Reliability between the two-colour chewing gum and the gummy-jelly tests used for the assessment of masticatory performance.

OBJECTIVE: This study aimed to evaluate the reliability of two methods used to assess masticatory performance and attempt to correlate them to achieve interchangeability between the methods. METHODS: Twelve healthy dentate volunteers (men = 6, women = 6; mean age = 28.3 ± 4.1) with no known dental or medical pathologies were requested to participate in this study. Each participant completed three masticatory performance assessments, including two two-colour mixing-ability tests using chewing-gums (CG: gum#1 and gum#2) and the gummy-jelly (GJ) test. For each method, participants created five samples each (total = 15 measurements per participant, gum#1 = 5, gum#2 = 5, GJ = 5). For the gum#1 and gum#2 methods, the predetermined chewing cycles were fixed at 10, 15, 20, 25 and 30 cycles, and for the GJ method, the time duration was fixed at 10, 15, 20, 25 and 30 s. The parameter measures were submitted to Z-score transformation, and Bland-Altman plots were generated to graphically compare the differences between two techniques against their means. Additionally, mountain plot was used to assess the cumulative distribution of measurement error between the methods. RESULTS: A total of 180 measurements were recorded. There were significant correlations between the number of chewing cycles/chewing time and masticatory performance using the gum#1 (r = -.753; p < .001), gum#2 (r = -.838; p < .001) and GJ (r = .730). When all tests were considered together for each method, significant correlations were found (p < .001). A descriptive range of mean values aiming to produce reference value ranges for predictive purposes was achieved considering the interchangeably among the methods [CG = GJ (VoH-mg = dL): 10 cycle = 10 s: 0.329 = 110; 15 cycles = 15 s: 0.177 = 164; 20 cycles = 20 s: 0.130 = 205; 25 cycles = 25 s: 0.086 = 200; 30 cycles = 30 s: 0.077 = 267]. CONCLUSION: The strong correlations and high consistency between the two masticatory performance methods found in this study conclude that the two assessment methods are reliable and interchangeable. Further evaluations are warranted to arrive at a conversion formula for translation of the results between the two methods.

Impact of shortened dental arch therapy on nutritional status and treatment costs in older adults: A systematic review.

OBJECTIVE: This review was undertaken to evaluate, whether a shortened dental arch (SDA) was a good alternative to a conventional prosthodontic rehabilitation (RPD) in older adults when nutritional and economic factors are compared. DATA: A total of 92 studies were included for the full-text analysis, and finally 4 reports from two RCTs qualified for data extraction and analysis. The final search update was performed on 06.11.2022 and no further searches and updates were performed after this date. SOURCES: Electronic databases [PubMed (MEDLINE), Embase, CENTRAL] were systematically searched to identify studies comparing nutritional and economic outcomes in partially edentate adults rehabilitated with conventional RPD and SDA therapy. STUDY SELECTION: Studies were excluded if there were less than 10 participants per group, and if the subjects were not clinically followed up in recall visits. Two investigators performed the data extraction and were reciprocally blinded. Inter-investigator reliability was assessed using Cohen's unweighted kappa (κ). A meta-analysis could not be performed and the results were reported qualitatively. RESULTS: The calculated κ ranged between 0.80 and 1.00. Three reports from two studies reported on nutritional outcomes and one report provided information on economic benefits, when comparing between the SDA therapy and conventional prosthodontic rehabilitation. No significant difference was recorded in the nutritional status of patients rehabilitated using the SDA concept compared with RPDs. Higher costs for treatment provision and maintenance for patients in the RPD group was found when compared to SDA treatment. CONCLUSIONS: This systematic review identified the shortened dental arch concept as a reasonable alternative to the conventional prosthodontic rehabilitation where cost-effectiveness and nutrition are concerned based on the limited evidence obtained from current literature. CLINICAL SIGNIFICANCE: SDA therapy may be considered as a feasible treatment concept in older adults especially in those with complex medical statuses and limited finances.

Clinical outcomes and costs of conventional and digital complete dentures in a university clinic: A retrospective study.

STATEMENT OF PROBLEM: Scientific data analyzing the clinical outcomes and costs of complete dentures fabricated by using conventional and computer-aided design and computer-aided manufacturing (CAD-CAM) processes are lacking. PURPOSE: The purpose of this retrospective study was to compare the treatment duration, financial costs, and postdelivery adjustments of CAD-CAM and conventional removable complete dentures. MATERIAL AND METHODS: Thirty-two edentulous participants (16 women, 16 men; age 35-85 years) who had received either CAD-CAM (n=16) or conventional (n=16) maxillary and mandibular removable complete dentures provided by prosthodontists with a minimum of 2 years of experience were evaluated. The CAD-CAM denture systems were either DDS-AV (AvaDent Digital Dental Solutions) (n=11) or DD-IV (Wieland Digital Denture) (n=5). The total treatment period (days) was recorded at 3 different time points (T0: preliminary alginate impression; T1: denture delivery; T2: last scheduled postdelivery adjustment). Adjustments during the follow-up (after T2) were noted and included the removal of areas of excessive pressure, relining, or repairs. The costs of the dental treatment and the laboratory fees were calculated. The Wilcoxon rank sum tests were used for statistical analysis (α=.05). RESULTS: No statistically significant difference regarding the treatment duration between digitally and conventionally fabricated removable complete dentures was found: T0-T1 (P=.889); T1-T2 (P=.675); T2- T3 (P=.978). No significant difference was found in the number adjustments for areas of excessive pressure, relines, or repairs (P=.757, P=1.000, P=1.000) during the period. Laboratory costs of CAD-CAM removable complete dentures were significantly lower than those of conventional removable complete dentures (P<.001), but clinical fees were similar between groups (P=.596), resulting in a reduction in the overall total costs for the CAD-CAM removable complete dentures (P=.011). Regarding the number of clinical visits, neither the group (conventional/CAD-CAM (P=.945)/DDS-AV/DD-IV [P=.848]) nor the interaction group (conventional/CAD-CAM and DDS-AV/DD-IV)/period (P=.084/P=.171) showed any significant differences. CONCLUSIONS: CAD-CAM removable complete dentures can be considered a viable alternative to conventional removable complete dentures regarding treatment duration, clinical and follow-up visits, adjustments, and maintenance requirements.

Extra-oral assessment of conventional and CAD-CAM complete denture appearance by dental professionals and CRDP wearers: A randomized survey.

INTRODUCTION: Complete removable dental prostheses' (CRDPs) appearance may vary between conventional and contemporary CAD-CAM manufacturing techniques. OBJECTIVES: The aim of this randomized survey was to analyze appreciation of CRDPs, manufactured with different techniques, by dental professionals and elder CRDP wearers. METHODS: Four participant groups, comprised of undergraduate students (n=10), postgraduate residents (n=10), dental technicians (n=10) and elder CRDP wearers (n=10), evaluated the appearance of maxillary CRDPs manufactured by six different techniques: three conventional methods 1. flask-pack-press (FP), 2. Injection-molded (IM), 3. intrinsically colored natural gingiva finish before injection-molded (NG) and three CAD-CAM methods 4. milled base with bonded prefabricated teeth (M), 5. fully milled including milled teeth (FM) and 6. rapid-prototyped including printed teeth (P). A randomized, blinded survey included 18 pairwise comparative assessments and 12 individual judgements of the CRDPs on general appearance as well as pink and white aspects. Statistical analyses included parametric- and nonparametric tests as well as linear regression models; the level of statistical significance was set at p<.05. RESULTS: NG was preferred by the professional groups but not by the elder CRDP wearers (p<.05). P was scored lowest by all four participant groups (p<.05). CRDP wearers' ratings were less severe and within a narrower range. The ratings of the two CAD-CAM milled CRDPs (M and FM) were ranked closer to FP and IM); the order of preference was different depending on the participant groups. CONCLUSIONS: The findings of this study revealed marked differences in the assessment of CRDP appearances between dental professionals and older CRDP wearers. CLINICAL SIGNIFICANCE: A shared and informed approach to decision making concerning the CRDP appearance might foster denture acceptance and treatment success.

Immediately loaded single-implant mandibular overdentures compared to conventional complete dentures: A cost-effectiveness analysis.

BACKGROUND: In recent years, the single-implant mandibular overdenture (SIMO) has been proposed as an alternative to more complex overdenture designs as a simplified implant intervention for edentulous patients. OBJECTIVE: The aim of this study was to run a cost-effectiveness analysis alongside a randomized clinical trial comparing the SIMO and the conventional complete denture (CCD) treatment. Imediately loaded external hexagon implant and ball attachment were used for the overdenture goup. Direct costs related to therapies were identified and valuated throughout a 1-year period after delivery, in Brazilian currency (R$) and converted into international dollars (I$) using purchase power parity exchange rates. Treatment effectiveness was measured using the OHIP-Edent and satisfaction scores for calculation of incremental cost-effectiveness ratios (ICER). RESULTS: Outcomes were assessed at the 1-year follow-up for 65 patients (CCD=34; SIMO=31). Overall OHIP-Edent and satisfaction scores improved significantly in the SIMO group, while remained unchanged in the CCD group. The mean overall costs were R$1,179.04 (I$590.99) for the CCD group and R$2,127.91 (I$1,068.20) for the SIMO group - 80.7% incremental cost for SIMO. The ICER calculation for SIMO treatment showed a mean cost of I$48.20 for 1-point reduction in OHIP-Edent scores, and I$12.56 for 1-point increase in satisfaction score. CONCLUSIONS: Findings support the effectiveness of this simplified and low-cost implant intervention for edentulous patients. SIMO also seems a cost-effective alternative to the CCD and the relatively low incremental cost may potentially increase the utilization of dental implants among older subjects, especially those with limited financial resources. CLINICAL SIGNIFICANCE: The immediately loaded single-implant mandibular overdenture was superior to the conventional complete denture in terms of patient-reported outcome measures at a low incremental cost.

CAD-CAM removable complete dentures: A systematic review and meta-analysis of trueness of fit, biocompatibility, mechanical properties, surface characteristics, color stability, time-cost analysis, clinical and patient-reported outcomes.

OBJECTIVES: This review compared Computer-aided designand Computer-aided manufactured (CAD-CAM) and conventionally constructed removable complete dentures (CDs). DATA: Seventy-three studies reporting on CAD-CAM (milled/3D-printed) CDs were included in this review. The most recent literature search was performed on 15/03/2021. SOURCES: Two investigators searched electronic databases [PubMed (MEDLINE), Embase, CENTRAL], online search engines (Google) and research portals. Hand searches were performed to identify literature not available online. STUDY SELECTION: Studies on CAD-CAM CDs were included if they reported on trueness of fit, biocompatibility, mechanical, surface, chemical, color , microbiological properties, time-cost analysis, and clinical outcomes. Inter-investigator reliability was assessed using kappa scores. Meta-analyses were performed on the extracted data . RESULTS: The kappa score ranged between 0.897-1.000. Meta-analyses revealed that 3D-printed CDs were more true than conventional CDs (p = 0.039). Milled CDs had a higher flexural-strength than conventional and 3D-printed CDs (p < 0.0001). Milled CDs had a higher flexural-modulus than 3D-printed CDs (p < 0.0001). Milled CDs had a higher yield-strength than injection-molded (p = 0.004), and 3D-printed CDs (p = 0.001). Milled CDs had superior toughness (p < 0.0001) and surface roughness characteristics (p < 0.0001) than other CDs . Rapidly-prototyped CDs displayed poor color-stability compared to other CDs (p = 0.029). CAD-CAM CDs d displayed better retention than conventional CDs (p = 0.015). Conventional CDs had a higher strain at yield point than milled CDs (p < 0.0001), and had superior esthetics than 3D-printed (p < 0.0001). Fabrication of CAD-CAM CDs required less chairside time (p = 0.037) and lower overall costs (p < 0.0001) than conventional CDs. CONCLUSIONS: This systematic review concludes that CAD-CAM CDs offer a number of improved mechanical/surface properties and are not inferior when compared to conventional CDs. CLINICAL SIGNIFICANCE: CAD-CAM CDs should be considered for completely edentulous patients whenever possible, since this technique offers numerous advantages including better retention, mechanical and surface properties but most importantly preserves a digital record. This can be a great advantage for older adults with limited access to dental care.

Patient preferences for different tooth replacement strategies for the edentulous mandible: A willingness-to-pay analysis.

Purpose The aim of this study was to evaluate patients' economic preferences for two different tooth replacement strategies for the edentulous mandible namely conventional complete dentures (CCDs) and implant overdentures supported by two implants (IODs), using a willingness-to-pay (WTP) analysis.Methods Twenty-six elderly patients who had been rehabilitated with either a mandibular CCD or IOD were invited to participate in this study. All participants were provided with the details of the two treatment protocols, including advantages, disadvantages, and treatment costs. The patients were then asked to indicate their maximum WTP values for each protocol using a payment card method for contingency evaluation.Results Fifteen patients with mandibular CCD (CCD-Group) and 12 patients with IOD (IOD-Group) participated in the study. Overall, the median and maximum WTP values recorded for IOD therapy were significantly higher than those for CCD therapy (p<0.05). Both treatment groups recorded maximum WTP values for CCD therapy, which exceeded the market cost (¥30,000 [US$280]), CCD-Group: ¥50,000 (interquartile range [IQR]: 40,000 - 65,000), and IOD-Group: ¥45,000 (IQR: 30,000-85,000)]. However, both groups registered a median and maximum WTP values for IOD therapy lower than the market cost (¥780,000 [US$7,300]), (CCD-Group: ¥500,000 [IQR: 300,000 - 750,000], IOD-Group: ¥700,000 [IQR: 500,000-800,000]).Conclusion The maximum WTP values recorded for IOD therapy were significantly higher than CCD therapy in both treatment groups. While patients were willing to pay more than the current market costs for CCDs, they were not willing to meet the market value for IODs.

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.

CAD/CAM milled removable complete dentures: time and cost estimation study.

OBJECTIVE: This study compared the clinical time spent and the costs incurred whilst constructing complete dentures (CDs) using a two-visit digital-denture protocol with the conventional complete denture protocol, in a university setting. METHODS: Twelve undergraduate final-year dental students utilized both the digital denture protocol and the conventional complete denture protocol to construct two sets of CDs for patients requiring either an upper CD opposing a partial natural dentition restored using a partial removable prosthesis [Group#1: students: n = 6, upper CD: n = 12 (6-digital complete dentures +6-conventional complete dentures)] or both upper and lower CDs [Group#2: students: n = 6, upper and lower CDs: n = 24 (12-digital complete dentures+ 12-conventional complete dentures)]. Overall time spent and costs (clinical, materials, and laboratory) were calculated. A cost minimization analysis was performed to compare the economic costs of the two protocols. Paired t-tests were applied for the statistical analyses (p < 0.05). RESULTS: Conventional complete denture protocol required longer clinical time than digital complete dentures for both Group#1 (p = 0.0206) and Group#2 (p = 0.0020). The materials costs were higher for the digital complete dentures in both groups (Group#1 p < 0.0001; Group#2: p = 0.0002). The overall costs, were significantly higher for the conventional complete denture protocol than for the digital denture protocol (Group#1: p = 0.0032; Group 2: p = 0.0080). CONCLUSIONS: In a university setting student clinic in Geneva in Switzerland, the digital denture protocol is less costly when compared with the conventional complete denture protocol. The costs for clinical chairside time, laboratory and the overall costs were significantly lower for the digital denture protocol, even though the materials costs for this protocol were higher. CLINICAL SIGNIFICANCE: The digital denture protocol might prove highly beneficial to the elderly and/or the compromised edentulous patient, as it can help decrease the treatment burden on the patient by reducing the clinical procedures, number of visits, treatment time and incurred costs.