Daiane Cerutti-Kopplin

Tooth Loss Increases the Risk of Diminished Cognitive Function A Systematic Review and Meta-analysis

Emerging evidence suggests that oral health is associated with cognitive function. This review aims to systematically assess this association in adult populations via prospective cohort study designs. Eligible study reports were identified by searching the MEDLINE (via Ovoid), EMBASE, PsycoINFO, and Cochrane Library databases. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated with a random effects model. From 1,251 identified articles, 10 were included in the systematic review and 8 in the meta-analysis. Random effects analysis showed, with statistically low heterogeneity, that individuals with suboptimal dentition (<20 teeth) were at a 20% higher risk for developing cognitive decline (HR = 1.26, 95% CI = 1.14 to 1.40) and dementia (HR = 1.22, 95% CI = 1.04 to 1.43) than those with optimal dentition (≥20 teeth). Studies on the association between periodontal disease and cognitive status showed conflicting results. Within the limits of the quality of published evidence, this meta-analysis lends further support to the hypothesis that tooth loss is associated with an increased risk of cognitive impairment and dementia. Knowledge Transfer Statement: Based on the published literature, the results of this study show that the risk for cognitive impairment and dementia increases with loss of teeth. This information adds to the evidence showing links between oral and general health and suggests that oral health strategies aimed to preserve teeth may be important in reducing risk of systemic disease.

Cognitive status of edentate elders wearing complete denture: Does quality of denture matter?

BACKGROUND Emerging evidence suggests that an individuals level of mastication may play a role in their cognitive status. This suggests that in edentate individuals wearing complete denture, non-optimal mastication via inadequate denture could be related to cognitive status. OBJECTIVES To examine the impact of quality of denture on cognitive status of a sample of elderly edentate Brazilian individuals wearing complete denture. METHODS This study is a cross-sectional analysis of data collected from 117 edentate elders (mean age 73.7 ± 5.6 years) wearing complete denture, in southern Brazil. Cognitive impairment was assessed using the Brazilian version of the mini-mental state examination (MMSE). Clinical examination was conducted to evaluate the quality of dentures by use of the FAD (functional assessment of dentures) instrument. Masticatory ability was assessed by self-reported questions. RESULTS The mean MMSE score for the total sample was 23.1 (SD=4.4) and was associated with age (p=0.001), education (p<0.0001), depressive symptoms (p=0.003), as well as the masticatory ability (p=0.001) and functional quality of dentures (p<0.0001). Unsatisfactory masticatory ability was more frequent in edentate individuals with lower FAD score (p<0.0001) and led to a lower MMSE total score. Unsatisfactory masticatory ability was associated with MMSE scores (p=0.002) after adjustment. CONCLUSION The study results support the potential role of optimal functional quality of dentures in maintaining cognitive activity in elders. This association may be explained via mastication pathway. CLINICAL SIGNIFICANCE The potential beneficial effect of functional dentures on cognitive status via mastication could encourage preventive strategies to decrease substantial risk of morbidity in elders.

Does immediate loading affect clinical and patient-centered outcomes of mandibular 2-unsplinted-implant overdenture? : a 2-year within-case analysis

OBJECTIVE To provide 2-year clinical- and patient-oriented data with regard to mandibular overdenture assisted by 2 immediately loaded unsplinted implants. MATERIAL AND METHODS In this pre-post design, Phase-I clinical trial, 18 edentate individuals (62.4±7.7years) received a new set of complete denture. Then, following standard procedures, 3 threaded implants (OsseoSpeed TX™, Dentsply Implants, Mölndal, Sweden) were placed in the mandible in each patient, and locator abutments (Zest Anchors LLC, Escondido, U.S.A.) were inserted on the right and left side implants. The midline implant served as a control for within-patient comparison. The immediate loading was conducted within 24h of surgery. Data were collected at baseline (T0), 12 (T1) and 24 (T2) months after immediate loading. The clinical outcomes included implant survival rate, crestal bone level changes and implant stability. These criteria were assessed through clinical and radiographic examinations as well as resonance frequency analysis. Patient-centered outcomes included patient satisfaction and oral health-related quality of life measured using validated questionnaires. Brunner-Langer approach was used for statistical analysis. RESULTS Implant survival rate for immediate loaded implants was 91.7% at 2-year follow-up. None of the unloaded implants failed. There was no statistically significant difference at baseline and follow-ups with regard to clinical outcomes between loaded and unloaded implants. Patient satisfaction and quality of life improved (p<0.0001) from baseline to 2-year follow-up. CONCLUSION Immediate loading protocol did not negatively affect clinical outcomes, satisfaction and quality of life of patients wearing 2-unsplinted-implant mandibular overdenture for 2 years. This conclusion requires confirmation by randomized control trials. CLINICAL SIGNIFICANCE STATEMENT Mandibular overdenture assisted by two immediately-loaded unsplinted implants is successful treatment based on 2-year clinical and patient-based outcomes.

Efficacy of Mandibular 2-implant Overdenture An Updated Meta-analysis on Patient-based Outcomes

The extent of heterogeneity regarding the efficacy of the mandibular 2-implant overdenture is still in question. The aim of this meta-analysis is to provide an update on the existing evidence from randomized controlled trials assessing the efficacy of the mandibular 2-implant overdenture in regard to patient-based outcomes. Electronic searches were carried out to September 2015 through MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and the Cochrane Systematic Reviews. Only randomized controlled trials that compared conventional dentures with mandibular 2-implant overdentures were included. Patient-based outcomes were assessed, including patient satisfaction and oral health– and general health–related quality of life. Random effects models were used to pool the effect sizes of all included studies. Further stratified analyses and heterogeneity analyses were tested, as was publication bias. In addition to the 7 randomized controlled trials that were included in the previous meta-analysis, 4 new trials were identified and included in this update. A random effects model showed that, when compared with conventional dentures, mandibular 2-implant overdentures significantly improved patient satisfaction (pooled effect size = 0.87, z = 5.31, 95% confidence interval: 0.55 to 1.19, P < 0.0001, χ2 = 41.82, df = 8, P < 0.0001, I2 = 81%) and oral health–related quality of life (pooled effect size = −0.66, z = 2.72, 95% confidence interval: –1.13 to −0.18, P = 0.007, χ2 = 21.26, df = 4, P = 0.0003, I2 = 81%). The differences in participant recruitment and their pretreatment condition were important sources of heterogeneity among the studies. Only 1 study investigated the impact of mandibular implant overdentures on perceived general health, and it revealed no between-treatment differences. The 2-implant mandibular overdenture improves patient satisfaction and quality of life for the general edentate population. Health status, poor oral condition, and patient characteristics may effect patient-based outcomes and should be considered by clinicians in treatment planning. Knowledge Transfer Statement: This meta-analysis shows that mandibular 2-implant overdentures are significantly more satisfactory to the general edentate populations than new conventional dentures. The results also show that mandibular 2-implant overdentures provide significantly better oral health–related quality of life than do new conventional dentures. These results should be shared with edentate patients in planning their treatment.

A method of assessing the effectiveness of the friction fit interface by measuring reverse torque

STATEMENT OF THE PROBLEM The connection between abutments and implants is fundamental to successful prosthetic rehabilitation, and the loosening or fracture of the parts are undesirable outcomes. PURPOSE The purpose of this study was to measure the reverse torque values of 2 different types of Morse taper implants. MATERIAL AND METHODS Ten Morse taper implants were used, with their respective abutments. They were divided into 2 groups (n = 5): Group DH, implant interface with a double hexagon and Group OI, octagonal implant interface. Each abutment received 2 consecutive insertion torques (32 Ncm) at a 10-minute interval and 1 reverse torque after 5 minutes. The data were analyzed with the Student t test (α= .05). RESULTS The Student t test demonstrated no significant differences between the values of the insertion and removal torques of the 2 groups (Group DH, P= .22 and Group OI, P= .42) or the removal torque values of the groups (P= .12). CONCLUSION The results suggest that the strength required to loosen the abutment screws as measured by reverse torque is similar for both a double hexagon interface (DH) and an octagonal interface (OI).

Influence of reverse torque values in abutments with or without internal hexagon indexes

STATEMENT OF PROBLEM The mechanical stability of the implant-abutment connection is of fundamental importance for successful implant-supported restorations. Therefore, understanding removal torque values is essential. PURPOSE The purpose of this study was to evaluate the reverse torque values of indexed and nonindexed abutments of the Morse Taper system. MATERIAL AND METHODS Twelve Morse taper implants with their respective abutments were divided into 2 groups (n=6): group NI, nonindexed abutments; and group IN, indexed abutments. Each abutment received a sequence of 2 consecutive torques for insertion (15 Ncm) at an interval of 10 minutes, and 1 reverse torque, all measured with a digital torque wrench. The Student t test with a 5% significance level was used to evaluate the data. RESULTS Statistical analysis showed no significant difference in reverse torque values between nonindexed and indexed abutments (P=.57). When comparing insertion torque and reverse torque values between the groups, group NI presented a mean torque loosening percentage of 8% (P=.013), whereas group IN presented a loosening of 15.33% (P<.001). CONCLUSION The use of indexed abutments for the Morse taper system presented similar biomechanical stability when compared with nonindexed abutments, both with a significant reduction in reverse torque values.

Food intake selection influenced by opposing functional natural teeth or removable denture: observational study

AIM: The purpose of this study was to investigate the relationship between types of dentition in occlusion and the perceived ability to eat a range of common foods in elderly. MATERIAL AND METHODS: We included 363 individuals (117 men, 246 women; mean age = 73.4 ± 5.8 years) Self-reported information on questionnaires were linked to oral examination to establish types of dentition in occlusion assessing their influence on the needs to alter the food selection and on the difficulty to chew key foods. RESULTS: The individuals were classified as having their occlusion performed by completed removable prostheses (D/D) (51.2%), mixed dentition (D/N-N/D) (32.8%) or with natural teeth (N/N) (16%). Individuals with natural teeth N/N or mixed dentition (N/D-D/N) had less necessity to change their food intake, relative to individuals with their occlusion performed by complete removal denture (D/D) (p<0.05). Most of the individuals that had to modify their food intake avoided hard-to-chew food (p<0.05). CONCLUSION: The reduced masticatory ability may lead to changes in dietary selection with risk of an impaired nutritional status especially in elderly complete denture wearers.