Fertilization using sewage sludge in unfertile tropical soils increased wood production in Eucalyptus plantations.

Fertilization of Eucalyptus plantations using sewage sludge on unfertile tropical soils represents an alternative to using mineral N and P fertilizers. A 44-month field experiment was conducted to study the effects of increasing application of sludge, and its interactions with mineral N and P fertilizers, on wood volume. Four rates of sludge (0, 8, 15 and 23 Mg ha-1, dry base), N (0, 47, 95 and 142 kg ha-1) and P (0, 28, 56 and 84 kg ha-1 of P2O5) were combined in a 4 × 4 × 4 factorial scheme in a totally randomized block design. Response surface and age-shift modeling was used to establish an initial recommendation for mineral fertilization of the Eucalyptus plantations treated with sludge and to analyze the implications of increased growth on the duration of the forest cycle in a tropical climate. The results showed that from 8 to 44 months after planting, the sludge application (with or without N and P) yielded a statistically larger wood volume (P < 0.05), compared to application of N and P fertilizers only. The response surface modeling showed the following outcomes: i) application of sludge based on N criterion reduced the need for N and P fertilizers by 100%; and ii) an increase in wood volume by 7% could be achieved, compared to NPK fertilizers only, if 2/3 of the recommended P was applied. The cultivation time to produce 150 m3 ha-1 of wood volume was 45 months for the control and was reduced by two, three, four, or five months, respectively, through application of recommended P, sludge dose, sludge plus one third of P, and sludge plus two thirds of P. On the whole, sewage sludge could represent an excellent unconventional N and P fertilizer source for wood production on unfertile tropical soils.

Assessment of early harvest in the prevention of aflatoxins in peanuts during drought stress conditions.

The present study aimed to evaluate the effectiveness of early harvest in preventing aflatoxins in peanuts under drought-stress conditions. A field experiment was conducted on the 2018-2019 and 2019-2020 growing seasons in a greenhouse with an irrigation system to induce three drought stress conditions: no stress, mild, and severe stress. In addition, three harvest dates were proposed: two weeks earlier, one week earlier, and ideal harvest time. The mean peanut yield was 2634 kg/ha, considering the two growing seasons, and the drought stress conditions and harvest dates did not influence significantly. The shelling percentage was significantly higher in samples harvested at ideal harvest (77.7 %) than two weeks earlier (76.2 %) and was not influenced by drought stress conditions. Although a low mean percentage of grains with insect damage was identified, this percentage was statistically higher under severe stress (0.4 %) compared to no-stress conditions (0.2 %). The soil contamination ranged from 2.52 × 103 to 1.64 × 104 CFU/g of Aspergillus section Flavi, and the drought stress resulted in significantly higher concentrations in mild and severe stressed samples. A. section Flavi was found to infect all the peanut kernel samples. The drought stress resulted in higher percentages of A. section Flavi infections in samples from mild and severe stress conditions. The harvest date did not influence the soil and peanut kernel occurrence of A. section Flavi. A total of 435 and 796 strains of A. section Flavi were isolated from soil and peanut kernels, respectively. The potential of aflatoxin production by soil isolates was 31, 44, and 25 % for aflatoxin non-producers, aflatoxin B producers, and aflatoxin B and G producers, respectively, while in peanut kernel isolates were 44, 44, and 12 %. Three different A. section Flavi species were identified from peanut kernels: A. flavus, A. parasiticus, and A. pseudocaelatus. The mean aflatoxin concentration in peanut kernels was 42, 316, and 695.5 µg/kg in samples under no stress, mild stress, and severe stress conditions, respectively. Considering the harvest time, the mean aflatoxin concentration was 9.9, 334.3, and 614.2 µg/kg in samples harvested two weeks earlier, one week earlier, and in ideal harvest, respectively. In conclusion, the early harvest proved to be a viable, cost-free alternative for controlling aflatoxin in the peanut pre-harvest, resulting in a safer product and a better quality for sale and economic gain.

Risk assessment of inferior alveolar neurovascular bundle by multidetector computed tomography in extractions of third molars.

PURPOSE: This study aimed to assess the reliability of multidetector computed tomography (MDCT) in determining the surgical risk of the inferior alveolar neurovascular bundle in extractions of third molars. METHODS: The sample comprised thirty-three individuals (63 third molars) who underwent preoperative evaluation by MDCT before extraction of impacted mandibular third molars. MDCT was used to determine the relationship between the roots of the third molars and the mandibular canal, and the course of the mandibular canal. Inferior alveolar nerve (IAN) exposure and the presence of hemorrhage were analyzed after removal of the teeth. IAN neurosensory deficit was recorded after 7 days. Clinical and MDCT findings were compared using Fisher's exact test (P < 0.05). RESULTS: There was a statistically significant association between IAN exposure and the tomographic relationship between the roots of third molars and the mandibular canal (P = 0.015). Conventionally, all cases of IAN neurosensory deficit and hemorrhage occurred when the roots of the third molar presented in an at-risk relationship with the mandibular canal, however, this association was not statistically significant (P > 0.05). A statistically significant association was found between the lingual course of the mandibular canal and IAN exposure (P = 0.03). CONCLUSIONS: MDCT is an effective tool for determination of the surgical risk to the inferior alveolar neurovascular bundle in extraction of mandibular third molars.

Effectiveness of a Uniquely Designed Oral Appliance on Obstructive Sleep Apnea Control: A Pilot Study.

OBJECTIVES: Obstructive sleep apnea is an inflammatory, chronic, and evolutive disease often needing adequate treatment and follow-up. The oral appliance (OA) is an accepted alternative therapy for obstructive sleep apnea (OSA) control. Due to greater adherence, OA with mandibular advancement (OAm) is being recommended treatment for patients who refuse or do not tolerate continuous positive airway pressure. The mode of action of OAm is to promote the advancement of the mandible or tongue with a subsequent increase in the tone of the pharyngeal muscles and the permeability of the upper airway, but most OAm use conventional models as reference, analogic, or digital, dissociating dental arches of the skull structures. MATERIALS AND METHODS: A retrospective longitudinal study of 33 OSA patient treated with a different OAm, that use Camper plane as reference with skull structures for dental arches disocclusion, where polysomnographic, cephalometric measures, and subjective data from questionnaires pre- and post-treatment were assessed and correlated. Descriptive analysis, correlated Chi-square tests, and basic statistics were used. Generalized linear mixed model for repeated measure and post hoc Tukey-Kramer test compares the variables pre- and post-treatment. Shapiro-Wilk test and Pearson's correlation coefficients were used. All statistical tests were set in 5% level of significance. RESULTS: Regarding polysomnography data, there was a significant association between apnea hypopnea index (AHI) with oxygen saturation, arousal index (AI) and the maximum heartbeats, and sleep improvement and health risk reduction. Additionally, from cephalometric data, it was found a significant association between the tongue posture with the soft palate, hioyd-C3 and, lower and posterior airway. When both parameters are correlated, there are a significant dependent association with hyoid bone position with AHI and AI. The limitation of this study was the two-dimensional image used without provide volumetric measurements, but this limitation was reduced with the follow-up polysomnography parameters. CONCLUSION: In this pilot study, DIORS OAm as an uniquely designed device using Camper plane as a reference for disocclusion was effective in the control of OSA.

Influence of NaOCl irrigation and water storage on the degradation and microstructure of the resin/primary dentin interface.

PURPOSE: To evaluate the influence of NaOCl irrigation and water storage on the degradation and microstructure of the resin/dentin interface of primary teeth bonded with three different adhesive systems using the microtensile bond strength test (µTBS) and scanning electron microscopy (SEM). MATERIALS AND METHODS: Ninety sound primary molars were used. Eighteen groups were formed according to different adhesive systems (Adper Single Bond 2, SB; Clearfil Protect Bond, CP; Adper Prompt L-Pop, APL) with or without 0.5% NaOCl irrigation and water-storage time (24 h, 45 days, 90 days). The middle dentin was exposed. In the NaOCl group, NaOCl irrigation was performed for 30 min, and all groups were restored with composite (Charisma). Sticks with a 1-mm2 cross-sectional area were prepared for the µTBS test. The data were analyzed by ANOVA and Tukey's test (p < 0.05). The failure modes, presence or absence of resin tags, and the resin/ dentin interface were evaluated by SEM, and data were analyzed using Cochran-Mantel-Haenszel statistics (p < 0.05). RESULTS: The µTBS of APL was significantly lower than the other groups regardless of treatment and storage time. A significant decrease of µTBS values after 90 days of water storage occurred only in the non-NaOCl irrigation groups. After 90 days of storage, resin tags partially disappeared in APL and CP, and in SB, 100% of the resin tags remained. CONCLUSION: The choice of adhesive system is one of the factors when bonding to primary dentin is considered. In this study, the etch-and-rinse and the two-bottle self-etching adhesive system produced the highest µTBS values irrespective of prior NaOCl irrigation even up to 90 days of water storage.

Influence of different enamel substrates on microtensile bond strength of sealants after cariogenic challenge.

PURPOSE: To evaluate the microtensile bond strength (µTBS) of resin sealer on enamel substrates after cariogenic challenge. MATERIALS AND METHODS: Enamel blocks were obtained from human third molars and randomly divided into 6 groups (n = 10) according to enamel substrates (S: sound, CL: caries-like lesion, or CLTF: caries-like lesion + topical fluoride application) and sealant material (F: FluroShield, or H: Helioseal Clear Chroma). Sealants were placed on enamel surfaces, stored in 100% humidity (24 h, 37°C), and longitudinally sectioned into hourglass shapes. According to the groups, pH cycling was applied and the µTBS test was performed. The fracture patterns were assessed by SEM. RESULTS: Regarding substrates, the highest µTBS values in MPa were observed for CLTF enamel (26.0 ± 7.6), followed by S (22.0 ± 7.4) and CL (15.5 ± 4.9). A significant interaction was found between material and pH cycling (p = 0.0395). F (23.9 ± 7.6) showed higher µTBS values than H (18.3 ± 7.5) when submitted to pH cycling. The majority of samples presented mixed failure. CONCLUSIONS: Enamel substrate significantly affected µTBS, with the highest values for remineralized caries-like enamel lesions. Furthermore, µTBS values were dependent on both materials and pH cycling.

Correction: Trans,trans-farnesol, an antimicrobial natural compound, improves glass ionomer cement properties.

[This corrects the article DOI: 10.1371/journal.pone.0220718.].

Effect of oxalate desensitizer on the durability of resin-bonded interfaces.

Potassium oxalate desensitizers were previously shown to effectively reduce the immediate permeability of resin-bonded dentin. The current study evaluated whether the effect of the combined application of oxalate with etch-and-rinse adhesives interferes with the durability of resin-dentin bonds when using etch-and-rinse adhesives. The bond strength of resin-bonded dentin specimens composed of two-step or three-step etch-and-rinse adhesives (Single Bond, One-Step and Scotchbond Multi-Purpose, respectively) was tested immediately (24 hours) and after 12 months of water storage. The adhesives were used either according to the manufacturers' instructions (control groups) or after treating acid-etched dentin with a potassium oxalate gel (BisBlock, BISCO, Inc). The treatment of dentin with potassium oxalate was shown to negatively affect the baseline bond strength of resin-bonded dentin specimens, regardless of the adhesive used (p < 0.05). After storage, the bond strength of the resin-bonded interfaces was significantly reduced for all the tested groups (p < 0.001). Nevertheless, the rate of decreasing bond strength was significantly lower for oxalate-treated specimens than for the controls (p < 0.05).

Reattachment of anterior fractured teeth: effect of materials and techniques on impact strength.

BACKGROUND/AIM: The reattachment of dental fragments, as a conservative treatment, should be the first choice to restore fractured teeth. Therefore, the aim of this study was to evaluate the effect of different materials and reattachment techniques on impact strength of bovine incisors. MATERIAL AND METHODS: Standardized fragments were obtained when 80 crowns were sectioned 12 mm from the incisal edge. Teeth were mounted in PVC rings, embedded in acrylic resin and polyether to simulate bone support and periodontal ligament. Specimens were distributed in nine groups (n = 10), according to the reattachment technique (Direct bonding or Circumferential chamfer); the adhesive system (Single Bond or Clearfil SE Bond); and the intermediated material (Filtek Z350 Flow or Rely X CRA). Sound teeth composed the control group. Circumferential chamfer was prepared after the bonding of the fragment by means of a spherical point and filled with the composite Filtek Z250. The impact strength was evaluated in a universal testing machine Instron. A compressive load was applied at a crosshead speed of 500 mm min(-1) on the buccal surface, 2 mm from the incisal edge. Data were submitted to anova and Ryan-Einot-Gabriel-Welsch Multiple Range test (5%). RESULTS: Mean value of impact strength for control group was 64.8 Kgf. The fragment reattachment using Circumferential chamfer was significantly superior to Direct Bonding. The use of Single Bond significantly increased the impact strength when compared to the use of Clearfil SE. There was no significant difference among Rely X and Filtek X350 Flow. CONCLUSION: No technique or material, when individually considered, was capable of achieving the mechanical strength of the sound teeth; however, the association of reattachment technique Circumferential chamfer with bonding system Single Bond could approximate the immediate impact strength of the restored teeth to that observed in the sound teeth.

A singular oral appliance to treat obstructive sleep apnea in CPAP non-adherent patients.

INTRODUCTION: The most prescribed treatment option for Obstructive Sleep Apnea (OSA) is CPAP; however, its adherence is limited. Oral Appliance therapy (OAT) is frequently an option or even an adjuvant, being the mandibular advancement Oral Appliance (OAm) the most used prescription. It modifies the upper airway, improving the airway patency. OAm construction is based on the occlusal plane to disocclusion. In this study, the DIORS® appliance was used, a singular OAm, based on Neuro-Occlusal Rehabilitation concepts, that uses Camper's plane as a disocclusion reference, in order to achieve neuromuscular balance and functional stability. OBJECTIVE: This study primarily aimed to assess the DIORS® effectiveness in relation to clinical and polysomnographic outcomes. It was also evaluated if the use of DIORS® is as effective as titrated CPAP to treat CPAP non-adherent patients. METHODS: Twenty patients were included in this study. Objective and subjective clinical data were assessed at a sleep laboratory using all-night polysomnography, and Epworth Sleepiness Scale (ESS), taken at three moments: Baseline, CPAP titration, and using DIORS®. Analysis of respiratory parameters as apnea/hypopnea index (AHI), oxyhemoglobin saturation levels, the arousal index and daytime sleepiness were taken as criteria for a successful OAT. RESULTS: Respiratory and arousal parameters improved in both therapies, while DIORS® promoted a better ESS. CONCLUSION: Results from the present work support that DIORS® is a viable and effective adjuvant therapy for patients with moderate to severe OSA non-adherent to CPAP.

Effectiveness of resin composite polymerization when cured at different depths and with different curing lights.

This study evaluated how photocuring devices affected the microhardness of composite resin cylinders. For this study, 120 specimens of composite were fabricated and allocated randomly into 12 groups (n = 10), according to the light source (quartz-tungsten-halogen (QTH), LED, argon laser, plasma arc) and the height of the specimen (2.0, 4.0, or 6.0 mm). Twenty-four hours after the specimens were fabricated, the Knoop microhardness test was performed on bottom and top surfaces. Statistical analysis showed significant interaction among light sources, between light sources and specimen heights, and between the surfaces. Compared to the QTH specimens, the argon laser and plasma arc specimens showed reduced polymerization on the top surface, while the plasma arc specimens showed reduced polymerization on the bottom surface. The 4.0 mm samples demonstrated higher Knoop microhardness than the 2.0 mm and 6.0 mm samples, especially when argon laser and plasma arc curing lights were used. The microhardness was always higher on the top surface than on the bottom surface. No photocuring unit was able to properly polymerize the bottom surface as completely as the top surface.

Effect of different exposure times on caries detection and pixel value in a wireless digital system.

OBJECTIVES: : The aim of this study was to assess, using the CDR Wireless®, the effect of different exposure times on caries detection and pixel intensity values. MATERIALS AND METHODS: Forty teeth were x-rayed using a Schick CDR Wireless sensor at eight different exposure times - 0.06, 0.10, 0.13, 0.16, 0.20, 0.25, 0.30, and 0.32 s. Four observers evaluated the images for presence of carious lesions scoring proximal surfaces of each tooth on a 5-point scale. Scores were compared to histological sections of the teeth. Accuracy was evaluated by means of ROC curve analysis. Radiographs of an aluminum step wedge were obtained using the same eight exposure times. Pixel intensity measurements were obtained, and mean pixel values were statistically analyzed using linear regression. RESULTS: The Az for each exposure time varied from 0.53 to 0.62. Two-way analysis of variance and Tukey test demonstrated that the exposure time of 0.25 s presented the best result and was significantly higher than 0.30 s and 0.35 s. In regard to mean pixel values, two different behaviors were observed, and the exposure time of 0.20 s presented mean pixel values in both phases. CONCLUSION: The performance of the exposure times from 0.06 s to 0.25 s was satisfactory for proximal caries detection, and 0.25 s is the best as indicated for this finality. CLINICAL RELEVANCE: Considering that a reduction of exposure time represents a reduction of patient exposure dose, and this reduction cannot neglect image quality, the behavior of any digital system must be carefully evaluated.

Trans,trans-farnesol, an antimicrobial natural compound, improves glass ionomer cement properties.

A series of experiments were conducted to characterize a novel restorative material. We explored the effect on biological, physical and chemical properties of glass ionomer cement (GIC) adding-the naturally occurring tt-farnesol (900 mM). Two groups were accomplished for all assays: GIC+tt-farnesol and GIC (control). Biological assays: 1) agar diffusion against some cariogenic bacteria; 2) S. mutans biofilm formation and confocal laser scanning microscopy-CLSM. 3) gtfB, gtfC, gtfD, gbpB, vicR, and covR expression; 4) MTT and microscopic morphology. Physical properties assays: 1) roughness; 2) hardness; 3) compressive strength and 4) diametral tensile strength. Chemical assay: Raman spectroscopy. The adding of tt-farnesol to GIC led to larger zones of inhibition (p<0.05), biofilms with a short-term reduction in bacterial viability but similar biomass (p>0.05). Polysaccharides levels increased over time, similarly over groups (p>0.05). Viable and non-viable S. mutans were seen on the specimens' surface by CLSM but their virulence was not modulated by tt-farnesol. The tt-farnesol increased the HaCaT cell viability without impact on compressive and diametral tensile strength and roughness although the hardness was positively affected (p<0.05). Raman confirmed the presence of tt-farnesol. The incorporation of tt-farnesol into GIC inhibited the growth of cariogenic bacteria but had a little effect on the composition, structure and physiology of the biofilm matrices. Also, the tt-farnesol increased the hardness and the biocompatibility of the GIC, not influencing negatively other physical properties of the restorative material.

Asymmetric activation of temporalis, masseter, and sternocleidomastoid muscles in temporomandibular disorder patients.

The aim of this study was to analyze the symmetry of the electromyographic (EMG) activity of the temporalis, masseter, and sternocleidomastoid (SCM) muscles in volunteers divided into a control group and a temporomandibular disorder (TMD) group. The surface EMG recordings were made during mandibular rest position, maximal intercuspal position, and during the chewing cycle. Normalized EMG waves of paired muscles were compared by computing a percentage overlapping coefficient (POC). The difference between the groups and between the static and dynamic clenching tests was analyzed through repeated measures, ANOVA. Symmetry of the temporalis, masseter, and SCM muscles activity was smaller in the TMD group compared to the control group. The mandibular postures were also significantly different among themselves. The asymmetric activation of jaw and neck muscles was interpreted as a compensatory strategy to achieve stability for the mandibular and cervical systems during masticatory function.

Radiographic patterns of multiple myeloma in the jawbones of patients treated with intravenous bisphosphonates.

BACKGROUND: The purpose of this study was to evaluate whether intravenous (IV) bisphosphonate (BP) therapy can change the radiographic patterns of multiple myeloma (MM) in the jawbones. METHODS: The authors evaluated panoramic radiographs obtained from 188 patients with MM for the presence of solitary osteolytic lesions, multiple osteolytic lesions, diffuse osteoporosis, diffuse sclerosis, lamina dura abnormalities, nonhealing alveolar sockets, and bone sequestration. The authors compared results obtained from patients treated with IV BPs with those obtained from patients who had never been exposed to BPs. RESULTS: Multiple osteolytic lesions (P = .001), diffuse osteoporosis (P = .001), and diffuse sclerosis (P = .0036) occurred more often in the mandible in both groups. Solitary osteolytic lesions occurred less frequently in the BP group (P = .0078). Lamina dura abnormalities (P = .0006) and nonhealing alveolar sockets (P = .0021) were associated with BP treatment. CONCLUSIONS: IV BP therapy changes the radiographic patterns of MM in the jawbones. PRACTICAL IMPLICATIONS: The effect of BPs in the maxillofacial area is a matter of concern for health practitioners because this type of medication causes several alterations of the jawbones in patients with cancer.

Effectiveness in the Removal of Endotoxins and Microbiological Profile in Primary Endodontic Infections Using 3 Different Instrumentation Systems: A Randomized Clinical Study.

INTRODUCTION: This clinical study was conducted to correlate the microbiological profile and levels of endotoxins found in primary endodontic infection with the presence of clinical features and to evaluate the removal of microorganisms and endotoxins using rotary, reciprocating, and hybrid systems for biomechanical preparation. METHODS: Thirty single root canals with primary endodontic infection were evaluated with signs and symptoms and were randomly divided into 3 groups according to the instrumentation system used (n = 10) as follows: rotary Mtwo instruments (VDW, Munich, Germany) with 8 files, the reciprocating Reciproc system (VDW) with a single file, and Genius hybrid instruments with 3 files (1 rotary and 2 reciprocating files) with irrigation using 24 mL 2.5% sodium hypochlorite. Samples were collected before (S1) and after instrumentation (S2) before being submitted to microbiological culture (colony-forming units/mL) and the checkerboard DNA-DNA hybridization test. Endotoxins were quantified using the limulus amebocyte lysate assay. RESULTS: Microbiological culture showed statistical differences in the reduction of colony-forming units/mL with all systems tested (P < .05), but no statistical difference was found among the groups. The most frequently detected species were Capnocytophaga ochracea (53%) and Fusobacterium nucleatum (53%) at S1 and F. nucleatum (50%) and Leptotrichia buccalis (50%) at S2. As for the reduction of endotoxins at S2, Mtwo presented the best results (95.05%) followed by the Genius (91.85%) and Reciproc (64.68%) groups, but no statistical difference was found among the groups. Previous pain, tenderness to percussion, and presence of a sinus tract were associated with specific microorganisms (P < .05). CONCLUSIONS: Signs and symptoms were correlated with microorganisms. Endodontic treatment was effective in reducing bacteria and endotoxins but was not capable of completely removing them from the root canal.

Mandibular sexual dimorphism analysis in CBCT scans.

The aim of this study was to evaluate sexual dimorphism using anthropometric measurements on mandibular images obtained by cone beam computed tomography (CBCT). The sample consisted of 160 CT scans collected from a Brazilian population (74 males, 86 females) aged 18-60 years. The CBCT images were analyzed by five reviewers. Six measurements (ramus length, gonion-gnathion length, minimum ramus breadth, gonial angle, bicondylar breadth, and bigonial breadth) were collected for the sexual prediction analysis. For the statistical analysis, intraclass correlation was used to evaluate intra- and inter-reviewers, analysis of variance was used to compare the mean values of these measurements, binary logistic regression equations were created to predict sex. Using these four variables, the rate of correct sex classification was 95.1%. After, the discriminant function was used to validate the formula built. Accuracy of 93.33% and 94.74% was found for estimating male and females, respectively. Thus, the formula developed in this study can be used for sex estimation in forensic settings.

Could Acupuncture Be Useful in the Treatment of Temporomandibular Dysfunction?

In this study, the effects of acupuncture in comparison with flat occlusal plane appliance were evaluated in patient with myogenic temporomandibular dysfunction (TMD). The sample consisted of 40 women with TMD and unbalanced energy predominance of Yang Liver Ascension, selected using the Renying and Cunkou pulses, randomly divided into two groups: acupuncture and splint. The effect of treatments on the masseter and anterior temporal muscles was evaluated after 4 weeks of treatment, by means of electromyographic activity (root mean square) and pain pressure threshold. Pain intensity was measured using the visual analog scale, and range of mouth opening was evaluated using a millimeter ruler. All evaluations were performed at the beginning and end of the treatment. Visual analog scale score was reduced equally in the two groups (p < 0001), and the increase in range of mouth opening was significant in both groups. A significant difference was detected only in pain pressure threshold of the left masseter in the acupuncture group (p < 0.05). Only root mean square in the at rest position of the right temporal muscle diminished in the final stage of the splint group (p < 0.05). Both treatments reduced the pain intensity of myogenic TMD in the short term and may be considered strategies for control of chronic pain related to TMD.

A singular oral appliance to treat obstructive sleep apnea in CPAP non-adherent patients

ABSTRACT Introduction: The most prescribed treatment option for Obstructive Sleep Apnea (OSA) is CPAP; however, its adherence is limited. Oral Appliance therapy (OAT) is frequently an option or even an adjuvant, being the mandibular advancement Oral Appliance (OAm) the most used prescription. It modifies the upper airway, improving the airway patency. OAm construction is based on the occlusal plane to disocclusion. In this study, the DIORS® appliance was used, a singular OAm, based on Neuro-Occlusal Rehabilitation concepts, that uses Camper's plane as a disocclusion reference, in order to achieve neuromuscular balance and functional stability. Objective: This study primarily aimed to assess the DIORS® effectiveness in relation to clinical and polysomnographic outcomes. It was also evaluated if the use of DIORS® is as effective as titrated CPAP to treat CPAP non-adherent patients. Methods: Twenty patients were included in this study. Objective and subjective clinical data were assessed at a sleep laboratory using all-night polysomnography, and Epworth Sleepiness Scale (ESS), taken at three moments: Baseline, CPAP titration, and using DIORS®. Analysis of respiratory parameters as apnea/hypopnea index (AHI), oxyhemoglobin saturation levels, the arousal index and daytime sleepiness were taken as criteria for a successful OAT. Results: Respiratory and arousal parameters improved in both therapies, while DIORS® promoted a better ESS. Conclusion: Results from the present work support that DIORS® is a viable and effective adjuvant therapy for patients with moderate to severe OSA non-adherent to CPAP.

RESUMO Introdução: A opção mais indicada para tratamento da apneia obstrutiva do sono (AOS) é o CPAP; contudo, a aderência é limitada. A Terapia com Aparelho Oral (TAO) é, frequentemente, uma opção, ou mesmo um adjuvante. A prescrição mais utilizada é o Aparelho Oral de avanço mandibular (AOm). O AOm modifica a via aérea superior, melhorando a patência do espaço aéreo. A construção do AOm se baseia no plano de oclusão para desoclusão. No presente estudo, usamos o DIORS®, um AOm diferente, baseado nos conceitos da Reabilitação Neuro-Oclusal (RNO), que utiliza o Plano de Camper como referência da desoclusão para alcançar o equilíbrio neuromuscular e estabilidade funcional. Objetivo: O presente estudo teve como objetivo principal abordar a eficácia do DIORS®, considerando-se os resultados clínicos e polissonográficos. Adicionalmente, foi avaliado, também, se o uso desse AOm é tão eficaz quanto a titulação do CPAP para tratar pacientes com AOS não aderentes ao CPAP. Métodos: Vinte pacientes foram incluídos neste estudo. Dados clínicos objetivos e subjetivos foram avaliados em um laboratório de sono usando polissonografia de noite inteira e a Escala de Sonolência de Epworth (ESE) observando-se três momentos: inicial, titulação do CPAP e usando o DIORS®. Os critérios de sucesso da TAO foram assumidos pela análise dos parâmetros respiratórios como Índice de Apneia e Hipopneia (IAH) e níveis de saturação de oxi-hemoglobina, o índice de despertar e a sonolência diurna. Resultados: Em ambas as terapias, os parâmetros respiratórios e de despertares melhoraram. Adicionalmente, uma melhora na ESE foi alcançada com o DIORS®. Conclusão: Os resultados do presente trabalho apoiam que o DIORS® é uma terapia adjuvante viável e bastante eficaz para pacientes com AOS moderada a grave não aderentes ao CPAP.

Facial pain associated with fibromyalgia can be marked by abnormal neuromuscular control: a cross-sectional study.

BACKGROUND: Temporomandibular disorder (TMD) development in fibromyalgia syndrome (FMS) is not yet fully understood, but altered neuromuscular control in FMS may play a role in triggering TMD. OBJECTIVE: The purpose of this study was to verify the association between neuromuscular control and chronic facial pain in groups of patients with FMS and TMD. DESIGN: A cross-sectional study was conducted. METHODS: This study involved an analysis of facial pain and electromyographic activity of the masticatory muscles in patients with FMS (n=27) and TMD (n=28). All participants were evaluated according to Research Diagnostic Criteria for Temporomandibular Disorders and surface electromyography (SEMG). Myoelectric signal calculations were performed using the root mean square and median frequency of signals. RESULTS: The data revealed premature interruption of masticatory muscle contraction in both patient groups, but a significant correlation also was found between higher median frequency values and increased facial pain. This correlation probably was related to FMS because it was not found in patients with TMD only. Facial pain and increased SEMG activity during mandibular rest also were positively correlated. LIMITATIONS: Temporal conclusions cannot be drawn from the study. Also, the study lacked a comparison group of patients with FMS without TMD as well as a control group of individuals who were healthy. CONCLUSIONS: Altered neuromuscular control in masticatory muscles may be correlated with perceived facial pain in patients with FMS.