Does the sequence of plyometric and dynamic stretching exercises influence subsequent sprint performance? A randomized crossover intervention study.

The objectives of this study were to evaluate the acute effects of the sequence order of drop jumps (DJ) and dynamic stretching (DS) on sprinting performances in competitive athletes and to investigate the relationships between post-activation performance enhancement (PAPE) in sprint performance and lower limb power. Thirteen male jumpers and sprinters participated in this study (19 ± 2 years; 177 ± 7 cm; 71.7 ± 5.6 kg). Through a randomized crossover design, the athletes were exposed to three different conditions after a standardized warm-up: DS+DJ, DJ+DS, and control. Sprinting performance over 40 m was analysed with consideration of initial (0 to 20 m) and final acceleration (20 to 40 m) phases. The effect of intervention was examined by two-way repeated-measures of ANOVA. Pearson's correlation test was used to determine the association between PAPE during sprinting and jump performance. There was no effect of any factor on 40-m sprint performance. Meanwhile, the performance at 20-40 m was higher after the DS+DJ condition when compared to baseline (8.79 ± 0.43 vs. 8.91 ± 0.35 m/s; p = 0.015). However, the initial acceleration was worsened in the DJ+DS condition when compared to baseline (6.26 ± 0.25 vs. 6.22 ± 0.26 m/s; p = 0.002). There was a negative correlation between CMJ height and the improvement in final acceleration (r = -0.741; p = 0.004). The use of DS prior to DJ is an effective strategy to improve performance in the final acceleration phase (20-40 m). The athletes with lower levels of lower limb power benefited the most from this PAPE strategy.

Effects of High-Intensity Warm-Up on 5000-Meter Performance Time in Trained Long-Distance Runners.

Warm-up protocols with high intensities before continuous running provide potential benefits for middle-distance runners. Nevertheless, the effect of high-intensity warm-ups on long-distance runners remains unclear. The purpose of this study was to verify the effect of a high-intensity warm-up protocol on 5000 m performance in trained runners. Thirteen male runners (34 ± 10 years, 62 ± 6 kg, 62.7 ± 5.5 ml/kg/min) performed two 5000 m time trials, preceded by two different warm-ups. One high-intensity warm up (HIWU: 1x 500 m (70% of the running intensity) + 3x 250 m (100% of the running intensity) and one low-intensity warm up (LIWU: 1x 500 m (70% of the running intensity) + 3x 250 m (70% of the running intensity)), where the running intensities were calculated using the results obtained in the Cooper test. Physiological and metabolic responses, and endurance running performance parameters, were evaluated by the Counter Movement Jump (CMJ), running rating of perceived exertion (RPE), blood lactate concentration (BLa), and performance running. Total time for the 5000 m was lower using HIWU when compared to LIWU (1141.4 ± 110.4 s vs. 1147.8 ± 111.0 s; p = 0.03; Hedges' g = 0.66). The HIWU warm-up led to an improvement in pacing strategy during the time trial. After warm-up protocols, the performance on the CMJ was improved only when applying HIWU (p = 0.008). Post warm-up BLa was significantly higher for HIWU vs. LIWU (3.5 ± 1.0 mmol·L-1 vs. 2.3 ± 1.0 mmol·L-1; p = 0.02), with similar behavior for the RPE (p = 0.002), internal load of the session (p = 0.03). The study showed that a high-intensity warm-up protocol can improve performance in the 5000 m in trained endurance runners.

Can patients detect peri­implant mucosal inflammation? Results from a multicentre randomized trial.

PURPOSE: The objective of this study was to compare patient-reported outcomes (PROs) of peri­implant soft tissue inflammation and aesthetics around single-tooth implants in the anterior maxillary region with three different implant-abutment interface designs. METHODS: Participants were randomized to one of three different types of implant-abutment interface designs [Conical (CI), flat-to-flat (FI), and Platform Switched (PS)]. Implants and provisional crowns with prefabricated titanium abutments were placed 5 months following extraction and/or ridge augmentation. Permanent ceramic crowns with zirconia abutments were placed after 12 weeks. To assess PROs, appearance and inflammation questionnaires were completed from provisional crown placement to the 3-year follow-up. RESULTS: Tooth appearance at the 3-year follow-up revealed a difference amongst CI, FI and PS implants (p=0.049; Kruskal-Wallis test). PS was rated better than FI (p=0.047) at 1 year for appearance of soft-tissue and satisfaction with colour. There were no differences for self-consciousness, smile and pain/discomfort while eating/hard food items. CONCLUSIONS: Although participants tended to rate the health of mucosa around PS implants as slighty better than the other two implant systems, the differences were minimal and inconsistent. Thus, patient satisfaction in terms self-perceived gingival health and esthetics was high for all 3 systems tested, suggesting that patients are unable to detect mucosal inflammation. CLINICAL SIGNIFICANCE: Patients find it difficult to perceive mucosal inflammation; hence, it is recommended that patients attend implant follow-up visits, even if they do not perceive inflammation. The study suggests that there is a relationship between the PROs and the clinical outcomes of tested implants.

The impact of implant-retained overdentures on type-2 diabetic and non-diabetic edentulous patients: Satisfaction and quality of life in a prospective cohort study.

OBJECTIVES: To evaluate the benefits of implant therapy for patients with diabetes, we compared (i) healthy, (ii) well controlled T2DM and (iii) poorly controlled T2DM patients, in terms of oral health-related quality of life (OHRQoL) and satisfaction with mandibular 2-implant overdentures over 12 months following restoration. MATERIALS AND METHODS: This single-center, prospective, cohort study recruited 165 edentulous adults (HbA1c<12%) to receive two endosseous implants in the anterior mandible to support mandibular overdentures. Participants were enrolled as having T2DM or not, with T2DM participants divided according to HbA1c into well-controlled (<8.1%) and poorly controlled (≥ 8.1%) groups. Participants provided responses to the OHIP-20 (OHRQoL) and the McGill Denture Satisfaction Questionnaire, before implant therapy and 6 and 12 months after overdenture insertion using Locator attachments. HbA1c was measured at the same time points. The effect of groups and time was verified using generalized estimating equations (α=0.025). RESULTS: At 12 months, 137 participants provided responses. The two diabetes groups showed improvements in OHRQoL to the same extent as the non-diabetic control group at both 6 and 12 months. Patient satisfaction showed similar improvements with no between-group differences and similar increases identified at 6 and 12 months. HbA1c was not affected by time or groups. CONCLUSIONS: Dental implant therapy provided significant improvements in patient-perceived benefits of mandibular two-implant overdentures for T2DM individuals, which are similar to those found for healthy edentulous individuals. Importantly, those benefits extend to those individuals with poorly controlled glycaemia. The addition of 2-implant supported mandibular overdentures did not affect glycaemic status over 12 months following insertion. CLINICAL SIGNIFICANCE: As risks for implant therapy relative to glycaemic status are better understood, this study documents that implant therapy may offer important benefits in QoL for T2DM patients independent of glycaemic status.

The McGill Denture Satisfaction Questionnaire revisited: Exploratory factor analysis of a binational sample.

OBJECTIVES: To examine the McGill Denture Satisfaction Questionnaire (MDSQ) in terms of dimensionality, item reduction and construct validity in a binational sample of complete denture wearers. MATERIALS AND METHODS: We conducted secondary analyses of baseline data from two studies on implant-retained overdentures: a quasi-experimental study in the United States (n = 145) and a randomised trial in Brazil (n = 120). All participants wore upper/lower dentures and responded at baseline to the MDSQ items concerning their original mandibular dentures. A putative model of the MDSQ items resulted in two question subsets: (a) overall satisfaction, retention/stability, aesthetics, cleaning, speech and comfort, plus general chewing ability; (b) mastication of specific foods. Analyses focused on the internal consistency of each subset and possible item reduction, using Cronbach's alpha (Cα), inter-item correlation and exploratory factor analysis (EFA). RESULTS: The 1st subset showed high inter-item correlation for most question combinations and no redundancy (r ≤ .8). An item on cleaning had low correlation, but its removal does not increase internal consistency (Cα ≥ .83). Results were similar for both studies, with EFA showing a single significant factor (namely "overall satisfaction, lower denture") able to explain nearly 54% of the variance. The 2nd subset also shows strong internal consistency (Cα ≥ .95) and inter-item correlation, with a single factor representing 65% of the variation. CONCLUSIONS: This study discloses the reliability and construct validity of the MDSQ for patient-centred evaluation of complete dental prostheses in the edentulous mandible. Findings also support the use of both "overall satisfaction" and "masticatory ability" as summary scores, for improved outcome assessment.

Is a two-step impression mandatory for complete denture fabrication on the severely resorbed mandible? A randomized trial on mastication, patient satisfaction and adjustments.

OBJECTIVES: To compare one- vs two-step impression procedures for the provision of conventional complete dentures (CCDs) for edentulous individuals with severe mandibular resorption, in terms of (1) masticatory performance and ability; (2) satisfaction with mandibular CCDs; and (3) post-delivery adjustments. METHODS: Fifty-two patients requiring maxillary + mandibular CCDs were randomly divided into two parallel arms according to the impression method of the mandibular ridge: (SI) single impression with stock trays (irreversible hydrocolloid); (TI) two-step impression in custom trays, with border molding (impression compound) followed by the impression itself (polyether). Mastication performance was evaluated by a colorimetric test, whereas patients answered questions on masticatory ability and satisfaction with mandibular CCDs (100-mm visual analogue scale). The number of post-delivery sessions for adjustments were also quantified. Outcomes were assessed at 3 and 6 months after delivery. RESULTS: The masticatory performance was similar for both groups, regardless of time (3 months, P = 0.62; 6 months, P = 0.61). No significant difference was found for patient-reported (P > 0.05), i.e. masticatory ability (general ease of chewing and quality of grinding food; ability to chew specific foods), general satisfaction with the mandibular CCD (general satisfaction, comfort, aesthetics, ability to speak and to perform correct cleaning, retention and stability). Both methods resulted in a similar number of post-delivery adjustment sessions [SI: 3.8 (1.7); TI: 3.2 (1.4); P = 0.09]. CONCLUSIONS: Compared to a traditional approach, CCDs obtained from a single impression achieve similar masticatory performance/ability and patient satisfaction, even in patients with severely reabsorbed mandibular ridge. Both methods demand the same amount of post-delivery adjustment. CLINICAL SIGNIFICANCE: A simplified impression technique which eliminates the secondary impression can provide CCDs of good clinical quality, which influences the OHRQoL, and satisfaction in the same extent they would by a two-step procedure, even for patients with severely reabsorbed mandibular ridges (ClinicalTrials.gov: NCT02339194).

Is a two-step impression mandatory for complete denture fabrication on the severely resorbed mandible? A randomized trial on patient perception and denture quality.

OBJECTIVES: To evaluate the effectiveness of CCDs produced by two impression procedures for the mandibular ridge, in patients with severe mandibular atrophy. METHODS: Fifty-two completely edentulous patients with severely resorbed mandibles were randomly allocated into two groups according to the impression procedure of the mandibular ridge: SI - single impression (stock tray and irreversible hydrocolloid); TI - two-step impression (custom tray, border molding with compound, and polyether). Assessments of oral health related quality of life (OHRQoL, primary outcome) and denture satisfaction were performed by using validated questionnaires. Denture quality was evaluated by means of functional tests. RESULTS: Regardless of the technique, participants reported better OHRQoL (P < 0.001) in both follow-up periods (3 and 6 months after denture delivery), and groups resulted in similar OHIP-EDENT scores in its different domains (P > 0.05). Between-group differences were insignificant for general satisfaction (3 months, P = 0.699, 6 months, P = 0.392), as well as for aspects such as esthetics, comfort, mastication, speech, and prosthesis retention (P > 0.05). Overall clinical quality of the CCDs (P = 0.383) was similar between-group, as well as in specific aspects - interocclusal distance, occlusion, articulation, retention of the maxillary denture, and stability of both maxillary and mandibular dentures (P > 0.05). CONCLUSIONS: Mandibular CCDs based on a single impression technique showed quality levels comparable to those generated by a two-step impression, both from the patient and clinician perspective. CLINICAL SIGNIFICANCE: A simplified impression technique which eliminates the secondary impression can provide CCDs of good clinical quality, which influences the OHRQoL, and satisfaction in the same extent they would by a two-step procedure, even for patients with severely reabsorbed mandibular ridges. (ClinicalTrials.gov: NCT02339194).

Purified anacardic acids exert multiple neuroprotective effects in pesticide model of Parkinson's disease: in vivo and in silico analysis.

Parkinson's disease (PD) induced by environmental toxins involves a multifactorial cascade of harmful factors, thus motivating the search for therapeutic agents able to act on the greatest number of molecular targets. This study evaluated the efficacy of 50 mg/kg purified anacardic acids (AAs), isolated from cashew nut shell liquid, on multiple steps of oxidative stress and inflammation induced by rotenone in the substantia nigra (SN) and striatum. Adult mice were divided into four groups: Control, rotenone, AAs + rotenone, and AAs alone. Lipoperoxidation, nitric oxide (NO) levels, and reduced glutathione (GSH)/oxidized gluthatione (GSSG) ratio were evaluated. NF-kB-p65, pro-IL-1ß, cleaved IL-1ß, metalloproteinase-9, Tissue Inhibitory Factor-1 (TIMP-1), tyrosine hydroxylase (TH), and glial fibrillary acidic protein (GFAP) levels were assessed by Western blot. In silico studies were also made using the SwissADME web tool. Rotenone increased lipoperoxidation and NO production and reduced TH levels and GSH/GSSG ratio in both SN and striatum. It also enhanced NF-kB-p65, pro, and cleaved IL-1ß, MMP-9, GFAP levels compared to control and AAs groups. The AAs alone reduced pro-IL-1ß in the striatum while they augmented TIMP1 and reduced MMP-9 amounts in both regions. AAs reversed rotenone-induced effects on lipoperoxidation, NO production, and GSH/GSSG ratio, as well as increased TH and attenuated pro-IL-1ß and MMP-9 levels in both regions, NF-kB-p65 in the SN and GFAP in the striatum. Altogether, the in vivo and in silico analysis reinforced multiple and defined molecular targets of AAs, identifying that they are promising neuroprotective drug candidates for PD, acting against oxidative and inflammatory conditions induced by rotenone.

Global Active Stretching (SGA®) Practice for Judo Practitioners' Physical Performance Enhancement.

In order to analyze the Global Active Stretching (SGA®) practice on the physical performance enhancement in judo-practitioner competitors, 12 male athletes from Judo Federation of Sergipe (Federação Sergipana de Judô), were divided into two groups: Experimental Group (EG) and Control Group (CG). For 10 weeks, the EG practiced SGA® self-postures and the CG practiced assorted calisthenic exercises. All of them were submitted to a variety of tests (before and after): handgrip strength, flexibility, upper limbs' muscle power, isometric pull-up force, lower limbs' muscle power (squat-jump - SJ and countermovement jump - CMJ) and Tokui Waza test. Due to the small number of people in the sample, the data were considered non-parametric and then we applied the Wilcoxon test using the software R version 3.3.2 (R Development Core Team, Austria). The effect size was calculated and considered statistically significant the values p ≤ 0.05. Concerning the results, the EG statistical differences were highlighted in flexibility, upper limbs' muscle power and lower limbs' muscle power (CMJ), with a gain of 3.00 ± (1.09) cm, 0,42 ± (0,51) m and 2.49 ± (0.63) cm, respectively. The CG only presented statistical difference in the lower limbs' test (CMJ), with a gain of 0,55 ± 2,28 cm. Thus, the main results pointed out statistical differences before and after in the EG in the flexibility, upper limbs and lower limbs' muscle power (CMJ), with a gain of 3.00 ± 1.09 cm, 0.42 ± 0.51 m 2.49 ± 0.63 cm, respectively. On the other hand, the CG presented a statistical difference only the lower limbs' CMJ test, with a gain of 0.55 ± 2.28 cm. The regular 10-week practice of SGA® self-postures increased judoka practitioners' posterior chain flexibility and vertical jumping (CMJ) performance.

Single-implant overdentures retained by the Novaloc attachment system: study protocol for a mixed-methods randomized cross-over trial.

BACKGROUND: Overdentures retained by a single implant in the midline have arisen as a minimal implant treatment for edentulous mandibles. The success of this treatment depends on the performance of a single stud attachment that is susceptible to wear-related retention loss. Recently developed biomaterials used in attachments may result in better performance of the overdentures, offering minimal retention loss and greater patient satisfaction. These biomaterials include resistant polymeric matrixes and amorphous diamond-like carbon applied on metallic components. The objective of this explanatory mixed-methods study is to compare Novaloc, a novel attachment system with such characteristics, to a traditional alternative for single implants in the mandible of edentate elderly patients. METHODS/DESIGN: We will carry out a randomized cross-over clinical trial comparing Novaloc attachments to Locators for single-implant mandibular overdentures in edentate elderly individuals. Participants will be followed for three months with each attachment type; patient-based, clinical, and economic outcomes will be gathered. A sample of 26 participants is estimated to be required to detect clinically relevant differences in terms of the primary outcome (patient ratings of general satisfaction). Participants will choose which attachment they wish to keep, then be interviewed about their experiences and preferences with a single implant prosthesis and with the two attachments. Data from the quantitative and qualitative assessments will be integrated through a mixed-methods explanatory strategy. A last quantitative assessment will take place after 12 months with the preferred attachment; this latter assessment will enable measurement of the attachments' long-term wear and maintenance requirements. DISCUSSION: Our results will lead to evidence-based recommendations regarding these systems, guiding providers and patients when making decisions on which attachment systems and implant numbers will be most appropriate for individual cases. The recommendation of a specific attachment for elderly edentulous patients may combine positive outcomes from patient perspectives with low cost, good maintenance, and minimal invasiveness. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03126942 . Registered on 13 April 2017.

Influence of aquatic exercises in physical condition in patients with multiple sclerosis.

BACKGROUND: Multiple sclerosis (MS) is a disabling chronic disease of the nervous system in which the myelin system of the central nervous system is deteriorated. This study aimed to evaluate the effectiveness of an aquatic exercise program on the physical condition of patients suffering from multiple sclerosis. METHODS: The study included 26 participants divided into two groups: an experimental group (EG) with 13 individuals and a control group (CG) also with 13 individuals. The EG underwent 12 weeks of aquatic exercise, three times per week and 45-60 minutes per session. The groups were evaluated pre- and post-intervention, and were later compared to check for differences between groups. Data was collected by using functional tests such as the Timed "Up and Go" Test, the Timed 7.62 Meters Walk Test, the Getting up from a Sitting Position Test and the Balance Test. RESULTS: Significant differences were found between the groups in the post-intervention stage. Furthermore, significant differences were also observed in all domains of physical condition of EG patients, in the post-intervention stage. Results obtained from the intention-to-treat analysis were consistent with those found in the literature. CONCLUSIONS: Therefore, this study's results suggest that aquatic exercise programs can effectively improve multiple sclerosis patient's physical condition and should be considered when coping with this public health problem.

A randomized trial of the effects of an aquatic exercise program on depression, anxiety levels, and functional capacity of people who suffered an ischemic stroke.

BACKGROUND: Aquatic exercise programs are used in rehabilitation and might help to reduce disability after stroke. This was a randomized intervention trial to assess the influence of an aquatic exercise program on people suffering from depression and anxiety after ischemic stroke. METHODS: Participants were randomized to an experimental group (EG) composed of 19 individuals (51.8±8.5 years; ten males and nine females), and a control group (CG) composed of 17 people (52.7±6.7 years; nine males and eight females). The aquatic exercise program consisted of two sessions per week, each lasting between 45 and 60 minutes and divided into 5 to 10 minutes exercise sections during 12 weeks. The State-Trait Anxiety Inventory was used to determine anxiety levels while the Beck Depression Inventory was used as a self-assessment of depression. RESULTS: EG improved measures of depression, anxiety trait and anxiety state between pre- and post-treatment, with no changes in CG. EG improved in all tests related to functional capacity compared to CG. CONCLUSIONS: The practice of aquatic exercises promotes improvements in the levels of depression and anxiety in people who suffered an ischemic stroke.

Improving practice guidelines for the treatment of denture-related erythematous stomatitis: a study protocol for a randomized controlled trial.

BACKGROUND: Denture-related erythematous stomatitis (DES) is a chronic biofilm-mediated disease, affecting one in every three complete denture wearers. Antifungals are the treatment most commonly prescribed by oral health professionals, based on the belief that colonization by Candida spp. is the main cause of DES. However, high recurrence rates and adverse effects are commonly observed, prompting the need for practice guidelines regarding treatment. Results from our pilot study demonstrate that palatal brushing can reduce the palatal inflammation and potentially associated Candida carriage without any need for antifungal therapy. The objective of this study is to validate these pilot results by means of a randomized controlled trial (RCT) and provide a practice guideline for clinicians. METHODS/DESIGN: A pragmatic, two-parallel-arm, multicenter RCT will be conducted in Canada, Brazil, and Chile. Fifty-two adult complete denture wearers presenting with moderate to severe DES will be allocated randomly to two groups: the Intervention arm will consist of palatal brushing and standard oral and denture hygiene measures, while the Control arm will include only standard oral and denture hygiene measures. The study outcome will be the oral Candida carriage. Participants will be assessed at baseline, and at 3 and 6 months post intervention. Descriptive, bivariate, and mixed models with repeated measures will be performed following the intention-to-treat principle. DISCUSSION: This pragmatic RCT will serve to provide a clinical practice guideline regarding the use of preventive measures in the treatment of biofilm-mediated oral diseases. Moreover, it will have a great impact on reducing the harm of antifungal overtreatment on patients suffering from DES. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02686632 . Registered on 15 February 2016.

Patient perceptions of the mandibular three-implant overdenture: a practice-based study.

OBJECTIVES: Although three-implant overdentures have often been used in clinical practice, there are few studies to support this approach. Therefore, this study aimed to determine the magnitude of change in ratings of oral health-related quality of life and to assess patients' satisfaction ratings with mandibular three-implant overdentures. MATERIALS AND METHODS: This quasi-experimental study examined oral health-related quality of life and satisfaction with prosthesis in 135 edentate participants (mean age 61.6 ± 7.9 years) who received mandibular three-implant overdentures from 2006 to 2009 in a private practice in Quebec, Canada. Data were collected from individual's dental records and a follow-up survey. The Oral Health Impact Profile (OHIP-20) was used to assess oral health-related quality of life at baseline and at follow-up. Satisfaction with the mandibular prostheses and perception of rocking movements were measured by use of a denture satisfaction questionnaire at follow-up. Descriptive statistics, bivariate and multivariate statistical analyses were used to analyse the data. RESULTS: Individuals who received mandibular three-implant overdentures had statistically significant improvements in all seven domains of the OHIP-20 from pre- to post-treatment (total OHIP change score -25.1 P < 0.001). Pre-treatment OHIP scores and rotational movement explained 58% of the variance in the OHIP's change score (P ≤ 0.05). More than three quarters of the sample population (75.6%) were completely satisfied with their three-implant overdentures, and 81.5% reported having no rocking movement. General satisfaction with the prostheses was not influenced by gender, type of fixture, or type of attachment. CONCLUSIONS: The treatment of edentulism by three-implant overdentures has favourable patient-based outcomes, with negligible perceptions of rotational movement. However, further research is needed to compare the efficacy of this alternative to other treatment modalities, such as the two-implant overdenture.

Phase 1 clinical trial on the effect of palatal brushing on denture stomatitis.

PURPOSE: This study aimed to assess the efficacy of palatal brushing in the treatment of denture stomatitis. MATERIALS AND METHODS: After screening 143 individuals with a potential diagnosis of denture stomatitis, 48 patients (mean age: 66.0 ± 11.2 years) were enrolled in a two-center phase 1 clinical trial with a one-group pretest/posttest design. The intervention of interest was manual palatal brushing after each meal and before bedtime. Clinical and microbiologic examinations were performed at baseline and 1 and 3 months after treatment. Additional data were obtained using a validated questionnaire. The primary and secondary outcomes were the remission of denture stomatitis and diminution of Candida colony-forming units (CFUs), respectively. Descriptive and nonparametric statistical tests were conducted to analyze the data. RESULTS: At the 3-month follow-up, denture stomatitis was completely cured in 10.4% of the participants, and 70.8% of denture wearers showed improvement in the clinical signs of denture stomatitis. There was a significant reduction in the area and severity of the palatal inflammation (P < .0001). The effect size ranged from medium to large (0.34 to 0.54) depending on the classification used for the diagnosis of denture stomatitis. A significant reduction in the number of Candida CFUs isolated from the palatal mucosa and dentures (P ≤ .05) was observed. CONCLUSIONS: The results of this study suggest that palatal brushing is an effective treatment of denture stomatitis.

Crossover clinical trial of the influence of the use of adhesive on biofilm formation.

STATEMENT OF PROBLEM: Contrasting results have been reported regarding the influence of the use of adhesive on biofilm formation. PURPOSE: The purpose of this study was to evaluate the influence of the use of adhesive on the formation of biofilm on the internal surface of complete dentures and the palatal mucosa of denture wearers. MATERIAL AND METHODS: Thirty participants with well-fitting complete dentures were randomly divided according to the experimental design: protocol 1, adhesive use during the first 15 days, followed by no use of adhesive over the next 15 days; protocol 2, no use of adhesives during the first 15 days, followed by adhesive use over the next 15 days. After each period, material from the mucosa and intaglio of the maxillary dentures was collected. Replicate aliquots were plated onto Petri dishes containing selective media for Candida spp, Streptococcus mutans, and a nonselective culture medium. Colony-forming units were expressed as log (CFU+1)/mL. In addition, the internal surfaces of the maxillary and mandibular complete dentures were stained and photographed. From the photographs, the total internal surface and the surface stained with biofilm were quantified (software ImageTool 3.00), and the percentage of the biofilm-covered area (%) on the maxillary and mandibular dentures was calculated and compared with 2-way ANOVA. For the nonselective culture medium, data were compared with the paired-sample t test, and the Wilcoxon signed rank test was performed to compare the colony counts of Candida spp and Streptococcus mutans (α=.05). RESULTS: Similar colony counts were found with or without the use of adhesive for the mucosa and internal surfaces of maxillary dentures, irrespective of the culture medium (P>.05). The area of dentures covered with biofilm was influenced by the use of adhesive (P=.025), regardless of the type of denture (P=.121). CONCLUSIONS: The use of adhesive did not alter the colony counts of microorganisms from the palatal mucosa and maxillary dentures of complete denture wearers during the 15-day period, but it did influence the area covered with biofilm on the internal surfaces of the complete dentures.

Focusing on outcomes and methods in removable prosthodontics trials: a systematic review.

OBJECTIVES: The aim of this study was to systematically examine the outcomes of interest of trials in removable prosthodontics and to assess their overall quality. MATERIAL AND METHODS: Electronic databases were searched up to August 2011 and complemented by hand searching for published randomized controlled trials (RCTs) in the field of removable prosthodontics in the six major prosthodontic and implant journals. The primary outcome of RCTs was considered as the outcome of interest of this review, and only manuscripts in which the study's primary outcome was reported in the abstract were included. Outcomes were classified according to the Strength of Recommendation Taxonomy (SORT) classification. The quality of individual reports of RCTs was assessed following the Cochrane Handbook for Systematic Reviews of Interventions (Higgins & Green, www.cochrane-handbook.org). RESULTS: The search retrieved 86 reports of RCTs. Among these publications, 43% reported a patient-oriented primary outcome. Most of the publications did not present a clear description of sequence generation (54%) or allocation concealment (65%). Blinding of participants, clinicians, and outcomes assessors was not applicable or reported in most trials. Handling of withdrawals and losses was adequate in 52% of trials. CONCLUSIONS: Although published RCTs in removable prosthodontics have increased over time, efforts should be made to increase patient-reported outcomes and the methodological quality of these reports. Such improvement will lead to a better body of evidence in the field, thus providing increased support for clinical decision-making.

Electromyography of masticatory muscles after denture relining with soft and hard denture liners.

We evaluated electromyograms of masticatory muscles after denture relining with soft and hard liners. In total, 44 patients with complete dentures were studied: 22 underwent chairside relining of mandibular dentures with a soft, silicone-based liner (Mucopren Soft); the other 22 underwent relining with a hard, acrylic resin-based liner (Kooliner). Electromyograms of the masseter and temporal muscles were obtained before (T0) and 90 days after (T90) relining. Participants performed a maximum voluntary contraction (static test), on which percentage-overlapping coefficient (%), mandibular displacement (%), and standardized electromyographic activity, i.e., impact, (µV / µVs %) were analyzed. Participants were also asked to chew a wafer, cereal bar, and peanuts (dynamic test) to determine symmetrical mastication index (SMI%), frequency (Hz), and impact. The data were analyzed using a generalized linear model (α= 0.05). On the static test, mandibular displacement was lower and impact was higher at T90, as compared with baseline. On the dynamic test, SMI and impact were higher after relining for all foods. Frequency at T90 was higher only during cereal and peanut mastication. There were no differences between groups except for greatest impact during wafer chewing in patients with hard liners. Relining with hard and soft materials increased electromyographic activity and improved masticatory function. There was little difference between groups.

The association of denture stomatitis and partial removable dental prostheses: a systematic review.

PURPOSE: The aim of this systematic review was to analyze the evidence on the occurrence of denture stomatitis (DS) and potential risk factors in patients wearing partial removable dental prostheses (RDPs). MATERIALS AND METHODS: MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews were searched and complemented by manual searching. Outcome measures were the presence of DS in patients wearing partial RDPs and an assessment of associated risk factors. All types of experimental and observational studies investigating an association between DS and the wearing of partial RDPs were included. Methodologic quality and level of evidence were assessed using valid scales. Two authors performed study selection, data extraction, and quality assessment independently. RESULTS: A total of eight studies met the inclusion criteria. The prevalence of DS in partial RDP wearers ranged from 1.1% to 36.7%. Data on the potential risk factors were not consistent. Despite the heterogeneity and methodologic quality of included studies, an association between DS and the wearing of partial RDPs was found. CONCLUSIONS: There is some evidence that the presence of DS is associated with the wearing of partial RDPs. However, because of methodologic limitations and cross-sectional designs of research studies, no cause-effect relationship could be inferred. Future research should provide higher levels of evidence to confirm the etiology of DS in partial RDP wearers.

Effect of chlorhexidine on denture biofilm accumulation.

PURPOSE: Adequate denture hygiene can prevent and treat infection in edentulous patients, who are frequently elderly and have difficulty brushing their teeth. This study evaluated the efficacy of complete denture biofilm removal using a chlorhexidine solution in two concentrations: 0.12% and 2.0%. MATERIALS AND METHODS: Sixty complete denture wearers participated in a trial for 21 days after receiving brushing instructions. They were distributed into three groups, according to the tested solution and regimen (n = 20): (G1) Control (daily overnight soaking in water); (G2) daily immersion at home in 0.12% chlorhexidine for 20 minutes after dinner; and (G3) a single immersion in 2.0% chlorhexidine for 5 minutes at the end of the experimental period, performed by a professional. Biofilm coverage area (%) was quantified on the internal surface of maxillary dentures at baseline and after 21 days. Afterward, the differences between initial and posttreatment results were compared by means of the Kruskal-Wallis test (α= 0.05). RESULTS: Median values for biofilm coverage area after treatment were: (G1) 36.0%; (G2) 5.3%; and (G3) 1.4%. Differences were significant (KW = 35.25; p < 0.001), although G2 and G3 presented similar efficacy in terms of biofilm removal. CONCLUSIONS: Both chlorhexidine-based treatments had a similar ability to remove denture biofilm. Immersion in 0.12% or 2.0% chlorhexidine solutions can be used as an auxiliary method for cleaning complete dentures.