Residual ridge resorption (RRR) following tooth loss is a continuous and irreversible process that limits the effectiveness of conventional complete dentures and compromises masticatory function and quality of life. Implant-supported overdentures (implant overdentures [IODs]) can reconstruct physiological stress distribution, regulate inflammatory molecular signalling and optimise bone remodelling through combined biological and mechanical pathways, thereby helping to slow RRR. This review systematically summarises the biological mechanisms of RRR, including inflammatory mediators, the receptor activator of nuclear factor-kappa B ligand/osteoprotegerin pathway and systemic factors; the mechanical mechanisms, including Wolff’s law and stress distribution patterns; the protective effects of IODs on residual ridges; key determinants of their bone-preserving efficacy, including implant-, attachment-, occlusion- and patient-related factors; current controversies; and advances in digital applications. Regarding attachment systems, current evidence from randomised controlled trials, long-term cohort studies and meta-analyses indicates that ball, Locator and bar attachments demonstrate broadly comparable peri-implant marginal bone outcomes, although Locator attachments may be associated with lower posterior RRR over 10 years, whereas bar attachments may offer superior crestal bone stability in specific clinical scenarios. No single attachment system demonstrates a clinically meaningful, reproducible advantage in bone preservation, and selection should be individualised based on anatomical, functional and maintenance considerations. Current evidence remains limited by heterogeneous study designs, variable follow-up periods and an overreliance on finite element analyses, underscoring the need for standardised long-term clinical trials with harmonised outcome measures. Evidence from recent high-quality studies over the past 5 years is integrated to propose stratified clinical recommendations according to bone volume, systemic status and economic factors. Digital technologies, including computer-guided surgery, digital impressions and occlusal analysis, further enhance precision and predictability of bone-preserving outcomes. This review provides a theoretical basis and clinical reference for optimising rehabilitation protocols, preserving residual ridges over the long term and improving prosthetic prognosis in patients with edentulism.
Objective: To assess the differences in treatment outcome evaluation using the Dental Health Component (DHC) and Aesthetic Component (AC) of the Index of Orthodontic Treatment Need (IOTN), the Index of Complexity, Outcome and Need (ICON), and the Peer Assessment Rating (PAR), and to examine scoring agreement between orthodontic residents and undergraduate students. Material and methods: A total of 87 study casts were assessed using the IOTN, ICON, and PAR indices to evaluate treatment outcome, with intra- and inter-examiner reliability examined. Results: High to very high correlation was observed among AC, ICON, and PAR at T1 (p < 0.0001), while at T2, a high correlation was found between ICON and AC (p < 0.0001). Low correlations were found between DHC and both PAR and ICON. A negligible correlation was found between AC and DHC at T2. IOTN components showed good reproducibility at T1, whereas DHC, ICON, and PAR demonstrated moderate reliability at T2. Among orthodontic residents, ICON showed moderate (T1) and good (T2) reliability. PAR showed excellent reliability at T1. Among all examiners, all indices had moderate reliability at T1, and both ICON and PAR had poor reliability at T2. Conclusions: ICON was the most reliable index among orthodontic residents and required less scoring time than PAR, although IOTN remained the quickest to apply.
Objective: The Swedish Quality Register for Caries and Periodontal Disease (SKaPa) is a national registry providing oral health data for children and adolescents. Since no validation has been performed on adolescents with permanent dentitions, the aim of this study was to evaluate SKaPa data for dental caries in 19-year-olds. Material and Methods: This diagnostic accuracy study included a random sample of 19-year-olds (N = 250) examined in 2014 in the Public Dental Service, Region Värmland. Clinical records served as the reference standard and SKaPa variables as the index test. Number of decayed and filled teeth (DFT), number of decayed, missing, and filled teeth (DMFT), missing teeth due to caries (MTC), missing teeth due to any reason (MTA), number of decayed teeth (DT), and number of filled teeth (FT) were evaluated. Agreement was evaluated using exact agreement, Cohen’s kappa, and intraclass correlation coefficients. Results: Data showed high agreement for DFT, DMFT, MTA, DT, and FT (kappa between 0.82 and 0.90; ICC 0.93–0.96). SKaPa underestimated caries by 6–7%. Among 155 participants with DFT/DMFT ≥1, only three had MTC, limiting evaluation. Conclusions: SKaPa caries data demonstrate high accuracy. However, as MTC could not be evaluated, DMFT should be used with caution in research at this point. Researchers should instead use DFT but be observant of the risk of an underdiagnosis of dental caries in SKaPa for 19-year-olds.
Objective: To compare systemic profiles, oral findings, and documented soft tissue healing between cancer and osteoporosis patients with medication-related osteonecrosis of the jaw (MRONJ). Material and methods: This retrospective single-center cohort included 105 cases treated in 2013–2019 (56 cancer; 49 osteoporosis). Healing at last follow-up was analyzed using adjusted logistic regression and Firth sensitivity analysis. Results: Of 102 cases with known final status, 68 had documented healing. Osteoporosis cases were older, predominantly female, and had longer antiresorptive exposure than cancer cases (76.7 ± 11.1 vs. 70.0 ± 8.5 years; 102.5 ± 77.8 vs. 34.6 ± 28.5 months; both p < 0.001). Stage II predominated and Stage 0 was uncommon (3/105, 2.9%). Previous tooth extraction at the MRONJ lesion site was more frequent in osteoporosis (95.9% vs. 71.4%; p < 0.001). Surgical treatment was associated with higher healing odds (adjusted odds ratio [OR]: 11.12, 95% confidence interval [CI]: 4.12 to 33.35; p < 0.001), whereas cancer indication was associated with lower odds (adjusted OR: 0.23, 95% CI: 0.07 to 0.68; p = 0.011). Conclusions: Systemic profiles differed; oral patterns were similar. Non-random treatment and missing healing dates limit interpretation. Previous tooth extraction was the most frequent antecedent event; its indication and timing were unverified.
