Misfit simulation on implant-supported prostheses with different combinations of engaging and nonengaging titanium bases: Part 3: A radiographic evaluation.

STATEMENT OF PROBLEM: The fit of implant-supported prostheses plays an important role in their mechanical and biological stability. Clinically, the prosthetic fit is typically assessed radiographically, but this method relies on the operator's subjective evaluation. Whether available digital tools could optimize the evaluation of the prosthetic fit is uncertain. PURPOSE: The purpose of this in vitro study was to evaluate the influence of an image processing program on the radiographic detection of discrepancies in the active and passive fit of implant-supported prostheses. Two-implant-supported screw-retained prostheses were analyzed by simulating the vertical and horizontal misfits of 3 different implant abutment configurations. MATERIAL AND METHODS: Seven casts were fabricated using 2 internal-connection titanium implants: 1 control; 3 with vertical (V) misfit of 50 µm, 100 µm, 150 µm; and 3 with horizontal (H) misfit of 35 µm, 70 µm, 100 µm. Thirty bar-shaped zirconia frameworks were fabricated and divided into 3 groups (n=10) according to their attachment to 2 engaging (E-E), 2 nonengaging (NE-NE), and engaging and nonengaging (E-NE) titanium bases. Digital parallel periapical radiographs were made of each specimen in the passive and active fit situation on each cast (1-screw test), except for the E-E specimens, which were only seated on the control, H35, and H70 casts because the fit on the remaining casts was poor. The mean gray value (MGV) was measured at the chosen regions of interest on the second implant (side B) using the ImageJ software program. Differences in the MGV measurements between the passive and active conditions were tested using a t test (α=.05) and compared the different misfit levels using analysis of variance (1-way ANOVA), followed by the Tukey HSD test (α=.05). RESULTS: The highest values for the differences between passive and active fit were found for the V150 and H100 misfit simulations (P<.05). Statistical differences between the MGVs were found with some exceptions: the smallest simulated misfits (H35 and V50) revealed statistically significant MGV differences from the highest simulated misfits (V150, H100) and from the H70 in the groups where an engaging component was present (P>.05). In the horizontal misfit group of NE-NE abutment configuration, H70 revealed no significant difference from the control group cast (P>.05). CONCLUSIONS: Measuring MGV differences between passive and active fit could be a promising alternative for detecting 70- to 150-µm gaps in the implant-abutment connection that result from the misfit. However, the procedure was not adequate for detecting <50 µm gaps, cannot be uniformly applied to all types of implant-abutment connections, and requires 2 exposures to X-radiation.

Australian adults cooked more and tried new recipes during COVID-19 restrictions and lockdowns.

The lockdowns and restrictions due to COVID-19 caused changes in both food accessibility and availability for people around the globe resulting in changes in food habits and behaviours. To enable a better public health response to the next pandemic, lessons must be learnt from this most recent emergency. This study aimed to examine self-reported changes in food habits and behaviours, of Australian adults during COVID-19 restrictions in 2020. A cross-sectional, convenience, Australia-wide survey, with open-ended and closed-ended questions was conducted online. Respondents were asked to report their demographic characteristics, positive food habit development, worst food-related experiences, changes in food habits and behaviours and cooking and food preparation practices during the COVID-19 restriction period. Adult Australian residents, recruited through social media advertising of the survey. Respondents (n = 764) were mostly female (86%), over 55 years of age (57%, mean age (SD) 53.4 (18.1) years), and half (51%) were not in paid employment. Nearly two-thirds (63%) developed positive food habits, including trying new recipes (54%), eating less take-away (53%) and cooking from scratch (46%) during the COVID-19 restrictions. Furthermore, respondents reported including family members in food preparation and eating together as a family. Negative experiences included being unable to buy certain foods (due to lack of stock and store limits), cooking at home, and being unable to access some food outlets. Australians experienced both positive and negative food experiences during the COVID-19 pandemic and associated lockdown periods, with most experiencing positive changes such as cooking at home from scratch and trying new recipes and relying on less take-away. Females and those who experienced a change in employment status were more likely to develop positive new food habits.

Survival of fixed prosthetic restorations on vital and nonvital teeth: A systematic review.

PURPOSE: To evaluate the survival rate of full-coverage tooth-supported fixed prosthetic restorations, single crowns (SCs), and fixed dental prostheses (FDPs), taking into consideration the potential influence of tooth-vitality, presence and type of post, and type of prosthetic restoration material. MATERIALS AND METHODS: In October 2022, two authors independently conducted a search in PubMed, Web of Science, and Scopus electronic databases as well as a hand search to identify clinical human studies on full-coverage SCs and FDPs supported by vital and/or non-vital abutments and/or a combination of both, with a minimum observation period of 24 months. RESULTS: Out of 4198 studies identified through the database search and 22 through hand searching, 26 studies fulfilled the inclusion criteria and were included in the analysis of the present systematic review. Included studies scored six points and more according to Newcastle-Ottawa Scale (NOS). The highest estimated 5-year survival rate was observed for (metal-ceramic and all-ceramic) SCs on vital teeth (98.3%; 95% CI [98.1, 98.6%]) and all ceramic SCs on non-vital teeth with fiber post (95.0%; 95% CI [94.5-95.4%]). Metal-ceramic SCs on vital teeth (97.1%; 95% CI [95.6-98.7%]) showed a statistically significant higher estimated 5-year survival rate compared to metal-ceramic SCs with cast metal post (90.7%; 95% CI [87.4-94.0%], P < 0.001), fiber post (91.3%; 95% CI [90.9-91.6%], P < 0.001) and without post (85.7%; 95% CI [80.7, 90.6%], P < 0.032). All-ceramic SCs with fiber post had a statistically significant higher estimated 5-year survival rate (95.0%; 95% CI [94.5-95.4%]) compared to metal-ceramic SCs on non-vital teeth with fiber post (91.3%; 95% CI [90.9-91.6%], P < 0.001). SCs (all-ceramic and metal-ceramic) with fiber post had a statistically significantly higher estimated 5-year survival rate of (92.7%; 95% CI [92.4-92.9%]) than SCs made of metal-ceramic and retained by cast metal post (90.7%; 95% CI [87.4-94.0%], P < 0.001). For FDPs, the 5-year survival rate was significantly higher for FDPs on vital abutments (84.9%; 95% CI [75.9, 93.9%]) compared to FDPs retained by non-vital abutment/s (81.3%; 95% CI [80.3, 82.2%], P = 0.049) irrespective to presence, type of post, and FDPs material. The results are limited by the limited number of studies and the presence of uncontrolled confounding clinical variables. CONCLUSIONS: Within the limitations of the study, tooth vitality is suggested to contribute positively to the survival of SCs and FDPs.

Food literacy and diet quality in young vegans, lacto-ovo vegetarians, pescatarians, flexitarians and omnivores.

OBJECTIVE: To investigate whether food literacy competencies and diet quality vary between 16-to-24-year-olds vegans, lacto-ovo vegetarians, pescatarians, flexitarians and omnivores and to assess whether food literacy is associated with diet quality. DESIGN: Cross-sectional study. Food literacy (general nutrition knowledge, critical nutrition literacy and food skills) and diet quality were measured using an electronic questionnaire. SETTING: Southern Norway, September 2021 - March 2022. PARTICIPANTS: Healthy 16-24-year-olds (n 165). RESULTS: Overall, the mean general nutrition knowledge score was moderate (48·0 out of 67·0); the lowest mean score was found in omnivores and the highest in flexitarians (45·6 v. 51·5) (P = 0·034). The mean score of critical nutrition literacy was also moderate (3·7 out of 5·0); vegans showed higher scores compared to other dietary practices (P = 0·018). No difference was observed in food skills between the different dietary practices. The overall median diet quality score was 46·0 out of 80·0, lowest in omnivores and highest in vegans (42·0 v. 56·0) (P =< 0·001). In multivariate regression analyses, general nutrition knowledge, food skills and vegan dietary practice were significantly associated with higher diet quality. CONCLUSIONS: We found moderate levels of food literacy across all dietary practices. The food literacy competencies, general nutrition knowledge and food skills were associated with higher diet quality in our sample. Omnivores showed both the lowest general nutrition knowledge level and lowest diet quality scores. In contrast, both flexitarians and vegans scored highest on general nutrition knowledge and diet quality scores, despite being one of the less restrictive and one of the strictest plant-based dietary practices, respectively.

Adolescents' attitudes, preferences and perceived behaviours regarding healthy eating and whole grains from a gender and health interest perspective.

Background: A healthy diet is important not only for the growth and development of the human body but also for the prevention of chronic diseases. However, most Swedish adolescents do not follow dietary recommendations, especially the intake of whole grain is very low. To create targeted conditions for healthy food choices amongst adolescents, comprehensive knowledge of factors related to adolescents' unhealthy and healthy eating is needed. Objective: To investigate adolescents' attitudes, preferences and perceived behaviours regarding healthy eating, with a specific focus on whole grains and to evaluate differences between genders and between adolescents with higher versus lower health interest. Design: A total of 1,178 Swedish adolescents responded to a questionnaire about their attitudes, preferences and perceived behabviours towards healthy eating and whole grains, and their general interest in nutrition and health. Results of girls and boys were compared, as well as adolescents with a higher versus lower health interest. Results: Displays information about healthy eating among adolescents and a comprehensive set of factors that may affect their ability to eat healthier. Overall, adolescents had a positive attitude towards food and health, but less than half felt that they managed to eat healthy. The consumption of different whole grain products was low, although the willingness to eat healthier and more whole grain was high. The most reported barrier to healthy eating, as well as increasing whole grain intake, was the unavailability of tasty healthy products, taste being even more important for adolescents with a low health interest than those with a high interest. Whole grain consumption and factors increasing the willingness of whole grain consumption were most prominent not only in adolescents with high health interest but also in girls compared with boys. Conclusion: The results show good potential to improve dietary habits amongst adolescents. Taste and availability of healthy products were rated the most important, whilst knowledge about the products' healthiness was rated the least important, especially amongst those with low health interest. By focusing on the attitudes and preferences of adolescents, the effectiveness may increase of initiatives to improve their dietary habits.

Clinical Outcome of Three Different Types of Posterior All-Ceramic Crowns. A 3-Year Follow-up of a Multicenter, Randomized, Controlled Clinical Trial.

PURPOSE: To assess and compare the clinical outcomes of three different types of all-ceramic posterior monolithic tooth-supported crowns. MATERIALS AND METHODS: A total of 71 patients received 90 all-ceramic crowns randomized to be either high-translucency zirconia (ZC), high-translucency zirconia with a partial buccal veneer (ZC-V), or lithium disilicate glass-ceramic (LDS). All treatments were performed by four general dentists who were blinded to the material used. Baseline and subsequent annual evaluations were based on modified California Dental Association (CDA) criteria. A questionnaire was used to include patient-reported outcomes and to compare them to the crown quality rating performed by dentists. RESULTS: A total of 66 patients with 84 crowns were examined after 3 years. The survival rate was 98.8%. No crowns fractured during the observation period. One ZC-V crown failed due to loss of retention, and three complications were noted: loss of retention occurred in one ZC crown, and two ZC crowns needed to be endodontically treated. There was no significant difference between the different crowns regarding marginal integrity, surface, or anatomical form. Both patients and examining dentists rated the crowns favorably regarding esthetics, patients more than dentists. CONCLUSIONS: All crown types used show excellent and promising clinical outcomes from a short-term perspective. Patients and dentists rate the restorations favorably concerning esthetics and function. Int J Prosthodont 2023;36:546-553.

Loss of pulp vitality correlated with the duration of the interim restoration and the experience of the dentist: A retrospective study.

STATEMENT OF PROBLEM: The second most common biological complication in fixed prosthodontics is loss of pulp vitality, which may lead to restoration loss. While reasons for loss of pulp vitality are unclear, 2 potential contributing factors, duration of the interim restoration and operator experience, have not been fully investigated. PURPOSE: The purpose of this retrospective study was to investigate whether the duration of the interim restoration or the experience of the dentist was correlated with loss of pulp vitality. MATERIAL AND METHODS: Fixed prosthetic restorations placed between 2005 and 2012 were retrospectively analyzed. Abutment teeth supporting single-unti or multiunit restorations were evaluated regarding loss of pulp vitality. The Mann-Whitney U test and simple logistic regression were used, with α=.05 for the subsequent multiple logistic regression. The experience of dental professionals was defined by the number of treatments performed and coupled with failure rate by using an analysis of variance. RESULTS: One hundred seventy-four dentists made 15 879 restorations, of which 1136 failed during the observation period, a failure rate of 7.2%. Two hundred fifty restorations were randomly selected from the failed restorations, and a corresponding 250 restorations were randomly selected from nonfailed restorations for the control group. Increased duration with interim replacement was linked to a higher risk of loss of pulp vitality (P<.001). Failure rate in the dentist group varied from 0% to 100%. No significant differences in failure rate were found among dentists who did few restorations and those who performed larger numbers of restorations. CONCLUSIONS: The results of the present study suggest that operator experience does not affect failure rate. However, extended time with an interim restoration was a contributing factor to the loss of pulp vitality.

Long-term retrospective clinical study of tooth-supported fixed partial dentures: A multifactorial analysis.

PURPOSE: To assess the influence of several factors on the survival of tooth-supported fixed partial dentures (FPDs) with vital and non-vital abutments. METHODS: The present retrospective cohort study was based on the records of patients treated with 3-to-7-unit tooth-supported FPDs with a minimum follow-up time of 6 months after prosthesis delivery. Cumulative survival rate (CSR) was calculated over the maximum follow-up period. Cox regression models were used to evaluate the association between the clinical covariates and prosthesis failure. RESULTS: A total of 331 FPDs in 229 patients were included. The CSRs were 90.1% and 77.6% after 5 and 10 years and 67.9% and 52.1% after 15 and 20 years, respectively. Tooth-supported FPD failure was more prevalent within the first years of prosthesis delivery. Loss of one or more abutment teeth and loss of prosthesis retention were the main reasons for failure. Smoking and type of prosthesis material significantly influenced the survival of FPDs. Abutment vitality, position of the non-vital abutment, or prosthesis length did not show any significant influence on the occurrence of prosthesis failure. CONCLUSIONS: Smoking and the type of prosthesis material are suggested to contribute to an increased rate of FPD failure irrespective of abutment vitality.

Consumption of foods with the Keyhole front-of-pack nutrition label: potential impact on energy and nutrient intakes of Swedish adolescents.

OBJECTIVE: The Keyhole is an internationally recognised front-of-pack nutrition label, guiding consumers to healthier food options. It indicates products in accordance with specific criteria for dietary fats, sugars, fibres, salt and wholegrains. The objective of this study was to simulate the potential impact of the Keyhole on adolescents' energy and nutrient intakes by modelling a shift from reported food intakes to foods meeting the Keyhole criteria. DESIGN: Self-reported dietary intake data were derived from a cross-sectional survey. Multiple replacement scenarios were calculated, where foods meeting the Keyhole criteria replaced reported non-compliant foods with varying proportions of replacement. SETTING: Dietary survey 'Riksmaten Adolescents 2016-2017' in schools across Sweden. PARTICIPANTS: A nationally representative sample of 3099 adolescents in school years 5, 8 and 11 (55 % girls). RESULTS: Overall, replacement with foods meeting the Keyhole criteria led to more adolescents meeting nutrition recommendations. Largest median intake improvements were seen for wholegrains (+196 %), SFA (-13 %), PUFA (+17 %) and fibres (+15 %). Smallest improvements were seen for free sugars (-3 %) and salt (-2 %), partly explained by the ineligibility of main food sources of free sugars for the Keyhole, and non-inclusion of ready meals that are often high in salt. Most micronutrient intakes were stable or improved. Unintentional effects included decreases in vitamin A, MUFA and energy intakes. Largest potential improvements in fat and fibre sources were observed in the youngest age group. CONCLUSIONS: A shift to Keyhole alternatives for everyday foods would improve adolescents' nutrient intakes, even with smaller exchanges.

Misfit simulation on implant prostheses with different combinations of engaging and nonengaging titanium bases. Part 2: Screw resistance test.

STATEMENT OF PROBLEM: Prosthesis fit is 1 of the main factors influencing the success and survival of an implant-supported screw-retained restoration. However, scientific validation of the performance of engaging and nonengaging components in a fixed partial denture (FPD) and the effect of their combinations on the fit of FPDs is lacking. The screw resistance test has been used for the fit assessment of screw-retained FPDs. However, objective assessments by using analog and digital devices are now available. PURPOSE: The purpose of this in vitro study was to investigate the effect of engaging and nonengaging components on the fit of screw-retained frameworks, supported by 2 conical connection implants with simulated vertical and horizontal misfits, by performing 2 different screw resistance tests (analog and digital). MATERIAL AND METHODS: Thirty 2-implant-supported bar-shaped zirconia frameworks cemented on two 2-mm titanium bases were fabricated and divided into 3 groups (n=10) according to different abutment combinations: both engaging, engaging and nonengaging, both nonengaging. The fit of each framework was tested on the control cast and on 6 definitive casts simulating 50-, 100-, and 150-µm vertical and 35-, 70-, and 100-µm horizontal misfit levels. The abutment screws were tightened on each implant, and the screw rotation angle was measured both digitally, with a custom-made digital torque wrench and a computer software program, and conventionally, with an analog torque wrench and protractor. Clearly ill-fitting specimens were excluded. The data were statistically analyzed by 1-way analysis of variance (ANOVA) and the Tukey post hoc test (α=.05). RESULTS: Both engaging specimens on the 100-µm horizontal misfit group and on all vertical misfit groups were clearly ill-fitting and excluded. Statistically significant differences among groups with different combinations of abutments were found (P<.05). The engaging abutments had a higher angle of rotation than the nonengaging abutments on all casts. In the horizontal misfit group, both engaging specimens had the highest angle of rotation, followed by engaging and nonengaging and both engaging specimens. In the vertical misfit group, the engaging and nonengaging specimens had the highest angle of rotation on the side of the engaging abutment. The angle of rotation increased with the increasing level of misfit. CONCLUSIONS: Both nonengaging frameworks showed superiority in misfit tolerance, as the angle of rotation was lower than that of the engaging and nonengaging and both engaging frameworks. Conventional and digital torque wrenches showed similar results.

Effects of a palaeolithic diet on obstructive sleep apnoea occurring in females who are overweight after menopause-a randomised controlled trial.

BACKGROUND/OBJECTIVES: Obesity is the main risk factor for obstructive sleep apnoea, commonly occurring in females who are overweight after menopause. We aimed to study the effect of a palaeolithic diet on sleep apnoea in females with overweight after menopause from the population. METHODS: Seventy healthy, non-smoking females with a mean age of 60 years and a mean BMI of 33 kg/m2 were randomised to a palaeolithic diet or to a control low-fat diet according to Nordic Nutritional Recommendations, for 2 years. The apnoea-hypopnoea index was measured and daytime sleepiness was estimated during the intervention. RESULTS: The mean apnoea-hypopnoea index at baseline was 11.6 (95% CI 8.6-14.5). The mean weight loss was 7.2 kg (95% CI 5.3-9.2 kg) in the palaeolithic diet group and 3.9 kg in the control group (95% CI 1.9-5.9 kg); p < 0.021 for the group difference. The reduction in weight corresponded to a reduction in the apnoea-hypopnoea index in the palaeolithic diet group (r = 0.38, p = 0.034) but not in the control group (r = 0.08, p = 0.69). The apnoea-hypopnoea index was reduced in the palaeolithic diet group when the weight was reduced by more than 8 kg. Daytime sleepiness according to the Epworth Sleepiness Scale score and the Karolinska Sleepiness Scale score was unaffected by dietary group allocation. CONCLUSIONS: A substantial decrease in body weight of 8 kg was needed to achieve a reduction in sleep apnoea in this small trial of women who are overweight after menopause. The palaeolithic diet was more effective for weight reduction than a control low-fat diet and the reduction in sleep apnoea was related to the degree of weight decrement within this diet group. TRIAL REGISTRATION: Clinicaltrials.gov: NCT00692536.

Retrospective clinical study of tooth-supported single crowns: A multifactor analysis.

The purpose of the study was to investigate the influence of multiple factors on the survival of tooth-supported single crowns and assess the biological and technical complications. This retrospective study included patients rehabilitated with single crowns with a minimum follow-up time of 6 months after delivery. The cumulative survival rate was calculated over the maximum period of follow-up time and reported in a life-table survival analysis. Univariate and multivariate Cox regression was used to evaluate the associations between clinical covariates and crown failure. The included cohort group consisted of 1037 single crowns delivered in 401 patients and followed for a mean of 134.8 ± 80.2 months. Cumulative survival rate was 89.9% and 80.9% after 5 and 10 years and 70.5% and 61.8% after 15 and 20 years, respectively. The main reasons for single crown failure were loss of retention, tooth loss, and fracture. Anterior placement, non-vital abutments, and bruxism significantly influenced the survival of single crowns. The survival of single crowns was not influenced by patient's age and sex, location of the crowns in relation to the jaws, type of tooth, presence of post and core, and type of crown material, treatment providers, or smoking. Anterior placement, non-vital abutments, and bruxism are factors suggested to increase the risk of single crown failure and the prevalence of technical and biological complications.

Retrospective Study Comparing Clinical Outcomes of Fixed Dental Prostheses in Matched Groups of Bruxer and Nonbruxer Patients.

Background: Tooth-supported fixed dental prosthesis (FDP) is one of the most reliable treatment options to replace missing teeth. The longevity of the treatment could, however, be affected by several general and local factors, especially bruxism. Objective: To investigate the influence of bruxism on the long-term survival of tooth-supported FDPs in bruxers compared to a matched group of nonbruxers, taking several clinical variables into account. Materials and Methods: The present retrospective cohort study was based on records of patients treated with 3-7-unit tooth-supported FDPs with a minimum follow-up time of 6 months after prosthesis delivery. The criteria for the diagnosis of "possible" and "probable" sleep or awake bruxism were used. A matched group of nonbruxers was selected on the basis of similarities in four factors, patients' gender and age, number of prosthetic units of the FDPs, and follow-up time. The paired-samples t-test or Wilcoxon signed rank test were used to compared mean values between the two groups. Contingency tables of categorical data were analyzed by McNemar's test. Results: The cohort group consisted of 62 noncantilevered FDPs in each group, followed up for a mean of 110.1 and 106.5 months (bruxers and nonbruxers, respectively). Tooth-supported FDPs in bruxers presented significantly higher failure rate than in nonbruxers (32.3% vs. 25.8%, respectively; p = 0.001). Loss of retention and tooth loss were the main reasons for failures in both groups. For nonsmokers, the FDP failure rate was higher in nonbruxers. Technical and biological complications were significantly more prevalent in bruxers compared to nonbruxers. Conclusions: Bruxism is suggested to increase technical and biological complications and FDP failure.

Comparative cost analysis of different prosthetic rehabilitations for the edentulous maxilla: early results from a randomized clinical pilot study.

OBJECTIVES/AIM: To analyze and compare costs of different prosthetic rehabilitations for the edentulous maxilla. MATERIALS AND METHODS: Patients with edentulous maxillae were rehabilitated with either of three implant-supported prosthetic protocols; removable overdenture supported by 2 implants (ISOD 2), fixed dental prostheses supported by 4 (ISFAFDP 4) or 6 (ISFAFDP 6) implants. Cost of treatment and costs during follow-up were registered and compared. RESULTS: Twenty-four patients were included: six patients received ISOD 2 treatment, eight patients received ISFADP 4 treatment and ten patients received ISFADP 6 treatment. Initial costs for ISFAFDP 6 were higher than costs for ISFAFDP 4 and ISOD 2, but there were no differences in cost for maintenance i.e., the ISOD treatment remained the least costly treatment alternative after 1-year follow-up. DISCUSSION: The lack of difference in cost for maintenance and repair over the first year suggests that implant-supported overdentures will remain the least costly treatment option for the edentulous maxilla, at least in a short-term perspective. CONCLUSIONS: Removable maxillary overdentures supported by 2 implants may be a valid low cost treatment option.

Enough time for lunch? The duration and governance of lunch eating times in Australian primary schools: A mixed-methods study.

Developing healthy eating behaviours is important to assist children in maintaining good health and decrease the risk of chronic health conditions. Recent nutrition promotion efforts in Australian primary schools have mainly focused on canteen guideline compliance and obesity prevention interventions. The aim of this study was to investigate the primary school food environment, specifically, allocated lunch eating duration and the governance of children's lunch breaks. Parents (n = 402) and teachers (n = 123) were asked via an online survey, about school allocated lunch eating duration and its adequacy. Respondents were asked about the supervision, monitoring and feedback of children's lunches, as well as how they felt about these practices. Parents (n = 308) and teachers (n = 102) also responded to the open-ended question "What could be done to improve the school food environment at your school?". Ten minutes was the allocated lunch eating duration reported by most parents and teachers and 58% of those parents and 30% of those teachers rated this as inadequate. Increasing the allocated lunch eating duration was frequently cited as a way to improve the school food environment. A similar proportion of parents and teachers agreed with teachers monitoring food intake, not providing feedback on food brought to school, and that parents should decide what children eat. More parents (44%) than teachers (23%) believed that teachers should eat their own lunch with the children. These findings provide an insight into the primary school lunch environment and the views of two key stakeholder groups. School food policies should consider these findings in future revisions, particularly with regards to eating times.

Impact of design elements of the implant supracrestal complex (ISC) on the risk of peri-implant mucositis and peri-implantitis: A critical review.

OBJECTIVE: The aim of this review was to investigate the evidence correlating the emergence profile (EP) and emergence angle (EA), peri-implant tissue height, implant neck design, abutment and/or prosthesis material, retention and connection types with risk of peri-implant mucositis and peri-implantitis. METHODS: Seven focus questions were identified, and seven electronic search queries were conducted in PubMed. Human studies reporting on bleeding on probing, probing depth or case definitions of peri-implant mucositis and peri-implantitis were included. RESULTS: Emerging evidence with bone-level implants suggests a link between EA combined with convex EP and peri-implantitis. Depth of the peri-implant sulcus of ≥3 mm is shown to be reducing the effectiveness of treatment of established peri-implant mucositis. Modification of the prosthesis contour is shown to be an effective supplement of the anti-infective treatment of peri-implant mucositis. Limited evidence points to no difference with regard to the risk for peri-implant mucositis between tissue- and bone-level implants, as well as the material of the abutment or the prosthesis. Limited evidence suggests the use or not of prosthetic abutments in external connections and does not change the risk for peri-implantitis. Literature with regard to prosthesis retention type and risk for peri-implantitis is inconclusive. CONCLUSIONS: Limited evidence indicates the involvement of EA, EP, sulcus depth and restricted accessibility to oral hygiene in the manifestation and/or management of peri-implant mucositis/peri-implantitis. Conclusions are limited by the lack of consensus definitions and validated outcomes measures, as well as diverse methodological approaches. Purpose-designed studies are required to clarify current observations.

Quality Assessment of Five Randomly Chosen Ceramic Oral Implant Systems: Cleanliness, Surface Topography, and Clinical Documentation.

PURPOSE: After some initial setbacks in the 1970s, ceramic implants seem to be a promising alternative to titanium implants. Since the surface of an implant system represents the interface to surrounding biologic structures, the study focuses on cleanliness and surface topography. Clinical documentation of the corresponding systems completes the picture and allows a better evaluation of zirconia implant systems. MATERIALS AND METHODS: Five different ceramic implant systems were selected randomly and purchased via blind-shopping: Z5s (Z-Systems), ZiBone (COHO), W implant (TAVDental), ceramic. implant (vitaclinical), and BioWin!/Standard Zirkon Implantat (Champions-Implants/ZV3 system). Three samples of each implant system underwent scanning electron microscopy (SEM) imaging and elemental analysis (EDS). Where appropriate, subsequent Time-of-Flight Secondary Ion Mass Spectrometry (ToF-SIMS) was performed to identify the chemical nature of impurities. Surface topography was evaluated, and a search for clinical trials in the PubMed database, on the websites and by written request to each dental implant manufacturer, was performed. RESULTS: Surfaces of Champions implants (ZV3) and Z-Systems implants were relatively clean, whereas the other investigated surfaces of vitaclinical, TAV Dental, and ZiBone implants all displayed organic contaminations on their surfaces. Four of the investigated ceramic implants showed a moderately rough implant surface. Only the vitaclinical ceramic.implant had minimal surface roughness. Three ceramic designs-vitaclinical, ZV3, and Z-Systems-had clinical trials documented with up to 3 years of follow-up and results varying between 82.5% and 100% survival. TAV Dental W and ZiBone implant systems lacked properly conducted clinical recording of results. CONCLUSION: The results of this study showed that it is technically possible to produce zirconia implants that are largely residue-free. On the other hand, the variety of significant residues found in this analysis raises concerns, as contamination may lead to undesirable biologic effects. The lack of clinical studies in peer-reviewed journals does not seem to be relevant for the approval of marketing, nor does the lack of surface cleanliness. In the authors' opinion, a critical analysis of these aspects should be included in a more stringent future analysis prior to the marketing of oral implant systems.

Translucent Zirconium Dioxide and Lithium Disilicate: A 3-Year Follow-up of a Prospective, Practice-Based Randomized Controlled Trial on Posterior Monolithic Crowns.

PURPOSE: To systematically evaluate and compare the clinical performance of lithium disilicate (LDS)- and zirconium dioxide (ZrO2)-based ceramic monolithic crowns in the posterior dentition. MATERIALS AND METHODS: Treatment was administered by two experienced general dental practitioners in two public dental health care clinics. Forty-four patients received 60 crowns randomized to be either LDS or ZrO2 and cemented with resin cement. Evaluations were performed after 3 years using California Dental Association criteria. RESULTS: The mean follow-up time was 40 months (range: 31 to 50). No crown fractured during the observation time, and no chip-off fractures occurred. The success rate for ZrO2 was 80%, and the survival rate was 93.3%. For LDS, the success rate was 89.7%, and the survival rate was 100%. Survival after 3 years for all crowns together was 96.6%, and success was 84.7%. There was no significant difference between the two materials. CONCLUSION: Crowns made of monolithic translucent ZrO2 and LDS show equal and promising clinical results from a short-term perspective. There seems to be a difference between how patients and professionals rate crowns concerning esthetics (color and shape), with patients rating the restorations more favorably.

Implant and prosthesis failure rates with implant-supported maxillary overdentures: a systematic review.

PURPOSE: To assess the clinical outcomes of maxillary overdentures supported by dental implants by conducting a literature review. MATERIALS AND METHODS: An electronic search was undertaken in March 2019. Eligibility criteria included publications reporting cases of implant-supported maxillary overdentures with follow-up information. RESULTS: A total of 131 publications were included (1,478 overdentures supported by 6,681 implants). The mean number of attachments per overdenture was 3.8 ± 1.2 (range: 1 to 9), and a bar-clip system was used in about half of the cases. The prostheses were followed up for a mean of 47.9 ± 32.8 (range 1: to 240) months. A total of 401 implants (6.0%) failed in 219 patients (14.8%), and 55 prostheses (3.7%) failed at a mean of 40.2 ± 53.2 (6 to 240) months after placement. Most of the failures happened within the first year after placement for both implants (52.1%) and prostheses (41.8%). Patients with fewer implants per prosthesis presented higher prosthesis failure rates than patients with more implants per prosthesis. The cumulative survival rate for dental implants after 19 years was 70.4%, and for implant-supported maxillary overdentures was 79.8%. Presence of palatal coverage and/or metallic structure/reinforcement does not seem to have an influence on failure rate. Of the most commonly used attachment systems, the ball/O-ring and the Ceka were the ones with the highest rates of patients having at least one implant failure. CONCLUSION: Most of the prosthesis failures were due to loss of implants, and the first year was the most critical period for failures. The number of dental implants placed per patient seemed to have an impact on the occurrence of overdenture failure.