Retention systems for extraoral maxillofacial prosthetic implants: a critical review.

We describe the techniques available for retention of implant-supported prostheses: bar-clips, O-rings, and magnets. We present reported preferences and, although this is limited by the heterogeneity of methods used and patients studied, we hope we have identified the best retention systems for maxillofacial prosthetic implants. If practitioners know the advantages and disadvantages of each system, they can choose the most natural and comfortable prosthesis. We searched the PubMed and Scopus databases, and restricted our search to papers published 2001-13. MeSH terms used were Maxillofacial prosthesis and Craniofacial prosthesis OR Craniofacial prostheses. We found a total of 2630 papers, and after duplicates had been removed we analysed the rest and found 25 papers for review. Of these, 12 were excluded because they were case reports or non-systematic reviews. Of the remaining 13, 10 described group analyses and seemed appropriate to find practitioner's choices, as cited in the abstract (n=1611 prostheses). Three papers did not mention the type of prosthetic connection used, so were excluded. The most popular choices for different conditions were analysed, though the sites and retention systems were not specified in all 10 papers. The bar-clip system was the most used in auricular (6/10 papers) and nasal prostheses (4/10). For the orbital region, 6/10 favoured magnets. Non-osseointegrated mechanical or adhesive retention techniques are the least expensive and have no contraindications. When osseointegrated implants are possible, each facial region has a favoured system. The choice of system is influenced by two factors: standard practice and the abilities of the maxillofacial surgeon and maxillofacial prosthetist.

Avaliação clínica e da qualidade de vida de indivíduos com disfunção temporomandibular / Clinical and quality-of-life assessment among women with temporomandibular disorder

OBJETIVOS: Este estudo teve como objetivo avaliar sintomas de dor, apertamento dos dentes, qualidade do sono e sensibilidade dolorosa nos principais músculos mastigatórios e estabilizadores cervicais e qualidade de vida de mulheres com Disfunção Temporomandibular (DTM). MÉTODOS: Foram avaliadas 45 mulheres, divididas em dois grupos. O grupo I, composto por 27 mulheres (30,1±5,8anos) com diagnóstico de DTM e o grupo II, controle, composto por 18 mulheres saudáveis (23,4±2,3 anos). A intensidade dos sintomas de dor, cefaleia, cervicalgia, de apertamento dos dentes e dificuldade de dormir foram avaliados por escala visual analógica (EVA), o limiar de dor dos músculos masseter, temporal anterior, trapézio superior e esternocleidomastoideo, com dolorímetro e a qualidade de vida, pelo SF-36. Foi realizada análise estatística e o nível de significância foi α=0,05. RESULTADOS: Os resultados mostram que mulheres com DTM têm sintomas mais intensos de cefaleia (p<0,001), cervicalgia (p<0,001), intensidade de apertamento dos dentes (p<0,001) e dificuldade de dormir (p<0,001). Também apresentam limiar de dor mais baixo nos músculos masseter (p<0,001), temporal anterior (p<0,001), trapézio superior (p<0,001), esternocleidomastoideo (p<0,001) e pior qualidade de vida em todos os domínios avaliados (p<0,05), quando comparados com o grupo controle. CONCLUSÕES: Mulheres com DTM têm maior intensidade dos sintomas de dor, apertamento dos dentes, dificuldade de dormir, maior sensibilidade dolorosa em músculos mastigatórios e cervicais e pior qualidade de vida quando comparadas com mulheres sem DTM.

OBJECTIVES: The aim of this study was to evaluate pain symptoms, teeth clenching, quality of sleep, sensitivity to pain in the main masticatory and stabilizer muscles, and quality of life among women with temporomandibular disorder (TMD). METHODS: Forty-five women were evaluated and divided into two groups. Group I included 27 women (mean age 30.1±5.8 years) with a diagnosis of TMD and Group II (control) included 18 healthy women (mean age 23.4±2.3 years). The intensity of pain symptoms (headache, neck pain), teeth clenching and trouble sleeping was evaluated using a visual analog scale (VAS). The pain thresholds of the masseter, anterior temporalis, upper trapezius and sternocleidomastoid muscles were evaluated using a dolorimeter. Quality of life was evaluated using SF-36. Statistical analysis was performed and the significance level was α<0.05. RESULTS: The results showed that the women with TMD presented more intense headache (p<0.001), neck pain (p<0.001), teeth clenching (p<0.001) and trouble sleeping (p<0.001). They also presented lower pain threshold in the masseter (p<0.001), anterior temporalis (p<0.001), upper trapezius (p<0.001) and sternocleidomastoid (p<0.001) muscles and lower quality of life in all evaluated domains (p<0.05) when compared with the control group. CONCLUSIONS:Women with TMD had greater intensity of pain symptoms, teeth clenching, trouble sleeping, sensitivity to pain in the masticatory and neck muscles and lower quality of life, compared with women without TMD.