Edentulous patients' knowledge of dental hygiene and care of prostheses

Objective: The aim of this study was to analyse denture users' oral care habits with regard to the use of their prostheses. Background: Rehabilitative treatment is only successful when patients are motivated and aware of correct prosthesis use and hygiene. Materials and methods: Questionnaires were distributed to 150 complete denture users at the Federal University of Bahia School of Dentistry, the Esmeralda Natividade Health Center, the Bahian Science Development Foundation and a Salvador nursing home. The questionnaire included information on gender, age, length of prosthesis use, cleaning methods and materials, etc. The data were analysed using EpiInfo version 6 software. The chi-squared test was used for statistical analysis, with a significance level of 5%. Results: Questionnaire results showed that 78% of the subjects, with an average age of 67.3 years, had used the same complete denture for over 5 years. 64% slept with their prostheses and 44% removed them from the mouth only for cleaning. None of the patients interviewed knew anything about brushes designed specifically for complete dentures. 37.3% had a restricted diet and 44% believed that a complete denture would last for more than 10 years. Conclusion: Within the limitations of this study, it was concluded that the edentulous patients surveyed had limited awareness of prosthetic hygiene and long-term oral care despite extended periods of denture use. © 2008 The Authors.

Accuracy of impression techniques for implants. Part 1 - Influence of transfer copings surface abrasion

Purpose: This study evaluated the influence of surface abrasion of transfer copings to obtain a precise master cast for a partially edentulous restoration with different inclinations. Materials and Methods: Replicas (N = 30) of a metal matrix (control group) containing two implants at 90° and 65° in relation to the benchtop were obtained using a polyether impression material and three impression techniques: square impression copings splint with dental floss and autopolymerizing acrylic resin (TRS), square impression copings abraded with aluminum oxide (TA), and square impression copings abraded with aluminum oxide and adhesive-coated (TAA). The replicas obtained in type V stone were digitalized, and the images were exported to AutoCAD software to perform the readings of possible degree alterations in implant inclinations. The results were submitted to analysis of variance (ANOVA) and Tukey test (α < 0.05). Results: Comparing the techniques with regard to the 90° implant inclination, no statistical difference was observed between the three techniques and the control group. Analyzing the three techniques with regard to the 65° implant inclination, no significant difference was seen between technique TA and the control group. Conclusions: Technique TA presented more accurate master casts than TRS and TAA techniques. The angulated implant (65°) tended to generate more imprecise master casts than implants perpendicular to the surface. © 2008 by The American College of Prosthodontists.

Effectiveness of six different disinfectants on removing five microbial species and effects on the topographic characteristics of acrylic resin

Purpose: The aim of this study was to evaluate the effectiveness of disinfectant solutions (1% sodium hypochlorite, 2% chlorhexidine digluconate, 2% glutaraldehyde, 100% vinegar, tabs of sodium perborate-based denture cleanser, and 3.8% sodium perborate) in the disinfection of acrylic resin specimens (n = 10/group) contaminated in vitro by Candida albicans, Streptococcus mutans, S. aureus, Escherichia coli, or Bacillus subtilis as measured by residual colony-forming unit (CFU). In a separate experiment, acrylic resin was treated with disinfectants to monitor potential effects on surface roughness, Ra (μm), which might facilitate microbial adherence. Materials and Methods: Three hundred fifty acrylic resin specimens contaminated in vitro with 1×10 6 cells/ml suspensions of standard strains of the cited microorganisms were immersed in the disinfectants for 10 minutes; the control group was not submitted to any disinfection process. Final counts of microorganisms per ml were performed by plating method for the evaluation of microbial level reduction. Results were compared statistically by ANOVA and Tukey's test (p ≤ 0.05). In a parallel study aiming to evaluate the effect of the tested disinfectant on resin surface, 60 specimens were analyzed in a digital rugosimeter before and after ten cycles of 10-minute immersion in the disinfectants. Measurements of superficial roughness, Ra (μm), were compared statistically by paired t-test (p ≤ 0.05). Results: The results showed that 1% sodium hypochlorite, 2% glutaraldehyde, and 2% chlorhexidine digluconate were most effective against the analyzed microorganisms, followed by 100% vinegar, 3.8% sodium perborate, and tabs of sodium perborate-based denture cleanser. Superficial roughness of the specimens was higher after disinfection cycles with 3.8% sodium perborate (p = 0.03) and lower after the cycles with 2% chlorhexidine digluconate (p = 0.04). Conclusion: Within the limits of this experiment, it could be concluded that 1% sodium hypochlorite, 2% glutaraldehyde, 2% chlorexidine, 100% vinegar, and 3.8% sodium perborate are valid alternatives for the disinfection of acrylic resin. © 2008 by The American College of Prosthodontists.

Evaluation of temporomandibular joint noise in partially edentulous patients.

In order to evaluate the presence of TMD (temporomandibular disorder), dissatisfaction related to the use of removable partial dentures (RPD) and the effect of the treatment on temporomandibular joint noises, 13 female patients with Kennedy class I and II mandibular arch were selected. Another 13 young, asymptomatic, dentate patients, also female, were used as reference. After four years, 38.4% were found to have a moderate or severe degree of TMD. Over the four years, the degree of TMD increased in 46.15% of the patients, was not affected in 20.07%, while in 15.38% it decreased or the patients remained free from signs and symptoms. About 30% of the patients at the second year and 46% after the fourth year, had complaints regarding retention and stability. It was concluded that there is no relationship between TMD and the condition of partially edentulous Kennedy class I and II, but patient dissatisfaction increased after the second year and temporomandibular joint noise was reduced significantly with the replacement of the teeth.

Severe fracture of the maxillary alveolar process associated with extrusive luxation and tooth avulsion: A case report

Aim: The aim of this report is to present a case of severe fracture of the maxillary anterior alveolar process with substantial bone dislodgement associated with extrusive tooth luxation and avulsion. Background: Dentoalveolar trauma is a challenge to dentistry, especially in young patients, for it can lead to early tooth loss which compromises oral function, esthetics, self-esteem, and alter the long-term plan of care for the victim. Case Report: A 12-year-old girl with severe dentoalveolar trauma to the maxillary anterior region presented for emergency care for her injury. Treatment consisted of fracture reduction of the alveolar process, repositioning of the teeth that had suffered extrusive luxation, placement of a semi-rigid splint, and suturing of soft tissue lacerations. The traumatized teeth presented with pulpal necrosis and were treated endodontically. After 24 months of follow up, the fracture of the alveolar process was completely healed and the displaced teeth presented no signs of ankylosis or root resorption. Summary: First-aid care contributed remarkably to this case allowing the re-establishment of esthetics, function, and patient's self-esteem. In spite of trauma extension the treatment outcomes were favorable. Clinical Significance: Cases of dentoalveolar trauma should be evaluated on an individual basis. However, early emergency management and adequate follow-up can prevent further complications and contribute to treatment success.

Evaluation of hardness and colour change of soft liners after accelerated ageing.

INTRODUCTION: Soft liners have been developed to offer comfort to denture wearers. However, this comfort is compromised when there is a change in the properties of the material, causing colour change, solubility, absorption and hardening. These characteristics can compromise the longevity of soft liners. AIM: The aim of this in vitro study was to investigate the effect of ageing on both the hardness and colour change of two soft liners following accelerated ageing. METHODS: Two denture liners, one resin based (Trusoft, Bosworth, Illinois, USA) and one silicone based (Ufi Gel P, Voco GMBH, Cuxhaven, Germany), were tested in this study for both hardness (using the Shore A scale) and colour change (using the CIE L*a*b* colour scale), initially and after 1008 hours (6 weeks) of accelerated ageing. Statistical analysis was performed using the unpaired t-test with the Welch correction. RESULTS: These indicated that both materials increased in hardness and underwent colour change after accelerated ageing. The initial hardness of Trusoft was far lower than that of Ufi Gel P (18.2 Shore A units vs 34.8 Shore A units). However, for Trusoft the changes for both hardness (from 18.2 to 52.1 Shore A units) and colour change (16.85 on the CIE L*a*b* colour scale) were greater than those for Ufi Gel P, for which hardness changed from 34.8 to 36.5 Shore A units and the colour change was 5.19 on the CIE L*a*b* colour scale. CONCLUSIONS: Ufi Gel P underwent less hardness and colour change after accelerated ageing than Trusoft. On the other hand, the use of Trusoft may be preferable in cases where initial softness is a major consideration, such as when relining an immediate denture after implant surgery.

Overdenture as a restorative option for hypocalcified-hypoplastic amelogenesis imperfecta: a case report.

AIM: The aim of this report is to describe the restorative treatment of an 18-year-old patient diagnosed with autosomal recessive hypocalcified-hypoplastic amelogenesis imperfecta (AI). BACKGROUND: Esthetic and functional rehabilitations in AI cases are challenging and should consider individual aspects, such as age, socioeconomic status, AI type, and intraoral condition. REPORT: AI was diagnosed in an 18-year-old patient. SUMMARY: Considering the short length of crowns and roots, patient life expectancy, minimal invasiveness, amount of treatment time required, and lower costs, oral rehabilitation with overdentures provided an adequate functional and esthetic rehabilitation of the patient. CLINICAL SIGNIFICANCE: This report demonstrated overdentures to be a viable, relatively inexpensive, and non-invasive treatment choice of a patient with AI with concerns about treatment longevity, invasiveness, cost, esthetics, and long-term maintenance.

Evaluation of hardness and color stability in the soft lining materials after thermocycling and chemical polishing.

The aim of this study was to evaluate the Shore A hardness and color stability of two soft lining materials after thermocycling and when chemical polishing was used or omitted. Two acrylic-based soft lining materials were tested: Coe-Soft and Soft Confort, 14 specimens were made for each material. They were distributed in four groups according to the treatment performed. The specimens were thermocycled (1000 cycles) and half of the group submitted to chemical polishing (methyl methacrylate). Shore A hardness was determined and color stability was calculated by means of Commission International de l'Eclairage Lab uniform color scale using a spectrophotometer, the measurements were made immediately after deflasked, chemical polishing and thermocycling. Analysis of variance (ANOVA) and Tukey's tests were performed at p < 0.01. Color changes (deltaE) were observed after thermocycling in both soft lining materials: Soft Confort (10.60) showed significantly higher values than Coe-Soft (4.57). Coe-Soft (26.42) showed higher Shore A hardness values than Soft Confort (19.42). Chemical polishing did not influence in the color stability of both materials; however, influenced in the hardness values of Coe-Soft.

Effect of sodium bicarbonate on Candida albicans adherence to thermally activated acrylic resin

The purpose of this study was to evaluate the effect of 5% sodium bicarbonate on the adherence of Candida albicans to thermally activated acrylic resin. Fifty 4 mm specimens of acrylic resin were obtained using a metallic matrix. The specimens received chemical polishing, were sterilized and then immersed in Sabouraud broth, inoculated with Candida albicans standardized suspension. After 24 hours of incubation at 37°C, the specimens were divided into four groups according to the substance used for disinfection (5% sodium bicarbonate, 0.12% digluconate chlorhexidine, vinegar and Corega Tabs). A control group was included, in which distilled water was used. The adhered microorganisms were dispersed, diluted and plated onto culture media to determine the number of colony-forming units (cfu/mL). The results were analyzed through the Mann-Whitney statistical test at the 5% level of significance. Only 0.12% digluconate chlorhexidine and 5% sodium bicarbonate presented a statistically significant difference (p = 0.0010 and p = 0.0156, respectively) compared to the control group, decreasing the number of cfu/mL. However, when the different disinfecting solutions were compared with each other, only 0.12% digluconate chlorhexidine presented a statistically significant difference in the reduction of cfu/mL. It was concluded that although 0.12% digluconate chlorhexidine was more effective in the reduction of Candida albicans adherence values to thermally activated acrylic resin, 5% sodium bicarbonate also proved to be a viable alternative.

Integrated clinical treatment of gingival recession secondary to root perforation: case report.

Among the factors that influence the success of treatment of a root perforation, its location and possibility of contamination are determinant because the interaction of these 2 factors may result in significant periodontal injury. The management of cases of hard-to-reach contaminated perforations depends on the choice of an adequate technique. In the case reported in this article, controlled orthodontic tooth extrusion was successfully performed to treat gingival recession secondary to root perforation. The outcomes showed that this technique preserves the zone of attached gingiva, maintains the crown height, and prevents the involvement of the supporting bone tissue. The favorable clinical and radio?graphic conditions after 7 years of follow-up demonstrate the viability of this treatment approach.

Effects of mandibular fixed implant-supported prostheses on masticatory and swallowing functions in completely edentulous elderly individuals

Purpose: To evaluate the effect of oral rehabilitation with immediately loaded fixed implant-supported mandibular prostheses on chewing and swallowing in elderly individuals. Materials and Methods: Fifteen completely edentulous patients aged more than 60 years (10 women and rive men), wearing removable dentures in both arches, had a mandibular denture replaced by an implant-supported prosthesis. All individuals were evaluated before surgery and again 3, 6, and 18 months later with regard to mastication and swallowing conditions. Examinations entailed an interview, evaluation of tactile sensitivity of the face, and observation of food intake, masticatory type, formations of bolus, and pain during mastication. The swallowing evaluation comprised observation of clinical signs related to the oral and pharyngeal stages of swallowing, as well as the presence of oral residue. The findings of different evaluations before and 3, 6, and 18 months after the surgical-prosthetic procedure were statistically compared by analysis of variance for repeated measurements at a significance level of 5%. Results: The questionnaire revealed a reduction in complaints of masticatory and swallowing disturbances, a decreased need for liquid ingestion, and reduced choking and coughing. Clinical evaluations showed improved oral function and bolus propulsion for both solid and paste-consistency foods; pain during mastication was also resolved. Conclusion: Treatment with mandibular implant-supported dentures had positive effects on the clinical aspects of mastication and swallowing in elderly individuals.

Effect of light-curing method and indirect veneering materials on the Knoop hardness of a resin cement

This study evaluated the Knoop hardness of a dual-cured resin cement (Rely-X ARC) activated solely by chemical reaction (control group) or by chemical / physical mode, light-cured through a 1.5 mm thick ceramic (HeraCeram) or composite (Artglass) disc. Light curing was carried out using conventional halogen light (XL2500) for 40 s (QTH); light emitting diodes (Ultrablue Is) for 40 s (LED); and Xenon plasma arc (Apollo 95E) for 3 s (PAC). Bovine incisors had their buccal face flattened and hybridized. On this surface a rubber mold (5 mm in diameter and 1 mm in height) was bulk filled with the resin cement. A polyester strip was seated for direct light curing or through the discs of veneering materials. After dry storage in the dark (24 h 37°C), the samples (n = 5) were sectioned for hardness (KHN) measurements, taken in a microhardness tester (50 gF load 15 s). The data were statistically analyzed by ANOVA and Tukey's test (α = 0.05). The cement presented higher Knoop hardness values with Artglass for QTH and LED, compared to HeraCeram. The control group and the PAC/Artglass group showed lower hardness values compared to the groups light-cured with QTH and LED. PAC/HeraCeram resulted in the worst combination for cement hardness values. © 2009 Sociedade Brasileira de Pesquisa Odontológica.