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BACKGROUND: In older patients with progressive neurodegeneration, replacing fixed implant-supported prostheses (FIP) with implant overdentures (IOD) has been proposed to prevent future mucosal injury and create an oral environment that is easier for caregivers to clean. However, there have been no reports on the progress after replacing FIP with IOD. In this report, we present the progress of an older patient with Parkinson's disease in whom FIP was replaced with IOD. CASE PRESENTATION: An 81-year-old male patient with Parkinson's disease presented to our outpatient clinic with bruxism and crossbites. FIPs, with five Brånemark system implants, were placed in the bilateral lower molars. The FIP was replaced with an IOD with two locator attachments to create an oral environment that was easier for caregivers to clean and allow easy recovery of masticatory function if residual teeth were fractured in the care environment. As his systemic condition deteriorated, treatment was changed from outpatient to in-home visits. During dental care visits, professional oral cleaning and denture repair were continued, and good nutritional status was maintained. However, the patient developed cholecystitis and was hospitalized. During hospitalization, gastrostomy was performed because he developed aspiration pneumonia. After discharge from the hospital, the patient remained in bed all day and could not wear an IOD, resulting in buccal mucosa ulceration due to abrasion of the locator abutment. We decided to replace the abutment with cover screws; however, not all the implants could sleep submucosally. Although regular oral cleaning was resumed, new ulcers developed even when cover screws were installed. Additionally, swelling and drainage were observed at the peri-implant mucosal site where peri-implantitis had once occurred during an outpatient visit. The patient was readmitted to the hospital for a urinary tract infection, and subsequent visits were abandoned. CONCLUSIONS: By replacing FIP with IOD in an older patient with Parkinson's disease, we addressed a barrier to caregiver-provided oral management. The removable prosthesis facilitated smooth oral care by caregivers and functional recovery in the event of trouble with residual teeth. However, it could not completely avoid the recurrence of buccal mucosal ulcers or peri-implantitis.
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Prótesis Dental de Soporte Implantado , Prótesis de Recubrimiento , Enfermedad de Parkinson , Humanos , Masculino , Anciano de 80 o más Años , Estudios de SeguimientoRESUMEN
PURPOSE: This prospective cohort study examined the effects of the number of present and functional teeth on mortality among older Japanese adults requiring nursing care in an environment of comprehensive oral hygiene and nutritional management. METHODS: The study included 174 older adults (mean age: 84.4 ± 8.3 years; male/female: 49/125) in need of support or long-term care, who resided in either a local specialized healthcare facility or their own homes, and received daily oral hygiene and nutritional support at facilities in Okayama, Japan. The initial clinical oral examination along with assessment of general physical condition and nursing environment of the participants were performed in July 2013 and followed up for one year. RESULTS: All-cause mortality occurred in 28 (mean age: 88.7 ±13.4 years; male/female: 6 /22) individuals during the follow-up period. Cox proportional hazard analysis indicated that older age, low performance in activities of daily living (Barthel Index <40), and underweight status (body mass index <18.5) were significant risk factors for mortality. The number of present and functional teeth were not found to be significant risk factors for mortality. CONCLUSIONS: During the one-year follow-up period, the number of present and functional teeth did not have a significant impact on mortality among older Japanese adults requiring nursing care in a well-managed environment of oral hygiene and nutritional status.
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OBJECTIVE: This systematic review aimed to provide an overview of the most recent evidence on the association between measured masticatory function and cognitive status. MATERIALS AND METHODS: Literature and manual searches were conducted using three electronic databases (PubMed, Web of Science and CINAHL). Observational studies published between 2011 and 2021 investigating the association between masticatory function, dementia and cognitive status in adult humans were abstracted and reviewed by three reviewers. Studies that assessed participants' masticatory function using objective and subjective measurements and that individually examined its association with cognitive function were included. The included studies were divided into cross-sectional and cohort studies, and the quality of each study was analysed using critical appraisal skills checklists. Additionally, the main conclusions and strength of the evidence were assessed for each article. RESULTS: A total of 21 studies (11 cross-sectional studies that objectively evaluated masticatory function, 9 cross-sectional studies that subjectively evaluated masticatory function and 1 prospective cohort study) were evaluated. The poorer masticatory function was associated with lower cognitive status even after adjusting for potential risk factors of dementia in four of 11 and six of nine cross-sectional studies where the masticatory function was respectively evaluated objectively and subjectively. One prospective cohort study also demonstrated that masticatory function, as evaluated based on measurements of occlusal force, predicted cognitive decline during the follow-up period. CONCLUSION: Several studies demonstrated a positive association between masticatory function and cognitive status. However, further studies, particularly longitudinal studies, are required to determine whether the association is causal.
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PURPOSE: To compare the accuracy of the tooth morphology fusion (TMF) digital technique and customized impression transfer coping (conventional) technique when transferring the morphology of a provisional crown to a definitive screw-retained implant-supported crown. METHODS: Six cases of partial edentulism (one anterior and five posterior) treated with oral implant placement in our clinic for the loss of three or fewer teeth in the maxilla or mandible between April 2017 and September 2018 were included. After implant placement and re-entry surgery, provisional restorations were made and adjusted to obtain the ideal morphology. Two definitive restorations were constructed by transferring the complete morphology of the provisional restorations, including the subgingival contour, using the TMF digital and conventional techniques. Three sets of surface morphological data were obtained using a desktop scanner. The three-dimensional total discrepancy volume (TDV) between the provisional restoration (reference) and the two definitive restorations was digitally measured by overlapping the surface data of the stone cast using the Boolean operation. Each TDV ratio (%) was calculated by dividing the TDV by the volume of provisional restoration. The median TDV ratios for TMF and conventional techniques were compared using the Wilcoxon signed-rank test. RESULTS: The median TDV ratio between provisional and definitive restorations constructed using the TMF digital technique (8.05%) was significantly lower than that obtained using the conventional technique (13.56%, P < 0.05). CONCLUSIONS: In this preliminary intervention study, the TMF digital technique was more accurate than the conventional technique for the transfer of morphology from provisional to definitive prosthesis.
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Implantes Dentales , Técnica de Impresión Dental , Coronas , Prótesis Dental de Soporte ImplantadoRESUMEN
PURPOSE: The aim of this study is to compare dental implant placement accuracy of three surgical guide fabrication methods: single (SCT) and double computed tomography (DCT), and a newly developed modified SCT (MSCT) scan method. METHODS: A total of 183 cases (183 surgical guides, and 485 implants) of static-guide-assisted implant placement surgery using the SCT, DCT, or MSCT methods in a dental clinic were included in the study. Three-dimensional (3D) deviations (mm) at the entry and tip of the implant body between preoperative simulation and actual placement were measured as surrogate endpoints of implant placement accuracy. The following survey details were collected from medical records and CT data: sex, age at implant placement surgery, surgical guide fabrication method, number of remaining teeth, implant length, implant location, alveolar bone quality, and bone surface inclination at implant placement site in preoperative simulation, etc. Risk factors for reducing implant placement accuracy were investigated using generalized estimating equations. RESULTS: The SCT and DCT methods (odds ratios [ORs] vs. MSCT method: 1.438, 1.178, respectively), posterior location (OR: 1.114), bone surface buccolingual inclination (OR: 0.997), and age at implant placement surgery (OR: 0.995) were significant risk factors for larger 3D deviation at the entry; the SCT (OR: 1.361) and DCT methods (OR: 1.418), posterior location (OR: 1.190), implant length (OR: 1.051), and age at implant placement surgery (OR: 0.995) were significant risk factors for larger 3D deviation at the tip of the implant body. CONCLUSIONS: Implant placement accuracy was better using the MSCT method compared to the SCT and DCT methods.
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Implantes Dentales , Cirugía Asistida por Computador , Implantación Dental Endoósea/métodos , Tomografía Computarizada de Haz Cónico , Cirugía Asistida por Computador/métodos , Imagenología TridimensionalRESUMEN
PURPOSE: The aim of this study was to introduce rating criteria to evaluate student performance in a newly developed, digital wax-up preclinical program for computer-aided design (CAD) of full-coverage crowns and preliminarily investigate the reliability and internal consistency of the rating system. MATERIALS AND METHODS: This study, conducted in 2017, enrolled 47 fifth-year dental students of Okayama University Dental School. Digital wax-up training included a fundamental practice using computer graphics (CG), multipurpose CAD software programs, and an advanced practice to execute a digital wax-up of the right mandibular second molar (#47). Each student's digital wax-up work (stereolithography data) was evaluated by two instructors using seven qualitative criteria. The total qualitative score (0-90) of the criteria was calculated. The total volumetric discrepancy between each student's digital wax-up work and a reference prepared by an instructor was automatically measured by the CAD software. The inter-rater reliability of each criterion was analyzed using a weighted kappa index. The relationship between the total volume discrepancy and the total qualitative score was analyzed using Spearman's correlation. RESULTS: The weighted kappa values for the seven qualitative criteria ranged from 0.62 - 0.93. The total qualitative score and the total volumetric discrepancy were negatively correlated (ρ = -0.27, P = .09, respectively); however, this was not statistically significant. CONCLUSION: The established qualitative criteria to evaluate students' work showed sufficiently high inter-rater reliability; however, the digitally measured volumetric discrepancy could not sufficiently predict the total qualitative score.
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We introduce a new digital workflow to fabricate a fixed partial denture (FPD) utilizing the three-dimensional surface morphology of provisional restoration (PR) and abutment teeth. Scanned images of the full maxilla with abutment teeth, full maxilla with PR, and PR alone were superimposed. The surfaces of the final FPD were designed based on the entire morphology of the PR and abutment teeth surfaces. The inner and outer surfaces converged at the margin lines of the abutment teeth. Fine modifications to the final FPD design were performed manually, and the final FPD was fabricated and successfully installed in the patient.
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Diseño Asistido por Computadora , Reparación de Restauración Dental/métodos , Dentadura Parcial Fija , Femenino , Humanos , Persona de Mediana EdadRESUMEN
OBJECTIVES: In this study, we aimed to compare the long-term survival of vital teeth adjacent to bounded edentulous spaces rehabilitated using an implant-supported prosthesis (ISP), a resin-bonded fixed partial denture (RBFPD), or a conventional fixed partial denture (CFPD). The risk factors for complications in teeth adjacent to the edentulous space (TAES) were also investigated. METHODS: We followed-up a consecutive series of 514 patients who underwent rehabilitation of a single bounded edentulous space with vital TAES (ISP: 103; RBFPD: 216; and CFPD: 195) from 2008 to 2017. Cumulative survival rates of prosthesis and TAES, and complication-free rates of TAES, were evaluated using the Kaplan-Meier analysis and log-rank test. Risk factors were evaluated using a Cox proportional hazards model. RESULTS: Cumulative complication-free rates of TAES showed no significant differences among the three groups. The cumulative survival rate of TAES in CFPD was significantly lower than that of ISP (p = 0.037); no significant differences were observed between ISP and RBFPD (p = 0.513), and RBFPD and CFPD (p = 0.076). Older age (p = 0.027) was the only independent significant risk factor for complications in TAES. Installation of CFPD (p = 0.019), ceramic prosthesis in edentulous space (p = 0.026), and deeper periodontal probing depth (p = 0.018) of TAES were significant risk factors for non-surviving TAES. CONCLUSIONS: Rehabilitating a single bounded edentulous space with CFPD could increase the risk for TAES loss compared with ISP. Risk of TAES loss remained similar between ISP and RBFPD, which can minimize the loss of coronal tooth structure during tooth preparation. CLINICAL SIGNIFICANCE: Teeth adjacent to edentulous space show equivalent longevity when rehabilitating a single bounded edentulous space with resin-bonded fixed partial dentures or single standing implant-supported prosthesis, at least 10 years post-installation.
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Implantes Dentales , Dentadura Parcial Fija con Resina Consolidada , Boca Edéntula , Diente , Prótesis Dental de Soporte Implantado/efectos adversos , Fracaso de la Restauración Dental , Dentadura Parcial Fija/efectos adversos , Estudios de Seguimiento , Humanos , Estudios RetrospectivosRESUMEN
PURPOSE: We aimed to determine root caries annual incidence (RCAI) and root caries annual progression (RCAP) and risk factors for them among older people requiring nursing care. METHODS: The target population comprised 186 dentate individuals aged ≥ 65 years who required nursing care while living in nursing homes (NHs) or their own homes (OHs) in Okayama, Japan. Survey items included presence/absence and severity of root caries, age, sex, living environment (NH or OH), the Clinical Dementia Rating, and the Barthel Index (BI). Baseline surveys were conducted from 2015 to 2017; subjects were followed up for one year. RCAI and RCAP per tooth and per person were calculated, and risk factors for them were identified using generalized estimating equations. RESULTS: In total, 104 individuals (mean age: 82.0 ± 12.4 years) completed the follow-up survey. RCAIs per tooth and per person were 14.6% (173/1188) and 59.6% (62/104), respectively. RCAP per tooth was 22.5% (51/227 teeth with root caries at baseline). Significant risk factors for RCAI were living environment (OH, odds ratio [OR]: 2.14), sex (male, OR: 1.84), clasped tooth (OR: 1.82), and older age (OR: 1.05) at baseline. Significant risk factors for RCAP were sex (male, OR: 5.20), regular dental checkup (OR: 2.74), and high BI score (OR: 1.02) at baseline. CONCLUSION: At one-year follow-up, 59.6% of the subjects developed at least one root caries. Risk factors for RCAI were living environment (OH), male, clasped tooth, and older age, whereas those for RCAP were male, regular dental checkup, and high BI score.
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Caries Dental , Caries Radicular , Anciano , Anciano de 80 o más Años , Caries Dental/epidemiología , Femenino , Humanos , Incidencia , Masculino , Estudios Prospectivos , Factores de Riesgo , Caries Radicular/epidemiologíaRESUMEN
Purpose The purpose of the study was to compare the long-term performance of three prostheses for partial edentulism: implant-supported, fixed denture (IFD), fixed partial denture (FPD), and removable partial denture (RPD), in terms of prosthesis survival and oral health-related quality of life (OHRQoL).Methods The 138 patients in our previous study (Kimura et al., 2012) received one of the three prosthetic treatments and answered a validated OHRQoL questionnaire before and immediately after treatment. In the present study, the patients were followed up six years after treatment using medical records and OHRQoL examinations to evaluate prosthesis survival and change in OHRQoL. The cumulative survival rates were calculated using the Kaplan-Meier analysis. The Steel-Dwass test was used to compare the median OHRQoL scores at the three time points.Results For the 105 patients (66.8 ± 10.8 years, IFD/FPD/RPD: 58/27/20 patients) who successfully completed the follow-up assessments, the six-year estimated cumulative survival rates of the IFDs, FPDs, and RPDs were 94.7%, 77.4%, and 33.3%, respectively. The log-rank tests indicated that the survival curves were significantly different (IFDs vs. FPDs: p = 0.01; RPDs vs. IFDs, FPDs: p < 0.01). The median OHRQoL scores of the IFD group immediately after treatment and six years after treatment were significantly higher than those observed before treatment (p < 0.01). There was no significant difference in the median OHRQoL scores among the three time points in the RPD or FPD groups.Conclusions IFDs showed significantly longer survival rates than FPDs and RPDs in partially edentulous patients. Only in the IFD patients was the OHRQoL level six years after treatment significantly higher than that before treatment.
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Dentadura Parcial Removible , Calidad de Vida , Prótesis Dental de Soporte Implantado , Dentadura Parcial Fija , Estudios de Seguimiento , Humanos , Salud Bucal , Falla de PrótesisRESUMEN
PATIENTS: The patient was a 55-year-old woman with left upper molar free-end edentulism and 9 full cast metal crowns in her mouth. Three three-dimensional (3D) images were superimposed: a computed tomography (CT) image with the patient wearing the CT-matching template (CTMT) with six glass ceramic markers, which hardly generate any artifacts, on the template surface, and oral plaster model surfaces with and without CTMTs. Metal artifacts were automatically removed by a Boolean operation identifying unrealistic images outside the oral plaster model surface. After the preoperative simulation, fully guided oral implant surgery was performed. Two implant bodies were placed in the left upper edentulism. The placement errors calculated by comparing the preoperative simulation and actual implant placement were then assessed by a software program using the 3D-CT bone morphology as a reference. The 3D deviations between the preoperative simulation and actual placement at the entry of the implant body were a maximum 0.48 mm and minimum 0.26 mm. Those at the tip of the implant body were a maximum 0.56 mm and a minimum 0.25 mm. DISCUSSION: In this case, the maximum 3D deviations at the entry and tip section were less than in previous studies using double CT. CONCLUSIONS: Accurate image fusion utilizing CTMT with new reference markers was possible for a patient with many metal restorations. Using a surgical guide manufactured by the new matching methodology (modified single CT scan method), implant placement deviation can be minimized in patients with many metal restorations.
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Implantes Dentales , Cirugía Asistida por Computador , Artefactos , Diseño Asistido por Computadora , Implantación Dental Endoósea , Femenino , Humanos , Imagenología Tridimensional , Persona de Mediana Edad , Tomografía Computarizada por Rayos XRESUMEN
PURPOSE: This report was written to introduce an attempt at clinical application of our newly developed digital workflow to reproduce the morphology of the subgingival contour and the emergence profile of the provisional restoration within the final bone-anchored fixed restoration, using a bounded unilateral edentulous case. METHODS: This digital workflow involves superimposition of the composite images of two specific types of working casts onto the working cast for the provisional restoration namely, a split cast screwed with a titanium base and a split cast screwed with a provisional restoration and integrating these with the whole intraoral surface image, in which the provisional restoration was present. The final restoration fabricated using this technique could be installed without any clinical problems. The results of in silico analysis revealed that the cubic volume ratio of the total discrepancy between the provisional and the final restorations was only 2.4%. Further, sufficient oral hygiene was maintained and the patient was satisfied with the outcome of the treatment. CONCLUSIONS: This technical report suggests that our newly developed digital workflow provided clinical applicability and may enable accurate transfer of the morphology of the subgingival contour and emergence profile of the provisional to the final bone-anchored fixed restoration.
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Técnica de Impresión Dental , Diseño de Prótesis Dental/métodos , Restauración Dental Permanente/métodos , Encía/anatomía & histología , Boca Edéntula/rehabilitación , Simulación por Computador , Diseño Asistido por Computadora , Implantes Dentales , Femenino , Humanos , Persona de Mediana Edad , Titanio , Resultado del TratamientoRESUMEN
PURPOSE: The aim of this article was to investigate the accuracy in the reproducibility of full-arch implant provisional restorations to final restorations between a 3D Scan/CAD/CAM technique and the conventional method. METHODS: We fabricated two final restorations for rehabilitation of maxillary and mandibular complete edentulous area and performed a computer-based comparative analysis of the accuracy in the reproducibility of the provisional restoration to final restoration between a 3D scanning and CAD/CAM (Scan/CAD/CAM) technique and the conventional silicone-mold transfer technique. Final restorations fabricated either by the conventional or Scan/CAD/CAM method were successfully installed in the patient. The total concave/convex volume discrepancy observed with the Scan/CAD/CAM technique was 503.50mm(3) and 338.15 mm(3) for maxillary and mandibular implant-supported prostheses (ISPs), respectively. On the other hand, total concave/convex volume discrepancy observed with the conventional method was markedly high (1106.84 mm(3) and 771.23 mm(3) for maxillary and mandibular ISPs, respectively). CONCLUSIONS: The results of the present report suggest that Scan/CAD/CAM method enables a more precise and accurate transfer of provisional restorations to final restorations compared to the conventional method.
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Diseño Asistido por Computadora , Implantación Dental/métodos , Implantes Dentales , Diseño de Prótesis Dental/métodos , Imagenología Tridimensional , Boca Edéntula/rehabilitación , Anciano , Prótesis Dental de Soporte Implantado , Humanos , Masculino , Reproducibilidad de los ResultadosRESUMEN
(K(x),Na(1-x))NbO(3) (KNN) thin films were deposited on (001)SrRuO(3)/(001)Pt/(001)MgO substrates by RF-magnetron sputtering, and their piezoelectric properties were investigated. The x-ray diffraction measurements indicated that the KNN thin films were epitaxially grown with the c-axis orientation in the perovskite tetragonal system. The lattice constant of the c-axis increased with increasing concentrations of potassium. The KNN thin films showed typical ferroelectric behavior; the relative dielectric constant epsilon(r) was 270 to approximately 320. The piezoelectric properties were measured from the tip displacement of the KNN/MgO unimorph cantilevers; the transverse piezoelectric coefficient epsilon*(31) (= d(31)/s(E)(11)) of KNN (x = 0) thin films was calculated to be -0.9 C/m(2). On the other hand, doping of potassium caused an increase in the piezoelectric properties, and the KNN (x = 0.16) films showed a relatively large transverse piezoelectricity of epsilon*(31) = -2.4 C/m(2).