Edentulism among diabetic patients compared to non-diabetic controls: A systematic review and meta-analysis.

OBJECTIVE: The purpose of this paper is to systematically and critically appraise the available scientific evidence concerning the prevalence of edentulism among diabetic patients compared to non-diabetic people. METHODS: MEDLINE-PubMed and Cochrane-CENTRAL databases were comprehensively searched up to April 2023 to identify appropriate studies. The inclusion criteria were observational studies conducted in human subjects ≥18 years of age with the primary aim of investigating the prevalence of edentulism among diabetic patients. Based on the extracted data, a meta-analysis was performed. Recommendations based on the body of evidence were formulated using the GRADE approach. RESULTS: Independent screening of 2085 unique titles and abstracts revealed seven publications that met the eligibility criteria. Study size ranged from 293 to 15,943 participants. Data from all seven studies were suitable for meta-analysis. Overall, 8.3% of the studied population was edentulous. The weighted mean prevalence of edentulism among diabetic and non-diabetics was 14.0% and 7.1%, respectively. The overall odds ratio for diabetic patients to be edentulous as compared to non-diabetics was 2.39 (95% CI [1.73, 3.28], p < 0.00001). CONCLUSION: There appears to be moderate certainty that the risk of being edentulous for diabetic patients compared to non-diabetic people is significant, but the odds ratio is estimated to be small.

Fracture treatment in atrophic mandible.

BACKGROUND: Fractures of the atrophic mandible have been historically treated in various ways, from intermaxillary fixation to internal fixation, some cases require bone grafts. Besides, the Luhr classification serves as a guide to select the type of treatment. OBJECTIVE: To show the treatment of fractures in atrophic mandible with plates and screws, and the potential indications of bone graft in this type of fractures. METHOD: We presented a serie of 17 patients with atrophic mandible treated with plates and screws, some of them no blocked system and other with locked screws. For patients in luhr classes II and III cancellous bone grafts were used, looking for best osteogenic response, harvesting for the proximal third of the tibia. RESULTS: Postoperative progress was generally uneventful. Oral intake with purees was resumed 24 hours after surgery, as well as ambulation. Fracture healing at 6 months was seen in 17 patients. One patient died before the 6-month time point as the result of a stroke. Delayed union was diagnosed 3 months after surgery in another patient, who refused secondary treatment. CONCLUSIONS: Treatment of fractures in atrophic mandibles with plates and screws is a reliable procedure. Luhr classification provide useful guidance regarding the use of bone grafts for best osteogenic response in the fracture. This treatment allows a quick restart of the feeding by mouth and movilization of the patients.

ANTECEDENTES: Las fracturas en mandíbula atrófica han sido tratadas desde con fijación intermaxilar hasta con osteosíntesis. Pueden requerir injertos óseos. La clasificación de Luhr es una guía para orientar el tratamiento. OBJETIVO: Mostrar el tratamiento de fracturas en mandíbula atrófica con placas y tornillos y las posibles indicaciones de uso de injerto óseo en este tipo de fracturas. MÉTODO: Se presenta una serie de 17 pacientes con mandíbula atrófica fracturada tratada con placas y tornillos, algunas con sistemas no bloqueados y otros bloqueados. En las de clase II and III se aplicó injerto óseo esponjoso para mejorar la capacidad osteogénica. El injerto se tomó del tercio proximal de la tibia, previa evaluación radiológica. RESULTADOS: La evolución en general fue satisfactoria. Se inició la vía oral con papillas y los pacientes deambularon a las 24 h de posoperatorio. Se observó consolidación en 17 pacientes. Hubo una defunción por enfermedad vascular cerebral antes de 6 meses. Una paciente tuvo retardo de consolidación diagnosticado al tercer mes, pero no aceptó tratamiento secundario. CONCLUSIONES: El tratamiento de las fracturas mandibulares atróficas con placa y tornillos bajo concepto de carga absorbida es un procedimiento confiable. La clasificación de Luhr es útil para orientar la utilización de injerto óseo, buscando mejorar la capacidad osteogénica en la fractura. Este tratamiento permite un pronto reinicio de la vía oral, así como la movilización de los pacientes.

Effects of magnetostimulation on muscle activity and pain in edentulous adults with temporomandibular disorders.

INTRODUCTION: Multifactorial aetiologies of painful temporomandibular disorders (TMD) have an impact on correct diagnosis and consequently prevent proper treatment. AIM OF THE STUDY: The aim of the study was to evaluate the effect of magnetic stimulation on electromyographic activity in temporal muscles and masseters in patients using occlusal splints. MATERIALS AND METHODS: The examined group consisted of 40 edentulous patients with TMD. The patients were examined based on Helkimo Index. Next, electromyographic activity of the temporal muscle and masseter were investigated using 8-channel surface electromyography. All patients received acrylic occlusal splints for 12 weeks. The group qualified for the study included 20 randomized patients, whose therapy was additionally carried out by extremely low-frequency magnetic fields for a period of 21 days. Following examinations were conducted after 3, 6 and 12 weeks with surface electromyography recording of the examined muscles. Patients received occlusal splint corrections using the T-Scan III system. The clinical evaluation of TMD was analysed using Helkimo index and VAS scale before and after the treatment. All the data were analysed using Statistica 12.5 PL. RESULTS: Patients with combination therapy had lower asymmetry of temporal muscle activity. CONCLUSIONS: Combination therapy using magnetic stimulation reduced intensity of pain in patients with TMD and decreased values of the Helkimo indices.

Diagnosis and treatment of orofacial pain in a patient with unserviceable complete dentures: A clinical report.

An ill-fitting complete denture has the potential to create pain and discomfort as well as conceal or confound the diagnosis of other primary sources of orofacial pain such as trigeminal neuralgia. Guidelines of the American Academy of Orofacial Pain offer an evidence-based approach for the assessment, diagnosis, and management of orofacial pain. A complete and accurate differential diagnosis is paramount to the success of treatment as well as to the circumvention of unnecessary therapy. The purpose of this clinical report was to emphasize an evidence-based approach to the diagnosis and treatment of orofacial pain in a patient with edentulism and a history of prolonged denture wear.

Management of Bilateral Edentulous Mandible Fractures Through an Intraoral Approach Using CAD/CAM Technology: A Case Report.

The surgical management of edentulous mandible fractures presents unique challenges secondary to poor bone stock and the absence of dentition to assist with fracture reduction. In complex injury patterns, such as bilateral edentulous mandible fractures, an external approach is often necessary to achieve adequate reduction and adaptation of a load-bearing reconstruction plate. We report a case in which computer-assisted design/computer-assisted manufacturing (CAD/CAM) was applied as an adjunct for the acute management of bilateral edentulous mandible fractures in a 58-year-old man. CAD/CAM technology was used to fabricate a patient-specific reconstruction plate and a maxillomandibular splint, which facilitated the successful treatment of this complex injury through an intraoral approach. This case highlights the potential of CAD/CAM technology to improve operative efficiency and clinical outcomes in the acute management of complex edentulous mandible fractures.

Rehabilitation of an Edentulous Maxilla in a Patient with Isolated Cleft Palate.

This article aims to discuss the use of short dental implants in cleft patients, the construction of an implant-retained obturator and the use of a Createch milled titanium bar with three Locator overdenture attachments incorporated within the bar. CPD/Clinical Relevance: Implant-retained obturators offer a possible solution for treating patients with isolated cleft palate who are struggling with dentures due to the unfavourable soft and hard tissue profile. This paper demonstrates how to manage such patients and shows all the clinical and laboratory stages involved.

Assessing the effects of tooth loss in adult crania using geometric morphometrics.

With high numbers of unidentified skeletonised remains recovered annually in South Africa and an increased number of edentate individuals being reported, the question arises as to whether tooth loss would result in craniofacial changes which might alter the accuracy of osteological analyses. Forty-five fixed landmarks together with sliding semilandmarks were collected from 229 white South African crania and were used to capture curve data pertaining to the basicranium, alveoli, zygomatic arches, nasal aperture and orbits. Geometric morphometric methods were employed to assess the effects of tooth loss on these structures. Although a number of effects were seen when the skull was analysed in its entirety, only the alveoli proved to be significantly affected when regions were analysed individually. Both upper facial height and palate shape were affected by tooth loss, which may influence various osteometric measurements and qualitative traits that are used during the assessment of ancestry and sex.

Implant Prosthetic Rehabilitation in Controlled HIV-Positive Patients: A Prospective Longitudinal Study with 1-Year Follow-Up.

PURPOSE: The clinical trial aimed to evaluate the survival of implant-prosthetic rehabilitation in controlled HIV-positive patients. MATERIALS AND METHODS: This mono-centric study included HIV patients with a stable disease, requiring implant rehabilitation, with good oral hygiene. Each patient received at least one dental implant. After 90 days in the upper jaw and 60 days in the lower jaw, the appropriate prosthesis was delivered.Primary outcome measures were prosthetic failures, implant failures, peri-implant marginal bone level changes (MBLCs), and biological complications (peri-implantitis, pus, pain, paresthesia). Data were recorded before the intervention (T0), and 6 (T1) and 12 months (T2) after. RESULTS: Implants were positioned in 68 patients (22 females and 46 males; 194 implants). Two dropouts occurred for exacerbation of the disease before the sixth month of follow-up, and 66 patients (with 190 implants) completed the study. Forty-eight patients (70.6%) received total removable dentures; 11 patients (16.2%) received partial prosthesis, and nine patients (13.2%) received single elements.Implant failure occurred in nine patients (15 fixtures out of 190). These were early implant failures due to primary infection (five fixtures out of 190: 2.6%) and to peri-implantitis (10 fixtures out of 190: 5.2%). Prosthetic failure was registered in two patients (3% of patients) due to the loss of all the fixtures. Pus and pain were observed in 4/7 and 3/7 patients with peri-implantitis, respectively. No fractures of fixtures or paresthesia were registered. At T2, the mean peri-implant MBLC was -1.19 ± 0.87 mm. CONCLUSIONS: Within its limitations, the study showed that in a well-controlled population of HIV patients implant rehabilitation can be a suitable options with results slightly worse to those obtained in normal population. A higher incidence of peri implant infections in the first six months was present pointing to the need of a proper protocol for infection control.

Clinical evaluation of the oral health status in vascular-type dementia patients. A case-control study.

AIM: The aim of this study was to evaluate the oral health status in patients with vascular dementia (VaD). Moreover, the association of the disease severity and the patients' cognitive and functional impairment with the oral findings have been recorded. METHODS: The study was directed on the study group (86 VaD patients) and the control group (82 healthy volunteers of the same age) from the IRCSS Neurolesi Bonino-Pulejo in Messina, Italy. Cognitive status was evaluated with the MMSE scoring system. Oral parameters, such as decaying, missing, filled teeth (DMFT) index, plaque index (PI), periodontal probing depth (PPD) and bleeding on probing (BOP) were evaluated in all patients. Denture condition and denture-induced stomatitis were also analysed. The frequency of untreated caries, periodontal diseases and missing teeth of the Study Group was significantly higher than in Control Group. RESULTS: Particularly, VaD patients presented higher number of decayed teeth and deeper periodontal pockets. Decreased cognitive functions in VaD patients have been demonstrated to result in a decline of denture care and increased denture-related mucosal lesions. CONCLUSION: These results underlined that clinicians should direct high attention to oral hygiene of patients with VaD in order to prevent the evolution of those pathologic dental and periodontal conditions, especially in patients with decreased cognitive functions.

Interrami intraoral fixation technique utilized as a conservative approach to edentulous/atrophic mandibular fractures.

Interrami intraoral Kirschner wire fixation (IRIF) technique is presented as new conservative successful indirect rigid fixation utilized for the reduction and fixation of edentulous/atrophic mandible fractures. This technique is carried out under local anesthesia without the need for open reduction internal fixation, which can lead to a compromise in the blood supply of fracture region. It is also quicker, easier, requires fewer postoperative visits, and cheaper than small or large bone plate fixations.Five edentulous mandibular fractures, 2 of them atrophic, 2 non-atrophic, and 1 partial edentulous, were successfully treated. In all cases, the IRIF technique was utilized to establish an indirect rigid fixation using horseshoe-shaped Kirschner wire with a 2-mm diameter. No complication was reported during these cases. This technique prevails over the Gunning splint and external edentulous fracture fixation techniques as it provides adequate fracture site stability, is more comfortable, and is better tolerated for a longer period of time by the patient. In addition, there are fewer complications caused by malunions from direct intraoral or extraoral small and large plate fixation techniques. Other advantages of the IRIF technique are that it enables the mandible to function as a single unit and preserves its function and anatomical position immediately after surgery. In contrast, the Gunning splint acts only to preserve the balance of a single segment's position.

Effects of edentulism in obstructive sleep apnea syndrome.

OBJECTIVES: The purpose of this study was to investigate the effects of edentulism in obstructive sleep apnea syndrome (OSAS) patients. MATERIALS AND METHODS: The study patients' were selected from the Gaziantep University Sleep Clinic and Orthodontic Department archives between the years of 2009 and 2011. Study groups were determined according to age and edentulism, and the overall study population consisted of 42 (21 male, 21 female) OSAS patients. Data from 14 edentulous (Group I), 14 older dentate (Group II), and 14 middle-aged dentate OSAS patients (Group III) were compared in this study. Polysomnographic parameters, which were measured and analyzed included: Sleep time, sleep efficiency, sleep stage 1, sleep stage 2, sleep stage 3, percentage of rapid eye movement sleep, apnea-hypopnea index, oxygen saturation and arousal index. The Kruskal-Wallis and Mann-Whitney U statistical tests were used for comparing the differences between the three groups and subgroups. RESULTS: Sleep time parameters showed significant differences between the groups (P<0.05). Differences occurred between Group I and Group III in the sleep time parameter (P<0.05), while the edentulous subjects showed lower mean sleep time values when compared to the older and middle-aged dentate groups. CONCLUSION: According to our results, edentulism may not impact polysomnography parameters, with the exception of the sleep time parameter. Important attention should be given to edentulous individuals during sleep with their dentures to prevent OSAS complications. The use of dentures may prevent or protect patients from the predisposing factors of OSAS.

The effect of nocturnal wear of complete dentures on sleep and oral health related quality of life: study protocol for a randomized controlled trial.

BACKGROUND: Edentulism and sleep disturbance are chronic conditions that are common in older people and have serious adverse consequences for their functioning and quality of life. Edentulism can disturb sleep through the alteration of the craniofacial structure and surrounding soft tissue. However, the effect of prosthetic rehabilitation of edentulism on sleep quality is still not well understood. The objectives of this study are to test whether nocturnal denture wear affects sleep quality, daytime sleepiness, and the oral health related quality of life of edentate older people with moderate to severe sleep apnea, and to identify modifiers of effect of nocturnal denture wear. METHODS/DESIGN: We will carry out a single-blind randomized cross-over trial. Seventy edentate older people with moderate to severe obstructive sleep apnea will be enrolled. The study participants will be assigned to wear and not wear their dentures on alternate periods of 30 days. The outcome measures will be sleep quality (assessed by portable polysomnography), daytime sleepiness (assessed by the Epworth Sleepiness Scale), and oral health related quality of life (assessed by validated questionnaire). A number of characteristics (sociodemographic, oropharyngeal morphology, oral and prosthesis characteristics, and perceived general health quality of life) will be assessed by means of clinical examination, 3D imaging of the craniofacial structure, and validated questionnaires at baseline. Linear mixed effects regression models for repeated measures will be fitted to test the study hypotheses. The main analyses will be based on the intention-to-treat principle. To assess the robustness of the findings to potential incomplete adherence, sensitivity analyses will be conducted while applying the per-protocol principle. DISCUSSION: This practice-relevant evidence could represent a preventive approach to improve sleep characteristics of the older population and improve their well-being and quality of life. TRIAL REGISTRATION: ClinicalTrials.gov NCT01868295.

Fracture of the genial tubercles of the mandible: case report and review of the literature.

Fracture of the genial tubercles is a rare occurrence and can occur as a solitary fracture or an associated fracture of the mandible. A solitary fracture seems to be associated with severe atrophy of the mandible. A report of a case of fractured genial tubercles in an 80-year-old edentulous female patient is described and a review of the literature is presented.

The 'anatomically difficult' denture case.

UNLABELLED: Complete loss of teeth from one or both arches is a disabling condition which is usually managed by a conventional removable denture. Rehabilitation may be poorly tolerated by patients, particularly in the lower jaw, and is more difficult in situations when the anatomy of the denture-bearing area is less favourable. These situations may require specific prosthodontic or surgical techniques, or a combination of both. Prosthodontic solutions involve special impression techniques and the use of soft linings and it is vitally important to manage patient expectations in such cases. This article describes prosthodontic management options for dealing with the fibrous (flabby) anterior ridge and bony exostoses. CLINICAL RELEVANCE: Although tooth loss in the UK is diminishing, it is nevertheless important that dental practitioners are able to demonstrate good prosthodontic skills for managing an ageing population. Surgical correction of anatomical defects may occasionally be employed.

Implant rehabilitation in bruxism patient.

A white female patient presented to the university clinic to obtain implant retained prostheses. She had an edentulous maxillary jaw and presented three teeth with poor prognosis (33, 34 and 43). The alveolar bone and the surrounding tissues were healthy. The patient did not report any relevant medical history contraindicating routine dental treatment or implant surgery, but self-reported a dental history of asymptomatic nocturnal bruxism. The treatment plan was set and two Branemark protocols supported by six implants in each arch were installed after a 6-month healing period. A soft occlusal splint was made due to the patient's history of bruxism, and the lack of its use by the patient resulted in an acrylic fracture. The prosthesis was repaired and the importance of using the occlusal splint was restated. In the 4-year follow-up no fractures were reported.

[Reconstruction of the atrophic edentulous maxilla for implant placement]. / Reconstruction pré-implantaire du maxillaire atrophique.

INTRODUCTION: Extreme maxillary atrophy results from partial or total maxillary bone defect, affecting the alveolar and basal segments. The residual bone is only a few millimeters high and does not allow retention of dental prostheses (complete edentulation), or placing implants. Bone reconstruction with cranial bone grafts usually allows obtaining enough bone volume in a single step to place implants for prosthetic rehabilitation, 3 months later. TECHNICAL NOTE: Reconstruction begins by inserting bone grafts on the sinus floor. The pre-maxilla is then rebuilt with bone grafts placed on the nose floor then on the palate and vestibule. The premolar and molar sectors are rebuilt last with vestibular and palatine bone grafts assembled and stabilized by screws, or steel wire rings, and reinforced on their deep portion with diploe sheets. DISCUSSION: Extreme maxillary atrophy reconstruction with cranial bone grafts is a reliable technique with reproducible results and few complications (sinusitis, bone sequester). Nevertheless, it requires strong experience to adequately perform harvesting and reconstruction.

An algorithm for the treatment of noncondylar mandibular fractures.

An algorithm for the treatment of noncondylar mandibular fractures is presented based on outcomes from studies that have been performed during the past 30 years. It is designed to assist clinicians in formulating a treatment plan that can be expected to provide the patient with a predictable outcome.

[Clinical research on curative effect of complete denture with two kinds of occlusion for temporomandibular joint disorders of aged edentulous patients].

OBJECTIVE: To compare curative effect between complete denture with lingualized occlusion and anatomic occlusion on temporomandibular joint disorders (TMD) of aged edentulous patients with severe residual alveolar ridge resorption. METHODS: Seventy aged edentulous patients with severe residual alveolar ridge resorption were recruited in this study and randomly assigned into two groups, thirty-five each. In Group A, patients received complete denture with lingualized occlusion, and in Group B, patients received complete denture with anatomic occlusion. The condition of TMD was examined and recorded by the same TMD specialist at baseline, 3 months and 6 months following denture delivery. The recovery effect of TMD was evaluated according to Fricton Index. Related data were analyzed statistically with t-test and rank sum test. RESULTS: Three months following denture delivery, the craniomandibular index (CMI) decrease value was (0.064 ± 0.022) in group A, and was significantly higher than that in group B (0.043 ± 0.018) (P < 0.01). Six months following denture delivery, the CMI decrease value was (0.084 ± 0.020) in group A, and was significantly higher than that in group B (0.070 ± 0.021) (P = 0.011<0.05). CONCLUSIONS: Complete denture with lingualized occlusion may be more conducive to the remission of TMD for aged edentulous patients with severe residual alveolar ridge resorption.

[Zygomatic anchorage concept in full edentulism]. / Le concept de l'ancrage zygomatique dans l'édentation totale.

The zygoma anchorage concept for severe atrophy of the maxilla was developed by Brånemark in the 1980s. It concerned patients having undergone maxillectomy as well as patients with edentulous upper jaws and mild to severe maxillary atrophy. The concept was created and clinically developed in 1997, by placing two zygomatic implants and four standard ones to compensate sub-sinus bone resorption. It was applied later to patients presenting extremely severe maxillary atrophy, using the "zygoma quad" concept with the placement of four zygomatic implants. Zygoma anchorage is reliable in terms of osseo-integration and biomechanical support of screwed prostheses, according to frequently published data (overall survival rate ranging between 91 and 100%). The increasing practice of immediate loading makes it the treatment of choice for oral rehabilitation. It decreases surgical invasiveness and the delay between surgery and oral rehabilitation. It allows a quick social and professional reinsertion and increases the comfort and quality of life for patients with fully edentulous maxilla with mild, moderate, or severe atrophy.