Impact of seniors centers on oral health-related quality of life of older adults

ABSTRACT OBJECTIVE This study evaluated the oral health-related quality of life (OHRQoL) of older adults participating or not in Seniors Centers (SC). METHODS Two independent samples were compared: older adults who participate in SC (n = 124) and older adults who visited Primary Healthcare Centers (PHC) and do not participate in SC (n = 164). The data collected consisted of sociodemographic (sex, age, educational level, marital status, family income) and psychosocial characteristics—Sense of Coherence (SOC), anxiety and depression using HADS, happiness—, and oral clinical evaluation—use and need of dental prosthesis and decayed (D), missing (M), or filled (F) teeth. The resulting OHRQoL was evaluated using the Oral Health Impact Profile (OHIP-14). The Mann-Whitney test was used to assess the associations between the independent variables and the OHIP-14. Poisson regression models were also used in the analyses (α=0.05). RESULTS In the PHC, of the 270 individuals invited to participate in the study, 164 (60.7%) were interviewed and clinically examined; while in the SC, of the 166 individuals invited to participate in the study, 124 (74.7%) were interviewed and clinically examined. After adjustments for sociodemographic, psychosocial and clinical factors, we found that the impact on OHRQoL was 2.8 times higher (95%CI 2.0-4.2) for older adults who did not participate in SC. CONCLUSION Older adults who participated in SC showed better perception on OHRQoL, independently of sociodemographic, psychosocial and clinical factors.

Postoperative pain after root canal filling with different endodontic sealers: a randomized clinical trial

Abstract The aim of this randomized clinical trial was to compare the occurrence and intensity of postoperative pain and analgesic intake after root canal treatment, using different root canal sealers. Sixty single-rooted teeth diagnosed with asymptomatic necrosis and apical periodontitis were randomly assigned to 3 experimental groups (n=20), according to the root canal sealer: AH Plus, Endofill or MTA Fillapex. Endodontic treatment was performed in two sessions, and calcium hydroxide was used as the intracanal dressing. Patients were instructed to record pain intensity as none, slight, moderate and severe. Scores from 1 to 4 were attributed to each level of pain after 24 h, 48 h and 7 days. The need for analgesic intake was also recorded. Differences in the incidence of postoperative pain and the need for an analgesic were analyzed using the chi-square test. Differences in pain intensity after treatment were analyzed using the ordinal (linear) chi-square test. No significant differences were detected among the groups in terms of either incidence or intensity of postoperative pain, or need for analgesic intake, at any timepoint (p>0.05). No pain was reported after 7 days. AH Plus, Endofill and MTA Fillapex used for filling root canals resulted in the same rate of postoperative pain and need for analgesic medication.

Inorganic filler content of resin-based luting agents and the color of ceramic veneers

Abstract The influence of inorganic filler content of resin-based luting agents (RBLAs) on color change (ΔE00), CIEL*a*b* (individual color coordinates), and translucency parameters (TP) of simulated ceramic laminate veneer (CLV) was investigated. RBLAs with low, intermediate, and high inorganic filler content (55%, 65%, and 75% mass fractions, respectively) were prepared. Feldspar ceramic (Vitablocs Mark II) specimens (1.2 mm × 0.8 mm, A1C shade) were bonded to simulated composite resin substrates (1.6 mm × 1.2 mm, A2D shade) using three experimental and a commercial (RelyX Veneer) RBLA (translucent shade). The ΔE00 was calculated by CIEDE2000 color difference metric under three conditions (before, immediately after, and 24 h after luting). The TP was calculated using CIEL*a*b* color coordinates measured over white and black backgrounds. Surface morphology of the RBLAs was analyzed. One-way and two-way analyses of variance with a post-hoc Tukey's test were used respectively to calculate TP, CIEL*a*b* coordinates, and ΔE00 (α= 0.05). Overall, the tested RBLAs presented clinically visible ∆E00 values under the three conditions evaluated. For all RBLAs, higher ∆E00 values were observed between measurements obtained before and immediately after luting. Different inorganic filler content did not significantly increase the opacity of the ceramic-luting agents-resin composite set. The variation in inorganic filler content did not influence significantly the TP of simulated CLV; although all of the experimental RBLAs tested yielded ∆E00 above the perceptibility threshold. The L*, a*, and b* individual color coordinates were cementation-dependent.

Restabelecimento funcional e estético com coroas e facetas laminadas / Functional and aesthetic reestablishment with full crowns and laminate veneers ­ a case report

A adequada estética do sorriso é cada vez mais almejada pelo paciente e pelo profissional. Dentes escurecidos e com lesões de abfração, causadas por excessiva carga oclusal, desfavorecem o agradável aspecto dos dentes e a estética facial como um todo. Este caso clínico relatou o procedimento restaurador de dentes anteriores superiores que apresentavam cor e forma inadequadas. Foram confeccionadas facetas e coroas com cerâmica termoprensada reforçada por dissilicato de lítio (IPS e.max Press, Ivoclar), que tem sido frequentemente utilizada na confecção de restaurações em dentes anteriores e posteriores por apresentar propriedades estéticas e mecânicas satisfatórias. Após a reabilitação, pôde-se perceber que o detalhado planejamento do tratamento e a correta escolha do material restaurador resultaram no restabelecimento funcional e estético. Foi possível concluir que restaurações obtidas a partir da cerâmica de dissilicato de lítio mostraram ser uma ótima alternativa para a confecção de facetas e coroas, considerando que houve perfeita concordância de cor entre ambas as restaurações, resultando no sucesso do tratamento e satisfação do paciente.

Adequate aesthetic appearance of the smile is increasingly desired by patient and professional. Darkened teeth and abfraction injuries caused by excessive occlusal load jeopardizes the appearance of the teeth, and the facial aesthetics as a whole. This case describes the restorative treatment of upper anterior teeth that presented inadequate color and form. Crowns and laminate veneers were made with lithium disilicate ceramic, which has often been used in the fabrication of anterior tooth restorations because it presents satisfactory aesthetic and mechanical properties. After the restorative process, it can be concluded that the detailed treatment planning and the correct choice of restorative material result in the reestablishment of function and aesthetics. It was concluded that the lithium disilicate ceramic showed to be an excellent alternative for making laminate veneers and adjacent crowns, considering that there was perfect color matching between both restorations, resulting in the success of treatment and patient satisfaction.

Parameters Associated with Marginal Bone Loss around Implant after Prosthetic Loading

Abstract This study evaluated retrospectively the association among occlusal, periodontal and implant-prosthetic parameters and marginal bone loss (MBL) around implants and survival rate at 5.7 ±3.2 years of follow-up after prosthetic loading. Eighty-two patients received 164 external hexagon implants. After the standard healing period (3 to 6 months), the implants were restored with single-tooth or up to three splinted crowns. All patients were followed according to a strict maintenance program with regular recalls and clinically evaluated by a calibrated examiner. The MBL measurements taken from standardized radiographs made at permanent crown placement (baseline) and after the last evaluation were calculated considering occlusal, periodontal and implant-prosthetic parameters. Veneer fractures and abutment loosening were not considered failure. Two implants failed during the follow-up period, resulting in a survival rate of 98.8%. Cox regression analyses showed MBL associated with non-working side contacts (p=0.047), inadequate anterior guidance (p=0.001), lateral group guidance involving teeth and implants (p=0.015), periimplant plaque index (p=0.035), prosthetic design (p=0.030) and retention (p=0.006). Inadequate occlusal pattern guide, presence of visible plaque, and cemented and splinted implant-supported restoration were associated with greater MBL around the implant.

Resumo Este estudo avaliou retrospectivamente a associação entre os parâmetros oclusais, periodontais e implante-protéticos e perda óssea marginal (POM) ao redor de implantes e taxa de sobrevivência, em 5,7 ± 3,2 anos de acompanhamento após o carregamento protético. Oitenta e dois pacientes receberam um total de 164 implantes com hexágono externo. Após o período de cicatrização (3 à 6 meses), os implantes foram restaurados com coroa unitária ou até três coroas ferulizadas. Todos os pacientes seguiram um programa de manutenção rigoroso, com consultas regulares e avaliações clinicas realizadas por um examinador calibrado. As medições de POM obtidas de radiografias padronizadas realizadas na colocação da coroa permanente (baseline) e após a última avaliação foram calculadas considerando os parâmetros oclusais, periodontais e àqueles relacionados ao implante e prótese. Fratura na cerâmica de cobertura e afrouxamento do pilar não foram considerados falhas. Dois implantes falharam durante o período de acompanhamento, resultando em uma taxa de sobrevivência de 98,8%.A análise de regressão de Cox mostrou POM associado com contatos no lado de balanceio (p= 0,047), inadequada guia anterior (p=0,001), guia lateral em grupo envolvendo dentes e implantes (p=0,015), índice de placa visível em torno do implante (p=0,035), tipo de prótese (p= 0,030) e retenção (p=0,006). Guia de padrão oclusal inadequado, presença de placa visível e restaurações implanto-suportadas cimentadas e ferulizadas resultaram em maior POM ao redor do implante.

Effect of filling technique on the bond strength of methacrylate and silorane-based composite restorations

Abstract The bond strength of methacrylate (Z350, 3M ESPE) and silorane (P90, 3M ESPE) restorations, using different cavity filling techniques, was investigated. Cavities (6 × 3 × 3) in bovine teeth were filled using bulk, oblique, or horizontal increments. A push-out test was carried out after 24 h. Data were statistically analyzed (α = 5%). Methacrylate-based composites and the horizontal filling technique showed the highest bond strength values (10.2 ± 3.9, p < 0.05). Silorane-based composites showed no statistically significant differences regarding the filling techniques (p > 0.05).

Effectiveness of Combination of Dentin and Enamel Layers on the Masking Ability of Porcelain

This study evaluated the masking ability of different porcelain thicknesses and combination of enamel and/or dentin porcelain layers over simulated background dental substrates with higher (A2) and lower (C4) color values. Combination of the enamel (E) and dentin (D) monolayer porcelain disks with different thicknesses (0.5 mm, 0.8 mm, and 1 mm) resulted in the following bilayer groups (n=10): D1E1, D1E0.8; D1E0.5; D0.8E0.8; D0.8E0.5, and D0.5E0.5. CIELAB color coordinates were measured with a spectrophotometer. The translucency parameter of mono and bilayer specimens and the masking ability estimated by color variation (ΔE*ab) of bilayer specimens over simulated dental substrates were evaluated. Linear regression analysis was used to investigate the relationships translucency parameter × ΔE*, translucency parameter × porcelain thickness, and ΔE* × porcelain thickness. Data were analyzed statistically (α= 0.05). Thinner porcelain disks were associated with higher translucency. Porcelain monolayers were considerably more translucent than bilayers (enamel + dentin). Dentin porcelain was less translucent than enamel porcelain with same thickness. ΔE* was always lower when measured over A2 background. Higher ΔE* was observed for the C4 background, indicating poorer masking ability. Increased ΔE* was significantly associated with increased translucency for both backgrounds. Decreased translucency and ΔE* were associated with increased total porcelain thickness or increased dentin thickness for both backgrounds. In conclusion, increased porcelain thickness (particularly increased dentin layer) and increased porcelain opacity resulted in better masking ability of the dental backgrounds.

Resumo Este estudo avaliou a capacidade de mascaramento de diferentes espessuras de porcelana e a combinação de camadas de porcelana de esmalte e/ou de dentina sobre substratos dentais simulados de fundo com cores de maior (A2) e menor (C4) valor. Combinação de discos de porcelana em monocamadas de esmalte (E) e dentina (D) com diferentes espessuras (0,5 mm, 0,8 mm e 1 mm) resultou nos seguintes grupos bicamadas (n=10): D1E1, D1E0,8; D1E0,5; D0,8E0,8; D0,8E0,5 e D0,5E0,5. Coordenadas de cor CIELAB foram mensuradas com um espectrofotômetro. O parâmetro de translucidez de espécimes mono e bicamadas e a capacidade de mascaramento estimada pela variação de cor (ΔE*ab) dos espécimes bicamadas sobre os substratos dentais simulados foram avaliados. Análise de regressão linear foi utilizada para investigar as relações parâmetro de translucidez x ΔE*, parâmetro de translucidez x espessura da porcelana, e ΔE* x espessura da porcelana. Os dados foram analisados estatisticamente (α=0,05). Discos de porcelana mais finos foram associados a maior translucidez. Monocamadas de porcelana foram consideravelmente mais translúcidas que bicamadas (esmalte + dentina). Porcelana de dentina foi menos translúcida que porcelana de esmalte com mesma espessura. ΔE* foi sempre menor quando mensurado sobre fundo A2. Maior ΔE* foi observado para o fundo C4, indicando pior capacidade de mascaramento. Maior ΔE* foi significativamente associado à maior translucidez para ambos fundos. Menor translucidez e ΔE* foram associados ao aumento da espessura total da porcelana ou aumento da espessura de dentina para ambos fundos. Em conclusão, aumento da espessura da porcelana (particularmente aumento da camada de dentina) e aumento da opacidade da porcelana resultaram em melhor capacidade de mascaramento dos fundos dentários.

Importância do enceramento diagnóstico na reabilitação estética e funcional / The diagnostic wax-up as an important tool in the aesthetic and functional rehabilitation

Restaurações à base de resina composta direta têm mostrado boas taxas de longevidade, no entanto, apresentam comprometimento estético ao longo do tempo. Para suprir essa carência, as restaurações cerâmicas têm se tornado uma ótima opção de tratamento para dentes anteriores, sendo a cerâmica feldspática a que apresenta melhores propriedades estéticas e capacidade de reprodução de detalhes. Assim, este artigo procurou descrever a confecção de quatro laminados cerâmicos, à base de cerâmica feldspática, para restauração de incisivos superiores, inicialmente restaurados com restaurações insatisfatórias em resina composta. Após a conclusão da reabilitação, foi possível concluir que o tratamento restabeleceu satisfatoriamente a estética e a função da paciente.

Resin composite restorations show good survival rates; however, they present esthetic problems after longer clinical periods. For this, ceramic restorations are a good alternative and feldspathic ceramics present the best esthetic properties. This article describes the fabrication of four laminate veneers with feldspathic ceramics to restore the maxillary incisors with unsatisfactory composite restorations. Good levels of esthetic and function were achieved at case conclusion.

Effect of cariogenic challenge on the stability of dentin bonds

Objective: The oral environment is subject to biofilm accumulation and cariogenic challenge, and few studies exist on the effect of these factors on the bond strength of adhesive systems. The aim of this study was to test if the exposure of adhesive interfaces to cariogenic challenge under biofilm accumulation could promote higher degradation than the exposure to biofilm accumulation alone. Material And Methods: Five molars were ground until exposure of medium dentin and then restored (Single Bond 2 and Z250 3M ESPE). The tooth/resin sets were cut to obtain beam-shaped specimens, which were distributed according to the aging conditions (n=20): water for 24 h (control); biofilm under cariogenic challenge for 3, 5 or 10 days; biofilm without cariogenic challenge for 10 days; and water for 3 months. Microcosm biofilms were formed from human saliva and grown in a saliva analogue medium, supplemented or not with sucrose to promote cariogenic challenge. Specimens were tested for microtensile bond strength, and failure modes were classified using light microscopy. Bond strength data were analyzed using ANOVA and failure modes were analyzed using ANOVA on ranks (α=0.05). Results: No significant differences in bond strength were detected among the aging methods (P=0.248). The aging period was associated with an increase in the frequency of adhesive failures for the groups aged for 10 days or longer (P<0.001). Conclusion: Aging leads to a higher prevalence of interfacial adhesive failures, although this effect is not associated with cariogenic challenge or reduction in bond strengths. .

Combinação de cirurgia ortognática e tratamento protético para má oclusão esquelética classe III de Angle / Combined orthognathic surgery and prosthetic treatment for class III skeletal malocclusion

Este caso clínico descreve a situação de uma paciente parcialmente desdentada com má oclusão esquelética classe III de Angle que apresentava pobre função mastigatória e desagradável aparência estética, originada pela grave discrepância anteroposterior entre as arcadas dentárias e pela perda de dimensão vertical de oclusão. Sua reabilitação funcional e estética foi realizada através de cirurgia ortognática e tratamento protético mediante a instalação de uma prótese parcial removível tipo overlay. Ao final do tratamento, a paciente foi reabilitada funcionalmente e esteticamente com sucesso através do restabelecimento da dimensão vertical de oclusão e correção da discrepância anteroposterior entre os arcos dentários. A prótese parcial removível tipo overlay é uma alternativa simples e rápida para o tratamento de pacientes parcialmente desdentados com má oclusão esquelética classe III e pequena discrepância anteroposterior entre os arcos dentários. Neste caso clínico, foi obtido de forma satisfatória o restabelecimento estético e funcional do sistema estomatognático através da combinação de cirurgia ortognática e tratamento protético...

This clinical report discusses the case of a partially edentulous patient with class III skeletal malocclusion, suffering from poor masticatory function and esthetic appearance caused by severe anteroposterior discrepancy between the dental arches and loss of occlusal vertical dimension. The functional and esthetic rehabilitation was performed with orthognathic surgery followed by prosthetic treatment using an overlay removable partial denture. At the end of the treatment, the patient was successfully rehabilitated, both functionally and esthetically, through reestablishment of the occlusal vertical dimension and correction of the anteroposterior discrepancy between the dental arches. The overlay removable partial denture is a simple and time-efficient alternative in the treatment of partially edentulous patients with class III skeletal malocclusions and small anteroposterior discrepancies between dental arches. Additionally, an esthetic smile and functional rehabilitation of the stomatognathic system was satisfactorily obtained with orthognathic surgery followed by prosthetic treatment...

Abordagem multidisciplinar para o tratamento das sequelas de uma reabsorção radicular cervical / Multidisciplinary approach for treatment of cervical root resorption lesions

O presente trabalho relata o tratamento clínico integrado de uma seqüela de reabsorção cervical que evoluiu para fratura da coroa dentária, com a invasão do espaço biológico periodontal. Paciente de 14 anos de idade, do sexo masculino, relatando trauma no incisivo lateral direito na infância, apresentava sinais de reabsorção cervical severa, com comprometimento abaixo da junção esmalte-cemento associada a calcificação pulpar parcial. O exame clínico-radiográfico inicial sugeriu prognóstico duvidoso para o caso clínico, no entanto, uma extrusão ortodôntica radicular propiciou nova acomodação dos tecidos periodontais, além da exposição radicular adequada para reabilitação protética. O acompanhamento clínico evidenciou reabilitação protética associada à saúde periodontal, concluindo-se que a abordagem clínica multidisciplinar foi a chave para a resolução do problema.

The present study reports the clinical treatment of cervical root resorption lesions that progressed to crown fracture with biological width invasion. A 14-year-old male patient, reporting a dental trauma of the maxillary right lateral incisor presented signs of severe cervical root resorption with involvement of cemento-enamel junction associated with a partial pulp calcification. The initial clinical-radiographic suggested a doubtful prognosis. However, orthodontic root extrusion for six months improved the periodontal tissues and exposed properly the root for prosthetic rehabilitation. Clinical follow-up showed a satisfactory prosthetic rehabilitation associated with an excellent periodontal health, allowing us to conclude that the multidisciplinary approach was the key to solve the problem.

Efeito dos métodos de polimerização sobre o deslocamento dental em prótese total superior / Effect of polimerization methods on the tooth shift in maxillary complete dentures

Os autores avaliaram o efeito dos métodos de polimerização sobre a movimentação dental linear em prótese total superior. Vinte conjuntos modelo-base de prova de cera com dentes artificiais foram separados aleatoriamente em dois grupos de dez elementos, recebendo os seguintes tratamentos experimentais: Grupo 1-Inclusão em muflas metálicas com muralha de gesso-pedra e polimerização convencional em água. Grupo 2: Inclusão em muflas de fibra de vidro com muralha de gesso pedra e polimerização com energia de microondas. As distâncias entre os dentes I-I, PM-PM, M-M, ID-MD e IE-ME foram mensuradas antes e depois da polimerização da base e os dados obtidos submetidos ANOVA e ao teste de Tukey em nível de 5 porcento da significância. Não houve diferença estistica significativa nas distância lineates transversais e ântero-posteriores entre os dentes.

Prognóstico das próteses sobre implantes osseointegrados: revisäo da literatura / Prognosis of implant supported prosthesis: a literature review

Com o advento dos implantes osseointegrados e sua aceitaçäo por parte da Odontologia,novas técnicas e novos materiais têm marcado muitos avanços na clínica protética. Inicialmente, as pesquisas realizadas por Bränemark foram direcionadas à fixaçäo de implantes osseointegrados para tratamento protético de pacientes desdentados totais, mas, diante dos índices de sucesso da técnica, desenvolveu-se a possibilidade de tratar pacientes parcialmente desdentados, abrindo-se um panorama mais amplo no campo da reabilitaçäo bucal. Neste trabalho, é apresentado um estudo das próteses sobre implantes osseointegrados, através da revisäo literária das publicaçöes dos últimos anos, no que se refere ao prognóstico desse método de tratamento em pacientes total ou parcialmente desdentados