Conventional and digital maxillary occlusal record for the manufacture of complete-arch implant-supported fixed prostheses: randomized controlled clinical trial.

OBJECTIVES: To evaluate the trueness of the digital maxillary occlusal records in comparison with the conventional records for the fabrication of complete-arch implant-supported fixed prostheses. MATERIALS AND METHODS: This randomized controlled clinical trial followed the recommendations of the CONSORT statement. Twenty participants who used a mandibular interim complete-arch fixed prosthesis and conventional complete maxillary dentures were included in the study. The participants were randomized into two types of maxillary occlusal records: conventional (COR) and digital (DOR) (TRIOS; Shape A/S). After fabricating the prostheses, the distribution and number of occlusal contact points, and the time taken to obtain the maxillary occlusal record and work model were evaluated. Descriptive analysis was used to evaluate the distribution of occlusal contact points. The Wilcoxon test was employed for assessing the number of occlusal contact points, while the Mann-Whitney U test was used for the time taken to obtain the working casts and the maxillary occlusal record and occlusal adjustment times (p < 0.05). RESULTS: There was a similarity in the jaw relation recording methods regarding the distribution of occlusal contact points. There was no difference in the number of occlusal contact points between the anterior (p = 0.439) and posterior (p = 0.227) teeth. No relationship was observed between the distribution and number of occlusal contact points (COR, p = 0.288; DOR, p = 0.183). DOR required less occlusal and clinical adjustment time, on the other hand more laboratory and total workflow time than COR (p < 0.001). CONCLUSION: The DOR may be an option for obtaining the functional space necessary for the assembly of teeth in complete-arch implant-supported fixed prostheses; however, it requires more working time. CLINICAL RELEVANCE: The digital occlusal recording method can be used to assess the interocclusal space for the virtual tooth setup of a complete-arch implant-supported fixed prosthesis.

Accuracy and reproducibility of real and virtual occlusal contact points in implant-supported fixed prostheses.

AIM: To evaluate the accuracy and reproducibility of real and virtual occlusal contact points in implant-supported, fixed complete dentures. MATERIALS AND METHODS: The study included 19 participants using mandibular interim complete-arch fixed prosthesis supported by 3 or 4 implants as opposed to conventional removable complete dentures. At installation, an examiner installed the prostheses and verified the occlusal contact points through 2 methods: recording the real contact points with carbon paper (RC) followed by occlusal photography and intraoral scanning (VC) to record the virtual contact points to obtain a screen print of the software. Then, the two images were randomized to determine the order to be inserted into Microsoft PowerPoint for blind and paired evaluation. The independent variables consisted of the distribution of occlusal contacts points (qualification through pre-defined scores based on the position of the contact points on the surfaces of the teeth) and the reproducibility of the methods by verifying the number of occlusal points. For this, a descriptive analysis was used to evaluate the distribution of occlusal contacts points and the Wilcoxon test for the reproducibility of the occlusal contact points between the methods (p<0.05). RESULTS: The methods had 100% and 73.6% real and virtual occlusal contact points, respectively, which is considered clinically excellent. There was no significant difference regarding the reproducibility of the methods by the number of occlusal contact points (RC: x̅13.32; VC: x̅13.68; p=0.715). CONCLUSION: The use of the tested intraoral scanner can be an easy and fast tool for studying and mapping the occlusion, and storing data for future treatment, with the conventional method being the preferred method for performing the occlusal adjustment.

Device trueness in passivity and misfit of CAD-CAM frameworks: Conventional versus printed casts.

STATEMENT OF PROBLEM: Obtaining a passive and well-adapted framework is challenging when intraoral scanning edentulous arches with multiple implants. The trueness of the printed casts is unclear. PURPOSE: The purpose of this clinical study was to evaluate the trueness of frameworks made from conventional and printed casts regarding clinical passivity and misfit. MATERIAL AND METHODS: Ten participants with complete mandibular fixed implant-supported interim prostheses retained by 4 implants were included. Each participant had a conventional impression and a digital scan made. The digital scan was made using an innovative device. Both conventional and digital casts were made, and the virtual images were used for milling the digital framework in cobalt chromium alloy. All frameworks were evaluated for passivity and marginal vertical misfit with the single screw test, with 4 attempts consisting of the tightened screw position, a test with all screws tightened, and an interspersed tightening test. The Kruskal-Wallis test was used to evaluate the trueness of the tested device for framework construction through the single screw test on vertical marginal misfit in the conventional and printed groups (α=.008). The Friedman test was used to assess the effect of test type (α=.05), and the Wilcoxon test was used to identify group-to-group differences (α=.017). RESULTS: The absence of space between the framework and the abutments and interferences during its placement, as well as good stability, were observed clinically. In laboratory analysis, greater framework misfits were observed in the printed group compared with the conventional group when the single screw test was applied. Comparing the 3 tests used, the greatest misfits were observed when the framework was screwed onto the printed cast. CONCLUSIONS: The innovative device tested for the intraoral scanning of multiple implants had clinically acceptable accuracy for the construction of passive and adapted frameworks. The conventional cast was more accurate than the printed cast, with lower misfit values, in all tests.

Effect of cantilever extension on bone loss in mandibular complete-arch implant-supported fixed prosthesis about 3 and 4 implants.

STATEMENT OF PROBLEM: The assessment of bone loss around implants has been widely studied, but the effect of cantilever length as a risk factor is not fully understood. PURPOSE: The objective of this randomized controlled clinical trial was to compare the peri-implant bone loss of mandibular complete-arch implant-supported fixed prosthesis supported (FPS) by 3 and 4 implants and to correlate with the size of the horizontal and vertical distal cantilever at prosthesis installation (T1) and after one year (T2). MATERIALS AND METHODS: 72 external hexagon (EH) type implants were installed in 20 participants. Of these, 24 support FPS with 3 implants (GI3) and 48 with 4 implants (GI4). The inferior implants were named 1, 2, 3, and 4 according to their location in the mandibular arch, in a clockwise direction. Digital periapical radiographs were taken at times T1 and T2 for analysis and measurement of peri-implant bone loss. The horizontal and vertical distal cantilevers were measured with a digital caliper and correlated with peri-implant bone loss. RESULTS: The survival rate of implants in GI3 was 91.66%, in GI4 it was 97.91%. The mean bone loss in GI3 was 0.88 (± 0.89) mm and in GI4 it was 0.58 (± 0.78) mm (P = 0.225). There was no correlation between distal horizontal cantilevers and bone loss in the studied groups, with GI3 being -0.25 (P=0.197) and GI4-0.22 (0.129). Larger vertical cantilevers of implants 1 (P=0.018), 3 (P=0.015) and 4 (P=0.045) correlated with greater bone loss in GI4. CONCLUSION: The number of implants in FPS did not influence peri-implant bone loss after 1 year of follow-up. Larger vertical cantilevers influenced greater bone loss in complete-arch implant-supported fixed prosthesis supported by 4 implants. Int J Prosthodont. 10.11607/ijp.8347.

Conventional and digital impressions for complete-arch implant-supported fixed prostheses: time, implant quantity effect and patient satisfaction.

PURPOSE: To evaluate and compare the effect of impression type (conventional vs digital) and the number of implants on the time from the impressions to the generation of working casts of mandibular implant-supported fixed complete-arch frameworks, as well as on patient satisfaction. MATERIALS AND METHODS: 17 participants, 3 or 4 implants, received 2 types of digital impression methods (DI) and conventional (CI). In DI, two techniques were performed: scanning with the scan bodies (SC) and scanning with a device attached to the scan bodies (SD) (BR 10 2019 026265 6). In CI, the making of a solid index (SI) and open-tray impression (OT) were used. The outcomes were used to evaluate the time and the participant satisfaction with conventional and digital impressions. The time was evaluated through the timing of the time obtained in the workflow in the conventional and digital impression. The effect of the number of implants on time was also assessed. Satisfaction was assessed through a questionnaire based on seven. The Wilcoxon test used to identify the statistical difference between the groups in terms of time. The Mann-Whitney test was used to analyze the relationship between the time and the number of implants. Fisher's test was used to assess the patient satisfaction (P < .05). RESULTS: The time with DI was shorter than with CI (DI, x̃=02:58; CI, x̃=31:48) (P < .0001). The arches rehabilitated with 3 implants required shorter digital impression time (3: x̃=05:36; 4: x̃=09:16) (P < .0001). Regarding satisfaction, the DI was more comfortable and pain-free than the CI (P < .005). CONCLUSION: Digital impressions required shorter chair time and had higher patient acceptance than conventional impressions.

Impact of residual ridge anatomy on masticatory efficiency of conventional complete denture users / Impacto da anatomia do rebordo residual na eficiência mastigatória em usuários de próteses totais convencionais

ABSTRACT Objective: The aim of this cross-sectional study was to evaluate the anatomical characteristics of edentulous residual ridges in stone casts of complete dentures users and assess correlations with masticatory efficiency. Methods: The sample included 74 study casts, of which 37 were higher and 37 bottom. Measurements were performed using a drypoint compass and a transparent ruler. Arches and ridges of maxillae and mandibles were classified into small, medium, and large. Masticatory efficiency was obtained by the sieve method with the old prostheses and 3 months after placement of new prostheses. The correlations between the anatomical variables of the ridges and arches (height, width and size) and masticatory efficiency were verified by the Spearman correlation test. Significant differences in masticatory efficiencies were assessed by the Wilcoxon test. Results: People with larger maxillary alveolar ridge presented better masticatory performance with old and new dentures. There was no correlation between maxillary ridge width and size with masticatory efficiency, but a correlation was found between maxillary arch width and masticatory efficiency evaluated with the old dentures. Conclusions: With the new dentures, the correlation had a tendency for significance. For the mandible, no correlation was found between height, width, and size of the ridge or with width, length, and size of the arch and masticatory efficiency. In addition, there was no significant difference between masticatory efficiencies evaluated with the old and new prostheses. For the maxilla, ridge height and arch width influence masticatory efficiency. For the mandible, the anatomy had little influence on masticatory performance.

RESUMO Objetivo: Este estudo transversal objetivou avaliar as características anatômicas de rebordos residuais de usuários de próteses totais em gesso pedra e avaliar correlações com a eficiência mastigatória. Métodos: A amostra incluiu 74 modelos de estudo, sendo 37 superiores e 37 inferiores. As medidas foram realizadas com um compasso de ponta seca e régua transparente. Os arcos e rebordos da maxila e mandíbula foram classificados em pequenos, médios e grandes. A eficiência mastigatória foi obtida pelo método da peneira com as próteses antigas e 3 meses após a instalação das próteses novas. As correlações entre as variáveis anatômicas dos rebordos e arcos (altura, largura e tamanho) e a eficiência mastigatória foram verificadas pelo teste Spearman. Diferenças significativas nas eficiências mastigatórias foram avaliadas pelo teste de Wilcoxon. Resultados: Pessoas com crista alveolar maxilar alta apresentaram melhor desempenho mastigatório com próteses novas e antigas. Não houve correlação entre a largura e o tamanho da crista maxilar com a eficiência mastigatória, mas foi encontrada uma correlação entre a largura do arco maxilar e a eficiência mastigatória avaliadas com as próteses antigas. Para a mandíbula, não foi encontrada correlação entre altura, largura e tamanho da crista ou com largura, comprimento e tamanho do arco e eficiência mastigatória. Além disso, não houve diferença significativa entre as eficiências mastigatórias avaliadas com as próteses antigas e novas. Conclusão: Para a maxila, a altura da crista e a largura do arco influenciam a eficiência mastigatória. Para a mandíbula, a anatomia teve pouca influência no desempenho mastigatório.

Manual Therapy in the Treatment of Myofascial Pain Related to Temporomandibular Disorders: A Systematic Review.

AIMS: To evaluate the effectiveness of manual therapy in the treatment of myofascial pain related to temporomandibular disorders. METHODS: Randomized clinical trials were searched in the Cochrane Library, MEDLINE, Web of Science, Scopus, LILACS, and SciELO databases using the following keywords: temporomandibular joint disorders; craniomandibular disorders; myofascial pain syndromes; myofascial pain; exercise therapy; myofunctional therapy; physical therapy modalities; clinical trial; prospective studies; and longitudinal studies. Studies using the RDC/TMD and manual therapy for myofascial pain were included. All studies were evaluated using the Cochrane Risk of Bias tool. RESULTS: Five studies were included in the present review. Of 279 total patients, 156 were treated with manual therapy only or manual therapy with counseling. Manual therapy was efficient for pain relief in all studies evaluated; however, manual therapy was not better than counseling or botulinum toxin. CONCLUSION: Manual therapy was better than no treatment in one study and better than counseling in another study; however, manual therapy combined with counseling was not statistically better than counseling alone, and manual therapy alone was not better than botulinum toxin. Manual therapy combined with home therapy was better than home therapy alone in one study. Further studies are required due to the inconclusive data and poor homogeneity found in this review.

Improvement in Quality of Life of Elderly Edentulous Patients with New Complete Dentures: A Systematic Review.

PURPOSE: To evaluate whether treatment with new complete dentures improves quality of life in elderly patients. MATERIALS AND METHODS: A literature search was conducted in the MEDLINE/PubMed, Scopus, LILACS, SciELO, Web of Science, and Cochrane Library databases using specific keywords for relevant articles published up to March 2018. Three reviewers obtained the data and compared the results from reports that evaluated denture wearers 60 years of age or older whose old dentures were replaced with new ones. RESULTS AND CONCLUSION: Of 282 published studies, 7 met the inclusion criteria (5 evaluated quality of life before and after treatment using the Oral Health Impact Profile, 1 using the Oral Impacts by Daily Performance, and 1 using the Geriatric Oral Health Assessment Index). The articles showed a similar increase in quality of life after elderly patients were treated with new complete dentures; however, the limited methodologic quality in the reported and analyzed studies underscores the need for more robust controlled investigations to strengthen the current body of evidence, which is limited.

Performance mastigatória e impacto da saúde oral na qualidade de vida em pacientes reabilitados com prótese fixa implantossuportada com carga imediata / Masticatory performance and impact of oral health on quality of life in patients rehabilitated with implant-supported fixed prosthesis with immediate loading

O impacto da saúde oral na qualidade de vida (OHRQoL) dos pacientes através da substituição de próteses totais convencionais (PTC) por próteses fixas implantossuportadas (PFIS) ainda não está totalmente claro, devido à grande heterogeneidade metodológica. O objetivo desse ensaio clínico controlado não randomizado foi comparar a OHRQoL e a performance mastigatória (PM) em pacientes reabilitados com PTC e com PFIS com carga imediata na mandíbula. A amostra foi composta por 40 indivíduos com idade média de 59,08 anos (± 7,04), predominantemente do sexo feminino (n=36), distribuídos em dois grupos: PTC e PFIS. Todos os pacientes foram reabilitados com PTC inicialmente, 23 permaneceram com suas PTC, e o restante (17 pacientes), após 3 meses de uso das PTC tiveram suas próteses convertidas em PFIS com barra distal com carga imediata, sendo 7 suportadas por 3 implantes e 10 suportada por 4 implantes. O OHRQoL foi mensurado através do questionário OHIP-Edent (versão brasileira) e a PM, através do método das tamises com o X50 calculado. Dados foram coletados antes (T0), e após 3 meses da instalação das PTC e da PFIS (T1). Para a análise dos dados, Teste t de Student para amostras pareadas foi aplicado para avaliar o mesmo grupo antes e após a intervenção clínica, sendo na comparação entre os grupos aplicado o Teste t para grupos independentes e o "d" de Cohen calculado para ambas comparações. Teste de correlação de Spearman foi empregado para avaliar a correlação entre as variáveis. Os resultados mostraram que ao comparar o grupo PTC em T0 e T1, não houve melhora na OHRQoL e nem redução do X50, indicando que a PM não melhorou. Já no grupo PFIS, houve melhora significativa na OHRQoL (p < 0,001) com tamanho do efeito "muito grande" (Cohen'd = 2,49) e melhora significativa na PM com tamanho do efeito "muito grande" (Cohen' d = 2,47). Considerando a comparação no tempo T1 de ambos os grupos, o grupo PFIS apresentou menor valor de OHRQoL e menor valor de X50, indicando maior impacto positivo na qualidade de vida e melhor PM, quando comparado ao grupo PTC (p < 0,001). Constatou-se correlação entre a PM e o OHIP-Edent de forma positiva apenas para o grupo PTC, no tempo T0, no domínio "desconforto psicológico", indicando que a medida que a PM piorava, o desconforto psicológico aumentava. Concluiu-se que a conversão da prótese total convencional em prótese fixa implantossuportada impacta positivamente na qualidade de vida e na performance mastigatória dos usuários com um tamanho de efeito "muito grande" (AU).

Oral health impact on the quality of life (OHRQoL) of patients through the replacement of conventional complete dentures (CCD) to implant suported dentures (ISD) is still not completely clear due to the great methodological heterogeneity. The objective of this nonrandomized controlled clinical trial was to compare OHRQoL and masticatory performance (PM) in rehabilitated patients with CCD and ISD under lower immediate loading. The sample consisted of 40 individuals, mean age of 59.08 years (± 7.04), predominantly female (n = 36), were divided into two groups: CCD and ISD. All patients were rehabilitated with CCD initially, 23 remained with their CCD, and 17 patients after 3 months of CCD use had their dentures converted into ISD under immediate loading, supported by 3 or 4 implants. The OHRQoL was measured by OHIPEdent questionnaire (Brazilian version) and the PM, using the sieve method with the calculated X50. Data were collected before (T0), and after 3 months of installation of CCD and ISD (T1). Student's t-test for paired samples was applied to evaluate the same group before and after the clinical intervention, in the comparison between the groups the t test was applied for independent groups and the "d" of Cohen calculated for both groups comparisons. Spearman's correlation test was used to evaluate the correlation between the variables. Comparing the CCD group at T0 and T1, there was no positive impact on the OHRQoL and no significant X50 reduction, which indicates that there was no improvement in the PM. For ISD, there was an improvement in the OHRQoL (p < 0.001) with a large size effect (Cohen'd = 2,49) and a significant improvement in the PM with a large size effect (Cohen'd= 2,47). Comparison in time T1 for both groups, ISD presented lower OHRQoL and lower value of X50, which indicates a higher positive impact on the quality of life and better PM when compared to CCD (p < 0.001). Correlation between PM and OHIP-Edent was found only positively for CCD at time T0, in the "psychological discomfort" domain, indicating that as the PM worsens, the psychological discomfort increases. It is concluded that the conversion of complete dentures into implanted suported denture has a positive impact on the quality of life and on masticatory performance (AU).