Orofacial esthetics, chewing function, and oral health-related quality of life in Kennedy class I patients with mini-implant-retained removable partial dentures: A 3-year clinical prospective study.

This prospective clinical study aimed to assess self-reported orofacial esthetics, chewing function, and oral health-related quality of life (OHRQoL) over three years in the Kennedy Class I patients without posterior dentition who received free-end saddle removable partial dentures (RPDs) retained by two mini dental implants (MDIs) inserted in the canine/first premolar region. The study's robust findings reaffirm the viability of MDI-retained RPDs as a treatment modality in contemporary prosthodontics, instilling confidence in the dental community. MATERIALS AND METHODS: 92 participants with posterior edentulism in the maxilla or mandible received 184 MDIs and 92 RPDs. After one year, three participants were excluded, and another seven were excluded after three years. The final sample was 82 participants. Self-perceived orofacial esthetics was assessed by the Orofacial Esthetic Scale (OES), chewing function by the Chewing Function Questionnaire (CFQ), and the OHRQoL by the OHIP-14. Statistical analysis utilized multivariate regression analysis, standardized effect size calculation, Wilcoxon Signed Rank test, and Friedman's test. RESULTS: OHRQoL and chewing function significantly improved (p < 0.001) one month after MDI loading by the new RPDs and continued to improve over the observation period (p < 0.05). The OES also significantly improved (p < 0.001) and remained almost unchanged over the next three years (p = 0.440). CONCLUSION: Despite the limitations of this study, the MDI-retained RPD appears to be a viable treatment modality in contemporary prosthodontics from the patients' perspective.

Adhesion of Candida Albicans to digital versus conventional acrylic resins: a systematic review and meta-analysis.

BACKGROUND: The present systematic review and meta-analysis investigated the available evidence about the adherence of Candida Albicans to the digitally-fabricated acrylic resins (both milled and 3D-printed) compared to the conventional heat-polymerized acrylic resins. METHODS: This study followed the guidelines of the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA). A comprehensive search of online databases/search tools (Web of Science, Scopus, PubMed, Ovid, and Google Scholar) was conducted for all relevant studies published up until May 29, 2023. Only in-vitro studies comparing the adherence of Candida albicans to the digital and conventional acrylic resins were included. The quantitative analyses were performed using RevMan v5.3 software. RESULTS: Fourteen studies were included, 11 of which were meta-analyzed based on Colony Forming Unit (CFU) and Optical Density (OD) outcome measures. The pooled data revealed significantly lower candida colonization on the milled digitally-fabricated compared to the heat-polymerized conventionally-fabricated acrylic resin materials (MD = - 0.36; 95%CI = - 0.69, - 0.03; P = 0.03 and MD = - 0.04; 95%CI = - 0.06, - 0.01; P = 0.0008; as measured by CFU and OD respectively). However, no differences were found in the adhesion of Candida albicans between the 3D-printed digitally-fabricated compared to the heat-polymerized conventionally-fabricated acrylic resin materials (CFU: P = 0.11, and OD: P = 0.20). CONCLUSION: The available evidence suggests that candida is less likely to adhere to the milled digitally-fabricated acrylic resins compared to the conventional ones.

Mandibular Overdenture Supported by Two or Four Unsplinted or Two Splinted Ti-Zr Mini-Implants: In Vitro Study of Peri-Implant and Edentulous Area Strains.

Clinical indications for the newly released Ti-Zr (Roxolid®) alloy mini-implants (MDIs) aimed for overdenture (OD) retention in subjects with narrow alveolar ridges are not fully defined. The aim of this study was to analyze peri-implant and posterior edentulous area microstrains utilizing models of the mandible mimicking a "real" mouth situation with two (splinted with a bar or as single units) or four unsplinted Ti-Zr MDIs. The models were virtually designed from a cone beam computed tomography (CBCT) scan of a convenient patient and printed. The artificial mucosa was two millimeters thick. After MDI insertion, the strain gauges were bonded on the oral and vestibular peri-implant sites, and on distal edentulous areas under a denture. After attaching the ODs to MDIs, the ODs were loaded using a metal plate positioned on the first artificial molars (posterior loadings) bilaterally and unilaterally with 50, 100, and 150 N forces, respectively. During anterior loadings, the plate was positioned on the denture's incisors and loaded with 50 and 100 N forces. Each loading was repeated 15 times. The means with standard deviations, and the significance of the differences (two- and three-factor MANOVA) were calculated. Variations in the MDI number, location, and splinting status elicited different microstrains. Higher loading forces elicited higher microstrains. Unilateral loadings elicited higher microstrains than bilateral and anterior loadings, especially on the loading side. Peri-implant microstrains were lower in the four-MDI single-unit model than in both two-MDI models (unsplinted and splinted). Posterior implants showed higher peri-implant microstrains than anterior in the four-MDI model. The splinting of the two-MDI did not have a significant effect on peri-implant microstrains but elicited lower microstrains in the posterior edentulous area. The strains did not exceed the bone reparatory mechanisms, although precaution and additional study should be addressed when two Ti-Zr MDIs support mandibular ODs.

Influence of education level and gender of dental students on perception of dental aesthetics.

BACKGROUND: Fulfilling aesthetic norms is an imperative of modern society. Accordingly, aesthetics has found its important role in dental medicine. The aim was to study whether there is a difference in the perception of tooth shade change and anatomical variations of anterior maxillary teeth among dental students depending on the level of education, gender, and experience in assisting in a dental office. METHODS: The research was conducted among dental students via the Google Forms platform. Students evaluated the aesthetic acceptability of a smile on the unaltered, reference photograph (RP) and on the other 28 photographs in which the tooth shade (lighter and darker teeth), length (shortened central incisors, elongated, and beveled lateral incisors, elongated canines) and position (atypical and typical rotations and diastemas) of the upper maxillary teeth were altered by digital manipulation. The 1-10 assessment scale was used. Statistical analysis comprised one-way Kolmogorov-Smirnov test, X2 tests, t-test, and 3-way MANOVA. RESULTS: In the research 208 students participated, 113 were preclinical students, 104 assisted in dental office and 175 were females. There were no significant effects of gender regarding length and position modifications (p > .05), while women were stricter in evaluation of lighter shade (p < .05). Clinical students were stricter in evaluating all manipulated photographs (MP) except those towards darker shade modifications, while assisting in a dental office or having a dentist in close family showed no significant effects (p > .05). CONCLUSIONS: With a higher level of targeted academic education, dental students sharpen their ability to notice deviations from the aesthetic norms of a smile.

Bennett Angle, Condylar and Jaw Movements in Asymptomatic Athletes with a History of a Blow to One Side of the Mandibula.

Sports activities may induce long-lasting changes in mandibular trajectories. The aim was to compare condylar and mandibular movements in athletes with orofacial injuries with values measured in non-injured athletes. The group of 132 athletes without mandibular injury included asymptomatic athletes with a history of a blow to the right side (N = 43) and the group included asymptomatic athletes with a history of a blow to the left side (N = 41) of the mandible. The injured athletes suffered from stiffness/pain and/or limitation of jaw movements. The symptoms disappeared shortly after the injury. Athletes with a history of injury have smaller mean values of Bennett angle on the side of impact, and Bennett angle on the opposite side is greater than the mean found in non-injured athletes. Significantly smaller Bennett angle values in athletes with a history of a blow to one side of the mandible are due to the adaptability of the orofacial system. The larger Bennett angle on the opposite side of the injury is also due to the adaptive mechanism of the TMJ. Clinical Relevance: An individualized approach to TMJ values is mandatory in restorative procedures in every patient, especially in patients with a history of trauma to the orofacial system.

Mini-Implants Retaining Removable Partial Dentures in Subjects without Posterior Teeth: A 5-Year Prospective Study Comparing the Maxilla and the Mandible.

Background and objectives: Long-term studies of clinical outcomes of mini-implants (MDIs) in the first premolar/canine sites retaining a bilateral free-ending removable partial dentures (RPD) in Kennedy class I subjects have not been well documented. The aim was to assess clinical outcomes in a prospective 5-year cohort study comparing the mandible and maxilla. Material and Methods: Participants (n = 92) who received two MDIs each and a new RPD were reviewed after one, three and five years. A total of 71 participants (82 mini-implants in the mandible; 58 in the maxilla) completed the study. Marginal bone level change, success, survival rates, Modified Plaque (MPI) and Bleeding Indices (MBI) were assessed. Results: The five-year success rate was 93.3% and 93.4% (p > 0.05), in the mandible and the maxilla, respectively. Mean peri-implant bone loss (MBL) increased significantly over five years (p < 0.01) to 0.50 mm in the mandible and 0.52 mm in the maxilla. Age had a significant effect on the MBL (higher rates in younger participants), while jaw of insertion, gender, and antagonistic jaw status did not. MPI and MBI were not significantly correlated with MBL. Conclusions: The insertion of two MDIs in previous first premolar/canine sites for retention of a free-end saddle RPD can be a successful treatment modality in subjects with narrow alveolar ridges.

Subjective and Objective Assessment of Chewing Performance in Older Adults with Different Dental Occlusion.

OBJECTIVES: Satisfactory masticatory function is a significant indicator of improved oral health-related quality of life in older adults, either with or without artificial teeth. The purpose of this study was to examine masticatory performance of older adults with different prosthodontic reconstructions and occlusion, as well as to compare subjective and objective assessment of chewing performance. MATERIAL AND METHODS: This study included 100 participants aged 65 and more. The chewing function questionnaire (CFQ) with answers on the Likert scale 0-4 (0 = no difficulties; 4 = maximum difficulties) was used as an indicator of subjective masticatory assessment. The two-color chewing gum test was used as objective assessment of masticatory function (mixing ability), based on the Z-score values. Dental occlusion was assessed using functional teeth units (FTU). RESULTS: The results obtained using the CFQ and the clinical mixing ability test are in compliance with each other (r = 0.742). A decrease in the number of natural teeth, especially posterior teeth, progressively reduced chewing ability and increased difficulties in mastication. Participants with less FTUs, or with FTUs that are a part of removable denture, had greater reduction in masticatory function compared to those with FTUs composed of natural teeth or fixed partial dentures. CONCLUSION: This study revealed a strong positive correlation between the subjective masticatory assessment in older adults using the validated questionnaire and the objective clinical test of the mixing ability of two chewing gums. Our data on influence of the number and the type of FTU on masticatory performance will be valuable when planning prosthodontic therapy.

Clinical Outcomes of Three versus Four Mini-Implants Retaining Mandibular Overdenture: A 5-Year Randomized Clinical Trial.

Background and Objectives: Due to a lack of long-term clinical studies that would clarify whether the insertion of three mini-implants (MDIs) can be as successful treatment as the insertion of four MDIs for the retention of mandibular overdentures (ODs), this 5-year prospective cohort study was set up. Materials and Methods: Participants (n = 83) randomly received either four or three MDIs and a mandibular OD. Clinical examinations were performed at the baseline, as well as after one, three, and five years, respectively. A total of 73 participants (38 in the four-MDI and 35 in the three-MDI groups) partook in the study. The marginal bone level change, success and survival rates, and prosthodontic maintenance were assessed. Results: Repeated measures showed that the mean peri-implant bone loss increased progressively at a small amount over five years in both groups (four-MDI group = -0.36 ± 0.74; three-MDI group = -0.33 ± 0.27 mm; p < 0.05). However, an ANCOVA revealed no significant effects of the group (no significant difference between the three- and the four-MDI groups; F = 0.085; p = 0.771), gender (F = 0.023; p = 0.88), or covariate age (F = 1.95; p = 0.167) on the dependent variable: the 5-year MBL change. The success rate (together with successful survival) was 93.8% in the four-MDI group and 91.7% in the three-MDI group. The log-rank (Mantel-Cox) test revealed no significant differences between them (X2 = 0.373; p = 0.541). Conclusions: In patients with narrow ridges, the insertion of three MDIs in the mandible for overdenture retention can be equally as successful as the insertion of four MDIs.

Knowledge, beliefs, attitude, and practices of E-cigarette use among dental students: A multinational survey.

BACKGROUND: E-cigarette use is a trend worldwide nowadays with mounting evidence on associated morbidities and mortality. Dentists can modify the smoking behaviors of their patients. This study aimed to explore the knowledge, beliefs, attitude, and practice of E-cigarette use among dental students. MATERIALS AND METHODS: This multinational, cross-sectional, questionnaire-based study recruited undergraduate dental students from 20 dental schools in 11 countries. The outcome variable was current smoking status (non-smoker, E-cigarette user only, tobacco cigarette smoker only, dual user). The explanatory variables were country of residence, sex, age, marital status, and educational level. Multiple linear regression analysis was performed to explore the explanatory variables associated with E-cigarette smoking. RESULTS: Of the 5697 study participants, 5156 (90.8%) had heard about E-cigarette, and social media was the most reported source of information for 33.2% of the participants. For the 5676 current users of E-cigarette and/or tobacco smoking, 4.5% use E-cigarette, and 4.6% were dual users. There were significant associations between knowledge and country (P< 0.05), educational level (B = 0.12; 95% CI: 0.02, 0.21; P = 0.016) and smoking status (P< 0.05). The country of residence (P< 0.05) and smoking status (P< 0.05) were the only statistically significant factors associated with current smoking status. Similarly, there were statistically significant associations between attitude and country (P< 0.05 for one country only compared to the reference) and history of previous E-cigarette exposure (B = -0.52; 95% CI: -0.91, -0.13; P = 0.009). Also, the practice of E-cigarettes was significantly associated with country (P< 0.05 for two countries only compared to the reference) and gender (B = -0.33; 95% CI: -0.52, -0.13; P = 0.001). CONCLUSION: The knowledge of dental students about E-cigarette was unsatisfactory, yet their beliefs and attitudes were acceptable. Topics about E-cigarette should be implemented in the dental curriculum.

Are Mini Dental Implants Suitable for Support of Crowns or Small Bridges in the Mandibular Incisor Region? A 5-year Longitudinal Study.

PURPOSE: It has not been previously studied whether 1-piece category 1 narrow dental implants (≤2.5 mm wide) can successfully support crowns or small bridges. The purpose of this study was to evaluate the long-term benefits of the fixed-type mini dental implants (MDIs) for replacement of mandibular incisors. MATERIALS AND METHODS: In a prospective cohort study, fixed-type 1-piece MDIs, replacing single or multiple mandibular incisors, supporting metal-ceramic single crowns (unsplinted group), or splinted crowns/small bridges (splinted group) were observed over the period of 5 years. The primary predictor was the splinting status. The primary outcome variables were peri-implant marginal bone level (MBL) change, success, and survival rates (assessed as per Pisa Consensus Conference). The secondary outcomes were dental patient-reported outcome measures (dPROMs) and oral hygiene assessment. Descriptive statistics, Chi-squared test, t-test, Mann-Whitney and Wilcoxon tests, Kaplan-Meier survival analysis, log-rank (Mantel-Cox) comparison, Cox proportional hazard analyses adjusting for number of implants, Spearman correlation, and repeated measures were used for data analysis. RESULTS: From 44 participants (mean age 56.02 ± 5.72 years), 40 completed the 5-year study: 23 in the splinted and 17 in unsplinted group. Three subjects did not respond, while 1 MDI failed (third year) in the unsplinted group. Mean marginal bone level (MBL) change in both groups was small; however, it increased over time (-0.22 ± 0.38 mm after 1 year; -0.54 ± 0.56 mm after 5 years; P < .05). After 5 years mean MBL change was -0.59 ± 0.71 mm in the unsplinted and -0.50 ± 0.41 mm in the splinted group (P > .05). Survival analysis revealed no significant difference between the unsplinted (85.7% success, 4.8% failures, and 9.5% satisfactory survivals) and splinted group (93.4% success and 6.6% satisfactory survivals) (P > .05). The group affiliation (unsplinted vs splinted) and number of implants were not significant predictors of MDI failure or survival rates (P > .05). Significant improvement in dPROMs after rehabilitation remained unchanged over 5 years (P > .05). Modified plaque index significantly increased over time, correlating with the MBL loss. CONCLUSION: MDIs supporting crowns and/or small bridges in the mandibular incisor region showed small rates of marginal bone loss, acceptable success, and survival rates and improved dPROMs over a 5-year observation period.

Assessment of Orofacial Esthetics among Different Specialists in Dental Medicine: A pilot study.

Objectives: Little is known whether specialists in different dental fields assess orofacial esthetics differently due to various focus of their interest. The aim was to find out if there is a difference in judgement of orofacial esthetics among specialists in three different fields of Dental Medicine, i.e. specialists in Prosthodontics (S-Prosthod), Periodontology (S-Perio), and Orthodontics (S-Ortho). Material and methods: A total of 69 specialists (23 participants in each group) assessed the same 60 photographs of the lower third of the face of young healthy people with Angle Class I and natural teeth while smiling. Moreover, the assessed anterior teeth on the photographs of similes had to be without any restorations. The assessments were made using 7 out of 8 Items of Orofacial Esthetic Scale (OES). A face profile assessment was not performed. A Likert 1-5 scale was used for assessments (1-the worst score; 5-the best score). Mean values of summary scores as well as of each OES item were calculated for each specialist for further statistical analysis. One-sample Kolmogorov-Smirnov test, descriptive statistics, one-way ANOVA, and Sheffe post-hoc tests were performed. Results: The specialists in Periodontology gave significantly lowest scores to all 7 items related to orofacial esthetics, while the specialists in Prosthodontics gave the highest scores (p<0.05). Conclusion: Assessments of orofacial esthetics differ significantly among specialists in Prosthodontics, Periodontology and Orthodontics. Further study is needed to clarify the factors which influence the judgement, and to find out if specific education in certain specialties can modify the assessment.

Adaptation to New Dentures and 5 Years of Clinical Use: A Comparison between Complete Denture and Mini-implant Mandibular Overdenture Patients based on Oral Health-Related Quality of Life (OHRQoL) and Orofacial Esthetics.

Objective of work: It is unclear how long patients need to adapt to new dentures. This study assessed adaptation and five years of clinical use, comparing complete denture wearers (CDs) and mini-implant mandibular overdenture wearers opposing a maxillary CD (MDI-OD), based on oral health reported quality of life (OHRQoL) and orofacial esthetics (OES). Material and Methods: A total of 36 subjects in the CD group (25 females) and 30 subjects in the MDI group (20 females) completed the 5-year study. All patients received new CDs, but in the MDI-OD group, four mini-implants were inserted interforaminally in the mandible before denture manufacture. Participants filled in the OHIP-EDENT and OES questionnaires one day after dentures' delivery, on the 3rd, 8th, 15th, 30th day, and at the 1-, 3- and 5-year follow-up examinations. Statistical analysis comprised descriptive methods, X 2 test, independent t-test, Friedman, and Mann-Whitney test. Results and Conclusions: Both groups' adaptation to new dentures was completed within a month. The MDI-OD group had significantly better OHRQoL in all follow-ups except for the 3rd and 8th day, probably due to soreness and pain, the reason why the MDI-OD group had limitation in functioning in the first days after new dentures' delivery. Already after the third year and at the fifth year, OHRQoL worsened (p<0.01) in both groups. However it was significantly more pronounced in the conventional CD wearers (p<0.01) than in the MDI-OD group. Orofacial esthetics was highly scored in both groups. The scores dropped down only after three years, equally in both groups. Keywords: OHRQoL, OES, prospective study, complete dentures, mini-implants, adaptation. MeSH Terms: Complete Dentures; Dental Implants; Quality of Life; Dental Esthetics.

Oral health practices and self-reported adverse effects of E-cigarette use among dental students in 11 countries: an online survey.

OBJECTIVES: E-cigarette use has become popular, particularly among the youth. Its use is associated with harmful general and oral health consequences. This survey aimed to assess self-reported oral hygiene practices, oral and general health events, and changes in physiological functions (including physical status, smell, taste, breathing, appetite, etc.) due to E-cigarette use among dental students. METHODS: This online, multicounty survey involved undergraduate dental students from 20 dental schools across 11 different countries. The questionnaire included demographic characteristics, E-cigarette practices, self-reported complaints, and associated physiological changes due to E-cigarette smoking. Data were descriptively presented as frequencies and percentages. A Chi-square test was used to assess the potential associations between the study group and sub-groups with the different factors. Statistical analysis was performed using SPSS at P < 0.05. RESULTS: Most respondents reported regular brushing of their teeth, whereas only 70% used additional oral hygiene aids. Reported frequencies of complaints ranged from as low as 3.3% for tongue inflammation to as high as 53.3% for headache, with significant differences between E-cigarette users and non-users. Compared to non-smokers, E-cigarette users reported significantly higher prevalence of dry mouth (33.1% vs. 23.4%; P < 0.001), black tongue (5.9% vs. 2.8%; P = 0.002), and heart palpitation (26.3%% vs. 22.8%; P = 0.001). Although two-thirds of the sample reported no change in their physiological functions, E-cigarette users reported significant improvement in their physiological functions compared to never smokers or tobacco users. CONCLUSION: Dental students showed good oral hygiene practices, but E-cigarette users showed a higher prevalence of health complications.

Frequency of Four-dimensional Oral Health Problems across Dental Fields - a Comparative Survey of Slovenian and International Dentists.

OBJECTIVES: To compare the frequency of patients' oral health problems and prevention needs among Slovenian and international dentists with the aim to validate the four oral health-related quality of life (OHRQoL) dimensions across six clinical dental fields in all World Health Organization (WHO) regions. METHODS: An anonymous electronic survey in the English language was designed using Qualtrics software. A probability sampling for Slovenia and a convenience sampling strategy for dentist recruitment was applied for 31 countries. Dentists engaged in six dental fields were asked to categorize their patients' oral health problems and prevention needs into the four OHRQoL dimensions (Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact). Proportions of patients' problems and prevention needs were calculated together with the significance of Slovenian and international dentists' differences based on dental fields and WHO regions. RESULTS: Dentists (n=1,580) from 32 countries completed the survey. There were 223 Slovenian dentists (females: 68%) with a mean age (SD) of 41 (10.6) years and 1,358 international dentists (females: 51%) with a mean age (SD) of 38 (10.4). Pain-related problems and prevention needs were the most prevalent among all six dental fields reported by dentists; Slovenian (37%) and 31 countries (45%). According to Cohen, differences between Slovenia, the broader European Region, and 31 countries were considered non-significant (<0.1). CONCLUSION: According to the dentists' responses, the frequency of patients' oral health problems and prevention needs are proportionate between Slovenia and 31 countries, regionally and globally. The four OHRQoL dimensions can be considered universal across all dental fields.

Oral Health Status and Nutritional Habits as Predictors for Developing Alzheimer's Disease.

OBJECTIVE: Poor oral health, mainly tooth loss, has been suggested to pose a risk factor for Alzheimer's disease (AD). The nature of this relationship can be explained by mastication deficit and nutritional status. Also, the influence of nutritional parameters on cognitive impairment has been documented. The aim of this study was to investigate whether poor dental status and nutrition habits can be potential separate or associated risk factors for development of the AD. METHODS: The study sample included 116 patients with AD and 63 controls. Sociodemographic variables were investigated as factors potentially associated with AD. Dental examination included recording the number of natural teeth, presence of fixed or removable dentures, and the number of functional tooth units (FTUs). Nutritional status analysis included qualitative nutrition information, body mass index, serum albumin level, food consistency, and need for assistance in feeding. Regression analysis was used to investigate the predictors for development of AD. RESULTS: Variables with significant differences between groups, which were analyzed by using the binary regression analysis, were marital status, residence, number of total FTUs (no matter whether the contacts were between natural teeth or dentures), eating meat/fish and fruits/vegetables, food consistency, and serum albumin level. Logistic regression analysis showed that being single/widowed/divorced, eating more meat/fish or fruit/vegetable, eating blended/mashed/liquid food, having low levels of serum albumin, and having less FTUs were significant predictors for developing dementia. CONCLUSION: Having fewer occlusal contacts, consumption of soft food, and lower serum albumin levels can be considered as associated risk factors for AD.

Comparison of different surgical procedures on the stability of dental implants in posterior maxilla: A randomized clinical study.

BACKGROUND: Stability of a dental implant is very important when planning immediate loading and design of a final restoration. The aim of this study was to compare the primary and the secondary stability of dental implants inserted by three different surgical techniques: conventional (standard) technique using a sequence of drills for implant bed preparation, osteotome technique using tapered hand instruments for creating implant sites by condensing the bone and guided flapless implant surgery with surgical templates. MATERIAL AND METHODS: The study included 150 patients (80 males and 70 females), 46-71 years old, who required implant supported fixed partial dentures in the posterior maxilla of D3 or D4 bone density. Patients were randomly assigned into one of the three surgical insertion technique groups. All patients received tapered implants of the same manufacturer of the same length and two different widths (3.3 × 11.5 mm or 4.2 × 11.5 mm). Primary and secondary implant stability were measured by means of resonance frequency analysis (RFA) at the time of implant placement and 5 months after surgery using the Ostell ISQ device (Osstell AB, Sampgatan, Goteborg, Sweden). Statistical analysis included one-sample Kolmogorov Smirnov test, descriptive statistics, multivariate analysis (Bonferoni post-hoc tests) and paired t-tests. RESULTS: Patients in the osteotome group exhibited higher primary stability (P < 0.01) than in the conventional and surgically guided flapless groups. There were no significant differences in the secondary stability (p > 0.05). Wider implants presented higher ISQ values (P<0.01). CONCLUSION: The osteotome technique led to the highest implant primary stability, therefore it can be recommended when immediate loading is planned or for one-piece implant insertion.

Perception of orofacial appearance among laypersons with diverse social and demographic status.

BACKGROUND: The perception of dentofacial esthetics differs considerably between patients and dentists. Patient's expectations regarding his/her esthetics are important and should be assessed ahead of any planning of esthetic treatment. The aim of this study was to explore the differences in perception of orofacial appearance by laypersons with different social and demographic status. MATERIALS AND METHODS: Self-administered questionnaires were distributed to 400 subjects. The questionnaire comprised three parts; the first part addressed the demographic variables. The second part queried about dental prosthesis, orthognathic or plastic surgery, and/or ongoing or previous orthodontic treatment. The third part included the Arabic version of the-8-item Orofacial Esthetic Scale (OES-Ar) whose responses were scored in the 5-point Likert scale. These scores were compared by different grouping factors (age, gender, marital status, and education) using non-parametric Mann-Whitney U and Kruskal Willis tests with 95% confidence interval (α > 0.05). RESULTS: A total of 268 questionnaires were eligible for analysis, representing 67% response rate. The satisfaction with facial profile appearance was the highest (4.0±1.1) followed by facial appearance (3.9±1.1), while the color of teeth was the least satisfying item (3.1±1.3). No significant differences were found between age groups for the mean summary score as well as for each item independently. No significant difference was found between both sexes except for the last item "overall impression". Married subjects rated one item (alignment of teeth) better than their counterparts. Positive perception of orofacial appearance increased significantly with the increase of education level, the perception of the oral health status, and the perception of the general health status. CONCLUSION: Good oral health and/or high education level are significant determinants of more positive perception of orofacial esthetic appearance. Patients with these characteristics might be more concerned about their orofacial appearance, and this should be taken into consideration before planning any esthetic restorative dental treatment.

Happiness among dentists: a multi-scale, multi-national study from 21 countries.

OBJECTIVES: The extent to which dentists are happy with their profession and their life has not been well studied. The present study aimed to explore the level of happiness, satisfaction with life and psychological well-being among a sample of dental professionals from 21 countries. MATERIALS AND METHODS: The sample comprised 2,200 dentists from 21 countries. Three scales - Subjective Happiness Scale (SHS), Satisfaction With Life Scale (SWLS), and Affect Balance Scale (ABS) - were used to measure the subjective responses. Data related to demographic and social characteristics were recorded. Mann-Whitney and Kruskal-Wallis tests were used as appropriate. Scales were correlated, and multiple linear regression analyses were employed to identify the independent determinants of SHS, SWLS and ABS. Data were analysed using the SPSS software program; a value of P <0.05 was considered significant. RESULTS: The overall mean scores of SHS, SWLS and ABS were 18.53 ± 5.06, 23.06 ± 6.25 and 1.26 ± 2.40, respectively, with significant differences found across countries: dentists working in Croatia, Peru and Serbia recorded the highest scores, unlike dentists practicing in Yemen, Syria, and Iraq, who recorded the lowest scores. There were significant, moderately positive correlations between the various scales: SHS and SWLS: r = 0.535, P < 0.001; SHS and ABS: r = 0.58, P < 0.001; and SWLS and ABS: r = 0.533, P < 0.001. Country of practice, age, qualification and monthly income were the significant independent predictors of SHS, SWLS and ABS. CONCLUSION: Country of residence and social characteristics were associated with dentists' responses regarding their feelings and subjective well-being.

Psychometric Characteristics of the Croatian and the Serbian Versions of the Oral Health Impact Profile for Edentulous Subjects, with a Pilot Study on the Dimensionality.

INTRODUCTION: The aim was to adapt the Croatian and the Serbian versions of the Oral Health Impact Profile for the edentulous population (OHIP-EDENT-CRO and OHIP-EDENT-SRB). METHODS: The translation and cross-cultural adaptation were carried out in accordance with accepted international standards. A total of 95 and 177 removable denture wearers were recruited in Croatia and Serbia respectively. The reliability was evaluated by calculating Cronbach's alpha coefficient and by test-retest (30 participants in each country). The concurrent validity was determined by calculating the Spearman's rank coefficient between the OHIP-EDENT summary scores and one question related to removable denture satisfaction. Construct validity was determined by exploratory factor analysis (EFA). Responsiveness was determined by comparison of the OHIP-EDENT summary scores before and after dental implant placement to support mandibular overdentures (23 patients in Croatia, 21 in Serbia). RESULTS: Cronbach's alpha coefficient was 0.92 in Croatia and 0.87 in Serbia. The intraclass correlation coefficient was 0.98 in Croatia and 0.94 in Serbia. In Croatia the Spearman's correlation coefficient was -0.71 (p<0.001) and in Serbia -0.74 (p<0.001). Both confirmed concurrent validity. Construct validity was tested by EFA, which extracted four factors in each country, accounting for 66.59% of the variance in Croatia and 59.33% in Serbia. Responsiveness was confirmed in both countries by a significant OHIP-EDENT summary score reduction and a high standardised effect size (3.9 in Croatia, 1.53 in Serbia). CONCLUSION: The results prove that both instruments, the OHIP-EDENT-CRO and the OHIP-EDENT-SRB, have very good psychometric properties for assessing OHRQoL in the edentulous population.