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.

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).

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...

A survey on the use of techniques, materials in dental implantology practice.

Purpose: To present results of a survey on the status of an implantology amongst implant-practicing dentist across the world in 2009. Materials and Methods: A questionnaire was sent to the members of EAO (European Association of Osseointegration), ICOI (International Congress of Osseointegrated Implants), ISOI (Indian Society of Oral Implantologists), Asian Academy of Osseointegration (AAO), Deutsche Gasellschaft Fur Orale Implantologie (DGOI), Philippines Implant Organization, Korean Society of Oral Implantologist, Japanese Association of OralIimplantologists, Chinese Dental Association, Pakistan Dental Association, asking for the personal (anonymous) background data and their implantology concepts. Specific questions dealt with level of recognition of implants, use of implants, superstructures, techniques followed, and materials used. Results: A total of 1500 (63.6%) of the 2358 questionnaires were answered. Dental implants were the most preferred treatment modality for restoring the missing teeth. Threaded implants were the most preferred. Cement retained implant prosthesis was the most preferred restoration procedure. Dentists believe that the general dentist should practice dental implant treatment modality, preferably teamwork. Immediate loading was the much-accepted concept among the dentists of the developed nations. Conclusion: Dental implants were much accepted treatment modality for the replacement of missing teeth. Most the dentists follow the well documented technique and proven materials, which have been documented in the literature, an evidenced based practice, thus, delivering the best to their patients. Dentists from the developing nations agreed to have standardization in implants.

Immediate natural tooth pontic: A viable yet temporary prosthetic solution: A patient reported outcome.

Introduction: In patients with hopeless prognosis of the anterior teeth there is still a strong desire to save them for the sake of esthetics. If not grossly carious, broken down or discolored the extracted tooth after suitable modifications can be placed back in its original site by splinting it to the adjacent stable teeth. Materials and Methods: Fifteen patients (10 males, 5 females) in the age range of 40-65 years with pathologically migrated, unsalvageable teeth were treated by splinting the extracted teeth immediately with the stable adjacent teeth. After 12 weeks, all the patients were explained various treatment options available for replacement of the lost teeth. The patients were asked to fill out a simple closed ended questionnaire citing the various difficulties encountered during this transitional period, selection of further treatment modalities and the reasons for their choice. The feedback obtained was then analyzed statistically. Results: Hundred percent of patients were happy with the esthetics; however, 60% of them were dissatisfied with the function that it provided. The primary problem being apprehension of splint fracture and difficulty while incising and the data was found to be statistically significant (P=0.01**). All patients demanded a permanent treatment option following this with a fixed prosthesis. None of the patients were interested in the implant supported prosthesis due to cost, treatment time involved, and need for surgery. Conclusion: The concept of immediate pontic placement is surely a viable treatment option and promises an excellent transient esthetic solution for a lost tooth as well as enables good preparation of the extraction site for future prosthetic replacement.

Needs and demands of prosthetic treatment among two groups of individuals.

Objectives: The level of knowledge, awareness, and attitude about teeth-replacement options among a group of medical and paramedical subjects and to compare them with the general population. Materials and Methods: A self-administered questionnaires using simple Arabic language were distributed to two groups of subjects. Questions focused on the willingness to replace the missing teeth, the preferable methods of choice for replacement, and the reasons for these choices. The first group (G-I) was from the medical and paramedical staff who work in a military hospital at Jordan Royal medical services, the dental staff was excluded from the study. The other group (G-II) was from the general population who attended the dental department in the same hospital with comparable level of education. All the participants were partially edentulous excluding the third molars. Clinical examination was done by qualified prosthodontist to evaluate the possible prosthetic treatment options for replacement. A total of 612 questionnaires were distributed, of which 533 questionnaires were returned (response rate 87.09%). The results were analyzed and comparison was made between the two groups. Results: Responses to questions about awareness and attitude about prosthetic management of missing teeth revealed that G-I have more awareness than G-II to the probable causes for tooth/teeth replacement and limitation of the preferable method for replacement (P<0.05). More than 80% of the participants believed that replacement of anterior teeth is more important than the posterior teeth. Implants and fixed partial denture (FPD), respectively, were more preferable than removable prosthesis, although clinically was not indicated in cases (P<0.05). There was no clinical benefit from replacement of missing teeth in 33.4% while only 6% believe this. Conclusions: This study showed that the awareness and attitude between the medical and paramedical staff to prosthetic needs is better than between general populations. The demands for dental replacement by patients were significantly different when compared with the actual needs.

Perda dentária e expectativa da reposição protética: estudo qualitativo / Dental loss and prosthetic replacement expectation: qualitative study

Esse estudo qualitativo analisou as repercussões da perda dentária total de usuários do serviço público. Aplicou-se o Oral Health Impact Profile simplificado(OHIP14) a cinquenta voluntários e, após a apuração dos resultados, foram selecionados treze pacientes para entrevistas individuais baseadas em um roteiro com questões abertas. A seleção das pessoas foi de acordo com o grau de percepção do impacto da condição bucal na qualidade de vida, medida pela pontuação OHIP, de forma a incluir a maior variedade de perfis da amostra inicial. Da análise do conteúdo dos depoimentos, verificou-se que a perda dentária total tem forte impacto na vida das pessoas e implica consequências negativas como vergonha, dificuldade em se alimentar, prejuízo ao relacionamento social e sentimento de incompletude. A possibilidade de reposição protética dos dentes gera ansiedade nas pessoas e, embora elas saibam que a utilização das próteses possa representar sacrifícios, a expectativa de retorno ao padrão social geralmente aceito e de recuperação de sua própria imagem rejuvenescida faz valer a pena quaisquer sacrifícios.

This qualitative research analyses the repercussions of total dental loss on people's quality of life. The Oral Health Impact Profile short-form (OHIP14) was applied to 50 volunteers, and after analyzing the results, 13 out of those 50, were selected to be individually interviewed in an opened questions script. The criteria to select these 13 people were: perception of the impact of mouth condition on quality of life measured by the score reached on OHIP. We tried to comprise the sample with a good variety, according to the profile of the initial sample. After analyzing people's statements, it was possible to verify that dental loss had strong negative consequences on people's life, like shame, difficulty to eat, impact on social relationship and feeling of not being complete. The possibility of having their teeth replaced generates some anxiety. Although being aware that wearing total prosthesis represents some sacrifices, people considered it worthwhile because the possibility of regaining the social pattern and the self-image is renewed.

Improving prosthetic prognosis by connective tissue ridge augmentation of alveolar ridge.

The contour of edentulous ridge should be carefully evaluated before a fixed partial denture is undertaken. The ideal ridge height and width allows placement of a natural looking pontic which facilitates maintenance of plaque-free environment. The localized alveolar ridge defect refers to the volumetric deficit of the limited extent of bone and soft tissue within the alveolar process. Such type of ridge defects can be corrected by surgical ridge augmentation that can be accomplished by the addition of either soft or hard tissues. This article describes a procedure of surgical connective tissue augmentation of a localized deficient alveolar ridge in the maxilla, followed by fixed partial denture, enhancing the esthetics, function and health.

Papillon-Lefevre syndrome: a case report.

Papillon-Lefevre syndrome is a rare autosomal recessive genetic disorder. The clinical manifestations include palmer planter hyperkeratosis with precocious progressive periodontal disease that results in premature exfoliation of primary and permanent dentitions. Patients are often edentulous at an early age. This is a case report of prosthodontic rehabilitation of a 15-year-old girl with Papillon-Lefevre syndrome.

Patients' self-perceived impacts and prosthodontic needs at the time and after tooth loss

Studies on self-perception have demonstrated that tooth loss is associated with esthetic, functional, psychological and social impacts for individuals. However, not all subjects seek treatment immediately after tooth loss, even when desire for replacement is strongly expressed. The aim of this study was to evaluate the perception of patients submitted to tooth extraction about factors associated with tooth loss and prosthodontic treatment, at the time and after extraction. A convenience sample of 211 consecutive patients were clinically evaluated and answered to a questionnaire about perceived impacts and prosthodontic treatment needs. Data were collected at the time of extraction and after a 3-month time interval. Perceived impacts were high (21 to 76 percent at the time and 35 to 87 percent after extraction). From 72.5 percent patients who expressed intention of immediate replacement of edentulous spaces, only 8.1 percent had actually been treated. Financial limitation was considered the most important factor that restricted access to treatment. Bivariate statistical analysis showed association between immediate dental replacement and anterior tooth loss (p=0.00) and extension of edentulous space (p=0.01). Position of lost teeth was associated to perceived functional limitation (p=0.03). Worsened appearance was associated to tooth loss in the maxillary arch (p=0.02), and desire of prosthodontic treatment was associated to the extension of edentulous space (p=0.05). Perceived impacts were more frequent in women than men. It was concluded that although patients usually expressed prosthodontic treatment needs, clinical and financial issues are determinant factors for tooth replacement.

Estudos de autopercepção têm demonstrado que a ausência de dentes pode resultar em impactos estéticos, funcionais, psicológicos e sociais, embora nem todos os indivíduos demandam por tratamento protético imediato após a perda dentária. O objetivo do estudo foi avaliar a percepção de pacientes submetidos a exodontia em relação a fatores associados à perda e ao tratamento protético, no momento e após a perda dos dentes. Uma amostra de conveniência de 211 pacientes consecutivos foi avaliada quanto à condição clínica, autopercepção dos impactos orais e necessidade de tratamento, por meio de exame clínico e questionário, no momento e após 3 meses da exodontia. A percepção de impactos da perda dentária foi alta (21-76 por cento no momento e 35-87 por cento após a exodontia). Dos 72,5 por cento pacientes que relataram pretender a reposição protética imediata apenas 8,1 por cento realizaram o tratamento. A motivação financeira foi relatada como o maior impedimento para o tratamento. A análise univariada mostrou associação entre reposição imediata e localização anterior da perda (p=0,00) e extensão do espaço desdentado (p=0,01), entre localização da perda e limitação funcional percebida (p=0,03). O incômodo com a aparência foi relacionado à localização da perda no arco superior (p=0,02), o desejo por tratamento protético foi relacionado à extensão do espaço desdentado (p=0,05). Na maioria dos aspectos avaliados a percepção de problemas associados à perda foi maior no sexo feminino. Conclui-se que, embora a necessidade percebida de tratamento protético seja alta, fatores clínicos e sócio-econômicos são determinantes para a realização do tratamento.

Prótesis unitaria implantoasistida: estrategias para el mantenimiento de la anatomía gingival. Caso clínico / Implant-supported single prosthesis: strategies for the maintenance of gingival anatomy. Report of a clinical case

La restauración de espacios desdentados con prótesis fija retenida por implantes es, en la actualidad, la primera indicación en pacientes con pérdida de piezas dentarias, si estos pacientes adhieren a los requisitos necesarios para realizar estos tratamientos con el adecuado margen de previsibilidad. El estado actual de las técnicas y materiales permite, en casos clínicos seleccionados, la inserción de implantes y su inmediata provisionalización. Este hecho ayuda a la estabilidad de los tejidos periféricos durante el período de consolidación de los tejidos de soporte y avanza en el logro de restauraciones funcionales y estéticamente aceptables.

Necesidad de prótesis buco maxilofacial en el municipio Matanzas: año 1999 / The need of buccomaxillofacial prosthesis in Matanzas: year 1999

Las prótesis faciales se usaron desde épocas remotas. En Cuba comenzó a brindarse este servicio a partir de 1967, el cual se incrementó, gracias al desarrollo social y científico-técnico de las Ciencias Médicas en nuestro país. La rehabilitación funcional y estética de los pacientes con deformidades o estructuras perdidas en la cara resultó muy difícil, por lo que fue necesario establecer un diagnóstico exhaustivo y un tratamiento altamente calificado para lograr el éxito. Con este trabajo nos propusimos conocer la necesidad de prótesis buco maxilofacial en el municipio Matanzas, así como el comportamiento de las mismas y su relación con el sexo, la edad y la etiología.Se realizó un estudio descriptivo de corte transversal donde se tomó como referencia la población perteneciente a las distintas áreas de salud de este municipio. Para la obtención de la muestra se aplicó un diseño muestral estratificado por conglomerado, lo cual quedó constituida por 1937 personas y aquellas que reunieron los criterios de inclusión, se les aplicó la encuesta de necesidad de rehabilitación buco maxilofacial.Se obtuvo como resultado que existía necesidad de prótesis buco maxilofacial con preferencia por la del tipo ocular, sexo masculino y pacientes jóvenes. La etiología traumática fue la predominante como causa de lesión para ambos sexos, seguida por la oncológica. Las regiones auriculares y maxilares estuvieron afectadas en el sexo masculino en mayor cuantía que en el femenino. En las regiones orbital, nasal, mandíbular y compleja no hubo afectaciones

Arco dental reducido, una alternativa para el paciente adulto / Shortened dental arch, an alternative for the adult patient

La restauración de una arcada dental completa es sin duda el objetivo principal de la odontología restauradora, pero en numerosas ocasiones este planteamiento no puede ser asequible ni permisible para la mayoría de los pacientes mayores. En tal sentido, este propósito puede ser considerado muchas veces irrealista. El concepto de arco dental reducido sugeire que las personas a una edad media pueden ser satisfechas con 20 dientes naturales, por lo que se cuestiona la necesidad de reemplazo de los molares perdidos, los cuales son los dientes más comúnmente afectados por caries y enfermedad periodontal. Este concepto podría ser aplicado en numerosos casos siempre y cuando no interfiera en los requerimientos de estética y estabilidad funcional

Conseqüências e tratamento das perdas precoces de dentes decíduos / Consequences and treatment of premature loss of deciduous teeth

Os autores apresentam uma avaliaçäo das conseqüências de perdas precoces de dentes decíduos nas diferentes regiöes dos arcos dentários, enfatizando as indicaçöes dos diferentes tipos de mantedores de espaço