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.

Diagnostic criteria for temporomandibular disorders: self-instruction or formal training and calibration?

BACKGROUND: To investigate the difference in diagnostic reliability between self-instructed examiners and examiners taught in a Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) course and if the reliability of self-instructed examiners improves after the course. METHODS: Six examiners were divided into three groups: (1) formal two-day training and calibration course at a DC/TMD training center (Course group), (2) self-teaching through documents and movie (Self group) with three examiners on each and the Self group later participated in the course (Self + course group). Each group examined sixteen subjects, total of 48 volunteers (36 patients with TMD and 12 asymptomatic) and the reliabilities in relation to the diagnoses derived by a Reference Standard Examiner were compared by Cohen's Kappa coefficient. RESULTS: The reliability was good to excellent in all three groups of examiners for all DC/TMD diagnoses, except for Myofascial pain with referral in the Self + course group. The course seemed to improve the reliability regarding Myalgia and Arthralgia at the same time as the examiners experienced the course to be valuable for self-perceived ability and confidence. CONCLUSIONS: This study shows that the diagnostic reliability of formal DC/TMD training and calibration and DC/TMD self-instruction are similar, except for subgroups of Myalgia. Thus, self-instruction seems to be possible to use to diagnose the most common TMDs in general dental practice. The course further improves the reliability regarding Myalgia and Arthralgia at the same time as the examiners experienced the course to be valuable for self-perceived ability and confidence.

Kinesiographic study of masticatory movements in denture wearers with normal and resorbed denture-bearing areas.

STATEMENT OF PROBLEM: An unfavorable denture-bearing area could compromise denture retention and stability, limit mastication, and possibly alter masticatory motion. PURPOSE: The purpose of this study was to evaluate the masticatory movements of denture wearers with normal and resorbed denture-bearing areas. MATERIAL AND METHODS: Completely edentulous participants who received new complete dentures were selected and divided into 2 groups (n=15) according to the condition of their denture-bearing areas as classified by the Kapur method: a normal group (control) (mean age, 65.9 ± 7.8 years) and a resorbed group (mean age, 70.2 ± 7.6 years). Masticatory motion was recorded and analyzed with a kinesiographic device. The patients masticated peanuts and Optocal. The masticatory movements evaluated were the durations of opening, closing, and occlusion; duration of the masticatory cycle; maximum velocities and angles of opening and closing; total masticatory area; and amplitudes of the masticatory cycle. The data were analyzed by 2-way ANOVA and the Tukey honestly significant difference post hoc test (α=.05). RESULTS: The group with a resorbed denture-bearing area had a smaller total masticatory area in the frontal plane and shorter horizontal masticatory amplitude than the group with normal denture-bearing area (P<.05). CONCLUSIONS: Denture wearers with resorbed denture-bearing areas showed reduced jaw motion during mastication.

Mastication movements and sleep quality of patients with myofascial pain: occlusal device therapy improvements.

STATEMENT OF PROBLEM: Patients with myofascial pain experience impaired mastication, which might also interfere with their sleep quality. PURPOSE: The purpose of this study was to evaluate the jaw motion and sleep quality of patients with myofascial pain and the impact of a stabilization device therapy on both parameters. MATERIAL AND METHODS: Fifty women diagnosed with myofascial pain by the Research Diagnostic Criteria were enrolled. Pain levels (visual analog scale), jaw movements (kinesiography), and sleep quality (Epworth Sleepiness Scale; Pittsburgh Sleep Quality Index) were evaluated before (control) and after stabilization device use. Range of motion (maximum opening, right and left excursions, and protrusion) and masticatory movements during Optosil mastication (opening, closing, and total cycle time; opening and closing angles; and maximum velocity) also were evaluated. Repeated-measures analysis of variance in a generalized linear mixed models procedure was used for statistical analysis (α=.05). RESULTS: At baseline, participants with myofascial pain showed a reduced range of jaw motion and poorer sleep quality. Treatment with a stabilization device reduced pain (P<.001) and increased both mouth opening (P<.001) and anteroposterior movement (P=.01). Also, after treatment, the maximum opening (P<.001) and closing (P=.04) velocities during mastication increased, and improvements in sleep scores for the Pittsburgh Sleep Quality Index (P<.001) and Epworth Sleepiness Scale (P=.04) were found. CONCLUSION: Myofascial pain impairs jaw motion and quality of sleep; the reduction of pain after the use of a stabilization device improves the range of motion and sleep parameters.

Craniofacial Morphology Affects Bite Force in Patients with Painful Temporomandibular Disorders.

Craniofacial morphology affects masticatory performance in healthy dentate subjects, but little is known about its effects in patients with painful temporomandibular disorders (TMDs). Forty-eight female patients (mean age of 28±5.8 years) with painful TMDs underwent lateral cephalometric radiography. Using Ricketts' cephalometric analysis and the Vert method, subjects were assigned to three groups according to their craniofacial morphology: brachyfacial (n=22), mesofacial (n=13), and dolichofacial (n=13). Research diagnostic criteria for TMD were used to confirm the TMD diagnosis for each patient. Pain intensity was reported by each patient based on a visual analog scale (VAS). Maximum bite force (MBF) was measured with pressure sensors placed on the first molar site. Masticatory performance (MP) was assessed by chewing a silicone-based artificial material and determining the resulting particle size by the sieve method. Chewing ability (CA) was evaluated for seven food types and analyzed by a VAS questionnaire. Data were analyzed by one-way ANOVA followed by a Tukey-Kramer test (p<0.05). MBF differed in each group, with brachyfacial patients having the highest MBF values. There was no difference in MP among the groups. The groups differed only in their ability to chew one of the seven evaluated food types. In summary, craniofacial morphology affects the MBF without impairing MP or CA in patients with painful TMDs.

Conventional Complete Denture in Patients with Ectodermal Dysplasia.

Ectodermal dysplasia is described as heritable conditions that involve anomalies of structures derived from the ectoderm, including hypodontia. In the cases of edentulous young patients, who did not finish their craniofacial growth, treatment with conventional complete denture is a suitable alternative. The aim of this study was to report a case of mandibular edentulism treated with conventional complete denture in a thirteen-year-old patient diagnosed with hidrotic ectodermal dysplasia. Typical features, such as frontal bossing, depressed nasal bridge, protuberant lips, scarce hair, and brittle nails, were visualized during the extraoral examination. The intraoral inspection and radiographic analysis revealed oligodontia, dental malformation, and prolonged retention of deciduous teeth at maxilla and total edentulism at mandible. A conventional complete denture was planned and constructed following the same steps of technique as recommended in adults. Although this option is not a definitive treatment, the patient and his parents were satisfied with his improvement in chewing and speech, as well as with the aesthetic benefits.

Apexification of an Immature Permanent Incisor with the Use of Calcium Hydroxide: 16-Year Follow-Up of a Case.

Apexification is a process of forming a mineralized apical barrier and had been performed by using calcium hydroxide paste, due to its biological and healing performances in cases of existent trauma. This clinical report aims to report the results of a 16-year follow-up study of an apexification treatment applied to nonvital tooth 22 of a healthy 8-year-old male after a trauma. Clinical inspection of the tooth showed fractures of the incisal edge and mesial angle, absence of coronal mobility, and negative pulp vitality under cold testing. Radiographic analysis of the root revealed incomplete apex formation. The possibility of fracture into the root or luxation injury was rejected, and the diagnosis of pulp necrosis was verified. Apexification by calcium hydroxide and subsequent endodontic treatment were planned. Initial formation of the mineralized apical barrier was observed after 3 months, and the barrier was considered to be completed after 8 months. Clinical, radiographic, and CBCT examinations after 16 years verified the success of the treatment, although the choice of calcium hydroxide for apexification treatment is discussed.

Esthetic Rehabilitation of the Smile with No-Prep Porcelain Laminates and Partial Veneers.

Rehabilitation of patients with anterior conoid teeth may present a challenge for the clinician, especially when trying to mimic the nature with composite resins. This clinical report exemplifies how a patient with conoid upper lateral incisors was rehabilitated with minimally invasive adhesive restorations. Following diagnostic wax-up and cosmetic mock-up, no-prep veneers and ceramic fragments (partial veneers) were constructed with feldspathic porcelain. This restorative material presents excellent reproduction of the optical properties of the dental structure, especially at minimal thicknesses. In this paper, the details about the treatment are described. A very pleasing outcome was achieved, confirming that minimally invasive adhesive restorations are an excellent option for situations in which the dental elements are healthy, and can be modified exclusively by adding material and the patient does not want to suffer any wear on the teeth.

Reproducibility of a silicone-based test food to masticatory performance evaluation by different sieve methods.

The aim of this study was to evaluate the reproducibility of the condensation silicone Optosil Comfort® as an artificial test food for masticatory performance evaluation. Twenty dentate subjects with mean age of 23.3±0.7 years were selected. Masticatory performance was evaluated using the simple (MPI), the double (IME) and the multiple sieve methods. Trials were carried out five times by three examiners: three times by the first, and once by the second and third examiners. Friedman's test was used to find the differences among time trials. Reproducibility was determined by the intra-class correlation (ICC) test (α=0.05). No differences among time trials were found, except for MPI-4 mm (p=0.022) from the first examiner results. The intra-examiner reproducibility (ICC) of almost all data was high (ICC≥0.92, p<0.001), being moderate only for MPI-0.50 mm (ICC=0.89, p<0.001). The inter-examiner reproducibility was high (ICC>0.93, p<0.001) for all results. For the multiple sieve method, the average mean of absolute difference from repeated measurements were lower than 1 mm. This trend was observed only from MPI-0.50 to MPI-1.4 for the single sieve method, and from IME-0.71/0.50 to IME-1.40/1.00 for the double sieve method. The results suggest that regardless of the method used, the reproducibility of Optosil Comfort® is high.

Marginal microleakage of class V resin-based composite restorations bonded with six one-step self-etch systems.

This study compared the microleakage of class V restorations bonded with various one-step self-etching adhesives. Seventy class V resin-based composite restorations were prepared on the buccal and lingual surfaces of 35 premolars, by using: Clearfil S3 Bond, G-Bond, iBond, One Coat 7.0, OptiBond All-In-One, or Xeno IV. The Adper Single Bond etch-and-rinse two-step adhesive was employed as a control. Specimens were thermocycled for 500 cycles in separate water baths at 5°C and 55°C and loaded under 40 to 70 N for 50,000 cycles. Marginal microleakage was measured based on the penetration of a tracer agent. Although the control showed no microleakage at the enamel margins, there were no differences between groups (p = 0.06). None of the adhesives avoided microleakage at the dentin margins, and they displayed similar performances (p = 0.76). When both margins were compared, iBond® presented higher microleakage (p < 0.05) at the enamel margins (median, 1.00; Q3-Q1, 1.25-0.00) compared to the dentin margins (median, 0.00; Q3-Q1, 0.25-0.00). The study adhesives showed similar abilities to seal the margins of class V restorations, except for iBond®, which presented lower performance at the enamel margin.

Is migraine a complicating factor for evidence-based therapy for masticatory myofascial pain? A case-control study.

OBJECTIVE: This study aimed to assess the response to conservative treatment of pain in patients diagnosed with masticatory myofascial pain (MMP) with or without migraine. STUDY DESIGN: A total of 61 patients were evaluated and divided into 2 groups: Group 1 (G1), patients with MMP (n = 34); Group 2 (G2), patients with MMP and migraine (n = 27). Pain was assessed subjectively by visual analog scale (VAS) and objectively through masticatory muscle palpation at baseline and after 3 treatment visits. Treatment included occlusal appliances, medication, and self-care exercises. RESULTS: G2 reported greater discomfort subjectively and objectively at all evaluation visits; however, significant difference between groups was noted objectively only at baseline (P = .0052). Regardless of group, pain levels decreased significantly over time as measured by VAS analyses (G1 P = .0033; G2 P = .0031) and muscle palpation (G1 P < .0001; G2 P < .0001). CONCLUSIONS: Evidence-based therapy improved pain scores over time in MMP patients regardless of the presence of migraine.

Otimização da moldeira individual / Individual tray optimization

A moldeira individual é preconizada para a realização da moldagem funcional, confeccionada a partir de um modelo preliminar realizado com moldeiras de estoque, para determinar os limites da área basal de acordo com a fisiologia das estruturas anatômicas presentes. O objetivo deste estudo foi relatar a técnica de Tomaz Gomes para confecção de moldeira individual, com o intuito de facilitar sua execução. A técnica preconiza a inserção primeiramente do polímero, seguido de gotas de monômero auto polimerizável, em 3 camadas para cada hemi-arco, até que apresente uma espessura aproximada a 3 mm, em toda a sua extensão, lisura, transparência e distância de 2 a 3 mm entre a borda da moldeira e o fundo de sulco. Desta maneira, a moldeira individual de Tomaz Gomes flexibilizou o tempo de trabalho e não requer grandes habilidades manuais, facilitando a execução da mesma.

The individual tray is recommended to perform the functional impression made from a preliminary model performed with stock trays to determine the limits of maximum edentulous area according to the anatomical structures. Thus, the aim of this study was to report a Tomaz Gomes technique for making custom tray, in order to optimize and reduce thermal expansion and distortion during the creation. The technique demands, firstly the insertion of the polymer powder followed by monomer drops, in three layers until the individual tray presents a thickness of approximately 3 mm in its entire length, smoothness, and has a distance of 2 to 3 mm from the edge of tray to labial vestibule, and wear in the regions of the frenulum and muscle insertions, and holds the entire length of the tray. Thus, the individual tray of Tomaz Gomes produces a regular layer of molding material is anatomically and faithfully reproduces the shaped areas, in particular the total edentulous mucosa.

Craniofacial Morphology Affects Bite Force in Patients with Painful Temporomandibular Disorders

Abstract Craniofacial morphology affects masticatory performance in healthy dentate subjects, but little is known about its effects in patients with painful temporomandibular disorders (TMDs). Forty-eight female patients (mean age of 28±5.8 years) with painful TMDs underwent lateral cephalometric radiography. Using Ricketts' cephalometric analysis and the Vert method, subjects were assigned to three groups according to their craniofacial morphology: brachyfacial (n=22), mesofacial (n=13), and dolichofacial (n=13). Research diagnostic criteria for TMD were used to confirm the TMD diagnosis for each patient. Pain intensity was reported by each patient based on a visual analog scale (VAS). Maximum bite force (MBF) was measured with pressure sensors placed on the first molar site. Masticatory performance (MP) was assessed by chewing a silicone-based artificial material and determining the resulting particle size by the sieve method. Chewing ability (CA) was evaluated for seven food types and analyzed by a VAS questionnaire. Data were analyzed by one-way ANOVA followed by a Tukey-Kramer test (p<0.05). MBF differed in each group, with brachyfacial patients having the highest MBF values. There was no difference in MP among the groups. The groups differed only in their ability to chew one of the seven evaluated food types. In summary, craniofacial morphology affects the MBF without impairing MP or CA in patients with painful TMDs.

Resumo A morfologia craniofacial afeta a performance mastigatória em individuos dentados saudáveis, mas pouco é conhecido sobre seus efeitos em pacientes com desordens temporomandibulares (DTMs) com sintomatologia dolorosa. Quarenta e oito pacientes do gênero feminino (idade média de 28±5,8 anos) com DTM e sintomatologia dolorosa foram submetidas à radiografia cefalométrica lateral. Por meio da análise cefalométrica de Ricketts e método Vert, as voluntárias foram divididas segundo a morfologia crabiofacial em: braquifaciais (n=22), mesofaciais (n=13) ou dolicofaciais (n=13). O Research Diagnostic Criteria for TMD (RDC/TMD) foi utilizado para diagnosticar a presença de DTM em cada paciente. A intensidade de dor foi reportada por cada paciente usando a escala visual analógica (EVA). A força máxima de mordida (FMM) foi medida com sensores de pressão colocados na região de primeiros molares. A performance mastigatória (PM) foi avaliada por meio da mastigação de material artificial confeccionado à base de silicone e determinada pelo tamanho da partícula, usando o método de fracionamento em peneiras. A habilidade mastigatória (HM) foi avaliada por meio de sete tipos de alimento e analisada por meio de EVA. Os dados foram analisados por ANOVA, seguido por teste de Tukey-Kramer (p<0,05). A FMM foi diferente entre cada grupo, sendo que as pacientes braquifaciais apresentaram os maiores valores. Não houve diferença na PM entre os grupos. Os grupos somente diferiram quanto à HM para mastigar apenas um dos sete tipos de alimentos avaliados. Em resumo, a morfologia craniofacial afeta a FMM sem prejudicar a PM ou HM em pacientes com DTM e sintomatologia dolorosa.

Female hormones fluctuation and chewing movement of patients with disc displacement / Flutuação hormonal feminina e o movimento mastigatório de pacientes com deslocamento de disco

PURPOSE: This study aimed to verify the influence of hormonal fluctuations on chewing movement in women with disc displacement (DD). METHODS: Fourteen women with DD taking oral contraceptives (OC); 12 DD-free controls taking OC; 12 normally cycling women with DD; and 14 DD-free normally cycling women were included. The Research Diagnostic Criteria for Temporomandibular Disorders diagnosed DD, and subjects without pain were selected. Chewing movements were recorded using a kinesiograph. Dependent variables were: vertical, lateral, and anterior-posterior amplitudes (mm), opening and closing velocity (mm/s), which was evaluated in 4 phases of 3 menstrual cycles, identified by ovulation test. Data were submitted to Mauchly's sphericity test, Proc Mixed for repeated measures, and Tukey-Kramer test (P ≤ 0.05). RESULTS: Comparisons among menstrual cycle phases showed no differences in vertical (P = 0.25), lateral (P = 0.12), and anterior-posterior amplitudes (P = 0.61); as well as opening (P = 0.57) or closing velocity (P = 0.73). The OC use or presence of DD did not influence the variables (P > 0.05). CONCLUSION: Hormonal fluctuation did not influence chewing mandibular movement of women with DD.

OBJETIVO: Este estudo objetivou verificar a influência das flutuações hormonais nos movimentos mastigatórios de mulheres com deslocamento de disco (DD). METODOLOGIA: Foram selecionadas 14 mulheres com DD usuárias de contraceptivos orais (CO), 12 mulheres sem DD usuárias de OC (controle); 12 mulheres com DD e ciclos menstruais regulares e 14 mulheres sem DD e ciclos menstruais regulares. O Research Diagnostic Criteria para Desordens Temporomandibulares diagnosticou o DD, e voluntárias sem dor foram selecionadas. Os movimentos mastigatórios foram registrados usando um cinesiógrafo. Variáveis ​dependentes foram: amplitudes vertical, lateral e ântero-posterior (mm), velocidade de abertura e fechamento (mm/s), sendo avaliadas nas 4 fases de 3 ciclos menstruais, identificado por teste ovulatório. Os dados foram submetidos ao teste de esfericidade de Mauchly, Proc Mixed para medidas repetidas e Tukey-Kramer (P ≤ 0,05). RESULTADOS: Comparações entre as fases do ciclo menstrual não mostraram diferenças nas amplitudes vertical (P = 0,25), lateral (P = 0,12), e ântero-posterior (P = 0,61), bem como na velocidade de abertura (P = 0,57) ou fechamento (P = 0,73). O uso OC e a presença de DD não influenciaram as variáveis (P > 0,05). CONCLUSÃO: A flutuação hormonal não influenciou o movimento mandibular mastigatório de mulheres com DD.

Fechamento de diastema com restaurações cerâmicas ultraconservadoras / Midline diastema closurewithultra-conservativeceramicrestorations

A literatura sugere diferentes abordagens para o fechamento de diastemas, as quais podem incluir tratamento ortodôntico, restaurador, ou a combinação de ambos. O presente trabalho tem o objetivo de relatar, por meio de um caso clínico, uma abordagem ultraconservadora para o fechamento de diastema entre incisivos centrais superiores com fragmentos cerâmicos. Os fragmentos cerâmicos û facetas parciais sem preparo - quando corretamente indicados para fechamento de diastema podem ser considerados uma excelente opção, pois aliam os benefícios da Odontologia minimamente invasiva, como a máxima preservação da estrutura dentária, às vantagens dos sistemas cerâmicos. A cerâmica mimetiza ao máximo as estruturas naturais dos elementos dentários, sendo uma excelente opção para suprir as diversas deficiências da resina composta.

The literature suggests different approaches for closing diastema, which may include orthodontic treatment, restorative treatment, or a combination of both. This study aims to report a clinical case, an ultra-conservative method to close adiastema between the maxillary central incisors with ceramic fragments. Ceramic fragments ûunprepared partial veneers - when properly indicated for diastema closure may be considered an excellent option since it combines the benefits of minimally invasive Dentistry, such as the maximum preservation of dental structure, to the advantages of ceramic systems. Ceramic can mimic natural teeth structure and is an excellent option to make up the various shortcomings of the composite resin.