'They think we're just in God's waiting room': A discursive study on identity aloneness in stroke survivors.

This paper examines the rhetorical strategies used by stroke survivors to attend to identity aloneness, a phenomenon in which individuals experience a sense of disconnect from others as a consequence of identity change, for which stroke is known as an antecedent. Three stroke survivors, and their spouses, were interviewed about their stroke, social support, and experiences with loneliness and identity change. The data was transcribed using a simplified version of the Jeffersonian method and analysed using a critical discursive psychological approach. This made it possible to examine the way in which the psychological business of identity aloneness was managed in participants' talk via discursive devices such as metaphors and category entitlement, while also leaving room to consider how broader societal discourses were drawn upon. The analysis revealed two critical ways in which participants attended to the issue of identity aloneness: (1) by crafting and occupying a position of resilience; (2) by managing the impact of the post-stroke social world on their identities. These findings offer insight into how the issue of identity aloneness is made sense of by stroke survivors in the context of a discussion with an interviewer. Finally, findings informed future directions for research, including developing a comprehensive theory of identity aloneness using a grounded theory approach and developing and validating a psychometric measure of identity aloneness to be applied in a rehabilitative setting.

Self-administered mindfulness interventions reduce stress in a large, randomized controlled multi-site study.

Mindfulness witnessed a substantial popularity surge in the past decade, especially as digitally self-administered interventions became available at relatively low costs. Yet, it is uncertain whether they effectively help reduce stress. In a preregistered (OSF https://doi.org/10.17605/OSF.IO/UF4JZ ; retrospective registration at ClinicalTrials.gov NCT06308744 ) multi-site study (nsites = 37, nparticipants = 2,239, 70.4% women, Mage = 22.4, s.d.age = 10.1, all fluent English speakers), we experimentally tested whether four single, standalone mindfulness exercises effectively reduced stress, using Bayesian mixed-effects models. All exercises proved to be more efficacious than the active control. We observed a mean difference of 0.27 (d = -0.56; 95% confidence interval, -0.43 to -0.69) between the control condition (M = 1.95, s.d. = 0.50) and the condition with the largest stress reduction (body scan: M = 1.68, s.d. = 0.46). Our findings suggest that mindfulness may be beneficial for reducing self-reported short-term stress for English speakers from higher-income countries.

Life after lockdown: loneliness, exclusion and the impact of hidden disability.

Background Stroke survivors are a population at increased risk of experiencing loneliness, thus exploring the effect of lockdown measures on stroke survivors is of paramount importance. We explored the personal experiences of loneliness among stroke survivors during lockdown in the COVID-19 pandemic and the lessons that can be learned from these experiences. Methods Seventeen stroke survivors from across the United Kingdom (10 females, 7 males; 45-83years old; M age =63.47) participated in semi-structured interviews. Reflexive thematic analysis was employed in the interpretation of the data. Results Three overarching themes were constructed: (1) hidden struggles, isolated lives; (2) divergent experiences and adaptations; and (3) rebuilding after lockdown. These themes explore survivors' experiences of loneliness generally after stroke and how this loneliness was assuaged with online video conferencing and other technological solutions. They also chronicle how these feelings changed during lockdown and survivors' feelings regarding society returning to 'normal' and the associated apprehension and anxiety this brings. Conclusions We recommend a focus on improving understanding of the challenges faced after stroke to reduce stigma, increase empathy and promote inclusive attitudes within society, alongside better pandemic preparedness through engagement with hybrid support solutions.

Uncovering the social determinants of brain injury rehabilitation.

Social determinants of health (SDH), such as social isolation and loneliness, are often more frequently experienced in brain injury survivors. The paper explores the personal experiences of loneliness among brain injury survivors during lockdown to negate health inequalities and improve rehabilitation for this population in the future. Twenty-four brain injury survivors participated in semi-structured interviews and questionnaires relating to loneliness, resilience and wellbeing. Three themes (the experience of loneliness, loneliness during the pandemic and loneliness after the pandemic) explored survivors' experiences of loneliness generally post-brain injury, but also chronicle how these feelings developed in lockdown and survivors' feelings regarding society returning to 'normal'. Future interventions should focus on reframing survivors' beliefs regarding societal expectations and minimise the pressure they experience to keep up with their peers physically and emotionally. Additionally, we recommend creating accessible peer support options for all brain injury survivors as an important step for alleviating loneliness.

The meaning of loneliness to stroke survivors: A qualitative study in Northeast England.

This study explored stroke survivors' experiences of loneliness. Drawing on interviews with 29 community-dwelling stroke survivors living in the Northeast of England, we found several themes: loneliness as being alone, the season or time, lack of understanding from those without any experience of stroke, reduced autonomy, and deterioration of social relations. It is important that healthcare professionals pay attention to the aspects of life that may increase the chances of a stroke survivor becoming lonely after being discharged from hospital, and to measure loneliness in stroke survivors a more valid scale should include items that touch on the aspects reported here.

Maximizing Telerehabilitation for Patients With Visual Loss After Stroke: Interview and Focus Group Study With Stroke Survivors, Carers, and Occupational Therapists.

BACKGROUND: Visual field defects are a common consequence of stroke, and compensatory eye movement strategies have been identified as the most promising rehabilitation option. There has been a move toward compensatory telerehabilitation options, such as the Durham Reading and Exploration (DREX) training app, which significantly improves visual exploration, reading, and self-reported quality of life. OBJECTIVE: This study details an iterative process of liaising with stroke survivors, carers, and health care professionals to identify barriers and facilitators to using rehabilitation tools, as well as elements of good practice in telerehabilitation, with a focus on how the DREX package can be maximized. METHODS: Survey data from 75 stroke survivors informed 12 semistructured engagement activities (7 focus groups and 5 interviews) with 32 stroke survivors, 10 carers, and 24 occupational therapists. RESULTS: Thematic analysis identified key themes within the data. Themes identified problems associated with poststroke health care from both patients' and occupational therapists' perspectives that need to be addressed to improve uptake of this rehabilitation tool and telerehabilitation options generally. This included identifying additional materials or assistance that were required to boost the impact of training packages. The acute rehabilitation setting was an identified barrier, and perceptions of technology were considered a barrier by some but a facilitator by others. In addition, 4 key features of telerehabilitation were identified: additional materials, the importance of goal setting, repetition, and feedback. CONCLUSIONS: The data were used to try to overcome some barriers to the DREX training and are further discussed as considerations for telerehabilitation in general moving forward.

Real-world applications in vision and attention: How to help patients find their (golf) balls again.

The loss of visual function is a common and debilitating effect of brain injury. Such effects include the inability to attend to the contralesional part of space (visual neglect) and loss of vision in part of the visual field in both eyes (homonymous visual field defects). The underlying mechanism of these functional deficits are varied which explains why no one intervention is effective in their treatment. In this chapter, we examine the cognitive neuroscience that underlies visual performance and attention with particular focus on what we know about visual exploration using search tasks in the laboratory. We then discuss how this knowledge has informed the development of interventions for poor visual function and how these can be maximized.

The Limitations of Reward Effects on Saccade Latencies: An Exploration of Task-Specificity and Strength.

Saccadic eye movements are simple, visually guided actions. Operant conditioning of specific saccade directions can reduce the latency of eye movements in the conditioned direction. However, it is not clear to what extent this learning transfers from the conditioned task to novel tasks. The purpose of this study was to investigate whether the effects of operant conditioning of prosaccades to specific spatial locations would transfer to more complex oculomotor behaviours, specifically, prosaccades made in the presence of a distractor (Experiment 1) and antisaccades (Experiment 2). In part 1 of each experiment, participants were rewarded for making a saccade to one hemifield. In both experiments, the reward produced a significant facilitation of saccadic latency for prosaccades directed to the rewarded hemifield. In part 2, rewards were withdrawn, and the participant made a prosaccade to targets that were accompanied by a contralateral distractor (Experiment 1) or an antisaccade (Experiment 2). There were no hemifield-specific effects of the reward on saccade latency on the remote distractor effect or antisaccades, although the reward was associated with an overall slowing of saccade latency in Experiment 1. These data indicate that operant conditioning of saccadic eye movements does not transfer to similar but untrained tasks. We conclude that rewarding specific spatial locations is unlikely to induce long-term, systemic changes to the human oculomotor system.

Social cognition and executive functioning predictors of supervisors' appraisal of interpersonal behaviour in the workplace following acquired brain injury.

BACKGROUND: Social cognition and executive functioning difficulties following acquired brain injury have been linked to negative employment outcomes, such as demotion and loss of vocational roles. These are very counter-intuitive and challenging difficulties for other employees and work supervisors who have little or no brain injury knowledge, whose perceptions of play a key role in their responses to these difficulties and the final outcome of such problems for vocational status. OBJECTIVES: This study aimed to study the relationship between social cognition and executive functioning difficulties and the perceptions of work supervisors' appraisal of survivor interpersonal behaviour and social skills in the workplace. METHOD: The performance of 73 survivors of acquired brain injury (47% TBI, 38% CVA, 15% other ABI type; 73% male; mean age 45.44 years, range 19-64 years; mean time since injury 6.36 years, range 10.5-31.33 years), currently in a vocational rehabilitation placement) on neuropsychological tests of executive functioning and social cognition was measured. Informant ratings on the Social Skills Factor subscale from the Work Personality Profile (WPP, Bolton & Roessler, 1986) were used as the primary outcome measure, a vocational functioning questionnaire assessing social and presentational aspects of workplace behaviour. The raters were non-clinical workplace informants acting in a supervisory role (supervisory placement providers and job coaches). RESULTS: Correlational analysis identified significant associations between the WPP and survivor goal-orientated planning and implementation, mentalising ability, recognition of positive and negative emotions, and recognition of simple sarcasm (all significant at p <  0.05). These correlates were entered into a stepwise multiple regression. The combination final of survivor mentalising ability and executive functioning explained 32 % of the variance in the WPP ratings (F (2, 52) =  12.15, p <  0.001). CONCLUSION: Certain limitations of the study withstanding, the current findings add to previous literature in highlighting the relevance of survivor executive functioning and social cognition difficulties for the perceptions and appraisal of work colleagues, consistent with other studies that have identified negative vocational outcomes associated with such neuropsychological difficulties. The implications for vocational rehabilitation are discussed.

A Systematic Review of the Effect of Individualized Risk Communication Strategies on Screening Uptake and Its Psychological Predictors: The Role of Psychology Theory.

People might be more likely to attend for health screening if they are told their individual risk of an illness. The way this risk of ill-health is communicated might have an effect on screening uptake or its psychological proxies. It is possible that the format, presentation, and details of the information as well as the complexity of an intervention and use of psychological theory to inform the intervention may impact the effectiveness of individual risk communication. This systematic review collates, analyses and synthesizes the evidence for effectiveness of these aspects of individual risk communication. The synthesis indicated that written, individualized risk scores or categories are effective at supporting screening uptake and its psychological proxies. Complex, or theory-based interventions, surprisingly, are no more effective than simpler or atheoretical interventions.

Micro-invasive interventions for managing proximal dental decay in primary and permanent teeth.

BACKGROUND: Proximal dental lesions, limited to dentine, are traditionally treated by invasive (drill and fill) means. Non-invasive alternatives (e.g. fluoride varnish, flossing) might avoid substance loss but their effectiveness depends on patients' adherence. Recently, micro-invasive approaches for treating proximal caries lesions have been tried. These interventions install a barrier either on top (sealing) or within (infiltrating) the lesion. Different methods and materials are currently available for micro-invasive treatments, such as sealing via resin sealants, (polyurethane) patches/tapes, glass ionomer cements (GIC) or resin infiltration. OBJECTIVES: To evaluate the effects of micro-invasive treatments for managing proximal caries lesions in primary and permanent dentition in children and adults. SEARCH METHODS: We searched the following databases to 31 December 2014: the Cochrane Oral Health Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE via OVID, EMBASE via OVID, LILACs via BIREME Virtual Health Library, Web of Science Conference Proceedings, ZETOC Conference Proceedings, Proquest Dissertations and Theses, ClinicalTrials.gov, OpenGrey and the World Health Organization (WHO) International Clinical Trials Registry Platform. We searched the metaRegister of Controlled Trials to 1 October 2014. There were no language or date restrictions in the searches of the electronic databases. SELECTION CRITERIA: We included randomised controlled trials of at least six months' duration that compared micro-invasive treatments for managing non-cavitated proximal dental decay in primary teeth, permanent teeth or both, versus non-invasive measures, invasive means, no intervention or placebo. We also included studies that compared different types of micro-invasive treatments. DATA COLLECTION AND ANALYSIS: Two review authors independently screened search results, extracted data and assessed the risk of bias. We used standard methodological procedures expected by Cochrane to evaluate risk of bias and synthesise data. We conducted meta-analyses with the random-effects model, using the Becker-Balagtas method to calculate the odds ratio (OR) for lesion progression. We assessed the quality of the evidence using GRADE methods. MAIN RESULTS: We included eight trials, which randomised 365 participants. The trials all used a split-mouth design, some with more than one pair of lesions treated within the same participant. Studies took place in university or dental public health clinics in Brazil, Colombia, Denmark, Germany, Thailand, Greenland and Chile. Six studies evaluated the effects of micro-invasive treatments in the permanent dentition and two studies on the primary dentition, with caries risk ranging from low to high. Investigators measured caries risk in different studies either by caries experience alone or by using the Cariogram programme, which combines eight contributing factors, including caries experience, diet, saliva and other factors related to caries. The follow-up period in the trials ranged from one to three years. All studies used lesion progression as the primary outcome, evaluating it by different methods of reading radiographs. Four studies received industry support to carry out the research, with one of them being carried out by inventors of the intervention.We judged seven studies to be at high overall risk of bias, primarily due to lack of blinding of participants and personnel. We evaluated intervention effects for all micro-invasive therapies and analysed subgroups according to the different treatment methods reported in the included studies.Our meta-analysis, which pooled the most sensitive set of data (in terms of measurement method) from studies presenting data in a format suitable for meta-analysis, showed that micro-invasive treatment significantly reduced the odds of lesion progression compared with non-invasive treatment (e.g fluoride varnish) or oral hygiene advice (e.g to floss) (OR 0.24, 95% CI 0.14 to 0.41; 602 lesions; seven studies; I(2) = 32%). There was no evidence of subgroup differences (P = 0.36).The four studies that measured adverse events reported no adverse events after micro-invasive treatment. Most studies did not report on any further outcomes.We assessed the quality of evidence for micro-invasive treatments as moderate. It remains unclear which micro-invasive treatment is more advantageous, or if certain clinical conditions or patient characteristics are better suited for micro-invasive treatments than others. AUTHORS' CONCLUSIONS: The available evidence shows that micro-invasive treatment of proximal caries lesions arrests non-cavitated enamel and initial dentinal lesions (limited to outer third of dentine, based on radiograph) and is significantly more effective than non-invasive professional treatment (e.g. fluoride varnish) or advice (e.g. to floss). We can be moderately confident that further research is unlikely to substantially change the estimate of effect. Due to the small number of studies, it does remain unclear which micro-invasive technique offers the greatest benefit, or whether the effects of micro-invasive treatment confer greater or lesser benefit according to different clinical or patient considerations.

Rewards modulate saccade latency but not exogenous spatial attention.

The eye movement system is sensitive to reward. However, whilst the eye movement system is extremely flexible, the extent to which changes to oculomotor behavior induced by reward paradigms persist beyond the training period or transfer to other oculomotor tasks is unclear. To address these issues we examined the effects of presenting feedback that represented small monetary rewards to spatial locations on the latency of saccadic eye movements, the time-course of learning and extinction of the effects of rewarding saccades on exogenous spatial attention and oculomotor inhibition of return. Reward feedback produced a relative facilitation of saccadic latency in a stimulus driven saccade task which persisted for three blocks of extinction trials. However, this hemifield-specific effect failed to transfer to peripheral cueing tasks. We conclude that rewarding specific spatial locations is unlikely to induce long-term, systemic changes to the human oculomotor or attention systems.

Extrasinus zygomatic implant placement in the rehabilitation of the atrophic maxilla: three-dimensional finite element stress analysis.

Placement of zygomatic implants lateral to the maxillary sinus, according to the extrasinus protocol, is one of the treatment options in the rehabilitation of severely atrophic maxilla or following maxillectomy surgery in patients with head and neck cancer. The aim of this study was to investigate the mechanical behavior of a full-arch fixed prosthesis supported by 4 zygomatic implants in the atrophic maxilla under occlusal loading. Results indicated that maximum von Mises stresses were significantly higher under lateral loading compared with vertical loading within the prosthesis and its supporting implants. Peak stresses were concentrated at the prosthesis-abutments interface under vertical loading and the internal line angles of the prosthesis under lateral loading. The zygomatic supporting bone suffered significantly lower stresses. However, the alveolar bone suffered a comparatively higher level of stresses, particularly under lateral loading. Prosthesis displacement under vertical loading was higher than under lateral loading. The zygomatic bone suffered lower stresses than the alveolar bone and prosthesis-implant complex under both vertical and lateral loading. Lateral loading caused a higher level of stresses than vertical loading.

Zygomatic implants: the impact of zygoma bone support on biomechanics.

Maxillectomy and severely resorbed maxilla are challenging to restore with provision of removable prostheses. Dental implants are essential to restore esthetics and function and subsequently quality of life in such group of patients. Zygomatic implants reduce the complications associated with bone grafting procedures and simplify the rehabilitation of atrophic maxilla and maxillectomy. The purpose of this study was to compare, by means of 3-dimensional finite element analysis, the impact of different zygomatic bone support (10, 15, and 20 mm) on the biomechanics of zygomatic implants. Results indicated that maximum stresses within the fixture were increased by 3 times when bone support decreased from 20 to 10 mm and were concentrated at the fixture/bone interface. However, stresses within the abutment screw and the abutment itself were not significantly different regardless of the bone support level. Supporting bone at 10 mm sustained double the stresses of 15 and 20 mm. Fixture's deflection was decreased by 2 to 3 times when bone support level increased to 15 mm and 20 mm, respectively. It was concluded that zygomatic bone support should not be less than 15 mm, and abutment screw is not at risk of fracture regardless of the zygomatic bone support.

Summary of: Influence of root canal fillings on longevity of direct and indirect restorations placed within the General Dental Services in England and Wales.

AIM: To consider the survival of restorations in root filled and non-root filled teeth. METHODS: A data set was established consisting of patient's, 18 years or older. For each patient on the database with a tooth restored with a direct or indirect restoration with or without a root filling, the subsequent history of intervention on that tooth was consulted, and the next date of intervention, if any could be found in the data set, was obtained. Thus a data set was created of restored teeth and whether they have also received root fillings, with the dates of restoration and root filling placement and the dates, if any, of re-intervention. Modified Kaplan-Meier statistical analysis was used to quantify the distribution of time to intervention.Results Data for over 80,000 different adult patients were analysed, of whom 46% were male and 54% female. A total of 538,967 restoration placements were obtained from the data over a period of 11 years, of which 30,073 were root fillings. CONCLUSIONS: Examination of the survival of restorations in teeth with and without root canal fillings indicated that those with root canal fillings have shorter intervals before re-intervention than teeth without root fillings. Restorations on root canal treated anterior teeth with post and cores had the lowest survival time.

Replacement versus repair of defective restorations in adults: resin composite.

BACKGROUND: Composite filling materials have been increasingly used for the restoration of posterior teeth in recent years as a tooth-coloured alternative to amalgam. As with any filling material composites have a finite life-span. Traditionally, replacement was the ideal approach to treat defective composite restorations, however, repairing composites offers an alternative more conservative approach to the tooth structure where restorations are partly still serviceable. Repairing the restoration has the potential of taking less time and may sometimes be performed without the use of local anaesthesia hence it may be less distressing for a patient when compared with replacement. OBJECTIVES: To evaluate the effects of replacing (with resin composite) versus repair (with resin composite) in the management of defective resin composite dental restorations in permanent molar and premolar teeth. SEARCH METHODS: For the identification of studies relevant to this review we searched the Cochrane Oral Health Group's Trials Register (to 24 July 2013); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 6); MEDLINE via OVID (1946 to 24 July 2013); EMBASE via OVID (1980 to 24 July 2013); BIOSIS via Web of Knowledge (1969 to 24 July 2013); Web of Science (1945 to 24 July 2013); and OpenGrey (to 24 July 2013). Researchers, experts and organisations known to be involved in this field were contacted in order to trace unpublished or ongoing studies. No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA: Trials were selected if they met the following criteria: randomised controlled trial (including split-mouth studies), involving replacement and repair of resin composite restorations in adults with a defective molar restoration in a permanent molar or premolar teeth. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed titles and abstracts for each article identified by the searches in order to decide whether the article was likely to be relevant. Full papers were obtained for relevant articles and both review authors studied these. The Cochrane Collaboration statistical guidelines were to be followed for data synthesis. MAIN RESULTS: The search strategy retrieved 298 potentially eligible studies, after de-duplication. After examination of the titles and abstracts, full texts of potentially relevant studies were retrieved but none of the retrieved studies met the inclusion criteria of the review. AUTHORS' CONCLUSIONS: There are no published randomised controlled trials relevant to this review question. There is therefore a need for methodologically sound randomised controlled trials that are reported according to the Consolidated Standards of Reporting Trials (CONSORT) statement (www.consort-statement.org/). Further research also needs to explore qualitatively the views of patients on repairing versus replacement and investigate themes around pain, anxiety and distress, time and costs.

Replacement versus repair of defective restorations in adults: amalgam.

BACKGROUND: Amalgam is a common filling material for posterior teeth, as with any restoration amalgams have a finite life-span. Traditionally replacement was the ideal approach to treat defective amalgam restorations, however, repair offers an alternative more conservative approach where restorations are only partially defective. Repairing a restoration has the potential of taking less time and may sometimes be performed without the use of local anaesthesia hence it may be less distressing for a patient when compared with replacement. Repair of amalgam restorations is often more conservative of the tooth structure than replacement. OBJECTIVES: To evaluate the effects of replacing (with amalgam) versus repair (with amalgam) in the management of defective amalgam dental restorations in permanent molar and premolar teeth. SEARCH METHODS: For the identification of studies relevant to this review we searched the Cochrane Oral Health Group's Trials Register (to 5 August 2013); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 7); MEDLINE via OVID (1946 to 5 August 2013); EMBASE via OVID (1980 to 5 August 2013); BIOSIS via Web of Knowledge (1969 to 5 August 2013); Web of Science (1945 to 5 August 2013) and OpenGrey (to 5 August 2013). Researchers, experts and organisations known to be involved in this field were contacted in order to trace unpublished or ongoing studies. No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA: Trials were selected if they met the following criteria: randomised controlled trial (including split-mouth studies), involving replacement and repair of amalgam restorations in adults with a defective restoration in a molar or premolar tooth/teeth. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed titles and abstracts for each article identified by the searches in order to decide whether the article was likely to be relevant. Full papers were obtained for relevant articles and both review authors studied these. The Cochrane Collaboration statistical guidelines were to be followed for data synthesis. MAIN RESULTS: The search strategy retrieved 201 potentially eligible studies after de-duplication. After examination of the titles and abstracts, full texts of the relevant studies were retrieved but none of these met the inclusion criteria of the review. AUTHORS' CONCLUSIONS: There are no published randomised controlled trials relevant to this review question. There is therefore a need for methodologically sound randomised controlled trials that are reported according to the Consolidated Standards of Reporting Trials (CONSORT) statement (www.consort-statement.org/). Further research also needs to explore qualitatively the views of patients on repairing versus replacement and investigate themes around pain, distress and anxiety, time and costs.

Dentist-patient communication: what do patients and dentists remember following a consultation? Implications for patient compliance.

BACKGROUND: There is a lack of information about the extent to which patients recall key facts of dental consultations. Forgetting health advice undermines adherence with such instructions and is a potential problem. This study assessed the quantity and type of information recalled in a dental consultation, dentist-patient agreement over the contents of the consultation, and the relationship of such recall with patient satisfaction. METHODS: Using a cross-sectional design, questionnaire data were obtained from patients recruited through a letter and presenting for a routine dental consultation. General issues discussed, specific information about oral health given, dentist-performed procedures, and agreed future actions were reported independently in writing, by patients and also by the treating dentist immediately postconsultation. Additionally, patients completed a dental visit satisfaction questionnaire. RESULTS: Responses (n = 26, 55% response rate) were content-analyzed, and data on the number and type of information that was recalled were obtained. Interrater reliability was established. Inferential testing showed differences in dentist-patient recall, dentist-patient agreement, and the association between patient recall and satisfaction. Dentists recalled more information than patients (P = 0.001). Dentists further reported giving more dental health education (P = 0.006) and discussing more future actions (P = 0.002) than patients actually remembered. Technical (eg, crowns/bridges) rather than psychosocial (eg, pain/embarrassment) issues were reported more often (P = 0.001) by both dentists and patients. Dentist-patient agreement over issues discussed and procedures performed was higher (kappa = 0.210-0.310) than dental health education agreement and agreed future actions (kappa = 0.060-0.110). There was no relationship between patient recall and patient satisfaction with the consultation (P = 0.240). CONCLUSION: Patients do not recall as much advice and agreed actions about future dental care as dentists believe they have discussed. These results have implications for patient adherence with oral health instructions.

Marginal bone loss influence on the biomechanics of single implant crowns.

Marginal bone loss, whether it is physiological or pathological, is one of the implant treatment complications. The biomechanical consequences of marginal bone loss could be catastrophic particularly when the abutment screw is at supraosseous level. This study aimed at investigating marginal bone loss influence on the biomechanics of single implant crown using finite element (FE) analysis. Four FE models for a 3.5 × 13 mm implant supported by 4 bone levels (8.5 mm, 10 mm, 11.5 mm, and 13 mm) were subjected to 3 loading conditions: vertical, oblique, and horizontal. The results indicated 5-10 times increase in maximum von Mises stresses under oblique and horizontal loading. The maximum stresses within the fixture were concentrated at the bone/fixture interface with highest value under horizontal loading at 10 mm bone support. Abutment screw was most susceptible to fracture as the highest stress was concentrated at the screw/fixture interface. Cortical bone suffered its greatest stress level at the fixture/bone interface at 10 mm bone support. However, increasing bone support to 11.5 mm has improved the fracture resistance of the abutment screw to a great extent especially under oblique and vertical loading. Severe marginal bone loss might be attributed for abutment screw and fixture head fracture especially under horizontal loading.