Influence of malocclusion on sleep bruxism and orofacial pain: data from a study in school children.

OBJECTIVES: This cross-sectional school-based study explored the influence of malocclusion on temporomandibular disorders (TMD) pain complaints, and whether this association would be mediated by sleep bruxism in a representative sample of 7- to 8-year-old children. METHODS: Path analysis estimated direct, indirect, and total effects of occlusal features on sleep bruxism and TMD pain in 7- to 8-year-old children. Occlusal features were assessed with Dental Aesthetic Index (DAI), orofacial pain complaints using the TMD pain screener, possible sleep bruxism based on self-reports, and probable sleep bruxism based on self-reports combined with clinical findings. Structural equation modeling analyzed data with confounding factors. RESULTS: From 580 participants, possible sleep bruxism was observed in 136 children (31.5%), probable sleep bruxism in 30 children (6.7%), and TMD pain complaints in 78 children (13.8%). Malocclusion had no direct effect on either possible sleep bruxism [standardized coefficient (SC) 0.000; p = 0.992], or TMD pain complaints (SC - 0.01; p = 0.740). When probable sleep bruxism was set as the mediator of interest, malocclusion did not directly affect probable sleep bruxism (SC 0.01; p = 0.766), nor TMD pain complaints (SC - 0.02; p = 0.515). A direct effect of probable sleep bruxism on TMD pain complaints was observed with an SC of 0.60 (p < 0.001). However, in neither case, malocclusion indirectly affected TMD pain complaints via bruxism. CONCLUSION: Malocclusion in 7- to 8-year-old children did not directly influence possible or probable sleep bruxism or TMD pain complaints. Instead, probable sleep bruxism was strongly associated with TMD pain complaints. CLINICAL SIGNIFICANCE: The impact of occlusal features on TMD pain complaints and bruxism has been a long-standing controversy in dentistry. However, the scientific literature linking this association may be inconsistent, mainly due to biased sample selection methods with inadequate consideration of confounders. Further research should try to identify additional risk factors for TMD pain in addition to probable sleep bruxism in children.

Effect of shade and opacity on color differences and translucency of resin composite veneers over lighter and darker substrates.

To evaluate color differences (ΔE00) and translucency parameters (TP) from mono, bi, and trilayer resin composite veneers using different opacities and shades of resin composite over lighter and darker simulated tooth-colored substrates. Mono, bi, and trilayer veneers (1.5 mm) (n = 12) were made using two shades (A1 and A2) and three opacities (enamel, body, and dentin) of resin composite over simulated lighter (A1) and darker (C4, and C4+) tooth-colored substrates. CIEDE2000 formula was used to calculate ΔE00 considering simulated tooth-colored substrate versus opacities in distinct mono, bi, and trilayer combinations of resin composite over the simulated tooth-colored substrate. The TP was calculated using color coordinates measured over standard white and black backgrounds. Differences in ΔE00 and TP values were calculated with a Three-way Analysis of Variance followed by Tukey's post-hoc test. A1E and A1B monolayer veneers showed similar TP values. Significantly higher ΔE00 values were observed over darker (C4 and C4+), and lower over lighter (A1) simulated tooth-colored substrate. Bilayer and trilayer veneers using dentin opacity provided similar ΔE00 values over the darker tooth-colored substrate. Distinct shades and opacities of resin composite layer combinations over lighter and darker tooth-colored substrates significantly affected TP and ΔE00 values. A1 shade and dentin opacity of monolayer resin composite veneers yielded higher ΔE00 values over darker tooth-colored substrates.

Sleep hygiene measures combined with mindfulness meditation in the management of sleep bruxism in children: A randomized controlled clinical trial.

BACKGROUND: Sleep hygiene measures and meditation may reduce stress and improve sleep quality, but their effect on the occurrence of sleep bruxism in children has not yet been investigated. AIM: To explore the effects of sleep hygiene measures combined with mindfulness meditation (relaxation audio) in the management of probable sleep bruxism (SB) in children. DESIGN: This clinical trial (no. NCT04501237) randomized 36 children with 3-8 years of age. Probable SB detection was performed according to the criteria established by the International Consensus on The Assessment of Bruxism-2018. Intervention group was instructed to practice sleep hygiene measures and mindfulness meditation (i.e., the use of a digital app to broadcast audio relaxation) each night before bedtime for 5 weeks; control group did not receive guidance for therapies. Parents completed a bruxism diary for 5 weeks, and the outcome was the number of SB episodes-day reported in the week (ranging from 0 to 7) in each period. A multilevel mixed-effects Poisson regression model was performed. RESULTS: A total of 32 children (mean age: 6.1 years) completed the study. The children who received the therapies related to sleep hygiene measures and mindfulness meditation had a reduction in the SB incidence rate ratio (IRR) of 46% (IRR = 0.54 [Confidence Interval 95%, 0.45-0.65]) during a 5-week observation period. The sensitivity analyses did not show relevant changes in the measure of the effect. CONCLUSION: Sleep hygiene measures combined with mindfulness meditation reduced the SB in children.

Daily screen time, sleep pattern, and probable sleep bruxism in children: A cross-sectional study.

OBJECTIVE: This study aimed to evaluate the prevalence of probable sleep bruxism (SB) in children aged 7-8 years and its association with sleep pattern and the time spent using devices with a screen. MATERIAL AND METHODS: A cross-sectional study was conducted with children from Pelotas, Brazil (n = 556). Parents/caregivers were interviewed and provided demographic/socioeconomic information, children's daily screen time, nighttime tooth grinding or clenching, sleep duration and answered the Biological Rhythms Interview for Assessment in Neuropsychiatry for Kids (BRIAN-K-sleep domain). Probable SB was determined based on a positive clinical inspection with/without a positive parental/caregiver's reports of tooth clenching or grinding. Hierarchical Poisson regression was performed. RESULTS: The prevalence of probable SB was 15.83% (n = 88). There was no difference in the probable SB prevalence according to the daily screen time (p = 0.744), and low family socioeconomic status was associated with higher SB prevalence (Prevalence Ratio [PR] = 1.95; 95% Confidence Interval [95% CI]: 1.21-3.17; p = 0.006). Higher scores in the sleep domain of the BRIAN-K scale were associated with probable SB [PR = 1.07; 95% CI: 1.01-1.30; p = 0.013]. CONCLUSIONS: Difficulties in maintaining sleep and low family socioeconomic status were associated with probable SB in schoolchildren, while screen time spent using devices with a screen was not associated.

Sleep Bruxism in Puerperal Women: Data from a Population-Based Survey.

OBJECTIVE: To evaluate the self-reported SB prevalence and explore associated risk factors in puerperal women who had given birth in Rio Grande, Southern Brazil. METHODS: A single, standardized questionnaire was given within the 48 h postpartum period. Self-reported SB was the main outcome investigated. Chi-square test was used to compare proportions, and Poisson regression with robust variance adjustment was used in the multivariate analysis. RESULTS: A total of 2225 women were included. Only 79 (3.6%) of these reported clenching or grinding their teeth during sleep. Adjusted analysis showed that the higher education level of the mothers (PR = 3.07; 95% CI 1.49-6.28; P = 0.006); living with three or more persons in the household (PR = 0.54; 95% CI 0.34-0.84; P = 0.007); medication intake during pregnancy (PR = 1.68; 95% CI 1.09-2.58; P = 0.017); smoking (PR = 1.93; 1.16-3.23; P = 0.024), or ever smoked (PR = 1.82; 95% CI 0.85-3.90; P = 0.024); severe anxiety (PR = 1.36; 95% CI 0.61-3.02; P = 0.005); and headache upon waking (PR = 4.19; 95% CI 1.95-9.00; P < 0.001) were significantly associated with self-reported SB. CONCLUSION FOR PRACTICE: Our data pointed towards new factors in a specific group of women that may be relevant for preventing sleep-related behaviors in the pregnancy-puerperal cycle. The higher levels of education, medication intake, smoking or even smoked, severe anxiety, the higher the probability of puerperal woman to self-report SB. The nighttime tooth clenching strongly increased headache upon waking.

Agreement between self-rated denture condition and clinical examination in older adults.

OBJECTIVES: This study aimed to compare differences between complete denture conditions self-rated by older adult wearers and clinically exanimated by a professional based on standardised aesthetics and functional criteria. MATERIALS AND METHODS: Complete denture clinical examination was based on the functional (stability, retention, occlusion and articulation, vertical dimension of occlusion) and aesthetics criteria. Data on self-rated complete denture conditions were measured using the Patient's Denture Assessment (PDA) questionnaire based on standardised aesthetic and functional criteria (n = 122). Prevalence rates of clinical and self-rated complete denture condition, sensitivity, specificity, positive and negative predictive values, and absolute and relative bias were calculated. RESULTS: The highest sensitivity (66.7% [95% CI 55.3-76.7]) was obtained for aesthetic criterion, whereas occlusion revealed the lowest sensitivity (14.9% [95% CI 6.2-28.3]). Stability had the highest specificity (91.3% [95% CI 72.0-98.9]) and aesthetics the lowest (21.4% [95% CI 8.3-41.0]). Stability also yielded the highest positive predictive value (83.3% [95% CI 51.6-97.9]), and vertical dimension of occlusion the lowest (26.3% [95% CI 9.1-51.2]). The vertical dimension of occlusion yielded the highest negative predictive value (71.2% [95% CI 58.7-81.7]). Self-rated data underestimated the complete denture condition in 6.5% compared with clinical examinations when the aesthetic criterion was excluded from the analysis and 7.6% when added. CONCLUSIONS: Older adult wearers better identified the condition of their complete denture when the aesthetic criterion was excluded from examination. In contrast, considering functional criteria (retention, stability, occlusion and vertical dimension of occlusion), self-rated complete denture conditions underestimated clinical examination. CLINICAL RELEVANCE: Using standardised aesthetic criteria in epidemiological studies for assessing complete denture conditions self-rated by wearers could avoid underestimating or overestimating the information regarding the use or need for dental prostheses.

Validity of self-reported oral conditions among Brazilian older women: Do socio-economic factors matter?

OBJECTIVE: To validate the level of agreement between self-report and clinical examination for oral conditions and evaluate the effect of sociodemographic conditions on the validity of self-report among women aged 60 and older. METHODS: A cross-sectional study was conducted in a social community center for seniors in Southern Brazil. Sociodemographic data (age, level of education, and income) were measured. Participants were interviewed and clinically examined for the number of teeth (DMF-T index) and the use of dental prostheses. The self-reported number of teeth in each arch and the use of dental prostheses were gathered through interviews. The level of agreement was estimated using the observed agreement, Kappa statistics, sensitivity/specificity (edentulism/prostheses) and Lin's concordance correlation coefficient, and related tests (number of teeth). The validity of the oral conditions was estimated according to sociodemographic information. RESULTS: Ninety-nine women participated in the study. High levels of agreement were observed for edentulism (97.8%; 95%CI 92.8;99.7; Kappa 0.947) and the use of dental prostheses (97.0%; 95%CI 91.3;99.4; Kappa 0.922). In both conditions, despite achieving similar concordance correlation coefficients (ranging from weak to moderate), the mean number of upper teeth was lower in clinical examination (7.1 ± 5.2) compared with self-reported (8.6 ± 3.6), while the opposite was observed for lower teeth (clinical examination: 9.1 ± 3.4; self-reported: 6.6 ± 5.3). Larger differences were found among women of low income and educational levels. CONCLUSIONS: Our findings suggest that the participants' socio-economic position might influence their self-reported number of teeth.

Invasive surgical procedures for the management of internal derangement of the temporomandibular joint: a systematic review and meta-analysis regarding the effects on pain and jaw mobility.

OBJECTIVES: This systematic review compared minimally and invasive surgical procedures to manage arthrogenous temporomandibular joint (TMJ). MATERIALS AND METHODS: The review included clinical trials assessing surgical procedures of arthrogenous temporomandibular disorder (TMD) management by carrying out comparisons within the same surgical procedure (pre- and post-treatment) as well as between different surgical procedures. Meta-analyses were conducted only for similar comparison reporting the same outcome measures, visual analog scale (VAS) values to evaluate pain and maximum incisal opening (MIO) values. RESULTS: Of the 1,015 studies identified by the search strategy, 26 were selected for full-text reading, and 19 were included in the review. Of these, 16 studies were included in the meta-analysis and 3 in the qualitative analysis. The VAS scores showed significantly lower values after discectomies (p < 0.001) and discoplasties (p < 0.001) in the within-group comparison. Moreover, significantly lower VAS scores and higher MIO values were observed after discectomy compared to arthroscopy, eminectomy, and discoplasty (p < 0.05). CONCLUSION: The findings of this systematic review suggest that although significantly lower VAS scores and higher MIO values were observed after discectomy, the currently available scientific evidence is unclear, and the use of invasive surgical procedures should not be implemented as an efficient first-line treatment option for arthrogenous TMD management. CLINICAL SIGNIFICANCE: VAS and MIO outcomes could be insufficient to describe the success or failure of open surgical procedures like discectomy and discoplasty.

A systematic review and meta-analysis on using preheated resin composites as luting agents for indirect restorations.

OBJECTIVES: This systematic review investigated the hypothesis that preheated resin composites (RCs) used as luting agents improve the mechanical properties, physicochemical performance, and color of indirect ceramic restorations. MATERIALS AND METHODS: Literature search was performed in three databases (Medline/PubMed, Scopus, and Web of Science) and in the grey literature (OpenGrey, ProQuest, and Catalog of Theses & Dissertations from CAPES). Eligibility criteria included only studies comparing at least one preheated RC used as a luting agent with resin cements. RESULTS: Data regarding the mechanical properties, physicochemical characteristics, and color were analyzed qualitatively, and the microtensile bond strength and film thickness were also evaluated by meta-analysis. The search strategy identified 3894 papers, and 28 were full-text screened. Seven studies were included in the review, and 5 were included in the meta-analysis. No significant difference was found for microtensile bond strength (P = 0.14). Preheated RCs showed significantly higher film thickness than resin cements (P = 0.001). CONCLUSION: Overall, the use of preheated RCs as luting agents offers similar to poorer performance than using resin cements for bonding indirect restorations. CLINICAL RELEVANCE: Despite the claim that preheated RC could be used as a luting agent, further studies should investigate the effect of clinically unacceptable film thickness.

Impact of oral motor task training on corticomotor pathways and diadochokinetic rates in young healthy participants.

BACKGROUND: Studies addressing the training-induced neuroplasticity and interrelationships of the lip, masseter, and tongue motor representations in the human motor cortex using single syllable repetition are lacking. OBJECTIVE: This study investigated the impact of a repeated training in a novel PaTaKa diadochokinetic (DDK) orofacial motor task (OMT) on corticomotor control of the lips, masseter, and tongue muscles in young healthy participants. METHODS: A total of 22 young healthy volunteers performed 3 consecutive days of training in an OMT. Transcranial magnetic stimulation was applied to elicit motor evoked potentials (MEPs) from the lip, masseter, tongue, and first dorsal interosseous (FDI, internal control) muscles. MEPs were assessed by stimulus-response curves and corticomotor mapping at baseline and after OMT. The DDK rate from PaTaKa single syllable repetition and numeric rating scale (NRS) scores were also obtained at baseline and immediately after each OMT. Repeated-measures analysis of variance was used to detect differences at a significance level of 5%. RESULTS: There was a significant effect of OMT and stimulus intensity on the lips, masseter, and tongue MEPs compared to baseline (p < .001), but not FDI MEPs (p > .05). OMT increased corticomotor topographic maps area (p < .001), and DDK rates (p < .01). CONCLUSION: Our findings suggest that 3 consecutive days of a repeated PaTaKa training in an OMT can induce neuroplastic changes in the corticomotor pathways of orofacial muscles, and it may be related to mechanisms underlying the improvement of orofacial fine motor skills due to short-term training. The clinical utility should now be investigated.

Effect of preheated composite resin luting agents on the color of ceramic laminates.

This in vitro study evaluated the effects of preheating, ultrasound application, and composite resin luting agent composition on the optical characteristics of feldspar ceramic laminates. The hypothesis was that the optical properties of the ceramic-luting agent-substrate unit would be affected by the composition of the luting material and use of ultrasound. Preheated restorative composite resins Charisma, IPS Empress Direct, and Filtek Z350 were used, with unheated RelyX Veneer resin cement serving as the control. The response variables for the physical properties of the materials were degree of conversion (n = 3 per material) and viscosity (n = 3 per material). Seven groups were generated based on the tested luting agent and the use of ultrasound. Color parameters were evaluated with a spectrophotometer at 3 timepoints (before luting [baseline], 24 hours after luting, and 1 month after luting), and color change was calculated according to the Commission Internationale de l'Eclairage (CIE) CIEDE 2000 formula and translucency parameters. The statistical significance of color change and viscosity was measured using 2-way analysis of variance (ANOVA), while the degree of conversion was measured using 1-way ANOVA. For translucency parameters, ANOVA on ranks and post hoc Duncan multiple range tests were performed. The control group showed the highest degree of conversion, while Filtek Z350 showed the highest viscosity. Statistically significant differences in color change between luting material groups were found under most conditions (P < 0.001), but there was no difference in translucency parameters between the luting materials (P = 0.446). Overall, the use of preheated composite resins as luting agents offers similar to poorer performance than conventional resin cement.

Influence of feldspar ceramic thickness on the properties of resin cements and restorative set.

This in vitro study evaluated the influence of feldspathic ceramic thickness on the properties of light- and dual-cured resin cements. For each cement (RelyX Veneer, Allcem Veneer, RelyX Ultimate, and Allcem Dual), three ceramic specimens were prepared, with seven thicknesses for each (0.5, 1.0, 1.5, 2.0, 2.5, 3.0, and 3.5 mm). The degree of conversion, Vickers microhardness, irradiance power, color variation (ΔE00 ), and translucency parameters were assessed. Microhardness and irradiance power were analyzed using analysis of variance (ANOVA) with post hoc Tukey's test, while ΔE00 , translucency parameters, and degree of conversion were analyzed using ANOVA of ranks with post hoc Duncan's Multiple Range Test. The relationship between each of the dependent variables (degree of conversion, ΔE00 , and translucency parameter tests) and the specimen thickness was described using linear regression for each of the four resin cements. The significance level for all analyses was set at 5%. RelyX Ultimate yielded the lowest degree of conversion values among all resin cements. Allcem Veneer produced the lowest microhardness values, without statistical differences between thicknesses, of up to 1 mm. Allcem Dual produced the highest ΔE00 and translucency parameter values. Feldspathic ceramic thickness influenced the mechanical properties of resin cements and optical aspects of the restorative set.

Multidisciplinary Approach for Reestablishing Function and Aesthetic of Unilateral Cleft Lip Defect: A Case Report.

Cleft lip and/or cleft palate defects often result in a functional deficiency in the patient's chewing, speech ability, and aesthetic appearance, usually demanding multidisciplinary effort for addressing the aesthetic and functional patient's requirements. This clinical report describes the planned oral rehabilitation of a 46-year-old woman with unilateral cleft lip defect based on the patient's peculiarities and age. Due to limitations concerning bone grafts and implant procedures, as well as orthodontic treatment, the prosthodontic rehabilitation using the metal-ceramic fixed partial denture was chosen. The treatment adequately reestablished the aesthetic and functional activities, positively impacting the patient's quality of life.

Early-predictors of marginal bone loss around morse taper connection implants loaded with single crowns: A prospective longitudinal study.

BACKGROUND AND OBJECTIVE: Few studies estimated the joint effect of implant design (length and diameter), peri-implant, and occlusal variables on early marginal bone loss. The monitoring of these factors during the first year after implant loading may be effective in preventing early implant failure. This prospective longitudinal study aimed to identify early-predictors of marginal bone loss around morse-tapered connection implants 12 months after implant loading. METHODS: Participants (n = 33) received 109 morse taper implants inserted subcrestally (diameter: 3.5 to 5 mm, length: 6 to 15 mm) loaded with single crowns. Implants were radiographically examined at the implant placement (baseline) and 12 months after prosthetic loading. Implant, peri-implant, and occlusal-related independent variables were analyzed by decision tree analysis. Mixed-effects multilevel analysis was used to estimate adjusted predictive values of marginal bone loss based on the early-predictors identified in decision tree analysis. RESULTS: Higher marginal bone loss was observed at mesial (mean of 0.87 mm; ranged from 0.5 to 1.19) than at distal sites (mean of 0.73 mm; ranged from 0.4 to 1.12 mm). The predictive model revealed of the largest marginal bone loss in association with cement-retained prostheses, a platform diameter of 3.5 mm, papilla sizes up to 2 mm, keratinized mucosa width inferior to 3 mm, implant lengths above 8.5 mm, inadequate occlusal relations, presence of bleeding on probing and deep peri-implant pocket. CONCLUSION: As implant dimensions, peri-implant and occlusal-related factors were associated with early marginal bone loss around morse taper implant, intervention in these factors might prevent early marginal bone loss.

Interventions to reduce bruxism in children and adolescents: a systematic scoping review and critical reflection.

The aim of the present study was to perform a critical reflection about intervention options for bruxism reduction in children and adolescents. Search was conducted based on the PICO-structured question: "What are the intervention options to reduce bruxism in children/adolescents?". No language, year, or study design restrictions were imposed. Studies reporting interventions to reduce bruxism in children (< 10) and adolescents (10 to 19 years old) were included. Reviews and letters to editors were not included. From 2723 records, 17 papers were included. Included studies were primarily randomized clinical trials performed in Brazil (35.3%) and using different criteria for the diagnosis of bruxism. Reduction in self-reported bruxism and headaches associated with bruxism were observed in studies that used medications (hydroxyzine/trazodone/flurazepam), occlusal splints, orthodontic interventions, and psychological and physical therapy interventions. Reduction in Rhythmic Masticatory Muscle Activity was observed with the use of the occlusal splint and in orthodontic interventions. Alternative treatments (medicinal extracts such as Melissa officinalis-L) have shown inconclusive results.Conclusions: Several intervention options are available to inhibit or reduce bruxism activity. The respective indication, contraindications, and side effects of each treatment option must be assessed individually and carefully, taking into account that bruxism is not considered a disorder in otherwise healthy individuals.What is known• Biological and psychological factors have been strongly correlated to the development of bruxism• Bruxism prevalence ranging from 6 to 50% in childrenWhat is new• Reduction in self-reported bruxism and headaches associated with bruxism were observed in studies that used medication (Hydroxyzine/ Trazodone/ Flurazepam), occlusal splints, orthodontic interventions, psychological, and physical therapy interventions• A reduction in Rhythmic Masticatory Muscle Activity was observed with the use of the occlusal splint and orthodontic interventions. Alternative treatments (medicinal extracts such as Melissa officinalis L) show inconclusive results in respect of the reduction in bruxism.

Tooth discoloration caused by endodontic treatment: A cross-sectional study.

INTRODUCTION: This cross-sectional study evaluated the influence of endodontic filling material, cervical limit of root filling, and tooth location on the color variation (∆E00 ) from 1 to 60 months of follow-up. MATERIALS AND METHODS: Color records were obtained from 70 participants who received 83 endodontic treatments. CIEL*a*b* color coordinates were measured on the homologous tooth, which was considered as baseline, and on endodontic treated teeth with a spectrophotometer. ∆E00 was calculated by the CIEDE2000 method at three conditions (condition 1: homologous tooth vs endodontically treated tooth after ≤1 month; condition 2: homologous tooth vs endodontically treated tooth after >1-12 months; condition 3: homologous tooth vs endodontically treated tooth after >12 months up to 5 years) for each variable. The zinc oxide and eugenol mineral trioxide aggregate or resin-based filling materials, dental cervix or ≥2 mm in the apical direction cervical limit of root filling and anterior or posterior tooth location were considered in the comparisons. Confidence intervals for the means (95% CI) were calculated, ∆E00 values and CIEL*a*b* individual color coordinates were compared for each pair of variables using the Student t test or Welch test (α = .05). RESULTS: Greater ∆E00 values were generally observed in the condition 3 for cervical limit (∆E00 = 10.7), use of zinc oxide and eugenol and mineral trioxide aggregate-based filling materials (∆E00 = 10.7), and anterior teeth (∆E00 = 12.4). Only in the condition 1, the ∆E00 values of the filling materials did not show statistical differences (P = .198). CONCLUSIONS: Higher ∆E00 values were yielded from zinc oxide and eugenol and mineral trioxide aggregate-based filling materials, anterior teeth, and dental cervix cervical limit of root filling. CLINICAL SIGNIFICANCE: Tooth discoloration yielded by endodontic materials and procedures is a challenge to clinical practice resulting in aesthetic problems and discomfort to both patient and professional, especially when it occurs in anterior teeth.

Sense of Coherence mediates the association between temporomandibular disorders and quality of life.

OBJECTIVE: This study aimed to evaluate whether sense of coherence (SOC) mediates the association between temporomandibular disorders (TMD) and oral health-related quality of life (OHRQoL) and general quality of life (QoL) in Brazilian elders. METHODS: Informations on sociodemographic, psychological, and presence or absence of temporomandibular disorders (TMD) were collected by trained dentists among non-institutionalized elders (n = 110). OHRQoL was measured with the Oral Health Impact Profile (OHIP-14) and QoL using the WHOQOL-BREF. Structural equation modeling (SEM) was used to estimate the standardized direct effect of TMD on OHRQoL and on QoL, and the indirect effect mediated by SOC. RESULTS: Temporomandibular disorders had no direct effect on OHRQoL (coef. -0.10), whereas indirect effect mediated by SOC was noted (coef. 0.35). Regarding QoL, the indirect effect of TMD, mediated by SOC, on QoL (coef. 0.58) was higher than the direct effect (coef. 0.34). CONCLUSION: Sense of coherence mediated the effect of TMD on oral and general quality of life among elders.

Influence of inorganic filler content of resin luting agents and use of adhesive on the performance of bonded ceramic.

STATEMENT OF PROBLEM: The inorganic filler of resin-based luting agents and the use of an adhesive layer could influence the bonding ability, mechanical performance, and interface morphology of bonded feldspathic ceramic. PURPOSE: The purpose of this in vitro study was to investigate the influence of resin-based luting agents loaded with different inorganic filler content, with or without an adhesive, on microtensile bond strength, biaxial flexural strength, and the adhesive interface morphology of bonded ceramic specimens. MATERIAL AND METHODS: Experimental resin-based luting agents with low (55wt%), intermediate (65wt%), and high (75wt%) filler contents were bonded to ceramic specimens, with or without a layer of adhesive. The resin-based luting agents were characterized by measuring viscosity, elastic modulus, Poisson ratio, and degree of conversion (n=3 for each test). The response variables for the bonded ceramic specimens were ceramic-resin microtensile bond strength (n=30), biaxial flexural strength (n=30) and characteristic strength, and Weibull modulus. Scanning electron microscopy was used for fractographic and interface analyses of the specimens fractured in the microtensile test (n=3). Data were subjected to ANOVA with the post hoc Tukey test (α=.05). Weibull moduli were also calculated. RESULTS: Increased inorganic filler content yielded significantly higher viscosity, stiffness, and film thickness. However, the Poisson ratio and degree of conversion were not affected. The lowest bond strength values were observed for the resin-based luting agents with high inorganic filler content when no adhesive was used and for the resin-based luting agent with low filler content when the adhesive was used. The increase in filler content of the resin-based luting agent appeared to be associated with a higher frequency of mixed failures. Increased filler content resulted in higher biaxial flexural and characteristic strength and decreased structural reliability. The adhesive helped fill irregularities on ceramic and slightly increased film thickness but had only a minor effect on mechanical strength. CONCLUSIONS: Experimental resin-based luting agent loaded with high inorganic filler content strengthened the bonded feldspathic ceramic and yielded significantly higher viscosity and film thickness. In contrast, the bond strength was lower if no adhesive was used.

Chemical hygiene protocols for complete dentures: A crossover randomized clinical trial.

STATEMENT OF PROBLEM: Clinical evidence on the best chemical protocol for the disinfection and removal of biofilm from complete dentures is lacking. PURPOSE: The purpose of this crossover randomized clinical trial was to assess the effectiveness of various chemical hygiene clinical protocols in reducing the microbial viability of biofilm formed on complete dentures. MATERIAL AND METHODS: In this triple-blind (participants, dentist, and outcome evaluator) study, complete denture wearers without candidiasis were randomly divided into 4 groups (n=40) according to the chemical hygiene protocol: water (placebo), 0.5% sodium hypochlorite solution, 0.12% chlorhexidine gluconate solution, and 5% sodium bicarbonate solution. The biofilm formed on the palate intaglio and denture teeth was collected and assessed in each experimental phase for quantitative microbial viability at the seventh and 14th day after using the chemical protocol. RESULTS: Two participants were lost. Data were analyzed by MANOVA and Tukey HSD tests. Soaking dentures was not effective in decreasing Candida albicans, C. non-albicans, and lactobacillus counts. The use of sodium hypochlorite and chlorhexidine decreased total microorganisms and Streptococcus mutans counts for both palate and teeth compared with water and sodium bicarbonate. The intaglio of the dentures always presented higher microbial counts than did the denture teeth. CONCLUSIONS: The use of sodium hypochlorite and chlorhexidine and mechanical cleansing with a toothbrush decreased microbial viability in healthy complete denture wearers.

Parafunctional loading and occlusal device on stress distribution around implants: A 3D finite element analysis.

STATEMENT OF PROBLEM: An occlusal device is frequently recommended for patients with bruxism to protect implant-supported restorations and prevent marginal bone loss. Scientific evidence to support this treatment is lacking. PURPOSE: The purpose of this 3-dimensional (3D) finite element study was to evaluate the influence of an acrylic resin occlusal device, implant length, and insertion depth on stress distribution with functional and parafunctional loadings. MATERIAL AND METHODS: Computer-aided design software was used to construct 8 models. The models were composed of a mandibular bone section including the second premolar and first and second molars. Insertion depths (bone level and 2 mm subcrestal) were simulated at the first molar. Three natural antagonist maxillary teeth and the placement or not of an occlusal device were simulated. Functional (200-N axial and 10-N oblique) and parafunctional (1000-N axial and 25-N oblique) forces were applied. Finite element analysis (FEA) was used to determine the maximum principal stress for the cortical and trabecular bone and von Mises for implant and prosthetic abutment. RESULTS: Stress concentration was observed at the abutment-implant and the implant-bone interfaces. Occlusal device placement changed the pattern of stress distribution and reduced stress levels from parafunctional loading in all structures, except in the trabecular bone. Implants with subcrestal insertion depths had reduced stress at the implant-abutment interface and cortical bone around the implant abutment, while the stress increased in the bone in contact with the implant. CONCLUSIONS: Parafunctional loading increased the stress levels in all structures when compared with functional loading. An occlusal device resulted in the lowest stress levels at the abutment and implant and the most favorable stress distribution between the cortical and trabecular bone. Under parafunctional loading, an occlusal device was more effective in reducing stress distribution for longer implants inserted at bone level. Subcrestally, implant insertion yielded the most favorable biomechanical conditions at the abutment-implant interface and at the coronal surface of the cortical bone, mainly when there was no occlusal device.