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)

Assessment of quality of life in total edentulous patients rehabilitated with implants and fixed prosthesis

Aim: Tooth loss is very prevalent in Brazil, reflecting high demand for dental services, especially those related to oral rehabilitation. This study aimed to assess the quality of life in total edentulous patients rehabilitated with implants and fixed prosthesis. Methods: Thirty-two patients were evaluated before and after rehabilitation with dental implants and fixed prosthesis using the OHIP-14 questionnaire and the Visual Analogue Scale (VAS) after 6 months follow-up. Results:OHIP-14 revealed a significant improvement after treatment in all seven parameters and in the global score (P < 0.001). VAS presented positive results related to patient satisfaction regarding oral rehabilitation, except for the hygiene of the fixed dentures. Conclusion: At the end of this study, OHIP-14 scores decreased by 50% in most of the questions raised, and VAS presented positive results, except for hygiene of the fixed dentures, presenting an improvement in the quality of life of total edentulous patients after rehabilitation with implants and fixed prosthesis

Associação entre o uso de prótese dentária total e o tipo de serviço odontológico utilizado entre idosos edêntulos totais / Association between the use of total dental prosthesis (denture) and the type of oral health care service used by toothless elderly individuals

Resumo A reabilitação protética foi prevista pela política nacional de saúde bucal em função da alta prevalência de perda de todos os dentes e do baixo uso de prótese dentária entre idosos. Há necessidade de se avaliar o impacto dessa política de reabilitação. Portanto, objetivou-se investigar se o tipo de serviço odontológico utilizado foi um dos fatores associados ao uso de prótese dentária total entre idosos. Trata-se de um estudo transversal conduzido em uma amostra probabilística de idosos (60 anos ou mais) residentes na zona urbana de um município brasileiro de pequeno porte populacional por examinadores calibrados. Realizaram-se análises descritiva, bivariada e múltipla (Regressão logística - odds ratio - OR). Participaram 287 idosos, destes, 186 (64,8%) faziam uso de prótese dentária total. O uso de prótese dentária total foi associado a maiores chances de uso de serviços odontológicos supletivos ou particulares (OR = 4,19; p < 0,001) e a presença de lesão no palato (OR = 7,52; p = 0,002) e, também, a menores chances em idades maiores ou iguais a 73 anos (OR = 0,52; p = 0,023) e entre os com comprometimento na dimensão incapacidade física do OHIP-14 (OR = 0,20; p = 0,002). O uso de prótese dentária total foi associado ao tipo de serviço odontológico entre idosos, sendo maior o uso entre usuários dos serviços supletivos ou particulares.

Abstract Oral rehabilitation with dental prosthesis was mandated by national oral health policy in Brazil, due to the high prevalence of total teeth loss and low use of dental prosthesis among the elderly. There is a pressing need to assess the impact of this rehabilitation policy. An attempt was therefore made to investigate if the dental service used was one of the factors associated with the use of total dental prosthesis among the elderly. To achieve this, a cross-sectional study using a probabilistic sample of elderly (60 years and above) urban-area residents of a small city was conducted by qualified examiners. Descriptive, bivariate and multiple (logistic regression/odds ratio - OR) analyses were conducted on 287 elderly people, of which 186 (64.8%) used dental prosthesis. The use of total dental prosthesis was associated with a higher probability of being attended by private dental services (OR = 4.19; p < 0.001) and the presence of lesions on the palate (OR = 7.52; p = 0.002). Conversely, it was associated with lower probability in ages greater than or equal to 73 years (OR = 0.52; p = 0.023) and among those with impairment of OHIP-14 (OR = 0.20; p = 0.002) in the physical disability dimension. The use of total dental prosthesis was associated with the type of dental service used by the elderly, it being greater among private service users.

Cost-effectiveness of implant-supported dental prosthesis compared to conventional dental prosthesis / Custo-efetividade da prótese implanto-suportada comparada à prótese total convencional

ABSTRACT OBJECTIVE To conduct a cost-effectiveness analysis of alternatives for rehabilitation treatment of mandibular edentulism in the context of the Brazilian Unified Health System (implant-supported total dental prosthesis versus conventional total dental prosthesis). METHODS A Markov model was developed to capture long-term clinical and economic outcomes. The model's population was comprised of a hypothetical cohort of 1,000,000 patients, aged 55 years, with total mandibular edentulism and without medical contraindications for performing surgical procedures. The adopted analysis perspective was that of the Brazilian Unified Health System. Based on the proposed model, we calculated cost - in BRL, and effectiveness - measured by quality-adjusted prosthesis year (QAPY). The time horizon of the analysis was 20 years. RESULTS Considering a 5% discount in costs and effects, the incremental cost-effectiveness ratio of implant-supported total dental prostheses compared to conventional total dental prosthesis (BRL 464.22/QAPY) was lower than the willingness to pay threshold adopted in the model (BRL 3,050.00/QAPY). CONCLUSIONS The results of this economic analysis showed that the rehabilitation of mandibular edentulous patients by implant-supported total prosthesis is very cost-effective when compared to conventional complete prosthesis, considering the cost-effectiveness limits employed.

RESUMO OBJETIVO Conduzir uma análise de custo-efetividade das alternativas para tratamento reabilitador do edentulismo mandibular no contexto do Sistema Único de Saúde (prótese total implanto-suportada e prótese total convencional). MÉTODOS Foi desenvolvido um modelo de Markov para captar os resultados clínicos e econômicos de longo prazo. A população do modelo consistiu em uma coorte hipotética de 1.000.000 pacientes, com 55 anos, desdentados totais mandibulares e sem contraindicações médicas para a realização de procedimentos cirúrgicos. A perspectiva de análise adotada foi a do Sistema Único de Saúde. Com base no modelo proposto, calculamos o custo (em reais) e a efetividade, medida pelo ano de prótese ajustado à qualidade (QAPY). O horizonte temporal da análise foi de 20 anos. RESULTADOS Considerando o desconto de 5% nos custos e efeitos, a razão de custo-efetividade incremental da prótese total implanto-suportada em relação à prótese total convencional (R$ 464,22/QAPY) foi menor que o limiar de disposição a pagar adotado no modelo (R$ 3.050,00/QAPY). CONCLUSÕES Os resultados desta análise econômica mostraram que a reabilitação de edêntulos mandibulares por meio da prótese total implanto-suportada é muito custo-efetiva em comparação à prótese total convencional, de acordo com os limites de custo-efetividade empregados.

Exploratory and confirmatory factorial analysis of the OHIP-Edent instrument

Abstract Several instruments have been used to measure oral health-related quality of life (OHRQoL). The Oral Health Impact Profile (OHIP) questionnaire was based on the concept that sequential events related to oral diseases can cause discomfort, functional limitations and consequently, result in dysfunctions and even disabilities. There are few studies in the literature that structurally analyze the instruments to verify whether they measure the requirements to which they were designed to. The objective of the study was to evaluate the internal structure of the OHIP-Edent questionnaire. The OHIP-Edent was administered to 54 edentulous patients' wearers of conventional complete dentures. For structural analysis, an exploratory factorial analysis (EFA) was carried out. After determining the internal consistency of the model (Cronbach's alpha = 0.88), the fit was checked using the root mean square error approach (value 0.04), the comparative fit index (value 0.982) and the Tucker-Lewis index (value 0.976). After analysis of the 19 questions and the seven domains proposed in the OHIP-Edent questionnaire, the hypothetical factorial model showed three dimensions denominated "Physical Impact", "Psychological Impact" and "Social Impact". In this sample of conventional complete denture wearers, the OHIP-Edent seems adequate to measure the "Physical Impact", "Psychological Impact", and "Social Impact" of the OHRQoL. The confirmatory factorial analysis confirmed the model and, through adjustment indexes, it was verified that the three dimensions have convergence and consistence adequate in order to characterize the OHRQoL construct with validity.

Quality of life and mastication in denture wearers and cleft lip and palate adults

Abstract The impact of oral rehabilitation on masticatory function and oral health-related quality of life (OHRQoL) may vary with the experience of the individual with tissue loss. Our hypothesis is that patient-centered outcomes vary among adults who have experienced large defects in the maxilla due to congenital or acquired conditions even after oral rehabilitation to restore aesthetics and function. This study compared OHRQoL, perceived masticatory ability, maximum bite force (MBF), and symptoms of pain and depression among subjects with acquired (edentulous maxilla) and congenital (cleft lip and palate) loss of oral tissues in the maxilla after dental treatment. A gender-matched sample (n = 60) of cleft lip and palate (CLP), maxillary denture wearers (DENT) and controls (CONT) was recruited. OHRQoL was assessed using OHIP-14. Chewing was evaluated through a masticatory ability questionnaire and by MBF. The RDC/TMD Axis II questionnaire was used to assess symptoms of pain and depression. Data were analyzed by Fisher's test, Kruskal Wallis test, and Spearman correlation coefficients. CLP showed higher OHIP-14 and depression scores than DENT and CONT (p < 0.05). Sub-analysis by OHIP-14 items (%FOVO) showed higher prevalence of psychological impact for CLP and of functional impacts for DENT. The number of foods difficult to chew, of food textures difficult to chew, and avoided foods were similar between CLP and DENT. OHIP-14, MBF, and depression scores showed significant correlation (p < 0.05). The results suggest that adults with treated CLP or maxillary DENT have chewing impairment and lower MBF than healthy subjects, with different psychological and functional impacts.

Geriatria ­ atualização em pistas deslizantes / Geriatria ­ sliding plates atualization

No artigo é proposta a substituição da resina lisa na região posterior das pistas deslizantes por dentes cúspide zero, respeitando o plano de orientação obtido através do desgaste de Paterson, na reabilitação do paciente edentado e sugerido um esquema de montagem dos dentes anteriores visando o equilíbrio articular.

The authors propose replacing the smooth resin in the posterior region of the sliding tracks by zero cusp teeth, respecting the guidance plan obtained by Paterson wear in the rehabilitation of the edentulous patient and suggest an arrangement of the anterior teeth in order to articulate the balance.

Perception of caregivers on health and oral hygiene care of institutionalized impaired elderly / Percepción de cuidadores sobre salud y cuidados de higiene oral de ancianos discapacitados institucionalizados

This study assessed the perception of caregivers on oral health of institutionalized impaired elderly, and the care provided for them in oral hygiene and prosthetic rehabilitation. A descriptive observational study was developed with caregivers of 32 institutionalized impaired elderly, in the state of Sergipe, Brazil. Data collection was performed by interviewing the caregivers, researching records of the Institution, and by clinical examination of the oral cavity of the elderly during a period between the months of March and May, 2013. Data were analyzed by descriptive statistics of absolute frequency (n) and relative frequency (%). All of the elderly presented partial (50 %) or total (50 %) tooth losses, and only 28.1 % wore removable denture. The prosthetic devices and remaining teeth of the elderly were cleaned with only toothbrush and toothpaste (100 %), with different daily frequencies among caregivers and no dentist instruction. The majority of caregivers was satisfied with the oral hygiene of the elderly (75 %) and the oral hygiene method (96.9 %) used, and showed no interest in learning new methods (81.3 %). The caregivers have an inadequate perception on oral health of the elderly population investigated, and oral hygiene care provided to the elderly is precarious.

Este estudio analizó la percepción de cuidadores sobre la salud oral de ancianos discapacitados asilados y los cuidados entregados en la higienización oral y frente a la rehabilitación protética. Se realizó un estudio observacional descriptivo, por medio de entrevistas con los respectivos cuidadores de los 32 ancianos seleccionados, institucionalizados en el Estado de Sergipe, Brasil. Todos los ancianos presentaban pérdidas dentales parciales (un 50 %) o totales (un 50 %) y solo el 28,1 % hacía uso de prótesis dentaria removible. Los aparatos protéticos y dientes remanecientes de los ancianos se higienizaban solo con cepillo y crema dental (un 100 %), con frecuencias diarias divergentes entre los cuidadores, sin la orientación de un dentista. La mayoría de los cuidadores se mostró satisfechos con la salud oral del anciano (un 75 %) y (un 96,9 %) con el método de higiene oral que utilizaban, y no expresaron interés en conocer nuevos métodos (un 81,3 %). Se concluyó que los cuidadores tienen una percepción inadecuada sobre la salud oral de la población de ancianos investigada y que los cuidados de higiene oral entregados a los ancianos son precarios.

Distribution of traumatic injuries after the installation of complete dentures in adult patients

Aim Describe the location of traumatic lesions of the oral mucosa that develop after the installation of complete dentures, as well as to quantify the number of post-operative controls that are required. A descriptive study was conducted by examining 84 patients who attended the dental center of Universidad de Los Andes, San Bernardo, during the period from July 2012 to July 2013. A sample of 120 edentulous patients was obtained. After the fabrication and installation of the complete dentures, at least 3 post-operative controls were performed and the location of oral lesions was recorded. Documentation of the association between the patient's clinical variables and the appearance of oral lesions during the first 3 controls was performed using a logistic regression. Results For maxillary dentures, 5 post-operative visits were made and 6 controls for mandible dentures. In the upper jaw the anatomical areas of higher incidence of traumatic injuries were: canine fossa (23.9%), average bridle (23.1%), and distobuccal sulcus (20.1%). In the lower jaw, the highest number of lesions were recorded on the anterior lingual flank (16.5%), anterior and posterior lingual flank (13.4%), and distobuccal sulcus (12.8%). A significant association was observed between subjects who reported consumption of cholesterol-lowering medications and the development of traumatic lesions of the oral mucosa (OR: 0.25 and 95% CI: 0.055-0.939). The installation of complete dentures does not determine that the treatment has ended. Post-operative controls are needed to assess areas of erythema and ulceration.

Objetivo Describir la ubicación y frecuencia de las lesiones traumáticas de la mucosa oral que se generan después de la instalación de las prótesis dentales completas, y cuantificar el número de controles postoperatorios necesarios. Se realizó un estudio descriptivo, examinando a 84 pacientes que asistieron al centro dental de la Universidad de Los Andes, durante el período comprendido entre de julio de 2012 y julio del de 2013. Se obtuvo una muestra de 120 pacientes edéntulos. Después de la fabricación e instalación de las dentaduras completas se realizaron por lo menos 3 controles postoperatorios y la localización de las lesiones orales fue registrada. La documentación de la asociación entre las variables clínicas de los pacientes y la aparición de lesiones orales durante los 3 primeros controles fue realizado por medio de una regresión logística. Resultados Para prótesis maxilar 5 visitas de controles postoperatorios fueron realizados y 6 para mandibulares. En el maxilar superior las zonas de mayor incidencia de lesiones traumáticas fueron: fosa canina (23,9%), flanco medio (23,1%) y distovestibular del surco (20,1%). En la mandíbula se registraron mayor frecuencia de las lesiones en el flanco lingual anterior (16,5%), anterior y posterior (13,4%) y distovestibular del surco (12,8%). Una asociación significativa se observó entre los sujetos que reportaron consumo de medicamentos reductores del colesterol y el desarrollo de las lesiones traumáticas de la mucosa oral (o: 0,25 e IC: 0,055-0,939). La instalación de las prótesis dentales completas no determina que el tratamiento haya terminado. Los controles postoperatorios son necesarios para evaluar las áreas de eritema y ulceración.

Percepción estética del paciente desdentado comparada con la opinión de expertos / The aesthetic self-perception of the edentulous patient compared to the opinion of experts

Objetivo Relacionar la autopercepción estética de pacientes desdentados rehabilitados protésicamente con la opinión de expertos en estética facial. Materiales y métodos A una muestra por conveniencia de 40 pacientes desdentados se les tomó 2 fotografías faciales 3D: sin prótesis y con prótesis nuevas, respectivamente. Posteriormente a cada paciente se le mostró sus imágenes y evaluó su satisfacción respecto al cambio facial mediante una pregunta en escala tipo Likert. A continuación se mostró las imágenes a 5 profesionales con especialidades relacionadas con estética facial, quienes evaluaron el cambio facial de cada paciente utilizando la misma escala tipo Likert. Finalmente, se procedió a comparar los resultados mediante el test no paramétrico de Wilcoxon para determinar diferencias estadísticas entre las preferencias de los pacientes y los expertos. Resultados Tanto las respuestas de los pacientes como de los expertos fueron positivas. Se encontró diferencia estadística al comparar las respuestas de ambos grupos, con un valor p = 0,00, siendo los expertos más críticos en su evaluación. Conclusión La autopercepción estética del paciente desdentado total rehabilitado con prótesis totales y la opinión del panel de expertos son concordantes, siendo ambas positivas. Cabe destacar que estos últimos fueron más críticos en sus apreciaciones.

Objective To determine the relationship between the aesthetic self-perception of edentulous patients rehabilitated with dentures and the opinion of facial aesthetics experts. Materials and methods Two facial 3D photographs, without dentures and with new dentures, respectively, were taken of a convenience sample of 40 edentulous patients. The images were subsequently shown to the patients, and they assessed their satisfaction of the facial change using Likert scale question. The photographs of the patients were also shown to 5 professionals with specialties related to facial aesthetics. Facial change was evaluated using the same Likert scale as the patients. Finally, the results were compared using the non-parametric Wilcoxon test to determine any statistical differences between the preferences of patients and the experts. Results The perception of patients and experts are positive. Significant statistical differences were found after comparing the responses of both groups, with p=.00, with the experts being more critical in their assessment. Conclusion The aesthetic perception of edentulous patients rehabilitated with complete dentures and the opinion of a panel of aesthetic experts are concordant, both being positive. It is important to note that experts were more critical in their assessment.

Implant-Supported Removable Partial Denture Improves the Quality of Life of Patients with Extreme Tooth Loss

Abstract: This study aimed to evaluate oral health-related quality of life (OHRQoL) in partially dentate subjects, presenting extreme tooth loss in posterior region with missing post-canines, comparing the use of conventional removable partial dentures (RPDs) and implant-supported RPDs. OHRQoL was measured using the Brazilian version of the Oral Health Impact Profile. Twelve subjects presenting maxillary total and mandibular Kennedy Class I edentulism (mean age 62.6±7.8 years) first received complete maxillary dentures and conventional mandibular free-end RPDs. After two months, the subjects had their OHRQoL assessed. Osseointegrated implants were inserted bilaterally in the mandibular first molar regions, and after four months ball abutments were placed to support the free-end RPD. Two months later, the patients had their OHRQoL reassessed. Wilcoxon signed-rank test was used to evaluate differences in OHRQoL (α=0.05). Results showed improvement in all OHIP-49 domains (p<0.05) after associating implants to the RPD. The mandibular implant-supported free-end RPD significantly improved OHRQoL.

Resumo: Este estudo avaliou a qualidade de vida relacionada à saúde bucal (QVRSB) em indivíduos parcialmente dentados, apresentando perda extrema de dentes na região posterior com ausência de dentes pós-caninos, comparando a reabilitação por meio de próteses parciais removíveis convencionais (PPRs) e PPRs implanto-suportadas. A QVRSB foi mensurada utilizando a versão brasileira do Oral Health Impact Profile (OHIP-49). Doze indivíduos apresentando edentulismo total maxilar e Classe I de Kennedy mandibular (idade média 62,6±7,8 anos) receberam primeiramente próteses totais maxilares e PPRs mandibulares convencionais de extremidade livre. Após dois meses de uso destas próteses, a QVRSB dos voluntários foi avaliada. Implantes osseointegrados foram bilateralmente instalados na região de primeiros molares inferiores e, após quatro meses, pilares do tipo bola foram instalados para suportar a extremidade livre da PPR. Após dois meses a QVRSB dos voluntários foi reavaliada. O teste pareado de Wilcoxon foi utilizado para avaliar as diferenças de QVRSB (α=0,05). Os resultados mostraram melhora em todos os domínios do OHIP-49 (p<0,05) após a associação dos implantes à PPR. PPRs de extremidade livre mandibulares implanto-suportadas melhorou significativamente a QVRSB.

Patient satisfaction concerning implant-supported prostheses: an observational study

The aim of this observational study was to assess the degree of patient satisfaction toward implant-supported prostheses. A questionnaire was used with two scales (one consisting of detailed adjectival and the other of numerical responses) regarding chewing, esthetics, speaking, comfort and overall satisfaction. The scales were administered to a sample of 147 patients treated with implants and prostheses. The data were submitted to the Kappa statistic and the Chi-square test to analyze the association between dependent and independent variables. High degrees of satisfaction (greater than 91%) were found for all categories evaluated, regardless of gender, age, number of implants or type of prosthesis. “Comfort” was associated significantly with the number of implants (p = 0.038), and “speaking” was associated significantly with the type of prosthesis (p = 0.029). Positive agreement was found between the scales for all categories evaluated, without statistically significant differences regarding respondent preference (p = 0.735). Patients treated with implant-supported prostheses were highly satisfied with the treatment.

The influence of mandibular ridge anatomy on treatment outcome with conventional complete dentures

Since prognostic indicators are likely to take on increasingimportance as a diagnostic tool for selection of patients forimplant provision, this study investigated the influence of theshape and resiliency of the mandibular alveolar ridge on theretention and stability of conventional complete dentures. Ninety-three edentulous patients wearing both maxillary andmandibular conventional complete dentures composed the sample.Data were collected regarding shape and resiliencyof themandibular residual ridge. Dentures were assessed for retentionand stability using an objective and reproducible tool.The associationsbetween the clinical characteristics of the mandibularalveolar ridge and denture retention and stability were analyzedusing chi-square and Fisher exact tests (α = 0.05). A significantassociation between ridge shape and denture stability (p < 0.05)was found, while ridge resiliency was significantly associated todenture retention (p < 0.001). Based on the results, mandibularridge shape and resiliency influenced the retention and stabilityof conventional complete dentures...

Reabsorción ósea del reborde residual mandibular en desdentados totales / Bone resorption of the residual ridge in edentulous patients

Al perder los elementos dentarios, la remodelación ósea y mucosa produce una nueva estructura anatómica, el reborde residual. La reducción del reborde residual (RRR) es considerada como una enfermedad crónica, progresiva, irreversible, acumulativa en el tiempo, de etiología multifactorial. Objetivo: evaluar la pérdida del hueso alveolar en pacientes edéntulos usuarios y no de prótesis. Métodos: estudio en 115 pacientes, de 41 a 88 años, ambos sexos, edéntulos. Se realizó radiografía panorámica junto a historia clínica. Se cuantificó la altura ósea vertical, lado izquierdo y derecho, desde el borde inferior de la mandíbula al foramen mentoniano y desde el borde inferior mandibular al superior de la cresta. Se recabaron datos sobre edad, sexo, uso de prótesis dental y enfermedades sistémicas. Resultados: edad promedio 64,5 años; 71 por ciento usaba prótesis (71,91 por ciento mujeres y 28,09 por ciento varones). Hubo diferencias significativas en ambos sexos entre uso y no uso de prótesis y RRR en cada sector, derecho p=0,0173 e izquierdo p=0,0153. Los valores de RRR fueron 14,24 mm en varones y 18,03 mm en mujeres. La pérdida ósea fue mayor en mujeres posmenopáusicas y en hombres de más de 70 años. No se observaron asociaciones significativas con edad y con enfermedades sistémicas. Conclusión: la pérdida ósea aumenta en desdentados con la edad, por un factor fisiológico y pérdida de la función, el hueso no recibe fuerzas estimulantes. Las mujeres pierden más hueso que los hombres por factores hormonales propios u otros.

Restoration of blinking reflex and facial symmetry in a Bell's palsy patient.

Patients afflicted with Bell's palsy are faced with both functional and esthetic impairment. Prominent among these are the inability to close the eyelids and abnormal facial appearance, with concomitant difficulty in eating, drinking and speaking. Rehabilitation of such patients can be achieved by a multispecialty approach, with the prosthodontist functioning as an integral part of the treatment team. This article describes a simple and effective approach to restore the blinking reflex of the upper eyelid with custom gold implant and facial esthetics with cheek support prosthesis.

Confecção de uma guia cirúrgica avançada para cirurgia guiada em maxila edêntula

O desenvolvimento de guias cirúrgicas para a cirurgia avançada de implantes osseointegrados é uma realidade que está sendo alcançada graças ao aparecimento de softwares e ferramentas específicas...

Relation between oral stereognosis and masticatory efficiency in complete denture wearers: an in vivo study

Aim: The purpose of the present study was to evaluate the possible association between the oral stereognostic ability and masticatory efficiency at the time of denture insertion and after 6 months in complete denture wearers. Methods: Sixty edentulous patients were selected. The study was conducted in two parts. First, on the day of denture fit-in oral stereognostic ability test was conducted,followed by masticatory efficiency was carried out. The patients were recalled for check up after 6months and the same test was performed again. Data were tabulated and analyzed statistically by paired t-test and Pearson’s correlation coefficient. Results: There was weak correlation between oral stereognosis and masticatory efficiency. Many opinions have been presented in the literature in the past regarding oral stereognosis. The issue whether oral stereognosis also helps inpatients’ adaptation towards complete denture prosthesis is still ambiguous. No consensus has been reached. This study is further an attempt to understand the basic physiology of oral stereognosis and whether there is any possible relation between oral stereognosis and masticatory efficiency.Conclusions: Within the limitation of this study, it can be concluded that oral stereognostic ability improves with time, which might be due to adaptation to the denture. As adaptation towardsdenture improves masticatory efficiency improves as well. This study showed that there might bea weak association between oral stereognosis and masticatory efficiency.

Reconstrução mandibular utilizando calota craniana para reabilitação implantossuportada / Mandible reconstruction with calvarial bone graft to implant-supported rehabilitation

A perda dos dentes, juntamente com a utilização de próteses mucossuportadas, por longos períodos de tempos, podem causar reabsorção óssea levando à perda de volume e má qualidade óssea, diminuindo o sucesso na instalação de implantes. Foi realizada reconstrução de mandíbula atrófica com enxerto retirado da calota craniana e reabilitação protética sobreimplantes. A técnica utilizada mostrou ser adequada para reabilitar defeitos extensos em rebordos alveolares edêntulos que requerem grande quantidade óssea, pois apresentou osso em qualidade e quantidade ósseas suficientes com mínima reabsorção no período pós-operatório, preenchendo todos os quesitos funcionais e devolvendo a estética ao paciente.

Tooth loss and long-time wear of mucous-supported removable partial prostheses cause bone resorption leading to volume loss and poor bone quality, diminishing implant success. A case of reconstruction of atrophic mandible with calvarial bone graft and subsequent implant-supported prosthesis is presented. The technique was successfully performed, resulting in adequate rehabilitation of large defects in edentulous jaws that require large amounts of alveolar bone, showed sufficient bone quantity and quality with minimal resorption during the postoperative period, improving function and retrieving esthetics.

Uso da prototipagem e do guia cirúrgico justaósseo em carga imediata de maxila edêntula / The use of prototyping and osseous surgical guide for immediate loading of implants in the edentulous maxilla

A técnica da carga imediata trouxe novas perspectivas de reabilitação para os pacientes edêntulos totais maxilares. A prototipagem e o guia cirúrgico justaósseo podem ser utilizados como importantes ferramentas no planejamento e execução destes tratamentos. O objetivo deste trabalho foi demonstrar, por meio de um relato de caso clínico, a técnica da carga imediata para reabilitação de maxila edêntula com implantes osseointegráveis e prótese total fixa implantossuportada, com o uso da prototipagem e do guia cirúrgico justaósseo, esclarecendo os benefícios de seus empregos nesta técnica.

Immediate loading technique has brought new perspectives on rehabilitation of the completely edentulous maxilla. Prototyping techniques and bone surgical guide can be used as resources for treatment planning and execution. The aim of this report is to describe a case of immediate rehabilitation of the edentulous maxilla with osseointegrated implants and full fixed prosthesis, using prototyping and osseous surgical guide, showing the combined advantages in the above-described technique.

Papillon-Lefevre syndrome: a case report.

Papillon-Lefevre syndrome is a rare autosomal recessive genetic disorder. The clinical manifestations include palmer planter hyperkeratosis with precocious progressive periodontal disease that results in premature exfoliation of primary and permanent dentitions. Patients are often edentulous at an early age. This is a case report of prosthodontic rehabilitation of a 15-year-old girl with Papillon-Lefevre syndrome.