Functional oral status and oral health-related quality of life in community-dwelling older adults in Singapore.

OBJECTIVES: The objectives were to investigate the association between oral functional status (defined by the number of functional teeth and functional occluding units [FOUs]) on oral health-related quality of life (OHRQoL). It also aimed to determine if dentures could compensate for the loss of FOUs in terms of OHRQoL in community-dwelling older adults in Singapore. METHODS: Community-dwelling older adults, aged 60 years and above, were recruited from a community-based oral health functional screening programme from 1 May 2018 to 31 December 2019. During the screening, an Oral Health Impact Profile-14 (OHIP-14) questionnaire and oral examination were administered. Statistical analysis was performed using the chi-square test, univariate logistic regression and multivariate predictive modelling. RESULTS: Data from 1037 participants were analysed (52% female; mean age 71.5 (SD 7.15)). The mean OHIP-14 score was 4.5 ± 7.2. The OHIP-14 scores were significantly associated with the number of functional teeth and the number of FOUs (p < .001). Having at least 20 functional teeth or 10 FOUs was associated with a significantly lower OHIP-14 score. Those with no FOUs had higher OHIP-14 scores compared to those with at least 10 FOUs, even in the presence of a satisfactory denture. CONCLUSION: Maintaining at least 20 functional teeth or 10 FOUs was associated with better OHRQoL among community-dwelling older adults in Singapore. Dentures may have limited compensatory ability in terms of replacing natural functional occlusal units and maintaining OHRQoL.

A Fully Digital Auricular Splint Workflow for Post-Keloid Excision.

Ear keloids are challenging lesions to treat due to high recurrence rates postexcision. Conservative compression techniques as adjunct treatment have been reported to be effective. An innovative technique of using computer-aided design/computed-aided manufacturing to print a customized auricular splint improves efficiency and comfort level for patients compared with conventional methods. The ear is scanned using an intraoral scanning 2 weeks postsurgery. A two-piece auricular splint is designed on the digital model, incorporating perforated projections for three nylon screws for retention of the splint. The splint is printed with clear acrylic material, postprocessed, and finished. The patient is taught to assemble the components of the splint and instructed to wear for at least 8 hours daily. The surgery site reviewed for any ulceration, pain, or recurrence of keloid for 6 months. During the 6-month review, the excision scar remained flat and pink. The patient also reports unrestricted daily activities. The digital workflow increases comfort for the patient and reduces the number of hours required to produce a customized auricular splint compared with conventional methods. A fully digital workflow for a printed auricular splint should be considered for adjunctive treatment to excision of ear keloids.

Esthetic Evaluation of Anterior Implant-Supported Single Crowns: A Comparison Between Patients and Dentists.

PURPOSE: To compare the esthetic outcomes of anterior implant-supported single crowns as evaluated by patients and clinicians of different specialties. MATERIALS AND METHODS: A total of 133 patients with 138 implant-supported crowns were recalled from the National Dental Centre Singapore Implant Registry to rate the esthetic outcomes of their restorations using a visual analog scale (VAS) questionnaire. Patients with crowns in the maxillary or mandibular canine-to-canine region with a contralateral natural tooth and minimum time in function of 6 months were recruited. Three clinicians trained in prosthodontics rated each restoration using the modified Pink Esthetic Score/White Esthetic Score (PES/WES) index through photographs and models. Two periodontists, two orthodontists, and two general dentists each rated a randomized sample of 40 crowns using the same index for comparison. Statistical analysis was done using a linear mixed model, analysis of variance, intraclass correlation coefficient, kappa score, Spearman rank correlation, and Mann- Whitney U tests. RESULTS: Mean PES, WES, and PES/WES scores for the 138 implants were 4.7, 5.0, and 9.7, respectively. Based on modified PES/WES criteria, 22 (15.9%) of the 138 implants were deemed clinically acceptable. Mean patient VAS scores ranged from 79.3 to 84.4 out of 100. Prosthodontists had significantly lower mean PES, WES, and PES/WES scores (P < .05) than the other specialties. When orthodontists were excluded, papilla scores had the highest agreement of all the variables. CONCLUSION: Patients were less critical of esthetic outcomes than clinicians. A weak correlation was found between patients' subjective evaluations and the modified PES/WES index as rated by prosthodontists. Prosthodontists were the strictest assessors.

Spectrophotometric and Visual Evaluation of Maxillary Anterior Implant Crowns and Peri-implant Soft Tissues: A Retrospective Study.

PURPOSE: To visually and spectrophotometrically determine the differences in the shades of maxillary anterior implant crowns and peri-implant soft tissues compared to a natural teeth control group. MATERIALS AND METHODS: A total of 44 patients restored with single implant-supported restorations were assessed after at least 6 months in function. Images of the implant crowns, peri-implant soft tissues, and their controls were captured using a spectrophotometer (SpectroShade Micro, Medical High Technologies). Visual assessment of shade differences between the implant crowns and peri-implant soft tissues and their controls were performed by the patients and four dental professionals using a visual analog scale (VAS). Analysis of variance was applied to detect differences between groups. RESULTS: The mean color differences (ΔE) between the implant crowns and peri-implant soft tissues and their respective controls were 4.8 ± 2.6 and 6.6 ± 2.7, respectively. A significant difference (P = .025) in mean ΔE values was observed only at the cervical third of the implant crowns. The patient group showed the highest mean VAS scores for shade matching of the implant crowns (8.4 ± 1.2) and peri-implant soft tissues (7.8 ± 1.6) with their respective controls. CONCLUSION: Spectrophotometric analysis showed significant shade differences at the cervical third of the implant crowns. The patients were more satisfied with the shade matching of their implant restorations than the dental professionals.

A Retrospective Study on the Success, Survival, and Incidence of Complications of Post-Retained Restorations in Premolars Supporting Fixed Dental Prostheses with a Mean of 7 Years in Function.

PURPOSE: To evaluate the survival and success rates of post-and-core restorations supporting fixed dental prostheses (FDPs) after a mean time in function of 7 years and to assess the incidences of biologic and technical complications. MATERIALS AND METHODS: Patients from the National Dental Center Singapore (NDCS) with endodontically treated premolars restored with post-retained FDPs from 2007 to 2009 were recruited from the Endodontic Registry and evaluated by three clinicians. A total of 265 patients with 329 treated premolars were examined clinically. Digital radiographs were also obtained. Complications were classified as tooth- or prosthesis-related. Failure and complication rates were calculated based on person-time-at-risk. RESULTS: The mean time in function was 7.1 years. A total of 25 teeth in 23 patients were lost, resulting in a 7-year survival rate of 92.7% (95% CI: 89.5%, 95.0%). The corresponding success rate was 75.1% (95% CI: 70.5%, 79.1%). A total of 40 FDPs failed, resulting in a 7-year prosthetic survival rate of 88.6% (95% CI: 84.8%, 91.5%). Common complications observed were recurrent periodontal disease (3.9%), periapical pathology (7.3%), caries (3.9%), porcelain chipping (9.9%), and tooth fractures (5.0%). For the incidence of tooth fracture, a risk analysis yielded significant associations with the number of occluding teeth (odds ratio: 4.2; 95% CI: 1.1, 16.7) and the number of adjacent teeth (odds ratio: 4.0, 95% CI: 1.5, 10.9). CONCLUSION: Restoration of premolar teeth requiring root canal treatment with a post and core and crown is a viable treatment when premolar teeth have adjacent teeth.

In Vitro Three-Dimensional Accuracy of Digital Implant Impressions: The Effect of Implant Angulation.

PURPOSE: To compare the three-dimensional (3D) accuracy of conventional impressions (CIs) with digital scans (DSs) using an intraoral scanner (IOS) with intraoral scan bodies (SBs) and varying buccolingual interimplant angulations. A secondary aim was to measure the SB machining tolerance and height with and without application of torque. MATERIALS AND METHODS: Three master models (MMs) with two implants simulating an implant-supported three-unit fixed partial denture for bone-level implants were used. The implants had buccolingual interimplant angulations of 0, 10, and 20 degrees. Test models for the CI test groups were made with impression copings and polyether impressions. SBs were attached to the MMs, tightened to 15-Ncm torque, and scanned by an IOS for the DS test groups (six test groups, n = 5). A coordinate measuring machine measured linear distortions (dx, dy, dz), 3D distortions (dR), angular distortions (dθx, dθy), and absolute angular distortions (Absdθx, Absdθy) of the physical CI test models and STL files of the DS virtual models relative to the MMs. Metrology software allowed both physical and virtual measurement of geometric targets that were comparable and allowed computation of relative displacements of implant centroids and axes. RESULTS: Mean dR ranged from 31 ± 14.2 to 45 ± 3.4 µm for DS and 18 ± 8.4 to 36 ± 6.5 µm for the CI test groups. Mean Absdθx ranged from 0.041 ± 0.0318 to 0.794 ± 0.2739 degrees for DS and 0.073 ± 0.0618 to 0.545 ± 0.0615 degrees for the CI test groups. Mean Absdθy ranged from 0.075 ± 0.0615 to 0.111 ± 0.0639 degrees for DS and 0.106 ± 0.0773 to 0.195 ± 0.1317 degrees for the CI test groups. Two-way analysis of variance showed that the impression technique (P = .012) and implant angulations (P = .007) had a significant effect on dR. Distortions were mostly in the negative direction for DS test groups. Perfect coaxiality of the SB with the implant was never achieved. For SB to implant machining tolerances, the mean absolute horizontal displacement ranged from 4 ± 1.2 to 7 ± 2.3 µm. The SB dz was -5 ± 3.2 µm, which increased in the negative direction to -11 ± 4.9 µm with torque application (P = .002). CONCLUSION: Distortions were found for both DS and CI test groups. The best accuracy was obtained with CIs for parallel implants. With angulated implants, conventional and DSs were not significantly different. Excessive torque application that causes negative dz for SB fit would position the virtual implant at a deeper location compared with reality, resulting in possible framework misfit.

Dental health status of community-dwelling older Singaporeans: findings from a nationally representative survey.

OBJECTIVES: To assess the dental health status of older Singaporeans by age, gender and ethnicity. BACKGROUND: Poor dental health in elders has been linked to a number of adverse health conditions and is often associated with an increased risk of mortality in older people. MATERIALS AND METHODS: Data came from a nationally representative cross-sectional 2009 survey of community-dwelling Singaporeans aged 60 and over. The distribution of the number of natural teeth, chewing ability and the presence of dentures were assessed by age, gender and ethnicity (Chinese/Malay/Indian) using sampling weights. RESULTS: With increasing age, there was a decrease in the average number of natural teeth, a decrease in the proportion of people with 20 or more natural teeth and with the strongest chewing ability, and an increase in the proportion that was edentulous or had dentures. Women, vs. men, had a lower average number of natural teeth (10.3 vs. 12.8), and they were more likely to be edentulous (37 vs. 24%) and to have dentures (73 vs. 63%). Across ethnic groups, Indians had the highest average number of natural teeth (17.0). However, among those who had dentures, Indians were the least likely to have the strongest chewing ability. CONCLUSIONS: The findings demonstrated differences in dental health status by age, gender and ethnicity. They highlight the need for improvements in the dental health status of all older Singaporeans, especially older women. The data presented herein may serve as a baseline for policymakers to evaluate the impact of recent schemes launched by the Ministry of Health (Singapore) to subsidise dental treatment.