Immediate versus conventional loading of mandibular implant-retained overdentures: a 3-year follow-up of a randomized controlled trial.

OBJECTIVES: There is a scarcity of randomized clinical trials (RCT) that report medium- and long-term results and a lack of consensus in the literature on the predictability of immediately loaded unsplinted narrow diameter implants supporting mandibular overdentures. This RCT compared the performance of conventional (CL) and immediate loading (IL) of mandibular overdentures retained by two narrow-diameter implants for 3 years. MATERIALS AND METHODS: Patients from an RCT treated with CL or IL were invited to attend to 2- and 3-year follow-ups. Clinical, radiographic, functional, and oral health-related quality of life parameters were evaluated. Prosthetic maintenance events, biological complications, and success and survival rates were also recorded. The data were tested by multilevel mixed-effects linear regression analysis and chi-squared tests. RESULTS: The 1-year survival rates of 90% in the CL group and 85% in the IL group were maintained as no implants were lost between 1 and 3 years. The marginal bone loss (MBL) in the IL group was significantly lower after year 3 (-0.04; p < 0.01). Significant changes were found only for the intra-group comparisons in the third year of function: (i) CL and IL presented similar progression of implant stability, MBL, and posterior bone area resorption; (ii) while CL started deteriorating of masticatory function, IL still exhibited functional evolution and (iii) oral comfort domain in the CL and pain domain in the IL were improved. CONCLUSION: Although IL experienced the lowest MBL after 3 years, the outcomes showed that both loading protocols result in predictable medium-term rehabilitation when monitored annually. CLINICAL RELEVANCE: It can be expected that in the third year of function, patients with immediate loading may present more complaints related to general performance even with acceptable masticatory function and self-reported improvements in oral comfort.

Is predicting masticatory function based on mandibular bone atrophy as defined by clinical and radiographic parameters possible? A clinical study.

STATEMENT OF PROBLEM: The degree of mandibular bone atrophy can guide and determine the choice of prosthetic treatment. Although several methodologies have been proposed for classifying atrophy, the clinical and radiographic parameters considered for the classification of mandibular bone atrophy should be standardized. PURPOSE: The purpose of this clinical study was to evaluate the influence of methodologies of mandibular bone atrophy categorization on the masticatory function in complete denture (CD) wearers and to verify the relationship between these parameters according to the retention and stability of the mandibular CD. MATERIAL AND METHODS: CD wearers were radiographically and clinically evaluated to determine the mandibular bone atrophy levels. Three classifications were adopted: the Cawood and Howell criteria, the Wical and Swoope criteria, and the Kapur classification. CD retention and stability were scored based on the Sato et al method. The masticatory function was evaluated by the multiple sieve method using optical test food to determine the masticatory performance (MP) indexes (median particle size, MP X50; homogeneity index, MP B) and the masticatory efficiency (sieves 4 and 2.8). RESULTS: In this sample of 63 individuals (mean age of 67.4 years), atrophic participants presented significant differences in all radiographic parameters (Mann-Whitney test, P<.05) with both the Cawood and Howell and Wical and Swoope methodologies. No differences in masticatory function were found, except for atrophic participants classified by Wical and Swoope criteria, who had worse MP X50 (P=.047) than nonatrophic participants, with a medium effect size of 0.7. The retention of the mandibular CD significantly affected the masticatory outcomes, with higher values for MP X50 (P=.012) and MP B (P=.040) and lower values for masticatory efficiency, 2.8 (P=.008) for atrophic participants. The presence of mandibular bone atrophy showed an association with poor retention (P=.04) and poor stability (P=.002) when the Cawood and Howell criteria were adopted (Fisher exact test, P<.05). CONCLUSIONS: The Kapur classification confirmed the clinical condition of the participants' atrophy, and the most clinically atrophic participants showed poor retention and stability of the mandibular CD. Only the poor retention directly affected the masticatory function. Radiographic evaluations alone did not provide sufficient data to determine the predictability of CD treatment regarding the participants' masticatory function. Radiographically, atrophic participants with poor retention had impaired mastication.

Influence of facial patterns on the masticatory function and quality of life of completely edentulous patients during the transition to implant-retained mandibular overdentures.

STATEMENT OF PROBLEM: Although implant-retained mandibular overdentures (IMOs) provide functional benefits, the influence of the vertical facial pattern (FP) and the anteroposterior skeletal discrepancy (ASD) on the masticatory function and patient-centered outcomes during the transition to IMOs is still uncertain. PURPOSE: The purpose of this interventional clinical study was to evaluate the influence of the FP and ASD on the masticatory function, oral health-related quality of life (OHRQoL), and satisfaction of completely edentulous patients before and after transition to IMOs. MATERIAL AND METHODS: Cephalometric analysis was performed on 42 participants before treatment. Ricketts analysis was used to classify the FP, and the maxillomandibular relationship to the base of the skull determined the ASD. Masticatory performance (MP) and swallowing threshold (ST) test results were evaluated by the multiple sieve method by using artificial test food (Optocal cubes) to determine the median particle size (×50), homogenization index (B), and masticatory efficiency based on sieves 5.6 (ME: 5.6) and 2.8 (ME: 2.8). OHRQoL and satisfaction were evaluated by using the Dental Impact on Daily Living questionnaire. The data were analyzed using mixed-effects linear regression models to estimate the effect of time, FP, ASD, age, and sex on MP, ST, and OHRQoL. RESULTS: The MP, ST, OHRQoL, and satisfaction improved significantly after IMO loading, irrespective of FP and ASD. However, MP outcomes were most negatively affected mainly among dolichofacial (B and ME: 2.8), class II, and class III (×50, B, and ME: 2.8) participants. The ST test showed that class II participants still showed inferior ×50 values and performed a lower number of cycles than class I and class III participants. Women presented reduced masticatory function for all MP and ST outcomes and reported lower coefficients for appearance and general performance domains than men. CONCLUSIONS: The MP test detected more subtle improvements than the ST test, especially in class III participants. The class II participants benefited the least from the IMO installation according to the ST test. The IMO treatment improved the OHRQoL and satisfaction of edentulous patients, irrespective of the FP or ASD.

Efficacy of citric acid denture cleanser on the Candida albicans biofilm formed on poly(methyl methacrylate): effects on residual biofilm and recolonization process.

BACKGROUND: It is well known that the use of denture cleansers can reduce Candida albicans biofilm accumulation; however, the efficacy of citric acid denture cleansers is uncertain. In addition, the long-term efficacy of this denture cleanser is not well established, and their effect on residual biofilms is unknown. This in vitro study evaluated the efficacy of citric acid denture cleanser treatment on C. albicans biofilm recolonization on poly(methyl methacrylate) (PMMA) surface. METHODS: C. albicans biofilms were developed for 72 h on PMMA resin specimens (n = 168), which were randomly assigned to 1 of 3 cleansing treatments (CTs) overnight (8 h). CTs included purified water as a control (CTC) and two experimental groups that used either a 1:5 dilution of citric acid denture cleanser (CT5) or a 1:8 dilution of citric acid denture cleanser (CT8). Residual biofilms adhering to the specimens were collected and quantified at two time points: immediately after CTs (ICT) and after cleaning and residual biofilm recolonization (RT). Residual biofilms were analyzed by quantifying the viable cells (CFU/mL), and biofilm architecture was evaluated by confocal laser scanning microscopy (CLSM) and scanning electron microscopy (SEM). Denture cleanser treatments and evaluation periods were considered study factors. Data were analyzed using two-way ANOVA and Tukey's Honestly Significant Difference (HSD) test (α = 0.05). RESULTS: Immediately after treatments, citric acid denture cleansing solutions (CT5 and CT8) reduced the number of viable cells as compared with the control (p < 0.01). However, after 48 h, both CT groups (CT5 and CT8) showed biofilm recolonization (p < 0.01). Residual biofilm recolonization was also detected by CLSM and SEM analysis, which revealed a higher biomass and average biofilm thickness for the CT8 group (p < 0.01). CONCLUSION: Citric acid denture cleansers can reduce C. albicans biofilm accumulation and cell viability. However, this CT did not prevent biofilm recolonization.

Functional performance and impact on the quality of life of three treatment strategies for mandibular edentulism: Results of a parallel 3-group cross-sectional study.

OBJECTIVES: This parallel cross-sectional study compared masticatory function and patient-centered outcomes among 3 removable treatment strategies for mandibular edentulism. METHODS: Thirty-six edentulous participants rehabilitated using 3 removable treatment strategies for mandibular edentulism were allocated to one of the three groups (n=12): CCD (control), 2-IMO, and 3-IMO. Narrow diameter implants were installed using single-stage surgery and conventionally loaded with stud abutments. After 3 months of usage, the quality of life, maximum bite force, and masticatory function were evaluated. Data were analyzed with the Kruskal-Wallis test and post hoc pairwise Mann-Whitney tests with Bonferroni correction (α=0.05). RESULTS: The 2-IMO and 3-IMO wearers did not show significant differences in any outcome, except for the 2 domains of 3-IMO wearers quality of life that obtained better Pain and General Performance scores. Both IMO groups presented significantly higher maximum bite force than CCD wearers. The 2-IMO wearers showed superior outcomes to the CCD group in all outcomes of the masticatory performance test and the X50, B and ME5.6 outcomes of the swallowing threshold test (p = 0.01), while 3-IMO participants only showed superior masticatory performance in terms of lower X50 values (19.86%, p = 0.02) and higher ME 2.8 (141.15%, p = 0.04) than CCD wearers. CONCLUSIONS: Compared to 2-IMO wearers, 3-IMO wearers report superior impact of treatment on daily living activities in the Pain and General Performance domains. 2-IMO and 3-IMO wearers showed no significant differences between them for all evaluated bite force and masticatory function parameters. CLINICAL SIGNIFICANCE: Although overdentures retained by 3 implants (3-IMO) provide biomechanical advantages over those retained by 2 implants (2-IMO), superior clinical and functional effectiveness is not yet proven.

Microscopical analysis of Candida albicans biofilms on heat-polymerised acrylic resin after chlorhexidine gluconate and sodium hypochlorite treatments.

The ability of Candida albicans to form biofilms on denture surfaces is a significant cofactor in the pathogenesis of denture stomatitis. In this study, we applied a differential staining approach and scanning electron microscopy (SEM) to analyse the effect of sodium hypochlorite and chlorhexidine gluconate on the viability, removal and morphology of C. albicans forming biofilms on denture acrylic using an in vitro model. Immediately after treatment, to distinguish live from dead C. albicans cells in the remaining biofilms, the specimens were stained differentially and analysed by confocal scanning laser microscopy. Moreover, morphological alterations of fungal cells were investigated using scanning electron microscopy. All disinfectant solutions killed all remaining fungal cells on the specimens. Interestingly, 4% chlorhexidine did not remove these cells from the acrylic resin surface whereas sodium hypochlorite solutions (1% and 2%) provided almost complete biofilm removal. Furthermore, treating the specimens with sodium hypochlorite induced cell morphology alterations, as seen in the residual fungal cells. Finally, according to our findings, it can be suggested that sodium hypochlorite solutions are the first choice as denture cleanser when compared with 4% chlorhexidine because those solutions not only killed C. albicans biofilms but also removed them from the heat-polymerised acrylic resin.

Prosthetic aftercare, mastication, and quality of life in mandibular overdenture wearers with narrow implants: A 3-year cohort study.

OBJECTIVES: This cohort study investigated clinical, functional, and quality of life outcomes, along with prosthetic maintenance events in mandibular overdenture (MO) wearers for 3 years. METHODS: Thirty MO wearers with narrow diameter implants (NDIs) and locking taper stud abutments (Facility-Equator system) were annually monitored by registering the visible plaque index (VPI), peri­implant inflammation (PI), calculus presence (CP), probing depth (PD), bleeding on probing (BOP), secondary implant stability (ISQ), marginal bone loss (MBL), masticatory performance and dental impact in daily life (DIDL) questionnaire domains. Multilevel mixed-effects linear regression was performed to analyse changes over time. Chi-square tests were performed to analyse the relationship between the appearance of prosthetic complications and maintenance occurrences. The survival rate of patients with NDIs was calculated using the Kaplan-Meier test. RESULTS: Twenty-six individuals attended all follow-ups, the survival rate of 83.3% in the first year was maintained, and no one implant was lost over the 3-year period. There were significant differences for PD between 1 and 3 years (p ≤ 0.01) and between 2 and 3 years for PI (p ≤ 0.01), GI (p ≤ 0.01), ISQ (p = 0.02), and MBL (p ≤ 0.01). All masticatory performance outcomes showed significant differences (p ≤.01). Prosthetic maintenance events decreased significantly over time. Appearance, general performance, and eating and chewing domains presented high effect sizes. CONCLUSION: Continued changes were observed in the clinical parameters of MO users over the 3-year period. In addition, most functional parameters, except for particle homogenization, improved significantly over time. The positive impact on quality of life is likely related to the significant reduction in prosthetic maintenance events. CLINICAL SIGNIFICANCE: Periodic returns to assess peri­implant tissues and MO maintenance should be performed to ensure the success of rehabilitation to assure improvements in masticatory function and oral health-related quality of life.

Influence of Facial Morphology on Masticatory Function and Quality of Life in Elders Using Mandibular Overdentures: 3-Year Results.

Background: Facial types may interfere in the oral health-related quality of life (OHRQoL) and masticatory performance of implant-retained mandibular overdenture (IMO) wearers. Purpose: Investigate the medium-term changes in the masticatory function (MF) and OHRQoL parameters of IMO users, as a function of facial pattern, anteroposterior skeletal discrepancy, and sex. Methods: Forty IMO users, most of them Caucasian (90%) with average age of 69.17 years were classified according to their facial pattern and antero-posterior discrepancy prior to rehabilitation. MF was evaluated by the multiple sieves method to determine the average particle size (X50), heterogeneity (B) and masticatory efficiency (ME, calculated as the percentage of material retained in the 5.6 and 2.8 mm sieves), using Masticatory performance (MP) and swallowing threshold (ST) tests. OHRQoL was measured by applying the dental impact on daily life (DIDL) questionnaire. The data were analyzed by Wilcoxon-paired tests to analyze changes in MF parameters over time, and mixed-effect multilevel regression models were employed to verify differences between groups. Results: Significant changes were still observed in the 3rd year for the ST test with improvements in B for Mesofacial and in time for Dolichofacial individuals, while ME_2.8 deteriorated for Brachyfacial participants. B values of Class I and male individuals improved and brachyfacial individuals still presented worse homogenization (B) than Mesofacial participants in both masticatory tests. Class II and III participants still showed improvements in ME_5.6 and time compared to Class I despite increases in X50. Class II individuals needed less cycles than Class I in the 3rd year. Brachyfacial participants scored lower in the Appearance domain than Mesofacial ones in the 3rd year. Dolichofacial participants and Class III patients scored lower in the Oral Comfort domain than Mesofacial and Class I, respectively. In addition, age influenced the Pain, Oral Comfort and General Performance domains in the 3rd year. Conclusions: Differences in facial morphology continue to influence the MF and OHRQoL outcomes in the 3rd year, and age influenced some OHRQoL domains. Brachyfacial individuals continue to benefit least from rehabilitation with IMO according to masticatory parameters.

Effect of repeated cycles of chemical disinfection on the roughness and hardness of hard reline acrylic resins.

OBJECTIVE: The aim of this study was to assess the effect of repeated cycles of five chemical disinfectant solutions on the roughness and hardness of three hard chairside reliners. METHODS: A total of 180 circular specimens (30 mm x 6 mm) were fabricated using three hard chairside reliners (Jet; n = 60, Kooliner; n = 60, Tokuyama Rebase II Fast; n = 60), which were immersed in deionised water (control), and five disinfectant solutions (1%, 2%, 5.25% sodium hypochlorite; 2% glutaraldehyde; 4% chlorhexidine gluconate). They were tested for Knoop hardness (KHN) and surface roughness (microm), before and after 30 simulated disinfecting cycles. Data was analysed by the factorial scheme (6 x 2), two-way analysis of variance (anova), followed by Tukey's test. RESULTS: For Jet (from 18.74 to 13.86 KHN), Kooliner (from 14.09 to 8.72 KHN), Tokuyama (from 12.57 to 8.28 KHN) a significant decrease in hardness was observed irrespective of the solution used on all materials. For Jet (from 0.09 to 0.11 microm) there was a statistically significant increase in roughness. Kooliner (from 0.36 to 0.26 microm) presented a statistically significant decrease in roughness and Tokuyama (from 0.15 to 0.11 microm) presented no statistically significant difference after 30 days. CONCLUSIONS: This study showed that all disinfectant solutions promoted a statistically significant decrease in hardness, whereas with roughness, the materials tested showed a statistically significant increase, except for Tokuyama. Although statistically significant values were registered, these results could not be considered clinically significant.

Clinical Versatility of the Facility-Equator Implant System as Mandibular Overdenture Retainers.

The use of mandibular overdentures (MO) for the rehabilitation of totally edentulous individuals with limited bone availability is widespread and has proven clinical success. Narrow diameter implants (NDI) are available on the market as MO retainers to solve problems related to limited bone availability and bone thickness, providing a low-cost, minimally invasive treatment option. This technique evolved over the years, and changes frequently involved the number of implants used as MO retainers, as the adoption of a smaller number of implants can generate biomechanical disadvantages, contributing to the increased stress in peri-implant tissues, which may accelerate marginal bone loss (MBL), in addition to reducing masticatory capacity and satisfaction with rehabilitation. Some studies pointed out that the use of 3 or more implants as MO retainers improves the biomechanics. Thus, the objective of this study was to report 3 different clinical cases where 3 or more NDI were adopted to retain mandibular overdentures in association with diverse loading protocols: (i) 3 implants adopting conventional loading, (ii) 4 implants using progressive loading, and (iii) 4 implants with hybrid loading. The case with 4 implants and progressive loading showed a slight worsening of masticatory function at 1 year, in addition to a more pronounced MBL compared to other cases, but with improvements in satisfaction and oral health-related quality of life. Thus, NDI can be used as MO retainers with predictability and clinical success, using different numbers of implants and loading protocols.

Discriminating Masticatory Performance and OHRQoL According to Facial Morphology in Complete Denture Wearers: A Single-Center Controlled Study.

PURPOSE: To evaluate the influence of facial type and anteroposterior skeletal discrepancy of complete denture wearers on residual ridge height, masticatory performance, oral health-related quality of life (OHRQoL), and satisfaction levels. MATERIALS AND METHODS: A total of 56 edentulous patients (mean age of 67.1 years) were radiographically evaluated prior to rehabilitation to determine residual ridge height in the maxilla and mandible, facial type, and anteroposterior skeletal discrepancy. Masticatory performance tests with 40 chewing cycles were applied. The Dental Impact on Daily Living questionnaire was used to measure OHRQoL and satisfaction. Data were analyzed with Kruskal-Wallis test and logistic regression. RESULTS: Dolichofacial participants presented with significantly higher bone height than mesofacial and brachyfacial types in the anterior region of the maxilla and mandible and had more mandibular bone than mesofacial types in the premolar region. Class II patients presented significantly higher bone height than Class I participants in the anterior maxilla. Dolichofacial patients performed significantly better than brachyfacial patients in the masticatory performance test. Class I patients achieved more homogenous artificial food trituration than Class III patients (P < .05). High OHRQoL scores were reported in appearance and general performance irrespective of facial type or anteroposterior skeletal discrepancy. CONCLUSION: Dolichofacial patients had superior masticatory performance compared to brachyfacial patients. Class III patients showed a reduced capacity to homogenize the food bolus. Mesofacial, dolichofacial, and Class III patients reported the best perceptions of their OHRQoL. Anteroposterior skeletal discrepancy seems to be the main factor contributing to mastication impairments in totally edentulous patients.

A simplified technique for fabricating complete dentures for patients with Parkinson's disease: a case report / Técnica simplificada como alternativa para confecção de próteses totais para paciente com Doença de Parkinson: relato de caso

BACKGROUND AND OBJECTIVE: Parkinson's disease is a neurological disorder that affects 1% of individuals aged 60 years and older. The associated symptoms can impose limitations on the available dental treatment options. CASE DESCRIPTION: This case report follows the CARE guidelines and presents an adapted and simplified technique to fabricate complete dentures for a 74-year-old male edentulous patient with Parkinson's disease. This modified technique enabled the fabrication of complete dentures in 4 clinical sessions of approximately 40 minutes. The first session involved manufacturing a preliminary impression with fast-setting alginate. The base plates and occlusal rims were then adjusted for artificial teeth arrangement during the second session. The final prosthesis was completed in the third session, which involved a teeth try-in and fabrication of a functional impression with low-melting thermoplastic material and polyether. Finally, denture installation was performed in the fourth session and follow-up consisted of 3 weekly sessions. DISCUSSION: Considering that the treatment provided satisfactory aesthetics and function, mastication and socialization benefits, and improved the self-esteem and well-being of the older patient with Parkinson's disease, the authors suggest this adapted and simplified technique for fabricating complete dentures. (AU)

JUSTIFICATIVA E OBJETIVO: A doença de Parkinson é uma desordem neurológica que afeta 1% dos indivíduos com 60 anos ou mais. Os sintomas associados podem impor limitações nas opções de tratamento odontológico disponíveis. DESCRIÇÃO DO CASO: Este relato de caso segue o protocolo CARE e apresenta uma adaptação da técnica simplificada para confecção de novas próteses totais, para um paciente edêntulo, do sexo masculino, de 74 anos com doença de Parkinson. Essa técnica modificada possibilita a confecção de próteses totais em quatro sessões clínicas de aproximadamente 40 minutos. A primeira sessão envolveu uma moldagem preliminar com alginato de presa rápida. As placas articulares com rodetes de cera foram ajustadas para montagem dos dentes artificiais durante a segunda sessão. A prótese definitiva foi concluída na terceira sessão, que envolveu a prova dos dentes e moldagem funcional com material termoplástico de baixa fusão e poliéter. Por fim, a instalação da prótese foi realizada na quarta sessão e o acompanhamento consistiu em três sessões semanais. DISCUSSÃO: Considerando que o tratamento proporcionou estética e função satisfatórias, benefícios mastigatórios e de socialização, melhora da autoestima e bem-estar do idoso com doença de Parkinson, os autores sugerem o uso da adaptação da técnica simplificada para confecção de prótese total. (AU)

Masticatory function of conventional complete denture wearers changing to 2-implant retained mandibular overdentures: clinical factor influences after 1year of function.

PURPOSE: Evaluate how clinical factors related to conventional complete denture (CCD) wearers, can influence masticatory function (MF) of totally edentulous patients before and after one-year transitioning to implant-retained mandibular overdentures (IMO). METHODS: Forty patients using CCD were rehabilitated with IMO and their MF was evaluated by: (i) ST_X50: theoretical aperture through which 50% of the weight of the particles would pass; (ii) STB: distribution homogeneity of the crushed particles. The clinical parameters analyzed were: atrophy, retention, stability, facial type, anteroposterior skeletal discrepancy, and type of loading. The statistical association was tested through crude and adjusted logistic regression. RESULTS: IMO promoted improvements in the MF, irrespective of the clinical parameters. CCD wearers with poor retention had 86% less chance of achieving a good ST_X50. STB was associated with stability, facial type, and anteroposterior discrepancy. Subjects with poor mandibular CCD stability had a 76% lower chance of achieving a good test food homogenization, whereas brachyfacial individuals were 1.3 times more likely to have a good STB. Class II patients had an 89% lower chance of having a good homogenization of the particles as CCD users and after transition to IMO. CONCLUSIONS: CCD users with poor retention achieved an inferior ST_X50. The STB performance can be compromised by poor stability or Class II characteristics, while brachyfacial individuals achieve better homogenezation of the food bolus. Although the transition to IMO improved the masticatory function, the anteroposterior discrepancy still maintained an association with STB, as Class II individuals still presented difficulties homogenizing food.

Death Cafe como uma estratégia formativa em fonoaudiologia paliativista / Death Cafe as a formative strategy in speech and language and audiology in in palliative care

RESUMO As intervenções fonoaudiológicas podem ser influenciadas pela forma como se pensa, sente e fala sobre a morte e o morrer. A literatura sugere que o (futuro) fonoaudiólogo deve aprender a administrar suas respostas emocionais relacionadas à morte e ao morrer e ampliar suas perspectivas para considerar a morte e o morrer como parte da experiência humana, por meio de estratégias formativas reflexivas e de aprendizagem experiencial, assemelhando-se às características de um Death Cafe, tornando seu uso formativo potencialmente aplicável neste contexto. O Death Cafe é uma franquia social global com regras preestabelecidas, em que as pessoas se reúnem para discutir livremente a morte como parte da vida, sem objetivos ou temas predefinidos, distinguindo-se do apoio ao luto, palestras e afins. Estudos discutem os benefícios da participação de estudantes e profissionais de saúde em Death Cafe, incluindo a transformação da morte numa perspectiva naturalista, a exploração da humanidade do morrer, a reavaliação de como abordam e querem abordar os cuidados de fim de vida, a gestão das emoções e a melhoria do julgamento clínico.

ABSTRACT Speech therapy interventions may be influenced by how one thinks, feels, and talks about death and dying. The literature suggests that the (future) speech therapist should learn how to manage their emotional responses related to death and dying and broaden their perspectives to consider death and dying as part of the human experience through reflective formative strategies and experiential learning, resembling the characteristics of a Death Cafe. This makes its formative use potentially applicable in this context. The Death Cafe is a global social franchise with pre-established rules, where people gather to freely discuss death as a part of life, without predefined objectives or themes, distinguishing it from grief support, lectures, and the like. Studies discuss the benefits of students and healthcare professionals participating in Death Cafe, including transforming death into a naturalistic perspective, exploring the humanity of dying, reassessing how they approach and want to approach end-of-life care, managing emotions, and enhancing clinical judgment.

Etiology, diagnosis, and demographic analysis of maxillofacial trauma in elderly persons: A 10-year investigation.

PURPOSE: The aim of this study was to investigate etiologies and diagnoses of maxillofacial trauma in emergency services in Brazil over a period of 10 years. Additionally, associations among sex, age, accident location, and dependent variables were analyzed. Understanding the epidemiology of trauma and the physiology of aging is important in maintaining health and bettering service for the elderly population. MATERIALS AND METHODS: The primary mode of investigation was analysis of medical records from 2003 to 2013. These researchers recorded the diagnosis and etiology of the trauma, the location where the accident occurred, and the sex and age of the participants. Variable categories were compared using Chi-squared distribution, and logistic regression was used to analyze the associated factors. RESULTS: Of the 677 individuals analyzed, the female sex was predominant (57.61%) and the most prevalent age ranges were between 60 and 69 years (40.18%) and between 70 and 79 years (35.16%). Chi-squared distribution showed that men suffered more fractures (18.47%, p = 0.028) and women suffered more contusions (21.54%, p = 0.028). With regard to the various etiologies related to the traumas, traffic accidents (17.77%, p < 0.001) and aggression (17.42%, p < 0.001) were more frequent in males, and falls (83.03%, p < 0.001) were more frequent in females. The primary etiologies for maxillofacial trauma in the elderly population were falls, and the primary diagnoses were fractures. CONCLUSION: A deeper understanding of the physiological changes associated with aging, and preventive action to reduce falls, traffic accidents, and aggression in this population could be beneficial with regard to quality of life for elderly persons.

Short-term quality of life change perceived by patients after transition to mandibular overdentures

The aim of this longitudinal observational study was to evaluate the oral health-related quality of life (OHRQoL) following patient rehabilitation with implant-retained mandibular overdentures (IMO) and to identify the contribution of the different domains to OHRQoL. The Oral Health Impact Profile (OHIP-EDENT), Dental Impact on Daily Living (DIDL), and Geriatric Oral Health Assessment Index (GOHAI) questionnaires were completed twice by 25 patients: after 3 months of rehabilitation with complete dentures (CD) and after 3 months of IMO loading using stud abutments. The evaluation after IMO rehabilitation showed significant improvement in three DIDL domains: appearance (p = 0.011), eating and chewing (p = 0.003), and general performance (p = 0.003). The GOHAI results showed significant differences in two domains: psychosocial (p = 0.005) and pain and discomfort (p = 0.0004). The OHIP-EDENT outcomes showed significant improvements in five domains: functional limitation (p = 0.0001), physical pain (p = 0.0002), physical disability (p = 0.0010), and psychological disability and handicap (p = 0.032). The largest observed effect sizes were close to one standard deviation and were observed in the eating and chewing domain (0.93) of the DIDL; the pain and discomfort domain (0.83) of the GOHAI, and the functional limitation (0.89), physical pain (1.02), physical disability (0.84) domains of the OHIP-EDENT. The percentage of satisfied patients increased in all domains. Self-reported OHRQoL of CD wearers was significantly improved after 3 months of treatment with IMO, especially concerning the functional and pain-related aspects.

Masticatory function parameters in patients with varying degree of mandibular bone resorption.

PURPOSE: This cross-sectional study analyzes how bone resorption affects the masticatory function and investigates the relation between perceived and measured masticatory function. METHODS: Thirty complete dentures wearers were divided in two groups according to mandible bone atrophy based on the classification criteria from Cawood & Howell. Retention and stability of the mandibular complete denture, masticatory performance (MP) indexes (X_50 and B) and masticatory efficiency (ME, sieves 4 and 2.8) were evaluated. Geriatric Oral Health Assessment Index (GOHAI) and Dental Impact on Daily Living (DIDL) questionnaires were completed by the patients. RESULTS: A strong correlation between bone atrophy and poor retention was found (P=0.0132). Neither masticatory performance indexes nor GOHAI and DIDL domains showed statistical differences (P>0.05) when patients were compared according to the atrophy criteria. Mandibular length showed a negative correlation with ME4, showing a positive association (R2=0.17, ß=-0.67, P=0.029). Mandibular denture retention was significantly correlated with MPB (P=0.01) and ME2.8 (P=0.01). GOHAI showed a positive association between the physical and the functional domains and ME2.8 (R2=0.17; ß=1.22; P=0.02). DIDL showed a negative association between ME4 and oral comfort domain (R2=0.16; ß=-2.94; P=0.02). CONCLUSION: Mandibular bone height does not directly affect the masticatory function and is inversely correlated with the self-perceived masticatory ability.

Semirigid cantilever extension system for splinting implants: a clinical report.

In mandibular edentulous patients, treatment based on immediate loading with rigid splinting in the mandible is well accepted; however, it is cost and time dependent, which sometimes limits this type of rehabilitation. To overcome these problems, the technique of immediate loading using a semirigid splinting extension system has been developed. Its advantages include low cost, technical feasibility, and reduced clinic time. This clinical report presents the applicability and the predictability of semirigid splinting of implants in the mandibular arch of an edentulous patient using a distal extension bar prosthesis system.

Prevalence of risk factors for denture stomatitis in complete denture wearers

Aim: The prevalence of denture stomatitis and the relationship with its risk factors was evaluated via secondary data from 62 complete denture (CD) wearers, between 2015 and 2017. Methods: The data was stored in an Excel database and was analyzed using the statistics software STATA/SE 12.0. A descriptive analysis was performed taking into account a categorization of the clinical variables according to risk factor in 4 domains: CD usage, systemic health, hygiene habits, and usage habits. The association amongst the denture stomatitis and risk factors variables was tested by the Chi-square test and the results were statistically significant at p-values <0.05. Results: The CD wearers participants were composed by a majority of elderly (80.64%) and women (72.78%); with 45.16% having been using the current denture for more than 10 years and another 74.19% related a continuous usage. Diabetes and hypertension were related by 83.87% and 67.74%, respectively, with 87.10% using medication. Although 75.80% reported cleaning their dentures 3 times per day or more, and 59.68% considered their oral hygiene very good, 50% of the complete dentures showed dirtiness and clinical signs of Denture Stomatitis were present in 30.64% of the patients. Despite of the evaluated sample shows many risk factors for the development of the disease, an association between the variables was not observed. Conclusion: Considering the high prevalence of the disease in the studied sample, preventive and educational measures on denture usage and hygiene must be reinforced in order to maintain the oral health of the edentulous patients

Short-term quality of life change perceived by patients after transition to mandibular overdentures

Abstract The aim of this longitudinal observational study was to evaluate the oral health-related quality of life (OHRQoL) following patient rehabilitation with implant-retained mandibular overdentures (IMO) and to identify the contribution of the different domains to OHRQoL. The Oral Health Impact Profile (OHIP-EDENT), Dental Impact on Daily Living (DIDL), and Geriatric Oral Health Assessment Index (GOHAI) questionnaires were completed twice by 25 patients: after 3 months of rehabilitation with complete dentures (CD) and after 3 months of IMO loading using stud abutments. The evaluation after IMO rehabilitation showed significant improvement in three DIDL domains: appearance (p = 0.011), eating and chewing (p = 0.003), and general performance (p = 0.003). The GOHAI results showed significant differences in two domains: psychosocial (p = 0.005) and pain and discomfort (p = 0.0004). The OHIP-EDENT outcomes showed significant improvements in five domains: functional limitation (p = 0.0001), physical pain (p = 0.0002), physical disability (p = 0.0010), and psychological disability and handicap (p = 0.032). The largest observed effect sizes were close to one standard deviation and were observed in the eating and chewing domain (0.93) of the DIDL; the pain and discomfort domain (0.83) of the GOHAI, and the functional limitation (0.89), physical pain (1.02), physical disability (0.84) domains of the OHIP-EDENT. The percentage of satisfied patients increased in all domains. Self-reported OHRQoL of CD wearers was significantly improved after 3 months of treatment with IMO, especially concerning the functional and pain-related aspects.