Exploring botulinum toxin's impact on masseter hypertrophy: a randomized, triple-blinded clinical trial.

The present study aimed to assess the effectiveness and functional adverse effects of a single and multiple injections of botulinum toxin A (BoNT-A) for masseter hypertrophy (MH). Twenty-six women complaining about lower third facial enlargement due to MH, received 75 U of BoNT-A (abobotulinum toxin) in each masseter muscles. After 3 months, patients were randomly assigned to receive a second treatment session of Saline Solution: (G1; n = 11) or BoNT-A: (G2; n = 12). Muscle thickness (ultrasound), electrical activity (electromyography; EMG), masticatory performance, and subjective perception of MH were evaluated. Follow-up was performed at 1, 3 and 6 months. Muscle thickness, EMG activity, and masticatory performance were analyzed using ANOVA two-way and Sidak test as post-hoc. Masticatory performance was analyzed by the Friedman's test and Mann-Whitney test. Regarding inter-groups comparisons, there was a significant decrease in the left masseter muscle thickness in the G2 group at the 6 month follow-up (p < 0.02). For EMG, significant differences were evident at the 6 month assessment, with higher masseter activity for G1 (p < 0.05). For masticatory performance, no significant differences were observed throughout the study (p > 0.05) and a higher improvement in subjective perception of MH was observed in the 1 month follow-up for G2 (p < 0.05). In conclusion, BoNT-A is effective for MH, however multiple injections cause functional adverse effects in masseter muscle.

Trial data for precision analysis of a three-dimensional mandibular mechanical advantage.

The data presented in this manuscript describe craniofacial landmark coordinate values, muscle and load moment arm lengths, and mechanical advantage rates for constructing a three-dimensional model of masticatory muscles. Cone-beam computed tomography scans from 30 subjects (aged 12-19 years, 16 females) were used. Thirty-six craniofacial landmarks were identified. Subsequently, the moment arms for 7 muscles and their corresponding load moment arms at incisor and molar positions were determined. Then, the three-dimensional mechanical advantage for each muscle and tooth position was calculated as the ratio of muscle moment arm to load moment arm. This procedure was repeated three times by a main examiner and once by two other examiners. The Friedman test and the square root of the 'method of moments' variance estimator were used to compare data among examiners and calculate random errors, respectively. Although the values for the craniofacial landmark coordinates and biomechanical variables are very close, differences were found between measurements, especially in the interexaminer comparisons. Values served as the basis for reliability (intraclass correlation coefficient) and errors (average mean of absolute differences) analysis in the research paper titled "A three-dimensional method to calculate mechanical advantage in mandibular function: Intra- and interexaminer reliability study," published in the Journal of Orofacial Orthopedics.

Influence of the radius of Monson's sphere and excursive occlusal contacts on masticatory function of dentate subjects.

OBJECTIVE: To determine the influence of the radius of Monson's sphere, the number of posterior laterotrusive, mediotrusive, and protrusive contacts, and the chewing rate on food comminution. DESIGN: Sixty healthy dentate subjects, aged 21.22 ± 2.30 years, were selected. The three-dimensional coordinates of the cusp tips of the lower canine, premolar, and molar teeth were identified from the subjects' digital models. Monson's sphere was designed using the simplex method for function minimisation by adjusting the coordinates on its surface. The contacts were verified using 12 µm metal strips in jaw excursions at 0.5, 1.0, 2.0, and 3.0 mm. The masticatory performance and efficiency, swallowing threshold, and chewing rate were assessed through particle size fractionation. Data were analysed with multiple linear regression (α = 0.05). RESULTS: The sphere's radius, laterotrusive and protrusive contacts at 0.5 mm, and chewing rate were found to be negative predictor variables for masticatory performance until 20 chewing cycles (R2 = 0.429). For 40 cycles, the radius and total contacts (0.5 mm) were also explanatory factors (R2 = 0.223). Only the radius (R2 = 0.176) and the chewing rate (R2 = 0.082) were found to be significant for 60 cycles and swallowing threshold, respectively. Masticatory efficiency was influenced by masticatory performance until 40 and 60 cycles, as well as the radius and total contacts at 2.0 and 3.0 mm (R2 = 0.958). CONCLUSION: A larger radius of Monson's sphere and a greater number of posterior excursive contacts were found to be related to better masticatory function.

Effect of artificial eccentric occlusal interferences on masticatory performance: A randomised double-blind clinical trial.

BACKGROUND: Occlusal interferences lead to changes in mandibular kinematics to compensate and improve function. However, the effects of different types of eccentric disturbance on the comminution capacity are not known. OBJECTIVE: To determine the immediate effect of eccentric occlusal interferences on masticatory performance. METHODS: This crossover clinical trial included 12 healthy dentate subjects aged 25.2 ± 3.3 years who were randomly submitted to seven types of occlusal interference: unilateral and bilateral laterotrusive and mediotrusive, protrusive, dummy and control (no interference). The interference forms were planned in a semi-adjustable articulator, fabricated with composite resin and adhered to the mandibular first molars such that subjects' maximum intercuspation was maintained. Masticatory performance and the chewing rate during 20 cycles were evaluated during subjects' comminution of silicone test food under one interference condition per test day; the multiple sieve method was applied to the comminuted particles. The interference was removed upon test completion, and a 1-week washout period was applied between tests. RESULTS: Comminuted median particle sizes were larger under unilateral (4.94 ± 0.41 mm) and bilateral (4.81 ± 0.49 mm) laterotrusive, bilateral mediotrusive (4.65 ± 0.50 mm) and protrusive (4.83 ± 0.54 mm) interferences (p < .05) than under the control (4.01 ± 0.52 mm) and dummy (4.18 ± 0.58 mm) conditions (p < .05). Only unilateral and bilateral laterotrusive interferences narrowed the comminuted particle size dispersion (p < .05). The chewing rate did not differ among conditions (p = .1944). CONCLUSION: Artificial eccentric interferences had an immediate adverse effect on masticatory performance by resulting in larger comminuted particles. CLINICAL TRIAL REGISTRATION: Brazilian Registry of Clinical Trials (RBR-8g5zfg8).

Self-perceived oral health: a study with patients wearing removable dentures

Aim: This study aimed to investigate the relationship between self-perceived oral health and the prosthetic status of individuals who seek care in prosthodontics clinics. Methods: Self-perceived oral health was analyzed through the Geriatric Oral Health Assessment Index (GOHAI). Abutment tooth mobility was assessed, and denture status was determined by clinical assessment of stability, retention, occlusal balance, vertical dimension, and integrity of dentures. The frequency of individuals in each variable was determined for the low and very low GOHAI conditions. Chi-square, Pearson, and stepwise logistic regression tests were used for the statistical analyses (α = 0.05). Results: Ninety wearers of removable dentures with a mean age of 55.1±9.1 years were evaluated. None of the variables was related to GOHAI values (p > 0.05). The regression analysis showed that age predicts (p = 0.006) the variation of GOHAI conditions (OR = 0.924, CI = 0.873- 0.978), showing only 7.6% protective effect against very low GOHAI. Unsatisfactory stability showed the opposite effect (p = 0.034) and the individuals with this characteristic are more likely (OR = 3.055) to have very low GOHAI scores (CI = 1.085- 8.602). Conclusions: The self-perceived oral health of wearers of removable dentures worsens with age and unsatisfactory stability of dentures

Republication of "Ankle Fracture-Dislocations: A Review".

Ankle fractures are common musculoskeletal injuries that may result in tibiotalar joint dislocations. Ankle fracture-dislocations occur via similar mechanisms as ankle fractures, although the persistence or magnitude of the deforming force is sufficient to disrupt any remaining bony or soft-tissue stability. Ankle fracture-dislocations likely represent distinct clinical entities, as the pathology, management, and patient outcomes following these injuries differ from those seen in more common ankle fractures without dislocation. Ankle fracture-dislocations have higher rates of concomitant injury including open fractures, chondral lesions, and intra-articular loose bodies. Long-term outcomes in ankle fracture-dislocations are worse than ankle fractures without dislocation. Higher rates of posttraumatic osteoarthritis and chronic pain have also been reported. In this review, we discuss the current literature regarding the history, management, and outcomes of ankle-fracture dislocations and highlight the need for future study.

The Boyd approach: a valuable alternative to treating simple to complex elbow fractures and dislocations.

BACKGROUND: The Boyd approach is a single-incision posterior approach to the proximal radius and ulna based on a lateral anconeus muscle reflection and release of the lateral collateral ligamentous complex. This approach remains a lesser-used technique following early reports of proximal radioulnar synostosis and postoperative elbow instability. Although limited by small case series, recent literature does not support these early reported complications. This study presents a single surgeon's outcomes using the Boyd approach for the treatment of simple to complex elbow injuries. METHODS: Following institutional review board approval, a retrospective review of all patients with simple to complex elbow injuries treated consecutively using a Boyd approach by a shoulder and elbow surgeon was conducted from 2016 to 2020. All patients with at least 1 postoperative clinic visit were included. Data collected included patient demographics, injury description, postoperative complications, elbow range of motion, and radiographic findings including heterotopic ossification and proximal radioulnar synostosis. Categorical and continuous variables were reported using descriptive statistics. RESULTS: A total of 44 patients were included with an average age of 49 years (range 13-82 years). The most commonly treated injuries were Monteggia fracture-dislocations (32%) and terrible triad injuries (18%). Average follow-up was 8 months (range 1-24 months). Final average elbow active arc of motion was from 20° (range 0°-70°) of extension to 124° (range 75°-150°) of flexion. Final supination and pronation were 53° (range 0°-80°) and 66° (range 0°-90°), respectively. There were no cases of proximal radioulnar synostosis. Heterotopic ossification contributing to less than functional elbow range of motion occurred in 2 (5%) patients who elected conservative management. There was 1 (2%) case of early postoperative posterolateral instability due to repair failure of injured ligaments that required revision using a ligament augmentation procedure. Five (11%) patients experienced postoperative neuropathy, including 4 (9%) with ulnar neuropathy. Of these, 1 underwent ulnar nerve transposition, 2 were improving, and 1 had persistent symptoms at final follow-up. CONCLUSIONS: This is the largest case series available demonstrating the safe utilization of the Boyd approach for the treatment of simple to complex elbow injuries. Postoperative complications including synostosis and elbow instability may not be as common as previously understood.

A three-dimensional method to calculate mechanical advantage in mandibular function : Intra- and interexaminer reliability study.

PURPOSE: Masticatory muscles are physically affected by several skeletal features. The muscle performance depends on muscle size, intrinsic strength, fiber direction, moment arm, and neuromuscular control. To date, for the masticatory apparatus, only a two-dimensional cephalometric method for assessing the mechanical advantage, which is a measure for the ratio of the output force to the input force in a system, is available. This study determined the reliability and errors of a three-dimensional (3D) mechanical advantage calculation for the masticatory system. METHODS: Using cone-beam computed tomography images from teenage patients undergoing orthodontic treatments, 36 craniofacial landmarks were identified, and the moment arms for seven muscles and their load moment arms (biomechanical variables) were determined. The 3D mechanical advantage for each muscle was calculated. This procedure was repeated by three examiners. Reliability was verified using the intraclass correlation coefficient (ICC) and the errors by calculating the absolute differences, variance estimator and coefficient of variation (CV). RESULTS: Landmark coordinates demonstrated excellent intra- and interexaminer reliability (ICC 0.998-1.000; p < 0.0001). Intraexaminer data showed errors < 1.5 mm. Unsatisfactory interexaminer errors ranged from 1.51-5.83 mm. All biomechanical variables presented excellent intraexaminer reliability (ICC 0.919-1.000, p < 0.0001; CV < 7%). Interexaminer results were almost excellent, but with lower values (ICC 0.750-1.000, p < 0.0001; CV < 10%). However, the muscle moment arm and 3D mechanical advantage of the lateral pterygoid muscles had ICCs < 0.500 (p < 0.05) and CV < 30%. Intra- and interexaminer errors were ≤ 0.01 and ≤ 0.05, respectively. CONCLUSIONS: Both landmarks and biomechanical variables showed high reliability and acceptable errors. The proposed method is viable for the 3D mechanical advantage measure.

Effect of frozen storage on preservation of a silicone-based test food material

Aim: This study aimed to evaluate the effect of frozen storage on the physical properties of a silicone-based test food material, highly used to evaluate the masticatory performance in research settings. Methods: A total of 1,666 silicone cubes of Optosil Comfort® with 5.6-mm edges were shaped and stored at -18°C. The cubes were subsequently tested for flexural strength (maximum force, displacement, stress, and strain) before breaking (n = 136), changes in weight and size (n = 170), and masticatory performance (n = 1360) at eight timepoints: immediately after cube preparation (baseline, no freezing), and 1, 2, 3 and 4 weeks, and 2, 4 and 6 months after frozen storage. The cubes were thawed 8 h before each assessment. Results: The maximum force, stress, maximum displacement, and deformation values for the cubes were not affected by freezing (P > 0.05). At all of the time points, the cubes exhibited similar weight (P = 0.366) and size (identical values). The masticatory performance for the cubes also showed no differences from baseline through 6 months (P = 0.061). Conclusion: Freezing Optosil Comfort® silicone cubes did not alter the physical and mechanical properties of the material, being suitable to optimize the assessment of masticatory parameters for research purposes

Effect of Fibular Malrotation on Tibiotalar Joint Contact Mechanics in a Weber B Ankle Fracture Model.

BACKGROUND: In minimally displaced Weber B ankle fractures, the distal fibular fracture fragment can be externally rotated. This malrotation is difficult to detect on radiographs and, when left malreduced through nonoperative treatment, may contribute to altered joint mechanics, predisposing to posttraumatic osteoarthritis. This study evaluates the effects of fibular malrotation on tibiotalar joint contact mechanics. METHODS: Six cadaveric ankles were tested using a materials testing system (MTS) machine. A tibiotalar joint sensor recorded contact area and pressure. Samples were tested in the intact, neutrally rotated, and malrotated state. Each trial applied a 686N axial load and a 147N Achilles tendon load in neutral position, 15° dorsiflexion, and 15° plantarflexion. RESULTS: In the comparison of malrotated to intact ankles, peak contact pressure was found to be significantly greater at neutral flexion (intact 5.56 MPa ± 1.39, malrotated 7.21 MPa ± 1.07, P = .03), not significantly different in dorsiflexion, and significantly decreased in plantarflexion (intact 11.2 MPa ± 3.04, malrotated 9.01 MPa ± 1.84, P = .01). Significant differences in contact area were not found between conditions. CONCLUSION: The findings suggest that fibular malrotation contributes to significant alterations in tibiotalar joint contact pressures, which may contribute to the development of posttraumatic osteoarthritis. When malrotation of the fibula is suspected on plain radiographs, a computer tomography (CT) scan should be obtained to evaluate its extent and further consideration should be given to surgical treatment. LEVELS OF EVIDENCE: Level V: Bench testing.

Sensitivity and Specificity of Capsules Containing Fuchsin-Based Beads for the Evaluation of Masticatory Performance.

PURPOSE: To determine the sensitivity and specificity of capsules containing fuchsin-based beads for evaluating masticatory performance. MATERIALS AND METHODS: A total of 60 healthy subjects (mean ± SD age: 41.0 ± 13.2 years) were categorized according to number of occlusal pairs (n = 15 per group) as follows: 16-14 (control group); 13-10; 9-6; and 5-1. The subjects chewed the capsules to assess masticatory performance, which was defined as the concentration of fuchsin released and measured using ultraviolet-visible spectrophotometry. The subjects also comminuted silicone cubes, and median size was calculated via the sieving method. The test foods were compared using analysis of variance, receiver operating characteristic (ROC) curve, and Bland-Altman analysis. RESULTS: The control group presented the highest masticatory performance for chewing the capsules (P < .05), except when compared to the 13-10 occlusal pairs group (P = .667). There was no difference between the partial edentulism groups (P > .05). An acceptable area under the ROC curve of 0.744 was observed, with 73.33% sensitivity and 70.00% specificity. The control group also showed the best results for chewing the cubes (P < .01); however, the 9-6 and 5-1 groups were equivalent (P = .133). An excellent area under the ROC curve of 0.887 was found, with 80.00% sensitivity and specificity. The bias between the capacity of both test foods to recognize subjects with < 10 occlusal pairs was -3.56%. CONCLUSION: Capsules containing fuchsin-based beads were viable for evaluating masticatory performance, as they showed sufficient sensitivity and specificity for characterizing subjects presenting with < 10 occlusal pairs.

Reliability and validity of a new colour-changing test food with an acid-base reaction for the clinical assessment of masticatory performance.

The aim of this study was to determine the reliability and validity of a new test food for the clinical assessment of masticatory performance. The test food had two overlapping acidic/basic halves. Ten dentate subjects chewed one unit for 10-100 cycles. One subject chewed ten units for the same number of cycles. Differences in the L*, a* and b* colour axes were determined before and after chewing by ANOVA. Colour guides were created based on the values of these axes and matched with the number of cycles. The reliability of the guides was evaluated using 30 images, where three examiners indicated the number of cycles in which the colour closest to that of a chewed material was found. The data were contrasted with the real values of the guides to determine the validity (Kappa coefficients). The equivalence of the guides with the median particle size (X50) was determined using equidimensional curves. The test food progressively changed from green to pink during chewing. As the number of cycles increased, the a* values increased and the b* values decreased (p < 0.05). Overall, the guides showed a Kappa value >0.8 for the intra-examiner and inter-examiner reliability and the validity comparisons. The a* and X50 values were inversely proportional to each other, and the b* values showed a direct relationship with the X50 values. The L* values did not show correspondence. The new test food showed high reliability and validity for the assessment of masticatory performance through clinical colour guides matched with the number of cycles and X50.

Effects of Botulinum Toxin Type A on the Psychosocial Features of Myofascial Pain TMD Subjects: A Randomized Controlled Trial.

AIMS: To determine the effects of botulinum toxin type A (BoNT-A) on the psychosocial features of patients with masticatory myofascial pain (MFP). METHODS: A total of 100 female subjects diagnosed with MFP were randomly assigned into five groups (n = 20 each): oral appliance (OA); saline solution (SS); and three groups with different doses of BoNT-A. Chronic pain-related disability and depressive and somatic symptoms were evaluated with the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis II instruments at baseline and after 6 months of treatment. Differences in treatment effects within and between groups were compared using chi-square test, and Characteristic Pain Intensity (CPI) was compared using two-way ANOVA. A 5% probability level was considered significant in all tests. RESULTS: Most patients presented low pain-related disability (58%), and 6% presented severely limiting, high pain-related disability. Severe depressive and somatic symptoms were found in 61% and 65% of patients, respectively. In the within-group comparison, BoNT-A and OA significantly improved (P < .001) scores of pain-related disability and depressive and somatic symptoms after 6 months. Only the scores for pain-related disability changed significantly over time in the SS group. In the between-group comparison, BoNT-A and OA significantly improved (P < .05) scores of all variables at the final follow-up when compared to the SS group. No significant difference was found between the BoNT-A and OA groups (P > .05) for all assessed variables over time. CONCLUSION: BoNT-A was at least as effective as OA in improving pain-related disability and depressive and somatic symptoms in patients with masticatory MFP.

Trends in Utilization and Perioperative Outcomes in Robotic-assisted Bariatric surgery using the MBSAQIP database: A 4-Year Analysis.

PURPOSE: Robotic-assisted surgery has become increasingly popular across surgical subspecialties. We aimed to analyze trends in the national utilization and outcomes in bariatric surgery. MATERIALS AND METHODS: The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP®) data for 2015-2018 was queried. We included robotic-assisted sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), adjustable gastric band (AGB), biliopancreatic diversion with duodenal switch (BPD-DS), and revisional cases. The Kruskal-Wallis test or Wilcoxon rank-sum were used for comparing continuous variables and Cochran-Armitage trend analysis for categorical variables when comparing years, or with Fisher's Exact Test when directly comparing categories. RESULTS: Of 760,076 bariatric cases performed between 2015 and 2018, 7.4% with robotic and 90.4% with laparoscopic approach. SG constituted 61.3% of robotic volume. Utilization of robotic surgery increased 1.96-fold; SG represented the most substantial increase of 2.16-fold, followed by a 1.53-fold in RYGB. The 30-day readmission and re-intervention rates decreased from 5.63% to 4.78% (p<0.01), and 2.31% to 1.46% (p<0.01), respectively. The overall leak rate improved from 0.64% to 0.39% (p=0.01). Mortality and re-operations remained statistically unchanged. When compared to laparoscopic approach, the operative time were significantly longer in the robotic group. Regarding postoperative outcomes, when adjusted for patient characteristics, there were no differences between two approaches except a higher leak rate in robotic group in 2015. CONCLUSION: A steady increase in robotic bariatric surgery is apparent. While the operative time remains significantly longer in the robotic group, trends indicate improvement in key quality metrics and patient outcomes as utilization increases.

Anterior Percutaneous-Assisted Total Hip Arthroplasty: Surgical Technique and Early Outcomes.

BACKGROUND: Percutaneous-assisted arthroplasty was introduced to minimize complications traditionally associated with minimally invasive techniques, such as component malposition and periprosthetic fracture. Proponents of percutaneous-assisted techniques have more than 15 years of clinical utilization with good outcomes. This study reports our early experience, and outcomes, with an anterior percutaneous-assisted total hip arthroplasty (AnteriorPath). METHODS: A retrospective evaluation of a single-surgeon experience with the first 46 patients undergoing AnteriorPath using a cannula for acetabular cup instrumentation was compared with a similar-sized cohort undergoing traditional direct anterior (DA) total hip arthroplasty. Patients needed at least 2 postoperative visits for inclusion. Baseline preoperative characteristics, operative time, component positioning, and 6-week all-cause complications were evaluated. P values <.05 were considered statistically significant. RESULTS: Longer operative times were experienced with the AnteriorPath vs DA THA (93.6 minutes ± 38.6 vs 79.6 minutes ± 23.2, respectively, P = .0503). There were no significant differences in component abduction (40.14° DA vs 41.95° AnteriorPath, P = .1058). A statistically significant difference was found in component anteversion (32.8° DA vs 27.25° AnteriorPath, P = .0039). There were higher rates of short-term complications in patients undergoing DA THA (9.09% DA vs 2.5% AnteriorPath). CONCLUSIONS: Early experience with an AnteriorPath demonstrates similar short-term outcomes compared with traditional DA THA. The use of a percutaneous technique has also allowed for a smaller incision, in-line acetabular cup reaming and impaction under direct visualization, and limited trauma to surrounding soft tissues. Further long-term studies with a larger sample size are needed to evaluate the potential benefits and complications of this novel technique.

Efficacy and Safety of Botulinum Toxin Type A on Persistent Myofascial Pain: A Randomized Clinical Trial.

This study assessed the safety and efficacy of three different doses of BoNT-A for persistent myofascial pain (MFP). One hundred female subjects were randomly assigned into five groups (n = 20): oral appliance (OA), saline solution (SS) and three BoNT-A groups with different doses. Pain intensity and pressure pain threshold were evaluated up to 24 weeks after treatment. Adverse effects related to muscle contraction, masticatory performance, muscle thickness and mandibular bone volume were also assessed. Changes over time were compared within and between groups. The "nparLD" package and Wilcoxon signed-rank test were used to analyze the data. BoNT-A reduced pain intensity (p < 0.0001) and increased pressure pain threshold (p < 0.0001) for up to 24 weeks compared to the placebo. No differences were found between BoNT-A and OA at the last follow-up. A transient decline in masticatory performance (p < 0.05) and muscle contraction (p < 0.0001), and a decrease in muscle thickness (p < 0.05) and coronoid and condylar process bone volume (p < 0.05) were found as dose-related adverse effects of BoNT-A. Regardless of the dose, BoNT-A was as effective as OA on MFP. Notwithstanding, due to BoNT-A dose-related adverse effects, we suggest the use of low doses of BoNT-A in MFP patients that do not benefit from conservative treatments.

The effect of stainable drinks followed by simulated brushing on the roughness and stainability of acrylic resins polymerized with different cycles.

STATEMENT OF PROBLEM: No information is available on roughness and stainability of acrylic resins polymerized by experimental microwave cycles after immersion in stainable liquids and simulated brushing. PURPOSE: The purpose of this in vitro study was to evaluate the effect of stainable drinks and brushing on roughness and stainability of acrylic resins (Vipi Cril [CA] and Vipi Wave [MA]) polymerized with different cycles. MATERIAL AND METHODS: CA and MA specimens (n=5; diameter, 20 mm; thickness, 3 mm) were made using 4 methods recommended by the manufacturer (water bath polymerization and microwave polymerization cycles) and experimental at 550 W or 650 W for 3 or 5 minutes (M550/3 and M650/5), respectively. After storage in distilled water at 37°C for 48 hours (T0), the specimens were stored in water, coffee, or red wine (37°C) for 36 days with simulated brushing (54 000 cycles, T1). Roughness (Ra) and stainability (ΔE/National Bureau of Standards) were measured at T0 and T1. Roughness and stainability data were analyzed by 3-way repeated measures and 2-way ANOVA, respectively, followed by the Bonferroni test (α=.05). RESULTS: After storing in coffee and brushing, CA showed the highest (M550/3=2.33 ±0.72 µm) and the lowest roughness (water bath polymerization=1.22 ±0.58 µm), whereas roughness of MA specimens processed by M650/5 increased (1.57 ±0.59 µm). Storing in wine and brushing increased roughness (1.75 ±0.32 µm) in the M550/3 group. No staining was observed on MA after brushing regardless of the polymerization cycle. All values were acceptable (ΔE≤3.3), except for MA (microwave polymerization), which showed National Bureau of Standards=4.49 (appreciable change) after storing in wine and brushing. CONCLUSIONS: A slight increase in material roughness was observed after staining and brushing. Only MA polymerized following manufacturer cycles showed relevant stainability after immersion in wine and brushing.

Patients' perception about the outcomes of prosthetic treatment in Southern Brazil - a cross sectional study

Aim: this study assessed the patients' perception of the outcomes of prosthetic treatment in a University of Southern Brazil. Methods: patients seeking for prosthetic treatment were invited to answer a questionnaire with 41 items about the potential risks, benefits, and consequences of no treatment. Answers were obtained according to a five-item Likert-scale varying from 1 (completely disagree) to 5 (completely agree). Sociodemographic data was included in the comparison. Mann-Whitney or Kruskal-Wallis (95%) compared data depending on the variable. Results: two-hundred twenty-five patients answered the questionnaire. Median age of participants was 45-54 years. The potential benefits were similar among participants irrespective of the variable adopted. The perception of risks was significant influenced by variables gender, age, education level, type of edentulous space, prior treatment with prosthodontics, type of prosthodontics, and prosthodontics usage in years. Consequences of no treatment were affected by age, prior treatment with prosthodontics, and prosthodontics usage in years. Conclusions: the study showed the fundamental importance of correct elucidation about the potential risks (negative perception) in the initial appointment for the studied population. Elucidation about the consequences of no treatment are relevant because some differences were seen into the variables. Prosthodontics patients from the city of Passo Fundo seem well informed about the benefits of the prosthetic treatment, besides the significant influence of some sociodemographic and prosthetic conditions

Preoperative Patient-Recorded Outcome Measures Predict Patient Discharge Location Following Unicondylar Knee Arthroplasty.

BACKGROUND: Advantages of unicondylar knee arthroplasty (UKA) over total knee arthroplasty include rapid recovery and shorter lengths of stay following surgery. Patients requiring extended postoperative care fail to recognize these benefits. Patient-reported outcome measures have proved useful in predicting outcomes following joint arthroplasty. The purpose of this study was to identify and report preoperative patient-reported outcome measures and clinical variables that predict discharge to skilled nursing facilities following UKA. METHODS: A prospective cohort of 174 patients was used to collect 36-Item Short Form scores and objective clinical data. Univariate and multivariate analysis with backward elimination were conducted to find a predictive risk model. RESULTS: The predictive model reported (78.7% concordance, receiver operating characteristic curve c-statistic 0.719, P = .0016) demonstrates that risk factors for discharge to skilled nursing facilities are: older age (odds ratio 4.18; 95% confidence interval [CI] 1.256-13.911, P = .019), bilateral UKA procedures (odds ratio 1.887; 95% CI 1.054-3.378, P = .0326) and lower patient-reported preoperative 36-Item Short Form physical function scores (odds ratio 0.968; CI 0.938-1, P = .0488). CONCLUSION: The information presented here regarding possible patient disposition following UKA could aid informed decision-making regarding patients' short-term needs following surgery and help streamline preoperative planning.

Reproducibility, Reliability, and Validity of Fuchsin-Based Beads for the Evaluation of Masticatory Performance.

PURPOSE: Rehabilitation of masticatory function is inherent to prosthodontics; however, despite the various techniques for evaluating oral comminution, the methodological suitability of these has not been completely studied. The aim of this study was to determine the reproducibility, reliability, and validity of a test food based on fuchsin beads for masticatory function assessment. MATERIALS AND METHODS: Masticatory performance was evaluated in 20 dentate subjects (mean age, 23.3 years) using two kinds of test foods and methods: fuchsin beads and ultraviolet-visible spectrophotometry, and silicone cubes and multiple sieving as gold standard. Three examiners conducted five masticatory performance trials with each test food. Reproducibility of the results from both test foods was separately assessed using the intraclass correlation coefficient (ICC). Reliability and validity of fuchsin bead data were measured by comparing the average mean of absolute differences and the measurement means, respectively, regarding silicone cube data using the paired Student's t-test (α = 0.05). RESULTS: Intraexaminer and interexaminer ICC for the fuchsin bead values were 0.65 and 0.76 (p < 0.001), respectively; those for the silicone cubes values were 0.93 and 0.91 (p < 0.001), respectively. Reliability revealed intraexaminer (p < 0.001) and interexaminer (p < 0.05) differences between the average means of absolute differences of each test foods. Validity also showed differences between the measurement means of each test food (p < 0.001). CONCLUSIONS: Intra- and interexaminer reproducibility of the test food based on fuchsin beads for evaluation of masticatory performance were good and excellent, respectively; however, the reliability and validity were low, because fuchsin beads do not measure the grinding capacity of masticatory function as silicone cubes do; instead, this test food describes the crushing potential of teeth. Thus, the two kinds of test foods evaluate different properties of masticatory capacity, confirming fushsin beads as a useful tool for this purpose.