Frauke Müller

A Double‐Blind Randomized Controlled Trial (RCT) of Titanium‐13Zirconium versus Titanium Grade IV Small‐Diameter Bone Level Implants in Edentulous Mandibles – Results from a 1‐Year Observation Period

BACKGROUND The use of endosseous dental implants has become common practice for the rehabilitation of edentulous patients, and a two-implant overdenture has been recommended as the standard of care. The use of small-diameter implants may extend treatment options and reduce the necessity for bone augmentation. However, the mechanical strength of titanium is limited, so titanium alloys with greater tensile and fatigue strength may be preferable. PURPOSE This randomized, controlled, double-blind, multicenter study investigated in a split-mouth model whether small-diameter implants made from Titanium-13Zirconium alloy (TiZr, Roxolid™) perform at least as well as Titanium Grade IV implants. METHODS AND MATERIALS Patients with an edentulous mandible received one TiZr and one Ti Grade IV small-diameter bone level implant (3.3 mm, SLActive®) in the interforaminal region. The site distribution was randomized and double-blinded. Outcome measures included change in radiological peri-implant bone level from surgery to 12 months post-insertion (primary), implant survival, success, soft tissue conditions, and safety (secondary). RESULTS Of 91 treated patients, 87 were available for the 12-month follow-up. Peri-implant bone level change (-0.3 ± 0.5 mm vs -0.3 ± 0.6 mm), plaque, and sulcus bleeding indices were not significantly different between TiZr and Ti Grade IV implants. Implant survival rates were 98.9 percent and 97.8 percent, success rates were 96.6 percent and 94.4 percent, respectively. Nineteen minor and no serious adverse events were related to the study devices. CONCLUSION This study confirms that TiZr small-diameter bone level implants provide at least the same outcomes after 12 months as Ti Grade IV bone level implants. The improved mechanical properties of TiZr implants may extend implant therapy to more challenging clinical situations.

Implant-supported Mandibular Overdentures in Very Old Adults A Randomized Controlled Trial

The purpose of this study was (1) to investigate denture satisfaction following the conversion of existing mandibular complete dentures to implant overdentures (IOD) in very old edentulous patients who depend on help for activities of daily living and (2) to evaluate secondary end points, such as functional, structural, nutritional, and patient-centered aspects. For this randomized clinical trial, 2 interforaminal short implants were placed in the intervention group (n = 16, 85.0 ± 6.19 yrs) to retain mandibular IODs; the control group (n = 18, 84.1 ± 5.55 yrs) received conventional relines. During the first year, no implant was lost; however, 2 patients died. IODs proved more stable, and participants in the intervention group demonstrated significantly higher denture satisfaction as well as an increased oral health–related quality of life compared to the control group. Maximum voluntary bite force improved significantly with IODs, yet the chewing efficiency was not different between groups. Masseter muscle thickness increased with IODs, mainly on the preferred chewing side. Body mass index decreased in both groups, but the decline tended to be smaller in the intervention group; blood markers and the Mini Nutritional Assessment did not confirm this tendency. These results indicate that edentulous patients who depend on help for activities of daily living may benefit from IODs even late in life (ClinicalTrial.gov NCT01928004).

Masseter muscle thickness, chewing efficiency and bite force in edentulous patients with fixed and removable implant‐supported prostheses: a cross‐sectional multicenter study

OBJECTIVES Edentulous patients may be restored with conventional dentures (C/C), implant-supported overdentures (IOD) or implant-supported fixed dental prostheses (IFDP). Null-hypotheses: chewing efficiency, maximum voluntary bite force (MBF) and masseter muscle thickness (MMT) are lower in patients with C/IOD compared with the patients with bimaxillary IFDPs. Both groups perform better than C/C and are inferior to fully dentate controls. MATERIAL AND METHODS Ethical approval was obtained. For this multicenter cross-sectional study, 80 patients were recruited. Four groups of different dental states comprised of either implant-supported prostheses (C/IOD and IFDP/IFDP) or served as control-groups (C/C and fully dentate D/D). Chewing efficiency was assessed with a two-colour mixing ability test. MBF was measured bilaterally with a force gauge. Two dimensional ultrasonography was used to measure MMT bilaterally. RESULTS Chewing efficiency in C/IOD and IFDP/IFDP (difference NS) was better than in C/C, but not as good as in D/D. MBF in C/IOD was lower than in IFDP/IFDP. Chewing efficiency and MBF were significantly lower in IFDP/IFDP, who had experienced chipping or fracture of the prosthetic superstructure. Median MMT of patients with implant-supported prostheses was between those with C/C and fully dentate participants. There was no significant difference in MMT between C/IOD and IFDP/IFDP. CONCLUSION Supporting complete prostheses with oral implants seems to have positive effects on the thickness of the masseter muscle, maximum bite force as well as chewing efficiency. The type of implant-supported prostheses may have an influence on the magnitude of the effect.

Loading protocols for implant-supported overdentures in the edentulous jaw: a systematic review and meta-analysis.

PURPOSE High survival rates have frequently been reported for immediately loaded implants. The aim of this systematic review was to compare immediately loaded with early and conventional loaded implants for overdenture treatment with regard to their 1-year survival rates. MATERIALS AND METHODS Systematic database (Medline, Embase, CENTRAL) and hand searches were performed to identify prospective studies reporting on loading protocols for two-piece implants with micro-rough surfaces and diameters > 3 mm. Studies were grouped according to loading protocol, jaw, number of implants per jaw, and splinting. Meta-analyses of comparative reports were performed based on the calculated risk difference (RD). Descriptive analyses included the remainder prospective studies. Two investigators extracted the data independently. Kappa statistics served to evaluate the inter-investigator agreement. RESULTS Of the 3,142 identified articles, 58 were included for data extraction. They comprised 11 studies comparing loading protocols as well as a further 47 prospective reports. Comparative studies were only available for mandibular overdentures. The meta-analysis revealed a statistical tendency to support conventional over immediate loading (RD: -0.03, 95% confidence interval: -0.06, 0.00). The descriptive analysis of studies with lower evidence demonstrated partially contradictory findings. There, reported survival rates for immediately loaded implants lay between 81.6% and 100%, but depended on the number of implants placed. Most investigators preferred verifying an initial high insertion torque (≥ 35 Ncm) or ISQ value (≥ 60) before considering an implant for an immediate or early loading protocol. CONCLUSIONS Although all three loading protocols provide high survival rates, early and conventional loading protocols are still better documented than immediate loading and seem to result in fewer implant failures during the first year. Only a few prospective case series are available to document immediate loading of implants supporting an overdenture in the edentulous maxilla.

Masticatory Function and Bite Force in Stroke Patients

Orofacial functions are frequently affected by stroke, but little is known on the nature and extent of the impairment of mastication, which is investigated in this observational study. Thirty-one stroke patients, aged 69.0 ± 12.7 yrs, presenting with a hemi-syndrome with facial palsy, were recruited. Chewing efficiency, maximum bite and restraining lip forces were tested. Stroke severity (National Institutes of Health Stroke Scale) and dental state were recorded. The control group was similar in age, gender, and dental state (n = 24). The chewing efficiency was significantly lower in the stroke group (p ≤ 0.0001) and was related to both the dental state and the lip forces measured with small and medium-sized labial plates. The maximum bite force proved to be not significantly different between sides or groups (n.s.), whereas lip force was significantly lower in the stroke group (p ≤ 0.05). Chewing efficiency is severely affected by stroke; thus, rehabilitation protocols should aim to restore the strength and co-ordination of the orofacial muscles.

European College of Gerodontology: undergraduate curriculum guidelines in Gerodontology

Effective undergraduate teaching of gerodontology to present and future dental students is important if good oral health care of older people is to be assured. A review of the undergraduate curriculum for gerodontology is presented and indicates the need for a knowledge base from which new graduates can develop a special interest in care of older patients. The aim is improved care of older patients, satisfaction for teaching staff involved and improved professional standing for Dentistry. Motivation of students could also be achieved by the positive match between rising patient awareness and ethical responsibility of the profession for those older patients. As it stands, the undergraduate curriculum should include topics on specific care for the elderly and other patient groups, which extend the competences already agreed by the Association for Dental Education in Europe (ADEE). The logistics of teaching these topics will need co-ordination of those staff with appropriate skill and interest, preferably as a development of existing curriculum content.

From brain to bridge: masticatory function and dental implants.

Masticatory function is an important aspect of oral health, and oral rehabilitation should aim to maintain or restore adequate function. The present qualitative review is the joint effort of a group of clinicians and researchers with experiences ranging from basic and clinical oral neuroscience to management of patients with dental implants. The aim is to provide a short summary for the clinician of the many aspects related to masticatory function (including quality of life) and rehabilitation with dental implants. While there are many reviews on the tissue responses to dental implants and technical aspects, the functional aspects have received relatively little focus.

The NADPH oxidase NOX2 plays a role in periodontal pathologies

Oxidative stress plays an important role in periodontal health and disease. The phagocyte nicotinamide adenine dinucleotide phosphate oxidase NOX2 is most likely one of the key sources of reactive oxygen species (ROS) in periodontal tissues. This review will discuss three clinical aspects of NOX2 function. We will first focus on oral pathology in NOX2 deficiency such as chronic granulomatous disease (CGD). CGD patients are thought to suffer from infections and sterile hyperinflammation in the oral cavity. Indeed, the periodontium appears to be the most common site of infection in CGD patients; however, as periodontitis is also common in the general population, it is not clear to which extent these infections can be attributed to the disease. Secondly, the role of oxidative stress in periodontal disease of diabetic patients will be reviewed. Diabetes is indeed a major risk factor to develop periodontal disease, and increased activity of leukocytes is commonly observed. Enhanced NOX2 activity is likely to be involved in the pathomechanism, but data remains somewhat preliminary. The strongest case for involvement of NOX2 in periodontal diseases is aggressive periodontitis. Increased ROS generation by leukocytes from patients with aggressive periodontitis has clearly been documented. This increased ROS generation is to be caused by two factors: (1) genetically enhanced ROS generation and (2) oral pathogens that enhance NOX function. NOX enzymes in the oral cavity have so far received little attention but are likely to be important players in this setting. New therapies could be derived from these new concepts.

The Seattle Care Pathway for securing oral health in older patients

There is a need for a structured, evidence based approach to care for older dental patients. The following article describes the development of the Seattle Care Pathway based upon a workshop held in 2013. An overview is provided on the key issues of older persons dental care including the demography shift, the concept of frailty, the need for effective prevention and treatment to be linked to levels of dependency and the need for a varied and well educated work force. The pathway is presented in tabular form and further illustrated by the examples in the form of clinical scenarios. The pathway is an evidence based, pragmatic approach to care designed to be globally applicable but flexible enough to be adapted for local needs and circumstances. Research will be required to evaluate the pathways application to this important group of patients.

Mundgesundheit, Zahnstatus und Ernährung im Alter

The loss of natural teeth impairs essentially the chewing function and can only partly be restored by the insertion of dental prostheses. Equally, xerostomia and dysphagia may aggravate the nutritional intake in older adults. Often denture wearers do subjectively not notice the adjustment of their food choice and the employment of special preparation techniques. Finally the dental state influences the nutritional intake. A reduced number of teeth correlates with the intake of less calories, proteins, fat, non-starch polysaccharides and vitamins. Often missing calories are compensated by an increased consumption of sugar and fat. Especially edentulous persons with a low level of education choose a diet which is rich in fat and sugar. Further the daily intake of fruit and vegetables diminishes along with fewer occlusal contacts in posterior teeth. The restoration of the chewing function by dental intervention does not lead to an improvement of the nutritional intake by itself and should therefore always be complemented by nutritional advice.ZusammenfassungDer Verlust natürlicher Zähne beeinträchtigt die Kaufunktion erheblich und kann durch die Eingliederung von Zahnprothesen nur teilweise ausgeglichen werden. Gleichzeitig erschweren oft Mundtrockenheit und Dysphagie die Nahrungsaufnahme bei alten Menschen. Subjektiv oft nicht wahrgenommen stellen Prothesenträger ihre Nahrungsmittelauswahl um und greifen auf spezielle Zubereitungsarten zurück. Letztendlich zeigt der Zahnstatus einen Einfluss auf die Nahrungsaufnahme. Mit abnehmender Zahnzahl werden weniger Kalorien, Proteine, Fett, nichtstärkehaltige Polysacharide und Vitamine aufgenommen. Oft werden die fehlenden Kalorien durch vermehrte Zucker und Fettaufnahme ausgeglichen. Besonders zahnlose Personen mit geringer Schulbildung greifen zu einer eher fett- und zuckerhaltigen Ernährung. Auch nimmt der tägliche Verzehr von Früchten und Gemüse mit der Anzahl der Seitenzahnkontakte ab. Eine Verbesserung der Kaufunktion durch zahnärztliche Maßnahmen geht nicht automatisch mit einer verbesserten Nahrungsaufnahme einher und sollte daher immer mit einer Ernährungsberatung kombiniert werden.SummaryThe loss of natural teeth impairs essentially the chewing function and can only partly be restored by the insertion of dental prostheses. Equally, xerostomia and dysphagia may aggravate the nutritional intake in older adults. Often denture wearers do subjectively not notice the adjustment of their food choice and the employment of special preparation techniques. Finally the dental state influences the nutritional intake. A reduced number of teeth correlates with the intake of less calories, proteins, fat, nonstarch polysaccharides and vitamins. Often missing calories are compensated by an increased consumption of sugar and fat. Especially edentulous persons with a low level of education choose a diet which is rich in fat and sugar. Further the daily intake of fruit and vegetables diminishes along with fewer occlusal contacts in posterior teeth. The restoration of the chewing function by dental intervention does not lead to an improvement of the nutritional intake by itself and should therefore always be complemented by nutritional advice.