Evaluation of Prosthetic Complications with Metal-Acrylic Resin Implant-Fixed Complete Dentures: A Medium- and Long-Term Retrospective Analysis with Up to 13 Years of Follow-up

PURPOSE: To present prosthetic complications observed in the medium and long term in patients treated with metal-acrylic resin implant-supported fixed complete dentures (MAIFCDs). MATERIALS AND METHODS: A total of 87 patients who were treated with MAIFCDs were included. Acrylic resin (denture teeth and base) fracture, screw loosening (prosthetic or abutment), screw (prosthetic or abutment), and framework fracture were analyzed for descriptive statistics. Product-limit survival estimates were used for the cumulative no-complication rate (CNCR) of prostheses. All results were assessed using α = .05. RESULTS: The average observation time was 42.9 months (range: 19 to 153). Of 597 implants, 8 mandibular (44.4%) and 10 maxillary implants (55.6%) failed. In total, 29 patients (33.3%) experienced no complications in an average of 7 years, and 58 patients (66.6%) experienced at least one complication. The average time for the first complication to occur was 23 months (range: 1 to 97 months). The average number of complications was 5.9/patient. Acrylic resin complications were the most frequent, followed by screw loosening, screw fracture, and framework fracture. Of those patients with complications, 9 (16%) had maxillary MAIFCDs with an average of 4 complications. In total, 28 patients (48%) had only mandibular MAIFCDs with an average of 5 complications, and 21 patients (36%) had both arches treated with MAIFCDs with an average of 9 complications. Mandibular MAIFCDPs in women had a higher CNCR compared to maxillary MAIFCDs of both women and men and when both arches of women were treated with MAIFCDs (P < .05). CONCLUSIONS: The CNCR of MAIFCDs differed depending on the arch treated and sex. Mandibular MAIFCDs in women had a lower complication rate than MAIFCDs in other arch-sex pairs. Acrylic resin related complications were commonly observed as well as prosthetic screw loosening.

Relation between the risk factors for the severity of denture stomatitis and quality of life of complete edentulous individuals: a cross-sectional study.

OBJECTIVE: To assess the association between risk factors for developing denture stomatitis (DS) and oral health-related quality of life (OHRQoL) in complete denture wearers. METHODOLOGY: Participants of both sexes, wearing complete dentures, were classified using the modified Newton classification for the absence or the severity of DS and allocated to groups Normal or zero, IA, IB, II, and III. Lifestyle, oral and denture history, and medication use were assessed using specific questionnaires; clinical parameters such as anatomical characteristics of support were evaluated with the Kapur classification; salivary flow (SF) was calculated by the volume of unstimulated saliva per minute; and microbial load was determined by counting colony forming units (CFU) of target microorganisms present in the biofilm collected from dentures and palate. OHIP-EDENT assessed the OHRQoL. Kendall's tau_b and Spearman tests were applied with a significance level of 5%. RESULTS: 184 patients (143 female and 41 male) aged 65.5 ± 6.8 years were evaluated. Positive correlations were found for sex (women; p=0.013, r=0.16), individuals who started to consume alcoholic beverages as a young adult (18-27 years) (p=0.008, r=0.22), CFU of Candida spp. (p<0.001, r=0.27 denture; p<0.001, r=0.31 palate); Candida albicans (p=0.004, r=0.22 denture; p=0.003, r=0.25 palate), and Candida glabrata (p=0.004, r=0.22 denture; p=0.001, r=0.27 palate). Moreover, negative correlations with DS were found for CFU of Staphylococcus spp. (p=0.004, r=-0.20 palate) and enterobacteria (p=0.002, r=-0.24 palate), as well as a negative correlation between SF (p=0.009, r=-0.193) and DS. The CFU of Staphylococcus spp. and enterobacteria on the palate significantly correlated with OHRQoL. CONCLUSION: Being female, consuming alcoholic beverages as a young adult, CFU of Candida spp., Candida albicans, Candida glabrata, and salivary flow may be the most significant risk factors for DS. The microbial load of Staphylococcus spp. and enterobacteria seems to influence the quality of life for complete denture wearers.

The association of denture wearing with reduced lung function and increased airflow limitation in 58-72 year old men.

OBJECTIVE: To investigate the association between denture wearing and airflow limitation in men in Northern Ireland enrolled in the Prospective Epidemiological Study of Myocardial Infarction (PRIME) study. METHODS: A case-control design was used to study partially dentate men. Cases were men aged 58-72 years who were confirmed as denture wearers. Controls were never denture wearers who were matched by age (± 1 month) and smoking habit to the cases. The men had a periodontal assessment and completed a questionnaire detailing their medical history, dental history and behaviours, social circumstances, demographic background and tobacco use. Physical examination and spirometry measurements of forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) were also undertaken. Spirometry data for edentulous men who wore complete dentures were compared with that recorded for the partially dentate men studied. RESULTS: There were 353 cases who were partially dentate and were confirmed denture wearers. They were matched for age and smoking habit to never denture wearer controls. The cases had an FEV1 that was on average 140 ml lower than the controls, p = 0.0013 and a 4% reduction in percent predicted FEV1, p = 0.0022. Application of the GOLD criteria indicated that 61 (17.3%) of the cases had moderate to severe airflow limitation compared with 33 (9.3%) of controls, p = 0.0051. Fully adjusted multivariable analysis showed that partially dentate men who were denture wearers were significantly more likely (p = 0.01) to have moderate to severe airflow reduction with an adjusted odds ratio (OR) of 2.37 (95% confidence intervals 1.23-4.55). In the 153 edentulous men studied moderate to severe airflow limitation was recorded in 44 (28.4%), which was significantly higher than in the partially dentate denture wearers (p = 0.017), and the men who had never worn a denture (p<0.0001). CONCLUSION: Denture wearing was associated with an increased risk of moderate to severe airflow limitation in the cohort of middle-aged Western European men studied.

Palatal brushing for the treatment of denture stomatitis: A multicentre randomized controlled trial.

PURPOSE: To determine the effectiveness of palatal brushing in the treatment of denture-related erythematous stomatitis (DES) in complete denture wearers. METHODS: This two-parallel-arm RCT was conducted in three university clinics in Brazil, Canada, and Chile. Participants (n=77) were randomly allocated to receive (i) instructions for palatal brushing and standard oral/denture hygiene ("intervention"); or (ii) standard oral/denture hygiene instructions only ("control"). Data collection was carried out at the baseline and at 3 and 6 months after intervention. Outcomes included the magnitude of oral Candida carriage and the degree of inflammation of denture-bearing tissues. Groups were compared using generalized estimating equations and chi-square test (α=0.05). RESULTS: Palatal inflammation levels were reduced significantly in the "intervention" compared to "control" group at 6 months (intervention: 70%, control: 40%; chi-square, p=0.04). There was no between-group significant difference in the Candida count from denture and palatal biofilms; however, a subgroup analysis restricted to baseline Candida carriers showed further reduction with the intervention at 6 months. No adversity was observed by trialist or reported by participants. CONCLUSIONS: Including palatal brushing in oral instructions for denture wearers has positive impact on DES-related mucosal inflammation. Thus, our findings endorse the inclusion of palatal brushing in standard oral hygiene instructions to treat DES.

Biomechanical variables affect peri-implant bone loss in implant-supported fixed complete dentures: A methodological and prospective study.

PURPOSE: Implant-supported fixed complete dentures (IFCD) experience failures and complications related to biological and technical risk factors. This study investigated the effect of biomechanical variables of IFCD on 1-year peri-implant bone loss at the buccal, palatal/lingual, mesial, and distal implant sides. A new method was used to measure the geometric biomechanical variables of IFCD using cone beam computed tomography (CBCT). METHODS: The study sample consisted of 246 external hexagon implants supporting 48 hybrid IFCD in 44 patients. CBCT images obtained immediately (T0) and 1 year (T1) after prosthesis installation were used to measure the support polygon area, clinical crown/implant (C/I) ratio (vertical lever), anteroposterior power and resistance arms, anterior and posterior cantilevers (horizontal levers), and peri-implant bone remodeling (T1-T0). Data were analyzed using multilevel multivariable models. RESULTS: The average total bone loss in the mandible and maxilla were 0.88 mm, with a loss of 0.62 mm in the mandible and 1.08 mm in the maxilla. The C/I ratio had a significant effect on bone loss on the mesial, distal, and palatal/lingual sides (P <.05). The anterior cantilever had a protective effect on the lingual side of the anterior implant. No effect on bone loss was found for the support polygon area, posterior cantilever, resistance arm, or power arm (P >.05). CONCLUSIONS: The results suggest that the C/I ratio and anterior cantilever in IFCD affect peri-implant bone loss according to the implant side and position in the arch.

Comparative analysis of Candida spp. isolated from complete denture wearers with and without an HIV diagnosis.

STATEMENT OF PROBLEM: Denture-related stomatitis (DRS), an inflammation frequently present in human immunodeficiency virus-positive (HIV+) individuals, can be attributable to colonization by Candida spp., which is considered a main factor. The virulence factors of these species are often modulated by the systemic condition of their hosts. PURPOSE: The purpose of this clinical study was to evaluate the incidence, virulence, and morphology of Candida spp. isolated from biofilms of complete denture wearers with DRS, with and without an HIV diagnosis. In addition, the interaction of the systemic condition with the ability of Candida spp. to colonize was evaluated. MATERIAL AND METHODS: Fifty-five complete denture wearers diagnosed with DRS were divided into 2 groups: experimental (HIV+) and control (human immunodeficiency virus-noninfected participants [HIV-]). Biofilm was collected by a standardized method of ultrasonification of prostheses. The incidence was evaluated by a chromogenic method and polymerase chain reaction (PCR). The virulence factors were assessed by using the capacity for biofilm formation by counting colony-forming units (CFUs/mL), biofilm metabolism by tetrazolium salt metabolization, and proteinase and phospholipase production by using a fluorimetric kit. Morphology was verified by using the hyphae-inducing test, and participants' health data were collected with a form. Data were analyzed by using the Student t, Mann-Whitney U, Spearman, and Fisher tests (α=.05). RESULTS: The results of incidence were related to 55 participants (22 experimental and 33 control); in total, 63 Candida spp. samples were isolated, showing 28 Candida albicans and 36 nonalbicans strains. No significant difference was found between groups in baseline CFU/mL counts, biofilm formation capacity, cell metabolism, and phospholipase production. Proteinase production was higher for C. albicans in the control (P=.031) and for nonalbicans in the experimental (P=.016) groups. Relative to health data, the experimental group showed a moderate negative correlation between the CFU count/mL at baseline for nonalbicans and DRS classification (P=.020). CONCLUSIONS: C. albicans was the most prevalent species. No difference was found in the Candida spp. of complete denture wearers with DRS, with and without an HIV diagnosis, with regard to virulence factors (except for proteinase production) and morphology.

Denture wearing status, cardiovascular health profiles, and mortality in edentulous patients: A prospective study with a 27-year follow-up.

OBJECTIVES: Life's Simple 7 (LS7) metrics provide insight into improving cardiovascular health (CVH) and help reduce mortality risks. Edentulous older adults have a higher mortality risk than dentulous ones, probably due to worse oral function. It is reported that wearing dentures will decrease the mortality risk factor by improving oral function. This prospective study aimed to investigate if denture wearing could modify the association between CVH profile and mortality risk among edentulous elderly. METHODS: From the Third National Health and Nutrition Examination Survey (NHANES III), 1,735 edentulous older adults (mean age 69.4 years old) with CVH profiles and data on denture wearing status were selected for this study. CVH profiles according to LS7 metrics were classified into poor, intermediate, or ideal. Denture wearers were defined as those wearing complete dentures in both arches all the time or only when awake. Multivariable Cox proportional-hazards regression was conducted to estimate the association of CVH profiles with all-cause and cardiovascular mortality. Stratified analyses and the testing of interaction terms were used to evaluate the difference between the association in edentulous patients with and without dentures. RESULTS: A total of 1,420 (81.8%) older adults died during the 27-year follow-up, with 478 (27.6%) cases attributable to heart disease. After controlling for potential confounders, edentulous patients with an ideal CVH (LS7 = 10-14) had a lower mortality risk than those with poor CVH (LS7 = 0-4). Furthermore, we observed an effect modification by denture use (Pinteraction = 0.046), with the role of ideal CVH in mitigating mortality among the denture wearers (Hazard Ratio = 0.440 [0.329-0.588]), while no significant association among those without dentures. Similar results were achieved for cardiovascular mortality, but there was no effect modification of denture use (Pinteraction = 0.352). CONCLUSION: In this study, a favorable cardiovascular health profile presents a protective effect on all-cause mortality only among edentulous patients wearing dentures instead of non-wearer. CLINICAL SIGNIFICANCE: Denture usage could improve oral function (e.g., chewing, smiling, speaking, etc.) and promote general health. Effect modification found in this study indicates having ideal CVH alone cannot substantially reduce mortality risk among edentulous patients. Therefore, health care professionals should keep an eye on the elderly not wearing dentures as they are probably more at risk for adverse health outcomes. It remains unclear if denture wearing has a causal relation with lower mortality risks, and further research is needed.

Impacto do uso de próteses totais na qualidade de vida de idosos institucionalizados / Impacto del uso de prótesis total en la calidad de vida de los ancianos institucionalizados / Impact of the use of complete dentures on the quality of life of institutionalized elderly people

RESUMO Introdução: O uso de próteses totais tem impacto na qualidade de vida relacionada à saúde bucal e os idosos são uma parcela da população a ser pesquisada sob essa perspectiva. Objetivo: Avaliar a autopercepção do impacto do uso de próteses totais na qualidade de vida relacionada à saúde bucal de idosos institucionalizados. Métodos: Participaram 20 idosos do Lar dos Idosos Recanto do Tarumã, Curitiba, Paraná, Brasil. Foram avaliados aspectos demográficos, econômicos, de hábitos e clínicos, juntamente com aplicação do questionário Geriatric Oral Health Assessment Index. Os dados foram submetidos à análise descritiva e bivariada (Teste do Qui-Quadrado), com significância de 5 porcento. Resultados: A média de idade foi de 75,2 anos (DP= 8,8) e o tempo médio de uso de prótese foi de 27,9 anos (DP= 18,5). Renda inferior a um salário mínimo foi indicada por 80,0 porcento, e visitas ao cirurgião-dentista pela última vez há mais de um ano, por 70,0 porcento. Os piores relatos foram referentes à mastigação, representados por problemas para mastigar alimentos e desconforto ao comer, com 25 porcento de respostas positivas em cada questão; a soma das frequências das respostas "às vezes" e "sempre" quanto à insatisfação ou à infelicidade com a aparência da boca foi reportada 60 porcento dos pesquisados. A retenção insatisfatória da prótese inferior se deu em 50,0 porcento casos, enquanto os problemas com oclusão estiveram presentes também em metade da amostra. Os defeitos estiveram presentes em 70,0 porcento das próteses superiores e 45,0 porcento das inferiores. Não foi encontrada associação significativa (p> 0,05) entre as variáveis independentes e o desfecho. Conclusões: Os idosos avaliados, independentemente das condições das próteses totais, relataram qualidade de vida relacionada à saúde bucal satisfatória(AU)

RESUMEN Introducción: El uso de prótesis totales tiene un impacto en la calidad de vida relacionada con la salud bucal, y los ancianos son parte de la población que se investigará desde esta perspectiva. Objetivo: Evaluar la autopercepción del impacto del uso de prótesis totales en la calidad de vida relacionada con la salud bucal de ancianos institucionalizados. Métodos: Participaron 20 ancianos de "Lar dos Idosos Recanto do Tarumã", Curitiba, Paraná, Brasil. Los aspectos demográficos, económicos, de hábitos y clínicos se evaluaron junto con la aplicación del cuestionario Geriatric Oral Health Assessment Index. Los datos fueron sometidos a análisis descriptivo y bivariado (prueba de chi cuadrado), con significación del 5 por ciento. Resultados: La edad media fue de 75,2 años (DE= 8,8) y el tiempo medio de uso de la prótesis fue de 27,9 años (DE= 18,5). Los ingresos menores a un salario mínimo se indicaron en el 80,0 por ciento, y las visitas al cirujano dental la última vez, hace más de un año, en el 70, 0 por ciento. Los peores informes estaban relacionados con la masticación, representados por problemas para masticar los alimentos y la incomodidad al comer, con el 25 por ciento de respuestas positivas en cada pregunta. La suma de las frecuencias de las respuestas "a veces" y "siempre" sobre la insatisfacción o la infelicidad con la apariencia de la boca se informó en el 60 por ciento de los encuestados. La retención insatisfactoria de la prótesis inferior se produjo en el 50 por ciento de los casos, mientras que la oclusión también presentó problemas en la mitad de la muestra. Los defectos estuvieron presentes en el 70,0 por ciento de las prótesis superiores y en el 45,0 por ciento de las inferiores. No se encontró asociación significativa (p> 0,05) entre las variables independientes y el desenlace. Conclusiones: Los ancianos evaluados, independientemente de las condiciones de las prótesis totales, informaron una calidad de vida relacionada con la salud bucal satisfactoria(AU)

ABSTRACT Introduction: The use of complete dentures has an impact on oral health-related quality of life. Elderly people are the population sector to be researched into from this perspective. Objective: Evaluate the self-perception of the impact of the use of complete dentures on the oral health-related quality of life of institutionalized elderly people. Methods: The study sample was 20 elderly people from Lar dos Idosos Recanto do Tarumã, Curitiba, Paraná, Brazil. Evaluation of demographic and economic details, habits and clinical aspects was based on the information collected with the Geriatric Oral Health Assessment Index questionnaire. The data were subjected to descriptive and bivariate analysis (Chi-squared test), with a significance of 5 percent. Results: Mean age was 75.2 (SD = 8.8) years and mean time of denture use was 27.9 (SD = 18.5) years. Income was below minimum wage in 80.0 percent of the participants, whereas the last visit to the dentist had occurred more than a year ago in 70.0 percent. The worst reports had to do with chewing, represented by problems to chew food and discomfort when eating, with 25 percent positive answers to each question. The sum of the frequencies of the answers "sometimes" and "always" about dissatisfaction with or unhappiness about the appearance of the mouth was reported by 60 percent of the respondents. Unsatisfactory retention of the lower denture occurred in 50.0 percent of the cases, whereas occlusion problems were present in half of the sample. Defects were present in 70.0 percent of the upper dentures and 45.0 percent of the lower dentures. No significant association (p> 0.05) was found between independent variables and outcome. Conclusions: The elderly people evaluated, regardless of the conditions of their complete dentures, reported satisfactory oral health-related quality of life(AU)

Denture Wearing and Malnutrition Risk Among Community-Dwelling Older Adults.

Most studies have associated denture wearing with a higher risk of malnutrition and lower nutritional intake in the elderly. As the effect of wearing dentures remains debatable, the aim of this study was to determine if older adults wearing dentures have a higher risk of malnutrition. We recruited 294 Japanese community-dwelling adults aged ≥65 years from two elderly welfare centers in Sapporo. The Mini Nutritional Assessment-Short Form (MNA-SF) was used to assess their nutritional status. Their demographic characteristics, eating habits, and health status were assessed using a questionnaire. Moreover, salt-impregnated taste paper and bioelectrical impedance analysis were used to obtain salt taste sensitivity and body composition (body mass index and protein mass). The mean age of older adults was 75.8 ± 5.8 years and 71.1% were women. We found that 74.1% of the older adults wore dentures. The proportion of the whole population with a risk of malnutrition was 23.5%. Multivariate analysis revealed that partial denture wearing could be protective against the risk of malnutrition. In this study, we found more partial denture wearers with normal nutritional conditions and cooking by themselves than non-denture-wearing older adults. Furthermore, complete denture wearers were eating significantly less meats or fish every day. This study suggests that using partial dentures to replace the lost teeth to meet the dietary needs of the elderly is critical to maintaining a healthy nutritional status. Moreover, it also indicates the importance of providing education to older adults who wear complete dentures.

Thirteen maxillary full dentures over 10 years: A case of peripheral painful traumatic trigeminal neuropathy.

There are multiple reasons for failure of full maxillary dentures. It is necessary for clinicians to consider the rationale behind the failure of the prosthesis before remaking a maxillary full denture. Diagnostic categories related to pertinent maxillofacial and oral neuropathies and psychosocial issues are also discussed. Here, we present a case with a natural history that supported a diagnosis of peripheral painful traumatic trigeminal neuropathy (PPTTN). Furthermore, the clinical oral examination revealed findings that were consistent with atrophic glossitis, necessitating an investigation of diagnoses of nutritional deficiency-induced neuropathy and/or oral candidiasis.

Evaluation of the treatment of halitosis with photodynamic therapy in older patients with complete denture: Protocol for a randomized, controlled trial.

BACKGROUND: Halitosis is the term used to define an unpleasant odor emanating from the mouth. However, no studies have evaluated the causes and treatment of halitosis in the population of older adults with denture. METHODS: A randomized, controlled trial is proposed. The patients will be divided into 2 groups: G1: older adults who wear complete dentures and will be treated with tongue scraper (n = 20); G2 older adults who wear complete dentures and will be treated with PDT (n = 20). If the halitosis persists, the participants will be submitted to hygiene procedures for the mucosa and dentures. The evaluation of halitosis will be made before and after treatments, with OralChroma. If the halitosis is solved, the participants will return after 1 week for an additional evaluation. Oral Health Impact Profile (OHIP-14) will be administered by a calibrated examiner on the day the patient history is taken (baseline) and 1 week after treatment for halitosis. DISCUSSION: This protocol will determine the effectiveness of photodynamic therapy regarding the reduction of halitosis in older adults with complete denture. TRIAL REGISTRATION: This protocol was registered in ClinicalTrial.gov, under number NCT03960983. It was first posted and last updated in May 23, 2019. https://clinicaltrials.gov/ct2/show/NCT03960983.

Risk factors for mandibular bone resorption in complete denture wearers.

This study aimed to evaluate the impact of factors related to the patient (age, sex, bruxism, and general health) or prosthesis (use of old dentures, duration of denture wear, and nocturnal wear) on the mandibular ridge resorption rate (RRR) of complete denture (CD) wearers. This retrospective cohort study was composed of edentulous patients who sought prosthodontic treatment for maxillary and mandibular CDs. The mandibular RRR was estimated based on panoramic radiographs (n = 120) obtained at the time of the clinical examination. The total height of the alveolar process was considered to be 3 times the distance from the inferior border of the mandible to the lower border of the mental foramen. Radiographic measurements were performed by 1 calibrated examiner. Data were collected from dental records related to the patient or prosthesis. Data were evaluated by 1-way analysis of variance or Student t test at a significance level of 5%. Of the factors evaluated, age (P ∼ 0.000), previous use of CDs (P ∼ 0.000), and bruxism history (P = 0.003) were statistically significant for the mandibular RRR. The RRR was greater among patients older than 60 years, those who had been wearing old CDs, and those who reported bruxism. Thus, the study results showed the negative influence of advanced age, use of old dentures, and bruxism on mandibular RRR.

Premaxilla Stress Distribution and Bone Resorption Induced by Implant Overdenture and Conventional Denture.

PURPOSE: To relate the principal stress, strain, and total deformation in the premaxilla region beneath a complete denture to the pattern of premaxilla bone resorption when opposed by a conventional complete denture (CD) or by a two-implant-retained overdenture (IOD) using finite element analysis (FEA). MATERIALS AND METHODS: Three-dimensional solid models of the maxilla, mucosa, and denture of a selected edentulous patient were created using Mimics and CATIA software. The FEA model was created and duplicated in ANSYS 16.0 to perform two simulations for the IOD and the CD models. The values of maximum stress and strain and total deformation were obtained and compared to the outcomes of premaxilla resorption from a parallel clinical study. RESULTS: The maximum principal stress in the premaxilla in the IOD model ranged from 0.019 to 0.336 MPa, while it ranged from 0.011 to 0.193 MPa in the CD model. The maximum principal strain in the IOD model was 1.75 times greater than that in the CD model. Total deformation was 1.8 times higher in the IOD model. Greater bone resorption was observed in regions of higher stress, which were on the occlusal and buccal sides of the premaxilla residual ridge. CONCLUSION: Stress, strain, and total deformation values present in the premaxilla area beneath a CD were approximately two times greater in a comparison between an opposing mandibular two-IOD and an opposing mandibular CD. The results were consistent with a parallel clinical study in which the rate of premaxilla bone resorption was almost three times greater in the IOD group.

Management of denture-related traumatic ulcers using ozone.

STATEMENT OF PROBLEM: Management of denture-related traumatic ulcers using ozone may improve tissue healing and reduce patient pain and discomfort. PURPOSE: The purpose of this clinical investigation was to assess the efficacy of ozone in the treatment of denture-related traumatic ulcers. MATERIAL AND METHODS: Seventy-five participants (study group) with denture-related traumatic ulcers were evaluated in this blinded, controlled cohort observational investigation. A control group (n=75) of participants with denture-related traumatic ulcers who matched the study group in sex and age were also recruited. Ulcers were treated with ozone gas for 60 seconds in the study group and with air for 60 seconds in the control group. Pain levels were evaluated by means of a visual analog scale (VAS), and ulcer sizes were measured in each participant at experiment baseline and each day for 15 days. Ulcer duration was established by calculating the period it took to completely heal and disappear. Major outcome measurements were ulcer duration, ulcer size, and levels of pain. RESULTS: Ulcer size decreased from day 2 in the study group (after ozone application) (P≤.01) and from day 4 in the controls (P≤.001). Recorded pain levels decreased from the first day soon after ozone application in the study group (P≤.001) and from day 3 in the controls (P<.001). Ulcer duration, ulcer size from day 3 to day 10, and reported pain levels from day 1 to day 10 decreased more in the study group (P≤.004). CONCLUSIONS: Exposure of denture-related traumatic ulcers to 60 seconds of ozone gas was associated with better ulcer healing and decreased pain levels, ulcer size, and ulcer duration.

Association between tongue and lip motor functions and mixing ability in complete denture wearers.

BACKGROUND: Masticatory performance of elderly complete denture wearers is low, which may lead to restriction on intakes of several foods such as fresh fruit or raw vegetables. AIM: The aim of this study was to investigate the relationship between tongue motor function, lip motor function, and mixing ability in complete denture wearers. MATERIALS AND METHODS: Participants comprised 54 complete denture wearers with a mean age of 77.1 years. Maximum tongue pressure and oral diadochokinesis were measured to evaluate tongue and lip motor functions. A color-changeable, chewing gum was used to evaluate mixing ability. The relationship between tongue and lip motor functions and mixing ability was assessed using stepwise multiple regression analysis. RESULTS: The stepwise multiple regression analysis identified maximum tongue pressure, the number of repetitions of the syllable "ka", and gender as significant predictors for mixing ability among complete denture wearers. DISCUSSION: The elderly edentulous individuals mainly used tongue motor function in oral motor functions for mixing color-changeable chewing gums, which might be ascribable to wearing complete dentures. CONCLUSIONS: Under the limited conditions of this study, factors relating to tongue motor function, tongue pressure and the number of repetitions of the syllable "/ka"/ significantly contributed to the mixing ability of complete denture wearers. It was suggested that tongue motor function had positive effect on the mixing ability of complete denture wearers.

Implant-supported cantilevered fixed dental rehabilitations in fully edentulous patients: Systematic review of the literature. Part II.

AIM: To investigate fully edentulous patients rehabilitated with cantilever-fixed implant-supported restorations and to analyse which complications are reported for this type of treatment. MATERIALS AND METHODS: Two operators screened the literature (MEDLINE, EMBASE) and performed a hand search on the main journals dealing with implantology and prosthetics until 31 December 2017. Only articles that considered cantilever implant-fixed restorations with at least 10 patients and with a mean follow-up of at least 5 years were selected. The outcome variables were survival of implants and prosthesis, mechanical, technical and biological complications, marginal bone loss. The review was performed according to the PRISMA statements. The risk of bias was evaluated for each article. Failure and complication rates were analysed using random effect Poisson regression models to obtain summary estimate of 5- and 10-year survival and complication rates. RESULTS: Fourteen papers for fully edentulous patients were selected. The estimated 5 to 10 years survival rate was calculated to be 99.00% and 96.7% for the implants and the prosthesis, respectively. A total of 299 complications (technical and biological) were reported with a cumulative 5-10 years complication rate of 44.41% and 39.46% for the patients and for the prosthesis, respectively. CONCLUSIONS: There is evidence that cantilever can be successful treatment in fully edentulous patients.

Biomechanical aspects: Summary and consensus statements of group 4. The 5th EAO Consensus Conference 2018.

OBJECTIVES: The aim of the present publication was to report on the EAO Workshop group-4 discussions and consensus statements on the five reviews previously prepared. These reviews provided the scientific evidence on the effect of crown-to-implant ratio, on reconstructions with cantilevers in fully and partially edentulous patients, on biological and technical complications of tilted in comparison with straight implants, and on the effects of osseointegrated implants functioning in a residual dentition. MATERIAL AND METHODS: The group discussed, evaluated, corrected where deemed appropriate, and made recommendations to the authors regarding the following five reviews submitted: (a) Is there an effect of crown-to-implant ratio on implant treatment outcomes?; (b) Implant-supported cantilevered fixed dental rehabilitations in fully edentulous patients; (c) and in partially edentulous patients; (d) Biological and technical complications of tilted implants in comparison with straight implants supporting fixed dental prostheses; (e) What are the adverse effects of osseointegrated implants functioning among natural teeth of a residual dentition? Based on the five manuscripts and the discussion among the group as well as the plenum members, the major findings were summarized, consensus statements were formulated, clinical recommendations were proposed, and areas of future research were identified. RESULTS: Crown-to-implant ratios ranging from 0.9 to 2.2 did not influence the occurrence of biological or technical complications also in single-tooth restorations. Reconstructions with cantilevers for the rehabilitation of fully and partially edentulous jaws showed high implant and reconstruction survival rates. In contrast, the rate of complications-in particular associated with veneering material-was high during the observation period of 5-10 years. The data reported were primarily derived from studies with high risk of bias. The data for single-implant reconstructions were small. There was no evidence that distally tilted implants were associated with higher failure rates and increased amounts of marginal bone loss. The data supporting these findings, however, were at high risk of bias and frequently incompletely reported. Frequent positional changes occurred between the natural teeth and the implant-supported restorations. These changes were more pronounced in younger individuals, and even though they were reduced with age, they still occurred in adult patients. Even though these changes were frequent, potential implications for the patient are unclear. CONCLUSIONS: The use of single-tooth restorations with crown-to-implant ratio in between 0.9 and 2.2 may be considered a viable treatment option. Multiunit reconstructions with cantilevers are a viable treatment option in fully and partially edentulous patients. Clinicians and patients should be aware, however, that complications are frequent and primarily related to resin material used for veneering. There is some evidence that tilting an implant does affect stability of the implant and the surrounding bone. Treatment options to tilted implants should carefully be considered, as the effect on soft tissues and on prosthesis behavior is poorly reported for tilted implants. Positional changes in the dentition in relation to implant-supported restorations occur frequently. The patient should be informed about the possible need for a treatment related to these changes in the long term.

Clinical outcomes of partial and full-arch all-ceramic implant-supported fixed dental prostheses. A systematic review and meta-analysis.

OBJECTIVE: To assess the survival and technical complication rate of partial and full-arch all-ceramic implant-supported fixed dental prostheses (P-FDP/FA-FDP) and supporting implants. MATERIALS AND METHODS: An electronic search through three databases (MEDLINE/Pubmed, Cochrane Library, Embase) was conducted to identify relevant clinical studies with an observation period of at least 12 months, including ≥15 patients. Reconstruction and implant survival rates, technical complications and confounding variables such as processed/installed materials, retention mode and location in the mouth were obtained. Failure and complication rates were analyzed using standard Poisson regression models to calculate 5-year survival and complication estimates. RESULTS: A total of five studies for the P-FDP group and seven studies for the FA-FDP group were included, throughout evaluating veneered zirconia reconstructions. In the P-FDP group, reconstructions were located in posterior regions. Meta-analysis indicated survival estimates on the reconstruction level of 98.3% and 97.7% for P- and FA-FDPs after 5 years. However, chipping of the veneering ceramic was frequent, resulting in estimated 5-year complication rates of 22.8% (P-FDPs) and 34.8% (FA-FDPs). Five-year survival estimates of implants supporting P-FDPs and FA-FDPs of 98.5% and 99.4% were calculated, respectively. Including a total of 540 FDPs, one screw-loosening and 11 de-cementations were reported. Confounding variables were not found to have a significant influence on survival and complication rates. CONCLUSIONS: All-ceramic implant-supported P- and FA-FDPs comprising veneered zirconia frameworks showed high survival but clinically inacceptable fracture rates of the veneering ceramic. Their suitability with regard to this indication and a successful long-term outcome needs to be further evaluated.

Effect of different maintenance time of torque application on detorque values of abutment screws in full-arch implant-supported fixed prostheses.

BACKGROUND: The effect of different maintenance time of torque application and screw loosening in full-arch implant-supported prosthesis remains uninvestigated. PURPOSE: To examine the effect of different maintenance time of torque application on detorque values of implant abutment screw in full-arch implant-supported fixed complete denture. MATERIALS AND METHODS: Passively fitting framework supported by four implants stabilized on resin model torqued to 35 N-cm and maintained for different times; instant torque application (protocol A), 10 seconds (protocol B), and 30 seconds (protocol C) were used. Detorque values were recorded during removal of the screws. Comparison between mean torque and detorque values were made using paired sample t-test. The mean removal torque values of each protocol were compared using three-way analysis of variance (ANOVA). RESULTS: The mean removal torque values were lower than the applied torque for all the protocols. The highest mean removal torque value was found in the immediate protocol (A) (24.44 ± 1.7), followed by the 30 seconds protocol (C) (23.37 ± 1.75), and then by the 10 seconds protocol (B) (23.35 ± 1.6). All these differences were found to be statistically significant between torque and detorque values (P = .001). However, the differences among detorque values were not statistically significant (P > .05). CONCLUSION: The application of 35 N-cm for different maintenance time of torque application on implant abutment screw did not appear to affect the detorque value in a multiple implant-supported fixed prosthesis. Maintaining the torque for prolonged time (10 seconds or 30 seconds) was not significantly associated with higher preload than instant torque application in full-arch implant-supported prosthesis.