Management of Chronic Atrophic Candidiasis (Denture Stomatitis)-A Narrative Review.

One of the most common oral diseases affecting people wearing dentures is chronic atrophic candidiasis or denture stomatitis (DS). The aim of the paper is to provide an update on the pathogenesis, presentation, and management of DS in general dental practice settings. A comprehensive review of the literature published in the last ten years was undertaken using multiple databases, including PubMed via MEDLINE, EMBASE, and Scopus. The eligible articles were analyzed to identify evidence-based strategies for the management of DS. Despite its multifactorial nature, the leading cause of DS is the development of oral Candida albicans biofilm, which is facilitated by poor oral and denture hygiene, long-term denture wear, ill-fitting dentures, and the porosity of the acrylic resin in the dentures. DS affects between 17 and 75% of the population wearing dentures, with a slight predominance in elderly females. The mucosal denture surfaces and posterior tongue are the common sites of DS, and the affected areas exhibit erythema, the swelling of the palatal mucosa and edema. Oral and denture hygiene protocols, adjusting or re-fabricating poorly adapting dentures, smoking cessation, avoiding nocturnal denture wear, and the administration of topical or systemic antifungals are the mainstay of management. Alternate treatments such as microwave disinfection, phytomedicine, photodynamic therapy, and incorporation of antifungals and nanoparticles into denture resins are being evaluated for the treatment of DS but require further evidence before routine use in clinical practice. In summary, DS is the most common oral inflammatory lesion experienced by denture wearers. Most patients with DS can be managed in general dental practice settings. Effective management by general dental practitioners may be supported by a thorough understanding of the pathogenesis, the recognition of the clinical presentation, and an awareness of contemporary treatment strategies.

Oral-Health-Related Self-Efficacy among the Elderly Population in Riyadh, Saudi Arabia.

Oral health self-efficacy is a fundamental determinant of behavioral changes among elderly patients. Objective: To assess the oral self-efficacy among the Saudi population aged 65 years old and above in Riyadh, Saudi Arabia. Methodology: This was a cross-sectional survey conducted on elderly individuals in Riyadh. An Arabic version of the Geriatric Self-Efficacy Scale for Oral Health (GSEOH) was administered to all participants. The dependent variables included oral function, oral hygiene habits, and dental visits. For the statistical analysis, two independent sample t-tests and a one-way ANOVA test were used. Significance was judged at a p-value less than 0.05. Results: Of 400 participants recruited, 53% were males. About 58% had retained teeth, and 72% had visited a dentist in the past 12 months. Overall, 31.6%, 34.64%, 22.65%, and 11.14% of the participants rated their oral health as good, fairly good, rather poor, and poor, respectively. Age (p < 0.001), educational level (p < 0.001), and working status (p < 0.001) were significantly associated with GSEOH scores. Other sociodemographic characteristics were not found to affect the GSEOH scores. Conclusions: The overall self-efficacy of oral health among Saudi elderly individuals is fairly good. Age, educational level, and occupational status are the main determinants of oral health self-efficacy scores.

Patient-reported outcome measures (PROMs) of implant-supported reconstructions using digital workflows: A systematic review and meta-analysis.

OBJECTIVES: To summarize the existing evidence on patient-reported outcome measures (PROMs) of implant-supported restorations fabricated using a digital workflow in comparison to conventional manufacturing procedures. METHODS: A PICO strategy was executed using an electronic and manual search focusing on clinical studies evaluating PROMs of implant-supported restorations. Only clinical trials assessing conventional versus digital workflows for implant-supported restorations were included. PROMS on implant impression procedures and fabrication of final restorations were evaluated using random and fixed effects meta-analyses, while implant planning/placement was reported descriptively. RESULTS: Among 1062 titles identified, 14 studies were finally included, and only seven studies were eligible for meta-analysis. For implant planning and placement, only a qualitative analysis was possible due to heterogeneity between the studies. For impression procedures, the random effects model revealed statistically significant differences in taste, anxiety, nausea, pain, shortness of breath, and discomfort in favor of optical impressions. No significant difference in the subjective perception of the duration of an impression could be reported. For the final fabrication of restorations, no significant difference between veneered and monolithic posterior restorations was found in terms of esthetic, function, and general satisfaction. CONCLUSION: Most of the studies reporting about PROMs were published during the last ten years and limited to implant-supported single crowns in the posterior region. Based on PROMs, no scientifically proven recommendation for guided implant placement could be given at this time. Patients showed high preference for optical impressions, whereas no differences between veneered and monolithic restorations could be reported.

Biofunctionalization of Dental Abutment Surfaces by Crosslinked ECM Proteins Strongly Enhances Adhesion and Proliferation of Gingival Fibroblasts.

To ensure the long-term success of dental implants, a functional attachment of the soft tissue to the surface of the implant abutment is decisively important in order to prevent the penetration of bacteria into the implant-bone interface, which can trigger peri-implant disease. Here a surface modification approach is described that includes the covalent immobilization of the extracellular matrix (ECM) proteins fibronectin and laminin via a crosslinker to silanized Ti6Al4V and Y-TZP surfaces. The surface properties are evaluated using static contact angle, X-ray photoelectron spectroscopy (XPS), and atomic force microscopy (AFM). The interaction of human gingival fibroblasts (HGFs) with the immobilized ECM proteins is verified by analyzing the localization of focal contacts, cell area, cell morphology, proliferation rate, and integrin expression. It is observed in the presence of fibronectin and laminin an increased cellular attachment, proliferation, and integrin expression of HGFs accompanied by a significantly higher number of focal adhesions. The presented approach holds great potential to enable a stronger bond between soft tissue and implant abutment surface. This could potentially help to prevent the penetration of bacteria in an in vivo application and thus reduce the risk of periimplant disease.

Removal of simulated biofilm at different implant crown designs with interproximal oral hygiene aids: An in vitro study.

OBJECTIVES: To compare the removal of simulated biofilm at two different implant-supported restoration designs with various interproximal oral hygiene aids. METHODS: Mandibular models with a missing first molar were fabricated and provided with single implant analogues (centrally or distally placed) and two different crown designs (conventional [CCD] and alternative crown design [ACD]). Occlusion spray was applied to the crowns to simulate artificial biofilm. Thirty participants (dentists, dental hygienists, and laypersons) were equally divided and asked to clean the interproximal areas with five different cleaning devices to further evaluate if there were differences in their cleaning ability. The outcome was measured via standardized photos and the cleaning ratio, representing the cleaned surfaces in relation to the respective crown surface. Statistical analysis was performed by linear mixed-effects model with fixed effects for cleaning tools, surfaces, crown design and type of participant, and random effects for crowns. RESULTS: The mean cleaning ratio for the investigated tools and crown designs were (in%): Super floss: 76 ± 13/ACD and 57 ± 14/CCD (highest cleaning efficiency), followed by dental floss: 66 ± 13/ACD and 56 ± 15/CCD, interdental brush: 55 ± 10/ACD and 45 ± 9/CCD, electric interspace brush: 31 ± 10/ACD and 30 ± 1/CCD, microdroplet floss: 8 ± 9/ACD and 9 ± 8/CCD. There was evidence of an overall effect of each factor "cleaning tool," "surface," "crown design," and "participant" (p < 0.0001). CONCLUSIONS: ACD allowed more removal of the artificial biofilm than CCD with Super floss, dental floss, and interdental brush. Flossing and interproximal brushing were the most effective cleaning methods. A complete removal of the artificial biofilm could not be achieved in any group.

Influence of different preparation forms on the loading-bearing capacity of zirconia cantilever FDPs. A laboratory study.

PURPOSE: To investigate the impact of inlay design and number of retainer wings on the failure load of all-ceramic resin-bonded inlay-retained cantilever fixed dental prostheses (IRCFDPs) made from a computer-aided design/computer-aided manufacturing (CAD/CAM) yttrium-oxide partially-stabilized zirconia framework(Y-TZP). METHODS: Sixty-four extracted human first molars were divided according to preparation design into four groups. Teeth were provided with IRCFDPs representing a premolar pontic and a retainer of variable design: (R1S) shallow inlay/one lingual retainer wing, (R2S) shallow inlay/two retainer wings (lingual/buccal), (R1D) deep inlay/one lingual retainer wing and (R2D) deep inlay/two retainer wings (lingual/buccal). All IRCFDPs were cemented using adhesive resin. Quasi-static fracture strength (QSFS) was tested for 32 specimens after 3 days in a universal testing machine (UTM). The other specimens were stored in a water bath (150 days/37 °C) and thermocycled (37,500 times, 5-55 °C); then exposed to dynamic loading in a chewing simulator (50 N/1,200,000 cycles). RESULTS: The median QSFS (N) for the different designs were: R1S:105.1, R1D:167.5, R2S:147.9, R2D:232.3. The number of retainer wings had a statistically significant influence on the fracture load of both groups, whereas the inlay design had an impact only in the double-retainer wing group. Under dynamic loading, lower failure loads within all groups were reported except for the group R2S. The number of retainer wings continued to significantly influence the failure loads of both groups, whereas no influence of inlay design could be revealed. CONCLUSIONS: Double-retainer IRCFDPs showed promising results for replacing single premolars. The inlay design seems to have no significant influence on the fracture strength of these restorations.

Retrievability of implant-supported zirconia restorations cemented on zirconia abutments.

STATEMENT OF PROBLEM: Retrievability of implant-supported restorations is important. Data are lacking for cemented zirconia crowns on zirconia abutments. PURPOSE: The purpose of this in vitro study was to investigate the influence of different cements and marginal discrepancy on the retrievability of implant-supported zirconia crowns. Furthermore, the influence of thermocycling on retrievability was evaluated. MATERIAL AND METHODS: Thirty tapered Camlog zirconia abutments (6-degree taper, 6×4.3 mm) were used. Thirty zirconia crowns with 3 different marginal cementation discrepancies (70, 130, 190 µm) were fabricated by using computer-aided design and computer-aided manufacturing (CAD-CAM) technology. Five cements for interim or semidefinitive cementation were used: eugenol-free zinc oxide (Freegenol) and acrylurethane (ImProv) and 3 different composite resin cements (X-Pand Implant, Dyna Implant, Telio CS Cem Implant). Specimens underwent either 3-day storage in sodium chloride or thermocycling (10 000 cycles). Crowns were removed by using a universal testing machine (UTM) and a clinical removal device. Data were analyzed using 1-way ANOVA and the Scheffé test (α=.05). RESULTS: Thermocycling decreased the retention force significantly (P<.001). Marginal discrepancy (70 to 190 µm) was not significantly influential on retrievability (P>.05). Therefore, groups were pooled according to the factor of marginal discrepancy. The mean retention force using the UTM after 3-day storage and thermocycling was as follows: Freegenol, 235 ±42 N (thermocycling, 29 ±9 N); Improv, 110 ±50 N (thermocycling, 35 ±38 N); Telio CS, 104 ±17 N (thermocycling, 6 ±10 N); Dyna implant, 61 ±17 N (thermocycling, 1 ±1 N); and X-Pand, 50 ±16 N (thermocycling, 2 ±2 N). CONCLUSIONS: Retention forces of the tested cements were significantly different and decreased considerably after thermocycling. Marginal cementation discrepancy between 70 and 190 µm did not influence retrievability.

Influence of additional reinforcement of fixed long-term temporary restorations on fracture load.

PURPOSE: In implant dentistry, temporary restorations (TR) might often be required for up to one year. The aim of this in vitro study was to evaluate the long-time performance of four-unit TRs in the posterior region based on different materials and reinforcement methods. METHODS: One hundred and forty four TRs were manufactured on 16 models simulating an oral situation of two missing posterior teeth. With a computer-aided-design/computer-aided-manufacturing (CAD/CAM) workflow, a TR was fabricated (CAD; Telio CAD), which served as a template for other subgroups. With a vacuum-formed template, unreinforced and reinforced TRs [glass fibres (g; EverStick); polyethylenefibres (p; Ribbond original) and TRs with increased connector area (c; 27.5-35mm2)] were manufactured. Two different composite materials were used (C1: Luxatemp, C2: Protemp). Altogether, 16 subgroups with 8 specimens each were tested. After temporary luting (Temp Bond NE) and artificial-aging [1600 thermo-cycles (5-55°C), 240,000 chewing-cycles (50N)], all specimens were tested until fracture in a universal testing machine. RESULTS: After artificial aging, mean fracture loads (N) were: (C1)201.2±109.7, (C1c)1033.0±173.1, (C1p)90.0±40.0, (C1g)75.9±25.9, (C2)108.6±58.6, (C2c)1363.3±148.6, (C2p)104.7±54.7, (C2g)50.0±0.0 and (CAD)232.5±19.1. The one-factor ANOVA analysis showed significant differences for the factors temporary material (p<0.047), reinforcement (p<0.0001) and artificial-aging (p<0.0001). CONCLUSIONS: The study indicated that both CAD/CAM TRs and TRs with increased connector areas are suitable for long-term use of one year. No enhancement of fracture load was observed for fibre-reinforced TRs except for the fact that fractured TRs were not totally separated.

Does professional experience save teeth? A survey among prosthodontists.

OBJECTIVES: The aim of this study is to investigate the effect of clinical experience and educational background on clinical decision-making of dentists presented with two prosthodontic cases. METHODS: A questionnaire-based survey was performed among 66 prosthodontists who were divided into two groups. The first group included clinicians from Belgium, Germany, and the Netherlands covering a wide spectrum of dental experience. The second (specialized) group consisted of German dentists performing their last module of a 3-year postgraduate master program in prosthodontics. Two patient scenarios of different complexities were presented to the participants who were asked to make an educated choice among seven therapeutic options. RESULTS: Sixty-six dentists participated. For case #1, 22 therapeutic suggestions were offered within the international group (variation 54%), while 17 options were chosen in the specialized group (variation 68%). For case #2, five (variation 12%) and four (variation 16%) different therapeutic options were planned in the groups, respectively. Treatment planning in combination with implants was clearly preferred by dentists with an experience of 20 years or less. Conversely, participants with more experience favored more conventional treatments. All differences were statistically significant (p < 0.05). CONCLUSION: Clinicians' experience and educational background had a clinically relevant influence on decision-making and treatment planning. A clear preference for implant-free therapies was noted for dentists with more than two decades of professional experience. CLINICAL SIGNIFICANCE: In complex cases, clinicians with more than 20 years of professional experience tend to save questionable teeth rather than to resort to implants. This interindividual variation might less likely occur when more external evidence is taken into account during the decision-making process.

Modified Glass Ionomer Cement with "Remove on Demand" Properties: An In Vitro Study.

OBJECTIVES: To investigate the influence of different temperatures on the compressive strength of glass ionomer cement (GIC) modified by the addition of silica-coated wax capsules; Material and Methods: Commercially-available GIC was modified by adding 10% silica-coated wax capsules. Test blocks were fabricated from pure cement (control) and modified cement (test), and stored in distilled water (37 °C/23 h). The compressive strength was determined using a universal testing machine under different temperatures (37 °C, 50 °C, and 60 °C). The maximum load to failure was recorded for each group. Fractured surfaces of selected test blocks were observed by scanning electron microscopy (SEM); Results: For the control group, the average compressive strength was 96.8 ± 11.8, 94.3 ± 5.7 and 72.5 ± 5.7 MPa for the temperatures 37 °C, 50 °C and 60 °C respectively. The test group reported compressive strength of 64.8 ± 5.4, 47.1 ± 5.4 and 33.4 ± 3.6 MPa at 37 °C, 50 °C and 60 °C, respectively. This represented a decrease of 28% in compressive strength with the increase in temperature from 37 °C to 50 °C and 45% from the 37 °C to the 60 °C group; Conclusion: GIC modified with 10% silica-coated wax capsules and temperature application show a distinct effect on the compressive strength of GIC. Considerable compressive strength reduction was detected if the temperature was above the melting temperature of the wax core.

Accuracy of computer-aided design/computer-aided manufacturing-generated dental casts based on intraoral scanner data.

BACKGROUND: Little is known about the accuracy of physical dental casts that are based on three-dimensional (3D) data from an intraoral scanner (IOS). Thus, the authors conducted a study to evaluate the accuracy of full-arch stereolithographic (SLA) and milled casts obtained from scans of three IOSs. METHODS: The authors digitized a polyurethane model using a laboratory reference scanner and three IOSs. They sent the scans (n = five scans per IOS) to the manufacturers to produce five physical dental casts and scanned the casts with the reference scanner. Using 3D evaluation software, the authors superimposed the data sets and compared them. RESULTS: The mean trueness values of Lava Chairside Oral Scanner C.O.S. (3M ESPE, St. Paul, Minn.), CEREC AC with Bluecam (Sirona, Bensheim, Germany) and iTero (Align Technology, San Jose, Calif.) casts were 67.50 micrometers (95 percent confidence interval [CI], 63.43-71.56), 75.80 µm (95 percent CI, 71.74-79.87) and 98.23 µm (95 percent CI, 94.17-102.30), respectively, with a statistically significant difference among all of the scanners (P < .05). The mean precision values were 13.77 µm (95 percent CI, 2.76-24.79), 21.62 µm (95 percent CI, 10.60-32.63) and 48.83 µm (95 percent CI, 37.82-59.85), respectively, with statistically significant differences between CEREC AC with Bluecam and iTero casts, as well as between Lava Chairside Oral Scanner C.O.S. and iTero casts (P < .05). CONCLUSION: All of the casts showed an acceptable level of accuracy; however, the SLA-based casts (CEREC AC with Bluecam and Lava Chairside Oral Scanner C.O.S.) seemed to be more accurate than milled casts (iTero). PRACTICAL IMPLICATIONS: On the basis of the results of this investigation, the authors suggested that SLA technology was superior for the fabrication of dental casts. Nevertheless, all of the investigated casts showed clinically acceptable accuracy. Clinicians should keep in mind that the highest deviations might occur in the distal areas of the casts.

Effect of the implant-abutment interface on peri-implant tissues: a systematic review.

OBJECTIVE: The aim of the present systematic review was to determine the peri-implant tissue response to different implant abutment materials and designs available and to assess the impact of tissue biotype. MATERIALS AND METHODS: Relevant literature published between December 2009 and August 2012 was searched to identify studies dealing with different implant abutment designs and materials, as well as the response of different tissue biotypes. The search terms used, in simple or multiple conjunctions, were 'implant abutment', 'interface', 'material', 'peri-implant', 'soft tissue' and 'esthetic'. Studies were selected according to pre-determined inclusion and exclusion criteria. RESULTS: The initial search yielded 2449 titles. After a subsequent filtering process, 23 studies were finally selected. The included studies revealed different factors responsible for the stability of peri-implant tissue and the esthetic outcome. These factors include tissue biotype and architecture, implant abutment material and implant abutment design. Several designs were suggested to prevent marginal bone loss and soft tissue recession. These included scalloped implants, platform-switched implants and gingivally converged or concave implant abutments. Due to the limited number of studies and the heterogeneity in their designs, it was not possible to perform a statistical analysis of the data. CONCLUSIONS: The current literature provides insufficient evidence about the effectiveness of different implant abutment designs and materials in the stability of peri-implant tissues.