PURPOSE: The purpose of this clinical study was to formulate a custom-made, 2-color chewing gum for the mixing ability test and to develop an image-processing method for color mixing analysis.
MATERIAL AND METHODS: Specimens of red-green (RG) chewing gum were prepared as a test food. Twenty dentate participants (10 men, 10 women; mean age 21 years) took part in this study. Each participant masticated 1 piece of RG gum for 3, 6, 9, 15, and 25 cycles, and this task was repeated 3 times consecutively (total n=15 for each participant). The boluses were retrieved and flattened to 1-mm-thick wafers and scanned with a flatbed scanner. The digital images were analyzed using ImageJ software equipped with a custom-built plug-in to measure the geometric dispersion (GD) of baseline red segment. The predictive criterion validity of this method was determined by correlating GD to the number of mastication cycles. The hardness and mass of RG chewing gum were measured before and after mastication. Hardness loss (%) and mass loss (%) were then calculated and compared with those of a commercially available chewing gum.
RESULTS: The 2-way repeated-measures ANOVA with post hoc Bonferroni test showed that GD was able to discriminate among the groups of different numbers of mastication cycles (P
PURPOSE: The purpose of this in vitro study was to compare the adherence of Streptococcus spp. and Candida spp. on 3D-printed denture bases prepared at different build orientations with conventional heat-polymerized resin.
MATERIAL AND METHODS: Resin specimens (n=5) with standardized 28.3 mm2 surface area were 3D printed at 0 and 60 degrees, and heat-polymerized (3DP-0, 3DP-60, and HP, respectively). The specimens were placed in a Nordini artificial mouth (NAM) model and exposed to 2 mL of clarified whole saliva to create a pellicle-coated substratum. Suspensions of Streptococcus mitis and Streptococcus sanguinis, Candida albicans and Candida glabrata, and a mixed species, each at 108 cfu/mL were pumped separately into the model for 24 hours to promote microbial adhesion. The resin specimens were then removed, placed in fresh media, and sonicated to dislodge attached microbes. Each suspension (100 μL) was aliquoted and spread on agar plates for colony counting. The resin specimens were also examined under a scanning electron microscope. The interaction between types of specimen and groups of microbes was examined with 2-way ANOVA and then further analysis with Tukey honest significant test and Kruskal-Wallis post hoc tests (α=.05).
RESULTS: A significant interaction was observed between the 3DP-0, 3DP-60, and HP specimen types and the groups of microbes adhering to the corresponding denture resin specimens (P
PURPOSE: The purpose of this network meta-analysis was to assess the comparative efficacy of interventions used for the treatment of DS.
MATERIAL AND METHODS: A search was conducted for trials published in Medline, Scopus, PubMed, and Cochrane Central Register of Controlled Trials from inception until February 2022 (PROSPERO Reg no: CRD42021271366). Network meta-analysis was performed on data from randomized controlled trials that assessed the comparative efficacy of any form of intervention for the treatment of DS in denture wearers. Agents were ranked according to their effectiveness in the treatment of DS based on outcomes using surface under the cumulative ranking (SUCRA).
RESULTS: A total of 25 articles were included in the quantitative analysis. Topical antifungal agents (risk ratio [RR]=4.37[95% confidence interval [CI]: 2.15,8.90), topical antimicrobial agents used along with systemic antifungal agents (RR=4.25[95% CI: 1.79,10.33]), systemic antifungal agents (RR=4.25[95% CI: 1.79,10.10]), photodynamic therapy (RR=4.25[95% CI: 1.75,8.98]), and topical plant products (RR=3.40[95% CI: 1.59,7.26]) were found to effectively improve DS. Microwave disinfection concurrently administered with topical antifungal agents (RR=7.38(95% CI: 2.75,19.81), microwave disinfection 7.38[95% CI: 2.75,19.81]), topical antifungal agents (RR=4.88[95% CI: 1.92,12.42]), topical plant products (RR=4.49[95% CI: 1.70,11.82]), systemic antifungal agents together with topical antimicrobial agents (RR=3.85[95% CI: 1.33,11.10]), topical antimicrobial agents (RR=3.39[95% CI: 1.17,9.81]), systemic antifungal agents (RR=3.37[95% CI: 1.21,9.34]), and photodynamic therapy or photochemotherapy (PDT) (RR=2.93[95% CI: 1.01,8.47]) were found to effectively resolve mycological DS. Topical antifungals ranked highest in the SUCRA ranking for clinical improvement, whereas microwave disinfection concurrently administered with topical antifungal agents ranked highest for mycological resolution. None of the agents demonstrated significant side effects except for topical antimicrobial agents which demonstrated altered taste and staining of oral structures.
CONCLUSIONS: Available evidence suggests that topical antifungals, microwave, and systemic antifungals are effective in the treatment of DS, but confidence in these findings is low because of the limited number of studies and a high risk of bias. Additional clinical trials are needed on photodynamic therapy, topical plant products, and topical antimicrobials.
PURPOSE: The purpose of this observational study was to measure the prevalence of the presence of the anterior loop and to estimate sex and ethnicity-related variations in anterior loop length in the Malaysian population.
MATERIAL AND METHODS: A total of 100 cone beam computed tomography (CBCT) Digital Imaging and Communications in Medicine (DICOM) files were selected from a pool of 810 ongoing or completed patients in 3 different ethnic groups: Malay (33), Indian (33), and Chinese (34). The DICOM data were imported into commercial software. The IAN was traced with software along with the anterior loop and part of the incisive nerve. The vertical length of the nerve was estimated from the canal to the opening of the mental foramen from the cross-sectional view and translated to the panoramic view. Measurement was made from this point to the most anterior point of the anterior loop by following the trajectory of the nerve and was repeated on the opposite side. A 2-way mixed analysis of variance (ANOVA) test was carried out to evaluate the sex- and ethnicity-related variations (α=.05).
RESULTS: The anterior loop was present in 94% of the 100 participants. Overall anterior loop length (AnLL) ranged between 0.73 and 7.99 mm with a mean length of 3.69 ±1.75 mm on the left side and 3.85 ±1.73 mm on the right side. Among all participants, no statistically significant differences were found between the left and right sides of the mandible (P=.379). Overall, no significant main effect of ethnicity (P=.869) or sex (P=.576) was found on AnLL measurements. Also, with multiple comparisons, no significant effect was found between each pair of ethnic groups. Men in all 3 ethnic groups had greater AnLL than women.
CONCLUSIONS: The anterior loop was present in 94% of the 100 participants among the 3 major ethnic groups of Malaysia. Overall AnLL ranged between 0.73 and 7.99 mm and mean lengths of 3.69 ±1.75 mm on the left side and 3.85 ±1.73 mm on the right side, with no significant ethnicity- or sex-related variations.
PURPOSE: The purpose of this clinical study was to evaluate the safe distance in the interforaminal region of the mandible measured from the genial tubercle level for implant osteotomy in a Chinese-Malaysian population.
MATERIAL AND METHODS: A total of 201 Digital Imaging and Communications in Medicine (DICOM) files were selected for the study from the CBCTs of dentate or edentulous Chinese-Malaysian adult patients with ongoing or completed treatments. Measurements were made with implant planning software. The anatomy of the whole mandible was assessed in the coronal cross-sectional, horizontal view and in panoramic view. Measurements were obtained in millimeters on one side by locating and marking a genial tubercle and then marking the mesial margin of the mental foramen and the anterior loop of the inferior alveolar nerve. The corresponding points of these landmarks were identified on the crest of the mandibular ridge to measure the linear distances. All the measurement steps were repeated on the other side. The linear distance of 2 mm was deducted from the total distance between the genial tubercle and the anterior loop separately for left and right side measurements to identify the safe zone. The mixed 2-way analysis of variance (ANOVA) test was used to analyze side and sex-related variations.
RESULTS: The mean safe zone measured at the crestal level from the genial tubercle site on the left side of the mandible was 21.12 mm and 21.67 mm on the right side. A statistically significant (P
PURPOSE: The purpose of this systematic review was to evaluate crestal bone loss (CBL) around zirconia dental implants and clinical periimplant inflammatory parameters.
MATERIAL AND METHODS: The focus question addressed was, "Do zirconia implants maintain crestal bone levels and periimplant soft tissue health?" Databases were searched for articles from 1977 through September 2014 with different combinations of the following MeSH terms: "dental implants," "zirconium," "alveolar bone loss," "periodontal attachment loss," "periodontal pocket," "periodontal index." Letters to the editor, case reports, commentaries, review articles, and articles published in languages other than English were excluded.
RESULTS: Thirteen clinical studies were included. In 8 of the studies, the CBL around zirconia implants was comparable between baseline and follow-up. In the other 5 studies, the CBL around zirconia implants was significantly higher at follow-up. Among the studies that used titanium implants as controls, 2 studies showed significantly higher CBL around zirconia implants, and in 1 study, the CBL around zirconia and titanium implants was comparable. The reported implant survival rates for zirconia implants ranged between 67.6% and 100%. Eleven studies selectively reported the periimplant inflammatory parameters.
CONCLUSIONS: Because of the variations in study design and methodology, it was difficult to reach a consensus regarding the efficacy of zirconia implants in maintaining crestal bone levels and periimplant soft tissue health.
PURPOSE: The purpose of this systematic review was to compare the cost-effectiveness and PROMs between digitally and conventionally fabricated complete dentures.
MATERIAL AND METHODS: An electronic search of publications from 2011 to mid-2023 was established using PubMed/Medline, EBSCOhost, and Google Scholar. Retrospective, prospective, randomized controlled, and randomized crossover clinical studies on at least 10 participants were included. A total of 540 articles were identified and assessed at the title, abstract, and full article level, resulting in the inclusion of 14 articles. Data on cost, number of visits, patient satisfaction, and oral health-related quality of life were examined and reported.
RESULTS: The systematic review included 572 digitally fabricated complete dentures and 939 conventionally fabricated complete dentures inserted in 1300 patients. Digitally fabricated complete dentures require less clinical time with a lower total cost, despite higher material costs compared with the conventional fabrication technique. Digitally and conventionally fabricated complete dentures were found to have significant effects on mastication efficiency, comfort, retention, stability, ease of cleaning, phonetics, and overall patient satisfaction, as well as social disability, functional limitation, psychological discomfort, physical pain, and handicap.
CONCLUSIONS: Digitally fabricated complete dentures are more cost-effective than conventionally fabricated dentures. There are various impacts of conventionally and digitally fabricated complete dentures on PROMs, and they are not better than one another.
PURPOSE: The purpose of this clinical study was to determine the prevalence of type of posterior mandibular ridge morphology in a Malaysian population and to evaluate the buccolingual width of the alveolar ridge (Wb and Wc); alveolar ridge height (Vcb); and concavity angle, length, and depth for both left and right first and second molars in different age groups and sexes by using cone beam computed tomography (CBCT).
MATERIAL AND METHODS: Bilateral posterior mandibular lingual concavities at the first and second molars were retrospectively studied in cross-sectional views of 150 CBCT scans (n=600 sites evaluated). The sample size was calculated at a power of 80%, confidence interval of 95%, and margin of error of .05. The buccolingual width from the base and crest of the ridge and the ridge height were measured to determine the type of ridge. For the U-shaped ridge, the concavity angle, length, and depth were assessed. The independent t test was used to compare mean values of CBCT measurements between sexes and tooth type, while the ANOVA and Pearson chi-squared test were used to determine the correlations with age groups and types of ridge morphology, respectively. To compare the left and right readings for first and second molars in the same patient, the paired t test was performed (α=.05 for all tests).
RESULTS: The Pearson correlation showed a strong agreement between the 2 examiners with an interobserver reliability of 87.3%. Significant difference was noted in all dimensional measurements when comparing right and left first and second molars (P
PURPOSE: The purpose of this study was to develop and validate a novel instrument, termed the questionnaire on perceived prosthodontic treatment needs (PPTN), that assesses perceived prosthodontic treatment needs in adults.
MATERIAL AND METHODS: The PPTN was developed following a literature review, consultation with healthcare workers, and patient interviews. It included 15 questions and a self-rated need for prosthodontic treatment, categorized on a Likert scale. A cross-sectional descriptive study was completed on 193 dental patients seeking or receiving prosthodontic treatment.
RESULTS: Three perceived prosthodontic treatment need factors were identified (psychosocial impact, esthetic concern, and function) by using exploratory factor analysis. A higher PPTN score indicated greater perceived prosthodontic treatment needs. The identified factors represent 67.8% of the variance with eigenvalues of >1. The PPTN had a high degree of internal consistency and reliability, as the final questionnaire received a Cronbach alpha of 0.75 and an intraclass coefficient of 0.75 with a 95% confidence interval of 0.68 to 0.80 (F(192, 576)=3.94, P
PURPOSE: The purpose of this systematic review of the literature and meta-analysis was to analyze the data on the survival of dental implants in patients with HIV.
MATERIAL AND METHODS: A search for relevant articles published up to November 2019 was performed in PubMed/Medline and Cochrane databases, Clinicaltrials.gov, and Google Scholar. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were adopted for the conduct of the systematic review. The most pertinent data were extracted and pooled for qualitative and quantitative analyses with 95% confidence intervals. Heterogeneity was analyzed by using I-squared statistics.
RESULTS: A total of 8 studies involving 411 individuals with HIV and 1109 implants were included in the meta-analysis. The mean follow-up period was 2.8 years. A pooled estimate of 95% of implant survival rate with 95% confidence interval(92% to 96%) was noted. Heterogeneity across the 8 studies was found to be 41% with moderate true variability.
CONCLUSIONS: This systematic review demonstrated that HIV infection does not pose a serious threat to implant survival on short-term evaluation, but the evidence is of low quality.
PURPOSE: The purpose of this in vitro study was to evaluate the SR, tensile strength (TS), and percentage elongation (% E) of different SEs subjected to outdoor weathering in the Malaysian climate.
MATERIAL AND METHODS: Type-II dumbbell-shaped specimens (N-120) (nonweathered=15, weathered=15) were made from 3 room-temperature vulcanized (A-2000, A-2006, and A-103) and 1 heat-temperature vulcanized (M-511) silicone (Factor II). For 6 months, weathered specimens were subjected to outdoor weathering inside a custom exposure rack. Simultaneously, the nonweathered specimens were kept in a dehumidifier. Subsequently, the SR was measured with a profilometer; TS and % E were measured by using a universal testing machine. Two-way ANOVA was used to compare the means of the tested properties of the nonweathered and weathered specimens, and pairwise comparison was carried out between the silicones (α=.05).
RESULTS: After outdoor weathering, the SR, TS, and % E were adversely affected by weathering in the Malaysian environment. Among the silicone materials, A-2000 showed the least TS changes (2.51 MPa), while A-2006 demonstrated significant changes in percentage elongation after outdoor weathering (266.5%). M-511 exhibited the highest mean value (2.50 μm) for SR changes. In addition, A-103 SE showed statistically significant differences in most pairwise comparisons for all 3 dependent variables.
CONCLUSIONS: Based on the evaluation of mechanical properties, A-103 can be suggested as a suitable silicone for maxillofacial prostheses fabricated for tropical climates. However, A-2000 can be a suitable alternative, although significant changes to surface roughness were detected after outdoor weathering.
PURPOSE: The purpose of this prospective randomized controlled clinical study was to evaluate crest bone-level changes and patient satisfaction with mandibular overdentures retained by 1 or 2 titanium-zirconium (Ti-Zr) implants with immediate loading protocols after 1 year.
MATERIAL AND METHODS: Thirty-six Ti-Zr implants were placed in 24 participants (single central implant in 12 participants and 2 interforaminal implants in 11 participants) by a single operator. LOCATOR attachments were used to retain the mandibular overdentures with an immediate loading protocol, and observations were made at 1 month and 1 year. Changes to the crestal bone level were evaluated with digital periapical radiographs. A 100-mm visual analog scale (VAS) was used to evaluate patient satisfaction. The Mann-Whitney U test was used to analyze the data.
RESULTS: At 1 month, the mean crestal bone loss was 0.23 mm in the 2-implant group (n=22) and 0.39 mm (P=.181) in the single-implant group (n=11). At 1 year, the bone loss was 0.67 mm in the 2-implant group and 0.88 mm (P=.248) in the single-implant group. The mean VAS score for patient satisfaction level increased from 38.3% to 49.7% for single-implant participants and from 40.5% to 54.8% for 2-implant participants 1 month after implant placement (P=.250) and from 38.3% to 54.5% for single-implant participants and from 40.5% to 58.9% for 2-implant participants after 1 year (P=.341).
CONCLUSIONS: Single-implant-retained mandibular overdentures with an immediate loading protocol may represent a viable treatment option considering crestal bone-level changes and patient satisfaction compared with 2-implant-retained mandibular overdentures after 1 year of follow-up.
PURPOSE: The purpose of this finite element analysis study was to evaluate the biomechanical behavior (stress distribution pattern) in the mandibular overdenture, mucosa, bone, and implants when retained with 2 standard implants or 2 mini implants under unilateral or bilateral loading conditions.
MATERIAL AND METHODS: A patient with edentulous mandible and his denture was scanned with cone beam computed tomography (CBCT), and a 3D mandibular model was created in the Mimics software program by using the CBCT digital imaging and communications in medicine (DICOM) images. The model was transferred to the 3Matics software program to form a 2-mm-thick mucosal layer and to assemble the denture DICOM file. A 12-mm-long standard implant (Ø3.5 mm) and a mini dental implant (Ø2.5 mm) along with the LOCATOR male attachments (height 4 mm) were designed by using the SOLIDWORKS software program. Two standard or 2 mini implants in the canine region were embedded separately in the 3D assembled model. The base of the mandible was fixed, and vertical compressive loads of 100 N were applied unilaterally and bilaterally in the first molar region. The material properties for acrylic resin (denture), titanium (implants), mucosa (tissue), and bone (mandible) were allocated. Maximum von Mises stress and strain values were obtained and analyzed.
RESULTS: Maximum stresses of 9.78 MPa (bilaterally) and 11.98 MPa (unilaterally) were observed in 2 mini implants as compared with 3.12 MPa (bilaterally) and 3.81 MPa (unilaterally) in 2 standard implants. The stress values in the mandible were observed to be almost double the mini implants as compared with the standard implants. The stresses in the denture were in the range of 3.21 MPa and 3.83 MPa and in the mucosa of 0.68 MPa and 0.7 MPa for 2 implants under unilateral and bilateral loading conditions. The strain values shown similar trends with both implant types under bilateral and unilateral loading.
CONCLUSIONS: Two mini implants generated an average of 68.15% more stress than standard implants. The 2 standard implant-retained overdenture showed less stress concentration in and around implants than mini implant-retained overdentures.