Analysis of the effects of a mandibular advancement device on sleep bruxism using polysomnography, the BiteStrip, the sleep assessment questionnaire, and occlusal force.

PURPOSE: This before and after study evaluated the effects of a mandibular advancement device (MAD) on sleep bruxism (SB) activity and its associated signs and symptoms. MATERIALS AND METHODS: Nineteen young adults (39.9 ± 12.9 years, 58% women) with a clinical history of SB without sleep or neurologic disorders and no spontaneous temporomandibular disorder pain were selected. SB activity was assessed after a habituation period of 2 weeks. The results of a 3-month treatment with a thermoplastic monoblock MAD were compared to baseline using electromyogram polysomnography and the BiteStrip, a portable EMG device. Sleep disorders were assessed and validated against the polysomnography sleep assessment questionnaire (SAQ). Additionally, common signs and symptoms of SB were evaluated with the research diagnostic criteria for temporomandibular disorders. Occlusal force was compared to baseline using a cross-arch force transducer. RESULTS: There was a significant improvement in both SB activity and sleep scores (including SB episodes per hour) according to the BiteStrip and the SAQ, respectively. There was also a significant reduction in the signs and symptoms of SB, including grinding and/or clenching, temporomandibular joint (TMJ) sounds, muscle pain, and occlusal force. None of the SB subjects experienced MAD breakage, but in 24% of patients, the MAD treatment had to be interrupted due to TMJ/muscle pain and/or discomfort. CONCLUSION: The MAD treatment resulted in the reduction of SB activity, SB signs and symptoms, sleep disorders, and occlusal force.

Effects of the bite splint 15-day treatment termination in patients with temporomandibular disorder with a clinical history of sleep bruxism: a longitudinal single-cohort study.

OBJECTIVE: The aim of this study was to assess the effects of bite splint (BS) treatment termination in patients treated for temporomandibular disorder (TMD) and sleep bruxism (SB). STUDY DESIGN: This longitudinal single-cohort study assessed 30 patients (29.5 ± 7.8 years old, 86.7% women) who were successfully treated with BS for SB and TMD for 30 days to 6 months prior to termination of the use of BS. The Research Diagnostic Criteria for TMD Axes I and II, Sleep Assessment Questionnaire, Beck Depression Inventory, and BiteStrip were used to assess TMD signs and symptoms, sleep disorders, depression, and SB at baseline and after 15 days of BS disuse. RESULTS: TMD symptoms, including the disability points, characteristic pain intensity, and present pain at rest, increased significantly (P < 0.05). After 15 days of BS termination, there were no significant differences in SB and depression levels, sleep quality, and TMD signs. CONCLUSIONS: In patients with TMD and SB, BS treatment cessation is not recommended.

Influence of ultrasound and diamond burs treatments on microtensile bond strength.

OBJECTIVE: To compare surface treatments with CVDentUS ultrasound tips (UT) and KGSorensen diamond burs (DB) on etched (e) and non-etched (n/e) dentin. The microtensile bond strength (µTBS) was measured and fractography was assessed by scanning electron microscope (SEM). MATERIALS AND METHODS: Sixteen molars were divided into four groups of four teeth each according to treatment (DB-n/e; DB-e; UT-n/e; UT-e). The teeth were restored, sectioned into samples for µTBS (n=40) and tested on a EMIC DL-2000 universal machine (0.5 mm/min) and analyzed by SEM for fracture classification. STATISTICAL ANALYSIS: For analysis of the data on µTBS, the two-way ANOVA, using treatment and acid etching as fixed factor, and the Tukey test were used (α=0.05). To failures classification in cohesive in dentin (CD); cohesive in composite resin (CC); cohesive interfacial on base or top of hybrid layer (CBT); cohesive in adhesive (CA); mixed (M); interfacial on smear layer (S) the Fisher's exact test (α=0.05) was performed. RESULTS: The mean values of µTBS (in MPa) in the different groups were as follows: UT-e: 45.31 ± 8.16; DB-e: 34.04 ± 9.29; UT-n/e: 15.17 ± 3.71; and DB-n/e: 9.86 ± 3.80. On analysis of the SEM micrographs, the DB-n/e group showed total obstruction of dentinal tubules; the UT-n/e group showed partial desobstruction of dentinal tubules and irregular surface; the DB-e group showed complete desobstruction of dentinal tubules; and the UT-e group showed complete desobstruction of dentinal tubules and irregular surface. CONCLUSION: The combination of ultrasound treatment and acid etching provides high values of µTBS. An association exists between CA/CC failures and the UT method, CBT failure and the DB method, CBT/CC failures and etching, S failure and non-etching.

Validation of the Bitestrip versus polysomnography in the diagnosis of patients with a clinical history of sleep bruxism.

OBJECTIVE: This validation study compared an electromyography (EMG) device, Bitestrip, versus polysomnography in the diagnosis of sleep bruxism (SB). STUDY DESIGN: Forty-nine consecutive patients (32 women and 17 men, 41.2 ± 12.9 years old) with a clinical history of SB were included in the study from the Orofacial Pain Clinic, Faculty of Dentistry, Pontifical Catholic University of Rio Grande do Sul in Brazil. RESULTS: Initially, we compared an SB positive/negative test result for both systems (agreement 87.8%, sensitivity 84.2%, positive predictive value 100%, and crude kappa 0.71). We then compared a 4-scale test (no, light, moderate, or severe bruxism) between the 2 methods (agreement 80.27%, weighted kappa 0.51, and Kendall W coefficient 0.575). CONCLUSIONS: The Bitestrip can be considered as a moderate screening method for the diagnosis of SB, because it is more precise in detecting the presence or absence of SB but less precise in detecting its intensity.

Surface changes in denture soft liners with and without sealer coating following abrasion with mechanical brushing.

AIM: To evaluate the surface alterations of soft liners with or without sealer coating following abrasion with mechanical brushing. METHODS: Thirty specimens were made of a methacrylate- (Coe-Soft) and a siloxane-based material (Ufi-Gel SC), and 15 received two coatings of surface sealer. The specimens were submitted to a mechanical brushing-dentifrice assay under 200g of force at 250 cycles/min. Mechanical brushing was simulated for a period of 1 (1250 cycles) and 6 months (5000 cycles). Surface roughness (Ra parameter) was measured, and scanning electron microscopy (SEM) images were obtained. Ra data were analysed by anova for repeated measures and Bonferroni's test (alpha=0.05). RESULTS: Ra increased from baseline to 6 months regardless of sealer coating. At baseline, only Coe-Soft without sealer had a higher Ra than the other groups. After 1 month, the Ra of Coe-Soft with sealer was three-fold higher than the Ra at baseline; the other groups showed no significant increase of Ra. SEM images showed degradation of the soft liners over time, except for the Ufi-Gel SC with sealer, which displayed minimum alteration of surface texture. CONCLUSION: Sealer coating reduced the surface degradation of the tested soft liners, but the protective effect was more pronounced for the siloxane-based material.

Analysis of the influence of a mandibular advancement device on sleep and sleep bruxism scores by means of the BiteStrip and the Sleep Assessment Questionnaire.

PURPOSE: A before-and-after experimental clinical study was carried out with the objective of evaluating the effect of a mandibular advancement device (MAD; 75% advancement), made of a thermoplastic material, on sleep bruxism (SB) and sleep scores. MATERIALS AND METHODS: After a habituation period of 1 week, SB scores were taken at baseline and after use of the MAD for 30 days. Scores were compared using the newly developed BiteStrip, which registers the number of contractions of the unilateral masseter muscle after a 5-hour period, giving a severity score from 0 to 3 after the registrations. To assess sleep, the Sleep Assessment Questionnaire (SAQ), a screening tool with scores ranging from 0 to 68, was used before and after use of the MAD. Twenty-eight subjects (13 women, 15 men; mean age: 42.9 +/- 12.0 years) with a clinical history of SB and no spontaneous temporomandibular disorder (TMD) pain were selected. The clinical diagnosis of either moderate or severe SB was further confirmed through use of the BiteStrip (scores 2 or 3) at baseline. A 30-day follow-up period was used for evaluation. Both methods were validated against polysomnography. In addition, common signs and symptoms of TMD based on the Research Diagnostic Criteria for Temporomandibular Disorders were also evaluated before and after use to assess the side effects of the MAD. RESULTS: There was a statistically significant improvement in both SB and sleep scores based on the BiteStrip and the SAQ (Wilcoxon signed rank and Student paired t test, P < .05). In the signs and symptoms of TMD, there was a significant reduction in temporomandibular joint sounds as well as in masseter and temporalis tenderness to palpation. None of the SB subjects experienced any breakage of the MAD. CONCLUSION: The MAD had a positive effect on SB and sleep scores, measured by the BiteStrip and the SAQ, respectively, and did not increase any traditional signs and symptoms of TMD in a 30-day evaluation period.

Rugosidade superficial de compósitos microparticulados e nanoparticulados após acabamento e polimento / Surface roughness of microparticulated and nanoparticulated composites after finishing and polishing procedures

Objetivo: Avaliar a rugosidade superficial de resinas compostas microparticulada (Durafill, Heraeus Kulzer Weihrheim, Germany), nanoparticuladas 4 Seasons (Ivoclar Vivadent, Schaan, Liechtenstein), Esthet X (Dentsply, Milford, DE, USA) Point 4 (Kerr CO, Orange, CA, USA),Filtek-Supreme (3M-ESPE, Dental Products, St. Paul, MN, USA). Métodos: Após o acabamento com pontas diamantadas F (KG Sorensen, Barueri, Brasil) e polimento com pontas de silicone Politipit (IvoclarVivadent, Schaan, Liechtenstein) nas cores cinza, verde e rosa, foram realizadas quatro etapas de finalização, uma de acabamento e três de polimento, simulando o acabamento e polimento de uma restauração de resina fotopolimerizável. Dez espécimens de cada resina composta foram mensurados quanto aos valores de rugosidade superficial com rugosímetro (Mitutoyo Corporation, Tokyo, Japan) após cada etapa de acabamento e polimento. Resultados: Os resultados demonstraram que as resinas nanoparticuladas e microparticuladas apresentaram diferenças significantes quanto aos valores de rugosidade superficial em todos os estágios de acabamento e polimento. Conclusão: Entre as resinas nanoparticuladas, a 4 Seasons (Ivoclar Vivadent, Schaan, Liechtenstein) e a Point 4 (Kerr CO, Orange, CA, USA), assim como a resina microparticulada Durafill (Heraeus Kulzer Weihrheim, Germany), apresentaram baixos valores de rugosidade superficial após esgotarem-se todas as etapas de acabamento e polimento.

Objective: To evaluated the surface roughness of one microparticulate resin composite Durafill (Heraeus Kulzer Weihrheim, Germany) and four nanoparticulate resins 4 Seasons (Ivoclar Vivadent, Schaan, Liechtenstein) Esthet x (Dentsply, Milford, DE, USA), Point 4 and Supreme(3M-ESPE, Dental Products, St. Paul, MN, USA). Methods: After finishing with a diamond bur point (F), and polishing with silicone points of gray, green and pink color Politipit (Ivoclar Vivadent, Schaan, Liechtenstein), four stages of completion were performed, simulating one of finishing and three of polishing a resin restoration. Ten samples of each composite resin were measured for surface roughness with surface profilometer (Mitutoyo Corporation, Tokyo, Japan) after each of finishing and polishing sequence.Results: The results showed that nanoparticulate and microparticulate resins presented a significant difference in the surface roughness values, in all finishing and polishing steps. Conclusion: Of the nanoparticulate resins 4 Seasons (Ivoclar Vivadent, Schaan, Liechtenstein), Point 4 (Kerr CO, Orange, CA, USA), and also microparticulate Durafill (Heraeus Kulzer Weihrheim, Germany) presented significantly lower surface roughness values after completing all the finishing and polishing stages.

Bite force and sleep quality in patients with bruxism before and after using a mandibular advancement device / Força de mordida e qualidade do sono em pacientes bruxômanos antes e após o uso de placa de avanço mandibular

Purpose: This study aimed to compare bite force and sleep quality in patients with bruxism before and after using a soft mandibular advancement device. Methods: Eighteen patients with bruxism attending the Occlusion Clinics of the PUCRS Dental School were selected according to the study eligibility criteria, examined according to the RDC/DTM protocol, and treated with a soft mandibular advancement device. Before the treatment and after 30 days the subjects were tested for: maximal bite force with a cross-arch force transducer placed in the first molar region, sleep quality assessed by means of the University of Toronto Sleep Assessment Questionnaire (SAQ), and number of masseter muscle contractions during sleep measured with the adhesive BiteStrip®. Data were analyzed by Student t tests, Wilcoxon tests, and McNemar tests at a significance level of 0.05. Results: After 30 days using the mandibular advancement device there was a significant decrease in some bruxism parameters, bite force, and total SAQ score (P < 0.05). Conclusions: The results suggest that the use of a soft mandibular advancement device for one month reduced bite force and bruxism and improved sleep quality in this sample.

Objetivo: Comparar a força de mordida e a qualidade do sono em pacientes com bruxismo antes e depois do uso de uma placa de avanço mandibular resiliente. Metodologia: Dezoito pacientes com bruxismo em atendimento na Clínica de Oclusão da Faculdade de Odontologia da PUCRS foram selecionados de acordo com os critérios de eligibilidade do estudo, examinados segundo o protocolo RDC/DTM e tratados com uma placa de avanço mandibular resiliente. Antes e após 30 dias de uso da placa de avanço mandibular os sujeitos foram submetidos a testes de força máxima de mordida com um transdutor de força compressiva de arco cruzado posicionado na região de primeiro molar; de qualidade do sono, de acordo com o questionário QAS da Universidade de Toronto; e de contagem do número de contrações do músculo masseter durante o sono usando-se o adesivo BiteStrip®. Os dados foram analisados por teste t de Student, teste de Wilcoxon e teste de McNemar ao nível de significância de 0,05. Resultados: Houve diminuição significativa (P < 0,05) dos parâmetros de bruxismo, de força de mordida e do escore total do QAS após o uso da placa de avanço mandibular por 30 dias. Conclusão: Os resultados sugerem que o uso da placa de avanço mandibular resiliente por um mês reduziu a força de mordida e o bruxismo e melhorou a qualidade do sono nesta amostra.

Interferência na reação de polimerização das siliconas de adição pelo contato direto ou indireto com luvas de látex / The interference in polimerization reaction of adittion silicones through direct or indirect contact with latex gloves

O objetivo deste estudo foi determinar quais marcas comerciais de luvas de látex apresentavam algum tipo de reação química impeditiva da polimerização completa das siliconas de adição (pasta densa e leve) pelo contato direto e indireto. Foi avalida a reação, de viscosidade leve e pesada, em contato direto com dez marcas comerciais de luvas de látex nacionais. A maior parte das luvas de látex testadas inibiu a polimerização da silicona de adição. Isso comprova que as siliconas de adição não devem entrar em contato com luvas de látex durante os procedimentos clínicos para evitar que sofram alterações das suas propriedades físico-químicas

Iatrogenia em dentística e prótese / Iatrogenics effetcs in dentistry

Este artigo mensiona os fatores que podem produzir ou provocar problemas periodontais e relacionada especialmente a prótese dentística operatória, mal executadas

Férulas de estabilização/placas de mordida / Oclusal bite-splint

Esta técnica aqui apresentada, demonstra a simplificação de um método para fabricação de uma placa oclusal estabilizadora, utilizando uma base de resina fotopolimerizável (Preci Tray Yeti), produzida pela Yeti Dentalprodulate, Industriosfrasse (Alemanha) e um aparelho fotopolimerizador para laboratório marca EDG. A maior vantagem desta técnica é a previsibilidade de sua pré-polimerização, pois permite resultados definitivos com relação ao trabalho final, já que é possível acrescentar fragmentos de resina ainda não ativados na matriz ou corpo principal da placa parcialmente fotopolimerizável.

Consideraçöes morfológicas sobre a preparaçäo de dentes pilares em prótese fixa / Morphology approach to tooth preparation in fixes prosthodontics

O diagnóstico perceptivo realizado pelo odontológo e a qualidade da preparaçäo dentária predeterminam a longevidade da maioria das próteses fixas. Procedimentos em próteses fixas biologicamente toleráveis iniciam-se pela preparaçäo dentária. Os princípios biomecânicos da preparaçäo dentária e sua relaçäo com a morfologia dos dentes são aqui discutidos

Utilização de implantes osseointegrados na reposição de dentes molares inferiores / The use of osseointegrated implants to replace lower molars

A última inovação da moderna Odontologia estética e a restauração de tecido duro e mole perdido pela recomposição da natualidade o mais próximo possível. Com o aumento da conscientização dos pacientes, do desenvolvimento das técnicas cirúrgica s e protéticas pela melhoria da proeficiêcia e conhecimento dos odontólogos, a função ideal e a estética podem ser obtidas até mesmo com restaurações protéticas suportadas por implantes, na região de molares. Fatores anatômicos, morfológicos e inadequadas quantidade e qualidade óssea, podem reduzir o grau de sucesso dos implantes dentários na parte posterior da mandíbula. Atualmente existem várias opções para reposição de dois dentes molares suportados por implantes: Implantes tipo Esthéticone-Brãnemark. Esta técnica é descrita, cirúrgica e proteticamente, em um caso cliníco.