Reabilitação oral com próteses parciais removíveis após restabelecimento de dimensão vertical de oclusão e tratamento multidisciplinar: relato de caso / Oral rehabilitation with removable partial dentures after restoration of the vertical dimension of occlusion and multidisciplinary treatment: case report

As próteses parciais removíveis (PPRs) são uma alternativa de tratamento viável na prática clínica para reabilitar arcos parcialmente desdentados. Entretanto, o planejamento dessas próteses e preparo bucal prévio são frequentemente negligenciados. O presente artigo tem como objetivo relatar o caso clínico de uma reabilitação oral com PPRs superior e inferior após abordagem multidisciplinar, de modo a enfatizar as fases de um planejamento criterioso e de preparo prévio dos dentes pilares, visando o sucesso e a longevidade da reabilitação. Paciente do sexo masculino de 57 anos de idade compareceu à clínica da Faculdade de Odontologia de Bauru, Universidade de São Paulo, queixando-se da estética de seu sorriso e de algumas ausências dentárias. O indivíduo utilizava uma PPR provisória inferior insatisfatória e apresentava perda de dimensão vertical de oclusão (DVO). Após o exame clínico, radiográfico e estudo do caso em articulador semi-ajustável, realizou-se o planejamento com abordagens restauradoras, endodônticas, periodontais e protéticas. Após tratamento periodontal, foi realizada endodontia dos elementos 12, 15 e 47, confecção de núcleos e coroas nos dentes 12 e 15, restauração a nível gengival para apoio residual no dente 47, restaurações nos dentes 11, 13, 22, 24 e 44 e, por fim, a confecção das PPRs superior e inferior. A abordagem multidisciplinar utilizada neste caso clínico viabilizou o restabelecimento da DVO e possibilitou o sucesso da reabilitação protética(AU)

Removable partial dentures (RPDs) are a viable treatment alternative in clinical practice to rehabilitate partially edentulous arches. However, the planning of these dentures and prior oral preparation are often neglected. This article aims to report the clinical case of an oral rehabilitation with upper and lower RPDs after a multidisciplinary approach, to emphasize the phases of careful planning and prior preparation of the abutment teeth, aiming at the success and longevity of the rehabilitation. A 57-year-old male patient came to the clinic of the Bauru School of Dentistry, University of São Paulo, complaining about the esthetics of his smile and some missing teeth. The subject was using an unsatisfactory lower provisional prosthesis and had a loss of vertical dimension of occlusion (OVD). After the clinical and radiographic examination and the case study in a semi-adjustable articulator, planning was carried out with restorative, endodontic, periodontal and prosthetic approaches. After periodontal treatment, endodontics were performed on elements 12, 15 and 47, creation of cores and crowns on teeth 12 and 15, restoration at the gingival level for residual support on tooth 47, restorations on teeth 11, 13, 22, 24 and 44 and, finally, the making of the upper and lower PPRs. The multidisciplinary approach used in this clinical case enabled the restoration of the OVD and enabled the success of the oral rehabilitation(AU)

The effect of different framework's material on strain induced in distal abutment in mandibular Kennedy's class II: an in-vitro study / O efeito de diferentes materiais de estrutura na deformação induzida na distal do pilar da classe II de Kennedy mandibular: um estudo in vitro

Objective: This study aims to compare the strain induced in the supporting structures of unilateral mandibular removable partial denture frameworks retained by extra-coronal attachments fabricated with three different materials. Material and Methods: Three mandibular class II digitally designed and printed acrylic models with detachable abutments were used to fabricate three removable partial denture framework with extra coronal attachments from three different materials. A total of 33 models were prepared for strain testing (n=11). Models were divided into three groups according to framework's material: porcelain fused to cobalt chromium (PFM), polyetherketoneketone (PEKK) and polyetheretherketone (PEEK) group. Unilateral load of 60 N was applied in the three groups and strains were measured around the main abutment and saddle area using strain gauge. Results: Statistical analysis was performed using Shapiro-Wilk's test and by checking data distribution. Data were found to be non-parametric and were analysed using Kruskal-Wallis test followed by Dunn's post hoc test with Bonferroni correction. PFM group showed significantly the highest strain values around abutment, slot 1 (1mm distal to the socket of the last abutment) and slot 2 (1 cm away from slot 1) respectively (843.00±23.08, 91.00±6.52 and 1274.00±65.71) than the other tested groups (p<0.05) at same tested sites respectively followed by PEKK group (384.00±37.48, 81.00±2.24 and 135.00±0.00) and PEEK group (29.00±4.18, 63.00±4.47 and 52.00±5.70). Conclusions: PEEK and PEKK for partial denture framework with extra coronal attachments are adequate alternative to PFM due to their good mechanical response applying less strain on supportive structures in free-end cases. PEEK induces lower strain magnitude on the supporting structures when compared to PEKK. (AU)

Objetivo: Este estudo tem como objetivo comparar a tensão induzida nas estruturas de suporte de estruturas de próteses parciais removíveis mandibulares unilateraisretidas por encaixes extracoronários fabricados com três materiais diferentes. Material e Métodos: Três modelos mandibulares de classe II digitalmente projetados e impressos em acrílico com pilares destacáveis foram usados para fabricar três estruturas de próteses parciais removíveis com encaixes extracoronários de três materiais diferentes. Um total de 33 modelos foram preparados para testes de deformação (n=11). Os modelos foram divididos em três grupos de acordo com o material da estrutura: porcelana fundida com cobalto-cromo (PFM), poliétercetonacetona (PEKK) e polieteretercetona (PEEK). Carga unilateral de 60 N foi aplicada nos três grupos e as deformações foram medidas em torno do pilar principal e área de sela usando medido de tensão. Resultados: A análise estatística foi realizada por meio do teste de Shapiro-Wilk e com a verificação da distribuição dos dados. Os dados mostraram-se não paramétricos e foram analisados pelo teste de Kruskal-Wallis seguido pelo de Dunn com correção de Bonferroni. O grupo PFM mostrou significativamente os maiores valores de tensão ao redor do pilar, slot 1 (1mm distal do último pilar) e slot 2 (1 cm de distância do slot 1) respectivamente (843,00±23,08, 91,00±6,52 e 1274,00±65,71) do que os outros grupos testados (p<0,05) nos mesmos locais testados, respectivamente, seguido pelo grupo PEKK (384,00±37,48, 81,00±2,24 e 135,00±0,00) e grupo PEEK (29,00±4,18, 63,00±4,47 e 52,00±5,70). Conclusão: PEEK e PEKK para estrutura de prótese parcial com encaixes extracoronários são alternativas adequadas ao PFM devido à sua boa resposta mecânica aplicando menos tensão nas estruturas de suporte em casos de extremidade livre. O PEEK induz menor magnitude de deformação nas estruturas de suporte quando comparado ao PEKK (AU)

X-linked hypohidrotic ectodermal dysplasia management with removable prosthesis in a pediatric patient: case report / Manejo de displasia ectodérmica hipohidrótica ligada al cromosoma X con prótesis removible en un paciente pediátrico: reporte de caso

Introduction: Ectodermal dysplasia is a rare genetic disorder that affects structures derived from ectoderm such as teeth, hair, nails, and sweat glands. Oligodontia is a common finding that affects the chewing, smiling and self- esteem of these pediatric patients. Case Report: We present a case report of a 7-years-old pediatric patient who consulted with his mother, showing the same condition. The intervention consisted of a removable prosthesis with satisfactory results. Conclusion: The X-linked hypohidrotic ectodermal dysplasia represents a challenge for a pediatric dentist who offers rehabilitation to the patient according to craniofacial development, age, socioeconomic status, and the number of missing teeth.

Introducción: La oligodoncia es un hallazgo común que afecta la masticación, la sonrisa y la autoestima de estos pacientes pediátricos. Case Report: Presentamos un reporte de caso de un paciente pediátrico de 7 años que consultó con su madre presentando la misma condición. La intervención consistió en una prótesis de remoción con resultados satisfactorios. Conclusión: La displasia ectodérmica hipohidrótica ligada al cromosoma X representa un desafío para un odontopediatra que ofrece rehabilitación al paciente de acuerdo con el desarrollo craneofacial, la edad, el nivel socioeconómico y el número de dientes faltantes.

Does the level of knowledge of denture hygiene affect their maintenance? / ¿El nivel de conocimiento de higiene protésica afecta el mantenimiento de estas prótesis?

Introduction: The lack of knowledge about denture hygiene can negatively affect their maintenance. On the other hand, good oral hygiene can reduce the chances of plaque accumulation. Objetive: To determine if there is a relationship between knowledge of hygiene and denture maintenance. Material and Methods: A questionnaire was applied to 67 patients who wore partial and/or total removable prostheses daily to evaluate their knowledge of denture hygiene. For the evaluation of denture maintenance, clinical inspection of the removable prosthesis was carried out using the Vigild criterion to observe the amount of plaque that was adhered to it. Data were statistically processed with Spearman's correlation test to determine the relationship between hygiene knowledge and denture maintenance. Results: The patients presented a medium (37.3%) and low (56.7%) denture hygiene knowledge; and fair (68.7%) and poor (11.9%) maintenance of their prosthesis. There is a statistically significant relationship between hygiene knowledge and denture maintenance (p<0.001). Conclusion: There is little knowledge of denture hygiene. This level of knowledge has a statistically significant relationship with the maintenance of the prostheses.

Introducción: El desconocimiento sobre la higiene de prótesis, de los pacientes portadores de estas, puede afectar negativamente en el mantenimiento protésico, una correcta higiene puede disminuir las probabilidades de acúmulo de placa. Objetivo: Determinar si existe relación entre el conocimiento de higiene y el mantenimiento protésico. Material y Métodos: Para la evaluación del conocimiento en higiene protésica se aplicó un cuestionario a 67 pacientes que utilizaban diariamente prótesis removibles parciales y/o totales; y para la valoración del mantenimiento protésico se realizó la inspección clínica de la prótesis removible mediante el criterio de Vigild, observando la cantidad de placa que se encontraba adherida. Se procesaron los datos estadísticamente con la prueba de correlación de Spearman para determinar la relación entre el conocimiento de higiene y el mantenimiento protésico. Resultados: Los pacientes presentaron un conocimiento de higiene protésica medio (37,3%) y bajo (56,7%); y un mantenimiento de la prótesis de forma regular (68,7%) y malo (11,9%). Existiendo relación estadísticamente significativa entre el conocimiento de higiene y el mantenimiento protésico (p<0, 0 01). Conclusión: Existe un bajo conocimiento de higiene protésica, teniendo este nivel de conocimiento una relación estadísticamente significativa con el mantenimiento que evidenciaban las prótesis.

Reabilitação oral utilizando prótese parcial removível associada a implantes osseointegrados: relato de caso / Oral rehabilitation using removable partial prosthesis associated with osseointegrated implants: case report

Introdução: As próteses parciais removíveis são alternativas amplamente utilizadas na reabilitação oral de pacientes parcialmente desdentados. Na atualidade os implantes dentais têm sido indicados para tratamento de pacientes edêntulos em associação com próteses parciais removíveis convencionais. Objetivo: Relatar um caso clínico utilizando uma prótese parcial removível convencional associada a implantes osseointegrados em paciente portador de Classe I de Kennedy. Relato de Caso: Paciente N.A.A.S., sexo feminino, 65 anos, procurou atendimento clínico no Instituto de Estudos da Saúde (IES) para reabilitação protética das arcadas dentais superior e inferior. A sua queixa principal era "dificuldade de mastigação". A paciente apresentava prótese total removível insatisfatória na maxila e não utilizava nenhum tipo de prótese dentária na mandíbula, que se apresentava parcialmente edêntula. O tratamento realizado foi a confecção de uma prótese total na arcada superior. Na arcada inferior foram inseridos dois implantes de hexágono externo nas regiões correspondentes às áreas dos dentes 34 e 44, após quatro meses a prótese parcial removível convencional foi confeccionada e incorporada aos implantes osseointegrados utilizando o sistema de retenção do tipo attachments Equator. Conclusão: Os resultados revelaram que a técnica de associação da prótese parcial removível convencional aos implantes osseointegrados demonstrou ser uma opção viável de tratamento com capacidade de devolver a função, a estética e manter a integridade dos dentes e tecidos periodontais(AU)

Introduction: Removable partial dentures are alternatives widely used in the oral rehabilitation of partially edentulous patients. Currently, dental implants have been indicated for the treatment of edentulous patients in association with conventional removable partial dentures. Objective: To report a clinical case using a conventional removable partial denture associated with osseointegrated implants in a patient with Kennedy Class I. Case Report: Patient N.A.A.S., female, 65 years old, sought clinical care at the Institute of Health Studies (HEI) for prosthetic rehabilitation of the upper and lower dental arches. His main complaint was "chewing difficulty". The patient had unsatisfactory removable total prosthesis in the maxilla and did not use any type of dental prosthesis in the mandible, which was partially edentulous. The treatment performed was the manufacture of a total prosthesis in the upper arch. In the lower arch, two external hexagon implants were inserted in the regions corresponding to the tooth areas 34 and 44, after four months the conventional removable partial denture was made and incorporated into the osseointegrated implants using the equator attachments retention system. Conclusion: The results revealed that the technique of associating conventional removable partial dentures with osseointegrated implants proved to be a viable treatment option with the ability to restore function, aesthetics and maintain the integrity of teeth and periodontal tissues(AU)

Combinando estratégias de aprendizagem para o desenvolvimento de habilidades e competências na Prótese Parcial Removível pré-clínica: um relato de experiência / Combining learning strategies for developing abilities and competencies in a preclinical Removable Partial Denture course: an experience report

O uso da metodologia ativa no ensino da Odontologia é recomendado nas Diretrizes Curriculares Nacionais, com a finalidade de desenvolver habilidades e competências, assim como de estimular a capacidade reflexiva dos egressos. Em Prótese Parcial Removível (PPR), alguns estudos apontam os benefícios do método centrado no aluno, utilizando diferentes estratégias, como Problem-Based Learning (PBL), Case-Based Learning (CBL) e Team-Based Learning (TBL) com resultados positivos no processo ensino-aprendizagem. Este artigo tem como objetivo relatar a experiência do uso de metodologias ativas como o CBL, a Sala de Aula Invertida e a estratégia do Brainstorming na disciplina de Prótese Parcial Removível da Universidade Federal da Paraíba, estimulando o desenvolvimento do pensamento crítico do aluno no planejamento de arcos parcialmente desdentados desde a fase pré-clínica. Como produto dessa mudança na estratégia pedagógica, desenvolveram-se materiais instrucionais como um checklist de perguntas e um fluxograma que foram implementados como ferramentas facilitadoras no processo ensino-aprendizagem durante as práticas de laboratório. A adaptação de estratégias de ensino com participação ativa dos estudantes pode ser útil na verificação das dificuldades durante o planejamento, as quais podem ser solucionadas previamente aos atendimentos de pacientes nas clínicas. Os materiais instrucionais desenvolvidos na disciplina podem auxiliar os professores de Odontologia a refletir sobre diferentes formas de metodologias no ensino da PPR e inserir o aluno no processo de construção do seu conhecimento (AU).

Active methodologies in dental education have been highly recommended by the National Curricular Guidelines in developing students' abilities and competency, and directly impact on the reflective capacity of new professionals. Some studies on Removable Partial Dentures (RPD) have pointed out benefits of the student- centered method by using different strategies such as Problem-Based Learning (PBL), Case- Based Learning (CBL) and Team-Based Learning (TBL), with positive results in the teaching and learning processes. This article aims to report the experience of using active methodologies such as CBL, Inverted Classroom and Brainstorming techniques as a strategy in the RPD Preclinical Course of the Federal University of Paraíba, focusing on the development of students' critical thinking for planning partial edentulous arches. As a result of this change, instructional materials such as a checklist of questions and a flowchart were developed and have started to be implemented as important tools during the laboratory classes. Adapting teaching strategies with the active participation of students can be a valuable tool to verify difficulties during prosthesis planning. As a result, it can improve self-confidence in determining the mechanical components prior to clinical care. The instructional materials developed can help professors to reflect on different forms of methodologies in RPD teaching and insert students in their own knowledge construction (AU).

Finite element analyses of retention of removable partial denture circumferential clasps manufactured by selective laser melting / 北京大学学报(医学版)

OBJECTIVE@#To compare the retentions of different designs of cobalt-chromium (Co-Cr), pure titanium (CP Ti), and titanium alloy (Ti-6Al-4V) removable partial denture (RPD) circumferential clasps manufactured by selective laser melting (SLM) and to analyze the stress distribution of these clasps during the removal from abutment teeth.@*METHODS@#Clasps with clasp arm size A (1.9 mm width/1.1 mm thickness at the body and 0.8-taper) or B (1.2 times A) and 0.25 mm or 0.50 mm undercut engagement were modeled on a prepared first premolar die, named as designs A1, A2, A3, and A4, respectively. The density and elastic modulus of SLM-built Co-Cr, CP Ti, and Ti-6Al-4V were measured and given to different groups of clasps. The density, elastic modulus, and Poisson ' s ratio of enamel were given to the die. The control group was the cast Co-Cr clasp with design A1, to which the density and elastic modulus of cast Co-Cr alloy were given. The Poisson's ratio of all metals was 0.33. The initial 5 N dislodging force was applied, and the maximum displacement of the clasp along the insertion path was computed. The load was reapplied with an increment of 5 N than in the last simulation until the clasp was completely dislodged. The retentive force range of different groups of clasps was obtained. The retentive forces of the SLM-built Co-Cr, CP Ti, and Ti-6Al-4V clasps with equivalent computed retentive force range to the control group were validated through the insertion/removal experiment. The von Mises stress distributions of these three groups of SLM-built clasps under 15 N loads were analyzed.@*RESULTS@#SLM-built Co-Cr, CP Ti, and Ti-6Al-4V clasps with designs B1 or B2, and Co-Cr clasps with design A2 had higher retentive forces than those of the control group. SLM-built CP Ti and Ti-6Al-4V clasps with design A1 had lower retentive forces than those of the control group. SLM-built Co-Cr clasp with design A1 and SLM-built CP Ti and Ti-6Al-4V clasps with design A2 had equivalent retentive forces to those of the control group. The insertion/removal experiment showed that the measured retentive forces of these three groups of SLM-built clasps were (21.57±5.41) N, (19.75±4.47) N, and (19.32±2.04) N, respectively. No statistically significant measured retentive force difference was found among these three groups of SLM-built clasps (P>0.05). The maximum von Mises stress of these three groups of SLM-built clasps exceeded their responding yield strength except for the Ti-6Al-4V one.@*CONCLUSION@#SLM-built Co-Cr circumferential clasps had higher retention than CP Ti and Ti-6Al-4V ones with the same clasp arm size and undercut engagement. The retention of SLM-built circumferential clasps could be adjusted by changing the undercut engagement and clasp arm size. If SLM-built circumferential clasps are used in clinical practice, the Ti-6Al-4V clasp with clasp arm size A and 0.50 mm undercut engagement is recommended considering the long-term use of RPD in the patient's mouth.

Atención odontológica humanizada a un paciente con neurofibromatosis tipo 1 atendido en una clínica de odontología de especialización infantil: reporte de Caso / Humanized dental care for a patient with type 1 neurofibromatosis attended in a specialized children's dentistry clinic: case report / Atendimento odontológico humanizado a paciente com neurofibromatose tipo 1 atendido em ambulatório especializado de odontologia infantil: relato de caso

Este trabajo tiene como objetivo relatar el abordaje individualizado, inclusivo y humanizado de un niño de 4 años y tres meses, con diagnóstico de neurofibromatosis tipo 1, atendido en la Carrera de Especialización en Odontopediatría de la Escuela de Graduados, Facultad de Odontología, Universidad de la Repú blica, Montevideo, Uruguay. En el examen clínico se pudo observar cicatrices derivadas del tratamiento quirúrgico del neurofibroma plexiforme en la zona cervical y la presencia de hipotonicidad muscular oral. Al examen clínico intraoral, se observaron amplias zonas desdentadas a consecuencia de exodoncias de quince dientes deciduos. Presentaba lesiones activas de caries en los dientes remanentes, acompañado de biopelícula generalizada y sangrado gingival provocado. Se realizó un abordaje integral del paciente y la terapia rehabilitadora mediante el uso de prótesis parcial removible superior e inferior. Concluímos que el tratamiento odontológico educativo, preventivo, restaurador y rehabilitador fue satisfactorio y la empatía, como proceso dinámico, involucró mecanismos cognitivos, afectivos y conductuales, y fue reconocida por sus efectos positivos en la promoción de la salud bucal del paciente.

Este trabalho tem como objetivo relatar uma abordagem odontológica individualizada, inclusiva e humanizada, enfatizando a importância do tratamento de uma criança de 4 anos e três meses, com diagnóstico de neurofibromatose tipo 1, que foi encaminhada e tratada en la clínica de la Carrera de Especialización en Odontopediatria de la Escuela de Graduados, Facultad de Odontología, Universidad de la República. O exame clínico revelou cicatrizes decorrentes do tratamento cirúrgico do neurofibroma plexiforme que acometia o pescoço da criança e hipotonicidade muscular oral. Ao exame clínico intraoral, quinze dentes decíduos estavam ausentes e cinco com lesões de cárie na primeira infância, além de presença generalizada de biofilme microbiano nas superfícies dentais e sangramento gengival provocado. Foi realizado tratamento odontológico necessário ao paciente, com os devidos cuidados e terapia reabilitadora com prótese parcial removível superior e inferior. Concluímos que o tratamento odontológico educacional, preventivo, restaurador e reabilitador foi satisfatório e a empatia, como processo dinâmico, envolveu mecanismos cognitivos, afetivos e comportamentais e foi reconhecida por seus efeitos positivos na promoção da saúde bucal do paciente.

This paper aims to report an individualized, inclusive, and humanized dental approach, emphasizing the importance of treating a child aged four years and three months with neurofibromatosis type 1. The patient was referred and treated at the Clinic of the Specialization Course in Pediatric Dentistry of the Graduate School, School of Dentistry, Universidad de la República, Montevideo, Uruguay. The clinical examination revealed scars from the surgical treatment of the plexiform neurofibroma and neck and oral muscle hypotonicity. The intraoral clinical examination showed large edentulous areas as 15 deciduous teeth were missing. The patient had active carious lesions, generalized microbial biofilm on the tooth surfaces, and gingival bleeding. A comprehensive treatment was provided, as well as restorative therapy with upper and lower removable partial dentures. We conclude that the dental educational, preventive, restorative, and rehabilitation treatment was satisfactory. Furthermore, empathy, as a dynamic process, involved cognitive, affective, and behavioral mechanisms. It also helped enhance the patient's oral health.

Patients' Management Patterns for Restorative Treatment Procedures: A 4-Year Overview at the Restorative Clinic of a Tertiary Hospital in Nigeria

Abstract Objective: To determine the patients' management pattern for restorative treatment procedures at the Restorative Dentistry Clinic at the Lagos State University Teaching Hospital (LASUTH). Material and Methods: A descriptive and retrospective study design was employed to determine patients' management patterns for the restorative treatment procedures at the Restorative Dentistry Clinic at LASUTH. Treatment records of patients who attended the Restorative Clinic at the Lagos State University Hospital, Ikeja, Lagos, Nigeria, from 2011 to 2014 were reviewed; the effective treatments during the period under review were recorded as treatment procedures and were recorded as operative, endodontic, fixed prosthodontics, and removable procedures. Results: A total of 14,437 (75%) operative; 1,353 (7.0%) endodontic; and 559 (2.9%) fixed prosthodontics and 2,852 (14.9%) removable prosthodontic procedures were carried out during the period under review. This study showed that operative procedures were the most performed restorative procedures, whereas removable prosthodontics and endodontic procedures ranked second and third, respectively, to operative procedures. Fixed prosthodontics procedures were the least performed restorative procedures. Conclusion: This study showed that more efforts were being expended by dentists on operative services compared to endodontic, removable, and fixed prosthodontics services combined. Comprehensive studies, embracing all disciplines of dentistry, should be carried out to determine the level of demand and clinical relevance of procedures in clinical dental practice and hence to set specific and general objectives of dental education for the populace. Access to dental health Insurance services should also be increased in the country.

Tooth Loss, Sociodemographic Conditions and Oral Health-Related Quality of Life in the Elderly

Abstract Objective: To verify the association between impacts produced by tooth loss and sociodemographic variables in the oral health-related quality of life (OHRQoL) in the elderly. Material and Methods: This is an analytical cross-sectional study carried out in the municipality of Vitória/ES, Brazil, which sample was composed of 402 older adults. The Oral Health Impact Profile (OHIP-14) was used to measure the individuals' OHRQoL. For data analysis, descriptive and bivariate analyses were performed using the Fisher's exact test and the Mantel-Haenzsel test to assess the effects of combined dimensions. The significance level adopted was 5%. To assess the strength of association between independent variables and dimensions, Odds-Ratio (OR) with 95% confidence interval (CI) was calculated. Results: The prevalence of negative impact on OHRQoL in the elderly was 32.6%. The greatest impact perception was found in individuals with up to 10 years of schooling (p=0.021 and OR=1.602), with need for removable partial dentures (p=0.000 and OR=2.873) and those who did not accept the loss of dental elements (p=0.000 and OR=3.064). Conclusion: Older female adults with socioeconomic class C/D-E, with up to 10 years of schooling, who lost 11 or more teeth, who declared the need for removable partial dentures, suffered greater impacts caused by tooth loss on OHRQoL.

Consensos referidos a conceptos rehabilitadores en la enseñanza de la odontología. Parte I: conceptos generales y diseño de la prótesis parcial removible / Consensus referring rehabilitative concepts in the teaching of dentistry. Part I: general concepts and design of removable partial prosthesis

En este artículo se desarrolla el consenso alcanzado entre profesores, referido a los conceptos generales, componentes y la secuencia del diseño de la prótesis parcial removible, durante la formación del odontó-logo en el ámbito de la Facultad de Odontología de la Universidad de Buenos Aires (AU)

This article develops the consensus between professors on the general concepts, components, and the sequence of the design of the partial removable prosthesis during the training of the dentist in the field of the Faculty of Dentistry of the University of Buenos Aires (AU)

Reabilitação Oral com Prótese Obturadora em Comunicação Buconasal após Ocorrência de Carcinoma de Células Escamosas: Relato de Caso / Oral Rehabilitation with Filling Prosthesis in Bucconasal Communication after the Occurrence of Squamous Cell Carcinoma: Case Report / Rehabilitación Oral con Prótesis Obturatriz en Comunicación Oral tras la Aparición de Carcinoma Epidermoide: Reporte de Caso

Introdução: O tratamento de neoplasia maligna pode consistir em ampla excisão cirúrgica. Em alguns casos, em razão do tratamento agressivo na remoção do tumor, há grande comprometimento das estruturas intrabucais. Assim, próteses são utilizadas para a obturação da cavidade maxilar, possibilitando a reconstrução da região afetada, juntamente com a reabilitação oral. Relato do caso: Paciente de 53 anos de idade, sexo feminino, ex-tabagista e ex-etilista, apresentou diagnóstico de carcinoma de células escamosas na região de palato mole, sendo necessária cirurgia de ressecção transoral associada à radioterapia. Após aproximadamente um ano, a paciente retornou com nova lesão em palato, que novamente evidenciou carcinoma de células escamosas, sendo necessária nova cirurgia de ressecção transoral. Após dois anos, a paciente retornou ao Departamento de Odontologia a fim de receber o tratamento reabilitador, pois a prótese parcial removível superior era provisória, não substituía todos os dentes ausentes e não obtinha adaptação adequada à comunicação buconasal. Foi realizado tratamento reabilitador definitivo com prótese parcial removível superior e com prótese total no rebordo residual inferior. Conclusão: A necessidade do acompanhamento odontológico nos casos de ocorrência de carcinoma de células escamosas oral bem como a importância do tratamento reabilitador e suas técnicas contribuem para a autoestima e a qualidade de vida do paciente

Introduction: The treatment of malignant neoplasm may consist in extensive surgical excision. In some cases, due to aggressive treatment in the removal of the tumor, intraoral structures are strongly compromised. Thus, prostheses are used to fill the maxillary cavity, allowing reconstruction of the affected region, together with oral rehabilitation. Case report: A 53-year-old female patient, ex-smoker and ex-alcoholic was diagnosed with squamous cell carcinoma in the soft palate region, requiring transoral resection surgery associated with radiotherapy. After approximately one year, the patient returned with a new palatal lesion, also diagnosed as squamous cell carcinoma, requiring further transoral resection surgery. After two years, the patient returned to the Dentistry Department to receive the rehabilitative treatment, as she had only a temporary removable upper partial denture, where all the missing teeth were not replaced and there was poor adaptation to bucconasal communication. A final rehabilitative treatment was performed with upper partial removable denture and total prosthesis in the inferior residual ridge. Conclusion: The need for dental follow-up in cases of oral squamous cell carcinoma as well as the importance of rehabilitation treatment and its techniques contribute for the patient's self-esteem and quality of life

Introducción: El tratamiento de las neoplasias malignas puede consistir en una exéresis quirúrgica extensa. En algunos casos, debido a un tratamiento agresivo para extirpar el tumor, existe un gran compromiso de las estructuras intraorales. Así, las prótesis se utilizan para rellenar la cavidad maxilar, permitiendo la reconstrucción de la región afectada, junto con la rehabilitación oral. Relato del caso: Paciente femenina de 53 años, exfumadora y exalcohólica, que presentó el diagnóstico de carcinoma epidermoide en la región del paladar blando, que requirió cirugía de resección transoral asociada a radioterapia. Después de aproximadamente un año, la paciente regresó con una nueva lesión en el paladar, en la que también se le diagnosticó un carcinoma epidermoide, requiriendo una nueva cirugía de resección transoral. A los dos años, la paciente volvió al Departamento de Odontología para recibir tratamiento rehabilitador, ya que la prótesis parcial superior removible era temporal, no reponía todos los dientes faltantes y no obtenía una adecuada adaptación a la comunicación bucconasal. El tratamiento de rehabilitación definitivo se realizó con una dentadura postiza parcial removible superior y una dentadura total en el reborde residual inferior. Conclusión: La necesidad de seguimiento odontológico en los casos de carcinoma epidermoide oral así como la importancia del tratamiento rehabilitador y sus técnicas contribuyen a la autoestima y calidad de vida del paciente

Lesiones paraprotésicas en pacientes geriátricos portadores de prótesis removibles / Paraprosthetic lesions in geriatric patients with removable prostheses / Lesões paraprotéticas em pacientes geriátricos com próteses removíveis

RESUMEN Introducción: Los pacientes geriátricos portadores de prótesis removible con frecuencia presentan lesiones paraprotésicas que repercuten en su calidad de vida. Objetivo: Identificar los tipos de lesiones paraprotésicas en pacientes geriátricos portadores de prótesis removibles. Método: Se realizó un estudio observacional y descriptivo en 97 pacientes de cualquier sexo, mayores de 60 años, portadores de prótesis removible, que acudieron a la Clínica Estomatológica Docente Provincial "Dr. Justo Ortelio Pestana Lorenzo" de Sancti Spíritus, por presentar algún tipo de lesión en la mucosa bucal, desde enero de 2019 hasta febrero de 2020. Se utilizaron métodos del nivel teórico, empírico y estadístico-matemático para el estudio de las variables: edad, sexo, tipo de lesión. Resultados: El 49,5 % del universo correspondió a pacientes de 60 a 69 años y el 66 % del sexo femenino. Las lesiones paraprotésicas más frecuentes fueron la estomatitis subprótesis (55,6 %) y las úlceras traumáticas (31,9 %). Conclusiones: Las lesiones de la mucosa bucal asociadas al uso de prótesis removible fueron más frecuentes en las mujeres. La estomatitis subprótesis fue la lesión paraprotésica que predominó, seguida de la úlcera traumática y épulis fisurado.

ABSTRACT Introduction: Geriatric patients with removable prostheses often present paraprosthetic lesions that have an unfavorable impact on their quality of life. Objective: To identify the type of paraprosthetic lesions in geriatric patients with removable prostheses. Method: An observational and descriptive study in a total of 97 patients with removable prostheses, no specific sex, and over 60 years of age, was carried out. All patients studied were presented to the Clínica Estomatológica Docente Provincial "Dr. Justo Ortelio Pestana Lorenzo" in Sancti Spíritus, from January 2019 throughout February 2020, with any type of oral lesions. Theoretical, empirical and statistical-mathematical methods were used to study the following variables: age, sex, type of lesions. Results: The 49.5% of the total of patients studied were 60 to 69 years old and 66% were female. Most common paraprosthetic lesions found were the subprosthetic stomatitis (55.6%) and traumatic ulcers (31.9%). Conclusions: The oral lesions related to removable prostheses were most common in females. The subprosthetic stomatitis was the most predominant followed by the traumatic ulcer and fissured epulis.

RESUMO Introdução: Pacientes geriátricos com próteses removíveis freqüentemente apresentam lesões paraprotéticas que afetam sua qualidade de vida. Objetivo: Identificar os tipos de lesões paraprotéticas em pacientes geriátricos com próteses removíveis. Método: Foi realizado um estudo observacional e descritivo em 97 pacientes de ambos os sexos, maiores de 60 anos, com próteses removíveis, atendidos na Clínica Provincial de Ensino de Estomatologia "Dr. Justo Ortelio Pestana Lorenzo "de Sancti Spíritus, por apresentar algum tipo de lesão na mucosa oral, de janeiro de 2019 a fevereiro de 2020. Foram utilizados métodos de nível teórico, empírico e estatístico-matemático para estudar as variáveis: idade, sexo, tipo de lesão. Resultados: 49,5% do universo corresponderam a pacientes de 60 a 69 anos e 66% ao sexo feminino. As lesões paraprotéticas mais frequentes foram estomatite subprotética (55,6%) e úlceras traumáticas (31,9%). Conclusões: As lesões da mucosa oral associadas ao uso de próteses removíveis foram mais frequentes nas mulheres. A estomatite subprotética foi a lesão paraprotética predominante, seguida por úlcera traumática e epúlide fissurada.

Reabilitação prótetica convencional após remoção cirúrgica de hiperplasia fibrosa: relato de caso / Conventional prosthetic rehabilitation after surgical removal of fibrous hyperplasia: case report

O uso de próteses mal adaptadas pode ocasionar o surgimento de processos proliferativos não neoplásicos. A hiperplasia fibrosa inflamatória (HFI) é uma lesão benigna, proveniente de reação hiperplásica do tecido conjuntivo fibroso em resposta às injúrias crônicas de baixa intensidade. O objetivo do presente trabalho é relatar um caso clínico sobre remoção cirúrgica de HFI, seguida de reabilitação oral com próteses removíveis. Paciente de 75 anos do sexo masculino relatou que gostaria de fazer a troca da sua prótese, pois a mesma estava fraturada. Ao exame clínico intra-oral constatou-se que suas próteses possuíam higienização precária, e, a superior, possuía uma borda cortante que causou uma lesão hiperplásica na região de fundo de vestíbulo anterior. Quanto ao aspecto clínico, apresentava-se com consistência fibrosa e firme à palpação, de coloração semelhante a mucosa e assintomática. O plano de tratamento proposto foi reembasamento da prótese antiga com resina Soft Confort (Dencril, Brasil) eliminando as áreas que traumatizavam a mucosa, cirurgia pré-protética para a remoção da HFI, exame histopatológico e a confecção de novas próteses, sendo a superior prótese total convencional e a inferior prótese parcial removível. Observa-se a importância no cuidado do planejamento reabilitador protético dos pacientes, pois, como foi descrito neste caso, em algumas situações pode haver necessidade de lançarmos mão de diversas modalidades de tratamento prévias à reabilitação(AU)

The use of poorly adapted prostheses can lead to the emergence of non-neoplastic proliferative processes. Inflammatory fibrous hyperplasia (HFI) is a benign lesion, resulting from a hyperplastic reaction of fibrous connective tissue in response to low-intensity chronic injuries. The aim of the present study is to report a clinical case about surgical removal of HFI, followed by oral rehabilitation with removable prostheses. A 75-year-old male patient reported that he would like to change his prosthesis, because it was fractured. On intra-oral clinical examination, it was found that his prostheses had poor hygiene, and the upper one had a cutting edge that caused a hyperplastic lesion in the deep region of the anterior vestibule. As for the clinical aspect, it was fibrous and firm on palpation, mucosa-like and asymptomatic. The proposed treatment plan was to repurpose the old prosthesis with Soft Confort resin (Dencril, Brazil), eliminating the areas that traumatized the mucosa, pre-prosthetic surgery for the removal of HFI, histopathological examination and the making of new prostheses, the upper prosthesis being conventional total and the lower partial removable prosthesis. It is observed the importance in the care of the prosthetic rehabilitation planning of the patients, because, as it was described in this case, in some situations it may be necessary to resort to different treatment modalities prior to the rehabilitation(AU)

Effects of 3 kinds of processing techniques on the fitness of metal clasp / 中南大学学报(医学版)

OBJECTIVES@#At present, removable partial denture is still one of the main restoration methods for dentition defects. However, the trend for digital partial denture is becoming more and more obvious in the field of oral repair. However, there are relatively few studies on digital removable partial denture. The aim of this study is to investigate the effects of 3 processing technologies (precision casting, digital cutting, and 3D printing) on the fitness for the clasps of cobalt chromium alloy and pure titanium removable partial denture, and to provide a theoretical basis for the clinical application of digital removable partial denture.@*METHODS@#Clasps of Co-Cr alloy and pure titanium were produced by 3 different processing technologies (precision casting, digital cutting, and 3D printing). There are 6 groups, including a casting pure titanium group, a casting cobalt chromium group, a cutting pure titanium group, a cutting cobalt chromium group, a printing pure titanium group, and a printing cobalt chromium group (@*RESULTS@#There was no statistical difference in fitness between the casting pure titanium group and the casting cobalt chromium group (@*CONCLUSIONS@#The cobalt chromium alloy and pure titanium clasps made by precision casting, digital cutting, and 3D printing have good fitness. Under the same process, there is no significant difference between cobalt chromium alloy and pure titanium clasps. The 3D printing pure titanium clasps have better fitness than casting pure titanium and cutting pure titanium clasps, which meet the needs of clinical application.

Evaluation of methods for fitness of removable partial denture / 北京大学学报(医学版)

OBJECTIVE@#To compare the differences and indications of three evaluation methods for fitness evaluation of removable partial denture (RPD).@*METHODS@#A RPD was fabricated and seated on the stone cast of a partially edentulous mandible, and the spaces between RPD and stone cast were recorded with polyvinyl siloxane (PVS) impression material forming PVS replicas. Using cross sectional measurement, the average thicknesses of PVS replicas were measured under stereomicroscope with different numbers of selected measuring points in the denture base, major connector, occlusal rest of the RPD, and the average thicknesses of the PVS replicas measured with different numbers of measuring points were compared using one-way analysis of variance (ANOVA) and independent sample t test. Three kinds of method, including cross sectional measurement, three-dimensional analysis on the stone cast, and three-dimensional analysis on the polyether cast, were applied to measure the average thicknesses of the PVS replicas, and the average thicknesses of the PVS replicas measured by these three evaluation methods were compared with ANOVA.@*RESULTS@#For cross sectional measurement, statistically significant differences were found in the average thicknesses of the PVS replicas in the denture base and the major connector among the different numbers of measuring points (P < 0.05), but no differences were found in the average thicknesses of the PVS replicas in the occlusal rest (P>0.05). There were significant differences among the average thicknesses of the PVS replicas measured by these three evaluation methods in each component of the RPD (P < 0.01). The average thickness measured by three-dimensional analysis on the stone cast and three-dimensional analysis on polyether cast were smaller than that measured by cross sectional measurement (P < 0.05). And there were no differences between the average thicknesses of PVS replicas measured by three-dimensional analysis on stone cast and three-dimensional analysis on polyether cast (P>0.05).@*CONCLUSION@#For cross sectional measurement, the average thickness of the PVS replicas was influenced by the number of measuring points, and the measurement accuracy of cross sectional measurement was not reliable enough. Three-dimensional analysis on stone cast which is suitable for evaluation in vitro and three-dimensional analysis on polyether cast which is suitable for evaluation in vivo can evaluate the fitness of RPD more comprehensively and effectively than that of cross sectional measurement.

Masticatory Function and Nutritional Status in Brazilian Institutionalized Elders: Influence of Denture Use

ABSTRACT Objective: To evaluate the influence of tooth loss and the use of removable dentures on chewing function and nutritional status of institutionalized elders. Material and Methods: Cross-sectional study with 155 elders from seven long-stay institutions in João Pessoa, Brazil. The participants were classified according to the presence of reminiscent teeth and use of dentures in four levels: toothless, without denture (1); toothless with a complete denture (2); partial toothless without denture (3) and partial toothless with a partial denture (4). Nutritional status was assessed using the Mini-Nutritional Assessment (MNA) instrument and the Body Mass Index (BMI). Swallowing threshold was used for the assessment of masticatory function, using a portion of roasted peanuts (3.7 g). Comparisons among groups were performed using Kruskal-Wallis test with Bonferroni adjustment, considering p<0.05. Results: MNA (p=0.702) and BMI (p=0.884) were not modified in relation to the presence of teeth and denture use. Toothless individuals without dentures had a lower swallowing threshold (p<0.001), whilst partial toothless with dentures had better masticatory function (p>0.05). Conclusion: The presence of reminiscent teeth and the use of dentures do not influence the nutritional status of the elders but interfere with the masticatory function. Prosthetic rehabilitation is desirable for complete toothless individuals.

Quality of life related to oral health in adults with removable prosthetic rehabilitation / Calidad de vida relacionada con la salud oral en adultos con rehabilitación protésica removible

The evaluation of the oral health-related quality of life (OHRQoL) is important for clinical assessment and could be an indicator of the quality of the treatment received. Objective: To evaluate the OHRQoL in adults with removable prostheses in relation with patient characteristics such as age, sex, type and time of use of the prosthesis, previous experience and perception about the stability of the prosthesis. Materials and Methods: 217 patients from the Dental Clinic of the National University of San Marcos-Peru were evaluated after rehabilitation with a removable prosthesis. A structured questionnaire was applied by telephone interview. The evaluation of the OHRQoL was carried out using the General/Geriatric Oral Health Evaluation Index (GOHAI). For the statistical analysis, the Mann Whitney U test, the Kruskal-Wallis H test and the Spearman correlation were used. Results:The sample included 63 men (29%) and 154 women (71%) with an average age of 66.34. The average GOHAI score was 52.44+8.15. The GOHAI score was related to age (p=0.241), sex (p=0.110), type of prosthesis (p=0.069), previous experience (p=0.293), and perception of movement of the prosthesis (p<0.001). Conclusions: The GOHAI score indicates a moderate quality of life related to oral health after prosthetic rehabilitation. The GOHAI index can be considered effective for the evaluation of the OHRQoL.

La evaluación de la calidad de vida relacionada a la salud oral (CVRSO) resulta importante para la valoración clínica pudiendo ser un indicador de la calidad en el tratamiento recibido. Objetivo: Evaluar la CVRSO en adultos con rehabilitación protésica removible relacionándola con características de los participantes como edad, sexo, tipo y tiempo de uso de la prótesis, experiencia previa y percepción sobre la estabilidad de la misma. Materiales y Métodos: Se evaluaron 217 pacientes de la Clínica Odontológica de la Universidad Nacional Mayor de San Marcos-Perú, posterior a la rehabilitación con prótesis removible. Se aplicó un cuestionario estructurado mediante entrevista vía telefónica. La evaluación de la CVRSO se realizó mediante el índice de Evaluación de Salud Oral General/Geriátrica (GOHAI). Para el análisis estadístico se utilizaron las pruebas de U de Mann Whitney, H de Kruskal-Wallis y correlación de Spearman. Resultado: La muestra incluyó 63 hombres (29%) y 154 mujeres (71%) con una edad media de 66.34. La puntuación media del GOHAI fue de 52.44 + 8.15. Se relacionó la puntuación del GOHAI con la edad (p=0.241), sexo (p=0.110), tipo de prótesis (p=0.069), experiencia previa (p=0.293) y percepción de movimiento de la prótesis (p<0.001). Conclusion: La puntuación del GOHAI indica una moderada calidad de vida relacionada a la salud oral después de la rehabilitación protésica. El índice GOHAI puede considerarse efectivo para la evaluación de la CVRSO.

Removable partial dentures: eliminating retainers in the anterior zone / Prótesis parcial removible: eliminación de retenedores en la zona anterior

Abstract Introduction: one of the main factors for discomfort in users of removable partial prosthesis is the presence of visible retainers in the anterior zone. In Kennedy Class III arches, that is, exclusively dental loading pathways (in which the functional forces reach their final receptor: the alveolar bone), anterior zone retainers may be eliminated by selecting an appropriate prosthetic insertion and removal axis, and mainly by carving guiding planes that should provide retention by mechanical rubbing. This in vitro experimental study aimed to prove the hypothesis that it is possible to obtain functional retention in a dental-loading pathway removable partial prosthesis without using retainers in the anterior zone. Methods: 7 maxillary models with different types of toothless process were used. As a common characteristic, they all were classified as Kennedy Class III with partial denture arches. A Cr-Co metallic base was built for each model according to their clinical situation. Their design allowed them to be exposed to traction in a universal traction machine (Tinius Olsen H5K-S). Results: the proposed hypothesis was confirmed as expected. The traction force needed to displace the metallic bases with retainers in the anterior zone was 16.93 Newton in average. On the other hand, the metallic bases without retainers in the anterior zone showed an average of 12.84 N. The average values obtained for both groups are higher than those reported in the literature (4.903 N). Conclusions: in Class III removable partial dentures it is possible to use metallic bases with no retainers in the anterior zone.

Resumen Introducción: un factor que incomoda a los usuarios de prótesis parciales removibles es la presencia de retenedores visibles en la zona anterior. En clases III de Kennedy, es decir, vías de carga exclusivamente dentarias, sería posible eliminar los retenedores del sector anterior mediante un adecuado tallado de planos guías que brinde retención por roce mecánico y la elección de un eje de inserción y remoción protésico. Este trabajo es un diseño experimental in vitro que tiene por finalidad validar la hipótesis propuesta por nuestro equipo de investigación, que es posible obtener retención funcional en una prótesis parcial removible de vía de carga dentaria sin utilizar retenedores en el sector anterior. Métodos: se utilizaron 7 modelos maxilares en yeso tipo IV, con distinto tipo de desdentamiento, cuya característica común era que correspondían a clases III de Kennedy de arcos parcialmente desdentados. A cada modelo se le confeccionó una base metálica de Cr-Co, de acuerdo con sus características clínicas individuales, las cuales presentaron un diseño que permitió utilizarlas en una máquina de tracción universal para someterlas a fuerzas de tracción. Resultados: la fuerza de tracción necesaria para desalojar las bases metálicas que contaban con retenedores en el sector anterior fue del orden de 16,93 N en promedio. En cambio, las bases metálicas sin retenedores en el sector anterior presentaron un valor promedio para su desalojo de 12,84 N. Conclusiones: los valores promedio obtenidos para ambos grupos son superiores a los que se señala en la literatura (4,903 N) como válidos para una retención adecuadamente funcional para una prótesis parcial removible.