Influence of the height of the mandibular ridge on the masticatory function during the functional adaptation with new complete dentures.

BACKGROUND: The period of functional adaptation to a new conventional complete denture embraces many transitory issues, and this period is directly related to the rehabilitation success. OBJECTIVE: This clinical trial evaluated the influence of the height of mandibular ridge on the masticatory function of complete denture (CD) wearers during the adaptation period. METHODOLOGY: A total of 28 individuals wearing new CDs (NR, n=14, normal mandibular ridges, 64±12.5 years, 9 female; RR, n=14, resorbed mandibular ridges, 69±6.8 years, 9 female) were assessed at 24 hours, 30 days, three months and six months after the insertion of the CDs for masticatory performance (MP, sieves method), satisfaction with CDs (questionnaire) and maximum occlusal bite force (MOBF) (gnatodynamometer). The classification of the mandibular ridges followed the Kapur index. Data of MP and MOBF were analyzed by two-way ANOVA and satisfaction with CDs was analyzed by Generalized Estimating Equations (GEE), α=.05. RESULTS: Participants with NR presented better masticatory performance (p=.000 - NR 30.25±9.93%, RR 12.41±7.17%), general satisfaction (p=.047), retention of mandibular denture (p=.001), chewing ability (p=.037), and comfort of wearing a mandibular denture (p=.000). Regardless of the mandibular ridge, MP (p=.000) was higher at three (21.26±12.07%) and six months (24.25±12.26%) in comparison to 24 hours (18.09±10.89%), the MOBF (p=.000) was higher at three months (78.50±6.49 N) compared to 24 hours (57.34±5.55 N) and 30 days (62.72±5.97 N), and the comfort of wearing a mandibular denture (p=.002) at three months (1.61 ± 0.07) was greater than 24 hours (1.29±0.10) and 30 days (1.36±10). CONCLUSIONS: The study suggests that the participants with NR have higher MP and satisfaction with their CD, regardless of the follow-up period after the insertion of the new CD. After subjects received the CD, a period of 3 months was necessary for achieving better achievement MOBF, MP, and self-perceived comfort with the mandibular denture, regardless of the height of the mandibular ridge.

Influence of the height of the mandibular ridge on the masticatory function during the functional adaptation with new complete dentures

Abstract The period of functional adaptation to a new conventional complete denture embraces many transitory issues, and this period is directly related to the rehabilitation success. Objective This clinical trial evaluated the influence of the height of mandibular ridge on the masticatory function of complete denture (CD) wearers during the adaptation period. Methodology A total of 28 individuals wearing new CDs (NR, n=14, normal mandibular ridges, 64±12.5 years, 9 female; RR, n=14, resorbed mandibular ridges, 69±6.8 years, 9 female) were assessed at 24 hours, 30 days, three months and six months after the insertion of the CDs for masticatory performance (MP, sieves method), satisfaction with CDs (questionnaire) and maximum occlusal bite force (MOBF) (gnatodynamometer). The classification of the mandibular ridges followed the Kapur index. Data of MP and MOBF were analyzed by two-way ANOVA and satisfaction with CDs was analyzed by Generalized Estimating Equations (GEE), α=.05. Results Participants with NR presented better masticatory performance (p=.000 - NR 30.25±9.93%, RR 12.41±7.17%), general satisfaction (p=.047), retention of mandibular denture (p=.001), chewing ability (p=.037), and comfort of wearing a mandibular denture (p=.000). Regardless of the mandibular ridge, MP (p=.000) was higher at three (21.26±12.07%) and six months (24.25±12.26%) in comparison to 24 hours (18.09±10.89%), the MOBF (p=.000) was higher at three months (78.50±6.49 N) compared to 24 hours (57.34±5.55 N) and 30 days (62.72±5.97 N), and the comfort of wearing a mandibular denture (p=.002) at three months (1.61 ± 0.07) was greater than 24 hours (1.29±0.10) and 30 days (1.36±10). Conclusions The study suggests that the participants with NR have higher MP and satisfaction with their CD, regardless of the follow-up period after the insertion of the new CD. After subjects received the CD, a period of 3 months was necessary for achieving better achievement MOBF, MP, and self-perceived comfort with the mandibular denture, regardless of the height of the mandibular ridge.

Retention Force and Wear Characteristics of three Attachment Systems after Dislodging Cycles.

Several attachment systems for mandibular implant-supported overdentures are currently available and studies are required to understand their mechanical properties. The objective of this study was to evaluate the retention force and wear characteristics of three attachment systems in a simulation of the cyclic dislodging of implant-supported overdentures. Thirty samples were fabricated and divided into 3 groups: 1-O-ring; 2-Mini Ball; and 3-Equator. A mechanical fatigue test was applied to the specimens using a servo-hydraulic universal testing machine performing 5500 insertion/removal cycles (f=0.8 Hz), immersed in artificial saliva. Retention force values ​​were obtained before and after 1500, 3000, and 5500 cycles using a speed of 1 mm/min and a load cell of 1 kN. One specimen from each group was randomly selected and analyzed by scanning electron microscopy. Two-way repeated measures ANOVA and the Bonferroni post hoc test were used for statistical analyses (α=0.05). The O-ring system remained stable during all periods tested and exhibited significantly lower retention force values than the Mini Ball and Equator systems. The Mini Ball system exhibited a significant increase in retention force after the mechanical test (baseline=21.04±3.29N; 5500 cycles=24.01±3.30N).The Equator system exhibited a significant decrease in retention force after each period tested, but the values were higher than the other systems. The type of attachment was found to influence retention force in different ways after mechanical tests. The Equator system exhibited the highest retention force values. The Mini Ball and Equator matrices produced deformation and wear on the surfaces without breakage of the polyamide rings.

Retention force and wear characteristics of three attachment systems after dislodging cycles

Abstract Several attachment systems for mandibular implant-supported overdentures are currently available and studies are required to understand their mechanical properties. The objective of this study was to evaluate the retention force and wear characteristics of three attachment systems in a simulation of the cyclic dislodging of implant-supported overdentures. Thirty samples were fabricated and divided into 3 groups: 1-O-ring; 2-Mini Ball; and 3-Equator. A mechanical fatigue test was applied to the specimens using a servo-hydraulic universal testing machine performing 5500 insertion/removal cycles (f=0.8 Hz), immersed in artificial saliva. Retention force values ​​were obtained before and after 1500, 3000, and 5500 cycles using a speed of 1 mm/min and a load cell of 1 kN. One specimen from each group was randomly selected and analyzed by scanning electron microscopy. Two-way repeated measures ANOVA and the Bonferroni post hoc test were used for statistical analyses (α=0.05). The O-ring system remained stable during all periods tested and exhibited significantly lower retention force values than the Mini Ball and Equator systems. The Mini Ball system exhibited a significant increase in retention force after the mechanical test (baseline=21.04±3.29N; 5500 cycles=24.01±3.30N).The Equator system exhibited a significant decrease in retention force after each period tested, but the values were higher than the other systems. The type of attachment was found to influence retention force in different ways after mechanical tests. The Equator system exhibited the highest retention force values. The Mini Ball and Equator matrices produced deformation and wear on the surfaces without breakage of the polyamide rings.

Resumo Vários sistemas de encaixe para sobredentaduras mandibulares implantossuportadas estão atualmente disponíveis e estudos são necessários para entender as suas propriedades mecânicas. O objetivo deste estudo foi avaliar a força de retenção e as características de desgaste de três sistemas de encaixe por meio de uma simulação de deslocamento cíclico de sobredentaduras implantossuportadas. Trinta amostras foram fabricadas e divididas em 3 grupos: 1-O-ring; 2-Mini Ball; e 3-Equador. Um teste de fadiga mecânica foi aplicado aos espécimes utilizando uma máquina de teste universal servo-hidráulica com 5500 ciclos de inserção/remoção (f = 0,8 Hz), imersos em saliva artificial. Os valores da força de retenção foram obtidos antes e após 1500, 3000 e 5500 ciclos utilizando uma velocidade de 1 mm/min e uma célula de carga de 1 kN. Um espécime de cada grupo foi selecionado aleatoriamente e analisado por microscopia eletrônica de varredura. O teste de Análise de Variância a dois fatores para medidas repetidas e o teste de comparações múltiplas de Bonferroni foram utilizados para análises estatísticas (α = 0,05). O sistema de O-ring permaneceu estável durante todos os períodos testados e apresentou valores de força de retenção significativamente menores do que os sistemas Mini Ball e Equator. O sistema Mini Ball apresentou um aumento significativo na força de retenção após o teste mecânico (controle = 21,04 ± 3,29N; 5500 ciclos = 24,01 ± 3,30N). O sistema Equator apresentou uma diminuição significativa na força de retenção após cada período testado, mas os valores eram maiores do que os outros sistemas. O tipo de sistema de encaixe influenciou na força de retenção de diferentes maneiras após testes mecânicos. O sistema do Equador exibiu os maiores valores de força de retenção. As matrizes dos sistemas Mini Ball e Equator produziram deformação e desgaste nas superfícies sem ruptura dos anéis de poliamida.

One-year prospective clinical study comparing patient satisfaction and masticatory performance of mandibular overdentures supported by one versus two implants.

OBJECTIVE: There is a lack of clinical evidence on mandibular overdentures (MOD) supported by a single implant. To compare patient satisfaction and masticatory performance in MOD supported by one versus two implants in a two-group parallel randomized clinical trial. MATERIAL AND METHODS: Twenty-one patients wearing new maxillary and mandibular complete dentures (CDs) were randomly divided to receive one (GI, n = 11) or two (GII, n = 10) implants in the mandibular arch. Four months after implant placement, o-ring abutments were installed in the implants, and matrix attachments were placed in the lower complete dentures. Patient satisfaction with their dentures and masticatory performance were compared at baseline, 3, 6, and 12 months after the procedure. Data on patient satisfaction were analyzed using the Friedman test and the Mann-Whitney U test. Data on masticatory performance were analyzed using one-way repeated measures analysis of variance (ANOVA) and Student's t test (α=0.05). RESULTS: Both groups exhibited a significant increase in overall patient satisfaction in all periods evaluated (p<0.05), except for GI after 12 months, which had values similar to baseline (p=0.74). Satisfaction levels of GI and GII were similar at baseline, 3 and 6 months, but GII showed higher satisfaction levels (p=0.01) than GI at 12 months. GI and GII exhibited a significant increase (p<0.05) in masticatory performance for all periods relative to baseline. However, GII had higher masticatory performance with dentures than GI, regardless of the period (p<0.05). CONCLUSION: MOD supported by two implants demonstrated better patient satisfaction in the follow-up at 12 months and better masticatory performance than MOD supported by one implant.

Effect of educational and self-care therapies on masticatory performance of women with painful temporomandibular disorder / Efeito das terapias educacionais e do autocuidado sobre o desempenho mastigatório de mulheres com disfunção temporomandibular dolorosa

Introduction: Temporomandibular disorders (TMD) can compromise masticatory performance due to the presence of pain, muscular dysfunction and limitation of mandibular movements. Substantial improvements in TMD pain can be achieved through therapeutic approaches including education and self-care. Objective: The aim of the present study was to investigate the impact of these treatment modalities in the masticatory performance of women with painful TMD. Material and method: Fifty-two women were randomly divided into three groups: Control Group (CG); Education Group (received education about TMD) (EG); Self-Care and Education Group (received education about TMD and instructions self-care therapies) (SEG). The education instructions about TMD and self-care therapies were transmitted through a video and printed illustrative material. The masticatory performance was evaluated through the sieves method ​​with natural tested foods in the evaluation periods: baseline evaluation, 30 days after and 60 days of follow-up. Data were analyzed and used with a one-way ANOVA parametric test for mean comparison of CG, EG and SEG groups (α = 0.05). Result: The masticatory performance of the participants was similar, irrespective of the proposed treatments, at baseline (p=.604), 30 days (p=.450) and 60 days (p=.669). Conclusions: The results indicated that treatment with educational and self-care therapies over a period of 60 days had no impact on the masticatory performance of women with painful TMD.

Introdução: As disfunções temporomandibulares (DTM) podem comprometer a capacidade mastigatória devido à presença de dor, disfunção muscular e limitação dos movimentos mandibulares. Melhorias substanciais da dor relacionada à DTM podem ser alcançadas através de abordagens terapêuticas incluindo a educação e os autocuidados. Objetivo: O objetivo do presente estudo foi investigar o impacto dessas modalidades de tratamento no desempenho mastigatório de mulheres com DTM dolorosa. Material e método: Cinquenta e duas mulheres foram divididas aleatoriamente em três grupos: Grupo Controle (CG); Grupo Educação (receberam instruções sobre DTM) (EG); Grupo de Autocuidado e Educação (receberam instruções sobre DTM e instruções sobre terapias de autocuidado) (SEG). As instruções de educação sobre DTM e terapias de autocuidado foram transmitidas através de vídeo e material ilustrativo impresso. O desempenho mastigatório foi avaliado através do método dos tamises com alimentos testes naturais nos períodos de avaliação: atendimento inicial, 30 dias após e ao fim de 60 dias de acompanhamento. Os dados obtidos, em porcentagem, foram analisados e foi utilizado o teste paramétrico ANOVA one-way para comparação das médias dos grupos CG, EG e SEG (α= 0,05). Resultado: O desempenho mastigatório dos participantes foi semelhante, independentemente dos tratamentos, no atendimento inicial (p=0,604), após 30 dias (p=0,450) e após 60 dias (p=0,669). Conclusão: Os resultados indicam que o tratamento com terapias educativas e de autocuidado durante um período de 60 dias não teve impacto no desempenho mastigatório das mulheres com DTM dolorosa.

Custom Cast Ball Attachments Used on Outdated Implants to Restore a Maxillary Implant-Supported Overdenture.

The lack of compatible prosthetic components can be a complication during oral rehabilitation using outdated implants. The aim of the present clinical report was to describe an alternative technique for the fabrication of a maxillary implant-supported overdenture in a patient with 20-year-old dental implants using castable spherical patterns and ball attachments. The patient had been wearing a relined bar/clip overdenture in the mandible on 4 external-hexagon dental implants and a relined complete denture in the maxilla on 4 internal-hexagon implants due to abutment screw fracture inside of the implants, losing the attachment system. The remaining maxillary dental implants did not possess attachments compatible with current systems due to configuration changes by the manufacturer in the dental implant's platform and the components over time. Therefore, castable spherical patterns and cast ball attachments were used to fabricate a maxillary implant-supported overdenture. The mandible rehabilitation was performed using 4 osseointegrated dental implants with a fixed implant-supported prosthesis. The use of cast ball attachments on the maxillary dental implants avoided invasive procedures on the remaining implants. Considering the lack of available compatible prosthetic components for the osseointegrated implants, this technique was considered a viable and satisfactory treatment option.

Free Gingival Graft to Increase Keratinized Mucosa after Placing of Mandibular Fixed Implant-Supported Prosthesis.

Insufficiently keratinized tissue can be increased surgically by free gingival grafting. The presence or reconstruction of keratinized mucosa around the implant can facilitate restorative procedure and allow the maintenance of an oral hygiene routine without irritation or discomfort to the patient. The aim of this clinical case report is to describe an oral rehabilitation procedure of an edentulous patient with absence of keratinized mucosa in the interforaminal area, using a free gingival graft associated with a mandibular fixed implant-supported prosthesis. The treatment included the manufacturing of a maxillary complete denture and a mandibular fixed implant-supported prosthesis followed by a free gingival graft to increase the width of the mandibular keratinized mucosa. Free gingival graft was obtained from the palate and grafted on the buccal side of interforaminal area. The follow-up of 02 and 12 months after mucogingival surgery showed that the free gingival graft promoted peri-implant health, hygiene, and patient comfort. Clinical Significance. The free gingival graft is an effective treatment in increasing the width of mandibular keratinized mucosa on the buccal side of the interforaminal area and provided an improvement in maintaining the health of peri-implant tissues which allows for better oral hygiene.

Reestablishment of Occlusal Vertical Dimension in Complete Denture Wearing in Two Stages.

The assessment and reestablishment of the occlusal vertical dimension (OVD) are considered important factors in the treatment of complete denture wearers. The long-time use of a complete denture can result in jaw displacement due to abrasion of the artificial teeth and residual ridge resorption, causing esthetic complications. Most patients with old dentures and incorrect OVD accept reestablishment of the OVD with new complete dentures, even if they were used to their old dentures. The present clinical report describes a method of gradual reestablishment of OVD using a diagnostic acrylic splint on artificial teeth in old complete dentures before the manufacture of new complete dentures. Clinical Significance. The use of a reversible treatment for reestablishment of the OVD in old complete dentures with a diagnostic occlusal acrylic splint allows for the reestablishment of the intermaxillary relationship, providing physiological conditions of masticatory performance associated with the recovery of facial esthetics in edentulous patients.

Split-Framework in Mandibular Implant-Supported Prosthesis.

During oral rehabilitation of an edentulous patient with an implant-supported prosthesis, mandibular flexure must be considered an important biomechanical factor when planning the metal framework design, especially if implants are installed posterior to the interforaminal region. When an edentulous mandible is restored with a fixed implant-supported prosthesis connected by a fixed full-arch framework, mandibular flexure may cause needless stress in the overall restorative system and lead to screw loosening, poor fit of prosthesis, loss of the posterior implant, and patient's discomfort due to deformation properties of the mandible during functional movements. The use of a split-framework could decrease the stress with a precise and passive fit on the implants and restore a more natural functional condition of the mandible, helping in the longevity of the prosthesis. Therefore, the present clinical report describes the oral rehabilitation of an edentulous patient by a mandibular fixed implant-supported prosthesis with a split-framework to compensate for mandibular flexure. Clinical Significance. The present clinical report shows that the use of a split-framework reduced the risk of loss of the posterior implants or screws loosening with acceptable patient comfort over the period of a year. The split-framework might have compensated for the mandibular flexure during functional activities.

Effect of a denture adhesive on the satisfaction and kinesiographic parameters of complete denture wearers: a cross-over randomized clinical trial.

The aim of the present study was to assess the effect of a denture adhesive (DA) on patient satisfaction and kinesiographic parameters of complete denture wearers by a cross-over study. Fifty edentulous patients received a set of new complete dentures. After an adaptation period, the participants were enrolled in the trial and randomized to receive a sequence of treatment protocols: Protocol 1- DA use during the first 15 days, followed by no DA for the next 15 days; Protocol 2- no DA during the first 15 days, followed by use of DA for the next 15 days. Outcomes were assessed after 15 days of each sequence of treatment. A questionnaire was used to assess the patients' satisfaction. A kinesiograph was used to record mandible movements and patterns of maxillary complete denture movement during chewing. The Wilcoxon test (α=0.05) and a paired sample t-test (α=0.05) were used to compare satisfaction levels and kinesiographic data, respectively. Use of DA improved the overall level of patient satisfaction (p<0.001). The kinesiographic recordings revealed a significant increase (1.7 mm) in vertical mandible movements (p<0.001) during chewing and a lower (0.3 mm) vertical intrusion of the maxillary complete dentures (p=0.002) during chewing after using the DA. Use of DA in complete denture wearers improved the patients' satisfaction and altered mandible movements, with increases in vertical movements during chewing and less intrusion of maxillary complete dentures.

Hipertonicidade muscular e confecção de próteses totais pela técnica da zona neutra: relato de caso clínico / Oral hypertonic muscles and complete denture treatment by the neutral zone technique: case report

Introdução: a reabilitação oral em pacientes desdentados totais, por meio de próteses totais removíveis, é um tratamento clássico, de fácil acesso e que tem resultados satisfatórios. Porém, para alcançar o sucesso nesse tipo de tratamento, a estabilidade é um fator de extrema importância. A técnica da zona neutra para confecção de próteses totais determina o espaço intrabucal para posicionamento dos dentes e base da prótese em que exista uma neutralização das forças proporcionadas pelos lábios, pelas bochechas e pela língua, conferindo melhor estabilidade e retenção das próteses, sendo indicada em casos que apresentam histórico de dificuldades de adaptação da prótese total convencional mandibular. Objetivo e relato de caso: o objetivo deste trabalho foi apresentar um relato de caso clínico da reabilitação oral de um paciente com hipertonicidade da musculatura paraprotética por meio de próteses totais removíveis confeccionadas pela técnica da zona neutra determinada com silicone de condensação. Considerações finais: a utilização do silicone de condensação para o desenvolvimento da técnica da zona neutra demonstrou ser uma boa alternativa para o desenvolvimento deste caso clínico, proporcionando boa estabilidade e retenção da prótese total inferior.

Effect of a Denture Adhesive on the Satisfaction and Kinesiographic Parameters of Complete Denture Wearers: A Cross-Over Randomized Clinical Trial

The aim of the present study was to assess the effect of a denture adhesive (DA) on patient satisfaction and kinesiographic parameters of complete denture wearers by a cross-over study. Fifty edentulous patients received a set of new complete dentures. After an adaptation period, the participants were enrolled in the trial and randomized to receive a sequence of treatment protocols: Protocol 1- DA use during the first 15 days, followed by no DA for the next 15 days; Protocol 2- no DA during the first 15 days, followed by use of DA for the next 15 days. Outcomes were assessed after 15 days of each sequence of treatment. A questionnaire was used to assess the patients´ satisfaction. A kinesiograph was used to record mandible movements and patterns of maxillary complete denture movement during chewing. The Wilcoxon test (α=0.05) and a paired sample t-test (α=0.05) were used to compare satisfaction levels and kinesiographic data, respectively. Use of DA improved the overall level of patient satisfaction (p<0.001). The kinesiographic recordings revealed a significant increase (1.7 mm) in vertical mandible movements (p<0.001) during chewing and a lower (0.3 mm) vertical intrusion of the maxillary complete dentures (p=0.002) during chewing after using the DA. Use of DA in complete denture wearers improved the patients´ satisfaction and altered mandible movements, with increases in vertical movements during chewing and less intrusion of maxillary complete dentures.

O objetivo deste estudo foi avaliar o efeito da utilização de um adesivo para prótese na satisfação e nos parâmetros cinesiográficos em usuários de próteses totais por meio de um estudo "cross-over". Cinquenta pacientes desdentados receberam novas próteses totais bimaxilares. Após um período de adaptação, os participantes incluídos no estudo receberam uma sequência de tratamento: Protocolo 1- utilização do adesivo para prótese durante os primeiros 15 dias, seguida por não utilização do adesivo os próximos 15 dias; Protocolo 2- não utilização do adesivo durante os primeiros 15 dias; seguida por utilização do adesivo nos próximos 15 dias. Os resultados foram avaliados após 15 dias de cada sequência de tratamento. Um questionário para avaliar a satisfação dos pacientes e um cinesiógrafo para registrar os movimentos mandibulares e o padrão de movimento da prótese total maxilar durante mastigação foram utilizados. O teste de "Wilcoxon" (α=0,05) e o "t-test" de Student para amostras pareadas (α=0,05) foram utilizados para comparar o grau de satisfação dos pacientes e os dados cinesiográficos, respectivamente. O adesivo para prótese melhorou significativamente a satisfação geral dos participantes (p<0,001). Os registros cinesiográficos mostraram um aumento significativo (1,7 mm) no movimento mandibular vertical (p<0,001) e uma menor intrusão (0,3 mm) da prótese total superior (p=0,002) durante a mastigação após o uso de adesivo. O uso de adesivo para prótese melhorou a satisfação dos usuários de próteses totais e gerou um aumento no movimento mandibular vertical e uma menor intrusão da prótese total maxilar durante a mastigação.

Reabilitação oral de paciente com Síndrome da Combinacão: relato de caso / Oral rehabilitation of a patient with combination syndrome: a case report

A Síndrome da Combinação representa uma importante condição patológica do sistema mastigatório que precisa de um tratamento reabilitador complexo. A presença de mucosa flácida é uma das caraterísticas mais comuns quando ocorre a reabsorção óssea anterior da pre-maxila ocasionada pela hiperfunção anterior dos dentes inferiores sobre a prótese total superior, onde a incidência de cargas nessa região resulta na movimentação da pró tese em direção ao rebordo, resultando no aumento da reabsorção do rebordo residual, na desadaptação interna da prótese e na perda de retenção da prótese. A presença de mucosa flácida, nesses casos, acarreta ainda problemas de suporte e estabilidade da prótese total superior, que podem ser tratados com redução cirúrgica da espessura do tecido ou usando técnicas específicas de confecção das próteses. Este artigo descreve a reabilitação oral de um paciente com Síndrome da Combinação onde a redução cirúrgica da mucosa flácida não foi realizada, utilizando uma técnica modificada de moldagem funcional em duas etapas, com o objetivo de gerar menos forças e distorções na fibromucosa flácida durante a moldagem funcional.

The Combination Syndrome represents an important pathologic condition of the masticatory system that requires a complex rehabilitation treatment. The presence of flaccid mucosa is one of the most common features due to bone resorption of the pre-maxilla caused by anterior hyperfunction of the mandibular teeth on the maxillary complete denture, where the impact of oclusal loading in this region results in movement of the maxillary prosthesis into the ridge, resulting in increased resorption of the residual ridge, internal misfit and 1055 of the retention of the maxillary complete denture. The presence of flaccid mucosa, in such cases, leads to problems of support and stability of the maxillary complete denture, which can be treated by surgical reduction of the thickness of the tissue or using specific techniques of fabrication of prostheses. This article describes the oral rehabilitation of a patient with the Combination Syndrome where the surgical reduction of flaccid mucosa was not performed, using a modified technique of functional impression in two steps, with the objective of generating forces and less distortion in flaccid mucosa during functional impression.

Influência da utilização de um adesivo para prótese na satisfação e nos parâmetros cinesiográficos de usuários de próteses totais / Effect of a denture adhesive in satisfaction and kinesiographic parameters in complete wearers: a cross-over randomized clinical trial

O objetivo deste estudo foi avaliar o efeito da utilização de um adesivo para prótese na satisfação e nos parâmetros cinesiográficos em usuários de próteses totais por meio de um estudo “cross-over”. Material e Métodos: Cinquenta pacientes desdentados receberam novas próteses totais bimaxilares. Após um período de adaptação, os participantes incluídos no estudo receberam uma sequência de tratamento: protocolo 1- utilização do adesivo para prótese durante os primeiros 15 dias, seguida por não utilização do adesivo os próximos 15 dias; protocolo 2- não utilização do adesivo durante os primeiros 15 dias; seguida por utilização do adesivo os próximos 15 dias. Os resultados foram avaliados após 15 dias de cada sequência de tratamento. Um questionário para avaliar a satisfação dos pacientes e um cinesiógrafo para registrar os movimentos mandibulares e o padrão de movimento da prótese total maxilar durante mastigação foram utilizados. O teste de “Wilcoxon” (α=0,05) e o “t-test” de student para amostras pareadas (α=0,05) foram utilizados para comparar o grau de satisfação dos pacientes e os dados cinesiográficos, respectivamente. Resultados: O adesivo para prótese melhorou significativamente a satisfação geral dos participantes (p<0,001). Os registros cinesiográficos mostraram um aumento significativo (1,7mm) no movimento mandibular vertical (p<0,001) e uma menor intrusão (0,3mm) da prótese total superior (p=0,002) durante a mastigação após o uso de adesivo. Conclusão: O uso de adesivo para prótese melhorou a satisfação dos usuários de próteses totais e gerou um aumento no movimento mandibular vertical e uma menor intrusão da prótese total maxilar durante a mastigação

The objective of this study was to evaluate the effect of a denture adhesive (DA) on patient satisfaction and kinesiographic parameters of complete denture wearers by a cross-over study. Material and Methods: Fifty edentulous patients received one set of new complete dentures. After an adaptation period, the participants were enrolled in the trial and randomized to receive a sequence of treatment: protocol 1- DA use during the first 15 days, followed by the no use of DA over the next 15 days; protocol 2- no use of DA during the first 15 days, followed by use of DA over the next 15 days. Outcomes were assessed after 15 days of each sequence of treatment. A questionnaire was used to evaluate patients´ satisfaction and a kinesiograph instrument was used to record mandible movements and pattern of maxillary complete denture movement during chewing. Wilcoxon test (α=.05) and a paired sample t-test (α=.05) were used to compare satisfaction levels and kinesiographic data, respectively. Results: The use of DA improved the overall patients´ satisfaction (p<.001). Kinesiographic recordings revealed a significant increase (1.7mm) on vertical mandible movements (p<0,001) during chewing and a lower (.3mm) vertical intrusion of the maxillary complete denture (p=0,002) during chewing after use of DA. Conclusion: The use of a DA in complete dentures wearers improved the patients´ satisfaction and change mandible movements, with increases in vertical mandible movements during chewing and lower intrusion of maxillary complete denture

Estudo prospectivo sobre a utilização de próteses totais implantossuportadas em pacientes edêntulos / Prospective study of the use of complete fixed dentures in edentulous patientes

Objetivos: o objetivo deste estudo foi avaliar o impacto da substituição de próteses totais convencionais mandibulares por próteses totais implantossuportadas sobre a qualidade de vida e os parâmetros cinesiográficos em pacientes desdentados totais bimaxilares. Métodos: indivíduos desdentados totais bimaxilares (n = 16) receberam próteses totais novas e após um período de adaptação (30 dias), a versão brasileira do Oral Health Impact Profile para indivíduos desdentados (Ohip-Edent) foi usada para avaliar a qualidade de vida relacionada à saúde oral dos participantes. Além disso, o cinesiógrafo K6-I (Myotronics Research Inc., Seattle, WA) foi utilizado pra realizar os registros dos movimentos máximos de abertura e fechamento e movimentação da prótese total superior durante a mastigação. Posteriormente, os indivíduos tiveram suas próteses totais convencionais mandibulares substituídas por próteses totais implantossuportadas e o mesmo protocolo de avaliação foi realizado após três e seis meses. Os resultados do Ohip foram avaliados utilizando os testes de Wilcoxon (α = 0,05) e os dados cinesiográficos avaliados por meio do teste t Student (α = 0,05). Resultados: os participantes apresentaram uma melhora significativa na qualidade de vida relacionada à saúde oral após três e seis meses de tratamento com próteses totais implantossuportadas. Os registros cinesiográficos demonstraram aumento significativo no movimento de abertura máxima vertical e nenhuma diferença significante foi encontrada no movimento da prótese total superior durante a mastigação após o tratamento com próteses totais implantossuportadas. Conclusão: a instalação de próteses totais implantossuportadas melhora a qualidade de vida dos pacientes e promove aumento na amplitude da abertura mandibular vertical.

Objectives: the objective of this study was to evaluate the impact of replacing conventional mandibular complete dentures by complete fixed dentures on the oral health-related quality of life and kinesiographic parameters of maxillary edentulous patients. Material and Methods: edentulous patients (n = 16) received one set of new complete dentures and after the intraoral adjustments and adaptation period (30 days), the Brazilian version of Oral Health Impact Profile for assessing edentulous subjects (Ohip-Edent) was used to evaluate the oral health-related quality of life (OHQOL) of the participants. Additionally, the kinesiograph instrument K6-I (Myotronics Research Inc., Seattle, WA) was used to record opening and closure range of movement, mandibular movement, and the pattern of maxillary complete denture movement on chewing. Afterwards, the patients had their mandibular complete dentures replaced by a complete fixed denture and the same evaluation protocol was performed after 3 and 6 months. Ohip-Edent responses were analyzed using Wilcoxon’s test for repeated measures (α = .05) and Kinesiographic data using the Student´s t test (α = .05). Results: The Ohip-Edent showed an improvement of general oral health-related quality of life after 3 and 6 months of the treatment with complete fixed dentures. Kinesiographic recordings revealed a significant increase on maximum mandibular movements of vertical opening and no differences for the movement of the maxillary complete denture on chewing after treatment with complete fixed dentures was observed. Conclusion: the installation of complete fixed dentures improved the OHQOL and changed mandibular movements, with increases in vertical amplitude of maximal opening.