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1.
J Oral Rehabil ; 2020 Feb 20.
Artigo em Inglês | MEDLINE | ID: mdl-32077514

RESUMO

BACKGROUND AND OBJECTIVE: The aim of this single-center, two-arm, parallel-group, double-blinded, randomized controlled trial was to investigate the disputed specific effectiveness of acupuncture by comparing acupuncture on specific and non-specific points among patients with non-chronic, painful TMDs. METHODS: Following predefined eligibility criteria, 49 consecutive patients of both sexes were recruited to the study. All subjects were diagnosed with a non-chronic (Graded Chronic Pain Scale grade<3) painful TMD, as assessed using the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). Patients were randomly assigned to group A (acupuncture on specific points) or group B (acupuncture on non-specific points) after the initial examination (T0). Both acupuncture treatment sessions were conducted by a trained dentist once a week for four weeks. The examination was repeated five weeks (T5) after T0 by one calibrated examiner who was unaware of the study groups. Characteristic pain intensity (CPI) was evaluated as the main outcome criterion and compared between times and treatment groups by means of non-parametric tests (significance level set at p=0.05). Secondary outcomes comprised the maximum corrected active mouth-opening without pain (MAO); patients' expectations regarding acupuncture treatment and pain development; depressivity; and oral-health-related quality of life (OHRQoL). RESULTS: A total of 41 patients (38 female) successfully completed the study (mean age: 40.17 ±16.61). The two groups did not differ significantly at any time in terms of age and CPI. However, CPI was significantly (p<0.05) lower at T5 than at T0 for both groups (29.66 and 30.35% lower in group A and group B, respectively). An increase in MAO was observed at T5 for both groups but was significant for group B only (p=0.016). All patients had positive expectations of acupuncture therapy, and the two groups did not differ significantly at T5 with regard to the extent to which their expectations had been fulfilled by the treatment (p=0.717). Comparison of T0 and T5 showed a statistically significant reduction of depressivity for group A (p=0.0205), but no significant change for group B (p=0.329). At T5, OHRQoL had improved significantly for both groups (group A, p=0.018; group B, p<0.001) compared with at T0. CONCLUSIONS: Acupuncture on both specific and non-specific points reduces the non-dysfunctional pain of TMD patients. The effect of acupuncture on painful TMD cannot be attributed to the specific point selection.

2.
J Oral Rehabil ; 47(2): 164-169, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31430389

RESUMO

As yet, there are still no evidence-based clinical diagnostic and management guidelines for ambulatory single-channel EMG devices, like the BUTLER® GrindCare® (GrindCare), that are used in patients with sleep bruxism. Therefore, a consensus meeting was organised with GrindCare developers, researchers, and academic and non-academic clinicians experienced with the use of ambulatory EMG devices. The aim of the meeting was to discuss and develop recommendations for clinical guidelines for GrindCare usage, based on the existing clinical and research experience of the consensus meeting's participants. As an important outcome of the consensus meeting, clinical guidelines were proposed in which an initial 2-week baseline phase with the device in its inactive (non-stimulus) mode for habituation and assessment of the number of jaw-muscle activities is followed by a 4-week active phase with contingent electrical stimuli suppressing the jaw-muscle activities. As to avoid the commonly reported reduction in sensitivity to the stimuli, a 2-week inactive phase is subsequently installed, followed by a repetition of active and inactive phases until a lasting reduction in the number of jaw-muscle activities and/or associated complaints has been achieved. This proposal has the characteristics of a single-patient clinical trial. From a research point of view, adoption of this approach by large numbers of GrindCare users creates a great opportunity to recruit relatively large numbers of study participants that follow the same protocol.


Assuntos
Bruxismo , Terapia por Estimulação Elétrica , Bruxismo do Sono , Consenso , Estimulação Elétrica , Eletromiografia , Humanos
3.
Am J Orthod Dentofacial Orthop ; 156(4): 442-452.e12, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31582116

RESUMO

INTRODUCTION: This study evaluated and compared the completeness of reporting of abstracts of orthodontics systematic reviews before and after the publication of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for Abstracts Checklist (PRISMA-A). METHODS: Abstracts of systematic reviews and meta-analyses in orthodontics published in PubMed, Latin American and Caribbean Health Sciences Literature, and the Cochrane Database of Systematic Reviews databases before March 23, 2018, that met the predefined inclusion and exclusion criteria, were evaluated using the 12 items of PRISMA-A, scoring each item from 0 to 2. Abstracts were classified into 2 groups: before and after publication of the PRISMA-A checklist. Three calibrated evaluators (intraclass correlation coefficient and kappa > 0.8) assessed the scores for compliance with the checklist. The number of authors, country of affiliation of the first author, performance of meta-analysis, and topic of the article were recorded. A regression analysis was performed to assess the associations between abstract characteristics and the PRISMA-A scores. RESULTS: Of 1034 abstracts evaluated, 389 were included in the analysis. The mean PRISMA-A score was 53.39 (95% CI, 51.83-54.96). The overall score for studies published after the publication of the checklist was significantly higher than for studies published before (P ≤ 0.0001). The components returning significantly higher scores after publication of PRISMA-A were title (P = 0.024), information from databases (P = 0.026), risk of bias (P ≤ 0.0001), included studies (P ≤ 0.0001), synthesis of results (P ≤ 0.0001), interpretation of results (P = 0.035), financing and conflict of interest (P ≤ 0.0001), and registration (P ≤ 0.0001). These results showed the positive effect of PRISMA-A had on the quality of reporting of orthodontics systematic reviews. Nevertheless, the poor adherence revealed that there is still need for improvement in the quality of abstract reporting. CONCLUSIONS: The quality of reporting of abstracts of orthodontic systematic reviews and meta-analyses increased after the introduction of PRISMA-A.


Assuntos
Medicina Baseada em Evidências/normas , Ortodontia/normas , Publicações Periódicas como Assunto/normas , Editoração/normas , Revisão Sistemática como Assunto , Bibliometria , Lista de Checagem , Humanos , Controle de Qualidade
4.
J Oral Facial Pain Headache ; 33(4): 389­398, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31247061

RESUMO

AIMS: To investigate whether an international consensus exists among TMD experts regarding indications, performance, follow-up, and effectiveness of jaw exercises. METHODS: A questionnaire with 31 statements regarding jaw exercises was constructed. Fourteen international experts with some geographic dispersion were asked to participate in this Delphi study, and all accepted. The experts were asked to respond to the statements according to a 5-item verbal Likert scale that ranged from "strongly agree" to "strongly disagree." The experts could also leave free-text comments, which was encouraged. After the first round, the experts received a compilation of the other experts' earlier responses. Some statements were then rephrased and divided to clarify the essence of the statement. Subsequently, the experts were then asked to answer the questionnaire (32 statements) again for the second round. Consensus was set to 80% agreement or disagreement. RESULTS: There is consensus among TMD experts that jaw exercises are effective and can be recommended to patients with myalgia in the jaw muscles, restricted mouth opening capacity due to hyperactivity in the jaw closing muscles, and disc displacement without reduction. The patients should always be instructed in an individualized jaw exercise program and also receive both verbal advice and written information about the treatment modality. CONCLUSION: This Delphi study showed that there is an international consensus among TMD experts that jaw exercises are an effective treatment and can be recommended to patients with TMD pain and disturbed jaw function.


Assuntos
Transtornos da Articulação Temporomandibular , Consenso , Técnica Delfos , Terapia por Exercício , Humanos , Mialgia
5.
Clin Oral Investig ; 22(6): 2309-2317, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29484547

RESUMO

OBJECTIVE: The aim of this study was to observe the adaptation strategy of the stomatognathic system during the adaptation of complete dentures, comprising masticatory parameters and subjective measures. Our hypothesis was that with new dentures, masticatory performance would increase while the effort of the system is kept constant. MATERIAL AND METHODS: Thirty-two patients received standardized new complete dentures. Masticatory performance tests were conducted with old dentures (T1), immediately after incorporation of new dentures (T2) and after an adaptation period of 3 months (T3). Patients habitually chewed the silicone-based artificial test food Optocal. The comminuted test food was analyzed and mean particle sizes (x50) were calculated. Simultaneously, surface EMGs of the anterior temporalis and masseter muscles were recorded. Specific (SMW) and total muscle work (TMW) were determined. Patients filled in the OHIP-49 questionnaire. Test conditions were compared using repeated-measures ANOVA with SPSS 22 (SPSS Inc.) RESULTS: Masticatory performance increased (P = 0.016) between old (x50 = 4.99 ± 0.28) and adapted new dentures (x50 = 4.80 ± 0.33). TMW deteriorated (P = 0.004) at T2 (from TMW1 = 119.77 ± 56.49 to TMW2 = 92.12 46.27), and increased again (P = 0.028) at T3 (TMW3 = 107.66 ± 44.65). OHIP scores decreased significantly in all subscales (P < 0.001…P = 0.046); the total score was reduced (P < 0.001) from 56.24 ± 29.05 (T1) to 34.66 ± 24.74 (T3). CONCLUSION: In complete denture wearers, masticatory performance improves over an adaptation period. Muscle work initially decreased before reaching its original level again after adaptation. Subjective parameters overestimated the functional improvements. CLINICAL SIGNIFICANCE: The subjective evaluation does not adequately reflect functional improvements. The assessment of function requires an adaptation period.


Assuntos
Adaptação Fisiológica , Prótese Total , Arcada Edêntula/reabilitação , Mastigação/fisiologia , Sistema Estomatognático/fisiologia , Idoso , Idoso de 80 Anos ou mais , Eletromiografia , Feminino , Humanos , Masculino , Mandíbula , Pessoa de Meia-Idade
6.
Arch Oral Biol ; 86: 87-93, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29202311

RESUMO

OBJECTIVE: Bruxism is discussed as an etiological factor in the pathogenesis of orofacial and cervical pain. As the sternocleidomastoid muscle (SCM) is co-activated during clenching, our aim was to investigate, whether the muscle loading leads to peripheral or central sensitizations. DESIGN: In twenty-one healthy female volunteers, somatosensory profiles of the SCM were recorded according to the test battery of the German Research Network on Neuropathic Pain (DFNS) prior to and after an isometric muscle exercise. QST comprised thermal and mechanical stimuli. A submaximal activation of the SCM (15% MVC) was kept for 10min in sitting position. In separate test sessions one month apart, one sham and one verum experiment were conducted in randomized order. During the muscle loading, the parameters cold detection threshold (CDT), mechanical pain sensitivity (MPS) and pressure pain treshold (PPT) were tested and experimental pain recorded by visual analogoue scales (VAS). All test sessions were performed during the follicular phase of the menstrual cycle (day 5), to avoid effects on pain perception. Data were analyzed with Repeated Measures ANOVA (SPSS 22.0) RESULTS: No significant changes were found during or after (sham) loading except for stimulus-response-function (SR, P=0.01) and PPT (P=0.02) in the sham test. No effect was observed in the verum experiment (P=0.12 up to 1.0). CONCLUSION: Prolonged low level contraction of the SCM does not evoke painful sensitization. In contrast, submaximal muscle activation seems to have a protective effect corresponding to a training effect preventing sensitization.


Assuntos
Bruxismo/fisiopatologia , Dor Facial/fisiopatologia , Músculos do Pescoço/fisiopatologia , Adulto , Feminino , Humanos , Contração Muscular/fisiologia , Medição da Dor , Limiar da Dor/fisiologia
7.
J Evid Based Dent Pract ; 17(3): 177-183, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28865814

RESUMO

OBJECTIVE: Shared decision-making involves the participation of patient and dental practitioner. Well-informed decision-making requires that both parties understand important concepts that may influence the decision. This fourth article in a series of 4 aims to discuss the importance of patients' values when a clinical decision is made. METHODS: We report on how to incorporate important concepts for well-informed, shared decision-making. Here, we present patient values as an important issue, in addition to previously established topics such as the risk of bias of a study, cost-effectiveness of treatment approaches, and a comparison of therapeutic benefit with potential side effects. RESULTS: We provide 2 clinical examples and suggestions for a decision tree, based on the available evidence. CONCLUSION: The information reported in this article may improve the relationship between patient and dental practitioner, resulting in more well-informed clinical decisions.


Assuntos
Tomada de Decisão Clínica , Participação do Paciente , Tomada de Decisões , Humanos
8.
Clin Implant Dent Relat Res ; 19(4): 643-653, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28440024

RESUMO

BACKGROUND: Prosthetic management of thin alveolar ridges in the edentulous mandibles of elderly patients, especially the time of loading, the number of implants needed, and patient expectations and perception, is a challenge in implant dentistry. PURPOSE: Survival of conventionally and immediately loaded 2-piece reduced-diameter implants in the interforaminal region of the edentulous mandible supporting locator-analog attachments was evaluated. Prosthetic complications and peri-implant hygiene were also studied, and patient expectation and subjective evaluation of the treatment were documented. MATERIAL AND METHODS: Twenty-five patients with adapted complete dentures received 4 reduced-diameter implants. All anterior implants were immediately loaded. Three months later, patients were allocated by randomization to 1 of 2 treatment groups: 2 locator-analog attachments on the anterior implants (Group A); or 4 locator-analog attachments (Group B). After another 3 months patient allocation was changed (crossover design) for the next 3 months. Questionnaires with Likert scales and numeric rating scales were used to assess patients' expectations and subjective overdenture-related variables, respectively. RESULTS: One implant was lost in the immediate-loading group. Survival was 98% and 100% for immediate and delayed loading, respectively. During 12-month observation, 8 complications required aftercare. At the beginning of treatment, patients' expectations were highly positive. Subjective assessment of overdenture-related variables 3 months after immediate loading of 2 implants revealed a statistically significant improvement for most of the variables studied; this was maintained 1 year later. In the subjective assessments, there were no statistically significant differences between Groups A and B. CONCLUSION: Immediate loading of reduced-diameter implants supporting locator-analog attachments resulted in high implant survival, few prosthetic complications, good oral hygiene, and improvement of subjective denture perception in the short-term. It might be a promising treatment option, especially for elderly patients with a narrow mandibular ridge.


Assuntos
Implantação Dentária Endo-Óssea/métodos , Carga Imediata em Implante Dentário/métodos , Arcada Edêntula/cirurgia , Idoso , Implantação Dentária Endo-Óssea/instrumentação , Implantes Dentários , Prótese Dentária Fixada por Implante , Prótese Total , Feminino , Humanos , Carga Imediata em Implante Dentário/instrumentação , Masculino , Mandíbula , Satisfação do Paciente , Resultado do Tratamento
9.
PLoS One ; 12(3): e0173437, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28253347

RESUMO

[This corrects the article DOI: 10.1371/journal.pone.0170262.].

10.
PLoS One ; 12(1): e0170262, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28107405

RESUMO

BACKGROUND: Consensus guidelines are useful to improve clinical decision making. Therefore, the methodological evaluation of these guidelines is of paramount importance. Low quality information may guide to inadequate or harmful clinical decisions. OBJECTIVE: To evaluate the methodological quality of consensus guidelines published in implant dentistry using a validated methodological instrument. METHODS: The six implant dentistry journals with impact factors were scrutinised for consensus guidelines related to implant dentistry. Two assessors independently selected consensus guidelines, and four assessors independently evaluated their methodological quality using the Appraisal of Guidelines for Research & Evaluation (AGREE) II instrument. Disagreements in the selection and evaluation of guidelines were resolved by consensus. First, the consensus guidelines were analysed alone. Then, systematic reviews conducted to support the guidelines were included in the analysis. Non-parametric statistics for dependent variables (Wilcoxon signed rank test) was used to compare both groups. RESULTS: Of 258 initially retrieved articles, 27 consensus guidelines were selected. Median scores in four domains (applicability, rigour of development, stakeholder involvement, and editorial independence), expressed as percentages of maximum possible domain scores, were below 50% (median, 26%, 30.70%, 41.70%, and 41.70%, respectively). The consensus guidelines and consensus guidelines + systematic reviews data sets could be compared for 19 guidelines, and the results showed significant improvements in all domain scores (p < 0.05). CONCLUSIONS: Methodological improvement of consensus guidelines published in major implant dentistry journals is needed. The findings of the present study may help researchers to better develop consensus guidelines in implant dentistry, which will improve the quality and trust of information needed to make proper clinical decisions.


Assuntos
Consenso , Implantes Dentários , Odontologia , Guias de Prática Clínica como Assunto , Humanos
11.
Clin Oral Implants Res ; 28(5): 529-534, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-27001374

RESUMO

OBJECTIVES: The purpose of this study was to investigate the adaptation behavior of the stomatognathic system after immediate loading (24 to 72 h after surgery) of two implants supporting mandibular overdentures, assessed on insertion and three months later. The study hypothesis was that insertion of the overdentures would significantly change masticatory performance and muscle activity at both times. MATERIAL AND METHODS: Thirty subjects (nine female, mean age 69.64 ± 11.81 years; 21 male, mean age 68.67 ± 7.41 years) who participated in a randomized clinical trial were included in the study. Each patient was examined three times: (i) at baseline, after already having worn new dentures for three months (T1); (ii) immediately after insertion of the overdentures on the implants (T2); and (iii) after an adaptation period of three months (T3). Examination comprised assessment of masticatory performance with artificial test food (Optocal), and simultaneous bilateral surface EMG recording of the masseter and anterior temporalis muscles. Particle-size distribution (representative value X50 ), maximum muscle contraction (MVC), and total muscle work (TMW; area under the curve) were compared by use of repeated-measures analysis of variance (ANOVA). RESULTS: At T3, all measured variables (i.e., masticatory performance and muscle activity) were significantly different from those at T1. At T2, no significant changes were observed. The study hypothesis had to be rejected for T2 but accepted for T3. CONCLUSION: Functional rehabilitation (in terms of masticatory performance and masticatory muscle activity) does not occur immediately after immediate loading of two implants with mandibular overdentures, but requires a significant time for functional improvement.


Assuntos
Prótese Dentária Fixada por Implante , Revestimento de Dentadura , Mastigação , Adaptação Fisiológica , Idoso , Prótese Dentária Fixada por Implante/efeitos adversos , Revestimento de Dentadura/efeitos adversos , Músculos Faciais/fisiologia , Feminino , Humanos , Masculino , Mandíbula , Mastigação/fisiologia , Fatores de Tempo
12.
Clin Implant Dent Relat Res ; 18(4): 752-61, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25950679

RESUMO

PURPOSE: The study aims to evaluate survival and incidence of complications for pairs of implants placed in the front region of edentulous mandibles and immediately loaded with either bar or Locator attachments. MATERIALS AND METHODS: Forty-six patients with edentulous mandibles (mean age 69.4 years at inclusion in the study; 73.9% male) received two implants in the interforaminal area of the symphysis. Dolder bar or Locator attachments, allocated randomly, were then attached immediately, and both clips and a framework were fastened to the denture by the dental technician within 72 hours. RESULTS: During the first 3 months of the 2-year period of observation, eight implants in five patients were lost, and were removed. Survival was 89.1% and 93.5% for the bar and Locator groups, respectively. During the entire period of observation, 38 prosthetic complications required aftercare. Five dentures had to be removed or reworked after implant failure, but no superstructure was lost or had to be remade for prosthetic reasons. Survival of the original dentures was 93.5% and 95.7% for the bar and Locator groups, respectively. CONCLUSION: Within the limitations of this study, results from immediate loading of two implants in the edentulous mandible with either Locator or bar attachments hardly differed. Prosthetic complications and aftercare measures in the Locator group were frequent but easy to handle. Ease of repair and cleaning, in particular, might be reasons for choosing the single-attachment system.


Assuntos
Implantes Dentários/efeitos adversos , Prótese Dentária Fixada por Implante , Revestimento de Dentadura , Carga Imediata em Implante Dentário , Arcada Edêntula/cirurgia , Idoso , Reabsorção Óssea , Planejamento de Prótese Dentária , Falha de Restauração Dentária , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Mandíbula , Estudos Prospectivos
13.
J Oral Maxillofac Surg ; 73(7): 1254-8, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25971920

RESUMO

PURPOSE: To prospectively compare changes of body temperature, white blood cell count, fibrinogen, and C-reactive protein between odontogenic infections in which the responsible tooth was removed and odontogenic infections in which the treatment included no extraction. MATERIALS AND METHODS: The sample was composed of patients admitted to the authors' maxillofacial unit for odontogenic infection from 2010 through 2013. One hundred seventy-nine patients were categorized into an extraction or a non-extraction group based on whether the causative tooth was non-restorable or restorable, respectively. Non-restorable teeth were extracted at admission of the patient. Otherwise, the treatment protocol, including incision of the involved space in conjunction with intravenous antibiotics, was the same for the 2 groups. The parameters were measured and recorded at admission and 2 days later. Data records were statistically analyzed by comparing the change of the parameters studied between the extraction and non-extraction groups. P values less than .05 were regarded as statistically significant. RESULTS: One hundred seventy-nine patients fulfilled the inclusion criteria and were enrolled in the study. The mean age of the patients was 39.1 years (minimum, 14 yr; maximum, 81 yr; standard deviation, 15.4 yr). One hundred nine patients (60.9%) were male, and 70 (39.1%) were female. Differences in the mean decrease of axillary temperature, white blood cell count, fibrinogven, and C-reactive protein between the 2 groups were 0.178, 2,300, 1.01, and 0.64, respectively. All these differences were statistically significant (P =.02, .001, .001, and .001, respectively). Also, the mean hospital stay in the extraction group was 1.05 days shorter than in the non-extraction group, with the difference being statistically significant (P = .006). CONCLUSIONS: In odontogenic maxillofacial infections, extraction of the causative tooth is associated with a faster clinical and biological resolution of the infection.


Assuntos
Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Odontopatias/microbiologia , Extração Dentária , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Temperatura Corporal/fisiologia , Proteína C-Reativa/análise , Cárie Dentária/cirurgia , Feminino , Fibrinogênio/análise , Seguimentos , Infecções por Bactérias Gram-Positivas/cirurgia , Humanos , Tempo de Internação , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Pericoronite/cirurgia , Estudos Prospectivos , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/cirurgia , Infecções Estreptocócicas/tratamento farmacológico , Infecções Estreptocócicas/cirurgia , Odontopatias/tratamento farmacológico , Odontopatias/cirurgia , Fraturas dos Dentes/cirurgia , Mobilidade Dentária/cirurgia , Raiz Dentária/lesões , Adulto Jovem
14.
Clin Oral Investig ; 19(2): 429-36, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25078549

RESUMO

OBJECTIVES: Standard procedure for the measurement of masticatory performance is the fractionated sieving of fragmented test food, which is substantially time consuming. The aim of this study was to introduce a less laborious, comparable, and valid technique based on scanning. METHODS: Fifty-six Optocal chewing samples were minced by wearers of complete dentures with 15 and 40 chewing strokes and analyzed by both a sieving and a scanning method. The sieving procedure was carried out using ten sieves (5.6, 4.0, 2.8, 2.0, 1.4, 1.0, 0.71, 0.5, 0.355, and 0.25 mm) and measuring the weight of the specific fractions. Scanning was performed with a flatbed scanner (Epson Expression1600Pro, Seiko Epson Corporation, Japan, 1,200 dpi). Scanned images underwent image analysis (ImageJ 1.42q, NIH, USA), which yielded descriptive parameters for each particle. Out of the 2D image, a volume was estimated for each particle. In order to receive a discrete particle size distribution, area-volume-conversion factors were determined. The cumulated weights yielded by either method were curve fitted with the Rosin-Rammler distribution (MATLAB, The MathWorks, Inc., Natick, USA) to determine the median particle size X 50. RESULTS: The Rosin-Rammler distributions for sieving and scanning resembled each other and showed an excellent correlation in 15/40 chewing strokes (r = 0.995/r = 0.971, P < 0.01, Pearson's correlation coefficient). The median particle sizes varied between 4.77/3.04 and 5.36/5.28 mm (mean 5.07/4.67) for scanning and 4.69/2.39 and 5.23/5.43 mm (mean 5.03/4.57) for sieving. On average, scanning overestimated the X 50 values by 1/2.4 %. The scanning method took 10 min per sample in contrast to 50 min for sieving. CONCLUSION: Optical scanning is a valid method comparable to sieving. CLINICAL RELEVANCE: The described method is feasible and appropriate for the measurement of masticatory performance of denture wearers.


Assuntos
Prótese Total , Mastigação , Humanos , Tamanho da Partícula
15.
Clin Implant Dent Relat Res ; 17(4): 629-38, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24215715

RESUMO

OBJECTIVE: The study aims to evaluate survival and the incidence of complications for pairs of implants placed in the frontal area of edentulous mandibles and immediately loaded with either bar or Locator® (Zest Anchors LLC, Escondido, CA, USA) attachments. MATERIAL AND METHODS: Forty-six patients (mean age 69.4 years; 73.9% male) with edentulous mandibles each received two immediately loaded implants in the interforaminal area of the symphysis. Immediately after implant placement, Dolder® bar (Sub-Tec Wirobond; BEGO Implant Systems GmbH & Co. KG, Bremen, Germany) or Locator® attachments, allocated randomly, were attached, and both clips and a framework were incorporated into the denture by the dental technician. The implants were loaded within 72 hours. RESULTS: During a mean observation period of 6 months (maximum 24 months, SD 0.43) eight implants in five patients were lost. Survival was 93.5% for the Locator® group and 89.1% for the bar group. Estimated cumulative survival after 1 year of function was 93.4% for the Locator® group and 87.1% for the bar group. During the observation period, 12 prosthetic complications required aftercare. No superstructure was lost or had to be remade for prosthetic reasons, but five dentures had to be removed or reworked after implant failure. Survival of the original dentures was, therefore, 95.7% for the Locator® group and 93.5% for the bar group. CONCLUSION: Within the limitations of this study, immediate loading of two implants in the edentulous mandible with either Locator® or bar attachments did hardly differ. Ease of repair and cleaning, in particular, might be arguments for choosing the single attachment system.


Assuntos
Implantes Dentários , Mandíbula/cirurgia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
16.
BMC Oral Health ; 14: 105, 2014 Aug 18.
Artigo em Inglês | MEDLINE | ID: mdl-25135370

RESUMO

BACKGROUND: The purpose of the present study was to assess the value for money achieved by bar-retained implant overdentures based on six implants compared with four implants as treatment alternatives for the edentulous maxilla. METHODS: A Markov decision tree model was constructed and populated with parameter estimates for implant and denture failure as well as patient-centred health outcomes as available from recent literature. The decision scenario was modelled within a ten year time horizon and relied on cost reimbursement regulations of the German health care system. The cost-effectiveness threshold was identified above which the six-implant solution is preferable over the four-implant solution. Uncertainties regarding input parameters were incorporated via one-way and probabilistic sensitivity analysis based on Monte-Carlo simulation. RESULTS: Within a base case scenario of average treatment complexity, the cost-effectiveness threshold was identified to be 17,564 € per year of denture satisfaction gained above of which the alternative with six implants is preferable over treatment including four implants. Sensitivity analysis yielded that, depending on the specification of model input parameters such as patients' denture satisfaction, the respective cost-effectiveness threshold varies substantially. CONCLUSIONS: The results of the present study suggest that bar-retained maxillary overdentures based on six implants provide better patient satisfaction than bar-retained overdentures based on four implants but are considerably more expensive. Final judgements about value for money require more comprehensive clinical evidence including patient-centred health outcomes.


Assuntos
Implantes Dentários/economia , Prótese Dentária Fixada por Implante/economia , Prótese Total Superior/economia , Revestimento de Dentadura/economia , Arcada Edêntula/cirurgia , Maxila/cirurgia , Análise Custo-Benefício , Árvores de Decisões , Implantes Dentários/psicologia , Prótese Dentária Fixada por Implante/psicologia , Falha de Restauração Dentária/economia , Retenção de Dentadura/economia , Retenção de Dentadura/instrumentação , Prótese Total Superior/psicologia , Revestimento de Dentadura/psicologia , Humanos , Cadeias de Markov , Modelos Econômicos , Método de Monte Carlo , Planejamento de Assistência ao Paciente/economia , Preferência do Paciente/economia , Satisfação do Paciente/economia , Probabilidade , Resultado do Tratamento
17.
J Clin Periodontol ; 40(5): 542-52, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-23557434

RESUMO

OBJECTIVE: To perform a systematic critical appraisal of the methodological quality of systematic reviews on the effect of a history of periodontitis on dental implant loss. MATERIALS & METHODS: PubMed, the Cochrane database for systematic reviews, the DARE, Biosis Preview, CINAHL, Web of Science, and LILACS electronic databases were searched on 16th June 2012, independently and in duplicate, for systematic reviews and meta-analyses related to dental implants for patients with and without a history of periodontitis. Manual searching of the reference lists of included papers was also conducted. The methodological quality of these systematic reviews was assessed by use of the AMSTAR and R-AMSTAR checklists. Before quality assessment was initiated, the reviewers were calibrated until they achieved excellent agreement. RESULTS: Sixty-eight papers were initially retrieved. Of these, nine systematic reviews and three meta-analyses were included. Some domains, for example, "characteristics of the included studies" were satisfied in both checklists. In contrast, domains such as "comprehensive literature search" and "assessment of likelihood of publication bias" were rarely met. CONCLUSION: Much methodological variability was encountered in the selected reviews. To furnish readers with a more comprehensive assessment of the evidence, authors should observe higher standards when conducting and reporting their reviews.


Assuntos
Implantes Dentários , Falha de Restauração Dentária , Periodontite/complicações , Lista de Checagem , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto/normas , Projetos de Pesquisa/normas , Análise de Sobrevida , Resultado do Tratamento
18.
J Orofac Pain ; 27(1): 61-71, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23424721

RESUMO

AIMS: To test the hypothesis that jaw muscles and specific neck muscles, ie, levator scapulae, trapezius, sternocleidomastoideus, and splenius capitis, co-contract at the different submaximum bite forces usually generated during jaw clenching and tooth grinding, and for different bite force directions. METHODS: Bite-force transducers that measured all three spatial force components were incorporated in 11 healthy subjects. The test persons developed feedback-controlled submaximum bite forces in a variety of bite-force directions. The electromyographic (EMG) activity of the levator scapulae, splenius capitis, and trapezius muscles was recorded, at the level of the fifth cervical vertebra, by use of intramuscular wire electrodes. The activity of the sternocleidomastoideus and masseter muscles was recorded by surface electrodes. For normalization of the EMG data, maximum-effort tasks of the neck muscles were conducted in eight different loading directions by means of a special force-transducer system. Differences between neck-muscle activity during chewing, maximum biting in intercuspation, and the force-controlled motor tasks were compared with the baseline activity of the various muscles by one-way repeated-measures analysis of variance. RESULTS: The results confirmed the hypothesis. Co-contractions of the neck muscles in the range of 3% to 10% of maximum voluntary contraction were observed. Significant (P < .05) activity differences were recorded as a result of the different force levels and force directions exerted by the jaw muscles. Long-lasting action potential trains of single motor units triggered by jaw clenching tasks were also detected. CONCLUSION: The findings support the assumption of a relationship between jaw clenching and the neck muscle activity investigated. The low level of co-contraction activity, however, requires further study to elucidate possible pathophysiological interactions at the level of single motor units.


Assuntos
Músculos da Mastigação/fisiologia , Contração Muscular/fisiologia , Músculos do Pescoço/fisiologia , Junção Neuromuscular/fisiologia , Potenciais de Ação/fisiologia , Força de Mordida , Eletrodos Implantados , Eletromiografia/instrumentação , Retroalimentação , Feminino , Humanos , Masculino , Músculo Masseter/fisiologia , Mastigação/fisiologia , Neurônios Motores/fisiologia , Transdutores , Adulto Jovem
19.
J Periodontol ; 83(10): 1251-6, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-22220771

RESUMO

BACKGROUND: Most readers, reviewers, and editors rely on abstracts to decide whether to assess the full text of an article. A research abstract should, therefore, be as informative as possible. The standard of reporting in abstracts of randomized controlled trials (RCTs) in periodontology and implant dentistry has not yet been assessed. The objectives of this review are: 1) to assess the quality of reporting in abstracts of RCTs in periodontology and implant dentistry, and 2) to investigate changes in the quality of reporting by comparing samples from different periods. METHODS: The authors searched the PubMed electronic database, independently and in duplicate, for abstracts of RCTs published in seven leading journals of periodontology and implant dentistry from 2005 to 2007 and from 2009 to 2011. The quality of reporting in selected abstracts with reference to the CONSORT (Consolidated Standards of Reporting Trials) for Abstracts checklist published in January 2008 was assessed independently and in duplicate. Cohen κ statistic was used to determine the extent of agreement of the reviewers. Pearson χ(2) test and/or Fisher exact test were used to assess differences in reporting in the two samples. Level of significance was set at P <0.05. RESULTS: Three hundred ninety-two abstracts are included in this review. Three items (intervention, objective, and conclusions) were almost fully reported in both samples. In contrast, other items (randomization, trial registration, and funding) were never reported. There were significant changes in reporting for only two items, trial design and title (items better reported in the pre- and post-CONSORT samples, respectively). Most topics, however, were similarly poorly reported in both samples of abstracts. CONCLUSIONS: The quality of reporting in abstracts of RCTs in periodontology and implant dentistry can be improved. Authors should follow the CONSORT for Abstracts guidelines, and journal editors should promote clear rules to improve authors' adherence to these guidelines.


Assuntos
/normas , Implantação Dentária , Publicações Periódicas como Assunto , Periodontia , Ensaios Clínicos Controlados Aleatórios como Assunto , Relatório de Pesquisa/normas , Lista de Checagem , Distribuição de Qui-Quadrado , Políticas Editoriais , Fidelidade a Diretrizes , Humanos , Variações Dependentes do Observador , Projetos de Pesquisa
20.
Clin Oral Investig ; 16(3): 781-8, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-21594656

RESUMO

There are numerous scientific articles of studies on the prevalence of disorders with non-standardised examination and diagnostic protocols. Because their quality is heterogeneous, a new instrument has been developed for the assessment of such studies. The new instrument is based mainly on statistical criteria. The points assigned for each of the main criteria according to the information gained from each paper are summed up to form a Total Quality Score (TQS). The interrater reliability of the instrument was tested by employing Kappa and Interrater Correlation Coefficient (ICC) statistics. The latter was assessed on the results of three independent investigators. The new quality instrument appeared to be easy to use, and the instructions were comprehensible. The ICC((2,1)) for the TQS ranged between 0.94 and 1.00 indicating almost perfect agreement between the investigators. The reliability of the new instrument enables its use for scientific review purposes. In this way, its validity will also be tested. The instrument could be adopted for assessment of scientific articles of studies on the prevalence of disorders in many, similar, scientific areas.


Assuntos
Estudos Transversais/normas , Prevalência , Pesquisa Biomédica/normas , Lista de Checagem , Interpretação Estatística de Dados , Guias como Assunto , Humanos , Variações Dependentes do Observador , Pesquisa Qualitativa , Controle de Qualidade , Reprodutibilidade dos Testes , Projetos de Pesquisa/normas , Relatório de Pesquisa/normas
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