Theoretical axial wall angulation for rotational resistance form in an experimental-fixed partial denture.

PURPOSE: The aim of this study was to determine the influence of long base lengths of a fixed partial denture (FPD) to rotational resistance with variation of vertical wall angulation. MATERIALS AND METHODS: Trigonometric calculations were done to determine the maximum wall angle needed to resist rotational displacement of an experimental-FPD model in 2-dimensional plane. The maximum wall angle calculation determines the greatest taper that resists rotation. Two different axes of rotation were used to test this model with five vertical abutment heights of 3-, 3.5-, 4-, 4.5-, and 5-mm. The two rotational axes were located on the mesial-side of the anterior abutment and the distal-side of the posterior abutment. Rotation of the FPD around the anterior axis was counter-clockwise, Posterior-Anterior (P-A) and clockwise, Anterior-Posterior (A-P) around the distal axis in the sagittal plane. RESULTS: Low levels of vertical wall taper, ≤ 10-degrees, were needed to resist rotational displacement in all wall height categories; 2-to-6-degrees is generally considered ideal, with 7-to-10-degrees as favorable to the long axis of the abutment. Rotation around both axes demonstrated that two axial walls of the FPD resisted rotational displacement in each direction. In addition, uneven abutment height combinations required the lowest wall angulations to achieve resistance in this study. CONCLUSION: The vertical height and angulation of FPD abutments, two rotational axes, and the long base lengths all play a role in FPD resistance form.

Daily Intake of Probiotic Lactobacilli May Reduce Caries Risk in Young Children.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Probiotic compared with standard milk for high-caries children: A cluster randomized trial. Rodríguez G, Ruiz B, Faleiros S, Vistoso A, Marró ML, Sánchez J, Urzúa I, Cabello R. J Dent Res 2016;95(4):402-7. SOURCE OF FUNDING: Chilean Government (CONICYT FONIS SA11I2035) TYPE OF STUDY/DESIGN: Cluster randomized controlled trial.

Limited Evidence Suggests Tooth Loss is Associated With Increased Risk of Cognitive Impairment.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Tooth loss increases the risk of diminished cognitive function: a systematic review and meta-analysis. Cerutti-Kopplin D, Feine J, Padilha DM, et al. JDR Clin Translational Res 2016;1(1):10-9. SOURCE OF FUNDING: Government. Dr Cerutti-Kopplin received a scholarship for the Coordenaçao de Aperfeiçoamento de Pessoal de Nível Superior, Brazil; Dr Booij received a new investigator award from the Canadian Institutes of Health Research; and Dr Emami holds a Canadian Institutes of Health Research Clinician Science Award and new investigator funds from the Fonds de Recherche du Québec-Santé TYPE OF STUDY/DESIGN: Systematic review with meta-analysis of data.

Alcohol Consumption May Increase the Risk for Periodontal Disease in Some Adult Populations.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Alcohol consumption and risk of periodontitis: a meta-analysis. Wang J, Lv J, Wang W, Jiang X. J Clin Periodontol 2016;43(7):572-83. SOURCE OF FUNDING: The authors reported that no external funding sources, apart from the support of the authors' institutions, were available for this study TYPE OF STUDY/DESIGN: Systematic review with meta-analysis of data.

Coffee consumption and periodontal disease in males.

BACKGROUND: Coffee is a major dietary source of antioxidants as well as of other anti-inflammatory factors. Given the beneficial role of such factors in periodontal disease, whether coffee intake is associated with periodontal disease in adult males was explored. METHODS: Existing data collected by a prospective, closed-panel cohort study of aging and oral health in adult males was used. Participants included the 1,152 dentate males in the Veterans Affairs (VA) Dental Longitudinal Study who presented for comprehensive medical and dental examinations from 1968 to 1998. Mean age at baseline was 48 years; males were followed for up to 30 years. Participants are not VA patients; rather, they receive their medical and dental care in the private sector. Periodontal status was assessed by probing depth (PD), bleeding on probing, and radiographic alveolar bone loss (ABL), measured on intraoral periapical radiographs with a modified Schei ruler method. Moderate-to-severe periodontal disease was defined as cumulative numbers of teeth exhibiting PD ≥4 mm or ABL ≥40%. Coffee intake was obtained from participant self-reports using the Cornell Medical Index and food frequency questionnaires. Multivariate repeated-measures generalized linear models estimated mean number of teeth with moderate-to-severe disease at each examination by coffee intake level. RESULTS: It was found that higher coffee consumption was associated with a small but significant reduction in number of teeth with periodontal bone loss. No evidence was found that coffee consumption was harmful to periodontal health. CONCLUSION: Coffee consumption may be protective against periodontal bone loss in adult males.

Incorporating severity and risk as factors to the Fardal cost-effectiveness model to create a cost-benefit model for periodontal treatment.

BACKGROUND: A previously described economic model was based on average values for patients diagnosed with chronic periodontitis (CP). However, tooth loss varies among treated patients and factors for tooth loss include CP severity and risk. The model was refined to incorporate CP severity and risk to determine the cost of treating a specific level of CP severity and risk that is associated with the benefit of tooth preservation. METHODS: A population that received and another that did not receive periodontal treatment were used to determine treatment costs and tooth loss. The number of teeth preserved was the difference of the number of teeth lost between the two populations. The cost of periodontal treatment was divided by the number of teeth preserved for combinations of CP severity and risk. RESULTS: The cost of periodontal treatment divided by the number of teeth preserved ranged from (US) $1,405 to $4,895 for high or moderate risk combined with any severity of CP and was more than $8,639 for low risk combined with mild CP. The cost of a three-unit bridge was $3,416, and the cost of a single-tooth replacement was $4,787. CONCLUSION: Periodontal treatment could be justified on the sole basis of tooth preservation when CP risk is moderate or high regardless of disease severity.

High-fiber foods reduce periodontal disease progression in men aged 65 and older: the Veterans Affairs normative aging study/Dental Longitudinal Study.

OBJECTIVES: To determine whether foods that are good to excellent sources of fiber reduce periodontal disease progression in men. DESIGN: Prospective, observational study. SETTING: Greater Boston, Massachusetts, metropolitan area. PARTICIPANTS: Six hundred twenty-five community-dwelling men participating in the Department of Veterans Affairs Dental Longitudinal Study. MEASUREMENTS: Dental and physical examinations were conducted every 3 to 5 years. Diet was assessed using food frequency questionnaires (FFQs). Mean follow-up was 15 years (range: 2-24 years). Periodontal disease progression on each tooth was defined as alveolar bone loss (ABL) advancement of 40% or more, probing pocket depth (PPD) of 2 mm or more, or tooth loss. Good and excellent fiber sources provided 2.5 g or more of fiber per serving. Multivariate proportional hazards regression estimated hazard ratios (HRs) and 95% confidence intervals (CIs) of periodontal disease progression and tooth loss in relation to fiber sources, stratified according to age younger than 65 versus 65 and older, and controlled for smoking, body mass index, calculus, baseline periodontal disease level, caries, education, exercise, carotene, thiamin and caffeine intake, and tooth brushing. RESULTS: In men aged 65 and older, each serving of good to excellent sources of total fiber was associated with lower risk of ABL progression (HR = 0.76, 95% CI = 0.60-0.95) and tooth loss (HR = 0.72, 95% CI = 0.53-0.97). Of the different food groups, only fruits that were good to excellent sources of fiber were associated with lower risk of progression of ABL (HR = 0.86 per serving, 95% CI = 0.78-0.95), PPD (HR = 0.95, 95% CI = 0.91-0.99), and tooth loss (HR = 0.88, 95% CI = 0.78-0.99). No significant associations were seen in men younger than 65. CONCLUSION: Benefits of higher intake of high-fiber foods, especially fruits, on slowing periodontal disease progression are most evident in men aged 65 and older.

Overweight and obesity predict time to periodontal disease progression in men.

AIMS: To examine whether overweight and obesity indicators - body mass index (BMI), waist circumference (WC), and WC-to-height ratio - predict progression of periodontal disease in men. MATERIAL AND METHODS: Participants were 1038 medically healthy, non-Hispanic, white males in the VA Dental Longitudinal Study who were monitored with triennial oral and medical examinations between 1969 and 1996. Periodontal disease progression in an individual was defined as having two or more teeth advance to levels of alveolar bone loss ≥40%, probing pocket depth ≥5 mm, or clinical attachment loss ≥5 mm after baseline. Extended Cox regression analyses estimated hazards of experiencing periodontal disease progression events due to overweight/obesity status, controlling for age, smoking, education, diabetes, recent periodontal treatment, recent prophylaxis, and number of filled/decayed surfaces. RESULTS: Body mass index and WC-to-height ratio were significantly associated with hazards of experiencing periodontal disease progression events regardless of periodontal disease indicator. Adjusted hazard ratios for periodontal disease progression were 41-72% higher in obese men (BMI ≥30 kg/m(2)) relative to men with both normal weight and WC-to-height ratio (≤50%). CONCLUSION: Both overall obesity and central adiposity are associated with an increased hazards of periodontal disease progression events in men.

Reduction of tooth loss associated with periodontal treatment.

Comparing tooth loss for populations comprising subjects with periodontal disease has been limited by broad and different definitions of disease severity. Numeric scores for periodontal disease severity and risk were used to enhance the precision of comparing tooth loss for two populations. Both populations received routine dental care, but only one received comprehensive periodontal treatment. The analysis provides evidence that adding periodontal treatment to routine dental care is associated with less tooth loss and more patients who do not lose any teeth. Furthermore, it may be possible to nearly eliminate tooth loss associated with periodontal disease.

Tooth loss and periodontal disease predict poor cognitive function in older men.

OBJECTIVES: To determine whether rates of tooth loss, periodontal disease progression, and caries incidence predict cognitive decline in men. DESIGN: Prospective study. SETTING: Community-dwelling men enrolled in the Veterans Affairs Dental Longitudinal Study. PARTICIPANTS: Five hundred ninety-seven dentate men aged 28 to 70 at study baseline who have been followed up to 32 years. MEASUREMENTS: Oral examinations were conducted approximately every 3 years. Periodontal disease measures included probing pocket depth and radiographic alveolar bone height. Participants underwent cognitive testing beginning in 1993. Low cognitive status was defined as less than 25 points or less than 90% of the age- and education-specific median on the Mini-Mental State Examination (MMSE) and less than 10 points on a spatial copying task. RESULTS: Each tooth lost per decade since the baseline dental examination increased the risks of low MMSE score (hazard ratio (HR)=1.09, 95% confidence interval (CI)=1.01-1.18) and low spatial copying score (HR=1.12, CI=1.05-1.18). Risks were greater per additional tooth with progression of alveolar bone loss (spatial copying: HR=1.03, CI=1.01-1.06), probing pocket depth (MMSE: HR=1.04, CI=1.01-1.09; spatial copying: HR=1.04, CI=1.01-1.06), and caries (spatial copying: HR=1.05, CI=1.01-1.08). Risks were consistently higher in men who were older than 45.5 at baseline than in younger men. CONCLUSION: Risk of cognitive decline in older men increases as more teeth are lost. Periodontal disease and caries, major reasons for tooth loss, are also related to cognitive decline.

Does the graft source really matter in the outcome of patients undergoing anterior cruciate ligament reconstruction? An evaluation of autograft versus allograft reconstruction results: a systematic review.

BACKGROUND: Despite the large number of anterior cruciate ligament reconstructions performed each year, there remains a significant controversy regarding the effect of the graft source on the functional outcome of patients. HYPOTHESIS: There is no difference in outcomes of autograft versus allograft anterior cruciate ligament reconstructions. STUDY DESIGN: Systematic review. METHODS: The authors systematically identified prospective studies (Oxford level of evidence I or II only) that included autograft patients, allograft patients, or both. Objective outcomes that were reported were meta-analyzed; this included pivot-shift results, KT-1000 arthrometer results, International Knee Documentation Committee (IKDC) scores, Lysholm Scores, graft failures, and postoperative complications. Two statistical analyses were performed. First a primary statistical analysis was performed comparing pooled autograft data (bone-patellar-tendon bone and hamstrings combined) and pooled allograft data (bone-patellar-tendon bone and hamstrings combined). To have a more comprehensive understanding of the differences between each specific graft source, a secondary analysis was performed without pooling the data; this directly compared the 4 types of graft sources that were studied. RESULTS: Over 400 scientific manuscripts were initially reviewed; 31 manuscripts fulfilled all of the search criteria. There were very few statistically significant differences between autograft and allograft tissue. The KT-1000 arthrometer laxity testing revealed a mean of 1.4 +/- 0.2 mm (weighted mean +/- standard error of the mean) for the allograft group compared with 1.8 +/- 0.1 mm for the autograft group (t = 2.40; P <.02). However, this difference was only for the mean score; there was no statistical significance when considering KT-1000 arthrometer measurements of greater than 3 or 5 mm. The percentage of patients receiving a final IKDC score of "A" (normal knee) was statistically significant for allograft tissue (43.9% +/- 5.5%) versus autograft tissue (28.2% +/- 1.0%) reconstructions. There was no statistically significant difference between the percentages of IKDC scores of A or B for patients receiving pooled allograft (82.9% +/- 4.2%) versus pooled autograft (87.2% +/- 0.9%) anterior cruciate ligament reconstruction (t = 1.01; P > .1). The graft failure rate was 4.7 +/- 0.5 per 100 for autograft reconstructions and 8.2 +/- 2.1 per 100 allograft reconstructions; although this may represent a trend, it is not statistically significant (t = 1.49; P > .1). The complication rate was slightly higher for autograft reconstructions at 3.5 +/- 0.4 complications per 100 autograft reconstructions compared with 2.4 +/- 1.1 complications per 100 allograft reconstructions, but not significant (t = 1.41; P > .1). CONCLUSION: After a comprehensive examination and statistical analysis of the modern literature, the authors could not identify an individual graft source that was clearly superior to the other graft sources. This led them to believe that, with currently available data, the graft source has a minimal effect on the outcome of patients undergoing anterior cruciate ligament reconstruction.

Arthroscopic versus open acromioplasty: a meta-analysis.

BACKGROUND: To address persisting controversy in the literature concerning the efficacy of arthroscopic compared to open acromioplasty, a meta-analysis was performed to evaluate the treatment effect after both approaches. HYPOTHESIS: The final clinical outcomes will be the same after both open and arthroscopic acromioplasty. However, the arthroscopic technique results in faster recovery and less postoperative morbidity as reflected by faster return to work and decreased hospital stays. STUDY DESIGN: Meta-analysis; Level of evidence, 3. METHODS: We performed our search of published English language literature using PubMed. We also searched the proceedings from 4 major orthopaedic meetings convened from 2000 to 2007. Furthermore, the reference sections of all relevant articles were reviewed for pertinent studies and presentations. Nine studies met the inclusion criteria that directly compared arthroscopic versus open acromioplasty with minimum follow-up of 1 year. The analysis focused on 1-year clinical outcome and included comparison of the objective 100-point score, hospital stay, time until return to work, operative time, and complications. RESULTS: No significant differences were found in clinical outcomes or complications for the 2 groups. However, open acromioplasty was associated with longer hospital stays (2.3 days, P = .05) and a greater length in time until return to work (65.1 days) compared with the arthroscopic technique (48.6 days) (P < .05). CONCLUSION: Arthroscopic and open acromioplasty have equivalent ultimate clinical outcomes, operative times, and low complication rates. However, arthroscopic acromioplasty results in faster return to work and fewer hospital inpatient days compared with the open technique.

Periodontitis severity plus risk as a tooth loss predictor.

BACKGROUND: Tooth loss can be a consequence of the natural history of periodontitis. Stratification of periodontitis severity, risk, and tooth loss exists within the United States adult population, and tooth loss correlates to severity and risk. We evaluated the loss of teeth for a periodontitis-affected population categorized by the combination of severity and risk in which the subjects predominantly did not receive periodontal treatment. METHODS: The clinical records of 523 subjects enrolled in the Veterans Affairs Dental Longitudinal Study, covering a period of 15 years, were used. Disease severity, risk level, and the number of teeth lost for each subject were determined. RESULTS: A stepwise regression analysis showed that disease and risk scores predicted mean tooth loss rate. The P value for the disease score was <0.0005, and the P value for the risk score was 0.001. The ordinal logistic regression model showed that disease (P = 0.002) and risk scores (P = 0.000) were significantly associated with the probability of subjects losing a specific number of teeth. CONCLUSIONS: Tooth loss is more precisely and accurately predicted by the combination of risk score and periodontal disease score than by either score alone. The combined scores may be a surrogate variable for periodontal status. Because the scores are derived from routine clinical measurements, they may be useful for population surveillance and dynamics, practice management, patient care decisions, practice-based research, and the determination of treatment effectiveness and the factors required for successful treatment, resulting in improved oral health and higher clinician productivity and income.

Arthroscopic versus mini-open rotator cuff repair: a comprehensive review and meta-analysis.

BACKGROUND: Controversy remains regarding the results of all arthroscopic rotator cuff repairs compared with the mini-open approach. The purpose of this study was to perform a comprehensive literature search and meta-analysis of clinical trials comparing the results of arthroscopic rotator cuff repairs and mini-open rotator cuff repairs. HYPOTHESIS: There is no difference between the clinical results obtained from all arthroscopic rotator cuff repairs compared with mini-open repairs. STUDY DESIGN: Meta-analysis. METHODS: A computerized search of articles published between 1966 and July 2006 was performed using MEDLINE and PubMed. Additionally, a search of abstracts from 4 major annual meetings each held between 2000 and 2005 was performed to identify Level I to III studies comparing the results of arthroscopic rotator cuff repair and mini-open repair. Studies that included follow-up of an average of over 2 years and a minimum of 1 year and included the use of 1 of 4 validated functional outcome scores used to study shoulder injuries were included in the present meta-analysis. All outcome scores were converted to a 100-point scale to allow for outcome comparison. RESULTS: Five studies that met the inclusion criteria were identified. There was no difference in functional outcome scores or complications between the arthroscopic and mini-open repair groups. CONCLUSION: Based on current literature, there was no difference in outcomes between the arthroscopic and mini-open rotator cuff repair techniques.

Extension and density of root fillings and postoperative apical radiolucencies in the Veterans Affairs Dental Longitudinal Study.

We evaluated the association between radiographically assessed extension and density of root canal fillings and postoperative apical radiolucencies (ARs) by using data from 288 participants in the Veterans Affairs Dental Longitudinal Study. Study subjects were not Veterans Affairs patients; all received their medical and dental care in the private sector. Generalized estimating equations were used to account for multiple teeth within subjects and to control for covariates of interest. Defective root filling density was associated with increased odds of postoperative AR among teeth with no preoperative AR (odds ratio, 3.0; 95% confidence interval [CI], 1.3-7.1), although preoperative AR was the strongest risk factor for postoperative AR (odds ratio, 29.2; 95% CI, 13.6-63.0 among teeth with ideal density). Compared with well-extended root fillings, neither overextended nor underextended root fillings separately were related to postoperative AR, but when those 2 categories were collapsed into one poorly extended category, poor extension was related to postoperative AR (odds ratio, 1.8; 95% CI, 1.1-3.2).

Bone health and oral health.

BACKGROUND: Low bone mass in the skeleton, which increases the risk of osteoporotic fracture, also may be associated with periodontal bone loss and tooth loss. Osteoporosis and periodontal disease share several common risk factors, including older age, smoking and perhaps insufficient dietary intakes of calcium and vitamin D. CONCLUSION: Research supports the idea that osteoporosis independently influences alveolar bone height loss. Strategies for reducing osteoporosis risk also may help retard alveolar bone loss. Meeting dietary intake recommendations for calcium and vitamin D is one strategy that is appropriate for a broad segment of the population. CLINICAL IMPLICATIONS: A healthy lifestyle has multiple benefits for the mouth and throughout the body. Dental professionals can play a role in preventing osteoporosis by reinforcing this message.

Posterior shoulder instability: comprehensive analysis of open and arthroscopic approaches.

Whether open surgery and arthroscopic repair of posterior shoulder instability have similar success rates remains unknown, but the literature suggests that arthroscopic soft-tissue stabilization procedures equal open surgery in managing posterior shoulder instability. A comprehensive PubMed computer search of the English-language literature from 1988 to 2004 was performed using the key phrase posterior shoulder instability. Studies included in our analysis addressed the surgical treatment of recurrent posterior instability and multidirectional instability with primarily a posterior component of instability; studies were excluded if their minimum follow-up was less than 1 year, if their patients had a history of habitual posterior shoulder instability, or if their patients had either bony procedures or thermal capsulorrhaphy. Data collected from each study included patient demographics, instability classifications (traumatic vs atraumatic), previous shoulder stabilizations, and clinical outcomes. After identifying and reviewing 283 abstracts, we found that 16 articles fulfilled the inclusion criteria--9 open studies (173 patients) and 7 arthroscopic trials (186 patients). The 2 treatment groups had similar sex distributions (P> .25). Mean age was 23 years for the open group and 26 years for the arthroscopic group (P< .02). Clinical outcomes were rated satisfactory by 72% of patients in the open group and 83% of patients in the arthroscopic group (P< .55), controlling for age. Eighty-five percent of patients treated with an open technique and 81% of patients treated arthroscopically returned to sports (P< .82). This study demonstrated no statistical difference in clinical outcomes for patients treated with either open or arthroscopic surgery for posterior shoulder instability.