La saliva en pacientes edéntulos completos / Saliva in totally edentulous patients

La saliva es un fluido biológico importante en la fisiología de la cavidad bucal. El propósito de estarevisión fue considerar las relaciones entre el edentulismo completo y el perfil fisiológico de la saliva. El flujo salival, el pH y la capacidad tampón tienen relación con el número de dientes perdidos, presencia de prótesis dentales y métodos de determinación del flujo (saliva no estimulada o estimulada). Las fracciones de proteínas en muestras de saliva total muestran diferencias entre individuos dentados y pacientes edéntulos. Este conocimiento permitirá a los clínicos, comprender mejor el impacto del edentulismo sobre las propiedades de la saliva y planificar el tratamiento en consecuencia.

Saliva is an important biological fluid in oralphysiology. The purpose of this review wasto consider relationships among complete edentulism and saliva physiological profile. Salivaryflow rate, pH and buffer capacity has a relationwith the number of missing teeth, presence ofdental prostheses and methods of determining flow rate (unstimulated or stimulated saliva). Protein fractions in whole salivary samplesshow differences between dentate individuals and edentulous patients. This knowledge willenable clinicians to better understand the impactof edentulism on salivary properties and plan treatment accordingly.

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.

Clinical and radiographic study of orofacial alterations in patients with systemic sclerosis

Systemic sclerosis (SS) is an autoimmune disease with great repercussions on the hard and soft tissues of the orofacial region. The aim of this study was to investigate the relationship between mandibular osteolysis and mouth opening measurements, duration of disease and presence/absence of teeth. Twenty-five subjects were selected: 15 diagnosed with systemic sclerosis and 10 healthy controls. The SS patients were grouped according to the presence (group I) or absence (group II) of mandibular osteolysis. The healthy subjects served as the control group (III). All of them underwent panoramic radiography on Ortophos® equipment (Siemens) and were clinically examined, with mouth opening measurement. We observed that group I had a longer duration of the disease than group II (p = 0.003). Groups I and II presented the same mean mouth opening. There was an increasing correlation between mouth opening and duration of the disease in group I (p = 0.095), but this was not observed in group II (p = 0.596). There was no correlation between presence/absence of teeth and osteolysis (p > 0.999), or between presence/absence of teeth and side of osteolysis (p = 0.143). We could conclude that osteolysis seemed to develop in patients with a longer duration of the disease, but did not modify the degree of mouth opening in relation to patients without osteolysis, and the presence/absence of teeth was not significant. On the other hand, in the osteolysis cases, the longer the duration of the disease, the greater the opening of the mouth.

Bite force in temporomandibular dysfunction (TMD) and healthy complete denture wearers

The signs and symptoms of temporomandibular dysfunction (TMD) may contribute to reduce bite force and muscular activity. The aims of this study were to compare bite force in complete denture wearers with TMD (TMD group) and without TMD (healthy group).The TMD group consisted of 9 individuals, who had worn a maxillary and a mandibular complete removable denture for more than 10 years. The healthy group consisted of 9 participants who wore dentures and had satisfactory interocclusal and maxillomandibular relationship. Helkimo Index was used to analyze the dysfunction level. Maximum bite force was measured using a digital dynamometer with capacity of 100 kgf and adapted to oral conditions.The TMD group presented smaller mean bite force values than the healthy group, though without statistical significance (p>0.05). This outcome suggests that the TMD signs and symptoms and the structural conditions of the dentures did not affect the maximal bite force of complete denture wearers.

Os sinais e sintomas de DTM podem contribuir na redução da força de mordida e da atividade muscular. O objetivo deste trabalho foi comparar a força de mordida em indivíduos com prótese total com DTM (Grupo CDTM) e sem DTM (Grupo SDTM). O Grupo CDTM (n=9) era composto por indivíduos que utilizavam as mesmas próteses totais há mais de 10 anos. O Grupo SDTM (n=9) por indivíduos com próteses totais satisfatórias quanto aos requisitos estruturais e funcionais, observados pelo profissional e relatados pelo paciente. O índice de Helkimo foi utilizado para análise do índice de disfunção. A força de mordida máxima foi medida na região de molares com gnatodinamômetro. Os resultados mostraram que o Grupo CDTM apresentou valor numérico médio de força de mordida menor que o Grupo SDTM, porém sem diferença estatisticamente significante entre os grupos avaliados (p<0,05) sugerindo que os sinais e sintomas da DTM e as condições estruturais das próteses não afetaram os resultados da força de mordida.

Complete denture impression techniques: evidence-based or philosophical.

Code of practice is dangerous and ever-changing in today's world. Relating this to complete denture impression technique, we have been provided with a set of philosophies--"no pressure, minimal pressure, definite pressure and selective pressure". The objectives and principles of impression-making have been clearly defined. Do you think any philosophy can satisfy any operator to work on these principles and achieve these objectives? These philosophies take into consideration only the tissue part and not the complete basal seat, which comprises the periphery, the tissues and the bone structure. Under such circumstances, should we consider a code of practice dangerous or should we develop an evidence-based approach having a scientific background following certain principles, providing the flexibility to adapt to clinical procedures and to normal biological variations in patients rather than the rigidity imposed by strict laws?

Electrognathographic evaluations of rehabilitated edentulous patients

This study investigated, through computerized electrognathographic evaluations (K6-I Diagnostic System, Myotronics-Noromed Inc., Tukwila, USA), the mandibular movement pattern of 16 patients rehabilitated with complete dentures presenting no symptoms of stomatognathic functional alterations. The patients were instructed to wear an intra-oral appliance for occlusal plane coverage over their usual superior denture and were then rehabilitated with new dentures preserving a free-way space of 3 mm. After sixty days, the occlusal vertical dimension was increased and the modified inferior dentures were used for another 60 days. The obtained results were submitted to the Tukey Test and to the Friedman test, depending on which variable was under consideration, both at a significance level of 5 percent. The data revealed a significant decrease in free-way space when the first and the last evaluations were compared. No significant differences were found during opening and closing. It was concluded that the presence of a free-way space at the end of the treatment confirms the importance of its existence for maintaining the balance of the masticatory system, assuming the occurrence of a postural repositioning.

O objetivo deste estudo foi avaliar por meio de eletrognatografia computadorizada (K6-I Diagnostic System, Myotronics-Noromed Inc., Tukwila, EUA) o padrão dos movimentos mandibulares de 16 pacientes reabilitados com dentaduras completas, livres de alterações funcionais do sistema estomatognático. Os pacientes foram instruídos a utilizar um aparelho intra-oral de cobertura oclusal plana adaptado na prótese usual superior e então reabilitados com novas próteses preservando a existência de um espaço funcional livre de 3 mm. Após 60 dias promoveu-se um aumento da dimensão vertical de oclusão e as próteses inferiores assim modificadas foram utilizadas por mais 60 dias. Os resultados foram submetidos ao Teste de Tukey e ao Teste de Friedman, dependendo da variável em estudo, ambos com 5 por cento de significância. Constatou-se decréscimo significante do espaço funcional livre quando compararam-se a primeira e a última avaliações. Não foram encontradas diferenças durante abertura e fechamento. Concluiu-se que a presença de um espaço funcional livre ao final do tratamento vem comprovar a importância de sua existência na manutenção do equilíbrio do sistema mastigatório, admitindo-se que ocorre o reposicionamento postural.

Estudo do grau de reprodutibilidade do arco gótico pelo articulador TT com a distância intercondilar ajustada individualmente e fixada em 10,0 centímetros / Study of the gothic arch reprodutibity with use of the TT articulator adjusted with individual intercondylar distance and fixed in 10,0 centimeters

Estudou-se em 30 pacientes totalmente desdentados, a capacidade de reproduçäo do traçado do arco gótico descrito pelo paciente, utilizando o articulador T.T, com a distância intercondilar ajustada com valor individual e com a distância intercondilar fixa em 10,0 cm. Com base nos resultados obtidos da amostragem, conclui-se: que a grandeza da distância intercondilar influi na angulagem do arco gótico; que a capacidade de reproduçäo do arco gótico pelo articulador T.T. devidamente programado, sendo a distância intercondilar ajustada com o valor resultante da equaçäo (DICE - 2,6 cm = DICI), é da ordem de 60,0 por cento; que nos demais 40,0 por cento aumentando ou diminuindo a DICI, de um dos lados reproduzir o arco gótico, com a mesma angulagem do traçado pelo paciente, e finalmente, que a condiçäo de reprodutibilidade é bastante comprometida quando se utiliza um articulador com a distância intercondilar fixa em 10,0 cm, como soem ser os parcialmente ajustáveis, sem o referido ajuste