Maxillomandibular relationship record methods for computer-engineered complete dentures: a scoping review.

OBJECTIVES: The purpose of this scoping review was to identify different methods employed for recording the maxillomandibular relationship (MMR) for computer-aided designed and manufactured (CAD-CAM) complete dentures (CDs). MATERIALS AND METHODS: This scoping review followed the PRISMA-ScR guidelines and was developed according to Arksey and O'Malley and The Joanna Briggs Institute protocol. The methods were registered on the Open Science Framework (< osf.io/rf4xm> ). The focus question was: "What are the different techniques for recording the maxillomandibular relationship in the digital workflow used in CECDs?" Two investigators searched 3 online databases [MEDLINE (PubMed), Scopus, and Science Direct] independently. The inclusion criteria were clinical studies and reviews that assessed techniques for recording MMR using digital workflow for manufacturing of CECDs. A descriptive analysis was performed considering the study design, manufacturing system, clinical steps, and tools for the determination of MMR, and the difficulty level of procedures. RESULTS: 4779 articles were identified in the electronic search and 10 studies were included for data analysis. The review identified 4 commercially available CAD-CAM denture systems and 3 innovative methods suitable for abbreviating the number of appointments (2 to 4 visits). The trial denture is inherent to the procedure for the Baltic System and 3 innovative techniques. Three techniques (2 innovative and WholeYouNexteeth) demonstrated lower difficulty levels for performing the clinical procedures, regardless of the professional skills. CONCLUSIONS: The commercially available and innovative techniques for the recording of MMR may provide predictability of the treatment. The techniques are effective, however, rely on the learning curve and the patient's clinical condition. CLINICAL RELEVANCE: Recording of the maxillomandibular relationship is paramount for the manufacturing and functionality of complete dentures. Clinicians should be aware of the different tools and techniques described for registering the jaw relationship.

Fabrication of digital complete dentures guided by facial scanning with a device for recording the maxillomandibular relation: A dental technique.

This article describes a technique for the fabrication of digital complete dentures guided by facial scanning using an innovative device for maxillomandibular relation records. For this, a device was designed and 3-dimensionally (3D) printed to assist in the maxillomandibular record stage. Digital files of the diagnostic casts, jaw relation record, and facial images were superimposed, and the complete denture was virtually planned. Subsequently, trial complete dentures were 3D printed, and a functional and esthetic clinical tooth evaluation was conducted. Then, definitive impressions were made, and definitive complete dentures were obtained. The method of recording the maxillomandibular relation associated with facial scanning in a digital workflow for manufacturing the dentures in a 3-appointment protocol provided better predictability of patient care and reduced clinical and laboratory time than with the conventional denture technique.

Complications and Patient-Centered Outcomes of an Implant- Supported Single Crown after Immediate and Delayed Loading: A Systematic Review and Meta-analysis.

Single implants are a predictable treatment, and immediate loading can be an option with acceptable survival rates. Clinical and patient-centered outcomes comparing immediate and delayed protocol of single implants are unclear. The purpose of this study was to assess complications, satisfaction, and quality of life of patients rehabilitated with delayed and immediate loading single crowns. An electronic search was conducted in PubMed/MEDLINE, Scopus, Web of Science, Cochrane Library, and Embase databases up to February 2023. Only prospective studies, randomized and non-randomized clinical trials comparing immediate and delayed loading were included. For the quantitative analysis, dichotomous and continuous variables were evaluated with a 95% confidence interval. A total of 20 studies were evaluated. No statistically significant difference between protocols was observed: satisfaction (I2: 0%; P = 0.42), quality of life (I2: 0 %; P = 0.05), biological complications (I2: 9%; P = 0.17) mechanical complications (I2: 58%; P = 0.84), and survival rate (I2: 0%; P = 0.38). Subgroup analysis showed significant differences only for marginal bone loss when immediate implants were placed in the mandible (IÇ: 15%; P = 0.01) and posterior zone (I2: 0%; P = 0.001). Complications and patient-centered outcomes for immediate single-implant crowns were comparable to delayed loading. Scientific evidence showed no significant difference between loading protocols for survival rates. Although several factors could interfere with the complication events, implant failures, and marginal bone loss, the subgroup analysis evidenced that only immediate implants placed in the posterior mandible zone had higher statistically significant mean marginal bone loss.

Impact of using magnifying dental loupes on clinical performance during tooth preparation: A systematic review.

Background: To assess whether using magnification loupes affects tooth preparation working posture performed by undergraduate students and dentistry professionals and whether it influences the quality of the preparation, operator satisfaction and procedure time. Material and Methods: This review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and registered in the International Prospective Register of Systematic Review (CRD42023482377). Electronic searches were conducted in PubMed/Medline, Cochrane Library, Web of Science, and Scopus databases for relevant articles published up to August 2023. Clinical or laboratory studies evaluating cavities or dental preparations performed with and without magnification loupes were considered eligible. The outcomes were operator working posture, dental preparation quality, operator satisfaction, and procedure time. The quality of the studies was evaluated using the JBI Critical Appraisal tools for Quasi-Experimental Studies. Results: The searches retrieved 1493 articles. Based on the eligibility criteria, 11 laboratory studies were included, where 410 undergraduate and graduate dental students conducted dental preparations in 1851 dental specimens. Of the 11 selected studies, 6 evaluated the working posture, 6 assessed the quality of the dental preparations, 5 reported operator satisfaction, and 2 assessed procedure time. The results showed that magnifying loupes significantly improved operator working posture, but did not influence the quality of tooth preparations. Although satisfaction reports about experiences with magnifying loupes were favorable, no significant difference was found. Conclusions: Magnification loupes improved operator working posture. However, clinical studies with more scientific evidence are needed for steady conclusions regarding operator satisfaction and procedural time. Key words:Magnification, dental loupes, tooth preparation, cavity preparation, dental education.

Complete denture rehabilitation for a patient with Parkinson's disease using clinical strategies: A case report.

OBJECTIVE: To present clinical strategies for prosthetic rehabilitation with complete dentures (CDs) of a Parkinson's disease patient. CASE REPORT: An 82-year-old patient sought the Department of Dentistry at UFRN, reporting retention dissatisfaction and hamper to the mandibular CD adaptation. Patient-reported a dry mouth sensation, and exhibited disordered mandibular movements, tremors, and resorbed mandibular ridge. Aiming retention and stability, double molding with zinc enolic oxide impression paste, neutral zone technique, and non-anatomic teeth were proposed as clinical strategies. At delivery, identification and relief in the supercompression areas were performed to facilitate the acceptance and use of the new dentures. CONCLUSION: The strategies promoted patient satisfaction regarding retention, stability, and comfort. This treatment may be considered for the rehabilitation of Parkinson's disease patients, favoring the adaptation process.

Factors Associated with Nonadaptation to New Mandibular Complete Dentures: A Scoping Review.

PURPOSE: To identify and map the scientific evidence regarding factors associated with the nonadaptation of completely edentulous patients to mandibular complete dentures. MATERIALS AND METHODS: This scoping review followed the PRISMA-ScR statement for Scoping Reviews and was based on guidelines proposed by Arksey and O'Malley and the Joanna Briggs Institute Manual for Evidence Synthesis. The methodology was registered on the Open Science Framework. An electronic search strategy was conducted in PubMed/MEDLINE, Web of Science, Scopus, Cochrane Library, Virtual Health Library, ClinicalTrials.gov, Google Scholar, and ProQuest databases was conducted. Studies that evaluated factors associated with adaptation to and acceptance of mandibular complete dentures were included, such as sociodemographic, psychologic, patient-related, and denture-related items. RESULTS: The search conducted in March 2022 yielded 9,978 studies. In total, 24 studies were included for data extraction. Sociodemographic factors did not interfere with adaptation to a mandibular complete denture. Psychologic factors and patient-related aspects showed greater association with nonadaptation to mandibular complete dentures than denture-reported factors. CONCLUSION: Although it is suggestive that psychologic and patient-related factors have higher association with the acceptance of new dentures, data must be interpreted with caution due to the variability of methodologies of the studies included in this review.

Prosthetic complications and failures of implant-supported fixed partial dentures: A scoping review.

STATEMENT OF PROBLEM: Although high survival rates of implant-supported fixed partial dentures (ISFPDs) have been reported, evidence for complications, failures, and factors that interfere with their longevity is lacking. PURPOSE: The purpose of this scoping review was to review the literature to investigate the most common failures and complications of ISFPDs. MATERIAL AND METHODS: This review followed the preferred reporting items for systematic reviews and meta-analyses scoping review (PRISMA ScR) guidelines, and the methodology was registered on the open science framework (osf.io/5xqkp). An electronic search was conducted in PubMed/MEDLINE, Embase, Cochrane Library, Scopus, and Web of Science databases and nonpeer-reviewed literature for articles published from 2013 to January 2023. Studies that evaluated the clinical performance of ISFPDs with at least 1 year of follow-up and described the concepts of failure and success were included. RESULTS: The search yielded 5695 studies. Fourteen articles were included in this review for data extraction. Veneering porcelain fracture, screw fracture, and implant loss were the most common failures reported. Technical complications mainly involved screw loosening, loss of retention, and wear of the screw-access restoration. CONCLUSIONS: Bruxism, mismatch of the thermal expansion coefficient, unsatisfactory support of the framework, choice of cement, shape of the titanium abutments, and extended length of the cantilever were associated with the longevity of the ISFPD. Despite the high survival rate of ISFPDs, data must be carefully interpreted because of the variation in the materials used to manufacture the ISFPD and the heterogeneity of the studies in this review.

Use of impression technique to identify areas of super compression before installation of new complete dentures: a randomized double-blind trial.

OBJECTIVE: To identify pressure areas using an impression technique and to evaluate whether adjustment of dentures prior to installation can decrease ulcer frequency, number of adjustments, and improve satisfaction with treatment. MATERIALS AND METHODS: Fifty complete denture users were selected and randomly divided into two groups. Pressure areas were identified in 25 subjects using the impression technique with fluid silicone, and the denture base in these areas was adjusted before installation. A total of 25 subjects received new complete dentures without adjustments before installation. The number of ulcers observed was registered at 1, 7, 15, and 30 days after installation. Patient satisfaction was collected before and 1 month after the installation. The number of necessary post-installation adjustments was considered. Comparisons between the groups with respect to the number of ulcers, adjustments, and patient satisfaction were performed using the Mann-Whitney test. RESULTS: Identification of pressure areas reduced the number of ulcers after installation of the new prostheses. These results were observed in the 1- (p = 0.004) and 7-day (p = 0.002) adjustments for the maxilla and in all the adjustments for the mandible. The technique improved patient satisfaction (p = 0.031) and reduced the number of post-installation adjustments (p ≤ 0.001). CONCLUSION: A reduction in the incidence of ulcers, number of adjustments and improvement in patient satisfaction could be observed with the use of the technique.

Virtual facebow techniques: A scoping review.

STATEMENT OF PROBLEM: Although advances in technology continue to improve the acquisition of patient data and the manufacturing of different oral rehabilitations, the method of transferring clinical information to a virtual environment has not yet been consolidated in the literature. PURPOSE: The purpose of this scoping review was to map the existing literature on different techniques of transferring information from virtual facebows for oral rehabilitation. MATERIAL AND METHODS: This scoping review was structured using a 5-step methodology based on guidelines proposed by Arksey and O'Malley: (1) characterization of the research question, (2) identification of relevant studies, (3) selection of studies, (4) mapping of results, and (5) selection, summary and reporting of the data. The Joanna Briggs Manual for Evidence Synthesis was followed and the review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). The guiding question for the development of this review was, "What virtual facebow techniques are being used to transfer anatomic data to the virtual environment?" RESULTS: A total of 1745 articles were found during the search, and 20 were included in this review. Nineteen of the included articles had positive results with the described techniques of registration and transfer of anatomic references to the virtual environment; however, 1 study indicated that the technique was negative. CONCLUSIONS: Based on the findings, facial scanning, 2-dimensional photographs, and cone beam computed tomography are feasible methods of acquiring extraoral anatomic landmarks. The use of a device that allows the convergence of intraoral and extraoral images by superimposing data was revealed to be a promising option.

Nonadaptation to New Mandibular Complete Dentures: A Survival Analysis and Interpretation of the Time to Adaptation.

PURPOSE: To determine the average time for patients to adapt to mandibular complete dentures (CDs) and the factors associated with this critical period. MATERIALS AND METHODS: In total, 108 completely edentulous patients were rehabilitated using CDs. Adaptation was evaluated based on the following criteria: mastication, comfort, speech, and swallowing with dentures. The Kaplan-Meier method was used to estimate the average time to adaptation. The logrank test was used to assess the adaptation period and associated factors. RESULTS: Of the 108 rehabilitated patients, 89 had adapted to mandibular CDs at the 6-month follow-up. The mean time to adaptation estimated from the Kaplan-Meier curve was 78.54 days (95% confidence interval [CI] 71.04 to 86.04). The factors associated with the adaptation period were previous experience with a mandibular denture (P = .032), the professional who made the previous CDs (P = .034), frequency of appearance of traumatic lesions after 15 days of rehabilitation (P = .023), posterior mandibular ridge height (P = .005), and regular use of the new dentures (P = .002). CONCLUSIONS: Most patients adapted to mandibular dentures after 2.6 months. Lack of prior experience with mandibular dentures, use of old dentures made by a dental technician, occurrence of traumatic injuries 15 days after CD delivery, presence of a resorbed posterior mandibular ridge, and nonregular wear were associated with longer adaptation time to new mandibular CDs.

Factors associated with the non-adaptation to new mandibular complete dentures: a scoping review.

PURPOSE: To identify and map the scientific evidence regarding the factors that may influence the adaptation of complete edentulous to the mandibular complete denture. MATERIALS AND METHODS: An electronic search strategy in the PubMed/MEDLINE, Web of Science, Scopus, Cochrane Library, and Virtual Health Library databases from 1945 to 2021, was conducted, according to the criteria established by PRISMA-ScR. Studies that addressed factors that influenced adaptation and acceptance to mandibular complete denture were included, such as socio-demographic and psychological aspects and patient-centered condition, and denturer-elated factors. RESULTS: The search yielded 9264 studies, of which 87 articles were considered eligible for full-text screening. Of this total, 23 were included for data extraction. Sociodemographic factors do not interfere with adaptation to a mandibular complete denture. Reports of complaints regarding pain and discomfort negatively impact the acceptance of complete dentures. Patients with a neuroticism personality have more difficulty accepting the complete dentures, being more predisposed to abandon them. CONCLUSION: The psychological condition interferes with the predictability of treatment. Older and female patients, using first mandibular dentures, with resorbed ridges, and poor technical quality had more difficulty adapting to the complete dentures. However, these data must be interpreted with caution due to the variability of methodologies of the studies included in this review. Int J Prosthodont 2023. doi: 10.11607/ijp.7774.

Flexural strength, surface roughness, micro-CT analysis, and microbiological adhesion of a 3D-printed temporary crown material.

OBJECTIVE: To evaluate the thermocycling effect of 3D-printed resins on flexural strength, surface roughness, microbiological adhesion, and porosity. MATERIALS AND METHODS: 150 bars (8 × 2 × 2 mm) and 100 blocks (8 × 8 × 2 mm) were made and divided into 5 groups, according to two factors: "material" (AR: acrylic resin, CR: composite resin, BIS: bis-acryl resin, CAD: CAD/CAM resin, and PRINT: 3D-printed resin) and "aging" (non-aged and aged - TC). Half of them were subjected to thermocycling (10,000 cycles). The bars were subjected to mini-flexural strength (σ) test (1 mm/min). All the blocks were subjected to roughness analysis (Ra/Rq/Rz). The non-aged blocks were subjected to porosity analysis (micro-CT; n = 5) and fungal adherence (n = 10). Data were statistically analyzed (one-way ANOVA, two-way ANOVA; Tukey's test, α = 0.05). RESULTS: For σ, "material" and "aging" factors were statistically significant (p < 0.0001). The BIS (118.23 ± 16.26A) presented a higher σ and the PRINT group (49.87 ± 7.55E) had the lowest mean σ. All groups showed a decrease in σ after TC, except for PRINT. The CRTC showed the lowest Weibull modulus. The AR showed higher roughness than BIS. Porosity revealed that the AR (1.369%) and BIS (6.339%) presented the highest porosity, and the CAD (0.002%) had the lowest porosity. Cell adhesion was significantly different between the CR (6.81) and CAD (6.37). CONCLUSION: Thermocycling reduced the flexural strength of most provisional materials, except for 3D-printed resin. However, it did not influence the surface roughness. The CR showed higher microbiological adherence than CAD group. The BIS group reached the highest porosity while the CAD group had the lowest values. CLINICAL RELEVANCE: 3D-printed resins are promising materials for clinical applications because they have good mechanical properties and low fungal adhesion.

Dual-cured adhesive system improves adhesive properties of dentin cavities restored with a bulk-fill resin composite

Aim: To evaluate the impact of a dual-cured adhesive system on the in situ degree of conversion (DC), bond strength (BS) and failure mode (FM) of adhesive interfaces in dentin cavities restored with a bulk-fill resin composite. Methods: 4-mm-deep dentin cavities with a 3.1 C-factor were created in 68 bovine incisors (n = 17 per group). The lightcured (Scotchbond™ Universal) or the dual-cured (Adper™ Scotchbond™ Multi-purpose Plus) adhesive system was applied to the cavities, which were then restored with a bulkfill resin composite (Filtek™ Bulk Fill). In situ DC analysis was performed by means of micro Raman spectroscopy at the top and bottom interfaces. Push-out BS was measured in a universal testing machine after 24-h or 6-month water storage. FM was determined with a stereomicroscope. Data of in situ DC and BS were analyzed by two-way analysis of variance (ANOVA) and Tukey test (p<0.05), while the FM was analyzed descriptively. Results: The groups that received the dual-cured adhesive system showed statistically higher in situ DC and BS than those that received the light-cured adhesive system. Cohesive failure mode was the most frequent in all conditions. Conclusion: In situ DC and BS were influenced by the curing strategies of the adhesive systems with better performance of the dual-cured material

Patient-reported outcome measures and prosthetic events in implant-supported mandibular overdenture patients after immediate versus delayed loading: A systematic review and meta-analysis.

STATEMENT OF PROBLEM: Immediately loaded mandibular overdentures are clinically acceptable treatment options that have gained popularity because their use shortens the treatment duration. However, whether the immediate loading of dental implants can match the prosthetic events, satisfaction, and quality of life of delayed loading is still unclear. PURPOSE: The purpose of this systematic review and meta-analysis was to compare the prosthetic events, satisfaction, and quality of life of immediate versus delayed loading implants in patients rehabilitated with mandibular overdentures. MATERIAL AND METHODS: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and was registered at The International Prospective Register of Systematic Reviews (PROSPERO) (CRD42021258187). Electronic searches were carried out by 2 independent reviewers in the PubMed/MEDLINE, Cochrane Library, and Web of Science databases up to May 2021. Only randomized clinical trials and prospective studies with at least 10 participants that compared immediate versus delayed loading were selected. A meta-analysis was performed by using the RevMan 5 software program for complications and maintenance outcomes. RESULTS: Seven articles were included in the qualitative analysis, and 4 were included in the quantitative analysis. The meta-analysis demonstrated no significant difference between immediate and delayed loading for prosthetic complications (RR=1.71; 95% CI=0.67-4.37; I2=85%, P=.27) or maintenance (RR=1.92, 95% CI=0.44-8.28; I2=94%, P=.38). CONCLUSIONS: Although the prosthetic complications and maintenance were more likely to favor the delayed loading group, available evidence showed no statistical difference for prosthetic complications and maintenance between immediate loading and delayed loading in mandibular overdentures.

Incidence and risk factors for non-adaptation of new mandibular complete dentures: a clinical trial.

OBJECTIVE: To investigate the incidence and risk factors for non-adaptation of the conventional mandibular complete denture (CMCD). MATERIALS AND METHODS: A total of 108 edentulous patients were rehabilitated with complete dentures (CDs) and followed up at 3- and 6-month intervals. Adaptation was confirmed based on chewing, phonetics, and comfortable swallowing with the CDs. The risk factors among sociodemographic and patient-centered factors were analyzed. Statistical analyses included the chi-square test and then a multivariate analysis. RESULTS: After 3 months, 38.0% of patients showed non-adaptation to CMCDs. Non-adaptation was significantly associated with the absence of previous mandibular denture experience (p = 0.042), ulcerations after 15 days of rehabilitation (p < 0.001), and a reduced posterior mandibular ridge (p = 0.035). After 6 months, this incidence decreased to 14.1%. The factors associated with non-adaptation were ulcerative lesions after 15 (p < 0.001) and 30 (p < 0.001) days of the delivery of CDs and the non-regular use of mandibular CDs (p < 0.001). CONCLUSION: The incidence of non-adaptation was higher after 3 months, with reduction after 6 months. Sociodemographic variables did not influence the adaptation. After 3 months, the absence of previous experience, traumatic ulcers, and reduced mandibular ridges hindered the adaptation of patients to mandibular CDs. After 6 months, only the occurrence of ulcerative lesions and non-regular wear of dentures were risk factors for non-adaptation. CLINICAL RELEVANCE: A considerable number of patients have difficulties in adapting to the mandibular dentures. Identifying the factors of non-adaptation of the dentures will contribute to increasing the predictability of this critical adaptation period.

Factors associated with edentulous patients' willingness about implant-supported complete denture: a multivariate analysis.

OBJECTIVE: The aim of this study was to evaluate the factors influencing edentulous patients' willingness about mandibular implant-supported complete denture. MATERIALS AND METHODS: A cross-sectional study was carried out with 117 bimaxillary edentulous patients wearing removable complete dentures (CDs). Patients were assessed concerning denture-related items (number of previous mandibular CDs, previous denture wearing period, dentures maker professional, and regular wearing of previous mandibular dentures) and individual-related aspects, such as mandibular edentulousness period, mandibular bone height, and willingness to the use of mandibular implant-supported complete denture. Masticatory performance was evaluated by the median particle diameter. Mandibular bone height and satisfaction were assessed using a validated method. The Chi-square test was used for data analysis and prevalence ratios were adjusted by using multivariate Poisson regression, both with 95% confidence interval. RESULTS: A total of 78 participants (66.7%) were interested in mandibular implant-supported overdenture (mean age 65.33 ± 9.49). Masticatory performance was not influenced by choosing mandibular implant-supported complete denture. The preference about mandibular implant-supported complete denture was correlated with longer mandibular complete denture experience (p = 0.021) and it was significantly associated with dissatisfaction about retention (p = 0.005). CONCLUSION: Previous experience with mandibular complete dentures and dissatisfaction about retention influence the willingness about mandibular implant-supported overdenture. CLINICAL RELEVANCE: Many factors are associated with rehabilitation preferences for edentulous patients and mandibular implant-supported complete denture is one of the available alternatives. Therefore, this study has demonstrated the factors influencing the decision to replace a mandibular conventional complete denture by dental implant treatment based on patient's outcomes. Such finding may be considered as a relevant aspect towards shared decision-making for prosthodontic rehabilitation of edentulous patients.

Restabelecimento da Dimensão Vertical de Oclusão com JIG estético modificado e Prótese Parcial Removível Overlay: relato de caso / Reestablishment of occlusal vertical dimension with a modified aesthetic JIG and an overlay removable partial denture: a case report

A reabilitação de pacientes parcialmente edêntulos com desgaste dentário severo e dimensão vertical de oclusão reduzida é desafiadora e complexa. Objetivo: Descrever o restabelecimento da dimensão vertical de oclusão e parâmetros estéticos com uma prótese parcial removível do tipo overlay (PPRO) com auxílio de um JIG estético modificado. Relato de caso: Paciente do sexo masculino, 58 anos de idade, procurou serviço odontológico queixando-se de insatisfação com a estética do sorriso e perda dos dentes posteriores. Ao exame clínico, foram observados desgaste dentário excessivo e edentulismo parcial nas arcadas superior e inferior. Então, foi proposto tratamento em 2 etapas (provisória e definitiva) com PPRO em maxila. O JIG estético foi usado como guia de referência para incrementos em resina composta fotopolimerizável e o restabelecimento da dimensão vertical de oclusão foi determinado a partir de métodos métrico, fonético e estético. Os dentes desgastados foram aumentados e os dentes ausentes substituídos por dentes artificiais a partir de uma PPRO provisória. Após 2 meses de adaptação, a reabilitação final com PPRO definitiva foi conduzida baseando-se na reabilitação com a PPRO provisória. Conclusão: O paciente relatou satisfação com a estética e desempenho funcional com o tratamento. Portanto, o JIG estético beneficia o planejamento e o tratamento para restabelecer a dimensão vertical de oclusão. Além disso, a PPRO é uma alternativa reversível, de baixo custo, para reabilitar a estética e a função de pacientes com desgaste severo e perda parcial dos dentes.

The rehabilitation of partially edentulous patients with severe tooth wear and reduced occlusal vertical dimension is challenging and complex. Objective: To describe the reestablishment of occlusal vertical dimension and aesthetic parameters with an overlay re-movable partial denture (ORPD) with the aid of a modified aesthetic JIG. Case report: A 58-year-old man sought dental service complaining of dissatisfaction with the aesthetics of his smile and a loss of posterior teeth. At clinical examination, excessive tooth wear and partially edentulism in the lower and upper arches were observed. A two-step treatment (interim and definitive) with an ORPD in the upper arch was proposed. The aesthetic JIG was used as a reference guide for the increments in light-curing resin composite, and the reestablishmentthe occlusal vertical dimension was determined using aesthetic, phonetic, and metric methods. The worn teeth were increased, and the missing natural teeth were replaced by artificial teeth using a temporary ORPD. After two months of adaptation, de-finitive rehabilitation with a definitive ORPD was performed based on the interim ORPD. Conclusion: The patient reported satisfaction with the esthetic and functional performance of this treatment. Therefore, the aesthetic JIG benefits the planning and treatment of reduced vertical dimension. Moreover, the ORPD is a reversible and lower-cost alternative to rehabilitate the aesthetics and function of patients with severe teeth wear and partial teeth loss.

Comparative analysis of the hemostatic, analgesic and healing effects of cyanoacrylate on free gingival graft surgical wounds in donor and recipient areas: a systematic review.

To analyze the hemostatic, Dsurgical wounds in donor and recipient areas of free gingival grafts (FGG). Five databases (PubMed, Scopus, Science Direct, Cochrane and Web of Science) were searched up to March 2021 (PROSPERO CRD42019134497). The focus of the study (cyanoacrylate) was combined with the condition (periodontal surgery OR free gingival graft OR free soft tissue graft OR autografts), and outcome (healing OR epithelialization OR pain OR analgesia OR bleeding OR hemostasis OR hemostatic). Studies reporting cyanoacrylate isolated or associated with another substance in FGG stabilization and closure were investigated and assessed for the quality and risk of bias through the Cochrane Manual. Six studies with 323 participants were included. Evaluation of the quality and risk of bias highlighted a low risk for four articles, intermediate for one and unclear for another. The use of cyanoacrylate associated or not with the hemostatic sponge or the platelet-rich fibrin was more effective in healing (three studies), analgesia (four studies), and hemostasis in one study (p < 0.05). However, groups with the association in cyanoacrylate showed superior healing, and analgesic action to the isolated cyanoacrylate group. In addition, two studies demonstrated that cyanoacrylate use reduces surgery duration, one study showed that it reduces postoperative sensibility, and another present hemostatic effect (p < 0.05). There is scarce literature for the use of cyanoacrylate in FGG wounds indicates that it can promote a minor inflammatory response, reduce operation time, does not interfere with healing, relieves postoperative discomfort, and suggests the possibility immediate hemostasis. Its use presents an alternative to suturing in FGG surgeries. But, the limited number of cases and the relative heterogeneity of the included studies suggest caution in generalizing the indication. CLINICAL RELEVANCE: Cyanoacrylate seems to present analgesic effects and less pain when applied to wound closure and covering donor and recipient areas reducing the need for postoperative analgesic medication; and has a healing effect in the closure of the donor area on the palate. In addition, it can reduce bleeding time after surgery, and prevents late bleeding during the first postsurgical week. Scientific justification: To evaluate the hemostatic, analgesic and healing actions of cyanoacrylate compared to the suture thread and other agents when used to close surgical wounds from periodontal free gingival graft surgical wounds in both the donor and recipient areas of the graft. MAIN FINDINGS: The use of cyanoacrylate individually or in association with wound dressing agents presents analgesic effects because the patient reports less pain experienced when cyanoacrylate is applied to the wound closure and covering, thereby reducing the need for postoperative analgesic medication. In addition, a healing effect is observed in the closure of the donor area on the palate; as well as it seems to present hemostatic effects, reducing the bleeding time after surgery, and preventing late bleeding during the first postsurgical week. PRACTICAL IMPLICATIONS: Dentists may cautiously apply cyanoacrylate after periodontal surgeries for free gingival graft in both the donor and recipient areas of the graft. However, they must consider the limitations of the surgery, tension-free positioning, the patient's dyscrasia and postoperative care, constituting a set of predictors for adequate clinical decision-making. Widespread use of such material for all patients and surgical configurations may not be recommended.

Effects of ionizing radiation on surface properties of current restorative dental materials.

To investigate the impact of radiotherapy on surface properties of restorative dental materials. A conventional resin composite-CRC (Aura Enamel), a bulk-fill resin composite-BFRC (Aura Bulk-fill), a conventional glass ionomer cement-CGIC (Riva self cure), and a resin-modified glass ionomer cement-RMGIC (Riva light cure) were tested. Forty disc-shaped samples from each material (8 mm diameter × 2 mm thickness) (n = 10) were produced according to manufacturer directions and then stored in water distilled for 24 h. Surface wettability (water contact angle), Vickers microhardness, and micromorphology through scanning electron microscopy (SEM) before and after exposition to ionizing radiation (60 Gy) were obtained. The data were statistically evaluated using the two-way ANOVA and Tukey posthoc test (p < 0.05). Baseline and post-radiation values of contact angles were statistically similar for CRC, BFRC, and RMGIC, whilst post-radiation values of contact angles were statistically lower than baseline ones for CGIC. Exposition to ionizing radiation statistically increased the microhardness of CRC, and statistically decreased the microhardness of CGIC. The surface micromorphology of all materials was changed post-radiation. Exposure to ionizing radiation negatively affected the conventional glass ionomer tested, while did not alter or improved surface properties testing of the resin composites and the resin-modified glass ionomer cement tested.

Incidência e fatores de risco a não adaptação de novas próteses mandibulares: ensaio clínico / Incidence and risk factors for non-adaptation of new mandibular prostheses: clinical trial

Este ensaio clínico não randomizado se propôs a investigar a incidência e os fatores de risco a não adaptação de prótese total convencional mandibular (PTCM). Um total de 108 edêntulos bimaxilares foram reabilitados com próteses totais e acompanhados por um período de 3 e 6 meses. Nesses períodos, os pacientes foram alocados em PTA (Pacientes adaptados a PTCM) e PTN (Pacientes não adaptados a PTCM). Os critérios que confirmaram a adaptação dos pacientes foram: realizar a mastigação, fonética e deglutição confortavelmente com as próteses. As variáveis analisadas como possíveis fatores de risco foram registradas em ficha clínica e estavam relacionadas aos aspectos sociodemográficos e fatores centrados no paciente. A estimativa do tempo médio para adaptação à PTCM foi obtida a partir da curva de Kaplan-Meier. Inicialmente, os fatores de risco foram analisados estatisticamente pelo Teste do Qui-quadrado ou Exato de Fisher. Em seguida, foi realizada uma análise multivariada e o risco relativo foi ajustado através da regressão múltipla de Poisson. Os resultados revelaram incidência de 38,0% (n=41) dos indivíduos não adaptados a novas próteses totais mandibulares após 3 meses. Essa não adaptação à prótese total mandibular esteve associada significativamente à ausência de experiência prévia com PTCM (p=0,042), à presença de ulcerações após 15 dias da reabilitação (p<0,001) e à altura do rebordo mandibular posterior reduzida (p=0,035). Após 6 meses, essa incidência reduziu para 14,1% (n=14), sendo a ocorrência de lesões ulcerosas após 15 dias (p<0,001) e 30 dias (p<0,001) da instalação das novas próteses e o uso não regular da nova PTCM (p<0,001) os fatores de risco associados à não adaptação à PTCM. A análise de sobrevida mostrou que 78,53 ± 36,11 dias são suficientes para adaptação da maioria dos pacientes à prótese, com o menor tempo médio de adaptação à PTCM associado significativamente à experiência prévia com PTs inferiores (p=0,032), ao uso de próteses antigas confeccionadas por dentista (p=0,034), à ausência de registro de lesões nos primeiros dias após reabilitação (p=0,023), à rebordo mandibular posterior não-reabsorvido (p=0,005) e ao uso regular das novas próteses mandibulares (p=0,002). Conclui-se que a incidência de indivíduos não adaptados a PTCM foi maior em um período de 3 meses, com redução após 6 meses de acompanhamento. As variáveis sociodemográficas não influenciaram na adaptação à prótese mandibular nos períodos de 3 e 6 meses. No tempo de 3 meses, a ausência de experiência prévia com PTCM, registro de úlceras traumáticas em arco mandibular e a presença de rebordos mandibulares reduzidos interferiram negativamente na adaptação às novas próteses inferiores constituindo-se como fatores de riscos ao não uso da PTCM. Todavia, após 6 meses de uso das próteses, apenas a ocorrência de lesões ulcerativas e o uso não regular das próteses foram fatores de risco à não adaptação à prótese mandibular. Em média, a maioria dos indivíduos se adaptou a nova PTCM em 2,6 meses. Essa adaptação em menor tempo esteve associada à experiência prévia com prótese inferior, ao uso de próteses antigas confeccionadas por dentista, à ausência de registro de úlceras traumáticas após tratamento reabilitador, à presença de rebordo não reabsorvido e ao uso regular das novas PTCM (AU).

This non-randomized clinical trial aimed to investigate the incidence and the risk factors to the non-adaptation of the conventional mandibular complete denture (CMCD). A total of 108 bimaxillary edentulous were rehabilitated with full dentures on a 3 month and 6 month follow-up. During these periods, patients were allocated into PTA (Patients adapted to CMCD) and PTN (Patients non-adapted to CMCD). The criteria that confirmed the patients' adaptation were: chewing, phonetics, and swallowing comfortably with the dentures. The variables analyzed as possible risk factors were recorded in a clinical record and were related to sociodemographic aspects and patientcentered factors. The estimate of the average time for adaptation to CMCD was obtained from the Kaplan-Meier curve. Initially, the risk factors were analyzed statistically by the Chi-square test or Fisher's Exact test. Then, a multivariate analysis was performed and the relative risk was adjusted by Poisson regression. The results revealed an incidence of 38.0% (n=41) of individuals non-adapted to new mandibular complete dentures after 3 months. Non-adaptation to the mandibular complete denture was significantly associated with the absence of past mandibular denture experience (p=0.042), the presence of ulcerations after 15 days of rehabilitation (p<0.001), and the height of the reduced posterior mandibular ridge (p=0.035). After 6 months, this incidence decreased to 14.1% (n=14), with the occurrence of ulcerative lesions after 15 days (p<0.001) and 30 days (p<0.001) of the delivery of new dentures and the nonregular use of new CMCD (p<0.001) being the risk factors associated with the nonadaptation of CMCD. Survival analysis showed that 78.53 ± 36.11 days are enough for most patients to adapt to the dentures, with the lower average time to adapt to CMCD significantly associated with previous experience with mandibular CDs (p=0.032), use of old dentures made by a dentist (p=0.034), no record of ulcers after the first days after rehabilitation (p=0.023), posterior mandibular ridge non-reabsorbed (p=0.005) and regular use of new mandibular dentures (p=0.002). It concluded that the incidence of patients non-adapted to CMCD was higher in 3 months, with a reduction after 6 months follow up. Sociodemographic variables not influenced the adaptation to the mandibular dentures in the periods of 3 and 6 months. After 3 months, the absence of previous experience with CMCD, registration of traumatic ulcers in the mandibular arch, and the presence of lower mandibular ridges interfered negatively in the adaptation to new lower dentures, constituting risk factors for non-use CMCD. However, after 6 months of wearing the prostheses, only the occurrence of ulcerative lesions and non-regular wear of dentures were risk factors for non-adaptation to mandibular prostheses. On average, most individuals adapted to the new CMCD in 2.6 months. This adaptation in less time was associated with previous experience with an inferior dentures, the use of old prostheses made by a dentist, the absence of a record of traumatic ulcers after rehabilitation treatment, the presence of non-resorbed ridge and the regular use of the new CMCD (AU).