Emerging evidence suggests that oral health is associated with cognitive function. This review aims to systematically assess this association in adult populations via prospective cohort study designs. Eligible study reports were identified by searching the MEDLINE (via Ovoid), EMBASE, PsycoINFO, and Cochrane Library databases. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated with a random effects model. From 1,251 identified articles, 10 were included in the systematic review and 8 in the meta-analysis. Random effects analysis showed, with statistically low heterogeneity, that individuals with suboptimal dentition (<20 teeth) were at a 20% higher risk for developing cognitive decline (HR = 1.26, 95% CI = 1.14 to 1.40) and dementia (HR = 1.22, 95% CI = 1.04 to 1.43) than those with optimal dentition (≥20 teeth). Studies on the association between periodontal disease and cognitive status showed conflicting results. Within the limits of the quality of published evidence, this meta-analysis lends further support to the hypothesis that tooth loss is associated with an increased risk of cognitive impairment and dementia. Knowledge Transfer Statement: Based on the published literature, the results of this study show that the risk for cognitive impairment and dementia increases with loss of teeth. This information adds to the evidence showing links between oral and general health and suggests that oral health strategies aimed to preserve teeth may be important in reducing risk of systemic disease.

The results of this study indicated that measures of denture stability, masticatory ability, and age of dentures appeared to be determinants of patients' satisfaction with dentures.

Mandibular overdenture assisted by two immediately-loaded unsplinted implants is successful treatment based on 2-year clinical and patient-based outcomes.

The potential beneficial effect of functional dentures on cognitive status via mastication could encourage preventive strategies to decrease substantial risk of morbidity in elders.

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The extent of heterogeneity Knowledge Transfer Statement: This meta-analysis shows that mandibular 2-implant overdentures are significantly more satisfactory to the general edentate populations than new conventional dentures. The results also show that mandibular 2-implant overdentures provide significantly better oral healthrelated quality of life than do new conventional dentures. These results should be shared with edentate patients in planning their treatment.

Objectives To examine the impact of adding a third midline implant with stud attachment to a mandibular two‐implant overdenture on patient‐oriented outcomes. Methods In this pre–post design clinical trial, following the standard procedures, mandibular two‐implant overdentures of 17 edentulous individuals (61.9 ± 6.6 years) were converted to three‐implant overdentures by adding a stud attachment to an unloaded midline implant. Patient‐oriented outcomes included patient expectations and satisfaction with implant overdenture as well as willingness to pay the cost of conversion. Data were collected at baseline and at the 6‐week follow‐up using visual analog and binary scales as well as open‐ended questions. Statistical analysis included descriptive statistics, Spearman's correlation, Fisher exact test, Mann–Whitney U test, and the exact sign test. Results After connecting the third midline implant to the mandibular two‐implant overdenture, there was a statistically significant decrease in the anteroposterior movement (p = 0.005) as evaluated by clinicians. Moreover, study participants reported an increase in perceived stability of the overdenture (95% CI; 0.68–1.00, p = 0.002) and in their ability to speak (95% CI; 0.63–1.00, p = 0.008). The addition of a third implant met the expectations of 94% of patients in regard to lower denture stability, 100% for retention, and 82.4% for comfort. The mandibular three‐implant overdenture increased patient general satisfaction over a short period of time, but this improvement was not statistically significant. About 80% of patients would recommend this type of prosthesis to their peers but only 47% of them would agree to pay a large increase in the cost of treatment compared to a two‐implant overdenture. Conclusions The addition of a midline third implant to an existing mandibular two‐implant overdenture resulted in several improved patient‐reported outcomes.

Ph.D.%student,%Faculty%of%Dentistry,%Federal%University%of%Rio%Grande%do%Sul,%Porto%Alegre,%Rio%Grande%do%Sul,%Brazil*% Department%of%Prosthodontics,%University%of%Southern%of%Santa%Catarina,%Tubarão,%Santa%Catarina,%Brazil**% Department%of%Prosthodontics,%Faculty%of%Dentistry%of%Bauru,%São%Paulo,%Brazil***% Master%student,%Faculty%of%Dentistry,%São%Leopoldo%Mandic,%Campinas,%São%Paulo,%Brazil****% Correspondence:%daianecerutti@hotmail.com%(CERUTTI%D)%|%Received%20%Aug%2013%Received'in'revised'form%28%Aug%2013%Accepted%01%Sep%2013% % %