EPA Consensus Project Paper: The Influence of Prosthetic Factors on the Incidence of Peri-implantitis Around Single Implants: A Systematic Review.

INTRODUCTION: The purpose of this systematic review was to evaluate how prosthetic factors affect the incidence of peri-implantitis in patients treated with single implant restorations. METHODS: Electronic and manual search of two indexed databases up to April 2023 were conducted, to identify clinical studies reporting on the effect of different prosthetic factors on the incidence of peri-implantitis around single implants and with at least 1 year follow-up. The risk of bias was assessed with the Joanna Briggs Institute critical appraisal checklist, the ROB2 and the ROBINS-I tools. RESULTS: From the 521 screened articles, 11 studies (1 randomized controlled trial, 7 cross-sectional, 3 retrospective) met the inclusion criteria. Based on three studies, emergence angle⟩30°, convex emergence profile and external connection are associated with a higher incidence of peri-implantitis. Nine studies pertaining to the effect of retention type on the prevalence of peri-implantitis reported conflicting results. Six out of eleven included studies presented some risk of bias. CONCLUSIONS: There is insufficient evidence regarding the influence of prosthetic factors on the incidence of peri-implantitis around single implants. Further studies are needed to draw definitive conclusions on this issue.

EPA Consensus Project Paper: Failure Rates of Direct Versus Indirect Single-Tooth Restorations. A Systematic Review and Meta-Analysis.

INTRODUCTION: The purpose of this systematic review and meta-analysis was to evaluate and compare the failure rates of direct and indirect restorations for single-tooth restorations. METHODS: A literature search was conducted by using electronic databases and relevant references for clinical studies on direct and indirect dental restorations with a follow-up of at least 3 years. The risk of bias was assessed with the ROB2 and the ROBINS- I tools. The I2 statistic was used for the assessment of heterogeneity. The authors reported summary estimates of annual failure rates of single-tooth restorations using a random-effects model. RESULTS: Of 1415 screened articles, 52 (18 RCTs, 30 prospective, 4 retrospective) met the inclusion criteria. No articles with direct comparisons were identified. No significant difference was found in the annual failure rates of single teeth restored with either direct or indirect restorations, which were calculated as 1% using a random-effects model. High heterogeneity was found, ranging from 80% (P⟨0.01) for studies on direct restorations to 91% (P⟨0.01) for studies on indirect restorations. Most of the studies presented some risk of bias. CONCLUSIONS: Annual failure rates were similar for direct and indirect single-tooth restorations. Further randomized clinical trials are needed to draw more definitive conclusions.

Assessing the Impact of Frailty on Cognitive Function in Older Adults Receiving Home Care.

It is commonly accepted that frailty and dementia-related cognitive decline are strongly associated. However, degree of this association is often debated, especially in homebound elders with disabilities. Therefore, this study aimed to investigate the association of frailty on cognitive function in older adults receiving homecare. A screening for frailty and cognitive function was conducted at 12 primary healthcare settings of the nationally funded program "Help at Home" in Heraklion Crete, Greece. Cognitive function and frailty were assessed using the Montreal Cognitive Assessment questionnaire and the SHARE-f index, respectively. Barthel-Activities of Daily Living and the Charlson Comorbidity Index were also used for the identification of disability and comorbidity, respectively. The mean age of the 192 participants (66% female) was 78.04 ± 8.01 years old. In depth-analysis using multiple linear regression, revealed that frailty was not significantly associated with cognitive decline (frail vs. non-frail (B'=-2.39, p=0.246) even after adjusting for depression and multi-comorbidity. Importantly, as protective factors for cognitive decline progression and thus dementia development, was scientifically correlated with annual individual income >4500 (B'=2.31, p=0.005) -poverty threshold-compared to those with <4500 and, higher education level as compared to Uneducated (B'=2.94, p=0.019). However, depression was associated with cognitive decline regardless of socioeconomic variables. In conclusion, our results suggest that health professionals caring for frail people with cognitive impairment, must focus on early recognition and management of depression.

Changes in corticospinal motor excitability induced by non-motor linguistic tasks.

The excitability of the corticospinal motor pathways to transcranial magnetic stimulation (TMS) can be differentially modulated by a variety of motor tasks. However, there is emerging evidence that linguistic tasks may alter excitability of the corticospinal motor pathways also. In this study we evaluated the effect of several movement-free, low-level linguistic processes involved in reading and writing on the excitability of the bilateral corticospinal motor pathways in a group of right-handed subjects. The study included two series of tasks, visual searching/matching and imaginal writing/drawing. The tasks were designed to roughly correspond with elemental aspects of the reading and writing, grapheme recognition and grapheme generation, respectively. Each task series included separate blocks with different task targets: letters, digits, semantically easy-to-code (i.e. geometric) shapes, and semantically hard-to-code shapes, as well as control blocks with no task. During task performance, TMS was delivered randomly over the hand area of either the left or right motor cortex and the modulation of the excitability of the corticospinal motor pathways was measured bilaterally through changes of the size of the motor-evoked potential (MEP) induced in the relaxed right and left first dorsal interosseous (FDI) muscles. We found that the size of the MEP in hand muscles increased during visual searching/matching tasks, particularly when targets were letters or geometric shapes, and the increase was significant for the dominant hand (left hemisphere) only. No such consistent effects were seen across subjects during imaginal tasks. This study provides evidence that even the performance of certain low-level linguistic tasks can modulate the excitability of the corticospinal motor pathways, particularly those originating from the left (dominant) hemisphere, despite the absence of overt motor activity. Moreover, in the light of the recently increased awareness of the role of "mirror neurons" in perception, the results suggest that activation of motor circuits used in generation of the written output may be an essential part of the perception of the written material as well. Understanding the patterns of task-dependent changes in excitability of the corticospinal motor pathways will provide insights into the organisation of central nervous system functional networks involved in linguistic processes, and may also be useful for future development of novel approaches to rehabilitation therapy of linguistic and motor functions.

Perceived stigma in Spasmodic Torticollis.

Little is known about the "stigmatizing" effects of Spasmodic Torticollis--a condition that produces physical disfigurement. This is important in understanding the social dimensions of this disorder. This study examined the presence, the dimensions, and the degree of perceived stigma in patients with Spasmodic Torticollis. The study was completed in two stages. In the first stage, ten patients were interviewed to identify the effects of their condition on their social interactions. In the second stage, a self-rating measure of stigma and questions about the impact of the condition on the patients' lives were devised. Perceived stigma was defined as avoidance of others, avoidance by others, self-consciousness, feeling unattractive, feeling apologetic, and feeling different from others. The questionnaires were sent to one hundred patients. The majority of the patients perceived "some" or "severe" stigma. Stigma was found to affect the patients' social, private, and working lives. It is suggested that stigma in Spasmodic Torticollis needs to be considered as a parameter relevant to the clinical management of these patients.

Case weighting in a speech and language therapy service.

This study present an approach designed to calculate input provided by a speech and language therapy service. A case weighting system was developed in order to evaluate the cost of services, predict the need for intervention, balance and prioritise the caseload among therapists. It is suggested that this approach can be use widely in clinical practice.

A case of verbal auditory agnosia: missing the word ... missing the sound....

The neuropsychological nature of verbal auditory agnosia is not fully understood. This study aims to describe the language deficits and the remediation strategies used in a person with verbal auditory agnosia. In addition, it will address the theoretical issues concerning the nature of the phenomenon and the clinical implications in the management of people with this disorder.