Assessment of postoperative pain, dysesthesia, and weather sensitivity after pterional and temporal neurosurgical approaches.

OBJECTIVE: Many neurosurgical approaches require incision of the temporal muscle (TM). Consequently, patients often report reduced opening of the mouth, facial asymmetry, numbness, and pain after lateral craniotomies. A systematic assessment of these postoperative subjective complaints is lacking in the literature. Therefore, in this study, the authors evaluate subjective complaints after pterional, frontolateral-extended pterional, or temporal craniotomy using a 6-item questionnaire. They examine the association of these subjective complaints with the extent of the mobilization of the TM. METHODS: The questionnaire assessed complaints about limited opening of the mouth, pain in the mastication muscles, facial asymmetry, sensory deficits in the temporal region, weather sensitivity, and headache. Eligible patients with benign intracranial processes operated on using lateral cranial approaches between 2016 and 2019 were included. The questionnaire was answered before surgery (baseline) and 3 and 15 months after surgery. Surgeons documented the extent of TM incision. RESULTS: Among the 55 patients in this study, all complaints apart from headache showed an increase at a statistically significant rate at 3 months postoperatively, that is, limited mouth opening (p < 0.0001), pain in the mastication muscles (p < 0.0001), an impression of asymmetry in the mastication muscles (p = 0.0002), sensory disturbances in the temporal region (p < 0.0001), and weather sensitivity (p < 0.001). Only pain in the mastication muscles showed a relevant decrease at 15 months postsurgery (p = 0.058). The extent of the mobilized TM was associated with pain in the mastication muscles at 3 months (p = 0.0193). CONCLUSIONS: Subjective complaints in patients following lateral craniotomy can be detected. As the extent of the mobilized TM relevantly influenced pain in the mastication muscles, the authors conclude that one should sparsely mobilize the TM. Furthermore, a neurosurgeon should be aware and warn the patient of subjective postoperative complaints and inform the patient about their natural course.

An engineering perspective of ceramics applied in dental reconstructions.

The demands for dental materials continue to grow, driven by the desire to reach a better performance than currently achieved by the available materials. In the dental restorative ceramic field, the structures evolved from the metal-ceramic systems to highly translucent multilayered zirconia, aiming not only for tailored mechanical properties but also for the aesthetics to mimic natural teeth. Ceramics are widely used in prosthetic dentistry due to their attractive clinical properties, including high strength, biocompatibility, chemical stability, and a good combination of optical properties. Metal-ceramics type has always been the golden standard of dental reconstruction. However, this system lacks aesthetic aspects. For this reason, efforts are made to develop materials that met both the mechanical features necessary for the safe performance of the restoration as well as the aesthetic aspects, aiming for a beautiful smile. In this field, glass and high-strength core ceramics have been highly investigated for applications in dental restoration due to their excellent combination of mechanical properties and translucency. However, since these are recent materials when compared with the metal-ceramic system, many studies are still required to guarantee the quality and longevity of these systems. Therefore, a background on available dental materials properties is a starting point to provoke a discussion on the development of potential alternatives to rehabilitate lost hard and soft tissue structures with ceramic-based tooth and implant-supported reconstructions. This review aims to bring the most recent materials research of the two major categories of ceramic restorations: ceramic-metal system and all-ceramic restorations. The practical aspects are herein presented regarding the evolution and development of materials, technologies applications, strength, color, and aesthetics. A trend was observed to use high-strength core ceramics type due to their ability to be manufactured by CAD/CAM technology. In addition, the impacts of COVID-19 on the market of dental restorative ceramics are presented.

An engineering perspective of ceramics applied in dental reconstructions

Abstract The demands for dental materials continue to grow, driven by the desire to reach a better performance than currently achieved by the available materials. In the dental restorative ceramic field, the structures evolved from the metal-ceramic systems to highly translucent multilayered zirconia, aiming not only for tailored mechanical properties but also for the aesthetics to mimic natural teeth. Ceramics are widely used in prosthetic dentistry due to their attractive clinical properties, including high strength, biocompatibility, chemical stability, and a good combination of optical properties. Metal-ceramics type has always been the golden standard of dental reconstruction. However, this system lacks aesthetic aspects. For this reason, efforts are made to develop materials that met both the mechanical features necessary for the safe performance of the restoration as well as the aesthetic aspects, aiming for a beautiful smile. In this field, glass and high-strength core ceramics have been highly investigated for applications in dental restoration due to their excellent combination of mechanical properties and translucency. However, since these are recent materials when compared with the metal-ceramic system, many studies are still required to guarantee the quality and longevity of these systems. Therefore, a background on available dental materials properties is a starting point to provoke a discussion on the development of potential alternatives to rehabilitate lost hard and soft tissue structures with ceramic-based tooth and implant-supported reconstructions. This review aims to bring the most recent materials research of the two major categories of ceramic restorations: ceramic-metal system and all-ceramic restorations. The practical aspects are herein presented regarding the evolution and development of materials, technologies applications, strength, color, and aesthetics. A trend was observed to use high-strength core ceramics type due to their ability to be manufactured by CAD/CAM technology. In addition, the impacts of COVID-19 on the market of dental restorative ceramics are presented.

Clinical outcomes of all-ceramic single crowns and fixed dental prostheses supported by ceramic implants: A systematic review and meta-analyses.

OBJECTIVE: To analyze the clinical outcomes of all-ceramic single crowns (SCs) and fixed dental prostheses (FDPs) supported by ceramic implants. MATERIALS AND METHODS: Based on a focused question and customized PICO framework, electronic (Medline/EMBASE/Cochrane) and manual searches for studies reporting the clinical outcomes of all-ceramic SCs and FDPs supported by ceramic implants ≥12 months were performed. The primary outcomes were reconstruction survival and the chipping proportion. The secondary outcomes were implant survival, technical complications, and patient-related outcome measurements. Meta-analyses were performed after 1, 2, and 5 years using random-effect meta-analyses. RESULTS: Eight of the 1,403 initially screened titles and 55 full texts were included. Five reported on monolithic lithium disilicate (LS2) SCs, one on veneered zirconia SCs, and two on veneered zirconia SCs and FDPs, which reported all on cement-retained reconstructions (mean observation: 12.0-61.0 months). Meta-analyses estimated a 5-year survival rate of 94% (95% confidence interval [CI]: 82%-100%) for overall implant survival. Reconstruction survival proportions after 5 years were: monolithic LS2, 100% (95%CI: 95%-100%); veneered zirconia SCs, 89% (95%CI: 62%-100%); and veneered zirconia FDPs 94% (95%CI: 81%-100%). The chipping proportion after 5 years was: monolithic LS2, 2% (95%CI: 0%-11%); veneered zirconia SCs, 38% (95%CI: 24%-54%); and veneered zirconia FDPs, 57% (95%CI: 38%-76%). Further outcomes were summarized descriptively. CONCLUSIONS: Due to the limited data available, only tendencies could be identified. All-ceramic reconstructions supported by ceramic implants demonstrated promising survival rates after mid-term observation. However, high chipping proportions of veneered zirconia SCs and, particularly, FDPs diminished the overall outcome. Monolithic LS2 demonstrated fewer clinical complications. Monolithic reconstructions could be a valid treatment option for ceramic implants.

Mastication after craniotomy: pilot assessment of postoperative oral health-related quality of life.

BACKGROUND: Neurosurgical approaches to the brain often require the mobilization of the temporal muscle. Many patients complain of postoperative pain, atrophy, reduced mouth opening, and masticatory problems. Although the pterional, frontolateral-extended-pterional, and temporal craniotomies are the most frequently used approaches in neurosurgery, a systematic assessment of the postoperative oral health-related quality of life has never been performed so far. This study evaluates the oral health-related quality of life of patients after pterional, frontolateral-extended-pterional, or temporal craniotomy using a validated and standardized dental questionnaire, compares the results with the normal values of the general population, and investigates whether this questionnaire is sensitive to changes caused by surgical manipulation of the temporal muscle. METHODS: The "Oral Health Impact Profile" (OHIP14) is a validated questionnaire to assess the oral health-related quality of life. It asks the patients to assess their oral health situation within the past 7 days in 14 questions. Possible answers range from 0 (never) to 4 (very often). Sixty patients with benign intracranial processes operated through a lateral cranial approach were included. The questionnaire was answered before surgery (baseline) and 3 months and 15 months after surgery. RESULTS: Overall, postoperative OHIP scores increase significantly after 3 months and decrease after 15 months, but not to preoperative values. No factors can be identified which show a considerable relationship with the postoperative OHIP score. CONCLUSIONS: Postoperative impairment of mouth opening and pain during mastication can be observed 3 to 15 months after surgery and sometimes cause feedback from patients and their dentists. However, in line with existing literature, these complaints decrease with time. The study shows that the OHIP questionnaire is sensitive to changes caused by surgical manipulation of the temporal muscle and can therefore be used to investigate the influence of surgical techniques on postoperative complaints. Postoperatively, patients show worse OHIP scores than the general population, demonstrating that neurosurgical cranial approaches negatively influence the patient's oral health-related wellbeing. Larger studies using the OHIP questionnaire should evaluate if postoperative physical therapy, speech therapy, or specialized rehabilitation devices can improve the masticatory impairment after craniotomy. TRIAL REGISTRATION: Clinical trial register: DRKS00011096.

Monolithic zirconia crowns: effect of thickness reduction on fatigue behavior and failure load.

PURPOSE: The objective of this study was to evaluate the effect of thickness reduction and fatigue on the failure load of monolithic zirconia crowns. MATERIALS AND METHODS: 140 CAD-CAM fabricated crowns (3Y-TZP, inCorisTZI, Dentsply-Sirona) with different ceramic thicknesses (2.0, 1.5, 1.0, 0.8, 0.5 mm, respectively, named G2, G1.5, G1, G0.8, and G0.5) were investigated. Dies of a mandibular first molar were made of composite resin. The zirconia crowns were luted with a resin composite cement (RelyX Unicem 2 Automix, 3M ESPE). Half of the specimens (n = 14 per group) were mouth-motion-fatigued (1.2 million cycles, 1.6 Hz, 200 N/ 5 - 55℃, groups named G2-F, G1.5-F, G1-F, G0.8-F, and G0.5-F). Single-load to failure was performed using a universal testing-machine. Fracture modes were analyzed. Data were statistically analyzed using a Weibull 2-parameter distribution (90% CI) to determine the characteristic strength and Weibull modulus differences among the groups. RESULTS: Three crowns (21%) of G0.8 and five crowns (36%) of G0.5 showed cracks after fatigue. Characteristic strength was the highest for G2, followed by G1.5. Intermediate values were observed for G1 and G1-F, followed by significantly lower values for G0.8, G0.8-F, and G0.5, and the lowest for G0.5-F. Weibull modulus was the lowest for G0.8, intermediate for G0.8-F and G0.5, and significantly higher for the remaining groups. Fatigue only affected G0.5-F. CONCLUSION: Reduced crown thickness lead to reduced characteristic strength, even under failure loads that exceed physiological chewing forces. Fatigue significantly reduced the failure load of 0.5 mm monolithic 3Y-TZP crowns.