Cambios en parámetros masticatorios con prótesis parcial removible para dientes posteriores perdidos / Changes in masticatory parameters with removable partial dentures for missing posterior teeth

Introducción: el reemplazo de dientes perdidos aspira a mejorar la función masticatoria. Aunque hay diferentes opciones para ello, la conveniencia de la prótesis parcial removible (PPR) es su bajo costo. Objetivo: comparar el desempeño masticatorio (DM) después de 20 ciclos masticatorios y al umbral de la deglución (UD) en adultos de 50 a 70 años con dientes posteriores perdidos (DPP), con/sin PPR; y los ciclos hasta la deglución. Material y métodos: estudio transversal en 35 adultos con dientes anteriores y PPR bien ajustadas y utilizadas para comer. El lado de prueba fue el lado con más DPP. El DM se evaluó después de 20 ciclos y al UD utilizando un alimento prueba artificial (Optosil Comfort®) con/sin la PPR en orden aleatorizado. Las partículas se tamizaron para determinar el tamaño medio de partícula (TMP) como medida del DM. Los ciclos se contaron visualmente. Estadística descriptiva y comparaciones con SPSS-v23. Resultados: hubo diferencias significativas (p ≤ 0.05) al masticar con/sin PPR. El TMP fue más pequeño (mejor DM) con la PPR después de 20 ciclos y al UD (3.9 vs 4.4 mm y 3.2 vs 4.2 mm). Los ciclos para llegar al UD disminuyeron con la PPR (40 vs 47). Conclusión: a pesar de una mejora limitada de la función masticatoria, las PPR ayudan a preparar los alimentos en partículas más pequeñas antes de deglutirlas. La mejoría en DM con PPR es de 24% al UD, realizando menos ciclos antes de deglutir sus alimentos (AU)

Introduction: replacement of missing teeth should improve masticatory function. Although there are different options removable partial dentures (RPD) are used due to their lower cost. Objective: to compare masticatory performance (MP) after 20 chewing-cycles and swallowing-threshold (ST) in 50-70 year-old adults with missing posterior teeth (MPT) with and without their cast-metal RPD; chewing cycles until swallowing were also compared. Material and methods: 35 adults participated in this cross-sectional study. Subjects with anterior teeth and welladjusted RPDs, used for eating were included. The side with more MPT was selected as the test side. MP was evaluated after 20 cycles and ST using an artificial test-food (Optosil Comfort®) with/without the RPD (subject-own-control) (randomized order). Chewed particles were sieved to determine medium-particle-size (MPS) as a measure of MP. Chewing cycles were visually counted. Descriptive statistics and comparisons were run with SPSS v23. Results: there were significant differences (p ≤ 0.05) for all parameters when chewing with/without the RPD. MPS was smaller (better MP) with the RPD (3.9 vs 4.4 mm and 3.2 vs 4.2 mm) after 20 cycles and ST respectively. Cycles required to reach ST were less when chewing with the denture (40 vs 47). Conclusion: despite a limited improvement of masticatory function RPDs help patients prepare their food into smaller particles before swallowing. Improvement in MP with RPDs for patients with MPT is 24% at ST and they perform fewer chewing cycles before swallowing food (AU)

Relationship between tooth loss, nutritional status and consumption of macro and micronutrients in elderly people from southern Brazil

Maintaining a functional natural dentition plays an important role in keeping a satisfactory nutritional status. The aim of this study was to evaluate the relationship between oral health conditions determined by the presence of edentulism and the number of missing teeth, nutritional status and consumption of nutrients by the elderly. This cross-sectional study comprised 494 independent elderly of both genders, over 60 years of age, registered at the Brazilian public health service in Londrina, southern Brazil. The data collection included: oral examinations; anthropometric measurements by calculating the Body Mass Index (BMI); analysis of food consumption based on a multiple pass 24-hour dietary recall and a food intake frequency questionnaire; and structured interviews to obtain sociodemographic information. Multiple linear regression, the Fisher's Exact test, chi-square and Mann-Whitney tests, were applied at a 5% significance level. The prevalence of edentulism was 47.3%; this predominated in females, age group from 65 to 74 years, low education level and low/medium economic classification. A larger numberof underweight and fewer number of overweight elderly were recorded among the edentulous versus dentate participants (< 0.0001). Significantly lower consumption of several nutrients, as well as fruit, was recorded among the edentulous group. In particular, carbohydrates, vitamins (B1, B9 and C), and the majority of the minerals studied were associated with a larger number of missing teeth. In conclusion, tooth loss was associated with the food consumption pattern of some macro-and micronutrients and the nutritional status of the Brazilian elderly.

Undesirable course of an oral implant rehabilitation in a patient with a long history of bulimia nervosa: case report and review of the literature.

BACKGROUND: Bulimia nervosa is an eating disorder resulting in an intended weight loss due to decreased food intake, induced vomiting, or hyperactivity, and is observed frequently between 12 and 25 years of age. One of the complications is early tooth loss. Moreover, since bulimia nervosa patients suffer from increased atrophy of the alveolar processes, oral rehabilitation even with short dental implants may be impossible. In these cases, lateralization or transposition of the inferior alveolar nerve (IAN) followed by implant placement can be useful. CASE PRESENTATION: A 40-year-old woman with a long-lasting history of bulimia nervosa requested a fixed rehabilitation of her partially edentulous mandible. In 2012, a bilateral IAN transposition approach was performed using piezosurgery, and without any postoperative neurosensory alterations. Two years later, bilateral insertion of each two implants was followed by an inflammatory destabilization of the lower left mandible; subsequent to the implant removal, a fracture occurred, and the latter was stabilized by osteosynthesis plates. In 2017, three additional implants were placed, finally providing the patient with a fixed restoration on five implants. CONCLUSION: Eating disorders may have a tremendous impact on both physical condition and oral health, resulting in early tooth loss and severe bone atrophy. IAN transposition is a viable treatment option to enable installing fixed prostheses via dental implants, but the latter will clearly increase the risk of inflammation and interruption of mandibular continuity. Close clinical and radiologic monitoring is mandatory to adequately respond to complications such as peri-implant mucositis, peri-implantitis, osteomyelitis, or concomitant fractures.

Rehabilitation of lost teeth related to maintenance of cognitive function.

OBJECTIVE: As the era of aging comes, cognitive impairment (CI) is increasing. The impact of rehabilitation of lost tooth on CI remains unclear. This study aimed to investigate whether non-rehabilitated lost teeth (NRLT) is associated with CI among Korean elders. METHODS: A total of 280 elders comprising of 140 cases and 140 age-sex-matched controls were included in this cross-sectional study. CI was assessed using the Mini-Mental Status Examination (MMSE). NRLT was evaluated using panoramic radiograph and oral examination. NRLT was categorized into low (≤4) and high (≥5). Age, sex, education, drinking, smoking, exercise, obesity, hypertension, subclinical atherosclerosis, glucose, cholesterol, depression, and denture-wearing were considered as confounders. Conditional multivariate logistic regression analysis was applied to assess the adjusted association. RESULTS: NRLT was associated with increased CI after controlling for confounders (odds ratio [OR] = 1.06, 95% confidence interval [95% CFI]: 1.00-1.13). However, lost teeth were not associated with CI. Those with high NRLT (≥5) compared to those with low NRLT (≤4) was more likely to have CI by 2.7 times (OR = 2.74, 95% CFI = 1.28-5.86). CONCLUSION: Our data showed that NRLT was independently associated with CI. Hence, rehabilitation of the lost teeth could be important for the maintenance of cognitive function.

A falta de dentição funcional está associada ao comprometimento das funções bucais entre adultos brasileiros / The absence of functional dentition is associated with the lack of commitment to oral functions among Brazilian adults

Resumo Objetivou-se identificar se a falta de dentição funcional (DF) está associada com o comprometimento das funções bucais/atividades diárias entre adultos brasileiros. Para isto, foram utilizados dados da Pesquisa Nacional de Saúde Bucal - SB Brasil 2010. A DF foi avaliada pelo critério proposto pela Organização Mundial de Saúde (pelo menos 20 dentes na boca). O instrumento Impactos Odontológicos nos Desempenhos Diários (IODD) foi utilizado para avaliar as atividades diárias/funções bucais. Análises descritivas, bivariadas (Qui-quadrado) e múltiplas (Regressão Logística) foram realizadas, sendo estimado o odds ratio e o intervalo de confiança 95% (OR/IC95%). Foram incluídos e avaliados 9564 adultos. Foram considerados sem DF 2200 adultos (20,5%). Tiveram impacto em pelo menos uma das atividades diárias/funções bucais avaliadas, 55,0% dos adultos. A falta de DF entre adultos foi associada (p ≤ 0,05) com o impacto na fala (1,88/1,33-2,64) e vergonha ao sorrir ou falar (1,35/1,00-1,83). Uma prevalência considerável de falta de DF foi identificada, esta ausência foi associada às atividades diárias/funções bucais (fala e vergonha ao sorrir e falar). A reabilitação dentária de pacientes sem DF deve considerar a devolução destas funções bucais perdidas (fala e vergonha ao sorrir ou falar).

Abstract The scope of this study was to identify if the absence of functional dentition (FD) is associated with a lack of commitment to oral functions/daily activities among Brazilian adults. For this purpose, data from the National Survey of Oral Health (referred to as SB Brasil 2010) was used. FD was evaluated by the criterion proposed by the WHO (at least 20 teeth in the mouth). The Oral Impacts on Daily Performance (OIDP) questionnaire was used to evaluate daily activities/oral functions. Descriptive, bivariate (chi-squared) and multiple (logistic regression) analysis was conducted, and the odds ratio estimated with a 95% confidence interval (OR/CI95%). The research evaluated 9,564 adults, of which 2,200 adults (20.5%) were considered to have poor FD, and at least one of the daily activities/oral functions evaluated had an impact among 55% of adults. The lack of FD between adults was associated (p ≤ 0.05) with the impact on speech (1.88/1.33-2.64) and being ashamed to smile or talk (1.35/1.00-1.83). A considerable prevalence of lack of FD was identified, this absence being associated with the lack of commitment to the daily activities/oral functions. Dental rehabilitation of patients with a lack of FD should consider the restoration of these lost oral functions (speech and being ashamed to smile or talk).

Full-Mouth Rehabilitation with Calvarium Bone Grafts and Dental Implants for a Papillon-Lefèvre Syndrome Patient: Case Report.

Papillon-Lefèvre syndrome (PLS) is a rare autosomal recessive disorder of keratinization associated with palmoplantar keratoderma and severe periodontitis resulting in complete edentulism in late adolescence. The pathognomonic dental features of PLS are pathologic migration, hypermobility, and exfoliation of the teeth without any signs of root resorption. It has been suggested that an effective way to treat PLS patients presenting early in the disease progression is extraction of the erupted primary dentition or hopeless permanent teeth followed by antibiotic coverage with periodontal therapy for the remaining teeth. Unfortunately, studies have shown that this regimen only temporarily delays the progression of periodontal disease and does not prevent further tooth loss and bone destruction in the long term. Post-tooth loss, atrophic ridges make conventional prosthodontic rehabilitation quite challenging, and more recently, implant-supported prostheses have been considered as a viable alternative. In a PLS patient, implant placement is complicated by inadequate bone volume; thus, bone augmentation techniques or the use of short implants is often considered. When large volumes of bone are required, parietal calvarium bone can be used to predictably reconstruct severe defects. A PLS patient aged 21 years presented a chief complaint of ill-fitting conventional complete dentures. The patient had severely atrophic ridges, requiring significant bone augmentation for an implant-supported prosthesis. The present case is the first example of bone augmentation using autogenous calvarium parietal graft followed by endosseous implant placement and prosthetic restoration in a PLS patient.

Dental implant treatment following trauma: An investigation into the failure to complete Accident Compensation Corporation funded care.

BACKGROUND AND OBJECTIVES: Among other restorative strategies, the Accident Compensation Corporation (ACC) provides benefits for dental implant treatment to replace teeth lost as a result of trauma. While ACC has funded over 15,000 dental implants since 2002, the outcomes of this treatment and patient perceptions of this treatment have not been investigated. The aim of this study was to investigate the perceptions of the dental implant treatment outcomes and reasons for failure to complete restorative treatment in patients who had undergone trauma-related implant surgery funded by ACC between February 2006 and September 2009, but had not completed the prosthetic component of the treatment. METHODS: A randomly selected sample of 399 patients, who had undergone dental implant surgery but not completed the crown restoration, was identified from the ACC database. These individuals were contacted by mail for expressions of interest and 181 clients were interviewed by telephone. Responses to open-ended questions were entered into an Excel spreadsheet and analysed using a general inductive technique. RESULTS: A common emergent theme was the high level of satisfaction expressed by participants with the implant process, however just under half of those responding felt they had been pushed into having implants and were given the impression that this was the only treatment ACC paid for. The cost of the prosthetic phase of the treatment and surgical complications were identified as the primary reasons why participants failed to complete the restorative phase of treatment, after completing the surgical phase. CONCLUSIONS: The results highlighted the need to better inform patients of their treatment options and to allow time for them to process this information before progressing with care. A patient decision tool may help to give greater ownership of the treatment options. Newly implemented protocols to assist dentists to better assess treatment needs may also assist in achieving improvements in perceived treatment outcomes for patients.

Single-Tooth Implant Versus Three-Unit Fixed Partial Denture: A Study of Oral Health-Related Quality of Life.

PURPOSE: Many studies have investigated the impact of prosthetic treatment on oral health-related quality of life (OHRQoL). However, most of these have been performed among fully or partially edentulous patients. Studies involving patients with a single missing tooth are limited. The purpose of this study was to compare the OHRQoL between patients treated by single-tooth implants and three-unit fixed partial dentures (FPDs) for single missing tooth restoration. MATERIALS AND METHODS: A cross-sectional survey was conducted in Korea with patients drawn by stratified purposive sampling based on age. OHRQoL was measured using the Korean version of the 14-item Oral Health Impact Profile (OHIP-14K) questionnaire. Pre- and posttreatment OHIP-14K scores were compared by paired t test. Single-tooth implants and three-unit FPDs were compared by two-sample t test. In addition, multiple regression analysis was used to evaluate the impact of treatment mode on OHIP-14K total score after adjusting the effect of demographics and clinical factors. RESULTS: Thirty-five patients with single-tooth implants and 36 patients with three-unit FPDs were included. All participants had a significant improvement in OHRQoL compared with before the treatment (P < .0001). However, there was no statistically significant difference in the change of OHIP-14K score between the two treatment modes. In addition, the treatment mode had no significant impact on the change of OHIP-14K total score after adjusting the influence of covariates (P = .170). CONCLUSION: Both single-tooth implants and three-unit FPDs for single missing tooth replacement resulted in significant and similar improvement of OHRQoL.

Duas coroas suportadas por um único implante em região estética / Two prosthetic crowns supported by a single implant in the esthetic zone

O objetivo desse relato de caso clínico foi apresentar uma opção terapêutica para casos em que há ausência de elementos dentários contíguos em região estética, por meio da utilização de duas coroas suportadas por um único implante. Recursos como compensação de tecido mole e um provisório imediato que ofereça conformação à gengiva mostraram-se previsíveis na obtenção de uma harmonia estética...

The objective of this case report was to present a therapeutic option for cases with loss of neighboring teeth, carried out by means of two prosthetic crowns supported by a single implant in the anterior maxilla.Techniques such as soft tissue augmentation and immediateprovisional implant crown are required to preserve soft tissue contour and prove predictable to achieve aesthetic harmony...

Influence of oral health condition on swallowing and oral intake level for patients affected by chronic stroke.

BACKGROUND: According to the literature, the occurrence of dysphagia is high in cases of stroke, and its severity can be enhanced by loss of teeth and the use of poorly fitting prostheses. OBJECTIVE: To verify that the status of oral health influences the level of oral intake and the degree of swallowing dysfunction in elderly patients with stroke in chronic phase. METHODS: Thirty elderly individuals affected by stroke in chronic phase participated. All subjects underwent assessment of their oral condition, with classification from the Functional Oral Intake Scale (FOIS) and nasoendoscopic swallowing assessment to classify the degree of dysphagia. The statistical analysis examined a heterogeneous group (HG, n=30) and two groups designated by the affected body part, right (RHG, n=8) and left (LHG, n=11), excluding totally dentate or edentulous individuals without rehabilitation with more than one episode of stroke. RESULTS: There was a negative correlation between the need for replacement prostheses and the FOIS scale for the HG (P=0.02) and RHG (P=0.01). Differences in FOIS between types of prostheses of the upper dental arch in the LHG (P=0.01) and lower dental arch in the RHG (P=0.04). A negative correlation was found between the number of teeth present and the degree of dysfunction in swallowing liquid in the LHG (P=0.05). There were differences in the performance in swallowing solids between individuals without prosthesis and those with partial prosthesis in the inferior dental arch (P=0.04) for the HG. CONCLUSION: The need for replacement prostheses, type of prostheses, and the number of teeth of elderly patients poststroke in chronic phase showed an association with the level of oral intake and the degree of oropharyngeal dysphagia.

Prosthodontic rehabilitation of Papillon Lefevre Syndrome.

Papillon Lefevre Syndrome (PLS) is an autosomal recessive (AR) disorder affecting the skin and intra oral soft tissues resulting in palmo plantar hyperkeratosis with premature periodontal problems leading to early tooth loss and associated functional and psychological disturbances. This report presents management of a 17 years old girl suffering from PLS. She was presented with the chief complaint of loss of many permanent teeth and mobility of the remaining teeth. Most of the teeth were lost very early after their eruption due to swollen infected gums. There were no other associated problems except for the mild burning sensation of the palms and soles. A decision was made and remaining teeth were extracted in order to prevent aggressive bone loss. She was then managed using removable complete dentures with bilateral balanced occlusion. The patient is comfortable and functioning well with her new dentition.

Application of digital diagnostic impression, virtual planning, and computer-guided implant surgery for a CAD/CAM-fabricated, implant-supported fixed dental prosthesis: a clinical report.

This clinical report demonstrated the use of an implant-supported fixed dental prosthesis fabricated with a contemporary digital approach. The digital diagnostic data acquisition was completed with a digital diagnostic impression with an intraoral scanner and cone-beam computed tomography with a prefabricated universal radiographic template to design a virtual prosthetically driven implant surgical plan. A surgical template fabricated with computer-aided design and computer-aided manufacturing (CAD/CAM) was used to perform computer-guided implant surgery. The definitive digital data were then used to design the definitive CAD/CAM-fabricated fixed dental prosthesis.

Sinus augmentation by orthodontic movement as an alternative to a surgical sinus lift: a clinical report.

Maxillary sinus pneumatization may significantly reduce the alveolar bone height. As a result, the sinus membrane may need to be apically repositioned, with or without grafts, before or at the time of implant placement. The sinus lift, however, is a relatively invasive surgical procedure that can lead to complications and sometimes unsuccessful results. This clinical report presents an orthodontic movement to enlarge the amount of bone at the sinus region for implant placement. The approach avoided surgery in a patient who used tobacco and exhibited recurrent sinusitis.

Coordinated reconstruction with bilateral condylar replacement and dental implant rehabilitation: a clinical report.

The evaluation of complex facial-cranial trauma and subsequent restoration requires multidisciplinary treatment planning for optimal success and patient satisfaction. Patients with bilateral subcondylar fractures and facial-dental trauma are invariably challenging. Consideration of total joint replacement, along with the comprehensive evaluation of facial-dental esthetics and occlusion is critical for an optimal long-term outcome and for patient comfort. This patient treatment illustrates team cooperation and an optimal patient treatment outcome with long-term follow-up in the reconstruction of a complex cranial-facial injury from an unrestrained motor vehicle accident. The treatment included bilateral temporomandibular joint replacement with computer-aided design and computer-aided manufacturing fitted total temporomandibular joint reconstruction, grafting of a deficient anterior maxillary alveolar ridge, and dental implant placement and subsequent restoration with a partial fixed dental prosthesis.

Surgical-orthodontic treatment of patients suffering from severe periodontal disorders - a clinical case study.

INTRODUCTION: Orthodontic or, more precisely, surgico-orthodontic treatment of patients suffering from periodontal disorders generally requires a multidisciplinary approach by a qualified dental team. Periodontal bone healing is an essential factor for successful orthodontic treatment in a compromised periodontal situation. CLINICAL CASE: We report on the case of an adult patient suffering from severe chronic periodontitis; he was a hyperdivergent skeletal Class III with dento-alveolar compensation, esthetic problems and a significant lack of dental material. A multidisciplinary approach was adopted. First of all, periodontal treatment was undertaken (root scaling and planing) accompanied by appropriate medical treatment and a bone graft to strengthen the area of the lower incisors. After that, surgical and orthodontic treatment to correct the malocclusion was begun. The difficulty lay in the significant absence of dental material to ensure proper intercuspation. A surgical repositioning splint was constructed on an articulator to ensure adequate mandibular retraction after maxillary advancement surgery. After treatment, the missing teeth were replaced by a prosthesis. RESULTS AND DISCUSSION: Following treatment, the periodontal bone resorption was stabilized; the bone deficit was improved and the malocclusion had been corrected; the missing teeth were replaced by appropriate dentures. Short- and medium-term follow-up confirmed the stability of the results obtained, which will be discussed. CONCLUSION: The right combination of properly managed orthodontic, periodontal and prosthetic treatment can contribute to effective elimination of chronic periodontitis, even at an advanced stage in an adult patient, while at the same time improving esthetic and functional parameters.

[Dental implants in complex oral rehabilitation in patients with class III occlusion and partial teeth loss].

To prove the efficiency of dental implantation in complex treatment of patients with class III malocclusion and partial teeth loss. Nine patients aged 18-35 years with class III malocclusion and partial teeth loss were included in the study. All patients received two-step treatment involving orthodontic correction with two-step implantation and provisional restorations placement followed by orthognatic surgery procedure. The patients were followed-up for three years with no recurrent malocclusion or implant failure revealed, thus proving dental implantation to be useful tool in complex oral rehabilitation of patients with class III malocclusion and partial teeth loss.