Effect of artificial eccentric occlusal interferences on masticatory performance: A randomised double-blind clinical trial.

BACKGROUND: Occlusal interferences lead to changes in mandibular kinematics to compensate and improve function. However, the effects of different types of eccentric disturbance on the comminution capacity are not known. OBJECTIVE: To determine the immediate effect of eccentric occlusal interferences on masticatory performance. METHODS: This crossover clinical trial included 12 healthy dentate subjects aged 25.2 ± 3.3 years who were randomly submitted to seven types of occlusal interference: unilateral and bilateral laterotrusive and mediotrusive, protrusive, dummy and control (no interference). The interference forms were planned in a semi-adjustable articulator, fabricated with composite resin and adhered to the mandibular first molars such that subjects' maximum intercuspation was maintained. Masticatory performance and the chewing rate during 20 cycles were evaluated during subjects' comminution of silicone test food under one interference condition per test day; the multiple sieve method was applied to the comminuted particles. The interference was removed upon test completion, and a 1-week washout period was applied between tests. RESULTS: Comminuted median particle sizes were larger under unilateral (4.94 ± 0.41 mm) and bilateral (4.81 ± 0.49 mm) laterotrusive, bilateral mediotrusive (4.65 ± 0.50 mm) and protrusive (4.83 ± 0.54 mm) interferences (p < .05) than under the control (4.01 ± 0.52 mm) and dummy (4.18 ± 0.58 mm) conditions (p < .05). Only unilateral and bilateral laterotrusive interferences narrowed the comminuted particle size dispersion (p < .05). The chewing rate did not differ among conditions (p = .1944). CONCLUSION: Artificial eccentric interferences had an immediate adverse effect on masticatory performance by resulting in larger comminuted particles. CLINICAL TRIAL REGISTRATION: Brazilian Registry of Clinical Trials (RBR-8g5zfg8).

The effect of stainable drinks followed by simulated brushing on the roughness and stainability of acrylic resins polymerized with different cycles.

STATEMENT OF PROBLEM: No information is available on roughness and stainability of acrylic resins polymerized by experimental microwave cycles after immersion in stainable liquids and simulated brushing. PURPOSE: The purpose of this in vitro study was to evaluate the effect of stainable drinks and brushing on roughness and stainability of acrylic resins (Vipi Cril [CA] and Vipi Wave [MA]) polymerized with different cycles. MATERIAL AND METHODS: CA and MA specimens (n=5; diameter, 20 mm; thickness, 3 mm) were made using 4 methods recommended by the manufacturer (water bath polymerization and microwave polymerization cycles) and experimental at 550 W or 650 W for 3 or 5 minutes (M550/3 and M650/5), respectively. After storage in distilled water at 37°C for 48 hours (T0), the specimens were stored in water, coffee, or red wine (37°C) for 36 days with simulated brushing (54 000 cycles, T1). Roughness (Ra) and stainability (ΔE/National Bureau of Standards) were measured at T0 and T1. Roughness and stainability data were analyzed by 3-way repeated measures and 2-way ANOVA, respectively, followed by the Bonferroni test (α=.05). RESULTS: After storing in coffee and brushing, CA showed the highest (M550/3=2.33 ±0.72 µm) and the lowest roughness (water bath polymerization=1.22 ±0.58 µm), whereas roughness of MA specimens processed by M650/5 increased (1.57 ±0.59 µm). Storing in wine and brushing increased roughness (1.75 ±0.32 µm) in the M550/3 group. No staining was observed on MA after brushing regardless of the polymerization cycle. All values were acceptable (ΔE≤3.3), except for MA (microwave polymerization), which showed National Bureau of Standards=4.49 (appreciable change) after storing in wine and brushing. CONCLUSIONS: A slight increase in material roughness was observed after staining and brushing. Only MA polymerized following manufacturer cycles showed relevant stainability after immersion in wine and brushing.

Reproducibility, Reliability, and Validity of Fuchsin-Based Beads for the Evaluation of Masticatory Performance.

PURPOSE: Rehabilitation of masticatory function is inherent to prosthodontics; however, despite the various techniques for evaluating oral comminution, the methodological suitability of these has not been completely studied. The aim of this study was to determine the reproducibility, reliability, and validity of a test food based on fuchsin beads for masticatory function assessment. MATERIALS AND METHODS: Masticatory performance was evaluated in 20 dentate subjects (mean age, 23.3 years) using two kinds of test foods and methods: fuchsin beads and ultraviolet-visible spectrophotometry, and silicone cubes and multiple sieving as gold standard. Three examiners conducted five masticatory performance trials with each test food. Reproducibility of the results from both test foods was separately assessed using the intraclass correlation coefficient (ICC). Reliability and validity of fuchsin bead data were measured by comparing the average mean of absolute differences and the measurement means, respectively, regarding silicone cube data using the paired Student's t-test (α = 0.05). RESULTS: Intraexaminer and interexaminer ICC for the fuchsin bead values were 0.65 and 0.76 (p < 0.001), respectively; those for the silicone cubes values were 0.93 and 0.91 (p < 0.001), respectively. Reliability revealed intraexaminer (p < 0.001) and interexaminer (p < 0.05) differences between the average means of absolute differences of each test foods. Validity also showed differences between the measurement means of each test food (p < 0.001). CONCLUSIONS: Intra- and interexaminer reproducibility of the test food based on fuchsin beads for evaluation of masticatory performance were good and excellent, respectively; however, the reliability and validity were low, because fuchsin beads do not measure the grinding capacity of masticatory function as silicone cubes do; instead, this test food describes the crushing potential of teeth. Thus, the two kinds of test foods evaluate different properties of masticatory capacity, confirming fushsin beads as a useful tool for this purpose.

A Survey of the Management of Patients with Temporomandibular Disorders by General Dental Practitioners in Southern Brazil.

PURPOSE: Temporomandibular disorders (TMD) are recognized as one of the most controversial topics in dentistry, despite the fact that both basic science and clinical researchers have currently reached some degree of consensus. This study aimed to conduct a questionnaire-based survey about the management of TMD patients by general dental practitioners (GDPs). MATERIALS AND METHODS: One hundred fifty-one GDPs with a private practice in a city of southern Brazil were included, independent of school of origin, gender, graduation year, and curriculum content. All participants were administered a questionnaire about the management of patients with TMD, and the responses were analyzed by binomial and chi-square tests (α = 0.05). RESULTS: Of the GDPs, 88.7% received TMD patients, who were primarily diagnosed on the basis of medical history (36.6%) or physical examination (30.4%). Of these, 65.4% referred the patients elsewhere, primarily to specialists in occlusion (36.1%) or orthodontics (29.7%). Occlusal splinting was the most commonly used management modality (20.8%), followed by occlusal adjustment (18.1%) and pharmacotherapy (16.6%). Splints were fabricated in maximum habitual intercuspation or centric relation depending on individual patient (54.8%). The hard stabilization form was the most common type of appliance used (35.0%). Moreover, 73.8% of the GDPs did not employ semi-adjustable articulators, and 69.5% adjusted the appliances at the time of fixing. The duration of splint use and the frequency of follow-up were considered patient dependent by 62.1% and 72.8%, respectively. GDPs considered the two major TMD etiologic categories as multifactorial (20.8%) and occlusion (19.9%). Multidisciplinary medical and dental treatment was considered necessary by 97.9%. CONCLUSIONS: The evaluated general dental practitioners manage TMD patients according to international guidelines.

Influence of the radius of Monson's sphere and excursive occlusal contacts on masticatory function of dentate subjects.

OBJECTIVE: To determine the influence of the radius of Monson's sphere, the number of posterior laterotrusive, mediotrusive, and protrusive contacts, and the chewing rate on food comminution. DESIGN: Sixty healthy dentate subjects, aged 21.22 ± 2.30 years, were selected. The three-dimensional coordinates of the cusp tips of the lower canine, premolar, and molar teeth were identified from the subjects' digital models. Monson's sphere was designed using the simplex method for function minimisation by adjusting the coordinates on its surface. The contacts were verified using 12 µm metal strips in jaw excursions at 0.5, 1.0, 2.0, and 3.0 mm. The masticatory performance and efficiency, swallowing threshold, and chewing rate were assessed through particle size fractionation. Data were analysed with multiple linear regression (α = 0.05). RESULTS: The sphere's radius, laterotrusive and protrusive contacts at 0.5 mm, and chewing rate were found to be negative predictor variables for masticatory performance until 20 chewing cycles (R2 = 0.429). For 40 cycles, the radius and total contacts (0.5 mm) were also explanatory factors (R2 = 0.223). Only the radius (R2 = 0.176) and the chewing rate (R2 = 0.082) were found to be significant for 60 cycles and swallowing threshold, respectively. Masticatory efficiency was influenced by masticatory performance until 40 and 60 cycles, as well as the radius and total contacts at 2.0 and 3.0 mm (R2 = 0.958). CONCLUSION: A larger radius of Monson's sphere and a greater number of posterior excursive contacts were found to be related to better masticatory function.

Trial data for precision analysis of a three-dimensional mandibular mechanical advantage.

The data presented in this manuscript describe craniofacial landmark coordinate values, muscle and load moment arm lengths, and mechanical advantage rates for constructing a three-dimensional model of masticatory muscles. Cone-beam computed tomography scans from 30 subjects (aged 12-19 years, 16 females) were used. Thirty-six craniofacial landmarks were identified. Subsequently, the moment arms for 7 muscles and their corresponding load moment arms at incisor and molar positions were determined. Then, the three-dimensional mechanical advantage for each muscle and tooth position was calculated as the ratio of muscle moment arm to load moment arm. This procedure was repeated three times by a main examiner and once by two other examiners. The Friedman test and the square root of the 'method of moments' variance estimator were used to compare data among examiners and calculate random errors, respectively. Although the values for the craniofacial landmark coordinates and biomechanical variables are very close, differences were found between measurements, especially in the interexaminer comparisons. Values served as the basis for reliability (intraclass correlation coefficient) and errors (average mean of absolute differences) analysis in the research paper titled "A three-dimensional method to calculate mechanical advantage in mandibular function: Intra- and interexaminer reliability study," published in the Journal of Orofacial Orthopedics.

Exploring botulinum toxin's impact on masseter hypertrophy: a randomized, triple-blinded clinical trial.

The present study aimed to assess the effectiveness and functional adverse effects of a single and multiple injections of botulinum toxin A (BoNT-A) for masseter hypertrophy (MH). Twenty-six women complaining about lower third facial enlargement due to MH, received 75 U of BoNT-A (abobotulinum toxin) in each masseter muscles. After 3 months, patients were randomly assigned to receive a second treatment session of Saline Solution: (G1; n = 11) or BoNT-A: (G2; n = 12). Muscle thickness (ultrasound), electrical activity (electromyography; EMG), masticatory performance, and subjective perception of MH were evaluated. Follow-up was performed at 1, 3 and 6 months. Muscle thickness, EMG activity, and masticatory performance were analyzed using ANOVA two-way and Sidak test as post-hoc. Masticatory performance was analyzed by the Friedman's test and Mann-Whitney test. Regarding inter-groups comparisons, there was a significant decrease in the left masseter muscle thickness in the G2 group at the 6 month follow-up (p < 0.02). For EMG, significant differences were evident at the 6 month assessment, with higher masseter activity for G1 (p < 0.05). For masticatory performance, no significant differences were observed throughout the study (p > 0.05) and a higher improvement in subjective perception of MH was observed in the 1 month follow-up for G2 (p < 0.05). In conclusion, BoNT-A is effective for MH, however multiple injections cause functional adverse effects in masseter muscle.

Relationship between chewing rate and masticatory performance.

The influence of mandibular movement timing on food breakdown remains unclear. The authors, therefore, sought to relate chewing rate with masticatory performance. Chewing rate, defined as the number of masticatory cycles habitually achieved per minute, was measured in 55 healthy dentulous subjects (age, 22.2 +/- 5.0 years). Subjects were grouped according to obtained values (cycles/minute): slower: < 70; middle: 70-90; and faster: > 90. Masticatory performance was determined through the sieve method, and the estimated comminuted median particle size (X50). Data was analyzed using the one-way ANOVA and chi-square tests (alpha = .05). Subjects with slower chewing rates showed higher (p < .05) masticatory performance (X50 = 3.05 +/- 0.77 mm). X50 was associated with chewing rate when subjects were categorized as better or poorer performers (chi-square = 11.25, p < .005). Thus, chewing rate was related to masticatory performance, with smaller food particles being achieved with a slower chewing rate.

Relationship between body fat and masticatory function.

PURPOSE: The aim of this cross-sectional study was to investigate the relationship between body fat and masticatory function. MATERIALS AND METHODS: One hundred dentate and partially edentulous participants (33 male; mean age, 39.7 ± 16.6 years) were selected. Body fat was established through body mass index (BMI). Masticatory function was evaluated by quantifying occlusal pairs and determining masticatory efficiency and swallowing threshold with the sieving method. During the swallowing threshold test, chewing rate was registered. Masticatory ability was also evaluated with a 5-point Likert scale questionnaire. Data were analyzed with Spearman and chi-square tests, as well as binary logistic regression analysis for the presence of increased BMI (α= 0.05). RESULTS: Age (rho = 0.517), occlusal pairs (chi-square = 26.353), masticatory efficiency (chi-square = 30.935), masticatory ability (chi-square = 25.132; p < 0.001), and swallowing threshold (chi-square = 8.730; p < 0.005) were related to BMI. Age (odds ratio, OR = 1.048, 95% CI = 1.008 to 1.089) and lower masticatory efficiency (OR = 4.792, 95% CI = 1.419 to 16.183) were predictive of increased body fat (p < 0.05). Gender (chi-square = 0.402, p= 0.526) and chewing rate (rho =-0.158, p= 0.117) were not related to BMI. CONCLUSIONS: These results suggest that people with lower masticatory efficiency may be at risk for increased body fat.

Influence of length of occlusal support on masticatory function of free-end removable partial dentures: short-term adaptation.

PURPOSE: To analyze masticatory function after a short adaptation period relative to occlusal support length reduction in free-end removable partial denture (RPD) wearers. MATERIALS AND METHODS: Twenty-three patients (55.2 ± 8.4 years) were rehabilitated with maxillary complete and mandibular free-end RPDs extending to the second molars. Five occlusal support length conditions were determined by removing artificial teeth from the RPDs: full occlusal support (control); occlusal support to the first molars, second premolars, and first premolars; and no occlusal support. To explore a probable short-term adaptation to occlusal support length reduction, participants wore their dentures at each condition for a period of 1 week before starting masticatory function assessment. For this purpose, masticatory performance, masticatory efficiency, chewing rate, selection chance, and breakage function were evaluated at each condition using the sieving method. Data were analyzed using repeated-measures ANOVA and post hoc Dunnett tests (α = 0.05). RESULTS: Masticatory performance and masticatory efficiency for 2 to 4 mm particles under the condition of occlusal support to the first molars and second premolars were similar to control values (p > 0.05). Masticatory efficiency relative to particles smaller than 2 mm was also seen at the condition of support length to the first premolars (p > 0.05). Chewing rates showed adaptation only at the condition of support length to the first molars (p > 0.05). A similar trend was noted for the selection chance of 8-mm particles, and breakage function for 8- and 2.4-mm particles (p > 0.05). CONCLUSION: After a 1-week adaptation period to free-end RPDs with occlusal support lengths reduced to the premolars, participants were able to achieve adequate masticatory function.

Surgical resection and prosthetic treatment of an extensive mandibular torus.

The aim of this case report was to describe the surgical removal of an extensive mandibular torus and the conventional prosthetic treatment that was performed. During surgery, the torus was exposed by a intrasulcular lingual incision from molar to contralateral molar side and displacement of the mucoperiosteal flap. The bone volume was carefully removed in three separate blocks by sculpting a groove in the superior lesion area and chiseling. After a 30-day postoperative period, a prosthetic treatment was performed using a conventional distal extension removable partial denture. The patient's esthetic and functional expectations were achieved. The surgical procedure and prosthetic treatment performed in the treatment of the mandibular torus in this clinical case is a viable treatment that produces few complications and re-establishes normal masticatory function.

A three-dimensional method to calculate mechanical advantage in mandibular function : Intra- and interexaminer reliability study.

PURPOSE: Masticatory muscles are physically affected by several skeletal features. The muscle performance depends on muscle size, intrinsic strength, fiber direction, moment arm, and neuromuscular control. To date, for the masticatory apparatus, only a two-dimensional cephalometric method for assessing the mechanical advantage, which is a measure for the ratio of the output force to the input force in a system, is available. This study determined the reliability and errors of a three-dimensional (3D) mechanical advantage calculation for the masticatory system. METHODS: Using cone-beam computed tomography images from teenage patients undergoing orthodontic treatments, 36 craniofacial landmarks were identified, and the moment arms for seven muscles and their load moment arms (biomechanical variables) were determined. The 3D mechanical advantage for each muscle was calculated. This procedure was repeated by three examiners. Reliability was verified using the intraclass correlation coefficient (ICC) and the errors by calculating the absolute differences, variance estimator and coefficient of variation (CV). RESULTS: Landmark coordinates demonstrated excellent intra- and interexaminer reliability (ICC 0.998-1.000; p < 0.0001). Intraexaminer data showed errors < 1.5 mm. Unsatisfactory interexaminer errors ranged from 1.51-5.83 mm. All biomechanical variables presented excellent intraexaminer reliability (ICC 0.919-1.000, p < 0.0001; CV < 7%). Interexaminer results were almost excellent, but with lower values (ICC 0.750-1.000, p < 0.0001; CV < 10%). However, the muscle moment arm and 3D mechanical advantage of the lateral pterygoid muscles had ICCs < 0.500 (p < 0.05) and CV < 30%. Intra- and interexaminer errors were ≤ 0.01 and ≤ 0.05, respectively. CONCLUSIONS: Both landmarks and biomechanical variables showed high reliability and acceptable errors. The proposed method is viable for the 3D mechanical advantage measure.

Sensitivity and Specificity of Capsules Containing Fuchsin-Based Beads for the Evaluation of Masticatory Performance.

PURPOSE: To determine the sensitivity and specificity of capsules containing fuchsin-based beads for evaluating masticatory performance. MATERIALS AND METHODS: A total of 60 healthy subjects (mean ± SD age: 41.0 ± 13.2 years) were categorized according to number of occlusal pairs (n = 15 per group) as follows: 16-14 (control group); 13-10; 9-6; and 5-1. The subjects chewed the capsules to assess masticatory performance, which was defined as the concentration of fuchsin released and measured using ultraviolet-visible spectrophotometry. The subjects also comminuted silicone cubes, and median size was calculated via the sieving method. The test foods were compared using analysis of variance, receiver operating characteristic (ROC) curve, and Bland-Altman analysis. RESULTS: The control group presented the highest masticatory performance for chewing the capsules (P < .05), except when compared to the 13-10 occlusal pairs group (P = .667). There was no difference between the partial edentulism groups (P > .05). An acceptable area under the ROC curve of 0.744 was observed, with 73.33% sensitivity and 70.00% specificity. The control group also showed the best results for chewing the cubes (P < .01); however, the 9-6 and 5-1 groups were equivalent (P = .133). An excellent area under the ROC curve of 0.887 was found, with 80.00% sensitivity and specificity. The bias between the capacity of both test foods to recognize subjects with < 10 occlusal pairs was -3.56%. CONCLUSION: Capsules containing fuchsin-based beads were viable for evaluating masticatory performance, as they showed sufficient sensitivity and specificity for characterizing subjects presenting with < 10 occlusal pairs.

Relationship between non-ulcerative functional dyspepsia, occlusal pairs and masticatory performance in partially edentulous elderly persons.

OBJECTIVE: To relate occlusal state, masticatory performance and non-ulcerative functional dyspepsia. BACKGROUND: In spite of the relationship between gastric disturbances and number of present teeth being recognised, the influence of the number of occlusal pairs and masticatory performance, expressed as median particle size, has not been considered. MATERIALS AND METHODS: Thirty-eight subjects (mean age = 71.8 ± 7.7 years) diagnosed with non-ulcerative functional dyspepsia were selected. A further 38 healthy subjects (mean age = 71.9 ± 7.0 years) acted as controls. Subjects were subdivided according to their number of occlusal pairs: (1) 0-4, (2) 5-9 and (3) 10-14. Masticatory performance was evaluated by using the sieving method. Data were analysed using 2-way anova and Bonferroni post-hoc, Chi-square and Odd ratio tests. RESULTS: Subjects presenting with non-ulcerative functional dyspepsia and 0-4 occlusal pairs showed the lowest masticatory performance (p < 0.01). No association between the dyspepsia and the number of occlusal pairs (χ(2) = 0.48, p = 0.785) was observed, however results showed association between functional dyspepsia and masticatory performance (χ(2) = 4.07, p = 0.0437) presenting an odds ratio = 3.46 (Confidence Interval = 0.99-12.10). CONCLUSION: Changes in masticatory performance were associated with the presence of non-ulcerative functional dyspepsia.

Reliability and validity of a new colour-changing test food with an acid-base reaction for the clinical assessment of masticatory performance.

The aim of this study was to determine the reliability and validity of a new test food for the clinical assessment of masticatory performance. The test food had two overlapping acidic/basic halves. Ten dentate subjects chewed one unit for 10-100 cycles. One subject chewed ten units for the same number of cycles. Differences in the L*, a* and b* colour axes were determined before and after chewing by ANOVA. Colour guides were created based on the values of these axes and matched with the number of cycles. The reliability of the guides was evaluated using 30 images, where three examiners indicated the number of cycles in which the colour closest to that of a chewed material was found. The data were contrasted with the real values of the guides to determine the validity (Kappa coefficients). The equivalence of the guides with the median particle size (X50) was determined using equidimensional curves. The test food progressively changed from green to pink during chewing. As the number of cycles increased, the a* values increased and the b* values decreased (p < 0.05). Overall, the guides showed a Kappa value >0.8 for the intra-examiner and inter-examiner reliability and the validity comparisons. The a* and X50 values were inversely proportional to each other, and the b* values showed a direct relationship with the X50 values. The L* values did not show correspondence. The new test food showed high reliability and validity for the assessment of masticatory performance through clinical colour guides matched with the number of cycles and X50.

Effects of Botulinum Toxin Type A on the Psychosocial Features of Myofascial Pain TMD Subjects: A Randomized Controlled Trial.

AIMS: To determine the effects of botulinum toxin type A (BoNT-A) on the psychosocial features of patients with masticatory myofascial pain (MFP). METHODS: A total of 100 female subjects diagnosed with MFP were randomly assigned into five groups (n = 20 each): oral appliance (OA); saline solution (SS); and three groups with different doses of BoNT-A. Chronic pain-related disability and depressive and somatic symptoms were evaluated with the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis II instruments at baseline and after 6 months of treatment. Differences in treatment effects within and between groups were compared using chi-square test, and Characteristic Pain Intensity (CPI) was compared using two-way ANOVA. A 5% probability level was considered significant in all tests. RESULTS: Most patients presented low pain-related disability (58%), and 6% presented severely limiting, high pain-related disability. Severe depressive and somatic symptoms were found in 61% and 65% of patients, respectively. In the within-group comparison, BoNT-A and OA significantly improved (P < .001) scores of pain-related disability and depressive and somatic symptoms after 6 months. Only the scores for pain-related disability changed significantly over time in the SS group. In the between-group comparison, BoNT-A and OA significantly improved (P < .05) scores of all variables at the final follow-up when compared to the SS group. No significant difference was found between the BoNT-A and OA groups (P > .05) for all assessed variables over time. CONCLUSION: BoNT-A was at least as effective as OA in improving pain-related disability and depressive and somatic symptoms in patients with masticatory MFP.

Nutritional effects of implant therapy in edentulous patients--a systematic review.

PURPOSE: The aim of this study was to present all the relevant studies that have evaluated, with valid scientific methodology, the possible physical and nutrient intake improvement of edentulous subjects rehabilitated with removable and supported or retained implant denture, without restriction of suprastructure modalities, compared with those wearing conventional removable dentures. METHODS AND MATERIALS: Several electronic databases (Pubmed, Medline-Medline In-Process, Cochrane Library Database, Embase, and Lilacs) were searched, without language limitation. References from the selected articles were also hand searched. Abstracts which appeared to fulfill the initial selection criteria (comparison of nutritional state between conventional removable and supported or retained implant denture wearers) were selected by consensus and their original articles were then retrieved. Clinical trials that included anthropometric measurements or nutrient intake in removable and supported or retained implant denture wearers without syndrome and systemic influences, nor presenting surgical or other simultaneous treatment, which could affect the integrity during the evaluation period were finally selected. RESULTS: Only 5 articles met the selection criteria. Two studies (randomized clinical trials and prospective) found inadequate nutrient intake after treatment. One randomized clinical trial presented an improvement in nutritional state after treatment. One cross-sectional study showed an adequate nutritional state before and after treatment. These 4 studies found no significant difference between implant and conventional treatments. Finally, 1 cross-sectional study presented a difference between treatments, showing that the risk of malnutrition was higher for removable complete denture wearers. CONCLUSION: Considering the available evidence, the effect on the nutritional state in edentulous subjects treated with implant therapy is similar to the 1 obtained with conventional removable dentures. This effect does not necessarily mean an optimum nutritional state, which also depends on other factors not related to prosthodontic treatment.

Efficacy and Safety of Botulinum Toxin Type A on Persistent Myofascial Pain: A Randomized Clinical Trial.

This study assessed the safety and efficacy of three different doses of BoNT-A for persistent myofascial pain (MFP). One hundred female subjects were randomly assigned into five groups (n = 20): oral appliance (OA), saline solution (SS) and three BoNT-A groups with different doses. Pain intensity and pressure pain threshold were evaluated up to 24 weeks after treatment. Adverse effects related to muscle contraction, masticatory performance, muscle thickness and mandibular bone volume were also assessed. Changes over time were compared within and between groups. The "nparLD" package and Wilcoxon signed-rank test were used to analyze the data. BoNT-A reduced pain intensity (p < 0.0001) and increased pressure pain threshold (p < 0.0001) for up to 24 weeks compared to the placebo. No differences were found between BoNT-A and OA at the last follow-up. A transient decline in masticatory performance (p < 0.05) and muscle contraction (p < 0.0001), and a decrease in muscle thickness (p < 0.05) and coronoid and condylar process bone volume (p < 0.05) were found as dose-related adverse effects of BoNT-A. Regardless of the dose, BoNT-A was as effective as OA on MFP. Notwithstanding, due to BoNT-A dose-related adverse effects, we suggest the use of low doses of BoNT-A in MFP patients that do not benefit from conservative treatments.

Self-perceived oral health: a study with patients wearing removable dentures

Aim: This study aimed to investigate the relationship between self-perceived oral health and the prosthetic status of individuals who seek care in prosthodontics clinics. Methods: Self-perceived oral health was analyzed through the Geriatric Oral Health Assessment Index (GOHAI). Abutment tooth mobility was assessed, and denture status was determined by clinical assessment of stability, retention, occlusal balance, vertical dimension, and integrity of dentures. The frequency of individuals in each variable was determined for the low and very low GOHAI conditions. Chi-square, Pearson, and stepwise logistic regression tests were used for the statistical analyses (α = 0.05). Results: Ninety wearers of removable dentures with a mean age of 55.1±9.1 years were evaluated. None of the variables was related to GOHAI values (p > 0.05). The regression analysis showed that age predicts (p = 0.006) the variation of GOHAI conditions (OR = 0.924, CI = 0.873- 0.978), showing only 7.6% protective effect against very low GOHAI. Unsatisfactory stability showed the opposite effect (p = 0.034) and the individuals with this characteristic are more likely (OR = 3.055) to have very low GOHAI scores (CI = 1.085- 8.602). Conclusions: The self-perceived oral health of wearers of removable dentures worsens with age and unsatisfactory stability of dentures

Repair of furcal perforation with mineral trioxide aggregate: long-term follow-up of 2 cases.

Previous studies have demonstrated the efficacy of mineral trioxide aggregate (MTA) in repair of furcal perforation. In this article, the use of MTA in treating 2 cases of furcal perforation (accidental and caries-related) and subsequent long-term follow-up are described.