Anti-Candida activity and biocompatibility of silver nanoparticles associated with denture glaze: a new approach to the management of denture stomatitis.

The association of silver nanoparticles (AgNps) to sealant agent Palaseal® can be a promising alternative for complete denture wearers who may develop denture stomatitis (DS). The study aimed to evaluate the anti-Candida and biocompatible potential of silver nanoparticles synthesized by three routes associated with denture glaze to prevent and/or treat oral candidiasis. Surface acrylic resin specimens were treated with different associations of glaze with AgNps (VER+AgUV, VER+AgTurk and VER+AgGm). As controls, specimens were treated with glaze+nystatin (VER+Nyst), glaze only (VER) or submerged in PBS (PBS). Afterwards, Candida albicans biofilm was developed for 24 h, 15 d and 30 d. Subsequently, the biofilm was quantified by CFU/mL, XTT assay and confocal laser scanning microscopy. Fibroblasts were submitted to conditioned medium with the same associations for 24, 48 and 72 h and LIVE/DEAD® viability test was carried out. Regardless of the period, there was a significant reduction (p < 0.01) of viable fungal cells load, as well as inhibition of fungal metabolic activity, in specimens treated with glaze+AgNps associations, compared to VER and PBS. The anti-Candida effects of the associations were similar to the VER+Nyst group, with emphasis on VER+AgGm, which showed the highest percentage values of non-viable fungal cells maintained over time. The associations did not prove toxicity to fibroblasts. The AgNps exerted antimicrobial activity against C. albicans biofilms and are biocompatible. The most effective results were achieved with the association of glaze+silver nanoparticles synthesized by the green chemistry method (AgGm), proving to be an innovative alternative in the management of DS.

Anti-biofilm effectiveness of protocols for cleaning complete dentures in hospitalized patients: a randomized controlled trial.

BACKGROUND: Denture biofilm acts as a potential reservoir for respiratory pathogens, considerably increasing the risk of lung infections, specifically aspiration pneumonia, mainly 48h after hospital admission. The establishment of a straightforward, affordable, and applicable hygiene protocol in a hospital environment for the effective control of denture biofilm can be particularly useful to prevent respiratory infections or reduce the course of established lung disease. OBJECTIVES: To evaluate the anti-biofilm effectiveness of denture cleaning protocols in hospitalized patients. METHODOLOGY: The maxillary complete dentures (MCDs) of 340 hospitalized participants were randomly cleaned once using one of the following 17 protocols (n=20): brushing with distilled water, toothpaste, or neutral liquid soap (controls); immersion in chemical solutions (1% sodium hypochlorite, alkaline peroxide, 0.12% or 2% chlorhexidine digluconate), or microwave irradiation (650 W for 3 min) combined or not with brushing. Before and after the application of the protocols, the biofilm of the intaglio surface of the MCDs was evaluated using two methods: denture biofilm coverage area (%) and microbiological quantitative cultures on blood agar and Sabouraud Dextrose Agar (CFU/mL). Data were subjected to the Wilcoxon and Kruskal-Wallis tests (α=0.05). RESULTS: All 17 protocols significantly reduced the percentage area of denture biofilm and microbial and fungal load (P<0.05). The highest percentage reductions in the area of denture biofilm were observed for 1% hypochlorite solution with or without brushing and for 2% chlorhexidine solution and microwave irradiation only in association with brushing (P<0.05). The greatest reductions in microbial and fungal load were found for the groups that used solutions of 2% chlorhexidine and 1% hypochlorite and microwave irradiation, regardless of the association with brushing (P<0.05). CONCLUSIONS: A single immersion for 10 min in 1% sodium hypochlorite, even in the absence of brushing, proved to be a straightforward, rapid, low-cost, and effective protocol for cleaning the dentures of hospitalized patients.

Mucoadhesive delivery systems for oral candidiasis treatment: A systematic review and meta-analysis.

OBJECTIVES: This systematic review and meta-analysis aimed to evaluate the clinical and mycological effectiveness of mucoadhesives as vehicles for drugs or natural products in the treatment of oral candidiasis. MATERIALS AND METHODS: The search for articles was carried out in the Medline/PubMed, SCOPUS, EMBASE, Web of Science, Cochrane Library, and SciELO databases before August 2023. We selected the studies, extracted the data, evaluated the study quality, graded the evidence, performed the risk of bias, and carried out meta-analysis. RESULTS: A total of 389 potentially relevant articles were identified, and 11 studies (1869 participants) met the inclusion criteria of the systematic review. The overall risk of bias was considered low. The most common presentation of mucoadhesives was tablets, with miconazole being the most frequently drug used in the delivery system. Mucoadhesives demonstrated comparable efficacy with topical or systemic antifungal agents, with no significant differences between treatments in terms of clinical (RR = 0.907; 95CI = 0.3-1.297; p = 0.591; I2 = 64.648) or mycological (RR = 0.95; 95CI = 0.667-1.360; p = 0.789; I2 = 73.271) efficacy. CONCLUSIONS: Mucoadhesives may be a suitable alternative to conventional treatments, with the advantage of reducing the frequency of application by up to 5 times and the daily dosage by up to 20 times.

Anti-biofilm effectiveness of protocols for cleaning complete dentures in hospitalized patients: a randomized controlled trial

Abstract Denture biofilm acts as a potential reservoir for respiratory pathogens, considerably increasing the risk of lung infections, specifically aspiration pneumonia, mainly 48h after hospital admission. The establishment of a straightforward, affordable, and applicable hygiene protocol in a hospital environment for the effective control of denture biofilm can be particularly useful to prevent respiratory infections or reduce the course of established lung disease. Objectives To evaluate the anti-biofilm effectiveness of denture cleaning protocols in hospitalized patients. Methodology The maxillary complete dentures (MCDs) of 340 hospitalized participants were randomly cleaned once using one of the following 17 protocols (n=20): brushing with distilled water, toothpaste, or neutral liquid soap (controls); immersion in chemical solutions (1% sodium hypochlorite, alkaline peroxide, 0.12% or 2% chlorhexidine digluconate), or microwave irradiation (650 W for 3 min) combined or not with brushing. Before and after the application of the protocols, the biofilm of the intaglio surface of the MCDs was evaluated using two methods: denture biofilm coverage area (%) and microbiological quantitative cultures on blood agar and Sabouraud Dextrose Agar (CFU/mL). Data were subjected to the Wilcoxon and Kruskal-Wallis tests (α=0.05). Results All 17 protocols significantly reduced the percentage area of denture biofilm and microbial and fungal load (P<0.05). The highest percentage reductions in the area of denture biofilm were observed for 1% hypochlorite solution with or without brushing and for 2% chlorhexidine solution and microwave irradiation only in association with brushing (P<0.05). The greatest reductions in microbial and fungal load were found for the groups that used solutions of 2% chlorhexidine and 1% hypochlorite and microwave irradiation, regardless of the association with brushing (P<0.05). Conclusions A single immersion for 10 min in 1% sodium hypochlorite, even in the absence of brushing, proved to be a straightforward, rapid, low-cost, and effective protocol for cleaning the dentures of hospitalized patients.

What is the Best Tooth-Supported Attachment System for Distal-Extension Removable Partial Dentures? A Systematic Review with Meta-Analysis.

PURPOSE: To evaluate the published literature on tooth-tissue supported removable partial dentures (RPDs) and determine the attachment system that provides the best clinical outcome. MATERIALS AND METHODS: A comprehensive search of studies published up to November 2021 was performed in the PubMed/MEDLINE, Web of Science, and Cochrane Library databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. The study protocol was approved and was registered in the International Prospective Register of Systematic Reviews (PROSPERO: CRD42021268449). The PICO question was, "What is the best attachment system used in Kennedy class I and II removable partial dentures?" RESULTS: The search identified 871 articles, of which 21 met the inclusion criteria. The evaluation period in the studies ranged from 3 to 282 months. A total of 1,357 patients were included, of which 526 used prostheses with attachments. The mini SG attachment (extracoronal) was the most commonly used attachment, and the survival rate ranged from 37% to 98.1% in 10 studies, with no significant differences between the systems. Among the 10 studies selected for quantitative analysis, the meta-analysis revealed an overall failure rate of 16.6% (95% confidence interval: 10.4-25.4%), and heterogeneity of I²=65.725 (Q-value: 26.258, P=.002). CONCLUSION: Clinical studies comparing different attachment systems for rehabilitation are lacking. Our findings suggest that attachment-retained RPDs have good retention and better esthetics than conventional RPDs and that the extracoronal attachment system is the most viable choice for treatment at the free end.

A systematic review and meta-analysis of the clinical performance of implant-supported overdentures retained by CAD-CAM bars.

Currently, there is no consensus on the indications and clinical performance of implant-supported overdentures (IODs) involving computer-aided design and manufacturing (CAD-CAM) bars. OBJECTIVE: To evaluate the performance of IODs involving CAD-CAM bars. METHODOLOGY: A comprehensive search of studies published until May 2023 was conducted in many databases, including PubMed/MEDLINE, Web of Science, Cochrane Library, and SciELO, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The population, intervention, comparison, outcome (PICO) question was: "How do IODs retained by bars fabricated by CAD-CAM technology perform in daily clinical practice?" The meta-analysis included clinical studies based on effect size and a two-tailed null test with a 95% confidence interval (CI). RESULTS: Ten studies were included in the meta-analysis. Among them, nine reported a 100% implant survival rate for all CAD-CAM milled bars. Complications were reported in two studies with CAD/CAM-milled titanium bars, and one study reported more fractures in soldered gold bars used in maxillary rehabilitation. However, no fractures were observed in IODs retained by PEEK and zirconia bars. According to six studies, biological complications, including peri-implantitis, were minimal in the BioHPP and PEEK bar groups, while no cases were reported in the titanium or zirconia bar groups. CAD-CAM-milled zirconia bars had higher plaque and bleeding indices compared with titanium bars, as evidenced by findings from five studies. All four studies that evaluated Oral Health Impact Profile (OHIP) scores showed a positive effect of IODs retained by CAD-CAM milled titanium bars on quality of life. Patient satisfaction and acceptance by prosthodontists were significantly high, according to the results of five studies. CONCLUSION: Overdentures retained with CAD-CAM milled titanium bars show great potential for use in daily clinical practice. Moreover, patient and practitioner satisfaction was very high when this method was used.

Reabilitação oral com próteses parciais removíveis após restabelecimento de dimensão vertical de oclusão e tratamento multidisciplinar: relato de caso / Oral rehabilitation with removable partial dentures after restoration of the vertical dimension of occlusion and multidisciplinary treatment: case report

As próteses parciais removíveis (PPRs) são uma alternativa de tratamento viável na prática clínica para reabilitar arcos parcialmente desdentados. Entretanto, o planejamento dessas próteses e preparo bucal prévio são frequentemente negligenciados. O presente artigo tem como objetivo relatar o caso clínico de uma reabilitação oral com PPRs superior e inferior após abordagem multidisciplinar, de modo a enfatizar as fases de um planejamento criterioso e de preparo prévio dos dentes pilares, visando o sucesso e a longevidade da reabilitação. Paciente do sexo masculino de 57 anos de idade compareceu à clínica da Faculdade de Odontologia de Bauru, Universidade de São Paulo, queixando-se da estética de seu sorriso e de algumas ausências dentárias. O indivíduo utilizava uma PPR provisória inferior insatisfatória e apresentava perda de dimensão vertical de oclusão (DVO). Após o exame clínico, radiográfico e estudo do caso em articulador semi-ajustável, realizou-se o planejamento com abordagens restauradoras, endodônticas, periodontais e protéticas. Após tratamento periodontal, foi realizada endodontia dos elementos 12, 15 e 47, confecção de núcleos e coroas nos dentes 12 e 15, restauração a nível gengival para apoio residual no dente 47, restaurações nos dentes 11, 13, 22, 24 e 44 e, por fim, a confecção das PPRs superior e inferior. A abordagem multidisciplinar utilizada neste caso clínico viabilizou o restabelecimento da DVO e possibilitou o sucesso da reabilitação protética(AU)

Removable partial dentures (RPDs) are a viable treatment alternative in clinical practice to rehabilitate partially edentulous arches. However, the planning of these dentures and prior oral preparation are often neglected. This article aims to report the clinical case of an oral rehabilitation with upper and lower RPDs after a multidisciplinary approach, to emphasize the phases of careful planning and prior preparation of the abutment teeth, aiming at the success and longevity of the rehabilitation. A 57-year-old male patient came to the clinic of the Bauru School of Dentistry, University of São Paulo, complaining about the esthetics of his smile and some missing teeth. The subject was using an unsatisfactory lower provisional prosthesis and had a loss of vertical dimension of occlusion (OVD). After the clinical and radiographic examination and the case study in a semi-adjustable articulator, planning was carried out with restorative, endodontic, periodontal and prosthetic approaches. After periodontal treatment, endodontics were performed on elements 12, 15 and 47, creation of cores and crowns on teeth 12 and 15, restoration at the gingival level for residual support on tooth 47, restorations on teeth 11, 13, 22, 24 and 44 and, finally, the making of the upper and lower PPRs. The multidisciplinary approach used in this clinical case enabled the restoration of the OVD and enabled the success of the oral rehabilitation(AU)

Silver nanoparticles in denture adhesive: An antimicrobial approach against Candida albicans.

OBJECTIVE: To evaluate the antimicrobial potential of silver nanoparticles (Ag NPs) synthesized using three different routes (ultraviolet light, Turkevich, and green chemistry method using Glycine max extract) associated with COREGA® denture powder adhesive. METHODS: Heat-cured acrylic resin specimens were treated with different Ag NPs associated with the adhesive (AD + Ag UV, AD + Ag Turk, and AD + Ag Gm groups). As controls, the specimens were treated with a combination of adhesive and nystatin (AD + Nyst group), only adhesive (AD group), or submerged on the surface of the specimens (PBS group). After the treatments, biofilms of C. albicans developed for 3, 6, and 12 h on the specimen surfaces. The biofilm was quantified using colony-forming units per milliliter, colorimetric assay, and confocal laser scanning microscopy. RESULTS: Regardless of the period, we observed an inhibition of fungal load and a reduction in metabolic activity and biofilm mass in the resin specimens treated with the combinations AD/Ag NPs, compared to AD and PBS. The antimicrobial action of the AD + Turk and AD + Ag Gm groups was similar than that for the AD + Nyst group in all periods and viability tests, except for the biofilm mass (12 h). CONCLUSIONS: The COREGA® adhesive with Ag NPs, mainly those synthesized using the Turkevich and Glycine max methods, showed excellent antimicrobial activity against C. albicans biofilms, maintained for up to 12 h. CLINICAL SIGNIFICANCE: The association of Ag NPs to the adhesive can add preventive or therapeutic effects against denture stomatitis, to this prosthetic material.

Evaluation of the clinical performance of dentures manufactured by computer-aided technology and conventional techniques: A systematic review.

STATEMENT OF PROBLEM: The introduction of computer-aided design and computer-aided manufacturing (CAD-CAM) technology for complete denture fabrication may have improved clinical outcomes compared with conventional techniques. However, systematic reviews comparing these techniques are lacking. PURPOSE: The purpose of this systematic review was to identify, compare, and synthesize the outcomes of published clinical studies related to complete denture fabrication, with respect to the differences between CAD-CAM technology and conventional techniques. MATERIAL AND METHODS: A comprehensive search of studies published up to March 16, 2020, was conducted by using the PubMed/MEDLINE, Web of Science, Cochrane Library, SciELO, and Embase databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement criteria and was registered in the International Prospective Register of Systematic Reviews (PROSPERO ID 42020202614). The population, intervention, comparison, and outcome (PICO) question was: Do CAD-CAM complete dentures have a similar functional performance to those fabricated by conventional techniques? The quality of publications was appraised by using the Critical Appraisal Skills Program (CASP) checklists. RESULTS: Of the 1232 titles, 6 articles were selected. The studies reported better retention of digitally manufactured complete dentures without denture adhesives than that of conventional complete dentures with or without denture adhesives. Other studies reported that dentures manufactured with digital systems were better adapted to tissue surfaces, required less clinical time, were lower in cost, and provided better experience and satisfaction to patients. CONCLUSIONS: The assessment of CAD-CAM planning and manufacturing through clinical studies is ongoing. However, preliminary results indicate better clinical performance and lower overall costs of digital complete dentures than conventional dentures.

A systematic review and meta-analysis of the clinical performance of implant-supported overdentures retained by CAD-CAM bars

Abstract Currently, there is no consensus on the indications and clinical performance of implant-supported overdentures (IODs) involving computer-aided design and manufacturing (CAD-CAM) bars. Objective: To evaluate the performance of IODs involving CAD-CAM bars. Methodology: A comprehensive search of studies published until May 2023 was conducted in many databases, including PubMed/MEDLINE, Web of Science, Cochrane Library, and SciELO, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The population, intervention, comparison, outcome (PICO) question was: "How do IODs retained by bars fabricated by CAD-CAM technology perform in daily clinical practice?" The meta-analysis included clinical studies based on effect size and a two-tailed null test with a 95% confidence interval (CI). Results: Ten studies were included in the meta-analysis. Among them, nine reported a 100% implant survival rate for all CAD-CAM milled bars. Complications were reported in two studies with CAD/CAM-milled titanium bars, and one study reported more fractures in soldered gold bars used in maxillary rehabilitation. However, no fractures were observed in IODs retained by PEEK and zirconia bars. According to six studies, biological complications, including peri-implantitis, were minimal in the BioHPP and PEEK bar groups, while no cases were reported in the titanium or zirconia bar groups. CAD-CAM-milled zirconia bars had higher plaque and bleeding indices compared with titanium bars, as evidenced by findings from five studies. All four studies that evaluated Oral Health Impact Profile (OHIP) scores showed a positive effect of IODs retained by CAD-CAM milled titanium bars on quality of life. Patient satisfaction and acceptance by prosthodontists were significantly high, according to the results of five studies. Conclusion: Overdentures retained with CAD-CAM milled titanium bars show great potential for use in daily clinical practice. Moreover, patient and practitioner satisfaction was very high when this method was used.

Resilient liner modified by antimicrobials for denture stomatitis treatment: A randomized controlled trial.

OBJECTIVES: This randomized clinical trial evaluated the effectiveness of an interim denture resilient liner (Trusoft) modified with minimum inhibitory concentrations (MICs) of antimicrobial agents for Candida albicans biofilm in the denture stomatitis (DS) treatment. METHODS: Forty participants with DS and maxillary complete denture (MCD) wearers were randomly assigned to one of the treatments for 14 days (n=10): nystatin oral suspension (Control-100,000IU/mL; 4 × /day), MCD relined with Trusoft either without (Tru) or with nystatin (Ny) or chlorhexidine diacetate (Chx) at MICs. Cytological smears and mycological quantitative cultures were taken from the palate and denture before treatment (baseline), at the end of treatment (day 14), and at follow-up (days 30, 45, and 60). Photographs of the palate were made at each visit. Data were analyzed by the Cochran and χ2 tests, ANOVA and the Tukey test or the Friedman and Kruskal-Wallis tests (α=0.05). RESULTS: Palatal smears of the Ny and Chx groups exhibited no mycelial Candida (0%) on day 14, and, at the 60-day follow-up, it was observed for only 1 participant from Chx group. MCD smears showed reduction in mycelial forms for all groups on day 14 (P<0.05), but this difference was maintained at follow-up only for the relined dentures (P<0.05). Unlike Tru and the control groups, Ny and Chx groups evidenced a significant reduction in CFU/mL values and DS severity throughout the trial (P<0.05). CONCLUSIONS: The addition of nystatin and chlorhexidine at MICs to an interim resilient liner is a promising treatment for DS, with better results than those for conventional therapy with nystatin suspension, including the follow-ups. CLINICAL SIGNIFICANCE: Compared with conventional topical antifungal therapy, modifying a denture reline material with antimicrobials provided a therapeutic option for denture stomatitis. This non-invasive, straightforward therapeutic approach can be easily adopted by dentists and has the advantage of not requiring patient compliance while maintaining therapeutic concentrations on the denture base.

A modified Newton classification for denture stomatitis.

The effectiveness of denture stomatitis (DS) treatment should be evaluated by associating clinical and mycological parameters. Although widely used in clinical studies, the Newton classification does not accurately represent the degree of severity of palatal inflammation in terms of extent of the lesions and intensity of the erythema. Therefore, a modified Newton classification has been proposed considering the coverage area of palatal inflammation and the erythema level. This consistent and direct ranking will help standardise randomised clinical trials, as well as the statistical comparison among blind evaluations of the obtained scores within and between studies.

Effect of denture liners surface modification with Equisetum giganteum and Punica granatum on Candida albicans biofilm inhibition.

Aim: This study investigated the effect of denture liners surface modification with Equisetum giganteum (EG) and Punica granatum (PG) on Candida albicans biofilm inhibition supposing its usage as a sustained-release therapeutical delivery system for Candida-associated denture stomatitis. Materials & methods:C. albicans biofilm (SC5314 or ATCC 90028) was formed on soft liners superficially modified by a primer mixed to drugs at minimum inhibitory concentrations (0.100 g for EG and PG or 0.016 g for nystatin per ml of primer). After 24 h, 7 or 14 days, antibiofilm activity was evaluated by colony-forming unit counts. Results: Not all groups were equi-efficient to nystatin after 24 h and 7 days. After 14 days, EG and PG efficacies were not different from nystatin (almost 100% inhibition). Conclusion: The proposed protocol presents a promising option to allopathic drugs for Candida-associated denture stomatitis treatment.

A New Proposal for Calibrated Gauges for Removable Partial Dentures: A Finite Element Analysis.

AIM: The aim of this study was to evaluate the stress distribution of a planned removable partial denture (RPD) using new proposals for calibrated gauges of 0.3 mm and 0.35 mm undercuts through the three-dimensional (3D) finite element methodology, and compare them with 0.25 mm and 0.5 mm gauges that are already existing in clinical practice. MATERIALS AND METHODS: Kennedy class-I edentulous 3D models and their respective RPDs (InVesalius software; Rhinoceros and SolidWorks CAD) were created and exported to the finite element program HyperMesh 2019 for mesh configuration. In the following steps, axial loading (0º) of 40 N per point was performed, with 3 points on the molars and 2 points on the premolars, totaling 280 N unilaterally. The model was processed by the OptiStruct 2019 software and imported into the HyperView 2019 software to obtain the stress maps (MPa). RESULTS: The use of 0.30 and 0.35 mm calibrated gauges presented tensions similar to those with the 0.25 mm gauge (gold standard) and caused no significant damage to biological structures. The use of a 0.5 mm undercut caused greater traction force in the periodontal ligament of the abutments. CONCLUSIONS: The 0.35 mm undercut seems promising as it presented more favorable results in this simulation, on the other hand, a 0.5 mm undercut is greater than that necessary for retainers made of CoCr. CLINICAL SIGNIFICANCE: This study aims to measure a new undercut gauge (0.35 mm) to increase the retention area in abutment teeth of removable partial dentures.

Does microwave disinfection affect the dimensional stability of denture base acrylic resins? A systematic review.

OBJECTIVE: To systematically evaluate the effect of microwave disinfection on the dimensional stability of denture base acrylic resins. BACKGROUND: Microwave disinfection has been considered as an alternative method for disinfecting complete dentures to help prevent and treat denture stomatitis. However, data on the impact of microwave disinfection on the dimensional stability of acrylic resins are still scarce. METHODS: The PubMed/Medline, SCOPUS and EMBASE databases were searched in order to assess articles published in English up to January 2021 (CRD42021212267). We included studies that have assessed the effect of microwave disinfection, on the dimensional stability of acrylic resins, comparing them with negative or positive controls. RESULTS: A total of seven in vitro studies were included. The qualitative synthesis demonstrated that, in general, microwave disinfection produced more distortion on the materials than do immersion in sodium hypochlorite, chloride solution, chlorhexidine, and water immersion. However, considering the dimensional stability of the specimens, microwave disinfection at 500 W for 3 minutes, and at 450 W for 5 minutes, produced similar or better outcomes than did control groups. CONCLUSION: In general, microwave disinfection promotes changes in the dimensional stability of denture base acrylic resins, and should thus be used with caution. However, microwave disinfection protocols at lower power settings (500 and 450 W) and exposure times (3 and 5 minutes) produces similar or less distortion than chemical disinfection. More studies are still required in order to evaluate the clinical and long-term implications of microwave disinfection.

Occlusal marking film for accurate interference assessments of removable partial denture frameworks: A dental technique.

A technique is described for detecting areas of interference for removable partial denture frameworks. An occlusal marking film is placed between the misfitted abutment teeth and framework region. Gentle pressure is applied to seat the framework, and the exact areas of interference are seen on removal. With this clean, rapid, cost-effective, and straightforward approach, areas of interference can be precisely adjusted for complete seating of the removable partial denture framework.

Computer-aided technology for fabricating removable partial denture frameworks: A systematic review and meta-analysis.

STATEMENT OF PROBLEM: A consensus that establishes the indications and clinical performance of removable partial denture (RPD) frameworks designed and manufactured with computer-aided design and computer-aided manufacturing (CAD-CAM) systems is lacking. PURPOSE: The purpose of this systematic review and meta-analysis was to evaluate the currently published literature investigating different CAD-CAM methods and techniques for RPD manufacturing and their clinical performance. MATERIAL AND METHODS: A comprehensive search of studies published up to September 2019 was performed in PubMed/MEDLINE, Web of Science, Cochrane Library, and SciELO databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA Statement) criteria and was registered and approved in the International Prospective Register of Systematic Reviews (PROSPERO: CRD42020152197). The population, intervention, comparison, outcome (PICO) question was "Do the CAD-CAM frameworks have similar performances to those fabricated by conventional techniques?" The meta-analysis included clinical and in vitro studies based on the effect size and test of Null (2-Tail) with 95% confidence interval (CI). Clinical and in vitro studies were selected and analyzed separately. RESULTS: A total of 15 articles out of 358 were selected. For clinical studies, quantitative analysis with a sample of 25 participants showed a mean discrepancy between occlusal rests and rest seats of 184.91 µm (95% CI: 152.6 µm-217.15 µm) and heterogeneity (I2) of 0%. Clinical data considered that frameworks were acceptable for continuity of treatment. The predominant materials were cobalt-chromium (Co-Cr) and polyetheretherketone (PEEK), and studies using Co-Cr reported that the structure required adjustments. In addition, it has been reported that the indirect technique was time-consuming and selective laser melting (SLM) can be costly. PEEK structures have been more widely accepted because of improved esthetics. Quantitative data from the in vitro studies revealed that the additive manufacturing technique (2.006 mm: 95% CI: -2.021 mm to 6.032 mm) was not significantly different from the indirect technique (0.026 mm; P=.455; random: I2: 98.402%). CONCLUSIONS: Clinical studies and in vitro research on CAD-CAM planning and manufacturing of removable prosthesis frameworks are still sparse. However, preliminary data indicate a similar fit and esthetic improvement when compared with the conventional technique.

Surgical restoration of interocclusal space and maxillary sinus floor elevation for prosthetic purposes: a case report / Reestabelecimento cirúrgico do espaço interoclusal e levantamento do assoalho do seio maxilar para fins protéticos: relato de caso

Aim: To report on a surgical procedure with osteotomy in the posterior region of the maxilla and lifting of the maxillary sinus floor for the installation of implants and rehabilitation with implant-supported crowns. Case report: A 54-year-old female patient was admitted to the dental clinic, complaining that she was dissatisfied with her smile and the missing teeth. After the clinical, radiographic, and tomographic examinations, a well as a case study of a semi-adjustable articulator, multidisciplinary planning was carried out using surgical, endodontic, periodontic, orthodontic, and prosthetic approaches. A lack of interocclusal space was observed in the posterior region of the maxilla. After osteotomy in tuberosity, maxillary sinus lift using an autogenous bone graft was performed, and three implants were installed. After the osseointegration period, provisional crowns were placed, followed by definitive metal-ceramic crowns. Conclusion:The surgical techniques used in this clinical case made it possible to install implants in a single clinical session for prosthetic rehabilitation.

Introdução: A reabilitação oral envolve um tratamento integrado, que inclui diversas especialidades odontológicas para restabelecer os aspectos estéticos e funcionais, resultando também na satisfação do paciente. Objetivo: O objetivo foi relatar um procedimento cirúrgico com osteotomia na região posterior da maxila e levantamento do assoalho do seio maxilar para instalação de implantes e reabilitação com coroas implantossuportadas. Relato de caso: Paciente do sexo feminino, 54 anos, apresentou-se ao ambulatório queixando-se de insatisfação com o sorriso e com a falta de dentes. Após os exames clínicos, radiográficos, tomográficos e estudo de caso em articulador semi-ajustável, foi realizado o planejamento multidisciplinar com abordagens cirúrgica, endodôntica, periodontal, ortodôntica e protética. Observou-se falta de espaço interoclusal na região posterior da maxila. Após a osteotomia na tuberosidade, foi realizada a elevação do seio maxilar com enxerto ósseo autógeno e foram instalados três implantes. Posteriormente, no período de osseointegração, foram colocadas coroas provisórias e, posteriormente, coroas metalocerâmicas definitivas. Conclusão: As técnicas cirúrgicas utilizadas neste caso clínico possibilitaram a instalação de implantes em uma única sessão clínica para a reabilitação protética.

Nanoparticle-modified PMMA to prevent denture stomatitis: a systematic review.

This systematic review aimed to evaluate the antifungal effectiveness of polymethylmetacrylate (PMMA) modified by nanoparticles (NPs) and to compare it with conventional acrylic resins for denture bases. The present study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Searches were performed using PubMed, SCOPUS, SciELO, EMBASE, and LILACS. Eligibility criteria were as recommended by PRISMA. The studies presented great variability regarding NP type, synthesis method, antifungal evaluation method, and antifungal effect. The most commonly used NPs were silver (AgNP) and zinc oxide (ZnONP), ranging in size from 10 to 100 nm. The incorporation methods were mechanical or agitated. Despite PMMA modification by ZnONP being shown in vitro to be a combination with the best antifungal effect, future studies are still needed to determine the minimum inhibitory concentration for Candida spp. and assess its biocompatibility before the protocol is clinically tested.

Fibrin Biopolymer Incorporated with Antimicrobial Agents: A Proposal for Coating Denture Bases.

The characteristics of the denture base surface, in combination with the oral environment, promote the colonization and development of Candida albicans biofilm, which is the main cause of denture stomatitis. This study evaluated the effectiveness of fibrin biopolymer with digluconate chlorhexidine or Punica granatum alcoholic extract to prevent C. albicans biofilm. Conventional heat polymerized and pre-polymerized poly(methyl methacrylate) (PMMA) circular specimens (10 × 2 mm) were fabricated (n = 504) and randomly divided into groups: no treatment (control-CT), fibrin biopolymer coating (FB), fibrin biopolymer with P. granatum (FBPg), or digluconate of chlorhexidine (FBCh) coating. The specimens were inoculated with C. albicans SC5314 (1 × 107 cells/mL) and incubated for 24, 48, and 72 h. Crystal violet and colony-forming unit assays were used to quantify the total biofilm biomass and biofilm-living cells. A qualitative analysis was performed using confocal laser scanning microscopy. Data obtained are expressed as means and standard deviations and were statistically analyzed using a three-way analysis of variance (α = 0.05). The FBPg and FBCh groups inhibited the growth of C. albicans biofilm in both PMMA materials analyzed, with FBCh performing better in all periods evaluated (p < 0.0001). The colony forming unit (CFU) assay showed that the FB group favored the C. albicans biofilm growth at 24 h and 48 h (p < 0.0001), with no differences with CT group at 72 h (p = 0.790). All groups showed an enhancement in biofilm development up to 72 h (p < 0.0001), except the FBCh group (p = 0.100). No statistical differences were found between the PMMA base materials (p > 0.050), except in the FB group (p < 0.0001). Fibrin biopolymer, albeit a scaffold for the growth of C. albicans, when combined with chlorhexidine digluconate or P. granatum, demonstrated excellent performance as a drug delivery system, preventing and controlling the formation of denture biofilm.