Association between Diabetes and the Use of Removable Dental Prostheses among the Korean Population

BACKGROUND

A balanced nutrient intake is important for patients with diabetes. Even if individuals have the same number of residual natural teeth, there are large differences in the masticatory performance between edentulous sites restored with a fixed dental prosthesis, including dental implants, and those restored with a removable dental prosthesis. This study assessed whether the prevalence and control of diabetes differed based on the use of removable dental prostheses through an analysis of nationally representative data.

METHODS

Overall, 8,155 individuals (3,525 men and 4,630 women) aged ≥ 50 years were included in this study and were classified into the following 3 groups: group 1, did not use any removable dental prostheses (NF); group 2, used removable partial dentures (RPD); and group 3, used removable complete dentures on at least 1 jaw (CD). The characterization of diabetic patients and glycemic control were analyzed and compared among groups. To determine the relationship between diabetes and the use of dental prostheses, multivariable logistic regression analysis was performed (P < 0.05).

RESULTS

The adjusted odds ratios and 95% confidence intervals for diabetes in men participants in groups NF, RPD, and CD were 1 (reference), 1.165 (0.878-1.544), and 1.491 (1.034-2.151), respectively, after adjusting for confounding factors. Diabetes and glycemic control were significantly associated with the use of removable dental prostheses among men.

CONCLUSION

The use of removable dental prostheses is a potential risk indicator for uncontrolled diabetes in Korean men adults, suggesting the need for a comprehensive approach to minimize the complications of diabetes mellitus.

Status of Tooth Loss and Denture Restoration in Chinese Adult Population: Findings from the 4th National Oral Health Survey

OBJECTIVE

To investigate the status of tooth loss and denture restoration in Chinese adults, analyse the changing trend and provide fundamental data for oral health policy.

METHODS

According to the protocol of the 4th National Oral Health Survey, a multistage stratified random cluster-sampling method was used to enrol adult subjects aged 35 to 44, 55 to 64 and 65 to 74 years in all 31 provinces, municipalities and autonomous regions of the mainland of China. The status of tooth loss and denture restoration was investigated. SPSS20.0 software was used for statistics analysis.

RESULTS

Among the 13,464 subjects investigated, 13.8% had complete dentition, 84.4% had dentition defects, and 1.8% was edentulous. Urban subjects showed a significantly higher proportion of complete dentition than those in rural (P = 0.02), and males showed the statistically higher proportion of complete dentition than females (P = 0.01). The mean of remaining teeth was 26.1 ± 6.90, which in urban areas was significantly higher than in rural areas (P < 0.01). The means of remaining teeth were 29.6 ± 2.3, 26.3 ± 6.1, and 22.5 ± 8.7 in the 35 to 44, 55 to 64 and 65 to 74 age groups, respectively. The detection rate of fixed partial dentures (FPD) was statistically higher in urban than in rural areas and in males than that in females (P < 0.01). The detection rate of removable partial dentures (RPD) was statistically higher in urban areas than in rural locations (P < 0.01). However, the detection rates of irregular denture and unrepair of tooth loss were both significantly lower in urban than in rural areas (P < 0.01). The rate of restoration of tooth loss was 41.6% in Chinese adults.

CONCLUSION

Although the tooth loss and denture restoration status recorded in the survey was improved compared with the results of 10 years ago, more efforts need to be made on strengthening oral health promotion, particularly for elderly people and those living in rural areas.

Sociodemographic determinants of usage of removable partial denture in a tertiary hospital: A retrospective study

OBJECTIVE

To determine the influence of sociodemographic characteristics on pattern of removable partial denture use in a tertiary institution over a one-year period.

METHODS

This was a retrospective study using records of partially dentate patients seeking replacement for their missing teeth within one-year duration. Information retrieved from the patients’ records included demographic characteristics such as gender, age, marital status, occupation, arch type, number and reasons for missing teeth and type of removable partial denture. Statistical analysis was performed using statistical package for social science (SPSS) version 17 (Chicago, IL.). The analysis was done using frequency distribution, cross tabulations, t test and test of significance with chi square. P<0.05 was considered statistically significant.

RESULTS

A total of 98 patients were seen over the study period with a male/female ratio of 1:1.45. The patients’ age ranged from 20 to 89 years with a mean age of 47.19 ± 18.37. The number of teeth replaced ranged from 1 to 17 with a mean of 3.13 ± 3.30 teeth. The mean number of missing teeth was significantly higher among patients aged 50 years and above (p = 0.002). Majority (69.4%) of the patients were married and 59.2% were working class (skilled and unskilled). The Kennedy’s Class III saddle was the most prevalent in the maxilla while Class IV was most prevalent in the mandible; a difference that was statistically significant. Conclusion: Socioeconomic status, age and gender influenced the use of removable partial denture.

Three-Year Analysis of Fixed and Removable Telescopic Attachment-Retained Implant-Supported Dental Prostheses: Survival and Need for Maintenance

PURPOSE

The purpose of this retrospective clinical study was to evaluate the clinical outcomes of fixed implant-supported dental prostheses (FISDPs) and removable ISDPs (RISDPs) retained by telescopic attachments, the factors influencing survival, and the type and number of maintenance treatments required during the observation period.

MATERIALS AND METHODS

This retrospective clinical study is based on patients who were provided with ISDPs between 2004 and 2010. Patient sex, type of prosthesis, location, opposing dentition, and the effect of continuous follow-up on the probability of a favorable outcome, as well as the number of maintenance treatments, were analyzed. A statistical analysis was performed using the Kaplan-Meier method.

RESULTS

A sample of 233 patients with 157 FISDPs and 76 RISDPs supported by a total of 567 implants was randomized and included in the analysis. The mean observation period was 15.9 ± 15.4 months (maximum, 66.0 months). During the observation period, 3.9% of prostheses (7/157 FISDPs and 2/76 RISDPs) ceased to function and 2.3% of implants (13 implants) were lost. The mean survival time was 59.7 ± 2.3 months, with a survival probability of 90.2% after 3 years. Prostheses in the mandible showed significantly higher survival rates than those in the maxilla. Maintenance treatments had to be performed at an earlier stage for patients with RISDPs than for patients with FISDPs. In patients with a conventional removable prosthesis in the opposing arch, the time until maintenance was needed was significantly shorter.

CONCLUSION

Within the limitations of a retrospective study, it can be concluded that the FISDPs and RISDPs show equally good survival rates after 3 years in function. RISDPs showed a greater and earlier need for maintenance treatments during the first years in function.

Dental technology services and industry trends in New Zealand from 2010 to 2012

OBJECTIVE

To provide a snapshot of the New Zealand dental technology industry and influencing factors.

BACKGROUND

Developing an understanding of the commercial dental laboratory environment in New Zealand can provide insight into the entire dental industry.

METHODS

A web-based survey was the primary method for data collection, with separate questionnaires used for dental laboratory owners and dental technician employees.

RESULTS

The mean net income for dental laboratory owners in New Zealand was similar to that of the United Kingdom, at $40.50 per hour. Clinical dental technicians are the highest paid employees, with a mean of $33.49 per hour. The mean technical charge for complete dentures was $632.59; including clinical services, it was $1907.00. The mean charge for a porcelain-fused-to-metal (PFM) crown was $290.27. Dental laboratory owners expressed fear about the possibility of losing dental clients to overseas laboratories due to the availability and cheap charge of offshore work. Only 25.4% of dental laboratories surveyed had computer-aided design (CAD) facilities, and even fewer (7.9%) had computer-aided manufacturing (CAM) systems.

CONCLUSION

Clinical dental technology appears to be prospering. The dental technology industry appears to be adapting and remains viable, despite facing many challenges.

Partial edentulism and unmet prosthetic needs amongst young adult Nigeria

INTRODUCTION

Treatment options for missing tooth/teeth which are mostly commonly caused dental caries, periodontitis and trauma include partial dentures, bridge and implant. In developing countries, missing tooth/teeth replacement constitutes a high unmet dental need. The objective of the study was to determine the prevalence of partial edentulism and prosthetic unmet dental needs among young adults in Nigeria.

MATERIALS AND METHODS

A total of 244 medical students of college of medicine were recruited and studied using interviewer administered questionnaire which elicited information on sociodemographic, tooth loss and replacement. Data was analyzed with SPSS version 16.0 statistical software for windows.

RESULTS

There were 98 males (40.2%) and 146 females (59.8%). A total of 35 participants out of the 244 studied participants had missing tooth/teeth giving a prevalence of 14.3%. The major reason of tooth loss was caries (48.6%). The upper left (16.7%) and right (16.7%) had the highest tooth mortality. Of the 35 participants with missing teeth, 4 (11.4%) of had replacement while 31 (88.6%) did not have any form of replacement. The teeth replaced were upper right, left anterior (75%) and upper right posterior (25%). Reasons for non-replacement were not being bothered--14 (45.2%), ignorance of replacement therapy-- 7 (22.6%), misinformation--1 (3.2%) and lack of money--2 (6.5%). Those that replaced 4/42 (9.5%) did so with removable partial dentures (100%). The majority that replaced were females 3/4 (75%). Half (50%) of those that replaced were satisfied and the reasons for non-satisfaction were pain from denture and unnatural feel of denture.

CONCLUSION

Data from this study revealed low prevalence of tooth loss with high unmet tooth replacement needs among the participants. Tooth/teeth replacement options should be incorporated in postoperative instructions after extraction and dental awareness should be improved among medical students.

Occlusion of artificial teeth in partial dentures in the "chewing center"--first exploratory population-based evaluations

Occlusal performance is a substantial determinant of the quality of dental prosthetic restorations. In the follow-up (SHIP 1) to the Study of Health in Pomerania (SHIP), a representative population of 3300 subjects was studied in the first exploratory evaluation of the occlusion of artificial teeth in the chewing center (first molar region) of partial dentures. A digital analysis of interocclusal records of habitual intercuspation position (ICP) was performed using the Greifswald Digital Analyzing System (GEDAS), a software package that identifies contact points as transparent areas. 562 subjects (280 men aged 61.7 ± 11.9 years and 282 women aged 60.7 ± 10.7 years) had maxillary removable partial dentures (RPDs), and 619 (271 men aged 65.0 ± 11.5 years and 348 women aged 62.4 ± 10.6 years) had mandibular RPDs. Most RPDs were retained with either attachment retainers (11.7% maxilla, 11.7% mandible), cast clasps (38.4% maxilla, 40.7% mandible), telescopes with double crowns (15.7% maxilla, 19.1% mandible), or wrought wire clasps (16.4% maxilla, 8.2% mandible). Some had a combination of different retention elements. The mean number of artificial teeth was 7.8 ± 2.9 in the maxilla and 7.5 ± 3.0 in the mandible. Only the artificial teeth (first molars) in mandibular partial dentures showed differences in the frequency of occlusal contacts between groups (chi-square test). Of these, telescopic crown-retained RPDs had the highest frequency of occlusal contacts (74.4% at tooth 36 and 77.1% at tooth 46), and wrought wire-retained RPDs had the lowest (48.4% at tooth 36 and 45.2% at tooth 46). The results for RPDs with a free-end saddle were comparable and analogous; contact frequencies for those with an interdental saddle did not differ significantly. Notably, the overall frequency of occlusal contacts was greater for tooth 46 (62.9%) than for tooth 36. In conclusion, when replacing teeth in the chewing center, particularly in the mandible, telescopic crown-retained RPDs offer a distinct advantage in terms of occlusal contacts and thus provide better occlusal stability.

How long will it last? The expected longevity of prosthodontic and restorative treatment

With the Internet facilitating access to vast amounts of free information, dental practitioners face providing treatment for an increasingly informed public. However, the available content is not filtered, and it can be difficult for patients to discriminate between research-informed evidence and "glamorised" material of dubious origin. Patients reasonably expect a return for their investment and want to know how long their treatment will last. Clinicians have an obligation to inform their patients so that they can make reasoned decisions about treatment options. Longevity data are also informative for health agencies setting service schedules for publicly funded treatment, and for determining settlements by insurers such as ACC. Historically, much of the prosthodontic treatment performed in practice has relied heavily on dogma, low-level anecdotal evidence, and clinical case reports. This paper considers the literature on fixed and removable prosthodontic restorations and provides a critical review which can be used practically as the basis for informing patients, and to assist decision-makers in making fair and appropriate judgements.

Does a case completion curriculum influence dental students' clinical productivity?

The purpose of this study was to evaluate the effects of a new clinical curriculum on dental student productivity as measured by number of procedures performed in the student teaching practice. Harvard School of Dental Medicine adopted a new clinical education model for the predoctoral program in summer 2009 based upon a Case Completion Curriculum (CCC) rather than a discipline-based numeric threshold system. The two study groups (threshold group and case completion group) consisted of students who graduated in 2009 and 2010. Clinical performance was assessed by clinical productivity across five major discipline areas: periodontics, operative dentistry, removable prosthodontics, fixed prosthodontics, and endodontics. The relationships between the two study groups with regard to number of procedures performed by category revealed that the case completion group performed a significantly higher number of operative and removable prosthodontic procedures, but fewer periodontal and endodontic procedures (p≤0.03). No statistically significant difference in number of procedures was observed with fixed prosthodontic procedures between the two groups. Clinical productivity as a result of redesigning the clinical component of the curriculum varied in selected disciplines. The CCC, in which the comprehensive management of the patient was the priority, contributed to achieving a patient-based comprehensive care practice.

Tooth loss and oral rehabilitation in Greek middle-aged adults and senior citizens

PURPOSE

The aims of this study were to investigate the prevalence of tooth loss in Greek individuals aged 35 to 44 and 65 to 74 years in relation to sociodemographic parameters and to describe their prosthetic status and needs.

MATERIALS AND METHODS

A stratified cluster sample of 1,188 middle-aged adults and 1,093 senior citizens was selected according to World Health Organization (WHO) guidelines for national pathfinder surveys. Tooth loss and prosthetic status and needs were recorded according to WHO criteria. Sociodemographic data were collected through face-to-face interviews.

RESULTS

Complete edentulism affected 0.3% of individuals aged 35 to 44 years and 31.5% of those aged 65 to 74 years. Most middle-aged adults (92.1%) had ≥ 21 natural teeth, while the corresponding percentage for the senior citizens was 23.1%. The mean number of missing teeth was 5.2 in middle-aged adults and 21.6 in senior citizens. The multivariate analysis showed that education level was the only predictor of tooth loss in both age groups. Approximately 38% of those aged 35 to 44 years and 80% of those aged 65 to 74 years had dental prostheses, while 47.6% of middle-aged adults and 66.3% of senior citizens did not need any prosthetic treatment. The need for complete dentures was relatively low in both age groups. Comparisons of the present results with those of 1985 indicate that the dentate status of Greek adults aged 35 to 44 years has not improved. Furthermore, the prevalence of tooth loss in the elderly population was high compared with internationally reported findings.

CONCLUSION

The replacement of missing teeth with fixed or removable prostheses will continue to be common in Greece for the foreseeable future.

Comparison of oral status in an adult population 35-75 year of age in the county of Dalarna, Sweden in 1983 and 2008

The aim was to study the prevalence and distribution of number of teeth, number of intact and decayed teeth and prevalence and distribution of removable dentures and periodontal disease over 25 years 1983-2008. Two cross-sectional studies (EpiWux) were performed in the County of Dalarna, Sweden in 1983 and 2008. In the 1983 study a random sample of 1012 individuals were invited to participate in this epidemiological and clinical study and 1440 individuals in 2008. A total number of 1695 individuals, stratified into geographical areas (rural and urban areas), in the age groups 35, 50, 65 and 75 answered a questionnaire and were also clinically and radiographically examined.The number of edentulous individuals decreased from 15% in 1983 to 3% in 2008. Number of teeth increased from 22.7 in 1983 to 24.2 in 2008 and decayed surfaces per tooth showed a three-time reduction over this period of time. As a consequence of better oral status the prevalence of complete removable dentures in both jaws decreased from 15% in 1983 to 2% in 2008. Individuals with moderate periodontitis decreased from 45% in 1983 to 16% in 2008.

CONCLUSION

Covering a period of 25 years the present study can report dramatic improvements in all aspects of dental status that were investigated.This is encouraging for dental care professionals, but will not necessarily lead to less demand for dental care in the future as the population is aging with a substantial increase in number of teeth.

A follow-up study on removable partial dentures in undergraduate program: part I. participants and denture use by telephone survey

The aim of this study was to investigate the clinical outcome of removable partial dentures (RPDs) designed to minimize denture mobility during function. Using archived files of the undergraduate program between 2003 and 2005 at Tokyo Medical and Dental University, a list of 169 patients treated with 184 RPDs was created. The RPDs had either an acrylic resin-base or a cobalt-chrome framework-base. Two examiners telephoned all the listed patients and interviewed 118 patients (70%) regarding the use of their RPDs. Of 118 patients, 42 (36%) had stopped using, mainly due to problems with abutment teeth in resin-based dentures, and replacement in cobalt-chrome-based dentures. There was no significant difference in mean age, gender distribution, mean number of remaining/abutment teeth, distribution of denture arch, and Kennedy classification between denture use and nonuse groups (p>0.05). The nonuse group showed a significantly higher percentage of resin-base compared to the use group (p = 0.006). Logistic regression analysis indicated that resin-base was a significant risk factor for nonuse (p = 0.008). The present findings suggest that abutment teeth should be selected carefully, especially in this type of resin-based RPDs, and that the denture base material may be a critical factor which determines denture use.

[Dental treatment strategies for elderly patients]

The elderly are influenced from a various and complex combination of factors, such us individual genetic predispositions, lifestyle, society and environment, the sum of all the individual life experiences concerning the dental care, the caries, the periodontal and iatrogenic diseases.

AIM

This paper evaluates the dental treatment in the elderly.

MATERIAL AND METHODS

The study was performed on 112 patients, aged over 65, at the Clinical Department of Dental Semiology und Geriatric Dentistry, Iaşi, Romania.

RESULTS

The treatment interventions were dental hygiene procedures (in 97 patients), restaurations (in 29 patients), removable partial and total denture preocedures (in 50 patients), fixed prosthetic procedures (in 18 patients), rebasing of dentures (in 25 patients) and teeth extractions (in 26 patients). There were 36 endodontic emergencies and 15 periodontal emergencies and 8 emergencies that resulted from other causes.

CONCLUSIONS

The periodical dental examinations and the proper daily oral hygiene routine are still important in the old age and they should not be neglected, because the prosthetical components request also treatment interventions.

Oral health-related quality of life of elderly Germans--comparison of GOHAI and OHIP-14

OBJECTIVE

To obtain information about the subjective oral health status of non-clinical elderly populations of urban regions of Germany, one in the East and one in the West, by using OHIP-14 and, for first time, the GOHAI, and, furthermore, to compare the results obtained by use of both instruments.

BASIC RESEARCH DESIGN

Cross-sectional.

CLINICAL SETTING

Randomly chosen, non-clinical elderly population in urban regions of Germany.

PARTICIPANTS

197 participants (51% male) born in the years 1930-1932.

MAIN OUTCOME MEASURES

GOHAI, OHIP-14.

RESULTS

Median GOHAI score was 54; median OHIP-14 score was 2. Scores indicative of severely impaired oral health were rare. The effect of living in eastern or western Germany was of minor significance. Although the internal consistency of both measures was comparable and the same positive association with psychological wellbeing, absence of dry mouth, burning mouth, and removable dentures (p < 0.05) was observed, differences occurred. In simultaneous analysis of all items, factor analysis revealed only partial overlap of the items in extracted factors. Furthermore, the extreme score indicating no impairment was five times more frequent for OHIP-14. Of those who scored zero in OHIP-14, only 20% had the GOHAI equivalent score of 60, and for some GOHAI items the answer category for highest impairment was obtained.

CONCLUSIONS

GOHAI scores for this randomly chosen non-clinical group enable comparison with scores for Germany measured in the future. The differences between GOHAI and OHIP-14 make it necessary to select the most appropriate instrument for a planned purpose and study population.

Clinical experience of residents with RPD treatment in U.S. graduate prosthodontics programs

This cross-sectional study was conducted to quantify the clinical experience of prosthodontic residents with cast metal removable partial denture (RPD) treatment based on their year of training, geographic location of the program, and nature of the program. A web-based survey consisting of five questions was e-mailed to program directors from forty-two programs across the United States. A 62 percent response rate was obtained (26/42). Thirteen of the programs (50 percent of respondents) stipulated a specific number of RPDs to be done prior to completion of the program. Clinical experience of residents varied vastly based on year of training, geographic location of the program, and nature of the program. Prosthodontic residents from southern states, university-based programs, and public school programs had more clinical experience than residents from other programs. The average clinical experience for a prosthodontic resident during three years of training was eight traditional RPDs and two implant-supported RPDs. This is the first study done exploring this topic and provides baseline information on residents' clinical experience in RPD treatment. Future studies will determine educational trends and reassess this portion of the curriculum in graduate prosthodontics.

Outcomes of root canal treatment in Dental Practice-Based Research Network practices

This study sought to quantify the incidence of root canal treatment (RCT) failure and identify its predictors in root canals that were performed or referred by general dentistry practices in a practice-based research network (PBRN). This retrospective cohort study involved 174 endodontically treated teeth. Mean duration from initial therapy to follow-up was 8.6 years. Permanent restorations were ultimately placed in 89% of teeth, although 18% of teeth were ultimately extracted anyway. Receiving a permanent restoration was a significant predictor of treatment failure (in other words, patients who did not receive a permanent restoration were more likely to experience RCT failure), whether failure was determined clinically or radiographically. This study of PBRN practices suggests a higher failure rate compared with studies that utilized highly controlled environments or populations with high levels of dental insurance.

Replacement of missing teeth in a southern region of Vietnam--a descriptive dental laboratory study

AIM

To explore whether tooth replacement in a southern region of Vietnam is in line with the primary health care approach, aiming at health services for all people at affordable costs.

METHODS

Tooth replacement was investigated by means of prostheses as delivered by four dental laboratories of which the output was considered representative. Information was based on dental casts related to the prostheses.

RESULTS

Prostheses replaced almost all missing teeth, irrespective of the types (interrupted or shortened dental arches) and numbers of missing teeth in the dental arch they were made for. Acrylic removable partial dentures were the most common prostheses delivered (65% of removable partial dentures).

CONCLUSION

It cannot be stated that dental arch conditions in this study were representative for the southern Vietnamese population. However, it is concluded that dental practitioners tend to provide complete dental arches by tooth replacements. This morphologically based approach might introduce over treatment. In line with primary oral health care, a functionally oriented treatment management, including the shortened dental arch concept, should be implemented.

[The principal components analysis--method to classify the statistical variables with applications in medicine]

Based on the eigenvalues and the eigenvectors analysis, the principal component analysis has the purpose to identify the subspace of the main components from a set of parameters, which are enough to characterize the whole set of parameters. Interpreting the data for analysis as a cloud of points, we find through geometrical transformations the directions where the cloud's dispersion is maximal--the lines that pass through the cloud's center of weight and have a maximal density of points around them (by defining an appropriate criteria function and its minimization. This method can be successfully used in order to simplify the statistical analysis on questionnaires--because it helps us to select from a set of items only the most relevant ones, which cover the variations of the whole set of data. For instance, in the presented sample we started from a questionnaire with 28 items and, applying the principal component analysis we identified 7 principal components--or main items--fact that simplifies significantly the further data statistical analysis.

Dental state, prosthodontic treatment and chewing ability ? a study of five cohorts of 70-year-old subjects

The aim was to study the relationship between dental state, prosthetic rehabilitation and chewing ability in 70-year-old subjects examined between 1971 and 2001. Five birth cohorts born in 1901/1902 (I), 1906/1907 (II), 1911/1912(III), 1922 (V), and 1930 (VI) were examined at 70 years of age. The number of participants in the odontological cohorts varied between 386 and 583. The prevalence of total edentulism changed from 51% in cohort I to 7% in cohort VI. The proportion of subjects using removable dentures decreased from 76% to 17%, whereas those with >or=20 teeth increased from 13% to 65%. The prevalence of subjects with fixed partial dentures increased from 26% to 58%. Of the 70-year-old subjects examined in 2001, 5% had implant-supported restorations. The self-assessed chewing ability showed only weak associations with dental state, and there was no significant cohort trend. When all cohorts were pooled together, 80% considered their chewing ability good, 16% less good and 4% poor. Among the edentulous subjects, more individuals complained about poor chewing ability in the last two cohorts than in the first three. It was concluded that there were great differences in dental state between the five cohorts of 70-year-old subjects examined from 1971 to 2001. Edentulism and wearing of removable dentures decreased substantially, whereas the proportion of subjects with fixed partial dentures showed a marked increase. In spite of the improved dental state, the self-assessed chewing ability exhibited only minor variation over time.

The oral hygiene and denture status among residential home residents

The aim of this study was to investigate the oral hygiene practices and denture status of elderly people living in a residential home. One hundred one elderly people living in Gurcesme Zubeyde Hanim Residential Home, Izmir-52 women (mean age 75.5 +/- 7.8) and 49 men (mean age 75.3 +/- 8.8)-participated in an interview. Their oral hygiene practices, self-perceived oral health, denture status, and needs of denture were noted down. Self-perceived oral health was very bad in 9.9%, bad in 47.5%, good in 33.7%, and very good in 8.9%. From 69 people who reported maintaining oral hygiene, the incidence of oral hygiene practice was 36.2% once a day, 31.9% three times a day, 21.8% once a week, and 10.1% seldom. The majority, 60 people (59.4%), were dentate. Among the dentate, 47 people (78.3%) had full denture, 4 (6.6%) removable partial denture, 2 (3.3%) fixed/removable partial denture, 5 (8.3%) full/removable partial denture, and 2 (3.3%) one or more fixed partial dentures. By gender, 57.6% female and 61.2% male subjects were dentate. The relationship between having a social security and having a denture was significant (p = 0.02); having a denture and needing a denture was also significantly related (p = 0.00). The high prevalence of needs for denture pointed to the requirement for frequent dental check ups. The most important need within the residents of the residential home was daily oral hygiene. Nurses trained on this subject are required.

Attitudes and practice in the provision of removable partial dentures

OBJECTIVE

To identify the factors shaping the pattern of removable partial denture (RPD) provision by dentists in England. Design Cross sectional survey of general dental practitioners.

METHODS

Details of current practice and provision, influences, attitudes and demographic details were collected using a self-completion questionnaire mailed to general dental practitioners identified through the Dental Practice Board register.

RESULTS

Three hundred and eighty-five questionnaires were returned by general dental practitioners from 62 health authorities throughout England. The most important factor reported as influencing both the GDP's decision to provide a partial denture and its subsequent success was patient desire to have a partial denture. Constructing the denture from cobalt chrome, advising the patient on aftercare, making time available to make minor adjustments and being responsible for design were all factors dentists associated with success of a RPD. However, for a number of dentists there was a reported divergence between knowledge and practice.

CONCLUSION

Overall it is clear that provision of partial dentures continues to be patient led. However, the decision making process is also influenced by a number of factors including time, cost and the NHS fee structure.

Secular trends of dental status in five 70-year-old cohorts between 1971 and 2001

OBJECTIVE

The aims of this study, which are part of the gerontological and geriatric population studies in Göteborg, Sweden (H70), were to describe cohort differences and trends in dental status and utilization of dental care in 70-year-olds. The study is based on five cohorts examined in 1971/72, 1976/77, 1981/82, 1992/93 and 2000/01 (called cohort I, II, III, V and VI, respectively). The total number of participants was 2290 and varied between 386 and 583 in the different cohorts. The proportion of dentate 70-year-olds changed gradually from 49% in the first to 93% in the last cohort. The mean number of teeth in the dentate 70-year-olds was 14 in cohort I and 21 in cohort VI. The proportion of subjects with 20 or more teeth changed from 13% in cohort I, to 20% in cohort III, and to 65% in cohort VI. In cohort I, 76% of the 70-year-olds had some kind of removable denture; 37% in cohort III, but only 17% in cohort VI. About 20% of all 70-year-olds in cohort I reported regular yearly visits to a dentist. The corresponding figures in cohort III and cohort VI were 50% and 80%, respectively. Even though positive cohort trends were observed in all studied subgroups, factors such as low education, smoking, being un-married, having high waist circumference and being physically inactive were negatively associated with dental status at the end of the study period as well as at the beginning.

Survival Rate of Endodontically Treated Teeth With Posts After Prosthetic Restoration

The purpose of this retrospective clinical study was to evaluate the survival rate of teeth that were endodontically treated and restored with endodontic posts and prosthodontic restorations. A total of 864 teeth in 360 patients were included in the study. Dental records and radiographs of the patients were evaluated and four parameters were documented. The parameters were type of post, type of prosthodontic restoration, observation time, and, in cases of failure, failure mode. Statistical survival analyses were performed according to Kaplan-Meier. The mean observation time was 22.5 +/- 14.9 months. The calculated survival rates of the abutments were statistically significant different for fixed partial dentures (FPDs) and for removable partial dentures (RPDs) with survival rates of 92.7% and 51.0% after 60 months, respectively. Most of the presumed factors influencing the survival rate of endodontically treated abutment teeth only affected the outcome in the RPD group. Teeth restored with post and cores present a high risk for failure when used as abutments for conical-double-crown-retained RPDs.

Factors Affecting Denture Use in Some Institutionalized Elderly People

This study was conducted to assess which factors were related to the ability of elderly residents of nursing homes to use dentures. For 205 patients in two nursing homes in Chuou-ku, Tokyo, dentists and caregivers examined oral status (caries, status of restoration, missing teeth and occlusal support) as well as denture use, Activities of Daily Living (ADL), ability to rinse the mouth, and degree of dementia. Fifty percent of subjects lacked dentures. Seven items were selected for variance in factor analysis. There was a significant relationship between denture use and all analyzed items except age. The items which proved to be significant, included the number of remaining teeth, the ability to rinse, communication, ability to dress/undress, ability to transfer, and eating (Fisher's exact test). A multiple stepwise logistic regression analysis showed that the nonuse of dentures was significantly related to dressing (p<0.01), the number of remaining crowns (p<0.01) and the ability to rinse the mouth (p<0.0001). The nonuse of dentures was also related to the number of remaining teeth and to the disability of hand and oral functions.

Development and evaluation of a self-report measure for identifying type and use of removable partial dentures

AIM

To develop and validate a self-complete questionnaire suitable for use in primary dental care settings.

DESIGN

A questionnaire survey.

PARTICIPANTS

The research was undertaken in primary dental care (general dental practices, Newcastle upon Tyne, UK) and two teaching hospitals (Newcastle Dental Hospital, UK; University Dental School and Hospital, Cork, Ireland). A self-assessment of numbers of teeth and removable partial dentures questionnaire was devised and distributed to 137 patients in the three settings. Following completion of the questionnaire, each patient's dentist then examined them and completed the same questionnaire. The two sets of information were then compared. In the second phase of the study, 37 subjects completed the questionnaire in their own home and their dentist completed the questionnaire at a subsequent clinical examination.

RESULTS

There was excellent agreement regarding counting of teeth [80%, Kappa = 0.79, s.e. 0.04 for maxillary teeth and 77%, Kappa = 0.68, s.e. 0.03 for mandibular teeth]. There was also good agreement between dentists and patients in terms of positioning of spaces in the dental arch (79.6-92.6%). Subjects in the study were also able to accurately identify the type of denture they had (either acrylic or cobalt-chromium based). These findings were confirmed in the second phase of the study.

CONCLUSIONS

Agreement between dentists and patients was very good. This self-report measure could be of use when gathering data for studies of partially dentate patients.

Risk factors associated with denture stomatitis in the United States

BACKGROUND

This study reports denture stomatitis (DS) prevalence from a large USA probability sample from the National Health and Nutrition Examination Survey, 1988-1994 (NHANES III).

METHODS

Oral examinations were performed on 3450 individuals 18-90+ years of age (mean: 59.2; SD: 0.50 years), 57.7% male and 42.3% female. Multivariable logistic regression models were fitted for DS using sociodemographic, denture quality, blood analytes, alcohol and tobacco use, history of diabetes, and current antibiotic use as covariates. Odds ratios (OR), adjusted for other covariates in each model (AOR) are presented.

RESULTS

Of 3450 removable denture wearers, 963 (27.9%) had DS. DS prevalence was associated with wearing maxillary (AOR: 6.20) and mandibular (AOR: 5.21) complete dentures continuously; smoking >/=15 cigarettes day (maxillary complete: AOR = 1.31; mandibular complete: AOR = 1.50; maxillary partial: AOR = 2.04); vitamin A deficiency (mandibular complete: AOR = 5.97; maxillary partial: AOR = 5.67; mandibular partial: AOR = 24.42). Maxillary dentures with inadequate relines had approximately half the OR of DS than those with adequate relines (maxillary complete: AOR = 0.42; mandibular complete: AOR = 0.50).

CONCLUSIONS

Denture stomatitis prevalence is associated with the amount of tissue covered by dentures, low vitamin A levels, cigarette smoking, and constant denture wear.

Factors Associated with Implant Recommendation for Single-Tooth Replacement

The use of dental implants for single-tooth replacement has been established as a predictable treatment option; yet, limited data are available as to how frequently this option is recommended to patients. The aim of the present study was to examine the frequency of implant recommendation by general dental practitioners after single-tooth extraction and factors influencing their decision to recommend an implant. All single-tooth extractions performed in 26 general dental practice clinics in Kuwait over a 30-day period were examined. Dentists in these centers used the study form to record demographic data, the type of tooth extracted, reason for extraction, and replacement options presented to the patients. Univariate and logistic regression analyses were used to examine associations between background factors and decisions to recommend implant therapy. A total of 1367 patients (mean age, 37.9 +/- 11.8 years) had an extraction of one tooth during the study period. Forty-three patients were offered implants as a replacement option (3.3% of the total sample; 8.6% of patients who were offered tooth replacement options). Factors associated significantly with the recommendation of an implant by Kuwaiti dentists to their patients included younger age, regular dental maintenance visits, and adequate oral hygiene practices (P < 0.05; binary logistic regression). Dental implant recommendation for single-tooth replacement in the present sample of dentists was low. Factors associated significantly with dentist recommendation of an implant for single-tooth replacement included age, history of dental maintenance, and oral hygiene practices.

Influence of mental status on removable prosthesis compliance in institutionalized elderly persons

PURPOSE

It is well-recognized that many institutionalized elderly persons with dementia do not wear dentures. The objective of this study was to evaluate the current status of denture use among elderly patients with dementia, in association with degree of mental impairment, to provide information relating to a decision-making process for optimal denture treatment.

MATERIALS AND METHODS

From August 2001 to December 2002, 101 hospitalized elderly persons in a geriatric hospital dental clinic received removable denture treatment by two certified prosthodontists. Prior to denture treatment, patient mental status was evaluated using the Mini Mental Status Examination (MMSE). Basic activities of daily living, including mobility, feeding, toilet use, dressing, and bathing, were also evaluated. Denture acceptance was determined 6 months after denture delivery.

RESULTS

Eight patients were excluded; 73 patients had accepted their dentures and 20 had not 6 months after denture delivery. The mean MMSE score for patients who did not accept denture delivery (11.7+/-7.0) was significantly lower than that of those who did accept and wear their dentures (16.0+/-6.8).

CONCLUSION

The cognitive status of institutionalized elderly persons with dementia should be a criterion for clinical decision making relating to denture treatment.

[The survey of prosthetic treatment in the elderly]

OBJECTIVE

To acquire teeth and prosthetic conditions of the elderly.

METHODS

1166 patients of over 60 years old had been given prosthetic treatment, and the teeth conditions were analyzed.

RESULTS

The average number of missing teeth was 10.25. The maxillary missing teeth were more than mandibular ones. The rate of missing teeth were as follows: maxillary teeth > mandibular teeth; molars > bicuspids > incisors > cuspid. 1120 cases were treated with removable dentures. 59% of the removable partial dentures had free-end saddles. 46 cases were treated with fixed bridges.

CONCLUSION

The characteristics of prosthetic patients in the elderly were as follows: a large number of missing teeth and free-end missing teeth, attrition of resident teeth, food impaction, existing-residual root and loosen teeth. Removable denture was the main method of the prosthetic therapy for the elderly patients. Fixed bridge was used when the patient condition was good. The cuspid, treated residual root and the third molar should be used for the retention and support of the prosthesis.

[Statistical analysis of the fabrication of fixed and removable partial dentures (in 2002)]

A statistical survey based on laboratory records was performed on the number of fixed partial dentures and removable partial dentures fabricated at the dental hospital of Tokyo Medical and Dental University from April 1 to September 30, 2002. A comparison was also performed with a previous survey that had been carried out in 1997 to detect any change and possible alternations in the near future. From the findings of this statistical survey, the conclusions were as follows: 1. A total of 2,656 fixed and removable partial dentures were fabricated during the six-month period in 2002. 2. The 3-unit fixed partial denture was most common (64.0%), and the number of fixed partial dentures decreased as the number of units increased. 3. For a single missing tooth, a fixed partial denture was more popular (80.8%) than a removable partial denture. 4. For two missing teeth, there was little difference between the number of fixed and removable partial dentures. In the anterior region, fixed partial denture was more common, while in contrast, in the posterior region, removable partial denture was more common.

A 5-year follow-up study on the prosthetic rehabilitation of the elderly in Helsinki, Finland

In 1990, 364 elderly (76-86 years) inhabitants of Helsinki, Finland, attended a dental and oral examination study that was conducted as part of the Helsinki Aging Study. In spring 1996, these subjects were recalled for a 5-year follow-up. Between the baseline and follow-up examinations, 114 (31%) subjects had deceased (86 women and 28 men), whereas 134 had either moved, were too ill, or refused to participate in the follow-up. Follow-up examination was conducted for 113 subjects (79 women and 34 men), with the participating rate being 46%. Five subjects became edentulous during the follow-up. Of the subjects, 61% had 1-32 teeth at follow-up. In these subjects, the mean number of teeth decreased from 14.9 (+/-8.3) to 13.5 (+/-8.6) (P < 0.0001). Prosthetic status changed in 40% of the elderly dentate people: 25% received new prostheses whereas 15% lost prostheses that were not replaced. New fixed partial dentures were made in five maxillae and in nine mandibles during the follow-up. Acrylic removable partial dentures (ARPD) were most frequently used: 35% of dentate subjects had an ARPD. Subjects with removable prostheses had higher levels of salivary microbes and higher root caries incidence than those with natural teeth. Furthermore, the presence of removable prostheses at baseline, together with the male gender, was clearly associated with tooth loss during follow-up. This study indicates that fixed rather than removable prostheses should be used in elderly patients. The need for a removable denture ought to be carefully considered.

Oral health and treatment needs of the long-term hospitalised elderly

OBJECTIVES

To determine the oral health and treatment needs of the long-term hospitalised elderly.

SETTING

The Laakso long-term hospital, Helsinki, Finland.

DESIGN

A cross-sectional study with clinical oral examinations.

SUBJECTS

All long-term patients (n = 260) aged 60 and older.

MAIN OUTCOME MEASURES

Edentulousness, presence and hygiene of dentures, mucosal findings, number of teeth, functioning teeth and tooth remnants, level of dental hygiene, and need for operative treatment.

RESULTS

Subjects' mean age was 83.3 years (SD = 8.1); 42% were edentulous, 45% of women and 33% of men (p = 0.12). With no gender difference, 41% had removable dentures, but one in four were considered to be in need of repair or replacement. Denture hygiene was good in 19%, moderate in 44%, and poor in 37%, and for men worse than for women (p = 0.02). Stomatitis was found in 25%, and angular cheilitis in 28% of the denture wearers. The dentate subjects had on average 12.4 (SD = 8.6) teeth with a clear difference by age (p = 0.03), but no difference by gender. Dental hygiene was considered poor. Of the dentate subjects, 37% were in need of restorations, 51% of periodontal therapy and 42% of extractions.

CONCLUSIONS

Oral cleanliness should be improved with regards to dentures and teeth. More attention should be focused on dental care of the long-term hospitalised elderly.

Prosthodontic status among old adults in Pomerania, related to income, education level, and general health (results of the Study of Health in Pomerania, SHIP)

PURPOSE

The aim of the study was to evaluate associations among prosthetic status, socioeconomic factors, and general health of subjects aged 55 to 79 years. The data were taken from the Study of Health in Pomerania (SHIP).

MATERIALS AND METHODS

Socioeconomic information (age, sex, education level), medical information (number of diseases), and details on smoking and alcohol consumption were obtained. Prosthetic status in the maxilla and mandible was classified into complete denture (CD), removable partial denture (RPD), > or = 10 natural teeth or teeth replaced with fixed prosthodontics (10T+), and < or = nine natural teeth including fixed prosthodontics (9T-).

RESULTS

The data of 1,877 subjects were evaluated. CDs in the maxilla were more frequent than in the mandible. RPDs were more frequent in the mandible and in the group aged 65 to 74 years. Of the individuals with a low education level, 47% had a CD in the maxilla, and only 21% had 10T+. However, of subjects with a high education level, 22% had a CD in the maxilla, and 54% had 10T+. The odds ratio of having a CD in the maxilla increased to 11.9 at the age of 75 to 79 years, compared to 0.6 at the age of 55 to 59 years. Logistic regression analyses showed that the risk of wearing a CD was significantly associated with old age, low education level, low income, smoking, and alcohol abuse, whereas the number of diseases (used as an indicator of general health) was not.

CONCLUSION

Alcohol abuse, smoking, low education level, low income, and old age were significant predictors of wearing CDs.

Validity and limitations of self-reported periodontal health

OBJECTIVES

To study the agreement between self-reported dental conditions and clinical findings in an adult population (20-84 years of age), and thus evaluate questionnaires as a tool in epidemiological studies of oral health, in general, and periodontal health, in particular.

MATERIAL AND METHODS

A questionnaire was sent to 900 randomly selected subjects in the age groups 20-29, 50-59 and 75-84 years. Of these, 723 subjects (81.0%) answered the questionnaire and 20% of them underwent a clinical examination.

RESULTS

As regards the remaining teeth, there was a mean difference of 1.4 teeth between the number indicated in the questionnaire and that found on the clinical examination. This difference was most marked in the older subjects. Eight of the nine subjects with removable dentures reported in their answers that they had removable dentures. Periodontal variables--we found significantly more subjects with pathological gingival pockets among those who stated that they had pockets than among those who answered that they did not (P = 0.01; chi-square independent test). Gingival bleeding was common in those who answered 'Yes' than in those who answered 'No' to the question concerning bleeding gums. This difference was significant (P = 0.05; chi-square independent test) in the three age groups. However, there was no correlation between the questionnaires and the clinical examination concerning tooth mobility.

CONCLUSION

Questionnaires concerning oral status are valid concerning the number of remaining teeth and use of removable dentures. They are less reliable about specific periodontal variables, but can still become a valuable tool for epidemiological studies of periodontal health.

Removable partial denture design: a study of a selected population in Saudi Arabia

Determination of the incidence of various classes of removable partial dentures (RPDs) including their designs and their comparison with previous studies provide clinically useful information for dental training and continuing education. The purpose of this study is to determine the pattern of partial edentulism, the major connector, clasping, and design of 740 cobalt chromium RPD frameworks constructed for a selected population in Saudi Arabia. RPD framework design information and patient personal data were obtained from the work authorization form and the dental records respectively. The relationship among age, sex, nationality, and various Kennedy classes of the RPDs was determined by chi-square statistical analysis. Results indicate that Kennedy Class III removable partial dentures were the most frequently constructed. Although gender had no significant relationship, age and nationality had statistically significant relationship with the distribution of various Kennedy classes of removable partial dentures. Lingual bars and anterior posterior palatal straps were the most commonly used mandibular and maxillary major connectors. Lingual and palatal plates, however, were more frequently used than any major connectors for distal extension RPDs. Comparison with previous findings confirms the established variation in designing RPDs. The distribution of partially edentulousness revealed the influence of the general pattern of tooth loss, which could be modified by patient's demands and socio-economic status. Practitioners need to avail themselves fully of basic RPD design principles concerning the most commonly encountered classes of RPDs.

Subjective need for implant treatment among middle-aged people in Sweden and Denmark

BACKGROUND

The use of oral implants in prosthodontics has become widespread and regarded as a predictable treatment modality. However, there is a lack of knowledge among the general population about the prevalence and need for implant treatments.

PURPOSE

This study was undertaken to register and compare the prevalence of dental implants and the subjective need for implant treatment among people in Sweden and Denmark.

MATERIALS AND METHODS

Random samples taken from the national population registers in Sweden and Denmark comprised 1001 Swedish subjects aged 55 to 79 years and 1175 Danish subjects aged 45 to 69 years. Subjects were requested to fill out questionnaires regarding dental conditions, subjective need for implant treatment, whether they had received treatment with dental implants during the previous 10 years, and so on.

RESULTS

Of the Swedes, 4.8% reported that they had dental implants, compared with 2.5% of the Danes. In the Swedish sample, age was significantly associated with subjective need for implant treatment. In the Danish sample, women showed a significantly higher subjective need for implant treatment than did men.

CONCLUSIONS

Compared with the Swedish sample, the subjective need for treatment with dental implants was higher in the Danish sample, although the patient fees were substantially higher in Denmark.

Quality of removable partial dentures worn by the adult U.S. population

STATEMENT OF PROBLEMS

Research-based assessments of the quality of removable partial dentures (RPDs), especially within a large patient population, are lacking.

PURPOSE

This study evaluated the prevalence and quality of RPDs by use of the National Health and Nutrition Survey (NHANES III) data set.

MATERIAL AND METHODS

Estimates of the health and nutritional status of the American population were obtained from the NHANES III data set (1988-1994). Calibrated dentists performed dental examinations on 17,884 adults. If the subject wore an RPD, its quality was assessed with 5 criteria: integrity, tooth wear, the presence of temporary reline material or adhesive, stability, and retention. In this study, the data on RPD defects were used to assess the prevalence of problems. The original population was divided into 4 subgroups: paired RPD data = subjects wearing both maxillary and mandibular RPDs (n = 600 prostheses, 300 maxillary and 300 mandibular); single RPD data = subjects with only one RPD (n = 1003 prostheses, 511 maxillary and 492 mandibular); maxillary versus mandibular RPD data = all subjects with all RPDs (n = 1603 prostheses, 811 maxillary and 792 mandibular); and pooled RPD data = all subjects with a single RPD plus subjects with 2 RPDs, counting only the RPD with the most defects (n = 1303 prostheses, 674 maxillary and 629 mandibular). The subjects were analyzed with descriptive statistics. The distribution of defects in the RPDs was examined for possible associations with chi(2) tests. The paired data for patients with both maxillary and mandibular RPDs were analyzed with Wilcoxon signed rank tests. The prevalence of RPDs as a function of patient age and the association between RPD defects and patient age were analyzed with chi(2) tests. The results were considered highly significant at P<.0001 and significant at P<.05.

RESULTS

Of the 17,884 adults who underwent a dental examination, 1306 had RPDs. Three patients were excluded because their records were incomplete, leaving 1303 patients available for analysis. Most of the prostheses examined (65%) had at least 1 defect. Lack of stability was the most prevalent single defect. Distinctions in the type and prevalence of defects were observed between mandibular and maxillary RPDs. Mandibular RPDs had significantly more problems related to retention, whereas maxillary RPDs had significantly more problems related to the presence of reline material and to integrity defects. Tooth wear defects were significantly associated with patient age (P<.0001). Only one third of the RPDs were considered satisfactory according to NHANES III criteria.

CONCLUSION

A review of the database used in this study indicated that, in spite of a decline in tooth loss, RPDs are still used in all age cohorts, including young adults. A large number of RPDs were found to have defects.

Usage and status of cobalt-chromium removable partial dentures 5-6 years after placement

The aim of this study was to describe the usage of cobalt-chromium (Co-Cr) removable partial dentures (RPDs) by patients 5-6 years after denture insertion and to find out the factors that affected their denture usage. A random sample of patients provided with Co-Cr RPDs from a dental teaching hospital in Hong Kong was selected. Patients were interviewed using a structured questionnaire concerning their assessment and use of the dentures. Those who had been constantly wearing their original RPDs were examined by one calibrated examiner under optimal clinical conditions. The response rate of the patients who could be contacted was 98%. The results from 189 patient interviews showed that usage of the RPDs declined with time and that half of the dentures had been discarded or replaced 5-6 years after insertion. These discarded RPDs had been in use for an average of 19.5 months. The main reason given by the patients for not using the RPDs was general dissatisfaction with the dentures in various combinations of comfort, fit and chewing ability and, less importantly, with food trapping and appearance. No statistically significant association between denture usage and their respective Kennedy classification was found. The status of the Co-Cr RPDs that had been constantly used for 5-6 years was generally good. The majority of these RPDs demonstrated fair to good cleanliness, stability and retention and had no defect of any sort.

Prosthetic treatment need in a representative German sample

Regarding declining resources epidemiological data on needs for oral rehabilitation are required. Within the framework of an oral health survey a non-stratified two-stage random sample was taken to represent the over 14-year-old population of Saxony/Germany. The participation rate was 55%. Normative need was determined by dental assessment and guidelines developed in a consensus process, subjective prosthetic treatment need by self-complete questionnaire. About 97% of the realized sample could be planned within the guidelines. About 81% had normative prosthetic treatment need. Compared with the rate of normative need the rate of subjective need (13%) was considerably lower (chi(2) P < 0;01). Different predictive parameters of subjective need were identified by logistic regression. Besides other factors subjective need was associated with giving dentist's recommendation as significant reason for prosthetic restorations [odds ratio (OR)=5;43], not believing that the own teeth were all right (OR=0;17), and the existence of prosthetic restorations (OR=3;87 for fixed restorations; OR=4;05 for removable dentures). The guidelines proved their suitability to assess normative prosthetic treatment need in oral health surveys. Further research is necessary to find adequate options for including patients' preferences in an adequate need definition.

Influence of dental care systems on dental status. A comparison between two countries with different systems but similar living standards

OBJECTIVE

To evaluate the influence of two different dental care systems on dental status, taking into account relevant socio-economic factors.

BASIC RESEARCH DESIGN

Questionnaire studies on randomly sampled subjects in Denmark and Sweden using questionnaire forms as identical as possible with regard to the different languages.

SETTING

The studies were performed late in 1998 in both countries.

PARTICIPANTS

Questionnaires were sent to 1,175 subjects aged 45-69 years in Denmark (response rate 73%) and to 1,001 subjects aged 55-79 years in Sweden (response rate 67%).

MAIN OUTCOME MEASURES

Questions about dental status and about socioeconomic factors and attitudes toward dental care were included. In logistic regression models, various dichotomies of dental conditions were used as dependent variables. State (Denmark vs. Sweden) was used as an independent variable together with socioeconomic factors and attitudes.

RESULTS

There were great differences between the countries in dental status. In the regression model with 'wearing removable denture(s)' as the dependent variable, state was the strongest predictor with an OR of above 4.1 for Denmark compared to Sweden. much stronger than variables such as age, income, education and residence.

CONCLUSION

The results indicate that the Swedish dental care system has been superior to the Danish one regarding dental status in middle aged and older populations in these two countries.

Accuracy of three corrective techniques for implant bar fabrication

STATEMENT OF THE PROBLEM

Numerous articles emphasize the importance of passivity of implant-prosthetic component interfaces. Nonpassive interfaces can lead to bone loss, abutment fracture, and connecting screw breakage.

PURPOSE

The purpose of this study was to evaluate 3 postcasting techniques for the correction of non-passive fit between a cast bar superstructure and its interface with an implant abutment.

MATERIAL AND METHODS

Thirty implant Hader bars were fabricated based on a metal model composed of two 3.8/4.5 HL PME titanium implant abutments. Initial measurements were collected on the y-axis of the left implant abutment-bar interface by using a M2001ARS toolmaker microscope. Means were calculated from buccal, distal, and lingual measurements on each specimen. Ten specimens were sectioned, indexed, and corrected by casting the same alloy (group 1). Ten specimens were sectioned, indexed, and corrected by soldering (group 2). The last 10 specimens were submitted to 2 cycles of electrical discharge machining on a MedArc M-2 EDM machine (group 3). Postcorrection measurements were collected on the 3 groups. A 1-way ANOVA and a Tukey-Kramer test at a 0.05 significance level were performed on the 3 groups after the corrective techniques.

RESULTS

Initial gap means were 192 microm for group 1, 190 microm for group 2, and 198 microm for group 3. There was a significant difference (P<0.05) in gap means between group 1 (15 microm) and group 2 (72 microm) as well as between group 2 and group 3 (7.5 microm) after each correction technique. No difference was detected between group 1 and group 3.

CONCLUSION

The electrical discharge machining group resulted in the smallest mean gap distance of 7.5 microm, thus meeting the criteria of passive fit (within 10 microm) described in the literature.

A ten-year clinical follow-up study of prosthetic rehabilitation of the edentulous lower jaw with endosteal dental implants

This paper reports on 10 years of clinical experience with implant prosthodontic treatment of total edentulism. During this period, of the 735 implants that were inserted, only 19 were lost, a 97.4% success rate. The authors believe that evaluating the success of implant treatment requires examining the health of the peripilastrium with periodontologic methods. The indices the authors used for such an evaluation were plaque accumulation, crevicular fluid flow rate, and sulcus bleeding; crevicular fluid flow proved the most satisfactory for estimating the health of peri-implant tissues. The results demonstrate that peri-implant-tissue health is similar to that of the tissues surrounding nontreated natural teeth and better than that of the tissues surrounding natural teeth wearing crowns.

Measurement of misfit at the implant-prosthesis interface: an experimental method using a coordinate measuring machine

Measurement of misfit at the implant-prosthesis interface is a difficult procedure. One factor common to all methods that attempt to measure 3-dimensional distortion to the micron level is the difficulty in providing verifiably consistent reference points between individual measurement sets. Consequently, the majority of studies use a relative distortion model in which the coordinate reference system is integral to the framework, thus limiting the value of the data gathered. In the method described, the datum plane and the coordinate reference system were set up external to the framework and could be re-established between measurement sets in a verifiable manner.

Partial dentures as an independent indicator of root caries risk in a group of older adults

OBJECTIVES

To estimate the independent association between the wearing of removable partial dentures (RPD) and the presence of root caries in a population of older adults.

DESIGN

Multivariate logistic regression modeling of root caries prevalence using different measures of root caries as dependent variables. The model included measures of disease history as indicators of historical risk.

SETTING

Data collected in the field from three areas of England.

SUBJECTS

Random sample of adults aged 60 years and over, drawn from lists of patients registered with general medical practitioners.

INTERVENTION

Field measurements of a range of oral health variables including oral disease, disease history, oral status and various social and demographic measures.

MAIN OUTCOME MEASURES

The presence of root caries, unsound and sound root restorations.

RESULTS

Of the five different models of root caries prevalence which were used, RPDs featured as an independent risk indicator for root surface caries in the three which were related to the presence of untreated disease. The odds ratios for the contribution made by RPDs were all over 1.6, and when considered alone was in excess of 2 in one model. These models were generally well fitting. RPDs did not feature as a risk indicator in the two models which related only to the presence of root surface restorations.

CONCLUSIONS

In this study, where RPDs were present, the odds of untreated disease being present increased substantially.

[Statistical analysis of fabrication of fixed and removable partial dentures]

A statistical survey based on laboratory records was performed on the number of fixed and removable partial dentures fabricated at the dental hospital of Tokyo Medical and Dental University from April 1 to September 30, 1997. A comparison was also performed with a previous survey, which had been carried out in 1986, in order to detect any change and possible alterations in the near future. From the findings of this statistical survey, the conclusions were as follows: 1. A total of 2,478 fixed and removable partial dentures were fabricated during the six month period in 1997. 2. The 3-unit fixed partial denture (bridge) was most common (63.1%) and the number of bridges decreased as the number of units increased. 3. For the single missing tooth, a fixed bridge was more popular (81.0%) than a removable partial denture. 4. For two missing teeth, there was no difference between the number of fixed bridges and removable partial dentures. 5. The percentage of fixed and removable partial dentures, which were not covered by health insurance, decreased to a large extent in comparison with the survey in 1986.

[Statistical analysis of fabrication of indirect single restorations]

A statistical survey based on laboratory records was performed on the number of indirect restorations fabricated at the dental hospital of Tokyo Medical and Dental University from April 1 to September 30, 1997. A comparison was also carried out with a previous survey, which had been carried out in 1986, in order to detect any change and possible alterations in the near future. Based on the results of this statistical survey, the conclusions were as follows: 1. A total of 9,126 indirect restorations were fabricated during the six month period in 1997; among them, 8,007 (87.7%) restorations were covered by health insurance and 1,119 (12.3%) restorations were not. 2. The most common restoration was the cast post and core (28.6%), followed by full crowns (18.5%) and removable partial dentures (15.6%). On the other hand, the least number were post crowns (0.03%) and resin jacket crowns (0.2%). 3. When making a comparison with the data in 1986, an increase in the number of removable partial dentures and a decrease in the number of inlays were the most distinctive features. 4. For anterior teeth, resin-veneered crowns were most common, especially for lower teeth. The percentage of restorations, which were not covered by health insurance, decreased from 45.0% (in 1986) to 12.3% (in 1997).

Investigation of the effect of three sprue designs on the porosity and the completeness of titanium cast removable partial denture frameworks

STATEMENT OF PROBLEM

Although titanium has been used to cast removable partial denture frameworks, the casting process is arduous and requires specialized equipment.

PURPOSE

This study evaluated the ability of 3 sprue designs (tree, ball, and circular) to produce complete, void-free castings of removable partial denture frameworks made from commercially pure titanium.

METHODS AND MATERIAL

A cast with a Kennedy class III, modification 1, partially edentulous arch was used. The blocked-out cast was modified to facilitate assessment of the completeness of the casting of the clasp arms. Thirty refractory casts were made, and 10 wax patterns for each sprue design were fabricated and invested with ethyl silicate investment. Castings were made with an arc-type automatic casting machine in an argon atmosphere. Castings were examined with radiographic equipment to detect the presence of voids in the castings, and the completeness to each casting was visually verified. Data on porosities were tabulated and statistically analyzed with 1-way ANOVA followed by Student Newman-Keuls test. Chi-square analysis was used to identify statistically significant differences in casting defects among the 3 sprue designs.

RESULTS

No statistically significant differences in the total number of porosities were found between the 3 sprue designs (P =.51). Results of completeness of castings evaluated by using chi-square test revealed a statistically significant deference among the 3 sprue designs (P =.008).

CONCLUSION

The ball-sprue design produced the most complete castings for the removable partial denture titanium frameworks.

[Evaluation of the dental status from he viewpoint of denture requirements in the adult population of Hungary]

Authors found a rather high number of missing teeth of the Hungarian population, whereas the claim of the patients to dentures is less than the capacity of the dental professionals. The percentage of the patients wearing fixed and/or removable dentures is only around 50% (mean value), in the aesthetically not disadvantageous cases (i.e.: classes 1/a; 2/a; Fábián-Fejérdy) only 30-40%, but in the aesthetically disadvantageous cases 70-80% (i.e.: classes 1/b; 2/a/1; 3; Fábián-Fejérdy). The percentage of the men wearing dentures is higher than the percentage of the men (61.9% and 44.9% respectively). Authors concluded that, the most important expectations of the patients to dentures are aesthetic. The injurious effects of not reconstructed missing teeth have minor effects on the patients motivation.

Prosthodontic profiles relating to economic status, social network, and social support in an elderly population living independently in Canada

STATEMENT OF PROBLEM

Previous evaluations of life satisfaction and health have not completely explained the impact of social network, social support, and economics on the oral health-related behavior of elderly patients, particularly in relation to missing teeth.

PURPOSE

This study measured the strength of associations between social network/support/class and the use of complete and removable partial dentures in elderly patients living independently.

MATERIAL AND METHODS

A multiple stepwise logistic regression was used to contrast data from previous studies relating to the subject and to explore the influence of these social variables.

RESULTS

The results substantiated the links observed in a previous study between some social features and oral fitness. More frequent use of complete dentures was identified among participants who reported higher incomes and among those who thought their incomes were sufficient for their needs. Unreplaced missing anterior teeth were associated more commonly with subjects less willing or able to leave their homes.

CONCLUSIONS

Some salient features of prosthodontic care and oral health status were common to 2, comparable social environments. A minority within the elderly population may not see a need to make use of clinical dental services, regardless of how accessible these services are to them. Social network and social support issues may be important determinants in this perceived need to use clinical services.