Influence of denture-bearing conditions on masticatory function and patient-reported outcomes measures.

PURPOSE: To investigate the influence of different denture-bearing conditions on the masticatory function and patient-reported outcome measures (PROMs) of complete denture wearers. METHODS: Sixty edentulous patients were selected and allocated into two groups according to the American College of Prosthodontics' (ACP) classification: non-atrophic (NAT) (Classes I and II) (n = 24) and atrophic (AT) (Classes III and IV) (n = 36). All patients received new complete dentures (CDs). The objective variables (masticatory performance and swallowing threshold) were assessed as well as the PROMs (oral health-related quality of life (OHIP-EDENT), patient satisfaction) and quality of the prosthesis, at baseline (using the old CD) and after 4 months new prostheses use. Data were analyzed by Mann-Whitney test followed by the Generalized Equations Estimation (GEE), linear regression and Chi-square test. RESULTS: Higher masticatory performance was observed in the NAT group (p < .05) for both time points, baseline and after 4 months. However, compared to baseline, both groups showed significant masticatory improvement after 4 months (p < .05). Satisfaction and overall quality of life improved after 4 months with no difference between groups (p > .05). Regarding the quality of the CD, baseline results were significantly (p < .05) lower in the AT group, but after 4 months, no significant differences were found between groups and in intragroup analysis (p > .05). CONCLUSIONS: The denture-bearing conditions seems to impact masticatory function, but the PROMs are barely affected.

Performance of complete dentures fabricated with the simplified and the traditional technique: A randomized clinical trial.

STATEMENT OF PROBLEM: The simplified technique has been recommended for the fabrication of removable complete dentures. However, a consensus regarding the performance of the simplified and the traditional techniques is lacking. PURPOSE: The purpose of this randomized clinical trial was to compare the performance of prostheses fabricated with the simplified and the traditional techniques. MATERIAL AND METHODS: Sixty participants were recruited and randomized into 2 groups: traditional technique (control group) and simplified technique (experimental group). The assessments were performed before treatment (baseline) and 2 and 4 months after adaptation to the new complete dentures. The variables evaluated were satisfaction, oral health-related quality of life (OHRQoL) by using the Brazilian version of the OHIP-EDENT, the quality of the prostheses, and, for the functional assessment, the masticatory performance and swallowing threshold. The data were analyzed by the Fisher exact test, the Mann-Whitney test, and the generalized equations estimating (GEE) method. RESULTS: At baseline, the mean ±standard deviation quality of the prostheses was 5.3 ±2.3 for the traditional technique and 4.9 ±2.3 for the simplified technique, and at 4 months, it was 9.3 ±0.9 and 9.1 ±0.9, respectively. For masticatory performance, the mean ±standard deviation X50 at baseline was 5.7 ±1.4 for the traditional technique and 5.7 ±0.9 for the simplified technique, and at 4 months, it was 3.8 ±1.2 and 3.7 ±0.9, respectively. The mean ±standard deviation OHRQoL at baseline was 14.1 ±8.6 for the traditional technique and 12.5 ±9.4 for the simplified technique, and at 4 months, it was 3.2 ±4.3 and 2.6 ±5.1, respectively. The mean ±standard deviation satisfaction at baseline was 9.5 ±3.9 for the traditional technique and 9.3 ±4.2 for the simplified technique; after 4 months, it was 14.8 ±2.0 for both techniques. There was a significant improvement (P<.05) for all variables in the study when comparing them at the baseline to those at the evaluation after provision of new complete dentures. There was no significant difference in all analyzed variables (P>.05) between the 2 techniques for prosthesis fabrication. CONCLUSIONS: The simplified technique appears to be a suitable alternative to the traditional technique for the fabrication of complete dentures, with similar performance.

Intra- and extraoral prostheses retained by zygoma implants following resection of the upper lip and nose.

Upper lip cancers are infrequent lesions, being aggressive unless diagnosed and treated early. After the surgical resection, maxillofacial defects require special care in rehabilitation. This article describes the maxillofacial rehabilitation of an edentulous patient diagnosed with upper lip squamous cell carcinoma. The treatment consisted of a large amount of upper lip and nose tissue resection, followed by chemoradiotherapy. After the first surgical healing, zygoma implants were inserted in a two-step procedure. The maxillary and nasal prostheses were installed and fixed by a titanium framework. After 6 years follow-up, no recurrences were observed, and the patient did not develop metastases. Tissues around implants were in good health, and the prostheses remained well-fitted. The use of implant-retained prostheses improved the quality of life, and the patient was extremely satisfied with the final result. The implant-retained prostheses are well accepted by the patient, improving comfort and safety during function while recovering her esthetic apperance.

Titanium Surface Roughing Treatments contribute to Higher Interaction with Salivary Proteins MG2 and Lactoferrin.

UNLABELLED: Some surface treatments performed on titanium can alter the composition of salivary pellicle formed on this abiotic surface. Such treatments modify the titanium's surface properties and can promote higher adsorption of proteins, which allow better integration of titanium to the biotic system. PURPOSE: This study aimed to evaluate the interactions between salivary proteins and titanium disks with different surface treatments. MATERIALS AND METHODS: Machined titanium disks (n = 48) were divided into four experimental groups (n = 12), according to their surface treatments: surface polishing (SP); acid etching (A); spot-blasting plus acid etching (SB-A); spot-blasting followed by acid etching and nano-functionalization (SB-A-NF). Titanium surfaces were characterized by surface roughness and scanning electron microscopy (SEM). Specimens were incubated with human saliva extracted from submandibular and sublingual glands. Total salivary protein adsorbed to titanium was quantified and samples were submitted to western blotting for mucin glycoprotein 2 (MG2) and lactoferrin identification. RESULTS: Surface roughness was statistically higher for SB-A and SB-A-NF groups. Scanning electron microscopy images confirmed that titanium surface treatments increased surface roughness with higher number of porous and scratches for SB-A and SB-A-NF groups. Total protein adsorption was significantly higher for SB-A and SB-A-NF groups (p < 0.05), which also presented higher interactions with MG2 and lactoferrin proteins. CONCLUSION: The roughing of titanium surface by spot-blasting plus acid etching treatments contribute to higher interaction with salivary proteins, such as MG2 and lactoferrin. CLINICAL SIGNIFICANCE: Titanium surface roughing increases the interactions of the substratum with salivary proteins, which can influence the integration of dental implants and their components to the oral environment. However, those treatments should be used carefully intraorally, avoiding increase biofilm formation.

Total rehabilitation of maxilla using a tooth-to-implant restoration: case report.

Dental implants in partially edentulous patients are a predictable therapeutic option. However, using tooth-to-implant restorations to rehabilitate partially edentulous patients involves highly complex biomechanical aspects. This type of prosthesis utilizes different kinds of support that react distinctly to the functional forces developed in the oral cavity. In some cases, a tooth-to-implant restoration is a treatment option for difficulties related to reduced bone volume, inadequate interdental space, or an implant's failure to osseointegrate. This case report describes the rehabilitation of a patient whose partially edentulous maxilla was treated with a tooth-to-implant restoration. In this case, telescopic crowns were used to better match the tooth-implant union. No biomechanical or functional problems were found 8 years post-treatment, indicating that the combination of implant and tooth support is a possible treatment option with an improved long-term prognosis.

Reabilitação oral utilizando prótese parcial removível associada a implantes osseointegrados: relato de caso / Oral rehabilitation using removable partial prosthesis associated with osseointegrated implants: case report

Introdução: As próteses parciais removíveis são alternativas amplamente utilizadas na reabilitação oral de pacientes parcialmente desdentados. Na atualidade os implantes dentais têm sido indicados para tratamento de pacientes edêntulos em associação com próteses parciais removíveis convencionais. Objetivo: Relatar um caso clínico utilizando uma prótese parcial removível convencional associada a implantes osseointegrados em paciente portador de Classe I de Kennedy. Relato de Caso: Paciente N.A.A.S., sexo feminino, 65 anos, procurou atendimento clínico no Instituto de Estudos da Saúde (IES) para reabilitação protética das arcadas dentais superior e inferior. A sua queixa principal era "dificuldade de mastigação". A paciente apresentava prótese total removível insatisfatória na maxila e não utilizava nenhum tipo de prótese dentária na mandíbula, que se apresentava parcialmente edêntula. O tratamento realizado foi a confecção de uma prótese total na arcada superior. Na arcada inferior foram inseridos dois implantes de hexágono externo nas regiões correspondentes às áreas dos dentes 34 e 44, após quatro meses a prótese parcial removível convencional foi confeccionada e incorporada aos implantes osseointegrados utilizando o sistema de retenção do tipo attachments Equator. Conclusão: Os resultados revelaram que a técnica de associação da prótese parcial removível convencional aos implantes osseointegrados demonstrou ser uma opção viável de tratamento com capacidade de devolver a função, a estética e manter a integridade dos dentes e tecidos periodontais(AU)

Introduction: Removable partial dentures are alternatives widely used in the oral rehabilitation of partially edentulous patients. Currently, dental implants have been indicated for the treatment of edentulous patients in association with conventional removable partial dentures. Objective: To report a clinical case using a conventional removable partial denture associated with osseointegrated implants in a patient with Kennedy Class I. Case Report: Patient N.A.A.S., female, 65 years old, sought clinical care at the Institute of Health Studies (HEI) for prosthetic rehabilitation of the upper and lower dental arches. His main complaint was "chewing difficulty". The patient had unsatisfactory removable total prosthesis in the maxilla and did not use any type of dental prosthesis in the mandible, which was partially edentulous. The treatment performed was the manufacture of a total prosthesis in the upper arch. In the lower arch, two external hexagon implants were inserted in the regions corresponding to the tooth areas 34 and 44, after four months the conventional removable partial denture was made and incorporated into the osseointegrated implants using the equator attachments retention system. Conclusion: The results revealed that the technique of associating conventional removable partial dentures with osseointegrated implants proved to be a viable treatment option with the ability to restore function, aesthetics and maintain the integrity of teeth and periodontal tissues(AU)

Prótese parcial removível com attachment para reabilitação oral: relato de caso / Removable dental prosthesis with attachment for oral rehabilitation: a clinical report

Abordar os principais aspectos relacionados à reabilitação oral ao relatar um caso clínico utilizando prótese parcial removível (PPR) com attachment ball. Discussão: As próteses implanto-suportadas são consideradas um tratamento efetivo para a reabilitação de muitos pacientes desdentados parciais. No en¬tanto, limitações ósseas e/ou sistêmicas e o custo elevado dos implantes podem contraindicar essa modalidade terapêutica. Assim, a reabilitação oral com PPR torna-se uma ótima opção de tratamento. É conhecido que as PPRs a grampo não apresentam boa estética em muitas situações clínicas; porém, PPRs associadas a attachments permitem diversas possibilidades de soluções clínicas quando um diagnóstico e plano de tratamento mais elaborado podem ser executados. Conclusão: A PPR retida por attachment propicia resultado estético superior, transmissão adequada da carga mastigatória aos dentes suportes e excelente retenção...

To discuss the main aspects related to oral rehabilitation through the report of a clinical case using removable dental prosthesis (RDP) with ball attachment. Discussion: The implant-supported fixed restorations are considered an effective treatment for the rehabilitation of many partially edentulous patients. However, bone and/or systemic limitations and the high cost of implants may contraindicate this therapeutic modality. Thus, the oral rehabilitation using RDP becomes a great treatment option. It is known that RDP retained to a clip do not present a good esthetic in several clinical conditions; however, the RDP with attachments allows several possibilities for clinical solutions when a diagnosis and a more elaborated treatment plan can be performed. Conclusion: The RDP with attachment provides better aesthetical result, adequate transmission of masticatory load to support teeth and an excellent retention...

O desempenho da zircônia como biomaterial de uso odontológico / Performance of zirconia as a biomaterial for dental use

As cerâmicas de zircônia apresentam ótimas propriedades como biocompatibilidade, resistência flexural e dureza, tornando-se uma possível alternativa para substituição das restaurações metalocerâmicas. Entretanto, a zircônia sofre degradação superficial quando exposta ao calor e à umidade, e a utilização de estabilizadores e o domínio do processamento são relatados para melhorar a sua resistência. O uso da zircônia na Odontologia é uma realidade, mas pesquisas ainda são necessárias para avaliar seu desempenho a longo prazo na cavidade oral. Dessa forma, o objetivo deste estudo foi, através de uma revisão bibliográfica, avaliar o desempenho da zircônia como um biomaterial de uso odontológico...

Zirconia ceramics have excellent properties, such as biocompatibility, flexural strength and, hardness, and therefore are viable alternatives to metal-ceramic restorations. However, zirconia suffers superficial degradation when exposed to heat and humidity, thus the use of stabilizers and proper process of the area are important in order to improve its resistance. The use of zirconia in Dentistry is a reality, but studies are needed to assess its performance in long periods in the oral cavity. Thus, the objective of this study was to evaluate the performance of zirconia as a biomaterial for dental use through a literature review...

Revisão dos princípios fundamentais de prótese sobreimplante parafusada e cimentada / Review of fundamental principles for screwed- and cement-retained implant-supported prostheses

Os implantes osseointegráveis representam grande avanço no tratamento odontológico, proporcionando significativa melhora no restabelecimento da saúde bucal, da função e da estética. Com seu advento, novos conceitos foram incrementados às técnicas de reabilitação oral. Ao revisar esses conceitos, o presente trabalho busca avaliar as vantagens, desvantagens, indicações e contraindicações de cada modalidade de retenção sobreimplantes. A pesquisa da literatura pertinente ao tema avaliou estudos clínicos, experimentais, revisões da literatura e livros entre os anos de 1981 a 2010. Muitas vezes, a escolha do tipo de retenção baseia-se somente na preferência do profissional, porém, a seleção do sistema de retenção deve ter uma indicação precisa para cada caso. Para tanto, o protesista deve ter conhecimento sobre os princípios fundamentais de passividade e adaptação da restauração protética, estética, espaço interoclusal, saúde dos tecidos moles peri-implantares, necessidade de manutenção, reversibilidade da restauração e aspectos oclusais de cada uma das opções protéticas para adequada execução dos casos clínicos. Conclui-se que a escolha do sistema de retenção não deve ser feita de forma genérica e sim ser individualizada dentro da particularidade de cada caso. Não devemos pensar que uma retenção seja melhor ou pior quando comparamos próteses retidas por cimento versus parafuso, o que deve ser levado em consideração são vantagens, desvantagens, indicações e contraindicações de cada caso em particular.

The osseointegrated implants represent a major advance in dental treatment, providing a significant improvement in the restoration of oral health, function, and aesthetics. Since its advent, new concepts evolved in techniques for oral rehabilitation. When reviewing these concepts, this study sought to determine the advantages, disadvantages, indications, and contraindications for each type of retention. The literature research evaluated clinical studies, research, literature reviews, and books between the years of 1981 to 2010. Oftentimes, the choice of retention is based solely on the preference of professional, but selection of the system should have an indication for each case. Thus, dental clinicians must know the fundamental principles of passivity and fit of prosthetic restorations; interocclusal space; aesthetic; peri-implant soft tissue health; need for maintenance; retrievability, and occlusal aspects of each prosthetic option for proper implementation in clinical cases. We conclude that the choice of retention system should never be made by chance, but individualized within the particularity of each case. Screwed- are not superior to cement-retained prostheses and vice-versa; thus one must take into account the advantages, disadvantages, indications, and contraindications of each particular case.

Investigação sobre técnicas para obtenção de modelo de trabalho em prótese sobreimplante / Investigation on the working cast fabrication in implant-supported prosthesis: a case report

A adaptação passiva da prótese implanto-suportada é um requisito essencial para a estabilidade mecânica. Para que ocorra essa adaptação precisa, fases clínicas e laboratoriais da produção da estrutura, como a moldagem e obtenção do modelo de trabalho, são críticas. Para confecção da prótese, diferentes técnicas de moldagem têm sido indicadas para obtenção de uma transferência correta dos implantes, buscando, com isso, um modelo de trabalho fiel e a conseqüente execução precisa do trabalho. Entretanto, acredita-se ser improvável a transferência sem erros da posição dos implantes para o modelo de trabalho. O objetivo deste trabalho é relatar um caso clínico de prótese fixa parafusada em maxila, em que os passos para obtenção do modelo de trabalho foram realizados seguindo técnicas descritas na literatura que sugerem resultados mais precisos. Técnicas, como moldagem de arrasto com união dos transferentes com barras de acrílico pré-fabricadas e vazamento de pouco volume de gesso ao redor dos componentes, foram utilizadas. As fases técnicas e o resultado final do caso relatado são discutidos.