Occlusal splints pretreatment for long-term complete denture wearers: A systematic review / Pré-tratamento com placas oclusais para usuários de prótese total durante longos períodos. Uma revisão sistemática

The aim of this systematic review was to answer the focused question: "Would the use of occlusal splints be beneficial prior to the rehabilitation of long-term complete denture wearers?" Eletronic searches were performed until November 2016 in MedLine (PubMed), ISI Web of Science, Scopus, Scielo, Lilacs, Ibecs and the Cochrane Library. As eligibility criteria, any prospective or retrospective clinical trials that evaluated the use of occlusal splints in long-term complete denture wearers was selected. It was evaluated the extent of mandibular movements, pain symptomatology, intra-articular space, vertical dimension, and muscle activity. A total of 1152 potentially relevant records were identified from all databases. After title and abstract examination, 577 studies were excluded. Only 4 studies fulfilled all the selection criteria. All studies were longitudinal, and the period using the occlusal splints ranged from 30 to 360 days. Electromyography was the main evaluation method used, but pain scales and electrognathography were also used in two studies. There is scientific evidence supporting that occlusal splints pretreatment should be considered for patients whose long- term denture wearing experience is associated with compromised mandibular movements and vertical dimension of occlusion.

O objetivo desta revisão sistemática foi responder à questão: "Seria benéfico o uso de placas oclusais antes da reabilitação de usuários de próteses totais durante longo período?". Foram realizadas buscas nas bases eletrônicas MedLine (PubMed), ISI Web de Ciência, Scopus, Scielo, Lilacs, Ibecs e a Cochrane Library até novembro de 2016. Incluíam-se nos critérios de elegibilidade qualquer ensaio clínico prospectivo ou retrospectivo avaliando o uso de placas oclusais em usuários de prótese total durante longos períodos. Foi avaliada a extensão dos movimentos mandibulares, sintomatologia da dor, espaço intra-articular, dimensão vertical e atividade muscular. Um total de 1152 registros potencialmente relevantes foram identificados nos bancos de dados. Após a leitura do título e resumo, 577 estudos foram excluídos. Apenas 4 estudos preencheram todos os critérios de inclusão. Todos os estudos incluídos eram longitudinais, e o período em que usavam as placas oclusais variou de 30 a 360 dias. A eletromiografia foi o principal método de avaliação utilizado, mas as escalas de dor e a eletrognatografia também foram utilizadas em dois estudos. Há evidências científicas para suportar o uso de placas oclusais como pré-tratamento de pacientes que apresentam movimentos mandibulares e a dimensão vertical de oclusão comprometidos devido ao uso de próteses totais durante longos períodos.

Masking Colored Substrates Using Monolithic and Bilayer CAD-CAM Ceramic Structures.

OBJECTIVE: To evaluate the masking ability and translucency of monolithic and bilayer CAD-CAM ceramic structures. METHODS: Discs of high translucency (HT) and low translucency (LT) lithium disilicate-based ceramic (IPS e.max CAD) with different thicknesses (0.7, 1, 1.5, and 2 mm) were evaluated as a monolithic structure or combined (bilayer) with a 0.5-mm-thick zirconia framework (IPS e.max ZirCAD). The masking ability and translucency were calculated based on CIE L*a*b* color coordinates measured with a spectrophotometer (SP60, X-Rite). The translucency parameter (TP) was calculated using color coordinates measured over standard white-and-black backgrounds. The masking ability was calculated by CIEDE2000 color difference metric (ΔE00) for each specimen measured over a tooth-colored substrate (shade A2) compared to three darker backgrounds (shade C4 and two metal substrates). Confidence intervals (CI) for the means (95% CI) were calculated for TP and ΔE00. The Pearson correlation between ΔE00 and TP was investigated for monolithic and bilayer structures over all backgrounds. RESULTS: The thinner the lithium disilicate layer, the greater the translucency and the higher the ΔE00 values. The effect of ceramic thickness on both translucency and masking ability was more pronounced for the monolithic structures. In addition, monolayers always presented a greater color variation than their bilayer counterparts. The metallic background produced greater ΔE00 than the C4-shaded substrate. CONCLUSION: Monolithic veneers were able to mask C4-shaded background but did not mask metallic backgrounds. Bilayer structures showed greater shade masking ability than monolithic structures.

Influence of anxiety on temporomandibular disorders--an epidemiological survey with elders and adults in Southern Brazil.

The socio-economic and psychological factors and the use of and need for dental prostheses have been associated with prevalence and severity of temporomandibular disorders (TMD). The aim of this study was to evaluate the association of socio-economic and psychological factors, use of and need for dental prostheses with the prevalence and severity of signs and symptoms of temporomandibular disorders (TMD). A cross-sectional study was conducted in Luzerna/Brazil. All individuals aged 35-44 (adults) and 65-74 (elders) were invited to participate in this study. The measuring instrument included a questionnaire application and the clinical evaluation regarding signs and symptoms of TMD. Descriptive analyses, chi-squared test, unadjusted and adjusted Poisson regression were used for the statistic analysis. The level of statistical significance was given when P ≤ 0·05. In total, 568 individuals (338 adults and 230 elders) were included; among them, 43·5% had absent, 42·6% mild, 11·3% moderate and 2·6% severe TMD. The presence of higher TMD rates was found in females (P = 0·001), and the TMD occurrence increased with anxiety level (P = 0·001). Other socio-economic factors, such as colour (P = 0·115), family structure (P = 0·478), age (P = 0·143), social class (P = 0·935) and education (P = 0·678) showed no influence. In conclusion, the female gender and individuals with higher levels of anxiety had increased prevalence of signs and symptoms of TMD. Additionally, was not founded association between TMD and use of and need for dental prostheses.

Dual and self-curing potential of self-adhesive resin cements as thin films.

In this study, the dual- and self-curing potential of self-adhesive resin cements (SARCs) as thin, clinically-relevant cement films was investigated. The SARCs tested were: BisCem (BSC; Bisco), Maxcem Elite (MXE; Kerr), RelyX Unicem clicker (UNI; 3M ESPE), seT capsule (SET; SDI), and SmartCem 2 (SC2; Dentsply Caulk). The conventional cement RelyX ARC (3M ESPE) was tested as a reference. The degree of conversion (DC) as a function of time was evaluated by real-time Fourier transform infrared spectroscopy with an attenuated total reflectance (ATR) device. The cements were either photoactivated for 40 seconds (dual-cure mode) or not photoactivated (self-cure mode). The cement film thickness was 50 ± 10 µm. The DC (%) was evaluated 1, 5, 10, 15, 20, 25, and 30 minutes after placing the cement on the ATR cell. Data for DC as a function of time were analyzed by two-way repeated measures analysis of variance (ANOVA). DC values at 30 minutes for the self- and dual-cure modes were submitted to one-way ANOVA. Post hoc comparisons were performed using the Student-Newman-Keuls test (p<0.05). The rate and the extent of conversion were lower for the SARCs compared with the conventional cement. Means ± standard deviations (SD) for the dual-cure mode at 30 minutes were: 75 ± 5 (ARC)a, 73 ± 8 (SET)a, 61 ± 4 (MXE)b, 51 ± 9 (BSC)c, 51 ± 4 (UNI)c, and 48 ± 3 (SC2)c, while in the self-cure mode means and SD were 62 ± 6 (ARC)a, 54 ± 3 (MXE)b, 40 ± 6 (SC2)c, 35 ± 2 (UNI)c, 35 ± 3 (SET)c, and 11 ± 3 (BSC)d. The DC for the dual-cure mode was generally higher than the self-cure, irrespective of the time. Discrepancies in DC between the dual- and self-cure modes from 11% to 79% were observed. In conclusion, SARCs may present slower rate of polymerization and lower final DC than conventional resin cements, in either the dual- or self-cure mode.

Tumour-specific induction of immune complexes: DCP-IgM in hepatocellular carcinoma.

BACKGROUND: In the sera of liver, colorectal and prostate cancer patients, several biomarkers may be detected as IgM immune complexes. To determine whether the presence of immune complexes was correlated to an increase of IgMs, we measured the IgM content in the sera of patients with hepatocellular carcinoma (HCC) and cirrhosis, and evaluated the occurrence of des-gamma-carboxy prothrombin (DCP) as immune complexes (DCP-IgM) compared to the levels of DCP and alpha-fetoprotein (AFP). PATIENTS AND METHODS: Serum samples from 31 patients with cirrhosis, 33 untreated HCC patients diagnosed by ultrasound, computed tomography and/or magnetic resonance and confirmed by histopathology, when indicated, and 30 healthy controls were analysed. Concentrations of IgM and DCP-IgM were determined by ELISAs. RESULTS: Circulating IgM in patients with HCC (median level = 1.79 mg mL(-1)) and cirrhosis (1.09 mg mL(-1)) were not significantly different (P = 0.1376) while DCP-IgM were significantly higher in HCC patients (median level = 2171.2 AU mL(-1)) than in those with cirrhosis (1152 AU mL(-1), P = 0.0047). No correlation was found between DCP-IgM and IgM in HCC (r = 0.227) and cirrhosis patients (r = 0.475). DPC-IgM was positive in 55% (18/33) of HCC patients and in 26% (8/31) of cirrhosis patients compared to 39% and 26% for DCP and 48% and 13% for AFP. DCP-IgM, DCP and AFP tests had 100% specificity in healthy controls. CONCLUSIONS: DCP-IgM in HCC patients was not associated with an increase in IgM concentration. DCP-IgM was more frequently detected in HCC patients than DCP and AFP, strengthening the diagnostic role of IgM immune complexes for liver cancer.

Clinical evaluation of allografts and homografts for restoration of missing tooth structure.

STATEMENT OF PROBLEM: The clinical performance of bonding human tooth fragments to either replace missing teeth or to restore defective teeth is unclear. Prospective studies can help to predict the success of such treatment options. PURPOSE: This study evaluated the feasibility of bonding tooth tissue homografts and allografts either to replace missing teeth or to restore defective teeth, and estimated the success rate of bonded allograft and homograft restorations 3 years after placement. METHOD AND MATERIAL: Twenty clinical cases were treated by bonding tooth fragments or crowns into 6 groups (Gp): Gp1, cervical erosion and abrasion lesions (6); Gp2, incisal edge fractures (4); Gp3, partially destroyed crowns (4); Gp4, teeth placed in a removable prosthesis (2); Gp5, missing tooth with no opposing tooth (2); and Gp6, temporary space maintenance (2). Restorations were examined using USPHS criteria every 2 months and whenever a patient called to report a failure. RESULTS: After a 3-year follow-up, the overall success rate was 80% for the 20 restorations. The 95% confidence interval was 63% to 94%. Four restorations failed by debonding (Gp2 [2]; Gp5 [1]; Gp6 [1]) during the first 4 months. The main cause of failure appeared to be excessive occlusal loading. CONCLUSION: Within the limitations of this clinical study, the results after a 3-year follow-up showed the success rate was not less than 63% for bonded allograft and homograft restorations.