The Effects of Wearing a Removable-Partial-Denture on the Bite Forces: A Cross-Sectional Study

Abstract: Background: Removable partial dentures are a frequently used prosthetic treatment in the elderly population, but different types or RPDs might guarantee different chewing capabilities. In many studies, the relationship between chewing and aging has been reported and it has been shown that efficient chewing can improve the overall quality of life. Objectives: In the present study, the relationship between maximum bite force (MBF) and RPDs was studied. A relationship between the body mass index (BMI) and the type of prosthesis was also analyzed. Methods: 240 elderly patients, 120 males and 120 females, with bilateral posterior edentulism (class 1 of Kennedy classification) who had been wearing an RPD for at least a year, were recruited. Patients were divided into two groups: Group 1: male (n = 60) and female (n = 60) patients with bilateral edentulous areas located posterior to the remaining natural teeth and natural teeth in the opposite dental arch. Group 2: male (n = 60) and female (n = 60) patients with maxillary and mandibular bilateral edentulous areas located posterior to the remaining natural teeth. Their Body Mass Index (BMI) and Maximum bite force (MBF) were measured and compared according to the material and design of their RPD. Results: In both Groups, patients wearing cobalt-chrome alloy RPDs (Co-Cr-RPD) (Group 1: 20.25 ± 6.7 MBF, p < 0.001; Group 2: 16.0 ± 5.7 MBF, p < 0.001) had an increased MBF when compared to polymethylmethacrylate RPD (PMMA-RPD) (Group 1: 12.9 ± 3.36 MBF; Group 2: 10.4 + 2.8 MBF), and Valplast RPD (V-RPD) (Group 1: 14.3 ± 4.7 MBF; Group 2: 11.3 ± 3.4 MBF) users. There were no significant differences in bite force between patients wearing PMMA-RPD and V- RPD in both Groups. Patients in Group 2 showed a lower MBF than those in Group 1 (Group 1: 16.05 ± 6.13 MBF; Group 2: 12.6 ± 4.84 MBF; p < 0.001). Conclusions: A reduction in chewing force can lead to choosing softer foods for nutrition, which can lead to an increase in BMI. Our results show that only CoCr- RPD wearers were able to chew consistent food, whereas PMMA- RPD and V-RPD, due to the properties of the materials, their instability, and the possibility of causing pain during mastication, determined a limitation in the choice of food for many of the participants

Autoantibodies Against Proteins Previously Associated With Autoimmunity in Adult and Pediatric Patients With COVID-19 and Children With MIS-C

The antibody profile against autoantigens previously associated with autoimmune diseases and other human proteins in patients with COVID-19 or multisystem inflammatory syndrome in children (MIS-C) remains poorly defined. Here we show that 30% of adults with COVID-19 had autoantibodies against the lung antigen KCNRG, and 34% had antibodies to the SLE-associated Smith-D3 protein. Children with COVID-19 rarely had autoantibodies; one of 59 children had GAD65 autoantibodies associated with acute onset of insulin-dependent diabetes. While autoantibodies associated with SLE/Sjögren’s syndrome (Ro52, Ro60, and La) and/or autoimmune gastritis (gastric ATPase) were detected in 74% (40/54) of MIS-C patients, further analysis of these patients and of children with Kawasaki disease (KD), showed that the administration of intravenous immunoglobulin (IVIG) was largely responsible for detection of these autoantibodies in both groups of patients. Monitoring in vivo decay of the autoantibodies in MIS-C children showed that the IVIG-derived Ro52, Ro60, and La autoantibodies declined to undetectable levels by 45-60 days, but gastric ATPase autoantibodies declined more slowly requiring >100 days until undetectable. Further testing of IgG and/or IgA antibodies against a subset of potential targets identified by published autoantigen array studies of MIS-C failed to detect autoantibodies against most (16/18) of these proteins in patients with MIS-C who had not received IVIG. However, Troponin C2 and KLHL12 autoantibodies were detected in 2 of 20 and 1 of 20 patients with MIS-C, respectively. Overall, these results suggest that IVIG therapy may be a confounding factor in autoantibody measurements in MIS-C and that antibodies against antigens associated with autoimmune diseases or other human proteins are uncommon in MIS-C

Immunopathological signatures in multisystem inflammatory syndrome in children and pediatric COVID-19

: Pediatric Coronavirus Disease 2019 (pCOVID-19) is rarely severe; however, a minority of children infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) might develop multisystem inflammatory syndrome in children (MIS-C), with substantial morbidity. In this longitudinal multi-institutional study, we applied multi-omics (analysis of soluble biomarkers, proteomics, single-cell gene expression and immune repertoire analysis) to profile children with COVID-19 (n = 110) and MIS-C (n = 76), along with pediatric healthy controls (pHCs; n = 76). pCOVID-19 was characterized by robust type I interferon (IFN) responses, whereas prominent type II IFN-dependent and NF-κB-dependent signatures, matrisome activation and increased levels of circulating spike protein were detected in MIS-C, with no correlation with SARS-CoV-2 PCR status around the time of admission. Transient expansion of TRBV11-2 T cell clonotypes in MIS-C was associated with signatures of inflammation and T cell activation. The association of MIS-C with the combination of HLA A*02, B*35 and C*04 alleles suggests genetic susceptibility. MIS-C B cells showed higher mutation load than pCOVID-19 and pHC. These results identify distinct immunopathological signatures in pCOVID-19 and MIS-C that might help better define the pathophysiology of these disorders and guide therapy

Bite Force in Elderly with Full Natural Dentition and Different Rehabilitation Prosthesis

(1) Background: This study aimed to investigate maximum bite force (MBF) in elderly patients with natural full dentition (FD), patients rehabilitated with Traditional Complete Dentures (CD), with overdentures (IRO) and edentulous patients (ED). We also tested whether MBF changes are associated with gender, age of the patients and body mass index (BMI) as result of altered food; (2) Methods: Three hundred and sixty-eight geriatric patients were included. We studied two types of prostheses: (a) IRO with telescopic attachments. (b) CD (heat polymerized polymethyl methacrylate resin). The MBF was measured using a digital dynamometer with a bite fork; (3) Results: We found that MBF is higher in males than females, regardless of teeth presence or absence (p < 0.01). In patients with CD or IRO, there are no differences between males and females; prostheses improve MBF compared to edentulous patients (p < 0.0001) and this effect is greater with IRO prostheses (p < 0.0001); the chewing force of FD subjects remains greater (p < 0.0001); there are no differences among chewing strength based on different BMI categories, although FD subjects have a reduced incidence of obesity; there is a significant negative correlation between MBF and age (p = 0.038; R = 0.145), and no correlation between MBF and BMI; (4) Conclusions: This study showed that MBF improves more in patients using IRO prostheses, although not reaching the MBF of FD subjects. MBF does not correlate with BMI, although we found increased percentages of obesity in edentulous subjects or those with prostheses. Thus, old people wearing prostheses require special attention by a nutritionist to avoid risk of malnutrition

A case report of a TPS dental implant rigidly connected to a natural tooth: 19-year follow-up

A partial edentulous area was restored with a tooth to implant fixed partial denture and a rigid connection between the two elements. Maintenance recalls were performed over a 19-year period of ob- servation on a yearly basis. Methods. The following parameters were collect- ed during each examination over the entire period of observation: PD around the implant and natural tooth abutment, gingival index, modified gingival index, plaque index, modified plaque index, oc- clusal assessment, marginal bone loss. Radi- ographic assessment of peri-implant bone remod- eling was performed in a retrospective way. The following reference points were assessed on each image: fixture-abutment junction, threads, first contact of the crestal bone with the implant on both mesial and distal side. This made possible, with the known values for implant diameter and length, to make linear measurements of remain- ing peri-implant bone measured from the mesial and distal marginal bone levels and the fixture- abutment junction. The amount of bone change over the baseline to a 19 years follow-up observa- tion time was calculated for both the implant and the natural tooth. Results. Clinical parameters showed healthy values over the entire period of observation with slight iso- lated positive bleeding on probing. Bone remodel- ing values were constant over the entire period with slight higher values around the tooth. Peri-apical ra- diographs did not show any intrusion of the tooth. Conclusions. The present case report showed the complete functionality and stability of a tooth to im- plant rigidly connected FPD over a period of 19 years

Case report di carico immediato: impianti con design a plateau e protesi definitiva in TRINIA e policeramica

INTRODUZIONE Metal Free è una definizione utilizzata in ambito odontoiatrico/odontotecnico per classificare le riabilitazioni protesiche fisse senza un supporto metallico. Tale termine non indica un unico materiale, ma diversi materiali ceramici, ognuno dei quali ha indicazioni cliniche precise. Caratteristica comune e peculiare di queste restaurazioni protesiche è il loro eccellente risultato estetico. Ciò è dovuto al fatto che essendo prive di metallo, presentano una certa traslucenza che permette alla luce di essere in parte riflessa e in parte di penetrare nel manufatto protesico consentendo la mimetizzazione e garantendone un risultato cromatico ed estetico molto simile al dente naturale. Tuttavia questi materiali presentano delle limitazioni; quelli più rigidi e fragili non permettono la realizzazione di travate estese, altri più resistenti e più duri risultano invece più abrasivi e meno estetici. L’evoluzione continua delle tecnologie dentali ha messo a disposizione nuovi materiali sempre più resistenti. Ultimo ritrovato nell’ambito delle fibro-resine è il TRINIA. TRINIA è una cialda da lavorazione per sistematica CAD/CAM , costituita da un intreccio multi direzionale di fibre di vetro e resina in diversi strati. Questo nuovo materiale unisce un’ottima resilienza (300 KJ/m2) ad una buona resistenza alla compressione(530 MPa) offrendo caratteristiche intermedie tra la diffusa zirconia e le protesi in metallo-ceramica. Tali caratteristiche unite a quelle dei policeramici di ultima generazione possono essere sfruttabili a vantaggio del carico immediato. MATERIALI E METODI Lo scopo di questo studio è quello di mostrare un case report riguardante una riabilitazione implanto-protesica nella quale gli impianti, inseriti con tecnica flapless, vengono caricati a distanza di pochi giorni con protesi definitiva in trinia e policeramica. Questo tipo di riabilitazione prevede quindi l’inserimento della protesi definitiva prima che avvenga la completa osteointegrazione dell’impianto e guarigione dei tessuti di supporto. Si presenta alla nostra osservazione un paziente maschio di anni 65, da esami radiografici viene rilevata la completa edentulia del quarto quadrante ad eccezione dell’elemento 41, estratto il giorno dell’inserimento degli impianti. Prima vengono sviluppati i modelli di studio, si procede quindi, tramite la ceratura diagnostica alla simulazione del piano di trattamento; questa viene effettuata con monconi standard definitivi, i quali fungono da guida per la realizzazione di una dima chirurgica e una mascherina in resina acetalica per mezzo della quale viene successivamente confezionata la protesi provvisoria immediata. Previa anestesia infiltrativa (mepivacaina con o senza adrenalina 1:100000 Pierrel Pharma srl - Pierrel spa)viene eseguita l’estrazione del 41 e applicata la dima chirurgica. Si procede all’impiego della fresa pilota per 6 mm di profondità, al fine di effettuare un foro d’invito che permetta di verificare con l’ausilio dei pin di parallelismo la corretta inclinazione dell’asse d’inserimento. Vengono successivamente inseriti i pin guida al di sopra dei quali viene inserito un mucotomo circolare dal diametro di 5mm, una volta effettuata la mucotomia si rimuovono i manicotti di mucosa e con l’ausilio di una sonda, si misura lo spessore della stessa. Tale valore viene sommato alla profondità necessaria per l’inserzione della fixture 3mm al di sotto della cresta ossea. A questo punto, stabilita la profondità di lavoro, si procede alla realizzazione dell’osteotomia finale che sarà pari al diametro della fixture da inserire(4.5x8mm in corrispondenza del 41e 5x8mm in corrispondenza di 43,44e 46). Dopo l’inserimento delle fixture, vengono applicati gli abutment definitivi in titanio precedentemente selezionati in laboratorio, e rilevata istantaneamente l’impronta per la realizzazione del manufatto protesico definitivo. Si può, quindi, applicare la mascherina in acetalico ,tramite la quale viene confezionata la protesi provvisoria immediata in resina che, non viene cementata, ma utilizzata come restauro telescopico al fine di facilitarne la rimozione. Dopo 5 giorni il paziente ritorna alla nostra osservazione per rimuovere la protesi provvisoria e applicare quella definitiva in trinia e policeramica fornitaci dal laboratorio. DISCUSSIONI Trinia è un nuovo materiale venduto in cialde da lavorare tramite sistematica cad/cam , è costituito da strati di fibroresina tenuti insieme da resina epossidica. La cialda viene lavorata con macchinario CAD / CAM per sottrazione, al fine di realizzare sottostrutture di ponti e cappette cementate o telescopiche. Caratteristiche di Trinia sono : l’ elevata resistenza ai carichi compressivi e la buona resistenza alla flessione al fine di sopportare elevati carichi masticatori e ridurre il rischio di frattura meccanica. Queste caratteristiche della sottostruttura ,unite a quelle della policeramica micro-fine al 73%(CERAMAGE), conferisce al manufatto protesico caratteristiche biomeccaniche ed estetiche tali da rendere possibile la realizzazione di ricostruzioni sia frontali che laterali. Infatti, l’innovativa struttura del micro riempitivo, garantisce resistenza a decolorazione e placca; la struttura stessa del materiale favorisce rifinitura e lucidatura garantendo una lucentezza paragonabile a quella dello smalto naturale. Tutto ciò ha permesso di realizzare una protesi che risulta: precisa, in quanto realizzata con tecnologia cad/cam;estetica, grazie all’utilizzo dei policeramici di ultima generazione e vantaggiosa perché assicura una distribuzione uniforme delle forze biomeccaniche sugli impianti a carico immediato.The use endosseous implants can now be considered as a therapeutic solution of great reability and predictability of single tooth reabilitation along with partial and total edentulous arches as well. Numerous practitioners now advocate immediate loading of implants ( placing a full occlusal load onto the implant via the prosthesis within 72 hours after placement). The advantages of immediately loading implants are clear: they allow for shorter treatment times and allow for immediate restoration of function and esthetics. To ensure the durability of osseointegration the splinting of two or more implants requires the realization of prosthesis , which must meet two fundamental requirements : accuracy of the fit and liabilities. The modern digital dentistry allows a more precise taking impression and the rapid execution of metal-free prosthesis . Utilizing dental CAD software, TRINIA, may be mechanically modeled into the desired shape of a substructure for dental prosthetics such as crowns, bridges, or fixed and removable dentures . This case report discusses the immediate implant loading and final restoration in compromised mandibular posterior region, in which patient got immediate restoration of edentulous area. More importantly, from the patients’ point of view, immediate loading can produce positive social and psychological effects

Protesi dentale fissa con cantilever supportata da impianti (PDFIC) ultracorti: nostra esperienza clinica

In questo studio siti edentuli mandibolari posteriori con osso alveolare molto riassorbito di tre pazienti sono stati riabilitati con Protesi dentale fissa con cantilever supportata da impianti (PDFIC) ultracorti e ne è stata valutata la sopravvivenza a due anni (T2) dalla protesizzazione. MATERIALI E METODI L'osteointegrazione degli impianti è stata valutata radiograficamente con l'utilizzo di radiografie periapicali, eseguite al tempo 0 (T0 applicazione della protesi), al tempo 1 (T1 a sei mesi) ed al tempo 2 (T2 a due anni), secondo la tecnica del cono lungo con centratore di Rinn e l’ausilio di una griglia millimetrata in rame di dimensioni 31x41 mm, applicata sulla pellicola radiografica , al fine di misurare in mm l'eventuale riassorbimento di osso crestale. RISULTATI In tutti e tre i pazienti si è osservato un riassorbimento medio (mesio-distale) della cresta ossea di 0.5 mm a T1; non ci sono state modifiche fra T1 e T2. CONCLUSIONI L’utilizzo di impianti corti e ultracorti si è dimostrato essere un’interessante opzione terapeutica e alternativa agli interventi di aumento verticale della cresta ossea, più rapida, più economica e con una ridotta morbilità (1) (2) (3) (4). Nonostante ciò, spesso ci si trova di fronte all'impossibilità di inserire un impianto nel sito edentulo. L'ausilio del cantilever in protesi implantare si è dimostrata essere una buona opzione per sopperire a tali problematiche. (5) (6). L'utilizzo di impianti corti per supportare una protesi con cantilever ha mostrato risultati simili a quelli degli impianti con lunghezze tradizionali (7). Nonostante il numero limitato di pazienti, in questo studio abbiamo osservato come, nei casi di pazienti con quantità di osso alveolare molto limitate, l'utilizzo di impianti ultracorti per supportare protesi dentale fisse con cantilever è da considerarsi una valida opzione terapeutica.Posterior mandibular edentulous ridges with extreme residual bone resorption within three patients have been rehabilitated using ultrashort implant-supported cantilever fixed dental prostheses (ICFDPs)(one5.0x5.0, three4.5x6, two4.0x5.0 Bicon Dental Implants, Boston, MA, USA) and 2 years survival rate since prosthetic rehabilitation (T2) has been evaluated. MATERIALS AND METHODS Implants’ osseointegration has been evaluated at T0 (prostheses insertion) T1 (12 months after prostheses insertion) and T2 (24 months after prostheses insertion) using Periapical x-rays performed accordingly to the long cone paralleling technique and using both a Rinn positioning system and a radiographic template in order to evaluate in millimetres the amount of marginal bone loss in both mesial and distal point. RESULTS We have observed an average mesio-distal bone-loss of 0,5 mm at T1 within all the three patients while there hasn’t been any modification between T1 and T2, so as in accordance with other literature works (4). CONCLUSIONS Short and ultrashort implants rehabilitation have proven to be a valuable alternative therapy when compared to surgical vertical bone ridge augmentation procedures, the former being more inexpensive, more rapid and presenting less morbidity (1) (2) (3) (4); yet, it could still be impossible to insert an implant on the edentulous ridge. Implant-supported cantilever fixed dental prosthesis is a good option in order to provide such cases (5) (6).The choice of short implants instead of traditional ones as prosthesis’ support has proven to give similar results (7). Despite the limited number of patients, it’s been possible to show that ultrashort implant-supported cantilever fixed dental prosthesis (ICFDPs) is a valuable therapeutic option for patients with reduced amount of bone left. 1 Carl E. Misch, Jennifer Steigenga, Eliane Barboza, Francine Misch-Dietsh, Louis J. Cianciola, Christopher Kazor Short Dental Implants in Posterior Partial Edentulism: A Multicenter Retrospective 6-Year Case Series Study J Periodontol 2006;77:1340-1347. 2 Douglas Deporter, Bunnai Ogiso,Dong-Seok Sohn,Kevin Ruljancich, Michael PharoahUltrashort Sintered Porous-Surfaced Dental Implants Used To Replace Posterior Teeth J Periodontol 2008;79:1280-1286. 3 M. Esposito, G. Cannizarro, E. Soardi, G. Pellegrino, R. Pistilli, and P. Felice, “A 3-year post-loading report of a randomised controlled trial on the rehabilitation of posterior atrophic mandibles: Short implants or longer implants in vertically ugmented bone?” European Journal of Oral Implantology, vol. 4, no. 4, pp. 301–311, 2011). 4 Eduardo Anitua, MD, DDS, PhD, Laura Piñas, Degree of Dentistry; Gorka Orive, PhDRetrospective Study of Short and Extra-Short Implants Placed in Posterior Regions: Influence of Crown-to-Implant Ratio on Marginal Bone LossClinical Implant Dentistry and Related Research 2013 5 Marco Aglietta Vincenzo Iorio Siciliano Marcel Zwahlen Urs Bragger Bjarni E. Pjetursson Niklaus P. Lang Giovanni E. Salvi A systematic review of the survival and complication rates of implant supported fixed dental prostheses with cantilever extensions after an observation period of at least 5 years Clin. Oral Impl. Res. 20, 2009 / 441–451 6 Aglietta M, Iorio Siciliano V, Blasi A, Sculean A, Bragger U, Lang NP, Salvi GE. Clinical and radiographic changes at implants supporting single-unit crowns (SCs) and fixed dental prostheses (FDPs) with one cantilever extension. A retrospective study.Clin. Oral Impl. Res. 23, 2012, 550–555 7 Anka k Ipikcioglu H Finite element stress analysis of the effect of short implants usage in place of cantilever exension in mandibular posterior edentulism Jornal of oral rehabilitation 2002 29; 350-35

Masticatory Force in Relation with Age in Subjects with Full Permanent Dentition: A Cross-Sectional Study

Masticatory performance is directly correlated with masticatory muscle work to grind and cut the food. Chewing efficacy is decisive to eating a variety of foods needed maintain general health status at all ages. Older people have oral problems that get worse with age. Elders have more pathologies such as periodontal diseases, caries, tooth loss and inadequate dental prostheses than younger subjects. Objectives: to investigate the correlation between masticatory bite force (MBF) and body mass index (BMI) vs. aging and sex. Methods: This study was performed on 426 subjects (213 females plus 213 male) assigned into five different groups by age. Group “A” aged from 20 to 35 years; group “B” aged 45–59 years; group “C” aged 60–69 years; group “D” aged 70–79 years; and group “E” aged more than 79 years. Results: There were not statistically significant differences in right-side MBF versus left-side MBF. The differences between sex were statistically significant with a stronger bite in males than females (p < 0.05). At the same time, younger subjects had a stronger bite than elders (p < 0.05). In group “E”, more corpulent subjects (BMI > 25) had an MBF higher than less corpulent subjects (BMI < 25, p < 0.05). The analysis of mean MBF showed a statistically significant difference within all groups stratified by BMI with mean values inversely proportional with age (p < 0.001). Conclusion: The results in our study confirm data from many scientific papers. The importance of the present paper was to correlate data between and within a large sample with a wide range of ages. Our sample subjects had a 31%–33% decrease in MBF from group “A” to group “E” group, but they all had full permanent dentation and they preserved a valid MBF

Management of a Fractured, Nonremovable Implant: A Clinical Report With a 12-Month Follow-Up

Abstract Implant failures could be due to biological or mechanical factors, which also include fracture of the fixture. The present report presents a case of a single fractured implant placed in the left mandibular molar region. Since the residual portion of the fixture was perfectly osseointegrated with no signs of peri-implantitis, and in direct contact with the roof of the inferior alveolar nerve canal, it was decided to treat the patient with a short implant positioned on top of the fractured, and not removing the fractured implant. Clinical and radiographical follow-up was performed for 12 months after loading. Periimplant soft tissues healing and implant osseointegration were achieved 6 months after implant placement; at the end of the follow-up a periimplant bone remodeling of 0.3 mm was observed. In conclusion, short implants could be taken into consideration as a treatment option in cases of nonremovable implants and sufficient residual bone height