Autologous platelet concentrates in maxillofacial regenerative therapy.

Platelet concentrates have emerged as innovative autologous blood products that enhance tissue healing and regeneration in regenerative therapy. A common feature of these products is their higher than baseline platelet concentration, which improves wound healing and tissue repair. Four main categories of products can be easily defined, based on their leukocyte content and fibrin architecture: pure platelet-rich plasma, such as Cell Separator PRP or Anitua' PRGF; leukocyte- and platelet-rich plasma (L-PRP), such as PCCS or Ace PRP; pure platelet-rich fibrin (P-PRF), such as Fibrinet PRFM; and leukocyte- and platelet-rich fibrin (L-PRF), such as Choukroun's PRF. Two families contain significant concentrations of leukocytes: L-PRP and L-PRF. These four families of products have different biological signatures and mechanisms and obviously different clinical applications. An L-PRF membrane releases growth factors and matrix proteins over a period longer than 7 days, whereas a PRP gel matrix releases and disperses its growth factors in a relatively quick download. In the near future, simple and inexpensive products such as L-PRF are expected to have applications in oral-maxillofacial surgery, periodontal surgery, plastic surgery, orthopedic surgery, and sports medicine. Leukocytes substantially affect the intrinsic biology and properties of platelet concentrates, not only because they enhance immune function and antibacterial potential, but also because they have essential roles in the wound healing process. Unfortunately, their impact has been almost completely neglected in the literature. Improved understanding of the effects of leukocytes in wound healing is essential for development of new clinical applications of platelet concentrates.

Dentist-Patient Communication and Denture Quality Associated with Complete Denture Satisfaction Among Taiwanese Elderly Wearers.

PURPOSE: The aim of this study was to explore individual (ie, sociodemographic characteristics, patient personality) and clinical factors (ie, dentist-patient communication, denture quality) associated with complete denture satisfaction among the Taiwanese elderly population. MATERIALS AND METHODS: A multistage sampling and cross-sectional design was used to collect data. A total of 387 fully edentulous citizens, aged 65 years and older and who had received new sets of complete dentures, were selected. The participants completed clinical dental examinations and questionnaires by personal interview to collect information on denture satisfaction and associated variables. The relationship among three groups of these participants (satisfied, neutral, and dissatisfied) and potential factors were simultaneously examined using polytomous logistic regression analysis. RESULTS: Overall, 36.7% of the participants were dissatisfied with their dentures. Living status (crude odds ratio [COR] = 2.04), personality (COR = 4.86), dentist-patient communication (COR = 7.46), and denture quality (COR = 5.02) were associated with complete denture satisfaction. The multivariate regression model showed that dentist-patient communication (adjusted odds ratio [AOR] = 6.41) and denture quality (AOR = 4.40) were significant complete denture satisfaction factors that diluted the effect of living status and personality. CONCLUSIONS: Inadequate dentistpatient communication and low denture quality were associated with the dissatisfaction of patients with dentures. To increase complete denture satisfaction, the importance of training programs aimed at enhancing dentist-patient communication and denture quality cannot be overemphasized.

Tongue support of complete dentures in the elderly.

This study aimed to evaluate the tongue's role in supporting maxillary denture retention (MDR), in providing additional stabilization for the mandibular denture, and the tongue's relationship with the oral health-related well being in elderly complete denture patients. Four hundred elderly individuals, 263 males and 137 females, were enrolled in this study. All were older than 65 years, and wore complete dentures. Intraoral examinations were performed in accordance with the 10 criteria embedded in the Functional Assessment of Dentures (FAD). Participants also received personal interviews and completed the Oral Health Impact Profile-14 (OHIP-14) questionnaire. The associations between MDR (tongue support) with the mean OHIP-14 sum scores and FAD categories were analyzed using the t test or analysis of variance (ANOVA). Combinations of MDR (tongue support), MDR (resistance to vertical pull), and mandibular denture stability (anterior-posterior movement) were also assessed with the remaining FAD criteria and OHIP-14 domain scores. Individuals with adequate MDR (tongue support) were significantly associated with denture articulation, denture occlusion, MDR (resistance to vertical pull), maxillary denture stability (pronounced rocking), and mandibular denture stability (anterior-posterior movement). When individuals with adequate MDR (tongue support) were analyzed in conjunction with adequate MDR (resistance to vertical pull) and adequate mandibular denture stability (anterior-posterior movement), significant associations were observed with the mean OHIP-14 sum score and three individual OHIP-14 domains: functional limitation, physical pain, and physical disability (p ＜ 0.05). The mean OHIP-14 sum score was lower among individuals with both adequate MDR (tongue support) and inadequate MDR (resistance to vertical pull) than among participants with both inadequate MDR (tongue support) and inadequate MDR (resistance to vertical pull). MDR (tongue support) demonstrated significant differences from denture occlusion, denture articulation, MDR (resistance to vertical pull), maxillary denture stability (pronounced rocking), and mandibular denture stability (anterior-posterior movement). MDR (tongue support), in conjunction with both adequate MDR (resistance to vertical pull) and adequate mandibular stability (anterior-posterior movement), were significantly associated with the individuals' oral health-related well being.

Maximizing mandibular denture retention in the sublingual space.

PURPOSE: This study was designed to investigate potential discrepancies between the depth and width of the mandibular denture anterior lingual flange and the alveolingual sulcus and to measure the changes in retention when flange lengths were modified to optimal dimensions in a sample population of elderly edentulous subjects. MATERIALS AND METHODS: The anterior lingual flange and alveolingual sulcus were measured in 66 randomly selected elderly Taiwanese denture patients. The length and width of corresponding regions of the anterior lingual flange and alveolingual sulcus were compared. Mandibular denture retention was recorded and compared prior to and following modification of the anterior lingual flange with border molding. RESULTS: A significant statistical difference existed between the mean anatomical dimensions of the alveolingual sulcus and the corresponding denture flanges. Following functional border molding, the mean retention of the mandibular denture increased in a statistically significant manner. CONCLUSION: The discrepancies between the anterior lingual denture flange and alveolingual sulcus dimensions appeared to significantly diminish mandibular denture retention and reinforce the value of proper flange extensions in the sublingual region.

Application of the Oral Health Impact Profile (OHIP) among Taiwanese elderly.

PURPOSE: To validate the Chinese (Taiwan) version of the Oral Health Impact Profile (OHIP-49T) and develop a short form of the OHIP (OHIP-14T) for the elderly. METHODS: A total of 1402 subjects, aged 65 and above, received a personal interview and oral examination. Internal consistency, measured by Cronbach's alpha, and test-retest reliability were assessed by intra-class correlation coefficient (ICC) during a 2-week interval. The criterion-related validity of OHIP-49T was evaluated through associations between the OHIP-49 score with prosthetic need and prosthetic status. A subset (OHIP-14T) questionnaire, derived through a controlled regression procedure, was compared with the original OHIP-14 by Slade (OHIP-14S). RESULTS: The Cronbach's alpha and ICC values were 0.97 and 0.98 for OHIP-49T and 0.90 and 0.93 for OHIP-14T. Mean scores of the OHIP-49T were significantly associated with prosthetic status (P = 0.0013) and prosthetic need (P = 0.0004), which were examined by dentists. The OHIP-14T score had stronger discriminatory ability than OHIP-14S. CONCLUSIONS: The OHIP-49T showed satisfactory reliability and validity for this Taiwanese elderly population. The OHIP-14T is more effective to measure OHRQoL than OHIP-14S.

The association of chewing ability and diet in elderly complete denture patients.

The purpose of this study was to investigate the relationship between chewing ability and diet among elderly edentulous patients whose dentures were funded by the Department of Health in Kaohsiung City, Taiwan. A cluster sample of 103 elderly edentulous subjects 65 years and older (68 men, 35 women) was gathered randomly and assessed through use of a questionnaire. The responses to queries regarding demographics, health, and chewing capabilities were correlated with dietary guidelines for the five basic food groups. Chi-square test analysis revealed that subjects with chewing difficulty consumed fewer vegetables. Only 17% of the total subject pool consumed the recommended daily allowance (RDA) of vegetables. Approximately 58% of subjects reported dissatisfaction with their dentures and 51% reported discomfort on chewing. Approximately 4% of the subjects met the RDA standards for all five food groups and 4% did not meet the RDA standards for any of the five food groups. Patient satisfaction with the comfort of their denture during mastication significantly impacted the diet of these elderly edentulous patients.

Improved denture retention in patients with retracted tongues.

BACKGROUND: Patients who wear mandibular dentures and hold their tongues in retracted positions alter the dimensions of the sublingual space and disrupt the peripheral seal that is needed for optimal denture retention. The authors studied whether retention could be improved if patients moved their tongues from a retracted resting position to an ideal resting position. METHODS: The authors observed and classified the mandibular residual ridge morphologies of 85 participants who wore complete dentures. The authors recorded and compared the retention of the mandibular denture before and after repositioning the tongue to the ideal resting position. RESULTS: When the participants' tongues were in a retracted resting position, the average retention of the mandibular denture was 75.38 gram weight (+/- 81.83 standard deviation [SD]). After participants repositioned their tongues to the ideal resting position, the average retention of the mandibular denture was 118.89 gw (+/- 93.00 SD), an increase of 57.73 percent. CONCLUSIONS: In all morphological classes, when participants held their tongues in the ideal resting position, the average mandibular denture retention increased by 57.73 percent, a statistically significant improvement compared with when participants held their tongues in a retracted resting position. CLINICAL IMPLICATIONS: Clinicians are encouraged to evaluate carefully the tongue resting position in all patients who wear dentures, help create reasonable therapeutic expectations by informing patients about the significant effect that tongue position will have on future denture retention and provide helpful neuromuscular training for patients with retracted-tongue habits.

Evaluation of the effect of laser tooth whitening.

PURPOSE: This study aimed to determine whether gender, age, and initial tooth hue impacted the effect of laser tooth whitening. MATERIALS AND METHODS: Ninety-one subjects were enrolled in a laser tooth whitening study at Kaohsiung Medical University. Sensitivity was evaluated by asking the patients about any tooth sensitivity they experienced after the whitening procedures were performed. The LaserSmile tooth whitener, containing 35% hydrogen peroxide, was applied to the tooth surfaces of both arches from the central incisor to the second premolar, and the LaserSmile Twilite diode laser was applied to the same maxillary and mandibular teeth. After removal of the whitening gel, shade matching was immediately performed with the ShadeEye NCC Dental Chroma Meter. Patients were classified into the following groups: tetracycline stain, gender, age, and initial tooth hue. Only 5 of the 91 individuals had tetracycline staining. RESULTS: The initial tooth shade and the amount of shade change showed no significant differences between female and male patients, but a significant difference was found between hue and age group. CONCLUSIONS: Teeth with hue A showed greater shade improvement than teeth with hue C and hue D. Whitening response was better in younger individuals, and gender was not a factor that affected the whitening response. Sensitivity is common during the whitening procedure but can be tolerated by the patients.

The proportion of 3 classes of lateral throat form.

The aim of this study was to investigate the proportion of 3 Neil's classifications of lateral throat forms and the difference in the length of the lateral throat form between the dentures and the patient's actual anatomy. The classification of lateral throat form was determined by the patient's functional movements, and an implant depth gauge was used to measure the length of the lateral throat form in the patient's mouth and compare it to that of the dentures. One hundred mandibular edentulous patients were measured. The proportion of Neil's Class I lateral throat form was 70%, the proportion of Class II was 25%, and the proportion of Class III was 5%. The mean difference between the actual lateral throat forms and the dentures was 6.7 +/- 2.9 mm at the anterior point of measurement (from the anterior part of the retromolar pad to the mouth floor) and 10.0 +/- 3.7 mm at the posterior point (from the middle of the retromolar pad to the mouth floor). The difference in length between the ridge height of the mouth and the denture was statistically significant (P < .001).

Predictable reproduction of the buccal shelf area in mandibular dentures.

The objective of this study was to assess whether a periodontal probe measurement could be used to obtain a predictable reproduction of the buccal shelf areas in mandibular dentures. One hundred patients were measured for the anterior, middle, and posterior width of the buccal shelf with a periodontal probe. This measurement was then compared with that of the corresponding portion of the existing denture. At each portion, there were statistically significant differences in the width of the buccal shelf and that of the corresponding portion of the existing denture from dental clinics of general dentists. The periodontal probe could be used to measure the width of the buccal shelf to obtain a predictable reproduction of the buccal shelf areas in mandibular dentures.

Canine transposition.

Transposition is described as an interchange in the position of two teeth within the same quadrant of the dental arch. Canine transposition is reportedly the most common transposition in human dentition. The incidence of maxillary canine-premolar transposition is reported to be 0.135-0.510%. Although the exact mechanism of canine transposition is unclear, it seems to be closely related to genetically influenced, retained deciduous canine, and a history of trauma. In this article, we focus on the classification, incidence, etiology, and treatment modalities of tooth transposition. We hope this information will help clinicians treating patients with this kind of dental anomaly.

Cranial-base morphology in children with class III malocclusion.

The association between cranial-base morphology and Class III malocclusion is not fully understood. The purpose of this study was to investigate the morphologic characteristics of the cranial base in children with Class III malocclusion. Lateral cephalograms from 100 children with Class III malocclusion were compared with those from 100 subjects with normal occlusion. Ten landmarks on the cranial base were identified and digitized. Cephalometric assessment using seven angular and 18 linear measurements was performed by univariate and multivariate analyses. The results revealed that the greatest between-group differences occurred in the posterior cranial-base region. It was concluded that shortening and angular bending of the cranial base, and a diminished angle between the cranial base and mandibular ramus, may lead to Class III malocclusion associated with Class III facial morphology. The association between cranial-base morphology and other types of malocclusion needs clarification. Further study of regional changes in the cranial base, with geometric morphometric analysis, is warranted.

Tooth morphometry in lingual orthodontics.

Lingual orthodontics is used clinically. This study investigated the lingual crown angulation and inclination of optimal occlusion in Taiwanese people. The sample included 45 sets of dental study casts from 28 males and 17 females with optimal occlusion selected from approximately 5,000 young adults. Mesial tipping occurred in all teeth except the upper second molars, the lower central incisors, and the lower lateral incisors. The greatest mesial tipping was observed in the lower second molars. The greatest distal tipping was observed in the lower lateral incisors. Labial (buccal) inclination was observed in all teeth except the lower first molars and the lower second molars. Maximum labial inclination occurred in the upper central incisors. Maximum lingual inclination was observed in the lower first molars.