Full-Arch Rehabilitation With Mucosa-Supported Prostheses Utilizing a Digital Workflow: A Case Report.

The advent of digital workflows has revolutionized oral rehabilitation, offering excellent prosthesis and restoration adaptation while reducing work time. This case report aims to describe a full-arch rehabilitation protocol using mucosa-supported prostheses through a digital workflow. The technique begins with scanning the upper jaw and taking an impression of the lower jaw, followed by scanning to create a digital cast. Next, border molding and the final impression of both arches are performed using a closed-mouth technique, during which the patient is guided to perform lateral and protrusive movements. Subsequently, intraoral scanning of the occlusion and both impressions is conducted, leading to the design of the final dentures with the established occlusion. Finally, the dentures are printed in Formlabs resin specifically designed for dentures. The digital workflow facilitates the manufacturing of mucosa-supported full-arch prostheses effectively. This method allows for the adjustment of the vertical dimension of occlusion, ensures excellent adaptation of the prosthesis to the soft tissues, and provides aesthetic satisfaction for the patient. Additionally, it reduces the number of sessions required to install the definitive prosthesis.

Criteria for choosing prosthetic biomaterials according to their physicochemical properties for anterior and posterior sectors. a comprehensive review.

Objective: To describe the existing knowledge about metal-free prosthetic biomaterials according to their physicochemical properties and based on this, define criteria for their placement in both the anterior and posterior sectors. Materials and methods: A digital search was carried out in the databases: PubMed/Medline, Scopus, Web of Science and Google Scholar of the literature published in the English language without time restrictions and included original articles such as case reports, retrospective and prospective studies, narrative, comprehensive, systematic reviews and meta-analysis. Meanwhile, short communications, editorials and articles in a language other than English were excluded. Results: 40 articles were evaluated, published between 2000 and 2023. The main characteristics and physicochemical properties of ceramic biomaterials such as zirconia, feldspathic based ceramics, lithium disilicate and alumina, among others, were analyzed and summarized. In addition, certain criteria were defined based on the available scientific evidence on the use of different ceramic systems both in the anterior sector and in the posterior sector for patients who need some type of prosthetic restoration. Conclusions: Among the different metal-free materials used for the construction of fixed dental prostheses, zirconia has been shown to have better aesthetic, biomechanical and biocompatibility properties, which makes it a candidate material for the rehabilitation of partially edentulous patients.

Objetivo: Describir el conocimiento existente sobre los biomateriales protésicos libres de metal, según sus propiedades fisicoquímicas, y definir, con base en ello, criterios para su colocación tanto en el sector anterior como en el posterior. Materiales y métodos: Se realizó una búsqueda digital en las bases de datos PubMed/Medline, Scopus, Web of Science y Google Scholar de la literatura publicada en idioma inglés, sin restricciones de tiempo. Se incluyó artículos originales como reportes de casos, estudios retrospectivos y prospectivos, revisiones y metanálisis narrativos, exhaustivos y sistemáticos. Por otra parte, se excluyeron comunicaciones breves, editoriales y artículos en idioma distinto al inglés. Resultados: Se evaluaron 40 artículos, publicados entre 2000 y 2023. Se analizaron y resumieron las principales características y propiedades fisicoquímicas de biomateriales cerámicos, como circonia, cerámicas de base feldespática, disilicato de litio y alúmina, entre otros. Además, se definieron ciertos criterios basados en la evidencia científica disponible sobre el uso de diferentes sistemas cerámicos, tanto en el sector anterior como en el posterior, para pacientes que necesitan algún tipo de restauración protésica. Conclusiones: Entre los diferentes materiales libres de metales utilizados para la construcción de prótesis dentales fijas, la circonia ha demostrado tener mejores propiedades estéticas, biomecánicas y de biocompatibilidad, lo que la convierte en un material candidato para la rehabilitación del paciente parcialmente edéntulo.

Validation of the conceptual framework and intervention scope of oral function rehabilitation exercise.

OBJECTIVES: This study used a Delphi survey to define the concept of oral function rehabilitation exercise (OFRE) based on the International Classification of Functioning, Disability, and Health (ICF) and to categorise intervention domains for community-dwelling older adults. BACKGROUND: While numerous studies have been conducted to improve oral function through exercise interventions, the conceptual definition of oral exercise remains unclear and there is a lack of systematic categorisation of oral exercise intervention domains. METHODS: A preliminary model was developed based on the key findings of 19 papers selected from a prior systematic review. Its validity was confirmed through a Delphi survey conducted twice with eight expert panellists. Consensus was achieved by evaluating the validity of the OFRE conceptual framework, the accuracy of OFRE conceptual definitions, and intervention domains. RESULTS: Through expert consensus, an ICF-based OFRE conceptual framework was developed that includes 21 factors that affect the oral health status of the older adults. The OFRE intervention domain for improving the health status consisted of oral function rehabilitation warm-up exercise, masticatory function exercise, swallowing function exercise, articulatory function exercise, salivary function exercise, and oral function rehabilitation cool-down exercise, and 11 specific intervention methods were derived. CONCLUSIONS: The OFRE intervention can be used for planning and applying successful interventions to improve oral function and life function of older adults.

Oral-Health-Related Quality of Life in Elderly Edentulous Patients with Full-Arch Rehabilitation Treatments: A Systematic Review.

Background: The improvement of oral-health-related quality of life (OHRQoL) with different types of prosthesis for completely edentulous jaws in the elderly population is a critical factor in clinical decision making for these vulnerable patients. This review aims to evaluate the changes in OHRQoL after treatment with different types of full-arch prostheses in the elderly edentulous population to determine the prostheses that result in the greatest improvement in OHRQoL. Materials and Methods: Clinical studies of different types of full-arch prostheses that measured the OHRQoL in edentulous patients 60 years or older were searched for in the PubMed, Embase and Scopus electronic databases, with additional hand searching to summarize the outcomes of the selected studies. Result: Among the 302 identified studies, 10 studies were selected. A total of 504 patients wearing 133 complete dentures, 372 implant overdentures and 39 fixed prostheses were assessed among the selected studies. The overall OHIP and GOHAI scores were evaluated at baseline and in the 3rd, 6th, 12th and 18th months of treatment with the respective prostheses. The improved OHRQoL with overall OHIP scores associated with conventional dentures were 9.21-12.5% from the 3rd month to 1 year after treatment, whereas those associated with implant overdentures and full-arch fixed prosthesis were 9-25.26% at 1 year and 18.53-26.79 at the 18th-month follow-up, respectively. The increased overall GOHAI scores were 21.3-25.43% for conventional dentures, 36.82-41.32% for implant overdentures and 39.48-42.83% for full-arch fixed prosthesis from the 3rd month to the 6th-month follow-up. Conclusion: In general, the improvement in OHRQoL after rehabilitation with implant overdentures declined at one year, and that with full-arch fixed prosthesis declined at the 18th-month follow-up; meanwhile, the OHRQoL associated with conventional dentures improved stably up to one year, but the implant-supported prostheses resulted in an obviously greater improvement in the OHRQoL than that obtained with conventional dentures. However, studies with longer follow-up periods are still required to evaluate the long-term clinical effectiveness.

Contact point marking with the OccluSense system-an in vitro study on reliability and validity.

BACKGROUND: Occlusal contacts can be stained and thereby visualised employing occlusal indicators. Qualitative and quantitative indicators are differentiated. The hybrid system OccluSense supposedly combines analogue contact marking and digital registration of contacts. The reliability and validity of its contact marking have not yet been validated. OBJECTIVES: The aim of this controlled randomised in-vitro study was to examine the reliability and validity of analogue contact staining with OccluSense compared to Arti-Fol and the reference standard Gnatho-Film. MATERIALS AND METHODS: An experimental apparatus was designed to simulate static occlusion. The occlusal contacts were stained 50 times with Gnatho-Film to determine the average number and location of contacts registered. For comparison, the contacts were pre-stained with Gnatho-Film and then registered with Arti-Fol or OccluSense 50 times each. Every staining was statistically evaluated and compared to Gnatho-Film alone, regarding the number and location of contacts. Based on the observed characteristic staining behaviour of OccluSense, a modified evaluation strategy was developed for its colour markings (OccluSense (mod.)). RESULTS: Both evaluations of OccluSense determine that the same number of contacts was registered in over 94% of all cases. Neither OccluSense nor Arti-Fol stain the exact same number of contacts as Gnatho-Film, but the modified evaluation OccluSense (mod.) did improve the results for validity. CONCLUSION: When employing the modified evaluation strategy, OccluSense staining achieves similar reliability and validity as the reference standard. Pre-colouring of occlusal contacts with Gnatho-Film and the modified evaluation strategy, might become standard for analysing occlusal contacts stained by OccluSense in the future.

Prospective case series study on the survival rates of occlusal polymethyl methacrylate veneers as a semipermanent therapy in patients with severe pathologic tooth wear.

OBJECTIVES: To evaluate the survival rate of minimally invasive semipermanent occlusal polymethylmethacrylate (PMMA) onlays/veneers in previous temporomandibular disorder (TMD) patients with severe tooth wear and with a loss of vertical dimension after up to 7 years. METHOD AND MATERIALS: This case series was designed as a follow-up evaluation with consecutive patient recruitment. All patients bearing the indication for this kind of rehabilitation were treated by the same clinician using the same adhesive methodology. The study included 22 patients (3 males/19 females), with a mean [SD] age of 50.7 [11.6] years. Controls followed within the first 4 weeks (and subsequently as required). Failure criteria included damage by fracture, chipping, and retention loss. Survival rates were determined based on the Kaplan-Meier analysis. RESULTS: 328 semipermanent occlusal/incisal veneers were included (142 maxillary/186 mandibular teeth). Almost 80% of the restorations were in place and in function when starting the follow-up treatment after 180 days; failures predominantly occurred within the first 3 to 6 months but proved reparable. Depending on the patients' priorities, scheduled replacements followed successively, and more than 65% did not show repair or any renewal needs for more than 360 days. CONCLUSION: Within the limitations of this study the survival rates of occlusal veneers made of PMMA were sufficiently high to allow for consecutive treatment of the respective teeth by means of permanent restorations while preserving the restored vertical dimension. In patients with severe tooth wear and a TMD history, semipermanent restorative therapy with occlusal PMMA onlays/veneers would seem a noteworthy option.

Effectiveness of zygomatic-implant fixed rehabilitation for the atrophic edentulous maxilla: protocol for a systematic review and network meta-analysis.

BACKGROUND: Atrophic edentulous maxilla is a debilitating condition caused by the progressive and irreversible bone resorption following loss of teeth, that results in bone of inadequate volume and density. This makes conventional implant therapy extremely challenging without complex reconstructive procedures. Several techniques such as sinus augmentation, short implants, and tilted implants have been used for the rehabilitation of the atrophic maxilla. In recent years, zygomatic implants have emerged as a graftless rehabilitation technique. However, few studies compare zygomatic-implant fixed rehabilitation with other fixed rehabilitation techniques. The existing body of evidence on zygomatic implants is largely based on clinical and disease-oriented outcomes. METHODS: A network meta-analysis (NMA) will be conducted in order to compare the effectiveness of zygomatic-implant fixed rehabilitation with the other rehabilitation techniques. Experimental and observational studies comparing different implant-assisted fixed rehabilitation in adults with atrophic maxilla will be included. The primary and secondary outcomes will be patient's satisfaction and quality of life respectively. Additional outcomes include the implant's survival/success, and biological and prosthetic complications. An electronic search will be performed through various databases for articles in English and French, without time limits. Risk of bias will be assessed using the Revised Cochrane Risk-of-Bias tool for randomized controlled trials, and ROBINS-I for non-randomized and observational studies. Two independent reviewers will screen the titles and abstracts and extract data. Any discrepancy between reviewers will be discussed and resolved through consensus or with the help of a third reviewer. Pairwise meta-analyses will be performed using a random effects model. I2, τ2, transitivity, subgroup/meta-regression analyses will assess and explain heterogeneity and distribution of effect modifiers. A network plot will be created to connect the different interventions directly and indirectly. Interventions will be ranked using the surface under cumulative ranking curve. Confidence in the results of the NMA will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). DISCUSSION: This study will be the first to assess the effectiveness of zygomatic-implant fixed rehabilitation for the atrophic maxilla using NMA. The evidence obtained will aid clinical decision-making and will advance the knowledge of the rehabilitation techniques for the atrophic maxilla. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42023353303.

A Literature Review of Vertical Dimension in Prosthodontics Theory and Practice - Part 1: Theoretical Foundations.

Vertical dimension (VD) is a critical factor in prosthodontics, playing a pivotal role in the functional and aesthetic outcomes of dental treatments. This literature review explores theoretical foundations and the various aspects of VD, including its definition, measurement, and clinical significance in prosthodontics. The relationship between VD and temporomandibular disorders (TMDs) is examined. Additionally, the impact of VD on facial proportions and aesthetics is significant, as it affects the lower third of the face and influences the patient's overall appearance and self-esteem. In conclusion, understanding the intricate relationship between VD, TMDs, facial aesthetics, and psychological well-being is essential for effective prosthodontic treatment. This comprehensive review provides valuable insights into the multifaceted role of VD in enhancing both functional and aesthetic outcomes, ultimately improving patient satisfaction and quality of life.

Analysis of the Improvement Effect of Combined Application of Oral Rehabilitation Training and Neuromuscular Electrical Stimulation on Pediatric Swallowing Disorders.

Pediatric swallowing disorders are common yet often overlooked neuro-muscular system diseases that significantly impact the quality of life and development of affected children. This study aims to explore the effect of combined application of oral rehabilitation training and neuromuscular electrical stimulation on improving pediatric swallowing disorders. Children meeting the inclusion criteria for swallowing disorders were divided into control and experimental groups based on different intervention protocols. The experimental group received combined oral rehabilitation training and neuromuscular electrical stimulation, while the control group received only oral rehabilitation training. Results showed that the intervention was more effective in the experimental group, with shorter recovery time for normal swallowing function and improved nutritional status and quality of life. This study provides scientific evidence for clinical treatment of pediatric swallowing disorders. In conclusion, the combined application of oral rehabilitation training and neuromuscular electrical stimulation effectively improves pediatric swallowing disorders, with superior efficacy compared to single treatment methods. Further research is needed to elucidate the mechanism of action and optimize treatment protocols to enhance the therapeutic outcomes and prognosis of pediatric swallowing disorders.

Pain-free bite force in a healthy population: Within-session test-retest reliability in different sitting positions.

BACKGROUND: Pain-free bite force (PFBF) is a promising measure to evaluate bite function in temporomandibular disorders (TMDs), yet the reliability of the measure is unknown. OBJECTIVES: Establish the (1) within-session test-retest reliability of PFBF in a healthy population for a single and mean of three trials in supported and unsupported sitting; (2) standard error of measurement (SEM) and minimal detectable change (MDC). METHODS: Thirty healthy participants (n = 15 female, mean [SD] age = 34.4 [11.0] years) completed two sessions (30-60 min apart) comprising three PFBF trials on each side, in both supported and unsupported sitting, to provide data for 60 (30 participants × two sides) test-retest assessments. Test-retest reliability for the first trial and mean of three trials in each position were determined using intraclass correlation coefficients (ICCs), before calculating the corresponding SEM and MDC for males (M) and females (F) respectively. RESULTS: Within-session reliability was considered excellent for a single trial in supported sitting (ICC = 0.85; SEM M/F = 99/84 N; MDC M/F = 275/232 N) and unsupported sitting (ICC = 0.91; SEM M/F = 72/59 N, MDC M/F = 200/163 N), and for a mean of three trials in supported sitting (ICC = 0.89; SEM M/F = 66/79 N, MDC M/F = 182/220 N) and unsupported sitting (ICC = 0.92; SEM M/F = 64/59 N, MDC M/F = 177/164 N). CONCLUSION: Single and a mean of three trials in supported and unsupported sitting appear reliable methods to measure PFBF in a healthy population. Testing PFBF using a mean of three trials in unsupported sitting appears superior over other methods though due to higher test-retest reliability, and lower SEM and MDC. Future studies should examine the reliability of PFBF in TMD populations.

Oral rehabilitation and associated quality of life following mandibular reconstruction with free fibula flap: a cross-sectional study.

Introduction: Mandibular reconstruction with the free fibula flap (FFF) has become a standardized procedure. The situation is different with oral rehabilitation, so the purpose of this study was to investigate the frequency of implant placement and prosthetic restoration. Additionally, the patients' situation, motivation, and treatment course were structurally assessed. Materials and methods: All cases between January 2013 and December 2018 that underwent mandibular reconstruction in our department with a free fibula flap and gave written informed consent to participate were interviewed with two structured questionnaires about their restoration and quality of life. Additionally, medical records, general information, status of implants and therapy, and metric analyses of the inserted implants were performed. Results: In total 59 patients were enrolled and analyzed in this monocentric study. Overall, oral rehabilitation was achieved in 23.7% at the time of investigation. In detail, implants were inserted in 37.3% of patients and showed an 83.3% survival of dental implants. Of these implanted patients, dental implants were successfully restored with a prosthetic restoration in 63.6. Within this subgroup, satisfaction with the postoperative aesthetic and functional result was 79.9% and with the oral rehabilitation process was 68.2%. Satisfaction with the implant-borne prosthesis was 87.5%, with non-oral-squamous-cell-carcinoma patients being statistically significantly more content with the handling (p=0.046) and care (p=0.031) of the prosthesis. Discussion: Despite the well-reconstructed bony structures, there is a need to increase the effort of achieving oral rehabilitation, especially looking at the patient's persistent motivation for the procedure.

Assessment of oral hypofunction and its association with age among Korean community-dwelling older adults.

BACKGROUND: Due to the increasing proportion of older adults in Korea and growing interest in aging, the concepts of oral aging and oral hypofunction have recently been introduced. Thus, it is necessary to investigate the age-specific oral function levels of Korean older adults and develop expert intervention methods for healthy aging. METHODS: Dysphagia, independence of daily living, and oral hypofunction were assessed in 206 older adults living in Wonju, Gangwon State, South Korea. Subjective dysphagia was assessed through self-report questionnaires using the Dysphagia Handicap Index (DHI), the Korean version of Eating Assessment Tool-10, and the Korean version of the Modified Barthel Index. In addition, the oral hypofunction assessment items included decreased chewing ability, occlusal pressure, tongue pressure, oral dryness, and oral cleanliness. RESULTS: DHI increased significantly with age, with those in their 80 s reporting the most difficulty swallowing. Oral function in terms of chewing ability (maximum occlusal pressure and number of remaining teeth), maximum occlusal pressure, and maximum tongue pressure also declined with increasing age. While there was no significant difference in oral dryness by age, those in their 80 s had dry mouth according to the criteria of the oral moisture checking device. CONCLUSIONS: In an assessment of oral function in community-dwelling, independent Korean older adults, the number of items that were assessed as oral hypofunction increased with age. The findings can be used to standardize the oral hypofunction assessment item and develop age-based individualized intervention plans for the early management of oral health and individual oral myofunctional rehabilitation in Korean community-dwelling older adults.

Personalized and Complex Esthetic Oral Rehabilitation in a Case of Non-Syndromic Oligodontia.

Dental agenesis is one of the most common developmental anomalies in humans and it is frequently associated with several other oral abnormalities. The present case describes non-familial agenesis of permanent teeth in a twenty-one-year-old boy with no apparent systemic abnormalities. The treatment included a personalized and interdisciplinary approach involving endodontics, orthodontics, implant-supported restorations and prosthetic treatments. The treatment plan was thoroughly elaborated using photographic analysis, study models, orthopantomogram, CBCT and cephalograms. Virtual smile design, diagnostic waxing and mock-ups previsualized the treatment objectives. The edentulous spaces were reconstructed by inserting dental implants and monolithic zirconia implant-supported restorations. The final results showed a highly esthetic and functional rehabilitation. Periodic check-ups have shown that the stability of the result is well maintained and that the implant-supported restorations are an optimal solution for patients with multiple anodontia.

Comparison between Conventional and Digital Impressions for Determining Axes and Distances of Three Implants in Straight and Curved Lines: An In Vitro Study.

Background: In this study, we aimed to compare the effects of conventional and digital impressions on several parameters (inter-implant distance, intra-implant distance, inter-implant axis, and intra-implant axis) of three implants in curved lines and straight lines by using a laboratory scanner (LBS) versus an intra-oral scanner (IOS). Methods: Two 3D models were fabricated using a printer, each model with three internal hex implants analogues at the positions of 15#,16#,17# (straight line) and 12#,13#,14# (curved line). Standard intra-oral scan bodies (ISBs) were used, and the two models were scanned using 7 Series dental wings (LBS, reference model), followed by ten scans with Primescan (digital method). Standard Tessellation Language (STL) files were created. Five polyether impressions were taken from each model (straight and curved), and gypsum type 4 models were poured; each model was scanned five times to create a total of 25 STL files for each group (conventional method). The comparison between all the STL files (conventional and digital) was made by superimposition of the STL files on the STL reference model laboratory file using a 3D analyzing software. A Kolmogorov-Smirnov test was performed, followed by Mann-Whitney tests and Wilcoxon signed-rank tests. (p < 0.05). Results: For the conventional method, the mean errors were significantly higher for the curved line model (12-14) compared to the straight line model (15-17) for most parameters (p < 0.05). For the digital method, the mean errors were significantly higher for the curved-line model (12-14) compared to the straight line model (15-17) in half of the parameters (p < 0.05). Within the curved line model (12-14) and the straight line model (15-17), the mean errors between the conventional method and the digital method were not significant for most variables. Conclusions: The difference between curved lines and straight lines has an impact on the mean error of the conventional method. Both methods are reliable for straight and curved lines in partially dentate situations.

5.5-year-survival of CAD/CAM resin-based composite restorations in severe tooth wear patients.

OBJECTIVES: Aim of this prospective study was to assess full mouth rehabilitation of severe tooth wear patients using minimally invasive CAD/CAM resin-based composite (RBC) restorations and direct veneers by evaluating restoration survival up to 5.5-years. METHODS: Twenty-two patients with generalized severe tooth wear with functional and/or esthetic problems were included. Following minimally invasive preparation, CAD/CAM RBC restorations (LAVA Ultimate,3M) were adhesively luted, direct RBC veneers (Filtek Supreme XTE, 3M) were applied in the aesthetic region. Patients were recalled after 1m,1y,3y,5y and seen in between recalls by their general dentists or at the clinical study center if complaints occurred. Failures were categorized as F1 (severe deficiencies requiring replacement/extraction), F2 (localized deficiencies requiring re-cementation/repair) and F3 (small chippings requiring refurbishment/monitoring). Survival of indirect restorations was evaluated using lifetables and Kaplan-Meier-graphs, distinguishing between failure categories and tooth type (front teeth=FT, premolars=PM, molars=M). F1 + F2 and F1 + F2 + F3 failures were analyzed using Cox regression on the variables tooth type/ location, age, gender and VDO increase (p < 0.05). RESULTS: 568 indirect restorations and 200 direct veneers in 21 patients evaluated for up to 5.5-years. For indirect restorations, 96 failures were recorded (F1:6;F2:41;F3:49) and annual failure rates were 0.29%(FT), 1.56%(PM), 2.93%(M) for F1 +F2 and 0.53%(FT), 2.42%(PM), 6.11%(M) for F1 + F2 + F3. Reasons for failure were chipping fracture (48), adhesive fracture (32), complete debonding (7), caries (4), endodontic treatment (1) and reasons unknown (documentation general dentists, 4). Molar tooth type had a statistically significantly increased probability of failure compared with front teeth and premolars for F1 + F2 + F3 (p < 0.006). Direct veneer restorations showed 18 failures (F1:2;F2:9;F3:7). SIGNIFICANCE: Minimally invasive CAD/CAM RBC restorations combined with direct RBC veneers showed an acceptable clinical mid-term survival for restorative rehabilitation of severely worn dentitions.

Patient Satisfaction with the Quality of Oral Rehabilitation Dental Services: A Comparison between the Public and Private Health System.

Measuring satisfaction can help us understand patients' expectations and adopt individualized treatment according to their expectations. In the current study, we applied the DPQ (Dental Practice Questionnaire) to analyze the degree of patient satisfaction regarding medical services in the public and private sector in a Romanian city from the central region. A group of 200 patients, 100 patients from the public sector and 100 patients from the private sector, participated in the survey. The results showed significant differences in response when patients were stratified by age, gender, visit frequency and length of time attending the same practice. Significant differences between public and private practices were encountered. Moreover, the degree of patient satisfaction was found to be related to appointment promptness/length of time and the confidentiality/ability to listen/knowledge/respect shown by the dentist, while patients' recommendations to others were influenced by dentists' explanations and warmth, followed by the appointment system and confidentiality. Patient satisfaction with oral rehabilitation dental services plays an essential role in maintaining patients' addressability, but there is a multitude of factors that can influence patients' opinions. Further analysis of the evolution of the influencing factors (causing satisfaction or dissatisfaction), in time, could provide deeper insights into the links between patient satisfaction and these factors.

Aesthetic oral rehabilitation of the upper-anterior sector with supra-nano filling resin in a patient with woolly hair syndrome: case report.

BACKGROUND: Woolly Hair Syndrome (WHS) is a rare birth condition that affects the structure of hair in non-black people. The pathogenesis is not yet defined. It is postulated that the hair follicle's desmosomes (specifically desmoplaquine, placoglobin and placofilin-1, which are cell structural proteins that keep the adhesion among close cells) would be altered in this pathology, leading to fragility in the cellular union. It is subdivided into two large groups: the localized or circumscribed variant and the generalized variant. From birth or first months of life, patients with WHS are clinically characterized by the presence of a portion or entire scalp area of very short frizzy hair, usually of a smaller diameter, brittle and lighter color. The most frequent skin manifestations are pilar keratosis and palmo-plantar keratodermia. The diagnosis is based on the clinical findings, and it is facilitated by trichotoscopic examination. However, a definitive diagnosis of WHS requires genetic testing. Oral agenesis, enamel defects (such as hypomineralization), atypical caries, dental inclusion, and malformed pin-shaped teeth may occur. OBJECTIVE: To describe an aesthetic alternative of oral rehabilitation using the mock-up technique in a patient with WHS. CLINICAL CASE: A 5-year-old female patient diagnosed with WHS from the National Institute of Child Health NIHCH: Breña, Lima, who was referred from the Genetic service to the Pediatric Dentistry service in order to screen outbreaks of infection associated with odontogenic origin and dental anomalies. At the ectoscopy, a patient with short capillary length, brittle and curly hair, dry skin, and nail dystrophy was observed. At the intraoral clinical examination, anterior pieces of 52, 51, 61, 62, and enamel hypomineralization were observed in all teeth. The radiographic examination showed agenesis of parts 41, 34, and 45. Integral dental treatment was performed in the operating room under general anesthesia due to the complexity of the case. Pulpectomy in pieces 52, 51, 61, 62, post of composite resin, and rehabilitation with supra-nanow filling resin using the mock-up technique were proposed as alternative treatments. CONCLUSION: The making of supra-nano filling resin-based crowns using the mock-up technique is an alternative treatment for aesthetic oral rehabilitation in deciduous dentition of patients with WHS. The aesthetic treatment was achieved using supra nano-filling resins. After 12 months of dental treatment, a favorable response was observed, improving the chewing, phonation and aesthetics of the patient.

Outcomes and influencing factors of dental implants in fibula, iliac crest, and scapula free flaps: a retrospective case-control study.

PURPOSE: Reconstruction with vascularized bone grafts after ablative surgery and subsequent dental rehabilitation with implants is often challenging; however, it helps improve the patient's quality of life. This retrospective case-control study aimed to determine the implant survival/success rates in different vascularized bone grafts and potential risk factors. METHODS: Only patients who received implants in free vascularized bone grafts between 2012 and 2020 were included. The free flap donor sites were the fibula, iliac crest, and scapula. The prosthetic restoration had to be completed, and the observation period had to be over one year after implantation. Implant success was defined according to the Health Scale for Dental Implants criteria. RESULTS: Sixty-two patients with 227 implants were included. The implant survival rate was 86.3% after an average of 48.7 months. The causes of implant loss were peri-implantitis (n = 24), insufficient osseointegration (n = 1), removal due to tumor recurrence (n = 1), and osteoradionecrosis (n = 5). Of all implants, 52.4% were classified as successful, 19.8% as compromised, and 27.8% as failed. Removal of osteosynthesis material prior to or concurrent with implant placement resulted in significantly better implant success than material not removed (p = 0.035). Localization of the graft in the mandibular region was associated with a significantly better implant survival (p = 0.034) and success (p = 0.002), also a higher Karnofsky Performance Status Scale score with better implant survival (p = 0.014). CONCLUSION: Implants placed in vascularized grafts showed acceptable survival rates despite the potential risk factors often present in these patient groups. However, peri-implantitis remains a challenge.

Comparison of masticatory muscle activity between young adults and elderly participants using a novel standardized bite device.

OBJECTIVES: Standardized bite training is required to prevent oral hypofunction in elderly individuals. We aimed to compare masticatory muscle activity between 24 young adults and 16 pre-elderly individuals during a biting task using a novel standardized bite device (BD). METHODS: The BD was made of silicone rubber and included a high-force or low-force plate spring or no plate spring (dummy). The compressive stiffness of the material in each BD was measured using a texture analyzer. All participants performed a biting task 50-times at a rate of 1/s each using the three types of BDs on the right first molar. Electromyographic (EMG) activity was recorded bilaterally from the masseter and temporalis muscles. The variability of each biting training session was calculated as the coefficient of variance (CV) from the EMG activity during each biting task for each muscle. Masticatory muscle fatigue was assessed using a numerical rating scale (NRS). RESULTS: Compressive stiffness was significantly different between each BD (P < 0.001). The CV and NRS scores were not significantly different between the groups. The EMG activities during each bite task in all muscles were not significantly different for any measurement item between the age groups. The EMG activities of high- and low-force BDs in the right temporalis (ipsilateral) muscle were significantly higher than those of the dummy BD (P < 0.001). CONCLUSIONS: Compressive stiffness of the BD affected EMG activity only in the ipsilateral temporalis muscle, but not in the masseter or contralateral temporalis muscles, without any age effect.

Chewing performance of patients with worn dentition before and after restorations: A scoping review.

BACKGROUND: Tooth wear is a multifactorial complex process related to the loss of dental tissue, due to chemical or mechanical processes, by abrasion, attrition, erosion. Restorative treatment represents an attempt to rebuild and recreate the lost structure. OBJECTIVE: This scoping review aims to investigate whether restorative treatment of worn dentition (either with direct or indirect adhesive composite adhesive procedures or with prosthetic techniques) can have an impact on the masticatory performance parameters. METHODS: A scoping review was conducted on multiple databases (Pubmed, Medline CENTRAL, ICTRP), following the PRISMA guidelines. Abstracts of research papers were screened for suitability, and full-text articles were obtained for those who satisfied the inclusion and exclusion criteria. RESULTS: Only one article meet the inclusion criteria of the review. Restorative treatment of worn dentition although have a positive impact on the self-report ability to chew, has no effect on the masticatory performance test. CONCLUSION: At the moment, not enough evidence to comment on the actual therapeutic role of restorative treatment on tooth wear is available. Clinicians, before taking any clinical decision, should carefully discuss with patients the needs and expectations of the treatment plan.