Co-Influence of Restoration Bonding and Inlay Cavity Design on Fracture Load of Restored Tooth.

INTRODUCTION: The aim of this study was to investigate the co-influence of indirect mesio- occlusal-distal (MOD) cavity geometry and inlay restoration bonding on quasi-static fracture load of the restored tooth. METHODS: Forty-eight intact human molar teeth were selected and prepared for standardized edge-shaped or round-shaped MOD cavities. The resin composite (Cerasmart, GC) inlays were bonded with the state-of-the-art inlay bonding protocol or with intentionally deteriorated bonding using n-hexane-wax solution for preconditioning. Restored teeth were loaded along the long axis of the tooth. Ultimate fracture load was recorded, and the type of fracture was visually determined and classified. Statistical analysis of load values was performed by Kruskal-Wallis test. RESULTS: Round-shaped cavity design with bonded restoration presented the highest fracture load (1658N). Bonding had significant influence on the fracture load of roundshaped cavity design (p=0.0003), whereas cavity design had no influence when the bonding was deteriorated (p=0.8075). In the case of deteriorated bonding, either the inlay or tooth fractured separately whereas in the bonded inlays fractures were commonly found both in the tooth and inlay. CONCLUSIONS: According to this study, bonded inlay restoration increased fracture resistance, while cavity design had no statistical difference on fracture resistance of the restored tooth.

Prosthetic Rehabilitation with Implant-Supported Mandibular Overdenture after Partial Glossectomy and Radiation Therapy: A Case Report.

Implant-supported overdenture is a well-established treatment option for many patients who have functional problems with conventional dentures. It may be primary choice for patients with altered jaw anatomy, neuromuscular disorders, pronounced gag reflex, severe residual ridge resorption and oral tissue defects. In this article we describe a case report, where tongue cancer patients occlusion was rehabilitated with an implantretained overdenture. In 2001 patient was operated for squamous cell carcinoma on the left side of the tongue. Before preoperative radiation therapy, small residual mandibular dentition was removed because of its poor prognosis. Radiation dose on mandible was 57-66 Gy. After tumor surgery patient received conventional complete dentures. Ten years later, the patient was referred again to the Turku University Central Hospital due to constant ulceration under the mandibular denture. The residual ridge of the mandible was severely resorbed. Patient's existing lower complete denture was replaced with a milled bar-retained overdenture on four implants. Treatment turned out to be challenging due to severely restricted tongue movement and tissue defects.

Adhesion and Early Colonization of S. Mutans on Lithium Disilicate Reinforced Glass-Ceramics, Monolithic Zirconia and Dual Cure Resin Cement.

OBJECTIVE: Monolithic zirconia and glass ceramics are increasingly used in implant crowns. Limited data is available on bacterial adhesion and early biofilm formation on these materials. METHODS: Four different materials were investigated: (1) Lithium disilicate glass-ceramics (LDS), (2) Fully stabilized zirconia (FSZ), (3) Partially stabilized zirconia (PSZ), and (4) Dual curing cement (DCC). The materials' surfaces were characterized with spinning disc confocal microscopy and by water contact angle and surface free energy (SFE) measurements. For the adhesion tests the materials were rolled in suspensions of Streptococcus mutans. Early biofilm formation was studied on the materials and allowing the biofilms to form for 24 h. S. mutans cell counts were determined by plate culturing. ANOVA and post-hoc Tukey's tests (p⟨0.05) were used for statistical evaluation. RESULTS: The LDS surfaces were clearly hydrophilic with the highest SFE value (p⟨0.001). For S. mutans adhesion, the ranking of the materials from lowest to highest was: LDS = FSZ ⟨ DCC ⟨ PSZ (p⟨0.05). No significant differences among the materials were noticed in biofilm formation. CONCLUSIONS: LDS has lower S.mutans adhesion than other materials examined in this study, but the difference was not reflected in early biofilm formation.

The influence of SrO and CaO in silicate and phosphate bioactive glasses on human gingival fibroblasts.

In this paper, we investigate the effect of substituting SrO for CaO in silicate and phosphate bioactive glasses on the human gingival fibroblast activity. In both materials the presence of SrO led to the formation of a CaP layer with partial Sr substitution for Ca. The layer at the surface of the silicate glass consisted of HAP whereas at the phosphate glasses it was close to the DCPD composition. In silicate glasses, SrO gave a faster initial dissolution and a thinner reaction layer probably allowing for a continuous ion release into the solution. In phosphate glasses, SrO decreased the dissolution process and gave a more strongly bonded reaction layer. Overall, the SrO-containing silicate glass led to a slight enhancement in the activity of the gingival fibroblasts cells when compared to the SrO-free reference glass, S53P4. The cell activity decreased up to 3 days of culturing for all phosphate glasses containing SrO. Whereas culturing together with the SrO-free phosphate glass led to complete cell death at 7 days. The glasses containing SrO showed rapid cell proliferation and growth between 7 and 14 days, reaching similar activity than glass S53P4. The addition of SrO in both silicate and phosphate glasses was assumed beneficial for proliferation and growth of human gingival fibroblasts due to Sr incorporation in the reaction layer at the glass surface and released in the cell culture medium.

Osseointegration of fiber-reinforced composite implants: histological and ultrastructural observations.

OBJECTIVES: The aim of this study was to evaluate the bone tissue response to fiber-reinforced composite (FRC) in comparison with titanium (Ti) implants after 12 weeks of implantation in cancellous bone using histomorphometric and ultrastructural analysis. MATERIALS AND METHODS: Thirty grit-blasted cylindrical FRC implants with BisGMA-TEGDMA polymer matrix were fabricated and divided into three groups: (1) 60s light-cured FRC (FRC-L group), (2) 24h polymerized FRC (FRC group), and (3) bioactive glass FRC (FRC-BAG group). Titanium implants were used as a control group. The surface analyses were performed with scanning electron microscopy and 3D SEM. The bone-implant contact (BIC) and bone area (BA) were determined using histomorphometry and SEM. Transmission electron microscopy (TEM) was performed on Focused Ion Beam prepared samples of the intact bone-implant interface. RESULTS: The FRC, FRC-BAG and Ti implants were integrated into host bone. In contrast, FRC-L implants had a consistent fibrous capsule around the circumference of the entire implant separating the implant from direct bone contact. The highest values of BIC were obtained with FRC-BAG (58±11%) and Ti implants (54±13%), followed by FRC implants (48±10%), but no significant differences in BIC or BA were observed (p=0.07, p=0.06, respectively). TEM images showed a direct contact between nanocrystalline hydroxyapatite of bone and both FRC and FRC-BAG surfaces. CONCLUSION: Fiber-reinforced composite implants are capable of establishing a close bone contact comparable with the osseointegration of titanium implants having similar surface roughness.

Application of second derivative spectroscopy for increasing molecular specificity of Fourier transform infrared spectroscopic imaging of articular cartilage.

OBJECTIVE: Fourier transform infrared (FT-IR) spectroscopic imaging is a promising method that enables the analysis of spatial distribution of biochemical components within histological sections. However, analysis of FT-IR spectroscopic data is complicated since absorption peaks often overlap with each other. Second derivative spectroscopy is a technique which enhances the separation of overlapping peaks. The objective of this study was to evaluate the specificity of the second derivative peaks for the main tissue components of articular cartilage (AC), i.e., collagen and proteoglycans (PGs). MATERIALS AND METHODS: Histological bovine AC sections were measured before and after enzymatic removal of PGs. Both formalin-fixed sections (n = 10) and cryosections (n = 6) were investigated. Relative changes in the second derivative peak heights caused by the removal of PGs were calculated for both sample groups. RESULTS: The results showed that numerous peaks, e.g., peaks located at 1202 cm(-1) and 1336 cm(-1), altered less than 5% in the experiment. These peaks were assumed to be specific for collagen. In contrast, two peaks located at 1064 cm(-1) and 1376 cm(-1) were seen to alter notably, approximately 50% or more. These peaks were regarded to be specific for PGs. The changes were greater in cryosections than formalin-fixed sections. CONCLUSIONS: The results of this study suggest that the second derivative spectroscopy offers a practical and more specific method than routinely used absorption spectrum analysis methods to obtain compositional information on AC with FT-IR spectroscopic imaging.

Prepolymerized vs. in situ-polymerized fiber-reinforced composite implants--a pilot study.

The aim of this study was to investigate bone response to bioactive fiber-reinforced composite (FRC) implants under two polymerization conditions. Glass-fiber-dimethacrylate composite was tested as prepolymerized cylinder-shaped FRC implants and as cylindrical FRC implants polymerized in situ with blue light transmitted and scattered by the glass fibers. Ten FRC implants (6 prepolymerized and 4 in situ-polymerized implants) were placed in the right tibias of 3 pigs by means of a press-fit technique. After 12 weeks, light microscopy revealed only mild foreign-body reaction, with no accumulation of inflammatory cells on both the prepolymerized and the in situ-polymerized implants. The prepolymerized implants appeared to be fully integrated, whereas the in situ-polymerized implants were almost completely surrounded by a fibrous capsule. The present study suggests that in situ polymerization of FRC implants results in fibrous capsule formation and prevents integration with bone.

Adhesion and proliferation of human fibroblasts on sol-gel coated titania.

The objective of this study was to evaluate growth and attachment of human gingival fibroblasts on nonresorbable sol-gel-derived nanoporous titania (TiO2) coated discs and noncoated commercially pure titania (cpTi) discs in vitro. The strength of attachment was evaluated using serial trypsinization. The number of cells detached from TiO2-substrates was 30% +/- 3%, whereas those detached from the cpTi was 58% +/- 4% indicating a stronger cell attachment on the coated surfaces. In scanning electron microscopy (SEM) images fewer cells, with more rounded shape, were seen with cpTi than with TiO2 after the detachment assay. Fibroblasts grew more efficiently on TiO2 than on cpTi substrates, showing significantly higher cell activities at all times. In transmission electron microscopy (TEM), a continuous layer of two to three cells thick covered the coated and noncoated discs after 7 days of culture. The plasma membrane of cells in contact with the coating was in close opposition and the cytoplasm was ultrastructurally similar to the cells grown on noncoated discs with well-preserved organelles. In conclusion, we demonstrated that the sol-gel-derived TiO2 coatings can facilitate cell growth and attachment of human gingival fibroblasts on titanium in vitro. This in vitro study is in line with our previous in vivo observations of improved soft tissue attachment of TiO2 coatings in comparison with cpTi.

Quantitative analysis of spatial proteoglycan content in articular cartilage with Fourier transform infrared imaging spectroscopy: Critical evaluation of analysis methods and specificity of the parameters.

OBJECTIVE: To evaluate the specificity of the current Fourier transform infrared imaging spectroscopy (FT-IRIS) methods for the determination of depthwise proteoglycan (PG) content in articular cartilage (AC). In addition, curve fitting was applied to study whether the specificity of FT-IRIS parameters for PG determination could be improved. METHODS: Two sample groups from the steer AC were prepared for the study (n = 8 samples/group). In the first group, chondroitinase ABC enzyme was used to degrade the PGs from the superficial cartilage, while the samples in the second group served as the controls. Samples were examined with FT-IRIS and analyzed using previously reported direct absorption spectrum techniques and multivariate methods and, in comparison, by curve fitting. Safranin O-stained sections were measured with digital densitometry to obtain a reference for depthwise PG distribution. RESULTS: Carbohydrate region-based absorption spectrum methods showed a statistically weaker correlation with the PG reference distributions than the results of the curve fitting (subpeak located approximately at 1,060 cm(-1)). Furthermore, the shape of the depthwise profiles obtained using the curve fitting was more similar to the reference profiles than with the direct absorption spectrum analysis. CONCLUSIONS: Results suggest that the current FT-IRIS methods for PG analysis lack the specificity for quantitative measurement of PGs in AC. The curve fitting approach demonstrated that it is possible to improve the specificity of the PG analysis. However, the findings of the present study suggest that further development of the FT-IRIS analysis techniques is still needed.

Biomechanical, biochemical and structural correlations in immature and mature rabbit articular cartilage.

OBJECTIVE: The structure and composition of articular cartilage change during development and growth. These changes lead to alterations in the mechanical properties of cartilage. In the present study, biomechanical, biochemical and structural relationships of articular cartilage during growth and maturation of rabbits are investigated. DESIGN: Articular cartilage specimens from the tibial medial plateaus and femoral medial condyles of female New Zealand white rabbits were collected from seven age-groups; 0 days (n=29), 11 days (n=30), 4 weeks (n=30), 6 weeks (n=30), 3 months (n=24), 6 months (n=24) and 18 months (n=19). The samples underwent mechanical testing under creep indentation. From the mechanical response, instantaneous and equilibrium moduli were determined. Biochemical analyses of tissue collagen, hydroxylysylpyridinoline (HP) and pentosidine (PEN) cross-links in full thickness cartilage samples were conducted. Proteoglycans were investigated depth-wise from the tissue sections by measuring the optical density of Safranin-O-stained samples. Furthermore, depth-wise collagen architecture of articular cartilage was analyzed with polarized light microscopy. Finite element analyses of the samples from different age-groups were conducted to reveal tensile and compressive properties of the fibril network and the matrix of articular cartilage, respectively. RESULTS: Tissue thickness decreased from approximately 3 to approximately 0.5mm until the age of 3 months, while the instantaneous modulus increased with age prior to peak at 4-6 weeks. A lower equilibrium modulus was observed before 3-month-age, after which the equilibrium modulus continued to increase. Collagen fibril orientation angle and parallelism index were inversely related to the instantaneous modulus, tensile fibril modulus and tissue thickness. Collagen content and cross-linking were positively related to the equilibrium compressive properties of the tissue. CONCLUSIONS: During maturation, significant modulation of tissue structure, composition and mechanical properties takes place. Importantly, the present study provides insight into the mechanical, chemical and structural interactions that lead to functional properties of mature articular cartilage.

Bone tissue responses to glass fiber-reinforced composite implants--a histomorphometric study.

OBJECTIVES: The aims of this study were to evaluate bone-to-implant contact (BIC) and the osteoconductive capacity of bioactive fiber-reinforced composite implant (FRC) in vivo. MATERIAL AND METHODS: Threaded sand-blasted FRC implants and threaded FRC implants with bioactive glass (BAG) were fabricated for the study. Titanium implants were used as a reference. Eighteen implants (diameter 4.1 mm, length 10 mm) were implanted in the tibia of six pigs using the press-fit technique. The animals were sacrificed after 4 and 12 weeks. Histomorphometric and scanning electron microscopic (SEM) analyses were performed to characterize BIC. RESULTS: In general, the highest values of BIC were measured in FRC-BAG implants, followed by FRC and Ti implants. At 4 weeks, the BIC was 33% for threaded FRC-BAG, 27% for FRC and 19% for Ti. At 12 weeks, BIC was 47% for threaded FRC-BAG, 40% for FRC and 42% for Ti. Four weeks after implantation, all the implants appeared biologically fixed by a newly formed woven bone arranged in the thin bone trabeculae filling the gap between the implant and the bone of the recipient site. Twelve weeks after implantation, the thickness of the woven bone trabeculae had increased, especially around the FRC-BAG implants. CONCLUSION: Our results suggest that the FRC implant is biocompatible in bone. The biological behavior of FRC was comparable to that of Ti after 4 and 12 weeks of implantation. Furthermore, the addition of BAG to the FRC implant increased peri-implant osteogenesis and bone maturation.

Biocompatibility of sol-gel-derived titania-silica coated intramedullary NiTi nails.

We investigated bone response to sol-gel-derived titania-silica coated functional intramedullary NiTi nails that applied a continuous bending force. Nails 26 mm in length, either straight or with a radius of curvature of 28 or 15 mm, were implanted in the cooled martensite form from a proximal to distal direction into the medullary cavity of the right femur in 40 Sprague-Dawley rats. Body temperature restored the austenite form, causing the curved implants to generate a bending force on the bone. The femurs were examined after 24 weeks. Bone length measurements did not reveal any bowing or shortening of the bone in the experimental groups. The results from histomorphometry demonstrated that the stronger bending force, together with sol-gel surface treatment, resulted in more bone deposition around the implant and the formation of significantly less fibrous tissue. Straight intramedullary nails, even those with a titania-silica coating, were poorly attached when compared to the implants with a curved austenite structure.

Implants and/or teeth: consensus statements and recommendations.

In August 23-25, 2007, the Scandinavian Society for Prosthetic Dentistry in collaboration with the Danish Society of Oral Implantology arranged a consensus conference on the topic 'Implants and/or teeth'. It was preceded by a workshop in which eight focused questions were raised and answered in eight review articles using a systematic approach. Twenty-eight academicians and clinicians discussed the eight review papers with the purpose to reach consensus on questions relevant for the topic. At the conference the consensus statements were presented as well as lectures based on the review articles. In this article the methods used at the consensus workshop are briefly described followed by the statements with comments.

Soft tissue attachment on sol-gel-treated titanium implants in vivo.

This study was designed to examine the attachment and reactions of soft tissues to sol-gel-derived TiO2 coatings. In the first experiment, TiO2 coated and uncoated titanium cylinders were placed subcutaneously into the backs of rats for 3, 11 and 90 days. Tissue response and implant surfaces were characterized with routine light microscopy and scanning electron microscopic (SEM) analysis. In the second experiment, TiO2-coated and uncoated discs were implanted subcutaneously into the backs of rats for 14 and 21 days. The discs were pulled out from the implantation sites with a mechanical testing device using a constant speed of 5 mm/min. Rupture force was registered, after which the discs were assigned for SEM and transmission electron microscopic (TEM) analysis. All the coated implants showed immediate contact with the surrounding soft tissues without a clear connective tissue capsule. Significantly better soft tissue response was measured for all the coated compared to the uncoated cylinders (p<0.01). Higher rupture forces were measured for all coated discs, although the differences were not statistically significant. An immediate and tight connection between connective tissue fibroblasts and coatings was noticed in TEM analysis. Our study indicates that TiO2 coatings improve soft tissue attachment on a titanium surface.

Comparison between sol-gel-derived anatase- and rutile-structured TiO2 coatings in soft-tissue environment.

The bioactivity of the surface reactive TiO(2) coatings for medical implants can be locally modified by CO(2) laser processing to match with the properties of surrounding tissues. The TiO(2) coatings heat-treated at 500 degrees C exhibit in vitro bioactivity. With further CO(2) laser treatment they exhibit enhanced in vitro bioactivity. The aim of this in vivo study was to compare the performance of heat-treated anatase-structured TiO(2) coatings with preheat-treated and CO(2) laser-treated rutile-structured coatings in terms of their ability to attach soft connective tissues. The coatings were characterized with TF-XRD and AFM. TiO(2)-coated discs were implanted in rats. The samples were analyzed with routine histology, SEM-EDS, and TEM. In both groups, already at 3 days, soft connective tissues were in immediate contact with the surface. No thick crystalline CaP layer was detected by SEM-EDS, but a thin amorphous CaP layer was detected by XPS. No gap between the cell membrane and the coating could be observed in TEM pictures. No differences were observed between the anatase- and rutile-structured coatings in terms of tissue responses. Further studies are needed to verify if the tissues are adherent to the surface of the implant.

Crosslinked poly(epsilon-caprolactone/D,L-lactide)/bioactive glass composite scaffolds for bone tissue engineering.

A series of elastic polymer and composite scaffolds for bone tissue engineering applications were designed. Two crosslinked copolymer matrices with 90/10 and 30/70 mol % of epsilon-caprolactone (CL) and D,L-lactide (DLLA) were prepared with porosities from 45 to 85 vol % and their mechanical and degradation properties were tested. Corresponding composite scaffolds with 20-50 wt % of particulate bioactive glass (BAG) were also characterized. Compressive modulus of polymer scaffolds ranged from 190+/-10 to 900+/-90 kPa. Lactide rich scaffolds absorbed up to 290 wt % of water in 4 weeks and mainly lost their mechanical properties. Caprolactone rich scaffolds absorbed no more than 110 wt % of water in 12 weeks and kept their mechanical integrity. Polymer and composite scaffolds prepared with P(CL/DLLA 90/10) matrix and 60 vol % porosity were further analyzed in simulated body fluid and in osteoblast culture. Cell growth was compromised inside the 2 mm thick three-dimensional scaffold specimens as a static culture model was used. However, composite scaffolds with BAG showed increased osteoblast adhesion and mineralization when compared to neat polymer scaffolds.

Level of education and incidence of caries in the elderly: a 5-year follow-up study.

OBJECTIVE: This study aimed to examine the possible association between level of education and 5-year caries increment in the elderly inhabitants of Helsinki. BACKGROUND: Low salivary flow and high numbers of salivary microorganisms are associated with the presence of caries, but cannot predict the increment in caries in the elderly. MATERIALS AND METHODS: This study group was derived from a population-based Helsinki Aging Study, which consisted of a random sample of elderly born in 1904, 1909 and 1914. The 71 dentate elderly who underwent clinical oral examinations at baseline (1990-91) and 5 years later (1995-96) were included in the study group. Decayed, Missing or Filled Tooth (DMFT) and Root Caries Index (RCI) indexes were used to study subjects' caries experience. Data on subjects' education came from questionnaire studies. The subjects were divided into four groups according to their level of education and occupation. Bivariate and multivariate analyses were used to evaluate relationships between subjects' caries experience and level of education. RESULTS: At baseline the elderly with high level of education had more teeth and more root surfaces at risk than those with low level of education. Number of teeth decreased (-1.085, p < 0.0001), while both DMFT (1.164, p < 0.0001) and RCI (0.081, p < 0.0001) indices increased during follow-up. The increments in DMFT and RCI were not directly associated with the level of education. Multivariate analysis in which subjects' gender, number of teeth, level of education, frequency of eating and frequency of brushing were taken into consideration, showed no significant association with caries increment. CONCLUSIONS: Within the limitations of this study it can be concluded that the level of education of the elderly is not directly associated with the increment in caries.

Implants coated with bioactive glass by CO2-laser, an in vivo study.

Due to ageing of the population, the number of revision operations is expected to increase. Thus good fixation of medical implants is crucial for successful treatment. In our previous studies, a method to coat titanium implants with bioactive glass (BAG) via CO2 laser treatment was introduced. It allows to localise the application of a bioactive coating, without heat treatment of the whole implant. In the present study, cylindrical titanium implants were used (BAG-coated, control group: NaOH-treated and grit-blasted Ti). Three implants were placed in each femoral epicondyle of six rabbits. After eight weeks the animals were sacrificed. Half of the implants were subjected to a torsional loading test. In the control groups, the failure occurred at the bone-implant interface, in the BAG group the failure occurred mainly in the reacted glass. The implants coated with BAG were integrated into host bone without a connective tissue capsule and were surrounded by significantly more bone than the control implants. The findings indicate clearly that the use of CO2 laser radiation to create BAG coatings did not inhibit the bioactive properties of the glass in terms of osteoconduction.

In vitro cytotoxicity of E-glass fiber weave preimpregnated with novel biopolymer.

The aim of this study was to investigate cytotoxicity of composition of E-glass fibers and novel biopolymer of poly(hydroxyproline). Growth and proliferation of the human gingival fibroblast cells on the surface of the materials was evaluated. The number of cells grown and proliferated on cell culture plastic was used as a control. Bi-directional fiber weaves were preimpregnated with poly(hydroxyproline). Cytotoxicities of the preimpregnated and nonimpregnated materials were evaluated bythe release of lactate dehydrogenase from the cells during the culture period of 24 h. The values of the lactate dehydrogenase activity of the materials' extracts showed non-toxicity for poly(hydroxyproline) preimpregnated E-glass fiber weaves. The growth of fibroblasts on the surface of the materials appeared normal after 11 days culture period; they looked healthy and normal in size and shape. The results of this study suggest that based on its' non-cytotoxicity the composition of E-glass fibers and poly(hydroxyproline) can further be evaluated as a material that is suitable for biomedical use.

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.