Benefits of the combination of digital and analogic tools as a strategy to control possible awake bruxism: A randomised clinical trial.

BACKGROUND: Awake Bruxism (AB) management includes cognitive and behavioural changes. Digital and analogic tools can be used to remind the individual to control/avoid AB behaviours. However, no study addressed both tools together. OBJECTIVE: To compare the efficacy of the combination of digital (smartphone application) and analogic (adhesive reminders) tools versus digital tool alone for AB management. METHODS: Seventy-two individuals diagnosed with probable AB were divided into 3 groups: Group 1 (n = 24), used both digital and analogic tools during 30 days; Group 2 (n = 24), used only a digital tool during 30 days and Group 3 (n = 24), used only a digital tool for the first 15 days and then added the analogic tool for 15 days. The AB frequency was measured in real-time with a smartphone app, which sent alerts asking the individuals if they were doing any AB behaviours (bracing, teeth contact, clenching or grinding). Groups were compared using one-way ANOVA and before-after adding an analogic tool (group 3) by paired t-test, considering α = 0.05. RESULTS: All groups showed a decrease in AB behaviours at the end of the evaluation period. Group 1 (digital and analogic tools) showed the lowest average of AB behaviours among all groups; however, statistically significant differences were found only for the comparison between groups 1 and 2. In group 3, a significantly greater reduction in AB behaviours was found after combining both approaches. CONCLUSION: The combination of digital and analogic tools showed the greatest reduction of AB frequency and can be recommended for AB control.

Influence of different presentations of denture adhesives on masticatory function of complete denture wearers: A systematic review and meta-analysis.

STATEMENT OF PROBLEM: Denture adhesives improve the mastication of complete denture wearers. However, the impact of denture adhesives with different presentations on mastication remains unclear. PURPOSE: The purpose of this systematic review was to answer the focused question, "Do different presentations of denture adhesives affect the masticatory function of complete denture wearers?". MATERIAL AND METHODS: This review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Six databases and the non-peer-reviewed literature were searched up to July 2021. Only clinical studies (randomized clinical trials and nonrandomized clinical trials) comparing the use of different denture adhesive presentations (cream, powder, or strips) were included, without language or follow-up restrictions. The risk of bias was assessed by using the Cochrane tools (RoB 2.0 and ROBINS-I). Masticatory performance, by using single and multiple sieves, masticatory performance with color-changing chewing gum (mixing ability), swallowing threshold (particle size and number of cycles), jaw kinematics, and occlusal force were considered. Meta-analyses were conducted to evaluate masticatory performance (single sieve) and occlusal force outcomes (α=.05), and the certainty of the evidence was determined with the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) evaluations. RESULTS: Nine studies (6 randomized and 3 nonrandomized clinical trials) were included. The risk of bias was considered moderate. Meta-analyses showed no differences between cream and powder denture adhesives for masticatory performance (standard mean difference=0.02; 95% CI=-0.46 to 0.50, P=.93) or between cream and strip denture adhesives for occlusal force (mean difference=14.35; 95% CI=-11.14 to 39.84, P=.27). Similarly, in qualitative analysis, cream and powder denture adhesives' performances were similar regarding masticatory performance with color-changing chewing gum (mixing ability), occlusal force, swallowing threshold (particle size and number of cycles), and jaw kinematics (P>.05). However, for resorbed ridges, cream denture adhesive resulted in a higher masticatory performance than strip (P<.05). When comparing powder to strip denture adhesives, the occlusal force was higher in the powder group (P<.05). The certainty of evidence was very low for all evaluated outcomes. CONCLUSIONS: Different presentations of denture adhesives seem to improve the masticatory function of complete denture wearers in a similar way. However, the qualitative analysis showed that, in patients with a resorbed ridge, a cream denture adhesive may be better than strips to improve mastication, although the certainty of evidence was very low.

Association of sleep bruxism with oral health-related quality of life and sleep quality.

OBJECTIVES: To compare the oral health-related quality of life (OHRQoL) and sleep quality of subjects with and without sleep bruxism (SB). MATERIALS AND METHODS: Participants of both genders were assigned as bruxers (n = 30, age 21-45 years) and non-bruxers (n = 30, age 24-40 years). SB was clinically diagnosed and confirmed with an electromyography/electrocardiograph portable device (Bruxoff). The OHRQoL was assessed using the Oral Health Impact Profile (OHIP-14). The sleep quality was determined using the Pittsburg Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) questionnaires. OHIP-14, PSQI, and ESS data were analyzed by one-way ANOVA, considering a significance level of 5%. RESULTS: Bruxers had worse OHRQoL (mean = 16.43) than controls (mean = 4.1), with an effect size (ES) of 1.58. Moreover, SB volunteers showed the highest PSQI scores (mean = 7.07; ES = 0.82) and excessive daytime sleepiness (mean = 10.33; ES = 0.65), compared to non-bruxers (means = 4.7 and 7.8, respectively). CONCLUSIONS: SB may be associated with a negative impact on OHRQoL and sleep quality. CLINICAL RELEVANCE: Determining that SB may have a marked role in OHRQoL and sleep quality is important for dental professionals establish proper multifactorial management, and understand patient-related psychosocial aspects.

Is there enough evidence to use botulinum toxin injections for bruxism management? A systematic literature review.

OBJECTIVE: The objective of the study was to conduct a systematic review of the literature assessing the effects of botulinum toxin (BoNT-A) injections in the management of bruxism. MATERIALS AND METHODS: Search for articles involved the PubMed, Scopus, Web of Science, Embase, Cochrane, Scielo and Lilacs databases. Specific terms were used and the search carried out from 1980 to March 2016 by three independent researchers. Randomized controlled studies (RCTs), prospective and before-after studies that applied BoNT-A at the masseter and/or temporalis muscles were included. RESULTS: Three RCTs and two uncontrolled before-after studies out of 904 identified citations were included in this review. All five articles dealt with sleep bruxism and featured a small sample size. None of them was about awake bruxism. Two randomized clinical trials were double-blinded, with a control group using saline solution. Two studies used polysomnography/electromyography for sleep bruxism diagnosis, whilst others were based on history taking and clinical examination. All studies using subjective evaluations for pain and jaw stiffness showed positive results for the BoNT-A treatment. In contrast, the two studies using objective evaluations did not demonstrate any reduction in bruxism episodes, but a decrease in the intensity of muscles contractions. CONCLUSION: Despite the paucity of works on the topic, BoNT-A seems to be a possible management option for sleep bruxism, minimizing symptoms and reducing the intensity of muscle contractions, although further studies are necessary especially as far as the treatment indications for bruxism itself is concerned. CLINICAL RELEVANCE: BoNT-A has been increasingly diffused in dentistry over recent years, being also used for pain management in patients with bruxism. Nonetheless, there is no consensus about its effects in this disorder.

Botulinum Toxin-A for the Treatment of Myogenous Temporomandibular Disorders: An Umbrella Review of Systematic Reviews.

OBJECTIVE: Temporomandibular disorders (TMDs) encompass several conditions that cause pain and impair function of the masticatory muscles (M-TMDs) and temporomandibular joints. There is a large interest among clinicians and researchers in the use of botulinum toxin-A (BoNT-A) as a treatment for M-TMD. However, due to the lack of consistent evidence regarding the efficacy as well as adverse events of BoNT-A, clinical decision making is challenging. Therefore, this umbrella review aimed to systematically assess systematic reviews (SRs) evaluating BoNT-A treatment effects on pain intensity, mandibular movements, and adverse events in patients with M-TMDs. METHOD: An electronic search was undertaken in the databases MEDLINE, EMBASE, CINAHL, Cochrane Central Registry of Controlled Trials (CENTRAL), Web of Science, Epistemonikos, ClinicalTrials.gov, and ICTRP to identify SRs investigating BoNT-A effects on M-TMDs, published from the inception of each database until 6 December 2023. The quality of evidence was rated according to the critical appraisal checklist developed by the umbrella review methodology working group. Only high-quality SRs were included. RESULTS: In total, 18 SRs were included. BoNT-A was shown to be more effective than placebo to reduce pain intensity, but not compared to standard treatments. Additionally, BoNT-A was not superior to placebo or standard treatments regarding improvement of mandibular movements. BoNT-A was considered to have a higher risk for adverse events on muscle and bony tissue compared with other treatments. CONCLUSION: The synthesis in this umbrella review provides the highest level of evidence present. Taken together, there are indications of effectiveness of BoNT-A for treatment of M-TMDs, supported by moderate evidence. However, considering the risk of causing serious adverse events, treatment with BoNT-A is recommended to be the last treatment alternative.

Awake bruxism frequency and psychosocial factors in college preparatory students.

OBJECTIVE: To assess the frequency of reported masticatory muscles activity during wakefulness (i.e., awake bruxism [AB]), levels of anxiety, depression, stress, and the oral health-related quality of life (OHRQoL) in college preparatory students. METHODS: Sixty-nine college preparatory students participated in the study. AB was evaluated by the Oral Behaviors Checklist (OBC) and a smartphone-based ecological momentary assessment (EMA; [Bruxapp®]). Anxiety and depression were measured by the Hospital Anxiety and Depression Scale, stress was evaluated by the Perceived Stress Scale, and OHRQoL was obtained by The Oral Health Impact Profile-14. Data were analyzed by Pearson's correlation coefficient (α = 0.05). RESULTS: The average EMA-reported frequency of AB behaviors was 38.4%. Significant correlations were found between AB and the OBC, anxiety, depression, stress, and OHRQoL (p < 0.001). CONCLUSION: College preparatory students demonstrated moderate frequency of AB, which was significantly correlated with psychosocial factors.

Ecological Momentary Assessment of Awake Bruxism Frequency in Patients with Different Temporomandibular Disorders.

Self-reported awake bruxism (AB) has been associated with temporomandibular disorders (TMD). However, the daily amount of AB behavior has not been quantified in pain patients. Therefore, this study aimed to assess AB frequency in patients with myofascial pain and temporomandibular joint (TMJ) pain and compare it to a group of pain-free individuals. Eighty-four individuals belonging to either a TMD group (n = 54) or a healthy control group (n = 30) were selected. AB frequency was obtained by ecological momentary assessment with a dedicated smartphone application that sent sound alerts at random intervals during the day for one week. Upon receiving the alert, the volunteer reported the current muscular condition and/or the teeth position, i.e., relaxed jaw muscle, jaw bracing, teeth contact, teeth clenching, or teeth grinding. Data were evaluated by independent t-test (α = 0.05). During the seven days, AB frequency was 62.1% ± 26.8% for TMD patients and 36.2% ± 27.3% for pain-free subjects (p < 0.001). Mandible bracing was most common in the TMD group (p < 0.001), while teeth contact, clenching, and grinding did not differ between groups. Moreover, no differences were found in AB frequency between myofascial pain and TMJ pain patients. Therefore, TMD patients have higher AB frequency characterized by jaw bracing, irrespective of pain location.

Single implant overdenture reinforced with a metallic framework: A 2-year clinical follow-up.

INTRODUCTION: To prevent single-implant overdenture (SIO) fracture, the inclusion of a framework in the overdenture has been suggested. However, no investigations verified their benefits. OBJECTIVE: To evaluate prosthetic maintenance events, patient satisfaction, and mastication of SIO reinforced by metallic framework users. MATERIAL AND METHODS: Fifteen volunteers had a new set of complete dentures converted into an SIO containing a framework. Maintenance events were recorded, while patient satisfaction was assessed using a visual analog scale. Masticatory performance (MP) was evaluated using the sieving method, maximum bite force (MBF) by pressure sensors, and masseter thickness by ultrasound. Measurements were performed 2, 12, and 24 months after SIO use. Repeated-measures ANOVA and paired Student's t-tests (p < 0.05) were applied. RESULTS: Matrix exchange was the most prevalent maintenance event (83.6%), and no SIO was fractured during the entire follow-up. Satisfaction with the SIO stability decreased (p < 0.01) after 12 months. MP did not change between evaluations (p > 0.05). Conversely, MBF and masseter thickness improved after 12 and 24 months of SIO use (p < 0.05). CONCLUSIONS: Reinforced SIO did not fracture during 2 years but requires maintenance. It improves bite force and muscle thickness, maintaining MP values. Satisfaction with SIO stability decreased in the first year of use.

Orthodontic tooth movement alters cementocyte ultrastructure and cellular cementum proteome signature.

Cementum is a mineralized tissue that covers tooth roots and functions in the periodontal attachment complex. Cementocytes, resident cells of cellular cementum, share many characteristics with osteocytes, are mechanoresponsive cells that direct bone remodeling based on changes in loading. We hypothesized that cementocytes play a key role during orthodontic tooth movement (OTM). To test this hypothesis, we used 8-week-old male Wistar rats in a model of OTM for 2, 7, or 14 days (0.5 N), whereas unloaded contralateral teeth served as controls. Tissue and cell responses were analyzed by high-resolution micro-computed tomography, histology, tartrate-resistant acid phosphatase staining for odontoclasts/osteoclasts, and transmission electron microscopy. In addition, laser capture microdissection was used to collect cellular cementum, and extracted proteins were identified by liquid chromatography coupled to tandem mass spectrometry. The OTM model successfully moved first molars mesially more than 250 µm by 14 days introducing apoptosis in a small number of cementocytes and areas of root resorption on mesial and distal aspects. Cementocytes showed increased nuclear size and proportion of euchromatin suggesting cellular activity. Proteomic analysis identified 168 proteins in cellular cementum with 21 proteins found only in OTM sites and 54 proteins only present in control samples. OTM-down-regulated several extracellular matrix proteins, including decorin, biglycan, asporin, and periostin, localized to cementum and PDL by immunostaining. Furthermore, type IV collagen (COL14A1) was the protein most down-regulated (-45-fold) by OTM and immunolocalized to cells at the cementum-dentin junction. Eleven keratins were significantly increased by OTM, and a pan-keratin antibody indicated keratin localization primarily in epithelial remnants of Hertwig's epithelial root sheath. These experiments provide new insights into biological responses of cementocytes and cellular cementum to OTM.

Chewing ability and oral health-related quality of life in frail elders after new complete dentures insertion: A paired controlled clinical trial.

AIMS: To compare the effect of new complete dentures (CDs) on self-perceived masticatory ability (MA) and oral health-related quality of life (OHRQoL) in frail and nonfrail elders. METHODS AND RESULTS: Twenty completely edentulous elders were assigned to two groups: frail and nonfrail (n = 10/each). MA was evaluated using a visual analogue scale. OHRQoL was assessed with the Oral Health Impact Profile (OHIP-Edent). Variables were evaluated with volunteers wearing their old and unsatisfactory CDs. Then, a new set of CDs was manufactured and all outcomes were reassessed 2 months after the insertion. Data were analyzed by repeated measures' analyses of variance and Tukey tests. MA for lettuce and peanuts was improved (P < .05) for the frail group after new CD insertion. Psychological discomfort and handicap OHIP-Edent domain improved (P < .05) for both groups after prosthetic treatment. Before treatment, controls reported greater psychological discomfort than the frail group. Meanwhile, the handicap domain score of frail patients improved to a level similar to that of the nonfrail group after treatment. Regardless of frailty, elders showed better MA scores for most food types after treatment and decreased OHIP-Edent domain values. CONCLUSION: Self-reported MA and OHRQoL of frail elderly people were greatly improved after new CD use.

Mastication and oral sensory function in frail edentulous elderly: a case-control study.

OBJECTIVE: To evaluate the maximum bite force (MBF), masticatory performance and oral sensory function (OSF) of frail edentulous elderly. The correlation of MBF with maximum grip strength (MGS) was also assessed. METHODS: Twenty edentulous elderly [10 with and 10 without the frailty phenotype (FP)] were selected to participate in this case-control study. The FP was diagnosed using the criteria of Fried et al., which consider weight loss, exhaustion, physical activity level, weakness and slowness to the evaluation. All volunteers received new complete dentures (CDs) to standardise the occlusal status, and after 2 months of use with no complaint, all variables were assessed. MBF was measured by pressure sensors positioned bilaterally on the first artificial molars. Masticatory performance was assessed using the sieving method and was expressed as the median particle size (X50 ) of Optocal after 40 masticatory cycles. OSF was evaluated using the oral stereognosis test, and MGS was measured using a dynamometer. Groups were compared using one-way analysis of variance. The Pearson coefficient of correlation between MBF and MGS was calculated. RESULTS: Frail elderly people showed reduced MBF (P = 0.0431) and larger X50 values (P = 0.0053) than did non-frail elders, while OSF did not differ between the groups. MBF had a moderate positive correlation with MGS (r = 0.690, P = 0.003). CONCLUSIONS: Frail elderly had reduced MBF and impaired mastication. On the other hand, OSF does not seem to be affected by frailty. MBF was moderately correlated with MGS.

Masticatory function and oral stereognosis in bruxers.

Objective: To compare the mastication and oral sensory function of individuals with and without sleep bruxism. Methods: The sample comprised 60 volunteers, of which 30 were bruxers (mean age = 30.5 ± 6.0) and 30 non-bruxers (mean age = 28.6 ± 3.3). Sleep bruxism was clinically diagnosed and confirmed using the Bruxoff® device. Mastication was evaluated according to swallowing threshold and masticatory efficiency. Swallowing threshold was determined from the median particle size of Optosil®, obtained after an individualized number of masticatory cycles, which was first determined by chewing peanuts; masticatory efficiency was estimated by the sieving method. Oral stereognosis test was used to determine the oral sensory function. Variables were compared using one-way ANOVA (p < .05). Results: The median particle size, masticatory efficiency, and oral sensory function did not differ significantly between bruxers and non-bruxers (p > .05). Conclusion: Dentate adults present similar mastication and oral sensory function, despite the presence of sleep bruxism.

Bite Force, Masseter Thickness, and Oral Health-Related Quality of Life of Elderly People with a Single-Implant Mandibular Overdenture.

PURPOSE: To compare maximum bite force, masseter thickness, and oral health-related quality of life (OHRQoL) in elderly patients rehabilitated with conventional complete dentures (CDs) and single-implant overdentures (SIOs). MATERIALS AND METHODS: A paired design was conducted, and 12 elderly patients were selected. Initially, a set of new CDs was manufactured and placed. After a 2-month adaptation period, the mandibular CD was transformed into an SIO by inserting one osseointegrated implant into the symphysis region. All variables were evaluated 2 months after both treatments (CD and SIO). Maximum bite force was evaluated using pressure sensors, while masseter thickness was obtained via ultrasound during muscle contraction and relaxation. The Oral Health Impact Profile for edentulous people (OHIP-Edent) was used to measure OHRQoL. Data were analyzed using Student t test and Wilcoxon test. Pearson coefficient of correlation between bite force and masseter thickness was calculated. RESULTS: Values for maximum bite force and masseter thickness during contraction increased significantly after SIO use (P < .001), indicating an improvement in muscle function. Considering OHRQoL, the general score and the domains functional limitation and physical pain were reduced (P < .05), indicating better perception of OHRQoL, with SIO use. Moreover, masseter thickness during contraction was moderately correlated with bite force (r = 0.480; P = .018). CONCLUSION: Using SIO increased the maximum bite force and masseter thickness of elderly patients, leading to an improved OHRQoL.

Cervical posture analysis in dental students and its correlation with temporomandibular disorder.

OBJECTIVE: To evaluate the relationship between temporomandibular disorders (TMD) and craniocervical posture in the sagittal plane measured from lateral radiographs of the head. METHODS: The sample was comprised of 80 randomly selected students of dentistry at the Federal University of Rio Grande do Norte. Research Diagnostic Criteria for TMD (RDC/TMD) was used to evaluate the signs and symptoms of TMD. Lateral radiographs of each individual were used to measure the position of the hyoid bone, the craniocervical angle, and the occiput-atlas distance. A chi-square test was used to evaluate the relationships between craniocervical posture measures and TMD. RESULTS: No relationship was found between TMD and the craniocervical posture measured by the positioning of the hyoid bone, head rotation, and the extension/flexion of the head (p > 0.05). CONCLUSION: It can be concluded, therefore, that no relationship exists between cervical posture in the sagittal plane and TMD.

Relationship between anxiety and temporomandibular disorders in dental students.

OBJECTIVE: To evaluate the prevalence of temporomandibular disorder (TMD) in dental students and its correlation with anxiety. METHODS: After probability sampling, 105 students were selected. The diagnosis of TMD was carried out using the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) - Axis I; the anxiety level was obtained by the State-Trait Anxiety Inventory (STAI). Data from TMD and anxiety were calculated through frequency and Chi-square test to assess the association between TMD and anxiety, considering a significance level of 5%. RESULTS: TMD was present in 36.2% of the students; disc displacement (42.1%), and arthralgia (42.1%) were the most prevalent subtypes. The majority of students presented both traits (57.1%) and state (65.7%) anxiety in mild levels, followed by moderate levels. No statistical association between TMD and anxiety was found (p > 0.05). CONCLUSION: Joint TMD was the most prevalent subtype of TMD in dental students and was not associated with anxiety levels.

Academic perspectives and psychosocial aspects of final-year dental students during COVID-19 pandemic

Aim: This cross-sectional observational study aimed to evaluate the influence of the Universities lockdown measures on academic perspectives and psychosocial aspects of Brazilian finalyear dental students. Methods: 268 undergraduate students regularly enrolled in a Dentistry course at public universities were asked about anxiety, depression, stress sensitivity, and their academic perspectives by using an online survey. The Hospital Anxiety and Depression Scale (HADS) was used to measure anxiety and depression, while the Perceived Stress Scale (PSS) evaluated stress levels. The academic perspective was evaluated by five affirmatives regarding possible difficulties that will be faced when school reopens and after graduation. The possible association between fear of having COVID-19 with psychosocial outcomes and COVID-19 association with academic perspectives were analyzed by ANOVA and chisquare tests, respectively, considering a significance level of 5%. Results: Considering possible associations between the fear of having COVID-19 and psychosocial aspects, significant values were found for anxiety (P = 0.018) and stress sensitivity (P = 0.002). Regarding students' academic perspectives, COVID-19 had significant impact on less opportunity to perform procedures (P = 0.023), additional expenses with personal protective equipment (P = 0.007), and concerns of consulting elderly people (P = 0.012). Conclusion: The COVID-19 pandemic led to increased psychological impairments and enlarged concerns with learning and biosecurity, which might impact academic perspectives. Thus, being aware of these apprehensions, university professors and staff can improve the clinical training of final-year dental students in an empathetic way

Effect of frozen storage on preservation of a silicone-based test food material

Aim: This study aimed to evaluate the effect of frozen storage on the physical properties of a silicone-based test food material, highly used to evaluate the masticatory performance in research settings. Methods: A total of 1,666 silicone cubes of Optosil Comfort® with 5.6-mm edges were shaped and stored at -18°C. The cubes were subsequently tested for flexural strength (maximum force, displacement, stress, and strain) before breaking (n = 136), changes in weight and size (n = 170), and masticatory performance (n = 1360) at eight timepoints: immediately after cube preparation (baseline, no freezing), and 1, 2, 3 and 4 weeks, and 2, 4 and 6 months after frozen storage. The cubes were thawed 8 h before each assessment. Results: The maximum force, stress, maximum displacement, and deformation values for the cubes were not affected by freezing (P > 0.05). At all of the time points, the cubes exhibited similar weight (P = 0.366) and size (identical values). The masticatory performance for the cubes also showed no differences from baseline through 6 months (P = 0.061). Conclusion: Freezing Optosil Comfort® silicone cubes did not alter the physical and mechanical properties of the material, being suitable to optimize the assessment of masticatory parameters for research purposes

Mandibular single-implant overdenture as an alternative for full arch rehabilitations: a literature review

Oral rehabilitation with mandibular single-implant overdentures (SIO) has been characterized as a solution to improve retention and stability of conventional complete dentures (CD). Among the benefits of this therapy, it can be mentioned minimally invasive surgery, simple prosthetic technique, better retention, and significantly reduced costs. However, the application of this protocol in daily clinic is still not widespread. Aim: Thus, this study aimed to perform a literature review to address the clinical characteristics of this rehabilitation, when compared to two-implant mandibular overdentures and CD. Methods: For this, a search was conducted in the PubMed database, considering articles published in English language, without date limitation. Results: It was found 243 manuscripts, of which 20 were compatible with the aim of this study after title/abstract reading. The selected papers focused on masticatory muscles function, satisfaction levels and self-reported quality of life, as well as surgical and prosthetic outcomes, such as maintenance, repair and implant failure rates. All evaluated manuscripts showed similar masticatory function and patient's satisfaction with SIO and two-implant overdenture, while results for a SIO were greater when compared to rehabilitations with CD. In addition, SIO have proven to do not damage the implant, being implant loss close to zero. However, the prosthesis fracture adjacent to the implant was a recurrent clinical outcome, which requires further studies to solve this impairment. Conclusion: Thus, it can be concluded that SIO represents an alternative treatment for frail elders or low-income patients, leading to higher masticatory function, as well as improved quality of life

Sensitivity and specificity of different indexes used to diagnose Temporomandibular Disorders / Sensibilidade e especificidade de diferentes índices utilizados para o diagnóstico de disfunções temporomandibulares

Objective: To verify the level of agreement among different indexes used to achieve the prevalence of Temporomandibular Disorders (TMD). Material and Methods: One hundred one dental students were selected by a randomized process. TMD were evaluated by the Fonseca's Anamnestic Index (FAI), Helkimo's Clinical Index (HCI), and the Research Diagnostic Criteria for TMD (RDC/TMD). Data was analyzed using Chi-square and Kappa tests, considering a significance level of 5%. Results: HCI showed the highest prevalence of TMD, and the comparison between RDC/TMD, FAI, and HCI showed low agreement (k=0.17 and k=0.35 respectively). Most individuals presented mild TMD for both FAI and HCI indexes. A moderate correlation for TMD severity was obtained (kw=0.53) between FAI and HCI, and a high sensitivity and low specificity were observed for both diagnosis when compared to RDC/TMD. Conclusion: The prevalence of TMD may vary significantly depending on the index used for its diagnosis, which may lead to a large number of false positives and overtreatments. (AU)

Objetivo: Verificar o nível de concordância entre diferentes índices utilizados para avaliar a prevalência de disfunções temporomandibulares (DTMs). Material e Métodos: Cento e um estudantes de odontologia foram selecionados por um processo randomizado. As DTMs foram avaliadas pelo Índice Anamnéstico de Fonseca (IAF), pelo Índice Clínico de Helkimo (ICH) e pelo Research Diagnostic Criteria for TMD (RDC / TMD). Os dados foram analisados pelos testes Qui-quadrado e Kappa, considerando um nível de significância de 5%. Resultados: A aplicação do ICH levou a uma maior prevalência de DTM, e a comparação entre o RDC/TMD, IAF e ICH mostrou baixa concordância (k = 0,17 e k = 0,35, respectivamente). A maioria dos indivíduos apresentou DTM leve para os índices FAI e ICH. Uma correlação moderada para a gravidade da DTM foi obtida (kw = 0,53) entre FAI e HCI, e uma alta sensibilidade e baixa especificidade foram observadas para ambos os diagnósticos quando comparados com o RDC/TMD. Conclusão: A prevalência de DTM pode variar significativamente, dependendo do índice usado para o seu diagnóstico, o que pode levar a um grande número de falsos positivos e sobretratamentos. (AU)

Vantagens da utilização do protocolo dentogengival total em zircônia / Advantages of using the full-contour zirconia dentogingival protocol

A reabilitação protética por meio de implantes tem se confi gurado como o padrão-ouro para a devolução da função previamente perdida pelo paciente, podendo ser realizada com próteses removíveis ou fixas sobre os implantes osseointegrados. As próteses fixas do tipo protocolo proporcionam maior estabilidade durante as atividades cotidianas, como falar e comer, além de alta performance estética, quando bem indicada. Vislumbrando uma maior resistência das próteses, melhor harmonização do sorriso e adequada adaptação, as infraestruturas em zircônia vêm sendo altamente difundidas na literatura. Confeccionadas pelo método CAD/CAM, as próteses em zircônia dispensam as etapas de solda, o que elimina possíveis distorções de grandes estruturas, além de serem produzidas mais rapidamente e com uma estética maior, caracterizando-se como a melhor opção para pacientes que buscam a mimetização do sorriso natural.

The prosthetic rehabilitation using dental implants has been featured as the gold standard for retrieving patient's lost function, and may be performed by implant-supported removable or fixed dental prostheses. The implant-supported fixed prosthesis provides greater stability during daily activities, such as talking and eating, and high aesthetic performance, when properly indicated. In order to obtain higher resistance, superior smile esthetics and adequate prosthesis fit, the zirconia infrastructure have been highly disseminated in the literature. The CAD/CAM zirconia prosthesis avoids welding/soldering, which eliminates possible distortions of large structures. In addition, it is produced faster and with greater aesthetic, being nowadays characterized as the best option for patients who seek to emulate the natural smile.