Impact of shortened dental arch therapy on nutritional status and treatment costs in older adults: A systematic review.

OBJECTIVE: This review was undertaken to evaluate, whether a shortened dental arch (SDA) was a good alternative to a conventional prosthodontic rehabilitation (RPD) in older adults when nutritional and economic factors are compared. DATA: A total of 92 studies were included for the full-text analysis, and finally 4 reports from two RCTs qualified for data extraction and analysis. The final search update was performed on 06.11.2022 and no further searches and updates were performed after this date. SOURCES: Electronic databases [PubMed (MEDLINE), Embase, CENTRAL] were systematically searched to identify studies comparing nutritional and economic outcomes in partially edentate adults rehabilitated with conventional RPD and SDA therapy. STUDY SELECTION: Studies were excluded if there were less than 10 participants per group, and if the subjects were not clinically followed up in recall visits. Two investigators performed the data extraction and were reciprocally blinded. Inter-investigator reliability was assessed using Cohen's unweighted kappa (κ). A meta-analysis could not be performed and the results were reported qualitatively. RESULTS: The calculated κ ranged between 0.80 and 1.00. Three reports from two studies reported on nutritional outcomes and one report provided information on economic benefits, when comparing between the SDA therapy and conventional prosthodontic rehabilitation. No significant difference was recorded in the nutritional status of patients rehabilitated using the SDA concept compared with RPDs. Higher costs for treatment provision and maintenance for patients in the RPD group was found when compared to SDA treatment. CONCLUSIONS: This systematic review identified the shortened dental arch concept as a reasonable alternative to the conventional prosthodontic rehabilitation where cost-effectiveness and nutrition are concerned based on the limited evidence obtained from current literature. CLINICAL SIGNIFICANCE: SDA therapy may be considered as a feasible treatment concept in older adults especially in those with complex medical statuses and limited finances.

Influence of the vegan, vegetarian and omnivore diet on the oral health status in adults: a systematic review and meta-analysis.

OBJECTIVE: This systematic review aimed to evaluate the influence of the nature of diet (vegan, vegetarian, and omnivore) on the oral health status in adults. METHODS: This systematic review and meta-analysis was performed using the PRISMA guidelines. Electronic databases [PubMed, Embase, CENTRAL], online search engines (Google Scholar), research portals, and hand searches were performed systematically to identify studies. The last literature search was performed February 1st, 2021. Studies were included if they reported on the influence of the nature of diet on the oral health status (oral hygiene, periodontal health, dental status, and salivary function) in adults, by two investigators. Inter-investigator reliability was evaluated using Kappa (κ) statistics. PROSPERO registration number: CRD42020211567. RESULTS: Twenty-two studies were included for data extraction and final analysis. The meta-analysis revealed that the bleeding on probing measure was higher in omnivores (Z = -4.057, p < 0.0001; 95% CI: -0.684, -0.238; I2 = 0.0%) and the overall periodontal health was significantly better in vegan/vegetarians than omnivores (Z = -2.632, p = 0.008; 95% CI: -0.274, -0.073; I2 = 29.7%). Vegan/vegetarians demonstrated more dental erosion (Z = 3.325, p = 0.001; 95% CI: 0.170, 0.659; I2 = 0.0%). In adults over 60 years old, the prevalence of caries was higher in omnivores (Z = 3.244, p = 0.001; 95% CI: 0.092, 0.371; I2 = 0.0%), while complete edentulism was more prevalent in vegetarians (Z = -4.147, p < 0.0001; 95% CI: -0.550, -0.197; I2 = 0.0%). CONCLUSIONS: This review reveals that adults on an omnivore diet may be associated with a higher risk for periodontal problems and dental caries, while vegetarians/vegans may be associated with a higher risk for dental erosion.

CAD-CAM complete removable dental prostheses: A double-blind, randomized, crossover clinical trial evaluating milled and 3D-printed dentures.

OBJECTIVE: This double-blind, randomized, crossover, clinical trial aimed to evaluate and compare the differences between milled and 3D-printed complete removable dental prostheses (CRDPs). METHODS: Fifteen edentulous patients (men: n = 10, women: n = 5; age: 66.7 ± 8.0 years) rehabilitated with conventional CRDPs were recruited for this trial. Participants were randomized to first receiving either the milled or 3D-printed CAD-CAM manufactured CRDPs and then after 6-weeks cross over to the other set. Both, clinicians and participants were blinded to the group allocation. Outcomes included patient's denture satisfaction (PDS), oral-health related quality of life (OHIP-EDENT), willingness-to-pay analysis, final choice (FC) of CRDPs, clinician's denture quality evaluation (CDQE), chewing efficiency (CE), maximum-voluntary-bite-force (MBF), and prosthodontic maintenance needs. The outcomes were measured at baseline (with old CRDPs), at 1 and 6 weeks after new CRDP insertion; following crossover with the second set of CRDPs, an identical protocol was followed. Generalized linear regression for repeated measures was used for statistical analysis with α=0.05. RESULTS: All participants completed the trial. 3D-printed CRDPs required more maintenance visits, adjustment time (p = 0.0003), and adjustment costs (p = 0.021). Patients were willing-to-pay an average of 606.67 Swiss Francs more than the actual cost for the milled CRDPs. There were no differences in the PDS, OHIP, FC, CDQE, CE, and MBF between the two CRDPs groups. CONCLUSIONS: The findings of this double-blind randomized crossover clinical trial confirm that both milled and 3D-printed CRDPs are valid treatment modalities for edentulous patients, with the latter performing inferiorly with regard to the time and costs involved with the prosthodontic aftercare, as well as the patients' willingness-to-pay. CLINICAL RELEVANCE: The findings of this trial provide evidence to help the clinician in choosing the appropriate CAD-CAM manufacturing process for fabricating the CRDPs.

Comparison of smartphone-camera and conventional flatbed scanner images for analytical evaluation of chewing function.

BACKGROUND: The two-colour mixing test is a quick method to assess chewing function (CF). The use of smartphone cameras for acquiring images may help in further simplifying the process. OBJECTIVE: This study evaluated the reliability of smartphone-camera images of chewing gums to assess CF. METHODS: Five test samples of a bicoloured chewing gum were produced by a single fully dentate adult volunteer. The specimens were flattened to 1-mm thick wafers. The two sides of the wafers were digitised with a conventional flatbed scanner (control) and were photographed 20 times using 8 different smartphones. The images were assessed optoelectronically to obtain the variance of hue (VoH) and subjectively by visual assessment (SA) using a categorical scale (SA1-SA5). Spearman's correlation and regression models were used for statistical analyses. RESULTS: The intra-group variability for SA1-SA3 was <1% for all smartphones, but significantly higher than controls for SA4 and SA5 (smartphone: SA4 = 5.57%; SA5 = 8.76%; control: SA4 = 2.5%; SA5 = 0.79%). VoH was progressively lower from SA1 to SA5 for all imaging devices (r > -.97; P < .001). VoH comparisons between control and smartphone images revealed significant differences for the individual SA categories, and however, the magnitude of differences was small and non-significant when the full range of SA levels were considered. The linear mixed model regression showed significant effects for all the smartphones (P < .001) and SA levels (P < .001) in relation to the flatbed scanner values. CONCLUSIONS: Smartphone cameras may be used to evaluate colour mixture for a bolus-kneading test, however, the precision is lower with higher degrees of colour mixing.