Inter and intra-operator reliability of Lekholm and Zarb classification and proposal of a novel radiomic data-driven clustering for qualitative assessment of edentulous alveolar ridges.

OBJECTIVES: The present study was conducted to evaluate the reproducibility of Lekholm and Zarb classification system (L&Z) for bone quality assessment of edentulous alveolar ridges and to investigate the potential of a data-driven approach for bone quality classification. MATERIALS AND METHODS: Twenty-six expert clinicians were asked to classify 110 CBCT cross-sections according to L&Z classification (T0). The same evaluation was repeated after one month with the images put in a different order (T1). Intra- and inter-examiner agreement analyses were performed using Cohen's kappa coefficient (CK) and Fleiss' kappa coefficient (FK), respectively. Additionally, radiomic features extraction was performed from 3D edentulous ridge blocks derived from the same 110 CBCTs, and unsupervised clustering using 3 different clustering methods was used to identify patterns in the obtained data. RESULTS: Intra-examiner agreement between T0 and T1 was weak (CK 0.515). Inter-examiner agreement at both time points was minimal (FK at T0: 0.273; FK at T1: 0.243). The three different unsupervised clustering methods based on radiomic features aggregated the 110 CBCTs in three groups in the same way. CONCLUSIONS: The results showed low agreement among clinicians when using L&Z classification, indicating that the system may not be as reliable as previously thought. The present study suggests the possible application of a reproducible data-driven approach based on radiomics for the classification of edentulous alveolar ridges, with potential implications for improving clinical outcomes. Further research is needed to determine the clinical significance of these findings and to develop more standardized and accurate methods for assessing bone quality of edentulous alveolar ridges.

Oral health-related quality of life (OHRQoL) and implant therapy: A prospective multicenter study of preoperative, intermediate, and posttreatment assessment.

The purpose of this multicenter continuation study was to use high patient numbers in order to generate reliable statements regarding the association between different implant indications and OHRQoL. Patients with various types of indication for dental implants, ranging from single tooth loss to edentulous jaws, were included. Quality of life relating to dental implants was assessed through the oral health impact profile (OHIP-G-21), which has a summary score from 0 to 20 in healthy patients. In total, 16 253 patients from 29 centers (European Centers for Dental Implantology (ECDI)) were involved in the study between 2009 and 2021.8251 patients (50.7%) completed the questionnaire after implant insertion, and 4996 patients (30.7%) after prosthodontic treatment. The average age was 54 years (range 18-88 years). Posterior single-tooth gap (28.5%) and free-end gap (27.8%) were the most frequent indications. The preoperative OHIP-G-21 score for all patients was 32.81 (SD 11.92), while the score during the healing period was 30.00 (SD 10.72), and after completion of treatment 27.24 (SD 9.26) (p < 0.001). The most significant improvements in OHIP-G-21 scores were in the indication of edentulous jaw (phase 1, 41.81 (SD 15.53); phase 2, 35.39 (SD 14.22); phase 3, 29.60 (SD 10.12) (p < 0.001). The study revealed significant improvements in the most frequently reported problems (chewing, serious concerns, appearance) (p < 0.001). Insertion of dental implants and prosthodontic rehabilitation led to an improved OHRQoL for patients with all indications for dental implants. Special attention should be paid to patients with edentulous jaw, since in comparison with other indications it had the greatest impact on improving OHRQoL. The psychological dissatisfaction scale of the OHIP-G-21 represented the most important factors for patients, and these scores were substantially influenced by implant therapy. Thus, treating physicians should increase their focus on these factors, in order to avoid dissatisfaction and increase the likelihood of complete implant therapy success.

Cost/effectiveness analysis of treatment options for the rehabilitation of the total edentulous mandible.

BACKGROUND: Several solutions are available for the rehabilitation of edentulous jaws. Each treatment option is characterised by specific advantages and drawbacks. OBJECTIVE: The aim of this research was to perform a cost-effectiveness (CE) analysis of the main rehabilitative solutions of totally edentulous mandibles. METHODS: Decision tree models were built using TreeAge Pro Healthcare 2021 software to compare the following strategies: Conventional Denture (CD), Overdenture retained by two implants (OD-2), Overdenture retained by a bar on two implants (ODbar), Overdenture retained by 4 mini-implants (ODmini) and Fixed denture supported by 4 implants (FD). Costs were estimated using data from public rate tables. Effectiveness measures were obtained from a meta-analysis of literature data, normalising the different scales in 0-1 range. A value of 30 000€ per 1 normalised utility points was set as threshold of willingness to pay (WTP). Probabilistic sensitivity analysis (PSA) with 1000 Monte Carlo Simulations was performed to characterise uncertainty. RESULTS: Total costs ranged between 1804,40€ for CD and 10 008,80€ for FD rehabilitations, with an effectiveness of 0,69 and 0,95 normalised points (0-1 scale) for the two solutions. The ODbar resulted to be the most CE strategy at the established WTP value, with the highest Net Monetary Benefit (22 001,20€), followed by the OD-2 rehabilitation (21 866,80€). PSA analysis confirmed the dominance of OD-2 and ODbar strategies, confirming a net separation from the other alternatives. CONCLUSION: OD stabilised by 2 implants could represent a good rehabilitative solution for patients with edentulous mandible, being a good trade-off in terms of costs and effectiveness. Nevertheless, a standardised measure of oral health-related quality of life is needed to obtain more reliable results.

Retrospective cohort assessment of survival and complications of zygomatic implants in atrophic maxillae.

OBJECTIVES: To report on zygomatic implant (ZI) survival rate and associated complications through a longitudinal retrospective cohort assessment. MATERIAL AND METHODS: A total of 940 ZIs (rough: 781, machined: 159; immediate loading: 454, delayed loading: 486) and 451 standard implants (rough: 195, machined: 256; immediate loading: 58, delayed loading: 393) were placed in 302 adult patients with atrophic maxilla from December 1998 till September 2020. Following data collection reported complications were grouped based on their origin as infectious/ non-infectious biological and mechanical. Statistical analysis was performed to identify risk factors and preceding complications leading to implant loss (P < 0.05). RESULTS: The survival rate of ZI was found to be 89.9% and the average time between implant placement and an eventual loss was 4.8 years. The mean ZI follow-up period was 7.9 ± 4.9 years. Amongst the infectious biological complications, sinusitis was the most reported (n = 138) occurring at a mean follow-up time-point of 4.5 years, whereas infraorbital nerve hypoesthesia occurred more frequently in the non-infectious biological category (n = 8, meantime: 0.3 years). The prosthetic screw fracture was the most reported complication of mechanical origin (n = 29, meantime: 4 years). Furthermore, sinusitis, standard implant loss, zygomatic/peri-zygomatic region infection, and oroantral communication were significantly associated with ZI loss. CONCLUSIONS: ZI placement offered a high survival rate for the rehabilitation of severely atrophied maxilla with most losses occurring within the first 5 years at follow-up. The most frequently observed complication was sinusitis which tends to develop several years following implant placement.

Patient-reported outcome measures and clinical assessment of implant-supported overdentures and fixed prostheses in mandibular edentulous patients: A systematic review and meta-analysis.

STATEMENT OF PROBLEM: A consensus based on patients' perceptions as to whether to use overdentures or fixed prostheses to rehabilitate mandibular edentulous arches is limited. PURPOSE: The purpose of this systematic review and meta-analysis was to compare the patient-reported outcome measures (PROMs) and clinical outcomes associated with implant-supported overdentures and fixed prostheses in edentulous mandibles. MATERIAL AND METHODS: Nine electronic databases were searched for randomized clinical trials (RCTs) and nonrandomized clinical trials (N-RCTs). The risk of bias was assessed by the revised Cochrane risk of bias tool for RCTs (RoB 2) and N-RCT (ROBINS-I). Data sets for oral health-related quality of life (OHRQoL), satisfaction, survival rate, implant probing depth, and marginal bone loss were plotted, and the appropriate analyses were applied by using the Rev Man 5.3 software program. Certainty of evidence was also evaluated by means of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. RESULTS: Ten eligible trials were included and evaluated quantitatively. For 3 domains of OHRQoL, fixed prostheses showed significantly higher quality of life when compared with overdentures regarding functional limitation (P<.001), physical disability (P=.001), and physical pain (P=.003). Fixed prostheses also improved satisfaction, when compared with overdentures for comfort (P=.02), ease of mastication (P<.001), retention (P<.001), and stability (P<.001). The same pattern was observed for overall OHRQoL (P=.01) and satisfaction (P=.01) in which fixed prostheses improved patient satisfaction. Only ease of cleaning presented greater satisfaction for the overdenture group. Clinical parameters did not differ statistically (P>.05) between both types of prosthesis. CONCLUSIONS: Fixed rehabilitations for mandibular edentulous patients seem to be a well-accepted treatment from the patients' oral health perspective. However, mandibular overdentures are no less efficient than fixed prostheses in terms of clinical outcomes.

Cost and complications associated with implant-supported overdentures with a resilient-attachment system: A retrospective study.

STATEMENT OF PROBLEM: Implant-supported overdentures with a splinted or nonsplinted attachment system have been a successful treatment option for edentulous mandibles with excessive hard tissue resorption. Currently, the 2 most common treatment approaches for an implant overdenture uses either a bar attachment system (splinted) or resilient (LOCATOR)-attachment system (nonsplinted). The LOCATOR-attachment system is often chosen for the lower initial cost. However, whether the ongoing maintenance costs of the LOCATOR-attachment system increase the overall cost of this system is unclear. PURPOSE: The purpose of this retrospective study was to investigate the frequency of maintenance procedures, complications, and costs associated with the LOCATOR-supported overdenture treatment. MATERIAL AND METHODS: The retrospective data of 75 patients who had received implant-supported overdentures with LOCATOR-attachments at the University of Colorado School of Dental Medicine in the previous 10 years were collected and screened to evaluate the number of maintenance visits, type of complications, and cost (actual fees for the service) of the maintenance visits. The data were analyzed, and the mean values calculated. RESULTS: The average number of maintenance visits was 7.7 in the mean observation time of 5.2 years. Replacement of the attachment was the most frequent complication (63%). The average maintenance cost charged to the patient for maintenance was 56.2% ($795) of the initial cost over the average 5.2 years of follow-up. The average total maintenance cost (actual fees for the service) was 95.4% ($1349) of the initial cost over the average of 5.2 years of follow-up. The average maintenance cost adjusted or lost over the 5.2 years follow-up was 39.2%. CONCLUSIONS: The 5-year costs for the maintenance of mandibular overdentures with a LOCATOR-attachment system were equal to or higher than the initial cost of the treatment. The number of maintenance visits and the cost were higher for patients who were older than 75 years.

Valoración del grado de pigmentación en dientes acrílicos sometidos a humo del cigarrillo / Assessment of the degree of pigmentation in acrylic teeth subjected to cigarette smoke

INTRODUCCIÓN. Los cambios de color en los dientes acrílicos dependen de varios factores, con el humo de cigarrillo como uno de los principales agentes de igmentación de las prótesis. OBJETIVO. Valorar el grado de pigmentación en dientes acrílicos sometidos al humo del cigarrillo, mediante espectrofotometría digital. MATERIALES Y MÉTODOS. Estudio observacional, analítico, de caso y control. Muestra de 60 dientes acrílicos divididos en dos grupos: A (resina acrílica de 3 capas) y B (resina acrílica de 4 capas). Se subdividió en: grupo 1: dientes sometidos a humo de cigarrillo estándar con filtro de carbón; grupo 2: dientes sometidos a humo de cigarrillo estándar sin filtro; y, grupo 3: grupo control. Cada uno de éstos se expuso a 150 cigarrillos, 5 diarios durante 30 días y el grupo control fue mantenido a 37ºC en saliva artificial durante 30 días sin aplicación de humo de cigarrillo. Para la toma de color se empleó espectrofotómetro Vita Easyshade®. Los análisis se realizaron en el programa estadístico International Business Machines Statistical Package for the Social Sciences mediante la prueba de Kruskal-Wallis y comparaciones de Dunn. RESULTADOS. Se determinó que la pigmentación del grupo B fue mayor a la del grupo A, con una diferencia significativa entre ellos (p< 0,05). No se encontró datos estadísticamente significativos entre cigarrillos (con filtro - sin filtro). CONCLUSIÓN. La exposición al humo de cigarrillo pigmentó los dientes acrílicos de ambas propiedades siendo mayor en los dientes de resina acrílica de 4 capas.

INTRODUCTION. Color changes in acrylic teeth depend on several factors, with cigarette smoke as one of the main agents of denture pigmentation. OBJECTIVE. To assess the degree of pigmentation in acrylic teeth subjected to cigarette smoke, using digital spectrophotometry. MATERIALS AND METHODS. Observational, analytical, case-control study. Sample of 60 acrylic teeth divided into two groups: A (3-layer acrylic resin) and B (4-layer acrylic resin). It was subdivided into: group 1: teeth subjected to standard cigarette smoke with charcoal filter; group 2: teeth subjected to standard cigarette smoke without filter; and, group 3: control group. Each of these was exposed to 150 cigarettes, 5 daily for 30 days and the control group was maintained at 37ºC in artificial saliva for 30 days without application of cigarette smoke. Vita Easyshade® spectrophotometer was used for color determination. The analyses were performed in the statistical program International Business Machines Statistical Package for the Social Sciences using the Kruskal-Wallis test and Dunn's comparisons. RESULTS. It was determined that the pigmentation of group B was greater than that of group A, with a significant difference between them (p< 0,05). No statistically significant data was found between cigarettes (filtered - unfiltered). CONCLUSION. Cigarette smoke exposure pigmented acrylic teeth of both properties being higher in 4-layer acrylic resin teeth.

Overdentures as an alternative to conventional dentures: a micro-costing analysis for Public Health Service in Brazil.

This study aimed to estimate cost and compatibility with public financial incentives of two technologies for treating the edentulous mandible: lower complete dentures (CD) and overdentures retained by two dental implants (OD). This study consisted of a partial economic evaluation, with a micro-costing bottom-up approach for the calculation of direct costs. The estimates involved the number of consultations, proportion of materials, equipment, instruments' lifetime, and human resources, described in the price panel website of the Ministry of Economy in Brazil. Complementary information was obtained from a panel of experts. A sensitivity analysis was based on 20% variation. The estimated cost of a CD was R$ 189.89 (base scenario), and this varied between R$ 151.91 and R$ 227.89 according to sensibility analysis. The cost of an OD was R$ 663.05 (ranging from R$ 795.66 to R$ 530.44 - 1US=R$ 3.80/July 2019). The Ministry of Health covers appropriately the costs of the CD and OD. Both technologies showed costs that are within the limits of financial public incentives obtained by municipalities. The technologies are economically viable and should be induced through public policies due to their positive impacts on several functional domains of health.

Overdentures as an alternative to conventional dentures: a micro-costing analysis for Public Health Service in Brazil / Overdentures como alternativa às próteses convencionais: uma análise de micro-custeio para o Sistema Único de Saúde

Abstract This study aimed to estimate cost and compatibility with public financial incentives of two technologies for treating the edentulous mandible: lower complete dentures (CD) and overdentures retained by two dental implants (OD). This study consisted of a partial economic evaluation, with a micro-costing bottom-up approach for the calculation of direct costs. The estimates involved the number of consultations, proportion of materials, equipment, instruments' lifetime, and human resources, described in the price panel website of the Ministry of Economy in Brazil. Complementary information was obtained from a panel of experts. A sensitivity analysis was based on 20% variation. The estimated cost of a CD was R$ 189.89 (base scenario), and this varied between R$ 151.91 and R$ 227.89 according to sensibility analysis. The cost of an OD was R$ 663.05 (ranging from R$ 795.66 to R$ 530.44 - 1US=R$ 3.80/July 2019). The Ministry of Health covers appropriately the costs of the CD and OD. Both technologies showed costs that are within the limits of financial public incentives obtained by municipalities. The technologies are economically viable and should be induced through public policies due to their positive impacts on several functional domains of health.

Resumo Estimar os custos e a compatibilidade dos incentivos públicos de duas tecnologias para o tratamento da mandíbula edêntula: prótese total convencional (PTC) e overdenture retida por dois implantes (OD). Este estudo consistiu em uma avaliação econômica parcial, com abordagem "bottom-up" para o cálculo dos custos diretos. As estimativas levaram em consideração o número de consultas, proporção de materiais, equipamentos, vida útil dos instrumentais e recursos humanos. Os custos foram baseados no painel de preços do Ministério da Economia do Brasil e informações complementares foram obtidas de um painel de especialistas. Uma análise de sensibilidade foi baseada na variação de 20% dos custos. Os custos da PTC foram estimados em R$ 189,89 (cenário base) com variação entre R$ 151,91 e R$ 227,89 na análise de sensibilidade. Os custos da OD foram R$ 663,05 (variando de R$ 795,66 a R$ 530,44). O Ministério da Saúde cobre apropriadamente os custos de ambas as tecnologias nos cenários base e mais otimista. Ambas as tecnologias apresentaram custos dentro dos limites dos incentivos públicos recebidos. As tecnologias são economicamente viáveis e devem ser induzidas por políticas públicas diante do impacto positivo em vários domínios funcionais da saúde.

Quantitative assessment of the jawbone quality classification: A meta-analysis study.

AIM: Bone quality is evaluated using bone density for qualitative classification, a characteristic that may be delicate to evaluate. Contemporary implantology that relies on modern measurement techniques, needs a more quantitative estimate of the bone quality. MATERIALS AND METHODS: PubMed and EMBASE databases were searched with no time restriction. Clinical and radiographic studies reporting on alveolar ridge dimensions and its parameters in different areas of the dentate and edentulous jaws were included. A meta-analysis was performed using random effect models to report a combined mean for alveolar ridge and its parameters. Meta regression statistical tests were performed in order to identify differences in those outcome parameters. RESULTS: 30 studies were included. The majority of the selected studies (total of 27) used live human subjects and CBCT to analyze alveolar ridge dimensions and its parameters. Using the combined mean obtained from the meta-analysis, a typical portrait of the alveolar ridge was constructed, and a geometrically based quantitative bone classification proposed. The quantitative classification was found to match the existing qualitative classification. CONCLUSION: A geometry-based analysis was constructed that yields valuable insights on the bone type based on its components and on the dynamics of the dentate / edentulous states.

Clinical assessment of pterygoid and anterior implants in the atrophic edentulous maxilla: a retrospective study.

OBJECTIVES: This study aims to evaluate the short-term clinical outcomes and patient satisfaction of anterior and pterygoid implants in the rehabilitation of edentulous maxilla with posterior atrophy. METHODS: Given a minimum follow-up of 1 year, 25 patients with fixed maxillary rehabilitation over anterior and pterygoid implants were enrolled in this retrospective study. The implant survival rates, peri-implant soft tissue status (including probing depth, modified sulcus bleeding index, and plaque index), marginal bone loss, and patient satisfaction were measured. RESULTS: The survival rates for anterior and pterygoid implants at 1-year follow-up were 96.5% and 97.8%, respectively (P>0.05). No statistically significant difference in probing depth, modified sulcus bleeding index, and plaque index was observed between the two types of implants (P>0.05). The marginal bone losses of anterior implants were 0.62 mm± 0.44 mm (mesial) and 0.61 mm± 0.40 mm (distal), and those of pterygoid implants were 0.64 mm± 0.46 mm (mesial) and 0.68 mm± 0.41 mm (distal) mm. These results showed no statistical difference in mesial and distal sites (P>0.05). Patients indicated a high degree of satisfaction with the full-arch prostheses supported by anterior and pterygoid implants. CONCLUSIONS: For the edentulous maxilla with posterior atrophy, full-arch fixed prostheses supported by anterior and pterygoid implants has an acceptable short-term clinical outcome and excellent patient satisfaction. It may be considered as a predictable and feasible method for maxillary rehabilitation.

Different Interventions for Rehabilitation of the Edentulous Maxilla with Implant-Supported Prostheses: An Overview of Systematic Reviews.

PURPOSE: To synthesize evidence derived from systematic reviews (SRs) on different interventions for rehabilitation of the edentulous maxilla with implant-supported restorations. MATERIALS AND METHODS: A protocol-oriented search was established to address the PICO question: What is the current evidence regarding rehabilitation of the edentulous maxilla with different implant-supported prostheses in terms of implant and prosthesis survival? The primary outcomes were implant and prosthesis survival rates evaluated from SRs of clinical studies including adult patients with complete edentulism of the maxilla and comparing different implant-supported rehabilitation strategies. Methodologic quality of the SRs was assessed with the AMSTAR-2 tool. RESULTS: The final selection process led to the inclusion of 36 SRs that were grouped as: (1) addressing maxillae with sufficient bone to place implants; (2) addressing maxillae with insufficient bone to place implants; and (3) comparing different types of prosthesis, number of implants, patient-reported outcomes, and economic evaluations. The literature describes four or more implants as suitable for full-arch fixed prostheses and implant-supported overdentures; in both cases, the overall survival rate is > 95%. Mini-implants present very high short-term failure rates (> 30%). Poor description of technical complications, adjustments, and maintenance and corresponding costs precluded a cost-effectiveness analysis. CONCLUSION: No implant-supported rehabilitation of the edentulous maxilla (fixed or removable) should be supported on fewer than four implants. A one-piece full-arch fixed dental prosthesis can be supported by a minimum of two anterior axial plus two posterior distally tilted implants or by six to eight axial implants symmetrically distributed through the posterior and anterior regions of the arch. Four to six implants is the advised number to support an overdenture. The use of mini-implants in the maxilla is inadvisable.

Prosthodontic Principles in Dental Implantology: Adjustments in a Coronavirus Disease-19 Pandemic-Battered Economy.

More patients are requesting fixed prosthesis to replace missing teeth. More than 5 million dental implants are placed annually in the United States. This number will decrease in 2020 owing to the coronavirus disease-19 pandemic. The edentulous patient has a decreased quality of life. Prosthodontic rehabilitation/reconstruction of edentulism improves overall quality of life. Patient-reported outcome measures are subjective reports of patients' perceptions of their oral health status and the impact that it has on their quality of life. This chapter contains a variety of prosthodontic principles for the reader to help satisfy the needs and expectations of the patient.

Cost-effectiveness of three different concepts for the rehabilitation of edentulous mandibles: Overdentures with 1 or 2 implant attachments and hybrid prosthesis on four implants.

BACKGROUND: There are scarce data regarding the combined assessment of the costs and effects of implant treatments for edentulous patients when multiple options are available. AIM: This randomised clinical trial aimed to assess the cost-effectiveness of three different concepts for treatment: mandibular overdenture retained by a single (Group I; n = 11) or two implants (Group II; n = 13) and fixed hybrid prosthesis on four implants (Group III; n = 13). METHODS: Treatment effectiveness was measured as the 1-year before-after changes in patient satisfaction with the mandibular prosthesis. Costs were prospectively quantified from the perspective of the health provider, including all direct cost items attributed to the delivery of treatments and up to the 1-year follow-up, using a "bottom-up" costing estimation method. RESULTS: Patient satisfaction after treatment improved significantly for the three groups. The overall costs were R$ 2370.66, R$ 3185.21 and R$ 5739.52 for Groups I, II and III, respectively (P < .001). Analysis of incremental cost-effectiveness ratios suggested that the overdentures retained by one or two implants were more cost-effective than the fixed implant treatment, considering the mean cost and effectiveness values and the ±20% one-way sensitivity analysis. CONCLUSION: This study suggests that the incremental costs for the fixed hybrid prosthesis, compared to the overdenture treatments, is not proportional to the respective gain in effectiveness. Therefore, although all treatment options had satisfactory outcomes, the use of implants to retain a mandibular overdenture, irrespective of the use of one or two implants, is more cost-effective than the fixed implant treatment for the edentulous mandible.

Quality assessment of systematic reviews regarding the effectiveness of zygomatic implants: an overview of systematic reviews.

BACKGROUND: Oral rehabilitation of atrophic maxillae features high complexity, for which there are several therapeutic modalities reported on scientific literature. Zygomatic implant placement is a viable option that features low morbidity and allows immediate prosthetic loading. The purpose of the present study was to determine the methodological quality of systematic reviews that assessed the effectiveness of zygomatic implants placed in atrophic maxillae. MATERIAL AND METHODS: Searches were conducted on Medline via Pubmed, LILACS, Dare Cochrane, Scopus, and Sigle via Open Grey up to June 2019. RESULTS: Seven systematic reviews were eligible for Overview and comprised a total of 2313 patients, 4812 zygomatic implants, and a 96,72% success rate. Common surgical complications, in decreasing order, were: maxillary sinusitis, peri-implant mucositis, prosthetic fracture, and infections. Methodological quality was assessed using the AMSTAR 2 tool, which revealed that six systematic reviews showed critically low methodological quality and one review was assessed as of low methodological quality. CONCLUSIONS: Zygomatic implants seem to be an adequate option for atrophic maxilla rehabilitation, however, new studies with a higher methodological rigor are needed to provide more reliable results to professionals and patients undergoing this modality of oral rehabilitation.

Versatility of Overpartial Abutments Key to Economical Restoration of Patient's Smile.

Combination syndrome (CS) is a dental condition commonly seen in patients with a completely edentulous maxilla and partially edentulous mandible with preserved anterior teeth. Overgrowth of the tuberosities, papillary hyperplasia of palatal mucosa, and decreased occlusal vertical dimension are typically associated with this syndrome. This article describes a case report where the patient was showing initial signs of CS with irritation from an ill-fitting maxillary denture and a loose mandibular acrylic partial denture. As part of the treatment, implant-supported abutments were used to stabilize the maxillary denture, and implants were placed in the posterior mandible to prevent further resorption. The case demonstrates the use of LOCATOR R-Tx® abutments (Zest Dental Solutions) to enable the patient to regain her smile and confidence, showing the versatility of these overpartial abutments.

SES and correlated factors do not explain the association between periodontal disease, edentulism, and cancer risk.

PURPOSE: Severe periodontal disease and edentulism have been previously reported to be significantly associated with cancer risk and mortality, including in the Atherosclerosis Risk in Communities study (2018); however, complex sources of confounding by socioeconomic status (SES), and characteristics correlated with SES, could have been present in earlier analyses. METHODS: To capture life course SES and its correlates, we generated a propensity score and included it, along with other potential confounders such as smoking and obesity, into a Cox regression model to examine the association between periodontal disease and cancer risk. In addition, we stratified the model with the propensity score by low and high SES. All statistical tests were two-sided. RESULTS: Compared with our previous study, the associations for severe periodontitis and cancer incidence remained comparable after weighting by the propensity score (e.g., for total cancer: before weighting, hazard ratio = 1.24, 95% confidence interval = 1.07-1.42 vs. after weighting, hazard ratio = 1.23, 95% confidence interval = 1.05-1.44 when comparing severe periodontitis to no or mild periodontitis). Associations were comparable in low and high SES strata and statistically significant among participants with high SES. CONCLUSIONS: Complex sources of confounding by SES and its correlates are unlikely to fully account for the positive associations observed for periodontal disease and edentulism and cancer risk.

Health insurance and education: major contributors to oral health inequalities in Colombia.

BACKGROUND: Health inequalities, including inequalities in oral health, are problems of social injustice worldwide. Evidence on this issue from low-income and middle-income countries is still needed. We aimed to examine the relationship between oral health and different dimensions of socioeconomic position (SEP) in Colombia, a very unequal society emerging from a long-lasting internal armed conflict. METHODS: Using data from the last Colombian Oral Health Survey (2014), we analysed inequalities in severe untreated caries (≥3 teeth), edentulousness (total tooth loss) and number of missing teeth. Inequalities by education, income, area-level SEP and health insurance scheme were estimated by the relative index of inequality and slope index of inequality (RII and SII, respectively). RESULTS: A general pattern of social gradients was observed and significant inequalities for all outcomes and SEP indicators were identified with RII and SII. Relative inequalities were larger for decay by health insurance scheme, with worse decay levels among the uninsured (RII: 2.57; 95% CI 2.11 to 3.13), and in edentulousness (RII: 3.23; 95% CI 1.88 to 5.55) and number of missing teeth (RII: 2.08; 95% CI 1.86 to 2.33) by education, with worse levels of these outcomes among the lower educated groups. Absolute inequalities followed the same pattern. Inequalities were larger in urban areas. CONCLUSION: Health insurance and education appear to be the main contributors to oral health inequalities in Colombia, posing challenges for designing public health strategies and social policies. Tackling health inequalities is crucial for a fairer society in a Colombian post-conflict era and our findings highlight the importance of investing in education policies and universal health care coverage.

Prosthetic Rehabilitation of Edentulous Patients With Implants Based on Facial Profile Assessment: A Case Report.

PURPOSE: To introduce a user-friendly protocol for implant-retained prosthetic rehabilitation of fully edentulous patients based on facial profile and the cephalometric intermaxillary relationship. MATERIALS AND METHODS: The prosthetic rehabilitation of edentulous patients with implants based on facial profile assessment protocol commences with a clinical and cephalometric analysis, followed by a preliminary projection to obtain a harmonious interarch relationship, eventually stabilized by the preplanned prosthesis. The protocol is divided into the following 5 phases: esthetic evaluation; cephalometric-occlusal assessment; surgery; provisionalization; and definitive prosthesis. Evaluation of patient's satisfaction from the treatment provided was performed through a preoperative and postoperative visual analogue scale scores. RESULTS: The patient was granted immediate function and superior esthetics at day 1 of the treatment. These results were re-evaluated on an interval of 18 months and continued to be stable. The overall treatment time was significantly reduced. CONCLUSION: Our recommended protocol gives the clinician a chance to grasp results beyond the offered by traditional protocols by using a wider perspective of rehabilitation, involving the patient's facial profile, thus fulfilling the integration of both occlusal and cephalometric parameters in a unified surgical-prosthetic approach.

Functional Assessment of the Stomatognathic System, after the Treatment of Edentulous Patients, with Different Methods of Establishing the Centric Relation.

The study compares subjective experiences of patients, wearing complete dentures. Two different methods of determining a centric relation were performed: the traditional method using wax occlusal rims and the Gerber method, based on gothic arch tracings. The success rate of establishing a centric relation in both methods was evaluated (rentgenodiagnostics). The influence of the method used to obtain the centric relation on patients' stomatognathic system (condyle centralization, pain) was also evaluated. Better results were achieved in gothic arch tracing method. Before every prosthetic treatment of edentulous patients, a functional analysis of the TMJ is necessary. The lack of centric relation, in a long term adaptation patients, does not lead to TMD symptoms. This trial is registered with NCT03343015.