Mundgesundheitskompetenz von Menschen mit Migrationshintergrund – Erste Auswertungen der MuMi-Studie

Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz - Erste Studien heben den Migrationshintergrund von Menschen in Deutschland als eigenständigen Risikofaktor für eine...     

Oral health and access to dental care – a comparison of elderly migrants and non-migrants in Germany

Objectives: To compare oral health, access barriers to dental care, oral health behavior and oral hygiene behavior of elderly German residents with and without immigration background.

Design: In this cross-sectional explorative study, a convenience sample (N?=?112, age?≥?60 years, 54% immigrants) was recruited in four dental practices in Hamburg, Germany. Oral health was assessed with Decayed/Missing/Filled Teeth (DMFT), Papillary Bleeding Index (PBI), and Approximal Plaque Index (API). Dental health was operationalized as number of decayed teeth, and poor oral hygiene based on a PBI?≥?40%. Access barriers and oral health behavior were assessed with a standardized questionnaire.

Results: While caries experience was similar in migrants and non-migrants (DMFT mean: 24.8 vs. 23.4, n.s.), significantly more teeth were decayed (5.3 vs. 2.1, p?p?=?0.002) and PBI (46.3% vs. 30.5%, p?=?0.016) were significantly higher in migrants. After adjusting for age, sex, income, education, and number of teeth, migrants still had on average 3 decayed teeth more than non-migrants. However, impact of migration background on poor oral health changed from OR?=?3.61 (p?=?0.007) to OR?=?1.05 (n.s.) after adjusting for confounders, mainly due to lower income in migrants. Fewer migrants had visited a dentist within the past 12 months, and migrants were less likely to have a regular dentist that they visit and more often indicated language or cost barriers than non-migrants.

Conclusion: Elderly German migrants have higher treatment needs than non-migrants. Likely causes are poorer oral hygiene and lower utilization of dental care services. Specific prevention programs targeting migrants are warranted to improve oral health in this disadvantaged group.     

Clinical comparison of postoperative sensitivity for an adhesive resin cement containing 4-META and a conventional glass-lonomer cement

PURPOSE: The aim of this clinical 2-year follow-up study was to compare the postoperative sensitivity of abutment teeth restored with full coverage restorations retained with either conventional glass-ionomer cement or a new adhesive resin cement containing 4-methacrylolyloxyethyl trimellitate anhydride (4-META). MATERIALS AND METHODS: Sixty patients received 120 full-coverage restorations on vital abutment teeth, cemented with either a glass-ionomer cement (Ketac-Cem) or a new adhesive resin cement (Chemiace II). A randomized split-mouth design and a patient double-blind data acquisition protocol were used. The teeth were examined before cementation, after 1 week, and after 6, 12, and 24 months. RESULTS: With regard to postcementation sensitivity, a low incidence was observed for both groups. With the adhesive resin cement, little postoperative hypersensitivity was observed after 1 week (13.3%), 6 months (5.9%), 12 months (2.1%), and 24 months (none); results were similar with the conventional glass-ionomer cement Ketac-Cem after 1 week (5.9%), 6 months (5.9%), 12 months (6.4%), and 24 months (none). After 6 months, 2 teeth of the Chemiace II group showed no sensitivity. Endodontic treatment was carried out for these 2 abutment teeth. After 24 months, no cases of postoperative hypersensitivity were recorded for either group. CONCLUSION: In this study, the incidence of postoperative hypersensitivity after cementation of full-crown restorations with a conventional glass-ionomer cement and a new adhesive resin cement was similar.     

A prospective multicenter evaluation of immediately functionalized tapered conical connection implants for single restorations in maxillary anterior and premolar sites: 3-year results

Objectives

This multicenter prospective clinical trial investigated immediately provisionalized, anodized, conical connection, tapered implants with platform shifting in maxillary anterior and premolar sites.

Materials and methods

Patients requiring single-tooth implant-supported restorations in maxillary anterior and premolar sites were enrolled. Implants were immediately provisionalized and evaluated at insertion, 6 months, and annually thereafter. Outcome measures were marginal bone level change (ΔMBL), cumulative survival rate (CSR), and success rate, soft-tissue parameters, and oral health impact profile (OHIP). ΔMBL and Pink Esthetic Score were analyzed using Wilcoxon signed-rank tests. CSR was calculated using life table analysis. Other soft-tissue parameters were analyzed using sign tests.

Results

Of 94 enrolled patients (99 implants), 84 (88 implants) attended the 3-year follow-up. After an initial bone loss between implant insertion and 6 months (− 0.92 ± 1.23 mm), bone levels stabilized from 6 months to 3 years (0.13 ± 0.94 mm) with no significant change. The 3-year CSR was 98.9%, and the cumulative success rate was 96.9%. Papilla index scores of 2 or 3 were observed at 88.6% of sites at the 3-year visit compared with 32.8% at implant insertion. Improvements were observed for all other outcomes, including bleeding on probing, esthetics, plaque, and OHIP.

Conclusions

This restorative protocol was associated with high primary stability, patient satisfaction, stable bone levels, and an overall improvement of the soft tissue outcomes over a 3-year period.

Clinical relevance

The presented treatment is a viable option for single-tooth restorations of maxillary anterior teeth and premolars with successful short- to mid-long-term clinical outcomes.

     

The color of human gingiva and mucosa: visual measurement and description of distribution

No soft tissue shade guide is available for matching the color of denture resins to human intraoral soft tissues. To determine the color of both the gingiva and the alveolar mucosa, intraoral soft tissue colors of 150 men and women were assessed under standardized lighting conditions. Colors of the papilla, attached gingiva, and alveolar mucosa in the central incisor region of the maxilla and mandible were examined using Munsell color tabs and their corresponding notations (value, hue, chroma). Statistical evaluation was performed by using frequency tables and multiple regression (level of significance p=0.05). Color ratings for the maxillary interincisal papilla lay in the yellow hue spectrum. A high incidence of ratings was found between 7/6 2.5R and 7/4 5R (Munsell color notations). Two further peaks were identified for the colors 3/6 2.5 R and 8/4 10R. Five peaks with the highest frequency of ratings were present with regard to the color of the mucosa in the maxillary incisal region: 6/6 2.5R, 7/6 2.5R, 6/8 5R, 5/8 7.5RP, and 5/6 10RP. In the mandible, a similar pattern was found. Using the results from visual matching tests, five color frequency peaks were identified. They could be used to construct an intraoral soft tissue shade guide.     

Impact of implant support for mandibular dentures on satisfaction, oral and general health-related quality of life: a meta-analysis of randomized-controlled trials

Objectives: The aim of this study was to examine systematically the data published on the efficacy of mandibular implant-retained overdentures from the patient's perspective.
Material and methods: Medline, Embase, The Cochrane Central Register of Controlled Trials and The Cochrane Systematic Reviews Database were searched and complemented by hand searching. All randomized-controlled trials published in English or French up to April 2007 were included, in which conventional dentures and mandibular implant overdentures in adult edentulous individuals were compared. The outcomes of interest were patient satisfaction, oral and general health-related quality of life. Random effects models were used to pool the effect sizes (ES) of all included studies.
Results: Ten publications of seven randomized-controlled trials were identified and eight were included in the meta-analysis. When compared with mandibular conventional dentures, implant overdentures were rated to be more satisfactory at a clinically relevant level [pooled ES 0.80, z =3.56, 95% confidence intervals (CI) 0.36–1.24, P =0.0004], but a statistical heterogeneity was found (χ²=31.63, df=5, P <0.00001, I ²=84%). The pooled ES for oral health quality of life was −0.41 ( z =1.31, 95% CI, −1.02 to 0.20; P =0.19, χ²=11.53, df=2, P <0.003, I ²=83%). There was a lack of evidence to show the impact of mandibular implant overdenture on perceived general health.
Conclusions: Our findings suggest that, although mandibular implant-retained overdentures may be more satisfying for edentulous patients than new conventional dentures, the magnitude of the effect is still uncertain. There is a need for additional evidence including cost-effectiveness analyses on the impact of mandibular implant overdentures and conventional dentures.     

Double-layer porcelain veneers: effect of layering on resulting veneer color

STATEMENT OF PROBLEM: Densely sintered aluminum oxide veneered with feldspathic porcelain seems to be a promising technology for the fabrication of porcelain laminate veneers, which provide both strength and esthetics. To effectively use this approach for porcelain veneers, practitioners should know how the resulting color is affected by adding a layer of veneering porcelain onto the aluminum oxide. PURPOSE: This study compared changes in CIE L*a*b* color coordinates of simulated stained teeth when covered with the aluminum oxide core disks alone and after the disks had been veneered with 3 different shades of porcelain. MATERIAL AND METHODS: Fifteen aluminum oxide disks were divided into 3 groups. Each of 5 disks was veneered with porcelain of the Vita shades A1, A2, and B4, respectively. The colors of the substrate covered with the nonveneered disks and the veneered disks were measured separately, and the color differences were calculated. Measurements of the disks on a white background were also performed and used as controls. The extracted data were compared with Vita shade values available from the literature. RESULTS: Statistically significant differences in color coordinates of dark substrates were recorded between the substrate covered by an aluminum oxide disk and the addition of veneering porcelain to the aluminum oxide disks. Veneering the aluminum oxide disks with A1, A2, and B4 porcelain produced significant differences in the resulting color when placed on a dark substrate. The direction of the color modifications correlated with values obtained from the literature. The resulting color was also affected by the color of the underlying structures. CONCLUSION: Although aluminum oxide alone does have a degree of masking capability, the resulting color of porcelain veneers with the use of this material can successfully be modified with the veneering porcelain.     

Zygoma implant-supported prosthetic rehabilitation after partial maxillectomy using surgical navigation: a clinical report

The rehabilitation of patients with acquired defects of the maxilla is a challenge in terms of reestablishing oronasal separation. In most patients these goals are met by means of prosthetic rehabilitation with an obturator prosthesis. If the remaining dentition does not offer sufficient retention and support, the placement of zygoma implants can enhance the stability of the prosthesis. Due to the anatomic intricacies of the zygomatic bone and the implant length, computer-supported navigated implant placement can be advantageous. In the following clinical report, a diabetic patient with a status of posthemimaxillectomy secondary to aspergillusis infection is presented, in whom a zygoma implant was placed using a CT scan-based navigation system. A special retentive anchoring abutment was used to integrate the zygoma implant into a telescopic crown-retained denture on the residual dentition. This tooth-implant-supported obturator prosthesis restored function and phonetics, as well as esthetics, for this young patient.     

Technical complications of implant-supported fixed partial dentures in partially edentulous cases after an average observation period of 5 years

OBJECTIVES: The purpose of this prospective long-term study was to evaluate the incidence of the most common technical problems, namely screw loosening, screw fracture, fracturing of veneering porcelain and framework fracture in implant-supported fixed partial dentures (FPDs), and assess the survival and success rate (event-free survival) after 5 years of function. MATERIALS AND METHODS: In 76 partially edentulous patients, a total of 205 3i-implants (machined surface) were placed and restored with 112 implant-supported FPDs (46 single crowns, 81 splinted crowns, seven FPD bridges and 23 FPDs with cantilevers). The survival rate of FPDs supported by implants was 94.5% (CI-95: 90.1-98.8) after an average observation period of 5 years. The success rate (event-free survival) of the FPDs was 80% (CI-95: 87.3-72.7). After an observation period of 5 years the cumulative incidence of screw loosening was 6.7% (CI-95: 1.8-11.5), the cumulative incidence for screw fracture was 3.9% (CI-95: 0.1-7.7). Fracture of the veneering porcelain occurred in 5.7% (CI-95: 1.2-10.2) of all FPDs. Fracturing of the suprastructure framework was rare (1%; CI-95: 0-2.9). The overall complication incidence after 5 years was highest in the group of FPDs with cantilever, which showed the lowest success rate 68.6% (CI-95: 50-87.3), followed by single crowns (77.6%; CI-95: 53.3-100) and splinted crowns (86.1%; CI-95: 59.5-100). No complication occurred in FPD bridges. CONCLUSION: Fixed partial dentures supported by 3i-implants showed low technical complications rates, the most common being loosening of the abutment screw. Managing these complications can cause extra amount of chair-side time and patient dissatisfaction.