One-year prospective clinical study comparing patient satisfaction and masticatory performance of mandibular overdentures supported by one versus two implants

There is a lack of clinical evidence on mandibular overdentures (MOD) supported by a single implant. Objective: To compare patient satisfaction and masticatory performance in MOD supported by one versus two implants in a two-group parallel randomized clinical trial. Material and Methods:Twenty-one patients wearing new maxillary and mandibular complete dentures (CDs) were randomly divided to receive one (GI, n = 11) or two (GII, n = 10) implants in the mandibular arch. Four months after implant placement, o-ring abutments were installed in the implants, and matrix attachments were placed in the lower complete dentures. Patient satisfaction with their dentures and masticatory performance were compared at baseline, 3, 6, and 12 months after the procedure. Data on patient satisfaction were analyzed using the Friedman test and the Mann-Whitney U test. Data on masticatory performance were analyzed using one-way repeated measures analysis of variance (ANOVA) and Student's t test (α=0.05). Results: Both groups exhibited a significant increase in overall patient satisfaction in all periods evaluated (p<0.05), except for GI after 12 months, which had values similar to baseline (p=0.74). Satisfaction levels of GI and GII were similar at baseline, 3 and 6 months, but GII showed higher satisfaction levels (p=0.01) than GI at 12 months. GI and GII exhibited a significant increase (p<0.05) in masticatory performance for all periods relative to baseline. However, GII had higher masticatory performance with dentures than GI, regardless of the period (p<0.05). Conclusion: MOD supported by two implants demonstrated better patient satisfaction in the follow-up at 12 months and better masticatory performance than MOD supported by one implant. &nbsp

Influence of the height of the mandibular ridge on the masticatory function during the functional adaptation with new complete dentures

The period of functional adaptation to a new conventional complete denture embraces many transitory issues, and this period is directly related to the rehabilitation success. Objective: This clinical trial evaluated the influence of the height of mandibular ridge on the masticatory function of complete denture (CD) wearers during the adaptation period. Methodology: A total of 28 individuals wearing new CDs (NR, n=14, normal mandibular ridges, 64±12.5 years, 9 female; RR, n=14, resorbed mandibular ridges, 69±6.8 years, 9 female) were assessed at 24 hours, 30 days, three months and six months after the insertion of the CDs for masticatory performance (MP, sieves method), satisfaction with CDs (questionnaire) and maximum occlusal bite force (MOBF) (gnatodynamometer). The classification of the mandibular ridges followed the Kapur index. Data of MP and MOBF were analyzed by two-way ANOVA and satisfaction with CDs was analyzed by Generalized Estimating Equations (GEE), α=.05. Results: Participants with NR presented better masticatory performance (p=.000 - NR 30.25±9.93%, RR 12.41±7.17%), general satisfaction (p=.047), retention of mandibular denture (p=.001), chewing ability (p=.037), and comfort of wearing a mandibular denture (p=.000). Regardless of the mandibular ridge, MP (p=.000) was higher at three (21.26±12.07%) and six months (24.25±12.26%) in comparison to 24 hours (18.09±10.89%), the MOBF (p=.000) was higher at three months (78.50±6.49 N) compared to 24 hours (57.34±5.55 N) and 30 days (62.72±5.97 N), and the comfort of wearing a mandibular denture (p=.002) at three months (1.61 ± 0.07) was greater than 24 hours (1.29±0.10) and 30 days (1.36±10). Conclusions: The study suggests that the participants with NR have higher MP and satisfaction with their CD, regardless of the follow-up period after the insertion of the new CD. After subjects received the CD, a period of 3 months was necessary for achieving better achievement MOBF, MP, and self-perceived comfort with the mandibular denture, regardless of the height of the mandibular ridge

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Influência da utilização de um adesivo para prótese na satisfação e nos parâmetros cinesiográficos de usuários de próteses totais

Objetivo: O objetivo deste estudo foi avaliar o efeito da utilização de um adesivo para prótese na satisfação e nos parâmetros cinesiográficos em usuários de próteses totais por meio de um estudo “cross-over”. Material e Métodos: Cinquenta pacientes desdentados receberam novas próteses totais bimaxilares. Após um período de adaptação, os participantes incluídos no estudo receberam uma sequência de tratamento: protocolo 1- utilização do adesivo para prótese durante os primeiros 15 dias, seguida por não utilização do adesivo os próximos 15 dias; protocolo 2- não utilização do adesivo durante os primeiros 15 dias; seguida por utilização do adesivo os próximos 15 dias. Os resultados foram avaliados após 15 dias de cada sequência de tratamento. Um questionário para avaliar a satisfação dos pacientes e um cinesiógrafo para registrar os movimentos mandibulares e o padrão de movimento da prótese total maxilar durante mastigação foram utilizados. O teste de “Wilcoxon” (α=0,05) e o “t-test” de student para amostras pareadas (α=0,05) foram utilizados para comparar o grau de satisfação dos pacientes e os dados cinesiográficos, respectivamente. Resultados: O adesivo para prótese melhorou significativamente a satisfação geral dos participantes (p<0,001). Os registros cinesiográficos mostraram um aumento significativo (1,7mm) no movimento mandibular vertical (p<0,001) e uma menor intrusão (0,3mm) da prótese total superior (p=0,002) durante a mastigação após o uso de adesivo. Conclusão: O uso de adesivo para prótese melhorou a satisfação dos usuários de próteses totais e gerou um aumento no movimento mandibular vertical e uma menor intrusão da prótese total maxilar durante a mastigaçãoObjectives: The objective of this study was to evaluate the effect of a denture adhesive (DA) on patient satisfaction and kinesiographic parameters of complete denture wearers by a cross-over study. Material and Methods: Fifty edentulous patients received one set of new complete dentures. After an adaptation period, the participants were enrolled in the trial and randomized to receive a sequence of treatment: protocol 1- DA use during the first 15 days, followed by the no use of DA over the next 15 days; protocol 2- no use of DA during the first 15 days, followed by use of DA over the next 15 days. Outcomes were assessed after 15 days of each sequence of treatment. A questionnaire was used to evaluate patients´ satisfaction and a kinesiograph instrument was used to record mandible movements and pattern of maxillary complete denture movement during chewing. Wilcoxon test (α=.05) and a paired sample t-test (α=.05) were used to compare satisfaction levels and kinesiographic data, respectively. Results: The use of DA improved the overall patients´ satisfaction (p<.001). Kinesiographic recordings revealed a significant increase (1.7mm) on vertical mandible movements (p<0,001) during chewing and a lower (.3mm) vertical intrusion of the maxillary complete denture (p=0,002) during chewing after use of DA. Conclusion: The use of a DA in complete dentures wearers improved the patients´ satisfaction and change mandible movements, with increases in vertical mandible movements during chewing and lower intrusion of maxillary complete dentur

Surface properties and color stability of an acrylic resin combined with an antimicrobial polymer

INTRODUCTION: The occurrence of stomatitis is common since the surface characteristics of the dentures may act as reservoirs for microorganisms and have the potential to support biofilm formation. PURPOSE: To assess the surface properties (wettability/roughness) and color stability of an acrylic resin combined with the antimicrobial polymer poly (2-tert-butylaminoethyl) methacrylate (PTBAEMA). MATERIAL AND METHOD: Thirty disc-shaped specimens of an acrylic resin (Lucitone 550) were divided into three groups: 0% (control); 5% and 10% PTBAEMA. Surface roughness values (Ra) were measured using a profilometer and wettability was determined through contact angle measurements using a goniometer and deionized water as a test liquid. Color data were measured with a spectrophotometer. Kruskal-Wallis and Dunn's test were used to compare roughness values. Wettability data were analyzed using ANOVA and Tukey's test. Color data were compared using the Student's t-test and ∆E values were classified according to the National Bureau of Standards (NBS). All statistical analyses were performed considering α=.05. RESULT: Significant differences (p<.05) were detected among the groups for roughness, wettability and color stability. According to the NBS, the color changes obtained in the 5% and 10% PTBAEMA groups were appreciable and much appreciable, respectively. CONCLUSION: It could be concluded that PTBAEMA incorporation in an acrylic resin increased the roughness and wettability of surfaces and produced color changes with clinical relevance.INTRODUÇÃO: A ocorrência de estomatite protética é relativamente comum uma vez que as superfícies das próteses bucais representam um ambiente propício para adesão de microrganismos orais e formação de biofilme. OBJETIVO: Avaliar as propriedades de superfície (molhabilidade/rugosidade) e estabilidade de cor de uma resina acrílica combinada com o polímero antimicrobiano poli (2-tert-butilaminoetil) metacrilato (PTBAEMA). MATERIAL E MÉTODO: Trinta espécimes em formato de disco de uma resina acrílica (Lucitone 550) foram divididos em três grupos: 0% (controle), 5% e 10% PTBAEMA. Os valores de rugosidade (Ra) foram medidos utilizando um rugosímetro, e a molhabilidade foi determinada através de medições de ângulo de contato utilizando um goniômetro e água deionizada como líquido teste. Dados de cores foram medidos com um espectrofotômetro. Os testes de Kruskal-Wallis e Dunn foram utilizados para comparar os valores de rugosidade. Os dados de molhabilidade foram analisados utilizando-se ANOVA e teste de Tukey. Os dados de cor foram comparados com o teste t de Student e valores ΔE foram classificados de acordo com o National Bureau of Standards (NBS). Todas as análises estatísticas foram realizadas considerando α = 0,05. RESULTADO: Diferenças significativas (p<0,05) foram detectadas entre os grupos para rugosidade, molhabilidade, e estabilidade de cor. De acordo com o NBS, as alterações de cor obtidas nos grupos 5% e 10% PTBAEMA foram marcante e extremamente marcante, respectivamente. CONCLUSÃO: Pode-se concluir que a incorporação de PTBAEMA em uma resina acrílica aumentou a rugosidade e molhabilidade das superfícies e produziu alterações de cor com relevância clínica.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq

Free Gingival Graft to Increase Keratinized Mucosa after Placing of Mandibular Fixed Implant-Supported Prosthesis

Insufficiently keratinized tissue can be increased surgically by free gingival grafting. The presence or reconstruction of keratinized mucosa around the implant can facilitate restorative procedure and allow the maintenance of an oral hygiene routine without irritation or discomfort to the patient. The aim of this clinical case report is to describe an oral rehabilitation procedure of an edentulous patient with absence of keratinized mucosa in the interforaminal area, using a free gingival graft associated with a mandibular fixed implant-supported prosthesis. The treatment included the manufacturing of a maxillary complete denture and a mandibular fixed implant-supported prosthesis followed by a free gingival graft to increase the width of the mandibular keratinized mucosa. Free gingival graft was obtained from the palate and grafted on the buccal side of interforaminal area. The follow-up of 02 and 12 months after mucogingival surgery showed that the free gingival graft promoted peri-implant health, hygiene, and patient comfort. Clinical Significance. The free gingival graft is an effective treatment in increasing the width of mandibular keratinized mucosa on the buccal side of the interforaminal area and provided an improvement in maintaining the health of peri-implant tissues which allows for better oral hygiene

Surface properties and color stability of an acrylic resin combined with an antimicrobial polymer

INTRODUCTION: The occurrence of stomatitis is common since the surface characteristics of the dentures may act as reservoirs for microorganisms and have the potential to support biofilm formation. PURPOSE: To assess the surface properties (wettability/roughness) and color stability of an acrylic resin combined with the antimicrobial polymer poly (2-tert-butylaminoethyl) methacrylate (PTBAEMA). MATERIAL AND METHOD: Thirty disc-shaped specimens of an acrylic resin (Lucitone 550) were divided into three groups: 0% (control); 5% and 10% PTBAEMA. Surface roughness values (Ra) were measured using a profilometer and wettability was determined through contact angle measurements using a goniometer and deionized water as a test liquid. Color data were measured with a spectrophotometer. Kruskal-Wallis and Dunn's test were used to compare roughness values. Wettability data were analyzed using ANOVA and Tukey's test. Color data were compared using the Student's t-test and ∆E values were classified according to the National Bureau of Standards (NBS). All statistical analyses were performed considering α=.05. RESULT: Significant differences (p<.05) were detected among the groups for roughness, wettability and color stability. According to the NBS, the color changes obtained in the 5% and 10% PTBAEMA groups were "appreciable" and "much appreciable", respectively. CONCLUSION: It could be concluded that PTBAEMA incorporation in an acrylic resin increased the roughness and wettability of surfaces and produced color changes with clinical relevance

Effect of educational and self-care therapies on masticatory performance of women with painful temporomandibular disorder

Abstract Introduction Temporomandibular disorders (TMD) can compromise masticatory performance due to the presence of pain, muscular dysfunction and limitation of mandibular movements. Substantial improvements in TMD pain can be achieved through therapeutic approaches including education and self-care. Objective The aim of the present study was to investigate the impact of these treatment modalities in the masticatory performance of women with painful TMD. Material and method Fifty-two women were randomly divided into three groups: Control Group (CG); Education Group (received education about TMD) (EG); Self-Care and Education Group (received education about TMD and instructions self-care therapies) (SEG). The education instructions about TMD and self-care therapies were transmitted through a video and printed illustrative material. The masticatory performance was evaluated through the sieves method with natural tested foods in the evaluation periods: baseline evaluation, 30 days after and 60 days of follow-up. Data were analyzed and used with a one-way ANOVA parametric test for mean comparison of CG, EG and SEG groups (α = 0.05). Result The masticatory performance of the participants was similar, irrespective of the proposed treatments, at baseline (p=.604), 30 days (p=.450) and 60 days (p=.669). Conclusions The results indicated that treatment with educational and self-care therapies over a period of 60 days had no impact on the masticatory performance of women with painful TMD

Antimicrobial activity of a tissue conditioner combined with a biocide polymer

The characteristics of tissue conditioners support microorganism development that can threaten the health of the dentures user. The object of this study was to evaluate the effect on antimicrobial activity, roughness and wettability surface of a tissue conditioners material combined with the antimicrobial polymer poly (2-tert-butilaminoethyl) methacrylate (PTBAEMA). Specimens of tissue conditioner (Coe Soft(®)) were divided into three groups, according to the concentration of PTBAEMA incorporated (0, 10 and 25%). Antimicrobial activity was assessed by adherence assay of one of the microorganisms, Staphylococcus aureus, Streptococcus mutans and Candida albicans. Roughness measurements were made using a Mitutoyo SJ-400, and the mean arithmetic roughness values (Ra) obtained were used for the comparisons. The wettability properties were determined by contact angle measurements. The group containing 25% of PTBAEMA inhibited totally the S. aureus and S. mutans biofilm formation. A significant reduc tion in the S. aureus (Kruskal-Wallis, p = 0,001) and S. mutans (Kruscal-Wallis, p = 0,001) count for 10% PTBAEMA group compared with respective control group. No significant difference was found for C. albicans among PTBAEMA groups and control group (ANOVA, p > 0,05). Incorporating 10 and 25% PTBAEMA increased surface roughness and decreased contact angles (ANOVA and Tukey's post hoc tests, α = 5%). Incorporating 10% PTBAEMA into tissue conditioner increases wettability and roughness of tissue conditioner surface; and decreases the adhesion of S. mutans and S. aureus on material surface, but did not exhibit antimicrobial effect against C. albicans. The PTBAEMA incorporated into tissue conditioner could prevent biofilm formation on elderly patient