Disfunção craniomandibular em pacientes desdentados totais com alteração da dimensão vertical. -

Pós-graduação em Reabilitação Oral - FOAR

Estudo da apneia do sono em pacientes obesos em programação de cirurgia bariátrica

Pós-graduação em Bases Gerais da Cirurgia - FMB

Perfil das condições sistêmicas e bucais de usuários de próteses removíveis atendidos em um Serviço de Medicina Bucal

A presença de doenças sistêmicas, uso de medicamentos, e uso de próteses removíveis, entre outros fatores, podem alterar o equilíbrio fisiológico da cavidade bucal favorecendo o estabelecimento de diversas alterações e/ou patologias bucais. Assim, o estudo das prevalências destes fatores, nos pacientes odontológicos, tornam-se importantes pois devem ser considerados para elaborar o diagnóstico e definir a conduta terapêutica. Com o objetivo de delinear um perfil, avaliamos os prontuários de 500 usuários de próteses removíveis atendidos no Serviço de Medicina Bucal da Faculdade de Odontologia de Araraquara - UNESP. Analisamos os dados referentes a: características da população e das próteses removíveis, prevalência das doenças sistêmicas, uso de medicamentos e diagnóstico final das patologias ou alterações bucais. Os resultados obtidos nos permitem concluir que a maioria (74%) dos usuários de próteses removíveis eram mulheres brancas; metade da população pertencia a faixa etária de 41 a 60 anos e, quase a metade (49,2%) usava a combinação de prótese total superior e inferior. As doenças sistêmicas foram relatadas por 57,2% da amostra e a prevalência maior foi de doenças do sistema cardiovascular (25,4%). A maioria (60,4%) da população relatou uso de medicamentos e, dentre os mais freqüentes, a prevalência maior foram dos cardiovasculares (26,4%). A prevalência de patologias ou alterações bucais foi de 99,6%, sendo as relacionadas ao uso de próteses removíveis as mais freqüentes. Dentre estas, a candidose crônica atrófica ocorreu em 81,8% da população estudada e a hiperplasia fibrosa em 29,2%.

Hipertonicidade muscular e confecção de próteses totais pela técnica da zona neutra: relato de caso clínico

Introduction: the oral rehabilitation in edentulous patients using removable complete dentures is a classic treatment, easily accessible, and presenting satisfactory results. However, to succeed in this type of treatment, stability is an extremely important factor. The neutral zone technique for the production of complete dentures determines the oral cavity space for the positioning of teeth and denture base that provide a neutralization of the forces delivered by lips, cheeks, and tongue, providing better stability and retention of prostheses, which is indicated in cases with history of difficulties in adapting the conventional mandibular denture. Objective and case report: this paper aimed to describe a clinical case report of the oral rehabilitation of a patient with paraprosthetic muscles hypertonicity through removable complete dentures produced by the neutral zone technique, using condensation silicone. Final considerations: the use of condensation silicone for the development of the neutral zone technique showed to be a good alternative for the development of this clinical case, providing satisfactory stability and retention of the complete mandibular denture.

Estudo prospectivo sobre a utilização de próteses totais implantossuportadas em pacientes edêntulos

The objective of this study was to evaluate the impact of replacing conventional mandibular complete dentures by complete fixed dentures on the oral health-related quality of life and kinesiographic parameters of maxillary edentulous patients. Material and Methods: edentulous patients (n = 16) received one set of new complete dentures and after the intraoral adjustments and adaptation period (30 days), the Brazilian version of Oral Health Impact Profile for assessing edentulous subjects (Ohip-Edent) was used to evaluate the oral health-related quality of life (OHQOL) of the participants. Additionally, the kinesiograph instrument K6-I (Myotronics Research Inc., Seattle, WA) was used to record opening and closure range of movement, mandibular movement, and the pattern of maxillary complete denture movement on chewing. Afterwards, the patients had their mandibular complete dentures replaced by a complete fixed denture and the same evaluation protocol was performed after 3 and 6 months. Ohip-Edent responses were analyzed using Wilcoxon's test for repeated measures (α = .05) and Kinesiographic data using the Student´s t test (α = .05). Results: The Ohip-Edent showed an improvement of general oral health-related quality of life after 3 and 6 months of the treatment with complete fixed dentures. Kinesiographic recordings revealed a significant increase on maximum mandibular movements of vertical opening and no differences for the movement of the maxillary complete denture on chewing after treatment with complete fixed dentures was observed. Conclusion: the installation of complete fixed dentures improved the OHQOL and changed mandibular movements, with increases in vertical amplitude of maximal opening.

Prótese total imediata: relato de caso clínico

The immediate complete denture is defined as a removable or partial denture made to be installed immediately after the extraction of the natural teeth. This type of prosthesis can be used for a short period of time, for aesthetic reasons, mastication, occlusal support, convenience or for the adaptation of the patients to the edentulous state, until the final prosthesis is installed. The objective of this study was to report a surgical and prosthetic rehabilitation planning of a patient by means of an immediate complete maxillary denture, and the results obtained with this treatment modality. The immediate complete denture is a necessary, well-established, useful and effective prosthetic procedure for patients who, inevitably, will present an edentulous state, despite it is a slightly more expensive and it requires more sessions for adjust

[Does the combination syndrome exist? A case report]

This case report documents the prosthetic rehabilitation of a patient showing the typical features of combination syndrome. This case documentation gives a general overview of the suspected development and the prevalence of this "syndrome". A treatment option should be shown by the example of a patient from the starting situation until the prosthetic therapy by means of a complete maxillary denture and an implant-supported mandibular overdenture rigidly retained with a milled bar.

Cretaceous planktonic foraminifera of the Kerguelen Plateau

An almost complete Upper Cretaceous sedimentary sequence recently recovered on the Kerguelen Plateau (southern Indian Ocean) during ODP Leg 183 was analysed for planktonic foraminifera in order to refine and integrate the zonal schemes previously proposed for the Southern Ocean area. Detailed biostratigraphic analysis carried out on holes 1135A, 1136A and 1138A (poleward of 50°S palaeolatitude during Late Cretaceous time) has allowed recognition of low and mid-high latitude bioevents, useful for correlation across latitudes, in addition to known Austral bioevents. The low latitude biozonation can be applied to Turonian sediments, because of the occurrence of Helvetoglobotruncana helvetica, which marks the boundary between Whiteinella archaeocretacea and Helvetoglobotruncana helvetica zones. The base of the Whiteinella archeocretacea Zone falls within the uppermost Cenomanian-Turonian black shale level in Hole 1138A. The stratigraphic interval from upper Turonian to uppermost Santonian can be resolved using bioevents recognized in the mid-high latitude sections. They are, in stratigraphic order: the last occurrence of Falsotruncana maslakovae in the Coniacian, the first occurrence of Heterohelix papula at the Coniacian/Santonian boundary, the extinction of the marginotruncanids in the late Santonian, and the first occurrence of Globigerinelloides impensus in the latest (?) Santonian. The remainder of the Late Cretaceous fits rather well in the Austral zonal scheme, except that Globigerinelloides impensus exhibits a stratigraphic range in agreement with its record at the mid-high latitude sections and extends further downwards than previously recorded at southern sites. Therefore, despite the poor recovery in certain intervals and the presence of several hiatuses of local and regional importance as revealed by correlation among holes, a more detailed zonal scheme has been obtained (mainly for the less resolved Turonian-Santonian interval). Remarks on some species often overlooked in literature are also provided.

Calcareous nannofossil stratigraphy, mass accumulation rates and bulk density of sediments from ODP Leg 173 sites

Drilling on the Iberia Abyssal Plain during Ocean Drilling Program Leg 173 allowed us to recover Upper Cretaceous through Paleocene sediments at Sites 1068 and 1069 and only upper Paleocene sediments at Site 1067, which expands considerably the Upper Cretaceous to Paleocene record for this region. Of these three sites, Site 1068 recovered uppermost Cretaceous sediments as well as the most complete Paleocene record, whereas Site 1067 yielded only uppermost Paleocene sediments (Zone CP8). Site 1069 provided a rather complete upper Campanian through Maastrichtian section but a discontinuous Paleocene record. After a detailed calcareous nannofossil biostratigraphy was documented in distribution charts, we calculated mass accumulation rates for Holes 1068A and 1069A. Sediments in Hole 1068A apparently record the final stages of burial of a high basement block by turbidity flows. Accumulation rates through the Upper Cretaceous indicate relatively high rates, 0.95 g/cm**2/k.y., but may be unreliable because of the lack of datum points and/or possible hiatuses. Accumulation rates in the Paleocene section of Hole 1068A fluctuated every few million years from lower (~0.35 g/cm**2/k.y.) to higher rates (~0.85 g/cm**2/k.y.) until the latest Paleocene, when rates increased to an average of ~2.0 g/cm**2/k.y. Mass accumulation rates for the Upper Cretaceous in Hole 1069A indicate a steady rate of ~0.60 g/cm**2/k.y. from 75 to 72 Ma. There may have been one or more hiatuses between 72 and 68 Ma (combined Zone CC24 through Subzone CC25b), as indicated by the very low accumulation rate of 0.15 g/cm**2/k.y. The Paleocene section of Hole 1069A does not show the same continuous record, which may result from fluctuations in the carbonate compensation depth and poor recovery (average = 40%). Zones CP4 and CP5 are missing within a barren interval; this and numerous other barren intervals affect the precision of the nannofossil zonation and calculation of mass accumulation rates. However, in spite of these missing zones, mass accumulation rates do not seem to indicate the presence of hiatuses as the rates for this barren interval average ~1.0 g/cm**2/k.y. This study set out to test the hypothesis that a reliable biostratigraphic record could be constructed from sediments derived from turbidity flows deposited below the carbonate compensation depth. As illustrated here, not only could a reliable biostratigraphic record be determined from these sediments, but sedimentation and mass accumulation rates could also be determined, allowing inferences to be drawn concerning the sedimentary history of this passive margin. The reliability of this record is confirmed by independent verification by the establishment of a magnetostratigraphy for the same cores.

Late Paleocene to Eocene stable isotope record od ODP Site 143-865

An expanded and largely complete upper Paleocene to upper Eocene section was recovered from the pelagic cap overlying Allison Guyot, Mid-Pacific Mountains at Ocean Drilling Program (ODP) Site 865 (18°26'N, 179°33'W; paleodepth 1300-1500 m). Reconstructions show that the site was within a few degrees of the equator during the Paleogene. Because no other Paleogene sections have been recovered in the Pacific Ocean at such a low latitude, Site 865 provides a unique record of equatorial Pacific paleoceanography. Detailed stable isotopic investigations were conducted on three planktonic foraminiferal taxa (species of Acarinina, Morozovella, and Subbotina). We studied benthic foraminiferal isotopes at much lower resolution on species of Cibicidoides and Lenticulina, Nuttallides truempyi and Gavelinella beccariiformis, because of their exceptional rarity. The d18O and d13C stratigraphies from Site 865 are generally similar to those derived from other Paleocene and Eocene sections. The planktonic foraminiferal records at Site 865, however, include significantly less short-term, single-sample variability than those from higher-latitude sites, indicating that this tropical, oligotrophic location had a comparatively stable water column structure with a deep mixed layer and less seasonal variability. Low-amplitude (0.1-0.8 per mil) oscillations on timescales of 250,000 to 300,000 years correlate between the d13C records of all planktonic taxa and may represent fluctuations in the mixing intensity of surface waters. Peak sea surface temperatures of 24°-25°C occurred in the earliest Eocene, followed by a rapid cooling of 3-6°C in the late early Eocene. Temperatures remained cool and stable through the middle Eocene. In the late Eocene, surface water temperatures decreased further. Vertical temperature gradients decreased dramatically in the late Paleocene and were relatively constant through much of the Eocene but increased markedly in the late Eocene. Intermediate waters warmed through the late Paleocene, reaching a maximum temperature of 10°C in the early Eocene. Cooling in the middle and late Eocene paralleled that of surface waters, with latest Eocene temperatures below 5°C. Extinction patterns of benthic foraminifera in the latest Paleocene were similar to those observed at other Pacific sites and were coeval with a short-term, very rapid negative excursion in d13C values in planktonic and benthic taxa as at other sites. During this excursion, benthic foraminiferal d18O values decreased markedly, indicating warming of 4 to 6°C for tropical intermediate waters, while planktonic taxa show slight warming (1°C) followed by 2°C of cooling. Convergence of d18O values of planktonic and benthic foraminifera suggests that thermal gradients in the water column in this tropical location collapsed during the excursion. These data are consistent with the hypothesis that equatorial Pacific surface waters were a potential source of warm, higher salinity waters which filled portions of the deep ocean in the latest Paleocene. Oxygen isotopic data indicate that equator to high southern latitude sea surface thermal gradients decreased to as little as 4°C at the peak of the excursion, suggesting some fundamental change in global heat transport.

Maestrichtian calcareous nannofossils of MAud Rise, Weddell Sea

Recovery of an essentially complete upper Maestrichtian/lower Paleocene interval on Maud Rise at 65 °S latitude in the Weddell Sea during Ocean Drilling Program Leg 113 marks the first time that this interval has been cored at these high latitudes. The entire interval was missing at all Falkland Plateau sites drilled during DSDP Legs 36 and 71. Maestrichtian nannofossil assemblages in sediments from Sites 689 and 690, therefore, provide the basis for a needed revision of Maestrichtian coccolith zonation schemes for high southern latitudes. Three zones and two new subzones are described: the uppermost Maestrichtian Nephrolithus frequens Zone, which is subdivided into the Cribrosphaerella daniae Subzone and the underlying N. corystus Subzone, and the Biscutum magnum and B. coronum Zones. A complete calcareous nannofossil biostratigraphy based on the proposed scheme is given including a description of individual species abundance, preservation, and stratigraphic distribution. At this site, the southernmost carbonate site yet drilled by DSDP/ODP, it is evident that the Falkland Plateau Nannofossil Biogeographic Province can be extended to the margins of Antarctica. In addition, the biogeographic ranges of many calcareous nannofossils can likewise be extended. Last, we hypothesize that Nephrolithus frequens evolved from N. corystus prior to its dispersal to the lower latitudes where it is an important zonal marker. Three new taxa, Neocrepidolithus watkinsii n. sp., Nephrolithus frequens miniporus emend, n. comb, and Psyktosphaera firthii n. gen., n. sp. are described.

Maxillary complete denture movement during chewing in mandibular removable partial denture wearers

To evaluate the pattern of maxillary complete denture movement during chewing for free-end removable partial dentures (RPD) wearers, compared to maxillary and mandibular complete denture wearers. Eighteen edentulous participants (group I) and 10 volunteers with bilateral posterior edentulous mandibles (group II) comprised the sample. Measures of mean denture movement and its variability were obtained by a kinesiographic instrument K6-I Diagnostic System, during the mastication of bread and a polysulphide block. Data were analysed using two-way anova (alpha = 0.05). Upper movement during chewing was significantly lower for group II, regardless of the test food. The test food did not influence the vertical or lateral position of the denture bases, but more anterior dislocation was found when polysulphide blocks were chewed. Group II presented lower intra-individual variability for the vertical axis. Vertical displacement was also more precise with bread as a test food. It can be concluded that mandibular free-end RPD wearers show smaller and more precise movements than mandibular complete denture wearers.

Maxillary complete denture movement during chewing in mandibular removable partial denture wearers

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Kinesiographic study of complete denture movement related to mucosa displacement in edentulous patients.

The mucosa that covers the residual ridges of edentulous patients may present some distortion or displacement when occlusal loading is applied in complete dentures. This distortion and movement of the denture can result in acceleration of residual ridge resorption and loss of retention and stability. The aim of this study was to analyze the pattern of upper complete denture movement related to underlying mucosa displacement. A sample of 10 complete denture wearers was randomly selected, which had acceptable upper and lower dentures and normal volume and resilience of residual ridges. The kinesiographic instrument K6-I Diagnostic System was used to measure denture movements, according to the method proposed by Maeda et al.7, 1984. Denture movements were measured under the following experimental conditions: (A) 3 maximum voluntary clenching cycles and (B) unilateral chewing for 20 seconds. The results showed that under physiological load, oral mucosa distortion has two distinct phases: a fast initial displacement as load is applied and a slower and incomplete recovery when load is removed. Intermittent loading such as chewing progressively reduces the magnitude of the denture displacement and the recovery of the mucosa is gradually more incomplete.

Complete denture wear during sleep in elderly sleep apnea patients-a preliminary study

There is no consensus in the literature about the impact of complete denture wear on obstructive sleep apnea (OSA). The goal of this randomized clinical study was to assess if complete denture wear during sleep interferes with the quality of sleep. Elderly edentulous OSA patients from a complete denture clinic were enrolled and received new complete dentures. An objective sleep analysis was determined with polysomnography performed at the sleep laboratory for all patients who slept either with or without their dentures. Twenty-three patients (74% females) completed the study with a mean age of 69.6 years and a mean body mass index of 26.7 kg/m(2). The apnea and hypopnea index (AHI) was significantly higher when patients slept with dentures compared to without (25.9 +/- 14.8/h vs. 19.9 +/- 10.2/h; p > 0.005). In the mild OSA group, the AHI was significantly higher when patients slept with the dentures (16.6 +/- 6.9 vs. 8.9 +/- 2.4; p < 0.05), while in moderate to severe OSA patients, the AHI was not significantly different when sleeping with dentures (.30.8 +/- 15.6 vs. 25.7 +/- 7.5; p = 0.2). The supine AHI in mild patients was related to a higher increase in AHI while wearing dentures (12.7 +/- 8.4/h vs. 51.9 +/- 28.6/h; p < 0.001). A limitation of the study is that the mild OSA patients had a higher BMI when compared to the moderate to severe OSA patients. Ten out of 14 patients who preferred to sleep with their upper and lower dentures showed an increase in their AHI while wearing dentures to sleep. Contrary to previous studies, we found that OSA patients may experience more apneic events if they sleep with their dentures in place. Specifically, in mild OSAS patients, the use of dentures substantially increases the AHI especially when in the supine position.