Prevalencia del Síndrome de Combinación y sus factores asociados en la Clínica de la Facultad de Odontología de la Universidad de Cuenca, periodo 2015-2016 / Prevalence of Combination Syndrome and associated factors at Clínica de la Facultad de Odontología, Universidad de Cuenca, 2015-2016

INTRODUCCIÓN: Un conjunto de cambios patológicos en el sistema estomatognático frente a la pre-sencia de una prótesis total maxilar y una prótesis parcial removible mandibular han sido descritos como el Síndrome de Combinación. El objetivo de este estudio fue determinar la prevalencia del sín-drome y si factores como la edad, el sexo o el tipo de edentulismo mandibular están asociados al mis-mo en los pacientes de la Clínica de la Facultad de Odontología de la Universidad de Cuenca período 2015-2016. MÉTODOS: Estudio observacional,transversal, descriptivo y de correlación. La muestra estuvo cons-tituida por 312 pacientes edéntulos. Se estableció la presencia del síndrome de combinación cuando un paciente presentaba un mínimo de tres signos asociados. Se determinó la prevalencia del síndro-me de combinación en la muestra y la asociación entre las variables sexo, edad, tipo de edentulismo con la presencia de síndrome de combinación. RESULTADOS: La prevalencia del SC resultó en un 21.8%. Padecer de edentulismo parcial clase I de Kennedy (3.6 veces mayor probabilidad que los otros tipos de edentulismo) y ser adulto mayor de 60 años (1.8 veces mayor probabilidad), tuvieron asociación con el desarrollo del síndrome de Combinación. CONCLUSIÓN: La prevalencia de SC es del 21.8%, la progresión de la edad y el edentulismo parcial clase I de Kennedy conducen a una mayor probabilidad para desarrollar el síndrome de combinación y deben evaluarse como factores de riesgo.(au)

BACKGROUND: The set of pathological changes in the stomatognathic system in the presence of a total maxillary prosthesis and a removable partial mandibular prosthesis has been described as the Combi-nation Syndrome. The main purpose of this study was to determine its prevalence and if features such as age, sex or type of mandibular edentulism are associated with the syndrome in the patients of the Odontologic Clinic of the of Faculty of Dentistry, Universidad de Cuenca during the academic period 2015-2016. METHODS: Cuantitative, cross sectional descriptive and correlational study. The sample consisted of 312 edentulous patients. The diagnosis of the syndrome in this study was determined by the presence of a minimum of three associated signs. We determine the prevalence of combiantion syndrome and the as-sociation between sex, age and edentulism type and combination syndrome. RESUlTS: The prevalence of combination syndrome is 21.8%. Adults 60 years or older (1.8 times higher probability) and patients who suffer from Kennedy class I partial edentulism (3.6 times higher probability than other types of edentulism), have a higher probability for developing the syndrome. CONClUSION: The prevalence of CS was 21.8%, age and suffering from Kennedy class I partial edentulism should be considered as risk factors for developing the syndrome.(au)

Assessment of oral health and cost of care for a group of refugees in Germany: a cross-sectional study.

BACKGROUND: There is a research gap concerning the evaluation of the oral healthcare of refugees. Therefore, the aim of this study was to evaluate the oral health of refugees and to estimate the costs of oral care. METHODS: The study was conceptualized as a pilot study. The study participants were refugees who lived either in collective living quarters or at a reception center in a region of the federal state of Schleswig-Holstein, Germany. The cross-sectional design was complemented by dental screening. Data were collected from August 2016 until July 2017. The basic condition of the teeth was evaluated using a convenience sample by a single dentist. The assessment of caries was carried out visually in accordance with the International Caries Detection and Assessment System from code 3 and higher. The DMF-T (decayed, (D), missing, (M), filled (F), teeth (T)) index was calculated. The costs of oral care were analyzed for conservative treatment (filling or extraction) and for prosthetic treatment (missing teeth) in the form of a bridge or crown. RESULTS: The dental screening was attended by 102 refugees, with a mean age of 28 years. A total of 49% of the study sample suffered from toothache, and the DMF-T index had a mean of 6.89. For 92% of the study sample, treatment was indicated, and a cost estimate of the treatment could be calculated. The average cost of conservative treatment was estimated to be 205.86 EUR, and the average cost of prosthetic treatment was estimated to be 588.0 EUR. The oral healthcare costs of the different treatment procedures were higher for refugees that presented with toothache than for those without toothache, with the exception of prosthetic treatment procedures. CONCLUSIONS: There is a lack of population-based data that survey the oral health status of refugees. Therefore, the current study presents an initial overview regarding the oral health status and the potential costs of oral healthcare of refugees.

[The need for, and allocation of, regional prosthodontics laboratories in Brazil: an exploratory study]. / Necessidade e alocação de laboratórios regionais de prótese dentária no Brasil: um estudo exploratório.

The scope of this study was to compare epidemiological indicators of the need for prosthetic rehabilitation in 2003 with the number of regional prosthodontic laboratories (LRPD) and technicians in prosthodontics (TPD) in the five Brazilian regions between 2012 and 2013. Data regarding health services were obtained from DATASUS and epidemiological data were obtained from SBBrasil 2003. The rates of dental prostheses produced and LRPD and TPD were calculated per 100,000 people. The Kruskal-Wallis and chi-square test were used for analysis. The results show that the sex/age adjusted prevalence of edentulism varied between regions (p < 0.01), being higher in the Southeast (13.9%). The highest mean number of missing teeth was found in the North (10.3 teeth). The highest availability of LRPD (1.16 per 100,000) and TPD (1.05 per 100,000) occurred in the Northeast region. The highest need for complete dentures (7.2%) was reported in the North, but was the lowest in delivery of dentures (9.71 per 100,000). There were statistically significant differences (p < 0.01) among regions for both LRPD, TPD rates for prostheses. It is considered that criteria other than epidemiological aspects influenced the opening of LRPD in the country.

Necessidade e alocação de laboratórios regionais de prótese dentária no Brasil: um estudo exploratório / The need for, and allocation of, regional prosthodontics laboratories in Brazil: an exploratory study

ResumoObjetivou-se comparar os indicadores epidemiológicos e de necessidade de reabilitação protética de 2003 com o número de Laboratórios Regionais de Prótese Dentária (LRPD) e Técnicos em Prótese Dentária (TPD), nas cinco regiões brasileiras, entre 2012 e 2013. Os dados sobre os serviços de saúde foram obtidos no DATASUS e os epidemiológicos a partir SBBrasil 2003. As taxas de próteses dentárias produzidas, de LRPD e de TPD foram calculadas por 100.000 habitantes. Para a análise, utilizaram-se os testes de Kruskal-Wallis e Qui-quadrado. A prevalência de edentulismo, ajustada por sexo e idade variaram entre as regiões (p < 0,01), sendo maior na região Sudeste (13,9%). O maior número médio de dentes perdidos foi encontrado na região Norte (10,3 dentes). A maior disponibilidade de LRPD (1,16 por 100 mil/hab) e TPD (1,05 por 100 mil/hab) ocorreu na região Nordeste. A maior necessidade de prótese total (7,2%) foi registrada no Norte, mas a mesma foi a mais baixa na entrega de próteses (9,71 por 100 mil/hab). Houve diferença estatisticamente significativa (p < 0,01) entre as regiões, para taxas de LRPD, TPD e de próteses. Sugere-se que outros critérios além dos epidemiológicos, influenciaram na abertura de LRPD no país.

AbstractThe scope of this study was to compare epidemiological indicators of the need for prosthetic rehabilitation in 2003 with the number of regional prosthodontic laboratories (LRPD) and technicians in prosthodontics (TPD) in the five Brazilian regions between 2012 and 2013. Data regarding health services were obtained from DATASUS and epidemiological data were obtained from SBBrasil 2003. The rates of dental prostheses produced and LRPD and TPD were calculated per 100,000 people. The Kruskal-Wallis and chi-square test were used for analysis. The results show that the sex/age adjusted prevalence of edentulism varied between regions (p < 0.01), being higher in the Southeast (13.9%). The highest mean number of missing teeth was found in the North (10.3 teeth). The highest availability of LRPD (1.16 per 100,000) and TPD (1.05 per 100,000) occurred in the Northeast region. The highest need for complete dentures (7.2%) was reported in the North, but was the lowest in delivery of dentures (9.71 per 100,000). There were statistically significant differences (p < 0.01) among regions for both LRPD, TPD rates for prostheses. It is considered that criteria other than epidemiological aspects influenced the opening of LRPD in the country.

Implants for the ageing population.

Dental implant treatment has established benefits over traditional alternatives. Age-related changes in systemic and oral health in conjunction with social, economic and resource considerations often introduce complexities into dental implant treatment of ageing patients. When time, opportunity, discomfort and maintenance costs are coupled with cost-benefit and quality of life predictions, otherwise simple treatment decisions can become more difficult. Implants for different types of prostheses in both arches and the different types of prostheses themselves present a variety of treatment challenges, risks, benefits and maintenance requirements. This narrative review discusses selective literature pertinent to the provision of dental implant treatment in the ageing population.

Agenesis of maxillary lateral incisor and tooth replacement: cost-effectiveness of different treatment alternatives.

PURPOSE: To evaluate the long-term cost-effectiveness of five treatment alternatives for maxillary lateral incisor agenesis where space maintenance and tooth replacement are indicated. MATERIALS AND METHODS: The following treatment modalities were considered: single-tooth implant-supported crown, resin-bonded fixed partial denture (FPD), cantilever FPD, full-coverage FPD, and autotransplantation. The cost-effectiveness for each treatment modality was determined as the ratio of the outcome of each modality divided by the cost. Direct costs, clinical and laboratory, were calculated based on national fee schedules and converted to international dollars using purchasing power parity exchange rates. Outcomes were based on the most recently published long-term (10-year) survival rates. Sensitivity analyses were carried out, testing the robustness of the cost-effectiveness analysis. RESULTS: The five treatment modalities ranked in the following order from most to least cost-effective: autotransplantation, cantilever FPDs, resin-bonded FPDs, single-tooth implants and implant-supported crowns, and full-coverage FPDs. Sensitivity analysis illustrated that the cost-effectiveness analysis was reliable in identifying autotransplantation as the most and full-coverage FPDs as the least cost-effective treatment modalities. CONCLUSIONS: When replacing a missing maxillary lateral incisor, the most costeffective, long-term treatment modality is autotransplantation, whereas the least cost-effective is full-coverage FPDs. However, factors such as patient age, the state of the dentition, occlusion, and tooth conservation should also influence the choice of restoration.

[Preventive strategies in prosthetic dentistry]. / Präventionsorientierte Strategien in der prothetischen Zahnmedizin.

Despite the success in preventing oral diseases, the prevalence of tooth loss in the German population remains high and increases with age. Today, the advances in prosthetic dentistry allow necessary tooth replacement following preventive strategies-after considering benefits and risks. Modern treatment options improve the overall prognosis of the stomatognathic system and the quality of life of the affected patients significantly. Hereby, adverse iatrogenic effects can be minimized or even completely avoided by extending the traditional treatment spectrum, e.g., using adhesively fixed restorations and implant-supported restorations, and refraining from placing restorations that are unnecessary from the medical point of view. Generally, patients benefit greatly from prosthetic treatment and the achieved health gain is remarkably high. It encompasses not only the recovery of the impaired oral functions but also extends to the whole human organism, including nutrition, digestion, musculoskeletal system, as well as mental and social well-being.

Cumulative costs for the prosthetic reconstructions and maintenance in young adult patients with birth defects affecting the formation of teeth.

OBJECTIVES: To assess retrospectively the cumulative costs for the long-term oral rehabilitation of patients with birth defects affecting the development of teeth. METHODS: Patients with birth defects who had received fixed reconstructions on teeth and/or implants > or =5 years ago were asked to participate in a comprehensive clinical, radiographic and economic evaluation. RESULTS: From the 45 patients included, 18 were cases with a cleft lip and palate, five had amelogenesis/dentinogenesis imperfecta and 22 were cases with hypodontia/oligodontia. The initial costs for the first oral rehabilitation (before the age of 20) had been covered by the Swiss Insurance for Disability. The costs for the initial rehabilitation of the 45 cases amounted to 407,584 CHF (39% for laboratory fees). Linear regression analyses for the initial treatment costs per replaced tooth revealed the formula 731 CHF+(811 CHF x units) on teeth and 3369 CHF+(1183 CHF x units) for reconstructions on implants (P<.001). Fifty-eight percent of the patients with tooth-supported reconstructions remained free from failures/complications (median observation 15.7 years). Forty-seven percent of the patients with implant-supported reconstructions remained free from failures/complications (median observation 8 years). The long-term cumulative treatment costs for implant cases, however, were not statistically significantly different compared with cases reconstructed with tooth-supported fixed reconstructions. Twenty-seven percent of the initial treatment costs were needed to cover supportive periodontal therapy as well as the treatment of technical/biological complications and failures. CONCLUSION: Insurance companies should accept to cover implant-supported reconstructions because there is no need to prepare healthy teeth, fewer tooth units need to be replaced and the cumulative long-term costs seem to be similar compared with cases restored on teeth.

Prosthodontic treatment of patients with disabilities at dental specialist clinics in the County of Västra Götaland.

In 1998 the Swedish Parliament decided about increased financing of dental support and service given to persons with disabilities who were dependent on nursing personnel or others in their activities of daily life including oral hygiene procedures. One part of the legislation called "Necessary dental care, group 3" (NDC3) includes persons with intellectual disabilities and disabilities due to brain damage, autism and autism-like disorders, and persons with lasting mental and physical disabilities not related to normal ageing. The objectives where to investigate persons affected by this legislation; how many and what patients covered by NDC3 in Västra Götaland County received prosthodontic therapy from 2001 through 2004, at hospital dental clinics or dental specialist clinics. Patients treated with prosthodontic restorations covered financially by the county council under the terms of NDC3 were identified through the county council's registers. The application forms for NDC3 were retrieved and information about patient characteristics and type of treatments were compiled. It was shown that 57 patients covered by NDC3 in Västra Götaland County received prosthodontic therapy at dental specialist clinics and 50 were treated at the hospital dental clinics for extensive prosthodontic treatment needs. The mean age for the patients rehabilitated with removable dentures was higher (56.2 years) compared with patients treated with single tooth implants (39.7 years). About 30 patients, representing 1 to 2% of the NDC3 population in Västra Götaland County were rehabilitated with more advanced prosthodontic restorations in hospital dental clinics or dental specialist clinics each year. In conclusion and with respect to the probably large need for prosthodontic therapy among persons with disabilities, the use of NDC3 has not been properly utilized.

Evidence-based decision making: replacement of the single missing tooth.

Single-tooth replacement may be effected through various methods, including the use of a resin-bonded fixed partial denture, a conventional fixed partial denture, and a single implant-supported crown. Although the introduction of newer therapeutic modalities, surgical and restorative techniques, and restorative materials has significantly expanded available treatment options, a greater demand is now placed on the diagnostic and treatment planning acumen of the clinician. The questions confronting each clinician are when to apply each treatment modality and how to use these therapeutic approaches to their maximum benefit for the patient. This article focuses on the factors that should be considered when making such clinical decisions and offers a framework within which to formulate appropriate treatment algorithms.

Effects of the new fixed-subsidy system for prosthetic dental care in Germany: results of descriptive research.

OBJECTIVE: To detail how provision of prosthetic treatments altered in Germany following changes in legislation on 1 January 2005, enacted as part of the health system modernisation law (GMG). This legislation directs health insurance companies to fix subsidies on dental prostheses based on diagnostic findings. The goal of the reform is to ensure that insured persons can select any medically recognised form of prosthetic treatment without losing their right to a health insurance subsidy. AIM: To show subsequent effects on provision of prosthetic treatments. METHOD: The four largest substitute health insurance funds each collected the billing data from 300 medical and costs projections and/or from the submitted bills in June 2005, allowing access and analysis of a randomised sample (n = 1,200), which in turn made usable assertions possible. RESULTS: Under the fixed-subsidy system the co-payment from the insured person has risen as soon as the area of Standard Prosthetic Care is left and dental prostheses treatment is provided from the categories care of a similar or different kind. The costs of dental prostheses in the new fixed-subsidy system are composed of approx. 39% dentists' fee and 61% dental materials. Only a small proportion of insured persons capitalise on these changes; in fact only 1.2% of the subsidy is for surgically implanted prostheses in the new fixed-subsidy system. CONCLUSIONS: The current fixed-subsidy system results in substantially higher co-payments for the insured, as soon as Standard Prosthetic Care is left and care of a similar or different kind is provided. This raises the question as to whether the marginalisation of contractual care to fund the additional costs resulting from surgically implanted prostheses was necessary.

Patients' self-perceived impacts and prosthodontic needs at the time and after tooth loss.

Studies on self-perception have demonstrated that tooth loss is associated with esthetic, functional, psychological and social impacts for individuals. However, not all subjects seek treatment immediately after tooth loss, even when desire for replacement is strongly expressed. The aim of this study was to evaluate the perception of patients submitted to tooth extraction about factors associated with tooth loss and prosthodontic treatment, at the time and after extraction. A convenience sample of 211 consecutive patients were clinically evaluated and answered to a questionnaire about perceived impacts and prosthodontic treatment needs. Data were collected at the time of extraction and after a 3-month time interval. Perceived impacts were high (21 to 76% at the time and 35 to 87% after extraction). From 72.5% patients who expressed intention of immediate replacement of edentulous spaces, only 8.1% had actually been treated. Financial limitation was considered the most important factor that restricted access to treatment. Bivariate statistical analysis showed association between immediate dental replacement and anterior tooth loss (p=0.00) and extension of edentulous space (p=0.01). Position of lost teeth was associated to perceived functional limitation (p=0.03). Worsened appearance was associated to tooth loss in the maxillary arch (p=0.02), and desire of prosthodontic treatment was associated to the extension of edentulous space (p=0.05). Perceived impacts were more frequent in women than men. It was concluded that although patients usually expressed prosthodontic treatment needs, clinical and financial issues are determinant factors for tooth replacement.

Prosthodontics, care utilization and oral health-related quality of life.

The main aim of this thesis was to study the impact of oral health and oral prostheses on oral health-related quality of life (OHRQOL) in an adult Swedish population. Additional aims were to study social inequalities in oral health, attitudes towards the cost for dental care and dental care utilization. The study base was 1294 responses to a questionnaire from a random sample of 1974 persons aged 50-75 years, all of whom were resident in the County of Skine, Sweden. There was an association between impaired dental conditions and poor social conditions. Low dental care utilization covaried with impaired dental conditions and with stating a perceived need to obtain dental care but with no possibility to obtain it because of a cost barrier. In factor analysis, three factors captured 22 variables that aimed to measure OHRQOL. The constituent variables were summed into three index variables interpreted as oral health impact on everyday activities, on a psychological dimension and on oral function. The three variables were set as dependent variables in regression models with the independent variables social attributes, individual attributes, dentures, number of teeth and dental care attitudes. The models were run in three steps taking into account the interaction between the type of denture and the number of remaining teeth. The number of remaining teeth was more important than the type of denture when explaining OHRQOL. The type of replacement, in terms of fixed or removable denture, was less important for those with few or no remaining teeth, than for all others. OHRQOL was also explained by general health in relation to age peers as well as by varying attitudes towards dental care costs. Statistically significant interactions were observed between the number of remaining teeth and the type of denture when explaining OHRQOL. As a whole the thesis shows that social and dental conditions and cost for dental care play a great role for dental care utilization as well as for OHRQOL. Prosthodontics has an important role, where type of replacement interacts with tooth loss in its effect on QOL.

Patients' self-perceived impacts and prosthodontic needs at the time and after tooth loss

Studies on self-perception have demonstrated that tooth loss is associated with esthetic, functional, psychological and social impacts for individuals. However, not all subjects seek treatment immediately after tooth loss, even when desire for replacement is strongly expressed. The aim of this study was to evaluate the perception of patients submitted to tooth extraction about factors associated with tooth loss and prosthodontic treatment, at the time and after extraction. A convenience sample of 211 consecutive patients were clinically evaluated and answered to a questionnaire about perceived impacts and prosthodontic treatment needs. Data were collected at the time of extraction and after a 3-month time interval. Perceived impacts were high (21 to 76 percent at the time and 35 to 87 percent after extraction). From 72.5 percent patients who expressed intention of immediate replacement of edentulous spaces, only 8.1 percent had actually been treated. Financial limitation was considered the most important factor that restricted access to treatment. Bivariate statistical analysis showed association between immediate dental replacement and anterior tooth loss (p=0.00) and extension of edentulous space (p=0.01). Position of lost teeth was associated to perceived functional limitation (p=0.03). Worsened appearance was associated to tooth loss in the maxillary arch (p=0.02), and desire of prosthodontic treatment was associated to the extension of edentulous space (p=0.05). Perceived impacts were more frequent in women than men. It was concluded that although patients usually expressed prosthodontic treatment needs, clinical and financial issues are determinant factors for tooth replacement.

Estudos de autopercepção têm demonstrado que a ausência de dentes pode resultar em impactos estéticos, funcionais, psicológicos e sociais, embora nem todos os indivíduos demandam por tratamento protético imediato após a perda dentária. O objetivo do estudo foi avaliar a percepção de pacientes submetidos a exodontia em relação a fatores associados à perda e ao tratamento protético, no momento e após a perda dos dentes. Uma amostra de conveniência de 211 pacientes consecutivos foi avaliada quanto à condição clínica, autopercepção dos impactos orais e necessidade de tratamento, por meio de exame clínico e questionário, no momento e após 3 meses da exodontia. A percepção de impactos da perda dentária foi alta (21-76 por cento no momento e 35-87 por cento após a exodontia). Dos 72,5 por cento pacientes que relataram pretender a reposição protética imediata apenas 8,1 por cento realizaram o tratamento. A motivação financeira foi relatada como o maior impedimento para o tratamento. A análise univariada mostrou associação entre reposição imediata e localização anterior da perda (p=0,00) e extensão do espaço desdentado (p=0,01), entre localização da perda e limitação funcional percebida (p=0,03). O incômodo com a aparência foi relacionado à localização da perda no arco superior (p=0,02), o desejo por tratamento protético foi relacionado à extensão do espaço desdentado (p=0,05). Na maioria dos aspectos avaliados a percepção de problemas associados à perda foi maior no sexo feminino. Conclui-se que, embora a necessidade percebida de tratamento protético seja alta, fatores clínicos e sócio-econômicos são determinantes para a realização do tratamento.