BACKGROUND:Population aging is reshaping prosthodontic care for both partially and completely edentulous individuals. In older adults, conditions such as frailty, comorbidities, polypharmacy, and cognitive decline can have a direct impact on the biological and biomechanical demands of implant therapy, thereby influencing the success of implant treatment. MATERIALS AND METHODS:This narrative review synthesizes evidence on implant therapy in older patients, integrating prosthetic and biomechanical considerations with patient-related factors. The literature search addressed implant survival, complications, prosthetic and material design, peri-implant soft tissue considerations, and treatment options such as shortened dental arch approaches, implant-assisted removable partial dentures (IARPDs), implant overdentures, and complete dentures, as well as maintenance strategies with patient and caregiver education. RESULTS:Implant survival in older patients remains high, and age alone should not be considered as a limiting factor for implant treatment. Hygiene-oriented prosthetic designs, including non-mucosa-contact intaglio surfaces and emergence angles less than 30°, were associated with reduced plaque accumulation and peri-implant bone loss in older adults. While limited keratinized mucosa correlated with greater plaque and recession, phenotype modification should be evaluated on a case-by-case basis, carefully weighing the benefits against the surgical burden for the older patient. Ceramic materials accumulate less plaque as compared with processed acrylic resin, and veneered zirconia remained more prone to chipping than monolithic zirconia. Alternative treatment options-such as overdentures to enhance bite force, a shortened dental arch when posterior implants are contraindicated, or IARPDs to improve stability-may be especially appropriate for older patients with functional limitations. Caregiver participation and structured maintenance significantly reduce peri-implantitis risk. CONCLUSION:Implant therapy in older patients, including individuals aged 75 years and above, is highly feasible when age-related risks are addressed, prostheses are designed for cleansability and retrievability, and maintenance includes structured follow-up and caregiver support. CLINICAL RELEVANCE:Clinicians should emphasize functional goals, hygiene-accessible designs, pragmatic treatment alternatives, selective peri-implant soft tissue management when indicated, and personalized maintenance supported by patient and caregiver education.

BACKGROUND:Social support is an important determinant of health in later life, yet no study has synthesised the relevant evidence. This systematic review and meta-analysis aimed to synthesise evidence on the association between social support (functional, structural, and perceived dimensions) and oral health among older adults aged 75 years and over. METHODS:The review process, using a systematic approach and random-effects meta-analysis, was conducted in accordance with PRISMA guidelines. Searches were carried out in Medline, Embase, and CENTRAL up to November 2025. Eligible studies examined associations between social support and oral health, including dentition status, oral conditions, oral function, oral health behaviours, and oral health-related quality of life. Risk of bias was assessed using the Newcastle-Ottawa Scale. RESULTS:Forty studies were included. Meta-analyses showed that low functional support-defined as having fewer people to rely on-was associated with edentulism (OR 1.21, 95% CI: 1.15, 1.27) and non-regular dental service use (OR 1.20, 95% CI: 1.17, 1.23). Low structural support, in terms of living conditions, was associated with edentulism and lacking functional dentition (OR 1.34, 95% CI: 1.02, 1.75; and OR 1.41, 95% CI: 1.20, 1.67, respectively). The evidence on the associations between low social support and other oral health measures was sparse and heterogeneous. CONCLUSION:Poor social support was associated with poor dentition status and oral health behaviours among older adults aged 75 years and over. These findings underscore the importance of incorporating psychosocial factors into oral health assessment and care planning for this population. TRIAL REGISTRATION:PROSPERO; registration number: CRD420251231319.

OBJECTIVES:To assess the effect of prosthodontic treatment and management on oral function and oral-health-related patient reported outcome measures (PROMs) in older adults with tooth loss. METHODS:A systematic search of four databases identified clinical studies (≥ 10 participants) reporting functional or PROM outcomes in partially or fully edentulous adults ≥ 65 years rehabilitated with dental prostheses for ≥ 6 months. Pooled standardized mean differences in pre-post changes were estimated by prosthesis type and follow-up using random-effects models (REML), with heterogeneity assessed by Cochran's Q and I2 (p < 0.05). RESULTS:From an initial 7654 studies, 24 were included in this review, covering 1711 individuals. Fourteen studies assessed masticatory performance (MP), masticatory ability (MA), and maximum bite force (MBF). Complete dentures (CDs) showed modest functional improvement, while implant overdentures (IODs) consistently produced higher MP and MBF with significant long-term improvements. Eighteen studies evaluated OHRQoL using OHIP variants, OIDP, and modified GOHAI-11. IODs and fixed full-arch prostheses showed the greatest improvements, while CDs and removable partial dentures were associated with smaller but positive changes. Subjective MA improved over 6-12 months post insertion in regardless groups, with high heterogeneity. OHRQoL showed short-term benefits of implant-supported prostheses, particularly for OHIP-20, while OHIP-14 results were inconsistent over time, indicating more reliable functional and patient-reported outcomes with dental implants. CONCLUSIONS:Tooth loss leads to functional and psycho-social limitations, and although restorative measures can alleviate these shortcomings, they require ongoing maintenance, highlighting the complexity of care in this vulnerable older population. TRIAL REGISTRATION:PROSPERO International prospective register of systematic reviews (CRD420251077683).

INTRODUCTION:Gerodontology lacks a unified framework to describe case complexity and assess the multidimensional determinants shaping oral health. METHODS:An international initiative developed an evidence-based case definition for staging and grading older adults' oral health. RESULTS:Staging includes three domains: person, oral function (clinical and subjective), and oral disease (caries, periodontal disease, mucosal conditions) level staging. Grading incorporates risk factors at the oral, systemic, and social levels, including caries and periodontal risk, prosthetic maintenance, xerostomia, multimorbidity/polypharmacy, care dependency, nutritional status, socioeconomic position, and social support. CONCLUSIONS:This framework integrates biological, functional, systemic, and social factors within a single structure and reached strong international consensus. It offers a common language for clinical care, research, education, and policy. Further work should evaluate its feasibility, validity, and responsiveness. Companion papers in this issue provide the detailed staging and grading criteria.

OBJECTIVE:This systematic review and meta-analysis evaluated the relationship between multimorbidity and polypharmacy on the oral health in older adults (aged 75 years or older). The PECO focus question set for this study was, 'What is the occurrence, association and impact of multimorbidity and polypharmacy on the oral conditions and its management in older adults?'. METHODS:Electronic searches of MEDLINE (PubMed), Embase, and the Cochrane Library were conducted using the PECO (Population Exposure Comparison Outcome) framework. About 3433 studies published until April of 2025 were screened. Risk of bias was assessed using the Newcastle-Ottawa Scale. All eligible studies were descriptively analysed; studies that provided sufficient information were meta-analysed. RESULTS:Twenty-three studies [21 cross-sectional and 2 cohort studies] were included. Polypharmacy showed a significant association with dry mouth, as demonstrated by the pooled analysis (OR = 2.05; 95% CI: 1.31-3.22), along with consistent findings linking a higher number of medications to dry mouth and hyposalivation. Poor oral health assessment tool (OHAT) scores were also consistently associated with polypharmacy. In contrast, findings regarding multimorbidity/comorbidity were not consistently associated with dry mouth or with poor OHAT scores. Both exposures showed inconsistent associations with number of teeth, edentulism, and oral function. Quality assessment indicated that the included studies were predominantly at low risk of bias. CONCLUSIONS:Polypharmacy may impact on dry mouth and hyposalivation in older adults, potentially independent of multimorbidity. However, the impact of multimorbidity and polypharmacy on other oral conditions remains unclear. Further high-quality evidence, particularly from longitudinal studies, is needed to clarify these relationships and establish causal associations. TRIAL REGISTRATION:PROSPERO Registration: CRD420251003698.

OBJECTIVES:The increasing longevity of populations has resulted in a growing number of older adults requiring prosthodontic care, including those with neurodegenerative diseases (NDs). Neurodegenerative diseases pose significant challenges to prosthodontic care, and it remains unclear whether implant therapy in this population achieves outcomes comparable to those observed in the general older population. MATERIALS AND METHODS:A first systematic review was reframed to a scoping review using a PCC framework with Population (individuals with neurodegenerative diseases, who were partially or completely edentulous), Concept (implant therapy, planning, placement and maintenance, and any reported complications) and Context (dental and geriatric care settings). RESULTS:The literature search identified 634 studies or case reports, of which none fulfilled the inclusion criteria. Seven papers (1 retrospective study, 2 prospective studies and 4 case reports) outside the inclusion criteria reported on patients with neurodegenerative diseases receiving implants, which suggest that dental implants seem to offer initial benefits in improving chewing efficiency, the quality of life and weight gain, especially in Parkinson's disease (PD) patients. However, their suitability for patients with advanced ND is uncertain. CONCLUSION:Although high-level evidence on implant survival and success in patients with neurodegenerative diseases is lacking, the limited available evidence offers promising indications of reasonably successful implant treatments in early-stage cases. However, continuous monitoring of disease progression, oral health and denture management is crucial to retrofit the restoration when necessary.

Digital technologies have already reshaped large parts of prosthodontics from design to fabrication, bringing greater efficiency, precision and patient comfort. Yet one key question remains unresolved: how close are we to a truly end-to-end digital workflow for removable dentures? In this edition of “Ask the experts”, Frauke Müller, Martin Schimmel, Benedikt Spies and Nicola U. Zitzmann share their perspectives on where digital workflows stand today – and where critical gaps persist.

Introduction Comprehensively, systematically and reproducibly assessing and describing the (oral) health status and care needs of older adults is challenging. We aimed to provide a framework for evaluating and reporting older adults' oral health, capturing general and oral function and disease, as well as oral, systemic and socio-economic/social risk factors determining oral care complexity and capability, care needs and levels, and clinical management, including prevention, active and supportive therapy, as well as informing education, research, surveillance and health services. The present paper describes the first aspect, staging of oral health in this population.Methods Eight reviews were conducted to identify risk factors for deterioration of oral health in older adults; existing systematic reviews were further considered during the framework development. A 2.5-day workshop with 31 international researchers and stakeholders was held and a structured consensus process implemented to come to an agreed, internationally applicable framework. A 75% level of agreement was achieved after two rounds of voting.Results A case definition based on staging and grading, reflecting the current general and oral health and function, care complexity, and the risk of deterioration of oral health due to local, systemic, and socio-economic and social factors, was developed. Staging includes person-level (based on clinical frailty), function-level (based on clinical and subjective evaluations reflecting oral function, such as tooth loss and oral impacts), and disease-level (including caries, periodontal disease, and oral mucosa assessments) domains.Conclusion Oral health staging in older adults can allow clinicians, carers, and policymakers to systematically and comprehensively define and classify patient cases in order to derive appropriate and adequate care. Staging should be used in combination with grading, and both may allow capturing the overall health status and care needs of older patients for health surveillance, research, and education purposes. Next steps will include validation, dissemination, and implementation of the framework.

BACKGROUND:Oral diseases remain disproportionately prevalent among older adults. However, evidence on oral health inequalities among older adults remains dispersed across studies that have used different socioeconomic indicators and oral health measures and has not been synthesised. OBJECTIVE:To synthesise the evidence on the association between socioeconomic factors and oral health among older adults aged 75 years and older. METHODS:A systematic review and meta-analysis was conducted following PRISMA guidelines. The Medline, Embase, and CENTRAL databases were searched. Studies reporting socioeconomic factors (education, income, occupation, area-level deprivation, and multi-aspect socioeconomic position) and oral health (dentition status, dental caries, periodontal disease, dry mouth, oral function, oral health behaviours, and oral health-related quality of life (OHRQoL)) among older adults were included. Risk of bias was assessed using the Newcastle-Ottawa Scale. RESULTS:Sixty-eight studies were included. Meta-analyses showed that socioeconomic disadvantage in older adults was associated with: (1) poor dentition status: fewer natural teeth, higher prevalence of edentulism, and lacking a functional dentition; (2) more teeth with decay; (3) irregular dental attendance; and (4) poorer OHRQoL. Similar patterns were generally observed for periodontal disease, dry mouth, and oral function, although no meta-analysis could be performed due to limited evidence and heterogeneous oral health measures. CONCLUSION:Socioeconomic disadvantage was consistently associated with poor oral health in older adults. Associations were more pronounced for dentition status, reflecting the cumulative socioeconomic disadvantage over the life course. Socioeconomic factors should be considered to inform prevention, clinical decision-making and oral healthcare planning for the ageing population. TRIAL REGISTRATION:PROSPERO Registration CRD420251231319.

Introduction Understanding and anticipating oral health deterioration in older adults requires more than describing their current oral and general health. Risk factors arising from oral, systemic and social domains strongly influence disease progression, care complexity and the ability to maintain function over time. We aimed to establish a framework for staging and grading oral health and disease in older adults, with grading systematically assessing and describing determinants of oral health deterioration. The developed framework is intended to support care planning, education, research and health-service policy.Methods Eight reviews examining oral, systemic and social risk factors for worsening oral health in older adults informed framework development. Additional existing reviews were also considered. A 2.5-day international workshop involving 31 experts from 13 countries was conducted, during which structured subgroup discussions and Delphi-style anonymous voting were used to refine and agree on the framework. Consensus was predefined at 75% agreement, and that was subsequently reached for all statements in a single voting round. The current paper presents the grading aspect of the developed framework; it should be used jointly with the paper on staging oral health in older adults.Results Grading encompasses three levels of risk factors: (1) oral-level factors such as dental caries risk, periodontitis risk and risks associated with the maintenance of existing dental prostheses; (2) systemic-level factors including xerostomia, multimorbidity, polypharmacy and nutritional aspects and (3) social-level factors such as social status and social support. Together, these domains reflect the likelihood of oral health deterioration, the intensity and frequency of required supportive care and the potential complexity of clinical management. Grading complements staging-which describes the current oral health status-by identifying the underlying risks shaping each older adult's oral health trajectory.Conclusion Grading provides a structured, evidence-based method for assessing risk and care complexity in older adults. When combined with staging, it should enable clinicians, caregivers and policymakers to classify cases comprehensively, tailor preventive and supportive interventions, and inform resource planning, surveillance, research and education. Future work should focus on validating, disseminating and implementing the framework across diverse care settings.

Background: Empathy and a positive attitude are essential competencies in healthcare, particularly when caring for older adults. Their development is therefore a critical component of undergraduate dental education. This study evaluates whether using aging simulation suits can enhance empathy and improve attitudes toward older adults among dental students. Methods: Third- to fifth-year dental students from the University Clinics of Dental Medicine in Geneva, Switzerland, participated in an aging-simulation experience using the GERonTologic age simulation suit (GERT®), which replicates age-related physical impairments. Students performed tasks in four predefined scenarios, both with and without the suit. Changes in empathy and attitudes were measured using the Jefferson Scale of Empathy-Health Profession Students’ version (JSE-HPS) and the Geriatric Attitudes Scale (GAS) questionnaires. Perceptions of the intervention were evaluated using a 5-point Likert scale questionnaire. Results: Sixty-three undergraduate students (45 women, 18 men), aged 20–53 years, participated. The suit significantly impaired their physical abilities (p < 0.001). Empathy improved post-intervention (p = 0.038), particularly in the third-year group. Attitude towards older adults improved significantly post-intervention (p = 0.001), mainly among fourth- and fifth-year students. All participants endorsed the positive value of the intervention. Conclusions: The intervention’s impact varied by clinical experience: empathy increased mainly in less experienced students, while attitudes improved in those with more exposure to elderly care. This suggests that the timing of simulation within the curriculum influences outcomes. Aging simulation represents a promising educational approach to enhance empathy, improve attitudes toward older adults, and prepare dental students for the clinical and psychosocial aspects of geriatric care.

PURPOSE:To investigate the neuromuscular position of the mandible in the fifth and final part of a comprehensive investigation of the positions of the temporomandibular joint condyles. MATERIALS AND METHODS:The neuromuscular condylar positions were recorded by four independent operators in 81 fully dentate subjects with healthy oral function using a central bearing point system and rapid closing movements. The most frequent adduction point was determined, and the recordings were repeated twice for each subject. The subjects' maxillary casts were mounted in an articulator using an individual facebow transfer, and subsequently the mandibular casts were mounted with a central bearing point registration on the tip of the Gothic arch, ie, in centric condylar position (CR). A custom-made electronic measuring articulator was used to determine the spatial distance between the condyles in centric relation, maximal occlusion, and the newly determined neuromuscular position. RESULTS:The reproducibility of the neuromuscular registrations was on average 0.52 ± 0.16 mm (range 0.04 to 2.53 mm) with the right and left side averaged. The average spatial distance of the condyles between maximal intercuspal position (MI) and neuromuscular position was 0.88 ± 0.30 mm (range 0.12 to 5.98 mm), again averaged for the right and left sides, whereas that between the CR and the neuromuscular position was 0.83 ± 0.27 mm (range 0.10 to 7.89 mm). CONCLUSIONS:The neuromuscular mandibular position is neither identical to MI nor to CR. It can therefore be concluded that the registration of the neuromuscular adduction field should not be recommended for prosthodontic restorations in dentate or edentulous patients.

PURPOSE:To evaluate monolithic digital complete dentures fabricated from shell-geometry two-colored polymethyl methacrylate (PMMA) disks (Ivotion, Ivoclar). MATERIALS AND METHODS:The Biofunctional Prosthetic System (BPS; Ivoclar) workflow was used for manufacturing complete maxillary and mandibular prostheses. The primary outcome was esthetic appearance, assessed by the accuracy of the pink-white resin transition and an esthetic score. Secondary outcomes included oral health-related quality of life (OHRQoL), denture satisfaction index (DSI), masticatory performance (MP), maximum bite force (MBF), bite pressure (BiP), and prosthetic maintenance. Data analysis included descriptive statistics and multivariate comparison tests. The sample size was limited to 10 participants. RESULTS:Three women and seven men (mean age: 65 years) participated in the study; nine completed the 3-month follow-up. Among the 20 prostheses, 8 presented imperfections of the white-pink transition (median: 1 mm; range: 0.3 to 10 mm). From 2 weeks onward, the novel dentures scored higher on the esthetic score than the previous dentures, which were considered ideal/ near-ideal (P < .05). A nonsignificant improvement in OHRQoL, DSI, and MP was noted, whereas MBF and BP improved significantly over the observation period (P < .05). Prosthodontic maintenance events included two small adjustments before the 2-week follow-up. CONCLUSIONS:The positive evaluations on esthetics with no or minor deviations in the transition from white to pink confirm the suitability of the design of the two-colored shell-geometry resin disk for CAD/CAM complete denture manufacturing. Furthermore, favorable patientreported and clinical outcomes suggest that this novel system seems to be a viable treatment modality that warrants further investigation.

Due to effective preventive measures and advanced techniques in operative dentistry, tooth loss occurs later in life and implant restorations have become a common solution for replacement of missing teeth. Therefore, the use of removable dental prostheses (RDPs) is expected to decline over time. This study aims to evaluate the expected decrease in the production of RDPs in Swiss dental laboratories over the past decade. From 2012 to 2022, two indicators of prostheses production were examined: the number of dental laboratories (DL) and dental technicians in Switzerland, and the import and sale rates of denture teeth. 85 DL participated in a survey and indicated their perception regarding market trends. Finally, in-depth data collection was conducted in 16 DL in French-speaking Switzerland to gather the production of various types of RDPs over the last ten years. Over the observation period, the number of DL significantly decreased (p<0.05), while the decrease in dental technicians was less pronounced. The overall quantity of prosthetic teeth imported into Switzerland or sold by Curaden AG witnessed a significant decline (p<0.05). Survey findings revealed inconsistent perspectives from the respondents on the profession's development, despite a tendency suggesting a decline in complete prostheses and an increase in partial or hybrid removable prostheses (p<0.01). Except for a decline in the number of chrome-cast partial prosthesis manufactured (p=0.04), no clear trend was observed in the 16 DL. Despite lower import rates of denture teeth and a perceived shift in denture type, the overall production of RDPs seems to remain substantial.

This RCT aimed to test the impact of an educational intervention, supported by a Personalized Oral Health Instruction Form (POIF), on oral health indices in institutionalized older adults. Older adults aged 65 years and above living in a long-term care facility were recruited. Baseline oral health indices were recorded for all participants. Caregivers received training on oral health care in small groups. Custom-made software was used to create a POIF for each participant, which was then implemented alongside verbal instructions and the provision of an oral hygiene kit in the intervention group, whereas in the control group, the participants received verbal instructions and an oral hygiene kit only. After three weeks, a second examination was conducted by the same examiner, who was blinded to participants' group allocation. Plaque index (PI), denture cleanliness (DCI), and tongue coating (TCI) were recorded at baseline and after intervention. Oral health-related quality of life (OHRQoL), assessed at baseline and after intervention using the Geriatric Oral Health Assessment Index (GOHAI). Wilcoxon signed rank tests were conducted with the level of significance set at P<0.05. A total of 46 patients (mean age: 85.5 ± 7.7 years) were included. Plaque index (PI) significantly decreased in both groups from baseline to postintervention (p < 0.001), with a significantly lower median score in the intervention group (31.6

BACKGROUND/OBJECTIVES:The aim of this study was to examine if a person's preferred chewing side (PCS) corresponds to his/her hemispheric body laterality (HBL) or is dominated by the dental state. METHODS:After ethical approval, 82 volunteers were recruited. Asymmetry of bite force (ABF) was tested using an occlusal force-meter (GM-10) on both sides separately. The occlusal contact area (OCA) was observed using a pressure-indicating film (GC Fujifilm Prescale). The PCS was evaluated using an asymmetry index (ASI) or a visual analogue scale (VAS). Both tests were repeated. For the HBL, participants underwent four different tests to assess handedness, footedness, earedness and eyedness, respectively. Statistical analysis comprised kappa agreement for HBL tests and their repetition, as well as paired Wilcoxon tests for intraoral parameters. RESULTS:Hand, eye and ear showed a substantial reproducibility, while foot produced moderate agreement (kappa = 0.58, p < 0.001). No correlation was found between a participant's PCS and HBL, with the exception of EAR with VAS (kappa = 0.29, p = 0.001). There was a significant correlation between ABF and the number of residual teeth (NNT) both for PCS (p < 0.01; r2 = 0.29) and NPCS (p < 0.01; r2 = 0.18). There was no significant difference between PCS and NPCS for OCA (p = 0.13). The results revealed a significantly higher number of residual posterior teeth on the participant's PCS (for VAS p < 0.0001; ASI p < 0.03). CONCLUSION:Masticatory laterality does not correspond to body hemispheric laterality. Rather than HBL, the number of residual teeth seems to determine on which side a person prefers to chew.

OBJECTIVE:This systematic review and meta-analysis evaluated the relationship between nutritional status and the oral health of older adults (aged 75 years or older). The PECO focus question was, 'What is the occurrence, association and impact of nutritional state on the oral health outcomes and its management in older adults?' METHODS:A comprehensive literature search was performed across MEDLINE (PubMed), Embase and the Cochrane Library. Publications up to April 2025 were considered, yielding 3324 records for initial screening. Quality assessment of the included studies predominantly revealed a low to moderate risk of bias. RESULTS:Eighty-three studies were included for data analysis. Meta-analyses demonstrated that older adults at risk of malnutrition had fewer teeth (SMD = -0.29; 95% CI: -0.46, -0.11; p = 0.002). Those with < 20 teeth and who were not rehabilitated with dentures were more likely to be malnourished (OR = 4.00; 95% CI: 1.21, 13.18; p = 0.02). Malnutrition was associated with self-reported chewing problems (OR = 2.38; 95% CI: 1.74, 3.26; p < 0.0001), swallowing problems (OR = 3.18; 95% CI: 2.20, 4.61; p < 0.0001) or dry mouth (OR = 2.35; 95% CI: 1.91, 2.88; p < 0.0001). Conversely, those with oral pain showed lower odds of malnutrition risk (OR = 0.68; 95% CI: 0.52, 0.89; p = 0.005). CONCLUSIONS:Fewer teeth, existing chewing or swallowing problems, dry mouth and the absence of removable dentures where needed, were associated with malnutrition in care-dependent older adults. The current lack of longitudinal studies and proof of causality for malnutrition affecting oral health outcomes underscores the need for further research to better clarify the complex relationship between oral health and nutrition in older populations. TRIAL REGISTRATION:PROSPERO Registration: CRD420251003549.