Time-study research on maxillofacial prosthetic treatment.

Unreasonable medical fees can cause problems such as increased medical costs, greater medical disparities, decreased medical standards, and physician shortages. To prevent such problems, it is important to set appropriate medical fees, ensure their proper use, and improve the efficiency of medical care. The treatment of patients with maxillofacial defects is generally more expensive compared with general prosthodontic treatment because it involves more materials and requires more frequently follow-ups for longer period. However, the actual time required for maxillofacial prosthetic treatment is unclear. Therefore, in this study, we aimed to clarify the amount of time spent treating maxillofacial prosthetic patients. We analyzed clinical data from patients undergoing routine maxillofacial prosthetic treatment, irrespective of difficulty level, at 8 university hospitals and 2 dental clinics. We also collected data from maxillofacial prosthodontists on the treatment time required for various Japanese health insurance items, including the fabrication of maxillofacial prostheses. The results revealed that some aspects of maxillofacial prosthetic treatment may take longer to perform and are more costly to perform than previously thought, suggesting the need for some adjustments to the health insurance reimbursement system. Maintaining an appropriate balance between expenditures and fees will greatly benefit patients and physicians, ensuring positive health outcomes and a healthy society.

Effect of soft denture liners on complete denture treatments: A systematic review.

PURPOSE: This systematic review examined the effectiveness of soft denture relining (SDR) materials. STUDY SELECTION: A comprehensive search of MEDLINE, Cochrane Library, and ICHUSHI was conducted up to July 26, 2020. Target outcomes were patient satisfaction, oral health-related quality of life (OHRQOL), masticatory ability (MA), denture functional duration, residual ridge resorption (RRR), and microbial contamination. An organization specializing in literature searches performed the reference searches, and two reviewers independently selected the literature sources, extracted the data, and assessed the risk of bias. The reviewers resolved any disagreements concerning the assortment of literature sources through discussion. SDR included acrylic- and silicone-based materials, which were evaluated separately. RESULTS: Reviewers selected 7, 5, 11, 1, 4, and 6 studies to assess patient satisfaction, OHRQOL, MA, functional duration, RRR, and microbial contamination, respectively. The results confirmed that SDR improved patient satisfaction, OHRQOL, MA, and RRR. However, the functional duration of SDR material is shorter than that of hard denture relining (HDR) or acrylic resin material. Furthermore, SDR material is more susceptible to microbial contamination in the long term. The risk of bias for the included studies tended to be high because of specific issues (difficulty in blinding SDR versus HDR). CONCLUSIONS: For patients who wear complete dentures, SDR often provides beneficial outcomes such as pain reduction and recovery from MA. However, caution should be exercised regarding their use owing to insufficient functional duration and the possibility of microbial contamination during long-term use.

A report on the clinical use of bonding systems for coronal restorations produced from CAD/CAM resin blocks.

Computer-aided design and manufacturing (CAD/CAM) resin-produced restorations were approved by a health insurance system in Japan from the year 2014. In this study, we investigated the use of CAD/CAM resin blocks in Japan since 2014, and the clinical use of adhesive systems for CAD/CAM resin-produced restorations in dentistry. Our findings indicated a rise in the clinical application of these products; however, some studies have reported instances of debonding and fracture of the restorations. CAD/CAM resin blocks were implemented in the health insurance system in Japan as an alternative for alloys due to the continuous rise in the prices of gold and palladium. Thus, in order to reduce the number of failures in CAD/CAM resin-produced restorations due to debonding and fracture, the integration of these restorations with the tooth structures is of utmost importance.

Concept and clinical application of the resin-coating technique for indirect restorations.

The resin-coating technique is one of the successful bonding techniques used for the indirect restorations. The dentin surfaces exposed after cavity preparation are coated with a thin film of a coating material or a dentin bonding system combined with a flowable composite resin. Resin coating can minimize pulp irritation and improve the bond strength between a resin cement and tooth structures. The technique can also be applied to endodontically treated teeth, resulting in prevention of coronal leakage of the restorations. Application of a resin coating to root surface provides the additional benefit of preventing root caries in elderly patients. Therefore, the coating materials have the potential to reinforce sound tooth ("Super Tooth" formation), leading to preservation of maximum tooth structures.

Titanium removable denture based on a one-metal rehabilitation concept.

The use of a single metal for all restorations would be necessary because it protects against metal corrosion caused by the contact of different metals. For this "one-metal rehabilitation" concept, non-alloyed commercially pure (CP) titanium should be used for all restorations. Titanium frameworks have been cast and used for the long term without catastrophic failure, whereas they have been fabricated recently using computer-aided design/computer-aided manufacturing (CAD/CAM). However, the milling process for the frameworks of removable partial dentures (RPDs) is not easy because they have very complicated shapes and consist of many components. Currently, the fabrication of RPD frameworks has been challenged by one-process molding using repeated laser sintering and high-speed milling. Laser welding has also been used typically for repairing and rebuilding titanium frameworks. Although laboratory and clinical problems still remain, the one-metal rehabilitation concept using CP titanium as a bioinert metal can be recommended for all restorations.

Evaluation of psychological effect of prosthetic treatment using Emotion Spectrum Analysis Method (ESAM).

PURPOSE: The aim of this pilot study was to consider evaluation of the psychological effects of dental prosthetic treatments using ESAM. METHOD: We examined gum chewing with and without an occlusal interference device that simulated a negative change in oral sensation in four subjects. First, we analyzed the temporal components of mandibular movement trajectories as indices for evaluating the degree to which chewing is actually impaired by occlusal interference. Subsequently, we measured brain activity before and after chewing for each of the two conditions (with or without the occlusal interference device). For brain activity, we used the four emotional indices of stress, sadness, joy and relaxation based on ESAM to estimate psychological states before and after chewing, and made a comparison between the two conditions. Statistical analyses were performed with Mann-Whitney's U-test (p<0.05). RESULTS: The opening phase and chewing cycle were shorter when wearing the occlusal interference device in every subject. There was a significant difference for all subjects (p<0.05) in the closing cycle. Therefore, because a significant difference occurred for at least one temporal component of the mandibular movement trajectory for every subject, we concluded that normal chewing in subjects was impaired by wearing the occlusal interference device. Similarly, in ESAM analyses using EEG, stress tended to increase due to occlusal interference in every subject. In addition, relaxation decreased due to occlusal interference in three subjects. CONCLUSION: The results suggested the potential for evaluating the psychological effects of dental prostheses using emotional indices based on ESAM.