Periodontal Tissue Responses to Restorations with and without Cervical Finish Line: A Systematic Review and Meta-analysis.

The purpose of this review was to evaluate the periodontal and peri-implant tissue responses to restorative approaches with and without cervical finish line on teeth and dental implants. An electronic search was performed in PubMed/MEDLINE, Embase, Cochrane Library, LILACS, Web of Science, and Scopus databases, and in the gray literature. Controlled clinical trials and prospective cohort studies were included. Analyzed outcomes included gingival index (GI), bleeding on probing (BOP), probing depth (PD), gingival thickness (GT), marginal stability (MS), and marginal bone loss (MBL). A meta-analysis was then performed in two parts: the first compared results of restorations on teeth with and without cervical finish line, and the second compared results of restorations on implant abutments with and without cervical finish line. Regarding the tooth-based restoration analysis, 7 out of 1,388 selected articles were included in the systematic review, and 2 were selected for the meta-analysis. For implantbased restorations on abutments with and without cervical finish line, 6 out of 707 selected articles were included in the systematic review, and 2 in the meta-analysis. No significant differences in periodontal and peri implant indexes were identified between both prosthetic approaches in situations with and without cervical finish lines.

Depression and the risk of developing temporomandibular disorders in different diagnostic groups: A systematic review with meta-analysis.

OBJECTIVE: To evaluate the role of depression in the development of TMD groups. METHODS: This systematic review with meta-analysis compared the prevalence and scores of depression between TMD groups and controls. RESULTS: The results showed that depression was a significant risk factor in the development of RDC/TMD axis I muscle disorders (group I) and arthralgia/osteoarthritis/osteoarthrosis (group III), and non-significant for disc displacements (group II). Severe depression had almost four times the risk of developing TMD as compared to moderate depression. CONCLUSION: These findings suggest that addressing psychological factors in general, and depression in particular, in the managemenof TMD is crucial, especially in those TMD groups with higher pain levels (I and III), and the TMD pain reduction is crucial in reducing depression levels.

Evaluation of the ceramic laminate veneer-tooth interface after different resin cement excess removal techniques.

OBJECTIVES: To compare, in vitro, resin cement excess removal techniques at the veneer-tooth interface. MATERIALS AND METHODS: Anterior human teeth were restored with ceramic veneers and randomly divided according to the following techniques (n = 10): removal of excess resin cement with brush and dental floss, followed by light-curing with Valo (Group 1) or Elipar (Group 2) for 1 min and 40 s; tack-curing with Valo (Group 3) or Elipar (Group 4) for 1 s; and tack-curing with Valo (Group 5) or Elipar (Group 6) for 5 s. The tack-curing was followed by removal of excess with probe and dental floss and light-curing for 1 min and 40 s. The area of excess resin cement (mm2) was measured in micro-CT images using AutoCAD program. The failures at the cervical margin in the X, Y, and Z axes (µm) of greater value were measured using the DataViewer program. The specimens were submitted to microleakage with 2% basic fuchsin. RESULTS: According to the Kruskal-Wallis and multiple comparison test, the highest area of excess resin cement was found in Group 1 (5.06 mm2), which did not differ statistically from Groups 2 (3.70 mm2) and 5 (2.19 mm2). Groups 2, 3 (1.73 mm2), 4 (1.14 mm2), and 5 (2.18 mm2) did not differ statistically. Group 6 (0.77 mm2) obtained the lowest value, which did not differ statistically from Groups 3 and 4. According to the Kruskal-Wallis and Dunn test, there was no significant difference in failures in X (p = 0.981), Y (p = 0.860), and Z (p = 0.638) axes and no significant difference in microleakage (p = 0.203) among the groups. CONCLUSIONS: Tack-curing for 1 s or 5 s, followed by removal of excess resin cement using a probe and a dental floss, tended to result in a lower amount of excess material around the margin. CLINICAL RELEVANCE: The technique used for resin cement excess removal influences the amount of excess leaved at the veneer-tooth interface. Tack-curing for 1 s or 5 s is recommended to mitigate the excess resin cement.

Can hard and/or soft occlusal splints reduce the bite force transmitted to the teeth and temporomandibular joint discs? A finite element method analysis.

OBJECTIVE: To test whether two different materials used for occlusal splints would reduce the stress to the temporomandibular joint discs. METHODS: Geometric data from a young-adult male patient were obtained from computed tomography and magnetic resonance imaging. 3D biomodels and the finite element analyses were performed using specific software. RESULTS: The mandibular model presented the highest bone stress areas in the mandibular rami and insertion of the temporalis muscles. Regardless the material, the highest stress in the occlusal splints was located in the second molar regions on the occlusal splint surface and in the opposing mandibular second molars. Stress reduction was only observed in the internal surface of the occlusal splints embracing the maxillary teeth. No differences between occlusal splints were found in the stress intensity and distribution in either left or right TMJ discs, being concentrated more in the anterior portion of the disc. DISCUSSION: Hard acrylic OS should be preferred over soft EVA OS in the majority of cases, soft OS only for temporary use. Thinner OS (2-3 mm anterior thickness) should be preferred over thick ones (3-4 mm) in order to keep the stress concentrations in the center of the TMJ discs. Lighter contacts over heavier contacts should be preferred in the second molar OS contact surface area to prevent stress concentrations and fractures. Maxillary occlusal splints should be chosen if the teeth or implant are in the maxilla, and vice-versa.

Depression, somatization, and sleep disorders as risk factors for temporomandibular disorders development: a population-based case-control study / Depressão, somatização e distúrbios do sono como fatores de risco para o desenvolvimento de disfunções temporomandibulares: um estudo de controle de casos baseado na população / Depresión, somatización y trastornos del sueño como factores de riesgo para el desarrollo de trastornos temporomandibulares: un estudio de casos y controles de base poblacional

The objective of this study was to determine the association between temporomandibular disorders (TMD) with depression, somatization and sleep disorders in the city of Maringá, Brazil. A total of 1,643 participants were selected from the Brazilian Unified Health System (SUS). Of these, the test group consisted of 84 participants who had moderate or severe limitations due to TMD pain and the control group consisted of 1,048 participants with no pain. There was a highly statistically significant difference (p<0.001) between cases and controls regarding depression (82.1 versus 37.4%), somatization (84.5 versus 31.4%), and sleep disorders (84.6 versus 36.4%), in moderate to severe levels. The levels of moderate to severe depression, somatization and sleep disorders were significantly higher in TMD subjects with high TMD pain disability. The risk of developing TMD increased 4 to 5 times when the individual has moderate to severe levels of depression, somatization, and sleep disorders.

O objetivo deste estudo foi determinar a associação entre disfunções temporomandibulares (DTM) com depressão, somatização e distúrbios do sono na cidade de Maringá, Brasil. Foram selecionados 1.643 participantes atendidos no Sistema Único de Saúde (SUS). Desses, o grupo caso foi formado por 84 participantes que apresentaram limitações moderada ou grave devido à dor na DTM e o grupo controle foi formado por 1.048 participantes com ausência de dor. Verificou-se diferença estatisticamente significativa (p<0,001) entre casos e controles em relação à depressão (82,1 versus 37,4%), somatização (84,5 versus 31,4%) e distúrbios do sono (84,6 versus 36,4%), em níveis moderados a graves. Os níveis de depressão moderada a grave, somatização e distúrbios do sono foram significativamente mais altos em indivíduos com DTM com alta incapacidade devido à dor por DTM. O risco de desenvolver DTM aumentou quatro a cinco vezes quando o indivíduo apresenta níveis moderados a graves de depressão, somatização e distúrbios do sono.

El objetivo de este estudio fue determinar la asociación entre los trastornos temporomandibulares (TMD) con la depresión, la somatización y los trastornos del sueño en la ciudad de Maringá, Brasil. Un total de 1.643 participantes fueron seleccionados del Sistema Único de Salud (SUS) de Brasil. (SUS). De estos, el grupo de casos fue formado por 84 participantes que presentaban limitaciones moderadas o graves debido al dolor TMD y el grupo de control estaba formado por 1.048 participantes sin dolor. Hubo una diferencia estadísticamente significativa (p <0,001) entre casos y controles con respecto a depresión (82,1 frente a 37,4%), somatización (84,5 frente a 31,4%) y trastornos del sueño (84,6 frente a 36,4%), en niveles moderados a severos. Los niveles de depresión moderada a grave, somatización y trastornos del sueño fueron significativamente más altos en personas con TMD con alta discapacidad por dolor en TMD. El riesgo de desarrollar TMD aumenta de 4 a 5 veces cuando el individuo tiene niveles moderados a severos de depresión, somatización y trastornos del sueño.

Subjective sleep quality and temporomandibular disorders: Systematic literature review and meta-analysis.

STUDY OBJECTIVES: To assess the general subjective sleep quality in individuals with and without TMD, and its distribution among the TMD diagnostic groups. METHODS: A systematic review search was performed in Pubmed/MEDLINE, Embase, LILACS, Web of Science, SciELO, CINAHL and Cochrane Central as well as in the grey literature. Observational studies published since 1992 which used either the DC/TMD or RDC/TMD for TMD diagnosis and either the PSQI, SAQ or ESS questionnaires for sleep assessment were included. Articles selected for meta-analysis underwent quality, heterogeneity and publication bias evaluation. RESULTS: A total of 1071 articles were found by online search, and 10 articles were added manually. For full-text reading, 138 papers were selected. Thirty-six articles were included in the final review, and 19 in the meta-analysis (PSQI only). Subjective sleep quality was shown to be associated with all RDC/TMD or DC/TMD Axis I diagnostic groups: muscle disorders, arthralgia/osteoarthritis/osteoarthrosis and disk displacements; with the highest association in the first two groups, and the lowest in the last one. A 4.45 times increased odds ratio of TMD prevalence was found for individuals who presented poor subjective sleep quality. CONCLUSION: Subjective sleep quality should be considered in the management of TMD.

Quality of life in young and middle age adult temporomandibular disorders patients and asymptomatic subjects: a systematic review and meta-analysis.

AIMS: To compare the difference in the quality of life between temporomandibular disorders (TMD) patients and non-TMD subjects diagnosed with the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) or the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). METHODS: Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica database (EMBASE) and Latin American and Caribbean Health Sciences Literature (LILACS) databases were searched in studies published in English and Portuguese. The search was performed by two independent reviewers in duplicate. A manual search and the gray literature were also included. The inclusion criteria were clinical studies that used the RDC/TMD axis I and quality of life with standard questionnaires in young and middle-aged adult population (18-55 years). The data were analyzed quantitatively by combining the results in a meta-analysis using forest plots. The measure of effect used was the standardized mean difference (SMD) in depression levels. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of the studies. The publication bias was assessed by funnel plots. The initial search included 806 articles without duplications. RESULTS: Twenty-four articles were included in the final systematic review. Of these, 9 were included in the meta-analysis, where it was shown a statistically significant in all axis I groups: (a) global TMD-groups I, II and III combined, N = 3829, SMD (95% CI) = 1.06 (0.65-1.51), p = 0.000; (b) group I-muscle disorders, N = 3,056, SMD (95% CI) = 0.82 (0.45-1.18), p = 0.000; (c) group II-disc displacements, N = 3,184, SMD (95% CI) = 0.59 (0.26-0.91), p = 0.000; and (d) group III-arthralgia/arthritis/arthrosis, N = 2781, SMD (95% CI) = 0.98 (0.59-1.36), p = 0.000. When compared to controls. CONCLUSIONS: Quality of life is affected in all axis I TMD patients, especially in groups I and III with higher pain intensity and disability as compared to group II.

Violência contra mulheres idosas em Manaus: do silêncio ao enfrentamento / Violence against elderly women in Manaus: from silence to coping

A violência contra a pessoa idosa é um grave problema mundial, cujas manifestações têm profundos impactos na saúde e na qualidade de vida dessas pessoas. Como problema sócio-histórico, a violência faz parte da história da humanidade e tem se manifestado de forma crescente contra mulheres, incluindo as idosas. O objetivo deste artigo é analisar as experiências sociais de mulheres idosas que sofreram violência e buscaram a rede de proteção, e a perspectiva dos profissionais que atuam nos serviços de atendimento à violência contra a pessoa idosa em Manaus. Os resultados apontam para a compreensão de violência associada à violência física predominantemente, seguida da violência verbal e moral, todas vivenciadas no âmbito das relações interpessoais. Apontam também para a necessidade de divulgar os instrumentos de proteção legal e capacitar melhor os profissionais para tratar as especificidades desse grupo

Violence against the elderly is a serious global problem, and its manifestations have profound impacts on the health and quality of life of these people. As a socio-historical problem, violence is part of the history of mankind and has increasingly manifested itself against women, including the elderly. The aim of this article is to analyze the social experiences of elderly women who have suffered violence and sought the State's safety net, as well as the perspective of professionals who work in social services that deal with violence against the elderly in Manaus ­ AM, Brazil. The results point to an understanding of violence associated predominantly with physical violence, followed by verbal and moral violence, all experienced within the scope of interpersonal relationships. Results also point to the need to disseminate legal protection instruments and to better train professionals to deal with the specificities of this group

Periodontitis is an inflammatory disease of oxidative stress: We should treat it that way.

Periodontitis is a highly prevalent disease. As it progresses, it causes serious morbidity in the form of periodontal abscesses and tooth loss and, in the latter stages, pain. It is also now known that periodontitis is strongly associated with several nonoral diseases. Thus, patients with periodontitis are at greater risk for the development and/or exacerbation of diabetes, chronic obstructive pulmonary disease, and cardiovascular diseases, among other conditions. Although it is without question that specific groups of oral bacteria which populate dental plaque play a causative role in the development of periodontitis, it is now thought that once this disease has been triggered, other factors play an equal, and possibly more important, role in its progression, particularly in severe cases or in cases that prove difficult to treat. In this regard, we allude to the host response, specifically the notion that the host, once infected with oral periodontal pathogenic bacteria, will mount a defense response mediated largely through the innate immune system. The most abundant cell type of the innate immune system - polymorphonuclear neutrophils - can, when protecting the host from microbial invasion, mount a response that includes upregulation of proinflammatory cytokines, matrix metalloproteinases, and reactive oxygen species, all of which then contribute to the tissue damage and loss of teeth commonly associated with periodontitis. Of the mechanisms referred to here, we suggest that upregulation of reactive oxygen species might play one of the most important roles in the establishment and progression of periodontitis (as well as in other diseases of inflammation) through the development of oxidative stress. In this overview, we discuss both innate and epigenetic factors (eg, diabetes, smoking) that lead to the development of oxidative stress. This oxidative stress then provides an environment conducive to the destructive processes observed in periodontitis. Therefore, we shall describe some of the fundamental characteristics of oxidative stress and its effects on the periodontium, discuss the diseases and other factors that cause oxidative stress, and, finally, review potentially novel therapeutic approaches for the management (and possibly even the reversal) of periodontitis, which rely on the use of therapies, such as resveratrol and other antioxidants, that provide increased antioxidant activity in the host.

Evaluation of Marginal Misfit of Implant-Supported Fixed Prostheses Made Using Different Techniques.

PURPOSE: To evaluate the vertical marginal (VM) and horizontal marginal (HM) misfit of frameworks made using different techniques. MATERIALS AND METHODS: A total of 30 frameworks were divided into three groups of 10 samples each based on manufacturing technique: nichrome cast (G1), milled in zirconia (G2), and milled in wax and fused to metal (G3). Marginal misfit was measured using a three-dimensional optical microscope. RESULTS: The highest VM misfit was in G3 (83.5 µm), followed by G1 (55 µm) and G2 (42 µm). The highest HM misfit was in G2 (118 µm), followed by G3 (102 µm) and G1 (-85 µm). CONCLUSION: Frameworks milled in zirconia resulted in the lowest VM misfit, while frameworks filled in wax and fused to metal resulted in higher VM. The HM misfit was favorable in the lost-wax technique.

Evaluation of Sexual, Physical, and Emotional Abuse in Women Diagnosed with Temporomandibular Disorders: A Case-Control Study.

PURPOSE: To compare the prevalence of physical and sexual abuse in women with temporomandibular disorders (TMD) vs women without TMD. METHODS: Forty women (age range 16-45 years) with idiopathic TMD were selected from the Occlusion Clinic at the Pontifical Catholic University of Rio Grande do Sul Faculty of Dentistry and were compared to 40 TMD-free women within the same age range. The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axes I and II and the Sexual Abuse History Questionnaire (S/PAHQ) were used to collect data. RESULTS: Women with TMD diagnosed with myofascial pain had higher levels of chronic pain grade, disability points, chronic pain intensity, depression, and nonspecific physical symptoms with and without pain (ie, somatization). Women with TMD were significantly less educated, had lower family income, and were older than women without TMD. They also had significantly older partners, but there were no differences in the partners' occupation or education levels. Regarding emotional abuse, women with TMD reported significantly more insults and diminishing/humiliation in front of other people than the controls. The prevalence of physical and sexual abuse was higher in the TMD group, but this difference was nonsignificant. CONCLUSION: Emotional abuse, more than physical and sexual abuse, is an important risk factor for the development of TMD, even when controlling for education level, income, age, ethnicity, marital status, and occupation. Emotional abuse, as well as physical and sexual violence, should be assessed routinely in women suffering from chronic TMD.

Analysis of Marginal Adaptation of Porcelain Laminate Veneers Produced by Computer-Aided Design/Computer-Assisted Manufacturing Technology: A Preliminary In Vitro Study.

PURPOSE: To analyze the marginal adaptation of computer-aided design/computer-assisted manufactured (CAD/CAM) porcelain laminate veneers. MATERIALS AND METHODS: A total of 25 three-dimensional (3D) machine-milled laminate veneers were divided into five groups of five each according to fabrication material (E-max; Empress; Lava Ultimate; Suprinity; and Vita Mark II) and cemented in 25 prepared acrylic central incisors. Digital microscopy images (×7.5 magnification) were analyzed for gaps in the mesial/distal surfaces of the prepared tooth and in the cervical, medial, and incisal thirds. RESULTS AND CONCLUSION: All CAD/CAM laminate veneers except for Empress and Suprinity in the middle and incisal thirds showed good results (ie, gaps < 120 µm in the cervical, middle, and incisal thirds).

Analysis of the Marginal Fit and Dimensional Stability of Cast-to Cobalt-Chromium Implant Cylinders Cast from Different Alloys.

PURPOSE: To evaluate the influence of cobalt-chromium (Co-Cr) casting alloys' melting temperatures on the cast-to Co-Cr implant cylinders' marginal fit. MATERIALS AND METHODS: Co-Cr alloys with different melting ranges were cast into 20 Co-Cr cylinders: 10 in a high-melting temperature (HMT) group and 10 in a low-melting temperature (LMT) group. Ten cylinders were used as received as a control group. Cylinders' marginal misfit and dimensional stability were evaluated using scanning electron microscopy (×500). RESULTS AND CONCLUSION: HMT cylinders showed significant differences in marginal misfit (2.48 ± 1.07 µm2) compared to LMT (1.53 ± 0.37 µm2) and control (1.27 ± 0.57 µm2) cylinders, but there were no differences in dimensional stability. HMT Co-Cr alloys produce implant-supported prostheses with poor marginal fit.

The Effects of Sleeping With or Without Prostheses on Sleep Quality, Sleep Bruxism, and Signs of Obstructive Sleep Apnea Syndrome: A Pilot Study.

PURPOSE: To evaluate the effects of sleeping with or without a maxillary mucosa-supported complete denture (CD) in edentulous patients wearing a mandibular fixed implant-supported CD on sleep quality, sleep bruxism (SB) activity, and signs of obstructive sleep apnea syndrome (OSAS). MATERIALS AND METHODS: A total of 18 female patients with maxillary mucosa-supported CDs opposing mandibular fixed implant-supported CDs were selected and tested for sleep quality, SB activity, and signs of OSAS during one night while wearing the maxillary CD and another night without wearing it, with a washout period of 7 days in between. The validated Brazilian Portuguese versions of the Pittsburgh Sleep Quality Index (PSQI-BR), Sleep Assessment Questionnaire (SAQ), and Epworth Sleepiness Scale (ESSBR) were used to assess subjective sleep quality. Diagnosis of OSAS followed the American Academy of Sleep Medicine (AASM) guidelines and was confirmed with an objective and validated type 3 portable cardiorespiratory monitor (ApneaLink Plus v.9.00) by measuring the respiratory disturbance index (RDI). SB activity was assessed with a subjective self-report questionnaire and an objective and validated portable electromyographic device (BiteStrip). RESULTS: The objective measurements of SB activity and the RDI showed significant reduction (ie, improvement) when patients did not wear the maxillary CD. The subjective measurements of sleep quality and self-reports of SB activity showed no significant differences between wearing and not wearing a maxillary CD. CONCLUSION: The present results have shown that not wearing a maxillary CD at night is preferable as far as SB and OSAS are concerned, but larger-scale studies are still needed.

Parallel Randomized Controlled Clinical Trial in Patients with Temporomandibular Disorders Treated with a CAD/CAM Versus a Conventional Stabilization Splint.

PURPOSE: This parallel randomized controlled trial (RCT) compared the efficacy of a computer-aided design/computer-assisted manufacture (CAD/CAM) splint versus a conventional stabilization splint in patients with temporomandibular disorders (TMD). MATERIALS AND METHODS: A sample of 48 age-matched TMD patients from the Ludwig Maximilian University Prosthodontic Department in Munich, Germany, were randomly allocated into groups 1 (CAD/CAM splint) and 2 (conventional splint). The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) was used for TMD Axis I (groups I, II, and III) and Axis II (chronic pain grade [CPG]) diagnoses. Numeric scales (TMD/NS, 10 cm) were used to measure headaches, face pain, jaw joint pain, jaw joint noises, mastication pain, neck pain, face tension, limitation of mouth opening, complaints during mastication, and teeth sensitivity at baseline and then monthly for 9 months (T1 to T10). Optical axiography was used to measure right and left condyle movements (mm) at baseline, 3 months, and 6 months (T1, T4, and T7). RESULTS: A total of 32 patients (drop-out rate = 33%; 68.75% women; 28.51 ± 7.13 years old), 16 per group, completed the study. RDC/TMD Axis I showed the following diagnoses: 93.75% muscle disorders, 37.75% disc displacement with reduction, 3.12% disc displacement without reduction, and 56.25% arthralgia. There was a significant reduction in 10 out of 13 items of the TMD/NS in the CAD/CAM splint versus 8 out of 13 in the conventional splint. However, no significant improvement in mandibular movements (ie, increase in range of motion and reduction in asymmetry between right and left condyles) was observed. CONCLUSION: Both treatments were equally efficacious and no difference was found between them.

Stress Distribution Study Using the Finite Element Method in Three Different Implant-Supported Fixed Complete-Arch Mandibular Prostheses.

PURPOSE: The objective of this study was to assess the stress distribution generated by a simulated loading (100 N) in the area of the cantilever in three different five-implant mandibular protocol prosthesis models. MATERIALS AND METHODS: The finite element analysis was carried out in three-dimensional models simulating: (1) a temporary all acrylic resin mandibular protocol prosthesis; (2) a metal-acrylic mandibular protocol prosthesis; and (3) a metal-ceramic mandibular protocol prosthesis. RESULTS: The all acrylic model promoted the highest stress values on the implant closest to the cantilever loading point. CONCLUSION: This study supports the need for a metallic bar reinforcement in the denture base.

Prevalence of Temporomandibular Disorders in an Adult Brazilian Community Population Using the Research Diagnostic Criteria (Axes I and II) for Temporomandibular Disorders (The Maringá Study).

PURPOSE: The primary objective of this study was to assess the prevalence of temporomandibular disorders (TMDs) and comorbid factors (sleep bruxism and headaches). This study was a cross-sectional population survey in the city of Maringá, state of Paraná, Brazil. MATERIALS AND METHODS: Axes I and II of the Research Diagnostic Criteria for TMD (RDC/TMD) were used for assessment of TMD signs and symptoms. The population was users of the Brazilian public health system (SUS), of both sexes, between the ages of 20 and 65 years, and not seeking treatment for TMD. RESULTS: The selected population (N = 1,643) was composed mostly of (a) women (65.9%), (b) married or single individuals (90.6%), (c) Caucasians (70.1%), (d) individuals aged 32.7 ± 10.3 years, (e) individuals earning a medium income (75.1%), and (f) those who had completed a high school education or higher (79.9%). According to the chronic pain grade classification (CPG) in the RDC/TMD Axis II, 36.2% of the population had some degree of TMD pain (CPG I to IV); however, only 5.1% had severe limitation due to pain (CPG III or IV). In the RDC/TMD Axis I diagnoses, 29.5% presented with muscle disorders (group I), 7.9% with disk displacements (group II), and 39.1% with other joint disorders (group III). Headaches were present in 67.9% and awake and sleep bruxism in 30% and 33.4% of the population, respectively. CONCLUSION: The prevalence of signs and symptoms of TMD was high in this population, but with low disability; however, the proportion of patients in need of treatment was much lower.

The effect of a positioning index on the biomechanical stability of tapered implant-abutment connections.

The biomechanical stability of the implant-abutment connection is critical for the success of implant-supported restorations. This study investigated the effect of a positioning index on the abutment screw preload values of tapered connection implants. Twenty Morse taper implants presenting an internal locking hex received 10 solid and 10 straight screw retained abutments for cemented single-crown restorations. Ten abutments had a positioning index to fit the internal locking hex of the implant (straight), and 10 were locked only by the implant taper (solid). The preload values for each abutment screw after a tightening torque were registered by strain gauges. Prosthetic crowns were placed on each abutment and subjected to mechanical cycling. Detorque forces were applied to each abutment and compared with the initial torque values. Data were statistically analyzed using Kolmogorov-Smirnov and Student t tests. The nonindexed group presented higher initial preload (6.05 N ± 0.95 N) compared with the indexed group (4.88 N ± 0.92 N; P < .05). After cycling, the nonindexed group exhibited less reduction of preload (13.84% ± 6.43%) compared with the indexed group (52.65% ± 14.81%; P < .01). Indexed tapered abutments for single-crown restorations might represent greater biomechanical risk under function.