implants need further investigation. OBJECTIVE: The aim was to evaluate edentulous patient's willingness to accept or refuse the offer and provision of implant-retained treatment. METHODS: As part of a clinical trial, edentulous subjects were offered a mandibular overdenture retained by four mini-implants opposing a conventional maxillary denture. Treatment was offered without any financial costs for the patients. Patients' level of interest in receiving treatment was assessed using a 5-point Likert scale, and they were asked to respond to a list of reasons that led to their decision to accept or refuse implants. Those who refused implants received conventional prosthodontic interventions as required, and those who accepted implant treatment underwent surgical planning and implant placement. RESULTS: Of 175 eligible subjects, 147 accepted the offer of treatment and were invited to take part in the study (69.4% women, mean age 67.4 ± 10.0 years). Overall, 111 patients (75.5%) expressed a positive intention to undergo implant treatment at the initial contact. Implant treatment was performed for 56.3% (9/16) of those who answered 'probably yes' about their level of interest in implant treatment on the Likert scale, and 69.6% (64/92) of 'certainly yes' (p < .001). Older subjects were less likely to receive implants (OR = 0.93; p = .036), whilst those with a positive intention towards implants (OR = 3.15; p = .001), those previously treated by the dental team (OR = 7.89; p < .001), and who actively demanded implants (OR = 18.1; p < .001) were more likely to accept treatment. Improved chewing was the most common reason for accepting implants, whilst fear of surgery was the most reported reason for refusal. CONCLUSION: Refusal of implants was high among edentate patients even when financial costs were removed. Patients' initial attitude towards acceptance is a key factor in the demand for and uptake of implant therapy.

Exploring facilitators and barriers associated with oral care for inpatients with dysphagia post-stroke.

OBJECTIVE: To explore the attitudes, facilitators and barriers in providing oral care for inpatients with dysphagia post-stroke as perceived by healthcare professionals. BACKGROUND: Dysphagia is a common complication of stroke and is associated with a higher incidence of aspiration pneumonia, malnutrition and dehydration. In the acute phase of stroke recovery, a dental professional is not usually part of the multidisciplinary team caring for the patient and oral care is the responsibility of the healthcare professionals in the stroke unit. There is a lack of high-quality evidence to demonstrate the most effective method of providing oral care for patients with dysphagia post-stroke. MATERIALS AND METHODS: This was a single-site study conducted with healthcare professionals working in the Stroke Unit of Cork University Hospital in Ireland, using focus groups and a qualitative thematic analysis approach. RESULTS: A total of three focus groups were conducted in the Stroke Unit with 17 healthcare professionals. The focus groups included representation from all healthcare professional groups providing direct clinical care to patients on the Stroke Unit including geriatric medicine, dietetics, speech and language therapy, healthcare assistance, nursing, occupational therapy and physiotherapy. A qualitative thematic analysis was carried out and seven overarching themes emerged from the data. Three themes related to facilitators to providing oral care for this patient group: (i) a focus on oral care in both policy and practice, (ii) expanding professional roles in the provision of oral care, (iii) perceived importance of oral care in recovery and rehabilitation. Four themes related to barriers to the provision of oral care for this patient group: (i) lack of confidence and concerns related to the perceived risk for patients with dysphagia, (ii) unique challenges of patient and stroke-related factors, (iii) lack of resources and time and (iv) perceived importance of oral care in recovery and its relative importance with competing demands. CONCLUSION: Members of the stroke multidisciplinary team believe that they all have a part to play in the delivery of oral care for patients with dysphagia post-stroke. Opportunities exist for the development of multidisciplinary interventions to improve the oral cavity assessment and oral care provided in the Stroke Unit.

Putting guidelines into practice: Using co-design to develop a complex intervention based on NG48 to enable care staff to provide daily oral care to older people living in care homes.

OBJECTIVES: (1) Explore the challenges of providing daily oral care in care homes; (2) understand oral care practices provided by care home staff; (3) co-design practical resources supporting care home staff in these activities. METHODS: Three Sheffield care homes were identified via the "ENRICH Research Ready Care Home Network," and three to six staff per site were recruited as co-design partners. Design researchers led three co-design workshops exploring care home staff's experiences of providing daily oral care, including challenges, coping strategies and the role of current guidelines. New resources were prototyped to support the use of guidelines in practice. The design researchers developed final resources to enable the use of these guidelines in-practice-in-context. FINDINGS: Care home staff operate under time and resource constraints. The proportion of residents with dementia and other neurodegenerative conditions is rapidly increasing. Care home staff face challenges when residents adopt "refusal behaviours" and balancing daily oral care needs with resident and carer safety becomes complex. Care home staff have developed many coping strategies to navigate "refusal behaviours." Supporting resources need to "fit" within the complexities of practice-in-context. CONCLUSIONS: The provision of daily oral care practices in care homes is complex and challenging. The co-design process revealed care home staff have a "library" of context-specific practical knowledge and coping strategies. This study offers insights into the process of making guidelines usable for professionals in their contexts of practice, exploring the agenda of implementing evidence-based guidelines.

Exploring preferences of older adults for dental services: A pilot multi-national discrete choice experiment.

OBJECTIVES: To pilot an exploration of older adults' future preferences using discrete choice experiments to understand who should provide dental examinations and treatment, where these services should be provided, and participants' willingness to pay and willingness to travel. BACKGROUND: The proportion of older adults in the general population is increasing and is recognised as a pressing public health challenge. MATERIALS AND METHODS: Older people aged 65 years and over were recruited into this study from the UK, Switzerland and Greece. Drawing on earlier stakeholder engagement, a set of choice experiments are developed to explore the future preferences of older people for dental examinations and dental treatment, as they anticipated losing their independence. These were presented to the participants using a range of platforms, because of the COVID pandemic. Data were analysed in STATA using a random-effects logit model. RESULTS: Two hundred and forty-six participants (median age 70 years) completed the pilot study. There was a strong preference across all countries for a dentist to undertake a dental examination (Greece: ß = 0.944, Switzerland: ß = 0.260, UK ß = 0.791), rather than a medical doctor (Greece: ß = -0.556, Switzerland: ß = -0.4690, UK: ß = -0.468). Participants in Switzerland and the UK preferred these examinations to be undertaken in a dental practice (Switzerland: ß = 0.220, UK: ß = 0.580) while participants in Greece preferred the dental examination to be undertaken in their homes (ß = 1.172). Greek participants preferred dental treatment to be undertaken by a specialist (ß = 0.365) in their home (ß = 0.862), while participants from the UK and Switzerland preferred to avoid any dental treatment at home (Switzerland: ß = -0.387; UK: ß = -0.444). Willingness to pay analyses highlighted that participants in Switzerland and the UK were willing to pay more to ensure the continuity of future service provision at a family dental practice (Switzerland: ß = 0.454, UK: ß = 0.695). CONCLUSION: Discrete choice experiments are valuable for exploring older people's preferences for dental service provision in different countries. Future larger studies should be conducted to further explore the potential of this approach, given the pressing need to design services that are fit for purpose for older people. Continuity of dental service provision is considered as important by most older people, as they anticipate losing their dependence.

Associations between self-reported periodontal disease and nutrient intakes and nutrient-based dietary patterns in the UK Biobank.

AIM: To examine the cross-sectional associations between single nutrient intakes and posteriori nutrient-based dietary patterns and periodontal disease risk in a subset of the UK Biobank cohort. MATERIALS AND METHODS: Dietary data were collected by 24-h dietary recall on up to five separate occasions over 16 months. A touchscreen questionnaire was used to collect oral health information. Participants were considered at high risk of periodontal disease if they reported having painful gums and/or bleeding gums and/or loose teeth. Principal component analysis identified four nutrient-based dietary patterns from 20 nutrients. Logistic regression was used to estimate the odds ratio of periodontal disease risk for single nutrients and nutrient-based dietary patterns. RESULTS: A total of 9476 participants (mean age 56.2 years [SD 8.0]) were included in the analysis. Higher intakes of vitamin B6, B12, C, and E, folate, iron, potassium, magnesium, polyunsaturated fatty acids, and total sugar were associated with a lower risk of periodontal disease. Higher intake of saturated fat was associated with an increased risk. A dietary pattern characterized by high micronutrients and fibre intake was associated with low risk of periodontal disease. CONCLUSION: Within this sample of middle-aged and older adults, a "high micronutrient and fibre" dietary pattern was associated with reduced risk of periodontal disease.

Flapped versus flapless surgery and delayed versus immediate loading for a four mini implant mandibular overdenture: A RCT on post-surgical symptoms and short-term clinical outcomes.

OBJECTIVE: This factorial randomized clinical trial (RCT) tested the effects of the surgical approach (flapped-FPS vs. flapless-FLS surgery) and loading protocol (delayed-DL vs. immediate-IL) for treatment with a four mini implant mandibular overdenture. MATERIAL AND METHODS: A total of 296 one-piece titanium-zirconium mini-implants were inserted in 74 patients (IL/FLS = 17; IL/FPS = 18; DL/FLS = 20; and DL/FPS = 19). Outcomes included patient's perceived surgical burdens, clinical time, implant survival, and post-surgical symptoms and complications, assessed immediately after surgery, in the 7-day and 6-week follow-ups. RESULTS: Perceived surgical burdens were relatively low, higher for females, and no difference was found between FPS and FLS surgery. Surgical time was lower for FLS surgery. Overall symptoms were mild after 24 h, and higher for females. Less symptoms were recorded for the FLS surgery compared to the FPS for the delayed loading patients, and FLS surgery was associated with a lower risk of bleeding. No early implant failure was observed until the 6-week follow-up. Delayed was associated with discontinuous use of the prosthesis and poor function. Lower complaint rates were observed for immediate loading regardless of the surgery protocol. CONCLUSIONS: Mini implants for mandibular overdenture are a feasible option regardless of surgical access and loading protocol, with high safety and predictable survival rates, and low incidence of post-insertion complications. FLS surgery requires less clinical time and results in easier intraoral prosthetic incorporation of attachments compared to FPS surgeries. Immediate loading did not increase the risk of early implant failure when satisfactory primary stability was achieved.

General dentists' attitudes and perceived barriers in providing domiciliary dental care to older adults in long-term care facilities or their homes in Northern Ireland: A descriptive qualitative study.

OBJECTIVE: Many older patients, housebound or living in long-term care facilities (LTCFs) have limited access to dental care. This descriptive qualitative study aimed to understand general dental practitioners (GDPs) attitudes and perceived barriers to undertaking Domiciliary Dental Care (DDC) for those patients in Northern Ireland (NI). METHODS: Semi-structured telephone interviews were conducted with a purposive sample of 12 GDPs in Northern Ireland. Interviews were digitally recorded and transcribed verbatim. An iterative coding process using theme-analytic methods was used. RESULTS: The data were characterised into four major themes-risk of professional litigation, remuneration for those undertaking DDC, complexity of treatment, and the overall framework of the dental care system in NI. Two minor themes identified were practice culture and reasons for undertaking DDC. The GDPs in the study identified a number of barriers to undertaking DDC including a legal requirement to transport oxygen, lack of organisation and limited oral hygiene care provision in LTCFs, and confusion around their responsibilities for provision of DDC. Those GDPs who were providing DDC indicated that they did so out of kindness and a sense of loyalty to their long-standing patients. CONCLUSION: The GDPs in this study identified a number of significant barriers to provision of DDC at organisational, structural and clinical levels. The GDPs indicated that they required clarification of their responsibilities around DDC with clear guidelines necessary given the increase in demand for this service.

Evaluating the effectiveness of fluoride varnish in preventing caries amongst Long-Term Care Facility Residents.

OBJECTIVE: To evaluate the effectiveness of professionally applied fluoride varnish on the incidence of dental caries amongst older adults resident in LTCFs in Northern Ireland. BACKGROUND: The oral health status of older adults within Long-Term Care Facilities (LTCFs) is significantly worse than their community living peers. Whilst evidence suggests an important role for fluoride varnish in preventing caries in this population, very few studies have evaluated this intervention. MATERIALS AND METHODS: A quality improvement project was undertaken with dentate residents (n = 190) in nine LTCFs who had fluoride varnish applied by Dental Care Professionals on two separate occasions during a 12-month period (intervention group). Nine LTCFs were chosen as matched controls (control group) with comparable numbers of residents of similar medical status (n = 217). For the intervention group, oral hygiene training was also provided for the care home staff. RESULTS: A total of 407 patients (n = 271 female) were included in the analyses (mean age [SD]: 84.1 [6.6] years). After 12 months, the intervention group recorded a significant reduction in mean number of carious teeth (mean [95% CI]: -0.85 [-1.12, -0.58]; P < .001). Patients in the control group had significant increases in the mean number of carious teeth (mean [95% CI]: 0.21 [0.05, 0.37]; P = .012), mean plaque score (mean [95% CI]: 1.16 [0.28, 2.04]; P = .010) and mean DMFT score (mean [95% CI]: 0.13 [0.04, 0.22]; P = .004). CONCLUSIONS: This study demonstrates the potential role of fluoride varnish in combination with oral hygiene training for staff in the prevention and arrest of carious lesions among older adults in LTCFs.

EFFECT OF AUTOGENOUS BONE GRAFT SITE ON DENTAL IMPLANT SURVIVAL AND DONOR SITE COMPLICATIONS: A SYSTEMATIC REVIEW AND META-ANALYSIS.

OBJECTIVES: This systematic review and meta-analysis was undertaken to answer the following focus questions: Is the implant survival in augmented bone utilizing iliac crest bone grafts the same as while using intraoral autologous bone grafts? Is the incidence of postoperative donor site complications the same when using iliac crest bone grafts as opposed to intraoral grafts? METHODS: Systematic searches of electronic databases (PubMed, Embase, CENTRAL) were performed to identify studies which reported on implant survival and postoperative complications for dental implants placed in grafted partially/completely edentulous human jaws. Studies were included if: they reported on 2-piece micro-rough surface root form dental implants placed in bone-augmented completely or partially edentulous human jaws, and the jaws must have been augmented with autologous bone graft materials. Time and nature of postoperative complications must have been reported. Two investigators performed data extraction and a Cohen's unweighted kappa was calculated for inter-investigator reliability. A meta-analysis was performed for the extracted data on implant survival rate in both iliac crest grafts and intra-oral grafts. A qualitative analysis was performed on the information extracted on graft donor site complications. Quality assessment of the included studies were done using the Cochrane collaboration tool and the Newcastle-Ottawa scales. RESULTS: A total of 23 studies were included in the final analysis. The calculated kappa ranged between 0.77-0.89 for the literature search and identification process. Fourteen studies were included with data on implant survival including five randomized controlled clinical trials. The meta-analysis of included studies revealed that the implant survival rate of dental implants placed in jaws augmented with iliac crest grafts was lower than those placed in jaws augmented with intra-oral bone grafts at 6-months [ICG = 95.8% IOG = 98.4%; P < .001], 12-months [ICG = 97.0%, IOG = 98.4%; P < .001], 24-months [ICG = 85.9%, IOG = 98.2%; P < .001], 60-months [ICG = 90.0%, IOG = 91.5%; P < .001], and at 120-months [ICG = 88.8%, IOG = 95.2%; P < .001] follow-up periods. Iliac crest grafts were also frequently associated with donor site complications including pain / discomfort, gait disturbance, and sensory disturbance. CONCLUSIONS: This systematic review and meta-analysis demonstrates that implant survival is consistently higher in bone harvested from intraoral sites compared to iliac crest grafts. Donor site complications seemed to be a frequent finding with iliac crest grafts and mental grafts. FUNDING: None. REGISTRATION: The review protocol was registered with PROSPERO: International prospective register of systematic reviews (CRD42021283738).

Mandibular implant-supported fixed complete dental prostheses on implants with ultrashort and standard length: A pilot treatment.

Edentulous patients may be restored with complete-arch implant-supported fixed complete dental prostheses (IFCDPs) on angled distal implants or on parallel implants distributed equally across the mandible to increase the area of support. A treatment is presented to introduce the clinical concept of providing edentulous patients with an implant-supported fixed complete dental prosthesison parallel tissue-level implants in the mandible with standard length implants interforaminally and ultrashort implants distally. A structured prosthetic approach was used for the tooth arrangement with a modified workflow as per the Biofunctional Prosthetic System adapted for static computer-aided implant surgery (s-CAIS) and computer-aided design and computer-aided manufacturing (CAD-CAM) of the screw-retained implant-supported fixed complete dental prosthesis. The concept offered advantages in challenging anatomic, surgical, and prosthetic conditions; providing distal nonangled abutments and implant platforms, which were straightforward to clean. If necessary, the prosthesis could have been easily converted into a removable overdenture using the existing digital prosthetic arrangement. Should implant removal be required, the extrashort implants can be removed with minimal surgical risk or morbidity.

Cost of providing a mobile dental service for dependent older people.

BACKGROUND AND OBJECTIVE: Dental care provision in long-term care facilities (LTCFs) is often a problem despite the high demand. LTCF residents would greatly benefit from a concept that provides an onsite dental care. A rational evaluation of the costs to render this service as well as the cost benefits is worth investigating. This study aimed to calculate the costs involved in providing a mobile dental clinic (MDC) service for LTCF residents in Zurich, Switzerland. MATERIALS AND METHODS: Cost models for setting up, executing and maintaining an MDC unit were generated. The costs included personnel, equipment/material, maintenance and running costs. The treatment costs were calculated for the treatment in MDC, university-setting dental clinic (UC) and private practice (PP). Hypothetical cost estimates were generated for the return of the invested capital. Costs incurred for the institutions for accommodating the MDC visit were also calculated. RESULTS: The set-up capital required to start a MDC in Switzerland (for 2020) was approximately around CHF 505'007.90 (Euros 466'576.80) and was around CHF 452'666.48 (Euros 418'218.56) when a dental care professional (DCP) substituted the dentist. The estimated cost savings for an LTCF resident in the MDC were CHF 205.60 (Euros 189.95) when compared to a UC and approximately CHF 226.34 (Euros 209.12) when compared to a PP. With the dentist, the return of the invested capital can be expected by 3 years while it would take around 6 years with the DCP, assuming that the maximum number of patients possible-to-treat are treated every year. The daily running costs for the LTCF for accommodating the MDC visit were approximately CHF 299.04 (Euros 276.28). CONCLUSIONS: Delivery of oral health services for LTCF residents through the use of a MDC service seems to be an effective model for dependent elders with limited access to care. However, the costs of maintaining this service are high with similarly large start-up costs. Future development of this model by utilising dental care professionals may produce cost savings but with a more limited range of services offered.

COVID-19: Impacts on oral healthcare delivery in dependent older adults.

OBJECTIVES: To evaluate the impacts of restrictions to the provision of dental services for dependent older patients due to the COVID-19 pandemic. METHODS: Data were gathered on the number of dependent older patients treated, emergency treatment provided and the revenues generated by a specialised clinic for geriatric dentistry during the current pandemic period and compared with the recorded clinical activity from the preceding year. Hypothetical projections were generated for the remainder of the current year based on the assumption that restrictions due to COVID-19 would remain. RESULTS: A significant decrease in the total number of dependent older patients treated was recorded during the periods of January-March 2020 (P = .026) and April-May 2020 (P = .001) when compared to 2019. According to projections, by December 2020 the clinic will be providing 81.14% less clinical activity compared to 2019 (P < .0001), including a complete cessation of domiciliary services. Despite decreases in expenditure, revenues generated by the clinic have decreased significantly due to reduced clinical activity during January-March 2020 (P = .268) and April-May 2020 (P = .010) compared to 2019, and would decline further by 899.61% by December 2020. CONCLUSIONS: The restrictions implemented to prevent the spread of COVID-19 have resulted in a significant reduction in oral healthcare provision for dependent older adults. Within this clinic, dedicated to dependent older adults, clinical activity is projected to reduce by 81% by the end of 2020 with associated reductions in revenue generation. Given the importance of oral healthcare delivery for this patient group, this may have significant and lasting impacts.

A systematic review of the use of virtual reality or dental smartphone applications as interventions for management of paediatric dental anxiety.

BACKGROUND: Virtual reality (VR) has been used successfully in medicine both as a distraction tool during procedures, and as an acclimatisation tool to prepare for a procedure or experience. It has not yet become widely used in dentistry, but could theoretically have a role in exposure-based acclimatisation for dental experiences. METHODS: To examine the use of VR or bespoke dental smartphone applications pre- or perioperatively in dentistry, to decrease anxiety in a paediatric population attending for dental examination or treatment, compared with children/adolescents who receive no intervention, or more conventional behavioural management techniques. Searches were made of eight electronic databases: the Cochrane Oral Health Group's Trials Register, The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE(PubMed), EMBASE, PsycINFO, CINAHL, Scopus and Web of Science. Further searches reference cross-checks were performed to identify studies that were not discovered online. RESULTS: Systematic reviews and randomised control trials have demonstrated the successful use of VR to both distract patients perioperatively during medical procedures, and also preoperatively to prepare them for these interventions. However, to date, VR has only been applied to dentistry in a very limited number of studies. Three studies using virtual reality in a dental setting demonstrated decreased pain and anxiety compared with no intervention. All three of these studies were carried out in the perioperative period. A fourth study used a bespoke dental app and imagery to prepare patients with Autism Spectrum Disorder (ASD) for dental treatment, finding statistically significant decreases in both the number of appointments and number of attempts required to carry out a procedure. CONCLUSION: VR is a promising tool which to date has been under-utilised in dentistry. High quality, clinical studies are required to assess the use of preoperative VR and smartphone applications to prepare patients for dental examination and procedures under local or general anaesthetic.

The impact of oral rehabilitation coupled with healthy dietary advice on the nutritional status of adults: A systematic review and meta-analysis.

As natural teeth are lost, many older adults choose softer foods lacking in essential micronutrients and fiber, yet replacing missing teeth alone does not positively influence diet. Dietary intervention in combination with treatment to replace missing teeth is increasing, though understanding of effective intervention components is limited. This systematic review synthesized literature relating to oral rehabilitation coupled with dietary intervention in adults. The primary outcome was dietary intake; secondary outcomes pertained to oral health and dietary intervention characteristics including: theoretical basis and behavior change techniques (BCTs). MEDLINE, Web of Science, PubMed and CENTRAL were searched. Nine studies were included. Study designs were heterogeneous involving 526 participants. Narrative synthesis identified improvements in at least one aspect of participants' oral health (i.e. biting/chewing) alongside at least one positive diet/nutrition outcome post-intervention for all studies. F/V results were pooled for three studies using meta-analysis techniques resulting in a standardized mean difference (SMD) of 0.29 [CI -0.54, 1.12], p = 0.49, but with marked heterogeneity (p = 0.0007). Few interventions were theory-based and intervention components were poorly described. Overall, narrative synthesis indicated support for dietary intervention coupled with oral rehabilitation on diet. Meta-analysis was only possible with three studies highlighting limitations. Large-scale, appropriately described trial methodologies are needed.Trial registry: This review was prospectively registered with PROSPERO on the 11 July 2017 [CRD42017071075].