Einführung: Die Mundgesundheit spielt eine zentrale Rolle für das allgemeine Wohlbefinden, auch bei Menschen im fortgeschrittenen Alter. Der demografische Wandel mit seinen Auswirkungen führt zu einem größeren Anteil älterer Menschen ohne und mit Pflegebedarf. Der vorliegende Beitrag gibt eine Übersicht über die zahnmedizinische Situation älterer Menschen aus der 6. Deutschen Mundgesundheitsstudie (DMS • 6). Methode: Die DMS • 6 ist eine bevölkerungsrepräsentative oralepidemiologische Studie zur Erfassung der Mundgesundheit in Deutschland. Daten von 797 jüngeren Seniorinnen und Senioren im Alter von 65 bis 74 Jahren wurden von kalibrierten Untersuchenden erhoben. Die Methodik entspricht weitgehend derjenigen der Vorläuferstudien. Ergebnisse: In der Gruppe der jüngeren Seniorinnen und Senioren (65- bis 74-Jährige) hat sich die Zahnlosigkeit mit 5,0 % gegenüber der Fünften Deutschen Mundgesundheitsstudie (DMS V) (12,4 %, 2014) mehr als halbiert. Die mittlere Anzahl fehlender Zähne (8,6) hat sich weiter verringert im Vergleich zur DMS IV (14,1) und zur DMS V (11,1). Der FST-Index (Anzahl restaurierter [filled] oder primär gesunder [sound] Zähne [teeth]) ist mit 18,8 Zähnen im Vergleich zu den vorherigen Studien (DMS IV: 13,6; DMS V: 16,4) gestiegen. Die Prävalenz der Wurzelkaries nahm mit 59,1 % im Vergleich zur DMS IV (28,0 %) zu. Die Karieserfahrung (decayed [kariöse], missing [fehlende], filled [restaurierte] teeth [Zähne] [DMFT]: 17,6) hingegen hat sich im Vergleich zur DMS V (17,7) kaum verändert. Jede(r) zweite 65- bis 74-Jährige hatte eine moderate Parodontitis (49,4 %) und fast jede(r) dritte (30,4 %) eine schwere Parodontitis. Bei fast jeder/jedem zweiten der jüngeren Seniorinnen und Senioren mit Pflegebedarf (47,4 %) war die Therapiefähigkeit und bei jeder/jedem fünften (18,5 %) die Mundhygienefähigkeit stark reduziert. Diskussion: Es bleiben mehr Zähne bis ins hohe Lebensalter erhalten; daher liegen die Herausforderungen in der zahnmedizinischen Therapie u. a. bei der Behandlung von Parodontalerkrankungen, Wurzelkaries und beim abnehmbaren Zahnersatz, der auch im hohen Alter für Patientinnen und Patienten und das unterstützende Umfeld ein- und ausgliederbar sein muss. Ein möglichst chancengleicher und barrierearmer Zugang zu den zahnmedizinischen Behandlungen ist für alle Seniorinnen und Senioren, insbesondere Menschen mit Gebrechlichkeit und Pflegebedarf, sicherzustellen. Modelle zur mobilen Zahnmedizin sollten zur Versorgung der älteren Menschen weiter implementiert werden. Schlussfolgerungen: Die Prävalenz von Zahnverlust und Zahnlosigkeit bei jüngeren Seniorinnen und Senioren in Deutschland geht weiter zurück. Aufgrund der weiteren Morbiditätskompression liegen die Herausforderungen der zukünftigen präventivzahnmedizinischen Therapie darin, jüngere Seniorinnen und Senioren zahnmedizinisch auf ein höheres Alter vorzubereiten. Keywords: DMS 6, Epidemiologie, geriatrische Zahnmedizin, Karieserfahrung, Mundgesundheit, Pflegebedürftigkeit, Schwerbehinderung, Seniorenzahnmedizin, Zahnärzte, zahnärztliche Versorgung

Einführung: Die Deutschen Mundgesundheitsstudien (DMS) sind eine Reihe aufeinanderfolgender Untersuchungen, die den Mundgesundheitszustand von Erwachsenen, Seniorinnen und Senioren sowie Kindern erheben. Die DMS sind ein Projekt des Instituts der Deutschen Zahnärzte (IDZ) mit dem Ziel, Gesundheitsstatistiken für Deutschland zu erstellen. Zahnverlust, Zahnlosigkeit und prothetische Versorgung haben eine erhebliche sozioökonomische Bedeutung. Das Ziel dieses Artikels ist es, Erkenntnisse zu diesen Aspekten zu berichten. Methode: Die Untersuchung kombiniert sozialwissenschaftliche Befragungen mit zahnmedizinisch-klinischen Untersuchungen. Frühere DMS-Studien konzentrierten sich hauptsächlich auf Zahnverlust, Zahnlosigkeit und die Art der prothetischen Versorgung. Bezüglich des abnehmbaren Zahnersatzes wurden im Rahmen der 6. Deutschen Mundgesundheitsstudie (DMS • 6) der Zustand und der Behandlungsbedarf ergänzend erfasst und notwendige Wiederherstellungsmaßnahmen nach Aufwand (chairside oder labside) gruppiert. Ergebnisse: Die Prävalenz vollständiger Zahnlosigkeit ist im Vergleich zur Fünften Deutschen Mundgesundheitsstudie (DMS V) aus dem Jahr 2014 erheblich zurückgegangen. In der Gruppe der jüngeren Erwachsenen (35- bis 44-Jährige) spielt sie praktisch keine Rolle mehr; in der Seniorengruppe (65- bis 74-Jährige) hat sie sich mit 5,0 % seit 2014 (12,4 %) mehr als halbiert. Jüngere Erwachsene haben im Mittel 26,6 Zähne, die jüngeren Seniorinnen und Senioren im Mittel noch 19,3 Zähne. Ein niedriger Bildungsstatus ist ein wichtiger prognostischer Faktor für den Zahnverlust. Aufgrund der niedrigen Prävalenz von Zahnlosigkeit bei den jüngeren Erwachsenen spielt der abnehmbare Zahnersatz in dieser Gruppe keine Rolle, während er bei den jüngeren Seniorinnen und Senioren – vornehmlich als Kombinationsersatz – dominiert. Die Prävalenz festsitzender, teilweise implantatgestützter prothetischer Versorgungen steigt weiter an. Von den abnehmbaren Prothesen befanden sich 50 – 60 % in einem sehr guten bzw. guten klinischen Zustand. Mängel betrafen vor allem einfache Kunststoffprothesen. Die Zufriedenheit der Studienteilnehmenden mit abnehmbarem Zahnersatz ist dennoch sehr groß; dieser wird nahezu durchgehend getragen. Diskussion: Das wichtigste Ergebnis dieser Studie ist der anhaltende signifikante Rückgang der Prävalenz vollständiger Zahnlosigkeit bei jüngeren Seniorinnen und Senioren, der auf einen weiteren Rückgang der Zahnlosigkeit in der Zukunft mit Schätzungen von rund 4 % im Jahr 2030 schließen lässt. Die beobachtete Verschiebung der prothetischen Leitversorgung vom abnehmbaren zum festsitzenden Zahnersatz sowie die steigende Prävalenz inserierter Implantate sind positiv zu sehen. Schlussfolgerungen: Die Daten zeigen eine weitere Morbiditätskompression im Vergleich zur DMS V, da die vollständige Zahnlosigkeit weiter zurückgegangen ist und sich die Art des Zahnersatzes immer mehr zu festsitzenden, teilweise implantatgestützten Formen verschiebt. Dabei ist der Bildungsstatus ein wichtiger Einflussfaktor. Keywords: DMS 6, Epidemiologie, Zahnersatz, Zahnlosigkeit, Zahnverlust, Zahnärze, zahnärztliche Versorgung

Objectives: Oral health plays a central role in overall well-being, including in the elderly. The demographic transition and its effects are resulting in a higher proportion of older people, both with and without care requirements. This paper provides an overview of the dental situation of the elderly from the 6th German Oral Health Study (DMS • 6). Method and materials: DMS • 6 is a population-representative oral epidemiologic study that surveys oral health in Germany. Data from 797 younger seniors aged 65 to 74 were collected by calibrated examiners. The methodology remains largely consistent with that of the previous studies. Results: Among the younger seniors (65- to 74-year-olds), edentulism has more than halved to 5.0% compared to the Fifth German Oral Health Study (DMS V) (12.4% in 2014). The mean number of missing teeth (8.6) decreased further, compared to DMS IV (14.1) and DMS V (11.1). At 18.8 teeth, the FST Index (number of filled or sound teeth) has shown improvement compared to the previous studies (DMS IV, 13.6; DMS V, 16.4). The root caries (59.1%) increased compared to DMS IV (28.0%). Caries experience (decayed, missing, filled teeth [DMFT]: 17.6), in contrast, hardly changed from DMS V (17.7). Half of 65- to 74-year-olds were diagnosed with moderate periodontitis (49.4%) and almost a third (30.4%) with severe periodontitis. In younger seniors with care requirements, therapeutic capability was greatly reduced for almost half (47.4%) and oral hygiene ability for one fifth (18.5%). Conclusion: The prevalence of tooth loss and edentulism among younger seniors in Germany continues to decline. Due to further morbidity compression, the challenges of dental treatment lie in the continuous treatment of younger seniors to prepare them for older stages of life. Keywords: care needs, dental care, dental care for persons with disabilities, dental caries, dentists, DMS 6, epidemiology, geriatric dentistry, oral health

Objectives: The German Oral Health Study (DMS) is a series of consecutive studies designed to assess the oral health status of adults, seniors, and children in Germany. DMS is a major program of the Institute of German Dentists (Institut der Deutschen Zahnärzte) with the aim to produce health statistics for Germany. Tooth loss, edentulism, and prosthetic care have considerable socioeconomic significance; it is the aim of this paper to report findings on these aspects. Method and materials: The survey combines interviews and clinical examinations. Previous DMS studies focused primarily on tooth loss, edentulism, and prosthetic care. In the DMS • 6 survey, the condition of removable dentures and need for adjustments were additionally recorded, as well as necessary repair measures that were grouped according to their complexity (chairside or laboratory). Results: The prevalence of edentulism decreased considerably compared to that in the Fifth German Oral Health Study (DMS V) in 2014. Among younger adults (35- to 44-year-olds), the prevalence of edentulism was negligible, with an average of 26.6 teeth present. The younger senior group (65- to 74-year-olds) had an average of 19.3 teeth; the prevalence of edentulism was 5%, which is a reduction of > 50% compared to 2014 (12.4%). Lower education status was an important prognostic factor for tooth loss. Owing to the low prevalence of edentulism in younger adults, removable dentures were not prevalent in this age group, whereas combined fixed–removable dentures were most frequently used in seniors. Regarding the type of denture, a shift towards fixed as well as implant-supported types was observed. Of the removable dentures, 50% to 60% were in a very good or good clinical condition. Problems were mainly identified with simple acrylic dentures. Nonetheless, participants’ satisfaction with removable dentures was extremely high, and the dentures were used almost continuously. Conclusion: The most important finding in this study is the continued significant decline in the prevalence of complete edentulism among seniors that suggests a further reduction in edentulism in the future with an estimate of around 4% in 2030. The shift observed in primary prosthetic care from removable to fixed prostheses as well as the increasing prevalence of implants placed are positive developments. The data revealed further compression of morbidity compared to DMS V. Complete edentulism declined, and fixed partial dentures, including implant-supported prostheses, were increasingly used. Lower education status was an important predictor for tooth loss. Keywords: dental care, dental prostheses, dentists, DMS 6, edentulous mouth, epidemiology, tooth loss

Aim: Fracture of abutment teeth with telescopic crown-retained removable partial dentures (TCDs) is a common cause of failure for this prosthetic restoration. In many cases, a telescopic crown (TC) can only be refitted after post and core (PC) treatment due to an insufficient retention surface. Furthermore, if the root canal has an elliptic cross-sectional area or the coronal defect is severe, customized cast post and cores (CPCs) are still the therapy of choice. Nevertheless, the disadvantage of CPCs is longer chair time due to the need for a second appointment for insertion. In addition, the mechanical properties of the alloy do not match with dentin, leading to a higher risk of root fracture. In such cases, CAD/CAM PCs fabricated in a fully digital chairside workflow can accelerate the treatment and decrease the risk of root fractures by using materials with matching mechanical properties. Materials and methods: The case series presented in this article includes 12 patients who were treated with TCDs and experienced abutment tooth fracture that required PC treatment to refit TCs. The post space preparation as well as the TCDs were scanned in less than 10 min for the fabrication of CAD/CAM PCs out of a fiber-reinforced CAD/CAM composite. Conclusions: With the presented fully digital chairside workflow, PC fabrication can be accelerated because a second appointment is not needed for customized PCs. The presented workflow might be an alternative to that for conventional PCs to refit TCs after abutment tooth fracture. The CAD/CAM-fabricated PC offers mechanical properties close to dentin and can be fabricated chairside in a short period of time. Keywords: abutment tooth fracture, CAD/CAM, fiber-reinforced composite, intraoral scanner, post and core, telescopic denture

Aim: Although many fields of dentistry allow digital processes today, analog procedures are still widely used. The present cross-sectional pilot study aimed to provide insights into the digitalization of dental practices using the example of Hesse. Materials and methods: Between April and June 2022, 4840 active practicing dentists registered by the State Dental Association of Hesse were invited via email to fill out an online questionnaire regarding their technical requirements in dental practice, dental treatment procedures, and attitude toward digitalization in dentistry. Demographic questions were asked. Besides descriptive statistics, correlations were analyzed (P 0.05). Results: Questionnaires of 937 dentists (279 females, 410 males, 4 inter/diverse, 244 no answers; mean age of 51.4 ± 10.4 years) were examined, representing a response rate of 19.36%. In the area of practice administration and dental radiography, the majority of the dentists surveyed were already working digitally, which is predominantly assessed as a positive development. One third of the respondents stated that they already used an intraoral scanner for dental treatments, but for indications mainly limited to minor restorations. However, many dentists rated the use of social media accounts and telemedicine rather negatively. Conclusion: Within the limitations of this cross-sectional pilot study, it was shown that many dental treatments were still being performed by analog processes. However, 60% of the participants planned the digitalization of their dental practices within the next 5 years, which indicated a clear shift from analog to digital dentistry. Keywords: analog–digital conversion, CAD/CAM, dental practice pattern, dentistry, dentists, digital technology, intraoral scanner, organization and administration, real world data on dentistry, surveys and questionnaires

Purpose: To update data on the transfer accuracy of digital implant impressions using a coordinate-based analysis, the latest intraoral scanners (IOS) were investigated in an established clinical close model setup. Materials and Methods: An implant master model (IMM) of the maxilla with four implants in the posterior area (maxillary first premolars and first molars) and a reference cube were scanned 10 times each with four different IOS: i700 (i7; Medit), Primescan (PS; Dentsply Sirona), and Trios 4 (T4) and Trios 5 (T5; 3Shape). Datasets were compared to a reference dataset of IMM that was generated with x-ray computed tomography in advance. 3D deviations for the implant-abutment interface points (IAIPs) were calculated. Statistical analysis was performed by multifactorial ANOVA (P < .05). Results: Overall deviations for trueness (mean) ± precision (SD) of the IAIPs ranged from 88 ± 47 μm for PS, 112 ± 57 μm for i7, 121 ± 42 μm for T4, and 124 ± 43 μm for T5 with decreasing accuracy along the scan path. For trueness, a significant difference between the PS and the T4 was detected for one implant position. For precision, no significant differences were noticed. Conclusions: Although the latest IOS showed a significant improvement in transfer accuracy, the accumulating deviation along the scan path is not yet resolved. Considering the Trios system, the innovation seems to be limited because no improvement could be detected between T4 and T5.

Purpose: The aim of this study was to evaluate the marginal quality and wear of bulk-fill composite resins (BFs) for Class-II restorations of primary and permanent molars in comparison to a conventionally layered composite resin (RC) and to compare the results of the two dentitions. Materials and Methods: Eighty (40 primary and 40 permanent) extracted molars received standardized Class-II cavity preparations and were restored with either one of two flowable BFs, one of two high viscous BFs, or a composite resin (RC). Thermomechanical loading (TML; 2,500 cycles +5°C/+55°C; 100,000 cycles, 50N, 1.67Hz) followed. A quantitative marginal analysis using SEM images and a profilometric quantification of two-body wear were carried out using replicas. ANOVA, Kruskal–Wallis, Mann–Whitney U, and Wilcoxon signed-rank tests were used for statistical analysis (P < 0.05). Results: For both dentitions, a significant reduction of perfect margins was observed after TML (P < 0.02). For the primary dentition, the flowable BFs showed significantly less perfect margins than all high viscous materials (P < 0.005). For the permanent dentition, RC showed significantly fewer gaps than the flowable BFs (P < 0.04). Regarding wear, within the dentitions, no significant differences could be computed between groups with regard to the maximum height loss (P < 0.05). Conclusion: All of the investigated bulk-fill composite resins showed satisfactory in-vitro results for both tested parameters in primary and permanent teeth, with a superiority of the high-viscosity materials in terms of marginal quality. Keywords: bulk-fill composite resins, marginal quality, permanent teeth, primary teeth, restoration materials, wear

Purpose: To assess the survival of double-crown-retained implant-and-tooth-supported removable partial dentures (DCR-ITSRPDs), evaluate abutment survival, and identify first aftercare measures. Materials and Methods: The influence of various factors on the survival of the DCR-ITSRPDs and the abutments were observed in this retrospective and clinical follow-up study using the Kaplan-Meier estimate. In addition, the first-required aftercare measure for each prosthesis was evaluated. Results: In total, 47 DCR-ITSRPDs were investigated (mean observation: 4.3 ± 3.8 years; max: 14.3 years), 3 of which (6.4%) had to be replaced. The survival probability for DCR-ITSRPDs was 100% at 5 years and 75% at 10 years. A total of 297 abutments (120 natural teeth and 177 dental implants) were observed, 22 of which (7.4%; 6 teeth and 16 implants) failed. The survival probability for teeth was 90.2% at the 5- and 10-year mark; for dental implants, it was 90.4% at 5 years and 76.3% at 10 years. Conclusions: DCR-ITSRPDs are a successful and durable treatment option for patients with substantially reduced residual dentitions. Both prostheses and abutments show good survival times after 5 and 10 years in function. The patient-associated factors tested showed no influence on the survival of DCR-ITSRPDs and abutments. Peri-implant infection was the decisive factor for abutment loss; therefore, regular dental prophylaxis and examinations are of major importance.  Keywords: removable dental prosthesis, double crown, dental implants, tooth-implant supported, survival