Cognitive deterioration in association with teeth loss in elderly population: A study from Eastern India

Background: With the global increase in cognitive impairment and dementia, the need to investigate into the possible ways that can be used to prevent or delay such occurrence has been growing. Maintenance of dental care and oral hygiene has been promoted as one such aspect. Aims and Objectives: To study the association between cognitive impairment in patients without registered diagnosis of dementia with tooth loss and chewing ability. Materials and Methods: It was a cross-sectional hospital-based study where consenting elderly persons attending Dental outpatient department over 1½ years were included. Data obtained on socio-demographic details, number of tooth loss, number of remaining teeth, subjective chewing ability, cognitive assessment as per mini-mental state examination (MMSE), and Clock Drawing Test were analyzed statistically to check correlational association. Results: In this study 96 eligible elderly persons of mean age of 68.30±6.28 years showed increased cognitive impairment among females (P=0.003), increased age (P=0.009), rural background (P=0.033) and low income groups (P=0.001). Positive correlation was found between chewing capacity (P=0.348), number of remaining teeth (r=0.418) with MMSE scores. Conclusion: Our study population showed positive correlation between impaired cognition and the number of extracted tooth and chewing capacity. With further study on wider and representative population, we hope to project the role of maintaining good oral hygiene and dental care as a possible preventive strategy among many others to combat the increased burden of cognitive impairment.

Comparison of two resilient attachment systems for implant-/mucosa-supported overdentures with a PEKK framework: a clinical pilot study

Objectives The aim of the study was to determine differences between Locator and CM LOC attachment systems regarding patient satisfaction and wear of the abutments and their inserts. Plaque accumulation onto the polyetherketoneketone (PEKK) framework and polymethylmethacrylate (PMMA) was investigated for the implant-supported overdentures. Methods Seventeen edentulous patients were randomised to receive either Locator or CM LOC system for the first year. The total number of implants was 53. After the randomisation, 25 implants received Locator system, and 28 implants received CM LOC system in the first year. After a period of 12 months, the attachment system was exchanged from either Locator to CM LOC or vice versa. Oral Health Impact Profile (OHIP-14) questionnaires were used to evaluate patient satisfaction, chewing comfort, and pressure lesions. Prosthesis hygiene on the PMMA and PEKK surfaces was evaluated by using Stark plaque index. After the exchange of the abutments, they were stored until the end of the 24 months, and the surface wear of the abutments was analysed using a scanning electron microscope. Results Three patients (10 implants) died shortly before the end of the first year. Two patients (7 implants) received only Locator system since CM LOC was not indictable for their implant system. Patient’s satisfaction was increased when the attachment system was changed from Locator to CM LOC after 12 months of wearing time. Chewing ability and comfort were increased when the attachment system was changed from CM LOC to Locator after 12-month wearing time. There was no influence of the change of the attachment system on pressure lesions. The observed plaque accumulation was higher on the PMMA than on the PEKK surface. For the 8 investigated Locator abutments, the wear was within low and middle level. For the 28 investigated CM LOC abutments, the wear was within middle and high level for the terminal implants and between low and middle for the central implants (for patients who received 4 implants). Conclusions Patient’s satisfaction and wearing comfort can be improved with implant-supported overdentures with CM LOC abutments in comparison to Locator. There was no clear difference between both attachment systems concerning the chewing ability of the patients. Plaque accumulation was observed on both attachment systems in different areas. Plaque accumulation on PEKK surface was less than on PMMA surface. Clinical relevance The CM LOC attachment system offers stable and comfortable wearing conditions for implant-supported overdentures. The use of PEKK as a framework material could reduce the incidence of pressure lesions.

Traditional Removable Partial Dentures versus Implant-Supported Removable Partial Dentures: A Retrospective, Observational Oral Health-Related Quality-of-Life Study

Removable partial dentures (RPD) are still a valid alternative for the restoration of missing teeth. Additionally, implant-supported removable partial dentures (ISRPD) represent a valid alternative as it allows to avoid the use of clasps and increase stability. The objective of this study was to evaluate through an OHIP-14 questionnaire the level of satisfaction and quality of life (QoL) of patients treated before RPD and then with ISRPD. Twenty patients were rehabilitated with traditional RPDs, and after one year the prosthesis was modified into ISRPD, by inserting an implant and a ball or locator attachment. At the end of both phases, patients completed the Oral Health Impact Profile (OHIP-14) questionnaire. The collected data were statistically analyzed through the Wilcoxon U test, as overall OHIP score and difference between treatments. The mean of the OHIP summary (range from 0 to 56) in the RPD Group was 20.95 (±5.27). In the ISRPD Group it was 13.95 (±3.91), with a statistically significant difference (p < 0.05) between the two Groups. The same findings were highlighted for the differences between groups in every domain question. Patients showed significant improvements after rehabilitation in all areas of investigation, stating how the transformation of a removable prosthesis into an implant-supported one can improve patients’ QoL with benefits in chewing ability, aesthetics and self-satisfaction.

Strategic Implants under Existing Partial Removable Dentures, Why, How Many, and Which Type?

Inserting strategic implants under existing removable partial dentures requires a comprehensive understanding of removable prosthodontic basics and possible designs, as well as a thorough understanding of implant therapy. Prior to the widespread adoption of implants as standard prosthetic therapy, remaining roots were preserved and used to minimize bone resorption under the removable denture. Root-supported overdentures become less common after the overwhelming clinical studies that emphasize dental implants’ reliability and high success and survival rate. Fixed prostheses cannot be used to treat a severely decreased dentition unless a significant number of implants can be inserted, sufficient bone quantity and quality are available, and the patients can afford the treatment. On the other hand, using strategic implants under existing RPD upgrades the design to a more favorable support type. It improves patient satisfaction with the RPD in speaking, chewing, retention, stability, and RPD support. This improvement could be reached earlier if the patient received immediate loading. Strategic implants can also improve chewing ability, stabilize the occlusion, increase bite force and improve patient oral health-related quality of life. Moreover, better distribution of occlusal forces that may reduce bone resorption may be gained. Furthermore, strategic implants can improve comfort, confidence, and esthetics by reducing the RPD size and removing the retainers from the esthetic zone.

200 A Scoring System for Equine Dental Health

Scoring systems have been implemented in veterinary practice to indicate the severity of pathologies, such as lameness and gastric ulceration. The need for a scoring system of equine dentition in relation to digestive health has been identified. A scoring system would allow veterinarians, owners, and researchers to more accurately assess dental health and the resulting impact it may have on chewing ability. A proposed system, the Equine Dental Scoring System (EDSS), was developed via collaboration of a team of veterinarians and equine nutritionists familiar with equine dental abnormalities. The EDSS was designed to assign higher scores corresponding to increasing severity of dental abnormalities that would impede proper chewing. The proposed scoring system ranges from 0 to 5 as follows: 0) no sharp enamel points, soft tissue damage, or malocclusion, (1) sharp enamel points, but no soft tissue damage or malocclusion, (2) sharp enamel points and soft tissue damage, but no malocclusion, (3) mild malocclusion with all aligned teeth meeting level (ex. ramps, hooks), (4) moderate malocclusion with all teeth meeting but not level (ex. wave, smile, diagonal, frown), (5) major malocclusion with one or more teeth not meeting or inhibited temporomandibular joint movement (ex. step, shear, retained cap), and/or infection, and/or pain while chewing. The EDSS was validated by assessing agreement via the Cohen’s kappa statistic between four trained professionals scoring ten images of horse dentition. Both the weighted (к = 0.62) and unweighted (к = 0.73) kappa statistics indicated substantial agreement between scorers, signifying reliable repeatability of the EDSS. Presenting dental health in the form of a score would indicate severity of dental pathologies and allow for quantitative and statistical evaluation of dental health in nutrition research and veterinary medicine.

Analysis of the Hardness of Soft Relining Materials for Removable Dentures

The main functional feature of elastomeric soft linings materials is the ability to discharge loads in the tissues of the mucosa. As a result, there are fewer injuries to the mucosa and chewing ability increases. In addition, these prostheses are more comfortable in the patient’s opinion. To obtain the equal distribution of forces on the muco-bone basis and to reduce the traumatizing effect of the denture plate for patients using full dentures, soft lining materials can be used. Aim of the study: the aim of the work was a comparative laboratory study of ten materials used for soft lining of acrylic complete dentures. Methodology: Materials based on acrylates (Vertex Soft, Villacryl Soft, Flexacryl Soft) and on silicones (Sofreliner Tough Medium, Sofreliner Tough Medium, Ufi Gel SC, GC Reline Soft, Elite Soft Relining, Molloplast) were compared. Laboratory tests include tests of changes in Shore’a A hardness of soft lining material. The tests were conducted taking into account 90 day term aging in the distilled water environment based on the methodology presented in the European Standard ISO 10139-2. Results: For most silicone materials, only small changes in hardness were found in the range of 0.7 (Ufi Gel SC) to 3.3 (Sofreliner Tough Medium) on the Shore A scale. The exception was GC Reline Soft, for which a marked increase in hardness was noted. All materials based on acrylates were characterized by successive increase in hardness over time. However, in the case of the Vertex Soft material, the increase in hardness was relatively small (5.5 ShA).

Comparative Evaluation of Salivary Malondialdehyde Levels in Children with Different Caries Status- A Cross-Sectional Observational Study

Background and Objectives: Early childhood caries is a major public health problem especially in young children. ECC affects the quality of life of young children by affecting the chewing ability of children due to the development of pain and swelling, and this may indirectly affect the nutritional status of a child. The present study was done to assess the level of salivary malondialdehyde in children with and without Early childhood caries. The main objective of the study is to determine the salivary malondialdehyde levels and to compare it with the three groups of children with different caries experiences. Materials and Methods: It is cross-sectional observational research carried out at Saveetha Dental College and Hospitals. Children between 3-6 years were examined and 20 caries-free, 20 children with ECC as well as 20 children with S-ECC were recruited for the study. The caries status was assessed using dmfs and the severity of caries was assessed using pufa index. Salivary samples were collected and analysed for salivary malondialdehyde levels. Statistical Analysis: The data was entered and analysed using SPSS software version 20.0. One-way ANOVA was done to determine the difference in malondialdehyde levels between the groups. “Post-hoc Tukey” test was done to measure the intergroup significance. A “P value of < 0.05” was measured as statistically “significant” and P < 0.001 was deemed as statistically “highly significant”. Pearson’s correlation was done to correlate pufa values with malondialdehyde levels. Results: The results demonstrated that there was a statistically significant difference in salivary malondialdehyde levels among caries-free, ECC as well as S-ECC children. There was a positive correlation between the pufa score and salivary malondialdehyde levels. Conclusion: 1. There is a significant difference in the salivary malondialdehyde levels among caries-free, ECC as well as S-ECC children. There was a positive correlation of salivary malondialdehyde levels and pufa score in ECC and S-ECC children.

Functional and Patient-Centered Treatment Outcomes with Mandibular Overdentures Retained by Two Immediate or Conventionally Loaded Implants: A Randomized Clinical Trial

This study aims to assess the treatment outcomes (functional and subjective) of mandibular overdentures retained on two implants with or without an immediate loading protocol. In this randomized clinical trial, twenty fully edentulous patients were treated with a mandibular two-implant-retained overdenture and a complete new maxillary denture. In half of the sample, the implants were loaded immediately by means of VulkanLoc® abutments after emplacement of the implant, but in the counterparts, these VulkanLoc® abutments were connected to implants two months after the surgery (conventional protocol), and until that time the dentures were retained by healing abutments. Treatment outcomes were assessed at two, six, and twelve months after surgery. Functional outcomes were calculated according to masticatory performance, estimated by the mixed fraction of a two-coloured chewing gum after five, ten, and fifteen chewing strokes, by the occlusal force recorded by pressure-sensitive sheets, and by the bioelectrical muscular activity. The subjective outcomes of the treatment were assessed using both the oral satisfaction scale (visual analogue scale) and the Spanish version of the Oral Health Impact Profile (OHIP-20). The findings of the present study show that new complete dentures resulted in significant improvements in chewing ability, patient satisfaction, and oral health-related quality of life and that subsequent implant-retained overdentures produced further and faster significant improvements. The loading protocol may influence those positive self-reported outcomes rather than the objective functional evaluations.