Assessment of bone density in edentulous maxillae using cone beam computed tomography (CBCT).

INTRODUCTION: In edentulous maxillae, the anterior maxilla is the region of interest for implant placement due to posterior bone resorption and sinus pneumatization. This study aimed to assess variations in bone density in different regions of the edentulous maxilla according to sex and age, using cone beam computed tomography (CBCT). MATERIALS AND METHODS: 69 CBCT from edentulous maxilla were analyzed. Six virtual implants were planned between the maxillary sinuses at incisor, canine, and premolar sites. Bone densities (in Hounsfield units HU) were recorded at six points on the neck, body, and apex of the buccal and lingual areas of each virtual implant. We used the two-sample t-test to compare male and female bone densities, and the Spearman correlation coefficient to analyze the correlation between mean bone density and age. One-way analysis of variance with post hoc pairwise t-tests was used to analyze the differences in density between three sites of the edentulous maxilla and the differences in density between three parts of the implant. The significance level was set at 5%. RESULTS: Mean bone density in males was significantly higher than in females. There was a significant correlation between mean bone density and age in females. Incisor sites showed the highest mean bone density, followed by canine and premolar sites. There was a significant decline in bone density from the neck to the apex. CONCLUSIONS: Bone density varied within and among edentulous maxillae. Bone density of the edentulous maxilla seemed to be influenced by age in women and by sex.

Quality of life of patients irradiated for head and neck cancer and impact of rehabilitation with a removable dental prosthetic: 1-year follow-up study.

Background: Head and neck cancer and its treatment cause significant functional, aesthetic, and social disabilities. These disabilities have a major impact on the quality of life of patients. When irradiation is required, removable dental prostheses are often the treatment of choice. This study investigated whether removable prosthetic rehabilitation improved patient function and aesthetics over the long term. Material and Methods: In this prospective study, we assessed quality of life in 78 patients with the General Oral Health Assessment Index (GOHAI) questionnaire. Assessments were performed before, and 1 week, 3 months, 6 months, and 12 months after denture insertion. We evaluated whether quality of life was influenced by the type of removable prosthesis and the primary tumour location. Results: We constructed mixed-effects linear regression models to identify correlates of the overall GOHAI score (GOAHI-add score) and the three domain-scores (functional, psychosocial, and discomfort/pain) in a longitudinal analysis over a 12-month follow-up. We compared scores (GOHAI-add score and domain-scores) in multivariate analyses between baseline (T0) and four post-insertion timepoints to determine significant changes. Conclusions: We found that removable prosthetic rehabilitation had an influence on the evolution of quality of life. The psychosocial component scores increased steadily over the year and changed more significantly than the functional and discomfort-pain components. The mandibular location of the primary lesion had a negative influence on quality of life. The type of removable prosthesis did not influence the results. Key words:Quality of life, head and neck cancer, GOHAI, dental prosthesis, radiotherapy.

Quality of life in irradiated patients with head and neck cancer: A preliminary study about the impact of prosthetic rehabilitation.

BACKGROUND: Oral quality of life is of great importance in head and neck cancer, where each patient combines functional, social and esthetic needs. Our study aimed to evaluate the influence of prosthetic and/or maxillofacial rehabilitation on patients' perceived oral quality of life. MATERIAL AND METHODS: The General Oral Health Assessment Index (GOHAI) was used in 28 patients with head and neck cancer who had undergone radiotherapy, recruited at La Timone University Hospital, Marseille, France, and who required prosthetic rehabilitation. The questionnaire was completed at three timepoints in the study: before insertion of the prosthesis (T0), then one week (T1) and three months after insertion (T2). RESULTS: The percentage of patients with poor quality of oral health decreased from 96.4% to 64.3% between T0 and T1. Between T0 and T1, the mean score of the psychosocial component of the GOHAI increased from 14.28 ± 4.51 to 20.14 ± 5.20 and the mean functional component score increased from 9.32 ± 3.86 to 12.07 ± 4.04. CONCLUSIONS: Prosthetic rehabilitation appeared to have a positive impact on oral quality of life in our study subjects, particularly on social relations and self-esteem. Its influence on pain and discomfort remains to be clarified. This preliminary study gives a prospective view of the impact of prosthetic rehabilitation in patients with head and neck cancer who had undergone radiotherapy. Analysis of data yielded by cross-referencing of different questionnaires should make it possible to refine these results. Key words:GOHAI, quality of life, head and neck cancer, prosthetic rehabilitation.

Cone beam computed tomography analysis of the edentulous mandibular symphysis.

BACKGROUND/PURPOSE: Overdenture with single symphyseal implant is one of the useful clinical approach for elderly edentulous patients. We aimed to evaluate edentulous patients with regards to the relationship between dimensions, bone characteristics, cancellous densities, and cortical thickness of the mandibular symphyseal region using cone beam computed tomography (CBCT). MATERIAL AND METHODS: We analyzed 103 CBCT from pre-implant investigations. All included patients were healthy without any disorders affecting bone metabolism. We performed 13 measurements for each patient: 9 of height, width, and thickness (mm) and 4 of density (Hounsfield Units; HU). Fisher's exact test was applied to examine the association between two categorical variables, the Pearson correlation coefficient to measure the strength of linear relationship between two quantitative variables. We used the two-sample Student's t-test to compare mean symphysis height between men and women, the paired Student's t-test to compare mean lingual and buccal cortical thickness. For all tests, the threshold of significance was fixed at 5%. RESULTS: Men and women significantly differed with regards to mean total symphysis height (p = 0.004) and the distribution of Cawood and Howell classifications (p = 0.033). Symphysis height was negatively correlated with mean density of cancellous bone (r = -0.453, p < 0.001). Mean lingual cortical thickness significantly differed from mean vestibular thickness (p < 0.001, paired Student's t-test). CONCLUSION: Present findings supported that symphyseal measurements are parameters that reflect the symphysis bone characteristics, and can guide the choice of a suitable implant design.

Objective and perceived oral health status of elderly nursing home residents: a local survey in southern France.

OBJECTIVE: The aim of this study was to compare the perceived oral health of elderly persons and the clinical reality of their oral status. BACKGROUND: Persons aged over 60 have considerable need for oral health care; a need that increases over time. However, this population appears to be unaware of their state of oral health, and this may be a further obstacle to professional management. We thought it useful to examine the objective and the perceived oral health of these patients. Understanding what may influence their perception can help us to improve their management. METHODS: The data analyzed in this work are the findings of a field survey carried out in elderly nursing home residents. Their objective oral health was evaluated by using two variables: oral profile, determined by clinical examination, and the oral health index determined using the Oral Health Assessment Tool (OHAT). Perceived oral health was evaluated using the various categories and fields of the General Oral Health Assessment Index (GOHAI). RESULTS: Our clinical study showed a discrepancy between perceived oral health and the clinical reality: although a significant association can be demonstrated between the OHAT and the GOHAI, there are considerable variations. It also appeared that the number of teeth and total edentation considerably influence perceived oral health and that findings vary according to different situations. CONCLUSION: Numerous factors influence elderly persons' perception of their true oral health. In order to improve our elders' quality of life, the necessary measures must be taken for the follow-up and regular monitoring of their oral health. At the same time, all possible means should be used and awareness should be raised to improve the health behavior and perception of patients and their entourage.

Ethical issues and dentists' practices with children with intellectual disability: A qualitative inquiry into a local French health network.

BACKGROUND: The provision of dental care for children with intellectual disability raises many ethical questions. OBJECTIVE: The aim of this qualitative study was to explore approaches to dental treatment in an anxious child with intellectual disability and the ethical dilemmas that ensue. METHODS: Semi-structured interviews were conducted between February and May 2012. A clinical scenario was used to establish a starting point for a discussion of the clinical approach and lead to an ethical reflection. Four topics were discussed: first contact with the patient, information, attitude towards the patient and outcome from the practitioner's viewpoint. The coding procedure used thematic content analysis. RESULTS: Most practitioners fetched the patient from the waiting room personally, greeted them, gave them special attention, and either began the consultation at once, or used distraction to relax the patient. Verbal language and tell-show-do were most often used to provide information. Anxiety and pain were evaluated using parental assessment and standardized scales. A reassuring attitude was adopted. An ethical dilemma arose if the patient refused care or had to be restrained. Practitioners reported sacrificing ethical values (patient autonomy, beneficence and non-maleficence) when making a clinical decision. CONCLUSIONS: There is a wide range of practices but no consensus. This study shed some light on the different perspectives of dentists, most of whom adopted a utilitarianist viewpoint. In this context, ethical reflection is necessary to avoid a detached attitude or, worse, abuse. Further study would enrich this reflection.

A Numeric Analysis of Bone Density in the Edentulous Interforaminal Region.

PURPOSE: The purpose of this study was to assess the density of interforaminal bone using quantitative computed tomography (QCT) in simulated case histories to be prescribed an All-on-Five fixed implant treatment protocol. MATERIALS AND METHODS: QCT scans from 30 edentulous patients (15 men and 15 women; mean age 63.33 ± 9.3 years) were analyzed using the Nobel Clinician software. Densities (in Hounsfield units [HU]) were recorded at the neck, middle part of the body, and apex of the lingual and buccal parts of proposed implant sites. RESULTS: The highest bone densities were measured at the neck of the implant (1,187 ± 382 HU), with lower densities at the apex (774 ± 571 HU) (P < .01). Bone densities decreased on the lingual interforaminal portion of the implant, especially on the two intermediate implants. Bone density was lower in women (917 ± 510 HU) than in men (1,095 ± 601 HU) (P < .01). CONCLUSION: The interforaminal measured bone densities are lower on the paramedian region of the symphysis and in women. However, these levels are in accordance with immediate loading with a fixed partial denture.

Use of care and the oral health status of people aged 60 years and older in France: results from the National Health and Disability Survey.

OBJECTIVE: We aimed to analyze, from the data in a national survey, the use of oral care and the oral health status of patients living at home or in an institution. BACKGROUND: Patients aged 60 years and older have important oral health needs, but their oral management may differ according to their immediate environment. The fact of living at home or in an institution can influence the use of care and alter the patients' perception of their oral health status. METHODS: The data analyzed were taken from a survey on disability and health carried out in 2008-2009, which is representative of the population living in France. It consists of two sections, one centered on disability and health among home-dwellers and the other on patients living in an institution. In each of these two populations, we carried out descriptive analysis of three themes: use of care, forgoing of care, and oral health. RESULTS: Although visits to physicians and specialists were frequent, visits to dentists were lower in both populations. While a minority of patients forwent care, it was dental care that was mainly forgone by both home-dwellers and institutionalized patients. The cost factor remained the principal reason, but other factors such as fear or accessibility problems were cited. Use of a dental appliance was considerably more frequent among institutionalized patients than among home-dwellers, with just over half the institutionalized population wearing a dental appliance. Perceived state of oral health remained difficult to interpret. CONCLUSION: To improve access to oral care for the elderly, the patients, their entourage and health providers need increased awareness and information on the importance of good oral health. Better information must be associated with regular clinical examination.

Alveolar bone loss and ageing: possible association with coronary heart diseases and/or severe vascular diseases.

OBJECTIVE: The objective of this study was to utilise a new methodological approach based on radiographic examinations to demonstrate a potential association between coronary heart diseases (CHD) as well as severe hypertension and alveolar bone loss (ABL) in older adults. BACKGROUND: Many studies, primarily assessing clinical parameters, underline the association between periodontal diseases and cardiovascular diseases. The relationship between ABL and CHD/vascular diseases (VD) is potentially of high importance because of their prevalence in populations, and they represent an important issue in the fields of epidemiology and public health. Therefore, this topic was approached with new tools. MATERIALS AND METHODS: The study was comprised of 236 participants over 50 years. A clinical examination and a radiographic assessment of ABL were performed. Direct measures of alveolar bone level were recorded using CT scans, and different variables were studied (age, sex, Plaque index, cigarettes per day, coronary heart disease and vascular disease status). A medical examination report was attached to the investigation file. RESULTS: The results confirmed a positive association between CHD/VD and periodontal destruction; alveolar bone destruction represented a risk factor for CHD/VD [odds ratio (OR): 1.27; 95% CI: 1.01-1.60; p < 0.037]. CONCLUSION: This study supports an association between periodontal diseases and CHD/VD independent of known confounders, although an aetiological link of causality has not been established.

Estimation of Age Using Alveolar Bone Loss: Forensic and Anthropological Applications.

The objective of this study was to utilize a new odontological methodological approach based on radiographic for age estimation. The study was comprised of 397 participants aged between 9 and 87 years. A clinical examination and a radiographic assessment of alveolar bone loss were performed. Direct measures of alveolar bone level were recorded using CT scans. A medical examination report was attached to the investigation file. Because of the link between alveolar bone loss and age, a model was proposed to enable simple, reliable, and quick age estimation. This work added new arguments for age estimation. This study aimed to develop a simple, standardized, and reproducible technique for age estimation of adults of actual populations in forensic medicine and ancient populations in funeral anthropology.

Three-dimensional modeling of the various volumes of canines to determine age and sex: a preliminary study.

Canines are usually used in anthropological and forensic sciences for sex and age determination. The best methods to estimate age are based on secondary dentine apposition, evaluated from periapical X-rays. The aim of this study was to propose a new method of sex and age estimation using 3D models to obtain more precise predictions using tooth volumes. Fifty-eight dental CT scans of patients aged 14-74 with a well-balanced sex ratio composed the sample. One hundred and thirty-three healthy canines were modeled (Mimics 12.0). The sample was divided into a training sample and a validation sample. An age formula was determined using the "pulp volume/tooth volume" ratio. Sex prediction was adjusted with total volumes. Applying the equations to the validation sample, no significant difference was found between the real and predicted ages, and 100% of the sex predictions were correct. This preliminary study gives interesting results, and this method is worth being tested on a larger data sample.

Estimation of gestational age from tooth germs: Biometric study of DentaScan images.

The few available studies on fetal age estimation concern very small samples, and statistical analysis is sometimes inadequate. In this survey, we used germs of deciduous teeth to estimate fetal age. Forty-nine fetuses and 40 mandibles were scanned, and observations and measurements were made on DentaScan images. After checking their repeatability and reproducibility (analysis of variance), we defined thresholds using Fisher's linear discriminant analysis to calculate the probability that a fetus was over or below a predefined age threshold. The forensic threshold which is of particular interest in France is 22 weeks amenorrhea. Relationships between fetal age and deciduous germ measurements were then sought by multiple linear regression. The thresholds gave very good results: 91.84% of good probability for the threshold of 22 weeks amenorrhea with no chance of error. The most precise age evaluation obtained nevertheless gave a range of ±4.6 weeks amenorrhea, so greater accuracy is still needed.