O tratamento ortodôntico em uma perspectiva a longo prazo: avaliação da estabilidade oclusal e do grau de satisfação dos pacientes

This study aimed to evaluate factors associated to orthodontic treatment stability and patient satisfaction in the long-term. A total of 209 patients (88 class I and 121 class II) treated with straight wire fixed appliance were selected at least 5 years post treatment. Six hundred twenty seven dental casts were examined with the PAR Index at pretreatment (T1), end of treatment (T2), and at long-term follow up (T3, mean 8.5 years post treatment). At T3, a Dental Impact on Daily Living questionnaire was used to assess patient satisfaction with the dentition in the long-term. Friedman test and multiple regression analysis were used to evaluate changes among the time points and factors associated with stability and patient satisfaction. Predictive factors used to exam the occlusion were: PAR Index at T1 and T2, age at T1, the amount of time without retainer, length of Hawley retainer wear, length of follow-up, sex, extraction and third molar status. To assess patient satisfaction were considered: changes produced by the orthodontic treatment (PAR T2-T1), post treatment stability (PAR T3), age at the start of treatment (T1), length of treatment (T2-T1), gender, and extraction. Orthodontic treatment produced a significant improvement of 94.2% in the PAR Index (T2-T1), but this change was not associated with the level of satisfaction when the patient was questioned at T3. No significant change was observed between T2 and T3. However, when the sample was divided according to the level of finalization (PAR T2), it was observed that well-finished patients experienced some deterioration (P<.001), whereas the less well-finished ones showed some improvement (P<.05). Even with the deterioration, the well-finished patients still had a better PAR Index at T3 compared to the less well-finished ones (PAR T2- T3). Regression analysis showed that PAR Index at T1 and T2, age at T1, and length of retainer wear had a slight association with occlusal stability (R2 = 0.27). Patient satisfaction was significantly associated only with PAR Index at T3 (r2=0.125, P<.0001). We can conclude that, even thought orthodontic treatment is quite stable, not so well-finished treatments tend to show some improvement and well-finished ones deteriorate some in the long-term. Despite of that, well-finished patients still have better occlusal characteristics. Patient satisfaction is not related to the result of orthodontic treatment; nevertheless, there is a slight association with dentition in the long-term

Fatores que afetam a satisfação de pacientes em serviços de saúde :um estudo em setor ambulatorial de hospital

This thesis shows concepts and models related to customer satisfaction measurement, focusing in detail on patients satisfaction evaluations in a policlinic sector of a hospital located in Natal RN. To reach this aim, two hundred and fifty one patients of this hospital were interviewed. The methodology approach includes a theoretical basis through a review and study of previous research on the topic, governmental initiatives and management systems which deal with excellence and need more reports concerning customers perceptions about satisfaction. Furthermore, it was included some models of nationals index about customer satisfaction. The Norwegian model was used in this thesis. The use of this approache, together with a multiple regression analysis, led to results that shows the factors which affect patients satisfaction in a policlinic sector. They are four as following: The evaluation of physician attendance; its results; simplicity of accessibility when health services are needed; and both support and tranquility given by the hospital. The study results can support researches of a conceptual model to determinate the aspects which affect the patient s satisfaction and could be a contribution to a development of a national costumer satisfaction index

Complete denture occlusion: an evidence-based approach

Purpose: This study involved an extensive search for randomized controlled clinical trials comparing bilateral balanced and canine-guided dentures, and questioned whether a bilateral balanced occlusion is imperative for successful denture treatment. Materials and Methods: Studies were identified by searching electronic databases (PubMed/MEDLINE, ISI Web of Science, LILACS, and BBD). The keywords “denture” and “occlusion” were used. The minimum inclusion requirements were (1) randomized controlled trials with patients of any age wearing both maxillary and mandibular conventional complete dentures (CDs), (2) comparison between bilateral balanced and canine-guided dentures, and (3) assessment of masticatory function and/or patients’ satisfaction. Results: The search resulted in the identification of 5166 articles. Subsequently, 5156 articles were excluded on the basis of title and abstract. By the end of the search phase, seven randomized controlled trials were considered eligible. Conclusions: Current scientific evidence suggests that bilateral balanced occlusion is not imperative for successful treatment with conventional CDs in average patients. More studies are necessary to identify if specific clinical conditions may benefit from a balanced occlusion.